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The application of nanofluids in the presence of a magnetic field holds promise for advanced drug delivery systems, where controlled manipulation of magnetic nanoparticles within nanofluids can enhance targeted and localized drug delivery. This study explores the instability of a viscous fluid-nanofluid interface arranged in a planar configuration influenced by a tangential magnetic field using the irrotational flow theory. When the nanofluid is positioned above a viscous fluid, the interface is susceptible to the Rayleigh-Taylor instability. Employing linear stability theory, an explicit relationship connecting the perturbation growth parameter with the wavenumber is derived. Different dimensionless quantities such as the Atwood number, Weber number, Froude number, and Reynolds number are analyzed using stability plots. These plots provide valuable information about the behavior of interfaces. Increased magnetic field strength is observed to delay instability onset. Surface tension is found to stabilize the interface, whereas inertial forces destabilize it. This investigation contributes to understanding and controlling the interface dynamics in nanofluid systems.

Introduction: The preferred management of medial meniscus tears has notably moved from meniscectomies towards repair. With a higher volume of meniscal repairs being done all across the world with every passing day, the lack of an objective and definitive sign suggesting the adequacy of its repair is daunting. The purpose of our study was to introduce a unique and novel arthroscopic sign formed after adequate repair of the medial meniscus, the AMR (Adequacy of Medial meniscus Repair) sign. We hypothesised that it is not only the objective end point for repair, but can also form the indicator for excellent clinical, functional, and radiological outcome even in the long term. Materials and methods: This was a multicentric, prospective study initiated by the corresponding author, and the findings validated subsequently by the other authors. Overall, it included 804 patients of isolated medial meniscus tear operated with arthroscopic all-inside technique between January 2014 and December 2017. Patients were segregated into three groups based on whether an S-shaped curve in the free, inner edge of the medial meniscus sign was formed post-repair, lost after further tightening, or not formed upon subjective completion of repair. All the patients were followed-up and evaluated based of medial joint line tenderness, McMurray’s test for medial meniscus, IKDC score, WOMET score, and radiologically using an MRI at the terminal follow-up. Results: The mean terminal follow-up was 42.34±4.54 months. There was significant (p

Introduction: Open tendoachilles injuries are rare and associated with significant soft tissues complications. The objective of the present study was to assess the clinical outcome and safety of a simple and minimally invasive technique, with a goal to assess if it may help minimise flap and wound related complications in open tendoachilles injuries. Materials and methods: This prospective study of four years duration included 20 patients with open tendoachilles injuries managed with a simple minimally invasive tunnel technique. The primary outcome variable was occurrence of a major soft tissue complication. The secondary outcome variables included functional outcome measured using AOFAS Ankle hind foot score, re-rupture of tendoachilles and need for revision surgery. Results: None of the patients in the present series developed a serious soft tissue complication. Based upon the AOFAS hind foot scoring system, good to excellent outcome was achieved in 19 (95%) patients. All the patients were able to perform tip toe walking at six months post-surgery. None of the patients had a re-rupture of the tendoachilles and no patient needed a revision surgery. The complications encountered include thickening of the tendon at the repair site (15%), superficial wound infection (5%), stitch granuloma (5%) and hypertrophic scar (5%). Conclusion: This technique seems to be promising in reducing the soft tissue complications associated with the surgical management of open tendoachilles injuries. Most patients had a good final clinical outcome. The technique is safe, simple and reproducible. However, further randomised control studies with a larger sample size assessing the technique are recommended.

Cedric J Rutland,1 Onyinye I Iweala,2 Kyle Anders,3 Jinnie Ko,3 Parul Mital,3 Sachin Gupta,3 Arjun Mohan4 1Rutland Medical Group, Newport Beach, CA, USA; 2Division of Rheumatology, Allergy, and Immunology, University of North Carolina, Chapel Hill, NC, USA; 3Genentech, Inc., South San Francisco, CA, USA; 4Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USACorrespondence: Sachin Gupta, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA, Tel +1 650-763-7791, Email Guptas71@gene.comAbstract: Acute and chronic cough are common symptoms in patients with severe allergic asthma. Although asthma-related cough can be controlled by asthma-specific medications, both prescription and over-the-counter antitussives are often also necessary. The anti-immunoglobulin E monoclonal antibody omalizumab is an effective treatment for patients with moderate-to-severe asthma, but little is known about subsequent antitussive use patterns. This post hoc analysis examined data from the Phase 3 EXTRA study that included patients aged 12– 75 years with inadequately controlled moderate-to-severe asthma. Baseline antitussive use was low overall (16/427, 3.7% for omalizumab and 18/421, 4.3% for placebo). Among patients with no baseline antitussive use (n = 411 omalizumab, n = 403 placebo), most patients (88.3% omalizumab, 83.4% placebo) reported not using antitussives during the 48-week treatment period. The percentage of patients using 1 antitussive was lower for patients treated with omalizumab than placebo (7.1% vs 13.2%), although the adjusted rate of antitussive use during the treatment period was similar for omalizumab and placebo (0.22 and 0.25). Non-narcotics were used more often than narcotics. In conclusion, this analysis found low use of antitussives in patients with severe asthma and suggests that omalizumab may have the potential to decrease antitussive use.Keywords: antitussive, asthma, cough, omalizumab

Md Anwarul Azim Majumder,1,2 Keerti Singh,2 WMS Johnson,3 Archana Rajasundaram,3 Subir Gupta,2 Uma Gaur,2 Santosh Kumar,4 Madhuri Chatterjee,5 Ahbab Mohammad Fazle Rabbi,6 Vijay Prasad Sangishetti,7 Sayeeda Rahman,8 Michael H Campbell,2 Heather Harewood,2 Ambadasu Bharatha,2 Kandamaran Krishnamurthy,2 Russell Kabir,9 Ali Davod Parsa,9 Shegufta Mohammmad,10 Mainul Haque,11 Mohammed S Razzaque12 1Public Health Foundation of Bangladesh, Dhaka, Bangladesh; 2Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados; 3Department of Anatomy, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India; 4Karnavati School of Dentistry, Karnavati University, Ahmedabad, Gujarat, India; 5Department of Pharmacology, Shri Ramkrishna Institute of Medical Science, Durgapur, West Bengal, India; 6Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh; 7Department of Pharmacology, Govt. Medical College, Shivpuri, Madhya Pradesh, India; 8School of Medicine, American University of Integrative Sciences (AUIS), Bridgetown, Barbados; 9Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, Essex, UK; 10BRAC Learning Division, BRAC University, Dhaka, Bangladesh; 11Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000, Malaysia; 12Lake Erie College of Osteopathic Medicine, Erie, PA, USACorrespondence: WMS Johnson, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India, Email johnsonmoses@gmail.com; johnsonmoses@yahoo.com Mainul Haque, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia, Email runurono@gmail.com; mainul@upnm.edu.myBackground: Efficacy and safety are fundamental for the development of successful COVID-19 vaccines. Vaccine-associated side effects influence vaccine hesitancy. This study investigated the prevalence, severity, and onset of side effects following the first dose of COVID-19 vaccines among physicians and dentists working in various healthcare settings across India.Methods: A cross-sectional survey collected self-report data from April to June 2021 on side effects following the first dose of the vaccine. An online validated questionnaire using the Google Docs® platform was circulated via email and social media platforms.Results: More than 40% of participants experienced at least one side effect after the first dose of vaccination; the most common were mild and resolved within three days after vaccination. More than 91% of respondents received the Covishield (AstraZeneca) vaccine; the most prevalent adverse effects were soreness of the injected arm (78.9%), tiredness (71.1%), and fever (54.9%). Logistic regression showed that women were almost 60% less likely to report side effects.Conclusion: Findings supported the safety of the first dose of the COVID-19 vaccine based on relatively few self-limiting side effects, mainly soreness of the injected arm and tiredness. Further research is needed to determine the long-term safety of COVID-19 vaccines, especially after booster doses.Keywords: prevalence, adverse effects, COVID-19 vaccine, physicians, dentists, India

