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Climate change affects each and every one of us and has far reaching consequences. As healthcare providers and responsible citizens, it is our duty to make our practices environmentally sustainable. Endoscopy practice involves frequent use of single-use items, resource-heavy decontamination practices, water consumption, patient and staff travel as well as high electricity consumption. The present review highlights the measures that can be taken to reduce the carbon footprint of endoscopy practice. Proper waste management, judicious use of electricity, proper selection of cases for anesthesia and biopsy, and appropriate use of noninvasive tests in practice are discussed in the review.

This study examines the linkages between technological green innovations, financial performance and investor enthusiasm in listed Indian manufacturing firms, a context under-represented in extant literature. It aims to address the gap in understanding how investor enthusiasm drives the adoption of green innovation practices and their subsequent impact on financial performance. Moreover, the study investigates the moderating effects of green image and green production incentives, providing comprehensive insights into adopting environmentally sustainable practices. Using a quantitative analysis approach, the research uncovers that green process innovation positively influences green product innovation, contributing to financial performance and investor enthusiasm. However, it also reveals that macroeconomic factors and consumer purchasing power challenge green process innovation. Unexpectedly, no empirical evidence supports the moderation effect of green image between green production incentives and investor enthusiasm. Overall, the study contributes to a better understanding of the complex interplay between green innovation, financial performance and investor enthusiasm in the Indian manufacturing context. The findings hold significant implications for practitioners, policymakers and investors towards fostering a more sustainable future for the Indian manufacturing sector. Future research directions include further exploring dynamic relationships, incorporating other types of green innovations, and considering additional metrics for financial performance and investor enthusiasm.

Abstract The spatial and temporal distribution of Alpine snow is a sensitive gauge of environmental change. While understanding past snow dynamics is essential for reconstructing past climate and forecasting future trends, reliable snowpack data prior to the instrumental record are scarce. We present a novel pairing of cosmogenic paleothermometry and luminescence photochronometry which constrain the temperature and insolation history of bedrock outcrops at the Gotthard Pass, Switzerland, over the last ∼15,000 years. By coupling these results with cosmogenic 14C‐10Be chronology and modern in situ rock thermometry, we infer a ∼70‐day reduction of snowpack at the topographic mid‐slope. Our data indicate stable environmental conditions throughout the Holocene, followed by a 6.6 ± 2.9°C increase of ground surface temperature, coeval with an order‐of‐magnitude or more increase in ground surface insolation. Bracketing the onset of these changes between 1504 and 1807 CE, our findings tie the snowpack decline with the onset of human industrialization.

This study examines the relationship between industry concentration and financial performance among Indian-listed firms across various industries. Using a sample of over 2,078 firms from 29 distinct sectors, Herfindahl-Hirschman Index for each company and industry was calculated and categorized into high, medium and low-concentration industry categories. To ensure representativeness and data reliability, 1,583 small companies with HHI scores below 0.6 were excluded from the analysis at the stage of comparative analysis after calculating the industry-wise concentration. The remaining 495 firms were classified and compared using the Student and Welch t-test across three industry concentration groups: high versus medium, medium versus low and high versus low. The findings revealed heterogeneous relationships between industry concentration and financial performance across various ratios. For instance, return on equity (ROE) and return on assets (ROA) demonstrated a positive relationship with concentration levels, whereas liquidity and solvency ratios showed mixed results. Operating performance, dividend and valuation ratios displayed an inconclusive pattern. These results provide valuable insights into the complex concentration-performance nexus and offer valuable theoretical and managerial implications. This study contributes to the existing literature by addressing research gaps and inconsistencies concerning the concentration-performance relationship in the context of emerging markets. Additionally, the study offers valuable information to policymakers, investors and managers seeking to better understand the impact of industry concentration on firm performance.

Abstract Understanding light propagation and attenuation in cavities is limited by lack of applicable light sensing technologies. Here we demonstrate the use of light-sensitive metastable states in wide bandgap aluminosilicates (feldspar) as passive optical sensors for high-resolution mapping of light flux. We develop non-destructive, infrared photoluminescence (IRPL) imaging of trapped electrons in cracks as thin as 50 µm width to determine the spatio-temporal evolution of light sensitive metastable states in response to light exposure. Modelling of these data yields estimates of relative light flux at different depths along the crack surfaces. Contrary to expectation, the measured light flux does not scale with the crack width, and it is independent of crack orientation suggesting the dominance of diffused light propagation within the cracks. This work paves way for understanding of how light attenuates in the minutest of cavities for applications in areas as diverse as geomorphology, biology/ecology and civil engineering.

Introduction: Depression is the leading cause of disease-related disability among women in the world today. Depression is a serious condition that can impact every area of women’s life. It affects social life, family relationships, career, and one’s sense of selfworth and purpose. Objective: To determine the prevalence and associated risk factors of depression among rural housewives aged 18–59 years. Method: A community based cross sectional study was carried out among 414 housewives in rural field practice area of Department of Community Medicine, Jhalawar Medical College, Jhalawar, Rajasthan. Participants were selected by simple random sampling technique. A pre designed semi structured proforma was used for collecting information on socio-demographic characteristics, medical history, family problems, personal history and obstetrical and gynecological history. Assessment of depression was done by using self-reported instrument Patient Health Questionnaire-9 (PHQ-9) Results: Out of 414 Housewives, 63 (15.2%) were found to have depression. With increasing education level, there was a declining trend toward depression. Significantly higher rates of depression were observed among housewives reporting any debilitating ailments in one or more family members (31.2%), some unusual events occurred in family in past (56.2%), presence of any addiction in family members (22.7%) and debt on family (58.8%). Marriage at early age, having first pregnancy at early age, more than two children, menstrual irregularities and suffering from unable to conceive or infertility were the biological factors significantly associated with depression. Conclusion: Prevalence of depression was high among housewives in rural community. Many social and biological factors were contributing towards high rate of depression among housewives.

