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Purpose of review Nasal high flow therapy (NHF) is increasingly used in acute care settings. In this review, we consider recent advances in the utilization of NHF in chronic obstructive pulmonary disease (COPD), terminal cancer and symptom management. Considerations around NHF use during the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic are also discussed. Recent findings NHF enables humidification and high flows to be provided together with titrated, supplemental oxygen therapy. Compared to conventional oxygen therapy, NHF improves respiratory physiology by reducing workload, enhancing muco-ciliary clearance and improving dead space washout. Some studies suggest that early use of NHF in people being cared for in the emergency department leads to lower rates of invasive ventilation and noninvasive ventilation. There is also emerging evidence for NHF use in people with COPD and chronic respiratory failure, and in palliative care. NHF is comfortable, well-tolerated and safe for use in the management of breathlessness in people with cancer. NHF can be delivered by face mask to patients with SARS-CoV-2 infection, to ease the burden on critical care resources. Summary The evidence base for NHF is rapidly growing and offers promise in relieving troublesome symptoms and for people receiving palliative care.

Background: Posterior reversible encephalopathy syndrome (PRES) is clinicoradiological disease entity characterized by headache, seizures, altered sensorium and corticalvisual loss with characteristic MRI features of subcortical white matter hyperintensities on T2W imaging. Though hypertension is a traditional hallmark of PRES, uncommon causes without hypertension have been described. We report an unusual such case without hypertension, precipitated by red cell transfusion. Case Presentation: A 40 years female received six units of packed cell transfusion for severe anemia (Hemoglobin 3.0 Gm %) transfused over 8 hours. She was having menorrhagia and was operated on for a hysterectomy. She developed a headache on the second postoperative day for five days and no cause was revealed in spite of extensive workup, including MRI brain and CSF study. On the sixth day, she had recurrent seizures followed by altered sensorium in the absence of hypertension. Her repeat MRI brain findings were consistent with PRES. Conclusion: We reviewed 25 cases, including the present one as PRES after the blood transfusion. 24 were females, and 16 of 19 developed PRES in the course of chronic anemia lasting over 1 month. Anemia was severe in 18 of 25 cases, with haemoglobin (Hb) levels < 4.0 Gm%. In 16 of 20 cases, Hb levels increased to 5 g/dl by red cell blood transfusion until the onset of PRES. On MRI brain, 23 of 25 cases showed vasogenic edema and 3 of 25 cases showed an irreversible neurological deficit. When treating severe chronic anemia rapid correction of Hb with blood transfusion, one should consider a possibility of PRES in post-transfusion neurological symptoms in spite of normal diagnostic workup.

PURPOSE Visual outcomes after postinjection endophthalmitis have been well-studied, but the effect of endophthalmitis on the underlying exudative disease process remains unclear. We investigate the need for continued anti-vascular endothelial growth factor injections after endophthalmitis. METHODS Eyes that developed endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor between January 1, 2016, and May 31, 2018, at a single academic retina practice were identified. Retrospective chart review was performed to determine 1) the proportion of eyes without recurrence of macular edema or subretinal fluid after endophthalmitis and 2) the proportion achieving a 12-week or greater interval between anti-vascular endothelial growth factor injections or exudation after endophthalmitis compared with internal controls before endophthalmitis. RESULTS Of 50 eyes with endophthalmitis, seven (14.0%) had no fluid recurrence at a mean of 98.1 week. Of 43 eyes with recurrence, 48.0% achieved a >12-week recurrence-free interval after endophthalmitis (vs. 8.3% before endophthalmitis; P < 0.0001). Eyes with compared to those without choroidal neovascularization were more likely to achieve this interval (60.5% vs. 8.3%, respectively; P = 0.002). CONCLUSION Endophthalmitis after anti-vascular endothelial growth factor injection is associated with relative stability of the underlying exudation. Further research is necessary to elucidate the mechanism, which may be useful in developing strategies and targets for the treatment of exudative macular diseases.

Hepatitis C is a positive stranded enveloped RNA virus belonging to the Flaviviridae family. HCV infection leads to severe liver diseases, cirrhosis and hepatocellular carcinoma worldwide. Although treatments have been available for a while, due to its complexity and genetic diversity, only few are reported to be effective against all HCV genotypes. Here, we review the HCV life cycle and its immunogenic potential and various mechanisms via which the virus interferes in the signalling process. A comprehensive overview of current anti-HCV therapeutics, such as, Direct Acting Antiviral (DAA) as well as Host Targeting Agents (HTA), along with their scope, known mechanism of action and limitations are presented. Supplementary Information The online version contains supplementary material available at 10.1007/s13337-021-00697-0.

BACKGROUND Breast cancer is the most commonly diagnosed malignancy in women worldwide (22%), and in India (18.5%) it ranks second to cervical cancer. The burden of breast cancer is increasing in both developed and developing countries. India is a vast country with huge population, cultural diversity, geographical variations, diets and habits; sources of information on cancer risk factors are limited. Ageing is the main risk factor for breast cancer. Some of the associated factors related to reproductive and lifestyle includes literacy, diet, age at menarche and menopause, age at first delivery, abortion, and family history of breast cancer. Various pneumonic devices are used in teaching breast self-examination which includes “7Ps” - position, perimeter, palpation, pressure, pattern, practice, and planning, what to do if a change is found in a breast tissue. This study was carried out with the intention of assessing the level of knowledge and prevention of breast cancer and breast self-examination (BSE) in female nursing students. METHODS A descriptive study was carried out in the Nurses’ Training Institute, Agartala, Tripura. A total of 100 students present on those days of data collection and who gave consent were included in the study. RESULTS 94 % were in the age group of 18 - 22 (reproductive age group) years. Among the 100 study participants, only 1 % had adequate knowledge followed by 36 % having moderate knowledge and majority (63 %) were under ‘inadequate level of knowledge’. Study showed that, there is a significant association between nursing student’s religion and educational level with the knowledge score on breast cancer and its preventive measures with chi square = 20.46 and chi square = 31.47 respectively at P < 0.05 level of significance. CONCLUSIONS This study concluded that the knowledge level of breast cancer among nursing students was poor. Nurse educator has ample opportunity for taking active part in educating the nursing students regarding breast cancer and its prevention. Education is of utmost importance for early detection of breast cancer and reduction of mortality. KEYWORDS Breast Cancer, Adequate, Moderately adequate, Inadequate

Background: Autoimmune polyglandular syndrometype-2 (APS-2) is an uncommon endocrine disorder of Addison’s disease with an autoimmune thyroid disorder and/or type 1 diabetes mellitus. The diagnosis is more challenging when a patient presents with nonspecific neuropsychiatric features with hypothyroidism in the setting of unrecognized Addison’s disease. Case Report: We report a case of subclinical autoimmune hypothyroidism presented with nonspecific neuropsychiatric symptoms precipitated by stress. Despite levothyroxine treatment, her symptoms deteriorated and she was admitted with persistent vomiting and hypovolemic shock. Clinical features and laboratory parameters were suggestive of underlying adrenocortical insufficiency. Preexisting autoimmune hypothyroidism combined with Addison's disease confirmed the diagnosis of unrecognized APS-2. She remarkably improved and her thyroid function tests also normalized with the treatment of corticosteroids only. Review of the Literature: We identified only five published case reports of our title by searching the database. Neufeld and Betterle have reported their data of APS-2 and concluded that a full- blown clinical picture of two or more components of the syndrome is like the tip of the iceberg. Conclusion : The patients of one major component of APS-2 should be screened for other components of the disease to pick up latent cases. Addison’s disease should be ruled out in patients of hypothyroidism who are intolerant to levothyroxine.

