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Background: Recently, among child disability disorders nervous system diseases are prevailing 19.5%, while mental disorders are 14.3% and congenital malformations 21%. In most cases, children’s neurological disability is associated with pathology during the perinatal period, while 24% of patients have a cerebral impairment. Premature newborns perished 30 to 35 times more often than in-time newborns, and perinatal mortality in case of premature pregnancies is 30 to 40 times higher than in term delivery. Aim: This article is studying catamnestic observation of premature newborns with nervous system injury and with perinatal pathology in Kyrgyzstan for the period 2020-2021. Preterm newborns’ anthropometric characteristics and main diagnoses associated with diseases in the gestational period were shown. Methods: A comprehensive clinical and laboratory examination including premature newborns health dynamic monitoring with gestational age from 28 to 36 weeks, who were treated in the neonatal pathology department of the Regional Maternity Hospital in Osh for the period from 2020-2021 were carried out. Literature review analysis from PubMed database, MEDLINE, EMBASE, Science Direct, Google Scholar, and clinical trials performed. Results: after clinical examination, it was revealed that pregnancy and childbirth in all mothers of the studied group passed with complications. In mothers of the studying group, the most common pathologies during pregnancy were chronic fetal hypoxia 49 (58.4%), acute respiratory infections 28 (33.4%), the threat of termination of pregnancy 20 (23.9%), preeclampsia 16 (19.11%), sexually transmitted infections 9 (10.8%), pyelonephritis 14 (16.7%), polyhydramnios 9 (10.8%), 71 children (84.6%) were born with asphyxiation and 25 children extracted by cesarean section with varying degrees of severity. Conclusions: Depending on the severity of the perinatal lesion of the nervous system and pathological factor effects, it is very important to start early habilitation measures with preterm newborns who are at risk of developmental delay deviations, and to exit disabling disorders.

BACKGROUND COPD is characterized by chronic airflow limitation and a range of pathological changes in the lungs. In addition, COPD presents significant extrapulmonary effects and is associated with important comorbidities that may contribute to the disease severity. COPD affects pulmonary blood vessels, right ventricle, as well as left ventricle leading to the development of pulmonary hypertension, cor-pulmonale, right ventricular dysfunction, and left ventricular dysfunction. This study was undertaken to evaluate cardiac function with ECG and echocardiography in COPD patients which may further help to assess the prognosis and identifying the individuals likely to suffer increase morbidity and mortality. METHODS An observational, cross sectional study was conducted among 100 patients attending the Department of General Medicine of Burdwan Medical College and Hospital, diagnosed as having COPD wherein detailed history taking and clinical examination was done along with routine investigations such as complete blood count, renal functions, randomized blood sugar and further for a Chest X-ray, electrocardiography, and two-dimensional (2D)-echocardiography. Statistical analysis was done by SPSS version 19.0. RESULTS Majority of the COPD patients were male and belonged to GOLD stage 2. The most electrocardiographic finding was P-Pulmonale and Echocardiographic finding was PAH (Pulmonary Arterial Hypertension) with maximum patients having mild PAH. Most common clinical finding was pedal edema. Severity of the disease was found to have linear relation with severity of cardiac complications. CONCLUSION There is significant involvement of the cardiovascular system in COPD patients. The electrocardiographic and echocardiographic findings had linear relation with the severity of the disease. It is mandatory to investigate all the COPD patients with ECG and 2D ECHO as it aids in early detection and treatment of cor pulmonale.

Background Fungal sphenoid sinusitis mimicking as malignant tumor and invading the pituitary fossa is an uncommon entity. This report aims to highlight radiological salient features to help differentiate fungal lesion from malignant tumor in sphenoidal sinus mass lesions. Case presentation We intend to report a case of middle-aged female who presented with gradual progressive diminution of vision since 3 years complicated with acute attack of unilateral headache and numbness. Computed tomography (CT) showed hyperdense lesion involving the sphenoid sinus extending into pituitary fossa and bilateral cavernous sinuses with smooth bony remodeling. Lesion appeared hypointense on T2-weighted and hyperintense on T1-weighted images on magnetic resonance imaging (MRI). Surgical excision of the lesion was done and pathological examination showed fungal hyphae and aspergillus fumigatus species on culture after 2 weeks of incubation. Post-operative CT revealed empty sinuses with surrounding bone remodeling. Conclusion Combination of T1 hyperintensity, T2 hypointensity, and hyperdense sinus is a strong predictor of fungal mass lesion involving sphenoid sinus.

