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Cellular angiofibroma (CA) is a relatively recently described, rare, benign soft tissue tumor that predominantly occurs in the vulvoperineal region. It was first described in 1997 as a mesenchymal-origin tumor composed of connective (fibrous) tissue and blood vessels. We report a case of vaginal CA in a 40-year-old woman who presented with pressure symptoms, incidentally diagnosed with a vaginal mass and clinically suspected as vaginal myoma. This case was diagnosed based on histomorphology and immunohistochemistry and underwent surgical treatment. This tumor was a diagnostic dilemma for other benign and aggressive spindle cell tumors in the same area, such as endometrial stromal nodule, spindle cell lipoma, solitary fibrous tumors, and mixed tumors of the vagina.

Background: Thyroid dysfunction evaluation during pregnancy is important for the mother’s health, obstetric outcomes, and the child’s cognitive development. This study is conducted to know various thyroid disorders that can occur during antenatal and their impact on mother and fetus outcomes. Materials and Methods: This observational research was conducted over two years at a tertiary center in Western Rajasthan, India. Seven hundred and seventy-two low-risk singleton pregnant patients who met the inclusive criteria were recruited. The estimation of T3, T4, and TSH was done along with a routine investigation in antenatal women. Antenatal having abnormal thyroid profiles were then analyzed for mother and fetus problems. Results: The prevalence of thyroid dysfunction in antenatal women is 16.5%. Subclinical hypothyroidism (SCH) was seen in 12.5% of cases, overt hypothyroidism in 3.36%, and subclinical hyperthyroidism in only 0.51% of cases. Anti-TPO was positive in 46 (41.44%) women with hypothyroidism and 1 (25%) with hyperthyroidism. Compared to euthyroid women, women with overt hypothyroid (19.23% vs 3.1%, P = 0.002) and subclinical hypothyroid (9.27% vs 3.1%, P = 0.003) were found to be associated with a higher risk of hypertensive disease. Concerning fetal outcomes. There was a high risk for preterm (12.37% v/s 4.9%, P = 0.004) and fetal growth retardation (FGR) in patients with SCH (7.21% v/s 3.1%, P = 0.04). Conclusion: Considering the significant influence of thyroid disorders on mother and fetus outcomes, the screening for thyroid during pregnancy should be considered universally, particularly in developing countries with high prevalent rates, such as India.

Objective Due to its comprehensive, reliable, and valid format, the objective structured clinical examination (OSCE) is the gold standard for assessing the clinical competency of medical students. In the present study, we evaluated the importance of the OSCE as a learning tool for postgraduate (PG) residents assessing their junior undergraduate students. We further aimed to analyze quality improvement during the pre-coronavirus disease (COVID) and COVID periods. Methods This quality-improvement interventional study was conducted at the Department of Obstetrics and Gynecology. The PG residents were trained to conduct the OSCE. A formal feedback form was distributed to 22 participants, and their responses were analyzed using a five-point Likert scale. Fishbone analysis was performed, and the ‘plan-do-study-act’ (PDSA) cycle was implemented to improve the OSCE. Results Most of the residents (95%) believed that this examination system was extremely fair and covered a wide range of clinical skills and knowledge. Further, 4.5% believed it was more labor- and resource intensive and time-consuming. Eighteen (81.8%) residents stated that they had learned all three domains: communication skills, time management skills, and a stepwise approach to clinical scenarios. The PDSA cycle was run eight times, resulting in a dramatic improvement (from 30% to 70%) in the knowledge and clinical skills of PGs and the standard of OSCE. Conclusion The OSCE can be used as a learning tool for young assessors who are receptive to novel tools. The involvement of PGs in the OSCE improved their communication skills and helped overcome human resource limitations while manning various OSCE stations.

Objective The study was conducted to determine the frequency of alloimmunization to various blood group antibodies in pregnant women, and the risk of hemolytic disease in the fetus and newborn. Methods All antenatal women, irrespective of the period of gestation or obstetric history, were included, whereas those taking anti-D immune-prophylaxis or with a history of blood transfusion were excluded. Antibody screening and identification were performed using a Bio-Rad ID microtyping system. Results Of 2,084 antenatal females, 1,765 were D-antigen positive and 319 D-antigen negative. Sixty-five (3.119%) women alloimmunized. Out of 54 (2.591%) who had sensitized to D-antigen, 11 (0.527%) also sensitized to other antibodies. These 11 alloantibodies identified included: anti-M (n=6; 9.23%), anti-C (n=1; 3.076%), anti-E (n=1; 1.538%), anti-e (n=1; 1.538%), anti-Lewis (a) (n=1; 1.538%), and unspecified antibodies (n=1; 1.538%). Multiple antibodies were seen in four patients that combined: anti-D and anti-C (n=2; 3.076%), anti-e and anti-c (n=1; 1.538%), and anti-D and anti-G (n=1; 1.538%). Conclusion The rate of alloimmunization in D-antigen-negative women was high. Apart from this, the alloimmunization rate in women with bad obstetric history was very high, at 8.1%. In developing countries such as India, universal antenatal antibody screening, though desirable, may not be justified at present, as the cost and infrastructure required would be immense because of the lower alloimmunization rates in RhD antigen-positive women. However, it is necessary to impose properly formulated protocols to screen pregnant women with bad obstetric history.

