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PURPOSE Insertion mutations in Erb-b2 receptor tyrosine kinase 2 gene ( ERBB2 or HER2) exon 20 occur in 2%-5% of non–small-cell lung cancers (NSCLCs) and function as an oncogenic driver. Poziotinib, a tyrosine kinase inhibitor, was evaluated in previously treated patients with NSCLC with HER2 exon 20 insertions. METHODS ZENITH20, a multicenter, multicohort, open-label phase II study, evaluated poziotinib in patients with advanced or metastatic NSCLC. In cohort 2, patients received poziotinib (16 mg) once daily. The primary end point was objective response rate evaluated by independent review committee (RECIST v1.1); secondary outcome measures were disease control rate, duration of response, progression-free survival, and safety and tolerability. Quality of life was assessed. RESULTS Between October 2017 and March 2021, 90 patients with a median of two prior lines of therapy (range, 1-6) were treated. With a median follow-up of 9.0 months, objective response rate was 27.8% (95% CI, 18.9 to 38.2); 25 of 90 patients achieved a partial response. Disease control rate was 70.0% (95% CI, 59.4 to 79.2). Most patients (74%) had tumor reduction (median reduction 22%). Median progression-free survival was 5.5 months (95% CI, 3.9 to 5.8); median duration of response was 5.1 months (95% CI, 4.2 to 5.5). Clinical benefit was seen regardless of lines and types of prior therapy, presence of central nervous system metastasis, and types of HER2 mutations. Grade 3 or higher treatment-related adverse events included rash (48.9%), diarrhea (25.6%), and stomatitis (24.4%). Most patients had poziotinib dose reductions (76.7%), with median relative dose intensity of 71.5%. Permanent treatment discontinuation because of treatment-related adverse events occurred in 13.3% of patients. CONCLUSION Poziotinib demonstrates antitumor activity in previously treated patients with HER2 exon 20 insertion NSCLC.

INTRODUCTION: An ideal hernia repair should be tension free, tissue based, with no potential damage to vital structures, no long term pain or complications and no recurrence. Although Lichtenstein's prosthetic repair is simple and safe, but it is also correlated with risk of infections, recurrence, chronic pain, testicular atrophy and infertility, foreign body sensations and chronic groin sepsis. Desarda hernia repair does not require mesh and provide more physiological support. It is simple, easy to learn. AIMS AND OBJECTIVES: a) To compare the operative time, postoperative stay and time required to return normal activity between two groups. b) To compare early complication rate and late complication rate between two groups. MATERIALAND METHODS: This observational study was conducted among patients admitted with the diagnosis of primary inguinal hernia in SMIMER, Surat. The patients were randomly allocated to either Lichtenstein or Desarda method of hernia repair. Operating time, post operative stay and duration of return to normal activity were recorded. Early complications were noted and the patients were followed up to 12 months for late complications (chronic pain, foreign body sensation, and recurrence). RESULTS: The mean operative time and postoperative stay did not show signicant differ for both groups. Patients operated by Desarda technique returned to normal activity signicantly early by 12.2 ± 2.54 days as compared to patients operated by Lichtenstein techniques (14.0 ± 2.76 days, p = 0.01). Most common early complication in both groups was pain (D group; 40.0%, Lgroup: 45.2%) followed by wound infection (D group; 8.0%, Lgroup: 6.5%) and seroma (D group; 0.0%, Lgroup: 3.2%). Occurrence of chronic pain was more in Lgroup (58.1%) as compared to D group (16.0%, p=0.001). None of the patients from D group had foreign body sensation. Foreign body sensation was observed only in ve patients of Lgroup (16.1%). Recurrence rate during one year in Lgroup (6.5%) was higher than D group (4.0%). CONCLUSION: Early return to work was potential benet of Desarda repair. Early complications were similar in both procedures. Desarda repair has lower incidence of chronic pain and foreign body sensation. However, there is no signicant difference for chronic pain in Desarda group when compared in same patients operated bilaterally with different technique. This study was conducted with small sample size with short follow up. Therefore, result of late complication in the present study may insufcient to conclude the probability of occurrence as longer follow up and larger sample size is required.

