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Background and Aims: Gastrointestinal (GI) symptoms occur among patients diagnosed with coronavirus disease 2019 (COVID-19), and there is clear evidence that SARS-CoV-2, the causative pathogen, infects the GI tract. In this large, multicenter cohort study, we evaluated variations in gastrointestinal and hepatic manifestations of COVID-19 throughout the United States (US). Methods: Patients hospitalized with a positive COVID-19 test prior to October 2020 were identified at 7 US academic centers. Demographics, presenting symptoms, laboratory data, and hospitalization outcomes were abstracted. Descriptive and regression analyses were used to evaluate GI manifestations and their potential predictors. Results: Among 2031 hospitalized patients with COVID-19, GI symptoms were present in 18.9%; diarrhea was the most common (15.2%), followed by nausea and/or vomiting (12.6%) and abdominal pain (6.0%). GI symptoms were less common in the Western cohort (16.0%) than the Northeastern (25.6%) and Midwestern (26.7%) cohorts. Compared to nonintensive care unit (ICU) patients, ICU patients had a higher prevalence of abnormal aspartate aminotransferase (58.1% vs 37.3%; P < .01), alanine aminotransferase (37.5% vs 29.3%; P = .01), and total bilirubin (12.7% vs 9.0%; P < .01). ICU patients also had a higher mortality rate (22.7% vs 4.7%; P < .01). Chronic liver disease was associated with the development of GI symptoms. Abnormal aspartate aminotransferase or alanine aminotransferase was associated with an increased risk of ICU admission. Conclusion: We present the largest multicenter cohort of patients with COVID-19 across the United States. GI manifestations were common among patients hospitalized with COVID-19, although there was significant variability in prevalence and predictors across the United States.

Purpose: Dosimetric predictors of toxicity after Stereotactic Body Radiation Therapy (SBRT) are not well-established. We sought to develop a multivariate model that predicts Common Terminology Criteria for Adverse Events (CTCAE) late grade 2 or greater genitourinary (GU) toxicity by interrogating the entire dose-volume histogram (DVH) from a large cohort of prostate cancer patients treated with SBRT on prospective trials.Methods: Three hundred and thirty-nine patients with late CTCAE toxicity data treated with prostate SBRT were identified and analyzed. All patients received 40 Gy in five fractions, every other day, using volumetric modulated arc therapy. For each patient, we examined 910 candidate dosimetric features including maximum dose, volumes of each organ [CTV, organs at risk (OARs)], V100%, and other granular volumetric/dosimetric indices at varying volumetric/dosimetric values from the entire DVH as well as ADT use to model and predict toxicity from SBRT. Training and validation subsets were generated with 90 and 10% of the patients in our cohort, respectively. Predictive accuracy was assessed by calculating the area under the receiver operating curve (AROC). Univariate analysis with student t-test was first performed on each candidate DVH feature. We subsequently performed advanced machine-learning multivariate analyses including classification and regression tree (CART), random forest, boosted tree, and multilayer neural network.Results: Median follow-up time was 32.3 months (range 3–98.9 months). Late grade ≥2 GU toxicity occurred in 20.1% of patients in our series. No single dosimetric parameter had an AROC for predicting late grade ≥2 GU toxicity on univariate analysis that exceeded 0.599. Optimized CART modestly improved prediction accuracy, with an AROC of 0.601, whereas other machine learning approaches did not improve upon univariate analyses.Conclusions: CART-based machine learning multivariate analyses drawing from 910 dosimetric features and ADT use modestly improves upon clinical prediction of late GU toxicity alone, yielding an AROC of 0.601. Biologic predictors may enhance predictive models for identifying patients at risk for late toxicity after SBRT.

Abstract Objectives Oropharyngeal squamous cell carcinoma (OPSCC) treatment results in impaired swallowing and quality of life (QOL). We analyzed a cross‐section of advanced stage OPSCC patients treated with multimodal therapies at our Survivorship Clinic to investigate treatment factors associated with QOL. Methods Retrospective analysis of patient‐reported outcomes (PROMs) after primary OPSCC treatment using AJCC seventh edition staging. Results A total of 73 patients were included (90.1% human papillomavirus positive [HPV+]). There were no QOL differences between robotic surgery with radiation ± chemotherapy patients (n = 29) and those treated by radiation ± chemotherapy (n = 44). Radiation field analysis demonstrated significant correlations between increasing doses to larynx and contralateral parotid and submandibular gland and worse swallowing as measured by the Eating Assessment Tool‐10 (P = .02; P = .01; P = .01). Conclusions In advanced, mostly HPV+, OPSCC, we did not find clinically significant differences between QOL PROMs between surgical and radiation ± chemotherapy treatment groups. This highlights the need for continued therapy de‐escalation along with improved interventions for treatment related toxicities. Level of evidence 4.

