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Introduction: Brain arteriovenous malformations (AVM) are complex vascular pathologies with a significant risk of hemorrhage. Stereotactic radiosurgery (SRS) is an effective treatment modality for AVM, initially popularized on the Gamma Knife (Elekta AB, Stockholm, Sweden) platform, and now benefits from the modern advances in linear accelerator (LINAC)-based platforms. This study evaluates the outcomes of LINAC-based SRS/hypofractionated stereotactic radiotherapy (hFSRT) for cerebral AVMs., Materials and Methods: Between December 2018 and April 2024, 15 patients with cerebral AVMs underwent SRS/hFSRT at a tertiary government hospital. Patient selection was based on AVM size, location, surgical unsuitability, and patient preference. All patients underwent MRI and cerebral angiography for nidus delineation. SRS was planned using Monaco TPS (treatment planning system) (Elekta AB, Stockholm, Sweden) with VMAT (volumetric modulated arc therapy) technique, delivering a median dose of 20 Gy in single fractions for small AVMs and 28 Gy in four fractions for large AVMs. Patients were followed up with annual MRI and angiography to assess obliteration., Results: The cohort had a median age of 22 years, with a median nidus volume of 3.76 cc. The crude obliteration rate was 60%, confirmed by MRI/angiography. Actuarial obliteration rates at two, three, and five years were 65.71%, 73.57%, and 77.14%, respectively. Smaller AVMs (<3 cc) and those with a modified AVM radiosurgery score <1.5 had nearly 100% obliteration rates. Large AVMs (>10 cc) treated with hypofractionated SRT showed partial responses only. Significant predictors of obliteration included prescription dose, AVM volume, and modified AVM radiosurgery score., Conclusion: LINAC-based SRS demonstrates comparable efficacy to other modalities for treating cerebral AVMs, with obliteration rates influenced by dose, AVM volume, and pre-treatment radiosurgery score. Larger AVMs pose a greater challenge, suggesting a need for adjunctive treatments or higher fractionated doses to improve outcomes., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, All India Institute of Medical Sciences, Jodhpur issued approval AIIMS/IEC/2018/782; dated December 22, 2018. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mohan et al.)

Vertical maxillary excess (VME) is a facial condition characterized by an increased height in the lower third of the face, leading to a longer overall facial appearance. This condition is linked to a significant proportion of malocclusions and is often associated with greater dissatisfaction among patients concerning their appearance. The amalgamation of orthodontics with surgery is a desirable protocol to address VME. The present clinical case exemplifies the effect of LeFort I with segmental anterior maxillary osteotomy and advancement genioplasty on improving the patient's skeletal, dental, soft tissue, and overall aesthetics., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mohelay et al.)

Class I bimaxillary protrusion is characterized by proclined incisors, a convex facial profile, procumbent lips, and increased lip strain. Treatment includes the extraction of premolars and the mesial movement of the proclined anterior teeth in the extraction spaces to correct the inclination. This case report describes the treatment of an 18-year-old male patient who presented with class I bimaxillary protrusion and procumbent lips. Clinical examination revealed a convex profile, potentially competent lips, and increased lip strain. The treatment plan included therapeutic extraction of all first premolars and complete retraction of the anterior teeth in the extraction spaces. Absolute anchorage was required, and therefore, mini-implants were placed in both the upper and lower arches. Sliding mechanics were used to retract the anterior teeth in the extraction spaces. The use of mini-implants for absolute anchorage allowed for complete retraction of the anterior teeth without the inadvertent mesial movement of the posterior teeth. Posttreatment, the inclination of the anterior teeth was corrected, achieving normal overjet and overbite. Lip procumbancy was reduced, resulting in a more harmonious facial profile., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Malhotra et al.)

The class II bimaxillary protrusion malocclusion with class II or end on molar relation is generally associated with procumbency of lips. This case report presents a case of a 17-year-old nongrowing male patient with a traumatized left central incisor due to a fall with a chief complaint of forwardly placed and gap in upper front teeth. The traumatized left central incisor with Ellis class IV fracture was with a loss of crown structure and a poor prognosis of remaining tooth structure. Class II bimaxillary protrusion malocclusion was planned to be treated with orthodontic camouflage. A fixed mechanotherapy orthodontic treatment was performed by extracting the right first premolar and left central incisor and substituting the extracted maxillary central incisor with the lateral incisor. Thus, the maxillary canine was substituted for the lateral incisor, and the first premolar was substituted for canines. It was followed by substituting the lateral incisor with canine by recontouring the crown and restoring the substituted lateral incisor with veneer. The case was completed in 24 months, smile esthetics were improved, and functional occlusion of the class I canine and Angle's class II molar relationship bilaterally was achieved., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Arora et al.)

This report describes a rare presentation of atypical hemolytic uremic syndrome with multi-system involvement, including unilateral blindness and stroke. Only a few cases of atypical hemolytic uremic syndrome with unilateral blindness as a presentation have been reported and all have been attributed to central retinal artery obstruction (CRAO). This is the first described case to our knowledge of atypical hemolytic uremic syndrome presenting with unilateral blindness, which was caused by grade four hypertensive retinopathy., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Girdhar et al.)

Introduction: Neoadjuvant chemoradiation (NACRT) followed by surgery has become the standard of care for esophageal squamous cell carcinoma (ESCC). This study compared the tolerability and oncological benefit of neoadjuvant chemotherapy (NACT) with those of NACRT for the treatment of ESCC., Methods: A prospective quasi-experimental comparative study was conducted from July 2019 to August 2023 to assess the efficacy of the NACT regimen of two cycles of paclitaxel and carboplatin as an alternative to standard NACRT. Either NACT or NACRT was given to patients with resectable ESCC (clinical stage IB-IIIC), after which they underwent minimally invasive esophagectomy with two-field lymphadenectomy. Radiological and pathological responses to neoadjuvant therapy, perioperative morbidity, mortality, and recurrence-free and overall survival rates were compared., Results: Out of the 74 patients enrolled, 63 were included in the study after exclusion. Of these, 30 received NACT, and 33 received NACRT. The baseline demographics, tumor characteristics, incidence of neoadjuvant therapy-related adverse events, and perioperative morbidity were comparable between the two groups. The median number of lymph nodes retrieved (21 vs 19, p=0.19) and R0 resection rate (100% vs 94%) were similar. Although the pathological response was significantly better in the NACRT arm, at a median follow-up of 32.5 (20.75-48) months, there was a non-significant trend toward better recurrence-free survival in the NACRT group (57 vs 36 months, p-value - 0.831), with median overall survival yet to be achieved in both groups., Conclusion: Compared with NACRT, NACT for ESCC is well tolerated and has non-inferior oncological outcomes. NACT could be a feasible alternative to NACRT in such patients, especially if the radiotherapy option is not feasible or available., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institute Review Board and Ethics Committee of All India Institute for Medical Sciences, Jodhpur issued approval AIIMS/IEC/2019-20/863. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Varshney et al.)

Class III malocclusion presents many challenges due to its varying elements of imbalance in skeletal, dental, and soft tissues. This necessitates a comprehensive treatment plan, including growth modification during the pre-pubertal growth phase, and long-term retention to reduce the chances of orthognathic surgery later. The components of Class III malocclusion include maxillary retrognathism, mandibular prognathism, or, in some cases, a combination of both. This article presents a case report of a pre-pubertal female patient, 11.5 years old, with skeletal Class III malocclusion, who sought orthodontic treatment for a backwardly positioned upper jaw. The case was complicated due to a vertical growth pattern with an FMA of 36 degrees, a constricted maxilla in a retrognathic position, unerupted maxillary canines, mandibular anterior crowding, and an anterior open bite. During the first phase of treatment, maxillary protraction with rapid palatal expansion was performed using a facemask appliance and a bonded Hyrax expander. Corrective orthodontics with a fully fixed labial appliance followed after the retention period for maxillary expansion. A functionally stable occlusion was achieved with good vertical control. The patient was satisfied with an aesthetically pleasing smile at the end of the treatment. However, orthognathic surgery might be needed to address the problem of a prominent chin and severe vertical growth pattern. Furthermore, the patient was recommended to wear a vertical pull chin cup for 12 hours daily to prevent any further mandibular growth. Early intervention yielded favorable outcomes, including improvement in skeletal discrepancy, spontaneous eruption of maxillary canines, and an aesthetically enhanced facial profile. The present case report highlights the importance of timely management of malocclusion in growing patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Aziz et al.)

