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Background Young (≤40 years) breast cancers (YBC) are uncommon, inadequately represented in trials and have unique concerns and merit studying. Methods The YBC treated with a curative intent between 2015 and 2016 at our institute were analysed. Results There were 1228 patients with a median age of 36 (12–40) years; 38 (3.1%) had Stage I, 455 (37.1%) - II, 692 (56.3%) –III, and remaining 43 (3.5%) Stage IV (oligo-metastatic) disease; 927 (75.5%) were node positive; 422 (34.4%) were Triple negatives (TNBC), 331 (27%) were HER-2 positive. There were 549 (48.2%) breast conservations and 591 (51.8%) mastectomies of which 62 (10.4%) underwent breast reconstruction. 1143 women received chemotherapy, 617 (53.9%) received as neoadjuvant and 142 (23.1%) had pathological complete response; 934 (81.9%) received adjuvant radiotherapy. At the median follow-up of 48 (0–131) months, 5-year overall and disease-free survival was 79.6% (76.8–82.5) and 59.1% (55.8–62.6). For stage I, II, III and IV, the 5-year overall-survival was 100%, 86.7% (82.8–90.6), 77.3% (73.4–81.2), 69.7% (52.5–86.9) and disease-free survival was 94% (85.9–100), 65.9% (60.3–71.5), 55% (50.5–59.5), and 29.6% (14–45.2) respectively. On multivariate analysis, TNBC and HER-2+ subgroups had poorer survival (p = 0.0035). 25 patients had BRCA mutations with a 5-year DFS of 65.1% (95% CI:43.6–86.6). Fertility preservation was administered in 104 (8.5%) patients; seven women conceived and 5 had live births. Significant postmenopausal symptoms were present in 153 (13%) patients. Conclusion More than half of the YBC in India were diagnosed at an advanced stage with aggressive features leading to suboptimal outcomes. Awareness via national registry and early diagnosis is highly warranted. Menopausal symptoms and fertility issues are prevalent and demand special focus., Highlights • Largest data of young breast cancer from India analysing demographics, outcomes and fertility. • Higher proportion of YBC with advanced stage and aggressive features compared to western data. • Inferior survival in HER-2+ not receiving Trastuzumab, need access of life saving drugs to all. • Scope of improvement and collaboration in challenges like fertility, pregnancy and quality of life.

BACKGROUND: Kidney transplant recipients are at increased risk of severe outcomes during COVID-19. Antibodies against the virus are thought to offer protection, but a thorough characterization of anti–SARS-CoV-2 immune globulin isotypes in kidney transplant recipients following SARS-CoV-2 infection has not been reported. METHODS: We performed a cross-sectional study of 49 kidney transplant recipients and 42 immunocompetent controls at early (≤14 days) or late (>14 days) time points after documented SARS-CoV-2 infection. Using a validated semiquantitative Luminex-based multiplex assay, we determined the abundances of IgM, IgG, IgG1–4, and IgA antibodies against five distinct viral epitopes. RESULTS: Kidney transplant recipients showed lower levels of total IgG antitrimeric spike (S), S1, S2, and receptor binding domain (RBD) but not nucleocapsid (NC) at early versus late time points after SARS-CoV-2 infection. Early levels of IgG antispike protein epitopes were also lower than in immunocompetent controls. Anti–SARS-CoV-2 antibodies were predominantly IgG1 and IgG3, with modest class switching to IgG2 or IgG4 in either cohort. Later levels of IgG antispike, S1, S2, RBD, and NC did not significantly differ between cohorts. There was no significant difference in the kinetics of either IgM or IgA antispike, S1, RBD, or S2 on the basis of timing after diagnosis or transplant status. CONCLUSIONS: Kidney transplant recipients mount early anti–SARS-CoV-2 IgA and IgM responses, whereas IgG responses are delayed compared with immunocompetent individuals. These findings might explain the poor outcomes in transplant recipients with COVID-19. PODCAST: This article contains a podcast athttps://www.asn-online.org/media/podcast/JASN/2021_11_23_briggsgriffin112321.mp3

Acute toxicity study describes the adverse effects of a substance that result either from a single exposure or from multiple exposures in a short period of time. Whenever an investigator administered a chemical substance or herbal drug to a biological system different types of interactions can occur and a series of dose-related responses result. In most cases these responses are desired and useful, but there are a number of other effects which are not advantageous. These may or may not be harmful to the patient. Acute toxicity study is involved in estimation of LD50. Also it determines the therapeutic index i.e ratio between the lethal dose and the pharmacologically effective dose in the same strain and species. This article Review the methods so for utilized for the determination of acute toxicity.

To investigate patient-reported outcome (PRO) measures in patients with relapsing–remitting multiple sclerosis (RRMS) who transition to secondary progressive multiple sclerosis (SPMS). Subjects enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital (CLIMB) who completed PRO measures in the RRMS and SPMS phases were identified (n = 52). The PRO measures were Medical Outcomes Study Short-Form 36 Health Survey (SF-36), the Modified Fatigue Impact Scale (MFIS), and the Center for Epidemiologic Studies Depression Scale (CESD). Two control groups of RRMS CLIMB patients who did not progress to SPMS were identified based on different matching criteria related to age, sex, disease duration and Expanded Disability Status Scale (EDSS). Summary statistics for each PRO were calculated at the last RRMS measurement and first SPMS measurement, and the change over this transition was calculated using a paired t-test. Patients who transitioned were compared to the control groups using linear regression to adjust for age, disease duration and EDSS and a mixed model to further account for the matching with a random effect for matched group. Patients who transitioned from RRMS to SPMS had noticeable deficits in terms of Quality of Life (QOL) and fatigue at the visit prior to the transition. Patients worsened in terms of SF-36 Role Physical (− 3.6 [− 6.6, − 0.7]), Social Functioning (− 3.7 [− 6.4, − 1.0]), and Physical Component Summary (− 2.3 [− 4.5, − 0.1]) during the transition from RRMS to SPMS. When patients who transitioned were compared to the matched subjects, they had worse scores on several outcomes, including Physical Functioning (adjusted mean difference = − 10.8 [− 14.1, − 7.5]), Physical Component Summary (− 5.2 [− 9.3, − 1.0]), fatigue (8.9 [1.7, 16.1]), and depression (3.1 [0.3, 5.9]). Patients in the period closely preceding transition from RRMS to SPMS have worse physical QOL and fatigue compared to subjects who remain RRMS.

In this article, a standalone solar tracking system is intended and successfully synchronized using proteus 7.6 ISIS. Best at instantly aligning a solar panel with the position of the sun, resulting in a 40% increase in efficiency. A low-cost solar tracking detector is being used to rotate the solar panel paired to the motor at such a specific angle to rotate 180°s in 8 steps per day with better accuracy. A microcontroller (Atmega3285P) is used as a control unit, and ADC ports are used to interconnect sensor units. To interconnect a solar array, the motor driver ULN 293D is also used to rotate the solar panel at the highest solar power angle. The modeling is performed in two ways, using four LDRs and eight LDRs, and the results of both are measured. The simulation and analysis results show that the maximum current drawn by the solar tracking sensor is less than 0.5 mA. “Proteus 7.6 ISIS” and “Arduino UNO” and “Code Vision AVR” are used to write the program code and to burn over Atmega3285P for parameters estimation.

