Morel-Lavallée lesion (MLL) is a closed degloving injury resulting from the separation of the subcutaneous tissue from the underlying deep fascia due to shearing forces. It most commonly occurs around the pelvis, hip, and thigh. We describe an unusual post-traumatic lesion resembling an MLL but occurring at the periosteal interface of the tibia. A 49-year-old man presented with a localized swelling over the upper anterior aspect of the right leg that developed two months after a blunt injury sustained while kick-starting a motorcycle. Physical examination revealed a firm, mildly tender swelling over the proximal tibia. Ultrasonography demonstrated a well-defined subperiosteal anechoic collection with minimal heterogeneous echogenic contents, consistent with an organized chronic subperiosteal hematoma. Unlike a conventional MLL, the lesion was confined to the plane between the tibial periosteum and the overlying fascial-soft tissue envelope, without intramuscular extension or internal vascularity. Plain radiographs showed no osseous involvement. Ultrasound-guided aspiration confirmed the diagnosis of chronic hematoma. This case highlights a previously undescribed Morel-Lavallée-like periosteal degloving lesion of the tibia resulting in a chronic subperiosteal hematoma. Recognition of this atypical injury pattern and its characteristic ultrasonographic appearance may facilitate the accurate diagnosis of chronic post-traumatic tibial swellings and help avoid unnecessary investigations.

BACKGROUND:Inguinal hernia repair remains one of the most common surgical procedures performed in the elective setting. trans abdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) are the two well-established laparoscopic methods of inguinal hernia repair. However, doubts still exist about their relative merits and risks. In this study, we are sharing our observations on the comparative analysis of TAPP versus TEP. MATERIALS AND METHODS:This retrospective analysis was carried out on 105 cases of inguinal hernia, repaired laparoscopically over the last 2 years. Patients within the age group of 20-60 years, operated for primary unilateral inguinal hernia using either TAPP or TEP were included in this study. All the repairs were done by a single surgeon in the same unit, having more than 3 years of experience in laparoscopic hernia repair. RESULTS:Among 105 patients, who underwent laparoscopic hernia repair, 53 were operated on by TAPP and 52 by TEP. There was no significant visceral or vascular injury in either group. The mean duration of surgery in the TAPP group was 103.43 ± 12.24, and in TEP group 89.83 ± 14.25 min (P < 0.0001) Mean hospital stay was 2.47 ± 0.79 and 2.0 ± 0.65 days in TAPP and TEP groups (P = 0.001). Patients in the TAPP group were able to return to their work after 14.30 ± 1.60 and in TEP after 13.73 ± 1.24 days (P = 0.04). CONCLUSION:Both TAPP and TEP are well-established methods for laparoscopic hernia repair. In terms of outcome, we observed that TEP requires less operative time and is associated with a relatively shorter hospital stay and earlier return to work.

Cerebral palsy (CP) remains a leading cause of childhood disability, with varying clinical presentations and comorbidity patterns. This study explored the clinical spectrum, functional severity, and perinatal risk factors of CP among children aged 4–14 years in eastern India to identify priority areas for early intervention and support. A cross-sectional study was conducted over one year at a tertiary care centre. Data were collected through structured caregiver interviews and clinical assessments using standardized tools—the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS). Associations between demographic, perinatal, and clinical variables and CP severity were analysed using likelihood ratio tests and partial correlation analyses. Among 127 children with CP (median age: 5.9 years; 74.0

