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Synovial sarcoma (SS) is a rare soft tissue sarcoma usually arising in the deep soft tissues of the limbs, trunk, and head and neck region. Due to its rarity, diagnosis can be difficult to establish, especially when it involves an uncommon location like the breast. In this case report, we describe a young woman who was found to have primary SS of the breast. Initial immunohistochemistry staining was focally positive for cytokeratin and S100 and she was misdiagnosed with atypical spindle cell carcinoma. Due to the unusual presentation, further testing was performed which showed TLE1 and epithelial membrane antigen positivity, establishing the diagnosis of SS of the breast. A FISH was later sent out and was positive for SS18-SSX fusion transcript. This case highlights the importance of considering rare histopathology in breast lesions and using additional staining and cytogenetics to confirm diagnosis.

Aluminum phosphide (ALP) is a pesticide agent and infrequent culprit of accidental poisoning. We present a case of severe reversible cardiomyopathy and left ventricular apical thrombus in a patient who worked as an exterminator and had ALP poisoning.

In herbal medicine, there is a substantial amount of variety of plants have been used to treat neurodegenerative disorders including Alzheimer's (AD)as well as other memory-related issues. Dementia is a neurological condition characterised by a progressive loss in emotional and cognitive abilities. Dementia is linked to a number of conditions like inadequate cerebral blood flow, poison toxicity, and other risk factors and conditions mitochondrial dysfunction, oxidative injury, and, in certain cases coexistence with other diseases like Alzheimer's disease (AD), Huntington's disease, Parkinson's syndrome (PD) and Attention Deficit Hyperactivity Disorder (ADHD).Despite the fact that there are well-established semi-synthetic medications for the treatment of AD and AD-related dementia, the majority of them have a number of side effects. As a result, conventional medicine offers a variety of plant-derived lead molecules that may be valuable in future medical studies. In this paper, we look at how ayurvedic plants are used to treat neurodegenerative disease around the world. Plants are also neuroprotective against proinflammatory cytokines including IL-6, IL-1b, TNF-a and it was reported that Antioxidant activity was increased, oxidant levels were reduced, and acetylcholinesterase activity was inhibited in the nervous system by these medicinal plants. We've highlighted the most essential ayurvedic medicinal plants as well as their biochemical effects. As a result, the effects of the above medicinals plants and their active constituents strengthened neurodegenerative conditions, indicating their therapeutic potential in ailments like Alzheimer's disease. and depression that are linked to neuroinflammation and neurotransmitter dysfunction.

For much of the 20th century, smoking was regarded as a socially learned habit and as a personal choice. It is only in the past decade or so that the fundamental role of nicotine in sustaining smoking behaviour has begun to be more widely accepted. It is now recognized that cigarette smoking is primarily a manifestation of nicotine addiction and that smokers have individually characteristic preferences for their level of nicotine intake. Smokers regulate the way they puff and inhale to achieve their desired nicotine dose. The link with nicotine addiction does not imply that pharmacological factors drive smoking behaviour in a simple way and to the exclusion of other influences. Social, economic, personal, and political influences all play an important part in determining patterns of smoking prevalence and cessation. Therefore, the aim of this review was to emphasize information about the nicotine replacement therapy.

Abdominal trauma management has seen a paradigm shift over the last few decades. There is wide variation in the treatment depending on the level of healthcare facilities available. With an aim to standardise the treatment of solid organ injuries in blunt abdominal trauma, Indian Society for Trauma and Acute Care (ISTAC®) formulated consensus guidelines to benefit doctors engaged in trauma care in the country.

The novel coronavirus outbreak is a contagious disease affecting the countries around the world. The quick advancing nature of pandemic has gripped the entire community making it a public health emergency. Infection control preventive measures are necessary to prevent it from further spreading. Medical practitioners, health care workers and Dentists are at high risk of acquiring and transmission of infection. The virus transmission occurs through respiratory tract, aerosols and droplets. Clinical manifestations of virus vary from mild to severe sickness. This review article mainly emphasizes on all the information collected to date on the virus, and future recommendations for dental settings to manage the further spread of this virus.

Chlorella vulgaris is known for its protein, growth factor, and nutritional constituents. Chlorella vulgaris was cultivated in a 1000-L outdoor open raceway pond with a maximum volumetric productivity of 130 mg L-1 day-1. The harvested biomass was dried through different methods, viz., sun drying (30 °C), oven drying (60 °C), lyophilization (−110 °C), drum drying (120 °C), and spray drying (100–150 °C). The effect of the drying method on proximate composition, pigments (chlorophyll, carotenoids), bioactive compounds (total phenolic content, flavonoid content), vitamin B12, antioxidant properties (ferric reducing antioxidant power, DPPH, and total antioxidant activity), and the color quality of C. vulgaris biomass was evaluated. Surface characterization by scanning electron microscopy (SEM) and functional group characterization through Fourier transform infrared spectroscopy were also performed. The biomass dried through lyophilization and sun drying retained maximum bioactive compounds and antioxidant activities. In contrast, drum drying resulted in a loss of nutrients, viz., protein (up to 44%), lipid (up to 41%), vitamin B12 (up to 40%), total phenolic content (> 50%), total flavonoid content (> 50%), and antioxidant activity (> 50%). Oven drying led to a loss of 30% in total flavonoid content and 17% in ferric reducing antioxidant power. SEM showed the destruction of cell wall integrity in the drum-dried sample and porous structure in the spray-dried sample. This study suggests that drying methods affect the nutrients and bioactive compounds of C. vulgaris biomass, and therefore a drying method should be selected carefully depending on the end use of the biomass.

