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Background The objective of this study was to evaluate pattern and distribution of neovascularization of optic disc (NVD) and elsewhere (NVE) in proliferative diabetic retinopathy (PDR). Methods A cross-sectional study was conducted among freshly detected cases of PDR. Fundus fluorescein angiographic images of 61 eyes were assessed. Parameters studied for NVD were their number and location and for NVE were their number, location, type of leak, and distance from center of optic disc. Results Of 61 eyes, 29 eyes (47.5%) had NVD with a total of 49 leaks. Of these 49 NVD leaks, the maximum was concentrated in the superotemporal quadrant with 21 leaks (42.9%; 95%CI 28.8–57.8%). Of 61 eyes, 50 eyes (82%) had NVE with 97 leaks. Of 97 NVE leaks, 41 were found in the superotemporal quadrant (42.3%; 95%CI 32.3–52.7%). Maximum NVE was found within the circle of radius 3–6 mm centered on optic disc (p value = 0.001) with no leaks in central macula. Of 29 eyes with NVD, only 7 eyes had >1/3 area of disc involvement. Also, of 18 eyes with concurrent NVD and NVE, only 2 eyes had >1/3 area of disc involvement which is a high-risk characteristic of PDR. Conclusion Neovascular lesions have a predilection for superotemporal part for both NVD and NVE. NVE leaks were almost double the number of NVD leaks. Maximum NVE leaks were found at posterior pole with no central macular involvement. This study provides comprehensive data and further adds to knowledge of neovascularization for early diagnosis and management of PDR.

Sepsis cases caused substantial mortality and a significant burden on healthcare costs and resources. To tackle this problem, there has been discussion surrounding O2 parameters as it has a distinct outcome in septic patients. This review aimed to evaluate the prognostic value of the central venous-arterial carbon dioxide difference (PCO2) gap in patients with septic shock. A comprehensive systematic search was performed through electronic databases including Pubmed, Scopus, and Embase for studies focusing on the use of PCO2 gap as a mortality predictor in septic shock patients. Other secondary outcomes such as mean arterial pressure, lactate clearance, the acute physiology and chronic health evaluation II score, and intensive care unit length of stay were also measured. The Newcastle-Ottawa Scale tool was used to assess the risk of bias. A total of 8 studies were analysed. The mortality rate (odds ratio=0.50, 95% CI=0.28-0.87, P.01) and lactate levels (mean difference [MD] = -0.98; 95% CI=-1.62 to -0.35; P=.001) of the low PCO2 gap group were significantly lower than the high gap group. The low gap group had a significantly higher mean arterial pressure compared to the high gap group (MD=4.54; 95% CI=2.14 to 6.95; P=.001). There were no pronounced outcomes in acute physiology and chronic health evaluation score and intensive care unit length of stay. PCO2 gap can potentially be used as a marker for mortality rate in septic shock patients. It is also significantly associated with other predictors, such as mean arterial pressure and lactate clearance.

A 9-year-old male patient presented with recurrent episodes of corneal ulcers in both eyes since the age of 2 years. The patient had profound bilateral hearing loss and multiple left-sided preauricular skin tags. He was diagnosed with neurotropic keratitis with bilateral corneal anesthesia in both eyes and on further work-up was diagnosed to have Goldenhar Syndrome with features of left-sided facial skeletal hypoplasia and bilateral auditory nerve atresia. The patient was managed by multiple specialities with standard of care medications, therapies, and procedures and is presently thriving. Goldenhar syndrome is a rare congenital disorder which involves ocular, auricular, and cranial nerves along with facial and vertebral anomalies. The insufficient knowledge of its pathogenesis and variable clinical presentations present a challenge in timely diagnosis and management of these cases. The involvement is generally unilateral and unilateral skeletal asymmetry with bilateral cranial nerve involvement is a rare event. The wide variation in clinical presentation and under diagnosis of these cases in India mandates a better understanding of this entity among medical professionals to facilitate early diagnosis and favorable clinical outcomes.

Background: Malaria is endemic in many states of India. Though there are reports of maternal and congenital malaria from endemic areas, however, there remains a paucity of data from hilly terrains. The present study evaluated the prevalence, clinical and microbiological spectrum of maternal and congenital malaria at a tertiary health care facility in Northern India over a period of 18 months. Methods: In this observational study, mothers along with their newborns were evaluated for malaria by maternal, placental, and cord blood smear examination and rapid point-of-care diagnostic serological tests. Positive cases were confirmed by polymerase chain reaction. Mother-newborn duos were followed up till discharge from the hospital. Results: A total of 843 mothers delivered during the study period and were screened along with their newborns and placentae. A total of Ten (1.18%) mothers had evidence of malarial parasitemia (Plasmodium vivax, n=7 and Pl. falciparum, n=3), however, none of the placental and cord blood samples were positive for malaria. Overall, 127 (15.1%) neonates required admission in neonatal intensive care unit for various morbidities. Incidence of small for gestational age (SGA) was high (n=210; 24.9%). Multivariate logistic regression analysis demonstrated maternal malaria to be an independent contributor for SGA [Odds Ratio (95% Confidence Interval), 10.7 (2.06 - 49.72)]. However, only 2% variance of SGA could be explained by maternal malaria alone. Conclusions: We report an encouragingly lower incidence of maternal malaria in mothers attending for delivery and a ‘Zero’ incidence for placental and congenital malaria during the study period as compared to national data (upto 7.4% in non-immune mothers), although maternal malaria could be a causative factor for SGA.

Background Young (≤40 years) breast cancers (YBC) are uncommon, inadequately represented in trials and have unique concerns and merit studying. Methods The YBC treated with a curative intent between 2015 and 2016 at our institute were analysed. Results There were 1228 patients with a median age of 36 (12–40) years; 38 (3.1%) had Stage I, 455 (37.1%) - II, 692 (56.3%) –III, and remaining 43 (3.5%) Stage IV (oligo-metastatic) disease; 927 (75.5%) were node positive; 422 (34.4%) were Triple negatives (TNBC), 331 (27%) were HER-2 positive. There were 549 (48.2%) breast conservations and 591 (51.8%) mastectomies of which 62 (10.4%) underwent breast reconstruction. 1143 women received chemotherapy, 617 (53.9%) received as neoadjuvant and 142 (23.1%) had pathological complete response; 934 (81.9%) received adjuvant radiotherapy. At the median follow-up of 48 (0–131) months, 5-year overall and disease-free survival was 79.6% (76.8–82.5) and 59.1% (55.8–62.6). For stage I, II, III and IV, the 5-year overall-survival was 100%, 86.7% (82.8–90.6), 77.3% (73.4–81.2), 69.7% (52.5–86.9) and disease-free survival was 94% (85.9–100), 65.9% (60.3–71.5), 55% (50.5–59.5), and 29.6% (14–45.2) respectively. On multivariate analysis, TNBC and HER-2+ subgroups had poorer survival (p = 0.0035). 25 patients had BRCA mutations with a 5-year DFS of 65.1% (95% CI:43.6–86.6). Fertility preservation was administered in 104 (8.5%) patients; seven women conceived and 5 had live births. Significant postmenopausal symptoms were present in 153 (13%) patients. Conclusion More than half of the YBC in India were diagnosed at an advanced stage with aggressive features leading to suboptimal outcomes. Awareness via national registry and early diagnosis is highly warranted. Menopausal symptoms and fertility issues are prevalent and demand special focus., Highlights • Largest data of young breast cancer from India analysing demographics, outcomes and fertility. • Higher proportion of YBC with advanced stage and aggressive features compared to western data. • Inferior survival in HER-2+ not receiving Trastuzumab, need access of life saving drugs to all. • Scope of improvement and collaboration in challenges like fertility, pregnancy and quality of life.

