Background and Objectives: The widespread use of mobile phones and personal listening devices (PLDs) poses potential health risks, particularly noise-induced hearing loss. Among younger generations, high-volume PLD use is associated with auditory and vestibular system changes. Clinical vestibular testing, including vestibular-evoked myogenic potentials (VEMP) and the video head impulse test (vHIT), may reveal peripheral vestibular impacts from prolonged PLD exposure at volumes over 60%. This study examines VEMP and vHIT results in individuals with normal hearing who have had extended high-volume PLD exposure. Subjects and Methods: A cross-sectional comparative study was conducted on individuals aged 15-24 years. All the participants had normal pure tone thresholds with “A” type tympanogram, present acoustic reflexes, and history of PLD usage. Participants were divided into groups according to PLD exposure of <1 year (group A), 1.1-2 years (group B), 2.1-3 years (group C), and 3.1-4 years (group D). The output sound pressure level (dB SPL) near the tympanic membrane was measured. Furthermore, cervical VEMP, ocular VEMP, and vHIT were assessed. Results: The VEMP and vHIT findings were statistically analyzed and compared across groups. The peak-to-peak amplitudes of VEMP showed a statistically significant difference between groups A and D. Conclusions Potential subclinical damage to the otolith organs can be associated with increased PLD exposure. No damage to the semi-circular canals was observed as the participants used lower dBA values by the PLDs.

Background and Objectives: The widespread use of mobile phones and personal listening devices (PLDs) poses potential health risks, particularly noise-induced hearing loss. Among younger generations, high-volume PLD use is associated with auditory and vestibular system changes. Clinical vestibular testing, including vestibular-evoked myogenic potentials (VEMP) and the video head impulse test (vHIT), may reveal peripheral vestibular impacts from prolonged PLD exposure at volumes over 60%. This study examines VEMP and vHIT results in individuals with normal hearing who have had extended high-volume PLD exposure. Subjects and Methods: A cross-sectional comparative study was conducted on individuals aged 15-24 years. All the participants had normal pure tone thresholds with “A” type tympanogram, present acoustic reflexes, and history of PLD usage. Participants were divided into groups according to PLD exposure of <1 year (group A), 1.1-2 years (group B), 2.1-3 years (group C), and 3.1-4 years (group D). The output sound pressure level (dB SPL) near the tympanic membrane was measured. Furthermore, cervical VEMP, ocular VEMP, and vHIT were assessed. Results: The VEMP and vHIT findings were statistically analyzed and compared across groups. The peak-to-peak amplitudes of VEMP showed a statistically significant difference between groups A and D. Conclusions Potential subclinical damage to the otolith organs can be associated with increased PLD exposure. No damage to the semi-circular canals was observed as the participants used lower dBA values by the PLDs.

Background and Objectives: The widespread use of mobile phones and personal listening devices (PLDs) poses potential health risks, particularly noise-induced hearing loss. Among younger generations, high-volume PLD use is associated with auditory and vestibular system changes. Clinical vestibular testing, including vestibular-evoked myogenic potentials (VEMP) and the video head impulse test (vHIT), may reveal peripheral vestibular impacts from prolonged PLD exposure at volumes over 60%. This study examines VEMP and vHIT results in individuals with normal hearing who have had extended high-volume PLD exposure. Subjects and Methods: A cross-sectional comparative study was conducted on individuals aged 15-24 years. All the participants had normal pure tone thresholds with “A” type tympanogram, present acoustic reflexes, and history of PLD usage. Participants were divided into groups according to PLD exposure of <1 year (group A), 1.1-2 years (group B), 2.1-3 years (group C), and 3.1-4 years (group D). The output sound pressure level (dB SPL) near the tympanic membrane was measured. Furthermore, cervical VEMP, ocular VEMP, and vHIT were assessed. Results: The VEMP and vHIT findings were statistically analyzed and compared across groups. The peak-to-peak amplitudes of VEMP showed a statistically significant difference between groups A and D. Conclusions Potential subclinical damage to the otolith organs can be associated with increased PLD exposure. No damage to the semi-circular canals was observed as the participants used lower dBA values by the PLDs.

