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Background Postgraduate residents’ ability to understand and effectively manage their finances is variable. We conducted this study to assess the awareness of personal financial literacy among Indian residents. Methods We circulated a web-based cross-sectional Google Forms multiple-choice questionnaire having questions in three categories including financial awareness, current financial status and plans among 400 Indian residents. Results A total of 215 Indian residents (53.75%) responded to the survey (men 80.9%, unmarried 74.4% and pursuing broad specialties 83.3%). The majority were unaware of stocks, special student/doctor loans, tax planning, life insurance, professional indemnity and tax/financial planning. The majority opined that personal finance and investing should be taught at medical school/residency. A financial pyramid based on the hierarchy of needs is proposed. Conclusion Lack of financial literacy and planning was seen among the majority of Indian residents. Our study highlights this gap in the medical curriculum and the need for formal structured financial education during training.

Summary Background Loss of sensations in the sole following diabetic sensorimotor polyneuropathy (DSPN) leads to diabetic foot ulcers and its sequelae. We hypothesized that sensory reinnervation of sole by transfer of saphenous nerve (SN) to sensory fascicles of posterior tibial nerve (PTN) in these patients may reverse the neuropathy. Methods This prospective interventional case series included patients with advanced DSPN and intact sensory supply of SN. PTN was neurotized by transfer of SN nerve in the tarsal tunnel and postoperatively sensations of the sole were tested. Any existing ulcers on sole were noted and their healing was monitored. Finding A total of 17 patients (22 feet), 9 male and 8 female, were included. Seven patients had ulcers in the feet. At 6 months follow-up all patients developed protective sensation in the sole. The average 2 PD improved from 60 mm to 45.5 mm, average vibration perception improved from 34.12 V to 24.33, Medical Research Council (MRC) score improved from S0 in 12 feet and S1 in 10 feet to S3+ in 13 feet, S3 in 5 feet, and S2 in 2 feet at 6 months along with healing of ulcers in all 7 feet. Interpretation Transfer of SN to PTN for sensory neurotization is an innovative and simple option to prevent complications of DSPN. This procedure has the potential to change the natural history of DSPN.

Clinical trials in Surgery are central to research; however, very few surgical clinical trials are conducted in India. Such paucity of surgical trials is a cause for concern, and prompted us to explore the recent landscape of surgical trials in India. We reviewed all clinical trials from general surgery or subspecialties of general surgery registered with the Clinical Trials Registry of India website between 2018 to 15 th May 2021. Specific details such as the surgical subspecialty, study design, multicentric or single institution and funding were obtained. We found a total of 16,710 trials, out of these 4119 (24.6%) were related to all surgical fields. Only 136 (0.8%) trials were found from general surgery and its subspecialties. Most trials were registered from Central Government Institutions (48%), followed by State Government Medical Colleges (11%). Most number of trials was registered from GI surgery (32%). Most (90.5%) trials were single centre based. Common barriers to research are well known; if the State Government Medical Colleges can mentor a culture of research from an early stage of surgical training it can improve research productivity. Multicentre trials, involving smaller hospitals from tier 2 and tier 3 cities, are a potential solution to one of the major obstacles of surgical trials i.e. small number of patients; especially in this pandemic induced draught of elective surgical operations. A positive change in attitude of surgeons and provision of necessary funding can encourage more surgical clinical trials in India.

Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy which leads to insensate sole, diabetic foot ulcers (DFU) and its complications. We share our experience in recovery of sensation in the sole after prophylactic surgery such as nerve decompression (ND) or sensory neurotization by nerve transfer (NT) in patients having Diabetic sensorimotor polyneuropathy DSPN. 32 patients (46 feet) were selected for either nerve decompression or sensory neurotization depending upon presence or absence of Tinel’s sign at tarsal tunnel. At 6 month post-operatively perception of touch and pain recovered in all feet; temperature and pressure perception recovered in ∼95% feet; average vibration perception threshold returned to normal range and 2-Point Discrimination came down significantly. There were no ulcers or amputation in operated limbs during follow up period of 6 months. Prophylactic surgery in the form of ND and NT can be offered with minimal complications which significantly improve sensations in the sole in selected cases of DSPN. These have the potential to improve the quality of life of patient and change the natural course of disease.

