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Purpose Hepatoblastoma (HB) and hepatocellular carcinoma (HCC) are the most common primary malignant tumors of childhood. Intraoperative indocyanine green (ICG) administration with near-infrared imaging (NIR) has emerged as a surgical technology that can be used to assist with localization of pulmonary metastases secondary to HB; however, there has been limited application as an adjunct for resection of the primary liver tumor and assessment of extrahepatic disease. Methods We present 14 patients treated for HB, HCC, and malignant rhabdoid tumor at our institution with the use of intraoperative NIR-ICG guidance. All patients were treated with 0.2–0.75 mg/kg IV ICG, 48–96 h prior to surgery. Intraoperative NIR-ICG guided imaging was performed with several commercial devices. Results Intraoperative NIR-ICG guidance allowed pulmonary metastasectomy in five patients using thoracoscopy or thoracotomy allowing for visualization of multiple nodules not seen on preoperative imaging most of which were positive for malignancy. NIR-ICG guidance allowed for assessment of extrahepatic extension in three patients; an HCC patient with extrahepatic lymph node extension of disease, an HB patient with extrapulmonary thoracic recurrence in the diaphragm and chest wall, and a patient with tumor rupture at diagnosis with peritoneal nodules at the time of surgery. This technique was used to guide partial hepatectomy in 11 patients for which the technique enabled successful identification of tumor and tumor margins. Three patients had nonspecific staining of the liver secondary to decreased timing from ICG injection to surgery or biliary obstruction. NIR-ICG enabled resection of satellite HB lesions in three multifocal patients and confirmed a benign satellite lesion in two additional patients. Conclusions Intraoperative use of NIR-ICG imaging during partial hepatectomy enabled enhanced identification and guidance for surgical resection of extrahepatic disease and multifocal liver tumors for the treatment of children with primary liver cancer.

Introduction: Worldwide, Stroke becomes a public health problem. In India, reports indicating towards its emerging epidemic in near future. Hypertensive disease is considered as predisposing factor for Stroke. The present study aimed to assess knowledge, attitude and practice of hypertensive patients for stroke prevention in Uttarakhand, India. Methodology: The present study was a cross sectional study conducted on 243 hypertensive patients who were visiting outpatient department of All India Institute of Medical sciences (AIIMS), Rishikesh by using purposively sampling technique. Structured questionnaire of knowledge, attitude and practice were used to collect data from participants of the study. Data analysis was done by using SPSS version 23.0 statistical package. Results: Majority participants were of more than 60 years age, male, illiterate and no family history of hypertension. Most of participants were taking their regular treatment for hypertension. 185 (76%) hypertensive patients were having poor knowledge for stroke prevention. 215 (88%) participants had neutral attitude towards stroke prevention strategies whereas majority (64%) were following good practices. Conclusion: Findings suggested that policy makers should focus on health education of high risk group for stroke and also empower them with knowledge to control rising curve of stroke globally.

The FDA approved capmatinib and tepotinib on May 6, 2020, and February 3, 2021, respectively. Capmatinib is indicated for patients with metastatic non–small cell lung cancer (mNSCLC) whose tumors have a mutation leading to mesenchymal–epithelial transition (MET) exon 14 skipping as detected by an FDA-approved test. Tepotinib is indicated for mNSCLC harboring MET exon 14 skipping alterations. The approvals were based on trials GEOMETRY mono-1 (capmatinib) and VISION (tepotinib). In GEOMETRY mono-1, overall response rate (ORR) per Blinded Independent Review Committee (BIRC) was 68% [95% confidence interval (CI), 48–84] with median duration of response (DoR) 12.6 months (95% CI, 5.5–25.3) in 28 treatment-naïve patients and 41% (95% CI: 29, 53) with median DoR 9.7 months (95% CI, 5.5–13) in 69 previously treated patients with NSCLC with mutations leading to MET exon 14 skipping. In VISION, ORR per BIRC was 43% (95% CI: 32, 56) with median DoR 10.8 months (95% CI, 6.9–not estimable) in 69 treatment-naïve patients and 43% (95% CI, 33–55) with median DoR 11.1 months (95% CI, 9.5–18.5) in 83 previously-treated patients with NSCLC harboring MET exon 14 alterations. These are the first two therapies to be FDA approved specifically for patients with metastatic NSCLC with MET exon 14 skipping.

On December 18, 2020, the FDA approved osimertinib as adjuvant therapy in patients with non–small cell lung cancer (NSCLC) whose tumors have EGFR exon 19 deletions or exon 21 (L858R) mutations, as detected by an FDA-approved test. The approval was based on the ADAURA study, in which 682 patients with NSCLC were randomized to receive osimertinib (n = 339) or placebo (n = 343). Disease-free survival (DFS) in the overall population (stage IB–IIIA) was improved for patients who received osimertinib, with an HR of 0.20; 95% confidence interval (CI), 0.15–0.27; P < 0.0001. Median DFS was not reached for the osimertinib arm compared with 27.5 months (95% CI, 22.0–35.0) for patients receiving placebo. Overall survival data were not mature at the time of the approval. This application was reviewed under FDA's Project Orbis, in collaboration with Australia Therapeutic Goods Administration, Brazil ANVISA, Health Canada, Singapore Health Sciences Authority, Switzerland Swissmedic, and the United Kingdom Medicines and Healthcare products Regulatory Agency. This is the first targeted therapy adjuvant approval for NSCLC and has practice-changing implications.

BACKGROUND There is a high incidence of atrial fibrillation (AF) in patients with isolated rheumatic mitral regurgitation (MR). The histopathologic changes in the atria of patients with isolated rheumatic MR with and without AF are unknown. OBJECTIVES We aimed to determine the histological findings in patients with isolated severe rheumatic MR with and without AF. METHODS Patients with severe isolated rheumatic MR undergoing valve replacement surgeries underwent endocardial biopsies from right atrial appendage, left atrial appendage, right free wall, left free wall, left posterior wall, and mitral valve. Group I consisted of patients in sinus rhythm (SR), and Group II included patients with AF. We analyzed and compared these 10 histological features in the biopsies of patients in Groups I and II. RESULTS Of the 25 patients, 12 were in Group I and 13 in Group II. In Group I, patients had severe myocyte hypertrophy (60% vs. 18%, p = .04) that was significantly more in the right atrium (22.7% vs. 11.4%, p = .059). Interstitial adipose tissue deposition was more common in Group I (30% vs. 25%, p = .06). Interstitial fibrosis was evenly distributed at all sites without significant difference between the two groups. Group II patients had a higher prevalence and severity of vacuolar degeneration (91% vs. 60%, p = .09). CONCLUSIONS Patients with isolated severe rheumatic MR and AF have more vacuolar degeneration in the atrial tissue. Patients with SR have myocyte hypertrophy and interstitial adipose tissue deposition. Interstitial fibrosis is uniformly distributed in patients in SR and AF.