A bipartite patella results from the failure of the ossification centres to unite, resulting in a fibrocartilaginous union between the bipartite fragment and patella body. Fibrocartilaginous interface is present between the accessory and main patella. A bipartite patella is usually an incidental finding and can be hard to distinguish from a patella fracture. Here, we present a case of bipartite patella in 16 year old male and its further management.

Background Patient navigation is a complex intervention that has garnered substantial interest and investment across Canada. We conducted an environmental scan to understand the landscape of patient navigation programs within the health care system in Alberta, Canada. Methods We included patient navigation programs within Alberta Health Services (AHS) and Alberta's Primary Care Networks (PCNs). Key informants were asked in October 2016 to identify existing programs and their corresponding program contacts. These program contacts were invited to complete a telephone-based survey from October 2016 to July 2017, to provide program descriptions and eligibility criteria, and to identify gaps in navigation. Programs were included if they engaged patients on an individual basis, and either facilitated continuity of care or promoted patient and family empowerment. We tabulated results and calculated summary statistics for program characteristics. Results Ninety-five potentially eligible programs were identified by key informants. The response rate to the study survey was 73% (n = 69). After excluding programs not meeting inclusion criteria, we included a total of 58 programs in the study: 43 AHS programs and 15 PCN programs. Nearly all programs (93%, n = 54) delivered navigation via an individual acting as a navigator. A minority of programs also included nonnavigator components, such as Web-based resources (7%, n = 4) and process or structural changes to facilitate navigation (22%, n = 13). Certain patient subgroups were particularly well-served by patient navigation; these included patients with cancer, substance use disorders or mental health concerns, and pediatric patients. Gaps identified in navigation fell under 4 domains: awareness, resources, geographic distribution and integration. Interpretation Patient navigation programs are common and have extended beyond cancer care, from which the construct originated; however, gaps include a lack of awareness and inequitable access to the programs. These findings will be of interest to those developing and implementing patient navigation interventions in Alberta and other jurisdictions.

In this paper, we propose a detailed approach to create a Bone age assessment model. Bone age assessment is a common medical practice in the assessment of child development, who are less than 18 years of age. In this proposed model, the Xception architecture is being used for transfer learning. Using feature extraction and transfer learning, the pre-trained convolutional neural network were custom trained. The dataset used for training the model is obtained from the Kaggle RNSA Bone Age dataset containing 12811 male and female bone images of different age groups. Finally, we were able to attain a mean absolute error (MAE) of 8.175 months in male and female patients, which aligns with our initial goal of achieving MAE in under a year.

The alkali-soluble cell wall polysaccharides (CWPs), extracted from Nelumbo nucifera rhizome flour (NNRF), were treated with microwave radiation to modify their physical characteristics, functional properties, and antioxidant potential. The NNRF was treated at different levels of microwave treatment time (1, 2, 3, 4 and 5 min) using the low-medium intensity (200 W). The cell wall was isolated and CWPs were extracted in 10% KOH solution followed by their physical, functional, and antioxidant characterization. Microwave treatment resulted in the morphological, structural and compositional modifications in CWPs that were directly correlated with their functional properties and antioxidant potential. A significant (p

Background: The purpose of the study was to assess the benefits of dual antithrombotic therapy in the management of peripheral arterial disease in Indian population. Methods: We conducted a prospective review of patients on dual antithrombotic therapy who underwent infra-inguinal endovascular revascularisation at JIVAS for 18 months. Objectives: To study the outcomes with aspirin + clopidogrel (CA) versus aspirin + rivaroxaban (RA) after infrainguinal endovascular revascularization for critical limb ischemia. The main objective was to assess primary patency of vessel after endovascular revascularization. The secondary objectives were to study limb salvage, major adverse limb events (MALEs), major adverse cardiac events (MACEs), bleeding events (major and minor), and wound healing. Results: In the present study, a total of 104 patients underwent infrainguinal revascularization and fulfilled the inclusion criteria, of which 48 received RA and 56 received CA. The mean age was 49.8 years with no significant differences in the baseline demographics and comorbidities between the two groups. The primary objective of vessel patency was assessed measuring the ankle brachial index which was 0.91 in the RA group and 0.96 in the CA group and remained the same on follow-up till 6 months and mean trans cutaneous oxygen pressure of around 34 in both the groups. There was no significant difference in the incidence of MALE (2.1% in RA vs. 7.1% in CA; P = 0.2), MACE (6.3% in RA vs. 10.7% in CA; P = 0.4), wound healing (81% RA vs. 75% CA; P = 0.4), safety parameter of bleeding (6.3% RA vs. 3.6% CA), creatinine, and liver function tests (LFT) during the study period. Conclusion: Both the antithrombotic regimens can be considered safe and efficacious in the postoperative management of patients undergoing infrainguinal revascularization; with maintenance of primary patency, comparable wound healing, incidence of MALE and MACE, and safe with no bleeding; and no impairment in the serum creatinine and LFTs during follow-up.

