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Suction blister epidermal grafting (SBEG) is a time-tested surgical treatment to correct small patches of stable vitiligo on any part of the body. The cosmetic result, especially on the lips, is highly satisfying. The most difficult part of this procedure is graft retention on the dermabraded lip. In this article, we present our observation of open and closed dressing in the same patient who underwent SBEG on the lip and chin simultaneously. We find that the results of the open dressing are equally good as the closed dressing area.

Abstract Background Bronchogenic cysts are congenital foregut anomalies predominantly mediastinal or pulmonary. Retroperitoneal localization is exceedingly rare, with fewer than 50 cases reported worldwide. They are often misdiagnosed as Gastro-Intestinal Stromal Tumors (GISTs) or as lymphatic cysts. This case highlights the diagnostic pitfalls and emphasizes the importance of histopathological confirmation in the diagnosis of retroperitoneal bronchogenic cysts. Case presentation A 68-year-old lady with diabetes and asthma presented with postprandial abdominal discomfort and regurgitation for 2 months. Imaging revealed an exophytic growth arising from the lesser curvature of the stomach, initially suspected as GIST. Surgical excision was performed, and histopathology confirmed it to be a bronchogenic cyst lined by ciliated pseudostratified columnar epithelium with cartilaginous elements. Conclusion Retroperitoneal bronchogenic cysts (RBCs) are rare but should be considered in the differential diagnosis of retroperitoneal cystic lesions. This case underscores these tumors as a diagnostic mimic and highlights the role of a high index of suspicion and the role of histopathology for definitive diagnosis. Complete surgical resection remains curative.

BACKGROUNDLung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure (PEEP) adjustments and to evaluate the weaning process from mechanical ventilation. The effects of PEEP may vary across different lung pathologies and may not consistently correlate with changes in lung aeration as assessed by lung ultrasound scores (LUSs).AIMTo assess the role of lung ultrasonography in evaluating lung aeration during the application of PEEP in mechanically ventilated patients with various lung pathologies.METHODSAn observational study was conducted over 18 months in a tertiary care hospital. Patients of both genders, aged between 18-75 years, who had been admitted to the intensive care unit, and required mechanical ventilation, were studied. A standard ventilatory strategy was used and incremental levels of PEEP [5, 10, and 15 cm water (H2O)] were applied. Baseline characteristics, including oxygen saturation (SpO2), LUS, mean arterial pressure (MAP), heart rate (HR), and their changes with incremental PEEP levels, were recorded and analyzed.RESULTSIn this study, 45.9% of patients required a PEEP of 5 cm H2O to achieve the endpoint of lung aeration (LUS of 0). In addition, 86.5% and 13.5% of patients reached the endpoint of lung aeration at PEEP levels of 10 and 15 cm H2O, respectively. The proportion of patients with higher lung scores decreased significantly with increasing PEEP levels (P < 0.001 for 5 and 10 cm H2O and P = 0.032 for 15 cm H2O). SpO2 increased significantly with higher PEEP levels (P < 0.001), confirming the effectiveness of PEEP in improving oxygenation. The results also revealed a significant increase in HR and a decrease in MAP following the application of higher PEEP levels.CONCLUSIONIncreasing PEEP levels in mechanically ventilated patients improves lung aeration, which can be effectively assessed using bedside lung ultrasonography.

ObjectivesThis study aimed to analyse the number of myocardial infarction (MI) admissions during the COVID-19 lockdown periods of 2020 and 2021 (March 15th to June 15th) and compare them with corresponding pre-pandemic period in 2019. The study also evaluated changes in critical treatment intervals: onset to door (O2D), door to balloon (D2B) and door to needle (D2N) and assessed 30-day clinical outcomes. This study examined MI care trends in India during the COVID-19 lockdown period, irrespective of patients’ COVID-19 infection status.DesignMulticentre retrospective cohort studySettingTwenty-three public and private hospitals across multiple Indian states, all with 24/7 interventional cardiology facilities.ParticipantsAll adults (>18 years) admitted with acute myocardial infarction between March 15 and June 15 in 2019 (pre-pandemic), 2020 (first lockdown) and 2021 (second lockdown). A total of 3614 cases were analysed after excluding duplicates and incomplete data.Primary outcomesNumber of MI admissions, median O2D, D2B and D2N times.Secondary outcomes30-day outcomes including death, reinfarction and revascularisation.ResultsMI admissions dropped from 4470 in year 2019 to 2131 (2020) and 1483 (2021). The median O2D increased from 200 min (IQR 115–428) pre-COVID-19 to 390 min (IQR 165–796) in 2020 and 304 min (IQR 135–780) in 2021. The median D2B time reduced from 225 min (IQR 120–420) in 2019 to 100 min (IQR 53–510) in 2020 and 130 min (IQR 60–704) in 2021. Similarly, D2N time decreased from 240 min (IQR 120–840) to 35 min (IQR 25–69) and 45 min (IQR 24–75), respectively. The 30-day outcome of death, reinfarction and revascularisation was 4.25% in 2020 and 5.1% in 2021, comparable to 5.8% reported in the Acute Coronary Syndrome Quality Improvement in Kerala study.ConclusionDespite the expansion of catheterisation facilities across India, the country continues to fall short of achieving international benchmarks for optimal MI care.