To compare 2 mg intravitreal triamcinolone (IVT) versus 40 mg posterior sub-Tenon triamcinolone acetonide (STT) for the treatment of eyes with pseudophakic cystoid macular edema.A retrospective, single-center review of eyes receiving 2 mg IVT between 3/1/2012-3/1/2017 and 40 mg STT between 1/1/2015-3/1/2017. Visual acuity (VA) and central macular thickness (CMT) were recorded at baseline, 1-, 3-, and 6-month follow-up visits.Forty-five eyes were included in the IVT group and 50 eyes in the STT group. Change in VA from baseline to 1, 3, and 6 months was not significantly different between IVT and STT (6 months: 2.3 lines vs. 2.4 lines,2 mg IVT and 40 mg STT both achieved significant improvement in vision and CMT with no significant difference between interventions at 3- and 6-month follow-up.

Aims: To study the impact of vestibular suppressant drugs (VSD) on provocative positional tests (PPT) in patients with benign paroxysmal positional vertigo (BPPV). Settings and Design: A prospective case-control observational study. Materials and Methods: Patients with a history suggestive of BPPV were tested for PPT. Patients with vertiginous symptoms and with nystagmus on PPT were classified as objective BPPV (O-BPPV, control group), while those without nystagmus with no alternate diagnosis were classified as subjective BPPV (S-BPPV, case group). Details of VSD treatment were noted in all the patients. In both groups, patients were instructed to discontinue VSD and were further assigned as the VSD and non-VSD subgroups. Patients were followed for 2 months with PPT every week. PPT positive patients were treated by vestibular rehabilitation maneuvers. Statistics: Student t-test with two-tailed, unpaired, was used for continuous scale and Chi-square test for categorical differences between the two groups. Results: 295 consecutive BPPV patients were enrolled in the study, 55 in the S-BPPV group and 240 in the O-BPPV group. Significantly higher proportion of patients in the S-BPPV group were on VSD at presentation, 80.00% vs. 53.75% (OR 2.52; 95% CI: 1.30–4.86), P = 0.006. In an unadjusted analysis of the S-BPPV group following discontinuation of VSD, PPT became positive in 79.54% of patients as compared to 18.19% in the non-VSD group (OR 35.0; 95% CI: 6.2–197.3), P < 0.001. Conclusion: A higher proportion of S-BPPV patients were receiving VSD in comparison to O-BPPV at the initial visit. The PPT converted positive four times higher after ceasing the VSD in S-BPPV patients. Study Design: Prospective case-control observational study.

Kawasaki disease (KD) is the most common pediatric vasculitis with coronary involvement feared as the most serious complication. The reported case describes a child presenting initially with atypical KD and coronary artery aneurysms. He was treated with intravenous immunoglobulin and aspirin. In spite of adequate compliance and no clinical recurrence, serial echocardiography revealed nonregression of aneurysm and new-onset moderate aortic regurgitation (AR) in the subacute phase produced by prolapse of noncoronary cusp of the aortic valve. AR without aortic root dilatation from persistent inflammation of the valve leaflets in KD is a rare phenomenon. This case demonstrates unusual cardiac manifestations of KD and reoriented our protocol for long-term surveillance in infantile KD.

To compare rates of ocular hypertension (OHT) in eyes receiving 40 mg sub-Tenon triamcinolone (STT), 0.7 mg dexamethasone implant (DEX), and 2 mg intravitreal triamcinolone (IVT).This study is a single-centre, retrospective case series. All patients receiving STT and DEX between 4/1/2014 and 3/1/2017 and IVT between 3/1/2012 and 3/1/2017 with a minimum of 3 months' follow-up were included. OHT was defined as an intraocular pressure (IOP)24 mm Hg. Patients receiving any other form of topical, oral, or intravitreal steroid were excluded.113 eyes from 104 patients in the STT group, 122 eyes from 109 patients in the DEX group, and 109 eyes from 103 patients in the IVT group were included. The mean number of injections for each eye was 1.7 in the STT group, 2.6 for the DEX group, and 2.8 for the IVT group (p0.001). Twenty eyes (17.7%) developed OHT in the STT group, 19 eyes (15.6%) developed OHT in the DEX group, and 14 eyes (12.8%) developed OHT in the IVT group (p = 0.60). IOP was controlled in all eyes with observation, topical IOP-lowering medication, or surgical intervention. The rate of incisional glaucoma surgery was 1.7% in the STT group, 1.6% in the DEX group, and 0% in the IVT group (p = 0.55).The rate of OHT was similar across treatment groups. The proportion of OHT in patients with a history of glaucoma was no different from that in patients without a history of glaucoma. All cases were successfully managed with observation, medical treatment, or incisional surgery.

Introduction: Efforts to improve the outcomes of triple negative breast cancer (TNBC) have been hampered by the inability to identify the key risk factors for prognosis. We focus solely on female TNBC and explored its survival by age, marital status, treatment and race. Data from Surveillance, Epidemiology and End Results Program (SEER) Database 18 of National Cancer Institute were used to assess TNBC survival by the above factors. Results: A total of 26,413 female patients diagnosed with TNBC from 2010 to 2015 were included in the current study, including 15840 (60.0%) Non-Hispanic white women. The follow up time ranges: 0 to 83 months. Younger (≤ 49) and elderly (≥ 65) age is associated with poorer survival, with reference to middle age group (50-64). The breast cancer specific survival (BCSS) rate for the three age groups (≤ 49, 50-64 and ≥ 65) are 78.6%, 81.0% and 78.1%, respectively; hazard ratio (HR) (95% confidence interval [CI]): 1.17 (1.08-1.27) in ≤ 49 and 1.24 (1.15-1.34) in ≥ 65 patients, individually. We further categorized elderly group into two strata: aged 65 -74 (age group recommended by U.S. Preventive Services Task Force to have breast cancer [BC] screening) and ≥75 (not recommended for BC screening). Our data revealed that the BCSS rate of 65-74 cohort rises to 81.9%; HR (95% CI): 0.97 (0.88-1.07), not significantly different from group aged 50-64. In contrast, the ≥75 group, as against middle age cohort, has the worst BCSS rate of 71.6%; HR (95% CI): 1.74 (1.58-1.92). In patients ≥75, there is highest proportion of metastatic disease (2.9%) at diagnosis and advanced lymph node involvement (N2 + N3 = 11.9%); their percentage of receiving perioperative chemotherapy (CT) and radiation therapy (RT) is lowest across all age groups: 33.3% and 43.6%, respectively. The mean age of single (never married), married and widowed patients at diagnosis was 52 ± 13, 56 ± 12 and 72 ± 11, respectively. The single cohort has the second worst BCSS rate of 76.1% [HR (95% CI): 1.46 (1.34-1.59)], in comparison with married women (BCSS rate of 81.6%). The BCSS rate of single patients is only better than that of widowed population (74.7%), who have significantly advanced age. Our analyses also showed that single patients have the highest percentage of Black women (37.7%) that are known to have unfavorable prognosis of TNBC. Also, single female patients have high proportion of large tumor (T3 + T4 = 18.5%, highest among all women in study) and metastatic disease (2.9%, secondary to widowed group only). Single group compared with married group, tends to have lower percentage of completing RT: 49.9% versus 53.4%, respectively. Conclusion: Advanced age is associated with worse BCSS. However, discontinuation of BC screening may partly account for the phenomenon that ≥ 75-year-old patients lost survival benefits (i.e., highest metastatic disease at diagnosis and worst BCSS), that is maintained in patients aged 65-74, who are recommended for BC screening. Further, low adherence to receive or complete adjuvant therapy may attenuate the survival in elderly patients aged ≥ 75. The poor outcome in single women with relatively young age indicates that both biological and socioeconomic factors and their interactions (e.g., high proportion of black women and low proportion of receiving RT) may influence TNBC prognosis. Our findings suggest a greater need for early and extended BC screening in the above two populations. Citation Format: Zikun Wang, Zheyu Lu, Maitri Kalra, Zhongxue Chen, Yi Dong. Disparities in triple negative breast cancer survival in the United States by patient characteristics: A population-based study from SEER database, 2010 - 2015 [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-19.

