A number of studies on population-based cancer registries (PBCRs) data have been reported from India about various cancers. However, updated status of colorectal cancer is not available in literature. The objective is to provide an overview of age-specific and age-adjusted colorectal cancer incidence reported in 27 PBCRs in India. Secondary data on age-specific and age-adjusted rates of incidence rate, the lifetime risk of the disease was computed using cumulative risk and a number of cases for all ages (0–75 years), were collected from the report of the National Cancer Registry Program 2012-2014 in 27 population-based control registries. The annual incidence rates (AARs) for colon cancer and rectal cancer in men are 5.36 and 5.17/100,000, respectively. The AAR for colon cancer in women is 4.3/100,000. Males were comparably at higher risk than females. The maximum lifetime risk of developing colon cancer ranged from 167 to 500 females and lifetime risk of developing rectum cancer ranged from 100 to 353 in males. The risk of colorectal cancers was high amongst the Northeast population followed by South regions of India. The management of colon and rectal cancer cases and screening could serve to control the disease.

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Background: Tissue expansion is defined as the expansion of an area of the skin by progressive distension of an underlying balloon. Human tissue readily adapts to physiological expansion without excessive thinning of the overlying skin. Living tissue responds to gradual stress stimuli by increasing mitotic activity to maintain its thickness and protective integrity. This principle of tissue expansion is used for obtaining tissue to cover many defects. This article reviews the various aspects of tissue expanders including their parts, types and their planning with uses to cover the defects.

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COVID-19 pandemic has been associated with increased morbidity, mortality and economic loss globally. In the absence of definitive treatment, the only way to develop herd immunity and to curtail the spread of infection is through an effective vaccination programme. Under normal circumstances, a vaccine development would have taken 8–12 years; however, in case of COVID vaccine, this process has been reduced to 10 months. Since the lockdown, multiple countries have used various platforms to develop COVID vaccines at a war footing and recently close to five vaccines that have been approved for emergency use. This has lead to confusion, controversy and debate among the medical fraternity about the safety and efficacy of these vaccines. This articles gives an overview of the vaccines present, various trial results and adverse effects seen till now.

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Context: Malnutrition is a silent emergency and a leading cause of morbidity and mortality amongst children under 5 years of age. There are intra and inter-generational consequences of malnutrition. Aim: To study the trends of prevalence of malnutrition among under-five children in India since its independence. Subjects and Methods: The trends in malnutrition indicators from 1947 to 2021 in India through 40 studies out of 186 descriptive, cross-sectional and epidemiological studies, reports, etc., from the national and international electronic databases were reviewed and analysed. Results: Indicators of malnutrition have changed over the years. There is the paucity of data on child malnutrition from 1947 to 1972. Until the 1980s, the data were represented in the proportion of under-five children falling below a specified percent of the median as per weight-for-age. From 1980 to 2021, the data on the nutrition status of children under five are available as prevalence based on weight-for-age, height-for-age and weight-for-height. Overall, not much progress can be observed towards achieving sustainable development goals (SDGs) targets for underweight, stunting and wasting since 2005. Conclusions: The past seven decades have witnessed upward as well as downward trends during various periods of time in the prevalence of undernutrition. However, there has always been an upward trend in the prevalence of over-nutrition. To achieve SDG-2 by 2030, i.e., to reduce and maintain wasting by 5%, stunting by 40% and no further increase in childhood obesity, there is a need to strengthen the existing strategies and focus on the most vulnerable and critical age groups.

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SARS-CoV-2 is a dangerous virus which first emerged in China in December 2019. Till now, it has affected more than 4215,497 people in 212 countries and territories. No drug or vaccine is currently recommended, but scientists and researchers are trying their best to identify potential medications and clinical management practices for this virus. The aim of this paper is to find and compare clinical management practices and suggest potential treatment options for COVID-19 in highly infected countries of the Indian sub-continent (India, Bangladesh and Pakistan). Necessary information has been collected from various clinical management guidelines for COVID-19, available at the health ministry websites of India, Bangladesh and Pakistan. Although clinical management practices vary from country to country, all of these countries utilise mechanical ventilation. Moreover, some potential drugs have been suggested by all countries that may be utilised for treatment but did not recommend any of the medications yet because all of them are under evaluation in various clinical trials. Hydroxychloroquine has been suggested by all of these countries but in different situations. All countries are trying their best to follow their government guidelines. In addition, it has been found that the recovery rate of patients from Bangladesh, India and Pakistan is 18.08%, 30.76% and 26.58%, respectively. Although all the suggested treatment protocols have potentiality against COVID-19, they can only be recommended in the treatment procedure after necessary experiments and investigations.