Introduction: Magnetic resonance (MR) imaging is a valuable tool in the evaluation of hip disorders. With these, a study was conducted to assess the role of MRI in the early evaluation of painful hip joints. Materials and Methods: It was a cross-sectional study conducted in the department of Radiodiagnosis, GSL Medical College, Rajahmundry. The study protocol was approved by the Institutional Ethical Committee. Patients presenting with acute or chronic hip pain pathology of all age groups, both gender who referred for MRI were included in the study. Imaging has been done with 1.5 Tesla Philips Achieva machines using abdominal surface coils and spine coils. Results: Out of the 30 participants, avascular necrosis was diagnosed in 46.6% (14) participants, joint effusion in 10% (3) cases, osteoarthritis (OA) in 4 (13.3%) cases, tuberculosis (TB) in 10% (3), 6.6% (2) each was diagnosed to be Perthe’s, developmental dysplasia of the hip (DDH) and metastasis, respectively. All the pathological findings were diagnosed using MRI also. Conclusion: MRI helps in the evaluation of the involvement of articular cartilage in the form of T2W hyperintensity. It also helps in the evaluation of soft tissue involvement along with the detection of bone marrow edema.

Background. Cystic artery pseudoaneurysms are rare. Most commonly, they occur secondary to acute cholecystitis or after a cholecystectomy. Complications include haemobilia, biliary obstruction, and haemorrhage. Given the rarity and associated morbidity, a high index of suspicion is required. This article reviews the current literature on cystic artery pseudoaneurysms to investigate its aetiology, clinical presentation, and management options. Methods. A broad search of the Medline and PubMed databases was carried through. All peer reviewed literatures published in the English language between 1991 and 2020 with keywords “cystic” and “artery” and “pseudoaneurysm” in the title were selected for review. No further exclusion criteria; all studies yielded from the search were included in the results of this review. Additionally, we present a case of cystic artery pseudoaneurysm treated at our centre and included this in our analysis. Results. Sixty-seven case reports were found between 1991 and 2020. Aetiologies: Aetiology of cystic artery pseudoaneurysm was found to be cholecystitis in 41 instances (61.2%), cholecystectomy in 18 instances (26.8%), idiopathic in 6 instances (8.9%) cholelithiasis in 1 instance (1.5%), and pancreatitis in 1 instance (1.5%). Complications: Fifty-two cases were complicated by haemobilia (77.6%), 36 by anaemia (53.7%), 25 by biliary obstruction (37.3%), 13 by haemodynamic shock (19.4%), 9 by haemoperitoneum (13.4%), and 6 by contained rupture (8.9%). Most commonly, patients had two or more of these complications. Management: Forty-four patients were managed with endovascular embolisation (65.7%), 21 with endoscopic intervention (31.3%), 18 with open cholecystectomy (26.9%), 13 with laparoscopic cholecystectomy (19.4%), and 6 with pseudoaneurysm ligation (9%). Delayed presentation postcholecystectomy ranged from 8 days to 3 years. Conclusions. Cystic artery pseudoaneurysms are rare complications of a common operation. The most common clinical presentation is haemobilia, which can be difficult to diagnose clinically. A high index of suspicion and prompt investigation with targeted imaging and intervention is required. This is especially pertinent in gastrointestinal bleeding postlaparoscopic cholecystectomy as a missed diagnosis could cause significant morbidity.

Patients with cirrhosis have high prevalence of erectile dysfunction (ED). The aim of this study was to study the efficacy and safety of tadalafil for ED in patients with cirrhosis.140 cirrhotic males with ED were randomized into tadalafil 10 mg daily (n = 70) or placebo (n = 70) for 12 weeks. ED was diagnosed if erectile function (EF) domain score was 25 in International Index of Erectile Function (IIEF) questionnaire. The erectile function domain consists of six questions concerning erection frequency, erection firmness, frequency of partner penetration, frequency of maintaining erection after penetration, ability to maintain erection to completion of intercourse and confidence in achieving and maintaining erection. Primary outcome was proportion of patients having an increase in 5 points in EF domain of the IIEF. Generalized Anxiety Disorder 7 (GAD-7) questionnaire was used for screening and severity measuring of GAD. The presence of depression was screened using the Patient Health Questionnaire (PHQ-9) and the assessment of health related quality of life was done using the Short Form (36) Health Survey.At the end of 12 weeks, more patients in tadalafil group achieved 5 points increase in the EF domain of the IIEF when compared with the placebo group [44(62.9%) vs. 21(30%), p 0.001]. At the end of 12 weeks, patients receiving tadalafil had significantly more change in scores on the erectile function domain, orgasmic function domain, intercourse satisfaction domain, overall satisfaction domain, erection vaginal penetration rates and successful intercourse; significantly more decline in the GAD-7 and PHQ-9 scores; significantly more improvement in scores of five of the eight domains of SF-36 (general health perception, vitality score, social functioning, role emotional and mental health) and the mental component summary rates when compared with placebo. The development of side effects and the changes in HVPG were not significantly different between the two groups.Tadalafil therapy may enhance erectile function, improve anxiety, depression and quality of life; and is well tolerated by men with cirrhosis (CTP score 10) and ED. However, further larger and long-term studies are needed to confirm these results and look for rarer side effects of using tadalafil in patients with cirrhosis.ClinicalTrials.gov identifier number NCT03566914; first posted date: June 25, 2018.

Background Survivors of invasive group B Streptococcus (iGBS) disease, notably meningitis, are at increased risk of neurodevelopmental impairment. However, the limited studies to date have a median follow-up to 18 months and have mainly focused on moderate or severe neurodevelopmental impairment, with no previous studies on emotional-behavioral problems among iGBS survivors. Methods In this multicountry, matched cohort study, we included children aged 18 months to 17 years with infant iGBS sepsis and meningitis from health demographic surveillance systems, or hospital records in Argentina, India, Kenya, Mozambique, and South Africa. Children without an iGBS history were matched to iGBS survivors for sex and age. Our primary outcomes were emotional-behavioral problems and psychopathological conditions as measured with the Child Behavior Checklist (CBCL). The CBCL was completed by the child’s primary caregiver. Results Between October 2019 and April 2021, 573 children (mean age, 7.18 years) were assessed, including 156 iGBS survivors and 417 non-iGBS comparison children. On average, we observed more total problems and more anxiety, attention, and conduct problems for school-aged iGBS survivors compared with the non-iGBS group. No differences were found in the proportion of clinically significant psychopathological conditions defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Conclusions Our findings suggested that school-aged iGBS survivors experienced increased mild emotional behavioral problems that may affect children and families. At-risk neonates including iGBS survivors need long-term follow-up with integrated emotional-behavioral assessments and appropriate care. Scale-up will require simplified assessments that are free and culturally adapted.

Background Invasive group B Streptococcus disease (iGBS) in infancy, including meningitis or sepsis, carries a high risk of mortality and neurodevelopmental impairment (NDI). We present data on iGBS from 2 decades of surveillance in Manhiça, Mozambique, with a focus on NDI. Methods Morbidity surveillance databases in a rural Mozambican district hospital were screened for iGBS cases. From February 2020 to March 2021, surviving iGBS patients (n = 39) plus age- and sex-matched children without iGBS (n = 119) were assessed for neurocognitive development, vision, and hearing. The role of GBS in stillbirths and infant deaths was investigated using minimally invasive tissue sampling (MITS). Results Ninety iGBS cases were included, with most children being Conclusions In absence of preventive strategies, such as intrapartum antibiotics, iGBS remains a significant cause of perinatal and infant disease and death. GBS also causes major longer-term neurodevelopmental sequelae, altogether justifying the need for maternal GBS vaccination strategies to increase perinatal and infant survival.

