ABSTRACT
Abstract: Schwannoma of the superficial peroneal nerve is very rare, with only four cases reported till 2006. Unlike neurofibromas, schwannomas do not traverse through the nerve but remain in the sheath lying on top of the nerve. Here we present a rare case of Schwannoma of the superficial peroneal nerve with split fat sign. A 48 year old woman complained of a swelling in the lateral aspect of proximal 1/3rd of right leg below the knee joint for 2 weeks. The swelling was painless and very small to begin with but it gradually progressed to the current size of 4 x 2 cm and caused mild pain. On examination mild tenderness and increased local warmth was noted at the site of the swelling. Sensations were intact at the site of swelling. There was no history was trauma or co-morbidities. MRI findings revealed a well-defined ovoid lesion which shows isointensity to muscle in T1WI and hyperintensity in T2 STIR, arising from the nerve sheath in the subcutaneous plane lateral to the right fibular neck. Axial and Coronal T2 STIR MR image of right fibular neck shows an image of right fibular neck with a large ovoid lesion which has predominantly high signal and is eccentrically located in distribution of superficial peroneal nerve which has central region low signal intensity representing “target” sign, which is also known as split fat sign. Differential diagnosis considered were schwannoma and neurofibroma. Later bone curettage was performed and histopathology examination revealed findings consistent with schwannoma.

ABSTRACT
Abstract: Introduction: Gall bladder carcinoma was first described in 17th century, Incidence of gall stones increased over time and so is the incidence of carcinoma gall bladder. Still tumor remains characterized by an unfavourable prognosis due to silent progression of the clinical course and limited knowledge of its aetiology and poor scientific capability for epidemiological forecasting. The incidence of GBC varies in different parts of the world. Overall incidence ranges from 0.11/100000 to 10.6/100000 in different cancer registries worldwide [1]. Our study is an attempt to establish relationship between CA19-9, CEA with metastasis, operability and resectability. Methods: Study type is prospective cohort study. It was carried out among newly diagnosed, intraoperative and referred cases of carcinoma gall bladder at IGMC Shimla. All newly diagnosed, intraoperative and referred cases of carcinoma gallbladder were recruited in the study. The total duration of study was of one year. Result: Female sex in their sixties are most commonly involved. Gall stones are associated with 56% of the patients. In CECT abdomen most common finding is of metastatic disease. Adenocarcinoma is most common HPE finding. CEA and CA19-9 both show direct relation with metastasis and in operability and inverse relation with resectability however results were not statistically significant. Conclusion: Gall bladder carcinoma incidence is increasing with time but measures to tackle it not evolving at the desired speed. CEA and CA19-9 showed some promising results but still a larger study needed to establish relation between them and the factors mentioned above. Primary prevention will arrive once high risk environmental toxins and genetic abnormalities are clearly identified and further studies should be dedicated for its early diagnosis and treatment.

ABSTRACT
Abstract: Coronavirus disease-2019(COVID-19) pandemic has quickly become an infectious disease of worldwide concern and there exists gaps in the proper understanding of various patterns on HRCT imaging. This meta-analysis aims to summarise the most frequent HRCT patterns in COVID-19 from various published studies to aid the quick diagnosis. We aim to consolidate knowledge from original studies done on COVID-19 patients and characterise the imaging patterns on HRCT for quick diagnosis. This is a Meta-analysis on the various HRCT chest findings of COVID-19.Studies were procured from PubMed and Google Scholar database published between December 2019 and September 2020.The specific demographic and imaging patterns were analysed and pooled to form the meta-analysis using the random effects model and single-arm analysis. Total of 12 studies met the inclusion criteria. Total pooled data consisted of 2787 RT-PCR positive cases. The three CT patterns most characteristic included Ground Glass Opacities (52%), Consolidation (40.4%), Interlobular Septal Thickening (14%). A combination of GGO and consolidation was most prevalent (59%). Other patterns noted included Crazy Paving pattern, Air Bronchogram, Pleural thickening, Pleural effusion, Bronchiectasis and Tree in bud. Most cases were bilateral (79%) and peripheral (77%). Lower lobe involvement: bilateral (66%), RLL (87%), LLL (81%). Upper lobe: Bilateral (61%), RUL (65%), LUL (69%). Right Middle lobe (55%). 25% had pan-lobar involvement. CT pattern recognition in potentially asymptomatic patients can be a diagnostic aid in early diagnosis of COVID-19. Ground glass opacities, consolidation and interlobar septal thickening in bilateral peripheral lungs was the most typical in COVID-19.

ABSTRACT
African men tend to present late with advanced prostate cancer (CaP) making prognosis grave despite treatment. This study was carried out to document findings in patients with metastatic prostate cancer at presentation. Seventeen (17) patients with metastatic CaP at presentation who had complete data were recruited. Peak age group was between 51 and 70 years of age with the commonest site of metastasis being bone (68.42%) and 2 patients (10.52%) having multiple sites of metastasis. The PSA range was 5.5-140 ng/ml with most patients having values above 20ng/ml and most patients were found to be within the higher prognostic grade groups. Metastatic prostate cancer is a challenge in our setting and there is need for routine screening for this disease.

ABSTRACT
Gastrulation, primary neurulation and secondary neurulation are the stages of spinal cord development. Spinal dysraphisms are caused due to aberration in the stages. Lipomyelocele is an occult spinal dysraphism with an estimated incidence of 3.1 cases per 10,000 people. arly detection and prompt neurosurgical intervention is mandatory, for which spinal neuroimaging plays a critical role. Here: we present to a rare case of lipomyelocele with pilonidal sinus.

ABSTRACT
Introduction: Diabetic foot ulcers constitute one of the most important complications of diabetes mellitus, with a staggering 25% lifetime risk. If not treated promptly, progression of infection and sepsis may necessitate a limb amputation. Studies from western population have shown significant implication of vacuum-assisted closure (VAC) therapy in various wounds including Diabetic foot ulcers. Considering the early onset of complications including diabetic foot ulcers in Indian diabetic patients due to differences in lifestyle, culture, socioeconomic status and health education, the role of VAC therapy needs to be studied to establish the efficacy and safety of VAC therapy in the management of diabetic foot ulcers in an Indian population. Materials and methods: Randomized controlled trail conducted in the Department of General surgery PESIMSR from January 2018 to December 2018, in patients with Grade 1 and 2 diabetic foot ulcers (As defined by Wagner‟s classification). Results: Granulation tissue appeared in 28 patients by the end of week-2 in group I, while it appeared in 11 patients by that time in Group II. Wound was favourable for grafting in Group I compared to Group II by 4 weeks. Conclusion: In the present study it was concluded that the rate of granulation tissue formation, overall graft survival and patient compliance was better in negative pressure dressing group compared to conventional dressing group.

ABSTRACT
The way to perform Cesarean Section (CS) is different among countries and hospitals but even between obstetricians working in the same department. The post-operative outcome depends on the way how, and which surgical steps are performed. Therefore, it is important to use a universal and evidence-based method which has been compared in scores of studies with other methods and proved to show benefits, and is worldwide accepted. This method is the Misgav Ladach (Stark) operation, which has been developed while examining each single step for its necessity, and when so, for the most optimal way to perform it. The aim of this article is to share the method with our African colleagues, to explain the different steps and the logic behind them, in order to accept it for universal use all over the African continent.