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Background The role of PI3K/AKT/mTOR pathway hyperactivation in localized brain overgrowth is evolving. We describe two patients with focal cortical dysplasia (FCD) who demonstrated somatic mutations in TSC1 and TSC2 genes in the dysplastic brain tissue but not peripheral blood. Methods Paired whole-exome sequencing was performed on genomic DNA extracted from blood and excised brain tissue in two children with FCD who underwent excision of dysplastic tissue. Results Patient 1, a 14-year boy, had drug-resistant focal epilepsy with onset at 20 months. His brain MRI showed abnormalities suggestive of FCD in the left superior and middle frontal lobes. Patient 2 presented at the age of 10 years with pharmaco-resistant focal epilepsy (onset at six years). His MRI suggested FCD in the left insular lobe. Both patients underwent surgical excision of FCD, and excised tissues were pathologically confirmed to have type IIb FCD. For patient 1, a missense mutation (c.64C > T; p.Arg22Trp) was detected in the TSC1 gene in DNA of dysplastic brain tissue but not peripheral blood lymphocytes. Similarly, for patient 2, a frameshift mutation (c.4258_4261delCAGT; p.Ser1420GlyfsTer55) in the TSC2 gene was identified in the brain tissue but not blood. Both gene variants are likely pathogenic and cause mTOR pathway activation. Conclusion Our report of TSC1/TSC2 somatic mutations in patients with non-syndromic FCD suggests that localized hyperactivation of the mTOR pathway can cause focal malformations during cortical development and presents pharmacological targets for precision therapy in FCD management.

Summary Cardiovascular disease, including myocardial infarction (MI), is the leading cause of death globally. Current antithrombotic medications used during MI treatment are predominantly directed towards platelet inhibition and, to a lesser extent, anticoagulation. Bleeding is a major risk of such treatment and could be circumvented by targeting other causative factors essential for arterial thrombus formation. We sought to re-evaluate the cellular composition of arterial thrombus in order to better understand mechanisms that lead to coronary artery thrombosis in acute MI. We performed detailed histological and immunohistochemical analysis of coronary artery thrombi aspirated from 26 patients undergoing emergency percutaneous coronary intervention for acute ST elevated myocardial infarction (STEMI). Coronary arterial thrombi had an unanticipated cellular heterogeneity. Neutrophil extracellular traps (NETs) were observed in thrombi as identified by anti-citrullinated histone 3 and anti-myeloperoxidase staining. Increased abundance of NETs was seen directly surrounding erythrocytes. Extracellular iron and erythrocyte fragments were also associated with areas of NETs suggesting a possible link. Our results shed light on potential involvement of erythrocytes in coronary arterial thrombosis through activation of platelets and induction of NETs. If supported by further in vitro and in vivo studies, novel therapies to inhibit NET formation or coagulation activation by erythrocyte release products, could bolster current myocardial infarction treatment.

Study Design: Retrospective study.Purpose: This study was undertaken to compare the patterns of syringomyelia in patients with presumed idiopathic and congenital scoliosis.Overview of Literature: The incidence of neuraxial anomalies presenting as idiopathic scoliosis ranges from 2% to 14%; the common ones are idiopathic syringomyelia (IS) and Chiari malformation type 1 (CM1) with syringomyelia. Some authors have speculated that scoliosis is caused by the asymmetrical compression of anterior horn cells by a syrinx, which causes an imbalance of the trunk musculature. In congenital scoliosis, syringomyelia is the second commonest cord anomaly, and the deformity progression depends upon the underlying vertebral abnormality, the location of the abnormality, and the age of patient, and is independent of the intraspinal anomaly.Methods: We analyzed the radiological records of 44 consecutive patients with scoliosis and syringomyelia. Of these 44 patients, 13 had IS, 12 had CM1, and 19 had congenital scoliosis. The radiographs were evaluated to determine the curve magnitude, sagittal alignment, side of convexity, and type of vertebral anomaly, if any. T1- and T2-weighted magnetic resonance imaging of the whole spine was analyzed to determine the presence of craniovertebral anomalies, syrinx length, syrinx diameter, and syrinx-cord ratio (SCR).Results: The frequency of left convex curves was 26.1%, with no significant differences across the three groups. The mean length of the syrinx was 7.2±4.9 vertebral levels, and the mean SCR was 0.39±0.2. The mean syrinx length was significantly higher in patients with CM1 and IS, compared to patients with congenital scoliosis. The mean SCR was highest in patients with CM1. In congenital scoliosis, syringomyelia was seen most frequently in patients with a failure of formation, and 63.2% had concomitant cord anomalies.Conclusions: Syrinxes were smaller in size and length in patients with congenital scoliosis, and are distinct from those seen in IS and CM1.

INTRODUCTION Large tumors may prove unsuitable for surgical cure or other local therapies due to their size, involvement of critical structures, prior non-ablative treatment failure, or coexisting disease burden. This study was performed to assess the safety and feasibility of percutaneous cryoablation for treatment of large tumors exceeding 6 cm in size, and to highlight the key technical considerations inherent to such cases. MATERIALS AND METHODS This single-institution retrospective study identified 77 patients (42 male, 35 female; median age 55 years) who underwent 96 cryoablation procedures for treatment of 78 tumors (mean diameter 9.8 ± 3.6 cm) from 2008 through 2020. Technical success, procedure-related complications, mortality, oncologic outcomes, and procedural logistics were evaluated. Technical success was defined as ice ball extension at least 5 mm beyond the tumor margins. RESULTS Intentional subtotal ablations were performed in 32% of cases due to tumor encroachment on vulnerable structures or as part of staged/combined therapies. Of the 68% of cases that were planned for complete ablation, the technical success rate was 100%. Major complications occurred after 19/96 (20%) procedures, with hemorrhage and acute kidney injury each occurring in 6/96 (6%). Post-procedural myositis occurred in 24/96 (25%) cases and was not considered a major complication in the absence of acute kidney injury. Local recurrence occurred in 2/23 (8.7%) of patients undergoing ablation for cure or local control at a median follow-up duration of 13 months. CONCLUSION Percutaneous cryoablation may be used to treat large (> 6 cm) tumors with a high degree of technical success and an acceptable safety profile.

