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Introduction: Colorectal Cancer (CRC) has been primarily considered a disease of the elderly, but recent data have shown an alarming rise among young people. It has also been suggested that young age is associated with aggressive histopathological characteristics and advanced stages of the disease at diagnosis. Aim: To assess and compare the clinical and pathological characteristics of patients with rectal cancer diagnosed at ages over and below 45 years. Materials and Method: This prospective cross-sectional study was conducted between January 2020 and August 2022 in the Departments of Surgical, Medical, Radiation Oncology, Surgical Gastroenterology, and General Surgery at All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakand, India. All patients underwent a biopsy from the representative site for histological documentation of the disease. They then underwent treatment (surgery/chemotherapy/radiotherapy) as required. All the data were categorised into two groups: an early-onset group (age <45 years) and a late-onset group (=45 years). A comparison of the clinicopathological characteristics (age, gender, comorbidities, tumour subsite, clinical presentation, clinical stage, etc.), pathological data (grade and differentiation of tumour, as per World Health Organisation (WHO) grading system), and serum Carcinoembryonic Antigen (CEA) levels between the two groups was performed. The association between categorical variables was investigated using the Chi-square test. The mean difference was assessed using an independent t-test. A p-value of 0.05 or below was considered statistically significant. Results: A total of 51 patients with rectal cancer, 35 males and 16 females, were included in the study. The mean age was 44.73±16.47 years. Out of the total of 51 (100%) patients, lower rectum involvement was seen in 22 (43.1%) patients, followed by 7 (13.7%) patients each with ascending colon and sigmoid involvement resepectively. However, the Chi-square test showed no statistically significant association of location involved with age groups (2=9.09; p=0.16). Out of 51 (100%) adenocarcinoma patients in total, three patients each under 45 years of age had signet cell adenocarcinoma and mucinous adenocarcinoma (2=7.07; p=0.029). Among the total of 51 (100%) patients, moderately differentiated lesions were seen in 17 (33.3%) patients, poorly differentiated lesions were seen in 15 (29.4%) patients, and well-differentiated lesions were seen in 10 (19.6%) patients 2=13.01; p=0.005). Conclusion: Younger patients tended to have larger tumours that were of a higher grade and had signet ring or mucinous histopathology. The social and clinical implications of these findings are to be explored. [ABSTRACT FROM AUTHOR]

Introduction: Cancer impacts not only people living with cancer but also their caregivers. In hospital, caregivers always have pressure on them and their personal and private lives are disrupted during the caring process. Aim: To identify the various factors affecting the Quality Of Life (QOL) among caregivers of cancer patients. Materials and Methods: This quantitative study with an exploratory research design was conducted in oncology Outpatient Department (OPD) of All India Institute of Medical Sciences, Rishikesh, India, from November 2019 to February 2020. A total of 256 caregivers of cancer patients, who were visiting various oncology units were included. Data regarding caregiver's sample characteristics, clinical variables and caregiver's Oncology Quality of Life questionnaire (CarGOQoL) were collected. Statistical analysis was done using Chi-square test and Fisher-exact tests were used to study variables. Results: Majority, 94 (37%) belonged to 41-50 years age group, 143 (56%) were females, and 142 (56%) lived in rural areas. Patients' diagnoses were breast cancer in 94 (37%), Stage-III in 133 (52%), symptoms lasting more than 6-12 months in 103 (40%), and were partial dependent in 172 (67%). A total of 123 (48%) of caregivers scored less in the CarGOQoL questionnaire, so about half of the caregivers had a poor QOL. Caregiver coping (43%) and the private life domain were enormously affected in 193 (37%). Significant relationships with caregivers' QOL were seen for variables like female gender (p-value=0.037), educational level of patients (p-value=0.018), caregivers with co-morbidities (p-value=0.05), and the number of earning members in the family (p-value=0.022). Conclusion: Care burden always has an impact on the caregiver's overall QOL. It mainly affected their psychological well-being, burdens, and private lives. Therefore, comprehensive attention should be given to patients as well as caregivers. [ABSTRACT FROM AUTHOR]

