ABSTRACT Charles Bonnet Syndrome (CBS) is characterized by vivid visual hallucinations in individuals with significant vision loss who retain cognitive clarity. While often reported in older adults with chronic ophthalmologic disease, it can also occur in younger patients following acute injury to the visual pathway. We report the case of a 33-year-old Indonesian man who developed CBS after neurosurgical resection of a pituitary macroadenoma compressing the optic chiasm. Postoperatively, he experienced agitation and visual hallucinations initially attributed to postoperative delirium. Although delirium resolved, the hallucinations persisted with preserved insight, leading to a diagnosis of CBS. Cultural interpretation played a central role: the patient and his family understood the visions as spiritual phenomena, reinforced by a local shaman, which delayed acceptance of a medical explanation. Management involved psychoeducation delivered in a culturally sensitive manner, low-dose quetiapine, and ongoing follow-up. Hallucinations gradually diminished and resolved within 1 month. This case underscores the diagnostic challenge of CBS in the postoperative setting, especially when cultural beliefs shape symptom interpretation. Clinicians practicing in culturally contextualized environments should integrate respectful engagement with cultural narratives into their diagnostic and therapeutic approach to improve recognition, treatment adherence, and patient outcomes.

ABSTRACT Background: With the coming of the New Criminal Laws 2023, which came into effect on July 1, 2024, major changes and additions in various laws, including medicolegal cases (MLCs), have come into full swing. Awareness of the interns in regard to the new laws and various other medicolegal knowledge, and the updates, is of prior importance in the clinical as well as nonclinical settings in all medical institutes. As an internship is the stage where MLCs are first faced head-on, this study will be conducted among the interns to assess their understanding, applicability, and recent updates of medicolegal knowledge. Materials and Methods: A cross-sectional study was conducted to assess the medicolegal knowledge among 164 interns of the Regional Institute of Medical Sciences (RIMS) during May 2025–July 2025. Results: A total of 164 interns were assessed for the adequacy of medicolegal knowledge, and it was found that 58 participants (35.4%) had adequate knowledge with a score of ≥10, that is, ≥50%, and 106 participants (64.6%) had inadequate knowledge with a score of <10, that is, <50%. Out of all the interns, 92 (56.1%) had completed an internship in Forensic Medicine and Toxicology (FMT), and 72 (43.9%) had not yet undergone the compulsory rotatory posting in FMT. Of the total interns, only 34.1% had adequate knowledge about postmortem examination, 50.3% had adequate knowledge about consent in medical practice, 25% were well updated with the medicolegal systems, 28% had good knowledge about medical records, and 30.5% were aware of the Consumer Protection Act. Conclusion: Medical interns of RIMS Imphal, Manipur, India, have inadequate medicolegal knowledge and meticulous training for undergraduates, especially for the interns is of utmost urgency. Addressing the issue of inadequate medicolegal knowledge and its application in medical practice should be dealt with promptly. Decreased confidence in handling MLCs by medical professionals can be countered with increased awareness, workshops, frequent conferences, and discussions.

ABSTRACT Background: Firearm-related violence is a growing concern in India, where an estimated 40 million civilian-owned firearms exist, with only 15% legally registered. The northeastern states, including Manipur, have long witnessed firearm-related incidents due to sociopolitical factors, yet limited scientific analyses exist. This study examines the sociodemographic profile of victims and the medicolegal aspects of firearm and explosive injuries. Methods: A retrospective analysis was conducted on medicolegal autopsy records from the Department of Forensic Medicine and Toxicology, Regional Institute of Medical Sciences, Imphal, covering firearm-related deaths between January 2012 and December 2022. Data sources included autopsy reports, police documentation, requisition forms, and relatives’ accounts. Information was categorized by demographics, weapon type, injury distribution, motive, timing, and manner of death. Results: A total of 200 cases were reviewed, with an overwhelming male predominance (99%). The most affected age group was 21–30 years (39.5%), followed by 31–40 years (24%). Rifled firearms were used in 90% of cases. The head and face were the most common injury sites (21.5%), followed by combined head and thorax injuries (17.5%). Encounters (43%) and terrorism (18.5%) were the leading motives. Most incidents occurred between 6 am–12 noon (31%). In 65.5% of cases, more than two shots were fired. Homicides accounted for 88% of deaths, while suicides and accidents comprised 8% and 4%, respectively. Death was primarily due to injury to vital organs (64%), head trauma (20%), and hemorrhage/shock (16%). Conclusion: The study highlights the predominance of young male victims, the extensive use of rifled firearms, and the high rate of homicidal deaths in Manipur. The findings underscore the severity, intentionality, and public health implications of firearm violence in northeastern India, emphasizing the need for stricter firearm regulation and preventive interventions.

