Background: Radiological evaluation of the lumbosacral angle (LSA) and the heights of the lumbar vertebrae is crucial in the management of lumbosacral pathologies. This study determined the LSA and the vertebral body heights of the lumbar vertebrae on radiographs of adult Nigerian patients. Materials and Methods: Lumbosacral spine radiographs from the radiological database of a teaching hospital in Delta State, Nigeria, were retrieved after ethical clearance of the study protocol. Three hundred apparently normal lumbosacral spine radiographs of 158 males and 142 females were used to assess the LSA, anterior vertebral body height (AVBH) and posterior vertebral body height (PVBH), which were analysed using the Statistical Package for the Social Sciences (SPSS) version 22. The independent t-test and analysis of variance were employed for the comparison of the mean variables in the different gender and age groups, respectively. Pearson's correlation test assessed the relationship between the parameters and age. Statistical significance was set at P < 0.05. Results: The average PVBHs were larger than their corresponding AVBH except in the L5 vertebrae, where the AVBH was greater than the posterior height. The mean LSA was 33.41°. The vertebral heights were significantly larger in males than in females (P < 0.05). The AVBH of L4 had a significant weak negative correlation with age (r = −0.132, P = 0.022). Conclusion: This study establishes a valuable reference database which will enhance accurate diagnosis and effective management of lumbosacral pathologies in our population. The sexual dimorphism of the vertebral heights may be explored further for forensic purposes.

Rationale: This case report spotlights the pathologies which need immediate surgical treatment and the need for the clinicians to be diligent in assembling the differential diagnosis for acute pelvic pain. Patient Concerns: A 32-year-old female, presented with chief complaints of amenorrhea for one and a half months followed by bleeding per vaginum and lower abdominal pain for 15 days. Diagnosis: On ultrasound pelvis, there was evidence of heteroechoic collection in right adnexa with suspicious left tubal extrauterine gestational sac with yolk sac and fetal pole. Fetal heart rate was also present with surrounding collection and gestational sac. A radiological diagnosis of bilateral adnexal echogenic cyst likely teratoma with left ectopic tubal pregnancy was made. Interventions: In the present case, exploratory laparotomy followed by left salpingectomy with bilateral cystectomy was done. The treatment modality of a dermoid cyst depends upon the age of the patient. In the case of young individuals, surgeons prefer to remove the cyst only leaving behind the ovaries for hormonal benefits. Usually, cystectomy is not an emergency but sometimes due to its complications like rupture, torsion or infection medical advice is important. Outcomes: Rapid diagnosis and intervention led to improved prognosis for the patient before development of any torsion of the cyst or ruptured ectopic. Lessons: The present case highlights the challenge to clinicians and histopathologists to deal with the multiple coexisting pathologies. The clinician should have a high index of suspicion while working up a patient with acute pelvic pain.

Introduction: Idiopathic granulomatous mastitis (IGM) is a benign chronic inflammatory disease of the breast. The diagnosis depends on histopathological examination after ruling out all other diseases causing granulomatous lesions. Although diagnosis by cytology is a challenging task, especially in a tuberculosis-prevalent country, it helps in early diagnosis if certain protocols are followed and helps to avoid the complications related to biopsy. Aims and Objective: In this study, 52 cases of IGM were followed retrospectively to analyse the cytological findings, which are helpful for a conclusive diagnosis of the disease. Materials and Methods: An institution-based retrospective observational study conducted over a period of 7 years, and patients with histologically proven cases of granulomatous mastitis were selected for this study. Fifty-two cases were analysed. For cytologic evaluation, parameters evaluated were – (1) presence of granulomas, (2) predominant cell of infiltration, (3) presence of fibrocapillary fragments, (4) presence or absence of caseation necrosis, (5) morphology of multinucleated giant cells and if present, (6) ductal cells – normal or atypical. Statistical Analysis: Conducted in MS Excel and R 4.2.1. Results: Epithelioid cell granuloma is the most consistent finding, as it was present in 90% of cases. Other findings such as neutrophilic infiltrate (76.9%), presence of fibrocapillary fragments (86.5%), absence of caseation necrosis (98.1%) and lack of ductal cell atypia (94.2%) carry significance in diagnosis. Conclusion: Cytological findings such as epithelioid cell granulomas with the absence of caseation necrosis, predominant neutrophilic infiltrates, presence of fibrocapillary fragments and absence of ductal cell atypia when collaborated with special stains for fungus and acid-fast bacilli, will correctly help in diagnosing IGM by fine-needle aspiration cytology.