Introduction: Management of renal calculus in a patient of chronic kidney disease (CKD) is always challenging. Treatment options include extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy (PCNL). With PCNL being gold standard for renal calculus .1.5 cm in normal kidneys, we aimed to analyze the safety and efficacy of PCNL in CKD patients with calculus .1.5 cm. Materials and Methods: Sixty patients of CKD with renal calculus were included in the study: Group A with glomerular filtration rate (GFR) ≤30 ml/min/m2 and Group B with GFR >30

Purpose: Head tilt associated with infantile nystagmus syndrome (INS) can be corrected by (a) operating the oblique muscles, (b) horizontally transposing the vertical rectus muscles, or (c) vertically transposing the horizontal rectus muscles. We report three cases of INS with head tilt corrected by vertically transposing the horizontal rectus muscles in both the eyes. Methods: Three cases of head tilt with INS from an institutional practice operated by a single surgeon were retrospectively reviewed and analyzed. The intervention included full tendon width transposition (upward or downward) of all four horizontal rectus muscles to induce cyclotorsion in the direction of head tilt. The primary outcome measure was the correction of head tilt in the primary position. Results: Three patients (boys) of ages ranging from 4 to 7 years with a pre-operative head tilt of 30° were operated upon. Although one patient's oblique muscles had been operated on to correct head tilt, another patient had an unmasked face turn after the surgery, which was corrected with a modified Anderson's procedure. Post-operatively, all patients had a reduction of head tilt to a range of 0–10°. Conclusion: Vertical transposition of horizontal rectus muscles is a simple surgical option to correct head tilt in INS. However, the results may vary based on individual cases.

Background: Ideal bilio-pancreatic limb (BPL) length is a highly debatable issue in one anastomosis gastric bypass (OAGB). Whether to use a tailored BPL or a fixed-length BPL needs to be answered. Materials and Methods: One-hundred and one patients who have undergone tailored OAGB based on basal metabolic index (BMI) and type 2 diabetes mellitus (T2DM) were analysed. Sixty-three patients had BPL of 150 cm and 38 patients had BPL of 180 cm. Mean pre-operative BMI of BPL 150 and 180 cm groups were 39.73 and 51.92 kg/m2, respectively. Results: There was a significant drop in mean total body weight, BMI and excess body weight of both the groups at 1 year which persisted for 5 years post-operatively. The mean BMI of BPL 150 and BPL 180 cm group at 5 years was 29.17 and 32.88 kg/m2, respectively. Although mean percentage excess weight loss (%EWL) and percentage of excess BMI loss in the two groups was similar, the mean percentage total weight loss (%TWL) was significantly higher for the BPL 180 cm group. There was no difference between the two groups in the number of patients who had >50% EWL and >20% TWL. At 5 years of follow-up, the mean serum iron level was significantly low in BPL 180 cm group. There was a significant drop in mean haemoglobin A1c values postoperatively, with no difference between the two groups. Conclusions: Tailored BPL of 150 and 180 cm do not show any difference in the number of patients achieving >50% EWL or >20% TWL and so increasing limb length may not increase the number of good responders for weight loss. Although the resolution of T2DM and improvement of QoL score do not change significantly with increase in BPL length, mean serum iron levels may be lower with longer BPL.

Magnetic Resonance Imaging (MRI) is the most commonly used non-intrusive technique for medical image acquisition. Brain tumor segmentation is the process of algorithmically identifying tumors in brain MRI scans. While many approaches have been proposed in the literature for brain tumor segmentation, this paper proposes a lightweight implementation of U-Net. Apart from providing real-time segmentation of MRI scans, the proposed architecture does not need large amount of data to train the proposed lightweight U-Net. Moreover, no additional data augmentation step is required. The lightweight U-Net shows very promising results on BITE dataset and it achieves a mean intersection-over-union (IoU) of 89% while outperforming the standard benchmark algorithms. Additionally, this work demonstrates an effective use of the three perspective planes, instead of the original three-dimensional volumetric images, for simplified brain tumor segmentation.

Ground-based sky imagers (GSIs) are increasingly becoming popular amongst the remote sensing analysts. This is because such imagers offer fantastic alternatives to satellite measurements for the purpose of earth observations. In this paper, we propose an extremely low-cost and miniature ground-based sky camera for atmospheric study. Built using 3D printed and off-the-shelf components, our sky camera is lightweight and robust for use in diverse climatic conditions. With a 63° field of view angle, the camera captures high resolution sky/cloud images for both day and night times at 5 min intervals. The camera is designed to be mounted on a pole-like architecture and with its compact form, it can be installed at any location without requiring any change in the existing infrastructure. For remote areas, the camera also has a local backup facility from which data can be easily accessed manually. We have open-sourced the hardware design of our sky camera, and therefore researchers can easily manufacture and deploy these cameras for their respective use cases.

Penile fracture with an associated urethral injury is a rare urological emergency resulting from trauma to the erect penis during vigorous sexual intercourse. The patient often presents with swelling of the penis, discoloration of the penile skin, localized pain, and hematuria with a typical history of sudden detumescence during intercourse. Subcoronal penile degloving incision has been conventionally described and is frequently used by many clinicians for the management of penile fracture-urethral injury. Here, we describe a case of complex penile fracture managed through the vertical penoscrotal incision. The penoscrotal approach confers excellent exposure to both the ruptured corpus cavernosum and urethra. This approach ensures successful outcomes in such an emergency procedure without having disadvantages of the degloving incision.

Abstract Background The kidneys are the most common site of urogenital tuberculosis. Tuberculosis of the urethra and bladder is caused by a descending infection through the urinary collecting system. Urogenital tuberculosis affects 2% to 10% of pulmonary tuberculosis cases in developed countries, but 15% to 20% in developing countries. Case presentation A 55-year-old male referred to us with bilateral percutaneous nephrostomy, which was done for obstructive uropathy with raised creatinine of 4.5 mg/dl. He was diagnosed with pulmonary tuberculosis two years back and took antitubercular therapy for one year. His routine blood parameters were within normal limits. On evaluation with bilateral nephrostograms, he was found to have right-sided pelvic ureteric junction stricture and left-sided vesicoureteric junction stricture. On retrograde urethrography, there was evidence of 4-cm stricture at proximal bulbar urethra. On contrast-enhanced CT whole abdomen, he was found to have small-sized right kidney and findings in par with nephrostogram with thickened, small capacity bladder (thimble bladder). Patient underwent urethroscopy and urethral dilatation followed by augmentation ileocystoplasty with left ureteric reimplantation and right nephrectomy done at 3 months of follow-up. Conclusion Only 1.9 percent to 4.5 percent of all cases of urogenital tuberculosis are urethral tuberculosis, and it never happens alone. For urogenital tuberculosis diagnosis, imaging techniques are up to 91.4 percent sensitive, with intravenous urography and abdominal computerised tomography being the most widely used. Diagnosis relies on a range of signs such as “caliceal irregularities; infundibular stenosis; pseudotumor or renal scarring; nonfunctioning kidney; renal cavitation; urinary tract calcification (present in 7% to 19% of cases); collecting system thickening, stenosis, or dilatation; contracted bladder”.

