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Abstract Background Alpha-1 adrenergic receptor antagonists (α1-ARAs) are frequently used in treatment of Hypertension and symptomatic benign prostatic hypertrophy (BPH). Numerous studies have demonstrated the association between α1-ARAs like Tamsulosin and increased surgical risks for patients undergoing cataract surgery. This study aims to identify and study the effects of α1-ARAs on iris parameters and the subsequent operative challenges encountered during cataract surgery. Methods A cross-sectional, prospective study involving 30 patients on α1-ARAs planned for cataract surgery and equal number of age and sex matched controls were subjected to evaluation of changes on iris parameters and subsequent challenges in cataract surgery. Results The study group had statistically significant lesser pupil diameter. Iris thickness at sphincter muscle region (SMR) was similar between groups (P = 0.53). Significantly lower values of iris thickness at dilator muscle region (DMR) found in treated subjects (P =

Hypopharyngeal cancer usually presents at a locally advanced stage. Almost all patients are treated with a curative intent. As surgical approaches are functionally and cosmetically morbid, nonsurgical modalities are preferred. This review emphasizes a comprehensive diagnosis workflow, the integration of less toxic induction chemotherapy regimens, and a multidisciplinary approach to patient care. It aims to optimize treatment outcomes while preserving quality of life, particularly in the Indian healthcare context.

Oropharyngeal cancer typically presents at a nonmetastatic stage and is primarily treated with curative intent. While surgical options are available, they are often associated with significant functional and cosmetic morbidity, leading to a preference for nonsurgical modalities. The updated guidelines address the management of oropharyngeal squamous cell carcinoma in the Indian context, emphasizing the importance of a multidisciplinary approach. The guidelines detail diagnosis workflows, treatment protocols for early-stage and locally advanced cancers, and the role of human papillomavirus (HPV) status in guiding therapy. Special attention is given to emerging treatment deintensification strategies for HPV-associated cancers, aiming to optimize outcomes while minimizing treatment-related toxicity.

Oral cavity cancer (OCC) essentially presents at a non-metastatic stage. Almost all patients are treated with a curative intent. Surgical approaches are the mainstay of treatment accompanied by radiotherapy and chemotherapy where applicable. This updated guideline emphasizes a personalized approach to the treatment of OCC, considering tumor characteristics, patient preferences, and the latest advancements in diagnostic methods. These guidelines aim to optimize treatment strategies, improve patient quality of life, and ensure adherence to the most current clinical practices in managing OCC, especially with respect to the Indian scenario.

Head-and-neck squamous cell carcinoma (HNSCC) remains a significant public health concern, particularly in India, where its incidence is disproportionately high due to risk factors such as tobacco and alcohol use. The updated guidelines for the management of HNSCC reflect a comprehensive review of current evidence and practices tailored to the Indian context. They emphasize a multidisciplinary approach and the integration of novel therapeutic modalities, including immune checkpoint inhibitors and metronomic chemotherapy. Enhanced diagnostic protocols and a focus on supportive care underscore the commitment to improving patient outcomes and quality of life. This update aims to provide healthcare professionals with clear, evidence-based recommendations that address the unique challenges faced by patients with HNSCC in India.

Laryngeal cancer typically presents at a nonmetastatic stage, and the majority of patients are treated with curative intent. Due to the functional and cosmetic morbidities associated with surgical approaches, nonsurgical modalities are increasingly favored. This update to the guidelines emphasizes a multidisciplinary approach tailored to the Indian healthcare context, enhancing treatment strategies and optimizing patient outcomes. Key recommendations include the use of concurrent chemoradiotherapy and induction chemotherapy regimens, with a focus on organ preservation whenever feasible.

Nasopharyngeal carcinoma (NPC) is a rare malignancy that poses significant treatment challenges, particularly in the context of curative intent. This updated guideline consolidates contemporary evidence and clinical practices tailored to the Indian healthcare landscape. It emphasizes a multidisciplinary approach to diagnosis and treatment, incorporating advances in chemotherapy, radiotherapy, and supportive care. Key recommendations include the use of induction chemotherapy for locoregionally advanced cases, detailed risk stratification, and specific management strategies for recurrent and metastatic disease, all aimed at improving patient outcomes.

