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Background (SARS-COV-2) infection, led to a pandemic affecting many countries, resulting in hospitals diverting most of their resources to fight the pandemic. Breast cancer, already a healthcare dilemma, is also affected in this scenario. Our aim was to find out the impact of COVID-19 on presentation of breast cancer stage and its effects on overall onco-surgical management. Methods This cohort single-centered retrospective review was carried out at our hospital, over a period of 18 months. Females with known breast cancer were included in the study. Data was collected on performas by a single researcher. Effect of COVID pandemic on presentation stage and its impact on overall management was studied. SPSS 23.0 used for data analysis. A 95% CI was used. Descriptive statistics were presented as range/means. Categorical data was analyzed by Fisher exact test, t -test was applied to numerical data, p value ≤ 0.05 was considered significant. Results Out of 87 patients presenting with suspicious lump, 69 who had malignancy on histo-pathology were included in study. Twelve out of 69 were COVID positive. Sixty patients presented with advanced stage (≥stage 2b) out of which 21 underwent upstaging of disease due to delay in presentation/management. We found that 9 out of 12 (majority) Covid positive patients had disease upstaging. Overall main reason for delay in presentation was found to be unawareness of disease. Conclusion We concluded that COVID-19 pandemic had no impact on presentation delay, breast cancer management/treatment and disease upstaging as compared to figures available for our population before the pandemic. However, our study showed significant correlation between disease upstaging and COVID status. This led us to reconsider our preformed protocols for COVID positive breast cancer patients. Our results can be used by future researchers to investigate if COVID itself can contributes in patho-physiology of upstaging in breast cancer or not.

Background:Cases of de novo glomerular disease with various renal histologies have been reported after vaccination against SARS-CoV-2. Causality has not been established and the long-term outcomes are not known. To better characterize the glomerular diseases and clinical course/outcomes, we created the International Registry of COVID-19 vaccination and Glomerulonephritis (IRocGN2) to study in aggregate de novo glomerulonephritis cases suspected after COVID-19 vaccine exposure Methods:A RedCap survey was used for anonymized data collection. Detailed information on vaccination type and timing and glomerular disease histology were recorded in the registry. We collected serial information on laboratory values (before and after vaccination and during follow-up), treatments, and kidney-related outcomes. Results: Ninety-eight glomerular disease cases were entered into the registry over eleven months from 44 centers throughout the world. Median follow-up was 89 days after diagnosis. IgA nephropathy (IgAN) and minimal change disease (MCD) were the most the common kidney diseases reported. Recovery of kidney function and remission of proteinuria was more likely in IgAN and MCD at 4-6 months than with pauci immune glomerulonephritis /vasculitis and membranous nephropathy. Conclusions:Development of glomerular disease after vaccination against SARS-CoV-2 may be a very rare adverse event. Temporal association is present for IgAN and MCD, but causality is not firmly established. Kidney outcomes for IgAN and MCD are favorable. No changes in vaccination risk-benefit assessment is recommended based on these findings.

Ventilator-associated pneumonia (VAP) is the most common ICU acquired pneumonia among patients who are invasively intubated for mechanical ventilation. Patients with VAP suffer an increased mortality risk, financial burden, and length of stay in the hospital. The authors aimed to review the literature to describe the incidence, mortality, and microbiological evidence of VAP. We selected 13 peer-reviewed articles published from 1 January 2010 to 15 September 2022 from electronic databases for studies among adult or pediatric patients diagnosed with VAP expressed per thousand days admitted in the ICU. The VAP rates ranged from 7 to 43 per thousand days, varying among different countries of the world. A significant rate of mortality was observed in 13 studies ranging from 6.3 to 66.9%. Gram-negative organisms like Acinetobacter spp., Pseudomonas aeruginosa Gram-positive organisms like Staphylococcus aureus were frequently found. Our findings suggest an alarming situation of VAP among patients admitted to the intensive care units with increasing incidence and mortality. The review also found that VAP is more common in males and that there is a significant variation in the incidence and mortality rates of VAP among different countries. The findings of this review can inform the development of infection control and prevention strategies to reduce the burden of VAP. Thus, there is a crucial need for control and preventive measures like interventional studies and educational programs on staff training, hand-hygiene, and the appropriate use of ventilator bundle approach to curb this preventable threat that is increasing at an alarming rate.

Background: Hypothyroidism is a disease characterized by the thyroid gland's compromised ability to produce the thyroid hormone. The condition is often accompanied by Iron Deficiency Anemia (IDA). Together the two have a significant impact on the quality of life (QoL). To gauge the effect of correcting iron deficiency anemia among women with clinical hypothyroidism, improving the quality of life. Methodology: A total of 140 women pre-diagnosed with hypothyroidism and IDA were included in this experimental study and were presented to the medical outpatient department at Liaquat University Hospital, Hyderabad. All-female participants were recruited via non-probability – consecutive sampling and were included after taking written informed consent and administered corrective treatment (Iron salts). Data was recorded onto a pre-structured questionnaire containing inquiries about basic biodata, sociodemographic details, disease history, present clinical condition, laboratory findings and QoL using Thyroid-Dependent Quality of Life Questionnaire (ThyDQoL), and was analyzed using SPSS version 21.0. Results: The mean age of participants included in the study was 29 ± 03 years (range 21 to 43). The mean serum ferritin level was 33 ± 03 ng/mL, while the total mean Iron Binding Capacity (TIBC) was 514 mcg/dL. In 92.1% of the patients, the normalized post-4-week treatment of the Underactive ThyDQoL score suggests improvement from a negative 7 to a negative 3 (cumulative mean value) of the sample. Conclusion: The study results concluded that correcting anemia helps improve the QoL among patients with hypothyroidism. Since the remedy to anemia is achieved earlier than hypothyroidism management in most cases, it is recommended that the efforts are directed to screen and correct anemia (iron deficiency) among such patients.

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