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Background It is imperative that non-compliance with statins be identified and addressed to maximize their clinical benefits. Patient self-reporting methods are convenient to apply in clinical practice but need to be validated. Objective We studied the concordance of a patient self-report method, Morisky eight-item medication adherence scale (MMAS)), with the pill count method in measuring adherence with statins and their correlation with extended lipid profile parameters and serum hydroxyl-methylglutaryl coenzyme A reductase (HMGCoA-R) enzyme levels. Methods MMAS and the pill count method were used to measure the adherence with statins in patients on statins for any duration. Patients were subjected to an estimation of extended lipid profile and serum HMGCoA-R levels at the end of three months follow-up. Results Out of a total of 200 patients included in the study, 117 patients had a low adherence (score less than 6 on MMAS) whereas 65 and 18 patients had medium (score 6 or 7) and high adherence (score of 8), respectively. The majority of patients who had low adherence to statins by MMAS were nonadherent by the pill count method yielding a concordance of 96.5%. Medium or high adherence to statins by the MMAS method had a concordance of 89.1% with the pill count method. The levels of total cholesterol, low-density lipoprotein-cholesterol, apolipoprotein B, and HMGCoA-R were negatively correlated with compliance measured by pill count and MMAS in a statistically significant way and with similar correlation coefficients. HMGCoA-R levels demonstrated a plateau phenomenon, with levels being 9-10 ng/ml when compliance with statin therapy was greater than 60% by pill count and greater than 6 on the Morisky scale. Conclusion In conclusion, MMAS and the pill count method showed concordance in measuring adherence to statins. These methods need to be explored further for their interchangeability as surrogates for biomarker levels.

This paper proposes an optimized Genetic Algorithm (GA) based sustainable and secure green data collection/transmission method for IoT enabled WSN in healthcare by optimizing intra cluster distance, systematic utilization of node’s energy and reducing hop count. For secure transmission of data, the communication data is encrypted us ing stream cipher and a pseudo randomly generated security key. Additionally, the proposed movable sink and data collection/transmission strategies shorten communication distance between sink and cluster head (CH) which diminishes the hotspot problem. The direct data collection helps in transmitting data directly to the sink, when the sinks are nearer to the sensor nodes with re spect to CH. Further, the incorporated dynamic sensing range minimizes overlapping of sensing range with a significant decrement in the transmission energy. The simulation results show that the proposed protocol outperforms the existing protocols on the performance metrics such as remaining energy, lifetime, stability period, throughput and number of clusters per rounds.

The application of video processing techniques are useful for the safety of nuclear power plants by tracking the people online on video to estimate the dose received by staff during work in nuclear plants. Nuclear reactors remotely visually controlled to evaluate the plant's condition using video processing techniques. Internal reactor components should be frequently inspected but in current scenario however involves human technicians, who review inspection videos and identify the costly, time-consuming and subjective cracks on metallic surfaces of underwater components. In case, if any frame of the inspection video degraded/corrupted/missed due to noise or any other factor, then it may cause serious safety issue. The problem of missing/degraded/corrupted video frame estimation is a challenging problem till date. In this paper a systematic literature review on video processing techniques is carried out, to perform their suitability analysis for NPP applications. The limitation of existing approaches are also identified along with a roadmap to overcome these limitations.

The Internet of Healthcare Things (IoHT) consists of a wide variety of resource-restricted, heterogeneous, IoT-enabled, wearable/non-wearable medical equipment (things) that connect over the internet to transform traditional healthcare into a smart, connected, proactive, patient-centric healthcare system. The pivotal functions of the 6LoWPAN protocol stack enable comprehensive integration of such networks from wearable wireless sensor networks (W-WSN) to IoHT, as TCP/IP does not suffice the requirements of IoHT networks. As a result, the congestion in the IoHT network increases with a growing number of devices, resulting in loss of critical medical information due to buffer loss and channel loss, which is unacceptable. In this paper, we explored different applications of patient-centric IoHT architectures to draw a realistic resource-limited topological layout of IoHT for congestion estimation. After critically reviewing existing congestion schemes for 6LoWPANs, we proposed an effective buffer-loss estimation model based on the Queuing Theory to determine the number of packets lost at the node’s buffer. The buffer is modeled as an M/M/1/K Markov Chain Queue. The M/M/1/K Queue equilibrium equation is used to establish a relationship between the probabilities of the buffer being empty or completely filled. We derived the expressions for total buffer-loss probability and expected mean packet delay for the resource-constraint IoHT network. Furthermore, to validate the buffer-loss estimation, an analytical model is used to compare buffer-loss probabilities, the number of packets dropped at leaf/intermediate nodes and the number of packets successfully received at the local sink node. The results show a close correlation between both the models on varying values of the number of leaf nodes, buffer size, offered packet load and available channel capacity. Thus, in resource-restrictive IoHT, the proposed model performs better than two related works.

Primary surgical management is successful as the sole therapeutic modality in the majority of women with early-stage cervical, vaginal and vulvar cancer, but the presence of certain risk factors in the surgico-pathological specimen indicates a poorer prognosis. Adjuvant treatment can improve overall survival in such cases. Important risk factors in cervical cancer include intermediate-risk factors (large tumor size, deep cervical stromal invasion, lymph-vascular space invasion) and high-risk factors (positive or close margins, lymph nodes, or parametrial involvement). In vulvar cancer, positive margins and lymph nodes are the two most important factors for adjuvant therapy. Radiation therapy has been the mainstay of adjuvant therapy in these cancers, supplemented by chemotherapy. Recent advances have witnessed the inclusion of newer therapeutic modalities such as immunotherapy. This review addresses the current status of various adjuvant therapeutic modalities for these gynecological cancers.

The primary objective of this article is to explore effects of latest development in the area of three dimensional (3D) printing & to assess its abilities, and further undertake helpful reporting. Here the focus is to assess advantages of 3D printing in orthopedics and analyze how 3D printed models help solve complex 3D orthopedics distortions. This study identified that 3D models manufactured by 3D printing models reduce medical parts development cost and surgical planning time. Integrating 3D printing with orthopaedics helps in understanding the conditions of problems and achieving the operation successfully. This technology can enable doctors/surgeons to design, produce, recreate and plan operations more accurately, carefully, and economically. 3D models can assist specialists with a visual comprehension of the patient-particular pathology and life structures. Innovation in 3D printing initiated a scaffold for the virtual outline and execution of medical procedures. This research proposes the utilisation of 3D printers as an elective procedure for the fabrication of parts. It empowers surgeons/patients for better training, education and research. In the future, there is a foreseeable expansion of additive manufacturing in orthopedics.

