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Background: The relationship between anterior cruciate ligament (ACL) injury and anatomical structures is still a topic of debate. Purpose: The aim of this study was to compare knee geometry in demographically matched ACL-injured and ACL-intact athletes. Methods: We conducted a case-control study comparing 2 groups, each consisting of 55 professional athletes (44 men and 11 women): 1 group with complete ACL tears (cases) and 1 group with intact ACLs (controls). The groups were compared using magnetic resonance imaging (MRI) in terms of intercondylar notch geometry, tibial plateau characteristics, and ACL volume. Results: Among cases and controls, we found the cases had lower notch width (20.24 ± 2.68 mm vs. 22.04 ± 2.56 mm, respectively) and notch width index (0.29 ± 0.03 vs. 0.31 ± 0.03, respectively). The mean ACL volume in the cases (1181.63 mm3 ± 326 mm3) was also lower than in controls (1352.61 mm3 ± 279.84 mm3). The parameters of tibial slope geometry were comparable between groups. In addition, women had lower ACL volume than men (1254 ± 310 mm3 vs. 890 ± 267 mm3, respectively) and higher medial posterior tibial slope (4.76 ± 2.6 vs. 6.63 ± 1.83, respectively). Among cases, women had narrower notch width than men (16.9 ± 2.42 mm vs. 21.08 ± 2.03 mm). However, notch width index was comparable between male (0.3 ± 0.02) and female (0.28 ± 0.03) cases. Conclusion: Our findings suggest that narrow notch width and low ACL volume may enhance the risk of ACL injury among athletes. There was no association found between posterior tibial slope and ACL injury between athletes with injured ACLs and controls. Further study is indicated.

Background: Sleep state misperception (SSM) is seen among patients with obstructive sleep apnea (OSA) as well as those having insomnia. Moreover, OSA and insomnia can also be comorbid. This study aims at finding the proportion of SSM and “Comorbid Insomnia with OSA” (COMISA) among patients of OSA and chronic insomnia. Macroachitecture of sleep was also compared across groups. Methods: This study utilized the retrospective laboratory and medical records of two groups of patients: chronic insomnia and OSA. Sleep disorders were diagnosed according to standard criteria. Daytime sleepiness was examined using the Epworth Sleepiness Scale. Diagnosis of SSM was based on the difference between subjective and objective sleep onset latency (Subjective SOL > 1.5 × Objective SOL). Results: Sixteen adult subjects were included in each group. Based on the difference between subjective and objective sleep onset latency, SSM was reported by 62.5% subjects of chronic insomnia and 56.25% subjects having OSA (OR = 1.29; 95% CI = 0.31–5.33; P = 0.79). The proportion of COMISA in subjects with chronic insomnia was 18% and among subjects with OSA, it was 43%. Effect size for the proportion was calculated as odds ratio (33.96; 95% CI = 7.48–154.01; P < 0.0002). Thus, the odds for COMISA were higher among subjects with OSA than those with chronic Insomnia. The three groups (OSA, COMISA and Chronic Insomnia) were comparable with regard to the macro-architecture of sleep. Conclusion: SSM is common among subjects with OSA and chronic insomnia. COMISA was commoner among patients with OSA compared to those with chronic insomnia. Macro-architecture of sleep is comparable among groups.

Purpose: This study was aimed to assess knowledge regarding RLS among medical teachers and medical students. Method: ‘Knowledge about RLS (K-RLS)’ questionnaire was developed, validated and used to assess knowledge of study participants about RLS. It was applied to 50 medical teachers likely to get patients with RLS in addition to 324 undergraduate medical students. Results: Individual item validation ranged between 0.8 and 1. Average scale CVI (S-CVI/Ave) was 0.95 for the whole questionnaire and universal agreement (S-CVI/UA) scores for whole of the questionnaire was 0.75. K-RLS had good internal consistency (Cronbach’s alpha = 0.89). Results showed that knowledge regarding RLS was poor among students as well as medical teachers. Conclusion: K-RLS is a reliable tool to assess knowledge about RLS among health care professionals. Knowledge about RLS is poor among medical students as well as teachers.

Objectives: Kabaddi is a commonly played sport in Asia and now it is getting recognition worldwide. With the emergence of this sport, concern related to injuries associated with this sport is also increasing. For uniform reporting of injuries and illness in the epidemiological study (Kabaddi), it desired to have standard definitions on Kabaddi-related injuries. Materials and Methods: After the initial review of various studies on other sports; the definitions and terms which can be valid for Kabaddi were selected and modified according to this sport. These definitions were then reviewed by experts, who have an abundance of experiences in the treatment of injuries related to this sport. After multiple meetings among the expert panel final definitions, terms, and methodology for injury surveillance studies were laid down. Results: Only new and modified definitions were used in this paper, therefore, it is advised to use this paper in conjunction with STROBE-SIS. Injury rates were defined per 1000 raids or 1000 tackles. Various definitions like match time loss, general time loss, match injury incidence, training injury incidence, match injury prevalence, etc. were included in this paper. Conclusion: These standard definitions will help inconsistent and better data collection in injury surveillance studies. This will also help in a better understanding of injury patterns.

In Medical Science, Hoarseness is the term used to describe a change in normal quality of voice of a patient which is rough or harsh, lower in pitch and more or less discordant Depends on duration of illness, hoarseness can be divided into acute or chronic condition. The acute onset is more common and mainly caused by inflammation (acute laryngitis) chronic sinusitis acid reflux disease, excessive alcohol use, smoking and over use or misuse of voice whereas other cause may be, laryngeal trauma or thyroid surgery and systemic disease The aim of our study is to analyse clinical profile, assess different etiological factors and to find out common precipitating factors leading to hoarseness of voice.A total of 34500 patients visited OPD of Otolaryngology department from June 2017 to May2019. Out of these,253 cases presented with complaint of change in voice (Hoarseness). The incidence of hoarseness among total OPD patient was 0.73%. Among 253 cases ,165 (65.21%) were male and 88 (34.78%) were female. Male predominance was observed with Male: female ratio of 1.87:1 in this study. Majority of patients (22.13%) were reported in 51-60 years age group followed by 31-40 years age group (21.73%). Largest group of patients were housewives (19.76%), then farmer (19.36%%) and labour (18.57%). Rest was teacher (13.43%), singer (5.92%) politician (5.13%), policeman (1.97%) and sportsman (0.79%).Many predisposing factors were noted like tobacco chewing, smoking, alcohol drinking. Tobacco chewing (38.33%), smoking (33.99%) and alcohol consumption (15.81%) were most common predisposing factors in descending order. Functional disorder was reported in (5.13%) cases and vocal abuse in 2.37% cases. In present study most of the patients were referred for speech therapy and psychotherapy along with vocal conservation and maintenance of vocal hygiene.