This review aims to evaluate the current ethical dilemmas faced by healthcare practitioners, especially in dentistry, and analyze how conventionalism with ethical norms influences these challenges. By exploring the balance between evolving healthcare practices and established ethical principles, the review aims to provide insights into the ongoing ethical discussions and dilemmas within the field. A systematic search for relevant articles published between 2000 and July 2024 was conducted across various databases, including Web of Science, PubMed, Scopus, and EBSCO host. Studies that met specified eligibility criteria were included, and data on ethical dilemmas in healthcare and dentistry were assessed. To identify trends and inconsistencies in the existing literature, data extraction and synthesis of the findings were performed. Various ethical conundrums that affect dental healthcare professionals were identified by the literature review. The ethical dilemmas that are revealed through this are substandard dental care, inadequate treatment, inadequate sterilization, identity-related dilemmas, overtreatment, and conflict between truthfulness and beneficence. The review highlights common ethical dilemmas in healthcare, underscoring the need for improved resource management, patient communication, and consistent ethical practices., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ahuja et al.)

Transmigration of mandibular canine teeth is a rare dental anomaly characterized by the tooth's aberrant migration through the alveolar bone. This deviation from the expected eruption pathway can lead to tooth impaction, root resorption, periodontal problems, and aesthetic concerns. The exact cause of transmigration is not fully understood, but it is believed to be influenced by a combination of genetic, developmental, and environmental factors. Early diagnosis and appropriate treatment are essential to prevent complications and achieve optimal functional and aesthetic outcomes. This case report presents a 19-year-old female with impacted left mandibular canine teeth. An interdisciplinary approach involving orthodontic therapy and surgical exposure to disimpact the transmigrated canine into the normal occlusal position. The treatment utilized modified orthodontic mechanics, including uprighting springs and temporary anchorage devices (TADs) to treat transmigration. This case also highlights the importance of early diagnosis and timely intervention for transmigrated canine teeth to prevent complications and achieve optimal aesthetic and functional outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Singh et al.)

Advances in orthodontic treatment, particularly with the use of temporary anchorage devices (TADs), have significantly improved outcomes for adult patients with skeletal Class II malocclusion. Traditionally reliant on orthognathic surgery, these malocclusions can now benefit from non-surgical options like maxillary molar distalization. Bone screws offer superior anchorage compared to conventional methods, enabling precise tooth movement without undesirable side effects. This case report explores the efficacy of TAD-assisted maxillary molar distalization in an adult patient while focusing on a 50-year-old female who sought orthodontic treatment for Class II malocclusion, characterized by deep bite and increased overjet. Treatment involved the use of an infra-zygomatic crest (IZC) bone screw for maxillary molar distalization as a camouflage strategy to achieve optimal dento-skeletal and soft tissue profile improvements. The case also discusses the key considerations and benefits of utilizing bone screws in adult orthodontic treatment, particularly in minimizing reciprocal effects and reducing dependence on patient compliance., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ahuja et al.)

Meleney's gangrene (necrotizing fasciitis (NF)), also known as progressive bacterial synergistic gangrene, is a potentially fatal subcutaneous tissue infection with abdominal wall necrosis that progresses rapidly and systematically. It has been observed to exhibit the cultural characteristics of a symbiotic organism. Due to its rarity and high mortality rate, this infection needs to be diagnosed promptly and treated aggressively with antibiotics and rigorous debridement. There are several approaches to management, which include intravenous antibiotics, aggressive debridement, and dressings, along with the application of negative pressure wound therapy (NPWT). Herein, we report the case of a 45-year-old male patient with type 2 diabetes mellitus who presented to our facility after being bitten by an insect and exhibiting symptoms of Meleney's gangrene of the abdomen., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sharma et al.)

A recurring abscess or draining sinus overlying the sacrococcygeal area is the hallmark of the chronic, well-known condition known as sacrococcygeal pilonidal disease. It is among the most difficult surgical challenges. Rarely, recurrent illness, persistent infection, and associated inflammation result in malignant transformation, most frequently in the form of squamous cell carcinoma (SCC). We report a similar case of an 84-year-old man who presented to our outpatient clinic and had a persistent, recurring sacrococcygeal pilonidal sinus for 28 years. He had already undergone several surgical excisions for the same and now developed an ulceroproliferative growth on his right gluteal cleft since his previous resection when he first appeared., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sharma et al.)

Persistent left superior vena cava (PLSVC) is a relatively rare anatomical anomaly, with a higher prevalence in those with congenital heart defects. While typically asymptomatic, its presence can complicate certain medical procedures, particularly cardiac interventions, such as the implantation of cardiac resynchronization therapy (CRT) devices, due to acute angulation. In this report, we discuss the challenges posed by the unanticipated presence of PLSVC during CRT device implantation and describe the technique used for lead placement using Judkins Right catheter for support, placing coronary wire, and later placing the left ventricle (LV) lead with the help of buddy wire technique, resulting in successful insertion of all three CRT leads despite the anatomical challenges., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Aithal et al.)

Purpose Artificial intelligence (AI) has rapidly gained popularity with the growth of ChatGPT (OpenAI, San Francisco, USA) and other large-language model chatbots, and these programs have tremendous potential to impact medicine. One important area of consequence in medicine and public health is that patients may use these programs in search of answers to medical questions. Despite the increased utilization of AI chatbots by the public, there is little research to assess the reliability of ChatGPT and alternative programs when queried for medical information. This study seeks to elucidate the accuracy and readability of AI chatbots in answering patient questions regarding urology. As vasectomy is one of the most common urologic procedures, this study investigates AI-generated responses to frequently asked vasectomy-related questions. For this study, five popular and free-to-access AI platforms were utilized to undertake this investigation. Methods Fifteen vasectomy-related questions were individually queried to five AI chatbots from November-December 2023: ChatGPT (OpenAI, San Francisco, USA), Bard (Google Inc., Mountainview, USA) Bing (Microsoft, Redmond, USA) Perplexity (Perplexity AI Inc., San Francisco, USA), and Claude (Anthropic, San Francisco, USA). Responses from each platform were graded by two attending urologists, two urology research faculty, and one urological resident physician using a Likert (1-6) scale: (1-completely inaccurate, 6-completely accurate) based on comparison to existing American Urological Association guidelines. Flesch-Kincaid Grade levels (FKGL) and Flesch Reading Ease scores (FRES) (1-100) were calculated for each response. To assess differences in Likert, FRES, and FKGL, Kruskal-Wallis tests were performed using GraphPad Prism V10.1.0 (GraphPad, San Diego, USA) with Alpha set at 0.05. Results Analysis shows that ChatGPT provided the most accurate responses across the five AI chatbots with an average score of 5.04 on the Likert scale. Subsequently, Microsoft Bing (4.91), Anthropic Claude (4.65), Google Bard (4.43), and Perplexity (4.41) followed. All five chatbots were found to score, on average, higher than 4.41 corresponding to a score of at least "somewhat accurate." Google Bard received the highest Flesch Reading Ease score (49.67) and lowest Grade level (10.1) when compared to the other chatbots. Anthropic Claude scored 46.7 on the FRES and 10.55 on the FKGL. Microsoft Bing scored 45.57 on the FRES and 11.56 on the FKGL. Perplexity scored 36.4 on the FRES and 13.29 on the FKGL. ChatGPT had the lowest FRES of 30.4 and highest FKGL of 14.2. Conclusion This study investigates the use of AI in medicine, specifically urology, and it helps to determine whether large-language model chatbots can be reliable sources of freely available medical information. All five AI chatbots on average were able to achieve at least "somewhat accurate" on a 6-point Likert scale. In terms of readability, all five AI chatbots on average had Flesch Reading Ease scores of less than 50 and were higher than a 10th-grade level. In this small-scale study, there were several significant differences identified between the readability scores of each AI chatbot. However, there were no significant differences found among their accuracies. Thus, our study suggests that major AI chatbots may perform similarly in their ability to be correct but differ in their ease of being comprehended by the general public., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Carlson et al.)

