Stevens–Johnson syndrome presents as mucocutaneous blistering and sloughing, which may follow a devastating clinical course. Although Stevens–Johnson syndrome has been reported following the administration of anticancer drugs, only a few cases induced by cytotoxic anticancer drugs, administered after immune checkpoint inhibitors, have been reported. The present report describes a case of Stevens–Johnson syndrome caused by capecitabine and oxaliplatin (CAPEOX) combination chemotherapy, in a patient with esophageal squamous cell carcinoma, who had been previously treated with nivolumab.

Atypical teratoid/rhabdoid tumors (AT/RTs) of the central nervous system (CNS) are rare and aggressive, typically occurring in early childhood or infancy, with adult cases being extremely rare. These tumors are associated with the inactivation of the integrase interactor 1 (INI1) gene. The prognosis is poor, worsening significantly if metastasis is detected at diagnosis. While CNS tumors rarely metastasize to cervical lymph nodes, recent findings have shown that such dissemination is possible, challenging the previously held belief that CNS malignancies do not spread via the lymphatic system. Awareness of this potential pathway is crucial for early diagnosis and avoiding unnecessary treatments. We present a case of a young adult male patient with a primary CNS AT/RT who had presented with cervical lymph node metastasis.

ABSTRACT:Oxaliplatin is a common drug used in the management of colorectal malignancies. Rare neurological side effects including amaurosis fugax, urinary retention, stroke, cranial nerve palsy, dysarthria, and dysphagia have been reported in the literature. Usually, such incidences are reported immediately after 1st dose of oxaliplatin infusion. We report a rare transient ischemic attack (TIA))-like side effects after 2nd dose of oxaliplatin infusion.

INTRODUCTION:The COVID-19 pandemic affected the healthcare system worldwide. Cancer patients and oncologists faced challenges equally in the context of the pandemic. The present study was undertaken to assess the impact of COVID-19 on cancer patients, encompassing infection source, care type, treatment delays, and infection outcomes.MATERIALS AND METHOD:This single-center retrospective study was conducted between March 2020 and January 2022 at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India. It examined COVID-19 cases in cancer patients with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) results. Data collection included demographics, clinical details, COVID-19 specifics, treatment delays, and infection outcomes.RESULT:In our study of 9,854 oncology patients' visits, 26 (0.26%) tested COVID-19 positive by RT-PCR, aged three to 70 years with a male-female ratio of 1:1.67. Twenty-three percent had comorbidities, mainly hypertension. Gastrointestinal cancers (30.8%) and hepatobiliary origin (15.5%) were common. Most patients (69.2%) had stage IV cancer, and 34.6% aimed for curative treatment. The majority of the patients (76.9%) were community-acquired, and the rest (23.1%) contracted during hospital stay. Fever (34.5%) and asymptomatic infection (30.8%) were common presentations. Six (23.1%) comorbid patients required ICU care. Median treatment delay was three weeks, with one COVID-19-related death (3.8%) and six cancer-related deaths. On follow-up, 19.2% had stable disease, 7.7% partial response, 7.7% recurrence, and 23.1% had progression.CONCLUSION:Amid the pandemic, cancer patients safely received treatment. Mild cases were managed at home. Poor outcome was found in comorbid, severe COVID-19 cancer patients. However, the impact of treatment delays on long-term oncological outcomes needs further study.

Introduction Biliary tree stenting for malignant biliary tract obstructions is a routine modality for the relief of jaundice. Treatment is palliative in most circumstances. However, adequate reduction in bilirubin levels after percutaneous transhepatic biliary drainage (PTBD) may help to offer chemotherapy, which may improve survival in a limited number of cases. Materials and methods Between March 2017 and March 2023, patients who were treated with PTBD to relieve malignant biliary tract obstruction were included in the analysis. Patients who achieved bilirubin levels <= 5 mg/dL after PTBD were considered for chemotherapy. For survival analysis, a comparison was done between patients treated with chemotherapy after PTBD versus patients who did not receive any treatment after PTBD. Results Data was available for 43 (100%) patients. After PTBD, 16 (37.2%) patients responded and were considered for further treatment. One patient who was advised of radical surgery refused treatment and did not return for further treatment or follow-up. The remaining 15 cases (34.9%) received Gemcitabine and platinumbased chemotherapy as a first -line option. Out of 15 cases who received chemotherapy only one patient (6.6%) received neoadjuvant chemotherapy and the rest of 14 (32.5.%) cases received palliative chemotherapy in view of metastatic disease. PTBD complications including leakage, dislodgement of PTBD catheter, pain, and bleeding were seen in 16 (37.2%) cases. Overall survival was 57% for the entire population. Patients treated with chemotherapy after PTBD had better overall survival compared to patients who did not receive any treatment after PTBD (73.3% vs 33% (p=0.008)). Conclusion PTBD is an excellent technique for the relief of biliary obstruction. More than one-third (34.9%) of the cases received further cancer -directed treatment after relief of jaundice by PTBD. Chemotherapy after PTBD is associated with improvement in overall survival in malignant biliary obstructions.

