Background The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.

Background: Emergency Laparotomy is one of the most common surgical procedures performed in Surgical Emergencies, which leads to significant mortality and morbidity. The aim of this study was to evaluate the patients undergoing emergency midline laparotomy, utilizing POSSUM scoring system to help to predict morbidity and mortality in patients, and assuring improved management in present setup. Methods: Total 104 consecutive patients underwent emergency midline laparotomy over a period of two years were included in this prospective study. Surgical outcome was assessed and compared with POSSUM scoring system. The relevant data was recorded on predesigned proforma and analysed. Results: We studied 104 emergency midline laparotomy patients, which resulted in 15 deaths (14.4% Mortality rate). On applying POSSUM, we found that the expected number of deaths for our study group was 24 (O: E= 0.63), relationship was statistically significant. Observed morbidity was 61 (58.65%). On applying POSSUM we found that the expected number of morbidity for our study group was 65 (O: E= 0.93), relationship was statistically significant. Conclusion:The present study validates that the POSSUM is an accurate scoring system for predicting postoperative adverse outcome among patients undergoing major general surgeries in present setup.

Purpose The B-MaP-C study investigated changes to breast cancer care that were necessitated by the COVID-19 pandemic. Here we present a follow-up analysis of those patients commenced on bridging endocrine therapy (BrET), whilst they were awaiting surgery due to reprioritisation of resources. Methods This multicentre, multinational cohort study recruited 6045 patients from the UK, Spain and Portugal during the peak pandemic period (Feb–July 2020). Patients on BrET were followed up to investigate the duration of, and response to, BrET. This included changes in tumour size to reflect downstaging potential, and changes in cellular proliferation (Ki67), as a marker of prognosis. Results 1094 patients were prescribed BrET, over a median period of 53 days (IQR 32–81 days). The majority of patients (95.6%) had strong ER expression (Allred score 7–8/8). Very few patients required expedited surgery, due to lack of response (1.2%) or due to lack of tolerance/compliance (0.8%). There were small reductions in median tumour size after 3 months’ treatment duration; median of 4 mm [IQR − 20, 4]. In a small subset of patients (n = 47), a drop in cellular proliferation (Ki67) occurred in 26 patients (55%), from high (Ki67 ≥ 10%) to low (< 10%), with at least one month’s duration of BrET. Discussion This study describes real-world usage of pre-operative endocrine therapy as necessitated by the pandemic. BrET was found to be tolerable and safe. The data support short-term (≤ 3 months) usage of pre-operative endocrine therapy. Longer-term use should be investigated in future trials.

AIM AND OBJECTIVETo find out the safety and efficacy of sclerotherapy in management of symptomatic first and second degree haemorrhoids. PATIENTS AND METHODSTotal 53 patients of both genders were selected with diagnosis of symptomatic first or second degree haemorrhoids, all of them were subjected for injection sclerotherapy and procedure repeated as per need. Patients were assessed at 1 week, 1 month, 3 months and 6 months thereafter. RESULTSBleeding stopped in 94.3% of the patients after treatment at 6 months follow-up with early and smooth recovery without any significant morbidity. CONCLUSIONThis prospective study concluded sclerotherapy as a safe, easy, cheap and effective method of treatment of first degree and early second degree haemorrhoids devoid of any significant complications. KEYWORDSHaemorrhoids, Sclerotherapy, First Degree Haemorrhoids, Second Degree Haemorrhoids, Rubber Band Ligation, Anorectal Symptoms. HOW TO CITE THIS ARTICLE:Ambedkar V, Singh A, Gaharwar APS, et al. A prospective study on role of sclerotherapy in management of first and second degree haemorrhoids.

AIMS AND OBJECTIVESTo study the incidence of Benign Prostatic Hyperplasia (BPH) in reference to age of the patients, to study the common symptoms and signs of BPH and classify on the basis of American Urological Association Symptoms Score (AUASS), to evaluate the role of various investigations, to study the relation of weight/volume and size of prostate, and to grade the prostate on the basis of AUASS. MATERIAL AND METHODSTotal 138 patients with symptoms of BPH were selected and detailed history was elicited with special reference to AUASS, according to which BPH was graded, investigated properly, and managed accordingly. RESULTSOverall incidence of BPH out of total patients admitted (8562) in surgical wards during period of one year was found 1.61%. Majority of the patients were in the age group 61-70 years and average age in present study was 67.8 years. According to AUASS, most of the patients (62.32%) had moderate grade symptoms (Score 8-19) followed by patients (37.68%) had severe symptoms (Score 20-35). On digital rectal examination, 73.18% of the patients had grade II prostate, 14.42% had grade III, and grade I in 12.31%. The blood urea and serum creatinine levels were normal in majority of the patients, 62.77% and 58.69% respectively. On USG prostate, most of the patients (65.81%) had prostatic weight in range of 41-60 grams and majority of the patients (47.22%) had PVR volume of urine ranging between 101-200 mL. Weight of prostatic specimen on prostatectomy showed that most of the patients (64.86%) had prostatic weight in range of 41-60 grams. On histopathological examination of prostatectomy samples, it was found that 91.90% of specimens showed BPH and rest 8.10% were suggestive for carcinoma prostate. CONCLUSIONBPH is a condition intimately related to ageing, which needs treatment when symptoms are bothersome and reduces the quality of life. Patients with mild-to-moderate enlargement of the prostate in 5 th and 6 th decade of life often respond to watchful waiting and medical treatment. Patients presenting with acute or chronic retention with or without haematuria finally needs surgical intervention.