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Dirofilariasis is an emerging rare zoonotic disease in which man is a dead-end host and it is transmitted by mosquitoes. The cases of dirofilariasis are increasing over the past few years. Several species of the genera Culex spp., Aedes spp., and Anopheles spp. are involved in the transmission of this parasite. These species represent a constant risk of infection because they feed on both animal and human hosts. For this reason, dirofilariasis is considered an emerging public health problem because of its zoonotic potential. Most of the cases are ocular and subcutaneous presentations are rare. Here, we present a rare case of dirofilariasis presenting as a subcutaneous swelling near the knee joint. Dirofilariasis should be kept in mind as one of the differential diagnosis of subcutaneous nodule. In endemic areas, it can present in atypical forms like rash similar to this case; therefore, clinicians should be aware about this disease.
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Background: Diabetes distress (DD) refers to the negative emotional or affective experience resulting from the challenge of living with the demands of diabetes, regardless of the type of diabetes. In addition to the chronic treatment of diabetes, patients with type 2 diabetes mellitus (T2DM) often experience psychosocial difficulties which can go unnoticed. Hence, it is necessary to identify DD at an early stage to prevent its effect on the patients� long-term self-care and management plan. This study was conducted to assess the prevalence of DD and its psychosocial determinants among T2DM at a tertiary care centre. Methods: This was a cross sectional, observational study which included patients of either gender, who were between 18-65 years of age with T2DM for more than 3 months to 12 years. DD was assessed using the diabetes distress scale (DDS17) scale. In addition, association between the level of DD with the sociodemographic and clinical characteristics of the patients was assessed. Results: The prevalence of DD in type II diabetic patients in suburban population was found to be 17.69%. The psychosocial determinants which influence DD were found to be age, treatment modality, hypothyroidism, hypertension, and smoking. Conclusions: This study signifies the importance of identifying DD by the primary care physician which often remain unrecognized in clinical practice and to implement the interventions at early stages to improve the quality of life of diabetic patients.
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Background: Cigarettes smoking is the principal cause of preventable disease, disability, and premature death in the world. Tobacco smoking affects multiple organ systems resulting in numerous tobacco-related diseases. The study aimed to investigate interrelationship of pulmonary functions between current smokers and never smokers. Methods: Asymptomatic, 50 males current tobacco smokers and 50 healthy never smokers aged between 25 to 50 years were selected as cases and controls. Detailed description of the subject抯 selection, data collection and methods used for performing the test. Results: Maximum incidence was seen in >31 yrs of age with mean of 38.681�5. The study found that never smokers had significantly higher pulmonary functions as compared to current smokers:- FVC in liters (3.43�55 Vs 2.44�58; p<0.05); FEV1 in liters (2.86�57 Vs 1.76�32; p<0.05); FEV1/FVC in percentage (82.72�67 Vs 73.72�.40; p<0.05); FEF 25-75 ratio in percentage (3.18�91 Vs 1.60�45; p<0.05); PEFR in liters per second (6.63�00 Vs 3.16�26; p<0.05); breath holding time in seconds (25.54�14 Vs 21.36�10; p<0.05); 40mm endurance test in seconds (22.36�58 Vs 17.70�01; p<0.05); MEP in mmHg (83.48�28 Vs 64.38�31; p<0.05) were found significant. Conclusions: The strong relationship between cigarette smoking and respiratory disease has been seen independent of the other risk factors in a number of well-designated epidemiologic studies. Spirometry is an excellent screening test to detect chronic airflow obstruction, but may be useful in detecting restrictive disorders as well to study the effect of tobacco smoking on pulmonary functions.