Vidhu Sethi,1 Luke Van der Laan,2 Sanjeev Gupta,3 K Cornelius Piros4 1GlaxoSmithKline Consumer Healthcare, Singapore; 2Faculty of Business, Education, Law & Arts, University of Southern Queensland, Queensland, Australia; 3Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; 4Regena Healthcare, Selangor, MalaysiaCorrespondence: Vidhu Sethi, GlaxoSmithKline Consumer Healthcare, Singapore, GSK Asia House, 23 Rochester Park, 139234, Singapore, Tel +65 96447203, Email vidhu.x.sood@gsk.comPurpose: To seek indicative evidence on clinical prescription practice and perspectives regarding combined oral paracetamol (APAP) and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) therapy for managing mild-to-moderate osteoarthritis (OA) pain.Participants and Methods: An exploratory qualitative study to investigate the perspectives towards using APAP and/or topical NSAIDs for OA pain management and whether current clinical practices are aligned with OA guidelines was conducted using a two-round modified Delphi methodology among three general practitioners, three orthopedists, and two pharmacists from Australia, Malaysia, and Sweden during January–June 2021. In the first round, 60-minute virtual in-depth interviews were conducted individually; in the second round, summary of the key findings was shared with the panel to seek clarity on the level of consensus (≥ 70% unanimity) and disagreement.Results: The healthcare professionals (HCPs) agreed that APAP was considered as a universally accepted pharmacologic for most OA patients except those with contraindications or allergies. Consensus was achieved towards APAP combination with topical NSAIDs being a safer alternative than with oral NSAIDs. However, prescription uptake of combined therapy APAP with topical NSAIDs was low among the panel due to lack of strong scientific evidence on efficacy and awareness. Differences in clinical practice across and within countries could be due to different reference sources for OA pain – clinical practice experience or local/international guidelines/medical products handbooks.Conclusion: The study suggests an opportunity to raise awareness of the suitability and potential benefits for adjuvant topical NSAIDs to APAP for effective OA pain management as well as a need for universal OA guidelines.Keywords: combination therapy, pain relief, Delphi methodology, consensus, prescription uptake

Shilpy Bhullar,1 Navdeep Goyal,1 Shikha Gupta2 1Department of Physics, Centre of Advanced Study in Physics, Panjab University, Chandigarh, 160014, India; 2Department of Physics, Goswami Ganesh Dutta Sanatan Dharma College, Chandigarh, 160032, IndiaCorrespondence: Shikha Gupta, Department of Physics, Goswami Ganesh Dutta Sanatan Dharma College, Sector-32c, Chandigarh, 160032, India, Email shikhagupta16@gmail.comIntroduction: Titanium dioxide nanoparticles (TiO2 NPs) have shown tremendous potential in targeted drug-delivery applications. Among various mechanisms, magnetically guided transport of drugs is one such technique for the said purpose. TiO2 NPs being diamagnetic or sometimes exhibiting very weak ferromagnetism can be modified by treating them with suitable magnetic materials.Methods: Rutile TiO2 NPs were synthesized and doped with Iron Supplement FericipXT and rare-earth metals like cerium, erbium and neodymium via sol–gel technique. FericipXT-coated rutile TiO2 NPs were synthesized in three different core-shell ratios (1:3, 1:1 and 3:1). The resulting samples were characterized via X-ray Diffraction (XRD), Vibrating Sample Magnetometer (VSM) and High-Resolution Transmission Electron Microscopy (HR-TEM).Results: XRD of FericipXT-doped TiO2 NPs showed a rutile phase for 1% and 3% doping; however, only a small fraction of the maghemite phase was obtained for 5% doping. The XRD plots of Ce-doped, Er-doped and Nd-doped TiO2 NPs showed a variety of phases of TiO2 NPs (such as anatase/rutile/mixed) along with the oxide phases of the corresponding rare-earth metal. The presence of various iron titanium oxides and iron oxides was found in core-shell NPs. HR-TEM images confirmed the formation of 1:3, 1:1 and 3:1 core-shell TiO2 NPs. VSM studies showed that the resulting NPs depicted magnetism in the form of superparamagnetism, ferromagnetism and even paramagnetism.Discussion: The doping to 3% does not affect the original phase of the resulting TiO2 NPs as depicted from the XRD; however, a doping of 5% and more resulted in extra phases corresponding to the dopant added. FericipXT was loaded over TiO2 NPs in amorphous form. Among all the samples synthesized, FericipXT-coated TiO2 NPs demonstrated the best magnetic ability. It was deduced that coating with a magnetic material drastically improves the magnetic character of the host NPs.Keywords: magnetically-guided drug delivery, drug delivery, rare-earth metals, iron supplement, TiO2 nanoparticles, superparamagnetism, paramagnetism, ferromagnetism

Brian D Moseley,1 Shaloo Gupta,2 Nate Way,2 Jonathon Wright,2 John C Rowland,2 Victoria E Barghout,3 Feride Frech,4 Craig Plauschinat4 1Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, 45267, USA; 2Real World Evidence, Cerner Enviza, Malvern, PA, 19355, USA; 3VEB HealthCare LLC, Morristown, NJ, 07960, USA; 4Health Economics, Outcomes Research, and Real World Evidence, Eisai Inc., Nutley, NJ, 07110, USACorrespondence: Craig PlauschinatEisai Inc, 200 Metro Blvd, Nutley, NJ, 07110, USA, Tel +1 551-284-9216, Fax +1 201-692-1804, Email craig_plauschinat@eisai.comBackground: Epilepsy is a complex disorder that can affect patients’ medical, psychological, and social well-being. The purpose of this study was to evaluate the patient-reported outcome (PRO) measures of health-related quality of life (HRQoL), satisfaction, and adherence in adult patients diagnosed with epilepsy treated with perampanel in the United States (US).Methods: A US-based, multicenter, observational cross-sectional survey was completed by 61 patients taking perampanel with or without other antiseizure medications (ASMs). Respondents were ≥ 18 years old, had a physician-confirmed diagnosis of epilepsy, used perampanel for ≥ 4 months, and provided informed consent. Patients responded to questions concerning their demographic characteristics, treatment history, experiences before perampanel, experiences while taking perampanel, HRQoL, treatment satisfaction, and medication adherence.Results: Patients (N=61) were 42.8 years old on average; majority were female (63.9%) and white (75.4%). Mean time on perampanel was 2.5 years, with sodium channel blockers often (55.7%) used concomitantly with perampanel. Patients reported, on average, 5.5 (standard deviation [SD]=13.2) seizures/month after initiating perampanel, whereas these same patients reported experiencing 20.4 (SD=60.0) seizures/month prior to perampanel. When comparing their experience on perampanel with their experience with previous ASMs, more patients “strongly agreed” that perampanel allowed them to live a more normal life (36.1% vs 27.5%) and worked as intended if they missed taking a dose (16.4% vs 7.8%). Average satisfaction scores were high, with ratings of 71.8 for effectiveness, 84.0 for convenience, and 71.9 for global satisfaction (0– 100 scores). Perampanel use was associated with improvements in HRQoL and fewer symptoms of depression and anxiety. The majority of patients were adherent (62.3%) to perampanel.Discussion: Perampanel use was associated with reductions in number of seizures, better HRQoL, and high adherence rates. These results provide initial evidence that perampanel can be an effective, tolerable, and valid option for patients with epilepsy in the real world.Keywords: epilepsy, perampanel, quality of life, medication adherence, healthcare resource use

Mondher Mtibaa,1 Subhajit Gupta,2 Madhusubramanian Muthukumar,2 Jessica Marvel,3 Harneet Kaur,2 Ryotaro Ishikawa,3 Ron Olivenstein4 1Novartis Pharmaceuticals Canada Inc., Dorval, Quebec, Canada; 2Novartis Healthcare Private Limited, Hyderabad, India; 3Novartis Pharma AG, Basel, Switzerland; 4McGill University, Montreal, Quebec, CanadaCorrespondence: Mondher MtibaaNovartis Pharmaceuticals Canada Inc., 385 Bouchard Blvd., Dorval, Quebec, H9S 1A9, CanadaTel +1 514 631-6775 ext. 1367Email mondher.mtibaa@novartis.comPurpose: We evaluated the cost-effectiveness of high-dose indacaterol acetate (IND)/glycopyrronium bromide (GLY)/mometasone furoate (MF) (150/50/160 μg, once daily) compared with high-dose salmeterol/fluticasone (SAL/FLU; 50/500 μg, twice daily)+tiotropium (TIO; 5 μg, once daily) (SAL/FLU+TIO) and with high-dose SAL/FLU (50/500 μg, twice daily) for the treatment of inadequately controlled moderate-to-severe asthma.Patients and Methods: A Markov model estimated the incremental cost-effectiveness ratio of treatment with high-dose IND/GLY/MF compared with SAL/FLU+TIO and high-dose IND/GLY/MF compared with SAL/FLU. The model included three health states (day-to-day symptoms without exacerbations, day-to-day symptoms with exacerbations, and death) with a 4-week cycle length. A lifetime time horizon was used. Exacerbation rates and utility values were derived from ARGON and IRIDIUM clinical trials. Canadian dollars (CAD$, 2020) were applied.Results: IND/GLY/MF was the less costly and more effective treatment strategy compared with SAL/FLU+TIO and SAL/FLU in the base-case analyses. IND/GLY/MF had lower costs (CAD $33,501 versus CAD $50,907) and higher quality-adjusted life-years (QALYs) (18.37 versus 18.06 QALYs) compared with SAL/FLU+TIO. Compared with SAL/FLU, IND/GLY/MF had lower costs (CAD $33,408 versus CAD $36,577) and higher QALYs (19.33 versus 19.04 QALYs). IND/GLY/MF was the most cost-effective option in all scenarios tested.Conclusion: IND/GLY/MF was cost-effective at a willingness-to-pay threshold of CAD $50,000/QALY in patients with uncontrolled, moderate-to-severe asthma versus SAL/FLU+TIO and SAL/FLU in the base case and all scenarios tested.Keywords: moderate to severe asthma, indacaterol acetate, glycopyrronium bromide, mometasone furoate, cost-effectiveness, health care payer perspective, Canada, uncontrolled asthma