Objective To determine treatment responses to various antiseizure medicines (ASMs) in patients with drug resistant juvenile myoclonic epilepsy (DRJME) Methods We reviewed records of all JME patients attending epilepsy clinics at 5 centers during a 5-year period. We used International Consensus Criteria to diagnose JME and International League Against Epilepsy Criteria to define drug resistance and sustained seizure freedom. We only used broad spectrum medicines which included valproate, lamotrigine, topiramate, levetiracetam, clobazam, phenobarbitone, clonazepam, and zonisamide. We considered an ASM successful if patient achieved seizure freedom within 3 months of attaining maintenance dose. Results We studied 116 patients (61 males) with DRJME. At terminal followup, 82 (70.7%) patients had achieved sustained seizure freedom with a mean followup of 3.2 ± 1.3 years after last dose change. In patients where valproate failed as first- or second-line ASM (n=70; 60.3%), 49(70%) became seizure-free. In this group, 33(67%) patients became seizure-free after addition of lamotrigine. Success rate of lamotrigine and valproate combination was 69% as compared to 9% with all other combinations (p = 0.001). In patients who were not exposed to valproate as initial therapy (n=46), 33 (71.7%) became seizure-free, 30 (91%) after adding valproate. At last follow-up, 75 (90%) seizure-free patients were receiving valproate including 45 (55%) patients with a combination of valproate and lamotrigine. Only one of 24 patients became seizure-free after failing valproate and lamotrigine combination. Conclusion Seizure freedom can be achieved in two-thirds of patients with DRJME. A combination of valproate and lamotrigine is the most effective duotherapy.

Objectives: Change in the past few decades in human life style, nowadays international health organizations, i.e., World Health Organization are also focusing on prevention along with treatment aspect of chronic illness. Researches focus that women of age group 30–45 years are at increased risk for hypertension and heart disease due to increased weight. Yoga is an effective method to control our physiological variables like blood pressure (BP), pulse, etc. The main aim of this study was to identify the effects of yoga on physiological variables. Methods: The study was an experimental study with two group, pretest and posttest control group, design, which was conducted on 40 female participants. Pranayama and meditation for a period of 6 weeks was done by these women. Results: Yoga therapy significantly reduced the BP (0.000*) and pulse rate (0.000*) of women, which was also statistically proved. Conclusions: Yoga therapy can be an effective method to control BP and pulse rate of patients with chronic diseases.

Background: Coronavirus disease affects mainly the respiratory system. Other systems, including blood, are also affected. Blood cell abnormalities have varied between studies. The majority of patients present with platelet abnormalities. Methods: This was a laboratory observation study. All cases positive for the coronavirus disease 2019 (COVID-19) by reverse transcriptase — polymerase chain reaction (RT-PCR) test during the study period were considered for inclusion. Platelet index data were captured from an automated hematology analyzer: platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet–large cell ratio (P-LCR). Platelet lymphocyte ratio (PLR), platelet neutrophil ratio (PNR), and platelet monocyte ratio (PMR) were calculated. The cases were classified into two groups: moderate and severe. The difference in alteration of platelet parameters between moderate and severe COVID-19 cases was analyzed using SPSS 22 version software. A p-value of < 0.05 was considered statistically significant. Results: Most cases (44.9%) were in the age group of 41 – 60 years. The male-to-female ratio was 1.9:1. Moderate cases comprised 53.4%, and 46.6% of cases were severe. The association of PLR and PNR between moderate and severe cases was statistically significant. PLR was higher in severe cases than moderate cases, whereas PNR was higher in moderate cases than severe cases. Conclusions: Studying platelet index profiles in COVID-19 patients can improve our limited knowledge of the disease progression regarding platelet parameters. PLR and PNR are the more reliable platelet parameters in managing COVID-19 patients, which help predict the prognosis and aid in improving therapeutic options for severe cases.

Introduction: Cervical dysplasia is a term used to describe a condition that is on the verge of becoming malignant where aberrant cell proliferation takes place on the cervix or endocervical canals surface lining. Another name for it is cervical intraepithelial neoplasia (CIN) can occur at any age. It has a strong relationship to human papillomavirus (HPV) infection spread through sexual contact. Case History: A case of 34 year old woman admitted in gynecology unit on date June 3, 2021, a month ago when she started experiencing pain in abdomen. It was insidious in onset, continuous type, not associated with bleeding per vaginal. Patient has previous history of five abortions. Patient underwent investigations like complete blood count, kidney function test, liver function test, radiographic investigations and colposcopy where she was found to have moderate dysplasia and chronic cervicitis. Histopathology report also indicated moderate dysplasia with chronic cervicitis. Interventions: Primarily, the pain management is necessary for such patients. Later on all further investigations and procedures performed to confirm the diagnosis and treat the patient accordingly. The aim during the treatment is to safeguard the life and further complications. Outcomes: Over this period of long course treatment, the patient significantly reduced the severity of infection and pain. Improved the daily activities, appetite and sleep. Progress of patient towards her goal of recovering as early as possible. Discussion: The patients response was quite good to treatment, however additional interventions could be used in the future for her greater improvements in disease.

Background: Pregnancy brings a slew of morphological and physiological changes to the body. The gravida must not only nourish the foetus, but also adjust to a new body habit and hormonal changes. These alterations, unsurprisingly, have an impact on the musculoskeletal system, which can lead to a number of issues, such as generalized arthralgias, back pain, separation of the pelvic bones, transient osteoporosis, and tendonitis. Objectives: 1. To assess the pretest and posttest musculoskeletal pain among postpartum women in experimental and control group. 2. To assess the effectiveness of postnatal exercises related to musculoskeletal pain among postpartum women in experimental group. 3. To find association between posttest musculoskeletal pain score among postpartum women with selected demographic variables in experimental and control group. Materials and Methods: Quasi-experimental pretest posttest design is used to assess the effectiveness of postnatal exercises, among postpartum women in selected hospitals of Wardha. 80 sample size taken who fulfils the inclusion criteria, 40 postpartum women for control and 40 for experimental group with non-probability convenience sampling. Expected Results: This study is planned to assess the effectiveness of postnatal exercises to the postpartum women experiencing musculoskeletal pain syndrome. Hence, it is expected to identify the level of pain and may reduce their level of pain. The conclusion will be drawn from the results and will be published in per review journal.

Introduction: Apprehension pertaining to adverse events associated with vaccine can create hesitancy in population which undermines their confidence in vaccination programmes. Clarity regarding what could be expected post-vaccination through reliable scientific data helps in allaying the apprehension. Our research aims at gauging the adverse experiences of oral health care professionals following first dose of immunization against COVID-19 with ChAdOx1 nCoV-19 (COVISHIELD™) and BBV152 (COVAXIN®). Materials and Methods: Data was collected by means of e-questionnaire circulated through online media such as social media platforms to oral health care professionals in India. Data was subjected to statistical analysis using Statistical package for social sciences (SPSS v 26.0, IBM). Descriptive statistics like frequencies and percentage for categorical data, Mean & SD for numerical data has been depicted. Comparison of frequencies of categories of variables with groups was done using chi square test. Results: Pain at site of injection (n=243) was the most frequently reported AEFI, followed by fever (n=225), headache (n=185), body ache (n=156) and fatigue (n=146). Majority of the AEFIs were perceived to be of mild (58.22%) to moderate (31.50%) severity by the respondents and resolved within first two days of immunization. Conclusion: AEFIs are almost inevitable when population on a nation-wide scale is involved in the vaccination scheme Availability of scientific data pertaining to AEFIs that could be expected post-vaccination such as our findings could provide clarity to general population about the issue, thereby purging any apprehension developed due to myths circulation through various modes of media. Keywords: AEFI, Adverse experiences, Vaccine, ChAdOx1, BBV152