Introduction: Delirium is underdiagnosed especially in ICU. In a study done in the Netherlands investigators found not only ICU nurses but also intensivists had difficulty in diagnosing delirium. With the impact that delirium has on patients’ health, its monitoring and detection should be considered an integral part of patient care in critical care medicine, Knowledge and attitude are one of the primary unmet needs regarding early detection and treatment of delirium. Since nurses are the first line assessors in any ward we would like to carry out this cross-sectional survey on a group of nurses. Objective: To assess the nurses’ knowledge about delirium & to compare the knowledge between those that have worked in ICU or critical care to those who haven’t. Methodology: This was a cross-sectional survey carried out at Birat medical college and teaching hospital. Here all nurses were requested to fill a questionnaire that consisted of 15 questions. A time-frame of 1 week was taken to gather the data. Results: We collected data from 124 nurses, who had varying educational degrees, Eighty-four were currently working in an ICU and 32.5% of those not working had previously worked in an ICU. Over all knowledge level for nurses was poor where 94 of 124 nurses had less than 50% scores. About 27% of those who had worked in an ICU setting had good knowledge compared to 17.5% of those who had not. Conclusion: Training regarding delirium is required to increase identification and adequate management to decrease morbidity due to delirium.

Contribution: This article details a systematic study to investigate knowledge that graduate students have about reliability and safety engineering (RSE), comparing it with industry expectations. Background: Reliability and safety have always been the main focus while developing safety-critical systems (SCS). An interview study was conducted with engineering students in India and Brazil and with experienced practitioners to investigate a perceived mismatch between education and employment on knowledge related to RSE in SCS. Research Question: How does student knowledge of RSE for SCS compare with industry expectations? What measures could be taken by institutes and universities providing computer engineering courses to better meet the expectations of industries regarding SCS? Methodology: Interviews and discussions were conducted with 21 practitioners from ten different organizations to identify what expectations they hold for the students they recruit to develop SCS, as these SCS have high reliability and safety requirements. Interviews were conducted with graduate students of various engineering disciplines to assess their knowledge of RSE for SCS. Analyses were conducted to compare industry expectations with students’ knowledge. Findings: Analyses indicated most graduate students do not have the range of knowledge regarding RSE that recruiters see as essential for the development of SCS. Hence, it is paramount to rethink computing curricula—to include RSE-related topics.

Contribution: This article shares the learning ecosystem of a project-based safety-critical systems (SCS) course, identifying course contents that support self-directed learning and how assignments develop students’ knowledge and understanding toward meeting the demand of industries. Background: The syllabus for undergraduate and postgraduate students of the engineering stream has been periodically updated by universities and higher education institutes to meet the demand of industries. Due to high reliability and safety requirements, the development process of SCS differs from that of other industrial systems in many ways. This article seeks to further understand ways that a project-based learning approach in an undergraduate and postgraduate SCS can earn a systematic knowledge to meet industrial demands. Research Question: In what ways can a project-based learning and experimental approach in the undergraduate and postgraduate course can embed the expertise on the development of SCS among the students to meet the industrial demands and increase the employability. Methodology: In-depth reviews with 21 experienced industry experts from ten different organizations, working on different domains, were conducted in the context of the development of SCS in order to investigate critical aspects related to the development of SCS. Then, students and faculty members of different universities and institutes were interviewed to know the existing course structure of SCS. Findings: The salient differences between the university students and practices were analyzed, based on which a systematic course on the development of SCS is proposed that can meet the industry demand.

Instrumentation and Control systems (I&C) play a significant role in nuclear power plants (NPP) and other safety critical systems (SCS). We have conducted a rigorous study and discussions with experienced practitioners worldwide the strategy for the development of I&C systems to investigate the several aspects related to their dependability. We discussed with experienced practitioners that work on nuclear domain with the intention of knowing their approach, they use day-to-day for the development of such systems. The aim of this research is to obtain to provide guidance to those building I&C systems of NPP and have implications on state engineering licensure boards, in the determination of legal liability, and in risk assessment for policymakers, corporate governors, and insurance executives.

To date, although the microscopic alterations present in Alzheimer's disease (AD) have been well known for over a century only a handful of symptomatic treatments have been developed which are a far cry from a full cure providing volatile benefits. In this context, the intervention of stem cell therapy (SCT) has been proposed as an auxiliary treatment for AD as suggested by the rising number of pre-clinical studies that stem cell engraftment could provide an exciting future treatment regimen against neurodegeneration. Although, most of the primary enthusiasm about this approach was based on replacing deteriorating neurons, the latest studies have implied that the positive modulations fostered by stem cells are fuelled by bystander effects. Present review provides a detailed update on stem cell therapy for AD along with meticulous discussion regarding challenges in developing different stem cells from an aspect of experiment to clinical research and their potential in the milieu of AD hallmarks. Specifically, we focus and provide in depth view on recent advancements in the discipline of SCT aiming to repopulate or regenerate the degenerating neuronal circuitry in AD using stem-cell-on-a-chip and 3D bioprinting techniques. The focus is specifically on the successful restoration of cognitive functions upon engraftment of stem cells on in vivo models for the benefit of the current researchers and their understanding about the status of SCT in AD and finally summarizing on what future holds for SCT in the treatment of AD.

Background: Routinely, patient’s planning scans are acquired after administration of iodinized contrast media but they will be treated in the absence of that. Similarly, high energy photons have a better penetrating power, while low energy photons will result in tighter dose distribution and negligible neutron contamination. The aim of the study was to investigate a suitable photon beam energy in the presence of intravenous contrast medium. Materials and methods: An indigenously made original-contrast (OC) phantom was mentioned as virtual-contrast (VC) and virtual-without-contrast (VWC) phantom were generated by assigning the Hounsfield Units (HU) to different structures. Intensity-modulated (IMRT) and volumetric-modulated-arc (VMAT) plans were generated as per criteria of the TG-119 protocol. Results: It was observed that the maximum dose to the spinal cord was better with 6 mega-voltage (MV) in IMRT. The coverage of Prostate PTV (PR PTV) was similar with all the photon energies and was comparable with TG-119, except for original-contrast (OC) phantom using the VMAT technique. Homogeneity-index (HI) was comparatively better for VMAT plans. Conclusion: The contrast CT images lower the dose to targets. IMRT or VMAT plans, generated on such CT images will be delivered with higher doses than evaluated. However, the overdose remains non-significant

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 Treatment of patients with platinum resistant/refractory epithelial ovarian cancer (EOC) is an unmet need. We evaluated the role of oral metronomic therapy in this setting. Patients and methods Between October 2017 and September 2019 seventy five patients with platinum resistant/refractory EOC were enrolled. Patients received oral etoposide (50 mg, day 1 to 14, cyclophosphamide 50 mg, day 1 to 28, every 4 weeks (Arm A, n = 38). Patients in Arm- B (n = 37) received Pazopanib (400 mg once daily) in addition to etoposide and cyclophosphamide. Quality of life (QoL) was evaluated using the EORTC questionnaire. Serum VEGF and PDGF were estimated at baseline, after 3rd and 6th cycle. The primary endpoint was progression free survival (PFS). Secondary endpoints were overall survival (OS), toxicity and QoL. Results Patients characteristics were well matched. Median PFS was higher in arm B, 5.1 months (95% CI 3.13 to10.33) compared to 3.4 months (95% CI 3.0 to 6.53) in arm A, p = 0.045. Median OS has ‘not reached’ in Arm B compared to 11.2 months (95% CI, 5.66 - not reached) in arm A, p = 0.032. Therapy was tolerated well; oral mucositis (p = 0.36) and fatigue (p = 0.08) being more in arm B. QoL assessment revealed modest improvement in ‘symptom scales’ in Arm B. Serum VEGF and PDGF levels decreased with therapy in both arms (Arm A-p Conclusion Addition of pazopanib to etoposide and cyclophosphamide could be a novel oral combination for metronomic therapy for platinum resistant/refractory EOC. Trial registration CTRI/2017/10/010219.