Introduction: The world has faced the pandemic of COVID-19 in the march of 2020 and still it continues to effect in 2021. Hence, in the present study we aim to evaluate the gulps in the research so that certain recommendations can be made for the future research. We conducted a scoping review of the COVID meta-analysis. Materials and Methods: Online data was collected from the search engines of EBSCO, PubMed, Google Scholar, and Scopus. The searched terms were COVID-19, CORONA, SARS-CoV-2, clinical features, Wuhan, etc. The study articles were collected that from January 2020 to February 2021. Based on the PRISMA guidelines, the meta-analysis was performed. Results: In the present study, we finalized 316 articles. On February 2020, the first article was published. We observed a spike in the meta-analysis later on. Most of the meta-analysis were issued in the virology and infection magazines. As expected, the majority studies were from Wuhan. The other countries that published the meta-analysis were the USA, the UK, and Italy. The studies included in each meta-analysis were nearly 25 and the subjects were approximately 16 thousand. However, we noticed a poor quality in majority of these meta-analysis and

Reduction mammoplasty with free nipple graft can be a good choice for early pubertal patients requiring massive reduction given its low recurrence and greater patient satisfaction.

Toad venom (Chansu) is used in the treatment of infectious and inflammatory diseases in China and East/Southeast Asian countries. However, the anti-inflammatory components of toad venom have not yet been systematically evaluated and clearly defined. To investigate the anti-inflammatory effects of toad venom and identify new anti-inflammatory ingredients, we used zebrafish, an alternative drug screening model, to evaluate the anti-inflammatory effects of 14 bufadienolides previously isolated from toad venom. Most of the bufadienolides were found to exert significant anti-inflammatory effects on lipopolysaccharide-, CuSO4-, or tail transection-induced zebrafish inflammatory models. Moreover, gammabufotalin ( 6) inhibits lipopolysaccharide-induced inflammation by suppressing the myeloid differentiation primary response 88/nuclear factor-kappa B and STAT3 signal pathways. This study confirms the potential of zebrafish in drug screening, clarifies the anti-inflammatory effects of bufadienolides from toad venom, and indicates that gammabufotalin may be developed as a novel therapeutic agent for inflammatory diseases in the future.

