Robotics and Artificial Intelligence complement surgical technical expertise and judgement. A robot’s accuracy in the programmed performance of predesignated tasks is exquisite. Historically, with the evolution of microsurgery, senior surgeons designated delicate suture placement to more steady handed, sharper eyed young fellows or even nurses. Tactile feedback and ultrasensitive pressure velocity controls make robotics a viable but expensive option to fine surgical assistance. Autonomous surgical robots are however a distinct paradigm. Myriad unfathomed mysteries of human pathophysiology and anatomy confer upon surgical procedures complexities which defy stratification and simplification into sets of preordained tasks. In the current scenario where fuzzy logic, neural networks and intuitive computing are still in early evolution, robots replacing master surgeons seem as improbable as Google self driving cars in formula one racing. Robots have evolved as dextrous, fatigue and tremor free surgical tools. The data crunching capability of computers is improving in speed and in capability for machine learning. Human surgical maturity on the other hand is attained and matures through phases of information assimilation, knowledge consolidation and attainment of surgical wisdom. Human surgeons at the helm will, in this decade harness robotic capabilities and information template paradigms to fine tune many procedures and to augment surgical reach. Quantum leaps and paradigm shifts towards robotic surgical autonomy may be neither desirable nor practical.

Objectives: To evaluate the spectrum of diagnostic findings in hysterosalpingography (HSG) examinations performed at a tertiary care centre for past two years. Method: All the patients who underwent HSG at INHS Asvini between Jan 2014 to Jan 2016 for primary as well as secondary infertility were included in the study. The images were evaluated on the PACS by a radiology resident (2nd Yr) and a radiologist (11Yrs of experience). A total 102 cases were analysed. A total of 89 cases (87%) had normal findings and 13 cases (13%) had pathological findings. Conclusion: The results were compared with the prevalence of pathological findings in the review of literature. Good acceptance of HSG by the patients.No major complication.

Objective: Mycobacterial infections of the genital tract have been implicated in the etiology of female infertility. However it is almost impossible to get a tissue diagnosis due to inaccessibility of the genital organs involved. Hence a need was felt to put forward and validate certain clinical diagnostic criteria for Genital Tuberculosis in cases of infertility. Methods: Certain major and minor clinical criteria were selected and definitive diagnostic criteria to diagnose Genital tuberculosis was proposed. Those diagnosed as Genital Tuberculosis were exhibited six months of ATT. Results: 120 infertile couples were enrolled in the study. Out of 120 couples, 61(50.8%) were diagnosed as Genital Tuberculosis. Out of the 61 patients, 20(32.8%) conceived spontaneously while on ATT. Conclusion: The high conception rate in this study is most probably due to the fact that these are the patients who had early TB endometritis which carries a better prognosis as compared to those who have TB salpingitis who have a poor prognosis in terms of conception rate.

Cardiomyopathy is a primarily disorder of the heart muscle that causes abnormal myocardial performance and is not the result of disease or dysfunction of other cardiac structures. It is an important and heterogeneous group of diseases. We conducted this study at a tertiary care center with the aim to study the clinical profile and echocardiographic findings of cardiomyopathy patients. This study was a descriptive cross-sectional study conducted over a period of 18 months from September 2013 to August 2015. 50 consecutive patients of cardiomyopathy, attending out-patient department and admitted in tertiary care hospital and meeting inclusion and exclusion criteria were selected. Microsoft Office® Excel software was used for data entry and IBM SPSS 18 was used for descriptive statistics. In our study maximum number of patient belonged to age group of 30 to 49 years (n= 25, 50%). The mean age of presentation was 45.16 years where as mean age for male patients was 45.68 and for female patients was 45.18 years. Male to female ratio was 3.16:1.Dilated cardiomyopathy (n= 26, 52%) was most common type of cardiomyopathy. In DCM patients most common symptom was dyspnea (n=26,84.6%) and most common sign was pedal edema (n=14,53.8%). Among HCM patients, dyspnea (33.3%) was the commonest presenting complaint but large number of patients were asymptomatic (28.6 %) and commonest sign was pedal edema (n=5, 23.8%). In DCM patients common ECG findings include Left ventricular hypertrophy (34.6%), Left axis deviation (30.8%), Left bundle branch block (23.1%), atrial fibrillation (23.1%), sinus tachycardia (23.1%) and ventricular premature complex (11.5%). Common ECGfinding in HCM patients were Left ventricular hypertrophy (47.6%), giant T wave inversion in V2- V6 (42.9%), Left axis deviation (33.3%), ventricular premature complex (14.3%), Left bundle branch block (9.5%) and atrial fibrillation (9.5%). Echocardiography findings for DCM patients in our study were, LV systolic dysfunction (Mean LVEF: 26.3±10.3%), Global hypokinesia, Dilation of all four chambers (Mean LVIDd: 66.4±3.4mm and LVIDs 54.6±3.5mm), Mitral regurgitation (30.8%), Pulmonary hypertension (38.5%), Pericardial effusion (11.5%) and LV thrombus (7.7%).Echocardiographic findings in HCM patients showed marked LV hypertrophy, LVOT obstruction (38.1%), Asymmetric septal hypertrophy (52.4%), Apical hypertrophy (47.6%) and Systolic anterior motion of mitral valve (23.8%). In HCM patients, most common pattern of LV hypertrophy was pattern 3 (42.8%) i.e. Apical hypertrophy with any other segment hypertrophy followed by Pattern 1 (38.1%) i.e. Septal hypertrophy alone, pattern 2 (14.3%) i.e. septal and other segment hypertrophy excluding apex; and pattern 4 (4.8%) i.e. apical hypertrophy alone.

