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Background: Osteoporosis projects a dominant issue related to health in the community in developing country like ours –India and is often unrecognised or undiagnosed. Early Diagnosis and treatment of osteoporosis is of utmost importance. This study evaluates the accuracy of Radiological Indices in comparison to gold standard DEXA scan for diagnosis of osteoporosis, so that diagnosis of Osteoporosis can be done using simple radiographs which would be cost effective and less exposure to radiation. Methods and Material: The is study is a one year hospital based comparative study which included a total of 80 patients who presented to OPD / IPD of Department of Orthopaedics and met the inclusion criteria were enrolled in the study. Patients were subjected to DEXA scan and a plain radiograph of either of the hip joint with full length femur in AP and Lateral views. Subsequently, the Singh’s Index, Cortical Thickness Index(CTI) AP and Lateral, Calcar to Canal Ratio (CCR) were measured and compared with the standard DEXA scan. Statistical analysis used: Spearman’s Rank co-efficient was used to find correlation between Radiological Indices and DEXA scan, Kappa Statistics for level of agreement, Sensitivity and Specificity for Radiological Indices was calculated. Results: The data analysed showed significant correlation (Spearman co-efficient) between Radiological Indices and DEXA scan. Cortical thickness index Antero-posterior view and Lateral view with cut-off 0.43(r=0.8172, p< 0.0001 and r=0.8243, p< 0.0001 respectively), calcar to canal ratio with cut-off 0.50 (r=0.8188, p< 0.0001). Similarly for Singh’s Index (r=0.6002, p< 0.0001). Conclusion: Radiological indices are reliable in the diagnosis of Osteoporosis and have a good correlation with T scores decuded by DEXA scan.

Introduction/Background* To report outcomes of non metastatic advanced cervical cancer patients treated with neoadjuvant chemotherapy (NACT) followed by chemoradiation/radiation. Methodology 104 patients treated between January 2015 and December 2019 were analyzed and restaged as per FIGO 2018. RECIST criteria v1.1 was used to assess response to NACT and toxicity was assessed using CTCAE v4.0. Survival analysis was done using Kaplan-Meir method. Univariate and multivariate analysis was done using Log-rank test and Cox-regression model respectively. Result(s)* 104 patients (median age: 52 years) of advanced cervical cancer (92% SCC) received NACT for following reasons: bulky pelvic nodes (n=20), bulky para-aortic nodes (n=10), bulky pelvic + para-aortic nodes (n=31), bladder invasion (n=43). Baseline median pelvic and para-aortic nodal size was 2.5 cm (range: 1-8) and 1.8 cm (range: 1-3.5) respectively. Baseline median tumor infiltration size into bladder on cystoscopy was 3 cm (range 0.5-7). NACT regimen was Paclitaxel (175 mg/m2) and Carboplatin (AUC 5) 3 weekly IV infusion for 3 (median) cycles (range: 1-6). Post NACT completion, 9 (8.6%) defaulted from subsequent treatment, 8 (7.7%) were labeled as best supportive care, 1 received palliative chemotherapy for progressive disease and 13 (12.5%) patients received palliative RT. 73 (70.2%) patients received radical pelvic EBRT (median dose of 46Gy/23Fr) of which 68 (93.1%) received brachytherapy boost (median dose 21Gy/3Fr). 32 (43.8%) and 28 (38.3%) patients also received extended field RT (EFRT) and nodal boost (median dose 5.4Gy/3Fr) respectively. 64 (87.6%) patients received concurrent cisplatin. On univariate analysis, patients with comorbidities, bladder invasion, pelvic nodal disease, NACT dose reduction, incomplete radical treatment post-NACT and pelvic nodal size ≥ 2.5cm at baseline had poor outcomes (table 1). On multivariate analysis, none of the variables reached levels of significance. At median follow-up of 26 months (IQR: 11-45), 34 patients had died of disease, 51 were alive, of which 34 were disease-free. The 2 year LC, RC, DMC, DFS and OS for the entire cohort was 75%, 68%, 72%, 48% and 60% respectively whereas for the patents who completed NACT and radical local treatment was 92%, 82%, 76%, 62% and 75% respectively (figure 1). Conclusion* NACT followed by radiation therapy in non metastatic advanced cervical cancer is a feasible option with good survival outcomes and acceptable toxicity.

In recent years, sentiment analysis became an important concept which is used to extract an important feature or text mining according to our interest. It is very difficult to judge the polarity or the review of particular product. This problem is solved by ontology. Ontology is a formal and shared specification of a particular domain. It is a large semantic network used to extract a domain specific concept or domain specific features of a particular product. Ontology contains concept which means domain and sets of objects or we can say instance of concept and relationship between various objects. Ontology based approach is classification of opinion and feature-based approach. Ontology gives domain specific features along with the hieratical relationship between them. Ontology generates semantic graphs and tree for showing relationship between different domains and entities. The relationship can be done on the basis of nodes and edges connections. We use some contextual lexicons which are used to provide the opinion about particular domain like SentiWordNet, SenticNet, WordNet etc. This survey aims to provide an insight on Opinion target, Opinion lexical and Aspect based Polarity detection, sentiment aggregation.

