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The coronavirus disease (COVID-19) pandemic in 2020 has brought about complex challenges in healthcare delivery. With the new rules of lockdown and social distancing and with resources diverted to the management of COVID-19, there are difficulties in continuing usual cancer care. Patients are at risk of contracting COVID-19 with a high chance of patient to healthcare transmission and vice versa. Hospital visits, investigations and all modalities of treatment have potential complications that put patients at risk, some more than others. In this situation, there is a need to change our approach in the management of breast cancer to deliver it safely. We present modified guidelines based on the available consensus statements and evidence.

Objective: To analyze two techniques of papaverine application, topical spray on the harvested left internal mammary artery (LIMA) and perivascular injection, to find out their ability to improve LIMA flow. Methods: Forty patients were randomized into two groups. In Group 1, papaverine was sprayed on the harvested pedunculated LIMA. In Group 2, papaverine was delivered into the perivascular plane. Drug dosage was the same for both groups. LIMA flow was measured 20 minutes after applying papaverine. Blood flow was recorded for 20 seconds and flow per minute was calculated. The systemic mean pressures were maintained at 70 mmHg during blood collection. The data collected was statistically evaluated and interpreted. Results: The LIMA blood flow before papaverine application in the Group 1 was 51.9±13.40 ml/min and in Group 2 it was 55.1±15.70 ml/min. Statistically, LIMA flows were identical in both groups before papaverine application. The LIMA blood flow, post papaverine application, in Group 1 was 87.20±13.46 ml/min and in Group 2 it was 104.7±20.19 ml/min. The Group 2 flows were statistically higher than Group 1 flows. Conclusion: Papaverine delivery to LIMA by the perivascular injection method provided statistically significant higher flows when compared to the topical spray method. Hence, the perivascular delivery of papaverine is more efficient than the spray method in improving LIMA blood flow.

Infected non-union has been defined as a state of failure of union and persistent infection at the fracture site for 6-8months 1 and union is not likely to occur without active intervention. Infected non-union has been a challenge in orthopaedic surgical care. Open debridement of the infected non-union site appropriate antibiotics and stabilization of fracture are the basic principles of treatment in an infected non-union. Internal fixation of such fracture is fraught with recurrence and or persistence of infection as the implant so placed will act as a foreign body. The best way to stabilize such a fracture is with an external fixation. External fixation so used should not only stabilize the fracture but should also take the cyclical loading of day to day activities and also weight bearing. MATERIALS AND METHODS: In this study 18 cases of infected non-union of long bones were treated from 2009 to 2012. Their age ranged from 22 to 51. There were 13 male and 5 female patients. Basic principles followed in the treatment. 1. Elimination of infection by physical debridement removal of implants if any and antibiotic treatment based on culture sensitivity reports. 2. Stabilization of fracture to give the fracture area rest and allow it to heal. 3. Restoration of function of the limb and also the adjacent joints. RESULTS: 17 of the 18 patients had good results. Patient had to be treated with amputation as the infection was severe. CONCLUSION: Based on our study, experience and also after reviewing the published reports we conclude that "Best treatment for infection is Prevention". Treatment infected non-union is a long drawn battle. It needs an aggressive approach and a lot of patience from the patient. Basic treatment protocol for infected non-union is thorough debridement, removal of all infected material including the internal fixation devices. Long duration antibiotics treatment as per the culture and sensitivity pattern. Fracture stabilized with external fixation. Monolateral external fixators like LRS are equally effective and a good modality of treatment in infected non-union of long bone fractures. Treatment of Infected non-union of long

