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Introduction: Gastric Cancer (GC) is the fifth most common malignancy worldwide. Transabdominal Ultrasonography (TA-USG) is a non invasive and inexpensive imaging modality that is widely available. However, there is a lack of knowledge regarding the utility of USG among radiologists in the diagnosis of GC. Aim: To evaluate the accuracy of TA-USG in the detection of gastric malignancy. Materials and Methods: This was a cross-sectional study conducted in the Department of Radiodiagnosis at Father Muller Hospital, Mangaluru, Karnataka, India from October 2021 to February 2023. Patients with Upper Gastrointestinal (UGI) symptoms and suspected Gastric Carcinoma, who underwent UGI scopy (n=107) referred from the Departments of Gastrosurgery, Medical Gastroenterology, and Oncosurgery, were included. The sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of TA-USG in the diagnosis of GC were determined. Results: The TA-USG could diagnose 94 out of 107 cases of malignancy, with the best results in detecting antropyloric malignancy. TA-USG performed worst in early GC. The authors had four cases of early GC, all of which were not diagnosed with TA-USG. The sensitivity, specificity, PPV, NPV, Positive Likelihood Ratio (PLR), Negative Likelihood Ratio (NLR), and accuracy were calculated to be 87.85%, 93.83%, 86.24%, 94.61%, 14.23, 0.13, and 92%, respectively, with a p-value of

Cognitive radio wireless sensor networks (CRWSN) is a promising technology for developing bandwidth constrained applications. Future Internet of Things (IoT) applications may extensively use CRWSN. CRWSN consists of cognitive radio enabled sensor nodes which are energy constrained, in general. Hierarchical cluster based approach for overall network management is suitable for network stability and scalability. Thus node clustering is an important problem in CRWSN setup. Objective of this work is to develop a suitable node clustering algorithm for CRWSN, in which nodes are expected to be mobile. A node clustering protocol for CRWSN has been proposed in this paper. The proposed clustering protocol is based on evolutionary game theory (EGT). Initial clusters are formed through a simple partitioning approach. Eventually, initial clusters are merged to form the final clusters. After forming the clusters by the resourceful sink node, the cluster head nodes for respective clusters are determined. The sink node runs the EGT based algorithm to identify the most capable node as the cluster head. The strength of this approach is that while identifying the cluster head node, various parameters such as residual energy level, geographic location, mobility, and the probability of primary user (PU) arrival are considered. The clusters and therefore, the cluster head nodes are distributed uniformly in the geographical area. The proposed clustering protocol has been compared with LEACH, RARE and the spectrum aware clustering algorithm. The simulation results show that the proposed clustering protocol outperforms all these similar node clustering protocols. On average, the proposed protocol outperforms the benchmarks protocols by 25% in terms of number of high energy nodes selected as cluster head, by 37% in terms of uniform geographical distribution of cluster head nodes, by 23% in terms of total energy consumed during the simulation time, and by 27% in terms of network lifetime. The future scope of the work has been outlined.

Introduction: Breast carcinoma demands attention as it causes high morbidity and mortality. It is important to recognise benign lesions to distinguish them from in situ and invasive breast cancer and to assess a patient’s risk of developing breast cancer, so that the most appropriate treatment modality for each case can be established. The p63 has been characterised as a reliable marker of myoepithelial cells of lactiferous duct. It is exclusively expressed in myoepithelial cells of normal breast tissue. Hence, p63 can be of great help in the differential diagnosis involving benign lesions. Also, p63 may aid in distinguishing benign from malignant lesions. Aim: To study the Immunohistochemistry (IHC) expression of p63 in benign and malignant breast lesions. Materials and Methods: The prospective study was conducted on 76 breast specimens for a period of one year, from 1st December 2018 to 30th November 2019 in the Department of Pathology, Bhagat Phool Singh, Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India. IHC assessment for p63 nuclear protein was performed. The intensity of p63 expression was evaluated as continuous positive, discontinuous positive and negative. The extent was scored on the basis of percentage of positive cells and assigned a score of negative (0%), 1 (

