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Over the past 4 decades, the clinical care of people living with HIV (PLWH) evolved from treatment of acute opportunistic infections to the management of chronic, noncommunicable comorbidities. Concurrently, our understanding of adipose tissue function matured to acknowledge its important endocrine contributions to energy balance. PLWH experience changes in the mass and composition of adipose tissue depots before and after initiating antiretroviral therapy, including regional loss (lipoatrophy), gain (lipohypertrophy), or mixed lipodystrophy. These conditions may coexist with generalized obesity in PLWH and reflect disturbances of energy balance regulation caused by HIV persistence and antiretroviral therapy drugs. Adipocyte hypertrophy characterizes visceral and subcutaneous adipose tissue depot expansion, as well as ectopic lipid deposition that occurs diffusely in the liver, skeletal muscle, and heart. PLWH with excess visceral adipose tissue exhibit adipokine dysregulation coupled with increased insulin resistance, heightening their risk for cardiovascular disease above that of the HIV-negative population. However, conventional therapies are ineffective for the management of cardiometabolic risk in this patient population. Although the knowledge of complex cardiometabolic comorbidities in PLWH continues to expand, significant knowledge gaps remain. Ongoing studies aimed at understanding interorgan communication and energy balance provide insights into metabolic observations in PLWH and reveal potential therapeutic targets. Our review focuses on current knowledge and recent advances in HIV-associated adipose tissue dysfunction, highlights emerging adipokine paradigms, and describes critical mechanistic and clinical insights. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) is the most common malignancy and one of the leading causes of cancer death among women worldwide (Mavaddat et al., 2019). The incidence of breast cancer has been rising steadily and for the first time in 2012, breast cancer was the most common cancer in women in India. Breast cancer seems to be more common in the younger age group as a significant number of patients are below 30 years. Aim To compare rate of breast-conserving surgery vs mastectomy in breast cancer patients Method and materials: Eighty- Six breast cancer patients were clinically staged using the American Joint Committee on Cancer (AJCC) TNM staging. All patients were offered BCS. For large operable breast cancer (LOBC) and locally advanced breast cancer (LABC), neoadjuvant chemotherapy (NACT) followed by BCS was offered to these patients who wish to conserve their breast. Results and Observations: Right side was involved in 52% and left in 48%. There were 64% pre- /perimenopausal and 36% postmenopausal patients. Upper outer quadrant was involved in 55% and upper inner in 45%. Early breast cancer (EBC) was involved in 72%, large operable breast cancer (LOBC) in 15% and locally advanced breast cancer (LABC) in 13%. The difference was significant (P< 0.05). Mastectomy was performed in 30 and breast conserving surgery on 56. Lumpectomy in 26, quadrantectomy in 10, revision of positive or unknown margins post-lumpectomy in 12 and wire-guided wide local excision of non-palpable lump in 8 cases. The difference was significant (P< 0.05). Common subtype ER+/PR+/HER2- in T1 was seen in 7, in T2 in 18, in T3 in 22 and in T4 in 18. ER+/PR+/HER2+ in T1 was seen in 2, T2 in 4, ER-/PR-/HER2+ was seen in 3 in T1 and 2 in T2 and triple negative 2 in T1 and 10 in T2. Mastectomy was performed in 61% ER+/PR+/HER2-, 47% ER+/PR+/HER2+, 78% ER-/PR-/HER2+ and 56% triple negative subtypes and BCS in 39% ER+/PR+/HER2-, 53% ER+/PR+/HER2+, 22% ER-/PR-/HER2+ and 44% triple negative subtypes. The difference was significant (P< 0.05) Conclusion: The incidence rates of breast cancer and death are rising in many Asian countries that threatens the health of Asian population. Increased age, early menarche, delayed first menstruation, peri menopausal women and family history positive are common major risk factors associated with breast cancer in India and Asia. Majority of the women presented with early breast cancer which makes them suitable for breast conserving surgery. [ABSTRACT FROM AUTHOR]

