PURPOSE Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron emission tomography (iPET) scan after 2 cycles (iPET2) in identifying this high-risk subset. PATIENTS AND METHODS This cohort study used secondary data from 12 tertiary care centers in South India gathered over 10 years (2008-2018). OS, event-free survival (EFS), determinants of EFS, and complete response (CR) in iPET2 were assessed. RESULTS The study included 409 patients with HL (mean age, 34.5 years; male/female ratio, 1.4:1). The median duration of follow-up was 2.8 years. Of 409 patients, 63% underwent PET-based staging and 37% underwent computerized tomography (CT) staging. Stage IV (28.9%) and bone involvement (9.2%) were seen more often with PET than with CT staging (9.2% and 2%, respectively). Among 171 patients with iPET2 results, 24% did not achieve CR, and no factors were significantly associated. The 5-year EFS and OS rates of the entire cohort were 78% and 97%, respectively. The 5-year EFS and OS rates of patients with CR on iPET2 were 90% and 99%, respectively, whereas these were 65% and 100%, respectively, for patients not achieving CR. On univariable analysis, sex, stage, and iPET2 response significantly predicted inferior EFS. On multivariate analysis, only iPET2 response significantly predicted EFS ( P < .000). CONCLUSION Our study supports the use of PET for staging and iPET2 for response assessment. Nonachievement of CR on iPET2 indicates unfavorable outcome, and such patients may benefit from more intensive treatment.

Background: The use of the COVID-19 vaccines Vaxzevria from AstraZeneca and Covishield from Janssen has been associated with sporadic reports of thrombosis with thrombocytopenia, a complication referred to as vaccine-induced immune thrombotic thrombocytopenia (VITT) or vaccine-induced prothrombotic immune thrombocytopenia. It presents commonly as cerebral sinus venous thrombosis (CSVT), within 4–30 days of vaccination. Females under 55 years of age are considered to be especially at high risk. Mortality up to 50% has been reported in some countries. Identification of early warning signs and symptoms with prompt medical intervention is crucial. Case Description: We report here a case of VITT in a young female who presented 11 days after receiving the first dose of the Covishield vaccine, with severe headache and hemiparesis. She was diagnosed with CSVT with a large intraparenchymal bleed, requiring decompressive craniectomy and extended period on mechanical ventilation. Conclusion: The patient was successfully treated with intravenous immunoglobulin and discharged after 19 days in ICU. Although she was left with long-term neurological deficits, an early presentation and a multidisciplinary approach to management contributed toward a relatively short stay in hospital and avoided mortality.

Introduction Most Indian centers use Adriamycin/Bleomycin/Vinblastine/Dacarba-zine (ABVD) chemotherapy for pediatric Hodgkin lymphoma (pHL). To reduce the late toxicity, robust predictive markers are needed to risk stratify pHL patients, thereby limiting the number of chemotherapy cycles and omitting radiation for low-risk and intensifying treatment for high-risk children. Objective This study was conducted to analyze the outcome of pHL patients treated with ABVD and various factors predicting the outcome. Materials and Methods This retrospective study analyzed the outcome of 113 consecutive pHL children treated with ABVD chemotherapy from 11 tertiary care centers in South India from 2009 to 2019. Results The median duration of follow-up was 2.73 years. The median age was 13 years. B symptoms are seen in 50.5% patients, bulky disease in 23%, and stage IV in 28.3%. Of 113 pHL, 69% had a positron emission tomography (PET) and 31% had computed tomography (CT)-based staging. Stage IV (37.1%) and extranodal involvement (31.2%) were seen more often with PET than with CT staging (8.5 and 2.8%, respectively). Among 64 patients with interim PET scan after two cycles (iPET2), 20.3% did not achieve complete remission (CR) and no factors were significantly associated. The 4-year event-free survival (EFS) rate of the entire cohort was 86%. The 4-year EFS rate was 93% for patients with CR in iPET2 and 52% for patients not achieving CR. The only independent predictor of low EFS was iPET2 response (p < 0.05). Conclusion Our study confirms the prognostic role of PET scan staging and response assessment. Not achieving CR on the iPET2 scan indicates poor prognosis and warrants clinical trial enrollment for a better outcome.

COVID-19 has emerged as a pandemic in the month of March 2020. It was first discovered in China, with a geographical focus in the city of Wuhan. Since then, it has spread to various parts of the world. Initially, the virus was called as 2019-nCoV, but the International Committee of Taxonomy of Viruses later termed it as the SARS CoV2 virus, given its similarity to the SARS CoV virus of 2003. According to WHO, more than 8 million confirmed cases have been reported so far and the numbers keep on rising every day. In India, there have been 380,532 confirmed COVID positive cases 12,573 deaths according to the report released by WHO as on the 19 th of June 2020. The disease outbreak is unprecedented and has managed to wreak havocs in the healthcare systems globally. COVID-19 has been declared as a public health emergency and lot of research is currently targeted in the understanding of the novel virus so as to accelerate the diagnosis and the treatment approaches for the novel virus. We bring forth an overview of the currently available data and resources in understanding about the SARS CoV2 virus, trends of transmission, the pathogenesis of the disease, clinical features, epidemiological transition of the disease in India, various tools for the diagnosis and the available treatment approaches that are currently under trail but have resulted in clinical recovery of the patients.

Introduction: Mechanical Neck Pain (MNP) is a prevalent musculoskeletal problem. MNP has a high-risk of becoming chronic in nature. Recent studies demonstrate altered Postural Sway (PS) among MNP patients. There are various management strategies used for improving pain and PS among Chronic MNP (CMNP). Numerous studies have been done on the effect of thoracic thrust manipulation on pain. However, the evidence is deficient for the impact of thoracic manipulation on PS in MNP patients. Aim: To analyse the effect of Thoracic Spine Manipulation (TSM) on pain and PS in CMNP patients. Materials and Methods: The quasi-experimental study was carried out on 31 patients. All the patients received three sessions of thoracic manipulation on three consecutive days. Numeric Rating Scale (NRS) and PS were measured during three treatment sessions and at baseline. One-way repeated measure Analysis of Variance (ANOVA) was used to examine the effects of treatment on each outcome variable. Results: Thirty-one patients with a mean age of 22.23 (SD=2.667) years with 61.3% females, and 38.7% males fulfilled the prerequisite considerations to be in the study. Patients showed significant improvements in pain after TSM 1 (F=105.8, p<0.05). The PS measured as sway velocity based on the Center of Foot Pressure (COFP) showed a significant reduction in both anteroposterior direction (F=3.55, p=0.02) and mediolateral direction PSY (F=5.10, p=0.03). Conclusion: The results demonstrated that thoracic manipulation improves pain and reduces PS. The study concludes that TSM can alter PS immediately post manipulation. TSM can be an alternative to Cervical Spine Manipulation (CSM) in patients with a contraindication for CSM.