A Comprehensive Study on Ruptured Liver Abscess in a Tertiary Care Center.

Background Bacteria and parasites cause liver abscesses (LAs), with the unusual but fatal consequence of ruptured LA. Along with the clinical signs of icterus, right upper quadrant pain, and a history of loose stools, patients present with non-specific symptoms such as fever, nausea, and generalized weakness. Consistent findings include male sex prevalence and frequent alcohol consumption. Leukocytosis, abnormal liver function, and an increased international normalized ratio have been identified by biochemical analysis; however, these findings are not specific to a ruptured LA diagnosis, and imaging is necessary to reach a definitive diagnosis. Ultrasonography usually confirms the diagnosis, and computed tomography is required in certain situations. In confined ruptures, percutaneous drainage combined with antibiotic therapy is typically the initial treatment course. Generally reserved for non-responders or moribund patients with delayed presentation, an open surgical approach may involve simple draining of a ruptured abscess or ileocecal resection, or right hemicolectomy in cases of large bowel perforations, both of which increase patient morbidity. A definite guide to management is still missing in the literature. In this article, we have discussed and correlated with data the predictors of surgery and preoperative predictors of perforation. Materials and methods This retrospective study was performed at Safdarjung Hospital, New Delhi, between January 2022 and December 2023. The study included 115 patients diagnosed with ruptured LA by ultrasound. Medical records were analyzed, and various parameters of the illness, clinical features, hematological and biochemical profiles, ultrasound features, and therapeutic measures were noted and assessed. Results Of the 115 patients, 88% (n = 101) were male. The most common symptoms were abdominal pain (114 patients) and right upper abdominal tenderness (107 patients). Fifty-two patients were treated with percutaneous drainage, and 42 underwent laparotomy. Intercostal drainage (ICD) tubes were placed in 19 patients. Sixteen patients had large bowel perforations. Twenty-three patients died (20%), including 17 patients who underwent laparotomy and nine patients who had large bowel perforation (39.1% associated with overall mortality, 52.9% associated with mortality in laparotomy). One patient with percutaneous drainage and a right ICD tube died in the intensive care unit. Four patients died before intervention. Significant associations were noted between perforation and mortality in patients who underwent surgical drainage. Loose motions, alcohol and smoking consumption, and deranged creatinine and albumin levels were found to have a significant association with surgical drainage. Conclusion The study found that a ruptured liver abscess (LA) may require surgery to drain the collection or repair the pathological bowel, which increases the morbidity, but it is a lifesaving procedure over percutaneous catheter drainage. The study also identified factors associated with a higher risk of death, such as a history of loose stools and low blood albumin levels.

Clinical Efficacy of Concentrated Growth Factors for the Management of Marginal Tissue Recession: A Systematic Review and Meta-Analysis.

INTRODUCTION: To systematically review existing scientific literature to determine, compare, and evaluate whether concentrated growth factors (CGF) or connective tissue grafts (CTG) is a better treatment alternative for patients with marginal tissue recession (MTR). METHODS: Electronic databases like PubMed, Embase, Scopus, and Google Scholar were screened from the last 20 years reporting treatment of MTR using CGF or CTG and other techniques. Periodontal parameters like probing depth, clinical attachment level, recession depth, recession width, keratinized tissue width, root coverage, increase in gingival thickness and plaque index, and gingival index were compared. Standardized mean difference was used as a summary statistic measure with a random effect model and P value <0.05 as statistically significant. RESULTS: Six studies fulfilled eligibility criteria and were included in qualitative synthesis, of which only 4 studies were suitable for meta-analysis. The pooled estimate through standardized mean difference signifies that CGF was superior to CTG in the reduction of probing depth, gingival index, and plaque index and gain in clinical attachment level while CTG was superior in reducing the recession depth and recession width. Both the procedures had an overall equal effect on keratinized tissue width and root coverage, but these differences were statistically insignificant (P>0.05). Publication bias through the funnel plot showed symmetric distribution without systematic heterogeneity. CONCLUSION: The present study suggests that treatment of MTR with CTG or CGF resulted in clinically favorable outcomes, but no statistically significant differences was observed between these 2 procedures regarding the outcome.

