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Deep neck space infections are potentially life-threatening due to their rapid progression and risk of airway compromise. Emergency airway management in such cases may be further complicated by consent-related challenges. A 28-year-old previously healthy woman presented with dysphagia following recent hemodialysis with right-sided central venous catheterization. Her symptoms progressed to neck swelling, hoarseness, and respiratory distress. Fiber-optic examination suggested deep neck space involvement, and contrast-enhanced CT confirmed a right parapharyngeal space abscess. Despite initiation of intravenous antibiotics and planned drainage, the patient deteriorated rapidly with signs of impending airway compromise. Emergency tracheostomy and surgical drainage were planned. However, consent for tracheostomy was refused by the patient's relatives despite detailed counselling. Following urgent multidisciplinary deliberation and in view of life-threatening airway obstruction, a decision was made to proceed with emergency airway management. Tracheostomy and drainage were successfully performed, resulting in stabilization and subsequent clinical recovery. This case highlights the importance of early recognition of airway compromise in deep neck infections, the need for timely and decisive airway management, and the ethical challenges encountered when life-saving interventions are refused.

Background AI is rapidly transforming healthcare delivery and medical training. While global bodies advocate for incorporating AI competencies into medical curricula, limited data exist on the perceptions, knowledge levels, ethical concerns, and training needs of Indian medical students. Understanding student perspectives is vital for designing future-ready curricula. Methodology A descriptive cross-sectional study was conducted among MBBS students at Government Medical College, Nagpur, between August and September 2024. A pretested, semi-structured, self-administered Google Form questionnaire (Google LLC, Mountain View, CA, USA) assessed perceptions of AI utility, ethical concerns, self-rated knowledge, and preferences for AI training. A convenience sample was obtained by inviting ~50 students from each academic phase (response rate: 94.4%, n = 236/250). Data were analyzed using IBM SPSS Statistics for Windows, version 25.0 (released 2017; IBM Corp., Armonk, NY, USA). Ethical approval was obtained from the Institutional Ethics Committee, and informed consent was collected digitally. Results A total of 236 students participated (mean age 20.52 &#xb1; 1.47 years; 53% male). Most respondents expressed positive perceptions of AI's potential to enhance decision-making, improve precision, and support healthcare accessibility (&#x2265;60% agreement). However, concerns about erosion of humanistic care, compromise of patient-physician relationships, and data privacy breaches were prominent. Only 31 students (13.1%) had received prior AI training. Students without training were significantly more likely to believe that AI threatens physician employment (71.2% vs. 35.5%; p = 0.00042), whereas trained students viewed AI as an augmentative tool and felt more confident about using AI in future practice (p < 0.00001). Self-rated knowledge was low, with 66.5% reporting no or minimal familiarity. A substantial majority (78.8%) expressed willingness to receive AI training. Students strongly supported integrating practical AI skills, ethics, research applications, predictive modeling, and clinical decision-support tools into the curriculum (&#x2265;60% endorsement across domains). Online learning was the preferred mode (38.1%). Conclusions Medical students demonstrate high enthusiasm for AI but possess limited knowledge and significant ethical concerns. Prior exposure to AI training correlates with more informed, positive perceptions of AI as a supportive rather than a replacement technology. The strong demand for a structured AI curriculum highlights the need for integrating foundational, technical, and ethical AI competencies into undergraduate medical education. A balanced, context-sensitive curriculum emphasizing both technological literacy and humanistic values is essential for preparing future physicians for AI-enabled healthcare.