The Coronavirus Disease 2019 (COVID-19) pandemic wreaked havoc on almost all aspects of life and has undeniably altered the landscape of the world forever. In the medical profession, everything from education to scheduling operations was affected. Educational events such as conferences, Continuing Medical Education (CME) and other events had to be converted into virtual conferences and meetings. However, now that the pandemic is slowly coming to an end and countries and borders have started to reopen, the question now remains-should we go back to our old ways or has this become the new normal? This review discusses the advantages and limitations of conducting virtual events and discusses future trends of holding such events in these uncertain times. [ABSTRACT FROM AUTHOR]

Introduction: It is well established that overt hypothyroidism, itself was a risk factor for atherosclerosis. Retinal Venous Occlusion (RVO) is caused by localised atherosclerosis. Subclinical Hypothyroidism (SCH) also cause arteriosclerosis thereby could be an important causative factor for RVO. But no study on SCH in RVO has taken place in Indian population. Aim: To find the prevalence of SCH in RVO in Indian Population. Materials and Methods: Thyroid hormones and Anti-Tissue Peroxidise (TPO) antibody was measured in 479 RVO cases in this two year prospective cross-sectional study in ESIC medical college. Data was entered into Microsoft Excel and presented in tables. Results: In this study, 312 males (aged 52±7.2 years) and 167 females (aged 47±7.7 years) with RVO were screened for thyroid hormones and anti-TPO antibody. Thyroid disorders were found in 162 patients out of 479 participants in this study (33.8%). Moreover, 52 cases were found to have SCH (10.8%) which is 32.1% of total thyroid disorder among RVO cases. An118 patients had high anti-TPO antibody among 162 RVO cases with thyroid disorders (72.8%) and only 67 had high anti-TPO antibody among 317 euthyroid RVO cases (21.1%). Conclusion: This study has shown that SCH was a modifiable risk factor of RVO. Therefore, understanding the prevalence of SCH in this population might help in the prevention of RVO by secondary preventive intervention. Moreover, all SCH cases should be referred to ophthalmologist for evaluation of retinal vasculature. [ABSTRACT FROM AUTHOR]

Introduction: Acne vulgaris is a chronic inflammatory disease of pilosebaceous unit characterised by areas of seborrhoea, comedones, papules, nodules, pimples, and possibly scarring that may remain for rest of the life. Acne is a treatable disease but needs prolonged treatment with patience and its onset in adolescence has been found to influence the patient physically, socially, economically as well as psychologically. This can seriously affect their quality of life. Aim: To determine patients' knowledge and perception about acne vulgaris and analyse the association of patient characteristics with the impact of acne on their psychosocial life. Materials and Methods: A total of 183 subjects of acne vulgaris of either gender, visiting Dermatology OPD and willing to participate in the study were asked to fill in a pre-tested, prevalidated questionnaire consisting 20 items-6 based on general information about their condition, 5 based on knowledge about acne and 9 questions on perception about their condition and its treatment. A total of >4 questions about knowledge correctly answered was considered as good knowledge and <4 correctly answered as poor knowledge. Data were analysed by using chisquare test. Results: Study participants had inappropriate knowledge about the causes or predisposing factors of acne as well as about the treatment options for this condition. Social advertising media was seen to be influencing their beliefs and decisions regarding the same but was unable to provide complete and correct information which was a significant finding (p<0.001). <57% of study participants believed that the disease had a moderate to severe impact on their self-image and this was found to be statistically significant (p<0.001). There was a statistically significant association (p=0.002) between the study subjects who had poor information about the causes of acne vulgaris and the impact (moderate to severe) this disease had on their psychosocial life-meaning impact on self-image, relationship with friends and family and impact on work or school performance. Results were interpreted based on direct analysis of study questionnaire without using any scoring system. Conclusion: Study subjects lacked correct knowledge about acne and its treatment where advertising media was the most influential but incomplete source of information found. Acne had a significant impact on their psychosocial life, specially self-image. [ABSTRACT FROM AUTHOR]

