Congenital dislocation of the knee (CDK) is a rare orthopaedic condition identified at birth, characterised by hyperextension and anterior displacement of the tibia relative to the femur. We present the case of a term neonate with a hyper-extended and anteriorly dislocated right knee, observed immediately after birth. Clinical evaluation and radiographic imaging confirmed the diagnosis of an isolated CDK. A conservative treatment approach was undertaken using serial above-knee casting, with the knee maintained in maximal flexion. The casts were changed weekly for 5 weeks, resulting in gradual and complete correction of the deformity. This case highlights the importance of early recognition and timely conservative management in achieving successful outcomes in isolated congenital knee dislocation, potentially avoiding the need for surgical intervention.
Segmental jejunal dilatation (SJD) is an exceptionally rare congenital condition that is often misdiagnosed. When associated with gastric heterotopia and intestinal malrotation, it presents a unique diagnostic and therapeutic challenge to the surgeon. We report the case of a 5½ month-old female infant with a concurrent moderate ostium secundum atrial septal defect with a left-to-right shunt, who presented with failure to thrive and recurrent vomiting. Imaging and surgical exploration revealed SJD with gastric heterotopia and intestinal malrotation. The patient underwent segmental bowel resection and Ladd’s procedure, with excellent post-operative recovery.
Background: Chemotherapy-induced thrombocytopenia (CIT) is a common haematological adverse effect in patients with cancer receiving cytotoxic chemotherapy. It is associated with an increased bleeding risk, treatment delays, dose reductions and compromised therapeutic outcomes. Despite global studies on CIT, data from South Indian tertiary care hospitals remain limited, necessitating institution-specific evidence to guide clinical decision-making. Aim: The study aimed to evaluate the incidence, severity grades and management outcomes of CIT amongst cancer patients and to identify the most common chemotherapeutic agents implicated. Materials and Methods: After approval by the Institutional Human Ethics Committee, we conducted a retrospective observational study over 1 year at a tertiary care oncology centre. Data were collected from the electronic medical records of 150 cancer patients who had received at least three cycles of chemotherapy and had complete haematological data. Platelet counts before and after chemotherapy were recorded, and thrombocytopenia was graded according to the Common Terminology Criteria for Adverse Events. Management strategies were analysed, including dose modification, treatment delay, platelet transfusion and thrombopoietin receptor agonist (TPO-RA) use. Results: CIT was frequently observed amongst patients receiving platinum-based regimens, accounting for 48.6%. Platinum coordination complexes, particularly carboplatin, caused CIT in 24% of patients and were associated with the highest incidence of thrombocytopenia. Grade 1 CIT accounted for 82% of CIT cases, Grade 2 for 9%, Grade 3 for 3% and Grade 4 for 6%. Severe cases were managed with romiplostim and/or platelet transfusion. Mild-to-moderate cases were managed conservatively. High treatment costs limit the routine use of TPO-RAs. Conclusion: CIT remains a significant clinical challenge, particularly with platinum-based chemotherapy, especially carboplatin. Most cases are mild and self-limiting; however, severe thrombocytopenia requires active intervention. Early identification, grading and structured management of CIT can help prevent complications, reduce unnecessary treatment delays and improve overall patient outcomes.
Background: The relative prevalence of specific influenza subtypes and lineages significantly impacts seasonal epidemiology and the effectiveness of vaccines. Detailed virological data from regional centres in India are crucial, yet often limited. Aims: The objective is to determine the subtype and lineage-specific distribution of influenza viruses and analyse their distinct temporal patterns and clinical correlations. Methods: A detailed analysis was conducted on 598 influenza-positive samples identified through prospective surveillance of 7,231 patients with influenza-like illness (July 2019–June 2020). Subtyping for A(H1N1) pdm09 and A(H3N2) and lineage determination for B/Victoria and B/Yamagata were performed using real-time RT-PCR. Statistical comparisons were performed using Chi-square tests. Results: Influenza A accounted for 83.6% (500/598) of all positive results. Among these,A(H3N2) was overwhelmingly predominant (379/500, 75.8%; P < 0.001 vs. A(H1N1) pdm09). All influenza B viruses (98/598, 16.4%) belonged to the B/Victoria lineage. Temporal analysis revealed distinct patterns: A(H3N2) circulated during both monsoon and winter peaks, whereas A(H1N1) pdm09 cases were concentrated significantly in winter (51.2% of total, P < 0.001). Influenza B (Victoria) activity was restricted exclusively to the monsoon season (96.9% of cases, P < 0.001). A(H1N1) pdm09 infected a significantly higher proportion of individuals aged 41–59 years compared to A(H3N2) (25.6% vs. 17.4%, P = 0.037). The clinical presentations did not differ significantly between the subtypes. Conclusion: The complex co-circulation of influenza viruses in North India, with a significant predominance of A(H3N2) and exclusive circulation of B/Victoria. The clear temporal separation and age-specific differences highlight the importance of subtype-specific surveillance for informing regional vaccination strategies and preparedness for waves of illness caused by different viruses.
