Abstract Introduction: Evidence on the outcomes of laparoscopic surgeries, especially in emergency conditions such as peptic ulcer, remains unknown. A retrospective study was conducted in a rural surgical unit in Andhra Pradesh to compare morbidity, mortality, and duration of hospital admission in patients undergoing laparoscopic (Group L) and open (Group O) closure of duodenal perforations. Methods: Retrospective data of adult patients with peptic ulcer perforation treated by surgical approach during January 2012 and December 2017 were scrutinized. Pre- and postoperative records were abstracted for clinical conditions. Mortality was compared between the two groups with appropriate statistical tests. Results: A total of 120 patients, 60 in each group, were recruited for the study. The preoperative clinical characteristics of the two groups were similar. The mean duration of surgery was significantly higher in Group L (212.8 ± 29 min) compared to Group O (107 ± 16 min) (P < 0.001). Wound discharge (n = 3, 5%) and postoperative leak (n = 2, 3.3%) were the only complications noted in the L group. Several complications were noted in the O group including wound discharge (n = 51, 85%), wound dehiscence (n = 12, 20.0%), postoperative leak (n = 8, 13.3%), pneumonia (n = 1, 1.7%), and need for ventilation (n = 6, 10.0%). Three (5%) patients died in the hospital in Group O while none died in Group L. The average duration of hospital admission was 7.1 days (standard deviation [SD] =1.0 days) for Group L and 11.7 days (SD = 2.2 days) for Group O (mean difference: 4.6 days; 95% confidence interval: 4.6–5.2 days). Conclusion: Laparoscopic correction of duodenal ulcer perforation is both feasible and effective in reducing morbidity and mortality and overall treatment duration at peripheral centers.

Abstract Background: This cross-sectional observational study aimed to analyze the clinical and mycological characteristics of dermatophytosis in patients visiting the outpatient clinic of the department of dermatology at a tertiary care hospital in Telangana. Methodology: The study was conducted from November 2017 to July 2019, involving patients clinically diagnosed with dermatophytosis. Data collection included detailed demographic and clinical information and laboratory investigations such as direct microscopy, fungal culture, and hematological examinations. Specimens were collected from skin lesions, nails, and hair, processed using appropriate methods, and subjected to culture and microscopic examination. Descriptive statistics was performed to present the findings. Results: A total of 100 participants were recruited, with a median age of 24 years. The majority were male (n = 75, 75%) and students (n = 47, 47%). Most participants (n = 71, 71%) presented with extensive tinea followed by tinea corporis and tinea capitis. Trichophyton mentagrophytes was the most isolated variant (n = 42, 97.7%) among positive cultures. Conclusion: Young male populations are the most common victims in this region. The significant number of tinea cases and the high prevalence of T. mentagrophytes underscore the necessity for precise diagnosis and effective management strategies in treating dermatophytosis.

Abstract Introduction: The burden of open extremity fractures is well recognized in placing a burgeoning demand on an already exhausted medical facility in low- and middle-income countries. This study aims to evaluate the functional outcome following “orthoplastic management” by orthopedic surgeons trained in limb reconstruction surgery. Methodology: Adult patients with open lower limb injuries treated from January 1, 2022, to December 30, 2022, who underwent single or staged fixation and reconstruction procedures were identified. Patients with Gustilo–Anderson type IIIB fractures requiring skeletal stabilization with soft-tissue cover were included. Polytrauma patients requiring multidisciplinary surgical attention were excluded. A team of orthopedic surgeons trained in limb reconstruction was involved in the management. Inpatient and outpatient department follow-up by the treating team was done to document complications (infections, reoperations, and graft failures) and functional outcomes using the Lower Extremity Function Score. The duration of mean follow-up was 1 year since index surgery. Results: A total of 24 adult patients with open lower limb injuries with preoperative Ganga Hospital Score (GHS) were included. Decision toward fixation with primary closure or further reconstruction was made collectively. The gray zone (GHS score of 15–16) of patients was more aggressively managed with emphasis on salvage. Additional reconstructive procedures were carried out based on the assessment at consequent follow-up. Three patients had a suboptimal joint function (less than functional range of motion for the involved joint) due to the resultant loss of compartment(s) and joint contracture. Five patients were retaken to the theater for further supplementary or corrective procedures following the index, definitive surgical procedure (bone grafting, partial flap loss, and fixator readjustment). Conclusion: Good-to-excellent functional outcome was demonstrated with the “orthoplastic approach” where skeletal stabilization as well as soft-tissue reconstruction was performed by trained orthopedic surgeons. This study demonstrated that orthoplastic surgery is a safe and effective method of limb salvage.