Introduction: Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Remdesivir, a broad spectrum antiviral agent, is currently the only drug that is approved by the Food and Drug Administration for the treatment of COVID-19. It is recommended for use in hospitalized patients who require supplemental oxygen. There are insufficient data either for or against to recommend for routine use of Remdesivir in high risk patients who doesn’t require supplemental oxygen. Aim: To evaluate the efficacy of Remdesivir in covid positive patients. Materials and Methods: A retrospective analysis of 300 patients was done, out of which 150 patients belong to Group 1 and 150 patients belong to Group 2. Group 1-Elderly patients with comorbidities who doesn’t require supplemental oxygen Group 2- Patients requiring oxygen supplementation (SpO2 88% to 94% on room air). Results: Group 1 patients were discharged earlier than Group 2 patients. Conclusion: Elective use of Remdesivir has a definitive role in prevention of progression of disease especially in high risk susceptible individuals. Keywords: Remdesivir, COVID 19, Elderly patients, Hypoxia, Oxygen supplementation.

Background Diagnosis of extrapulmonary tuberculosis including tuberculous lymphadenitis (TBLN) is challenging because of its atypical clinical presentation, paucibacillary nature of mycobacteria at the infected sites, variation in sensitivity of a test to specimens collected by different methods and from different infected tissues. Methods In the present study, suspected individuals for lymph node tuberculosis irrespective of age were enrolled prospectively and specimens were collected aseptically by fine needle aspiration (FNA). After the implementation of exclusion criteria, FNA specimens from a total of 278 cases of suspected TBLN were evaluated for cytomorphology (FNAC), presence of acid-fast bacillus (AFB) in smear microscopy and specific detection of mycobacterial DNA in cartridge-based nucleic acid amplification test (CBNAAT). Results The results showed high prevalence of Type II (59.71%), followed by Type I (34.53%) and Type III (5.75%) pattern in FNAC. Non-type II patterns were significantly high in regions outside of the head and neck region (P = 0.031; OR = 2.125) and had an increasing trend of their occurrences with progression of age. The most affected age group was between 16 and 30 years with female preponderance documented in individuals below 45 years, whereas male preponderance was observed in higher age group patients, majority of whom had infected lymph nodes outside of HAN region (P = 0.063, OR = 1.998). The results also showed high sensitivity of CBNAAT (83.04%) method followed by FNAC (72.17%) with AFB smear exhibiting the disappointing results (sensitivity of 10.86%) compared to the CRS. High percentage of positivity was observed in Type III (AFB:25% vs CBNAAT: 100%) followed by Type II (AFB:10.2 vs CBNAAT: 76.5), while low detection was observed from samples with Type I (AFB:4.2 vs CBNAAT: 50). Interestingly, CBNAAT detection of TB was shown to be unaffected by gender, age and site of infection. Conclusion The study suggests a possible contributary role of age and gender for cytomorphological pattern distribution of TBLN at various body parts. Although FNAC detected TB in 77.1% of cases which were identified positive by CBNAAT and/or AFB, it is being solely based on cytomorphology cannot be used alone as a reliable diagnostic method for TBLN detection. Further, the negative results in CBNAAT for FNAC positive cases may not necessarily be non-TB cases and must be evaluated by other diagnostic modalities. We recommend for both cytomorphological investigation and CBNNAT for the fine needle aspirates from suspected TBLN and subsequent treatment to reduce the disease burden.

Acne vulgaris is a common skin condition encountered in specialties outside of dermatology, including obstetrics and gynecology. The pathophysiology of acne is complex and includes disruption of the cutaneous microbiome, abnormal keratinization, inflammation, and hormonal influences. Various topical and systemic treatment modalities target each component of acne pathophysiology. Clinically, acne can be broken down into noninflammatory, inflammatory, or mixed subtypes. The age of the patient at presentation and signs and symptoms of hormonal imbalance might prompt workup for underlying disorders. The severity as well as type of acne dictates the type of treatment.

ObjectiveTo evaluate pertussis antibody status of pregnant women and their newborns, and the impact of antenatal immunisation.DesignObservational study.SettingHospitals in urban western India.ParticipantsPregnant women and their newborns.MethodsPertussis antibody titres in mothers and their newborns were determined. Vaccinated and unvaccinated mothers and their newborns were compared for baseline characteristics, geometric mean titres (GMTs) and placental transfer ratio of antibodies. Multivariate logistic regression was performed to understand the influence of different factors on protective antibody titres.ResultsOf 284 mother–infant pairs, 75 mothers and 73 of their newborns were seropositive for anti-pertussis toxin (PT) IgG antibodies. 94 women were vaccinated in pregnancy; 51 (54.3%) of these mothers and newborns were PT IgG positive, compared with 24 (12.3%) of the women (and 22 newborns) not vaccinated in pregnancy. Women vaccinated in pregnancy and their newborns had higher GMT (30.88 and 32.54 IU/mL), compared with women who were not vaccinated (12.63%, 2.24 IU/mL) and their newborns (11.58%, 2.53 IU/mL). Placental transfer ratios in newborns of mothers vaccinated in pregnancy and those who had childhood immunisation or natural immunity were similar (1.05 and 1.12, respectively). Protective titres of antibodies at birth (>20 IU/mL) were observed in 72.3% vs 21% of newborns of vaccinated and unvaccinated pregnant women, respectively; influenced by mother’s vaccination status and seropositivity.ConclusionProtection against pertussis is low in newborns of mothers who are only immunised during childhood. Vaccination early in pregnancy boosts maternal and neonatal immunity.

PRECIS Glaucoma can cause disturbance in psychological and emotional functioning of patients, leading to anxiety and depression, even early in the disease. Identification and management of these problems should be included as a part of the holistic approach for patient care. PURPOSE To assess the prevalence of anxiety and depression in patients with primary glaucoma using a standard validated questionnaire. METHODS A cross-sectional prevalence study was carried out on 200 patients attending the glaucoma outpatient clinic at a tertiary care eye hospital in Pune, India. After obtaining written consent, all patients underwent a thorough ophthalmic examination. Those with primary glaucoma were included in the study and classified on the basis of the Hodapp-Parrish-Anderson criteria. Participants were asked to respond to the Hospital Anxiety and Depression Scale (HADS) questionnaire and responses were analyzed statistically. RESULTS Mean HADS- Anxiety (HADS-A) score was 4.5 (SD 3.4) while HADS-Depression (HADS-D) was 4.1 (SD 3.8). Severity of disease was associated with significantly higher HADS scores. Mean HADS-A scores were 3.1 (SD 2.9) mild glaucoma, 4.4 (SD 2.6) for moderate and 7.7 (SD 3.0) for advanced disease (P