Introduction: Approximately 15 to 20 percent of tuberculosis patients have extra-pulmonary tuberculosis (EP-TB), which is often difficult to diagnose. Further multi drug resistant tuberculosis (MDR-TB) in EP samples has not been reported. The aim of the present study was rapid diagnosis of MDR-TB in EP samples by using Mycobacteria Growth Indicator Tube (MGIT) 960 and GenoType MTBDRplus Line Probe Assay (LPA). Methods: A total of 429 extra pulmonary specimens (pleural fluid, lymph node biopsy, cerebrospinal fluid, skin biopsy, urine, faeces) were processed for acid fast bacilli (AFB) smear microscopy and culture by MGIT-960. SD Bioline TB Ag MPT 64 rapid assay was carried out on MGIT positive isolates to differentiate between MTB and Non Tuberculous Mycobacteria (NTM). Growth obtained was tested by Line Probe assay (LPA)- GenoType MTBDRplus assay for the identification of Rifampicin and Isoniazid resistance and GenoType CM-AS assay for species identification of NTM. Results: Among 429 specimens, 58 (13.5%) were AFB positive and 371 (86.5%) were negative on MGIT 960 culture. Amongst 58 positive isolates, 56 were MTB (96.6%) and 2 (3.4%) were NTM, subsequently identified as M. fortuitum and M. intracellulare. In 56 MTB positive isolates, 35 (62.5%) were sensitive to Rifampicin (RFM) and isoniazid (INH). Two isolates (3.6%) were found mono RFM resistant, 11 (19.6%) were mono INH resistant and 8 (14.3%) were resistant to both (MDR). Conclusion: Mycobateria were isolated in 13.5% cases, 14.3% of these were found to be MDR-TB. Overall MDR in EP-TB may be in the same range as pulmonary TB as there was no isolate in 371/429 specimens/cases, this may be due to impact of prior therapy. All these issues need to be investigated by more sensitive molecular methods and correlated microbiologically as well as clinically. Specimens from EP-TB cases must be processed for LPA and DST which will be of help in rapid diagnosis of MDR-TB and institution of right treatment strategy.

Neurofibromatosis type 1 (NF1) or Von Recklinghausen disease comes under a group of multisystem hereditary syndromes called phakomatoses. It presents with skin, ophthalmic, bony, and systemic manifestations. We present a photographically well-documented case series of NF in a family (n = 3). Skin manifestations were present in all the patients. The ophthalmic manifestations were Lisch nodules (100% of eyes), subcutaneous neurofibroma of eyelids (33% of eyes), mechanical ptosis (33% of eyes), and mechanical ectropion (16.5% of eyes). We report the rare occurrence of multiple solitary neurofibromas causing mechanical ptosis and mechanical ectropion.

Introduction: The cure of corneal blindness requires manifold increase in the rate of eye donation. The present study was undertaken to assess the knowledge and attitude about eye donation among medical students. A secondary objective of the study was to assess the impact of knowledge of eye donation after studying ophthalmology among the final year students of the MBBS (Bachelor of Medicine Bachelor of Surgery) graduation course. Aim: To assess knowledge and attitude about eye donation among first, second and final year medical students. Also, to assess the impact of studying ‘Ophthalmology’ on their knowledge. Materials and Methods: A cross-sectional study was conducted by collecting information on a predesigned, structured questionnaire on ‘Google forms’ and sending a soft copy to 601 students of two medical colleges i.e, GGS Medical College, Faridkot and Dayanand Medical College, Ludhiana, Punjab, India, by email, from March 2019 to April 2019. There were questions about awareness and source of information about eye donation in medical students, knowledge of criteria, and willingness to donate eyes. Responses were accepted till a period of seven days. Students were divided into two groups; group A (n=320 students) with 165 students in first professional year and 155 in second professional year, who had not studied Ophthalmology. Group B (n=281 students) with 142 students in final (part I) professional year and 155 in final (part II) professional year, who had/were studying Ophthalmology. Results were analysed and compared using Chi-square test. Results: Out of 601 students, 527 responded (272 of group A and 255 of group B). The results on knowledge and willingness to donate eyes were quite encouraging. Most of the questions were answered by more than 400 students. Majority of students cited teachers/friends as their source of knowledge. However, there was a saw significant gaps in knowledge in the students, specially before reading Ophthalmology (p-value