The global burden of Group B Streptococcus (GBS) was estimated for 2015 prompting inclusion of GBS as a priority in the Global Meningitis Roadmap. New estimates for the year 2020 and a WHO report analysing the full value of GBS maternal vaccines has been launched to advance evidence based decision making for multiple stakeholders. In this first of a 10-article supplement, we discuss the following (1) gaps in evidence and action, (2) new evidence in this supplement, and (3) what actions can be taken now and key research gaps ahead. We call for investment in the research pipeline, notably description, development, and delivery, in order to accelerate progress and address the large burden of GBS for every family in every country.

Purpose Lutetium-177 prostate-specific membrane antigen-617 (177Lu-PSMA-617) in end-stage metastatic castration-resistant prostate cancer (mCRPC) has reported favourable outcomes. In this study, we aimed to prospectively compare the efficacy and safety of 177Lu-PSMA-617 and docetaxel in chemotherapy-naïve mCRPC patients. Methods This was a randomized, parallel-group, open-label, phase 2, and non-inferiority trial. Chemotherapy-naïve patients with mCRPC and high PSMA-expressing lesions on 68 Ga-PSMA-11 PET/CT were randomly assigned in 1:1 ratio to 177Lu-PSMA-617 (6.0–7.4 GBq/cycle, every 8 weeks, up to 4 cycles) or docetaxel (75 mg/m2/cycle, every 3 weeks, up to 10 cycles). The primary end-point was best prostate-specific antigen response rate (PSA-RR), defined according to Prostate Cancer Clinical Trials Working Group-3 as proportion of patients achieving ≥ 50% decline in PSA from baseline. Non-inferiority margin of − 15% was pre-specified for PSA-RR. Results Between December 2019 and March 2021, 40 of the 45 patients assessed for eligibility underwent randomization. Fifteen of 20 patients in 177Lu-PSMA-617 arm and 20/20 patients in docetaxel arm received treatment per protocol. Of these, best PSA-RR in the 177Lu-PSMA-617 arm was 60% (9/15) versus 40% (8/20) in the docetaxel arm. The difference in the PSA-RRs between the two arms was 20% (95% confidence interval, CI: − 12–47, P = 0.25), meeting the pre-specified criterion for non-inferiority in per-protocol analysis. Further, progression-free survival rates at 6 months were 30% and 20% in the 177Lu-PSMA-617 and docetaxel arms respectively (difference 10%, 95% CI: − 18–38, P = 0.50). Overall, treatment-emergent grade ≥ 3 adverse events occurred less frequently with 177Lu-PSMA-617 than with docetaxel (6/20, 30% versus 10/20, 50%, respectively, P = 0.20). Quality-of-life outcomes improved significantly in 177Lu-PSMA-617 arm compared to docetaxel arm (P

Objective: This study assessed the prevalence of anaplastic lymphoma kinase (ALK) rearrangements in US oncology practices. Materials and Methods: Using a nationwide real-world database, we included adults with advanced non-small cell lung cancer (aNSCLC, stage IIIB- IV) diagnosed January 2015 – May 2019, with documented ALK testing results and smoking status. Rearrangement prevalence was assessed overall and then stratified by patient characteristics. Results: The cohort included 19,895 eligible patients with a mean age 68.5 years, majority ever-smokers (85.5%) and from community centers (92.2%). The overall ALK rearrangement prevalence was 2.6%. Positivity rate varied by histology and smoking status; it was the highest among non-smoking patients with non-squamous histology (9.3%). Differences in ALK status also varied by age and race, with young patients (18–39 years) having a higher prevalence (21.6%) vs. older patients (age ≥55 = 2.2%); Asian patients had a prevalence of 6.3%. Patients that were positive for other mutations or rearrangements had a lower ALK positivity rate (0.5%) and patients positive for PD-L1 had a rate of 3.0%. Conclusions: The likelihood of finding an ALK translocation was highest in younger patients and nonsmokers; however, age and smoking history were not discriminative enough to exclude testing based on clinical variables.

Background This study is part of a multicountry matched-cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI) of children exposed to invasive group B Streptococcus (iGBS). The specific objective of this paper is to compare NDI across domains of iGBS survivors with a matched non iGBS group in our population. Methods Survivors of iGBS in a South Indian hospital were identified and recruited between January 2020 and April 2021. Cases were compared with age- and gender-matched non iGBS children. Participants were assessed using Bayley Scales of Infant and Toddler Development–3rd edition (BSID-III), Wechsler Preschool and Primary Scale of Intelligence–4th edition (WPPSI-IV), Wechsler Intelligence Scale for Children–5th edition (WISC-V), Child Behavior Checklist (CBCL), and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2), depending on age. Results Our cohort comprised 35 GBS-exposed and 65 matched non iGBS children, aged 1–14 years. The iGBS-exposed group had 17 (48.6%) children with impairment in ≥1 domain compared to 25 (38%) in the non iGBS group (unadjusted OR, 1.51; 95% CI, .65–3.46), 9 (26%) children with “multi-domain impairment” compared to 10 (15.4%) in the non iGBS group (unadjusted OR, 1.90; 95% CI, .69–5.24), and 1 (2.9%) child with moderate to severe impairment compared to 3 (4.6%) in the non iGBS group (unadjusted OR, .60; 95% CI, .06–6.07). In the iGBS group, more children had motor impairments compared with the non iGBS group (unadjusted OR, 10.7; 95% CI, 1.19–95.69; P = .034). Conclusions Children with iGBS seem at higher risk of developing motor impairments compared with a non iGBS group.

Little is known about the relationship of COVID-19 outcomes with onychomycosis. We investigated the relationship of onychomycosis with COVID-19 outcomes. A retrospective cohort study was performed on SARS-CoV-2 positive adult outpatients or inpatients who had onychomycosis and other skin diseases. Overall, 430 adults were identified with SARS-CoV-2 and a skin disease, including 98 with diagnosed onychomycosis. In bivariable logistic regression models, onychomycosis was associated with increased hospitalization {odds ratio(OR) [95% confidence interval (CI)]: 3.56 [2.18-5.80]}, initial inpatient vs. outpatient visits (OR [95% CI]: 2.24 [1.35-3.74]), use of oxygen therapy (OR [95% CI]: 2.77 [1.60-4.79]), severe-critical vs. asymptomatic-mild severity (OR [95% CI]: 2.28 [1.32-3.94]), and death (OR [95% CI]: 7.48 [1.83-30.47]) from COVID-19, but not prolonged hospitalization (OR [95% CI]: 1.03 [0.47-2.25]). In multivariable models adjusting for socio-demographics, comorbidities, and immunosuppressant medication use, the associations with onychomycosis remained significant for hospitalization, inpatient visits, oxygen therapy, severe-critical COVID-19. Onychomycosis was a significant independent risk factor for COVID-19 severity, hospitalization, and receiving supplemental oxygen therapy.

Background: Pregnancy is a wonderful landmark in the life of a woman. It is the origin of human life. Pregnancy is a time of physical and hormonal changes and of emotional and psychological preparation for motherhood. Comforting techniques may enhance the women to settle and provide with an appreciation of personal capabilities. Therefore yoga can be an effective way to emancipate women during labour and to assist in attaining and maintaining their optimal level of functioning. Yoga is the great way to stay fit during pregnancy because yoga posture can easily meet the needs of pregnant women. It educates pregnant women to listen to their body and reduce stress and anxiety, and to calm the mind. Methodology: The research approach selected for this study was Quasi experimental -Pre and Post test design. The intervention for study group consisted of selected yoga which includes Asanas (tadasana, utkatasana, katichakrasana, konasana, ardhatitali, purnatitali), pranayama (nadishodhana, bhramari, sheetkari, sheetali, OM chanting), ashwini mudra, deep relaxation practice from 28th weeks of pregnancy till delivery. Result: There was a significant reduction in level of anxiety and pregnancy discomfort for primigravida women and improved maternal and neonatal outcome. The selected yoga was found to be effective in reduction of anxiety and pregnancy discomfort and improved the maternal and neonatal outcome for study group. Conclusion: Regular practices of selected yoga were effective in minimizing the level of anxiety during pregnancy, pregnancy discomfort and improving maternal and neonatal outcome.