Introduction: The school going age is a formative period, both physically as well as mentally. Poor health status in school aged children is among the causes of poor class performance and high absenteeism. Objectives: to assess the health and nutritional status of the school going children in urban area and to determine the association of health problems with age and gender. Method: A cross sectional study was carried out in government schools of urban field practice area of tertiary care institute, Jhalawar, Rajasthan. Study was carried out among 2193 students in four government schools. A pretested, semi structured questionnaire was used for collection of data on socio-demographic characters and their health profile. A detailed clinical examination was done from head to toe for every child. Weight and height were measured. Data was entered into the Microsoft Excel 10. Chi square test of significance was used for statistical analysis. Results: Most common health problem was dental caries (15.0%) followed by refractive errors (13.1%) and pallor (12.6%). Proportions of pallor and refractive error were significantly increased with increase in age of study participants. 16.8% of the students were found to be having thinness. Moderate stunting was present in 7.3% students. Conclusion: Dental caries, refractive errors and pallor were the common morbidities. A significant proportion of school children were undernourished.

Purpose: The aim of this study was to report the proportion and patterns of eye diseases observed among infants seen at two rural eye care centers in South India. Methods: A retrospective review of case records of infants seen between January 1, 2017 and December 31, 2017 at two rural secondary eye care centers attached to L V Prasad Eye Institute, Hyderabad. Data were collected regarding their demographic profile, the pattern of eye problems observed, management at the facility itself, and need for referrals. Results: During this period, a total of 3092 children were seen. Among them, 141 were infants (4.56%, 71 boys: 70 girls, median age: 8 months). Twenty-five percent of infants were less than 6 months of age. The most common eye problem was congenital nasolacrimal duct obstruction (n = 76, 53.90%), followed by conjunctivitis (n = 33, 23.40%), retinopathy of prematurity (n = 4, 2.84%) and strabismus (n = 3, 2.13%). One case each of congenital cataract and suspected retinoblastoma were identified. Majority of the cases (58.8%) belonged to the oculoplastic and orbital surgery sub-specialty. Sixteen percent of the infants (n = 23) had sight-threatening eye problems. Twenty percent (n = 28) were referred to tertiary care hospital for further management. Conclusion: Profile of eye disease in infants in secondary or rural eye care centers ranged from simple to complex, including sight-threatening diseases. While our study concluded that nearly 4/5th of these eye problems were simple and could be managed by a well-trained comprehensive ophthalmologist, 20% of these cases required a referral to a tertiary care center.

Background: PCNL is the treatment of choice for renal stones. But wide array of complications due to larger tract size(>20 Fr) has lead to development of improved techniques like miniPCNL( 51.58 min; p=0.003), lesser radiation exposure (p=0.012), shorter hospital stay (p =0.15), lesser blood loss and lesser post operative pain on POD1 and POD2 (p =0.005, p=0.001 respectively). RIRS group patients sufferred more post op complications (p=0.03 )of which urosepsis was most common. Stone free rate is significantly better(p =0.003) in miniPCNL group on POD1 , while SFR's at 1 month (miniPCNL-90% and RIRS -85%) and 3 month (miniPCNL- 92.5% and RIRS -87.5%) was better in miniPCNL group, but statistically insignificant.On subgroup analysis SFR in lower pole calculus was better in miniPCNL group at 1month and 3 month (p=0.008). Second intervention for stone clearance was required in 3 patients of miniPCNL and 5 patients of RIRS, out of which 4 had lower pole stone.No significant differnce was found in quality of life in both groups at 1 month. Conclusion: MiniPCNL is a better treatment modality for higher single step stone free rate, shorter operative time and fewer postop complication. RIRS has SFR slightly less than miniPCNL but has less radiation exposure and much less post operative pain. There is no significant difference in quality of life in both groups.

Aim: Metabolic syndrome (MeS) refers to metabolic risk factors with different phenotype combinations. The study aim was to determine the clusters of MeS components by age and gender as predictors for the presence of fatty liver (FL). Materials and Methods: The cohort consisted of 990 subjects, undergoing executive health check between January 2019 and February 2020. Baseline data, anthropometric parameters, and ultrasound findings were noted. Patients with normal ultrasound were categorized as group 1 and those with FL as group 2. MeS is defined and clustered and risk of predicting FL was analyzed in age and gender. Results: Of the 990 subjects, 689 (69.6%) had FL (group 2); 554 patients (56%) were >45 years. Females had significant grade 1 (P < 0.05) and grade 2 (P < 0.01) FL, ≥45 years, and MeS of three or more components in FL, both above (P < 0.01) and below (P < 0.03) 45 years of age. Waist circumference (WC), diabetes mellitus (DM) with hypertension, triglyceride, and high-density lipoprotein (cluster 3) were statistically significant in males, both 45 years of age (P < 0.001); in females, the same cluster was statistically significant only for >45 years (P

Background: Calcium supplementation during pregnancy has a proven potential to reduce adverse gestational outcomes, in particular by decreasing the risk of developing hypertensive disorders during gestation. Objective: to evaluate various factors influencing the consumption of iron folic acid and calcium tablets supplementation during pregnancy. Methodology: A community based analytical cross-sectional study was conducted among 200 women in the rural field practice area of Jhalawar. Data were collected by house to house visit and analysed using chi-square test. Results: Only 55.5% pregnant women have taken IFA tablets while 23.5% women have taken tablets of calcium during their pregnancy. IFA consumption were significantly associated with level of education of women and their husband, socio-economic class, type of family, number of ANC visits and presence of husband during those visits and mass media exposure Calcium consumption were also associated with level of education of women, socio-economic class, number of ANC visits and presence of husband during those visits. Conclusions: Consumption of IFA tablets was higher than the national level however calcium consumption was low. Emphasis should be given on early registration, multiple ANC visits, role of family and husband in caring of mother during pregnancy to improve consumptions of IFA and Calcium supplements.

