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After Independence, Goods and Service Tax (GST) would be a very significant and giant indirect tax structure reforms in the country. It is designed to support and enhance the economic growth of the country. It is a comprehensive tax that will integrate all indirect taxes of states and central governments and the unified economy into a seamless national market. Because of its transparent and self-policing character, it would be easier to administer. According to me, it is expected to iron out wrinkles of the existing indirect tax system and play a vital role in a country’s growth. By amalgamating a large number of Central and State indirect taxes, it would mitigate cascading effect or double taxation in a major way and pave the way for a common national market. So, from a common man or consumer point of view, the biggest advantage would be in terms of reduction in the overall tax burden on goods, which was estimated to be around 25%-30% before the implementation of GST. This paper highlights the concept of GST and its impact on the common man.

Introduction/Background* Thrombocytosis is a poor prognostic indicator in malignancies especially in gynecological one such as carcinoma ovary, cervix, and endometrium. Recent evidence indicates that platelets are present in the tumor microenvironment and could play important roles in stimulating tumor growth. The aim of this study is to analyze the impact of platelet count on the prognosis of ovarian cancer Methodology Baseline platelet count (prior to surgery or chemotherapy) was analyzed in 151 cases of ovarian cancer confirmed by histopathological examination. Thrombocytopenia & thrombocytosis were defined as platelet count (PC) 4.0 lakh/cumm respectively. Result(s)* Out of 151 cases, thrombocytopenia was seen in 3.3% (5/151), whereas thrombocytosis in 20.5% (31/151) and 76.2% (115/151) of cases were within normal range of platelet count. Data for thrombocytopenia cases are very few so we can’t make any opinion over this except that most of the cases of OC have normal or above normal platelet count. Recurrence In TP cases, recurrence was seen in 20% cases, but it is the result of very small data(5/151), so it may not have any significance. If we analyze base line Platelet count (PC), it is noticed that higher count cases have shown more percentage of recurrence. With PC 1–2 Lakh/cumm, recurrence is seen in 11.1%, PC 2-3 Lakh/cumm, it is 33.3%; thrice the value of previous one. It grossly appears to be statistically significant. PC between 2-3 lakh/cumm & between 3-4 lakh/cumm, no significant difference is being seen. It is 33.3% and 30.00% respectively. Now if we analyze recurrence rate with PC >4 lakh/cumm cases, it is around 60%, which is statistically significant. Mortality 13/151 cases expired within 4 years of treatment. 60% of these expired cases had platelet count >3lakh/cumm. Conclusion* Study shows that platelet count is directly proportional to the prognosis of cases of ovarian cancer.

Introduction/Background* Ovarian cancer is currently diagnosed using CAl25, which has a number of fallacies. Recently HE4 (human epididymis protein) is an emerging biomarker. It has higher potency to differentiate benign tumours from malignant one. Methodology We studied 123 cases of ovarian cancer confirmed by histopathological examination. Whole blood samples were collected at the time of diagnosis prior to therapy (chemotherapy or surgery). We tested them for serum level of CA 125 & HE4. Cut off values for HE4 and CA125 were Result(s)* Total 123 cases were evaluated for serum level of HE4 & CA125 prior to therapy. Results are being displayed in table 1. Out of 123 cases 38 showed CA 125 values negative, whereas the same was 14 for HE4, indicating a better diagnostic performance by HE4. As studied by Drapkin et al 2005, serum level of HE4 will not be raised in 50% cases of clear-cell variant and almost all cases of mucinous tumors. It is positive in 93% cases of serous tumors and almost all cases of endometrioid tumors. It will not be raised in benign ovarian cysts. Among premenopausal cases (42/123), 10 showed CA 125 negative where as HE4 was negative in 7/42 cases. Out of 10 CA 125 negative cases, 5 were HE4 positive. Out of HE4 negative cases 2/7 showed CA 125 positive result. Mucinous and clear cell variants show HE4 negative result. Among postmenopausal cases (81/123), 25 showed CA 125 negative where as HE4 was negative in 7/42 cases. 18/25 CA 125 negative cases showed positive HE4 results. None of HE4 negative case showed higher CA 125 value. Conclusion* Study shows HE is more accurate in diagnosing OC & differentiating it from benign tumors. The study is continued to achieve a decisive conclusion.