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The use of artificial intelligence (AI) in medicine made its beginning five decades ago in 1972 when researchers at Stanford University in the USA developed an expert system MYCIN for treating blood infections. Since then, AI-based research in medicine is evolving every day to bring efficiency into medical diagnosis, early prediction of outcome, better clinical treatment and for rapid prognosis and recovery of patients. With the availability of an increasingly growing patients' associated information such as texts, audios, images and videos in structured and unstructured formats, it has become a challenge for computer scientists to process such information and to understand its insights into meaningful conclusions. With the development of powerful algorithms, AI has proven its ability in understanding the insights into data and taking health-related decisions in real time and improving clinical practice. This article provides an overview of various AI techniques in healthcare, especially deep learning used in medical diagnosis. The article also highlights the challenges and concerns of AI implementation.

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Although abdominal pain is common and often inconsequential, acute and severe abdominal pain is almost always a symptom of intrabdominal disease. Ascertaining the cause of abdominal pain is quite like solving a puzzle. Putting together the history, clinical findings and the result of investigations into perspective makes the diagnosis apparent. Textbook descriptions of abdominal pain have limitations because people react to and interpret pain differently. Proper understanding of the anatomy and the embryological origin of the abdominal organs is necessary for a proper understanding of the disease process. Referred pain is one particular diagnostic dilemma. Neuroscientists are still trying to understand which anatomical connections are responsible for referred pain. Referred pain is experienced when nerve fibres from regions of high sensory input (such as skin) and nerve fibres from regions of low sensory input (such as the viscera) happen to converge on the same or adjacent levels of the spinal cord. Referred pain can be both somatic and visceral and has to be interpreted judiciously while attempting to reach a diagnosis. This article attempts to understand the anatomical and neurological relationships of the intrabdominal organs and its relevance in various causes of acute abdominal pain.

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Background: Epilepsy is a common neurological disorder and affects approximately 70 million people worldwide. The traditional approach used by neurologists for the detection of seizure is time consuming. Aim: An automated approach is required that can assist the neurologists in seizure diagnosis in order to minimise the diagnostic time. Materials and Methods: Electroencephalogram (EEG) signals record the electrical activities of the brain and can be used effectively in seizure diagnosis. We have evaluated our system using Bonn university database. Appropriate feature selection is very important in pattern recognition problems. We used recursive feature elimination (wrapper method), for the selection of best features. In our study, we have used EEG signals to evaluate the performance of seven machine learning algorithms. Results: We obtained a classification accuracy of 99%, which is a significant improvement over the state-of-the-art methods. The classification performance across 10 folds of cross validation of Logistic regression and Adaboost was the highest with an accuracy of 99%. While using naive bayes and random forest, the Area under the ROC curve value obtained was 1. The sensitivity obtained using naive bayes classifier was 100%. Conclusion: Our approach requires minimum feature extraction that makes it an efficient approach. Recursive feature elimination was used to select the features which yield good accuracy results. It was observed that logistic regression and Adaboost performed superior with an accuracy of 99%.

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The COVID-19 pandemic has resulted in serious consequences for all those patients who need treatment for any other routine ailments. The worst sufferers are the patients who need to undergo elective or non-emergency surgical procedures. But globally, no concrete steps have so far been taken to reduce the huge suffering of routine surgical patients either during or the aftermath of the pandemic. The aim of this study is not only to draw global attention by highlighting the magnitude of suffering faced by routine surgical patients but also to put the much-needed proposal for the urgent need of universal guidance to counter the huge challenges waiting ahead. In an attempt to find the scale of problems faced by patients in need of routine surgical procedures and their suggested solutions available to date, we did an extensive search online on different search engines and scientific databases. Unfortunately, no country is tracking or reporting the data of routine surgical patients affected by this pandemic. Whatever estimated data in this regard is projected, is catastrophic. The worst at the global level is that no step has so far been taken to look into any solution for this huge suffering faced by millions of people. The COVID-19 pandemic has posed a huge challenge for routine surgical patients across most of the affected parts of the world, and we cannot turn a blind eye for long time on this issue. All stakeholders at the global level must come forward with uniform guidance to handle this global emergency during and post-pandemic time.