Vidarabine as a novel antifungal agent against Candida albicans: insights on mechanism of action.

Around 1.5 million mortality cases due to fungal infection are reported annually, posing a massive threat to global health. However, the effectiveness of current antifungal therapies in the treatment of invasive fungal infections is limited. Repurposing existing antifungal drugs is an advisable alternative approach for enhancing their effectiveness. This study evaluated the antifungal efficacy of the antiviral drug vidarabine against Candida albicans ATCC 90028. Antifungal susceptibility testing was performed by microbroth dilution assay and further processed to find the minimum fungicidal concentration. Investigation on probable mode of vidarabine action against C. albicans was assessed by using the ergosterol reduction assay, reactive oxygen species (ROS) accumulation, nuclear condensation, and apoptosis assay. Results revealed that C. albicans was susceptible to vidarabine action and exhibited minimum inhibitory concentration at 150 µg/ml. At a concentration of 300 µg/ml, vidarabine had fungicidal activity against C. albicans. 300 µg/ml vidarabine-treated C. albicans cells demonstrated 91% reduced ergosterol content. Annexin/FITC/PI assay showed that vidarabine (150 µg/ml) had increased late apoptotic cells up to 31%. As per the fractional inhibitory concentration index, vidarabine had synergistic activity with fluconazole and caspofungin against this fungus. The mechanism underlying fungicidal action of vidarabine was evaluated at the intracellular level, and probably because of increased nuclear condensation, enhanced ROS generation, and cell cycle arrest. In conclusion, this data is the first to report that vidarabine has potential to be used as a repurposed antifungal agent alone or in combination with standard antifungal drugs, and could be a quick and safe addition to existing therapies for treating fungal infections.

Male Breast Cancer With Dual BRCA2 and BRIP1 Deleterious Gene Mutations.

Background: Male breast cancer remains relatively underexplored in the medical literature. At present, male patients with breast cancer follow the same treatment guidelines as female patients with breast cancer, principally because of similar outcomes with treatment. However, this practice should not preclude generating evidence for male breast cancer surveillance, diagnosis, and management. BRCA2 gene mutations are associated with an increased risk of male breast cancer, along with lesser-known gene mutations that could also increase this risk, such as mutations of the BRIP1 gene. This case report presents a male patient with dual BRCA2 and BRIP1 deleterious gene mutations. To our knowledge, this combination has not been reported in the medical literature to date. Case Report: A 53-year-old male presented with a palpable symptomatic mass underneath the right nipple-areolar complex. Biopsies confirmed a poorly differentiated, infiltrating ductal carcinoma that was estrogen and progesterone receptor positive and human epidermal growth factor receptor-2 negative. The patient underwent a left modified radical mastectomy, with a right prophylactic simple mastectomy. Postoperatively, he underwent adjuvant chemotherapy and endocrine therapy. Conclusion: This novel case of genetically based male breast cancer with dual deleterious gene mutations provides insight into current treatment recommendations and the subtle differences between male breast cancer and female breast cancer. Engaging in discussions surrounding such rare cases not only raises awareness of male breast cancer but also indicates the need for further research aimed at establishing evidence-based management strategies for male patients with breast cancer.

Antifungal Activity of Mefloquine Against Candida albicans Growth and Virulence Factors: Insights Into Mode of Action.

The antimalarial drug Mefloquine has demonstrated antifungal activity against growth and virulence factors of Candida albicans. The current study focused on the identification of Mefloquine's mode of action in C. albicans by performing cell susceptibility assay, biofilm assay, live and dead assay, propidium iodide uptake assay, ergosterol quantification assay, cell cycle study, and gene expression studies by RT-PCR. Mefloquine inhibited the virulence factors in C. albicans, such as germ tube formation and biofilm formation at 0.125 and 1 mg/ml, respectively. Mefloquine-treated cells showed a decrease in the quantity of ergosterol content of cell membrane in a concentration-dependent manner. Mefloquine (0.25 mg/ml) arrested C. albicans cells at the G2/M phase and S phase of the cell cycle thereby preventing the progression of the normal yeast cell cycle. ROS level was measured to find out oxidative stress in C. albicans in the presence of mefloquine. The study revealed that, mefloquine was found to enhance the ROS level and subsequently oxidative stress. Gene expression studies revealed that mefloquine treatment upregulates the expressions of SOD1, SOD2, and CAT1 genes in C. albicans. In vivo, the antifungal efficacy of mefloquine was confirmed in mice for systemic candidiasis and it was found that there was a decrease in the pathogenesis of C. albicans after the treatment of mefloquine in mice. In conclusion, mefloquine can be used as a repurposed drug as an alternative drug against Candidiasis.

