Addressing the Crimean-Congo Hemorrhagic Fever Crisis in Pakistan's Healthcare System: An Urgent Call for Holistic Action.

The recent resurgence of the Crimean-Congo hemorrhagic fever (CCHF) in Pakistan's Balochistan province has significantly impacted both the medical community and the general population. Initially perceived as a concerning development, the situation has deteriorated, culminating in the infection and mortality of healthcare workers directly engaged in managing this virulent outbreak. This critical situation necessitates an urgent and collective response, transcending national boundaries to involve the international healthcare community.

Gender Bias in Leadership Roles in General Surgery: A South Asian Perspective.

This article addresses the significant issue of gender bias in leadership roles within the realm of general surgery, with a particular focus on the South Asian context. The persistence of cultural norms, entrenched gender stereotypes, and discriminatory practices in this region significantly limits the opportunities available to female surgeons. It calls on all stakeholders, including medical institutions, governing bodies, and surgeons, to take an active role in eliminating gender bias and fervently supporting diversity and inclusivity in leadership positions. By doing so, it argues, we can create a more equitable and promising future for the field of general surgery in South Asia.

Multifocal Desmoplastic Small Round Cell Tumor: A Case Report of a Rare Neoplasm.

Desmoplastic small round cell tumor (DSRCT) is a rare, highly aggressive malignancy predominantly affecting adolescents and young adults. We report a case of multifocal DSRCT in an 11-year-old male who presented with complaints of unilateral forehead swelling, proptosis, and ophthalmoplegia for four months along with abdominal pain and dysphagia for six months. A whole-body computed tomography revealed widespread lesions in the skull, orbit, thorax, and abdomen with local infiltration. Ultrasound-guided biopsy of the forehead lump was performed. Based on histopathological and immunohistochemical investigations, it was diagnosed to be a DSRCT with multifocal presentation. The patient underwent chemo-radiation but unfortunately succumbed to neutropenic sepsis and renal failure. DSRCT is a very rare, highly aggressive malignancy with an extremely poor prognosis. Orbital presentations are even rarer, with less than 10 such cases currently described in English medical literature.

Psychological Stress Experienced by First-Year Medical Undergraduates: A Cross-Sectional Study From Eastern India.

Background While medical education is vital for producing competent physicians, its rigorous curriculum can harm students' mental well-being. This study focuses on assessing psychological stress in first-year medical students in Eastern India and aims to identify its primary causes. Methods This cross-sectional study involved 125 first-year MBBS students in a tertiary care medical teaching institution in eastern India. They completed the Medical Student Stressor Questionnaire (MSSQ-40) questionnaire to measure stress and provided academic records to be reviewed.  Results Among the 125 students included in the study, male students demonstrated greater academic and interpersonal stress. The findings revealed that a substantial proportion (79%) of the student population experienced high to severe levels of academic stress, followed by 88% who reported moderate to high levels of social-related stress. Furthermore, it was observed that those students who experienced high to severe stress across all six domains tended to perform poorly during the initial half of their academic year. Conclusion The high levels of stress experienced by medical students can have significant implications for their academic performance. However, the nature of our study limits us to only highlight the existence of a correlation between the two. Future studies on the same should be conducted to assess the causal relation between these factors.

Artificial intelligence assisted endoscopic ultrasound for detection of pancreatic space-occupying lesion: a systematic review and meta-analysis.