Introduction: Globally, 3.8% of adults have severe disabilities and 19.4% have moderate-to-severe disabilities. Individuals with impairments frequently endure unbearable pain and hefty weights, which poses unique challenges for their families. This study’s primary goal was to identify the clinical and epidemiological traits of musculoskeletal disability patients who visited the physical medicine and rehabilitation (PMR) outpatient department (OPD). Materials and Methods: This retrospective study was conducted in the PMR Department of All India Institute of Medical Sciences, Deoghar, Jharkhand. The study aimed to assess and describe the pattern and profile of patients seeking treatment in PMR OPD, based on 4 years of records (2021–2024). During this time, 2174 patients in total visited PMR OPD. The Institutional Ethical Committee granted ethical approval. Results: The mean age of the 2174 patients who visited the PMR OPD was 43.48 years. The majority of patients in the PMR department were female (51%) and underwent occupational therapy and physical therapy (87%). The majority of them had disorders of the upper and lower limbs (each 36%). Most patients (66%) in the PMR department travelled 50 km or less to get to the OPD. Only 9% of patients went more than 100 km, while 25% of patients travelled between 51 and 100 km to receive PMR OPD care. Conclusions: Physical constraints can have a major impact on people’s daily activities, social participation, and overall quality of life, and no research was done to assess clinical and epidemiological features of musculoskeletal patients in the tribal areas of Jharkhand.

Background: Heat stroke is a growing public health concern exacerbated by rising temperatures and prolonged heat waves. This study examines the clinical profile, prognostic markers, and outcomes of heat stroke patients presenting to a tertiary care center in India and compares findings with previous global studies. Objective: The objective of this study was to analyze the clinical profile, prognostic markers, and outcomes of heat stroke patients presenting to a tertiary care center in India and to compare findings with previous global studies. Materials and Methods: A retrospective study was conducted between March and July 2024 at a tertiary care center in Eastern India. Data on demographics, clinical parameters, laboratory values, and outcomes were collected and analyzed using appropriate statistical methods. Results: During the study period, 43 patients were admitted with heat stroke, the mean age (in years) was 57, and 67% were male. The overall mortality rate was 21%. Significant predictors of mortality included hypotension (systolic blood pressure <100 mmHg, P = 0.040), tachypnea (respiratory rate >20/min, P = 0.001), Glasgow Coma Scale score <9 (P < 0.001), elevated creatinine, and multi-organ dysfunction syndrome involving the renal system and central nervous system (P < 0.01). Younger, active individuals were disproportionately affected due to occupational exposure to high ambient temperatures. Conclusion: Our findings highlight key clinical and biochemical predictors of poor outcomes in heat stroke. Indian patients, being younger and functionally active, may face increased exposure to high ambient temperatures.

Background and objective Disability assessments are crucial for identifying barriers faced by individuals with disabilities, particularly in countries like India, where disability is often underreported. The Labour Force Survey Disability Module (LFS-DM) is a widely used tool for disability assessment. It is available in English, and Indian Hindi-speaking people who are not proficient in English may face difficulties in responding to it. This study aimed to translate and culturally adapt the LFS-DM into Hindi. This will improve its accessibility and relevance for Hindi-speaking populations in India. Methods The LFS-DM was translated into Hindi using a forward and backward translation process involving three bilingual experts. The resulting Hindi version was reviewed for conceptual equivalence (on a 10-point scale) by three healthcare professionals. Pilot testing was conducted with 51 participants with various disabilities who completed the questionnaire and participated in cognitive interviews. The test-retest reliability was assessed using the intraclass correlation coefficient (ICC) with a two-week interval between administrations. Results The linguistic validation process ensured that the Hindi version of the LFS-DM was conceptually equivalent to the original English version with an average score of 9.57 ±0.48. Pilot testing revealed that all participants (27 males, 24 females, mean age: 45.6 ±7.8 years) easily understood the questions, with no major issues reported. Test-retest reliability was good to excellent, with ICC ranging from 0.843 (minimum) to 0.999 (maximum). Conclusions The Hindi-translated LFS-DM was linguistically valid and had similar conceptual equivalence with the original questionnaire. It showed good to excellent test-retest reliability. Hence, it can be used in the assessment of disability among Hindi-speaking populations. This tool can be used in future research, healthcare assessments, and policy development, contributing to more inclusive practices for persons with disabilities in India.

