Introduction: Labyrinthine fistula (LF) is a complication of chronic otitis media, especially in cases involving Squamosal disease. The primary objective in managing these cases is to safeguard both cochlear and vestibular functions while effectively addressing the disease. In this study, we provide compelling data from cases treated at our institution, highlighting their presenting symptoms, therapeutic strategies and outcomes. Methods: A retrospective review was performed of 20 patients with LF among 96 patients with chronic otitis media squamosal disease managed at our centre between 2018 and 2024 by two surgeons. The clinical features, management, and outcomes were analysed. Results: The incidence rate of LF was 20.8%. Although a positive fistula test was observed in only 15% of cases, preoperative imaging with computed tomography (CT) of the temporal bone was conducted in all 20 patients, suggesting a LF. Around nine patients (45%) had symptoms of vertigo preoperatively and all improved after surgery. There was an average increase of 5 dB, 8 dB and 2 dB improvement in hearing on comparing preoperative and postoperative pure tone average, air bone gap and bone conduction thresholds, respectively, in 15 patients who came for follow-up (average duration of three months follow-up). It was also found that those with a higher stage of fistula had poorer hearing outcomes. Conclusion: In our study, we observed a striking incidence of LF at 20.8%. Notably, the most frequently affected area was the dome of the lateral semicircular canal, underscoring the importance of careful evaluation in this region. The positive fistula sign and preoperative symptoms of giddiness are unreliable in the preoperative diagnosis of LF. The higher the stage of LF, the greater were the symptoms of giddiness, positive was the fistula sign, and the poorer was the hearing outcome.

Background: The Percheron artery (APn) is an uncommon anatomical variation wherein the bilateral medial thalami are vascularised by a predominant thalamoperforating artery, as initially described by Frances Gerard Percheron in 1973. This study aims to clarify the mechanism of infarction by analysing the clinical characteristics and common locations of the APn. Materials and Methods: This narrative review attempted to summarise 140 publications regarding the APn, encompassing its surgical treatment, diagnosis, complications, and prevalent demographic data, searching ScienceDirect and PubMed/MEDLINE. Subsequently, utilised software such as Excel and Rayyan, an intelligent system. The investigation encompassed publications from January 2010 to June 2024. Conclusion: The study demonstrates that APn arteries are rare yet appear with noticeable and common symptoms affecting the paramedian thalamic arteries on both sides. Identified lately as a variant artery, it is connected with many clinical diseases. We advise rapid magnetic resonance imaging (MRI) diagnosis, coupled with patient examination, to diagnose APn infarction.

Background: Type 2 diabetes mellitus (T2DM) significantly impacts the severity of influenza infection, leading to higher risks of complications, prolonged hospitalisation, and increased mortality. Understanding this relationship is crucial for developing effective preventive and management strategies. Vaccination, glycaemic control, and timely antiviral treatment can help mitigate adverse outcomes and reduce the burden on healthcare systems. Methods: This retrospective study analysed 282 patients diagnosed with influenza from January 2024 to December 2024 in a tertiary care hospital. Data collected included demographic factors (age, gender) and clinical parameters (T2DM status, ICU stay, hospital stay duration, oxygen requirement, and mortality). Results: Among 292 patients, 168 (57.5%) had T2DM, while 124 (42.5%) were non-diabetic. The mean age was 58.9 years, with a male predominance. The average hospital stay was 8 ± 1.5 days. ICU admission was significantly higher in diabetic patients (58.9%) compared to non- diabetic patients (21%) ( P < .001). Oxygen requirement was also significantly higher in diabetic individuals (60.1%) than in non-diabetics (21.8%) ( P < .001). The controlled HbA1c level for a diabetic patient is 33% and the uncontrolled level is 67%. About 175 (60%) patients were vaccinated, and 117 (40%) were not. Mortality was notably higher in T2DM patients, demonstrating a strong association between diabetes and severe influenza-related complications. Conclusion: T2DM patients infected with influenza face significantly worse outcomes, including double the risk of mortality, triple the risk of hospitalisation, and quadruple the risk of ICU admission. These findings emphasise the critical need for routine influenza vaccination and optimised diabetes management to reduce severe complications in this high-risk population.