Traumatic brain injury (TBI) can result in prolonged post-concussive syndrome and chronic hypoxic-ischemic brain injury (HIBI) sequelae remains therapeutically challenging with the persistence of significant neurological and cognitive impairments. While conventional treatments often provide limited relief, emerging research explores alternative therapeutic interventions, including psychedelic compounds combined with therapeutic interventions. This naturalistic case series examines clinical observations following an integrative, participant-directed iboga-containing microdosing protocol paired with Accelerated Experiential Dynamic Psychotherapy (AEDP) in three individuals with persistent neurologic symptoms after traumatic brain injury (TBI) or hypoxic-ischemic brain injury. Three participants completed a 6&#xa0;week protocol using Tabernanthe iboga root bark biomass (participant-directed titration 0.1-1.0&#xa0;g/day, 4&#xa0;days-on/3&#xa0;days-off). Quantitative qNMR/HPLC analysis (University of Cape Town) demonstrated approximately 3.845% ibogaine content by mass, yielding estimated ibogaine-equivalent exposure of 3.8-38.5&#xa0;mg/day. All administration utilized whole root bark biomass only. Weekly AEDP psychotherapy and supportive nutraceuticals were provided concurrently. A 43&#xa0;year-old man with TBI sustained in a motorcycle accident. Patient Two: A 40-year-old woman with chronic hypoxic brain injury sustained during an avalanche burial event. Patient Three: A 19&#xa0;year old woman with TBI sustained in a motor vehicle accident. All three patients demonstrated progressive neurological recovery over the 6-week microdosing iboga protocol with two of the patients declaring complete symptom remission at a long term follow up assessment. Initial reported symptoms included a constellation of daily headaches, episodic migraines, disequilibrium, irritability, mood swings, fatigue, brain fog, sleep disruptions, and loss of interest in typical life activities. At the conclusion of the protocol, and at long term follow-up visits, patients felt able to discontinue all prescription medications for symptomatic treatment, reporting absence of severe migraine headaches, resolution of brain fog, fatigue, irritability, and stabilized mood, with the ability to return all regular activities with a renewed enthusiasm for life. All patients provided consent to share their significant clinical and therapeutic improvement journey in this publication. The microdosing protocol was carefully implemented with rigorous screening to mitigate potential cardiac and neurological risks associated with iboga administration, including medical background screening for potential drug interactions, and past medical history contraindications including heart conditions and/or the concomitant administration of selective serotonin reuptake inhibitors (SSRIs). This naturalistic case series provides hypothesis-generating observations regarding possible clinical improvement following an integrative iboga-containing intervention paired with psychotherapeutic and supportive care. The findings do not establish causality or iboga-specific efficacy and should be interpreted within the context of multimodal therapeutic exposure and substantial methodological limitations. These preliminary observations suggest that an integrative iboga microdosing protocol, in association with psychotherapeutic and supportive care, may be linked to meaningful improvements in prolonged post-concussive symptoms. As a hypothesis-generating case series, these findings warrant further investigation in controlled trials to establish causality and specificity.

Introduction Growth assessment is a fundamental process in orthodontics&#xa0;as accurate determination of skeletal maturity guides the timing of treatment intervention. Biochemical and radiographic indicators can be used to evaluate growth status during adolescence. Insulin-like growth factor-1 (IGF-1) serves as a reliable biochemical marker of active growth, while the cervical vertebral maturation index (CVMI) provides a radiographic assessment of skeletal maturity. Vitamin D plays a vital role in bone metabolism and skeletal development. It may also influence growth mediators such as IGF-1. This study aims to assess and correlate levels of vitamin D with both IGF-1 and CVMI in 10-14-year-old patients. Method Patients who visited the Department of Orthodontics and Dentofacial Orthopaedics at Ranjeet Deshmukh Dental College and Research Centre of 10 to 14 years age were included in the study, provided they were not suffering from any systemic or endocrine disorders and had not consumed any vitamin D supplements. According to the established inclusion and exclusion criteria, a total of 50 subjects were selected for the study. Cervical vertebral maturation stages were assessed on a lateral cephalogram, which is routinely taken for orthodontic treatment. Two milliliters of blood samples were collected under all aseptic conditions with parental consent for assessment of IGF-1 by ELISA (DRG Diagnostics IGF-1 kit in Lisa Plus Elisa microplate reader) and vitamin D level by using ichroma vitamin D neo fluorescence Immunoassay. Results&#xa0; There was a statistically significant difference in vitamin D levels across CVMI stages (&#x3c7;&#xb2; = 14.813, p = 0.005). Mean vitamin D levels increased from Stage 2 (11.97 &#xb1; 0.96 ng/ml) to Stage 4 (24.54 &#xb1; 4.76 ng/ml), followed by a slight decline in Stage 5 (23.05 &#xb1; 4.88 ng/ml) and Stage 6 (19.10 ng/ml). Mean IGF-1 levels showed a consistent increasing trend: Stage 2 (19.57 &#xb1; 0.90 &#xb5;g/dl), Stage 3 (24.77 &#xb1; 2.56 &#xb5;g/dl), Stage 4 (28.78 &#xb1; 2.49 &#xb5;g/dl), Stage 5 (29.25 &#xb1; 2.84 &#xb5;g/dl), and Stage 6 (33.80 &#xb5;g/dl). This demonstrates a progressive rise in IGF-1 levels with skeletal maturation. Considering the overall sample, there was a weak to moderately positive correlation between vitamin D and IGF-1 levels (&#x3c1; = 0.428). Conclusion Levels of vitamin D had significant variations among CVMI stages. IGF-1 showed a consistent increase with advancing stages of CVMI, reflecting its positive association with pubertal growth and skeletal maturation. Correlation analysis revealed a weak to moderately positive correlation between vitamin D and IGF-1 levels. Therefore, IGF-1 is a more reliable indicator of skeletal maturation as compared to vitamin D, while vitamin D may still play a supportive role in growth-related biologic processes and skeletal development.