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Background: Ultrasound guided measurement of optic nerve sheath diameter (ONSD) is an emerging non invasive bedside tool that is being used to detect raised intracranial pressure (ICP) in patients with traumatic brain injury(TBI). Early detection of raised ICP can guide in the timely management of such patients with raised ICP due to TBI. Methods: A prospective, observational, open labelled study planned with a 30 patients of TBI of both genders, aged between 18 to 70 years. ONSD readings were taken 3 times a day for three days from the time of admission with portable SonoSite ultrasound machine. Data was expressed as mean ±standard deviation. Values were compared using T test and P value was calculated. Results: Highest reading recorded in patients with GCS <8 was 6.26±0.73 in comparison to 5.38±0.56 (p=0.001) in patients with GCS >8. Highest reading of ONSD correlating with a positive CT finding at admission was 6.22±.81 and was 5.46±.57 (p=0.006) in patients with negative findings on CT. ROC curve with average cut off of 6 mm correlated with positive CT findings with sensitivity of 80%, specificity of 70% and negative predictive value of 87% was found. Conclusions: Ultrasound-guided ONSD monitoring shows promise for diagnosing intracranial hypertension in traumatic brain injury. Correlations with CT, GCS, and outcomes emphasize its clinical relevance, warranting further validatio.
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Background: Mucormycosis is an angio-invasive fungal infection with high morbidity and mortality. This infection seems to be increasing during the second wave of COVID-19. Objectives of this study were to identify and characterise the fungal species causing post-covid-mycosis, to analyze the cases for underlying co-morbidities if any and to correlate the associated risk factors with the progression of disease. Methods: Prospective observational study which constituted conventional fungal culture of 188 tissue specimens collected from clinically suspected mucormycosis patients who had history of COVID. Results: This study noted the occurrence of disease with predominance of males (72.03%). Most common symptoms were facial/periorbital swelling, followed by facial pain and headache. Among co-morbid conditions, diabetes mellitus was the most common (71.17%). Use of steroids (65.25%), antivirals therapy (22.86%), oxygen support (11.86%) used in management of COVID patients were found to be risk factors in post-covid-mucormycosis. radiological diagnosis showed involvement of paranasal sinuses (77.11%), followed by orbit (16.94%) and brain (5.90%). Mucor spp. was isolated in 21 cases. Although commonest fungus isolated was Aspergillus, analysis of the data for last 5 years showed a significant rise of Mucormycosis cases. Mortality was seen in 17.79% cases. Conclusions: Fungal aetiology should be kept in mind in patients with above clinical presentations with history of recent COVID-19 infection especially who received steroids.
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Background: Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) constitute a major burden of infectious diseases in India. TB is the most common opportunistic infection and a leading cause of death among HIV positive patients. This study was conducted to assess the HIV–TB co-infection in newly diagnosed HIV patients and correlate co-infection with CD4 and viral load (VL). Methods: A prospective observational study was carried out from January 2021 to June 2022 at ART center of a tertiary care hospital. Screening for TB was done by GeneXpert and Radiology. These patients were monitored for absolute CD4 count by flow cytometer and VL by Real time PCR. Results: Among 380 newly diagnosed HIV patients screened, 94 (24.70%) had HIV-TB coinfection. Of these, 42 (44.6%) were pulmonary tuberculosis (PTB) and 52 (55.3%) were extrapulmonary tuberculosis (EPTB) of 42 patients with PTB, 31 (73.80%) were microbiologically confirmed by GeneXpert whereas of 52 patients with EPTB, 33 (63.46%) were diagnosed clinically and radio-logically. Of 94 patients, only 55 patients could be followed up further at 6 months. Of 55 patients, 33 (60%) had CD4 count <350 cells/mm3 and 2 (3.6%) had baseline VL?1000 copies/ml. 46.80% patients completed their anti-tubercular treatment. Conclusions: EPTB was more as compared to PTB. Co-infection was more with low CD4 counts. Hence, CD4 test can be used as a good immunological marker in co-infection. The study highlights the need of periodic screening of newly diagnosed HIV patients for TB and their monitoring for CD4 and VL.
