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Pneumomediastinum (mediastinal emphysema) is an uncommon condition characterized by the accumulation of air or gas in the mediastinum. Here is a case of a 16-year-old female known to have depression who presented to the emergency department with complaints of shortness of breath, restlessness, chest discomfort, and hoarseness of voice for 2 days. She was initially diagnosed with panic attack, and later on clinical examination, surgical emphysema over the right supraclavicular area was noticed. Chest X-ray was found to be normal, and further imaging with high-resolution computed tomography (HRCT) of the thorax showed pneumomediastinum. In this report, the clinical presentations, radiological features, and management of pneumomediastinum will be discussed.

Hypertrophy of the adenoid is a rare condition in adults, often suspicious of malignancy. We present a case of a 31-year-old female with a clinical presentation of a giant nasopharyngeal mass, clinically suspicious for malignancy, given the size and greyish discoloration. She presented with left-side otalgia, hearing loss, and nasal obstruction. After broad investigations on adenoid tissue following adenectomy, a reassuring diagnosis of adenovirus-related adenoiditis could be made. This case demonstrates the importance of broad microbiological testing in ruling out malignancies. The patient recovered completely. 

Compacted bentonite or sand-bentonite mixtures are considered buffer/backfill materials in the engineering barriers of deep geological repositories for high-level nuclear waste (HLW) disposal in many countries. The design and long-term functionality of nuclear repositories have critical importance for environmental safety and public health. The initially unsaturated buffer material could become re-saturated long after following the sealing of the repository. Although the saturation degree of the buffer might decrease due to high temperatures and evaporation, it tends to increase with groundwater intrusion. Therefore, the soil water characteristic curves (SWCCs) for these unsaturated soils are a key factor in geotechnical engineering. Yet, the determination of SWCCs can be time-consuming and prone to inaccuracies. The HYPROP (Hydraulic Property Analyzer) evaporation technique is a preferred method for accurately determining water retention curves of soils. This reliable method was applied to estimate the water retention curves for sand-bentonite mixtures in the presence of boron minerals. Known for their minimal thermal expansion and commonly used in various industries, boron minerals may improve the thermal stability of sand-bentonite mixtures. The findings revealed that the boron addition increased the water retention capacity of the 10% bentonite mixtures but had a negligible impact on the 20% bentonite mixtures.

Deaths can result from deliberate self-harm (DSH), accidents, natural causes, homicides, or remain unidentified, causing prolonged distress for the deceased’s family and challenges for authorities. Suicide, a significant public health concern, exemplifies self-destructive behavior often unnoticed or partially noticed. Psychological Autopsy (PA) is highly needed in India due to the significant suicide rate and the complex factors contributing to it. Various nations, including the USA, UK, Canada and Australia, have already recognized psychological autopsy as crucial evidence in court. Although PAs are performed in India, their legal acceptability remains debated. It helps in giving a lesser clouded vision of the victim profile and at times even facilitates the specific definition of the cause of death. Studies reveal that about 90% of those who commit suicide suffer from one or more mental disorders, with depression most common; hence, this finding has been beneficial in identification and treatment of such cases at earliest so as to prevent suicide. Recommendations for the future development of this method include embracing modern communication methods and ‘invisible informants’, cultural intersections, safeguarding of reliability and validity, and the use of feasibility trials. The emphasis remains on collating the raw narratives at the core of these interviews, which make the psychological autopsy such a unique and perceptive tool.

It is still not well known the prognostic cardiovascular value of 24h ambulatory blood pressure monitoring in the pregnant woman with hypertension. Objectives: Assess to the prognostic value of ABPM parameters in predicting maternofetal event. Methods: Retrospective and observational study which included 166 pregnant women. Results: The authors found that the night time DBP was the best predictor of adverse events. Non-dipper profile had worse survival at follow up until delivery compared to those with a dipper profile. Conclusions: ABPM is a tool for pregnant with HT because this is the unique method available that analyses the night blood pressure.

A gossypiboma is a mass of cotton material from any source, left in a body cavity after a surgical procedure. This enhances the morbidity, cost of treatment and potential mortality to the patient with the addition of medicolegal issues. We report a case of a 32 year old lady who presented with complaints of central abdominal pain and vomiting for 1 month, fever for 20 days and non-passage of flatus and faeces for 5 days. She had undergone a total abdominal hysterectomy 4 months prior. On clinical examination, adhesive small intestinal obstruction was suspected. On CECT evaluation, a gossypiboma was suggested to have possibly migrated into the small bowel. Laparotomy revealed the presence of clumped bowel loops, which on dissection got torn and showed a gauze like material within the bowel lumen. A diagnosis of gossypiboma with intestinal migration of a retained surgical sponge was ascertained. The possibility of a gossypiboma, particularly in previously operated cases, must be kept in mind and measures must be taken to prevent such incidences.