Background Professional identity formation (PIF) in medical students is a multifactorial phenomenon, shaped by ways that clinical and non-clinical experiences, expectations and environmental factors merge with individual values, beliefs and obligations. The relationship between students’ evolving professional identity and self-identity or personhood remains ill-defined, making it challenging for medical schools to support PIF systematically and strategically. Primarily, to capture prevailing literature on PIF in medical school education, and secondarily, to ascertain how PIF influences on medical students may be viewed through the lens of the ring theory of personhood (RToP) and to identify ways that medical schools support PIF. Methods A systematic scoping review was conducted using the systematic evidence-based approach. Articles published between 1 January 2000 and 1 July 2020 related to PIF in medical students were searched using PubMed, Embase, PsycINFO, ERIC and Scopus. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. Concurrent thematic and directed content analyses were used to evaluate the data. Results A total of 10443 abstracts were identified, 272 full-text articles evaluated, and 76 articles included. Thematic and directed content analyses revealed similar themes and categories as follows: characteristics of PIF in relation to professionalism, role of socialization in PIF, PIF enablers and barriers, and medical school approaches to supporting PIF. Discussion PIF involves iterative construction, deconstruction and inculcation of professional beliefs, values and behaviours into a pre-existent identity. Through the lens of RToP, factors were elucidated that promote or hinder students’ identity development on individual, relational or societal levels. If inadequately or inappropriately supported, enabling factors become barriers to PIF. Medical schools employ an all-encompassing approach to support PIF, illuminating the need for distinct and deliberate longitudinal monitoring and mentoring to foster students’ balanced integration of personal and professional identities over time.

Background Transdermal delivery of drugs is a quite challenging task for pharmaceutical scientists. The transdermal route is preferred over the oral route due to various advantages like avoidance of the first-pass effect, non-invasiveness, and high patient compliance. Therefore, it is necessary to develop an effective carrier system that enables the effective passage of the drug through the dermal barrier. Main body of abstract Various novel drug delivery systems are used to enhance the permeation of a variety of drugs through the skin barrier. Researchers around the globe have explored nanofibers for the transdermal delivery of various therapeutic agents. Nanofibers are designed to have a high concentration of therapeutic agents in them promoting their flux through various skin layers. Polymeric nanofibers can be explored for the loading of both hydrophilic and lipophilic drugs. Biopolymer-based nanofibers have been also explored for transdermal delivery. They are capable of controlling the release of therapeutic agents for a prolonged time. Short conclusion The literature presented in this review paper provides significant proof that nanofibers will have an intense impact on the transdermal delivery of different bioactive molecules in the future. Graphic abstract

Regardless of progress in therapy management which are developed for colon cancer (CC), it remains the third most common cause of mortality due to cancers around the world. Conventional medicines pose side effects due to untoward action on non-target cells. Their inability to deliver drugs to the affected regions of the colon locally, in a reproducible manner raises a concern towards the efficacy of therapy. In this regard, nanoparticles emerged as a promising drug delivery system due to their flexibility in designing, drug release modulation and cancer cell targeting. Not only are nanoparticles making their way into colon cancer research in the revolution of conventional onco-therapeutics, but they also offer promising scope in the development of colon cancer vaccines and theranostic tools. However, there are challenges with respect to drug delivery using nanoparticles, which may hamper the delivery of these novel carriers to the colon. The present review addresses recent advents in nanotechnology for colon-specific drug delivery (CDDS) which may help to overcome the existing challenges and intends to recognize futuristic potentials in the treatment of CC with CDDS.

Background: Laryngoscopy and intubation have been associated with increased sympathetic responses such as hypertension, tachycardia, arrhythmias, and myocardial infarction. This response is usually transient and variable but might be life threatening in cardiovascular and cerebrovascular compromised patients. So controlling this response is utmost goal of anaesthesia. We evaluated the effectiveness of dexemedetomidine/clonidine to attenuate pressor response. Aims: Evaluation of efficacy of addition of Dexemedetomidine/ clonidine to fentanyl in attenuation of pressor response of laryngoscopy and intubation. Materials and Methods: 96 patients were enrolled and randomly divided in three groups having 32 patients each. Group NS received 10 ml normal saline, Group CL received 2mcg/kg Inj. Clonidine and Group DE received 1mcg/kg Inj. Dexemedetomidine infusion over 10 min before laryngoscopy. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were studied immediately after premedication, 10 min after study drug infusion and then at 1, 2,3,4,5 and 10 min intervals. Results: There was significant fall in mean HR and mean MAP after 10 min of study drug infusion. Clonidine and dexemedetomidine groups had significantly less rise in heart rate and mean arterial pressure after intubation and then at 1,2,3,4,5 and 10 min time intervals compared to placebo group. No significant side effects were observed. Conclusion: Use of dexemedetomidine 10 min before laryngoscopy was associated with significantly less rise in pressor response compared to placebo group. Dexemedetomidine better attenuates the pressor response compared to clonidine but the difference was statistically insignificant. Keywords: Dexemedetomidine, Intubation, Laryngoscopy, Pressor response.

Reliability and safety have always been the main focus while developing safety critical systems (SCS). In this article, we have conducted a rigorous study and discussions with experienced practitioners worldwide the strategy for the development of SCS to investigate the several aspects related to reliability and safety analysis for SCS. We discussed with 21 practitioners from ten different organizations with the intention of knowing their approach they use day-to-day for the development of such systems. The aim of this research is to obtain an in-depth understanding of how reliability and safety engineering are carried out in the industries that develop SCS.

Climate and environmental change are critical factors affecting water resources, irrigation and farming systems in Ethiopia as most of the population and the country’s economy depend on agriculture...

