Background: Hypospadias is a common congenital defect of the male urethra, with distal types comprising 70–80% of cases. The standard treatment is urethroplasty, with tubularized incised plate (TIP) urethroplasty, which is widely accepted for distal variants. A key postoperative debate involves using urethral stents, which are traditionally used to aid healing and reduce complications. However, concerns about discomfort, infection, and mixed outcomes have led to growing interest in stentless repairs. Recent studies show comparable results between stented and non-stented approaches, though opinions remain divided due to variations in surgical techniques, patient factors, and outcome definitions, highlighting the need for standardized management strategies. Aim of the study: The aim of this study was to compare the surgical outcomes, complication rates, and functional and cosmetic results of stented versus non-stented urethroplasty in patients with distal hypospadias. Methods: This prospective, comparative observational study was conducted over 12 months (start to end) at the Department of Paediatric Surgery, Parkview Medical College & Hospital, Sylhet, Bangladesh from July 2023 to July 2024. Sixty male children (6 months–12 years) with distal hypospadias were randomized into two groups: Group A underwent urethroplasty with postoperative stenting, and Group B without stenting. Exclusion criteria included proximal hypospadias, reoperations, severe chordee, UTI, and significant anomalies. Surgeries employed the TIP or Only technique. Data on demographics, clinical features, complications, and outcomes were collected. Follow-ups occurred at 2 weeks interval initially for 3 months, then monthly for 1 year. Outcomes were evaluated using HOSE scores, parental satisfaction, and statistical analysis via SPSS v26.0. Result: In this study of 60 male children with distal hypospadias, patients were divided into groups of stented (Group A) and non-stented (Group B). Both groups had comparable baseline characteristics. Group A showed a longer operative time (78.4 vs. 72.6 minutes, p=0.03), a longer hospital stay (5.1 vs. 3.4 days, p<0.001), and higher pain scores (3.8 vs. 2.5, p<0.01). Early and late complication rates were slightly higher in the stented group, though not statistically significant. Both groups had high functional and cosmetic success at the six-month follow-up, with similar parental satisfaction and HOSE scores. Reoperation rates were marginally higher in Group A (6.7% vs. 3.3%). Conclusion: Non-stented urethroplasty is a safe, effective alternative for distal hypospadias repair, offering outcomes comparable to the stented approach. It provides advantages such as shorter operative time, reduced hospital stay, and less postoperative pain. Despite slightly higher complications in the stented group, differences were not statistically significant, supporting non-stented repair as favorable.

Background: Diabetes mellitus, characterized by chronic hyperglycemia due to insulin secretion defects or resistance, leads to microvascular and macrovascular complications. Diabetic foot ulcers (DFUs), a severe manifestation of these complications, contribute significantly to morbidity and the risk of amputations among diabetic patients. Effective wound management in DFUs is critical, and growth factors like recombinant human epidermal growth factor (hEGF) have shown promise in promoting wound healing through cellular proliferation and angiogenesis. Aim: This study aimed to assess the efficacy of topical recombinant hEGF in enhancing wound healing in diabetic foot ulcers compared to conventional saline dressing. Materials and Methods: In this randomized controlled trial, 80 patients with diabetic foot ulcers were recruited and allocated into two groups: Group A received normal saline dressing with topical recombinant hEGF, while Group B received normal saline dressing alone. Participants were matched for demographic variables including age, gender, and duration of diabetes. Wound size, rate of granulation, and duration of hospital stay were measured at baseline, 7, 14, and 21 days. Data were analyzed using independent t-tests and chi-square tests, with statistical significance set at p < 0.05. Results: The study found that Group A, treated with recombinant hEGF, had a significantly greater reduction in wound size and area compared to Group B. Final wound size and duration of hospital stay were significantly lower in Group A. Staphylococcus aureus was the most commonly isolated organism, followed by Escherichia coli. There were no significant differences in adverse effects between the groups. Conclusion: Topical recombinant hEGF, when used with normal saline dressing, significantly improves wound healing in diabetic foot ulcers, evidenced by reduced wound size and shorter hospital stays. These findings suggest that incorporating recombinant hEGF into standard DFU care protocols could enhance treatment outcomes and potentially lower healthcare costs.

Introduction: Drug Promotional Literature (DPL) is a key marketing tool used by pharmaceutical companies to influence prescribing patterns of healthcare professionals. However, these materials often lack comprehensive, evidencebased information. This study aims to evaluate the rationality of DPLs distributed in a tertiary care teaching hospital in Maharashtra using WHO guidelines and compare it with similar studies. Methodology: A cross-sectional, observational study was conducted from July to September 2023. A total of 100 DPLs were collected from various outpatient departments. Each DPL was analyzed for compliance with WHO criteria. All the data was entered in Microsoft Excel and analyzed using descriptive statistics. Results: Among the 100 DPLs assessed, compliance with WHO criteria varied significantly. While 95% of the DPLs mentioned the brand name, only 62% provided the active ingredient. Details on side effects and adverse reactions were found in only 40% of cases, whereas drug interactions were mentioned in just 35%. Compared to previous studies, compliance with scientific references was slightly higher (28% vs. 22% in Mali et al., 2010). Conclusion: The study highlights significant gaps in the completeness and transparency of DPLs. The findings call for stricter regulatory oversight and improved ethical standards in pharmaceutical marketing.