An incisional hernia is being a universal problem and topic of discussion worldwide. There is no clear-cut guideline of abdominal wall closure after major abdominal surgeries that can effectively prevent the occurrence of incisional hernia. We found out that most of the patients presented with pain over previous surgery scar with swelling. The defect was usually larger than 2 cm. Most postoperative patients complaint of pain, seroma, and hematoma formation. There was a minimal recurrence rate after onlay mesh repair in our setup.

Intraoperative imaging has become one of the most important adjuncts in neurosurgery, especially in the surgical treatment of intra-axial tumors. Navigation and intraoperative magnetic resonance imaging have limitations, and intraoperative ultrasonography (IOUS) has emerged as a versatile and multifaceted alternative. With technological advances in ultrasound scanners and newer multifunctional probes, the potential of IOUS is increasingly being utilized in the resection of tumors. The addition of image guidance to IOUS has exponentially increased the power of this technique. Navigated ultrasonography (nUS) can now overcome many of the limitations of conventional standalone two-dimensional ultrasonography. In this pictorial essay, we outline our nUS technique (both two- and three-dimensional) for the resection of intra-axial tumors with illustrated examples highlighting the various steps and corresponding benefits of the technique.

Owing to the growing population with end stage heart failure, the use of left ventricular assist devices (LVADs) have become more widely accepted. Although survival has improved with newer generation LVADs, multiple complications including pump failure due to outflow graft obstruction have become more clinically relevant. Patients with this complication will present with heart failure symptoms due to inadequate unloading of the left ventricle by LVAD. This rare complication often requires open surgical repair in an already high-risk patient population. Alternative means to relieve the obstruction via percutaneous intervention has been described in rare cases. We present two unique cases of LVAD outflow graft obstruction which were percutaneously treated successfully. This article illustrates a potential treatment strategy for outflow graft obstruction with stenting as an alternative to open-heart surgery.

Maximizing resection is an oft-sought-after albeit challenging goal in diffuse gliomas. Microsurgical technique remains the mainstay. By virtue of their pattern of growth and spread, gliomas respect anatomical boundaries like the pia. Using subpial dissection, en bloc resections provide the most optimal surgical technique. This paper revisits this technique and describes the rationale and basic principles integrating it in the modern multimodal glioma surgery workflow. Subpial resection is a very useful and “anatomical” technique for en bloc resection of diffuse gliomas which is easy to master and execute and optimizes the extent of resection and minimizes complications effectively.

Cancer is one of the prominent global causes of death and the foremost worldwide health concern. Despite unprecedented progress in cancer chemoprevention, a vast number of cancers, however, remain an undefeatable challenge for treatment modalities. Immense therapeutic activities of puerarin contribute to its use in various health disorders. In this review, we explored the potential molecular mechanisms and targets of puerarin, proving its potential as a novel anticancer agent, for future cancer therapy and chemoprevention. Several mechanisms account for anticancer activity of puerarin which includes downregulation of NF-kB signalling pathway, mTOR signalling pathway, PI3K and BCl-2 proteins and upregulation of miR-16, caspase proteins, c- Jun N terminal kinase and extracellular signal-regulated kinase 1/2. These alterations result in inhibition of cancer cell proliferation and/or induction of apoptosis. Understanding the molecular mechanisms involved in chemotherapy and chemoprevention could aid in the more pronounced exploration of puerarin in effective cancer treatment.

Background: Laparoscopic inguinal hernia repair is a common surgical procedure performed worldwide. In this era of rapidly advancing surgical technology, surgeons are often keen to modify the technique of laparoscopic surgery by reducing the number and size of incisions. The aim of this observational study was to present the results of a single incision laparoscopic surgical (SILS) approach for trans- abdominal preperitoneal mesh hernioplasty (SITAPP) in cases of bilateral inguinal hernia. Methods: Forty eight patients with bilateral inguinal hernia who underwent TAPP were prospectively evaluated. Data regarding patient demographics, type of hernia, operating time, complications and duration of hospital stay were prospectively collected. Single incision TAPP (SITAPP) was performed using conventional instruments and surgical technique similar to standard 3 port TAPP was used, except that it was conducted through a single umbilical port. Results: All patients were male and the mean age was 50 years (range 30 - 68 years). The mean duration of surgery was 155.83 minutes (range 120 - 310 minutes). The procedures were completed successfully in all the patients without requiring conversion to the traditional laparoscopic surgery or use of additional ports. There was no evidence of early recurrence after a follow up period of 42 days. Conclusion: SITAPP for bilateral hernia is feasible and seems to be safe in experienced hands. However, studies with larger sample size with comparative analysis are required to establish long term clinical outcomes and recurrence rates.