Background: Recurrent laryngeal nerve damage is a well-recognized morbidity after thyroidectomy and has been involved in most claims concerning complications of thyroid surgery. Thyroidectomy is one of the most commonly performed procedure for thyroid disorders. The mortality and mobidity of thyroidectomy was very high. Sterile surgical arenas, advent of anaesthesia, and improved surgical techniques have reduced it considerably. Patients must be appropriately counseled in the preoperative period regarding the potential complications. They must be well aware of the surgical risks they are to undertake. A thorough understanding of anatomy and with experience, the surgeon can minimise the risk associated with the procedure. Aim: To evaluate the challenges and complications of thyroidectomy with special reference to recurrent laryngeal nerve injury. Method And Materials: This is a hospital based prospective study, from Jan 2021 to Feb 2023. 100 cases who underwent thyroidectomy for any indications, in the department of surgery at S.R.V.S, Medical College, Shivpuri, MP, a detailed clinical evaluation was done. Intra operative documentation of surgical details was done. Post operatively the patients were monitored for any complications. Follow up serum TSH was monitored in second post op week, and then every month till six months Results And Observations: The overall incidence of complications is 35.76%. Commonest complication is transient hypoparathyroidism(21.87%), followed by transient RLN injury (3.4%), permanent hyoparathyroidism (3.2%), flap edema (2.3%), EBSLN injury (2.06%), hematoma (1.45%), hypothyroidism (0.97%) and wound infection (0.73%). Conclusion: Unrecognized recurrent laryngeal nerve palsy occurred after thyroidectomy. Thyroid surgery for malignant neoplasms and recurrent substernal goiter was associated with an increased risk of permanent recurrent nerve damage. Meticulous dissection, absolute hemostasis, and a thorough knowledge of neck anatomy are the key in reducing the post thyroidectomy complications. Identification and preservation of the laryngeal nerves and parathyroids are mandatory. Incidences of other complications are on the decline. [ABSTRACT FROM AUTHOR]

Background: We know turnaround time for the complete blood count is much faster than that of various inflammatory markers like LDH, CRP, interleukins like IL-6, D-dimer. Thus using cell counts as a marker of severity and the prognosis is need of the hour. This will reduce the burden of the health care facilities. Complete blood count including the variation in RBC, WBC and platelets changes has been thoroughly studied. Various retrospective studies have shown that the absolute lymphocyte count can be taken as a marker of severity in COVID 19 patients. In December 2019, several cases of new corona virus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2) have been emerged from Wuhan, China, which was later declared as a global pandemic by World Health Organisation (WHO) on March 11th 2020. Aim: In our study, we analyse and assess the severity of Covid-19 Vs d-NLR and RDW, PLR at our centre. Method and materials: This is the retrospective observational study. We actually collected the data of 300 cases but out of 300 cases only 268 laboratory confirmed COVID-19 cases, Age, neutrophil to lymphocyte ratio (NLR), derived-NLR (d-NLR), platelet to lymphocyte ratio (PLR) and red cell distribution width (RDW) of 268 laboratory confirmed COVID-19 patients, at the time of admission, belonging to clinical category B and C were recorded and compared in this single-center, retrospective observational study. The receiver operating characteristic (ROC) curve was applied to determine the thresholds for bio-markers and their prognostic values were assessed. Results and Observations: A statistically significant elevated NLR (P=0.001), d-NLR ( P=0.001), PLR (P=0.001) and RDW (P=0.026) were noticed in Category C (severe) group when compared to Category B group. From the ROC curve, it was established that d-NLR, NLR and WBC count proved to be a fair distinguisher (area under the curve between 0.7- 0.8) in predicting the clinical severity in COVID-19 patients. NLR and WBC count was found to be having the highest sensitivity of 82%, while d-NLR proved to be highly specific. Elevated age was also significantly associated with illness severity (P=0.001). Conclusion: COVID-19 is giving rise to tremendous challenges in the entire world and over pressurised the health care system and as of yet, efforts have been devoted to artificial intelligence based analysis of HRCT and x-rays have been used to indicate severity in the patients of SARSCoV2. Elevated age, WBC count, NLR, d-NLR, RDW and PLR may be considered as useful prognostic biomarkers for predicting the severity of COVID-19 infection and adverse outcome, with NLR and WBC count showing the highest sensitivity and d-NLR with the highest specificity. [ABSTRACT FROM AUTHOR]

Background: Ileal perforation peritonitis is a frequently encountered surgical emergency in the developing countries lead to high morbidity and mortality. The nature of the disease itself predisposes to a number of complications including wound infections, faecal fistulas and complications associated with a stoma. Aim: To evaluate the role of ileostomy in patients with ileal perforation Materials and Methods: The present descriptive study included 80 patients with ileal perforation admitted at the department of surgery. Patients were studied for etiology, site, operative technique, appliance used and complications if any. All the data was presented in the observation tables, analysed and interpretation was done Results: Most of the patients (47.5%) were 21-40 years age group with male preponderance. Abdominal pain (100%) and tenderness (97.5%) were the common clinical presentation. Single perforation was commoner (66.3%) than multiple perforations. It was caused by typhoid in 48.7% followed by tuberculosis in 18.7%, cases. Surgical site infection and skin excoriation were the commonest complication. Mortality rate was high in primary closure with ileostomy group. Conclusion: Ileal perforation is caused by typhoid in majority of the cases and presents with pain abdomen and tenderness. Morbidity, mortality and complication were higher in ileostomy with primary closure cases. [ABSTRACT FROM AUTHOR]

