Background: Reconstruction of extensive defects of the perineum and scrotal region, with exposure of the testes, following avulsion injury or severe infections represents a significant challenge. Replacement with sensate, durable cover is mandatory for functional, cosmetic, and psychological reasons. A wide range of flap techniques has been reported for this purpose with their advantages and disadvantages. We describe the use of the anteromedial thigh flap in our case series with the advantages and disadvantages. Materials and Methods: We had seven patients in our series, of which two patients were posttraumatic defects and other five were post-Fournier’s gangrene unilateral scrotal defects. We describe few case examples in the series in detail, of which the first patient was 21-year-old labor who presented with avulsion injury to penis and scrotum. He had a loss of scrotal skin near totally, except for 2cm × 2cm areas posteroinferiorly. In addition, he also had a loss of penile skin from the glans to the base of the penis. We used bilateral anteromedial thigh fasciocutaneous flap based on the longitudinal axiality of the anteromedial thigh suprafascial plexus for reconstruction. The patient had an excellent recovery, a good aesthetic result at the end of 1 year. Another posttraumatic defect was unilateral and the patient also had a good recovery.The other five patients in series were of Fournier’s gangrene. All patients underwent initially debridement and then flap cover on day 7. All of them needed unilateral scrotal reconstruction. The unilateral anteromedial flap was carried out with good recovery at the end of the 6 weeks. Results: This flap has provided nice durable cover for the testes with an acceptable aesthetic appearance, although the color match was not good in case 3 of the series. Conclusion: In conclusion, anteromedial fasciocutaneous thigh flap is a good choice for scrotal reconstruction that could provide a sensate, durable cover that fulfills patient satisfaction. It is technically easy and has favorable functional and aesthetic results.

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Cryptococcal meningitis caused by the environmental yeast Cryptococcus neoformans has emerged as a significant pathogen in immunocompromised and immunocompetent patient especially in human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS). Recent advances in the diagnosis and management of cryptococcal meningitis are promising and have been improving long-term survival. Point-of-care testing has made diagnosing cryptococcal meningitis rapid, practical, and affordable. Cryptococcus neoformans var. neoformans is predominantly found in Cerebro Spinal Fluid sample. Although the diagnostic testing and the antifungal treatment of cryptococcal infections have become firmly established in clinical practice, new developments and the areas of ambiguity merit further consideration. Early diagnosis followed by the institution of specific therapy, where possible, has effectively reduced mortality. This review aims to present status of cryptococcosis in India. Fortunately, new approaches have been leading the way toward improving care for cryptococcal meningitis patients. New trials using different combinations of antifungal therapy are reviewed, and we summarize the efficacy of different regimens.

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Background: Areca nut (Areca Catechu) is considered to be the fourth extremely prevalent addictive psychoactive substance consumed widely by about 10%–20% of the world population. Due to its theological and cultural acceptance, areca nut is chewed in different forms and formulations. It has been observed that people who chew supari (areca nut) exclusively for many years suffer from diabetes mellitus, coronary artery disease (CAD), oral submucous fibrosis, and oral cancer. We, therefore, planned to see its association with various cardiovascular ailments at our center. Materials and Methods: This was a single-center observational study carried out on people chewing areca nut exclusively (no other toxic or addicting substance) attending cardiac outpatient department (OPD) in National Heart Institute and Research Centre, Delhi, India. The subjects data were collected regarding the history of the disease, consumption of areca nut, and socioeconomic status with relevant work up. Results: There were 17 subjects who primarily chewed areca nut; 11 of them had CAD, diabetes, oral submucous fibrosis, and aplastic anemia. Further, one particular case not only suffered oral cancer but also had two episodes of myocardial infarction, but continued to chew areca nut. The second episode of myocardial infarction was fatal. Conclusion: Areca nut chewing is also associated with significant cardiovascular morbidities besides oral cancer. In such preparations, the risk of some other toxic substances together with areca nut cannot be eliminated as no empirical analysis has been carried out to the best of our knowledge and belief. In order to clarify its effect on other vascular diseases, further work with a larger sample size is required.

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A case of iatrogenic bladder perforation as a complication of dilatation and curettage was reported. A 28-year-old patient with a history of medical termination of pregnancy by dilatation and evacuation performed 3 days back, presented with distension of abdomen and giddiness. The laboratory investigations pointed toward renal failure with raised serum creatinine, and ultrasound was suggestive of ruptured ectopic pregnancy with hemoperitoneum. An emergency laparotomy was performed. Intraoperative findings were hemoperitoneum, left ruptured ectopic pregnancy, uterine perforation, and urinary bladder perforation. Left salpingectomy was performed, and urinary bladder was repaired. The serum creatinine levels were normal within 24h. Urinary bladder perforation may be suspected in postoperative dilation and evacuation (D and E) patients with impaired renal function tests.

