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Cancer has long been recognized as a complex, multifactorial disease, in which genetic mutations and epigenetic alterations drive unchecked proliferation, tissue invasion, and metastasis.

Obesity is a multifactorial epidemic disease of environmental origin that affects subjects of all countries and whose origin is not in the stomach or intestines. Surgical treatment represents a unique case of surgery for operating healthy organs, which are not the cause of the disease and do not improve after the operation. Kremen and Linner [1] and Varco and Buchwald teams of in Minneapolis, MN began the intestinal deviation (ID) of malabsorption in 1954. Payne [2] and Scott [3] developed these ID techniques in the 1960s leaving only 14- 4 inches (35 -10 cm) as an absorption zone and were abandoned in the 1970s due to its serious metabolic (malnutrition) and liver complications (liver failure).

 62-year-old female with a history of arterial hypertension, attended the emergency department due to pain in the left flank. On physical examination no showed signs of peritoneal irritation. Urinalysis was indicated, that reported microscopic hematuria and negative abdominal ultrasound.

In today’s busy world, people don’t even have the time to fall ill. Diseases don’t just demand time but also physical efforts, mental peace, loss of work, distress of loved ones and financial loss. According to a report published in Harvard business review, each year in India, 39 million people are pushed into poverty by out-of-pocket payments for healthcare, with households on average devoting 5.8% of their expenditures to medical care [1].

Depression is currently one of the main barriers to further civilizational development. Despite intensive efforts, it is a growing health, social and economic problem. We still lack clarity regarding the ethology of depression and treatment is still mainly symptomatic. The authors postulate that depression has similarities with anxiety and from an evolutionary perspective is an archaic defence mechanism. Formerly, through the agency of complex psychological, biological and social mechanisms, healing was facilitated in conditions of an intense, short-term nature. Adverse civilizational and environmental changes have caused pathological changes in both the mechanism of depression and corresponding defence mechanisms such as the induction of an anxiety state. Related to depression is the mechanism of thanatosis, concerning chronic biological and psychosocial dysfunctions. It is a mechanism for activating self-eliminating processes to free the community from the burden of a dysfunctional individual.

The case is that of 83 year-old African American man with hypertension, hepatitis C induced decompensated cirrhosis with ascites, end-stage renal disease (ESRD) on hemodialysis, fluid overload with peripheral edema and chronic hypotension. The patient was referred to the dialysis access center of Pittsburgh, PA for evaluation of his prolonged bleeding from the left upper arm brachial-basilic arterial-venous fistula (BBAVF).

Chronic occlusive arterial disease of the periphery is primarily caused by atherosclerotic disease. In young patients with no identifi able risk factors for atherosclerosis, who present with symptoms of claudication or critical ischemia, other rare causes need to be suspected. Cystic adventitial disease is one such condition affecting young healthy patients. Although it has been reported most commonly in relation to the popliteal artery, other sites including the iliac artery can also get affected. Isolated short segment stenosis or occlusion can lead to signifi cant disabling symptoms restricted to one side. Imaging studies show pristine arterial anatomy with no evidence of systemic atherosclerotic disease and an isolated area of luminal stenosis. Defi nitive treatment involves open surgical excision with interposition grafting for optimal long-term results. We report a case of cystic adventitial disease affecting the external iliac artery in an otherwise healthy young man. 

COVID-19 pandemic soon apparently proved to be havoc and a great stressor. During such a stressful time, mental health is in threat. Here, we intend to review the presenting problems/ symptoms as shared in psychiatry helpline of a Teaching Hospital in eastern Nepal during the second week of lockdown and to reflect on to emotional, including mood problems. It is an institute based period observation noted for all psychiatry helpline calls during 1 week of lockdown days of COVID-19. Their concerns and problems were listened and symptoms clarified by a consultant psychiatrist to help them as far as possible through the telephonic conversation. Maintaining the confidentiality, basic information were noted down in a semi-structured proforma to record certain socio-demographic and clinical information (including mood and other emotional symptoms). We received 102 helpline calls of 60 clients for psychiatry in 1 week, from 14 districts. More patients being discussed were males (35/60), average age being 34.15 (15 - 70) years. More patients were regular follow-up cases with some new issues (24/60) and 18/60 each were new clients and regular follow-up cases. Majority had exacerbated symptoms in the wake of COVID-19 as: emotional (47/60; mood 24/60, anxiety/worry 23/60) symptoms along with disturbed sleep (32/60); treatment/service issues (31/60) and changed routines. Most common mental problems were Bipolar affective disorder, Psychosis, Anxiety and Depression and advices included Antipsychotics, Benzodiazepines, Antidepressants, along with some Psycho-education. Most common concerns were about OPD service, worsening symptoms and local unavailability of medicines. Many had mood and emotional symptoms in this stressful time, both simple amenable to telephonic advices and severe requiring to be called to emergency service.

The issues investigated in the current study pertain to selected psychological aspects of human functioning in long-term stress conditions. Results of the analyses performed in this study have submitted evidence to confirm the hypothesis in which it is stated that staying on the sea for a long time is a difficult situation which contributes - to a greater or smaller extent - to starting the stress process in sailors. The role of interpersonal competencies that has been found most distinct; high level of this variable contributed to reducing both anxiety and the feeling of loneliness. It has been evidenced in the research that the skill of good functioning in varied social groups, which results from high level of development of several traits including: openness, spontaneity, responsibility, and sensitivity, becomes particularly important in long-term difficult situations in which there is little possibility of eliminating the real menace. Another conclusion to be inferred from the research is the one confirming the theoretical suggestion in which the importance of ‘ego strength’ in modifying the course of stress process is emphasised. This personality dimension has turned out to constitute the factor capable of protecting an individual against increase in both anxiety states and the feeling of loneliness during sea isolation. Another issue considered in the current study pertains to defining the role of ‘family variable’ in mediating the course of stress process under conditions of long-term task isolation. The analyses have confirmed the hypothesis in which it was assumed that sailors functioning in family systems characterised by high level of integration and quality, experience lower emotional costs during a voyage. Generally, it may be claimed that - according to the research results of the study - ‘family variables’ may constitute a significant predictor of both the ‘quality’ of a man’s functioning and personal costs he experiences in long-term stress conditions.

It is well known that depression is more common in women than in men with more prescriptions for antidepressants, hospital admissions for depression and suicide attempts. However another aspect to be considered is that depression is different in women than men because women have depressive episodes at times of hormonal shift which is a physiological phenomenon not encountered in men. This is why hormone therapy is so important.