Evidence-based recommendations for clinical practice are intended to help health care providers and patients make decisions, minimize inappropriate practice variation, promote effective resource use, improve clinical outcomes, and direct future research. The Society for Cardiovascular Angiography and Interventions (SCAI) has been engaged in the creation and dissemination of clinical guidance documents since the 1990s. These documents are a cornerstone of the society's education, advocacy, and quality improvement initiatives. The publications committee is charged with oversight of SCAI's clinical documents program and has created this manual of standard operating procedures to ensure consistency, methodological rigor, and transparency in the development and endorsement of the society's documents. The manual is intended for use by the publications committee, document writing groups, external collaborators, SCAI representatives, peer reviewers, and anyone seeking information about the SCAI documents program.

INTRODUCTION The NCCN recommends either PCV (Procarbazine, CCNU and vincristine) or Temozolomide (TMZ) as adjuvant therapy in high-risk grade 2 & grade 3 gliomas. In this ongoing study we are comparing PCV with TMZ as adjuvant therapy in this setting. METHODS This is a randomised phase 3 study that includes patients with high risk (as per RTOG) grade 2 gliomas and grade 3 gliomas after surgery. Patient are randomly assigned in 1: 2 to receive either adjuvant PCV or TMZ after adjuvant RT. The primary end-point is progression-free survival & key secondary end points are overall survival, toxicity and quality of life. The current analysis focuses on the compliance and adverse events seen in patients enrolled till 30th April 2020. RESULTS 46 patients were enrolled, with 30 patients in TMZ arm. The median age of patients was 37 years (range 23-64). The ECOG PS was 1 in 45 (97.8%) patients and 2 in 1(2.2%) patient at enrolment. The number of patients who have completed all planned cycles of chemotherapy in the PCV arm is 62.5% (10, n=16) as compared to 90% (27, n=30) in the TMZ arm (P=0.047). The incidence of grade 3 or higher adverse events is 68.8% (n=11) in the PCV arm and 16.7% (n=5) in the TMZ arm (P=0.001). The most common grade 3 or higher toxicities noted are lymphopenia in 50% (n=8), neutropenia in 37.5% (n=6), and thrombocytopenia in 25% (n=4) in the PCV arm; while the corresponding numbers in the TMZ arm are 13.3% (n=4), 3.3% (n=1) and 10% (n=3) respectively. CONCLUSION In the current study the chemotherapy completion rates are higher with TMZ and it is associated with lower grade 3-4 events, whether this will lead to an improvement in outcomes remains to be seen.

Background and Objectives There are reports of outcomes of elective major cancer surgery during the COVID‐19 pandemic. We evaluated if reinforcement of hand hygiene, universal masking, and distancing as a part of pandemic precautions led to a decrease in the incidence of surgical site infections (SSIs) in major oncologic resections. Methods Propensity score matching using the nearest neighbor algorithm was performed on 3123 patients over seven covariates (age, comorbidities, surgery duration, prior treatment, disease stage, reconstruction, and surgical wound type) yielding 2614 matched (pre‐COVID 1612 and COVID 1002) patients. Conditional logistic regression was used to identify if SSI incidence was lower amongst patients operated during the pandemic. Results There was a 4.2% (p = 0.006) decrease in SSI in patients operated during the pandemic. On multivariate regression, surgery during the COVID‐19 period (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.61–0.98; p = 0.03), prior chemoradiation (OR = 2.46; CI = 1.45–4.17; p 4 h (OR = 2.17; 95%CI = 1.55–3.05; p

Coronary air embolism is a rare iatrogenic complication during invasive coronary angiography or angioplasty that can cause acute chest pain, hypotension, ST-segment elevation myocardial infarction, and even death. We present a case of left anterior descending coronary artery air embolization in a 58-year-old heart transplant patient that occurred during cardiac allograft vasculopathy surveillance angiography. The patient was managed successfully with rapid coronary injections of heparinized saline, catheter disengagement to increase coronary blood flow, and supplementation of 100% oxygen to dissolve the coronary air embolus. This case highlights this rare complication of coronary angiography, importance of prompt recognition of the pathology and subsequent management.

Olecranon bursa endoscopy (bursoscopy) is a minimally invasive technique for resection of olecranon bursitis and spurs. The principal advantages are minimal operative site morbidity, excellent visualization secondary to endoscopic magnification, and early return to function. Dry endoscopy is performed with the hooded endoscope to keep the operating space patent, allowing illumination while also eliminating potential issues with wet endoscopy like postoperative soft tissue edema, sinus formation, and swelling.

