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There is a pressing need to address the noticeable disparity in biomedical research output between High-Income Countries (HICs) and Low-Middle Income Countries (LMICs). This imbalance raises urgent concerns about equity and the impact on global health. Despite being home to most of the global population, LMICs face numerous challenges that hinder their ability to contribute significantly to research. This review explores the factors contributing to the disparities and proposes potential solutions to address this global imbalance. A comprehensive strategy is needed to tackle the differences in biomedical research productivity between high-income and low-middle-income nations. Enhancing global partnerships, ensuring fair allocation of resources, and prioritizing the development of research capabilities are crucial measures in nurturing a more diverse and influential worldwide biomedical research landscape. Closing this divide is essential for advancing scientific inclusivity and tackling the health issues economically disadvantaged countries face.

Objective The aim of this study is to create clinical normative data for ulnar length in the pediatric population and to demonstrate the usefulness of such data.

Introduction This article aims to establish the relative thumb length in comparison to the index finger in central Indian adults.

Idiopathic chylopericardium (CP) in the pediatric population is a rare entity with very few reported cases and is characterized by the accumulation of chyle in the pericardial cavity. There are no guidelines for the management of this rare entity. The present study reports a case of idiopathic CP in an infant and our experience of managing it by pericardial window creation using VATS and a multidisciplinary approach providing the optimum care for the child.

South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions—initiatives and innovations—toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).

Background: The revolutionary concept of using the body's innate stress response to surgery to access the advantage of early recovery in the postoperative period has changed the overall outcome of health systems of LMICs in terms of cost-effectiveness and increased patient turnover. Hence, is now the standard of care in many adult surgical specialities, but with very little evidence in paediatric surgical fields. This lacuna in the knowledge was identified and addressed which yielded positively comparable results. Methods: This is a retrospective and prospective validation study conducted in the Department of General Surgery, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, Madhya Pradesh, India between 1st March 2020 - 30th May 2022. The peri‑operative parameters affecting convalescence after surgery were reviewed and the results of the conventional peri‑operative protocols were compared with the ERAS group. Results: 50 patients with Ano-rectal malformations underwent laparoscopic anorectoplasty, of which 25 patients were treated with conventional peri‑operative protocol and 25 were treated with ERAS protocol. The results obtained were comparable and effective with the existing results in adult surgical specialities and also were statistically significant in most of the parameters. Conclusion: Shorter hospital stay reduces the financial burden alleviating both the physical and psychological stress of the patients and their parents. Also, judicious use of the available resources can increase the patient turnover of the existing health systems with the same financial assistance.

Contralateral sacral roots (cS1) transfer to treat avulsion injuries of lumbosacral plexus (LSP) has been described, however; concerns about its safety remain. We performed a systematic review of a hypothesis regarding safety of cS1 transection and transfer for treatment of LSP avulsion injuries from available studies. A literature search on Pub Med, Cochrane database and Goggle scholar was performed using appropriate key words for choosing relevant articles. Two authors independently assessed the methodological quality of selected articles using Brink’s criteria and results were analysed using level of evidence. The literature search retrieved a total of 877 publications; out of which 9 articles met the inclusion criteria and were reviewed. 6 articles were investigated for both the reliability and validity and 3 articles evaluated qualitatively; all were of limited quality. Though all studies showed that cS1 nerve root transfer leads to improvement in motor power of muscles and sensory recovery neurotised by cS1 with transient donor site morbidity however; evidence is limited. cS1 nerve root transection and transfer for the repair of LSP avulsion injury appears to be a safe option but the evidence is limited and further validation of this finding is needed.

Introduction Treatment of complex fistulas such as inter- or transsphincteric, recurrent, and high fistulae have high rate of recurrence or incontinence. Fistulectomy with primary sphincter reconstruction might represent an effective and safe alternative to reduce rate of recurrence and incontinence. The aim of this study is to assess incontinence and recurrence after fistulectomy with primary sphincter reconstruction for management of complex fistulas.