The role of vitamin D was well established in bone metabolism as well as in the inflammatory process of a disease. The periodontal disease which is a chronic inflammatory condition with destructive bone metabolism and type II diabetes mellitus which is a metabolic condition with more prone to inflammatory reactions are prevalent in middle-aged patients. Hence the present study is done to assess the vitamin D levels in serum of chronic generalized periodontitis patients with type2 Diabetes mellitus and simple gingivitis patients Two groups with 50 patients of both periodontal disease with type 2 diabetes and 50 simple gingivitis patients of age 35 to 55 years old were recruited in this study. For all the patient's serum 25(OH)D levels, oral hygiene index (OHI), Russel’s periodontal index, and presence of bony defects in radiographs were assessed.After assessment of all the parameters patients with periodontal disease and type 2 diabetes mellitus showed significantly higher proportion levels than the simple gingivitis patients and significantly lower levels in 25(OH)D (

Inflammatory factors have been considered to contribute to keratoconus (KC) pathogenesis. This study aims to determine the immune cells subsets and soluble inflammatory factor profile on the ocular surface of KC patients. 32 KC subjects (51 eyes) across different grades of severity and 15 healthy controls (23 eyes) were included in the study. Keratometry and pachymetry measurements were recorded. Ocular surface immune cells (collected by ocular surface wash) immunophenotyped using flow cytometry include leukocytes, neutrophils, macrophages, natural killer (NK) cells, pan-T cells, gamma delta T (gamma delta T) cells and NKT cells. Tear fluid collected using Schirmer's strip was used to measure 50 soluble factors by multiplex ELISA. Proportions of activated neutrophils, NK cells and gamma delta T cells were significantly increased in KC patients. Significantly higher levels of tear fluid IL-1 beta, IL-6, LIF, IL-17A, TNF alpha, IFN alpha/beta/gamma, EPO, TGF beta 1, PDGF-BB, sVCAM, sL-selectin, granzyme-B, perforin, MMP2, sFasL and IgE, along with significantly lower levels of IL-1 alpha and IL-9 were observed in KC patients. Alterations observed in few of the immuno-inflammatory parameters correlated with grades of disease, allergy, eye rubbing and keratometry or pachymetry measurements. The observation implies a distinct immuno-inflammatory component in KC pathogenesis and its potential as an additional therapeutic target in KC management.

A Hand Sanitizer dispensing machine is automatic, alcohol based hand sanitizer dispenser and non contact which is used in offices, hospitals, schools, work places etc. Basically, alcohol is a solvent and very good disinfectant as compared to liquid or solid soap. It is volatile and vaporizes fatly so it does not need water to wash out. It is proved that a concentration of > 70 % alcohol which can kills corona or other viruses in hands ultrasonic sensor which senses hand when placed near it, microcontroller used in that is the Arduino uno and which senses the distance and the result is the sanitizer.

Myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently identified autoimmune disorder that presents in both adults and children as CNS demyelination. Although there are clinical phenotypic overlaps between MOGAD, multiple sclerosis, and aquaporin-4 antibody-associated neuromyelitis optica spectrum disorder (NMOSD) cumulative biological, clinical, and pathological evidence discriminates between these conditions. Patients should not be diagnosed with multiple sclerosis or NMOSD if they have anti-MOG antibodies in their serum. However, many questions related to the clinical characterisation of MOGAD and pathogenetic role of MOG antibodies are still unanswered. Furthermore, therapy is mainly based on standard protocols for aquaporin-4 antibody-associated NMOSD and multiple sclerosis, and more evidence is needed regarding how and when to treat patients with MOGAD.

Coronavirus disease (COVID -19) is an infectious disease caused by a newly originated virus called coronavirus. It is a communicable disease and spreads at a very fatser rate. Thus to prevent the spread of virus governemnet anncounced first lockdown on 24 th march 2020 till 31 at may 2020.During this pandemic induced lockdown the lifestyle and the dietary pattern of the people changed as compared to before the pandemic period .The research work entitled “ Assessement Of Lifestyle Changes Among Adults During The Covid -19 Lockdown Period “ assessed the changes in the dietary pattern and lifestyle among the adults of Prayagraj district , Uttar Pradesh . The study was carried out on 100 participants out of which 70 were female and 30 were male . Purposive sampling and simple random sampleing was used as a sampling method.. The results showed the highest number of respondents i.e 47 % of the respondents got up between 7 am to 9 am in the morning during the pandemic lockdown which was 43 % before the lockdown. The percentage of people exercising during lockdown also decreased from 49 % to 38 %. The percentage of people sitting more than 3 hours without any physical activity has increased from 24 % to 32% during the lockdown. The percentage of people watching television and using mobile phones or laptops for more than 3 hours in a day has also shown rise from 6 % to 13 % and 13 % to 52 % respectively . The percent of people wearing mask in order to stop the spread of virus also increased from 28 % to 85 % during the pandemic lockdown .The habit of binge eating among the respondents also increased from 12% to 97 % during lockdown. The sleeping pattern of the people also changed during the lockdown . It was found that 58 % of the people among 100 respondents slept between 10 pm to 12 pm during lockdown . The duration of the sleeping hours among the respondents (53%) was more between 7 hours to 8 hours during the pandemic lockdown.With this findings it can be concluded that the lifestyle of the people is now more sedentary . No or less time in exercising , binge eating, spending hours near television and less physical activity is more practiced by the respondents. Keywords :Corona Virus , Sedentary Lifestyle , Physical Activity

BACKGROUND Mediastinal lesions are one of the most common lesions of the chest in children and adults. Multidetector computed tomography (MDCT) is the most common investigation done in patients with suspected abnormalities on X-ray. Crosssectional imaging visualises complex anatomy, helps in predicting the tissue of origin, characterises lesions and depicts the extent of involvement of adjacent structures. Complications of mediastinal lesions and emergent conditions, for example, sealed pneumo-mediastinum, tracheoesophageal / pulmonary fistula, a peri-lesional abscess can be well assessed on CECT. The possibility of the lesion as benign or malignant and can be well predicted. Vascular lesions like aneurysms, dissections, and embolism can be evaluated and stable lesions requiring to follow up and unstable lesions requiring emergent treatment are differentiated using MDCT. The objectives of the study were to characterize and identify features pathognomic of specific mediastinal masses on computed tomography and find out diagnostic accuracy of MDCT in mediastinal masses and compare them with pathological results wherever possible. METHODS A prospective study was done in the Department of Radiodiagnosis, Rohilkhand Medical College and hospital, Bareilly for a span of 1 year from November 2018 to October 2019. Our study included 51 patients. Mediastinal lesions were assessed based on size, compartmental localisation, and attenuation and enhancement patterns. RESULTS In our study with 51 patients, 16 lesions were non-neoplastic and 35 were neoplastic lesions. Anterior mediastinal lesions constituted maximum lesions followed by middle and posterior mediastinal lesions. Lymph nodal masses were the commonest lesions out of which 4 cases were tubercular in origin, 4 were lymphomatous and 4 were metastatic. Neurogenic tumours were most common in the posterior mediastinum consisting of 6 cases. 2 vascular lesions were seen, 1 of aortic aneurysm and 1 aortic dissection. The diagnostic accuracy of MDCT was 93 % compared to histopathological results. Computed tomography (CT) plays a major role in evaluating mediastinal masses by virtue of its excellent multiplanar reconstruction capabilities and demonstration of exact anatomic relationships. However, in many situations, histopathological examination is needed to know the exact tissue of origin and for further management. CONCLUSIONS We conclude that CT has a major role in evaluating mediastinal masses regarding location, extent and tissue characterization. It can display certain features pathognomic for particular masses thus obviates the need for invasive procedures. KEY WORDS Mediastinal Lesions, MDCT, Imaging Modality, Histopathology