BACKGROUND: Diagnosing pancreatic lesions, including chronic pancreatitis, autoimmune pancreatitis, and pancreatic cancer, poses a challenge and, as a result, is time-consuming. To tackle this issue, artificial intelligence (AI) has been increasingly utilized over the years. AI can analyze large data sets with heightened accuracy, reduce interobserver variability, and can standardize the interpretation of radiologic and histopathologic lesions. Therefore, this study aims to review the use of AI in the detection and differentiation of pancreatic space-occupying lesions and to compare AI-assisted endoscopic ultrasound (EUS) with conventional EUS in terms of their detection capabilities. METHODS: Literature searches were conducted through PubMed/Medline, SCOPUS, and Embase to identify studies eligible for inclusion. Original articles, including observational studies, randomized control trials, systematic reviews, meta-analyses, and case series specifically focused on AI-assisted EUS in adults, were included. Data were extracted and pooled, and a meta-analysis was conducted using Meta-xl. For results exhibiting significant heterogeneity, a random-effects model was employed; otherwise, a fixed-effects model was utilized. RESULTS: A total of 21 studies were included in the review with four studies pooled for a meta-analysis. A pooled accuracy of 93.6% (CI 90.4-96.8%) was found using the random-effects model on four studies that showed significant heterogeneity ( P <0.05) in the Cochrane's Q test. Further, a pooled sensitivity of 93.9% (CI 92.4-95.3%) was found using a fixed-effects model on seven studies that showed no significant heterogeneity in the Cochrane's Q test. When it came to pooled specificity, a fixed-effects model was utilized in six studies that showed no significant heterogeneity in the Cochrane's Q test and determined as 93.1% (CI 90.7-95.4%). The pooled positive predictive value which was done using the random-effects model on six studies that showed significant heterogeneity was 91.6% (CI 87.3-95.8%). The pooled negative predictive value which was done using the random-effects model on six studies that showed significant heterogeneity was 93.6% (CI 90.4-96.8%). CONCLUSION: AI-assisted EUS shows a high degree of accuracy in the detection and differentiation of pancreatic space-occupying lesions over conventional EUS. Its application may promote prompt and accurate diagnosis of pancreatic pathologies.

Mesenchymal hamartoma versus hepatoblastoma: A diagnostic dilemma.

INTRODUCTION AND IMPORTANCE: Pediatric hepatic tumors present diagnostic challenges due to diverse clinical presentations and limited patient communication. Elevated serum alpha-fetoprotein (AFP) levels, often associated with hepatoblastoma, can occur in various hepatic conditions, adding complexity to diagnosis. This report emphasizes the importance of comprehensive assessment and integrated interpretation in such cases. CASE PRESENTATION: We present a rare case of a 1-year-old female child with abdominal swelling and hepatomegaly. Imaging revealed a hypodense hepatic lesion with punctate calcifications. Initial biopsy suggested mesenchymal hamartoma, but subsequent biopsy confirmed hepatoblastoma, highlighting the diagnostic complexity. CLINICAL DISCUSSION: Hepatoblastoma is the most common pediatric liver tumor, typically presenting with nonspecific symptoms. Serum AFP levels are elevated, aiding diagnosis. Imaging reveals heterogeneous, hypervascular masses. Treatment includes surgery and chemotherapy. Mesenchymal hamartoma is a rare benign tumor with variable symptoms and imaging features, emphasizing the need for histopathological confirmation. This case underscores the importance of a comprehensive diagnostic approach. CONCLUSION: Diagnosing pediatric hepatic tumors requires an integrated assessment of clinical, laboratory, and imaging findings. Confirmatory biopsies are essential, as demonstrated by this case, where an initial diagnosis of mesenchymal hamartoma was revised to hepatoblastoma. Collaborative, multidisciplinary approaches are crucial for accurate diagnosis and effective therapeutic planning, offering hope for improved outcomes in these complex cases.

Challenges in managing anorectal melanoma, a rare malignancy.

INTRODUCTION AND IMPORTANCE: Anorectal melanoma is a rare and aggressive malignancy that can be difficult to diagnose due to its nonspecific presentation. CASE PRESENTATION: We present a case of a 69-year-old woman who presented with painful defecation, bleeding per rectum, and a mass coming out of her anal opening. The initial differential diagnosis included hemorrhoids, rectal polyp, or a malignant lesion of the rectum. However, histopathological evaluation following transanal excision of the rectal mass revealed mucosal melanoma in the anorectal region. Further investigation showed no evidence of locoregional or distant metastasis. CLINICAL DISCUSSION: Surgery remains the primary treatment option for anorectal melanoma, but complete resection is often not feasible, leading to high rates of local recurrence and distant metastasis. The incidence of metastatic disease at the time of presentation is high, and a multidisciplinary approach is necessary to manage these patients. Currently, standard systemic therapies used for cutaneous melanoma are the mainstay of treatment for metastatic anorectal melanoma, but there is a need for further research to develop tailored treatment strategies. CONCLUSION: Our case report highlights the importance of considering anorectal melanoma in the differential diagnosis of patients presenting with anorectal symptoms. It emphasizes the need for a multidisciplinary approach to managing this rare malignancy. Early diagnosis, a multidisciplinary approach, and ongoing research into more effective treatments are crucial for improving outcomes for patients with anorectal melanoma.

