Introduction Osteoporosis is a common, but often underdiagnosed, condition in elderly males, characterized by decreased bone mineral density (BMD), which leads to an increased risk of fractures. This study aims to assess the prevalence of osteoporosis and osteopenia in elderly men and investigate the association between osteoporosis, serum testosterone, and vitamin D levels. Methodology This cross-sectional study was carried out in a tertiary care centre during a period of two years (2019-2020). The study recruited 370 elderly male patients who were aged 60 years old or older. Patients had clinical examination with detailed medical history, physical examination, and laboratory investigations for measurement of serum total testosterone and vitamin D. Bone mineral density (BMD) was measured using DEXA scans, and subjects were classified according to their T-scores as having osteoporosis, osteopenia, and normal BMD. The relationship of T with VitD deficiency and osteoporosis was considered. Results The prevalence of osteoporosis, osteopenia, and normal BMD was 39.5%, 48.3%, and 12.2%, respectively. Low testosterone level was significantly associated with osteoporosis, and 47.5% of patients with low testosterone (<3 ng/ml) were osteoporotic (P = 0.001). Vitamin D deficiency was high and 50.6% of participants were having D level less than 20 ng/ml. Prevalence of osteoporosis was significantly higher in participants with vitamin D deficiency in comparison to those without (p-value = 0.03). The findings suggest that having the right amounts of testosterone and vitamin D are important for maximum bone health. Conclusion Osteoporosis and osteopenia are prevalent in a high proportion of elderly males, and deficiency in serum testosterone and vitamin D are significant risk factors. The early detection of those deficiencies and further management, replacement therapy of testosterone, and supplementation of vitamin D, could be used to prevent the oncoming of osteoporosis and related fractures. The results of this study underscore the importance of implementing standing programs and assessments designed to maintain bone health and thus also reduce the burden fracture-related osteoporosis has on elderly males by enhancing their quality of life.

Introduction: Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. OSA is associated with significant morbidity, including cardiovascular diseases, metabolic syndrome, and impaired quality of life. Understanding the predisposing factors for OSA is crucial for early diagnosis and effective management. This study aims to identify the key factors predisposing adults to OSA, including obesity, anatomical abnormalities, lifestyle factors, and comorbidities. Materials and Methods: A cross-sectional study was conducted on 70 adults aged 18–65 years. Participants underwent polysomnography and completed questionnaires assessing lifestyle, medical history, and symptoms of OSA. Inclusion criteria included adults with suspected sleep-disordered breathing, while exclusion criteria included individuals with central sleep apnea or severe psychiatric disorders. Participants underwent overnight polysomnography to assess the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and other sleep parameters.  Results: The study identified obesity (BMI ≥30), male gender, age >40 years, and smoking as significant predisposing factors. An AHI ≥5 is diagnostic for OSA, and the mean AHI of 18.5 in the OSA group indicates moderate OSA. The extremely low AHI in the non-OSA group (2.1) confirms the absence of significant sleep-disordered breathing. The ODI measures the number of times per hour that blood oxygen levels drop by ≥3% from baseline. The OSA group had a significantly higher ODI (15.2 events/hour) compared to the non-OSA group (1.8 events/hour), indicating frequent oxygen desaturations in OSA patients. The OSA group had a lower mean SpO₂ (91.3%) compared to the non-OSA group (95.6%), indicating poorer oxygenation in OSA patients.  Conclusion: Obesity, anatomical abnormalities, and lifestyle factors are major contributors to OSA. Early identification and intervention can reduce the burden of OSA-related complications.

Background: Pulpotomy is a conservative treatment modality that aims to preserve radicular pulp vitality in cases of reversible pulpitis or traumatic pulp exposure in permanent teeth. Mineral Trioxide Aggregate (MTA) has been widely used due to its biocompatibility and sealing ability, but it has certain limitations such as prolonged setting time and discoloration. Bio dentine, a calcium silicate-based material, has been introduced as a promising alternative with improved physical properties. Objective: This systematic review aimed to evaluate and compare the clinical and radiographic success of Bio dentine and MTA in pulpotomy of permanent teeth. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Cochrane, and Google Scholar databases. Ten eligible studies, including randomized controlled trials and clinical evaluations, were selected according to PRISMA 2020 guidelines. Data regarding clinical outcomes, radiographic healing, postoperative symptoms, and handling characteristics were extracted and synthesized. Results: Both Biodentine and MTA showed comparable success rates, ranging from 90–97%, with no statistically significant differences. Biodentine exhibited superior handling and faster setting time. Conclusion: Biodentine is a clinically effective and practical alternative to MTA for pulpotomy in permanent teeth, offering similar success rates with added advantages in manipulation and setting characteristics.