Objective:We evaluated the beneficial effect of Ormeloxifene (Centchroman) versus a combination of Gamma Linolenic acid (GLA), methylcobalamine and vitamin C on mastalgia in a three-arm, open-label, placebo-controlled trial.Materials and Methods:Patients aged above 18 years with mastalgia were recruited between January 2019 and July 2021. Patients were divided in three arms: Ormeloxifene arm, GLA arm and Placebo arm. Response was evaluated using visual analogue scale (VAS) and score below 3/10 was defined as complete relief.Results:A total of 113 consecutive women with mastalgia were randomized to the GLA group (Group 1, n = 39 women), Ormeloxifene (Group 2, n = 36) and Placebo (Group 3, n = 38). Complete response was observed in 94% patient in Group 1, 96% in Group 2 and 87% in Group 3 at the end of 12 weeks and it was not significant (p = 0.49). Adverse events were reported by eleven patients taking Ormeloxifene, compared to none in the other two groups. Conclusion:In this study Ormeloxifene and GLA were not superior to placebo for pain relief in mastalgia. Furthermore, there were concerning side effects associated with Ormeloxifene therapy. The role of Ormeloxifene in mastalgia needs further evaluation before recommending it as preferred therapy.

Introduction: Despite remarkable improvement in Wilms' tumor (WT) survival in Western world, sub-optimal outcome in resource-constrained settings is influenced by late presentation, larger size, and poor access to treatment. This prompted us to study the outcome at a tertiary care center and to identify the global and local practice gaps. Materials and Methods: A retrospective, observational study of WT was conducted from October 2009 to September 2019 at a tertiary care setting. Following the National Wilms' Tumor Study Group protocol, an upfront nephrectomy (unilateral resectable tumors) and preoperative chemotherapy (large/unresectable Stage I–III) were followed. The records were reviewed for demographics, stage, preoperative chemotherapy, predictive factors, and outcome. Survival curves were plotted by the Kaplan–Meier method, and analysis was performed using the SPSS software version 16. Results: One hundred and fifty-six children were included, median age was 4.1 years, with a male predominance. The most common stages of the presentation were II (40.4%) and III (34.6%). An upfront surgery was done in 27.6%, while remaining received preoperative chemotherapy. The median follow-up was 22 months, and the events included relapse in 46 (29.48%) and death in 54 (34.61%). The mean survival time was 45.7 (95% confidence interval [CI], 41.08–50.30). The 2-year overall survival was 65.38% (95% CI, 59–73), and the 2-year event-free survival was 36% (95% CI, 32–41). On comparison of the impact of preoperative chemotherapy, the survival estimates in Stages I–III and relapse rate were statistically similar, tumor size reduced significantly, and tumor spill was significantly lower (P < 0.05). Conclusion: WT is associated with late presentation, sub-optimal survival, and higher relapse in our setting associated with practice gaps related to the management including practice violations.

Introduction: Laparoscopic anorectoplasty (LAARP) is useful for the management of rectoprostatic urethral fistula (RPUF), due to easier rectal mobilization, avoidance of posterior sagittal muscular incision, and shorter hospital stay. However, its role in rectobulbar urethral fistula (RBUF) is still debated as there is a chance of urethral diverticulum (UD), due to incomplete dissection. Laparoscopy-assisted modified posterior sagittal anorectoplasty (LAMPSARP) utilizes advantages of LAARP combined with fistula dissection using small sagittal incision preserving puborectalis. The present study compares the results of LAMPSARP with LAARP for correction of RBUF associated with anorectal malformations (ARMs). Materials and Methods: All male ARM with RBUF presenting in a tertiary center in Central India (January 2014–January 2016) were included. Low male ARM, RPUF, rectovesical fistula, and congenital pouch colon were excluded. They were randomized into LAARP and LAMPSARP groups. Complications were assessed in terms of anal stenosis, mucosal prolapse, and UD. Kelly's scoring and Krickenbeck scoring were used to assess continence, and visible anal cosmesis scale (VACS) was used to assess wanal cosmesis. Results were statistically analyzed using a comparison of means and 2 × 2 contingency tables. Results: Fifty-six colostomized patients with RBUF (26 LAARP, 30 LAMPSARP) were included. Mean operative duration in the LAARP group and LAMPSARP group was 42 ± 10 min and 56 ± 12 min, respectively (P < 0.0001). On mean follow-up of 4.5 years, mucosal prolapse (53.9%) and UD (15.38%) were significantly higher in LAARP group, while anal stenosis was similar. All three, Kelly's score, Krickenbeck score, and VACS, were better (P < 0.05) in the LAMPSARP group. Conclusion: Laparoscopy-assisted modified posterior sagittal approach is better for RBUF and offers better surgical outcome.

