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Benign mature cystic teratoma has been seen through all ages of a woman’s age. It has varied presentations. Malignant transformation in teratoma though rare is usually seen in postmenopausal women. Malignant transformation is usually detected postoperatively on histopathology. We are reporting a case in which a postmenopausal lady was operated and squamous cell carcinoma in a dermoid cyst was detected postoperatively. Certain signs on the imaging can help to diagnose this in the preoperative period so that proper counselling and treatment can be given to the patient. Keywords: MCT, MT.

Background: Among all blood group systems and antigens, ABO and D antigens of the Rh blood group system are of primary importance, hence included in routine blood grouping and transfusion. Other blood group systems and antigens that are important in multiparous women, multi-transfused patients and hemolytic disease of newborn are Kell, Rh, Duffy, and Kidd.Aims and Objectives:  To know the pattern of ABO, RhD and other clinically significant major antigens of Rh, Kell, Duffy and Kidd blood group systems as well as evaluation of phenotypes, genotypes and gene frequency of related antigens among blood donors in Gwalior region.Materials and methods: A prospective study was carried out at the Blood Bank from July 2017 to June 2019. During the study period 48500 blood donors were included for ABO and RhD grouping, Out of them 1000 randomly selected donor samples were processed for complete Rh, Kell, Duffy and Kidd blood grouping.Result:  ABO group pattern was; A - 22.56%, B -  36.52%, AB - 9.8% and O -31.12 %, while RhD status was RhD+ 90.99% and RhD- 9.01% . Prevalence of Rh phenotypes was DCCee 43%, DCcee 33%, DCcEe 10%, dccee 6.5%, DccEe 4.5%, Dccee 1%, DCCEe 0.3% and dccEe 0.2%. Kell phenotype was K-k+ 95.5%, K+k+ 4.5%, while K+ k- and K- k- phenotypes were not encountered in this study. Duffy phenotypes were Fya+ Fyb+ 47.5%, Fya+ Fyb- 35%, Fya- Fyb+17% and Fya- Fyb- 0.5%. Kidd phenotype was Jka+ Jkb- 44.5 %, Jka- Jkb- 26.5%, Jka+ Jkb+ 18% and Jka- Jkb+ 11%.Conclusion: Present study is helpful in the transfusion management of multiparous women and multi-transfused patients. Extended blood grouping is the need of future to ensure safe blood transfusion practices.

Objective To examine predictors of spirometry use at a tertiary academic health system and association between receipt of spirometry and outcomes. Patients and methods We conducted a retrospective cohort study of adult patients with an ICD-9 CM diagnostic code for asthma and a 2014 outpatient visit in either a community health center or private practice associated with a tertiary academic medical center. The main outcome was receipt of spirometry during a 2007-2015 "exposure period." We secondarily examined future hospitalizations and emergency department (ED) visits during a follow-up period (2016-2019). Results In a sample of 394 patients, the majority were white (48%; n=188) and female (72%; n=284). Mean (SD) age was 52 years. Approximately half (185, 47%) of the patients received spirometry and 25% (n=97) saw a specialist during the exposure period. Nearly, 88% (n=85) of patients who saw a specialist received spirometry. More than half of the cohort (220/394, 56%) had an ED visit or admission during the follow-up period. Of these, 168 (76.4%) had not seen a specialist and 111 (50.5%) had not received spirometry within the exposure period. We saw no association between spirometry in the exposure window and future ED visit or hospitalization. Conclusion In a cohort of patients at a tertiary medical center, spirometry was underused. We observed a strong association between seeing a specialist and use of spirometry, suggesting a need to better incorporate spirometry into routine primary care for patients with asthma. Among 220 patients who had an asthma-related hospitalization or ED visit in 2016-2019, the majority had no record of receiving spirometry and no documentation indicating a prior specialist visit.

Background: Pain and depression are associated, but it is uncertain if effective pain relief during labor by labor analgesia reduces the incidence of postpartum depression (PPD). This randomized, controlled study assessed whether combined spinal-epidural (CSE) labor analgesia is associated with a decreased risk of PPD. Other reported risk factors for PPD were also assessed. Materials and Methods: Parturients were randomly assigned to either CSE labor analgesia or normal vaginal delivery (n = 65 each). CSE parturients received 0.5 ml of 0.5% hyperbaric bupivacaine intrathecally and PCEA with continuous infusion of 0.1% levobupivacaine and 2 μg/ml fentanyl @5 ml/h along with patient-controlled boluses with a lockout interval of 15 min. Parturients of both the groups were assessed using Edinburgh Postnatal Depression Scale (EPDS) for depressive symptoms at day 3 and PPD at 6 weeks (primary outcome; defined as EPDS score ≥10 at 6 weeks postpartum). Secondary outcomes included pain scores, maternal satisfaction, and Apgar scores at 1 and 5 min. Parturients were also screened for several risk factors for PPD. Results: Incidence of PPD was 22.3%. The difference in incidence of PPD between the CSE group vs. control group was not significant (27.7% vs. 16.9%; Fisher's exact P = 0.103). Of all the risk factors analyzed in logistic regression model, perceived stress during pregnancy was the only significant predictor of the development of PPD (adjusted Odds Ratio 11.17, 95% Confidence interval 2.86–43.55; P = 0.001). Conclusion: CSE analgesia in laboring parturients does not reduce PPD at 6 weeks. Instead, perceived high stress during pregnancy appears to be the most important factor.

