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Background Clinical guidelines on infection control strategies in healthcare workers (HCWs) play an important role in protecting them during the severe acute respiratory syndrome coronavirus 2 pandemic. Poorly constructed guidelines that are incomprehensive and/or ambiguous may compromise HCWs’ safety. Objective The objective of this study was to develop and validate a tool to appraise guidelines on infection control strategies in HCWs based on the guidelines published early in the coronavirus disease 2019 pandemic. Design, setting, and outcomes A three-stage, web-based, Delphi consensus-building process among a panel of diverse HCWs and healthcare managers was performed. The tool was validated by appraising 40 international, specialty-specific, and procedure-specific guidelines along with national guidelines from countries with a wide range of gross national income. Results Overall consensus (≥75%) was reached at the end of three rounds for all six domains included in the tool. The Delphi panel recommended an ideal infection control guideline should encompass six domains: general characteristics (domain 1), engineering recommendations (domain 2), personal protective equipment (PPE) use (domain 3), and administrative aspects (domain 4-6) of infection control. The appraisal tool performed well across the six domains, and the inter-rater agreement was excellent for the 40 guidelines. All included guidelines performed relatively better in domains 1–3 than in domains 4–6, and this was more evident in guidelines originating from lower income countries. Conclusion The guideline appraisal tool was robust and easy to use. Engineering recommendations aspects of infection control, administrative measures that promote optimal PPE use, and HCW wellbeing were generally lacking in assessed guidelines. This tool may enable health systems to adopt high-quality HCW infection control guidelines during the severe acute respiratory syndrome coronavirus 2 pandemic and may also provide a framework for future guideline development.

Clear cell carcinoma (CCC) of the female genital tract can arise in the ovary, endometrium, cervicovaginal region, in peritoneal and other extra pelvic sites. However, CCC involving anterior abdominal wall is a very rare entity. We are reporting a case of 55-year-old postmenopausal lady with ECOG PS-I with no comorbidity had history of cesarean section about 30 years back and presented with pain in abdomen at periumbilical region about 9 months back. She underwent evaluation at outside clinic with finding of an anterior abdominal wall swelling of size approximately 3 × 3 cm which was completely neglected by the patient. In the next period of 2 months, the swelling suddenly increased in size. CECT/PET CT showed a solid cystic mass involving anterior abdominal wall with possibility of desmoid tumor. We had decided to plan for surgical excision of the tumor. Intraoperatively we found that there was bicornuate uterus. The lesion was arising from one of the cornue of uterus and it was extended anteriorly to anterior abdominal wall with no ascites, no pelvic, or retroperitoneal lymphadenopathy. She underwent hysterectomy with bilateral salpingo-oophorectomy and defect was closed with bioabsorbable mesh. Final histopathology report was clear cell endometrial carcinoma mostly mullerian tract origin arising from endometriosis focus. Tumor cells were diffusely positive for PAX-8 and Napsin-A and negative for WT 1 with patchy positivity for P53 (wild type expression). She had received adjuvant chemotherapy and she is disease free after 2 years of completion of the treatment. Clear cell endometrial carcinoma arising from malignant transformation of an endometriosis focus to anterior abdominal wall is a very rare phenomenon and it is a difficult task to reach its final diagnosis.

Introduction: We are reporting a case of 18 year old boy who presented with features of lower respiratory tract infections and labelled as suffering from left suprarenal gland tumor. However, after complete evaluation, it is diagnosed as left retroperitoneal tumor extending into left thoracic cavity with involvement of left lower lobe lung. He underwent debulking surgery. Rhabdomyosarcoma (RMS ) originates from immature striated muscle and it is considered as the most aggressive malignant mesenchymal tumor. The most common location of RMS is head and neck region. The retroperitoneal presentation of embryonal RMS is extremely rare. The four histological features of RMS, classified by WHO are embryonal, alveolar, pleomorphic and spindle cell or sclerosing. Pleomorphic RMS has worse prognosis. The incidence of embryonal tumors is higher in males with bimodal age distribution, between 2-6 years and second peak between 10-18 years. Their detection is incidental when the size is small and as the size enlarges, symptoms helps in detection. Due to its rarity at retroperitoneal location, there is a lack of literature over the adjuvant treatment. As the size enlarges at retroperitoneal region, enblock resection with clear margins becomes a difficult task and if planned for R0 resection, multiorgan resection escalates surgical morbidity rate. Conclusion: It is a rare location of embryonal rhabdomyosarcoma at retroperitoneal region with rare presentation of intra-thoracic infiltration. R0 resection is the principle goal of surgical excision of retroperitoneal sarcoma.

Background: Despite advances in surgery and pharmacotherapy, there remains significant residual ischemic risk after coronary artery bypass grafting surgery. Methods: In REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl–Intervention Trial), a multicenter, placebo-controlled, double-blind trial, statin-treated patients with controlled low-density lipoprotein cholesterol and mild to moderate hypertriglyceridemia were randomized to 4 g daily of icosapent ethyl or placebo. They experienced a 25% reduction in risk of a primary efficacy end point (composite of cardiovascular death, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina) and a 26% reduction in risk of a key secondary efficacy end point (composite of cardiovascular death, myocardial infarction, or stroke) when compared with placebo. The current analysis reports on the subgroup of patients from the trial with a history of coronary artery bypass grafting. Results: Of the 8179 patients randomized in REDUCE-IT, a total of 1837 (22.5%) had a history of coronary artery bypass grafting, with 897 patients randomized to icosapent ethyl and 940 to placebo. Baseline characteristics were similar between treatment groups. Randomization to icosapent ethyl was associated with a significant reduction in the primary end point (hazard ratio [HR], 0.76 [95% CI, 0.63–0.92]; P =0.004), in the key secondary end point (HR, 0.69 [95% CI, 0.56–0.87]; P =0.001), and in total (first plus subsequent or recurrent) ischemic events (rate ratio, 0.64 [95% CI, 0.50–0.81]; P =0.0002) compared with placebo. This yielded an absolute risk reduction of 6.2% (95% CI, 2.3%–10.2%) in first events, with a number needed to treat of 16 (95% CI, 10–44) during a median follow-up time of 4.8 years. Safety findings were similar to the overall study: beyond an increased rate of atrial fibrillation/flutter requiring hospitalization for at least 24 hours (5.0% vs 3.1%; P =0.03) and a nonsignificant increase in bleeding, occurrences of adverse events were comparable between groups. Conclusions: In REDUCE-IT patients with a history of coronary artery bypass grafting, treatment with icosapent ethyl was associated with significant reductions in first and recurrent ischemic events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01492361.

Background: Ischemic heart disease is a major cause of the diastolic heart failure. Risk of heart failures was increased with microvascular coronary disease, which is characterized by left ventricular stiffness with impaired relaxation and reduced compliance. Aim of this study is to estimate the effect of the severity of myocardium ischemia on the left ventricle ejection fraction and left ventricular volume using SPECT with 99mTc MIBI and to compare the results with the echocardiography. The study included 117 subjects with ischemic heart disease were examined using SPECT and echocardiography techniques. The following parameters were measured: left ventricular end systolic volume (LVESV) , left ventricular end diastolic volume (LVEDV) , and left ventricular ejection fraction (LVEF). Results show that the change difference in EDV between the two technique was (98.79%) with insignificant (p > 0.05). While the change in the LVEF% between both groups was (105.40%) with significant (p 0.05). It was concluded that SPECT with 99mTc MIBI had a good relation with the echocardiography technique for evaluation of the left ventricular ejection fraction and the left ventricular volumes. The results showed that LVEF was decreased in patients with severe ischemic disease.