BACKGROUND Bleeding during functional endoscopy sinus surgery (FESS) remains a main consideration. Even a small amount of blood may disturb the endoscopic view, increasing the likelihood of complications. So, we decided to compare the effects of clonidine and atenolol as oral premedication for hypotensive anaesthesia in patients undergoing FESS under general anaesthesia. The purpose of this study was to analyse and compare the efficacy of oral atenolol versus oral clonidine as premedication under general anaesthesia for induced hypotension in patients undergoing a functional endoscopic sinus surgery. METHODS The study included total 100 patients of age (18 – 60 years) [American Society of Anaesthesiologists (ASA grade I and II)] who were randomly divided into two groups of 50 each. Group - A (n = 50), a non-labelled clonidine tablet PO was given to the patients in the clonidine group in the dose of 2 mcg/kg at 7 pm the day before surgery and 4 mcg/kg two hours before surgery. Group - B (n = 50), a non-labelled atenolol 25 mg tablet was given PO to the patients in the atenolol group at 7 pm the day before surgery and also 2 hours before surgery. Induction and maintenance of general anaesthesia was performed by the same standard protocol for both groups. Hemodynamic effects [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), quality of surgical field, intraoperative complications, and post anaesthetic discharge score system (PADSS)] were recorded and statistically analysed. RESULTS The hemodynamic stability and good quality surgical field was obtained in both the groups. The lesser incidence of intraoperative complications recorded with atenolol gives it a more favourable profile when compared to clonidine. CONCLUSIONS We conclude that both oral clonidine and atenolol premedication provides superior and predictable perioperative hemodynamic control, reduces the requirement of hypotensive agents, and produces acceptable recovery characteristics. The lesser incidence of intraoperative complications recorded with atenolol gives it a more favourable profile when compared to clonidine. KEYWORDS Atenolol, Clonidine, Functional Endoscopic Sinus Surgery (FESS)

Purpose: The study aims to document use value analysis of some ethnomedicinal plants in LADs preparation. Subject & Methods: Field data was collected through semi-structured interviews from knowledgeable people. The relative importance of each LADs & plant species useful in making of LADs was assessed by calculating a general Use Value Index (UV general), a current UV (UV current) and a past UV (UV past).Status of cultivation, occurrence and DMR score was also assessed to show additional uses of plants besides their use in LADs preparation. Results: Fifty-four plant (H=23, Sh=11, T= 20) species were recorded in present study. Out of which 30 (Herbs=11, Shrubs =7, Trees=12) belonging to 17 families and 25 genera (Cultivated=5;Wild=16;Both=9) were mainly used in making of LHDs. while 24 (Herbs=12, Shrubs=4, Trees=8) belonging to 20 families and 24 genera were used as herbal ingredients according to their availability and preference of local people. LADs were categorized into 7 main types. Among LADs aromatic drinks showed maximum (UVgeneral = 0.8) UVcurrent & effective value (0.4 each). DMR value was highest for Terminalia chebula (26) followed by Bauhinia variegata (25) and Prunus cerasoides (24). Conclusions: LADs proved to occupy a pivotal role in the traditional culture and social life of indigenous people in past, but traditional knowledge related to processing and utilization of LADs is on sharp decline and is further merge among young generation due to increased literacy, strict law against their production for commercial uses and easy availability of commercial alcoholic drinks even in villages. Some plant and ingredients useful in making LADs have potential nutraceutical and medicinal relevance that are well known by local people. These properties could constitute and contribute an additional socio-economic value for LAD's commercialization, which in turn could promote the local rural economy boost immunity and culinary tourism.

Ocimum species represent commercially important medicinal and aromatic plants. The essential oil biosynthesized by Ocimum species is enriched with specialized metabolites specifically, terpenoids and phenylpropanoids. Interestingly, various Ocimum species are known to exhibit diverse chemical profiles, and this chemical diversity has been at the center of many studies to identify commercially important chemotypes. Here, we present various chemotypes from the Ocimum species and emphasize trends, implications, and strategies for the quality and yield improvement of essential oil. Globally, many Ocimum species have been analyzed for their essential oil composition in over 50 countries. Asia represents the highest number of chemotypes, followed by Africa, South America, and Europe. Ocimum basilicum L. has been the most widespread and well-studied species, followed by O. gratissimum L., O. tenuiflorum L., O. canum Sims, O. americanum and O. kilimandscharicum Gürke. Moreover, various molecular reasons, benefits, adverse health effects and mechanisms behind this vast chemodiversity have been discussed. Different strategies of plant breeding, metabolic engineering, transgenic, and tissue-culture, along with anatomical modifications, are surveyed to enhance specific chemotypic profiles and essential oil yield in numerous Ocimum species. Consequently, chemical characterization of the essential oil obtained from Ocimum species has become indispensable for its proper utilization. The present chemodiversity knowledge from Ocimum species will help to exploit various applications in the industrial, agriculture, biopharmaceutical, and food sectors. Supplementary Information The online version contains supplementary material available at 10.1007/s11101-021-09767-z.

PurposeThis paper aims to examine new housekeeping procedures introduced in response to COVID-19. The pandemic has required hotels to reassess their standard operating procedures, especially in housekeeping to retain the confidence of guests in the hotel/brand via high standards of sanitization, hygiene and the maintenance of social distancing.Design/methodology/approachThe article draws on publications and announcements made by major brands and associations about their updated standards of cleaning, hygiene and sanitisation, social distancing and workplace protocols arising from the pandemic. Further, a survey was used to determine the impact of new processes on housekeeping teams and their perceptions of its effect on service quality, guests and employee safety.FindingsSome key new processes are: keeping the hotel room vacant for several hours after departure, the sanitisation of every room, cleaning and sanitisation of high touch points, linen and waste management and low frequency or complete avoidance of the cleaning of occupied rooms. The survey questionnaire establishes that housekeepers value their new standard operating procedures (SOPs) and agree that “clinically clean” is the new normal and essential to avoid cross-contamination and keep guests and employees safe.Research limitations/implicationsAs the pandemic is a current phenomenon, the guidelines and protocols are rapidly evolving. Hotels are innovating and looking for new processes to manage infection control. This study has mainly focused on cleanliness and hygiene protocols and procedures prevalent in the industry. Currently, future work could be useful to evaluate the long-term impact of COVID-19 on the new processes and procedures that have been deployed.Practical implicationsIn order to recover from the pandemic, the Indian hotel industry faces a colossal task. Even when the virus peaks have passed and hotels can safely reopen, the fear of infection will continue and so guest trust and confidence is essential. Given this, the paper should be of interest to hoteliers and policymakers seeking to implement the best possible post COVID-19 housekeeping practices.Originality/valueThis paper identifies and analyses best practice in hotel housekeeping in response to COVID-19. The new standards that are being adopted aim to assure hotel guests and employees about the hygiene and safety measures and standards that have been adopted.