Parthenium weed (Parthenium hysterophorus L.) is an invasive alien plant species that is spreading rapidly all over the world. With globalization and climate change, it will continue to spread, posing threats to agriculture, biodiversity and the environment. To determine its invasion and impacts in Bhutan, an investigation was undertaken in West-Central Bhutan using a questionnaire survey, complemented by MaxEnt modelling. Most farmers (19–30%) recall having seen parthenium for the last 11–15 years, or more. Infestations of parthenium differed significantly (P

Introduction: Medullary thyroid carcinoma is an uncommon primary thyroid tumour (5-10% of all thyroid malignancies) arising from parafollicular cells or C-cells. Most tumours are sporadic (75-80%) and familial syndrome multiple endocrine neoplasia; MEN-2A, MEN-2B and familial MTC in 20 to 25% cases. Case Report: We report a case of primary medullary thyroid carcinoma in a 30 years old male patient presented with complaint of midline neck swelling. On fine needle aspiration cytology diagnosis of medullary carcinoma was suggested with a differential of SETTLE (spindle epithelial tumor with thymus like differentiation). The swelling was excised and send for histopathological examination which revealed polygonal to plump spindle shaped tumor cells, arranged in lobules separated by fibrous septa, having abundant eosinophilic granular cytoplasm with round to oval nuclei, finely stippled nuclear chromatin and indistinct nucleoli and diagnosed as primary medullary thyroid carcinoma, confirmed on immunohistochemistry. Conclusion: MTC is the first human malignancy known to be associated with tumour marker and hormone calcitonin. Immunohistochemistry has definite role in confirmation of diagnosis. Keywords: Amyloid, Medullary carcinoma, Procalcitonin, Synaptophysin.

Intra-abdominal hypertension (IAH) is a known but neglected complication in acute pancreatitis. The present study was conducted to establish the role of intra-abdominal pressure (IAP) as a prognostic marker in patients with acute pancreatitis and also to correlate IAP with APACHE II and SOFA scores. A prospective observational single-center cohort study was conducted on adult patients diagnosed with acute pancreatitis. Intra-abdominal pressure was measured through a transurethral Foley’s bladder catheter. APACHE II and SOFA scores were calculated at the time of admission (day 1). APACHE II score was reevaluated on day 3 and 5. SOFA score was reevaluated everyday till day 5. APACHE II score, SOFA score, and IAP at admission were significantly higher among non survivors when compared to survivors. There was significant correlation of IAP with APACHE II and SOFA scores. APACHE II and SOFA scores at cut-off values of 12 and 6 predicted IAP of > 12 (mm of Hg) with reasonable sensitivity and specificity. IAP could be used as a reliable negative prognostic marker in acute pancreatitis. APACHE II and SOFA scores could be used to predict intra-abdominal hypertension in patients of acute pancreatitis.

Modified Radical Mastectomy (MRM) is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection.We hypothesized that instillation of 0.25% bupivacaine and 0.2% ropivacaine through chest and axillary drains into the wound may provide postoperative analgesia, even better than infiltration along the line of incision. In this prospective randomized controlled study 68 patients aged more than 18 years were divided into four groups. All patients were administered general anesthesia. At the end of the procedure, axillary and chest drains were placed before closure. Group C was the control group with no instillation, group B received 40 ml 0.25% bupivacaine, group R received 40 ml 0.2% ropivacaine and group S received 40 ml normal saline (20ml through each drain) and the drains were clamped for 10 mins. After extubation, pain score was evaluated using Visual Analogue Scale (VAS) at rest, cough and overhead abduction of the arm at 0,1,2,3,4,8,12 and 24 hours. Rescue analgesia was injection tramadol, given if the pain score ≥ 3. Statistical analysis was performed using SPSS version 21. There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (p Wound instillation with local anesthetics is a simple and effective means of providing good analgesia without any major side effects.

Human metapneumovirus (hMPV) is an enveloped virus that causes serious respiratory tract infection among immunocompromised populations especially haematopoietic stem cell transplant (HSCT) recipients. Here, we describe 3 cases of hMPV infection which led to mortality among post HSCT adults. 66 post HSCT adults enrolled between January 2017 and March 2019 at Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi, were followed up for a period varying from 16 days to 18 months for any episode of respiratory illness until March 2019. Real time reverse transcriptase polymerase chain reaction (rRT-PCR) was used to detect the virus from appropriate specimens when symptoms of acute respiratory infection appeared. Samples from 88 out of a total of 172 episodes of suspected acute respiratory infection could be tested by rRT-PCR. Of these, 9 episodes were positive for hMPV. Three patients with hMPV associated lower respiratory tract infection (LRTI) expired within 30 days of HSCT. The possible risk factors associated with mortality included LRTI, infection during early post-transplant period (first week following HSCT), absolute lymphocyte count less than 200/µl, absolute neutrophil count less than 500/µl, use of steroid within 30 days prior to infection and need for mechanical ventilation.

Precise identification of Plasmodium species is critical in malaria control and elimination. Despite several shortcomings, microscopy and rapid diagnostic test (RDT) continue to be the leading diagnostic methods. Polymerase chain reaction (PCR) is the most sensitive method but its dependency on advanced laboratory and skilled workers limits its use. Here, we compared the diagnostic performance of microscopy, RDT, and PCR in clinically suspected patients from a high malaria burden state (Odisha) of India. The diagnostic performance (sensitivity, specificity, positive predictive value, and negative predictive value) of all three methods was compared using microscopy and PCR as the gold standard. PCR identified 323 (76.5 %) positive cases out of 422 samples, whereas microscopy and RDT identified only 272 (64.4 %) and 266 (63.0 %) positive cases, respectively. The sensitivity of RDT and microscopy for detecting malaria and P. falciparum cases was >80% compared to that by PCR. However, the sensitivity in identifying P. vivax (57.0 %) and a mixture of P. falciparum and P. vivax (18.0 %) was poor. We highlight application of PCR in malaria diagnosis and its benefits in reducing the transmission. This emphasizes the need for incorporation of molecular diagnostic approaches for effective elimination strategies.

Purpose: Trauma is the leading cause of mortality in people below the age of 45 years. Abdominal trauma constitutes one-fourth of the trauma burden. Scoring systems in trauma are necessary for grading the severity of the injury and prior mobilization of resources in anticipation. The aim of this study was to evaluate RTS, ISS, CASS and TRISS scoring systems in blunt trauma abdomen. Materials and methods: A prospective single-center study was conducted on 43 patients of blunt trauma abdomen. Revised trauma score (RTS), Injury Severity Score (ISS), Clinical Abdominal Scoring System (CASS) and Trauma and Injury Severity Score (TRISS) were calculated and compared with the outcomes such as need for surgical intervention, post-operative complications and mortality. Results: The majority of the study subjects were males (83.7%). The most common etiology for blunt trauma abdomen as per this study was road traffic accident (72.1%). Spleen was the most commonly injured organ as per the study. CASS and TRISS were significant in predicting the need for operative intervention. Only ISS significantly predicted post-operative complications. All scores except CASS significantly predicted mortality. Conclusions: Among the scoring systems studied CASS and TRISS predicted the need for operative intervention with good accuracy. For the prediction of post-operative complications, only the ISS score showed statistical significance. ISS, RTS and TRISS predicted mortality with good accuracy but the superiority of one score over the other couldn’t be proved.