Background: The recent increase in the cesarean section (CS) rate worldwide has led to global concerns and vaginal birth after CS (VBAC) as an effective way to reduce the CS rate. In this study, our main aim was to know about various factors that help women make their preferred mode of delivery following a previous CS. Material and Method: This was a questionnaire-based study conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Jodhpur, among 200 women with previous one lower segment CS (LSCS). Results: Elective repeat cesarean delivery (ERCD) was found to be more among uneducated women and those who had complications in their previous babies. The most common reason for opting for ERCD was fear of labor pains. Women who were counseled by senior doctors were more likely to opt for a trial of labor after cesarean section (TOLAC). Conclusion: Improving the education levels of mothers, counseling about advantages associated with vaginal birth, counseling by senior obstetrician, and information regarding labor analgesia can decrease CS rates.

Background and Aims: Programmed death ligand-1 (PD-L1) is a co-regulatory molecule that suppresses local immunity, and mismatch repair (MMR) deficiency (dMMR) is reported to influence the response to anti-PD-L1-targeted therapy. This study was conducted to find the PD-L1 status, the occurrence of dMMR in endometrial carcinomas, and the association between them. Materials and Methods: The study included 35 resected specimens of endometrial carcinomas represented on formalin-fixed paraffin-embedded sections from January 2016 to July 2020. The clinicopathologic information including patient age, tumor histologic type, grade, stage, lymphovascular invasion, the extent of myometrial invasion, and the percentage of tumor-infiltrating lymphocytes (TILs) were obtained in all cases. The expression of PD-L1 and MMR antibodies including mutS homolog 2 (MSH-2), MSH-6, mutL homolog 1 (MLH-1) and MLH-3, and postmeiotic segregation 2 were assessed using immunohistochemistry. The statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 26. Results: PD-L1 expression was noted in 48.6% of the cases in tumor cells and 65.7% of the cases in TILs and MMR was deficient in 28.6% of endometrial carcinomas. A statistically significant relation was noted between dMMR and TILs, PD-L1 expression in tumor cells and TILs, PD-L1 expression in tumor cells, and extent of myometrial invasion. Although there was no statistically significant association between MMR status and PD-L1 expression in tumor cells or TILs, 60% of patients with dMMR were PD-L1 positive. Conclusion: Sixty percent of dMMR cases showed PD-L1 expression in tumor cells. We conclude, ECs that are MMR deficient might get better response to anti-PD-L1 therapy. This study also revealed the prognostic use of TILs in PD-L1-expressed tumors.

Myocardial infarction (MI) can have significant physical and mental consequences. Depression is a prevalent psychiatric condition after MI which can reduce the quality of life and increase the mortality rates of patients. However, the connection between MI and depression has remained under-appreciated. This review examines the potential connection between depression and MI by overviewing the possible pathophysiologic mechanisms including dysregulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, coagulation system dysfunction, inflammation, environmental factors, as well as, genetic factors. Furthermore, depression can be an adverse event of medications used for MI treatment including beta-blockers, statins, or anti-platelet agents. The need for early detection and management of depression in patients with MI is, therefore, crucial for improving their overall prognosis. Adherence to treatments and regular follow-up visits can ensure the best response to treatment.

Mature cystic teratoma is a benign ovarian tumor that usually presents in reproductive-age females. This tumor usually presents with pain abdomen, bloating, and a lump. Hereby, we describe a case of an ovarian dermoid presented with features of intestinal obstruction secondary to ileo-dermoid fistula formation. A 55-year-old postmenopausal female presented with lower abdominal pain, nausea, vomiting, and the feeling of a lump in the abdomen. On evaluation and imaging, it was diagnosed as a large ovarian dermoid (with malignant transformation) with multiple fistulous communications with ileal loops. The patient was managed by laparotomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy, bowel resection, and anastomosis. The patient was discharged in good condition. The rupture of malignant ovarian dermoid followed by enterodermoid fistula formation and intestinal obstruction is rare. Complete cytoreduction and bowel repair should be considered for optimal results.

Background: Children are considered as an important asset for any country and their health as one of the important indicators of a healthy country. There are several factors affecting children's health and anemia is one of them. Globally around 1.62 billion people are affected by it, which corresponds to 24.8% of the population, with the highest prevalence of anemia (47.4%) among preschool-aged children. Aim: The present study was conducted to estimate the prevalence of anemia among toddlers (12–36 months) and to determine the associated factors. Materials and Methods: A cross-sectional study was carried out among toddlers (12–36 months) in the urban field practice area of Pt. B.D. Sharma PGIMS, Rohtak. A total of 170 toddlers were enrolled in the study and their mothers were interviewed using a semi-structured pretested questionnaire. Hb was estimated by Sahli's acid hematin method. The data were analyzed using SPSS software version 20. Results: In the present study, more than half (55.9%) participants were girls and 44.1% were boys. The overall prevalence of anemia was found to be 62.4%, with mild, moderate, and severe anemia being 41.8%, 17.7%, and 2.9%, respectively. The children with regular intake of iron supplementation were found to be 6.625 times likely to be nonanemic as compared to those with no supplementation. Conclusion: Every endeavor should be made to combat the anemia in children through multisectoral and multipronged approach such as nutritional education of mothers, growth monitoring, nutritional supplementation, etc.

