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With majority of the medical journals having a rejection rate of more than 80% of submitted manuscripts, it does come as a shock and grief to the author who had a lot of expectations before submission. Though most of the literature available does mention how to overcome the lacunae in the manuscript before considering resubmission in another journal, none addresses the mental agony and setback the author faces and the way to overcome this setback. Every author should develop immunity and be adequately mentally prepared to overcome this misery. A question- answer session between an eager enthusiastic author, a highly experienced reviewer, and the final authority Editor is presented for guidance.

Anal fistula can be a challenging condition to manage, with complex fistulas presenting even greater difficulties. The primary concerns in treating this condition are a risk of damage to the anal sphincters, which can compromise fecal continence, and refractoriness to treatment, as evidenced by a high recurrence rate. Furthermore, the treatment of complex anal fistula involves several additional challenges. Satisfactory solutions to many of these obstacles remain elusive, and no consensus has been established regarding the available treatment options. In summary, complex anal fistula has no established gold-standard treatment, and the quest for effective therapies continues. This review discusses and highlights groundbreaking advances in the management of complex anal fistula over the past decade.

Mesodiverticular band associated with Meckel’s diverticulum can lead to surgical emergencies like intestinal obstruction or volvulus and may prove fatal as this pathology is quite rare, it may escape the clinical diagnosis. This band needs to be excised during emergent laparotomy along with Meckel’s diverticulectomy. A high level of clinical suspicion and surgical acumen is required to manage this rare condition and have an uneventful recovery of the patient.

Ainhum is an extremely rare and challenging case where there is development of a constricting ring along the digits leading to autoamputation. As rare case .it is being reported from India as not many literatures on this case from this part of the continent.

Phytobezoar causing acute intestinal obstruction is a rare event. A case of accidental ingestion of mango seed causing intestinal obstruction is being reported requiring surgical intervention to extract the mango seed from the ileum. This condition must be kept in mind during the mango season while dealing with a case of intestinal obstruction in an emergency.

Giant subpectoral lipoma is an extremely rare case that can occasionally turn malignant. We highlight this case for the first time from India.

Scrolling smartphones while sitting on the toilet is believed to be one of the reasons predisposing to haemorrhoidal disease. Not much is written about the problem of the use of smartphones and the development of haemorrhoidal disease in the literature, but the rising incidence of haemorrhoids globally does require guidelines to be set for toilet hygiene, especially in the young generation to prevent this issue from becoming an epidemic in future. It may be time to designate the washroom as a smartphone-free zone.

Pilonidal sinus disease (PSD) is a chronic inflammatory disease affecting the soft tissue of the sacrococcygeal region and remains a challenging disease for surgeons to treat. With controversies in management to prevent recurrence leading to economic burden to the patient, these cases require special care by expert surgeons. From Jan 2023 to Nov 2023, 10 patients with pilonidal sinus were treated with complete excision of the tract and reconstruction using a rhomboid flap. The factors evaluated included the duration of surgery, postoperative pain, length of hospital stay, and postoperative complications. The patients were followed up on an outpatient basis, monthly for the first three months. The majority of the patients were young males with a mean age of 28 years. The surgery time was 40 to 75 minutes, and the mean operation time was 55 minutes. The stitches were removed after 2 weeks. Among complications, two patients developed mild discharge with infection. In one patient, necrosis at the tip of the flap was noted. We recommend the Rhomboid flap as a method of choice for surgical management of Pilonidal sinus in a postgraduate medical college as it is easy to teach, learn, and perform and gives complete recovery of the patient with negligible recurrence rate.

Umbilicus is a rare site of endometrioma. Spontaneous or primary umbilical endometrioma are still rarer. A 41years old primipara presented with 1.5 years history of nodular umbilical swelling with cyclical pain and increase in size occurring more pronounced during menses with no prior history of any abdominal surgery or procedure or abdominal trauma. Clinical history gave a likely possibility of umbilical endometrioma. Surgical excision was done as she had not responded to prior hormonal treatment and histopathology confirmed the diagnosis.