Introduction: With the advent of technology, medical education has been transformed to the extent that internet has become a necessary part of it. The use of Internet ranges from purely academic purposes like acquisition of knowledge and research to completely leisure activities. While proper use of internet has its own benefits, problematic internet use can disrupt occupational and social life. It has been reported to be allied with anxiety disorders, introversion, pathological gambling, personality disorders, bipolar disorder and depression in young people. DSM-V classifies Internet Gaming Disorder in Section III and in the beta draft of ICD-11 it is included as a diagnosis under disorders due to addictive behaviours (6C51). Aim: To study the prevalence of internet addiction and its association with Depression and Anxiety among Medical Students. Materials and Methods: Cross sectional study involving 700 medical students who were using internet for more than 6 months duration was conducted. A pretested self-reported questionnaire, Young’s Internet Addiction Test, Beck’s Anxiety Inventory and Beck’s Depression scale were administered. Statistical analysis was done using latest IBM SPSS 2.0 Software. Results: Majority of the students 51.8 % belonged to 21-25 years age group. The prevalence of Internet Addiction was found out to be 19.1% with moderate addiction of 17.4%, and severe addiction of 1.7%. Among the internet addicts, 58.9% reported anxiety symptoms and 32.8% scored high on Becks Depression Scale. Conclusion: Around 1/5th of our sample had internet addiction which had positive correlation with Depression & Anxiety, indicating need for preventive measures like proper education, support groups and physical activities etc. Keywords: Internet addiction (IA), Young’s Internet Addiction Test (IAT) Beck’s Anxiety Inventory (BAI) and Beck’s Depression Scale (BDS).

Objectives Anti-cyclic citrullinated peptide antibody (ACPA) has excellent specificity and prognostic value in patients with early rheumatoid arthritis (RA). The American College of Rheumatology included ACPA in their 2010 classification criteria for RA, but we hypothesize that primary care physicians (PCPs) underuse ACPA, even when clinical suspicion for RA is high. We aimed to describe their use of diagnostic testing in patients who were referred to a rheumatologist and eventually diagnosed as having RA. Methods In this retrospective cohort study, a systematic abstraction tool was used to review the medical records of patients seen between January 1, 2010 and June 15, 2014 in two rheumatology clinics: one private practice and one community health center associated with an academic medical center. For purposes of hypothesis generation, we compared the characteristics of patients with and without testing using unpaired t tests or Fisher exact tests. Results We identified 173 patients with RA referred from 141 different PCPs: 82.7% were women with a mean ± standard deviation age of 55.5 ± 18.6 years. ACPA and rheumatoid factor were ordered in 28.9% (95% confidence interval 22.6-36.2) and 41.0% (95% confidence interval 33.9-48.6) of patients, respectively. Imaging was underused. Almost half (45.7%, or 37/81) of the patients with documented symptom duration had a delay of at least 1 year before referral; however, ACPA utilization was not associated with the delay to treatment initiation. Conclusions Most PCPs failed to order diagnostic tests for RA before referring a patient with polyarthritis who eventually received a diagnosis of RA. We also observed delays in diagnosis, with half of the patients waiting >1 year from symptom onset to diagnosis. These findings suggest educational efforts for PCPs should focus on emphasizing earlier diagnostic workups, especially ACPA, in patients suspected to have RA.

Objective.To examine racial differences of clinical features, medication usage, and comorbidities of patients with ankylosing spondylitis (AS) in the United States.Methods.In the Explorys database, 28,520 patients with AS were identified. Data were stratified by 2 rheumatology visits, race, sex, clinical characteristics, medication use, and comorbidities. Datasets were recorded as proportions, which were compared using chi-square test (p < 0.05).Results.Of the 10,990 patients with AS, 8% were African Americans and had elevated erythrocyte sedimentation rate and C-reactive protein, and high frequency of anterior uveitis, hypertension, diabetes, depression, and heart disease.Conclusion.African Americans with AS in the United States have high disease activity and comorbidities compared to whites.

With a rapid increase in the volume of data, it is extremely critical for a business to display users with personalized recommendations. Applications such as Youtube, Amazon Prime Video, etc., keep track of the user’s activity, preferences, and ratings in order to provide meaningful recommendations. Such recommenders are typically based upon long-term preference profiles. However, our proposed approach implements a deep learning model that overcomes the current limitations of content and collaborative based filtering approaches and achieved a root mean squared error of 0.8659. These intermediate recommendations are further filtered based upon the changes in user preferences over time and provides the final recommendations tailored to user’s recent interactions. The proposed approach obtains a hit rate of 63% taking the user’s current interests and behavior into account.

OSSEOUS CHORISTOMA OF THE TONGUE: A RARE ENTITYDilpreet Kaur 1, Dr Aznim Hani2 Otorhinolarngology Department of Hospital Putrajaya, Pathology Department of Hospital Putrajaya, MalaysiaIntroductionAn Osseous Choristoma is a rare benign lesion composed of normal matured bone tissue seen in a location where bone tissue is not normally found. This is a case report of a Osseous Choristoma found on the tongue in a 16-year-old female who presented to our clinic in Hospital Putrajaya. She first noticed a swelling two years ago which has been recently increasing in size although was not causing any problems to her.Physical examination showed a 1.5 x 1.5 cm smooth surfaced lesion located on the left side of the tongue. On palpation the lesion was stony hard. Mobility of the tongue was normal.A wide local excision was done under general anesthesia and the histopathology report was a Osseous choristoma. She came for follow up a month after the procedure and there was no evidence of any recurrence.Objective: To report a rare case of Osseous choristoma of the tongueMethod: - Result: -Conclusion: Lingual Osseous choristoma is a rare benign oral lesion. The management is complete wide local excision.