Pseudorabies, commonly known as Aujeszky’s disease, is a viral infection caused by the pseudorabies virus (PRV).[1] The virus was discovered in 1902 and has since spread around the world, particularly in countries with high pig populations. PRV-infected pigs excrete a large amount of the virus in their bodily secretions and excretions, making it easily transmissible. PRV is typically transmitted through direct contact between infected and susceptible animals. The virus, on the other hand, can spread through the air, water, and contaminated items (fomites). The disease is difficult to control, and outbreaks in pig herds can result in large financial losses for the swine industry. While the Bartha-K61 vaccine for PRV is available, it is a live attenuated form of the virus. This vaccination is helpful in limiting virus spread but does not completely prevent illness. A combination of interventions such as rigorous biosecurity regulations, good sanitation techniques, and vaccination programs are often used to effectively manage and prevent the spread of PRV. Ongoing research and surveillance are critical for understanding the epidemiology of PRV and creating better control methods to reduce the disease’s impact on the swine industry.[2] An important concern is whether this disease will be the emerging infectious disease that causes problems in humans. According to the available information, pseudorabies virus infection may constitute an occupational hazard and may cause disease in humans. However, because live virus has not been isolated from infected patients, fulfilling all of Koch’s postulates and establishing a conclusive evidence of PRV-induced disease in people is challenging. Experiments with PRV infection in rhesus macaques have yielded inconclusive results. An early study in England using an Aujeszky virus strain failed to induce infection via several modes of inoculation, but subsequent studies with different strains were effective in inducing neurological symptoms by intracerebral injection.[3] In macaques, pre-existing immunity to herpes B virus was revealed to have a protective effect against intracerebral PRV injection.[3] This shows that PRV infectivity to monkeys or humans may vary by strain and that prior immunity to related viruses may influence the severity of disease symptoms. In the future, researchers should try to extract the virus from patient samples using cell culture as well as live animals vulnerable to Aujeszky’s disease, such as BALB/c mice. In addition, modern detection technologies such as next-generation sequencing (NGS) should be used in concert with serological, virological, and epidemiological studies to uncover novel pathogens that infect and cause disease in people.[4] These initiatives will significantly help in determining the true public health risk associated with PRV infections and forecasting future outbreaks. However, the latest report from China that can successfully identify the causal relationship between the pathogen and clinical issues in a patient with encephalitis highlight the importance of zoonotic transmission of the disease.[5] A PRV strain was identified from an acute human encephalitis case in that case report. This isolate shared similar phylogenetic and etiological characteristics with Chinese PRV variant strains, demonstrating a high risk of PRV transmission from pigs to humans.[5] Continued study in this area is critical for gaining a better understanding of the potential hazards and repercussions of PRV infection in humans. This will aid in the implementation of suitable preventative measures and the successful management of any possible PRV public health risks. Conflict of interest There are no conflict of interest. Acknowledgement Not applicable. Author contributions AK 50% ideas, writing, analyzing, and approval. VW 50% ideas, supervision, and approval. Ethical policy and Institutional Review Board statement Not applicable. Financial support and sponsorship Nil.

Sir, The recent report on the emerging problem of the COVID-19 variant is very interesting.[1] At present, some new variants such as the UK variant or South African variant (501Y.V2) become a global concern. The increased transmissibility is mentioned in the UK variant and the possible vaccine escape is noted in 501Y.V2. Abdullahi et al. noted that the molecular change due to mutation is the cause of the alteration of clinical characteristics of COVID-19, and it is necessary for further studies to correspond to the emerging mutation problem.[1] In fact, the mutation is basically due to at least one amino acid change and the change will further affect the total molecular weight, epitope property, or polar charge property of the mutated molecule. The effect of the mutation with relationship to basic molecular change is well demonstrated in many infections like bird flu.[2] Regarding the new disease, COVID-19, the molecular pathology can also explain the clinical phenotypic change due to mutation. For the new South Africa mutation, 501Y.V2, the basic change is a single amino acid substitution, E48K. The magnitude of molecular weight change per molecule is only one. Therefore, there is not much impact on transmissibility. However, the change is related to polar amino acids, and the overall charged change is equal to two, which is different from the UK variant that is related to nonpolar amino acids. This could provide an explanation for how the UK version does not exhibit the impact on antibody response, which necessitated bonding through molecular charged due to 501Y.V2. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

