Search

Introduction: Orthopaedic surgeons are among the most frequent users of radiation and are often exposed to X-Ray radiation regularly. There is an overall unsatisfactory level of knowledge, attitude, and practices regarding the same among surgeons. This study aimed to assess the practices among orthopaedic surgeons regarding radiation and its hazards in India. Methodology: This questionnaire-based survey was conducted between March and September 2022. The questionnaire broadly assessed the knowledge, awareness, and practices among orthopaedic surgeons regularly exposed to X-ray radiation. The questionnaire consisted of objective and Likert scale questions which were distributed to the respondents electronically using publicly available contact information. A qualitative review of interpretations obtained from the responses and available evidence in the literature was then performed. Results: The response rate for the survey was 36.4%. 65.9% reported using trunk protection all the time during procedures. 57.1% of respondents reported not using thyroid protection during procedures. 92.3% reported not using protective goggles and 100% did not use appropriate gloves. 76.9% were not issued dosimeters, and only 5.5% of those who had been issued one wore it during radiation procedures. 58.2% reported having a dedicated employee to operate the machine. 86.8% of respondents did not have formal training and 81.3% were not aware of institutes offering formal training. Conclusion: There is very high compliance with the use of protection aprons among the respondents however, the use of other apparel like thyroid shields, protection goggles and gloves was poor. The awareness regarding radiation exposure was also poor as most respondents were not issued dosimeters, however, those issued with one were well aware of their exposure. It is imperative to prioritize both surgeons' and patients' safety where radiation exposure is concerned. [ABSTRACT FROM AUTHOR]

The healthcare system in India faces an acute shortage of medical staff, significantly impacting the nation's ability to provide sufficient healthcare services. X-ray reports are paramount to orthopaedic surgeons for making critical patient care decisions. Implementing automated systems for detecting bone fractures offers a potentially efficient solution to supplement the limited workforce. However, these systems encounter substantial hurdles, such as inconsistent image quality and the risk of incorrect diagnosis due to the limitations of current technology. The research provides a specialised tool for identifying bone fractures with high precision (97% accuracy) and an excellent overall rating (F1 score of 0.98), showing it can reliably detect fractures. The assessment of this model is augmented by visual tools like heatmaps and performance graphs, providing an in-depth analysis of its operational effectiveness. Furthermore, creating a user-friendly interface is intended to streamline the adoption of this tool in clinical settings. Notwithstanding its demonstrated precision, the model must navigate data-related challenges, precisely data complexity and the representation of different categories, to prevent skewed outcomes. Clarifying the model's decision-making process and adaptability to various clinical situations are also critical. The study emphasises the need for thorough testing to ensure the model's dependability in diagnosing fractures before being deployed effectively in the medical field. [ABSTRACT FROM AUTHOR]

Background: Proximal tibia fractures are often accompanied by extensive soft tissue injuries, which lead to frequent post-operative complications like wound dehiscence, infection, and non-union. In such injuries, there is a need for anatomical reduction and stable fixation for a good surgical outcome. The surgical procedures involving internal fixation have increased the complication rate of such fractures. Ilizarov ring fixation can provide stable fixation, does not need extensive soft tissue dissection, and encourages early mobilization. Objectives: This study aimed to assess the functional and radiological outcome of proximal tibia fractures managed with Ilizarov technique with or without minimal internal fixation. Methods: 35 patients with either intra-articular as well as extra-articular proximal tibia fractures between January 2018 and May 2022 were included in this study. All the included patients were operated on using Ilizarov technique. The functional outcome was assessed using the Modified Rasmussen Criteria for clinical assessment, and the radiological outcome by Modified Rasmussen Criteria for radiological assessment. Results: All patients achieved radiological union at a mean duration of 16 weeks. Full weight-bearing was also allowed at a mean of 12 weeks. Functional results were excellent in 22 cases, good in 12 cases and poor in one. Most patients achieved functional range of motion at the knee joint (average flexion 128o ) except one, who had a flexion of less than 110o . Axial malalignment of less than 10o was seen in 4 cases, and articular step of less than 5 mm was seen in 2 cases. Conclusion: Ilizarov ring fixation is an excellent method of fixation in proximal tibia fractures, both extra-articular and intra-articular. It gives stable fixation, encourages early mobilization, has a higher union rate, and prevents damage to the soft tissue envelope, which is often compromised in such fractures. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the complications of central venous catheterization (CVC). Methods: A prospective, observational study was conducted at a tertiary care center in India from December 2018 to September 2020. Critically ill patients (aged ≥18 years) in the intensive care unit undergoing CVC procedures were included in the study. Baseline demographics and detailed medical history were recorded. Chest X-rays and electrocardiography were performed on all the patients. Complications associated with CVC were recorded. Results: A total of 100 patients with the indication for central venous catheter insertion were included. The majority (81%) of the patients were inserted with CVC at the right internal jugular vein. Complications such as arterial puncture (2%), hematoma (4%), blood clot formation (4%), catheter kinking (3%), thoracic injury (1%), thrombophlebitis (6%), sepsis (9%) and nerve injury (1%) were reported. Conclusions: Though central venous access is preferred in management of critically ill patients, it has its risks. However, early recognition and prompt management of complications may reduce mortality and morbidity. Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications. Suitable site selection, operator experience, and proper catheter maintenance are associated with optimal outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Spinopelvic malalignment causes continual backache. Intervertebral Disc Degeneration (IDD) is a leading cause of low backache. Understanding the relationship between spinopelvic parameters and IDD can help with better diagnosis and treatment and avoid unnecessary investigations. Aim: To measure radiographic spinopelvic parameters of patients diagnosed with varying grades of IDD in the lumbosacral spine on Magnetic Resonance Imaging (MRI), and to compare them with radiographs of the asymptomatic population (controls). Materials and Methods: A hospital-based retrospective observational study was done from January 2021 to August 2022 at a tertiary care hospital in Uttar Pradesh, India with 80 patients diagnosed with IDD on MRI and 80 controls. Cases were defined as patients diagnosed to have IDD on MRI and controls were those individuals who did not have disc degeneration on MRI. Lateral lumbosacral spine radiographs were taken, and spinopelvic parameters {Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Lumbar Lordosis (LL), lumbo-sacral angle, and sacral horizontal angle} were measured using Surgimap Spine Software. T-test and Chi-square test were used for comparison between cases and controls. Results: Six patients had asymmetric disc bulge, 11 had symmetric disc bulge, 18 had disc extrusion and 45 had disc protrusion. Mean PT in patients with IDD was 11.05±3.84°, and control was 8.65±3.19°, p-value=0.009. Mean SS in case group was 38.38±3.03° and control was 36.56±3.43°, p-value=0.031. The mean PI of cases was 49.44±8.39° and control 46.19±9.01°, p-value=0.02. LL angle was higher in IDD at 46.34°, and was 45.36° in healthy individuals, without statistically significant difference. The mean lumbo-sacral angle in both study groups was similar. The mean Sacral Inclination Angle (SIA) was found to be 43.99° and 44.96° in the case and control group respectively without showing significant differences. A statistically significant difference was found only for the comparison of PT between different grades of IDD (p-value=0.039). Conclusion: Using Surgimap Spine Software, one can predict the individuals that possess a greater propensity of developing degeneration of disc and chronic low back pain in a more costeffective manner. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare the efficacy of daily v. weekly oral vitamin D3 therapy in radiological healing of nutritional rickets. Children 6 months to 12 years (n 132) diagnosed with nutritional rickets were randomised into three groups (n 44): group A – 2000 IU daily vitamin D3 for 12 weeks, B – 60 000 IU weekly for 3 weeks, C – 60 000 IU weekly for 6 weeks. Serum calcium, phosphorus, 25-hydroxyvitamin D (25(OH)D), parathyroid hormone and X-ray score were estimated at baseline and 12 weeks (endline). The proportion of children who achieved complete radiological healing at endline was compared between three groups by χ 2 and delta change in laboratory parameters by ANOVA (parametric data) or Kruskal Wallis test (non-parametric data), respectively. Baseline 25(OH)D ≤ 20 ng/ml was seen in 119 (90·2 %), hyperparathyroidism in 90 (68·8 %) and hypocalcaemia in 96 (72·7 %). A total of 120/132 children completed the study. Complete radiological healing seen in 30 (75 %) in group A, 23 (60·5 %) in group B and 26 (61·9 %) in group C; P = 0·15, with comparable endline X-ray scores; P = 0·31. The median (interquartile range (IQR)) delta X-ray score (baseline–endline) was 7 (4,9), 5 (2·25, 6) and 6 (4,7) in groups A, B and C, respectively; P = 0·019. Median (IQR) 25(OH)D endline levels in groups A, B and C were 50·0 (26·5, 66·5), 42·1 (28·4, 54·4) and 53·5 (33·7, 71·2) ng/ml, respectively; P = 0·045. Radiological scores were comparable at endline among daily and weekly vitamin D groups with greater change from baseline in daily supplemented group. [ABSTRACT FROM AUTHOR]