IntroductionImaging is integral part of cervical cancer management. Currently, MRI is used for staging, follow up and image guided adaptive brachytherapy. The ongoing IQ-EMBRACE sub-study is evaluating the use of MRI for functional imaging to aid in the assessment of hypoxia, metabolism, hemodynamics and tissue structure. This study reviews the current and potential future utilization of functional MRI imaging in diagnosis and management of cervical cancer.MethodsWe searched PubMed for articles characterizing the uses of functional MRI (fMRI) for cervical cancer. The current literature regarding these techniques in diagnosis and outcomes for cervical cancer were then reviewed.ResultsThe most used fMRI techniques identified for use in cervical cancer include diffusion weighted imaging (DWI) and dynamic contrast enhancement (DCE). DCE-MRI indirectly reflects tumor perfusion and hypoxia. This has been utilized to either characterize a functional risk volume of tumor with low perfusion or to characterize at-risk tumor voxels by analyzing signal intensity both pre-treatment and during treatment. DCE imaging in these situations has been associated with local control and disease-free survival and may have predictive/prognostic significance, however this has not yet been clinically validated. DWI allows for creation of ADC maps, that assists with diagnosis of local malignancy or nodal disease with high sensitivity and specificity. DWI findings have also been correlated with local control and overall survival in patients with an incomplete response after definitive chemoradiotherapy and thus may assist with post-treatment follow up. Other imaging techniques used in some instances are MR-spectroscopy and perfusion weighted imaging. T2-weighted imaging remains the standard technique used for diagnosis and radiation treatment planning. In many instances, it is unclear what additional information functional-MRI techniques provide compared to standard MRI imaging.ConclusionsFunctional MRI provides potential for improved diagnosis, prediction of treatment response and prognostication in cervical cancer. Specific sequences such as DCE, DWI and ADC need to be validated in a large prospective setting prior to widespread use. The ongoing IQ-EMBRACE study will provide important clinical information regarding these imaging modalities.

Introduction: Chronic hyperglycemia in diabetic patients cause many microvascular and macrovascular changes in the body. PAD is considered to be an important macrovascular complication of diabetes mellitus, especially among those with prolonged duration of diabetes. As PAD can be asymptomatic initially, it can lead to important morbidities including amputation of limbs if not detected early. ABPI is a cheap, easy and useful tool to assess PAD even in asymptomatic diabetic patients. Methods: This is a randomized cross-sectional study of 120 diabetic patients, asymptomatic for peripheral arterial disease, attending Medicine OPD or admitted in our tertiary care hospital of South Gujarat. Pretested proforma was used to collect data after taking informed consent. Investigations including ABPI with sphygmomanometer and colour doppler as mentioned in the proforma was carried out. Final analysis has been done with the help of Open EPI and SPSS software. Results: 30.83 % of patients of our study population were found with abnormal ABPI. Our data shows PAD is directly associated with high HbA1c, duration of DM, and BMI. No correlation was found between age and gender. Out of 37 significant ABPI patients, 28 patients were found to have PAD by colour doppler also. Conclusion: Among diabetic patients, high HbA1c, prolong duration of DM and high BMI were associated with abnormal ABPI, which was suggestive of PAD.

Abstract Pemphigus is a life‐threatening disease but timely recognition of oral lesions is critical to prevent serious cutaneous and fatal complications.

Introduction: Type 2 Diabetes mellitus is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. These processes play the main role in causing impairments of collagen & elastin cross linkage, which thereby causes reduced elasticity of connective tissue. .The presence of abundant connective tissue and micro-vascular circulation in lung raises the possibility that in diabetic patients, lung could also be a “target organ”.Pulmonary function test is a useful test to assess involvement of lung connective tissues and micro vascular bed in diabetic patients. Methods: In this study, which was conducted in a tertiary care hospital of South Gujarat, we enrolled 65 subjects who were known cases diabetes mellitus. Result: Diabetes Mellitus in patients alters Various parameters of PFT like FVC, FEV1 which are reduced while FEV1/FVC increased showed restrictive pattern compared to normal individual. Conclusion: Diabetes mellitus patients have positive correlation with interpretation of PFT as with HbA1c increases a greater number of patients develop abnormal PFT in which Restrictive pattern is seen more commonly.