After release of post burn flexion contracture and repair of soft tissue injury of digits, it is desirable to maintain the digits in full extension. This is conventionally done by insertion of Kirschner wires across the interphalangeal or metacarpophalangeal joints. We have been inserting a spinal or intracath needle in a dorsal supra-periosteal plane for immobilizing digits after release of post burn contractures or repair of soft tissue injury. The needle is maintained for 2–3 weeks, and all patients achieved stable immobilization of digits. There were no major complications. This procedure is minimally invasive, simple to perform, and provides stable immobilization. Level of Evidence: Level V (Therapeutic)

Complex soft-tissue defects of the distal third of the leg, foot and ankle with exposed bones/joints, tendons and implants need a flap for their closure. Distally based sural flap is commonly used, but it has a high partial necrosis rate due to venous insufficiency. We addressed this issue with AV supercharging by dorsalis pedis artery with short saphenous vein. Eight patients (seven males, mean age 34.12 years) with post traumatic lower limb defects over heel and foot were included. All flaps survived and healed although four flaps developed superficial partial epidermolysis. Average healing time was 20.12 days. Closure of the AV fistula was not required in any of the patients. At mean follow-up of two months, all patients were ambulatory with well settled flap. Arteriovenous supercharging of distally based sural flap through short saphenous vein improves the distal arterial perfusion in the flap and prevents distal flap necrosis.

Awareness of second victim syndrome and available support systems in South Asia is quite limited. We conducted this survey to assess its prevalence and impact among the surgeons from South Asia. A multiple choice pattern web-based cross-sectional Google forms questionnaire was developed which focused on demographics of respondent, prevalence, impact (physical, personal and professional), available coping mechanisms, gap in support systems, and future suggestions for dealing with “second victim” syndrome. Answers were sought from surgeons of all surgical specialties from South Asia. A total of 658 surgeons responded to the survey, 91.03% (n = 599) reported having experienced the “second victim” syndrome. Majority (54.3%) of respondents was from India; surgeons from 8 other countries also responded to the survey. Prevalence of “second victim” syndrome was found similar among the two genders, different experience groups, and different specialties (p > 0.05). A varied set of physical, psychological, and professional impacts were noted; however, any structured institute-based support system was lacking and victims sought help from colleagues. Development of a structured “crisis plans” providing emotional, psychological, and legal support, minimizing the trauma, and guiding the second victim through the recovery process is the need of the hour.

We report a simple cost effective alternative to commercially available vessel loops made from sterilized surgical gloves for retraction of vital structures during vascular trauma, micro-vascular, micro-neural surgery.

Occipital pressure ulcers and wound gaping may occur in unconscious and malnourished patients. Most of the time, a large defect requires wound coverage by scalp flaps. This video describes a rotational occipital scalp flap for occipital pressure ulcer and wound gaping in a patient of operated midline posterior fossa massventriculoperitoneal shunt. The defect measured 2.25 × 2.5 cm with exposed inion. The wound was included in an imaginary triangle, and the horizontal and vertical incision lengths were about four times the base of the triangle. The flap was based on the left occipital artery and raised in an avascular plane above the periosteum. The wound margins were freshened and undermined. The flap was rotated to bring it over the defect, and suturing was done in the standard manner. The flap had good healing, and the patient continued to be under care for his cerebellar medulloblastoma.

We describe a low-cost simulation model for teaching core needle biopsy to surgical trainees in Low- and Middle-income countries (LMICs). Pre-session and post-session surveys showed that correct core sampling (ability to hit the beetroot) after training was 91.4% compared to 75.7% before demonstration and improved adequacy (68.5% before v. 85.7% after). This low-cost model using locally available products is designed to simulate a palpable breast lump and can easily be incorporated into surgical training in LMICs, where a palpable breast lump is the commonest presentation of breast cancer.

The work pressure, challenging environment, and the difficult terms/conditions of the course lead to several unique problems amongst general surgery trainees in India. Self-assessment of one’s strengths and weaknesses is essential to maximally avail the opportunities and combat professional threats. SWOT stands for Strengths, Weaknesses, Opportunities, and Threats, a technique that is utilized in formulating strategies for success. Despite a strong and time-tested training module in India, trainees perceive many deficiencies in the general surgery training viz. high work pressure, burn-out, limited time for research/publications, long and hefty rural service bond, etc., which leads to a negative impact on their personal and professional trajectory. Despite such challenges in majority of trainees, only a small minority of them discuss this with their mentors. We propose a self SWOT analysis matrix, constructed in collaboration of the trainees with their mentors, helping them to develop strategies to self-manage their training period.