Background: Pre-term birth (PTB) is the leading cause of mortality and morbidity in newborn and infants. One of the proposed theories is the withdrawal of progesterone, either actual or functional, to be an antecedent to the onset of labor. The aim of the study is to evaluate the role of vaginal progesterone in delaying delivery following an episode of arrested pre-term labor. Methods: This is a pragmatic open-label randomized controlled trial that was conducted in the Department of Obstetrics and Gynecology at All India Institute of Medical Sciences, Jodhpur. Hundred patients with singleton pregnancies presenting with pre-term labor between 24 and 34 weeks of gestation and treated successfully with acute tocolysis for 48 hours and steroids covered were randomized to receive either progesterone 400 mg vaginal suppository or no treatment. Results: The primary outcome was the duration of randomization to delivery interval, which was significantly higher in the study than in the control group (28 days versus 10 days). The secondary outcomes such as gestational age at delivery was also higher in the study group compared to the control group (82% versus 60% delivered after 37 weeks in the study group and control group, respectively). The neo-natal outcomes such as birth weight (2802 grams versus 2324 grams), incidence of respiratory distress syndrome (RDS) (13% versus 26%), and newborn intensive care unit (NICU) admission (17% versus 31%) were lower in the study group, which signifies decreased neo-natal morbidities and mortalities in pre-term labor treated with maintenance tocolysis in the form of vaginal progesterone. Conclusion: Administration of vaginal progesterone (400 mg, daily) following an episode of arrested pre-term labor significantly increased the duration to delivery interval; that is, it reduced the rate of PTB before 37, 32, and 28 weeks of gestation among women. It further reduced the neo-natal morbidities such as RDS and NICU admission and increased the birth weight among infants of women assigned to progesterone treatment.

Introduction: Rabies is one of the oldest and deadliest diseases known to man. After the clinical occurrence of rabies, there is no comprehensive treatment possible. However, the development of rabies can be prevented to a large extent if animal bites are managed appropriately and in time. The post-exposure treatment of animal bite cases is of prime importance in this regard. India has the highest burden of animal bite and rabies cases in the world. This imposes a substantial burden on the healthcare delivery services of the country. Materials and Methods: This was a cross-sectional study conducted in the immunization clinic of a tertiary care hospital in Haryana from January 2018 to December 2018. A total of 614 cases were interviewed using a pre-designed, pre-tested, and semi-structured interview schedule. Results: Around 80.5% of the bites were inflicted by stray animals, among which 70% of cases were by stray dogs. Precisely, 97.7% of cases took anti-rabies vaccine and 96.6% of cases took Tetanus Toxoid. 204 (33.2%) of victims were category III cases, who needed local infiltration of immunoglobulin but only 46% of them got it. The association of time lag between bite and reporting to the first health facility with socio-economic status, residence, and education was found to be statistically significant. Conclusion: To conclude it was observed that proper wound management practices were lacking in the people of the study area and there is a need to strengthen the availability of provision of free-of-cost life-saving immunoglobulin at the health facility, under the rabies control program.

Objective The primary objective of this study was to establish the presence of nerve fibers in the eutopic endometrium of women with endometriosis and to determine whether these nerve fibers are exclusive to endometriosis or are also found in other pelvic pathologies associated with dysmenorrhea. Methods Endometrial tissue was obtained by aspiration (Pipelle), endometrial curettage, or following hysterectomy in women with endometriosis confirmed through histopathological examination, leiomyomas, and adenomyosis. The eutopic endometrium was subjected to immunohistochemical staining to detect PGP 9.5, which is a highly specific pan-neuronal marker. The nerve fiber density was correlated with the patient’s pain score, as indicated by the Visual Analog Scale. A control group was formed by staining the endometrium of women presenting with dysmenorrhea but without the above-mentioned disorders. Results Nerve fibers were observed in sections of the endo-myometrium (in the deep endometrium) in 68% of patients with endometriosis who underwent hysterectomy or a deep endometrial biopsy. Nerve fibers were not observed in the aspirated endometrium of women with endometriosis. Only 13.7% of women with adenomyosis and 3.3% of women with fibroids had nerve fibers in their endometrium. Nerve fiber density was correlated with pain score in women with endometriosis. Conclusion Nerve fibers were found in the functional layer of eutopic endometrium in women with endometriosis; hence, we concluded that the presence of nerve fibers in the eutopic endometrium could diagnose endometriosis with a fairly good specificity of 92.7%. However, the absence of nerve fibers does not always exclude the disease.

Biotic stress affects crop yield and production. It is essential to acquire the knowledge necessary for designing resistance in host plants by understanding the interaction between pathogens and the host. Salicylic acid and jasmonic acid are principal regulators of interconnected signaling pathways of plant defense mechanisms to overcome stress conditions. Plants on pathogen attack experience transient increase in the reactive oxygen species production which in turn activates local programmed cell death and confers systemic resistance. Disease management is largely done by chemical compounds like fungicides, insecticides, and herbicides. However, these chemicals are hazardous to the environment and living beings hence it is necessary to search for novel harmless means of disease control. Elicitors are molecules that initiate systemic acquired resistance or induced systemic resistance in the host by inducing the expression of pathogenesis-related genes and protecting plants from diseases. This review discusses biotic stress, elicitors, and elicitor-receptor mediated defense mechanism acquired for systemic resistance and in this context, it attempts to draw the attention of the researchers to find novel elicitors as disease control alternatives.

