Summary: In addition to the overwhelming and uncontrollable second wave of COVID‐19 in India, the country is also dealing with an outbreak of mucormycosis, a deadly fungal infection, which is affecting thousands of COVID‐19 patients. With the increasing number of cases of mucormycosis and a fatality rate of 50%, many Indian states and union territories have declared an epidemic of black fungus due to its unprecedented emergence, which has adversely affected the already debilitated health system of the country. The advent of the new fungal epidemic in the country is due to the overdosage, panic and injudicious use of corticosteroids among COVID‐19 patients, as well as their pre‐existing medical history of diabetes, given that India is the diabetes capital of the world. Thus, there is an urgent need to address this public health concern by having nationwide surveillance, diagnostic and management system of the disease, along with public awareness and education to combat the syndemic of COVID‐19 and mucormycosis in the country.

Hepatocellular carcinoma ranks fifth amongst the most common malignancies and is the third most common cause of cancer-related death globally. Artificial Intelligence is a rapidly growing field of interest. Following the PRISMA reporting guidelines, we conducted a systematic review to retrieve articles reporting the application of AI in HCC detection and characterization. A total of 27 articles were included and analyzed with our composite score for the evaluation of the quality of the publications. The contingency table reported a statistically significant constant improvement over the years of the total quality score (p = 0.004). Different AI methods have been adopted in the included articles correlated with 19 articles studying CT (41.30%), 20 studying US (43.47%), and 7 studying MRI (15.21%). No article has discussed the use of artificial intelligence in PET and X-ray technology. Our systematic approach has shown that previous works in HCC detection and characterization have assessed the comparability of conventional interpretation with machine learning using US, CT, and MRI. The distribution of the imaging techniques in our analysis reflects the usefulness and evolution of medical imaging for the diagnosis of HCC. Moreover, our results highlight an imminent need for data sharing in collaborative data repositories to minimize unnecessary repetition and wastage of resources.

As the world continues to battle the COVID-19 pandemic, India was struck by the second wave of this disease during the past few months. There was a rapid spread of the SARS-CoV-2 virus across the c...

Psoas abscess is a rare condition that can present with vague clinical features. Its insidious onset can lead to a delay in diagnosis, resulting in high rates of complications and mortality. Here we describe a unique case of a patient presenting with enterocutaneous fistula and pneumoretroperitoneum due to ruptured psoas abscess.

A 63 year old female presented with the complaint of lump in left upper quadrant of abdomen since two years which had gradually increased in size reaching up to umbilicus. It was associated with dull aching abdominal pain. Her vitals and initial laboratory investigations were in normal range. Her family history was insignificant. Contrast enhanced computed tomography (CECT) of abdomen revealed a grossly enlarged spleen with parenchyma greatly replaced by cysts of variable sizes, largest one measuring 72mm x 69mm x 69mm. Few cysts had peripheral discontinuous rim like calcifications (A,B). Splenectomy done via subcostal incision revealed a spleen weighing 1800 gram and measuring 28cm x 16cm x 9cm with irregular surface showing numerous cysts filled with serous and serosanguinous fluid (C,D). Normal architecture of spleen was replaced almost completely by cysts filled with proteinaceous fluid containing red blood cells. There was dystrophic calcification in the periphery of the cysts. The endothelial cells were diffusely positive for CD34 and factor VIII, focally positive for CD31 but not for CD8. The diagnosis of splenic hemangiomatosis was made. Splenic hemangiomatosis is extremely rare with unknown incidence and is most frequently seen in cases of diffuse angiomatosis. The imaging characteristics of splenic hemangiomas are non-specific. The differential for a cystic lesion of the spleen includes lymphoma, metastases, abscess, cyst, lymphangioma and hematoma. Due to poor specificity of imaging and the risks associated with percutaneous biopsy of the spleen, splenectomy is performed when definitive characterization of splenic lesions is needed.

Introduction The COVID-19 pandemic has resulted in a significant burden on healthcare systems causing disruption to medical and surgical training of doctors globally. Aims and objectives This is the first international survey assessing the perceived impact of the COVID-19 pandemic on training of doctors of all grades and specialties. Methods An online global survey was disseminated using Survey Monkey® between 4th August 2020 and 17th November 2020. A global network of collaborators facilitated participant recruitment. Data was collated anonymously with informed consent and analysed using univariate and adjusted multivariable analysis. Results 743 doctors of median age 27 (IQR: 25-30) were included with the majority (56.8%, n=422) being male. Two-thirds of doctors were in a training post (66.5%, n=494), 52.9% (n=393) in a surgical specialty and 53.0% (n= 394) in low- and middle-income countries. 69.2% (n=514) reported an overall perceived negative impact of the COVID-19 pandemic on their training. A significant decline was noted among non-virtual teaching methods such as face-to-face lectures, tutorials, ward-based teaching, theatre sessions, conferences, simulation sessions and morbidity and mortality meetings (p≤0.05). Doctors from low or middle-income countries were associated with perceived inadequate supervision while performing invasive procedures under general, local or regional anaesthetic. (p≤0.05) Conclusion In addition to the detrimental impact of the COVID-19 pandemic on healthcare infrastructure, there has been an indirect consequence of disrupted training within medical and surgical subspecialties. A focus on reconfiguration of training programs through a variety of additional resources will become imperative to reduce the long-term sequalae of COVID-19 on doctors’ training.