Glucocorticoid (GC), such as prednisolone, is an essential component of multidrug chemotherapy regimen for pediatric acute lymphoblastic leukemia (ALL). Resistance to GC in leukemia cells is associated with disease progression and poor prognosis. Despite the extensive use of GC for many years, molecular mechanisms underlying its resistance in ALL have not been fully uncovered. Recent studies have shown a potential role of EMP1, CASP1, and NLRP3 genes in prednisolone response. In this study on 148 pediatric B-ALL patients, we studied these three genes to assess their association with prednisolone response measured by day 8 blast count after 7 days of induction therapy with prednisolone. Intriguingly, ALL samples exhibited higher expression of EMP1 along with a low expression of CASP1 and NLRP3 compared to disease free normal bone marrow collected from patients with solid tumors. Among the three analyzed genes, only EMP1 was found to be overexpressed in prednisolone poor responders (p=0.015). Further, a comparison of gene expression between cytogenetic subtypes revealed higher expression of EMP1 in BCR-ABL subtype. Expression of EMP1 in multiple gene expression datasets was used for gene set enrichment analysis, which revealed TNF-α, IL-2-STAT5 signaling, inflammatory responses and hypoxia as the major positively associated pathways and E2F targets as negatively associated pathways. Interestingly, the clinical remission rate was higher in CASP1 high patients (p=0.048). In univariate survival analysis, higher EMP1 expression was associated with poor prognostic measures while higher expression of NLRP3 and CASP1 was associated with better prognostic measures in our data. Further, multivariate analysis revealed an independent association of high CASP1 and NLRP3 with a better prognosis. This study strengthens the available evidence that mRNA expression of EMP1, CASP1, and NLRP3 may serve as potential biomarkers for risk stratification of pediatric B-ALL patients.

Context: Acute myeloid leukemia (AML) is a highly heterogeneous hematological malignancy characterized by different genetic and epigenetic aberrations. Several epigenetics modifications were observed in the promoter regions of the cellular epigenome, including hypomethylation or hypermethylation of CpG islands during the onset and progression of AML. DNA methylation is an epigenetic modification that regulates gene expression and plays a pivotal role in tumorigenesis, including AML. Wilms tumor 1 (WT-1) is a transcription factor involved in the differentiation and proliferation of AML. The clinical relevance of WT-1 gene expression and its underlying epigenetic alterations has not been fully addressed in AML. Objective: This work aimed to investigate promoter methylation and mRNA expression of WT-1 gene in AML. Patients: Bone marrow samples were collected at the time of diagnosis and after completion of induction chemotherapy from 10 newly diagnosed AML patients. Five non-malignant BM samples were recruited as controls. Methods: Quantitative assessment of WT-1 gene transcripts was performed using real-time PCR. In addition, methylation-specific PCR was done to evaluate the promoter methylation status of the WT-1 gene in AML. Results: Robust promoter hypermethylation and higher expression of the WT-1 gene were observed in AML patients at time of diagnosis. In contrast, hypomethylation and lower WT-1 gene expression were observed after completion of induction therapy (p Conclusions: This is the first report, to our knowledge, regarding WT-1 gene overexpression/hypermethylation signature as a characteristic marker that correlates with leukemic burden in AML among the Indian population. Increased expression and methylation signature of the WT-1 gene can be used as a promising molecular marker for diagnosis, clinical progression of the diseases, or monitoring response to treatment, as well as a target for the development of novel therapeutic approaches.

Introduction Lesions of liver cause significant morbidity and mortality. Liver biopsy may not give the exact picture on lesions of liver. Autopsy study may be a better choice for this. The aims and objectives are: 1) to analyze lesions of liver in autopsy in India; 2) to establish the usefulness of autopsy pathology in clinical practice, teaching medical students and for research purposes. Methods Retrospective analysis of histopathological findings of autopsy cases was done for the year 2017 to 2020. Inclusion criteria were cases showing positive histopathological finding in any of the following organs heart, lung, liver, spleen, kidney, and brain. Total 70 cases were taken out. The age ranged from 4 days to 77 years. Male and female were 52 and 18 respectively. Out of total 70 cases, 40 showed lesions in liver. Results Most common lesion was Hepatic steatosis with foci of cirrhosis 14/70 (20%). This was followed by cirrhosis (9/70)12.8%, chronic hepatitis & granuloma 4/70 (5.7%) each, Cardiac cirrhosis (2/70), Nonalcoholic hepatic steatosis in an 11 months old male baby with umbilical granuloma, hydatid cyst, metastasis from primary cancer & chronic hepatitis in 1/70 cases. Rest cases didn't show any pathology. Conclusions The pattern of liver diseases is different in the different ethnic groups. In India, no such study is available. Autopsy study may have clearer picture of lesions of liver than what we see in liver biopsy, which may be used for academic & research purposes.

