Testicular Torsion and Irreversible Loss in an Adolescent Male: A Harrowing Case Report With Emphasis on Timely Intervention and Literature Review.

Testicular torsion is a condition characterized by the twisting of the testis and spermatic cord within the scrotum, resulting in the obstruction of venous return and subsequent swelling. If left untreated, the torsion can progress to block the arterial blood supply, leading to ischemia. Prolonged ischemia can result in testicular necrosis and decreased fertility. Recognizing the urgency of this condition, timely diagnosis and management are crucial. In this clinical case, a 16-year-old male presented with left-sided scrotal pain following a minor trauma. Despite prompt medical attention, the delay in seeking treatment resulted in irreversible testicular necrosis. The case emphasizes the urgency of diagnosing and managing testicular torsion to prevent serious consequences such as testicular loss and reduced fertility. It serves as a poignant reminder for healthcare professionals to remain vigilant in recognizing this urological emergency and advocating for timely intervention to optimize patient outcomes.

Efficacy in Predicting Negative Appendectomy Rates in Operated Acute Appendicitis Patients Using the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Score Versus Modified Alvarado Score.

Introduction Acute appendicitis is the commonest abdominal surgical emergency globally. The most accepted management of acute appendicitis is surgical, either open or laparoscopic appendectomy. Overlapping clinical presentations with many genitourinary and gynecological conditions lead to difficulty in accurate diagnosis, making negative appendectomies an unwanted reality. With the advancement in technology, there have been constant efforts to minimize negative appendectomy rates (NAR) using imaging modalities like USG of the abdomen and the gold-standard imaging test, the contrast-enhanced computed tomography of the abdomen. Due to the cost incurred and the lesser availability of such imaging modalities and needed expertise in resource-poor settings, various clinical scoring systems were devised to accurately diagnose acute appendicitis and thereby decrease NAR. We conducted our study to determine the NAR between the Raja Isteri Pengiran Anak Saleha Appendicitis score (RIPASA) and the modified Alvarado (MA) scoring methods. Methods A prospective observational analytical study was conducted, including 50 patients presenting to our hospital with acute appendicitis and who underwent emergency open appendectomy. The need to operate was decided by the treating surgeon. Patients were stratified by both scores; the pre-operative scores were noted and were later compared with the histopathological diagnosis. Results A total of 50 clinically diagnosed patients with acute appendicitis were evaluated utilizing the RIPASA and the MA scores. The NAR was 2% using the RIPASA score vs 10% with the MA score. The sensitivity was 94.11% vs 70.58% (p<0.0001), the specificity was 93.75% vs 68.75% (p<0.0001), the positive predictive value (PPV) of 96.96% vs 82.75% (p<0.001), the negative predictive value (NPV) of 88.23% vs 52.38% (p<0.001), and NAR of 2% vs 10% (p<0.0001) in the RIPASA vs MA scoring method, respectively. Conclusions RIPASA score is highly efficacious and statistically significant in diagnosing acute appendicitis with higher PPV at higher scores and higher NPV with lower scores leading to decreased NAR compared with MA score.

The Role of the Mannheim Peritonitis Index for Predicting Outcomes in Patients With Perforation Peritonitis in a Rural Hospital in India.

Introduction Acute secondary peritonitis due to hollow viscus perforation is a life-threatening surgical condition with significant morbidity and mortality, depending on the severity with outcomes that differ in the Western and developing world. Various scoring systems have been developed to assess the severity and its relation to morbidity and mortality. We conducted this study to evaluate the role of the Mannheim peritonitis index (MPI) in predicting outcomes in perforation peritonitis patients in a rural hospital in India. Materials and methods A prospective study of 50 patients with hollow viscus perforation with secondary peritonitis presented to the emergency department, Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, from 2016 to 2020. Each operated patient was scored according to the MPI to predict mortality. Results The majority of the patients were discharged uneventfully and about 16% (8/50) of the patients expired. The patients with an MPI score of more than 29 had maximum mortality of 62.5%. Mortality was seen in 37.5% of the patients with MPI scores between 21 and 29, whereas no mortality was recorded in patients with an MPI score of 21. Higher mortality was associated with age greater than 50 years (p=0.007), the presence of malignancy (p=0.013), colonic perforation (p=0.014), and fecal contamination (p=0.004). There was no significant correlation with gender (p=0.81), the presence of organ failure (p=1.6), delayed presentation, i.e., preoperative duration >24 hours (p=0.17), and the presence of diffuse peritonitis (p=0.25). Conclusion MPI is a specific, easily reproducible, and less cumbersome scoring method for predicting mortality in patients with hollow viscus perforation (secondary) peritonitis with minimal laboratory investigations. Higher scores correlate with a poorer prognosis and need intensive management, making use of MPI in clinical practice relevant and beneficial, especially in resource-poor settings.