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.

Background The purpose of this study was to evaluate the functional outcomes of a modified technique of double rectangle pattern for correction of severe ptosis. Methods This is a retrospective study over a period of 8 years including patients who underwent correction of ptosis by double rectangle using autologous fascia lata sling. Surgical outcomes were assessed postoperatively by distance from the corneal light reflex to the upper eyelid margin (MRD1) and levator function. Results Twenty-six eyelids were operated in 20 patients. There were 9 males and 11 females, with age ranging from 4 to 35 years. Preoperatively, all patients had poor MRD1 and poor levator function. Postoperative MRD1 was good in 13 patients (17 eyelids), fair in 5 (7eyelids), and poor in 2 patients (2 eyelids). Postoperative levator function was excellent in 12 patients (15 eyelids), good in 6 (9 eyelids), and fair in 2 patients (2 eyelids). At a mean follow-up of 12 months, adequate correction was achieved in 24 eyelids, and 2 eyelids had undercorrection. Conclusion Frontalis sling with a double rectangle is simple and more efficient, as it provides a straight line of pull to the eyelid for correction of severe ptosis.

Introduction: Under-nutrition increases the susceptibility to active tuberculosis and delays recovery. Nikshay Poshan Yojana provides a financial incentive of Rs. 500/month for each notified TB patient for a duration until the patient is on anti-TB treatment. Objectives: 1. To find out the utilization of the nutritional support scheme among TB patients. 2. To give evidence-based recommendations. Methods: It is a retrospective cross-sectional study conducted among TB patients. 2 DMC's in each of the 2TU (randomly selected from 12 TUs) were chosen. 83 patients responded to telephonic interview out of all patients registered in the last six months. The demographic details were collected from TB treatment cards and registers and other information by telephonic interview of 10–15 min each conducted over a period of 15–20 days. The quantitative data thus collected was analysed in terms of frequency, percentage and Chi-square test and qualitative data from patients and providers were analysed by thematic analysis. Results: Majority were of 40–60 years of age and were males. A total of 76 patients were aware of the scheme but only 17 patients had received their first instalment after two months in their account. Among the 17 who faced difficulty while getting the money, 13 TB patients spent it on nutrition. Lack of communication, stigma, unawareness, ignorance, illiteracy, multistep approval process and technical issues were few themes that emerged as difficulties encountered while utilisation. Conclusion: There is a large gap between demand and supply chain of services. A majority were unsatisfied and thus the administrative scale up for proper implementation of services and measures to bring down the stigma attached with the disease was recommended.

Introduction: Laparoscopic pyloromyotomy (LP) for the treatment of infantile hypertrophic pyloric has advantage of smaller incisions, faster recovery, reduction in wound-related complications and better cosmesis. Various laparoscopic knives and spreaders have been used for LP, but they do not provide the depth and tissue perception as in open surgery. We describe the laparoscopic hybrid pyloromyotomy (LHP) which makes procedure simple and safe without the requirement of any special instrument. Materials and Methods: This retrospective and prospective comparative study was conducted over a period of 4.5 years in a tertiary teaching hospital in central India. All patients with infantile hypertrophic pyloric stenosis diagnosed on the basis of clinical history, examination and ultrasonography were included in the study. Retrospective data of three-port conventional LP (CLP) using monopolar diathermy hook for incision was used as control group against prospective data of 25 patients undergoing LHP. After a proper layout, LHP was done using one umbilical optical port, right paraumbilical grasper of holding the pyloric olive and an epigastric incision for hybrid pyloromyotomy using 11 no blade and blunt-tipped mosquito artery forceps. Results: Prospective group of LHP included 25 patients which were compared with a retrospective group of CLP consisting of 25 patients. On comparison of two groups, it was found that LHP reduces operative duration significantly. The outcome in terms of complications and recovery was comparable in two groups. None of the patients developed recurrence and required any redo surgery. Conclusion: LHP is a simplified approach which is easy to learn and teach, improves safety and accuracy of the procedure.