BACKGROUND: An association between increasing anaesthetic depth and decreased postoperative survival has been shown in observational studies; however, evidence from randomised controlled trials is lacking. Our aim was to compare all-cause 1-year mortality in older patients having major surgery and randomly assigned to light or deep general anaesthesia.METHODS: In an international trial, we recruited patients from 73 centres in seven countries who were aged 60 years and older, with significant comorbidity, having surgery with expected duration of more than 2 h, and an anticipated hospital stay of at least 2 days. We randomly assigned patients who had increased risk of complications after major surgery to receive light general anaesthesia (bispectral index [BIS] target 50) or deep general anaesthesia (BIS target 35). Anaesthetists also nominated an appropriate range for mean arterial pressure for each patient during surgery. Patients were randomly assigned in permuted blocks by region immediately before surgery, with the patient and assessors masked to group allocation. The primary outcome was 1-year all-cause mortality. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12612000632897, and is closed to accrual.FINDINGS: Patients were enrolled between Dec 19, 2012, and Dec 12, 2017. Of the 18 026 patients screened as eligible, 6644 were enrolled, randomly assigned to treatment or control, and formed the intention-to-treat population (3316 in the BIS 50 group and 3328 in the BIS 35 group). The median BIS was 47·2 (IQR 43·7 to 50·5) in the BIS 50 group and 38·8 (36·3 to 42·4) in the BIS 35 group. Mean arterial pressure was 3·5 mm Hg (4%) higher (median 84·5 [IQR 78·0 to 91·3] and 81·0 [75·4 to 87·6], respectively) and volatile anaesthetic use was 0·26 minimum alveolar concentration (30%) lower (0·62 [0·52 to 0·73] and 0·88 [0·74 to 1·04], respectively) in the BIS 50 than the BIS 35 group. 1-year mortality was 6·5% (212 patients) in the BIS 50 group and 7·2% (238 patients) in the BIS 35 group (hazard ratio 0·88, 95% CI 0·73 to 1·07, absolute risk reduction 0·8%, 95% CI -0·5 to 2·0). Grade 3 adverse events occurred in 954 (29%) patients in the BIS 50 group and 909 (27%) patients in the BIS 35 group; and grade 4 adverse events in 265 (8%) and 259 (8%) patients, respectively. The most commonly reported adverse events were infections, vascular disorders, cardiac disorders, and neoplasms.INTERPRETATION: Among patients at increased risk of complications after major surgery, light general anaesthesia was not associated with lower 1-year mortality than deep general anaesthesia. Our trial defines a broad range of anaesthetic depth over which anaesthesia may be safely delivered when titrating volatile anaesthetic concentrations using a processed electroencephalographic monitor.FUNDING: Health Research Council of New Zealand; National Health and Medical Research Council, Australia; Research Grant Council of Hong Kong; National Institute for Health and Research, UK; and National Institutes of Health, USA.

OBJECTIVE Nosocomial infections increase mortality and morbidity in preterm infants. Central venous line colonization is a major risk factor for the development of such infections. In adults and children, antibiotic and antimycotic impregnated catheters have been demonstrated to reduce colonization. However, recently published data showed no significant difference in bloodstream infection in neonates when an impregnated catheter was used. We investigated the effect of impregnation of percutaneously inserted micro-catheters (PICC) on colonization in preterm and sick term infants in our unit. METHODS Neonates were randomly assigned to receive either a standard (S-PICC; n = 34) or antibiotic and antimycotic impregnated (IP-PICC; n = 37) PICC. Catheters were placed and removed according to a standard procedure and subsequently examined by roll-out culture. The primary outcome was the rate of colonization defined as \textgreater15 colony-forming-units/ml. Additional outcomes were catheter associated or systemic infections. RESULTS The rate of colonization was lower in neonates who received an IP-PICC as compared to S-PICC (5.6% vs. 12.1% respectively; p = 0.42). However, the difference was not significant. In IP-PICC vs S-PICC, catheter related local infection (CRI) although lower was not statistically significant (2.9% vs. 6.1%; p = 0.60). We observed no difference in catheter related systemic infection (CR-SI) (0% vs. 3.1%, p = 0.48). The neonates whose catheters were colonized were predominantly of a lower gestational age (median 254/7, p = 0.05) and males (100%, p = 0.01). In addition, the median colony count in the colonized IP-PICC catheters was lower as compared to S- PICC group (53 vs 250, p = 0.06). CONCLUSIONS The use of antibiotic and antimycotic impregnated PICC-lines in neonates tended to decrease colonization rates in neonates in our centers but this difference was not significant. Lower gestational age and male sex are risk factors for catheter colonization.

