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Background: In today's era, cardiac catheterization procedures are becoming increasingly safe, but they are still fraught with complications. We aimed to study the outcomes of patients who underwent emergency surgical intervention for complications in the cardiac catheterization laboratory., Methods: A retrospective analysis of patients who required emergency surgical management following a complication in the cardiac catheterization laboratory in our institute from July 2017 to July 2022 was done., Result: A total of 57 patients out of a total of 52,326 patients (0.1%) were included. The average age of presentation was 10.4 years. Congenital heart disease (CHD) constituted the majority of the cases (28/57-49.1%), coronary artery disease (CAD) constituted 19.3% (11/57), and rheumatic heart disease (RHD) constituted 8.8% (5/57) of the cases. Apart from this, 22.80% patients (13/57) were grouped together in the miscellaneous group. In total, 76.9% (10/13) of these patients had pericardial effusion and they developed a right ventricular (RV) rent following an attempted pigtail drainage. Also, one patient each had a RV rent following an attempted permanent pacemaker implantation for heart block and an endocardial biopsy respectively. One patient had a left bronchial rupture following thoracic endovascular aortic repair (TEVAR) for descending thoracic aorta (DTA) aneurysm. Thirty-day mortality was 7% (4/57), and the mean time of shifting the patients from the catheterization laboratory to the operating room was 8.3 h., Conclusion: Cardiac catheterization procedures have become increasingly safe, but complications can still occur, for which the cardiac surgeon should be briefed in a Heart Team meeting before taking up such cases. Even though these complications form a small percentage, the cardiologist should exercise some caution in attempting cases which could have a relatively easier surgical correction., Competing Interests: Conflict of interestNone., (© Indian Association of Cardiovascular-Thoracic Surgeons 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Oral Lichen Planus (OLP) presents a significant challenge in diagnosis due to its varied clinical manifestations and the absence of specific biomarkers. Timely and accurate diagnosis is crucial, particularly given its association with oral squamous cell carcinoma (OSCC). This review aims to explore the potential role of exosomes, small extracellular vesicles, in the pathogenesis of OLP and their utility as diagnostic biomarkers. Exosomes facilitate the exchange of information between cells and modulate immune responses by carrying various bioactive molecules such as proteins, lipids, and nucleic acids. In the context of OLP, exosomes derived from affected tissues or immune cells are thought to contribute to disease progression by mediating the transfer of pro-inflammatory molecules, including cytokines like interleukin-6 and tumour necrosis factor-alpha and chemokines such as CCL2, CCL5 and microRNAs such as miR-155, miR-146a, miR-21, and miR-34a, etc. Additionally, the distinct molecular contents of exosomes derived from OLP lesions may accurately represent the pathological changes occurring in these tissues. This suggests the potential of exosomes to be used as non-invasive biomarkers for diagnosing and tracking the progression of the disease. Understanding the immune microenvironment of OLP and the role of exosomes within this context is critical for advancing our knowledge of OLP pathogenesis and identifying new diagnostic and therapeutic strategies. However, challenges remain in identifying and characterising exosomes and their clinical translation. Further research is warranted to address these challenges and fully exploit exosomes' diagnostic and therapeutic potential in OLP and other inflammatory oral diseases., Competing Interests: The authors have no conflicts of interest relevant to this article., (© 2024 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.)

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. However, there is a lack of comprehensive data from low- and middle-income countries (LMICs) regarding factors influencing COPD outcomes, particularly in regions where biomass exposure is prevalent., Objective: The Factors Affecting Survival in Severe and Very Severe COPD Patients Admitted to Tertiary Centers of India (FAST) study aims to address this gap by evaluating factors impacting survival and exacerbation rates among COPD patients in LMICs like India, with a specific focus on biomass exposure, clinical phenotypes, and nutritional status in patients admitted to the Intensive Care Unit (ICU)., Methods: The FAST study is an observational cohort study conducted in university teaching hospitals across India. The study aims to enroll 1000 COPD patients admitted to the ICU meeting specific inclusion criteria, with follow-up assessments conducted every 6 months over a 2-year period. Data collection includes demographic information, clinical manifestations, laboratory investigations, pulmonary function tests, medications, nutritional status, mental health, and health-related quality of life. Adjudication of exacerbations and mortality will also be undertaken. The FAST study seeks to provide crucial insights into COPD outcomes in LMICs, informing more precise management strategies and mitigating the burden of COPD in these settings. By evaluating factors such as biomass exposure, clinical phenotypes, and nutritional status, the study aims to address key knowledge gaps in COPD research., How to Cite This Article: Arunachala S, Devapal S, Swamy DSN, Greeshma MV, Ul Hussain I, Siddaiah JB, et al . Factors Affecting Survival in Severe and Very Severe COPD after Admission in ICUs of Tertiary Care Centers of India (FAST COPD): Study Protocol for a Multicentric Cohort Study. Indian J Crit Care Med 2024;28(6):552-560., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2024; The Author(s).)