Introduction: Laparoscopic herniotomy (LH) for hydrocele is an accepted procedure and provides advantages of contralateral diagnosis and repair with the same incisions. The suturing of patent processus vaginalis is associated with various complications. We describe suture-less herniotomy using tissue-sealing device for LH of hydrocele in children. Materials and Methods: The study was carried out on a prospective group of 21 children presenting with hydrocele after 1 year age over a period of 2 years. All infants with hydrocele and complicated hydroceles were excluded. The technique involved peritoneal incision and sealing of hydrocele sac with tissue-sealing device. Results: A total of 21 patients (28 hydroceles) were operated. The age ranged from 1 year to 14 years (mean age, 4 years). Ten right, 4 left and 7 bilateral hydroceles (2 diagnosed on laparoscopy) were operated. Operative time ranged from 15 to 32 min, with a mean time of 18 min. All patients were discharged after a hospital stay of 12 h. No recurrences were observed during the follow-up period. One patient had persistent hydrocele for 4 months which resolved spontaneously. Conclusion: The laparoscopic suture-less herniotomy for paediatric hydrocele is a safe, secure and easy procedure which can reduce suture and suturing-related complications following LH in hydroceles.

AimAchieve an international consensus on how to recover lost training opportunities. The results of this study will help inform future EAES guidelines about the recovery of surgical training before and after the pandemic.BackgroundA global survey conducted by our team demonstrated significant disruption in surgical training during the COVID-19 pandemic. This was wide-spread and affected all healthcare systems (whether insurance based or funded by public funds) in all participating countries. Thematic analysis revealed the factors perceived by trainees as barriers to training and gave birth to four-point framework of recovery. These are recommendations that can be easily achieved in any country, with minimal resources. Their implementation, however, relies heavily on the active participation and leadership by trainers. Based on the results of the global trainee survey, the authors would like to conduct a Delphi-style survey, addressed to trainers on this occasion, to establish a pragmatic step-by-step approach to improve training during and after the pandemic.MethodsThis will be a mixed qualitative and quantitative study. Semi-structured interviews will be performed with laparoscopic trainers. These will be transcribed and thematic analysis will be applied. A questionnaire will then be proposed; this will be based on both the results of the semi structured interviews and of the global trainee survey. The questionnaire will then be validated by the steering committee of this group (achieve consensus of >80%). After validation, the questionnaire will be disseminated to trainers across the globe. Participants will be asked to consent to participate in further cycles of the Delphi process until more than 80% agreement is achieved.ResultsThis study will result in a pragmatic framework for continuation of surgical training during and after the pandemic (with special focus on minimally invasive surgery training).

There is a great thrust for improving water and sanitation facilities in the community since 2014. The present study was aimed at assessing the water and sanitation facilities among slum households in an urban area. The design was a cross-sectional study covering 750 households in an urban area in South India. Data were gathered using a structured questionnaire on the source of drinking water and sanitary facility in the households. Out of all households surveyed, 743(99.1%) were using an improved source of water for drinking and 742(98.9%) were using septic tank as their main sanitation facility. Our study concludes that most of the household in the urban slum have improved the water and sanitation facility.

Background Global surgery has recently gained prominence as an academic discipline within global health. Authorship inequity has been a consistent feature of global health publications, with over-representation of authors from high-income countries (HICs), and disenfranchisement of researchers from low-income and middle-income countries (LMICs). In this study, we investigated authorship demographics within recently published global surgery literature.Methods We performed a systematic analysis of author characteristics, including gender, seniority and institutional affiliation, for global surgery studies published between 2016 and 2020 and indexed in the PubMed database. We compared the distribution of author gender and seniority across studies related to different topics; between authors affiliated with HICs and LMICs; and across studies with different authorship networks.Results 1240 articles were included for analysis. Most authors were male (60%), affiliated only with HICs (51%) and of high seniority (55% were fully qualified specialist or generalist clinicians, Principal Investigators, or in senior leadership or management roles). The proportion of male authors increased with increasing seniority for last and middle authors. Studies related to Obstetrics and Gynaecology had similar numbers of male and female authors, whereas there were more male authors in studies related to surgery (69% male) and Anaesthesia and Critical care (65% male). Compared with HIC authors, LMIC authors had a lower proportion of female authors at every seniority grade. This gender gap among LMIC middle authors was reduced in studies where all authors were affiliated only with LMICs.Conclusion Authorship disparities are evident within global surgery academia. Remedial actions to address the lack of authorship opportunities for LMIC authors and female authors are required.

