South Eastern Railway

A 35-year-old man presented with a hard, curved, nail-like projection arising adjacent to the right ring-finger nail for 1 year.e lesion was asymptomatic.He reported a history of trauma to the same finger 2 years earlier.Examination revealed a separate, well-defined, translucent keratin plate distal to the proximal nail fold, distinct from the main nail [Figure 1].Dermoscopy was performed using contact polarized (10x) mode with a liquid interface, which demonstrated parallel longitudinal striations with a smooth, shiny surface, and absence of vascular or hemorrhagic structures, consistent with an accessory (ectopic) nail [Figure 2].e patient was counseled regarding the benign nature of the lesion.Surgical excision was advised; however, he opted for conservative management as the lesion was asymptomatic.Ectopic nail (onychoheterotopia) is a rare entity, with fewer than 100 cases reported in the literature. [1]It may be congenital or acquired following traumatic implantation of nail matrix cells.Surgical excision of the ectopic matrix is the definitive treatment. [2]Recognition of this benign condition prevents misdiagnosis as onychomatricoma or cutaneous horn.

Abstract Background & Aims: Small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO) are increasingly recognised in functional and structural gastrointestinal disorders, yet uncertainty persists regarding the accuracy of breath tests, the true effect of antibiotic and non-antibiotic therapies, and the risk of recurrence after apparent eradication. We conducted a comprehensive systematic review and meta-analysis to evaluate diagnostic performance, treatment efficacy and recurrence patterns, and to grade the certainty of evidence across these domains. Methods: We searched MEDLINE, Embase, Web of Science, CENTRAL and Scopus from inception to 30 November 2025, supplemented by trial registries and reference lists. Prospective diagnostic accuracy studies comparing glucose breath test (GBT) and/or lactulose breath test (LBT) with small-bowel aspirate culture, interventional studies of antibiotics, herbal antimicrobials or elemental diet, and cohorts reporting SIBO/IMO recurrence after eradication were included. Two reviewers independently performed screening, data extraction and risk-of-bias assessment (QUADAS-2, RoB 2, ROBINS-I, AMSTAR 2). Random-effects bivariate models were used for diagnostic accuracy and random-effects meta-analyses for treatment outcomes. Certainty of evidence was rated using GRADE. Results: Eighty-nine studies met inclusion criteria: 14 diagnostic accuracy studies (n = 757), 32 treatment studies, 18 systematic reviews/meta-analyses and 25 additional observational cohorts. GBT showed pooled sensitivity 54.5% and specificity 83.2% versus culture (diagnostic odds ratio [DOR] 5.17; area under the curve [AUC] 0.74), whereas LBT had sensitivity 42.0%, specificity 70.6% and AUC 0.56, indicating clearly inferior performance. Lower hydrogen cut-offs (10–15 ppm) and post–gastrointestinal surgery cohorts improved GBT accuracy (AUC up to 0.86). Rifaximin achieved pooled intention-to-treat eradication of 70.8% and per-protocol eradication of 72.9%, with adverse events in 4–5%. Across six randomized trials (n = 196), antibiotics increased global symptom response versus placebo (risk ratio 2.46; 95% CI 1.33–4.55). In methane-positive IMO, combination rifaximin–neomycin therapy yielded methane eradication rates of 87% and higher clinical response than either agent alone. Observational cohorts reported recurrence rates of approximately 40–45% within 9–12 months after successful eradication, with lower relapse when prokinetic maintenance was used. GRADE ratings were moderate for GBT accuracy and low for rifaximin eradication, symptom benefit, combination therapy in IMO and recurrence outcomes. Conclusions: GBT, interpreted with contemporary cut-offs, offers moderate, clinically useful accuracy and outperforms LBT as a non-invasive diagnostic test for SIBO. Rifaximin provides substantial but not definitive microbiological eradication and symptom relief, while combination therapy appears necessary for optimal management of methane-dominant IMO. High recurrence rates and low-certainty treatment evidence support viewing SIBO/IMO as chronic relapsing conditions that require integrated strategies targeting motility, structural risk factors and diet, alongside judicious antimicrobial use. Large, well-designed randomized trials with standardized diagnostic and outcome criteria are urgently needed to refine these estimates and guide precision management.