Introduction With an increase in the number of total joint arthroplasties, the count of prosthetic joint infections (PJIs) is also increasing and has become a nightmare for an orthopaedic surgeon. Microbiological diagnosis is important for administering definitive antimicrobial treatment. Negative culture reports hamper patient management and prolonged incubation periods have increased the culture yield but at the risk of culture contamination in conventional microbiology settings. Thus, we aimed to optimize the best incubation time for culture and the aerobic bacterial profile of PJIs. Material and Methods Over a year, samples from clinically suspected PJI patients were collected and processed for culture using standard techniques. The samples were incubated for up to 10 days with daily subculturing on to solid media. The bacterial isolates were identified and antibiotic susceptibility was performed. Results Out of 200 patients, 105 were included in the study and samples were collected in triplicate. In 70 cases culture was positive and 35 were culture negative PJIs. Mean incubation days to culture positivity was 3.6 days with 97.14% culture positivity seen by the seventh day of incubation. Twenty-four percent methicillin-resistant Staphylococcus aureus, and more than 50% extended spectrum β lactamase producing Klebsiella pneumoniae and Escherichia coli were isolated. Discussion Culture positivity in PJIs provides definitive evidence of infection and guides the treatment. Increasing the incubation times can help in maximizing the culture yield, and we found that 97.14% pathogens grew within 7 days of incubation. Prolonging it further would not provide an added advantage especially in a resource-constraint setting.

The effect of high-grade preoperative pivot shift test on outcomes of anterior cruciate ligament (ACL) reconstruction surgery is not very well established. The present study was conducted to study the factors associated with high-grade pivot shift test and effect of high-grade preoperative pivot shift test on functional outcomes after ACL reconstruction surgery.Three hundred and sixty-two patients who underwent primary ACL reconstruction surgery were enrolled in the study. The pivot shift test was performed preoperatively under anesthesia in all patients. Side of the meniscal tear, if present at the time of ACL reconstruction, was documented. Patients were divided into two groups depending upon the grade of pivot shift test: group H, high-grade pivot shift (The presence of lateral meniscus tear (27/84 vs. 53/278) or both menisci tear (29/84 vs. 60/278) was associated with high-grade pivot shift (The high-grade pivot shift is associated with chronic ACL tear (6 months) and concomitant lateral meniscus tear. The presence of high-grade pivot shift preoperatively is associated with inferior clinical outcomes and lower rate of return to sports.Level IV, case-control study.

Many surgeons are still hesitant to do arthroscopic anterior cruciate ligament reconstruction (ACL) in patients above 40 years old. The effect of ACL reconstruction on functional outcomes in patients above 40 years of age. Patients of age > 40 years who underwent ACL reconstruction were enrolled in the study. Functional outcomes (Lysholm, WOMAC score, and Tegner activity scale), pain (VAS score), and knee stability (KT-1000) were assessed at final follow-up and compared with pre-operative scores. All patients were followed up for a minimum of 2 years. A total of 112 patients were included in the study. Eighty-eight were males and 24 were females. The mean age at the time of surgery was 44.8 ± 5.6 years (40–63 years). The mean Lysholm score was improved from 64.1 ± 11.7 to 87.2 ± 5.9 (p = 0.0001). Similarly, the WOMAC score was also improved from 8.8 ± 6.9 to 2.3 ± 1.9 (p = 0.0001). The mean side-to-side difference (KT-1000) also improved from 6.65 ± 2.25 mm to 2.32 ± 1.45 mm (p = 0.0001). More than 70% of the patients had excellent or good outcomes. Median pre-injury Tegner activity scale was 5 (3–8) and the median post-ACLR Tegner activity scale was 5 (3–7; p = 1). ACL reconstruction in patients > 40 years of age results in good functional outcomes and knee stability.

The optimization of device dimensions along with high-k gate dielectric is investigated in this work for improving RF/analog performance of double gate (DG) TFET device. Through simulation, it is seen that RF/analog performance of DG-TFET deteriorate by the use of high-k gate materials in place of SiO2 as gate oxide. It has been anticipated that this degradation (ΔFoM = FoM(k = 3.9) – FoM(k = 40)) can be abated by optimizing the device dimensions particularly the channel thickness (Tc) and length (Lc). It is seen that deprivation in intrinsic dc gain (ΔAV), cut –off frequency (ΔfT), maximum oscillation frequency (ΔfMAX), gain-frequency product (ΔGFP), transconductance-frequency product (ΔTFP), and gain-transconductance-frequency product (ΔGTFP) is 11.3%, 11.84%, 11.17%, 52.16%, 19.69% & 56.42% respectively for Tc = 12 nm and 32.6%, 10.96%, 12.8%, 59.58%, 14.61% & 61.24% respectively for Tc = 6 nm. Furthermore, it is seen that deprivation in RF/analog parameters as a result of high-k gate dielectrics varies with channel length (Lc). The ΔAV, ΔfT, ΔfMAX, ΔGFP, ΔTFP, and ΔGTFP is observed to be 32.6%, 10.96%, 12.8%, 59.58%, 14.61% & 61.24% respectively for Lc = 30 nm and 17.2%, 7.41%, 10.36%, 58.67%, 8.95% & 59.36% respectively for Lc = 15 nm. Consequently, high-k gate dielectrics-based DG-TFET should be designed at thicker Tc and lower Lc for improved analog/RF performance of TFET device.

Due to the rapid growth in sleep medicine's professional content, several countries have recognized sleep medicine as an independent specialty. The practice of sleep medicine and the demand for this service in Asian countries are expanding. At this point of growth, the accreditation of sleep medicine specialists is paramount to patient care and the training of physicians and technologists. The Asian Society of Sleep Medicine (ASSM) mandated a taskforce committee for the accreditation of sleep medicine practice. This taskforce developed Asian accreditation practice guidelines for sleep medicine physicians and technologists. This paper presents the newly approved Asian accreditation practice guidelines for sleep medicine physicians and technologists by the ASSM.

Objective:To determine the demographic pattern of juvenile-onset parkinsonism (JP, Materials and Methods:We conducted a 2-year, pan-India, multicenter collaborative study to analyze clinical patterns of JP, YOPD, and EOPD. All patients under follow-up of movement disorders specialists and meeting United Kingdom (UK) Brain Bank criteria for PD were included.Results:A total of 668 subjects (M:F 455:213) were recruited with a mean age at onset of 38.7 ± 8.1 years. The mean duration of symptoms at the time of study was 8 ± 6 years. Fifteen percent had a family history of PD and 13% had consanguinity. JP had the highest consanguinity rate (53%). YOPD and JP cases had a higher prevalence of consanguinity, dystonia, and gait and balance issues compared to those with EOPD. In relation to nonmotor symptoms, panic attacks and depression were more common in YOPD and sleep-related issues more common in EOPD subjects. Overall, dyskinesias were documented in 32.8%. YOPD subjects had a higher frequency of dyskinesia than EOPD subjects (39.9% vs. 25.5%), but they were first noted later in the disease course (5.7 vs. 4.4 years).Conclusion:This large cohort shows differing clinical patterns in JP, YOPD, and EOPD cases. We propose that cutoffs of

