Aims: To guide diabetes practitioners on setting up of basal rates in patients initiated on continuous subcutaneous insulin pump therapy (CSII) in India. Methods: Fifty patients on CSII for more than six months duration and stable glycemic control were analysed for mean basal rates. Results: Five basal rates per day with a thumb rule of 55% basal and 45 % bolus seems a good starting point for patients initiated on CSII therapy in the sub-continent. Conclusions: Our pilot study should guide medical professionals in setting up basal rates during CSII initiation to optimise glycemic control efficiently.

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Context: Oral cavity offers diverse habitats to various species of different microorganisms; some of them, under certain conditions cause loss of connective tissue and bone, ultimately leading to periodontitis. Once such complex of bacteria often referred to as red complex bacteria consisting of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia have been regarded as those associated with periodontitis. With increasing advances in the field of medicine N-benzoyl-DL-arginine-2-naphthylamide (BANA) test, a modern chair-side paraclinical method has been designed to detect the presence of one or more such bacteria. Aim: The aim of the study was to detect the presence of these bacteria in patients suffering from various forms of periodontitis using BANA test kit. Settings and Design: A total of 1500 patients suffering from various forms of periodontitis were selected for the study. Subjects and Methods: These were divided into three groups: Group I: Mild periodontitis, Group II: Moderate periodontitis, and Group III: Severe periodontitis. Microbial parameters were recorded using BANA test. Statistical analysis used Mann–Whitney test and Pearson's Chi-square test. Results: Group III had significantly greater percentage of BANA-positive sites followed by Group II and Group I. Conclusions: There is a positive correlation between the presence of red complex bacteria and severity of periodontitis.

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With increasing numbers of primary knee replacements and the growing concerns of revision knee replacements, research is now tending to look back and look forward for all that is possible to reduce the complications and improve patient satisfaction in this highly successful surgery. The clinician must make a comprehensive assessment of the patient, identify the real needs and optimize the risks of this major surgery, against real benefits. This article reviews relevant aspects of preoperative, intraoperative, and postoperative care that practically influence a successful outcome that every potential candidate for knee replacement rightfully deserves.

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Introduction: Thyroid disorders during childhood are quite common and presentations are nonspecific. Congenital hypothyroidism (CH), among all causes of childhood hypothyroidism, is the most important, as early detection and appropriate therapy can prevent the onset of brain damage. The delay in diagnosis is attributable to the lack of awareness, lack of available facilities, or newborn screening programs. Aims: This study aims to study the spectrum of clinical presentation of thyroid disorders in children in a tertiary care teaching hospital. Materials and Methods: A descriptive observational study was conducted for a 2-year period, from January 2018 to January 2020. All children who were referred to the pediatric endocrine out-patients clinic for suspected thyroid dysfunction were included in this study. Data on patients history, clinical examination including the presence of goiter and laboratory tests were collected and analyzed. Results: Of 86 children with suspected thyroid dysfunction, 32 had abnormal thyroid function tests. Six had CH, 19 had overt acquired hypothyroidism and six had subclinical acquired hypothyroidism. Thyroid peroxidase antibodies were elevated in 13 children with no gender predilection. There was a female preponderance across all the age groups but no gender predilection was noted in the CH group. Short stature was noted in 70.9% of cases, diminution in school performance in 58% and pallor in 29%. Goiter was observed in 9.6% of children. Conclusions: In our study, 80.6% had acquired hypothyroidism. The most common presenting feature was short stature which was observed in 70.9% of our children. Diminution of scholastic performance was the second common clinical feature which was observed in 58% of children.

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Hydatid cysts most commonly present in the liver and the lungs; however, they can appear more rarely in other locations, such as the mesentery, with a rather unclear mechanism of manifestation. Herein, a case of the simultaneous presence of hydatid cysts in the mesentery and multiple splenic calcified granulomas in a 62-year-old elderly man has been presented that was managed surgically by pelvic mesenteric cyst deroofing and subtotal cystectomy.

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Competency-based medical education (CBME) is an approach to producing competent doctors by the adoption of a framework of competencies, which in turn are derived from the needs of the patients and the general population. A number of expected outcomes have been identified for different stakeholders and efforts should be taken to accomplish them. Evaluation is an important aspect of any initiative and the same stands true even in the case of CBME as it has been introduced across all the medical colleges in the nation and the future of thousands of students depend on the same. In general, any evaluation process has to evaluate the input, the process, the output, and the outcomes. To conclude, the CBME curriculum has been formulated and implemented to produce competent health-care physicians that can improve the health-care outcomes of the community. However, the success of the program has to be determined and there arises the need to periodically evaluate the program. The outcomes of the evaluation can be used to modify the program and thereby ensure better implementation.

