Background: Surgical Site Infections (SSIs) are among the most common serious complications after surgery and associated with increased morbidity, mortality and health care costs. The use of preoperative Surgical Antimicrobial Prophylaxis (SAP) is an effective measure that helps to protect against SSIs. This study aims to evaluate the knowledge, attitude and practice of Doctors towards preoperative antibiotic prophylaxis at GMC Jammu. Methodology: Present study was a cross sectional observational descriptive study was conducted among doctors working in surgical departments at GMC Jammu selected by random sampling technique. Information regarding their socio-demographic characteristics and surgical antimicrobial prophylaxis was obtained using a self-administered, pre-tested, semi-structured questionnaire. Data was analyzed using epi info v7 software using appropriate statistical tests. Results: A total of 100 doctors including faculty members and Residents working in surgical specialties & super-specialties were participated in the study. Among the 61 were Males while 39 were females, 57 were less 40 years of age while 43 were above 40 years of age, 63 were having less than 5 years of service while 37 had more than 5 years of services at GMC Jammu and 88 were working in surgical specialties while 12 were working in surgical super-specialties. Among the total, 22 participants had very good knowledge regarding SAP, 55 had good knowledge, 14 had fair knowledge and 9 had poor knowledge regarding SAP. In the study, 14 participants had very good practices of SAP, 57 follow good practices, 11 had fair practices and 18 follow poor practices of SAP. In the present study, 14 participants had very good practices of SAP, 57 follow good practices, 11 had fair practices and 18 follow poor practices of SAP. Conclusion: The results of this study showed that doctors’ knowledge regarding surgical antibiotics prophylaxis in various clinical scenarios and their attitude and practices of SAP guidelines was satisfactory.

Fracture of humerus shaft are commonly encountered by orthopaedic surgeons. The incidence of these fractures is relatively low compared to other long bone fractures. Various modalities are available for surgical treatment of humerus shaft fractures but plate osteosynthesis and intramedullary nail are the commonest one. Intramedullary nail has benefit of smaller incisions, preserved fracture site biology and load sharing properties but have disadvantage due to concern of non-union, higher reoperation rate, stiffness, fracture at the insertion point and adjacent joint pain. In this article, we discuss the management of the fractures of the shaft of humerus using locking compression plates.

Humerus is the longest and largest bone of the upper limb which provides strength and resistance to both torsional and bending forces proximally and distally it tapers to triangular shape. Knowledge of the anatomy and pathophysiology of humeral shaft can facilitate the course and attachment of muscles and can explain the displacements of fractures and preoperative planning and fixation techniques. As the upper extremity functions with a long lever arm and highly exposed to external forces, it is predisposed to injuries frequently. In this article, we review the advantages of locking compression plates over intramedullary nails in the management of fracture of shaft of humerus.

Background: Coronavirus Disease (COVID-19) now considered as the most infectious disease occurring once in a century, spreading all over the world in past 2 years in different waves. India accounting for the second largest number of COVID-19 positive patients worldwide and is causing the burden on health facilities and economy. Aim: Assessing the specific epidemiological factors and clinical outcomes in hospitalized patients with mild to moderate severity of COVID -19 in a tribal district of Northern India. Methods: Authors retrospectively investigated epidemiological, demographic, laboratory and clinical data of 420 laboratory confirmed COVID-19 positive patients admitted in Dedicated COVID Care Center from 3rd June 2020 to 24th November 2021. Results: Study period from 16th May 2020 to 22nd Dec 2021 in tribal district of Himachal Pradesh reveals that the positivity rate was 4.28%, admission rate of 11.9% and death rate of 1.1%. Male predominance of admitted patients was there in Dedicated COVID Health Centre at Reckong Peo, Kinnaur. Mean age during admission ranges from 45-46 years in females and male. Patients with moderate to severe patients were referred to higher Dedicated COVID Hospitals within 2 days of their admission. Conclusion: Study suggested that age group of 18-59 years were more hospitalized due to symptoms ranging from mild to severe in Dedicated COVID facilities and required medical attention. Challenge for a Tribal District with highly rugged terrain, limited human resources, health institutions and facilities in hospitals, practicing appropriate COVID-19 behavior is necessary in containment of COVID-19 waves in future.

Laurence-Moon-Bardet-Biedl Syndrome (LMBBS) is a rare autosomal recessive genetic disorder. It is a congenital ciliopathy manifesting with primary and secondary characteristics affecting function of brain, eyes, kidneys, hand and feet. One of the primary features is genital abnormalities in about 75% cases. There are reported crytorchidism, hypogonadism and gynaecomastia features associated. Cyptorchidism is an established risk factor for carcinoma testis. Here we are reporting a rare case of association of LMBBS with seminoma testis in a 45 year old male.

Patients with laryngeal cancer have a high risk of developing lung cancer in the future. A patient treated for supraglottic cancer in 2011 presented with complaint of shortness of breath and right sided chest pain for the last 4-5 months. Chest X-ray posterior-anterior view showed a homogeneous opacity in the right hilar region. CECT thorax revealed a heterogeneously enhancing soft tissue density mass lesion in hilar region of the right lung. On histopathology, it was adenocarcinoma of the lung. Patients with laryngeal cancer should be routinely screened during follow-up with X-ray chest or CECT thorax for the early detection of lung cancer.

We report here a case of 50-year-old female with ca breast presenting with second malignancy ca cervix. She underwent modified radical hysterectomy followed by adjuvant chemotherapy and radiotherapy to chest wall in 2017. She then presented with ca cervix in 2019 for which she received two cycles of chemotherapy followed by CRT and ICBT. Now the patient is on close follow up.