Accumulation of anomalous tissue in the head formed the Brain Tumor. Brain tumor is basically caused by the uncommon growth of the anomalous cells in the brain. Since the skull encloses the very rigid brain. Any unspecified growth inside the restricted space where the cells multiply abruptly and ceaselessly can create the major problem. After the 20th century, the number of the patient who have the brain tumor is increasing day by day for the aging population is a worldwide health problem. Basically Malformed mass called tumor can be identified into two types cancerous (malignant) or noncancerous (benign). The main objective of this research is to create the technique that reliably identifies the existence of a tumor that includes all cancerous tissues. Fish schooling Genetic algorithm is used to recognize a presence of cancerous part called tumor area from a soft tissue called brain MRI images and to predict that detected area whether it is a tumor or not. The proposed module consists of the steps such as Brain MRI dataset Pre-processing of MRI image, remove noise through image Enhancement, stripping the skull part, fish school search algorithm based indication are used in the research. According to the results acquire from the performance of Fish School Search Algorithm in detection of tumor achieves the better performance in terms of comparing the quality parameters such as accuracy, efficiency with the previous method used.

Pre-operative optimization of cardiovascular conditions in patients awaiting renal transplantation significantly improves post-transplantation cardiac complications. We describe a case of symptomatic coronary fistula treated with percutaneous coil embolization in a young adult awaiting renal transplantation. (Level of Difficulty: Advanced.), Graphical abstract

Background: The availability of safe, clinically useful, and cost-effective bone allografts have led to modifications in surgical therapy, as well as a rise in demand for bone allografts grafts for use in plastic surgery reconstruction. They are an appealing alternative to bone autograft because their supply is less limited, they allow structural restoration of the skeleton, and their surfaces promote bone formation. Case Series: We provide a case series of 13 patients who were treated with freeze-dried bone allografts. The FDA and the Bone Banks both advised that all grafts meet certain parameters. The objective evaluation of graft volume persistence was achieved using radiography, whereas the subjective estimation of graft volume was obtained through patient response throughout a one-year period of follow-up. Objective of this study was to establish the clinical use of bone allografts in various reconstructive surgeries and compare its utility with bone autografts. Conclusion: Bone allografts can be used in any type of bone surgery, from minor defects to major bone loss following tumour resection. Without donor-site morbidity, freeze-dried allograft bone is a safe and equal alternative to bone autograft.

Achilles tendon rupture is a well‐documented adverse effect of Fluoroquinolones; however, herein we present a case of complete iliopsoas and Achilles, and partial semimembranosus tendon rupture secondary to Levofloxacin.

Risk-averse behavior has been reported among physicians and facilities treating cardiogenic shock in states with public reporting. Our objective was to evaluate if public reporting leads to a lower use of mechanical circulatory support in cardiogenic shock. We conducted a retrospective study with the use of the National Inpatient Sample from 2005 to 2011. Hospitalizations of patients ≥18 years old with a diagnosis of cardiogenic shock were included. A regional comparison was performed to identify differences between reporting and nonreporting states. The main outcome of interest was the use of mechanical circulatory support. A total of 13043 hospitalizations for cardiogenic shock were identified of which 9664 occurred in reporting and 3379 in nonreporting states (age 69.9 ± 0.4 years, 56.8% men). Use of mechanical circulatory support was 32.8% in this high-risk population. Odds of receiving mechanical circulatory support were lower (OR 0.50; 95% CI 0.43–0.57; p<0.01) and in-hospital mortality higher (OR 1.19; 95% CI 1.06–1.34; p<0.01) in reporting states. Use of mechanical circulatory support was also lower in the subgroup of patients with acute myocardial infarction and cardiogenic shock in reporting states (OR 0.61; 95% CI 0.51–0.72; p<0.01). In conclusion, patients with cardiogenic shock in reporting states are less likely to receive mechanical circulatory support than patients in nonreporting states.

The cohesionless soil overburden experiences large vertical displacements when shallow jacked box tunnel is constructed through it. A modelled steel box tunnel was jacked through cohesionless soil ...