This study was conducted to assess outcomes of propeller flaps for reconstruction of small- to medium-sized defects in the distal third of the leg. Of 53 lower third leg defects covered using the propeller flap, 43 survived without complications. Only minor complications were seen and no flap was lost completely. The propeller flap is thus a safe option for medium-sized defects of the lower leg.

Shortage of plastic surgeons is well known in the developing countries, and this leads to denial of plastic surgery facilities to a very large population especially in the rural area. We report a retrospective review of our experience with 60 rural plastic surgery camps in Central India over 16 years. A total of 4317 patients were operated, and majority (~ 65%) of patients had cleft lip/palate and post-burn contractures. Results were satisfactory, and there were no major complications. Usefulness of such camps is obvious, and we wish to share lessons learnt during these camps.

Background: Internet has become the major source of health-related information, leading to a growing trend toward unsupervised self-medication using internet. This survey was conducted to assess the extent of internet use to obtain health information/self-medication, their perception regarding side effects of drug used, types/quality of information, and which site was commonly surfed for information. Materials and Methods: A web-based tool (Google Forms) was used to develop a questionnaire to obtain information about extent and impact of internet on self-medication by general population. The questionnaire included 9 questions along with demographic details of participants. The questionnaire was sent to participants by WhatsApp and E-mail and their responses were analyzed. Results: Four hundred and forty-eight (56%) persons responded to survey. There were 226 (50.4%) males and 222 (49.6%) females. The average age of responders was 35.10 years. Overall, 59.8% of responders used internet to obtain health information and self-medication. Out of these, 54.47% took allopathic medications without consulting the doctors. The majority of persons self-medicated for minor illnesses, but 11.6% of persons self-diagnosed and self-medicated for serious illnesses such as heart disease, diabetes, cancers, and psychological problems. 23.2% of peoples think that information on internet carries no risk for self-medication and 21% think that internet use can be a substitute for consulting a doctor. Google was the most common site (93.8%) surfed by participants. The health information provided on net was perceived as very good by 43.7%. Conclusions: There are growing trends toward the self-medication using internet. The health information on internet should be made easier, simpler, and safer to achieve positive health outcomes, but patients should be discouraged for self-medication. To support the safe and appropriate use of nonprescription medicines, minimum practice standards should be set by the governing medical bodies in each country.

Objective The transfer of peripheral nerves originating above the level of injured spinal cord into the nerves/roots below the injury is a promising approach. It facilitates the functional recovery in lower extremity, bladder/bowel and sexual function in paraplegics. We assessed anatomical feasibility of transfer of lower intercostal nerves to S2 ventral root in human cadaver for management of neurogenic bladder dysfunction in patients with spinal cord injury. Methods Study was performed in five formalin fixed cadavers. Cadavers were placed in prone position. A transverse incision was made along 11th ribs on both sides and 10th, 11th Intercostal nerves (ICN) and subcostal nerve were harvested up to maximum possible length. In four cadavers the ventral root of S2 was exposed by endoscope and in one by the standard open laminectomy. Intercostal nerves were brought down to lumbo-sacral region, S2 ventral root was cut cranially and feasibility of intercostal to S2 anastomosis was assessed. Results The mean length of intercostal nerves was 18.4 cm for the 10th 19.5 cm for the 11th and 22.15 cm for the subcostal nerve. The length of harvested nerve and the nerve length necessary to perform sacral roots neurotization were possible in all cases by only by subcostal nerve while T11 and T10 ICN fall short of the required length. Conclusion For Spinal cord lesions located at the conus, subcostal nerve could be connected to ventral root of S2 in an attempt to restore bladder function while 10th and 11th ICN had enough length to neurotize lumbar plexus.

Temporo-mandibular joint (TMJ) ankylosis is characterized by a decreased mouth opening which affects mastication, speech, and facial aesthetic. Interpositional arthroplasty using autologous tissue is accepted treatment for TMJ Ankylosis; however, harvesting autologous tissue is associated with additional morbidity. In this article we report our results of silicon interpositional arthroplasty for TMJ ankylosis. 20 patients with TMJ ankylosis were included in the study. All patients underwent standard operative procedure using preauricular incision for release of TMJ ankylosis by excision of at least 1 cm of bony block and insertion of 2 cm thick silicon block in the joint space. Postoperatively early mobilization of TMJ was advised from 3rd day onwards. Post operative result was evaluated by assessing the mouth opening as inter incisor distance (IID). 20 patients (27 joints) of TMJ ankylosis were included in the study. There were 8 male and 12 female patients with age ranged from 3–35 years. According to Sawhney classification bony ankylosis was present as Type-IV (n = 13 joints), Type-III (n = 12 joints) and Type-II (2 joints). Preoperative mean IID was 7.15 mm and post operative mean IID was 43.5. There was no facial nerve paresis, malocclusion or recurrence but infection and extrusion of implant occurred in 1 case each. Silicon interpositional arthroplasty is an effective procedure for the treatment of TMJ Ankylosis; as it restores mouth opening and function, maintains the vertical ramus height, and prevents re-ankylosis without any donor site morbidity.