Objectives Hyperthermic IntraPeritoeneal Chemotherapy (HIPEC) after maximal cytroreduction is a promising modality of treating women with ovarian cancer. In order to determine the feasibility of setting up a HIPEC programme in India, we document our initial experience. Methods Ethics Committee clearance was obtained to start the programme. The electronic medical records of all patients who underwent HIPEC in our department was reviewed. Results A total of 14 patients underwent HIPEC in the first 2 years: one primary, 6 interval and 7 recurrent cytoreductions. The women had a mean age of 46.9 years (36 to 62), median performance score of 1 (o to 2) and a median peritoneal carcinomatosis index (PCI) of 10 (2 to 25). The histology was serous in 9, mucinous in 4 and endometrioid in one. Four patients had bowel resection of whom 2 had an end ileostomy and one had an end colostomy. The median duration of surgery was 9 hours (5 to 10) and the median completeness of cytoreduction score was 1 (0 to 2). The drugs used in HIPEC were Cisplatin and Oxaliplatin. The median duration of hospital stay was 9 days (6 to 21). Two patients were readmitted to hospital and 3 patients had re-laparotomy. The main complications were venous thromboembolism in one, bleeding in one and wound dehiscence in one. Conclusions Cytoreductive surgery with HIPEC is feasible in a low resource setting with acceptable morbidity where the main limitations are non-availability of operating time and patient’s ability to pay for treatment.

Numerical investigations were carried out on 1.27 mm thick 2024-O aluminum plates against hemi spherically tipped nose, steel projectiles, of 12.7 mm diameter and 37.7 gram mass. Three-dimensional numerical simulations of the problem were carried out using finite element code ABAQUS. The ABAQUS/Explicit finite element code, in conjunction with Johnson-Cook elasto-viscoplastic material model, proposed by Lesuer [1] was employed to perform the simulation. The present studies are concerned with the measurement of impact forces and permanent deflections produced by rigid projectiles during contact and perforation of the plates. The numerical results thus obtained were compared with the experimental results obtained by Levy and Goldsmith [2] and a close correlation between the two was found. The results obtained showed a consistent increase in the ballistic resistance of target with an increase in the incidence velocity. The failure mode of the target was also found to be affected by a change in the incidence velocity.

Introduction and objectives : Over the last few decades, congenital anomalies of the urogenital system have increased globally as a consequence of advanced maternal age at pregnancy and developments in assisted reproductive techniques. The aim of this study was to determine the incidence of apparent congenital urogenital anomalies in North Indian newborns and the causative factors. Subjects and methods : The data of all newborns delivered at our institute between September 2012 and August 2014 were collected for this prospective study. The predetermined data format included the new- borns’ birth weight and gestational age, the maternal age, parity and infertility treatment, if any. Newborns weighing less than 1000 g or born before 32 weeks of gestation were excluded from the study. Results : During the study period, 20,432 deliveries were recorded (10,952 male and 9480 female babies). Apparent urogenital congenital anomalies were diagnosed in 799, with an incidence of 39.1 per 1000 new- borns. The most common anomaly was cryptorchidism found in 678 newborns, while hypospadias was noted in 61, ambiguous genitalia in 34, congenital hernia/hydrocele in 20 and an exstrophy–epispadias complex in 5 children. Prune belly syndrome was seen in 1 newborn. Newborns weighing less than 2500 g had a higher proportion of anomalies (9.64%) in comparison to those weighing over 2500 g (1.99%) (p = 0.0001). A maternal age >30 years, parity >2 and infertility treatment were recorded in 5.40%, 4.93% and 9.80%, respectively, and all were independently associated with an increased risk of urogenital anomalies (p = 0.0001). Conclusions : The incidence of apparent congenital urogenital anomalies was 3.91%. Infertility treatment,parity >2 and a maternal age >30 years were independently associated with an increased risk of congenitalurogenital anomalies Keywords : Congenital anomalies; H ypospadias; Epispadias ; Exstophy bladder; Hydrocele; Cryptorchidism; Exstrophy–epispdias; Prune belly syndrome; Ambiguous genitalia

Pyridoxine-dependent epilepsy is a treatable cause of epilepsy, which is very well known. It is most commonly caused by mutations in ALDH7A1 and PNPO genes. A 5-month-old infant presented with refractory seizures. Magnetic resonance imaging (MRI) brain was normal. Clinical exome sequencing showed a novel mutation in PROSC gene. He responded very well to pyridoxine and has been seizure free since the beginning of the treatment. PROSC gene mutations have been recently described as a cause for pyridoxine-dependent epilepsy. Here, we describe a first case report of PROSC mutation from India with a rare genetic variant presenting as pyridoxine-dependent epilepsy.