Objective To determine the incidence of accidentally diagnosed genital malignancies in women undergoing gynecological surgeries for pathologies presumed to be benign. Methods Data of all women who underwent hysterectomy for benign indications were retrieved from hospital records. A total of 628 cases of hysterectomy and 35 cases of myomectomy were included. The final histopathology was accessed through the computer records, and the total number of genital tract malignancies was included. Results The incidence of occult uterine, ovarian, and cervical malignancies in women undergoing hysterectomy was 0.47%, 0.31%, and 0.15%, respectively. The incidence of uterine corpus malignancies in women undergoing myomectomy was 2.8%, and 3 cases of smooth muscle tumor of uncertain malignant potential (STUMP) were also identified. Endometrial stromal sarcomas were the most common pathology among uterine malignancies, followed by leiomyosarcoma and endometrial adenocarcinoma. Conclusion Postoperative diagnosis of malignancies in women undergoing surgery for benign indications poses great challenges to the treating surgeon. Occult malignancies must be ruled out by thorough preoperative assessment, especially in some subsets of women. Morcellation is an inevitable technique and complement to laparoscopic surgeries, although little chances of malignancy spread is related to its use. Nevertheless, thorough preoperative investigations and always ensuring contained morcellation can minimize these chances.

Primary hypothyroidism is observed in adult patients with chronic kidney disease (CKD) though described scantily in the pediatric population. The primary objective of this study was to detect the prevalence of hypothyroidism in children (1-18 years) with CKD as assessed by thyroid profile. This cross-sectional study was conducted in the department of pediatrics of a tertiary care teaching hospital between January 2016 and January 2017. Clinical examination and biochemical investigations were performed for children with CKD aged 1 -18 years. Sixty-five children (51 boys, 43 CKD Stages 1-3) with a mean [standard deviation (SD)] age of 7.9 (3.2) years were enrolled. Overall, 17 (26.2%) had thyroid dysfunction; nine (13.8%) had subclinical hypothyroidism, three (4.6%) overt hypothyroidism, and five (7.7%) had isolated low T3 levels. The prevalence of hypothyroidism increased from 20.9% in CKD Stages 1-3 to 40.9% in Stages 4-5 of CKD; P = 0.09. The mean (SD) height SD scores were lower in those with hypothyroidism than with normal thyroid function [−1.02 (1.69) and −1.89 (1.12), P = 0.003, respectively], lowest at -2.79 (0.65) in overt hypothyroidism. A significant proportion of children with CKD manifest with hypothyroidism who have more profound growth failure. It may be prudent to screen CKD patients for thyroid dysfunction.

When implantation of the early embryo occurs at the scar of previous cesarean, it is called cesarean scar pregnancy. Though in uterus, it behaves like an ectopic pregnancy with risk of rupture and hemoperitoneum. A 37-year-old woman came with missed period and vague abdominal discomfort; she had a positive pregnancy test. She had previous two cesarean sections. The last cesarean section was 12 years ago and the patient was not using any contraception. Her ultrasonography (USG) was inconclusive; β human chorionic gonadotropin was 2,980 mIU/mL. Her repeat USG showed a hypoechoic area at the cesarean scar site, behind the reflection of bladder, separated from bladder by a thin layer of myometrium. She was counseled regarding the management options and prognosis. She was managed with two doses of injection. Methotrexate on day 1 and day 4. β human chorionic gonadotropin was repeated until it was close to normal. USG was also repeated. Cesarean scar pregnancy can be managed by many ways; the one most suitable to the patient with least side effects should be adopted, after adequate counseling of the patient.

Vaccination against COVID-19 is one of the highly effective preventative strategies to reduce morbidity and mortality associated with COVID-19 infection. The rapid approval of COVID-19 vaccination due to the raging pandemic, media coverage, anti-vaccination groups, and concerns about adverse effects associated with vaccination has given rise to COVID-19 vaccine hesitancy. Current evidence suggests that psychosomatic and nocebo-related adverse effects account for a significant proportion of common adverse effects following COVID-19 vaccination. The most common adverse effects are headache, fatigue, and myalgia, which are highly prone to nocebo effects. In our review article, we discuss the role of psychosomatic and nocebo effects in COVID-19 vaccination-related hesitancy, predictors of such effects, and strategies to reduce vaccine hesitancy. General education regarding psychosomatic and nocebo effects and specialized education for at-risk populations may reduce psychosomatic and nocebo-related adverse effects following COVID-19 vaccination, ultimately reducing hesitancy.