Introduction: Fungal keratitis has been reported to cause up to 50% of all corneal ulcers in the Indian subcontinent. Fungal keratitis is also associated with a very poor outcome with conventional treatment modalities. A few limited case reports/series have demonstrated the usefulness of Intracameral injection of liposomal Amphotericin B in severe fungal keratitis. However, several questions regarding intracameral therapy using antifungal agents are, as yet, unanswered, including when to intervene with this treatment modality. Aim: To evaluate whether an 'early' versus 'delayed' intervention using Intracameral Injection of Liposomal Amphotericin B (ICAMB) influences the efficacy, outcomes and complications in severe recalcitrant Keratomycosis. Materials and Methods: This prospective interventional study enrolled 50 eyes of proven fungal keratitis, not responding to conventional antifungal therapy administered over two weeks. They were randomly allocated to Group A (25 eyes) and Group B (25 eyes). Intervention with Intracameral injection of liposomal Amphotericin B, 10 micrograms/0.1 mL was done at either two weeks (Group A) or at four weeks (Group B). The clinical profile, visual acuity, time to epithelial defect closure, time to heal, final anatomical outcome, surgical interventions and complications were compared between the groups. Spearman correlation between healing time and other clinical characteristics was also done. The primary outcome measures were healing time, functional (final visual acuity) and anatomical outcomes (type of corneal opacity). Results: The mean healing time in Group A was 17.5±3.64 days and 32.2±8.89 days in Group B (p<0.001). The anatomical outcome in the form of a maculo-leucomatous corneal opacity was observed in 12 (48%) eyes in Group A versus 4 (16%) eyes in Group B (p=0.03), leucomatous corneal opacity in 13 (52%) eyes in Group A versus 16 (64%) eyes in Group B (p=0.56), and adherent leucoma in none of the eyes in Group A versus 5 (20%) eyes in Group B (p=0.05). None of the eyes in Group A required additional surgical intervention while 10 eyes in Group B developed corneal perforation, thus requiring surgical intervention (p=0.006). Conclusion: The present data has shown that eyes with severe non-responding keratomycosis may have a satisfactory outcome if Intracameral liposomal Amphotericin B therapy is initiated early rather than delaying this adjunctive treatment. In the authors' experience, ICAMB significantly hastened the resolution and reduced the incidence of corneal perforation and ocular morbidity in resistant keratomycosis. [ABSTRACT FROM AUTHOR]

With an increasing number of COVID-19 cases and a lack of definitive treatment, there is an increasing burden on already stressed health care sector in India.The patients that require medical and surgical intervention need to be triaged and provided with adequate treatment. India has a major chunk of head and neck malignancy in the world attributable to tobacco use. These patients when diagnosed early have a fair survival rate. Health personals bear the responsibility to provide early and adequate treatment to these patients and at the same time, need to follow all measures to contain the spread of the virus. The present review highlights the various issues and newer guidelines in the management of head and neck malignancy patients during the COVID pandemic. The current review aims to present a comprehensive outlook of the updated evidence base available from PUBMED and other search engines. In India, treatment of head and neck malignancy patients are severely affected at this time of COVID-19, due to the long waiting period, delayed diagnosis, limited dedicated centres for head and neck cancer.The pandemic had diverted resources and manpower leading to potentially poor outcome of the head and neck malignancy patients. Triage policy, safety precautions for health care staff is the need of the hour and should be imbibed in regular practice. [ABSTRACT FROM AUTHOR]

Proteinuria is a marker and predictor of cardiovascular morbidity and mortality. Blockade of angiotensin receptor might result in reduction in proteinuria. Olmesartan, an Angiotensin Receptor Blocker (ARB) which is approved for the treatment of hypertension is believed to produce antiproteinuric effects through different mechanisms. The objective of this review is to assess the cause, duration and degree of proteinuria and understand the current place of olmesartan in management of proteinuria associated with Cardiovascular Disease (CVD) and hypertension. We performed a comprehensive search of MEDLINE, PubMed and Google Scholar databases for articles related to Olmesartan and proteinuria (till June 2017). Angiotensin-II induces transforming growth factor-ß upregulation and increase transcapillary pressure. AT-I receptor blocked by olmesartan result in reduction in proteinuria. Olmesartan significantly reduces Blood Pressure (BP) and delays the onset of Chronic Kidney Disease (CKD), it also delayed the risk of onset of microalbuminuria. Olmesartan have nephroprotective, antioxidant, antifibrotic activities and proteinuria reducing effects which can be beneficial in patients with hypertension. Olmesartanis believed to produce antiproteinuric effects through different mechanisms. It is indicated for treatment of hypertension to reduce the risk of fatal and non fatal CV events which may or may not be associated with proteinuria. [ABSTRACT FROM AUTHOR]

