Background: Accurate assessment of burn wound depth is crucial for appropriate management and improved outcomes. Clinical evaluation remains subjective, and advanced diagnostic modalities are often costly or impractical. Methylene blue, a vital dye, has been proposed as a simple and reliable method for differentiating viable from non-viable tissue during burn wound management. Objectives: To evaluate the efficacy of methylene blue in determining burn wound depth during tangential excision, to compare healing outcomes between grafted and non-grafted areas, and to assess patient satisfaction and aesthetic outcomes. Methods: A prospective observational study was conducted on 20 patients with mixed flame burns requiring tangential excision. Methylene blue dye was applied over burn wounds, where viable tissue decolorized the dye while non-viable tissue retained the blue stain. Tangential excision was performed accordingly until viable tissue was reached. Excised areas were divided into grafted and non-grafted regions. Outcomes measured included healing time, graft take, complications, patient satisfaction, and scar appearance. Results: Methylene blue effectively differentiated viable from non-viable tissue, aiding precise excision. Grafted areas healed within 2 weeks, whereas non-grafted areas required more than 3 weeks. The mean graft take was 95%. Complications such as itching (35.3%) and hypertrophy (35.3%) were more common in non-grafted areas compared to grafted areas (11.7% and 23.5%, respectively). Although grafted areas healed faster, non-grafted areas showed better cosmetic appearance with uniform pigmentation. Hospital stay was reduced by approximately one week with early excision and grafting. No adverse effects related to methylene blue were observed. Conclusion: Methylene blue is a safe, cost-effective, and reliable adjunct for burn wound depth assessment. Its use improves surgical precision during tangential excision, enhances healing outcomes, and reduces morbidity. While grafting accelerates healing, non-grafted areas may offer better cosmetic results at the expense of higher complication rates.

Background: Femoral shaft fractures are common high-energy injuries associated with significant morbidity, particularly in young adults. Antegrade intramedullary interlocking nailing has become the gold standard for their management due to its advantages of minimal soft tissue disruption, stable fixation, high union rates, and early mobilization. In addition to fracture union, functional recovery has emerged as a key outcome measure. This study aimed to evaluate the functional outcomes of femoral shaft fractures managed with antegrade intramedullary interlocking nailing in a tertiary care setting. Materials and Methods: A prospective observational study was conducted over 18 months at AIMS & RC Hospital, Rajasthan. A total of 56 adult patients (≥18 years) with fracture shaft of femur, including closed and Gustilo-Anderson type I and II fractures, were included. All patients underwent antegrade intramedullary interlocking nailing under spinal anaesthesia. Clinical and radiological evaluations were performed pre- and postoperatively, with regular follow-up. Fracture union was assessed radiologically, and functional outcomes were evaluated using the Thoresen et al. scoring system. Results: The mean age was 31.54 years, with the majority in the 18–30 years group (50%), and a male predominance (66.07%). Road traffic accidents accounted for 94.64% of cases. Type III fractures were most common (46.4%). Most patients had a hospital stay of 10–15 days (53.57%). Partial weight bearing was achieved within 12 weeks in 71.4% of patients, while 71.4% achieved full weight bearing between 13–16 weeks. Radiological union was most commonly observed between 17–20 weeks (39.2%), with an average union time of 20.27 weeks; delayed union occurred in 3.57% and no non-union was observed. Full knee range of motion was achieved in 69.6% of patients. Malunion was seen in 10.71% (valgus 7.14%, varus 3.57%) with no rotational deformities. Limb length discrepancy was absent in 92.8% of patients. Complications included superficial infection in 1 case and knee pain in 6 patients. Functional outcomes were excellent in 69.64%, good in 19.64%, and fair in 10.71% of patients, with no poor outcomes. Conclusion: Antegrade intramedullary interlocking nailing is an effective and reliable modality for the management of femoral shaft fractures, providing high union rates, satisfactory alignment, low complication rates, and favourable functional outcomes.

Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis, particularly in developing countries. Early and accurate diagnosis is essential for timely management and prevention of complications. This study evaluates the concordance between cytopathology using fine needle aspiration cytology (FNAC) and Gene Xpert MTB/RIF assay in diagnosing lymph node tuberculosis. Materials and Methods: A prospective study was conducted on 120 patients presenting with lymphadenopathy clinically suspected for tuberculosis. FNAC was performed, and aspirates were subjected to cytological examination and Gene Xpert testing. Cytological findings were categorized into granulomatous lymphadenitis with necrosis, without necrosis, suppurative lesions, and reactive lymphadenitis. Results: Out of 120 cases, cytopathology suggested tuberculosis in 85 cases (70.8%), while Gene Xpert detected Mycobacterium tuberculosis in 78 cases (65%). Concordance between FNAC and Gene Xpert was observed in 72 cases, yielding an overall agreement of 85%. Gene Xpert showed higher specificity in detecting Mycobacterium tuberculosis, particularly in necrotic and suppurative lesions. However, FNAC demonstrated higher sensitivity in identifying granulomatous inflammation even in Gene Xpert-negative cases. Conclusion: The combined use of cytopathology and Gene Xpert significantly improves diagnostic accuracy. While FNAC remains a rapid, cost-effective screening tool, Gene Xpert provides microbiological confirmation and detects rifampicin resistance. The dual diagnostic approach is therefore recommended for better clinical decision-making in lymph node tuberculosis.

Background: Tracheoesophageal fistula (TEF) is a rare congenital anomaly with significant morbidity and mortality, particularly in resource-limited settings. Prognosis is influenced by factors such as birth weight, associated anomalies, and postoperative complications. Objective: To evaluate the diagnosis, outcome, and prognosis of patients with tracheoesophageal fistula at a tertiary care centre. Methods: A retrospective and prospective study was conducted in the Department of General Surgery over five years (2020–2024). A total of 46 neonates diagnosed with TEF were included. Data on demographics, clinical presentation, associated anomalies, surgical management, and postoperative outcomes were analyzed. Statistical analysis was performed using SPSS version 25. Results: The mean age at presentation was 1.91 days, and mean birth weight was 2.04 kg. Type C TEF was the most common (93.5%). Associated anomalies included cyanotic congenital heart disease (23.9%) and spinal anomalies (28.3%). Postoperative ventilator support was required in 58.7% of cases. Overall mortality was 52.2%, with ventilator-associated pneumonia (21.7%) and sepsis (19.6%) being the leading causes of death. Survival was poorest in neonates weighing <1.5 kg and those with associated cardiac anomalies. Conclusion: Outcomes in TEF are strongly influenced by low birth weight, associated congenital anomalies, and postoperative infectious complications. Early diagnosis, multidisciplinary care, and improved neonatal intensive care support are essential to reduce mortality, particularly in high-risk groups.