Objective: The research focuses its efforts on knowing the clinical evaluation of patients with gallstones, where the effects were evaluated for patients who had their gallbladder removed, most of the time, these stones occur in an adult and a gallbladder removed is used in case there are symptoms. Material and Method: About100 samples were collected from Yarmouk Teaching Hospital, Baghdad, Iraq and most of the patients were men. The samples were divided into two parts: men 62 patients and 38 women. The clinical file was evaluated for patients suffering from gallstones who resorted to having them removed by laparoscopy, all demographic information and private data were identified with patients. Result: Through the statistical analysis of SPSS Soft 25, the average age was identified by finding the true value in addition to the arithmetic mean and it was 40.93±9.90. The most common ages among the injured were between 40-49 and Pain in the upper abdomen was found, Pain in the right side of the abdomen addition to the type of diseases that existed were diabetes, in addition to HTN Laparoscopic cholecystectomy is the usual treatment for symptomatic gallstones, acute cholecystitis and pancreatitis caused by gallstones.

Background: Smart phone is viewed as an important communication tool and is an integral part of the human society in the present era. Excessive smart phone use has been found to be associated with various health problems. This study was done to evaluate the pattern of Smart Phone usage among adult population of District Shimla. Methods: A descriptive cross sectional survey was conducted amongst the participants in the age group of 18 to 60 years, using google forms. The questionnaire was circulated among residents of district Shimla for responses. Results: Among the total 400 participants, 389 (97.3%) were using personal smart phone. About 169(42.3%) participants were using smart phone for 3-4 hours per day. About 395 (98.8%) were using social networking sites, 107(26.8%) were using gaming apps, 297(74.3%) were using music and video apps, 185(46.3%) were using app related to the academic work and 174 (43.5%) were using news app. About 200(50.0%) participants were suffering from eye strain/ watering/ itching for eyes, 92(23.0%) were having difficulty in sleep, 85(21.3%) were having headache, 41 (10.3%) were having cervical problem, 61 (15.3%) were having mental health problems and 31(7.8%) were having musculoskeletal problem due to usage of smart phone. About 27(6.8%) were suffered from any injury or met an accidents due to use of smart phone, 46 (11.5%) were using smart phone while driving,157(39.3%) were using smart phone while in conference and workshop, 275(68.5%) were using smart phone while they were sitting in group of family members, 311(77.8%) were using smart phone after going to bed in night, 181(45.3%) were using smart phone if ever wake up in night, 255(63.5%) were using smart phone soon after wake up in morning, 186(46.5%) were using smart phone in toilet and 221(55.3%) were felt that they were addicted to smart phone. Conclusion: Even though smart phone has positive role in our daily lives, its overuse leads to negative impact on health, sleep, day to day performance and lead to dependence and addiction.

The research focused on assessing complications and effects resulting from cholecystectomy, where 120 patients were collected from AL-Ramadi Teaching Hospital, Al-Anbar, Baquba Teaching Hospital Diyala and Al-Yarmouk Teaching Hospital, Baghdad, Iraq. It relied on surgical intervention through a laparoscopy for cholecystectomy. The results showed that the mortality rate due to elective cholecystectomy is low and ranges from 0 to 0.5%. The most common cause of death is pre-existing cardiovascular disease and therefore the importance of careful screening for cardiovascular disease symptoms before the operation cannot be underestimated; Any cardiac disease must be corrected before the cholecystectomy procedure and on the other hand, the post-operative infectious complications have been greatly reduced since prophylactic antibiotics are used during and after the operation as observed after laparoscopic cholecystectomy procedures, the average stay is two days; Some patients can be treated for two days, In addition, the rates of incisional hernias and wound sepsis are very low and the need for opioid analgesia is also very low.

The study aimed to compare two types of appendectomy regarding complications. Materials and Methods: A total of 90 Patients older than 12 years, attending AL-Yarmouk Teaching Hospital, in Baghdad, for the period from January to March 2021, with acute appendicitis (based on clinical, laboratory and ultrasonography, examination and investigation), were randomized to open and laparoscopic appendectomy and analyzed for the outcomes. Results: About 90 patients were randomized to 60 patients for open and 30 for the laparoscopic approach. The two groups were close in their mean ages. The analgesia and minor complications were more in the open group, while operative time was longer in the laparoscopic group. Conclusion: the laparoscopic approach is an effective procedure with many advantages compared to open operation and a better outcome. Significant association was found between the type of operation and some factors, such as analgesia, return to activity and minor complications.

Homocysteine was first described by Butz and du Vingeaud et al. However, a link to human disease was not suggested until 1962, Carson and Neil discovered high homocysteine concentrations in urine of some children with mental retardation. The elevated homocysteine levels in these patients were caused by enzymes defects which blocked the metabolism of homocysteine. During the last 15 years it has been thoroughly documented that even moderately elevated homocysteine level is a strong risk factor for cardiovascular disease. In this article we describe the systematic review of the literature.

Background:Complementary feeding is needed to provide energy and essential nutrients required for continued growth and development. Present study was carried out to evaluate the knowledge towards complementary feeding among postnatal mothers of rural areas of District Sirmaur. Methods: This cross sectional study was conducted between March 2021- August 2021 among postnatal mothers came in Pediatric OPD in civil hospital Dadahu selected by convenience sampling technique. Data was collected through face-to-face interview using a semi-structured questionnaire. Data was analyzed using epi info v7 software using appropriate statistical tests. Results:A total of 400 Post Natal Mothers came to Pediatric OPD and having children aged less than 2 year were selected after explaining the purpose of the study. Among the total mothers, maximum 201(50.25%) were having age between 26-30 years, educated up to Matric & Senior Secondary 162(40.5%) Hindu 326(81.5%), Housewife 351(87.75%), Multigravida 280(70%) and delivered in government hospitals 278(69.5%). In the present study 8.25%(33) postnatal mothers’ had very good knowledge (16-20 marks) towards complementry feeding , 72.0%(288) having good knowledge (12-15 marks), 15.25%(61) having fair knowledge (8-11 marks) and 4.5%(18) having poor knowledge (<8 marks). Conclusions: Complementary feeding knowledge was good among postnatal mothers. Appropriate complementary feeding education emphasizing timely initiation and meal diversity is necessary to improve complementary feeding knowledge and feeding practices of mothers.