Background Metformin, by reducing intracellular Mycobacterium tuberculosis growth, can be considered an adjunctive therapy to anti-tuberculosis treatment (ATT). We determined whether metformin with standard ATT reduces time to sputum culture conversion and tissue inflammation in adults with pulmonary tuberculosis (PTB). Methods In a randomized, 8-week, clinical trial, newly diagnosed, culture-positive PTB patients were randomized to standard ATT (HREZ = control arm) or standard ATT plus daily 1000 mg metformin (MET-HREZ = Metformin with Rifampicin [METRIF] arm) for 8 weeks during 2018–2020 at 5 sites in India. The primary end point was time to sputum culture conversion by liquid culture during 8 weeks of ATT. Plasma inflammatory markers were estimated in a subset. A Cox proportional hazard model was used to estimate time and predictors of culture conversion. Results Of the 322 patients randomized, 239 (74%) were male, and 212 (66%) had bilateral disease on chest radiograph with 54 (18%) showing cavitation. The median time to sputum culture conversion by liquid culture was 42 days in the METRIF arm and 41 days in the control arm (hazard ratio, 0.8; 95% confidence interval [CI], .624–1.019). After 8 weeks of ATT, cavitary lesions on X-ray (7, 5.3% vs 18, 12.9%; relative risk, 0.42; 95% CI, .18–.96; P = .041) and inflammatory markers were significantly lower in the METRIF arm. Higher body mass index and lower sputum smear grading were associated with faster sputum culture conversion. Conclusions The addition of metformin to standard ATT did not hasten sputum culture conversion but diminished excess inflammation, thus reducing lung tissue damage as seen by faster clearance on X-ray and reduced inflammatory markers. Clinical Trials Registration Clinical Trial Registry of India (CTRI/2018/01/011176)

Introduction: Skin problems are common and diverse in patients with chronic kidney disease (CKD). Pruritus is a highly prevalent condition in patients with chronic kidney disease. It is associated with poor sleep quality, anxiety and depression which may contribute to reduction in quality of life. Objective: To study the prevalence and severity of pruritus among patients with chronic kidney disease. Materials and Methods: An observational study was conducted in 77 consecutive chronic kidney disease patients receiving maintenance hemodialysis for more than 3 months at Manik hospital, Aurangabad, Maharashtra, India were studied during January 2015 to December 2015. Results: Out of 77 patients, 51 (66.23%) of males and 26 (23.67%) of females were examined. The mean age was 51.17 years. Xerosis was the commonest manifestation (87.01%), followed by pruritus (57.14%). Mild pruritus was reported in 59.09% patients whereas severe pruritus was noted in 22.27% patients. High urea, phosphate and ALP levels were noted in severe pruritus group, but difference not statistically significant. 32 patients with pruritus on maintenance HD were followed over next 6 months. Out of 32 patients followed, 37.5% had no change in pruritus. Pruritus improved in 28.12%, while it actually worsened in 34.37% patients. Conclusion: In this study, 57.14% of patients with chronic kidney disease experience pruritus. Gender, age, presence of DM, duration of dialysis was not statistically significant between pruritus and non-pruritus group. Also hematocrit was similar in pruritus and non-pruritus groups. There was no significant difference in calcium, phosphorus and alkaline phosphatase levels in pruritus and non-pruritus groups. Keywords: Pruritus, Skin Disorders, Hemodialysis.

Background: This study was conducted to compare the results of skin closure using skin staples versus sutures in distal 1/3rd of lower limb surgery using Southampton Wound Scoring System. This study suggested there was higher incidence of inflammation wound gaping associated with skin staples however it was associated with better surgical scar after removal.Methods: Out of 60 participants who underwent distal 1/3rd lower limb surgery, in 30 patients wounds were closed with conventional nylon sutures and in other 30 patients wounds were closed with skin staples. Patients were evaluated post-operatively every 3rd day untill the day of suture removal and results were compared on the basis of Southampton wound scoring system, surgical time for closure and in terms of cosmetic appearance of scar. Results: Out of 60 patients, 34 were males and 26 were females. The Mean age group of this study population was 46.6 years with SD of 12.5 years. Wound infection rate was found to be higher with skin staples (13.33%) as compared to conventional nylon sutures (6.66%). However average surgical time for closure for skin staples was low (2.4 min) as compared to conventional sutures (5.7 min). But skin closure with nylon sutures resulted in a better surgical scar post-operatively. Conclusion: Primary wound closure in distal 1/3rd of lower limb surgeryis very important to reduce postoperative morbidity and complications. Wound closure with nylon sutures not only results in lesser rates of infection as compared to skin staples but also it gives better cosmetic results post sutures removal. The only advantage of using skin staples bekng less surgical time for wound closure.

Objective: In several countries including India, leprosy is an older disease & until now continuous to be an important health issue. Leprosy is a chronic granulomatous disease, the causative agent for which is mycobacterium leprae. Due to imbalance between natural antioxidants and oxidative stress is significant event occurs that influences the pathogenesis of leprosy. Considering this the study was carried out to find, what type of relationship between MDA, Protein carbonyl and thiols as disease advances. Methods: 50 diagnosed leprosy patients & 50 healthy controls were included in this study. In leprosy group, 16 were Paucibacillary (PB) and 34 were Multibacillary (MB) type leprosy patients. Results: Serum Protein carbonyl and serum Malondialdehyde increased in leprosy patients than controlling. Further analysis reveals that the serum malondialdehyde was significantly increased in MB leprosy patients than PB leprosy patients. On the other hand, our proposed system significantly lowers the total thiols in leprosy patients when compared with controls. Serum total thiols were lower in MB leprosy than PB leprosy patients. Among leprosy patients the negative correlation of Malondialdehyde with total thiol and Protein carbonyl with total thiols was observed. Conclusion: Thus, as protein oxidation and lipid per oxidation in leprosy increases, the total thiols decreases which may lead to modifications of protein and lipids that are responsible for severity of disease hence therapy aimed at reducing generation of free radicals that can result in oxidative stress and as a result a modification of proteins and lipids.

Objective: In several countries, including India, leprosy is an older disease & till now continues to be an important health issue. Leprosy is a chronic granulomatous disease, the contributing agent for this is mycobacterium leprae. Nitric oxide (NO) plays a significant role in immunity to fight against bacteria. But increased NO can harm host tissue by causing altered structure of thiol-containing compounds, which is a significant event that influences the pathogenesis of leprosy. Considering this, the study was planned to determine the type of relationship between NO, nitrothiols, and thiols as disease advances. Methods: 50 newly diagnosed leprosy patients & 50 healthy controls were included in the study. In the leprosy group,16 were Paucibacillary (PB), and 34 were Multibacillary (MB) type, leprosy patients. Results: Serum NO and serum nitrothiol significantly increased (p

Neonatal infection with SARS-CoV-2 is considered to have no major complications. A neonate with lower limb gangrene owing to spontaneous aortic thrombosis in the setting of a fetal inflammatory response syndrome (FIRS) post-intrauterine COVID-19 infection is presented. A healthy full-term newborn discharged from hospital on Day 3 developed irritability and progressive blackish discoloration of the toes of the right lower limb on Day 6 of life. Doppler imaging revealed acute thrombosis of the abdominal aorta with a critically ischaemic right lower limb. On Day 11 of life, SARS-CoV-2 RT-PCR was negative but total antibodies (IgG and IgM) were positive in both mother and neonate. The neonate showed raised inflammatory markers including CRP, ESR, interleukin-6, procalcitonin, ferritin and LDH along with elevated N-terminal pro-brain natriuretic peptide and D-dimer. In the absence of clinical signs of sepsis, FIRS was diagnosed. The neonate was treated with corticosteroids, heparin infusion and recombinant tissue plasminogen activator, and required surgical embolectomy followed by right limb amputation. By Day 31 of life, inflammatory markers showed serial return to normal and the neonate was discharged on oral steroids and aspirin. Intrauterine SARS-CoV-2 infection may trigger a systemic inflammatory response in some fetuses which is similar to post-COVID-19 multisystem inflammatory syndrome in children (MIS-C). Development of lower limb gangrene is a unique COVID-19-related neonatal complication and is attributed to thrombo-inflammation.ABBREVIATIONSCRP: C-reactive protein; FIRS: fetal inflammatory response syndrome; MIS-C: multisystem inflammatory syndrome in children; NT-proBNP: N-terminal pro-brain natriuretic peptide; RT-PCR: real-time polymerase chain reaction.

