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In their consultations, family physicians are regularly confronted with complaints in the anal area. Anal bleeding or pain, pruritus ani, and perianal hematoma are common problems that cause considerable discomfort to those affected. Adequate clinical skills for diagnosis and treatment of these conditions are therefore necessary for high-quality patient care, as is knowledge of potential red flags. [ABSTRACT FROM AUTHOR]

Background Anal fissure (AF) is the most common cause of severe anorectal pain in adults, with an overall annual incidence of 0.1%. The primary objective of this pilot trial was to evaluate the safety and efficacy of an Olea europaea leaf extract (OELE)-based hydrogel (EHO-85), as a supportive treatment for acute AF episodes. Methods Prospective, open-label, pilot study (May to October 2022). Adult patients with AF were recruited from three centers in Bulgaria and one in Romania. Patients were allocated 1:1 to each treatment using a computer-generated-based system and received either EHO-85 or customary supportive therapy (CST) for 60 days. The primary endpoint was the time to bleeding disappearance. Results 42 patients were included by web-based allocation to receive EHO-85 (n=21) or CST (n=21). All patients completed the 60 days' study. Patients reporting bleeding absence were significantly higher in the EHO-85 group at days 7 (p=0.032) and 15 (p=0.006). From day 29 or 36, no bleeding at defecation was reported in the EHO-85 and CST groups, respectively. On day 60, all subjects were bleeding-free. No adverse events were reported. Conclusion EHO-85 was feasible to deliver and showed efficacy, safety, and apparent superiority in promoting and speeding up the healing process. In a future definitive trial, the sample size and diversity may be increased, and new objective methods may be considered. Implications in clinical practice It highlights the combined wound-healing properties of EHO-85 as a promising noninvasive, cost-effective, and easy-to-apply alternative to current CSTs for AF wound repair. [ABSTRACT FROM AUTHOR]

Vipul D Yagnik,1 Kaushik Bhattacharya,2 Pankaj Garg,3 Prema Ram Choudhary,4 Mrunal Sadhu,5 Sushil Dawka6 1Department of Surgery, Banas Medical College and Research Institute, Palanpur, GJ, India; 2Department of Surgery, MGM Medical College, Kishanganj, BR, India; 3Department of Colorectal Surgery, Garg Fistula Research Institute (GFRI), Panchkula, HR, India; 4Department of Physiology, Banas Medical College and Research Institute, Palanpur, India; 5Final Year MBBS Student, Pramukhswami Medical College, Karamsad, GJ, India; 6Department of Surgery, SSR Medical College, Belle Rive, MauritiusCorrespondence: Vipul D Yagnik, Department of Surgery, Banas Medical College and Research Institute, Palanpur, Gujarat, India, Email vipul.yagnik@gmail.comAbstract: This article explores the potential benefits and challenges of incorporating Patient-Generated Images (PGIs) into the clinical practice for perianal conditions. PGIs refer to photographs (and video) captured by patients themselves of affected areas of their own bodies to illustrate potential pathologies. It facilitates remote patient assessments and swift evaluation for coloproctologist. They potentially reduce the need for in person follow-up particularly after operation if the patient is asymptomatic. However, concerns with PGI include quality of images, risk of misinterpretation, ethical, legal, and practical problems, especially when imaging private or sensitive body regions. Any platform transmitting and storing PGIs should prioritize data protection with advanced encryption. Comprehensive guidelines should be developed by collaboration between healthcare administrators, regulators, and professionals, and a thorough framework formulated to ensure that quality care is delivered always while respecting patient privacy and dignity. It should be considered as complementary to, rather than a replacement for, traditional clinical consultations. However, patient awareness and education regarding the limitations are key to ensuring that this modality is not misinterpreted or misused.Keywords: fistula, haemorrhoids, fissure in ano, telemedicine, patient generated images