Blunt abdominal trauma commonly results from either a compression force or a deceleration injury. It has greater mortality than penetrating trauma as there is often injury to multiple organ systems. Spleen and liver are the most commonly injured organs in blunt trauma abdomen. The objective of our study was to determine the modes of blunt trauma abdomen and patterns of injury among the patients admitted to the department of general surgery at Indira Gandhi Medical College, Shimla, Himachal Pradesh. It was a descriptive cross-sectional study that was conducted on the patients with blunt abdominal trauma in the department of General Surgery over a period of one year. A total of 400 patients of Blunt Abdominal Trauma were studied. Out of 400 patients, nearly 70% patients acquired injury due to fall, 28.25 % patients acquired injury due to road side accidents (RSA), 2.25 % patients acquired injury due to assault and no patient sustained sports injury. Spleen was the most commonly injured organ followed by liver. Further analytical studies are required to determine the risk factors responsible for such type of abdominal injuries so that such injuries may be prevented to happen in future.

Background: Literature shows various benefits of Transoral robotic surgery (TORS) for the management of oropharyngeal tumors. The aim of this prospective study was to evaluate the recurrence at one year follow-up of patients having early tumors of oropharynx undergoing Transoral Robotic Surgery. Material & methods: This prospective study was conducted in patients of T1 & T2 tumours of the oropharynx who were treated by Transoral robotic Surgery between the period August 2016 to October 2018 at the Department of Otolaryngology and Head and Neck surgery, PGIMER, Chandigarh. During this period 42 patients were operated by TORS. All the patients were asked to follow up once in 2 months up to a period of 1 year and disease free survival and recurrence rate was noticed. Results: The mean age of patients enrolled in the study was 53.17 ± 11.491years, range being 28 - 70 years there were 38 males (90.5%) and 4 females (9.5%) in the study with a male to ratio of 9.5:1. A total of 5 patients had Recurrence after 1 year of follow up. Recurrence was in one patient of Soft palate and 4 patients of carcinoma Tonsil. No recurrence was seen in patients with Base of tongue malignancy. Recurrence was seen in 2 patients in stage I and 3 patients in stage II. The difference was statistically not significant (p=0.365).Recurrence was found in three patients in Salvage group and in 2 patients where surgery was done as Upfront (primary modality). There was not statistically significant difference (p=0.072). Two patients had recurrence even with surgical margins being free and three patients had recurrence in which margins were positive on histopathology. Statistically this difference was not significant (p=0.072). 3 patients had recurrence in which post operative resection margins were free and two patients had recurrence in which deep resection margins were involved(p=1.00) 12 patients out of 16 patients completed one year follow up who received adjuvant radiotherapy and there was no recurrence of tumor in these patients. No evidence of recurrence was seen in two patients who were HPV positive. Conclusion: TORS has also shown promise in the salvage setting to provide recurrence free survival.

Background: Interstitial Lung Disease (ILD) defines any disease that affects the interstitium and the distal alveoli of the lungs, leading to impaired lung diffusion. The present study was done to evaluate the Socio-demographic and etiological profile of Interstitial Lung Diseases (ILDs) patients. Material and Methods: This cross-sectional study was conducted at Indira Gandhi Medical College, Shimla from July 2018 to June 2019. All consecutive patients of all types of ILDs, attending the outpatient services of the Department of Pulmonary Medicine, IGMC Shimla were enrolment and subjected to focused socio-demographic history. Data was analyzed using Epi info V7 software by applying appropriate statistical tests. Results: The present study includes 50 patients of different types of ILD. Among these, 27 (54%) were female and 23 (46%) were male. The mean age of the study population was 57.821+5.03years. 44(88%) were of rural background and majority were from the lower class of socioeconomic status. The prevalence of active smoking was reported in small percentage of the patients 2(4%). The majority of the study population was either ex-smokers 17(34%) or non-smoker 31(62%). The mean duration of symptoms of ILD was 3.034+2.62 years. Among the study population, a total of 8 (16%) had a history of ATT intake and 10 (20%) patients were on domiciliary oxygen therapy. Among all these ILD patients, 24 (48%) had Idiopathic Pulmonary Fibrosis (IPF), 11(22%) had sarcoidosis, 8(16%) had systemic sclerosis-associated Interstitial Lung Diseases (PSSc-ILD), 3(6%) had Systemic Lupus Erythematous associated Interstitial Lung Diseases (SLE-ILD), 1(2%) patient had Combined Pulmonary Fibrosis and Emphysema (CPFE) and 3(12%) patients had suffered from Hypersensitive Pneumonitis (HP). Conclusion: Most of ILD patients were females, were of rural background, from the lower class of socioeconomic status and either ex-smokers or non-smoker. IPF, Sarcoidosis and CTD-ILDs were the most common ILDs seen at a tertiary center of hilly state in northern India.