Objective The emergence of distraction‐based growing rods has provided the means to reduce the progression of spinal deformity in early onset scoliosis (EOS). The current protocols for evaluating spinal implants (ie, ASTM‐F1717 and ISO‐12189) were developed for fusion/dynamic devices. These protocols do not feature long unsupported rod lengths subjected to distraction. Due to the unsuitability of the existing guidelines for the evaluation of growing rods, a new distraction‐based finite element protocol is presented herein for the first time. Method A vertebrectomy (VO) model from current protocols was modified to accommodate multi‐spinal segments (ie, MS model) in which springs with appropriate stiffness were simulated in between the plastic blocks. To assess the efficacy of the protocol, two different computational studies were conducted: (a) compression‐bending (MS‐CB) with no distraction, and (b) distraction followed by compression‐bending (MS‐D + CB). In each study, the model with no axial connector (rods‐only) was modified to include a) 80‐mm long tandem (LT) connectors, and b) side‐by‐side (SBS) connectors. Stiffness and yield loads were calculated as per ASTM‐F1717 guidelines and compared with the corresponding VO models with no distraction. In the MS‐D + CB models, distraction was applied at the top block, stretching the spring‐block construct in a simulation of scoliosis surgery prior to locking the construct at the connector‐rods' interface. Results MS‐CB models predicted higher stiffness and yield loads, compared to the VO models. The locking mechanism produced pre‐existing stresses on the rod‐connector interface, which caused a shift in the location of high‐stress regions to the distraction site. Distraction led to a decrease in the construct's stiffness and yield load. Discussion The proposed protocol enables the simulation of clinical parameters that are not feasible in the F1717 models and predicted stress patterns in the hardware consistent with observed clinical failures.

Context: Atypia of undetermined significance/Follicular lesion of undetermined significance [AUS/FLUS] is a heterogeneous category with a wide range of risk of malignancy [ROM] reported in the literature. The Bethesda system for reporting thyroid cytopathology [TBSRTC], 2017 has recommended subcategorization of AUS/FLUS. Aims: To evaluate the ROM in thyroid nodules categorized as AUS/FLUS, as well as separate ROM for each of the five subcategories. Settings and Design: Retrospective analytic study. Methods and Materials: A retrospective audit was conducted for all thyroid fine-needle aspiration cytology (FNAC) from January 2013 to December 2017. Slides for cases with follow-up histopathology were reviewed, classified into the five recommended subcategories, and differential ROM was calculated. Statistical Analysis Used: z test for comparison of proportions was done to evaluate the difference in ROM among different subcategories of AUS/FLUS. The P value of less than 0.05 was taken as statistically significant. Results: Total number of thyroid FNACs reported was 1,630, of which 122 were AUS/FLUS (7.5%). Histopathology was available in 49 cases, out of which 18 were malignant (ROM = 36.7%). The risk of malignancy (ROM) for nodules with architectural and cytologic atypia was higher (43.8%) than ROM for nodules with only architectural atypia (16.7%). Conclusions: The sub-classification of AUS/FLUS into subcategories as recommended by TBSRTC, 2017 may better stratify the malignancy risk and guide future management guidelines.

MANET is a self-configuring network, in which topology is dynamic. These nodes are struggling to cope with the normal effect of radio communication channels, multi-user interference, multi-path fading etc. The design of an optimum routing protocol for MANET is highly difficult. To determine the connectivity of network organizations, there is a need for an efficient algorithm link scheduling, and routing in such dynamic scenarios, becomes very important. The efficiency of a routing algorithm depends on the proficient and winning route computation. Usually, the shortest path algorithm is a successful method to calculate the optimal way in static networks. But this idea is not possible in MANET platform. There are many factors which can be considered for routing. Multihop paths are used in MANET for interconnecting the nodes. All the nodes are present in the network which are used for path construction for delivering a packet from source to destination node.

INTRODUCTION: Breast lumps are a common problem encountered in pregnancy and lactation. These lumps are generally benign like broadenoma, lactating adenoma, mastitis and galactocele. Although rare the possibility of breast cancer (Pregnancy Associated Breast Cancer) should be considered, which is increasing in incidence nowadays. MATERIAL AND METHOD: A prospective study for 18 months was conducted on pregnant and lactating females for evaluating the role of cytology in interpretation of breast cancers. Clinical details, imaging ndings and histopathological correlation (wherever available) was also analyzed. RESULT: 85 breast lumps were identied and benign lesions were the most common etiology seen. Three cases were identied as pregnancy associated breast carcinoma (PABC) constituting 3.5% of all breast lumps. CONCLUSION: Cytology was an effective tool with minimal surgical intervention in identifying the etiology of breast masses in pregnancy and lactation. However, the cytopathologists must be aware of the characteristic patterns seen in breast FNAC smears during pregnancy and lactation and the associated atypia seen in glandular epithelium during this period. Breast carcinoma is the most common malignancy associated with pregnancy. The incidence is low but increasing due to late childbirth. Breast cancer during pregnancy has a similar prognosis to that of breast cancer in young.