X-class solar flares, which occurred in the daytime from 2008 to 2016 during solar cycle 24, were studied for their influence on the lower ionosphere over the lowequatorial Indian region. To understand the D-region behaviour during flare events, we used the very low frequency (VLF) navigational transmitter NWC (19.8 kHz) signal recorded at Pryagraj, Uttar Pradesh, India. A total of seven parameters were estimated: (i) the magnitude of X-ray flux, (ii) VLF signal rising amplitude perturbation (SRAP), (iii) X-ray flux and NWC signal start time difference (STD), (iv) peak time difference (PTD), (v) Wait’s ionospheric parameters h′ (reference height), (vi) β (sharpness factor) and (vii) D-region electron density difference (EDD) to determine the overall effect of solar flares on the D-region. The results suggest that three parameters (X-ray flux, SRAP and h′) show a decreasing trend through the linear fit line, two parameters (β and EDD) show an increasing trend, while the remaining two parameters show a mixed trend (decrease during low activity and increase during high activity). Further, the trend line during the diurnal variation shows an increasing trend for X-ray flux, PTD and h′, and a decreasing trend for SRAP, STD, β and EDD. Deviation in the case of individual events may indicate the dependence of these parameters on the seasons as well. The present study will provide the base for more robust analysis and modelling work in the future to understand the complexity of ionospheric change during flare events, and to develop a predictive model for space weather mitigation. [ABSTRACT FROM AUTHOR]

Introduction: The Posterior Tibial Slope (PTS) is an angle formed by the tibial plateau and supports the biomechanics of the knee joint. This slope is found to be a factor in differentiating ACL tear injuries. Earlier studies have shown the association of PTS with Anterior Cruciate Ligament (ACL) tears but have not evaluated the PTS values for different gradings. Aim: To evaluate the PTS on X-ray and Magnetic Resonance Imaging (MRI), for patients with different grades of ACL tears, and patients identified with meniscal tears. Materials and Methods: This cross-sectional study was conducted from April 2020 to March 2021 at the Department of Radiodiagnosis and Imaging, KS Hegde hospital, Mangaluru, Karnataka, India. A total of 30 patients were studied, in which 20 patients with ACL tears underwent both X-ray and MRI, while the 10 patients with meniscal tears were only subjected to MRI. The PTS was evaluated for different grades of ACL tears on X-ray and MRI by an experienced Radiologist. The number of patients with grade I, grade II, and grade III ACL tears were 7, 6 and 7, respectively. Paired t-test was used to evaluate the mean PTS for the identified grade of the ACL tear. One-way Analysis of Variance (ANOVA) and Bonferroni post hoc test was used to analyse the difference between grades of the ACL tear. Results: The mean age of the study population was 32.50±16.363 years, and the male-to-female ratio was 4:1. Both right, as well as the left knee, were included in the study, and the left-to-right knee ratio was 3:2. There was a significant difference in PTS between Grades of ACL tears (p-value-0.001). The PTS was observed to increase as the severity of the ACL injury increased. The mean PTS value obtained on x-ray for grade I, grade II, and grade III ACL tears were 10.85±0.54, 14.18±0.62, and 16.46±1.56, respectively. While the mean PTS value obtained on MRI for grade I, grade II, and grade III ACL tears were 10.85±0.53, 14.19±0.60, and 16.47±1.55, respectively. There was no significant difference in the PTS measured for ACL tears between the X-ray and MRI (p-value>0.05). Further, the results did not show any difference of significance in the PTS measured on MRI between ACL tears and meniscal tears (p-value>0.05). Conclusion: The PTS can be used as an aid in the identification of the severity of the ACL injury. The PTS could also be used as a tool to recognise the presence of ACL tears on X-ray and this could be an important prognostic factor towards the functional outcome. [ABSTRACT FROM AUTHOR]

Despite the availability of factor replacement therapy, including prophylaxis, to treat and prevent bleeding, haemophilic arthropathy continues to be the most common complication of haemophilia and significantly impairs the quality of life in people with haemophilia (PwH). Regular periodic assessment of joint status in PwH is essential to identify early arthropathic changes and prevent the development or progression of haemophilic arthropathy. Kinematic and kinetic assessment are preferable and MRI is the gold standard for diagnosing haemophilic arthropathy, but availability is limited in developing countries. HJHS and ultrasound in conjunction with HEAD-US have been shown to effective in assessing changes indicating arthropathy. This study is designed to identify which radiological assessment tool(s) works best when integrated with clinical assessment tools to examine joint health in PwH, with the aim of establishing a cheap, effective, multimodal approach to joint assessment in clinical practice in low resource settings which can then help to guide treatment. A cross-sectional observational study was carried out among PwH attending a clinic in the department of medicine at Assam Medical College and Hospital, Northeast India, over a one-year time period. The elbow, knee and ankle joints of participants were assessed clinically and functionally using HJHS and FISH and radiologically by Pettersson (X-ray) and HEAD-US (ultrasound) scoring. The resulting data was analysed statistically to ascertain correlation between these parameters. Sixty-seven PwH were enrolled in the study, with a mean age of 21.69±8.24 years (median 21 years); 38 (57.72%) had severe factor deficiency. The majority (71.70%) presented with joint bleeds; 40 (59.70%) had the knee as a target joint, followed by the elbow (11; 16.41%) and ankle (6; 8.95%). Mean ABR (annual bleed rate), AJBR (annual joint bleed rate) and ATJBR (annual target joint bleed rate) values had a positive correlation with increased severity of factor deficiency (p <0.001). FISH score increased with factor activity level; HJHS, HEAD-US and Pettersson scores decreased with factor activity level. Significant positive correlation was established between Pettersson score, age and ABR. The degree of association was greatest between HJHS and HEAD-US at 60.62%; between HJHS and Pettersson it was 57.74%. Statistically significant negative correlation was established between FISH and HEAD-US. A combined multimodal approach using the HJHS, FISH and HEAD-US scoring systems can provide a cheap, quick, more reliable and accurate option for assessing haemophilic joints, with minimal inter and intra observer reliability. This can support the optimisation of management of joint damage in PwH in resource-constrained settings. [ABSTRACT FROM AUTHOR]

The health organisation has suffered from the lack of diagnosis support systems and physicians in India. Further, the physicians are struggling to treat many patients, and the hospitals also have the lack of a radiologist especially in rural areas; thus, almost all cases are handled by a single physician, leading to many misdiagnoses. Computer aided diagnostic systems are being developed to address this problem. The current study aimed to review the different methods to detect pneumonia using neural networks and compare their approach and results. For the best comparisons, only papers with the same data set ChestXray14 are studied. [ABSTRACT FROM AUTHOR]

