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Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-U.S. institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection.

This article investigates the stock market reaction to appointments of newly created chief digital or data officer (CDO) positions. The analysis is based on a sample of 112 CDO appointment announcements by publicly traded companies listed in the US stock market from 2004 to 2017. We ground our arguments in signaling theory along with the institutional entrepreneurship and synergy and redundancy perspective to understand the factors that could influence the market reaction to CDO appointments. Although the results show that the stock market reacts neutrally to announcements of newly created CDO positions, the market does react positively under certain conditions. The market reacts positively when appointing firms exhibit high growth prospects. The article supports the redundancy perspective, and the results show that the market reacts positively when a potentially conflicting and overlapping role such as chief information officer (CIO) is absent in appointing firms. Our analysis also shows that when CIO is absent, the market reacts more positively to outsider CDO relative to insider CDO, thereby indicating the interaction between redundancy and institutional entrepreneurship perspectives.

BACKGROUND AND OBJECTIVES: Cholangiocarcinoma is a highly aggressive and heterogenous group of biliary malignancies arising from any site in the biliary tree, comprising 15% of all primary liver cancers. The nature of the disease and nonspecific presentation leads to late diagnosis and ultimately poor outcomes for patients. Combination gemcitabine and cisplatin has been the standard of care for cholangiocarcinoma (CCA) since 2010, with a median overall survival of 11.7 months. The five-year survival for CCA remains 5–10%, revealing a clear need for improved treatment options. METHODS: This targeted review highlights the role of next generation sequencing in CCA and the clinically relevant tumor biomarkers that have become the focus of therapeutic development. KEY CONTENT AND FINDINGS: These tumor biomarkers or actionable mutations hold the potential to enable earlier diagnosis, provide prognostic information, and guide treatment decisions for patients with CCA. Specifically, the FGFR2 fusion and IDH1 mutation have shown considerable promise in development of targeted therapies. Clinical trials with inhibitors targeting FGFR2 fusion and IDH1 mutation have created expectations that these drugs will soon enter clinical practice. Other biomarkers including KRAS and B-raf protooncogenes, Her2/neu genes, and BRCA1 and 2 tumor-suppressor genes have also been touted as potential targets for future therapies, with early data showing promise for new drug development. CONCLUSION: The discovery of these actionable mutations and identification of targeted therapies have challenged the notion of a “one-size fits all” for treatment of CCA, and generated optimism that these novel treatments will soon be available for patients with CCA.

BACKGROUND: Saroglitazar is a novel, dual peroxisome proliferator-activated receptors-α/γ agonist and is being investigated for the treatment of nonalcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS: Consecutive overweight (body mass index [BMI] >23 kg/m(2)) patients of NAFLD, diagnosed based on controlled attenuation parameter (CAP) >248 dB/m, and attending the outpatient department of a tertiary care centre in New Delhi, were enrolled. Patients with cirrhosis (liver stiffness measurement [LSM] >13.5 kPa) and those with concomitant liver disease due to other aetiologies (alcohol, viral, etc.) were excluded. All patients received saroglitazar 4 mg/day; in addition, they were advised to reduce weight and were counselled regarding diet and exercise. At 3-month follow-up, patients were categorized into those who were able to reduce ≥5% body weight and those who could n’ot, and both these groups were compared. RESULTS: A total of 91 patients (median age 45 years [range 18–66 years]; 81% men) were included in the study. The median BMI was 29.3 kg/m(2) (range 23.6–42.2 kg/m(2)). The baseline median (range) aspartate transaminase, alanine transaminase, gamma glutamyl transferase, LSM and CAP values were 40 IU/dL (range 22–144 IU/dL), 48 IU/dL (range 13–164 IU/dL), 42 IU/dL (range 4–171 IU/dL), 6.7 kPa (range 3.6–13.1 kPa), and 308 dB/m (range 249–400 dB/m). All patients tolerated saroglitazar well. At 3-month, 57 patients (63%) were able to reduce ≥5% weight, whereas in the remaining 34 patients (37%), the weight reduction was

Enlargement of the sinus of Valsalva (SOV) is common in patients with bicuspid aortic valves (BAVs), and management at the time of aortic valve replacement (AVR) and concomitant ascending aorta replacement/repair is controversial.Between January 2000 and July 2017, 400 patients with BAVs underwent AVR and concomitant ascending aorta repair (graft replacement, 79%; aortoplasty, 21%). To assess the impact of the initial SOV dimension on future dilatation and outcomes, patients were stratified into 2 groups: SOV of less than 40 mm (SOV40 mm) (n = 209) and SOV of 40 mm or larger (SOV≥40 mm) (n = 191).Patients with SOV≥40 mm were older and more often male. At a median follow-up of 8.1 years (interquartile range, 7.4-9.1 years), 6 patients underwent reoperations on the ascending or sinus portion of the aorta due to aneurysmal dilatation, and enlargement of the sinus was the primary indication for operation in 1 patient. Adjusted analysis showed that baseline SOV and SOV dimension over time were not associated with late outcomes. A gradual increase in SOV diameter over time was identified (P = .004). Patients with smaller baseline SOV diameters showed an initial early decrease in diameter, followed by gradual increase, whereas those with larger baseline diameters had a stable early phase, followed by gradual dilatation.Ascending aorta replacement may lead to an initial remodeling/stabilizing effect on the spared bicuspid aortic root, which is more pronounced in patients with lower SOV diameters. In addition, our data demonstrate that the retained aortic sinuses enlarge slowly, and within the limited follow-up of our study, SOV diameter was not a risk factor for survival or reoperation.

AIM: Aim of this cross sectional study was to compare the bite force and the individual tooth load among three groups of patients: cases finished with the Self ligation appliance (Damon-Q®, 0.022”X0.028” prescription) cases finished with the MBT (McLaughlin, Bennett and Trevisi) appliance system (0.022”X0.028”prescription) and orthodontically untreated cases using T-Scan® 9.0 version. MATERIAL & METHODS: A sample size of sixty non-extraction cases were divided equally into three groups – Group 1: patients treated with Self-ligation appliance (Damon Q®), Group 2: cases treated with the MBT prescription and Group 3: untreated subjects with Class I canine and molar relationship who were used as the control group. The bite force and distribution of force was measured on the right and left side as well as individual tooth loads were measured using the T-Scan® 9.0 device and inter-and intra-group comparisons made using Paired t-Test, ANOVA and Chi-square test. RESULT: The bite forces were balanced on both the sides in cases treated with Self-ligation and MBT appliance. The Self-ligation finishes were marginally better than the MBT group but the difference was statistically insignificant. CONCLUSION: Orthodontically treated individuals had a better (or more even) bite force distribution compared to untreated participants.