Techniques for Diagnosing Anastomotic Leaks Intraoperatively in Colorectal Surgeries: A Review.

Colorectal cancer is one of the most common surgically curable malignancies worldwide, having a good prognosis even with liver metastasis. This improved patient outcome is marred by anastomotic leaks (AL) in operated patients of colorectal cancer despite a microscopically margin-negative resection (R0). Various risk factors have been attributed to causing this. Preoperative non-modifiable factors are age, male sex, cancer cachexia, and neoadjuvant chemo-radiotherapy, and modifiable factors are comorbidities, peripheral vascular disease, anemia, and malnutrition. Intraoperative risk factors include intraoperative surgical duration, blood loss and transfusions, fluid management, oxygen saturation, surgical technique (stapled, handsewn, or compression devices), and approach (open, laparoscopic, or robotic). Postoperative factors like anemia, infection, fluid management, and blood transfusions also have an effect. With the advent of enhanced recovery after surgery (ERAS) protocols, many modifiable factors can be optimized to reduce the risk. Prevention is better than cure as the morbidity and mortality of AL are very high. There is still a need for an intraoperative technique to detect the viability of anastomotic ends to predict and prevent AL. Prompt diagnosis of an AL is the key. Many surgeons have proposed using methods like air leak tests, intraoperative endoscopy, Doppler ultrasound, and near-infrared fluorescence imaging to decrease the incidence of AL. All these methods can minimize AL, resulting in significant intraoperative alterations to surgical tactics. This narrative review covers the methods of assessing of integrity of anastomosis during the surgery, which can help prevent anastomotic leakage.

Early Diagnosis and Surgical Management of Tropical Chronic Pancreatitis in a Tertiary Care Rural Hospital: A Case Report.

Tropical chronic pancreatitis represents a variant of chronic calcific non-alcoholic pancreatitis, typically found in adolescents and young adults, predominantly in developing nations. This condition usually presents as a classic triad of recurrent and severe abdominal pain, diabetes, and steatorrhea. As the disease progresses and diabetes develops, it is called fibrocalculous pancreatic diabetes. A defining characteristic of this ailment is the presence of pancreatic calculi, leading to duct dilation. Key features of this condition include an early onset in youth, intraductal calculi, an aggressive disease course, and a heightened susceptibility to pancreatic cancer. Diagnostic tools such as ultrasound, CT, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography aid in identifying the disease. Timely diagnosis and treatment significantly reduce mortality and morbidity. Our patient, a young female, presented solely with recurrent episodes of abdominal pain resembling pancreatitis, along with a normal biological profile and an absence of readily apparent symptoms. She received a diagnosis of tropical chronic pancreatitis and underwent the Partington-Rochelle procedure for surgical decompression of the main pancreatic duct.

Endometrial Cyst Presenting as a Vague Abdominal Lump in a Postmenopausal Woman.

A postmenopausal woman presented with a predominantly right-sided abdominal lump, insidious in onset and not associated with any aggravating or relieving factors. Physical examination revealed a soft cystic mass extending from the right hypochondrium to the right iliac fossa region crossing the midline. Ultrasonography of the abdomen and pelvis showed a large cystic anechoic area noted in the abdomen extending from the epigastric region to the pelvis. Contrast-enhanced CT of the abdomen and pelvis showed a large non-enhancing cystic lesion in the pelvis suggesting the possibility of a right ovarian cyst or mesenteric cyst. Laparotomy was performed and the excised specimen was sent for histopathological analysis, which confirmed it to be an endometrial cyst.

Magnitude and gender-specific circumstances of depression among elderly population residing in an Urban slum area of a City in Maharashtra: A mixed-method study.