Introduction: Perfluorocarbon (PFCL) is an essential adjunct of retinal detachment surgery. Subfoveal migration of PFCL is a rare and vision threatening complication of its use. Various techniques have been described for its removal. However, no consensual technique of its removal has been established. We present a nova, relatively atraumatic and cost effective way of PFCL removal using a widely available 26G spinal anesthesia needle. Case: An 18 years old myopic patient who had undergone left eye pars plana vitrectomy (PPV) for myopic Rhegmatogenous Retinal Detatchment (RRD) in the past presented after 1 month with retained subfoveal PFCL. Its subretinal location was confirmed by Optical Coherence Tomography (OCT). He was taken up for early Silicone Oil Removal (SOR) along with removal of retained subfoveal PFCL under high magnification by using a surgical disposable contact macula lens. A 26G spinal anesthesia needle tip was used to dissect a small separation parallel to the nerve fibers at the temporal edge of tense cystic PFCL bleb. Silicone tipped flute cannula was used to passively aspirate the sub retinal PFCL under fluid with no additional intervention. No barrage LASER was done. Observation: Anatomical restoration of the retina was noted both intraoperatively and post-operatively. SD-OCT showed complete restoration of anatomical layers with no presence of intraretinal cystic cleft both at day 1 and 30 days postoperatively. Conclusion: Safe removal of subfoveal PFCL can be done with 26G spinal anesthesia needle which is atraumatic, inexpensive and readily available. However, long term validity of this process needs to be established in a case series.

Mucormycosis isolated to the mandible is a rare presentation occurring generally after dental procedures. The case we report presented with discharging sinuses over facial region with radiological appearance of isolated osteomyelitis of the mandible. The patient used to apply an addictive dental powder over his teeth leading to caries. Following this, he pulled out all his teeth, which probably led to his condition. Invasive sampling revealed mucormycosis. An extensive search for an underlying immunodeficiency revealed that the patient had chronic granulomatous disease (CGD). Despite a prolonged course of L-Amphotericin B, the patient continued to have intermittent pus discharge and surgical debridement and curettage was eventually required. The patient had a chronic course with minimal soft tissue involvement which initially did not raise the suspicion of mucormycosis. The main learning point is that an unusual invasive fungal infection in an otherwise healthy host can be the first symptom of an underlying primary immunodeficiency, like CGD. Invasive fungal infections in patients with CGD often have an indolent course., Highlights • Mucormycosis isolated to the mandible is a rare presentation, occurring generally after dental procedures. • Self-extraction of teeth as in our patient can result in isolated mucormycosis of the mandible. • Isolated mucormycosis of the mandible can be a presenting symptom of chronic granulomatous disease. • Combination of medical and surgical treatment is usually needed in mandibular mucormycosis.

Introduction: Pathological myopia is commonly associated with myopic traction maculopathy, which includes foveoschisis, foveal retinal detachment, macular hole (MH) and/or macular detachment (MD). Macular buckling is a rarely practiced extraocular surgical modality these days. The purpose of this study was to investigate the efficacy of primary buckling with Morin–Devin T implant for MD with MH and posterior staphyloma. Case description: A 52-year-old female presented with light perception vision in her right eye with posterior staphyloma, localized neurosensory detachment, and MH. She underwent primary macular buckling with Morin–Devin T implant. During the immediate postoperative day the wedge indentation was found misaligned to the fovea. A revision surgery was done after 2 weeks for repositioning of the macular wedge. Spectral domain optical coherence tomography confirmed indentation at the MH with resolution of subretinal fluid and hole closure. Her BCVA was 2/60 at 3 months postoperative and it remained the same even at 6 months of follow-up. Conclusions: Primary macular buckling can be an effective procedure in eyes with MH with detachment and posterior staphyloma with or without associated foveoschisis. Morin–Devin T implant placement is a relatively simple procedure with short surgical time and excellent outcome.

Introduction: Mediastinal lymphadenopathy is secondary to various benign and malignant etiologies. There is a variation in the underlying cause in different demographic settings. The initial clue to the presence of enlarged mediastinal lymph nodes is through thoracic imaging modalities. Malignancy (Lung cancer, lymphoma, and extrathoracic cancer) and granulomatous conditions (sarcoidosis and tuberculosis) are the most common causes. For a confident diagnosis, the clinician must choose from several available options and integrate the clinical, radiological, and pathology findings. An accurate diagnosis is necessary for optimal management.Areas covered: We performed a search of the PUBMED database to identify relevant articles on the causes, imaging modalities, and interventional modalities to diagnose these conditions. We discuss a practical approach toward the evaluation of a patient with mediastinal lymphadenopathy.Expert opinion: Mediastinal lymphadenopathy is a commonly encountered clinical problem. Treating physicians need to be aware of the clinico-radiological manifestations of the common diagnostic entities. Selecting an appropriate tissue diagnosis modality is crucial, with an intent to use the least invasive technique with good diagnostic yield. Endosonographic modalities (EBUS-TBNA, EUS-FNA, and EUS-B-FNA) have emerged as the cornerstone to most patients' diagnosis. An accurate diagnosis translates into favorable treatment outcomes.