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.

Introduction: Choledochal cyst (CDC) is often associated with intrahepatic stones (IHSs) in children which necessitate their removal during excision. The endoscopic equipment needed for their clearance such as paediatric flexible cholangioscope and other advanced modalities are not freely available in resource-poor setups. We describe per-operative modified rigid cholangioscopy using rigid paediatric cystoscope for stone removal during open CDC excision. Methods: All children with CDC presenting with IHSs between January 2015 and December 2017 were included in the present study. IHSs were diagnosed by ultrasound/magnetic resonance cholangiopancreatography (MRCP). In these patients, after cyst excision by open technique, a 9 Fr paediatric cystoscope with 4 Fr working channel was inserted into the common hepatic duct for visualisation and clearance of stones from (intrahepatic bile ducts). Follow-up was done using liver function tests, ultrasound and MRCP (if needed). Patients underwent three monthly liver function test and ultrasound and if needed MRCP. Results: Six cases of CDC presenting with IHS were managed, and one case with post-R-en-Y IHS was treated with this technique. Rigid paediatric cystoscope with working channel and forceps was used. All cases were successfully managed, and one case was found to have intrahepatic duct stenosis was dilated. Conclusion: Per-operative rigid endoscopy using paediatric cystoscope is an easily available tool in most of the setups for the management of IHS associated with CDC in children.

Introduction: Since the first description by William Ladd, the Ladd's procedure has been the surgery of choice for the correction of malrotation. The laparoscopic Ladd's procedure is becoming popular with the advent of minimal access surgery and is described in the literature. Various techniques of the Ladd's procedure have been described but none of them describes the stepwise technique for derotation of volvulus which is the most difficult and confusing part of the surgery. We describe 'steering wheel' technique for easy derotation of volvulus associated with malrotation. Method: A total of 62 patients were diagnosed to have an intestinal malrotation between 2010 and 2017. All cases which had complete non-rotation with a midgut volvulus were reviewed. Out of these, 48 patients were operated with open technique and 14 patients were subjected to the laparoscopic correction. Technique: Using three-port technique, stepwise derotation of volvulus is done which simulates the rotation of steering of car at an acute turn and has been described in four simple steps. This technique also stresses the importance of the release of Ladd's band before derotation. Results: Of 62 patients diagnosed with malrotation, 14 (22.6%) patients underwent the laparoscopic Ladd's procedure. The mean age was 26 + 8 months, mean weight was 10 + 2 kg and included eight males (57%) and six females (43%). There was only one (7.14%) conversion to open technique, due to a huge dilatation of duodenum causing difficulty in dissection in a patient with malrotation without volvulus. The laparoscopic Ladd's procedure took an average time of 70 ± 15 min. Conclusion: The laparoscopic 'steering wheel' derotation technique is easy and provides a stepwise description of the laparoscopic derotation of volvulus associated with malrotation in children.

Background: Treatment adherence will help to achieve good glycemic control among diabetics and will lead to lesser complications associated with the disease. This study was carried out to determine the compliance to treatment among previously diagnosed diabetic patient and their level of glycemic control, in a rural area. Materials and Methods: This cross-sectional study was conducted among all previously diagnosed diabetics above 30 years, on treatment for more than 6 months. Nonadherence was defined as “missing more than 2 doses” in the last 15 days. Glycemic control was assessed by performing glycated hemoglobin (HbA1c). Results: Among 155 people interviewed, 140 (90.3%) were found to be compliant to the treatment. Treatment compliance was significantly associated with duration of Diabetes and age. However gender, literacy status, occupation, and socioeconomic status were not significantly associated with compliance. The most common reasons for noncompliance was the asymptomatic nature of the disease (60%) and the high cost of treatment (33.3%). Forty-two percent of participants were found to have poor glycemic control (HbA1c >8%). Conclusion: Treatment compliance was found to be good among diabetic patients. The treatment compliance increases with increase in the duration of the disease. Many have poor glycemic control, which is a matter of concern. They need more regular follow-up to adjust the treatment label for better glycemic control.