Background: Leiomyosarcoma (LMS), accounting for 7-10% of all soft tissue tumors, is derived from smooth muscles and arises most commonly from uterus, retroperitoneum, extremities, but can potentially involve any site of the body. Through this case series of 12 extra-uterine LMSs, we highlight the wide variety of clinical presentations of this tumor. Methods: Retrospective analysis of clinical details, histopathological examination (HPE) and immunohistochemistry (IHC) of LMSs diagnosed in the extra uterine sites from 2012-2016 in our tertiary care institute. Result: The mean age of presentation was 55.8 years, with male: female ratio 2:1. The site distribution was: stomach (3), non visceral soft tissue-thigh (2), breast (2), cutaneous (2), ileum(1), esophagus(1), and larynx (1). Conclusion: The variable presentations of LMS at extra-uterine sites, makes it a challenging diagnosis for the unsuspecting clinicians and histopathologists. Thus, any soft tissue tumor in similar clinical scenarios may turn out to be LMS. DOI:10.21276/APALM.1588

Background: This study analyzed the clinical outcomes in the obstetric patients with COVID-19 and their neonates in first wave of COVID-19 pandemic in North India, 2020.Methods: This prospective study was conducted between 10 May 2020 to 31 December 2020 on 83 obstetric patients with COVID-19 and their 52 neonates.Results: 36.14% obstetric patients presented with COVID-19 like symptoms with most common symptom as fever in 60% and cough in 53.33%. 4.81% patients were admitted in HDU and 1/83 (1.20%) patient who required ICU had mortality due post-operative complications. 20.48% had pre-existing medical diseases. Amongst (78) antenatal patients, 21.79% had pregnancy related hypertensive disorders, 12.82% had deranged liver function tests without hypertension and 8.97% had gestational diabetes mellitus. More probability of pre-term labour pains 2.4 (95% CI, 1.37-4.18) and IUFD 2.18 (1.13-4.20) were observed in symptomatic patients as compared to asymptomatic patients. Neonates born to COVID-19 symptomatic mothers had 1.81 (95% CI, 0.73-4.49) times the risk of being symptomatic, 1.37 (95% CI, 0.54-3.41) times the risk of getting admitted to NICU and 1.57 (95% CI, 0.48-5.09) times the risk of getting infected by SARS-CoV-2 and increased morbidity in neonates. 8% neonates had perinatal and 1.5% had horizontal transmission of SARS-CoV-2.Conclusions: First wave of COVID-19 pandemic did not cause significant adverse outcome in pregnant patients and mother-newborn dyads in our tertiary care centre when active and intensive management of mothers and newborns were done but still there is possibility of severe morbidity and mortality due to COVID-19.

Steganography is the art of secret communication and evolved rapidly in the research community, and hiding data in images is relatively secure against spoofing; buying these point researchers targeted hiding secrets in LSBs of image pixels, and that particular method is known as LSB image steganography and evolved as an emerging method of secure data transmission over Internet. Influenced with this fundamental concept, this research is presenting a secure data hiding approach that ensures to maintain the quality of stego image while concealing more data per image. This research leverages the LZW compression technique to enlarge the text coverage in cover images, and for added security, it hides data in random pixels of the image which deliver the strength of “transposition cryptography.” LSB-based presented approach is influenced by the novel invention of H. B. Kekre and same algorithm would be considered for the comparative analysis of data hiding capabilities of presented method. This research is focused to hide data in LSB bits and will target MSBs only in the cases when LSB bits of all image pixels have conceived the secret bits, and this approach is the heartbeat of this research and ensures the better quality stego image after the hiding process, it could be considered that a bare eye cannot distinguish any difference comparing with original image. Presented approach is fully secured against the possibility of R-S detection attacks. Experimental analysis indicates that presented approach is very secure even having 2 times more data concealing as compared to kekre’s method. Apart from that all digested data was recovered at the destination, this approach is a lossless data hiding approach.

the increasing problems of uncertainty, vagueness and imprecision during the modeling of various control system, the fuzzy logic comes into account. Fuzzy logic was first introduced by a Polish philosopher, Jan Lukasiewicz, in 1930. As the classical logic operates with only two values- 1 (true) and 0 (false), Lukasiewicz introduced a new logic which has more than two truth values. Lukasiewicz extends the range of classical logic to all the real numbers in the interval between 0 and 1 and named it as fuzzy logic. Fuzzy logic is a powerful tool which represents and process human knowledge in the form of fuzzy if-then rules. As the fuzzy logic systems is based on human thinking and natural language and also has a good stability, fast response and less complexity, the applications based on fuzzy logic have been increased significantly. To follow the trend, this paper presents the basic introduction of fuzzy logic, fuzzy sets and its operations. This paper provides a huge description of fuzzy logic system and fuzzy inference system and also provides comparison between fuzzy logic system and conventional control system. In this paper, the various applications of fuzzy logic have been simulated using the MATLAB.

Basal cell carcinoma (BCC) commonly affects the elderly and is mostly confined to the head and neck region. Only 10% of all cases occur on the trunk. We presented a case of bullous lesion on the abdomen in a young male, initially diagnosed by clinicians as a vascular nevus. Histopathological examination and immunohistochemistry (IHC) revealed it to be Nodular cystic variant of BCC. This rare variant of BCC morphologically resembles benign skin adnexal tumor of Eccrine syringofibroadenoma. Ber Ep4 positivity on IHC established the correct diagnosis. This case highlights that nodular cystic variant of BCC can be a diagnostic dilemma for clinicians and pathologists.

