JMS SKIMS

Artificial Intelligence in Plastic Surgery: Innovation or Illusion!

2026-06-13T12:06:32+0530

Plastic surgery has long stood at the crossroads of artistry and precision, where innovation is not merely welcomed but expected. In recent years, however, the speciality finds itself at the threshold of a transformative force called ‘Artificial Intelligence (AI)’. What was once speculative has now begun to permeate multiple domains, including clinical practice, research, and surgical training. The integration of AI into plastic surgery is driven by advances in machine learning, computer vision, and predictive analytics. These technologies are particularly well-suited to this speciality that relies heavily on visual interpretation, photography and outcome prediction. AI-based systems are increasingly being utilized for facial analysis, surgical simulation, and outcome prediction, thereby enhancing preoperative planning and improving patient counselling.

From Oxidative Stress to Genomic Instability: A Comparative Overview of Hemodialysis and Peritoneal Dialysis

2026-06-13T12:12:41+0530

Chronic kidney disease (CKD) is linked to elevated oxidative stress (OS) due to impaired renal function, inflammation, and uremic toxin accumulation. In end-stage renal disease, renal replacement therapies—hemodialysis (HD) and peritoneal dialysis (PD)—further increase oxidative burden, contributing to DNA damage and genomic instability. HD triggers acute oxidative bursts through blood contact with bio-incompatible membranes and complement activation, whereas PD causes sustained oxidative stress via continuous exposure to glucose-based dialysate and its degradation products. Excess reactive oxygen species induce DNA base oxidation, strand breaks, chromosomal alterations, and telomere shortening. Biomarkers such as 8-hydroxy-2′-deoxyguanosine (8-OHdG), comet assay, and micronucleus test consistently show higher DNA damage in individuals undergoing dialysis. Impaired DNA repair mechanisms and polymorphisms in base excision repair pathways exacerbate genomic instability. Long-term consequences include increased risk of cardiovascular disease, cancer, and cellular senescence. Preventive strategies, including antioxidant supplementation, biocompatible or vitamin E-coated membranes, lifestyle modifications, and optimization of dialysis modality and dialysate quality, may mitigate genotoxic risk. This review compares HD and PD in relation to oxidative DNA damage, highlighting mechanisms, biomarker evidence, and current preventive approaches

Real-world Outcomes of Emergency ERCP in Acute Cholangitis

2026-06-13T12:16:20+0530

Background: Acute cholangitis is a potentially life-threatening condition caused by biliary obstruction and infection. Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice; however, optimal timing and strategy, especially in severe (grade III) disease, remain critical. This study evaluated the clinical spectrum, ERCP strategies, and short-term outcomes of patients with acute cholangitis at a tertiary care centre in North India.

Methods: This prospective observational study included 50 patients undergoing ERCP at the Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, over six months from September 2024. Demographic, clinical, radiological, and microbiological parameters were recorded. ERCP timing, intervention type (upfront biliary stenting vs ductal clearance), and outcomes were assessed using Tokyo Guidelines 2018 severity grading. Early ERCP was defined as ≤24 hours from presentation.

Results: Mean age was 57.9 ± 14.0 years, with female predominance (52%). Most patients were 51–70 years old (62%) and from rural areas (76%). Severity grading: grade I 36%, grade II 38%, grade III 26%. Abdominal pain (96%) and fever (64%) were most common. Choledocholithiasis accounted for 84% of cases; malignancy 10%, benign strictures 6%. Upfront biliary stenting was performed in 66%, complete CBD clearance in 34%. Early ERCP was performed in 80% of cases. Early ERCP (≤24 h) was associated with a significantly shorter hospital stay compared with delayed ERCP (2.4 ± 0.7 vs 4.6 ± 1.8 days; p = 0.01), while rates of early clinical improvement and complications were comparable. In Grade III patients, upfront stenting shortened hospital stay and improved short-term outcomes. Bile cultures were positive in 84%, with Escherichia coli in 46%. Laboratory parameters improved significantly post-ERCP (bilirubin: p = 0.001, ALP: p = 0.022, ALT: p = 0.030). Complications occurred in 4% (mild cholangitis and pancreatitis), all managed conservatively with no ERCP-related mortality. Most patients were discharged within 3 days.

Conclusion: Early ERCP is critical for rapid clinical improvement in acute cholangitis. Overall outcomes were comparable between upfront biliary stenting and immediate ductal clearance; however, in Grade III cholangitis, upfront stenting was associated with more favourable short-term outcomes, including shorter hospital stay.These findings support early, context-specific ERCP strategies in high-grade disease.

Neurofibromatosis

2026-06-13T12:18:59+0530

A 52-year-old female presented with diffuse cutaneous involvement of Neurofibromatosis Type 1, with lesions distributed extensively over the face, scalp, neck, trunk, and both upper and lower extremities. The patient reported that several lesions had become tender over time, causing discomfort. Moreover, several lesions, owing to their size and anatomical location, were causing significant functional impairment, particularly with dressing and undressing, and were also compromising personal hygiene. In view of these symptoms, the patient sought surgical excision of the symptomatic and functionally limiting lesions.

Young Heart, Rare Tumor: A Case Report On Pericardial Synovial Sarcoma

2026-06-13T12:21:16+0530

Pericardial synovial sarcoma [PSS] is a sporadic rare primary malignant tumour of the heart. It belongs to a category of synovial sarcoma [SS] which accounts for approximately 5-10% of all soft tissue sarcomas and 4^th most common sarcoma. Mostly occur in people aged 20 to 40 years [1]. SS usually occurs in the extremities near joints, though it can rarely appear in other sites such as thoracic cavity [2]. Patients usually present with a deep-seated mass that has been present for several years. Most synovial sarcoma show a characteristic chromosomal translocation t(x;18) (p11;q11.2) producing SS18-SSX1-SSX2 or SSX4 fusion genes that encode chimeric transcription factors [3]. Histologically PSS may be monophasic, characterized by uniform spindle cells, or biphasic, containing both spindle and epithelial components. The diagnosis of PSS can be challenging due to its non-specific presentation. Today we will discuss one such case.

Preservation and Transport of the Amputated Part for Replantation: Principles, Practice, and Pitfalls

2026-06-13T12:23:50+0530

Traumatic amputation remains one of the most dramatic emergencies in reconstructive surgery, where the fate of the amputated part is determined not only in the operating theatre but, crucially, at the scene of injury and during transport. The interval between injury and definitive microsurgical repair represents a vulnerable window during which inappropriate handling can irreversibly compromise tissue viability. Accordingly, the preservation and transport of the amputated part are cornerstones of successful replantation, directly influencing survival rates, functional recovery, and long-term outcomes. However, unfortunately, the majority of patients who suffer traumatic amputations do not present properly. Dissemination of awareness and education to referring facilities may improve outcomes for patients who experience a traumatic amputation of an extremity or digit.