Introduction: During postpartum period women are at high risk for developing episodes of depression. Postnatal depression (PND) is a major public health issue because of its adverse effects on the infant and entire family. Objective: To find the prevalence of PND among postnatal(PN) women in Singupuram rural health training centre(RHTC) area, Srikakulam district, Andhra Pradesh and to find association between socio-demographic, obstetric and pregnancy outcomes and PND. Method: Sampling Method- Non-probability convenient sampling. This cross-sectional study was carried out among PN women (4th-10th week) in Singupuram RHTC area, Srikakulam district during May to August 2019. Details were collected using a pre-tested semi-structured questionnaire pertaining to socio-demographic profile, obstetric and pregnancy outcomes along with an Edinburg Postnatal Depression Scale (EPDS) translated into local language (telugu) cut-off score of ≥13 was used as high risk of PND. Result: The study included 229 PN women. Prevalence of PND was 28.3%. PND showed significant association (p

Background: Many treatment modalities are available for the treatment of ischemic ulcers in Buerger's disease (thromboangiitis obliterans [TAO]). Objectives: The objective of the study was to evaluate the efficacy and clinical outcome of autologous platelet-rich plasma (PRP) for the treatment of ischemic ulcers in TAO patients. Methods: This prospective observational study was conducted on selected TAO patients who underwent autologous PRP treatment in surgery department of a teaching hospital in Central India. Diagnosis of TAO was made on clinical grounds and Color Doppler study. Autologous PRP was injected subcutaneously around the area of ulcer on day 0 and then on the 5th and 10th day. Results were noted on day 1, day 5, day 10, and on day 15. Outcome monitored was improvement in pain (using visual analog scale) and healing of ischemic ulcers. Results: All 14 patients were males, chronic smokers, and most of the patients were in the 4th decade of life. All had involvement of lower limbs; one had upper limb ischemia as well. All patients had ischemic ulcers. Pain relief, as measured with visual analog scale score, was good; most of the patients had 50% relief within 24 h of injecting PRP, which persisted/continued to improve on days 5, 10, and 15. Similarly, ulcer healing showed improvement on days 5, 10, and 15. Conclusions: PRP can provide efficient treatment for pain and healing of ischemic ulcers in TAO patients.

Introduction: Accurate assessment of burn wound depth is important because it determines the choice of treatment and prognosis. Clinical evaluation remains the most commonly used modality with its accuracy varies from 50% to 70%. This study was conducted to assess the accuracy and feasibility of burn wound depth using noninvasive noncontact technique using infrared thermometry. Materials and Methods: Fifteen patients' burn wounds depth was classified clinically into full-thickness, deep partial-thickness, or superficial partial-thickness burns. Thermometry was performed on 3rd day of burn injury using the handheld infrared thermometer. A punch biopsy was taken from all three areas (deep, deep-partial, and superficial-partial burns). A correlation between surface temperature and depth of burn by histopathology was done. Results: 12/15 patients total burn surface area (TBSA < 65%) survived and three patients (TBSA > 65%) died. In 11/12survivors, thermometry correctly predicted final burn depth. One of 12 burns superficial burn was wrongly assessed clinically as full thickness but was correctly classified by thermometry and healed within 21 days without surgery. 3/12 burns on clinical assessment thought to be superficial were deep; two were correctly predicted by thermometry. Conclusions: Handheld infrared thermometer can be used in conjunction with clinical examination to improve the efficacy of burn wound depth assessment.