There is paucity of evidence related to mechanical ventilation in the general ward setting. We aimed to study the clinico-etiological profile, outcomes and prognostic factors of patients receiving invasive mechanical ventilation in non-ICU (ward) setting, and compare these parameters with that of patients in the ICU, wherever it was reported. A systematic review and meta-analysis was done on articles published till June 2020. Two authors independently extracted the data. The study population included patients who received mechanical ventilation in ward setting. Fourteen studies reporting on 20833 patients were included (20252 exclusively ventilated in ward), with most of the studies being from Israel, USA, Japan and Taiwan. Risk of bias was estimated using the Newcastle-Ottawa Scale for observational studies, and was found to be low. Most common reason for intubation was respiratory illness. Most common variables predicting mortality were prognostic scores like APACHE-II and Acute Physiology Score (APS). Pooled mortality rate in ward across 6 studies was 0.72 (95% CI 0.69-0.74) with no heterogeneity among these 6 studies (I2=0.0). Mortality rate varied significantly with study population characteristics, and was lower among patients being weaned in ward. A major limitation of our study was the paucity of studies and significant heterogeneity among existing studies, with respect to outcomes like duration of ventilation, hospital stay, rates of complications, and prognostic factors. This systematic review and meta-analysis found that mortality among patients receiving invasive mechanical ventilation in ward settings remains high. Data regarding other outcomes and prognostic factors predicting mortality was very heterogeneous highlighting the need for future studies concentrating specifically on these aspects.Systematic review registration: PROSPERO 2020 (CRD42020166775)

Objective: We compared the pre- and post-operative right ventricular (RV) function by tricuspid annular plane systolic excursion (TAPSE) between trans-right atrial (t-RA) versus t-RA/RV (RA/RV) approach for the repair of Tetralogy of Fallot (TOF). Patients and Methods: Fifty consecutive patients, 1–15 years of age, undergoing intracardiac repair of TOF between September 2015 and June 2016 were randomized into two groups based on the approach for repair as follows: t-RA or t-RA/RV approach. TAPSE was used for the assessment of pre- and post-operative RV function. Results: Age, body surface area, preoperative saturation, cardiopulmonary bypass and aortic cross-clamp times, inotropic score, postoperative intensive care unit, and hospital stay were similar in both the groups. However, t-RA/RV group had significant mediastinal drainage (169 ± 163 ml vs. 90.6 ± 58.7 ml, P < 0.05) and pleural effusions (8 vs. 2 patients, P < 0.05), but had better relief of RV outflow tract gradients. The mean follow-up was 23 ± 6.7 (median 26, range 21–29) months. There were no differences in arrhythmias in either group up to the 1st month and at last follow-up. Preoperative TAPSE for t-RA and t-RA/RV was similar (1.49 ± 0.29 vs. 1.66 ± 0.34, P > 0.05) and so was the post-operative TAPSE at discharge (1.52 ± 0.30 vs. 1.43 ± 0.32, P > 0.05), at 1 month (1.6 ± 0.27 vs. 1.43 ± 0.032, P > 0.05) and at last follow-up (1.79 ± 0.15, median 1.8 vs. 1.72 ± 0.17, median 1.7 P > 0.05). Conclusion: Both t-RA and t-RA/RV approaches provide safe palliation for patients with TOF. A limited right ventriculotomy neither leads to deleterious effects on early RV function nor does it increase the incidence of arrhythmias at early follow-up. Larger studies with longer follow-up are needed to further address these issues.

Introduction: Negative pressure wound therapy (NPWT) in its present form was first described by Fleischmann et al. 1 in 1993. In Orthopaedics it has gained popularity in past 2 decades for management of acute open fractures, pressure sores as well as chronic wounds associated with osteomyelitis2. It involves the controlled application of sub atmospheric pressure to a local wound environment, using a sealed wound dressing connected to a vacuum pump. In our institute, we provided NPWT using locally available materials to manage Orthopaedic wounds. This present study evaluates the efficacy of NPWT. Aims and Objective: To evaluate the efficacy of indigenously developed negative pressure wound therapy. Methodology: In Our study we included 15 patients in the age group of 10 to 69 years to evaluate the efficacy of indigenously developed NPWT this is 6 months prospective study. Result Granulation Tissue: About 80 percent wounds were granulated till 6 week.At 3 months 15 (100%) wounds were healed. Conclusion: Indigenously negative pressure wound therapy has a safe and effective method of wound coverage. It decreases the bacterial load and promote the neovascularization. Further long term controlled studies are needed which would help in providing affordable and effective wound management.

BACKGROUND India has emerged as the diabetes capital of the world. A large percentage of these patients have metabolically uncontrolled Diabetes Mellitus. High glucose level has deleterious effect on corneal endothelial health due to various mechanisms and is associated with changes in central corneal thickness (CCT). We intend to compare the CCT of established DM patients with normal population and correlate its impact with increasing diabetic population. The objectives of the study were to evaluate the effect of diabetes mellitus on central corneal thickness (CCT) by comparing the CCT of diabetic and non-diabetic patients and association of CCT with duration of diabetes mellitus. MATERIALS AND METHODS The study group was composed of 53 non-diabetic (29 male and 24 female) and 50 diabetic subjects (15 male and 35 female). Among the diabetic subjects, 27 out of 50 had diabetes of less than 10 years of duration and 23 had diabetes for more than 10 years. The CCT assessment was done for 105 eyes of 53 non-diabetic subjects and 100 eyes of 50 diabetic subjects with Sonomed Pacscan Plus, an ultrasound pachymeter, in the multiple reading single point mode. Each CCT considered in study was the average of 5 readings with standard deviation less than 0.003mm. RESULTS The statistical difference in the CCT between diabetic (524.264±29.21 microns) and non-diabetic (513.228±30.81 microns) group was significant (two-tailed P value is 0.0167 – Mann-Whitney test). When the CCT of non-diabetic group was compared with those with diabetes of less than 10 years duration, it was not significant (p value 0.13); and those with diabetes of more than 10 years duration, the difference was significant (p value 0.0216). The statistical difference between male and female in either group was not significant. CONCLUSION With rapid increase in number of diabetic patients, it is necessary to evaluate its effect on cornea, especially in the pre-operative work-up. A thickened cornea in diabetic patients needs to be evaluated for its functional and morphological characteristics.