Poly-vinyl chloride (PVC) is one of the most demandable, usable commonly used thermoplastic polymer. Lots of research work related to PVC polymer has been highlighted in the past work due to its better mechanical strength such as elongation, flexibility and dimensional accuracy. In the past few years, it has been trying to add some properties which helps PVC polymer are easily used in the 3D printing technology. In the present study main highlight is to make accurate dimension of feedstock filament using twin-screw extruder (TSE). In this research work an effort has been made to fabricate PVC based feedstock filament which helps 3D printing are to be performed with easy flexibility. In this research work graphite fine powder has been reinforced in PVC thermoplastic extrusion using TSE process. Variation of graphite fine powder is varied from 5% to 15% with the gap of 5. For this research work, Taguchi L9 (3^3) orthogonal array has been used for fabrication of 3D printer feedstock filaments. Process capability analysis has been performed on fabricated feed stock filament for commercially fabrications. In this research work dimensional accuracy has been determined.

Nanotechnology is the most well-known research area in the field of since the last century. The dimensions which are presented with less than 100 nm with one dimension are called nanoparticles (NPS). Depending upon their shape and size NPS can be one dimensional (1D), 2D, 3D or 0D. In the past century, researchers have found that size and shape have affected the different properties as like; chemical, physical, structural properties. For measuring the size and shape of NPS normally scanning electron microscope (SEM) has been used. In some cases, transmission electron microscopy (TEM) is also used for observing their shape and size. In this review paper, it has been analysed and observed that the properties, synthesis and applications of NPS in 3D printing applications. Normally NPS are present in different size ranges, so as per requirement different sizes of nanoparticles are to be used in different applications. In this paper, we also discuss that different types of NPS according to different categories. Their properties are mainly depending on their shape, size and structure. This review paper applications of NPS in the different area has been also discussed. Biomedical, aerospace and the aeronautical area is the most demanding sector of NPS. This review paper, it has been also discussing the use of NPS in additive manufacturing (AM) due to most emerging field in the current century.

Multi-organ segmentation in computed tomography (CT) images is essential for a variety of clinical applications. Due to variations in acquisition protocols, clinical data differ in terms of soft tissue contrast, noise, and artifacts. Devising automatic multi-organ segmentation approaches, which are generalized to data acquired using different CT protocols, are challenging and essential when conducting any multi-center/scanner analyses. In this study, we investigate the use of dual-energy CT images to train a fully convolutional segmentation network which is generalized to CT images acquired using different protocols (i.e. at different energy levels and using a variety of reconstruction kernels) from different CT scanners. Furthermore, a novel image fusion approach in frequency domain is proposed and compared to state-of-the-art fusion approaches, in terms of the segmentation quality achieved by the network. Overall, the experiments indicate that the generalization capability of the segmentation network is improved using dual-energy CT image fusion. The proposed fusion method outperforms all single-energy CT approaches. It provided a significant improvement in segmentation accuracy, ranging from 16.0% to 23.35% with p≤0.03. Furthermore, two image fusion methods statistically significantly improve segmentation quality in the abdominal organs compared to simply using all available dual-energy CT data.

This paper presents a new reconfigurable complex multi-band delta sigma polar modulator (CMB-DSPM) architecture for multi-band transmission. In this paper, a 6th order band-pass delta sigma modulator (DSM) is designed and implemented for reconfigurable triple-band transmission. The proposed DSM architecture utilizes the advantage of a complex DSM structure to reduce the required processing block and polar quantizer to reduce the quantization noise. The proposed CMB-DSPM architecture improves the in-band and out-of-band performance in terms of signal-to-noise distortion ratio (SNDR) and coding efficiency (CE), respectively. The proposed scheme is validated in MATLAB/Simulink-based digital signal processing platform using three 5 MHz long-term evolution (LTE) signals. The results show up to 12.4 dB improvement in SNDR and 12.3% improvement in CE compared to the standard cartesian DSM architecture. The measured EVM is below 3%, which shows the good in-band performance of the proposed scheme.

BACKGROUND: Artificial intelligence is a relatively newer technology in the field of medical world. This science uses the machine – learning algorithm and computer software to aid in the diagnostics in medical and dental fields. It is a huge talking point in the field of technology which is spreading it’s wings in all possible sectors at a great speed. This field covers solutions from coaching solutions to diagnostics in medical field covering under the umbrella of all what can be achieved by machine and deep learning. CONTENT: In dentistry, artificial intelligence is creating a revolution in all sections from collection of data, creating algorithms for orthodontic procedures, diagnostic records in the aspect of radiographic data, three dimensional scans and cone beam computed tomography, CAD CAM systems for restorative and prosthetic purposes. Similarly continuous research is being done in the field of periodontics in terms of measuring bone loss, amount of plaque present and much more. CONCLUSION: The field of artificial technology with its varied applications will change the face of dentistry in the upcoming times. Artificial intelligence with its application of machine learning will change the face of dentistry in future.

Introduction Obesity has been considered as one of the independent risk factors for a severe form of coronavirus disease-2019 (COVID-19) and relationship between obesity, critical illness, and infection is still poorly understood. We herein discuss clinical course and outcome of critically ill obese patients with COVID-19 admitted to critical care unit. Materials and methods We retrospectively analyzed data of critically ill obese patients hospitalized with COVID-19 over a span of 6 months. Management was guided according to the institutional protocol. Collected data included demographic parameters (age, sex, comorbidities, and body mass index (BMI)), complications, inflammatory markers (interleukin (IL)-6, Ferritin), length of mechanical ventilation, length of intensive care unit (ICU) stay, and inhospital death. Results There was no appreciable difference in terms of demographics, inflammatory markers, predictors of mortality scores, and comorbidity indices between the survivors and nonsurvivors. Among outcome analysis, there was a statistically significant difference between ventilator days between survivors and nonsurvivors (p = 0.003**). Conclusion Obesity itself is a significant risk factor for severe COVID-19 infection; however, if efficiently managed and in a protocol-determined manner, it can have a favorable outcome. How to cite this article Kaur M, Aggarwal R, Ganesh V, Kumar R, Patel N, Ayub A, et al. Clinical Course and Outcome of Critically Ill Obese Patients with COVID-19 Admitted in Intensive Care Unit of a Single Center: Our Experience and Review. Indian J Crit Care Med 2021;25(12):1382–1386.