Background: Insufficient height and width of the alveolar ridge at the implant site remains with inadequate bone volume following extraction in older age people especially in postmenopausal women. Postmenopausal women are susceptible to primary osteoporosis where more bone resorption than formation is seen resulting in decreased bone mass. Hence the present study aims to evaluate the zygomatic bone region for placement of quad zygomatic implants using CBCT. Materials and Methods : A total of 120 CBCT images of female patients who were between the age group of 45 yrs to 65 yrs were taken. The zygomatic bone was evaluated for pneumatisation zones and thickness of zygomatic bone at three different regions i.e., superior, middle and inferior at nine points on zygoma bone along with bone to implant contact (BIC) region using virtual software. Results: The largest thickness in the superior, middle and inferior regions were at Point A2(8.01+/-2.10 mm), Point B2 (7.01+/-1.62 mm), and Point C1 (6.65+/-1.64 mm), respectively. The virtually placed implants at Point A3 (15.92+/-4.16 mm) and Point B2 (12.02+/-3.62 mm) had the highest BICs. Conclusions : To obtain the largest BICs, results suggested that the posterosuperior region (Point A3) and the centre of zygoma (Point B1) were the optimal places for the placement of quad zygomatic implants. Keywords: Postmenopause, Zygomatic implants, Zygomatic thickness, Bone-to-implant contact.

This paper explores the views on the creation of knowledge, innovations, and inventions from the Bhagavad-Gita and its significance in today’s context. A review of literature on Bhagavad-Gita shows that a number of studies have been done on the Bhagvad Gita from various perspectives; however, very few have been done to integrate the Bhagvad-Gita’s interpretation of knowledge, self-knowledge, innovations, and inventions as a necessity in the contemporary world. As a result, this paper not only interprets the literature but also provides some significance and insights on the contents of Bhagvad Gita and from the ancient Indian philosophical perspective. Chinmayananda asserted that an ancient philosophical scripture like the Bhagavad-Gita needs intelligent re-interpretation to apply effectively in the context of modern times. This paper is based on published literature and its interpretations, a qualitative research methodology that involves the study, understanding, and interpretation of ancient classical scripture. The Bhagavad-Gita is more than 5,000 years old and is written in the Sanskrit language. In a nutshell, the Bhagavad-Gita provides an inside-out approach to knowledge, innovations, inventions management, unlike the outside-in western perspective. The Shrimad Bhagavad-Gita is one of the most popular ancient religious scriptures not only amongst the Indians but also throughout the world. It speaks to the mind that has fought in life, a mind that is dissatisfied, a mind that is alert and thinking and that has many conflicts. Bhagavad Gita inspires the mind and provides strength, moral courage, and clarity of thought with which one can steer through the struggle.

Kashtartava (dysmenorrhoea) affects women’s day to day activity and it is most common complaints amongst adolescents. 75% of adolescents experience pain during menstruation. Dysmenorrhoea can also be associated with nausea, vomiting, diarrhoea, fatigue, blotting abdomen etc. As per Ayurveda Apanavata is the governing force of menstruation; its vitiation gives rise to many gynaecological diseases ( yonivyapad). Kashyapa has mentioned Shatapushpa (Anethum sowa Kurz.) as drug of choice for Artava related problems. So that group A is treated with Shatapushpa churana and group B with Shatapushpa taila matra basti. Shatapushpa Churna and Shatapushpa taila matrabasti showed extremely significant (P< 0.0001) relief in severity of pain however showed significant relief in duration of Pain, Nausea and Breast Tenderness. Overall effect of treatment on Group A showed complete remission 27.27% whereas Group B showed 63.64%. Statistically both groups are expressed significant results, whereas on the basis of clinical symptoms and overall effect of treatment illustrated in the study the Shatapushpa taila matrabasti is more effective than Shatapushpa churna.

In most cases, multiple sclerosis (MS) begins with a relapsing-remitting course followed by insidious disability worsening that is independent from clinically apparent relapses and is termed secondary progressive MS (SMPS). Major differences exist between relapsing-remitting MS (RRMS) and SPMS, especially regarding therapeutic response to treatment. This review provides an overview of the pathology, differentiation, and challenges in the diagnosis and treatment of SPMS. We emphasize the criticality of conversion from a relapsing-remitting to a secondary progressive disease course not only because such conversion is evidence of disability progression, but also because, until recently, treatments that effectively reduced disability progression in relapsing MS were not proven to be effective in SPMS. Clear clinical, imaging, immunologic, or pathologic criteria marking the transition from RRMS to SPMS have not yet been established. Early identification of SPMS will require tools that, together with the use of appropriate treatments, may result in better long-term outcomes for the population of patients with SPMS.

Background Overexpression of anti-apoptotic MCL-1 protein in oral squamous cell carcinoma (OSCC) is linked to disease progression, therapy resistance and poor outcome. Despite its characteristic short half-life owing to ubiquitin-proteasome-dependent degradation, oral tumours frequently show elevated MCL-1 protein expression. Hence, we investigated the role of deubiquitinase USP9X in stabilising MCL-1 protein and its contribution to oral tumorigenesis. Methods Expression of MCL-1 and USP9X was assessed by immunoblotting and immunohistochemistry in oral cancer cell lines and tissues. The association between MCL-1 and USP9X was confirmed by coimmunoprecipitation and immunofluorescence. Cell death assessment was performed by MTT, flow cytometry and clonogenic assays. Results Both USP9X and MCL-1 are significantly elevated in oral premalignant lesions and oral tumours versus normal mucosa. USP9X interacts with and deubiquitinates MCL-1, thereby stabilising it. Pharmacological inhibition of USP9X potently induced cell death in OSCC cells in vitro and in vivo. The elevated expression of USP9X and MCL-1 correlated with poor prognosis in OSCC patients. Conclusion We demonstrate the oncogenic role of USP9X in driving early-to-late stages of oral tumorigenesis via stabilisation of MCL-1, suggesting its potential as a prognostic biomarker and therapeutic target in oral cancers.

Surgery is the primary treatment of phyllodes tumor of the breast, and margins are the most important risk factor associated with local recurrence. We conducted a retrospective audit of 433 patients treated at our center.Women who presented with phyllodes tumors between 1999 and 2017 were included in the analysis. Data was collected from the hospital medical records, telephonic interviews, and electronic mail.Of the 433 women included in this study, 177 (40.9%) had benign phyllodes tumors, 84 (19.4%) were borderline, 131 (30.3%) were malignant, and 41 (9.5%) had sarcoma. A history of previous excision was noted in 154 (35.6%) patients, of which 104 presented with local recurrence. Of the total patients, 209 (48.3%) underwent breast conservation surgery; the median pT was 6 cm. At a median follow-up of 37.9 months, the 5-year disease-free survival (DFS) was 82.9%. On multivariate analysis, the factors that impacted DFS were histology (hazard ratio, 4.1; 95% confidence interval [CI], 1.5-10.9; P = .005) and history of previous excision biopsy (hazard ratio, 3.39; 95% CI, 1.76-6.52; P .001). We analyzed 231 women who presented without any prior excision separately, wherein at a median follow-up of 44.1 months, the DFS was 92.1% (95% CI, 92.05%-92.15%). In addition, less recurrences were noted in this cohort (5.6% [13/231] in no-excision biopsy vs. 12.5% with surgery done prior to presentation to our institute).A previous history of excision and the histologic subtype of phyllodes tumor are factors that have an impact on DFS, thus emphasizing the need for appropriate surgical planning and en bloc excision of the phyllodes at presentation.

PurposeThis research develops and tests a model for organizational identification (OID) in a sample of knowledge workers in India. It calls attention to the relational antecedents of OID that are often overlooked in existing literature. Strong theoretical arguments are also built for context-specific outcome behaviors such as intrinsic motivation (IM) and innovative work behavior (IWB) that are relevant to knowledge work.Design/methodology/approachData were collected from 357 IT industry employees in India. Partial least squares structural equation modeling (PLS-SEM) was used to test the hypotheses and the path model.FindingsStrong support was found for relational antecedents of OID and the outcome variable IWB. The findings indicated that OID impacts IWB through the mediating mechanism of IM. Overall, the model demonstrated strong predictive power.Practical implicationsThe findings suggest that social and relational variables could be strong managerial levers to increase the feeling of belongingness experienced by knowledge workers in India. In turn, OID can impact IWB, which is a significant outcome for knowledge work.Originality/valueThe study finds strong support for hypothesized relationships that have been unexplored or underexplored in mainstream OID literature. Relational antecedents were found to be strong predictors of OID in this sample. Also, the relationship between OID and IWB, an outcome behavior that is specifically relevant to knowledge-driven businesses, has not been explored earlier.