Introduction: Anal fissure, characterized by a painful ulcer in the anal canal, presents a significant medical challenge. While surgical approaches like lateral internal sphincterotomy (LIS) have been the gold standard for chronic anal fissures, they come with potential complications such as incontinence and abscess formation. In contrast, medical treatments, including topical glyceryl trinitrate and diltiazem, have emerged as alternatives, offering non-invasive options with potentially fewer complications. Method: In this retrospective study, we evaluated 136 patients treated for chronic anal fissures between June 2019 and December 2022 at Balikesir University Hospital, comparing surgical and medical interventions. The study encompassed demographic analysis, treatment modalities, complete recovery, recurrence rates, and side effects/complications. Statistical analyses, including logistic regression, were performed to assess the efficacy and risks associated with different treatments. Results: Our findings indicated a higher rate of complete recovery with surgical treatment (86.1%) compared to medical treatments (glyceryl trinitrate: 64.8%, diltiazem: 69.6%). However, no significant difference was observed in recurrence rates between treatment groups. Surgical intervention exhibited a higher incidence of complications such as incontinence and abscess formation, while medical treatments were associated with side effects like headache and gastrointestinal disturbances. Notably, diltiazem therapy showed outcomes comparable to other modalities, indicating its potential as an effective and safer alternative. Conclusion: Despite the favorable outcomes of surgical treatment, considerations of potential complications underscore the importance of tailored approaches. Prospective, randomized controlled trials with larger cohorts are warranted to further elucidate the efficacy and safety profiles of medical treatments in chronic anal fissures, facilitating informed decision-making in clinical practice. [ABSTRACT FROM AUTHOR]

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Chronic constipation, with a worldwide prevalence of 10-15%, is one of the most common gastrointestinal diagnoses in clinical practice and the most common reason for referrals to gastroenterologists and surgeons in Turkey. Although constipation is more common in women and the elderly, it can affect anyone regardless of race, age, or gender. It can cause significant health burden by negatively affecting the quality of life. Primary treatment is lifestyle changes, especially fiber dietary supplementation and exercise. Laxatives are used as the gold standard pharmacological treatment of chronic constipation. One of the effective nursing interventions used to treat chronic constipation is abdominal massage. The aim of this review is to briefly summarize the literature on the definition, classification, epidemiology, clinical symptoms and management of constipation. The relationship between constipation and abdominal massage was discussed in depth. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Anal fissure is one of the most prevalent diagnosis in patients with anorectal symptoms. Depending on the chronicity, treatment choices vary, from topical and conservative management to operative ones. PRP is a blood‐derived product with a three to five‐fold platelet count and can be used for restorative purposes. The objective of this study is to assess the therapeutic effect of intralesional PRP in acute and chronic anal fissures and comparing it with the classic topical approach. We included 94 patients with acute and chronic anal fissures and divided them into intervention and control groups. Control patients were treated only with topical compounds, and the intervention group received one dose of intralesional autologous PRP plus the same classic treatment. We assessed patients 2 weeks, 1 month, and 6 months later. The mean pain score in the intervention group was significantly lower than control groups in all visits (p‐value <0.001). During the follow‐ups, the bleeding rate was significantly lower in the intervention group, so in the sixth month, the bleeding was 4% in the intervention group against 32% of the control (p‐value <0.001). The healing rate assessed by examination was 96% in the intervention group against 66% in the control in the sixth month (p‐value <0.001). Although there may be no significant difference in healing rate between groups in the acute anal fissure, the PRP group is significantly superior in the chronic setting. We concluded that in anal fissure treatment, PRP plus topical products are significantly superior to alone topical treatment. [ABSTRACT FROM AUTHOR]

Background: Thrombosed external hemorrhoids (TEH) and anal fissure are benign anorectal diseases that seriously impair the quality of life during pregnancy and the postpartum period. The actual incidence of these lesions in the population and the relationship between their progression and pregnancy are not well known. The aim of our study is to determine the incidence of TEH and anal fissure that develop from the last trimester of pregnancy to the first postpartum month and to reveal the relationship between this condition and the weight gained during pregnancy, newborn weight and the duration of the second phase of labor. Materials and Methods: Among the pregnant patients who applied to the gynecology and general surgery outpatient clinic between July 25, 2021 and October 25, 2021, patients who had TEH and anal fissure in the third trimester and the first postpartum month and whose records were complete were followed prospectively and analyzed retrospectively. Weight gain of patients in the third trimester was calculated as a percentage. All third trimester pregnant patients were examined at least three times by an obstetrician or general surgeon while they were asymptomatic and in the first postpartum month. Patients with a previous history of surgery due to hemorrhoidal disease were not included in the study. Results: In patients developing TEH; Weight gain during pregnancy, baby birth weight, and prolongation of the second phase of labor were determined as risk factors (p=0.003, p<0.001, p<0.001, p<0.001, respectively). Among the risk factors for anal fissure, weight gain during pregnancy, baby birth weight, and prolongation of the second phase of labor were determined (p=0.003, p<0.001, p<0.001, p<0.001, respectively). It was observed that the first birth being a normal spontaneous vaginal birth and being overweight before pregnancy did not cause an increase in the frequency of TEH and anal fissure. Conclusions: Weight gain during pregnancy, baby birth weight and prolongation of the second phase of labor can be considered as risk factors for the development of Anorectal diseases such as TEH and anal fissure. [ABSTRACT FROM AUTHOR]