Introduction: Laparoscopic management of giant hydatid cyst has limitations such as spillage, poor control, difficulties in suctioning the contents through special ports which are not easily available, difficulty in the obliteration of residual cavity and recurrence. We describe single-incision trocar-less endoscopic (SITE) technique which simplifies enucleation and management of residual cavity. Method: Inclusion criteria for these cases were patients having single uncomplicated giant hydatid cyst >5 cm present at the surface of the liver and palpable on clinical examination. The cysts which were

Objectives: The objective of this study was to evaluate the efficacy, safety, and clinical outcome of percutaneous chemical lumbar sympathectomy (PCLS) in Buerger's disease (thromboangiitis obliterans [TAO]). Design: This was a retrospective comparative study. Methods: TAO patients who underwent PCLS in surgery department of a teaching hospital in Central India. Diagnosis of TAO was made on clinical grounds and color Doppler study. PCLS was done under image guidance after amputation of gangrene or before if a clear line of demarcation was lacking. After PCLS, patients were followed up on next day and after 2, 4, 8, and 12 weeks. Outcome monitored were improvement in rest pain (using visual analog scale) and healing of ischemic ulcers. Results: All patients were males, chronic bidi smokers, mostly in the third decade of life. All had involvement of lower limbs either ischemic rest pain or ischemic ulcers or gangrene of toes/forefoot. A total of 167 PCLS (20 bilateral) were performed on 147 TAO patients from June 2008 to January 2016. Imaging modalities were computed tomography scan (n = 67), digital X-ray (n = 50), and C-arm fluoroscopy (n = 50). Success rate for chemical neurolysis was > 82%. Excellent long-lasting rest pain relief was obtained in > 80% patients. Ulcer healing was seen in majority of patients. Large number of limbs (103/167) had gangrene of toe/multiple toes/part of forefoot. Those with patent popliteal artery fared better. Conclusions: PCLS can provide safe and efficient treatment for rest pain and healing of ischemic ulcers in TAO.

Introduction: Gastrocnemius muscle is a workhorse flap to cover upper third tibial defects but has a limitation in covering middle one-third tibial defects. The inferiorly based hemi gastrocnemius muscle flap can be useful for reconstruction of the middle third of the leg. The arterial communication between the gastrocnemius muscle heads has been demonstrated, the consistent location, however, was not studied in large specimens. Materials and Methods: This study was conducted on sixty specimens of gastrocnemius muscles harvested from thirty fresh cadavers to determine arterial communication between two heads of gastrocnemius muscle using radio-opaque contrast with future application of taking one head of muscle distally based for coverage of middle third defect of tibia. A total of 60 specimens were obtained from thirty fresh cadavers. In thirty specimens, medial sural artery ligated and divided and 20 ml iohexol (350) given through popliteal artery. In remaining thirty specimens lateral sural artery ligated and divided and 20 ml iohexol (350) given through popliteal artery. Digital X-rays of gastrocnemius muscle specimens were taken, and collaterals between two bellies in lower half were noted and the distance of collaterals from the muscles top edge was also noted. Results: We found the communications between both bellies of the gastrocnemius muscle in all specimens in both legs. The mean distance of communications from the upper edge of the medial belly was 15.88 cm and from upper edge of the lateral belly was 14.72 cm in the right leg, respectively. The mean distance of communications from upper edge of the medial belly was 16.01 cm and from upper edge of the lateral belly was 13.78 cm in the left leg. The distal communications between gastrocnemius bellies were not constant in their location, but all the connections were present in distal 3.79 cm of raphe. Conclusion: This study supports the future application of inferior-based hemigastrocnemius muscles flap to cover defects of middle third leg. When distally based hemigastrocnemius flap is planned roughly 1/3rd of distal attachment or distal 3.79 cm of connection between raphe should be maintained to preserve the vascular communications between the two bellies.