Repatriation experience is attributed to many factors, a phenomenon much lesser studied compared to expatriation. Considered as merely coming back home could be extremely stressful as given to understand through previous studies and while many factors could attribute to the same, many practitioners argued that it could be repatriate’s own attitude towards pro-activeness that is an increasingly important component of the repatriate transition outcome. The study includes the feedback of such repatriates from the IT companies and understands the behaviour they were involved in while returning back home. It further establishes the role of pro-activeness and provides a set of suggestions for repatriates returning home.

Background: It is unknown how individuals with multiple sclerosis (MS) age compared to unaffected peers. Objectives: The objective of the study is to describe the impact of MS on health and functioning in aging women. Methods: We used 10-item Physical Functioning Scale (PF10) scores (from the Short Form-36 (SF-36)) and other indicators of general, physical, mental health, and memory collected repeatedly over 25 years with self-administered questionnaires among participants in the Nurses’ Health Study ( n = 121,700 recruited at ages 30–55) and Nurses’ Health Study II ( n = 116,429 recruited at ages 25–42) to compare women with MS ( n = 733) to unaffected peers in their health and disability, and describe/quantify the burden of aging with MS. Results: Women with MS had a consistently lower PF10 by 0.9–1.7 standard deviations with greater overall variability than unaffected women. PF10-scores gradually decreased with increasing age in both groups, but MS cases declined 3–4 times faster in midlife, while decline was similar in old age. The physical function score of 45-year-old women with MS was comparable to that of 75-year-old unaffected women; 70-year-old women with MS scored similarly to 85-year-old unaffected women. MS cases also reported worse health/more disability throughout adulthood on the other indicators. Conclusion: The age-related decline in physical health is accelerated by 15–30 years in MS patients compared to unaffected peers.

Objective No relapse risk prediction tool is currently available to guide treatment selection for multiple sclerosis (MS). Leveraging electronic health record (EHR) data readily available at the point of care, we developed a clinical tool for predicting MS relapse risk. Methods Using data from a clinic‐based research registry and linked EHR system between 2006 and 2016, we developed models predicting relapse events from the registry in a training set (n = 1435) and tested the model performance in an independent validation set of MS patients (n = 186). This iterative process identified prior 1‐year relapse history as a key predictor of future relapse but ascertaining relapse history through the labor‐intensive chart review is impractical. We pursued two‐stage algorithm development: (1) L1‐regularized logistic regression (LASSO) to phenotype past 1‐year relapse status from contemporaneous EHR data, (2) LASSO to predict future 1‐year relapse risk using imputed prior 1‐year relapse status and other algorithm‐selected features. Results The final model, comprising age, disease duration, and imputed prior 1‐year relapse history, achieved a predictive AUC and F score of 0.707 and 0.307, respectively. The performance was significantly better than the baseline model (age, sex, race/ethnicity, and disease duration) and noninferior to a model containing actual prior 1‐year relapse history. The predicted risk probability declined with disease duration and age. Conclusion Our novel machine‐learning algorithm predicts 1‐year MS relapse with accuracy comparable to other clinical prediction tools and has applicability at the point of care. This EHR‐based two‐stage approach of outcome prediction may have application to neurological disease beyond MS.

Inflammation of knee joint is called knee arthritis. Among various forms of knee arthritis common is degenerative type of knee osteoarthritis It is the major cause of loco motor disability in old age people particularly among women. Analgesics and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are the current available pharmaceutical management of knee osteoarthritis which are associated with adverse side effects. Thus, there is need of research in traditional system of medicines for cost effective and long-term management of knee OA. Degenerative Knee osteo arthritis is almost similar to the Sandhivata describes in Ayuveda with respect to aetiology, pathology and clinical features. With the use of medicines Ayurveda also employs the prospective of Panchakarma in the various therapeutic measures, which is a kind of Shodhan Chikitsa. Panchakarma provides various therapeutic benefits as detoxification, improved circulation, spasm and pain relief. Hence objective of this review article is to describe the efficacy of Panchakarma in knee-arthritis with taking consideration of disease mentioned in Ayurvedic classics as Sandhivata

Elective paraesophageal hernia (PEH) repair in asymptomatic or minimally symptomatic patients ≥ 65 years of age remains controversial. The widely cited Markov Monte Carlo decision analytic model recommends watchful waiting in this group, unless the mortality rate for elective repair was to reach ≤ 0.5%; at which point, surgery would become the optimal treatment. We hypothesized that with advances in minimally invasive surgery, perioperative care, and practice specialization, that mortality threshold has been reached in the contemporary era. However, the safety net would decrease as age increases, particularly in octogenarians. We identified 12,422 patients from the 2015–2017 ACS-NSQIP database, who underwent elective minimally invasive PEH repair, of whom 5476 (44.1%) were with age ≥ 65. Primary outcome was 30-day mortality. Secondary outcomes were length of stay (LOS), operative time, pneumonia, pulmonary embolism, unplanned intubation, sepsis, bleeding requiring transfusion, readmission, and return to OR. Patients age ≥ 65 had a higher 30-day mortality (0.5% vs 0.2%; p 80 showed a 30-day mortality of 0.4% vs. 1.8%, respectively (p 80 (OR 5.23, p

Background: There is enough evidence to suggest that vancomycin increases the risk of acute kidney injury (AKI) but the exact mechanism is not well understood. This study aims to understand the incidence of vancomycin-associated acute kidney injury (VA-AKI) among hospitalized patients and to identify the risk factors for VA-AKI. Methods: Patients aged 18 and above who received a minimum of 24 hours of intravenous vancomycin and who had serial creatinine measurements over a 13-month period were identified through electronic records. Patients with pre-existing AKI, or eGFR of less than 30ml/min, and patients with end stage kidney disease were excluded. Results were analyzed using t-test and Fisher’s test. A logistic regression model was used to identify the predictors for VA-AKI. Results: From the 598 patients who met the inclusion criteria, 70 developed AKI. Compared to those without AKI, patients with VA-AKI had higher mean serum vancomycin trough levels (22.6 mg/L vs. 14.6 mg/L), and a statistically significant longer duration of vancomycin use (6.7 vs. 5.2 days). Multivariate analysis revealed that serum vancomycin level of > 20 mg/L was associated with a six-fold increase in odds of VA-AKI when compared to those with vancomycin levels < 15 mg/L. The presence of hypotension, iodinated contrast use, and concomitant use of piperacillin-tazobactam were all associated with increased odds of VA-AKI. Conclusion: The incidence of VA-AKI in hospitalized patients with eGFR > 30 ml/min was 11.7%. Serum vancomycin levels of > 20 mg/L, hypotension and administration of iodinated contrast significantly increased the risk of VA-AKI. Piperacillin-tazobactam, when used with vancomycin, was noted to be an independent predictor of AKI, regardless of serum vancomycin trough levels, prompting a reevaluation of the safety of this widespread practice as empiric therapy. Close monitoring of kidney function, avoiding high serum vancomycin levels, maintaining hemodynamic stability, and avoiding unnecessary use of iodinated contrast seem to be essential for the prevention of VA-AKI.

