Active Community-Based Case Finding of Endemic Leishmaniasis in West Bengal, India.

INTRODUCTION: The ongoing visceral leishmaniasis (VL) elimination programme in India is targeting the elimination of the disease VL but not the pathogen. The persistence of hidden parasite pool may initiate a resurgence in suitable conditions. This study dealt with a novel approach to unearth such pathogen pool and their proper management to prevent the resurgence of VL. MATERIALS AND METHODS: We deployed a new approach for detection of pathogen pool by following up the VL and post kala-azar dermal leishmaniasis patients treated during the last 10 years along with mass sero-surveillance within a radius of 500 m of recently treated individuals. RESULTS: We followed up 72.6% (3026/4168) previously treated VL and post kala-azar dermal leishmaniasis patients and diagnosed 42 (1.4%) new and 38 (1.3%) recurrent post kala-azar dermal leishmaniasis. We detected 93 asymptomatic leishmanial infection, 8 VL and 1 post kala-azar dermal leishmaniasis by mass sero-surveillance. CONCLUSION: Our three-step process including mapping and follow-up of previously treated cases, mass surveillance within 500 m of radius of known cases, and 6 monthly follow-on clinical and serological screening of asymptomatic cases, enabled detection of previously undetected cases of post kala-azar dermal leishmaniasis and VL. Recurrent post kala-azar dermal leishmaniasis deserves special attention regarding their treatment guideline. Early diagnosis and effective treatment of all leishmaniasis cases will hasten pathogen elimination and prevent resurgence of VL. This may help the policymakers to develop appropriate strategy for elimination of pathogen to prevent resurgence of VL.

A Systematic Review Article on Orbital Exenteration: Indication, Complications and Reconstruction Methods.

Orbital Exenteration is a major surgical procedure that consists of the removal of the orbital bone, orbital fat, eyeball, and its contents including extraocular muscles. It is an extensive and morbid surgical procedure. Our aim is to systematically review the indications, complications and reconstruction methods utilised for orbital exenteration. An objective electronic database search was conducted in PUBMED Central, MeSH, NLM Catalog, Bookshelf, and PUBMED published in 20 years period from 1999 till 2019. A total of 29 articles were shortlisted for the present review. Most of the studies have eyelid and canthus as most common primary site of malignancy leading to orbital exenteration. Basal cell carcinoma and squamous cell carcinoma being most common pathology. Other intraocular pathology was Retinoblastoma and melanoma. There were various reconstruction methods used by different authors and Sino-orbital fistula was most commonly occurring in majority of studies. Inspite of being a morbid surgery, Orbital Exenteration had acceptable survival and good quality of life. The aggressive pathology that requires orbital exenteration worldwide is mostly periorbital skin, sinus, and intraocular malignancies. The morbidity of the procedure is high with many surgical complications. However, in properly selected patients it can give better outcomes and survival.

High-grade mixed neuroendocrine non-neuroendocrine neoplasm of the gastroesophageal junction: A rare case report and review of literature.

Mixed neuroendocrine non-neuroendocrine neoplasm (MiNeN) is a recently described entity of the esophagus in the latest (fifth) edition of WHO Classification of Digestive System Tumors. It is often a difficult pathological diagnosis, especially in small preoperative biopsies. We herein report a case of high-grade MiNeN of gastroesophageal junction diagnosed as a squamous cell carcinoma in preoperative biopsy and subsequently as a high-grade MiNeN in esophagogastrectomy specimen comprising areas of mucoepidermoid carcinoma and large-cell neuroendocrine carcinoma (NEC). This report accentuates the importance of deeper multisite preoperative biopsies as the management is completely different in a MiNeN from esophageal squamous cell carcinoma.

Patterns of Multimodality Management of Gastric Cancer-Single Institutional Experience of 372 Cases From a Tertiary Care Center in North India.