Background Literature is controversial on femoral tunnel length as a risk factor for graft injury if the graft length in the tunnel is kept constant at ≥15 mm. Methods A total of 1079 sportspersons, meeting our inclusion criteria, were assessed for graft rupture. Patients with femoral tunnel length (FTL) ≤30 mm were labeled as Group 1, while those with FTL > 30 mm were labeled as Group 2. Both groups were compared for potential risk factors for graft injury keeping graft length in the tunnel at ≥15 mm and statistical analysis was performed to study whether the femoral tunnel length acted as an additional risk factor. Results Of 1079 sportspersons, 37 suffered from graft rupture. Patients with FTL > 30 mm were included in Group 1(n = 22) and patients with FTL ≤ 30 mm (n = 15) were included in Group 2. Both groups were comparable for risk factors for ACL injury: age (P = 0.37), gender (P = 0.53), mode of re-injury (P = 0.38), graft diameter (P = 0.71), level of sports activity (P = not significant), duration from injury to index surgery (P = 0.74), duration from index surgery to re-injury (P = 0.52), timing of return to sports after index surgery (P = 0.30), duration of sporting activity before second injury (P = 0.31), Tegner’s level (P = not siginificant), Notch width index (P = 0.12) posterior slope (P = 0.77) and height (P = 0.41). Conclusion Because the graft length in the tunnel was kept at optimum and the risk factors for ACL injury were comparable in both groups at a follow up period, we suggest that femoral tunnel length is not a risk factor for graft failure.

Leber congenital amaurosis (LCA) is a severe autosomal recessive retinal degenerative disease. The current study describes exome sequencing results for two unrelated Indian LCA patients carrying novel nonsense p.(Glu636*) and frameshift p.(Pro2281Leufs*63) mutations in the ALMS1 gene. Although ALMS1 gene mutations are associated with Alstrom syndrome (AS), the current patients did not exhibit typical syndromic features of AS. These data suggest that ALMS1 should be included in the candidate gene panel for LCA to improve diagnostic efficiency.

Background: Osteoarthritis (OA) in the anterior cruciate ligament (ACL)–deficient knee is seen in approximately 50% of affected patients. Possible causes include biochemical or biomechanical changes. Purpose: We sought to study the correlation between inflammatory cytokines and chondral damage in ACL-deficient knees. Methods: Seventy-six male patients who underwent ACL reconstruction were enrolled in a cross-sectional study. Synovial fluid was aspirated before surgery and analyzed for levels of the inflammatory cytokines tumor necrosis factor-α, interleukin-1 (IL-1), and interleukin-6 (IL-6). At the time of ACL reconstruction, the severity of chondral damage was documented as described by the Outerbridge classification. Results: Patients with grade 2 or higher chondral damage were observed to have elevated IL-6 levels when compared to patients who had no chondral damage. Interleukin-6 levels had no correlation with the duration of injury. Conclusion: Elevated levels of IL-6 in synovial fluid were associated with chondral damage in ACL-deficient knees. Further study is warranted to determine whether inflammatory cytokines contribute to the development of OA of the knee after ACL injury.

Background Literature shows that home confinement during coronavirus disease 2019 (COVID-19) pandemic has significantly affected sleep. However, such information regarding subjects having Parkinson’s disease (PD) is unavailable. Methods This cross-sectional study was conducted using a questionnaire, developed and validated by experts. PD subjects from nine centers across India were included. Questionnaire assessed presence as well as change in sleep-related parameters and PD symptoms during home confinement. Restless legs syndrome (RLS) and REM sleep behavior disorder (REMBD) was diagnosed using validated questionnaire. Additionally, changes in physical activity, adoption of new hobbies during home confinement and perceived quality of life were assessed. Results Of 832 subjects, 35.4% reported sleep disturbances. New-onset/worsening of sleep disturbances (NOWS) was reported by 23.9% subjects. Among those with sleep disturbances (n=295), insomnia symptoms worsened in half (51.5%) and nearly one-fourth reported worsening of RLS (24.7%) and REMBD (22.7%) each. NOWS was common in subjects lacking adequate family support during home confinement (P=0.03); home confinement > 60 days (P=0.05) and duration of PD > 7 years (P=0.008). Contrarily, physical activity > 1 hour/day and engagement in new hobbies during home confinement were associated with better sleep. NOWS was associated with worsening of motor as well as non-motor symptoms of PD (P 1 hour/day and adoption of new hobbies during home confinement were associated with better sleep., Highlights • New onset/worsening of sleep (NOWS) was reported by one-fourth subjects with Parkinson’s disease (PD) during home confinement. • While insomnia symptoms worsened in half, RLS and REMBD worsened in one-fourth of those with sleep disturbances. • Duration of PD >7 years, home confinement >60 days and absence of emotional support contributed to NOWS. • Adequate physical activity and adoption of hobbies during home confinement were protective factors.

Introduction Bone-patellar tendon-bone (BPTB) and semitendinosus-gracilis (STG) are the commonest grafts used for ACL reconstruction. However even after having been debated for years, there is no consensus about the ideal graft. Moreover, the literature is deficient about STG graft with preserved tibial insertion (STGPI) which preserves the proprioception. Our aim is to compare the outcome of BPTB, free STG and STGPI grafts after ACL reconstruction in professional sports persons. We compared the outcome in terms of mechanical stability, functional outcome, return to sports activity and degenerative changes. Material and methods Professional sports persons aged between 16-50 years operated for ACL tear using BPTB, free STG and STGPI grafts with minimum follow-up of two years were identified from hospital records. Patients with associated knee injuries were excluded. Patients, divided in three groups according to graft used, were compared in terms of mechanical stability (arthrometric examination KT-1000 score), functional outcome (Lysholm Score), return to sports activity (Tegner score and difference in thigh circumference) and degenerative changes (KL grading). Results BPTB graft group was found to be better than free STG and STGPI graft groups in terms of KT-1000 score. There was no statistically significant difference among the groups in terms of Lysholm score, Tegner score, difference in thigh circumference and KL grading. Conclusion BPTB graft is better than free STG and STGPI grafts in terms of knee stability. When compared for patient reported outcome, return to sports activity, osteoarthritic changes and graft failure there is no significant difference among the three types of grafts.

INTRODUCTION: Patient satisfaction is an important outcome indicator for health care system. The present study presents the level of satisfaction of COVID 19 patients with facilities provided and effect of subsequent corrective measures that were done based on the feedback taken from the admitted patients. METHODOLOGY: This is an observational study conducted on admitted COVID 19 patients through telephonic interviews. The enrolled patients were interviewed between 2nd to 4th day of the patients' stay with the help of a questionnaire. After the phase I of feedback collection, certain changes/ improvements were done based on the feedback of the patients. Then phase II of the feedback collection was done. The results were compared and statistical signicance calculated. RESULTS: The satisfaction level with respect to cleanliness improved signicantly from Phase I (70.5%) to Phase II (97.6%). There was signicant improvement in level of satisfaction with the diet quality and quantity from Phase I (82.1%) to Phase II (99.2%). The mean satisfaction level was higher in phase II as compared to phase I. There was signicant change (t value= 47.810) in level of satisfaction among the patients in phase II after the implementation of improvement steps. CONCLUSION: The study shows that the actions and policies implemented after taking the patients' perspective into account helped the hospital to improve its services during these testing times of COVID 19 pandemic.