Kandamaran Krishnamurthy,1 Natasha Sobers,2 Alok Kumar,1 Nkemcho Ojeh,1 Andrea Scott,3 Clyde Cave,3 Subir Gupta,1 Joanne Bradford-King,3 Bidyadhar Sa,4 Oswald Peter Adams,1 Michael H Campbell,1 Md Anwarul Azim Majumder1 1Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados; 2Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados; 3The Queen Elizabeth Hospital, Bridgetown, Barbados; 4Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and TobagoCorrespondence: Md Anwarul Azim MajumderFaculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, BarbadosEmail azim.majumder@cavehill.uwi.eduIntroduction: Due to increased exposure risk and the potential impact of COVID-19 infection, health care professionals (HCP) are a target group for COVID-19 vaccination. This study aimed to examine the acceptability of COVID-19 vaccines among HCP at the Queen Elizabeth Hospital, Barbados.Design and Methods: A cross-sectional survey of HCP was conducted between February 14 and 27, 2021 using an online questionnaire. The questionnaire included demographic information, knowledge of novel coronavirus, intention to accept the COVID-19 vaccination, vaccine literacy (VL), and perceptions and attitudes regarding COVID-19 vaccines. Mean VL scores were calculated. The relationship between socio-demographic variables and vaccine intent was assessed using a multivariable logistic regression model.Results: Of 343 HCPs, 55.1% indicated they would accept the COVID-19 vaccine if it were available; 44.9% expressed hesitancy towards the COVID-19 vaccine. We assessed the impact of socio-demographic factors and previous vaccine behavior on vaccine intent; after adjustment of the multivariable logistic regression model, non-Barbadian nationality and previous flu vaccine uptake were statistically significant predictors of reported intent to take the COVID-19 vaccine. Persons who indicated that they would take the vaccine had a higher mean vaccine literacy score [3.46 95% CI (3.40, 3.52)] than those who were not ready to take the vaccine immediately [3.23 95% CI (3.15, 3.30)]. VL scores were higher among the 29.5% of HCPs who believed vaccines should be mandatory.Conclusion: This study highlighted vaccine hesitancy among HCPs in the sole public tertiary hospital of Barbados. As HCP perceptions may help or hinder the campaign to promote vaccine uptake in Barbados, vaccine promotion programs targeting HCPs are needed to ensure the success of the country’s COVID-19 vaccination drive.Keywords: vaccine intake, vaccine hesitancy, vaccine literacy, healthcare professionals, COVID-19, Barbados

Mrityunjay Singh, Harinder Singh Sethi, Sukriti Gupta, Ram Kishan Duvesh, Mayuresh Naik Department of Ophthalmology, VMMC and Safdarjung Hospital, New Delhi, IndiaCorrespondence: Ram Kishan DuveshDepartment of Ophthalmology, VMMC and Safdarjung Hospital, New Delhi, India, Tel +91 9654530391Email mayureshpnaik@gmail.comBackground: To study the prevalence of coronavirus infection among asymptomatic patients requiring eye surgery and the role of screening in prevention of spread of infection among the healthcare workers.Design: The prospective observational study was conducted in the Ophthalmology department of a tertiary care center in Delhi from September 2020 to December 2020.Setting: Patients requiring elective ophthalmological procedures in a tertiary care hospital were screened for coronavirus using the RT-PCR method. Testing methods and results were documented.Results: Among the 218 asymptomatic patients posted for elective surgery in that period, 16 (7.3%) were found to be positive for COVID-19. Those who tested positive were advised home isolation and surgery was postponed for the next 14 days. No complications were reported in these patients. One health-care worker also tested positive for COVID-19 during our study period.Conclusion: In our study, 1 out of 14 asymptomatic patients were found to be carriers for the novel virus. Asymptomatic COVID-infected patients may lead to transmission of the virus inside the hospital among the visiting patients and hospital staff while they have no adverse effect on the surgery and its outcome.Keywords: COVID-19, elective procedure, phacoemulsification

INTRODUCTION: To evaluate the trends of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) in the first three weeks after uncomplicated total hip (THR) and total knee (TKR) arthroplasty/replacement in the Indian population and to compare it with available literature. MATERIALS AND METHODS: A total of 90 patients were enrolled for this prospective study, of which 30 were unilateral THR, 30 were unilateral TKR (U/L TKR) and 30 were simultaneous bilateral TKR (B/L TKR). Serum CRP and ESR were measured on the day before surgery and postoperatively on day 1st, 2nd, 3rd, 7th, 12th, and at the end of 3rd week. RESULTS: CRP showed a peak at day 2nd with normalisation to pre-operative value by the end of 3rd week. While ESR showed a peak on day 3rd and continued to remain elevated even at end of 3rd week post-operatively. Both mean CRP and ESR values were higher in THR patients followed by in B/L TKR and then in U/L TKR patients. CONCLUSION: CRP persists to be the best acute phase reactant in the early post-operative phase with a relatively typical pattern as compared to ESR. CRP values peak at postoperative day 2nd and then show a gradual decline. However, its normalisation to pre-operative baseline values may vary among different groups of population.

Sukriti Gupta,1 Priyanka Singh,2 Mrityunjay Singh,1 Mayuresh Naik,3 Kartikeya Srivastava1 1Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, New Delhi, 110029, India; 2Department of Ophthalmology, ESI Medical College and Hospital, Faridabad, Haryana, 121012, India; 3Department of Ophthalmology, H.I.M.S.R & H.A.H. Centenary Hospital, New Delhi, 110062, IndiaCorrespondence: Mayuresh NaikDepartment of Ophthalmology, H.I.M.S.R & H.A.H. Centenary Hospital, Room no. 3 of Eye OPD, 1st Floor of OPD Building, Near GK-2, Alaknanda, New Delhi, 110062, IndiaTel +91-8287344576Email mayureshpnaik@gmail.comPurpose: To compare the efficacy of eye-drop interferon (IFN) α-2b 1 millionIU/mL with eye-ointment tacrolimus 0.03% in refractory vernal keratoconjunctivitis (VKC).Materials and Methods: Fifty patients with VKC refractory to conventional treatment with topical corticosteroids and antihistamines after 4 weeks of regular use were selected retrospectively. Patients were divided into two groups depending on whether they received eye-ointment tacrolimus 0.03% three times a day or eye-drop IFN alpha-2b 1 millionIU/mL three times a day and were followed up for 24 months. The main outcome measures were total subjective symptom score (TSSS) and total objective ocular score (TOSS).Results: Mean baseline TSSS was 7.24± 1.98 in Group A (tacrolimus group) and 7.84± 1.82 in Group B (IFN group), and it reduced to 1.12± 0.83 in Group A and 0.62± 0.41 in Group B at 6 months, which was statistically significant compared to the baseline score (p< 0.05) as well as between the two groups. Mean baseline TOSS was 6.72± 2.07 in Group A and 6.56± 2.04 in Group B, and it improved to 1 month onwards to 1.52± 0.87 in Group A and 1.0± 0.71 in Group B at 6 months, which was statistically significant compared to the baseline score (p< 0.05) as well as between the two groups. Side effects like stinging and burning sensations were seen in the tacrolimus group only.Conclusion: Our study suggests that while both eye-drop IFN α-2b 1 millionIU/mL and eye-ointment tacrolimus eye ointment 0.03% are both safe and effective steroid-sparing agents in steroid-resistant VKC. IFN α-2b results in greater improvement in subjective symptoms and objective signs, has fewer side effects in long term and is better tolerated as compared to tacrolimus.Keywords: refractory vernal keratoconjunctivitis, tacrolimus, interferon α-2b, VKC

