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Introduction and Objectives: Alcohol-associated hepatitis (AH) is a severe entity associated with high mortality. Corticosteroids might be used in cases with severe disease and several dynamic models can predict mortality and response to corticosteroids in AH patients. However, there is no consensus on the best of them. This study aimed to evaluate dynamic models to predict response to corticosteroid treatment based on short-term mortality in patients with severe AH based on a worldwide cohort. Materials and Methods: A retrospective cohort study of patients with severe AH (between 2009 – 2019). We included patients who received corticosteroid treatment and calculated the Lille model of day 4 (Lille-4), day 7 (Lille-7) (cut-off value ≥0.45), and the Trajectory of Serum Bilirubin (TSB)(cut-off value ≥0.8 of the ratio between bilirubin at admission and day 7) to predict mortality. We estimated up to 30-day survival using Kaplan-Meier curves, and we performed multivariable analyzes using Cox regression. Specifically, we constructed two models to compare Lille-4 vs. TSB and Lille-7 vs. TSB, adjusting by well-known clinical variables associated with higher mortality in AH (age, sex, and creatinine at admission). Results: 1,066 patients were included (30 centers, 10 countries), age 47.7 ± 10.9 years, 30% women. The MELD score on admission was 25 [21-30]. Responders were considered by Lille-4 49.1%, Lille-7 46.6%, and TSB 55.4%. In the first Cox regression, we observed that Lille-4 and TSB predicted 30-day mortality (HR 3.0, 95%CI: 1.7-5.1; p

Abstract Terlipressin with albumin, the recommended treatment for hepatorenal syndrome-acute kidney injury (HRS-AKI), is associated with adverse events. Furthermore, the course of AKI in patients with acute-on-chronic liver failure (ACLF) is unknown. We aimed to analyze the safety and efficacy of terlipressin infusion and AKI course in patients with ACLF. We prospectively enrolled consecutive adult patients with ACLF with HRS-AKI (satisfying EASL criteria) treated with terlipressin infusion between 14 October 2019 and 24 July 2020. The objectives were to assess the incidence of adverse events, response to terlipressin, course of HRS-AKI and predictors of mortality. A total of 116 patients were included. Twenty-one percent of patients developed adverse effects. Only 1/3rd of patients who developed adverse events were alive at day 90. Sixty-five percent of the patients responded to terlipressin. Nearly 22% developed recurrence of HRS, and 5.2% progressed to HRS-chronic kidney disease. TFS was 70.4% at day 30 and 57.8% at day 90. On multivariate stepwise Cox regression analysis terlipressin non-response (hazard ratio [HR], 3.49 [1.85–6.57]; P

Millions of people across the world are suffering from diabetic retinopathy. This disease majorly affects the retina of the eye, and if not identified priorly causes permanent blindness. Hence, detecting diabetic retinopathy at an early stage is very important to safeguard people from blindness. Several machine learning (ML) algorithms are implemented on the dataset of diabetic retinopathy available in the UCI ML repository to detect the symptoms of diabetic retinopathy. But, most of those algorithms are implemented individually. Hence, this article proposes an effective integrated ML approach that uses the support vector machine (SVM), principal component analysis (PCA), and moth-flame optimization techniques. Initially, the ML algorithms decision tree (DT), SVM, random forest (RF), and Naïve Bayes (NB) are applied to the diabetic retinopathy dataset. Among these, the SVM algorithm is outperformed with an average of 76.96% performance. Later, all the aforementioned ML algorithms are implemented by integrating the PCA technique to reduce the dimensions of the dataset. After integrating PCA, it is noticed that the performance of the algorithms NB, RF, and SVM is reduced dramatically; on the contrary, the performance of DT is increased. To improve the performance of ML algorithms, the moth-flame optimization technique is integrated with SVM and PCA. This proposed approach is outperformed with an average of 85.61% performance among all the other considered ML algorithms, and the classification of class labels is achieved correctly.

Solar Photovoltaic (SPV) and wind energy are two major sources of renewable energy that are intermittent in nature. A hybrid system consisting of SPV and Wind Energy Conversion System (WECS) can meet the energy needs as either of the sources continues to generate energy, in the absence of the other, that is reliable and cost-effective. The paper presents detailed mathematical modeling, simulation, and performance analysis of a single cell SPV and Permanent Magnet Synchronous Generator (PMSG) based WECS. These two sources are integrated to form a hybrid renewable energy system. The hybrid model is simulated and the overall performance is analyzed using MATLAB/Simulink for varying temperature/irradiation conditions and varying wind speeds for SPV and WECS respectively. Performance characteristics of the hybrid PV and WECS are presented. The paper also presents as a case study, the annual energy generation for a chosen location from individual SPV and WECS systems based on the real time data collected from the Solacast website. This study evaluates the feasibility of the implementation of a hybrid system at the site.

The most extensively employed strategy to control the AC output of power electronic inverters is the pulse width modulation (PWM) strategy. Since three decades modulation hypothesis continues to draw considerable attention and interest of researchers with the aim to reduce harmonic distortion and increased output magnitude for a given switching frequency. Among different PWM techniques space vector modulation (SVM) is very popular. However, as the number of output levels of the multilevel inverter (MLI) increases, the implementation of SVM becomes more difficult, because as the number of levels increases the total number of switches in the inverter increases which will increase the total number of switching states, which will result in increased computational complexity and increased storage requirements of switching states and switching pulse durations. The present work aims at reducing the complexity of implementing the space vector pulse width modulation (SVPWM)technique in multilevel inverters by using a generalized integer factor approach (IFA). The performance of the IFA is tested on a three-level inverter-fed induction motor for conventional PWM (CPWM) which is a continuous SVPWM method employing a 0127 sequence and discontinuous PWM (DPWM) methods viz, DPWMMIN using 012 sequences and DPWMMAX using a 721 sequence.