Introduction The immediate postpartum period represents a critical opportunity to initiate contraception to prevent short interpregnancy intervals and associated adverse maternal and neonatal outcomes. However, uptake of postpartum contraception remains low in many low-resource settings despite increasing rates of caesarean delivery. This study assessed the uptake and determinants of immediate postpartum contraception (IPPC) following cesarean delivery in Uganda. Objectives To determine the prevalence of IPPC uptake and factors associated with IPPC among women delivering by cesarean section (CS) at Mbarara Regional Referral Hospital, Mbarara, Uganda. Methods Between November 2024 and February 2025, we conducted a cross-sectional study and systematically sampled mothers who delivered by CS. Data were collected through structured electronic surveys and medical records abstraction. IPPC uptake was defined as a mother who took on a contraceptive method within the first 72 hours following a CS. We estimated the prevalence of IPPC and used logistic regression to identify sociodemographic, medical,&#xa0;obstetric, and contraceptive factors associated with IPPC. Results A total of 429 women were enrolled, with a mean age of 27 years. The prevalence of IPPC uptake was 6.8% (95% CI: 4.7-9.6). The commonest contraceptive method taken up was bilateral tubal ligation (75.8%, 22/29). The reasons for IPPC non-uptake were preference to first heal (238/400, 59.5%), chose natural methods (92/400, 23%), lack of awareness (42/4000, 10.5%), needed partner consent (14/400, 3.5%), and unavailability of the methods (7/400, 1.75%). Factors associated with immediate postpartum uptake were no formal education (adjusted odds ratio (aOR) = 8.52, 95% CI: 1.88-38.5; p < 0.005) and having ever used postpartum contraception (aOR = 5.08, 95% CI: 1.32-19.44; p < 0.018).&#xa0; Conclusion and recommendation Uptake of immediate postpartum contraception remains suboptimal among women undergoing cesarean delivery. Having no formal education and prior postpartum contraception use were independently associated with IPPC uptake. Strengthening the integration of contraceptive counseling and method provision during the antenatal, intrapartum, and postpartum periods may substantially improve uptake and improve maternal and neonatal outcomes.

