Background: s/Aims: Hepatocellular carcinoma (HCC) is generally diagnosed at an advanced stage, which limits curative treatment options for these patients. Locoregional therapy (LRT) is the standard approach to bridge and downstage unresectable HCC for liver transplantation (LT). Atezolizumab-bevacizumab (atezo-bev) can induce objective responses in nearly one-third of patients; however, the role and outcomes of downstaging using atezo-bev remains unknown. Methods: In this retrospective single-center study, we included consecutive patients between November 2020 and August 2023, who received atezo-bev with or without LRT and were subsequently considered for resection/LT after downstaging. Results: Of the 115 patients who received atezo-bev, 12 patients (10.4%) achieved complete or partial response and were willing to undergo LT; they (age, 58.5 years; women, 17%; Barcelona Clinic Liver Cancer stage system B/C, 5/7) had received 3-12 cycles of atezo- bev, and four of them had received prior LRT. Three patients died before LT, while three were awaiting LT. Six patients underwent curative therapies: four underwent living donor LT after a median of 79.5 days (range, 54-114) following the last atezo-bev dose, one underwent deceased donor LT 38 days after the last dose, and one underwent resection. All but one patient had complete pathologic response with no viable HCC. Three patients experienced wound healing complications, and one required re-exploration and succumbed to sepsis. After a median follow-up of 10 months (range, 4-30), none of the alive patients developed HCC recurrence or graft rejection. Conclusions Surgical therapy, including LT, is possible after atezo-bev therapy in well-selected patients after downstaging.

Background: One of the symptoms annoying patients after total knee replacement (TKR) is numbness around the operative scar. Some studies have shown that altering the incision in terms of placement or length may decrease the incidence of numbness. It still remains unknown whether numbness affects patient-reported outcomes. Methods: We conducted a randomized study to compare a short-length incision (n = 50) and a lateral exit incision (n = 50) with a standard midline TKR incision (n = 50) in terms of the incidence of numbness and its progress over 1 year of follow-up. Our secondary objective was to look at the involved zone, area of numbness, and secondary symptoms. We also looked at patient-reported outcome in terms of satisfaction in all groups using a visual analog scale and Forgotten Joint Score. Results: At 3 months postoperatively, the incidence of numbness was least in the lateral exit group: 46.2% as compared to midline (62%) and short (58.3%), but the difference was not significant (p = 0.07). At 6 months, the short incision group had a significantly lower incidence (8%) of residual numbness as compared to 30% in the other two groups (p = 0.003). At 1 year, most patients recovered sensation loss and had similar function. Conclusions Placement or length of an incision did not significantly affect the incidence of numbness; however, the short incision led to early recovery of numbness. At 1 year of follow-up, most patients did not complain of loss of sensation and had similar functional outcome.

Humans ; Fasciitis, Necrotizing/diagnosis* ; Prospective Studies ; Organ Dysfunction Scores ; Prognosis

PURPOSE: Various surgical modalities are available to treat Neer types 2 and 5 unstable fractures of lateral end clavicle but none of them are standardized. Arthroscopic fixation of the displaced lateral end clavicle fractures provides good short-term results but mid- to long-term outcomes are not available. The purpose of this study was to show the mid- to long-term radiological and functional outcomes of these fractures treated arthroscopically by a TightRope device, and to show the complications associated with this procedure. METHODS: A retrospective study was conducted over 2 years from January 2014 to December 2015 with a minimum 5-year follow-up. Active patients aged 18-50 years with acute (less than 3 weeks) displaced fracture of lateral end of the clavicle, with a minimum 5-year follow-up were included in the study. Patients with associated fractures of the proximal humerus, glenoid, scapula and acromioclavicular joint injuries were excluded from the study along with open fractures and neurovascular injuries. The outcomes were assessed by objective (complications and radiographic examination) and subjective criteria (quick disabilities of the arm, shoulder and hand score, the Constant-Murley score and the visual pain analogue scale). The data were analyzed by SPSS version 21.0. RESULTS: Totally, 42 patients were operated during the study period and 37 were available with a minimum 5-year follow-up. Thirty were male and 7 were female with a mean age of 29.5 years and a mean follow-up of 6.1 years. The mean quick disabilities of the arm, shoulder and hand score was 68.2 ± 4.6 preoperatively and 1.27 ± 2.32 at final follow-up (p < 0.001); the mean visual pain analogue scale score was 6.85 ± 2.2 preoperatively and 0.86 ± 1.60 at final follow-up (p < 0.001). The average Constant-Murley score was 93.38 ± 3.25 at the end of the follow-up. There were 2 fixation failures, with established non-union and 3 patients developed radiographic acromioclavicular joint arthritis. CONCLUSIONS Arthroscopic TightRope fixation of displaced lateral end clavicular fractures provides good radiological and functional outcomes at mid- to long-term follow-up. With the low complication rates and high patient satisfaction, this technique can be considered as a primary option in the surgical treatment of these fractures.
Humans ; Male ; Female ; Adult ; Follow-Up Studies ; Clavicle/surgery* ; Retrospective Studies ; Fractures, Bone/complications* ; Fracture Fixation, Internal/methods* ; Fractures, Open ; Pain ; Treatment Outcome

