Endometriosis is referred to the presence of functioning, ectopic endometrial tissue outside the pelvic cavity. Their occurrences after abdominal or pelvic surgeries especially cesarean section, at the site of scar incision, are documented. The patient experiences cyclical pain at the incision site related to the menstrual cycle. Imaging can be used to detect the lesion and medical management can be provided. However, in severe cases, total excision is recommended to avoid the chances of recurrence. Here, we present a case series of two cases of scar endometriosis after cesarean section, and both presented with cyclical pain in the abdomen. Medical management was provided for both cases.

The present pilot study aims to investigate the diagnostic and prognostic efficacy of serum HSP90 beta in Head and Neck Squamous Cell Carcinoma (HNSCC) patients subjected to localized hyperthermia therapy (HT). Serum levels of HSP90 beta were measured by ELISA and its diagnostic and prognostic efficacy was determined by receiver operating characteristic curve (ROC) analysis. HNSCC patients showed significantly (P<0.05) higher serum levels of HSP90 beta (65.6±13.08 ng/ml) compared to Healthy Controls (HC: 23.5±3.8 ng/ml). No significant difference was observed in serum HSP90 beta levels between complete responders (CR) and non-responders (NR) in the chemo-radiation therapy (CRT) cohort. However, in CRT+HT cohort, CR showed significantly (P = 0.02) lower serum HSP90 beta levels at 24 h after HT (25.6±9.04 ng/ml) compared to NR (130.5±34.2 ng/ml). Youden's index values between HNSCC versus HC, CR versus NR (CRT) and CR versus NR (CRT+HT) were found to be 0.47, 0.45 and 0.80, respectively. Thus, alterations in the serum HSP90 beta after HT suggest its potential in prognosis of HT response in HNSCC patients. Elevated levels of HSP90 beta may serve as a promising diagnostic serum bio-marker for HNSCC. However, further validation in larger patient samples is needed for clinical translation of HSP90 beta as diagnostic and prognostic biomarker.

The online version contains supplementary material available at 10.1007/s13193-023-01790-0.

Unplanned hospital readmission (UHR) is an important indicator of the quality of the healthcare system in place. It has various implications for the patients and the healthcare system at large. In this article, we have attempted to understand the various factors influencing UHR and the start of adjuvant treatment following cancer surgery. In this study adult patients above 18 years of age with upper aerodigestive tract squamous cell carcinoma who underwent surgery at our center between July 2019 to December 2019 were included in the study. Various factors influencing UHR and delay in receiving adjuvant treatment were analyzed. A total of 245 patients satisfied the inclusion criteria. Surgical site infection (SSI) was the factor that had the maximum influence on the UHR (p < 0.002, OR: 5.6, 95% CI: [1.911-16.4]) and delaying the start of adjuvant treatment (p = 0.008, OR: 3.786, 95% CI: [1.421-10.086]) on multivariate analysis. Surgery lasting for >4 h and patients who had received prior treatment tended to develop SSI postoperatively. The presence of SSI also seemed to have had a negative influence on disease-free survival (DFS) as well. SSI is an important postoperative complication having major implications in terms of increased UHR and delays in starting adjuvant treatment which in turn is reflected as a poorer DFS among patients who develop SSI postoperatively.

Cardiovascular diseases (CVDs) are responsible for 17.5 million deaths globally, and India is more susceptible to coronary artery disease (CAD) than its western counterparts because of certain challenges such as suboptimal management, increased healthcare costs, and physicians undermining the extent of limitation in angina patients. All of these could be resolved by employing strategies starting with accurate diagnosis to timely implementation of aggressive management techniques to contain morbidity and mortality. Pan India, experts from the field of cardiology came together in order to discuss risk stratification and aggressive management of chronic coronary syndromes (CCS). The expert consensus laid down a path of recommendations considering the prevailing healthcare service infrastructure, local evidence-based studies and key international guidelines. With the wide diversity in terms of geographical distribution in India and the risk factors presented across various divisions of the population, risk stratification is necessary for prompt identification and subsequent management of CCS. In this consensus, various risk stratification techniques such as risk stratification based on ventricular function, electrocardiogram (ECG), stress echocardiography (ECHO), the Duke treadmill score (DTS), and myocardial perfusion imaging (MPI) were discussed. After risk stratification, the consensus focused on aggressive management of CVDs with therapeutic optimization for various types of patient profiles such as revascularization for stable angina and angina with comorbidities (diabetes and renal failure), apart from emphasis on various medications and their roles in ameliorating disease symptoms.