Context: In recent years, increasing awareness and early detection has made total anomalous pulmonary venous connection (TAPVC) a relatively common congenital heart condition presenting to children's heart centers in India. The condition was associated with significant morbidity and mortality in the past due to various reasons. Improvement in perioperative management has markedly changed the outcomes of TAPVC even in a developing country. Material and Methods: All patients with TAPVC operated between June 2013 and February 2018 at our center were included in the study. Post repair 30-days mortality and morbidity were analyzed. Results: A total of 166 patients were divided into supracardiac (91), infracardiac (45), cardiac (18), and mixed type (12). It also divided our cohort into obstructed and unobstructed types. The duration of inotrope usage in the obstructed group was significantly higher compared to the unobstructed group. Statistically, significant difference was noticed for the duration of ventilation 85.17 ± 80.94 h in obstructed type versus 49.23 ± 60.7 h in the unobstructed group, and in ICU stay (days) in obstructed (9.64 ± 5.96) and unobstructed group (6.29 ± 5.12). The morbidity parameters such as duration of an inotrope, ventilation, and length of ICU stay had a negative correlation between body surface area (BSA) of the patient but no correlation in respect to duration of CPB and ACC time. Mortality was found to be higher in lower BSA, infracardiac type (7/9), and obstructed variants of TAPVC (9/9) patients. Conclusions: Longer duration of inotrope usage, mechanical ventilation, and ICU stay were seen in obstructed TAPVC in comparison to unobstructed TAPVC patients. Duration of CPB or aortic cross-clamp had no effects on morbidity parameters. In our cohort of TAPVC patients, lower BSA was strongly associated with the longer requirement of inotropes, prolong ventilation time, and ICU stay. The risk factors for mortality in our study include lower BSA, infracardiac, and obstructed type of TAPVC.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common and treatable vestibular disorder. It is commonly seen in the elderly population. BPPV is a type of vertigo that is brought on by change in position of the head with respect to gravity. The objective of this study was to find out the prevalence of appropriate age group of the individuals suffering from BPPV in elderly population. The study was an observational study. A total of 64 people were recruited for the study aged between 60-70 and 71-80yrs that were selected from Krishna hospital Karad through a simple random sampling method. Inclusion and exclusion criteria were used to select the individuals for the study. Individuals of age group between 60-80 years of both the sex were also considered for the study. The individuals who were not included in the study were those not willing to participate, individuals’ history of acute trauma. Demographic data, assent and consent were taken from the individuals and the explanation of the study was given. The special tests like Dix-Hallpike positioning test, Horizontal roll test and Head pitch test were performed over the individuals. In this study the overall prevalence of age induced BPPV was evaluated according to Dix-Hallpike test it was found that out of 64 individuals 61% were positive for Dix-Hallpike test. Out of 45 males 26 were positive and 13 females from total 19 were indicated Dix-Hallpike test as positive. Thus, this result shows that females are more prone to develop BPPV. This study concluded that BPPV was common among the age group of 71-80 years than the age group of 60-70 years. The study revealed that the individuals in middle old age group are getting more affected by BPPV than the individuals in young old age group. Thus the societal impact which affects the individuals with BPPV can be reduced by making preventive strategies to improve the quality of life and to decrease the disability adjusted years.

Deep Neural Network (DNN) stands for multilayered Neural Network (NN) that is capable of progressively learn the more abstract and composite representations of the raw features of the input data received, with no need for any feature engineering. They are advanced NNs having repetitious hidden layers between the initial input and the final layer. The working principle of such a standard deep classifier is based on a hierarchy formed by the composition of linear functions and a defined nonlinear Activation Function (AF). It remains uncertain (not clear) how the DNN classifier can function so well. But it is clear from many studies that within DNN, the AF choice has a notable impact on the kinetics of training and the success of tasks. In the past few years, different AFs have been formulated. The choice of AF is still an area of active study. Hence, in this study, a novel deep Feed forward NN model with four AFs has been proposed for breast cancer classification: hidden layer 1: Swish, hidden layer, 2:-LeakyReLU, hidden layer 3: ReLU, and final output layer: naturally Sigmoidal. The purpose of the study is twofold. Firstly, this study is a step toward a more profound understanding of DNN with layer-wise different AFs. Secondly, research is also aimed to explore better DNN-based systems to build predictive models for breast cancer data with improved accuracy. Therefore, the benchmark UCI dataset WDBC was used for the validation of the framework and evaluated using a ten-fold CV method and various performance indicators. Multiple simulations and outcomes of the experimentations have shown that the proposed solution performs in a better way than the Sigmoid, ReLU, and LeakyReLU and Swish activation DNN in terms of different parameters. This analysis contributes to producing an expert and precise clinical dataset classification method for breast cancer. Furthermore, the model also achieved improved performance compared to many established state-of-the-art algorithms/models.

Iron is a crucial element necessary for blood formation in the body and its normal growth. However, irregular metabolism of iron due to absence of an elimination mechanism may deposit excess iron in the organs (iron overload) leading to metabolic disorders. Interactions between the iron regulatory peptide hormone, hepcidin and the iron exporter ferroportin plays major role in regulating the iron metabolism. Mutations in the ferroportin encoding genes, and dysregulation of hepsidin production often results in iron overload resulting in conditions like hemochromatosis, β-thalassemia, and sickle cell anemia. Until today, there is no efficacious treatment available for managing iron overload targeting ferroportin inhibition via oral administration.Novel salts of substituted benzoimidazole compounds useful for the prophylaxis and/or treatment of iron overload are claimed. These compounds act as hepcidin mimetic and inhibit the ferroportin thereby preventing iron overload. The claimed actives are useful in the treatment of disease conditions such as neurodegenerative and cardiac diseases triggered by iron overload. Preclinical studies of these salts on mouse model are also discussed.Prevention and/or treatment of iron overload is critical. The claimed compounds are the first oral drug candidate to treat iron overload and reach the pre-clinical development stage.

To look for early breast cancer signs and indications, mammography screening is one of the best approaches available. Screening mammograms are the most commonly recognized procedure and remain the gold standard for early breast cancer screening. But many times, a relatively low positive predictive rate of breast biopsy demonstrated by this diagnostic technique leads to unneeded biopsies for abnormal findings that are ultimately proven benign in many cases. Random Forest (RF)—which evolves from Decision Trees (DTs)—is one of the most practical and powerful ensemble learning concepts (or meta estimators). Breast Imaging Reporting and Data System (BI-RADS) is developed as a standardized system or tool for reporting breast mammograms. This technique is used to locate unusual findings into groups. In this study, the RF classifier with Chi-Square (χ2) and Mutual Information (MI) procedures of relevant Feature Selection (FS) has been applied successfully, in an attempt to predict cancer biopsy outcomes from BI-RAD findings and the patient’s age. For validation purposes, the UCI Mammographic Mass dataset has been used and assessed using accuracy, AUC, and several other performance criteria through a 10-fold CV approach. The prediction findings from the proposed method were very encouraging (84.70% accuracy and AUC 0.9023). Similarly, the proposed system gave better results in terms of MCC and F1-score. The results were directly compared with the RF classifiers and other state-of-the-art classification methods. This comparative analysis indicates that the proposed model is superior in terms of various efficiency indicators to the RF classifier and all standard models used in the study. These findings also confirm that the χ2 and MI FS approaches correctly as well as efficiently obtained the relevant and discriminating feature subset. The result also points out that the suggested approach is a comparable approach to different classification models present in the relevant literature. It is an advantageous, practical, and sound method to predict cancer biopsy outcomes.

