Background: Opioids administered as bolus doses or continuous infusions are widely used by anesthesiologists worldwide for major and day care surgeries. Opioid-free anesthesia is a multimodal anesthesia and analgesia technique that does not use opioid drugs, thereby benefitting patients from opioid-related adverse effects. In this study, we compared the postoperative analgesic requirements of patients scheduled for elective laparoscopic cholecystectomy under opioid-free and opioid-based anesthesia. Methods: This study included 88 patients aged 18–60 years with American Society of Anesthesiologists physical status 1 and 2 who underwent elective laparoscopic cholecystectomy. Participants were randomly divided into two groups with forty-four participants in each group. The opioid-free anesthesia group was administered an intravenous bolus of ketamine and dexmedetomidine, whereas the opioid-based group was administered fentanyl with conventional general anesthesia. The primary outcome was to compare the total amount of fentanyl consumed by both groups during the 6 h postoperative period following extubation. Episodes of postoperative nausea and vomiting (PONV) and vital signs were noted throughout the postoperative period to analyze the secondary outcomes. Results: Both the groups had similar demographic characteristics. The opioid-free group required less postoperative analgesia within the first 2 h (61.4 ± 17.4 vs. 79.0 ± 19.4 of fentanyl, P < 0.001), which was statistically significant. However, fentanyl consumption was comparable between the groups at the sixth postoperative hour (opioid-free group 152 ± 28.2 vs. opioid group 164 ± 33.4, P = 0.061). Compared with 4.5% of the participants in the opioid-free group, 34% of those in the opioid-based group developed moderate PONV. Conclusions The opioid-free anesthesia technique in patients undergoing laparoscopic cholecystectomy reduced the requirement of analgesia in the first two hours of the postoperative period and was associated with decreased PONV.

Purpose: This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of parents or caregivers of children suffering from migraines at a tertiary care center in North India. Methods: We conducted a cross-sectional study involving 100 parents or caregivers, using convenience sampling. A 20-item questionnaire was administered in English and also translated into the local language (Hindi). The study included children with migraines who visited the pediatric outpatient department within a 6-month period (December 2022 to May 2023). Results: Over 60% of caregivers were aware of the chronic nature of the illness, its triggering factors, the role of family history, and the importance of lifestyle modifications. However, only 46% understood the pathophysiology of the illness, and 53% were aware of the medication used for childhood migraines. More than 85% of caregivers believed that recurrent headaches necessitate a doctor’s consultation, may require regular visits for optimal treatment, and were willing to alter their child’s lifestyle to prevent headaches. However, a significant percentage of caregivers (47%) practised self-medication for their children’s headaches. Most caregivers believed that lifestyle modifications and avoiding triggers were the best treatments for migraines. There were significant associations (P<0.05) between the level of education and responses to questions related to migraine definition, prophylaxis, treatment, investigations, lifestyle modifications, and screen time. Conclusion Most participants were well-educated on migraine, and their KAP regarding migraine prevention and treatment were generally adequate. However, the practice of self-medication without professional guidance is a significant concern.

Globally, it is estimated that more than 50% of antibiotics are obtained without a prescription. The main purpose of this study is to determine the knowledge and practice of primary caregivers about self-medication in children with antibiotics, as studies on self-medication is lacking in India, also, it will help is assessing parents’ knowledge and attitude towards self medication. This cross-sectional study conducted in the urban community of Shastri Nagar, Patna, aimed to evaluated antibiotic use in children aged 0-12. From January 2023 to March 2023, 173 caregivers were randomly selected through house visits. Data collection used a pre-tested questionnaire, ensuring confidentiality. In this study of 173 participants, caregivers in an urban community demonstrated varying knowledge regarding antibiotic use in children. Mothers and postgraduates possessed better awareness of antibiotic consequences. Fathers exhibited better understanding of side effects. Knowledge on antibiotics’ action was seen among mothers, those aged 30-39, with family income of Rs. 20,000-40,000 and those with family members in medical field. Fathers had more incorrect beliefs about antibiotics treating viral infections. Common conditions for self-medication included cough/cold, fever and diarrhea, with hospitals being the primary source of antibiotics. Majority obtained information from pharmacies but awareness about antibiotic course completion and versatility was limited. Caregivers’ antibiotic knowledge varied; mothers and postgraduates were more aware, while fathers understood side effects better.

Gallbladder perforation with spillage of gallstones is not uncommon during laparoscopic cholecystectomy. Stone spillage can cause several complications. We report a case of recurrent discharging sinuses on the right back 4 years after laparoscopic cholecystectomy in a 44-year-old female patients. She suffered for 9 years to undergo empirical treatment for suspected tuberculosis, including repeated attempts at sinus tract excision done at different hospitals. We did a computed tomography sinogram, which revealed the tract extending from the right flank into a cavity in the right subpleural space. We proceeded with the sinus tract excision which extended between the tips of the 10th and 11th ribs, spreading to the right subpleural space where pus mixed with multiple gall stones were retrieved. Spilled stones may result in complications, making diagnosis difficult and seriously harming the patient physically, mentally, and economically. The need for accurate documentation and patient knowledge of missing gallstones cannot be understated.

Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.