Purpose: To compare the efficacy of peribulbar bupivacaine with routine analgesics for pain management in patients undergoing scleral buckling., Methods: In total, 72 patients undergoing scleral buckling or combined with vitrectomy were enrolled in this study. Patients were randomized into two groups, each containing 36 patients. Patients of group A received 5 mL of bupivacaine (0.5%) injection at the end of surgery, whereas group B patients received routine analgesics. The postoperative pain score was assessed in the first 24 hours of the postoperative period with the visual pain analog score., Results: Maximum postoperative pain scores were lower in patients receiving bupivacaine block (median: 3; range: 3-7) than in the control group (median: 5; range: 3-9). Pain scores in group A were lower than in the control group both at 3 and 6 hours after surgery, which was statistically significant ( P < 0.001). Four patients in group A and 17 patients in group B needed additional analgesia in the first 24 hours of the postoperative period. In addition, two patients in group A and seven patients in group B experienced episodes of nausea and vomiting in the first 24 hours of surgery., Conclusion: The results of this study suggest that the postoperative experience of patients undergoing scleral buckling surgery can be made more comfortable with the use of bupivacaine block at the end of surgery., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Background: Pregnancy imposes significant physiological changes, including alterations in electrolyte balance and renal function. This is especially important because certain disorders might worsen and make people more susceptible to electrolyte abnormalities. One such condition is Sjogren's syndrome (SS), an autoimmune disease that can cause distal renal tubular acidosis (dRTA). This case report offers a unique perspective on the intricate physiological interplay during pregnancy, emphasizing the critical importance of recognizing and managing electrolyte abnormalities, particularly in the context of autoimmune disorders such as Sjogren's syndrome., Case Presentation: We report a case of a 31-year-old pregnant Indian woman at 24 weeks gestation presenting with fever, gastrointestinal symptoms, and progressive quadriparesis followed by altered sensorium. Severe hypokalaemia and respiratory acidosis necessitated immediate intubation and ventilatory support. Investigations revealed hypokalaemia, normal anion gap metabolic acidosis, and positive autoimmune markers for SS. Concurrently, she tested positive for IgM Leptospira. Management involved aggressive correction of electrolyte imbalances and addressing the underlying SS and leptospirosis., Conclusion: This case underscores that prompt recognition and management are paramount to prevent life-threatening complications in pregnant patients with autoimmune disease. This report sheds light on the unique challenge of managing hypokalaemic quadriparesis in the context of Sjogren's syndrome during pregnancy., (© 2024. The Author(s).)

Introduction: During orthodontic treatment, temporary anchoring devices (TADs) are used to restrain tooth movement. They are a relatively recent addition to the dental toolkit., Aim: As TADs have limitations, Dr. Eric Lieu of Taiwan developed Infra Zygomatic Crest (IZC) screws which are placed between the maxillary second premolar at the bony crest., Treatment Planning: The goal of this case study is to emphasize the value of anatomy, site selection, and IZC retrieval in the event of an accident. Cone beam computed tomography was used as a diagnostic tool for the precise location of the displaced IZC and immediate surgical retrieval was done under local anesthesia from the infratemporal space to prevent further complications., Takeaway Lessons: Orthodontists knowledge of soft tissue and hard tissue anatomy and precise positioning is crucial for successful TAD implantation., (Copyright © 2024 Copyright: © 2024 Indian Journal of Dental Research.)

Rationale: Cancrum oris, also known as noma, is a rare and rapidly progressing gangrenous infection affecting the oral cavity, commonly seen in malnourished children. We discuss the clinical presentation, diagnostic dilemma and management in a 54-year-old male human immunodeficiency virus-positive patient with oral ulceration clinically resembling squamous cell carcinoma (SCC)., Patient Concerns: The patient had severe oral ulceration with pain and difficulty eating food., Diagnosis: Histopathological examination was misleading as it revealed features akin to early invasion of SCC. Immunohistochemistry findings were not in favour of SCC., Treatment: Antiretroviral therapy was started owing to the decreased CD4 cell count., Outcomes: Lesions began to show signs of healing on follow-up., Take-Away Lessons: This case aims to highlight the unique challenges of diagnosing and emphasises the importance of considering opportunistic infections in immunocompromised patients presenting with oral ulcerations to prevent misdiagnosis and maltreatment., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Annals of Maxillofacial Surgery.)

Radical prostatectomy (RP) constitutes the primary treatment option for patients with clinically localized, biopsy-proven prostate cancer that requires local treatment with curative intent. Accurate reporting of radical prostatectomy specimens is required to guide further risk stratification and management of patients. Hence, for the handling and reporting of RP specimens, a standardized protocol should be followed. Many general pathologists may not be well-versed with the guidelines for the handling of radical prostatectomy specimens. This article discusses a detailed approach to grossing techniques, including specimen description, fixation requirements, gross cut-up, and reporting of the grade and stage of RP specimens. This will enable the pathologist to aid in multidisciplinary management., (Copyright © 2023 Copyright: © 2023 Indian Journal of Cancer.)

Introduction: Despite several in vitro and in vivo applications of low-intensity pulsed ultrasound (LIPUS), it remains an under-studied feature of the oral and maxillofacial region. The goal of this in vivo study was to objectively investigate the efficacy of low-intensity pulsed ultrasound on wound healing and related morbidities following surgical removal of an impacted third molar., Materials and Methods: The following in vivo prospective, comparative, randomised controlled clinical study was carried out amongst 56 patients who reported to the Department of Oral and Maxillofacial Surgery fulfilling the inclusion criteria. Group A received sham ultrasound, whereas Group B received LIPUS therapy. Based on the group allocated LIPUS 1 MHz, pulsed 20% and dose 1.0 watts/square centimetre (W/cm 2 )/sham, ultrasound therapy was given on 1 st , 2 nd and 3 rd post-operative days. The assessment of post-operative pain, oedema, trismus and wound healing on preoperative, first, third and seventh postoperative days., Results: The quantitative variables of the study were assessed using independent sample t -test, and qualitative variables were assessed using the Chi-square test. The P < 0.05 on third and seventh post-op days for pain, trismus and wound healing in the LIPUS group compared to control group making it statistically significant. There was no statistically significant difference in the reduction of oedema amongst the two groups., Discussion: Post-LIPUS application in the patients, postoperative pain was significantly reduced, trismus was noticeably improved and wound healing was satisfactory and can be employed as a complementary technique., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Annals of Maxillofacial Surgery.)

Competing Interests: The authors have no funding or conflicts of interest to declare.