Background: Coagulase negative Staphylococci (CoNS) are important. The common antibiotics used for the treatment of the infections caused by CoNS are penicillin, oxacillin, ciprofloxacin, clindamycin, erythromycin, gentamicin, and vancomycin. Linezolid is an oxazolidinone group of antibiotic with activity against Gram-positive bacteria. It is used for the treatment of serious infections caused by Gram-positive bacteria resistant to other antibiotics, including streptococci, vancomycin-resistant enterococci (VRE). Aim and Objective: This study emphasizes on the judicious use of newer antibiotics to contain the spread of resistance. Methods: We are discussing five cases of Linezolid resistant Staphylococcus Haemolyticus which were reported in our laboratory during one year from patients with device related infections and also review of literature is being presented for an update. Results: In our study, the isolates were resistant to other groups of antimicrobials but susceptible to glycopeptides. All the isolates were methicillin-resistant. Conclusion: Linezolid is approved as an alternative drug to be given for catheter-related bloodstream infections. In earlier studies, linezolid-resistant staphylococci have been reported increasingly all over the world. This study is to create awareness amongst clinicians that improper and excessive use of linezolid will make this antibiotic-resistant and thus will be of no help in future, so judicious and relevant use of antibiotics needs to be emphasized.

Introduction: The prevalence of psychiatric disorders among the general population is 10.6%. Primary care doctors (PCDs) are often the first contact for patients with common psychiatric disorders, but the majority of them are ill equipped to handle the same leading to symptomatic treatment. Hence, an innovative digitally driven and modular-based 1-year primary care psychiatry program (PCPP) was designed and implemented exclusively for practicing PCDs of Uttarakhand. Aim: The aim of the study was to assess the impact of this digitally driven 1-year PCPP on the general practice of PCDs. Materials and Methods: Ten PCDs were trained in the curriculum module “Clinical Schedule for Primary Care Psychiatry” which is a validated concise guideline for screening, classification, diagnosis, treatment, follow–ups, and referrals. Furthermore, they underwent training in on-site basic module (10 days); three online modules (with nil or minimal disruption in their regular clinical work) – Telepsychiatric On-Consultation Training (Tele-OCT), Collaborative Video Consultations, and weekly virtual classroom; and one public health module. In addition, PCDs underwent 10 criteria-based formative assessment including self-reports of weekly patients' audit (Primary Care Psychiatry Quotient [PCPQ]) and quarterly Tele-OCT evaluation sessions (Translational Quotient [TQ]). Results: PCPQ was 11.09% (2182 psychiatric patients of total 19,670 general outpatients) which means 11.09% of PCDs' total general consultations had psychiatric disorders, which would have been otherwise missed. Average scores obtained in first and second Tele-OCT evaluations (similar to clinical examination but in their real-time consultation) were 70.33% and 76.33%, respectively, suggestive of adequate TQ at 6 and 9 months of the course. Conclusions: One-year PCPP is shown to be effective in acquiring psychiatry knowledge, skills, and retention of skills (TQ) and also translated in providing psychiatric care in general practice with a positive impact on the delivery of primary care psychiatry.

Adolescence is a significant period in the lifespan of an individual when several changes including physical and mental development take place. These transitional changes are associated with various health consequences that also includes sleep and its various problems. The World Health Organization and the Centres for Disease Control and Prevention have pointed out in their reports that adolescence is sleeping less than the recommended duration. Research has pointed out that inadequate sleep is associated with various negative influences on the psychosocial wellbeing of an individual. Therefore, due attention should be given to sleep and sleep-associated problems for the normal development of an adolescent. This review was written after the online search using various search methods in PubMed using keywords as adolescence and sleep disorders. The articles in English were identified and subsequently analysed for consideration for this review. The evidence suggests that there are various reasons for insufficient sleep among adolescents, which may range from phase delay due to biological reasons or genetic disorders like narcolepsy but despite having a significant negative influence on health and well-being they are relatively unappreciated and thus they are needed to be taken into account while conducting a clinical interview in this vulnerable population. So with this review, we aim to focus on common sleep disorders during adolescence so that the clinician should be able to notice the sleep-related problems and thus any potentially reversible condition can be noticed in time to avoid deterioration of health. The common conditions selected for discussion in this paper include delayed sleep phase syndrome, restless legs syndrome, obstructive sleep apnoea, sleep-related bruxism, narcolepsy, and insomnia.

INTRODUCTION: Few authors have addressed risk factors related to an ipsilateral graft rupture and contralateral anterior cruciate ligament (ACL) injury after return to sports (RTS) following primary ACL reconstruction. MATERIALS AND METHODS: Patients with ACL re-injury to either knee after successful primary ACLR were included in Group I and those with no further re-injury were included in Group II. Variables including age, gender, side, body mass index (BMI), thigh atrophy, anterior knee laxity difference between both knees measured by KT-1000 arthrometer, mean time of return to sports (RTS), graft type, type of game, mode of injury, Tegner Activity Score, hormone levels, femoral tunnel length (FTL), posterior tibial slope (PTS) and notch width index (NWI) were studied. Binary logistic regression was used to measure the relative association. RESULTS: A total of 128 athletes were included with 64 in each group. Mean age in Group I and II were 24.90 and 26.47 years respectively. Mean follow-up of Group I and Group II were 24.5 and 20.11 months respectively. Significant correlation was present between ACL re-injury and following risk factors; PTS of >10º, KT difference of >3.0mm, thigh atrophy of >2.50cm and time to RTS

Objectives: The present study was conducted with the objective of identifying the cause of injuries in fast bowlers. Materials and Methods: The present study is a video analysis study, keywords such as “fast bowler’s injury,” “failure of bowling,” and “cricket injuries” were searched on YouTube. Bowling action was divided into four stages – Stage 1 – jump, Stage 2 – back foot contact, Stage 3 – front foot contact, and Stage 4 – follow-through. The type and timing of injury (stage) were noted after analyzing the videos. Results: Sixteen injuries were identified in five videos. It was observed that 15 athletes had acute injury to lower limb and 1 athlete had an acute injury to lower back. 13/16 injuries happened in Stage 2 and 3/16 injuries happened in Stage 4. Conclusion: Most of the injuries happened at the time of landing and follow-through. Therefore, improvement of ground conditions, especially around the bowling area, and addition of exercise-based injury prevention programs can reduce the risk of injuries. This is more important for young fast bowlers at the club levels and state levels, as proper training at an early stage, can prevent injuries in many young fast bowlers.