Since students must take theory, clinical, and practical courses in a range of subjects, including anatomy, physiology, biochemistry, community medicine, etc., the MBBS curriculum is more demanding and challenging. In a brief period of time. Students often experience stress as they discover novel ideas and theories that are used in clinical settings. Since they are fresh to the subject, first-year MBBS students are undoubtedly a little stressed. One hundred first-year MBBS students were chosen for the study using a survey. Students studying medicine completed a survey. In this study, we looked at how much more stress female students take on in terms of academic stressors, interpersonal and intrapersonal stressors, teaching and learning stressors, and social stressors. [ABSTRACT FROM AUTHOR]

Background: Preoperative education is reported to be effective in improving postoperative outcomes and patients' satisfaction. Hence, this study was designed to estimate the impact of preoperative education programme on postoperative outcomes and patients' satisfaction in patients undergoing visceral organ surgery. Methods: A quasi-experimental study was designed wherein 100 patients who were admitted for elective visceral organ surgery were divided randomly in intervention (50) and control group (50). Intervention group received preoperative education based on patient centered communication by trained nurses. Patients' satisfaction, postoperative complications and length of stay in hospital were measured. Results: Satisfaction scores were greater for intervention group. Post-operative complications and length of hospital stay were lesser for intervention group as compared to the comparison group. Conclusions: Preoperative education increases satisfaction of patients undergoing surgery and can reduce postoperative complications and ICU stays in surgical patients. [ABSTRACT FROM AUTHOR]

Background: Breast abscess continues to be a major cause of morbidity in developing countries. The treatment of breast abscess continues to be a challenge. In era of technical advances management of breast abscess has shifted to minimally invasive and painless techniques which are more patient friendly. Aims: to compare outcomes in management of breast abscess by incision and drainage versus ultrasound guided needle aspiration. Methods: The present study was carried out in the department of surgery in a tertiary care hospital central India. A total of 100 female patients with acute lactational breast abscess between 18 and 45 years of age were enrolled in our study. The patients were randomized into group A (incision and surgical drainage) and group B (ultrasound-guided needle aspiration). Results: In our study total 100 patients were analysed, majority of the cases (53% in group A & 54% in group B) belong to 21-25 years age group. Post operative pain, high recurrence rate, fistula formation, cessation of breast feeding, ugly scar formation and longer duration of hospital stay were observed in incision & drainage procedure as compared to USG aspiration. Conclusions: USG guided aspiration is the safest, painless, day care and widely accepted procedure for treatment of breast abscess as compared to the incision and drainage, it reduced the post-procedure hospital stay and minimum scar formation. [ABSTRACT FROM AUTHOR]

Persons living with HIV (PLWH) manifest chronic disorders of brown and white adipose tissues that lead to diabetes and metabolic syndrome. The mechanisms that link viral factors to defective adipose tissue function and abnormal energy balance in PLWH remain incompletely understood. Here, we explored how the HIV accessory protein viral protein R (Vpr) contributes to adaptive thermogenesis in two mouse models and human adipose tissues. Uncoupling protein 1 (UCP1) gene expression was strongly increased in subcutaneous white adipose tissue (WAT) biopsy specimens from PLWH and in subcutaneous WAT of the Vpr mice, with nearly equivalent mRNA copy number. Histology and functional studies confirmed beige transformation in subcutaneous but not visceral WAT in the Vpr mice. Measurements of energy balance indicated Vpr mice displayed metabolic inflexibility and could not shift efficiently from carbohydrate to fat metabolism during day-night cycles. Furthermore, Vpr mice showed a marked inability to defend body temperature when exposed to 4°C. Importantly, Vpr couples higher tissue catecholamine levels with UCP1 expression independent of β-adrenergic receptors. Our data reveal surprising deficits of adaptive thermogenesis that drive metabolic inefficiency in HIV-1 Vpr mouse models, providing an expanded role for viral factors in the pathogenesis of metabolic disorders in PLWH. [ABSTRACT FROM AUTHOR]

Background: Recurrent Kawasaki disease is rare. Case characteristics: An eight-month old infant had classic Kawasaki disease with transient coronary artery dilatation. Observations: Recurrence of incomplete Kawasaki disease after two years of initial diagnosis. Outcome: The index episode of Kawasaki disease was resistant to single infusion of immunoglobulin, while repeat episode responded within 24 hours of institution of therapy. Message: Early recognition of recurrent Kawasaki disease requires a high index of suspicion. [ABSTRACT FROM AUTHOR]