Odontogenic cysts are fluid-filled sacs arising from tooth-developing tissues within the jawbone, often causing swelling, pain, or displacement of teeth. A dentigerous cyst, specifically encapsulating the unerupted tooth's crown, can interfere with dental development by displacing teeth, causing resorption of adjacent teeth, and complicating dental or surgical interventions. This case report represents a long-term follow-up of a 35-year-old male with a large mandibular dentigerous cyst extending to the lower right border of the mandible, associated with a horizontally impacted third molar in the lower right mandibular region. The treatment consisted of cone beam computed tomography(CBCT) evaluation, followed by enucleation of the cyst with the extraction of second and third molars, root canal treatment (RCT) of the first molar, followed by autogenous symphyseal bone graft placement. Eighteen months later, the implant was placed with respect to the missing second molar. After osseointegration, an implant-supported crown was placed., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Batra et al.)

Gastric volvulus, characterized by stomach rotation, is a rare condition arising from congenital or acquired factors. Predominantly affecting pediatric and elderly populations, it necessitates a high index of suspicion for timely diagnosis. Delayed recognition may precipitate severe complications such as ischemia, strangulation, and septic shock, often culminating in fatal outcomes. We present a case of a 71-year-old male initially admitted for suspected gastroenteritis, subsequently developing acute gastric volvulus during hospitalization, necessitating immediate surgical intervention. This case contributes to the scant literature on gastric volvulus in the elderly demographic., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nagpal et al.)

A distal femoral cemented modular prosthesis is a viable option for post-bone tumor and limb salvage procedures. The major reasons for implant failures are the poor quality of implants, mechanical stress, biochemical reactions, and extended period of the implant in vivo use. Rare incidences have been reported of distal femur prosthesis implant malfunctioning in a subject having osteosarcoma. Common adverse events associated with implant failure include surgical site infections, swelling, pain, revision of the surgical procedure, cyst formation, and build-up of metal debris on soft tissues. Our case report summarizes gross malfunctioning of a distal femur cemented modular prosthesis experienced by a 24-year-old post-operated osteosarcoma patient who developed excruciating sudden pain and the inability to bear weight on the right leg, with the sudden onset of these symptoms developing while turning in bed., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Agarwal et al.)

Progressive multifocal leukoencephalopathy (PML) is considered an often fatal, demon-leading disease primarily associated with immunosuppression. Immunocompromised individuals predominantly exhibit this manifestation, while immunocompatible patients rarely encounter it. We present a unique case of PML in an immunocompetent individual who initially presented with stroke-like symptoms, received management, and was subsequently discharged. He returned to our hospital a few days later with similar complaints, prompting further investigations that revealed PML, a condition often overlooked, especially in individuals with an intact immune system. Although he received successful treatment with mefloquine and other anti-malarial medications and followed up on an outpatient basis, his subsequent outcome was unfavourable. As a result, this case emphasises the importance of having PML as a significant differential and therapeutic option., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Arumugam et al.)

Anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor encephalitis is a rare form of autoimmune encephalitis. We report a case of a patient with myasthenia gravis post-thymoma treatment who presented with deteriorating mental status. She was found to have positive AMPA receptor titers in her cerebrospinal fluid and subsequently attained full recovery. Of the limited number of cases that were documented, we report the only case of a patient who was previously immunocompromised to develop the condition. Even though autoimmune encephalitis is an emerging condition, its early differentiation from other causes of encephalitis is crucial in the prognosis of the patient., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tan et al.)

Hereditary transthyretin amyloidosis (ATTR) is an autosomal dominant, life-threatening genetic disorder caused by a single-nucleotide variant in the transthyretin gene. This mutation leads to the misfolding and deposition of amyloid in various body organs. Both mutant and wild-type transthyretin contribute to the resulting polyneuropathy and cardiomyopathy, leading to significant sensorimotor disturbances and severe cardiac conditions such as heart failure and arrhythmias, thereby impacting quality of life. Despite several treatments, including orthotopic liver transplantation and transthyretin tetramer stabilizers, their limitations persisted until the introduction of RNA interference (RNAi). RNAi, a means to regulate mRNA stability and translation of targeted genes, has brought about significant changes in treatment strategies for ATTR with the introduction of patisiran in 2018. This study reviews patisiran, vutrisiran, inotersen, and eplontersen, developed for the treatment of ATTR. It provides an overview of the clinical trial outcomes, focusing mainly on quality of life, adverse reactions, and the future of RNAi-based therapies., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dave et al.)

Introduction: Diabetic autonomic neuropathy (DAN) is a prevalent yet often overlooked complication of diabetes mellitus (DM), impacting multiple organs and substantially elevating the risk of morbidity and mortality. This study aimed to assess the effectiveness of yoga-based intervention (YBI) compared to the American Diabetes Association exercise regimen (ADA Ex. Regime) and standard care for treating autonomic neuropathy in type 2 DM., Methods: This open-label exploratory clinical trial featured two parallel study arms: Group A (Intervention), which received YBI alongside standard care, and Group B, which adhered to the ADA Ex. Regime in conjunction with standard care. A total of 80 participants aged 35-60, diagnosed with type 2 DM and autonomic neuropathy, were equally allocated to both groups. Data collection included nerve conduction velocity (NCV) tests, autonomic function tests (AFTs), as well as evaluations of depression and quality of life., Results: YBI demonstrated a drop in parasympathetic tone compared to the ADA Ex. Regime. Following a six-month intervention, the sympathetic activity indicator (SD2) exhibited a significantly lower value in the YBI group than in the ADA Ex. Regime group, indicating a positive effect (p < 0.05), while the ADA Ex. Regime showed more improvement in certain areas of NCV (e.g., left and right peroneal NCV, right and left peroneal F-latency), notable differences were observed in alkaline phosphatase levels, depression scores, and WHO-5 wellness, all reaching statistical significance at p < 0.05., Conclusions: The study findings observed that a 24-week YBI significantly reduced in symptoms of diabetic neuropathy and stress. Although the ADA Ex. Regime demonstrated greater improvement in specific aspects of NCV compared to YBI, YBI outperformed the ADA Ex. Regime in enhancing WHO-5 wellness and reducing depression symptoms., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institute Ethics Committee, All India Institute of Medical Sciences, Rishikesh issued approval AIIMS/IEC/21/617. CTRI Registration Number: CTRI/2021/12/039068. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kumar et al.)