To evaluate the feasibility and safety of percutaneous image-guided cryoablation of abdominal wall endometriosis (AWE). A retrospective review of percutaneous cryoablation (CT or MR) of AWE was performed from January 2018 to December 2020. Eighteen patients were identified from an internal percutaneous ablation database. Technical success, complications, and outcomes were analyzed according to standard nomenclature. Patients comprised 18 females (mean age 36.9 years) who underwent 18 cryoablation procedures to treat 23 AWE deposits. Three of the 18 cases were performed under MR guidance, while the remaining 15 employed CT guidance. Technical success was achieved in all 18 cases (100%). Fifteen of 18 patients (83%) had biopsy proven AWE deposits prior to treatment. Hydrodisplacement was used to displace adjacent bowel, bladder, or neurovascular structures in 13/18 cases (72%). The mean number of probes used per case was 3. Sixteen of 23 (70%) of AWE deposits had imaging follow-up (median 85 days). Of the 16 lesions with imaging follow-up, 15 (94%) demonstrated no residual enhancement or T1 hyperintensity at the treatment site and 1 lesion (6%) demonstrated residual/progressive disease. At clinical follow-up, 13 of 14 (93%) patients reported improvement in AWE-related symptoms. Eleven patients had clinically documented pain scores before and after ablation and all demonstrated substantial symptomatic improvement. No society of interventional radiology (SIR) major complications were observed. Percutaneous cryoablation of AWE is feasible with a favorable safety profile. Further longitudinal studies are needed to document durable response over time.

Ayurveda physicians provide treatment for viral hepatitis patients in Kerala. A survey was conducted to assess the knowledge and practices in viral hepatitis management among Ayurveda physicians (APs) of Kerala. Materials & Methods: An in depth telephonic interview and a questionnaire were administered among APs in Kerala for assessing knowledge about viral hepatitis and its treatment. Results: All the 150 participants were aware about different types of viral hepatitis. Around 90% Aps know about complications of viral hepatitis and mode of transmission. Only 20% screen their patients before performing Panchakarma therapy and para-surgical procedures in their clinic. All physicians depends liver function test for diagnosing and assessing different types of Hepatitis; only 6.6% physicians additionally prescribe Ultrasonogram of abdomen and viral load. Majority physicians reported chronicity for HBV and HCV infections and good outcome/ curable for hepatitis A. Only a few physicians were documenting the cases in their clinics. The lack of structured case proforma for documentation and guidelines for management, research, patient education and time constraints was reported as challenges in the treatment of viral hepatitis by the majority of AP in the current survey. Conclusion: The majority of doctors had a good knowledge of the different types of viral hepatitis and they depended on laboratory examinations for diagnosis and evaluation. The treatment strategies were based on the treatment principles of Kamala and Panduroga in Ayurveda.

Background and aims Capsule endoscopy (CE) interpretation requires the review of many thousands of images, with lesions often limited to just a few frames. In this study we aim to determine whether lesion detection declines according to the number of capsule videos read. Methods 32 participants, 16 of which were novices (NR) and 16 experienced (ER) capsule readers took part in this prospective evaluation study. Participants read six capsule cases with a variety of lesions, in a randomly assigned order during a single sitting. Psychomotor Vigilance Tests and Fatigue Scores were recorded prior to commencing and then after every two capsules read. Changes in lesion detection and measures of fatigue were assessed across the duration of the study. Results Mean agreement with the predefined lesions was 48.3% (SD:16.1), and 21.3% (SD:15.1) for the experienced and novice readers respectively. Lesion detection declined amongst experienced reader after the first study (p = 0.01), but remained stable after subsequent capsules read, while NR accuracy was unaffected by capsule numbers read. Objective measures of fatigue did not correlate with reading accuracy. Conclusion This study demonstrates that reader accuracy declines after reading just one capsule study. Subjective and objective measures of fatigue were not sufficient to predict the onset of the effects of fatigue.

Development of pulmonary AV fistula (PAVF) after bidirectional glenn shunt (BDG) results in significant cyanosis, impaired exercise performance, and increased morbidity and mortality. We attempted to detect and quantify PAVF in post-BDG patients by saline contrast transesophageal echocardiography (TEE) and compare with pulmonary angiography and pulmonary vein oximetry. This was a prospective study done between 2017 and 2018. Twenty-five children who underwent BDG and planned for cardiac catheterization prior to Fontan completion were included in the study. All patients underwent pulmonary angiography, oximetry, and saline contrast TEE at the time of cardiac catheterization. Twenty-two patients had undergone unilateral BDG surgery and three were palliated by bilateral BDG. The mean oxygen saturation was 80 ± 5.2%. Thirteen patients (52%) had preserved antegrade pulmonary blood flow. Eighteen patients (72%) had PAVF by angiography and oximetry, while 19 (76%) had PAVF identified by contrast echocardiography. There was moderate correlation between the degree of pulmonary venous desaturation and grading of PAVF by contrast echocardiography. PAVF was predominantly located in the lower zones of the lungs. Higher grades of PAVF were not seen in patients with preserved antegrade flow after BDG. Angiographically detected PAVF showed a steady increase with increasing delay to cardiac catheterization from BDG. Significant reduction in systemic saturation was limited to advanced grades of PAVF in patients after BDG. Saline contrast TEE, pulmonary venous oximetry, and pulmonary angiography equally identified PAVF in patients after BDG. Prognostic utility of the same needs to be assessed by long-term follow-up of these subjects.

A novel coronavirus has resulted in a pandemic with over 176 million confirmed cases and over 3.8 million recorded deaths. In the USA, SARS-CoV-2 infection has a significant burden on minority communities, especially Hispanic and Black communities, which are overrepresented in cases compared to their percentage in the population. SARS-CoV-2 infection can manifest differently in children and adults, with children tending to have less severe disease. A review of current literature was performed to identify the hypothesized protective immune mechanisms in children, and to describe the rare complication of multisystem inflammatory syndrome in children (MIS-C) that has been documented in children post-SARS-CoV-2 infection. Epidemiologic data and case studies have indicated that children are less susceptible to more severe clinical features of SARS-CoV-2 infection, a finding that may be due to differences in the cytokine response generated by the innate immune system, high amounts of ACE-2 which maintain homeostatic functions by preventing inflammation, and trained immunity acquired from regular vaccinations. Despite these protective mechanisms, children are still susceptible to severe complications, such as MIS-C. The racial disparities seen in MIS-C are extremely apparent, and certain populations are more affected. Most specifically, 33% of MIS-C patients are Hispanic/Latino, and 30% Black. Current studies published on MIS-C do not detail whether certain symptoms are more present in certain racial/ethnic groups. Knowledge of these disparities could assist health care professionals with devising appropriate strategies for post-acute SARS-CoV-2 infection follow-up in children as well as vaccine distribution in specific communities to help slow the spread of SARS-CoV-2 infection, and ultimately reduce the potential for complications such as MIS-C.

The predominant paradigm for using machine learning models on a device is to train a model in the cloud and perform inference using the trained model on the device. However, with increasing numbers of smart devices and improved hardware, there is interest in performing model training on the device. Given this surge in interest, a comprehensive survey of the field from a device-agnostic perspective sets the stage for both understanding the state of the art and for identifying open challenges and future avenues of research. However, on-device learning is an expansive field with connections to a large number of related topics in AI and machine learning (including online learning, model adaptation, one/few-shot learning, etc.). Hence, covering such a large number of topics in a single survey is impractical. This survey finds a middle ground by reformulating the problem of on-device learning as resource constrained learning where the resources are compute and memory. This reformulation allows tools, techniques, and algorithms from a wide variety of research areas to be compared equitably. In addition to summarizing the state of the art, the survey also identifies a number of challenges and next steps for both the algorithmic and theoretical aspects of on-device learning.

