Objective: To evaluate the differences in the presentation, their operative implications and difficulties of single stone versus multiple gall stone disease.Methods: This is a prospective study of a minimum of 60 patients with gall stone disease (Group 1-single, Group 2-multiple) from January 2019 to December 2019 in KGH, Visakhapatnam.Results: More common in females, 40-50 years symptoms and complications, TC count difficult cholecystectomies were more in multiple gall stone pts.Conclusion: Multiple gall stones have led to more severe symptoms and complications and difficult surgery. should be motivated for early surgery even in incidental finding and should not opt for conservative management.

<p><strong>Background:</strong> Abnormal serum vitamin D3 levels have been implicated as risk factors for development of various skin disorders. Hence this study was planned to assess the prevalence of vitamin D3 deficiency among patients with <em>Tinea corporis</em> who were attending outpatient department of dermatology in a tertiary care centre.</p><p><strong>Methods: </strong>The cross sectional study was conducted by the department of dermatology, venereology and leprosy, at Sri Muthukumaran Medical College Hospital and Research Institute, among the patients attending the outpatient department, during the month of June to August 2019. A total of fifty cases with extensive <em>Tinea corporis</em> infection were included in the study. The study was conducted using a proforma with the detailed clinical history and also patients underwent skin scrapping for KOH mount and serum vitamin D3 analysis. Data was entered in Microsoft excel and data analysis was done using Statistical Package for Social Sciences (SPSS) version 17.</p><p><strong>Results: </strong>Among the cases with extensive <em>Tinea corporis</em> infection, only 20% of cases were found to have normal levels of serum vitamin D3 whereas 48.3% of cases were found to have serum vitamin D3 insufficiency and 31.7% of cases had deficiency of serum vitamin D3</p><p><strong>Conclusions: </strong>Screening for vitamin D3 deficiency for all cases with extensive <em>Tinea corporis</em> infection can be recommended. Further large scale clinical trials are needed to assess whether vitamin D3 deficiency has any role to play in pathogenesis and treatment of extensive <em>Tinea corporis</em> infection.</p>

Epiphrenic diverticula (ED) is a rare disorder which can be associated with significant surgical morbidity. Presence of an esophageal motility disorder, often achalasia, is classically associated with ED with some arguing that symptoms are primarily attributed to the motility disorder rather than the diverticula itself. The role of peroral endoscopic myotomy (POEM) is expanding for palliation of achalasia. The objective of our study is to investigate the outcomes of POEM in patients with epiphrenic diverticula. Methods A retrospective analysis of a prospectively maintained database was conducted in a tertiary care institution between April 2014 and July 2019. A total of 217 patients receiving a POEM during the study time period were identified with 13 patients having ED. Video recordings of POEM with and without ED were compared for technical differences. Patient demographics, prior esophageal procedures and epiphrenic diverticula characteristics were collected. Primary outcome was post-operative Eckardt scores. We also explored integrated resting pressure (IRP) on manometry, barium column height and width, complications and patient reported outcomes. Standard statistical methods were applied using R. Results Among 13 patients with ED (median age 74.2, 69% male), 7 small and 6 large diverticula were identified. No post-operative complications were noted. The median Eckardt score significantly decreased from 8 [IQR 5–9] pre POEM to 0 [IQR 0–2] post POEM, with similar improvements in median IRPs (24.5 mmHg [IQR 16.9–31.3] vs. 4.3 mmHg [IQR 2.4–7.6], 1 min barium column height (9.2 cm [IQR 6.3–17.9] vs. 3.2 cm [IQR 0–7.1] and 1 min barium column width (3.3 cm [IQR 2.7–3.5] vs. 0.75 cm [IQR 0–3.7]. Post-operative pH studies were conducted in 7 (53.8%) patients demonstrating a DeMeester score of more than 14.72 in 5 (71.4%) patients. Conclusion We demonstrate that POEM is technically feasible, safe and associated with excellent outcomes in patients with small and large diverticula. In our study cohort no further surgical therapy was required to address the diverticula. Reflux was managed medically. Considering its low morbidity profile POEM should be considered for therapy in selected patients with epiphrenic diverticula.

<p class="abstract"><strong>Background:</strong> Skin diseases among the pediatric age group people are more common and it contributes to significant burden to health sectors. Also, the pattern of skin diseases changes consistently with reference to place and time. Hence the present study was conducted to assess the pattern of skin diseases in pediatric age group patients attending a tertiary care hospital.</p><p class="abstract"><strong>Methods:</strong> The cross-sectional study was conducted by the department of Dermatology, Venereology and Leprosy at Sri Muthukumaran Medical College Hospital and Research Institute, among the pediatric age group patients attending the outpatient department, during the month of October to December 2019. A total of 412 pediatric age group patients with skin disorder were included in the study. The study was conducted using a proforma with the clinical history and diagnosis of the participants. Data was entered in Microsoft excel and data analysis was done using SPSS version 17.<strong></strong></p><p class="abstract"><strong>Results:</strong> The common skin disorders reported in this study includes infections (34.7%) followed by dermatitis (32.3%), infestations (11.4%), miliaria (8.3%), popular urticaria (7.5%) and urticaria (6.1%). Among the infections fungal, bacterial and viral pathogens contributes to 16.3%, 10.9% and 7.5% of cases, respectively. Also 11.2% of cases were found to be infested with scabies (9.2%) and pediculosis (2.2%).</p><p class="abstract"><strong>Conclusions:</strong> Skin disorders in the pediatric age group are common and showing increasing trend. Hence health education of the parents and the school children about good nutrition, hygiene practices, and proper hydration of skin can be promoting in order to reduce the burden of skin disorders.</p>

Introduction: A Hernia is the protrusion of part of the abdominal contents beyond the abdominal wall's normal connes. In this study, an attempt is made to compare the results of two different modalities of hernia repair–Lichtenstein repair and repair of hernia with Polypropylene hernia system. Aim: The study aims to ascertain the Polypropylene hernia system's safety and benets for hernia repair against conventional Lichtenstein tension-free mesh repair technique. Materials and methods: The prospective clinical study comprises 30 patients presenting with inguinal hernia attending OPD and admitted to the General Surgery Department of King George Hospital, Visakhapatnam, during the study period of September 2018 to October 2020. Results: Age distribution between 10-90, most of the 50-70 age group (14 cases). Visual analog scale (VAS) score for PMR 4.55 ± 1.18 and LMR 6.06 1.27 (p-value <0.05). Wound infection for PMR 1 case and LMR 2 cases. Duration of surgery for PMR 65.40 ± 7.84 and LMR 51.33 ± 13.51 (p-value <0.05). Type of surgery and duration of hospital stay for PMR 4.93 ± 1.27 LMR 6.73 ± 2.12. Type of surgery and return to work for PMR 5.93 ± 1.27 and LMR 7.73 ± 2.12(p-value <0.05).Recurrence in PMR 0 % and LMR 6.67%. Conclusion: PHS repair is superior to Lichtenstein mesh repair about safe, tension-free method, shorter hospital Stay, early return to work, least recurrence rates, and a high subjective success rate and satisfaction rate.