Background: The majority of prolactin-secreting pituitary macroadenomas are effectively managed with dopamine-agonist therapy alone. Although surgical resection and radiotherapy are second- and third-line treatment options, there remains a paucity of therapies for when these options fail. Case description: We report a woman with a dopamine-agonist resistant macroprolactinoma. She initially presented at 49-years old with irregular menses, a prolactin of 63.1 ng/mL, and a hypoenhancing, 11.5 mm by 15.6 mm by 7.0 mm mass in the left sella. The tumor failed to shrink with bromocriptine. She underwent partial tumor resection with postoperative Gamma Knife radiosurgery. The residual tumor gradually progressed, warranting a second subtotal tumor resection 4 years later with postoperative fractionated radiation. Again, the tumor progressed, and 3 years later, she developed recurrent epistaxis, third nerve palsy, vision loss, and epilepsy. Despite switching to cabergoline therapy and increasing the dose to 4 mg/week, her prolactin rose to 1267 ng/mL. As a palliative measure, a third subtotal tumor resection controlled her epistaxis, and a craniotomy resolved her epilepsy. Despite cabergoline 4 mg/week, the tumor again progressed. Due to the trophic effect of estrogens on lactotrophs and the patient’s massive obesity with potential for extraglandular estrogen synthesis, we hypothesized that abnormal estrogen signaling may be contributing to the tumor’s growth and dopamine-agonist resistance. Tumor immunohistochemistry demonstrated a prolactin-secreting pituitary tumor that lacked estrogen receptor alpha but stained moderately for estrogen receptor beta. Tamoxifen was added to her cabergoline treatment regimen. Her prolactin decreased to 3 ng/mL over 8 months as the medications were tapered, and her MR scans revealed no residual tumor for the next 14 years until her death of unrelated causes. Conclusions: This case report suggests that tamoxifen’s therapeutic effect on a dopamine-agonist resistant macroprolactinoma is not mediated through estrogen receptor alpha but possibly through estrogen receptor beta.

Introduction: CD4 count is having special predictive value in oc- currence of opportunistic infection. Opportunistic infection mostly occurs when CD4 count goes below 250 cells/microL. Methodology: This was a cross sectional study, done in 50 HIV positive patients attending medicine OPD and admitted patients in SMIMER, a tertiary care hospital in Surat, Gujarat, India. All HIV positive patients above 18 years presenting with neurological manifestations and ready to give informed written consent to par- ticipate were included. Complete clinical assessment and laborato- ry investigations were performed in all cases. Results: Mean CD-4 count in TBM was 140, in Cryptococcal men- ingitis was 52, in Toxoplasmosis was 170 and in AIDP was 281. The difference in the mean CD4 count is statistically significant (p- Value

Introduction: Infection with HIV is associated with increased risk of activation of latent infection of Tuberculosis.. Furthermore, TB Meningitis have found that co-infection with HIV is associated with an increased risk of mortality. The present study was done with the objective of exploring socio demographic and clinical factors associated with TB Meningitis among HIV positive patients. Methodology: The present study was done among Patients Living with HIV/AIDS (PLHA) admitted patients in medicine department. Records of all HIV positive patients diagnosed with TB meningitis during the study period of one year were obtained. Records of presenting symptoms, Socio-demographic variables, all laboratory investigations including CD4 count, past history of TB and outcome of past TB of these patients were recorded in separate case record sheet and evaluated further for the study. Results: Maximum of patients (33.33%) were from age group of 31 to 40 years. Males were common among study participants. Previous history of Tuberculosis is important for the patients with TB meningitis in HIV patients. Mean CD 4 count in participants was 140 cells/μL. More than 70% patients of TBM had the CD4 count less than 200 cells/microL. Risk of TBM increased with CD4 count less than 200 cells/microL. Conclusion: TB Meningitis is mostly affecting HIV patients from age group of 21 to 40 years. Males are commonly affected. Previous history of Tuberculosis is important for the patients with TB meningitis in HIV patients. For TB meningitis patients fever, headache and altered sensorium are common presenting symptom.