Purpose To report the incidence and course of ocular hypertension after intravitreal injection of 2-mg triamcinolone acetonide (IVT). Methods In a retrospective, consecutive series, all patients receiving 2-mg IVT at a single institution between March 1, 2012, and March 1, 2017, with a minimum of 3-month follow-up were reviewed. Ocular hypertension was defined as an intraocular pressure (IOP) measurement over 24 mmHg at any follow-up visit after IVT. Patients receiving topical, periocular, or intravitreal corticosteroid other than 2-mg IVT were excluded. Results A total of 106 eyes in 100 patients receiving at least one injection of 2-mg IVT were included. Eyes received an average of 2.9 injections (range 1-17), and average patient follow-up was 15.1 months (range 3.0-52.5 months). A total of 14 eyes (13.2%) in 14 patients developed ocular hypertension after a median of 1.5 injections (range 1-9) with an average peak IOP of 29 mmHg (range 25-38 mmHg). Overall, a total of 11 eyes (10.4%) had an IOP elevation ≥10 mmHg above baseline at any point after first IVT. In all cases of ocular hypertension, IOP was successfully managed with observation or topical IOP-lowering medication alone; no patients required surgical intervention. Conclusion Ocular hypertension developed in 13.2% of eyes receiving intravitreal injection of 2-mg triamcinolone acetonide. Incidence of ocular hypertension after 2-mg IVT compares favorably with other intravitreally administered corticosteroids.

Objectives: Repeated migraine attacks may cause vestibular dysfunction and dislodge of otoconia from utricle to semicircular canals resulting in benign paroxysmal positional vertigo (BPPV). The aim of the present study was to evaluate risk factors and linkage of migraine in patients of BPPV. Material and Methods: This observational case-control study was conducted at Zydus medical college and hospital, Dahod, India from October 2018 to September 2019. Consecutive 18 to 70 years old patients of confirmed BPPV were assigned as the cases. Demographically matched healthy volunteers were assigned as the controls. The cases, as well as the control, were further evaluated for a past or present history and a family history of migraines. Results: 295 consecutive BPPV cases (250 posterior canals, 45 horizontal canals) and 300 control subjects were studied. In the case group, 55 (18.64%) were having past or present migraine (45 migraines without aura, 8 migraines with aura and 2 vestibular migraines), while in the control group 24 (8.0%) were having migraine (20 migraines without aura, 4 migraines with aura). Among BPPV patients, those associated with migraines were younger and more often females, with many having a history of diabetes mellitus and coronary artery disease and family/past history of migraines. Migraine was 2.3 times higher in cases as compared to the control with significant or Odds Ratio of 2.63 and 2.68 in unadjusted and adjusted analysis respectively. Conclusion: Migraine was more than two times more common in BPPV patients as compared to the age and sex-matched controls. Keywords: Headache, Benign paroxysmal positional vertigo, BPPV, Migraine, Vestibular migraine, Migraine Variants

Pulmonary alveolar proteinosis (PAP) is a rare respiratory syndrome, which can be challenging to diagnose given its non‐specific presentation and imaging findings. While most primary cases of PAP have an autoimmune basis, the triggers for the disease are uncertain with occupational factors increasingly thought to be important. We report the unusual complication of pneumomediastinum and bilateral pneumothoraces following endobronchial ultrasound‐guided transbronchial needle aspirate in the setting of PAP. We discuss the possible physiological mechanisms of this complication, which appears to be more common in conditions with reduced lung compliance., Pulmonary alveolar proteinosis is a rare disease which can be challenging to diagnose. We report the case of a 30‐year‐old male who developed the condition in the setting of occupational exposures and describe an unusual complication of bronchoscopy that presented management challenges.

The cancer-risk-associated rs6983267 single nucleotide polymorphism (SNP) and the accompanying long noncoding RNA CCAT2 in the highly amplified 8q24.21 region have been implicated in cancer predisposition, although causality has not been established. Here, using allele-specific CCAT2 transgenic mice, we demonstrate that CCAT2 overexpression leads to spontaneous myeloid malignancies. We further identified that CCAT2 is overexpressed in bone marrow and peripheral blood of myelodysplastic/myeloproliferative neoplasms (MDS/MPN) patients. CCAT2 induces global deregulation of gene expression by down-regulating EZH2 in vitro and in vivo in an allele-specific manner. We also identified a novel non-APOBEC, non-ADAR, RNA editing at the SNP locus in MDS/MPN patients and CCAT2-transgenic mice. The RNA transcribed from the SNP locus in malignant hematopoietic cells have different allelic composition from the corresponding genomic DNA, a phenomenon rarely observed in normal cells. Our findings provide fundamental insights into the functional role of rs6983267 SNP and CCAT2 in myeloid malignancies.

BACKGROUND AND OBJECTIVE: To evaluate the impact of systemic immunosuppressive therapy on the rates and outcomes of endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injections. PATIENTS AND METHODS: A retrospective, single-center, comparative cohort study examining eyes undergoing intravitreal anti-VEGF injections from January 2016 to September 2019. Cohorts were created based on concurrent immunosuppressive therapy at time of injection. RESULTS: Of 270,347 anti-VEGF injections administered, 1,300 injections (0.48%) were administered while on systemic immunosuppressive therapy. The odds of endophthalmitis occurring in the immunosuppression group was 9.86 (95% confidence interval [CI], 4.0–24.3; P < .001) times higher than the no-immunosuppression group. Symptom onset occurred 2.51 (95% CI, 0.15–4.870; P = .040) days earlier in the immunosuppression cohort; visual acuity at 6 months after treatment was similar in both groups. CONCLUSIONS: Patients on systemic immunosuppressive medications undergoing intravitreal injections may be at increased risk for post-injection endophthalmitis and may have earlier symptom onset. However, visual outcomes were similar between the two groups. [ Ophthalmic Surg Lasers Imaging Retina . 2021;52:S17–S22.]