Introduction Granular Cell Tumor (GrCT) is a rare benign tumor, likely arising from Schwann cells and accounts for 0.5% of soft tissue tumor. About 0.5% to 2% cases are malignant. Methods The case was retrieved from the hospital record. Results A 46 year old male presented with a painful nodular mass in flank for six months. It was firm, immobile subcutaneous swelling, fixed to skin with irregular margin measuring 3 × 2 cm. Ultrasonography revealed it as localized lesion. FNAC was inconclusive. Excision biopsy showed large polygonal cells with granular eosinophilic cytoplasm and eccentric nucleus with entrapped adnexal structure invading deep into adipose tissue. Cells were PAS positive & Diastase resistance. On immunohistochemistry, cells were positive for S-100 and CD-68 and negative for SMA & Vimentin. Diagnosis of GrCT of benign nature was made. Postoperative course was uneventful after 1.5 years of follow-up. Conclusions GrCT was originally named as myoblastoma, but currently, it is considered to be neural in origin. It is commonly found in females of 2nd to 4th decade, most common site being tongue, oral cavity. Fanburg Smith Criteria distinguishes benign from malignant lesions, that includes (i) necrosis (ii) spindling (iii) vesicular nuclei with large nucleoli (iv) increased mitotic activity (> 2 mitosis/HPF) (v) increased nucleo-cytoplasmic ratio (vi) pleomorphism. If out of these 6; > 3 features are indicates malignancy. Abdominal wall GrCT is rare. We found only 11 cases of abdominal wall GCT in medical literature. Prognosis is good in non-malignant cases. Excision is the treatment choice, rarely recurs.

Introduction Ultrasonography (USG)-guided fine needle aspiration cytology (FNAC) has become an indispensable component of diagnosis of abdominal masses especially the pancreato-biliary system. It allows the real time visualization of the needle tip as it passes through the tissue planes into the target area. Under USG guidance, needle can access smaller lesions and also lesions in critical anatomical areas. Methods The study involved 50 cases with clinically or ultrasonographically diagnosed of abdominal masses conducted in the department of pathology, Patna Medical College, Patna, India. Results Among total 50 patients in the study, 33 (66%) were female and 17 (34%) were male. The age ranged from 4 to 75 years. The most common site of FNAC was Gall bladder, being 38/50 (76%). Among the total 50 cases, 28 (56%) were malignant, 17 (34%) were benign and 5 (10%) were inconclusive. The most common age group was 51 to 60 years constituting 15/50 (30%) cases. Out of these 15 cases, 13 were malignant and 2 were benign. The most common malignancy seen, was carcinoma of Gall bladder, predominantly in females living in Gangetic belt (people living near the river Ganga) of Bihar, were the Arsenic content of soil is said to be very high. Conclusions USG-guided FNAC procedure involves the presence of both a pathologist and a radiologist, thereby facilitating the exact mass to be hit by the needle for FNAC and appropriate handling of aspirated material for routine and ancillary tests. Real time USG is a simple, cost-effective imaging modality, has an advantage over computed tomography (CT) in guiding non-axial needle trajectories and allowing the procedure to be accomplished more quickly than CT.

