Endovenous cyanoacrylate ablation for chronic venous insufficiency and varicose veins among Asians

INTRODUCTION@#Endovenous cyanoacrylate glue (CAG) ablation for the treatment of chronic venous insufficiency (CVI) and varicose veins has shown non-inferior outcomes with an excellent safety profile, high patient satisfaction rate, and excellent efficacy when compared to the gold standard of endothermal ablation. A review of the current literature for CAG use in CVI showed that most studies and longer-term data are from Caucasian-based populations, which are subject to different anatomical venous variations and socio-economical contexts. This review aimed to gather the current evidence for CAG use in Asian CVI patients.@*METHODS@#Asian studies for the use of CAG in CVI were included in this review. Successful ablation rates, quality of life improvement and novel complications such as glue hypersensitivity reactions are described, along with anatomical descriptions of superficial venous anatomy in study patients. Use of CAG in Singapore and Asia was addressed.@*RESULTS@#CAG has been gaining traction as an option for CVI treatment in Asians. In Singapore, it has been adopted with comparable low complication rates and significant improvement of quality of life after treatment. As we increase our understanding of the variations in venous anatomy in the Asian population, new techniques such as retrograde deployment of the device and use of CAG ablation for venous leg ulcers have been developed.@*CONCLUSION@#Further robust evidence in terms of large randomised control trials along with cost effectiveness studies are needed to determine the true value of CAG ablation in the Asian setting.

Temporal evolution of COVID-19 in the states of India using SIQR Model

COVID 19 entered during the last week of April 2020 in India has caused 3,546 deaths with 1,13,321 number of reported cases. Indian government has taken many proactive steps, including strict lockdown of the entire nation for more than 50 days, identification of hotspots, app-based tracking of citizens to track infected. This paper investigated the evolution of COVID 19 in five states of India (Maharashtra, UP, Gujrat, Tamil Nadu, and Delhi) from 1st April 2020 to 20th May 2020. Variation of doubling rate and reproduction number (from SIQR) with time is used to analyse the performance of the majorly affected Indian states. It has been determined that Uttar Pradesh is one of the best performers among five states with the doubling rate crossing 18 days as of 20th May. Tamil Nadu has witnessed the second wave of infections during the second week of May. Maharashtra is continuously improving at a steady rate with its doubling rate reaching to 12.67 days. Also these two states are performing below the national average in terms of infection doubling rate. Gujrat and Delhi have reported the doubling rate of 16.42 days and 15.49 days respectively. Comparison of these states has also been performed based on time-dependent reproduction number. Recovery rate of India has reached to 40 % as the day paper is written.

Modelling and analysis of COVID-19 epidemic in India.

COVID-19 epidemic is declared as the public health emergency of international concern by the World Health Organisation in the second week of March 2020. This disease originated from China in December 2019 has already caused havoc around the world, including India. The first case in India was reported on 30th January 2020, with the cases crossing 6000 on the day paper was written. Complete lockdown of the nation for 21 days and immediate isolation of infected cases are the proactive steps taken by the authorities. For a better understanding of the evolution of COVID-19 in the country, Susceptible-Infectious-Quarantined-Recovered (SIQR) model is used in this paper. It is predicted that actual infectious population is ten times the reported positive case (quarantined) in the country. Also, a single case can infect 1.55 more individuals of the population. Epidemic doubling time is estimated to be around 4.1 days. All indicators are compared with Brazil and Italy as well. SIQR model has also predicted that India will see the peak with 22,000 active cases during the last week of April followed by reduction in active cases. It may take complete July for India to get over with COVID-19.

Prostatic Adenocarcinoma Incognito Manifestation as Generalized Lymphadenopathy: a Rare Case Report.

Generalized lymphadenopathy is a rare manifestation of carcinoma prostate. Here, we report a case of a 73-year-old male who presented with left supraclavicular lymphadenopathy along with hoarseness of voice and weight loss. His CT neck, chest, abdomen, and subsequently18F-FDG PET CT were suggestive of generalized lymphadenopathy with skeletal involvement. He was not having any urinary or bone symptoms. The biopsy of supraclavicular lymph node revealed metastatic adenocarcinoma, whose prostatic origin was suggested by IHC staining of PSA. The diagnosis was confirmed by prostatic biopsy along with markedly raised serum PSA. We emphasize that in men with adenocarcinoma of undetermined origin, a suspicion of prostate cancer is important for accurate diagnosis and therapeutic approach.

Emergency cholecystectomy and hepatic arterial repair in a patient presenting with haemobilia and massive gastrointestinal haemorrhage due to a spontaneous cystic artery gallbladder fistula masquerading as a pseudoaneurysm.

BACKGROUND: Haemobilia usually occurs secondary to accidental or iatrogenic hepatobiliary trauma. It can occasionally present with cataclysmal upper gastrointestinal haemorrhage posing as a life threatening emergency. Haemobilia can very rarely be a complication of acute cholecystitis. Here we report a case of haemobilia manifesting as massive gastrointestinal haemorrhage in a patient without any prior history of biliary surgery or intervention and present a brief review of literature. CASE PRESENTATION: A 22 year old male admitted with history suggestive of acute cholecystitis subsequently developed waxing waning jaundice and recurrent episodes of upper gastrointestinal bleed. Endoscopy showed an ulcer in the first part of duodenum with a clot, no active bleed was visible. Angiography was suggestive of a ruptured pseudoaneurysm in the vicinity of the right hepatic artery probably originating from the cystic artery. Coil embolization was tried but the coil dislodged into the right branch of hepatic artery distal to the site of pseudoaneurysm. Review of angiographic video in light of operative findings demonstrated a fistulous communication between cystic artery and gallbladder as the cause, a simultaneous cholecystoduodenal fistula was also noted. Retrograde cholecystectomy, closure of cholecystoduodenal fistula and right hepatic arteriotomy with retrieval of the endo-coil and hepatic arterial repair was performed. CONCLUSION: Fistula between the cystic artery and gallbladder has been commonly reported to occur after laparoscopic cholecystectomy. Spontaneous fistulous communication, i.e. in the absence of any prior trauma or intervention, between cystic artery and gallbladder is rare with very few reports in literature. Aetiopathogenesis of the disease, in the context of current literature is reviewed. The diagnostic dilemma posed by the confounding finding of an ulcer in the duodenum, the iconic video angiographic depiction as also the therapeutic challenge of a failed embolization with consequent microcoil migration and primary hepatic arterial repair in the emergency situation is discussed.