Introduction: Condylar fracture accounts for 25-35% of all mandibular fracture. When it comes to open reduction and internal fixation, the design of the plate plays a crucial role to withstand the amount of masticatory force in the condylar region. Aim: To evaluate the biomechanical stability of osteosynthesis using the Trapezoidal plate, Delta plate and Miniplate in subcondylar fracture. Materials and Methods: The condyle of 36 porcine hemimandible was osteotomized at a defined location with the help of a jig. Three groups A, B, C were created and each group had 12 hemimandibles. Group A was fixed with trapezoidal plate, group B was fixed with delta plate and group C was fixed with 2 four-hole miniplates. Each group was subjected to a linear loading using a Universal Testing Machine (UTM) in four different directions. The direction of the force used was from lateral to medial, medial to lateral, anterior to posterior and posterior to anterior was indicated using (1,2,3,4) respectively. Yield load and yield displacement were measured for the trapezoidal plate, delta plate and miniplate. Means were derived and compared for statistical analysis using the Kruskal-Wallis test and Mannwhitney U test with a confidence level of 95%. Results: None of the plates fractured. Screw loosening was seen in one delta plate and in two miniplate. In posterior to anterior and from medial to lateral the trapezoidal plate tolerated the highest load. From anterior to posterior and lateral to medial the miniplate tolerated the maximum load. Statistically significant difference was seen for yield load and no difference was seen for yield displacement in three groups. Conclusion: This biomechanical study indicates that like miniplate, trapezoidal and delta plates exhibit stable osteosynthesis for subcondylar fractures. The trapezoidal and delta plate has the advantages of providing three dimensional stability using single plates. [ABSTRACT FROM AUTHOR]

A 13-year-old girl, who did not receive any treatment for few hours following Road Traffic Injury (RTI), reported to the Casualty Department and found to have patent airway with clinically normal C spine, air-hunger (RR 42/minute), trachea deviated to left, distended neck veins and absent breath sounds on the right side. The chest X-ray she carried, done immediately after the injury, showed right sided tension pneumothorax. She was put on oxygen at 11 L/minute and an Intercostal chest tube drainage (ICD) was inserted on right side. Her oxygen saturation (40%) failed to improve. ICD bag showed continuous bubbling and air entry remained absent on the right side. An urgent right thoracotomy was done which revealed right main bronchus tear; the tear was repaired using interrupted Prolene® sutures. Patient recovered well and was discharged 10 days later in a stable condition. [ABSTRACT FROM AUTHOR]

Perigraft seroma presenting as discharging sinus and spontaneous exteriorization of vascular graft are rare complication of vascular injury repair with polytetrafluoroethylene (PTFE) grafts. We hereby report a case of young boy who presented with discharging sinuses and vascular graft coming out from one of the sinuses following vascular repair of femoral artery with PTFE graft after a follow-up of six months but the limb was salvaged. On evaluation PTFE graft was found to be thrombosed and collaterals were formed for distal perfusion. Because of persistent discharging sinuses, PTFE graft was removed and femoral artery was ligated proximal and distal to the graft. This case highlights an unusual complication of PTFE grafts that is commonly used in vascular surgery and also highlights the fact that these graft buy time for gradual collaterals formation for distal perfusion and hence when thrombosed and complicated can be safely removed. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 53-year-old man with a history of left sided empyema who had endobronchial foreign body.

Spinal epidural haematomas (SEH) is a potentially reversible cause of spinal cord and nerve root compression which needs prompt surgical decompression for satisfactory neurological recovery. SEH occurs very rarely in pregnant woman with HELLP syndrome (hemolysis, elevated liver enzyme levels, and low platelet levels). Most of the SEH cases reported in HELLP syndrome in the literature are due to iatrogenic interventions. We report a still rarer case of non traumatic spinal epidural haematoma in a pregnant woman with HELLP Syndrome. [ABSTRACT FROM AUTHOR]

The article presents a case study of a seven-year-old boy presented with increasing pain and swelling in the right ankle joint. The patient underwent into contrast computed tomography (CT) and radiography and was diagnosed with giant cell tumour (GCT) at the periphery. The article discusses GCT treatment, bone grafting, and chlorpactin.