X-rays are the primary tools in examining the suspected fractures in humans in this era. Manual examination of X rays is a time-consuming process, which requires expert radiologists or trained orthopaedic surgeons. The demanding workloads, unavailability of radiologists in small setups and at primary/community health centres results in the inability to diagnose and delay in the treatment due to unnecessary referrals by the primary care clinicians. Moreover, the shortage of expert radiologists and orthopaedic surgeons in medically under-resourced areas such as rural areas in India have motivated us to develop an automated fracture detection model. We have developed a deep neural network to detect, localize and divide the wrist region into segments to identify fractures around wrist joint in radiographs. The orthopaedic surgeon has manually annotated the fractures by drawing a bounding box and segmented mask. We have utilized two different domains of datasets for the better convergence of the model. There is a similarity in the crack patterns of the surface crack image dataset and the wrist fracture dataset, which consists of 3000 and 315 images. A part of the dataset is made publicly available for research purposes to overcome data collection and labelling barriers for identifying wrist fractures. The crack patterns in the wrist bone samples are learned by effectively transferring the knowledge or weights obtained from surface crack datasets. The proposed architecture utilizes Feature Pyramid Network as the backbone architecture where the last-level max pool layer of the architecture is replaced with the concatenation of AdaptiveConcatPool, AdaptiveAvgPool, AdaptiveMaxPool layers. Additionally, the concept of freezing and unfreezing the network during two phases of transfer learning is utilized for better model convergence. Every radiograph is assigned a ground truth label for evaluating the accuracy of the model. The performance measure for fracture detection and localization is evaluated using the Average precision value using the concept of Intersection over Union. The result of the proposed model is compared against the ground truth label annotated by the radiologists and related studies. The average precision of 92.278 on 50° and 79.003 on a strict scale of 75° was reported for fracture detection. Similarly, the average precision of 77.445 on 50° and 52.156 on a strict scale of 75° was reported for fracture segmentation. [ABSTRACT FROM AUTHOR]

Background: In India, raw peanuts are obtained by aggregators from smallholder farms in the form of whole pods and the price is based on a manual estimation of basic peanut pod and kernel characteristics. These methods of raw produce evaluation are slow and can result in procurement irregularities. The procurement delays combined with the lack of storage facilities lead to fungal contaminations and pose a serious threat to food safety in many regions. To address this gap, we investigated whether X-ray technology could be used for the rapid assessment of the key peanut qualities that are important for price estimation. Results: We generated 1752 individual peanut pod 2D X-ray projections using a computed tomography (CT) system (CTportable160.90). Out of these projections we predicted the kernel weight and shell weight, which are important indicators of the produce price. Two methods for the feature prediction were tested: (i) X-ray image transformation (XRT) and (ii) a trained convolutional neural network (CNN). The prediction power of these methods was tested against the gravimetric measurements of kernel weight and shell weight in diverse peanut pod varieties1. Both methods predicted the kernel mass with R2 > 0.93 (XRT: R2 = 0.93 and mean error estimate (MAE) = 0.17, CNN: R2 = 0.95 and MAE = 0.14). While the shell weight was predicted more accurately by CNN (R2 = 0.91, MAE = 0.09) compared to XRT (R2 = 0.78; MAE = 0.08). Conclusion: Our study demonstrated that the X-ray based system is a relevant technology option for the estimation of key peanut produce indicators (Figure 1). The obtained results justify further research to adapt the existing X-ray system for the rapid, accurate and objective peanut procurement process. Fast and accurate estimates of produce value are a necessary pre-requisite to avoid post-harvest losses due to fungal contamination and, at the same time, allow the fair payment to farmers. Additionally, the same technology could also assist crop improvement programs in selecting and developing peanut cultivars with enhanced economic value in a high-throughput manner by skipping the shelling of the pods completely. This study demonstrated the technical feasibility of the approach and is a first step to realize a technology-driven peanut production system transformation of the future. [ABSTRACT FROM AUTHOR]

AstroSat, India's first UV and X-ray astronomy satellite, has completed over six years of observations while in orbit around the Earth. It has carried out detailed studies of all kinds of objects in the Universe ranging from single stars, stars in clusters, binary stars with compact companions like neutron stars and black holes, star formation in galaxies, supermassive black holes in active nuclei of galaxies, etc. Here, I give a short description of its UV and X-ray telescopes and detectors. Some of the most important results obtained using AstroSat will be described in Part II. [ABSTRACT FROM AUTHOR]

Background: Drug resistant tuberculosis is a major public health threat that hinders progress in tuberculosis control worldwide. In 2019, India contributed highest cases of TB (27%) Worldwide. In 2019, 3.3% of new TB cases and 18% of previously treated cases had MDR/RRTB worldwide and India (27%) had the largest share of the global burden. This study was done to find out the sociodemographic and clinical profile of drug resistant TB patients. Methodology: It is an observational descriptive study with cross-sectional design, conducted at the drug resistant tuberculosis centre of R. G. Kar Medical College of Kolkata, West Bengal. Study Population consisted of the patients who were registered for the DR-TB regimen. Study duration was July 2016-March 2017. Pre-tested, semi-structured schedule was designed to capture their sociodemographic profile, treatment history, clinical findings and available medical records. Data were compiled in MS Excel and analyzed in IBM SPSS 23.0. Results: Out of 159 cases, 27% patients were between 21-30 years. Males were predominant (68.6%). Most patients (56.6%) were underweight (BMI<18.5kg/m2). HIV seropositivity was found in 4 (2.5%) cases. Among all cases, 81.1% had history of taking ATD and 34.4% was cured in previous episode of treatment. The commonest associated comorbidity was DM (15.7%). Rifampicin resistance (93.1%) was most common followed by Isoniazid (8.2%). Pallor was found among 94.3% patients. Most patients had bilateral (62.3%) and moderately extensive (57.2%) lesions in chest x-ray. Conclusion: DR-TB control should focus adequately on younger age group as numbers of resistance is increasing among them. Relapse in previously cured cases was found to be major contributor of DR-TB suspect cases. Though, Rifampicin resistance was so common but prevalence of resistance to 2nd line drugs is still low. Focus should be given on early detection of drug resistance in all TB cases and improvement of nutritional status of the TB patient. [ABSTRACT FROM AUTHOR]

Infectious diseases are highly contagious due to rapid transmission and very challenging to diagnose in the early stage. Artificial Intelligence and Machine Learning now become a strategic weapon in assisting infectious disease prevention, rapid-response in diagnosis, surveillance, and management. In this paper, a bifold COVID_SCREENET architecture is introduced for providing COVID-19 screening solutions using Chest Radiography (CR) images. Transfer learning using nine pre-trained ImageNet models to extract the features of Normal, Pneumonia, and COVID-19 images is adapted in the first fold and classified using baseline Convolutional Neural Network (CNN). A Modified Stacked Ensemble Learning (MSEL) is proposed in the second fold by stacking the top five pre-trained models, and then the predictions resulted. Experimentation is carried out in two folds: In first fold, open-source samples are considered and in second fold 2216 real-time samples collected from Tamilnadu Government Hospitals, India, and the screening results for COVID data is 100% accurate in both the cases. The proposed approach is also validated and blind reviewed with the help of two radiologists at Thanjavur Medical College & Hospitals by collecting 2216 chest X-ray images between the month of April and May. Based on the reports, the measures are calculated for COVID_SCREENET and it showed 100% accuracy in performing multi-class classification. [ABSTRACT FROM AUTHOR]

The Mα and Mβ X-ray fluorescence cross sections, IMα/IMβ intensity ratio, M5 subshell fluorescence yield and M5 subshell Auger yield for gold, lead and bismuth elements were determined using Indus-2 synchrotron radiation available at the Raja Ramanna Center for Advanced Technology, India. A 7 keV synchrotron radiation was used to generate the characteristic M X-ray photons in gold, lead and bismuth and consequent X-ray photons were detected with Amptek silicon drift detector which has energy resolution of 129 eV at 5.9 keV. By measuring the area under Mα and Mβ X-ray peaks, Mα and Mβ X-ray fluorescence cross sections, IMα/IMβ intensity ratio, M5 subshell fluorescence yield and M5 subshell Auger yield were determined for gold, lead and bismuth. Experimentally determined values were compared with the theoretical and other experimental values available in the literature. [ABSTRACT FROM AUTHOR]

