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Background and Aims: Preoperative parental anxiety can have a profound impact on their children undergoing surgery. The present study was done to analyse the correlation between preoperative parental anxiety and their child’s anxiety in paediatric patients undergoing elective surgery. Methods: Paediatric patients aged 2–12 years, scheduled for elective surgeries under general anaesthesia, were included in the study. The child’s behaviour and anxiety were assessed in the preoperative area using the modified Yale Preoperative Anxiety Scale (m-YPAS). The parent filled out the demographic questionnaire and the Spielberger State–Trait Anxiety Inventory (STAI) form in the preoperative area on the day of surgery. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) statistics software version 23.0 (IBM Corp, Armonk, NY, USA). Results: A total of 150 children undergoing elective surgery were analysed. Our results showed a strong positive correlation between a child’s m-YPAS and his/her parents’ anxiety on the day of the surgery (STAI-state) (r = 0.545, P < 0.001). However, the correlation between a child’s m-YPAS and his/her parents’ anxiety levels (STAI-trait) was not found to be significant (r = 0.109, P = 0.188). A positive correlation was observed between a parent’s STAI-state and STAI-trait (r = 0.366, P < 0.001). Factors like area of residence, type of surgery and previous hospitalisation had an influence on the anxiety levels of the child. The birth order of the child, previous hospitalisation and gender of the parent also influenced parental anxiety. Conclusion: Parental anxiety has a significant impact on the child’s anxiety during the preoperative period.

The present study was aimed to assess the efficacy of different culture media for blastocyst development. Oocytes (2,539) from 1,059 ovaries recovered by follicle puncture technique were utilized for present investigation. In experiment 1, effect of different embryo culture media (Gr. 1; mKSOMaa; Gr. 2; TCM-199+OEC; Gr. 3; mSOFaa and Gr. 4; mCR2aa) and in experiment 2, effect of sequential embryo culture medium, Gr. 1: mKSOMaa containing 5% FBS (1–3 days) and 10% FBS (4–10 days); Gr. 2: 0.8% BSA (1–3 days) and continuous embryo culture medium, 10% FBS (4–10 days); Gr. 3: 0.8% BSA (1–10 days) and Gr. 4: 10% FBS (1–10 days) on in vitro blastocyst development potential was evaluated. Significant higher (P

Neonatal diarrhoea is one of the most important conditions of calves, associated with morbidity and mortalities. Diarrhoeal diseases have an adverse effect on calf health status, survival and productive performances. Corona virus is one of the etiological agents responsible for calf diarrhea worldwide. However there is paucity of literature stating the disease status in India. The present study was carried out to determine the prevalence of corona virus infection among cow calves in Mathura and adjacent regions. During the present study 63 diarrhoeic stool samples collected from cow calves were screened for corona virus. Of the 63 diarrhoeic samples 3 samples (4.76%) were found to be positive for corona virus by ELISA. [Vet. World 2012; 5(3.000): 166-168]

Background and Aims: There is limited literature wherein the hypotensive drugs have been compared to know the cerebral effects by monitoring regional cerebral oxygen saturation (rScO2). This study aimed to compare the effects of dexmedetomidine and nitroglycerin on rScO2 during controlled hypotensive anaesthesia using near-infrared spectroscopy (NIRS). The primary objective was to evaluate the non-inferiority of dexmedetomidine versus nitroglycerin in the occurrence of cerebral desaturation events (CDEs) during hypotensive anaesthesia. Methods: Adult patients scheduled to undergo head and neck surgery under general anaesthesia randomised to receive either dexmedetomidine or nitroglycerin infusion for controlled hypotensive anaesthesia. Cerebral oximetry was monitored with NIRS, and data regarding CDEs, bilateral rScO2, and peri-operative haemodynamics were collected. Continuous data were analysed using unpaired Student's t-tests except for intra-group analyses, which were analysed using paired t-tests. Categorical data were analysed using the Chi-square test. For comparison of time to CDEs, Kaplan–Meier survival analysis with log-rank test was performed. Results: Of the 82 patients in both groups, CDEs were observed in 15 patients each. A decrease from baseline by 20% was observed in three patients: one in Group N and two in Group D. Statistically, there was an equal risk of getting CDEs in the groups. The time to CDE was comparable (P > 0.05). The difference in heart rate was statistically significant (P < 0.001). Conclusion: Dexmedetomidine is non-inferior to nitroglycerin in terms of the occurrence of cerebral desaturation events when used for controlled hypotensive anaesthesia in head and neck surgeries.