Background:Healthcare professionals (HCPs) worldwide suffer from stress and poor sleep and the COVID-19 pandemic has further raised these issues. This study sought to determine whether HCPs had reduced stress and increased sleep quality while participating in a heartfulness meditation program. Subjects and Methods:For a 2-month (8 weeks) heartfulness meditation program, we included 41 individuals in a prospective one-group pretest post-test intervention design from February 2023 to April 2023. Scores on the Perceived Stress Scale and Pittsburgh Sleep Quality Index were gathered at baseline and 8 weeks. Forty-one (76%) of the 54 participants completed this study for 8 weeks. Results:Results showed a substantial decline in stress (preintervention mean ± standard deviation [SD] = 20.54 ± 4.46; postintervention mean ± SD = 18.42 ± 6.14; t-value = -1.947 [0.05*]) and improvement in sleep quality (preintervention mean ± SD = 6.63 ± 3.82; postintervention mean ± SD = 5.29 ± 2.44) among HCPs after following this 8-week heartfulness meditation program. In the end, a substantial decrease in perceived stress score and an improvement in the sleep quality index was found. Conclusion:Additionally, practicing heartfulness meditation may aid in developing the traits of empathy, acceptance, and inner serenity. We draw the conclusion that more extensive research is required to fully understand the impact of heartfulness meditation practice.

This study evaluated the three year clinical outcomes and predictors of success for unicompartmental knee arthroplasty (UKA) in an Indian population. Twenty patients with medial compartment osteoarthritis (≥ Ahlbäck grade 2) underwent UKA. American Knee Society Score (AKSS), Oxford Knee Score (OKS), and Visual Analogue Scale Score (VAS) were assessed at baseline, two weeks, six weeks, three months, and three years. Postoperative Hip Knee Ankle angle (HKA) and the Knee Joint Line Obliquity angle (KJO) were measured. At three years, UKA led to significant improvements in knee health, function, and pain. AKKS improved from 62.20 ± 5.27 to 90.60 ± 3.81, OKS from 37.00 ± 1.55 to 19.15 ± 1.93, and VAS from 8.45 ± 0.69 to 2.40 ± 0.59 (all P < 0.05). Preoperative VAS was significantly correlated with both preoperative and postoperative outcomes of knee health and function (preoperative and three year AKSS and OKS), and limb alignment (HKA and KJO). Preoperative AKSS correlated with postoperative knee health and functional outcomes (3-year AKSS and OKS), pain levels (3-year VAS), and limb alignment (KJO). In this study of an Indian population, UKA demonstrated significant, sustained clinical improvements over three years, with no implant-related complications. In our cohort, preoperative pain and knee health significantly predicted outcomes. These findings suggest that preoperative assessment and optimization of both pain and knee health may potentially enhance the postoperative outcomes after UKA.

Steroid-resistant nephrotic syndrome poses a significant therapeutic challenge in paediatric nephrology. Previously exact cause of steroid-resistant nephrotic syndrome was mostly unknown. Recently, advancements in diagnostic intervention, they are found to be a heterogeneous entity having an immune basis and genetic aetiology. With a better understanding of the pathogenesis of SRNS, leading to the development of novel therapeutic strategies. Novel therapeutic options include extracorporeal therapy, monoclonal antibodies, stem cell therapy, ACTH and galactose. The aim of this study was to provide an overview of emerging therapies for SRNS in paediatric populations.

