Medical internship is a yearlong experience that is physically, mentally, and emotionally exhausting. After five years as students, the interns finally get close to achieving what they have always dreamt of. Most of the fundamental clinical knowledge and skills that a student learns are acquired during their internship. For the first time, students gain financial freedom, recognise the importance of a white coat, and are recognised as doctors. Internship helps a student to realise the mechanics of how a hospital operates, how patients are treated, how crises are managed, and most crucially, how to think and work productively in a chaotic yet effective atmosphere. Each obstacle encountered serves as a training ground. The key dilemmas are whether to prioritise learning clinical skills or study for the post-graduation entrance examinations, and which specialty to opt for. Conscientious mentors are vital to this whole process.

Red meat is the muscle meat of mammals like beef, lamb, and pork that is red due to the abundance of myoglobin pigment and becomes even darker when cooked. The global average per capita consumption of meat and the total amount of meat consumed is rising, and there has been a particularly marked increase in the global consumption of chicken and pork. The consumption of red meat has always been a contentious issue, with data suggesting benefits in terms of nutritional value and at the same time linking its consumption to major health disorders such as endocrine abnormalities, gastrointestinal issues, cancers, and cardiovascular diseases (CVDs). Despite being normalized by major food franchises, red meat consumption may lead to adverse cardiovascular outcomes such as atherosclerosis, ischemic heart disease, stroke, and cardiac failure. Given the evidence that indicates the consumption of red and processed meat as a risk factor for cardiovascular diseases and all-cause mortality, it is important to review the effects of red meat on the risk of cardiovascular diseases.

113 Background: Bevacizumab (BVZ), a recombinant humanized monoclonal IgG antibody, is commonly used as first- and second-line adjuvant therapy in metastatic colorectal cancer. Recent guidelines have shown that a combination of three cytotoxic drug regimens FOLFOX (fluorouracil, leucovorin and oxaliplatin) along with BVZ is regarded as one of the first-line options. As we see an upward trend in using BVZ; it is crucial to analyze the side effects and potential toxicities. A frequent adverse effect with BVZ is hypertension. The prevailing hypothesis for the mechanism of BVZ induced hypertension is an increase in vascular tone due to the inhibition of VEGF-mediated vasodilation. A persistent elevation of arterial blood pressure is generally asymptomatic, but unmanaged hypertension can lead to cardiovascular complications, encephalopathy, and subarachnoid hemorrhage. Therefore, this meta-analysis aims to evaluate and assess the risk of BVZ induced hypertension. Methods: Our search included articles from PubMed, EMBASE, Web of Science, and Cochrane Library from 1980 to March 2022. Randomized controlled trials and clinical trials with BVZ as an add-on therapy mentioning cardiovascular side effects were included. Full analysis control group included various guideline directed chemotherapies and the subgroup analysis control group focused on FOLFOX therapy. A random-effects model was used with Review Manager, and a P value < 0.05 was considered significant. Results: We included a total of 17,807 patients in our study with an average age of 65 years. Analysis pooled from 19 RCTs showed that the odds of hypertension (Grade 3 or more) in patients treated with BVZ were about four times higher than the control group (OR 3.82, 95% CI 3.35-4.36, p-value < 0.00001, I2 = 78%). In a subgroup analysis, BVZ was compared with FOLFOX group, with odds of hypertension (Grade 3 or more) in BVZ group being about five times higher than in FOLFOX group (OR 5.24, 95% CI 4.06-6.77, p-value < 0.00001, I2 = 58%). Conclusions: Our meta-analysis demonstrates a significant cardiovascular risk of Bevacizumab when added to the standard regime for advanced colorectal cancer treatment. When BVZ was used as an add-on therapy to FOLFOX regimens for colorectal cancer, it was associated with about five times higher odds of developing hypertension (Grade 3 or more) in the treatment group with BVZ. Previous RCTs have demonstrated that BVZ add-on therapy to the standard regime is safe and without significant risk of toxicity. Our findings are important as they give vital information in assessing the risk-benefit ratio of adding BVZ, especially in a population with vascular comorbidities. Now that we have established the statistical significance of hypertensive risk with BVZ, it will be interesting to see how these events can be prevented in patients treated for metastatic colorectal cancer. Dedicated RCTs are needed to confirm these findings.

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