ABSTRACT Introduction: Acute appendicitis (AA) is one of the most prevalent causes of urgent abdominal surgery where timely diagnosis remains a challenge. Early intervention may lead to negative appendectomy and delay may lead to perforated appendicitis. Materials and Methods: A cross-sectional study was conducted on 72 patients presenting with features of AA from January 2021 to October 2022 in the Department of Surgery, Regional Institute Of Medical Sciences Hospital, Imphal, Manipur, India. Blood for serum fibrinogen was collected in all patients preoperatively. Results: Out of 72 patients, males were 52.8%. The majority of the patients were in the age group 20–30 years (33.3%), and the mean age was 29.83 ± 15.89 years. All the patients had pain in the right lower quadrant of the abdomen, tenderness at the right iliac fossa, and rebound tenderness. However, migratory right iliac fossa pain was present in only 51.4% of patients. Fever (70.8%), anorexia (86.1%), nausea (59.7%), and vomiting (41.7%) were also seen among the patients. Increased serum fibrinogen level (>400 mg/dL) and high total leucocyte count (>11,000/µL) were seen to be significantly associated with complicated appendicitis. The area under the curve was 0.925 that is, it has an accuracy of around 90% and this was statistically significant (P < 0.001). Taking a cut-off level of serum fibrinogen at 450.4, then it gives a sensitivity of 85.71% and specificity of 95.45%. Conclusion: Serum fibrinogen seems to be a useful marker for distinguishing between complicated appendicitis and uncomplicated AA, and the level of 450.4 mg/dL is the best serum fibrinogen value to predict complicated AA.

ABSTRACT Introduction: Surgeons often face complex wounds with full-thickness defects of the skin and difficult wound beds. A difficult wound bed is one with exposed bones, tendons, and joints. Traditionally such wounds are resurfaced with skin grafts alone or with flaps. Sometimes, there is a paucity of local tissue and complex reconstructive procedures are contraindicated or unsafe, particularly in frail, unstable patients. We must look at other available means of reconstruction. Here, we present a series of cases where defects were reconstructed using a biodegradable temporizing matrix (BTM) followed by a split-thickness skin graft (STSG). Materials and Methods: Records at our center were retrospectively reviewed from 2021 to 2024. Nine patients with complex wounds (exposed underlying structures in the wound bed, including bones, tendons, and joints) were identified and underwent reconstruction using a BTM. The matrix was placed into the defect at the first stage followed by skin grafting at the second stage. Nine patients (five males, four females) with a mean age of 45 years with skin defects ranging from 2 × 2 to 12 × 8 cm2 were included in the study. After an average of 21 days, patients underwent placement of an STSG over the vascularized temporizing matrix. Results: The STSG took well in every patient with no complications or re-operations required. Full-thickness defects of the skin over a difficult wound bed are challenging to reconstruct. Conclusion: This series demonstrates that BTM can re-vascularized and allow an STSG to take with minimal to no complications/morbidity, a relatively short operative time, and a stable outcome.

Background: Standard loading technique was seen to result in incomplete coverage of the primary disease extending to the vagina. Modification of loading technique with extended loading aims to deliver higher dose to vaginal extent of disease with acceptable toxicity. Objectives: This study was conducted to determine the feasibility of extended loading technique in intracavitary brachytherapy in cervical cancer patients with primary disease involving vagina in terms of dosimetry, response rates of primary disease, and associated toxicities. Methods: Twenty patients were selected who were registered and treated during January 2020 to December 2021. All patients (100%) completed the treatment with minimum of two follow-ups. Results: Overall, the response rate of 90% in primary disease was observed in patients treated, and interestingly, 50% of the patients had complete response. Moreover, 100% of patients reported improvement in at least one symptom. Only one patient had a static disease. As defined by the RTOG criteria for toxicity assessment, Grade I rectal toxicity (70%) and genitourinary toxicity (50%) were seen in most patients. Grade III toxicity was reported in five patients. No Grade IV toxicity was seen. Conclusion: Extended loading technique was an excellent method to adequately cover the vaginal disease in a setting where interstitial brachytherapy and intensity-modulated radiation therapy boost techniques are not available, with acceptable toxicity.

Background: Ossification of posterior longitudinal ligament (OPLL) is relatively a common form of ligamentous ossification in the cervical spine, especially in the East Asian populations. Reasons ascribed for the purpose of this study are the north-eastern region (NER) of India which is predominantly inhabited by diverse native Ethnic Communities and there is no published literature on the prevalence of OPLL from the NER of India so far. Study Design and Population: Retrospective analysis of cervical computed tomography scans that was available between September 2018 and December 2022 in the Hospital PACE systems at AGMC Agartala Tripura. Results: The incidence of OPLL was identified to be 21 (21/490), which amounts to 4.28% of cases, of which 74.4% were male and 28.5% were female with 52.8% falling into the age group between 50 and 59 years. 71.4% had a central location type, while 47.6% was of continuous type. In terms of ethnicity, it was more prevalent in the nontribe, accounting for around 57.14%, than the tribe which was about 47.58%. Conclusions: This is a pilot study, a monocentric study involving a single NER state of Tripura to generate a preliminary estimation of the current prevalence that would help in formulating further studies involving other Indian states for an overall picture of the cervical-OPLL and the disease burden in the NER, where there no data is currently available.