Aims and objective: The main aim of this study was to employ non-invasive methodologies, such as evaluating the portal vein diameter (PVD) and the size of the spleen, as well as the ratio of platelet count to splenic length, in order to identify individuals with cirrhosis who are at a heightened risk of developing esophageal varices. Materials and Methods: The present study utilized a descriptive analysis methodology to investigate a cohort of 50 individuals who received a diagnosis of liver cirrhosis. The individuals, ranging in age from 35 to 70 years, were subjected to both ultrasonography and upper gastrointestinal endoscopy. The statistical analysis was performed utilizing the one-way analysis of variance (ANOVA) and chi-square tests within the Stata 14 software. Results: In the sample of 50 patients, it was shown that 23 individuals (46%) demonstrated a PVD greater than 12mm. Additionally, a statistically significant correlation was observed between an increase in PVD and a rise in variceal grading. Additionally, it was noted that a total of 31 individuals, including 62% of the sample, displayed a splenic size above 13 cm. Nevertheless, no statistically significant positive connection was observed between the increase in splenic size and the grading of varices. The positive predictive value of a platelet count/spleen length ratio less than 909 is 100%. Conclusion: The application of ultrasound-guided measurement of PVD exceeding 12.0 mm and splenic size exceeding 13.0 cm can be considered a dependable and independent approach for predicting the presence of varices in persons with a diagnosis of cirrhosis. The reliability of predicting esophageal varices is higher when using the platelet count/spleen length ratio of less than 909, as opposed to relying solely on spleen size. However, in cases where there has been no previous instance of gastrointestinal bleeding, it is recommended to consider the use of surveillance endoscopy if any of these predictors are identified in individuals with cirrhosis.

Retroperitoneal cystic tumours often cause a diagnostic dilemma and present several clinical challenges because of their rarity, relative late presentation, anatomical location, close relationship with several vital structures in the retroperitoneal space and the surgical expertise required for the management. We present three challenging retroperitoneal cystic space occupying lesions – hydatid cyst, dermoid cyst, and cystic lymphangioma. All 3 cases underwent surgery after initial diagnostic difficulty and had smooth postoperative recovery. Retroperitoneal cyst needs surgical expertise for complete excision which is often difficult due to neighbouring important vital anatomical structures.

Aims and Objectives: The study aimed to assess the efficacy of incisional negative pressure wound therapy (iNPWT) in reducing the risk of suture site infections (SSI) in patients undergoing post-operative emergency non-traumatic laparotomy. Materials and Methods: A cross-sectional observational prospective study was conducted in a tertiary care setup in a rural area between March 2018 and July 2018. Fifty emergency exploratory laparoto-mies performed for non-traumatic reasons were included. Patients were randomized into two groups: one receiving conventional povidone-iodine dressing and the other receiving iNPWT over the main wound. After 7 days, SSI was assessed using the center for disease control and prevention's criteria. Results: iNPWT demonstrated a significant reduction in the risk of SSI development when compared to conventional povidone-iodine dressing (p

Abstract In this paper we investigate a non-minimal, space-time derivative dependent, coupling between the k-essence field and a relativistic fluid using a variational approach. The derivative coupling term couples the space-time derivative of the k-essence field with the fluid 4-velocity via an inner product. The inner product has a coefficient whose form specifies the various models of interaction. By introducing a coupling term at the Lagrangian level and using the variational technique we obtain the k-essence field equation and the Friedmann equations in the background of a spatially flat Friedmann–Lemaitre–Robertson–Walker (FLRW) metric. Explicitly using the dynamical analysis approach we analyze the dynamics of this coupled scenario in the context of two kinds of interaction models. The models are distinguished by the form of the coefficient multiplying the derivative coupling term. In the simplest approach we work with an inverse square law potential of the k-essence field. Both of the models are not only capable of producing a stable accelerating solution, they can also explain different phases of the evolutionary universe.

Background The treatment of keloidal scars with radiotherapy has been practiced for more than a century. Radiotherapy post-surgery has been deemed necessary and effective in preventing recurrence but still, no clear guidelines exist as to the best modality of radiotherapy, the ideal dose, and the time it should be given for keloidal scars. The purpose of this study is to confirm the effectiveness of this treatment and address these issues. Methods Since 2004, 120 patients presenting with keloidal scars were seen by the author. Out of them, 50 were managed with surgery followed by HDR brachytherapy/electron beam radiotherapy delivering 2000 rads to the scar within 24 hours of surgery. Patients were followed up for at least 18 months to assess the scar status and the recurrence of keloids. Recurrence was defined as the appearance of a nodule or an obvious return of the keloid within 1 year of treatment. Results Three patients developed a nodule in the scar, which was deemed a recurrence, making an incidence of 6%. There was no major problem after immediate postoperative radiotherapy. Five patients had delayed healing at 2 weeks and a hypertrophic scar was noted in five patients at 4 weeks that settled with conservative measures. Conclusion Treating the vexing problem of keloids with surgery and immediate postoperative radiotherapy is safe and effective. We recommend that this be adopted as the standard treatment in keloid management.