Background: Laryngeal injuries following intubation have a reported incidence from 63 to 94% and permanent sequelae are reported to be about 10 to 22% in the world literature. While several studies assessing the laryngeal complications are available in Western populations, minimal data is available in the literature regarding Indian population. Aim: The aim of this study is to evaluate laryngeal lesions in patients after prolonged intubation (>24 h), to correlate these lesions with the variables involved in the process of intubation and to determine the risk factors. Materials and Methods: The study was undertaken at the ICU of a Tertiary Care Hospital. AU patients extubated at the intensive care unit of our hospital after at least 24 h of intubation were included in the study. Fibreoptic Bronchoscopy was done on day of extubation, and weekly for 03 weeks. Result: 100 patients were included in the study. Laryngeal abnormalities were seen in 88 patients on the day of extubation. At the end of third week after extubation, only 09 patients had abnormal laryngeal findings. A multivariate stepwise regression model showed that bigger tube size and longer duration of intubation was associated with higher incidence of laryngeal complications on the day of extubation. At the end of third week laryngeal findings were influenced only by the duration of intubation and size of Endotracheal tube. Conclusion: Laryngeal alterations after extubation are directly associated with duration of intubation and size of Endotracheal tube.

Background: Thyroid Disorders are often underdiagnosed. This is probably due to the fact that most of the clinicians are unaware of that fact that clinical entities like Subclinical Hypothyroidism & Subclinical Hyperthyroidism do exist. Overt Hypothyroidism & Hyperthyroidism form only the tip of the iceberg of Thyroid Disorders. It has been shown in previous studies that unchecked subclinical hypothyroidism (SCH) in young individuals poses a risk for cardiovascular events in the future. This study attempts to assess the extent of Subclinical Hypothyroidism & Autoimmune Sub Clinical Hypothyroidism in the male members of the Indian Armed Forces. Through this study, the authors endeavour to bring to the notice that Subclinical Thyroid Disorders are an emerging health problem among the young individuals. It is also evident that clinical parameters alone are insufficient in establishing a diagnosis of hypothyroidism and are often misleading, thus biochemical confirmation is a must. Aims & Objectives: 1) To assess the thyroid function among asymptomatic male members of the Indian Armed Forces. 2) To study the distribution of non neoplastic thyroid disorders, if any, among the asymptomatic male members of the Armed Forces. 3) To detect the levels of Anti TPO antibodies among the members of the Armed Forces. 4) To correlate the variation in the T3, T4, TSH levels with the presence of Anti TPO antibodies. 5) To ascertain correlation, if any, between age of the subjects & presence of Anti thyroid antibodies. Materials & Methods: This is an Observation Crossectional Study performed at a Tertiary Care Naval Hospital over a period of 15 months.100 Male volunteers meeting the Inclusion & Exclusion criteria were enrolled using simple random sampling. The samples were tested for Serum T3, T4, TSH & Anti TPO Antibody levels using the STRATEC SR 300 Analyser on the day of collection. The data was analysed using the SPSS software & depicted in figures. Results: The prevalent non neoplastic Thyroid Disorders in the study population were Subclincal Hypothyroidism, Autoimmune Subclinical Hypothyroidism, Overt Hypothyroidism & High Anti TPO Antibody levels with normal Thyroid Function.The Mean Age of Presentation of Subclinical Hypothyroidism, Positive Anti TPO Antibodies & Autoimmune Subclinical Hypothyroidism were 27 ± 8.36 years (p>0.05), 26.12 ± 9.0 years (p>0.05) & 26.5 ± 7.0 years (p>0.05) respectively .The prevalence of Autoimmune Subclinical Hypothyroidism (p=0.0004), Overt Hypothyroidism (p value 0.042) & Anti TPO Antibody positivity (p=0.017) in the study population was significantly lower compared to the results of the prevalence of these disorders in General Population Based Studies. The Serum T4 levels and Age in the study population were found to have a statistically significant inverse correlation (p=0.041) Conclusion: Subclinical Autoimmune Hypothyroidism & Overt Hypothyroidism are the most prevalent non neoplastic thyroid disorders in the Male members of the Indian Armed with their prevalence in the study population being significantly less than the General population. Anti TPO antibody positivity precedes thyroid symptoms & deranged Thyroid Profile. Serum T4 has a significant inverse correlation with age & serum TSH levels. However, the correlation serum Anti TPO Antibody levels & age of the individuals is insignificant.