CLINICAL INTRODUCTION A man in his 30s presented with palpitations and worsening dyspnoea for 2 weeks, which started after a bout of heavy work. On examination, his blood pressure was 140/60 mm Hg, and his heart rate was 102 beats/min. Cardiovascular examination was notable for a highvolume collapsing pulse and a continuous murmur heard over the entire precordium. Transthoracic echocardiography was performed (figure 1, online supplemental file 1).

A 65-year-old woman presented to the emergency room with a syncope. An ECG done revealed complete heart block with a narrow QRS escape rhythm and a normal QT interval. Further investigation revealed severe hypercalcaemia and elevated parathormone levels. Her heart block disappeared on correction of the hypercalcaemia. A right inferior parathyroid adenoma was found and surgically removed. Thus, hypercalcaemia may lead to reversible complete heart block without QT interval shortening.

AbstractBiliary atresia (BA) is a progressive destructive cholangiopathy of unknown etiology that presents in early infancy. It has a worldwide frequency of 1:8,000–1:15,000 and is common in Asia than in the west. Based on the level at which the lumen of the extrahepatic duct is obliterated, BA is classified into three types. Type III is the commonest (∼85%) type and has the most proximal level of obstruction in the porta hepatis, while type II in which the atresia is at the level of the common hepatic duct, is the least common (∼2.5%) and has been rarely reported. Here, we report the imaging features of an infant with type IIB biliary atresia.

Introduction: Patellar fractures constitute almost 1% of total skeletal injuries. Existing common operative methods include the use of different types of Tension band wiring techniques like cannulated screws and K-wires. The Patellar plating construct is a relatively newer operative method for patellar fracture fixation with promising outcomes with fewer complications. Method: We conducted a pilot prospective study at our Apex Trauma center in twenty patients aged 18-65years with displaced patellar fractures, AO type A2, A3, B2, B3, C1, C2, C3. Fractures were fixed with low profile patellar plates (1.8 mm). Radiological and functional follow-up was done using X-rays, CT scans and BKS scoring (Bostman-Knee-Scale), Knee Society Score(KSS), and Tegner Lysholm knee scores respectively for two years. Result: Mean functional outcome scores at 6 weeks, 3 months, 6 months and 2 years was 25.5, 28.3, 29.05 and 29.9 for BKS; 64.62, 84.12, 90.6, and 97.5 for KSS; 73.75, 89.7,94.8, and 99.3 for Tegner Lysholm knee score respectively. Radiological union, confirmed by CT scan, was observed in all patients at 3 months. Two patients had superficial surgical site infection (SSI) at 2 weeks. Implant impingement was also found in 2 patients at 3 months. None of the patients had a failure of fixation at the end of the study. Conclusion: Patients with low profile patellar plate constructs have favorable clinical and radiological outcomes with minimal non-specific complications. (C) 2021 Elsevier Ltd. All rights reserved.

A 71-year-old man, a known hypertensive and diabetic, presented with inferior wall myocardial infarction within window period of 90 min. He was successfully thrombolyzed with 35 mg of tenecteplase and was further planned for pharmacoinvasive therapy; coronary angiography revealed mid-right

Colonopleurobronchial fistula (CPBF) is a rare complication which occurs due to diversified causes. Expectoration of the faecal material is the classical clinical symptom which suggests the diagnosis. Various causes include infection of pulmonary or abdominal origin, inflammatory bowel disease, colonic malignancy, diaphragmatic hernia and colonic interposition. Crohn’s disease is the frequent underlying pathology, colonic malignancy accounts for rare cause. Due to the presence of liver in right upper quadrant, most of the fistulas are on the left side. Here we describe a rare case of a 38-year-old man presented with right-sided CPBF due to underlying colonic malignancy. Bronchial block was done, however the patient succumbed to death.

Breast cancer is the most common malignancy in females. The common site for metastases is bone, lungs, liver, and regional lymph nodes. Larynx as a metastatic site from breast cancer is extremely rare. The authors report a 63-year-old female treated for carcinoma of right breast 5 years back who presented with hoarseness of voice. Clinicoradiological examination revealed a soft tissue lesion in larynx. Pathological evaluation of the laryngeal lesion revealed metastases secondary to breast cancer. The patient received systemic chemotherapy and local radiotherapy. Patients with a history of breast cancer presenting with hoarseness and shortness of breath should not only be evaluated for laryngeal primary but also for metastases. This case is reported in view of rarity of the case with laryngeal metastases from breast cancer masquerading as primary laryngeal disease. To the best of our knowledge, less than 20 cases of laryngeal metastases from breast cancer had been reported in literature till date. Patients with a history of breast cancer presenting with hoarseness and shortness of breath should not only be evaluated for laryngeal primary but also for metastases. Once the diagnosis is confirmed, the treatment of laryngeal metastases is multidisciplinary. Recognizing metastatic disease and prompt early treatment are very important to improve the quality of life.