Introduction Medial patellofemoral ligament (MPFL) reconstruction is the procedure of choice for lateral patellar dislocation. However, studies depicting the long terms results of this procedure is lacking. The present study was conducted to evaluate the functional outcomes after MPFL reconstruction at a minimum of five years follow-up. Methods This study was retrospective evaluations of patients who underwent MPFL reconstruction by basket weave method. A total of 35 patients (37 knees) with isolated MPFL tear who met the inclusion criteria were included in this study. These patients were assessed for functional outcome scores including Kujala score, International Knee Documentation Committee (IKDC) score, Lysholm score and Tegner activity score at a minimum follow-up of 5 years. Results The mean follow-up was 81.57 ± 16.07 months and mean age of patients was 19.56 ± 8.02 years. There was no re-dislocation in any of the patients but 4 patients had apprehension test positive (10.81%). The mean Kujala score, IKDC score and Lysholm score preoperatively and postoperatively after MPFL reconstruction were 62.20 ± 16.86 and 90.32 ± 16.42 respectively (p Conclusions MPFL reconstruction surgery for isolated MPFL tears without any associated bony deformity, or soft tissue alterations has a good long-term functional outcome.

Background There is little literature available about the type of sports and concomitant knee injury. The purpose of the study To help in better prediction of concomitant knee injuries in football and kabaddi players. Material method Five hundred and seventeen male athletes [Football (n = 226) and Kabaddi players (n = 291)] aged between 16 and 35 years were enrolled in the study. These were categorized into five groups depending upon the time interval between injury and surgery (0–3 months, 3–6 months, 6–9 months, 9–12 months, 12–18 months and 18–24 months). Meniscal and chondral damage present at the time of ACL reconstruction was documented. Results The overall incidence of meniscal tear was more in kabaddi players (220/291) as compared to football players (144/226; p = 0.003). The incidence of both menisci tear was more in kabaddi as compared to football (p = 0.02). Incidence of lateral meniscus tear (147/291) in kabaddi was more as compared to football (84/226; p = 0.002). The incidence of condylar damage was comparable in both groups. Medial femoral condyle was more commonly injured in both the sports irrespective of time frame. Conclusion The chances of meniscus injuries were more in kabaddi players compared to football players in ACL deficient knee. The time interval between injury and surgery had a direct correlation with meniscus and chondral injuries. Level of evidence Level III, retrospective study.

Role of core stability exercises in ACL rehabilitation program is not well studied. To study the effect of addition of core stability exercise on outcome of ACL reconstruction surgery. Ninety-two male sportspersons (18–40 years) who underwent ACL reconstruction were enrolled in the study. Sportspersons were divided into two groups depending upon the computer-generated random number sequence—group A (conventional rehabilitation; n = 46) and group B (core stabilization + conventional rehabilitation; n = 46). All sportspersons were assessed at 6, 9 and 12 months for the functional outcome (IKDC score, single hop test, triple hop test, and VAS score), return to sports, and knee laxity (KT-1000). IKDC scores were higher in group B as compared to group A at all follow-ups (p

BACKGROUND: Genome-wide polygenic scores (GPS) integrate information from many common DNA variants into a single number. Because rates of coronary artery disease (CAD) are substantially higher among South Asians, a GPS to identify high-risk individuals may be particularly useful in this population. OBJECTIVES: This analysis used summary statistics from a prior genome-wide association study to derive a new GPSCAD for South Asians. METHODS: This GPSCAD was validated in 7,244 South Asian UK Biobank participants and tested in 491 individuals from a case-control study in Bangladesh. Next, a static ancestry and GPSCAD reference distribution was built using whole-genome sequencing from 1,522 Indian individuals, and a framework was tested for projecting individuals onto this static ancestry and GPSCAD reference distribution using 1,800 CAD cases and 1,163 control subjects newly recruited in India. RESULTS: The GPSCAD, containing 6,630,150 common DNA variants, had an odds ratio (OR) per SD of 1.58 in South Asian UK Biobank participants and 1.60 in the Bangladeshi study (p

Introduction: To mitigate the spread of the pandemic coronavirus infection (COVID-19), governments across the world have adopted “lockdowns” which have confined many individuals to their homes. This disrupts normal life routines, elements of which are important circadian cues. The pandemic is also associated with new stressors, altered roles, and uncertainties about health and economic security, which are also likely to affect sleep. The current study is an online survey of sleep experience, routines, physical activity, and symptoms of anxiety and depression, to study the alterations associated with the lockdown. Materials and Methods: The survey was conducted in early May 2020 using a questionnaire circulated through social media platforms. Questions related to demographic characteristics, current and previous sleep schedules, routine, and working patterns. Insomnia (Insomnia Severity Index - 4), Stress (Perceived Stress Scale - 4), anxiety and depressive symptoms (Patient Health Questionnaire - 4) and physical activity (International Physical Activities Questionnaire) were assessed using standardized instruments. Results: A total of 958 valid responses were received. Compared to the prelockdown period, there was a shift to a later bedtime and waking time, with a reduction in night-time sleep and an increase in day-time napping. These effects were visible across occupational groups, but mostly affected working individuals except health professionals. Sleep quality deteriorated across groups. Reductions in sleep duration were associated with depressive symptoms. Conclusions: The COVID-19 lockdown is associated with changes in sleep schedule and in the quantity and quality of night-time sleep. Although these changes are associated with elevated rates of emotional symptoms, it is unclear from these cross-sectional results, whether sleep deterioration produces psychological distress, or vice versa.

Medical emergencies in dental practice are those adverse medical events that may present in the course of dental treatment. Each of those events requires a correct diagnosis for effective and safe management. Medical emergencies in dental practice are uncommon but could occur at any time. Dentist should be able enough to handle the emergency.

BACKGROUND: To study the effect of pre-operative joint inflammation on clinical outcome at 1 year follow-up following ACL reconstruction surgery. METHODS: Male patients, aged 18–40 years, suffering from isolated ACL injury were included. All patients were randomly divided into two groups based on the type of graft used: Group A: semitendinosus gracilis graft with preserved insertions (STG-PI), Group B: bone-patellar tendon-bone graft (BPTB). Patients were categorised based on the time of presentation after injury: (a) within 6 weeks of injury, (b) between 6 and 12 weeks of injury, (c) after 12 weeks of injury. Synovial fluid levels of Interlukin-1, Interlukin-6 and TNF-α were measured in all the ACL deficient knees by taking a joint fluid sample intra-operatively. RESULTS: The total number of patients in the study was 59; 23 in group A (STG-PI) and 36 in group B (BPTB). Mean age of patients was 26 ± 5.146 years. 14 out of 59 (23.7%) patients presented within 6 weeks of injury, 16 (27.11%) patients presented between 6 and 12 weeks after injury and 29 (49.1%) patients presented after 12 weeks of injury. IL-6 levels were significantly high in group with 12 weeks since injury. IL-6 had significant correlation with VAS scores, KT 1000, Lysholm knee scores and Tegner level of activity. There was no difference in outcome (pain scores, mechanical stability, Lysholm knee score and Tegner level of activity) at 1 year follow-up when patients with different time intervals since injury were compared. CONCLUSION: The clinical outcome in terms of pain score, mechanical stability, functional scores and return to sporting activity is comparable, irrespective of the time since injury, at short term follow-up.