Objectives of the study The objectives of the study were to assess the mortality among critically ill coronavirus disease (COVID) patients and to look at the factors which could have a bearing on mortality of these patients presenting to our designated tertiary COVID care institute. Method This was a retrospective observational study involving all adult patients admitted to our intensive care unit (ICU) with coronavirus disease-2019 (COVID-19) infection between June 30, 2020, and August 31, 2020. We compared patient-related factors and laboratory test results among all survivors vs nonsurvivors in our ICU with an aim to predict the factors which could predict increased risks of mortality among sick patients admitted to our ICU. Results and conclusion The overall ICU mortality in our ICU during the study period was 76.69% and less than 5% of the patients requiring mechanical ventilation within 1 day of admission, survived. More than half of the deaths (54.66%) occurred within 5 days of ICU admission. The best predictors for mortality based upon the Cox proportional hazard ratio are increasing age, neutrophilia, increased D-dimer, prolonged stay in ICU for 1–2 weeks, and those requiring mechanical ventilation. Patients with one or more comorbidities were noted to have 16% of higher risk of death than those without any comorbidity. How to cite this article Rai DK, Sahay N, Lohani P. Clinical Characteristics and Treatment Outcomes of 293 COVID-19 Patients Admitted to the Intensive Care Unit of a Tertiary Care Hospital of Eastern India. Indian J Crit Care Med 2021;25(12):1395–1401.

Face mask usage is one of the most effective ways to limit SARS-CoV-2 transmission, but a mask is only useful if user compliance is high. Through anonymous surveys (n = 679), it was shown that mask discomfort is the primary source of noncompliance in mask wearing. Further, through these surveys, three critical predicting variables that dictate mask comfort were identified: air resistance, water vapor permeability, and face temperature change. To validate these predicting variables in a physiological context, experiments (n = 9) were performed to measure the respiratory rate and change in face temperature while wearing different types of three commonly used masks. Finally, using values of these predicting variables from experiments and the literature, and surveys asking users to rate the comfort of various masks, three machine learning algorithms were trained and tested to generate overall comfort scores for those masks. Although all three models performed with an accuracy of approximately 70%, the multiple linear regression model provides a simple analytical expression to predict the comfort scores for common face masks provided the input predicting variables. As face mask usage is crucial during the COVID-19 pandemic, the goal of this quantitative framework to predict mask comfort is hoped to improve user experience and prevent discomfort-induced noncompliance.

BACKGROUND & AIMS Fungal infections (FIs) have serious implications, yet understated in cirrhosis. Therefore, we reviewed the epidemiology and trends of FIs among cirrhotics. METHODS Four electronic-databases were searched for full-text articles describing prevalence of FIs in cirrhosis. Studies from post-transplant, malignancy and classical-immuno-deficiency patients were excluded. A random-effects meta-analysis was done to pool estimates of FIs (overall, and by type and infection-site), and their variation(I2 ) was explored on moderator-analysis and meta-regression. Risk of bias and asymmetry in estimates was assessed by a checklist and Eggers-regression, respectively.(CRD42019142782) RESULTS: Thirty-four low-risk and four moderate-risk studies (31984 cirrhotics) were included. Pooled-estimates of overall-FIs (17 studies), invasive fungal infections (IFIs; 17 studies), invasive-candidiasis (23 studies), and invasive-aspergillosis (16 studies) in cirrhosis were 10.2%(6.0-16.9), 9.5%(5.4-16.2), 4.0%(2.0-8.0) and 2.8%(1.5-5.3); respectively (I2 >90%;each). Site of FIs in decreasing order of pooled-prevalence was pulmonary, urinary-tract, bloodstream, peritoneal, esophageal, and cerebral. Geographic differences in these estimates were remarkable, with highest burden of overall-FIs from Belgium, USA, and India. Non-albicans-Candida and Aspergillus infections have increased over the last-decade in cirrhosis. Intensive-care-unit (ICU)-admitted and acute-on-chronic liver failure (ACLF) patients had the highest prevalence of IFIs. MELD-score(cases), bias-score, and sample size across studies were the predictors of variance in overall-FI-estimates. Diabetes, steroid and broad-spectrum antibiotic-exposure, and multiple organ failures were the common predispositions reported in patients with FIs. CONCLUSIONS FIs impose a substantial burden in cirrhosis. ACLF and ICU-admission should be considered as a host factor for defining IFIs. Epidemiology of FIs can guide interpretation of biomarkers and antifungal treatment in cirrhosis.

Cancer is one of the leading causes of death worldwide. As the cancer burden continues to increase globally, it exerts tremendous physical, emotional, and financial strain on individuals, families, communities, and health care systems. Cancer can affect any part of the body and is characterized by its uncontrollable growth. Numerous treatments, such as radiation therapy and chemotherapy which utilize various drugs, are currently in use; however, their harmful side effects and the development of drug resistance have resulted in major roadblocks when treating cancer. With advancements in synthetic and polymer chemistry, the use of nanoparticle-based drug delivery systems and chemotherapeutic macromolecules have garnered increasing attention in the previous decade. This review discusses the recent advancements in the use of nanoparticle-based drug delivery systems as well as the development of synthetic biodegradable polypeptides and polymers for cancer treatment (both in vivo and in vitro). Additionally, we outline the potent selectivity and efficacy for immunotherapies and bacteria-based therapies that are used to treat various cancers.

Objectives To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. Methods Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. Results Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho‐oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. Conclusion Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post‐treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.

In recent years, the use of drones has drastically increased as the evolution of drone use in commercial sectors and reduced costs of the hardware. Earlier drone services were mostly used for military operations but nowadays the Unmanned Arial Vehicles (UAV) system is very advanced and its applications are not limited to military operations. The recent years have also witnessed a network evolution of UAVs from single ground to air network to multi-UAV network systems along with usage of wireless public networks like LTE which can act as UAV communication channel. In the proposed project, a communication system used in the UAS system is simulated to analyze the UAV behavior under different conditions with respect to mission planning and the communication networks used. A comprehensive study is done on communication networks used in controlling UAVs. For a safer approach, the proposed model is simulated using available software instead of hardware implementations. ArduPilot SITL, MAVProxy and Mission Planner are used to simulate the UAV system virtually. Whereas network simulations of Wi-Fi and LTE network are done with the help of NS-3 on a separate platform. Various network parameters like network delay, throughput, etc., are graphically represented.