Background: Delirium is a prevalent neuropsychiatric complication in critically ill patients, associated with increased morbidity, mortality and long-term cognitive impairment. Sedation practices are increasingly recognised as modifiable risk factors for delirium; however, the optimal approach remains debatable. Objective: This narrative review examines the bidirectional relationship between sedation management and delirium in the intensive care unit (ICU), by synthesising evidence from randomised controlled trials (RCTs), meta-analyses and systematic reviews published between January 2000 and December 2025. Methods: A structured literature search was conducted in PubMed, Embase, the Cochrane Library and Web of Science using predefined search terms related to ICU delirium and sedation. English-language RCTs, systematic reviews, meta-analyses, cohort studies and practice guidelines addressing sedation practices and delirium in adult ICU patients were included. Results: Contemporary evidence supports a paradigm shift towards lighter sedation targets and non-benzodiazepine approaches. Dexmedetomidine has been associated with lower delirium rates compared to benzodiazepines in several RCTs, though the magnitude of benefit varies across populations and comparator agents. Multi-component prevention bundles, including the ABCDEF bundle, have demonstrated consistent delirium reduction in observational and quasi-experimental studies. However, important heterogeneity exists across trials, and several key studies have produced null or conflicting results for the primary endpoints. Conclusions: Sedation minimisation and avoidance of benzodiazepines represent reasonable evidence-based strategies; however, the strength of evidence varies by population and context. Significant knowledge gaps persist regarding optimal strategies for specific subgroups, and the implementation of evidence-based practices remains suboptimal.
Background: Dengue is an emerging vector-borne disease of high significance to public health. Severe forms of dengue fever, such as Dengue Haemorrhagic Fever and Dengue Shock Syndrome, may lead to fatal consequences in areas where more than one dengue serotype is present. Aim: The present study was conducted to study the various serotypes of Dengue virus circulating in a locality and that it may be made known to the clinicians, public health professionals, and stakeholders such that a collective strategy for controlling the disease transmission can be developed. Materials and Methods: A hospital-based surveillance study was conducted over 1 year, specifically from June 2023 to October 2024, and the spatial distribution of DENV types among various local administrative sub-districts in India, comprising a town or city acting as its headquarters, along with surrounding villages (tehsils), was observed. Blood samples from the patients were subjected to IFAT for the presence of DENV using DENV type-specific antibodies. Results: Tehsil 2 reported the maximum number of dengue cases compared to the other tehsils. However, another interesting observation was that although the reporting was less in the other areas, there was more than one DENV strain in individual patients. Conclusion: The present study highlights the need for vigorous prevention and control measures to be adopted in these settings to prevent the transmission of multiple DENV types and minimise the severity of the disease.