Apart from identification, determination of age is required in various civil and criminal cases. Age estimation by observing appearance and fusion of ossification centres is most accurate and reliable method which is implemented universally. However, it is not possible to establish a uniform standard for age estimation from appearance and fusion of ossification centres for whole India as there is disparity in the timing of appearance and fusion of ossification centres in Indian population due to various factors. Hence, this descriptive observational study was conducted to estimate average age of fusion of ossification centres at lower end of radius and ulna in male population of North East Madhya Pradesh. Total 80 cases in the age group of 12 to 20 years attending the OPD of this tertiary care centre were included in the study. X-rays of both wrists were taken in anteroposterior view at Dept. of Radiology after taking written informed witnessed consent from parents and legal guardians of patients and examined in Dept. of Forensic Medicine. Age of fusion of lower end of radius and ulna is found to be 17-18 years in males of North East Madhya Pradesh. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common cancer in urban and second common in rural Indian women. In India, in spite of the best treatment available being given to the patients they lose their lives because of paucity of diagnostic aids and lack of an organized breast cancer screening program. Early detection, accurate staging, and initiation of appropriate therapy are the key factors for improving the treatment outcome and prognosis of the disease for the patients. Traditional staging methods include clinical examination, blood tests, chest X-ray, ultrasound of the abdomen, and/or skeletal survey. As these tests lack sensitivity and specificity, these are being scaled down. The hybrid positron emission tomography-computerized tomography (PET-CT) is a unique tool in the field of imaging modalities that combines the effectiveness of PET and CT. This study was undertaken to assess the efficacy and accuracy of PET-CT as a single-session staging modality in the very initial stage itself and if it can replace the conventional means of staging. Methods: This was a cross-sectional study conducted in the Radiotherapy department at GGS Medical College and Hospital Faridkot from March 2014 to October 2015. 52 patients with newly diagnosed and histopathologically proven carcinoma breast were staged by conventional modalities (clinical examination, blood tests, X-ray chest, mammography, ultrasonography abdomen, skeletal survey) and by 18F-fluorodeoxyglucose (18F FDG) PET/CT. PET-CT images were used for the detection, localization, staging of tumors and detection, evaluation, and diagnosis of metastatic lesions, disease burden and organ function along with treatment planning and planning therapeutic procedures. Following the completion of initial study, the results of 18F FDG PET-CT staging in comparison with conventional staging method were assessed. Along with this, the accuracy, changes in staging of cases of carcinoma breast and cost-effectiveness of 18F-FDG PET-CT were also studied. Results: All the pathologic entities identified by conventional imaging were also perceived with 18F-FDG PET/CT. Therefore, we recommend the use of PET/CT as an important imaging modality for initial diagnosis of carcinoma breast. [ABSTRACT FROM AUTHOR]

Euphorbia species are known for their diversity of terpenoid constituents. Euphorbia vajravelui is an endemic plant species distributed in the southern Western Ghats of India. Though conventional spectroscopic techniques are common in structure elucidation of secondary metabolites from plants, X-ray crystal structure analysis of a compound offers valuable information with minimum sample requirement. The present study reports the characterization of a new triterpene, 3,23-cycloglutin-5(10)-ene isolated from E. vajravelui, using single-crystal X-ray diffraction studies. Triclinic crystalline system was obtained for the compound, having P1 space group with unit cell parameters; a = 6.2907(8) Å, b = 7.4458(10) Å, c = 14.5802(18) Å, α = 94.899(6)°, β = 95.365(6)°, γ = 114.392(6)β, V = 613.43(14) ų and Z = 1. The triterpene has a glutinane skeletal structure containing a cyclopropane ring with a methyl group. [ABSTRACT FROM AUTHOR]

Background: Various environmental factors have been reported to play key role in the development of oral squamous cell carcinoma (OSCC). A lesser known risk factor of oral cancer in India is the uncontrolled use of areca nut chewing. In North-East India, Areca nut, locally called as "Tamol" in Assam, is raw betel nut, lime and betel leaf without tobacco, which are more effective as compared to dried which can be the important contributing factor for OSCC. Objectives: The aim of the study was to detect the association between XRCC1 polymorphisms and increased risk of OSCC in tamol chewers population in Assam, India. Methods: 50 OSCC patients, 50 tamol chewers and 50 controls were enrolled in the study. XRCC1 Arg399Gln polymorphisms were determined by using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Results: There was a significant association for XRCC1 codon 399 (Arg/Gln+Gln/Gln) (p<0.05; OR=1.909, CI= 0.8622- 4.227) with the wild type in cancer sample as compared with control sample. Similarly, the positive association for 399G/G (p<0.05; OR =2.842, CI = 0.919-8.79) genotypes with oral carcinoma and control sample. In case of tamol chewers, the AA genotype was found to be associated with 2-fold (OR- 2.25, CI= 0.709-7.14) increase risk of developing oral cancer while GA+AA genotype was associated with one and half fold (OR-1.62, CI=0.7354- 3.568) risk of developing oral cancer. Conclusions: Based on these results, the XRCC1399G>A genotype could be used as a useful molecular biomarker to predict genetic susceptibility in tamol chewers population and its susceptibility to develop OSCC. [ABSTRACT FROM AUTHOR]

Dimethylformamidase (DMFase) catalyzes the hydrolysis of dimethylformamide, an industrial solvent, introduced into the environment by humans. Recently, we determined the structures of dimethylformamidase by electron cryo microscopy and X-ray crystallography revealing a tetrameric enzyme with a mononuclear iron at the active site. DMFase from Paracoccus sp. isolated from a waste water treatment plant around the city of Kanpur in India shows maximal activity at 54 °C and is halotolerant. The structures determined by both techniques are mostly identical and the largest difference is in a loop near the active site. This loop could play a role in co-operativity between the monomers. A number of non-protein densities are observed in the EM map, which are modelled as water molecules. Comparison of the structures determined by the two methods reveals conserved water molecules that could play a structural role. The higher stability, unusual active site and negligible activity at low temperature makes this a very good model to study enzyme mechanism by cryoEM. [ABSTRACT FROM AUTHOR]

Background: Changing trends of privatization and globalization of health care compel the hospitals to practice cost accounting for providing accurate information about the cost of patient care. Objectives: The objectives were to determine unit cost and to identify major cost areas of outpatient department (OPD) services provided by the community health center (CHC) of Bankura district, West Bengal. Materials and Methods: A cross-sectional study was conducted at Amarkanan CHC in 2016. Work sampling (WS) and time motion (TM) study were conducted for assessing the workforce cost, otherwise complete enumeration was done to assess the cost of different service areas such as medicine, logistic, maintenance, transport, electricity, building, equipment, and furniture. A predesigned pro forma and a questionnaire were used for WS and TM study and for interviewing the key informants for collection of information pertaining to different costs. Unit cost of different services as well as overall unit cost was estimated. Results: If a patient received injection, undergone dressing, and had electrocardiogram and X-ray both done in a day, then the total cost of OPD services for workforce was Rs. 85.33/. Cost of logistics per patient per day was maximum in X-ray room. Manpower exerted the maximum cost incurred by the government to conduct OPD in Amarkanan CHC. Overall, the unit cost in OPD incurred by the government was Rs. 44.53/-. Conclusion: Close monitoring is required by aligning the staffing pattern and patient activities and having adequate number of staff with right skill at right place and time for efficiency, productivity, and cost-effectiveness. [ABSTRACT FROM AUTHOR]

The L1, L2 and L3 subshells of Hf, Ta and Re atoms have been excited selectively by using microprobe XRF beam line, Indus‐2, RRCAT, India. The consequent characteristic L X‐ray photons, emitted from the targets due to creations of vacancies in L subshells, are measured using silicon drift detector (X‐123) spectrometer. As the energy of synchrotron radiation increases, the contribution of characteristic L X‐ray intensity increases. The advantage of the increase in the intensity of the characteristic L X‐ray photons with an increase in the energy of synchrotron radiation has been used to determine the L subshell fluorescence yield ratios of Hf, Ta and Re atoms by adopting the selective excitation method. The measured ratios of L subshell fluorescence yield have been compared with theoretical and other experimental values. [ABSTRACT FROM AUTHOR]

