Bilateral abductor vocal cord paralysis is a distressing condition, often life threatening, most commonly results from iatrogenic trauma to the recurrent laryngeal nerve during surgical procedures in the anterior neck. Patients may require tracheostomy because of acute or gradual onset of dyspnoea and airway compromise. A-32 years-old male presented with stridor without dysphonia. Indirect laryngoscopy revealed paramedian position of bilateral true vocal cord. No etiology could be identified for abductor palsy of bilateral vocal cords. Patient symptomatically improved with medical management and was planned for tracheostomy followed by vocal cord lateralization procedures.

Portal hypertension during pregnancy, often associated with cirrhotic liver disease, presents unique challenges when attributed to non-cirrhotic causes. We present a case of a 26-year-old pregnant woman with non-cirrhotic portal hypertension, whose history included grade 3 varices managed with band ligation. Throughout her pregnancy, careful multidisciplinary management was employed, with monthly antenatal care, liver function tests, and surveillance. At 37 weeks and 6 days, she delivered a healthy infant via vacuum assistance, and postpartum, meticulous management included the avoidance of methergine and provision of blood products. This case highlights the importance of tailored care, collaboration between obstetricians, hepatologists, and hematologists, and the need for further research in this rare area to optimize maternal and fetal outcomes in non-cirrhotic portal hypertension during pregnancy.

Introduction: Degloving trauma is a skin disorder slightly to wide with variations in traumainduced tissue depth characterized by damage to the structure that connects the skin to the underlying tissue. Degloving trauma is also related to soft tissue surface, bone, nerve, or vascular. Degloving trauma mostly happens in extremity regions. The causes of degloving trauma are mechanical trauma and also blunt trauma. An open degloving trauma case should immediately be closed to reduce the risk of infection. A Case Report: A 36-year-old male patient came to the hospital with an accident. The chief complaints were the fingers of the patient's right hand was peeled off due to accidentally got into the grinding machine since 2 hours earlier. Hand removed from the grinding machine but the skin of the right fingers 3-4 lost. Discussion: Degloving injury signifies the release of the skin and subcutaneous tissue of the fascia and muscle beneath it. Open degloving is the most common type and requires immediate closure of the degloving area to reduce the risk of infection. The managements of the degloving patient should include adequate preparation of wound bed with bandages that minimize infection and stimulate granulation of the tissue, maintain good systemic conditions by providing adequate nutrition, pay attention to albumin and electrolyte levels, prevent SIRS and sepsis. The main and best choice of surgery in case of degloving injury is by replantation and revascularization. If replantation or revascularization is not possible, sometimes it may be by using degloved skin as full thickness graft or thick split skin graft. In addition, postoperative education and subsequent rehabilitation is essential to restore the functions as well as minimize disability. Conclusion: We report a 36 years old male with diagnosed as 3-4 right finger skin loss post open degloving with paired abdominal flap. The management taken to this patient is a paired abdominal flap that aims to restore the skin structure. The important thing should be noted while undergoing the procedure are the neurovascular conditions of the skin and tissue vitality. In addition, education regarding procedures, benefits and risks and further management is very important to be done so that patients can be cooperative.

Background: Recurrent Sore Throat (RST) is a prevalent yet often overlooked health issue with multifaceted implications. Its understanding and awareness within specific regional contexts, such as District Moga, Punjab, remain understudied. This research seeks to assess the knowledge and awareness of RST among the local population, aiming to bridge knowledge gaps and inform public health initiatives. Materials and Methods: A cross-sectional survey was conducted in District Moga, Punjab, from March to May 2023. The study included 400 adults aged 18 and above who had been residents for at least 12 months. A structured questionnaire, encompassing socio-demographic data and 20 knowledge-related questions on RST, was administered. Data were analyzed using Epi Info V7 software. Results: The study revealed varying levels of knowledge regarding RST among participants. Approximately 30.25% demonstrated "very good" knowledge, 39% "good" knowledge, 19% "fair" knowledge, and 11.75% "poor" knowledge. Urban areas exhibited higher awareness than rural areas. Notably, participants recognized the role of lifestyle and dietary habits in RST prevention, and over 50% understood the importance of seeking medical attention for RST. Conclusion: This study underscores the need for targeted health education campaigns to enhance public understanding of RST, particularly in rural areas. The relatively higher awareness levels in District Moga offer promise for tailored public health interventions. Addressing knowledge disparities and promoting preventive practices can contribute to improved RST management and overall community well-being.