Introduction Liver diseases needs adequate healing process. Apart from drugs, exercise is closely associated with healing process. It is especially helpful in hepato-biliary, cardiovascular, respiratory and musculoskeletal diseases. Liver diseases are preventable by avoiding key risk factors like physical inactivity, obesity, tobacco use, low fruit and vegetable intake, alcohol use, etc. Methods Literature survey has been done. Results Commonly used physical therapies are being mentioned below. Pain and fatigue seen after radiation therapy need physical care. It needs soft tissue mobilization, therapeutic massage, modalities, therapeutic stretching and strengthening. Lymphedema is seen in hepatic diseases may be managed with manual lymph drainage, range of motion exercises, aerobic exercise and lymphatic bandaging. Renal Failure: Aerobic/strength training and functional management training is advised. Peripheral neuropathy: Physical therapy can restore the function. Deconditioning: Rebuilding endurance for activities and cardiovascular function needs a skilled physical therapist. Genitourinary complications: In prostate, bladder and ovarian cancer, incontinence and sexual dysfunction needs physical strengthening of pelvic floor. Walking or cycling for 30 minutes per day decreases mortality if a person contracts the disease. 150 minutes of moderate aerobic physical activity a week is seen to be associated with risk reduction of some cancers. Exercise training during and after therapy results in to speedy recovery and improves quality of life. Conclusions Studies suggest that a large portion of liver disease patients are not being advised rehabilitation services resulting in poor outcome. Mass scale awareness is required among doctors.

Background: Esthesioneuroblastoma is a rare neuroepithelial tumor arising from the olfactory epithelium in the cribriform plate or nasal cavity. It accounts for 1-5% of cases of malignant neoplasms of the nasal cavity. Methods: A 20-year-old pregnant female presented with painful loss of vision in both eyes, on imaging diagnosed as meningioma. There was a progressive increase in pain along with diminution of vision to the extent of complete loss of vision in the right eye. Results: In view of increasing proptosis with progressive complete loss of vision in the left eye also, she consulted the neurosurgery department at a tertiary care hospital where a follow-up of contrast-enhanced computerised tomography was made. Histopathology of fluid obtained after craniotomy showed esthesioneuroblastoma. In view of intracranial space-occupying lesion applying pressure on the optic nerve, intravenous methylprednisolone (1 g, IV stat X 3 days) was given. She underwent extensive radiotherapy but died within 3 months of diagnosis. Conclusion: This case highlights the progressive and fatal course of olfactory neuroblastoma. As it can present with the complex symptoms related to ocular and nasal sites, timely referral of patients presenting with visual symptoms along with nasal involvement (frequent epistaxis) to otorhinolaryngologists is very important.

In high performance computing, researchers try to optimize the CPU Scheduling algorithms, for faster and efficient working of computers. But a process needs both CPU bound and I/O bound for completion of its execution. With modernization of computers the speed of processor, hard-disk, and I/O devices increases gradually. Still the data access speed of hard-disk is much less than the speed of the processor. So when processor receives a data from secondary memory it executes immediately and again it have to wait for receiving another data. So the slowness of the hard-disk becomes a bottleneck in the performance of processor. Researchers try to develop and optimize the traditional disk scheduling algorithms for faster data transfer to and from secondary data storage devices. In this paper we try to evolve an optimized scheduling algorithm by reducing the seek time, the rotational latency, and the data transfer time in runtime. This algorithm has the feature to manage the bad-sectors of the hard-disk. It also attempts to reduce power consumption and heat reduction by minimizing bad sector reading time., 21 pages, 21 figures, 3 table, International Journal of Computer Science, Engineering and Applications (IJCSEA)

Web portals are increasingly being used as excellent media to reach out to a wider user group irrespective of the nature of the organization be it government or business enterprise. Since more and more people are depending on websites for information access as well as various types of transactional applications, the design and features of websites play a crucial role from the user-friendliness point of view. Thus, lot of emphasis has been laid for developing effective websites. Standards such as “Web Content Accessibility Guidelines” (WCAG) have raised different requirements for websites in order to make them accessible to a wider range of users irrespective of their background and physical disabilities. This necessitates adoption of an engineering approach right from requirement analysis till the development of a full-fledged website and even beyond. Towards this end, we propose a Website Development Life Cycle approach referred as AWDLC, in order to facilitate building of accessible websites that are user- friendly in terms of design, content, assistive features, and online support. We elaborate on each step of the lifecycle approach which can address the growing requirements of accessible websites.