Background: To compare outcomes of transobturator tension-free vaginal tape using outside-in and inside-out approaches in women with stress urinary incontinence (SUI), and to identify risk factors for treatment failure. Methods: A prospective observational study was conducted at Central Hospital, Hubli, from July 2007 to June 2022. A total of 223 women with SUI refractory to conservative management were enrolled; 129 underwent the inside-out (TVT-O) procedure and 94 underwent the outside-in (TOT) procedure. Patients were followed annually for at least 3 years (maximum 10 years). Subjective and objective cure rates, complications, quality of life (QoL), and psychological outcomes were assessed. Results: At 5 years, subjective cure rates were 87% for TVT-O and 83% for TOT, while objective cure rates were 95.3% and 90%, respectively. Both techniques demonstrated significant improvements in QoL and Beck depression inventory scores. Dyspareunia was higher in the TVT-O group (p=0.02), but other complication rates were comparable. In 75 patients with 10-year follow-up, long-term success was maintained at 97%. Conclusions: Both TVT-O and TOT techniques are safe and effective for treating female SUI, with durable long-term results. The choice of procedure should be guided by surgeon expertise and patient preference.

Background: Hysterectomy is second most common major surgical procedure in women in world. A vaginal approach is preferred due to fewer complications, less postoperative pain, shorter hospital stay and lower cost over abdominal route Aim: To compare Bipolar vessel sealing clamp system (Group 2) with Conventional clamping & suturing technique (Group 1) for securing pedicles in non-decent vaginal hysterectomy. Total 26 women (13 in either group) underwent vaginal Method: hysterectomy. Results: Duration of surgery, Operative blood loss, Postoperative pain and Hospital stay was significantly lower in group 2 compared to group 1. Bipolar Conclusion: Vessel Sealing Clamp is an innovative & convenient technique leading to less operative time, less blood loss, less postoperative pain and faster recovery compared to conventional clamping & suturing in vaginal hysterectomy.

Phishing attacks are a major cybersecurity threat, exploiting human vulnerabilities by manipulating trust to access sensitive information. As phishing tactics evolve, the demand for advanced anti-phishing technologies has surged. This paper examines key measures such as email filters, SSL/TLS certificates, DNS-based authentication, multi-factor authentication, and URL filtering to protect against phishing. Advanced methods like machine learning, AI-driven analysis, and real-time threat detection have improved phishing prevention. It also discusses browser-based, cloud-based, and email security tools for mitigating risks. The paper highlights challenges such as evolving tactics, email filtering limitations, and user negligence, emphasizing the need for ongoing innovation in strategies. Future trends like AI, biometrics, and deep learning for threat intelligence are explored, showing potential to enhance phishing defense. A holistic approach integrating technology, protocols, and user awareness is advocated to combat phishing effectively at both individual and organizational levels.

Phishing is a dangerous online fraud tactic that tricks individuals into disclosing personal information, like usernames, passwords, and credit card numbers. It often appears through fake emails, messages, or websites designed to lure victims into sharing sensitive data. This illegal activity can cause significant financial losses for businesses and consumers, while also damaging trust in online transactions. Anti-phishing tools, such as SpamTitan and Barracuda Sentinel, use advanced algorithms and machine learning to detect and block phishing attempts in real time, protecting users from data breaches and financial harm. These solutions also offer user training to increase awareness of phishing tactics, enhancing defenses. Emphasizing the need for comprehensive anti-phishing strategies, it shows how organizations can safeguard sensitive information and maintain customer trust in a digital world. It explores technologies and methods for building a robust framework against phishing, detailing innovative ways to secure communication systems and ensure data integrity.

Molluscum contagiosum can mimic conditions like syringoma, warts, and closed comedones, making diagnosis challenging. Histopathological confirmation often causes delays in treatment. A bedside diagnostic approach involving dermoscopy and microscopy can rapidly confirm molluscum contagiosum. In this case, a 9-year-old boy with facial papules underwent enucleation of one lesion, followed by dermoscopy, which revealed white structureless areas and tortuous vessels, and microscopy, which identified molluscum bodies. This method allowed for quick confirmation without the need for histopathology.