Background and Aims: Hydatid cysts in the liver generally remain asymptomatic for years. However, they may rarely enlarge and spontaneously rupture, leading to anaphylaxis and the dissemination of the cyst into the abdominal, pleural, or biliary tract. Methods: Our patient was a middle-aged male who presented with a dual complication of an intrahepatic hydatid cyst rupturing into the inferior vena cava causing pulmonary embolism, and simultaneously rupturing into the pleural cavity, causing hydropneumothorax. Results: The patient was managed with antiprotozoals, anticoagulants and intercostal drain insertion for hydropneumothorax. Conclusion: Cyst rupture is a critical complication of a hydatid cyst. However, this unique presentation of a hepatic hydatid cyst needs awareness and attention from the medical fraternity for its early identification and optimal management.

Background: The term ascites refers to the presence of excessive pathological fluid in peritoneal cavity. The term spontaneous bacterial peritonitis (SBP) is defined as the infection of ascitic fluid without any evidence of intra-abdominal, surgically treatable cause of infection. The importance of early detection of SBP is must as it develops in about 10%–30% patients and has high mortality rates. Aims and Objectives: To study diagnostic significance of ascitic fluid Lactate Dehydrogenase (LDH) levels in evaluation of SBP in patients with liver cirrhosis and to find a correlation between ascitic fluid LDH and serum LDH in SBP and non-SBP cirrhotic patients. Materials and Methods: This is a cross-sectional observational study done at the Department of Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Sri Amritsar, where 152 subjects were taken and were divided into SBP ( n = 45) and non-SBP group ( n = 107). Ascitic fluid analysis (diagnostic paracentesis) was done, and samples were sent for cytology, biochemistry and culture sensitivity. Results: It was observed that ascitic fluid LDH in patients with SBP had median (IQR) value of 308 U/L (233–641) as compared to 102 U/L (83–124) in non-SBP group ( P < .01). The median (IQR) of ascitic fluid LDH to Serum LDH was 1.2 (0.74–1.96) in the SBP group as compared to 0.35 (0.27–0.46) in the non-SBP group ( P < .01). Conclusion: The results of our study suggest that ascitic fluid LDH and ascitic fluid LDH to serum LDH ratio can be used as a diagnostic marker for SBP in patients with cirrhosis of liver.

Background: Abdominal pain is one of the most common complaints of patients presenting to the gastroenterology outpatient department (OPD). Despite exhaustive evaluation, the cause of pain often remains elusive. This study was performed to assess the use of endoscopic ultrasound (EUS) examination in ascertaining the aetiology of upper abdominal pain and its impact on therapeutic decision making. Method: Fifty patients (19 male and 31 female) with chronic pain abdomen who were previously undiagnosed and had undergone biochemical and cross sectional imaging (either Contrast enhanced computed tomography of abdomen on Magnetic resonance imaging of abdomen) were included in the study. All underwent EUS using a linear and radial scope under general anaesthesia (GA). Results: EUS could reach a diagnosis in 24 (48%) patients. EUS diagnoses were as follows: gallbladder (GB) stones/sludge in 10 (20%) and common bile duct (CBD) stones/sludge in 9 patients (18%), CBD stricture in 2 (4%) and chronic pancreatitis in 3 patients (6%). Out of the 24 patients who were diagnosed on the basis of EUS, 19 underwent therapeutic procedures (endoscopic retrograde cholangiopancreatography (ERCP)/surgery) and 16 (84.21%) amongst them were pain free at six months follow-up. Conclusion: EUS could successfully diagnose the cause of pain in 48% of patients and this resulted in therapeutic interventions (medical, endoscopic or surgical) in 40% of them. Hence, it could significantly alter the management in a large number of patients resulting in pain relief.

Background: Once considered a vestigial remnant, the left atrial appendage (LAA) is now understood to play a critical role in cardiac hemodynamics, thrombogenesis, and arrhythmogenesis. Its clinical relevance is particularly evident in patients with atrial fibrillation (AF), where it is the predominant site for thrombus formation. Anatomy and Risk Factors: The morphological variants of the LAA—such as chicken wing, cactus, windsock, and cauliflower—have direct implications for stroke risk stratification. The chicken wing morphology is associated with lower stroke risk due to higher flow velocities, while the cauliflower type is more thrombogenic due to its complex structure and reduced flow. Other factors like LAA size, trabeculations, and degree of fibrosis also contribute significantly to thrombosis risk. Diagnostic Advances: Imaging modalities for LAA evaluation have evolved considerably. While transesophageal echocardiography (TEE) remains standard, newer techniques such as cardiac computed tomography (CT) and magnetic resonance imaging (MRI) offer superior sensitivity and specificity in detecting thrombi, while also providing detailed assessment of LAA anatomy and flow dynamics. Management and Treatment Options: Anticoagulation therapy, including warfarin and Direct Oral Anticoagulants (DOACs), remains the mainstay for stroke prevention. However, issues such as bleeding risk and patient noncompliance have led to the development of LAA occlusion strategies. Devices like WATCHMAN and AMULET, as well as surgical options like the AtriClip, are increasingly utilized in patients with contraindications to long-term anticoagulation. Clinical Evidence: Large clinical trials such as ATLAS (Apixaban for the Reduction of Thromboembolism in Patients With Device-Detected Subclinical Atrial Fibrillation) and LAAOS III (Left Atrial Appendage Occlusion Study) have demonstrated the efficacy of surgical LAA closure in reducing the risk of thromboembolic events in selected patient populations. Conclusion: The LAA is a dynamic and clinically significant structure with substantial implications in stroke prevention. Its anatomical diversity, enhanced imaging assessment, and evolving therapeutic approaches make it a crucial target in managing patients with atrial fibrillation.