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Primary adenoid cystic carcinoma (ACC) of the lung is a very uncommon thoracic neoplasm. In view of rarity of this entity, the management guidelines are not well defined. We report a case of primary ACC of the lung managed with surgery and adjuvant chemoradiation.

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Extrahepatic portal vein obstruction (EHPVO) refers to the cavernous transformation of the portal vein (also called “ portal cavernoma”) following acute thrombosis of the portal vein in the absence of recanalization. In adults, EHPVO mainly occurs following thrombosis, while in children it may be related to congenital malformations and/or neonatal umbilical venous catheterization. However, 50% of the cases of EHPVO remain idiopathic. This case report demonstrates the ultrasonography appearances of cavernous transformation of the portal vein in a 3-year-old child.

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Background: In the current coronavirus disease 2019 (COVID-19) pandemic, tracheostomy is an important surgical procedure on COVID-19 patients at the intensive care unit undergoing prolonged endotracheal intubation. The timing and outcome of tracheostomy in COVID-19 patients with ventilator are still controversial. Objective: The objective of this study was to evaluate the timing and outcome of tracheostomy in the airway management of patients with COVID-19 requiring mechanical ventilation. Materials and Methods: This is a retrospective study where 92 patients enrolled in this study and all were with positive reverse transcriptase–polymerase chain reaction which confirmed COVID-19 infection and requiring mechanical ventilation at a single tertiary care teaching hospital from May 2020 to June 2021. Results: Participants included 92 patients who underwent tracheostomy, 62 males and 30 females with a male-to-female ratio of 2.06:1. The age range of the participants was 18–68 years, with a mean age of 54.2 years. The mean time from onset of the symptoms to intubation was 9.46 days; the day of onset of intubation to day of tracheostomy was 18.34 days. Conclusion: The requirement of tracheostomy in COVID-19 is increasing. The tracheostomy should be performed in appropriate time with safe technique for benefit of the patients,particularly for avoiding transmission of infections to health-care workers.

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Background: It is not easy to predict either severity or mortality in a patient infected with coronavirus disease 2019 (COVID-19) as the clinical presentation is variable and treatment response varies from person to person, and at the same time, there is a lack of standard treatment protocol. Objective: The objective of this study is to study the risk factors of mortality among patients with COVID-19. Methods: A hospital-based retrospective study was carried out among 299 cases of COVID-19. Hospital records of patients admitted with COVID-19 at the study center from January 2021 to June 2021 were studied. Demographic, clinical, and laboratory variables were studied with respect to mortality. The Chi-square test for proportions and t-test for mean values was applied, and P < 0.05 was considered statistically significant. Results: Those who died were significantly older (55 years vs. 47 years). Gender and vaccine status were not associated with mortality; however, there were only eight cases who took vaccine and all of them recovered. Among clinical variables, SpO₂ at admission, severe disease, oxygen dependency, requirement of nasal canula, requirement of noninvasive ventilation, requirement of intubation, and requirement of remdesivir treatment were significantly associated with mortality. Among the CT scan severity score (CTSS), COVID-19 reporting and data system score (CORADS) and laboratory and inflammatory markers, the CTSS, CORADS, d-dimer, C-reactive protein, creatinine, urea, and alkaline phosphatase were significantly associated with mortality. Conclusion: Elderly patients, SpO₂ at admission, requirement of oxygen, and other supportive measures as well as inflammatory markers can be used for the early detection of those cases at risk of death. They can be given special care to reduce mortality.

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Vasculitis is a rare but important cause of diffuse alveolar hemorrhage (DAH) and should be considered in the differential diagnosis of patients who develop rapidly progressive dyspnea with nonresolving alveolar opacities on thoracic imaging. The coexistence of renal impairment is termed pulmonary-renal syndrome. Microscopic polyangiitis is a nongranulomatous necrotizing systemic vasculitis that affects arterioles and capillaries. We present a case of a 25-year-old female with hemoptysis with bilateral perihilar chest infiltrates and rapidly deteriorating renal function. Positive anti-myeloperoxidase antibodies, presence of significant hemoptysis, parahilar lung infiltrates, and rapidly deteriorating renal function clinched the diagnosis of DAH secondary to small-vessel vasculitis (microscopic polyangiitis). The patient showed significant improvement with hemodialysis, oxygen supplementation, steroids, and cyclophosphamide. Hemoptysis with rapidly deteriorating renal function in a young to middle-aged lady should raise suspicion of underlying vasculitis after ruling out other more common causes.

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Coronavirus disease-19 is a highly contagious disease caused by severe acute respiratory syndrome coronavirus-2. It has shown a debilitating and catastrophic effect on the world population and is emerging as a challenging global health crisis, resulting in the overwhelmed health-care systems. Even though substantial research and unprecedented speed of vaccine development, there is still a need for better therapeutic options. The urgency to mitigate the illness has resulted in many experimental therapies and drug repurposing, leading to a better understanding of the illness and the development of novel therapies.

