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Background: Dermatology is primarily an outpatient specialty. However, dermatology consultations play an important role in care of inpatients. Data on inpatient dermatological consultations in tertiary care settings is limited. Objectives: To evaluate clinical characteristics of inpatient dermatological consultations and effect on clinical outcomes in a tertiary care setting. Methods: This was a single-center retrospective study where the records of all dermatological consultations for patients admitted under various specialties, emergency services, and intensive care units (ICU) at our tertiary care institute over 2 years period were reviewed. The details of patients, primary care unit, dermatological complaints, diagnosis, investigations performed, treatment given, and follow-up were recorded and analyzed. Results: Total of 1717 dermatologic consultations (1000 males) were recorded, with mean age of study population being 33.6 ± 21.6 years (median - 32 years). Out of total 1717 patients, 136 (7.9%), 321 (18.7%), 1135 (66.1%), and 125 (7.3%) patients were infants, children, adolescents, adults, and elderly, respectively. The most frequent diagnostic group was infective diseases (586; 34.1%) followed by inflammatory diseases (442; 25.7%), mucocutaneous adverse drug reactions (160; 9.3%), and autoimmune diseases (65; 3.8%). Primary team's diagnosis was concordant with the dermatology consultation in 1112 (64.8%) patients and discordant observations were recorded in 605 patients (35.2%). Most discordant dermatological diagnoses included inflammatory disorders such as lichen planus, atopic dermatitis, bullous pemphigoid; mechanical disorders; nutritional deficiency disorders, and benign neoplasms. Conclusion: Common skin conditions account for a large majority of dermatologic consultations in a hospital setting. Inpatient dermatology consultations improve the diagnostic accuracy.

Opportunistic fungal infections account for a significant amount of morbidity associated with diabetic patients. Oral thrush is a condition in which the fungus Candida albicans accumulates on the lining of mouth. It is well known that Candida species are normal commensals of oral cavity in up to 50% of the healthy population but these commensals can cause opportunistic infection of the oral cavity, specially when person is having co-morbid disease that reduces the immune strength of patient as like in diabetes. Keywords: Oral thrush, Oral candidiasis, Diabetes, Anti-fungal, Poor Oral Hygiene.

For the better anti-inflammatory or analgesics effects of drugs; enzymes have been widely used in the medical field either it may be arthritis or fracture of the bone or it may be oedema. Along with antiinflammatory action these drugs have anti-oedema properties, healing properties and fibrinolytic properties as like trypsin-chymotrypsin. In this article we are going to discuss about the importance or applications of these enzymes either alone or in combination with other NSAIDS in the field of dental practice. Keywords: Antiinflammatory, Analgesics serratiopeptidases chymotrypsin oral cancer.

Removable complete denture till date exists as one of the treatment modality of choice to the edentulous patients. Complaints that are associated after delivery of complete denture is more of actual type and very less frequent of psychological type. In most of the cases education to the patient prior to the start of the procedure will help the clinician as well as the patient to understand the limitations associated with the use of complete denture. The most important thing is to motivate the patient to overcome these limitations. Keywords: Post insertion problems, Complete denture, Complaints.

Onychocryptosis, or ingrown toenail, is a frequent, painful condition affecting young individuals. Controversies still exist regarding its etiopathogenesis and treatment options, including conservative and surgical techniques. The choice of treatment method depends on the stage of disease as conservative measures are mostly effective in early stages and surgical procedures are required in the later stages. Among surgical techniques, phenol cauterization of lateral nail matrix has been the most effective, safe, and commonly performed method. Other more destructive surgical procedures are rarely done nowadays. In this review, we briefly discuss the etiopathogenesis, clinical features, and different treatment options of ingrown toenail.

Introduction: Acquired dermal hyperpigmentation (ADMH) presenting on periorbital region has been described as individual case reports. We tried to characterize the features of periorbital ADMH. Materials and Methods: This was a retrospective case-control study among our patients who attended the pigmentary clinic during January 2016–December 2017. Clinical, dermoscopic, and histopathological features of subjects who were recruited during the study period were prospectively evaluated. Results: Total 19 subjects (11%) were identified among 177 ADMH patients. Periorbital ADMH patients had a relatively younger age of onset (23.26 ± 11.06 vs. 36.16 ± 13.41, P < 0.001). Dermoscopy of early periorbital ADMH showed only imperceptible speckled blue-gray dots that accentuated at outer-corner creases of eyes (the “outer-corner crease sign”). Clinicopathological features and prognosis of periorbital ADMH were similar to that of ADMH per se. Conclusion: Periorbital ADMH should be considered as a differential diagnosis of periorbital hyperpigmentation in children and young adults. Outer-corner crease sign on dermoscopy may help to rule out other differentials in its early presentation.