Objectives: Tumefactive demyelination is a rare form of multiple sclerosis which is characterised by solitary, acute, demyelinating lesions in the central nervous system, usually larger than 2 cm, accompanied by surrounding oedema. They often present with features of mass effect and pose a ring enhancement on neuroimaging along with ill-defined border, central necrosis and perilesional oedema. Being clinically benign its pathology is till date unknown and debatable, and it may occur alongside other conditions like Sjögren’s syndrome, neuromyelitis optica, systemic lupus erythematosus or could occur post-acute haemorrhagic leukoencephalitis and acute disseminated encephalomyelitis, and sometimes certain medications pose as etiological factors. Methodology: We report a case of a middle-aged man who presented with a history of intermittent diminished vision in the right eye specifically in the temporal field alongside headache which was aggravated on defecation. These clinical features overlapped with those of intracranial space occupying lesions, infections or inflammatory conditions but all investigations done, ruled out such possibilities. MR spectroscopy findings and other investigations, further paved the diagnosis. Patient was treated with pulse therapy of intravenous methylprednisolone. Results: Post-steroid therapy, progressive improvement was seen clinically and radiologically, eventually leading to complete recovery. Overall, tumefactive demyelination carries a good prognosis since majority of the cases have a benign nature and are steroid responsive.

Introduction: Knee dislocations are an uncommon type of dislocation that requires surgical interventions and ligament reconstruction. There are various configurations and classifications of knee dislocation as described in Kennedy system, which is based on the direction of dislocation, and Schenck system based on the pattern of ligament injury. A multitude of causes can result in an irreducible knee dislocation. Case report: We report a case of 57 year old male patient with irreducible knee dislocation due to interposition of the vastus medialis muscle. Results: A rare case of irreducible knee dislocation due to interposition of vastus medialis that required open reduction is described. Conclusion: Vastus medialis muscle interposition is a rare cause for irreducible knee dislocation, and one needs to aware of this to decreased morbidity.

Background and Aims: Chronic suppurative otitis media (CSOM), a prevalent middle ear inflammation, presents challenges in the post-coronavirus disease era due to increased patient loads, stringent infection control and irrational antibiotic use. Understanding the evolving bacterial growth and antimicrobial sensitivity patterns of CSOM is vital for effective management and treatment in this changing healthcare landscape. Objectives: This study aims to identify prevalent bacteria in CSOM patients attending an ENT outpatient department (OPD) in the tertiary care hospital and determine their antibiotic sensitivity patterns, contributing to an antibiotic stewardship policy. Materials and Methods: This cross-sectional study, conducted over five months, investigated the bacterial aetiology and antibiotic susceptibility patterns in CSOM patients attending the tertiary care hospital’s ENT OPD. The sample of 100 patients was selected using convenience sampling. Aural swabs were collected and sent for culture and sensitivity tests. Data were analysed using the chi-square test and one-way analysis of variance. Results: The study investigated bacterial prevalence in 100 otitis media patients. Pseudomonas aeruginosa (34%) and Staphylococcus aureus (25%) were the most prevalent organisms. Ciprofloxacin and amikacin showed the highest overall sensitivity. No significant association was found between gender and pathogen ( P = .22316) or between mean ages across different pathogens ( P = .416). Conclusion: The study identified P. aeruginosa and S. aureus as the most prevalent bacteria in CSOM. Ciprofloxacin and amikacin were highly effective against all identified bacteria. Although these antibiotics can be used as empirical therapy in remote areas without antibiotic susceptibility testing facilities, we suggest initiating culture-directed antibiotics to prevent antibiotic resistance and ensure optimal treatment outcomes.