The ACOSOG Z0011 study, heralded as a "practice changing" trial, suggested that women with T1-2 breast cancer with 1-2 SLN+, undergoing breast conservation therapy, need not be offered further ALND. However, whether these results are applicable to all women in the Indian setting, it remains debatable. A retrospective audit of all cN0 operated from 2013 to 2018 was conducted. We analyzed the percentage of additional LN positive (LN+) in the ALND group and compared it to the ACOZOG Z11 trial. Of the 2350 cN0 with EBC who underwent LAS, 687 (29%) had positive lymph nodes on final histopathology. Five hundred ninety-seven (86.9%) patients had 1-2 LN+, 40 (5.8%) patients had 3 LN+, and 50 (7.3%) had 4 or more nodes positive. Demographic features in the ACOSOG Z11 are different from those in our study, looking at ACOZOG Z11 versus our cohort-median pT 1.7 cm versus 3 cm, 45% micrometastasis versus 99.16% macrometastasis, and 28-30% grade 3 tumors versus 73.7%. In our cohort 31.82% of the 1-2 LN positive had additional LN+ on ALND. Keeping in mind the difference in clinicopathological features between our cohort and that of ACOZOG Z0011 and that 31.82% of women had additional LN+ on ALND, it may not be appropriate to apply the results of the ACOSOG Z0011 trial directly to our general population. Possibly, only a select subset of patients who match the trial population of the ACOSOG Z11 could be offered observation of the axilla and validated nomograms can be used to identify high-risk patients.

Coronavirus Disease 2019, caused by the virus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), is a pandemic first discovered in Wuhan, China which has claimed over 1.7 million lives to date across the globe as of 24 December 2020. As the virus spreads across the world affecting millions of patients, there has been a massive movement to discover readily available and effective treatment options including vaccines. One of the limiting factors in treating the disease is its varied presentation and effect in patients, ranging from asymptomatic patients to those left in intensive care units, intubated and fighting for their lives. There are numerous clinical trials and small-scale studies underway to investigate potential treatment options. However, very few studies and drugs demonstrated efficacy while many more are under investigation, leaving care teams dependent on supportive care coupled with experimental treatment options. In this review, we summarize the various treatment options explored to treat COVID-19, discussing possible the mechanisms of fighting the virus.

Internet of Vehicles (IoV) can be pivotal factor towards realization of Intelligent Transportation Systems. IoV principle focus is to have time decisive safety applications, optimize traffic flow, infotainment and Vehicular network with the intention to improve road safety through deployment of application allowing drivers to anticipate danger on the road. One of the important challenges of IoV is timely, reliable, and consistent propagation of messages among vehicles which enable drivers to take appropriate decisions to have improved road safety. Many proposals has been put forward by researchers to identify the traffic jam and routing the vehicular nodes in urban and highway roads for consistent, safe and secured driving environment. Even though the protocols have several limitations including lack of scalability to larger networks, routing overheads, etc. To overcome these limitations bio-inspired, big data, genetic algorithm, machine learning approaches have been proposed to identify and route packets among vehicular nodes in an optimized manner. The paper contains the survey of already proposed method and new approach to identify and route the vehicular node for the IoV environment.

Background: Ductal carcinoma in situ (DCIS) identified by screening mammography accounts for 20% of breast cancer diagnoses, and microinvasion (DCIS-M) is found in 5%-10%. There are no defined treatment guidelines for palpable DCIS or DCIS-M. The role of screening mammography is now being questioned across the world and in the developing world with no national screening programs, women with DCIS present with a palpable lump in the breast. We conducted a retrospective audit of women with DCIS treated at our institution to classify palpable DCIS and DCIS-M as distinct clinical stages and emphasize the need for a change in management of ‘palpable DCIS’ Methods: Annually we register approximately 1700 new cases of early breast cancer of which DCIS and DCIS-M constitutes less than 1%. Between 2005-2016 we registered 784 cases of with DCIS, DCIS-M and early invasive cancer with extensive intraductal component (EIC) at our centre. A retrospective analysis of these cases was performed. Results: Of the 784 patients case records reviewed, 113 (14.4%) had Tis, 87 (11.1% of all early cases and 43.5% of DCIS) had T1mic, the rest had invasive cancer with EIC, of which 46 (5.9%) wereT1a, 28(3.6%) were T1b, 146 (18.6%) were T1c and 364 (46.4%) wereT2. The median age at presentation was 48 years, median clinical tumour size was 3cm; 740 (94.4%) presented with palpable breast lumps.At a median follow up of 86 months , the disease free survival was 95.6% for Tis, 96.6% T1mic, 90.5% T1 and 82.7% T2 (p=0.00). On follow up distant recurrences were noted in 5(4.4%) patients with Tis, 3(3.4%) with T1mic, 21(9.5%) with T1 and 63(17.3%) with T2, (p=0.00). Limited use of adjuvant chemotherapy in Tis and T1mic may have contributed to the high distant recurrences in that group. Also palpable Tis,T1mic and T1a had higher percentage of HR negative compared to those with larger invasive tumours. Conclusions: DCIS presenting in palpable lesions poses a clinical dilemma for the use of adjuvant therapy. In our cohort 43.5% of the palpable DCIS showed evidence of microinvasion with high risk of distant recurrence compared to screen detected DCIS. We thus need to reconsider grossing techniques to accurately identify foci of invasion, redefine DCIS-M based on number and size of foci of invasion and explore the possible role of adjuvant chemotherapy in treating large palpable DCIS. ResultsTis (N%)T1mic (N%)T1a (N%)T1b (N%)T1c (N%)T2 (N%)cT >2 cm63 (55.8)68 (78.2)28 (60.9)6 (21.4)1 (0.7)363 (99.7)Palpable lump85 (75.2)81 (93.1)39 (83)28 (100)144 (98.6)363 (99.7)Nipple discharge26 (23)6 (6.8)7 (14.9)0 (0)2 (1.3)1 (0.3)Hormone receptor positive (HR+ve)60 (53.1)18 (20.7)18 (38.3)15 (53.6)92 (63)218 (60.6)HER2neu +ve31 (27.4)41 (47.1)13 (27.7)8 (28.6)27 (18.5)93 (25)Axilla +ve6 (5.3)9 (10.3)9 (19.1)9 (32.1)50 (34.2)184 (50.7) Citation Format: Karishma Kirti, Nita Nair, Tanuja Shet, Rohini Hawaldar, Vani Parmar, Seema Gulia, Shalaka Joshi, Sridevi Murali, Vaibhav Vanmali, Bipin Bandre, Sudeep Gupta, Rajendra Badwe. Reconsidering the management of palpable DCIS - A single institution audit [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS14-23.