Cancer is one of the major causes of mortality, globally. Cancerous cells invade normal cells and metastasize to distant sites with the help of the lymphatic system. There are several mechanisms involved in the development and progression of cancer. Several treatment strategies including the use of phytoconstituents have evolved and been practiced for better therapeutic outcomes against cancer. Fisetin is one such naturally derived flavone that offers numerous pharmacological benefits, i.e., antioxidant, anti-inflammatory, antiangiogenic, and anticancer properties. It inhibits the rapid growth, invasiveness, and metastasis of tumors by hindering the multiplication of cancer cells, and prompts apoptosis by avoiding cell division related to actuation of caspase-9 and caspase-8. However, its poor bioavailability associated with its extreme hydrophobicity hampers its clinical utility. The issues related to fisetin delivery can be addressed by adapting to the developmental aspects of nanomedicines, such as formulating it into lipid or polymer-based systems, including nanocochleates and liposomes. This review aims to provide in-depth information regarding fisetin as a potential candidate for anticancer therapy, its properties and various formulation strategies.

Coconut ( Cocos nucifera L.) and its value-added products are rich in medium chain triglycerides, polyphenols and flavonoids with a significant anti-oxidant potential. However, coconut and its products are underutilized for the development of nutraceuticals. Coconut testa is a brown cover of the endosperm, which is characterized with the considerable amount of phytonutrients, especially phenolics and flavonoids. The nutrient rich coconut testa is generally diverted for the production of animal feed or abandoned. Around 10-15% of the coconut kernel is removed as testa while preparing coconut desiccated powder. The coconut testa from the virgin coconut oil (VCO) industry also remains underutilized. Nevertheless, biochemical characterization of coconut testa has revealed its enormous anti-oxidant and nutraceutical potential. On the other hand there are reports describing the suitable encapsulation techniques to develop nutraceuticals from the plant-derived bioactives. In this context this review explores the prospect of utilizing the coconut testa-derived phytonutrients in developing a nutraceutical product., Competing Interests: Conflicts of interestNone., (© Association of Food Scientists & Technologists (India) 2021.)

Introduction: Disimpaction is one of the most common operations done by oral and maxillofacial surgeons around the world. Ketamine is a well-known general anaesthetic and short-acting intraoperative analgesic. The aim of this study was to measure the efficacy of anaesthesia using combined treatment with local anaesthetic plus a subanaesthetic dose of ketamine and local anaesthetic alone in bilaterally impacted mandibular third molar surgery., Methods and Materials: A total of 24 patients who consented were taken up for a split-mouth study. In the control group, surgical extraction of the impacted lower third molar was done using local anaesthesia (lignocaine 2% with 1:80,000 adrenaline) only, and in the study group, local anaesthesia with ketamine extraction was done using ketamine (0.2 mg/kg) along with local anaesthesia (LA). The time of onset and the duration of anaesthesia intraoperatively were recorded using a digital stopwatch. The depth of anaesthesia was noted on the 10 th , 30 th and 60 th min. After extraction, the post-operative pain on the first, fourth, eighth and 12 th hour was evaluated using a Visual Analogue Scale (VAS) score rating of 1-10. The pulse was also noted and compared for any differences in either of the groups., Results: A statistically significant ( P < 0.005) difference in result was obtained for the onset, duration, depth and pain score after surgical extraction in both the evaluated groups. The pain index score by the ketamine group was significantly low as compared to the local anaesthesia-only group. Intraoperative onset, duration and depth of anaesthesia obtained had a significant difference., Discussion: Ketamine can be used as a viable option for surgical third molar extractions with reduced discomfort and post-operative pain., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Annals of Maxillofacial Surgery.)

Background: In the last two years, COVID-19 pandemic caused by SARS-CoV-2 has created a mass destruction among humanity causing a major health crisis around the world. With the emergence of new strains of the virus, lack of targeted drugs and antimicrobial resistance, there is a dire need to discover specific antiviral with minimum side effects targeted against COVID-19., Objective: The present study evaluates the antiviral efficacy of a novel Ayurvedic polyherbal formulation, NOQ19, composed of a 13 well known herbs, in a cell-based setting., Methodology: Vero E6 (CL1008), the African green monkey kidney epithelial cell, were infected with SARS-CoV-2 virus (isolate USA-WA1/2020) in a 96 well-plate. NOQ19 test material was diluted at different concentration: 0.05 mg/ml, 0.1 mg/ml, 0.2 mg/ml, 0.3 mg/ml, 0.4 mg/ml, 0.5 mg/ml, 0.6 mg/ml, 0.7 mg/ml, 0.8 mg/ml and 0.9 mg/ml. These different concentrations of NOQ19 were added to infected cells respectively and incubated for 3 days in 5% CO 2 incubator. Remdesivir was used as a positive control. The cells were finally fixed with formaldehyde, stained with crystal violet and plaques were visualized. The number of plaques were counted to determine the PFU(plaque forming units)/ml., Results: The results of the present study demonstrated an excellent an antiviral efficacy of NOQ19 at 0.9 mg/ml concentration, eliminating 100% virus. The IC 50 of the drug was found to be 0.2 mg/ml., Conclusion: There is limited data around pre-clinical efficacy of polyherbal Ayurvedic drugs. Ayurvedic and herbal formations need to be tested in a preclinical setting to support the human data. The results of the present study demonstrated viral load reduction using NOQ19 in Vero E6 cell lines infected with SARS-CoV-2 virus. These result along with other preclinical and clinical trials could further evaluate the efficacy of NOQ19 as a potential therapeutic option in the fighting the COVID-19 challenge., Competing Interests: The test resources were provided by Sriveda Sattva Pvt. Ltd (Sri tattva). Dr. Ravi Reddy is the chief scientific officer of Sriveda Sattva Pvt Ltd. In addition Dr Hari Venkatesh is the research head and development head at Sriveda Sattva Pvt. Ltd. Besides providing the NOQ19 intervention tablets, Sriveda Sattva Pvt. Ltd. Was not involved in any aspect of this study. All the other authors have no conflicts of interest to declare., (© 2022 The Authors.)

