The first quarter of the 21st century has remarkably been characterized by a multitude of challenges confronting human society as a whole in terms of several outbreaks of infectious viral diseases, such as the 2003 severe acute respiratory syndrome (SARS), China; the 2009 influenza H1N1, Mexico; the 2012 Middle East respiratory syndrome (MERS), Saudi Arabia; and the ongoing coronavirus disease 19 (COVID-19), China. COVID-19, caused by SARS-CoV-2, reportedly broke out in December 2019, Wuhan, the capital of China’s Hubei province, and continues unabated, leading to considerable devastation and death worldwide. The most common target organ of SARS-CoV-2 is the lungs, especially the bronchial and alveolar epithelial cells, culminating in acute respiratory distress syndrome (ARDS) in severe patients. Nevertheless, other tissues and organs are also known to be critically affected following infection, thereby complicating the overall aetiology and prognosis. Excluding H1N1, the SARS-CoV (also referred as SARS-CoV-1), MERS, and SARS-CoV-2 are collectively referred to as coronaviruses, and taxonomically placed under the realm Riboviria, order Nidovirales, suborder Cornidovirineae, family Coronaviridae, subfamily Orthocoronavirinae, genus Betacoronavirus, and subgenus Sarbecovirus. As of 23 September 2021, the ongoing SARS-CoV-2 pandemic has globally resulted in around 229 million and 4.7 million reported infections and deaths, respectively, apart from causing huge psychosomatic debilitation, academic loss, and deep economic recession. Such an unprecedented pandemic has compelled researchers, especially epidemiologists and immunologists, to search for SARS-CoV-2-associated potential immunogenic molecules to develop a vaccine as an immediate prophylactic measure. Amongst multiple structural and non-structural proteins, the homotrimeric spike (S) glycoprotein has been empirically found as the most suitable candidate for vaccine development owing to its immense immunogenic potential, which makes it capable of eliciting both humoral and cell-mediated immune responses. As a consequence, it has become possible to design appropriate, safe, and effective vaccines, apart from related therapeutic agents, to reduce both morbidity and mortality. As of 23 September 2021, four vaccines, namely, Comirnaty, COVID-19 vaccine Janssen, Spikevax, and Vaxzevria, have received the European Medicines Agency’s (EMA) approval, and around thirty are under the phase three clinical trial with emergency authorization by the vaccine-developing country-specific National Regulatory Authority (NRA). In addition, 100–150 vaccines are under various phases of pre-clinical and clinical trials. The mainstay of global vaccination is to introduce herd immunity, which would protect the majority of the population, including immunocompromised individuals, from infection and disease. Here, we primarily discuss category-wise vaccine development, their respective advantages and disadvantages, associated efficiency and potential safety aspects, antigenicity of SARS-CoV-2 structural proteins and immune responses to them along with the emergence of SARS-CoV-2 VOC, and the urgent need of achieving herd immunity to contain the pandemic.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is an enveloped, positive sense, single stranded RNA (+ssRNA) virus, belonging to the genus Betacoronavirus and family Coronaviridae. It is primarily transmitted from infected persons to healthy ones through inhalation of virus-laden respiratory droplets. After an average incubation period of 2–14 days, the majority of infected individuals remain asymptomatic and/or mildly symptomatic, whereas the remaining individuals manifest a myriad of clinical symptoms, including fever, sore throat, dry cough, fatigue, chest pain, and breathlessness. SARS-CoV-2 exploits the angiotensin converting enzyme 2 (ACE-2) receptor for cellular invasion, and lungs are amongst the most adversely affected organs in the body. Thereupon, immune responses are elicited, which may devolve into a cytokine storm characterized by enhanced secretion of multitude of inflammatory cytokines/chemokines and growth factors, such as interleukin (IL)-2, IL-6, IL-7, IL-8, IL-9, tumor necrosis factor alpha (TNF-α), granulocyte colony-stimulating factor (GCSF), basic fibroblast growth factor 2 (bFGF2), monocyte chemotactic protein-1 (MCP1), interferon-inducible protein 10 (IP10), macrophage inflammatory protein 1A (MIP1A), platelet-derived growth factor subunit B (PDGFB), and vascular endothelial factor (VEGF)-A. The systemic persistence of inflammatory molecules causes widespread histological injury, leading to functional deterioration of the infected organ(s). Although multiple treatment modalities with varying effectiveness are being employed, nevertheless, there is no curative COVID-19 therapy available to date. In this regard, one plausible supportive therapeutic modality may involve administration of mesenchymal stem cells (MSCs) and/or MSC-derived bioactive factors-based secretome to critically ill COVID-19 patients with the intention of accomplishing better clinical outcome owing to their empirically established beneficial effects. MSCs are well established adult stem cells (ASCs) with respect to their immunomodulatory, anti-inflammatory, anti-oxidative, anti-apoptotic, pro-angiogenic, and pro-regenerative properties. The immunomodulatory capabilities of MSCs are not constitutive but rather are highly dependent on a holistic niche. Following intravenous infusion, MSCs are known to undergo considerable histological trapping in the lungs and, therefore, become well positioned to directly engage with lung infiltrating immune cells, and thereby mitigate excessive inflammation and reverse/regenerate damaged alveolar epithelial cells and associated tissue post SARS-CoV-2 infection. Considering the myriad of abovementioned biologically beneficial properties and emerging translational insights, MSCs may be used as potential supportive therapy to counteract cytokine storms and reduce disease severity, thereby facilitating speedy recovery and health restoration.