Injury to the pudendal nerve leads to bowel/bladder incontinence which compromises the quality of life in these patients. Many peripheral nerves have been used to neurotize the pudendal nerve in order to regain bladder continence. The aim of this study was to assess the anatomic feasibility, by ultrasound, of transfer of the femoral nerve’s motor branch to the vastus lateralis (MNVL) to the pudendal nerve for restoring continence. Thirty healthy male volunteers were randomly selected, irrespective of age. The origin of MNVL was traced in the distal thigh, to the level the nerve was visible using high-frequency ultrasound probe. The length of the nerve was measured with the help of a measuring tape. The pudendal nerve was identified just medial to the ischial tuberosity on the same side. The distance between the origin of MNVL and the pudendal nerve was measured. The same procedure was performed in the opposite side. MNVL has enough length and calibre to neurotize the pudendal nerve in 28/30 (93.33%) individuals on the right side, and in 29/30 (96.66%) individuals on the left side. On ultrasonography, length of MNVL was found sufficient to reach the pudendal nerve in majority of the patients. USG can be a tool to assess the feasibility of transfer of MNVL to the pudendal nerve. Level of evidence: Level IV, risk/prognostic study.

Traditional Halstead teaching, which is time- and opportunity-dependent, has often been replaced by ‘boot’ camps which involve expensive modules and are usually a grand one-time event. This does not suit the complex teaching and learning needs of low- and middle-income countries (LMICs). We studied the impact of a needs-driven surgical training course implemented instead. The course was taken by 17 first-year residents of surgery, and included a pre-course knowledge assessment test, pre-test skills assessment, as well as post-test assessment and feedback impressions. Mean post-test scores improved significantly ( P

Differentiating motor and sensory fascicles before anastomosis is essential for achieving an excellent postoperative functional outcome for peripheral mixed nerves injuries. However, identifying them is not easy. There are several techniques to address this important issue. Each identifying technique has its own pros and cons; this narrative review highlights the salient features of each of these. Many of the newer techniques need to be tested in humans before they can be recommended for regular use; till then we have to rely mainly on per operative electrical stimulation of nerve to differentiate between sensory and motor fascicles to improve postoperative functional outcome.

Objective Glasgow Coma Scale (GCS) assessment is vital for the management of various neurological, neurosurgical, and critical care disorders. Learning GCS scoring needs good training and practice. Due to limitation of teachers, the new entrants of the clinical team find it difficult to learn and use it correctly. Training through videos is being increasingly utilized in the medical field. This study aimed to evaluate the efficiency of video teaching of GCS scoring among general surgery residents. Materials and Methods A prospective study was done utilizing the freely available video at glasgowcomascale.org. The participants (general surgery residents, 1st–3rd year) were asked to assess and record their responses related to GCS both before and after watching the video. A blinded neurosurgeon recorded the correct responses separately. Statistical Analysis The difference between correct responses of the residents before and after watching the video was calculated using the “chi-square test.” p-Value ≤ 0.05 was taken as significant. Results There was a significant improvement in GCS scoring by residents after watching the videos (p < 0.05). On estimating the responses separately, all the three responses (eye, verbal, and motor) improved significantly for 1st-year residents while only the motor response improved significantly for 2nd- and 3rd-year residents. The mode subjective improvement for the 1st-, 2nd-, and 3rd-year residents was 5, 4, and 3, respectively. Conclusion Training GCS scoring through videos is an effective way of teaching the surgery residents with maximum benefit to the junior-most ones.