Background: Bone marrow involvement by solid tumor implicates advanced disease and dismal prognosis. Bone marrow aspiration and biopsy are routinely performed as staging workup for certain small round cell tumors and also for unexplained cytopenia in other solid tumors. It is important to rule out bone marrow involvement before planning for curative treatment. Materials and Methods: This was a retrospective observational study. The aim of our study was to evaluate the pattern of bone marrow involvement by different solid tumors and their correlation with the hematological abnormalities. We retrospectively evaluated bone marrow aspirations and biopsy performed in past 3 years. Results: At our institution, bone marrow examinations were performed in 440 patients during past 3 years for solid malignancies. Out of 440, 206 were pediatric cases and 234 were adult cases. Bone marrow was involved in 56 (12.7%) patients. Among the pediatric cases, bone marrow involvement was present in 30 (12.8%) cases, and in adult cases, bone marrow was involved was in 26 (11.1%) cases. Neuroblastoma (40%) was the most common malignancy, which involved the bone marrow among pediatric cases, followed by retinoblastoma (26.6%) and Ewing’s sarcoma (20%). Among adult patients, neuroendocrine carcinoma (23%) was at the top of the list of tumors involving bone marrow, which is followed by Ewing’s sarcoma (19.2%) and nasopharyngeal carcinoma (11.5%). Conclusion: Neuroblastoma and neuroendocrine carcinoma are the major cause of bone marrow involvement among the solid malignancies in pediatric and adult population, respectively. Use of immunohistochemistry markers on bone marrow biopsies may result in higher detection rate.

Background: Bilateral breast cancer (BBC) is a rare clinical entity with limited data regarding clinicopathological aspects and treatment guidelines. Materials and Methods: This was an observational study of patients diagnosed with BBC from August 2012 to July 2014. Synchronous breast cancers (SBCs) was defined as two tumors diagnosed within an interval of 6 months and metachronous breast cancer (MBC) as second cancer diagnosed after 6 months. Results: Out of 750 breast cancer patients seen during a 2-year period, 35 had BBC. Ten patients were diagnosed as SBC whereas 25 patients as MBC. Among patients with MBC, the average time for development of contralateral breast cancer was 5 years. In 8 patients, the contralateral breast cancer was detected mammography whereas rest 27 patients were detected by clinical breast examination. At a median follow-up of 24 months, 23 (66%) patients were disease free, 9 (26%) patients had disease relapse, and 3 (8%) patients succumbed to the progressive disease. Conclusions: Every patient with breast cancer should be regularly followed up with clinical breast examination at a more frequent interval. The role of frequent clinical breast examination appears more than mammography especially beyond 5 years for early detection of contralateral breast cancer.

Background: In Indian Universities, much attention is not given to the mental and physical fitness of the students during routine teaching-learning sessions except in the courses related to physical education, medicine, and yoga. Even general health-related lessons are mostly not included in the curricula of most of the courses. This fact becomes important in the context of increasing prevalence of cardiovascular and metabolic diseases among the younger population. Yogic training happens to be one of the promising and effective methods of training in developing mental and physical fitness. Objective of the Study: The objective of this study was to find out the effect of Pranayama on physical fitness and mental health in University-level healthy students. Method: A total of 108 adult volunteers of University-level healthy students of both gender, aged 17–28 years were included in the study. The selected individuals were divided into two groups, experimental- and control-with (n = 54) individuals in each group. The training period of Anuloma-viloma and Bhastrika Pranayama for experimental group was 12 weeks. Physical fitness parameters and mental health were assessed at the baseline and after completion of 12 weeks of the training intervention. Mental health was tested with a validated Mental Health Inventory Questionnaire. Control groups did not undergo Pranayama training. Results: The experimental group showed significant improvement in most of the physical fitness parameters after 12 weeks of Pranayama practice; however, the control group did not show significant improvement. The positive effect of Pranayama though was observed on mental health parameters in the experimental group, the difference was not statistically significant when compared with the control group. Conclusion: Anuloma-viloma and Bhastrika Pranayama appear to be effective in improving physical health parameters among healthy University students.