Background Autoimmune pancreatitis (AIP) is a rare disease, and data from countries like India concerning its clinical presentation and long-term outcomes are scarce. We retrospectively evaluated the clinical presentation, imaging features and treatment outcomes of patients with AIP. Methods We carried out a retrospective analysis of our database to identify patients diagnosed with and treated for AIP at our unit in a tertiary care hospital in North India. Results Eighteen patients with AIP (mean age: 54.9±11.1 years; 13 male) were evaluated. Of these, 9 (50%) patients had probable type 1 AIP, 2 (11%) patients probable type 2 AIP, and 4 (22%) definite type 1 AIP. Patients with type 2 AIP were significantly younger than patients with type 1 (40.0±2.8 vs. 58.4±9.6 years). In type 1 AIP, other organ involvement was observed in 3/18 (17%) patients, whereas both patients with type 2 AIP had coexisting ulcerative colitis. The diagnosis of AIP was made after resective surgery in 6/18 (33.0%) patients. An accurate diagnosis of AIP could be made in all patients who underwent resection or core biopsy, but cytological examination after endoscopic ultrasound-guided fine-needle aspiration could not provide a definitive diagnosis in any patient. Initial treatment with steroids was given to 12 (67%) patients, with a 100% response, but the disease relapsed in 5/13 (38%) patients over a mean follow-up period of 34.2±21.6 weeks. Conclusion AIP is not rare in India and the majority of clinical manifestations, imaging features, treatment response and long-term outcomes are similar to those reported in the literature.

Any study involving a sample from population of interest may fail to detect the real significant difference in outcome between the groups being studied. The main reason for its failure may include a poorly designed study or a study that lacked power. This article will briefly summarize the concept of "power of study" which is necessary to validate clinical research work, wherein differences in outcome rates between the groups under a study are not very large.

Objective: Most studies published in the literature report on the results of tubularized incised plate urethroplasty (TIPU) for hypospadias repair in children. Hence, the objective of this study was to evaluate the results of TIPU repair in adults.Patients and methods: The records of 60 adult patients with primary hypospadias treated with TIPU between April 2009 and May 2012 were reviewed. All the procedures were done by the same surgeon under similar conditions and using the same kind of instruments and suture material. On clinical examination, the meatal location, as well as the presence/absence of chordee and penile torsion was assessed. The quality of the spongiosum and the width of the urethral plate were evaluated intraoperatively. The postoperative complications and results were recorded and the data were analyzed.Results: The patients’ age ranged from 16 to 27 years with a mean of 21 years. Out of the 60 cases, 43 (72%) had distal penile, 7 (11%) mid-penile and 10 (17%) proximal hypospadias. Penile torsion was present in 10 (17%) cases with 80% having a torsion ≤45◦ and 20% having a torsion of 45–90◦. Ventral chordee ranging from 30◦ to 90◦ was present in 14 (23%) cases. Chordee correction was possible by penile de-gloving in 4 (29%) patients (2 with distal and 2 with mid penile hypospadias), by further mobilization of the urethral plate with the corpus spongiosum in 3 (21%) and by proximal urethral mobilization in another 6 (42%) patients with proximal hypospadias. One (7%) patient also required tunica albuginea plication. The urethral plate was wide in 22 (37%), average in 26 (43%) and narrow in 12 (20%) patients. Fifty percent of the patients with a narrow urethral plate developed complications, compared to 15% of the patients whose urethral plate had an average width and none of the patients with a wide urethral plate. The spongiosum was well developed in 38 (63%) patients, while in 11 (18%) patients each the spongiosum was moderately and poorly developed. The complication rates were significantly higher (55%) in patients with a poorly developed spongiosum as compared to those with a well-developed spongiosum. The overall complication rate was 17% including fistula in 10% of the patients (2 patients with mid-penile and 4 patients with proximal hypospadias). Meatal stenosis was found in 4 patients with distal hypospadias (7%) who responded well to meatal dilatation. The fistula cases required surgical repair with a success rate of 100%. Mean hospitalization and follow-up were 9 days and 6–24 (median 37) months, respectively.Conclusions: Complications encountered in the present study were urethral fistula and meatal stenosis with a higher incidence in patients with proximal hypospadias than reported in the literature. The important factors for the outcome of TIPU were the severity of hypospadias, the degree of curvature and the development of the spongiosum and urethral plate. Proximal hypospadias with a poor urethral plate and severe curvature in adults is not suitable for TIPU. In such cases, single-stage flap urethroplasty or two-stage buccal mucosal urethroplasty should be considered instead.Keywords: TIPU; Hypospadias; Repair; Results; Adults; Pediatric; Variable; Chordee; Type of hypospadias; Spongiosum urethral plate

Effect of treadmill stress test on tricuspid flow and tissue Doppler imaging of tricuspid annulus were evaluated in 26 healthy persons. Exercise resulted in significant increase in A-wave velocity and significant reduction in E-wave deceleration time and E/A ratio. On tissue Doppler imaging Aa-wave increased significantly with decrease in isovolumic relaxation time and Ea/Aa ratio.