Background and objectives: Recurrent pterygium is an important ocular problem in our country. There are different modalities of treatment for recurrent pterygium. The present study was undertaken to determine the effect of intraoperative mitomycin C along with conjunctival auto graft to prevent recurrence of pterygium. Methods: Patients with recurrent pterygium attending a tertiary care hospital in Dhaka from January 2013 to June 2015 were included in the study. Cases were randomized into two groups. Group 1 had pterygium surgery with conjunctival auto graft and Group 2 had auto graft and intraoperative mitomycin C (0.02%). All cases were followed up for one year to assess recurrence of pterygium. Results: A total of 54 recurrent pterygia cases were included in the study. The age of study population was 25 to 65 years. The recurrence rate of pterygium after 12 months was 77.7% in group 1 and none in group 2. No major postoperative complication was observed. Conclusion: The study demonstrated that the use of intraoperative mitomycin C along with conjunctival auto graft had significant effect in preventing the recurrence of pterygium. IMC J Med Sci 2016; 10(2): 49-52

Spontaneous pneumothorax and subcutaneous emphysema are well-known but less common complications of pneumocystis pneumonia, whereas pnuemomediastinum is rare. We had a patient known to be HIV seropositive, who developed Pneumocystis jirovecii pneumonia. During the course of treatment, he developed spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema. He had no predisposing factors known to cause this complication

Background and objectives: Suture or glue has been used to secure the conjunctival auto graft after excision of the pterygium. Recently, auto grafting using patient’s own blood as a bioadhesive to secure the graft in position has been described by several authors. Therefore, the present study was undertaken to determine the outcome of excision of pterygium and sutureless conjunctival auto graft using patients’ own blood as a bioadhesive. Methods: Patients with primary and recurrent pterygium attending the Department of Ophthalmology of Bangladesh Institute of Research, Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital from March 2014 to July 2015 were included in the study. Pterygium was excised and conjunctival auto graft was applied. Grafts were secured to the pterygium excision area with auto blood fibrin clot. All patients were examined after 48 hr and followed for 1, 4 and 12 weeks for graft dislodgement, sub-conjunctival hemorrhage, graft recession, graft edema and recurrence of pterygium. Results: A total of 35 primary and 2 recurrent pterygium cases were included in the study. The mean operation time was 15±1 minutes. Out of 37 eyes 5 (13.5%) had subconjunctival hemorrhage and 2 (5.4%) had graft recession and edema after 48hrs of operation. At 3 months follow up, 2 cases (5.4%) of graft recession and no case of recurrence of pterygium was found. Conclusion: Pterygium excision and conjunctival auto graft without sutures appears to be an effective treatment modality for primary and recurrent pterygium with no additional cost. IMC J Med Sci 2016; 10(2): 36-38

Hemangiomas of muscles are rare congenital benign vascular tumors usually seen on the trunk and extremities, but can also appear on the head and neck regions. In a young adult with soft tissue attenuation mass in the skeletal muscle, hemangioma should be considered in the differential diagnosis. Ultrasound and computed tomography are the useful imaging modalities for the diagnosing of hemangioma and complete surgical excision is the treatment of choice. We report a case of 24 year old woman with an intramuscular hemangioma involving the posterior neck muscles who presented to our department with painful neck mass. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 56-59 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9674

DOI: http://dx.doi.org/10.3126/jcmsn.v8i3.8687 Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-3, 43-46

Background: Many reports have shown the various pharmacolosical effects for grape (Vitis vinifera) seed extract for instance: antioxidant, hypotensive and hypolipidemic and vasodilatory effects. We have recently shown the relaxatory effect of grape leaf extract on rat ileum, uterus, aorta and reducing the rate and contractility in frog isolated heart. Objective: The aim of present study was to investigate the effect of Vitis vinifera leaf hydroalcoholic extract (VLHE) on isolated rat tracheal contractions induced by KCl and acetylcholine. Methods: The trachea was removed from male adult Sprague Dalwey rat and placed in an organ bath containing Krebs-Henseleit solution. The tracheal contractions were recorded isometrically under 1.5g initial tension. Results: The results demonstrate that the VLHE at 0.5, 1, 2, 4 and 8 mg/ml reduces the tracheal contractions induced by KCl (60 mM) significantly and dose-dependently (P

Background: Zataria multiflora Boiss is used in traditional medicine to treat gastrointestinal disorders and menrrhalgia. The inhibitory effect of this herb on rat ileum contractions has also been reported. Objective: The aim of this study was to investigate the effect of Zataria multiflora Boiss hydroalcoholic leaf extract (ZHLE) on isolated rat uterus in the presence of some known uterus stimulants. Method: Pieces of virgin adult rat uterus were mounted in an organ bath containing Tyrode or De Jalon solutions. Uterus contractions were induced by KCl, oxytocin and BaCl2 in presence and absence of ZHLE. Animals in oxytocin studies received an injection of oestradiol valerate (5mg/kg, s.c.) 24 h prior experiment. Results: ZHLE (0.125, 0.25, 0.5, 1 and 2 mg/ml) relaxed the uterus precontracted by KCl (60mM) in a dose-dependent manner (p