To study the effect of age, duration of injury, type of graft and concomitant knee injuries on return to sports after anterior cruciate ligament (ACL) reconstruction.One-hundred and sixteen athletes underwent ACL reconstruction using either bone-patellar tendon-bone graft (BPTB; n = 58) or semitendinosus-gracilis graft (n = 58), depending upon their random number sequences. Five variables were analyzed in terms of their effect on return to sports-age, type of graft, time interval between injury and surgery, chondral damage and meniscal tears.Fifty-three out of 73 (72.6%) athletes aged between 16 and 25 years and 21/43 (49%) athletes aged between 25 and 40 years returned to sports (p = 0.02). The mean time to return to sports was 9.7 ± 2.1 months and 10.8 ± 1.7 months in athletes aged 25 years and 25-40 years, respectively (p = 0.04). ACL reconstruction with BPTB graft (43/58) was associated with higher rate of return to sports as compared to hamstring tendon graft (31/58; p = 0.02). The mean duration of return to sports with BPTB and STGPI graft was 9.7 ± 2.0 months and 10.7 ± 2.0 months, respectively (p = 0.02). 29/36 (80.5%) patients operated between 2 and 6 months, 18/29 (62%) operated in 2 months, and 27/51 (53%) operated after 6 months of injury had returned to sports (p = 0.03). Athletes who were operated within 2 months of the injury were the earliest to return to sports (9.4 ± 2.1 months), followed by those operated within 2-6 months (9.9 ± 1.9 months) and lastly by the ones operated after 6 months of the injury (10.9 ± 2.1 months; p = 0.04).The rate of return to sports was observed to be higher in athletes younger than 25 years as compared to older athletes ( 25 years). ACL reconstruction with BPTB graft was associated with higher and earlier returns to sports as compared to hamstring graft. The rate of return to sports was highest if surgery was performed between 2 and 6 months after the injury.III.

Background: The effect of dexmedetomidine as an adjuvant in the adductor canal block (ACB) and sciatic popliteal block (SPB) on the postoperative tramadol-sparing effect following spinal anesthesia has not been evaluated. Methods: In this randomized, placebo-controlled study, ninety patients undergoing below knee trauma surgery were randomized to either the control group, using ropivacaine in the ACB + SPB; the block Dex group, using dexmedetomidine + ropivacaine in the ACB + SPB; or the systemic Dex group, using ropivacaine in the ACB + SPB + intravenous dexmedetomidine. The primary outcome was a comparison of postoperative cumulative tramadol patient-controlled analgesia (PCA) consumption at 48 hours. Secondary outcomes included time to first PCA bolus, pain score, neurological assessment, sedation score, and adverse effects at 0, 5, 10, 15, and 60 minutes, as well as 4, 6, 12, 18, 24, 30, 36, 42, and 48 hours after the block. Results: The mean ± standard deviation of cumulative tramadol consumption at 48 hours was 64.83 ± 51.17 mg in the control group and 41.33 ± 38.57 mg in the block Dex group (P = 0.008), using Mann-Whitney U-test. Time to first tramadol PCA bolus was earlier in the control group versus the block Dex group (P = 0.04). Other secondary outcomes were comparable. Conclusions: Postoperative tramadol consumption was reduced at 48 hours in patients receiving perineural or systemic dexmedetomidine with ACB and SPB in below knee trauma surgery.

INTRODUCTION: Although many treatment modalities including rest, stretching, strengthening, change of shoes, arch supports, orthotics, night splints and anti-inflammatory agents have been advocated for plantar fasciitis, there is no report in the literature which compares the independent effectiveness of each treatment modality without the concomitant use of any other one. METHODS: A double blind, randomized controlled study was undertaken where 140 patients of plantar fasciitis were divided into four groups with 35 patients each. Patients in four groups received analgesics, hot water fomentation and silicon heel pads, plantar fascia stretching and calf stretching exercises, respectively. Heel pain was evaluated using Foot Function Index (FFI) and disability using Foot and Ankle Disability Index (FADI). Clinical evaluation was done weekly up to a period of 4 months and then at 6 months, 8 months, 10 months and 12 months. RESULTS: Mean age of patients was 43.4 ± 10.6 years with average duration of symptoms being 27.26 weeks (range 4–200 weeks). Both FFI and FADI showed statistically significant improvement at 12 months in all the four groups (p value

Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargement techniques have been described depending on anterior or posterior approach. Konno procedure uses anterior approach for aortic root enlargement. In this study, we reviewed results of Konno procedure done from 2011 to 2019 by a single surgeon. Methods: 12 adult patients who underwent aortic valve replacement along with Konno procedure for small aortic root by a single surgeon at a single center between 2011 and 2019 were reviewed. Echocardiographic and demographic data and post-operative data were obtained from medical records. Symptomatic profile was assessed as per New York Heart Association Classification. Intraoperative findings and post-operative period findings were noted. Follow up symptom profile was assessed for these patients. Results: 12 patients underwent Konno procedure between 2011 and 2019 for small aortic root along with valve replacement. The main indication for surgery was aortic stenosis with small aortic annulus, with or without involvement of the mitral valve. Preoperatively, 3 patients had NYHA class II and 9 patients had NYHA class III symptoms. Mean age at operation was 26.42 years, minimum age 10 years, and maximum age 39 years. 3 were females and 9 were males. Mean bypass time was 106.4 minutes and aortic cross clamp time was 80.67 minutes. Mechanical aortic valves were implanted in all patients. Mean post-operative blood loss was 134.2 ml and duration of ventilation before extubation was 14.5 hours. Mean duration of intensive care unit (ICU) stay was 2.83 days and hospital stay was 9.1 days. Mean gradient in the post-operative period was 10.75 mm Hg. There was no mortality in these 12 patients and no reoperation was needed in the follow up period. Follow up in the outpatient department suggested all patients had NYHA class I symptoms and anticoagulation with warfarin adjusted to prothrombin time— International normalised ratio. Conclusion: Konno procedure is effective for managing small aortic root as bigger outflow orifice area through the larger valve prosthesis improves ventricular outflow and hence, improves the outcomes.

Background: \ud The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes.\ud \ud Methods: \ud This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status.\ud \ud Findings: \ud Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years [IQR 17–43]) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio [HR] 2·26 [95% CI 1·32–3·89]). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 [1·08–1·95]). Most patients were unvaccinated (32 078 [74·0%] across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 [95% CI 0·47–8·05] and for hospital admission or emergency care attendance 1·58 [0·69–3·61]) were similar to the HRs for unvaccinated patients (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 for both) but the precision for the vaccinated subgroup was low.\ud \ud Interpretation: \ud This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant.\ud \ud Funding: \ud Medical Research Council; UK Research and Innovation; Department of Health and Social Care; and National Institute for Health Research.

Additive Manufacturing (AM) is a layer-by-layer deposition of material for the production of the desired product. The design flexibility associated with AM is much more when compared to the conventional manufacturing process. To manufacture a part with AM, two things play a critical role: the designing of the part and the other is the placement of the part in the build volume. As already mentioned, design flexibility associated with AM is much more when compared to the conventional manufacturing process. However, to correctly implement the design flexibility, we need a knowledge base at our disposal so that appropriate features can be used for the part production. The AM feature taxonomy forms the backbone of the knowledge base. The taxonomy comprises AM features classified based on different categories, which helps us understand every feature's importance. Talking about the part placement, we know that optimal placement is the key factor that makes the AM process economically feasible.