Background: Caesarean section (CS) rate is showing an alarming increase in India, as a result, high-risk pregnancies with previous CS are becoming more frequent. Objective: The present study compared the additional risk for previous CS among a retrospective cohort of women who had maternal near miss (MNM). Materials and Methods: Record analysis of women with MNM between April 2019 and March 2020 at the tertiary level teaching hospital of Kolkata, India. Data for the selected study variables were extracted from the patient's case record forms. The main outcome measures were crude odd's ratio for risk of post-partum haemorrhage (PPH), repeat CS and adverse birth outcome; difference of mean for units of blood products transfused, number of clinical signs and hospital stay and adjusted odds ratio for PPH. Results: In this study, 100 records were analysed. The mean age of the cohort was 27.65 years with a standard deviation (SD) of 6.25 years. Forty women had previous CS, among whom 27 (67.5%) had a single CS while 13 (32.5%) had CS twice. A number of clinical signs, duration of hospital stay, total units of packed red cells (PRBCs) and total units of blood products transfused were similar between the groups. Women with previous CS had a significantly higher risk for PPH and having a repeat CS in the present pregnancy. CS at the present pregnancy was the only predictor for PPH after adjusting for other variables. Conclusion: It is difficult to ascertain whether a patient's antepartum and intrapartum course prior to delivery is responsible for the patient's morbidity, or if the previous CS is responsible for some component of the adverse outcomes. Repeated, poor-quality, repeated, closely-spaced CS, can likely result in maternal morbidity, especially PPH. The effect of CS not only affects the incident pregnancy, but future ones as well.

Background: In patients undergoing coronary artery bypass grafting off-pump (CABG-OP) surgery with limited haemodynamic reserve, achieving the ideal anaesthesia depth is challenging. The risk of awareness during surgery increases with light anaesthesia, too deep anaesthesia can cause hypotension, delayed awakening, and increased morbidity and mortality. Aims and Objectives: In this study, we aimed to compare whether the use of the Bispectral Index (BIS) reduces the consumption of the anaesthetic drug and improves recovery time in CABG-OP surgery without awareness during surgery (ADS). Materials and Methods: This was a prospective, single-centre, randomised and double-blind comparative research performed on the American Society of Anaesthesiologists (PS) III patients booked for elective CABG-OP surgery under general anaesthesia. Patients received either propofol or isoflurane anaesthesia, and their consumption was calculated and compared. The conventional groups conventional propofol infusion group (CPG)-1 and conventional isoflurane group (CIG-3) received propofol and isoflurane, and haemodynamic parameters (±20% of initial values) were used to check the depth of anaesthesia. The groups BIS-guided propofol infusion group (BPG-2) and BIS-guided isoflurane group (BIG-4) received propofol and isoflurane, and BIS (value 50 ± 5) were used to check the depth of anaesthesia. In addition, haemodynamic parameters, awakening conditions, length of intubation, hospital stay and drug utilisation were recorded. To explicit ADS, patients were interviewed 24 h after extubation. Results: The quantity of propofol used was 178 ± 11 ml in CPG-1 and 117 ± 6 ml in BPG-2, with a 34.26% reduction with BIS. The isoflurane used was 39 ± 8 ml in CIG-3 and 25 ± 6 ml in BIG-4, with a 35.89% reduction in isoflurane requirement. This difference was statistically significantly low with BIS monitored anaesthesia compared to conventional anaesthesia. The length of intubation was 2.2 ± 1.27 and 2.3 ± 1.49 h in groups BPG-2 and BIG-4, respectively (P < 0.05). Conclusion: BIS monitoring aids CABG-OP surgeries by monitoring the depth of anaesthesia (BIS value 50 ± 5), preventing ADS (0%), reducing the anaesthetic agent requirement (propofol 34.26% and isoflurane 35.89%), reducing myocardial depression (mean arterial pressure maintained >74 mmHg) and aiding ultra-fast-track extubation (37% and 50% reduction in the duration of intubation in propofol and isoflurane with BIS).

Background: Major surgery is associated with a significant decline in the functional capacity of patients. Prehabilitation is the practice of enhancing a patient's functional capacity prior to surgery and thus improving postoperative outcomes. It is a multimodal approach, encompassing medical optimization, preoperative physical exercise, nutritional support, and stress/anxiety reduction. In this audit, we tried to find out how many resident doctors know about prehabilitation and, how they implement it in their patients in routine practice. Aims and Objectives: To study the knowledge amongst resident doctors regarding the role of prehabilitation in surgical patients; and to create awareness and implement quality practices for better post-operative outcomes. Materials and Methods: A questionnaire was prepared on Google docs with multiple choice questions and circulated electronically through emails with the participants. The submitted data were updated on Google docs and analyzed subsequently. Results: One hundred and ninety resident doctors participated in the audit. One hundred seventy residents (89.7%) were aware of holistic multimodal interventions. Three- fourths of residents (150 residents; 78.95%) accurately understood the rationale behind prehabilitation. Most of the residents (183 residents; 96.84%) were aware of preoperative medical optimization. A majority (188 residents; 98.95%) were familiar with the techniques of psychological support to patients. However, the knowledge with regard to the rationale behind prehabilitation and the category of patients requiring it, baseline functional capacity assessment, techniques for exercise intensity optimization, and questions pertaining to nutrition was unsatisfactory. Conclusion: Our audit focuses on the need to enhance the knowledge of resident doctors regarding the prehabilitation program to improve post-operative outcomes in patients.

