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Introduction: Diabetic foot ulcers (DFUs) have become a common and serious outcome of diabetes mellitus (DM). Diabetic peripheral neuropathy (DPN) is often underdiagnosed, which impairs the capacity to prevent foot ulceration. The clinical manifestations typically include sensory complaints, which leave patients vulnerable to increased risk of injury without their awareness., Aim: The current study aims to assess the viability of VPT (vibration perception threshold) testing using a biothesiometer as an early diagnostic tool for detecting diabetic neuropathy and reducing the burden of diabetic foot disease., Material and Methods: This prospective study was conducted in Dr. D. Y. Patil Medical College, Pimpri, Pune from August 2022 to July 2024 among 50 patients with DFUs. Ethical approval was taken from the Institutional Ethical Committee. An informed consent was obtained from all the study participants. VPT testing using a biothesiometer was done to assess the neurological status of the patient's limbs. A significant difference between the symptomatic and asymptomatic cases was also calculated to evaluate the co-relation of symptoms compared to VPT., Results: The largest age group among those surveyed is 41-50 with a mean age of 50.72. Males form a slightly larger proportion than females. A total of 22 (44%) ulcers are present over the plantar aspect of the foot. Out of the entire study, 37 (74%) individuals reported Grade II or III neuropathy, and 29 (58%) individuals reported no symptoms of diabetic neuropathy. The majority portion of individuals in the study had an HbA1c ranging from 6.5% to 8%. After an intervention, 44 (88%) patients did not experience a change in their VPT grading after six months., Discussion: The chi-square test results suggest that the onset period of diabetes in years or the type of treatment history for diabetes does not significantly influence VPT grading among the surveyed individuals. However, individuals with higher HbA1c levels tend to exhibit more severe VPT impairments., Conclusion: Regular monitoring of VPT grading is crucial for early diagnosis of neuropathy, tracking disease progression, and assessing intervention effectiveness. Hence, we recommend all diabetic patients regularly undergo biothesiometry as part of their routine diabetic check-ups to help prevent disease progression and complications like amputations and improve their overall quality of life., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Dr. D. Y. Patil Medical College, Hospital and Research Centre Ethical Committee issued approval I.E.S.C/PGS/2022/73. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kelshikar et al.)

Introduction: Diabetic foot ulcers (DFUs) stand out as a prevalent and debilitating condition. Furthermore, the progression of diabetes-related hyperglycemia and associated conditions such as peripheral arterial disease exacerbates the risks of DFUs, including complications like infection and gangrene. Given the significant burden of DFUs, there is a pressing need to improve preventive and therapeutic strategies. This study investigates the clinical profiles of patients with DFUs, including the importance of smoking and intermittent claudication, evaluates management strategies based on the vascular status assessed through Doppler scans, and provides insights into the importance of ankle-brachial pressure index (ABPI) and toe brachial index (TBI) values, which play a vital role in predicting and managing ulcer healing outcomes, highlighting the importance of vascular assessment in treatment planning., Aim: The study aims to assess the clinical profile of patients with DFUs based on their vascularity status using Doppler scans, predict the outcome of the ulcer using indexes like ABPI and TBI values, and decide on further management., Materials and Methods: This prospective study was conducted over 24 months, from August 2022 to July 2024, at the Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. The study included 50 patients presenting with DFUs. Approval was obtained from the Institutional Ethics Committee, and informed consent was obtained from all participants. A detailed history was taken, including the history of smoking and intermittent claudication, and a thorough examination of the ulcer was performed. HbA1c levels were measured, Doppler scans of the lower limbs were done, and the ABPI and TBI values were calculated. Management strategies were determined based on the assessed vascular status, leading to either medical or surgical interventions., Results: Twenty-one (42%) patients who presented with DFUs had a positive history of intermittent claudication, demonstrating a significant association between the history of intermittent claudication and the Doppler findings. Thirty-seven (74%) patients gave a positive history of smoking, which revealed a significant association between the history of smoking and Doppler findings. Thirty-eight (76%) patients had an ABPI of <0.9, out of which 33 (66%) patients showed an improved outcome of the ulcer after necessary management. There is also a statistically significant association between the ABPI and Doppler findings. Sixteen (32%) of patients had a TBI of <0.65, of which all showed an improvement. There is a highly significant association between TBI and the Doppler findings., Conclusion: This study concludes that integrated routine assessment of ABPI and TBI into DFU management protocols is necessary to guide treatment decisions and monitor response to therapy. Treatment and prevention of diabetes-related complications affecting the lower extremities require a dedicated interdisciplinary approach., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Subcommittee issued approval I.E.S.C./PGS/2022/76. Before the study started, ethics approval from the Research and Recognition Committee under the Faculty of Medicine of Dr. D. Y. Patil Medical College, Hospital and Research Centre was obtained. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Parekh et al.)

A rare side effect of cholelithiasis, called Mirizzi syndrome (MS), arises when gallstones that are impacted in the Hartmann's pouch or the cystic duct extrinsically compress the common bile duct. This condition is typically managed with a cholecystectomy. In this case report, different surgical approaches are described according to each type of Mirizzi. We report a 62-year-old female who presented with abdominal pain. She underwent endoscopic retrograde cholangiopancreaticography (ERCP) and was diagnosed with MS. We performed a subtotal cholecystectomy with a choledochoduodenostomy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kelshikar et al.)

Since the start of the SARS-CoV-2 pandemic, which is otherwise known as the worldwide coronavirus disease, 2019, has had a well-established pro-thrombotic character. Patients often first exhibit respiratory symptoms, and those whose severity increases eventually develop acute hypoxic respiratory failure. The systemic hypercoagulable condition and arterial/venous thrombosis related to COVID-19 have a poor prognosis. Even though superior mesenteric artery (SMA) thrombosis and acute mesenteric ischemia (AMI) are uncommon, they frequently coexist with fatal gastrointestinal (GI) pathologies that necessitate prompt diagnosis and treatment by the doctor. This calls for more research into the effects of anticoagulation therapy in COVID-19-positive patients. The main treatment aims for this condition are early detection, surgical or intravascular re-establishment of blood supply to the ischemic bowel, and surgical resection. The study aimed to see the outcome after surgical intervention in patients with SMA thrombosis post-COVID-19 infection. This study was from March 2021 to January 2022, with a sample size of 5 patients with SMA thrombosis, which was confirmed on contrast-enhanced computed tomography (CECT) abdomen and pelvis with angiography. The patients underwent exploratory laparotomy. Bowel resection and anastomosis were performed in three individuals; bowel resection and stoma placement were performed in two patients. Doctors have significant clinical challenges as a result of the thromboembolic manifestations of the unexpected and deadly nature of the virus, such as AMI. The high morbidity and mortality associated with AMI calls for further study on prophylactic anticoagulation therapy in COVID-19-positive individuals., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Parekh et al.)