Blast injuries due to explosions remain the leading cause of death and injury to military personnel. Explosive devices have also been a preferred weapon of terrorists as they are cheap to manufacture and can cause lots of casualties. Multiple system involvement including burns to partial to full traumatic amputations can even tax the advanced trauma centers. Death is often the result of combined blast, ballistic and thermal effect injuries (Multi dimensional injuries).

Vitamin D insufficiency is common in women across different races of childbearing age. It is being increasingly discovered that vitamin D has many important bodily functions apart from skeletal actions pertaining to Calcium homeostasis. Evidence suggests that the maternal risks due to vitamin D deficiency includes eclampsia, increased risk of gestational diabetes mellitus, glucose intolerance; and fetal risks include risk of rickets, osteoporotic fracture in late adulthood. It may be prudent to include screening of all pregnant women for vitamin D level as a part of routine antenatal care and supplementation be given if found deficient.

Appropriate and rational use of blood/components is essential for ensuring availability for the needy as well as preventing risks of transfusion-transmitted diseases and saving resources. Rational use means providing the right blood or products, in the right quantity, to the right patient and at the right time, bridging demand, and supply gap. The safety, adequacy, and effectiveness can only be achieved if unnecessary transfusions can be prevented. Further, risk can be reduced, but cannot be eliminated completely. Alternative to banked blood, autologous blood donation, normovolemic hemodilution, and intraoperative cell salvage should be considered as possible options. Recombinant factor VIIa is a new adjunct for treatment of massive hemorrhage and should be considered, if available.

Bronchogenic carcinoma is one of the most common cancers both in males and females worldwide. Lung malignancies can present with manifestations involving any organ system and also mimic like benign nodules or infective consolidation. Present review highlights spectrum of typical presentations and imaging features of lung malignancies.

Background: Succinylcholine-induced fasciculations and myalgia are common and troublesome for the patients. A few studies have used propofol to minimize succinylcholine-induced fasciculations and myalgia, but none of these have used a repeat bolus dose. Materials and Methods: A prospective, randomized, double blind study was designed to assess the effect of a repeat bolus dose of propofol on succinylcholine-induced fasciculations and myalgia. Ninety adult patients scheduled for elective surgery under general anesthesia were selected by computer-generated random numbers and allocated to one of the three equal groups randomly. Anesthesia was induced with intravenous injection of propofol 2 mg/kg, followed by administration of succinylcholine 1.5 mg/kg. Immediately after the injection of succinylcholine a repeat bolus of propofol was given as per group. Group I: No repeat dose of propofol; Group II: Repeat propofol bolus of 0.5 mg/kg body weight; Group III: Repeat propofol bolus of 1.0 mg/kg body weight. Muscle fasciculations were observed and graded as nil (0), mild (1), moderate (2), or severe (3). Postoperative myalgia were assessed every 6 hourly for 24 h and then at 48 h and graded as nil (I), mild (II), moderate (III), or severe (IV). Results: The overall incidence of muscle fasciculations was 73 and 33% in Groups II and III, respectively as against 90% in Group I. The incidence of postoperative myalgia was highest (86.67%) in Group I and lowest in Group III (60.0%). Conclusion: The technique of giving repeat bolus dose of propofol immediately after succinylcholine not only decreases the incidence and severity of fasciculations and postoperative myalgia, but also provides hemodynamic stability and satisfactory grade of relaxation for intubation.

Background and Aims: The present study was undertaken to report the observed variations in the features on the dorsal surface of the sacrum. Materials and Methods: Twelve female and 10 male sacra were used for the study. The studied features on the dorsum of the sacrum include sacral hiatus, spinous and articular tubercles (AT) of the median and intermediate sacral crests and sacral foramina. Results: The apex of the sacral hiatus was an inverted V in 10 and a U in 12 (54.5%) sacra. The apex was located between S3 and S4 in 12 (54.6%) and the base at S4 in 21 (95.5%) sacra. Spinal tubercles (ST) and AT were absent in two each of the sacra. Sacral foramina were seen five in one male sacrum along with ossified sacrococcygeal joint. In two female and two male sacra, sacralization of the 5 ^th lumbar vertebra were noted. Six features were a common occurrence in more than 50% of the female and male sacra: U-shaped apex; apex location between S3 and S4; base location below S4; medium length of hiatus with apex between S3 and S4; three numbers of ST; and four numbers of sacral foramina. Three features were commonly seen for the female sacra: U apex between S3 and S4; base below S4; and four numbers of AT. For the male sacra, the four common features were: V-shaped apex; base below S4; three AT; and circular sacral foramina. Conclusion: The implications from the findings of the present study are directed toward the importance of the variations in the features of the dorsal surface of the female and male sacra for any procedures involving caudal epidural anesthesia.