Management of chronic/recurrent erythema nodosum leprosum (ENL) is challenging. The majority of these patients become steroid-dependent and suffer from the adverse effects of long-term corticosteroid use. Minocycline has shown promising results in a small series of chronic/recurrent ENL patients. The aim of this study was to compare the efficacy and safety of minocycline and clofazimine in patients with chronic/recurrent ENL. In this prospective randomized clinical trial, 60 participants with chronic/recurrent ENL were randomized (1:1) to receive either minocycline 100 mg once daily or clofazimine 100 mg thrice daily for 12 weeks along with prednisolone according to WHO protocol and followed up for 6 months. The outcome measures were mean time for initial control of ENL, proportion of patients having a recurrence of ENL, mean time for recurrence after initial control, additional prednisolone requirement, and frequency of adverse events. Initial control of ENL was achieved earlier in the minocycline group as compared to the clofazimine group (2.97 ± 1.9 weeks vs. 4 ± 1.96 weeks, respectively; p-0.048). The number of participants having ENL flares/recurrences during the study period was comparable in both groups (71.4% in clofazimine vs. 55.2% in minocycline group; p-0.2). The participants in the minocycline group remained in remission for a longer duration after initial control of ENL as compared to the clofazimine group (p-0.001). Mean additional prednisolone dose required for control of ENL flares/recurrences was also comparable in both groups (p-0.09). The minocycline group had fewer side effects than the clofazimine group (p-0.047). Minocycline led to a rapid and sustained improvement of ENL episodes with fewer adverse events showing a superior efficacy to clofazimine.

BACKGROUND Leprosy relapse/recurrence is a serious concern particularly in a leprosy-endemic nation such as India. It is believed that bacilli persisting even after multidrug therapy can cause relapse; recently, however, drug resistance as a cause for recurrences and chronic erythema nodosum leprosum (ENL) has been speculated. AIM To study drug-resistance patterns in cases of leprosy relapse and chronic/recurrent (c/r)ENL. METHODS This cross-sectional study conducted over a period of 1 year included patients diagnosed as having leprosy relapse and those with c/rENL. Skin biopsy specimens were examined by conventional PCR for resistance testing for rifampicin, dapsone and ofloxacin, respectively targeting the rpoB, folP and gyrA genes of Mycobacterium leprae. RESULTS In total, 61 patients (25 smear-negative) were included in the study. Of these, 37 were diagnosed as having leprosy relapse and 24 as having c/rENL. Drug resistance to at least one drug was identified in 10 cases (16.4%). Rates of drug resistance were 5.4% (2 of 37) for dapsone, 10.8% (4 of 37) for rifampicin and 2.7% (1 of 37) for ofloxacin among cases of relapse, whereas it was 12.5% (3 of 24) and 8.3% (2 of 24) for dapsone and rifampicin respectively among those with c/rENL. Multidrug resistance was seen in 3.3% patients (2 of 61). CONCLUSION Drug-resistance rate among those with c/rENL was almost equalled that of relapse. Smear-negative leprosy relapse cases also had resistance to bactericidal drugs. These findings call for modifications in criteria for testing under leprosy drug-resistance surveillance and all cases of relapse and those with recalcitrant c/rENL should be tested.

Purpose A case of anterior lenticular opacities in a patient of Costello Syndrome is reported. Observations Bilateral anterior capsular plaque along with anterior lens opacities (Anterior Segment Optical Coherence Tomography) has been demonstrated in a patient of Costello Syndrome presenting with atopic dermatitis. Conclusions All patients with Costello Syndrome require a detailed anterior segment examination and a close follow up, as even minute lenticular opacities cause visual impairment leading to amblyopia and may require an early surgical intervention.