Sahil Gupta,1 Scott Palmer,2 Guilherme Ferreira-Dos-Santos,3,4 Mark Friedrich Hurdle2 1Department of Pain Medicine, Southern Illinois Healthcare, Carbondale, IL, USA; 2Department of Pain Medicine, Mayo Clinic, Jacksonville, FL, USA; 3Department of Physical Medicine and Rehabilitation, Central Lisbon University Hospital Center, Lisbon, Portugal; 4NOVA Medical School, NOVA University of Lisbon, Lisbon, PortugalCorrespondence: Sahil GuptaDepartment of Pain Medicine, Southern Illinois Healthcare, 305 W Jackson St Suite 103, Carbondale, IL, 62901, USATel +1 618-351-4972Fax +1 618-457-3020Email sahil.mamc@gmail.comObjective: To evaluate the content of Pain Medicine Fellowship Program websites in the United States of America.Methods: We obtained a list of accredited 104 Pain Medicine Fellowship Program websites from the Accreditation Council for Graduate Medical Education and the Electronic Residency Application Service. Individual Pain Medicine Fellowship Program websites were then evaluated on 14 different criteria. We grouped fellowship programs based on census region and Electronic Residency Application Service participation status, and analyzed the differences using nonparametric statistics.Results: A total of 104 accredited Pain Medicine Fellowship Program websites were evaluated for a total of 14 different criteria. Of the 14 different criteria, an average of 3.94 were described in each website. Number of Fellowship positions per year (71.8%), clinical rotations during the program (65.1%), and faculty background (62.2%) were the most frequently described features on the websites. Night call responsibilities (3.9%), meal allowance (7.8%) and parking availability (10.7%) were the least described features in the websites. There were no significant differences between program websites when grouped by census regions or the participation status in the Electronic Residency Applications Service.Conclusion: The content of Pain Medicine Fellowship Program websites is extremely variable across the United States of America. This study indicates that there is room for improvement and enhancement of the comprehensiveness of website content for the majority of the programs analyzed. Additionally, this study also emphasizes the importance of having accurate and easily available online information in a post-pandemic era, when prospective fellows evaluate programs online through their websites.Keywords: ACGME, application, ERAS, fellowship program, pain medicine, website

Maria Rosa Costanzo,1 Shahrokh Javaheri,2,3 Piotr Ponikowski,4 Olaf Oldenburg,5 Ralph Augostini,3 Lee R Goldberg,6 Christoph Stellbrink,7 Henrik Fox,8 Alan R Schwartz,6 Sanjaya Gupta,9 Scott McKane,10 Timothy E Meyer,10 William T Abraham3 for the remedē®System Pivotal Trial Study Group1Advocate Heart Institute, Naperville, IL, USA; 2Bethesda North Hospital, Cincinnati, OH, USA; 3The Ohio State University, Columbus, OH, USA; 4Department of Heart Diseases, Medical University, Military Hospital, Wroclaw, Poland; 5Ludgerus-Kliniken Münster, Clemens Hospital, Münster, Germany; 6University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; 7Bielefeld Medical Center, Bielefeld, Germany; 8Clinic for General and Interventional Cardiology Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany; 9University of Missouri-Kansas City School of Medicine, Saint Luke’s Mid-America Heart Institute, Kansas City, MO, USA; 10Respicardia, Inc., Minnetonka, MN, USACorrespondence: Maria Rosa CostanzoAdvocate Heart Institute, Naperville, IL, 60566, USAEmail mariarosa.costanzo@aah.orgBackground: The remedē System Pivotal Trial was a prospective, multi-center, randomized trial demonstrating transvenous phrenic nerve stimulation (TPNS) therapy is safe and effectively treats central sleep apnea (CSA) and improves sleep architecture and daytime sleepiness. Subsequently, the remedē System was approved by FDA in 2017. As a condition of approval, the Post Approval Study (PAS) collected clinical evidence regarding long-term safety and effectiveness in adults with moderate to severe CSA through five years post implant.Methods: Patients remaining in the Pivotal Trial at the time of FDA approval were invited to enroll in the PAS and consented to undergo sleep studies (scored by a central laboratory), complete the Epworth Sleepiness Scale (ESS) questionnaire to assess daytime sleepiness, and safety assessment. All subjects (treatment and former control group) receiving active therapy were pooled; data from both trials were combined for analysis.Results: Fifty-three of the original 151 Pivotal Trial patients consented to participate in the PAS and 52 completed the 5-year visit. Following TPNS therapy, the apnea-hypopnea index (AHI), central-apnea index (CAI), arousal index, oxygen desaturation index, and sleep architecture showed sustained improvements. Comparing 5 years to baseline, AHI and CAI decreased significantly (AHI baseline median 46 events/hour vs 17 at 5 years; CAI baseline median 23 events/hour vs 1 at 5 years), though residual hypopneas were present. In parallel, the arousal index, oxygen desaturation index and sleep architecture improved. The ESS improved by a statistically significant median reduction of 3 points at 5 years. Serious adverse events related to implant procedure, device or delivered therapy were reported by 14% of patients which include 16 (9%) patients who underwent a pulse generator reposition or lead revision (primarily in the first year). None of the events caused long-term harm. No unanticipated adverse device effects or related deaths occurred through 5 years.Conclusion: Long-term TPNS safely improves CSA, sleep architecture and daytime sleepiness through 5 years post implant.Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT01816776.Keywords: central sleep apnea, phrenic nerve stimulation

Subir Gupta,1 Nkemcho Ojeh,1 Bidyadhar Sa,2 Md Anwarul Azim Majumder,1 Keerti Singh,1 Oswald Peter Adams1 1Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados; 2Centre for Medical Sciences Education, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, St Augustine, Trinidad and TobagoCorrespondence: Md Anwarul Azim MajumderFaculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, BarbadosEmail azim.majumder@cavehill.uwi.eduBackground: Technology-enhanced learning includes the adaptive e-learning platform, a data-driven method with computer algorithms, providing customised learning enhancing critical thinking of individual learners. “Firecracker” – an online adaptive e-learning platform, and assessment software, promotes critical thinking, helps prepare students for courses and high-stakes examinations, and evaluates progress relative to co-learners. The objectives of this study were to determine the usage rates of Firecracker, examine the performance of Firecracker formative quizzes, identify the correlation between Firecracker use and performance with that of performance at summative course assessments, and assess students’ satisfaction with Firecracker usage.Methods: Study participants were Year-2 MBBS (Bachelor of Medicine, Bachelor of Surgery) students (n=91) of the Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados. The Firecracker Administrator uploaded quizzes covering basic science content in the Cardiovascular System course. Access, usage, and performance on Firecracker formative quizzes were retrieved from the Firecracker dashboard. A questionnaire sought the views of study participants.Results: Seven sets of quizzes were administered over nine weeks, with weekly student completion rates ranging from 53% to 73%. Mean quiz scores ranged from 52% to 72%. Students completing > 4 quiz sessions compared to those completing ≤ 4 demonstrated significantly better performance in Firecracker quizzes (P< 0.01), final examinations (P< 0.01) and in-course assessment plus final examination (P< 0.05) scores. Correlations between overall Firecracker performance and in-course assessment marks (P< 0.05); between total overall Firecracker performance and final examination (P< 0.01); and overall Firecracker performance and total course marks (P< 0.01) were all significant. Most students (70%) were happy using Firecracker and felt it complemented coursework (78%) and prepared them for course exams (58%) (P< 0.01).Conclusion: Overall, Firecracker was perceived very positively and welcomed by the students. Students were satisfied with the Firecracker as a formative assessment tool, and its use correlated with improved performance in the course examinations.Keywords: formative assessment, technology-enhanced learning, adaptive learning, Cardiovascular System course, Firecracker, Barbados

Caroline Beutner,1 Susann Forkel,1 Sidhi Gupta,1 Thomas Fuchs,1 Michael P Schön,1,2 Johannes Geier,2,3 Timo Buhl1,2 1Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany; 2Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany; 3Information Network of Departments of Dermatology (IVDK), University of Göttingen, Göttingen, GermanyCorrespondence: Caroline BeutnerDepartment of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Georg August University, Robert Koch-Str. 40, Göttingen D-37075, GermanyTel +495513966402Email caroline.beutner@med.uni-goettingen.deIntroduction: The prevalence of airway allergies in Europe has increased from 23% to 31% in recent years. Polysensitization is associated with the development and severity of relevant allergies, particularly allergic asthma.Objective: We investigated age- and sex-dependent monosensitization and polysensitization profiles as well as patterns of sensitization using skin prick test (SPT) reactivity to the most common aeroallergens.Patients and Methods: From 1998 to 2017, SPTs were retrospectively analyzed in 2886 symptomatic patients, referred to the University Medical Center Göttingen, located in central Germany. The major aeroallergen groups early flowering tree pollen, grass pollen, and house dust mites were evaluated in this study. Wheal diameters ≥ 2 mm were considered positive during the entire study period.Results: Polysensitization to the most common aeroallergen groups increased significantly over 20 years. Boys and young men displayed the most remarkable rise in total sensitization rates in our study group over time.Discussion: Our patient-based study demonstrates a continuing increase in polysensitization rates over the last 20 years, with boys and young men being most frequently affected. Our data—without being a population-based study—suggest a scenario with climbing rates of allergic rhinitis and asthma.Keywords: aeroallergens, polysensitization, sensitization pattern, skin prick test