Abstract The combination of cyclin dependent kinase 4/6 inhibitors with endocrine therapy is the standard therapy in hormone receptor positive HER-2 negative metastatic breast cancer (HR+/HER2− MBC). Several randomized trials have shown the benefits of this combination, however, real world evidence in the Indian patients is warranted. The present study reports the largest real world multicentric data from Indian population on the use of Palbociclib in HR+/HER2− MBC. A multicentric study on the HR+/HER2− MBC patients who received palbociclib with hormonal agent (Aromatase inhibitors/Fulvestrant) between February 2017 and May 2020 was conducted. Clinical and demographic information and survival data was retrieved from the Hospital medical records. Among a total of 188 patients, 57% patients were premenopausal and 17% patients had bone only disease. Altogether, 115 (61%) patients received palbociclib with Aromatase inhibitors in the first line whereas 73 (39%) patients received it in the second line with Fulvestrant. The median follow up period with advanced disease was 13 months. The median progression free survival in the first line and second line was 20.2 months and 12 months, respectively (p-value

Introduction: Cancer pain is known to be one of the Most severe pain anyone in life and is the primary reason for discontinuation of treatment. Sphenopalatine ganglion block (SPGB) can be useful in alleviating pain of carcinoma buccal mucosa. The study aims to analyze the effect of transnasal SPGB in pain management of patients suffering from carcinoma buccal mucosa. Materials and Methods: It was a hospital-based study done on 150 patients with carcinoma buccal mucosa using a prospective cross-sectional study design. To do statistical analysis, paired t-test was used having SPSS software. Results: On visual analogue scale, intensity of pain was found to be notably reduced from 7.42±2.02 to 3.45±1.21 (P < 0.0001), after first sitting. Preprocedure and postprocedure morphine requirement were 90.24 ± 30.24 and 60.42 ± 0.93 mg/day (P > 0.05) At the conclusion of study, the results were found to be statistically significant. Conclusion: Transnasal SPGB is beneficial in improving patient compliance and reducing pain scores and morphine requirement in patients suffering from carcinoma buccal mucosa.

Introduction: Antiepileptics and antidepressant medications are known for managing neuropathic pain. We aim to compare the effects of pregabalin with low-dose amitriptyline and gabapentin with low-dose amitriptyline in managing neuropathic pain in cancer patients undergoing palliative care. Materials and Methods: We conducted our study on 160 cancer patients who were having neuropathic pain and were undergoing palliative care treatment in our institute. It was a hospital-based, randomized, tertiary cancer center-based observational study. After taking approval from the institutional ethics committee and taking written informed consent from patients, the patients were divided into two groups and the effect of medicines on incidence of neuropathic pain was observed; the incidence of burning sensation and the incidence of adverse effects of medications were also analyzed. Statistical analysis was done using paired t-test and SPSS version 20 software. Results: The onset of relief in pain was earlier in the pregabalin group as compared to the gabapentin group. There was more reduction in a burning sensation in the pregabalin group as compared to the gabapentin group. The incidence of headaches was the same in both groups. Nausea and vomiting were more in the pregabalin group but the overall difference in adverse effects was not statistically significant (P > 0.05) Conclusions: In the management of neuropathic pain in cancer patients who are undergoing palliative care, a combination of pregabalin with amitriptyline was found to be more effective in pain relief than gabapentin with amitriptyline.

Here we present a rare case of spontaneous pneumomediastinum complicated with pneumorrhachis (PR) in a young man who is a known case of carcinoma rectosigmoid region. Our young male was diagnosed with novel coronavirus disease 2019 (COVID-19) and remained asymptomatic for any respiratory complaints. Though an association of pneumomediastinum has been reported in COVID 19 patients, to the best of our knowledge, this is the first report of PR in a COVID-19 oncological case. The role of a radiologist is to identify this condition as cases reported earlier may have serious neurological consequences. Pursuing the cause can be a diagnostic challenge but it reaps the clinical benefit in the appropriate management.