Osama H Mohammad,1 Vamanjore A Naushad,1 Nishan K Purayil,1 Laith Sinan,2 Naseem Ambra,1 Prem Chandra,3 Firjeeth C Paramba,1 Jassim Mohammad,4 Sajid Chalihadan,1 Irfan Varikkodan,1 Azeez Palol1 1Department of General Internal Medicine, Hamad Medical Corporation, Doha, Qatar; 2Glasgow Medical College, Glasgow, UK; 3Medical Research Center, Hamad Medical Corporation, Doha, Qatar; 4Accident & Emergency Department, Hamad Medical Corporation, Doha, QatarCorrespondence: Vamanjore A Naushad Department of General Internal MedicineHamad Medical Corporation, Doha 3050, QatarTel +974-55902242Email nousha87@hotmail.comBackground: Chest pain is a common symptom in patients visiting the emergency department (ED). Diagnosing acute coronary syndrome is a challenging task for emergency physicians. Evaluation of chest pain depends on clinical symptoms and signs, ECG, and cardiac enzymes. Here, we aimed to compare the diagnostic performance of the point-of-care troponin I assay with laboratory HsTnT assay in patients presenting to the ED with chest pain.Methods: A prospective study was done at the ED of Alkhor Hospital, Hamad Medical Corporation, between March 2016 and December 2016. Patients more than 18 years old who presented to the ED with chest pain were enrolled. Patients with renal failure, initial ECG showing ST-elevation MI, or arrhythmias, and hemodynamically unstable patients were excluded. A blood sample was collected at 0 and 3 hours post-admission for POC TnI and laboratory HsTnT assay. The sensitivity, specificity, PPV, NPV, and AUC were determined and compared.Results: Out of 313 patients enrolled, ten were excluded. At 0 hour, the POC TnI assay had a lower sensitivity (72.5% versus 97.5%) and had almost equal specificity (99.24% versus 93.2%) when compared to lab HsTnT assay. At 3 hours post-admission, the sensitivity increased to 95% versus 100%, and specificity was 100% versus 94.3% when compared to lab HsTnT. The POC TnI assay had a higher PPV than HsTnT, whereas both assays showed a high NPV at 0 and 3 hours.Conclusion: Although the diagnostic performance of POC TnI was lower than that of Lab HsTnT at 0 hour, at 3 hours post-admission, the diagnostic performance was almost equal to that of HsTnT. Hence we conclude that chest pain in patients with a negative POC TnI at 3 hours post-admission is unlikely to be due to NSTEMI.Keywords: point-of-care, POC, TnI, HsTnT, ED, chest pain, NSTEMI

Rare disease like primary spinal epidural diffuse large B‐cell lymphoma should be considered as a differential diagnosis in patients presenting with back pain and rapid neurological deterioration in the lower extremities., Rare diseases like primary spinal epidural diffuse large B‐cell lymphoma should be considered as a differential diagnosis in patients presenting with back pain and rapid neurological deterioration in the lower extremities.

Objective Idelalisib is an orally administered, highly selective inhibitor of phosphatidylinositol 3-kinase-δ. In this phase 1b study, the safety, tolerability and pharmacokinetics of idelalisib, an oral inhibitor of phosphatidylinositol 3-kinase-δ, were evaluated in Japanese patients with relapsed or refractory indolent B-cell non-Hodgkin lymphoma. Methods In total, six patients (follicular lymphoma: n = 3, chronic lymphocytic leukemia: n = 3) were enrolled to receive idelalisib 150 mg twice daily. Results No dose-limiting toxicities were reported. The most common adverse events were diarrhea (n = 5), gastritis (n = 3), insomnia (n = 3) and pyrexia (n = 3). The most common ≥grade 3 adverse events were diarrhea (n = 2), increased transaminase levels (n = 2) and decreased appetite (n = 2). The maximum idelalisib plasma concentrations (Cmax) were achieved at 2.50 h (range: 1.50–4.00 h). The mean idelalisib plasma concentrations decreased over time but remained detectable in most patients at 12 h. All enrolled patients underwent efficacy evaluation by investigators, and five patients (follicular lymphoma: n = 2, chronic lymphocytic leukemia: n = 3) achieved partial response. The median duration of partial response was 14.5 months (range: 3.7–31.3 months). Conclusion Idelalisib 150 mg twice daily was considered tolerable in Japanese patients with follicular lymphoma or chronic lymphocytic leukemia. (Clinical trial registration: NCT02242045)

Piper longum (long pepper) in dried form is used in several traditional medicines and as a spice. The present study highlights nutritional and toxic elements content, synthesis, and characterization of silver, copper oxide, and nickel nanoparticles using P. longum catkin extract. The study also determined anticancer, antioxidant, antimicrobial, and redox catalytic activities of the synthesized NPs. The P. longum extract mediated nanoparticles (PLNPs) synthesized at different pH and ratios were characterized by UV-Vis (ultra-violet-visible), FT-IR (Fourier-Transform infrared), and scanning electron and atomic force microscopic (SEM, AFM) techniques. Elemental content of P. longum catkin determined by inductively coupled plasma-optical emission spectroscopy (ICP-OES) and ICP-mass spectrometry (ICP-MS) indicated appreciable concentrations of nutritional elements, and well below permissible ranges of toxic elements. Well-defined and stable silver nanoparticles (PLAgNPs) were formed in 1:4 to 1:6 ratios, while copper oxide and nickel NPs (PLCuONPs and PLNiNPs) were found prominent in 1:6 ratio. In determining the effect of pH on synthesized PLNPs, sharp intense absorption peaks were obtained under slightly neutral to highly basic conditions (pH 6 to 13) for PLAgNPs, whereas for PLCuONPs and PLNiNPs, pH 7–8 was optimum. In biological activities, PLNPs exhibited significant anticancer efficacy against DU-145 (prostate cancer) cell line in the range from 92.7% (PLCuONPs) to 100% (PLAgNPs, PLNiNPs). Fuurthermore, the sythesized NPs exhibited significant antioxidant, antimicrobial, and redox catalytic properties. This study concluded the promising nutritional, biological and environmental remediation applications, and hence, further exploration of the synthesized NPs in biological and clinical applications is currently under investigation.