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Background: Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi. Aspergillus spp. predominates in colonizing the airways of asthmatics. Early and accurate identification of fungus in such cases can prevent worsening of asthma. Also, can help in retarding the progression of ABPM. Objectives of this study were to evaluate different fungal allergens associated with clinically diagnosed Asthma patients by Skin Prick testing (SPT), to study total IgE in asthmatic patients by serological testing and to characterize the fungal isolate associated with SPT+ cases by conventional mycological culture. Methods: A prospective study of known asthma cases was done. Their sensitivity to fungal allergens was tested by SPT. The total IgE levels were measured by ELISA. Sputum collected from SPT+ cases were subjected for fungal identification. Results: Out of 175 patients, 25 (14.2%) showed positive reaction against fungal antigens in which fungal growth was seen in 21 (84%) sputum specimens. Aspergillus fumigatus was isolated from 16 (76%) specimens followed by Candida albicans in 3 (14%) and Penicillium spp in 2 (9.5%) cases. Out of 25 SPT+ asthmatics, 21 patients with fungal growth had total IgE levels >600 IU/ml and 4 patients with negative culture had IgE levels 400-500 IU/ml. Conclusions: A significant prevalence of fungal asthma is seen among asthmatics. Thus, it is essential to screen asthma patients for fungal allergy. SPT seems to be a good screening test. SPT is easy to perform, less time consuming and inexpensive however needs to be performed under pulmonologist’s supervision.
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Background: Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) constitute a major burden of infectious diseases in India. TB is the most common opportunistic infection and a leading cause of death among HIV positive patients. This study was conducted to assess the HIV–TB co-infection in newly diagnosed HIV patients and correlate co-infection with CD4 and viral load (VL). Methods: A prospective observational study was carried out from January 2021 to June 2022 at ART center of a tertiary care hospital. Screening for TB was done by GeneXpert and Radiology. These patients were monitored for absolute CD4 count by flow cytometer and VL by Real time PCR. Results: Among 380 newly diagnosed HIV patients screened, 94 (24.70%) had HIV-TB coinfection. Of these, 42 (44.6%) were pulmonary tuberculosis (PTB) and 52 (55.3%) were extrapulmonary tuberculosis (EPTB) of 42 patients with PTB, 31 (73.80%) were microbiologically confirmed by GeneXpert whereas of 52 patients with EPTB, 33 (63.46%) were diagnosed clinically and radio-logically. Of 94 patients, only 55 patients could be followed up further at 6 months. Of 55 patients, 33 (60%) had CD4 count <350 cells/mm3 and 2 (3.6%) had baseline VL?1000 copies/ml. 46.80% patients completed their anti-tubercular treatment. Conclusions: EPTB was more as compared to PTB. Co-infection was more with low CD4 counts. Hence, CD4 test can be used as a good immunological marker in co-infection. The study highlights the need of periodic screening of newly diagnosed HIV patients for TB and their monitoring for CD4 and VL.
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Background: Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi. Aspergillus spp. predominates in colonizing the airways of asthmatics. Early and accurate identification of fungus in such cases can prevent worsening of asthma. Also, can help in retarding the progression of ABPM. Objectives of this study were to evaluate different fungal allergens associated with clinically diagnosed Asthma patients by Skin Prick testing (SPT), to study total IgE in asthmatic patients by serological testing and to characterize the fungal isolate associated with SPT+ cases by conventional mycological culture. Methods: A prospective study of known asthma cases was done. Their sensitivity to fungal allergens was tested by SPT. The total IgE levels were measured by ELISA. Sputum collected from SPT+ cases were subjected for fungal identification. Results: Out of 175 patients, 25 (14.2%) showed positive reaction against fungal antigens in which fungal growth was seen in 21 (84%) sputum specimens. Aspergillus fumigatus was isolated from 16 (76%) specimens followed by Candida albicans in 3 (14%) and Penicillium spp in 2 (9.5%) cases. Out of 25 SPT+ asthmatics, 21 patients with fungal growth had total IgE levels >600 IU/ml and 4 patients with negative culture had IgE levels 400-500 IU/ml. Conclusions: A significant prevalence of fungal asthma is seen among asthmatics. Thus, it is essential to screen asthma patients for fungal allergy. SPT seems to be a good screening test. SPT is easy to perform, less time consuming and inexpensive however needs to be performed under pulmonologist’s supervision.