Background: Health-related quality of life (HRQOL) is an important patient-reported outcome after gastrointestinal (GI) surgery and liver transplantation. Data from India, where patients present with diverse socioeconomic backgrounds and limited access to post-operative rehabilitation, are scarce. This study aimed to assess HRQOL in patients at 4 weeks following GI surgery, including liver transplantation, and compare the outcomes with non-operated controls. Aim: To assess HRQOL in patients at 4 weeks following major and minor GI surgery, including liver transplantation, and compare the outcomes with non-operated controls using the validated SF-36 questionnaire. Materials and Methods: This cross-sectional observational study was conducted at a Tertiary Care Centre in New Delhi, India. One hundred post-operative patients (50 major surgeries and 50 minor surgeries) and 100 age- and sex-matched non-operated control subjects were enrolled. The short form survey (SF-36) questionnaire (Ware and Sherbourne, 1992) was administered 4 weeks postoperatively. Domain scores (0–100) were calculated using the standard SF-36 scoring algorithm. Between-group differences were assessed using one-way analysis of variance and Chi-square tests (significance: P < 0.05). Results: The major surgery group included 12 liver transplant recipients. The mean SF-36 domain scores were significantly lower in the major surgery group across all eight domains (P < 0.001). Physical functioning scores: major surgery 45.2 ± 18.4, minor surgery 62.4 ± 15.6 and controls 81.8 ± 12.2. Liver transplant recipients had the lowest HRQOL scores in the major surgery subgroup. Patients who underwent minor surgery also showed significant physical domain impairment relative to controls. Conclusions: GI surgery, particularly major procedures such as liver transplantation, significantly impairs HRQOL at 4 weeks. Structured post-operative rehabilitation, adequate pain management and psychological support are essential, especially in the Indian healthcare context. Longitudinal studies are required to characterise these recovery trajectories.
Background and Aim: Opioid-sparing multi-modal analgesia is an important component of the enhanced recovery after surgery (ERAS) protocol. Lignocaine and dexmedetomidine have emerged as effective anaesthetic adjuvants. Laparoscopic cholecystectomy, an ambulatory surgery, has advantages such as better patient satisfaction, a significant reduction in hospital stay and a rapid return to normal activities. The primary aim of this study was to compare post-operative pain relief using the Visual Analogue Scale (VAS) score at 2, 4, 8, 12 and 24 h. Secondary objectives included intra-operative haemodynamic stability, post-operative nausea and vomiting (PONV), recovery of bowel function, post-operative sedation and satisfaction scores. Materials and Methods: This study included 78 American Society of Anesthesiologists 1 or 2 patients aged 18–65 years who underwent laparoscopic cholecystectomy under general anaesthesia at our institute. The patients were allocated to three groups: lignocaine (1%), dexmedetomidine (3.3 μg/ml) and normal saline. The standard anaesthesia technique was followed. A bolus injection of the study drug (1.5 ml/kg) was administered at induction, followed by an infusion of 0.15 ml/kg/h. Results: The three study groups were comparable to each other. VAS scores were significantly higher in Group 3 until 12 h, and the requirement for rescue analgesia was significantly higher in Group 3 at 2 and 4 h postoperatively. Patient satisfaction scores were lower in Group 3 than in Groups 1 and 2. Conclusion: Intra-operative lignocaine and dexmedetomidine provided significant pain relief and maintained haemodynamics. Both drugs decreased PONV and increased patient satisfaction. Lignocaine is accompanied by an early return of bowel function, and dexmedetomidine is associated with post-operative sedation.
Transcervical resection of the endometrium is a minimally invasive surgical procedure used to treat select cases of abnormal uterine bleeding (AUB). It involves excision of the superficial layers of the endometrium through the cervix, leaving the basal layer intact. The use of transcervical resection of the endometrium (TCRE) in conjunction with the insertion of Mirena, a trademarked hormonal intrauterine device (IUD) employed for contraception and the management of excessive menstrual bleeding, facilitates the procurement of tissue for histopathological analysis and is economically viable compared to hysterectomy. This study evaluated the effectiveness of TCRE with Mirena insertion for treating AUB. The objective of this study was to measure patient outcomes by examining amenorrhoea rates, complications, long-term effectiveness and associated costs. These costs were divided into direct costs, covering the expenses related to the procedure and hospitalisation and indirect costs, which included the number of workdays lost, the time taken to resume normal activities and morbidity. An ambispective (having both retrospective from 2013 to 2024 [August] and prospective components [from August 2024 to December 2024]) study was conducted on 50 women with AUB with failed medical management (6 months of medical treatment) who underwent TCRE with Mirena insertion at Sir Ganga Ram Hospital, Delhi, from 2013 to 2024. Patients were followed up for 3 months to 10 years. Data analysed included age, pre-operative symptoms, body mass index, procedure details, complications, histopathology results and menstrual outcomes. Amongst the 50 cases, the mean age was 40.42 years, with 32% of patients achieving amenorrhoea post-procedure. The majority (58%) of the patients experienced cyclical spotting, while 6% reported reduced menstrual flow. Of the 43 patients who received Mirena, 34% achieved amenorrhoea and 59% had cyclical spotting. The patient satisfaction rate was 94.12%. The unsatisfactory group underwent a hysterectomy. TCRE with Mirena insertion is an effective treatment for select cases of AUB, offering long-term symptom relief, low complication rate, histopathological diagnosis and cost-effectiveness in expert hands. Mirena insertion adds to the effectiveness of the long-term outcome. Further research with larger cohorts is required to optimise the results and reduce the need for hysterectomy.