Background The pathogen Orientia tsutsugamushi , which causes scrub typhus, is rapidly spreading throughout the tropics. As a measure to improve public health, the development of a vaccine for human use is essential. Scrub typhus is listed as one of the underdiagnosed and underreported febrile infections. This vector-borne zoonotic infection appears as eschar on the patient's skin. Methods Immunoinformatics was employed to predict the multi-epitope subunit vaccine that will activate both B and T cells. The final vaccine includes lipoprotein LprA as an adjuvant at the N-terminus along with B-cell, helper T lymphocyte (HTL), and cytotoxic T lymphocyte (CTL)-binding epitopes to boost immunogenicity. Assessing the vaccine's physiochemistry demonstrates that it is both antigenic and non-allergic. The vaccine structure was developed, enhanced, confirmed, and disulfide-engineered to provide the best possible model. Using molecular docking, the interaction of the produced vaccine with toll-like receptor 2 (TLR2) was analyzed, and the vaccine-receptor complex was stabilized by molecular dynamics (MD) simulation. According to in silico cloning, Escherichia coli can efficiently produce the recommended vaccine. Additionally, the efficacy of the in silico-developed vaccine must be evaluated in an in vitro and in vivo experiment. Results The developed vaccine successfully stimulates cellular and humoral immune responses. The vaccine, which has three B-cell epitopes, three HCL epitopes, and nine CTL epitopes, can bind firmly to immunological receptors. Dynamic investigations of the vaccine-receptor complex show a strong interaction and stable conformation. Conclusion In this study, the vaccine candidate demonstrated strong antigenicity, stability, and solubility while also being non-allergenic to host cells. The vaccine candidate's stability with the TLR2 immune receptor is established by binding studies, and in silico cloning verifies efficient and stable expression in the bacterial system., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Khichi et al.)

Coronary artery anomalies present unique interventional challenges, particularly when associated with significant coronary artery disease. This case report contributes to the limited literature on congenital coronary artery anomalies, emphasizing the need for tailored approaches to optimize patient care. We present a case of a 70-year-old male with refractory angina and a rare congenital coronary anomaly characterized by the absence of the right coronary artery ostium, necessitating reliance on the left coronary system for myocardial perfusion. Cardiac catheterization revealed mid-left anterior descending artery stenosis, prompting percutaneous coronary intervention. Despite the anatomical complexities encountered, the procedure was successfully performed. This case underscores the importance of meticulous diagnostic evaluation, advanced imaging techniques, and a multidisciplinary approach to managing patients with rare coronary anomalies. This report also emphasizes the unique diagnostic and therapeutic considerations by providing a comprehensive literature review and identifying areas for further research to advance treatment strategies and improve outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Zaveri et al.)

There is a need to establish consensus for harmonization in antiretroviral (ARV) therapy (ART) switch treatment strategy and address the dilemma that exists in terms of subpar immune response to therapy or an immunologic deterioration while on therapy. The purpose of this review is to identify the factors that contribute to ARV treatment failure, such as insufficient dosage, drug interactions, poor adherence, drug resistance, and poor medication absorption. It is crucial to adopt a more efficient strategy to address this challenging dilemma. After ARV treatment failure, the aim of therapy is virologic suppression, which targets plasma viral load below the limits of detection as assessed by very sensitive tests with lower limits of quantification of 20 to 75 RNA copies/ml. The therapeutic objectives when complete virologic suppression is not possible, should be to maintain or restore immunologic function, stop the progression of the clinical illness, and minimize the emergence of new drug resistance that could further restrict the options for ARV drugs. Treatment history and drug-resistance testing, including the findings of previous and ongoing resistance tests, should be considered while selecting ARV regimens. Hence, the treatment approach post-ARV failure can be personalized based on clinical, immunologic, virologic, or as a mix of the three domains on a case-to-case basis. The evaluation of projected ARV activity should be based on treatment history and previous resistance test findings., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Sharma et al.)

Background: Lenalidomide and Pomalidomide are chiral immunomodulatory drugs (IMiDs) and have antiangiogenic and anti-immunomodulatory activity. Each enantiomer may have distinct binding and biological activity. This study aimed to explore the in-silico binding of both enantiomers of Lenalidomide and Pomalidomide with Prostaglandin and its potential impact on persisting inflammatory activity in cancer. This can further provide insight into the transport of pro-inflammatory mediators and their potential implications for the inflammatory microenvironment within tumors., Materials and Methods: Molecular docking studies were performed to explore the binding potential of both enantiomers of Lenalidomide and Pomalidomide with Pg protein. The crystal structure of Pg-protein (PDB ID: 1IW7) was obtained from the Protein Data Bank., Results: The binding energies for (-)-Lenalidomide and (+)-Lenalidomide were -6.7 and -7.2 kcal/mol, respectively, while the binding energies for (-)-Pomalidomide and (+)-Pomalidomide were -7.8 and -8.1 kcal/mol, respectively. The binding mode analysis revealed that all four compounds formed hydrogen bonds with key amino acid residues of Pg-protein. The hydrogen bond distances for (-)-Lenalidomide, (+)-Lenalidomide, (-)-Pomalidomide, and (+)-Pomalidomide were 2.1 Å, 2.0 Å, 2.2 Å, and 2.1 Å, respectively., Conclusions: The present study suggests that both enantiomers of Lenalidomide and Pomalidomide have a high affinity for Pg-protein and can effectively target the Pg-protein pathway to persist inflammatory activity in cancer. By targeting inflammation-mediated processes, these drugs may offer a novel strategy to combat tumor progression., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Tiwari et al.)

Objectives The COVID-19 pandemic led to a nationwide lockdown that isolated numerous children and adolescents, significantly affecting their mental well-being. Therefore, this study aimed to assess the challenges faced by children during the pandemic and identify the potential contributing factors. Additionally, given the existing concerns surrounding the mental health of female children and adolescents, our study aimed to investigate the presence of sex-based disparities in children's observed emotional and behavioral difficulties during the COVID-19 lockdown. Methods Participants in this study were parents of children aged 6-17 years. An observational cross-sectional study was conducted through verbal administration of a validated semi-structured questionnaire, the Parent Report Measure, from June 2021 to August 2021 at a nearby community health center. The questionnaire collected socio-demographic details and utilized the Strengths and Difficulties Questionnaire (SDQ), a screening tool to assess children's emotional and behavioral aspects during the six-month lockdown period. The responses were then analyzed using appropriate statistical tools like SPSS statistics, and cumulative SDQ scores were used to categorize participants. Results Out of the total 280 responses analyzed, the prosocial subscale exhibited the highest number of abnormal responses, 73 (26.1%), followed by conduct (42; 15%), hyperactivity (41; 14.6%), and peer (41; 14.6%) subscales. These results indicated that children displayed decreased empathy towards others, restlessness, fidgetiness, reduced attention span, frequent tantrums, and a preference for solitary activities. Furthermore, there was a significant association between abnormal subscale scores and the sex of children. Females showed a considerably higher prevalence of emotional problems (172; 61.5%) than males. Among the behavioral responses, a more significant proportion of females displayed abnormal scores in the conduct subscale (170; 60.7%), while abnormal hyperactivity scores were more frequently observed among males (178; 63.4%). Regarding the peer problems subscale, the proportion of females was slightly higher than males (150; 53.7%) and nearly equal in the prosocial domain. A more significant proportion of females displayed abnormal scores for overall difficulties 144 (51.5%), indicating a notable sex-based disparity. Conclusion Our findings highlight the pandemic's significant impact on many children's psychological well-being. The results emphasize the need for targeted interventions to address the mental health concerns that arose in this population. The observed disparity in emotional and behavioral difficulties among female children is particularly concerning, highlighting the need for gender-sensitive support and care. Various strategies can be helpful, such as virtual support groups, indoor recreational activities, reduced screen time and excessive news consumption, and effective communication with parents. Furthermore, our study also indicates the need to dive deep into such areas of pediatric research to understand and plan timely interventions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Anand et al.)