Introduction: SARS-CoV-2 induces a cytokine storm and can cause inflammation, fibrosis and apoptosis in the lungs, leading to acute respiratory distress syndrome (ARDS). ARDS is the leading cause of mortality and morbidity the associated to COVID-19, and the cytokine storm is a prominent etiological factor. Mesenchymal stem cell-derived extracellular vesicles are an alternative therapy for the management of inflammatory and autoimmune conditions due to their immunosuppressive properties. The immunomodulatory and tissue regeneration capabilities of extracellular vesicles may support their application as a prospective therapy for COVID-19.Areas Covered: We explored the clinical evidence on extracellular vesicles as antiviral agents and in mitigating ARDS, and their therapeutic potential in COVID-19.Expert Opinion: Clinical trials using extracellular vesicles are registered against COVID-19 associated complications, with some evidence of safety and efficacy. Extracellular vesicles present an alternative potential for cell therapy for COVID-19 management, but further preclinical and clinical investigations are needed.

C677T (rs1801133) and A1298C (rs1801131) MTHFR gene polymorphisms and/or nutritional deficiency of folate/vitamin B12 leading to hyperhomocysteinemia is an established risk factor for CAD. The objective of this study was to evaluate the clinical usefulness of association between MTHFR C677T (rs1801133) and A1298C (rs1801131) polymorphisms with serum homocysteine, folate and vitamin B12 in addition to conventional cardiovascular risk factors in patients with young CAD. Genomic DNA was isolated from the whole blood. Genotyping of MTHFR C677T (rs1801133) and MTHFR A1298C (rs1801131) polymorphisms in young CAD patients and healthy controls was performed by ARMS-PCR method. Serum homocysteine, vitamin B12 and folate were estimated by CMIA and lipid profile parameters were measured by automated chemistry analyzers. Serum homocysteine levels were significantly higher but serum folate and vitamin B12 levels were not significantly different among young CAD group as compared to control group. Statistically significant hyperhomocysteinemia was observed in carriers of T allele for MTHFR 677C/T (rs1801133) genotype in young CAD group but this association was not significant for MTHFR 1298A/C (rs1801131) polymorphism. The association between hyperhomocysteinemia and CAD in young group was not independent of conventional cardiovascular risk factors. Risk of hyperhomocysteinemia and young CAD could be monitored by MTHFR polymorphism detection followed by serum homocysteine, folate and vitamin B12 measurements. The findings could help to prevent or delay the occurrence of young CAD through appropriate measures.

Many evidences suggested that stressful experience might affect diabetes. The estimate of the actual number of diabetes in India is around 40 million. This means India actually has the highest number of diabetic’s patient of any one country in entire world. No doubt, one of the natural element of life i.e. Stress is a major contributor to the diabetes. Stress can bring many unexpected changes in the blood sugar level; this could trigger symptoms associated with diabetes. Some retrospective human studies have suggested that the stress can participate in Type-1 diabetes, animal studies have shown that stress can cause Type-1 diabetes. impaired glucose tolerance and metabolic disease, however human studies have shown that stress can stimulate hyperglycaemia, insulin resistance. In contrast more consistentevidence support the role of stress in Type-2 diabetes. In recent year the complexities of the relationship between stress and diabetes have become well known but have been less well researched. Some studies have suggested that stressful experience may affect the onset and the metabolic control of diabetes, but finding have often been inconclusive. In this article we reviewed some of this research going on to consider how stress might affect the diabetes and physiological mechanism through which this may occurs and their preventions and management.

Background/Aim: Many patients experience moderate to severe pain after laparoscopic cholecystectomy. We aimed to compare efficacy of subcostal TAP block vs port site infiltration for post-operative analgesia in these patients.Methods: Patients undergoing elective laparoscopic cholecystectomy under general anaesthesia were divided randomly into two groups of 30 each to receive either ultrasound‑guided bilateral subcostal TAP block (T) with 0.25% ropivacaine total 20 ml each side or port‑site infiltration with 0.25% ropivacaine 5 ml each at 4 ports (I) at the end of the surgery before extubation. NRS for pain was assessed serially at 0 time point (after extubation), 1, 2, 3, 6, 12 and 24 h after surgery. Time for first rescue analgesia was noted. Inj.tramadol was used for rescue analgesia. Chi‑square test and independent t‑test were used to compare qualitative and quantitative data, respectively.Result: Time to first rescue analgesia in group I was 5.7±0.98 hr and in group T was 9±1.29 hr (p value=0.0001). Mean tramadol consumption in group I was 200 ± 64.33mg and in group T was 113.33 ± 34.57mg (p value =0.0001). Mean NRS score in group T was significantly lower in group T as compared to group I.Conclusion: Ultrasound guided subcostal TAP block provides better post-operative analgesia compared to port site infiltration in laparoscopic cholecystectomy patients.

Brain-derived neurotrophic factor (BDNF), a member of the neurotrophin family, has an extensively studied classical role in neuronal growth, differentiation, survival, and plasticity. Neurotrophic, from the Greek neuro and trophos, roughly translates as "vital nutrition for the brain." During development, BDNF and its associated receptor tyrosine receptor kinase B are tightly regulated as they influence the formation and maturation of neuronal synapses. Preclinical research investigating the role of BDNF in neurological disorders has focused on the effects of decreased BDNF expression on the development and maintenance of neuronal synapses. In contrast, heightened BDNF-tyrosine receptor kinase B activity has received less scrutiny for its role in neurological disorders. Recent studies suggest that excessive BDNF-tyrosine receptor kinase B signaling in the developing brain may promote the hyperexcitability that underlies refractory neonatal seizures. This review will critically examine BDNF-tyrosine receptor kinase B signaling in the immature brain, its role in the emergence of refractory neonatal seizures, and the potential of targeting BDNF-TrkB signaling as a novel antiseizure strategy.

BACKGROUND Chronic kidney disease (CKD) is a global health problem which is progressive and asymptomatic until the end stage in recent years which is most common in patients of middle and low socio-economic status. The disease is mostly associated with diabetes or hypertension, young and middle-aged individuals living in agricultural communities and drinking well water. We want to study the clinicopathological profile of chronic kidney disease of unknown aetiology (CKDU) cases admitted in a rural tertiary care hospital. METHODS A retrospective study was conducted among fifty patients who reported with ultrasonography (USG) report showing small shrunken kidneys and / or kidney biopsy suggestive of chronic tubulointerstitial nephritis with absence of immune deposits and admitted in the Medicine department of AVBRH Hospital and JNM College of Medical Sciences, Sawangi (M) Wardha of Central India. RESULTS The mean age was 36.46 ± 10.90 years with majority of the patients between the ages of 35 to 55 years. The body mass index (BMI) of the study group was within 22.52 ± 1.96. CKDU was more commonly seen in males (64 %) as compared to females (36 %). The subjects were predominantly farmers (54 %) who used to drink well water. USG showed small shrunken kidneys in all the study subjects, which was in 100 % cases. Pesticide exposure was seen in 32 % cases. The glomerular filtration rate (GFR) revealed that 30 % of the patients were in grade II. The biochemical report revealed the mean value of haemoglobin to be 8.75 ± 1.39, mean serum urea level to be 64.96 ± 15.19, mean serum creatinine level to be 4.5 ± 2.67, mean serum sodium level to be 132.48 ± 5.83 and mean serum potassium to be 4.43 ± 0.78. The mean random blood sugar (RBS) value was 98.64 ± 19.62, serum calcium level was 8.87 ± 0.43, serum phosphorus level was 5.05±0.39 and urine protein / creatinine ratio was 0.90 ± 0.12. CONCLUSIONS This study highlights the need to review health policies and allocates resources for prevention and treatment of CKDU in Central India, Maharashtra. KEY WORDS Chronic Kidney Disease of Unknown Aetiology (CKDU), Hypertension, Diabetes, Shrunken Kidneys

The aim of the present study is to compare the clinical and functional outcome in the patients with Lateral Epicondylitis elbow treated with local Corticosteroid injection vs Platelet Rich Plasma. A total of 74 patients were included in the study, divided into two groups equally. One group comprising of 37 patients with a mean age of 34 years was managed with intralesional autologous platelet rich plasma (PRP) injection and the other 37 patients with mean age of 37.20 years were treated with intralesional injection of 2ml Triamcinolone 40mg diluted with 2ml of 0.5% Bupivacaine. The results were calculated on the basis of the pre and post treatment VAS Score, DASH score and MAYO Elbow Performance score evaluated on 3 occasions post treatment, at 3 months, 6 months and finally at 12 months follow up. This study concludes that PRP injection gives slightly better functional outcome as compared to Corticosteroid injection however pain relief is comparatively similar with the two treatment procedures. A bigger sample size will be required to conclude a significant difference in the outcome of the two methods of management of lateral epicondylitis.

