Post Graduate Institute of Medical Education and Research

Background Neuroendocrine carcinoma of the prostate is a rare tumor subtype found in the spectrum of prostate cancer, and is more difficult to detect, due to the low prostate‐specific antigen values associated with it. A high degree of suspicion is hence needed to arrive at the diagnosis in such cases. Even rarer is the presentation of this subtype with metastasis to the penis. Case Presentation A 61‐year‐old South Asian gentleman presented with a penile swelling which, on evaluation with prostate‐specific membrane antigen positron emission tomography‐computed tomography and fine‐needle aspiration cytology, turned out to be metastatic involvement from neuroendocrine‐prostate cancer. The patient received a combination of pelvic radiotherapy, androgen deprivation therapy (ADT) and chemotherapy which led to a resolution in the penile lump, but subsequent rapid renal metastasis ensued and second‐line chemotherapy was instituted. Conclusion Our case illustrates an extraordinary presentation of neuroendocrine prostate cancer with penile metastasis and urinary retention, showcasing the efficacy of radiotherapy and ADT, but also rapid progression to the viscera, underscoring the complexity of this malignancy.

Background Non-communicable diseases (NCDs) are governed by a cluster of unhealthy behaviours and their determinants, like tobacco and alcohol, unhealthy diet, lack of physical activity, overweight and obesity, pollution (air, water, and soil), and stress. Regulation of these unhealthy behaviours plays a crucial role in blood pressure control among individuals on hypertensive treatment, especially those suffering from uncontrolled hypertension. Hence, the present study aims at identifying the unhealthy behaviours associated with uncontrolled hypertension. Materials and methods We did a secondary data analysis of the National Family Health Survey (NFHS) -5 data (2019–2021). Among those taking prescribed medication to lower blood pressure levels, SBP ≥140 mm Hg or DBP ≥90 mm Hg were considered uncontrolled hypertension. The other socio-demographic variables and unhealthy behaviours were used as independent variables for analysis. Results The proportion of uncontrolled hypertension was 49·5% (95% CI: 45·5–53·4) and 36·8% (95% CI: 35.8–37.8) among males and females, respectively. Alcohol consumption, clean fuel usage, and high BMI (≥30kg/m²) were the behavioural characteristics significantly associated with uncontrolled hypertension among males. In contrast, tobacco usage, alcohol consumption, coverage by Health insurance, presence of Diabetes, heart disease, usage of clean fuel, and high BMI (≥30kg/m²) were the behavioural characteristics significantly associated with uncontrolled hypertension among females. Regression results portrayed that higher age groups (45 and above) have found higher odds for men (OR: 7.6, CI: 4.6–12.3) and women (OR: 6.08, CI: 4.0–6.0) compared with 30 years and below age groups. Similarly, higher odds were found among the wealthiest wealth quintile than the poorest wealth quintile among men and women. Conclusion The current study reported a high proportion of uncontrolled hypertension. Providing opportunistic health education during blood pressure monitoring, regular screening, and targeted interventions will not only help to reduce its prevalence but also reduce the risk of developing related health implications.

Cardiovascular complications are one of the most common cause of morbidity and mortality in breast cancer patients and survivors. The clinical spectrum of the disease may vary from asymptomatic left ventricular dysfunction to valvular dysfunction, arrhythmias, conduction abnormalities, myocarditis, pericarditis and overt cardiac failure. Treatment guidelines remain the same as in general population; however, optimal sequencing of chemotherapy and radiotherapy and minimising chemoradiation dose can prevent or reduce the incidence of complications.

Breast cancer in young women (YBC) is usually preceded by symptoms and seldom on screening in high-risk women. Diagnosis is delayed and difficult due to a low index of suspicion, no regular screening, dubious or unclear family history, difficulty in imaging, and confusion with benign conditions at a young age, especially when detected during pregnancy or lactation. Treatment for YBC usually follows standard guidelines for breast cancer but some special consideration may be needed depending on patient choices or disease characteristics, concerns about late toxicity including second malignancies, and effects on fertility and ovarian function. Rehabilitation is an important aspect that needs to address sexual health, workplace and societal adjustments, social acceptance and stigma, counseling of caregivers, and psychosocial support to address body image and issues stemming from adverse prognosis. Appropriate discussion regarding contraception during therapy, future pregnancy planning, genetic testing, and counseling is crucial.