Background Cell-mediated immunity (CMI), or specifically T-cell-mediated immunity, is proven to remain largely preserved against the variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including Omicron. The persistence of cell-mediated immune response in individuals longitudinally followed up for an extended period remains largely unelucidated. To address this, the current study was planned to study whether the effect of cell-mediated immunity persists after an extended period of convalescence or vaccination. Methods Whole blood specimens of 150 selected participants were collected and tested for Anti-SARS-CoV-2 Interferon-gamma (IFN-γ) response. Ex vivo SARS-CoV-2-specific interferon-gamma Enzyme-linked Immunospot (IFN-γ ELISpot) assay was carried out to determine the levels of virus-specific IFN-γ producing cells in individual samples. Findings Out of all the samples tested for anti-SARS-CoV-2 T-cell-mediated IFN-γ response, 78.4% of samples were positive. The median (interquartile range) spots forming units (SFU) per million levels of SARS-CoV-2-specific IFN-γ producing cells of the vaccinated and diagnosed participants was 336 (138-474) while those who were vaccinated but did not have the disease diagnosis was 18 (0-102); the difference between the groups was statistically significant. Since almost all the participants were vaccinated, a similar pattern of significance was observed when the diagnosed and the never-diagnosed participants were compared, irrespective of their vaccination status. Interpretations Cell-mediated immunity against SARS-CoV-2 persisted, irrespective of age and sex of the participant, for more than six months of previous exposure. Participants who had a history of diagnosed COVID-19 infection had better T-cell response compared to those who had never been diagnosed, in spite of being vaccinated., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Misra et al.)

Introduction: Growing evidence indicates that individuals recovering from COVID-19 may experience prolonged health consequences, resulting in notable morbidity even after the acute phase. Limited published literature exists concerning sequelae of COVID-19 among the Indian population. Therefore, we conducted this study at a subdistrict hospital (secondary level) in Haryana, aiming to estimate the prevalence of long COVID and its determinants., Methods: This hospital-based study focused on outpatients who had a confirmed history of COVID-19, with a minimum of 28 days elapsed since the positive COVID-19 diagnostic test date. We administered a semi-structured questionnaire to gather sociodemographic information, a standardized symptom assessment checklist to identify long COVID symptoms, and the Patient Health Questionnaire (PHQ-9) to evaluate and grade depression severity. Additionally, we conducted pulmonary function tests, chest X-rays, complete blood counts, and kidney and liver function tests to assess the determinants of long COVID. STATA version 14 software (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP) was used for data analysis, and the bivariate and multivariate analyses (p-value <0.2 in bivariate analysis) were conducted to determine factors associated with long COVID., Results: A total of 212 participants (male 53%) were recruited in this study. Among the long COVID symptoms, fatigue, body pain, cough, joint pain, and breathlessness were the most frequently reported symptoms among the study participants. The prevalence of long COVID was found to be 37.3% (95%CI: 30.7-43.8%). In the multivariate model, depression (PHQ-9 scores) AOR-1.21 (95%CI:1.07-1.35) and severity of COVID-19 adjusted odds ratio (AOR)-2.22 (95%CI:1.05-4.69) came out to be statistically significant with long COVID., Conclusion: Findings show alarming rates of long COVID symptoms persisting in nearly 37% of COVID-19-recovered individuals. Establishing tailored guidelines is crucial to mitigate burdens and complications and enhance the quality of life for those affected., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Salve et al.)

Takotsubo cardiomyopathy (TTC) is a unique heart disease that mimics the clinical presentation of acute coronary syndrome and is seen more commonly in post-menopausal females. Here, we report a case that presents an ideal documentation of TTC depicting its characteristic clinical features and possible outcomes. TTC usually culminates in a complete reversal of both systolic and diastolic dysfunctions, however in our case of a post-COVID scenario, the persisting, rather worsening diastolic dysfunction might be a residual manifestation of COVID-19 myocarditis. Recent reports have found an increasing prevalence of TTC amidst the COVID-19 pandemic possibly as a result of the emotional and physical stress, and subsequent catecholamine surge caused by the virus in such patients. There might exist an independent association between TTC and the COVID-19 virus. Increased clinical evidence is required to establish the strength of this relationship, if any., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Wasir et al.)

Background COVID-19 has spread as two distinct surges of cases in many countries. Several countries have reported differences in disease severity and mortality in the two waves. Objective Compare the in-hospital mortality in the two COVID-19 waves at a tertiary care hospital in India. Methods We conducted a retrospective data collection. Distinct periods of surges in cases and admissions were defined as the first wave spanning from March 2020 to December 2020 and the second wave from April 2021 to June 21, 2021. The primary outcome of this study was to compare mortality rates in terms of total hospital mortality rate (TMR) and case fatality rate (CFR). Results Mortality rates of wave 2 were approximately 10 times that of wave 1 (TMR of 20.3% in wave 2 versus 2.4% in wave 1 and CFR of 1.5% versus 17.7% in wave 1 and 2, respectively). Mortalities in wave 2 had a larger proportion of severe disease at presentation, faster progression of symptoms to death, and more patients without any chronic comorbid condition dying due to the direct effect of COVID-19 acute respiratory distress syndrome (ARDS). Conclusion Our data matches the worldwide reported pooled hospital mortality figures and shows the comparative difference in disease severity between the two waves., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Vig et al.)

Intracranial hemorrhage (ICH) is a serious complication of hemophilia A with high morbidity and mortality. The management of such cases is complicated by nonspecific and often delayed presentation, increased frequency of rebleeding, low awareness regarding clotting factor replacement, and debate regarding the efficacy of surgical interventions. We report a case of an 18-year-old male patient with hemophilia A, who first presented to the emergency department in India in a comatose state. Neuroimaging revealed subdural hematoma with midline shift and uncal herniation. The patient was successfully managed with perioperative cryoprecipitate and factor VIII replacement, tiered intracranial pressure lowering strategies, and early decompressive craniectomy with clot evacuation. In India, there are no standardized guidelines for screening and routine care for hereditary diseases like hemophilia. In a resource-deficient country, management was complicated by the limited availability of factor VIII in the emergent setting, as well as the inability to obtain serial factor levels in the postoperative period. We hope that this article helps to guide the management of ICH and hemophilia in resource-limited countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Chopra et al.)

Context: Frontline healthcare workers are at risk of developing psychological distress during a pandemic. Yoga, a form of mind-body medicine can reduce body stress and increases well-being., Aims: To assess the effect of yoga on the stress and well-being of healthcare workers during the COVID-19 pandemic., Settings and Design: This single-arm pre-post study was conducted among frontline health workers (support staff, paramedics, and medics) posted at a secondary care hospital in a North Indian district., Methods and Materials: Basic demographic details, blood pressure, anthropometric variables like height, weight, and biochemical variables like glycosylated hemoglobin (Hb1Ac), fasting and post-prandial blood sugar, lipid profile, serum cortisol, and C-reactive protein were measured. Stress levels were assessed using the depression anxiety and stress scale (DASS)-21 while well-being was assessed using the World Health Organization (WHO)-5 well-being scale. Twelve weeks of supervised yoga session was provided for 1 hour per session, 3 times per week., Statistical Analysis: The mean value was compared from baseline to post-intervention with paired t-test/Wilcoxon signed rank test., Result: A total of 89 participants were enrolled, 53 (59.5%) being male. Two-thirds of the participants were aged 20-39 years. During follow-up, 80 participants completed 12 weeks of yoga sessions. Post-intervention DASS-21 score decreased and WHO-5 increased significantly. The glycosylated hemoglobin (HbA1c) level and cholesterol-HDL ratio decreased significantly. Other variables didn't change significantly. No adverse effects were reported by the participants., Conclusion: Supervised structured yoga sessions helped decrease stress, depression, and anxiety and improved well-being. Therefore, it can be a feasible strategy to manage workplace-related stress and phycological morbidities., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Misra et al.)