Background: Along with the growth rate of world population, the elderly population in general is expected to continue growing. With increasing age, there is a tendency of decreasing functional capacity both at the cellular and organ level in line with the aging process, one of which is the musculoskeletal system. As the elderly reach their sixth decade of life, there is a progressive decrease in their bone mineral density, muscle mass and strength, which predispose them to the risk of osteoporosis, sarcopenia, and combined condition named osteosarcopenia. Case illustration: A 78-year-old woman presented with current episode of pain in her left leg, with history of frequent falls in the last six years. After a series of examinations, patient was diagnosed with osteosarcopenia. Patient was then managed with nutritional therapy and vitamin D supplementation. Conclusion: Osteosarcopenia is a new geriatric syndrome with serious consequences in elderly. This report was presented to raise awareness of the diagnosis when faced with similar conditions. Early detection and diagnosis are crucial to provide prompt and better management, as demonstrated in this case.

Seckel syndrome, a rare genetic disorder known for its striking craniofacial and skeletal abnormalities, is characterized by severe intrauterine growth restriction (IUGR). We present a case of Seckel syndrome in a neonate born to non-consanguineous parents, emphasizing the clinical manifestations, genetic complexity, and challenges associated with this condition. The neonate exhibited classic features, including a "bird-like" head, slanting forehead, microcephaly, large eyes, beaked nose, low-set ears, high-arched palate, clinodactyly of the fifth fingers, medial deviation of toes, and bilateral cryptorchidism. This case highlights the importance of early diagnosis and genetic counseling for affected families, showcasing the clinical utility of recognizing Seckel syndrome in neonates with growth restriction and craniofacial anomalies. Further genetic research is warranted to unravel the underlying mechanisms and potential therapeutic avenues for this rare syndrome, offering hope for improved medical care and support services for affected individuals and their families.

Background: Preoperative preparation for anesthesia is a critical aspect of surgical care, impacting patient safety and outcomes. Adequate knowledge among the general population is essential to empower individuals in their healthcare decisions. This study assesses the levels of awareness and knowledge about preoperative preparation for anesthesia in District Shimla, Himachal Pradesh. Materials and Methods: A cross-sectional survey was conducted in District Shimla from April to June 2023. The study included 400 adults residing in urban (62.25%) and rural (37.75%) areas. A structured questionnaire was used to collect data on demographics and knowledge regarding preoperative preparation for anesthesia. Data analysis involved frequency and percentage calculations. Results: The study revealed varying levels of knowledge among participants. While 75.75% understood the purpose of anesthesia, only 25.25% could name the primary types. Approximately 67% recognized the role of the anesthesiologist, but only 53.75% correctly answered questions about fasting before surgery. Knowledge gaps were evident in areas such as informed consent (47.25%) and disclosing medical history (41.25%). However, 58.5% could describe the importance of preoperative evaluation. Overall, 22.25% had very good knowledge, 31% good knowledge, 24.25% fair knowledge, and 22.5% poor knowledge. Conclusion: This study highlights the need for targeted public education initiatives to enhance awareness and knowledge about preoperative preparation for anesthesia in District Shimla, Himachal Pradesh. Addressing these knowledge gaps can contribute to improved surgical outcomes and patient engagement in healthcare decisions.

Vision is a vital sense impacting daily life, and awareness of common eye conditions is crucial for maintaining eye health. This study assessed the knowledge and awareness of myopia, hyperopia, astigmatism, and presbyopia among the general population in District Kangra, Himachal Pradesh, India. Methods: A cross-sectional survey collected data from 400 adults using a structured questionnaire. The study evaluated demographic information, knowledge of common eye conditions, and related factors. Data analysis was performed using Epi Info V7. Results: The study found varying levels of knowledge among participants. While many recognized myopia (50.75%) and presbyopia (47.25%), understanding of hyperopia (46.5%) and astigmatism (43.25%) was lower. Notably, 71.75% understood the risks of neglecting these conditions, and 68.5% were aware of lifestyle factors contributing to them. Approximately 58.5% believed eyeglasses or contact lenses could correct these conditions. However, only 34.5% had undergone an eye examination, and 32.25% knew the recommended frequency for check-ups. Importantly, 51.25% expressed ideas to improve community awareness. Conclusion: While there is moderate knowledge about common eye conditions in District Kangra, opportunities for enhancing awareness, especially concerning hyperopia and astigmatism, exist. Promoting eye health education and increasing access to eye care services can improve visual health outcomes in the community. Early detection and intervention are essential to preserving vision.

Introduction: Paederus dermatitis (PD), is an irritant contact dermatitis, which is common throughout the world but more so in hot humid tropical and subtropical places. It is caused by Paederus or rove beetles, after it is crushed accidentally a vesicant substance paederin is released. Case report: A 32-year-old male presented in the Skin OPD. He had two well-defined erythematous plaques with a central cyanotic hue, and vehicle on his right elbow crease on the flexor aspect (Figure 1). The patient had an associated burning sensation at the site of the lesion. Treatment and resolution The diagnosis was made as Paederus dermatitis and the patient was treated with topical mometasone and fusidic acid. On follow up the lesion healed without any residual pigmentation.