Background: People's adherence to control measures is imperative in the fight against COVID-19. The present study was done to evaluate knowledge, attitudes, and practices towards COVID-19 among residents of Jharkhand and to assist the government in deciding further course of action during the COVID-19 outbreak. Methods: This study was an online cross-sectional survey. The link to the questionnaire was displayed on the official website of Rajendra Institute of Medical Sciences, Ranchi, National Health Mission, Jharkhand, official website of all districts under Jharkhand state administration, Integrated Disease Surveillance Programme and Information & Public Relations department. Participation of residents in the survey was extensively propagated using mass media mainly local television networks, radio channels and newspapers. Results: A total of 4683 responses were received from all districts of Jharkhand. The majority of the participants were young adults (47.5%) and the number of male participants was more than the females (81.4%). The mean correct knowledge score for participants of this study was 10.73+2.2 (maximum attainable score was 14) while the mean practice score for the participants was 4.5+0.69 (maximum attainable score was 5). The knowledge score of the participants was significantly associated with their age, education status and economic class (p

Introduction: World Health Organization (WHO) in 2014 recommended delayed cord clamping (DCC) in all babies who cry immediately after birth. Despite many benefits, there are concerns of increased rate of phototherapy in babies receiving DCC. This study was done to determine the increment in the rate of phototherapy required in infants managed with DCC vs infants managed with early cord clamping (ECC). Methods: A retrospective observational study was conducted in a tertiary care hospital in Pune, India. All the infants born between January 2018 and July 2018, for whom ECC was done, were compared with infants who were born between January 2019 and July 2019, after DCC policy was adopted. All the infants with birth weight ≥2 kg and gestation ≥35 weeks, who were with their mother, were included. Baseline characteristics were compared for both the groups. American Academy of Pediatrics guidelines for treatment of neonatal jaundice were used to determine the need for phototherapy. Number of infants in both the groups who required phototherapy were compared. Results: The ECC group had 565 infants while DCC group had 731 infants. There was no difference in the baseline characteristics of the 2 groups. Jaundice requiring phototherapy was noted in 31% of infants in the ECC group, compared to 45% in infants in the DCC group (relative risk: 1.47 [1.27-1.71] [ P < .001]). Conclusion: In this study, DCC increased the need for phototherapy by 47% in late preterm and term infants. Randomized control trials with larger sample size are required to confirm this finding.

Reactive Oxygen Species are chemically unstable molecules generated during aerobic respiration, especially in the electron transport chain. ROS are involved in various biological functions; any imbalance in their standard level results in severe damage, for instance, oxidative damage, inflammation in a cellular system, and cancer. Oxidative damage activates signaling pathways, which result in cell proliferation, oncogenesis, and metastasis. Since the last few decades, mesenchymal stromal cells have been explored as therapeutic agents against various pathologies, such as cardiovascular diseases, acute and chronic kidney disease, neurodegenerative diseases, macular degeneration, and biliary diseases. Recently, the research community has begun developing several anti-tumor drugs, but these therapeutic drugs are ineffective. In this present review, we would like to emphasize MSCs-based targeted therapy against pathologies induced by ROS as cells possess regenerative potential, immunomodulation, and migratory capacity. We have also focused on how MSCs can be used as next-generation drugs with no side effects.

Internet of Things (IoT)- based services connect the user with sensing devices through intermediary devices like a gateway. The authentication with secure key exchange assures security trio of confidentiality, integrity, and availability for the complete IoT-based system. It also ensures trusted privacy of communicated information. Recently, numerous authors proposed a Remote User Authentication scheme (RUA) on User-Gateway based secure key exchange for the tiny and lightweight sensor based paradigms such as an IoT and a wireless sensor network (WSN) using lightweight mathematical approaches. In this article, we propose a reliable and efficient lightweight key exchange scheme with the secure RUA for the user-gateway model. For designing a lightweight RUA scheme, we use elliptic curve cryptography (ECC). We use BAN-Logic for the validation of mutual authentication. We use widely accepted random oracle-based ROR model for formal security analysis and Dolev-Yao channel for informal security analysis. For the implementation and result collection of the proposed scheme, we used publisher-subscriber-based lightweight Message Queuing Telemetry Transport (MQTT) protocol. Overall, in this article, we propose a highly secure and efficient RUA scheme for the sensor-based environment with the formal security analysis and real-time implementation.

Background: Percutaneous Transhepatic Biliary Drainage (PTBD) is a minimally invasive procedure to palliate the biliary obstruction caused by unresectable malignancy. Aims and Objective: To analyze the outcome of PTBD in patients of unresectable gall bladder cancer presenting with obstructive jaundice in terms of reduction in serum bilirubin levels, symptomatic improvement, and overall survival (OS) at 4 weeks and 12 weeks following the procedure. Materials and Methods: In this retrospective study, PTBD was attempted on 30 patients diagnosed with inoperable gall bladder cancer. Various patient and procedure-related variables were analyzed and recorded both pre and post-PTBD. Outcome data on OS was collected at 4 weeks and 12 weeks. Results: Technical success was achieved in 29 (99.66%) patients. The mean fall in the serum bilirubin at the 7th post-procedural day was 41.5% after the successful PTBD. The most common complication in our study was cholangitis noted in six (21%) patients. OS at 4 weeks and 12 weeks was 79% and 41%, respectively. Conclusion: Younger age and good performance status favored better survival rate in our study.

In India just about 2% of people have access to palliative care and a vast majority of the palliative care services are located in the state of Kerala (Khosla et al., 2012). Conditions in other sta...

INTRODUCTION His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) have emerged as attractive alternatives to traditional biventricular pacing to achieve cardiac resynchronization therapy. Early reported results have been inconsistent, particularly amongst patients in whom initial placement with traditional approaches has been unsuccessful or those with complex anatomy or congenital abnormalities. In this report, we describe the use of three-dimensional electroanatomic mapping (EAM) in five selected cases. METHODS Five patients from multiple clinical sites underwent EAM-guided HBP or LBBAP by highly trained electrophysiologists with significant experience with conduction system pacing. Each patient in this series underwent EAM-guided conduction system pacing due to complex anatomy and/or prior failed lead implantation. RESULTS EAM-guided lead implantation was successful in all five cases. Capture thresholds were relatively low and patients continued to have evidence of successful lead implantation with minimum 1-month follow-up. The fluoroscopy time varied, likely owing to the variable complexity of the cases. CONCLUSIONS The use of EAM, in combination with traditional intracardiac electrograms with or without fluoroscopy, allows more targeted and precise placement of leads for HBP and LBBAP pacing. Further investigation is needed to determine this strategy's long-term performance and to optimize patient selection.