Chattogram is the second most populated city in Bangladesh. This port city faces a serious threat mainly due to the lack of safe drinking water. This study was conducted for determining drinking water quality of groundwater sources in Chattogram city. The study was performed in the BCSIR laboratory, Chattogram. It was carried out for a period of six months from 1st July, 2018 to 31th December, 2018. Total six water samples were collected from three different locations (Baluchora, C&B colony and Khulshi area). Each sampling location consists of two separate sampling points. Physicochemical parameters of the collected samples like Temperature, pH, Electrical Conductivity (EC), Total dissolved solid (TDS), Hardness, Turbidity and concentration of Cl, As, Mn, Fe, Pb, Cr and Cd were examined. Microbial parameters like Total Coliform (TC) were also measured. All the analyzed parameters compared with BSTI and WHO drinking water quality standards to understand the overall ground water quality status of the study area. The results reveal that water samples in almost all locations were contaminated with microbial contamination and that the range of physico-chemical parameters was not adequate for consumption. Preliminary treatments like boiling, filtering etc are required before using groundwater for drinking and the necessary measures must be taken for a safe alternative source of drinking water.

Inflammation is largely mediated by immune cells responding to invading pathogens, whereas metabolism is oriented toward producing usable energy for vital cell functions. Immunometabolic alterations are considered key determinants of chronic inflammation, which leads to the development of chronic diseases. Studies have demonstrated that macrophages and the NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome are activated in key metabolic tissues to contribute to increased risk for type 2 diabetes mellitus, Alzheimer disease, and liver diseases. Thus, understanding the tissue-/cell-type-specific regulation of the NLRP3 inflammasome is crucial for developing intervention strategies. Currently, most of the nutrients and bioactive compounds tested to determine their inflammation-reducing effects are limited to animal models. Future studies need to address how dietary compounds regulate immune and metabolic cell reprograming in humans.

β‐thalassemia heterozygosity can cause significant iron overload when accompanied by HFE gene mutations and inappropriate iron supplementation.

Background: Vaginal discharge is a common problem faced by women of the reproductive age group seeking consultation in the gynecology outpatient department (GOPD). If not treated, it can lead to pelvic inflammatory disease, infertility and further complicate pregnancy. Objective: The present study explores the etiology and clinical presentations of vaginal discharge among women of reproductive age presenting to the GOPD of our tertiary care hospital. Materials and Methods: The study group comprised of 200 sexually active women of age group ?18 years attending our GOPD. Four vaginal swabs were taken from the posterior fornix under aseptic condition. Direct wet mount microscopy, gram stain, and culture on Sabaroud’s dextrose agar and Kupferberg media were carried out. Results: Prevalence of vulvovaginal candidiasis, bacterial vaginosis, trichomoniasis, and mixed infection was 30%, 20%, 2%, and 2%, respectively. Candida albicans were present in 55% patients and non-albicans Candida in 45%. The most common associated presenting symptom of patients presenting with the discharge was lower abdominal pain. Conclusion: Simple diagnostic techniques such as microscopy and culture help in diagnosis and the precise managementprocess of such women presenting with discharge and thus circumvent impending complication.