Not all the significant progress made in the management of children with hepatoblastoma (HB) has translated into improved outcomes in limited-resource settings. There are limited data on outcomes in children with HB from India. All patients diagnosed with HB between July 2013 and December 2020 were risk-stratified and treated as per International Liver Tumor Strategy Group (SIOPEL). Patients with standard-risk HB received cisplatin monotherapy and those with high-risk HB received alternating cycles of cisplatin and the combination of carboplatin plus doxorubicin. Data regarding demographic details, chemotherapy, surgery, liver transplantation, outcomes, prognostic factors, and toxicity were collected. Of 157 patients with HB, 117 (74%) were high risk, 31 (20%) were standard risk, and nine (6%) unknown. Patients with standard-risk disease had excellent outcomes, with 3-year event-free survival (EFS) and overall survival (OS) of 96% and 100%, respectively. Among high-risk HB, six underwent orthotopic liver transplantation of which four were alive at last follow-up. The 3-year EFS and OS of patients with high-risk disease was 56% and 66%, respectively. Outcomes of patients with PRETEXT IV (3-year EFS: 42%, 3-year OS: 50%) and metastatic disease (3-year EFS: 30%, 3-year OS: 50%) were dismal. Patients with serum alpha-fetoprotein (AFP) reduction greater than 90% following two courses of chemotherapy had favorable outcomes; 3-year EFS: 80% versus 58% (p=.013) and 3-year OS: 95% vs. 68% (p<.01). Only two (6%) of 31 patients with relapse/refractory HB were alive at a median follow-up of 36months, and both had received salvage chemotherapy and surgery. While children with standard-risk HB had excellent outcomes, those with high-risk disease continue to do poorly. Serial monitoring of serum AFP values is a cost-effective and reliable predictor of outcomes. Orthotopic liver transplantation remains a viable option for inoperable disease in resource-limited settings as well.

Background: Ataxia neuropathy spectrum, including sensory ataxia neuropathy, dysarthria, and ophthalmoparesis (SANDO), is a part of polymerase gamma (POLG) gene-related disorder, a heterogeneous group of mitochondrial disorders. Childhood onset of the SANDO phenotype is rare, and we describe such a case here, probably the first from India. Clinical Description: A 17-year-old girl presented with progressive gait abnormality since 5 years of age, later associated with ptosis and seizures. On examination, she had atrophy of distal small muscles and absent tendon reflexes in addition to ataxia and ptosis. Differentials for a neurodegenerative disorder with cognitive sparing and ophthalmoplegia were suspected. Management: Investigations revealed a mild elevation in serum lactate, transaminases, and creatine phosphokinase, with abnormal neurophysiology showing primary muscle disease with symmetrical sensorimotor polyneuropathy, and a normal neuroimaging. Gene sequencing analysis for the mitochondrial disorder was done, which revealed a pathogenic variation in the POLG gene. The child was kept on supportive management, including antiepileptics. Conclusion: This case shows that the SANDO phenotype of POLG-related disorders, classically seen in adults, may rarely be seen in children. Our case highlights the fact that although many of the progressive neurodegenerative disorders have a nonspecific clinical presentation, biomarkers, and neurophysiologic abnormalities, a few important phenotypic clues and awareness of POLG-related disorders may enable a pediatrician to order focused genetic testing to delineate the etiology.

Treatment of cancer is carried out using photon beams from high-energy medical linear accelerators. Photo-neutrons are also produced as an unwanted by product in the process of dose delivery to the cancer patients during their radiation treatments. In the present study, photo-neutron dose equivalents (both thermal and fast components) per unit delivered gamma-photon dose were measured at different depths, as function of distances from iso-centre in patient plane, field sizes, wedge angles and at LINAC head for a 15-MV medical linear accelerator model Elekta Precise using multi-foil activation technique. The neutron dose equivalents determined for the above-mentioned parameters were found to be lower (<0.05%) in comparison with the therapeutic photon dose delivered and within the prescribed limits recommended by the national regulatory authority.