Background and Objectives: Dexamethasone has been shown to prolong the duration of analgesia when used as an adjuvant to local anesthetics in peripheral nerve blocks. This study aimed to compare the effects of ropivacaine alone and ropivacaine with dexamethasone on the onset and duration of sensory and motor block, as well as the duration of analgesia, in infraclavicular brachial plexus block for upper extremity surgeries. Methods: In this prospective, randomized study, 40 patients were allocated into two groups: Group R (n=20) received 20 mL of 0.5% ropivacaine with 2 mL normal saline, and Group D (n=20) received 20 mL of 0.5% ropivacaine with 8 mg dexamethasone. The onset and duration of sensory and motor block, duration of analgesia, postoperative pain scores, and rescue analgesic consumption were assessed. Results: The onset of sensory block (11.2 ± 2.9 min vs. 16.5 ± 3.8 min, p<0.001) and motor block (14.6 ± 3.5 min vs. 21.8 ± 4.7 min, p<0.001) was significantly faster in Group D compared to Group R. The duration of sensory block (738.6 ± 96.2 min vs. 512.4 ± 74.9 min, p<0.001), motor block (664.3 ± 88.7 min vs. 462.1 ± 63.5 min, p<0.001), and analgesia (875.2 ± 102.4 min vs. 589.3 ± 81.6 min, p<0.001) was significantly prolonged in Group D. Postoperative pain scores were lower, and rescue analgesic consumption was reduced in Group D (1.3 ± 1.0 vs. 2.4 ± 0.9, p=0.001). The incidence of adverse events was similar between the groups. Conclusion: The addition of dexamethasone to ropivacaine in infraclavicular brachial plexus block significantly enhances the onset and duration of sensory and motor block, as well as the duration of analgesia, compared to ropivacaine alone, without increasing the risk of adverse events.

Background: Primary dysmenorrhea, characterized by painful menstrual cramps without underlying gynecological pathology, affects a significant proportion of adolescent girls, leading to school absenteeism and reduced quality of life. Nonpharmacological interventions offer safe alternatives to manage this condition, yet awareness among adolescents remains limited. Objective: This study evaluated the effectiveness of a structured teaching program (STP) on knowledge regarding non-pharmacological management of primary dysmenorrhea among adolescent girls in selected government girls’ high schools in Kamrup (Metro) District, Assam. Methods: A pre-experimental study with a one-group pre-test-post-test design was conducted among 60 adolescent girls aged 13–16 years from two government girls’ high schools. A structured questionnaire assessed knowledge before and after a 45- minute STP. Data were analyzed using paired t-tests and chi-square tests to evaluate knowledge improvement and associations with socio-demographic variables. Results: The mean pre-test knowledge score was 12.3 ± 3.2, which increased significantly to 22.7 ± 2.8 post-intervention (p < 0.001). Significant associations were found between pre-test knowledge and age (p = 0.02), educational status (p = 0.04), and age at menarche (p = 0.03). Conclusion: The STP significantly enhanced knowledge of non-pharmacological management strategies, suggesting its potential as an educational tool to empower adolescent girls in managing primary dysmenorrhea.

Introduction: The objective is to evaluate efficacy of DWI and MR spectroscopy with conventional MRI in differentiation and grading of brain tumors. Material and Methods: A total number of 60 patients with brain tumours who were referred to Department of Radiodiagnosis, SSIMS&RC, Davanagere over a period of 2 years. Results: Study group consists of 39 male and 21 female patients, majority of the age group is 40.0%. Accordingly, the mean ADC value was 0.81 with a standard deviation of around ±0.216. However, the proportion of each diagnosis was found to be quite different from the actual diagnosis based on HPE, thereby suggesting the possibility of false reports from the DWI procedure. MRS was performed and ratios between choline and creatinine, NAA and creatinine, and choline and NAA to diagnose the condition. Conclusion: On performing both DWI and MRS among patients with history of headache and focal neurological deficits, the study observed the following; DWI was in correlation with ADC values which helped in diagnosing the condition appropriately in most of the cases. MR spectroscopy was successful in imaging and grading the brain tumors using the ratios between choline and creatinine, N-acetyl aspartate and creatinine, and choline and N-acetyl aspartate. MR spectroscopy proven to be more sensitive than diffusion weighted imaging in all the cases.