On one hand the horizon of human rights is expanding but at the same time the crime rate is also increasing. In this context, custodial deaths are among most contentious deaths for investigation by forensic experts. These deaths sometimes invite mass resentment and condemnation. Not that always such deaths are due to unnatural or violent causes; indeed most of the time they are due to natural causes. To analyse custodial deaths from all aspects present prospective study was undertaken. A total of 135 (119 male and 16 female) cases of custodial deaths were examined in detail over a study period of 2 years. Based on place of confinement 100 cases (74.07%) died in jail custody, 33 cases (24.45%) died in mental hospital custody and in 2 cases (1.48%) death occurred in police custody. Among 92 cases (out of 135) in which final cause of death was declared, the death was natural in 95.65% while in 4.35% it was unnatural. Pulmonary tuberculosis was the most common natural cause among prison custodial deaths (22.8%, n=16). In mental hospital custody coronary artery disease (12.8%, n=9) was the leading cause of natural death. As far as unnatural deaths are concerned, there were two cases each of suicidal and accidental deaths (2.17% each) and no case of homicidal death was noticed.

An efficient method for achieving the non-uniform grids on a spherical geometry is presented here. It uses the icosahedral–hexagonal grid with successive refinement to arrive at the target grid suitable for computational fluid dynamics (CFD) applications. It reduces the complexity of search from O(n2) to O(n) on icosahedral–hexagonal grids where n refers to the refinement level. The numerical solution of the transport equation is performed using the initial conditions of a well-known problem (solid-body rotation); the numerical scheme is second-order accurate. Since advection of chemically active tracers in the atmosphere and their modelling are becoming a major area of concern within the climate change scenario, this study assures the efficiency and accuracy of the numerical scheme as tested here for tracer transport. Copyright © 2010 Curtin University of Technology and John Wiley & Sons, Ltd.

Background: Cyclic vomiting syndrome is an increasingly recognized disorder with sudden, repeated episodes of severe nausea, vomiting, and physical exhaustion that occur with no apparent cause. It is more common in children than adults. However, we don’t often see a diagnosis of cyclic vomiting syndrome being made. Hereby we report 7 cases of cyclical vomiting.Methods: This is a retrospective study. Medical records of 5 years were review and consecutive paediatric patients discharged with a diagnosis of cyclic vomiting syndrome were identified, data collected and analysed.Results: Total of 7 cases were found, all of which were adolescents. The mean age was 13.28. 57.14% (4) were females and 42.86% (3) were boys. 42.86% (3) presented with complications. 14.28% (1) had an association with menstrual cycles and 14.28% (1) had an association with psychological stress.Conclusions: Cyclic vomiting syndrome should be kept in mind when a child presents with multiple episodes of vomiting, especially when repeated admissions have been made for the same. Early diagnosis and treatment can improve the quality of life.

Background: The study was aimed to evaluate the efficacy of Mifepristone for induction of labour and in improving the Bishop score at term. The study also aimed to assess induction delivery interval and maternal and fetal outcomes with Mifepristone.Methods: The study was carried out on 200 pregnant females with 2 study groups of 100 each. Group A females received tablet Mifepristone 400mg and Group B females received placebo. Results: Time interval between induction to onset of labour was 28 hours 54 min and 42 hours 18 min respectively in cases and control group. Mean induction delivery interval was 35 hours 38 min and 49 hours 52 minutes respectively in cases and control group. LSCS rate was less with Mifepristone group.Conclusions: This study showed that treatment with Mifepristone is a simple and effective method of inducing labour in women with term pregnancy with unripe cervix. The use of Mifepristone provides an interesting new alternative to classic uterotonic agents when induction is necessary. The potential advantage of Mifepristone over PGs or oxytocin requires further evaluation in scarred uterus.

In this paper the reclamation and reuse of municipal secondary effluents, as well as the reclamation and recycling of refinery secondary effluents, are technically and economically evaluated. It is shown that both practices are feasible and sustainable, and that the reclamation costs depend largely on specific circumstances such as legal requirements, price policy, reuse application, raw water composition, etc. The reclaimed water is reused, or respectively recycled, as boiler make-up. Therefore both reclamation plants employ advanced multi-barrier systems including ultra-filtration and reverse osmosis. The employed processes have shown excellent performance with regard to the removal of critical parameters such as silica. For example, this parameter was reduced from 13 mg/l in the raw water to 7 μg/l in the boiler make-up.