Aim: The main aim/objective of this study was to detect and characterize the  Brucella species   from patients having complaints of joint pain and also to know the potential causes of human brucellosis. In our study, we focused on joint pain symptoms that may be due to arthralgia or arthritis.  Introduction: Brucellosis is a neglected zoonotic disease that affects both humans and animals. In humans, brucellosis begins with chronic illness leading to great financial losses from not being able to work well and continued treatment costs, but few such studies have come from northern India. Joint pain is the common presentation of brucellosis and there are several risk factors associated with brucellosis., Methods: A total of 200 blood samples were collected from the participants having joints pain from September 2019 to September 2021 at Gandhi Memorial & Associated Hospitals of King George's Medical University, Lucknow, India, and tested by serology for anti -Brucella  IgM and IgG enzyme-linked immunosorbent assay (ELISA), molecular   tests byreverse transcriptase-polymerase chain reaction (RT-PCR),   conventional polymerase chain reaction (PCR), and automated blood culture system. The anti- Brucella IgM and IgG ELISA were performed using the kit from NovaTec Immundiagnostica GmbH (Dietzenbach, Germany). Isolation of DNA was carried out using the QIAamp DNA Mini kit (QIAGEN, Hilden, Germany), and the primers and probes specific for targeted regions ( BCSP31 and IS711 gene) in the  Brucella  genome were procured from Eurofins Scientific SE (Luxembourg, France), and for internal control from CDC., Result: The study showed 19 (9.5%) and 23 (11.5%) positive results by anti- Brucella  IgM ELISA and anti -Brucella  IgG, respectively, and of these, one (0.5%) was positive for both anti- Brucella  IgM and anti- Brucella  IgG ELISA. Out of 19 anti- Brucella IgM ELISA positive, eight (4%) samples were positive for PCR/RT-PCR and that was negative for anti- Brucella IgG ELISA. All blood culture reports of all patients were negative.  Conclusion: Anti- Brucella IgM ELISA was more accurate than anti- Brucella IgG ELISA in detecting human brucellosis. Consumption of animal products (i.e. milk, a dairy product of cow, buffalo, goat, and meat of goat) and contact with animals were the main risk factors that were identified for Brucella  disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kumari et al.)

Introduction The way pancreatoduodenectomy (PD) is performed can vary a lot around the world, and there is no agreed-upon standard approach. To learn more about how PD is practised in India, a survey was conducted among Indian surgeons to gather information about their current practices. Methods A survey was created and shared with surgeons in India who practice pancreatic surgery. It had 33 questions that aimed to capture information about different aspects of PD practice. These questions covered topics such as the surgeons' education and experience, how they evaluated patients before surgery, what they considered during the operation, and how they managed patients after surgery. Results A total of 129 surgeons were sent the survey, and 110 of them completed it. The results showed that 40.9% of the surgeons had less than five years of experience, and 36.4% of them performed more than 15 PDs in a year. When deciding whether to perform preoperative biliary drainage, 60% of surgeons based their decision on the level of bilirubin in the patient's blood, while the rest considered other specific indications. The majority of surgeons (72.7%) looked at the trend of albumin levels to assess the patient's nutritional status before surgery. Venous infiltration was seen as a reason for neoadjuvant therapy by 76.4% of the participants, whereas 95.5% considered upfront surgery in cases of venous abutment. When it came to the type of PD, 40% preferred classical PD, 40.9% preferred pylorus-resecting PD (PRPD), and the rest chose pylorus-preserving PD (PPPD). Pancreatojejunostomy (PJ) was the preferred method for 77.3% of surgeons, while 6.3% preferred pancreatogastrostomy (PG). About 65.5% of surgeons used octreotide selectively during the operation when the duct diameter was small. Nearly all surgeons (94.5%) preferred to secure feeding access during PD, and all of them placed intraperitoneal drains. As for postoperative care, 37.3% of surgeons attempted early oral feeding within 48 hours, while 28.2% preferred to wait at least 48 hours before initiating oral feeds. Conclusions The survey revealed significant differences in how PD is practised among surgeons in India, highlighting the heterogeneity in their approaches and preferences., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kaushal et al.)

Background: Brucellosis is a neglected zoonotic disease affecting humans and animals., Objectives: This study aimed to estimate the seroprevalence of brucellosis in patients with joint pain., Methods: A total of 200 participants aged from 7 to 86 years were involved in this study. Blood samples were collected from all the participants for two years, from September 2019 to September 2021, and screened for  Brucella  using anti-brucella IgM ELISA and anti-brucella IgG ELISA antibodies. A questionnaire was used to collect data on socio-demographic characteristics and human brucellosis-related risk factors., Results: Human  Brucella  seroprevalence was 19 (9.5%) for Brucella  IgM ELISA and 23 (11.5%) for  Brucella  IgG ELISA. The sensitivity for  Brucella  IgM ELISA and  Brucella  IgG ELISA was 65.2% and 31.6%, respectively, while the specificity was 44.1% for  Brucella  IgM ELISA and 77.9% for  Brucella  IgG ELISA. All blood culture reports of all patients were negative. The principal presentation was the observable symptoms of human brucellosis: fever, headache, chills, myalgia, and Joint pain., Conclusion: Risk factors like consumption of raw milk or their products were found to be the most important for  Brucella  infection, so the awareness or information of risk factors and the modes of transmission is much more important in control and prevention programs. General awareness about clinical symptoms should be increased, which will improve proper diagnosis and will be helpful in early treatment. An ELISA test should be considered for diagnosing brucellosis in both acute and chronic phases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kumari et al.)

Pediatric scurvy is uncommon in the twenty-first century but cases have been reported in children with neurodevelopmental issues and restricted diets. We are reporting a two-year and nine-month-old boy who had a coronavirus disease (COVID) infection and then presented with a refusal to walk. By careful history-taking, he was found to have a restricted diet, speech delay, and gum bleeding suggestive of scurvy, which was confirmed by extremely low levels of ascorbic acid. In this case, the diagnosis of scurvy was established before establishing the diagnosis of neurodevelopmental delay. Treatment with ascorbic acid resulted in a remarkable improvement in his symptoms. This case highlights the importance of collecting a thorough history, connecting exam findings to the history, and including scurvy in differential diagnoses for the presentation of inability to bear weight., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Jafri et al.)

Introduction This prospective observational study reports the association between baseline high-sensitivity C-reactive protein (hs-CRP) levels and adverse events at six months in patients who were diagnosed with symptomatic chronic stable angina and then underwent percutaneous transluminal coronary angioplasty (PTCA) with a drug-eluting stent (DES). Methods A total of 104 patients were examined with chronic stable angina over a period of six months. Before conducting percutaneous coronary intervention (PCI), the baseline levels of hs-CRP were measured, and based on the levels, the patients were grouped into high and low hs-CRP groups. Results The primary causes of death or the need for repeat revascularization or myocardial infarction or angina were concluded after assessing the patients for six months. A total of 104 patients were studied, among which 72 (69.23%) had low hs-CRP and 32 (30.77%) had high hs-CRP levels. The number of males in this study was 68 (65.38%) and females were 36 (34.62%). The mean age of the patients was 55.26 ± 10.31 years. There were no significant differences among the groups in terms of gender, age, comorbidities, and risk factors except for certain predisposing factors like dyslipidemia and smoking. Moreover, we did not find any significant difference among the groups in the cause of death and myocardial infarction after a follow-up of six months. However, we observed a higher need for revascularization and angina outcomes in the group with high hs-CRP compared to low hs-CRP. Conclusion It can be concluded that a higher risk of angina and repeat revascularization is related to a high baseline hs-CRP but there is no evidence whether it is somehow linked to myocardial infarction and mortality or not., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Nath et al.)