Background We reviewed the long-term results of surgery for discrete subaortic membrane (SubAM) from a single institute. Methods A retrospective review of medical records of all patients (n = 146) who underwent resection of a SubAM for discrete subaortic stenosis between 1990 and 2015 at the All India Institute of Medical Sciences, New Delhi, India was undertaken. Results Median age at surgery was 9.0 years (9 months-47 years). There was one early death. Preoperative peak left ventricular outflow tract (LVOT) Doppler gradient was 83.4 ± 26.2 mmHg (range: 34-169 mmHg). On preoperative echocardiography, aortic regurgitation (AR) was absent in 69 (47.3%), mild in 35 (24%), moderate in 30 (20.5%), and severe in 12 (8.2%). After surgery, the LVOT gradient was reduced to 15.1 ± 6.2 mmHg (P

Squamous cell carcinoma of the breast (SCCB) is a rare entity with limited data pertaining to the clinicopathological profile and treatment outcome. These tumors are characterized by rapid progression and have a poor outcome. The optimal therapy for SCCB has not yet been standardized. Most patients with SCCB are treated with the similar conventional chemotherapy regimens used in the ductal variant of breast cancer. This was an observational study of patients diagnosed with SCCB diagnosed from March 2013 to February 2015 at our institute. The medical records were reviewed and patients were contacted by telephone to study the clinicopathological profile and treatment outcome. We identified 5 (0.45%) patients of SCCB out of 1100 breast cancer patients treated in the department of medical oncology during this period. The median age at presentation was 48 years. All tumor specimens showed macroscopic findings of a cystic lesion and central necrosis. After a median follow-up of 32 months, 3 patients (60%) were alive, whereas 2 (40%) patients succumbed to disease progression after recurrence. SCCB is a rare subtype of breast cancer with no standard treatment approach. These are associated with poor prognosis and larger studies are needed to investigate different treatment options.

Background: Gastrointestinal tract (GIT) is the most common extranodal site for non-Hodgkin's lymphoma (NHL) and constitutes about 10%-15% of all NHL. This was a prospective study to evaluate the epidemiological, clinicopathological characteristics, and treatment outcome of primary GIT diffuse large B-cell lymphoma (PGIL). Materials and Methods: Newly diagnosed patients of PGIL with DLBCL histology were eligible. Lugano staging system was used. All patients were treated with prephase treatment (1 mg vincristine and 100 mg prednisolone) followed by CHOP-based chemotherapy (with or without rituximab) as definitive treatment. Results: A total of 21 patients of PGIL were diagnosed. The median age was 46 years (range: 27–69 years) with male:female ratio of 2:1. Dull aching abdominal pain was the most common presenting complaint. Stomach was the most common site involved (52.4%, n = 11) followed by the colon (23.8%, n = 5). The estimated median survival in patients with Stage IV disease was significantly lower as compared to patients with localized disease (Stage I and II) (6.23 months vs. 23.4 months; P = 0.04). Patients, who did not achieve complete response (CR), had 15.5 times higher risk of death, as compared to those who achieved CR (P = 0.01). Conclusions: Stomach was the most common site for PGIL. Localized disease and CR after first-line chemotherapy were associated with better survival. A higher cost of rituximab was the prohibitive factor for cure in these patients.

Abdominal tuberculosis in children is a great masquerader. Due to varied clinical presentation, diagnosis is challenging. Although peritoneal and nodal disease is the most common presentation but jejunal involvement is seen in widespread disease. Isolated jejunal stricture is extremely rare. We are presenting a case of 8 year old female child presented with intermittent bilious vomiting, constipation and inability to tolerate solid and semisolid food. Diagnosis was confirmed as isolated tubercular jejunal stricture after investigations and surgery. Keywords: Jejunum, Stricture, Tuberculosis, CECT, Congenital band

Background: Neuroendocrine carcinoma (NEC) is a rare tumor arising from the diffuse neuroendocrine system. Most of these present in the advanced stage and palliative chemotherapy remains the only option. The prognosis remains poor with the standard chemotherapy regimen of platinum and etoposide (EP) providing modest survival benefit. Methods: The study was done for 3 years at a tertiary cancer center in South India. Patients with a diagnosis of metastatic NEC were analyzed for clinical and pathological characteristics. The treatment outcomes and prognostic factors were evaluated using appropriate statistical test. Results: A total of 114 patients of metastatic NEC satisfied the inclusion criteria and were analyzed. Gastrointestinal including hepatobiliary tract (33%) was the most common site of primary disease followed by lung (26%), genitourinary (15%), head and neck (14%), and unknown primary (9%). On analysis of pattern of metastasis, liver (65%) was the most common site followed by bone (54%) and lung (42%). The median overall survival was 11 months with a statistically significant difference between pulmonary and extrapulmonary disease (8 vs. 13 months; P = 0.003). Ki67% value was strongly associated with prognosis (hazard ratio 0.517, 95% confidence interval; 0.318–0.840, P = 0.008) whereas age, sex, and lactate dehydrogenase level did not show any relation with survival. Conclusion: The outcome of advanced NEC with standard chemotherapy remains poor. Larger studies with other therapeutic and novel agents are warranted to improve the treatment outcomes.