Unusual Triggers of Acute Intestinal Obstruction in Surgical Emergencies: A Series of Five Cases.

Intestinal obstruction is a common surgical emergency that can be caused by mechanical causes or by different pathological processes. The most common cause of small bowel intestinal obstruction is post-operative adhesion, and the most common cause of large bowel obstruction is malignancy. These are classified into dynamic and adynamic types. The patient was selected based on the presentation management plan. Some cases require immediate operative intervention; however, some cases, as mentioned in this case series, require further investigation and a different approach. In this study, we report the rare causes of intestinal obstruction presented to Safdarjung Hospital, Department of General Surgery, New Delhi: one case of foreign body impaction, one case of spontaneous migration of feeding jejunostomy, one case of extrauterine IUCD causing intestinal obstruction, one case of mesentery band causing obstruction, and one case of abdominopelvic mass causing small bowel obstruction. These cases presented to the surgical emergency department with challenges in their diagnosis, intraoperative findings, and their outcomes.

Compound Volvulus: A Rare Case of Intestinal Obstruction.

Compound volvulus or ileosigmoid knotting is an uncommon surgical emergency that causes intestinal obstruction. The sigmoid and ileum are mostly involved in this closed-loop intestinal obstruction. It is regarded as a rather uncommon cause of intestinal obstruction. It's important to distinguish between an ileosigmoid knot and a simple sigmoid volvulus since the management of the two is different. CT and MRI are more helpful in the diagnosis than abdominal X-ray findings, which are not pathognomonic. After resuscitation, a patient with ileosigmoid knotting typically needs an emergency laparotomy. Different resectional and non-resectional surgical procedures may be employed depending on the viability of the ileum and sigmoid colon.

Evaluation of Negative Pressure Wound Therapy in the Management of Fournier's Gangrene.

Introduction Necrotizing soft tissue infections (NSTIs), including Fournier's gangrene (FG), are severe polymicrobial bacterial infections characterized by rapidly spreading inflammation and tissue necrosis. This study aims to compare the clinical outcomes of vacuum-assisted closure (VAC) dressing and conventional dressing in patients with FG. Materials and methods A prospective study was conducted from December 2020 to May 2022, including patients with clinical features suggestive of FG. Patients were divided into two groups: conventional dressing and VAC dressing. Relevant clinical data, including age, duration of hospital stay, wound status, Fournier's gangrene severity index (FGSI) scores, sepsis markers (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio, and procalcitonin), and pain assessment, were recorded and compared between the two groups. Results A total of 84 patients were included in the study, with 42 patients in each group. The mean age was 57.48 ± 15.74 years in the conventional dressing group and 50.83 ± 13.95 years in the VAC dressing group. VAC dressing was associated with a significantly shorter duration of hospital stay (8.14 ± 3.13 days) compared to conventional dressing (11.36 ± 4.75 days). The average time taken for wound closure was significantly reduced in the VAC dressing group (63 ± 14.81 days) compared to the conventional dressing group (112.56 ± 13.82 days). FGSI scores showed significant improvement after debridement in both groups, with lower scores in the VAC dressing group at discharge. Sepsis markers such as CRP and serum procalcitonin exhibited a significant decrease after VAC application. Discussion The study demonstrates that VAC therapy is associated with better clinical outcomes in FG, including reduced duration of hospital stay, faster wound closure, improved FGSI scores, decreased sepsis markers, and reduced pain. These findings align with previous studies highlighting the advantages of VAC therapy over conventional dressing methods. Conclusion VAC therapy provides significant benefits in the management of FG, leading to improved clinical outcomes and patient quality of life. It offers advantages such as shorter hospital stays, faster wound closure, and reduced sepsis markers. The application of VAC dressing should be considered a valuable treatment modality for FG.