Professionals and mountaineers often face the problem of reperfusion injury due to re-oxygenation, upon their return to sea-level after sojourn at high altitude. Small conductance calcium-activated potassium channels (SK channels) have a role in regulating hippocampal synaptic plasticity. However, the role of SK channels under hypoxia-reoxygenation (H/R) is unknown. The present study hypothesized that SK channels play a significant role in H/R induced cognitive dysfunction. Sprague–Dawley rats were exposed to simulated HH (25,000 ft) continuously for 7 days followed by reoxygenation periods 3, 6, 24, 48, 72 and 120 h. It was observed that H/R exposure caused impairment in spatial memory as indicated by increased latency (p

Magnetic resonance imaging (MRI) findings of acute metabolic crisis in maple syrup urine disease (MSUD) in neonates were reviewed. This case cohort study included six MSUD neonates imaged during acute metabolic decompensation. Specific diffusion imaging and proton spectroscopic findings were reviewed. All patients revealed extensive intramyelinic cytotoxic edema typically involving myelinated white matter structures. Brainstem, cerebellar white matter and peduncles, midbrain, posterior limbs of internal capsules, central portions of periventricular, and perirolandic white matter regions showed typical MSUD edema. Gray matter structures such as dentate nucleus and thalamus were involved in all patients. Involvement of other deep nuclei was also noted in a few patients. None of the patients showed involvement of the superficial cortex. Reduction in N-acetyl aspartate, a prominent lactate peak, and a peak representing methyl groups of amino acids were characteristic findings seen on intermediate short echo time MR spectroscopy. Our case series outlines the importance of diffusion and spectroscopy MR techniques in the diagnosis of acute neonatal MSUD metabolic crisis.

BACKGROUND: Umbilical venous catheters (UVC) and peripherally inserted central catheters (PICC) are commonly used in preterms. UVC is cheap, easy to insert but has shorter dwell time. UVC is replaced after 7 days due to the risk of complications. This is associated with increased cost, work, and risk of nosocomial infections. The aim of this study was to determine the antenatal and postnatal factors that predict the need for a central line for more than 7 days, thus helping select between UVC or PICC on day 1 of life in babies ≤1500 grams. METHODS: We retrospectively collected antenatal and postnatal data of VLBW neonates over a period of 1 year who needed CL during their NICU stay. We then divided them into two cohorts. Group 1: CL ≤7 days. Group 2: CL > 7 days. RESULTS: Sepsis and catheter complications were lower with use of a single CL or duration being ≤7 days. Birth weight, incomplete/no antenatal steroids, need for resuscitation, low Apgar’s, RDS, hs-PDA, and initiation of feeds beyond 24 hours of birth were significant. The score was devised based on factors found significant that had an acceptable AUC of 0.767 on ROC analysis with a score of 1 or above having 74.8% sensitivity and 67.7% specificity for prediction of need for CL > 7 days. CONCLUSIONS: Birth weight ≤1000 grams, incomplete steroids and need for resuscitation at birth were predictive of the need of CL beyond seven days, on day one of life.

Background: Malnutrition is a complex problem with double burden of undernutrition and overweight. India is no exception to it but there is a higher level of malnutrition in tribal blocks and to curb this situation,various activities have been undertaken but the slow pace of decline in malnutrition is a concern.The role of frontline health workers is crucial in strengthening primary health care.They serve as the bridge between the formal government health-care system and the community.The present study helps to seek the perception of primary health care service providers and challenges faced by them in reducing child deaths due to malnutrition. Method: A descriptive cross sectional qualitative study was conducted during August 2019 - February 2020 in three talukas of a tribal district. Focus group discussions (FGD) for each service providers Auxiliary Nurse midwife (ANM), Anganwadi worker (AWW) and Accredited Social Health activist (ASHA) were conducted. All the FGDs were audio recorded and transcripts were prepared,a thematic analysis framework was used for doing the analysis. Results: Most of the service providers were aware regarding their roles and responsibilities in implementation of schemes/ services related to malnutrition. The important factors influencing their performance were superstitions, more reliance on health seeking from unqualified health care providers and faith healers, poor road connectivity, network issues,lack of refresher training,overburdening with work,poor incentives. Conclusion: Specific training programs to tackle malnutrition along with frequent refresher training of the service providers,better infrastructure and human resources will help in achieving the desired results in future in dealing with child malnutrition.

Background: Lung is the main organ at risk for radiation induced injury while treating breast cancers with Post Mastectomy Radiotherapy (PMRT). Restrictive lung changes are usually seen in spirometry which tends to normalize by 1 year. Central Lung Distance (CLD) is shown to correlate well with the percentage of ipsilateral lung volume irradiated. Aims and Objectives: Spirometric changes following Radiation Therapy (RT) to chest wall in breast cancer patients using conventional fractionation and its correlation with acute radiation pneumonitis. Materials and Methodology: Thirty Breast cancer patients who received RT to chest wall +/- supraclavicular fossa and axilla, following Modified Radical Mastectomy (MRM) and neoadjuvant or adjuvant chemotherapy using tangential beams with Co60 teletherapy to a dose of 50 Gray in conventional fractionation were included and followed up till 6 months post RT. Baseline chest X-ray and spirometry done pre-RT were compared with those taken at 1, 3 and 6 months after completion of RT. Patients were evaluated at each visit for signs and symptoms of radiation pneumonitis, when present were graded as per Radiation Therapy Oncology Group (RTOG) criteria. Results: There was a significant fall in Forced Vital Capacity (FVC) by the end of 3 months (p value

The National Cancer Institute (NCI) Genomic Data Commons (GDC) contains more than 2.9 petabytes of genomic and associated clinical data from more than 60 NCI-funded and other contributed cancer genomics research projects. The GDC consists of five applications over a common data model and a common application programming interface.

Study of Maternal and Foetal outcome in Abruptio Placentae Introduction: Abruptio placentae (AP) is a significant obstetrical emergency and as per WHO 2009 maternal mortality rates reported due to AP worldwide was 2.1% and fetal perinatal mortality rate was 15%. AP cannot be prevented but maternal and perinatal morbidity and mortality due to AP can be reduced significantly by aggressive management. Methods: The present prospective study was conducted to evaluate the outcome of treatment on the perinatal and maternal outcome in Abruptio Placentae patients in a tertiary care hospital from January 2015 to January 2016 amongst 54 pregnant women diagnosed to have abruptio placentae from 28 weeks of gestation and above and all babies delivered. Face-to-face interviews was conducted. Results: Maximum no. of abruptio placentae were unbooked - 37 (69%) and 85% of patients belonged to the less than 30 years of age group. An abruptio placenta was more common in multipara. Anaemia was seen in 21 patients (38%). Anaemia and PIH was seen in 12 patients (23%). 7 patients had fetal distress at the time of admission (13%). Regarding mode of delivery, 50% of patients delivered vaginally by artificial rupture of membrane (ARM) and oxytocin augmentation and 50% underwent caesarean section. Conclusion: It was concluded that abruptio placentae is still a leading cause of maternal morbidity and mortality that can be reduced with modern management of abruptio placentae, but timely diagnosis and intervention is necessary. Key Words: Abruptio placentae, maternal mortality, fetal distress, anaemia

Targeting inhibitory immune checkpoint molecules has highlighted the need to find approaches enabling the induction and activation of an immune response against cancer. Therapeutic vaccination, which can induce a specific immune response against tumor antigens, is an important approach to consider. Although this approach has shown low clinical efficacy when combined with other treatment modalities, therapeutic cancer vaccines will have a better outcome when combined with immune checkpoint blockade therapy with potential for cancer free survival. In this review, we will discuss the results of our two recent publications in preclinical lung cancer models. Our studies reveal that anti-PD-1 administered in combination with CCL21-DC tumor antigen therapeutic vaccines eradicate lung cancer. The results of these studies highlight the importance of combination therapy of immune checkpoint blockade and therapeutic cancer vaccines for lung cancer patients.