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Medical education in India is at crossroads confronted with numerous serious challenges of monstrous proportions looking at virtual collapse adversely affecting the mindset and quality of doctors under the hypnotizing influence of corporatization and commercialization converting doctors into materialistic, self-centred, without values of sacrifice, service or commitment to the country as well as depriving the poor brilliant students a chance to become a doctor. The challenges in medical education are different for public medical education such as poor work environment, bureaucratic interferences, lack of funds and dilapidated infrastructure, whereas challenges in private medical institutions are generally about rampant and open illegal and unethical practices, excessive commercialization and being obnoxiously expensive. Moreover, both public and private medical institutes are governed by ineffective regulatory institutions like State Medical Councils and National Medical Commission. During COVID-19 pandemic, miserable deficiencies were exposed in our public health care and exploitation by private health institutions because of progressive deterioration and increasing commercialisation of medical education. All these factors seriously impact the health-care system both public and private leading to increased attention and focus on the state. Even with 541 medical colleges, medical education in India still needs revolutionary and urgent changes to fulfil the healthcare needs of the nation.

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COVID-19 has infected more than 32 million people globally in more than 100 countries. Diabetes mellitus (DM) has emerged as an important factor involved in the fatal outcomes of COVID-19. Accumulating evidence suggests that that reciprocal relationship may exist between these two raging pandemics, thus making COVID-19 more challenging for people with diabetes. Furthermore, poorly managed glycaemia in diabetes patients leads to increased risk of severe complications and higher mortality rate. The association between COVID-19 severity and DM can be supported by several pathophysiological mechanisms, such as compromised innate immune system, deranged cell-mediated immunity and adipose tissue infiltration of pro-inflammatory macrophages. Exaggerated coagulation and pro-thrombotic milieu in diabetes can predispose to thromboembolic complications associated with fatal outcomes in diabetic patients with COVID-19. Impaired pulmonary function and elevated levels of furin associated with diabetes can increase the chances of COVID-19 infection in patients with diabetes. In addition, SARS-CoV-2 infection can trigger stress hyperglycaemia leading to augmented viral replication and severity of infection associated with poor clinical outcomes in diabetic patients with COVID-19. Endothelial dysfunction associated with virus-induced endothelialitis can lead to organ ischaemia and life-threatening complications associated with COVID-19 with underlying DM. Vitamin D deficiency and insulin resistance worsened by SARS-CoV2 can lead to higher mortality and morbidity observed in diabetic patients with COVID-19. Therefore, COVID-19 patients should be adequately monitored for the development of new-onset diabetes, due to deranged glycaemic control, owing to underlying COVID-19 disease, and diabetic patients with COVID-19 should be kept under strict glycaemic control to avoid life-threatening complications.

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Background: COVID-19 has become a big challenge for the humanity and the public health; it is progressing in all the world and the number of cases exceeded the millions with a high rate of mortality. The disease is presented with a variety of symptoms and in different extents but predominantly with respiratory symptoms such as fever and shortness of breath. Methodology: It is a preliminary, descriptive cross-sectional study that includes 503 patients from four counties and more than ten isolation centres. It includes all the patients who were presented with frequency of urination in addition to the other disease's symptoms. The frequency of urination was identified by micturition frequency for more than 10 times a day with exclusion of the hormonal diseases related to the micturition. Results: 96.23% of the patients were presenting with fever and 89.28% of them with dry cough, only 39.68% of them were with mild to no symptoms. 59.72% of them urinated for 10–13 times per 24 h and 49.6% of them have the symptom for 3-day duration. 82.43% of the patients have a small amount of urine (<300 cc) for each micturition. Some of them were recognised to have diabetes mellitus, hypertension and urinary tract infections. Conclusion: Frequent urination can be considered a new symptom for COVID-19 with some criteria of presentation The duration of the symptom ranging from 3 days to 10 days, and it depends on the case and the patient's age and gender in addition to the severity of the disease.

