Abstract Tibial plateau fractures (TPFs) are complex intra-articular injuries associated with long-term disability if not optimally treated. In low- and middle-income countries (LMICs), where high-energy trauma is prevalent and health system resources are constrained, management strategies, and outcomes differ substantially from those reported in high-income countries. This systematic review synthesizes evidence from LMICs on treatment approaches, functional outcomes, and complications following TPFs. We systematically searched PubMed, EMBASE, Scopus, and regional databases for studies conducted in LMICs, published up to May 2025. Eligible studies included adult patients with TPFs managed surgically, reporting functional or radiological outcomes. Data were extracted on demographics, fracture type, surgical technique, and outcomes. Risk of bias was assessed using the Newcastle–Ottawa Scale and Cochrane ROB-2 tools. Fifteen studies comprising 1,213 patients from South Asia, and Africa were included. Patients were predominantly male (65–75%) with mean ages between 35 and 45 years; road traffic accidents were the leading cause. Dual plating yielded superior alignment and higher Knee Society Scores (75–85) but carried increased infection rates (10–18%). Ilizarov and hybrid fixators achieved high union rates (>90%) with acceptable function, although pin-tract infections (15–20%) and malalignment (10–12%) were common. Arthroscopic-assisted fixation improved articular reduction but was limited to tertiary centres. A randomized trial demonstrated that immediate weight-bearing enhanced gait recovery without increased implant failure. Across studies, complication rates exceeded those reported in high-income countries, reflecting systemic barriers such as limited rehabilitation access, implant scarcity, and inadequate soft tissue care. In LMICs, satisfactory union and functional recovery can be achieved following TPF surgery, but complication rates remain high. Dual plating offers superior stability, while Ilizarov fixation provides a resource-appropriate alternative. System-level improvements in rehabilitation, infection prevention, and trauma infrastructure are critical to narrowing outcome disparities with high-income countries.

Obesity as defined by the World Health Organization is an abnormal or excessive fat accumulation that imparts direct and indirect health-related risk.It is an emerging concern worldwide including the Middle Eastern countries.Obesity rates in Bahrain are higher in females (38%) than males (20%). 1The single anastomosis gastric bypass (SAGB) is one among the combined bariatric procedures adopted for weight loss in patients failing maximal medical therapy.It has a good safety profile and is becoming increasingly popular.Internal hernia (IH) refers to the protrusion of bowel through mesenteric defects or spaces.IH most commonly involves the intestinal bowel loops and cannot be visualized externally.High clinical suspicion with symptoms of severe colicky abdominal pain and tachycardia in a patient with Keywords ► single anastomosis gastric bypass ► contrast-enhanced computerized tomography ► Roux-en-Y gastric bypass ► excess weight loss ► internal hernia

The pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged health care professionals worldwide and continues to do so to date.In spite of all the efforts, the definitive treatment of coronavirus disease 2019 (COVID-19) remains controversial.Systemic steroid is one of the treatment modalities, but its unchecked use has adversely resulted in secondary bacterial and fungal infections. 1 Preexisting comorbidities such as diabetes mellitus, malignancy, immunocompromised states, lung diseases, etc. may also give rise to increased incidence of secondary infections.Secondary fungal infections are very rare, accounting for less than 1%, 2 but recent reports suggest an acute rise, especially in India.The risk of infection with Aspergillus, Candida, and Pneumocystis jirovecii in COVID-19 is well