Alzheimer’s disease (AD) is characterized by progressive loss of cognition and a gradual decrease in memory. Though AD is considered the most persistent form of dementia and a global concern, no complete cure or agents that can completely halt the progression of AD have been found. In the past years, considerable advancements in the understanding of cellular and molecular changes associated with AD has been investigated and numerous pharmacological targets have been recognized to enable drug development for the condition. Amyloid-beta (Aβ) plaques and neurofibrillary tangles (NFT) are the major attributes of AD. Symptomatic relief is the only possible treatment available at present and a disease modifying drug is of utmost importance. Development of drugs that can inhibit different targets responsible for the formation of plaques is a potential area in AD research. This review is not a complete list of all possible targets for AD but serves to highlight the targets related to amyloid pathology and pathway concerned with the formation of amyloid fragments. This shall serve as a prospect in identification of amyloid plaque inhibitors and pave the strategies for newer drug treatments. Nevertheless, substantial research is done in this area but to bridle, the clinical difficulty remains a concern.

BACKGROUND Prostate is an associated gland of the male reproductive system. Worldwide, among the men, prostate cancer (PC) is the second most common cancer. PC is the seventh commonest cancers among the Indian male. Studies reported that diffusion weighted imaging (DWI) and dynamic contrast enhanced imaging (DCE-MRI), can offer additional value in localizing cancer. A study was conducted to evaluate and correlate the role of DWI in detection and staging of PC and correlation with histopathology. METHODS A cross-sectional observational study was conducted in the Department of Radiodiagnosis, GSL Medical College, over a period of 18 months. Males with symptoms of nocturia, urinary urgency, frequency, hesitancy and bone pain were included in the study. Trans rectal ultrasound scan (TRUS) biopsy was collected, Gleason‘s score (GS) was considered for the histopathologic analysis. The evaluation of DWI as a tool for detection of PC was based on comparing the sensitivity and specificity of the results after taking histopathology as the gold standard test chi-square test was used to find the statistical significance and P < 0.05 was considered statistically significant. RESULTS Total, 36 (82 %) were diagnosed to be malignant, maximum number (18; 50 %) were between 61 – 70 years age group. Peripheral zone is the most common (61.2 %; 22) area for the PC followed by transitional (33.3 %) and central zone (5.5 %). In this study, 16.6 % members had GS ≤6; Apparent diffusion coefficient (ADC) was ranged between 0.81 to 0.87 and mean + SD were 0.85 + 0.02. Out of the 22.2 % members whose GS was 7, the mean + SD ADC were 0.74 ± 0.02. For 22 (61 %) members, GS was >8; the mean + SD ADC was 0.63 ± 0.08; statistically there was significant difference between the parameters. Magnetic resonance imaging (MRI) revealed that 61.3 % (27) cases as highly suspicious, 25 % (11) as probably malignant and 13.6 % (6) as indeterminate; the sensitivity for MRI was 94.5 % and specificity was 85.7 %. CONCLUSIONS Patients with increased prostate specific antigen (PSA), multi-parametric magnetic resonance imaging (MPMRI) is valuable, non-invasive and a better option to detect PC. Also helps in localizing the exact location. KEYWORDS Cancer, Tumour, Biopsy, Study

Background: Huntington’s disease (HD) is a genetic neurodegenerative illness characterized by progressive nerve cell degeneration in the brain, mainly in the basal ganglia. It often manifests itself between the ages of 30 and 40. The disease is including inherited genetic genes, which means that the affected person inherits the gene from a parent who also has the same genes. In populations of western European origin, the incidence of inherited genetic diseases is 3-10 per 1,00000. In India, it is far less common. Case Presentation: This is a case of a 57 -year-old female schoolteacher who was brought to our institution with a trembling movement all over the body and imbalancing while walking. The clinical presentation of characteristics such as difficulty controlling his hands and fingers due to involuntary, uncontrolled motions is used to make the diagnosis He walked without a cane and seemed to be in good physical shape, yet when asked to sit, he slumps heavily into the chair. CT or MRI scans indicate lacunar ischemic foci in bilateral periventricular white matter. Mild cerebral and cerebellar atrophy was present. Complete blood testing were also carried out. Conclusion: There are currently few therapies available. The emergence of treatment methods capable of directly targeting HTT, on the other hand, signals a new phase in HD research. There is now more than ever a serious possibility of modifying and preventing HD.

Background: Schizophrenia is one of the most leading perplexing complications, that creates a problem in an individual in which there is a disturbance in their thinking, emotion, and volition in the presence of their clear consciousness. Rehospitalization and reoccurrence of the symptoms are very common among these patients if medication is not taken properly. Objective: 1) To assess pre test level of medication adherence among Schizophrenic patients. 2) To assess the effectiveness of psycho education on medication adherence among Schizophrenic patients after intervention. 3) To evaluate the effectiveness of psycho education on medication adherence among Schizophrenic patients. 4) To associate the post test level of psycho education on medication adherence score with their selected demographic variables. Methodology: It is an interventional research approach study, and it will be conducted among 60schizophrenic inpatients who were selected by using a non-probability purposive sampling technique in psychiatric departments at Acharya Vinoba Bhava Rural Hospital, Sawangi (Meghe), Wardha. A standardized Medication Adherence Rating Scale (MARS) will be used to collect the data. Expected Outcome: It is expected that the psycho education given to the patient will be effective and thus improve their medication adherence. Conclusions: Medication non-adherence is not a recent problem among schizophrenic patients; it is a problem that remains for a long-time. This study thus will provide recent data regarding the effectiveness of psycho education among schizophrenic patients.

Rheumatoid arthritis (RA) is one of the most common inflammatory arthritides. It is associated with multiple systemic features, including hematological manifestations such as anemia, neutropenia and thrombocytopenia. However, immune hemolytic anemia is extremely rare with only 3 reports indexed in medline, and one of them being due to methotrexate toxicity. Microcytic anemia is a condition in which the body's tissues and organs do not get enough oxygen. This lack of oxygen can happen because the body does not have enough red blood cells, or because the red blood cells do not contain enough hemoglobin, which is a protein that transports oxygen in the blood. Case Presentation: A 60 year old female a known case of rhematoid arthritis and hypothyrodisam in 2013 for last past 3 years. Who presented to us with history of recurrent anemia . In march 2021, she was admitted to hospital because of palpitations and shortness of breath due to severe anemia. Results of laboratory studies were hemoglobin, 6.9 gm/dl and haptoglobin, less than 29.8mg/dl. A diagnosis of anemia was made on the basis of the laboratory findings She was transfused with 1units packed red blood cells (pRBCs) over less than 6 hours. High-dose PSL (50 mg/day) was started, and the anemia improved. The hemoglobin level increased to 7.0 gm/dl within the 1st week. Conclusion: The differential diagnosis of various hematological disorders should include rheumatic autoimmune diseases among other causes of blood cell and hemostasis abnormalities. It is crucial that hematologists be aware of Treatment should be administered promptly, with rheumatological consultation.

