Background: The advent and progress of endoscopic retrograde cholangiopancreatography (ERCP) for hepato-pancreaticobiliary diseases have introduced a paradigm shift in their treatment but have also been associated with complications that have been difficult to manage. We examined the outcome of patients who had duodenal perforations from periampullary endoscopic procedures who needed surgical intervention. Aim: To study the outcomes in patients who underwent surgical intervention for ERCP associated duodenal perforation. Materials and Methods: Between January 2001 and November 2021, we retrieved the details of 20 patients who had been operated on for duodenal perforations following ERCP from a prospectively maintained database. Results: There were nine males and 11 females whose mean age was 51.3 (range 29–81) years. The most common indication for the endoscopic procedure was choledocholithiasis in 16, followed by biliary stricture in 3 and malignancy in 1. The median duration between the diagnosis of perforation and surgery was 8.3 days (range 0–48). The mean hospital stay was 21.5 (range 5–60) days. Four (20%) patients underwent re-exploration. Seven (35%) patients died, in all of whom the diagnosis had been missed at the time of the procedure (P = 0.015). Eighty per cent of mortality occurred in patients with a Boey score of three. Conclusion: ERCP-related duodenal perforations though uncommon, are dreaded complications and do not have universally accepted standard management. Patients with delayed diagnosis of duodenal perforation and higher Boey scores have higher mortality rates.

Background: Human immunodeficiency virus (HIV) infects cells of the immune system, leading to a compromised and depleted immune system. Progressive failure of the immune system predisposes an individual to many life-threatening opportunistic infections and malignancies. As compared to the general population, the incidence of anal squamous cell carcinoma (ASCC) is substantially higher in HIV-infected individuals. Majority of ASCC are related to infections caused by high-risk strains of human papillomavirus (HPV). Aims: We conducted an observational study on HIV-positive men who had a history of homosexual contact. The aim of this study was to assess the spectrum of cytological abnormalities on anal smear cytology in individuals with HIV infection, and also estimate the prevalence of anal infection with high-risk HPV strains. Materials and Methods: We enrolled 56 individuals for this pilot study. This study involved the collection of specimens from the anal canal of the patients by using cytobrush in liquid-based cytology (LBC) vial. The sample was simultaneously tested for cytological abnormalities by LBC (Sure Path, BD) and for 13 high-risk strains by Hybrid Capture II technique (Qiagen) based on antibody capture and chemiluminescent signal detection. Anal smear cytology was reported as per guidelines of The Bethesda System of reporting anal cytology, 2014. Results: The prevalence of high-risk HPV infection was seen in 41.07% of individuals and low-grade squamous intraepithelial lesion and atypical squamous cells of undetermined significance were seen in 12.5% and 16.07% individuals, respectively. Cytology was useful in 7% of cases to diagnose opportunistic infections. The latter is a field yet to be tapped. Conclusion: We would recommend LBC in HIV-positive patients, for screening of cytological abnormalities and HPV status. This would also give an opportunity to screen for opportunistic infections, which have otherwise not been diagnosed.

Aim: Lamotrigine is a broad-spectrum anticonvulsant drug widely used as mono- or adjunct therapy in adults and children. The aim of this study was to develop a liquid formulation of lamotrigine to fulfil the unmet needs of children and geriatric epileptic patients. Materials and Methods: Suspension formulation was prepared using Carbopol 974P as a suspending agent. It was evaluated for its sedimentation and re-dispersibility, solubility, morphology, particle-size distribution, rheological properties, pH measurement, uniformity of dosage unit, in vitro drug release behaviour and results were compared with marketed formulation Lamictal tablets. Results: The release profile of marketed product Lamictal tablets and developed lamotrigine oral suspension shows a complete release profile throughout physiological pH in all three media (0.1N hydrochloric acid, 4.5 pH acetate buffer and 6.8 pH phosphate buffer) and shows similar release as a marketed product. Microscopic observation clearly indicates the stability of the suspension (no aggregation of suspended particles) during the storage period of 12 months. The content uniformity of suspension was found well within the specified limits. Conclusion: Lamotrigine oral suspension was developed successfully and found a suitable alternative for a commercially available tablet for the treatment of epilepsy in children and geriatric patients.