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Hemangiomas are usually congenital benign vascular tumors mostly found over the skin of head and neck. Tongue hemangiomas are relatively rare. Its treatment may include corticosteroid and beta-blocker therapy, interferon, sclerotherapy using bleomycin, cryotherapy, etc., but surgical therapy is the treatment of choice for solitary hemangioma. Transoral robotic surgery for hemangioma in the anterior tongue can be an added indication for robot-assisted procedure. Robotic technology offers numerous advantages and it can be a promising alternative in dealing with difficult oral cavity lesions like hemangioma.

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Round cell tumors are group of tumors exhibiting hyperchromatic round nucleus, scant cytoplasm, and high nuclear–cytoplasmic ratio in histopathological examination. These tumors need the application of immunohistochemical panel for accurate diagnosis. We are presenting a rare case of small round cell tumor in retroperitoneum in a 3-year-old male child because of rarity in this site and age.

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Professionalism in the branch of medicine is one of the key attributes which a medical professional should acquire to be successful in their medical practice. It continues to be the most challenging areas for teaching, training, and assessing in both undergraduate and postgraduate period of medical training. Nevertheless, we cannot lose the opportunity to train medical students on such an essential aspect of professionalism, and the best bet we have is to integrate professionalism within the medical curriculum so that students realize its significance and teachers employ methods for its assessment. Further, there is no point in training or exposing medical students to professionalism without assessing them to measure their learning progression. In conclusion, despite being an indispensable component of medical professionalism, we have not made significant progress in training our future medical doctors about the same. This calls for the need to not only integrate professionalism within the medical curriculum but also ensure its periodic assessment in a systematic manner, and thus, the role of administrators and teachers is crucial.

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A holistic approach is required for managing patients with nonalcoholic fatty liver disease (NAFLD). Lifestyle interventions and medical management of metabolic risk factors currently form the cornerstone of NAFLD management. A target weight loss of approximately 7%–10% in overweight/obese patients is recommended with the help of dietary calorie restriction and exercise. None the less, attaining and sustaining the target weight loss is a major challenge with lifestyle interventions. Exercise alone has also been shown to be beneficial even in the absence of weight loss and may be the modality of choice in patients with lean NAFLD. Currently, pioglitazone and Vitamin E are recommended by most of the scientific societies in patients with biopsy proven, noncirrhotic nonalcoholic steatohepatitis (NASH). Recently, saroglitazar has been approved by the drug controller general of India for management of NAFLD with comorbidities or NASH with F1-F3 fibrosis. Although not recommended as a primary modality to treat NAFLD per se, bariatric surgery is an alluring option in otherwise eligible obese patients without cirrhosis. A lot of research is being carried out in the field of NASH pharmacotherapy and many new drugs are in the pipeline.

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Biliary drainage is used to decompress bile duct, both in benign and malignant biliary strictures, to control cholangitis, pruritus, and increasing jaundice. This review is focused on analyzing the position of interventional radiology in the algorithm of management of biliary diseases in our daily practice. It gives a description of indications, techniques, safeness, effectiveness, and main risks involved in various percutaneous biliary procedures, while also providing useful and practical tips for clinical practice decisions.

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Nonalcoholic fatty liver disease (NAFLD) is ongoing pandemic of the 21^st century. The noninvasive assessment includes serum biomarkers, predictive models, and imaging modalities. The “Steato test,” “NAFLD liver fat score,” and “Fatty liver index” are models developed for noninvasive assessment of hepatic steatosis. Out of the imaging modalities, magnetic resonance imaging proton density fat fraction is the most sensitive test to detect hepatic steatosis. Out of the various serum biomarkers to detect nonalcoholic steatohepatitis (NASH), cytokeratin-18 has been the most widely investigated. Recent approach for the diagnosis of NASH has targeted research toward genetic biomarkers such as PNPLA3 and microRNAs. However, none of the presently available biomarkers or imaging modalities are able to differentiate simple hepatic steatosis from NASH with a high sensitivity and specificity. Different models have been developed to predict fibrosis which are aspartate transaminase (AST)/platelet ratio index (APRI), fibrosis-4 (Fib-4) index, nonalcoholic fatty liver disease fibrosis (NFS) score and body mass index, AST: Alanine transaminase Ratio, diabetes (BARD) score. The accuracy of BARD, APRI, FIB-4, and NFS to detect advanced liver fibrosis was found to be of 0.76, 0.77, 0.84, and 0.84, respectively, in a large meta-analysis. Transient elastography, acoustic radiation force impulse, and magnetic resonance elastography (MRE) are imaging techniques available to detect liver fibrosis. MRE has shown to have a pooled accuracy 0.96 to detect advanced fibrosis in NAFLD patients. Noninvasive tests may not completely replace liver biopsy, but it may help to avoid it where probability of fibrosis is low.