Contamination of aquatic systems with pharmaceuticals, personal care products, steroid hormones, and agrochemicals has been an immense problem for the earth's ecosystem and health impacts. The environmental issues of well-known persistence pollutants, their metabolites, and other micro-pollutants in diverse aquatic systems around the world were collated and exposed in this review assessment. Waste Water Treatment Plant (WWTP) influents and effluents, as well as industrial, hospital, and residential effluents, include detectable concentrations of known and undiscovered persistence pollutants and metabolites. These components have been found in surface water, groundwater, drinking water, and natural water reservoirs receiving treated and untreated effluents. Several studies have found that these persistence pollutants, and also similar recalcitrant pollutants, are hazardous to a variety of non-targeted creatures in the environment. In human and animals, they can also have severe and persistent harmful consequences. Because these pollutants are harmful to aquatic organisms, microbial degradation of these persistence pollutants had the least efficiency. Fortunately, only a few wild and Genetically Modified (GMOs) microbial species have the ability to degrade these PPCPs contaminants. Hence, researchers have been studying the degradation competence of microbial communities in persistence pollutants of Pharmaceutical and Personal Care Products (PPCPs) and respective metabolites for decades, as well as possible degradation processes in various aquatic systems. As a result, this review provides comprehensive information about environmental issues and the degradation of PPCPs and their metabolites, as well as other micro-pollutants, in aquatic systems., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Breast cancer is the second leading cancer among all types of cancers. It accounts for 12% of the total cases of cancers. The complex and heterogeneous nature of breast cancer makes it difficult to treat in advanced stages. The expression of various enzymes and proteins is regulated by several molecular pathways. Oxidative stress plays a vital role in cellular events that are generally regulated by nuclear factor erythroid 2-related factor 2 (Nrf2). The exact mechanism of Nrf2 behind cytoprotective and antioxidative properties is still under investigation. In healthy cells, Nrf2 expression is lower, which maintains antioxidative stress; however, cancerous cells overexpress Nrf2, which is associated with various phenomena, such as the development of drug resistance, angiogenesis, development of cancer stem cells, and metastasis. Aberrant Nrf2 expression diminishes the toxicity and potency of therapeutic anticancer drugs and provides cytoprotection to cancerous cells. In this article, we have discussed the attributes associated with Nrf2 in the development of drug resistance, angiogenesis, cancer stem cell generation, and metastasis in the specific context of breast cancer. We also discussed the therapeutic strategies employed against breast cancer exploiting Nrf2 signaling cascades., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kumar, Kumar, Bhattacharjee, Somanna and Jain.)

Background: Cardiomyopathy is an important cause of morbidity and mortality in boys with Duchenne muscular dystrophy (DMD). Early diagnosis is a prerequisite for timely institution of cardioprotective therapies., Objective: We compared cardiac MRI (CMRI) with transthoracic echocardiography (TTE) including tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) for diagnosis of cardiomyopathy in early ambulatory boys with DMD., Methodology: This cross-sectional study was conducted between June 2018 and December 2020. Consecutive boys between 7 and 15 years of age with DMD were enrolled. Percentage ejection fraction (EF), fractional shortening, wall motion abnormalities, early diastolic mitral annulus velocity (Ea), medial mitral annulus ratio (E/Ea), and global strain were measured with STE. CMRI-derived EF, segmental hypokinesia, and late gadolinium enhancement (LGE) were studied and compared., Results: A total of 38 ambulatory boys with DMD were enrolled. The mean age was 8.8 ± 1.6 years, and none had clinical features suggestive of cardiac dysfunction. In the TTE, EF was ≤55% in 5 (15%), FS was ≤28% in 3 (9%), and one each had left ventricular wall thinning and wall hypokinesia. In TDI, none had diastolic dysfunction, and STE showed reduced global strain of < 18% in 3 (9%) boys. CMRI-derived EF was ≤55% in 20 (53%) boys and CMRI showed the presence of left ventricular wall hypokinesia in 9 (24%) and LGE in 4 (11%) boys., Conclusion: Cardiomyopathy remains clinically asymptomatic among early ambulatory boys with DMD. A significantly higher percentage of boys revealed early features of DMD-related cardiomyopathy in CMRI in comparison with echocardiography., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Prakash, Suthar, Sihag, Debi, Kumar and Sankhyan.)

BRCA1 mutation carriers have a greater risk of developing cancers in hormone-responsive tissues like breasts and ovaries. However, this tissue-specific incidence of BRCA1 related cancers remains elusive. The majority of the BRCA1 mutated breast cancers exhibit typical histopathological features of high-grade tumors, with basal epithelial phenotype, classified as triple-negative molecular subtype and have a higher percentage of DNA damage and chromosomal abnormality. Though there are many studies relating BRCA1 with ER-α (Estrogen receptor-α), it has not been reported whether E2 (Estrogen) -ER-α signaling can modulate the DNA repair activities of BRCA1. The present study analyzes whether deregulation of ER-α signaling, arising as a result of E2/ER-α deficiency, could impact the BRCA1 dependent DDR (DNA Damage Response) pathways, predominantly those of DNA-DSB (Double Strand break) repair and oxidative damage response. We demonstrate that E2/E2-stimulated ER-α can augment BRCA1 mediated high fidelity repairs like HRR (Homologous Recombination Repair) and BER (Base Excision Repair) in breast cancer cells. Conversely, a condition of ER-α deficiency itself or any interruption in ligand-dependent ER-α transactivation resulted in delayed DNA damage repair, leading to persistent activation of γH2AX and retention of unrepaired DNA lesions, thereby triggering tumor progression. ER-α deficiency not only limited the HRR in cells but also facilitated the DSB repair through error prone pathways like NHEJ (Non Homologous End Joining). ER-α deficiency associated persistence of DNA lesions and reduced expression of DDR proteins were validated in human mammary tumors., Competing Interests: None., (AJCR Copyright © 2022.)