Kwashiorkor syndrome is a form of severe protein-energy malnutrition characterized by protein deficiency and bilateral extremity swelling. Worldwide, most affected regions include Southeast Asia, South Africa and Central America; it is rare in developed countries such as the USA. We report a case of profound kwashiorkor in a 38-year-old male with an underlying psychiatric disorder and restricted diet who presented with extensive abdominal distention and systemic findings indicative of protein malnutrition.

Title: Spectrophotometric assessment of tooth discoloration induced by various Antibiotic pastes. Aim: To evaluate tooth discoloration induced by various Antibiotic pastes using spectrophotometer. Materials and Methods: Sixty extracted upper front tooth were selected for the study. Access opening was done and root canal of each tooth was instrumented with hand files. The tooth were then randomly divided into 3 groups: Group A (Triple antibiotic paste: Ciprofloxacin+ Metronidazole+Minocycline), Group B (Modified Triple antibiotic paste: Ciprofloxacin+ Metronidazole+ Clindamycin) and Group C (Double antibiotic paste: Ciprofloxacin+ Metronidazole). In all the groups, medicaments were only applied inside the root canals of the teeth and access cavity was sealed with cotton pellet and temporary restoration. Spectrophotometric readings were obtained from buccal surface of the teeth immediately after placing the medicaments (Baseline data) and at 1 week and after 2 months. Based on spectrophotometric readings at different time interval, ∆E was then calculated. Data were analyzed using 2-way (ANOVA) tests. Results: The maximum color change (ΔE) was observed at 2 months with Triple antibiotic paste (p < 0.0001) followed by Modified Triple antibiotic paste. No significant color change was noted with Double antibiotic paste. Conclusion: Antibiotic paste should be used judiciously inside the root canals of teeth to eliminate chronic root canal infection due to risk of tooth discoloration. Double antibiotic paste is a more promising option.

Objective: Awake proning is an intervention that is being advocated for COVID-19 patients and has been suggested to improve the oxygenation, thereby decreasing oxygen requirements. We performed this systematic review with the aim of appraising the latest published evidence on the clinical effectiveness of awake proning in COVID-19 patients. Data sources: PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar, and one trial registry were searched until September 23, 2020, for studies on the use of awake proning for nonintubated COVID-19 patients. Study selection: Published or in-press peer-reviewed randomized control trials, case-control trials, and prospective or retrospective cohort studies in English language only were sought, assessing the effectiveness of awake proning for nonintubated patients diagnosed with COVID-19. Data results: We included 21 published studies (19 single arm and 2 with comparison group). Twenty-three registered clinical trials were identified. No randomized clinical trial has been published so far. Conclusions: Awake proning is probably safe and effective in enhancing oxygenation in nonintubated COVID-19 patients; however, there is insufficient evidence. Further high-quality clinical trials are urgently needed to assess the effectiveness of awake proning on a variety of patient-centered outcomes. How to cite this article: Parashar S, Karthik AR, Gupta R, Malviya D. Awake Proning for Nonintubated Adult Hypoxic Patients with COVID-19: A Systematic Review of the Published Evidence. Indian J Crit Care Med 2021;25(8):906–916.

Neuroendocrine tumors (NETs) are rare entities. Most common among them are gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and pulmonary NETs. Most of them are indolent in nature. Colonic NETs are rare among GEP-NETs and mostly present with large size and with metastasis. Emergency presentation with hematochezia is rare in colonic NETs. This case report discusses a rare emergency presentation of colonic NETs and highlights their poor biological nature.

Wound irrigation is described as the flow of a solution through an exposed fracture surface to reduce the microbial colonization, to remove apparent foreign particles and wound exudates. . While recent literature and various in-vitro and in-vivo trials have cleared some clouds of doubt from the mind, it still remains a topic of debate. Normal saline remains the standard irrigation solution as it is non tissue toxic and has the same tonicity as body fluids. The quantity and duration of washing though is not standardized and is the surgeon's choice. This adds to the dilemma in the minds of the surgeon, with the timing of the debridement and the duration of wound irrigation depending on the surgeon's discretion. Future studies should aim to regulate the duration of the wound irrigation besides guiding about the ideal fluid volume to be used for the irrigation. Further, secondary end-points like the duration of hospital stay, rate of infections and use of hospital resources, should be computed to know about the adequacy of the wound debridement and irrigation. Antimicrobial solutions can kill microorganisms in the wound but are toxic to the host tissues as well, which limits their use. In addition, pulsatile (high pressure) lavage has not been seen to increase overall effectiveness. Recent research trials have found cumulative use of innovative solutions like phenols and EDTA along with enzymes to be encouraging though large randomized controlled trials are lacking.

Background Preservation of hamstring tendon insertion at the time of anterior cruciate ligament (ACL) reconstruction is a well-known technique; however, its effect on graft integration is not well studied. The present study was conducted to study the graft integration inside the tibial and femoral tunnels, respectively, after ACL reconstruction using hamstring tendon graft with preserved insertion. Methods Twenty-five professional athletes who underwent ACL reconstruction using hamstring tendon graft with preserved tibia insertion were enrolled in the study. Functional outcomes were checked at final follow-up using Lysholm score and Tegner activity scale. Magnetic resonance imaging (MRI) was done at 8 months and 14 months follow-up to study the graft tunnel integration of the ACL graft at both tibial and femoral tunnels. Results The mean Fibrous interzone (FI) score (tibial tunnel) decreased from 2.61 (1–5) at 8 months to 2.04 (1–4) at 14 months follow-up (p = 0.02). The mean FI score (femoral side) decreased from 3.04 (2–5) at 8 months to 2.57 (2–4) at 14 months (p = 0.02). Conclusions Graft integration occurs early in the tibial tunnel as compared with the femur tunnel with preserved insertion hamstring tendon autograft. Trial registration CTRI/2019/07/020320 [registered on 22/07/2019]; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33884&EncHid=&modid=&compid=%27,%2733884det%27

Rapid COVID-19 diagnosis in the hospital is essential, although this is complicated by 30%–50% of nose/throat swabs being negative by SARS-CoV-2 nucleic acid amplification testing (NAAT). Furthermore, the D614G spike mutant dominates the pandemic and it is unclear how serological tests designed to detect anti-spike antibodies perform against this variant. We assess the diagnostic accuracy of combined rapid antibody point of care (POC) and nucleic acid assays for suspected COVID-19 disease due to either wild-type or the D614G spike mutant SARS-CoV-2. The overall detection rate for COVID-19 is 79.2% (95% CI 57.8–92.9) by rapid NAAT alone. The combined point of care antibody test and rapid NAAT is not affected by D614G and results in very high sensitivity for COVID-19 diagnosis with very high specificity., Graphical Abstract, Highlights Combined rapid antibody + nucleic acid detection correctly diagnoses SARS-CoV-2 Rapid antibody tests detect immune responses against SARS-CoV-2 bearing D614G Rapid SARS-CoV-2 antibody tests do not cross-react with antibodies to seasonal CoV False positivity in SARS-CoV-2 finger prick blood antibody tests can be very low, Mlcochova et al. report that combined rapid nucleic acid amplification testing (NAAT) and finger prick blood antibody tests can substantially improve the diagnosis of COVID-19 as compared to NAAT alone and is able to detect the SARS-CoV-2 Spike D614G variant that dominates the pandemic.