Oral cancer is the most common subtype of head and neck cancer, occupying a large proportion of all cancer patients in India. Since it is a non-communicable disease, it does not spread from person to person. The root of oral cancer development lies in the risk factors responsible for the disease. Addiction to tobacco and alcohol are the primary risk factors, followed by genetic and environmental factors. The gold standard treatment option for oral cancer includes the surgical excision of the tumor following the flap reconstruction for functional rehabilitation. Apart from this, help of radiotherapy, chemotherapy, and immunotherapy could be taken depending upon the disease condition. When patients get affected with the disease and visit the hospital, the primary concern of patients involves the course of disease progression, survival duration after the treatment, and the chance of recurrence of the disease. Despite advancements in medical technology, it is still not possible to predict the progression of disease, survival duration, and recurrence rate in oral cancer. Matrix metalloproteinases (MMPs) are novel biomarkers belonging to the family of the proteinases and are known to be involved in the degradation of the extracellular matrix (ECM). MMPs could be good predictors of disease progression, survival duration, and recurrence rate as the molecular changes appear in the body before the physical changes. By predicting the disease progression, survival duration, and recurrence rate of patients, it will become easy to manage the disease and improve the quality of life of the patients. MMPs can facilitate the regular monitoring of patients for changes in the tumor microenvironment, which can help monitor metastasis. In this review, we highlighted the various types of MMPs and their role in oral cancer. We also aim to integrate all the MMP data into a single molecular pathway so that scattered data can be observed as a useful information tool for further research.

Background Technological advancements and globalization have shifted dietary behaviours, contributing to increased chronic disease prevalence in Low- and Middle-Income Countries (LMICs) like India. Adolescents are particularly vulnerable due to these changes, which can impact their lifelong health. This study aimed to assess the nutritional status of adolescents in public schools in Chandigarh, India. Methodology Conducted as part of a cluster randomized control trial, the study used two-stage random sampling to select 12 schools and eighth-grade classes, recruiting 453 adolescents aged 10–16 years. Nutritional status was evaluated through dietary behaviour assessments, anthropometric measurements, and 24-hour urinary salt-level analysis. Dietary patterns were recorded using two 24-hour recalls, and analyzed with PURE study software based on 2010 Indian dietary data from ICMR-NIN. Anthropometric measures followed standardized protocols, and salt levels were assessed in laboratories. Results The mean age of the adolescents was 13.06 years, with 55% being boys. Among them, 32% had high salt intake, and 55% had high sugar intake. Additionally, 90% had low fruit intake, and 83% had low vegetable intake. The adolescents were deficient in several macro and micronutrients, including energy, fats, fibre, iron, zinc, iodine, riboflavin, and vitamins B-6 and B-12. A higher proportion of boys (10%) were classified as thin compared to girls (2%), while a greater proportion of girls (36%) had abdominal obesity. In contrast, a larger proportion of boys (23%) were severely acutely malnourished. Nearly all adolescents exhibited high urinary excretory salt levels. Conclusion Most adolescents exhibited dietary risk factors, including high salt and sugar intake, along with low consumption of fruits and vegetables. Many were deficient in various macro and micronutrients, with the coexistence of both thinness and obesity. Regular nutritional assessments in schools are essential to address the dual burden of undernutrition and overnutrition. Furthermore, health-promoting interventions should be developed within school settings to encourage healthy dietary practices.

Purpose Neoadjuvant chemotherapy followed by esophagectomy is the usual approach to manage esophageal squamous cell carcinoma (ESCC). The optimal interval to operate after completion of neoadjuvant chemoradiotherapy (NACRT) still remains controversial. Methods A prospective study was conducted to observe and compare postoperative complications and pathological outcomes in patients with squamous cell carcinoma of the esophagus who underwent NACRT followed by surgery within 8 weeks or after 8 weeks of NACRT completion. The pathological complete response was assessed using the Mandard tumor regression grade. Morbidity and mortality were compared and were graded using the Clavien–Dindo scale. Results The study included 50 patients, 19 patients in the < 8-week group and 31 in the > 8-week group study. Patients underwent thoracoscopy-assisted esophagectomy with neoesophagus formation using gastric conduit. There was a significant difference in mortality between the two groups, with three mortalities in the < 8-week group and none in the other group (p = 0.022). Postoperative complications and pathological outcomes did not have a statistically significant difference between the two groups. Conclusion The pathological response in ESCC cases does not appear to be impacted by the interval between NACRT and surgery; nevertheless, early surgery was associated with a higher risk of mortality.