Paranoid is the most common delusion in people living with schizophrenia spectrum disorders which are present in about half of all people seeking treatment for a psychotic disorder. Schizophrenia is a persistent mental illness characterized by a wide range of symptoms, including delusions, hallucinations, disorganized speech or behavior, and cognitive impairment. Capgras syndrome is a form of the delusional belief in which a person has been replaced by an imposter. It can be seen in mental disorders as well as in central nervous system diseases in the form of neurodegenerative and non- neurodegenerative diseases The Capgras Syndrome is not an unusual condition, but an infrequent one which is possibly often unnoticed. A 48- years- old woman was admitted in female psychiatric ward with known case of paranoid schizophrenia with capgras syndrome. In the present case, the treatment approach was mainly somatic therapy i.e. psychopharmacotherapy, Electro convulsive Therapy (ECT) and psychological therapy. Psychiatric nurses have to play an important role to identify the symptoms and they should think critically, take action immediately to provide care to such type of patients.

Purpose: Suboptimal diet is a preventable cause of cancer. We aimed to estimate the economic burden of diet-associated cancer among US adults. Methods: We used a Comparative Risk Assessment model to quantify the number of new cancer cases attributable to seven dietary factors among US adults ages 20+ years. A Markov cohort model estimated the 5-year medical costs for 15 diet-associated cancers diagnosed in 2015. We obtained dietary intake from 2013-2016 National Health and Nutrition Examination Survey, cancer incidence and survival from 2008-2014 Surveillance, Epidemiology, and End Results (SEER) program, and medical costs from 2007-2013 linked SEER-Medicare data. Results: The estimated 5-year medical costs of new diet-associated cancer cases diagnosed in 2015 were $7.44 (2018 US$). Colorectal cancer had the largest diet-related 5-year medical costs of $5.32B. Suboptimal consumption of whole grains ($2.76B), dairy ($1.82B) and high consumption of processed meats ($1.5B) accounted for the highest medical costs. Per-person medical costs attributable to suboptimal diet vary by gender, race and age group.Conclusions: Suboptimal diet contributes substantially to the economic burden of diet-associated cancers among US adults. This study highlights the need to implement population-based strategies to improve diet and reduce cancer burden in the US.

Background: Dementia is one of the most difficult medical and economic concerns that our society faces today. There are currently very few treatments available for those suffering with dementia. There are no medications available that can stop or reverse brain tissue deterioration. This is primarily due to a lack of understanding of how dementia develops. Aim: To improve the individual with dementias quality of life, followed by caregiver support. To minimize burden of this disease on caregivers. Presentation of Case: The authors present case of a 65-year-old female got admitted in female psychiatric ward AVBR Hospital Sawangi Meghe Wardha Maharashtra with chief complaint of forgetfulness, interest in environment decline, unable to communicate, poor performance at work, muttering to self, sleep disturbance, seeing people which are not seen other, fearfulness. all necessary investigation done, in mental status examination founded impairment in memory, disorientation cognitive function impairment, RBC count 3.82, WBC count 5300, Hb% 12, calcium 8.1, urea 26, creatinine 0.6, sodium 142, potassium 4.0. Alkaline phosphate 89. HIV, HBSAG non-reactive, Positron emission tomography finding that atrophy in the left temporal lobe or posterior region of the partial lobes. Positron emission tomography (PET) is a widely used imaging technique in many clinical applications including tumor detection and neurological disorder diagnosis. In particular, amyloid PET plays a significant role in dementia diagnosis. Results: The patient was received symptomatic treatment antidepressant, antianxiety, antipsychotic drug alleviates hallucinations and delusion. severity of Symptoms was minimized. Discussion: patient received treatment such antipsychotic drug according to symptom, not only antipsychotic drug is important but also other therapy are important to minimized symptoms such reorientation training, daily routine, occupation therapy, Nutrition and Body Weight, Mood changes are best controlled by keeping a calm environment with fixed daily routine. It is advisable to have some identification bracelet or card always in their possession. The doors of the house should be securely locked so that the patients cannot leave unnoticed. Conclusion: Patient received symptomatically treatment benzodiazepine antidepressant, antipsychotic to alleviate hallucinations and delusions, anticonvulsant to control seizures. Donepezil, galantamine, Memantine. Patient condition improved through reorientation training, therapy other and severity of symptoms was minimized.

Introduction: Acute and Transient Psychotic disorder (ATPD) is defined by the ICD-10 as hallucinations, delusions, and/or senseless or nonsensical speech having an acute [1]. The distinguishing characteristic of ATPD is its abrupt onset. Second, there are characteristic symptoms present, and third, there is related acute stress [2]. Clinical Findings: Sleep disturbance, aggressiveness, muttering to self, irritability, irrelevant talks and loss of appétit, hearing of voices not heard by others, suspiciousness, increased talkativeness, increased energy and fearfulness. Mental Status Examination: Conscious, dressed appropriately, well groomed, standing, eye to eye contact initiated, non cooperative, activity normal, and the mood is exhausted, frustrated, the affect is irritable, guarded, and the flow of speech rate is rapid with moderate volume and responsive quality, Thought-flight of thoughts is evident, as are perceptual abnormalities- auditory hallucination, impaired social judgment, and full denial of sickness. Outcome: After treatment, the patient shows improvement. Irritability has reduced, sleeping pattern is improved, self muttering has stopped, irrelevant talks are less, and aggressiveness is reduced. Conclusion: Patient was admitted to Psychiatric Ward with a known case of Bipolar Affective Disorder and after Mental Status Examination he is diagnosed as Acute Transient Psychotic Disorder with complain of Sleep disturbance, aggressiveness, muttering to self, irritability, irrelevant talks. He improved after receiving adequate treatment, and the treatment was continuously ongoing until my last date of care.

Purpose To elucidate visual outcome of patients after combined Descemet stripping endothelial keratoplasty (DSEK) with scleral fixated intra ocular lens (SFIOL) implantation in patients of endothelial decompensation with coexistent aphakia or lens subluxation. Materials and Methods A prospective interventional study of combined DSEK with sutured SFIOL in the patients who have undergone surgery at our center over 6-month follow-up period. Preoperative visual acuity and slit lamp findings were documented. Postoperative follow-up was done at days 1, 3, and 7 subsequently, months 1 and 3, and thereafter monthly till the sixth month. Results Mean age of the patients was 60.47 years. Six patients had aphakic bullous keratopathy, while 11 patients had pseudophakic bullous keratopathy with subluxated posterior chamber IOL (PCIOL). Preoperative visual acuity ranged from hand movements close to face (LogMar 2.4) with accurate projection of rays to 1/60 (LogMar 2) due to existing corneal edema and aphakia. Postoperatively uncorrected visual acuity at 6 months improved up to 6/36 (LogMar 0.8) in all cases. There was gradual improvement in corneal clarity and compactness during the follow-up. A good donor tissue endothelial count and an adequate IOP control were vital prognostic factors for the successful outcome. Conclusion This novel surgical merger reduces the complications of lenticule dislocation into vitreous and repeated surgeries and shows results akin to when performed in a staged manner.

Repair of meniscus injuries always posed a significant problem, especially in relatively avascular zones. Several methods to augment the repair were devised, but only a few had convincing results. Fibrin clot augmentation is one of the augmentation procedures that shows good promise in this premise. The major hurdle to it is difficulty in delivering into the meniscus tear under constant irrigation during arthroscopic procedures. This article presents a simple and unique way to prepare and transfer a fibrin clot into a meniscal tear in a step-by-step manner., Technique Video Video 1 Arthroscopic meniscus repair with fibrin clot augmentation.