Sangeeta Abrol,1 Sukriti Gupta,1 Mayuresh Naik,2 Siddharth Agarwal3 1Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, New Delhi 110029, India; 2Department of Ophthalmology, H.I.M.S.R & H.A.H. Centenary Hospital, New Delhi 110062, India; 3Department of Research, Mayo Clinic, Rochester, MN, USACorrespondence: Mayuresh NaikDepartment of Ophthalmology, H.I.M.S.R & H.A.H. Centenary Hospital, Room No. 3 of Eye OPD, 1st Floor of OPD Building, Near GK-2, Alaknanda, New Delhi 110062, IndiaTel +91-8287344576Email mayureshpnaik@gmail.comPurpose: To determine whether macular volume and macular GCA measurements in patients are comparable to their RNFL thickness parameters.Materials and Methods: The cross-sectional, observational study was conducted on 1380 eyes with 460 each, into three groups. Group I: patients with healthy eyes. Group II: patients diagnosed as pre-perimetric glaucoma. Group III: patients with diagnosed perimetric glaucoma. After patients were selected on the basis of inclusion and exclusion criteria, baseline standard ophthalmic examination was done by the same operator under the same settings, including SD-OCT using both the Spectralis SD-OCT and the Cirrus SD-OCT as elaborated below.Statistical Analysis: Data were checked for normality before statistical analysis using Shapiro–Wilk test. Normally distributed continuous variables were compared using ANOVA. For all statistical tests, a p < 0.05 was taken to indicate a significant difference. Receiver operating characteristic (ROC) curves were used to define the ability RNFL and GCC parameters to distinguish perimetric and preperimetric glaucomatous eyes from control eyes.Results: There was a statistically significant difference in the average, superior, inferior RNFL thickness and average, superior, inferior GCIPL thickness between Group I and Group II (p< 0.001), between Group I and Group III (p< 0.001) and also between Group II and Group III (p< 0.001). The statistical significance was also reflected in their AUROCs.Conclusion: Mean, superior, inferior GCIPL thickness along with macular volume analysis can substantiate RNFL analysis for diagnosis, serial monitoring and follow-up of glaucoma patients and suspects.Keywords: RNFL, GCC, perimetric glaucoma, pre-perimetric glaucoma

Somya Chowdhary,1 Pooja Garg,2 Vivek Sawhney,2 Abhijit Pandya,2 Kumar Sambhav,3 Shailesh Gupta2 1Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; 2Specialty Retina Centre, Coral Springs, FL, USA; 3Department of Ophthalmology, University of Florida, Jacksonville, FL, USACorrespondence: Shailesh GuptaSpecialty Retina Centre, Coral Springs, FL 33067, USATel +1561 322-3588Email sgupta1997@yahoo.comBackground: Penetrating intraorbital foreign body (IOFB) is usually associated with high-velocity trauma forces around the eye. IOFB injury to globe or optic nerve is considered a surgical emergency; an immediate diagnosis and management plan is generally indicated.Methods: A case report (design). The patient was a 78-year-old male presented with diminution of vision of the right eye following a high-velocity injury. The patient was noted to have a closed globe injury with associated retinal detachment and vitreous hemorrhage. An initial orbital CT scan did not reveal any IOFB, despite and intact globe. However, repeat a CT head and orbit scan revealed an intracranial magnetic foreign body lodged in the right frontal lobe.Conclusion: A CT scan of the brain and paranasal sinuses should be obtained along with a CT orbit in case of high-velocity orbital/ocular trauma.Keywords: intraorbital foreign body, IOFB, intracranial foreign body, CT scan, retinal detachment

Iraj Poureslami, 1, 2 Jessica Shum, 1, 2 Jacek Kopec, 3 Richard Sawatzky, 4 Samir Gupta, 5 Smita Pakhale, 6 Saron Kassay, 1, 2 Kassie Starnes, 1, 2 Alizeh Akhtar, 2 J Mark FitzGerald 1, 2 On behalf of the Canadian Airways Health Literacy Study Group 1Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, BC V5Z 1M9, Canada; 2Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada; 3Division of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada; 4School of Nursing, Trinity Western University, Langley, BC V2Y 1Y1, Canada; 5Division of Respirology, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; 6Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, CanadaCorrespondence: J Mark FitzGeraldDivision of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Gordon and Leslie Diamond Healthcare Centre, The Lung Centre, 7th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, CanadaTel +1 604 875 4122Email mark.fitzgerald@vch.caBackground: Health literacy (HL) is a person’s ability to practically apply a wide range of cognitive and non-cognitive skills in health-related decisions. HL includes five domains: navigate/access, understand, communicate, evaluate, and use of health information and services. Currently, no tool accurately captures and measures HL in adult patients with asthma and COPD, while utilizing all 5-HL domains.Objective: Develop a comprehensive functional-based measurement tool for adult asthma and/or COPD patients, while assessing HL on routine actions required to manage their chronic respiratory condition(s).Methods: We developed our HL tool based on a conceptualization of the link between HL and asthma and COPD management, during needs assessment stage including; a systematic review, which was followed by patient-oriented focus groups, and key-informant and respirologist interviews. Preliminary face and content validation were obtained by patients’ and health professionals’ input prior to the pretesting stage. The needs assessment information enabled us to develop passages in scenario-format and corresponding items to assess HL core domains, in addition to numeracy skills, across nine self-management topics: peak flow meters, prednisone use, pulmonary rehabilitation, action plans, flu shots, inhaler technique, lifestyle (nutrition and exercise), trigger control, and map navigation. The tool was pretested with asthma and COPD patients to assess its relevance, clarity, and difficulty.Results: Our systematic review identified the deficiencies of existing HL tools that assessed the HL skills of asthma and COPD patients. The patient-oriented focus groups (n=93) enabled us to identify self-management topics and develop items for our proposed HL tool, which were enriched by input from 45 key informants (eg, policy makers, clinicians, etc.) and 17 respiratory physicians. Preliminary pretesting with a new cohort of participants (36 asthma and COPD patients and 39 key informants) aided in the refinement and finalized our tool. The modified tool included passages and corresponding items related to asthma and COPD management was pretested with 75 asthma/COPD patients who completed the questionnaire and provided their feedback on the clarity, relevance, and difficulty of the tool. The main barrier to self-management pertained to “communication” skills. The flu shot was the most relevant topic (91.2%), while map navigation was the least relevant (63.9%). Action plans were the most difficult topic, where only 55% knew when to utilize their action plans. Numeracy items challenged COPD patients the most.Conclusion: We summarized findings from the development and preliminary testing stages of a new asthma/COPD HL tool. This tool will now be validated with a new cohort of patients.Practice Implications: Knowledge gained in this study has been applied to the final version of the tool, which is currently being validated.Keywords: COPD and asthma management, health literacy, measurement tool, functional skills

Amit Verma,1 Rohit Mathur,2 Abdullah Farooque3,†, Vandana Kaul,4 Seema Gupta,5 Bilikere S Dwarakanath6 1Armed Forces Radiobiology Research Institute, Uniformed Services University, Bethesda, MD, USA; 2Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 3Georgia Cancer Center, Augusta University, Georgia, GA, USA; 4Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, CA, USA; 5Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA; 6Shanghai Proton and Heavy Ion Center, Shanghai, People’s Republic of China†Dr. Abdullah Farooque passed away on August 19, 2016Correspondence: Seema GuptaLombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USAEmail sg1335@georgetown.eduBilikere S DwarakanathShanghai Proton and Heavy Ion Center, Shanghai, People’s Republic of ChinaEmail dwarakanath@sphic.org.cnAbstract: Regulatory T cells (Tregs) are important members of the immune system regulating the host responses to infection and neoplasms. Tregs prevent autoimmune disorders by protecting the host-cells from an immune response, related to the peripheral tolerance. However, tumor cells use Tregs as a shield to protect themselves against anti-tumor immune response. Thus, Tregs are a hurdle in achieving the complete potential of anti-cancer therapies including immunotherapy. This has prompted the development of novel adjuvant therapies that obviate their negative effects thereby enhancing the therapeutic efficacy. Our earlier studies have shown the efficacy of the glycolytic inhibitor, 2-deoxy-D-glucose (2-DG) by reducing the induced Tregs pool and enhance immune stimulation as well as local tumor control. These findings have suggested its potential for enhancing the efficacy of immunotherapy, besides radiotherapy and chemotherapy. This review provides a brief account of the current status of Tregs as a component of the immune-biology of tumors and various preclinical and clinical strategies pursued to obviate the limitations imposed by them in achieving therapeutic efficacy.Keywords: T-regulatory cells, cyclophosphamide, dendritic cells, immune enhancement, targeted cancer therapy, 2-deoxy-D-glucose, metabolic inhibitor