Introduction: The nervous system is among the most frequent and serious target of HIV infection and is most frequently occur in patient with profound immunosuppression. 40 to 70 percent persons with HIV have neurological disorder. In 10 to 20 percent it is AIDS defining illness. It has higher mortality than other infections. Considering these facts the current study was designed to check the differential diagnosis of various neurological manifestations in HIV patients. Methodology: All HIV positive patients above 18 years presenting with neurological manifestations and ready to give informed written consent to participate in the study were included in the study. Detailed clinical history with special emphasis on consciousness, convulsions and headache was taken. Thorough clinical examination included mental status examination including MMSE, sensory, motor and cranial nerves examination. Results: The present study comprises 50 HIV infected patients with neurological manifestation presenting at the hospital. There were total 15 (30%) patients diagnosed with primary neurological illness. Most of the patients were having DSPN as primary neurological illness. ADC is one of the common neurological manifestations. 4% of our patients had ADC which is diagnosed by MMSE (mini mental status examination) score. Out of total 50 patients, 35 (60%) patients were diagnosed as Secondary Neurological Illness. Out of these, TBM was the most common illness, Other common secondary illnesses were Cryptococcal Meningitis (16%), Toxoplasmosis (10%) and PML (8%). Conclusion: Tubercular Meningitis and Distal sensory polyneuropathy were the most common cause of neurological manifestation among HIV positive patients.

Background & objectives: Literature reports several studies on ABO groups and malaria but a study with anadequate sample size and controls is not available. ABO groups are genetically controlled, hence, large samplesize and comparison with population frequency is essential. To determine whether malaria infection with variableseverity has correlation with ABO groups.Study design & Methods: Blood samples of non-transfused malaria cases were obtained from pathology laboratoriesand transfused malaria patients’ from Blood Bank. The malaria parasites were identified by examination ofthick and thin smears. Control (normal population) included 11,303 students.Results: The ABO group frequency of normal population was ‘O’ 32.3%, ‘A’ 22.2%, ‘B’ 36.7% and ‘AB’ 8.8%.The overall ABO group distribution in 8028 malaria cases was ‘O’ 30%, ‘A’ 24.6%, ‘B’ 35.5% and ‘AB’ 8.9%.‘A’ group incidence was significantly higher than normal (‘A’ vs non-‘A’ 2 = 15, df=1, p

Background: There are very few studies are done on spirometry and X-ray findings in interstitial lung diseases (ILD) in India. Methods: Pulmonary function tests were performed on computerized spirometer, through Kit Microsystems in 30 patients of high resolution computed tomography (HRCT) proven interstitial lung diseases in tertiary care centre. Results: Majority were in age group 40-49 years (mean age-45.23 years) and 66.5% male patients. Restrictive pattern (96.57%) was present in majority patients in spirometry. Most of patients (60%) of ILD showed reticular-nodular in X-ray chest. Conclusion: Restrictive pattern were observed regardless of smoking status in ILDs. Availability of non-invasive investigations like HRCT chest has increased our early recognitions of ILDs. Reticular-nodular pattern in X-ray chest is very important for suspecting ILD.

Background: Fine Needle Aspiration Cytology (FNAC) is simple, quick, inexpensive and minimally invasive technique used to diagnose different types of swellings located in the head and neck. Aims: To assess the incidence of different sites, age, sex and distribution of inflammation. Material & Methods: A prospective study was conducted from July 2007 to November 2009. Fine Needle Aspiration Diagnosis was correlated with detail of relevant clinical findings and investigation. Total 100 cases were studied. Results: Highest incidence was found in the age group 11-20, and 41-50. Females were most common victims with female male ratio of11.5: 1. Head and Neck swelling is common finding now a days and Fine Needle Aspiration Cytology is most common diagnostic procedure for such type of cases and most common method to differentiating between benign and malignant lesion. As diagnostic procedure we came to know regarding the most common lesion involved in head and neck region. Conclusion: Fine Needle Aspiration Cytology is easy, simple, safe and non-invasive procedure for diagnosis of head and neck swelling and easy way for surgeon whether to decide surgery or not.

Abstract Background The TEACHH and Chow models were developed to predict life expectancy (LE) in patients evaluated for palliative radiotherapy (PRT). We sought to validate the TEACHH and Chow models in patients who died within 90 days of PRT consultation. Methods A retrospective review was conducted on patients evaluated for PRT from 2017 to 2019 who died within 90 days of consultation. Data were collected for the TEACHH and Chow models; one point was assigned for each adverse factor. TEACHH model included: primary site of disease, ECOG performance status, age, prior palliative chemotherapy courses, hospitalization within the last 3 months, and presence of hepatic metastases; patients with 0‐1, 2‐4, and 5‐6 adverse factors were categorized into groups (A, B, and C). The Chow model included non‐breast primary, site of metastases other than bone only, and KPS; patients with 0‐1, 2, or 3 adverse factors were categorized into groups (I, II, and III). Results A total of 505 patients with a median overall survival of 2.1 months (IQR: 0.7‐2.6) were identified. Based on the TEACHH model, 10 (2.0%), 387 (76.6%), and 108 (21.4%) patients were predicted to live >1 year, >3 months to ≤1 year, and ≤3 months, respectively. Utilizing the Chow model, 108 (21.4%), 250 (49.5%), and 147 (29.1%) patients were expected to live 15.0, 6.5, and 2.3 months, respectively. Conclusion Neither the TEACHH nor Chow model correctly predict prognosis in a patient population with a survival