This is an exciting phase of vitiligo research with the current understanding of vitiligo pathogenesis and its translation to successful treatment. The pathogenetic origin of vitiligo revolves around autoimmunity with supporting role from many other factors like oxidative stress, inherent melanocyte defects, or defective keratinocytes and fibroblasts. Vitiligo can be classified into segmental or non-segmental depending upon the clinical presentation, or it can be classified as progressing or stable based on the activity of the disease. Vitiligo treatments need to be stratified depending upon which type of vitiligo we are treating and at which phase the vitiligo patient presents to us. There are two different aims of treatment of vitiligo. The first involves rescuing the melanocytes from the damage to arrest the depigmentation. The second strategy focuses on replenishing the melanocytes so that successful repigmentation is achieved. It is also important to maintain the disease in a stable phase or prevent relapse. As stability in non-segmental vitiligo is a dynamic process, maintenance of the stability of repigmentation is also an important consideration in the management of vitiligo. In this review, we shall briefly discuss the current options and future insight into the management of vitiligo.

Placebo-controlled studies have reported the efficacy of apremilast in the management of palmoplantar psoriasis but studies comparing efficacy with a conventional agent are lacking. The objective of this article was to compare the efficacy and safety of apremilast and methotrexate in patients with palmoplantar psoriasis. In this prospective, randomized, active-controlled, observer-blinded clinical trial, conducted at a psoriasis clinic of a tertiary care institute in India from 1 July, 2019 to 1 June, 2020, 84 patients with palmoplantar psoriasis were randomized (1:1) to receive either methotrexate (0.4 mg/kg/week orally) or apremilast (30 mg twice daily). The treatment protocol was continued for 16 weeks or until achieving a ≥ 75% improvement in the Modified Palmoplantar Psoriasis Area and Severity Index (m-PPPASI 75), whichever was earlier. Changes in m-PPPASI and Dermatology Life Quality Index scores from baseline, the proportion of patients achieving m-PPPASI 75, and adverse events were assessed. Eighty-four patients were included (76 palmoplantar psoriasis and 8 palmoplantar pustulosis). The mean age (standard deviation) was 44.5 (12.9) years and 53 (63%) were women. The m-PPPASI score [median (interquartile range)] after 16 weeks of treatment showed a significant improvement from baseline in both apremilast [− 6.3 (10.9), p < 0.001] and methotrexate groups [− 8.5 (9.9), p < 0.001]. The estimated median difference between the groups was − 1.2 (p = 0.39, 95% confidence interval − 4.2 to 2.1). At 16 weeks, m-PPPASI 75 was achieved by 14/42 (33%) and 17/42 (41%) patients in the apremilast and methotrexate groups, respectively (p = 0.49). A significant reduction in the Dermatology Life Quality Index score [median (interquartile range)] was observed in both groups [apremilast: − 3.0 (6.0), p < 0.001; methotrexate: − 3.0 (6.3), p < 0.001] with an estimated median difference of 0.0 (p = 0.99, 95% confidence interval − 1.0 to 2.0). The proportion of patients experiencing adverse events was comparable (p = 0.49). Apremilast showed a comparable efficacy and safety profile to methotrexate in the management of palmoplantar psoriasis. CTRI/2019/06/019830, date of registration: 24 June, 2019; trial registered prospectively.

Noncultured epidermal cell suspension (NCES) is a well-established surgical treatment modality for stable vitiligo. The outcome of this procedure significantly depends on the method of recipient site preparation, a critical step to achieve cosmetically acceptable repigmentation. To compare the efficacy of recipient site preparation using three methods namely, dermabrasion, cryoblister, and dermaroller followed by NCES in stable vitiligo. In this single-center, prospective, intra-patient, randomized clinical trial; 36 participants having at least three vitiligo patches in same anatomic region with minimum lesional stability of 1 year were randomized 1:1:1 for recipient site preparation using manual dermabrasion, cryoblister, and dermaroller followed by NCES. Patients were followed up at 4, 8, and 12 weeks and assessment of extent and pattern of repigmentation, color match and patient satisfaction were done. Among 36 patients, 22 (61.1%) were females; mean (SD) age was 28.33 (9.4) years. Dermabrasion and cryoblister techniques showed equal efficacy with respect to extent of repigmentation (>75% repigmentation; 55.6% vs 47.2%; P = .63) and patient satisfaction score (20.2 ± 9.6 vs 19.9 ± 7.9, P = .194). However, dermabrasion was superior to cryoblister in terms of rapidity (65% vs 32.5% at 4 weeks, P = .04) and color match (47.2% vs 19.4%, P = .004). Dermaroller had poor repigmentation outcomes compared to both dermabrasion and cryoblister. Cryoblister as a method of recipient site preparation is equally effective as manual dermabrasion in NCES for attaining good to excellent repigmentation, but with risk of hyperpigmentation. However, dermaroller is inferior to both dermabrasion and cryoblister.