Background: The present study was aimed to see the effect of practice on visual information processing speed. Reaction time is one of the important physiological parameters, which gives information how fast and quickly person responses. Reaction is purposeful voluntary response to different stimuli as visual stimuli. Visual reaction time (VRT) is the time required to response to visual stimuli. Materials and Methods: The VRT was measured by the multiple choice apparatus in subjects. Simple reaction time and choice reaction time measured. Reaction time was measured in two sessions. In the first session, VRT was measured without practice of task and in the second session VRT was measured after practice of task. The results were statistically analyzed and were recorded as mean ± standard deviation and Student's paired t-test was applied to check the level of significance. Result and Conclusion: In the present study, we found that VRT was less after practice for both simple and choice VRT tasks. Reaction time decreases by practice. Skills can be improved by practice. In daily life majority of work is done by the use of visual information. By the practice of an important task time required for stimulus identification and response can be decreased. Practice is useful for driving vehicles. It is helpful to students, as they have identification of bones, instruments, graphs and viva questions in examination of various medical subjects. Hence by practice students can identify, understand and answer quickly.

Objective: The primary objective of the following study was to determine and secondarily to compare the clinical and epidemiological characteristics of hospitalized patients with severe and non-severe pandemic influenza A (H1N1) during two waves from September 2009 to January 2011. Materials and Methods: A total of 274 cases were hospitalized during the first wave from September 2009 to March 2010 and from June 2010 to February 2011, 237 cases hospitalized in different hospitals of Rajkot during the second wave. Real-time reverse-transcriptase-polymerase-chain-reaction testing was used to confirm infection. Two wave's comparison was made for factors associated with disease severity. Results: During the first wave 87 (31.8%) patients had severe disease with mortality of 81.6% while during the second wave there were 53 (22.36%) patients having severe disease with higher mortality (94.3%) than the first wave. There were more children up to 15 years of age that required intensive care during the second wave (30.2%) compared to the first wave (20.7%). First wave reported more females and cases from an urban area. Presence of co-existing condition, especially pregnancy was a significant risk factor during the first wave, but not during the second wave. All patients have received antiviral drug oseltamivir during both waves. During the second wave, 39.6% of patients with severe cases received it within 2 days of onset of illness. This was higher than the first wave (19.5%). Conclusion: Higher mortality was reported during the second wave of pandemic influenza A (H1N1) 2009 (H1N1pdm09). There were more cases among the younger age group than adults during the second wave.

Tubercular brain abscesses are uncommon and tubercular brainstem abscesses are rarely reported. Most of these cases occur in immunocompromised patients. We report a case of giant brainstem abscess in a 5-year-old human immunodeficiency virus-seronegative female child who presented with complaints of headache, diplopia and unsteadiness of gait since 6 months. Diagnosis was made by a magnetic resonance imaging scan of brain. The patient demonstrated a remarkable clinical recovery after microsurgery combined with a course of antituberculous therapy. Microbiological and histological findings confirmed the diagnosis of a tuberculous abscess.

Proliferating trichilemmal tumor (PTT) is typically seen in middle aged or elderly patients, with a strong predilection for women and is usually situated in scalp. We are reporting such a tumor located on the gluteal region of a 52-year-old male. The tumor was diagnosed as PTT based on its specific histological features. The case is unusual because of sex of the patient and the tumor location. Moreover, this report illustrates a rare tumor which can be diagnostically challenging. The differentiation between a benign or malignant process in these lesions can sometimes be difficult. Careful clinical and histological assessment is necessary for an accurate diagnosis.

