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In the current Indian medical practice, consent is not well understood, and practical obstacles tend to hinder meaningful applications of the concept. Consent cannot simply be bolted onto existing practices; old models of decision-making need to change, and now is the time to examine the underlying ethics. India in many ways is at a crossroad in terms of how clinical decisions are made, when and in particular, by whom. Some difficulties are structural, having to do with health care delivery and resources within the public sector; others are more subtle, having more to do with attitudes and cultural norms. Either way, there are no “quick fixes,” although detailed guidance on standards of consent would surely be a help, backed up by educational interventions for health care professionals on autonomy and consent. As an aid to this process, a flowchart for clinicians is included at the end of the paper, with potential applications for use in end-of-life, intensive care, and other clinical settings.

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Aims and Objectives: To analyze whether there is a significant difference in the width of the labyrinthine segment of the facial canal between the affected and the unaffected sides in cases of unilateral Bell's palsy, and also to ascertain whether there is any correlation between the degree of facial nerve degeneration and the width of the facial canal.Study Design: Prospective observational study. Setting: Tertiary care university hospital. Material and Methods: A total of 30 patients with unilateral Bell's palsy underwent high-resolution computed tomography with 1-mm-thick contiguous axial sections. The width of the labyrinthine portion of the facial canal at its proximal end (meatal foramen) and at the mid-labyrinthine portion was assessed on both the affected and the unaffected sides and was compared using the paired t tests. Nerve conduction studies were done to assess the degree of facial nerve degeneration. The percentage of facial nerve degeneration was compared with the width of the labyrinthine portion of the facial canal at both the aforementioned sites using the t tests of significance. Results: The width of the labyrinthine segment, both at the meatal foramen and at the mid-labyrinthine part, was significantly different on the affected side as compared with the unaffected side. The degree of facial degeneration was assessed using nerve conduction studies. Majority of the patients with less than 50% degeneration recovered within 1 month, and by 2 months, 100% of patients recovered, including those with more than 75% degeneration. The compound action potentials did not correlate significantly with the width of the facial canal. Conclusion: The width of the labyrinthine segment of the facial canal may be a potential predisposing factor in the etiopathogenesis of Bell's palsy. The degree of facial nerve degeneration, however, did not correlate with the narrowing of the labyrinthine segment of the facial canal on the affected side in Bell's palsy.

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Aims and Objectives: To find a predictive scale for the duration of stay in the hospital in patients of dengue with no previous comorbidities, at a tertiary care centre. Materials and Methods: All patients consenting to be a part of the treatment were subjected to a detailed history and physical examination. The diagnosis of dengue was confirmed by either Dengue NS1 antigen or IgM Dengue serology (ELISA). Thereafter, their general condition and investigations such as the platelet counts were closely monitored. Lactate dehydrogenase (LDH) levels were done on the day of minimum platelet counts. The duration of symptom onset, date of admission, and duration of hospital stay were recorded. They were discharged when their platelet count showed significant increase in three consecutive samples. Results: On statistical analyses, the mean number of days to discharge from the date of testing LDH was 2.43 ± 1.10 days (P = 0.0001, r = 0.8178). The mean number of days to discharge calculated by LDH in dengue (LID) scale was 2.43 ± 1.04 days and the mean number of days to actual discharge from the date of testing LDH was 2.43 ± 1.10 days (P = 1).Conclusion: A possible date of discharge could be determined accurately by the levels of LDH tested at the time of the lowest platelet count. Using this LID scale, discharge date can be predicted.

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X-rays have been used to diagnose diseases in the kidney and urinary tract for about a century. With the advent and advancement of endourology, fluoroscopy has become an integral part of urologic practice. Percutaneous nephrolithotomy, ureterorenoscopy, and extracorporeal shock wave lithotripsy now form the first line treatment modality for urinary calculi. The increased use of fluoroscopy has led to enhanced risk of occupational exposure of the urologist and assisting staff to radiation, leading to health hazards. Therefore, there is an urgent need for protection of both patient and staff from ionizing radiations during urological procedures. There is also a need for adopting dose management techniques in every radiological examination without compromising on the image quality, clinical purpose, to reduce the number of computed tomography scans, and other radiological evaluations for surveillance of various urological illnesses. This article provides a review on the risks of radiation, radiation doses in common urological procedures, current recommendations and regulations for radiation exposure, and methods of radiation protection to be adopted by health personnel.

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Purpose: The purpose of this article was to prospectively study the relationship between bone marrow apparent diffusion coefficient (ADC) obtained on diffusion-weighted magnetic resonance imaging (DWI) and bone mineral density. Materials and Methods: A total of 107 randomly selected postmenopausal women underwent dual-energy X-ray absorptiometry of the spine and were divided into three groups: normal (n = 25), osteopenic (n = 30), and osteoporotic (n = 45). A total of 100 subjects were examined (7 excluded from study owing to pre-existing marrow pathologies) with DWI at 1.5 tesla using b values of 0 and 1000 s/mm². ADC values of the L3 vertebral body were calculated, and the results were compared between three groups and correlated with BMDs. Results: The mean ADC values in the normal, osteopenic, and osteoporotic groups were 0.49 ± 0.03 × 10⁻³, 0.40 ± 0.03 × 10⁻³, and 0.34 ± 0.04 × 10⁻³ mm²/s, respectively. The ADC values were significantly different (p < 0.005) in the three groups. For paired data, a significant positive correlation was observed between ADC values and BMDs and also between ADC values and T scores. Conclusions: In this study, bone marrow ADC values were observed to decline in line with a fall in BMDs. This direct relationship between ADC values and BMDs is likely a reflection of an increase in bone marrow fat content, a histomorphological change in osteoporosis. Bone marrow ADC can thus serve as an indirect quantitative measure of bone density as well as bone strength.

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The current advancements in fetal medicine are a celebration of human ingenuity and triumph. A realm that is both poignant and captivating, the possibilities born out of progress in anesthesia and minimal access surgical techniques in the fetal microcosm are huge. A number of strategic approaches, including fetoscopic interventions, minimally invasive surgeries, and ex utero intrapartum—the so-called EXIT—procedures have facilitated correction of a number of life-threatening fetal conditions and anomalies. However, the challenges and risks in performing in utero fetal anesthesia and surgical maneuvers are so considerable that still only a few tertiary healthcare facilities across the globe carry out these procedures.

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