Caffey's disease is a rare and self-limiting condition characterized by bone inflammation and hyperostosis. We present a case of Caffey's disease in an infant, emphasizing the radiological findings that contributed to the diagnosis and subsequent management.

Background: Physical activity and yoga play pivotal roles in promoting holistic health and well-being. This study assesses the levels of awareness and knowledge about physical activity and yoga among the residents of District Shimla, Himachal Pradesh, exploring their potential impact on community well-being. Methods: A cross-sectional survey was conducted between April and June 2023 among 400 adults residing in District Shimla for at least 12 months. A structured questionnaire assessed knowledge related to physical activity and yoga. Data were analyzed using Epi Info V7 Software, and ethical considerations were maintained. Results: The study revealed commendable awareness of physical activity's importance (79.5%), although only 47.25% were aware of recommended weekly activity guidelines. Approximately 66.75% practiced or knew of yoga's benefits, but awareness of different yoga styles (45.5%) and specific poses (33.75%) was lower. Notably, 82% believed schools should include physical activity and yoga in their curriculum, and 71.25% provided suggestions for increasing awareness. Conclusion: While foundational awareness exists, opportunities exist to enhance knowledge, particularly regarding guidelines, diverse yoga styles, and practical aspects. These findings inform targeted public health campaigns and educational initiatives aimed at nurturing a culture of mindful movement and improving overall well-being in Himachal Pradesh.

Small Cell Carcinoma of Vagina is a rare and a aggressive tumour. It comprises only 1-2% of all gynaecological malignancies .This case report presents a detailed analysis of a 48 year old woman P3L3 with complaint of persistent vaginal discharge for 3 months and a whitish lesion of around 2*2cm size noted in posterior fornix of vagina which bleeds on touch. The patient underwent a series of investigations and a vaginal biopsy which confirmed it to be a small cell carcinoma of vagina. The patient was further evaluated and all the tumour markers namely Synaptophysin, Chromgranin A and Ki67(70-80%)all markers were positive. The patient is Stage 2 Vaginal Cancer and was started on Concurrent EBRT with Etoposide and Cisplatin and currently ongoing CTRT. The case report discusses Diagnostic challenges and Management approaches and timely reporting of such cases as only 44 cases have been reported in entire world of Primary Small Cell Carcinoma of Vagina and still there is ongoing research with the treatment options available.

Peripheral artery disease (PAD) is a commonly prevalent but underdiagnosed manifestation of atherosclerosis. There is insufficient awareness of its clinical manifestations, including critical limb ischemia and intermittent claudication. It also leads to risk of adverse cardiovascular and limb outcomes. Peripheral artery disease has a huge economic and social burden and is an important contributor to the global health burden. This case report demonstrates a case of peripheral vascular disease in a 57 years old male with history of being a chronic smoker. Patient presented with complaints of fatigue and heaviness in his lower thighs and calves during walking. A CT Angiogram was conducted which showed significant stenosis of both left and right common iliac arteries, as well as stenosis of the distal aorta. Peripheral arterial disease presentation depends on various genetic and environmental factors and it can lead to great reduction in the quality of living.

Background: Dyspnoea is the common manifestation of Pulmonary hypertension (PH). Pulmonary alveolar microlithiasis is one of the rare causes of PH with a handful of case reports in the literature.  Case Presentation: A 59 years old male presented with complaints of progressive dyspnoea of 06 months and dry cough of 01-month duration. He had clinically he had tachypnoea, tachycardia, hypoxia and Grade III clubbing and bilateral crackles in both lower lung fields. Evaluation he had Sandpaper like calcifications and black pleura sign on imaging suggestive of PH due to pulmonary alveolar microlithiasis and restrictive pattern on spirometry for which he was managed conservatively to which he had symptomatic relief. He is on follow up and planned for investigational therapy in case of deterioration of lung functions.  Conclusion: Pulmonary alveolar microlithiasis is a rare genetic disorder leading to pulmonary hypertension. Our case is peculiar as it presented late in the 6th decade of life with usual clinical features. He is under closed follow up for deterioration and starting investigational therapy.

Acute coronary syndrome is rarely presented in a young healthy male with no precious cardiac risk factor, factor V leiden mutation is known cause of venous thrombosis and rarely arterial. In this case we present a young male who presented with STEMi and was later found to have factor V leiden mutation as the underlying cause. Later, we discuss the management approach in such patients with tirofiban and lack of need off stent placement.

Peripheral Primitive Neuroectodermal Tumours (pPNETs) are rare, aggressive neoplasms derived from neural crest cells. They commonly originate in the central nervous system but can also occur peripherally in various locations. We present a case report of a unique pPNET located in the sino nasal area and orbit, highlighting the diagnostic challenges encountered and the multidisciplinary approach taken for successful management. This case demonstrates the complex nature of pPNETs and emphasizes the importance of a comprehensive evaluation, accurate diagnosis, and prompt intervention to optimize patient outcomes.