Cells are exposed to a wide variety of internal and external stresses. Although many studies have focused on cellular responses to acute and severe stresses, little is known about how cellular systems adapt to sublethal chronic stresses. Using mammalian cells in culture, we discovered that they adapt to chronic mild stresses of up to two weeks, notably proteotoxic stresses such as heat, by increasing their size and translation, thereby scaling the amount of total protein. These adaptations render them more resilient to persistent and subsequent stresses. We demonstrate that Hsf1, well known for its role in acute stress responses, is required for the cell size increase, and that the molecular chaperone Hsp90 is essential for coupling the cell size increase to augmented translation. We term this translational reprogramming the ‘rewiring stress response’, and propose that this protective process of chronic stress adaptation contributes to the increase in size as cells get older, and that its failure promotes aging.

Cadavers have been used for dissection to learn the basics of anatomy since the 3rd century BC. Even today freshly admitted medical students are first taken to the Anatomy dissection hall to learn from cadavers and get an understanding of the enormity of the profession they chose. Most institutes have teachers explaining to the freshers what their reaction should be on seeing a cadaver and how it is to be treated. Some institutes make students take a cadaveric Oath. Today, the cadaver is not just an anatomy learning tool, but has far more uses in surgical basic and advanced training and enhancing our knowledge of medicine. And cadaver transplantation is a common practice now. With many places finding it difficult to access cadavers now, due to human rights issues, it is very important for the medical community to not only adopt but showcase to the world that they respect and acknowledge the role of a cadaver in both diagnostic and therapeutic modality. And frame a strong, uniform Cadaveric Oath to be taken by all medical students to emphasize that.

The molecular chaperone Hsp90 decreases with age but whether organisms can physiologically tune expression is unclear. Here, the authors show that mammalian cells can adjust Hsp90 levels to accumulating cellular stress by translational reprogramming.

Hop, also known as Stip1 or Sti1, facilitates substrate transfer between the Hsp70 and Hsp90 molecular chaperones. Characterization of proteostasis-related pathways in STIP1 knock-out cell lines reveals that in eukaryotes Stip1 modulates the balance between protein folding and degradation.

In this article, we try to determine the conditions when a ghost field, in conjunction with a barotropic fluid, produces a stable accelerating expansion phase of the universe. It is seen that, in many cases, the ghost field produces a condensate and drives the fluid energy density to zero in the final accelerating phase, but there can be other possibilities. We have shown that a pure kinetic k-essence field (which is not a ghost field) interacting with a fluid can also form an interaction-induced condensate and produce a stable accelerating phase of the universe. In the latter case, the fluid energy density does not vanish in the stable phase.

The coronavirus, which is causing the ongoing Covid-19 pandemic and has crippled the entire world, was discovered by June Dalziel Almeida - a school dropout from Scotland who had no formal medical education. She had to master the knowhow of immune electron microscopy to climb up the academic ladder and she finally discovered the coronavirus only to see her research paper getting rejected by reputed journals. A single mother is now associated with the coronavirus, as well as with a significant contribution to the classification of viruses, viral imaging and bringing Rubella virus, Hepatitis B virus and Human immunodeficiency virus into the limelight.

COVID-19 pandemic mandates all the laparoscopic surgeons to don the personal protective equipment (PPE) to prevent getting infected in the operation theatre. PPE has few inherent problems which makes the surgery extremely challenging for all the surgeons. Dehydration and profuse sweating along with breathing difficulty due to N95 mask with PPE increases the chances of committing surgical error during laparoscopy.

The molecular chaperone Hsp90 is an essential and highly abundant central node in the interactome of eukaryotic cells. Many of its large number of client proteins are relevant to cancer. A hallmark of Hsp90-dependent proteins is that their accumulation is compromised by Hsp90 inhibitors. Combined with the anecdotal observation that cancer cells may be more sensitive to Hsp90 inhibitors, this has led to clinical trials aiming to develop Hsp90 inhibitors as anti-cancer agents. However, the sensitivity to Hsp90 inhibitors has not been studied in rigorously matched normal versus cancer cells, and despite the discovery of important regulators of Hsp90 activity and inhibitor sensitivity, it has remained unclear, why cancer cells might be more sensitive. To revisit this issue more systematically, we have generated an isogenic pair of normal and oncogenically transformed NIH-3T3 cell lines. Our proteomic analysis of the impact of three chemically different Hsp90 inhibitors shows that these affect a substantial portion of the oncogenic program and that indeed, transformed cells are hypersensitive. Targeting the oncogenic signaling pathway reverses the hypersensitivity, and so do inhibitors of DNA replication, cell growth, translation and energy metabolism. Conversely, stimulating normal cells with growth factors or challenging their proteostasis by overexpressing an aggregation-prone sensitizes them to Hsp90 inhibitors. Thus, the differential sensitivity to Hsp90 inhibitors may not stem from any particular intrinsic difference between normal and cancer cells, but rather from a shift in the balance between cellular quiescence and activity.