Objective: To compare the cost effectiveness and achievement of glycemic goals in patients inadequately controlled by conventional drugs receiving either intensified treatment or DPP4 inhibitor as an add on. It shall help us to identify a preferred choice of treatment. Materials and Methods: As per study protocol, 52 patients with inadequately controlled type 2 diabetes mellitus (DM) were included in the study. They received either intensified treatment or add-on with DPP4 inhibitor. Glycated hemoglobin (HbA1c), fasting blood sugar (FBS), postprandial blood sugar (PPBS), adverse drug reactions, and their cost were calculated for the next 6 months of therapy. Results: Add on therapy with DPP4 inhibitor showed a greater achievement of glycemic goals. Target HbA1c was achieved by 58.6% (P < 0.0001) versus 40% (P < 0.05), FBS was achieved by 78.50% (P < 0.0001) versus 50% (P < 0.16), and PPBS was achieved by 63.6% (P < 0.0001) versus 42.8% (P < 0.03) in the add-on with DPP4 inhibitor versus intensified treatment group. No hypoglycemic episodes were documented in both the groups. Add-on with DPP4 inhibitor cost (×5.13) as compared to intensified treatment. Conclusions: Add-on with DPP4 inhibitor therapy achieved glycemic goals in greater proportion of patients as compared to treatment intensification but at 5 times the cost of therapy. Since the patent restrictions for DPP4 inhibitors such as vildagliptin and teneligliptin are over, the cost of therapy has come down. Hence their benefits should be extended to a greater proportion of patients with inadequately controlled type 2 DM.

We report a newborn who presented with multiple limb and facial anomalies, endocrine disorders, and progressively worsening low-GGT cholestasis. A liver biopsy revealed hepatocellular cholestasis with giant cell transformation. Immunohistochemical staining revealed complete absence of BSEP protein compared to control liver. A large 2q24-32.2 deletion leading to loss of 78 OMIM genes. Multiple structural anomalies, epilepsy and endocrine anomalies have been described with hemizygous loss of these genes. This deletion also resulted in complete heterozygous deletion of ABCB11, which encodes the bile salt export pump (BSEP). Genetic analysis did not reveal any pathogenic variants, deletions, or duplications in the other ABCB11 allele. A heterozygous variant in NR1H4, which causes the autosomal recessive progressive familial intrahepatic cholestasis type 5, was also detected. The possible explanations for the PFIC type 2 phenotype in heterozygous loss of ABCB11 include genetic modifiers or di-genic disease with a compound ABCB11 deletion and an NR1H4 missense variant; or undetected pathogenic variants in the other ABCB11 or NR1H4 alleles.

Background: The Nagpur Metro rail project workers are involved in heavy activities like pulling, pushing, lifting heavy loads and other heavy tasks. This makes them susceptible to Musculoskeletal disorders (MSDs)/symptoms. Aim and objectives: To find out the presence of work related musculoskeletal symptoms in Metro workers in Nagpur city using Nordic musculoskeletal questionnaire. Methods: 120 workers falling, in the age range of 20 to 45 years and involved in labor work were included using the convenient sampling method. Samples were excluded if they have recent fractures or surgery, any neurological conditions or who were not willing to participate. Nordic Musculoskeletal questionnaire was explained to each and every worker in their vernacular language. Results and Conclusion: The result showed that there is multiple region involvement among the subjects. The most affected region was found to be upper back followed by low back, knee, shoulder, neck. Keywords: Metro Rail Workers, Work related Musculoskeletal Disorders.

The aim of the study was to find the association of various risk factors with permanent hearing impairment in infants. A case–control study was designed on 420 infants with permanent hearing impairment and normal hearing. The case control ratio was 1:1. Alternate sampling method was used for selecting the control group. Review of medical records and parent interview was done to collect the information of risk factors. Family history(adj. OR 7.5; 95% CI 3, 14; P = 0.000), Consanguinity (adj. OR: 4; 95% CI 2,4; P = 0.000), intra uterine infection (adj. OR 18, 95% CI: 2.3–126.5, P = 0.000), post natal infection (adj. OR 3, 95% CI: 1.3–5, P = 0.004), low Apgar score (adj.OR: 4.6, 95% CI: 1.3–15), craniofacial anomaly (OR-4.6, 95% CI: 1.4–9.5, P = 0.005) and low birth weight (adj. OR: 2.3, 95% CI: 1.2–3.8) were significantly associated with hearing impairment. Among the risk factors, intra uterine infection was having highest significant association with permanent hearing impairment. This is followed by family history, low Apgar score, craniofacial anomaly, consanguinity, post natal infection and low birth weight.

Mucormycosis is a opportunistic fungal infection that occurs in patients who are immunocompramised. The fungus causing mucormycosis belongs to the class of zygomycetes and the order of mucorales. It is highly life-threatening mycotic infection that is characterised by angioinvasion, infarction, and tissue necrosis. The risk factors include uncontrolled diabetes mellitus in ketoacidosis, various forms of metabolic acidosis, treatment with corticosteroids, organ or bone marrow transplantation etc. The diagnosis is challenging and treatment should start as early as possible to decrease mortality. Diagnosis is based on symptoms such as, in case of sinusitis, sinus biopsies are required. Ear, nose and throat endoscopy should be done. Molecular identification of mucormycosis can help in confirming diagnosis and identify the fungus from genus to species level. Different techniques are as follows: DNA probes targeting 18S subunit, ITS1 sequencing after PCR with pan-fungal primers, 18S-targeted semi-nested PCR and real time PCR targeting cytochrome b gene. The therapeutic approach should be multimodal including anti-fungal agents, surgical debridement, and correction of underlying symptoms predisposing the patient to disease.

Pancreatic angiosarcoma is an exceedingly rare malignancy accounting for

Unblinded trials are common in oncology, but patient knowledge of treatment assignment may bias response to questionnaires. We sought to ascertain the extent of possible bias arising from patient knowledge of treatment assignment.This is a retrospective analysis of data from 2 randomized trials in multiple myeloma, 1 double-blind and 1 open label. We compared changes in patient reports of symptoms, function, and health status from prerandomization (screening) to baseline (pretreatment but postrandomization) across control and investigational arms in the 2 trials. Changes from prerandomization scores at ~2 and 6 months on treatment were evaluated only across control arms to avoid comparisons between 2 different experimental drugs. All scores were on 0- to 100-point scales. Inverse probability weighting, entropy balancing, and multiple imputation using propensity score splines were used to compare score changes across similar groups of patients.Minimal changes from screening were seen at baseline in all arms. In the control arm, mean changes of7 points were seen for all domains at 2 and 6 months. The effect of unblinding at 6 months in social function was a decline of less than 6 points (weighting: -3.09; 95% confidence interval -8.41 to 2.23; balancing: -4.55; 95% confidence interval -9.86 to 0.76; imputation: -5.34; 95% confidence interval -10.64 to -0.04).In this analysis, we did not find evidence to suggest that there was a meaningful differential effect on how patients reported their symptoms, function or health status after knowing their treatment assignment.