Objective The aim of this study is to investigate the effects of gemcitabine maintenance on progression-free survival (PFS) in patients with metastatic gallbladder cancer (GBC). Materials and Methods Sixty patients with unresectable or metastatic GBC having ongoing response to treatment with initial six cycles of gemcitabine and a platinum-based doublet chemotherapy were prospectively randomized on day 21 of the 6th cycle in 1:1 fashion to receive either maintenance gemcitabine 1 g/m2 intravenously on day 1 and day 8 of three weekly cycle or observation. Survival analysis was performed using the Kaplan–Meier method and comparisons by the log-rank test. A p-value < 0.05 was considered as statistically significant. Results Of 60 patients, a total of 56 were available for final analysis. The median PFS was 4.7 months (3.1–6.3) in gemcitabine arm and 2.6 months (2.4–2.8) in observation arm, hazard ratio (HR) 0.196 (95% confidence interval [CI]: 0.1–0.39), p < 0.001. Median overall survival in gemcitabine arm was 12.4 months (9.15–15.6) as opposed to 9.9 months (8.29–11.5) in observation arm, HR 0.76 (95% CI: 0.43–1.35), p = 0.354. The grade 3 or 4 side effects in maintenance arm were transaminitis (17.9%), thrombocytopenia (17.8%), neutropenia (14.2%), and febrile neutropenia (7.1%). Conclusions Maintenance gemcitabine therapy in unresectable/metastatic GBC patients responding to first-line gemcitabine and platinum treatment contributes to increase PFS with minimal and manageable side effects.

Primary gastric squamous cell carcinoma is a very rare presentation. Its pathogenesis is obscure, and the treatment strategy is largely unknown and controversial. We report a case of primary squamous cell carcinoma of the stomach with liver metastases in a 66-year-old man. The patient presented with a 2-month history of abdominal pain, vomiting, hematemesis, and weight loss. Endoscopic examination revealed large ulceroproliferative growth in body of stomach. Integrated PET CT (positron emission tomography computed tomography) scan revealed metabolically active nodular wall thickening involving body of stomach with liver metastases. Multiple biopsies of the lesions revealed squamous cell carcinoma of the stomach. The patient was started on palliative chemotherapy and is presently in partial response to treatment. He is tolerating treatment with no major side effects.

Objectives: To evaluate the role of apparent diffusion coefficient (ADC) values in assessing response after chemo-radiotherapy in cervix cancer and investigate the utility of ADC as a tool to identify residual disease, after the treatment completion. Methods: A prospective study was done in 100 patients with histopathologically proven cancer of uterine cervix who were classified as either complete response (CR) or residual disease posttreatment. MRI was done pretreatment and after 6 weeks post-treatment with chemo-radiation. 53 patients among the cohort also underwent a fluoro-deoxy glucose positron-emission computed tomography (FDG-PET CT). ADC values, change in ADC values, and metabolic activity obtained from FDG-PET CT were correlated with clinical outcome, and statistical analysis was done to determine the better tool for assessing response evaluation between ADC and PET-CT. Results: Residual lesions have notably lower ADC value than that of posttreatment changes. The mean ADC values of residual tumors: 1.26 ± 0.238 × 10−3 mm2/s and mean ADC values of lesions due to posttreatment changes: 1.540 ± 0.218 × 10−3 mm2/s (statistically significant difference between malignant and posttreatment lesions, P < 0.05). ADC has 67% sensitivity, 83% specificity, 35% positive predictive values (PPV), 95% negative predictive values (NPV), and 81% accuracy in differentiating residual disease from post treatment changes. PPV, NPV, sensitivity, and specificity with PET-CT were 93%, 89%, 98%, and 73%, respectively. PPV, NPV, sensitivity, and specificity of contrast MRI were 16%, 91%, 58%, and 59%, respectively. Conclusion: Diffusion imaging differentiates residual cervix malignancies from post treatment changes based on ADC values and can be a promising and evocative biomarker. Complimentary use of ADC and PET/CT may increase diagnostic confidence.

Poly (ADP-ribose) polymerase (PARP) inhibitors are a unique class of therapeutic agents that focus on tumors with deficiencies in the homologous recombination DNA repair mechanism. Genomic instability outlines high-grade serous ovarian cancer, with 50% of all tumors displaying defects in the important DNA repair mechanism of homologous recombination. Earlier research studies have demonstrated considerable efficiency for PARP inhibitors in patients with germ line breast-related cancer antigens 1 and 2 (BRCA-1/BRCA-2) mutations. It has also been observed that BRCA wild-type patients with other defects in the homologous recombination repair mechanism get benefited from this therapy. Companion homologous recombination deficiency (HRD) scores are being developed to guide the selection of patients that are most likely to benefit from PARP inhibition. The selection of PARP inhibitor is mainly dependent upon the number of prior therapies and the presence of a BRCA mutation or HRD. The identification of cases which are most likely to get benefited from PARP inhibitor therapy in view of HRD and other biomarker assessments is still challenging. The purpose of this review is to focus and describe the current evidences for PARP inhibitors in ovarian malignancy, their mechanism of action, and the outstanding issues, including the rate of long-term toxicities and the evolving resistance.