Extensor mechanism tendon ruptures, including the quadriceps and patellar tendons, are devastating injuries that most often require acute surgical repair to restore knee mechanics and function. There are 2 well-described categories of quadriceps repair techniques, including superior pole suture anchor repairs and transosseous repairs, with recent studies reporting similar overall outcomes. However, failure rates have been reported to be as high as 18% and 21%, respectively. Extensor mechanism ruptures. The described technique utilizes 2 transosseous patellar tunnels. Retensionable all-suture anchor loops are then passed from the distal cortex to the near cortex, setting the suture anchors at the distal cortex. A Krakow stitch is passed from proximal to distal along the medial tendon, through the suture loop, and then distal to proximal through the central tendon and tied. This is repeated for the lateral half of the tendon. The suture loops are then tensioned to reduce the quadriceps tendon to the patella. The knee is cycled to remove creep from the Krakow suture, and the anchors are retensioned as needed to avoid gapping. This technique can also be utilized for patellar tendon ruptures in a similar fashion, with passage of the loops from proximal to distal and setting of the all-suture implant at the superior pole. In our experience, patients undergoing extensor mechanism repair with knotless retensionable all-suture anchors have achieved successful outcomes. The transosseous adjustable all-suture anchor has been shown to be biomechanically superior to a traditional transosseous suture repair, with significantly less gap formation, higher load-to-failure, and greater stiffness. Furthermore, the adjustable knotless anchor allows retensioning that may improve compression, minimize laxity both intra- and postoperatively, and allow more aggressive flexion range of motion during the early postoperative course. The all-suture anchor may also potentially limit complications related to hardware irritation when metal buttons are used for bicortical fixation or hard-bodied anchors are utilized at the superior pole. Transosseous retensionable all-suture anchors offer an alternative high- strength construct for extensor mechanism repairs, with a unique ability to minimize creep within repair constructs intraoperatively. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Background and objective Molar incisor hypomineralization (MIH) and hypomineralized second primary molars (HPSM) are significant developmental dental anomalies that affect children's quality of life. This study aimed to determine the prevalence, distribution, and correlation between MIH and HPSM among children aged 7-11 years in the five zones of Ahmedabad, Gujarat, India. Methodology A cross-sectional screening was conducted involving 1,860 schoolchildren (963 males, 897 females). Ahmedabad was divided into five zones. Inclusion criteria included children aged 7-11 years with parental consent, while children absent on the day of examination or those missing index teeth were excluded. Clinical examinations were performed using the 2021 European Academy of Paediatric Dentistry (EAPD) diagnostic criteria. Following data collection, all categorical data were compiled and statistically analyzed to evaluate the prevalence, clinical severity, and demographic distribution of the anomalies. Results The overall MIH prevalence was 2.04% (n = 38)&#xa0;while the dedicated HPSM prevalence was 0.27% (n = 5). Mild severity predominated, accounting for 65.79% of affected cases. The incidence of these developmental anomalies was entirely gender-neutral (p&#xa0;= 0.080 for MIH; p&#xa0;= 0.6769 for HPSM) and independent of specific age groups within the 7-11-year range (p&#xa0;= 0.984). Conclusions MIH and HPSM demonstrated a low but clinically significant prevalence within this cohort, with no statistically significant associations observed with gender or age groups. Despite the relatively low prevalence, the profound clinical consequences of these enamel defects highlight the critical need for early identification, heightened clinical vigilance, and timely preventive care.

Despite the growing awareness of emotional intelligence (EI) as an essential component in healthcare, there remains yet a substantial lack in comprehending how EI promotes workplace wellbeing. This study examined how emotional intelligence influences job satisfaction and wellbeing among nurses and midwives in Qatar, focusing on fostering resilience in a multicultural, high-pressure setting. This cross-sectional (convergent mixed-methods) study was carried out among nurses and midwives in a secondary hospital in Qatar after approval by the Institutional Review Board of Qatar. Our study included 121 registered nurses and midwives with at least 6 months of experience, fluent in English and Arabic, who consented and completed an online survey on seven EI domains. Descriptive statistics and inferential techniques were used for statistical analysis. The overall mean EI score was 47.9 &#xb1; 7.4, with the highest proficiency in awareness of others (7.0 &#xb1; 1.7) and lower scores in emotional reasoning (5.9 &#xb1;1.8). Correlation analysis revealed a positive relationship between self-awareness and all other EI domains (p < 0.001), particularly emotional self-control (r = 0.528). While EI dimensions showed weak correlations with job satisfaction, work-life balance emerged as the primary predictor of satisfaction (r = 0.500, p < 0.001). Qualitative themes validated these results, highlighting EI as a crucial tool for stress management and team dynamics. This study highlights the essential role of emotional intelligence in improving workplace wellbeing, decision-making, and team cohesion among nurses and midwives, advocating for its integration as a core competency in practice and education.