Background: To evaluate the role of hysteroscopy and ultrasound in relation to histological findings in patients of postmenopausal bleeding and to find out the sensitivity, specificity, positive predictive, negative predictive values and accuracy of ultrasound and hysteroscopy.Methods: A retrospective analysis of the 30 women who underwent hysteroscopic evaluation out of total 103 patients of postmenopausal bleeding over the period of one year (August 2017 and July 2018) was done. Records were taken out to collect the relevant information. USG and hysteroscopic findings were correlated with histopathology for the comparative analysis.Results: Indications of hysteroscopy cases were suspected polyp (5), fractional curettage (F/C) technically not feasible (7), inconclusive USG reports (5), recurrent bleeding with normal fractional curettage report (4), no tissue on F/C (1), removal of intra-uterine contraceptive device (1). Causes of postmenopausal uterine bleeding were found to be atrophic endometrium including one case of senile cystic atrophy (33.3%), secretory endometrium and endometrial polyps (23.3% each) and endometrial malignancy (20.0%) cases. Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy values of USG in various endometrial conditions was found to be 57.1%, 85.2%, 55.1%, 86.2% and 78.5% respectively and for hysteroscopy was 87.1%, 97.5%, 90.0%, 96.7% and 95.3% respectively.Conclusions: Hysteroscopy is a minimally invasive, safe and effective modality with least complications and morbidity rate and an ideal method for establishing the pathology as well as offering therapeutic intervention simultaneously.

Objective Long-term HCQ use for the treatment of rheumatic diseases has been associated with retinopathy in a daily and cumulative dose-dependent manner by weight. We examined the incidence of ocular toxicity in a large population of patients treated with HCQ for inflammatory arthritis and SLE and followed long term in a tertiary centre. Methods Our retrospective longitudinal review identified 2867 rheumatic patients from 1999 to August 2017 who had a prescription written for HCQ. Thirty-one patients were identified as having a diagnosis of blindness or toxic maculopathy in their electronic medical record, and we carried out an extensive chart review. Results Of our 31 patients with a diagnosis of blindness or toxic maculopathy, 11 had documented blindness, in all cases attributed to a cause other than HCQ-related ocular toxicity: stroke (27%), pre-existing macular disease (18%), diabetic retinopathy (18%), hypertensive retinopathy (9%) and cataracts (9%). Seventeen of 31 patients had visual impairment that was multifactorial and unrelated to HCQ. We identified two patients with bull’s eye maculopathy [person-time incidence rate, 0.12 cases per 1000 person-years (95% CI: 0.01, 0.43)] and one with early HCQ toxic maculopathy [person-time incidence rate, 0.06 cases per 1000 person-years (95% CI: 0.002, 0.33)]. All three patients received HCQ for >18 years, and none had functional vision loss at diagnosis. Conclusion HCQ-induced macular toxicity is rare in routine clinical practice, seems to require prolonged HCQ therapy (>18 years) and is not necessarily associated with functional visual loss. Our findings suggest that co-morbid conditions that are common in RA and SLE contribute substantially to vision loss and should not be ignored.

We thank Paras Karmacharya and colleagues for their letter to the editor1, which furthers the discussion about racial differences in patients with ankylosing spondylitis (AS). They highlight that the reported prevalence of AS in African Americans of 8% in our study is low2.

Background Salivary diagnostics is a dynamic and emerging field utilizing molecular diagnostics to aid in the diagnosis of oral and systemic diseases The present study was conducted to assess salivary parameters flow rate ph and buffer capacity among alcoholics and non alcoholics nbsp Materials and Method A total number of male subjects cases and controls between the age of years to years were examined Various salivary parameters like pH buffering capacity and salivary flow rate in chronic alcoholic and non alcoholic male subjects were assessed Data was analyzed by SPSS package version p value le and le was considered as significant and highly significant respectively Results The difference between the salivary flow rates among alcoholics and non alcoholics were highly significant p lt The salivary pH was more acidic in alcoholics only of the alcoholics compared to of the non alcoholics had normal salivary pH of alcoholic subjects had normal salivary buffer capacity as compared to of non alcoholic subjects who had normal salivary buffer capacity The difference among two groups was highly significant Conclusion Salivary diagnostics serves as a subset of the larger field of molecular diagnostics now recognized as a central player in a wide variety of biomedical basic and clinical areas Present study shows a significant relationship between smoking and decreased parameters having anti caries effect salivary flow and ph nbsp

The parallel corpus for multilingual NLP tasks, deep learning applications like Statistical Machine Translation Systems is very important. The parallel corpus of Hindi-English language pair available for news translation task till date is of very limited size as per the requirement of the systems are concerned. In this work we have developed an automatic parallel corpus generation system prototype, which creates Hindi-English parallel corpus for news translation task. Further to verify the quality of generated parallel corpus we have experimented by taking various performance metrics and the results are quite interesting.

Introduction: Subarachnoid block, although being highly efficient with lesser drug doses, often has limitation such as hypotension, continues to be a matter of concern to the anesthetist. The present study was aimed to compare the use of phenylephrine, ephedrine, and mephentermine bolus for maintenance of blood pressure during spinal anesthesia in lower abdominal surgeries. Subjects and Methods: In a randomized, prospective study, 90 adult patients of either sex who developed hypotension during surgery under subarachnoid block were allocated into three groups to receive bolus phenylephrine, ephedrine, and mephentermine. The number of boluses and time taken to recover from hypotension was noted. Occurrence of adverse effects in the perioperative and postoperative period was also noted. Results: Results were analyzed by Student's paired t-test and Chi-square test. The ANOVA test was used to compare the group variances among the study groups. P < 0.05 was considered statistically significant. Thirty-four hypotensive events (average 1.03 events/patient) took place in mephentermine group. In phenylephrine group, a total of 53 hypotensive events took place. On an average, the group had a total of 1.61 hypotensive events per patient. No hypotensive event took place in ephedrine group after the first bolus of drug (average 1 event/patient). Mean heart rate in phenylephrine group was significantly lower as compared to the other two groups (P < 0.001). Conclusion: Mephentermine and ephedrine were similar in performance, offered a better hypotensive control, and had lower recurring events as compared to phenylephrine.

Caesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Transvaginal ultrasound and color flow Doppler provides a high diagnostic accuracy. A delay in diagnosis and treatment can lead to uterine rupture, major hemorrhage, hysterectomy and serious maternal morbidity and mortality. Early diagnosis can offer treatment options of avoiding uterine rupture and hemorrhage, thus preserving the uterus and future fertility. Primary health care provider should know about this rare entity, because if diagnosed timely, and referral to specialized centre is done without delay will definitely save maternal morbidity and mortality. Management plan should be individualized. Termination of pregnancy is the treatment of choice in the first trimester. Expectant treatment has a poor prognosis because of risk of rupture. In this case report we aim to discuss the associated diagnostic dilemma, most appropriate methods of diagnosis and management, with their implications in clinical practice.Keywords: scar pregnancy; caesarian section; methotrexate. | PubMed

Introduction: Vaginal vault prolapse is one of the distressing conditions which occur after hysterectomy. This is due to the weakness or detachment of sacrouterine cardinal ligament complex from the vaginal cuff. Till now, the most accepted procedure for this condition is sacrocolpopexy. Materials and Methods: We present a cohort of patients who underwent abdominal sacrocolpopexy (ASC) from April 2009 to August 2013. These patients were followed till April 2014 and were evaluated for subjective and objective outcomes following ASC. Results: One patient had intraoperative hemorrhage and postoperative hematoma formation. One patient had vault abscess which was managed conservatively. Hundred percent success rate was noted at 1 year. Long-term patient satisfaction score was 85 (70-90).

Hidden node problem is the most common in communication process, where the two nodes that is sender or receiver in the network are not able to see each other and no communication is possible between them. With this problem, a node which wants to send data to other node will not be able to know whether the data has transmitted to the destination or not, which degrades the efficiency of the network. Several existing techniques have been proposed till now in order to resolve these issues in wireless networks but still these methods are not able to get out of it properly and capably. This study implements a new approach by dividing the area of the network in 4 equal sections on the basis of clusters. Then the concept of Cluster Head (CH) is introduced in order to maintain the information or status of the related nodes. The result section shows the proficiency of the proposed work over the traditional work with respect to enhanced accuracy and throughput.

Introduction: Puerperal genital haematomas although an uncommon entity but is elusive. This painful condition is not only distressing and dangerous to patient but is embarrassing to the obstetrician who has conducted the delivery. Aim: This study has been planned to evaluate the incidence and risk factors for puerperal genital haematomas. Materials and Methods: A case control study was done from August 2005 to August 2015, of all puerperal genital haematomas. All patients, who had undergone drainage for the puerperal genital haematoma, were enrolled as cases. Two controls were chosen for each case, who had delivered immediately after the case. All the patients were evaluated for the characteristics of haematoma and the management of the same. Cases and controls were compared for the evaluation of risk factors for puerperal genital haematoma. Results: During the study period 27,826 vaginal deliveries were performed in our institute. Thirty nine haematomas were drained during this period. Incidence of haematomas was one in 1,113 deliveries, in our institute. Among the puerperal haematomas, vulvovaginal was the most common type. Perineal pain was the most common complaint. To evaluate the risk factors, 77 controls were enrolled. Primigravida, hypertensive disease of pregnancy and coagulopathy were the significant risk factors with p-value of

ObjectiveTo evaluate whether there is a difference in time to recovery (TTR) between concussion patients who have and have not pursued litigation post injury, and determine what factors might influence someone’s decision to litigate.BackgroundAn investigation on how litigation influenced TTR in all types of recovery.Design/MethodsA retrospective study of 851 adult and pediatric patients, ages 1–78 (333men and 518 women) in a concussion clinic. Injuries included, motor vehicle accidents MVA (n = 181), falls (n = 140), assaults (n = 36), sporting injuries (n = 378) and other (n = 116). Full and matched samples were studied by symptom endorsement, (headache, dizziness, sleep disturbance, attention/concentration dysfunction and moodiness), litigation/non-litigation and TTR (survival-curve). Secondary analysis reviewed abuse/depression, mechanism-of-injury and symptom type as it related to litigation/non-litigation.Results1) The odds ratio (OR) in the logistic regression model for the unmatched sample shows increasing age, fewer total symptoms (ConclusionsWhile litigation patients are often stereotyped to malinger and exaggerate symptoms, this data showed that with appropriate matched analysis, there was no difference between litigation/non-litigation patients with TTR. The desire to pursue litigation may be influenced by several factors; athletes were less likely to litigate. These findings are important for physicians and attorneys to consider when tasked with focusing on recovery time in litigation cases.

Central venous catheterization (CVC) via infraclavicular subclavian approach in neurosurgical patients is very common practice. Malpositioning of central venous catheter inserted into subclavian vein is a known and dreaded complication. Malpositioning of catheter tip into ipsilateral jugular vein is an unusual occurrence. We hereby describe a case where a subclavian