The Solar X-ray Monitor (abbreviated as XSM) on board India's Chandrayaan-2 mission is designed to carry out broadband spectroscopy of the Sun from lunar orbit. It observes the Sun as a star and measures the spectrum every second in the soft X-ray band of 1 – 15 keV with an energy resolution better than 180 eV at 5.9 keV. The primary objective of the XSM is to provide the incident solar spectrum for the X-ray fluorescence spectroscopy experiment on the Chandrayaan-2 orbiter, which aims to generate elemental abundance maps of the lunar surface. However, observations with the XSM can independently be used to study the Sun as well. The Chandrayaan-2 mission was launched on 22 July 2019, and the XSM began nominal operations, in lunar orbit, from September 2019. The in-flight observations, so far, have shown that its spectral performance has been identical to that on the ground. Measurements of the effective area from ground calibration were found to require some refinement, which has been carried out using solar observations at different incident angles. It also has been shown that the XSM is sensitive enough to detect solar activity well below A class. This makes the investigations of microflares and the quiet solar corona feasible in addition to the study of the evolution of physical parameters during intense flares. This article presents the in-flight performance and calibration of the XSM instrument and discusses some specific science cases that can be addressed using observations with the XSM. [ABSTRACT FROM AUTHOR]

Back ground: Refractory Constipation is a prevalent problem in day to day practice. There are many secondary causes like drug-related, hypothyroidism, diabetes, which can be treated. However, primary refractory constipation is complex and difficult to treat as it can be due to normal transit, slow transit, or outlet obstruction. Objective: The role of colon transit time in patients with primary refractory constipation is examined in this study. Materials and Methods: The study was done in a Tertiary care Gastro center in the north coastal part of south India. Fifty three Consecutive primary refractory constipation patients were enrolled after excluding secondary causes from February 2018 to March 2019. The colon transit research was carried out using indigenous sitz makers in accordance with a standardized Indian protocol, in which 60 markers (20 each provided at intervals of 0, 12, and 24 hours) were administered and abdominal X-rays were taken at 36 and 60 hours. Slow transit was taken if more than 30 and 14 markers remained in the colon at 36 and 60 hours XRay, respectively. Outlet obstruction was taken when there was a significant hold up of markers in the pelvis. Results: Out of fifty three patients selected based on the inclusion criteria, 31 were males and 22 were females. The age ranges from 20 to 64 years with a mean age group 39.7±2.3 years. After using indigenously prepared radio-opaque sitz markers to perform a colonic transit, it was noticed that 15 patients had sluggish transit, 12 patients had outlet obstruction, and 26 patients had regular transit time. The findings were statistically insignificant. The results of present study revealed, at 36 hours of X-ray >55 ± 5% markers were identified in right, transverse and left segment of the colon in slow transit patients, <10 ± 5% markers in normal transit cases and >50 ± 5% markers in rectosigmoid segment whereas at 60 hours of X-ray >23 ± 3% markers were identified in right, and left segments in slow transit patients, hardly any in normal transit cases and >45 ± 5% markers in rectosigmoid segment. Conclusions: A colon transit study using radio-opaque markers is a simple technique for objectively identifying the various primary refractory constipation groups. The exact type of abnormality can be treated appropriately to yield the best results. [ABSTRACT FROM AUTHOR]

Introduction: Best radiography practice involves operational optimal machine performance, delivering costeffective healthcare services under appropriate safety conditions for workers and the public. The present study aimed to investigate the safety status of diagnostic X-ray installations in Mizoram, India. Material and Methods: Linearity of time (sec), linearity of current (mA), output reproducibility, table dose (μGy/mAs), peak voltage (kVp) accuracy, and 16 essential safety parameters of 135 X-ray machines were considered in this study. A battery-operated dosimeter and wide-range digital kVp meter were used to measure output radiation and effective peak potential of X-ray tube. Data analysis was performed using SPSS software to obtain the mean, standard deviation, and coefficient of variation. Results: Among different electronic parameters, 59.2% linearity of time, 82.6% linearity of current, 89.7% kVp accuracy, 35.1% output reproducibility, and 92.8% table dose were beyond the acceptable limits. Based on 16 essential safety parameters, it was observed that 98.7% of X-ray machines did not receive proper quality assurance test, 1.9% of the installations employed lead-line patient entrance doors, 46.8% of the machines were operated without any protective barriers and 83.1% of the units were operated without personnel monitoring service. Conclusion: The present study had concluded with more problems than the previous studies in different parts of the world in this regard. Due to the absence of proper quality control (QC) programs, many installations did not follow standard installation guidelines. The authors recommended that proper QC should be implemented by the frequent monitoring of each and every diagnostic X-ray installation. [ABSTRACT FROM AUTHOR]

Correct age determination has of great importance in legal prosecution. The principle means, which enable one to form a fairly accurate opinion about age of an individual are general physical development, dentition, secondary sex characters and ossification of bones. Among them Radiological examination of ossification process is most accurate than any other method up to 25 years of age. This study involves radiological examination of Pelvis (AP view) of 169 individuals for the study of age related appearance and fusion of ossification center of Iliac Crest in the individuals of age group of 14-22 years of both male and female in S P Medical college, Bikaner, Rajasthan. [ABSTRACT FROM AUTHOR]

Introduction: Hodgkin's lymphoma (HL) is one of the most curable malignancies with cure rates of above 85% across all stages. Bleomycin containing regimen is routinely employed in the treatment of HL. Pulmonary toxicity due to this drug is the most feared side effect in these regimens where the mortality rate is approximately 2%–3%. We have conducted this study to assess the genetic susceptibility among the Indian HL patients to bleomycin pulmonary toxicity (BPT). Materials and Methods: In a retrospective study conducted at a tertiary care hospital from South India between January 2013 and May 2019, we reviewed 100 HL patients who were treated with bleomycin-containing regimen (adriamycin, bleomycin, vinblastine, and dacarbazine or cyclophosphamide, vincristine, procarbazine, and prednisone/adriamycin, bleomycin, and vinblastine) for BPT. Results: A total of 100 patients with HL who had received bleomycin-containing regimen were analyzed, which included 23 females and 77 males. Twenty-nine patients had BPT and five deaths were attributed to the same. Radiology reports showed that 15 patients had acute BPT and eight patients had chronic changes. Four patients had rare findings of bleomycin-induced lung damage and computed tomography of the chest could not be done for two patients, whose chest X-ray showed features suggestive of BPT. Conclusion: The incidence of bleomycin induced pulmonary toxicity and mortality was significantly higher in our study compared to that of other Western studies. This could be probably due to the increased susceptibility of the Indian patients to bleomycin induced lung damage. In a highly curable cancer such as HL, it is unacceptable to have such a high life-threating toxicity. Hence, an alternative chemotherapy regimen without bleomycin is to be explored which would prevent toxicity and hence the compromise on survival. [ABSTRACT FROM AUTHOR]

Introduction: In early stage of disease of Corona Virus Disease 2019 (COVID-19) infection chest Computed Tomography (CT) imaging is considered as the most effective method for detecting lung abnormalities. A Brixia Chest X-ray (CXR) scoring system which uses an 18-point severity scale to grade lung abnormalities due to COVID-19 was developed to improve the risk stratification for infected patients. Aim: To ascertain the validity of Brixia scoring system and to measure the outcome in COVID-19 patients. Materials and Methods: A retrospective study was conducted from 1st April 2020 to 31st July 2020, at a tertiary care hospital in India. Baseline CXR of COVID-19 patients were scored based on Brixia scoring system. The lungs were divided into six equal zones. Subsequently, scores (from 0 to 3) were assigned to each zone, based on lung abnormalities. A group comparison was implemented using Chi-Square test for categorical variables. Whereas an independent t-test was applied for continuous variables that followed normal distribution. Results: The study included 130 patients. The mean age was 57.09±13.73 years, 70.8% patients included were males. Out of 130 patients, 79 patients died. Among patients who died the mean CXR score was calculated to be 12.13±2.50. The mean CXR score was calculated to be 11.18±2.30 in patients who recovered and got discharged. During the process of comparison of CXR scores with the outcomes, the t-value came out to be 2.20 and the resulting p-value was 0.03 (statistically significant). Conclusion: Brixia score more than 12 was associated with increased mortality due to COVID-19, with p-value of 0.03. [ABSTRACT FROM AUTHOR]