Critically ill patients with cirrhosis and liver failure not uncommonly have hypotension due to multifactorial reasons, that include hyperdynamic state with increased cardiac index, low systemic vascular resistance due to portal hypertension, following the use of beta blocker or diuretic therapy, and severe sepsis. These changes are mediated by microvascular alterations in the liver, systemic inflammation, activation of renin angiotensin aldosterone system, and vasodilatation due to endothelial dysfunction. Hemodynamic assessment includes measuring inferior vena cava indices, cardiac output and systemic vascular resistance using point-of-care ultrasound (POCUS), in addition to arterial waveform analysis, or pulmonary artery pressures, and lactate clearance to guide fluid resuscitation. Fluid responsiveness reflects the ability of fluid bolus to increase the cardiac output and is assessed effectively by POCUS, passive leg raise manoeuvre, and dynamic tests such as pulse pressure and stroke volume variation both in spontaneously breathing and mechanically ventilated patients. Albumin has pleotropic benefits through anti-inflammatory properties besides its standard action on oncotic pressure and volume expansion in patients with cirrhosis but has potential for precipitating pulmonary edema. In conclusion, fluid therapy in critically ill patients with liver disease is a complex and dynamic process that requires individualised management protocols to optimise patient outcomes.

Introduction: Integrin antagonist complex (IAC), a novel αvβ3 integrin antagonist peptidomimetic, has emerged as a promising agent for molecular imaging of tumor angiogenesis. This study evaluates the biodistribution and clinical efficacy of [68Ga]Ga-DOTAGA-IAC PET/CT in detecting radioiodine-refractory differentiated thyroid carcinoma (RAIR-DTC), comparing its diagnostic performance with [18F]F-FDG PET/CT. Materials and Methods: In this prospective pilot study, RAIR-DTC patients underwent whole-body imaging with [18F] F-FDG PET/CT, followed by [68Ga]Ga-DOTAGA-IAC PET/CT. Biodistribution patterns of [68Ga]Ga-DOTAGA-IAC were assessed. Lesions with abnormal, nonphysiologic tracer uptake (showing activity exceeding mediastinal blood pool) were considered positive for disease. Imaging findings were compared between the two modalities, and quantitative metrics, including SUVmax, metabolic tumor volume, and total lesion glycolysis, were analyzed statistically. Results: Among 30 patients with RAIR-DTC, [68Ga]Ga-DOTAGA-IAC PET/CT revealed predominant physiological tracer uptake in the kidneys. [18F]F-FDG PET/CT identified 97 lesions, predominantly nodal (73.2%), while [68Ga]Ga-DOTAGA-IAC PET/CT detected 34 lesions, 50% of which were nodal. Few patients exhibited multiple lesions with varying uptake grades, with 20% showing coexisting higher-grade lesions (grade II or above) on [68Ga]Ga-DOTAGA-IAC PET/CT. Conclusion: Angiogenesis imaging using [68Ga]Ga-DOTAGA-IAC PET/CT demonstrates limited sensitivity for lesion detection in patients with RAIR-DTC compared with [18F]F-FDG PET/CT. However, the potential of [68Ga]Ga-DOTAGA-IAC as a diagnostic tool for other cancers has been used in other cancers with positive imaging characteristics warranting further exploration.

A BSTRACT Introduction The classical definition of patient safety given by the IOM is, “the prevention of harm to patients.” To expect error less performance from human beings working in a complex, highly challenging, and stressful health care environment is unrealistic. The emphasis must be on fostering a culture of safety that involves multiple stakeholders including healthcare workers, healthcare organizations, and patients. Aim To assess the culture of patient safety among healthcare professionals. Settings and Design A descriptive cross-sectional study was conducted using a pre-validated survey instrument in a tertiary care pediatric hospital. Methods and Material The data were collected over a period of 1 month (from 4 th January 2022 to 5 th February 2022) using pre-validated questionnaire based on “Surveys on Patient Safety Culture™ (SOPS™) Hospital Survey Version 2.0 (SOPS Hospital Survey 2.0)”. Both web-based and paper-based questionnaire forms were distributed among the health care workers. Results Totally, 61% of the respondents had average positive response to patient safety, 75% positive response about communication of patient safety error and 74% about teamwork in crisis. A total of 74% responded that supervisors or clinical leaders support them in pursuit of patient safety, 73% about proper handovers. About 69% mentioned about a culture of organizational learning and continuous improvement, 59% reported any patient safety event, 49% believed in support from Hospital management and 42% believed that if a patient safety error is reported it is responded to positively by the seniors by taking corrective measures. Conclusions The study presented with a plethora of outcomes that can be used for promoting safe healthcare. A policy for continuous improvement should be implemented to ensure the culture of safe and sustainable patient care.