Abstract Background Achalasia cardia is a rare esophageal motor disorder that is frequently diagnosed late. Aim The aim of this study was to study the symptoms, treatment given, and response to treatment in patients with achalasia cardia in an Indian setting. Materials and methods This retrospective study included all patients diagnosed with achalasia cardia on high‐resolution esophageal manometry, using Chicago Classification v 3.0. On follow up, patients were contacted by telephone, and details of the treatment given and response were recorded in a predesigned pro forma. We excluded overseas patients, postoperative cases of achalasia, and those in whom the manometry catheter could not be passed across the gastroesophageal junction. Results A total of 452 patients (260 males, median age 44.5 years) were included in the study cohort. The major symptoms included dysphagia for solids and liquids (428, 94.7%), regurgitation (360, 79.6%), naso‐oral regurgitation (182, 40.3%), weight loss (322, 71.3%), and chest pain (158, 35%). Type 2 achalasia (229, 50.6%) was the most common subtype, followed by type 3 (154, 34.1%). Chest pain was more common in type 3, and weight loss and naso‐oral regurgitation were more common in type 2 achalasia. A majority of patients underwent Heller's myotomy and pneumatic dilatation. Of 280 patients for whom treatment details were available, 98% reported good response to endoscopic/surgical management. Conclusion The predominant symptoms of achalasia cardia vary per the manometric subtype. Heller's myotomy and pneumatic dilatation are the most commonly used treatment options. Response to treatment is good. The choice of treatment modality was likely influenced by financial reasons and availability of local expertise.

The major drawback of conventional white light endoscopy (WLE) is that it lacks accuracy in diagnosis and differentiation of various benign and premalignant mucosal gastrointestinal lesions. To overcome this, image-enhanced endoscopy techniques, which provide high-definition images with good resolution and contrast enhancement, have been developed. One such technique is narrow-band imaging (NBI). NBI functions by filtering the illumination light. The red component of the standard red, green, and blue filters is rejected and the selected bandwidth of the blue and green light is transmitted. The present review highlights the role of NBI in diagnosis of benign gastric lesions like atrophic gastritis, Helicobacter pylori–related gastritis, intestinal metaplasia, and other rarer conditions. NBI is a simple procedure which does not require any additional equipment and does not have a long learning curve. Use of NBI in daily practice is likely to improve detection of mucosal abnormalities.

Background and Aim To determine the concordance of liver explants with the pretransplant diagnosis. Methods This was a retrospective analysis of 251 liver explants. Patient information included demography, comorbidity, and etiological diagnosis. Final diagnosis was based on morphological and histological findings. For non‐alcoholic steatohepatitis (NASH) and cryptogenic cirrhosis, we investigated comorbid states such as obesity, hypertension, and diabetes. Chi square test and Cohen's Kappa value were used. A P value of

INTRODUCTION: Large scrotal hernias are rare, constituting

Context: Heterotaxy syndrome is a disorder that involves abnormal lateralization of the abdominal viscera, thoracic organs, and cardiac atria. The objective was to compare the frequency of morphologic profile of congenital heart defects associated with right isomerism and left isomerism in the Western Indian population. Materials and Methods: This cross-sectional observational study was conducted by the Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India, from January 2016 to April 2018. All children presenting to the hospital with suspected congenital heart defect were included in the study. Echocardiography-based sequential segmental analysis was used; various cardiac defects were noted for patients with right isomerism (RAI) and left isomerism (LAI). Results: Occurrence of heterotaxy in our screening population is 0.12%. A total of 93 children had atrial heterotaxy (M: F; 1.06:1), with 65 (69.89%) having RAI and 28 (30.11%) having LAI. Most common lesions associated with RAI included complete atrioventricular septal defect (n = 43, 66.2%), and pulmonary outflow tract obstruction (n = 35, 53.84%). LAI was associated with atrial septal defect (n = 24, 85.7%) ventricular septal defect (n = 23, 82.1%). Conclusion: Heterotaxy encompasses a wide spectrum of congenital cardiac defects. The frequency of various defects associated with RAI and LAI in Western India is compared here to those as reported in the Western world.

Background There is paucity of data on Bristol stool form (BSF) in healthy South Indian residents. Aim To determine the BSF types and associated factors in an urban bowel health noncomplainant population. Methods This cross‐sectional study, performed using a self‐administered questionnaire among adult Chennai residents, compared BSF types by gender for various factors (age, occupation, bowel frequency, and defecation‐related abdominal pain). BSF types 1/2 and 6/7 were grouped as hard and loose stools, respectively. The statistical tests used were proportion test, χ2, and Kruskal–Wallis tests (P < 0.05 deemed significant). Results The study cohort of 1402 subjects included 748 (53.3%) men and a third each of professionals, semiprofessionals, and “non‐office goers” (homemakers, retirees, students, and unemployed). A total of 97% had daily bowel movement, and 8.5% reported defecation associated abdominal pain. The BSF types in decreasing prevalence were: Type 3 (35.6%), Type 4 (32.5%), Types 1 or 2 (20.5%), Type 5 (6.9%), and Types 6 or 7 (4.5%). On gender comparison, significantly more men passed hard (P = 0.03) or loose stools (P = 0.001), while more women passed Type 3 (P = 0.0002). Loose stools in men were associated with abdominal pain (P = 0.0035). Women passing hard or loose stool types were slightly older (median age in 30s vs. 20s in Types 3–5) and had reduced stool frequency (P = 0.026: hard; P = 0.006: loose). Conclusions This South Indian noncomplainant cohort's most common stool types were BSF Types 3 and 4, with few gender variations in extreme stool types.

Laparoscopic suture transfixation and free tie ligation are the most commonly used cost-effective technique of managing the base of the appendix during laparoscopic appendectomy in low resource settings such as India. This becomes technically cumbersome especially in the presence of the long friable appendix and for novice surgeons. We hereby describe an innovative technique of suspending the appendix using a transfacial suture to ease the placement of suture at the base of the appendix during laparoscopic appendectomy.