Background: asthma, a chronic respiratory disease caused by inflammation and narrowing of the small airways in the lungs, is the most common chronic childhood disease. Prevalence of childhood asthma in the United States is 5.8%. In boys, prevalence is 5.7% and it is 6% in girls. Asthma is associated with other comorbidities such as major depressive disorder and anxiety disorder. This study explores the association between asthma and depression. Methods: we conducted a retrospective cross-sectional study using NHANES data from 2013 to 2018. Asthma and childhood onset asthma were assessed using questionnaires MCQ010 and MCQ025, respectively. Sociodemographic variables were summarized, and univariate analysis was performed to determine the association between asthma and major depressive disorder and its individual symptoms. Results: there were 402,167 participants from 2013–2018 in our study: no asthma in 84.70%; asthma in 15.30%. Childhood onset asthma (COA) included 10.51% and adult-onset asthma (AOA) included 4.79%. Median age of COA is 5 years and AOA is 41 years. Among the asthma groups, most AOA were females (67.77%, p < 0.0001), most COA were males (52.16%, p < 0.0001), and ethnicity was predominantly White in AOA (42.39%, p < 0001) and in COA (35.24%, p < 0.0001). AOA mostly had annual household income from $0–24,999 (35.91%, p < 0.0001), while COA mostly had annual household income from $25,000–64,999 (36.66%, p < 0.0001). There was a significantly higher prevalence of MDD in COA (38.90%) and AOA (47.30%) compared to NOA (31.91%). Frequency of symptoms related to MDD were found to have a significantly higher prevalence and severity in the asthma groups compared to no asthma, and slightly greater and more severe in AOA than in COA. Symptoms include having little interest in doing things (COA 18.38% vs. AOA 22.50% vs. NOA 15.44%), feeling down, depressed, or hopeless (COA 20.05% vs. AOA 22.77% vs. NOA 15.85%), having trouble sleeping or sleeping too much (COA 27.38% vs. AOA 23.15% vs. NOA 22.24%), feeling tired or having little energy (COA 39.17% vs. AOA 34.24% vs. NOA 33.97%), having poor appetite or overeating (COA 19.88% vs. AOA 20.02% vs. NOA 15.11%), feeling bad about yourself (COA 13.90% vs. AOA 13.79% vs. NOA 10.78%), having trouble concentrating on things (COA 12.34% vs. AOA 14.41% vs. NOA 10.06%), moving or speaking slowly or too fast (COA 8.59% vs. AOA 9.72% vs. NOA 6.09%), thinking you would be better off dead (COA 3.12% vs. AOA 4.38% vs. NOA 1.95%) and having the difficulties these problems have caused (COA 21.66% vs. AOA 26.73% vs. NOA 19.34%, p < 0.0001). Conclusion: MDD and related symptoms were significantly higher and more severe in participants with asthma compared to no asthma. Between adult-onset asthma compared to childhood onset asthma, adult-onset asthma had slightly greater and more severe MDD and related symptoms compared to childhood onset asthma.

Objectives: Lead is one of the most toxic heavy metal prevalent in the environment, which affects almost all major organs including heart, brain, intestines, kidneys as well as reproductive organs. It has been known that serum iron deficiency is associated with increased serum lead levels as lead is a particularly pernicious element to iron metabolism. Lead is also known to freely cross the placenta too; hence, this study was planned to determine any association between antenatal iron deficiency anemia (IDA), raised blood lead levels (BPb), and adverse pregnancy outcomes. Materials and Methods: This was an observational study done on 99 antenatal women with IDA and 41 nonanemic antenatal women. Lead levels were assessed in these 140 antenatal women and they were followed for adverse pregnancy outcomes. Chi-square test was used to find a difference in quantitative variables and Pearson's correlation test was used to assess association between BPb and hemoglobin levels. Results: We found that in 11 out of 99 (11.11%) women with IDA, BPb levels were high as compared to high BPb levels in only 1 out of 41 (2.4%) women without IDA and the high BPb levels ranged from 4 μg/dl–16.9 μg/dl with a mean BPb of 8.1 μg/dl. The difference in BPb among anemic and nonanemic antenatal women was significant (P < 0.05) and there was a negative dose effect relationship between BPb levels and hemoglobin levels. This difference in antenatal outcomes among women with and without high BPb levels was also significant with increased incidence of pre-eclampsia, FGR, and preterm deliveries in women with raised BPb levels. The incidence of NICU admission was also higher in the neonates of mothers with high BPb levels. Conclusions: We propose screening of high-risk women based on their social, occupational, environmental, and personal factors, with serum lead levels in the preconception period itself. All public and personal measures must be taken to reduce lead consumption and exposure in the preconception and antenatal period.

With the frequently changing guidelines on Pregnancy care, management of obstetric patients remains a major challenge during COVID-19 Pandemic. The department of Obstetrics and Gynecology had a huge responsibility to provide respectable maternity care to all women irrespective of their virologic status and at the same time protect the frontline warriors dealing with patient care during the COVID-19 pandemic. We would like to share our perspective regarding the challenges faced and the solutions sought for, in both patient care and teaching and research.

Background: Accurate prediction of adnexal tumors preoperatively is critical for optimal management of ovarian cancers. The International Ovarian Tumor Analysis Algorithms (IOTA) is a newer tool to characterize adnexal masses as benign or malignant. Objective: This study is aimed to predict malignancy in adnexal masses and differentiates benign from malignant, applying the sonography features of simple rules given by IOTA. Methodology: A prospective study was carried out at AIIMS Jodhpur for 1½ years. Women presenting with adnexal masses planned for surgery were recruited. Ultrasonography-transabdominal combined with transvaginal was done, and pelvic masses were characterized using IOTA simple rules. Patients underwent their planned surgery. Histopathology is considered the gold standard and was compared with the IOTA simple rules. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: One hundred and seventy-four women were included in the study, of which the majority (82.75%) were benign, the rest being frankly malignant or borderline cancer. The sensitivity of IOTA is 96.6%, specificity of 92.3%, PPV of 72.5%, NPV of 99.2%, where indeterminate cases were considered malignant. Conclusion: IOTA simple rule is an effective tool for identifying malignant adnexal masses. It also suggests that IOTA-simple rules can be used as a diagnostic criterion for differentiating adnexal masses into benign and malignant on an out-patient department basis.