Web portals are excellent means to connect with people. Governments in many countries are making innovative use of web portals for effective governance. While doing so one of the major requirements is to make the web portals accessible to all citizens irrespective of their background, physical abilities and age. Accessibility of web portals largely depends on their user- friendliness in terms of design, content, assistive features, and online support. In this work, we have evaluated the accessibility features of fifteen prominent Indian government web portals based on two guidelines, viz., Web Component Accessibility Guideline (WCAG 2.0) and Guidelines for Indian Government Websites (GIGW), while the first one is a standard proposed by the World Wide Web Consortium (W3C), the second one is a standard adopted by the Government of India recently. As part of the "Digital India" initiatives, government/semi-government organizations and educational institutions across India have been instructed to redesign their web portals to comply with the accessibility standards at the earliest. Keeping this in view, our work is aimed at finding out deficiencies in some of the frequently used web portals in India with respect to international and national accessibility guidelines. The objective is to help web developers to take care of such deficiencies in web portals so as to meet the expectations of a wide range of user groups.

Ovarian Cancer (OC) is the most fatal condition among all gynaecologic malignancies. The survival rate of early and advance stage of OC is 80-90% and 15-20% respectively. This data constitutes the need of a novel biomarker for early diagnosis, which may distinguish malignant tumours from benign ovarian cysts. Presently in practice there are three screening techniques: bimanual pelvic examination, serum Cancer Antigen (CA) 125 and transvaginal ultrasound. Bimanual pelvic examination can detect only 1 in 10,000 ovarian cancers in women presenting to the clinic. CA 125 is raised in 80% of cases of ovarian carcinoma; however, if the carcinoma is limited to ovary, the raised value is seen only in 50% of women. It is mainly useful in postmenopausal women. Ultrasonography also lacks specificity and sensitivity, apart from being costly as a screening test. Studies are going on for search of a biomarker, which may complement CA 125. Most common among these are Human Epididymis Protein 4 (HE4), Thrombopoietin (TPO), CA19-9, human kallikrein 10, human kallikrein 6, osteopontin, claudin 3, DF3 (murine monoclonal antibody), vascular endothelial growth factor, MUC1, mesothelin etc. In 2008, FDA approved the use of HE4 assay for monitoring of progressive disease in patients with epithelial ovarian cancer. Similarly TPO also holds the promise of being a biomarker to complement CA125 and many studies are indeed available to support the association of TPO and OC. In this review article we have summarised and analysed such studies.

With the increase in number of electronic services being delivered through web portals, a lot of emphasis is being given to ensure the quality of web portals in terms of contents and associated design aspects. This has led to studies investigating various requirements of web users and to guidelines for quality enhancement in order to make web portals accessible to all irrespective of one's age, physical challenges, ethnicity, and level of literacy. In this chapter, the authors address the accessibility issues of web portals based on ongoing research. They analyze the accessibility in three levels (i.e., at the levels of authoring tool, web component, and user-agent). The contents of this chapter can throw light on the design aspects of web portals, web browsers, and media players to make them more suitable for users in general.

Over the years, there has been steady increase in tele-density of developing countries which has enabled citizens to access digital services offered by their governments. This has not only reduced the digital divide but has become instrumental in realizing m-Governance to a large extent as more and more people have access to cell phones at an affordable cost. In keeping with the "Digital India" campaign to empower the citizens by ensuring that government services are made available through online infrastructure and Internet connectivity, a plethora of digital services are being delivered through government portals. But, this can have a real impact when common people can access government portals easily, irrespective of their age, culture, disabilities, literacy level etc. The accessibility of web portals largely depends on the design of portals as well as the web-browsers being used for the purpose. In this paper, we have critically analyzed the accessibility features of fifteen commonly used web browsers for android mobile phones with respect to the UAAG 2.0 international standards. The findings thereof, can guide the designers to improve upon the design of cell phone browsers by taking care of the deficiencies. The overall objective is to develop user-friendly web browsers for cell phones enabling diverse user groups to access a wide range of m-Governance services with ease.

Waldenstrom macroglobulinemia (WM) is a variant of lymphoplasmacytic lymphoma. In WHO classification of hematolymphoid malignancy 2016, WM has been placed in between lymphoma and plasma cell myeloma under the broad heading “Neoplasms of mature lymphocytes”. This is a rare and slowly progressive disorder, which needs therapy only when symptoms appear. The average age of diagnosis is 60–70 years. WM may progress to lymphoma in 2% cases per year. Here, we are discussing a case of WM having typical findings of this rare disease, who presented with 10%–12% plasma cell in bone marrow aspirate smear, high immunoglobulin M, high beta 2 microglobulin, bilateral axillary lymphadenopathy and gastrointestinal bleeding. At present, the patient is on chlorambucil plus prednisolone therapy and is doing well. Typically, this case presented with lesions of herpes zoster, which makes this case further uncommon.