This paper presents the results of adsorption and permeation experiments of hydrogen and methane at elevated temperatures on a carbon-based nanoporous membrane material provided by Fraunhofer IKTS. The adsorption of pure components was measured between 90 °C and 120°C and pressures up to 45 bar. The Langmuir adsorption isotherm shows the best fit for all data points. Compared to available adsorption isotherms of H2 and CH4 on carbon, the adsorption on the investigated nanoporous carbon structures is significantly lower. Single-component permeation experiments were conducted on membranes at temperatures up to 220 °C. After combining the experimental results with a Maxwell–Stefan surface diffusion model, Maxwell–Stefan surface diffusion coefficients Dis were calculated. The calculated values are in line with an empirical model and thus can be used in future multi-component modeling approaches in order to better analyze and design a membrane system. The published adsorption data fill a gap in the available adsorption data for CH4 and H2.

Context: Fine-needle aspiration cytology is considered the gold standard screening test in the evaluation of a thyroid nodule. We studied whether cell block cytology can be used in addition to conventional smears for the evaluation of tissue from fine-needle aspirations or fluid aspirations and also compared it with histopathological diagnosis. Aims: The primary aim of this study was to know the utility of cell blocks in the diagnosis of thyroid lesions. Settings and Design: This was a prospective observational study conducted from June 2018 to September 2020 at a tertiary Care Hospital in Eastern India. Ethical approval was obtained from the Ethics Committee of the institution. Patients above 18 years who presented with goiter were included in the study. Thirty patients were enrolled in the study after informed consent. Methods and Material: Smears prepared from the aspirates were stained with Leishman-Giemsa (LG) and Pap stain. The remnant from the needle hub was transferred to a sterile container. Cell blocks were prepared from the remnants. Smears were scored based on cell obscuration by blood, cellularity, cell degeneration, and cell architecture. The results were compared with histopathology. Statistical Analysis Used: Data were recorded using Microsoft Excel. Descriptive statistics, frequency, and proportion were used to describe demographic variables. Results: The majority of the patients (23.3%) were in their third decade of life, followed by 16.7% of the patients in their fourth and fifth decades. The patient age ranged from 25 to 80 years, with a mean age of 50.83 years and a standard deviation of 16.72. The largest number of patients were females accounting for 80% (24/30) of the total participants. The majority of the patients (36.7%) (11/30) had thyroid gland enlargement for a period of 15 days to three months. 14% of the participants were not able to recall its duration. The majority (60%) (18/30) had left lobe lesions, followed by 33.3% (10/30) who had right lobe lesions, and 6.7% (2/30) who had bilateral lobe swelling. The mean size of the lesion was 2.84 cm. 50% were found to be Bethesda II lesions, while 13.3% were Bethesda IV, and 36.7% were found to be Bethesda VI lesions. The cell block score (7) was found to be better compared to Fine Needle Aspiration Cytology (FNAC) (4.7). Tissue Coagulum Clot and Clot Scrape methods were found to yield better results compared to the Cytocentrifuge method. The P value was found to be significant (

Abstract The genomic diversity and relationship among seven diverse cattle breeds viz. Sahiwal, Tharparkar, Gir, Vechur, Ongole, Kangayam and Hariana were investigated in 132 random samples based on high density SNP array comprising > 777 K SNPs. A total of 1993 SNPs (0.25% of the total) having greater power (FST ≥ 0.20) to differentiate these cattle populations were identified, and utilized to partition genome of each animal into a predefined number of clusters. The structure of these cattle indicated shared ancestry of dairy breeds viz. Gir, Tharparkar and Sahiwal. Most of the animals (> 76%) of different populations under study except Vechur clustered into their own group of animals called breed. Vechur population retained highest rate of admixture, consistent with its crossing with other breeds. Ongole, Kangayam and Hariana shared comparatively less of their genome (≤ 15%) with other breeds. The study indicated that all seven breeds evolved from their independent ancestry but there was intermixing of these breeds in the recent past. The selection signatures identified between draft (Kangayam) and dairy breeds included several genes like FAM19A2, RAB31P, BEST3, DGKA, AHCY, PIGU and PFKP which are involved in immune response, metabolic pathway, transportation of glucose and sugars, signaling pathways, cellular processes, cell division and glycolysis regulation, respectively. Moreover, these genomic regions also harbour QTLs affecting milk performance traits. The signatures were also identified even between the dairy breeds. In comparison to large-sized cattle, there were significant differences in the number of QTLs affecting production (body weight, growth rate etc.) and morphological traits (height) in short-statured Vechur breed. The presence of HMGA2 gene in the selection signature on chromosome 5 may explain the variations in stature between these cattle.