Giant choledochal cyst: The largest reported!

Choledochal cyst (CC) is an atypical congenital abnormality of the biliary system. CC more than 10 cm is rare and only a few cases are reported. Herein, we reported a 25 × 18 cm CC and highlighted how definitive treatment after a timely diagnosis provides good prognosis irrespective of the size.

Factors affecting depression and anxiety in diabetic patients: A cross sectional study from a tertiary care hospital in Eastern India.

Background: Diabetes is one of the most common chronic disease in the world and its prevalence in India is rising day by day. Diabetic patients often suffer from depression and anxiety which has a negative impact on patients resulting in non-adherence to medication, rapid disease progression and overall poor prognosis. India is the land of diversity and so are the causes of depression and anxiety in the people from different parts of the country. The study done in the current population has revealed certain indicators of both depression and anxiety that were not significant in previous studies. These new findings point towards the changing scenario and the need for more precise steps for improving the quality of life of diabetics. Aims: The study aims to determine the prevalence of depressive symptoms and anxiety among diabetic patients and the factors associated with them. Methods: A prospective cohort study was conducted with 305 participants among which 152 were diabetic while 153 were non diabetic patients. Depression and anxiety of the patients was measured through PHQ-9 scale and GAD-7 scale respectively. Factors associated with prevalence of depression and anxiety in the diabetic population was analysed. Results: The prevalence of depressive symptoms (39.5% versus 12.4%) and anxiety (36.2% versus 14.4%) were significantly higher in diabetic patients as compared to non-diabetic participants. Low-income, urban residence, unmarried status, insulin therapy, presence of retinopathy, and ischemic heart disease were significantly associated with depression among diabetic group of patients. Similarly the major predictors of anxiety were marital status, literacy and diabetic complications like neuropathy, retinopathy and ischemic heart disease. Conclusion: Our study shows depression and anxiety are highly prevalent among diabetic patients. All diabetic patients while seeking clinical contact should be screened for depression and anxiety especially those patients with predisposing risk factors.

Prevalence of the Retro-Renal Colon: A Systematic Review and Meta-Analysis with Implications for Percutaneous Nephrolithotomy.

Background: This systematic review and meta-analysis aims to determine the prevalence of the retrorenal colon (RRC) and its implications in percutaneous nephrolithotomy with the overall objective of promoting the prevention of associated iatrogenic complications. Methods: A systematic search of literature was conducted on the electronic databases PubMed, ScienceDirect, and Hinari to identify studies eligible for inclusion. Search results were screened by title and abstract, and those potentially relevant were evaluated by full text. Studies were deemed eligible for inclusion if they reported clear extractable data regarding the prevalence of the retro-renal colon. A meta-analysis was completed using MetaX1 to calculate the pooled prevalence of the retro-renal colon. Sub-group analysis was performed based on geographical regions from which the studies originated, imaging modality, and patient position. Results: 174 records were screened and a total of 10 records included in the analysis with retrospective cohort studies being the most common study design. A male predominance was seen in most sample sizes that had reported data on gender demographics ranging from 41.5-62%. The most common imaging modality utilized was computerized tomography (CT) scan followed by ultrasound. The range of the unweighted prevalence of retro-renal colon across all studies that had absolute numbers reported was from 3.5-25%. One of the studies reported a colonic perforation rate of 0.3% in patients without CT images. Conclusion: The retro-renal colon is a relatively common finding with observed preponderance to females and left lateralization. The presence of RRC increases the likelihood of colon perforations while gaining percutaneous access to the kidney. Pre-procedural imaging can help detect its presence and choose an appropriate route of entry. USG and CT have both been found useful as a modality to pick up RRC.

Hilar tuberculosis versus Klatskin tumour: a diagnostic challenge.