Purpose: Indians have a higher incidence of cardiovascular diseases, often at a younger age, than other ethnic groups. This higher baseline risk requires consideration when assessing additional cardiac morbidity of breast cancer treatment. Superior cardiac sparing is a critical dosimetric advantage of proton therapy in breast cancer radiotherapy. We report here the heart and cardiac-substructure doses and early toxicities in breast cancer patients treated post-operatively with proton therapy in India’s first proton therapy center. Materials and Methods: We treated twenty breast cancer patients with intensity-modulated proton therapy (IMPT) from October 2019 to September 2022, eleven after breast conservation, nine following mastectomy, and appropriate systemic therapy, when indicated. The most prescribed dose was 40 GyE to the whole breast/chest wall and 48 GyE by simultaneous integrated boost to the tumor bed and 37.5 GyE to appropriate nodal volumes, delivered in 15 fractions. Results: Adequate coverage was achieved for clinical target volume (breast/chest wall), i.e., CTV40, and regional nodes, with 99% of the targets receiving 95% of the prescribed dose (V95% > 99%). The mean heart dose was 0.78 GyE and 0.87 GyE for all and left breast cancer patients, respectively. The mean left anterior descending artery (LAD) dose, LAD D0.02cc, and left ventricle dose were 2.76, 6.46, and 0.2 GyE, respectively. Mean ipsilateral lung dose, V20Gy, V5Gy, and contralateral breast dose (Dmean) were 6.87 GyE, 14.6%, 36.4%, and 0.38 GyE, respectively. Conclusion The dose to heart and cardiac substructures is lower with IMPT than published photon therapy data. Despite the limited access to proton therapy at present, given the higher cardiovascular risk and coronary artery disease prevalence in India, the cardiac sparing achieved using this technique merits consideration for wider adoption in breast cancer treatment.

Coronavirus disease 2019 (COVID-19) has developed as a pandemic, and it created an outrageous effect on the current healthcare and economic system throughout the globe. To date, there is no appropriate therapeutics or vaccines against the disease. The entire human race is eagerly waiting for the development of new therapeutics or vaccines against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Efforts are being taken to develop vaccines at a rapid rate for fighting against the ongoing pandemic situation. Amongst the various vaccines under consideration, some are either in the preclinical stage or in the clinical stages of development (phase-I, -II, and -III). Even, phase-III trials are being conducted for some repurposed vaccines like Bacillus Calmette–Guérin, polio vaccine, and measlesmumps-rubella. We have highlighted the ongoing clinical trial landscape of the COVID-19 as well as repurposed vaccines. An insight into the current status of the available antigenic epitopes for SARS-CoV-2 and different types of vaccine platforms of COVID-19 vaccines has been discussed. These vaccines are highlighted throughout the world by different news agencies. Moreover, ongoing clinical trials for repurposed vaccines for COVID-19 and critical factors associated with the development of COVID-19 vaccines have also been described.