Objectives: Preeclampsia (PE) is a multisystemic disorder portrayed by the new beginning of circulatory pressure more noteworthy than 140/90 mmHg and proteinuria with 0.3 g in a 24 h on dip stick emerging after 20 weeks of incubation. The hidden pathophysiology of PE includes endothelial brokenness and vasospasm beginning principally in the placenta. The unusual growth of blood vessels in placenta leads to poor perfusion. This relative hypoxic condition in placenta causes arrival of antiangiogenic factors into the maternal blood dissemination which prompts the modifications in maternal fundamental endothelial functions and causes hypertension. Soluble fms-like tyrosine kinase (sFlt) can form a heterodimer, binding with vascular endothelial growth Factor A and placental growth factor. In preeclamptic subjects, there will be an imbalance in anti-angiogenesis factors and there will be incomplete arterial transformation and cytotrophoblast cell division. Due to imbalance in sFlt levels in preeclamptic women it effects in the blood vessels by constriction and leads to endothelial dysfunction. This study aim is to compare the maternal serum concentration of sFlt levels in normotensive pregnant women to preeclamptic women in early and late gestational weeks. Material and Methods: Out of 300 participants in the case–control study, 150 were preeclamptic women as cases and 150 as normotensive pregnant women as controls participated in the present study. A 5 ml of maternal venous blood was collected; the serum was separated and stored at –800°C till the analysis. Using commercially available enzyme-linked immunosorbent assay (ELISA) kits from Chongqing Biospes Co., Ltd., (suppliers: Infobio Company, New Delhi) was measured with ELISA microplate reader at 450 nm (Merilyzer Eiaquant Company). Results: Out of 300 participants in the study, 46 pregnant women were early gestational weeks and 254 were late gestational weeks. The complications due to severe PE such as intrauterine death are 15%, intrauterine fetal growth retardation 33%, and premature 15%. The statistical analyses were performed by Statistical Packages for the Social Sciences Software 22. The area under the receiver operating characteristic curve is 0.82, with 91% sensitivity, and 79% specificity. The significance in the maternal serum sFlt levels was calculated by the Mann–Whitney U-test. By comparing the cases and controls, it was found that maternal serum sFlt1 were significantly higher in preeclamptic women with Z = 2.96 and U = 9021 with P = 0.005 significance. Conclusion: This is the first South Indian study. If we compare the sFlt1 levels in early and late gestational weeks, in late gestational weeks in controls and PE the levels were highly significant than early gestational weeks of PE and controls. Maternal serum sFlt can be used as a preeclamptic diagnostic marker in South Eastern Kolar population.

Background: India bears the second largest burden of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. A multitude of reverse transcription polymerase chain reaction (RT-PCR) detection assays with disparate gene targets, including automated high-throughput platforms, are available. Varying concordance and interpretation of diagnostic results in this setting can result in significant reporting delays, leading to suboptimal disease management. This article reports the development of a novel ORF1a-based SARS-CoV-2 RT-PCR assay – Viroselect – that shows high concordance with conventional assays and the ability to resolve inconclusive results generated during the peak of the epidemic in Mumbai, India. Methods: A unique target region within SARS-CoV-2 ORF1a – the non-structural protein 3 (nsp3) region – was used to design and develop the assay. This hypervariable region (1923–3956) between SARS-CoV-2, SARS-CoV-1 and Middle East respiratory syndrome coronavirus was utilized to design the primers and probes for the RT-PCR assay. The concordance of this assay with commonly used emergency use authorization (US Food and Drug Administration) manual kits and an automated high-throughput testing platform was evaluated. Further, a retrospective analysis was carried out using Viroselect on samples reported as ‘inconclusive’ between April and October 2020. Results: In total, 701 samples were tested. Concordance analysis of 477 samples demonstrated high overall agreement of Viroselect with both manual (87.6%) and automated (84.7%) assays. Also, in the retrospective analysis of 224 additional samples reported as ‘inconclusive’, Viroselect was able to resolve 100% (19/19) and 93.7% (192/205) of samples which had inconclusive results on manual and automated high-throughput platforms, respectively. Conclusion: Viroselect had high concordance with conventional assays, both manual and automated, and has potential to resolve inconclusive samples.

The FDA Oncology Center of Excellence (OCE) is a leader within the agency in scientific outreach activities and regulatory science research. On the basis of analysis of scientific workshops, internal meetings, and publications, the OCE identified nine scientific priority areas and one cross-cutting area of high interest for collaboration with external researchers. This article describes the process for identifying these scientific interest areas and highlights funded and unfunded opportunities for external researchers to work with FDA staff on critical regulatory science challenges.

ZusammenfassungIn Stresssituationen kommen bei Menschen laut Ayurveda die Eigenschaften stärker zum Vorschein, die den vorherrschenden Doshas entsprechen. Der Ayurveda kennt bei Stress und Stresssymptomen sowohl konstitutionstypische als auch allgemeine Maßnahmen der Therapie und Prophylaxe. Der zentrale Punkt der ayurvedischen Tagesroutine ist die Selbsteinölung. Sie wirkt unter anderem stärkend, schützend und entgiftend.

Introduction Microvascular reconstruction is the gold standard for reconstruction in oral cavity cancers. Age and comorbidities determine the type of reconstruction. We aimed to analyse the impact of high-risk comorbidities on perioperative morbidity. Methods This is a retrospective study of 317 patients undergoing microvascular reconstruction from January 2014 to December 2017. High risk patients were based on age, American Society of Anaesthesiologists (ASA) grade (III/IV) and Charlson comorbidity index (CCI) score >4; overall, 73 out of 317 patients were evaluated. Results Median age was 59 years. Five patients (6.8%) had complete flap failures and seven (9.5%) had minor complications (wound breakdown, bleeding, wound dehiscence, partial flap loss). ASA score of IV was significantly associated with morbidity while age >65 years and CCI >4 was not associated. The overall flap success rate was 93.2%. Conclusions A high-risk population has nearly similar outcomes for microvascular reconstruction as a younger age group. High ASA score adversely affects surgery-related outcomes.

Key Clinical Points Glucose-Lowering Drugs to Reduce Cardiovascular Risk in Type 2 Diabetes The attainment of glycemic targets and comprehensive reduction in risk factors for cardiovascular disease...

Background: COVID-19 has become a crisis across the country these days, which likewise changed living of individual to entity contact and its spread. There the presentation of Teledentistry will be the solitary solution that will have the option to treat patients quickly and expertly. Aim: The current study aims to assess the awareness of dental professionals towards teledentistry during COVID-19 crisis in India. Methods: A cross-sectional descriptive survey was conceded on over all 142 dentists. A self-organized, close-ended questionnaire containing 20 questions was appropriately assembled and distributed. Data collected from the survey was examined in terms of frequency (yes/no). One Way Anova test was used to exemplify statistical variances and result came as significant at p < 0.05. Results: The responses from specialist dental professionals (with or without practicing) responded (57%) and dentist working in a private sector (68%) having clinical experience of about 5-10 years (36%). Conclusion: Dentists were well aware of this advanced technique and due to feasibility, most of them were ready to practice it in future.