Colchicine, an inexpensive immunomodulatory drug used traditionally to treat gout and familial Mediterranean fever, is rapidly accumulating basic and clinical evidence for a therapeutic role in atherosclerotic cardiovascular disease. Its athero-protective properties are thought to be mainly related to its effect on tubulin polymerisation, enabling a broad range of effect on multiple atherosclerotic plaque cell types and cellular processes, including cell division, cell migration as well as pro-inflammatory cytokine and chemokine secretion. These properties indicate the potential to favourably affect all stages of atherosclerotic plaque development including formation, progression, destabilisation, and plaque rupture. This review focusses on the pharmacology of colchicine, the mechanisms by which it modulates atherosclerosis pathobiology, and summarises the current clinical evidence for its use along with the upcoming clinical trial landscape. Given the current lack of primary immunomodulatory drugs in the treatment of atherosclerosis, colchicine is a promising candidate to fill this therapeutic gap.

Background: Dengue is an arthropod borne viral hemorrhagic fever. It is a major public health concern throughout the tropical and subtropical regions of the world. Objectives: To study clinical profile and laboratory findings of dengue infection in children. Materials and Methods: Children up to the age of 15 years who were confirmed serologically dengue positive (either positive NS1 antigen or positive IgM antibody by ELISA method were included in study. Total 100 patients were studied. Pre tested, semi structured questionnaire were developed and used for data collection. Result and Discussion: In current study, maximum patients were found in Dengue Hemorrhagic Fever (DHF) group (68%), followed by Dengue Fever (25%). Fever was most common clinical manifestation. Maximum patients in this study were in 10 to 15 years of age group, male being more commonly affected. Thrombocytopenia and leukopenia were present in 90% and 69% of patients respectively. Conclusion: School going children were more exposed to mosquito bites during day time school activities, thus maximum patients were from 10 to 15 years of age group. In early diagnosis of dengue fever, ELISA NS1 antigen is seen more promisable. When used in combination with ELISA IgM antibody, it significantly improves the diagnostic algorithm. Thrombocytopenia is more consistent feature of Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). Key words: Dengue Hemorrhagic Fever (DHF), Dengue Shock Syndrome (DSS), ELISA NS1 antigen, ELISA IgM antibody.

In this era of the COVID-19 pandemic, patients with diabetes mellitus are at an increased risk of secondary infections and systemic complications. Here we are reporting 2 cases in post-covid-19 patients, who were uncontrolled type 2 diabetics and diagnosed with fungal osteomyelitis and mucormycosis respectively. Both patients were treated surgically immediately.

Aims: The aim of this study was to assess the relationship between the level of knowledge regarding self-care and awareness as well as long-term complications among type 2 diabetic patients in Guyana. Methods: A cross-sectional study was conducted at the Georgetown Public Hospital Corporation and West Demerara Regional Hospital Guyana during the period September 2020 and December 2020. Results: A total of 200 patients with type 2 diabetes mellitus who met the inclusion criteria were recruited via advertisement and telephone interviews. The data revealed about 66.5% of participants were deemed to have good knowledge with men accounting for the majority. Diabetic foot and hypertension were commonly seen among participants with complications. Significant association was noted with barrier level of patients with the level of education (p=0.001), ethnicity (0.006) and insurance plan (0.03). Adherence to self-care showed statistically significant association with patient’s level of education (p

People are generally poor reporters of time spent using digital technology. Advancing smartphone features, such as the iOS Screen Time application, allow researchers to obtain more objective measurements of digital technology use. Truth and Bias models were used to test how self-reported social networking site use aligns with device-reported use as recorded by the iOS Screen Time app (N=1585). This study explored use across four major platforms (Facebook, Instagram, Twitter, Snapchat) and examined how individual differences moderate biases in reports. Participants overestimated their use for all platforms at comparable levels. Moderation by individual differences was not consistent. These findings add to the growing call from researchers to utilize assessments other than self-reports in measuring digital technology use.

A 3-year-old boy presented with history of recurrent respiratory tract infections in infancy. Clinically he had hemodynamically significant pre-tricuspid left-to-right shunt and no pulmonary hypertension. Transthoracic echocardiography delineated anomalous drainage of the left sided pulmonary veins to a dilated coronary sinus opening into the right atrium. Closer evaluation from the subxiphoid and right parasternal views led to the diagnosis of an associated type IIb coronary sinus septal defect.

Neonatal abstinence syndrome (NAS), a constellation of predominantly autonomic, neurological and gastrointestinal symptoms, is caused by neonatal withdrawal from in utero exposure of maternal misuse of illicit or prescribed drugs. The severity of NAS depends on time, type and combination of drugs taken and the feto-maternal metabolic rate. The physical and psychological consequences of NAS are manifold, contributing to the difficulty in its diagnosis and management. Most babies exposed to opioids in utero require some form of treatment, either supportive or pharmacological treatment. Treatment is guided using standardised clinical scoring systems the most common being the Modified Finnegan Score. Although NAS is diagnosed clinically other possible diagnoses must be considered and toxicological confirmation is often helpful. The long-term neurodevelopmental side effects of NAS are yet to be fully explored. Early multidisciplinary intervention is required, and family integrated care should be actively encouraged. This paper summarises the symptomatology, investigations and current proposed management of NAS.

Crowdsourcing is a cost-effective method that gathers crowd wisdom to solve machine-hard problems. In crowdsourcing systems, requesters post tasks for obtaining reliable solutions. Nevertheless, since workers have various expertise and knowledge background, they probably deliver low-quality and ambiguous submissions. A task aggregation scheme is generally employed in crowdsourcing systems, to deal with this problem. Existing methods mainly focus on structured submissions and also do not consider the cost incurred for completing a task. We exploit features of submissions to improve the task aggregation for proposing a method which is applicable to both structured and unstructured tasks. Moreover, existing probabilistic methods for answer aggregation are sensitive to sparsity. Our approach uses a generative probabilistic model that incorporates similarity in answers along with worker and task features. Thereafter, we present a method for minimizing the cost of tasks, that eventually leverages the quality of answers. We conduct experiments on empirical data that demonstrates the effectiveness of our method compared to state-of-the-art approaches.