In their effort to measure yarn hairiness at high speed, the commercially available yarn hairiness testers resort to indirect techniques. Measurement of true length of all hairs can only be done by observing the yarn under a microscope and obtaining a trace of hairs. An attempt was made in this work to automate this task using digital image processing. The challenges were two-fold. The first was development of an algorithm capable of analysing yarn images taken under varying lighting conditions and varying yarn positions. The second was determination of minimum requirement of the image-capturing instrument. Both of these have been reported in this work. A new hairiness index has been proposed and suggested as a better indicator of hairiness than the traditional definition.

BACKGROUND: Ventilated neonates are prone to acquire ventilator-associated pneumonia (VAP). Consequently early diagnosis of pneumonia is required. Beside bacteria, fungi are suspected as a cause of VAP. However, fungal colonisation and infection of the lung have not been studied systematically. The purpose of this study was to evaluate pulmonary fungal colonisation in ventilated neonates and premature infants. MATERIALS AND METHODS: 187 tracheal aspirates (TA) from 29 ventilated neonates (23-35 weeks gestational age) were investigated. TAs were evaluated microscopically and by culture. Data were matched with clinical signs of VAP or sepsis. RESULTS: Candida species were not detected in TA or culture. In contrast, Malassezia furfur (Mf), a lipophilic fungus, was detected from the 10 th , 21 st and 31 st postnatal days onwards in TAs of 3 out of 17 extremely prematures (gestational age at birth > 25 weeks). The presence of Mf was associated with clinical deterioration either immediately or a few days after the first positive Mf smear. Topic steroids were more frequently applied to Mf-positive ELBW infants (p = 0.03). In vitro, natural surfactant was demonstrated to be a sufficient substrate for Mf in culture. CONCLUSION AND DISCUSSION: This is the first report on Mf lung colonisation of ELBWI during mechanical ventilation. Because Mf is generally not detected in standard cultures it appears to be an overlooked, potentially pathogenic fungus in prematures. Mf must be considered in the differential diagnosis of VAP in ELBWI exposed to topical steroids, especially when natural surfactant was administered.

The use of radiolabelled antibiotics is fast emerging as a promising diagnostic test for the detection of infective lesions, because of their specific binding to the bacterial component. Ciprofloxacin is a broad-spectrum antibiotic that has been used as a radiolabelled antibiotic in both the diagnosis of infections in rabbits and in clinical trials on humans. The diagnosis of skeletal microbial infections remains a challenge, especially in orthopaedic patients with implants. We present a case report of a patient with undiagnosed and unrelenting pain in the lower third of the left leg, which had persisted for 6 months. A novel scintigraphy, which was developed in-house using a 99mTc ciprofloxacin single vial kit, was used for diagnosing the active bacterial infection. A 99mTc methylene diphosphonate bone scan was also performed to locate precisely the site of the lesion. Gradually increasing concentrations of both the radiotracers confirmed the presence of active bacterial infection in the distal third of the left tibia. Follow-up scanning after antibiotic therapy showed the disappearance of the pooling of 99mTc ciprofloxacin, indicating a good response. Therefore, 99mTc ciprofloxacin has good diagnostic and prognostic applications in deep-seated covert skeletal microbial infections. However, the persistence of a focal concentration detected by the 99mTc methylene diphosphonate scan was attributed to the inflammatory and not the infective pathology.

Background: The optimal management of intrauterine fluid accumulation in postmenopausal women with cervical stenosis is currently debatable. Diagnostic challenge still remains, because of the low accuracy of sonographic histologic prediction. Case: In the case described, an asymptomatic postmenopausal woman was found to have an echogenic endometrial fluid collection on pelvic ultrasound, suspicious for uterine malignancy. Results: After a failed attempt at endometrial sampling secondary to cervical stenosis, the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. The fluid-filled endometrial cavity was found to have extensive benign squamous differentiation. Conclusions: Extensive endometrial squamous metaplasia should be considered as a rare differential diagnosis when postmenopausal women are found to have echogenic intrauterine fluid collections on ultrasound. (J GYNECOL SURG 29:148)

Hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is the most common form of hereditary colon cancer, accounting for about 2–5 % of all colorectal cancers [1]. It was first described by Dr Henry Lynch in 1966, when he noticed a high incidence of colorectal, stomach and endometrial cancer in two extended families [2].

Left ventricular outflow tract (LVOT) presystolic flow velocities were studied using pulse doppler echocardiography in 30 normal persons. Thirty patients of mild hypertension with transmitral flow velocity pattern suggestive of impaired relaxation were also studied. Transmitral flow velocity pattern was correlated with LVOT presystolic flow velocities in the two groups. Hypertensive patients had significantly higher transmitral A wave velocity (p < 0.001) and significantly lower transmitral E wave/A wave velocity ratio (p < 0.001) as compared to normal group. LVOT presystolic flow velocities had significant direct correlation with transmitral A wave velocity (p < 0.01) and significant inverse relation with transmitral E wave/A wave velocity ratio (p < 0.05). Our observations suggest that increased LVOT presystolic flow peak velocity can also be used as another marker of impaired left ventricular compliance during atrial contraction. More work is needed to establish exact status of this preliminary observation.