Background: As healthcare systems grow increasingly complex and technology-driven, there is a pressing need to equip future physicians with problem-solving skills, systems thinking and design principles that define engineering disciplines. Although isolated programmes have integrated engineering into medical training, there is a limited synthesis of how these approaches are operationalised and evaluated. Objective: This narrative review explores the integration of engineering principles into medical education and identifies models, thematic trends and opportunities for interdisciplinary innovation. Methods: Relevant literature was identified through a comprehensive search of PubMed, Scopus, IEEE Xplore and grey literature sources using keywords related to engineering mindsets, medical education and interdisciplinary training. A flexible and exploratory approach was used to include peer-reviewed and conceptual articles that addressed the application of systems thinking, simulation, quality improvement (QI) and design in medical training contexts. Results: Fifteen articles spanning North America and Europe were included in the study. Four themes emerged: (1) engineering-based curricula and dual-degree programmes; (2) simulation, modelling and systems thinking; (3) healthcare systems engineering and QI and (4) interdisciplinary collaboration and innovation. Programmes such as EnMED and MEDTEC exemplify dual-degree initiatives that foster innovation capacity. Simulation tools enhance experiential learning of physiology and pharmacokinetics. Lean methodology, human factors and system optimisation are embedded in QI education. Interdisciplinary programmes, such as healthcare hackathons and design thinking challenges, cultivate real-world problem-solving and team-based innovation. Conclusion: Integrating engineering principles into medical education enhances learners’ ability to navigate complex technology-intensive healthcare systems. Embracing systems thinking, process design and interdisciplinary collaboration represents curricular enhancement and a fundamental evolution in preparing future physician-innovators.
Biostatistics is an integral part of a surgeon’s practice. From prescribing the correct drugs to planning the proper procedure, an evidence-based approach must be followed. However, not all available evidence from the literature is clinically relevant, and its interpretation requires caution. This interpretation is possible only with a basic understanding of the various statistical terms that enable the critical analysis of the study results. This review aimed to provide a comprehensive overview of frequently used statistical terms and their significance for academic surgeons.
The tobacco epidemic poses a significant public health challenge globally, with over 8 million deaths annually, a substantial number of which occur amongst young people. In India, the Global Youth Tobacco Survey 2019 reports that 8.5% of students aged 13–15 currently use tobacco. This article examines the unique vulnerabilities of adolescents to tobacco addiction in India, where the tobacco industry employs deceptive marketing tactics that exploit their impressionability. These strategies include flavoured products, appealing packaging and targeted advertising through social media, all designed to normalise tobacco use amongst youth. The impact of nicotine on developing brains increases the risk of mental health issues and long-term health complications. This review highlights the urgent need for educational initiatives that equip young individuals with knowledge about tobacco’s dangers and the industry’s manipulative practices. It advocates for a comprehensive, multi-faceted approach combining educational programmes, effective communication and stringent tobacco control policies. Stakeholder involvement – from parents and educators to healthcare professionals and policymakers – is crucial for fostering a smoke-free environment and protecting young minds. By enhancing awareness and resilience against tobacco use, we can work towards building a healthier future for the youth of India.