Introduction: The coronavirus disease 2019 epidemic emerged in December 2019 and spread worldwide. Since workplaces are high-risk location for occupational exposure, understanding of the dynamics of COVID-19 clusters in occupational settings helps reduce the transmission of infectious disease in workplaces. This study presents an overview of the epidemiological characteristics of COVID-19 workplace clusters, preventive strategies adopted and outbreak responses undertaken in Muscat governorate. Materials and Methods: This is a descriptive study on the epidemiological characteristics of cases and distribution of workplace-related clusters of COVID-19 in Muscat Governorate in Oman. Results: A total of 36,798 COVID-19 cases were confirmed in Muscat from 24th February to 31st July 2020 in which 40.5% was belonging to clusters. Out of them 61% were Workplace-Dormitory clusters, predominantly expatriates. 78.6% of employees were symptomatic at time of examination. Fever and cough were the two most common symptoms reported in workplace related clusters. The number of affected employees ranged from 2 to 358 per cluster. Construction, retail, food, beverages, services, industrial manufacturing, oil & gas and transportation were identified as most at risk settings. Within the cases in workplace-related clusters, there was significant higher prevalence of diabetes, hypertension and obesity among females compared to males as also Omani nationals compared to expatriates and smoking among expatriate males compared to Omani males. In conclusion, understanding the epidemiological characteristics of the affected cases in organization setting will assist the policymakers to understand patterns of epidemiological spread and plan for robust interventions.

Video-assisted thoracoscopic surgery (VATS) in infants and young children increasingly require one-lung anesthesia. However, the maintenance of norms of gas exchange is difficult during one-lung anesthesia in some infants. A combination of factors including added dead space of HME and the circle Y piece, intrathoracic inflation of CO2 and its pressure, airway resistance and bilateral lung disease contribute. Seeping blood from the operating lung soiling the endobronchial tube causes airway narrowing and obstruction adding to this difficulty especially during prolonged thoracoscopy. We report two cases: hypoxemia in one and hypercapnia in the other. Guidance on safe limits of permissive hypoxemia or hypercarbia in this scenario is vague. Therefore, irreversible hypoxemia and hypercarbia with changes in acid-base status should be considered as indications for swift conversion to open thoracotomy and abandon one-lung ventilation.

Purpose An increasing number of implantable or external devices can impact whether patients can receive radiological imaging examinations. This study examines and tests the Neulasta (pegfilgrastim) Onpro on‐body injector in multiple imaging environments. Methods The injector was analyzed for four imaging modalities with testing protocols and strategies developed for each modality. In x‐ray and computed tomography (CT), scans with much higher exposure than clinical protocols were performed with the device attached to an anthropomorphic phantom. The device was monitored until the completion of drug delivery. For magnetic resonance imaging (MRI), the device was assessed using a hand‐held magnet and underwent the magnetically induced displacement testing in a 1.5T clinical MRI scanner room. For ultrasound, magnetic field changes were measured around an ultrasound scanner system with three transducers. Results For x‐ray and CT no sign of device error was identified during or after the high radiation exposure scans. Drug delivery was completed at expected timing with expected volume. For MRI the device showed significant attractive force towards the hand‐held magnet and a 50‐degree deflection angle at 50 cm from the opening of the scanner bore. No further assessment from the gradient or radiofrequency field was deemed necessary. For ultrasound the maximum magnetic field change from baseline was measured to be +11.7 μT in comparison to +74.2 μT at 4 inches from a working microwave. Conclusions No device performance issue was identified under the extreme test conditions in x‐ray or CT. The device was found to be MR Unsafe. Magnetic field changes around an ultrasound system met the limitation set by manufacture. Patient ultrasound scanning is considered safe as long as the transducers do not inadvertently loosen the device.

Introduction: The coronavirus disease 2019 (COVID-19) was declared as pandemic by WHO by March 11th. First case reported in Oman was on 24th February 2020 and later the country went through stages of epidemic progression. This study describes the sociodemographic and epidemiological characteristics of confirmed COVID-19 cases in Muscat governorate and related outcomes. Materials and Methods: This is a descriptive, exploratory analysis of all lab confirmed COVID 19 cases that were reported from 1st February to 31st May 2020. Data for the study was primarily extracted from notifications system established for surveillance (Tarassud). Secondary data sources were, contact listings and hospital medical records. Results: 11,648 initial cases of confirmed COVID-19 infections were included. The mean age was 35 years, 84.7% (N = 9862) were males, 25.9% (N = 3017) were Omanis, and 74.1% (N = 8631) were expatriates of which Indian origin were the majority (37%). Fever and cough were the most common presentations (46.3% and 29.5% respectively). Diabetes and hypertension were the most common comorbidities (4.9% and 4.6% respectively). Hospital admission was required for 7% (N = 811) of the total reported cases, out of them 171 cases (21%) were admitted to ICU, where 107 (13.2%) were ventilated. The case fatality rate (CFR) was 0.9%. 158 clusters containing 2949 contacts were identified from case records and categorised into 3 groups based on their exposure settings. The incubation period measured was 8 days (IQR 4.0 - 15.0) for workplace, 8 days (IQR 4 - 17) for dormitory and 4 days (IQR 2.0 - 7.0) for family groups. The secondary attack rate (SAR) estimated was 41.6% (95% CI: 0.34 - 0.48), 52% (95% CI: 0.40 - 0.63) and 33% (95% CI: 0.27 - 0.38) for workplace, dormitory and family groups, respectively. Conclusion: Results of this study, determine the transmission trend of COVID-19 in a country with high immigrant population. These findings could be utilised for further response planning in similar settings.

It is of interest to document data on the push – out bond strength of three different root canal treatment sealers such as MTA Fillapex (MTA based), AH plus (Epoxy Resin based) and Apexit plus (Calcium hydroxide based). Forty-five freshly extracted human maxillary central incisors with closed apices were selected randomly. All the teeth were sectioned at cement-enamel junction using a diamond disc before starting the root canal preparation to obtain root length of 12 mm. All teeth were instrumented using ProTaper rotary instruments. 5.25% sodium hypoclorite was used for irrigation between instrumentation followed by 17% EDTA, and final rinse by saline. Obturation procedures were done using the gutta-percha single cone technique. 45 roots were randomly assigned to 3 groups of 15 for obturation with gutta-percha cones and 1 of the 3 sealers (n=15). Group 1 = MTA Fillapex sealer + gutta-percha: Group 2 = AH plus sealer + gutta-percha: Group 3 = Apexit plus sealer + gutta-percha. The roots were sectioned horizontally to its canal into 3 sections: Coronal, Mid-root and Apical-thirds using a precision cutting machine, with a thickness of 3 mm. The specimens were subjected to push-out test using a universal testing machine that carried a plunger. The loading speed was 1mm/min until the dislodgment of the material occurred. The independent t- test was used to compare the mean scores among the study groups. The level of significance was set at 5% for all tests. After the push-out bond strength test, each sample was evaluated under stereomicroscope (40x) to determine the mode of failure and recorded as one of the following categories: adhesive, cohesive or mixed. The observations thus obtained were subjected to statistical analysis using Student - t test. AH Plus showed significantly higher values than MTA Fillapex and Apexit plus (p < 0.05). Amongst the push-out bond strength AH Plus sealer showed significant difference from MTA Fillapex and Apexit plus groups. There was no significant difference between MTA Fillapex and Apexit plus however (p>0.05). Microscopic analysis displayed that the majority of the modes were cohesive failures for AH Plus, adhesive failures for MTA Fillapex and mixed failures for Apexit Plus. . Thus, AH Plus had the highest bond strength and MTA Fillapex had the lowest bond strength to root dentin. Mean push-out bond strength values were ranked as follows; AH Plus >Apexit Plus > MTA Fillapex. Microscopic analysis displayed that the majority of the modes were cohesive failures of AH Plus, adhesive failures for MTA Fillapex and mixed failures for Apexit Plus.