Aims and Objectives: During course of radiation therapy, anatomical variations occur risking overdose of parotid gland. We tried to quantify volume of parotid gland and mean dose to parotid gland after every 10 fractions (#). Materials and Methods: We conducted the prospective study from July 2016 to May 2017 in 25 patients of early-stage oropharyngeal carcinoma. Patients had Karnofsy Performance Score of 80–100, median age was 54 years, and 18 patients were males. Patients were planned with intensity-modulated radiation therapy planning with dose as 66 Gy/30# to planning target volume (PTV) including primary and 54 Gy/30# to PTV-nodal including elective neck irradiation. After each 10#, replanning was done, and variations in parotid volume were studied including Dmean(mean dose to parotids) and D50(the dose delivered to 50% of volume). Other tumor characteristic like PTV of primary was also assessed and minimum PTV volume covered by 95% isodose line was kept as 95%. Results: Average parotid volumes decreased by the mean value of 10% and 6% for the left and right parotids, respectively, and PTV of primary target decreased by mean of 13%. The difference in Dmeandoses to parotid glands was 32% and 42% and difference in D50dose was 30% and 35% on the left and right side, respectively. Conclusions: The parotid volumes differ considerably during adaptive planning done after every ten fractions. These differences in parotid volumes and doses received to parotid glands play a significant role in the risk of xerostomia observed during later follow-up.

This paper highlights the significance of feedforward artificial neural network models for predicting shelf life of roasted coffee falvoured sterilized drink. Coffee is one of the most important products for trade in international market. Single as well as multilayer models were explored and different backpropagation algorithms were investigated, Root mean square error and coefficient of determination R2 were used to compare the prediction performance of single and multilayer feedforward ANN models. Experimental results suggested that multilayer models take less time and give better results as compared to single layer ANN models for prediction of sensory quality of roasted coffee falvoured sterilized drink..

Nanotechnology has an extremely high potential to benefit society through applications in food packaging. It can make the products cheaper and the production more efficient by producing less waste and using less energy. However, any new technology carries an ethical responsibility for wise application and the recognition that there are potential unforeseen risks that may come with the tremendous positive potential. The concept of nanocomposites represents a stimulating route for creating new and innovative materials, also in the area of natural polymers. The use of protective coatings and suitable packaging by the food industry has become a topic of great interest because of their potentiality for increasing the shelf life of many food products. Research and development of bio-nanocomposite materials for food applications such as packaging and other food contact surfaces is expected to grow in the next decade with the advent of new polymeric materials and composites with inorganic nano-particles.

For predicting the shelf life of processed cheese stored at 7-8º C, Elman single and multilayer models were developed and compared. The input variables used for developing the models were soluble nitrogen, pH; standard plate count, Yeast & mould count, and spore count, while output variable was sensory score. Mean Square Error, Root Mean Square Error, Coefficient of Determination and Nash - Sutcliffo Coefficient were applied in order to compare the prediction ability of the developed models. The Elman models got simulated very well and showed excellent agreement between the experimental data and the predicted values, suggesting that the Elman models can be used for predicting the shelf life of processed cheese.

Fenestration of the intracranial arteries is more commonly reported in the anterior communicating artery than in the basilar artery. Vertebrobasilar junction fenestration is a subtype of basilar artery fenestration with a different embryological origin and is rarely described in angiographic studies. Association of aneurysm with vessel fenestration has been well documented. We report a case of the vertebrobasilar junction fenestration in a patient with a ruptured anterior communicating artery aneurysm.

Many intracranial variations of middle cerebral artery, which occur infrequently compared to other intracranial vascular anomalies, are described in the literature. We describe a case of incidentally detected accessory middle cerebral artery on digital subtraction angiography. An understanding of such variations is important for those performing intracranial aneurysm surgeries. These variations may also serve as a source of collateral supply in cases of ischaemia.