Background: Helicobacter pylori is involved in many gastrodeudonal complications and many diagnostic tests are available for its identification. The present study was done with the objective to evaluate the morphological changes induced by H. pylori in the gastric mucosa and to correlate them with the severity of the infection. Methods: This study was conducted in a tertiary care hospital from July 2013 to June 2014. 60 patients with symptoms of dyspepsia and requiring an upper gastrointestinal endoscopy were included in the study. Upper gastrointestinal endoscopy was performed on all patients. Hematoxylin and Eosin staining (H and E), modified Giemsa staining were performed on tissue sections and examined microscopically for gastritis and presence and absence of H. pylori. Results: Out of 60 patients, 33 were male and 27 were females. Serology by immunochromatography technique was positive in 41 patients. Serology was found to have a sensitivity and specificity of 90.90% and 59.25% respectively. H. pylori was positive in 28 cases on H and E. With a sensitivity and specificity of 84.84% and 100% respectively. H. pylori was positive in 33 cases on modified Giemsa with a sensitivity and specificity of 100%. Conclusions: Simultaneous morphologic and serological detection of H. pylori helps in its complete distribution and identification of its precancerous morphological nature.

Web portals have become widely accepted and convenient means of electronic presence for organisations, businesses, and governments. As a result, a plethora of information services are now being delivered by organisations be it government, business firms, or academic institutions across the world. This has raised concern for accessibility of such web services by users belonging to different age groups, physical challenges, ethnicity, and levels of literacy. In order to enhance web accessibility, one must consider the accessibility of both web portals and web browsers. Towards this end, in this paper, we have studied the accessibility compliance of some popular web browsers with respect to User Agent Accessibility Guideline (UAAG 2.0). We have provided a quantitative evaluation of different aspects of accessibility of web browsers which we believe can help in the better designing of web browsers by taking care of the deficiencies inherent to them.

Governments in many countries today consider Web portals as excellent means of information dissemination and visibility. The number of electronic services rendered through government web portals is increasing day by day. However, accessibility to these web portals largely depends on their user-friendliness in terms of design, contents, assistive features, and online support. This has enthused researchers to investigate various requirements of web users and suggest guidelines for conformance in order to make a web portal accessible to all. In this work we have analyzed the web portals of fifteen Asian countries under different categories based on the WCAG 2.0 recommendations and also analyzed the performance of four mostly used media players based on UAAG 2.0. The purpose of this study is to bring out the deficiencies in their web portals so that improvements can be made in order to make them more accessible.

Introduction: The incidence of soft tissue tumours, especially the frequency of benign tumours relative to malignant ones, is nearly impossible to determine accurately. Benign soft tissue tumours outnumber malignant tumours by a wide margin. Objectives: The main purpose of this study was to look into the clinicopathological profile of benign soft tissue tumour in terms of hospital incidence of age, sex, site distribution and comparison of histological types of benign soft tissue tumours with other similar studies. Materials and Methods: The operated specimens or biopsy material of benign soft tissue tumours received from January, 2010 to July, 2010 in the Department of Histopathology of our hospital, were studied in detail. Age and sex incidence, site of lesion, clinical features, gross and microscopic appearance were carefully studied. Results: In our study, most common benign soft tissue tumour was lipoma (50.8%) followed by hemangioma (17.5%) which in turn was followed by neurofibroma, angiofibroma & schwannoma. Most common age group for benign soft tissue tumour were 31-40y (27.5%) followed by 21-30y (22.5%). Overall a male predominance was seen with 60.83% in males. The most common site of occurrence of benign soft tissue tumour overall was found to be trunk (25%), followed by upper extremities (21.7%), lower extremities (17.5%) and nose and nasopharynx (10.8%) in that order. Conclusion: With our study, we were able to reassess the clinical profile of soft tissue tumours and their different types with respect to age, sex, site distribution.