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Background: Hepatitis B virus (HBV) infection is a significant public health problem in third-world countries, including India. The risk of infection among close family members of patients infected with chronic HBV infection is four to six times higher than in the general population. However, literature is scarce regarding the Knowledge, attitude, and practice toward HBV infection among the first-degree relatives of patients suffering from chronic hepatitis B. Hence, this study aimed to assess the knowledge, attitude, and practice regarding hepatitis B virus infection among first-degree relatives of hepatitis B patients. Methods: A cross-sectional, observational study was conducted amongst the 354 first-degree relatives of HBsAg-positive patients. A validated questionnaire consisted of twenty questions of knowledge, seven questions of attitude, and ten practice questions were employed to gather information. Results: The mean knowledge, attitude, and practice (KAP) were significantly better amongst participants aged 55-65 years and those who were educated. There was a positive correlation between knowledge and attitude (r=0.58, p value<0.05) and knowledge and practice (r=0.64, p value<0.05). Conclusions: There is insufficient knowledge regarding hepatitis B, its common symptoms, modes of transmission, and preventive tools among close relatives of patients suffering from chronic hepatitis B.
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Background: One of the major challenges for pharmacology teachers is how to capture students’ interests and engage them in the subject, to create an engaging and enjoyable learning process. “Creative study guide posters” is one such novel educational tool that can help achieve these goals. Aims and Objectives: The authors tried to recreate visual artwork in the subject of pharmacology to engage students and at the same time make learning easy and fun-filled. Materials and Methods: In this study, 2nd year medical students participated and prepared creative study guide posters on antimicrobials and microbes in the form of two armies. On the one hand, antimicrobial drugs depicted the good army, consisting of the name of the drug, drug group, and mechanism of action, while on the other hand, the microorganisms depicted the evil army, consisting of the names of the common microbes, representing the battle of Kurukshetra as in the Indian epic of Mahabharata. Results: The majority of the students found this model interesting and useful for revising antimicrobials. About 82.3% of students agreed that their concepts of antimicrobials improved after this activity. About 86.46% of students believed that this model would foster interactive learning. Only 65.63% of students felt that the traditional methods of revising topics were better than this activity. Conclusion: Creative instruction encourages students to think independently, paricipate actively, and express themselves freely. Creative study guide poster activities help with better student engagement, reinforcing concepts, and better retention than just passing information passively in classrooms.
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Background: Family environment plays a significant role in socio-emotional and educational adjustment in adolescents. In the present scenario, parents are in hurry to improve their standard of living and they have no time to engage in child-bearing activities. Low self-esteem is creating mental and psycho-social problems such as poor academic achievement, inadequate adjustments among the siblings and peers, impaired social functioning, suicide, and substance abuse among adolescents. Methodology: A School-based cross-sectional study was conducted among adolescents of Hubli taluka. Information was collected by a self-administered questionnaire with components for Systematic assessment of family environment (SAFE), Self-esteem scale, and Adjustment inventory for school students (AISS). Results: Among 600 adolescents, 85.6% of adolescents had Normal self-esteem, 95%of families were competent, however only 1-7% of the students had an excellent adjustment. Emotional and social adjustment was better compared to Educational adjustment. Adjustment behavior and family environment had a positive association. There was a significant difference in the adjustment scores among low self-esteem and normal self-esteem (p<0.001) and also among discordant and competent families. Conclusion: The adjustment behavior depends on a better family environment and normal self-esteem. The Family environment has a positive effect on self-esteem as well as adjustment behavior. School mental health services should be initiated.
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Background: Extensive research is going on in the field of Yoga by various researchers. Even though thereis less work in effect of Yoga on physical fitness parameters.Objectives: The present study was aimed to find out the exact effects of Yoga and Surya Namaskar (SN)on the selected physical fitness parameters.Material and Methods: In this cross sectional descriptive study, subjects doing regular Yoga and SN(n=51) for more than 6 months and age, sex matched control subjects (n=52) were selected by conveniencesampling technique. Parameters compared were shoulder wrist flexibility, hip trunk flexibility, aerobic capacity,peak anaerobic power and peak expiratory flow rate.Results: Study group had significantly higher scores of shoulder wrist flexibility and hip trunk flexibility(p0.001 ) and peak anaerobic power (p=0.018). And no significant differences were observed in aerobiccapacity (p=5.22) and peak expiratory flow rate (p=0.139).Conclusion: Subjects who were practicing Yoga and SN, have better flexibility and peak anaerobic powerthan control group.