Simultaneous high-speed stereo-particle image velocimetry, OH planar-laser-induced fluorescence (PLIF), and C H 2 O PLIF measurements in a vitiated bluff body combustor are considered. An ex situ, simultaneous, time-resolved laser sheet intensity profile correction procedure is introduced. This procedure is easily implemented experimentally and is capable of correcting multiple sheets at the same time. As a proof of concept, the procedure is applied to perform correction of the C H 2 O PLIF images in vitiated and unvitiated conditions. The challenges associated with C H 2 O PLIF under these combustor operating conditions are also discussed.

The lack of traditional cancer treatments has resulted in an increased need for new clinical techniques. Standard two-dimensional (2D) models used to validate drug efficacy and screening have a low in vitro - in vivo translation potential. Recreating the in vivo tumor microenvironment at the three-dimensional (3D) level is essential to resolve these limitations in the 2D culture and improve therapy results. The physical and mechanical environments of 3D culture allow cancer cells to expand in a heterogeneous manner, adopt different phenotypes, gene and protein profiles, and develop metastatic potential and drug resistance similar to human tumors. The current application of 3D scaffold culture systems based on synthetic polymers or selected extracellular matrix components promotes signalling, survival, and cancer cell proliferation. This review will focus on the recent advancement of numerous 3D-based scaffold models for cancer tissue engineering, which will increase the predictive ability of preclinical studies and significantly improve clinical translation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Unnikrishnan, Thomas and Ram Kumar.)

Renal tumors comprise a wide spectrum of benign and malignant tumors. The important prognostic factors in renal cell carcinoma include pathological stage, tumor grade, morphological type, sarcomatoid/rhabdoid differentiation, and tumor necrosis. Therefore, the pathologist needs to be fully aware of how to gross nephrectomy specimens to be able to accurately provide the above prognostic information while reporting adult kidney tumors. With the advent of nephron-sparing surgeries, due diligence should be exercised to assess and sample the parenchymal surgical margin. This article discusses the approach to grossing nephrectomy specimens, elaborates the significance of every step, and also sheds light on the importance of clinical and radiological information in providing a holistic approach to the diagnosis and staging of adult renal tumors., Competing Interests: None

Objectives: The aim of this study is to determine the prevalence, clinical characteristics, angiographic profile and predictors of outcome for percutaneous coronary interventions (PCI) of coronary chronic total occlusions (CTO) in a tertiary referral centre of north India., Background: There is no data on the prevalence and very few reports on clinical characteristics, angiographic profile and outcome of PCI in CTO from India., Methods: Retrospective analysis was done for the data of 12,020 patients undergoing coronary angiography (CAG) between January 2018 to January 2019 at our centre. Detailed baseline clinical, angiographic and revascularization data was collected. Outcome of CTO PCI was also noted. All baseline parameters were analysed for predicting the outcome of CTO PCI., Results: CTO was identified in 16.3% (1968) patients undergoing CAG and in 24.4% of patients with hemodynamically significant CAD. CTO was predominantly found in LAD (48%) followed by RCA (42.9%) and LCx (25.3%) arterial distribution. Mean JCTO score was 1.93 ± 0.7. PCI as a management strategy was adopted in 456 of 1968 patients (23.1%) and was successful in 340 of 456 (74.6%) of patients. Almost all CTO PCI were attempted by an antegrade approach only. Increasing age, male sex, CTO in LCx arterial distribution and higher J CTO score were associated with poorer outcome in CTO PCI., Conclusions: CTO's are commonly encountered during CAG procedures. In patients undergoing CTO PCI, a fair success rate can be achieved in a high volume experienced centre., Competing Interests: Declaration of competing interest Nothing to disclose., (Copyright © 2021 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Posterior dislocation of the intraocular lens (IOL) is a rare but potentially dangerous complication encountered by a cataract surgeon. We describe a modified balanced two-string technique of internally fixing a posteriorly dislocated rigid IOL using the pars plana approach in eyes which lack adequate capsular support. Five eyes of five patients underwent the procedure. All eyes had successful IOL refixation. One eye had mild temporal decentration. BCVA improved in all patients. Our technique is an alternate method of scleral fixation of posteriorly dislocated IOL with advantages of minimal postoperative astigmatism, minimal anterior segment manipulation, and good IOL centration., Competing Interests: None

Improved-Samba-Mahsuri (ISM), a high-yielding, popular bacterial blight resistant (possessing Xa21, xa13, and xa5), fine-grain type, low glycemic index rice variety is highly sensitive to low soil phosphorus (P). We have deployed marker-assisted backcross breeding (MABB) approach for targeted transfer of Pup1, a major QTL associated with low soil P tolerance, using Swarna as a donor. A new co-dominant marker, K20-1-1, which is specific for Pup1 was designed and used for foreground selection along with functional markers specific for the bacterial blight resistance genes, Xa21, xa13, and xa5. A set of 66 polymorphic SSR marker were used for the background selection along with a pair of flanking markers for the recombination selection in backcross derived progenies and in BC 2 F 2 generation, 12 plants, which are homozygous for Pup1, all the three bacterial blight resistance genes and possessing agro-morphological traits equivalent to or better than ISM were selected and selfed to produce BC 2 F 3 s. They were evaluated in plots with low soil P and normal soil P at ICAR-IIRR, Hyderabad for their low soil P tolerance, and bacterial blight resistance and superior lines were advanced to BC 2 F 6 . One of the lines, when tested at multiple locations in India was found promising under both normal as well as low soil P conditions.