Vitex peduncularis, belongs to the Verbenaceae family, locally known as ‘Boruna’, ‘Horina’, ‘Ashmul gaas’, is commonly used for treating various chronic diseases in the folk medicine such as malarial fevers, jaundice, diabetes, chest pain, joint ache, abnormality in eyes & face, and urethritis, etc. In the present study, we investigated the anxiolytic, sedative, and antioxidant activities of ethanol extract of V. peduncularis leaves (EEVP) in both in vivo and in vitro models. Then, a molecular docking analysis was carried out to determine the possible lead compounds of EEVP for the biological properties described above. The anxiolytic and sedative activity of EEVP was determined using hole board and hole cross tests, respectively. Antioxidant activity was measured using DPPH and FRPA assays, whereas docking was done by using the Schrodinger suite (Maestro v10.1). Our result demonstrated that EEVP has significant and dose-dependent anxiolytic and sedative activity at the doses of 200 and 400 mg/kg (b.w.) in both models. This study also exhibited that EEVP has significant antioxidant activity compared to reference standard ascorbic acid. The molecular docking study revealed that 3,4-dihydroxybenzoic acid, 4-hydroxybenzoic acid, and vitexilactone have the best binding affinities against the target receptors (potassium channel receptor, human gamma-aminobutyric acid receptor, and human peroxiredoxin 5) for anxiolytic, sedative, and antioxidant activities. The present study confirmed that EEVP has anxiolytic, sedative, and antioxidant properties, which could be because of the occurrence of various phytochemicals and three bioactive phytocompounds which found potential during molecular docking analysis.

Background Curculigo recurvata (C. recurvata) is an enthnomedicinally important herb reported to have significant medicinal values. The present study aimed to explore the in vivo and in silico anti‐nociceptive and anti‐diarrheal effects of a C. recurvate rhizome methanol extract (Me‐RCR). Methods The analgesic effects of Me‐RCR were assessed using acetic acid‐induced writhing and the formalin‐induced flicking test. The drugs were administered intraperitoneally (IP) at doses of 200 and 400 mg/kg body weight (bw). Anti‐diarrheal activity was evaluated by assessing intestinal motility, hypersecretion, and fecal score in mice at oral doses of 200 and 400 mg/kg·bw. Computer facilitated analyses for anti‐nociceptive and anti‐diarrheal activities of three isolated compounds from C. recurvata were undertaken to identify the best‐fit phytoconstituents. Results The Me‐RCR showed significant (P

Introduction: Bcl 2 is one of the unique proto-oncogene, localized to mitochondria & interfering with apoptosis independent of promoting cell division. Bcl-2 is overexpressed mostly in SCLC and in a minority of the NSCLC. Cyclin D1 is an important cell cycle regulatory protein which controls the cell cycle transition from G1 to S phase. Materials and Methods: Here, we studied immunohistochemical expression of Bcl 2 & Cyclin D1 in 40 lung cancer patients to evaluate the immunohistochemical expression of Bcl 2 & Cyclin D1 in primary lung cancer, its expression with histological subtypes of lung cancer & to correlate the expression of Bcl 2 & Cyclin D1 with the clinical stage of disease. Results: The immunohistochemical expression of Bcl 2 & Cyclin D1 was studied in 40 cases of lung cancer and was also correlated with the histological subtypes. Out of 40 cases of lung carcinoma, 21 cases (52.5%) were positive and 16 cases (40%) were negative for Bcl 2. Among histological subtypes, Bcl 2 was significantly higher in patients with small cell carcinoma, (80%) followed by squamous cell carcinoma, (78.57%). Out of 40 cases of lung carcinoma, 16 cases (40%) were positive and 21 cases (52.5%) were negative for Cyclin D1. Among histological subtypes, expression of Cyclin D1 was significantly higher in patients with adenocarcinoma, (52.38%) as compared to Squamous cell carcinoma (35.71%). The immunohistochemical expression of Bcl 2 and Cyclin D1 was correlated with the clinical staging of lung cancer. We observed higher Bcl 2 expression in stage 3 disease (81.82%) followed by stage 4 disease (55%). Higher Cyclin D1 expression was seen in patients with stage 4 disease (80.00%). None of the stage 2 and stage 3 patients showed any expression with cyclin D1. Conclusions: In our study, higher Bcl 2 expression was associated with small cell carcinoma of lung and among non small cell carcinoma its expression was higher in squamous cell carcinoma. Cyclin D1 expression was observed mostl