Gastric Varices occur as a result of portal hypertension. Balloon Retrograde Transvenous Obliteration (BRTO) is a modality for managing gastric varices. The ultimate goal of this review is to promote the broader adoption of BRTO in managing gastric varices and to promote further research to improve patient outcomes. Before this study, an electronic literature search was undertaken based on identified concepts, keywords, and other pertinent descriptions. Search databases were developed and included "Gastric varices" AND "BRTO" OR "intervention" OR "treatment" OR "procedure" OR "glue" OR "adhesive".  The databases selected and thoroughly searched were PubMed, Cochrane Library and ScienceDirect. Following the first search, 274 articles were found in total. By applying inclusion criteria of full-text articles and a period of fewer than five years, the database was reduced to 37 articles, which was then further filtered to include only articles on adults over 19 years old, leaving a total count of 17 articles. BRTO is a relatively simple procedure to perform once the essential skill is attained and helpful in both emergency and elective management of gastric varices. Its use still needs to be improved by the unavailability and lack of skills. However, there are side effects associated with BRTO as it causes elevation of portal hypertension, recurrent bleeding, hemoglobinuria and pain post procedure. This review emphasizes the need for further research in this field, focusing on refining patient selection criteria, improving the technical aspect of the procedure and enhancing long-term outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Khakwani et al.)

A giant cell tumor of the tendon sheath (GCTTS) is a rare benign tumor that typically presents as a solitary mass in the hand or wrist. Multifocal presentation of GCTTS is extremely rare and has been reported in only a few cases. Although the origin of multifocal giant cell tumors of the tendon sheath remains incompletely elucidated, it is a rare disorder that distinguishes itself from the diffuse form of GCTTS that typically occurs near major joints. In this case study, we report a patient with a localized multifocal GCTTS affecting the tendon sheath of the flexor pollicis longus (FPL) on the volar surface of the right thumb. The diagnosis was confirmed by both radiological and histological examinations. Additionally, the patient underwent surgical excision of the tumor masses and did not encounter any recurrence during the six-month follow-up period., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Novick et al.)

Introduction High systolic blood pressure (SBP) and raised plasma glucose are major attributable and preventable causes of death worldwide. The objective of this study was to estimate the control rates and identify determinants of control of hypertension and diabetes among adults. Methods A longitudinal follow-up study was conducted among all the adults registered at the noncommunicable disease (NCD) clinics under the national program at two primary health centers in Faridabad, Haryana. Data were collected every month from the individual booklet generated for registered adults. Two monthly visits in three months and four in six months were considered adequate follow-ups at the NCD clinic. Results In the study, 495 (82.2%) adults had hypertension, and 242 (40.2%) had diabetes. The control rates at the third and sixth months were 37.1% (95% confidence interval (CI): 31.4-42.7) and 53.6% (95% CI: 43.4-59.8) among hypertensives and 28.7% (95% CI: 21.7-35.7) and 35.9% (95% CI: 27.5-44.4) among diabetics. Among hypertensives, six-month control status was associated with adequate follow-up at the NCD clinic (adjusted odds ratio (AOR) 2.3; 95% CI: 1.4-4.0; p-value: 0.002), male sex (AOR 0.5; 95% CI: 0.3-0.9; p-value: 0.02) and high SBP (AOR 0.5; 95% CI: 0.3-0.9; p-value: 0.017). Conclusions Control status was achieved in half of the adults with hypertension and one-third of adults with diabetes after six months of regular follow-up. Adequate follow-up at the NCD clinic, male sex, and raised SBP emerged as determinants of control among hypertensives., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Seth et al.)

Background In India, 44.8% of adolescent girls are under-nourished, while about 8%-13% of girls are overweight. Though several studies have been done regarding the nutritional status of adolescent girls over the years, there have been no significant changes. Also, there are several different anthropometric indicators for nutritional status assessment, due to which there are huge variations in the prevalence of malnutrition across different studies. So the objectives of this study were to determine the prevalence of malnutrition using different anthropometric indicators and compare them. Methods A random sample of 426 girls was taken from Health Management Information Systems (HMIS) of the Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), and a semi-structured questionnaire was administered among 386 of them to determine associated factors. Height, weight, and mid-upper arm circumference (MUAC) were measured for 386 girls, and BMI for age and height for age z scores were calculated using WHO AnthroPlus. Mid-upper arm circumference for age z scores (MUAC for age) were calculated using Lambda-Mu-Sigma (LMS) charts by the CDC for girls aged one year to 20 years. Results It was found in this study that using BMI for age z scores (BAZ), 33.4% of the adolescent girls were malnourished; 18.9% (95% CI 15.1-23.2) being underweight, 10.6% (95% CI: 7.7-14.1) being overweight, and 3.9% (95% CI: 2.2-6.3) were obese. While using BMI solely as an indicator, the prevalence of thinness was 51.8% (95% CI: 46.9-56.9), while that of overweight and obesity was 10.6% (95% CI: 5.7-11.5) and 1.0% (95% CI: 0.2-2.6), respectively. The prevalence of under-nutrition by MUAC for age z scores was 53.4% (95% CI: 48.2-58.4), and that of over-nutrition was 1.8% (95% CI: 1.0-3.7). BMI for age z scores positively and strongly correlated with both MUAC and MUAC for age z scores and had a significant association with both on univariable linear regression. Though there was a negative correlation between BMI for age z scores and height-for-age z scores, it was not significant. Height-for-age z scores, even though positively correlated with MUAC for age z scores, the correlation was not that strong., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Santra et al.)

Currarino syndrome or Currarino triad is a complex condition consisting of congenital anomalies. The triad consists of anterior sacral mass (meningocele, teratoma or dermoid/epidermoid cyst), sacral bone defect (hypoplasia, agenesis ), anorectal malformation/congenital anorectal stenosis. This condition is named after Dr Guido Currarino, an Italian-American paediatric radiologist, who first described it in 1975. This needs a multidisciplinary treatment approach. We describe a case of successfully managed young adult with Currarino syndrome. The latest artificial intelligence tool, Chat Generative Pre-Trained Transformer (ChatGPT), helped to write this case report., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Verma et al.)

Background: Age estimation is a critical aspect of human identification. Age is assessed using cranial suture obliteration, pelvic morphological changes, epiphyseal fusion of long bones, dental maturation, and other standard methods., Methods: The present study investigated three-dimensional (3D) computed tomography (CT) scans of 263 individuals (183 males and 80 females) to assess the extent of ectocranial suture closure. The assessment of obliteration was done using a three-stage scoring method. Spearman's correlation coefficient (p < 0.05) was calculated to assess the relationship between cranial suture closure and chronological age. Simple and multiple linear regression models were developed using the cranial suture obliteration scores to estimate age., Results: The standard errors of the estimate using multiple linear regression models developed for estimating age using obliteration scores of sagittal, coronal, and lambdoid sutures were 15.08 years in males, 13.27 years in females, and 14.74 years in the total study population., Conclusion: This study concludes that in the absence of additional skeletal age markers, this method can be used alone or in conjunction with other well-established methods of age assessment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Akbar N J et al.)

Introduction: Euthanasia or mercy killing has remained as a matter of extensive debate and ethical conflicts in the scientific literature. Discussions on this theme have got legal, religious, political and philosophical ramifications., Aim of the Study: The present study aimed to assess the knowledge, attitude and practices of medical professionals in a tertiary care hospital., Methods: After taking prior approval from the institutional ethics committee a structured questionnaire was prepared and distributed among 200 consenting medical professionals in a tertiary care centre in the North-Western region of India., Results: 50% of the respondents said that they were sure of the existing regulation on euthanasia in India. When gender differences were considered a significant difference (p=0.0147) was found between the two sexes regarding the alternate decision maker for deciding euthanasia. It was observed that there was a significant difference(p=0.0055) between those with the age more than 30 years and aged less than 30 years regarding the type of euthanasia that is justifiable., Discussion: In the present study, the percentage of doctors favouring euthanasia is higher than compared in previous studies. The view of euthanasia is highly variable in different studies. Even though passive euthanasia has been legalised recently, there is an apprehension that it might be misused., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Shekhawat et al.)