 Introduction: High altitude pulmonary edema (HAPE) is one of the acute, severe, non-cardiogenic disease that could be life threatening, occurs upon either the first or subsequent exposure to high altitude. It is triggered by a shortage of oxygen after ascending high altitude. The most effective therapeutic approach for HAPE is to immediately descend from high altitude and to give oxygenation, maintaining arterial saturation over 90%, as well as letting the patient rest from strenuous physical activity. The use of portable hyperbaric chamber is also deemed effective in certain circumstance, and nifedipine can also be used to treat HAPE, even as additional treatment in condition that the patients had yet to descend and oxygenation is still not administrable. Case Report: We reported a case at Rs. Dr. Saiful Anwar, a 23-year old male with High Altitude Pulmonary Edema (HAPE). Diagnosis established from anamnesis, physical examination, and laboratory tests. Patient complained shortness of breath when climbing Mt. Semeru, in which the patient reached an altitude of 2700 mdpl in 2 days. Physical examination showed oxygen saturation 46-49% with NRBM 10 lpm, and rhonchi breath sound in all lung areas. Laboratory examination showed leukocytosis, blood gas analysis showed hypocarbia, severe hipoxemia, metabolic acidosis, and type I respiratory failure. Ches XRay showed wide, irregular infiltrate in both lungs. Based on those, the patient was diagnosed with HAPE. In this case, the patient was given oxygenation.Conclussion: In this case, the patient was diagnosed with HAPE based on anamnesis, physical examination, and laboratory tests. Oxygenation given to the patient improved his condition.Key words: High altitude disease, Acclimatization, Pathophysiology, Management and treatment

Introduction: The geriatric population are the fastest growing segment around the world. The prevalence of multiple comorbidities in geriatric patients requiring special perioperative care. Perioperative management must be done properly, considering that surgical complications on geriatric can cause multiple comorbidities. There are many complications that often occur in geriatrics, one of which is infection. Case report: A 77-year-old man complained about pain on his right knee 1 – 2 weeks after doing TKR procedure. The pain accompanied with fever, swollen, and redness. Physical examination showed elevated blood pressure (140/90), Fever (37,4oC), obesity grade I (BMI 27.4 kg/m2), swollen and redness on his right knee, pain on palpation with VAS 5, edema (+). Barthel index ADL showed mild dependency, FRAIL score 3, qSOFA score 0. Laboratory result showed elevated leukocyte 14.900/µl. Conclusion: Geriatric patients are very vulnerable to the risks of surgery, one of which is septic arthritis. So that a good perioperative evaluation can reduce complications, comorbidities and decreased functional status

BACKGROUND Breast cancer is the second most common malignancy and most common among women next to lung cancer. A small lump in the breast leads to great physical, emotional, and psychological trauma to the victim and as well as family. In addition to clinical examination, imaging modalities like mammography (MG), ultrasonography (USG), cytological diagnosis by fine needle aspiration cytology (FNAC) and tissue diagnosis were used for the diagnosis. These diagnostic techniques have certain pitfalls in addition to their advantages. A study was conducted to evaluate the breast lesions according to breast imaging reporting and data system using MG and USG, correlation with FNAC. METHODS It was a cross-sectional study, conducted in the Department of Radio-diagnosis, GSL Medical College, Rajahmundry from January 2018 to June 2019, over a period of 18 months. An informed consent was taken from all the participants. The individual with palpable breast lesions detected in clinical examination were included. Physiological swelling, ulcerated and fungal breast growths were not considered. After the detailed clinical history, physical examination, MG and USG were performed, proceeded for FNAC, smears were stained with Leishman and Papanicolaou stain. Statistical analysis was performed by Statistical Package for Social Sciences (SPSS version 20.0). Descriptive data was presented in the form of mean, standard deviation and percentages. Chi-square test was done to assess the association among various categorical data, P < 0.05 was considered statistically significant. RESULTS Total 142 participants were included, maximum number belong to 41 to 50 years, 0.7 % were male. Right side lesion was the predominant. With FNAC, the sensitivity, specificity and the diagnostic accuracy were 86.5 %, 97.8 % and 93.7 %, respectively for benign breast lesions (BBL) diagnosis and 96.7 %, 84.6 %, 92.25 % respectively for malignant breast lesions (MBL) diagnosis. CONCLUSIONS The sensitivity, specificity and diagnostic accuracy was observed to be higher in diagnosis of both BBL and MBL with the combined modalities. KEYWORDS Breast Lesions, Benign, Malignant

Mycobacterium tuberculosis is the bacteria that cause tuberculosis. If the infection is not treated immediately the bacterium passes via the circulatory system and spread other organs and tissues. Pathogen will travel to the meninges and causes inflammation of membranes called as tubercular meningitis. Here, the authors report a case of tuberculous meningitis a 42- years-old male patient with the chief complaints of low grade fever with chills since 1 month, headache in frontal region since 5-6 days, altered sensorium, breathing difficulty, reduced speech and left side weakness of the body since 1 day. After admitting in the ward all investigation done like MRI brain, ECG, lumbar puncture, blood tests etc. and he diagnosed as tuberculous meningitis. Patient admitted in AVBRH in ICU, investigations done, where patient was on NIV support, nasogastric tube, foleys catheter and it has been removed as patient was improving the condition and shifted in ward. Patient medical treatment in the ward was inj. C-tri 2 gm, Inj.levoflox 500 mg, inj. thimine 100 mg, Inj.Dexamethasone 10 mg, tab. Pan 40 mg, tab. Akt4 3, Inj.manitol, tab. Lorazepam. History collection, Physical examination, neurological assessment and nursing care plan were done after all treatment patient condition has been improved.

Introduction: An impaired relationship with reality is a hallmark of psychosis. It is a sign of a serious mental disorder. People with psychosis may have delusions or hallucinations. The way your brain processes information can be affected by psychosis. Losing touch with reality is caused by it. It's possible to see, hear, or believe things that aren't true. Psychosis is a symptom, not a disease. It can be caused by a mental or physical illness, substance abuse, or stress. This case report aims to provide nursing care for psychosis. The objectives of this case report are to identify psychosis symptoms by the nurses and to report immediately and to take action immediately and to prevent complications. Case Presentation: A 17-years adolescent male admitted at Acharya Vinoba Bhave Rural Hospital Sawangi (M) Wardha with Auditory Hallucinations in psychosis since 7 (2014) years was admitted to a psychiatric ward with a chief complaint of muttering and smiling to self, decreased interaction sleep disturbance, aggressiveness. The perpetuating factors are poor drug compliance. Conclusion: The patient underwent psycho pharmacotherapy and the patient taking the medications regularly and minimized the symptoms. The relatives were informed about the prognosis and finally patient was discharged. The nurses play a vital role at the bedside and take care of psychiatric patients with auditory hallucinations effective nursing interventions for an adolescent male with auditory hallucinations in psychosis enhancing and improving patient’s mental illness who experience auditory hallucinations in psychosis.

Mother-to-child transmission of SARS-CoV-2 might occur during the antepartum (in utero), intrapartum, and/or postpartum period. Theoretically, in utero transmission is possible in cases of maternal COVID-19 infection due to disruption in the placental interface or viral particles in the amniotic fluid as a result of viremia. Intrapartum and postpartum transmission might occur due to the neonate's exposure to the mother's infected genital secretions and breastmilk.

Introduction: The psychotic state of Schizophrenia is characterized by a disruption in the existence of clear consciousness in the thought, emotion and faculties that typically leads to a social abrogation. In India, research found a prevalence 3/1000 individuals. It is more common in men, and when men begin to develop schizophrenia, they appear to be around five years younger by average than women. Case Presentation: A male patient 30 years from Hariom Nagar, Sindhi Meghe, Wardha was admitted to Psychiatric Ward, AVBRH on 20th January 2021 with a case of Schizophrenia. Symptoms: Behavioral changes like muttering to self, smiling to self, aggressiveness, irrelevant talk, sleep disturbance, hearing of voices not heard by others. Non adherence to medication in the last 1 years. Investigation: Hb% - 14.6 mg/dl; Glucose plasma random – 68 mg%; Monocytes- 3%, Granulocytes- 80% Lymphocytes- 15%; HIV, HCV, HBsAg, VDRL, all of these tests were negative. Surgical Management: Patient have no past surgical history. Medical Management: Patient was treated with Tab. Risperidone Plus x HS and Tab Clonazepam 0.25mg. Nursing Management: Assess for physical, psychological and social data. Aware for Impact of schizophrenia on physical health, emotions, thinking and natural capacity to cope. Remember that the defense mechanisms used, the nature or structure of the feeling, the suicidal risk, the capacity to work and the space accessible for social support services. Conclusion: Patient was admitted to AVBRH and was diagnosed to have Schizophrenia. The patient got appropriate treatment and therapy and his condition has improved well.