Introduction: Diving is an operational commitment of navy. Diving operations are conducted with / without the presence of a Marine Medical Specialist. Incidence of Decompression amongst naval divers is low compared to recreational SCUBA diving. Decompression Sickness (DCS) and Pulmonary Overinflation Syndrome (POIS), subsets of diving-related injury related to scuba diving. If adequate decompression time is omitted, the trapped bubbles may lead to DCS. POIS is due to an overly rapid ascent to the surface resulting in the rupture of alveoli and subsequent extravasation of air bubbles into tissue planes.On rare occasions, the bubbles may traverse the cerebral circulation (CAGE), causing a potentially fatal condition. Overall, the incidence of adverse effects can be diminished with safe diving practices. Decompression Sickness (DCS): DCS is a condition in which metabolically inert gas gas bubbles that form while diving do not have adequate time to be resorbed or “off-gassed.” It never happens with pure oxygen diving and never occur while at bottom. As per grading, Type I - minor DCS, generally known as bends and Type II - severe DCS. Treatment: Treatment for DCS is followed as per guidelines promulgated in INBR 2806. Mainstay of treatment remains with Oxygen Table 61 & 62 of INBR 2806 which is same as RNBR 2806 as table 5 & 6 of US navy Diving Manual. Incidences: Incidences of DCS are reported at Diving training centre and saturation diving vessels and incidences of diving related injuries like Mask injury, hypoxia, CAGE are documented are reported at Escape Training School. Conclusion: Incidence of DCS in Navy Divers is rather very low due to proper follow of procedures, stringent trainingand fitness of divers.

Introduction: Dapsone syndrome is a distinct hypersensitivity reaction characterized by skin rash, fever, generalized lymphadenopathy, hepatosplenomegaly and hepatitis which subside with cessation of dapsone therapy. Case Report: A 37 year old male on dapsone lOO mg twice daily for erythema elevatum diutinum (a cutaneous vasculitis) presented with fever, icterus, skin rash and hepatosplenomegaly at five weeks. Investigations revealed the following: Hb 9.8 g%, serum bilirubin 9.0 mg%, SGOT 600 IZJ/l and SGPT 650 IU/l. Peripheral blood smear showed haemolytic anemia; bone marrow biopsy revealed erythroid hyperplasia. ICT for falciparum malaria, DGI for leptospira, Weil-Felix test, HBsAg and HIV were negative. A diagnosis of Dapsone Syndrome was made. Dapsone was stopped and prednisolone started in a low dose. The patient recovered completely and was discharged after 03 weeks. Discussion: Dapsone syndrome is also called “five week dermatitis” because it commonly occurs during the fifth week dapsone intake. Although the exact cause of dapsone syndrome is unknown, preferential metabolism by the N-hydroxylation pathway is considered key to its pathogenesis. Using Naranjo’s ADR probability scale we inferred that dapsone intake was the probable cause in this case (score of 6). In view of its increasing incidence, practitioners prescribing dapsone need to be familiar with the syndrome.