Background:Snakebites are a common medical emergency and occupational hazard for children in India, particularly in rural areas where poverty is prevalent. However, there is limited data on the epidemiology of snakebites on the Indian subcontinent. Objective:This cross-sectional, observational study aims to investigate the epidemiology, major clinical manifestations, and outcomes of snakebites in children under the age of 15 who were admitted to a tertiary care center in Bihar, a state in East India, and draw attention to this public health concern. Methods:A cross-sectional observational study was conducted at the Department of Paediatrics, Patna Medical College and Hospital, Patna. The study included all cases of snakebites with features of envenomation involving patients less than 15 years of age who were brought to the department over a 2-year period. Data were collected using a data collection form and analyzed using the Statistical Package for the Social Sciences, version 11.0 (SPSS Inc., Chicago, IL, USA). Results:A total of 59 cases were recorded, with 62.71% (n = 37) being male and 37.28% (n = 22) being female. Kraits were responsible for 38.9% (n = 23) of cases, vipers for 42.3% (n = 25), and cobras for 5% (n = 3). Fang marks were present in 67.7% (n = 40) of cases, and the majority of bites (84.7%, n = 50) occurred on a lower limb during the day. The age distribution showed that 16.9% (n = 10) were below 5 years old, 44% (n = 26) were between 5 and 10 years old, and 22% (n = 13) were above 10 years old. Traditional treatment was used in 44.7% (n = 22) of cases, with the most common treatments being local incision + tourniquet (22%, n = 13) and no traditional treatment (55.9%, n = 33). The highest number of cases occurred during July-September (35.5%, n = 21). Conclusion:Snakebites are a significant public health issue in Bihar, India, with the majority of cases occurring in rural areas. The study highlights the importance of increased awareness and preparedness among healthcare providers and the general public, particularly during the monsoon season. Early hospital transfer, prehospital management, and prevention should be promoted through regular public health initiatives.

Intro: Invasive aspergillosis of CNS is a severe form of aspergillosis & is associated with high mortality. Most of these cases are suspected & diagnosed in neutropenic patients. We hereby describe a series of 15 patients with CNS aspergillosis in non-neutropenic patients from a tertiary care hospital in India. Methods: All patients with clinical & radiological features suggestive of CNS aspergillosis were screened for microbiological evidence of invasive aspergillosis, either by demonstration of hyphae by microscopy or histology, culture or galactomannan assay. Patients demographic details, clinical features, risk factors, diagnosis, management & outcome details were documented. Findings: A total of 15 patients were found to have CNS aspergillosis, 5 isolated CNS infections & 10 showing concomitant CNS & pulmonary aspergillosis in one between January 2021 to July 2022. The average age was 41.46±14.6y, with majority being male. Among the risk factors, most common ones were fungal sinusitis (46.6%), steroid use (40%), COVID-19 (33.3%). One patient had history of endoscopic sinus repair, another had h/o lung abscess. Most common symptoms of CNS aspergillosis were headache (73.3%), fever (60%), altered sensorium (53.3%) & seizures (47.6%). Radiologically, the common findings included ring enhancing lesion, s/o cerebral abscesses were observed in four patients. Direct microscopy s/o fungal hyphae were reported in 5 patients, with 4 culture positives. Average serum galactomannan was 1, while CSF galactomannan showed better sensitivity with mean CSF galactomannan being 2.53. Almost all patients were treated with Voriconazole based on weight, but showed high mortality of 60% even after initiation of therapy. Complete resolution were seen in only two patients, while 4 patients remaining static in improvement during 6 months follow up. Conclusion: Invasive CNS aspergillosis must be suspected even with nonneutropenic patients with newer emerging risk factors like steroid use, COVID-19 & h/o fungal sinusitis presenting with clinical & radiological manifestations.

Vitamin D dependent rickets (VDDR) type 2 is a very rare hereditary disease which has an autosomal recessive mode of inheritance. Patients with VDDR type 2 have a mutation in the gene encoding for vitamin D receptor on chromosome 12q12-q14, thus averting normal physiological action of 1,25 vitamin D. It's presents with the developmental delay in motor domain with features of rickets usually in the first year of life. Alopecia totalis has a frequent association with the disease. We are reporting a case of a 5-year-old boy who has a history of difficulty walking since 2 year of life, with a gradually progressive motor weakness course. Patients have a history of alopecia since 2 months of age, which progressed to alopecia totalis. On investigation, serum calcium was 7.2 mg/dl with a very high alkaline phosphate level of 1065 IU/ML with a normal vitamin D level was reported. The initial treatment started with IV calcium followed by 1000mg of oral calcium, along with a high dose of calcitriol. The patient was under periodic follow-up showing improvement in biochemical parameters. We reviewed literature of seven patient out of which 5 patients had alopecia and found 2 patients had enamel hypoplasia and all had features of rickets.