Background: Sepsis remains a major cause of morbidity and mortality worldwide, and early risk stratification is essential for guiding clinical decision-making. Although the Sequential Organ Failure Assessment (SOFA) score is widely used for prognostication, the incremental value of liver-related biomarkers such as the albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) scores in sepsis has not been fully elucidated. Aims: This study aimed to comprehensively evaluate biomarkers and clinical scoring systems associated with mortality in patients with sepsis admitted to the intensive care unit (ICU) and to determine the incremental prognostic utility of the ALBI and PALBI scores as emerging prognostic indicators. Materials and Methods: This retrospective observational study included adult patients (>= 18 years old) diagnosed with sepsis and treated in the anaesthesiology ICU of a tertiary teaching and research hospital. A total of 188 patients were analysed. The ALBI and PALBI scores, SOFA and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, lactate levels, C-reactive protein/albumin ratio, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were evaluated. Receiver operating characteristic curve analysis and multivariable logistic regression were used to determine the independent predictors of mortality. Results: The in-hospital mortality rate was 61.7%. Independent predictors of mortality were SOFA score >6 (odds ratio (OR) = 3.57; 95% confidence interval (CI): 1.74-7.31; P < 0.001), ALBI score >-1.93 (OR = 2.49; 95% CI: 1.13-5.50; P = 0.024), APACHE II score >28 (OR = 2.22; 95% CI: 1.05-4.71; P = 0.037), inappropriate empirical antibiotic therapy (OR = 7.50; 95% CI: 2.28-24.63; P < 0.001) and elevated lactate levels (OR = 2.63; 95% CI: 1.18-5.86; P = 0.018). Conclusion: The ALBI score was independently associated with mortality but showed limited sensitivity when used alone. Combined evaluation with the SOFA score improved both sensitivity and specificity, highlighting the complementary prognostic role of ALBI in sepsis.
Background:Human immunodeficiency virus (HIV) remains a global burden on healthcare. As per the latest epidemiological data, India is estimated to have around 24.01 lakh people living with HIV/acquired immunodeficiency syndrome (AIDS).Aim:This study analysed the epidemiological trends of HIV/AIDS from 2013 to 2022 in a tertiary healthcare centre in Central India.Materials and Methods:This is a retrospective study analysing data from 2013 to 2022 at the Integrated Counselling and Testing Centre of a tertiary healthcare centre in Central India. Variables included age and sex distribution, positivity rate, high-risk behaviour and referral efficiency of the antiretroviral therapy (ART) centre. To the best of our knowledge, this represents the first 10-year retrospective analysis of HIV trends at a tertiary centre in Central India.Results:A total of 116,523 cases were tested, of which 1664 were HIV-positive (1.43%). The positivity rate has declined from 2.6% in 2013 to 0.63% in 2022. The majority of positives were male (70.07%). The highest prevalence was observed in the 35-49-year age group (38.63%). ART linkage amongst positive patients was 93.6%.Conclusion:The prevalence of HIV has declined over the last decade, which could be attributed to the multipronged approach of the World Health Organization. These governmental and various non-governmental organisations consistently work towards controlling HIV cases. However, screening gaps persist amongst women, children and transgender individuals, suggesting a need for more inclusive and gender-sensitive strategies.
Background: Antibody screening is crucial in blood transfusion centres to detect unexpected antibodies against non-ABO blood group systems, including Duffy, Kell, Kidd, MNS and Rh types. These antibodies, often formed after exposure to foreign antigens during transfusion or pregnancy, can cause severe transfusion reactions, including haemolytic disease of the foetus and newborn. Despite being routine in many countries, pre-transfusion antibody screening is underutilised in India. Aims: This study aimed to determine the prevalence of unexpected red blood cell (RBC) antibodies amongst blood donors and patients at A. D. Gorwala Shree Krishna Hospital in Karamsad, Gujarat, to enhance transfusion practices. Materials and Methods: This retrospective cross-sectional study was conducted from January 2020 to June 2022 and involved 7117 participants, including 5113 patients and 2004 blood donors. The ScreenLys Kit, which utilises magnetised RBCs and an indirect antiglobulin test, was used for screening and identifying irregular antibodies. The Chi-square tests were performed to assess the statistical significance of antibody prevalence across the demographic variables. Results: The study found a 1.6% prevalence of unexpected antibodies, with a higher rate in females (P < 0.001). Anti-D was the most frequently identified antibody, followed by multiple antibodies and anti-E. The highest prevalence of positive cases occurred in individuals aged 41-60 years. The prevalence of this antibody was higher than that reported in similar studies from other regions, highlighting the importance of routine antibody screening in India. Conclusions: These findings emphasise the need for routine antibody screening to prevent severe transfusion reactions and improve the patient outcomes. Understanding the prevalence and specificity of unexpected antibodies is crucial for enhancing transfusion safety and practice.