Background: Breast cancer is the most common female cancer seen globally. Triple-negative breast cancer (TNBC) is a special subtype without any obvious target and optimum treatment remains challenging. The aim was to study the clinical, pathological profile and treatment outcome of TNBC patients. Methods: This was a retrospective observational study of TNBC patients diagnosed from January 2010 to June 2012 at a tertiary cancer center in South India. Patient’s clinical and pathological characteristics were studied. The 5-year estimate of survival for non-metastatic TNBC was done using the Kaplan-Meier method. Results: Out of 804 patients of breast cancer, 237 were diagnosed as TNBC. The median age was 45 years and 58% were premenopausal. The 5-year disease-free survival (DFS) and overall survival (OS) for non-metastatic TNBC patients were 59% and 74%, respectively. The addition of a taxane to anthracycline-based regimen did not show a significant difference in DFS (P = 0.885) as well as OS (P = 0.856). Conclusion: The role of adding taxanes to anthracycline-based chemotherapy in adjuvant setting for TNBC remains controversial and larger prospective studies are warranted. World J Oncol. 2017;8(4):110-116 doi: https://doi.org/10.14740/wjon1054w

Background: A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Pars plana vitrectomy and gas tamponade is a recognised modality of treatment for macular hole.Larger holes are more likely to remain open after repair and late reopening after an initially closed macular hole is seen in macular holes larger than 400 μm. Aims and Objective: To evaluate the anatomical and functional outcome of pars plana vitrectomy with internal limiting membrane peeling for chronic stage 3 macular hole. Materials and Methods: Records of 15 patients with stage 3 chronic macular holes operated from 1 st January 2013 to 30 th June 2013 and completed 1 year of follow up were retrospectively evaluated and included in the study. Preoperative best distance corrected visual acuity (BCVA), preoperative macular hole size, final BCVA and macular hole status at 1 year follow up were recorded. Macular hole closure and visual improvement was calculated. Correlation of macular hole closure and visual improvement with various macular hole parameter was estimated. Results: Eleven (73.3%) macular holes closed at 1 year follow-up. Mean BCVA improved from 1.2 ± 0.27 to 0.89 ± 0.36 logarithm of minimum angle of resolution at 1 year (p

Albeit, all forms of tuberculosis (TB) are endemic in India, spinal intramedullary TB and tubercular longitudinally extensive transverse myelitis (LETM) is deemed extremely rare. With recent advances in the field of neurology, autoimmune astrocytopathy (neuromyelitis optica spectrum disorders, NMOSD), myelin-oligodendrocyte glycoprotein associated encephalomyelitis (MOG-EM), metabolic myelopathy, connective tissue diseases and viral infections have gained considerable focus in the list of differentials of LETM whereas tubercular association is often forgotten. This report presents a rare case of acute transverse myelopathy which unveiled previously undiagnosed pulmonary tuberculosis in an adult rural Indian male. The patient responded well to anti-tubercular therapy and corticosteroids. Exact pathogenesis of LETM in TB remains elusive. Association of TB with MOG-EM has been one of the recent hot-cakes. However, an ill-defined immune-inflammatory response to the infectious agent is the likely cause of tubercular LETM. Hence, the primary care physicians who are the first medical contacts of acute LETM cases and in most cases due to diagnostic dilemma there is an unavoidable delay in accurate diagnosis and initiation of therapy. Primary care doctors should nurture a high index of suspicion to diagnose this potentially lifetime-debilitating yet absolutely treatable clinical condition i.e. tubercular LETM.

Introduction: Fine Needle Aspiration Cytology (FNAC) has become simple, safe, speedy, cost-effective, accurate and more diagnostic after advancement in imaging techniques. Sensitivity of image guided FNAC of intra-abdominal lymph nodes is relatively high. Ancillary techniques on FNAC material may increase the accuracy of diagnosis. Aim: To evaluate adequacy of material, cytologic assessment of samples obtained by image-guided aspiration and side effect/ complication on account of the procedure. Materials and Methods: Image guided FNAC were performed on 60 patients which include retroperitoneal and abdominal nodes. A sterile 3.5/5-MHz micro convex sector probe was used for localisation of the node. FNAC was performed using a 0.7-0.9 mm needle with stylet removed and attached to a 20mL syringe and FNAC handle after the needle was visualised in the lesion. For each case a minimum of 4-5 smears were made and two observers without bias interpreted the smears. Results: A total of 60 patients were aspirated, of which adequate material for cytologic diagnosis was obtained in 58(96.6%) patients with a similar diagnostic accuracy. The 6th and 7th decade accounted for approximately half of the cases. Male to female ratio in our study was 2.16:1 (41:19). Most common cytologic diagnosis was metastasis 22(37%) followed by Non-Hodgkin lymphoma 17(28%) and followed by tubercular etiology seen in 16(27%) cases. All patients were followed by six monthly period for five years to further validate the study. Conclusion: Image-guided FNAC has a pivotal role, and is a cost-effective tool for establishing tissue diagnosis as a primary investigative modality. It is also helpful and accurate in followup of patients with a known malignant disease, thereby avoiding surgical intervention.