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration number NCT04323644

Abstract Background To characterize the clinico-pathological features including estrogen receptor (ER), progesterone receptor (PR) and Her-2/neu (HER2) expression in breast cancers in Botswana, and to compare them by HIV status. Methods This was a retrospective study using data from the National Health Laboratory and Diagnofirm Medical Laboratory in Gaborone from January 1, 2011 to December 31, 2015. Clinico-pathological details of patients were abstracted from electronic medical records. Results A total of 384 unique breast cancer reports met our inclusion criteria. Of the patients with known HIV status, 42.7% (50/117) were HIV-infected. Median age at the time of breast cancer diagnosis was 54 years (IQR 44–66 years). HIV-infected individuals were more likely to be diagnosed before age 50 years compared to HIV-uninfected individuals (68.2% vs 23.8%, p

High endemicity of Johne’s disease (JD) in herds adversely affects heavy milk yielding breeds by reducing the per animal productivity and ‘productive life-span’. This review evaluates different vaccines used for its control and summarizes the benefits of ‘global vaccine’ in the four major domestic livestock species, namely goat, sheep, buffalo and cattle. Vaccines developed by using ‘native strains’ revealed both 'therapeutic' and preventive effects in domestic livestock. The 'therapeutic' role of vaccine in animals suffering from clinical JD turned out to be valuable in some cases by reversing the disease process and animals returning back to health and production. Good herd management, improved hygiene, ‘test and cull’ methodology, proper disposal of animal excreta and monitoring of MAP bio-load were also regarded as crucial in the 'therapeutic' management of JD. Vaccine approaches have been widely adopted in JD control programs and may be considered as a valuable adjunct in order to utilize huge populations of otherwise un-productive livestock. It has been shown that vaccination was the preeminent strategy to control JD, because it yielded approximately 3–4 times better benefit-to-cost ratios than other strategies. Internationally, 146 vaccine trials/studies have been conducted in different countries for the control of JD and have shown remarkable reduction in its national prevalence. It is concluded that for JD, there cannot be global vaccines or diagnostic kits as solutions have to come from locally prevalent strains of MAP. Despite some limitations, vaccines might still be an effective strategy to reduce or eradicate JD.

Photoionization or photodetachment is an important process. It has applications in solar- and astrophysics. In addition to accurate wave function of the target, accurate continuum functions are required. There are various approaches, like exchange approximation, method of polarized orbitals, close-coupling approximation, R-matrix formulation, exterior complex scaling, the recent hybrid theory, etc., to calculate scattering functions. We describe some of them used in calculations of photodetachment or photoabsorption cross sections of ions and atoms. Comparisons of cross sections obtained using different approaches for the ejected electron are given. Furthermore, recombination rate coefficients are also important in solar- and astrophysics and they have been calculated at various electron temperatures using the Maxwell velocity distribution function. Approaches based on the method of polarized orbitals do not provide any resonance structure of photoabsorption cross sections, in spite of the fact that accurate results have been obtained away from the resonance region and in the resonance region by calculating continuum functions to calculate resonance widths using phase shifts in the Breit–Wigner formula for calculating resonance parameters. Accurate resonance parameters in the elastic cross sections have been obtained using the hybrid theory and they compare well with those obtained using the Feshbach formulation. We conclude that accurate results for photoabsorption cross sections can be obtained using the hybrid theory.