Background and Aim Regional differences in gallstone (GS) composition are well documented in the Indian subcontinent. The reasons for the same are unknown. Etiopathogenesis of GS remains elusive despite advances in instrumentation. This was an in‐depth analysis of the chemical, structural, and elemental composition of GS with special reference to synchroton studies. Methods We used high‐end sensitive analytical complementary microscopic and spectroscopic methods techniques, such as X‐ray diffraction, scanning electron microscopy, Fourier transform infrared, synchrotron X‐ray fluorescence spectroscopy (SR‐XRF), and 2D and 3D synchrotron microtomography (SR‐μCT), to study the ultra structure and trace element composition of three major types of GS (cholesterol, mixed, and pigment). SR‐XRF quantified the trace elements in GS. Results The cholesterol GS (monohydrate and anhydrate) were crystalline, with high calcium content. The pigment GS were amorphous, featureless, black, and fragile, with high calcium bilirubinate and carbonate salts. They had the highest concentration of iron (average 31.50 ppm) and copper (average 92.73 ppm), with bacterial inclusion. The mixed stones had features of both cholesterol and pigment GS with intermediate levels of copper (average 20.8 ppm) and iron (average 17.78 ppm). Conclusion SR‐μCT has, for the first time, provided cross‐sectional computed imaging delineating the framework of GS and mineral distribution. It provided excellent mapping of cholesterol GS. SR‐XRF confirmed that pigment GS had high concentrations of copper and iron with bacterial inclusions, the latter possibly serving as a nidus to the formation of these stones.

Background and Objective: Reperfusion therapy for acute myocardial infarction has been shown to reduce mortality, yet it may also have deleterious effects, including myocardial necrosis and no-reflow. Postconditioning is known measure for cardioprotection from reperfusion injury in animal model. Postconditioning is known measure for cardioprotection from reperfusion injury in animal model and human studies have shown inconsistent results. Materials and Methods: From February 2013 through October 2014, at Institute of Postgraduate Medical Education and Research, Kolkata Cardiology department, we randomized 43 patients with acute ST-segment elevation myocardial infarction (STEMI) who were undergoing conventional primary percutaneous coronary intervention (PCI) (22 patients) and PCI with postconditioning by repeated transient balloon occlusion after establishment of flow (21 patients). Total creatine kinase-muscle/brain (CPK-MB) released within 72 h was compared as a surrogate marker of infarct size. Myocardial blush grade between two groups was also compared. Results: The area under curve of serum creatine kinase (CK) release during the 1st 72 h of reperfusion was significantly reduced (P = 0.0347) in the postconditioned group compared with the control group, averaging 9632 IU in postconditioned compared with 13493 IU in control group which represented 29% of reduction of infarct size. The peak of CPK-MB release was markedly lower in the postconditioned (290 ± 16.24 IU/L) than in the control (414.2 ± 51.34 IU/L) group (P ≤ 0.0001). Blush grading was also significantly improved in postconditioned group (P = 0.005). Mean ST-segment deviation at 48 h between cases and control groups was 0.87 ± 0.68 and 1.4 ± 0.94, respectively (P = 0.08). Conclusion: In patients with STEMI, postconditioning significantly improves blush grading and enzymatic infarct size reduction with a trend toward significant reduction of mean ST-segment deviation.

Background: A good bowel preparation for colonoscopy is the most important factor that has an impact on visualization and outcome of the procedure. Aim: The primary aim of the study was to assess the quality of bowel preparation as reported by the Boston Bowel Preparation Score (BBPS). The secondary aim of the study was to analyze the patient feedback on ease of administration, palatability, and side effects with the bowel preparation. Materials and Methods: Patients undergoing colonoscopy between March 2018 and September 2018 were enrolled in the study. Patients

Aim: This study aimed to determine the mortality in Indian patients awaiting liver transplantation and to assess the impact of cirrhosis-related complications (CRCs) on mortality. Materials and Methods: This was a prospective study on patients of Indian origin, aged >18 years, with cirrhosis liver (confirmed by imaging and/or liver biopsy), and registered for liver transplant (LTx) between November 2015 and May 2016. Patients were followed up for at least a year. Any admission or day-care procedure for complications after registration was recorded as an event, and outcome was noted as recovered, deterioration, or death. The primary end point of the study was LTx, survival, or death. Patients undergoing transplantation were grouped with survivors for analysis of factors predicting waitlist mortality. Statistics: t-test, Chi-square test, Mann–Whitney U-test, and univariate and logistic regression analyses were used for statistical analysis. P < 0.05 was considered statistically significant. Results: A total of 227 (72.3%) registered patients survived. Waitlist mortality at 1 year was 27.7%, and the waitlist mortality rate was 33.8 deaths/100 patient-years. A significant proportion of nonsurvivors belonged to the Child–Turcotte–Pugh C score (P = 0.031), with higher Model for End Stage Liver Disease (P = 0.002) and greater frequency of CRC (P < 0.001). Hepatic encephalopathy (HE), renal dysfunction (RD), infection, and variceal bleeding were significantly associated with death. A higher proportion of nonsurvivors had combination of more than two CRCs. Conclusion: The waitlist mortality was 27.7%. Complications such as variceal bleed, spontaneous bacterial peritonitis, HE, and RD were significantly high in nonsurvivors.

Background: Cirrhotic cardiomyopathy (CCM) occurs in 39.4%–48.3% of patients with chronic liver disease with or without decompensation. A significant number of patients are likely to be listed for liver transplantation (LT). The early outcome of LT in these patients is not known. Aims and Objectives: The aim is to study the prognostic implication of CCM on survival at 3 months post-LT. Materials and Methods: This prospective study was conducted from July 2016 to July 2017. Patients, who were diagnosed as cirrhosis of the liver based on clinical, biochemical, imaging, and endoscopic findings, were included in the study. After informed consent, details of demography, comorbidity, and cirrhosis-related complication were noted. Cardiac evaluation included electrocardiography, two-dimensional echocardiography, dobutamine stress test, and coronary angiography whenever indicated. CCM was diagnosed based on the standard criteria. Patients who underwent LT were followed up in the posttransplant period up to 3 months. Statistics: Mann–Whitney U-test, Chi-square test, and Kaplan–Meier survival plot were used for statistical analysis. P < 0.05 was considered statistically significant. Results: Five hundred and eighty-six adult patients with cirrhosis of the liver underwent cardiac evaluation. One hundred and ninety-eight (33.8%) patients were diagnosed with CCM. Forty-one patients underwent LT. Following LT, there was an improvement in diastolic dysfunction in a third of patients (12 patients; 29.3%) but with no survival benefit at 3 months (P = 0.23). Higher baseline model for end-stage liver disease and left ventricular diastolic dysfunction were more common among nonsurvivors. Conclusion: CCM does not influence the short-term survival in patients undergoing LT.

