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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Background: The COVID-19 pandemic caused by SARS-CoV-2 has made nearly 120 million people sick with more than 2 million dead. Many survivors of severe COVID-19 are experiencing post-COVID complications beyond 4 weeks from the disease onset. The decrease in lung function and pulmonary fibrosis are the serious manifestations of COVID-19. The burden of even a relatively mild fibrotic change could have considerable morbidity and mortality, especially in the elderly and those with comorbidities. Aim: To evaluate the effect of early intervention with anti-fibrotic pirfenidone and corticosteroids in preventing pulmonary fibrosis in severe COVID pneumonia patients. Methods: This randomised open-label pilot trial was conducted was conducted at Government Medical College, Srinagar for evaluating the role of anti-fibrotic drugs in preventing post-COVID pulmonary fibrosis. In this study, 60 patients with severe COVID-19 infection were screened and randomised into two groups, one receiving anti-fibrotic drug– pirfenidone (n = 17) and other receiving corticosteroids (n = 19). The study participants were evaluated at the baseline and after 6 ± 1 week using 6-min walk test, spirometry and high-resolution computed tomography (HRCT). Results: The mean (±standard deviation [SD]) age of the pirfenidone and steroid group was 64.16 ± 11.36 and 67.19 ± 13.32 (P = 0.929), respectively. There were no significant differences in clinically relevant baseline characteristics at the time of enrolment in the two treatment groups. The initial CT severity score was 14.84 ± 4.031 and 14.81 ± 4.722 (P = 0.400) in pirfenidone and corticosteroids groups. The mean (±SD) baseline forced expiratory volume in the first second (FEV1) in pirfenidone and corticosteroid was 73.32 ± 18.10 and 71.71 ± 17.92 (P = 0.670), while FEV1/forced vital capacity was 95.89 ± 23.40 and 90.00 ± 21.09 (P = 0.920), respectively, between the two groups. The final fibrosis score was 115.52 ± 12.32 and 138.22 ± 43.90 (P = 0.004) in the pirfenidone and corticosteroids groups, respectively. At the 6^th week, the proportion of patients who had died was less in the pirfenidone group as compared in the corticosteroid group (02 patients [11.76%] in the pirfenidone group vs. 08 patients [42.10%] P < 0.001). Conclusion: Pirfenidone, an anti-fibrotic agent, has a better outcome than corticosteroids in preventing post-COVID pulmonary fibrosis without serious adverse effects. Our study concludes that early initiation of pirfenidone therapy in patients with severe COVID-19 infection, especially those at higher risk like the elderly and those with co-morbidities has a better treatment and survival outcome compared to corticosteroids.

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Background: The coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and was declared as a pandemic by World Health Organization. Various haematological parameters alteration has been documented in SARS-CoV-2 infection. However, there is a need for research to evaluate the pattern of the haematological parameters of COVID-19 patients. Aims: The main aim of this study was to determine demographic characteristics, to study various haematological parameters and their relation with the outcome of the disease. Materials and Methods: A total of 150 patients who tested positive for COVID-19 were included in the study. A prospective study was done in the Department of Pathology, GCS Medical College, Hospital and Research Centre, Ahmedabad, for the period of 15 days (01 August 2020–15 August 2020). Patients were categorised according to severity, oxygen (O₂) requirement and their the outcome. Haematological parameters and clinical data were obtained. Median values of age and haematological parameters were compared between these groups. Results: Patients who needed oxygen support had higher median age, absolute neutrophil count and platelet-to-lymphocyte ratio. Patients in the intensive care unit (ICU) had higher age, leucocytosis with absolute lymphopoenia and a high neutrophil-to-lymphocyte ratio. The parameters found to be associated with a poor outcome were higher median age with low haemoglobin, low mean corpuscular volume and absolute lymphopoenia. Conclusions: Males and older people are more prone to COVID-19 infection. Parameters such as high total leucocyte count, high absolute neutrophil count, low absolute lymphocyte count and high neutrophil-to-lymphocyte ratio may be considered cardinal laboratory findings with prognostic potential for the requirement of O₂, ICU admission and poor outcome of COVID-19 disease.