Objective: Despite the increase in contraceptive usage over the years, there still exists a gap in the knowledge, attitude, and practices regarding contraception. The study has been designed to assess the knowledge, attitude, practice, and preferences on contraceptive methods among the nursing staff, to determine the association between knowledge and attitude on contraceptive methods with the variables. Materials and Methods: A cross-sectional descriptive study of 173 nursing staff using a structured questionnaire on knowledge, attitude scale, and practice and preference were done at AIIMS, Jodhpur during June 2018 to August 2019. Results: It was observed that 82.6% were of 21–30 years of age, 86.7% were Hindus, 67% were from the nuclear family, 41% were married between 19 and 25 years, 86.7% were nulliparous, 75.7% had access to various contraceptives through health workers, 79.8% got information through media. 73.4% were willing to use postpartum contraception. In our study, a major reason for 80.9% to use family planning was to prevent unintended pregnancies. Majority 71% had the favorable attitude and 14.4% had an unfavorable attitude toward contraceptive methods. In this study, 64.1% preferred male condom as Rank 1, intrauterine device 57.8% as Rank 2, and Lactational Amenorrhea Method 58.3% as Rank 3 for postpartum contraception. There was an association between the practice of family planning and marital status, age, and family size. Conclusions: The study showed that the majority of the females nursing staff had moderate knowledge and favorable attitude toward contraception use.

Endophytes live asymptomatically within the healthy tissues of plant parts of the host, has grabbed the attention of ecologists, chemists, and researchers to have a broad spectral of biotechnological potential. It has been proven that almost all plants harbor endophytes within themselves. Numerous studies indicated that endophytes act as chemical synthesizers of the secondary metabolites of their host plant. Various medicinal plants of the Thar Desert have been used by the local folks of the Rajasthan to treat several diseases ailments for time immemorial. On the basis of their prior knowledge of ethnopharmacological usage of medicinally important plants of Thar Desert, several researchers directed their studies in search of endophytic microflora of such medicinally important plants for the discovery of novel bioactive molecules of pharmaceutical importance, for instance, taxol producing endophytic fungus Phoma sp. isolated from Calotropis gigantea as well as Aspergillus fumigatus, an endophytic fungus reported from Moringa oleifera demonstrated an effective antibiofilm, antimicrobial and antiproliferative activity. This review sheds light on the endophytic microflora of the ethnomedicinal plants of the Thar Desert and their biopotential as a promising source of pharmaceutically important naturally derived compounds.

Nanotechnology has become a very advanced and popular form of technology with huge potentials. Nanotechnology has been very well explored in the fields of electronics, automobiles, construction, medicine, and cosmetics, but the exploration of nanotecnology’s use in agriculture is still limited. Due to climate change, each year around 40% of crops face abiotic and biotic stress; with the global demand for food increasing, nanotechnology is seen as the best method to mitigate challenges in disease management in crops by reducing the use of chemical inputs such as herbicides, pesticides, and fungicides. The use of these toxic chemicals is potentially harmful to humans and the environment. Therefore, using NPs as fungicides/ bactericides or as nanofertilizers, due to their small size and high surface area with high reactivity, reduces the problems in plant disease management. There are several methods that have been used to synthesize NPs, such as physical and chemical methods. Specially, we need ecofriendly and nontoxic methods for the synthesis of NPs. Some biological organisms like plants, algae, yeast, bacteria, actinomycetes, and fungi have emerged as superlative candidates for the biological synthesis of NPs (also considered as green synthesis). Among these biological methods, endophytic microorganisms have been widely used to synthesize NPs with low metallic ions, which opens a new possibility on the edge of biological nanotechnology. In this review, we will have discussed the different methods of synthesis of NPs, such as top-down, bottom-up, and green synthesis (specially including endophytic microorganisms) methods, their mechanisms, different forms of NPs, such as magnesium oxide nanoparticles (MgO-NPs), copper nanoparticles (Cu-NPs), chitosan nanoparticles (CS-NPs), β-d-glucan nanoparticles (GNPs), and engineered nanoparticles (quantum dots, metalloids, nonmetals, carbon nanomaterials, dendrimers, and liposomes), and their molecular approaches in various aspects. At the molecular level, nanoparticles, such as mesoporous silica nanoparticles (MSN) and RNA-interference molecules, can also be used as molecular tools to carry genetic material during genetic engineering of plants. In plant disease management, NPs can be used as biosensors to diagnose the disease.