This letter investigates an adaptive power allocation (APA) scheme for the simultaneous wireless information and power transfer (SWIPT) enabled full duplex (FD) cooperative non-orthogonal multiple access (NOMA) network under time switching (TS) protocol. The proposed APA involves the joint design of power allocation coefficient at the base station and the TS factor at the relay. We derive expressions for the outage probabilities (OP) experienced by the downlink users under APA as well as fixed power allocation (FPA) strategies, considering imperfect successive interference cancellation. By providing the asymptotic OP analysis, we establish that the proposed APA scheme: (i) resolves the zero diversity order problem inherent in FD-NOMA systems under FPA and (ii) significantly improves outage and throughput performance of SWIPT enabled FD-NOMA systems.

As of 27 October 2020, there have been 57,980 confirmed cases of COVID-19 in Singapore, with 28 fatalities. To summarise the Singapore experience in managing and containing COVID-19 based on available published data and from relevant sources, a review of literature using research databases such as PubMed and OVID Medline, along with non-peer-reviewed articles and other sources, was conducted with the search terms ‘COVID-19’ and ‘Singapore’. Research conducted in Singapore has provided insight into the clinical manifestations and period of infectivity of COVID-19, demonstrated evidence of pre-symptomatic transmission, linked infection clusters using serological tools, and highlighted aspects of hospital-based environmental contamination. It has also provided guidance for diagnostic testing and has described immune and virologic correlates with disease severity. Evidence of effectiveness of containment measures such as early border control, rigorous contact training, and calibrated social distancing measures have also been demonstrated. Singapore’s multipronged strategy has been largely successful at containing COVID-19 and minimising fatalities, but the risk of re-emergence is high. Keywords: Epidemiology, management, prevention, transmission

Congenital pseudoarthrosis of the radius is exceedingly rare. We report an isolated pseudoarthrosis of the radius in a five-year-old girl child with Neurofibromatosis type-I (NF–I). She underwent excision of the pseudoarthrosis tissue, ulna osteotomy, iliac crest cortico-cancellous bone grafting, and K wire fixation of both bones. A sound union of the radius and the ulna was achieved after 4 months. At two-year follow-up, mild shortening of the forearm persisted with maintenance of sound union of both bones. Accurate diagnosis of the condition is central in avoiding complications and the need for complex surgical procedures.

The non-nucleoside reverse transcriptase inhibitors (NNRTIs) are allosteric inhibitors of HIV-1 reverse transcriptase and are classified into generations depending on their discovery and resistance profiles. The NNRTIs are used in combination regimens with antiretroviral agents that target two or more enzymes in the viral life cycle. The combination regimens usually include a backbone of two nucleoside or nucleotide reverse transcriptase inhibitors and a third core agent among the NNRTIs or protease inhibitors. The combination regimens are maintained over long durations and consequently lead to long-term problems, including toxicity, drug-drug interactions, and increasing costs. This brief overview summarizes the pharmacokinetic profiles for NNRTIs and NNRTI-based combination regimens.

Aims: To evaluate the effect of a video educational intervention, on the knowledge of physicians and pharmacists with respect to their awareness of the difference between local bush medicines (bush) and imported herbal medicines (herb); and, their uses, side effects, contraindications and drug interactions. Also, to determine if there was exposure to and an interest in formal training on Complementary, Alternative and Bush Medicine (CABM). Study Design: A cross-sectional study of registered pharmacists and physicians in Guyana, attending their annual conferences, was carried out with a self-administered survey questionnaire on medicinal plants. Methodology: Participants completed the Pre-Questionnaire; then were shown a video and subsequently given a similar Post-Questionnaire. The impact of the video was investigated using Confirmatory Factor Analysis (CFA), Wilcoxon Sign Rank tests and logistic and multinomial regression models. Results: A total of 274 (134 pharmacists and 140 doctors) persons participated. The bush which most were aware of, was corilla/bitter melon, both in the pre-questionnaire (60%) and in the post-questionnaire (83%). Cranberry (pre-score 48%, post-score 51%) was the most identified herb. A comparison of the pre and post scores using the paired t-test (t=2.528, df=175, P=0.005) indicated improved awareness. Most persons were able to identify one use of corilla/bitter melon (pre-score 61%, post-score 70%). However, for the other bush/herbs, and for the side effects, contraindications and drug interactions, knowledge was lacking although there were significant improvements after the intervention. 44% indicated that CABM was part of their formal training and pharmacists were more likely to have had formal training. 88% were interested in further training. Conclusion: The study found a paucity of knowledge about medicinal plants and therefore strongly recommends implementing formal education on CABM in university curricula and in future Continuing Education (CE) sessions. The video intervention had a significant impact and should be used as a template.

