Background: Total knee arthroplasty (TKA) is an established and effective treatment for end-stage knee osteoarthritis, but postoperative recovery is influenced substantially by the timing of mobilization. Prolonged bed rest after TKA has been associated with increased thromboembolic risk, muscle deconditioning, and delayed functional return, prompting widespread adoption of early mobilization protocols within Enhanced Recovery After Surgery (ERAS) pathways. Objective: To assess the impact of early mobilization (within 24 hours of surgery) versus standard mobilization (after 24 hours) on postoperative pain, range of motion, length of hospital stay, discharge disposition, and complication rates following primary unilateral TKA. Methods: This prospective comparative study enrolled 150 patients undergoing primary unilateral TKA, allocated to an early mobilization group (n = 75, ambulation within 24 hours) or a standard mobilization group (n = 75, ambulation after 24 hours) based on physiotherapy and ward scheduling availability. Pain (visual analogue scale), knee flexion range of motion, ambulation distance, length of stay, discharge disposition, and complications were recorded and compared between groups. Results: The early mobilization group achieved significantly lower pain scores on postoperative day 1 and 3, greater knee flexion range of motion at day 3 and 6 weeks, longer ambulation distance by day 2, and a shorter hospital stay (3.2 ± 0.9 vs. 5.1 ± 1.4 days, p < 0.001) compared with the standard mobilization group. A higher proportion of early mobilization patients were discharged directly home (85.3% vs. 64.0%, p = 0.003), and the incidence of postoperative pulmonary infection was significantly lower in this group, with no corresponding increase in surgical or thromboembolic complications. Conclusion: Early mobilization following TKA is safe and is associated with reduced pain, improved early functional recovery, shorter hospital stay, and a higher rate of discharge to home, supporting its routine incorporation into postoperative care pathways

Background: Fine needle aspiration cytology (FNAC) is the first-line investigation for the preoperative evaluation of thyroid nodules, guiding the distinction between benign and malignant lesions and informing surgical decision-making. This study aimed to evaluate the diagnostic accuracy of FNAC in thyroid nodules using histopathology as the reference standard, with cytological findings reported according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Methods: A cross-sectional cytohistological correlation study was conducted on 210 patients with clinically or radiologically detected thyroid nodules who underwent ultrasound-guided FNAC followed by surgical excision and histopathological examination over a two-year period. Cytology smears were categorised according to TBSRTC, and results were correlated with the final histopathological diagnosis. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated for definitive cytological categories. Results: Of 210 cases, 157 (74.8%) were histologically benign and 53 (25.2%) were malignant. Among the 154 cases with definitive cytology (Bethesda II, V, or VI), FNAC showed a sensitivity of 91.9%, specificity of 98.3%, positive predictive value of 94.4%, negative predictive value of 97.5%, and overall diagnostic accuracy of 96.8%. The risk of malignancy increased progressively across Bethesda categories, from 2.5% in category II to 96.8% in category VI, with intermediate risks of 18.2% for category III and 40.0% for category IV. Conclusion: FNAC remains a highly sensitive and specific first-line diagnostic tool for thyroid nodules when reported using the Bethesda system, with excellent cytohistological concordance for definitively benign and malignant categories. Indeterminate categories continue to pose diagnostic challenges and warrant adjunctive molecular testing or repeat sampling to refine management.

Aim: to examine the risk factors and correlations for glaucoma and the prevalence of the condition in individuals 40 years of age and older. Methodology: The randomized observational study was conducted out in a tertiary care hospital's outpatient department (OPD). Results: Six patients had initial open angle glaucoma, one patient had angle closure glaucoma, and six patients had secondary glaucoma, making the prevalence of glaucoma 13.27% (13 out of 98). Five patients received a new diagnosis of glaucoma, whereas eight cases were known to exist. As people aged, the prevalence of glaucoma increased (5 times higher in those over 60). There was no correlation discovered with myopia, diabetes, hypertension, or sex. We also noticed the greater likelihood of hypertensives acquiring ocular hypertension than the normal population. Conclusion: The prevalence of glaucoma is higher in patients over 40. There is evidence that hypertensives are more likely to develop glaucoma.