Split-thickness autografts offer the best form of wound coverage, but limited donor sites and donor site related morbidity have resulted in the search for alternatives in the form of microskin graft. Twenty-five consecutive patients with post burn, post traumatic, and post cellulitis raw area were included in this study. After appropriate preparation of recipient bed, microskin graft was applied under general/regional anaesthesia. The assessment of microskin graft was done clinically on 5th, 7th, 10th, and 14th days and until the wound healed. Percentage of microskin graft take/loss, presence of infection, and duration of wound healing were noted. Complete wound healing was considered the endpoint of the study. Late assessment was done at 3 and 6 months postoperative to assess the scar. There were 19 male and 6 female patients with mean age of 27.52 years (range 18–54 years). Mean size of wound was 337.48 cm2 (range 120–770 cm2). All wounds healed in ~ 17.28 days without the need of secondary skin grafting. There was no clinically evident infection in the grafted wounds. Overall graft survival rate was ~ 94.76%. After 2 months, homogenous scar was present but there was hypo-pigmentation in 4 cases. There was no hypertrophy or scar contracture at 6 months. Micrografting is a feasible alternative for wound coverage and a useful tool for surgeons when donor sites are limited. Level of evidence: Level IV, therapeutic study.

Background Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy. Loss of sensations in sole leads to diabetic foot ulcers (DFU) and its complications. Surgical decompression has been used in the treatment of diabetic peripheral neuropathy, however; its effectiveness has been questioned. Purpose of this study was to evaluate the sensory recovery in sole after tarsal tunnel decompression (TTD) in patients having DSPN. Methods Thirteen patients (Age28-70 years, average 35.57 years; 7 Males, 6 Females; 20 feet) with DSPN and positive Tinel's sign over the tarsal tunnel were included in the study. Pre and post-operative sensory tests performed on the sole included tests for touch, pain, temperature, pressure, vibration perception threshold (VPT) and two-point discrimination (2-PD). Results were classified as per British Medical Research Council (MRC) scoring system. Results –Sixteen feet were followed-up for 6 months. In all feet perception of touch, pain and pressure recovered. Temperature perception recovered in 75% feet. VPT came to normal range (16.81V) from 40.37 V and 2-PD came down to average of 6.0 mm from preoperative average of11.2 mm.MRC scale improved from S0 in 5 feet and S2 in 15 feet to S3+ in all 16 feet.There were no ulcers or amputation in operated limbs during follow up period of 6 months. Conclusions TTD improves plantar sensations in diabetic neuropathy and prevents ulcers and its related complications.

Giant prepyloric perforation ( i.e size > 2 cm) is a challenging surgical problem; options include repair with an omental patch or an omental plug. Alternative methods are more complicated. However, the leak rate and mortality is unacceptably high. This prompted us to combine the omental plug and patch for an effective repair. We present a case series of five patients repaired in this fashion, all of whom had an uneventful recovery, except for one who had a superficial abdominal wound dehiscence, but there was neither post-operative leak nor mortality. The mean hospital stay was 12 days.

This systematic review endeavors to find an effective treatment protocol for subacute thyroiditis (SAT) to minimize side effects, recurrence and long-term hypothyroidism.We analyzed available original studies on treatment protocols for SAT. A thorough literature search was performed on the following online databases PubMed, Cochrane library nd Google Scholar using appropriate keywords for choosing relevant articles. Two reviewers assessed the methodological quality of selected articles independently using a critical appraisal instrument. The results were analyzed and synthesized qualitatively using the level of evidence method.The literature search retrieved a total of 460 publications after abstract screening; out of which 36 articles met the inclusion criteria. After full text screening, 23 articles were further excluded as they were focusing on aspects of SAT other than management, the remaining 15 articles were investigated for both reliability and validity. Thirteen studies provided low-quality evidence, and two randomized control trials (RCT) provided a high quality of evidence. Steroid therapy was found to be the most effective for moderate to severe SAT and provided relief from acute symptoms but was found to not be a risk factor for recurrence. Low initial doses of steroid (15 mg) were preferred over high initial dosage (30-40 mg). Furthermore, a look into the mode of steroid delivery (RCT) revealed that intrathyroidal steroid therapy can potentially become a safer and faster mode of therapy. The duration of tapering was found to be of significance as a short tapering period was linked with greater recurrence rates.Low initial doses of steroid along with an extended tapering period may help lower recurrence rates; also, intrathyroidal steroid injections are potentially a better alternative to oral prednisone (PSN) with regard to safety and speed of action. However, the evidence is of moderate quality and further investigation is required.