>Introduction: Spinal anaesthesia is the preferred technique for caesarean section. Around 80% of which is complicated by maternal hypotension. Vasopressors are currently the treatment of choice for spinal-induced hypotension but these may individually have significant maternal or foetal side effects. Aim: To compare ephedrine and phenylephrine infusion with ephedrine and phenylephrine combination for preventing the hypotension in patients undergoing emergency caesarean section under spinal anaesthesia.Materials and Methods: A prospective randomized double blind study of 90 parturients beyond 32 weeks of pregnancy for caesarean section under spinal anaesthesia. Assuming a potency ratio of 80:1 ephedrine to phenylephrine, the patients were divided into the following three groups: Group E - received infusions of ephedrine 8 mg/ml, Group P - received infusions of 100 mcg/ml phenylephrine and Group E + P received infusion of ephedrine 4 mg/ml + phenylephrine 50 mcg/ml. A predefined algorithm was used to adjust the infusion rate according to the systolic blood pressure (SBP). After spinal injection, SBP, diastolic blood pressures (DBP), heart rate (HR) were recorded every one minute until the cord was clamped. Also, the vasopressor infusion rates were collected till clamping of umbilical cord in each group. Foetal parameters were analyzed from umbilical blood gas. Results: The incidence of hypotension was significantly higher in ephedrine group. The mean rate of infusion was higher for group E (P < 0.05). The foetal metabolism measured by mean pH, was significantly higher in group P(P > 0.05) as compared to others. Complications of bradycardia were observed in 30% of patients receiving phenylephrine.Conclusions: Combination of both phenylephrine and ephedrine is efficacious for spinal-induced hypotension with least maternal or foetal side effects.

The pollution of soil is a worldwide concern as it has harmful consequences on the environment and human health. With the continuous expansion of industry and agriculture, the content of hydrophobic organic pollutants in the soil has been increasing, which has caused serious pollution to the soil. The removal of hydrophobic organic contaminants from soil, aiming to recover environmental safety, is an urgent matter to guarantee sufficient food and water for populations. Adsorption has proven to be an effective and economically practicable method for removing organic contaminants. This paper summarizes the use of low-cost adsorbents, such as biochar and activated carbon, for removing hydrophobic organic contaminants from soil. Biochar is usually appropriate for the adsorption of organic contaminants via the adsorption mechanisms of electrostatic interaction, precipitation, and ion exchange. Biochar also has numerous benefits, such as being obtained from several kinds of raw materials, having low costs, recyclability, and potential for environmental treatment. This paper illustrates biochar’s adsorption mechanism for organic contaminants and discusses the microbial degradation of hydrophobic organic contaminants.

The excitation cross-sections of the nS states of atomic hydrogen, n = 2 to 6, by electron impact on the ground state of atomic hydrogen were calculated using the variational polarized-orbital method at various incident electron energies in the range 10 to 122 eV. Converged excitation cross-sections were obtained using sixteen partial waves (L = 0 to 15). Excitation cross-sections to 2S state, calculated earlier, were calculated at higher energies than before. Results obtained using the hybrid theory (variational polarized orbital method) are compared to those obtained using other approaches such as the Born–Oppenheimer, close-coupling, R-matrix, and complex-exterior scaling methods using only the spherical symmetric wave functions. Phase shifts and elastic cross-sections are given at various energies and angular momenta. Excitation rate coefficients were calculated at various electron temperatures, which are required for plasma diagnostics in solar and astrophysics to infer plasma parameters. Excitation cross-sections are compared with those obtained by positron impact excitation.

Polarizabilities and hyperpolarizabilities, α1, β1, γ1, α2, β2, γ2, α3, β3, γ3, δ and ε of hydrogenic systems have been calculated in the presence of a Debye–Huckel potential, using pseudostates for the S, P, D and F states. All of these converge very quickly as the number of terms in the pseudostates is increased and are essentially independent of the nonlinear parameters. All the results are in good agreement with the results obtained for hydrogenic systems obtained by Drachman. The effective potential seen by the outer electron is −α1/x4 + (6β1 − α2)/x6 + higher-order terms, where x is the distance from the outer electron to the nucleus. The exchange and electron–electron correlations are unimportant because the outer electron is far away from the nucleus. This implies that the conventional variational calculations are not necessary. The results agree well with the results of Drachman for the screening parameter equal to zero in the Debye–Huckel potential. We can calculate the energies of Rydberg states by using the polarizabilities and hyperpolarizabilities in the presence of Debye potential seen by the outer electron when the atoms are embedded in a plasma. Most calculations are carried out in the absence of the Debye–Huckel potential. However, it is not possible to carry out experiments when there is a complete absence of plasma at a particular electron temperature and density. The present calculations of polarizabilities and hyperpolarizabilities will provide accurate results for Rydberg states when the measurements for such states are carried out.

