The novel corona virus has shown accelerated effect on stroke and stroke care. Worlds stroke organization has reported a decline in stroke admission due to use of FAST tool and usage of thrombolysis and thrombectomy. FAST stands for F=facial weakness, A=arm weakness, S=slurred speech T=time to call 911 in USA, 120 in China, 999 in England, 112 in EU. In case of 911, 9=word nine (slurred speech), 1 one arm weakness, 1=one side facial weakness. It has a record that 72% of the confirmed stroke patients had speech disturbance, 62% had facial drooping, and 87% had arm weakness. The most appropriate way to diagnose stroke is motor dysfunction or slurred speech than facial drooping. Articles have been selected from Google scholar, PubMed, PubMed Central, Scopus, Web of Science, Medline, Embase, Scimago, and Publon. Studies on stroke from these articles has shown that speech disturbance has a worse outcome after stroke compared with individuals where speech is unaffected. The incidence of speech disturbance is as high as 84.4% in stroke patients, and a speech disturbance persists at discharge in 75.8% of patients who survived their stroke. Therefore, presence or absence of speech disturbance has predictive value for outcome of a stroke patient. D dimer is very important haematological marker to diagnose Disseminated intra vascular   coagulation (DIC). Again, it is known that sepsis is a common cause of DIC. This biomarker is released when a fibrin blood clot undergo degradation. Tassiopoulos et al mentioned about anticoagulant administration according to D-dimer level can improve respiratory or kidney function in a COVID-19 patient.

Background: Cancer cervix is a leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities in the rural and suburban areas or due to the lack of awareness amongst the women. Cervical cancer is the fourth most common cancer in the world. Developing countries accounted to about 80% of the global burden. This study was conducted to find out importance of Pap Smear Test in differentiating premalignant and malignant lesions in a rural set up. Method: The study is carried out in a tertiary Care Hospital -Tezpur Medical College amongst asymptomatic women. Results: The study was carried out in 160 No. of women. Out of those 160 cases we have studied, 96.3% are inflammatory, 3.7% are epithelial cell abnormality, 2.5% are HSIL, 0.61% squamous carcinoma and 0.61 are LSIL Conclusion: This study shows that PAP smear examination is an important method for diagnosing cervical cancer.

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A 53-year-old male complained of gradual, painless dimness of vision with swelling of the right eye (R/E) for 15 days. Best-corrected visual acuity in R/E: Hand movement, left eye: 6/9, abaxial proptosis, restricted extraocular movements in all directions, conjunctival injection, and high intraocular pressure R/E were noted. Fundus showed pale optic disc R/E and macular exudates in both eyes. The patient was diabetic and on oral hypoglycemic agents with raised erythrocyte sedimentation rate and C-reactive protein; random blood sugar: 152 mg/dL. Magnetic resonance imaging (MRI) showed right-sided orbital abscess involving extraconal compartment extending into the right orbital apex with compression of the right optic nerve. Mantoux test was positive and computed tomography thorax was normal. Histopathology of biopsy from middle turbinate showed granulomatous inflammatory cellular lesion. The patient was started on anti-tubercular therapy. He got relieved of symptoms. Repeat MRI showed reduction in disease process.

Objectives: Little is known regarding the impact of mutation status on the costs of breast cancer care. This study sought to estimate health care charges (all-cause, BC related, other cancer related and non-cancer related) among women with breast cancer (BC) and BRCA mutations (BRCAm) in terms of BRCA status, HER2 expression status, ER/PR status, treatment patterns, serious adverse events related to the cancer or its treatment, and cancer treatment period. Methods: Adult women with invasive BC diagnosed from 1995-2014 and tested for a BRCAm were identified from the Huntsman Cancer Institute tumor registry (Salt Lake City, Utah) and via chart review. Patients with available charge data were included in the study. Patients were categorized by mutation status, receptor status and initial treatment setting. Charges were categorized as inpatient, outpatient and pharmacy (both anticancer and other medication) related charges as well as by type of service (diagnosis, surgery, reconstruction, radiation, office visit, and medication). Descriptive statistics were used to describe mean (SD) charges. Wilcoxon Rank-Sum test was used to compare health care charges. Results: There were 816 women with BC who underwent BRCA testing and had available charge data. There were 134 women with a BRCAm vs 682 with BRCA wild type (wt). Age at diagnosis was similar between the two groups, however, BRCAm patients had more triple negative BC and higher histologic grade. Total breast cancer related mean (SD) charges were similar between BRCAm vs BRCAwt ($86,689 (75,937) vs $85,843 (97,304), p=0.19). Of this a similar amount was due to facilities/ technical and pharmacy (41% each), while the remainder was physician/professional costs. Within pharmacy costs, similar amounts were due to chemotherapy (23%) and biologics (21%). However, while 58% received chemotherapy, only 8% received biologics. Patients seen initially in the neoadjuvant treatment setting (N=148) had higher breast cancer related mean charges than those in the adjuvant setting (N=553; $117,922 (102,108) vs $80,061 (90,010), p<.0001), while those seen initially in metastatic setting had a mean charge of $103,525 (135,029).There were 142 HER2+ (ER+/PR+/HER2+ or ER-/PR-/HER2+) and 521 HER2- (TNBC or ER-/PR+/HER2-) breast cancer patients (receptor status unknown in 153 patients). HER2+ patients had higher breast cancer related mean charges than HER2- patients ($155,858 (122,227) vs $69,883 (67,642), p<.0001). Further, anticancer treatment charges accounted for 53% ($82,890 (81,269)) of HER2+ costs and 11% ($7,929 (21,782)), p<.0001 of HER2- costs. Biologics accounted for 87% of the former and chemotherapy accounted for 78% of the latter charge. Conclusions: Mutation status was not associated with higher breast cancer charges. Patients initially seen in the neoadjuvant setting had higher breast cancer charges than those seen in the adjuvant setting. Receptor status (being HER2+) was associated with higher breast cancer charges and this was driven by expenditure on biologics. Citation Format: Biskupiak JE, Telford C, Yoo M, Unni SK, Ye X, Deka R, Brixner DI, Stenehjem DD. Evaluation of women with BRCA mutations and breast cancer tested at an NCI designated comprehensive cancer center: A cost of illness estimation [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-12-03.