Smokeless tobacco keratosis is a condition that causes thick white patches to form on mucosa with common sites are inner check , in between teeth & gums , appear wrinkled in texture usually develops in between 1-5 years of tobacco use. Educating and motivating a patient is very important in the prevention as well as cure of STK.

Oral submucous fibrosis (OSMF) is a premalignant condition caused by betel chewing. OSMF is a premalignant condition that can lead to oral cancer. A risk that is further increased by concomitant tobacco consumption. OSMF is a diagnosis based on clinical symptoms and confirmation by histopathology. Major constituents of betel quid are arecoline from betel nuts and copper, which are responsible for fibroblast dysfunction and fibrotic band formation. Drug therapy include antifibrotic, anti-inflammatory, and antioxidants, homemade remedies including turmeric and tulsi . Prevention is most important in case of OSMF , because severe cases of OSMF are irreversible.

A subset of leprosy patients has clinical and histopathological activity in the form of persistent plaques and granulomas after completion of multidrug therapy (MDT) which can have significant impact on their quality of life. In the absence of clear guidelines regarding management of such patients, majority of the times they are treated either as late reversal reaction with corticosteroids or no active treatment is offered. We observed 11 patients of leprosy with persistent plaques after completing the 6/12-months MDT who were treated favorably with minocycline 100 mg once daily for 16 weeks. Complete clinical resolution was observed in 9/11 patients while two patients had partial improvement. Histopathological improvement in the form of disappearance of granulomas corroborated with the clinical improvement. All the patients tolerated the treatment well and hyperpigmentation was the only adverse effect noted. Minocycline may be considered as a useful and well tolerated therapeutic option for this subset of leprosy patients due to its immune modulatory and anti-inflammatory effects.

Background Despite advances in surgical management of vitiligo, lesions on acral areas and bony prominences remain treatment refractory. There is lack of literature on the treatment efficacy of various surgical modalities over these treatment refractory sites. Objective To compare the efficacy of three common methods of grafting in vitiligo in known resistant areas. Methods A single-center interventional clinical trial involving 30 patients of stable vitiligo (disease stability ≥1 year) located over bony prominences and acral areas. All patients were treated with noncultured epidermal cell suspension (NCES), suction blister epidermal grafting (SBEG), and mini punch grafting (MPG) on three separate patches. Extent of repigmentation was assessed at 12 and 24 weeks, color matching and patient satisfaction were evaluated at 24 weeks. Results Among 30 participants, 22 (73%) were females, mean age was 27.4 (±10.7) years, and the majority (93.3%) had nonsegmental vitiligo. At 12 weeks, repigmentation >75% was noted in 56.6, 60, and 16.6% of patches treated by NCES, SBEG, and MPG, respectively. At 24 weeks, results remained the same in both the NCES and SBEG groups, while the number of patches with >75% repigmentation increased to 23.3% in the MPG group. The difference in repigmentation rate between NCES and MPG as well as between SBEG and MPG achieved statistical significance. Color matching of treated area and patient satisfaction were better in NCES and SBEG groups compared to MPG. Conclusion NCES and SBEG are superior to MPG with reasonably good efficacy and can be offered as a therapeutic modality for stable vitiligo patches over these sites.