PRP or autologous platelet-rich plasma, has been hailed as a successful method of treating wounds. There is, however, still a shortage of data to back up its application in patients with both acute and chronic wounds. This study set out to thoroughly investigate the efficacy, synergy, and potential mechanism of PRP-mediated treatment for acute fissure-in-ano. Acute fissure with indications of pain, bleeding, and elevated sphincter tone was identified at six o'clock. As a control, PRP was applied to the area of the fissure. The pace of fissure healing, as well as the reduction in discomfort, bleeding, and sphincter tone, were evaluated on the third and tenth days. PRP significantly enhanced fissure healing, which was connected to wound healing control, angiogenesis augmentation, re-epithelialization, and collagen deposition. As PRP raises local vascular intensity, enhances re-epithelialization, and is linked to increased growth factor production, it dramatically improves the healing process of fissures while also reducing discomfort, bleeding, and worsened sphincter tone. [ABSTRACT FROM AUTHOR]

Copyright of Colo-Proctology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Hospital a Domicilio is the property of Centro Internacional Virtual de Investigacion en Nutricion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Lower gut bleeding is an alarming sign among caregivers. Determining the etiology is of utmost importance for further management. This is the first study conducted in northernmost India. Methods: This cross-sectional study was conducted at the Department of Pediatrics, Government Medical College, Srinagar. This study aimed to describe the etiology of lower gastrointestinal bleeding in the age group of 1-18 years over the past 5 years from June 2017 to June 2022. Results: A total of 310 children presented with hematochezia (53.5%), blood mixed with loose stools for > 2 weeks (39.3%), melena (1.9%), and occult blood in stools (0.3%). The mean age was 5.12 years. The age group of 1-6 years was 73.5 %. The most common findings were rectosigmoid polyps n = 104 (33.5%), anal fissure n = 47 (15.1%), lymphoid nodular hyperplasia (LNH) n = 38 (12.2%), trichuris dysentery syndrome n = 30(9.7%), cow's milk protein allergy n = 27(8.7%), non-specific colitis n = 18(5.8%), solitary rectal ulcer syndrome n = 14(4.5%), inflammatory bowel disease n = 6 (1.9%),intestinal tuberculosis n = 3(0.9%), duodenal dieulafoy lesion 1(0.3%), and blue bleb nevus rubber syndrome n = 1(0.3%). 21 patients had a normal colonoscopy. The colonoscopy yield was 93.3 %. Among the colonoscopy-negative patients, 6(1.6%) had Meckel's diverticulum, and 1(0.3%) had a duodenal dieulafoy lesion. Conclusion: Lower GI bleeding most commonly presents as hematochezia, and the most common cause is a rectosigmoid polyp. Colonoscopy is the procedure of choice to evaluate the etiology of lower GI bleeding. Anal fissures, LNH, Trichuris trichiura, and cow's milk protein allergy are other common causes of lower gut bleeding in Kashmir, northernmost India. [ABSTRACT FROM AUTHOR]

Aloe Vera has different therapeutic effects, including wound healing. The objective of this review is to determine the potential efficacy of the topical use of Aloe Vera in the healing of skin wounds. A bibliographic search of preclinical and clinical studies was carried out from 1999 to 2020, which included the therapeutic use of Aloe vera in the healing of: burns, surgical wounds, lactation disorders, anal ssure and anal stula; in the databases of the VHL regional portal, PubMed and Google Scholar. It was obtained that the topical administration of Aloe vera was effective in the healing of the mentioned wounds by mainly increasing epithelization and collagen content. In conclusion, the evidence suggests that the properties and pharmacological presentation, chemical components and the effectiveness of Aloe vera to reduce the healing time of wounds make this plant a great therapeutic alternative; however, more studies are required regarding its antimicrobial property.