Background: Patients with heart failure and reduced ejection fraction in low resource settings may not have access to devices and expensive therapeutic options. We followed up a cohort of patients with non-ischemic dilated cardiomyopathy (DCM) with very low left ventricle ejection fraction (LVEF≤19%) on low cost medical therapy alone. By selecting patients with such low LVEF, this study was restricted to patients with severe disease. We studied long-term transplant free survival of these patients., Methods and Results: The study enrolled 130 patients (83 men and 47 women) of DCM cohort with LVEF≤19% from April 2003-December 2018 on medical therapy alone. Mean age was 40.35 ± 13.9 years. Mean follow-up was 45.6 ± 39 months while median follow-up was 39 months (range: 0-176 months). Patients on devices (ICD/CRT) for heart failure management were excluded. Fifty-four patients died and three underwent transplant during the study. Median survival was 86 months (S.E. 22.38). 113 patients had follow-up till end of study. In the worst case scenario, if all 17 patients who were lost to final follow-up were assumed to be dead, the median survival was still 57 (S.E.9.28) months. Higher baseline NYHA class, recurrent heart failure hospitalizations, absence of treatment with beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers and aldosterone antagonists were predictors of death on univariate analysis whereas none of these parameters were significant on multivariate analysis., Conclusions: Median survival of our DCM cohort with LVEF≤19% on medical therapy was over 7 years., Competing Interests: Declaration of competing interest Nil., (Copyright © 2020 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Soil and sludge are major reservoirs of organic compounds such as fluoroquinolones (FQs) which are broad-spectrum antibacterial agents. Hence, we monitored three major FQs, namely, ciprofloxacin (CIP), norfloxacin (NOR), and ofloxacin (OFL), in surface soil from two major dumpsites and dry and wet sludge from sewage treatment plants in Chennai city. The mean concentration of FQs in soil and sludge samples were 20 μg/g and 26 μg/g, respectively. Nearly 50% of the total FQs in dumpsite soil was contributed by CIP followed by NOR (32%) and OFL (13%). Similarly, CIP was the major contributor in sludge samples followed by NOR and OFL. The concentration of FQs was two folds higher in wet sludge than dry sludge most likely indicating that water solubility of these compounds might play an important role for elevated level of FQs in wet sludge. Solid waste from pharmaceutical industries, households, and sludge from wastewater treatment plants were expected to be the major source of FQs in dumpsite soil. Predicted risk assessment using soil to water migration concentrations via surface run off indicated high risk to aquatic organisms. However, risk quotient (RQ) was found less to earthworm in most of the soil samples. The findings from this study might help in future policies on disposal of household antibiotics in the solid waste stream., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Justification: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition., Process: Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of Medical Sciences, New Delhi. The meeting was supported by Children's HeartLink, a non-governmental organization based in Minnesota, USA., Objectives: To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases., Recommendations: Evidence based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heart diseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein anomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.

The majority of testicular tumors are germ cell tumors (GCTs), but there are numerous other types, making testicular tumors one of the most diverse areas of human pathology, despite their relative rarity. Testicular tumors are usually diagnosed only after radical surgery, as biopsies are not performed. Further management of the patient is dependent on the diagnosis at microscopy, which itself is based on the sections taken at the time of grossing the specimen. Many pathologists often aren't well versed with guidelines for handling of orchiectomy specimens and for microscopy. This article discusses, in detail, the approach to grossing of a testicular tumor specimen and elaborates of the reasons as to why we do what we do at the initial "cut-up". It explains the logic behind the reporting guidelines for testicular tumors and offer a clinical primer to the pathologist as to why we do what we do while grossing testicular tumor specimens., Competing Interests: None

A number of guidelines are available for the management of congenital heart diseases (CHD) from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for CHD, as often these patients present late in the course of the disease and may have coexisting morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on August 10 and 11, 2018, at the All India Institute of Medical Sciences. The meeting was supported by Children's HeartLink, a nongovernmental organization based in Minnesota, USA. The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common CHD; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for CHD; and (iii) indications for use of pacemakers in children. Evidence-based recommendations are provided for indications and timing of intervention in common CHD, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, and others), obstructive lesions (pulmonary stenosis, aortic stenosis, and coarctation of aorta), and cyanotic CHD (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein's anomaly, and others). In addition, protocols for follow-up of postsurgical patients are also described, disease wise. Guidelines are also given on indications for implantation of permanent pacemakers in children., Competing Interests: There are no conflicts of interest.

The objective of this study is to determine the diagnostic accuracy of frozen section in detecting epithelial ovarian tumor histological types and its effect on management. A retrospective review was done of all patients who had an intraoperative frozen section for an indeterminate ovarian tumor over a six-year period. The reference standard was final histology. The validity indices for frozen section in diagnosing benign, borderline, and malignant lesions were determined. One hundred thirty-five intraoperative frozen section-diagnosed epithelial ovarian tumors were reviewed. The mean age was 44.9 ± 14.2 years, the median parity was 2, and 57% (77/135) of patients were post-menopausal. The commonest histological subtype was mucinous 48.1% (65/135) on frozen section and 46.7% (63/135) on final histology. The overall concordance rate of frozen section to final histology was 81.5% ( ƙ  = 0.719, p  = 0.0001). The accuracy, sensitivity, specificity, and positive predictive value of frozen section to diagnose benign lesions were 86.7%, 85.7%, 97.2%, and 79.2% respectively. In borderline tumors, the diagnostic test characteristics were 88.1%, 81.2%, 90.3%, and 72.2%. For malignant lesions, these values were 88.1%, 77.8%, 95.1%, and 91.3% respectively. The odds ratios for frozen section being correct were 40.9 (95% CI 14.8-113.5) for benign lesions, 40.3 (95% CI 13.4-121.3) for borderline tumors, and 67.4 (95% CI 20.5-222.0) for malignancy. Over-treatment or under-treatment occurred in 19.3% of patients. Intraoperative frozen section is useful in situations where the nature of the ovarian tumor is uncertain. However, borderline ovarian tumors are more likely to be over-diagnosed. About a fifth of patients received inappropriate treatments based on the frozen section report., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest.