Aim: Retrospective analysis of medical records to determine whether diabetes mellitus (DM) was a risk factor for hepatocellular carcinoma (HCC) and whether it enhances the neoplastic potential of hepatotropic virus-related chronic liver disease (CLD). Materials and Methods: Patients registered between April 2017 and March 2018 with a clinical diagnosis of HCC in a pre-existing CLD were included. Controls were patients with CLD registered during the same period but with no HCC. Prevalence of DM, hypertension and coronary artery disease (CAD) alone or in combinations was noted in the two groups. The odds ratio (OR) of developing HCC was calculated independently for DM, hepatitis B and hepatitis C infection alone and in combinations. Chi-square test, Mann–Whitney test and OR calculation were done. A P < 0.05 was considered statistically significant. Results: The study population consisted of 150 cases of CLD with HCC and 812 controls (CLD with no HCC). CLD patients with HCC were significantly older (P < 0.0001) with a male preponderance, but no gender predisposition (P = NS). The overall prevalence of DM in patients with CLD was 31.9%, more significant amongst cases than in controls (50.7% vs. 28.7%) (P < 0.0001) and also for a significant duration (10.6 vs. 3.8 years; P < 0.03). Amongst the cases, comorbid conditions such as hypertension and CAD and diabetes in combination with hypertension and CAD was also more frequent among cases (P = 0.0001).The odds of developing HCC in CLD was higher for DM. The OR for HCC was highest for DM with hypertension and/or CAD at 4.69 (3.19–6.88, P < 0.0001). Conclusion: DM and other constituents of metabolic syndrome such as hypertension and CAD are significantly more common in CLD patients with HCC. DM is of prolonged duration and is a risk factor increasing the neoplastic potential of CLD.

Introduction: Retrograde Intrarenal Surgery (RIRS) is a preferred minimal invasive treatment modality for renal stones with advantages of being effective and having lower morbidity rates. Aim: To predict the Stone Free Rate (SFR) after RIRS with lower pole and non-lower pole stones. Materials and Methods: The records of 85 consecutive patients who underwent unilateral RIRS from September 2016 to July 2019 were retrospectively analysed. The studied parameters included patient demographics, stone characteristics (size, volume, and attenuation, Lower Pole Infundibulopelvic Angle (LP IPA) and operative time, presence of preoperative Double-J Stent (DJS) and Stone Free Status (SFS). Standard statistical tests were applied with level of significance as p45° were stone free. Patients with non-lower pole stones has SFR 2.8 times compared to LP stones (p

Aim: To estimate the differences in the maxillary arch morphology in buccal and palatal canine impaction in an Asian population of Gujarati origin. Methodology: An institutional ethics committee’s approval was acquired before the commencement of this study. Sixty subjects were enrolled in the study. Thirty subjects (20 females and 10 males) had a maxillary impacted canine either buccal or palatal and thirty control group participants were selected aged 13 to 18 years who sought orthodontic treatment at the tertiary health care center in Ahmedabad, Gujarat, in western India. Routine pre-treatment radiographs and dental plaster models with good anatomic details were recorded. Measurements of the inter-molar width, palatal depth, arch length, sum of the mesio-distal width of the upper incisors, and available arch space were recorded from prepared orthodontic study models using digital vernier calipers with an accuracy of 0.01 mm and brass wire. The ratio of palatal depth to inter-molar width (Ratio 1), arch length to inter-molar width (Ratio 2), and width of the maxillary incisors to available arch space (Ratio 3) were also secondarily calculated. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 21, IBM Inc. The normality of the data was assessed by the Shapiro–Wilk test. As the data was found to be normally distributed, bivariate analyses were also performed (one-way ANOVA test, Bonferroni post hoc correction). The level of statistical significance was set at a p-value less than 0.05. Results: The comparison of the inter-molar width, palatal depth, arch length, sum of the mesio-distal width of the upper incisors, available arch space, Ratio 1, Ratio 2, and Ratio 3 among controls and subjects with buccal and palatal canine impaction showed overall significant differences in the inter-molar width, palatal depth, arch length, sum of the mesio-distal width of the upper incisors, and available arch space when compared using one-way ANOVA as p < 0.05. Ratios 1, 2, and 3 also showed significant differences between the buccal and palatal canine impaction. Conclusion: An inadequate arch length (p < 0.0001) and a higher degree of crowding with reduced available arch space (p < 0.0001) may be considered as early risk factors for buccal maxillary canine impaction. An inadequate inter-molar width (p < 0.0001), and an increased palatal depth (p < 0.0001) with a clinically reduced mesiodistal width of the sum of maxillary incisors may be considered as risk factors for palatal maxillary canine impaction in an Asian population of Gujarati origin.

ABSTRACT Acute Urinary Retention (AUR) caused by urological malignancy is a rare event, even in elderly. A solitary prostatic urethral Transitional Cell Carcinoma (TCC) causing retention of urine is even rarer. Hereby, a case of 60-year-old non-smoker, with sudden onset of AUR was reported. Detailed clinical examination, biochemical and radiological investigations were not conclusive. Cystoscopy revealed a solitary papillary prostatic urethral growth projecting from base probably causing urinary retention. Histopathology confirmed it as a low grade urothelial carcinoma. Patient voided well after complete transurethral resection. Hence, an urothelial malignancy can have varied presentation, and appropriate histological diagnosis with cross-sectional imaging and regular follow-up with cystoscopy is mandatory.

Aim: This study aims to determine the clinical presentation, and ileal mucosal changes during colonoscopy for which terminal ileal (TI) biopsies were taken at our center and to determine the specific histopathology which had the best yield for specific colonoscopy findings. Materials and Methods: Retrospective audit of all patients who underwent colonoscopy with ileoscopy between 2012 and 2016. All patients with TI mucosal changes and normal colonic mucosa, who underwent ileal biopsy, were included in this study. Patient data regarding age, gender, indication for ileocolonoscopy (screening for colorectal cancers, inflammatory bowel disease [IBD], or irritable bowel syndrome [IBS]) and histopathology changes were collected. Appropriate statistical tests were used and P < 0.05 was considered statistically significant. Results: One hundred and nine patients had isolated ileal lesions. The median age was 44.1 years (range 8–80 years). Men outnumbered women in a ratio of 82:27. The major clinical indications for ileocolonoscopy were IBS (64.2%), followed by IBD (22%). Ulcers (aphthoid) were the most frequent finding followed by mucosal nodularity and nonspecific findings. Ulcers in ileum were most often reported as chronic ileitis (46.2%), followed by nonspecific changes (35.2%) Biopsy from nodular ileal lesions, were predominantly nonspecific (74.4%), followed by acute (15.4%) and chronic ileitis (10.2%). About 50% of specimens with nonspecific ileal changes had nonspecific histological changes. Ileal ulcers had the highest sensitivity, PPV, and NPV for significant histological findings. Conclusion: Ileal ulcers are the significant colonoscopy findings where tissue biopsy is likely to yield a definitive diagnosis and justify specific management. Biopsies from nonspecific ileal changes and nodularity should be discouraged as it is unlikely to pick up any major abnormality.

