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Background: Burn injury causes a systemic inflammatory response, leads to reduced platelet count, and leakage of a significant amount of albumin in the interstitium and urine. Prognostic indicators play a critical role in patient management. There are not set prognostic factors indicating the outcome of a patient post burn injury. Objective: Correlate microalbuminuria and platelet count with clinical variables in the post-burn injury patients. It is carried out in an attempt to find a simple, cost-effective and at the same time reliable prognostic factor in burn patients. Methodology: This is a Prospective Cohort study conducted from May 2017 to December 2018. Any patient presenting with thermal burn injury fulfilling the inclusion criteria was included. Patients with a history of renal dysfunction or co-morbidities precipitating were excluded. Inhalational injury, Systemic inflammatory response, renal failure were assessed along with microalbuminuria and platelet count to outcome variable of survivors and non-survivors. A total of 49Results: patients were included. The presence of microalbuminuria showed a strong association with outcome variables but quantitative analysis of the same was not indicative more over microalbuminuria was strongly positive in presence of Inhalational injury and renal failure. Platelet count reached minimum value at 3 - 5 days from injury showing a strong correlation with outcomes. : Microalbuminuria and Platelet count are promising prognostic factors and canConclusion be used to direct the management of the patient with burn injury.

Since the onset of the COVID-19 pandemic in 2020, students' right to education has been threatened globally, and medical colleges are not an exception to this. During COVID-19 induced lockdown, medical colleges had to resort to online classes instead of regular academic sessions. Medical colleges and other higher education institutions in India faced a challenge in determining on how to engage their students in the learning process and assess them using reliable, effective and acceptable methods. Now that the covid pandemic is nearly over, many medical colleges have already started regular sessions. At the same time, some continue to use online lectures and other tools for engaging their learners in addition to regular classes. Medical colleges also used different online tools for formative assessments. But the effectiveness of such online educational activities is yet to be established in India. This article discusses how unsupervised online tests can be used for formative and summative exams in post-covid medical education.

An efficient teacher needs to communicate effectively with the audience, which in turn largely depends on an engaging presentation. The goal of any presentation is to inform, entertain, persuade or inspire and academic presentations primarily provide information, as in a classroom lecture or in a conference research paper.The department of medical education at our institute has been conducting the ‘National course on educational sciences for teachers of health professionals’ since last four decades. Since 2015, newer learner engagement strategies (LES) were incorporated into the program. We analysed the feedback data from participants with an aim to understand the impact of implementation of LES in the course. Literature was further explored to identify other LES in practice. We collected data of five national courses conducted during 2018 to 2020 at our Institute. The in-campus national faculty development course, which is spread over 6 days, consists of about 42 sessions involving nearly 28 presentations. One hundred thirty-five (n= 135) participants from all over India had participated in this course during the period under review. Newer strategies must be used to engage new generation of learners during presentations. The best way to engage learners is by having an interactive presentation with a structured narrative that holds their attention and allows them to participate in the presentation process. Medical teachers should make themselves familiar with digital tools which help in interactive teaching. Further prospective research studies need to be carried out to understand outcomes and improve strategies of learner engagement. Keywords: Cognitive load, Learner engagement, Multimedia principles, PowerPoint, Short term memory, Visual presentation.