Introduction: Neonatal meningitis in developing countries is 0.8-6.1 per 1000 live births with mortality of 40-85% and has also has high morbidity. Since, the clinical signs and symptoms of meningitis are non-specific and like those seen in sepsis, Cerebrospinal Fluid (CSF) examination via Lumbar Puncture (LP) is essential to establish the diagnosis of meningitis. Performing a LP has its own set of complications. Hence, to predict meningitis amongst neonates with sepsis serum inflammatory markers are used for the diagnosis of sepsis, so that early antibiotic therapy and LP examination can be avoided. Aim: To investigate the role of serum inflammatory markers, to predict bacterial meningitis amongst neonates with sepsis and to determine the cut-off values for these markers to predict bacterial meningitis amongst neonates with sepsis. Materials and Methods: This was a cross-sectional observational study done over a period of 18 months in the paediatric wards in a tertiary care centre. All neonates presenting with clinical suspicion of sepsis were enrolled. The blood samples were collected for serum inflammatory markers and CSF examination was done as indicated (American Academy of Paediatrics, AAP guidelines). CSF examination findings and serum inflammatory markers were then statistically analysed to determine the significance in predicting bacterial meningitis in neonatal sepsis. A total of 234 neonates were selected as per laboratory investigations for enrollment in the study. Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean±SD (Standard Deviation) and median. Diagnostic tests were used to calculate sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV). Results: A total 234 neonates with features suggestive of sepsis and in whom C Reactive Protein (CRP) >10 mg/L, Erythrocyte Sedimentation Rate (ESR)>15 mm, White Blood Cell (WBC) 0.05). Receiver Operator Curve (ROC) for all the four parameters were constructed, they showed performance was non-significant. Conclusion: Based on the current single site study results, it is implicated that diagnosis and management of neonatal meningitis should be solely based on LP since serum inflammatory markers are poor discriminators for meningitis. Future studies should evaluate the diagnostic parameters from other inflammatory markers like Immature to Total Neutrophil (IT) ratio and micro ESR, which, if proven to be of diagnostic value, can reduce the time to initiate management and avert the need for LP in neonatal meningitis.

The pandemic of COVID 19 has proved to be a global catastrophe. Pregnant females could be more vulnerable to the infection owing to the immune modulation. According to the World Health Organization (WHO), pregnant females including those with COVID-19 suspicion or confirmed status have right to ´safe and positive childbirth experience´ which includes a companion. The birth companion, is present at all times with the patient, from the initiation of labor till breastfeeding. The COVID-19 crisis has taken its toll on the healthcare system. The number of infected antenatal females are expected to increase. If a birth companion is trained in basic intrapartum and postpartum observation and care, he/she can be utilised to minimize unnecessary patient-clinician interface and optimize manpower in this critical time.

Aim: To assess the effect of orthodontic treatment needs on oral health-related quality of life among the young people of Delhi NCR. Methods: The study was conducted on 12–15 years of individuals attending dental clinic/hospital in Delhi NCR region. Data were collected using Index of Orthodontic Treatment Need -Dental Component and oral health impact profile 14 questionnaire. The Chi-square test was used to analyze the qualitative data. SPSS software version 20 was used for statistical analysis. Results: Orthodontic treatment needs had an almost similar impact on the daily activities of both males and females. The sense of taste was not significantly affected by the need for orthodontic treatment in either males or females. The proportions of orthodontic patients found to have the painful arch, embarrassment, tension, and self-conscious both in males and females. Conclusion: There is a significant correlation of orthodontic treatment needs among oral health-related quality of life.

The understanding of ovarian malignancy pathogenesis has greatly increased with identification of varied genomic mutation profiles, which directs the clinical behavior of the tumors. The present case describes the rare subtype of pure transitional cell carcinoma which is no more included in the newer World Health Organization (WHO) classification as the WHO labels it as a type of high-grade serous ovarian cancer with transitional cell differentiation, although in our case no serous component was identified. Hence, with revised classification of ovarian malignancies, it is important to report all rare subtypes in order to understand their biology and behavior.

Struma ovarii is a variant of mature cystic teratoma, with predominant thyroid element. Confirmatory diagnosis is by histopathology. It may mimic as ovarian malignancy in some. It may be associated with ascites in minority; even CA-125 has been found to be raised in some cases. We here report three cases – two operated for suspected ovarian malignancy in a postmenopausal female and one case operated for persistent benign ovarian cyst with raised CA-125 in a young female. In all histopathological diagnosis was a benign struma ovarii. It is difficult to diagnose these cases preoperatively as there are no specific clinical, radiological or serum markers for these rare tumors in the absence of thyroid biology abnormality. Most cases are diagnosed on histopathology. These benign tumors many times require extensive staging laparotomy for suspected ovarian malignancy in the absence of preoperative diagnosis. Prognosis is good for these tumors. Subtle radiological signs and a clinical suspicion can avoid extensive staging laprotomies in these patients.

Gossypiboma is an uncommon but avoidable condition, which is mostly asymptomatic initially and difficult to diagnose but can cause serious postoperative complications. It is a mass lesion due to surgical sponge or swab if retained in the body after the surgery. Gossypiboma has a vague presentation, and it is difficult to diagnose. In patients with a prior history of surgery having soft-tissue masses or localized pain abdomen, gossypiboma should be included in the differential diagnosis. We are reporting a case of a 33-year-old woman referred to our center with a complaint of vague abdominal pain, mild distension for the past 7 days, and discharge from the stitch line for the past 1 day. After investigation, diagnosis of gossypiboma was made and an exploratory laparotomy was performed to remove the retained surgical mop.

Complete androgen insensitivity syndrome is a rare condition, wherein a genetic male is phenotypically female and is raised as a female. Treatement requires timely gonadectomy, need for long term hormonal replaceent therapy, psycological and genetic counseling. The type, dose, duration of hrt is not well studied. Reproductive issues also need to be addressed in these young woman. We report here a case of complete androgen insensitivity which posed a quandary for management of long term bone health. Review of literature for management is discussed. These cases are best managed by a multi-disciplenary team comprising of gynecologist, geneticist, endocrinologist and clinical psycologist or psychiatrist.