Qualitative studies in Surgery are important because they contextualize the previously missing social facets of the surgical narrative and inquire into the crucial issues of quality of life/well-being, gender and other discriminations and biases faced by surgeons and patients, surgical education/training, mental issues and burnout, etc. This has resulted in an increasing trend of qualitative studies in surgery. Authors, editors and journals have to ensure that the principles of scientific rigour in qualitative research are followed; otherwise, the answers will not be valid, thus rendering the whole exercise futile. More studies, addressing these fascinating ‘social’ facets of surgery, are needed.

PURPOSE: Acquired brain injury causing spasticity, pain and loss of function is a major cause of disability and lower quality of life. Sacral 1 (S1) neurectomy claims promising outcomes in spastic hemiparesis. This cadaveric study was conducted to study the surgical anatomy, surgical approach and feasibility of S1 neurectomy and contralateral S1 (cS1) transfer. METHODS: This study was conducted over a period of 10 months and 10 cadavers (age 18–60 years, 7 male and 3 female) were included in the study. 2 cadavers underwent endoscopic S1 neurectomy and 8 cadavers underwent open S1 neurectomy. Mean S1 root length and diameter were recorded using Schirmer tear strips and Vernier calliper. Feasibility of transfer was also assessed by measuring the length of donor nerve and distance between distal ends to proximal end of recipient nerve. RESULTS: Mean thickness of right S1 root was 4.02 ± 1.5 mm and left S1 was 3.89 ± 1.18 mm. Mean length of right S1 root was 24.9 ± 4.56 mm and left S1 was 23.6 ± 2.86 mm. Endoscopically dissected length of S1 was much less as compared to open technique. CONCLUSION: S1 neurectomy is simple procedure to reduce spasticity in lower limb without any permanent deficit. It can be done by open as well as with endoscopic approach while for contralateral S1 transfer open approach need to be used.

Contraction in a skin flap is unavoidable after it is raised because of its elastic content and despite the best of planning a flap may fall short which may lead to some necrosis. This study was conducted to ascertain the extent of contraction of flaps and the factors that might influence this contraction. This prospective study included 25 patients who underwent reconstructions of defects with different types of skin and fascio-cutaneous (FC) flaps. Clinical data including age; sex; body mass index; site/type of flap; and the flap’s surface area, thickness, and its contraction in relation with the relaxed skin tension lines (RSTL) were recorded and analyzed. The outcome of the success or failure of the flap was ascertained by clinical examination. There were 20 males and 5 female patients and their age ranged from 10 to 67 years. Mean flap contraction was 20.01% in skin flaps and 20.38% in FC flaps; overall mean contraction was 20.19%. Flaps retracted more when constructed parallel to RSTL, in females and in patients with high BMI. Age did not affect the contraction. Skin flaps can be stretched to a certain extent, but not up to pre-flap area without compromising the blood supply. Therefore, adequate allowance should be provided to avoid stretching, and subsequent necrosis and dehiscence. The most practical way of providing this allowance is by planning in reverse which flap size is always bigger than the defect, therefore providing margins for flap contraction. Level IV, risk/prognostic study

This paper presents a new predistortion linearization technique for high linearity and high modulation efficiency in millimeter-wave (mm-wave) CMOS power amplifiers (PA) for fifth-generation (5G) mobile communications. Our proposed linearizer adopts a transformer-based (i.e., inductive) self-compensated predistortion network at the input of the PA whose amplitude-modulation to phase-modulation (AM–PM) response is opposite compared with the AM–PM response of a CMOS PA, resulting in an AM–PM cancellation effect. This proposed inductive linearization method mitigates the large gain reduction problem in traditional capacitor-based linearization approaches while consuming no extra dc power or without introducing additional control circuitry. As a result, a significant improvement in power-efficiency and linearity is achieved with high-order complex modulation signals. To validate the proposed linearization method, a PA prototype in 65-nm CMOS technology was fabricated and tested, and it exhibited $\vert $ AM–PM $\vert $ distortion at $P_{\mathrm {o,1\, dB}}$ over 4 GHz of bandwidth (27–31 GHz). At 28 GHz, the measured saturated $P_{\mathrm {o}}$ and peak power-added-efficiency (PAE) was 15.6 dBm and 41%, respectively, while achieving a 6-dB $P_{\mathrm {o}}$ back-off PAE of 25%. To assess PA’s large-signal performance for 5G communications, the prototype was measured with the 64-quadratic-amplitude modulation (QAM) signal at 2-Gb/s data rates at 28 and 30 GHz, and the PA achieves modulated-PAE of 18.2%/17.6% and average- $P_{\mathrm {o}}$ of 9.8 dBm/10 dBm, respectively, while maintaining $2\times $ improvement in comparison with the recently reported 28-GHz linear CMOS PAs. Also, the PA occupies a compact active-area of 0.24 mm2.