Purpose The purpose of this study was to evaluate the relative utility and benefits of free-hand 2-dimensional intraoperative ultrasound (FUS) and navigated 3-dimensional intraoperative ultrasound (NUS) as ultrasound-guided biopsy (USGB) techniques for supratentorial lesions. Methods All patients who underwent USGB for suspected supratentorial tumours from January 2008 to December 2017 were retrospectively analyzed. The charts and electronic medical records of these patients were studied. Demographic, surgical, and pathological variables were collected and analyzed. The study group consisted of patients who underwent either FUS or NUS for biopsy. Results A total of 125 patients (112 adults and 13 children) underwent USGB during the study period (89 FUS and 36 NUS). NUS was used more often for deep-seated lesions (58% vs. 18% for FUS, P

An ecofriendly and efficient method (photoinduced) has been used for green synthesis of stable gold nanoparticles (AuNPs) using aqueous extract as a reducing and stabilizing agent, derived from halotolerant microalga Dunaliella salina. Synthesis of AuNPs was confirmed by UV–Vis spectroscopy showing sharp SPR band at 560 nm after 30 min exposure of sunlight. The synthesis was optimized further as exposure(75min) to sunlight, aqueous extract of Dunaliella (AED) inoculum dose(30%) and HAuCl4.xH2O (1 mM). The presence of nearly spherical shape of AuNPs with average size of 22.4 nm and crystalline nature were confirmed by TEM, SAED and XRD analysis. The XPS analysis of AuNPs showed presence of two individual peaks at 85.17 and 88.94eV that attributed to Au 4f7/2 and Au 4f5/2 respectively. Phycochemical analysis of AED demonstrated presence of phenolics, flavonoids, tannin and proteins. AED when subjected to SDS-PAGE showed protein bands of 92 and 66 KDa. AuNPs were tested for anticancer activity on MCF7 (cancer) and MCF 10A (normal) cell lines, keeping commercial drug cisplatin as positive control. AuNPs selectively killed cancer cells and were not detrimental to the normal cell line whereas cisplatin killed normal cells also at 48 h exposure, therefore, such AuNPs may be used as an anticancer agent.

Characterizing Alzheimer's disease (AD) at pre-clinical stages is crucial for initiating early treatment strategies. It is widely accepted that amyloid accumulation is a primary pathological event in AD. Also, loss of connectivity between brain regions is suspected of contributing to cognitive decline, but studies that test these associations using either local (i.e., individual edges) or global (i.e., modularity) connectivity measures may be limited. In this study, we utilized data acquired from 139 cognitively unimpaired participants. Sixteen gray matter (GM) regions known to be affected by AD were selected for analysis. For each of the 16 regions, the effect of amyloid burden, measured using Pittsburgh Compound B (PiB) positron emission tomography, on each of the 1761 brain network connections derived from diffusion tensor imaging (DTI) connecting 162 GM regions, was investigated. Applying our unique multiresolution statistical analysis called the Wavelet Connectivity Signature (WaCS), this study demonstrates the relationship between amyloid burden and structural brain connectivity as assessed with DTI. Our statistical analysis using WaCS shows that in 15 of 16 GM regions, statistically significant relationships between amyloid burden in those regions and structural connectivity networks were observed. After applying multiple testing correction, 10 unique structural brain connections were found to be significantly associated with amyloid accumulation. For 7 of those 10 network connections, the decrease in their network connection strength indexed by fractional anisotropy was, in turn, associated with lower cognitive function, providing evidence that AD-related structural connectivity loss is a correlate of cognitive decline.

Central neurocytomas are benign tumors accounting for0.5% of all intracranial tumors. They are usually intraventricular, the most common site being the lateral ventricles, and are associated with good prognosis if they are completely resected surgically.We report the case of a middle-aged woman who was evaluated for recent-onset headache and for whom magnetic resonance imaging of the brain was suggestive of a solid cystic intraventricular mass spanning all the ventricles. The patient underwent subtotal excision of the mass, with intraoperative neuromonitoring. The result of Histopathologic examination was suggestive of atypical neurocytoma. The patient had complete neurologic recovery in spite of immediate postoperative deficits.Gross total resection should be the goal in all patients with central neurocytoma, but it may be limited because of proximity of the tumor to eloquent areas, especially in large tumors. Intraoperative neuromonitoring plays a pivotal role in maximal safe resection of such large tumors. Tetraventricular atypical central neurocytoma is a very rare entity; and this case could be, to the best of our knowledge, only the second reported case.

AIMS The current opioid crisis in the USA is a formidable challenge for the healthcare system, and the general population. Our objective is to characterize the burden of opioid-related disorders in an inpatient setting in the USA for the years 2016, 2017 and 2018 using the National Inpatient Sample (NIS). METHODS A cross-sectional analysis of the NIS was performed to identify and analyse hospitalizations with an opioid-related diagnosis in 2016, 2017 and 2018. Descriptive statistics and regression models were utilized to define the demographics of the population of interest and measure the outcomes. RESULTS We identified 962 900 discharges with opioid-related diagnosis in 2016, 982 710 in 2017 and 942 110 in 2018. The majority were age