Survival Secrets: Unmasking the Factors Predicting Failure of Non-operative Management (NOM) in Splenic Injuries.

BACKGROUND: Splenic injuries are common solid organ injuries resulting from blunt abdominal trauma in road traffic accidents. Very often, splenic injuries can be life-threatening. Earlier, splenic injuries were often dealt with surgical intervention, such as splenectomy. With the recognition of the immunological function of the spleen and possible complications of splenectomy surgery, such as overwhelming post-splenectomy infections (OPSI), there has been a recent trend for non-operative management (NOM). OBJECTIVE: To study the variables predicting failure of NOM in blunt abdominal trauma patients with splenic injury. METHODS: This is a retrospective study that includes 235 patients who presented to the Safdarjung Hospital emergency room (New Delhi, India) with blunt trauma abdomen and splenic injuries with or without associated injuries between January 2019 and December 2021. The data was entered in a Microsoft Excel spreadsheet (Microsoft Corp., Redmond, WA, USA). Categorical variables were expressed as frequencies and percentages. Pearson's chi-square test of association was used to determine if there is a relationship between two variables. A p-value of <0.05 was considered statistically significant. RESULTS: Out of 235 patients with blunt abdominal trauma and splenic injuries, 82 were hemodynamically unstable despite resuscitation and were taken up for emergency laparotomy. The remaining 153 patients, who were either hemodynamically stable or stabilized after adequate resuscitation, were managed on the lines of NOM. The number of patients with splenic injury in AAST grades 1, 2, 3, 4, and 5 was 36, 50, 40, 24, and three, respectively. Out of 153 patients, 130 (85%) were successfully managed by NOM, while eight (5%) had to discontinue NOM as they required surgical intervention. The failure of NOM (fNOM) is seen mostly with grade 5 injuries (2/2, 100%, p<0.01), followed by grade 4 (4/20, 20%) and grade 3 (2/37, 5.7%). The mean age in fNOM was 58.3 years, as compared to 42.2 years in the success of NOM (sNOM). All eight patients had multiple concomitant injuries, with femur fracture being the most common association in up to six patients (p<0.01), followed by liver injury in four patients. There were 15 mortalities, irrespective of AAST severity grade. All of these patients had associated concomitant injuries, with intracranial bleeding (n = 10, 32%, p<0.01) being the most common association, followed by femur fracture (n = 6, 20%) and liver injury (n = 5, 16%). Also, the cause of death was unrelated to splenic trauma (p = 0.67), with pulmonary embolism (n = 6, 40%, p<0.01) being the most common cause, followed by brain stem herniation (n = 5, 34%). CONCLUSION: Non-operative management is a safe and efficient method for treating patients with splenic injuries who are hemodynamically stable or stabilized. The factors associated with fNOM include elderly age, a higher American Association for the Surgery of Trauma (AAST) grade of splenic injury, and associated concomitant injuries. Femur fracture was the most common concomitant injury present in cases where NOM failed, followed by liver injury. The presence of intracranial bleeds in these patients was a common association with mortality, irrespective of the grade of splenic injury.

Assessment of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Carcinoma Using Image-Guided Clip Placement.