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Background: Nowadays, the role of inflammation in malignancies is well understood, and it has been characterised at several phases of tumourigenesis (initiation, promotion, invasion and metastasis). Different studies suggested that the neutrophils/lymphocyte ratio (NLR) is linked with breast cancer (BC) survival and prognosis. Aim: In the present study, our aim was to study the blood parameters (neutrophils, lymphocytes, NLR, lymphocyte-to-monocyte ratio [LMR] and neutrophil-to-monocyte ratio [NMR]) in BC. We examined the correlation between white blood cells, NLR, LMR, NMR and BC. Materials and Methods: It was a case–control study, which included 97 individuals, in which 44 were confirmed BC patients by histopathological examination and 53 were healthy controls. Their personal and social status information were collected in questionnaire form. Results: The mean neutrophil count was higher in the case group as compared to the control group (65.45 ± 5.92/68.67 ± 9.13, P = 0.001). Lymphocyte count was significantly lower in the case group as compared to the control group (26.25 ± 8.78 vs. 29.79 ± 5.14, P = 0.00). NLR was higher in the case group as compared to the control group, 3.03 ± 1.36 versus 2.35 ± 1.02, P = 0.00. The monocyte level was significantly higher in BC patients as compared to the control group, i.e. 2.80 ± 0.79 versus 2.66 ± 1.07, P = 0.01, in the case group. The LMR was 13.55 ± 7.21 in the control group and 10.35 ± 5.57, P = 0177, in the case group. NMR was significantly higher in the control group as compared to the case group (30.42 ± 17.02 vs. 26.53 ± 8.50, P = 0.002). Conclusions: Low NMR value can be related to a greater survival rate. We concluded that complete blood count, NLR and NMR can be an alternative marker in BC risk.

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Duplication of the oesophagus has ranges from complete duplication which is very rare to a partial cystic duplication (also known as duplication cyst). The oesophagus is the second most common site after the ileum to be involved with gastrointestinal duplication. It commonly manifests in neonates and children. The adults are usually asymptomatic. In this report, we describe a case of an adult male presenting with dysphagia because of a lower oesophageal duplication cyst. The diagnostic features and treatment options are discussed.

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There is a huge gap between organ donation and the current demand for organ transplantation. With a very low donation rate of 0.26 per million in India, a high number of patients die due to lack of organ transplantation. Strategies such as increasing organ donation from the paediatric population can improve the void in the national donor pool. Increasing awareness among the general population, propitious support for families during the donation process, more dedicated clinical staff, development of better screening and assessment processes are some multifaceted methods to improve organ donation. We herein report a case of an 18-month-old girl child who donated her heart, liver, kidneys and cornea to five patients following her demise. This case emphasises that with advanced surgical techniques and meticulous organ procurement even from a very young donor, results can be rewarding.

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Uterocutaneous fistulae are rare fistulas of the female genitourinary tract. It mostly follows caesarean section and subsequent post-operative wound infection. Only a handful of cases have been published in the literature. Surgical excision is the definitive management in most cases. Laparoscopic management has been used by many authors and gives good results. A 30-year-old multigravida presented with symptoms typical of uterocutaneous fistula and confirmed by magnetic resonance imaging of the pelvis. On diagnostic laparoscopy, the tract was delineated by methylene blue dye both through the opening in the skin as well as through the cervix. The complete excision of fistulous tract was done laparoscopically along with omental interposition between the uterus and the abdominal wall at the site of the fistula. Histopathologic examination of the tract confirmed endometriotic tissues without any chronic inflammation, typical of uterocutaneous fistula. The patient had an uneventful recovery, was started on diet the following day and discharged the next day. There was minimal post-operative pain and helped in early ambulation. On follow-up at 12 months, the tract had completely healed and the patient was completely asymptomatic. Uterocutaneous fistula is a rare complication that follows wound infection or suboptimal wound closure following caesarean section. As compared to the traditional excision by laparotomy, laparoscopy not only aids in confirmation of the diagnosis but also helps in complete excision of the tract with good results.

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