To determine the prevalence and risk factors of under-nutrition amongst under-five children living in Jhadol Block of Udaipur, a cross-sectional survey of 350 randomly selected under-five children was carried out. The selected samples were taken out of the total 48426 children living in Jhadol Block. The findings reveal that 41.1% of the children were found to be stunted, 26% of them wasted and 20.3% of them were under-weight. Female children, children aged 48-59 months, children born to older mothers aged 20-29years, children with 1-2 siblings, low-birth-weight, having an illiterate mother or unskilled labourer father were observed to be at the highest risk of being under-nourished. Birth spacing of

Background The optimal management of progressive brain metastases in patients with germ cell tumors (GCTs) remains unsettled. This study reports the management of 25 consecutive patients with relapsed GCTs and progressive brain metastases undergoing high-dose chemotherapy (HDCT) with peripheral blood stem cell transplantation (PBSCT) at Indiana University from 2006 to 2016. Methods All patients were planned to undergo HDCT, which consisted of carboplatin at 700 mg/m2 on days 1 to 3 plus etoposide at 750 mg/m2 on days 1 to 3, followed by PBSCT on day 5 for 2 cycles. Patients were treated with brain metastectomy, stereotactic radiotherapy or whole-brain radiotherapy, HDCT alone, or a combination thereof. All 25 patients had progressive brain metastases at the time of initiating HDCT. Patient and disease characteristics, management of brain metastases, and outcomes were measured. Platelet transfusions were given to maintain platelet counts > 30,000/µL; the goal was >50,000/µL when there were signs of prior or active hemorrhaging. Results Twenty-two of 25 patients completed both courses of HDCT. The median α-fetoprotein level was 7.5 ng/mL (range, 1.6-1130 ng/mL), and the human chorionic gonadotropin level was 31.3 IU/mL (range, 0.5-25,601 IU/mL). At a median follow-up of 24.5 months (range, 0.4-117 months), 11 patients (44%) were alive with no evidence of disease, 2 patients were alive with relapsed disease, and 12 patients had died of disease progression or complications from HDCT. Fifteen patients developed progressive brain metastases despite radiation and/or craniotomy before HDCT, and 8 of these patients were alive without evidence of disease. There were no intracranial hemorrhagic events leading to death. Conclusions Patients with relapsed GCTs and progressive brain metastases are curable with multimodality therapy that includes HDCT and peripheral blood stem cell transplantation.

Purpose To assess whether vitreous culture results affect the clinical management of patients with acute endophthalmitis after intravitreal anti–vascular endothelial growth factor (VEGF) injection. Design Retrospective case series. Methods Setting : Single-center. Study Population : Patients who developed endophthalmitis after intravitreal injection of aflibercept, bevacizumab, or ranibizumab between January 1, 2016, and May 31, 2018. Observation : A change in clinical management was defined as additional intravitreal antibiotic injections or pars plana vitrectomy. Main Outcome Measures : A change in clinical management within 2 weeks of initial endophthalmitis culture and treatment; visual acuity. Results Of 204,986 intravitreal anti-VEGF injections performed, 60 cases (0.0293%) of endophthalmitis were identified, 18 of which were culture-positive. Six of 60 eyes (10%) had a change in clinical management. A change in clinical management was initiated in 3 of 18 (17%) culture-positive cases compared to 3 of 42 (7%) culture-negative cases (P = .357). Changes in management for culture-positive cases were performed based on declining vision (2 cases) and worsening clinical examination (1 case). Changes in management for culture-negative endophthalmitis cases were performed based on declining vision (1 case) and worsening clinical examination (2 cases). No additional interventions were initiated based on positive-culture results. Comparing vision loss from baseline by culture result, at final follow-up, oral flora-associated culture-positive cases lost 17.5 lines, non–oral flora-associated culture-positive cases lost 9.1 lines, and culture-negative cases lost 2.5 lines of vision (P Conclusion Following endophthalmitis from intravitreal injection of anti-VEGF agents, vitreous culture data may help prognosticate visual outcomes but appear to have a limited effect on clinical management.

To report the rate, risk factors, and outcomes of rhegmatogenous retinal detachment (RRD) after intravitreal injection of anti-vascular endothelial growth factor medications.Single-center, retrospective, consecutive review.All patients receiving ranibizumab, bevacizumab, or aflibercept for neovascular age-related macular degeneration or retinal vein occlusion between October 1, 2014, and October 1, 2017.The total number of eyes and injections were determined from billing codes. Rhegmatogenous retinal detachment patients were determined from billing records and confirmed with chart review.Rate of retinal detachment and visual acuity outcomes.A total of 180 671 intravitreal injections in 12 718 unique patients were included. An RRD occurred in 24 patients within 3 months after injection, giving a rate of 1 RRD per 7532 intravitreal injections (0.013%) and 1 RRD per 530 patients (0.19%). No association was found between RRD risk after injection and diagnosis (P = 0.54), physician experience (P = 0.23), injection site (P = 0.41), caliper use (P = 0.75), or 31- versus 30-gauge needle use (P = 0.18). A retinal tear was found located in the quadrant of the injection site (within 1.5 clock hours of the injection) in 15 of 24 patients (62.5%; P0.0001). At the time of RRD diagnosis, the macula was attached in 9 patients (37.5%). Interventions for RRD repair included pars plana vitrectomy (PPV; 15 patients), combined scleral buckle and PPV (4 patients), pneumatic retinopexy (3 patients), and laser or cryotherapy alone (2 patients). Single-surgery success rate was 54.2%, with 54.5% of recurrent detachments caused by proliferative vitreoretinopathy. Average loss from visual acuity recorded at the visit before diagnosis of RRD was 1.0 line for macula-on detachments versus 6.8 lines for macula-off detachments (P = 0.027) at final follow-up (average, 16.3 months).Retinal detachment after intravitreal injection is uncommon, with a rate of approximately 1 in 7500 injections. Macular status at the time of RRD diagnosis significantly affects visual outcomes.

Background: Acne is a disease that affects almost 100% of the population. The clinical presentation ranges from comedones, papules, pustules and nodules. Various systemic treatment modalities like oral antibiotics, retinoids, hormonal therapy and corticosteroids, are available with varied benefits and side effects. Aims: To study and compare the efficacy and safety profile of three low dose isotretinoin regimens in the treatment of mild to moderate acne vulgaris. Methods: 75 patients having mild to moderate acne vulgaris were randomized into three different low dose isotretinoin regimens. Each was consisting of 25 patients. Group A was prescribed 5 mg, Group B 10 mg and Group C 20 mg isotretinoin for 4 months. Clinical improvement and side effects were recorded. Results: All regimens showed clinical improvement in 4 months of therapy. Isotretinoin 20 mg was found to be superior in later half of therapy. But isotretinoin 10 mg and 20 mg both were statistically equally efficacious in mild to moderate acne vulgaris. Side effects were higher in Group C as compared to Group A and B. Conclusion: We conclude that all three low dose regimens were efficacious in mild to moderate acne vulgaris. Isotretinoin 10 mg was found to be an effective and safe treatment option in such cases.