Introduction: Historically, countless compounds in aqueous solution have been suggested as root canal irrigants. MTAD shows promise as an endodontic irrigant but there are very few studies comparing its antimicrobial effectiveness with NaOCl and Chlorhexidine. Objectives: To compare the antibacterial efficiency of MTAD, 2.5% Sodium Hypochlorite and 2% Chlorhexidine root canal irrigants against Enterococcus faecalis in root canals of single rooted mandibular premolars. Method: Inoculum of 10 μl, 24hrs pure culture Enterococcus faecalis was suspended into root canals of forty extracted, decoronated, double sterilized, human mandibular single rooted premolar teeth and incubated for 48hrs at 37°C. Teeth were randomly divided into 4 groups of 10 teeth in each group. The teeth were instrumented in step back technique till size 40 K- file and irrigated with respective root canal irrigants as per the groups. In Group A- MTAD, Group B- 2.5% NaOCl, Group C- 2% Chlorhexidine and Group D- normal saline was used. Bacterial sample from each tooth was collected and bacterial culture was carried out using standard Loop technique. Inoculated plates were incubated at 37°C for 48hrs. Bacterial colonies were counted using colony counter. Statistically Analysed: Using One way ANOVA and LSD Post Hoc test. Results: There was a statistically significant difference in the antibacterial efficiency between all the groups. Conclusion: Within limitations of this study it can be inferred that MTAD has best antibacterial efficiency against Enterococcus faecalis when compared to 2.5% Sodium Hypochlorite and 2% Chlorhexidine.

Genital tract and breast are two most common sites of malignancy in females. Out of the genital tract malignancies, carcinoma cervix is so far found to be the commonest followed by ovary and endometrium. In developed countries, carcinoma cervix incidence is comparatively quite low due to good regular screening of females. One year review of patients was done, who underwent definitive/debulking surgery for a diagnosed malignant pathology of the genital tract, in obstetrics and gynaecology department of Govt. medical College and Hospital, Chandigarh. Total 62 patients were operated, most common indication was carcinoma ovary, followed by endometrial cancer, cancer cervix and gestational trophoblastic neoplasia. 166 patients underwent biopsies for suspicious symptoms or the abnormal findings on examination and the patients with final malignancy report were either operated as described above and the inoperable cases were referred to oncotherapy department for further management.

A hybrid approach of cryptography, data compression and steganography has been proposed in this paper. Motivation behind this research is to provide a smart image steganographic technique which must be capable enough to provide better quality stego-image with a high data hiding capability. Proposed approach is a LSB based approach and inspired with the invention of H. B. Kekre in the field of image steganography. Maximum data hiding capability of proposed approach will be evaluated from kekre's algorithm. Proposed approach hides data in the upper LSB bit only when its adjacent LSB bit of all the pixel have conceived a bit of secret data for better quality of the stego-image. LZW compression scheme is used to optimize the size of secret data, it will enable a personal to hide approx 2 times more data in a cover-image. This approach is secure against the RS detection attack and its stego-image is totally indistinguishable from the original image (cover-image) by the human eye.

Proteomics is an attempt to describe or explain biological state and qualitative and quantitative changes of protein content of cells and extracellular biological materials under different conditions to further understand biological processes. Protein-Protein interaction prediction and classification is a very important task. Prediction and classification of protein-protein interactions can help in improving the understanding of diseases and can provide the basis for new therapeutic approaches. In this work a model is proposed to classify protein-protein interactions. Jordan Recurrent Neural Network is used to classify the proteinprotein interactions. The model developed gives 97.25% of accuracy which is 8.7% more than Back-Propagation Neural Network.

Mobile Ad-Hoc Networks (MANETs) are autonomous and decentralized wireless systems. Mobile Ad hoc Network is a collection of mobile nodes in which the wireless links are frequently broken down due to mobility and dynamic infrastructure. Routing is a significant issue and challenge in ad hoc networks. Many Routing protocols have been proposed so far to improve the routing performance and reliability. This research paper describes the characteristics of ad hoc routing protocols Ad-hoc On Demand Distance Vector Routing (AODV), Optimized link State Routing (OLSR), Temporally Ordered Routing Algorithm (TORA), Dynamic Source Routing (DSR), Destination-Sequenced Distance-Vector Routing (DSDV) based on the performance metrics like packet delivery fraction, Average delay, Normalized Routing load, Throughput and Jitter under low mobility and low traffic network as well as under high mobility and high traffic network. Results show that AODV has maximum throughput under low traffic and DSDV has maximum throughput under high traffic. As network becomes dense OLSR, DSR and DSDV perform well in terms of Throughput than AODV and TORA. TORA performs well in dense networks in terms of packet delivery fraction but at the same time Normalized Routing load of TORA is maximum among all the protocols in both the networks. DSDV has least Normalized Routing load in both low and high traffic. OLSR and DSDV give the least Jitter and Average Delay in both networks.

Awareness of morphological variations of the tooth can contribute to the successful outcome of the endodontic treatment. The morphological variations of the mandibular first molar radix entomolaris (RE) in terms of root inclination and root canal curvature demand careful clinical approach to avoid procedural errors during endodontic therapy. This paper describes 2 case reports of mandibular first molar with RE.

of the Quality of Service (QoS) in the UMTS (Universal Mobile Telecommunications System) network has been done using different parameters. UMTS is a universal telecommunication service which is more popularly known as 3G. It uses Wideband Code Division Multiple Access (WCDMA) techniques inculcating internet protocol, urban terrestrial and radio air interfaces. Thus, resources used here also allow lower generation services. It provides better speed, security, bandwidth utilization etc. Quality of Service is analyzed by changing the value of the precedence bit of the CBR application. The values of the precedence bits that have been taken are 0, 1, 4 and 6. The comparison has been done on the basis of throughput, average end to end delay etc.