Background: An association between lichen planus and systemic disorders such as diabetes mellitus, dyslipidemia and metabolic syndrome has been reported. Aim: To assess the clinico-epidemiological profile of lichen planus, evaluate prevalence of underlying metabolic complications and compare the clinical profile of patients with and without metabolic syndrome. Material and methods: All the patients with lichen planus attending dermatology out patient department of a tertiary care centre in South Rajasthan over a period of one year were studied. Patients with lichenoid drug eruptions and those receiving systemic treatment for lichen planus were excluded from the study. Statistical analysis was done using the chi – square test. A p value < 0.05 was considered significant. Results: A total of 270 patients of lichen planus were enrolled. Male to female ratio was found to be 0.76: 1. Maximum (64; 23.7%) patients belonged to the age group of 31 – 40 years. Classical morphology was the most common (128; 47.4%) cutaneous pattern. Mucosal and nail involvement was seen in 80 (29.6%) and 87 (32.2%) patients respectively. Koebner phenomenon was present in 57 (21.1%) patients. The investigations were completed by 175 (64.8%) patients. Diabetes mellitus and hypertension were found in 12.6% (22/175) and 14.3% (25/175) patients respectively. The diagnostic criteria for dyslipidemia and metabolic syndrome were fulfilled by 39.4% (69/175) and 27.4% (48/175) patients respectively. Majority (81.2%) of the patients with metabolic syndrome belonged to age group 40 years and above, and oral and nail involvement was found to be more common in them. It is recommended that these patients should be screened for complications like diabetes, hypertension, dyslipidemia and metabolic syndrome. Conclusion: Significant numbers of lichen planus patients were found to have dyslipidemia and metabolic syndrome. Patients aged 40 years and above, with oral and nail involvement have higher propensity to be associated with metabolic syndrome and therefore such patients should be screened for metabolic complications. Timely screening and early intervention may reduce the risk of related morbidity and mortality. Limitations: Lack of control group is the drawback of our study. Age and sex matched comparative studies are required for confirmation of the results.

As surface of tibia is subcutaneous along most of its length and its vascular supply of tibia is perilous compared to any other bone surrounded by heavy muscles? These type of fracture are often associated with compartment syndrome or neuro-vascular injuries. As there is existence of hinge joint at the knee and the ankle that permits no adjustment for rotational deformity after fracture, distinctive care is being required during reduction of these type of fractures to correct such deformity. The problems associated with fixation of distal tibia fractures include local and deep infections, local implant irritation, knee pain, stiffness of ankle, transient peroneal nerve palsy, malalignment and subsequent malunion and non-unionThis study deals with the ability to maintain a mechanically stable reduction in extraarticular distal one third tibia fractures managed with intramedullary nailing.Materials and Methods: This was a hospital based prospective study on the outcome in 20 patients of extra articular distal one-third tibia fractures, who will be admitted in the Department of Orthopaedics of Muzaffarnagar Medical College, Muzaffarnagar over a period of 18 months.Results: Mean age of patients was 39.05 years (18-80). Fracture union was seen radiologically within 3 to 6 months depending upon the pattern of fracture.Conclusion: We conclude that fractures of extraarticular distal one-third tibia with or without associated fractures of fibula managed with closed intramedullary nailing had least number of complications, allows early partial weight bearing and 95% of the patients achieved union by the end of 6 months. Thorough planning and placement of the nail at the center of a wide metaphysis in anteroposterior and lateral view is essential to overcome varus, valgus and posterior tilt.

BACKGROUND AND AIM: Chronic Hepatitis B (CHB) is a global health problem affecting around 400 million of people worldwide. Two available first-line antiviral drugs are tenofovir disoproxil fumarate (TDF) and Entecavir (ETV). Till date,there are few published reports from India comparing efficacy of TDF and ETV in CHB cases. Therefore, this present study was carried out with an aim to compare the efficacy of ETV and TDF in patients with nucleos(t)ide naïve CHB. MATERIALS AND METHODS: This retrospective cohort study was carried out in 192 treatment naïve CHB cases, who completed 24 months of treatment with either TDF or ETV between March 2015 and August 2017. The primary end point of the study was undetectable hepatitis B virus DNA after 24 months of therapy. RESULTS: Of total 192 patients with CHB, 38 hepatitis B e-antigen (HBeAg)–positive and 53 HBeAg-negative patients were treated with tenofovir, whereas 40 HBeAg-positive and 61 HBeAg-negative patients were treated with ETV. Pretreatment characteristics at baseline were not statistically different between the TDF and ETV groups. Patients treated with TDF achieved significantly higher complete viral suppression as compared with ETV-treated patients (Log rank: 7.04, P = 0.008) in HBeAg-positive CHB during the 24 months follow-up time; whereas no significant difference in viral suppression rate could be noticed in HBeAg-negative patients (Log rank: 0.98, P = 0.38). Both univariate and multivariate analysis by cox proportional hazard model confirmed that tenofovir had significant rate of complete viral suppression in comparison with ETV in HBeAg-positive patients (P < 0.05); whereas complete viral suppression rates were similar in HBeAg-negative patients. CONCLUSION: In our study, tenofovir had more effective antiviral suppressive effect compared with ETV in HBeAg-positive, nucleos(t)ide-naïve CHB cases.

Background: Before the approval of first-line immune checkpoint inhibitors, platinum doublets were the standard of care in patients with treatment-naïve advanced non-small cell lung cancer (NSCLC) without targetable driver mutations. Pemetrexed-platinum combinations are preferred in non-squamous NSCLC. However, there has been no direct comparison to paclitaxel-carboplatin. Methods: This open-label randomized trial was designed to compare pemetrexed-carboplatin with (weekly) paclitaxel-carboplatin in treatment-naïve advanced/metastatic non-squamous NSCLC without driver mutations. Patients received either pemetrexed 500 mg/m2 and carboplatin AUC 5 every 3 weeks, or paclitaxel 80 mg/m2 on day 1, day 8, and day 15 with carboplatin AUC 5 every 4 weeks for 4 cycles. Patients in both arms were allowed to receive pemetrexed maintenance. Results: A total of 180 patients were enrolled. The study was terminated early; however, at the time of analysis 75.8% of the required events had occurred. Finally, 164 patients were evaluable, 83 in the pemetrexed arm and 81 in the paclitaxel arm. After a median follow-up of 17 months, progression-free survival (PFS) rates at 6 months were not different in the two treatment arms (47.45 vs. 48.64%, p = 0.88). The median PFS values were 5.67 months (95% CI 3.73–7.3) and 5.03 months (95% CI 2.63–7.43) in each arm, respectively (HR 1.13, 95% CI 0.81–1.59, p = 0.44). The median overall survival was also not different: 14.83 months (95% CI 9.5–18.73) and 11.3 (95% CI 8.3–19.7; HR 1.19, 95% CI 0.8–1.78, p = 0.37). All grade toxicities were similar except for alopecia and peripheral neuropathy, which were higher in the paclitaxel arm. Conclusion: Pemetrexed-carboplatin is not superior to (weekly) paclitaxel-carboplatin as the first-line regimen in advanced non-squamous NSCLC in terms of PFS.