Background: Laparoscopic cholecystectomy is gold standard and most widely performed surgery for gallstone disease all over the world. Surgeons entering into the field of laparoscopic surgery for the first time faces challenges that are different from those with experienced hands. We in this study tried to enumerate the various such challenges and also recommend few steps to counter them. Aims & Objectives: To study the challenges faced by new surgeons in laparoscopic cholecystectomy and recommendations to reduce them. Material & Methods: This study was carried out in a medical college in the department of General and Minimal Access surgery. In this retrospective study, ten general surgeons working as senior residents in in this medical college over a period of 3 years having never performed laparoscopic surgery in past were included. Results: A total of 50 cases, five operated by each surgeon with minimal assistance by senior surgeon in few cases. Operative time varied from 90 to 120 minutes. The various technical challenges faced by the new surgeon were in the Creation of Pneumoperitoneum, Creation of second port (epigastric port 10mm), Gallbladder Retraction and Dissection at calot’s triangle, Dissection at gallbladder bed and Removal of the gallbladder from epigastric port.it has been observed that following various simple steps will abate these technical difficulties for these beginners while doing laparoscopic cholecystectomy. Conclusion: Laparoscopic cholecystectomy is the most commonly performed minimal access surgical procedure nowadays and almost all the new surgeons enter the world of laparoscopic surgery via this surgery. Knowing and following the above recommendations will help them abate the technical challenges generally faced during the initial phase in the laparoscopic field.

A 35-year-old man presented with swelling in the lower abdomen for 2 months. He was found to have left undescended testis. An ultrasound scan showed a solid floating pelvic mass. His chest x-ray and tumour markers for testicular cancer were normal. Exploratory laparotomy revealed the left intra-abdominal testicular tumour. Intra-abdominal left orchiectomy was performed. The patient made an uneventful recovery. Histology showed immature seminoma. A mass in the lower abdomen with a cryptorchidic testis strongly points towards the diagnosis of malignancy in abdominal testis. To prevent this complication all undescended testis gets orchiopexy before 2nd year or orchiectomy in post-adolescent life. But some cases remain unnoticed, which leads to this kind of presentation. So, we decided to present this rare and interesting case of intra-abdominal testicular tumour.

The present study was conducted to examine the relationship between work-stress, depression and anxiety among six major professionals (doctors, engineers, bankers, nurses, teachers, and lawyers). The inquiry included 260 professionals from different private and governmental sector organizations of Rawalpindi and Islamabad, Pakistan. Job Stress Scale and the subscales of Depression, Anxiety & Stress Scale for depression and anxiety were administered. Based on the hypotheses, a strong positive correlation was found between work stress and depression & anxiety. The current study revealed that stress at work not only prevailed among different Pakistani professionals on severely alarming levels but significantly contributed in developing depression and anxiety. 

A 40 year old woman presented to the emergency department with acute on chronic abdominal pain in her right iliac fossa. On history her pain had been present for over 6 months and had previously been investigated with ultrasound, CT and a diagnostic laparoscopy several months prior to presentation. Her pain had acutely worsened over the preceding two weeks. This was associated with two days of diarrhoea but nil other systemic symptoms. Her medical history was significant for immunosuppression with tacrolimus, azathioprine and prednisone post renal transplant for IgA nephropathy [1]. Her abdominal examination was unremarkable other than tenderness in her right iliac fossa and a palpable non-tender renal transplant. Her inflammatory markers, electrolytes and urine microscopy were unremarkable. She was further investigated with an ultrasound which demonstrated nil complications with her transplant and a non-contrast CT (due to contrast allergy). Her CT demonstrated a faecolith within the appendiceal lumen but no signs of acute appendicitis (Figure 1). Due to ongoing pain and CT finding of faecolith she was taken for a diagnostic laparoscopy with appendicectomy.   Figure 1: Non-contrast CT demonstrating faecolith. Intraoperatively she had a macroscopically normal appendix and no other cause for the patients symptoms could be identified. A laparoscopic appendicectomy was performed with no complications. Her pain persisted postoperatively and she was discharged post operative day two with analgesia. Histology subsequently revealed actinomyces-like organisms consistent with actinomycosis of the appendix (Figure 2). Her case was discussed with the Infectious diseases team and she was started on an extended course of oral amoxicillin [2].   Figure 2: High Powered H&E stain & gram stain of actinomyces like organisms