Mohsin Faysal Butt,1,2 Louise Salmon,3 Fahira Mulamehic,4 Avelyn Hixon,2 Abdul Rehman Moodambail,5 Sandy Gupta2 1Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AJ, UK; 2Cardiology Department, Whipps Cross University Hospital, Barts Health NHS Trust, London E11 1NR, UK; 3Refugee Assessment and Guidance Unit (RAGU), London Metropolitan University, London, UK; 4British Refugee Council, London, UK; 5Paediatrics Department, Newham University Hospital, Barts Health NHS Trust, London E13 8SL, UKCorrespondence: Mohsin Faysal ButtBarts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AJ, UKEmail mohsinfaysalbutt@doctors.org.ukPurpose: Refugee healthcare professionals (RHPs) may encounter several barriers to employment upon moving to the UK, such as conversion of professional qualifications and a lack of familiarity with the recruitment process. The Building Bridges Programme (BBP) is a London-based multi-agency collaboration which helps refugee healthcare professionals seek employment in the UK National Health Service (NHS).Methods: We have kept an electronic database of all RHPs who have participated in the BBP from October 2009 to March 2018. Data collected include gender, language spoken, country of initial medical qualification, immigration status, religion, ethnicity and professional work experience. In this paper, we focus on employment outcomes and determine the proportion (%) of RHPs joining the BBP who enter employment in the NHS.Results: Between October 2009 and March 2018, the BBP supported 372 refugee doctors, 42 refugee pharmacists, 69 refugee dentists, 25 refugee biomedical scientists, 4 refugee physiotherapists and 83 refugee nurses. The following are the results for the RHPs who settled into a registered NHS position appropriate to their (home country) professional qualifications: 98/372 (26%) doctors, 4/42 (10%), pharmacists, 17/69 (25%) dentists, 1/25 (9%) biomedical scientists, 1/4 (25%) physiotherapists and 2/83 (2%) nurses. The following are the results for the RHPs who settled in associated healthcare profession positions: 109/372 (29%) doctors, 16/42 (38%) pharmacists, 12/69 (17%) dentists, 10/25 (40%) biomedical scientists, 3/4 (75%) physiotherapists and 34/83 (41%) nurses.Conclusion: The BBP provides a useful model that is transferable to other countries. Future studies assessing the utility of such programmes should ensure that the long-term employment outcomes of RHPs are more closely tracked. A key limitation of this paper is the absence of a control group of participants who did not join the BPP, which would help to conclusively demonstrate whether participants who joined our programme had a statistically significant improvement in employment outcomes.Keywords: refugees, curriculum development, education, employment

Objectives: This study aims to examine the correlation between the different types of migrant acculturation strategies according to Berry’s model of acculturation (integration, assimilation, separation, and marginalisation) and their effects on mental health conditions, such as depression, anxiety and PTSD. Study design: Systematic Review. Methods: Three databases (PubMed, Ovid and Ebsco) were searched using different combinations of search terms to identify relevant articles to be included. The search terms were pre-identified using relevant synonyms for “migrants”, “mental health” and “integration”. The list of article titles from these searches were then filtered using predefined inclusion and exclusion criteria. The mental health consequences included a range of common conditions including suicide/self-harm, depressive disorders, psychosis, as well as substance misuse. Results: 21 primary studies were included in the review, which assessed 61,885 migrants in total (Fig. 1 and Supplemental File 1). Of these, seven were cohort studies and fourteen were cross-sectional studies.Most studies showed that marginalisation was associated with worse depression symptoms, compared to integration, assimilation and separation, while integration was associated with the least depressive symptoms.Marginalisation more than triples the likelihood of anxiety-related symptoms compared to integration. Similarly, separation increased the likelihood of anxiety-related symptoms nearly six-fold. Conclusions: Our review found out that marginalisation had the worst effects on mental health of the migrant populations while integration had the most positive effects. The study also identified three key sources which may contribute to acculturation stress and worse mental health: low education or skill set, proficiency of the host country’s language, and financial hardships.

Introduction: Early diagnosis of osteoarticular tuberculosis (OATB) is essential to prevent significant functional disability. There is no single test for diagnosis. Despite an array of investigations available, definitive diagnosis at early stage before starting antitubercular drugs is still a challenge. Materials and Methods: A cross sectional study was carried out between February 2016 and October 2017. All children less than 18 years of age with suspected osteoarticular tuberculosis were included. The cases were subjected to simple needle aspiration from whichever site was accessible. Multiple sample aspirations were done at site of involvement. Smears were prepared from the aspirated material. Results: Ziehl-Neelsen staining for Acid Fast Bacilli (AFB) showed deep pink red rods under light microscopy. Features suggestive of tuberculosis can be seen by May-GrünwaldGiemsa (MGG) staining. Auramine-O staining method of detecting AFB under fluorescent microscope shows the bacilli as greenish yellow slender curved rods in dark background. Fluorescent microscopy has higher sensitivity and comparable specificity. In our study, microbiological confirmation of OATB could be done in 100% cases where the lesion could be accessed for aspiration. The molecular techniques are relatively more expensive and not available everywhere. Conclusion: Meticulous search for AFB in a well stained smear using three different staining methods provides a direct evidence of infection over costly imaging especially in poor patients seen in resource limited settings.

Sanjay Kumar Singh, Santosh Pokalwar, Sandip Bose, Shivika Gupta, Suhani Almal, Ranjit Sudhakar Ranbhor Sun Pharmaceutical Industries Limited, Tandalja, Vadodara 390 012, India Background: Cell surface protein, CD20, is extensively expressed on the surface of B cells. Antibodies targeting CD20 protein are being used to treat B-cell malignancies and B-cell mediated autoimmune diseases. Considering the cost of therapy with innovator monoclonal antibodies for these diseases, development of biosimilar products for the treatment of such diseases provides affordable solution to rising healthcare costs. Materials and Methods: Reference products of rituximab (six batches) were procured and stored as per manufacturer's instructions. Cell lines used in bioassay were procured from American Type Culture Collection and all other reagents used for analysis were of analytical grade. Primary structure was studied by intact mass analysis, peptide fingerprinting, peptide mass fingerprinting and sequence coverage analysis. Higher order structure was studied by circular dichroism, ultraviolet-visible spectroscopy, fluorescence spectroscopy, and disulfide bridge analysis. Different isoforms of reference product and SB-02 were identified using capillary isoelectric focusing and capillary zone electrophoresis. Glycosylation was studied by N-glycan mapping using LC-ESI-MS, point of glycosylation, released glycan analysis using ultra performance liquid chromatography (UPLC). Product related impurities such as oligomer content analysis and oxidized impurities were studied using size exclusion chromatography and reverse phase high performance liquid chromatography, respectively.Results and Conclusion: Here, we report physicochemical and biological characterizations of Sun Pharma’s proposed biosimilar (SB-02) to rituximab, a monoclonal anti-CD20 antibody approved for the treatment of non-Hodgkin’s lymphoma and chronic lymphocytic leukemia. SB-02 and rituximab exhibited indistinguishable primary as well as higher-order structure upon analyzing with the array of analytical and extended characterization methods according to statistical methods. The molecule also displayed comparability to reference product in post-translational modifications and charge heterogeneity. In functional bioassays, SB-02 demonstrated comparable potency with respect to reference product. Our results indicate highly similar quality profile between SB-02 and rituximab. Keywords: biosimilar, rituximab, CD20, monoclonal antibody, Biosimilarity, ADCC, CDC

David D Stenehjem,1,2 Dao Tran,1 Michael A Nkrumah,1 Shilpa Gupta2,3 1Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, 2Masonic Cancer Center, University of Minnesota, 3Division of Hematology, Oncology and Transplantation, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA Introduction: Until recently, systemic chemotherapy was the only option for treating bladder cancer and outcomes remained dismal. After a long gap of no progress for 40 years, immunotherapy with checkpoint inhibitors (PDL1 and PD1) has revolutionized the treatment paradigm of bladder cancer, with five approved agents to treat platinum-refractory bladder cancer since the first approval of atezolizumab in May 2016. Methods: This review summarizes the most recent data on approved checkpoint inhibitors currently used in management of advanced bladder cancer. Early- and late-phase trials of the five checkpoint inhibitors (pembrolizumab, nivolumab, atezolizumab, durvalumab, and avelumab) in advanced bladder cancer are reviewed in detail. This review also describes the potential application of PD1/PDL1 inhibitors in adjuvant and neoadjuvant settings and non-muscle-invasive bladder cancer, as well as with radiation in muscle-invasive bladder cancer treatment. The role of PDL1 and tumor-mutation burden and clinical considerations in choosing a particular immunotherapy are also discussed. Results: The approved checkpoint inhibitors (PD1 and PDL1 inhibitors) have similar efficacy and safety profiles in metastatic platinum-refractory bladder cancer, but they vary in dose and frequency and cost burden. However, only pembrolizumab has shown superiority over standard chemotherapy in a randomized Phase III setting so far. In addition, in the first-line setting for cisplatin-ineligible patients, both pembrolizumab and atezolizumab are US Food and Drug Administration-approved and well tolerated. There is a lack of consensus on the utility of testing for PDL1 as a predictive biomarker, as patients with no PDL1 expression also derive some clinical benefit. Tumor-mutation burden is another predictive biomarker, but needs further validation. Conclusion: Immunotherapy has offered a glimmer of hope to patients with bladder cancer. The current landscape is rapidly evolving, with novel immunotherapy-combination trials to improve outcomes further and evaluate predictive biomarkers to help identify patients most likely to benefit from such therapies. Keywords: pembrolizumab, checkpoint inhibitors, urothelial cancer, tumor-mutation burden, bladder cancer, immunotherapy

