Articles

Background: Repair of a large ventral hernia is a challenge for surgeons. Component Separation Technique (CST) is a novel technique for closure of the midline with live tissues without undue tension. This can further be reinforced by a prosthesis. We wanted to see the outcome of mesh-reinforced open Anterior Component Separation (ACS) for large complex ventral hernia repair. We aimed to see the duration of surgery, hospital stay, Surgical Site Occurrence (SSO), and recurrence within the first year after surgery.Materials and methods: We analyzed data of patients operated from January 2014 to January 2024 for a period of 10 years in three centers. There were 13 patients with divarication of recti without any previous surgery. Rest 44 patients had either incisional hernia or port site hernia. All patients had defect sizes more than 8 cm. Open bilateral anterior component separations were done to achieve midline closure. Medium-pore soft Prolene mesh was used to reinforce the midline closure by an on-lay technique. Patients were followed up to 1 year after surgery to assess efficacy and complications of the procedure.Results: The average operating time was 73 ± 12 min. Hospital stay was 3 to 7 days, mean was 5.3 days. Surgical site occurrence was 14%. These include seroma formation, major wound infection, and abscess formation. There was no flap necrosis nor mesh removal. There was no recurrence within one year of follow-up after surgery. Conclusion: Open mesh Anterior Component Separation (mACS) is an easy and effective way of treating large and complex ventral hernia. Operating time is substantially less than posterior component separation. Reinforcement with mesh reduces recurrence.

This comprehensive review examines the impact of Artificial Intelligence (AI) on family medicine, focusing on its potential to improve diagnostic accuracy, optimize treatment, and enhance administrative efficiency. Analyzing literature from 2019 to 2024, the study highlights the use of AI applications, including machine learning, natural language processing (NLP), and clinical decision support systems (CDSS), in streamlining workflows, predicting health risks, and personalizing patient care. Key findings reveal significant benefits like reduced diagnostic errors, automated documentation, and proactive management of chronic conditions. However, considerable challenges remain, including algorithmic bias, data privacy concerns, limited explainability of AI outputs, and disparities in implementation across healthcare settings. Ethical considerations—such as equity, clinician autonomy, and patient trust—are emphasized as essential for the sustainable integration of these practices. The review concludes that while AI holds transformative potential for family medicine, its future success depends on collaborative design with clinicians, rigorous validation in primary care, and the establishment of ethical frameworks to ensure equitable and patient-centered adoption.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of illness and death worldwide, and inhalers are often used to manage its symptoms. However, patients’ ability to use inhalers correctly is crucial for the effectiveness of treatment.  Incorrect technique can lead to poor management of the disease and limit the effectiveness of the medication. This study aimed to assess the inhalation technique of patients with COPD who visited a teaching hospital in Chitwan.Methodology: A descriptive cross-sectional study was conducted among patients with COPD who had been using a dry powder inhaler through a rotahaler device for at least 1 month and were attending the Medicine and Respiratory OPD of the teaching hospital in Chitwan. A convenience sampling technique was used to select a total of 103 participants. An observational checklist was used to assess inhalation technique, and a structured interview schedule was used to collect socio-demographic information. Descriptive statistics were used to analyze the obtained data in SPSS version 20 for Windows.Findings: The mean age of the 103 respondents was 70.1 ± 9.56 years, and 62.1% of them were female. While 78.6% had observed a demonstration of the inhalation technique, only 5.8% of the respondents performed the inhalation technique correctly, and 94.2% performed it incorrectly. Only 22.3% of the participants were able to perform at least one critical step of the inhalation technique. The most commonly observed errors included placing the mouthpiece between the lips and teeth (20.4%), breathing out through the mouth (21.4%), and inhaling the powder forcefully and deeply (26.2%).Conclusion: Patients with COPD attending the teaching hospital in Chitwan exhibited incorrect inhalation technique, which can affect the effectiveness of medication and disease management. Healthcare providers should emphasize critical steps and common mistakes to ensure that patients receive maximum benefit from their medication.