Purpose To compare the rates of infectious endophthalmitis following intravitreal injection of ranibizumab using prefilled syringes vs conventional preparation. Design Multicenter retrospective cohort study. Methods All eyes receiving intravitreal injection of 0.5 mg ranibizumab for retinal vascular diseases at 10 retina practices across the United States (2016 to 2017) and Japan (2009 to 2017) were included. The total numbers of eyes and injections were determined from billing codes. Endophthalmitis cases were determined from billing records and evaluated with chart review. Primary outcome was the rate of postinjection acute endophthalmitis. Secondary outcomes were visual acuity and microbial spectrum. Results A total of 243 754 intravitreal 0.5 mg ranibizumab injections (165 347 conventional and 78 407 prefilled) were administered to 43 132 unique patients during the study period. In the conventional ranibizumab group, a total of 43 cases of suspected endophthalmitis occurred (0.026%; 1 in 3845 injections) and 22 cases of culture-positive endophthalmitis occurred (0.013%; 1 in 7516 injections). In the prefilled ranibizumab group, 12 cases of suspected endophthalmitis occurred (0.015%; 1 in 6534 injections) and 2 cases of culture-positive endophthalmitis occurred (0.0026%; 1 in 39 204 injections). Prefilled syringes were associated with a trend toward decreased risk of suspected endophthalmitis (odds ratio 0.59; 95% confidence interval 0.31-1.12; P = .10) and a statistically significant decreased risk of culture-positive endophthalmitis (odds ratio 0.19; 95% confidence interval 0.045-0.82; P = .025). Average logMAR vision loss at final follow-up was significantly worse for eyes that developed endophthalmitis from the conventional ranibizumab preparation compared to the prefilled syringe group (4.45 lines lost from baseline acuity vs 0.38 lines lost; P = .0062). Oral-associated flora was found in 27.3% (6/22) of conventional ranibizumab culture-positive endophthalmitis cases (3 cases of Streptococcus viridans, 3 cases of Enterococcus faecalis) compared to 0 cases in the prefilled ranibizumab group. Conclusion In a large, multicenter, retrospective study the use of prefilled syringes during intravitreal injection of ranibizumab was associated with a reduced rate of culture-positive endophthalmitis, including from oral flora, as well as with improved visual acuity outcomes.

Background: Major depressive disorder (MDD) is among the most common mental disorders. Apart from the high prevalence, depression has been found to contribute to a high degree of impairment in functioning, equalling or exceeding that associated with debilitating medical conditions. Despite this, research shows a large treatment gap and demonstrable benefits on addressing this gap. Hence, it becomes important to study the factors affecting help-seeking behaviors among patients with MDD. Our study aims to assess these factors. Methods: It was a cross-sectional study conducted on 100 consecutive consenting patients of MDD in the department of psychiatry of a tertiary care hospital. The instruments used were semi-structured pro forma for sociodemographic details, Big Five Inventory-10 Scale for personality traits, K10 rating scale for psychological distress, and Depression Stigma Scale to assess the stigma faced. Results: In our study, we found (a) sociodemographic factors such as higher family income, joint family type, and rural locality to be statistically significantly associated with late help seeking and (b) patient-related factors of higher levels of perceived stigma to be statistically significantly associated with late help-seeking behavior. Conclusions: Factors such as family type, stigma, and living in a rural area were significantly associated with late help seeking. Psychoeducation of family members and increased awareness and access to mental health-care professionals may help address these issues. Studying factors affecting help seeking on a larger scale may help with policy formulation in future.

Patients with triple-negative breast cancer (TNBC) who have residual disease after neoadjuvant therapy have a high risk of recurrence. We tested the impact of DNA-damaging chemotherapy alone or with PARP inhibition in this high-risk population. Patients with TNBC or deleterious BRCA mutation (TNBC/BRCAmut) who had >2 cm of invasive disease in the breast or persistent lymph node (LN) involvement after neoadjuvant therapy were assigned 1:1 to cisplatin alone or with rucaparib. Germline mutations were identified with BROCA analysis. The primary endpoint was 2-year disease-free survival (DFS) with 80% power to detect an HR 0.5. From Feb 2010 to May 2013, 128 patients were enrolled. Median tumor size at surgery was 1.9 cm (0–11.5 cm) with 1 (0–38) involved LN; median Residual Cancer Burden (RCB) score was 2.6. Six patients had known deleterious BRCA1 or BRCA2 mutations at study entry, but BROCA identified deleterious mutations in 22% of patients with available samples. Toxicity was similar in both arms. Despite frequent dose reductions (21% of patients) and delays (43.8% of patients), 73% of patients completed planned cisplatin. Rucaparib exposure was limited with median concentration 275 (82–4694) ng/mL post-infusion on day 3. The addition of rucaparib to cisplatin did not increase 2-year DFS (54.2% cisplatin vs. 64.1% cisplatin + rucaparib; P = 0.29). In the high-risk post preoperative TNBC/BRCAmut setting, the addition of low-dose rucaparib did not improve 2-year DFS or increase the toxicity of cisplatin. Genetic testing was underutilized in this high-risk population.

Aims: To evaluate whether the incidence, microbial spectrum, and visual outcomes of endophthalmitis following intravitreal injections have changed over time. Methods: Retrospective cohort study of ...

Dyslexia is a prodigious condition in which an individual has difficulty in reading and writing but has a greater intelligence level. People suffering from dyslexia are usually slow readers but have fast creative thinking and good reasoning capability. While dyslexia does not impact one’s intellect, it certainly affects reading and comprehension abilities. It impacts people in different ways, and every person faces different kinds of problems that require different ways to tackle them. This paper presents an integrated web application to enhance the reading experience for the dyslexic. Adaptable reading environment (font, background, font size), pictograph support, and a choice to disintegrate sentences/words to their corresponding sounds are some features of the application. A major concern with the dyslexic is their difficulty to accurately understand the essence of a text. This can be augmented by integrating 3D visualizations for sentences. Thus, in order to provide a wholesome reading experience, the paper includes 3D scene generation from the text. This application hence provides a one-stop solution to overcome learning problems faced by dyslexics.

BACKGROUND:In recent outbreak of COVID-19 infection,the risk of thrombosis should be concerned.We observed dynamic changes of D-Dimer level,C-Reactive Protein(CRP) level and Venous Thromboembolism risk assessment score(VTE score) during active disease.We included patients of conrmed covid-19 patients who were RT-PCR positive and patients of community acquired pneumonia(CAP) who were conrmed by CT-SCAN ndings.We observed correlation of D-dimer level with both CRP level & VTE score. METHOD:We examined the clinical laboratory result of 50 patients with conrmed COVID-19 positive patients and 50 patients with community acquired pneumonia(CAP).We analysed D-dimer level of this patients by Automated Coagulometer-STAGO in our hematological laboratory and CRP level by latex method.We use pauda prediction score to identify patients at high risk for venous thrombo embolism.We observed D-dimer level of all patients with their correlation to CRP level & VTE score.S RESULT:On admission,Both COVID-19 and CAP patients,D-dimer level were increased,more increased in COVID-19 patient compare to CAP patient. D-dimer level were related to inammatory marker,mainly with CRP level.There was low correlation between VTE score & Ddimer levels weakened the role of D-dimer in the prediction of thrombosis. CONCLUSION:Elevated baseline D-dimer levels are associated with inammation but not with VTE score in COVID patients,So we can't judge whether anticoagulation is needed only according to D-dimer levels. Abnormal D-dimer level with inammatory factors suggest that anticoagulant therapy might be needed.