Background: Interstitial Lung Disease (ILD) is an umbrella term used for a large group of diseases that cause scarring (fibrosis) of the lungs. The present study was done to evaluate the Clinical characteristics of Interstitial Lung Diseases (ILDs) patients. Material and Methods: This cross-sectional study was conducted at Indira Gandhi Medical College, Shimla from July 2018 to June 2019. All consecutive patients of all types of ILDs, attending the outpatient services of the Department of Pulmonary Medicine, IGMC Shimla were enrolment and subjected to focused socio-demographic history. Data was analyzed using Epi info V7 software by applying appropriate statistical tests. Results: The present study includes 50 patients of different types of ILD. Among these, 27 (54%) were female and 23 (46%) were male. The mean age of the study population was 57.821+5.03 years. The mean duration of symptoms of ILD was 3.034+2.62 years. Cough was the predominant symptom observed in 49(98%) of the patients followed by breathlessness mMRC grade II/III in 45(90%). The exertional chest pain was reported by 17 (34%) of the patients. History of syncope was recorded in 16(32%) while 32 (62%) patients had clubbing of different grades. Overall, eleven (22%) patients had raised JVP while Velcro crackle was detected on auscultation among 29 (58%) patients. There was no significant male-female difference with regards to symptoms except the cough status (p value 0.006). Conclusion: Most of ILD patient’s had cough, breathlessness mMRC grade II/III, exertional chest pain, history of syncope, clubbing, raised JVP and Velcro crackle on auscultation.

Introduction: Premature newborns with surgical conditions are at increased risk of morbidity and mortality due to their fragility and the immaturity of their organs. Our objective was to determine the prevalence of surgical conditions in premature infants, to identify them and to assess their morbidity and mortality. Method: This was a retrospective study carried out in the neonatology and pediatric surgery departments of the jeanne ebori foundation mother-child university hospital from January 2019 to October 2020. Results: During the study period, we collected 34 premature infants with surgical conditions. Premature infants accounted for 38, 2% of newborns with a surgical emergency. The prevalence of surgical emergencies in premature infants was 7.3%. The mean gestational age was 33 WA with extremes of 28 and 35+5 days WA. The sex ratio was 1. Digestive pathology represented 88, 2% of emergencies found. Abdominal wall emergencies accounted for 11, 8%. Neurological emergencies accounted for 8, 8%. 58, 8% of premature babies were operated on. The average time to surgical management was 5 days with extremes of 0 and 20 days. The average length of hospital stay was 17, 2 days with extremes of 1 and 69 days. The overall mortality was 50%. Postoperative mortality was 50%. Conclusion: The surgical emergencies of the premature newborn are represented in the foreground by the digestive affections. The improvement in their prognosis depends not only on the early diagnosis and treatment; but also the multidisciplinary collaboration between obstetricians, pediatrics surgeons and the neonatals resuscitators.

Background: Currently, very few data is available on Day Care Single Incision Laparoscopic Cholecystectomy (SILC). Hence, in this study we aimed to evaluate the incidence of rehospitalization in a hilly terrain like Shimla. Methods: This study was done in a single unit of the Department of General Surgery at Indira Gandhi Medical College and Hospital, Shimla w.e.f July 2018 to June 2019 on patients admitted for surgery. Results: None of the patient in our study required re-admission as none of the patient had any major post-operative complications like post op nausea vomiting, ileus, cystic stump leak, seroma formation, wound sepsis. Conclusion: None of the patient in our study required re-admission.

The peripheral venous catheterization is a commonly done invasive procedure to administer medications, fluids and bio products. Many factors have been implicated in the genesis of phlebitis. the objective of our study was to determine the contribution of various drugs towards thrombophlebitis and the significance of contribution of drugs under study as a risk factor, thereof. All adult patients admitted in Medicine wards and requiring intravenous cannulation over a period of one year were included in this observational study conducted in Department of Medicine, Indira Gandhi Medical College (IGMC), Shimla, Himachal Pradesh. we found that use of antibiotics, diuretics and proton pump inhibitors were found to be significantly associated with the occurrence of thrombophlebitis. Further studies are needed to determine whether the administration of injectable drugs are independently associated with thrombophlebitis or that the procedure and duration of insertion of cannula also attributes as a risk factor in addition to the infusate.

Thrombophlebitis is the inflammation of veins which usually occurs as a result of insertion of cannula. Mostly it is concluded that thrombophlebitis is a physicochemical phenomenon. There are many factors that contribute to thrombophlebitis such as the cannula material, the length, bore size, operator’s skill in the insertion, the anatomical site of cannulation, the duration of cannulation, and the frequency of the dressing changes. In this article we have discussed the various factors pertaining to cannula that may contribute to the incidence of thrombophlebitis. In addition, we have also described the various grades of thrombophlebitis.

The peripheral venous catheterization is a commonly done invasive procedure to administer medications, fluids and bio products. The most common complication associated with it is thrombophlebitis with incidence varying according to different settings. The objective of the study was to estimate the prevalence of superficial thrombophlebitis and assess the clinic-epidemiological profile of the patients admitted in Indira Gandhi Medical College, Shimla. In our study, the prevalence of thrombophlebitis was quite low. Several variables were found in our study such as diabetes, old age, hypertension that might contribute towards the incidence of thrombophlebitis. Further studies are, therefore, desired to determine an association among the factors responsible for thrombophlebitis.

Levobupivacaine is an amino-amide local anaesthetic drug belonging to the family of n-alkyl substitute pipecoloxylidide. Specifically, the drug binds to the intracellular portion of sodium channels and blocks sodium influx into nerve cells, which prevents depolarization. It blocks nerve conduction in sensory and motor nerves mainly by interacting with voltage sensitive sodium channels on the cell membrane. It also interferes with impulse transmission and conduction in other tissues. Dexamethasone, a high-potency long-acting glucocorticoid has been shown to prolong peripheral nerve blockade and duration of analgesia as perineural adjuvant to bupivacaine. This study was aimed to assess the effect of 0.25% Levobupivacaine and its adjuvant 4 mg Dexamethasone on the sensory and motor functions of the nervous system through a USG guided supraclavicular plexus block. It was a cross-sectional observational study that was conducted among the patients undergoing surgery at DRPGMC Kangra, Himachal Pradesh. The study was carried out over a period of 6 months. After excluding these patients, the total number of patients taken for the study were 30. Nearly 51% participants were females. The majority of the study participants belonged to ASA grade one (70%) while the rest belonged to ASA grade two. The onset of sensory block was nearly 8 minutes. The duration for which the sensory block was maintained was 210 minutes. The time taken to attain the motor block using 0.5% levobupivacaine was around 10 minutes. The duration for which the motor block could be sustained was 180 minutes. The onset of sensory and motor blockade is quick in the patients being administered with 0.25% levobupivacaine mixed with the adjuvant dexamethasone 4 mg. The duration for which the motor and sensory block was attained was short. The patients experienced painful interval between the onset through the offset of the anesthesia.