Background: Liver transplant (LT) is a well‑established therapeutic strategy for endstage liver diseases. In the absence of a biopsy diagnosis, it is a common practice to increase immunosuppression for raised liver function tests, which may prove harmful in a non-rejection setting, hence, an accurate histopathological diagnosis from liver biopsy plays a significant role in the management of transplant recipients.We aim to study the spectrum of histopathological findings in post-transplant graft biopsies performed within 3 months of LT. Methods: This was a retrospective study of 81 patients who underwent LT at Medanta-The Medicity in the year 2022 and had a liver biopsy performed within 3 months following the LT. All biopsies with T cell-mediated rejection (TCMR) and antibody-mediated rejection (AMR) were graded according to the 2016 Banff criteria by two assessors in a blinded manner. Immunohistochemistry for anti-C4d (polyclonal; BioGenex, Fremont, CA, USA), anti-cytokeratin7 (clone RM416; BioSB, Santa Barbara, CA, USA), anti-cytokeratin-19 (clone RCK108; BioGenex, Fremont, CA, USA), and anti-CMV (clone 8B1.2, 1G5.2, and 2D4.2; BioSB, Santa Barbara, CA, USA) were performed wherever required. Results: The median age of the cohort was 45.5 years with a male predominance.The main indications of LT were alcoholic liver disease (22.22%), cryptogenic cirrhosis (20.98%), non alcoholic steatohepatitis (11.11%), and hepatocellular carcinoma (7.2%). A total of 113 biopsies were performed in 81 patients. The most common histopathological findings were TCMR (n=43, 53.08%), cholestatic changes (n=19, 23.45%), cholangitis (n=16, 19.75%), and preservation/reperfusion injury (PRI) (n=13, 16.04%). Two patients who underwent ABO-incompatible LT showed AMR. Conclusion The most common pathological diagnosis was TCMR, followed by cholestasis, cholangitis, and PRI. A non-TCMR diagnosis was present in 28.39% of cases.

Background: s/Aims: The implementation of enhanced recovery after surgery (ERAS) protocols has demonstrated significant advantages for patients by mitigating surgical stress and expediting recovery across a spectrum of surgical procedures worldwide. This investigation seeks to assess the effectiveness of the ERAS protocol specifically in the context of major liver resections within our geographical region. Methods: Our department conducted retrospective analysis of prospectively collected data, gathered from consenting individuals who underwent liver resections from January 2018 to December 2023. The assessment encompassed baseline characteristics, preoperative indications, surgical outcomes, and postoperative complications among patients undergoing liver surgery. Results: Among the included 184 patients (73 standard care, 111 ERAS program), the baseline characteristics were similar. Median postoperative hospital stay differed significantly: 5 days (range: 3–13 days) in ERAS, and 11 days (range: 6–22 days) in standard care (p < 0.001). Prophylactic abdominal drainage was less in ERAS (54.9%) than in standard care (86.3%, p < 0.001). Notably, in ERAS, 88.2% initiated enteral feeding orally on postoperative day 1, significantly higher than in standard care (47.9%, p < 0.001). Early postoperative mobilization was more common in ERAS (84.6%) than in standard care (36.9%, p < 0.001). Overall complication rates were 21.9% in standard care, and 8.1% in ERAS (p = 0.004). Conclusions Our investigation highlights the merits of ERAS protocol; adherence to its diverse components results in significant reduction in hospital length of stay, and reduced occurrence of postoperative complications, improving short-term recovery post liver resection

Introduction: Open tendoachilles injuries are rare and associated with significant soft tissues complications. The objective of the present study was to assess the clinical outcome and safety of a simple and minimally invasive technique, with a goal to assess if it may help minimise flap and wound related complications in open tendoachilles injuries. Materials and methods: This prospective study of four years duration included 20 patients with open tendoachilles injuries managed with a simple minimally invasive tunnel technique. The primary outcome variable was occurrence of a major soft tissue complication. The secondary outcome variables included functional outcome measured using AOFAS Ankle hind foot score, re-rupture of tendoachilles and need for revision surgery. Results: None of the patients in the present series developed a serious soft tissue complication. Based upon the AOFAS hind foot scoring system, good to excellent outcome was achieved in 19 (95%) patients. All the patients were able to perform tip toe walking at six months post-surgery. None of the patients had a re-rupture of the tendoachilles and no patient needed a revision surgery. The complications encountered include thickening of the tendon at the repair site (15%), superficial wound infection (5%), stitch granuloma (5%) and hypertrophic scar (5%). Conclusion: This technique seems to be promising in reducing the soft tissue complications associated with the surgical management of open tendoachilles injuries. Most patients had a good final clinical outcome. The technique is safe, simple and reproducible. However, further randomised control studies with a larger sample size assessing the technique are recommended.

Airway management of morbidly obese patients is challenging due to inherent anatomical and physiological variations.[1] The frequent association of compromised hemodynamics, hypoxemia, or acidosis in an emergency department (ED) setting adds to the difficulty of the procedure. Rapid airway management position (RAMP), awake fiber-optic guided intubation, use of intubating laryngeal mask airway (ILMA), and video-laryngoscope are a few techniques that have been described to tackle difficult airways in these patients.[2] Studies have shown that the availability of fiber-optic scopes (3%-60%), video-laryngoscopes (39%-88%), and laryngeal mask airways (LMA) (65%-83%) varies in different ED settings.[3,4] Furthermore, a lack of adequate training and the need for time-bound resuscitation make implementation of the above techniques challenging. Supraglottic airway devices (SADs) are potential rescue airway devices with a fast-learning curve. Point-of-care ultrasound (POCUS) is an easily available, convenient adjunct for airway management in emergency and critical care settings. Various studies have shown the utility of POCUS in the confirmation of correct endotracheal tube placement in real time.[5,6]