Hepatobiliary tuberculosis is a rare condition causing obstructive jaundice either by enlarged lymph nodes around the bile ducts or involvement of biliary epithelium by the tuberculous process. Since a tissue diagnosis is not mandatory to proceed with the resection or initiation of a liver transplant protocol, benign lesions are occasionally misdiagnosed as hilar cholangiocarcinoma. Here, we present a case of hepatobiliary tuberculosis which presented as obstructive jaundice due to hilar obstruction. The mass causing the obstruction was then later found to be a pseudotumour, typical of tuberculosis. This diagnosis meant that extensive surgical resection as a protocol for cholangiocarcinoma was avoided. The patient recovered completely after a course of antitubercular therapy.

Effect of Hypodermic Needle Versus Safety Lancet on the Fear and Anxiety of Needle Prick Among Undergraduate Medical Students During Hematology Practical: A Cohort Study From a Resource-Limited Setting.

Background Most of the government-sponsored medical teaching institutions in India do not provide safety lancets, and hence, the students are compelled to use hypodermic needles. These needles are widely unpopular among students due to the potential hazards (pain, fear, anxiety) associated with them. This study aims to compare any difference in fear and anxiety associated with finger pricking with a hypodermic needle and a safety lancet. Methods This is a prospective cohort study. The current study included data from first-year undergraduate medical students for academic sessions 2021-22. Results A total of 121 students participated in the study. Eighty-two (67.8%) participants were male. 41/82 male participants and 20/39 female participants were allocated to the intervention cohort. 111 (91.7%) pricked their fingers by themselves. The sight of others pricking during the experiment (17 versus 5, p=0.004) and the thought of pain while pricking (36 versus 16, p<0.001) was significantly associated more with the use of a hypodermic needle compared to a safety lancet. There was no significant difference in students perceiving the smell of the hematology laboratory (4 versus 1, p=0.165) and the sight of blood (9 versus 3, p=0.064) as a factor influencing their fear and anxiety in both cohorts. There was no gender difference in the perception of these factors. Symptoms were significantly lower in the intervention cohort compared to the control cohort (8 versus 20, odds ratio 0.302, p=0.008). The most common symptom experienced was excessive sweating (n=22, 18.18%), followed by drying of the mouth (n=12, 9.91%). There was a significant difference in pain scores between the intervention and the control cohorts. There was no significant difference in pain scores among male and female subjects. Conclusion A considerable difference between the two cohorts was found. The use of lancets can be proposed to medical teaching institutions for psychological advantage, pain reduction, and overall better quality of the process.

Authorship diversity in Gastroenterology-related Cochrane systematic reviews: Inequities in global representation.

The need for promoting diversity and equitable authorship representation in academics faces increasing recognition, with some articles pointing out the lack of diversity in specific fields. Currently, there are no such articles scrutinizing the author diversity in the field of Gastroenterology. Cochrane systematic reviews are perceived worldwide to be amongst the highest quality of evidence available, thereby its conclusions often impact policy and practice globally. However, little is known about the current state of authorship diversity in Gastroenterology-related Cochrane reviews.

Solid Pseudopapillary Neoplasm of the Pancreas Presenting With Gastric Outlet Obstruction.

Solid pseudopapillary neoplasm (SPN) of the pancreas are rare tumors accounting for a minor portion of all exocrine pancreatic tumors. It usually occurs in young women. It has a very low malignant potential with a relatively indolent clinical course. A small subset of patients exhibits pathological features of malignancy. Herein, we present a rare case of pancreatic SPN that presented with gastric outlet obstruction. Despite the characteristic computed tomography (CT) findings, due to its rarity, it was missed in more common conditions such as gastrointestinal stromal tumors. In our case, we found that the tumor was causing extrinsic duodenal compression leading to gastric outlet obstruction, creating a diagnostic dilemma.

A case of anterior scleritis in association with posterior scleritis - a diagnostic riddle.