Introduction: Vitis vinifera (grape) is from Vitaceae family and many researches have performed on its seed but not on leaf. It has been reported that Vitis vinifera leaf extract induces relaxation in rat uterus, aorta, trachea and vas deferens precontracted by KCl. According to these reports, the inhibitory effects have been evoked through the voltage dependent calcium channels blockade. The aim of present study was to investigate the effect of Vitis vinifera leaf hydroalcoholic extract (VHLE) on rat ileum contractions induced by KCl, acetylcholine (ACh) and barium chloride. Methods: Vitis vinifera leaf powder was extracted using manerated method by 70% alcohol for 72 h at ambient temperature and then solvent was evaporated. From Sprague Dawley rats (male and female) pieces of ileum (2cm) were isolated and placed in an organ bath (10ml) containing Tyrode’s solution gassed with oxygen. An isotonic transducer recorded contractions under 0.5g initial tension. The mean±SEM of changes in length (mm) or the percentages of length changes were calculated. Results: The results indicate that VHLE (0.25, 0.5, 1, 2 and 4mg/ml) reduces the ileum contractions induced by KCl (60mM) dose dependently (P

Many reports have shown the various effects of grape (Vitis vinifera L.) seed extract for example antioxidant, protecting RBC against UV, also hypotensive, hypolipidemic and vasodilatory effects. We have recently shown the relaxatory effect of grape leaf extract on rat ileum and uterus and frog isolated heart rate and contractility. The aim of present study was to investigate the relaxant effect of Vitis vinifera leaf hydroalcoholic extract (VLHE) on isolated rat thoracic aorta contractions induced by phenylephrine and KCl, and the role of aorta endothelium on this action. Rat aorta was removed and placed in an organ bath containing Krebs-Henseleit solution and aorta contractions were recorded isometrically. The results demonstrate that the VLHE at 0.125, 0.25, 0.5, 1 and 2 mg/ml reduces the endothelial intact aorta contracted by phenylephrine (1 μM) significantly and dose-dependently. Endothelial denuded aorta showed the same relaxation but in much less extent. The IC50 of these two groups were 0.454±0.08 and 1.73±0.23 mg/ml respectively. VLHE also reduced the aorta contractions induced by KCl (80mM). The relaxatory effect of VHLE on KCl –induced contractions were less than those evoked by phenylephrine. Soluble guanylate cyclase inhibitor (methylene blue, 10 μM) and nitric oxide synthase inhibitor (L-NAME, 100μM) reduced the VHLE-induced relaxation in the intact aorta significantly but, atropine (1μM) was unable to decrease this vasorelaxant effect. These results suggest that the most vasorelaxant effect of VHLE on rat aorta is endothelium-dependent and also nitric oxide (NO) and cGMP are involved in this action.

Naphthalene (C10H8) is a natural component of fossil fuels such as petroleum, diesel and coal. The common consumer products made from naphthalene are moth repellents, in the form of mothballs or crystals, and toilet deodorant blocks. It is also used for making dyes, resins, leather tanning agents, and the insecticide carbaryl1. Naphthalene itself is a strong oxidizing agent, leading to formation of free oxygen radicals, which in turn cause erythrocyte membrane damage. It also leads to depletion of glutathione, a major reducing agent which protects erythrocyte from damaging effects of various oxidants.Major toxic effects of naphthalene are due to precipitation of acute intravascular hemolysis. Naphthalene poisoning has been commonly reported in children who accidently suck or chew the moth balls. Very few cases of naphthalene poisoning and its effects have been reported from India,. We report a case of accidental naphthalene poisoning, who presented with intravascular hemolysis and methemoglobinemia.