Vein of Galen malformation (VoGM) is a rare congenital vascular anomaly. It represents a well-recognized extracardiac cause of high-output cardiac failure in the neonatal period. We report a case of a 3.5-month-old boy who presented for routine vaccination and was incidentally found to have macrocephaly (head circumference 44.5 cm, >99th percentile) with early sun-setting eyes. He was otherwise well-appearing with a normal neurological examination. Bedside cranial ultrasound revealed bilateral lateral and third ventricular dilation with a cystic mass compressing the aqueduct, and brain MRI confirmed a dilated cystic malformation of the vein of Galen as the cause of obstructive hydrocephalus. His past medical history was significant for severe neonatal respiratory distress complicated by pulmonary hypertension and congestive heart failure, initially attributed to neonatal pneumonia. This case highlights that VoGM should be considered in the differential diagnosis of neonatal persistent pulmonary hypertension (PPHN) and high-output heart failure, even when a concurrent respiratory illness is present, and emphasizes the value of bedside cranial Doppler ultrasound and thorough physical examination including fontanel auscultation.

Previable premature prelabor rupture of membranes (PPROM) can lead to uterine infection, and sepsis with uterine necrosis is a rare complication. Prompt source control with abortion care if infection develops is an important component of management. We report the case of uterine necrosis in an immunosuppressed patient. A 25-year-old gravida 5, para 1-0-3-1, on immunosuppressive medications for systemic lupus erythematosus, presented at 15 weeks with PPROM and sepsis. She was treated with broad-spectrum intravenous antibiotics and dilation and evacuation (D&E) for a septic abortion. Her clinical status did not improve postoperatively, and workup, including imaging, revealed an ascending infection with a uterine source. After counseling, she underwent total abdominal hysterectomy with uterine necrosis confirmed on pathologic examination. Endometrial cultures grew multiple organisms sensitive to the antibiotic regimen. The patient recovered and was discharged on postoperative day five. Uterine necrosis can be a severe complication of septic abortion and presents as worsening pain and sepsis despite uterine evacuation. Non-toxin and non-gas-producing bacteria can be implicated. A high index of suspicion is required for appropriate treatment, particularly for immunosuppressed patients. Definitive surgical management of uterine necrosis with hysterectomy should be considered.

Salmonella is one of the leading foodborne pathogens worldwide. Their serotypes can be classified into typhoidal, which are known to cause enteric fever, and non-typhoidal, commonly known to cause gastroenteritis or food poisoning. Salmonella gastroenteritis is typically self-limiting, and most patients recover within a few days to a week without treatment. Intestinal perforation is an exceptionally rare and fatal complication. Here, we report a case of Salmonella gastroenteritis complicated by colonic perforation. Postoperatively, the patient succumbed due to multiorgan failure and intra-abdominal sepsis. This case highlights that even non-typhoidal Salmonella infection in an immunocompetent host may lead to catastrophic complications. Early recognition of clinical deterioration and timely surgical intervention are crucial to improve outcomes.