INTRODUCTION Intraoperative ultrasound (iUS) is a promising tool for glioma surgery. Navigated 3-D (n3D) iUS has many benefits over standard 2-D iUS. METHODS This was a retrospective comparative cohort study using propensity score matching (PSM). 500 consecutive histologically confirmed gliomas were divided into 2 cohorts – 2DiUS - Cohort A; and n3DiUS -Cohort B. PSM was used to account for known confounders (250 in each group; 1:1 matching). Gross total resection rates (based on iUS findings as well as postoperative MR) and perioperative morbidity were analyzed across the groups as were factors influencing these outcomes (using univariate as well as multivariate regression models). RESULTS Overall, the majority of the patients were adults (94%), males (71%) with hemispheric tumors (96%). 35% had tumors close to eloquent regions and 23% had received some prior treatment. The majority were high-grade gliomas (85%). 2D iUS was employed mainly for localization (80%) whereas n3D was used predominantly for resection control (84%) [p < 0.001]. GTR rate was higher in the n3D cohort (55.2% vs 38.4% in 2D; p = 0.001). The odds of having a complete resection in the n3D cohort was twice that of the 2D. Prior treatment, hemispheric location, and use of fluorescence were also significantly associated with higher GTR rates on univariate analysis. On multivariate analysis, all of these remained significant. There was no difference in the morbidity rates in the two cohorts. N3D iUS had a higher specificity and positive likelihood ratio in detecting tumor residue. CONCLUSION For hemispheric gliomas undergoing resective surgery, the use of navigated 3D ultrasound improves GTR rates, with no added morbidity. It is more likely to be used for resection control mode than is 2DUS and this is probably because n3DUS is more specific and likely to pick up tumor residues contributing to its better accuracy.

Achilles tendon rupture is a well-documented adverse effect of Fluoroquinolones; however, herein we present a case of complete iliopsoas and Achilles, and partial semimembranosus tendon rupture secondary to Levofloxacin.

Background People living with human immunodeficiency virus (PLWH) are at risk of developing pulmonary hypertension (PH) and right ventricular (RV) dysfunction, but understanding of the relationship of RV function to afterload (RV-PA coupling) is limited. We evaluated the clinical and hemodynamic characteristics of human immunodeficiency virus (HIV)-associated PH. Methods We performed a retrospective review of patients with a diagnosis of HIV undergoing right heart catheterization (RHC) from 2000–2016 in a tertiary care center. Inclusion criteria were diagnosis of HIV, age ≥ 18 years and availability of RHC data. PH was classified as either pulmonary arterial hypertension (PAH; mean pulmonary arterial pressure [mPAP] ≥ 25mmHg with pulmonary artery wedge pressure [PAWP] ≤ 15mmHg) or pulmonary venous hypertension (PVH; mPAP ≥ 25mmHg with PAWP > 15). We collected demographics, CD4 cell count, HIV viral load, RHC and echocardiographic data. The single beat method was used to calculate RV-PA coupling from RHC. Results Sixty-two PLWH with a clinical likelihood for PH underwent RHC. Thirty-two (52%) met PH criteria (15 with PAH, 17 with PVH). Average time from diagnosis of HIV to diagnosis of PH was 11 years. Eleven of 15 individuals with PAH were on antiretroviral therapy (ART) while all 17 patients with PVH were on ART. Compared to PLWH without PH, those with PH had an increased likelihood of having a detectable HIV viral load and lower CD4 cell counts. PLWH with PAH or PVH had increased RV afterload with normal RV contractility, and preserved RV-PA coupling. Conclusion PLWH with PH (PAH or PVH) were more likely to have a detectable HIV viral load and lower CD4 count at the time of RHC. PLWH with PAH or PVH had increased RV afterload, normal RV contractility, with preserved RV-PA coupling suggestive of an early onset, mild, and compensated form of PH. These results should be confirmed in larger studies.

Surface ozone is a major pollutant threatening public health, agricultural production and natural ecosystems. While measures to improve air quality in megacities such as Delhi are typically aimed at reducing levels of particulate matter (PM), ozone could become a greater threat if these measures focus on PM alone, as some air pollution mitigation steps can actually lead to an increase in surface ozone. A better understanding of the factors controlling ozone production in Delhi and the impact that PM mitigation measures have on ozone is therefore critical for improving air quality. Here, we combine in situ observations and model analysis to investigate the impact of PM reduction on the non-linear relationship between volatile organic compounds (VOC), nitrogen oxides (NOx) and ozone. In situ measurements of NOx, VOC, and ozone were conducted in Delhi during the APHH-India programme in summer (June) and winter (November) 2018. We observed hourly averaged ozone concentrations in the city of up to 100 ppbv in both seasons. We performed sensitivity simulations with a chemical box model to explore the impacts of PM on the non-linear VOC-NOx-ozone relationship in each season through its effect on aerosol optical depth (AOD). We find that ozone production is limited by VOC in both seasons, and is particularly sensitive to solar radiation in winter. Reducing NOx alone increases ozone, such that a 50% reduction in NOx emissions leads to 10-50% increase in surface ozone. In contrast, reducing VOC emissions can reduce ozone efficiently, such that a 50% reduction in VOC emissions leads to ∼60% reduction in ozone. Reducing PM alone also increases ozone, especially in winter, by reducing its dimming effects on photolysis, such that a 50% reduction in AOD can increase ozone by 25% and it also enhances VOC-limitation. Our results highlight the importance of reducing VOC emissions alongside PM to limit ozone pollution, as well as benefitting control of PM pollution through reducing secondary organic aerosol. This will greatly benefit the health of citizens and the local ecosystem in Delhi, and could have broader application for other megacities characterized by severe PM pollution and VOC-limited ozone production. This journal is