Introduction: Worldwide gastric cancer is the 5th most commonly diagnosed cancer and the leading cause of gastrointestinal cancer-related deaths. Alone surgery provides long-term survival improvements in 20% of the patients with local advanced gastric cancer. The results can be improved considering multimodal management including chemotherapy and radiotherapy. However, in low middle-income countries like India, multimodal management is challenging. Herein, we evaluated the experience of multimodal management of gastric cancer and the long-term outcome. Methods: Retrospective analysis of the data of 372 patients was done from a prospectively maintained computerized database from 1994 to 2021. Records were analyzed for demographic details, treatment patterns, recurrences, and long-term outcomes (DFS and OS). Statistical analysis was done with the package SPSS version 26 (IBM Corp, Chicago, Illinois, USA). Results: This study included 372 patients. The mean age of the patients was 54.07. A total of 307 patients (82.5%) were operated upfront, 45 (12%) received NACT, and 20 (5.5%) underwent the palliative procedure. A total of 53.2% underwent curative resection. R0 resection rate was achieved in 95% of patients. A total of 72.58% of patients required adjuvant treatment, and the majority of the patients underwent chemoradiotherapy. The most common site of metastasis was the liver. Median follow-up was 50.16 months. The 3-year disease-free survival and overall survival were 36.28% and 67.8%, and the 5-year disease-free survival and overall survival were 30.15% and 37.7%, respectively. Conclusion: Our study suggested that multimodal management is required in locally advanced gastric cancer to achieve good long-term outcomes. The treatment sequence can be tailored based on the available resources.

A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures.

At this moment the world is fighting with COVID-19 pandemic. Because of increasing number of critical cases, the ICU admissions are also increasing and overwhelming the hospital. These group of patients often required Tracheostomy for proper management and ventilation. As Surgeons we often required to examine and perform procedures in head and neck patients and are in high risk of exposure to aerosol and droplet contamination. We did a literature search for research regarding tracheostomy and its post procedure care during the ongoing COVID-19 pandemic. In this review various international guidelines and sources were put together, and we aim to summarize in a systematic way the available recommendations: indications, timing, technique and safety measures for tracheostomy for COVID-19 patients, from all over the world.

Impact of COVID-19 Pandemic on Cancer Surgical Services-AIIMS, New Delhi Experience.

COVID pandemic has impacted cancer care delivery and cancer surgical services globally. There is an urgent need to study the extent of the impact of COVID on cancer surgery and individual institutional response and strategies adopted to counter the adverse impact. A review of administrative and clinical policy changes adopted at the tertiary cancer center to combat COVID pandemic and resume cancer surgical services were performed. A retrospective comparative analysis of cancer out-patient census during COVID pandemic affected year and the preceding normal year along with cancer surgery data audit for the same periods was performed to assess the impact of the pandemic on cancer surgery. In addition, COVID infection rates among cancer surgery patients and healthcare workers were evaluated. There was approximately a 50% reduction in cancer outpatient registrations during COVID pandemic affected year. A trend of increasing footfalls was noted with decreasing COVID intensity and opening of lockdowns. There was a 33% reduction in major elective surgery and a 41% reduction in emergency surgery performed during the COVID period. As far as cancer surgeries are concerned, there was a 12-50% reduction in volumes involving different subsites. Overall COVID positivity rates among cancer surgery patients was low (8.17%), and approximately 30% of healthcare workers involved in cancer surgery were tested positive for COVID during the study period. Results of the current study indicate a significant impact of COVID pandemic on cancer surgical services. There was a significant impact on outpatient visits and cancer surgery volumes. However, a multidisciplinary-coordinated team approach, effective administrative and policy implementation, adoption of revised surgical safety and anesthesia protocols, COVID screening, and testing protocols facilitated resumption of cancer surgical services without adverse impact on surgical outcomes.

Pulmonary sclerosing pneumocytoma mimicking carcinoid on preoperative imaging in a 14-year-old female.

Pulmonary sclerosing pneumocytoma is a rare benign neoplasm of the lung, commonly occurs in middle-aged persons with a marked female predominance. Earlier, it was known as sclerosing hemangioma. Here, we present a case of pulmonary sclerosing pneumocytoma which was diagnosed as carcinoid of the lung, based on imaging, in a 14-year-old female. Besides radiology, the uniqueness of this case lies in the young age (14 years) of the patient. She was presented with a 3.3 × 2.5 × 2.2 cm soft tissue density mass with a tiny speck of calcification in the anterior basal segment of the lower lobe of the right lung. Based on imaging findings on fluorodeoxyglucose positron emission tomography (FDG PET) scan and DOTANOC scan, a diagnosis of carcinoid was made. We performed a video-assisted thoracoscopic right lower lobectomy. Histopathological examination showed features of pulmonary sclerosing pneumocytoma. Surgery is an established method of treatment for pulmonary sclerosing pneumocytoma. Enucleation, lobectomy, sleeve resection are possible treatment options. To define the role of adjuvant therapy, further direct evidence is required. The metastatic potential of this disease is yet to be established.