Vitiligo is an acquired disorder of depigmentation that is associated with immense stigma and psychological burden. Although there is a myriad of options available for therapy, the repigmentation is best achieved with surgical modalities for stable disease. Once the immune attack on melanocyte is halted, surgery can be undertaken. The principles of surgery may be to introduce artificial pigment, stimulate melanocyte proliferation and migration, removal of depigmented areas or repopulation of depleted melanocytes. Broadly these can be divided into grafting, non-grafting techniques, camouflage and excision. The grafting techniques are further divided into cellular and tissue grafts. The advantage of the former being a greater donor to recipient ratio, however with added cost and equipment requirement. Grafting techniques have undergone various innovations, be it in harvesting, recipient site preparation or dressing, each with their own advantages and disadvantages. New innovations continue to crop up, including the use of stem cells and regulatory T-cell modulation. A well performed surgery is incomplete if it was not done without proper patient selection, counseling and preparation. This review article briefly outlines the various techniques; pre, intra and post-operative intricacies and the innovations in each.

Tumour necrosis factor-alpha (TNF-α) inhibitors have been successfully used in the treatment of various immune-mediated inflammatory diseases. However, these agents are frequently associated with mucocutaneous adverse effects.1 Anti-TNF-α-induced lupus erythematosus (LE) represents an uncommon adverse effect and has implications on patient management.2 Herein, we report a female patient who developed cutaneous LE after treatment with adalimumab for her rheumatoid arthritis (RA). A woman aged 40 years presented with photosensitivity and painless oral ulcers of 1-month duration. On examination, ill-defined erythema was present over her nose extending to malar area. Well-defined erythematous ulcers were present over buccal mucosae, lips and hard palate (figure 1A,B). Chillblain-like lesions were present over both ears (figure 1C). Her medical history was significant for the presence of RA, for which she had received four doses of …

Empty sella turcica is a condition in which the pituitary gland is absent completely or partially from the sella turcica or pituitary fossa. The patient may be asymptomatic with empty sella turcica as an incidental finding, or may have symptoms of pituitary hormones deficiency. Perioperative management of these patients depends on the symptoms and signs of hormonal deficiencies and the hormonal replacement treatment.

Background: Clinicodemographic and laboratory parameters predicting the outcome of Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) may vary among populations owing to genotypic and environmental variations. There is a scarcity of studies evaluating these parameters in Indian population. Aims: To analyze clinicodemographic and laboratory parameters predicting disease outcome in patients of SJS/TEN. Materials and Methods: Clinical records of patients admitted with a diagnosis of SJS/TEN from January 2014 to December 2018 were reviewed retrospectively with respect to data pertaining to clinicodemographic details, laboratory parameters, and disease outcome. Results: Of 51 patients included in the study, 24 (47.06%) were females. Anticonvulsants [phenytoin (19.6%), carbamazepine (13.7%), others (5.88%)] were the most commonly implicated drugs followed by NSAIDs (19.6%). The overall mortality was 21.6% [SJS (0%), SJS-TEN overlap (18.8%), and TEN (28.6%)]. The mean detached body surface area (BSA) (35.4% ± 10.4% vs. 25.7% ± 11.8%; P = 0.02) was significantly higher among patients with mortality. Blood urea nitrogen, serum HCO3− levels, and random blood sugar were significantly associated with mortality. Presence of sepsis during the disease course was associated with higher mortality (9/12 vs. 2/39; P = 0.001). Other components of SCORTEN like age and heart rate were not significantly associated with poor outcome in our study. None of our patients had associated malignancy. Conclusion: A higher detached BSA, presence of sepsis, higher blood urea nitrogen and random blood sugar, and lower serum HCO3− levels were associated with mortality. Refinement of scoring systems predicting the outcome of SJS-TEN is needed for better disease prognostication.

Acute pseudo-obstruction of the colon is known as Ogilvie syndrome (OS). There are varied causes of OS. Myxedema ileus (MI) as a cause of acute pseudo-obstruction is rare. Surgery in cases of MI is reserved only in cases of cecal distension of >12 cm, bowel ischemia, and perforated bowel. We present a rare case of a 71-year-old female who was operated for abdominal compartment syndrome secondary to MI.

