HighlightsPancreatic hydatid cysts are very rare entities with an incidence ranging from 0.14% to 2%.They can masquerade as pseudocyst or cystic neoplasm of pancreas.Ultrasonography, Computed tomography and Hydatid serology help in diagnosis.Pericystectomy, Partial cystectomy with omentopexy/external drainage, Marsupialization, Cysto-enterostomy are some of the surgical options.Prophylactic preoperative and postoperative anti-helminthics(Albendazole) are recommended.

Background As the COVID-19 pandemic completes one year, it is prudent to reflect back upon the challenges faced and the management strategies employed to tackle this overwhelming healthcare crisis. We undertook this study to validate our institutional protocols which were formulated to cater to the change in volume and pattern of neurosurgical cases during the raging pandemic. Methods All admitted patients scheduled to undergo major neurosurgical intervention during the lockdown period (15 March 2020 to 15 September 2020) were included in the study. The data involving surgery outcomes, disease pattern, anaesthesia techniques, patient demographics as well as COVID-19 status was analysed and compared with similar retrospective data of neurosurgical patients operated during the same time period in the previous year (15 March 2019 to 15 September 2019). Results Barring significant increase in surgery for stroke (P = 0.008) and hydrocephalus (P <0.001), the overall case load of neurosurgery during the study period in 2020 was 42.75% of that in 2019 (P <0.001); and the same was attributable to a significant reduction in elective spine surgeries (P < 0.001). However no significant difference was observed in the overall incidence of emergency and essential surgeries undertaken during the two time periods (P = 0.482). There was an increased incidence in the use of monitored anaesthesia care (MAC) techniques during emergency and essential neurosurgical procedures by the anaesthesia team in 2020 (P < 0.001). COVID-19 patients had overall poor outcomes (P = 0.003), with significant increase in mortality amongst those subjected to general anaesthesia vis-a-vis MAC (p = 0.014). Conclusions Despite a significant decrease in neurosurgical workload during the COVID-19 lockdown period in 2020, the volume of emergency and essential surgeries did not change much compared to the previous year. Surgery in COVID-19 patients is best avoided, unless critical, as the outcome in these patients is not favourable. The employment of monitored anaesthesia care techniques like awake craniotomy, and regional anaesthesia; facilitate a better outcome in the COVID-19 era.

AbstractThe coronavirus disease 2019 (COVID-19) is a major health emergency in today’s time. In December 2019, a cluster of pneumonia cases in Wuhan, China was attributed to a novel coronavirus. The World Health Organization declared it as a pandemic. As the majority of the cases suffering from COVID-19 are mildly symptomatic or asymptomatic, it becomes a great challenge to identify the infected persons in the absence of extensive testing. In the hospital environment, it can infect several other vulnerable patients and healthcare providers, significantly impacting the hospital services. Anesthesiologists are at an increased risk of COVID-19 transmission from the patients, as they are frequently involved in several aerosol-generating procedures. It is not possible to identify asymptomatic COVID-19 patients solely based on history-taking during their first point of contact with the anesthesiologists at the preanesthetic checkup clinic.Most of the neurosurgical conditions are of urgent in nature and cannot be postponed for a longer duration. In view of this, the position statement and practice advisory from the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) provides guidance to the practice of neuroanesthesia in the present scenario. The advisory has been prepared considering the current disease status of the COVID-19 pandemic, available literature, and consensus from experts in the field of neuroanesthesiology. Since the pandemic is still progressing and the nature of the disease is dynamic, readers are advised to constantly look for updated literature from ISNACC and other neurology and neurosurgical societies.

HighlightsSurgical diagnosis of conditions causing acute abdominal pain in situs inversus is complicated by the mirror image anatomy.Chest X-ray and Ultrasonography abdomen can be helpful in diagnosing this condition.Laparoscopic cholecystectomy in situs inversus is problematic for right handed surgeons.We describe a modified 4 port configuration where right handed surgeons can use the left mid-clavicular port for dissection.

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) has rapidly spread across the world including India. Management of patients complicated with neurological illness requiring neurocritical care is challenging during this time. Patients with neurological disease may develop COVID-19 infection or there could be independent neurological manifestations of COVID-19. Critically ill neurological patients are more vulnerable to contracting SARS-CoV-2 infection. Also, neurological patients with comorbidities and multisystem involvement are at increased risk of adverse outcomes. Though SARS-CoV-2 predominantly affects the pulmonary system, it can complicate the assessment and management of neurological patients. With increasing COVID-19 numbers, the hospitalizations of both non-COVID and COVID-19 neurological patients will bring significant strain on the hospital and neurocritical care facilities. Streamlining work pattern, understanding the pathophysiology of COVID-19 and its impact on neurological function, establishing general and specific neurocritical care management strategies, ensuring protection and well-being of health care providers, and implementing effective infection control policies are key elements of efficient neurocritical care management during this pandemic. This joint position statement and advisory on the practice of neurocritical care during the COVID-19 pandemic by the Neurocritical Care Society of India and the Indian Society of Neuroanaesthesiology and Critical Care has been developed to guide clinicians providing care to the critically ill neurological patients in the neurocritical care unit during the current pandemic. As the situation from this novel disease is rapidly evolving, readers must constantly update themselves with newly emerging evidence to provide the best possible care to the critically ill neurological patients.