Background Pregnancy associated breast cancer (PABC) is a rare entity and defined as breast cancer diagnosed during pregnancy or one-year post-partum. There is sparse data especially from low and middle-income countries (LMIC) and merits exploration. Methods The study (2013–2020) evaluated demographics, treatment patterns and outcomes of PABC. Results There were 104 patients, median age of 31 years; 43 (41%) had triple-negative disease, 31(29.8%) had hormone-receptor (HR) positive and HER2 negative, 14 (13.5%) had HER2-positive and HR negative and 16(15.4%) had triple positive disease. 101(97%) had IDC grade III tumors and 74% had delayed diagnosis. 72% presented with early stage (24, EBC) or locally advanced breast cancer (53, LABC) and received either neoadjuvant (n = 49) or adjuvant (n = 26) chemotherapy and surgery. Trastuzumab, tamoxifen, and radiotherapy were administered post-delivery. At a median follow up of 27 (IQR:19–35) months, the estimated 3-year event-free survival (EFS) for EBC and LABC was 82% (95% CI: 65.2–100) and 56% (95% CI: 42–75.6%) and for metastatic 24% (95% CI: 10.1%–58.5%) respectively. Of the 104 patients, 34 were diagnosed antepartum (AP) and 15 had termination, 2 had preterm and 16 had full-term deliveries(FTDs). Among postpartum cohort (n = 70), 2 had termination, 1 had preterm, 67 had FTDs. 83(including 17 from AP) children from both cohorts were experiencing normal milestones. Conclusion Data from the first Indian PABC registry showed that the majority had delayed diagnosis and aggressive features(TNBC, higher grade). Treatment was feasible in majority and stage matched outcomes were comparable to non-PABCs., Highlights • Pregnancy associated breast cancer (PABC) is a rare and Challenging entity with lack of data from low-middle income countries. • First Indian data showed that stage matched oncologic outcomes were comparable to non-PABC. • Obstetric outcomes were similar to non-cancer associated pregnancies with normal cognitive development. • Creating awareness and early diagnosis is of utmost importance to improve prognosis in this unique entity

The field of acquired CNS neuroimmune demyelination in children is transforming. Progress in assay development, refinement of diagnostic criteria, increased biological insights provided by advanced neuroimaging techniques, and high-level evidence for the therapeutic efficacy of biological agents are redefining diagnosis and care. Three distinct neuroimmune conditions-multiple sclerosis, myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and aquaporin-4 antibody-associated neuromyelitis optica spectrum disorder (AQP4-NMOSD)-can now be distinguished, with evidence from humans and animal models supporting distinct pathobiological disease mechanisms. The development of highly effective therapies for adult-onset multiple sclerosis and AQP4-NMOSD that suppress relapse rate by more than 90% has motivated advocacy for trials in children. However, doing clinical trials is challenging because of the rarity of these conditions in the paediatric age group, necessitating new approaches to trial design, including age-based trajectory modelling based on phase 3 studies in adults. Despite these limitations, the future for children and adolescents living with multiple sclerosis, MOGAD, or AQP4-NMOSD is far brighter than in years past, and will be brighter still if successful therapies to promote remyelination, enhance neuroprotection, and remediate cognitive deficits can be further accelerated.

Introduction: Cancer has always been a menace for the society. Hepatocellular carcinoma (HCC) is one of the most lethal and 3rdlargest causes of deaths around the world.Area covered: The emergence of natural actives is considered as the greatest boon for fighting cancer. The natural actives take precedence over the traditional chemotherapeutic drugs in terms of their multi-target, multi-level and coordinated effects in the treatment of HCC. Literature reports have indicated the tremendous potential of bioactive natural products in inhibiting the HCC via molecular drug targeting, augmented bioavailability, and the ability for both passive or active targeting and stimulus-responsive drug release characteristics. This review provides a newer treatment approaches involved in the mechanism of action of different natural actives used for the HCC treatment via different molecular pathways. Besides, the promising advantage of natural bioactive-loaded nanocarriers in HCC treatment has also been also presented in this review. Expert opinion: The remarkable outcomes have been observed with therapeutic efficacy of the nanocarriers of natural actives in the treatment of HCC.Furthermore, it requires a thorough assessment of the safety and efficacy evaluation of the nanocarriers for the delivery of targeted natural active ingredients in HCC.].

Bicornuate, septate, or arcuate uterus are common mullerian anomalies which account for 85% of such anomalies. A rare mullerian anomaly is an asymmetric septate uterus with hematometra, reported first by Robert H. A complete septum divides the uterine cavity into one non-communicating hemi-cavity with hematometra, while menstruation occurs from the other hemi-cavity. This may be misdiagnosed as a unicornuate uterus with a non-communicating horn with hematometra. Suspicion of this anomaly, diagnosis, and its management including reproductive outcomes poses a challenge as the anomaly itself is rarely reported. We present a 19-year-old girl with worsening dysmenorrhea due to Robert’s uterus who was managed by resection of the uterine septum and unification of the two hemi-cavities. Seven years later, she underwent in vitro fertilization, had an uncomplicated pregnancy, and delivered by caesarean section at term. Until date, only two successful pregnancy outcomes were reported with Robert’s uterus. With advances in imaging modalities and minimally invasive surgery, diagnosis of Robert’s uterus is early, and hysterolaparoscopy has now become the gold standard therapy.

Objective Serum neurofilament light (sNfL) is a promising new biomarker in multiple sclerosis (MS). We explored the relationship between sNfL and health outcomes and resource use in MS patients. Methods MS patients with serum samples and health‐outcome measurements collected longitudinally between 2011 and 2016 were analyzed. sNfL values were evaluated across age and gender. Data were analyzed using correlation with log‐transformed sNfL values. Results A total of 304 MS patients with a mean age of 32.9 years, average EDSS of 1.6 (SD = 1.5) and baseline sNfL of 8.8 (range 1.23–78.3) pg/mL were studied. Baseline sNFL values increased with age and were higher in females. Baseline sNfL correlated with baseline Multiple Sclerosis Quality of Life physical composite (mean = 49.4 (9.1), P = 0.035) and baseline EDSS (P = 0.002). Other PRO measures at baseline did not show a significant relationship with baseline sNfL. Average of baseline and follow‐up sNfL correlated with MSQoL physical‐role limitations (mean = 48.9 (10.8), P = 0.043) and social‐functioning (mean = 52.3 (7), P = 0.034) at 24‐month follow‐up. We found a trend for numerically higher sNfL levels in nonpersistent patients compared to those who were persistent to treatment (11.13 vs. 8.53 pg/mL, P = 0.093) measured as average of baseline and 24‐month values. Baseline NfL was associated with number of intravenous steroid infusions (mean = 0.2; SD = 3.0, P = 0.013), whereas the average of baseline and 12 months NfL values related to inpatient stays at 12 months (mean = 0.2; SD = 3.0 P = 0.053). Conclusion Serum NfL is a patient‐centric biomarker that correlated with MS patient health‐outcomes and healthcare utilization measures in a real‐world cohort.

Reinforcing steel used in reinforced concrete all over the world is very expansive that leads to the proposal of using bamboo as a reinforcement in concrete in terms of culms or strips. Due to the high cost of steel, the need for a more sustainable and effective alternative that will be relatively cheaper becomes an important issue in the construction industry. Many pieces of research are going on for the productivity and usage of bamboo as a reinforcement material. This review paper addresses the concept of bamboo-reinforced concrete and assesses the mechanical and structural performances of bamboo as an alternative to steel. Various researchers conclude that the mechanical properties of bamboo are quite extraordinary. The tests regarding the compressive, tensile, and flexural strength of the bamboo show surprisingly comparable results to the alternative steel that makes it a useful and important asset to study which might revolutionize the construction industry.

The fundamental goal of a revocable biometric system is to defend a user’s biometrics from being compromised. This research explores the application of deep learning or Convolutional Neural Networks to multi-instance biometrics. Modality features are transformed into revocable templates through the application of random projection. During the user authentication phase, we employ Support Vector Machines, chosen over three other alternative classifiers after carrying out a comparative study. Comparison of the proposed method over other standard deep learning models and performance evaluation before and after revocability have also been discussed. Results demonstrate ability to improve identification accuracy and provide sound template security. The system was validated on three multi-instance iris and fingervein databases.