Coronavirus disease 19 (COVID-19) is caused by an enveloped, positive-sense, single-stranded RNA virus, referred to as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which belongs to the realm Riboviria, order Nidovirales, family Coronaviridae, genus Betacoronavirus and the species Severe acute respiratory syndrome-related coronavirus. This viral disease is characterized by a myriad of varying symptoms, such as pyrexia, cough, hemoptysis, dyspnoea, diarrhea, muscle soreness, dysosmia, lymphopenia and dysgeusia amongst others. The virus mainly infects humans, various other mammals, avian species and some other companion livestock. SARS-CoV-2 cellular entry is primarily accomplished by molecular interaction between the virus’s spike (S) protein and the host cell surface receptor, angiotensin-converting enzyme 2 (ACE2), although other host cell-associated receptors/factors, such as neuropilin 1 (NRP-1) and neuropilin 2 (NRP-2), C-type lectin receptors (CLRs), as well as proteases such as TMPRSS2 (transmembrane serine protease 2) and furin, might also play a crucial role in infection, tropism and pathogenesis and clinical outcome. Furthermore, several structural and non-structural proteins of the virus themselves are very critical in determining the clinical outcome following infection. Considering such critical role(s) of the abovementioned host cell receptors, associated proteases/factors and virus structural/non-structural proteins (NSPs), it may be quite prudent to therapeutically target them through a multipronged clinical regimen to combat the disease.

BACKGROUND Breast Carcinoma is the most common malignancy among Indian women 1 and the leading cause for carcinoma related death in women. According to GLOBOCAN 2012, India along with United States and China collectively accounts for almost one-third of the global breast cancer burden. In India for the year 2012 -144,937 women were newly detected with breast cancer and 70,218 women died of breast cancer. India is facing challenging situation due to 11.54% increase in incidence and 13.82% increase in mortality due to breast cancer during 2008 -2012. 2,3 Aims and Objectives-To identify various risk factors associated with breast carcinoma, age, parity, menarche, menopause etc., various clinical presentations and also various modes of management. MATERIALS AND METHODS RESULTSThe youngest woman in our study was 28 years old and oldest 65 years. In the present series, 12.9% of the patients attained menarche at the age of 11 yrs. or below, 77.6% of the patients were in the age group (12, 13 or 14 yrs.), only 9.2% of the patients attained menarche at 15 yrs. or above. 98% of the patients had breast-fed their children for more than 6 months in our study. 9% of the patients had a family history of breast cancer in either first-or second-degree relatives. All the cases presented to us with history of lump in the breast. The next common symptom was pain followed by axillary mass. 42% of the cases presented with tumour size of 2 -5 cm with axillary node positive, and only 11% of the cases with tumour size < 2 cm was positive for axillary node. In the present study, sensitivity for FNAC procedures was 66% and for Tru-Cut biopsy was 90%. In the present series, only 18% of the patients underwent Breast Conserving Surgery, majority of them underwent MRM, Auchincloss type. ER status was found to be positive in 51% of patients and PR status was positive in 50% of cases. Post-operatively, 78% of our cases were discharged without any significant complications. CONCLUSIONThe mean age of presentation for breast carcinoma in the present study was a decade earlier compared to western patients. Most of the breast cancers are sporadic rather than familial. 100% of the patients presented with lump in the breast. Upper outer quadrant is the common site for breast cancer due to greater amount of breast tissue in the upper outer quadrant. The finding of present series strengthens the notion that the likelihood of axillary involvement is directly related to the size of the primary tumour. Most cases of early breast cancer belonged to Stage IIB. 50% of the patients had ER/PR positive, reflecting an overall low positivity rate when compared to western studies. Majority of the patients underwent Modified Radical Mastectomy as surgical treatment. The comparatively low take-up rate of BCS may relate to factors such as social and economic circumstances. KEYWORDSEarly Breast Carcinoma. HOW TO CITE THIS ARTICLE: Vora K, Deka RK, Roshan R. A clinical study of early breast carcinoma and its management. J. Evolution Med. Dent. Sci. 2018;7(11...