OBJECTIVE This study aimed to assess the potential benefits and tolerability of an empirical dose of approximately 0.8-1.2 mCi (29.6-44.4 MBq) of Re-4-hexadecyl-1-2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol/lipiodol (Re-HDD/lipiodol) per milliliter of tumor volume, administered after super-selection of the tumor feeding branches of hepatic artery for treatment of inoperable hepatocellular carcinoma (HCC). METHODS Patients with advanced HCC or classified as inoperable, with no demonstrated extrahepatic disease and no significant comorbidities were eligible. The patients selected for this study had a single tumoral lesion, measuring less than 150 cc. The range of total activity administered was between 30 and 100 mCi (1.2-3.7) GBq Re-HDD/lipiodol, administered in the super selected branches of the hepatic artery supplying the tumor in 42 Patients. Whole-body scintigraphies and single-photon emission computed tomography-computed tomography (SPECT-CT) of the liver including tumor were performed at four-time points after injection. Absorbed doses to the various organs were calculated according to the Medical Internal Radiation Dose formalism. Blood and urine samples were collected at multiple time points until 72 h after injection. Hematological, hepatic and pulmonary toxicity was assessed until 12 weeks after administration using the Common Toxicity Criteria for Adverse Events (version 3.0) scale. Responses were evaluated on contrast enhanced computed tomography (CECT) and by alfa-fetoprotein (AFP) level monitoring. RESULTS About 40.6 ± 4.8% of the injected activity was excreted in the urine by 72 h after injection. The mean absorbed dose to the liver, lungs, stomach, kidney and intestine was 14.4 ± 1.8, 4.8 ± 0.6, 5.5 ± 1.1, 5.1 ± 0.7, and 6.5 ± 1.0 Gy (mean ± SD), respectively. Up to 6 days after administration, 26 of 44 patients had adverse events consisting of aggravations of preexisting laboratory changes (24 patients), fatigue (5 patients), vomiting (6 patients), fever (2 patients), right hypochondrial pain (8 patients), and pain at site of femoral catheter insertion (8 patients). Toxicity assessment at weeks 6 and 12 revealed two cases of mild worsening of liver function tests and no lung or hematological toxicity noted. Two patients were lost to follow-up after the 6-week visit. The response was assessed on CECT in all the remaining patients and the classification of results was more standardized when using European Association for the Study of the Liver (EASL) criteria rather than response evaluation criteria in solid tumors (RECIST) criteria. According to EASL criteria, 8 patients had a partial response, 28 patients had a complete response, 4 patients had progressive disease and 4 patients with stable disease were reported. Thirty-six patients had a baseline elevated AFP and on follow-up at 6 weeks, 6 of these patients showed stable AFP, progression in 4 patients and 26 showed a reduction. CONCLUSION After the administration of 1.2-3.7 GBq Re-HDD/lipiodol based on empirical activity calculation of 0.8-1.2 mCi/mL of tumor volume, more than half of the patients in the present study had an objective response on imaging and biochemically. No significant adverse side effects were noted and most of the laboratory markers as well as symptoms returned to normal after 48-72 h post-administration. Selective administration of the radiopharmaceutical into the tumor feeding arteries gives a good anti-tumoral effect with minimal side effects and damage to surrounding normal liver tissue.

Hepatocellular carcinoma (HCC) is a frequent and increasing cause of cancerrelated deaths worldwide. Reversing this trend is complicated by the varied aetiological factors leading to liver cirrhosis resulting in molecular genetic and clinical heterogeneity, combined with frequent presentation at advanced stage. Large-scale genomic studies have identified alterations in key signalling pathways for HCC development and progression, but these findings have not yet directly influenced patient management in the clinical setting. Despite these translational challenges, a small number of anti-angiogenic systemic therapy agents have succeeded in recent randomized trials enriching the repertoire of available treatments for advanced HCC. In addition, the early promise of immune checkpoint inhibition is now on the cusp of delivering changes to standard systemic therapy algorithms. This review focuses on recent translational and clinical developments that have advanced current practice and explores the challenges encountered in attempting to improve the outcomes and experience of patients diagnosed with advanced HCC.

Erythema Multiforme is an acute, self- limiting inflammatory mucocutaneous condition caused by a hypersensitivity reaction with distinctive clinical eruption manifested as iris or target lesions. It is a life-threatening mucocutaneous disorder where early diagnosis and management are of utmost importance. Erythema Multiforme results from a cell-mediated immune reaction against a precipitating factor. It is clinically characterized by a ‘‘minor'' form and a ‘‘major'' form. In the Erythema Multiforme minor, only one mucous membrane is affected and usually is the oral mucosa. Erythema Multiforme is diagnosed based on stringent clinical findings which are pathognomic as microscopic evaluation carries the least significance. The range of possible etiologies for the oral disease is immense including infectious agents, drugs, food additives, etc. We report a case of a 68-year-old female who presented with a complaint of painful ulcers and burning sensation in her mouth making her difficult to eat & drink. History revealed the usage of clove to get rid of tooth pain following which she developed ulcers in the mouth. In the present case, based on patient history, the clove was found to be a probable etiological agent. The patient was successfully treated with corticosteroids adhering to systemic corticosteroid administrative protocols and no remissions and exacerbations were noticed in 6 months follow up. Early diagnosis of the disease remains essential to promptly initiate appropriate management and proper follow up. Recognition and withdrawal or prevention of contact with the etiological agent is an important step in the management of EM. In the present case, the clove was found to be a probable etiological agent.

Patient safety events occur in health care, and root cause analysis (RCA) meetings held after these incidents often reveal valuable insights into systemic barriers between optimal processes or stated policies and actual practice, providing critical opportunities for improvement. The patient safety team that facilitates RCA meetings in the radiology department at the authors' institution received feedback suggesting dissatisfaction with the RCA process. The team followed a structured process improvement framework to analyze the root causes of this dissatisfaction and create a better system. Using a post-RCA survey to target satisfaction scores as an improvement goal, the team successfully increased participant and facilitator satisfaction levels with sustained results. The patient safety team applied structured process improvement methodologies to their own daily work, learning lessons about measuring difficult processes and choosing appropriate metrics, the benefits of standardized work, and how to continuously improve a quality program. In the course of improving the satisfaction of employees participating in the RCA process, a more robust, continuously improving patient safety program has emerged to enhance the ability of those within the department to report, learn from, and hopefully prevent patient safety events in the future.©RSNA, 2020.

Background China has great student participation in STEM education. Chinese society has a progressive and positive attitude towards STEM as it is considered to provide more opportunities in life. Teachers play a vital role in the success of any STEM program in K-12 schools. However, teachers are facing instructional challenges because of the interdisciplinary nature of the STEM curriculum and the current typical school structure. The success of the STEM programs depends on teachers’ beliefs and their knowledge in adapting to instructional implementation of STEM concepts. Results The data (n = 216) was collected from STEM primary and secondary teachers from 25 provinces in mainland China. Exploratory factor analysis (EFA) was applied, and Pearson’s correlation analysis was used to examine the correlation between Chinese STEM teachers’ beliefs, knowledge, implementation, and the intrinsic challenges of STEM education; t tests and analysis of variance (ANOVA) were performed to ascertain whether there were differences. The structural equation model (SEM) was applied to identify interrelationships. The results indicated that Chinese STEM teachers encounter higher-level intrinsic challenges to instructional implementations based on their beliefs and knowledge. Teachers who utilize their experience of teaching science as their main discipline and then attempt to integrate STEM using mathematics and engineering are likely to encounter higher-level intrinsic challenges in implementation. Conclusion The intrinsic challenges perceived by Chinese teachers in the practice of STEM education can be predicted by their beliefs and knowledge base. Teachers who understand the nature and pedagogy of STEM education are more likely to encounter lower-level intrinsic challenges of STEM teaching, while teachers who utilize their main discipline when conducting integrated STEM learning activities through modeling based on science, technology, engineering, and mathematical problem situations are more likely to encounter higher-level intrinsic challenges. This study also reveals that there are some significant differences in the level of STEM teachers’ beliefs, knowledge base, instructional practice, and their intrinsic challenges based on their teaching grade, seniority, and experience of STEM training and teaching.