Introduction: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition., Process: Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on the 10th and 11th of August, 2018 at the All India Institute of Medical Sciences., Objectives: The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases and (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases., Recommendations: Evidence-based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts, obstructive lesions, and cyanotic congenital heart diseases. In addition, protocols for follow-up of postsurgical patients are also described., (Copyright © 2019 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Background: The goal of radical prostatectomy is to achieve the optimal balance between complete cancer removal and preserving a patient's urinary and sexual function. Performing a wider excision of peri-prostatic tissue helps achieve negative surgical margins, but can compromise urinary and sexual function. Alternatively, sparing peri-prostatic tissue to maintain functional outcomes may result in an increased risk of cancer recurrence. The objective of this study is to determine the effect of providing surgeons with detailed information about their patient outcomes through a surgical report card., Methods: We propose a prospective cohort quasi-experimental study. The intervention is the provision of feedback to prostate cancer surgeons via surgical report cards. These report cards will be distributed every 3 months by email and will present surgeons with detailed information, including urinary function, erectile function, and surgical margin outcomes of their patients compared to patients treated by other de-identified surgeons in the study. For the first 12 months of the study, pre-operative, 6-month, and 12-month patient data will be collected but there will be no report cards distributed to surgeons. This will form the pre-feedback cohort. After the pre-feedback cohort has completed accrual, surgeons will receive quarterly report cards. Patients treated after the provision of report cards will comprise the post-feedback cohort. The primary comparison will be post-operative function of the pre-feedback cohort vs. post-feedback cohort. The secondary comparison will be the proportion of patients with positive surgical margins in the two cohorts. Outcomes will be stratified or case-mix adjusted, as appropriate. Assuming a baseline potency of 20% and a baseline continence of 70%, 292 patients will be required for 80% power at an alpha of 5% to detect a 10% improvement in functional outcomes. Assuming 30% of patients may be lost to follow-up, a minimum sample size of 210 patients is required in the pre-feedback cohort and 210 patients in the post-feedback cohort., Discussion: The findings from this study will have an immediate impact on surgeon self-evaluation and we hypothesize surgical report cards will result in improved overall outcomes of men treated with radical prostatectomy.

Neuroblastoma (NB), a developmental cancer, is often fatal, emphasizing the need to understand its pathogenesis and identify new therapeutic targets. The heterogeneous pathological and clinical phenotype of NB underscores the cryptic biological and genetic features of this tumor that result in outcomes ranging from rapid progression to spontaneous regression. Despite recent genome-wide mutation analyses, most primary NBs do not harbor driver mutations, implicating epigenetically-mediated gene regulatory mechanisms in the initiation and maintenance of NB. Aberrant epigenomic mechanisms, as demonstrated by global changes in DNA methylation signatures, acetylation, re-distribution of histone marks, and change in the chromatin architecture, are hypothesized to play a role in NB oncogenesis. This paper reviews the evidence for, putative mechanisms underlying, and prospects for therapeutic targeting of NB oncogenesis related to DNA methylation., Competing Interests: CONFLICTS OF INTEREST The authors declare no conflicts of interest.

Introduction: Evidence for second transurethral resection of bladder tumour (TURBT) for pTa high-grade lesions is limited. This study aims to examine the role of a second TURBT in the pTa high-grade group and to generate recurrence and progression data for this group., Material and Methods: We retrospectively studied the clinical profiles and outcomes of all patients diagnosed with high-grade pTa lesions at first TURBT, between the years 2006-2015. Firstly, in patients who underwent a complete first TURBT, we calculated the proportion of patients with positive findings on second TURBT. Secondly, we assessed whether those who underwent a second TURBT had a longer recurrence-free survival compared to those who underwent a single TURBT., Results: One hundred and twelve patients had a pTa high-grade urothelial bladder tumor (WHO 2004 classification) at first TURBT, out of whom 43 (38.3%) had a second TURBT. Indications for second TURBT were high-grade lesions (n = 36), absence of detrusor muscle (n = 2), and incomplete resection (n = 5). Out of the 36 patients who had a complete first TURBT and underwent a second look TURBT, 7 patients had positive findings (3 carcinoma in situ, 2 pTa low-grade lesions and 2 pTa high-grade lesions) and there was no upstaging. Of the 5 patients with an incomplete first TURBT, one upstaged to pT1 on second TURBT. Of the 81 patients who followed up with us, 25.9% had a recurrence and 8.6% progressed. The estimated median recurrence free survival was 60 months (95% CI 29.2-90.7) for the whole group and 76 months vs. 45 months for the second and single TURBT group respectively - a difference that was clinically, though not statistically, significant. Multiple (≥2) tumours had a lower recurrence free survival (HR of 4.60, CI 1.67-12.63, p = 0.003)., Conclusions: Of the patients with pTa high-grade tumours who had a second TURBT after a complete first TURBT, 19.4% had a positive finding. Multiple tumours are four times as likely to recur as solitary tumours. The role of a second TURBT in this group needs to be studied in larger patient cohorts before a recommendation regarding its lack of clinical utility can be made conclusively.

