Early recognition of citrobacter head and neck infections, an awareness of the peculiarities of the clinical course of such infections, and timely surgical intervention can prevent catastrophic outcomes. A minimally invasive approach to mediastinal collections can be considered as a viable alternative to open thoracotomy, which carries a high morbidity rate.

Background: It's always a burning debate, whether a simultaneous or staged bilateral Total Hip Arthroplasty (THA) should be performed for patients with painful disabling bilateral hip diseases. Although, many studies now indicate that the treatment option should be patient specific to achieve the maximum efficiency without increasing risk of perioperative complications. The purpose of this study to compare simultaneous vs staged procedure in order to determine the functional outcomes, risks and benefits of each procedure. Materials and Methods: Our study includes total 80 patients (160 hips) with advanced bilateral hip diseases, underwent simultaneous or staged bilateral THA during 2015 to 2019. Study population was randomly divided into two groups with 40 patients in each one. The post-op evaluations were done according to Harris Hip Score (HHS) at one, three, six and 12 months and yearly thereafter for 2 years. The second procedure in staged group was done at 6 weeks to 3 months interval. All possible outcomes and complications regarding each procedure were accessed. Results: As compared to staged procedure, estimated blood loss was significantly less in simultaneous THA (group A). Although, requirement of blood transfusion was significantly higher in this group. The length of hospital stay was significantly shorter in group A. Although, overall complication rate was higher in group A but it was statistically not significant. Superficial surgical site infection was significantly lower in simultaneous THA group. There was no post-op dislocation, no in-patient mortality and no need of revise the surgery in any of our study group within 2 years of follow-up. Conclusion: With proper patient selection, simultaneous bilateral THA is safe, effective and good alternative to staged procedure for painful disabling bilateral hip diseases.

Background: The optimal treatment of proximal humeral fractures remains always challenging and controversial. The purpose of this prospective study was to evaluate the functional outcome of proximal humerus internal locking system (PHILOS) plate fixation for displaced or complex proximal humeral fractures and to establish the influencing factors of an unfavourable outcome. Materials and Methods: After obtaining approval from institutional ethics committee, 55 patients with the displaced proximal humeral fractures were managed by open reduction and PHILOS plate fixation through delto-pectoral approach and as per standard protocol. The results of follow-ups were analysed radiologically and clinically, using the "Constant and Murley scoring system" at once in a month for first three months, once in three months for next six months and once in six months thereafter upto 2 years post-operatively. Results: In the present study, out of 55 patients, clinical results were excellent in 50.9%, good in 21.8%, fair in 16.4% and poor in 10.9% patients. Radiological union was achieved in all patients, including two cases of mal-union and one case of delayed union. Post-traumatic frozen shoulder (7 cases), secondary arthritis (5 cases), secondary screw penetration (3 cases), and AVN humeral head (3 cases) were the main complications observed in this study during 2 years of follow-ups, which were treated accordingly. Conclusion: Pre-contoured PHILOS plate preserves shape of humeral head, provides angular stability, facilitates to restore the medial column and prevent secondary varus collapse in severe comminuted and osteoporotic proximal humeral fractures. With proper patient selection, PHILOS plate provides favourable clinical and radiological outcome with acceptable complication rates.