Background and aim Acute myocardial infarction (AMI) remains a major cause of cardiovascular morbidity and mortality worldwide, particularly in low- and middle-income countries. Although right ventricular dysfunction (RVD) has emerged as an important determinant of outcomes in AMI, its relationship with coronary angiographic complexity remains inadequately explored. This study aimed to evaluate the association between RVD and coronary angiographic complexity in patients with AMI. Methods A hospital-based, prospective observational study was conducted at Chittagong Medical College Hospital, Bangladesh, from March 2024 to February 2025. A total of 98 patients with AMI were included via consecutive sampling. Right ventricular function was assessed using echocardiographic parameters, including tricuspid annular plane systolic excursion (TAPSE), S' velocity, and fractional area change (FAC). Coronary angiographic complexity was evaluated using the SYNTAX score. The data were analyzed using IBM SPSS Statistics for Windows, version 23.0 (released 2015; IBM Corp., Armonk, NY, USA). Appropriate comparative tests and multivariable logistic regression analysis were performed to explore independent predictors while considering the limited number of outcome events. Results The mean age of the participants was 54.9 &#xb1; 11.5 years, and 85.71% were male. RVD was significantly associated with intermediate and high SYNTAX scores (p = 0.002). Among patients with RVD, 47.0% had low SYNTAX scores, whereas 26.5% and 26.5% had intermediate and high SYNTAX scores, respectively. In contrast, among patients without RVD, 76.9% had low SYNTAX scores, whereas 14.3% and 6.1% had intermediate and high scores, respectively. Patients with RVD had significantly lower systolic blood pressure (120.9 &#xb1; 18.3 vs 132.6 &#xb1; 23.5 mmHg, p = 0.013). Echocardiographic parameters, including TAPSE (16.3 &#xb1; 4.2 vs 19.2 &#xb1; 4.5 mm, p = 0.002) and FAC (25.6 &#xb1; 10.7% vs 35.9 &#xb1; 11.3%, p < 0.001), were significantly reduced in patients in the intermediate and high SYNTAX score groups. In the multivariable analysis, RVD showed the strongest association with intermediate and high SYNTAX scores (OR = 7.86, 95% CI: 2.53-24.39, p < 0.001), followed by diabetes mellitus (OR = 5.44, 95% CI: 1.78-16.68, p = 0.003). Conclusions RVD was significantly associated with greater coronary angiographic complexity in patients with AMI. It was more common among patients with intermediate and high SYNTAX scores and remained independently associated with increased angiographic complexity. These findings suggest that RVD may serve as a useful noninvasive marker for early risk stratification. Larger multicenter studies are needed to confirm its prognostic significance.

Epidemic keratoconjunctivitis (EKC) is a highly contagious viral ocular surface infection characterized by conjunctivitis with corneal involvement. Although EKC is usually self-limiting, corneal sequelae can persist for weeks to months and may significantly impact the quality of life. To analyze the effectiveness of the treatment protocol and healing of nummular keratitis after&#xa0;EKC. This is&#xa0;a retrospective observational study of&#xa0;eight patients with a history of viral conjunctivitis and EKC. Diagnosis and management in the acute stage relied solely on clinical evaluation, as laboratory testing remains significantly limited, often resulting in underdiagnosis and inadequate treatment. Thorough slit lamp evaluation, fluorescein staining, and visual acuity assessment were performed for all patients during follow-up. These cases of EKC were initially managed suboptimally elsewhere and later presented with decreased vision, photophobia, and nummular subepithelial infiltrates. All patients were treated with a tapering course of low-dose topical corticosteroids, leading to complete resolution in six cases (75%), while two (25%) required long-term topical cyclosporine therapy. This study highlights the importance of close monitoring of patients with acute infectious conjunctivitis until full resolution, enabling timely initiation of topical immunosuppressive therapy when indicated for nummular subepithelial infiltrates. Our study suggests that treatment and follow-up protocols, along with screening for other household contacts with conjunctivitis, can significantly reduce the severity and duration of EKC and help preserve final visual acuity after resolution.

Choledocholithiasis after cholecystectomy is a clinically significant cause of recurrent biliary symptoms and may result from retained stones, recurrent stone formation, or calculi within the cystic duct remnant. Although uncommon, cystic duct stump calculi can present several years after surgery and may be associated with chronic inflammation, adhesions, and, rarely, biliary fistula formation. We report the case of a 48-year-old female with a history of open cholecystectomy who presented with recurrent right upper abdominal pain, intermittent jaundice, clay-colored stools, and high-colored urine. Magnetic resonance cholangiopancreatography (MRCP) revealed choledocholithiasis with proximal biliary dilatation, along with a cystic duct stump calculus. The patient was planned for choledochoduodenostomy; however, intraoperative findings included dense adhesions, a cystic duct remnant-common bile duct (CBD) fistula, and an impacted stump stone, making the planned procedure unsafe. The surgical approach was modified, and CBD exploration with stone extraction and T-tube drainage was performed. The postoperative course was uneventful, and a T-tube cholangiogram confirmed satisfactory ductal clearance. The patient remained asymptomatic on follow-up, with normalization of liver function tests. This case highlights the importance of considering cystic duct stump pathology in post-cholecystectomy patients with recurrent biliary symptoms and underscores the need for individualized surgical decision-making in complex reoperative biliary surgery.

