Limberg's flap procedure appears to be superior to Karydakis' procedure, and the results are reproducible even by budding surgeons with little experience in the procedure.

Background: Trauma represents a major challenge worldwide and is the leading cause of morbidity and mortality in young population. There is significant change in trauma related injuries due to urbanization, motorization, industrialization and the socioeconomic changes in India. Road traffic accidents (RTA) pose the largest threat to human lives and have become the number one public hazard all across the world causing morbidity and mortality. The aim of this study is to find out the demographics and to determine the injury pattern of surgical trauma cases presenting to this tertiary care zonal hospital.Methods: A prospective observational study was conducted in a tertiary care zonal hospital from June 2018 to December 2018. Data was collected for 105 patients presented with trauma in surgical emergency centre of this hospital were included in the study which excluded only orthopaedic trauma cases. The data collected was analysed.Results: Out of 105, 76 (72.38%) were male and 29 (27.61%) were female with 21 (20%) in the 31-40 age group. The average age of cases was 40.2 years.  RTA was the major cause of trauma i.e. (77.14%) followed by accidental fall and slips (18.09%) and assaults (4.76%). Contusion was the common injury sustained (45.71%) followed by laceration (38.09%), abrasion (35.23%) and fracture (17.14%).Conclusions: There is a need for trauma registries which can help to formulate strategies towards decreasing the burden of trauma and improved outcomes at hospital as well as in public health.

Near Infra Red Spectroscopy (NIRS) is a good screening tool for prediction of intra cerebral haemorrhage in the field and even intensive care units. This was the first study of its kind in the Indian subcontinent and the results suggest that NIRS is a good device to predict intracranial subdural and epidural haematomas. It is however not superior to computer tomography and magnetic resonance imaging.

Background: Karl Landsteiner discovered the ABO blood group system in 1901 and Rh factor in 1940, since then, scientists searched for an association between different pathologies and the ABO blood group system of patients. ABO blood groups have been shown to be associated not only with various diseases but also with metabolic process. Objective: This study was done to determine if there is any significant correlation between ABO-Rh and cholelithiasis. Materials and Methods: This is hospital-based prospective observational study in which 360 patients with ultrasonography proven symptomatic cholelithiasis, belonging to different socioeconomic conditions and various geographical locations of India, underwent laparoscopic cholecystectomy formed the study population. The ABO Rh of the 360 patients was done by standard agglutination technique in blood bank of department of pathology. For statistical analysis data were enter into the MS Excel sheet. Results: Cholelithiasis was predominant in females (85%) than males. Age group of 51–60 years has the maximum number of patients. Blood group “O” has maximum number of cholelithiasis patients (69.6%) followed blood group “B” (37.2%). Among blood group “O” Rh positive had numerous stone of cholesterol type, followed by blood group “B” Rh positive. Conclusion: In this study, incidence of cholelithiasis was maximum in the blood group “O” Rh positive with the cholesterol stones as the predominant type of stone. These results has not corroborated with the existing literature, suggesting variability. A large prospective study could potentially reveal if any correlation exists and this could open the doorway to future research on the etiologies of gall stone diseases.

Dear Editor,We appreciate the recent letter to the editor by Wysocki A in response to our article. We are grateful and acknowledge the typographical error on the year of Hodges' article in the main text.We need to focus on a broader perspective on certain issues raised. There is no best surgical procedure for all. We do not claim to have irrefutably established the superiority of off-midline closure. Various studies have done this, and our study has not addressed the issue of midline vs off-midline closure at all. Our data, however, indicate that Karydakis' procedure has a much steeper learning curve. The images depicted in our article are of the Dufourmentel flap. The rhomboid flaps chosen by the surgical residents ranged from a classical Limberg to Dufourmentel to various modifications of them. Limberg AA described the mathematics of his flap in 1946 [1] paving the way for its numerous modifications, and hence, we have generically labelled our flaps ''Limberg'' in his honour instead of obfuscating the issue for surgical residents. As is said, coming close to a tree, one loses sight of the forest. Our focus was on teaching the residents the principles of flaps and their correct execution rather than deliberating on differences.