We report a case of a pregnant woman with Cushing’s disease (CD) and performed a systematic review of literature on diagnosis, treatment, maternal and fetal outcomes of CD in pregnancy. A PubMed search was performed for manuscripts in English language from inception till June 2020. Cases of CD with hypercortisolism during pregnancy were included and categorized into three groups based on treatment received. Data on diagnostic modalities, CD remission, materno-fetal outcomes were analysed. Fifty-five patients of CD with 62 pregnancies were analysed. 24-h urinary free cortisol(UFC) was elevated by a mean of 5.4 ± 4.2 fold upper limit of normal non-pregnant level. 12/19 (63.1%) CD patients had more than threefold elevation of UFC measured during pregnancy. Mean midnight serum cortisol was 753.7 ± 270.5 nmol/l. At a midnight serum cortisol cut off of 440 nmol/l, 15/16 patients were correctly identified as CD. 23.2% underwent trans-sphenoidal surgery (group 1), 16.1% received only medical treatment (group 2) while 60.7% received no treatment (group 3) during pregnancy. Remission rates for CD in groups 1 and 2 were 76.9% and 77.8%, respectively. Adverse maternal and fetal outcomes were seen in 53.9% and 59.3% of the patients, respectively and were not significantly different between groups, although, lesser live births and greater pregnancy losses were seen in group 3. Midnight serum cortisol had better sensitivity than UFC for diagnosing hypercortisolism due to CD during pregnancy. In general, CD should be treated during pregnancy in order to optimize maternal and fetal outcomes as a trend towards increased live births is seen in treated subjects.

Background Children with unresectable hepatocellular carcinoma (HCC) have a poor prognosis and limited treatment options. Transarterial radioembolization (TARE) using Yttrium-90 (Y90) has emerged as a potential bridge therapy to hepatic resection or transplantation for HCC with very limited studies in children. Observations Here we present the clinical course of 2 children successfully treated with TARE Y90 for initially unresectable fibrolamellar HCC (FL-HCC) and bridged to partial hemihepatectomy with >1-year overall survival post-TARE. Conclusion Although there have been prior published reports of pediatric patients with HCC being treated with TARE Y90 and some being able to undergo subsequent orthotopic liver transplantation, this is the first report of pediatric HCC patients treated with TARE Y90 as a bridge to nontransplant resections and going on to have >1-year overall survival.

Vyanga is one of the Kshudraroga1, characterized by the presence of painless, bluish-black patches on face. On the basis of clinical features, it can be compared with Facial melasma. Melasma is characterized by dark, discolored patches on skin. It's also called chloasma. It typically occurs in the face and symmet-rical, with matching marks on both sides of the face. Area of the body which exposed to sun can also de-velop melasma. According to Ayurveda, vitiated Dosha mainly Pitta along with Vata produce blackish patches on the face which is called Vyanga. Vyanga is Rakta Pradoshaj Vikar and in its Doshas involved is Udana Vayu, Bhajrak Pitta and Dushya Rasa and Rakta Dhatu, as this condition disturbed our mental and physical state. In modern medical science, topical steroids have been described in the management of faci-al melasma. However, the topical steroids are may cause adverse effects such as irritation, rashes etc. and are expensive too. Ayurveda treatment includes Abhyanga with Taila, Lepa, Pradeha, Nasya, Rak-tamokshana etc. Ayurveda mentions a good number of drugs like Kusthaghna, Kandughna, Raktasho-dhaka, Twakprasadaka and Varnyakara properties e.g. Arjuna, Nimba, Manjistha are helpful in manage-ment and can produce cutaneous depigmentation that remove the blackish discoloration of skin.

Women are worshipped as Goddess due to their ability of bringing new life on earth. During reproductive period of women’s life there are varieties of ovarian cysts formation which leads to menstrual disturbance which might further lead to infertility. In recent years there is gradual rise in detection of ovarian cysts due to advance diagnostics. There is prevalence of 17 to 44% of ovarian cysts formation during reproductive phase. In this article, a case report regarding a patient of age 30 years having previous H/O bilateral choco-late cyst with both tubes thick with endometriosis and laparoscopic findings s/o impatiens tubes. For which patient had undergone laparoscopic aspiration. She was again diagnosed with recurrence of chocolate cyst by ultrasonography for that she came to my OPD for treatment. In Ayurveda it is stated that Shuddha yoni, Ambu, Beej and Kshetra are needed for Garbhadharan. Treatment plan was Shodhana, Uttar Basti with lekhandravyas and Shamanachikitsa. After 3 months of treatment regimen ultrasonography and hyster-osalpingography were repeated and reports revealed that previous mentioned left ovarian com-plex/haemorrhagic cyst is not seen, and tubes are patent. Hence, case study confirms that we can treat chocolate cyst with the help of Uttar Basti and Shamanachikitsa which acts as Lekhan and normalizes Vat-adosha and Raktadosha.

Cancer predisposition syndromes (CPS) are generally heritable conditions that predispose individuals to develop cancer at a higher rate and younger age than their representative general population. They are a significant cause of cancer related morbidity and mortality in the pediatric population. Therefore, recognition of lesions that may be associated with a CPS and alerting the clinicians to its implications is a crucial task for a diagnostic pathologist. In this review we discuss benign pediatric head and neck lesions associated with CPS namely: odontogenic keratocyst, juvenile nasopharyngeal angiofibroma, ossifying fibroma of the jaw, paraganglioma, plexiform neurofibroma, plexiform schwannoma, mucosal neuroma, and nevus sebaceous syndrome; along with malignant tumors such as squamous cell carcinoma. Several head and neck melanocytic, endocrine, and central nervous system tumors can also be associated with CPS; they are beyond the scope of this article. Nasal chondromesenchymal hamartoma is discussed elsewhere in this issue.

On April 10, 2020, the FDA approved selumetinib (KOSELUGO, AstraZeneca) for the treatment of pediatric patients 2 years of age and older with neurofibromatosis type 1 who have symptomatic, inoperable plexiform neurofibromas. Approval was based on demonstration of a durable overall response rate per Response Evaluation in Neurofibromatosis and Schwannomatosis criteria and supported by observed clinical improvements in plexiform neurofibroma–related symptoms and functional impairments in 50 pediatric patients with inoperable plexiform neurofibromas in a single-arm, multicenter trial. The overall reponse rate per NCI investigator assessment was 66% (95% confidence interval, 51–79) with at least 12 months of follow-up. The median duration of response was not reached, and 82% of responding patients experienced duration of response ≥12 months. Clinical outcome assessment endpoints provided supportive efficacy data. Risks of selumetinib are consistent with MAPK (MEK) inhibitor class effects, including ocular, cardiac, musculoskeletal, gastrointestinal, and dermatologic toxicities. Safety was assessed across a pooled database of 74 pediatric patients with plexiform neurofibromas and supported by adult and pediatric selumetinib clinical trial data in cancer indications. The benefit–risk assessment for selumetinib in patients with inoperable plexiform neurofibromas was considered favorable.