Introduction: Magnetic Resonance Imaging (MRI) is emerging as a powerful tool in the evaluation and management of cervical cancer. The role of Diffusion Weighted Imaging (DWI) with Apparent Diffusion Coefficient (ADC) as a non-invasive imaging biomarker is promising in characterization of the tumour and prediction of response., Aim: The aim of this study was to evaluate the role of conventional MRI and diffusion weighted MRI in predicting clinicopathological prognostic factors., Materials and Methods: This was a retrospective study. The data of 100 cervical cancer patients who had MRI with DWI was retrieved from the database and analysed. Clinico pathological details were collected from the computerized hospital information system. SPSS version 15.0 was used for statistical analysis., Results: The mean tumour dimensions on MRI in x, y and z axes were 43.04 mm (±13.93, range: 17-85), 37.05mm (±11.83, range: 9-80) and 39.63 mm (±14.81, range: 14 -76). The mean T 2 W MRI based tumour volume (TV) was 48.18 (±34.3, range: 7-206) and on DWI images was 36.68(±33.72, range: 2.5-200). The mean ADC value in patients with squamous cell carcinoma was 0.694 (±0.125, n=88), adenocarcinoma was 0.989 (±0.309, n=6), adenosquamous was 0.894 (±0.324, n=4). There was statistical significant difference in mean ADC between squamous vs. non squamous histology (p = 0.02). The mean ADC values of well differentiated, moderately differentiated, and poorly differentiated tumours were 0.841(±0.227, n= 26), 0.729 (±0.125, n=28), 0.648 (±0.099, n=46) respectively. There was significant statistical difference of mean ADC between well differentiated, moderately differentiated (p=0.020) and poorly differentiated tumours (p=0.0001). Difference between the mean ADC values between the node positive and node negative disease was statistically significant (p=0.0001). There was no correlation between the tumour volumes on T 2 W and DWI images and ADC values. Sixteen patients had residual/recurrent disease at a median follow up of 12 months (range: 3-59 months). The mean ADC values in this group was 0.71 (n=16) and was not significantly different from the disease free group (mean ADC =0.72, n=74)., Conclusion: Higher ADC values are associated with favourable histology and differentiation. Adenocarcinomas have higher ADC values followed by adenosquamous followed by squamous cell carcinomas. Well differentiated tumours had higher ADC values than moderately followed by poorly differentiated tumours. DWI with ADC have a potential role as an imaging biomarker for prognostication and needs further studies for routine clinical applications.

Introduction: We aimed to determine how renal tumour scoring systems, such as RENAL, PADUA, and Centrality (C)-index, compare to clinical judgement at predicting time required for tumour removal and kidney reconstruction during partial nephrectomy., Methods: A consecutive cohort of partial nephrectomy patients treated at The Ottawa Hospital, a tertiary care uro-oncological centre, was retrospectively reviewed. Preoperative axial images were reviewed by four experienced urological oncologists who independently rated the complexity of a partial nephrectomy from 1 - 10 to generate a clinical judgement score. Two independent reviewers determined the RENAL, PADUA, and C-index scores. The time to complete tumour resection and renal reconstruction during partial nephrectomy was prospectively recorded., Results: During the study period, 104 partial nephrectomies were performed. The mean partial nephrectomy complexity score based on clinical judgement was 3.4 (standard deviation [SD] 2.1) out of 10. There was good agreement between surgeons in assessing tumour complexity (intraclass correlation coefficient 0.72; 95% confidence interval [CI] 0.65, 0.78). The mean RENAL score was 6.7 (SD 1.6) out of a maximum of 12, the mean PADUA score was 8.5 (SD 1.5) out of a maximum of 14, and the mean C-index score was 3.8 (SD 2). Mean resection and reconstruction time was 24 minutes (SD 10 minutes). The correlation between clinical judgement score and time was 0.27 (p=0.005). The correlation between renal tumour scoring systems and time was 0.20 (p=0.04) for RENAL, 0.21 (p=0.03) for C-index, and 0.26 (p=0.007) for PADUA. RENAL and PADUA scores were significantly associated with surgical and total complications., Conclusions: The majority of variance in ischemia time is not explained by clinical judgement or renal tumour scoring systems. Renal tumour scoring systems were not better than the clinical judgement of urological oncologists at predicting ischemia time during partial nephrectomy., Competing Interests: Competing interests: Dr. Cagiannos reports personal fees from Abbvie, Ferring, and Janssen, outside the submitted work. Dr. Lavallee reports grants from Sanofi and personal fees from Sanofi and Ferring, outside the submitted work. The remaining authors report no competing personal or financial interests.

Context: Asthma is a chronic inflammatory disorder of the airway with involvement of various cellular populations and release of many inflammatory mediators. Eosinophils and serum immunoglobulin E (IgE) are considered a good marker of airway inflammation in asthma. The correlation of clinical assessment with various markers of airway inflammation in asthma is not well established in the Indian population., Aims: This study aims to study the correlation of serum IgE, sputum eosinophil count, and peripheral eosinophil count with clinical severity of Asthma., Methods: This is a cross-sectional study involving 76 stable asthmatic patients of 18-60 years of age attending the pulmonary medicine OPD. Spirometry measured at baseline. Participants were categorized according to the GINA criteria based on clinical symptoms and pulmonary function test. Blood samples were collected for peripheral eosinophil count, serum IgE levels, and sputum samples for eosinophil count. All three parameters were compared with severity of asthma. The correlation of sputum eosinophil count, peripheral eosinophil count, and serum IgE with severity of asthma was analyzed by Pearson's Chi-square test, Fisher's exact test, and the correlation coefficient was reported together with standard error of the estimate., Results: The mean age of patients in our study was 37.42 years and 56.6% were male. There was a significant inverse correlation between serum IgE levels and predicted forced expiratory volume 1 s (FEV1). Sputum eosinophilia was significantly seen in severe persistent asthma patients (19.7%). There was a significant inverse correlation between sputum eosinophil count and predicted FEV1and forced vital capacity. We also found there was a significant association between peripheral eosinophil count, sputum eosinophil count, and elevated serum IgE (g100 IU/mL) with severe persistent asthma., Conclusions: The assessment of sputum eosinophil count is simple, inexpensive, noninvasive, and direct measurement of airway inflammation. It could be the preferred method in monitoring airway inflammation and guided management in day-to-day practice.