Background Breast cancer is a heterogeneous disease which is divided broadly into luminal, HER2 and basal type based on molecular profiling. Increased body mass index (BMI) has been associated with the risk of developing breast cancer but the association based on molecular subtype remains conflicting. Methods This was an observational study carried out over a period of 2 years. Nonmetastatic breast cancer patients were evaluated for the tumour subtype based on surrogate markers (ER, PR and HER2). The BMI of these patients was correlated with the tumour subtype and size. Results We studied 476 patients with breast cancer with the median age of 46 years (range, 25-86) and 58% were premenopausal. The mean BMI of the cohort was 24.1, which was significantly higher in postmenopausal women (24.9 versus 23.6, p < 0.05). Overall, only 10% of patients were obese. The mean BMI in the luminal, HER2 and TNBC subtypes was 24.7, 22.4 and 23.9, respectively (p < 0.01). Also, the mean tumour size in luminal, HER2 and TNBC subtype was 4.02, 3.80 and 4.27 cm, respectively (p = 0.158). Conclusion The average BMI was higher in patients with luminal subtype followed by TNBC and lowest for HER2 at the time of diagnosis. The mean tumour size was numerically higher for TNBC and lowest for HER2 subtype although the difference was not statistically significant. Larger studies may provide clarity of association between the BMI and tumour subtype.

We report a rare case of 40-years-old male patient who presented with right shoulder joint swelling and reduced range of motion since one and half month. Subsequent X-ray and Magnetic Resonance Imaging (MRI) revealed completely resorbed humeral head, extensive intra-articular debris, joint effusion and thickened synovium. MRI of whole spine showed long segment syrinx, pointed peg of tonsils with tonsillar ectopia and basilar invagination. Diagnosis of atrophic type of Neuropathic shoulder joint secondary to syrinx and Chiari malformation was made.

A mucocele is a common salivary gland disorder that most commonly affects young adults. A 35‑year‑old female patient reported to the Department of Oral and Maxillofacial Surgery, with the chief complaint of swelling on the left side of floor of mouth. The aim of this case report is to present the management of mucocele present in floor of the mouth in a young female patient using liquid nitrogen cryosurgery. The present case report has also discussed mechanism of action, current protocol of cryosurgery with emphasis on clinical pros and cons along with the clinical outcomes.Keywords: Cryotherapy, liquid nitrogen, mucocele, ranula

Introduction Primary angiosarcoma of the breast is a rare entity with incidence of less than 0.05% of all malignant breast neoplasms. It occurs in young females without any associated risk factors. The tumor behaves aggressively and has a poor prognosis compared to invasive ductal carcinoma. Method It was a retrospective observational study done at a tertiary cancer center from January 2012 to December 2016. The medical records of patients diagnosed with primary breast angiosarcoma were reviewed for the study. Clinicopathological profile, treatment, and the outcomes were analyzed. Results Four patients were diagnosed with primary breast angiosarcoma out of 2560 breast cancer patients seen over a period of 5 years. Two had metastatic disease at presentation. Among four patients, two underwent surgery of the primary tumor, whereas, all received chemotherapy either as adjuvant or palliative setting. One patient received adjuvant radiation therapy. Three patients received 2nd line and one received 3rd line chemotherapy on disease progression. After a median follow-up of 18 months one patient was surviving on 3rd line chemotherapy with trabectedin. Other three succumbed to disease after progression. Conclusion Due to a small number of this malignancy randomized studies are difficult to perform and optimum treatment strategy still need to be defined.

AIM: The aim of this study was to validate the role of fluorescence in situ hybridization (FISH) in investigating HER2/neu gene amplification (human epidermal growth factor receptor 2) in patients with HER2/neu equivocal breast cancer diagnosed on immunohistochemistry (IHC). MATERIALS AND METHODS: This was a retrospective study conducted from January 2013 to October 2017. A total of 134 patients diagnosed with invasive breast carcinoma and HER2/neu equivocal status on IHC were analyzed. Also, the cases for the years 2016 and 2017 formed a subgroup that was analyzed further to study the impact of pre-analytical factors on IHC and FISH results. RESULTS: A total of 134 women with HER2/neu IHC equivocal breast cancer were included in the study with a median age of 50 years (range 25–81). HER2/neu amplification by FISH was noted in 72 (54%) cases, whereas it was non-amplified in 52 (39%) cases. Ten cases were reported as equivocal even on FISH (ASCO/CAP 2013 guidelines). Polysomy 17 was noted in 55 cases (41%), of which 26 patients were≤50 years and 29 patients were >50 years of age. Twenty (36%) of these 55 cases showed HER2/neu amplification, whereas 26 (48%) cases were non-amplified and 9 (16%) cases were reported as equivocal on FISH. Also, more than half of the polysomy cases were hormone receptor negative. CONCLUSION: IHC is a good screening tool for negative and positive results. Any patient targeted for trastuzumab therapy should undergo confirmation of HER2/neu equivocal status by FISH analysis. We also suggest that if a non-classical FISH pattern is seen, the test should be repeated with a non-centromeric chromosome 17 reference locus probe for better treatment planning.