Background: Chronic anal fissure is a common benign anorectal condition that causes significant morbidity. Symptoms consist primarily of pain and bleeding during defecation. Fissures are predominantly located in the posterior midline, but 25% of women and 8% of men have anterior fissures. Aims and Objectives: The aim of the study is to determine the outcome of various nonsurgical therapy for chronic anal fissure and comparison with the outcome of surgical treatment. Materials and Methods: This study was a non-randomized and observational study. All patients referred to the department of general surgery between December 2012 and November 2014 for a chronic anal fissure were included in the study, above the age of 12 years, and diagnosed to have anal fissure (Both Acute and Chronic) were included in the study. Results: Seventy-nine patients (91.9%) were having symptoms of pain; this pain was persistent for hours after defecation in 67 (78%) patients. Seventy-one (82.6%) patients complained of at least one episode of bleeding per Anum, other symptoms were perianal lump (10.5%), perianal itching (23.3%), and perianal discharge (30.2%). The examination findings of these patients revealed that 81 patients (94%) had developed sentinelpiles subsequently and anal fissure with visible fibers of underlying muscle were seen in 9 (10.5%) patients. Conclusion: Chronic anal fissures can be simply and effectively treated medically without the risk of incontinence associated with sphincterotomy. Topical nifedipine and botulinum toxin injections are an excellent combination, associated with a low recurrence rate and minimal side effects.

Background: The anal fissure is one of the most common anorectal diseases that is associated with reduced quality of life and productivity loss. We aimed to compare the efficacy of topical nifedipine and diltiazem for the treatment of acute anal fissure (AAF). Methods: This single-blind randomized clinical trial was conducted at Ziaeian hospital, Tehran. Patients with an acute fissure diagnosis were allocated to two groups. Group A applied 3 grams of 0.3% nifedipine cream on the peri-anal area, three times a day, for 8 weeks. Group B also applied the same amount of 2% diltiazem-ointment on the peri-anal area for the same period. The primary outcome was fissure remission in the 8th week of the treatments. The duration of pain relief, the side effect of treatment, and the recurrence rate were also compared between the groups. Results: After 8 weeks of treatment, a remission rate of 77.4% was shown in the nifedipine group which was significantly higher than the diltiazem group with a remission rate of 54% (P = 0.01). Applying nifedipine ointment is associated with earlier pain relief compared with diltiazem (P < 0.001). After 6 months of follow-up, the relapse rate was not statistically different between the nifedipine and diltiazem groups (16.3% versus 21.4%, respectively). Conclusion: The application of topical nifedipine is associated with shorter pain relief and more remission rate for AAF compared with topical diltiazem. However, both methods were not different in terms of related side effects and AAF recurrence rate. [ABSTRACT FROM AUTHOR]

Background: The current study aimed to investigate the prevalence, risk factors, endoscopic findings, and outcome of gastrointestinal bleeding in COVID-19 hospitalized patients. Materials and Methods: This study is a retrospective review of COVID-19 hospitalized patients with gastrointestinal bleeding from a large university hospital in southeast Iran. This study was conducted over one year from April 2020 to March 2021. Results: Out of 3563 COVID-19 inpatients with approximately equal sex distribution (52.5% of men and 47.5% of women), 80 (2.24%) patients with a mean age of 58.01±20.71 were identified with signs of gastrointestinal bleeding, including; melena (48.8%), hemoglobin drop (42.5%), fresh blood hematemesis (31.3%), rectorrhagia (20%) and coffee ground emesis (10%). 52 patients (65%) had signs of gastrointestinal bleeding on admission, and 28 patients (35%) developed gastrointestinal bleeding during their hospital admissions, most of whom were men (63.8%). Endoscopic characteristics were; gastric erosion (27.7%), gastric ulcer (23%), duodenal ulcer (21.5%), esophageal ulcer (12.3%), and esophageal erosion (6.1%) in upper gastrointestinal endoscopy. On colonoscopy, hemorrhoids (25%), mass lesions (16%), fissures (8.3%), diverticular lesions (8.3%), and polyps (8.3%) were the most common findings. The overall mortality of the patients in the present study was 36.2%. However, gastrointestinal bleeding related deaths were 7.5%. Conclusion: Gastrointestinal bleeding was identified in 2.24% of hospitalized COVID-19 patients, with gastroduodenal ulcers and erosions as the most common symptoms. [ABSTRACT FROM AUTHOR]

