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The revolutionary concept of enhanced recovery after surgery (ERAS), recognized and proven in colonic surgery, soon caught on as an attractive proposition that translated into better and faster patient recovery after various types of surgery. As an evolving concept, it is being widely accepted, with various surgical specialties suitably adapting the guidelines for use in the perioperative setting. Identification and mitigation of risk factors in special groups of patients such as patients presenting for emergency surgery, those in the extremes of age and weight, and those with various comorbidities require additional care and investigations. The use of ERAS in emergency setting has been remarkably difficult to implement, owing to a short preoperative period, altered physiology, and unexpected postoperative outcomes. There is reluctance in the application of ERAS in emergency due to difficulty in implementing all its components, especially the preoperative components. The rapid advancements in technology and increased availability of point of care diagnostics, such as ultrasound and intraoperative electroencephalogram, and the increasing number of anesthesiologists getting trained in their usage are important factors that are positively influencing perioperative patient care in the last decade. This has led to significant developments in noninvasive and rapid methods of monitoring hemodynamics and postoperative care. This review aims to highlight the influence of newer perioperative practices that are already included or are likely to have positive impact when included in an ERAS program and provide comprehensive review on the application of ERAS in emergency setting and in various surgical specialties.

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A normally functioning esophagus is a specialized functioning organ, and it functions in concert with other derivatives of foregut origin. Unlike adults, esophageal replacement (OR) in infants and children is uniformly done for benign conditions. The complexity of esophageal substitution techniques and its sequelae are not experienced only during childhood, but they spill over into adult life as well making life-long commitment and follow-up necessary. Although multiple technical approaches and their modifications are being practiced for OR over the past century, there is no clear consensus regarding the best one. In recent years, realizing that patient's own esophagus suits him/her best, esophageal lengthening and tissue engineering techniques are challenging the replacement techniques. There are no randomized controlled pediatric studies to compare different types of OR.

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Background: Vitamin D deficiency is a global health concern affecting individuals across all the age groups in both the genders. Aims and Objectives: The present study intends to assess the prevalence of Vitamin D deficiency and associated risk factors in adult males and females of Chandigarh. Materials and Methods: The sample included 332 males and 295 females of the age ranging between 30 and 70 years. Vitamin D level of all the participants was estimated by employing chemiluminescence immunoassay method. All the subjects were divided into three categories of Vitamin D level, i.e., normal range (>30–100 ng/ml), insufficiency (21–29 ng/ml), and deficiency (0–20 ng/ml) as per the Endocrine Society Guidelines (2011). Results: The overall prevalence of Vitamin D deficiency was found to be 28.5% in males and 63.4% in females of Chandigarh. The prevalence of Vitamin D deficiency exhibited an age-associated increment in both the males and females. Conclusion: Lesser physical activity and no intake of calcium, Vitamin D, and multivitamin supplements were possible determinants of Vitamin D deficiency.

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Background: Further care needs and impact of repaired cleft lip and palate (CLP) on the daily life of children are unknown in our setting, since many of them are lost to follow-up after surgery. Aim: To assess the oral health-related quality of life (OHRQoL) of children with repaired CLP and to identify the main issues that deserve additional care. Methods: We carried out a single-center, cross-sectional study of 27 children (mean age: 7.74 ± 0.7 years; 16 girls) operated for CLP and 30 healthy controls (mean age: 8.03 ± 0.7 years; 15 girls). Self and proxy-rated OHRQoL was assessed by the child oral health impact profile, a reliable and valid questionnaire designed for use with children and teenagers. Results: Patients had lower quality of life scores than controls for functional well-being (22.1 ± 1.2 vs. 27.9 ± 0.74;P< 0.001), emotional well-being (32.3 ± 1.4 vs. 37.3 ± 0.6; P = 0.002), and self-esteem (24.4 ± 0.9 vs. 29.2 ± 0.4;P< 0.001). Redo surgeries (n = 10) and a visible facial difference (n = 17) were the main depreciative determinants of the OHRQoL, particularly for emotional well-being (30.2 ± 1.7 vs. 35.2 ± 1.4;P= 0.003 and 29.6 ± 1.8 vs. 36.8 ± 1.3; P = 0.003; respectively). Conclusion: Children with repaired CLP have a lower OHRQoL than their healthy peers. Psychosocial care, orthodontics, and speech therapy are the main needs for further care aimed at improving their quality of life.

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Background: Medical students are expected to be self-directed learners and constantly update their knowledge. Apart from the books, journals also help in this knowledge gathering exercise. This study was conducted with an objective to assess the journal usage pattern among undergraduate medical students and to consider implementing a training program on journal use based on the survey findings. Materials and Methods: This was a cross-sectional study conducted among the undergraduate medical students using anonymous self-administered online questionnaire. The e-mail address and WhatsApp number of the students were initially collected with the help of student volunteers from each batch, and then, an online link to the survey was sent to all of them by these volunteers. Results: Around 37% (190/505) of the respondents reported having used journals, and nearly three-fourths of them were introduced to journals by their faculties. Research articles were the most sought after article type among the students. The Medline database was very commonly used by the students. Around 80% of the respondents opined that journal usage may be included as a training program at the undergraduate level. Conclusion: Perception regarding including journal usage as a training program at the undergraduate level was significantly associated (P < 0.05) with journal use among students.

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Background: Dengue is globally the most common arboviral disease. As the primary immunopathological target in dengue is the endothelium, presentations beyond the typical triad of fever, myalgias, and thrombocytopenia are increasingly encountered. Severe systemic organ involvement can occur even without evidence of dengue hemorrhagic fever (DHF). These manifestations of dengue have been termed the “expanded dengue syndrome” by WHO. Aim: To observe the types and frequency of organ involvement in patients admitted with acute dengue fever. Methods: This is a retrospective cross-sectional study. Records of patients above 18 years admitted with acute dengue fever from December 2016 to December 2017 were reviewed. Patients fulfilling WHO criteria for probable or confirmed acute dengue fever were included. Patients with definite laboratory evidence of other systemic infections and patients with autoimmune or hematological disease were excluded. Data were obtained for 129 patients and analyzed using IBM-SPSS-21. Frequencies of clinical manifestations and organ involvement were noted. Results: Gastrointestinal manifestations occurred in 89% of patients. Transaminitis, organomegaly, and serositis were common. About 19% had pulmonary involvement, and 9% of patients had neurological features. Renal dysfunction, dyselectrolytemia, ophthalmic, muscular, and lymphoreticular abnormalities were also seen. Conclusion: Systemic involvement in dengue is not uncommon, and organ dysfunction can occur in the absence of severe DHF. Recognition of myriad range of organ involvement is crucial for optimal management.

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