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Background: There are reports regarding the origin of the inferior thyroid artery from the vertebral artery and internal thoracic artery. The absence of inferior thyroid artery has been reported in studies, but most of these studies have reported the unilateral absence of inferior thyroid artery. Objective: The objective of the study was to identify and variations in origin (especially presence or absence of artery) and branches of inferior thyroid artery. Materials and Methods: A total of 96 cadavers were dissected and observed for origin and branching pattern of inferior thyroid artery. Results: Inferior thyroid artery originated from thyrocervical trunk in 94 cadavers, in one cadaver there are bilateral absence of inferior thyroid artery and in one case unilateral absence of Rt. inferior thyroid artery. Multiple variations of relations of recurrent laryngeal nerve and inferior thyroid artery are found. Conclusion: Knowledge of arterial variation is extremely important while carrying out surgical procedures in the neck region. During operations of the thyroid gland, surgeries of neck region, carotid angiographies any misinterpretation can lead to life-threatening complications. This study is not only focusing on the presence of different branching pattern but also the absence of major arteries. Studies like these can help surgeons to look closely for variations in both cases either presence or absence of main arteries.
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Diabetes mellitus and thyroid disorders are the most common endocrine disorders worldwide. Various studies have found that diabetes and thyroid disorders mutually influence each other and both disorders tend to coexist. Objective: To study the prevalence of different forms of thyroid dysfunctions, their risk factors and clinical implications in cases of type 2 diabetes mellitus. Methods: The study was conducted on 300 patients of Type 2 diabetes mellitus. All the patients were evaluated for thyroid dysfunction by testing thyroid profile (T3, T4 and TSH). The correlation of prevalence of thyroid disorder with gender distribution, age distribution, HbA1C, duration of diabetes, hypertension, BMI, microvascular complication and dyslipidaemia was done. The observations and interpretations were recorded and results obtained were statistically analysed. Results: There was a high prevalence (20%) of thyroid disorders in patients of type 2 diabetes mellitus. Most common was subclinical hypothyroidism (11.66%) which was further found to be more in females, in middle to elderly patients, less than 5 years duration and patients with normal BMI. Conclusion: Screening for thyroid disorders should be done in all diabetic patients. Treatment of thyroid disorder in diabetics may be beneficial for their glycemic control and prevention of progression of microvascular complication.
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Background: Total aplasia of paranasal air sinuses is a very rare condition. Dandy Walker malformation is the most common posterior fossa malformation involving cerebellum and IV ventricle. We present herewith a rare case of aplasia of paranasal sinuses with Dandy Walker malformation. There is no parallel case reports of these combined anomalies found in one patient available to our knowledge. Case report: A mentally retarded 7 years old male child was referred for CT scan study of P.N.S. and Brain. The C.T. findings of P.N.S. and Brain showed aplasia of all paranasal air sinuses and characteristic of Dandy Walker malformation such as Hypoplasia of cerebellar vermis, Dilated IV ventricle, Mega cistern magna etc. Conclusions: Total aplasia of paranasal sinuses is a very rare condition. Computed Tomography (CT) scan remains the gold standard in revealing anatomic details of paranasal sinuses. Dandy-Walker malformation is a rare congenital anomaly of posterior fossa involving cerebellum and IVth ventricle. Treatment depends upon the severity of abnormality and status of patient at the time of its detection.