Background Deficiency of vitamin D along with traumatic brain injury (TBI) augments the risk of injury severity. This possibly affects the therapeutic regimen prescribed for TBI which may pessimistically affects its outcome.Methods Studies literature search was conducted in Google Scholar and PubMed. The inclusions were studies performed clinically on both male and female. All included studies’ references were also reviewed to find any additional relevance related to this review. Studies published in English were considered for this review. This review focuses upon the incidence of vitamin D deficiency in TBI and how it affects the Quality of life of the sufferer.Results A total of 176 studies were reviewed and 58 were thoroughly focussed for review as they met inclusion criteria. These studies demonstrate that levels of vitamin D influence the recovery outcome after TBI. Vitamin D deficiency has been found to cause more deterioration in severe TBI than in patients with mild TBI.Conclusion Paucity of vitamin D significantly affects the outcome after brain injury. This clearly validates the necessity for screening of vitamin D levels in neurological deficit in order to reduce the risk of morbidity in terms of neurocognitive disorder.

Background: Fractures of the patella constitute approximately 1% of all skeletal injuries, resulting from either direct or indirect trauma. Many forms of internal fixation for patellar fractures have been described in the literature but perfect anatomical reduction during surgery has an excellent outcome irrespective of the method of fixation used. The conventional method of patellar tension band wiring (TBW) is being done always with the help of two parallel Kirschner wires (K-wires). Objectives: Here in our prospective study, we intended to see whether the use of three parallel K-wires in comparison to the conventional one results in superior functional outcomes. Materials and Methods: A prospective cohort study was carried out in New Delhi from November 2016 to November 2019 in a total of 44 patients with patellar fractures operated by TBW with 22 patients in two parallel K-wires and three parallel K-wires groups, respectively. Patients were followed up postoperatively for 1 year and assessed by Lysholm knee score (LKS), pain status, working status, and other variables Normality of data was tested by Kolmogorov–Smirnov test and paired t test/Wilcoxon rank-sum test. Results: The total mean age was 40.27 years (41.86 in 2K-wire and 38.68 in 3K-wire) in this study. LKS (0.00 in both groups on first day; 99.23 and 99.45 after 1 year in 2K-wire and 3K-wire groups, respectively, pain status (was 5.0 in both groups on the first day and 1.0 after 6 month), and working status (was 5.0 in both groups on the first day and 1.09 after 1 year), were not significantly different throughout the mean to follow up periods for both groups (P > 0.05). Conclusions: No significant difference was observed between patellar TBW in 3K-wire and 2K-wire groups.

Cerebral palsy (CP) is a neurological disorder that affects muscle tone, movement, and motor skills in children. One of the most common symptoms of cerebral palsy is spasticity, which is characterised by involuntary muscle contractions and stiffness. Both botulinum toxin and casting have been used as standalone treatments for spasticity in cerebral palsy, but which is better is still unclear. The aim of the present meta-analysis was to compare the effects on spasticity of serial casting and/or botulinum toxin type A (BoNT-A) in conjunction with or as independent therapies. Studies up to February 2022 were identified in four separate databases. The inclusion criteria were randomised controlled trials (RCTs) that compared different therapies (Botulinum toxin A, or BoNT-A, and casting) and assessed spasticity improvement in children with spastic cerebral palsy who were younger than 18 years old and were published in English. With a 95% confidence interval (CI), the standardised mean difference (SMD) was utilised to calculate treatment effects. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist was followed to undertake the current study. The search for relevant literature in four databases generated 147 results. After the abstract and full-text screening, five publications with a total of 190 cerebral palsy patients were included in this systematic review and meta-analysis. In patients with cerebral palsy, both methods - botulinum toxin and casting- apply globally; our systematic review tries to find out the most effective treatment between the two but does not show any significant difference in these methods. As we know, botulinum toxin is expensive, and the casting method is time-consuming and poorly accepted by patients. There is a need for an excellent study to examine the impact of casting and botulinum toxin type A.