Leiomyomas are most common uterine and pelvic tumours. The most common anatomical location is uterus. Fibroids arising from cervix are rare tumours accounting for 2% of all fibroids. A cervical leiomyoma is commonly single and is either interstitial or subserous, rarely it becomes submucous and polypoidal. Here authors report a case of huge cervical fibroid in an unmarried lady who presented to us with complaint of heaviness in abdomen. On per abdomen examination a firm mass of 32 weeks size arising from pelvis with restricted mobility was noticed. Ultrasound showed 21*10.3*10 cm heterogenous mass in pelvis with evidence of internal vascularity. MRI was suggestive of fibroid arising from body of uterus. True cut biopsy of the lesion was taken which showed benign lesion. Decision for myomectomy or Hysterectomy (according to intraoperative findings) was taken. While doing the procedure, after accidental ligation of left ureter and injury to bladder, diagnosis of cervical fibroid was made. Hence pre-operative diagnosis of cervical fibroid is very important in order to avoid damage to bladder and ureters.

Background: The present study evaluates safety, efficacy, expulsion rate and complications of PPIUCD insertion in women undergoing caesarean section in a medical college for 2 years period.Methods: This is a prospective cohort study done over a 2 year period. Total 185 patients undergoing caesarean section and fulfilling medical eligibility criteria for PPIUCD were enrolled in the study. The followup of these patients was done at 6 weeks, 6 months and 1-2 years.Results: Thirteen patients (7%) lost to follow up so final outcome analysis was done in 172 patients. The problems encountered were spontaneous expulsion in 4 patients, removal due to heavy menstrual flow in 13 patients, non-visibility of threads in 4 patients, discharge per-vaginum in 1 patient and pain lower abdomen in 1 patient. Voluntary removal was done in 3 patients by 2 years who wished to conceive. The successful continuation rate came out to be 84.9% by 2 years. There was no failure reported in terms of intra-uterine or extra-uterine pregnancy and no increased risk of infection or perforation over the 2 years follow up.Conclusions: Immediate post-placental IUCD insertion is safe and effective method of contraception with no need to wait for 6 weeks which thereby reduces unwanted pregnancy rates. Mild discomfort and the minor post procedure complaints are taken care of well in puerperium. Higher rate of expulsion can be taken care of by early follow-up with regular visits and offering other safe and effective method of contraception.

Background: Decreased core stability displaces center of gravity away from base of support reducing activity participation of athlete. Present study was conducted to study the effect of core stabilization exercises after reconstruction surgery of ACL on functional outcomes. Methods: 30 subjects following 5 months of ACL reconstruction were randomly assigned to either group that performed (study group) or did not performed (control group) additional core stabilization exercises in conjugation with standard rehabilitation protocol. Outcome measures were: activity level using Tegnar activity level scale and functional performance using triple hop test. Outcome measures were compared at day 1 and day 42 of the treatment. Result: Significant improvement was seen in the study group for Tegnar score with mean difference changing from 4.5 to 1.5 from day 1 to day 42 of treatment (p=0.039) while the control group showed improvement in mean difference changing from 3.8 to 1.4 (p=.045) from day 1 to day 42 of treatment. Highly significant improvement was seen in the study group for triple hop test with mean difference changing from 25 to 6.7 (p

Climate change is a reality, and the modern healthcare sector not just contributes towards this grave phenomenon but is itself being affected by it. The present review was thus conducted to understand the meaning of ‘Green Hospital’, to identify the many ways in which health sector is contributing towards climate change, to explore possibilities for countering this grave trend and last of all to look for institutions that are pioneering change. Data for the review was extracted from multiple online sources using the Google search engine. It was found that hospitals, being resource intensive establishments, consume vast amounts of electricity, water, food and construction materials to provide high quality care. It was also found that certain healthcare institutions, by employing simple, smart and sustainable measures can greatly reduce their environmental footprint. But constructing Green Hospitals can be a challenge considering the local conditions and growing customer expectations.

Renal failure and uremic encephalopathy are rare findings in Plasmodium vivax malaria. Thrombocytopenia is also an unusual manifestation of P. vivax malaria. This report highlights the occurrence of these rare manifestations in an 8-year-old boy who presented to us with fever, rash and progressive deterioration of renal functions.

Rudimentary horn pregnancy is rare, but can cause considerable morbidity and mortality. We discuss five cases presented to our hospital in the last 10 years and systematically review the 10-year literature of rudimentary horn pregnancies diagnosed antenatally pre-rupture. The aim of the review was to find radiologic investigations/criteria to diagnose rudimentary horn pregnancy antenatally pre-rupture. A systematic literature review was carried out in Pubmed search for rudimentary horn pregnancies. The radiologic findings of the cases diagnosed before rupture were analyzed. Ultrasound is the most commonly used technique, though MRI seems to delineate details better. Non-continuity of the lumen of the cervix with the pregnant uterine horn is an important imaging finding. High clinical suspicion and radiologic skill for diagnosis are emphasized. The review presents the existing imaging criteria to diagnose rudimentary horn pregnancy and suggests future research to enhance the limited evidence.

Asymmetric overgrowth has many differential diagnoses with considerable overlap, posing a diagnostic dilemma. The presence of chylous ascites, though unreported, might be expected as a manifestation of overgrowth syndromes with lymphatic involvement. We present a patient with hemihypertrophy who presented with chylous ascites at birth.

Dilatation and evacuation (D and E) is the most commonly used method for later abortion. It is one of the safest procedure when performed by experienced personnel. Complication rates are high in second trimester abortion compared to first trimester. Rupture of uterine wall covered with organized blood clots is very rare complication after second trimester surgical abortion. It is a surgical emergency and may have deleterious consequences if diagnosis is delayed.How to cite this articleKaur M, Pandhar DK, Mehra R, Huria A. A Complication of Surgical Abortion: A Rare Presentation. J South Asian Feder Obst Gynae 2014;6(1):33-34.