A comparison of four widely used linear equations of the Langmuir types of isotherm (The Langmuir Type 1, 2, 3 and 4 ) were examined in an experiment using dye sorption onto derived acid and salt treated Fish Activated Carbon (H3PO4-FAC and ZnCl2-FAC respectively). Isotherm parameters obtained from the four Langmuir linear equations differed. Though Langmuir type 1 is the most popular form, but the type 2 had the highest coefficient of determination (R2 = 0.931-0.984) compared with the other Langmuir linear equations (with R2 values ranges of 0.696-0.982, 0.613-0.926 and 0.613-0.926 for Langmuir type 1,3 and 4 isotherm models respectively). 3,7 bis(dimethylamino) phenothiazin-5-ium ion was used to measure the Extent of monolayer coverage (qm) and specific surface areas (SMB) following the application of type 1 isotherm. From this study, Value obtained for the Acid treated carbon (H3PO4-FAC with SMB; 18.170) is higher than that of the Salt treated carbon, (ZnCl2-FAC, SMB ; 13.579) which compared more to that of commercial carbon, CAC (SMB; 13.884) units in multiple of 10-3km2kg-1. The reliability of the Langmuir type 1 and 2 methods seems very good in specific surface area estimation. @JASEM J. Appl. Sci. Environ. Manage. December, 2010, Vol. 14 (4) 141 - 145

The removal of textile dyestuff from waste water was investigated in a batch sorption process using shea nut (Vitellaria paradoxa) shell activated carbon. The data were tested using the Rudishkevich – Dubinin and Temkin isotherm models. The result showed that removal efficiency increases with increase in contact time. This critical study which utilizes these more recent adsorption isotherms was found to present the mean free energy values (ED =1.036 – 1.406 kJmol-1) as a direct proportionality to the theoretical saturation capacities (qD = 2.032 – 4.169mgg-1). Sorption energy values proves to be higher for biosorbent, SS/A/15 (1.364 KJmol-1) ,which also gave the corresponding higher adsorption capacity (4.169 mgg-1) than the other three biosorbent in the series. A thermodynamic parameter (ΔG) was investigated to be more negative with sorbent – dye contact time, within the equilibration limit. The Close similarities of analytical results to those reported in reviewed literature, and the good degree of adsorption is an indication that using shea nut shells as a low cost biomass for generating activated carbon could be a feasible outlet in bioremediation. @JASEM J. Appl. Sci. Environ. Manage. December, 2010, Vol. 14 (4) 163 - 168

We report the clinicoradiological features of tuberculosis in the clavicle in 4 patients. The patients' ages ranged from 9 months to 29 years. All patients were managed with antitubercular drug therapy for one year and one underwent surgical debridement and curettage as well. Clinicians should be aware of the varied presentation (pain, non-healing ulcer, abscess, multifocal osteoarticular tuberculosis) of this condition. With the worldwide resurgence of turberculosis, clinicians should maintain a high index of suspicion. The diagnosis of osteoarticular tuberculosis is usually made on clinico-radiological features.

Cartilage tissue engineering (CTE) is a field of regenerative medicine focused on constructing ideal substitutes for injured cartilage by effectively combining cells, scaffolds, and stimulatory factors. In vitro CTE employing chondrocytes and biopolymer-based hydrogels has the potential to repair damaged cartilage. In this research, primary chondrocytes were extracted from the rib cartilage of rats and seeded on a hydrogel construct named HACF, which is made from hydroxyapatite, alginate, chitosan, and fucoidan. We then evaluated in vitro chondrogenesis on HACF cartilage construct. The results revealed that the primary chondrocytes were successfully isolated from rat rib cartilage by collagenase D digestion and HACF cartilage construct was effectively synthesized. Chondrocyte viability and its differentiation inside the scaffold HACF were determined by MTT assay, NRU assay, live/dead assay, DAPI nuclear staining, flow cytometry analysis (FCA), mRNA expression studies, and quantification of extracellular matrix components in the HACF scaffold. The findings indicated excellent chondrocyte viability within the HACF scaffold, with no noticeable changes in morphology. Apoptosis was not detected in the chondrocytes cultured on these hydrogels, as confirmed by DAPI staining, live/dead assay, and FCA. This demonstrates that the cells were capable of proliferating, dividing, multiplying, and maintaining their integrity on HACF scaffold. The results also showed more collagen deposition and glycosaminoglycan synthesis showing the good health of chondrocytes on the HACF construct. It indicates that HACF is an ideal scaffold supporting stable cartilage matrix production, highlighting its suitability for cartilage tissue engineering.