A descriptive and retrospective study was conducted in the hospital, which included all age groups with a clinical diagnosis between January 1, 2019 and June 30, 2020. Ninety patients were collected from AL-Hussein Medical City, Karbala, Iraq, where the study aims to describe the clinical and epidemiological profile of patients with diseases. Bullous pemphigoid is an autoimmune skin disease that occurs mainly in the elderly. It is estimated that it affects between seven and thirteen people per million. Neurological symptoms often start very subtly and the onset of autoimmune diseases may contribute to a delay in neurological diagnosis", who consider it reasonable to speculate that some neurological disorders may predispose to bullous pemphigoid. “The association between bullous pemphigoid and neurodegenerative disease has been the subject of several prominent clinical cases, but a subset of these patients has not been characterized. We have shown a significant association between the two and that neurodegenerative disease can be a predisposing factor. Pemphigus can coexist with central nervous system disorders, particularly dementia, epilepsy and Parkinson's disease. It is present in CNS neurons (and in all epithelial cells) and an immune cross-reactivity between CNS and epithelial isoforms has been suggested.

Background: Mammographic breast density is well known and one of the most important non-modifiable risk factors of breast cancer, which increases breast cancer risk by about five times for those with percent density ≥ 75% compared to women with percent density ＜5%. The present study was done to characterize the breast density and pattern of presentation in breast cancer patients. Material & methods: Present study was conducted in the Department of General Surgery and Radio diagnosis IGMC Shimla from 1st July 2018 to 30 June 2019. A total of 30 patients of breast cancer were included and evaluated in the present study. Results: The mean age of patients was 55.4±10.9 years. In our study, maximum 12 patients were in the age group of 40-50 years followed by 9 patients in age group of 51-60 years. Among all 30 patients, 28 patients complained of breast lump, 1 patient presented with nipple discharge and 1 patient was subjected for screening mammography. Among all 30 cancer patients, 5 patients (16.7%) had breast density of Type A, while majority of patients i.e. 21patients (70%) had breast density of Type B and 4 patients (13.3%) had breast density of Type C. Among all 30 breast cancer patients, 10 patients (i.e.33.3%) were BIRADS 4, 14 patients (46.7%) were BIRADS 5 and 6 patients (20%) were BIRADS 6. Among all 30 cancer patients, 27 patients were diagnosed with duct cell carcinoma (90%) while 2 patients were reported as lobular carcinoma (6.7%) and 1 patient was diagnosed with tubular carcinoma (3.3%). Conclusion: Maximum patients in this study were in the age group of 40-50 year. The most common presenting complaint in breast cancer patients was breast lump. Most patients had higher BIRADS 5&6 and had breast density of Type B. Majority of the patients were reported as Duct Cell Carcinoma.

Background: Wound dehiscence is multifactorial in etiology, conditioned by local and systemic, as well as pre-, intra-, and post-operative factors. The present study was done to evaluate the effect of various Co-morbidities on abdominal wound dehiscence After Midline Laparotomy. Material & Method: The present cross-sectional study was conducted in the Department of General Surgery, IGMC, Shimla, Himachal Pradesh from June 2018 to December 2019. The patients who require midline laparotomy were randomized into Group 1 and Group 2. The patients in Group 1 underwent closure of rectus sheath with conventional continuous closure technique and in Group 2 underwent closure with interrupted X suture technique.  A total of 100 patients were included in each group. Results: In this study there were 79% males and 21% females in Group -1 while there were 89% males and 11% females in Group 2. In group 1, mean age was 47.08 years and SD ± 15.81. In group 2, mean age was 45.65 years and SD ± 14.93 In Group 1, out of 100 patients wound dehiscence occurred in 32 cases while in Group 2, out of 100 patients wound dehiscence occurred in 6 cases. In Group 1, 20 patients were anemic, 7 patients were diabetics, 20 patients had uremia, 75 patients had hypoalbuminemia, 62 patients had chest infection. In Group 2, 13 patients were anemic, 6 patients were diabetics, 19 patients had uremia, 67 patients had hypo-albuminemia and 39 patients had chest infection. Conclusion: Besides technique of closure, various factors like malnutrition, cough, intra-peritoneal sepsis, wound infection, wound gaping, abdominal distension are significant predictors of burst abdomen. Patients with these risk factors require more attention and in presence of these factors, the risk of wound dehiscence can be reduced considerably by using interrupted X-suture technique.