Abstract Background: Traumatic brain injury (TBI) is a significant global health issue, with India witnessing approximately 150,000 deaths and 50,000 TBI-related fatalities annually. Severity is classified as mild, moderate, or severe using the Glasgow Coma Scale (GCS). Imaging and blood biomarkers such as serum glial fibrillary acidic protein (GFAP) and S100B aid in diagnosis and outcome prediction, yet imaging facilities are scarce in India. This highlights the necessity for dependable biomarkers. GFAP indicates astroglial injury, while S100B suggests neuronal injury, both in TBI patients’ blood. However, their associations and utility in the Indian population require further exploration. Our study addresses this gap by examining serum GFAP and S100B levels in moderate and severe TBI patients, correlating them with radiological findings and clinical outcomes. Methodology: This prospective observational study was conducted in a tertiary care hospital on 212 patients (106 each for moderate and severely injured groups). Initial disease severity was assessed by GCS score. Outcome assessments were required of surgical intervention and mortality within 5 days. Results: S100B superseded GFAP in assessing disease severity. Receiver operating characteristic analysis showed that S100B was successful with 66% sensitivity and specificity for a cutoff value of 78.77 pg/ml. For early mortality prediction, sensitivity (S100B = 81%–87%, GFAP = 64.1%–78.6%), specificity (S100B = 60.2%–99.2%, GFAP = 54.5%–74.6%), and area under the curve-wise (S100B = 0.721–0.909, GFAP = 0.614–0.763) S100B model performed better than the GFAP model for all corresponding cutoffs (ranged S100B = 86.53–118.56 pg/ml, GFAP = 30.87–34.5 ng/ml). Conclusion: Taken together, our study provides strong evidence that S100B is a better marker of severity and outcome assessment than GFAP.