OBJECTIVE: To study body composition, measures of insulin resistance and dyslipidemia in Indian men with paraplegia as compared to age and body mass index (BMI) matched able-bodied men. DESIGN: Cross sectional study SETTING: Departments of Physical Medicine and Rehabilitation and Endocrinology PARTICIPANTS: Males aged 18–45 years with chronic traumatic paraplegia versus age and BMI-matched able-bodied men INTERVENTIONS: None MAIN OUTCOME MEASURES: Measures of body composition such as total body fat, lean mass, regional adiposity using dual energy x-ray absorptiometry (DXA), metabolic profile and insulin resistance RESULTS: Subjects with paraplegia (n = 43), compared to controls (n = 36), had higher %Fat mass (FM) (25.5 (21.2–28.9) vs 20.2 (15.9–22.2); P

Genital infections and subsequent vaginosis diagnosed through high vaginal swab in women is caused due to fungi or bacteria. The presented study focused on determining the types, numbers and antibacterial susceptibility pattern of aerobic bacteria causing vaginosis in 147 female patients attending infertility centre in Chennai, Tamil Nadu, India. Candida spp. caused 17% of infections with 15.7% of vaginosis caused by E.coli, Klebsiella spp., Acinetobacter spp., Citrobacter spp. and Gram positive cocci – Methicillin Sensitive Staphylococcus aureus (MSSA), Coagulase Negative Staphylococci(CONS), Staphylococcus aureus and Enterococcus spp. causing 12.9% of vaginitis in the study population. A total of 20 different antibiotics – cell wall inhibitors, protein synthesis inhibitors and nucleic acid synthesis inhibitors; were tested to determine the response of bacterial isolates by Kirby-Bauer disc diffusion method. The study result determined that the most effective drug for treating Gram positive bacterial vaginitis as per CLSI guidelines based on susceptibility pattern as: Linezolid(100%), Gentamycin(91.6%), Amikacin(87.5%),Erythromycin(79.2%), Co-Trimoxazole(72.2%), Ciprofloxacin(65.6%) and least Chloramphenicol(44.3%). High level gentamycin(83.3%) was found to be effective in treating Enterococci. The descending order of susceptibility of Gram negative aerobacteria causing vaginitis as per CLSI guidelines are: Amikacin(87.5%), Gentamycin(82.5%), Cefoperazone sulbactam (76.3%), Ciprofloxacin(68.5%), Ceftazidime(62.5%) and least Amoxyclav(25%).All Gram negative bacteria tested were susceptible to– Imipenem and Meropenem as well as Chloramphenicol. Ceftriaxone (87.5%) and Nitrofurantoin(72.3%) among other antibiotics was effective against Gram negative bacteria while all Enterobacteriaceae members were found to be resistant to tetracycline.

Aim The predominant pattern of failure for oral carcinoma is locoregional failure. With improvement in locoregional control, incidence of distant metastasis has increased. Reported incidence of distant metastasis is 8 to 10%. With an aim to define incidence and predictive factors for distant metastasis posttreatment of oral cavity cancer, the present analysis was done. Materials and Methods This is a retrospective chart review of 531 patients who underwent surgery for oral cavity carcinoma from August 2013 to December 2017. All patients had undergone surgery followed by adjuvant treatment as per histopathology report. Results The median age of the cohort was 49 years. The median follow-up of alive patients was 21 months (range: 1–56 months). Locoregional recurrence seen in 61, distant metastasis in 23, and 72 patients had locoregional recurrence with distant metastasis. Total incidence of distant metastasis was 18% (95 patients) with median detection 7 months’ posttreatment. The sites of distant metastasis were: lung in 49 patients, bone in 9 patients, and multiple sites in 37 patients. Nodal stage (N2 and N3), differentiation, young age, and perineural invasion were associated with higher incidence of distant metastasis on multivariate analysis. Conclusion The incidence of distant metastasis was found to be higher as compared with published literature. Possibility of adjuvant systemic therapy may be explored in future studies.

Background Vitamin D supplementation may prevent falls in older persons, but evidence is inconsistent, possibly because of dosage differences. Objective To compare the effects of 4 doses of vitamin D3 supplements on falls. Design 2-stage Bayesian, response-adaptive, randomized trial. (ClinicalTrials.gov: NCT02166333). Setting 2 community-based research units. Participants 688 participants, aged 70 years and older, with elevated fall risk and a serum 25-hydroxyvitamin D [25-(OH)D] level of 25 to 72.5 nmol/L. Intervention 200 (control), 1000, 2000, or 4000 IU of vitamin D3 per day. During the dose-finding stage, participants were randomly assigned to 1 of the 4 vitamin D3 doses, and the best noncontrol dose for preventing falls was determined. After dose finding, participants previously assigned to receive noncontrol doses received the best dose, and new enrollees were randomly assigned to receive 200 IU/d or the best dose. Measurements Time to first fall or death over 2 years (primary outcome). Results During the dose-finding stage, the primary outcome rates were higher for the 2000- and 4000-IU/d doses than for the 1000-IU/d dose, which was selected as the best dose (posterior probability of being best, 0.90). In the confirmatory stage, event rates were not significantly different between participants with experience receiving the best dose (events and observation time limited to the period they were receiving 1000 IU/d; n = 308) and those randomly assigned to receive 200 IU/d (n = 339) (hazard ratio [HR], 0.94 [95% CI, 0.76 to 1.15]; P = 0.54). Analysis of falls with adverse outcomes suggested greater risk in the experience-with-best-dose group versus the 200-IU/d group (serious fall: HR, 1.87 [CI, 1.03 to 3.41]; fall with hospitalization: HR, 2.48 [CI, 1.13 to 5.46]). Limitations The control group received 200 IU of vitamin D3 per day, not a placebo. Dose finding ended before the prespecified thresholds for dose suspension and dose selection were reached. Conclusion In older persons with elevated fall risk and low serum 25-(OH)D levels, vitamin D3 supplementation at doses of 1000 IU/d or higher did not prevent falls compared with 200 IU/d. Several analyses raised safety concerns about vitamin D3 doses of 1000 IU/d or higher. Primary funding source National Institute on Aging.

BACKGROUND Currently, the Coronavirus disease 2019 (COVID-19) has become pandemic globally. Elevated inammatory markers are observed and are a common pathophysiological response to acute illness. Chest X-ray changes are also commonly seen in COVID -19 patients. The present study was undertaken to determine the relationship between inammatory markers to chest X-ray ndings in COVID-19 patients. METHODS This is a prospective observational study of COVID-19 patients admitted to tertiary care hospital from may 2020-November 2020. Comorbidities, inammatory markers, and Chest X ray were collected and analyzed. Correlations between radiological and inammatory markers were studied. AIMS & OBJECTIVES: Ÿ Correlation of inammatory markers to radiographic ndings and their outcome in COVID 19 patients Ÿ The outcome was studied in terms of: Ÿ Patients requiring oxygen/ NIVsupport Ÿ duration of hospital stay Ÿ Number of patients Recovered/death RESULTS: Ÿ Out of 500 patients studied, the mean age was 49.41 years, and (295)59% of patients were male,(205)41% were females. (455)91% patients discharged and (43)8.6% died. We found a positive correlation between inammatory markers and Chest X-ray ndings at the time of admission with a signicant statistical P-value. The inammatory markers CRP, ESR, D-Dimer & Sr.ferritin compared with the mode of ventilation(O2 & NIV, duration of hospital stay and outcome also showed signicant statistical P-value. CONCLUSIONS We conclude that in patients with raised inammatory markers there were increased abnormalities on Chest X-rays which required an increase in oxygen or NIVsupport. This can be a useful predictor of the severity of the disease and assessment of outcome.