Introduction: Mitral stenosis (MS) may be a variety of valvular heart disease. Mitral stenosis is characterized by a narrowing of the mitral valve's orifice. Rheumatic fever is the most common cause of mitral stenosis today, yet the stenosis may appear clinically important just once in a lifetime [1]. Intellectual disability, with a prevalence of approximately 1 chronicle, may be a lifelong neurodevelopment disorder that impacts international cognitive talents and function perform or daily living skills [2]. Clinical Findings: Breathlessness, weakness, high blood pressure, pulmonary thrombus, anemia, disability to talk, face discoloration, not proper communication, weight loss. Diagnostic Evaluation: Blood investigation Hb -9.1gm,mch-82.3fl,mch-29.6piegon,mchc-36%, Total RBC count-5.31million/cu.mm RDW- 12.7% ,hct 35%, Total WBC count- 13,300cu.mm ,monocytes -4%, Granulocytes- 85%, Lymphocytes -10%, Esonophils-1%,Basophilis -0% , Total platelets conut-11.3, cu. mm. Urea 32mg/dl, creatinine-0.9mg/dl,sodium-131mmol/dl , potassium 5.1 mmol/L. Despite the fact that the patient was not diabetic, the random blood sugar test revealed a level of 160 mg/dL. RBC increase, 2D echo impression thrombus present in heart, Intellectual disabilities present, high blood pressure, urine albumin present, Therapeutic Intervention: Blood transfusion, and medical treatment. Conclusion: 48 years old female was admitted to medicine ICU diagnosed with the case of mitral stenosis with mental retardation with anemia with sepsis and she had complained of Breathlessness, weakness, high blood pressure, pulmonary embolism, anemia, disability to talk, face discoloration, not proper communication, weight loss. patient show great improvement after getting the treatment and the treatment was still going on still my last date of care. The patient and her family underwent psychological stress, which was resolved to an extent by being an active listener and providing proper counseling.

Papillon-Lefevere syndrome is a very rare autosomal recessive trait characterized by palmoplantar hyperkeratosis and severe generalized early-onset periodontitis leading to premature loss of primary and permanent dentitions. Various etiopathogenesis factors are associated with syndrome. The palmoplantar keratoderma typically has its onset between the ages of 1 and 4 years and severe periodontitis starts at age of 3-4 years. A dentist plays an important role in early diagnosing and preserving remaining teeth in oral cavity. This case series describes three cases of PLS in siblings with consanguineously married parents. All siblings in the family were affected which makes this a rare case. Keywords: Consanguineous, Palmoplantar keratosis, Periodontitis, Cathepsin­ C gene

Background: Bisoprolol is a beta-blocker agent that is widely used as an antihypertensive agent, cardiac rate control, and agent to improve the cardiac ejection fraction. Bisoprolol is commonly added to hypertension therapy in patients with a high risk of heart disease such as hypertension with diabetes. The effectiveness of beta-blocker agents in the treatment of hypertension in geriatrics with diabetes without a history of CVD who are currently using dual therapy is still minimal. Evaluation of this matter needs to be done to complement scientific evidence in the use of bisoprolol in the treatment of hypertension in geriatrics with type 2 diabetes mellitus. Objective: This study aims to compare the effectiveness of bisoprolol as additional therapy in geriatric patients who have diabetes hypertension without CVD history while they are ongoing dual oral antihypertension therapy. Method: A cohort study involving 82 geriatrics was prospectively observed for four weeks. The exposure in this study was the bisoprolol agent. Subjects were divided into two groups, where all patients would undergo dual antihypertensive agents, namely Angiotensin-Receptor-Blocker (ARB) and Calcium-Channel-Blocker (CCB). Reductions in systolic and diastolic blood pressure were observed as primary outcomes, and success in achieving blood pressure goals was observed as a secondary outcome in the study. Result: There was no difference in the decrease in systolic and diastolic blood pressure in the exposure and non-exposure groups (p> 0.05). Judging from the large number of patients who successfully achieved the therapeutic target also showed no significant difference between the exposure and non-exposure groups with systolic and diastolic risk difference (RD) values of 1,091 (CI95%: 0.545-2.184) and 1,222 (CI95%: 0.781-1.913). Conclusion: The addition of bisoprolol agents in geriatric patients with hypertension and diabetes without a history of CVD is not required.

BACKGROUND Excessive alcohol consumption is a global health burden and requires a better understanding of its neurobiology. A lower density of brain microtubules is found in alcohol-related human brain disease postmortem and in rodent models of chronic alcohol consumption. Here, we report in vivo imaging studies of microtubules in brain using our recently reported Positron Emission Tomography (PET) tracer, [11C]MPC-6827, in chronic alcohol-consuming adult male C57BL/6 J mice and control mice. METHODS In vivo PET imaging studies of [11C]MPC-6827 (3.7 ± 0.8 MBq) were performed in two groups of adult male mice: (1) water-consuming control mice (n = 4) and (2) mice that consumed 20% alcohol (w/v) for 4 months using the intermittent 2-bottle choice procedure that has been shown to lead to signs of alcohol dependence. Dynamic 63 min PET images were acquired using a microPET Inveon system (Siemens, Germany). PET images were reconstructed using the 3D-OSEM algorithm and analyzed using VivoQuant version 4 (Invicro, MA). Tracer uptake in ROIs that included whole brain, prefrontal cortex (PFC), liver and heart was measured and plotted as %ID/g over time (0-63 min) to generate time-activity curves (TACs). RESULTS In general, a trend for lower binding of [11C]MPC-6827 in the whole brain and PFC of mice in the chronic alcohol group was found compared with control group. No group difference in radiotracer binding was found in the peripheral organs such as liver and heart. CONCLUSIONS This pilot study indicates a trend of loss of microtubule binding in whole brain and prefrontal cortex of chronic alcohol administered mice brain compared to control mice, but no loss in heart or liver. These results indicate the potential of [11C]MPC-6827 as a PET ligand for further in vivo imaging investigations of AUD in human.

Background Excessive posterior tibial slope in medial unicompartmental knee arthroplasty (UKA) has been implicated in early failure. The purpose of this study was to evaluate the relationship between preoperative posterior tibial slope and postoperative slope of the implant (PSI) on outcomes in patients with anterior cruciate ligament (ACL) intact and ACL-deficient knees after fixed-bearing medial UKA. Methods Patients who underwent a medial UKA between 2002 and 2017 with a minimum 3-year follow-up were included. Preoperative posterior tibial slope and postoperative PSI were measured. Outcomes measures included Knee Injury and Osteoarthritis Outcomes Score (KOOS) subscales, Lysholm, and VR-12. Failure was defined as conversion to total knee arthroplasty. Results Of 241 knees undergoing UKA, 131 patients (70 women, 61 men; average age of 65 ± 10 years (average BMI of 27.9 ± 4) were included. For all patients, survivorship was 98% at 5 years and 96% at 10 years with a mean survival time for UKA was 15.2 years [95% CI: 14.6-15.7]. No failure had a PSI >7°. There were no superficial or deep infections. There were no significant differences in outcome scores between the ACL intact and the ACL-deficient group; therefore, the data were combined for analysis. At mean 8-year follow-up, KOOS pain scores were better in patients with PSI ≤7° (87 ± 16) than those with PSI >7° (81 ± 15). 76% of patients with PSI ≤7° reached the Patient Acceptable Symptom State for KOOS pain; whereas, 59% of patients with PSI >7° reached PASS for KOOS pain (P = .015). Conclusion Patients with postoperative posterior slope of the tibial implant >7° had significantly worse postoperative pain, without conversion to TKA, and with maintenance of high function. In ACL deficient and intact knees, nonrobotically-assisted, fixed-bearing medial UKA had a 96% survivorship at 10 years.