The prevalence and clinicopathological correlation of human papillomavirus in head and neck squamous cell carcinoma in India: A systematic review article.

OBJECTIVE: Head and neck squamous cell carcinoma (HNSCC) pose a great danger to society and now we have shreds of evidence for Human Papillomavirus (HPV) being one of the major causative agents for it. Though the prevalence of HPV varies throughout the world, it is gradually on the rise. The present systematic review aims to retrospect all the available studies on the prevalence of HPV in HNSCC in India and its clinicopathological aspect to study how it is different from HPV negative HNSCC. METHODS: An objective electronic database search was conducted in PUBMED Central, MeSH, NLM Catalog, Bookshelf, and PUBMED published in 25 years period from 1994 till 2019. A total of 33 articles were shortlisted for the present review. RESULTS: Studies conducted across India show the prevalence of HPV in Head and Neck Cancers ranging from 0-86.6%. Some studies reported that HPV positive HNSCC is more common in younger age, presents with advanced stage disease, and more commonly presents with nodal metastasis. As opposed to western literature HPV positive HNSCC in India is associated with a well-differentiated tumor grade. There is no difference in treatment outcome and survival among HPV positive and negative HNSCC. CONCLUSION: Exact prevalence of HPV in HNSCC is still doubtful but now we have some insight into it. The prevalence of HPV in Indian HNSCC patients has risen gradually but treatment outcome and survival may be poorer compared to other countries. However definite conclusions cannot be drawn without proper prospective study.

Prevalence and determinants of delay in diagnosis of pulmonary tuberculosis in Darjeeling district of West Bengal.

BACKGROUND: Delayed diagnosis of tuberculosis (TB) is a significant problem both in individual as well as community level. Different studies around globe revealed that these diagnostic delays are attributed to both patient delay and health system-related delay. AIMS: This study aims to assess the magnitude of delay in diagnosis and the association with sociodemographic profile among new sputum-positive pulmonary TB patients in Darjeeling district. MATERIALS AND METHODS: A cross-sectional study was conducted among 374 TB patients from October 2011 to March 2012 using a predesigned pretested schedule by face-to-face interview. STATISTICAL ANALYSIS: Logistic regression analysis, odds ratios (OR), adjusted ORs. RESULTS: Patient delay, health system delay and total diagnostic delay were 27 days, 20.1 days, and 20.6 days; mean delays were 23.64, 5.71, and 29.46 days, and median delays were 25, 5, and 32 days, respectively. Risk factors associated with patient delay were female gender, rural residence, illiteracy, smoking, alcohol consumption, taking two, or more alternate treatments; for health system delay were female sex, rural residence, time to reach health facility, time spent per visit; and for total diagnostic delay were female sex, alcoholism, and seeking more than two alternate treatment. CONCLUSIONS: The risk factors for delay identified may be the subject of future interventions.

Axillary arch muscle: a case report

An axillary arch is a regional muscle variation of the axilla. It is an additional muscle bundle which may extend from the latissimus dorsi to the pectoralis major in the anterior fold, to the short head of the biceps brachiior to the coracoid process. In the present case report, a 40 year-old female presented with a complaint of a right breast lump, which was gradually increasing in size. On triple assessment, it was diagnosed as an invasive ductal carcinoma of the breast. She underwent Skin Sparing Mastectomy and axillary lymph node dissection. While doing axillary lymph node dissection, we encountered an abnormal bundle of muscle fibre crossing the axilla from thelattisimus dorsi muscle to the posterior surface of the right pectoralis major muscle. It is important that surgeons should be aware of axillary arch while operating in the axilla, as it may lead to development of a different type of pathology of the axillary fossa and its constituents (AU)

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