Various posts COVID-19 complications have been reported recently in the patients. However, there is still a dilemma about whether this oral manifestation is occurred due to corona virus infection or secondary factors resulting from the patient’s systemic condition. These oral conditions in a patient diagnosed after discharge. The pathogen responsible for the pandemic is severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), which has resulted in global healthcare crises and strained health resources. The prevalence of clinical manifestations is still unidentified; the range of COVID-19 manifestations on the oral cavity has been seen in various forms. The current case aims to report a rare finding of bone and soft tissue defect in the mandible as a possible sequel of COVID-19 infection.

A better understanding of what skin conditions are most commonly diagnosed in different pediatric racial and ethnic groups in outpatient dermatology clinics could help guide the development of pediatric dermatology educational initiatives for primary care providers and general dermatologists who have limited access to pediatric dermatologists. Using a nationally representative dataset, we evaluated the most common diagnoses in patients younger than 15 years of age (children) and 15-24 years of age (youth) who present to outpatient dermatology clinics, stratified by race and ethnicity. While acne and dermatitis were among the top ten most common diagnoses in all racial and ethnic groups studied, Black children were also commonly diagnosed with dermatophytosis and impetigo, and Black and Hispanic children were often diagnosed with seborrheic dermatitis; pigmentary disorders were among the top three most common diagnoses in Black, Asian, and Hispanic youth. Training more physicians how to evaluate and treat common skin conditions in children and youth of diverse racial and ethnic backgrounds may improve access to care for skin disease in the United States.

Rheumatoid arthritis is an autoimmune disease, causing chronic inflammation of small joints in hands and feet. The chronic inflammation and corticosteroid use in rheumatoid patients predispose them to insulin resistance and diabetes. Hydroxychloroquine, a proven drug in rheumatoid arthritis, seems to be beneficial in diabetes and also reduces the risk of cardiovascular events. This study was done to find out the role of hydroxychloroquine on the glycemic status and lipid profile in Rheumatoid patients having treatment with Diabetes mellitus. 50 patients with both RA and DM in the middle age group were categorized into HCQ and Non-HCQ group. Both the groups were followed up for 6 months. Their glycemic status and lipid profile were compared by measuring FBS, PPBS, HbA1C, triglycerides, total cholesterol, VLDL, LDL and HDL. Statistical analysis was done by student t test. The mean FBS, PPBS, HbA1C values in HCQ Group patients decreased significantly from 155.16, 200.12 and 8.26 to 135.80, 174.60 and 7.49 respectively in the follow-up period. In the Non-HCQ group, there was no significant change in mean FBS and PPBS after 6 months. Mean HbA1C increased from 8.13 to 8.33 in Non-HCQ group. Triglycerides, total cholesterol, VLDL and LDL also were found to be reduced in patients who had taken HCQ. In Rheumatoid patients with diabetes, use of HCQ improves their glycemic status and reduces the lipid abnormalities.

Objective: The objective of the study was to measure the health-related quality of life (HRQoL) in pancreatitis and to appraise the risk factors associated with the pancreatitis. Methods: A prospective observational study was performed with admitted cases of pancreatitis over 6 month’s period. A total of 150 patients were selected for the study. All data concerning risk factors were recorded and Short-Form-36 (SF-36) questionnaire was applied and quality of life (QOL) was analyzed in all patients with in study group. Results: All domains of (HRQoL) were assessed; it shows highest effect on role limitations due to physical health (36%), role limitations due to emotional problems (29%), role limitations due to physical health, and role limitations due to emotional problems (10%). Finally, our study revealed that there is a profound deterioration in physical components of QOL. The risk factors that majorly influence the QOL in association with disease were found to be alcohol consumption and smoking (70%). Conclusion: Pancreatitis remarkably diminishes the patient’s HRQoL which predominantly shows negative impact on physical health.

Introduction: This prospective clinical trial was designed to assess the effects of a long-term therapy with spironolactone, with and without dietary-induced weight-loss, on clinical features, lipid profile, and insulin levels in women with polycystic ovary syndrome (PCOS). Materials and Methods: Twenty-five patients (range of age 16–32 year; 13 lean and 12 overweight) fulfilling formal diagnostic criteria for PCOS (oligomenorrhea and/or amenorrhea, biochemical and/or clinical evidence of hyperadrogenism) were studied at baseline and then received oral spironolactone (100 mg/die) for 12 months; association with lifestyle modifications was recommended to all overweight patients. Clinical, endocrine, and metabolic parameters (oral glucose tolerance test [OGTT], lipid profile) were measured at baseline and at the end of the antiandrogen treatment. Results: The therapy was associated with a significant average decline of triglycerides in overweight subjects and with increased high-density lipoprotein-cholesterol levels in lean patients. The insulin levels at 60 min during OGTT, homeostasis model assessment-insulin resistance and area under curve of insulin were significantly lowered in overweight women after 12 months of spironolactone and weight loss and no negative changes in insulin secretion and sensitivity were observed in PCOS women after pharmacological treatment alone. Conclusion: The efficacy of spironolactone on the androgenic clinical aspects of PCOS has been confirmed in this study. Furthermore, our data show that long-term treatment with spironolactone exerts no negative effects on lipoprotein profile and glucose metabolism; more relevant beneficial effects on glucose and lipid metabolism were observed when the antiandrogen was associated with weight loss in overweight PCOS women.

Context: Multidrug Resistant (MDR) organisms transmitted through the hands of Health Care Workers (HCWs) are a major cause of Health Care-Associated Infections (HCAI). Practicing hand hygiene and knowledge regarding the same is essential for reducing HCAI and drug resistance. Aims: To determine the frequency and antimicrobial susceptibility pattern of microorganisms in the isolates from the hands of HCWs and to assess the extent of knowledge regarding hand hygiene among HCWs. Settings and Design: This was a cross-sectional study conducted at the Department of Microbiology in association with clinical departments for a period of two months. Methods: Glove juice samples were obtained from the hands of 94 HCWs. Bacterial isolates were subjected to Antibiotic Susceptibility Testing. Knowledge about hand hygiene was assessed using WHO Hand Hygiene Questionnaire for HCWs (revised August 2009). Statistical analysis used: SPSS software Version 17. Results: Bacterial growth was observed in 33% of the study population. The most common was Staphylococcus aureus (10.6%) followed by CONS (7.4%), Aerobic Spore Bearing bacilli (3.2%), E.coli (3.2%), Pseudomonas spp (1.1%) and Acinetobacter spp (1.1%). Prevalence of Methicillin Resistant Staphylococcus aureus was 6.4%. Formal training on hand hygiene practices was received by 67% of HCWs in the last 3 years. Good level of knowledge was found among 7 medical (77.77%) and 2 (22.2%) paramedical staff. Conclusions: The most predominant MDR organism to be isolated was MRSA. Significant difference in knowledge regarding hand hygiene was observed among medical and paramedical staff. The results of this study could help us to reduce the burden of HCAIs by strengthening Infection Control surveillance activities, thus improving patient care.