Background: Platelets are increasingly recognized as important inflammatory markers. This study explores the association between platelet indices and disease severity in ulcerative colitis (UC).Objective: To evaluate platelet parameters in patients with newly diagnosed UC and assess their correlation with disease severity indices.Methods: A cross-sectional observational study was conducted at IMS & SUM Hospital, Bhubaneswar, between October 2022 and September 2024. A total of 62 newly diagnosed UC patients aged over 18 years were included. Disease severity was evaluated using Truelove and Witts (TLW) criteria, Mayo Disease Activity Index (Mayo DAI), and Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Platelet count, mean platelet volume (MPV), platelet distribution width (PDW), platelet mass index (PMI), and platelet large cell ratio (PLCR) were measured. Statistical analysis included Pearson correlation, ROC curves, and sensitivity/specificity assessment.Results: The majority of patients were male (81%) with a mean age of 28.2 years. A significant positive correlation was observed between platelet count and disease severity by UCEIS (r = 0.32, p = 0.015) and Mayo DAI (r = 0.35, p = 0.009). PMI showed strong correlations with UCEIS (r = 0.45, p = 0.001) and Mayo DAI (r = 0.48, p < 0.001). MPV was inversely correlated but showed weak significance. PLCR also showed significant correlations. ROC analysis revealed platelet count (AUC = 0.815) and PLCR (AUC = 0.729) as good predictors of disease severity.Conclusion: Platelet parameters, particularly PMI, PLCR, and platelet count, may serve as accessible, non-invasive biomarkers for assessing disease severity in UC. Further studies with larger cohorts are warranted.

A study of palm lines, various landmarks on the hand, and their correlation with the hand's anthropometric dimensions may sometimes help predict various future events in the life of an individual. We try to find out any correlation between these appearances and the sudden death of an individual. In the present study, we collected data from an individual’s hand after carefully breaking the rigor mortis in the deceased brought for medicolegal postmortem examination and measured the different dimensions. The data were then subjected to statistical analysis. The article may help rule out the cultural belief about the study of the lifeline and age at the time of death. Palmistry is a self-interpretation of changes in or around the lifeline by an individual, and it varies from person to person. There is no concrete literature proof available that suggests its importance in ascertaining the age of the individual.We also observed that there is no close relation between the age interpreted by the lifeline and the biological age of the individual. Our study shows that the individual either lives too long or too short compared to age by the lifeline.We observed that unnatural deaths are more common in young individuals, and males outnumber females. According to the cause of death, hanging, accident, and poisoning are the most common, followed by sudden death and homicide. In our study, we observed that there is no correlation between unnatural death and the lifeline of an individual and age at the time of death.

Introduction: Sophisticated technological advancements for the identification of people are readily available in developed countries.  Meanwhile, relatively less expensive algorithms in physical anthropometry could be employed for such identification purposes. Although such evaluations have been done in some countries, due to interpopulation variations, such relations should be ethnic-and sex-specific.  Aim: Therefore, the present study sought to assess the relationship between the long bones of the upper and lower limbs among two ethnic groups in Ghana for stature estimation. Methodology: Using a purposive non-random sampling technique, participants made up of 140 Asantes and 102 Ewes aged 20 to 25 years were recruited after an ethical approval was obtained from the Committee on Human Research, Publication and Ethics, KNUST.  Results: For the same sex, there was no statistically significant difference between Asantes and Ewes concerning height. The most useful parameters for stature estimation among the Asante males were left fibular and tibial lengths, with those of the females being left ulnar, fibular, and radial lengths.  However, for the Ewe males, the most significant parameters for height estimation were right fibular and humeral lengths, whereas for the Ewe females, being right tibial and humeral lengths.  Conclusion: Findings of the study are useful for the identification of humans with dismembered body parts involved in various disasters, such as automobile accidents.  The database and formulae derived would be useful for stature estimation needed in biological profiling and other assessments of bedridden patients.

Introduction: The medial collateral ligament (MCL), a primary stabilizer against valgus forces, often requires surgical intervention in severe injuries, especially when associated with anterior cruciate ligament (ACL) tears. However, MCL repair or reconstruction is typically reserved for patients who continue to experience persistent valgus instability after nonoperative management has failed. The use of synthetic and biological implants is increasingly popular to augment these procedures, providing both biomechanical reinforcement and promoting natural healing. BioBrace, a biocomposite of collagen and bioabsorbable microfilaments, provides structural support and enhances tissue healing. This article explores the surgical treatment of high-grade medial collateral ligament (MCL) injuries of the knee using BioBrace augmentation through a case series.Methods: Cohort of patients who underwent MCL repair surgery with a bioinductive membrane augmentation (BioBrace) between December 2023 and February 2024. This article presents surgical techniques, indications, and clinical outcomes from a case series, highlighting the benefits of BioBrace augmentation in improving stability and functional recovery. Results: A total of 4 patients underwent MCL repair surgery with BioBrace. Results show that patients experienced reduced instability, faster rehabilitation, and favorable outcomes without significant postoperative complications. Conclusion: This method offers a promising alternative for patients with complex knee injuries, especially athletes, by facilitating early rehabilitation and improving joint stability. Further research is recommended to evaluate long-term efficacy and optimize the surgical approach.