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Background: Intrahepatic cholestasis of pregnancy (IHCP) is characterized by itching with or without icterus in pregnant women. IHCP is likely to be associated with adverse perinatal outcomes. Objective: This study was conducted at Sir Ganga Ram Hospital to determine the prevalence of IHCP and to evaluate the associated perinatal outcome among pregnant women during a period of 1 year (1 January 2003 to 31 December 2003). Methods: All pregnant women with pruritus and/or jaundice were enrolled as study subjects. The patients without these symptoms were classified as controls. The enrolled subjects were studied in terms of demographic data and pregnancy outcome measures, such as preterm-birth, low birth-weight, operative intervention for fetal distress, meconium staining of amniotic fluid, Apgar score, transfer to the neonatal intensive care unit (NICU) with a resultant stay and the perinatal deaths. Results: Among the 2195 patients delivering during the study period, a total of 73 (3.3%) patients had IHCP. The mean gestational age and birth weight in patients with and without IHCP were 37.6±2.4 vs. 36.6±1.41 days (p=0.218) and 2.58±0.47 vs. 2.78±0.56 kg (p=0.695), respectively. There was a 4.3-fold increased occurrence of meconium staining of amniotic fluid in the IHCP group (25.3% vs. 5.8%, p<0.001). Operative interventions for fetal distress were significantly higher in the IHCP group (41.3% vs. 18.2%, p<0.001). The perinatal mortality in patients with or without IHCP was comparable (2.7% vs. 1.4%, p=0.361). There were significantly increased transfers of the neonates to the NICU in the IHCP group (41.3% vs. 21.2%, p<0.001). However, the mean duration of stay in the neonatal unit was comparable. Conclusion: IHCP is a benign disease from maternal point of view, but has shown to adversely affect the perinatal outcome.

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In medical research, the word ‘association’ and ‘correlation’ between two attributes/variables are frequently used and many times interchanged. Simplifying these concepts may help the researchers in applying the appropriate test. The article makes an attempt to simplify the concept of statistical association and correlation, especially for the clinical practitioners and researchers. The article discusses various measures of association and relationship for testing and assessing the strength. It also includes discussion on three popular measures of association used in medical research, namely odds ratio (OR), relative risk (RR) and hazard ratio which measure association of outcome between the two groups. Pearson Chi-square test is the most common test and has been extensively used for studying the association without bothering about its limitations or strength. Many times, researchers take it granted that the OR and RR are one and the same thing. Our calculations suggest us that with probabilities of outcome of 0.5 and 0.1, the OR is 9, whereas RR is 5. Tools for studying the statistical association and correlation should be used cautiously and appropriate tests to be used, particularly when assumptions are violated. While studying the association, its strength should be assessed using the appropriate statistics. OR and RR measure the association for assessing the risk. However, we should avoid equating OR with RR, particularly when the probabilities of outcome are not small.

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Background: Azithromycin is an antibiotic, which is preferentially used in the treatment of Mycobacterium Avium Complex (MAC). However, it suffers from drawbacks such as poor solubility, poor bioavailability and adverse effects such as gastrointestinal intolerance, resulting into poor patient compliance. Aim: To develop and optimize lipid based nanocarriers of Azithromycin using QbD approach. Methods: Nanostructured lipid carrier (NLC) were developed by using the solvent diffusion evaporation method with view to release drug in a sustained release manner. The initial factors screening and risk assessment done through Taguchi design and afterwards the optimization of independent factors along with final outcome i.e. critical quality attributes (CQAs) were done by Box Behnken Design (BBD). Results: The results of Physicochemical analysis revealed that a size of optimized Azithromycin Nanocarrier is 346.18 ± 12.90 nm and Polydispersity Index (PDI) of 0.21 ± 0.08; the entrapment efficiency (% EE) of 68.45 ± 4.42% w/w and drug loading of 47.16 ± 0.80 % w/w. The in vitro release study of the Azithromycin Nanocarrier showed a biphasic drug release pattern in simulated intestinal fluid (SIF) nanocarrier shown sustained release kinetics up to 02 days and similar pattern shown in Phosphate buffer saline (PBS) pH 7.4, release kinetics shows initial burst release upto 12 hr followed by sustained release upto 04 days in PBS, pH7.4. The sustained release pattern of the formulation is beneficial to improve the oral bioavailability of the drug. Conclusion: Thus, present research leads to development of formulations which may reduce dose of drug, dosing frequency and enhanced efficaciously of drug. Ultimately it reducing the patient avoidance in treatment.