Background Racial disparities in outcomes among patients in the United States are widely recognized, but disparities in treatment are less commonly understood. This study is intended to identify treatment disparities in delivery of surgery and time to surgery for diagnoses managed by general surgeons-appendicitis, cholecystitis, gallstone pancreatitis, abdominal wall hernias, intestinal obstructions, and viscus perforations. Methods The National Inpatient Sample (NIS) was used to estimate and analyze disparities in delivery of surgery, type of surgery received, and timing of surgery. Age-adjusted means were compared by race/ethnicity and trends in treatment disparities were evaluated from 1993 to 2017. Linear modeling was used to measure trends in treatment and outcome disparities over time. Mediation analysis was performed to estimate contributions of all available factors to treatment differences. Relationships between treatment disparities and disparities in mortality and length of stay were similarly evaluated. Results Black patients were less likely to receive surgery for appendicitis, cholecystitis, pancreatitis, and hernias, and more likely to receive surgery for obstructions and perforations. Black patients experienced longer wait times prior to surgery, by 0.15 to 1.9 days, depending on the diagnosis. Mediation analysis demonstrated that these disparities are not attributable to the patient factors available in the NIS, and provided some insight into potential contributors to the observed disparities, such as hospital factors and socioeconomic factors. Conclusion Treatment disparities are present even with common indications for surgery, such as appendicitis, cholecystitis, and gallstone pancreatitis. Black patients are less likely to receive surgery with these diagnoses and must wait longer for surgery if it is performed. Surgeons should plan institution-level interventions to measure, explain, and potentially correct treatment disparities.

Background Currently, the methods for drainage of pelvic abscess primarily use computed tomography- or ultrasound-guided percutaneous drainage or surgical drainage. Endoscopic ultrasound-guided pelvic abscess drainage (EUS-PAD) is an alternative, minimally invasive tool to drain an abscess, localized close to the rectum or left colon, and therefore not accessible by other means.Methods We report on the success of endoscopic ultrasound-guided drainage of peridiverticulitic abscess based on the two cases presented here. Using endoscopic ultrasound guidance an aspiration of the abscess from the endoluminal could be realized. After successive balloon dilatation via a guidewire while using X-ray imaging, the placement of pigtail or flap stent was performed. In addition, conservative therapy measures such as antibiotics, diet, and pain management were performed.Results The interventions were successful in both patients, resulting in rapid recourse of discomfort, abscess size, and sepsis. After controlling the consequences of complicated diverticulitis, both patients underwent laparoscopic sigmoid resection with primary anastomosis and without ileostomy during an inflammation-free interval.Conclusion Both cases demonstrate the advantages of EUS-PAD. A laparoscopic operation with primary anastomosis, lower perioperative risk, and without need of a protective ileostomy in early elective setting became possible by bridging the time until surgery by using EUS-PAD.

Introduction Despite progress in eliminating the social and health disparity between men and women during the last century, gender equality remains an elusive goal, particularly in the developing world.This gender-based bias has been found to directly result into poor health outcome in females.Hence, it is vital to know the number and pattern of surgical diseases affecting females in any setup, so as to improve their admission rates and reach out to this neglected half of population. Materials and MethodsThis was a demographic study done at a teaching hospital in Central India from January to June 2020.Data of patients discharged from female surgery ward were collected from medical record department.Age, diagnosis, urbanrural distribution, and length of hospital stay of patients were noted, and data were analyzed statistically.Results A total of 187 patient records were studied, which revealed that the mean age of the patients was 40.35 years; maximum patients were of gastrointestinal surgery (53.42%) in which the most common diagnosis was cholelithiasis (25.13%).Urological diseases (15.50%), breast diseases (12.83%), perianal disease (9.09%), and thyroid diseases (5.34%) were found in decreasing order of frequency.Overall hospital stays of patients ranged from 1 to 14 days with average stay of 6.35 days.Conclusion In our study, cholelithiasis was found to be the most common surgically treated disease followed by urological diseases.Breast symptoms, although commonly affecting females, did not turn into admissions as there remains a social taboo attached to it.Breast cancer still presents late, despite being the most common cancer in females in India.Approximately 65% patients were discharged within first 5 days of their admission, which indicates good hospital care and improves patient satisfaction levels.Still there is greater need for public health efforts to improve the monitoring, safety, and availability of surgical services to female patients.