Purpose To determine safety and efficacy of retrograde pyeloperfusion for ureteral protection during cryoablation of adjacent renal tumors. Materials and Methods Retrospective review of 155 patients treated with renal cryoablation, including adjunctive retrograde pyeloperfusion, from 2005 to 2019 was performed. Ice contacted the ureter in 67 of the 155 patients who represented the study cohort. Median patient age was 68 years old (interquartile range [61, 74]), 52 patients (78%) were male, and 37 tumors (55%) were clear cell histology. Mean tumor size was 3.4 ± 1.3 cm, and 42 tumors (63%) were located at the lower pole. Treatment-related complication and oncologic outcomes were recorded based on a review of post-procedural images and chart review. Results Technical success of cryoablation was attained in 67 cases (100%), and technical success of pyeloperfusion was attained in 66 cases (99%). A total of 13 patients (19.4%) experienced SIR major C or D complications related to the procedure, including hemorrhage (n = 4), urine leak (n = 3), transient urinary obstruction (n = 2), pulmonary embolism (n = 1), hypertensive urgency (n = 1), acute respiratory failure (n = 1), and ureteropelvic junction (UPJ) stricture (n = 1). No complications were attributable to pyeloperfusion. Three of 45 patients with biopsy-proven renal cell carcinoma experienced local recurrence resulting in local recurrence-free survival of 92% (95% confidence interval, 81.5%–100%) 3 years after ablation. Conclusions Retrograde pyeloperfusion of the renal collecting system is a relatively safe and efficacious option for ureteral protection during renal tumor cryoablation. This adjunctive procedure should be considered for patients in whom cryoablation of a renal mass could potentially involve the ureter.

With recent advances in learning algorithms and hardware development, autonomous cars have shown promise when operating in structured environments under good driving conditions. However, for complex, cluttered, and unseen environments with high uncertainty, autonomous driving systems still frequently demonstrate erroneous or unexpected behaviors that could lead to catastrophic outcomes. Autonomous vehicles should ideally adapt to driving conditions; while this can be achieved through multiple routes, it would be beneficial as a first step to be able to characterize driveability in some quantified form. To this end, this paper aims to create a framework for investigating different factors that can impact driveability. Also, one of the main mechanisms to adapt autonomous driving systems to any driving condition is to be able to learn and generalize from representative scenarios. The machine learning algorithms that currently do so learn predominantly in a supervised manner and consequently need sufficient data for robust and efficient learning. Therefore, we also perform a comparative overview of 54 public driving datasets that enable learning and publish this dataset index at https://sites.google.com/view/driveability-survey-datasets . Specifically, we categorize the datasets according to the use cases and highlight the datasets that capture the complicated and hazardous driving conditions, which can be better used for training robust driving models. Furthermore, by discussions of what driving scenarios are not covered by the existing public datasets and what driveability factors need more investigation and data acquisition, this paper aims to encourage both targeted dataset collection and the proposal of novel driveability metrics that enhance the robustness of autonomous cars in adverse environments.

BACKGROUND In any given hospital set up, obtaining venous access is of utmost significance. Central venous catheterization is now an unavoidable component for invasive monitoring and management. Central venous access was first given by Aubaniac1 in 1953. Cannulation of the internal jugular vein is a procedure commonly performed by anaesthetists, in both the perioperative period and in intensive care.2 The internal jugular route for central venous access has been described as early as in 1966 by Hermosura.3 The very first and one of the most commonly followed method for central venous catheterization remains a blind surface landmarkguided technique. Ultrasonography guidance in central venous cannulation has converted a blind procedure into a procedure under vision which helps in reducing the complication rates. The aim of the study is to compare three ultrasound guided techniques (short axis vs long axis vs oblique axis) for cannulation of the right internal jugular vein. METHODS This is an observational study conducted among 151 patients who fulfilled the inclusion criteria and who had given a written informed consent. The patients were divided into groups of 51 each. Group 1- Short axis approach (SAX), Group 2- Long axis approach (LAX), Group 3- Oblique axis approach (OAX). The outcome variables used were- 1. Successful cannulation with the designated approach, 2. First needle pass success n (%), 3. Number of needle passes, 4. Cannulation time (s). 5. Complications. RESULTS The findings of the study indicate that Oblique axis approach to IJV cannulation is better than Long or Short axis approach in terms of number of needle passes, first needle pass success, and cannulation time . There was no statistically significant difference in complication rates among the three groups. CONCLUSIONS It can be concluded that while performing ultrasound guided Internal Jugular Vein cannulation, the Oblique axis approach can be considered as a safe and effective approach.

Background This study assesses the outcome of hemi epiphysiodesis with a 2-holed reconstruction plate using the tension band principle in angular deformities of the knee and variables influencing the outcome. Methods Prospective study from 2012 to 2016 included 23 children with coronal deformities of the knee joint. IMD, ICD, BMI, mLDFA, mMPTA, mTFA, Mechanical axis deviation, Perpendicular mechanical axis ratio, and screw angle measured. Correction and rate of correction compared with BMI, age, etiology, PMAR and MAD, deformity, a segment of bone and the screw angle. Results Total 65 segments operated in 23 children with 40 knees. Out of the total 65, 36 plates were kept in distal femur physis and 29 in the proximal tibial physis. Thirteen knees had genu varum and 27 had genu valgum. The mean age at the time of surgery was 11.25 months. The mean follow-up of 36 months and the average time for correction was 18.64 months. 77.5% correction achieved with ROC maximum in the initial 6 months. ROC in TFA per year were 7.80(femur), 50(tibia), and 120(femur with tibia). Complications included broken implant, screw back out, screw irritation and rebound phenomenon. Conclusions 2-holed reconstruction plate gives similar correction to that of the 8-plate within a comparable period without additional complications. It has the advantage of being cost effective and readily available. Age, BMI, type of deformity, amount of initial deformity, do not play a significant role in the outcome of correction. Screw placement may have a role in the final correction of the deformity. Level of evidence Level 3.