Introduction Bronchiolitis obliterans syndrome (BOS) after allogeneic haemopoietic stem cell transplant (HSCT) is an under-recognised and difficult to treat disease. This occurs in the context of limited clinical research and inconsistent diagnostic criteria. Method Retrospective data was collected on 275 patients who underwent allogeneic HSCT at an Australian tertiary hospital between 2007 and 2017. The prevalence of BOS, defined by 2014 National Institute of Health criteria, as well as predictors for BOS and mortality were determined. Treatment outcomes, using serial spirometry, were compared between patients who received early versus late immunosuppression for BOS. Results The prevalence of BOS was 9.1%. Myeloablative conditioning (OR: 2.7, 95%CI: 1.13–6.50, p = 0.03) and extra-pulmonary chronic graft-versus-host disease (OR 2.62, 95% CI: 1.04–6.60, p = 0.04) were associated with BOS. There was reduced median survival in the BOS group compared with the non-BOS group, but this was not statistically significant (4.1years (IQR: 2.8, 6.8) versus 4.6years (IQR: 2.4, 7.8), respectively, p = 0.33). The vast majority (87.5%) of BOS patients failed to attain improvement in FEV1 at 12 months, regardless of treatment strategy. Patients who underwent a late immunosuppression strategy had worse mean FEV1 decline compared to those who received early immunosuppression (−36.3% versus −1.6%, respectively, p = 0.03). Conclusion BOS is a common and progressive disease following HSCT and is largely refractory to current treatment strategies. Compared to late immunosuppression, early augmentation of immunosuppression may slow lung function deterioration in the short term. However, further research is urgently needed to identify effective prevention and treatment strategies for BOS.

Text to 3D scene generation requires an understanding of natural language as well as a rendering of 3D objects. The text is parsed and knowledge is extracted from it. This knowledge includes the identification of objects and their spatial relationship. Properties of objects are also extracted from the sentence. Spatial knowledge helps in the placement of the 3D objects in the scene space. 3D objects dataset is used to render the identified objects in the scene. The graphical view generated can be used by dyslexic children who have difficulty in reading and interpreting the text. Dyslexia is a learning disability but it is not indicative of their intellect. They also have extremely good visualization ability which could help them in apprehending their reading. This paper represents a text to 3D scene generation system which requires minimum physical interaction and might help dyslexic students to comprehend text.

Purpose To assess the utility of microbiologic culture data for the management of endophthalmitis after cataract surgery. Design Retrospective, single-center, cohort study. Participants All patients treated for endophthalmitis after cataract surgery between January 1, 2014, and December 31, 2017, at a single institution. Methods Endophthalmitis cases were determined from billing records and confirmed with chart review. A change in clinical management was defined as additional intravitreal antibiotic injections or pars plana vitrectomy. Main Outcome Measures A change in clinical management within 2 weeks of initial endophthalmitis culture and treatment; visual acuity (VA). Results A total of 111 eyes of 111 patients were treated for endophthalmitis after cataract surgery, of which 57 (51%) were culture-positive. After initial treatment of endophthalmitis, a change in clinical management after vitreous culture occurred in 9 of 111 eyes (8%), including 6 of 57 (11%) culture-positive eyes compared with 3 of 54 (6%) culture-negative eyes (P = 0.49). Change in clinical management for culture-positive eyes was based on declining vision (3 eyes), worsening clinical examination results (2 eyes), and retinal detachment (1 case). Change in clinical management for culture-negative endophthalmitis eyes was based on worsening clinical examination results (2 eyes) and declining vision (1 eye). No additional interventions were initiated on the basis of positive culture results. At final follow-up, mean logarithm of the minimum angle of resolution (logMAR) VA was 1.09 (∼20/250) for the culture-positive eyes compared with 0.59 (∼20/80) for culture-negative eyes (adjusted difference, 0.394; 95% confidence interval, 0.02–0.77, P = 0.03). Rhegmatogenous retinal detachments (RRDs) or retinal tears occurred in 19 of 111 eyes (17%) after developing endophthalmitis, and culture-positive eyes developed a secondary RRD in 11 of 57 eyes (19%) compared with 3 of 54 (6%) culture-negative eyes (P = 0.03). Conclusions After endophthalmitis related to cataract surgery, vitreous cultures may have prognostic value for final visual outcomes but have a limited effect on clinical management.

PurposeResearch on the impact of social distancing on mental health during epidemics is limited, especially in India. The purpose of this study is to scale the association between anxiety and socio-demographic factors during Covid19 lockdown among the general Indian population.Design/methodology/approachA descriptive cross-sectional nationwide study was designed to enrol the general population. The inclusion criteria for this study were Indian citizens aged 18 years and above. The study was conducted from 29th March to 12th April 2020, using an online google questionnaire. The anxiety among respondents was detected and measured using a Generalised Anxiety Disorder Scale which consists of 7 questions (in English), i.e. GAD-7.FindingsRespondees were 392, and from these participants, the prevalence of anxiety was 25.3 per cent. Based on the bivariate logistic regression analysis, the predictors of anxiety were gender, religion, occupation as business/self-employed, marital status, family size, health status and sleep deprivation.ConclusionThis study reports the prevalence of anxiety among Indian population who were grounded at their homes during lockdown due to coronavirus pandemic in the country.Limitations(1) The selection of participants through non-random sampling. (2) Because of the cross-sectional character of the study, causal conclusions cannot be drawn.Originality/ValueThis paper fulfils an identified need to study the mental health status of the population under situations like lockdown, thereby helping fill a persistent gap in Indian research on this issue.

Laryngopharyngeal Reflux Disease (LPRD) is form of extra-oesophageal reflux due to the backflow of gastric contents into the upper aero digestive tract leading to throat symptoms. World over, the prevalence rate of LPRD, ranges from 5 to 30%. The aim of this study was to find the prevalence rate of LPRD in Indian population. This was an observational study whereby the RSI questionnaire was circulated amongst the population and records collected. All subjects who had RSI score more than 13 were considered to be suffering from LPRD. 2300 responses were collected from almost all strata of population. Out of 2300 people who responded 253 had RSI score > 13, and were considered as suffering from LPRD. Thus the prevalence rate of LPRD in population was 11%. The prevalence rate of LPRD in females was 11.2% and in males was 10.6%. The difference in prevalence among both the genders was not significant.The most common symptom of LPR reported by subjects was heartburn followed by clearing of throat and excess throat mucous. The prevalence of LPRD in Indian population as assessed by RSI score > 13 was 11%. The prevalence is same in males and females.

Background: To compare the incidence and outcomes of ocular hypertension (OHT) after intravitreal injection of 0.7 mg dexamethasone (DEX) and 2 mg triamcinolone acetonide (IVT).Methods: In a single...