Ultrasound-guided erector spinae plane (ESP) block has been used to provide lumbar analgesia. The craniocaudal spread of local anesthetic in this block can be unpredictable in patients with kyphosis due to backward curvature of the spine, which might prevent longitudinal spread. Case: This is a case of a 33-year-old male (60 kg) diagnosed with type 3b kyphosis of the thoracolumbar region at the level of L1 who underwent extended pedicle subtraction osteotomy. ESP block was administered at two different levels, one at T12 (above the angle of the kyphosis L1) and another at L3 (below the angle of kyphosis L1), as the curvature of kyphosis can hinder the longitudinal spread of local anesthetic. Conclusions: Two-level ESP block results in better craniocaudal spread of local anesthetic in a patient undergoing kyphosis correction surgery.

Median nerve is formed by lateral root from lateral cord and medial root from medial cord of brachial plexus.Formation of median nerve occur in front or lateral to axillary artery in axilla. In the present study we observed anatomical variations of median nerve formation in the brachial plexus. We examined formalin fixed 60 upper limbs from 30 adult cadavers (15 males and 15 females) which were above the age 40 years from the department of Anatomy. All the cadavers were dissected on both sides according to Cunningham’s Manual of Practical Anatomy. Normal formation of median nerve by two roots noted in 42 (70.0%) of upper limb specimen. Variation of median nerve formation noted in 18 (30.0%) upper limb specimen. Three roots taking part in the formation of median nerve in 13 (21.7%) upper limb specimen where additional root coming from lateral cord of brachial plexus. Four roots taking part in formation of median nerve in 3 (5.0%) upper limb specimen, where additional roots coming from lateral cord and posterior cord of brachial plexus. Lateral root crossed the axillary artery anteriorly to join with medial root lying medial to axillary artery. The median nerve formed medial to third part of axillary artery. Additional communication with musculocutaneous nerve with median nerve seen in 2 (3.3%) upper limb specimen. Knowledge of such anatomical variations is of interest to the anatomist and clinician alike. Surgeons who perform procedures involving neoplasm or repairing trauma need to be aware of these variations. Median nerve variation may lead to confusions in surgical procedures and axillary brachial plexus nerve block anesthesia.

Retrospective cohort study.

Background: The emergence of drug-resistant tuberculosis (TB), is a major menace to cast off TB worldwide. Line probe assay (LPA; GenoType MTBDRplus ver. 2) and Xpert MTB/RIF assays are two rapid molecular TB detection/diagnostic tests. To compare the performance of LPA and Xpert MTB/RIF assay for early diagnosis of rifampicin-resistant (RR) TB in acid-fast bacillus (AFB) smear-positive and negative sputum samples. Methods: A total 576 presumptive AFB patients were selected and subjected to AFB microscopy, Xpert MTB/RIF assay and recent version of LPA (GenoType MTBDRplus assay version 2) tests directly on sputum samples. Results were compared with phenotypic culture and drug susceptibility testing (DST). DNA sequencing was performed with rpoB gene for samples with discordant rifampicin susceptibility results. Results: Among culture-positive samples, Xpert MTB/RIF assay detected Mycobacterium tuberculosis (Mtb) in 97.3% (364/374) of AFB smear-positive samples and 76.5% (13/17) among smear-negative samples, and the corresponding values for LPA test (valid results with Mtb control band) were 97.9% (366/374) and 58.8% (10/17), respectively. For detection of RR among Mtb positive molecular results, the sensitivity of Xpert MTB/RIF assay and LPA (after resolving discordant phenotypic DST results with DNA sequencing) were found to be 96% and 99%, respectively. Whereas, specificity of both test for detecting RR were found to be 99%. Conclusion We conclude that although Xpert MTB/RIF assay is comparatively superior to LPA in detecting Mtb among AFB smear-negative pulmonary TB. However, both tests are equally efficient in early diagnosis of AFB smear-positive presumptive RR-TB patients.

Background: The emergence of drug-resistant tuberculosis (TB), is a major menace to cast off TB worldwide. Line probe assay (LPA; GenoType MTBDRplus ver. 2) and Xpert MTB/RIF assays are two rapid molecular TB detection/diagnostic tests. To compare the performance of LPA and Xpert MTB/RIF assay for early diagnosis of rifampicin-resistant (RR) TB in acid-fast bacillus (AFB) smear-positive and negative sputum samples. Methods: A total 576 presumptive AFB patients were selected and subjected to AFB microscopy, Xpert MTB/RIF assay and recent version of LPA (GenoType MTBDRplus assay version 2) tests directly on sputum samples. Results were compared with phenotypic culture and drug susceptibility testing (DST). DNA sequencing was performed with rpoB gene for samples with discordant rifampicin susceptibility results. Results: Among culture-positive samples, Xpert MTB/RIF assay detected Mycobacterium tuberculosis (Mtb) in 97.3% (364/374) of AFB smear-positive samples and 76.5% (13/17) among smear-negative samples, and the corresponding values for LPA test (valid results with Mtb control band) were 97.9% (366/374) and 58.8% (10/17), respectively. For detection of RR among Mtb positive molecular results, the sensitivity of Xpert MTB/RIF assay and LPA (after resolving discordant phenotypic DST results with DNA sequencing) were found to be 96% and 99%, respectively. Whereas, specificity of both test for detecting RR were found to be 99%. Conclusion We conclude that although Xpert MTB/RIF assay is comparatively superior to LPA in detecting Mtb among AFB smear-negative pulmonary TB. However, both tests are equally efficient in early diagnosis of AFB smear-positive presumptive RR-TB patients.