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Background: Stent-related symptoms affect nearly 80% of patients with indwelling ureteral stents. Alpha blockers relieve flank pain by blocking alpha-adrenergic receptors and relaxing the smooth muscles of ureter, trigone, and prostatic urethra, thus reducing bladder outlet resistance and voiding pressure, whereas mechanism of anticholinergic drugs involves relief of involuntary bladder contractions that are mediated by muscarinic receptors. We have compared alpha blocker and anticholinergic drugs in reducing stent discomfort. Materials and Methods: The study was conducted from March 2017 to February 2018. A total of 100 patients with unilateral double-J ureteral stenting were randomized, postoperatively into two groups: tamsulosin 0.4mg daily (Group I) and tolterodine 4mg daily (Group II). Results: The mean age was 39.1 years in Group I and 38.0 years in Group II. The male:female ratio in Group I and Group II was 1.38:1 and 1:1, respectively. There was statistically significant difference in urinary symptom score, pain score, and general health score between the two groups in favor of Group I (tamsulosin 0.4mg) at 1week post-stenting and 4 weeks (at stent removal). Conclusion: Oral medication, with uroselective alpha blockers, in patients with indwelling stents reduces stent-related symptoms and negative impact on quality of life.

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A case of large rhinolith arising on a foreign body is presented. Rhinolith is synonymous with the stone in the nose. It may be asymptomatic in some patients. A 30-year-old female patient presented with nasal obstruction, intermittent foul-smelling nasal discharge, and bleeding from the right nasal cavity. The patient was diagnosed as a case of rhinolith by endoscopy, X-ray para nasal sinuses (PNS) and confirmed by computerized tomography scan of PNS. She was operated successfully and rhinolith was removed.

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Background: Varicose veins and their associated symptoms/complications constitute the most common chronic vascular disorders, affecting 20% of the adults, leading to surgical treatment. In general, this does not cause major life-threatening illness, yet the morbidity of venous ulceration places a substantial burden on community health care. Aim: The aim of our study was to evaluate various clinical presentations, management, and outcome in 50 patients who presented with varicose veins at tertiary center. Materials and Methods: This study is a descriptive review of clinical data of 50 patients diagnosed and treated for varicose veins at our tertiary center over 2 years. Results: Most commonly affected age-group was 41–60 years. Majority of patients were males, dilated veins being the most common presenting symptom. Increased incidence was observed in left leg (32%) as compared to right (26%). In unilateral leg involvement, great saphenous vein (GSV) was most commonly affected (62.06%), whereas in bilateral leg involvement, 73.8% had perforator incompetence. Patients with advanced disease had both saphenofemoral and perforator incompetence. Majority underwent Trendelenburg’s procedure with stripping of GSV and subfascial perforator ligation. Postoperative complications were minimal, and no patient developed recurrence at subsequent follow-ups. Conclusion: The use of color Doppler is an essential investigation along with clinical examination for effective treatment of varicose veins, to prevent recurrence and reduce morbidity. Operative treatment is the primary procedure in the management with minimal chance of recurrence.

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Introduction: Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) is a state governments’ health insurance scheme of free quality critical care for low income families. Aim: The aim of this study was to assess the patients’ awareness about the MJPJAY scheme and to study patients’ perception about the scheme through Service Quality (SERVQUAL) at tertiary care hospital. Materials and Methods: A total of 100 exit interviews of MJPJAY beneficiaries (patients) were conducted through structured questionnaire over 6 months’ study period, who availed the services of MJPJAY. Results were analyzed by descriptive statistics and displayed in the form of percentage. Service quality has been measured with “SERVQUAL” a scale to assess the perception of MJPJAY beneficiaries. Results: A total of 100, 71% males and 29% females benefitted by the scheme. The mean age of MJPJAY beneficiaries was 20 years. The SERVQUAL score of MJPJAY services provided at tertiary care hospital was found to be satisfactory at 4 rating on Likert scale for all five dimensions. Conclusion: In this study, their perception has been measured by service quality (SERVQUAL) tool, consisting a set of questions that mainly focuses on soft skills used by service provider, which allows patients to express their opinion regarding services rendered to them by the hospital.

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Introduction: In the countries where firearm possession is illegal, the gunshot traumas are very rare. However, even in these countries they remain as a significant health problem and affect both adult and pediatric populations. Materials and Methods: A total of 10,191 patients were hospitalized during the 9 years’ period at our center, of this 1,702 were trauma-related admissions. The gunshot trauma caused multi-organ injuries in six patients receiving surgery, with a mean age of 36.2 years. Results: The injuries to the particular organs were assessed according to the Organ Injury Scale proposed by the American Association for the Surgery of Trauma. Patients received damage control surgery, including laparotomies, thoracotomy and thoraco-phreno-laparotomies. Discussion: Gunshot trauma is one of the penetrating injuries, affecting predominantly young, adult males. In the civilian population of urban areas, low-energy gunshot traumas exceed high-energy ones. The trajectory of the bullet may help to assess potential organ injuries. The injuries to the organs and cavities were directly proportional to complications and mortality rates. Conclusion: The gunshot trauma is an uncommon cause of multi-organ injury compared to road traffic injuries. However, when it occurs, many organs may be involved or severely injured. The surgical approach depends on the severity of organ injuries and is usually a combination of laparotomy and thoracotomy. The damage control surgery is recommended for hemodynamically unstable patients.

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