Increased access to OTC has enabled the collection, with patient consent, of research tissue samples from healthy premenopausal patients. These samples are a critical resource to advance our understanding of fundamental ovarian biology. When choosing a preservation method for the tissue collected for research purposes, it is important to define what outcomes are desired from tissue analysis. If tissue is preserved in certain ways the types of analyses available will be limited. This review details various processing methods that can be undertaken in the operating room, or after transportation, and examples of experimental approaches that are applicable to ovarian tissue research.

Orthopaedic trauma remains a major public health problem, particularly in rural India, where preventive strategies and trauma-care resources are often limited. This single&#x2011;centre descriptive observational&#xa0;study aimed to describe the epidemiological profile of orthopaedic trauma patients admitted to a major trauma centre in rural North India, with emphasis on age, sex, mechanism of injury, and pattern of skeletal involvement. This observational study included 2,340&#xa0;consecutive&#xa0;patients of all ages&#xa0;admitted under orthopaedics with acute traumatic injuries after initial presentation to the emergency department&#xa0;between December 2022 and December 2024. Repeat admissions for the same injury episode were excluded, and polytrauma patients were included if they had at least one orthopaedic injury. Data were collected prospectively from patient interviews and direct observation, and&#xa0;supplemented by the hospital&#xa0;medical record system. Descriptive statistics&#xa0;were&#xa0;used to analyse the demographic characteristics, mechanisms of injury, injury types, and anatomical fracture sites; age&#x2011;group differences in selected injury categories were analysed using chi&#x2011;square tests. Out of 2,340 patients, the study population consisted of 1,760 (75.21%) male and 580 (24.79%) female patients. The most common age group was 20-29 years (480; 20.51%), followed by 30-39 years (419; 17.91%) and 10-19 years (390; 16.67%). Road traffic accidents were the leading mechanism of injury (1,242; 53.08%), followed by slip-and-fall on the ground (394; 16.84%) and falls from height (385; 16.45%).&#xa0;Other mechanisms included mechanical injury (98; 4.19%), hit by animal (88; 3.76%), assault (67; 2.86%),&#xa0;fall of heavy object&#xa0;(32; 1.37%), railway injury (18; 0.77%), and sports injury (16; 0.68%). Fractures were the most common injury type (2,182; 93.25%), followed by dislocations (80; 3.42%) and soft tissue injuries (78; 3.33%). Limb amputation/crush injury was recorded in 80 patients (3.42%). Single-bone involvement was seen in 2,006 patients (85.73%), while 176 (7.52%) had more than one fractured bone. Open fractures were 445 (19.02%) cases, and closed fractures were 1,737 (74.23%). The commonly involved anatomic sites included femur, distal radius, both-bone leg, ankle region, and foot. The number of recorded fracture sites exceeded the number of fracture patients because some patients had bilateral or multi-site injuries. In age-wise analysis, dislocations were most frequent in the 20-39-year group, while limb amputation/crush injuries and open fractures were most common in the 40-59-year group. There was no significant overall association between age group and selected injury categories. Most patients of orthopaedic trauma in rural North India are young adult males, most commonly injured in road traffic accidents. Fractures remain the leading injury pattern, with the femur and distal radius among the most commonly involved sites. Preventive strategies should focus on road safety, occupational protection, and strengthening trauma-care services.