We herein report a case of a young female presenting with multiple nodular scleral abscesses mimicking infective scleritis with exudative retinal detachment. Repeated diagnostic scraping for microbiological and histopathological analysis was inconclusive. The patient's systemic and collagen disease work-up was non-contributory. She was treated with multiple surgical debridement and de-roofing of the abscesses along with antibiotic irrigation. Topical and oral steroid was stopped on worsening of the condition, and the patient was maintained on topical and oral antibiotics. Complete resolution of scleritis and exudative detachment was noted at 1 month follow-up and no recurrence was noted until 6 months.

Perception of Online Learning Among Undergraduate Medical Students of Eastern India: A Cross-Sectional Study.

Background In 2020 WHO declared the coronavirus disease 2019 (COVID-19) outbreak as a global pandemic. To flatten the curve of infection, a nationwide lockdown was declared by the Indian government. All the schools and colleges were shut for an indefinite period. Like all other streams, medical education also got severely hampered. Adapting themselves to the changing environment, teachers started using different teaching-learning methods and media to get across to the students. The objective of the research was to study the perception of medical students towards online teaching during the COVID pandemic. Methods A descriptive cross-sectional study was conducted by the distribution of a pre-validated online questionnaire to medical students of West Bengal. From the collected data, relevant statistical averages and census domains were calculated. The chi-square test was done and assessed with a p≤0.05 significance level. Results A significant increase was noted in the time spent by students on various online teaching activities (p<0.05). Video tutorials, e.g., YouTube, were ranked as the most effective mode (17.2%), followed by live tutorials via Microsoft Teams, etc. (8.9%). A significant number (30.2%) of students strongly favoured online teaching over face-to-face teaching. Major challenges of online learning cited by students were internet connectivity issues (79.8%) followed by family distraction (37.9 %) and inconvenient timing of the classes (20.1%). Conclusion Our study highlighted the benefits, disadvantages and barriers to online learning from the perspective of undergraduate medical education in India. Even though the online mode of teaching was found to be beneficial in the context of the COVID-19 pandemic, it cannot be used as an absolute substitution for face-to-face teaching in the given context.

Clinical spectrum and management outcomes of Langerhans cell histiocytosis of the orbit.

Purpose: To describe the clinical spectrum and management outcomes of Langerhans cell histiocytosis (LCH) involving the orbit. Methods: Retrospective review of patients with orbital LCH presenting at the Sankara Nethralaya, Chennai, India, over the past 15 years. Demographic details, presenting features, radiology, histopathology, immunohistochemistry, and management outcomes were analyzed. Results: Nine patients were reviewed. The mean age of presentation was 10.12 ± 14.31 years (range: 6 weeks to 35 years). Eyelid swelling was the most common presenting feature (4, 44.4%), followed by proptosis (3, 33.3%). The mean duration of the presentation was 2.21 ± 2.77 months. Radiological investigations revealed orbital roof osteolytic defects in six (66.6%) patients. Six patients underwent near-complete excision of the mass while three underwent incisional biopsy. Histopathology revealed histiocytes with nuclear grooving and numerous eosinophils characteristic of LCH. The cells were positive for CD1a and S 100 antigens. None of the patients had any systemic involvement. Three received systemic steroids and four received systemic chemotherapy. At a mean follow-up of 17.85 ± 23.46 months, all had complete remission without any signs of recurrence. One patient was lost to follow-up after near-complete excision while one adult patient with a mass in the intraconal space had no recurrence after near-complete excision. Conclusion: LCH is a rare disorder of the orbit that commonly occurs in children and should be considered a differential for osteolytic lesions involving the orbit. All patients should undergo a systemic evaluation to rule out multifocal disease. The treatment depends upon disease extent and risk factors.

Case report on two diabetic donor eyes with no retinopathy: Clinicopathological and molecular studies.

We were intrigued to analyze donor eyes of two individuals without retinopathy even after 40 years of type 2 diabetes mellitus. Targeted molecular factors associated with angiogenesis and the key antioxidant enzymes in retinal tissue were analyzed. Accordingly PEDF, Adiponectin and Paraoxonase 2 showed augmented mRNA expression in both the retina with no significant change in VEGF expression. Vitreous showed increased PEDF protein in donor 1 and Adiponectin in donor 2 with no change in VEGF protein. This study highlights the profile of specific molecular factors that contribute to the non-development of diabetic retinopathy changes in these individuals.