In this paper, a compact, low-loss, dual-path phase-switched inductor suitable for millimeter-wave (mmWave) transceiver subblocks is proposed. The signal path through the structure is determined by the relative polarity of two differential excitation signals applied to the four-port structure. Because inductance is varied by altering signal path through the inductor, signal-path MOSFET switches are avoided. The inductor, therefore, demonstrates high, mode-invariant quality factor, facilitating the design of high-performance dual-band mmWave transceiver subblocks. Based on the proposed inductor, a dual-band Ka-band oscillator is designed in a 65-nm CMOS technology which covers two frequency bands from 14.8 to 18.7 GHz and from 20.8 to 26.6 GHz. The proposed inductor facilitates a widely tunable, dual-band frequency range while maintaining the state-of-the-art phase noise, power consumption, and figure of merit (FoM). The oscillator achieves measured fractional tuning ranges of 23.3% and 24.5% and phase noise of −115.1 dBc/Hz at 2-MHz offset while consuming only 4.8-mW dc power. A peak tuning-range FoM of −195.1 and −194.9 dBc/Hz is demonstrated across the low- and high-frequency bands.

Aim Restoration of bladder and bowel continence after pudendal nerve anastomosis has been shown successfully in animal models and may be applicable in humans. Aim of this cadaveric study was to assess feasibility of pudendal nerve neurotization using motor fascicles from sciatic nerve. Methods Pudendal and sciatic nerves were exposed via gluteal approach in 5 human cadavers (10 sites). Size of pudendal and sciatic nerves and the distance between two nerves was measured. Results There were four male and one female cadavers. Mean age was 62 (range, 50–70) years. Mean pudendal nerve diameter was 2.94 mm (right side) and 2.82 mm (left side). Mean sciatic nerve diameter was 11.2 mm (right side) and 14.2 mm (left side). The distance between two nerves was 23.4 mm on both sides. Conclusion Transfer of the motor fascicles from sciatic nerve to pudendal nerve to restore the bladder and bowel continence is feasible.

Low-cost healthcare innovations which are designed for economic reasons, popularly called frugal innovations (FI), are all about ‘doing more and better with less for more people’.1 Often synonymous with ‘work-arounds’ or ‘good-enough’ innovation, what FIs lack in sophistication or complexity they make up for in affordability, without scrimping on safety or effectiveness. Some good examples of FIs include the low-cost ECG machine GE MAC 400, Kangaroo Care, the Ponseti treatment for congenital clubfoot and mosquito net mesh used for hernia repair; each of which has a demonstrable evidence base for clinical effectiveness at extremely low cost.2–5 The philosophy of FI originates from grassroots, resource-constrained milieus, where most abundant of all-natural resources—human ingenuity—is used to optimise limited resources to solve problems.6 Any FI must result in substantial (at least one-third) cost reduction without compromising on its core functions and optimum performance level.7 Some FIs, although designed in the developing world, have been found useful for the developed world too and are labelled as ‘reverse innovation’, although this term is considered to be pejorative by some.8 9 Innovation, although central to the development of medical science, is a complex process and its definition continues to be debated.10 Its complexities are further reflected in challenges in its evaluation and reporting even though frameworks such as Idea, Development, Exploration, Assessment and Long-term monitoring, a widely accepted benchmark, are available.11 In a recent systematic review, the measurement and reporting of surgical innovations continues to be inconsistent, and there is a need for standardisation and guidance.12 FIs reporting is made even more complex for two reasons (1) that they are work-arounds and unconventional solutions for reducing the complexity and cost of an idea, oftentimes unpatented, not commercialised, without financial backing or simple changes in practice or technique, and …

Violence at work is becoming an alarming phenomenon worldwide affecting the millions of health care workers. This study was conducted to assess the violence towards Resident doctors in Indian teaching hospitals. Google forms questionnaire was developed and circulated electronically to resident doctors working in India. Data were collected and managed using the Google forms electronic tool. Vast majority (86%) of respondents reported having experienced violence with no difference among two genders. Prevalence of violence was maximum (35.5%) in general surgery. Verbal threat and abuse was the commonest (∼94%) form of violence. Mostly these acts of violence happened in Emergency/Trauma room. The most common reasons for violence in hospital were patient's death. Over 94% residents accepted that they had never received any training to deal with work place violence. Majority (80%) of the respondents favoured better communication, strict Laws and strengthening of security measures in hospital to prevent WPV. Workplace violence prevention should be addressed aggressively and comprehensively in health care. A workplace violence prevention program should be a required component of all health care organizations.