Background: Most individuals with NAFLD have insulin resistance but not necessarily overt glucose intolerance. Present study was done to describe the frequency of undiagnosed diabetes mellitus in patients of nonalcoholic fatty liver disease at IGMC Shimla. Material & Methods: This was a hospital based observational cross-sectional study conducted during November 2017 to November 2018 in the Department of Medicine and Radiology, IGMC Shimla. Data was entered on MS Excel spreadsheet. Results were summarized in tables and percentages. Quantitative data was summarized using means +/- & standard deviation. Cross tabulation with outcome variable of interest was done using statistical SPSS software version 22.0. Results: Total of 100 cases, ultrasonographically diagnosed as NAFLD were included in this study. Mean age of the cases was 51.59±11.44 years. The mean fasting blood glucose (mg/dl) was 116.59±73.64, mean HbAIC was 7.31±13.48. Mean serum cholesterol (mg/dl) was 192±28.27, mean serum triglyceride (mg/dl) was 169.729±1.01, mean serum HDL (mg/dl) was 40.786±.36 and mean serum LDL (mg/dl) was 111.86±28.79. 13(13%) patients were hypertensive. 14(14%) patients had diabetes mellitus. Out of 14 total diabetic patients, 85.71% were females and 14.28% were males Impaired fasting glucose were found in 45(45%) of patients. Increased serum Cholesterol level was seen in 46(46%) patients. Increased serum triglyceride level was seen in 60(60%) patients. Low serum HDL level was seen in 88% patients. Increased serum LDL levels were 31% of patients. Percentage of diabetic patients increased as grade of fatty liver increased i.e. 9.30%, 14.30% and 75% in grade I, II, III respectively. All grade III fatty liver patients had increased triglyceride level i.e. 4(100%) while 32 (76.2%) of grade II and 24(44.4%) of grade I patients were having increased triglyceride levels. Conclusion: Our study revealed that there is higher prevalence of various components of metabolic syndrome in the patients of NAFLD.

Palmoplantar Keratodermas (PPK) form a category of disorders typified by disproportionate epidermal thickening of the palms and soles. PPK may be inherited or acquired. The mutations in genes encoding different proteins involved in keratinization process are involved in the pathogenesis of inherited PPK. Majority of patients of inherited PPK manifest in infancy. Vorner's keratoderma and Unna-Thost keratoderma are two major types of non-transgradient diffuse palmo-planter keratoderma inherited as autosomal dominant trait. They are clinically similar but histologically there are minute differences. We are presenting here a case of mother and a child with thickening of palms and soles. The final diagnosis was made after the histopathological examination.

Background: This study was done to determine the Management and Outcome of Blunt Trauma Abdomen patients in a tertiary care Hospital. Material and Methods: This Observational prospective study was conducted from July 2018 to December 2019 and included all Blunt Trauma Abdomen (BTA) patients admitted in study period at advanced trauma center, PGIMER Chandigarh. Pattern, prevalence, non-operative versus operative management and outcome in term of mortality and morbidity were monitored. Results: Seventy-five patients admitted to ATC during study period were selected for the study. The most common age group affected was 16-30 years which constitute 42(56%) of total affected. Ninety two percent (n=69) of affected population were males whereas 8% (n=6) were females. In the present study, there were 20 patients (26.67%) who were surgically managed and 55(73.33%) were managed conservatively (NOM). Among the total 75 patients, 5 (6.66%) were died during treatment while 70(93.33%) were discharged after recovery. There was no mortality in NOM group. While 5 patients were expired who were surgically managed. Pneumonia was the most common complication that occurred in 45% (n=9) of patients followed by sepsis in 30% (n=6) of cases. No statistically significant difference was found for solid organ injury with mortality. However, injury to ileum, jejunum, colon and mesentery were found to be statistically significant predictors of mortality. Conclusion: Most of the blunt trauma patients were managed conservatively. All patients Involving hollow visceral organ injury required surgical intervention while it was required in only one patient involving solid organ injury Pneumonia followed by sepsis was the most common complication following surgery. There was no mortality in NOM group.

Background: The predominant source of morbidity and mortality in case of Solid Organ Injury among Blunt Trauma Abdomen patients are bleeding, shock and visceral perforation associated with sepsis. This study was done to determine the Pattern of Solid Organ Injury among Blunt Trauma Abdomen patients in a tertiary care Hospital. Material and Methods: This Observational prospective study was conducted from July 2018 to December2019 and included all Blunt Trauma Abdomen (BTA) patients admitted in study period at advanced trauma center, PGIMER Chandigarh. Pattern, prevalence, non-operative versus operative management and outcome in term of mortality and morbidity were monitored. Results: Seventy-five patients admitted to ATC during study period were selected for the study. The most common age group affected was 16-30 years which constitute 42(56%) of total affected. Ninety two percent (n= 69) of affected population were males whereas 8% (n= 6) were females. In the present study, Solid Organ injured in 54(72%) of cases, out of total 75 cases. Liver (40% n= 30) followed by spleen 28(37.33%) are the most common organ injured in case of blunt trauma abdomen. Kidney was third 7(9.33%) and Pancreas was found to be 4th solid organ injured in case of blunt trauma abdomen. Urinary bladder injuries and retroperitoneal hematoma were found to be relatively uncommon and both constituted 5.33% of total blunt trauma abdominal injuries. Conclusion: Solid organs such as liver, spleen, kidney, pancreas, etc., are the most vulnerable and are more likely to be involved in case of Solid Organ Injury among Blunt Trauma Abdomen patients.

Introduction: Generally, in well-equipped centres of the world, ERCP followed by laparoscopic cholecystectomy is recommended as a safe and cost-effective procedure. However, various centres advocate laparoscopic cholecystectomy with common bile duct (CBD) exploration or a Rendezvous technique where endoscopy and laparoscopy are performed simultaneously. They both have a similar efficacy profile with the added benefit of saving time. Material and Methods: This longitudinal descriptive study was carried out from 1-August-2018 to 31-July-2019. Detailed history was taken, thorough clinical examination was done and required investigations were done. Therapeutic decision making was based on expertise availability, number and size of CBD stones, impacted stones and presence of stricture at the lower end of CBD. Laparoscopic cholecystectomy with laparoscopic exploration of CBD was done in some cases depending on availability of expertise. In all cases, operative findings were noted, post-operative morbidity and mortality were noted. Results: Out of 108 patients nine patients had intra operative bleeding (8 during laparoscopic cholecystectomy and 1 during ERCP), three patients had post ERCP pancreatitis. One patient had dense adhesion (frozen calot) and one patient had intra operative bile spillage. Conclusion: Laparoscopic cholecystectomy with laparoscopic CBD stone extraction is a single-step approach and efficacious procedure though surgical expertise is a limiting factor. All modalities have comparable rate of complications and convenience. The modality chosen depends on patients’ choice and availability of facility and expertise.