Introduction: Hypertension is still one of the major causes of cardiovascular disease and death worldwide. Despite lifestyle modifications and medical treatment, blood pressure control rates remain suboptimal. The sympathetic nervous system plays a significant role in the pathophysiology of hypertension. Inhibition of the sympathetic nervous system leads to a reduction in blood pressure. In light of this, a catheter-based renal denervation procedure has been developed to selectively ablate the renal sympathetic nerves in order to lower blood pressure. Discussion: Renal denervation targets the afferent and efferent sympathetic nerves along the renal arteries. Interruption of the renal nerve fibers in the perivascular space reduces sympathetic-mediated renal vascular resistance, renin release, and sodium reabsorption. Consequently, the mechanisms driving systemic hypertension are gradually disrupted, and blood pressure falls over time. The current main methods of renal denervation are radiofrequency energy, ultrasound, and perivascular neurotoxin injection. Recent randomized sham-controlled trials have shown that renal denervation effectively and safely reduces blood pressure by approximately 5 to 10 mmHg in various hypertensive patients. It is important to have a multidisciplinary team of hypertension specialists and interventional experts to select appropriate patients for renal denervation. Shared decision-making is essential to consider hypertension-mediated organ damage, cardiovascular risk, and patient preferences. Conclusion: Catheter-based renal denervation is a relatively new treatment modality that provides meaningful and sustained reductions in blood pressure with an acceptable safety profile. Currently, it is recommended for patients with uncontrolled or resistant hypertension despite optimal lifestyle changes and medical treatment.

Background: Placenta accreta spectrum (PAS) refers to abnormal adherence of the placenta, including accreta, increta, and percreta, which can lead to severe maternal morbidity and mortality due to complications such as hemorrhage, invasion into adjacent organs, and need for blood transfusions.Methods: This retrospective study was conducted at the Government Maternity Hospital, Hanamakonda, Kakatiya Medical College, from January 2024 to June 2024. Data were collected on women presenting with PAS based on clinical and radiological diagnosis, including antenatal and intraoperative findings. Maternal demographic data, risk factors, and outcomes were analyzed.Results: Among 2,700 deliveries, 16 cases of PAS were identified (incidence: 0.59%). PAS subtypes consisted of 7 accreta, 5 increta, and 3 percreta. Major risk factors included advanced maternal age (56% ≥ 30 years), higher parity (81.2% gravidity 3 or more), previous lower-segment cesarean section (LSCS) in 87.5%, and history of D&C (31.2%). Placenta previa was present in 62.2% of cases. Unbooked status and late referrals were common (68.7%). Preterm termination occurred in 87.5% of cases, and 56.2% underwent cesarean hysterectomy. There was no reported perioperative maternal mortality or significant postoperative complications.Conclusion: Placenta accreta spectrum is increasingly recognized, i.e., PAS is being diagnosed and understood in more cases than in the past, because both the actual number of cases and clinical ability to diagnose the condition have increased dramatically in recent years, particularly among women with prior cesarean deliveries and placenta previa. Timely diagnosis, multidisciplinary management, and referral to tertiary care are essential to improve maternal outcomes.

Introduction: The annual rhythm of menarche was proposed to be due to climatic annual variations. The discovery that peaks of incidence of menarche were found in the same months in the North and the South Hemispheres made us to think this hypothesis was not correct. Then we proposed that periods of study (stress) and vacation (relaxation, fiesta) were better factors for this rhythm. If this is so, days of fiesta should present more menarches than current days. In the second hypothesis the age at menarche should be modified by the vacation-study rhythm. Thus, I tested two hypotheses: I) This rhythm and the age at menarche are conditioned by climate factors mostly seasonal variations. II) the contrast between expectancy of fiesta (relaxation) and stress is the main factor of the rhythm and the variation on the age at menarche during the year.Method: The monthly incidence and age at menarche were obtained from samples of girls in Santiago (Chile), Medellín (Colombia), Debrecen (Hungary), Chennai (India) with data collected directly in these countries. A sample from Barrinhas (Riberao Preto, Brazil) was taken from literature. The climatic hypothesis was tested knowing the main climatic parameters by the latitude of these cities. The annual study-vacation rhythm was obtained from the academic calendar at any city and from direct information of our colleagues working in these cities. A correlate between the climatic rhythm and the study-vacation rhythm with the incidence or age at menarche complete the refutation or affirmation of the hypotheses. Also, the expected peaks of menarche at significance fiesta-days or the birthday were studied directly form the calendar of holidays or the cultural information given by our colleagues. Results: In the five samples taken individually or together there were clear contradictions with the climatic hypothesis. On the contrary the fiesta-stress hypothesis shows a clear correlation with the monthly incidence and the age at menarche. Days of national, religious fiesta or the birthday showed greatly significant peaks of menarche. Conclusion: Data refute the climatic hypothesis of the annual rhythm of menarche and agree with the fiesta (vacation)-stress (study) hypothesis.