Innovation in technology has changed the way we interact, collaborate and conduct business. In the next 10 years, there will be a lot of changes in how we, as patients, clients and healthcare workers, experience healthcare. As they consider how to adapt medical and clinical specialists who focus on devices, such as prosthetists and orthotists, are presented with both an opportunity and a challenge. Less focus is placed on engineering and business abilities in the current prosthetic and orthotic education and practice, and more emphasis is placed on clinical skills. However, each of the three is important for a prosthetics and orthotics business to be successful and last for a long time. Furthermore, the latter two will have a significant impact on how prosthetics and orthotics look in the future. It is unclear how contemporary prosthetic and orthotic professionals can respond most effectively. In this editorial, one option is to rebalance their professional character so that the three most important parts are given equal weight. As a result, a Clinical Prosthetic Orthotic Technology Management Professional would practice their profession in a way that is client-centred, functionally grounded and incorporates eight professional traits: professional, advocate, scholar, leader, communicator, collaborator, assistive technology expert and business justification specialist.

Acute hemorrhagic edema of infancy (AHEI) is a benign and rare presentation of leukocytoclastic vasculitis that usually affects children between 4 months and 24 months of age. It is characterized by purpuric and ecchymotic lesions that mainly involve the distal extremities, the face, and the ears. It usually follows some viral or bacterial infection. Here, we report a case of a 25-month-old male child who presented with mild grade fever and upper respiratory tract infection symptoms. Subsequently, he developed progressive purpuric and ecchymotic lesions over his body, mainly on his lower limbs and face. Laboratory tests were done, showing elevated C-reactive protein and erythrocyte sedimentation rate with rest of normal results. In view of patients having respiratory symptoms, reverse-transcriptase polymerase chain reaction of a nasopharyngeal swab for coronavirus disease 2019 (COVID-19) was done, which came out to be positive. The baby received supportive care only. He gradually improved and was discharged successfully. AHEI may be a possible after effect of COVID-19 infection.

A renal angiomyolipoma is a benign kidney tumor composed of muscle, fat, and blood vessels. It is the most common benign kidney tumor, and it affects women more frequently than men. Angiomyolipomas can be small and asymptomatic, or they can be large, presenting with symptoms such as discomfort, hematuria, and hypertension. Occasionally, the rupture of an angiomyolipoma can cause a perinephric hematoma. This case report discusses a patient who developed a spontaneous large perinephric hematoma alongside a small renal angiomyolipoma. Aneurysm was seen on imaging. Angioembolization was successfully used for treatment. We explore the significance of the presence or absence of an aneurysm in predicting the risk of hemorrhage, particularly in association with small lesions. Angioembolization is an excellent choice for treating angiomyolipomas associated with significant hematomas.

Haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome is a rare condition associated with cerebrovascular accidents. It usually happens in the third trimester, although it can also present in the early weeks of pregnancy or the postpartum period. A 24-year-old female presented with 39 weeks of gestation. After 2 days of delivery, she developed generalised convulsions and following that she had burst abdomen with sepsis. She was diagnosed with a case of HELLP syndrome. After that she became coronavirus disease 2019 (COVID-19) positive and was shifted to a COVID-intensive care unit (ICU) where she was provided ventilator support. After 3 months of ICU stay, she was shifted to the rehabilitation unit. In the meantime, she had an episode of stroke with associated quadriparesis, impaired cognition, loss of vision, dysphagia and bladder-bowel involvement. Rehabilitation outcome was partially successful in her case. Post-partum HELLP syndrome associated with COVID-19 can develop severe complications. Medical management combined with goal-oriented customised rehabilitation can lead to a better outcome.