Goldenhar syndrome (GS) is the most severe form of the oculoauriculovertebral spectrum, a developmental disorder primarily involving the structures derived from the first and second branchial arches, intervening first pharyngeal pouch and branchial cleft characterized by microtia, facial asymmetry, ocular abnormalities, and abnormalities of the vertebral column. A multifactorial etiology involving genetic and environmental factors has been proposed and the majority of the cases are sporadic in occurrence. The clinical phenotype of GS is highly variable and multiple associated anomalies of various organ systems have been reported in the literature. The term “Expanded Goldenhar Complex” has been used when there are associated unusual extrafacial abnormalities involving major organ systems such as the central nervous system, cardiovascular system, and respiratory system. We report a case of Expanded Goldenhar Complex with multiple anomalies, some of which are very rarely reported associations. A 5-year-old boy presented with right-sided hemifacial microsomia, microtia, preauricular and malar skin tags, bilateral radial club hands, and scoliosis since birth. Imaging revealed additional abnormalities including aural atresia, unilateral pulmonary agenesis, dextrocardia, vertebral segmentation defects, left renal ectopia, and right undescended testis. Surgical corrections were undertaken for the right radial club hand and undescended testis and he is awaiting surgery for the left club hand. Complete imaging evaluation of children with dysmorphic facies and limb abnormalities helps in identifying the various associated organ anomalies and to arrive at an accurate syndromic diagnosis. These patients have to be managed by a multidisciplinary team of clinicians on a case-to-case basis and have a good prognosis if there are no major cardiac defects or intellectual disability.

Auricular perichondritis leading to perichondral abscess is an unusual complication of periauricular surgery. Early identification of the condition with aggressive and timely management is mandated to prevent permanent damage to the auricle. This article demonstrates the first reported case in literature of auricular perichondritis due to Neisseria flava. We discuss the presentation, diagnosis and management of auricular perichondritis in this patient and review mechanisms by which commensals acquire pathogenicity as seen in this report. An awareness of this unusual etiology and mechanisms of acquiring pathogenic nature by commensals will help guide clinicians in optimizing management of such conditions.

Introduction: Organ transplantation is growing in India but is mostly dependent on living donors. Deceased donor organ procurement has grown in certain parts of the country in the past decade. However, brain death certification and organ procurement predominantly happen in private health-care sector, with less contribution from public sector hospitals. Expanding the infrastructure for deceased donor transplantation program, especially in the public sector hospitals, is likely the most important step toward improving deceased donor organ donation rates in a country like India. Methods: Here, we describe our experience with setting up a deceased donor program in a public sector hospital and its outcomes. Results: We harvested organs and tissues from 42 deceased donors between December 2013 and March 2020. The deceased donor program has helped in establishing a multi-organ transplantation program at our center, including liver and hand transplantation, in addition to kidney and corneal transplantation. Conclusion: Gathering a committed team of direct stakeholders with domain expertise, creating an organizational system, and establishing clear standard operating procedures (SOPs) are critical for success, in addition to physical infrastructure.

Metaplastic breast carcinoma (MBC) is a rare malignant neoplasm of the breast which is highly aggressive and is known for its early recurrence and poor prognosis. Concurrent detection of a MBC and tuberculosis of the axillary lymph node is a rarity. To the best of our knowledge, there is no such case report in the literature. A 35-year-old premenopausal woman was diagnosed as a case of left carcinoma breast with a left axillary lymph node. Core-needle biopsy of the breast was suggestive of squamous cell carcinoma. The patient underwent modified radical mastectomy with a latissimus dorsi myocutaneous flap. The postoperative biopsy of the breast and axilla revealed MBC and tuberculous lymphadenitis of the axillary lymph node. The patient received antitubercular therapy and radiotherapy, followed by chemotherapy and had no recurrence on follow-up. This case report emphasizes that metaplastic carcinoma breast can coexist with tuberculous axillary lymphadenopathy.

Hand and upper-extremity transplantation restore severely damaged limbs that cannot be repaired with conventional surgical techniques. Over the past 20 years, more than 200 vascularized composite allotransplantations have been performed worldwide, among them 7 were cases of sex unmatched hand transplants. The long term effects of recipient sex hormones and nerve regeneration on the sexually dimorphic physical features of donor upper extremity have not been described previously. We report a case of sex congruent transformation of hand morphology in an intergender hand transplant.