Background: Bleeding per rectum is a fairly common clinical problem in children. Gastrointestinal infections, anal fissures, and polyps are the most common causes. However, many cases remain undiagnosed due to the nonavailability of diagnostic modalities. This prospective hospital-based study was designed to study clinical profiles and outcomes in children with lower gastrointestinal bleeding. Materials and Methods: Fifty-six children (1-12 years) presenting with bleeding per rectum were enrolled in the study. History and detailed examination were recorded. Investigations were done on basis of the clinical scenario. Children with bleeding per rectum were analyzed for demographic profile, clinical presentation, etiology, diagnostic investigations, and outcome in bleeding per rectum. Results and Observations: Anal fissure (67.3%) was the most common cause followed by colorectal polyp (16.4%), nonspecific colitis (7.3%), invasive amoebiasis (1.8%), intussusception (1.8%), and rectal mucosal prolapse (1.8%). Colonoscopy was diagnostic in 73% of children. Conclusion: Anal fissures and colorectal polyps are the most common noninfective cause of bleeding per rectum. Undiagnosed chronic cases of bleeding per rectum can result in complications such as anemia and malnutrition. The availability of diagnostic modalities can help in early diagnosis and treatment for better outcomes. [ABSTRACT FROM AUTHOR]

Berlin is amongst the cities most affected by the current monkeypox outbreak. Here, we report clinical characteristics of the first patients with confirmed monkeypox admitted to our center. We analyzed anamnestic, clinical, and laboratory data. Within a period of 2 weeks, six patients were hospitalized in our unit. All were MSM and had practiced condomless receptive anal intercourse in the weeks preceding admission. The chief complaint in all patients but one was severe anal pain unprecedented in severity. Investigations revealed proctitis, as well as anal and rectal ulcers with detection of monkeypox virus. Our findings support the hypothesis that sexual transmission plays a role in the current outbreak. [ABSTRACT FROM AUTHOR]

An anal fissure is a common problem in children and it refers to a longitudinal tear or an ulcer in the anoderm. The conventional therapy for anal fissures has been warm sitz baths and lthe ocal application of analgesic ointments, stool softeners, and behavioral therapy as necessary. Simple wound care may often be sufficient for the treatment of anal fissure, but a comprehensive approach is required for accompanying constipation. Between 2015-2022, a total of 263 children suffering from constipation and perianal pain were diagnosed with anal fissure (AF) based on physical examination. Anal fissure and constipation (AFC) questionnaire forms were retrospectively reviewed and results of routine management protocol were assessed which was focused on local wound care and dietary regulation. The ratio of children consuming more than 2-3 cups of packed beverages containing artificial sweeteners, colorants or corn syrup was found 63,89 % (n=167). Daily water consumtion of less than five glasses was 71.1% (n=187). Daily milk consuming was 71,86% (n=189). Stool withholding and soiling was found 57,41% (n=151) and 48,67% (n=128) respectively. In only four cases (1.52%), constipation persisted for more than eight weeks despite meticulous management and improvement was achieved with anal dilatation on the tenth week. It is possible to treat anal fissures successfully and in a reasonable duration with simple local care with prednisolone pomade and a strict diet arrangement that restricts the consumption of packed foods, beverages, snacks, and milk while promoting drinking water and raw fiber intake. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Clinical Healthcare is the property of Chinese Journal of Clinical Healthcare and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Anal fissure (AF) is a common anorectal disease. Although several pharmacological treatments are available, many patients still require surgical interventions. In this study, we aimed to evaluate the efficacy of an ointment based on a multifunctional blend of herbal ingredients including hemp (ProctoFiz) for chronic AF. Methods: A single-arm, questionnaire-based prospective study was conducted in a large tertiary center to evaluate the outcomes of patients suffering from chronic AF treated with topical ProctoFiz. Results: Ninety-two patients were included in the study, 54 (58.7%) were females with a median age of 39 (range 17–78). 32 patients (34.7%) suffered from recurrent AF before enrolling in the study, and 5 patients (5.4%) underwent previous surgical interventions for AF. Three patients (3.2%) were lost to follow-up, leaving 89 patients for analysis. Eighty patients (89.9%) reported significant improvement of symptoms after 1 week using ProctoFiz, and 79 patients reported continued improvement after 1 month of treatment. The mean pain Visual Analog Score (VAS) declined by 6.6 points (8.9 vs. 2.3; 95% CI: 7.20 to −5.99, p < 0.0001) following 1 week of treatment, with continuous improvement to a mean of 0.64 after 1 month. Negative impact on quality of life significantly decreased from a mean of 8.8 to 0.38 following a month of treatment (p < 0.0001), with significant reduction in the number of patients suffering from bleeding following bowel movements (64.1–2.5%; p = 0.0001). Conclusion: Hemp-based topical treatment of AF is feasible and significantly improves AF-correlated symptoms. [ABSTRACT FROM AUTHOR]