Background: Measurement of two-point discrimination (2-PD) is used in clinical practice to evaluate the severity of nerve injuries, neuropathy, and recovery of patients following nerve repair. Commercially available 2-PD testing devices are costly and therefore not available everywhere. Methods and Material: We made an economical indigenous 2-PD testing device from off-the-shelf components and tested its efficacy in volunteers. Statistical Analysis: The data were analyzed using Minitab Statistical Software Version 17.0 and Kappa statistics were used in the assessment of agreement between two devices. Results: A total of 30 (23 men, 7 women) subjects were included in the study. There was good agreement between the measurements of static 2-PD with the two different test devices: from fair (Kappa = 0.408, P = 0.018) to strong (Kappa = 0.618–0.795, P = 0.000). Conclusions: This device is simple to make, very economical, and obtains accurate 2-PD measurements.

Plasma is one of the mainstays of traumatic haemorrhage treatment. Fresh frozen plasma (FFP) is the commonest plasma formulation used. A recent in-vitro study showing significantly less growth factors (that play a role in angiogenesis, cell growth, and cell proliferation) and more pro-inflammatory chemokines in FFP, as compared to Never Frozen Plasma (NFP), has prompted a debate about preferred plasma formulation for transfusion in trauma patients. Hence, infusion of large amount of FFP may exacerbate an already activated inflammatory cascade. FFP has been shown to be associated with increased short-term mortality and enhanced risk of systemic inflammatory response syndrome, infection and sepsis. In light of these studies, a call can be made for increasing the use of NFP, which is safer, has immediate availability, a longer storage life, preserves potentially advantageous growth factors and avoids previously unrecognized possible harmful cytokines.

Personal protective equipment (PPE) plays a fundamental role in the prevention of spread to Health Care Professionals (HCP) ; especially in a surgical setting. This scoping review of surgery guidelines was performed to appraise the quality of appropriate PPE recommendations and propose a strategy to optimize the PPE usage. This rapid scoping review of guidelines on surgery during COVID-19 was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol. Important databases were searched from January 1, 2020 to July 31, 2020, for relevant studies produced by a national/international academic association/organization, in English literature, using relevant keywords. Quality of evidence was graded according to GRADE guidelines. The searches yielded a total of 1725 studies, out of these 41 guidelines on surgery during COVID-19 matching with pre-defined criteria were evaluated. The level of evidence was uniformly rated "low," as assessed by GRADE guidelines and recommendations provided by them were mostly non-specific covering a narrow range of items. The crucial issue of optimization of PPE was not addressed at all. Economic implications demand optimization of PPE and conservation of resources. A simple decision-making algorithm addressing all the limitations of guidelines can be constructed, which allows HCPs to safeguard themselves and at the same time optimize/ conserving resources.

BackgroundSurgical correction of ulnar drift of metacarpo-phalangeal joint (MPJ) due to Rheumatoid arthritis (RA) is conventionally done by silicon joint arthroplasty which is expensive and may be associated with many complications. We report the outcome of low-cost autologous interpositional arthroplasty.Material and methodsFive patients (8 hands, 32 arthroplasties) underwent correction of ulnar drift of MPJ by dorsal capsule interpositional arthroplasty. Results were assessed according to the degree of recovery of movement at the MPJ and correction of ulnar drift. Functional improvement was graded as excellent, good and fair. Pain alleviation was assessed by visual analogue score (VAS) score.ResultsExcellent results were seen in 3 patients (5 hands, 20 arthroplasties), good in 1 patient (2 hands, 8 arthroplasties) and fair in 1 patient (1 hand, 4 arthroplasties). VAS score for pain decreased from mean preoperative 8.2/10 to 1/10. On average follow up of 1.4 years there was good hand function, no recurrence of deformities and patients were pain free.ConclusionInterpositional arthroplasty for MPJ using dorsal capsule for correction of post RA ulnar drift is a low-cost option which improves the hand function and cosmesis. Additionally, it avoids all the complications related with the use of silicon joints.