Introduction: The knee joint is one of the most complex and frequently injured joints in the human body, serving as a critical hinge between the femur, tibia, and patella. The diagnosis of traumatic knee injuries has historically relied on clinical examination and conventional imaging modalities, such as radiographs and computed tomography (CT). Magnetic Resonance Imaging (MRI) has emerged as the gold standard for evaluating traumatic knee injuries due to its unparalleled ability to provide high-resolution, multiplanar images of the knee joint without the use of ionizing radiation. MRI offers exceptional soft tissue contrast, enabling the visualization of ligaments, tendons, menisci, cartilage, and bone marrow in exquisite detail. Materials and Method: This study was a retrospective analysis conducted at a tertiary care hospital over a period of one year. The study aimed to evaluate the diagnostic accuracy of Magnetic Resonance Imaging (MRI) in detecting traumatic knee injuries by correlating MRI findings with arthroscopic or surgical outcomes. The study protocol was approved by the Institutional Ethics Committee, and informed consent was obtained from all participants. Patients aged 18–50 years with a history of acute knee trauma (e.g., sports injury, motor vehicle accident, or fall) were included. Result: The study included 150 patients (90 males and 60 females) with a mean age of 32 years (range: 18–50 years). All patients presented with traumatic knee injuries and underwent MRI followed by arthroscopic or surgical evaluation. MRI demonstrated excellent sensitivity (96%) and specificity (92%) for ACL tears, with slightly lower but still high accuracy for PCL tears (90% sensitivity, 94% specificity). MRI showed high diagnostic accuracy for both medial and lateral meniscal tears, with sensitivity and specificity exceeding 90%. MRI's sensitivity and specificity for cartilage defects were slightly lower (88% and 85%, respectively), likely due to the difficulty in detecting early or subtle cartilage damage. Conclusion: Magnetic Resonance Imaging is an indispensable tool in the evaluation of traumatic knee joint injuries. Its ability to provide detailed visualization of soft tissue structures, combined with high diagnostic accuracy, makes it the preferred imaging modality for assessing ligamentous, meniscal, and cartilaginous injuries.

Introduction: Hysterectomy is one of the most common gynecological surgeries, with vaginal hysterectomy (VH) and total abdominal hysterectomy (TAH) being the two primary approaches. This study compares the outcomes of VH and TAH in women with a non-descent uterus. Despite these advancements, there remains a lack of consensus on the optimal approach for non-descent uterus, particularly in resource-limited settings where surgical expertise and infrastructure may be limited⁶. This study aims to compare the outcomes of VH and TAH in women with a non-descent uterus, focusing on operative parameters, postoperative recovery, and complications.  Material and Methods: A prospective comparative study was conducted on 120 women undergoing hysterectomy for benign conditions, divided equally into VH and TAH groups. Inclusion criteria included non-descent uterus, benign indications for hysterectomy, and no contraindications for either approach. Exclusion criteria included uterine descent, malignancy, and previous pelvic surgery. Data on operative time, blood loss, postoperative pain, hospital stay, and complications were collected and analyzed. Results: VH was associated with shorter operative time (65.2 ± 10.3 minutes vs. 92.4 ± 15.6 minutes, p < 0.001), less blood loss (150.5 ± 30.2 mL vs. 280.3 ± 45.6 mL, p < 0.001), and shorter hospital stay (3.1 ± 0.8 days vs. 5.2 ± 1.1 days, p < 0.001) compared to TAH. Postoperative pain scores were lower in the VH group (p < 0.05). Complication rates were comparable between the two groups. Conclusion: Vaginal hysterectomy is a safer and more effective approach for non-descent uterus, offering advantages in terms of operative time, blood loss, postoperative recovery, and hospital stay

In 2001 the annual estimated cost of dealing with bladder problems was £353.6 million.9 This included expenditure on pads. It is expected to be much higher now. Only a small proportion of the above amount was spent on drugs,10 the remainder being spent on secondary care and surgical treatment.