Background The present study aims to evaluate the response of locally advanced breast carcinoma (LABC) to neoadjuvant chemotherapy (NACT) using image-guided clip placement based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. Methods Thirty-four patients with LABC were included in the study. Consent for three-dimensional titanium clip placement (400/300/200 mm Liga clips) under local anesthesia with USG guidance was obtained. Serial sonographic/X-ray evaluations of tumor bed size were conducted before every cycle of NACT. All data were recorded in millimeters of concentric tumor regression/non-regression. Tumor regression in a concentric or Swiss cheese pattern and non-responders were evaluated. Assessment of the response to NACT was performed using RECIST criteria, dividing it into four categories. Tumor response was confirmed with computerized tomography (CT) conducted before and after the completion of NACT. Patients underwent surgical management, mostly modified radical mastectomy (MRM), as they had locally advanced breast carcinoma. Following MRM, the clips in the specimen guided the original site of the tumor for histopathological evaluation and response to chemotherapy. Results Tumor response was classified into four types: complete response (CR), partial response (PR), progressive disease (PD), and stable disease. RECIST 1.1 criteria were elaborated and defined. Data for all patients were entered into an Excel sheet (Microsoft Corporation, Redmond, Washington) to prepare a master chart, and the following observations were made and analyzed using SPSS software. The duration of chemotherapy for the study population ranged from 32 to 206 days, with a mean (±SD) of 111.82 (± 52.64) days and a median (IQR) of 81 (63, 158) days. The mean period between clip insertion and completion of NACT was 111.82 days. The baseline sum diameters and post-NACT diameters of the tumors were 70.50 (±13.60) mm before NACT and 17.75 (±17.20) mm after NACT. Hence, the mean size of the lump was statistically significantly lower after NACT, with a mean difference of 52.75 (p<0.05). The mean rate of reduction in tumor diameter was found to be 74.32% (±23.44%) based on RECIST 1.1 criteria. Pathological response was observed in all patients except for 8.8% of the patients. Clinical complete response was seen in 35.29% of patients, and partial response was observed in 52.92% of the patients based on RECIST 1.1 criteria. The study thus demonstrates the effectiveness of NACT in LABC, with a mean reduction in tumor diameter of 74.32%, assessed with the help of RECIST 1.1 criteria. Conclusion NACT for patients with LABC has shown a significant reduction in tumor size. NACT should be the initial mode of management for patients with LABC. RECIST 1.1 criteria are effective and can be used to assess tumor response to NACT. This has aided in the stratification of the response of NACT for further management through systemic therapy (adjuvant chemotherapy) after the surgical excision of the tumor.

Genetic analysis for semen quality traits in buffalo bulls.

This study was attempted to estimate the genetic parameters of semen quality traits in buffalo bulls. The study data consisted of 10975 ejaculates from 45 Murrah buffalo bulls (aged 24-72 months) used for breeding program during year 2010 to 2020. Semen quality traits (ejaculate volume, concentration of sperm, mass activity, initial and post-thaw motility, number of sperms per ejaculate, motile sperm number and discard rates) were studied. It was observed that average ejaculate volume was 2.82 ± 1.45 mL with mean concentration of 1040.12 ± 523.26 million/mL. Higher heritability was observed for number of sperms per ejaculate, number of motile sperm and sperm concentration. Significant phenotypic correlation was obtained between volume and number of sperms per ejaculate as well as volume and number of motile sperms. Likewise, significant phenotypic correlation was evident between sperm concentration with sperm number per ejaculate. Highest phenotypic correlation was obtained between sperm count per ejaculate and motile sperm count. Estimated genetic trends showed significant change in volume and motile sperm number. In conclusion, this study ascertains that genetic parameters of semen traits can be considered during the selection of buffalo bulls in breeding program.

Understanding painful versus non-painful dental pain in female and male patients: A transcriptomic analysis of human biopsies.

Dental pain from apical periodontitis is an infection induced-orofacial pain condition that presents with diversity in pain phenotypes among patients. While 60% of patients with a full-blown disease present with the hallmark symptom of mechanical allodynia, nearly 40% of patients experience no pain. Furthermore, a sexual dichotomy exists, with females exhibiting lower mechanical thresholds under basal and diseased states. Finally, the prevalence of post-treatment pain refractory to commonly used analgesics ranges from 7-19% (∼2 million patients), which warrants a thorough investigation of the cellular changes occurring in different patient cohorts. We, therefore, conducted a transcriptomic assessment of periapical biopsies (peripheral diseased tissue) from patients with persistent apical periodontitis. Surgical biopsies from symptomatic male (SM), asymptomatic male (AM), symptomatic female (SF), and asymptomatic female (AF) patients were collected and processed for bulk RNA sequencing. Using strict selection criteria, our study found several unique differentially regulated genes (DEGs) between symptomatic and asymptomatic patients, as well as novel candidate genes between sexes within the same pain group. Specifically, we found the role of cells of the innate and adaptive immune system in mediating nociception in symptomatic patients and the role of genes involved in tissue homeostasis in potentially inhibiting nociception in asymptomatic patients. Furthermore, sex-related differences appear to be tightly regulated by macrophage activity, its secretome, and/or migration. Collectively, we present, for the first time, a comprehensive assessment of peripherally diseased human tissue after a microbial insult and shed important insights into the regulation of the trigeminal system in female and male patients.