Background: Amidst the COVID-19 pandemic, cancer patients may have faced difficulty accessing health care. This study explored the challenges experienced by cancer patients in availing of healthcare during the pandemic, as well as the vaccination status and prevalence of COVID-19 infection among cancer patients in the year 2021., Method: A cross-sectional study was conducted in a tertiary care hospital in Jodhpur, Rajasthan, to interview 150 patients from the oncology department using convenience sampling. Face-to-face interviews lasted for 20-30 minutes. The first segment of the pretested semi-structured questionnaire was directed at obtaining the patient's socio-demographic characteristics, while the second segment focused on the problems that patients encountered during the pandemic in receiving cancer care. The data were analyzed using Statistical Packages for Social Sciences (SPSS) software (IBM Corp., Armonk, NY)., Results: Several constraints, such as a lack of transportation services, difficulty in availing outpatient department (OPD) and teleconsultation services, long waiting times, and deferred surgeries and therapies, have hampered cancer care. COVID-19 mitigation measures further imposed additional stress and financial burden on cancer patients. Moreover, there was low vaccination coverage among cancer patients, which increases their probability of acquiring an infection., Conclusion: Policy reforms must prioritize cancer care in India to maintain a continuum of care by ensuring medication, teleconsultation, uninterrupted treatment, and complete vaccination to decrease the risk of COVID-19 infection and facilitate patient compliance with the healthcare delivery system., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bal et al.)

Background  In the COVID-19 pandemic, vaccination is recognized as a global public-health goal for preventing, containing, and stopping transmission. But the reluctance of people to receive safe and recommended available vaccines (i.e., vaccine hesitancy) was a growing concern. One of the key elements that influence how people are perceived and their reluctance to get the COVID-19 vaccine was found to be personality traits. Hence, the aim of the study was to assess the influence of personality traits on perception and hesitancy towards COVID-19 vaccination among patients attending tertiary dental care hospitals in Delhi. Methodology A cross-sectional questionnaire survey was conducted among a sample of 322 participants aged 15-70 years attending the outpatient department of a public sector tertiary care dental hospital in New Delhi. Data was collected over a two-month period using a validated self-administered questionnaire which recorded demographic variables, individual perceptions, hesitancy towards COVID-19 vaccination, and personality traits [using 20-item mini international personality item pool (IPIP)]. Descriptive analysis followed by a Chi-square test and correlation test was applied. Results A total of 322 participants were contacted among which 300 participants (93%) responded which comprised 157 males (52.3%) and 143 females (47.7%). Dominant agreeableness personality shows a statistically significant positive correlation with individual perception (r=0.124, p=0.032) while a negative correlation with vaccine hesitancy (r= -0.146, p= 0.011). Among reasons for vaccine hesitancy, fear of side effects showed a significant association with personality traits (p= 0.018). Conclusion This study concluded that personality trait (dominant agreeableness) was an important factor in shaping individual perception and hesitancy towards COVID-19 vaccination., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Gupta et al.)

Introduction Halitosis (oral malodor) is a common health condition throughout the world. In India, data on self-reported halitosis and related factors is limited. Mouth mask usage has been made compulsory after the coronavirus disease 2019 (COVID-19) pandemic. This could possibly alter oral microflora and environment and contribute to halitosis. The aim of the study was to determine the prevalence of self-perceived halitosis (SPH) among mask-wearing patients visiting a tertiary care dental hospital in Delhi, India. Methods A cross‑sectional study was conducted among a convenience sample of 300 patients visiting a tertiary care dental hospital in the capital of India. SPH status was measured using a self-designed and structured questionnaire containing socio-demographic factors, mask-related habits, and self-perceived oral health status. Statistical analysis was done using Jamovi software (The jamovi project, Sydney, Australia) version 1.8. Descriptive analysis followed by a chi-square test and a multivariate logistic regression test was applied. Results Bad breath was perceived by 86 study subjects. Of the participants, 16.7% felt that they had bad breath before the pandemic, and 38% of the participants had an increased perception or feeling of bad breath since regular mask usage. Of the participants, 42.7% felt that they had an increased feeling of dryness in the mouth post-pandemic. SPH status was associated with mask usage frequency (p<0.001), change (p<0.001) and type of mask (p=0.004), increased feeling of dryness (p<0.001), frequency of toothbrushing (p<0.001), self-reported oral disease (p=0.007), and dental treatment in the past 12 months (p=0.005). Conclusion The SPH status of the study population was associated with mask-related habits and self-reported oral health status. The findings highlight the importance of possible amendments in preventive and curative care for patients with halitosis post-COVID-19 pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Bhatia et al.)

Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides (AAV) are a group of inflammatory disorders in which autoantibodies damage small arteries throughout the body, including in the upper and lower respiratory system, kidneys, as well as the skin. AAV may be precipitated by a variety of causes, including infections. In this report, we examine the case of a patient who developed AAV that was suspected primarily based on mucocutaneous hemorrhagic bullae, elevated ANCA levels, and subsequently confirmed by kidney biopsy, while recovering from coronavirus disease 2019 (COVID-19) infection. AAV and COVID-19 infections may present with similar symptoms, rendering an accurate diagnosis challenging. Additionally, only a few other cases describing a similar onset of AAV post-COVID-19 infection have been described in the literature. Initial presenting features of AAV in such cases have varied considerably, which makes the diagnosis even more challenging. We also engage in a review of such cases to assess key similarities, different treatment options, and outcomes. Lastly, the fact that several mechanisms have been proposed for AAV highlights the need for continued research to help clarify the pathophysiology while also identifying the optimal therapy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ta et al.)

Oral disease has affected almost half of the world's population, causing an enormous economic burden. To overcome this huge problem, oral health promotion is one of the most cost-effective methods. Digital media can play a pivotal role in achieving the goal of reducing this burden by providing a wider platform to reach out to the population even in the areas of deficit oral health care service. The aim of this systematic review is to assess the effectiveness of digital media in oral health promotion. The combinations of terms in the following two broad categories were used to search the literature on PubMed, Cochrane Library articles, WHO guidelines on oral health promotion through digital media, and Google Scholar: Intervention (digital media, Mobile phones, Text messages, social media, Cell phones, MHealth application, Telemedicine, Television, Videos) and Outcome (Oral Health education, Oral health, Oral health promotion, Oral health literacy, Oral health knowledge, Oral health attitude, Oral health practice, Oral hygiene improvement). The review was conducted in two phases, using the standardized checklist applicable to studies. Initially, abstracts were retrieved, followed by the assessment of the full papers against the review criteria. Among the selected studies, digital interventions helped in providing continuity of care and services in seven studies, eight addressed the increase in knowledge, attitude, and practice, and all the studies analyzed oral health needs. The findings concluded that digital media-based interventions can enhance oral health literacy and help in tackling this problem among different age groups., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Sharma et al.)

Background: Incarcerated individuals usually exhibit high oral health needs than the average population. Several factors contribute to these needs both before incarceration and during the sentence itself. Inmates are a marginalized group, who are at a higher risk for a variety of medical, dental, and emotional disorders than the general population. The aim of the study was to assess of effects of the imprisonment period on the oral health status of inmates., Material and Methods: A total of 532 inmates with imprisonment up to three years, three to six years, and six to ten years were included in the study. Incidence and prevalence of dental caries, decayed, missing, filled teeth (DMFT) index, and periodontal and prosthetic status were evaluated in detail., Results: Results showed that the prevalence of dental caries was relatively high among the convicts. It was found that 98.2% of the inmates had one or more teeth decayed. Additionally, 31.2% (pocket >4mm) of the inmates had poor periodontal status with 4.5% of the subjects having a loss of attachment score of 4-5mm or more. A total of 3.5% of the inmates had full dentures, either upper or lower arch. The relative need for full prosthesis was projected to be around 1.4% of the studied population., Conclusion: Within the limitations of the study, the authors found that dental healthcare delivered and received by the inmates is much below the acceptable limit. Additionally, the incidence of dental caries in inmates was unexpectedly higher with tooth decay in 98.2% of subjects. Hence, the need of the hour is to critically incorporate and reinforce our efforts with a special focus on the risk factors of oral health., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kumar et al.)