Purpose: The adrenal glands are a common site of metastases because of their rich blood supply. Previously, adrenal metastases were treated with systemic chemotherapy or, more rarely, with surgical resection or palliative radiation therapy. Stereotactic body radiation therapy (SBRT) has recently emerged as an attractive noninvasive approach to definitively treat these lesions. We present our experience in treating adrenal metastases using SBRT and review the current literature. Methods and materials: This is a single-institution retrospective review of patients who received SBRT to adrenal metastases originating from various primary malignancies. Patients who were eligible for SBRT included those with limited metastatic disease (≤5 sites) with otherwise controlled metastatic disease and uncontrolled adrenal metastases. Results: Ten patients met the study's inclusion criteria and received SBRT doses of 30 to 48 Gy in 3 to 5 fractions. Acute sequelae of SBRT treatment included 4 patients with grades 1 or 2 nausea, 3 patients with grade 1 fatigue, and 1 with grade 1 diarrhea. The median follow-up was 6 months with a median overall survival of 9.9 months. One patient demonstrated progressive adrenal gland disease 18.8 months after SBRT treatment. Seven patients developed new distant metastases after treatment, with a median progression-free survival of 3.4 months. Three months after SBRT to the adrenal gland, 1 patient developed a gastrointestinal bleed. Conclusions: These results complement the limited existing body of literature by demonstrating that SBRT provides good control of treated adrenal gland metastasis; however, high-grade late toxicities may occur. More stringent dose constraint limits may prevent associated serious adverse events.

A scattering process can be a natural process or a process carried out in a laboratory. The scattering of particles from targets has resulted in important discoveries in physics. We discuss various scattering theories of electrons and positrons and their applications to elastic scattering, resonances, photoabsorption, excitation, and solar and stellar atmospheres. Among the most commonly employed approaches are the Kohn variational principle, close-coupling approximation, method of polarized orbitals, R-matrix formulation, and hybrid theory. In every formulation, an attempt is made to include exchange, long-range and short-range correlations, and to make the approach variationally correct. The present formulation, namely, hybrid theory, which is discussed in greater detail compared to other approximations, includes exchange, long-range correlations, and short-range correlations at the same time, and is variationally correct. It was applied to calculate the phase shifts for elastic scattering, the resonance parameters of two-electron systems, photoabsorption in two-electron systems, excitation of atomic hydrogen by an electron and positron impact, and to study the opacity of the Sun’s atmosphere. Calculations of polarizabilities, Rydberg states, and bound states of atoms are also discussed.

The opacity of the atmosphere of the Sun is due to processes such as Thomson scattering, bound–bound transitions and photodetachment (bound–free) of hydrogen and positronium ions. The well-studied free–free transitions involving photons, electrons, and hydrogen atoms are re-examined, while free–free transitions involving positrons are considered for the first time. Cross sections, averaged over a Maxwellian velocity distribution, involving positrons are comparable to those involving electrons. This indicates that positrons do contribute to the opacity of the atmosphere of the Sun. Accurate results are obtained because definitive phase shifts are known for electron–hydrogen and positron–hydrogen scattering.

When an incident particle on a target gets attached to the target, the cross-section at that energy could be much larger compared to those at other energies. This is a short-lived state and decays by emitting an electron. Such states can also be formed by the absorption of a photon. Such states are below the higher thresholds and are called autoionization states, doubly excited states, or Feshbach resonances. There is also a possibility of such states to form above the thresholds. Then they are called shape resonances. Resonances are important in the diagnostic of solar and astrophysical plasmas. Some methods of calculating the resonance parameters are described and resonance parameters occurring in various systems are given.