Background: Anal fissure which is defined as a longitudinal tear in anoderm under the dentate line is one of the most common benign diseases of anorectal area, and due to the severe pain during the defecation and emotional stress that it causes may reduce people's quality of life. There are several treatment methods such as medical and surgical procedures. Objective: To determine the effectiveness of lateral internal sphincterotomy in the treatment of chronic anal fissures resistant to pharmacological treatment in terms of pain, healing, complications, recurrences and patients satisfaction Methods: This study includes retrospective analysis of 100 patients (male 71 and female 29) who underwent lateral internal sphinceterotomy for the treatment of chronic anal fissure between september 2020 to october 2022 for a period of about two years. All these patients were operated under general or spinal anesthesia after obtaining consent and routine examinations. We analysed the patients clinical features, complications and outcomes of Lateral internal sphincterotomy Results: As a result the final analysis included 71 were male patients and 29 were female patients with mean age of 38 years, age ranged between 18-56 years, 89% presented with pain, 45% bleeding per rectum, 37% constipation, 32% complain of hard stool, 26% had sentinel pile and 54% were having an increase anal tone. Bleeding per rectum was common problem in 34% patients in early post operative period followed by 3% perianal abscess, 2% perianal hematoma, 7% had incontinence of flatus followed by 2% liquid stool incontinence and 1% solid stool incontinence all patients with flatus and liquid stool incontinence regressed with conservative management. Recurrence occurred in 4% patients, nearly complete healing occur in 95% patients and 91% patients had no complain regarding pain: Conclusion Lateral internal sphincterotomy is a safe, effective, and inexpensive procedure that leads to quick symptomatic improvement and healing in chronic anal fissure with minimal complications. [ABSTRACT FROM AUTHOR]

Pankaj Garg’s story is an interesting one and is a source of inspiration for all physicians and budding innovators. He started his career as a community doctor about two decades back in the year 2001, then changed gears in between to become an avid researcher and innovator. He progressed to become a leading international figure in his field. Garg has exemplified three important points. First, with proper temperament, it is possible to achieve academic excellence and conduct research even in a primary care setting. Second, every specialist should fulfill the role of a family physician as well. While pursuing any specialty, the role of a “general physician” should never be ignored. Third, innovation is a state of mind, and big institutions and well-equipped laboratories with costly gadgets are not a prerequisite to it. This is clearly exemplified by Pankaj Garg’s story that it is possible to excel in research, academics, and clinical work at the global level without any research budget, big institute tag, or the help of government or non-government organizations. Garg has more than 175 publications in high-impact journals. He has 30 innovations to his name, in and outside his field of expertise, all of which have been published in international journals. The innovations include new operative procedures, successful non-operative management, the discovery of new anatomical spaces, new concepts in disease understanding and management, and finding non-operative treatment for diseases for which surgery is routinely performed. It is impressive that seven of his innovations are popularly known by his name - Garg classification, Garg space, Garg protocol, Garg cardinal principles, Garg scoring system, Garg phenomenon, and Garg incontinence scores. Due to 30 innovations done single-handedly, Garg has been certified as a “doctor with maximum innovations” by several record books. Due to his ability to think “out-of-the-box” and his immense contribution to advancements in the field of proctology, he is recognized as a global icon in his field. Garg is a master teacher. He has taught surgical skills and the art of scientific paper writing to hundreds of surgeons and doctors. In spite of limited resources at his disposal, Garg goes out of his way to help poor people. He performs about 30–40% of operations free of cost. He has successfully treated patients from 41 countries and several patients from royal families of the Gulf who offered him lucrative money to move to the Middle East. However, Garg flatly refused all offers because his priority was to serve his country and countrymen first. Hence, a simple doctor working in a small city was never discouraged by the lack of resources, and the fear of working alone in a small set-up and without any help from the government has carved out a tale that can motivate professionals in any corner of the world. Dr. Garg’s story provides immense inspiration to every practicing physician in the country to innovate whether he/she is practicing in a primary healthcare center or a rural area. [ABSTRACT FROM AUTHOR]