We present a novel, reverse thermo-responsive (RTR) polymeric osteogenic composite comprising demineralized bone matrix (DBM) and unmanipulated bone marrow cells (BMC) for repair of bone defects. The polymers investigated were low viscosity aqueous solutions at ambient temperature, which gel once they heat up and reach body temperature. Our goal to supplement DBM-BMC composite with RTR polymers displaying superior rheological properties, was to improve graft integrity and stability, during tissue regeneration. The osteogenic composite when implanted under kidney capsule of mice, proved to be biocompatible and biodegradable, with no residual polymer detected in the newly formed osteohematopoietic site. Implantation of the osteogenic composite into a large area of missing area of parietal bone of the skull of rats, resulted in an extensive remodeling of DBM particles, fully reconstituted hematopoietic microenvironment and well integrated normal flat bone within thirty days. The quality and shape of the newly created bone were comparable to the original bone and neither local or systemic inflammatory reactions nor fibrosis at the junction of the new and old calvarium could be documented. Furthermore, combined laser capture microdissection (LCM) technique and PCR analysis of male BMC in female rats confirmed the presence of male derived cells captured from the repaired/ regenerated flat bone defect. The use of active self sufficient osteogenic DBM-BMC composite supported by a viscous polymeric scaffold for purposive local hard tissue formation, may have a significant potential in enhancement of bone regeneration and repair following trauma, degenerative or inflamatory lesion, iatrogenic interventions and cosmetic indications. Fil: Kurkalli, Basan Gowda S. . The International Center for Cell Therapy & Cancer Immunotherapy; Israel. Tel Aviv Medical Complex. Weizman Center. Top Ichilov; Israel Fil: Gurevitch, Olga. Hebrew University Hadassah Medical School. Cell Therapy & Transplantation Research Laboratory; Israel Fil: Sosnik, Alejandro Dario. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. The Hebrew University Of Jerusalem; Israel Fil: Cohn, Daniel. The Hebrew University Of Jerusalem; Israel Fil: Slavin, Shimon. The International Center for Cell Therapy & Cancer Immunotherapy; Israel. Tel Aviv Medical Complex. Weizman Center. Top Ichilov; Israel

Right aortic arch with retroesophageal left innominate artery and patent ductus arteriosus (PDA) forming a complete vascular ring is a rare clinical condition. We present the case of a four-month-old child who was referred to our institution for evaluation of a cardiac murmur and repeated respiratory tract infections. The child had no history of feeding difficulties or breathing difficulties. On auscultation, continuous murmur was observed. Chest X-ray showed cardiomegaly, superior mediastinal widening, and increased pulmonary vascular markings. Transthoracic echocardiography showed right aortic arch, 1 Department of Cardiothoracic and Vascular Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India 2 Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India

No specific treatment exists for patients with multiple sclerosis (MS) who fail to respond to conventional immunosuppressive and immunomodulating modalities. Furthermore, no method is available for regeneration of existing defect in the central nervous system (CNS). The ultimate goals of MS treatment, similarly to other autoimmune diseases, are twofold: first, to eliminate self-reactive lymphocytes and to prevent de novo development of self-reactivity by induction of self-tolerance. Second, attempting regeneration and repair of existing damage. In the case of MS, there is a need to stop the ongoing process of inflammation against the CNS by self-reactive lymphocytes thus facilitating spontaneous re-myelinization while in parallel attempt to recover existing neurological deficits caused by the autoimmune process resulting in demyelinization. Cell therapy stands out as the most rationale approach for neurological regeneration. In the absence of clinically applicable approaches involving the use of embryonic stem cells, we are investigating the feasibility and efficacy of enriched autologous mesenchymal stromal cells (MSC) injected intrathecally and intravenously to induce in situ immunomodulation and neuroprotection and possibly facilitate repair of the CNS in patients with MS and other neurodegenerative disorders. Our preclinical results suggest that bone marrow cells may provide a source of stem cells with a potential for migration into inflamed CNS and differentiate into cells expressing neuronal and glial cell markers. Based on the preclinical data, we are currently evaluating the safety of a similar therapeutic approach in a small group of patients with MS and other neurodegenerative diseases.

A 21-year old male patient was evaluated for weakness and claudication of both lower limbs. Radio-femoral delay was present on palpation. No intracardiac anomalies showed up on echocardiography. Figures 1 and 2 show preoperative and postoperative computer tomography images and illustrations of the interrupted aortic arch. The aneurysm was excised and continuity established with an interposition graft.