It is a well-known fact, that music alone of all the arts and sciences has that dominating note of supreme mastership which compels unquestioned universal recognition. In painting, in sculpture, in architecture, in poetry, and in general literature in all its varying and varied moods and modes of expression, Indian music has won fame and occupied the highest place of appreciation in the world. It is admitted that Music is the last art to develop in any civilization, it must also be admitted that Indian civilization and culture have reached a point that would predicate a degree of development in Music, commensurate with our progress in other and kindred fields of creative activity.

Introduction: Inflammation of the infrapatellar bursa results from various causes like trauma, infection and overuse. Superficial skin or soft tissue infection can also lead to occasional septic bursitis. Infrapatellar bursa has two parts, superficial and deep bursae. Superficial bursa inflammation reactive to adjacent superficial skin infection may occasionally lead to secondary bursitis. Case Presentation: We report a rare finding of acute right knee pain with extraordinary amount of fluid collection within superficial part of infrapatellar bursa in an elderly male patient. A secondary, septic and massive superficial infrapatellar bursitis was unusual in its appearance mimicking neoplastic lesion. Judicious use of clinical assessment and imaging helped to diagnose the condition. Conclusion: Early diagnosis and treatment of bursitis can ensure optimal outcome and it can be used to check further complications. Atypical presentation of any bursitis should be acknowledged and the judicious use of clinical assessment and imaging is critical for prompt diagnosis and treatment.

Neuronal injury is a universal event that occurs in disease processes that affect both the central and peripheral nervous systems. A blood biomarker linked to neuronal injury would provide a critical measure to understand and treat neurologic diseases. Neurofilament light chain (NfL), a cytoskeletal protein expressed only in neurons, has emerged as such a biomarker. With the ability to quantify neuronal damage in blood, NfL is being applied to a wide range of neurologic conditions to investigate and monitor disease including assessment of treatment efficacy. Blood NfL is not specific for one disease and its release can also be induced by physiological processes. Longitudinal studies in multiple sclerosis, traumatic brain injury, and stroke show accumulation of NfL over days followed by elevated levels over months. Therefore, it may be hard to determine with a single measurement when the peak of NfL is reached and when the levels are normalized. Nonetheless, measurement of blood NfL provides a new blood biomarker for neurologic diseases overcoming the invasiveness of CSF sampling that restricted NfL clinical application. In this review, we examine the use of blood NfL as a biologic test for neurologic disease.

Widely used data processing platforms use distributed systems to process huge data efficiently. The aim of this article is to optimize the platform services by tuning only the relevant, tunable, system parameters and to identify the relation between the software quality metrics. The system parameters of data platforms based on the service level agreements can be defined and customized. In the first stage, the most significant parameters are identified and shortlisted using various feature selection approaches. In the second stage, the iterative runs of applications are executed for tuning these shortlisted parameters to identify the optimal value and to understand the impact of individual input parameters on the system output parameter. The empirical results imply significant improvement in performance and with which it is possible to render the proposed work optimizing the services offered by these data platforms.

Background Therapeutic decisions in breast carcinoma are being made on the basis of tumor cell proliferation using exorbitant genomic tests. The 2013 St Gallen meeting advocated surrogate definitions for classifying tumors into luminal subtypes on the basis of immunohistochemical (IHC) markers. We studied the classification of estrogen receptor (ER)-positive tumors using these definitions as well as different methods for Ki-67 labeling index (LI) estimation. Patients and Methods A total of 541 ER+ invasive breast carcinoma cases from January 2012 to December 2012 were evaluated for Ki-67 LI by the average and hot spot methods. The IHC results of ER, PR, and human epidermal growth factor receptor 2 (HER2) were noted. HER2 IHC equivocal (2+) samples were subjected to HER2 fluorescence in-situ hybridization testing. Luminal subgroups created on the basis of the 2013 St Gallen meeting guidelines were correlated with clinicopathologic variables and disease-free survival. Results The distribution of luminal subtypes was as follows: luminal A–like, 13.3%; luminal B–like (HER2−), 57.9%; and luminal B–like (HER2+), 28.8%. Approximately 6% of cases were recategorized into different subgroups when the average method was used instead of the hot spot method for Ki-67 LI assessment. Younger patients (≤ 50 years), grade 3 tumors, positive axillary nodes, recurrence, and distant metastasis had a positive statistical correlation with luminal B–like (HER2−) subtype. Patients with luminal B–like (HER2−) tumors had a shorter disease-free survival compared to patients with luminal A–like tumors. Conclusion Ki-67 LI, irrespective of the method of assessment, along with PR, can be efficiently used to divide ER+ tumors into prognostic subgroups in Indian patients.

Introduction: Oral health problems are more chronic and severe. Various instruments have been developed to measure Oral Health Quality of Life. General Oral Health Assessment Index (GOHAI) is a well-established, frequently used questionnaire for measuring OHQoL for geriatric and general population. Objectives: The objective of the study is to translate the GOHAI in Nepali and to assess its reliability and validity. Methodology: This study was conducted on the patient attending department of Prosthodontics, Kathmandu University School of Medical Sciences from March 2017 to February 2018. The GOHAI questionnaire was translated into Nepali version from English and back translated. Nepali version of GOHAI was pilot tested on 50 adult population to test the comprehensibility of the questionnaire, and then required alterations were done. The final Nepali version of GOHAI was administered to 301 (aged 20-70 years) adults along with the self-informed questionnaire. Clinical examination was done on the same day by a single examiner using World Health Organization (WHO) criteria. Reliability was analyzed using test-retest, cronbach alpha and split half reliability. For validity, discriminant validity and construct validity were calculated. Results: Cronbach's alpha was 0.749, which indicated good overall internal consistency and homogeneity. For test-retest, the spearman's rho correlation coefficient between visits ranged from 0.641-0.952 for all twelve questionnaires indicating strong correlation with p-value< 0.001. Conclusion Nepali version of the GOHAI exhibited acceptable reliability and validity in the people of Kathmandu valley, Nepal. This instrument can be applied to evaluate OHRQoL of different age groups as it was carried out in all the age groups.

Objective Positive CSF culture is the gold standard for the diagnosis of meningitis but it carries poor sensitivity. CSF procalcitonin (PCT) is shown to have some utility for the diagnosis of meningitis though there are limited studies in neonatal age group. We planned this study to compare CSF, serum, and CSF to serum PCT levels in neonates with confirmed, probable, and nonmeningitis groups to determine its optimal cut-off in CSF and serum for diagnosing meningitis. Study Design Sixty-seven neonates who qualified for lumbar puncture were enrolled in the study. Neonates were categorized into confirmed meningitis, i.e., CSF cytochemistry and culture positive (N = 17), probable meningitis, i.e., CSF cytochemistry positive but culture negative (N = 25) and nonmeningitis, i.e., both cytochemistry and culture negative (N = 25). CSF and serum samples were stored at −80°C for PCT assay. Results Significant difference was seen in mean of CSF PCT in neonates with confirmed (0.31 ng/mL), probable (0.22 ng/mL), and nonmeningitis (0.11 ng/mL) groups. Similarly, significant difference was observed in serum PCT levels also, though the ratio of serum to CSF PCT was comparable. At cut-off of 0.2 ng/mL, CSF PCT had sensitivity of 95.2% and specificity of 96% in the diagnosis of meningitis. Conclusion CSF PCT is more specific marker for the diagnosis of neonatal meningitis as compared with serum PCT and CSF to serum PCT ratio. Key Points