Background: Short small for gestational age (SGA) children not showing a catch-up growth by 2–4 years of age is an indication for growth hormone (GH) therapy. Objective: The objective of this study was to evaluate at what age short SGA patients present to our paediatric endocrine clinic and start on GH therapy. In addition, we aim to assess their GH response during the 1st year of therapy. Materials and Methods: This retrospective observational study included 108 'SGA' children with 'short stature' who were managed in the paediatric endocrine clinic at Tawam Hospital within 5 years. Patients' electronic medical records were reviewed and their data were retrieved. Results: The median (interquartile range) age at the time of presentation was 6.8 years (3.3, 10.0), with a statistically significant difference between the non-syndromic and syndromic patients, 7.3 (5.2, 10.7) versus 3.2 (1.8, 5.9) years, respectively, whereas the median age at the time of starting GH treatment was 10.7 years (8.1, 13.6), with 47.4% treated at 5–10 years of age and 42.1% at >10 years of age. The mean (±standard deviation) delta height z-score for all treated patients was 0.58 ± 0.40 at 1 year. There was a significant difference in both the mean height at pre and post 1 year of starting GH treatment between the non-syndromic and syndromic groups (P < 0.0001 and 0.003, respectively). Conclusion: The majority of our short SGA patients presented late and were subsequently treated with GH later than the international consensus or guideline recommendations. There is a need for increased awareness to refer these children earlier for a better outcome.

Background: Studies have shown LDH is raised in Pre-eclampsia (PE) with levels increasing with increased severity of PE. Aims and Objectives: To study lactate dehydrogenase (LDH) as a marker for foetal outcome in mothers with pre-eclampsia (PE). Materials and Methods: A prospective cohort study was conducted at our facility from February 2019 to November 2021 on all admitted patients with PE. Two hundred and two patients were studied during this period. The inclusion criteria were mild and moderate PE. The exclusion criteria were severe PE, haemolysis, elevated liver enzymes and low platelets syndrome, eclampsia, any comorbid disease, and multiple gestations. Patients were divided into two groups. Group 0 had mothers with LDH <600 IU/L and Group 1 included mothers with LDH ≥ 600 IU/L. Both groups were documented and monitored until delivery to document foetal outcome as live birth or death in utero. Results: The mean maternal characteristics were as follows: age in years (26.45 ± 3.74), body mass index (30.04 ± 1.58), parity (2.39 ± 0.91), and age of gestation in weeks (33.27 ± 1.18). Group 1 had 61 (30.2%) previous history of PE, 84 (41.6%) live births, and 17 (8.4%) deaths in utero. Group 0 had 60 (29.7%) previous history of PE, 95 (47%) live births and 6 (3%) deaths in utero. The mean gestational age of Group 1 was shorter; 32.29 ± 1.17 weeks versus 33.23 ± 1.16 for Group 0. LDH as a marker for death in utero had a P = 0.01 which is significant. Conclusion: LDH can be used as a marker for foetal outcome in women with PE.

Hemangioblastoma (HB) is a vascular tumour of the central nervous system mostly located in the cerebellum; the supratentorial location is rare, and meningeal attachment is even exceptional. A few cases were reported in the literature. We report the case of a 20-year-old male without personal or familial past medical history, who presented deep visual field amputation; imaging objectified supratentorial solid tumour attached on the occipital falx, the patient was operated on and the lesion was completely removed; pathology examination was in favour of HB, further exploration found no other systemic anomalies. There was no recurrence during 7 years of control imaging. We also reviewed the literature, and we found another 31 articles describing supratentorial meningeal HB; this topographic form seems to have epidemiologic, pathologic, imaging and management particularities that we discuss to better understand this rare pathology.

Sleep-related disorders necessitate adequate attention in the primary health care setting, the first point of contact for patients. Hence, this paper aims to identify factors reinforcing improvement strategies for sleep disorders management in primary health care. A narrative literature review was performed by examining sleep health-related scholarly sources identified in relevant databases. Subsequently, a comprehensive overview is shaped about potential factors catalysing active primary care practitioners' (PCPs') involvement in sleep disorders management. Eight key catalysts have been identified and described concisely based on current research. These eight catalysts could serve as an aide-memoire for primary care professionals for pursuing sleep-centric practices. Further, the identified catalysts could function as a reference for developing actions related to training, sleep medicine guidelines, policymaking, and public health programs dedicated towards sleep disorders' early detection, management, and education. As an important implication of this review, researchers interested in sleep health can utilize this review's outcome for crafting and validating a questionnaire to understand the involvement of PCPs in managing sleep disorders.