Introduction Hollow viscus perforation refers to the perforation of the gastrointestinal tract, including the stomach, intestines, or other hollow organs, leading to leakage of the contents into the peritoneal cavity. This paper aims to explore the disease burden of hollow viscus perforation in Sree Balaji Medical College & Hospital in Chennai, India, and its relation to patients' age and sex and analyze the etiology of hollow viscus perforation. Materials and methods This single-center retrospective study was conducted between May 2022 and August 2023, with a sample size of 100 patients. Data were extracted from the hospital's medical records based on the study's parameters. Results Our study shows that among the study group, hollow viscus perforation was more common in males (n = 78; 78%) than females. The highest incidence was observed in the 41-50 age group (n = 35; 35%), with the mean age being 43 years. The most common cause of perforation was a duodenal ulcer. Wound infection was the most frequent postoperative complication, affecting less than one-third of the patients (n = 29; 29%), followed by pneumonia and acute respiratory distress syndrome. Although large intestinal pathology affected only eight patients in the sample, it showed a high case fatality rate, with one-quarter of the patients (n = 2; 25%) succumbing to the condition. Conclusion Hollow viscus perforation is a life-threatening condition that requires prompt recognition and treatment. The etiology is diverse, ranging from peptic ulcer disease and malignancy to trauma and inflammatory conditions. Early diagnosis and aggressive management are essential for improving the outcome for patients with this condition., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Chandran et al.)

Background Lateral epicondylitis is a common condition involving the arm. It is caused by degenerative changes or overuse of the tendon connecting the elbow joint to the forearm muscle. Plyometric and TheraBand FlexBar (Theraband, Akron, OH, USA) exercises can relieve elbow discomfort, soreness, and weakness. This study examines the effects of plyometric and TheraBand FlexBar exercises with ultrasound on tennis elbow patients. Methodology It is an experimental study comprising a total of 30 participants, including individuals of both genders with age groups of 20-40 years were selected by specific criteria for inclusion and exclusion. The participants were randomly assigned into two groups. Group A received plyometric exercises with ultrasound, whereas Group B received TheraBand FlexBar exercises with ultrasound. The outcome measures utilized in this study include patient-rated tennis elbow evaluation (PRTEE) and visual analog scale (VAS) for evaluating the functional disability of the hand, arm, and shoulder. Results The results showed a substantial reduction in mean values in Group A compared to Group B, with a p-value of less than 0.001, indicating that plyometric exercises with ultrasound were more effective than TheraBand FlexBar exercises. Conclusion Plyometric exercises combined with ultrasound therapy demonstrated significant reductions in discomfort and improvements in function, with plyometric exercises showing superior efficacy compared to TheraBand FlexBar exercises., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, Faculty of Physiotherapy, Dr. M.G.R. Educational & Research Institute, Chennai issued approval E-29/PHYSIO/IRB/2023-2024. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, G et al.)

Background: Primary dysmenorrhea, commonly known as menstrual cramps, is a prevalent gynecological issue that impacts many women in their childbearing age. It manifests as reoccurring, cramp-like lower abdominal pain, usually commencing right prior to or during the menstrual period. These painful sensations can be severe, extending to the lower back and upper thighs can greatly disrupt a woman's daily life and overall well-being. The optimal exercise approach is needed for individuals seeking relief from primary dysmenorrhea, allowing healthcare providers and women themselves to make informed decisions regarding their treatment options. Though many forms of exercise interventions exist in the treatment of primary dysmenorrhea, this study aims to compare two forms of intervention namely pilates and gym ball exercises on pain and menstrual distress among women with Primary Dysmenorrhea., Methods: This experimental comparative study was carried out with 30 young female participants over a 12-week period. Participant recruitment was done through a simple random sampling method. The criteria of inclusion encompassed young females aged 17-25 years, those in good health, and those experiencing primary dysmenorrhea. Exclusion criteria included secondary dysmenorrhea, medication use, polycystic ovarian syndrome, bleeding disorders, positive pregnancy tests, breastfeeding, and other medical conditions. Group A received Pilates exercises, while Group B underwent Gym ball exercises. The assessment of both groups' menstrual distress levels was conducted using the Moos Menstrual Distress Questionnaire (MDQ) and pain scores using the Visual Analog Scale (VAS)., Result: In the statistical analysis, Group A (Pilates Exercises) showed a significantly lower mean value (2.60) on the VAS compared to Group B (Swiss Ball Exercises) (5.46), with both groups experiencing a notable reduction in post-test scores (p ≤ 0.001). Additionally, on the MOOS MDQ score, Group A (Pilates Exercises) achieved a lower mean value (79.33) compared to Group B (Swiss Ball Exercises) (103.26), with both groups demonstrating a significant decrease in post-test scores (p ≤ 0.001)., Conclusion: In conclusion, this study underscores the significance of exercise therapy, particularly Pilates exercises, as a holistic approach to addressing primary dysmenorrhea, improving physical well-being, and enhancing the overall quality of life., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kirthika S et al.)