The Möbius syndrome is rare and the cause is still unclear. We present here a case of a newborn baby with the Möbius syndrome, showing unilateral facial nerve palsy with asymmetrical facial expression, poor sucking, dysphagia, and ear abnormality. Though cardiac anomalies are very rare our case had atrial septal defect and a tiny patent ductus arteriosus in patient of Möbius syndrome.

The acute manifestations and subsequent complications call for early recognition and management of erythema nodosum leprosum (ENL). Its diagnosis is conventionally based on skin biopsy and slit skin smears. Fine needle aspiration cytology (FNAC) has been found to be a simple and useful tool in the diagnosis of this entity. Lymphadenopathy is a known manifestation of leprosy and its reactions. The present case is reported to underscore the importance of FNAC of lymph node in diagnosis of ENL. A 39-year-old male, known case of lepromatous leprosy on treatment, presented with fever, joint pains, raised lesions all over the body and enlarged bilateral inguinal lymph nodes. FNA of the lymph node revealed characteristic features of ENL. FNA of lymph nodes is simple, non-invasive, useful tool in early diagnosis of ENL.

Venomous snake bite is an important public health hazard in tropical countries including India. Vasculotoxic snake bites are well known to cause local cellulitis, local tissue necrosis, bleeding manifestations, disseminated intravascular coagulation (DIC), acute kidney injury (AKI), shock, cardiac arrhythmia, neurotoxicity, coma, and death. We present the case of a 30-year-old female who was bitten by a Russell's viper snake and complicated by AKI, DIC, and acute hypopituitarism during her hospital course. Acute hypopituitarism as a complication of snake bite is a rare entity.

The aim of this study was to report a congenital anomaly in a cadaveric dissection. During routine undergraduate dissection in a middle-aged male cadaver, we found that on the left side, there was a presence of an incompletely duplicated ureter. On the right side the ureter was single in its whole extent. No other congenital anomaly was found to be associated with this. The two limbs of the left ureter joined at about a distance of 5 cm from the bladder wall. A duplicated ureter is commonly found in association with other congenital anomalies and defects. The present case report describes a rare case of an isolated duplicated ureter with a normal kidney, urinary bladder, and renal vessels. This case report adds on to the literature and will be helpful and interesting for the surgeons. The possible embryological reasons for the formation of a duplicated ureter will be discussed.

Splenic parenchymal complications in pancreatitis are uncommon and these vary from invasion of pseudopancreatic cysts into spleen to hemorrhages, infarctions and splenic rupture. Spleen is prone to complications in both acute and chronic pancreatitis due to the anatomical relation of splenic hilum with the tail of pancreas. As clinical picture is non-specific, a high index of suspicion is mandatory for early detection to avoid shattering complications. Conservative management is feasible in patients with small and resolving pseudocysts of pancreas as well as of spleen. Surgery is a treatment of choice for large non-resolving and complicated cyst. We present a 26-year-male with huge pseudopancreatic cyst, which invaded into spleen. Patient was operated by open technique. The case is being presented because of uncommon occurrence along with review of the literature regarding the pre-operative evaluation and various treatment options

Giant cell tumor (GCT) also called osteoclastoma of bone is the most common bone tumor encountered by an orthopedic surgeon. GCT generally occurs in skeletally mature individuals with peak incidence in the third decade of life. Less than 5% are found in patients with open physis and only about 10% of cases occur in patients older than 65 years. We present a case of proximal tibia GCT managed with custom mega prosthetic arthroplasty.

Gradient recalled echo (GRE) T2 weighted imaging is more widely used as a standard magnetic resonance (MR) pulse sequence because of its exquisite sensitivity for detection of cerebral hemorrhages. Signal loss on GRE sequence is due to increased sensitivity of this sequence to magnetic susceptibility induced by static field inhomogeneities arising from paramagnetic blood breakdown products. T2 ^* signal intensity loss seen in GRE sequence is greater with longer TE, smaller flip angle, and larger magnetic field strength. The purpose of this review is to discuss the role of GRE imaging in cerebral disorders with bleed. Because of the sensitivity of this sequence to microbleeds, we describe its edge over baseline imaging sequences to provide insight in the etiology of certain diseases.