Background: Internal fixation is appropriate for most intertrochanteric fractures. Optimal fixation is based on the stability of fracture. The mainstay of treatment of intertrochanteric fracture is fixation with a screw slide plate device or intramedullary device. So, it is a matter of debate that which one is the best treatment, dynamic hip screw or proximal femoral nailing.Method: A prospective randomized and comparative study of 2 years duration was conducted on 60 patients admitted in the Department of Orthopedics in MGM Medical College and Hospital, Navi Mumbai with intertrochanteric femur fracture. They were treated by a dynamic hip screw and proximal femoral nail antirotation Asia. Patients were operated under image intensifier control. The parameters studied were functional outcome of Harris hip score, total duration of operation, rate of union, amount of collapse. These values were statistically evaluated and two tailed p-values were calculated and both groups were statistically compared.Result: The average age of our patient is 67.8 years. Among the fracture, 31% were stable, 58% were unstable, 11% were reverse oblique fracture. The average blood loss was 100 and 250 ml in PFNA2 and DHS group, respectively. In PFNA2 there was more no. of radiation exposure intra-operatively. The average operating time for the patients treated with PFNA2 was 45 min as compared to 70 min in patients treated with DHS. The patients treated with PFNA2 started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 months). In the long term both the implants had almost similar functional outcomes.Conclusion: In our study we have found that the unstable pattern was more common in old aged patients with higher grade of osteoporosis and PFN group has a better outcome in this unstable and osteoporotic fracture. PFNA2 group has less blood loss and less operating time compared to DHS group. In PFNA2 group patients have started early ambulation compared to DHS group.

BACKGROUND: Diagnosis of genital tuberculosis (TB) as a cause of infertility still remains a diagnostic dilemma for clinicians, as no standard guidelines exist. The recently proposed best practices for genital TB diagnosis have not been evaluated yet in India. OBJECTIVES: To implement best practices to diagnose and treat likely genital TB as a cause of infertility. METHODS: Between April 2016 and June 2018, consenting women seen at a tertiary hospital infertility clinic were assessed by thorough TB related clinical history, ultrasonography, tuberculin skin test (TST), and ESR. Those with suspected genital TB underwent laparohysteroscopy. Clinical and laboratory characteristics were compared between likely (microbiologically confirmed or probable TB) and unlikely (possible and no genital TB) genital TB. Fertility outcome was assessed among women initiated on anti-TB treatment (ATT). RESULTS: Of 185 women seeking infertility care, likely genital TB was identified among 29 (15.7%) women, with 6 (21%) confirmed and 23 (79%) probable genital TB. Compared to unlikely genital TB cases, the likely genital TB group were found to have past history of TB (p < 0.001); positive TST (p = 0.002) and elevated ESR (p = 0.001). Among the likely genital TB group, all 6 confirmed genital TB were started on ATT and 2 (33.3%) conceived. Of 5 probable genital TB started on ATT, 3 (60%) conceived. CONCLUSION: Approximately 1/6th of women seeking infertility care met the criteria for likely genital TB. Conception among over-half of treated probable genital TB cases provides preliminary evidence that best clinical practices can be utilized, but needs further confirmatory studies.

Objective: To assess the clinical characteristics, risk factors, and comorbidities associated with type 2 diabetes mellitus (T2DM) in young adult patients. Methods: This is a retrospective, multicentric real-world study that included young adults (18–45 years) with T2DM. Primary information including demographics, medical and family history, biochemical measures (pre-and post-prandial blood glucose levels, glycosylated hemoglobin [HbA1c] and blood pressure, and lipid parameters) smoking and drinking habits were collected retrospectively from the medical records of the respective hospitals/clinics. Data were analyzed using descriptive and appropriate comparative statistics. Results: A total of 22,921 patients from 623 sites were included. The median age was 37.0 years and the majority were men (61.6%). The proportion of patients from the age group >35–≤45 years was 62.7%. Among all patients, 46.9% had only T2DM; however, 53.1% of patients had T2DM with other comorbidities (T2DM with hypertension, dyslipidemia, and both). The majority of patients had elevated body mass index (BMI) (overweight, 46.6%; and obese, 22.9%). Family history of T2DM (68.1%) was most common in overall population. Sedentary lifestyle (63.1%), alcohol consumption (38.9%), and regular smoking (23.1%) were the most common associations in patients with T2DM with dyslipidemia and hypertension. Uncontrolled HbA1c level (≥7%) were observed in 79.2% of patients. The level of HbA1c was significantly increased with the duration of T2DM and sedentary lifestyle (p < 0.001). Conclusion: Higher BMI, family history of T2DM, sedentary lifestyle, alcohol consumption, and smoking were the most common risk facors, while hypertension and dyslipidemia were the most prevalent comorbidities associated with T2DM in young Indian adults.

Cerebral Palsy (CP) is a common disorder of posture and movement caused by a non-progressive injury to the developing brain. Based on the degree of brain lesion the child can have hemiplegia , spastic diplegia or even total cerebral palsy Achilles tendon spasticity, weakness, or contracture in these conditions may lead to gait abnormalities. Achilles tendon plays an important role in performing plantar flexion and dorsiflexion of the ankle. The objective of this study was to find out the effect of structured exercises for Achilles tendon tightness prevailing in spastic cerebral palsy children. A total 34 subjects was selected for the study. Inclusion and exclusion crieteria were used to select the children for the study. Children of ages between 2 to 6 years of both sex were also considered for the study. The subjects who were not included in the study were those not willing to participate, individual’s history of acute trauma or with any congenital musculoskeletal problems, previous surgery or pain in the lower limbs, Vision and hearing problems and Cardio-respiratory problems. Demographic data, assent and consent was taken from the child and their parents, respectively and the explanation of the study was given. Pre and post assessment was taken on the basis of Tardieu scale before and after 16 sessions of the treatment respectively. Each session was of 45 mins and was started with warm exercises and then functional exercises were carried out. Later evaluation and interpretation of the data was done. The study revealed that there was significant effect of structured exercises for Achilles tendon tightness in subjects with spastic cerebral palsy. The structured exercise for Achilles tendon tightness was very effective in improving the gait and strength of the spastic cerebral palsy children.

The field of sports dentistry mainly deals with the prevention and management of sports-related to maxillofacial trauma. There are many potential challenges to the oral health of athletes including exercise-induced trauma, dental decay due to specialized diet, lack of awareness, oral dehydration and lack of prioritization for dental care. However, there is good evidence that some oral diseases are preventable by simple interventions with good efficacy. Hence dentists today must respond to these patient's specialized needs, providing them with the quality of care that they deserve. In this review article, we discuss the various preventive aspects of sports-related injuries and the impeccable role of dentist in preventing and managing the sport-related oro-facial injuries.

The present study was a two year observational study of haematological profile in clinically suspected cases of neonatal sepsis. Study analyzed the haematological findings according to Rodwell’s haematological scoring system in neonates clinically suspicious of having sepsis. It included 108 neonates admitted in NICU of our hospital during the study period of June 2015 to May 2017. According to clinical findings, Rodwell’s hematological score and blood culture positivity 108 neonates were divided into three groups; proven sepsis, probable sepsis and no sepsis. Study show that Rodwell’s haematological scoring system is a simple, quick, cost effective tool which can be used as screening test for early diagnosis of neonatal sepsis.