The field of neurology is undergoing a rousing diagnostic and therapeutic revolution, anchored in a veritable explosion in the field of autoimmune neurology. This has, as a Domino’s effect, ramified into paradigm shifts in the field of movement disorders, epilepsy, dementia, and demyelinating disorders, to name a few. A plethora of antibodies have been identified, and exciting phenotype–antibody correlations continue to be reported in the literature. The foremost group of disorders among this is the autoimmune encephalitis syndromes. Defined by Graus et al. in 2016 as disorders with a subacute evolution, the presence of typical magnetic resonance imaging changes in the mesial temporal lobes, and the presence of inflammation in the cerebrospinal fluid (CSF), the autoimmune encephalitis syndrome has widely broadened to include limbic encephalitis, autoimmune movement disorders, paraneoplastic cerebellar degeneration, peripheral nerve hyperexcitability syndromes, meningoencephalitis, sleep disorders, and many more.[1] Some disorders, such as anti-IgLON5-related disease, remained perched on the tightrope of autoimmunity and neurodegeneration (tauopathy), providing valuable insights into pathophysiological underpinnings of both.[2] Another important group is the paraneoplastic antibody-related disorders, the recognition of which must lead to a comprehensive search for an occult neoplasm. There is increasing evidence that prompt and aggressive treatment may lead to better outcomes in the long term.[3] Testing for autoimmune or onconeural antibody panels is the cornerstone of diagnosis. Autoimmune encephalitis may be diagnosed in the absence of antibody positivity in the appropriate clinical context. However, antibody testing itself carries several caveats, which must be understood by all clinicians managing these patients. At present, antibody testing is available in the form of “panels” which contain a collection of antigen testing. Autoimmune or paraneoplastic panels must always be tested in an appropriate clinical context and interpreted in that clinical context only. Indiscriminate testing may lead to the conundrum of “antibodies of unknown significance (AUS),” which have been compared to the “variants of uncertain significance” in genetic disorders.[4] AUS may appear in patients who have other neurological illnesses, which may closely resemble autoimmune encephalitis, such as Creutzfeldt–Jakob disease, schizophrenia, and multiple sclerosis. Such AUS must always be correlated with the patient’s clinical phenotype, testing strategies (appropriate/inappropriate), and in some cases, titers (for example, in anti-glutamic acid decarboxylase (GAD) encephalitis). This can be considered to be the “3T” approach (type, test, and titer). The 3T paradigm is useful to apply when accosted with AUS. Appropriate testing invokes certain principles. For example, onconeural antibodies must be confirmed on at least two tests (brain immunohistochemistry or immunofluorescence, followed by immunoblot). Serum testing is recommended for anti-neuromyelitis optica (NMO) and anti-myelin oligodendrocyte glycoprotein (MOG) antibodies, and CSF testing will detect 14% of anti-NDMAR cases which would be missed on serum testing alone. Antibody panels are available in India in certain academic institutes and private laboratories, but the costs remain prohibitively high. Moreover, both serum and CSF testing are recommended, especially when testing onconeural/paraneoplastic antibodies and in the case of some cell-surface antibodies, such as anti-N-methyl-D-aspartate receptor (NMDAR) antibodies. Obviously, this would double the cost. Some antibodies, such as the Kelch-like protein 11 antibodies, are not available in the country or are available at extremely high costs, which would be in addition to the autoimmune “panel.” Furthermore, evaluation may also entail positron emission tomography scan, tumor markers, and biopsy. Treatment also comes with a hefty price and may entail intravenous steroids, intravenous immunoglobulins, and/or plasma exchange. None of these are available without significant cost at most centers in our country. Autoimmune neurological disorders, hence, become an expensive proposition for the patient.[5] As this field continues to advance, neurologists must gear up for several challenges. We have to be abreast of the newer immune phenotypes as they continue to be reported but also have working knowledge of the principles of autoimmune testing. Perhaps, most importantly in our setting, we must also learn to balance economic challenges with appropriate therapy. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Background: Acanthosis nigricans (AN) is a dermatosis that manifests as asymptomatic and symmetrical darkening, affecting the skin of intertriginous areas. It is a marker of insulin resistance and is usually associated with metabolic syndrome (MS). The present study was conducted to study the morphological patterns of AN and to assess its correlation with different components of MS. Methodology: Using the purposive sampling technique (1-year period), 100 patients fulfilling the case definition of AN were enrolled based on the inclusion and exclusion criteria. A detailed history and a cutaneous examination (color, texture, and sites of AN) were done. Anthropometric measurements and scoring of the AN were done. Investigations were reviewed. Data were recorded, and MS was diagnosed using the National Cholesterol Education Program’s Adult Panel III criteria. The data were analyzed using Microsoft Excel 13 software. Results: The mean age was 36.9 ± 10.1 years, with a male-to-female ratio of 1:1.38. The mean duration of AN was 18.8 ± 12.5 months. Seventy percent of cases had involvement of two or more sites. MS was present in 55% of cases of AN. Gender, duration of AN, site of AN, neck and axilla severity, and total cholesterol were not statistically significantly associated with MS (P > 0.05). Its association with systolic and diastolic blood pressure, waist circumference, fasting blood sugar, and high triglyceride was found to be statistically significant (P < 0.05). A low high-density lipoprotein level was found to be highly significant (P < 0.01). On applying the Chi-square test, all five parameters of MS had a significant association with AN. Conclusion: Understanding the relationship between AN and MS is important, as patients with AN are at risk for all the components of MS individually and collectively.

Abstract Placental site trophoblastic tumor (PSTT) represents a rare form of gestational trophoblastic disease. It occurs commonly in females with a history of miscarriage, termination of pregnancy, or any other ongoing pathological pregnancy. We report this rare case in a 23-year-old female, who previously had a history of recurrent miscarriages. In this case, we emphasize on clinical and histopathological features for better understanding and awareness of such rare entities.