Shikha Gupta,1 Mary Ann McColl,1 Sara J Guilcher,2 Karen Smith3 1School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada; 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; 3Department of Physical Medicine and Rehabilitation, School of Medicine, Queen’s University, Kingston, ON, Canada Purpose: The evidence is emerging that prescription medications are the topmost drivers of increasing health care costs in Canada. The financial burden of medications may lead individuals to adopt various rationing or restrictive behaviors, such as cost-related nonadherence (CRNA) to medications. Therefore, the purpose of this study is to provide an overview of the type, extent, and quantity of research available on CRNA to prescription drugs in Canada, and evaluate existing gaps in the literature.Methods: The study was conducted using a scoping review methodology. Six databases were searched from inception till June 2017. Articles were considered for inclusion if they focused on extent, determinants, and consequences of CRNA to prescription medication use in the Canadian context. Variables extracted for data charting included author(s), year of publication, study design, the focus of the article, sample size, population characteristics, and key outcomes or results.Results: This review found 37 studies that offered evidence on the extent, determinants, and consequences of CRNA to prescription medications in Canada. Depending on the population characteristics and province, the prevalence of CRNA varies between 4% and 36% in Canada. Canadians who are young (between 18 and 64 years), without drug insurance, have lower income or precarious or irregular employment, and high out-of-pocket expenditure on drugs are most likely to face CRNA to their prescriptions. The evidence that CRNA has negative health and social outcomes for patients is insufficient. Literature regarding the influence of prescribing health care professionals on patients’ decisions to stop taking medications is limited. There is also a dearth of literature that explores patients’ decisions and strategies to manage their prescription cost burden.Conclusion: More evidence is required to make a strong case for national Pharmacare which can ensure universal, timely, and burden-free access to prescription medications for all Canadians. Keywords: Pharmacare, medication adherence, drug costs, drug insurance

Robert A Hauser,1 Aaron Ellenbogen,2 Sarita Khanna,3 Suneel Gupta,3 Nishit B Modi3 1Departments of Neurology, Molecular Pharmacology, and Physiology, University of South Florida, Tampa, FL, USA; 2Quest Research Institute, Bingham Farms, MI, USA; 3Impax Laboratories, Inc., Hayward, CA, USA Background: In patients with Parkinson’s disease (PD), oral dosing of extended-release carbidopa-levodopa (Rytary, IPX066 [ER CD-LD]) achieves peak levodopa plasma concentrations within 1 hour and maintains them for 4–6 hours. Aims: To compare the onset and duration of ER CD-LD benefit with those of immediate-release carbidopa-levodopa (IR CD-LD) in PD patients with motor fluctuations, using crossover data, and to evaluate which threshold values of improvement in finger-tapping and Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores yield results most similar to those for trained raters’ “on”/“off” assessments. Methods: Patients underwent serial “on”/“off” rating and provided serial finger-tapping and UPDRS motor scores after receiving, in an “off” state, their usual morning IR dose or an ER dose designed to produce a similar levodopa peak concentration. Predefined improvement thresholds for analysis were 10%, 15%, and 20% increases in finger-tapping score and 2.5, 5, 7, and 11-point decreases in UPDRS motor score. Serial plasma samples were assayed for levodopa. Results: Among 27 patients, mean time to onset of an “on” state was similar for ER compared with IR CD-LD (0.83 vs 0.81 hour), but mean duration was significantly longer for ER CD-LD than for IR CD-LD (5.56 vs 2.69 hours; P

Femoral condyle fracture in coronal plane, also known as Hoffa fracture, is a rare fracture. Non-union of Hoffa fracture is even rarer. We present a case of fibrous nonunion of a Hoffa fracture in which the fractured fragment, though not freely movable, led to painful walking. Since the fragment was un-displaced and non-movable we fixed the fractured fragment in situ. Patient regained full range of motion of the knee and was asymptomatic on follow-up.

Niranjan J Sathianathen,1 Suprita Krishna,1 J Kyle Anderson,1,2 Christopher J Weight,1,2 Shilpa Gupta,2,3 Badrinath R Konety,1,2 Thomas S Griffith1,2,4,5 1Department of Urology, 2Masonic Cancer Center, 3Division of Hematology, Oncology, and Transplantation, 4Center for Immunology, 5Microbiology, Immunology, and Cancer Biology Graduate Program, University of Minnesota, Minneapolis, MN, USA Abstract: The management of metastatic renal-cell carcinoma (mRCC) represents an important clinical challenge. Since being approved in the early 1990s, aspecific immunotherapy has been a mainstay of treatment for mRCC and the only therapy that has demonstrated long-term cures for mRCC. However, in recent times there have been landmark advances made in the field of specific immunotherapy for a number of malignancies, including kidney cancer. This review outlines the range of immunobased agents currently available for the treatment of mRCC. Keywords: immunotherapy, cryosurgery, kidney neoplasm, vaccines, targeted therapy, immunocheckpoints

Gursaran P Talwar,1 Jagdish C Gupta,1 Abu S Mustafa,2 Hemanta K Kar,3 Kiran Katoch,4 Shreemanta K Parida,5 Prabhakara P Reddi,6 Niyaz Ahmed,7 Vikram Saini,8 Somesh Gupta9 1Talwar Research Foundation, New Delhi, India; 2Department of Microbiology, Kuwait University, Kuwait; 3Department of Dermatology, Paras Hospital, Gurgaon, 4National JALMA Institute of Leprosy and Other Mycobacterial Diseases, Agra, India; 5German Centre of Infection, Justus Liebig University, Giessen, Germany; 6Department of Comparative Biosciences, University of Illinois Urbana Champaign, IL, USA; 7Department of Biotechnology and Bioinformatics, University of Hyderabad, Hyderabad, India; 8Department of Microbiology, University of Alabama, Birmingham, AL, USA; 9Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India Abstract: This article reviews briefly the making of an immunoprophylactic-cum-immunotherapeutic vaccine against leprosy. The vaccine is based on cultivable, heat-killed atypical mycobacteria, whose gene sequence is now known. It has been named Mycobacterium indicus pranii. It has received the approval of the Drug Controller General of India and the US Food and Drug Administration. Besides leprosy, M. indicus pranii has found utility in the treatment of category II (“difficult to treat”) tuberculosis. It also heals ugly anogenital warts. It has preventive and therapeutic action against SP2/O myelomas. It is proving to be a potent adjuvant for enhancing antibody titers of a recombinant vaccine against human chorionic gonadotropin, with the potential of preventing pregnancy without derangement of ovulation and menstrual regularity in sexually active women. Keywords: leprosy, tuberculosis, anogenital warts, myeloma, adjuvant

Sanjiv Gupta Department of Interventional Cardiology, Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, Jaipur, India Abstract: The aim of this manuscript is to review available data to evaluate the present status of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in the treatment of hypercholesterolemia. Relevant literature since 2003 is reviewed. The effectiveness of PCSK9 inhibitors in lowering low-density lipoprotein cholesterol and other atherogenic lipid fractions was studied in various Phase 2 and Phase 3 trials of Alirocumab, Evolocumab, and Bococizumab. The results of published long-term ODYSSEY and OSLER studies are summarized. There have been three excellent meta-analysis studies on PCSK9 inhibitors which are outlined. The complex problem of cost-effectiveness was carefully evaluated by the Institute for Clinical and Economic Review (ICER). The draft report (ICER-2015) is summarized herewith. The cardiovascular outcome trials with Evolocumab (FOURIER), Alirocumab (ODYSSEY OUTCOME) and Bococizumab (SPIRE-1 and SPIRE-2) are the ongoing clinical trials, and their results are expected in 2017–2018. The search for new cost-effective analogs of PCSK9 inhibitors is ongoing. Keywords: PCSK9, LDLc, ASCVD