The burden of geriatric mental health in India is showing a silent epidemic trend, but the knowledge on spectrum of their mental well-being dwelling in slums is very trivial. This mixed-method study aimed to estimate the proportion of depression among elderly and to find out the gender-specific circumstances, leading to depression. A total of 209 subjects selected through multistage sampling from an urban slum in a city of Maharashtra were interviewed for estimating depression, and six focus group discussions (FGDs) were conducted to explore the circumstances. Overall, 42.1% of elderly people had depression with 2.8% severe depression. Major themes highlighted after FGDs were self-esteem, social role, dependence, negative experience, and disgrace among males, and among females, main themes were justifiable reason, managing mood, suppression, undesirable events, and stigma. Depression is a significant public health problem, and a diverse approach is required to understand the perception of elderlies which will highlight the core issues related to depression.

A study to assess the effect of stressful life events on psychological distress levels of participants living in an urban area.

CONTEXT: Stressful life events affect the psychological wellbeing of individuals. Through this study, we aim to understand this effect and various other factors affecting the psychological wellbeing of the study participants. AIMS: To determine the vulnerability of study participants to psychological distress following stressful life events. SETTINGS AND DESIGN: Cross-sectional observational study in an urban setting. METHODS AND MATERIALS: Systematic random sampling with a sample size of 178. STATISTICAL ANALYSIS USED: Analysis is done using SPSS version 22. Tests used are chi square test, Spearman's rank correlation test. RESULTS: The number of life events and psychological distress scores had a positive correlation.The events that occurred in one month before history taking, a correlation was found to be strongest and no correlation was found between the events which occurred more than one year before study enrolment and the psychological distress. Factors like sleeping patterns, exercise, and marital status also had a significant correlation with the psychological distress score of participants. CONCLUSIONS: Mental health is dependent on many parameters with life events being a major factor at a given point of time. However, different factors apart from life events will affect psychological wellbeing, and mental health is an interplay of all those factors.

A cross-sectional study to evaluate teaching skills of postgraduate medical students using component skill approach in microteaching.

BACKGROUND: Microteaching is a teacher training technique where a teachers get a constructive feedback from peer or faculty in order to improve their teaching skills. Microteaching is conducted at the departmental level. By evaluating the components of microteaching, better teaching skills can be developed in postgraduate (PG) students. OBJECTIVES: The objectives of this study were to determine the pattern of teaching skills and to evaluate the components of teaching skills of microteaching in PG students. MATERIALS AND METHODS: It was a retrospective record-based study done over a period of 1 month. Microteaching assessment records of 34 PG students of the department of community medicine were analyzed. RESULTS: Teaching skills including setting induction during the class, lesson planning, presentation, and use of audio-visual aids were found to be satisfactory. Students lacked the skills of interaction and summarization of the topic. CONCLUSION: PG students' performance with many components was satisfactory, but still, there is a scope for improvement. Internalization of microteaching skills can make doctors a better teacher, a better learner, and a better health educator.

Homozygosity mapping guided next generation sequencing to identify the causative genetic variation in inherited retinal degenerative diseases.

Inherited retinal degeneration (IRD) are a group of genetically heterogeneous disease of which retinitis pigmentosa (RP) and Leber congenital amaurosis (LCA) are the most common and severe type. In our study we had taken three unrelated South Indian consanguineous IRD families. Homozygosity mapping was done using Affymetrix 250K Nsp1 GeneChip in each of LCA, Cone-Rod dystrophy (CRD) and autosomal recessive RP (arRP) families followed by targeted re-sequencing by next generation sequencing (NGS) on Illumina MiSeq. Known candidate genes ranging from 1-8 in numbers within the homozygous blocks were identified by homozygosity mapping and targeted NGS revealed the causative mutations; RDH12 c.832A>C, ABCA4 c.1462G>T, CDHR1c.1384_1392delCTCCTGGACinsG, in the LCA, CRD and arRP families, respectively. The identified mutations were validated by Sanger sequencing, segregation in the families and their absence in 200 control chromosomes. Homozygosity mapping guided targeted NGS, especially when more numbers of known candidate genes within the homozygous blocks are observed is a comprehensive method for mutation identification. Molecular data from a larger retinal degenerative disease cohort would reveal the spectrum and prevalence of mutations and genes in Indian population. Molecular diagnosis also aids in genetic counseling, offering carrier and prenatal testing to family members.

Involvement of S. cerevisiae Rpb4 in subset of pathways related to transcription elongation.