Background There is no experience of point-of-care (POC) microbiological confirmation for TB in India in field settings. Methods Under the TB-Free Haryana project, a mobile van-mounted digital x-ray and portable GeneXpert system screened all presumptive TB patients with strong clinic-radiological suspicion for TB. Results Of 1673 x-rays, 215 (13%) had findings suggestive of TB, 109 had strong clinical suspicion and were eligible for POC GeneXpert, in whom a test was performed in 82 (75%) cases; 59 (72%) tested positive and were initiated on treatment within 24 h. Conclusions A mobile van equipped with digital x-ray and POC GeneXpert is feasible and has a good success rate with potential for replication. [ABSTRACT FROM AUTHOR]

Deep learning models deliver a fast diagnosis during triage prescreening for COVID-19 patients, reducing waiting time for hospital admission during health emergency scenarios. The Ministry of health and family welfare government of India provides guidelines from the Indian Council of Medical Research (ICMR) for triage requirements and emergency response with faster allotment of oxygen beds for COVID-19 patients requiring immediate treatment in Tamil Nadu, India. A combination of pretrained models provides a faster screening rate and finds patients with severe lung infections who need to be attended to and allotted oxygen beds. Deep learning (DL) algorithms need to be accurate in triaging undifferentiated patients entering the emergency care system (ECS). The major goal of this work is to analyze the accuracy of machine learning approaches in their application to triage the acuity of patients arriving in the ECS. The proposed triage model has an accuracy of 93% in classifying COVID/non-COVID patients. The proposed triage DL model effectively reduces the time for the triage procedure and streamlines screening and allocation of beds for patients with high risk.

As per latest Global TB Report (2018), an estimated 2.2 lakh children get tuberculosis (TB) each year in India and illness constitutes a very high global burden. Here we report an unusual case of a child aged 14 years (female), who presented to Emergency with complaints of cough and restlessness for the past 1 day. Working diagnosis of septic shock was kept and child was started on intravenous ionotropes, vasopressors, and an antibiotic. There was no significant history suggestive of TB. Patient was shifted to PICU and managed for shock accordingly. X-ray lung showed single right-sided cavitatory lesion. Bronchoalveolar lavage was positive for acid fast bacilli, confirming the diagnosis of pulmonary TB. The patient was started on antitubercular drug regimen (ATT) for 6 months and showed significant improvement with complete resolution. Literature was searched for association of septic shock in tubercular patients as a presenting complaint, which is a rare entity. [ABSTRACT FROM AUTHOR]

Background: India has the highest burden of tuberculosis (TB). Although most patients with TB in India seek care from the private sector, there is limited evidence on quality of TB care or its correlates. Following our validation study on the standardized patient (SP) method for TB, we utilized SPs to examine quality of adult TB care among health providers with different qualifications in 2 Indian cities.Methods and Findings: During 2014-2017, pilot programs engaged the private health sector to improve TB management in Mumbai and Patna. Nested within these projects, to obtain representative, baseline measures of quality of TB care at the city level, we recruited 24 adults to be SPs. They were trained to portray 4 TB "case scenarios" representing various stages of disease and diagnostic progression. Between November 2014 and August 2015, the SPs visited representatively sampled private providers stratified by qualification: (1) allopathic providers with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees or higher and (2) non-MBBS providers with alternative medicine, minimal, or no qualifications. Our main outcome was case-specific correct management benchmarked against the Standards for TB Care in India (STCI). Using ANOVA, we assessed variation in correct management and quality outcomes across (a) cities, (b) qualifications, and (c) case scenarios. Additionally, 2 micro-experiments identified sources of variation: first, quality in the presence of diagnostic test results certainty and second, provider consistency for different patients presenting the same case. A total of 2,652 SP-provider interactions across 1,203 health facilities were analyzed. Based on our sampling strategy and after removing 50 micro-experiment interactions, 2,602 interactions were weighted for city-representative interpretation. After weighting, the 473 Patna providers receiving SPs represent 3,179 eligible providers in Patna; in Mumbai, the 730 providers represent 7,115 eligible providers. Correct management was observed in 959 out of 2,602 interactions (37%; 35% weighted; 95% CI 32%-37%), primarily from referrals and ordering chest X-rays (CXRs). Unnecessary medicines were given to nearly all SPs, and antibiotic use was common. Anti-TB drugs were prescribed in 118 interactions (4.5%; 5% weighted), of which 45 were given in the case in which such treatment is considered correct management. MBBS and more qualified providers had higher odds of correctly managing cases than non-MBBS providers (odds ratio [OR] 2.80; 95% CI 2.05-3.82; p < 0.0001). Mumbai non-MBBS providers had higher odds of correct management than non-MBBS in Patna (OR 1.79; 95% CI 1.06-3.03), and MBBS providers' quality of care did not vary between cities (OR 1.15; 95% CI 0.79-1.68; p = 0.4642). In the micro-experiments, improving diagnostic certainty had a positive effect on correct management but not across all quality dimensions. Also, providers delivered idiosyncratically consistent care, repeating all observed actions, including mistakes, approximately 75% of the time. The SP method has limitations: it cannot account for patient mix or care-management practices reflecting more than one patient-provider interaction.Conclusions: Quality of TB care is suboptimal and variable in urban India's private health sector. Addressing this is critical for India's plans to end TB by 2025. For the first time, we have rich measures on representative levels of care quality from 2 cities, which can inform private-sector TB interventions and quality-improvement efforts. [ABSTRACT FROM AUTHOR]

Spinal muscular atrophy (SMAs) is a group of rare autosomal recessive diseases in which there is degeneration of alpha motor neurons in the spinal cord leading to progressive distal motor weakness. Here we report a case of type 0 SMA in a female neonate born at the Department of Pediatrics, PGIMS, Rohtak (Haryana) India, associated with generalized osteopenia and bony deformity in form of unilateral club foot. It may be emphasized that diagnosis of SMA should be kept in mind as a differential in cases of unexplained severe generalized hypotonia and severe respiratory compromise immediately after birth. [ABSTRACT FROM AUTHOR]

objective: This study was aimed to estimate age from epiphyseal fusions at shoulder joint in the local population of Warangal area in the age group of 14-16 years. Methods: 100 subjects (both male and female) between the age of 14 to 16 years in and around Warangal were studied. X-rays of the right shoulder joint was taken in the Anterior posterior view. Observations regarding the degree of epiphyseal union were recorded for each subject and tabulated in age groups. Results: Overall mean height of adolescents was found to be between 152± 8.02 cm and 149.71±6.12 cm in Adolescent males and females,respectively. Ossification was progressive with age in males of 14 to 16 years age and fusion of epiphysis with diaphysis was completed in about 46.6% of males of 16-years age group. In females, ossification was much more rapid that in males and by 16 years of age 93.4% of the female subjects showed fusion of the epiphysis with diaphysis. Conclusion: The ossification at the Shoulder joint is completed in all instances at the age groups of 17-18 year. It was progressive in both sexes. [ABSTRACT FROM AUTHOR]