Introduction The management of acetabulum fractures in osteoporotic elderly, as well as comminuted fractures in younger patients is likely to be difficult. These fractures need specific fixation techniques especially when the quadrilateral plate is involved. Standard implants may not be able to adequately support the fixation, so newer pre-shaped fixation plates have been proposed with some of these already in use. The concept of anatomic plates has come up for many fracture locations for providing a better buttress effect to the comminuted fragments. There has been a need to look for an anatomic buttress plates being developed for acetabulum fractures involving the quadrilateral surface. Materials and methods The literature has been reviewed to find the various newer designs that have been used for buttressing the quadrilateral surface in comminuted acetabular fractures. An attempt has been made to study their design characteristics and clinical outcomes. The review also includes the analysis of Anatomic Quadrilateral plate (AQP) used in fixation of acetabulum fracture involving quadrilateral surface in a series of 33 patients. Results There has been few anatomical plates developed for the stabilization of acetabular quadrilateral surface fractures. Some of these plates have been successfully used in management of acetabular fractures primarily in young patients. Issues however remain in their application and outcomes in osteoporotic fractures of the acetabulum, as these plates support the pelvic brim fragments either from superior or medial surface. The newer development i.e. ‘Anatomical Quadrilateral Plate’ is optimized to counter the displacement forces due to its positioning on the pelvic brim rather than its superior or medial surface. Other special features include the possibility of longer screws across bone due to oblique position of holes, the typical location of a locking hole on the plate beam which permits dual cortical compression fixation either by using a bigger screw or a specially designed screw in screw construct across the supra-acetabular corridor. The option of using hybrid fixation of both locking and unlocked screws in AQP allows proper stress distribution on the underlying bone, aiding both primary as well as secondary stability. The minimum of one year post surgery outcome of patients having acetabular fixation using this Anatomic quadrilateral plate has been analyzed in 33 patients. Twenty three of these were aged more than 50 years and 28 out of total 33 were males. Associated injuries included Ipsilateral lower limb injury in 2 patients and distal radius fracture in 5 patients. The fracture pattern included ‘Anterior column posterior hemi-transverse’ in 10 patients,’ Associated Both Column’ injury in 9 and ‘T type’ acetabular fractures in 8 patients. Isolated ‘Anterior column’ was fractured in 6 patients. The surgical approach was ‘Anterior Intra-pelvic’ (AIP) in 23 patients and ‘Modified Ileo-femoral’ in other 10 patients. One patient had additional K L approach. Among the implants, the AQP plate was used without its pubic arm in 6 patients. The post-operative x rays showed anatomical reduction in 28 patients, while other 5 had gaps and/or steps up to 2 mm size. In subsequent car, one of these patients needed hip arthroplasty for problem arising due to collapse in fixation within six months. EQ 5D 5L telephonic score was used to know the outcome at minimum of one year follow up in 33 patients. As per this score, only 3 patients had an issue with mobility, with only one having problem in self-care activity. Six patients complained of minor limitations in carrying out their usual activities and only one patient had anxiety affecting him. In their self-assessment of overall health status, 22 patients marked it 100, 7 made it 90, 3 as 80 and 1 had marked it as 70 in a score range of 0–100. Considering the predominant elderly profile in this series of patients, the acetabular reconstruction using ‘Anatomic quadrilateral plate’ has shown encouraging results. Conclusion For stabilization of acetabular fractures involving quadrilateral surface area and pelvic brim, various new implants have been used. The Anatomic quadrilateral plate due to its anatomical shape, the various options in fracture fixation is best optimized for management of comminuted acetabulum fractures especially in poor quality bones. It has been successful in achieving good outcome in elderly group of patients having these complex injuries.

Anaemia during pregnancy is a major public health problem throughout the world, particularly in the developing countries. According to WHO, prevalence of anaemia in pregnant women is estimated as 14 per cent in developed and 51 percent in developing countries. In India the prevalence is 65-75 percent. Acharya Kashyapa explained that like other disorders Samprapti of Pandu is also similar in Garbhini. So all narration mentioned in Ayurvedic classics regarding Pandu is applicable to Garbhini- Pandu. In the present study total 37 patients were recruited under the study and distributed into two groups Group-A (Draksha ghrita) and Group-B (Lakshmana lauha). After completion of trial 30 patients data was only available for assessment and 07 patients were dropped out from the study due to their irregular follow-up. On analysis of results, none of the patient has showed excellent relief. 10.00% and 30.00% patient has showed moderate relief in group A & B respectively. 06.00% and 10.00% patient in A and B group showed marked relief while 06.66% and 00.00% patient in has showed mild relief in A and B group and also the 26.66% and 16.66% patient has showed no relief. When the two groups A and B were compared with each other, the percentage of relief is found higher in group B, so it implies that group B is more clinically significant than group A. Overall conclusion of this study is that Draksha Gritha and Lakshmana lauha both drugs are effective, but Lakshmana lauha is comparatively better to cure the Subjective and Objective parameter of Garbhini Pandu.

Maxillary midline diastema is one of the most frequently encountered esthetic problems in mixed and permanent dentition. Several causes have been attributed to the midline diastema, including developmental, pathologic or iatrogenic. It can also be seen as a transient malocclusion in which case any intervention is contraindicated. A wide range of possible treatments like restorative procedures, composite build up, surgeries (frenectomies) can be done, based on etiology. Thus, correct diagnosis of etiology and specific early intervention plays a major role in deciding the treatment plan. Class I malocclusion is one of the most common problems around the globe affecting around one-third of the patients who come for orthodontic treatment. This case report evaluates the management of Class I malocclusion with spaced dentition and a tongue thrusting habit in a male patient with the help of a single phase appliance therapy without the need for 2 phase correction, i.e, 1st the correction of tongue thrusting with the help of a habit breaking appliance followed by Fixed appliance therapy with braces. This modality not only saves time, but also promotes faster habit breaking as intervention is done in the earlier stages of life when the patient is still growing. Severe maxillar incisor proclination with a convex Orthognthic facial profile, increased mandibular plane angle, incompetent lips and increased overjet was observed on clinical and cephalometric analysis. Orthodontic treatment resulted in a marked improvement of the patient’s smile and a remarkable increase in self-confidence and quality of life. The profile changes and treatment results were demonstrated with proper case selection and good patient cooperation with fixed appliance therapy. Keywords: Tongue thrust correction, Midline Diastema, Fixed Appliance Therapy, Class I malocclusion, Spaced dentition, Aesthetic Improvement, Habit breaking.

Objectives In the past few years, herbal medicines have gained popularity over synthetic drugs because of their natural source and minimal side effects which has led to a tremendous growth of phytopharmaceuticals usage. With the development of nanotechnology, it provides alternative approaches to overcome several limitations using nano-formulations. In spite of considerable quantity of antianemic preparations with different iron forms available, currently additives are used and represented in modern pharmaceutical market. Iron deficiency anemia is a major global public health problem which particularly affects pregnant women, children and elderly persons. The situation is complicated because of disadvantages and drug side effects from existing antianemic medicines. There is a great demand for the development of new antianemic preparations. Green synthesis of iron oxide nanoparticles, possess high potential in this field. Methods Our study focuses on developing green synthesis of iron oxide nanoparticles (IONPs) of 10-50 nm with spherical shape where different dosages were used -1 mg/kg, 10 mg/kg and 100 mg/kg for exposure in Wistar albino female rats for 28 days. The toxicity was assessed using various parameters such as measurements of the rat body and organ mass, hematology, biochemical evaluation and histopathological examinations. Results No significant differences were observed in body and organ weights. Hematological indices also indicated no significant differences whereas biochemical factors showed increase in levels of direct bilirubin and globulin of medium as well as high dose and SGPT levels were increased only in high dose. The major organs (heart, kidney and liver) showed histopathological alterations in 10 and 100 mg/kg whereas brain showed only in 100 mg/kg. Conclusion The toxicity of IONPs was found to be more significant when the concentration was increased; however, low doses can be used for further investigation as an antianemic preparation.