Shweta Gupta, Mohammad Javed Ali, Milind N Naik Govindram Seksaria Institute of Dacryology, L. V. Prasad Eye Institute, Hyderabad, India Purpose: The objective of this study was to ascertain the lacrimal drainage anomalies in a cohort of patients suffering from congenital rubella syndrome (CRS).Methods: This was a retrospective case series performed in patients with CRS presenting with associated lacrimal drainage anomalies (LDA) over 6 years from 2011 to 2016. All the patients were confirmed as having CRS after clinical and laboratory testing. Data collected include demographics; associated lacrimal, ocular, and systemic anomalies; interventions performed for lacrimal anomalies; and their anatomical and functional outcomes.Results: Eighty five patients were diagnosed as having CRS during the study period, and of these 23 eyes of 12 patients with associated LDA were included in the study. The prevalence of LDA was 14% in CRS. The mean age at presentation was 15.5 weeks, and all except one had bilateral presentation. Seventeen eyes were diagnosed with simple congenital nasolacrimal duct obstruction (CNLDO) and the remaining six eyes had complex CNLDO with buried probes. Additional lacrimal anomalies noted in the six complex CNLDO cases included punctal agenesis (n=3), atonic sac (n=3), incomplete punctal canalization (n=2), and single canalicular wall hypoplasia (n=1). At a mean follow-up of 12.54 months, anatomical and functional success were noted in 91.3% (21/23 eyes).Conclusion: Simple CNLDO was the most common of the LDA in CRS. Buried probe was universal among the cases with complex CNLDO. All CRS patients should be screened for lacrimal anomalies to initiate appropriate interventions for successful outcomes. Keywords: rubella, lacrimal drainage, CNLDO, buried probe, punctal agenesis

The laboratory testing process is divided into the pre-analytical, analytical and post-analytical phases. For obtaining reliable test results, the prevention and detection of errors at all steps is required. While analytical standards have been developed by recognized quality control criteria, there is a scarcity in the development of standards for the preanalytical phase. This phase is most prone to errors as the steps involved are directly dependent on humans and are out of direct control of the laboratory. Such errors in preanalytical stage often only become apparent in the analytical or post-analytical phase. The development of a pre-analytical quality manual is essential in achieving total quality control. Correct practices and strategies of error prevention can reduce preanalytical errors. This review focuses on prevention of pre-analytical errors that occur while collecting a specimen of blood, urine and cerebrospinal fluid. Most of these can be easily prevented with understanding and education of the personnel involved in and responsible for executing this crucial pre-analytical phase.

Nandita Mehta, Sunana Gupta, Atul Sharma, Mohd Reidwan Dar Department of Anesthesiology and Intensive Care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India Abstract: Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency. Keywords: geriatric anesthesia, bupivacaine, segmental anesthesia, laparoscopic surgery

Shaloo Gupta,1 Gina Isherwood,2 Kevin Jones,3 Kristel Van Impe4 1Kantar Health, Princeton, NJ, USA; 2Kantar Health, Epsom, Surrey, UK; 3European Federation of Associations of Families of People with Mental Illness, Diestsevest, Leuven, Belgium; 4Janssen-Cilag GmbH, Neuss, Germany Objective: This study aimed to understand the impact of providing care for adults with schizophrenia on productivity, resource utilization, and costs in the EU5 (France, Germany, Italy, Spain, and UK). Methods: Data from the 2010, 2011, and 2013 EU5 National Health and Wellness Survey, an online questionnaire of a nationwide sample of adults, were analyzed. Schizophrenia caregivers (n=398) were matched to noncaregivers (n=158,989) and other caregivers (n=14,341) via propensity scores. Outcome measures included health care utilization, Work Productivity and Activity Impairment questionnaire-based scores, and associated direct and indirect costs (estimated from the literature). Significant differences between schizophrenia caregivers vs noncaregivers and other caregivers (eg, cancer and Alzheimer's disease) were examined. Results: After matching, schizophrenia caregivers reported greater activity impairment (38.4% vs 26.1%), provider visits (8.0 vs 5.7), emergency room visits (0.9 vs 0.2), hospitalizations (0.8 vs 0.1), and direct costs (€2,258 vs €617) than noncaregivers, all P

Shaloo Gupta,1 Lance Richard,2 Anna Forsythe3 1Kantar Health, Princeton, NJ, USA; 2Eisai Europe Ltd, Hatfield, UK; 3Eisai Inc., Woodcliff Lake, NJ, USA Objectives: This study evaluated the association of body mass index (BMI) with health-related quality of life (HRQoL), health utilities, health care resource utilization, productivity, activity impairment, and the associated costs. Methods: Results were from the 2013 EU5 (France, Germany, Italy, Spain, UK) National Health and Wellness Survey, a nationally representative, online survey of respondents aged ≥18 years. Analyses focused on normal weight (BMI ≥18.5 kg/m2 and BMI

Smita Joshi,1 Vinay Kulkarni,2 Trupti Darak,2 Uma Mahajan,1 Yogesh Srivastava,3 Sanjay Gupta,3 Sumitra Krishnan,1 Mahesh Mandolkar,2 Alok Chandra Bharti31Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Jehangir Hospital Premises, Pune, Maharashtra, India; 2Prayas Health Group, Amrita Clinic, Pune, India; 3Institute for Cytology and Preventive Oncology, Indian Council of Medical Research, New Delhi, IndiaObjective: Female sex workers (FSWs) are at an increased risk of human immunodeficiency virus (HIV) as well as human papillomavirus (HPV) infections and thus have an increased risk of cervical intraepithelial neoplasia (CIN) and cervical cancer. We evaluated the feasibility of “screen and treat approach” for cervical cancer prevention and the performance of different screening tests among FSWs.Methods: Women were screened using cytology, VIA (visual inspection with acetic acid), and VILI (visual inspection with Lugol’s iodine) and underwent colposcopy, biopsy, and immediate treatment using cold coagulation, if indicated, at the same visit.Results: We screened 300 FSWs of whom 200 (66.67%) were HIV uninfected and 100 (33.34%) were HIV infected. The overall prevalence of CIN 2–3 lesions was 4.7%. But all women with CIN 2–3 lesions were HIV infected, and thus the prevalence of CIN 2–3 lesions in HIV-infected FSWs was 14/100 (14%, 95% confidence interval: 7.2–20.8). All of them screened positive by all three screening tests. Cold coagulation was well tolerated, with no appreciable side effects.Conclusion: Cervical cancer prevention by “screen and treat” approach using VIA, followed by ablative treatment, in this high-risk group of women is feasible and can be implemented through various targeted intervention programs. Keywords: cytology, VIA, VILI, CIN, cold coagulation, cervical cancer, HPV, FSWs

DC Doval,1 K Prabhash,2 S Patil,3 H Chaturvedi,4 C Goswami,5 AK Vaid,6 S Desai,2 S Dutt,7 VH Veldore,8 N Jambhekar,2 A Mehta,1 D Hazarika,8 S Azam,1 S Gawande,9 S Gupta10 1Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, 2Tata Memorial Hospital, Mumbai, 3Bangalore Institute of Oncology, HCG Group, Bengaluru, 4Max Super Speciality Hospital, New Delhi, 5B. P. Poddar Hospital, Kolkata, 6Medanta The Medicity, Gurgaon, 7Oncquest Laboratories Ltd., New Delhi, 8Triesta Reference Laboratory, HCG Group, Bengaluru, 9Pfizer India Ltd., Mumbai, 10Catalyst Clinical Services Pvt. Ltd., New Delhi, India Background: Mutation in the tyrosine kinase domain of epidermal growth factor receptor (EGFR) is a common feature observed in lung adenocarcinoma. A fusion gene between echinoderm microtubule-associated protein-like 4 (EML4) and the intracellular domain of anaplastic lymphoma kinase (ALK), named EML4-ALK, has been identified in a subset of non-small-cell lung cancer (NSCLC) tumors. The objective of this study was to determine the prevalence of EGFR mutations and EML4-ALK fusions in Indian patients with NSCLC (adenocarcinoma) as well as evaluate their clinical characteristics.Patients and methods: Patients with NSCLC, adenocarcinoma histology, whose tumors had been tested for EGFR mutational status, were considered for this study. ALK gene rearrangement was detected by fluorescence in situ hybridization using the Vysis ALK Break Apart Rearrangement Probe Kit. ALK mutation was tested in samples that were negative for EGFR mutation.Results: A total of 500 NSCLC adenocarcinoma patients were enrolled across six centers. There were 337 (67.4%) men and 163 (32.6%) women with a median age of 58 years. One hundred and sixty-four (32.8%) blocks were positive for EGFR mutations, whereas 336 (67.2%) were EGFR wild-type. Of the 336 EGFR-negative blocks, EML4-ALK fusion gene was present in 15 (4.5%) patients, whereas 321 (95.5%) tumors were EML4-ALK negative. The overall incidence of EML4-ALK fusion gene was 3% (15/500).Conclusion: The incidence of EGFR mutations (33%) in this Indian population is close to the reported incidence in Asian patients. EML4-ALK gene fusions are present in lung adenocarcinomas from Indian patients, and the 3% incidence of EML4-ALK gene fusion in EGFR mutation-negative cases is similar to what has been observed in other Western and Asian populations. The mutual exclusivity of EML4-ALK and EGFR mutations suggests implementation of biomarker testing for tumors harboring ALK rearrangements in order to identify patients that can benefit from newer targeted therapies. Keywords: NSCLC, Crizotinib, Vysis ALK Break Apart Rearrangement Probe Kit