Hepatocellular Carcinoma Evaluation and Management for Physicians: Joint Gastroenterology Research Society and Association of Physicians of India Guidelines

Hepatocellular carcinoma (HCC) is the most common cause of, and accounts for almost 90% of all liver cancers. Data from India is limited especially due to cancer not being a reportable disease and in view of wide variation in diagnostic modalities. This document is a result of a consensus meeting comprising Hepatologists, Interventional Radiologists, Hepatobiliary surgeons, medical and surgical Oncologists nominated by the Association of Physicians of India and Gastroenterology Research Society of Mumbai. The following Clinical Practice Guidelines for practicing physicians is intended to act as an up to date protocol for clinical management of patients with hepatocellular carcinoma. The document comprises seven sections with statements and sub-statements with strength of evidence and recommendation.

Left ventricular global longitudinal strain imaging in identifying subclinical myocardial dysfunction among covid-19 survivors

Background: Covid-19 is multi-system viral infection caused by SARS-CoV-2 virus. Apart from having acute severe respiratory illness causing high mortality, the disease also has a variety of cardiovascular manifestations contributing to morbidity as well as mortality. Cardiac dysfunction and myocarditis are well established complications of Covid-19 as evident in multiple studies after the Covid-19 pandemic. However it is not sufficiently studied in Indian patients either by Echocardiography or by any other imaging modalities like cardiac magnetic resonance imaging (MRI). Methodology: In this study, we analysed the severity of Left ventricular(LV) dysfunction in Covid-19 survivors. A total of 100 consecutive patients of Covid-19 after one month of discharge who had no underlying cardiovascular diseases underwent echocardiography and global longitudinal strain (GLS) imaging. This study cohort included patients with mild 42 (42%),moderate 46(46%) and severe 12(12%) Covid-19 disease as defined by computerised tomography (CT) severity score. Result: We observed that total 36(36%) patients had reduced ejection fraction(EF) which included 11 patients having EF <40% and remaining 25(25%) having EF 40e50% (p<0.002). Also 22 (22%) patients had abnormal global longitudinal strain (GLS) values with normal ejection fraction which is suggestive of subclinical myocarditis. We observed LV dysfunction in 7(19.5%) patients who had severe Covid-19 while mild to moderate LV dysfunction observed in 29(80.5%) non critical patients. Conclusion: In conclusion our study demonstrates that myocardial dysfunction is common in covid-19 regardless of disease severity. 2D-echocardiography with GLS is likely to detect early LV dysfunction among these patients.

A Review of Corporate Social Responsibility Programmes Conducted in a Large Public Hospital in a Metropolitan City

Background: Through Corporate Social Responsibility (CSR), a company achieves a balance of economic, environmental andsocial objectives and is also mandated by Indian law. CSR can help in strengthening healthcare in public hospitals catering to theneedy population. Aims: This study documents the various CSR activities going on in a large tertiary care teaching and publichospital in a metropolitan city, challenges in their implementation and effectiveness of such activities. Materials and Methods:Cross sectional questionnaire based descriptive study in a large public hospital in Mumbai, India. A questionnaire was distributedto nine departments which had received CSR support in the year 2017-18. Details recorded were the kind of initiatives andamount received, difficulties faced in implementation, mode of implementation, its effectiveness and number of people benefittedby the activity. Results: In all, companies have provided a total funding of Rs.10,18,24,940 in a year. Difficulties were faced dueto lack of knowledge of the procedure and clear guidelines for CSR implementation. Approximately 84,251 indoor patients and20,77,146 OPD patients were directly or indirectly benefited by these activities. Conclusions: Public hospitals are best settingswhere companies can implement their CSR activities for healthcare of the poorer sections of society, thus fulfilling their socialobligations in a fruitful way. In view of the advantages of CSR, a dedicated CSR department and guidelines for CSR utilisationneed to be set up with adequate expertise and responsibilities.

Mucormycosis of the bile duct: a case report.

A case of isolated localised mucormycosis of the bile duct in an immuno-competent 54 year old female patient is described. Mucormycosis is rare in immuno-competent patients. Isolated localised mucormycosis of the bile duct has not yet been described in the literature.

Transcatheter embolization as primary treatment for visceral pseudoaneurysms in pancreatitis: clinical outcome and imaging follow up.

BACKGROUND: Pseudoaneurysm formation is an uncommon but fatal complication of pancreatitis. The morbidity and mortality associated with surgical management is high. Transcatheter embolization is a definitive minimally invasive form of treatment. AIM: To review our experience with transcatheter embolization as a therapeutic modality for pseudoaneurysms complicating pancreatitis. METHODS: This retrospective analysis included data of 30 patients (mean age 37 years, range 25 to 65; 24 men) with visceral pseudoaneurysms secondary to pancreatitis, who underwent diagnostic angiography and transcatheter embolization, during the period March 1993 to February 2003. RESULTS: In 29 patients the pseudoaneurysms were successfully isolated from the circulation, and hemostasis was achieved. Re-bleeding occurred in one patient, for which re-embolization was done. Twenty-nine patients improved clinically. One patient in whom the pseudoaneurysm was successfully embolized died due to septicemic shock. CONCLUSION: Endovascular embolization is a safe and effective non-surgical modality of treatment for visceral pseudoaneurysms complicating pancreatitis.