Purpose: To review the role of high resolution chest computed tomography (HRCT) in ocular sarcoidosis in a high TB endemic population.Methods: This was a retrospective study.Results: Out of 140 cases, 54 had ocular sarcoidosis, while 86 cases had ocular tuberculosis. Abnormal HRCT findings was noted in 52 cases (96.3%) of ocular sarcoidosis compared with 55 cases (64.7%) of ocular tuberculosis (p = 0.001). Mediastinal lymphadenopathy was the most common finding in both groups (p = 0.544). Hilar lymphadenopathy and fissural nodules were significantly seen in ocular sarcoidosis (p = 0.001). Necrosis was seen in three cases of ocular sarcoidosis. In nearly half of the cases, it was not possible to differentiate between sarcoidosis and tuberculosis on HRCT.Conclusions: HRCT is a useful diagnostic tool in ocular sarcoidosis. Bilateral hilar lymphadenopathy and fissural nodules are significant findings in ocular sarcoidosis. A confident diagnosis of ocular sarcoidosis is made by the amalgamation of results of clinical, radiologic, and other laboratory investigations. [ABSTRACT FROM AUTHOR]

Nearly half of the smear negative pulmonary TB in National TB Programme remain undetected in Haryana (north Indian state), probably due to poor access to chest radiography. A corporate hospital stepped into fill this infrastructure gap in Rewari district of Haryana by sending a mobile van with digital x-ray facilities and paramedic staff. The staff of the public health facility coordinated with the eligible patients and ensured that they visited on the designated day. The District TB Officer interpreted the x-ray and made decisions about diagnosis and treatment. The support was provided between May and Dec 2014 in seven public health centres (primary/secondary level) of the district. A total of 355 patie-nts were examined, of whom 122 (34.4%) were diagnosed as smear negative pulmonary TB and started on treatment according to programme guidelines. This public-private partnership needs to be scaled-up and better designed studies are required to assess community-level impact and cost-effectiveness. [ABSTRACT FROM AUTHOR]

The feasibility of X-ray absorption fine-structure (XAFS) experiments of ultra-dilute metalloproteins under in vivo conditions (T = 300 K, pH = 7) at the BL-9 bending-magnet beamline (Indus-2) is reported, using as an example analogous synthetic Zn (0.1 mM) M1dr solution. The (Zn K-edge) XAFS of M1dr solution was measured with a four-element silicon drift detector. The first-shell fit was tested and found to be robust against statistical noise, generating reliable nearest-neighbor bond results. The results are found to be invariant between physiological and non-physiological conditions, which confirms the robust coordination chemistry of Zn with important biological implications. The scope of improving spectral quality for accommodation of higher-shell analysis is addressed., (open access.)

Trace elements are essential for the human body's various physiological processes but if they are present in higher concentration, these elements turn to be toxic and cause adverse effect on physiological processes. Similarly, deficiency of these essential elements also affects physiological processes and leads to abnormal metabolic activities. There is a lot of interest in recent years to know the mystery behind the involvement of trace elements in the metabolic activities of autistic children suspecting that it may be a risk factor in the aetiology of autism. The present study aims to analyse the plasma trace elements in autistic children using the total reflection X-ray fluorescence (TXRF) technique. Plasma samples from 70 autistic children (mean age: 11.5 ± 3.1) were analysed with 70 age- and sex-matched healthy children as controls (mean age: 12 ± 2.5). TXRF analysis revealed the higher concentration of copper (1227.8 ± 17.8), chromium (7.1 ± 2.5), bromine (2695.1 ± 24) and arsenic (126.3 ± 10) and lower concentration of potassium (440.1 ± 25), iron (1039.6 ± 28), zinc (635.7 ± 21), selenium (52.3 ± 8.5), rubidium (1528.9 ± 28) and molybdenum (162,800.8 ± 14) elements in the plasma of autistic children in comparison to healthy controls. Findings of the first study from India suggest these altered concentrations in elements in autistic children over normal healthy children affect the physiological processes and metabolism. Further studies are needed to clarify the association between the altered element concentration and physiology of autism in the North Karnataka population in India., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Timika scoring system is a radiographic grading tool, widely employed for grading the severity of tuberculosis (TB). We evaluated the predictive accuracy of this tool for adverse treatment outcomes among TB patients in Indian setting., Methods: We undertook a longitudinal analysis of cohort data under the RePORT-India consortium. Cohort having participants with active pulmonary TB were included. CXRs were independently scored by chest physicians. Timika scoring system had a total score of 140. The predictive nature of the tool was assessed using the ROC analysis., Results: Around 364 laboratory confirmed TB patients were enrolled. The mean (SD) of overall Timika score was 62.3 (24.9). Sputum conversion was achieved among 218/260 (83.8%) patients available at end of intensive phase. AUC for Timika score was 0.53 (95% CI: 0.43-0.63) and for percent lung affected, was 0.56 (95% CI: 0.46-0.65). Unfavorable treatment outcome was observed among 67/287 (23.3%) at the end of continuation phase. AUC for percent lung affected was 0.62 (95% CI: 0.54-0.70) and for Timika score was 0.59 (95% CI: 0.51-0.67)., Conclusion: Both Timika scoring system and percent lung affected had poor predictive accuracy, highlighting the inability of a single CXR scoring system to predict the treatment outcome in Indian setting., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2021 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Objective: To determine the prevalence and radiological pattern in pulmonary and skeletal system of HIV infected children. Subjects and methods: Serologically positive 62 children between the age group of 18 months to 12 years were studied from October 2010 to March 2012 (1 1/2 years period) admitted to pediatric ward SNMC, Bagalkot. All children were taken chest x ray and knee radiographs irrespective of symptoms at the time of first presentation. A single radiologist experienced in the field analyzed the radiographs. Results: Number of HIV seropositive children admitted during study period was 62. Of the 62 children, 29 children had abnormal chest x-ray and 30 had abnormal knee x-ray. Among the abnormal chest x-ray, bronchopneumonia (41.38%) was most common followed by Pneumocystis Carinii Pneumonia (17.24%), and osteopenia (33.33%), osteoporosis (23.33%) and scurvy (36.67%) were more common findings on knee x-ray. Conclusion: Routine chest and knee x-ray, will help in early diagnosis and timely treatment and help in increase in life expectancy of these children and micronutrient correction. [ABSTRACT FROM AUTHOR]

Background: This study was undertaken to highlight the clinical profile, misdiagnosis, surgical treatment,and prognosis of late-presenting congenital diaphragmatic hernia (CDH) cases in a tertiary level hospital. Patients and Methods: This retrospective study included all the babies and children >1 month of age with CDH who were admitted in our Hospital (Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India) during the period between January 2008 and December 2013. Babies with age <1 month were excluded from the study. Data regarding clinical profile, operative records, and follow-up was reviewed and analysed statistically. Results: A total of 20 patients were included in this study. The clinical picture ranged from respiratory distress (13 patients) to non-specific gastrointestinal complaints (5 patients). In two patients, CDH was misdiagnosed as pneumothorax and had got chest tube inserted in other hospitals before referral to this tertiary care centre. In 14 patients chest, X-ray revealed the diagnosis of CDH and in remaining five patients (including the two patients with misdiagnosis) further investigations were undertaken to establish the diagnosis. Age ranged from 45 days to 17 years with an average age of 58.9 months. There were 12 male and 8 female patients. In all the 20 patients, surgical procedures were undertaken with the retrieval of herniated contents from the thoracic cavity and repair of the diaphragmatic defect. There was no mortality in our series. All the 20 patients were followed-up for a period ranging from 6 months to 5 years (median 3.1 years). Conclusions: Late-presenting CDH can have diverse clinical presentation. Late diagnosis and misdiagnosis can result in significant morbidity and potential mortality if these cases are not managed properly at an appropriate stage. Outcome is favourable if these patients are expeditiously identified and surgically repaired. [ABSTRACT FROM AUTHOR]