Stercoral perforation of the colon is caused by progressive ischemic necrosis of the bowel wall by a faecal mass. It is the least likely diagnosis here as it usually occurs on the antimesenteric border of the sigmoid colon and is usually associated with a history of chronic constipation and megacolon. Typhlitis is a potentially life-threatening inflammatory bowel process that is a recognized complication of systemic chemotherapy. It can progress to bowel necrosis and perforation but is usually characterized by involvement of the caecum or ascending colon and the rectum is rarely involved. Clostridial gas gangrene infection occurs with tissue inoculation in a low oxygen tension environment. Approximately 80% of patients without trauma have a malignancy of which 40% are hematologic, however the vast majority of cases are preceded by trauma of which there was no history of in this case 1. Perineal Necrotizing fasciitis is a rare condition with an estimated 500 cases each year in the UK2. It can affect healthy individuals of any age but carcinoma and immunosuppression are known to increase susceptibility3. The initial lack of obvious skin findings makes this condition difficult to diagnosis but exquisite pain, especially pain that is disproportionate to what would be expected from the clinical findings is seen 2, 4. Where concurrent signs of sepsis exist, a high index of suspicion is required.

Another major study, looking at the dropping out from medical schools in the UK over a ten-year period (1990-2000),10 showed that drop-out rates increased during this period and concluded that the probability of dropping out of medical school is 20% lower for students with a parent who is a doctor. The authors comment that this may be the result of greater commitment or better preparation and insight before starting the course. Ethnic background of students was recorded only between 1998-2000. The study found that Indian females were around 1.9% less likely to drop out compared with white females, whereas Indian males were no different from white males. Other ethnic groups were less likely to drop-out by around 0.8%. A concerning fact in this paper was the degree to which drop-out rates varied between different medical schools. No study to date has been done to find the reasons for these differences. Surely potential applicants need to be aware of these results. The differences could be accounted for by variable selection processes among the medical schools.11 Some medical schools shortlist for interview only on predicted academic performance or the number of A* GCSEs or decide by the UK Clinical Aptitude Test (UKCAT) / BioMedical Admissions Test (BMAT) scores. Some use information presented in the candidate’s personal statement and referee’s report while others ignore this because of concern over bias. In some cases, candidates fill in a supplementary questionnaire. Interviews vary in terms of length, panel composition, structure, content, and scoring methods. Some schools do not interview. “The more we care for the happiness of others, the greater our own sense of well-being becomes.” The Medicine of Altruism: Dalai Lama

GORD in infants and children can present with a variety of symptoms many of which can be relatively non-specific. Equally, other pathologies may lead to the development of reflux. Those in the early years tend to be based on observations by parents, while older, more vocal children’s express symptoms more akin to adult presentations. As such, the history/symptoms will be broadly divided into those expected for infants (<1yr), young children (1-5yrs) and older children (>5yrs).

We present here a 63-year-old lady who had a primary total knee arthroplasty (TKA) for osteoarthritis of knee. She developed methicillin resistant staphylococcus aureus (MRSA) infection of the primary prosthesis following an intravenous (IV) cannula site infection with MRSA bacteremia. This was complicated by Stevens-Johnson syndrome following vancomycin therapy for the infection, which was confirmed by clinical features including typical skin rashes and skin biopsy. She was treated with alternative antibiotics and was referred to a specialist orthopaedic unit where she had a two- stage revision. In retrospect, the infection could have been avoided if the IV cannula was not left in for so long. She also unfortunately had an adverse reaction to the vancomycin which complicated the situation, making management difficult. A team consisting of orthopaedic surgeons, microbiologists, dermatologists and physiotherapists was essential for successful management of this difficult and complicated situation.

Abbreviations: MRSA (methicillin resistant staphylococcus aureus), IV (intravenous), TKA (total knee arthroplasty), DM (diabetes mellitus)

Hypertension is common, but with early detection and treatment, it is rare to see malignant hypertension. Malignant hypertension is a medical emergency with an incidence of 1% in hypertensive patients. We report on a patient who presented with signs suggestive of Thrombotic Thrombocytopenic Purpura and severe hypertension, which resolved with the treatment of hypertension.

Our patient presented somewhat like a stroke with visual field defect and right hemiparesis which is unusual in MS, but MRI and CSF exam yielded a diagnosis of probable MS. Because of his abrupt clinical deterioration and impressive worsening of his MRI, concern was raised about possibility of infection or neoplasm. Hence, he received two brain biopsies, the second of which showed active demyelination, confirming the diagnosis of severe tumefactive multiple sclerosis and can be consider as a Marburg variant multiple sclerosis. Marburg variant multiple sclerosis carries a high morbidity and mortality. This disease notoriously mimics other conditions leading to delay diagnosis and treatment. Absence of definitive diagnosis test apart from brain biopsy makes diagnosis, prognosis and treatment decisions difficult