Introduction: Gall bladder disease is a common health problem throughout the world. The earliest gallstone case was found in Gotland, in the remnants of a tomb dating back to the Stone Age, approximately 4000 years ago. The incidence of cholelithiasis is reported to vary between 5.9% and 21.9% of the general population. The clinical presentation of choledocholithiasis may vary widely, as CBD stones may be asymptomatic in 5-10% of cases. Material and Methods: This cross-sectional descriptive study was carried out in the department of General surgery in concordance with Department of Gastroenterology Indira Gandhi Medical College Shimla (H.P.) on patients admitted with diagnosis of Cholelithiasis with choledocholithiasis from 1-August-2018 to 31-July-2019. Results: A Total of 108 patients were included in the study. The age of patients in the present study ranged from 20 years to 70 years. The mean age of the patients was 47.60 years. Out of 108 cases, 21 (19.44%) cases were male and 87 (80.56%) were females with M: F of 1:4.14. Conclusions: Majority of the patients presented with cholelithiasis and choledocholithiasis are from 51-60 years age group females. All patients included in this study demonstrated cholelithiasis with dilated common bile duct.

Introduction: Currently, head and neck reconstruction is mainly performed with techniques based on free flaps. Advances in microsurgery have left pedicled flaps behind; however, the pedicled pectoralis major flap is an option for the reconstruction of these defects when there is no access to free flaps. The disadvantages such as its volume or its functional and aesthetic sequelae, have been some of the reasons why it is used less and less. Clinical Case: We present the case of a patient with oncologic resection of the neck due to recurrence of papillary thyroid cancer where neck reconstruction was performed with a pectoralis major flap with partial thickness skin graft. Conclusion: The use of the pectoralis major hanging to cover neck defects continues to be an option in the reconstruction of neck defects since it provides good coverage, it is an easy technique, it is performed in the same operative field and presents excellent functional and esthetic results.

As far as conventional treatment like homoeopathy is concerned disagreement or controversies are always exist when it comes to manage diseases like Haemorrhoids due to its tendency of recurrence, relapse and complications. Haemorrhoids are defined as enlargement of spongy blood containing cushions inside the wall of anus mostly a consequence of prolonged constipation or typically loose motions. Chronic constipation and consequent straining at stool raise intravenous pressure. Haemorrhoids may be external or internal to the sphincter. The external varieties are covered under skin while internal are clothed by mucus membrane. When internal Haemorrhoids have prolapsed and remained outside for months, covering mucus membrane becomes changed and assumed the characteristics of stratified squamous epithelium. Such Haemorrhoids are sometimes known as intra external. Here I tried to explore the efficacy of Homoeopathic medication with Poso logical variation of single drug (NUX VOMICA) in treatment of Haemorrhoids and I choose Haemorrhoids intentionally because Haemorrhoids is a most common and worldwide health hazard having its main impact on mind along with body due to its unwanted location, pain, itching and foul discharges, which compels me to involve myself in finding out gentle, smooth, non-harassing mode of treatment with Homoeopathic medication which most of the time proved beneficial in the treatment of both uncomplicated and complicated cases of Haemorrhoids with certain potencies like 200.

Background: A broken bone or a fracture is a very painful injury. Immediate first aid is crucial for broken bones. This study was undertaken with the objective to assess the knowledge about first aid knowledge regarding fractures among Ortho OPD patients in civil hospital Rohru, District Shimla. Material and Methods: This cross-sectional study was conducted between Aug- December 2020 among Ortho OPD patients in civil hospital Rohru selected by convenience sampling technique. Information regarding their socio-demographic characteristics and knowledge, about first aid knowledge regarding fractures were obtained using a self-administered, pre-tested, semi-structured questionnaire. Data was analyzed using epi info v7 software using appropriate statistical tests. Results: In the present study 35% (140) of the patients fall were below 40 years of age while 65% (260) were above 40 years. 54% (216) of patients were male and 46% (184) were female. among the total patients maximum 301(75.25%) replied that immobilization of the injured area is the first aid measure in case of fracture followed by apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing 289 (72.25%) and apply a splint to the area above and below the fracture sites 205(51.25%). Still 95 (23.75%) didn’t know about any first aid measure in case of fracture. Conclusion: Good first-aid care of fractures is always important. Any negligence can increase pain and bleeding and can damage tissues around the injury. This can lead to complications in the repair and healing of the injury later on.

The study and complete data collection were conducted in Shatra Hospital, Thi-Qar, Iraq. The purpose of this study was to evaluate the effectiveness of surgical procedures using nets in pelvic prolapse. Where it was 150 and the average woman's age was 50 ± 5.4 from Shatra Hospital, Thi-Qar, where a questionnaire was collected from patients in the hospital and it was identified that there are some complications from the surgery that weaken the muscles and ligaments that support the pelvic organs in r body, the pelvic organs can slip out of place and hang down insider body Vagina (pelvic organ prolapse). To treat pelvic organ, prolapse, a surgical mesh may be implanted to support the weakened vaginal wall. This surgery can be performed through the abdomen, using a net, or through the vagina without using a net. And surgery through the vagina using mesh is no longer an option. Each use of surgical mesh has its risks and benefits. The use of transvaginal surgical mesh to treat pelvic organ prolapse is associated with high rates of mesh-related complications, including mesh protrusion through the vaginal tissues and pelvic pain.