Nowadays, the industry uses 3D Scanners for reverse engineering, new product design, rapid manufacturing, multimedia, architecture, inspection, and quality control. The scanning process converts a real object into a digital format. This paper's essential purpose is to show the use of a 3D blue light Scanner/COMET 3D to redesign a carburetor body. The paper identifies different issues involved in the processes to help future users. COMET 3D does scanning of the carburetor body by which COLIN 3D software is used for measurements, editing, and analyzing of the acquired point clouds data. This paper also identifies the necessary steps to undertake 3D Scanning and part dimensioning for a carburetor body. It also discusses the error/problems that occurred during the process. The applications of non-contact blue light 3D Scanners are many as they can be innovatively used to redesign an existing part, architecture designing, and reducing production cycle time, biomedical and associated applications. This paper's contribution lies in achieving a step-by-step procedure of scanning any three-dimensional object as this helps in understanding the 3D scanning hardware and support software. It provides good knowledge of how to resolve the issues that can cause an error during the measurement of the surfaces and scan objects.

E-commerce is a market to deal on product and services with the help of internet. Many business get affected even online shopping in this pandemic period of COVID-19. To recover from the impact of COVID-19 on the business operation E-commerce giant; Flipkart is buckling down and working hard. This exploration research adopt the strategy towards getting its finding. This study is restricted to the NCR region (National Capital Region) only. This research help to measure this impact of COVID-19 on the business operations.

Introduction: Spinal anesthesia induced hypotension frequently complicates Cesarean delivery. This is usually due to sudden sympatholysis causing decreased venous return which can be aggravated by physiological changes of pregnancy leading to change in baseline peripheral vascular tone. Strategies to prevent hypotensive episodes should be the primary aim of anesthetic management. A simple noninvasive measurement of perfusion index derived from pulse oximeter predicting hypotension during the routine intraoperative course could provide a new dynamism to the management and improving the safe execution of anesthesia. Objectives: The primary objective of this study was to compare incidence of hypotension following SAB for LSCS in patients with baseline PI ≤ 3.5 to those with PI > 3.5. The secondary objectives were to compare PI, HR, SBP, MAP at various time intervals and also to study the side effects between the two groups. Methodology: This prospective observational study was conducted at Nobel Medical College Teaching Hospital from to July 2019 to October 2019. 73 Term parturients presenting for elective cesarean delivery were included for the study. Upon arrival in the operation room, standard monitors were attached and baseline HR, SBP, DBP, MAP, PI and SPO2 were recorded in supine position. The patients with baseline PI ≤ 3.5 were enrolled into Group I and those with a PI > 3.5 were enrolled into Group II. Spinal Anesthesia with 10mg of 0.5% heavy Bupivacaine and 20mcg Fentanyl ( total 2.4ml) was given at L3-L4 interspace in sitting position using midline approach. Patient was then returned to supine position with left lateral tilt of 15 degrees to facilitate left uterine displacement. Upper sensory level was checked at 5 minutes using alcohol swab. Once T-6 level was reached, surgery was started. Maternal SBP, DBP, MAP, HR and PI were recorded at 1 minute intervals between spinal injection and delivery and then 3 minutes until end of surgery. Clinically relevant hypotension was defined as the decrease in MAP by 20% or more from baseline value. Results: The incidence of hypotension in Group I was 18.8% (6/30) compared to 81.3% (26/38). This was clinically and statistically highly significant (P = 0.000, odds ratio 0.11). On Spearman’s rank correlation we found highly significant correlation between baseline PI >3.5 and number of episodes of hypotension (rs 0.482, P = 0.000). The sensitivity and specificity of baseline PI with cut-off 3.5 for predicting hypotension were 81.3% and 66.7% respectively. The ROC curve analysis showed 3.53 as appropriate cut‑off for our findings. The area under the ROC curve (AUC) was 0.734 [Figure 6](Lower bound 0.608 and upper bound 0.861, P=0.001). Conclusion : This study demonstrates that baseline PI of > 3.5 correlates with incidence of hypotension after spinal anesthesia for cesarean delivery in healthy parturients compared to a baseline PI of < 3.5.

Introduction: To avoid adverse effects of general anaesthesia, regional anaesthesia (RA) techniques are increasingly being practiced in children for different surgeries. These RA techniques are often combined with moderate degree of sedation to remain child calm and immobile. With limited literature available, we planned a prospective study to evaluate the effectiveness of dexemedetomidine as an intraoperative sedative agent with RA considering its short term sedation and least respiratory depression property. Materials and Methods: Fifty children of 1-8 year of age, ASA grade 1&2 undergoing below umbilical surgery under RA (caudal epidural anaesthesia) were selected and studied. After giving Inj. Ketamine (1mg/kg) intravenously, RA was performed with Inj. Bupivacaine. Then inj. Dexemedetomidine (1mcg/kg) IV was administered as bolus over 10 min followed by continuous infusion (0.4 mcg/kg/hr) till completion of surgery. Perioperative sedation score, vital parameters, peripheral oxygen saturation, respiratory rate and surgeon's satisfaction were observed. The Study was considered complete till stay of patient in PACU for 2hrs. Recovery time and any complications were noted. Results: The quality of sedation and surgeon's satisfaction were good in all children except three children who needed extra dose of sedative. The only adverse effects reported were bradycardia and hypotension in 3 patients which were well managed by reducing the infusion rate. Conclusion: Dexemedetomidine offers an adequate level of sedation in most of the children without haemodynamic or respiratory side effects when used intraoperatively with RA. Keywords: Dexemedetomidine, Ketamine, Regional anaesthesia, Caudal epidural anaesthesia.

Introduction and Object: Fentanyl and clonidine mostly used as adjuvant to improve quality and duration of nerve block. In present study we compared clonidine and fentanyl perineurally and systemically in Supraclavicular Brachial plexus block. Materials and Methods: Sixty eight patients were randomly assigned into four equal groups, scheduled for upper limb surgery. They received the drugs in Supraclavicular block and intravenous route as below: Group A: 24 ml 0.75% ropivacaine + 1 ml fentanyl (50µg/ml) + 5ml normal saline in block and 1ml normal saline intravenously. Group B: 24 ml 0.75% ropivacaine + 6ml normal saline in block, and 1ml fentanyl (50µg /ml) intravenously. Group C: 24 ml 0.75% ropivacaine + 1ml clonidine (150µg/ml) + 5ml normal saline in block, and 1ml normal saline intravenously. Group D: 24ml 0.75% ropivacaine +6ml normal saline in block, and 1ml clonidine (150µg/ml) intravenously. Results: Onset of sensory and motor block was significantly earlier in Group C (12.47±2.57 min & 18.00±3.46 min) than in Group A (14.65±3.41 min & 19.94±2.61 min) respectively (p0.05) between Group A (7.41±0.94hrs) and Group B (7.35±0.93hrs) while it was prolonged in Group C (8.94±0.97 hrs) than Group D (8.12±1.22 hrs) (p Conclusion: Fentanyl perineurally or systemically administered have comparable results while perineural clonidine offered prolonged duration of analgesia better than when it was used intravenously suggesting its local action. Keywords: Supraclavicular Block, Ropivacaine, Clonidine, Fentanyl.