Background: The Roux-en-Y hepaticojejunostomy (RYHJ) is the commonly done drainage procedure for strictures which occasionally follow operations on the gallbladder and bile ducts. However, 8%–40% of these anastomoses become narrowed again and the redo operation is technically challenging. There are only a few reports which have examined the results of these revision procedures and we therefore decided to analyse our experience of this unusual operation. Aim: To study the role of redo-hepaticojejunostomy in the management of bilio-enteric anastomotic strictures. Materials and Methods: Between January 2010 and January 2016, we performed 23 redo-hepaticojejunostomies for the strictures following an initial hepaticojejunostomy which was done for benign indications in our department and followed them for a minimum of 2 years with clinical, biochemical and radiological tests. Results: There were 7 males and 16 were females who had a median age of 37 years (range 15–63 years). The median interval between the index operation and the stricture recurrence was 10 months. Thirteen (57%) patients underwent initial surgical revision and 10 had the procedure following unsuccessful percutaneous intervention. The median length of hospital stay was 10 days and 21 (91%) only had minor complications. There was no operative mortality. On follow-up of all 23 patients after 2–8 years, six (26%) patients developed stricture recurrence, of whom three were managed with percutaneous dilatation and three required a second revisional surgery. Seventeen patients are symptom-free. Conclusion: Redo RYHJ is a feasible option for strictures following an initial biliary enteric anastomosis with no surgical mortality and three-quarters of the patients being rendered symptom-free.

Osteogenesis imperfecta (OI) is a rare congenital condition, marked by fragile bones, skeletal deformities and additional extra-skeletal symptoms. Depending upon the degree of seriousness, affected people can either carry on with a mostly unrestricted, independent life, or their mobility is severely affected, making them dependent on others for support. Despite that, there is no effect on intellectual capacities. The medical and surgical treatments of OI are directed towards improving the patient's quality of life, mobility and functional independence. Because of the close biochemical relationship that exists between collagen and dentine, the teeth are affected in certain patients, leading to dentinogenesis imperfecta (DI) which is described by the appearance of opalescent teeth. To enable preventive intervention and effective dental treatment, it is essential that the correct diagnosis of DI is done at an early stage.

The population of the United States, as well as developing countries like India, is rapidly ageing. Surgical operations are more common in the elderly than in younger age groups. A comprehensive pre-operative evaluation of these elderly patients is an important component of improving perioperative outcomes. It is very different from the pre-operative assessment in younger patients, which usually encompasses evaluating cardiac risk for non-cardiac surgery and single end-organ functional assessment. Functional and cognitive impairment are additional risk factors associated with poorer outcomes in older patients. Guidelines for pre-operative assessment of elderly surgical patients have been developed by the American College of Surgeons and the American Geriatrics Society.

Necrotising pneumonia (NP) is an uncommon condition in children when compared with the adult age group and is even more reported in the new-borns. The first published data on NP in children date back to 1994, but still there is a paucity of data when it comes to the new-borns. Pathologically, it is characterised by inflammation of the pulmonary tissue with consolidation and peripheral necrosis, thereby leading to local destruction of lung tissue and development of multiple small lung cavities. Bronchopleural fistula (BPF) is a rare complication of NP seen in new-born. In this case report, we discuss a case of new-born with severe NP complicated by BPF.

Cold agglutinin disease, commonly affecting females in the their seventh decade of life, is otherwise a rare entity and has an incidence of one case per million people per year. Cold reactive antibody is associated with autoimmune haemolytic anaemia (AIHA) in approximately 20% of the cases. Although the occurrence of AIHA in patients with non-Hodgkin's lymphomas is well known, aggressive lymphomas such as diffuse large B cell lymphoma (DLBCL) initially presenting as cold agglutinin AIHA is extremely rare. Here, we describe a case of DLBCL presenting few months before the diagnosis as cold antibody-AIHA.xs