Background: Necrotising fascitis is a life-threatening infection involving fascia and necrosis of subcutaneous tissue. The portal of entry usually is trivial trauma. It requires immediate diagnosis and intervention to reduce mortality. The objective of this study was to study clinical profile, predisposing risk factors and to formulate a protocol for management of necrotising fasciitis.Methods: The study was conducted at tertiary care teaching hospital in Punjab, India catering to a semi-urban and rural (agricultural based) population over a period of three years between January 2014 to January 2017. All the consecutive patients who came to the emergency department (ER) of the institute presenting early with clinical features suggestive of NF were included in the study. The study included total 50 cases. The cases were studied in detail according to study plan that included age, sex, clinical features, results of blood and wound cultures, the number of surgical interventions, total duration of hospitalization and the mortality rate.Results: The most common age group was between 40-60yrs and there were 48 males. There was history of trivial trauma or insect bite in majority of cases. Mostly patients presented with bullae formation, induration, edema. Diabetes was the commonest comorbid condition associated. All the patients were thoroughly investigated, swab cultures were taken. Debridements were done followed by grafting. In 10 patients, we could not salvage the limb and 10 patients expired after debridement.Conclusions: Necrotising fasciitis is more common in middle aged males with diabetes. Early diagnosis and aggressive treatment is required to reduce the mortality.

Positron emission tomography (PET) imaging has emerged as the most important component of medical imaging in the management of oncology patients. It is a functional imaging technique in which radioactive tracer distribution in tissues is projected as a computer-generated image. The image is produced through the detection of annihilation photons emitted by radionuclides, which decay by emission of positrons. PET imaging with F-18 FDG depends on alteration in glucose metabolism of tissues for detection of disease. It differs from conventional imaging techniques that rely on morphologic changes for disease detection. As glucose metabolism is increased in many malignancies, F-18 FDG PET is a sensitive method for detecting, staging, and monitoring the effects of therapy in various malignancies.

Sir, IgG4-related orbital disease is an immune-mediated fibro-inflammatory disease with systemic associations1, 2 and predominantly affects middle-aged and elderly patients,2 presentation of IgG4-related orbital disease in children is very rare.3, 4

We assessed the association of postmenopausal serum levels of oestrogens and sex hormone-binding globulin (SHBG) with endometrial cancer risk in a case–control study nested within the NYU Women's Health Study cohort. Among 7054 women postmenopausal at enrolment, 57 cases of endometrial cancer were diagnosed a median of 5.5 years after blood donation. Each case was compared to 4 controls matched on age, menopausal status at enrolment, and serum storage duration. Endometrial cancer risk increased with higher levels of oestradiol (odds ratio = 2.4 in highest vs lowest tertile, P for trend = 0.02), percent free oestradiol (OR = 3.5, P< 0.001), and oestrone (OR = 3.9, P< 0.001). Risk decreased with higher levels of percent SHBG-bound oestradiol (OR = 0.43, P = 0.03) and SHBG (OR = 0.39, P = 0.01). Trends remained in the same directions after adjusting for height and body mass index. A positive association of body mass index with risk was substantially reduced after adjusting for oestrone level. Our results indicate that risk of endometrial cancer increases with increasing postmenopausal oestrogen levels but do not provide strong support for a role of body mass index independent of its effect on oestrogen levels. © 2001 Cancer Research Campaign http://www.bjcancer.com

Background: Appendiceal mucinous neoplasm may be complicated by rupture, leading to peritonitis and pseudomyxoma peritonei. Despite a thorough intraoperative examination, both the presence...

Virtual paths (VPs) in an ATM network form a logical network, called VP network (VPN), over the underlying physical network. VPN allows flexible management of network resources and hence its design is an important issue in designing an ATM network. In this paper, we consider the VPN design problem which is formulated as an optimization problem with the objective of minimizing the switching and transmission cost, and control and management cost. We present here, a two-phase heuristic solution for designing a good VPN for a given traffic demand. The first phase is a routing phase in which a route is found between every node pair in the network. In the second phase, paths are selected as VPs using the set of routes generated in the routing phase. A path is selected as a VP so as to minimize the following parameters: (i) the total number of VPs configured; (ii) the number of VPs carried by a link (load); and (iii) the VP hopcount, the number of VPs that are concatenated to form a virtual channel (VC). We study the performance of the proposed algorithm through extensive simulation on various networks. The results show that the VPN generated by the proposed algorithm is good in minimizing the number of VPs configured, the load on a link, and the VP hopcount. The comparison of the results obtained by the proposed algorithm and that of Ahn et al. [Virtual path layout design in ATM networks, in: Proceedings of IEEE INFCOM'94, Toronto, Ontario, Canada, 1994, pp. 192-200] shows that our algorithm performs better.

