Objectives Traditionally, fasting before a contrast-enhanced computed tomography (CECT) scan was considered necessary due to the concerns of nausea, vomiting, and aspiration pneumonia. As per the recent international guidelines, fasting is not recommended prior to routine CECT; and with the use of non-ionic iodinated contrast media (ICM), the frequency of adverse reactions has decreased significantly. Our aim is to prospectively evaluate the effect of non-fasting on the occurrence of nausea, vomiting, aspiration pneumonia, and other acute adverse reactions (AARs) in patients undergoing non-emergent CECT and correlating these complications with the time of food ingestion, type (solid/liquid), and the quantity of food ingested. Material and Methods A 100 adult non-fasting patients who underwent a non-emergent CECT scan after intravenous injection of non-ionic ICM (iohexol-350 mg I/ml), were observed for 1 hour for the occurrence of AARs. The time, type, and quantity of food ingested prior to CECT were recorded. Results Four patients out of 100 (4%) developed mild emetic complications with spontaneous resolution within 1 hour. No aspiration pneumonia, urticaria, bronchospasm, or any severe AARs were seen. No statistically significant correlation was found between the time of food ingestion, type and quantity of food ingested, and the occurrence of AARs. (p = 0.61, 0.388, and 0.255, respectively). Conclusion No significant AARs or aspiration pneumonia were seen in non-fasting patients undergoing non-emergent CECT with non-ionic ICM, irrespective of the time of food ingestion, type, or quantity of food ingested.

A young adult male presented with a diminution of vision in his left eye 10 days after chickenpox infection. His best corrected visual acuity was 6/6 in his right eye and finger counting at close to face in his left eye. Fundus examination revealed serous macular detachment in the left eye, which was confirmed on spectral-domain optical coherence tomography (SD-OCT). Fundus fluorescein angiography of the left eye revealed a hot disc with no leakage or pooling of dye. The patient was monitored on a 1-month follow-up. His vision showed significant improvement over time. At the three-month follow-up, his visual acuity of the left eye improved to 6/6 with fluid resolution, as confirmed by SD-OCT. Acute retinal necrosis (ARN) has been reported with uncomplicated chickenpox infections. Our patient presented with a milder form of inflammation resulting in serous detachment of the macula. We hereby present this case in view of chickenpox.

Objectives The purpose of this study was to determine serum D-Dimer levels in patients with acute ischemic stroke (AIS) and their correlation with National Institutes of Health Stroke Scale (NIHSS). Material and Methods This prospective observational case-control study was conducted on 200 patients with AIS. In this study, 200 healthy age-matched and sex-matched individuals were taken as controls. Detailed history of the patient and control groups was recorded, and they underwent examination and D-Dimer level assessment. Neurologic examination using the NIHSS was conducted at admission and on discharge after treatment. Serum D-dimer level was evaluated within the first 24 hours of admission. Results Most subjects in our study were in the age range of 40-83 years, with more males (57%) than females (43%). The incidence of hypertension, diabetes mellitus, dyslipidemia, smoking, and alcoholism was more in the cases than controls. Mean D-Dimer was higher in the patients with AIS (1042.9±624.75 ng/mL) as compared to the control group (250±113.96 ng/mL) (p=0.0001). Moreover, there was statistically significant, positive correlation between D-Dimer and NIHSS score at admission. The D-Dimer value was significantly high in patients who deteriorated (1556.25±614.30 ng/mL), comparatively low in patients who improved (911.71±561.56 ng/mL), and remained static (1098.67±659.35 ng/mL). Conclusion Plasma D-Dimer levels were significantly higher in patients with AIS than in controls. D-Dimer levels increased with increasing severity of stroke.

Objectives The Prosopic index or Facial index is an important measurement, required to be taken during the orthodontic diagnosis phase. Classification of faces into broad, average, or narrow not only allows comprehensive orthodontic treatment planning based on aesthetics and facial form, but could also be used in other fields such as anthropology and forensic medicine. The authors have developed a photographic app for AndroidOS that will enable easy classification of the face into different facial types as given by Banister. The aim of this study is to compare the findings of the facial index of a sample of randomly selected subjects derived from the application with findings of the same subjects derived manually, to check for the accuracy of the new technology. Material and Methods The measurements of facial index derived from this app were compared to the facial index of a sample of Indians derived manually (using an independent t-test). Inter-examiner reliability of the measurements by three different investigators on the same sample was tested using Cronbach’s alpha. A Chi-square test was used to compare the Prosopic index based on the method of determination. Results There was no significant difference between the values of facial index generated from the app compared to those derived manually. The Cronbach’s Alpha value derived was 0.998, indicating the best agreement between examiners. Maximum subjects showed a hyperleptoprosopic facial phenotype in both the app and manual methods. Conclusion The app, utilizing a smartphone, enables quick and reliable measurement of the Facial Index without the need for equipment like calipers or calculations.

Percutaneous nephrostomy (PCN) is a common procedure performed in emergencies for obstructed and infected kidneys. While complications like sepsis, bleeding, pain, dislodgement, and accidental injuries to the colon, small intestine, and other visceral organs have been reported, cases of nephrostomy tube placement in the inferior vena cava (IVC) remains anecdotal. We present a rare case of accidental PCN placement in the IVC of a patient with prostate carcinoma and bilateral hydronephrosis. The patient underwent exploration, safe removal of the misplaced PCN, and correct placement into the renal pelvis. Although PCN insertion is generally a simple procedure, catastrophic complications like hemorrhage, and intestinal and other visceral injuries have been documented. This procedure requires precise puncture through the papilla and careful monitoring of the dilatation with ultrasound and fluoroscopy. We describe this case along with a review of the literature on managing accidental PCN placement in the IVC.