Background: Postcoronavirus disease 2019 (COVID-19) cough and dyspnea is reported as one of the most common symptoms following COVID-19 infection. Our study aimed to evaluate whether the severity of COVID-19 has any relation with post-COVID-19 cough and dyspnea. Even though the COVID-19 pandemic is over, there are some sporadic cases. Moreover, COVID-19 can be taken as a prototype for other severe viral respiratory illnesses. These findings may be extrapolated for other viral respiratory illnesses. Materials and Methods: This was a prospective study with convenience sampling of 88 patients diagnosed with COVID-19 infection by reverse transcriptase polymerase chain reaction testing. These patients were followed up at 2 weeks, 4 weeks, and 3 months after discharge at a tertiary care center. Patients who had a history of cough, dyspnea, obstructive airway disease, preexisting parenchymal lung disease, and pulmonary tuberculosis were excluded from the study. Results: Out of 65 patients with mild disease, 15.4% had a persistent cough 2 weeks after their COVID-19 infection, while 31.3% of patients with moderate disease had the same at 2 weeks follow-up. The number of patients with persistent symptoms went down during their next follow-ups. Even though there were only five patients with severe disease, 40% of them had persistent cough and dyspnea well into their 3 rd month after COVID-19 infection. Persistent cough and dyspnea were more common in those with advanced age and comorbidities. Conclusions: Post-COVID-19 cough and dyspnea were more common in patients who had moderate and severe COVID-19 and also in patients with advanced age and comorbidities, compared to those who had mild disease. Post-COVID-19 cough and dyspnea reduced with time.

Type 2 Diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and hyperglycemia, often preceded by latent metabolic disruptions. Early detection of metabolic alterations can facilitate timely intervention to delay or prevent T2DM onset. Metabolic profiling offers a useful tool to identify novel biomarkers and early metabolic alterations before clinical manifestations. This study aimed to identify early metabolic alterations and potential biomarkers predictive of T2DM in a cohort of healthy normoglycemic participants over a six-year follow-up. A cohort of 94 healthy participants, both men and women aged 18-40, was studied at six-year intervals. Clinical and biochemical parameters were measured, and LC/MS/MS-based untargeted metabolomics analysis of plasma was performed at both baseline and follow-up. At follow-up, 9 participants developed T2DM, 51 had prediabetes, and 34 remained normoglycemic. Increasing insulin resistance and elevated future T2DM risk were observed in both the prediabetes and normoglycemia groups. Metabolomics analysis identified phosphatidylethanolamine (PE) (20:3_18:0), 3beta,7alpha-dihydroxy-5-cholestenoate, and tridecanoic acid-as having good predictive capacity for future T2DM risk at baseline with alterations in PE (20:3_18:0), and tridecanoic acid persisting at follow-up. The study highlights the potential of metabolomics in identifying early metabolic predictors of T2DM, emphasizing the need for early interventions in healthy normoglycemic young adults.

Mpox, a zoonotic disease, was first reported in humans in 1970 in the Democratic Republic of the Congo. Since then, cases have increased significantly, leading to outbreaks in 2022 and 2024. The disease can present with generalized or localized symptoms, including genital involvement. Here, we report a case of a 48-year-old man with uncontrolled diabetes who presented with fever, fatigue, and umbilicated papulopustules with a hyperpigmented crust on the penis and arciform erythema over the suprapubic region. The differential diagnoses included Mpox and syphilis. Real-time polymerase chain reaction (PCR) tested positive for the Mpox virus in samples from the nasopharynx, tissue fluid, and tissue, while urine and serum tests were negative. Histopathology supported the diagnosis. The patient was treated with oral doxycycline and topical mupirocin and was isolated until repeated PCR tests were negative. This case is reported due to its unusual presentation and to highlight the histopathological findings of Mpox.

Background and objectives Post-spinal hypotension (PSH) is most commonly encountered in patients undergoing lower-segment caesarean section (LSCS). Passive leg raising (PLR) has been attempted in septic shock to predict fluid responsiveness. PLR is a novel and less-tried manoeuvre to prevent PSH in patients undergoing LSCS. This study aimed to compare the efficacy of PLR and prophylactic phenylephrine infusion in preventing PSH. Methods With the Ethical Committee's approval and patient consent, this randomized controlled trial included 180 parturients undergoing elective LSCS. The effects of PLR and phenylephrine infusion were compared. Parturients in the leg elevation group received leg raising approximately 30 cm from the horizontal position with a wooden block for three minutes. Parturients in the phenylephrine group received phenylephrine infusion at 100 µg/minute for three minutes following subarachnoid block. Those in the control group did not receive any intervention. Baseline systolic and diastolic blood pressure and heart rate were recorded every minute for three minutes and then every three minutes until the delivery of the foetus. Fetal appearance, pulse, grimace, activityand respiration (APGAR) score were noted at the firstand fifth minute following birth. Any episodes of hypotension, hypertensionor bradycardia were recorded. Results The incidence of hypotension was maximum in the control group (n = 23, or 38.3%), followed by the phenylephrine group (n = 4, or 6.7%)and least in the leg elevation group (n = 3, or 5.0%). The difference in the incidence rates was statistically significant (p < 0.05). The incidence rates of hypertension and bradycardia were not significant in any of the groups. The neonatal outcome was the same in all three groups. Conclusion PLR is a better alternative to prophylactic phenylephrine infusion in preventing PSH.