Dermatology consultation was sought for a middle-aged man with multiple asymptomatic skin nodules all over the body. The patient was admitted with neurology inpatient services for altered sensorium and loss of vision for the last 2 days. He also suffered from hyperaesthesia and weakness of limbs for the last 2 years. On physical examination, hepatosplenomegaly was also detected along with neurological and visual abnormalities. Multiple cutaneous erythematous to skin-coloured, dome-shaped, exophytic, sessile as well as pedunculated, soft to firm asymptomatic nodules were observed on trunk, limbs and scalp (figure …

An elderly woman presented with 6 months history of skin coloured to erythematous papules in annular pattern over extremities, upper back and neck. The patient was diagnosed with granuloma annulare (GA) and started on hydroxychloroquine (HCQ) 300 mg daily. After 4 months of treatment, she developed bluish grey pigmentation within the plaques of GA with normal surrounding skin (figure 1A,B). There was no pigmentation at other body sites. Biopsy from the plaque showed necrobiotic collagen with intradermal mucin and perivascular lymphohistiocytic infiltrate accompanied by brown coarse pigment in the dermis …

Small bowel volvulus is a rare clinical entity which presents as recurrent intermittent abdominal pain after consumption of food. Although the entity is well described in the literature, diagnosis is often difficult due to its clinical presentation being similar to mesenteric ischemia. Herein we present the case of a 44-year-old male who presented to us with this condition.

Importance Surgical interventions, notably noncultured epidermal suspension (NCES), are the next line of treatment in patients with vitiligo who fail to respond to medical therapy. Noncultured epidermal suspension is usually performed in patients with vitiligo with duration of clinical stability (DS) of 12 months or longer because DS is a vital parameter in determining outcome of NCES. In this pilot study, we planned to assess the efficacy of a novel combination of noncultured epidermal cell suspension and noncultured dermal cell suspension (NCES and NDCS) in patients with vitiligo with shorter DS (3-6 months). Objective To compare the efficacy of transplantation of NCES and NDCS vs NCES alone in patients with vitiligo with DS of 3 to 6 months. Design, Setting, and Participants A single-center randomized clinical trial including 40 patients with focal, segmental, or generalized vitiligo with DS of 3 to 6 months or more than 12 months was carried out. Based on DS, 2 groups including 20 patients each were recruited (DS in group 1, 3 to 6 months; DS in group 2, more than 12 months). Each group was further randomized into 2 subgroups, A and B. Intervention Patients in subgroups 1A and 2A underwent NCES alone, whereas patients in subgroups 1B and 2B underwent NCES and NDCS. Main Outcomes and Measures Extent of repigmentation, color match, and pattern of repigmentation at 24 weeks. Results Of the 40 study participants, mean (SD) age was 24.9 (4.0) years and 24 (60%) were women; in group 1 with DS for 3 to 6 months, more than 75% repigmentation at 24 weeks was observed in all 10 patients in subgroup 1B (NCES and NDCS) compared with 3 of 10 patients in subgroup 1A (NCES) (100% vs 30%,P = .003). In group 2 (DS > 12 months), the same was observed in 6 of 10 patients in subgroup 2A and 7 of 10 patients in subgroup 2B (NCES) (60% vs 70%,P > .99). The 2 groups and subgroups did not show any significant differences with respect to color matching and pattern of repigmentation. Conclusions and Relevance Combination of NCES and NDCS resulted in excellent response in patients with vitiligo with shorter duration of clinical stability compared with NCES alone. This combination may be used early in the course of stable vitiligo without waiting for a period of 12 months or more since last clinical activity. Trial Registration ClinicalTrials.gov identifier:NCT03013049

Background: Trastuzumab has been approved for the treatment of patients with HER-2 positive metastatic/locally advanced adenocarcinoma of the stomach by FDA.1 Most of gastric cancer patients present at an advanced stage in our country, all patients of gastric adenocarcinoma should be subjected to HER-2 testing at initial diagnosis. Immunohistochemistry should be the initial testing methodology and Fluorescence in-situ hybridization should be used to retest immunohistochemistry 2+ samples.Methods: We conducted this study with the aim to establish the expression profile of HER-2 and its correlation to clinicopathological characteristics in resectable cases of gastric adenocarcinoma, in patients presenting with gastric adenocarcinoma at IGMC Shimla. The study was conducted over a year from 1st July 2014 to 30th June 2015. Sample size included 40 diagnosed cases of resectable gastric adenocarcinoma. All patients with operable and resectable disease were subjected to surgery and the specimen were sent for detailed histopathological examination and immunohistochemistry . χ 2 statistical analysis was performed to assess the HER-2 positivity rate . All statistics were performed using 2-sided analysis, with a significance level of p< 0.05.Results: In our study , 7 cases (17.5%) were scored as strongly positive for HER-2 membrane staining (3+), 4 cases (10%) were moderately positive (2+) and 29 cases (72.5%) were HER-2 negative (0/1+) on IHC. The positivity rates in diffuse type (22.2%) and poorly-differentiated (25%) gastric cancer were higher than those in intestinal type (9.9%) and well-differentiated (14.3%) gastric cancer respectively.Conclusions: There is a strong association of human epidermal growth factor receptor-2 positivity with Gastric Malignancy in our country especially in poorly differentiated cancers. Targeted biological therapy with Trastuzumab hence becomes an attractive addition to the multimodality therapy usually required in the treatment of locally advanced /metastatic gastric cancers.