Objectives This study investigates the impact of long-term antiseizure medication (ASM) therapy on serum folate and vitamin B12 levels in pediatric epilepsy patients in the Bundelkhand region of Central India. Given the region’s socioeconomic challenges and the critical role of these vitamins in neurological development, the research aims to inform comprehensive treatment strategies that address both seizure control and nutritional well-being. Material and Methods A comparative cross-sectional study was conducted at Maharani Laxmi Bai Medical College, Jhansi, from May to December 2024. The study included 100 children aged 5-18 years with epilepsy on ASM therapy for over 1 year and 100 age- and sex-matched healthy controls. Participants were categorized into monotherapy (phenytoin-PHY, sodium valproate-SV, or levetiracetam-LEV) and polytherapy groups. Exclusion criteria encompassed factors like body mass index (BMI) below the 3 rd percentile, current vitamin supplementation, systemic illnesses, and malabsorption syndromes. Serum folate and vitamin B12 levels were measured using chemiluminescent microparticle immunoassay (CMIA). Data were analyzed using SPSS version 23, employing t-tests, Chi-square tests, and logistic regression. Results The mean age of participants was 10.48 ± 3.89 years, with 59% being male and 63% from rural areas. Among epilepsy patients, 34 and 66 were on monotherapy and polytherapy, respectively. Vitamin deficiencies were observed in 36% of cases versus 22% of controls. Folate deficiency was present in 24% of cases and 2% of controls, while vitamin B12 deficiency was more prevalent in the polytherapy group (53%) compared to the monotherapy group (29%). Within monotherapy, deficiency rates were highest in PHY users (39%), followed by SV (29%) and LEV (17%). All patients on a triple combination of PHY, SV, and LEV exhibited deficiencies in both vitamins. Longer treatment duration and polytherapy were significantly associated with lower serum vitamin levels. Conclusion The study highlights a significant association between long-term ASM therapy and deficiencies in vitamin B12 and folate among pediatric epilepsy patients. PHY and SV were particularly implicated in these deficiencies. The findings align with existing literature indicating that certain ASMs can impair the absorption and metabolism of these essential vitamins, leading to potential neurological and hematological complications. The higher deficiency rates in the Bundelkhand region may also reflect broader nutritional challenges prevalent in resource-constrained settings. Long-term ASM therapy, especially polytherapy and PHY monotherapy, is associated with increased deficiencies in vitamin B12 and folate among children with epilepsy. Regular monitoring and potential supplementation of these vitamins should be considered integral to epilepsy management, particularly in regions with underlying nutritional vulnerabilities. Incorporating nutritional assessments into routine care can mitigate adverse outcomes and enhance the overall well-being of pediatric epilepsy patients.

Heat-related illnesses (HRIs) continue to affect people worldwide, with the incidence expected to rise due to global warming. The cardiovascular system can be impacted either as part of a multisystem involvement or in isolation. Various electrocardiographic changes have been reported, with only one previous case of sinus node dysfunction in the literature. Here we report a case of transient sinus node dysfunction in a patient following exertional heat injury, which was managed with conservative measures. The patient recovered without complications. This is the second documented case of sinus node dysfunction in the context of heat injury. The patient made a full recovery, and this case highlights the importance of recognizing heat-related cardiac disturbances and managing them appropriately.

Glomus tumors are mesenchymal neoplasms originating from modified smooth muscle cells of the glomus body, which are relatively rare and help in maintaining thermoregulation. While these tumors are typically found in subungual regions, gastric glomus tumors are uncommon and challenging to diagnose due to imaging similarities with other lesions. We hereby present a case of a gentleman aged 61 years, who had complained of pain in the epigastrium. An endoscopic ultrasound with fine needle aspiration cytology (FNAC) diagnosed him with a gastric glomus tumor. We performed a successful laparoscopic wedge resection of the stomach. Histopathological analysis and immunohistochemistry confirmed the tumor characteristics. This case highlights the diagnostic challenges and the need for effective surgical intervention for gastric glomus tumors.

Objectives To determine the time taken for a cervical spine injury patient from the time of injury to the operating table in a tertiary care setting and to identify the roadblocks and reasons for the delay in surgery in these cases. Material And Methods We conducted an observational study by retrospective evaluation of prospective collected case records of 20 patients of traumatic cervical spine injury between June 2023 to October 2023 who underwent surgical management and recorded all the demographic, injury characteristics and time taken from injury to surgery, and the reasons for delay. Results The mean referral distance for these cases was 157.2 ± 86.13 km, and meantime for the injury to presentation was 60.4 ± 83.7 hours and presentation to surgery was 96.45 ± 64.49 hours, and the main reasons for the delay were a delay in presentation and unavailability of the slot of the operating room and intensive care facility. Conclusion Though there is evidence to support early decompression as an effective modality for traumatic cervical spine injury, there is a gap in the translation of this knowledge into practice due to practical reasons that need proper planning and streamlining to improve patient outcomes.