Vulvar carcinoma is a rare and aggressive gynecological malignancy. It affects elderly females, with the mean age at diagnosis being 55–60 years. Regional metastasis to inguinal lymph nodes is common. There is a high incidence of pelvic node involvement, especially in those with pathologically positive inguinal nodes. Surgery appears to be the only curative treatment option in the early stages of the disease. But in most patients, surgery is associated with considerable morbidities and psychosexual issues. Hence, in the quest for a less morbid form of treatment, multimodality approaches with various combinations of surgery, chemotherapy, and radiation therapy have been suggested for advanced vulvar cancers. Due to the low incidence of the disease, the level of evidence for the success of these treatment modalities is poor. In countries like India, a heterogeneous incidence of vulvar carcinoma exists across the country, with patients presenting at advanced stages when the option of surgery is often supplemented or replaced by chemotherapy and radiotherapy. In this review, we attempt to study the available published literature and trials and discuss the treatment options in various stages of vulvar carcinoma.

Renal artery aneurysm is a rare disease. With modern non-invasive imaging modalities, the disease is being increasingly diagnosed. It is a slow-growing aneurysm with high mortality in the event of rupture; especially in pregnant females and patients with multiple comorbidities. Traditionally, aneurysms located in the main renal artery had been successfully treated with endoprosthesis but technical limitations existed in more distal locations where patients were treated surgically. With advances in endovascular therapy, numerous techniques have been employed to manage complex RAA in artery bifurcation, branch and segmental arteries with excellent technical and clinical success. The various recent techniques include the use of flow diverter stents, remodelling with stent-assisted coil embolization[SACE], balloon-assisted coil embolization[BACE], selective embolization with coils-sac packing, inflow occlusion and coil trapping and selective embolization with liquid embolic agents-Hystroacril and Onyx. A combination of stent-graft with liquid embolization and liquid with microcoil embolization have been advocated with success. The most common complication encountered is renal infarction. This is mostly without impairment of renal function and secondary to embolization. Endovascular therapy has shorter operative time, less blood loss, shorter intensive care stay, done under conscious sedation and is associated with lesser postoperative morbidity compared to surgery. Reduction in hypertension, improvement of renal function and symptoms has been seen in most studies. Endovascular management of RAA has become the management of choice even with complex anatomy and technically challenging lesions.

Background:The term "THYROID DIABETES" was coined in early literature to depict the influence of thyroid hormone excess in deterioration of glucose control. Although autoimmune thyroid disease is more prevalent in Type1 Diabetes mellitus as a result of their common origin, the prevalence of hypothyroidism and hyperthyroidism is supposed to be similar to that of general population in patient with type2 DM. The purpose of the study was to evaluate the prevalence of thyroid dysfunction in patients with type2 diabetes mellitus and to correlate thyroid abnormalities with insulin resistance and serum markers for autoimmune thyroiditis. Methods: 120 cases of type2 diabetes mellitus patients satisfying WHO criteria without pre-existing thyroid disease were included in the study. Thyroid function test, fasting serum insulin was done.HOMA-IR & HOMA-B (HOMA-Homeostatic model assessment) was calculated. Serum antithyroid peroxidase anibody (anti-TPO) and antithyroglobulin antibodies (anti-TG) and ANA were done. Results: Prevalence of thyroid dysfunction in type2 diabetes mellitus was 28.33% according to our study, which included overt hypothyroidism (15%), subclinical hypothyroidism (8.33%), secondary hypothyroidism (0.83%), overt hyperthyroidism (1.67%) and subclinical hyperthyroidism (2.5%). Anti TPO and anti TG antibodies were elevated in 62.07% cases of hypothyroidism, 40% cases of hyperthyroidism and 6.9% euthyroid cases of type2 DM. Anti TPO and antiTG antibodies were significantly raised in type2DM patient with hypothroidism than that of euthyroid (p value<0.0001).Compared to euthyroid diabetics, hypothyroid cases had lower values of insulin resistance markers like fasting insulin, HOMA-IR and HOMA-B. Hyperthyoid cases had higher values. Conclusion: Hyperthyroid diabetics have higher insulin resistance as fasting insulin, HOMA-IR, HOMA-B showed negative correlation with TSH. (p value<0.05).

