BACKGROUND:Screening for latent tuberculosis (LTB) before initiating advanced therapy for inflammatory bowel disease (IBD) helps reduce the risk of tuberculosis (TB) development. However, there is limited data on screening practices from TB-endemic regions. AIM:To study the practices of screening for LTB and study the incidence of TB in patients with IBD on biological and small molecule inhibitors. METHODS:This retrospective multicentre study analyzed LTB screening practices in IBD patients starting advanced therapies between 2018 and 2022. We included patients who were initiated on biologics (infliximab, adalimumab, vedolizumab) or small molecule inhibitors (tofacitinib). We assessed compliance with LTB screening methods, including the tuberculin skin test, interferon-gamma release assay (IGRA), chest X-ray, and computed tomography chest, both at initiation and annually. We also evaluated the incidence of active TB and its predictors. RESULTS:Of 378 patients (mean age: 36.9 ± 14.9 years, males: 56.9%), 158 (41.8%) and 216 (57.1%) had ulcerative colitis and Crohn's disease, respectively. Advanced therapy used were anti-tumor necrosis factor in 309 (81.74%), tofacitinib in 41 (10.84%) and vedolizumab in 28 (7.40%). Standard screening and diligent screening strategy was employed in 59% and 33% of patients, respectively. Compliance with tuberculin skin test and IGRA was noted in 261 (69.04%) and 298 (78.83%) patients, respectively. Chest X-Ray and computed tomography chest were performed in 300 (79.36%) and 242 (64.02%), respectively. Annual screening in those on advanced therapy for > 1 year was performed in 27.2% (50/184). Active TB developed in 17 (4.49%); 15 (88.23%) were on anti-tumor necrosis factor. LTB was detected in 40 (10.72%), with most diagnosed on the basis of IGRA (21/40, 52.50%). Among 17 patients who developed active TB, LTB screen was negative in 12 (70.58%). CONCLUSION:Standard screening practices for LTB, prior to starting advanced therapy, remain suboptimal (< 60%) in India despite high TB endemicity.
Obesity is a global health crisis affecting developing nations, including India. The management of obesity continues to evolve with newer drugs, metabolic and bariatric surgery and endoscopic interventions, requiring family physicians and specialists to adapt their clinical practice accordingly. There is an urgent need for a standardized algorithm to diagnose, stage, and treat obesity. The Endocrine Society of India (ESI) and the Obesity Surgeons Society of India (OSSI) appointed a steering committee to develop an evidence-based algorithm for managing patients with obesity in India. This was put to vote by 80 specialists (38 from OSSI and 42 from ESI) in a physical meeting. A proposed stage-wise algorithm based on Edmonton Obesity Staging System, Asian definition of obesity, and resources in India, received 100
Breast cancer in women under 40 years of age represents a growing global oncological burden characterized by disproportionately advanced stage at diagnosis and inferior survival outcomes. Population-based data consistently demonstrate that 55–75% of young women worldwide present with stage III or IV disease, irrespective of geographic or economic setting. This pattern reflects a systemic failure of current screening paradigms, which are predominantly mammography-based and explicitly exclude average-risk women below 40 years of age. Breast self-examination has failed to demonstrate mortality benefit or meaningful stage migration, leaving a prolonged interval of unmonitored risk during young adulthood. This article synthesizes global data on stage at diagnosis in young breast cancer, examines biological and health-system determinants of late presentation, and evaluates the Brahams Protocol (BP) as a structured pre-clinical detection framework designed to operate prior to symptom onset and formal clinical staging. Persistent dominance of advanced-stage disease in young women is shown to be structurally determined rather than biologically inevitable, underscoring the need for paradigm-level innovation in early detection.
The term femicide, widely used in reference to the "killing of a woman because she is a woman," has been questioned on the ground that it implies unequal dignity of men and women victims of gender related death. This position called for an analysis of the terminology used to describe and define the various forms of killing of women and men. We conclude that the use of the term "femicide" retains as a central facet the objective of raising awareness of this crime and combating violence directed at women by men. We also analyzed the current use of the word "androcide" and concluded that its present use is limited to situations where the killing of men is systematic, such as illegal war crimes. In this regard, we address the occurrence of deaths that may be related to gender within or outside relationships. We addressed the under reported issue of intimate partner violence (IPV) and killing of men. The latter has not attracted as much attention and remains a complex problem to understand and study. The issue is further compounded because domestic violence has also been a factor in cases of suicide. Violent behavior directed against men may occur in heterosexual or gay relationships. Estimates of the prevalence of IPV against men in heterosexual relationships, vary from 3.4% to 20.3%. The victim's own behavior is often advanced in mitigation. Although reports on violent behavior among gay and bisexual men have been relatively rare, IPV is at least as prevalent in this group. Indeed, some studies report alarmingly high incidence. In conclusion, there must be a continued focus on gender related death of women, but this should not distract from the occurrences when the victim is a man. There needs to be a drive to improve data collection from all countries with special focus on those in Africa and Asia that do not fully contribute to the global effort. There is also a need to better define the underlying causes and triggers for death, including by suicide, to enable the development of informed prevention strategies.
Introduction The teres minor (Tm) plays an important role in external rotation and shoulder stability in patients with posterosuperior rotator cuff tears (PSRCTs). This study evaluated whether preoperative Tm trophicity affects clinical and radiologic outcomes following arthroscopically assisted posterior latissimus dorsi LD transfer in patients with irreparable PSRCTs. Methods Patients who underwent arthroscopically assisted posterior LD transfer for irreparable PSRCTs between April 2012 and June 2020 were retrospectively reviewed. Patients were classified into hypertrophic, normal, and hypotrophic groups based on the ratio of the Tm muscle area to the total external rotator muscle area. Clinical outcomes including the visual analog scale (VAS), Constant score, and American Shoulder and Elbow Surgeons (ASES) score were evaluated preoperatively and at final follow-up. Range of motion, shoulder strength, and radiologic outcomes including acromiohumeral distance (AHD) and Hamada grade were also assessed. The minimal clinically important difference (MCID) for the VAS, ASES, and Constant scores was calculated to determine the proportion of patients achieving clinically meaningful improvement at final follow-up, and patients with incomplete follow-up or missing data were excluded. Results After excluding 14 patients, 83 patients were included in the final analysis: 12 in the hypertrophic group, 56 in the normal group, and 15 in the hypotrophic group. All groups demonstrated significant improvements in clinical outcomes at final follow-up. The hypertrophic group showed greater improvement in external rotation at the side and at 90° of abduction. The hypotrophic group demonstrated a smaller AHD and a higher Hamada stage at final follow-up. However, the proportion of patients achieving the MCID and complication rates did not differ significantly among groups. Conclusion Arthroscopically assisted posterior LD transfer provides significant pain relief and functional improvement in patients with irreparable PSRCTs regardless of preoperative Tm trophicity. Although hypertrophic Tm was associated with greater postoperative external rotation, overall clinical improvement and MCID achievement were similar among groups. Despite smaller postoperative AHD and higher Hamada grades in the hypotrophic group, clinical outcomes were comparable. Level of Evidence IV, retrospective case series