Introduction Treatment options for xiphodynia are injections with local corticosteroid injections or surgical resection of the xiphoid process. Currently, there is no consensus as to which treatment is the most optimal. Objectives The aim of this case series was to compare the safety and efficacy of conservative and surgical treatment for patients with xiphodynia. Patients and Methods A retrospective case series was performed. All patients presenting with xiphodynia between 2016 and 2021 were eligible. Demographic data and treatment regimes, including preoperative work-up and surgical technique, were extracted from the electronic patient files. In addition, all patients received a follow-up phone call with a questionnaire. Patient satisfaction was measured using the Numeric Rating Scale. Results A total of five patients, suffering from xiphodynia for up to 10 years, completed the follow-up questionnaire (median patient age, 57 years; range 51-68 years). Three of these patients initially received conservative treatment with local injections with corticosteroids for at least 6 months. One patient was satisfied with the results and did not opt for surgical treatment. Eventually, four patients were treated surgically by removing the xiphoid process. No postoperative complications were recorded and 100% of the patients who underwent a xiphoidectomy were free of symptoms and satisfied with the results. Conclusion Symptoms related to xiphodynia can be relieved using conservative or surgical treatment, where the latter seems to be a safe and effective solution.

Objective Extracorporeal membrane oxygenation (ECMO) is a relatively new technology used for life support in patients with cardiopulmonary failure from various causes. The objective of this study is to review the first 5-year experience in adopting this technology in a teaching hospital in southern Thailand.Methods The data of ECMO-supported patients in Songklanagarind Hospital, from the years 2014 to 2018, were retrospectively reviewed. Data sources were from electronic medical records and the database of the perfusion service. Parameters in focus included prior conditions and indications of ECMO, type of ECMO and cannulation method, complications during and after the treatment, and discharge statuses.Results A total of 83 patients received ECMO life support during the 5-year period and the number of cases per year increased. The proportion of venovenous: venoarterial ECMO in our institute was 49:34 cases and there were three cases who used ECMO as a part of cardiopulmonary resuscitation. Moreover, there were 57 cases who used ECMO for cardiac failure and 26 cases were for respiratory causes, while premature withdrawal was decided in 26 cases (31.3%). Overall survival from ECMO was 35/83 cases (42.2%) and survival to discharge was 32/83 (38.6%). During therapy, ECMO could restore serum pH to the normal range in all cases. Furthermore, those who used ECMO for respiratory failure had significantly higher survival probability (57.7%) when compared to the cardiac counterpart (29.8%,p-value = 0.03). Patients with younger ages also had significantly better survival outcomes. The most common complications were cardiac (75 cases, 85.5%), followed by renal (45 cases, 54.2%), and hematologic systems (38 cases, 45.8%). In those who survived to discharge, average ECMO duration was 9.7 days.Conclusion Extracorporeal life support is a technology that bridges the patients with cardiopulmonary failure to their recovery or definitive surgery. Despite the high complication rate, survival can be expected, especially in respiratory failure cases and relatively young patients.

Introduction This study analyzes barriers to the adoption of emergency laparoscopy (EL), safety, and accessibility in a low-resource setting of a low- and middle-income country (LMIC).Methods In this prospective observational study, patients with blunt trauma abdomen (BTA) who required exploration were included and divided into two groups—open exploration (open surgery [OSx]) and laparoscopic exploration (laparoscopic surgery [LSx]). Data were compiled and analyzed.Results Out of 94 BTA patients, 66 required exploration, and the rest were managed conservatively. Out of 66 patients, 42 were in OSx and 24 were in LSx, reason for not selecting LSx was the surgeon's preference for OSx in 26 patients and the lack of availability of operation theater (OT) slots in 16 patients. LSx even after indication was less likely if patients had preoperative evidence of perforation peritonitis.Conclusion Lack of resources (OT availability and trained personnel) are barriers to the adoption of emergency LSx in low-resource settings.