Objective: Patients who have undergone a previous bidirectional superior cavopulmonary anastomosis and have hypoxemia and anatomy considered unsuitable for the Fontan completion present a difficult subset. We performed common carotid artery-to-internal jugular vein (CCA-IJV) shunt in these patients. Methods: Between January 2010 and January 2015, eight patients underwent a CCA-IJV shunt. Their records were analyzed retrospectively. Results: There were no early deaths. The baseline arterial saturation prior to the shunt procedure was median 67% (range 60%-72%), which increased to median 83% (range 80%-90%) after the procedure. The preoperative arterial oxygen partial pressure (Pao2) ranged from 30 to 49 mm Hg (median 40 mm Hg). The hematocrit dropped from a preoperative median of 65% (range 55%-72%) to a median of 45% (range 42%-48%) after the procedure. Median intensive care unit stay was 2.5 days, and the median hospital stay was 7 days. Median follow-up was 24 months. At the last follow-up, these patients were classified in New York Heart Association class II. Conclusions: In a selected group of patients who are considered to be unsuitable for completion of Fontan circulation following superior cavopulmonary anastomosis, creation of a CCA-IJV shunt may be helpful to improve saturations and improve ventricular function.

The Korsakoff syndrome is defined as “an abnormal mental state in which memory and learning are affected out of all proportion to other cognitive functions in an otherwise alert and responsive patient.” Confabulation refers to false or erroneous memories arising, not deliberately, in the context of a neurological amnesia and is often thought of as pathognomonic of the Korsakoff syndrome. Although the exact pathophysiology is unknown, various studies have identified brain lesions in the thalami, mammillary bodies, and frontal cortex. We report a case of a 68-year-old male presenting with acute altered mental status on July 16, 2015. The neuropsychological dysfunctions included prominent Korsakoff’s syndrome, which became apparent when the altered mental status resolved. Amnesia was accompanied by prominent confabulation, disorientation, and lack of insight into his own disability. Neuroradiological data indicated that the intralaminar and dorsomedial nuclei in bilateral thalami were infarcted by occlusion of the artery of Percheron. We believe that ours is one of few reported cases of Korsakoff syndrome in a patient with infarction involving the territory of the artery of Percheron. We conclude that bilateral thalamic lesions could cause Korsakoff’s syndrome and the intralaminar and dorsomedial nuclei might be important structures in the pathogenesis of confabulation.

BACKGROUND: Skin is the second most common site for extranodal non-Hodgkin's lymphoma (NHL). Most primary cutaneous NHLs are of T-cell origin (70%). Primary cutaneous B-cell lymphoma (PCBCL) is a rare entity. MATERIALS AND METHODS: Patients diagnosed with PCBCL between January 2012 and July 2017 at our center were retrospectively analyzed. RESULTS: Eight patients of PCBCL were diagnosed. Three patients (37.5%) were males while 5 patients (62.5%) were females. The median age at diagnosis was 45 years (range, 18–60 years). Scalp was the most common site of involvement (50% of the patients). Diffuse large B-cell lymphoma (DLBCL) was the most common histology (63%), with leg-type DLBCL diagnosed in 1 patient. Two patients had primary cutaneous follicle center lymphoma, whereas the remaining 1 patient had precursor B-lymphoblastic lymphoma. All 5 DLBCL cases were treated with CHOP chemotherapy, and rituximab was given to 3 patients. Of the primary cutaneous follicle center lymphomas, 1 patient with stage II disease was treated with CHOP and is alive without recurrence for the past 5 years, whereas the other patient is on observation alone. The patient with precursor B-lymphoblastic lymphoma was started on MCP-841 protocol; however, the patient did not complete the treatment and died after 11 months. CONCLUSIONS: PCBCL is a heterogeneous group of diseases and dividing them into subtypes, based on morphology and immunophenotype, has therapeutic implications.

Introduction: Lung cancer accounts for the highest mortality globally, and there is a need to find new strategies and novel treatment options. Lung cancer is genetically heterogeneous across various ethnic populations, and therefore identifying the mutational landscape in Indian patients is important. Methods: The aim of the pilot study is to identify the prevalence and temporal sequence of molecular lesions in lung cancer patients from a regional cancer institute in South India using the circulating tumor DNA technique. Genotyping was performed on 26 newly diagnosed metastatic lung cancer patients using Illumina Omni Express Exome. Chip data were inspected using Genome Studio and subsequently exported for use with PLINK and further annotation was performed. Results: Seven genes including TP53 (61.5%), MUC16 (57.6%), KRAS (38.4%), STK11 (19.2%), Epidermal growth factor receptor (15.3%), ataxia telangiectasia mutated (15.3%), and nuclear factor-κβ (7.6%) demonstrated high incidence of mutations in patients. The other genes identified were observed in

A 13-year-old boy presented with bilateral retrobulbar neuritis. Three months later he presented with unilateral proptosis and cervical lymphadenopathy. Lymph node biopsy confirmed non-Hodgkin's lymphoma, B-cell type. To the best of our knowledge, this is the first reported case of bilateral retrobulbar neuritis as the presumptive initial presentation of non-Hodgkin's lymphoma.

A 64-year-old female had symptomatic severe aortic insufficiency and was taken up for aortic valve replacement. The patient was found to have a quadricuspid aortic valve and abnormally located early bifurcated left coronary ostium which were very near to the commissures. There is a risk of damaging the coronary ostia while excising the valve or the prosthetic valve can obstruct the abnormally located ostia. Intraoperative transesophageal echocardiography can help in making an accurate intraoperative diagnosis and deciding aortotomy incision and valve excision. This patient underwent successful aortic valve replacement taking great care to save the abnormally located left coronary ostium.