Introduction: Sleep deprivation is a concern in young adults and the use of mobile phone is very common in this population. This study aimed to measure and correlate the sleep quality, pattern of sleep and problematic mobile phone use in young medical students. Methods: A cross-sectional study was conducted using the Pittsburgh Sleep Quality Index (PSQI), Problematic Mobile Phone Use Scale (PMPUS) and Morningness-Eveningness Questionnaire (MEQ) among medical students in a Malaysian medical college. Correlation among the variables was done using bi-variate analysis followed by Pearson correlation coefficient and 2-tailed significance. A level for p ≤ 0.05 was considered as statistically significant. Results: We found significant positive correlation between poor sleep quality and total problematic mobile phone use as well as its sub dimensions, namely deprivation, adverse outcomes and control disorder. PSQI score showed significant negative correlation with different patterns of MEQ like moderate evening, late sleepers, moderate morning and early risers. Positive correlation of the PSQI with sub dimension of PMPUS reflects unhealthy dependency on mobile phone in this population. Conclusion: Our study revealed that the unhealthy use of mobile phone adversely affected sleep quality in the cohort of young medical students. It is thus important for medical schools to formulate policies and create educational programs vis-a-vis sleep health and to increase awareness regarding controlled mobile phone usage.

Novel coronavirus disease, the latest world pandemic is one of the most contagious viral infections to date. There has been a lack of uniformity on recognizing this condition clinically because of poorly understood pathophysiology and clinical nature. Also due to ongoing clinical trials, its management is also varied. This is a systematic review from evidence-based studies until March 1st, 2020, covering an update on its clinical features and management. This study shows the multisystem involvement of COVID-19 with dominant respiratory features followed by the musculoskeletal, gastrointestinal system and others. The clinical features varied from asymptomatic to severe forms. Major causes of fatality were acute respiratory distress syndrome, shock, acute cardiac injury, acute kidney injury, rhabdomyolysis, and arrhythmia. Major modalities of management included supportive, antiviral and antibiotic therapy. There was no direct relationship between the specific treatment and the outcome.

Objective: Previous studies have indicated a convergent and bidirectional relationship between metabolic syndrome (MetS) and bipolar disorder (BD). As most of these studies focused mainly on adults diagnosed with BD, our study aims to investigate and characterize metabolic disturbances in child-adolescents diagnosed with BD. Methods: We retrospectively examined the medical records of psychiatric hospitalizations with admitting diagnosis of BD in child-adolescents (age ＜ 18 years). Body mass index (BMI), lipid profile, fasting blood glucose, and blood pressure were primary variables. National Cholesterol Education Program criteria were used to define MetS. Reference group data was obtained from the National Health and Nutrition Examination Survey study. Statistical analyses included t tests, chi-square tests, and Fisher’s exact tests. Results: We identified 140 child-adolescent patients with BD (mean age = 15.12 ± 1.70 years, 53% male). MetS was significantly more common in BD compared to the reference group: 14% (95% confidence interval [95% CI] 8−20) vs. 6.7% (95% CI 4.1−9.2), p = 0.001 with no significant difference by sex. MetS components were higher in the BD group, particularly BMI ≥ 95% (25% vs. 11.8%, p ＜ 0.001) and high blood pressure (17% vs. 8%, p = 0.05). Moreover, female patients had lower odds of high blood pressure (odds ratio = 0.24 [95% CI 0.08−0.69], p = 0.005). Conclusion Compared with the general child-adolescent population, the prevalence of MetS was significantly higher in patients with BD of same age. This reiterates the notion of an increased risk of MetS in patients diagnosed with BD; and thus, further exploration is warranted.

The Livestock Sector of India plays an important role in livelihood security and socioeconomic development of rural households. Leptospirosis is an important zoonotic disease responsible for septicaemia, interstitial nephritis, jaundice, abortion, reproductive problem in most of the animal species. Reproductive disturbances in bovine population is most often restricted to investigation of brucellosis, however apart from brucellosis, there are many undiagnosed diseases like leptospirosis that takes a toll in the reproductive anomalies of cattle and buffalo. Hence, the present study was elucidated to screen the seroprevalence of Leptospira in cattle and buffalo in various hamlets of North India using a user friendly screening test i.e. LipL32 latex agglutination test. The overall seropositivity was found to be 26.01% (230/884) in case of bovine in this study and the LipL32 LAT showed a profound sensitivity and specificity with level of 94.97% and 99.53% respectively.