Rickets is a disease that affects the growth of a child or individual because of defect in bone mineralization. There is utmost requirement of vitamin D for the proper bone formation and mineralization and any defect in its production and metabolism will lead to development of rickets. Though there is abundance of sunlight, vitamin D deficiency now emerges as a major health problem in the South East Asian population including India. A timely dental consultation and management is critical for prevention of significant oral findings in the affected individuals. Multiple dental abscesses in absence of caries or trauma is one of the most significant dental findings in Rickets. The goal of early intervention in the treatment of rickets is to minimize the late complications of rickets in affected children. The aim of this case report is to discuss about various oral findings of 17 years old boy suffering from rickets and to raise awareness on dental characteristics of this disorder.

The Bronze-age Indus civilisation (4.6–3.9 ka) was thought to have been linked to the development of water resources in the Himalayas. Here, the authors show that along the former course of the Sutlej River the Indus settlements developed along the abandoned river valley rather than an active Himalayan river.

Background: The histological nature of polyps by site prevalence and size is unclear. Aim: To determine the prevalence of polyps in patients undergoing routine lower gastrointestinal (LGI) endoscopy and identify the histological types and their characteristics by age, location and size. Materials and Methods: For this retrospective study, patients undergoing ileocolonoscopy or sigmoidoscopy between 2014 and 2016 were included. Data on age, gender, test indication, site and size of polyps and histology type were collected. Results: Two hundred and ninety (12.7%) of 2303 patients who underwent LGI endoscopy had colonic polyps (n= 317; single in 272 patients). The median age was 61.1 years (range 5-99 years) and 223 (76.4%) were men. Polyps were rare 60 years age. High grade dysplasia and carcinoma were rare (10.3%). While two-thirds of polyps

Background: The interface between tuberculosis (TB) and Crohn’s disease (CD) is relevant as TB complicates both the diagnosis and management of CD. Aim: This study aimed to identify the distinctive characteristics of ileocaecal and colonic TB (C‑TB) and colonic CD (C‑CD) at colonoscopy and to correlate the colonoscopy findings with histology. Materials and Methods: This prospective study included consecutive patients presenting with classical symptoms of TB or CD. The colonoscopic findings were compared with histology, which was taken as gold standard. Appropriate statistical tests were applied. Results: Fifty‑eight individuals fulfilled the inclusion criteria. Nine and 16 patients with C‑TB and C‑CD, respectively, had histological confirmation of respective diagnosis. In 33 specimens, the histological diagnosis was inconclusive. The sensitivity of colonoscopy for diagnosing C‑TB was high at 88.9% (95% confidence interval [CI]: 51.8–99.7). It was 50% (95% CI: 24.7–75.4) for CD. The reverse was true for CD whose specificity was high at 71.4% (95% CI: 55.3–84.3) and low for TB at 46.9% (95% CI: 32.5–61.7). All the patients diagnosed as confirmed CD or TB responded well to respective treatment. Six of the thirty patients with failed response to anti‑TB treatment required surgery or change in treatment after 2 months. Conclusion: Colonoscopic findings of isolated ileal involvement, aphthous ulcer, cobble stoning, long‑segment strictures, skip lesions and perianal involvement favored a diagnosis of CD. Correlation of colonoscopy with histology is poor for both CD and TB. The accuracy, sensitivity and specificity of colonoscopy were better and superior for the diagnosis of CD, than in the diagnosis of TB.

Background: Liver cirrhosis is a unique clinical entity wherein long-standing diabetes mellitus (DM) can predispose an individual to cirrhosis, and on the other hand, a long-standing cirrhosis liver can predispose a cirrhotic to DM, secondary to deranged glucose and insulin metabolism. Aim of the Study: The aim of this study is to determine the prevalence of impaired glucose tolerance (IGT) in patients with liver cirrhosis and risk factors predicting these patients to progression to DM. Materials and Methods: Adult patients above 18 years of age, with a diagnosis of cirrhosis of liver, irrespective of the diabetic status, the aetiology and severity of liver disease, were enrolled for the prospective cross-sectional study. The American Diabetes Association guidelines were followed for classification of DM. Fasting serum insulin assay was done for calculation of homeostatic model assessment insulin resistance (HOMA-IR) with a cut-off of >2.5. Patients with normal baseline glucose tolerance test (GTT) or IGT were followed up prospectively for 6 months at 3 monthly interval. Appropriate statistical tests were applied. Results: Of the 505 cirrhotic patients screened, 158 patients fulfilled the selection criteria. The overall mean age of these 158 patients was 53.3 ± 11.5 years; majority were men (93.7%). As a significant proportion of patients belonged to Child-Turcotte-Pugh (CTP)-C (51.3%) followed by CTP-B and CTP-A. Seventy-four patients had self-reported diabetes (46.8%) at registration. Post-GTT, the prevalence of impaired IGT was 27.4%, and new-onset diabetes mellitus (NODM) was 11.9%. Patients with CTP-C were at greatest risk for either IGT or NODM (P < 0.05). IGT+NODM patients had high median values of 2-h GTT, fasting serum insulin and HOMA-IR compared to non-diabetic participants at admission with a significant trend increase at 3 and 6 months. Conclusion: The prevalence of glucose intolerance is significantly high in individuals with cirrhosis. A 2-h GGT unmasks a significant number of cirrhosis with normal fasting blood sugar and glycated haemoglobin. A trend towards an increase in glucose intolerance and insulin resistance is noted with increasing duration of illness.