Acute respiratory distress syndrome (ARDS) is the main cause for the COVID-19 infection-related morbidity and mortality. Recent clinical evidences suggest increased level of cytokines and chemokines targeting lung tissue as a prominent etiological factor. The immunomodulatory effect of mesenchymal stem cells (MSCs) as the alternative therapy for the treatment of inflammatory and autoimmune diseases is well known. Several studies have also revealed that similar therapeutic impacts of parent MSCs are also exhibited by MSCs-derived extracellular vesicles (EVs) including exosomes. In this review, we explored the therapeutic potential of both MSCs and exosomes in mitigating the COVID-19 induced cytokine storm as well as promoting the regeneration of alveolar tissue, attributed to the intrinsic cytokines and growth factor present in the secretome. The preliminary studies have demonstrated the safety and efficacy of MSCs and exosomes in mitigating symptoms associated with COVID-19. Thus, they can be used on compassionate basis, owing to their ability to endogenously repair and decrease the inflammatory reactions involved in the morbidity and mortality of COVID-19. However, more preclinical and clinical studies are warranted to understand their mechanism of action and further establish their safety and efficacy.

Background: Anterior communicating (A-com) artery region is very complex; perforators are not always visualized on the microscope. The neuroendoscope with its higher magnification, better observation, and additional illumination can provide us information that may not be available with the microscope in aneurysm surgery. Objective: The objective was to study the use of endoscope in surgical management of A-com aneurysm surgery and its advantages, whether and how it changes operative management. Materials and Methods: We studied 25 serial cases of A-com aneurysm at Bantane Hospital, Fujita University, Japan, from November 2018 to October 2019. Once aneurysm was exposed, we did preclipping indocyanine green (ICG) study and examination with endoscope. After clipping, we again did ICG and endoscopic assessment. Preclipping and postclipping endoscopic information was used and necessary changes were made in the operative decisions. Whether endoscope gives any additional information over microscope and ICG which led to change in the operative decision was assessed. Results: In six out of 25 A-com aneurysm patients, the use of endoscope has given additional information over microscope, and ICG leading to change in the operative plans such as readjustment of the clip/application of the second clip or release of perforator compromise. Conclusion: Simultaneous endoscopic and microscopic guidance can reveal important information hidden from the microscope. Thus, this method increases the safety and durability of the A-com aneurismal clipping.

CONTEXT: The therapeutic role of D2 lymphadenectomy in the management of gastric cancer is an ongoing controversy. AIMS: To examine the morbidity and oncological outcomes of D2 lymph node dissection for gastric cancer patients treated in a stand-alone cancer center in rural India and to compare it with international data. SETTINGS AND DESIGN: Retrospective study on patients treated for gastric cancer from June 2009 to December 2014. METHODS AND MATERIAL: All patients underwent subtotal or total gastrectomy with modified D2 lymph node dissection preserving spleen and pancreas. The Clavien-Dindo model was used to stratify the severity of morbidity. STATISTICAL ANALYSIS: Descriptive statistics was used for data exploration. Chi-square test was used to compare the association of various factors with survival. Kaplan-Meier method was used to calculate the survival rates (RFS and DFS). Log-rank test was used to compare the survival of different subgroups. RESULTS: Fifty-four patients (41 males and 13 females) were included in the study. Four (7.4%) patients had significant postoperative morbidity. The 5-year OS and DFS respectively were 34.9% and 37.6%. Female sex was associated with poorer survival. Lymph node ratio of more than 0.2 and advanced stage at presentation showed strong tendency towards lower OS and DFS. CONCLUSIONS: An R0 resection with D2 lymphadenectomy for gastric cancer carries acceptable morbidity and mortality in Indian patients with survival rates comparable with the western studies. Lymph node ratio more than 0.2 and female gender and advanced stage were associated with poorer oncological outcomes.

A series of novel acridine-thiazole bridged coumarin derivatives 3a–3i were designed, synthesized and subjected for their in-vitro antiproliferative activity on human breast cancer (MDA-MB-231), lu...

Background Metformin is the first-line treatment for type 2 diabetes mellitus (T2DM), but many patients either cannot tolerate it or cannot achieve glycemic control with metformin alone, so treatment with other glucose-lowering agents in combination with metformin is frequently required. Remogliflozin etabonate, a novel agent, is an orally bioavailable prodrug of remogliflozin, which is a potent and selective sodium-glucose co-transporter-2 inhibitor. Objective Our objective was to evaluate the efficacy and safety of remogliflozin etabonate compared with dapagliflozin in subjects with T2DM in whom a stable dose of metformin as monotherapy was providing inadequate glycemic control. Methods A 24-week randomized, double-blind, double-dummy, active-controlled, three-arm, parallel-group, multicenter, phase III study was conducted in India. Patients aged ≥ 18 and ≤ 65 years diagnosed with T2DM, receiving metformin ≥ 1500 mg/day, and with glycated hemoglobin (HbA1c) levels ≥ 7 to ≤ 10% at screening were randomized into three groups. Every patient received metformin ≥ 1500 mg and either remogliflozin etabonate 100 mg twice daily (BID) (group 1, n = 225) or remogliflozin etabonate 250 mg BID (group 2, n = 241) or dapagliflozin 10 mg once daily (QD) in the morning and placebo QD in the evening (group 3, n = 146). The patients were followed-up at weeks 1 and 4 and at 4-week intervals thereafter until week 24. The endpoints included mean change in HbA1c (primary endpoint, noninferiority margin = 0.35), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), bodyweight, blood pressure, and fasting lipids. Treatment-emergent adverse events (TEAEs), safety laboratory values, electrocardiogram, and vital signs were evaluated. Results Of 612 randomized patients, 167 (group 1), 175 (group 2), and 103 (group 3) patients with comparable baseline characteristics completed the study. Mean change ± standard error (SE) in HbA1c from baseline to week 24 was − 0.72 ± 0.09, − 0.77 ± 0.09, and − 0.58 ± 0.12% in groups 1, 2, and 3, respectively. The difference in mean HbA1c of group 1 versus group 3 (− 0.14%, 90% confidence interval [CI] − 0.38 to 0.10) and group 2 versus group 3 (− 0.19%; 90% CI − 0.42 to 0.05) was noninferior to that in group 3 (p

Background: Flow 800 is microscope-integrated analytical visualization tool which analyses the indocyanine green (ICG) video sequence and converts it into an intensity diagram. This allows an objective evaluation of the result rather than subjective assessment of ICG fluorescence. The anatomy of anterior communicating artery region is complex because of multiple vessels and perforators in small space; hence, there is a need of objective assessment tool which can give precise idea about vascular compromise. Flow 800 can serve as a valuable tool in this complex surgery. Objective: The objective of this study was to evaluate the utility of microscope-integrated fluorescent ICG videoangiography (Flow 800) in A-com aneurysm surgery. Materials and Methods: We used Flow 800 in ten consecutive patients of A-com aneurysm surgery from July 2019 to October 2019. We studied patient characteristics, intraoperative observation of ICG and Flow 800, and corresponding changes made in the operative decisions. Results: The use of Flow 800 helped in intraoperative decision of four out of ten patients of A-com aneurysm. In two patients, incomplete clipping was confirmed with Flow 800 and the second clip was applied. In the third patient, perforator compromise was found hence needed clip readjustment, whereas in the fourth patient, ICG was inconclusive and Flow 800 confirmed complete clipping of aneurysm. Conclusion: Flow 800 is a conclusive reproducible and objective tool for early detection of vascular compromise of multiple vessels and perforators in A-com aneurysm surgery. It gives a better idea of vasculature, especially where ICG is ambiguous or inconclusive.