The sources of bioavailable vitamin B(12) are limited, and most of them are animal-derived. Chlorella vulgaris, a freshwater microalga, is known for immune system boosting, nutraceutical properties and presence of a natural form of vitamin B(12). The present study focused on the in vivo evaluation of the Chlorella biomass as a source of bioavailable vitamin B(12) to alleviate the vitamin B(12) deficiency status of Wistar rats. Experimental animals were evaluated for the vitamin B(12) deficiency-related circulatory marker (serum vitamin B(12)) and functional markers (plasma homocysteine and urinary methylmalonic acid), haematological and histological changes. The results showed that an increase of 2.4-fold in urinary methylmalonic acid (13.01 ± 0.89 µmoles moles of creatinine(−1)), 2.6-fold in plasma homocysteine (17.18 ± 3.57 µmole L(−1)), and 48% decrease in serum vitamin B(12) levels (252.69 ± 1.46 pg mL(−1)) in vitamin B(12) deficient group compared to control animals. The Chlorella biomass supplementation in the diet led to the restoration of the functional and circulatory markers, hematological parameters, and vitamin B(12) content of kidney and liver to control levels. The Chlorella biomass supplementation increased the erythrocyte precursors and MAST cells in the bone marrow and also normalized the histological features of kidney, liver, and lung tissues. The results suggest that the vitamin B(12) from the Chlorella biomass was bioavailable and facilitated the improvement of vitamin B(12) status in deficient rats. [Image: see text] ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13197-020-04901-9) contains supplementary material, which is available to authorized users.

Background: We have recently shown that PTSD/TBI takes an especially devastating toll on America’s veterans and their families with mental, physical and financial ramifications and poor clinical outcomes (Thakur et al. Epidemiology (Sunnyvale) 2018; 8:353). Patients with PTSD were found to have higher rates of cardiovascular symptoms, hospitalizations and mortality. Whereas electrocardiographic abnormalities, arrhythmias and ventricular dysfunction have been reported in patients with TBI. Association of PTSD/TBI with Myocardial Infarction (MI) is not well studied; the objective of this study was to examine the relationship between PTSD/TBI and MI in a large patient population. Methods: This retrospective study used national data from Veterans Administrations Informatics and Computing Infrastructure (VINCI). Propensity score analysis was performed to obtain matched pairs of (1) Non-PTSD/TBI vs. PTSD (2) Non-PTSD/TBI vs. TBI. Confounding variables used for matching were patients’ demographics and co-morbidities. Cox proportional hazard regression analysis was conducted on matched pairs to determine the relationship between PTSD, TBI and incidence of MI. Kaplan-Meier curves were plotted to compare the time to development of incident MI among the groups. Relationships between variables were examined using chi-square tests, t-tests and non-parametric tests. Results: The risk of new-onset MI was significantly higher for patients with PTSD/TBI when compared with their counterparts without PTSD/TBI. Risk of MI with TBI (HR=2.687, CI 2.546-2.835, P Conclusion: There is a significant increase in the incidence of MI in patients with a diagnosis of PTSD or TBI. Further studies are needed to formulate clinical guidelines to risk stratify and intervene to help reduce the incidence of MI in this patient population.

Introduction: Multiple previous studies have shown that insurance status of the patient impacts the management and overall outcomes of patients presenting with acute myocardial infarction. There are limited data on the impact of primary payer status in patients with non ST segment elevation myocardial infarction (NSTEMI). Hypothesis: Primary payer status influences management and overall outcomes independent of the clinical and hospital-based characteristics in NSTEMI patients. Methods and Results: Adult (>18 years) NSTEMI admissions were identified using the National Inpatient Sample database (2000-2017). Expected primary payer was classified into Medicare, Medicaid, private, uninsured, and others. Outcomes of interest included in-hospital mortality, use of coronary angiography, early coronary angiography and percutaneous coronary intervention (PCI), resource utilization, and discharge disposition. Of the 7,290,565 NSTEMI admissions, Medicare, Medicaid, private, uninsured, and other insurances were noted in 62.9%, 6.1%, 24.1%, 4.6%, and 2.3%, respectively. Compared to others, the Medicare cohort was older (76 vs. 53-60 years), more often female (48% vs. 25-44%), of white race, and with higher comorbidity (all p p p p p p =0.06). Coronary angiography (overall 52% vs. 65-74%; early 15% vs. 22-27%) and PCI (27% vs. 35-44%) were used less frequently in the Medicare population. The Medicare population had longer lengths of hospital stay, lowest hospitalization costs and fewer discharges to home. Conclusions: Compared to other types of primary payers, NSTEMI admissions with Medicare insurance had lower use of coronary angiography and PCI and higher in-hospital mortality.