BACKGROUND Abdominal surgery represents a premeditated trauma, which leads to nutritional depletion and its possible related adverse outcomes, especially in malnourished pre-operative patients. Hence, the aim of the study was to assess nutritional status of a cohort of preoperative patients undergoing major gastrointestinal surgery and its relation to post-operative outcome using different nutritional indices. MATERIALS AND METHODS The present study was a prospective observational study. The study group consisted of total of 139 patients undergoing elective abdominal surgeries in the Department of Surgery in Guwahati Medical College and Hospital between 1 st July 2016 and 30 th June 2017. Nutritional status of all patients was assessed preoperatively with the help of nutritional tools such as PG-SGA, NRI, Serum Albumin, NRS 2002 and MUST. Patients were observed in the post-operative period for specific complications until the period of discharge (By one of the authors who was unaware of the pre-operative nutritional status). To assess the efficacy of the nutritional indices in predicting post-operative complications p value, chi-square, odds ratio, sensitivity, specificity, positive predictive value and negative predictive value were calculated wherever applicable. Study Design-Prospective observational study. RESULTS Out of the 139 patients studied, 6 patients died in early post-operative period due to various reasons. The remaining 133 patients were analysed out of which 49.6%, 53.8%, 36%, 81.9% and 50.4% were found to be malnourished according to PG-SGA, NRI, Serum Albumin, NRS 2002 and MUST respectively. Out of 133 patients, 70 were found to be free of complication. All the tools showed positive correlation on comparing the preoperative nutritional status and post complication rate with a p value < 0.0001 consistently.

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A 32-year-old man, a known case of bronchial asthma was presented to our emergency department with chief complaint of sudden onset pain in the left lower chest wall after strong paroxysmal coughing due to aggravation of bronchial asthma symptoms. Chest pain was localised and aggravated with respiration without any radiation. There was no history of fever, abdominal pain, nausea and vomiting, diaphoresis or orthopnoea. History of any thoracic trauma, cardiac disease or osteoporosis due to chronic renal disease or any metabolic disease was not present. He was on intermittent oral and inhalational corticosteroid therapy, because of the uncontrolled bronchial asthma for last five years. On physical evaluation, he was tachypnoeic and vital was normal. He had tenderness over his left lower chest wall. Diffuse rhonchi were heard over both lung fields on auscultation. Cough is generally self-limited and uncomplicated, but can be associated with complications, particularly when it is paroxysmal and violent. Rib fracture is among the uncommon complications of cough. In this article, we report a case of 32year-old male who presented with complaints of acute chest pain after paroxysmal coughing and was diagnosed with cough fracture of the ninth rib on subsequent workup. Rib fracture in otherwise healthy young individual after coughing is not common. The purpose of this case report is to call attention on rib fracture as infrequent and often an unrecognised cause of sudden chest pain, so that it should be considered as differential diagnosis of acute chest pain after common causes. Coughing is a crucial defense mechanism in respiratory system and is usually uncomplicated, but sometimes can be with complications, especially when chronic. One of these complications is rib fracture. 1 In this case report, we present a case of cough fracture in young patient.

Background: Nausea and vomiting during and after the surgery are distressing for both the patient and his/her family. In addition, when vomiting occurs intraoperatively under regional anaesthesia, it offers significant challenge to the operating surgeon, potentially increasing the duration of the procedure and the risk of bleeding and inadvertent associated surgical trauma. Aim of the study: To assess postoperative nausea and vomiting after unrestricted clear fluids before day surgery. Subjects and Methods: The study was conducted in the