We herein report a case of small bowel obstruction and ileus secondary to impaction of Gall stone at terminal ileum. It is one of the rare complications of cholelithiasis usually presents in a patient with long standing disease. She presented with features of small bowel obstruction and distention of abdomen. The management dilemma was between simple enterotomy to relieve obstruction and repair of cholecystoduodenal fistula in addition. Doing only enterotomy, has a good prognosis but has chances of recurrence but, repair of fistula in addition to enterotomy in same setting have variable results in terms of morbidity.

Background: Anaphylaxis reactions are common during the use ofASV. We are reporting a case of ASV induced pulmonary edema in a 23 years old male with history of viperine snake bite. Case Report: A 23 years old ill looking male presented with swelling and pain left lower limb, was febrile with tachycardia, respiratory rate of 24/minute, Blood Pressure of 90/60 mm Hg and 02 saturation of 96% at room air. Local examination of revealed two puncture marks with edema andpetechiae. His bedside 20 min whole blood clotting test (WBCT) was deranged. The patient was given 10 vials of anti snake venom and after 90 mins of ASV administration, the patient became restless, with a temp of 104°F, pulse rate of 144/min, BP of140/70, RR of 38/min and Sp02 of 74% at room air with bilateral coarse crackles over all lung fields. Urgent chest x-ray suggested pulmonary edema. He responded well to symptomatic management. Discussion: Up to 80% of patients treated with antivenoms present with adverse effects like anaphylactoid or pyrogenic reactions, or late serum sickness4. In our case, the pulmonary edema was not due to the snake bite neither was it due to fluid overload. Pulmonary edema developed 90 mins after ASV administration. Conclusion: Direct causation of pulmonary edema due to ASV should be kept in mind while managing snake bite cases.

Toxic epidermal necrolysis (TEN) is a life-threatening, typically drug-induced, mucocutaneous disease. TEN has a high mortality rate, making early diagnosis and treatment of paramount importance. New but experimental diagnostic tools that measure serum granulysin and high-mobility group protein B1 (HMGB1) offer the potential to differentiate early TEN from other, less serious drug reactions, but these tests have not been validated and are not readily available. The mainstay of treatment for TEN involves discontinuation of the offending drug, specialized care in an intensive care unit or burn center, and supportive therapy. The effectiveness of systemic steroids, intravenous immunoglobulins, plasmapheresis, cyclosporine, biologies, and other agents is uncertain.

It was in 1872, the first case of a choroidal metastasis was reported by Perls. 90% of uveal tract metastasis is located in choroid. The most common primaries are from breast in females and lung in males. Here we report a case of choroidal metastasis from prostate adenocarcinoma. There had been reports of only 09 other patients with choroidal metastasis from prostate. We believe this is the first time this is being reported in India.

Military medicine is one of the most diverse fields of medicine and diving medicine forms an integral part. Diving medicine in fact grew out of concerns for military divers and till today the primary training and research involve military diving. Today, diving medicine training is faced with numerous challenges, right from lack of understanding and exposure of undergraduates to diving medicine, to a lack of awareness in the mainstream medicine fraternity. This paper is intended to deal with some current challenges facing the specialty and offers certain solutions. The solutions would mostly involve cooperation and collaboration of international agencies, organizations, and various countries to make a joint effort to resolve these challenges and take the field of military diving medicine forward.

Background: Health and medical issues are one of the most important aspects of disaster relief, as populations recovering from the aftermath of a disaster are extremely vulnerable from injuries and other health problems. Effective disaster management invariably involves complex health challenges and regional cooperation. Health Aspects of Disaster Cycle: The health aspects of a disaster are analysed according to the tools of the conventional disaster cycle to identify priority areas. Health challenges: Certain pertinent issues like, short and long term health burden, damage to health facilities and infrastructure and cost effectiveness of external aid are discussed which are outside the pale of the conventional disaster cycle approach. Salient features of disaster medicine: Quality control, epidemiological research, legal and ethical issues are crucial aspects of disaster medicine which need to be addressed. Regional cooperation: The role of regional cooperation to meet the health challenges should have a symbiotic approach.

Saturation Diving is a highly technical and advanced form of diving utilized to perform dives at depths greater than 55 metres. It employs physiological principles and decompression techniques which enables the diver to have an almost unlimited stay at the depth. This requires the diver to be saturated at the requisite pressure in a diving chamber for prolonged periods. Saturation diving necessitates stringent fitness standards of divers, careful and exhaustive planning of the dive, creating tailor made breathing mixtures, a high level of medical preparedness and response, continuous scrupulous monitoring of the divers’ physiological and environmental parameters and long term follow up to obviate any unwanted outcome. The purpose of Saturation diving is to provide cost effective and extensive period of stay underwater to perform useful work at great depths. It is employed commercially for exploration and maintenance of offshore platforms such as oil rigs and militarily for submarine rescue and salvage of sunken aircraft and ships. In Submarine rescue, it provides the valuable back up and training effort. The limitations of Saturation diving are: highly technical equipment which is expensive and maintenance intensive, prolonged training of personnel and meticulous execution of the dive is mandatory.