Background Cerebellar mutism syndrome (CMS) is a postoperative syndrome of decreased speech seen in children associated with neurobehavioral abnormalities, the incidence of which is up to 40%. Objective To evaluate pediatric patients with posterior fossa tumors for incidence, clinical characteristics, pathophysiology, risk factors, and neuroradiographic features of this syndrome. Materials and Methods The study included 60 pediatric patients with a posterior fossa tumor who underwent surgery by a telovelar approach. Detailed pre- and postoperative clinical and radiological evaluations were done. Patients with CMS were analyzed and compared with those without mutism to find risk factors for CMS. The presentation and characteristics of cerebellar mutism were studied along with the following risk factors: The preoperative, immediate postoperative, and 1-year postoperative imaging results were reviewed to assess the neuroradiographic features in the two groups. Results The incidence of this syndrome was 20%. The mutism was accompanied by some neurobehavioral abnormalities (p-value = 0.05). The most significant finding was the presence of a period of cerebellar dysarthria after the resolution of the muteness (p-value < 0.001) in all cases. Brainstem and related structures' involvement was the most significant risk factor (p-value = 0.03). The presence of brainstem and peduncular edema in the immediate postoperative period (p-value = 0.04) and gross atrophy of posterior fossa structures at 1 year (p-value = 0.01) showed significance toward the development of CMS. There was delayed neurological recovery in patients with CMS with a poor Glasgow Outcome Score at 1 year of follow-up. Conclusion The clinical presentation of this syndrome in context with neuroradiographic features suggests that it results from transient impairment of the afferent and/or efferent pathways of dentate nuclei that are involved in initiating complex volitional movements and are associated with brainstem involvement of tumor and poor functional outcome.

Background and Aims Various regional analgesia techniques, such as thoracic paravertebral (TPV) and serratus anterior plane (SAP) blocks, have been employed to manage postoperative pain following chest wall surgery. However, the comparative analgesic efficacy of these two approaches remains uncertain. This systematic review and meta-analysis aimed to assess the relative analgesic efficacy of these blocks in chest wall surgeries, including breast and thoracic procedures. The primary objective was the time to first rescue analgesia, and the secondary objective encompassed opioid consumption within 24 h, pain scores at different time intervals, opioid-related adverse effects and block-related complications. Methods A systematic search for randomised controlled trials (RCTs) was conducted in PubMed, EMBASE and Scopus databases, covering studies from their inception to September 2023. We included active treatment arms from RCTs comparing these analgesic modalities. Statistical analysis was conducted in Review Manager Version 5.3, and results were analysed and reported separately for breast and thoracic surgery subgroups. Results Eighteen trials enroling 1141 patients were included. Overall, no significant difference was observed in time to rescue analgesia, with a mean difference of 0.69 h (95% confidence interval −1.83, 0.45; P = 0.24, I ² = 98%) between the SAP and TPV block groups. However, the TPV block demonstrated superior results for secondary outcomes in thoracic surgery patients. Complications related to the TPV block included pleural puncture and haematoma at the injection site. Conclusions The evidence suggests that both blocks generally offer comparable analgesic efficacy for chest wall surgery patients, with the TPV block providing a slight advantage for those undergoing thoracic surgery.

Numerous barriers hinder the effective delivery of neurologic care as well as the education of health care professionals in the low-income and middle-income countries (LMICs). This study assessed the knowledge of the participants after Comprehensive Neurocritical Care Course (CN3C) in the LMICs. Data from 177 participants were collected and analyzed. The pre- and postcourse test scores of the participants were compared. There was improvement in their posttest scores (pretest score: 16.45 ± 5.35 vs posttest score: 24.96 ± 6.74; P < .01). The CN3C course improves the overall knowledge of neurocritical care in the participants, as evident by the posttest scores.