Introduction: Surgical vascular emergencies are infrequent, compared to bone and digestive emergencies [1]. A distinction should be made between minor vascular emergencies and major ones. The latter being the subject of our study, the objective of which is to describe the epidemiology and surgical aspects. Material and Method: We carried out a retrospective and descriptive study over a period of 4 years in the general surgery, otolaryngology and emergency departments of the Omar Bongo Ondimba Army Instruction Hospital. Results: 30 patients were collected, i.e. a prevalence of 1.6%. The male sex predominated at 67.8% and a sex ratio of 2.11. The young adult was the most affected age group with an average age of 35, 4 years. The stabbing agent was the main wounding agent followed by the arteriovenous fistula aneurysm. Vascular lesions mainly affected the limbs. Morbidity was marked by sensitive motor paralysis, joint tiffs and 10% mortality. Conclusion: Vascular wounds are major surgical emergencies, of which the stabbing is the main agent of vulnerability.

With interest we read the review article by Koike et al., [1] about the association between SARS-CoV-2 vaccinations and Guillain-Barre syndrome (GBS) [1]. It was concluded that the risk of GBS is not considered a legitimate reason to limit administration of currently available vaccines, because only a trivial association or no association with GBS [1]. The review is appealing but has a number of limitations which evoke the following comments and concerns.We do not agree with the statement that GBS is “mainly categorised into a demyelinating and an axonal subtype” [1]. GBS is not only categorised according to electrophysiological criteria into “axonal” and “demyelinating” but also according to clinical criteria, particularly if only peripheral nerves or also cranial nerves or both, or even the central nervous system (CNS) are involved. Accordingly, in addition to acute, inflammatory demyelinating polyneuropathy (AIDP) and acute, motor (and sensory), axonal, neuropathy (AMAN/AMSAN), Miller-Fisher syndrome (MFS), polyneuritis cranialis (PNC), the pharyngeal, cervical, and brachial (PCB) variant, and brainstem Bickerstaff encephalitis (BBE) are delineated [2]. All subtype of GBS are diagnosed according to the Brighton criteria.We do not agree with the notion that there is only a “trivial” or “no” association between SARS-CoV-2 vaccinations and GBS. According to a recent mini review at least 17 cases with SARS-CoV-2 vaccination associated GBS have been published so far [submitted]. In all cases GBS developed after the first dose of the vaccine. In two patients an mRNA-based vaccine and in 15 patients a vector-based vaccine was applied. Latency between vaccination and occurrence of GBS ranged between one day and 39 days. Eleven patients received IVIGs, two steroids, and one additionally plasma exchange. The outcome was fair in most cases.

Background: Hysterectomy is next only to cesarean section in women all over the world. There is a large variation in trends of hysterectomy in different parts of the world. The current study was carried out to find and analyze the trend of hysterectomy, route of hysterectomy, indications of surgery in the suburban population and trend change over the years. Materials and Methods: A retrospective observational study was conducted from 1st January 2014 to December 2019 which included 1411 cases of hysterectomy. Parameters like age, parity, type and indications of hysterectomy and route of hysterectomy were analyzed and presented in percentages and proportions. Results: Mean age group of patients was 44 years and most were in the age group 41 to 50 years. The most common complaint was heavy menstrual bleeding. Majority of the patients underwent hysterectomy for benign conditions (94.76%), with fibroid being the most common (51.73%), 3.96% cases were done for malignant conditions where as 1.28% underwent hysterectomy for obstetrics reasons. In the present study maximum number of hysterectomies were performed by vaginal route (51.09%), 47.2% abdominally and 1.72% laparoscopically. Conclusion: Fibroid uterus is the most common indication of hysterectomy. Although Minimal invasive surgeries like laparoscopic hysterectomies are gaining popularity, vaginal route and abdominal routes are still preferred by most gynecologist and patients in suburban/rural population.

Background: Worldwide it is becoming common to conceive at or beyond 35 years. The tendency of delayed conception has effect on the mother. The objectives of this study were to review the antenatal & obstetric complications among elderly gravida and compared to the younger gravid mothers of age 21-34 years Material & methods: This prospective study was carried out in the department of Obstetrics and Gynecology at Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla for one year period from 1st July 2018 to 30^th June 2019. All participants were divided into two groupsGroup1 (Study Group) had consisted of  all pregnant women with age 35 years or more while Group 2(Control Group) consisted of Every pregnant woman with age ≥20 to ˂35 years, who gets enrolled in the labor room admission register next to a case, was taken as a control. Comparative data of the two groups was subjected to statistical analysis. Results: There were 6922 deliveries out of which 415 subjects were >35 years, the incidence was 6.00%. It the study group, 349(84.10%) were between 35-39 years and 66(15.90%) were 40 years and above. Out of 415 subjects in the control group, 117(42.65%) were of 20-24 years, 148(35.66%) were of 25- 29 years and 90 (21.69%) were of 30- 34 years. It was observed that the total number of medical complications in the study group were 270(65.06%) and in the control group were 126(30.36%). Gynecological complications in the study group were 11(2.65%) and in the control group were 9(2.17%). Fetal complications in the study group were 199(47.94%) and in the control group were 184(44.34%). Placental complications in the study group were 21(5.06%) and in the control group were 9(2.17%). Maternal complications in the study group were 21(5.06%) and none in control group. Conclusion: All medical, gynecological, fetal, placental & maternal complications were increased with advanced maternal age. Timely and accurately diagnosis of complications and their treatment leads to favorable outcome.

Vertebral cysthidatic phenomenon is a very rare disease. Spinal involvement is usually seen with pulmonary, abdominal and pelvic involvement spreading in the thoracic region. A 35-year-old female patient presented with right-sided back pain and increased muscle weakness and loss of sensation for the last 6 months. By performing thoracotomy after MRI and CT evaluations; The cystic lesion involving vertebra, spinal canal and pleura was excised. There were no complications in the early postoperative period. The patient was administered albendazole 2x400 mg for three months and physical therapy. At the end of the first postoperative year, it was observed that there was almost complete recovery.