Endometrial stromal sarcomas (ESSs) are rare malignant tumors of the uterus that arise from the endometrial stroma, the annual incidence of ESS being 1–2/million women. Patients present with nonspecific complaints of abnormal uterine bleeding, pelvic pain, and pressure symptoms. Postmenopausal women rarely present with a low-grade ESS, as it is more common in younger women. ESS is usually confused with leiomyomas radiologically. Histopathological examination and immunohistochemistry are essential for the diagnosis. We, herein, report a case of a postmenopausal female who presented with something coming out per vagina. The clinical impression was that of a third-degree uterovaginal prolapse that on histopathological examination was diagnosed as a low-grade ESS.

“Minimal deviation adenocarcinoma” of the uterine cervix (MDA), historically known as Adenoma Malignum, is a rare variant of cervical adenocarcinoma. Both the clinicians and pathologists must be vigilant about this entity as it could be mistaken for a benign pathology both clinically and microscopically, which can prove disastrous to the patient as these tumors behave like adenocarcinomas We hereby report an incidentally detected case of AM which was diagnosed in a post-menopausal female postoperatively. We discuss the intraoperative complications, histopathological diagnosis, post-operative management and follow up.

India is second largest populated country and facing many problems related to energy and environment. Green building is one of the solutions which can be helpful in decreasing the energy demand and improving the environmental quality. Green buildings are designed to decrease the adverse effects of the built environment on human being and natural environment by using optimum energy, conserving natural resources and using the recycled water by providing healthier environment for human beings. The basic aim of the green buildings is to reduce the overall impact on the human being and environment. This paper focuses on the importance of green buildings in improving the environmental quality.

Introduction: Enterococci are recognized as opportunistic pathogens, as well as commensals in both humans and animals. They are an important cause of nosocomial infections, difficult to treat, as the organism have intrinsic and acquired resistance to many antibiotics. Aim: To isolate and identify clinically relevant Enterococcus up to species level from all the clinical samples processed in the microbiology laboratory and also to study their resistance pattern. Materials and Methods: A prospective study was carried out for a period of one year from May 2014 to April 2015 at the Department of Microbiology, Subharti Medical College, Meerut, Uttar Pradesh, India. A total of 200 isolates of Enterococcus species from 15342 clinical samples obtained from IPD/OPD patients irrespective of age, having suspicion of bacterial infection were processed in the microbiology laboratory. Identification was done with standard biochemical methods. Antibiotic susceptibility testing was done on Muller Hilton agar plate by Kirby Bauer disc diffusion method. High-Level Gentamycin Resistance (HLGR) and High-Level Streptomycin Resistance (HLSR) were further confirmed by Agar dilution method and Broth microdilution method. Vancomycin and linezolid resistance was further confirmed by Agar dilution method and MIC was calculated by using VITEK 2, Biomerieux. All methodology was followed as per Clinical and Laboratory Standards Institute (CLSI) M100-S 24, 2014 guidelines. Results: E. faecalis (n=169, 84.5%) was the predominant species isolated, followed by E. faecium (n=27, 13.5%) and E. casseliflavus (n=4, 2%). A total of 25 (12.5%) isolates were HLGR, 13 (6.5%) isolates were HLSR and 62 (31%) isolates were HLGR+HLSR. Vancomycin resistance was found in 14 (7%) isolates of which 11 (78.5%) were Van A and 3 (21.4%) were Van B, detected phenotypically as per relative MIC of vancomycin and teicoplanin. Linezolid resistance was seen in 4 (2%) of isolates which were vancomycin as well as high-level gentamycin and high-level streptomycin resistant. Conclusion: Isolation of Enterococcus species resistant to most of the higher antibiotics like vancomycin and linezolid, with high prevalence of High-Level Aminoglycoside Resistance (HLAR), from hospitalized patients is a major concern as such isolates have limited or no therapeutic option.

Background: Daily feeding and locomotion are interrelated behaviours. The time spent in feeding and rate of food intake depends on food availability. In low food condition, the birds would show intense movement (locomotion) for a longer time throughout the day however during abundant food supply they may chose higher activity and food intake in the morning and evening only. In the present study we hypothesized that in Spotted Munia (Lonchura punctulata), intermittent food availability during day would reallocate their interrelated behaviors, the feeding (food intake) and locomotor activity patterns. Methods: Two groups of birds (N = 6 each) were kept individually in activity cages under 12L:12D. Group 1 (Control; C) had ad libitum food but group 2 (Treatment; T) had food for 6 hours only (2 h presence followed by 2 h absence; 2P:2A) during 12 hour light period. In the first week, group 2 received food with ‘lights on’ (TI; ZT 0–2, 4–6 and 8–10; where ZT 0= zeitgeber time 0, time of lights ON). In the following week, the food was given 2 hours after ‘lights on’ (TII; ZT 2–4, 6–8, 10–12). The food intake and locomotor activity under each condition were observed. Results: The results showed that locomotor activity was induced during food deprivation and suppressed during food availability. Also the food deprivation led to increased food intake. Conclusion: Our results suggest that intermittent food availability/ deprivation reallocates the locomotor activity and food intake in Spotted Munia.