Purpose: Radiographs is an integral part of patient management in dentistry, despite their detrimental effects. As the literature pertaining to radiation protection among Indian dental practitioners is sparse, exploring such protection is needed. Materials and Methods: All private dental practitioners in Mangalore, India were included in the study. A structured, pre-tested, self-administered questionnaire was employed to assess the knowledge, attitudes, practices, previous training, perceptions towards the need to spread awareness, and willingness to gain and implement knowledge about radiation hazards and protection. Information regarding each respondent's age, gender, education, and type and duration of practice was collected. Results: Overall, 87 out of 120 practitioners participated in the study. The mean knowledge, attitude, and practice scores were 9.54±2.54, 59.39±7.01, and 5.80±3.19, respectively. Overall, 25.3% of the respondents had undergone training in radiation protection, 98.9% perceived a need to spread awareness, and 94.3% were willing to improve their knowledge. Previous training showed a significant correlation with age, sex, and duration of practice; attitude was significantly correlated with education and type of practice; and knowledge scores showed a significant correlation with type of practice. Conclusion: Although the knowledge and practices of respondents were poor, they had a positive attitude and were willing to improve their knowledge. Age, sex, and duration of practice were associated with previous training; education and type of practice with attitude scores; and type of practice with knowledge scores. The findings of this study suggest a policy is needed to ensure the adherence of dental practitioners to radiation protection guidelines. [ABSTRACT FROM AUTHOR]

According to Ayurveda, Kati Shoola is a disease with pain in lumbar region. Lumbar spondylolisthesis, anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below, is one of the common causes. Current case study was carried out at Ayurveda Teaching hospital, Borella, to evaluate the efficacy of a treatment regimen used by Sri Lankan traditional physician family "Weerasinghe." A 59-year-old female with a 9-month history of lumbar spondylolisthesis was treated with this regimen. The patient had progressive pain in left lower back, right and left buttocks, and difficulty in bending forward over 5°. X-ray of lumbo sacral region indicated that patient was suffering from Grade 3 lumbar spondylolisthesis. She was treated for 65 days with four treatment packages consisting of 13 prepared medicines. The response to the treatment was recorded and therapeutic effects were evaluated through symptomatic relief. Clinical symptoms were significantly reduced and degree of anterior flexion increased from 5° to 90°. However, X-rays indicated that the patient was still suffering from Grade 3 lumbar spondylolisthesis. This regimen is effective in successfully treating Kati Shoola (lumbar spondylolisthesis) by helping to reduce the symptoms and improving the degree of anterior flexion. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 28-year-old Indian man with 1 day history of fever followed by inability to speak and altered sensorium. It states that the patient seemed very small for his stated age and looked more like a 3-4 year old child. It notes that he had large dry lips and has a coarse facial features with coarse skin. It also mentions that his thyroid profile was indicative to hypothyroidism.

Pneumonia is one of the main causes of child mortality in the world and has been reported by the World Health Organization (WHO) to be the cause of one-third of child deaths in India. Designing an automated classification system to detect pneumonia has become a worthwhile research topic. Numerous deep learning models have attempted to detect pneumonia by applying convolutional neural networks (CNNs) to X-ray radiographs, as they are essentially images and have achieved great performances. However, they failed to capture higher-order feature information of all objects based on the X-ray images because the topology of the X-ray images' dimensions does not always come with some spatially regular locality properties, which makes defining a spatial kernel filter in X-ray images non-trivial. This paper proposes a principal neighborhood aggregation-based graph convolutional network (PNA-GCN) for pneumonia detection. In PNA-GCN, we propose a new graph-based feature construction utilizing the transfer learning technique to extract features and then construct the graph from images. Then, we propose a graph convolutional network with principal neighborhood aggregation. We integrate multiple aggregation functions in a single layer with degree-scalers to capture more effective information in a single layer to exploit the underlying properties of the graph structure. The experimental results show that PNA-GCN can perform best in the pneumonia detection task on a real-world dataset against the state-of-the-art baseline methods.

A total of 158 serum samples of newly diagnosed type 2 diabetes patients and control subjects were analyzed using Synchrotron Radiation X-ray Fluorescence (SRXRF) technique. The microprobe XRF beam line-16 of Indus-2 synchrotron radiation facility at Raja Ramanna Centre for Advanced Technology (RRCAT), Indore, India, was used to identify and quantify the elements K, Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Br, Rb, Sr, and Pb. A significant decrease in the mean concentrations of K, Ca, Ti, Cr, Mn, Ni, Zn, and As and an increase in the concentrations of V, Fe, Co, Cu, Se, and Pb were observed in the serum samples of the patient group when compared to the control group. It is hypothesized that the observed alterations in the elemental concentrations might have led to ineffective uptake of insulin and have interfered with glucose homeostasis by either directly or indirectly causing oxidative stress., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: Abdominal adiposity is an important risk factor for diabetes and cardiovascular disease in Indians. Dual energy Xray absorptiometry (DXA) can be used to determine abdominal fat depots, being more accessible and less costly than gold standard measures such as magnetic resonance imaging (MRI). DXA has not been fully validated for use in South Asians. Here, we determined the accuracy of DXA for measurement of abdominal fat in an Indian population by comparison with MRI. Design: 146 males and females (age range 18-74, BMI range 15-46 kg/m2) from Hyderabad, India underwent whole body DXA scans on a Hologic Discovery A scanner, from which fat mass in two abdominal regions was calculated, from the L1 to L4 vertebrae (L1L4) and from the L2 to L4 vertebrae (L2L4). Abdominal MRI scans (axial T1-weighted spin echo images) were taken, from which adipose tissue volumes were calculated for the same regions. Results: Intra-class correlation coefficients between DXA and MRI measures of abdominal fat were high (0.98 for both regions). Although at the level of the individual, differences between DXA and MRI could be large (95% of DXA measures were between 0.8 and 1.4 times MRI measures), at the sample level, DXA only slightly overestimated MRI measures of abdominal fat mass (mean difference in L1L4 region: 2% (95% CI:0%, 5%), mean difference in L2L4 region:4% (95% CI: 1%, 7%)). There was evidence of a proportional bias in the association between DXA and MRI (correlation between difference and mean 20.3), with overestimation by DXA greater in individuals with less abdominal fat (mean bias in leaner half of sample was 6% for L1L4 (95%CI: 2, 11%) and 7% for L2L4 (95% CI:3,12%). Conclusions: DXA measures of abdominal fat are suitable for use in Indian populations and provide a good indication of abdominal adiposity at the population level. [ABSTRACT FROM AUTHOR]

Abstract: A Total Solar Eclipse (TSE) provides us with an exciting opportunity to study the VLF propagation effects under a controlled experimental condition where the extreme ultraviolet and the X-rays from the sun are totally blocked by the moon. During the total eclipse of July 22nd, 2009, the Indian Centre for Space Physics conducted a VLF campaign to obtain the signal from a dozen of places in the Indian sub-continent. Six of these locations gave very good and noise-free data. In some of these data, the signal amplitude is found to be higher than that at non-eclipse condition, while in some other places, it is lower. We present the results of our campaign and give an interpretation of the results using the Long Wavelength Propagation Capability (LWPC) code in a perturbed waveguide both for the easterly and westerly propagation paths. [Copyright &y& Elsevier]

Background: Asbestos's production, processing, and consumption is on very high scale in India and it is increasing, and so do the related diseases. Asbestosis is such a disease which causes progressive respiratory disability. Aim: To find out perceptions and thinking about this disease and its risk among the patients which will help in constructing an effective community-based prevention and rehabilitation program. Materials and Methods: It was a community-based, qualitative study using a semi-structured interview schedule with 17 asbestosis patients from Mumbai, disgnosed by specialist with pulmonary function test and X-rays as per International Labour Organisation's recommandations. Results: The risk percived by the patients is very less and attitude toward the illness is bengine as there is no clear understanding about the causation. The prolong latent period appears to be the main cause. It suggests a need of very strong program for prevention of asbestosis with the incorporation of worker awareness and eduaction for safety. The socio-economical status and educational levels of the workers make this floating population more vulnarable for manipulation by the corporates. Conclusion: Apart from the radical step of ban on asbestos, there is a need of community-based sustainable, affordable, and accessible rehabilitation program with a component of palliative care which will consider the different needs of this marginalized group. The need for such a program is intense as the number of asbestisis patients will keep on increasing till 30 to 40 years of asbestos ban. [ABSTRACT FROM AUTHOR]