Rare Hernias as Surgical Emergencies: A Case Series of Five Cases.

Hernia is one of the most common clinically diagnosed cases seen in day-to-day practice. But some of them might pose a challenge in diagnosing the condition and, thus, their further management. Some types of hernias are rare and mimic the common presentation of the acute abdomen, thus requiring extra caution to keep hernias as a differential diagnosis in the acute abdomen. In this series, we report five cases of rare hernias presented to a tertiary care center in northern India over the course of one year. Two cases of paraduodenal hernias (PHs), a right and left, respectively, a male femoral hernia, an Amayand hernia, and an obturator hernia presented as acute abdomen in the emergency department, with challenges in their diagnosis, intraoperative findings, and their outcomes. Computed tomography is a useful diagnostic tool for arriving at the diagnosis pre-operatively in these situations.

Isothiocyanates as potential antifungal agents: a mini-review.

Cruciferous vegetables and mustard oil are rich in the glucosinolate group of molecules. Isothiocyanates are an important group of glucosinolate derivatives. These derivatives have various bioactive properties, including antioxidant, antibacterial, anticarcinogenic, antifungal, antiparasitic, herbicidal and antimutagenic activity. Previous studies indicate that regular intake of such vegetables may considerably reduce the incidence of various types of cancer. These studies have inspired studies where the bioactive agents of these plants have been isolated and explored for their therapeutic applications. The use of these bioactive compounds as antifungals could be a new therapeutic approach against human pathogenic fungi. Isothiocyanates have been studied for their antifungal activity and have the potential to be used for antifungal therapy.

Vegetables like cabbage, cauliflower and broccoli have a distinct flavor because of chemicals called glucosinolates. Whenever we cut and eat these vegetables, glucosinolates are broken down into isothiocyanates. Glucosinolates and isothiocyanates have health benefits because they stop the growth of bacteria, parasites and fungi that cause disease, such as Candida albicans. They may also prevent cancer, as regularly eating these vegetables has been shown to reduce the development of some types of cancer in humans. Investigation is needed to explore how glucosinolates and isothiocyanates could be used to treat fungal infections.

Outcomes of an enhanced recovery after surgery (ERAS) program to limit perioperative opioid use in outpatient minimally invasive GI and hernia surgeries.

BACKGROUND: Perioperative pain management is important for patient satisfaction while returning to homeostasis in the safest way possible. Studies show that patients don't require as much opioids as once thought. The benefits of ERAS pathways extend beyond enhancement of patients' perioperative experience, and include reducing opioid prescriptions in the face of the ongoing nationwide opioid crisis and evidence of prescription opioids as a contributor. METHODS: We performed a retrospective cohort study of patients undergoing same day minimally invasive surgery (MIS) procedures for GI and hernia disease using a minimal-opioid ERAS protocol at two community hospitals between January 2020 and May 2022. We included elective laparoscopic cholecystectomy (LC), laparoscopic appendectomy (LA) for acute appendicitis without perforation, and minimally invasive (laparoscopic and robotic) inguinal and ventral hernia repair or abdominal wall reconstruction (AWR). Primary outcome was postoperative opioid use. RESULTS: A total of 509 patients were included, undergoing procedures of MIS hernia repair (52.5%), LC (43.6%), and LA (7.9%). Only 9.4% of patients received opioid prescriptions at discharge, with no difference between groups. Among the patients receiving a prescription at discharge, there was a significant difference in morphine milligram equivalents (MME) prescribed (25.0 ± 0.0 in the LA group, 65.0 ± 41.4 in the LC group, 100.6 ± 46.2 in the MIS hernia/AWR group; P = 0.015). Nine percent of patients called with pain management concerns postoperatively. ASA score ≥ 3 was associated with increased odds for postoperative opioid prescription (OR 2.084; P = 0.014). CONCLUSIONS: We demonstrate that an opioid-sparing ERAS program effectively manages pain for patients undergoing multiple outpatient MIS GI/hernia procedures, and suggests generalizability across a diverse range of operations. Therefore, the use of ERAS may safely and effectively expand beyond inpatient MIS and open surgeries that target reduced length of stay to also minimize opioids for outpatient procedures.