Introduction: Medical students are future physicians. Life style and risk behaviour practices that are acquired in early life and in medi- cal college will have a direct impact on their clinical performances. Objective: to assess the dietary habits, physical activity and current habits of smoking, smokeless tobacco uses and alcohol consump- tion among undergraduate medical students. Material and method: A pretested, self-administered questionnaire was used for collection of data regarding socio-demographic char- acters i.e. age, sex, residence, and lifestyle ie. dietary habits, physical activities and risk behaviour practices i.e. smoking, smokeless to- bacco use and alcohol consumption. Results: 59.4% students had breakfast daily. Daily consumption of at least 5 portions fruits and vegetables was reported by only 36.9% of students. Moderate physical activity for at least 30 min/day for 5 or more days was reported by only 23.6% students. 15.6% students had junk foods 4-5 times a week while 29.7% had 2-3 times a week. Habits of smoking and alcohol consumption were significantly higher among male undergraduate students. Conclusion: The study revealed poor dietary habits, inadequate physical activity and high prevalence of substance abuse among the medical students. The students should be motivated to adopt healthy life style practices.

Introduction: Iron deficiency anaemia (IDA) is the most common nutritional deficiency in pregnant women. WHO estimates that anaemia affects 33% of women of reproductive age globally (about 613 million women between 15 and 49 years of age). Anaemia in pregnancy is a major issue in form of abortion, premature birth, in- trauterine growth retardation, high infant mortality and 20 to 40 percent maternal death of India. Objectives: To determine the prevalence of anemia among pregnant women and to determine association of anemia with socio-demographic factors. Material and Methods: A community based cross-sectional study was conducted among the pregnant women of rural area. A pre- designed and pre-tested proforma was used to collect the informa- tion regarding socio-demographic characteristics and possible risk factors of anemia. Association was established by using chi square test. Results: The Prevalence of anemia among the pregnant women was 81.8%. 35.0% women were mild anemic, 45.4% were moderate and 1.4% were severe anemic. Occurrence of anemia was signifi- cantly associated with age, occupation, Parity, Timing of first ANC check up and IFA consumption of study participants. Conclusion: A very high prevalence of anemia among pregnant women is a alarming sign and indicator of poor nutritional status and health care utilisation.

Introduction: Population explosion has been India's major prob- lem since independence. Adoption of family planning methods is one of the best solutions to tackle this problem. To achieve targets in family planning programme active involvement of men is re- quired hence exploring the role of men regarding contraceptive practices is important. Objective: The study conducted to assess Knowledge, Attitude and Practices regarding Family planning among the married men. Material and method: A cross-sectional study was conducted in a rural health-training center area of Jhalawar Medical College, Ra- jasthan from June, 2018 to Oct. 2018. A pretested semi structured questionnaire was used for data collection. Results: Among the 220 participants, (75.45%) were using some family planning method. 30% participant has average knowledge, 65.5% good knowledge about contraceptive method. 93.18% has good attitude and 6.82% has poor attitude. 80% participant had good practice regarding family planning. Conclusion: majority of participants were having good knowledge and attitude towards family planning methods and the current use of family planning methods was good.

Background: Neonatal cholestasis syndrome (NCS) is a major cause of morbidity and mortality in infants. The disorder has rarely been studied in centers from Central India. Objectives: To study the prevalence, clinical presentation and etiology of NCS at a tertiary referral center in Central India. Materials and Methods: The study was carried out at a tertiary referral center in Central India. The study is a descriptive study. The records of all patients with suspected NCS treated in the Department of Pediatrics from 2007−2012 were analyzed. Results: One hundred and sixty-eight children had a provisional diagnosis of NCS. The complete records of 100 children were available for the study. The median age of presentation was 78 days (range 15−270 days). The male: female ratio was 1.17:1. The clinical features noted were- jaundice (100/100,100%), failure to thrive (73,73%), organomegaly (68, 68%), acholic stools (38,38%), abdominal distention (52,52%) and poor feeding (29, 29%). The etiology as confirmed by investigations is as follows- neonatal hepatitis (20,20%), idiopathic neonatal hepatitis (18,18%), biliary atresia (41,41%), sepsis (14,14%) and others (7,7%). Conclusions: The proportion of NCS in our group of patients was 1.2 per 1000 patients. Jaundice, organomegaly and failure to thrive are the common presentations. Biliary atresia, neonatal hepatitis and idiopathic neonatal hepatitis were the common etiological factors at our center.

Introduction: Tuberculosis is a barrier to socio-economic development as the greatest burden of tuberculosis incidence and mortality in India is in adult and socio-demographic factors, are a major determinant of ill- health and barrier to health care. Methodology: Out of six Designated Microscopy Centres in Ujjain city (Madhya Pradesh), two DMCs were selected. 241 patients were included in the study from registered 253 patients. Results: Mean age of subjects was 35.9 ± 13.8 years. Tuberculosis was more common in males, >3/4th participants had pulmonary tuberculosis. Nearly 1/5th of participants were illiterate (24.5%),

Peroral Endoscopic Myotomy has become the preferred therapy for achalasia cardia.An important predictor of the success and safety of this technique remains the correct identification of the Esophago gastric junction and the extent of myotomy. However, this key step may be difficult in a subset of patients. The present case highlights the use of double scope technique to manage such technical issues.

Background and Objectives: Tracheoesophageal/bronchoesophageal fistula is a rare clinical condition, and occurs due to a variety of disease processes. This report describes the clinical profile, management, and outcome of bronchoesophageal fistulas due to tuberculosis in five patients. Patients and Methods: Patients diagnosed with esophageal tuberculosis over the last eight years were included. Details regarding the demographics, symptomatology, barium swallow, upper GI endoscopy, with biopsy and high resolution computed tomography of the chest were recorded for patients with tracheoesophageal fistula. The diagnosis was confirmed by acid fast bacilli (AFB) positive fluid aspirate/brush cytology from the fistula, lymph node biopsy showing caseous necrosis or AFB bacillus and tissue tuberculosis culture and polymerase chain reaction (PCR). Results: There were five patients (four males and one female) with a mean age of 43.8 ± 17 years (range, 17 to 59 years). The mean duration of symptoms was 38 ± 7 days. The most common symptom was coughing on swallowing followed by dysphagia. Two patients had concomitant pulmonary tuberculosis; two had human immunodeficiency virus (HIV) infection, and one was a post-renal transplant. The diagnosis of tuberculosis was established in all five patients with esophageal cytology, lymph node biopsy, and tissue tuberculosis PCR. All the patients were successfully treated with a combination of antituberculous drugs (five patients), glue application on fistula (one patient), Percutaneous endoscopic gastrostomy (PEG) tube insertion (three patients), and surgery (one patient). Conclusions: Tuberculous bronchoesophageal fistula is a rare complication and can be successfully managed predominatly with a combination of antituberculous treatment, PEG tube placement, and rarely surgery.