Yeast Rpb4, a subunit of RNA pol II is not essential for viability but is involved in multiple cellular phenotypes such as temperature sensitivity, enhanced pseudohyphal morphology, and decreased sporulation. Both in vivo and in vitro studies strongly support involvement of Rpb4 in transcription initiation, while its role in transcription elongation is not entirely consistent. Here we show that Rpb4 is not required for recruitment of RNA pol II on the coding region of YLR454w, a representative long gene. Yet we find strong genetic interaction of rpb4∆ with mutants in many transcription elongation factors such as Paf1, Spt4, Dst1, Elp3 and Rpb9. We demonstrate that, Rpb4 interacts functionally with Paf1 to affect the transcription elongation of the FKS1 gene. Our results suggest that while Rpb4 is not required for general transcription elongation, it could support transcription elongation for specific of class of genes by interaction with other elongation factors.

Evaluating real-time syndromic surveillance signals from ambulatory care data in four states.

OBJECTIVES: We evaluated a real-time ambulatory care-based syndromic surveillance system in four metropolitan areas of the United States. METHODS: Health-care organizations and health departments in California, Massachusetts, Minnesota, and Texas participated during 2007-2008. Syndromes were defined using International Classification of Diseases, Ninth Revision diagnostic codes in electronic medical records. Health-care organizations transmitted daily counts of new episodes of illness by syndrome, date, and patient zip code. A space-time permutation scan statistic was used to detect unusual clustering. Health departments followed up on e-mailed alerts. Distinct sets of related alerts ("signals") were compared with known outbreaks or clusters found using traditional surveillance. RESULTS: The 62 alerts generated corresponded to 17 distinct signals of a potential outbreak. The signals had a median of eight cases (range: 3-106), seven zip code areas (range: 1-88), and seven days (range: 3-14). Two signals resulted from true clusters of varicella; six were plausible but unconfirmed indications of disease clusters, six were considered spurious, and three were not investigated. The median investigation time per signal by health departments was 50 minutes (range: 0-8 hours). Traditional surveillance picked up 124 clusters of illness in the same period, with a median of six ill per cluster (range: 2-75). None was related to syndromic signals. CONCLUSIONS: The system was able to detect two true clusters of illness, but none was of public health interest. Possibly due to limited population coverage, the system did not detect any of 124 known clusters, many of which were small. The number of false alarms was reasonable.

RAM pathway contributes to Rpb4 dependent pseudohyphal differentiation in Saccharomyces cerevisiae.

Rpb4, a subunit of RNA Polymerase II plays an important role in various stress responses in budding yeast, Saccharomyces cerevisiae. In response to nitrogen starvation, diploid yeast undergoes a dimorphic transition to filamentous pseudohyphal growth, which is regulated through cAMP-PKA and MAP kinase pathway. In the present study, we show that disruption of Rpb4 leads to enhanced pseudohyphal growth, which is independent of nutritional status. We observed that the rpb4Delta/rpb4Delta cells exhibit pseudohyphae even in the absence of functional MAP kinase and cAMP-PKA pathways. Genome-wide expression profiling showed that in the absence of Rpb4 several genes controlling mother daughter cell separation are down regulated. Our genetic studies also provide evidence for involvement of RNA Pol II subunit Rpb4 in the expression of genes downstream of the RAM pathway. Finally, we show that this effect on expression of RAM pathway may at least be partially responsible for the pseudohyphal phenotype of rpb4Delta/rpb4Delta cells.

Investigation of Mycobacterium tuberculosis transmission aboard the U.S.S. Ronald Reagan, 2006.

Pulmonary tuberculosis (TB) was diagnosed in a sailor aboard the U.S.S. Ronald Reagan; an investigation was conducted to determine a screening strategy for 1,172 civilian passengers who were aboard during a temporary guest rider program. Sailors were screened for latent TB infection (LTBI) and TB disease. A case-control study was conducted among sailors to determine factors associated with new LTBI. No secondary TB disease was identified; 13% of close contacts had new LTBI. Factors associated with new LTBI among sailors were having been born outside the United States (adjusted odds ratio = 2.80; 95% confidence interval, 1.55--5.07) and being a carrier air wing member (adjusted odds ratio = 2.89; 95% confidence interval, 1.83--4.58). Among 38 civilian passengers berthed near the patient, 1 (3%) had LTBI. The investigation results indicated that Mycobacterium tuberculosis transmission was minimal and eliminated unnecessary TB screening for 1,134 civilians which saved public health resources.