Introduction: The pressor response during laryngoscopy and intubation is part of a huge spectrum of stress response, results from the increase in sympathetic and sympatho-adrenal activity. The present study was planned to observe the attenuation of pressor response during laryngoscopy and intubation with dexmedetomidine and fentanyl; also to compare the effectiveness between these two drugs. Materials and Methods: In this study we include 128 patients, of ASA grade I- II, aged 18- 65yrs, of either gender, scheduled for elective surgery under general anaesthesia. Groups: Group D – Dexmedetomidine (0.6µg/kg) and Group F – Fentanyl (2µg/kg), these drugs diluted with NS to make 10 ml, given I.V. slow over 10 min. Vital parameters (HR, SBP, DBP and MBP) were recorded as baseline, then at 10 minutes after pre-medication and then at 1,2,3,5,7 and 10 minutes after endotracheal intubation. Results: There was significant increase in heart rate, systolic blood pressure and diastolic blood pressure during laryngoscopy and intubation in group F as compared to group D (p Conclusion: Dexmedetomidine (0.6mcg/kg) is superior to fentanyl (2mcg/kg) in the attenuation of the pressor response and that the ideal time for its administration should be about 10 minutes before a laryngoscopy and intubation. Keywords: Dexmedetomidine, Fentanyl, Intubation, Laryngoscopy, Pressor response.

Introduction: Tracheoesophageal fistula (TEF) is one of the common congenital anomalies presented at birth. Management of TEF is a challenging task as outcome of these cases not only depends on surgeon and anaesthesiologist’s skills but also depends on various factors associated with new born. This prospective study evaluates the association of various factors on survival of TEF patients. Materials and Methods: 16 newborn patients in a calendar year were enrolled in this prospective study and impact of various factors like age, weight, parity of mother, associated congenital anomalies and family history, mode of delivery, place of delivery, associated hydramnios and type of TEF were evaluated on the survival of neonates born with TEF. Results: Male, female ratio was equal. Patient with birth weight >2.5 kg had higher survival rate (100%) compared to patient Conclusion: Birth weight remains the single most important predictor of mortality among TEF patients, as suggested with Waterston risk classification. Keywords: Tracheoesophageal fistula, Birth weight, Neonates, Waterston classification.

Introduction: The major responsibility of the anesthesiologist is to provide adequate ventilation to the patient because airway related problems are still the most common cause of anaesthesia related morbidity and mortality. The use of I-gel has been reported in laparoscopic surgeries and was found equally effective ventilatory device as PLMA. Therefore, we planned this study to compare I-gel and PLMA with ET tube in patients undergoing laparoscopic cholecystectomy. Materials and Methods: This prospective study was conducted on 90 patients of both sex, 18-60 years age, ASA grade I-II, scheduled for elective laproscopic surgery under general anaesthesia. All patients were randomised into three groups of 30 patients each; Group I (I-gel), Group P (PLMA), Group E (ET Tube). Attempts of insertion of devices, effective airway time and easiness of gastric tube; hemodynamic parameters (HR, MAP, SpO2 and EtCO2) were recorded. Results: There was significantly less 2nd attempt required in I-gel group(10%) as compared with ET tube (36.7%) and PLMA (13.3%),(p=0.019). Laryngopharyngeal morbidity were significantly more in Group E as compared to Group P and I (p

Background: Diabetic foot ulcer is an intractable complication of diabetes, characterized by the disturbed inflammatory and proliferative phases of wound healing. Sesamol, a phenolic compound, has been known for its powerful antioxidant, anti-inflammatory, antihyperglycaemic and wound healing properties. The aim of the present study was to develop a sesamol nano formulation and to study its effect on the various phases of the wound healing process in diabetic foot condition.Methods: Sesamol-PLGA (SM-PLGA) nanosuspension was developed using nanoprecipitation method. TEM, in vitro drug release assay and in vivo pharmacokinetic studies were performed for the optimised formulation. Diabetic foot ulcer (DFU) in high fat diet (HFD)-fed streptozotocin-induced type-II diabetic animal model was used to assess the SM- PLGA nanosuspension efficacy. SM-PLGA nanosuspension was administered by oral route. TNF-α levels were estimated using ELISA and Western blot analysis was performed to assess the effect on the expression of HSP-27, ERK, PDGF-B and VEGF in wound tissue. Wound reepithelization,fibroblast migration, collagen deposition and inflammatory cell infiltration were assessed by H&E and Masson’s trichrome staining. Effect on angiogenesis was assessed by CD-31 IHC staining in wound sections.Results: The optimized SM-PLGA nanosuspension had an average particle size of

Female urethral defects are rare, congenital defects being more uncommon than acquired, and difficult to manage. Most female urethral defects are associated with incontinence or acute urinary retention. There is a lack of standard protocol-based management of female urethral defects because of limited experience. In this study, we describe our results of using anterior or posterior bladder wall flaps in the management of a variety of female urethral defects. We reviewed the case records of 22 patients who had undergone either anterior or posterior bladder wall-based flap procedures for complex urethral defects at our institute. Patients were assessed by taking a comprehensive history including aetiological factors and details of prior surgical intervention, thorough physical and pelvic examination, cysto-urethroscopy and relevant imaging. These factors, along with availability and status of tissue available for reconstruction affected the selection of procedure for reconstruction. Out of 22 patients, anterior and posterior bladder flaps were used in 16 and 6 patients respectively. A total of 18 patients became socially dry and 15 achieved complete continence after removal of the catheter and were voiding satisfactorily, whereas the remaining 4 patients had incontinence postoperatively. An additional 3 out of 18 patients had minimal stress incontinence requiring conservative treatment and 2 patients developed voiding difficulty requiring self-calibration. Female urethral defects with bladder neck involvement are complex and challenging to manage. Bladder wall-based flaps offer a good chance of successful repair of these complex urethral defects.