In this work, we present some cosmologically relevant solutions using the spatially flat Friedmann-Lemaitre-Robertson-Walker (FLRW) spacetime in metric f ( R ) gravity where the form of the gravitational Lagrangian is given by 1 α e α R . In the low curvature limit this theory reduces to ordinary Einstein-Hilbert Lagrangian together with a cosmological constant term. Precisely because of this cosmological constant term this theory of gravity is able to support nonsingular bouncing solutions in both matter and vacuum background. Since for this theory of gravity f ′ and f ″ is always positive, this is free of both ghost instability and tachyonic instability. Moreover, because of the existence of the cosmological constant term, this gravity theory also admits a de-Sitter solution. Lastly we hint towards the possibility of a new type of cosmological solution that is possible only in higher derivative theories of gravity like this one.

The goal of cancer chemotherapy to induce multi-directional apoptosis as targeting a single pathway is unable to decrease all the downstream effect arises from crosstalk. Present study reports that Withanolide D (WithaD), a steroidal lactone isolated from Withania somnifera, induced cellular apoptosis in which mitochondria and p53 were intricately involved. In MOLT-3 and HCT116p53+/+ cells, WithaD induced crosstalk between intrinsic and extrinsic signaling through Bid, whereas in K562 and HCT116p53-/- cells, only intrinsic pathway was activated where Bid remain unaltered. WithaD showed pronounced activation of p53 in cancer cells. Moreover, lowered apoptogenic effect of HCT116p53-/- over HCT116p53+/+ established a strong correlation between WithaD-mediated apoptosis and p53. WithaD induced Bax and Bak upregulation in HCT116p53+/+, whereas increase only Bak expression in HCT116p53-/- cells, which was coordinated with augmented p53 expression. p53 inhibition substantially reduced Bax level and failed to inhibit Bak upregulation in HCT116p53+/+ cells confirming p53-dependent Bax and p53-independent Bak activation. Additionally, in HCT116p53+/+ cells, combined loss of Bax and Bak (HCT116Bax-Bak-) reduced WithaD-induced apoptosis and completely blocked cytochrome c release whereas single loss of Bax or Bak (HCT116Bax-Bak+/HCT116Bax+Bak-) was only marginally effective after WithaD treatment. In HCT116p53-/- cells, though Bax translocation to mitochondria was abrogated, Bak oligomerization helped the cells to release cytochrome c even before the disruption of mitochondrial membrane potential. WithaD also showed in vitro growth-inhibitory activity against an array of p53 wild type and null cancer cells and K562 xenograft in vivo. Taken together, WithaD elicited apoptosis in malignant cells through Bax/Bak dependent pathway in p53-wild type cells, whereas Bak compensated against loss of Bax in p53-null cells.

Visceral leishmaniasis (VL) caused by the intracellular parasite Leishmania donovani accounts for an estimated 12 million cases of human infection. It is almost always associated with anemia, which severely complicates the disease course. However, the pathological processes leading to anemia in VL have thus far not been adequately characterized to date. In studying the glycosylation patterns of peripheral blood cells we found that the red blood cells (RBC) of VL patients (RBC(VL)) express eight 9-O-acetylated sialoglycoproteins (9-O-AcSGPs) that are not detected in the RBC of healthy individuals (RBC(N)). At the same time, the patients had high titers of anti-9-O-AcSGP IgG antibodies in their sera. These two conditions appear to be linked and related to the anemic state of the patients, as exposure of RBC(VL) but not RBC(N) to anti-9-O-AcSGPs antibodies purified from patient sera triggered a series of responses. These included calcium influx via the P/Q-type but not L-type channels, activation of calpain I, proteolysis of spectrin, enhanced oxidative stress, lipid peroxidation, externalization of phosphatidyl serine with enhanced erythrophagocytosis, enhanced membrane fragility and, finally, hemolysis. Taken together, this study suggests that the enhanced hemolysis is linked to an impairment of membrane integrity in RBC(VL) which is mediated by ligand-specific interaction of surface 9-O-AcSGPs. This affords a potential explanation for the structural and functional features of RBC(VL) which are involved in the hemolysis related to the anemia which develops in VL patients.