Introduction: Menopause is defined as the permanent cessation of menstruation, as a result of decrease in ovarian follicles and the loss of ovarian activity. There is decrease in inhibin B level which causes decrease in negative feedback on the serum follicle-stimulating hormone (FSH), which in turn increases the level of serum FSH. Serum FSH is routinely used as a marker of menopause. Decline in the estrogen level causes thinning of vaginal epithelium, resulting in less exfoliation of the vaginal epithelial cells, lesser available glycogen, and decreased substrate for acid production, leading to increase in vaginal pH. Aims: The aim of this study is to compare the sensitivity of vaginal pH versus serum FSH level to diagnose menopause. Settings and Design: This is a cross-sectional study, performed in obstetrics and gynecology outpatient department of a teaching hospital of central Gujarat. Subjects and Methods: A total of 120 women who had their last menstrual period >1 year back (menopause) were included in the study. Vaginal pH was measured and serum sample was taken to measure FSH level. Sensitivity of both vaginal pH and serum FSH to diagnose menopause was compared. McNemar test was used to analyze the convergence of the two methods for the diagnosis of menopause. Results: In the absence of vaginal infection, sensitivity of vaginal pH to diagnose menopause was 90%, while sensitivity of the serum FSH was 85%. Conclusions: Sensitivity of the vaginal pH is similar to the serum FSH for diagnosis of menopause.

Myeloma is a cytogenetically heterogenous clonal plasma cells proliferative disorder and is almost always preceded by an asymptomatic premalignant stage termed monoclonal Gammopathy of Undetermined Significance (MGUS). Diagnosis of myeloma is based on International Myeloma Working Group (IMWG) 2003 which requires one or more CRAB features including hypercalcemia, renal insufficiency, anemia and lytic bone lesions. The IMWG 2014 updated criteria for the diagnosis of myeloma allows the use of early indicators for therapy before CRAB features happen. This is a case of a 53-year-old male, based on complete blood count and peripheral blood smear having normochromic normocytic anemia, NRBC 7/100 leucocytes, thrombocytopenia, 1% plasmoblasts, 11% plasmocytes and Erythrocyte Sedimentation Rate (ESR) 40 mm. The bone marrow evaluation showed plasmocytes 22.5% ANC with abnormal morphology. The diagnosis myeloma was made based on IMWG 2014 by the presence of plasmocytes 22.5% ANC the bone marrow and having one of Myeloma Defining Events (MDEs) in the form of anemia with hemoglobin level 8.5 g/dL. In addition, patient did examinations of protein electrophoresis, immunofixation and ratio involved/uninvolved Free Light Chain (FLC) serum. The results of those examination confirmed the diagnosis that has been made based on IMWG 2014. Prognosis of the patient is poor by the presence of 11% plasmocytes on blood peripheral and ratio FLC kappa/lambda 0.0010.

Introduction:Tumor boards (TB) at National Cancer Institute Designated Comprehensive Cancer Centers (NCI-CCC) are an important source of multidisciplinary education. Unfortunately, expert knowledge from NCI-CCCs is not systematically documented and made accessible to oncologists in the community. This represents a lost opportunity to capture and share clinical expertise that can impact patient care in community centers. Using an online oncologist-only social network, we sought to demonstrate the feasibility of systematically documenting expert insights from TBs and department conferences at NCI-CCCs in order to expand their reach and provide educational benefit to the greater oncology community. Methods: A pilot program was developed at the University of Texas MD Anderson Cancer Center (MDACC) to design a process in which discussions at departmental breast cancer conferences would be distilled down to clinical questions and answers (Q&A) and posted on theMednet.org, an online social Q&A website of over 3,800 US oncologists. An educational breast cancer conference was selected during a site visit. A faculty member was selected to distil discussions about patient management from the selected conference into a question that addressed the clinical situation being discussed. After the question was posted, the oncologist leading the discussion answered the question on theMednet. The Q&A was then indexed and stored for easy search retrieval and disseminated in a weekly newsletter to all registered medical oncologists. A detailed manual was created to document operating procedures for implementation at additional institutions. Results: After developing the process at MDACC, the program was expanded to 2 additional NCI-CCCs- University of Pittsburgh (UPMC) and UCLA. The educational breast cancer conferences selected varied by site and were the new patient planning conference at MDACC, tumor board at UPMC, and multidisciplinary clinic at UCLA. The most significant factor for success was involvement of one faculty member who regularly identified educational questions and additional faculty who posted their answers. Between December 2016 and May 2017, 17 answers to 17 questions were posted and shared with over 1,200 medical oncologists via an email newsletter. All questions were focused on topics not answered by NCCN or ASCO guidelines. The majority of questions focused on management decisions around chemotherapy and endocrine therapy. Answers were viewed by 339 oncologists at 260 institutions in 47 states. This included 190 community practices and 70 academic medical centers. Conclusion: We developed a process of capturing and sharing expert knowledge at NCI-CCC breast cancer conferences on questions not answered by current guidelines. These discussions are otherwise not documented or shared outside of academic centers. By translating discussions into actionable Q&A on an online oncologist network, we made them easily accessible to oncologists at nearly 200 community practices. Future efforts will be aimed at implementing the program into the breast cancer programs at additional NCI-CCCs. Citation Format: Kalra M, Karuturi M, Tripathy D, Jankowitz R, McCann K, Brufsky A, Hurvitz S, Bogler O, Housri S, Housri N. Documenting and sharing breast cancer knowledge from National Cancer Institute designated comprehensive cancer centers (NCI-CCCs) with community oncologists [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-16-01.

Objective: The present study was conducted to assess the validity of symptom score and Genital Health Clinical Evaluation (GHCE) score as diagnostic tools for urogenital atrophy in females of 40–75 years of age group. Materials and Methods: A cross-sectional study including 600 females in the age group of 40–75 years attending gynecology outpatient department was conducted. They were given a symptom score based on their history. GHCE score and smears for vaginal maturation index (VMI) were taken and percentages of superficial cells were counted. Statistical tests of significance such as Karl Pearson's coefficient of correlation were applied. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy of GHCE score, and symptom score with VMI score were calculated. Results: The prevalence of urogenital atrophy in females of 40–75 years of age group using VMI scoring was 38.1%. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of total symptom score for diagnosing urogenital atrophy were 66.4%, 75.3%, 56.3%, 82.4%, and 72.5%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of GHCE score for diagnosing urogenital atrophy were 43.4%, 80.7%, 75.3%, 51.3%, and 59.3%, respectively. Conclusion: Both symptom score and GHCE score can be used as valid alternatives to VMI as diagnostic tools for urogenital atrophy in females of 40–75 years of age group at least in resource-poor settings.

Background:Calciphylaxis is a complex dermatological lesion of micro vascular calcification that is typically presented as panniculitis with gangrenous painful lesions having uremic and non-uremic causes.Case Report:We present a case of a 48-year old male with a history of paroxysmal atrial fibrillation and hypertension taking amlodipine 5 mg and warfarin 5 mg daily for the last 26 months. The patient had a 6- months history of painful swelling followed by necrotic skin ulcer over the right leg. His remarkable examination findings were right leg tender ulcer with surrounding erythema and secondary sepsis. His hemogram, metabolic profile and connective tissue diseases work up were unremarkable except leucocytosis and raised inflammatory markers. His local part radiological and skin biopsy findings were suggestive of calciphylaxis.Results and Conclusion:In our case, warfarin and amlodipine were culprit drugs for the lesion, but Naranjo score (warfarin 7and amlodipine 1) speculate warfarin as a probable adverse reaction of warfarin. The lesion was cured with local wound treatment after discontinuation of warfarin. The physician should be aware of this rare cutaneous disorder of systemic origin for proper management.