Objectives: The aim of the study was to compare lecture-based teaching and simulation-based hybrid training for ENT induction and objectively assess the performance of trainees in a simulated environment., Methods: This is a prospective interventional study that included 60 interns in their rotatory internship with no prior exposure to ENT emergencies. The interns came in batches of 5‒6 for their 15-days ENT postings. On the first day, a pre-test questionnaire, lecture-based teaching on three scenarios and then allocation into one of the three simulation groups- Group A (Tracheostomy group), Group B (Nasogastric tube group), and Group C (Epistaxis group) was done. Hands-on simulation training was given only to the assigned group. At the end of 15-days, post-test questionnaire and an objective assessment of the three scenarios in a simulated environment was conducted. The same training was repeated for each batch of participants who attended the posting., Results: The participants had significant improvement in the post-test scores in all three scenarios (p <  0.05), and these improvements were marked in those who had received simulated training. On comparing simulation scores, the participants who received hands-on training on a particular scenario outperformed other (p <  0.05)., Conclusion: Simulation-based training improves cognition and overall confidence in managing ENT skills and emergencies. In simulation training, objective and standardized assessment is the key to achieve specific learning objectives to improve the psychomotor and cognitive skill., Level of Evidence: II., (Copyright © 2022 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Intrahepatic and extrahepatic anatomical knowledge is essential for pre procedural planning of liver transplantation, liver resection, complex biliary reconstruction and radiological biliary tree intervention. Indian data of biliary anatomy and its variation is scant in literature. The aim of our study is to find out the prevalence of common and uncommon pattern of biliary tree anatomy in magnetic resonance cholangiopancreatography (MRCP) in our population. A total of 1,038 cases of MRCP of population of Odisha were obtained from Picture Archiving and Communication System of the department and were reviewed by two senior radiologists for anatomical pattern and variations. The typical and most common pattern of right hepatic duct (RHD) branching was seen in 72.8% cases. The most common variant of RHD was trifurcation pattern of insertion of right anterior sectoral duct (RASD), right posterior sectoral duct and left hepatic duct (LHD) forming common hepatic duct (CHD) in 11.3% of cases. The common trunk of segment (SEG) II and III ducts joining the SEG IV duct was the most common LHD branching pattern in 90.3% of cases. The most common pattern of cystic duct was posterior insertion to middle third of CHD (42.8%). MRCP is the non-invasive imaging modality for demonstration of biliary duct morphology to prevent iatrogenic injury during hepatobiliary intervention and surgery., Competing Interests: Conflicts of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2020. Anatomy & Cell Biology.)

Chronic diseases impact 60% of Americans, with 42% reporting multiple chronic conditions, and account for $3.3 trillion in annual health care costs. In Hawai'i, about 80% of adults report having at least 1 chronic condition, and more than half of those report having multiple chronic conditions. Health coaching is a technique of engaging patients to help them obtain the knowledge, skills, and confidence to become an active and engaged participant in their health care. Health coaching aims to assist patients with understanding their care plans, exploring their perceptions of their care plans, and working collaboratively with their health care team to implement these plans to improve their overall health. In 2016, the Hawai'i Primary Care Association (HPCA) partnered with the University of California, San Francisco's Center for Excellence in Primary Care to train staff from HPCA and Hawaii's community health centers (CHCs) in health coaching. This 2-day training focused on using principles of adult learning theory to create interactive sessions aimed at building staff capacity to improve communication and empower patients to become active participants in their health care. The curriculum highlights 6 core elements of health coaching: ask-tell-ask, setting the agenda, closing the loop, know your numbers, behavior-change action plans, and medication adherence counseling. The aim of this case study is to present insights gained from the implementation of health coaching at 1 FQHC in Hawai'i. Health coaching is found to be an effective approach to engaging patients and improving communication with patients and across clinic departments. Health coaching is a promising practice to address the growing chronic disease burden in Hawai'i., Competing Interests: None of the authors identify a conflict of interest.