Background: Chronic ulcers in patients with diabetes are complex and treatment is often difficult. At the moment, negative pressure wound therapy (NPWT) is widely used for the treatment of several types of wounds. Nevertheless, the clinical evidence to support the application of this dressing in chronic diabetic ulcers is scarce. The aim of this study was to evaluate the efficacy of NPWT to treat chronic diabetic ulcers. Methods: Prospective time bound comparative study. Diabetic patients aged 18 years or older with an ulcer were assigned to treatment with NPWT. Primary efficacy end point was time in reaching complete ulcer closure. A size of sample of 15 patients was used. NPWT was prepared with a polyurethane foam dressing, a Silicone catheter, a transparent adhesive drape and continuous negative pressure of 125 mm Hg. The wound was treated for cycles of 5 days and evaluated at every dressing change. Descriptive and analytical statistics were used. Results: There were 15 patients, with a mean age of 54.4 years (73.3% men). The average time to complete ulcer closure was (41.2 [8.5] days) . Conclusions: NPWT is an effective modality of treatment of chronic diabetic ulcers with early appearance of granulation tissue and faster rates of overall complete wound closure.

Purpose of Review: Gossypibomas remain a dreaded and unwanted complication of surgical practice. Despite significant interest and numerous guidelines, the number of reported cases remains sparse due to various factors, including potential legal implications. Herein, we review related data from India to ascertain if the problem is better or worse than that reported in world literature. Materials and Methods: A literature search was performed on PubMed and Google Scholar, to collect and analyze all case reports and case reviews regarding the condition in India. Results: On analysis of the results, there were 100 publications reporting a total of 126 events. The average patient age was 38.65 years. Average time to discovery was 1225.62 days. Forty-nine percent of reported cases were discovered within the 1 st year. The most common clinical features were pain (73.8%), palpable mass (47.6%), vomiting (35%), abdominal distention (26%), and fever (12.6%). Spontaneous expulsion of the gossypiboma was noted in five cases (3.96%). Transmural migration was seen in 36 cases (28.57%). Conclusions: Despite advancements in surgical approaches and preventive measures, gossypibomas continue to be a cause of significant morbidity. A safe working culture, open communication, teamwork, and an accurate sponge count remain our best defence against this often unpredictable complication of surgery.

Background: Colorectal surgery has always been a challenge for surgeons due to a large number of bacteria present in this area. Some of these bacteria may cause wound infection, anastomotic leak or frank sepsis. Mechanical bowel preparation (MBP) has been one of the many practices which aim to mitigate these complications. However, the use of MBP has been controversial for sometimes. We performed a prospective study to investigate the outcomes of colorectal surgery with or without MBP. Materials and Methods: This prospective study was conducted in the Department of Surgery, IGMC, Shimla from July 1, 2014 to June 30, 2015 included forty patients admitted in an emergency, or for elective open colorectal surgery. All patients who were scheduled to undergo primary resection and anastomosis of the colon and upper rectum were eligible for inclusion in the study. Results: Complications in the form of surgical site infection, wound hematoma, and enterocutaneous fistula were present in both groups. However the value of P = 0.204 in either group indicated that statistically, there was no difference between results of two groups. The average duration of stay in the no bowel preparation group was 13.42 days, and in the MBP group was 11.5 days. Conclusion: This study suggests that MBP is not necessarily essential for safe colorectal surgery.