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INTRODUCTION: Unlike the developed countries, there is a lack of good epidemiologic data for testicular germ cell tumors (GCTs) in India with majority presenting in advanced stage. This study aims to elaborate on the epidemiology of testicular GCTs and response to standard first‑line chemotherapy (CT). METHODS: GCTs treated at our center from January 2013 to June 2014 were retrospectively analyzed. Patients underwent orchidectomy either outside or at our hospital. Based on stage and risk group, standard CT (bleomycin, etoposide, and cisplatin/etoposide and cisplatin/carboplatin AUC7) and radiotherapy were given as appropriate. Response was calculated based on the Response Evaluation Criteria in Solid Tumors. Statistical analysis was performed using SPSS 18 software. RESULTS: Fifty nonseminomatous germ cell tumor (NSGCT) and 36 of SGCT cases were studied. 30%, 46%, and 64% of NSGCT and 11%, 28%, and 22% of SGCT had N2, N3, and M1 diseases, respectively. The mean nodal size was 7 cm (1.5–19) in NSGCT and 5.5 cm (1.3–11) in SGCT. As per the International Germ Cell Cancer Collaborative Group classification, in patients with metastatic disease, 9% of NSGCT were good, 53% were intermediate, and 38% were poor risk whereas 75% of SGCT were good and 25% were intermediate risk. Following CT among NSGCT, 5% and 71% had radiologic complete response (CR) and partial response (PR), respectively. Among SGCT, 46% and 38% had radiologic CR and PR, respectively. 22%, 53%, and 13% of NSGCT and 12%, 24%, and 20% of SGCT developed febrile neutropenia, Grade 3 or 4 hematological and nonhematological toxicities, respectively, after standard chemotherapy. CONCLUSIONS: GCTs in India present with high nodal and high‑risk diseases wherein the standard first‑line CT may not be adequate as curative therapy; however, significant chemotoxicity is also a hindrance.
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OBJECTIVES: To study the utility of fluorodeoxyglucose (FDG) positron emission tomography (PET) in predicting (1) the World Health Organization (WHO) histologic type and differentiating low‑risk from high‑risk types. (2) Tumor stage and differentiate early from advanced stage disease. MATERIALS AND METHODS: Patients with thymic epithelial neoplasia who underwent a pretreatment FDG‑PET study were included. Tumor maximum standardized uptake value (SUVmax) was correlated with the WHO histologic type and also with the Masaoka‑Koga (MK) staging system. Patients with WHO Type A, AB, and B1 were classified as low risk and those with B2 and B3 as high risk. Thymic carcinomas belonged to Type C. Patients with MK Stage I and II disease were grouped as early stage and those with Stage III and IV as an advanced stage. Differences in SUVmax between the various groups were calculated. RESULTS: The SUVmax of thymic carcinomas was significantly higher as compared to low‑risk (P = 0.001) and high‑risk groups (P = 0.007). The SUVmax of high‑risk group was also significantly higher than the low‑risk group (P = 0.002). SUVmax cutoff of 6.5 was able to differentiate thymic carcinomas from thymomas with 100% sensitivity and 87.2% specificity. The SUVmax in patients with advanced stage disease showed a higher trend compared to those with early stage, but the difference was not significant (P = 0.167). CONCLUSION: PET can differentiate thymic carcinomas from rest of the thymoma subtypes by the virtue of their higher FDG uptake. It can also provide valuable information in differentiating high‑risk from low‑risk thymomas and in predicting disease stage.
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The development of targeted agents has expanded the anticancer arsenal available to oncologists and revolutionized the field of cancer treatment. In patients with advanced renal cell carcinoma (RCC), small molecule targeted therapies have improved clinical outcomes compared with cytokine‑based treatments. Sunitinib malate is one such drug that has demonstrated clinical efficacy in patients with metastatic renal cell carcinoma (mRCC). This oral, multi‑targeted tyrosine kinase inhibitor is approved for use in multiple countries for the treatment of advanced RCC and gastrointestinal stromal tumor patients who have progressed on imatinib therapy. In patients with advanced RCC, sunitinib significantly improves clinical outcomes with a favorable safety profile compared with conventional treatment with interferon‑a. The clinically proven treatment and safety outcomes have led investigators to evaluate the merits of sunitinib therapy in the adjuvant and neoadjuvant setting in patients with mRCC. In the neoadjuvant setting, preliminary data suggest that sunitinib can effectively reduce the primary tumor and facilitate surgical resection in patients with locally advanced and mRCC. Post‑operative complications were observed in some patients, but the overall safety profile and efficacy suggests that mRCC patients with surgically inoperable tumors may benefit from neoadjuvant sunitinib therapy. Ongoing clinical trials should provide insight into the value of sunitinib as adjuvant therapy.