Introduction: Dexmedetomidine has an ideal pharmacodynamic profile for attenuation of stress response during general anesthesia for laparoscopic cholecystectomy. Since, the value of dexmedetomidine as a single premedication dose remains largely unexplored, this study compared dexmedetomidine in 0.5μg/kg and 1μg/kg dose for laparoscopic cholecystectomy under general anesthesia. Objectives: The primary objective of this study was to compare dexmedetomidine in a single premedication dose of 0.5μg/kg and 1μg/kg in terms of hemodynamic (heart rate and mean arterial pressure) changes to critical incidences such as laryngoscopy, endotracheal intubation, pneumoperitoneum and extubation. The secondary objectives were to compare induction dose of propofol required, sedation scores in the immediate post anesthesia period and adverse events such as bradycardia and hypotension. Methodology: This was a prospective double blind study. Ninety-two patients aged 18-55 years of either gender of American Society of Anesthesiologists physical status I-II were randomly allocated into two groups to receive either Dexmedetomidine 1μg/kg or 0.5μg/kg slowly IV over 10 minutes as a premedication before induction. Heart rate, Mean arterial pressure, induction dose of propofol, sedation scores, and adverse events were compared. Results: The patient characteristics, Fentanyl consumption, duration of surgery and anesthesia in both groups were comparable. There was comparable attenuation of hemodynamics in both groups during laryngoscopy and intubation. Dexmedetomidine in 1μg/kg compared to 0.5μg/kg had significantly better attenuation of hemodynamics from 1 minute to 40 minutes of pneumoperitoneum. After 40 minutes, there was no attenuation in either group. The post anesthesia sedation scores were comparable. The induction dose of propofol was significantly less and the incidence of bradycardia was significantly higher with dexmedetomidine 1μg/kg. Conclusion This study demonstrates that a premedication dose of Dexmedetomidine in 1μg/kg compared to 0.5μg/kg has significantly betier attenuation of hemodynamics from 1 minute to 40 minutes of pneumoperitoneum.

Introduction: Stroke is life threatening & debilitating neurological disease, defined as focal neurological deficit of sudden onset lasting >24 hours & vascular in origin. Significant association between ischemic type of stroke with carotid artery disease seen, more prevalent with carotid artery stenosis. Objectives: This study was done to show association between extracranial carotid artery disease & cerebrovascular accidents (CVAs) with the help of Color Doppler Sonography (CDS). The association between carotid artery disease with associated risk factors were also assessed. Methodology: In this ethically approved prospective study, carotid CDS was done in 79 consecutive patients with diagnosis of acute ischemic stroke (AIS). The various parameters studied included peak systolic velocity (PSV) of internal carotid artery (ICA) & common carotid artery (CCA), ICA/CCA PSV ratio & plaque characteristics. The data collected was analyzed with appropriate statistical test of significance was calculated. Results: Total 79 patients with AIS included out of which 53 were males & 26 were females. The most common presenting complains were hemiparesis (30.4%) & most commonly associated risk factors included hypertension (62.02%). Right sided strokes were most common (44.3%) & middle cerebral artery was most commonly involved vascular territory. Significant stenosis (≥50%) of carotid artery was seen in 27 patients with ICA most common site (45.8%) for plaque formation. Bilateral carotid artery involvement (52.1%) with hypoechoic echotexture of atheromatous plaques (46.6%) was most responsible for significant stenosis & increased intima media thickness. Increased value of PSV & EDV was seen in the stenotic area in the proportion of stenosis with increased PSV ICA/CCA ratio of more than three indicates >60% stenosis. Conclusion: The present study showed well documented role of carotid doppler in detection of site & extent of carotid artery stenosis due to atheromatous plaques of various characteristics playing critical role in thromboembolic phenomenon responsible for development of stroke.

CD123 is overexpressed in many hematologic malignancies and found to be useful in characterizing leukemic blasts of both acute myeloid leukemia (AML) and B-acute lymphoblastic leukemia (B-ALL). CD123 has been recently found to be a marker of leukemic stem cells, and its utility to measure residual disease and potential role in disease relapse is under evaluation.Herein, we have evaluated the expression of CD123 in 757 samples of acute leukemia including 479 treatment-naive and 278 follow-up samples and compared with post-induction morphologic complete remission and measurable residual disease (MRD) status. Multiparametric flow cytometry was used for assessment of CD123 expression and immunophenotypic characterization of leukemic blasts at diagnostic and MRD assessment time points.Using variable cutoffs of 5%, 10%, and 20% to define a case as CD123-positive, expression of CD123 was observed in 75.6%, 66.2%, and 50% of AML and 88.6%, 81.8%, and 75% of B-ALL, respectively. Of 11 patients, 7 (63.63%) had mixed phenotype acute leukemia, but none of the 12 patients with T-acute lymphoblastic leukemia showed positivity for CD123. CD123 expression at diagnosis was associated with post-induction MRD-positive status in both B-ALL (P .001) and AML (P = .001). We also evaluated the utility of CD123 as a leukemia-associated aberrant immunophenotype and found it to be useful in both patients with AML (baseline, 50.6%; follow-up, 53%) and B-ALL (baseline, 75%; follow-up, 73.07%).In conclusion, CD123 may be considered as a cardinal marker for residual disease assessment and response evaluation in AML and B-ALL.

Software refactoring is a commonly accepted means of improving the software quality without affecting its observable behaviour. It has gained significant attention from both academia and software industry. Therefore, numerous approaches have been proposed to automate refactoring that consider software quality maximization as their prime objective. However, this objective is not enough to generate good and efficient refactoring sequences as refactoring also involves several other uncertainties related to smell severity, history of applied refactoring activities and class severity. To address these concerns, we propose a multi-objective optimization technique to generate refactoring solutions that maximize the (1) software quality, (2) use of smell severity and (3) consistency with class importance. To this end, we provide a brief review on multi-objective search-based software refactoring and use a multi-objective spotted hyena optimizer (MOSHO) to obtain the best compromise between these three objectives. The proposed approach is evaluated on five open source datasets and its performance is compared with five different well-known state-of-the-art meta-heuristic and non-meta-heuristic approaches. The experimental results exhibit that the refactoring solutions provided by MOSHO are significantly better than other algorithms when class importance and code smell severity scores are used.

Introduction: Cutaneous leishmaniasis (CL) is a vector-borne protozoal infection of the skin with variable clinical manifestations. In Rajasthan, western Thar desert is endemic for this disease. Aim: The present study was aimed to describe clinico-epidemiological features of cutaneous leishmaniasis cases from a non-endemic area of South Rajasthan. Materials and Methods: A hospital-based prospective study was carried out during a period of 3 years (2017-2019). Data regarding clinical profile and treatment outcome were recorded in a predesigned proforma for analysis. Diagnosis of CL was made clinically and confirmed by demonstration of amastigotes in microscopic examination of Giemsa stained tissue smear of lesions. Results: Out of 24 patients, 16 (67%) were females and 8 (33%) were males. The age ranged from 3 months to 68 years (median-25). Face (67%) and extremities (29%) were the common sites affected. The most common morphological form was crusted plaques (54%) followed by nodular lesions (38%). Slit skin smear for Leishmania donovani bodies was positive in all patients (100%). Conclusion: This study highlights a focus of CL in non-endemic areas of South Rajasthan. Of late leishmaniasis is breaking out of its classical boundaries and is increasingly being reported from new geographic locations with a possibility of a novel parasite variant. Therefore, a high clinical suspicion of CL should be kept in non-endemic area.