Background: The kneecap, also called the patella, is located in front of the knee joint and protects it from injury. It is the most prominent sesamoid bone of the body and is embedded in the quadriceps tendon. The purpose of this study is to perform a detailed morphometric examination of the patella and compare it to specimens from the right and left sides of the patella. Methods: In this cross-sectional observational study, 40 dried patellae were collected from the Department of Anatomy, Government Medical College, Srinagar, of which 21 were right-sided and 19 were left-sided specimens. Height, width, and thickness of the patella; length and width of the articular facets on the medial and lateral sides; and length of the central ridge were among the parameters examined in the study. Results: The mean height, width, and thickness of the patella specimens were 4.10 cm, 2.01 cm, and 4.10 cm, respectively, according to morphometric analysis. The dimensions of the articular facet on the lateral side were found to be statistically different from the dimensions of the articular facet on the medial side, with P = 0.05 considered statistically significant. According to Koyunco's classification, 87.5% of the patella specimens belonged to type B. Conclusion: The morphometric analysis of the patella in this study may help to design implants for reconstruction and guide orthopedic surgeons in reconstructive and fixation surgery of the patella.

Background: After puberty, breast cancer affects women of all ages in different regions of the world that cause a significant threat to public health. Its treatment is likely to be successful if it is discovered early. Aim: The aim of the study was to see how well undergraduate students at Achievers University know, feel about, and practice breast self-examination (BSE). Materials and Methods: Convenience sampling was used to choose the sample size (n = 333) for a descriptive cross-sectional study that lasted from September 2022 to December 2022. Statistical Package Service Software (SPSS) version 23.0 was used to evaluate the data by employing tables, percentages, and Chi-square test statistics were used at the 0.05 level of significance. Results: With a mean age of 20.1 years, 73.3% of the 333 female nursing students were between the ages of 19 and 21. The majority of respondents (95.8%) had a positive attitude and a solid understanding of BSE. In addition, this study demonstrates a strong correlation (χ2 = 38.10, df = 8, and P > 0.001) between knowledge of BSE and level of education. However, there is no correlation (χ2 = 9.76, df = I, and P = 0.08) between respondents’ level of BSE knowledge and practice. Conclusions: The study’s findings showed that there is low BSE practice; thus, we recommend putting more of an emphasis on health education.

Background: The sex hormones, estrogen, and progesterone, as well as the gonadotropins, luteinizing hormone, and follicle-stimulating hormone produced from the anterior pituitary, govern the three stages of the menstrual cycle: menstrual, follicular, and luteal. Hormone fluctuations cause changes in autonomic function. There have been relatively few studies that show autonomic function modification throughout various periods of the menstrual cycle. Aim and Objectives: The current study was undertaken to investigate the difference in mean parasympathetic autonomic characteristics between the proliferative and secretory stages of the menstrual cycle. Materials and Methods: A total of 120 healthy young adult female volunteers were recruited among Kalinga Institute of Medical Sciences, Kalinga Institute of Nursing Sciences, and Kalinga Institute of Dental Sciences students. The study eliminated 20 students who were in the bleeding phase of their cycle. The electrocardiogram was captured, and parasympathetic parameters were determined using the fully automated CANWin instrument in the Department of Physiology. The data of the abovementioned parameters were compiled, tabulated, and entered into Microsoft Excel 2013 and statistically analyzed using STATA software 15.1. Results: The subjects’ mean ages, heights, and weights were 18.9 ± 0.70 years, 156.6 ± 5.25 cm, and 53.7 ± 8.63 kg, respectively. The mean resting heart rate in the secretory phase was substantially greater than in the proliferative phase, indicating sympathetic dominance. The 30:15 ratio between proliferative and secretory stages. The mean E: I ratio calculated from the slow deep breathing maneuver reveals a statistically significant difference between the proliferative and secretory phases. Conclusion: During the secretory phase, there is a considerable rise in parasympathetic activity among the individuals in the current study. Changes in parasympathetic activity throughout the follicular and secretory stages of the menstrual cycle may be caused by fluctuations in estrogen and progesterone levels.