If the situation would so occur, during a disabled submarine (DISSUB) situation the decision on whether to escape or to wait for rescue to arrive would a difficult one to make for a submarine commander. There would be certain situations where the decision would be unilateral, but often not so. Escape on one’s own means using the submarine escape set would be fraught with the possibilities of a multitude of medical problems whilst rescue would be associated with the uncertainty of the long wait for help to arrive. Nevertheless, if the conditions so allow, rescue is a preferable option. However, the catch is, ‘if the conditions so allow’. That means that the conditions inside the submarine have to be favourable for the crew to survive inside the submarine for a period of 3 to 6 days. The submarine therefore is accordingly provisioned with emergency food and water and regeneration equipment. However, one factor which can be the deciding factor for the decision between escape and rescue is that of temperature inside the submarine. In a study carried out on survival inside a submarine, submarine crew were made to stay inside a simulated disabled submarine for 24 hours surviving only on emergency food and water supply. The temperature and humidity inside the submarine rose to an extent that the crew suffered from dehydration and severe thermal stress. Thermal stress, especially, uncompensable thermal stress as would be expected inside the DISSUB, has been seen to lead to cardiovascular strain and increased ventilation later progressing to hypotension, lassitude and reduced cognition. The thermal stress therefore would need to be addressed so as to not to become a factor which would lead the crew to escape sooner rather than wait inside the submarine for rescue. This paper discusses the effects and the resultant consequences of thermal stress that would likely occur inside the disabled submarine especially with respect to the decision between escape and rescue.

Endurance athletic activities, which requires top level cardio respiratory system fitness are recently becoming popular in the various parts of the country. Armed Forces are forefront in participation of those sporting activities, like marathon running, prolonged swimming or cycling. It has been found to have various long term beneficial effect in body function as a result of prolonged endurance activities, but it has also found that there are various bodily changes which may affect in anaesthetising the individual during emergency and elective surgeries. Literature review of various journals related to endurance sporting activities has described those bodily changes and effects of anaesthesia and pain on those changes. Based upon the available literature a guideline has been formulated for perioperative management of those patients. Most of those available literatures are from countries other than our country. The time has come for venturing in for carrying out further studies in our scenario, especially in Armed Forces in this new horizon of anaesthesia and critical care

Generally Nobel laureates are known and celebrated because of the discoveries for which prizes are awarded. Many of them possess unknown facets which are to be celebrated with equal recognition but go unreported because the award winning discovery overshadows other facets of the individual. Nobel prizes were awarded first time for achievements during the year 1901. During the first part of 20th century most of the individuals awarded were medical graduates and several among them were practicing doctors. While looking at the winners, few of them achieved remarkable landmarks in other fields but these “facets” were not known widely. Sir Frederick Grant Banting, Co discoverer of Insulin, researched in Aviation and Diving Medicines along with the gifted team of scientists and results when applied saved thousands of lives of flight crew. He was also the youngest to be awarded the prize and achieved it in a span of 3 years since commencement of research.

Indian Navy has recently joined the select band of countries that are operating nuclear powered platforms. Despite the fact, that the present day nuclear technology is quite advanced and safe; accidents on board can still happen. An accident on board a Nuclear Platform at sea can result in ‘Radiation Exposure and Contamination’ to the crew members; which can prove catastrophic. Management of casualties on board a Nuclear platform at sea presents a formidable challenge. The distressed platform being at sea will also bring in many other operational variables like distance from shore, geographical location, weather conditions, availability of rescue assets and trained manpower etc. Consequently, there is a necessity to have a well defined ‘Medical Contingency Plan’ to deal with any such eventuality happening at sea. The successful execution of the contingency plan will depend upon close coordination among diverse authorities like local Service Hospital, Command Medical & Operational Authorities, Naval Dockyard, Radiation Safety Organisations and the Rescue/Hospital Ship crew. The need is to have a holistic review of our existing medical set up and integrate new equipment, training methodologies, operating procedures to have a credible response capability.