An epiphrenic oesophageal diverticulum is most commonly a pulsion diverticulum which develops consequent to protrusion of mucosa through the muscular wall of the distal oesophagus. Most of them are associated with underlying oesophageal motility disorders. The predominant symptoms are dysphagia with regurgitation, and sometimes retrosternal pain, if accompanied by spasm of the oesophagus. Surgical management is recommended for symptomatic patients. Traditional procedures include thoracotomy or laparotomy with excision of the diverticula, but these are associated with high morbidity. Laparoscopic approach is a safe treatment option associated with lesser morbidity. Here, we present a case of epiphrenic diverticulum which was treated by the robotic approach without any complication. There was also no associated motility abnormality in our case so fundoplication was not done. Robotic surgery is a useful tool while operating near the hiatus and gastro-oesophageal junction. We consider transhiatal robotic approach as a safe and easy approach for surgery of epiphrenic diverticulum.

HIV infection is a worldwide phenomenon with serious public health implications. UNAIDS data 2017 stated that 36.7 million people are living with HIV infection and approximately one million death are caused due to AIDS-related illness in the year 2016. [1] Although the prevalence of HIV infection in India is less compared to other countries, currently 21.7 lakhs people carry HIV infection in India. [2] Diarrhea is a leading cause of substantial morbidity and mortality in persons infected with HIV, occurring at sometime during their illness in up to 60% of patients in industrialized nations and in up to 90% of patients in developing countries. [3] Diarrhea in these patients may occur due to various etiologies; among them, infection is been an important cause. The common organisms implicated are Cryptosporidium parvum, Isospora belli, Microsporidia species, Entamoeba histolytica, Cyclospora cayetanensis, Giardia species, Strongyloides stercoralis, Ascaris species, and Ancylostoma species. [4] Literature has shown that patients with CD4 counts <200 cells/mm 3 are 6 times more likely to develop opportunistic infections (OIs) compared to those with CD4 counts >350 cells/mm 3 . [5] There have been reports on frequency of various pathogens causing diarrhea from different parts of India. However, there appears to be a paucity of data on the correlation of CD4+ T-cell counts and the etiology of diarrhea among the HIV patients. Thus, this study was conducted to isolate and identify the opportunistic enteric parasites affecting the HIV patients and to correlate with CD4+ T-cell counts in HIV-infected patients.

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The incidence of bilateral gleno-humeral joint dislocation is rare, is almost always posterior and is usually caused by sports injuries, epileptic seizures, electrical shock, or electroconvulsive therapy. Bilateral fracture-dislocation is even rarer, with a few cases reported in the literature. We report an unusual case with dislocation of the both glenohumeral joints in opposite direction after a seizure episode, with fracture of greater tuberosity on one side and of the lesser tuberosity on the contralateral side. Although there have been a few reports of bilateral asymmetric fracture dislocations of the shoulder in the past, an injury pattern resembling our case has, to the best of our knowledge, not been described in the literature so far. This report includes a detailed discussion regarding the mechanism of injury in a case of asymmetrical dislocation following a seizure episode. At final follow-up, the patient had healed fractures, painless near normal range of motion with no redislocations.

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