Bearing this in mind, it makes sense that the general practitioner (GP) is ideally placed to screen and manage these patients in primary care. It is not necessary to refer all patients to secondary care. With the ever-increasing pressure on GPs to reduce unnecessary referrals, there is now a scope for commissioning this service. However, management of an overactive bladder is not part of the Quality and Outcome Framework - could be one reason why GPs are not keen or enthusiastic

Introduction: The nationwide implementation of ‘run-through’ training in 2007, based upon the new system of postgraduate medical training known as Modernizing Medical Careers (MMC), was the subject of much debate as to the suitability of the selection process, and the feasibility of the new system itself. One year after the start of the new Speciality Training (ST) grade this study obtains the views of core surgical trainees in the Oxford Deanery. Methods: Forty-six trainees in ST1, ST2, Fixed Term Specialty Training Appointment (FTSTA) 1 and FTSTA2 posts completed questionnaires at three and nine months from appointments in August 2007. Results: Fifty two percent (n=24) of respondents were appointed to their training posts from Round 1a, with 67% (n=16) to ST1 or ST2 level. Despite 61% (n=28) having initially selected Oxford as their first-choice deanery, 93% (n=43) now wished to remain in the region for further training, with 57% (n=27) of all trainees satisfied with their current position. At three months, only 9% (n=4) felt well informed regarding their surgical training, and 28% (n=13) well supported by their seniors; however, six months later these figures had risen to 64% (n=29) and 60% (n=24) respectively. Nearly half (43%, n=20) of surgical trainees had looked into moving abroad to train, and two thirds had considered leaving surgery all together. From August 2008, 70% (n=9) of ST2 trainees and 57% (n=4) of FTSTA2 trainees had obtained ST3 positions, with all but one in their desired surgical specialty. Conclusion: Despite MMC’s difficult introduction into higher specialist training, the majority of trainees surveyed expressed encouraging levels of job satisfaction, felt increasingly well informed and well supported, and had successfully negotiated the initial stages of the ‘run-through’ track. With continuing debate surrounding how MMC-based surgical training will work within the confines of National Health Service (NHS) provision and the European Working Time Directive, we present the opinions and outcomes of the first cohort of ‘run-through’ surgical trainees.

Cystic hydatidosis is a rare disease which mainly involves the liver and lungs, and rarely the brain. Cysts may be single or multiple. A 6-year-old boy presented with the chief complaint of ataxia. Brain imaging revealed a huge cystic structure involving the right side of the brain. A diagnosis of brain hydatid cyst was made and the patient was operated on. A large cyst was successfully delivered without rupture. Antihelminthic medication was started and the patient was discharged with full recovery of neurological function. Hydatid cysts must be considered as a differential diagnosis in patients with cystic lesions of the brain, especially in children. Surgery remains the standard method of treatment, and care must be taken in order to recover the cyst without rupture to avoid severe complications and recurrence.

A 36-year-old African American male with a history of chronic pancreatitis presented to the emergency department for abdominal pain in the epigastric area along with nausea, vomiting, diarrhoea, fever. His symptoms began 3-4 days before presentation. The abdominal pain was dull in nature and 6/10 in intensity, non-radiating. His past medical history was significant for HTN, diabetes mellitus and chronic diarrhoea secondary to chronic pancreatitis.

On admission the patient was alert and oriented, blood pressure was 97/44 mm Hg, heart rate 16 beats per minute, respiration 16 per minute, oxygen saturation 94% on room air and temperature 102*F. Abdominal examination revealed hyperactive bowel sounds and tenderness in the epigastrium & RUQ. Liver span was 14 cm. The rest of the examination was unremarkable.

Coronary vasospasm is an episodic, augmented, contractile response of coronary smooth muscles to variety of stimuli in the setting of established endothelial dysfunction. Various physiological including cold, stress and pathological factors like smoking, and ethanol have been well known to precipitate vasospasm. Despite these omnipresent factors, coronary vasospasm has become infrequent, in particular due to judicious use of medication including calcium channel blockers, statins and aspirin. We present a case of severe coronary vasospasm resulting in haemodynamic instability, in a patient with hypoxic respiratory failure. Recurrent symptomatic episodes required coronary angiography for the diagnosis and patient was successfully treated with calcium channel blockers.