Background: Although coronavirus disease-2019 (COVID-19) is predominantly a respiratory disease, cardiac involvement occurs commonly, especially in those with more severe illness. Echocardiography is the preferred imaging modality for diagnosing cardiac involvement in COVID-19. However, there are currently no data to describe echocardiographic abnormalities in Indian patients with COVID-19. Methodology: A cross-sectional observational analysis was performed among adult patients admitted to a tertiary care center between May 2020 and August 2020. Patients were included if they underwent transthoracic echocardiography during the hospitalization after a positive reverse transcriptase–polymerase chain reaction diagnosis for COVID-19 pneumonia. Demographic and clinical data were obtained and analyzed along with echocardiographic data. Results: During the study period, consecutive 245 patients were evaluated with echocardiography, of whom 11 were excluded due to nondiagnostic images. The remaining 234 (mean age 57 ± 16 years, 71.7% of men) were included in this analysis. All patients were admitted to intensive care unit or high-dependency unit. Right ventricular (RV) dilatation and/or dysfunction (37%) was the most common finding, followed by left ventricular (LV) systolic and diastolic dysfunction (27.7% and 23.1%, respectively). Pericardial effusion was present in 12% of cases. A total of 49 (20.9%) patients had preexisting LV systolic dysfunction (LVSD). After excluding them, the LVSD and LV diastolic dysfunction were observed in 8.6% and 2.7% of patients, respectively. Conclusions: This study demonstrates that RV dilatation/dysfunction is the most common echocardiographic abnormality in hospitalized patients with severe COVID-19. Further, larger, multicentric studies with systematic data collection and comparison with non-COVID patients are needed to determine the true incidence of echocardiographic abnormalities in COVID-19.

Background To evaluate the dosimetric impact of variable bladder filling on target and organ at risk (OARs) in cervical cancer patients undergoing chemoradiation. Forty consecutive patients with cervical cancer underwent radiotherapy planning as per the departmental protocol. All patients were asked to empty their bowel and bladder before simulation and catheterization was done. Normal saline was instilled into the bladder through Foleys till the patient had a maximal urge to urinate. Pelvic cast fabrication and CT simulation was done. Then, 30%, 50%, and 100% of the instilled saline was removed and rescans taken. Planning was done on full bladder (X) and the same plan applied to the contours with bladder volumes 0.7X (PLAN70), 0.5X (PLAN50), and empty (PLAN0). A dose of 50 Gy/25# was prescribed to the PTV and plans evaluated. Intensity-modulated radiotherapy plans with full bladder were implemented for each patient. Shifts in the center of mass (COM) of the cervix/uterus with variable bladder filling identified were noted. Statistical analysis was performed using SPSS software. A p value < 0.05 was considered significant. Results Bladder volume in 70%, 50%, and empty bladder planning was 78.34% (388.35 + 117.44 ml), 64.44% (320.60 + 106.20 ml), and 13.63% (62.60 + 23.12 ml), respectively. The mean dose received by 95% PTV was 49.76 Gy + 1.30 Gy. Though the difference in target coverage was significant between PLAN100 and other plans, the mean difference was minimal. A decrease in bladder filling resulted in an increase in OAR dose. Variation in the increase in dose to OARs was not significant if bladder filling was > 78.34% and > 64.44% of a full bladder with respect to the bowel and rectal/bladder doses, respectively. Inconsistent bladder filling led to a maximal shift in COM (uterus/cervix) in the Y- and Z-axis. Conclusion Bladder filling variations have an impact on cervico-uterine motion/shape, thereby impacting the dose to the target and OARs. It is recommended to have a threshold bladder volume of at least 70–75% of optimally filled bladder during daily treatment. Trial registration Institutional review board (IRB) registered by Drug Controller General (India) with registration number ECR/10/Ins/DC/2013. Trial Registration number - RGCIRC/IRB/44/2016, registered and approved on the 14th of May 2016.