There are no large volume comparative studies available to compare the efficacy of lasers over lights for hair removal in Fitzpatrick V and VI skin types. This study is designed to compare the efficacy of Nd:YAG laser versus IPL in the darker skin types.Thirty-nine patients included in Group-1 were treated with Nd:YAG and 31 in Group-2 with IPL. Both groups received 5 sessions of treatment. The hair counts were assessed using digital photography and manual counting method before and after treatment and the results were analysed. Patient satisfaction scores and pain scores were recorded in each session and compared.Mean hair reduction in the IPL group was 25.70 and Nd:YAG group was 24.12 (95% CI). In the Nd:YAG group, 59% of subjects had burning sensation while the figure was 32.3% in IPL group. Burning was less in IPL group (p0.023). There were no statistically significant differences noticed regarding hyperpigmentation in both the groups (p0.115).Both Nd:YAG and IPL are equally effective for epilation of the darker skin types. Nd:YAG is associated with mild burning sensation in a significant number of patients. Patient satisfaction scores were comparable in both the groups.

Rice bodies in wrist ganglia are highly suggestive of tuberculous tenosynovitis. The surgeon should be aware of the significance of these free corpuscles when performing wrist ganglia excision so that the diagnosis of tubercular tenosynovitis is not overlooked. These fibrinous corpuscles should be differentiated from the loose cartilaginous bodies of inflammatory arthritis.

BACKGROUND: Obesity is one of today’s most neglected public health problems, affecting every region of the world. Early identification of increased weight gain among the population is paramount to prevent the attendant complications associated with obesity. OBJECTIVES: The primary objective of this study was to measure the distribution of L score in the representative population and the secondary objective was to identify an association between L score values and other measures of obesity such as body mass index, waist circumference, waist-to-height ratio, neck circumference (NC), and total body fat percentage. METHODS: This study was conducted in the departments of plastic surgery and endocrinology of a tertiary care institute. The L score (a measure of fullness of the lateral retromalleolar fossa in the lower limb) was assessed in all the participating individuals. Statistical analysis was performed using the Statistical Package for the Social Sciences version 19.0. p < 0.05 was considered as statistically significant in statistical analysis. RESULTS: Among the 50 participants taken in this study, 24 had L score 0, 15 had score 1, and 11 had score 2. The participants with L score 1 and 2 had higher obesity, higher NC, and more body fat percentage compared to those having score 0. All the participants with L score 2 were overweight and had central obesity. CONCLUSIONS: The L score measure has a potential for simple and rapid screening of at-risk population for overweight and obesity.

Until, sometime ago, microsurgery meant mainly covering a defect or replanting severed parts back to where they belong. Now, restoration of original function and aesthetic consideration is a must in planning reconstructive procedure. Hand transplant combines hand surgery and microsurgery with complex multidisciplinary care.At the anniversary of our first cadaveric bilateral proximal forearm transplantation done in the country's government institute, we would like to share our experience in performing the surgery, outcomes so far, complications, and lessons learned, to contribute to the growing knowledge of vascularized composite allotransplant.

Background: Eyelids are important structures and play a role in protecting the globe from trauma, brightness, in maintaining the integrity of tear films and moving the tears towards the lacrimal drainage system and contribute to aesthetic appearance of the face. Ophthalmic trauma is an important cause of morbidity among individuals and has also been responsible for additional cost of healthcare. Periocular trauma involving eyelids and adjacent structures has been found to have increased recently probably due to increased pace of life and increased dependence on machinery. A comprehensive classification of periocular trauma would help in stratifying these injuries as well as study outcomes. Material and Methods: This study was carried out at our institute from June 2015 to Dec 2015. We searched multiple English language databases for existing classification systems for periocular trauma. We designed a system of classification of periocular soft tissue injuries based on clinico-anatomical presentations. This classification was applied prospectively to patients presenting with periocular soft tissue injuries to our department. Results: A comprehensive classification scheme was designed consisting of five types of periocular injuries. A total of 38 eyelid injuries in 34 patients were evaluated in this study. According to the System for Peri-Ocular Trauma (SPOT) classification, Type V injuries were most common. SPOT Type II injuries were more common isolated injuries among all zones. Discussion: Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. The SPOT classification has taken into account the periocular soft tissue injuries i.e., upper eyelid, lower eyelid, medial and lateral canthus injuries., based on observed clinico-anatomical patterns of eyelid injuries. Conclusion: The SPOT classification seems to be a reliable system to address eyelid injuries. This classification scheme would guide the ophthalmic and facial reconstructive surgeons to provide optimal outcomes in eyelid injuries. Based on the classification scheme and review of existing literature, an algorithm is presented to facilitate repair and reconstruction.