Correction of scissor bite often become a challenging task due to repetitive bonding failure and dependence on patient cooperation in wearing elastics.This article reports the successful treatment method of scissor bite using a simplified RM appliance.

Conventional criteria of ST segment elevation in right sided chest leads or loss of initial 'r' wave in leads V3R or V4R have low sensitivity and specificity in diagnosing right ventricular involvement in the presence of left ventricular posterior infarction. Slurring of R wave either in right sided chest leads or in lead aVR can diagnose right ventricular involvement in such a setting with a sensitivity of 70% and specificity of 94%.

A general-purpose backward equalizer for use in decision feedback equalization systems is described. Current-steering techniques are used to achieve high-speed low-power operation. A four-tap prototype for use in a magnetic disk read-channel chip has been implemented in a standard digital 1.2-/spl mu/m n-well CMOS process. The circuit operates at 67 MHz and dissipates 1 mW/tap from a 3.3 V power supply.

A 54-year-old African-American woman developed a pigmented papillary squamous cell carcinoma in the palpebral and bulbar conjunctiva of the right eye in areas that received no sun exposure. In situ hybridization performed on the tumor showed human papilloma virus 16. The left eye showed a pedunculated nonpigmented conjunctival dysplasia. The tumors were extirpated by cryosurgery and topical interferon alfa 2b in the right eye and simple surgical excision in the left eye.

Background This pilot project was undertaken to evaluate the toxicity of and tumor response to combined 131I anti-carcinoembryonic antigen monoclonal antibody (131I anti-CEA RMoAb) and hyperthermia in patients with metastatic colorectal adenocarcinoma. Methods Nine patients who had colorectal carcinoma with liver metastases were enrolled in this study. Intact 131I anti-CEA RMoAb was used (the specific antibody was IMMU-4, provided by Immunomedics, Inc., Morris Plains, NJ). During the diagnostic phase, dosimetry revealed that the tumor site received a higher radiation dose than the surrounding normal tissues in only six patients. These six, who were treated with radioimmunotherapy and hyperthermia, were the basis of this study. The first three patients were treated with 30 mCi/m2 of 131I anti-CEA RMoAb, and the next three received 60 mCi/m2. Pharmacokinetic clearance data were reported for all nine patients. Results Thermometry data revealed an average T90 of 40.3 (+/- 1.4 degrees C) and T50 of 41.1 (+/- 1.2 degrees C). The average thermal dose equivalent at 42.5 degrees C was 34.5 (+/- 21.5) minutes. The average Tmin, Tmax, and Tmeam were 40 (+/- 1.2 degrees C), 42.4 (+/- 0.7 degrees C), and 41.1 (+/- 1.1 degrees C), respectively. The pharmacokinetic clearance data of antibody showed monoexponential plasma clearances in all patients except one, in whom a biexponential plasma clearance was observed. In general, similar plasma and whole-body clearances as well as similar urinary excretions were observed when diagnostic and therapeutic phases for each patient were compared. Two of the six patients showed a marked improvement in their symptoms; five patients showed a drop in carcinoembryonic antigen levels. A follow-up computed tomography scan one month after treatment showed no change in tumor volume in five patients; one patient showed a partial response. Three patients developed toxicity, two developed moderate thrombocytopenia (39,000 and 58,000), and the other patient developed hematoma resulting from the insertion of a catheter for thermometry. Conclusions It is feasible to combine hyperthermia and radiolabeled monoclonal antibodies, and the combination was well tolerated by these patients. The interaction between hyperthermia and low dose rate radioimmunotherapy is complex. Further studies are necessary to explore the use of this combined modality in the management of maligancies.

Elastic nails are an established modality for treating forearm fractures in children. These nails are usually removed 6–9 months after surgery as refracture may occur in 10% of cases if the nails removed earlier. We report a case of refracture of the forearm bones with elastic nails in situ, 5 months after the original fractures. The fracture was angulated approximately 80° with the apex pointing anteriorly. Closed reduction was difficult and resulted in breakage of the ulnar nail. The authors describe the details and outline the management of this unreported complication.

Recent experiments coupled electron beams from the LOASIS TREX laser plasma accelerator (LPA) [1, 2, 3] to the Tapered Hybrid Undulator (THUNDER). Using the 1.5m, 66 period undulator, followed by an XUV spectrometer, spontaneous radiation was observed at photon energies extending to 100 eV. Previous experiments have reported visible [4] and soft-x-ray [5] radiation. The purpose of our experiments is to do highly precise, single shot diagnostics of the energy spread and emittance for each electron beam. We present recent results including measurements of electron beam transport through the undulator with and without the use of permanent magnetic quadrapoles, and measurements of XUV spectra up to 100 eV from LPA produced e-beams.