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Background: The ubiquitous access to media, the Internet, and suggestions from friends relatives have empowered patients not only choose but also make informed decisions about their health needs and how and where to be addressed. Although there are many guides and studies on the main factors which infl choice, particularly in the USA. There are very few from India and also hospitals from the large private sector constantly advertise their strengths. Aim: We studied the factors which influenced a patient's decision to seek medical attention at a not-for-profit tertiary care centre in India. Materials and Methods: Four hundred consecutive patients or their relatives were provided with a printed sheet that contained a total of 15 questions, which included the unit's and hospital's trustworthiness, reputation, infrastructure, affordability and accessibility, among others. SPSS (version 24) was used, and reliability and validity tests were done. Principal component analysis with Varimax rotation method was done. Results: There were four constructs from 15 observed variables with a cumulative variance of 55%. Construct 1 had a variance of 31%, and it included variables such as trust in hospital and doctor, infrastructure, diagnostic facilities and ancillary programmes. Construct 2, with a variance of 8.9%, had accreditation, academics and research. Construct 3, with a variance of 7%, had information seeking through the Internet and easy accessibility. Construct 4 had a variance of 7% with health insurance and a suggestion from a neighbour/family or from a friend. Nearly 64% of the patients in the study group travelled more than 100 km. Conclusion: The most influential factors for choosing a hospital are trust in hospital and doctor, along with infrastructure and ancillary services, followed by certified standards of care and academics and research. Surprisingly, the distance was not a deciding factor in the majority, nor was empanelment with insurance companies.

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Background and Objectives: Very low birth weight (VLBW) neonates are at risk of feed intolerance (FI) and necrotising enterocolitis. We planned this study to evaluate the risk factors for FI in VLBW neonates. Methods: Medical records of VLBW neonates admitted to the neonatal intensive care unit (NICU) during the study period were retrieved. Demographic and clinical characteristics of neonates with and without FI were studied. FI was defined as the presence of one or more of the following: Vomiting more than three times during the previous 24-h period, any episode of bile or blood-stained vomitus, an increase in abdominal girth of more 2 cm from baseline, abdominal wall erythema or tenderness, blood in stools. Factors associated with FI were identified by univariate analysis and those found significantly associated with FI were investigated using logistic regression analysis. Characteristics of neonates with Absent or reversed end diastolic doppler flow (AREDF), started on feeds within 24 h and after 24 h were also investigated. Results: Of 129 VLBW neonates enrolled in the study, 72 (55.8%) neonates experienced FI during NICU stay. The mean (standard deviation) birth weights and gestation of neonates in FI and No-FI groups were 1075 (231) and 1265 (201) grams (P < 0.01) and 29.5 (2.1) and 31.2 (2.5) weeks (P < 0.01), respectively. On univariate analysis, birth weight, gestational age and male gender were significant risk factors associated with FI. On multivariate analysis, gestational age and male gender were independent risk factors for FI in VLBW neonates. Among neonates with AREDF, there was no difference in the incidence of FI in those initiated on feeds within 24 h, versus those initiated after 24 h; 47.4%, 69.2%, respectively (P = 0.14). Conclusions: Lower gestation and male gender are significant risk factors for FI in VLBW infants. Early feeding <24 h in infants with abnormal Doppler flows is not associated with an increased risk of FI.

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Background: Total rectal prolapse is a disorder that affects both sexes in all age groups causing debilitating symptoms along with constipation, incontinence or both and results in a poor quality of life (QoL). Aim: We present our experience of laparoscopic rectopexy for procidencia in terms of change in scores of these factors following surgery and the long term results. Materials and Methods: This is a retrospective study with prospectively collected data. Fifteen patients who underwent laparoscopic rectopexy for complete rectal prolapse in our unit from January 2013 to 2016 were included. Preoperative and postoperative constipation, incontinence and QoL scores have been followed up for a period of 18 months following surgery. Other outcomes measured were major and minor complications, length of hospital stay and recurrence. Results: Almost all patients suffered from pre-operative incontinence and had a poor QoL before surgery. Improvement in incontinence following surgery was seen in 86.7% and improvement in constipation was seen in 53% of the patients. There were no major complications. Retrograde ejaculation was seen in two patients in the 20–30 year age group. One patient recovered partially in 6 months and the other was lost to follow-up. There was no incidence of recurrence in the median follow-up period. Conclusions: Laparoscopic rectopexy for rectal prolapse is associated with good post-operative outcome as far as incontinence and constipation is concerned. There is a significant improvement in QoL and associated with a low risk of recurrence. There is a risk of sexual disorders following 'posterior rectopexy' among sexually active males and can be a major source of dissatisfaction.

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