Atopic dermatitis is characterized by immune dysregulation, which may predispose toward worse COVID-19 outcomes. We conducted a retrospective cohort study to investigate the relationship of atopic dermatitis with COVID-19 symptom severity, hospitalization, length of hospital stay, requirement for oxygen therapy, long-term morbidity and mortality. Multivariable logistic regression models were constructed to examine the impact of atopic dermatitis (independent variable) on COVID-19 symptom severity, hospitalization, length of hospital stay, requirement for oxygen therapy, long-term morbidity and mortality (dependent variables). SARS-CoV-2 positive adult patients with diagnosed AD had similar odds of hospitalization (adjusted odds ratio [95% confidence interval]: 0.51 [0.20–1.35]), acute level of care at initial medical care (0.67 [0.35–1.30]), severe-critical SARS-CoV-2 (0.82 [0.29–2.30]), requirement of supplemental non-mechanical oxygen therapy (1.33 [0.50–3.58]), extended hospital stay (2.24 [0.36–13.85]), lingering COVID-19 symptoms (0.58 [0.06–5.31]) and COVID-19 death (0.002 [ 999]) compared to patients without AD. Our findings suggest AD is not an independent risk factor for COVID-19 severity or complications.

Insufficient use of Excel menus and formulas has been observed among certain medical personnel at Sokaraja 1 Health Center. Similar reports were also obtained for SPSS, QGIS and Rapidminer. The purpose of this study is to strengthen the use of statistical software by health workers to improve information management. An action research methodology was applied, subsequently the training was conducted using Google Meet and relevant statistical software e-module media, Ms Excel, SPSS, QGIS, and Rapidminer for 6 consecutive sessions. The results showed that knowledge and skills increased by 104 and 100%, respectively. These performances confirmed that the statistical software trainings were very significant in facilitating the operations of health workers, with enhanced knowledge and skills.

To understand alcohol and other drug (AOD) use and its impact among South Sudanese youth in Melbourne, Australia.This qualitative exploratory study was underpinned by the psychosocial conceptual framework. We undertook semi-structured interviews with 23 South Sudanese youth aged 14-21 years to explore attitudes and potential harms of AOD use. We also undertook focus groups with these participants and a focus group of 11 South Sudanese community elders and parents. Feedback on results was obtained through two forums with community members. The data collected were analyzed using thematic analysis.The participants revealed that AOD use was common, specifically the use of cannabis. The participants believed that there was a lack of basic understanding of the potential harm of cannabis use. The results also highlighted that the community was unaware how the use of drugs and alcohol can contribute and exacerbate poor mental health. Cannabis was a regular drug of choice used by young South Sudanese in this study. It was used daily as a coping mechanism both for stress and for undiagnosed mental health.The results of this study indicate increased potential harm for South Sudanese youth from AOD use. Of concern was a lack of diagnosis and treatment for mental health wellbeing due to the beliefs around AOD use. Without targeted interventions this has significant implications for the South Sudanese community and the young people affected. The significance of these findings may assist in the delivery of AOD treatment and improve health education for refugee youth.

When you exercise and your muscles work harder, your body uses more oxygen and produces more carbon dioxide. To cope with this extra demand, your breathing has to increase from about 15 times a minute (12 litres of air) when you are resting, up to about 40–60 times a minute (100 litres of air) during exercise. Your circulation also speeds up to take the oxygen to the muscles so that they can keep moving. Any kind of exertion causes some change in vitals. Some amount of fluctuation in vitals after any kind of exertion occurs in every individual and is considered to be normal. But if there is extreme fluctuation in vitals even after mild or moderate form of exertion, it indicates some kind of abnormality or an increased stress on cardiovascular or respiratory system and needs attention.In any case if the vitals fluctuate during any kind of exertion it needs to be stabilized so that its harmful effects can be avoided. For these breathing exercises have been proven to be very beneficial. There are several types of breathing exercises such as deep breathing, diaphragmatic breathing, pursed lip breathing, etc. The need for the study is to compare the effectiveness of Pursed-Lip Breathing & Diaphragmatic Breathing exercise instabilizing the vitals after 6 MWT in young individuals. The objective of this study is to measure the exertion level of the individual, to assess the effect of pursed lip and diaphragmatic breathing exercises on vitals after exertion and also the comparison of both techniques. In the present study we took 60 subjects from saaii college, Kanpur. Method of data collection is random and study design is comparative study with study duration of 4 weeks. Subjects were divided into two equal groups. The paired samples t-test shows significant changes observed i.e., null hypothesis is rejected and alternate hypothesis is accepted and we observed that significant improvement along with effectiveness of pursed lip breathing on stabilizing vitals in overweight individuals.

Kidney transplantation is the therapy of choice for patients with end-stage renal disease. Preexisting diabetes is highly prevalent in kidney transplant recipients (KTR), and the development of posttransplant diabetes is common because of a number of transplant-specific risk factors such as the use of diabetogenic immunosuppressive medications and posttransplant weight gain. The presence of pretransplant and posttransplant diabetes in KTR significantly and variably affect the risk of graft failure, cardiovascular disease (CVD), and death. Among the many available therapies for diabetes, there are little data to determine the glucose-lowering agent(s) of choice in KTR. Furthermore, despite the high burden of graft loss and CVD among KTR with diabetes, evidence for strategies offering cardiovascular and kidney protection is lacking. Recent accumulating evidence convincingly shows glucose-independent cardiorenal protective effects in non-KTR with glucose-lowering agents, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. Therefore, our aim was to review cardiorenal protective strategies, including the evidence, mechanisms, and rationale for the use of these glucose-lowering agents in KTR with diabetes. ispartof: TRANSPLANTATION vol:106 issue:4 pages:734-748 ispartof: location:United States status: published

BACKGROUND: Management of the airway in patients undergoing surgery is increasingly difficult. The airway management in the operating room in terms of the initial action of anesthesia is very important. Video-laryngoscopy has been shown to provide a better view of the larynx’s structure compared to direct visualization. AIM: We describe our experience using a custom made and inexpensive tool for a video-laryngoscopy. METHODS: This is an experimental research with single randomized clinical trial conducted at the Anesthesiology Department of Sanglah General Hospital Denpasar. There were 270 patients divides into three group with conventional, O-Mac® and Mc-GRATH™ BF laryngoscope, aged 18–65 years old, with Mallampati grade 1–2, randomly selected, and signed informed consent. RESULTS: Intubation time fastest with O-Mac® median 26 (15–36) s, p = 0.000. Laryngoscopy time fastest with O-Mac® median 5.5 (2–13 s), p = 0.000. O-Mac® does not use many tools, p = 0.000. All three did not produce tissue damage with results p = 0.007. Hemodynamic changes p = 0.000. CONCLUSION: The O-Mac® is superior in terms of laryngoscope time and intubation time compared to the Mc-GRATH™ BF blade and has the same level of safety as the patented Mc-GRATH ™ video laryngoscope, and better than conventional laryngoscopes.