Impact of Frailty Upon Surgical Decision-Making for Left-Sided Colon Cancer.

Background: Frailty is characterized by reduced physiologic reserve, and for patients with colon cancer, frailty is associated with increased morbidity after resection. One commonly cited reason for performing an end colostomy vs a primary anastomosis in left-sided colon cancer is the belief that frail patients do not have the physiologic reserve to withstand the morbidity associated with an anastomotic leak. We explored the impact of frailty on the type of operation performed in patients with left-sided colon cancer. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program for patients with colon cancer who underwent a left-sided colectomy from 2016 to 2018. Patients were categorized using the modified 5-item frailty index. Multivariate regression was used to identify independent predictors of complications and type of operation performed. Results: Of 17,461 patients, 20.7% were considered frail. Frail patients received an end colostomy more often than nonfrail patients (11.3% vs 9.6%, P=0.01). On multivariate analysis, frailty was a significant predictor for total medical complications (odds ratio [OR] 1.45, 95% CI 1.29-1.63) and readmission (OR 1.53, 95% CI 1.32-1.77) but was not independently associated with organ space surgical site infections or reoperation. Frailty was independently associated with receiving an end colostomy vs a primary anastomosis (OR 1.23, 95% CI 1.06-1.44), but an end colostomy did not decrease the risk of reoperation or organ space surgical site infections. Conclusion: Frail patients with left-sided colon cancer are more likely to receive an end colostomy, but an end colostomy does not lower the risk of reoperation or organ space surgical site infections. Based on these results, frailty alone should not prompt the decision to perform an end colostomy, but further studies are needed to guide surgical decision-making in this understudied population.

Revolutionizing Breast Healthcare: Harnessing the Role of Artificial Intelligence.

Breast cancer has the highest incidence and second-highest mortality rate among all cancers. The management of breast cancer is being revolutionized by artificial intelligence (AI), which is improving early detection, pathological diagnosis, risk assessment, individualized treatment recommendations, and treatment response prediction. Nuclear medicine has used artificial intelligence (AI) for over 50 years, but more recent advances in machine learning (ML) and deep learning (DL) have given AI in nuclear medicine additional capabilities. AI accurately analyzes breast imaging scans for early detection, minimizing false negatives while offering radiologists reliable, swift image processing assistance. It smoothly fits into radiology workflows, which may result in early treatments and reduced expenditures. In pathological diagnosis, artificial intelligence improves the quality of diagnostic data by ensuring accurate diagnoses, lowering inter-observer variability, speeding up the review process, and identifying errors or poor slides. By taking into consideration nutritional, genetic, and environmental factors, providing individualized risk assessments, and recommending more regular tests for higher-risk patients, AI aids with the risk assessment of breast cancer. The integration of clinical and genetic data into individualized treatment recommendations by AI facilitates collaborative decision-making and resource allocation optimization while also enabling patient progress monitoring, drug interaction consideration, and alignment with clinical guidelines. AI is used to analyze patient data, imaging, genomic data, and pathology reports in order to forecast how a treatment would respond. These models anticipate treatment outcomes, make sure that clinical recommendations are followed, and learn from historical data. The implementation of AI in medicine is hampered by issues with data quality, integration with healthcare IT systems, data protection, bias reduction, and ethical considerations, necessitating transparency and constant surveillance. Protecting patient privacy, resolving biases, maintaining transparency, identifying fault for mistakes, and ensuring fair access are just a few examples of ethical considerations. To preserve patient trust and address the effect on the healthcare workforce, ethical frameworks must be developed. The amazing potential of AI in the treatment of breast cancer calls for careful examination of its ethical and practical implications. We aim to review the comprehensive role of artificial intelligence in breast cancer management.

DOG1-Positive Extragastrointestinal Stromal Tumor Presenting As Large Abdomino-Pelvic Mass: A Case Report.