In a recent issue of Annals of Oncology , Vuylsteke and colleagues presented the interim analysis of phase II PEGGY study on the use of pictilisib [a pan-phosphoinositide-3-kinase (PI3K) inhibitor] plus paclitaxel in hormone receptor positive human epidermal receptor 2 (HER2) negative (ER+/HER2−) locally advanced or metastatic breast cancer (1). This clinical trial is one among the many clinical clinicals to report clinical benefits and toxicity associated with PI3K-targeted therapies.

Objectives: To measure the effect of vaginal estrogen cream in the treatment of vaginal atrophy in menopausal Indian women. Methods: A total of 50 menopausal women aged between 40 and 80 years old with symptoms of vaginal atrophy were selected and treated with 0.5 g vaginal estrogen cream, twice weekly for 12 weeks. The women were followed-up monthly where symptom score, Genital Health Clinical Evaluation (GHCE) score, vaginal pH, and vaginal maturation index (VMI) were assessed and compared to baseline data. Any adverse events were recorded. Results: There was a significant improvement (p < 0.010) in complaints such as vaginal dryness, itching, burning, and dyspareunia at the end of the study period. The clinical improvement of these patients was reflected in a decrease in GHCE score on every visit. Vaginal pH and VMI score also showed statistically significant improvements (p < 0.010). No side effects with the drugs used were recorded during the study period. Conclusions: Vaginal estrogen cream causes symptomatic relief in women of menopausal age in India suffering from vaginal atrophy.

Objectives The epidemiology, clinical characteristics and outcomes of antimicrobial-associated anaphylaxis remain ill-defined. We sought to examine antimicrobial anaphylaxis with regard to: (i) the frequency of implicated antimicrobials; (ii) attributable mortality; and (iii) referral for definitive allergy assessment. Methods This was conducted through a national retrospective multicentre cohort study at five Australian tertiary hospitals (January 2010 to December 2015). Cases of antimicrobial anaphylaxis were identified from ICD-10 coding and adverse drug reaction committee databases. Results There were 293 participants meeting the case definition of antimicrobial anaphylaxis and 310 antimicrobial anaphylaxis episodes. Of 336 implicated antimicrobials, aminopenicillins (62/336, 18.5%) and aminocephalosporins (57/336, 17%) were implicated most frequently. ICU admission occurred in 43/310 (13.9%) episodes; however, attributable mortality was low (3/310, 1%). The rate of anaphylaxis to IV antibiotics was 3.5 (95% CI = 2.9–4.3) per 100 000 DDDs and the rate of hospital-acquired anaphylaxis was 1.9 (95% CI = 2.1–3.3) per 100 000 occupied bed-days. We observed overall low rates of hospital discharge documentation (222/310, 71.6%) and follow-up by specialist allergy services (73/310, 23.5%), which may compromise medication safety and antimicrobial prescribing in future. Conclusions This study demonstrated that a high proportion of severe immediate hypersensitivity reactions presenting or acquired in Australian hospitals are secondary to aminopenicillins and aminocephalosporins. Overall rates of hospital-acquired anaphylaxis, predominantly secondary to cephalosporins, are low, and also associated with low inpatient mortality.

We report the first case of hypotensive episodes associated with intravenous (IV) azithromycin. This is a potentially fatal adverse drug reaction (ADR), with the risk of irreversible end-organ damage, and therefore must be recognized and treated immediately. In our case, the reaction was successfully managed by immediate cessation of the azithromycin infusion. It is important for clinicians to be aware of this ADR as azithromycin is a commonly prescribed medication worldwide.

Background: Compound tincture benzoin (CTB) is used as a post-procedure skin seal antiseptic agent since ancient times; but this drug is reported to cause allergic contact dermatitis and other unwanted side effects. Our aim of the present study was to compare alternative agent like Medicated Adhesive dressing (MAD) with CTB as a post-procedure skin seal dressing. Design: This prospective randomized controlled experimental study included an equal number of patients in MAD and CTB as a post-operative seal dressing material for percutaneous interventions. Both the groups were graded for various efficacy parameters like comfort, applicability, dressing material, and immediate post-operative complications by operating doctor and attending nurse with a maximum 10 points in each group. Results: 120 patients were studied in each MAD and CTB group. Out of total patients 31.25% were males and the mean age of the patient was 33.56 ± 11.10. Allergic contact dermatitis developed in 9 (7.49%) of CTB group and in 1 (0.83%) of MAD group (P < 0.002), while local site skin infections were noted in 8 (6.67%) of CTB group and in 1 (0.83%) of MAD (P < 0.002). Operating doctor graded MAD and CTB to 7.60 ± 0.49 and 3.62 ± 0.48 (P < 0.003); and attending nurse 7.40 ± 0.49 and 3.41 ± 0.49 (P < 0.003) respectively. Conclusion: MAD is a safe, efficient and non-inferior alternative dressing material for post-procedure skin incision seal in comparison to CTB.

It is important to assess the prevalence of hypogonadism and to identify the correlation between hypogonadism and cancer treatment with quality of life (QoL) in germ cell tumor (GCT) survivors. This is a single-center, non-randomized, prospective observational study in GCT survivors 18–50 years of age previously treated with surgery and chemotherapy (S+C) or surgery alone (S). Patients completed a validated QoL questionnaire at baseline, 3, and 6 months. Patients received supplemental testosterone as clinically indicated. Mean QoL scores were compared between two treatment groups (S+C vs. S) and within each group between survivors with hypogonadism (serum testosterone level

Purpose: To compare the visual outcomes and complications between the eyes receiving retropupillary iris claw intraocular lens (IOL) and scleral-fixated IOL (SFIOL) for post-cataract aphakia. Methods: Medical records of consecutive patients who had iris claw IOL and SFIOL surgery from January 2010 to March 2015, with > 1 year of follow up were retrospectively analyzed. The surgical technique was based on individual surgeon preference. The best-corrected distance visual acuity (BCDVA), previous surgery, surgical technique, and complications were analyzed. Results: Retropupillary iris claw IOL was fixated in 48 eyes (46%) and SFIOL was performed in 56 eyes. Iris claw was performed more frequently at the time of primary cataract surgery (56%) compared to SFIOL (14%) (P < 0.001). At 1 month postoperative, BCDVA was significantly better in the SFIOL group [0.7 ± 0.5 logarithm of minimum angle of resolution (logMAR) in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P < 0.001] but this difference did not persist at 1 year (0.4 ± 0.4 logMAR in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P = 0.56). Eyes with iris claw IOL experienced significantly more postoperative iritis (17%), intraocular pressure spikes (10%), and ovalization of the pupil (16%). Conclusion: Retropupillary iris claw IOL fixation is as safe as SFIOL for visual rehabilitation of post-cataract aphakia. Visual rehabilitation following iris claw IOL might take longer than SFIOL. Ovalization of the pupil is the commonest adverse effect reported with this type of IOL design.