The excitation cross sections of the nS states, n = 2 to 6, of atomic hydrogen at various incident positron energies (10.23 to 300 eV) were calculated using the variational polarized-orbital method. Nine partial waves were used to obtain converged cross sections. The present results should be useful for comparison with results obtained from other theories and approximations. The positron-impact cross section was found to be higher than the electron-impact cross sections. Experimental and other theoretical results are discussed. The threshold law of excitation is discussed and the cross sections in this region were seen to obey the threshold law proportional to ( ln k f ) − 2 . Cross sections were calculated in the Born approximation also and compared to those obtained using the variational polarized orbital method.

Purpose: Delays in diagnosis and treatment of cancers can lead to poor survival. These delays represent a multifaceted problem attributable to patient, provider, and systemic factors. We aim to quantify intervals from symptom onset to treatment start among patients with cancer in Botswana and to understand potential risk factors for delay. Patients and Methods: From December 2015 to January 2017, we surveyed patients seen in an oncology clinic in Botswana. We calculated proportions of patients who experienced delays in appraisal (between detecting symptoms and perceiving a reason to discuss them with provider, defined as > 1 month), help seeking (between discussing symptoms and first consultation with provider, defined as > 1 month), diagnosis (between first consultation and receiving a diagnosis, defined as > 3 months), and treatment (between diagnosis and starting treatment, defined as > 3 months). Results: Among 214 patients with cancer who completed the survey, median age at diagnosis was 46 years, and the most common cancer was cancer of the cervix (42.2%). Eighty-one percent of patients were women, 60.7% were HIV infected, and 56.6% presented with advanced cancer (stage III or IV). Twenty-six percent of patients experienced delays in appraisal, 35.5% experienced delays help seeking, 63.1% experienced delays in diagnosis, and 50.4% experienced delays in treatment. Patient income, education, and age were not associated with delays. In univariable analysis, patients living with larger families were less likely to experience a help-seeking delay (odds ratio [OR], 0.31; P = .03), women and patients with perceived very serious symptoms were less likely to experience an appraisal delay (OR, 0.45; P = .032 and OR, 0.14; P = .02, respectively). Conclusion: Nearly all patients surveyed experienced a delay in obtaining cancer care. In a setting where care is provided without charge, cancer type and male sex were more important predictors of delays than socioeconomic factors.

Background: Exfoliative cheilitis is a condition of unknown etiology characterized by hyperkeratosis and scaling of vermilion epithelium with cyclic desquamation. It remains largely refractory to treatment, including corticosteroid therapy, antibiotics, antifungals, and immunosuppressants. Objective: We sought to evaluate the safety and efficacy of excimer laser therapy and narrowband ultraviolet B therapy in female patients with refractory exfoliative cheilitis. Methods: We reviewed the medical records of two female patients who had been treated unsuccessfully for exfoliative cheilitis. We implemented excimer laser therapy, followed by hand-held narrowband UVB treatments for maintenance therapy, and followed them for clinical improvement and adverse effects. Results: Both patients experienced significant clinical improvement with minimal adverse effects with excimer laser therapy 600-700 mJ/cm2 twice weekly for several months. The most common adverse effects were bleeding and burning, which occurred at higher doses. The hand-held narrowband UVB unit was also an effective maintenance tool. Limitations: Limitations include small sample size and lack of standardization of starting dose and dose increments. Conclusion: Excimer laser therapy is a well-tolerated and effective treatment for refractory exfoliative cheilitis with twice weekly laser treatments of up to 700 mJ/cm2. Transitioning to the hand-held narrowband UVB device was also an effective maintenance strategy.

Background: In patients with heart disease, the presence of a fragmented QRS complex (fQRS) on the surface electrocardiogram (ECG) is associated with an increased risk of mortality. We sought to evaluate the prevalence and location of fQRS before and after left ventricular assist device (LVAD) implantation and any associated risk of mortality. Methods and results: Twelve-lead surface ECGs before (pre-LVAD, n = 98) and after (early [

Multiple pterygium syndrome (MPS) is a very rare autosomal recessive disorder characterized by flexion of joint and digit contractures, skin webbing, cleft palate, deformity of the spine, and cervical spine fusion. Difficult airway is associated mainly due to micrognathia, retrognathia, webbing of the neck, and limitation of the mouth opening and neck extension. We are reporting a case of a 5-year-old female diagnosed with MPS and exhibiting a bilateral club foot and congenital vertical talus. The patient was posted for manipulation and above the knee casting under general anesthesia.