The World Health Organization defines cancer as a group of diseases characterized by the uncontrolled growth of cells. Worldwide, it is estimated that there will be 19.3 million new cases in 2020. Risk factors in Portugal include alcohol, tobacco, excess weight and physical inactivity, highlighting the importance of early diagnosis for a favorable prognosis. Treatments vary, resulting in various adverse effects, particularly on the skin, such as xerosis, hyperpigmentation, hand-foot syndrome, sensitivity to light and itching, requiring care before, during and after treatments. This includes hygiene, moisturizing and sun protection. The careful choice of dermatological products is essential to minimize the adverse effects of treatments. Corrective make-up can help improve patients' quality of life by concealing certain skin alterations. This literature review aims to understand the skin changes inherent to cancer, the drugs that potentiate them and to explore the dermatological care available. To achieve this objective, a bibliographic search was carried out in different databases including Pubmed and google scholar, official entities such as the World Health Organization, the National Health Service and the library of the Coimbra School of Health Technology. Using keywords such as cancer, cosmetics, skin care, dermatology, quality of life, cancer treatments, considering a study period of the last 5 years. Drugs used in clinical practice were discussed, such as Apalutamide, Brigatinib, Capecitabine, Cetuximab, Erlotinib, Gefitinib, Panitumumab, Sorafenib associated with their adverse effects, promoting a better understanding of treatments and their effects, focusing on the needs of cancer patients. The promotion of well-being and adherence to treatment are facilitated by a careful approach to the choice of cosmetic and dermatological products, as discussed. Knowledge of dermatological toxicities is essential for improving the quality of life and therapeutic adherence of cancer patients.

Background: Diabetic ulcers are a significant complication of diabetes mellitus, often leading to prolonged healing and increased healthcare burden. This study aims to evaluate the efficacy of Carica papaya pulp in the management of diabetic ulcers. Methods: A prospective interventional study was conducted on 50 diabetic patients with chronic ulcers, admitted to the Department of General Surgery at Karpaga Vinayaga Institute of Medical Sciences, Chengalpettu, between November 2023 and November 2024. After initial standard wound care, patients received papaya pulp dressings for wound management. The primary outcomes measured were ulcer surface area reduction, granulation tissue formation, graft uptake, and duration of hospital stay. Results: The mean age of patients was 51.82 ± 7.94 years, with 72% male and 28% female. The mean surface area of the ulcers decreased from 56.68 cm² to 33.74 cm² post-treatment. Granulation tissue formation reached 43.08% of the ulcer area after 10 days. Graft uptake on the 5th postoperative day averaged 66.84%, and the average duration of hospital stay was 49.50 ± 11.22 days. Female patients showed slightly higher graft uptake and longer hospital stays compared to male patients. Conclusion: Carica papaya pulp dressings significantly improve the healing of diabetic ulcers, promoting faster granulation, better graft uptake, and shorter treatment periods. This study supports the use of papaya pulp as an effective, low-cost alternative for diabetic ulcer management, particularly in resource-limited settings. Further studies are warranted to refine treatment protocols and explore its broader clinical applications.

Background: Multidrug-resistant organisms (MDROs) are increasingly implicated in diabetic foot infections, particularly in rural populations, where limited healthcare resources may exacerbate the issue. This study aimed to evaluate the prevalence of MDROs in diabetic foot ulcers and assess factors influencing wound healing in a rural South Indian setting. Methods: A prospective, hospital-based observational study was conducted at Karpaga Vinayaka Institute of Medical Sciences, Tamil Nadu, from July 2024 to January 2025. A total of 85 diabetic patients with foot ulcers were enrolled. Clinical evaluations included history, physical examination, and laboratory investigations such as blood tests, chest X-ray, ECG, and wound culture and sensitivity. Patients were categorized based on the presence of MDROs and wound healing outcomes. Results: Of the 85 patients, 64.7% harbored at least one MDRO. The most common MDROs included Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis. Poor glycemic control (HbA1c > 8%) was significantly associated with the presence of MDROs (p = 0.031). Peripheral neuropathy was a significant predictor of non-healing ulcers (p = 0.007). Among patients with MDRO infections, wound healing was slower compared to those without MDROs. Conclusion: The high prevalence of MDROs in diabetic foot ulcers in rural South India highlights the need for stringent glycemic control, early intervention for neuropathy, and culture-based antibiotic therapy. These measures are crucial for improving wound healing and reducing the risk of amputation in diabetic foot patients.

Background: To analyze the spectrum of challenges faced in the treatment of Langerhen Cell Histiocytosis resource limited settings lacking salvage therapy. Methods: In this observational study, 30 patients of Langerhans cell histiocytosis were enrolled. Risk organ involvement, treatment course and outcome were analyzed. The patients were treated with vinblastine(iv) weekly, prednisolone(po) daily and MTX (iv) in 1st,3rd and 5th week for 6 weeks and then 6 MP daily, MTX weekly, vinblastine every 3 weekly for 6 to 12 months according to risk group. Intravenous Cytarabine pulses used for 5 days 3-weekly apart and Japanese Protocol used for refractory cases. The salvage therapy available in developed countries in the form of 2-CdA (2- chlorodeoxyadenosine) and RIC SCT reduced-intensity conditioning stem cell transplantation not available in our center. Results: Age of the patients range from< 1 to 10 years (19% 6 months after the onset of symptoms in 30/42 (72%) of cases with 100% expiries in this group and 89% of abandonment. The children presenting at younger age had risk of having MS-LCH 75% as compared to 36% in age >2years. Conclusion: Treatment abandonment, delayed diagnosis and poor social support are major challenges in treating LCH in developing countries. Early diagnosis and timely treatment with effective infection control measures and strong social support are of utmost importance to improve long term overall survival.