This paper presents a whole system model framework that enables a holistic prediction of accumulated track damage in railway turnouts. A modular approach allows for insight into the interaction of different damage mechanisms such as rail profile change due to the plastic deformation and wear as well as track settlement. The methodology focuses on the two most critical areas of the turnout in terms of damage: switch and crossing panels. It is shown that at the beginning of the service life of the turnout the running surface of the rails in these areas change significantly due to plastic deformation, which in turn increases the dynamic impact forces from passing vehicles. These impact forces cause vertical track settlement that is most pronounced in the crossing area. Track settlement introduces additional dynamics into the system leading to self-reinforcing behaviour. It is shown that the proposed methodology can predict accumulated track damage accounting for the coupling between different damage modes such as track settlement, rail profiles plastic deformation and wear. It can therefore be used for holistic assessment of turnouts e.g. in design optimisation studies.

Background The hallmark of lipoblastoma is a PLAG1 fusion. PLAG1 protein overexpression has been reported in sporadic PLAG1-rearranged lipoblastomas. Methods We evaluated the utility of PLAG1 immunohistochemical staining (IHC) in 34 pediatric lipomatous tumors, correlating the results with histology and conventional cytogenetics, FISH and/or next generation sequencing (NGS) results. Results The study included 24 lipoblastomas, divided into 2 groups designated as “Lipoblastoma 1” with both lipoblastoma histology and PLAG1 rearrangement (n = 16) and “Lipoblastoma 2” with lipoblastoma histology but without PLAG1 cytogenetic rearrangement (n = 8), and 10 lipomas with neither lipoblastoma histology nor a PLAG1 rearrangement. Using the presence of a fusion as the “gold standard” for diagnosing lipoblastoma (Lipoblastoma 1), the sensitivity of PLAG1 IHC was 94%. Using histologic features alone (Lipoblastoma 1 + 2), the sensitivity was 96%. Specificity, as defined by the ability to distinguish lipoma from lipoblastoma, was 100%, as there were no false positives in the lipoma group. Conclusions Cytogenetics/molecular testing is expensive and may not be ideal for detecting PLAG1 fusions because PLAG1 fusions are often cytogenetically cryptic and NGS panels may not include all partner genes. PLAG1 IHC is an inexpensive surrogate marker of PLAG1 fusions and may be useful in distinguishing lipoblastomas from lipomas.

Lip and oral cavity squamous cell carcinoma (SCC) develop from progressive dysplasia of these mucosal structures. The cancers are often preceded by premalignant lesions, and any nonhealing ulcers of the lip or oral cavity should be biopsied. Some risk factors for these 2 subsites overlap and include tobacco use, alcohol use, and an immunocompromised state. Lip and oral cavity SCC are clinically staged based on physical examination and imaging. The 5-year overall survival for early-stage lip and oral cavity SCC is around 70% to 90% but decreases to about 50% for late-stage disease.

Introduction: One of the most common fractures is a forearm fracture. The most common causes of these fractures include high-energy incidents, direct trauma, and falls from great heights. It's not unusual to have open wounds with a neurovascular impairment. Supination of the forearm with a backward and upward loading force with a forward angulation while falling on an outstretched hand is comparatively a less severe mechanism than pronation and upward force. Direct impact which is referred to as ‘Nightstick injury’ also lead to shaft of ulna fracture. The goal of this study was to assess the results of closed fixation in radius ulna fractures with intramedullary nailing for a minimum of 6 months. Nailing with square nails, titanium elastic nails (TENS nails), or long Kirschner wire has proven to be extremely effective. Method: Over the course of one year, this is a retrospective case series investigation of forearm bone fractures and the treatment options available. We chose patients where intramedullary nailing was used as a therapy option and were followed for at least 6 months. Galeazzi variety, monteggia variety, pathological fracture, and non-union following previous surgery were all ruled out. Disabilities of the arm, shoulder, and hand (DASH) score and Grace and Eversmann functional outcome score were used to assess the results. Results: Of the 25 patients, 14 patients had excellent functional outcome according to Grace and Eversmann score, 8 patients had good outcome, 4 patients had acceptable while 1 was unacceptable. The mean DASH score was 16.32. Conclusion: This study shows that closed method for fixation by intramedullary nailing of both bone forearm fractures leads to excellent to good functional outcomes (according to DASH score and Grace and Eversmann score) with less complications. In 6 months follow up x ray there is radiological union in all cases with no angulation, malunion or non-union.

Background and Aims: Newer supraglottic devices with an additional gastric channel offer greater protection from aspiration and avoidance of laryngoscopy for their insertion would result in attenuated hemodynamic responses.The primary objective was to assess hemodynamic responses to insertion of Baska mask as compared to tracheal intubation. The time and attempts taken to secure airway and evidence of regurgitation and pulmonary aspiration of gastric contents were also assessed. Material and Methods: This prospective, randomized study was conducted in 80 patients undergoing laparoscopic cholecystectomy. All patients received standardized anaesthesia protocol. Baska mask was used to secure airway in Group B, while tracheal intubation was done in group T. Methylene blue was injected through Ryle's tube into stomach in both groups. At end of surgery, fibreoptic bronchoscopy was performed to detect bluish staining of trachea and/or main bronchi as evidence of aspiration of gastric contents and bluish staining in oropharynx as evidence of regurgitation. Chi-square test and Independent sample t-test were applied. Results: The time taken to secure airway was significantly longer in Group B as compared to Group T (45.3 ± 12.6 vs. 24.3 ± 9.1 sec) Percentage of patients who had oropharyngeal blue stain was comparable in both groups. No patient in both groups had tracheal blue stain. Group T had significantly higher HR and MAP after intubation till 10 min later. Conclusion: Baska mask insertion was associated with attenuated hemodynamic responses, though more time and attempts were required for securing the airway. It could be considered as an alternative to tracheal intubation during laparoscopic surgeries.