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Acute liver failure is an uncommon disease presenting with abrupt failure of liver synthetic and detoxification functions on account of widespread damage to hepatocytes and is associated with high mortality. With advent of emergency liver transplant and tailored critical care its no longer a nontreatable disease.

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Chronic pancreatitis is a chronic inflammatory disorder in which irreversible changes result in fibrosis leading to endocrine and exocrine insufficiency. Pain is often the dominant symptom and as the disease is irreversible all therapy is directed at relieving pain. Lifestyle changes include the modification of diet as well as cessation of alcohol and smoking. A stepup approach in accordance with the WHO pain ladder is ideal for relief of pain. Exocrine deficiency is seen 6–15 years after the onset of chronic pancreatitis (CP) and clinically presents as steatorrhea, weight loss, and specific nutrient deficiency. Lipase is the rate-limiting enzyme and deficiency occurs when over 90% of the pancreatic tissue is lost. Pancreatic enzyme replacement therapy is the therapy of choice and coated microspheres are the mode of delivery for enzyme replacement. The enzyme preparations are best taken between meals and an acid suppressant such as proton pump inhibitor facilitates in better absorption and delivery as these enzymes act best in a high pH. The management of sequalae of CP such as PD strictures, common bile duct strictures, pancreatic leaks, and calculi is individualized, and endotherapy offers an excellent option in properly selected cases. Endoscopic retrograde cholangiopancreatoscopy (ERCP) and subsequent stenting of the pancreatic or biliary ducts is rewarding in strictures as well as in PD leaks. Large calculi are fragmented at ESWL before clearing the duct at ERCP. Endoscopic ultrasound is a rapidly evolving technology, now being increasingly used in the management of consequences of CP. Surgery is advised for patients not amenable or responding to endotherapy.

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The term “obscure gastrointestinal (GI) bleeding” is often replaced by “small bowel bleeding” by some authors. It accounts to 5%–10% of overall GI bleeding. We need to suspect obscure or small bowel bleeding when no source of bleeding is identified during routine standard endoscopy and colonoscopy. Video capsule endoscopy (VCE), balloon enteroscopy, spiral enteroscopy, etc., are some of the advances in small bowel evaluation that have improved the ability to detect the source of bleeding. The common causes in patients with 40 or more years of age are Angioectasia, Dieulafoy's lesions, Nonsteroidal anti-inflammatory drug-induced ulcers, and neoplasm. Black tarry stools with characteristic smell (melena) and/or passing of red blood from rectum (hematochezia) is the most common presentation. Routine performance of second look endoscopy is not always a cost-effective approach. The current available evidence is sufficient to suggest VCE as the first endoscopic investigation in diagnosis of obscure GI bleeding. In routine clinical practice the double balloon enteroscopy, single balloon enteroscopy, and spiral enteroscopy are the three different armamentariums available for evaluating small bowel. Motorized spiral enteroscopy (power spiral) is the new addition to it. Patients in whom the source of bleeding is not identified after appropriate small bowel evaluation should be initially managed conservatively with oral or intravenous iron therapy (strong recommendation). Medical management with iron supplements, somatostatin analogs, or antiangiogenic treatment should be administered to the patients with persistent and recurrent bleeding. The evaluation of small bowel in patients with obscure GI bleeding is a challenging task. There is a huge data on each of the modality involved in investigating small bowel. Systematic review of the topic is need of the hour to help understand the concept of diagnosis and management of obscure GI bleeding.

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Endoscopic ultrasound (EUS) has come a long way in the field of interventional gastroenterology. Majority of the advancements in the field of EUS over the past 20 years has been done by the group of endoscopist who are looking to break the convention. At this time both diagnostic and interventional EUS has become the standard of care in the management of large number pancreatic, biliary, luminal gastro-intestinal, and mediastinal diseases. It is now widely available as the large number of medical institutions, have added it to their endoscopic armamentarium. Scope of interventional EUS in clinical practice is rapidly expanding. Here in the current review, we highlight the key concepts of various interventional EUS procedures like-EUS guided drainage of pancreatic fluid collection; EUS guided vascular therapy; EUS guided enteral anastomosis; EUS guided biliary drainage; Role of EUS in hepatology; EUS guided celiac plexus neurolysis and neurolysis. We also discuss the indications, technical aspects, adverse events, and future directions of each of these procedures. If looking into future, we can predict an evolution of these techniques into an exciting newer horizon in the form of EUS-guided minimally invasive surgery.

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