The Earlobe is an essential part of the facial aesthetics. Almost all cultures of the world use the earlobe for improving their appearances. Deformities or absence of the earlobe is a cause of distress to many individuals. This article is protected by copyright. All rights reserved.

Background: All patients who presented to the emergency and trauma with a clinical evidence of hand injury were assessed based on the history and examination, mechanism of injury, common patterns of the injuries, management of the injuries and their functional outcome. The aim and objective were to study the mode, pattern, management and early outcome of hand injury cases attending Department of Emergency Medicine and trauma.Methods: This was a hospital based descriptive study, of patients presenting with hand injuries to the emergency department. The management plan was formulated and the outcomes of the treatment were assessed by limb function loss and Quick DASH 9 score.Results: Majority of our study population belonged to 16 to 35 years age group comprising of mostly males. Most of the incidents occurred within 50 km from our hospital. The mean duration to arrival at our hospital from site of injury was 2.71±2.61 hours. Road traffic accident in males and thermal burns in females were common. Fractures to phalanges of index and middle fingers were the most common type of injury. The average calculated Quick DASH 9 score was found to be 51.24±9.89.Conclusions: Hand injuries were found to be more prevalent in lower socioeconomic strata of the society with education status and occupation as major risk factors. Increased awareness and better implementation of traffic rules and better safety measures at workplace environment are the need of the hour to decrease the burden of hand injury.

Simulator training is important for understanding nipple-areolar complex reconstruction. Human tissue is the best tissue simulator for surgical training. Abdominoplasty specimen is a useful tissue simulator, which is suitable for practicing nipple-areolar complex reconstruction. It is similar to the natural mound created in breast reconstruction. Authors have shared their experience of using abdominoplasty specimen for simulator training of nipple-areolar complex reconstruction for plastic surgery residents. Abdominoplasty specimen is cost-effective, readily available, and an efficient tool for plastic surgery training for the residents.

Chronic lower limb swelling is frequently encountered in clinical practice. Secondary lymphoedema and chronic venous insufficiency are two frequent causes of chronic lower limb swelling. The most common form of secondary lymphoedema worldwide is filariasis, due to Wuchereria bancrofti. Chronic inflammation and fibrosis are histological hallmarks of lymphoedema. Chronic venous insufficiency refers to venous dilation and venous reflux of long duration. The classical signs include minimal superficial dilation with associated skin changes and ulceration. Both the conditions mimic each other although the treatment is different. The diagnosis need to be confirmed prior to institution of treatment. We present below two cases of chronic lower limb swelling with a review of literature.

Objective: To study the role of autologous bone marrow aspirate therapy (ABMAT) in wound healing. Approach: This is a retrospective analysis of 9 patients (11 chronic nonhealing wounds) in whom ABMAT was used. Patients (wounds) were grouped into two groups. Group 1 included 4 patients (5 wounds) refusing/unfit for reconstruction and managed only with ABMAT. Group 2 included 5 patients (6 wounds) who agreed/fit for reconstruction after wound bed preparation with ABMAT. End point of the study was complete wound healing. Results: ABMAT helped in complete healing of chronic nonhealing wounds by secondary intention in group 1 patients and enhanced process of wound bed preparation for reconstruction in group 2 patients. Innovation: This study highlights the importance of ABMAT in the management of chronic nonhealing wounds. Conclusion: ABMAT helps in wound bed preparation to allow the wound to heal completely or cover by skin graft/flap.