Many software solutions are available for proteomics and glycomics studies, but none are ideal for the structural analysis of peptidoglycan (PG), the essential and major component of bacterial cell envelopes. It icomprises glycan chains and peptide stems, both containing unusual amino acids and sugars. This has forced the field to rely on manual analysis approaches, which are time-consuming, labour-intensive, and prone to error. The lack of automated tools has hampered the ability to perform high-throughput analyses and prevented the adoption of a standard methodology. Here, we describe a novel tool called PGFinder for the analysis of PG structure and demonstrate that it represents a powerful tool to quantify PG fragments and discover novel structural features. Our analysis workflow, which relies on open-access tools, is a breakthrough towards a consistent and reproducible analysis of bacterial PGs. It represents a significant advance towards peptidoglycomics as a full-fledged discipline.

Background: The Hirsch index (h-index) is a measure that evaluates both research volume and qualityâtaking into consideration both publications and citations of a single author. No prior work has evaluated academic productivity and contributions to the literature of adult total joint replacement surgeons. This study uses h-index to benchmark the academic impact and identify characteristics associated with productivity of faculty members at joint replacement fellowships. Methods: Adult reconstruction fellowship programs were obtained via the American Association of Hip and Knee Surgeons website. Via the San Francisco match and program-specific websites, program characteristics (Accreditation Council for Graduate Medical Education approval, academic affiliation, region, number of fellows, fellow research requirement), associated faculty members, and faculty-specific characteristics (gender, academic title, formal fellowship training, years in practice) were obtained. H-index and total faculty publications served as primary outcome measures. Multivariable linear regression determined statistical significance. Results: Sixty-six adult total joint reconstruction fellowship programs were identified: 30% were Accreditation Council for Graduate Medical Education approved and 73% had an academic affiliation. At these institutions, 375 adult reconstruction surgeons were identified; 98.1% were men and 85.3% had formal arthroplasty fellowship training. Average number of publications per faculty member was 50.1 (standard deviation 76.8; range 0-588); mean h-index was 12.8 (standard deviation 13.8; range 0-67). Number of fellows, faculty academic title, years in practice, and formal fellowship training had a significant (P < .05) positive correlation with both h-index and total publications. Conclusions: The statistical overview presented in this work can help total joint surgeons quantitatively benchmark their academic performance against that of their peers. Keywords: Total joint replacement, Academic productivity, Hirsch index, H-index

The purpose of this study is to evaluate cytokine expression by peripheral blood mononuclear cells (PBMC) from stage I lung cancer patients and to confirm these expression patterns by exposing PBMCs to lung cancer cells in vitro. Five altered cytokines in stage I lung cancer patients (CCL3, IL8, IL1β, CXCL10, sIL2Rα) were identified in plasma from subjects (n = 15) before and after resection using a 30-plex panel protein assay. Gene expression studies using quantitative RT-qPCR were performed on PBMCs from stage I lung cancer patients (n = 62) before and after resection, and compared to non-cancer patients (n = 32) before and after surgery for benign disease. Co-culture experiments that exposed healthy donor PBMCs to lung cancer cells in vitro were performed to evaluate the effect on PBMC cytokine expression. PBMC gene expression of CCL3, IL8 and IL1β was higher in lung cancer patients compared to the same patients at each of four sequential timepoints after removal of their tumors, while CXCL10 and IL2Rα were essentially unchanged. This pattern was also detected when lung cancer patients were compared to non-cancer patients. When non-cancer patients underwent surgery for benign diseases, these cytokine expression changes were not demonstrable. Lung cancer cell lines, but not benign bronchial epithelial cells, induced similar changes in cytokine gene and protein expression by healthy donor PBMCs in an in vitro co-culture system. We conclude that PBMCs from stage I lung cancer patients possess distinct cytokine expression patterns compared to both non-cancer patients, and lung cancer patients following tumor removal. These expression patterns are replicated by healthy donor PBMCs exposed to lung cancer cell lines, but not benign bronchial epithelial cells in vitro. These findings have implications for understanding the immune response to lung cancer.