Prevention of Coronavirus results in lockdown in India from 24 March 2020 to 31 May 2020. Eastern India, which is having a dense cluster of coal-fired power plants and home to many mines, mineral industries, has not shutdown power plants and coal mines during this lockdown period, though other industrial and vehicular emissions were almost zero. The present study attempts to find the change in various atmospheric pollutants during this lockdown period over an eastern tropical Indian station-Bhubaneswar, which is the first smart city proposed in smart city mission of Government of India. The study analyses hourly concentrations of PM2.5, PM10, NO X , O3, and CO for March-May 2019 and 2020. The study shows a significant increase (rather than decrease) in PM2.5 and PM10, increase in O3 and a decrease in CO and NO X during the lockdown period. Results are advocating the impact of transported pollution over the study area for maintaining the PM2.5 and PM10 values even during the lockdown situation.

Lockdown measures to contain COVID-19 pandemic has resulted in a considerable change in air pollution worldwide. We estimate the temporal and diurnal changes of the six criteria air pollutants, including particulate matter (PM2.5 and PM10) and gaseous pollutants (NO2, O3, CO, and SO2) during lockdown (25th March – 3rd May 2020) across regions of India using the observations from 134 real-time monitoring sites of Central Pollution Control Board (CPCB). Significant reduction in PM2.5, PM10, NO2, and CO has been found in all the regions during the lockdown. SO2 showed mixed behavior, with a slight increase at some sites but a comparatively significant decrease at other locations. O3 also showed a mixed variation with a mild increase in IGP and a decrease in the South. The absolute decrease in PM2.5, PM10, and NO2 was observed during peak morning traffic hours (08–10 Hrs) and late evening (20–24 Hrs), but the percentage reduction is almost constant throughout the day. A significant decrease in day-time O3 has been found over Indo Gangetic plain (IGP) and central India, whereas night-time O3 has increased over IGP due to less O3 loss. The most significant reduction (∼40–60%) was found in PM2.5 and PM10. The highest decrease in PM was found for the north-west and IGP followed by South and central regions. A considerable reduction (∼30–70%) in NO2 was found except for a few sites in the central region. A similar pattern was observed for CO having a ∼20–40% reduction. The reduction observed for PM2.5, PM10, NO2, and enhancement in O3 was proportional to the population density. Delhi’s air quality has improved with a significant reduction in primary pollutants, however, an increase in O3 was observed. The changes reported during the lockdown are combined effect of changes in the emissions, meteorology, and atmospheric chemistry that requires detailed investigations., Graphical abstract Image 1, Highlights • Study representing 134 sites across India show decline in PM2.5, PM10 and NO2 during lockdown. • A reduction of ∼40–60% in PM2.5 and PM10; ∼30–70% in NO2; ∼20–40% in CO and mixed changes in O3 and SO2. • Major reduction in the night and peak traffic hours but no change in the diurnal profile. • Ozone decreased in the daytime but enhanced in night-time over Indo Gangetic plain. • Air quality in megacity Delhi has improved significantly but O3 increased marginally., First comprehensive study representing over 130 sites over India to Assess the changes in spatial, Temporal patterns in pollution during lockdown to support future mitigation strategies

Background ST‐segment elevation (STE) in lead aVR is a useful tool in recognizing patients with left main or left anterior descending coronary obstruction during acute coronary syndrome (ACS). The prognostic implication of STE in lead aVR on outcomes has not been established. Methods We performed a systematic search for clinical studies about STE in lead aVR in four databases including PubMed, EMBASE, Cochrane Library, and Web of Science. Primary outcome was in‐hospital mortality. Secondary outcomes included in‐hospital (re)infarction, in‐hospital heart failure, and 90‐day mortality. Results We included 7 studies with a total of 7,700 patients. The all‐cause in‐hospital mortality of patients with STE in lead aVR during ACS was significantly higher than that of patients without STE (OR: 4.37, 95% CI 1.63 to 11.68, p = .003). Patients with greater STE (>0.1 mV) in lead aVR had a higher in‐hospital mortality when compared to lower STE (0.05–0.1 mV) (OR: 2.00, 95% CI 1.11–3.60, p = .02), However, STE in aVR was not independently associated with in‐hospital mortality in ACS patients (OR: 2.72, 95% CI 0.85–8.63, p = .09). The incidence of in‐hospital myocardial (re)infarction (OR: 2.77, 95% CI 1.30–5.94, p = .009), in‐hospital heart failure (OR: 2.62, 95% CI 1.06–6.50, p = .04), and 90‐day mortality (OR: 10.19, 95% CI 5.27–19.71, p