Patients' preferences play a major role in selecting health care providers, yet, to our knowledge,&#xa0;no prior research in Saudi Arabia has examined which factors most influence the choice of an ophthalmologist. This study aimed to identify the key determinants guiding patients' decisions and explore demographic differences. An analytical cross-sectional survey was conducted from September 2025 to February 2026, among adults who had visited an ophthalmology clinic in the past 12 months. A total of 418 participants completed an online questionnaire assessing sociodemographic data, clinical background, Likert-scale ratings of 28 selection factors, and the top three most influential factors. Fisher's exact test and the Mann-Whitney U test were used, with significance set at p<0.05. &#xa0;Communication quality and clinical competence were the strongest influences. The most important factors were taking enough time to answer questions (90.7%), availability of modern equipment (88.3%), clinic cleanliness (88.0%), and clear explanation of test results (87.1%). Clinical expertise indicators, including years of experience (84.0%), subspecialty fellowship (78.7%), and low complication rates (76.1%), were also highly valued. The top three selected factors were years of experience (56.2%), subspecialty fellowship (53.6%), and board certification (40.4%). Social media presence and cost-related factors had a limited influence. Patients in Saudi Arabia prioritize professional expertise, effective communication, and a clean, well-equipped clinical environment when choosing an ophthalmologist. Convenience, cost, and social media play a secondary role. Strengthening clinical credibility and patient-centered communication may enhance patient trust and decision-making in ophthalmic care.

Compartment syndrome (CS) is a condition that requires immediate attention; if diagnosis is delayed and treatment is not provided promptly, it can lead to complications resulting in permanent functional disability or limb loss. As the name suggests, once a muscle compartment is affected by an injury, this syndrome may develop, manifesting as progressive inflammation and edema, leading to reduced blood flow to the limb. Diagnosis is primarily clinical, based on signs of impaired perfusion. Fasciotomy is the treatment of choice, helping to prevent amputations when performed in a timely manner. However, it is associated with significant complications, as closing the fasciotomy incision can pose a considerable surgical challenge; therefore, post-fasciotomy procedures are just as important as the decompression procedure itself. In this context, the use of grafts and delayed wound closure are frequent therapeutic options. When these measures fail, the use of flaps is feasible, although there is limited literature on their use following fasciotomy. The purpose of this article is to present the case of a patient whose forearm became trapped in a dryer, resulting in an injury from a combined crush and thermal mechanism. Despite multiple procedures, coverage of the open wound was not achieved, so the use of flaps was considered. The radial forearm flap sacrifices one of the main arteries of the hand, the interosseous flap can be difficult to perform, and the inguinal flap requires prolonged immobilization and two procedures. Therefore, we opted for the dorsal ulnar flap to close the post-fasciotomy wound, which is quick and easy to perform, relies on a continuous blood vessel without compromising the major arteries of the hand, allows for early mobilization, and enabled us to achieve adequate coverage of the wound with tendon exposure involving the wrist and hand. We conclude that the dorsal ulnar flap is a reliable and effective option for wound coverage following fasciotomy in forearm CS.

We report a rare case of bilateral acute retinal pigment epitheliitis (ARPE) documented using multimodal imaging, with detailed sequential optical coherence tomography (OCT) findings. A woman in her 30s presented with acute bilateral visual deterioration without prodromal symptoms. Fundus examination revealed yellowish-white lesions localized to the fovea in both eyes. OCT demonstrated dome-shaped hyperreflective lesions with disruption of the ellipsoid zone (EZ) and interdigitation zone (IZ). OCT angiography, fluorescein angiography, and indocyanine green angiography showed no significant abnormalities. Based on these findings, bilateral ARPE was diagnosed. Given the bilateral visual impairment, topical betamethasone sodium phosphate was initiated to facilitate early recovery. Sequential OCT demonstrated gradual restoration of the outer retinal layers, with recovery of the external limiting membrane, followed by the IZ and EZ. Best-corrected visual acuity improved to 1.0 in both eyes within two months, and near-complete anatomical resolution was confirmed by three months. No recurrence was observed after treatment cessation. This case highlights the rare bilateral presentation of ARPE and demonstrates the value of OCT in monitoring layer-by-layer recovery of the outer retina, while emphasizing the importance of differentiating it from other white dot syndromes.