There have been many clinical questions regarding whether the use of proton pump inhibitors (PPIs) could deteriorate the effects of cyclin-dependent kinase inhibitors (CDKIs) in HR+/HER2- advanced breast cancer patients. We performed a systematic review and meta-analysis of this clinical question, including studies enrolling HR+/HER2- metastatic breast cancer patients treated with CDKIs (Palbociclib or Ribociclib) and reporting at least one comparative survival outcome, either overall survival (OS) or progression-free survival (PFS), between concomitant PPI users and non-users. Eight studies met the eligibility criteria, with a total of 2584 patients included (PPI users: 830, PPI non-users: 1754), demonstrating that concomitant PPI use was associated with significantly higher risks of all-cause mortality (HR = 2.03; 95% CI, 1.49 to 2.77; I² = 0%) and disease progression (HR = 1.75; 95% CI, 1.26 to 2.43; I² = 59%) in breast cancer patients taking Palbociclib. In contrast, there were no significant survival impacts of PPIs on Ribociclib (HR = 1.46; 95% CI, 0.91 to 2.34; I² = 36%). Additionally, there was no significant difference in the risk associated with CDKI dose reduction due to drug toxicity (RR = 1.12; 95% CI, 0.97 to 1.29). Therefore, when HR+/HER2- advanced breast cancer patients require the use of PPIs, it may be reasonable to consider using Ribociclib.

A 19-year-old female presented with pain, deformity, and slightly restricted left wrist motion for five years with gradual progression. Physical examination revealed volar subluxation of the left hand, dorsally prominent ulnar styloid, radial and dorsal bowing of the distal forearm, and mild restriction in wrist dorsiflexion. Radiographs showed a failure of ossification of the ulnar side of the distal radial epiphysis, increased radial inclination angle, dorsal subluxation of the distal ulna, V-shaped proximal carpal row due to proximal migration of the lunate, and increased interosseous space. A diagnosis of Madelung deformity of the left wrist was made. Conservative management with oral analgesics, activity restriction, and a volar splint was done as the patient was skeletally mature, had only mild pain with no functional limitation or gross deformity. At the six-month follow-up, she was doing well with decreased pain and no new complaints.

Our aim in this study is to assess the prevalence of abuse in elders with psychiatric illness and its association with various sociodemographic variables. This cross-sectional comparative study included 300 elderly (aged more than 65 years) patients divided into two groups. Group 1 consisted of 150 patients with psychiatric illnesses presenting to the psychiatry outpatient department (OPD), whereas group 2 comprised 150 patients with somatic illnesses presenting to the OPDs of other departments. Elder Abuse Suspicion Index (EASI) was used as a screening tool for the detection of elder abuse. In patients with suspicion of abuse on EASI, the Actual Abuse Tool was used for confirmation and assessment. A significantly higher prevalence of abuse was seen in elders with psychiatric illness (21.3%) compared to those with somatic illness (4%). Among sociodemographic variables, a significant correlation was found between elder abuse and gender, literacy, and marital status. Elder abuse is a serious social problem. Awareness should be raised to improve the attitude and behavior towards seniors. Healthcare professionals, especially in the psychiatry field, should be made more capable of and open towards early detection of and intervention against elder abuse. Further research on this topic in India is highly recommended.

A 36-year-old man presented with incidental findings of an asymmetric chest with hypoplastic and flattened left anterior chest wall due to absent left pectoralis major. He also had short and webbed fingers in the left hand. These deformities were present since birth. Chest X-ray showed hyperlucency on the left side. Computerized tomography (CT) scan showed an absence of the left pectoralis major. X-ray of the left hand showed hypoplasia of the proximal phalanx and aplasia of the middle and distal phalanges of the second digit, and aplasia of the middle phalanges of the third and fourth digits. A diagnosis of left-sided Poland syndrome with associated ipsilateral brachysyndactyly, which is a very rare entity, was made. The patient opted against any reconstructive procedure as he had a minimal functional limitation.

Biliary strictures or narrowing of a portion of the biliary tree can have benign and malignant etiologies. One third of these will originate from iatrogenic injury and these are typically managed endoscopically. We present the case of a 76-year-old man with history of laparoscopic cholecystectomy ten years prior, who presented with one week of jaundice, dark urine, and pruritus. Along with non-invasive biliary imaging, he underwent cholangioscopy during endoscopic retrograde cholangiopancreatography revealing inflammatory-appearing stenosis of the common hepatic duct with embedded suture material. The stenotic area was biopsied using mini forceps and subsequently dilated with a balloon dilator. A plastic biliary stent was placed with improvement in the patient’s hepatic function, with final cytology and pathology being negative for malignancy. Cholangioscopy facilitated detailed visual inspection of strictures and biopsies under direct visualization. The visual impression increased the sensitivity of the biopsy and assisted in ruling out malignancy from the most critical portion of the stricture. While timing of cholangioscopy remains to be determined, its use is a valuable tool in the diagnosis of indeterminate biliary strictures.

An appendicolith is a calcified mass which can obstruct the appendix often leading to recurrent appendicitis. Failure to extract fecalith at the time of appendectomy can lead to recurrent inflammation in the appendiceal stump. We describe a 28-year-old man with stump appendicitis due to a retained fecalith postappendectomy. Our approach, akin to interval appendectomy, combines antibiotics and endoscopic intervention postinfection resolution. This case highlights the feasibility and safety of endoscopic management, offering a nonsurgical alternative to prevent the morbidity associated with revision surgery. Further exploration of nonsurgical modalities is warranted to optimize patient outcomes.