Increasing prevalence of diabetes mellitus warrants recognition of factors related to asymmetric diabetic retinopathy (DR). This thematic synthesis based on an iterative literature review conducted in Medline and Google Scholar pertaining to diabetes with coexistent asymmetry of retinopathy included 45 original articles, 21 case reports and series, and 18 review articles from 1965 to 2020. Asymmetric DR is defined as proliferative DR (PDR) in one eye and nonproliferative, preproliferative, background, or no DR in the other eye lasting for at least 2 years. It is observed in 5%-10% of patients with PDR. Associated factors can be divided into (i) vascular: carotid obstructive disease, ocular ischemic syndrome, and retinal vascular diseases; (ii) Inflammatory: uveitis, endophthalmitis, and Fuchs' heterochromic cyclitis; (iii) degenerative: posterior vitreous detachment, high myopia and anisometropia, uveal coloboma, retinal detachment, retinitis pigmentosa, and chorioretinal atrophy and scarring; (iv) cataract surgery and vitrectomy; and (v) miscellaneous: elevated intraocular pressure, glaucoma, amblyopia, retinal detachment, and optic atrophy. The gamut of diagnostic modalities for asymmetric DR includes thorough ocular examination, slit-lamp biomicroscopy, fundus photography, fundus fluorescein angiography, optical coherence tomography, and newer modalities such as ultra-widefield fluorescein angiography and optical coherence tomography angiography, along with a complete systemic evaluation and carotid Doppler studies. The differential diagnosis includes other causes of retinal neovascularization that may present in an asymmetric manner, such as sickle cell retinopathy, retinal vein occlusions, and featureless retina. This review discusses in detail the aforementioned considerations and draws a comprehensive picture of asymmetric DR in order to sensitize ophthalmologists to this important condition.

Tuberculosis (TB) is a highly contagious airborne disease caused by Mycobacterium tuberculosis that primarily affects the lungs. TB is a significant and major public health emergency globally. According to the WHO Global Tuberculosis Report 2020, 10 million people developed TB disease in the year 2019. The main objective of the study was to assess the level of knowledge, attitude and practice in TB patients. The study also reveals the association between KAP and the demographics of the subjects. An observational study was employed to collect data from a total of 71 subjects. Both quantitative and qualitative statistical analysis were adopted. From the findings, the mean age of the study population was 45.5 ± 13.96 years. Over 15.50% of subjects appeared to have adequate knowledge, 87.33% of subjects had a fair attitude, and around 58% of subjects were reported to have good practices towards TB. A weak positive correlation between knowledge and attitude (p = 0.051), weak positive correlation between knowledge and practice (p = 0.138) whereas, a significant and moderately positive correlation between attitude and practice (p = 0.002) was observed. The mean knowledge scores of graduates and post-graduates were higher in comparison with other study subjects. The study findings showed that the majority of subjects had several misconceptions about TB and hence prioritized interventions and more awareness programs at the root levels are needed to aid TB control and eradication.

Nd YAG laser is preferred method to manage thickened posterior capsule because it is an easy, non-invasive and an OPD basis procedure considering the comfort of the patients.: The present study was carried out with objectives to evaluate the safety profile of Nd-YAG Laser Capsulotomy mainly in terms of rise in intraocular pressure (IOP) and other intra as well as post-operative complications.This prospective observational study was carried out with prior Institutional Ethics Committee (IEC) approval and written informed consent from the participants at Ophthalmology Outpatients Department (OPD) of a tertiary care teaching hospital of western India, for the duration of two years from Oct’2015 to Sept’2017. A detailed ocular, systemic, family history was taken of all the enrolled patients with pre- and post-procedure evaluation of IOP by Goldman’s Applanation Tonometry, Slit lamp examination and Fundus examination by direct and indirect ophthalmoscopy. Capsulotomy was done using VISULAS YAG III laser of Zeiss company.The data was entered and tabulated in Microsoft Excel 2007 and analyzed. Data was analyzed by frequency distribution. The ‘p’ value was determined to finally evaluate and P Acute transient rise of IOP up to 5mmHg or more (P value Nd-YAG laser capsulotomy is an easy, practical modality to treat posterior capsular opacities, but is not a completely innocuous procedure. Nd-YAG laser capsulotomy is an easy, practical modality to treat posterior capsular opacities, but is not a completely innocuous procedure. Due precautions should be taken in pre- and post-procedural stages including medications, thorough counselling, proper focusing and steady fixation of the patients to minimise the complication.

Despite awareness regarding financial toxicity in breast cancer care, little is known about the financial strain associated with breast reconstruction. This study aims to describe financial toxicity and identify factors independently associated with financial toxicity for women pursuing post-mastectomy breast reconstruction. A 33-item electronic survey was distributed to members of the Love Research Army. Women over 18 years of age and at least 1 year after post-mastectomy breast reconstruction were invited to participate. The primary outcome of interest was self-reported financial toxicity due to breast reconstruction, while secondary outcomes of interest were patient-reported out-of-pocket expenses and impact of financial toxicity on surgical decision making. In total, 922 women were included (mean age 58.6 years, standard deviation 10.3 years); 216 women (23.8%) reported financial toxicity from reconstruction. These women had significantly greater out-of-pocket medical expenses. When compared with women who did not experience financial toxicity, those who did were more likely to have debt due to reconstruction (50.9% vs. 3.2%, p

The prime facets for the control of grid integrated voltage source converters (VSC) during abnormal grid variations are the control of voltage as well as power quality. In this article, a unique control strategy is presented for the control of solar photovoltaic (PV) system interfaced to the grid utilizing an interweaved generalized integrator. A single-stage three-phase topology is considered. The primary purpose of control is to deliver the PV power to the grid even during various abnormal grid variations. During normal operation, the system delivers power at unity power factor. However, during variations in the grid voltage, the profile of the PCC voltage is maintained within prescribed limits by reactive power injection. Moreover, LVRT operation is undertaken during severe voltage sags. The utilization of the system is increased in the absence of PV generation during night, the VSC and dc link capacitor act as a distribution static compensator. Contrary to traditional control techniques, power quality of the system is not compromised. The achievements of the control are demonstrated through simulation as well as with hardware implementation. Furthermore, a comparative analysis, with the state-of-the-art techniques, is highlighted, which shows the efficacy of the presented control.