BackgroundThe US Food and Drug Administration (FDA) plays a critical role in bolstering public confidence in vaccines and the vaccine review process. An important tool for enhancing transparency and public trust is the FDA’s Vaccine and Biological Related Products Advisory Committee (VRBPAC), a group of external experts that advises on scientific issues related to the licensure of vaccines.ObjectiveTo analyze key features of VRBPAC meetings convened over 20 years; estimate the probability of advisory committee review of newly approved vaccines, focusing on vaccines targeting emerging diseases; and examine the speed of and variance in approval times as a function of VRBPAC review.MethodsCross-sectional study of VRBPAC meetings convened and new vaccine licensure applications approved between January 1, 2000, and December 31, 2019. We analyzed the frequency of VRBPAC meetings and sessions; the percentage of newly licensed vaccines reviewed by VRBPAC; and the number of days between the submission of the licensure application and the date of FDA approval.ResultsBetween 2000 and 2019, VRBPAC convened for a mean of 4.1 sessions per year. One-quarter of sessions was devoted to the review of specific vaccine products. During the same period, 44 new vaccine licensures were approved, 20% of which were for vaccines targeting emerging diseases. Almost half (48%) of successful new vaccine applications were reviewed by VRBPAC (n=21), a rate lower than for therapeutic applications. Among new applications targeting emerging diseases, 29% of non-influenza vaccines were reviewed by VRBPAC. There was no difference in the median time to approval as a function of VRBPAC review (364 days with VRBAC review vs. 365 days with no review, p=0.870).ConclusionThe FDA has convened VRBPAC for reviews of about half of its vaccine products, less frequently for vaccines against non-influenza emerging diseases. There is considerable scope for the FDA to increase VRBPAC engagement in the vaccine review process.

Sleep disorders often disturb sleep. Daytime symptoms of disturb sleep mimic that of depression, somatoform disorder, fibromyalgia and chronic fatigue syndrome. We are presenting a case of depression who was not responding to antidepressant therapy. Based on clinical history, diagnosis was changed to chronic fatigue syndrome and in view of prominent sleep disturbances, polysomnography was done. Based on sleep study data, diagnosis of periodic limb movement disorder was made and he was started on ropinirole, that improved his symptoms.

Obstructive sleep apnea (OSA) co-occurring with Kleine–Levin Syndrome (KLS) is a rare condition. We present the case of a middle-aged woman who presented with short lasting episodes of hypersomnia, anorexia, irritability, crying and symptoms of derealization. She was given antidepressants considering depression earlier with which she was not responding. After ruling out other potential causes for the same, diagnosis of KLS was made. Oxcarbazepine 450 mg/day led to resolution of symptoms. However, daytime sleepiness and fatigue persisted. Polysomnography suggested the presence of severe OSA which resolved with use of CPAP. Addition of CPAP to oxcarbazepine resolved symptoms completely.

High Performance Liquid Chromatography is a technique in analytical chemistry used to separate, identify and quantify each component in a mixture. The HPLC is suitable for a variety of clinical applications, including pharmaceutical development, legal application such as detecting the Presence of illicit drugs in urine & blood. High-performance liquid chromatography is a technique introduced for the accurate diagnosis of hemoglobinopathies, thalassemias & estimation of glycosylated hemoglobin. The advantage of the HPLC system is the excellent resolution, reproducibility & quantification of several normal & abnormal hemoglobin resulting in accurate diagnosis of thalassemia syndromes. HPLC technique which is used to separate the component in across the two equivalents phases i.e. stationary phases is solid or liuqid supported on a solid which is packed into a column while sample moves in along with mobile phase is liuqid or gas. The purpose of this study is to evaluate the HPLC technique in diagnosis of thalassemia syndromes and also correlate it with clinicohematological profile in these cases.

Tonsillar carcinoma metastasis to the myocardium is undermined with detection rate often occurring at autopsy or advance stage. A 60-year-old male with a 1-month history of right-sided facial pain and failed antibiotics therapy underwent head and neck CT scan that revealed a tonsillar mass. Tonsillar biopsy revealed squamous cell carcinoma, HPV-16 positive. PET-CT scan showed a significant activity in the right tonsillar mass along with prominent right level 2 lymph nodes and no distant disease. Definite surgery was deferred and he underwent 7 weeks of radiation therapy with concurrent weekly Cisplatin. PET scan 8 weeks later showed significant improvement in large right palatine tonsil mass; however, a new FDG-avid cardiac mass of right ventricle. An echocardiogram showed an ejection fraction of 59% and a large mass in the apical portion of the right ventricle. Cardiac MRI confirmed a 9 cm right ventricular mass. Complete resection of the cardiac mass was unsuccessful; a partial tumor debulking provided adequate sample for pathologic examination, which was consistent with metastatic squamous cell cancer, p16+, clinical-stage T4aN1M1. Surgical intervention was not performed; instead, he received a palliative radiation therapy to his right-sided cardiac mass with concurrent Keytruda immunotherapy. Unfortunately, the evening of successfully completing his last therapy, he was found unresponsive and subsequently expired. Although tonsillar carcinoma metastasis to the myocardium is rarely coupled with its atypical presentations, clinicians should consider early echocardiogram evaluation for possible metastatic disease so as to provide early interventions.

Systemic Lupus Erythematosus (SLE) and ANCA-associated vasculitis are classically thought to be separate diseases with different pathophysiologies. An overlap of these diseases has been reported few times in the literature. We present a unique case of a Caucasian male in his third decade of life, without a previous personal or family history of autoimmune disease, with serological and biopsy findings of both diseases occurring simultaneously. ANCA, typically p-ANCA, can be detected in up to 30% of SLE patients and can be higher with renal involvement. Patients with overlap syndrome have increased complications and higher mortality rates than those with either disease alone. Our patient was found to have necrotizing and crescentic glomerulonephritis, most consistent with ANCA vasculitis, specifically microscopic polyangitis with MPO positive staining. The biopsy also revealed abundant immune-complex deposits consistent with WHO class V diffuse membranous lupus glomerulonephritis. These diseases are typically seen in young to middle aged females, and given the rarity of this case, biopsy findings were confirmed by two pathologists from separate institutions. Presentations of autoimmune diseases and vasculitis can be multi-systemic. Immediate action and appropriate work up with a multidisciplinary team is required for optimal patient care. Our patient displayed pulmonary-renal involvement in addition to systemic features such as fevers, myalgia and profound anemia. Considering overlap syndromes, especially in patients with underlying connective tissue disease or systemic vasculitis, is vital for the prevention of excess morbidity in this population.