AIM OF THE STUDY: The primary aim is to study the effectiveness of Homoeopathic medicines in managing anxiety disorders in school going children of Kanyakumari district. This is also aimed at determining the type of anxiety disorder prevalent in school going children and also the probable causes for it. MATERIALS AND METHODS: The study was conducted in a systematic way so as to achieve the aims and objectives of the study. A sample of 30 cases were selected after proper screening from OPD and rural centers of Sarada Krishna Homoeopathic Medical College and also from different School Health Programs conducted in and around Kanyakumari district. The school going children were screened for anxiety disorders using Screen for child anxiety related emotional disorders (SCARED) tool. Cases identified with anxiety disorders were screened and selected as per the inclusion and exclusion criteria. Data collected were recorded in the pre-structured SKHMC standardized case record. Cases were processed according to the Homoeopathic principles followed by case analysis; evaluation and the totality were constructed. Prescriptions were done with due reference to Repertory, Materia Medica and Organon of Medicine. Potency selection and repetition were done according to the demand of each case. Improvement of each case was assessed using the Screen for child anxiety related emotional disorders (SCARED) tool during the follow up after 3 to 6 months. Over all general well being of the patient were also assessed. Pre and post treatment analysis was done. Observations were recorded, before treatment scores were compared with after treatment scores and paired ‘t’ test was done to study the effectiveness of Homoeopathic medicines in managing anxiety disorders in school going children of Kanyakumari district. RESULT: After the assessment of study, majority of patients belonged to age groups of 6 – 8 years (40%) and 9 – 11 years (20%). Out of the total 30 patients, half were males (50%) and the others were females. The majority of the children belonged to average (46.66%) and above average (43.33%) socio-economic status. In the study, 60% of patients have natal risk factors, 40% have antenatal risk factors, and 20% have stimulating environmental factors and 23.33% patients have developmental delay as probable risk factors. Out of the 40% of antenatal risk factors, 33% of patients have antenatal maternal emotional causes as risk factor. The co – morbidity of anxiety disorders were with attention deficit hyperactivity disorder, epilepsy, intellectual disability, learning disability, attention deficit disorder, oppositional defiant disorder, nocturnal enuresis and cerebral palsy. According to the scoring done using SCARED tool, majority of patients belonging to 26 – 30 score (30%) and 16 – 20 score (26.66%) have higher possibility to have anxiety disorders in school going children. The most common type of anxiety disorders in children was found to be social anxiety disorder (83.33%) and separation anxiety disorder (76.66%). There was overlapping of different type of anxiety in the same patients. According to scoring of individual type of anxiety disorder, 56.66% of them were under 0 – 4 score in panic disorder, 66.66% of them were under 0 -4 score in generalized anxiety disorder, 43.44% of them were under 5 – 8 score in separation anxiety disorder, 46.66% of them were under 9 – 12 score in social anxiety disorder and even though majority of them doesn’t had significant school avoidance, 23.33% had score 2. Homoeopathic medicines seen to be more effective were Calcarea carbonica, Calcarea phosphoric, Phosphorous, Silicea, Natrum muriaticum etc. 9 patients (30%) showed marked improvement, 10 patients (33.33%) showed moderate improvement and 11 patients (36.66%) showed mild improvement. CONCLUSION: Therefore, Homoeopathy is effective in managing anxiety disorders of Kanyakumari district in school going children of Kanyakumari district based on the comparison of before and after treatment in the scores of anxiety disorders.

Aims This study was undertaken to describe the pattern of vertebral, intraspinal and other organ anomalies in patients with congenital scoliosis and to determine the correlation between them. Methods Complete medical and radiological records of 227 consecutive patients with congenital scoliosis were analysed. The radiographs were examined for type of vertebral anomaly, location and severity of deformity. The median curve progression index (MCPI) was calculated in 198 patients. The magnetic resonance imaging (MRI) of the whole spine was analysed to detect the presence of cord abnormalities. The presence of other organ-system anomalies was also noted. The independent sample t test was used to compare severity of deformity between those with and without cord anomalies. The Chi-square test was used to compare frequency of cord abnormalities in different vertebral and organ-system anomalies. Results Hemivertebra with contralateral bar had the highest MCPI, while block vertebrae and wedge vertebrae had the lowest MCPI. Forty-eight patients had 83 cord anomalies. There was no statistically significant difference in severity of deformity, between those with and without cord anomalies. Failure of segmentation had the highest frequency of cord anomalies (p = 0.01). There was no significant difference in the frequency of cord anomalies between those with and without other organ defects. Conclusion Curve progression can be predicted by the underlying vertebral abnormalities. However, it cannot predict cord and other organ-system anomalies. Thus, all patients with congenital scoliosis must undergo MRI of the spine, electro- and echocardiography and ultrasonography of the abdomen to detect occult abnormalities and optimize the patient prior to deformity correction.

Midfoot arthritis causes chronic foot pain and significant impairment of daily activities. Although post traumatic arthritis and primary osteoarthritis are the most common pathologies encountered, surgeons need to rule out inflammatory causes and neuropathic aetiology before starting treatment. Steroid Injections are invaluable in conservative management and have diagnostic value in guiding surgical treatment. For the definitive surgical option of fusion there are a variety of fixation devices available. A successful union is linked to a satisfactory outcome which most authors report to be in the range of 90% following the key principles of careful patient selection, pre-operative planning, adequate joint preparation and a stable fixation.

Purpose: To report the outcomes in eyes with noninfectious uveitis receiving dexamethasone implant at the time of pars plana vitrectomy (PPV).Methods: Retrospective analysis of visual acuity (VA), ...

Poor adherence to complex medication regimens is a global problem that affects the treatment of chronic diseases, which involves polypharmacy and requires long-term administration of medications. The most significant barrier to medication adherence in older adults is patient-related factors. The purpose of this study was to find evidence from the current literature to evaluate the effectiveness of electronic medication packaging (EMP) devices on improving medication adherence in older patients. MEDLINE and EMBASE databases were searched based on inclusion/exclusion criteria, focusing on medication adherence and EMP devices with specific technological features. Search results included studies with experiences of patients with four different devices and various medical conditions. Study results indicated that EMP devices may improve medication adherence in older patients. However, due to insufficient evidence that supports their effectiveness specifically in the aging population, further clinical validation in older adults is recommended to draw strong conclusions. [ Journal of Gerontological Nursing, 46 (3), 27–36.]

Objective Integrated Disease Surveillance Programme (IDSP) of Ernakulam district of Kerala, India received reports of a cluster of acute jaundice on 26th November 2016 at Panchayath A. We investigated to identify the agent, source and propose recommendations. Method We defined a probable case as acute onset of jaundice with or without malaise, anorexia, fever, dark urine among residents of Panchayath A, Ernakulam district, since 2nd week of November 2016. Result A total of 385 cases (Attack rate: 8/1000) and 3 deaths (Case fatality ratio: 0.8%) were reported from 45th week of 2016 to 1st week of 2017. The attack rate was highest among men (83%) and those aged 16–30 years (61%). The cases were clustered in ward 3 of the Panchayath, where a hotel was situated. Most case-patients interviewed (84%) stated that they dined at that hotel. The index case was a construction worker who resided with hotel staff and subsequently reported illness. We confirmed HAV IgM in all specimens tested. HAV was associated with consumption of lemon juice [OR = 17.1; 95% CI: 3.8–76.7; PAF = 61%] and drinking water [OR: 15.3; 95% CI: 3.7–63.2; PAF = 66%] at the hotel. Conclusion Consumption of lime juice prepared by infected food handlers led to outbreak of hepatitis A. We recommended safe food preparation, drinking boiled water and super-chlorination of wells.

This article presents a novel non-destructive microwave technique for predicting fluoride contamination in pure water. The proposed microwave-based sensing technique uses an open-ended coaxial prob...