To quantify the urinary bladder wall T1 relaxation time (T1) before and after the instillation contrast mixture in rats previously subjected to water avoidance stress (WAS) and/or acute exposure to protamine sulfate (PS). Female Wistar rats were randomized to receive either sham (control) or 1 h of WAS for ten consecutive days before the evaluation of nocturnal urination pattern in metabolic cages. T1 mapping of urinary bladder wall at 9.4 T was performed pre- and post- instillation of 4 mM Gadobutrol in a mixture with 5 mM Ferumoxytol. Subsequently, either T1 mapping was repeated after brief intravesical PS exposure or the animals were sacrificed for histology and analyzing the mucosal levels of mRNA. Compared to the control group, WAS exposure decreased the single void urine volume and shortened the post-contrast T1 relaxation time of mucosa- used to compute relatively higher ingress of instilled Gadobutrol. Compromised permeability in WAS group was corroborated by the urothelial denudation, edema and ZO-1 downregulation. PS exposure doubled the baseline ingress of Gadobutrol in both groups. These findings confirm that psychological stress compromises the paracellular permeability of bladder mucosa and its non-invasive assay with MRI was validated by PS exposure.

Explicit knowledge of object center of mass or CM location fails to guide anticipatory scaling of digit forces necessary for dexterous manipulation. We previously showed that allowing young adults to choose where to grasp the object entailed an ability to use arbitrary color cues about object CM location to gradually minimize object tilt across several trials. This conditional learning was achieved through accurate anticipatory modulation of digit position using the color cues. However, it remains unknown how aging affects the ability to use explicit color cues about object CM location to modulate digit placement for dexterous manipulation. We instructed healthy older and young adults to learn a manipulation task using arbitrary color cues about object CM location. Subjects were required to exert clockwise, counterclockwise, or no torque on the object according to the color cue and lift the object while minimizing its tilt. Older adults produced larger torque error during conditional learning trials, resulting in a slower rate of learning than young adults. Importantly, older adults showed impaired anticipatory modulation of digit position when information of the CM location was available via explicit color cues. The older adults also did not modulate their digit forces to compensate for this impairment. Interestingly, however, anticipatory modulation of digit position was intact in the same individuals when information of object CM location was implicitly conveyed from trial-to-trial. We discuss our findings in relation to age-dependent changes in processes and neural network essential for learning dexterous manipulation using arbitrary color cue about object property.

Emerging evidence shows co‐infection with atypical bacteria in coronavirus disease 2019 (COVID‐19) patients. Respiratory illness caused by atypical bacteria such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila may show overlapping manifestations and imaging features with COVID‐19 causing clinical and laboratory diagnostic issues. We conducted a prospective study to identify co‐infections with SARS‐CoV‐2 and atypical bacteria in an Indian tertiary hospital. From June 2020 to January 2021, a total of 194 patients with laboratory‐confirmed COVID‐19 were also tested for atypical bacterial pathogens. For diagnosing M. pneumoniae, a real‐time polymerase chain reaction (PCR) assay and serology (IgM ELISA) were performed. C. pneumoniae diagnosis was made based on IgM serology. L. pneumophila diagnosis was based on PCR or urinary antigen testing. Clinical and epidemiological features of SARS‐CoV‐2 and atypical bacteria‐positive and ‐negative patient groups were compared. Of the 194 patients admitted with COVID‐19, 17 (8.8%) were also diagnosed with M. pneumoniae (n = 10) or C. pneumoniae infection (n = 7). Confusion, headache, and bilateral infiltrate were found more frequently in the SARS CoV‐2 and atypical bacteria co‐infection group. Patients in the M. pneumoniae or C. pneumoniae co‐infection group were more likely to develop ARDS, required ventilatory support, had a longer hospital length of stay, and higher fatality rate compared to patients with only SARS‐CoV‐2. Our report highlights co‐infection with bacteria causing atypical pneumonia should be considered in patients with SARS‐CoV‐2 depending on the clinical context. Timely identification of co‐existing pathogens can provide pathogen‐targeted treatment and prevent fatal outcomes of patients infected with SARS‐CoV‐2 during the current pandemic.

We report an ultra-sensitive broadband photodetector based on horizontally aligned titanium disulfide nanosheets (TNs). Firstly, TNs were synthesized using the chemical vapor transport (CVT) technique to develop the photodetector, and then as-prepared TNs were deposited horizontally aligned between the interdigitated electrodes (IDEs) using the dielectrophoresis (DEP) technique. The photodetection performance of the as-prepared photodetector was analysed by illuminating the device with different wavelength low-power LED lights. The sensitivity of the as-developed photodetector has been studied for varying wavelength range (375 nm, 405 nm, 455 nm, 617 nm, 855 nm, 1050 nm) as well as for different power densities of individual incident lights. The as-developed photodetector shows high photoresponse for all mentioned wavelengths and shows a rapid response (10s) and recovery (10s) with ultra-high responsivity (1.174 × 104 AW−1), quantum efficiency (3.20 × 104 AW−1nm−1) as well as detectivity (3.039 × 1011 Jones) for 455 nm wavelength and 0.086 mW/mm2 power density of incident light. The ON/OFF ratio of the as-developed photodetector is found ultra-high i.e. 28.54. Its performance with respect to external bias voltage has also been studied and reported in the manuscript. The as-prepared TNs based photodetector shows many advantageous features like high stability and repeatability. The demonstrated ultra-sensitive photoresponse of as-prepared photodetector suggests the effectiveness of TNs for improving the characteristics of modern optoelectronic devices.

Background An early and accurate diagnosis of liver antibody-mediated rejection (AMR) followed by timely intervention is important for clinical management but remains challenging. The aim of this study was to assess the clinicopathologic characteristics and outcomes of late acute AMR in pediatric liver transplantation recipients. Methods We performed a retrospective review of 739 ABO-identical/compatible allograft liver biopsies from 199 pediatric transplantation recipients. Results Based on Banff 2016 AMR criteria, 3 recipients fulfilled the criteria for definite for late acute AMR, 2 met the criteria for suspicious for AMR, and 2 were indeterminate for AMR. We further assessed the clinicopathologic characteristics of these 7 patients. All 7 patients had at least 1 biopsy with a histopathologic pattern compatible with acute AMR. Additionally, we observed accompanied moderately to markedly dilated portal/central veins and endothelialitis disproportionate to the degree of bile duct injury in all 7 patients; periportal/perivenular hepatocyte necrosis was seen in 6/7 patients; and arteritis was seen in 3/7 patients. In each case, microvascular C4d deposition was present in at least 1 biopsy. Posttransplant donor specific anti-HLA antibodies were detected in 5 patients. Two of 7 patients were retransplanted, and 2 died after developing refractory AMR. The remaining 5 patients were alive with stable graft function at a median follow-up of 4.1 years. Conclusions Our data suggest that acute AMR in pediatric liver grafts is rare, can develop late, and may be associated with graft loss or patient death. The recurrent histopathologic findings of moderately to markedly dilated portal/central veins and endothelialitis disproportionate to the degree of bile duct injury are features that appear unique to pediatric acute AMR of liver grafts.

Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide synthase (NOS) inhibitor/uncoupler inducing vascular pathology. Vascular pathology is an important factor for the development and progression of CNS pathology of MS, yet the role of ADMA in MS remains elusive. Patients with multiple sclerosis (MS) are reported to have elevated blood levels of ADMA, and mice with experimental autoimmune encephalomyelitis (EAE, an animal model of MS) generated by auto‐immunization of myelin oligodendrocyte glycoprotein (MOG) and blood–brain barrier (BBB) disruption by pertussis toxin also had increased blood ADMA levels in parallel with induction of clinical disease. To explore the role of ADMA in EAE pathogenesis, EAE mice were treated with a daily dose of ADMA. It is of special interest that ADMA treatment enhanced the BBB disruption in EAE mice and exacerbated the clinical and CNS disease of EAE. ADMA treatment also induced the BBB disruption and EAE disease in MOG‐immunized mice even without pertussis toxin treatment, suggesting the role of ADMA in BBB dysfunction in EAE. T‐cell polarization studies also documented that ADMA treatment promotes T(H)1‐ and T(H)17‐mediated immune responses but without affecting Treg‐mediated immune response in EAE mice as well as in in vitro T‐cell culture. Taken together, these data, for the first time, document the vascular and immunopathogenic roles of ADMA in EAE, thus pointing to the potential of ADMA‐mediated mechanism as a new target of potential therapy for MS.

The quest to find the ideal prosthetic device interface that enables intuitive control has motivated several recent innovations. Although current prosthetic device control strategies have advanced the field of neuroprosthetic control, they are limited in their ability to generate reliable, stable, and specific signals to replicate the complex movements of the upper extremity. The regenerative peripheral nerve interface (RPNI) is a promising solution to enhance prosthetic device control. This article describes the development of RPNIs and summarizes its successful use in the control of advanced prosthetic devices in patients with upper extremity amputations.

To evaluate outcomes of elective surgical management of tricuspid regurgitation (TR) in patients with transvenous right ventricular leads, and compare results between non-lead-induced and lead-induced TR patients.We studied patients with right ventricular leads who underwent tricuspid valve surgery from January 1, 1993, through December 31, 2015, and categorized them as non-lead-induced and lead-induced TR. Propensity score (PS) for the tendency to have lead-induced TR was estimated from logistic regression and was used to adjust for group differences.From the initial cohort of 470 patients, 444 were included in PS-adjustment analyses (174 non-lead-induced TRs [123 repairs, 51 replacements], 270 lead-induced TRs [129 repairs, 141 replacements]). In PS-adjusted multivariable analysis, lead-induced TR was not associated with mortality (P=.73), but tricuspid valve replacement was (hazard ratio, 1.59; 95% CI, 1.13 to 2.25; P=.008). Five-year freedom from tricuspid valve re-intervention was 100% for non-lead-induced TR and 92.3% for lead-induced TR; rates adjusted for PS differed between groups (P=.005). There was significant improvement in TR postoperatively in each group (P.001). In patients having tricuspid valve repair, TR grades tended to worsen over time, but the difference in trends was not significantly different between groups.Lead-induced TR did not affect long-term survival after elective tricuspid valve surgery. In patients with lead-induced TR, tricuspid valve re-intervention was more common. Improvement in TR was achieved in both groups after surgery; however, severity of TR tended to increase over follow-up after tricuspid valve repair.

BACKGROUND The novel corona virus pandemic has a profound impact on health services throughout the world, which reflected the changing guidelines of different health societies in different time zones. We tried first to ensure the safety of our patients and surgical staff. Patient care priorities based on strict evidence-based management of a particular case and also COVID-19-adjusted governmentimposed restriction during the crisis. We aim to study postoperative complication after arthroplasty and readmission rate and compared the same with the prepandemic era. We also address our strategies, concerns, and regulatory barriers due to government-imposed lockdown, during initial surge of pandemic and also when restrictions were lifted. This study is unique in the way that there is no such study from Bihar, a state of developing country with scarcity of specialized health services. METHODS In this prospective study done in Indira Gandhi Institute Of Medical Sciences, Patna, Bihar between 1st December 2019 to 31st January 2021 (14 months duration). We have selected a subset of those patient who were admitted for primary arthroplasty of hip during the pandemic after lock down, and compared those with patient those underwent similar operative management before the lockdown period. RESULTS There was no significant difference in postoperative complication and readmission rate when compared with the pre-pandemic era. CONCLUSIONS There is no significant increase in risks of patient as well as operating surgeon before the pandemic and during the pandemic when the elective operative procedure (arthroplasty) was allowed. Communication, precautions, and proper preoperative planning remain essential part of management at each step of treatment. By following above mentioned standard operative procedure (SOP) chances of getting infection of COVID-19 is negligible from operative work. KEYWORDS COVID 19, SARS-CoV-2, Arthroplasty, Orthopaedics

The Coronavirus disease-2019 (COVID-19), has become a worldwide pandemic and the scientific communities are struggling to find out the ultimate treatment strategies against this lethal virus, Severe Acute Respiratory Syndrome Coronavirus–2 (SARS-CoV-2). Presently, there is no potential chemically proven antiviral therapy available in the market which can effectively combat the infection caused by this deadly virus. Few vaccines are already developed but it is not clear to the scientific community how much efficient they are to combat SARS-CoV-2. Mode of transmission and symptoms of the disease are two important factors in this regard. Rapid diagnosis of the COVID-19 is very much important to stop its spreading. In this scenario, a complete study starting from symptoms of the disease to vaccine development including various SARS-CoV-2 detection techniques is very much required. In this review article, we have made a partial analysis on the origin, virology, global health, detection techniques, replication pathways, doses, mode of actions of probable drugs, and vaccine development for SARS-CoV-2.