Gastrointestinal stromal tumors (GIST) are mesenchymal tumors commonly arising from the GI tract. Only a small number of GIST originating outside the GI tract have been reported in the literature. They are termed extraintestinal GIST (E-GIST), with histological features similar to GIST. These commonly arise from the omentum, mesentery, or abdominal wall. Microscopic examination shows spindle or epitheloid morphology with immunohistochemistry (IHC) positivity for the cluster of differentiation 117, 34 (CD117, CD34), or discovered on GIST-1 (DOG1). This case series describes the presentation of two cases of E-GIST as an abdominopelvic mass with DOG1 positivity and CD117 negativity on IHC. Patient in the first case presented with a giant abdominopelvic mass, clinically arising from the pelvis with a misdiagnosis of midline desmoid tumor. It was completely excised with a histological surprise of E-GIST with DOG1 positivity on IHC. The second case presented a swelling in the groin region, separate from the testis but arising from the anterior abdominal wall, with histological features of E-GIST with DOG1 positivity. The cases reported here show further evidence regarding the existence of a distinct subset of GISTs characterized by extraintestinal localization, with negative immunohistochemical expression of receptor tyrosine kinases (KIT) and positive DOG1 expression, which appears to be rare and makes DOG1 an emerging marker for GIST.

TiO2-modified g-C3N4 nanocomposite for photocatalytic degradation of organic dyes in aqueous solution.

In the current study, a direct S-scheme titanium dioxide/graphitic carbon nitride (TiO2/g-C3N4) heterojunction structure was fabricated via simultaneous calcination of TiO2 precursors and g-C3N4. Guava leaf extract was utilized as a reductant for TiO2 production through a green synthetic method, and g-C3N4 was prepared by thermal decomposition of melamine. The pristine and nanocomposite photocatalysts were characterized by XRD, FTIR, BET, TGA, HRTEM, UV-vis DRS, and PL to elucidate their physicochemical properties. The photocatalytic activity of synthesized photocatalysts was examined through the degradation of rhodamine B (RhB) and methylene blue (MB) dyes under simulated solar light irradiation. The nanocomposite exhibited commendable photocatalytic performances with 96% degradation efficiency of RhB attained in 120 min and 95% degradation efficiency of MB achieved in 150 min. The enhanced photocatalytic activities were attributable to visible light-harvesting characteristics and the formation of an S-scheme heterojunction system between two catalysts which promotes interfacial charge separation efficiency and longer charge carrier lifespan. After 4 consecutive cycles, the degradation efficiencies of both RhB and MB remained above 85%. According to the trapping experiments, OH• and O2 •- radicals were critical in the degradation of RhB, while h+ and O2 •- radicals were dominant in the degradation of MB. The nanocomposite was also tested for elution of actual water pollutants by combining two dyes, and above 90% degradation efficiencies were achieved for both dyes after 240 min.

International Council of Ophthalmology-Small Incision Cataract Surgery rubric: A roadmap to evaluate cataract surgical skill acquisition during residency training.

PURPOSE: The International Council of Ophthalmology-Small Incision Cataract Surgery (ICO-SICS) rubric is a tool to grade SICS steps from novice to competent. The study aimed to evaluate the progress of residents' surgical skills by using the ICO-SICS rubric and the perceptions of residents and faculties about its use. METHODS: This prospective educational interventional study, done in the Ophthalmology department between September 2019 and February-2020 included 14 residents and five faculties. Faculties scored residents' SICS by ICO-SICS-rubric (four sessions/resident) and helped them identify three steps as "area of focus" to work upon. Feedback was taken using a semi-structured pretested questionnaire. Focus group discussion was done for residents. Data were entered in MS Excel and analyzed using SPSS. Perception analysis presented as percentage of written responses. RESULTS: Step-wise rubric score showed improvement for initial SICS steps and wound closure (P < 0.05). Critical surgical steps and scores for three areas of focus steps showed no statistically significant improvement. Three steps as an area of focus changed partly for 11 residents and completely for three residents at the end of 6 months. Perception analysis of faculty and residents showed that the ICO-SICS rubric is a good tool to record surgical performance, identify steps needing improvement and provide structured feedback hence opined to continue it. Residents considered it as an effective learning and assessment tool. CONCLUSION: ICO-SICS rubric is a good teaching tool and helps to assess the progress of surgical skills. Identification of areas of poor performance and feedback given motivates them to focus on those areas leading to continuous professional development, resulting in competent surgeons performing SICS surgery independently at the end of the residency.