Introduction: Early appendicectomy has been found to be a safe and better alternative for management of appendicular mass in various studies in adults, while very few studies report such advantages in the paediatric population. We conducted this study to assess the safety, efficacy and need of early laparoscopic appendicectomy (ELA) in child patients with appendicular mass. Materials and Methods: All patients with appendicular mass who underwent ELA at our institute between September 2011 and August 2014 were retrospectively reviewed. Appendicular mass was defined as a right iliac fossa mass in a case of acute appendicitis, diagnosed by clinical, laboratory and radiological evaluation, and palpation under anaesthesia, the patient being subjected to laparoscopic treatment. Results: Forty-eight (48) patients were confirmed to have appendicular mass intraoperatively and were included in the analysis. There were 30 males and 18 females, with ages ranging 7-13 years (mean 9 years). In the present study, appendicular complications included appendicular abscess (62.5%), gangrenous appendicitis (25%), sloughed-out appendix (8.33%) and appendicular perforation (4.16%). The average operative time was 72 min (range 45-93 min). One case (1.92%) required conversion to open procedure due to failure of identification of the appendicular base of a sloughed-out appendix. Post-operative complications were found in 4 (7.69%) patients, of whom 3 (5.76%) had minor wound infection at the umbilical port site and 1 (1.92%) had post-operative pelvic abscess, which was managed with percutaneous aspiration. Discussion: ELA avoids misdiagnosis, treats complicated appendicitis at its outset, and avoids complications and/or failure of non-operative treatment of a potentially lethal, diseased appendix. This approach is associated with minimal complications in experienced hands and is a safe and feasible option in children with appendicular mass.

Introduction: Cataract surgeries have brought about a significant improvement in visual acuity in the patients. This study tried to find the improvement in the general and visual quality of life after cataract surgery apart from the improvement in visual impairment. Method: In this prospective study, 231 patients above the age of 50 years who underwent cataract surgery between February 2008 and January 2009 were followed up after six month of surgery. Both vision related quality of life and generic health related quality of life was assessed using WHO/PBD VF 20 and EuroQol (EQ-5D) questionnaire respectively. Results: Out of 231 participants, 204 could be followed up at six months. The proportion of people with a visual acuity of > 6/60 increased from 10.8% to 85.8%. Overall vision related quality of life improved significantly (p

Systemic lymphadenectomy for carcinoma of the oesophagus and stomach is increasingly accepted as effective surgical treatment. A review of available literature reveals a great variety in the number of lymph nodes removed during standard lymphadenectomy. The present study was conducted to find the normal number of lymph nodes in the Indian population in relation to lymphadenectomy for oesophageal and gastric carcinoma. Methods: Lymph nodes situated at stations 1-16, relevant to lymphadenectomy for gastric cancer, were removed by lymph node dissection according to the recommendations of the Japanese Research Society for Gastric Cancer and those at the 22 stations, relevant to lymphadenectomy in oesophageal cancer, were removed according to the International Society for Diseases of the Esophagus recommendations in 10 cadavers without a history of any abdominal pathology or haematological lymphatic disease. Nodes were cleared by dissolving fatty tissue. All lymph nodes were histologically confirmed and the diameter of each lymph node was recorded. Results: An average of 52.0 nodes (range, 37-78 nodes) was found at Stations 1-16, while an average of 183.6 nodes (range, 118-234 nodes) was found at the 22 stations. These numbers are higher than those in the literature. Conclusion: This anatomical study addresses the dual issues of determining the number of dissectable lymph nodes in a particular population as well as assessing the quality of nodal dissection by providing quantitative surgical guidelines.

Intraoperative cardiovascular instability is frequently observed during blunt finger dissection for transhiatal oesophagectomy. We conducted a prospective study using a metal ring dissector for blunt dissection of the oesophagus to overcome this problem. Methods: Dissection with a metal ring dissector was used in 30 consecutive patients undergoing transhiatal oesophagectomy for carcinoma of the lower oesophagus (n = 26) and oesophagogastric junction (n = 4). Results: Dissection of the oesophagus proximal to the growth was quick and straightforward in all instances. The procedure appeared less traumatic than the conventional manual technique and was not associated with any intraoperative cardiovascular instability or intramediastinal bleeding. None of the patients had tracheal injury or recurrent laryngeal nerve paralysis. There was one anastomotic leak and no deaths. Conclusion: Oesophageal blunt dissection with a metal ring dissector is safe, easy and quick. The correct plane of dissection minimizes the risk of intramediastinal bleeding and inadvertent trauma to neighbouring structures.