Abstract Background There is an increasing need for Mental Health Promotion (MHP) among adolescents, especially in developing countries with limited resources and rapid socio-demographic transition. With the growing burden of mental health problems among adolescents (suicide, depression) and their preferences to seek help from their peers, improving Mental Health Literacy (MHL) and behaviours for First Aid in Mental Health (MH-FA) becomes crucial to promote their mental health. Methods Schools are ideal settings for reaching the vulnerable adolescents. The proposed study evaluates the effectiveness of a classroom-based teacher-led integrated school mental health intervention called SUMS (MHP + MHL + MH-FA). The study will involve a pragmatic, cluster-randomised waitlist-controlled design to evaluate the effectiveness of SUMS intervention using schools as unit-of-randomisation. The study will be conducted in Srinivaspura taluka (Sub-district) of Kolar district (administrative unit of health) of Karnataka in collaboration with a multi-disciplinary expert team from NIMHANS (National Institute of Mental Health And Neuro Sciences), Bangalore-India and Department of Education, Government of Karnataka, India. A total of 8 schools (400 students studying in 6–8 grade) from Srinivaspura taluka will be randomised into intervention and waitlist control group. The intervention group will receive SUMS intervention through 10–15 h of classroom sessions. The primary outcome is the improvement in positive mental health literacy, as measured by the Mental Health-Promoting Knowledge (MHPK-10) scale. Changes in MH-FA knowledge and intentions, Mental health stigma, help-seeking and resilience are assessed as secondary outcomes. Data will be collected at baseline, 6-weeks, 6-months and 12-months post-intervention. The waitlist-control schools will receive the interventions at the end of the 12-month follow-up assessment in intervention-schools. Discussion This is the first study to integrate Mental Health Literacy with Mental Health Promotion and behaviours for First Aid in Mental Health to promote mental health well-being among adolescent school children in India. With a need to build a more substantial evidence base on School Mental Health Promotion approaches in developing countries, the study findings will have implications for implementing and operationalising Health and Wellness Ambassador initiative in India. Trial registration Clinical Trials Registry - India, CTRI/2019/07/020394. Registered prospectively on 29 July 2019. ( ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=35724&EncHid=&userName=sums ).

Dengue fever is not an uncommon arboviral infection in lieu of tropical geography. The gravity of the disease ranges from an Outpatient Department (OPD) visits for febrile illness to haemorrhagic complications like shock. Hereby, authors report a case of a 33-year-old female patient with no prior morbidities. Initial fever episodes due to dengue resulted but she deteriorated clinically with second wave of continuous fever spikes. On evaluation, a diagnosis of Haemophagocytic Lymphohistiocytosis (HLH) was made. The patient was treated with steroids and oral etoposide following which patient recovered completely. Although, scarce occurrence of HLH following viral illness needs strong suspicion, prompt investigation and management to avoid potentially life-threatening complications. On a case-to-case basis HLH protocol can be modified to make an OPD base treatment by switching to oral etoposide.

Objective: To test the feasibility of a real time miniature endoscope system for imaging the nasopharynx. Study design: Preclinical assessment on skull model and cadaver. Methods: A 3.5 mm miniature endoscope was fabricated and the image capture of the nasopharynx was investigated by positioning the miniature camera system at the posterior free edge of the vomer bone. Wireless real time transmission of the images and quality was tested in a skull model. Next, three nasopharyngeal surveillance miniature camera system were developed for possible clinical translation. Two prototypes were anchored on the nasal septum and the last prototype was designed using a patient self-administered surveillance process. These prototypes were tested for feasibility on both the phantom skull and cadaveric model. Risk assessments were also performed to assess risk, safety and validate the reliability of the material utilized for clinical translation. Results: Insertion and anchorage of the miniature surveillance endoscope prototypes at the vomer bone were feasible on all 3 prototypes. The quality of captured images was reasonable and miniaturized camera was responsive to pan at different angles so that the entire nasopharynx may be surveyed. Risk assessments on the material such as pull out test, breaking force analysis, finite element test and tensile strength test were reliable for possible clinical translation. Conclusions: Real time miniature endoscope system for surveillance of nasopharyngeal cancer is feasible. Clinical translation of this technology was possible but requires further refinement in enhancing image quality and wireless transmission of the captured images.

The COVID-19 pandemic has impacted transplantation worldwide in a major way with infections and post-COVID-19 complications contributing to increased mortality and morbidity. We present a case of a 42-year-old lady who developed rhino-orbital mucormycosis in a postliver transplantation period. The initial presentation of the patient was very subtle. She never had overt COVID-19 infection before surgery and in the recovery period. Though cases of mucormycosis in the wound site have been reported, this would be one of the rare cases of rhino-orbital mucormycosis postliver transplantation. This infection leads to a rapid downhill course and the death of the patient. Atypical infections and presentations need to be monitored in postliver transplantation patients who are getting operated on during this pandemic, and a high level of clinical suspicion is required to pick up these cases at an early stage.

Background: Immunosuppression and comorbidities increase the risk of severe coronavirus disease-2019 (COVID-19) in solid organ transplant (SOT) recipients. The outcomes of COVID-19 in liver transplant (LT) recipients remain unclear. We aimed to analyse the outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in LT recipients. Methods: The electronic databases were searched for articles published from 1 December 2019 to 20 May 2021 with MeSH terms COVID-19, SARS-CoV-2, and liver transplantation. Studies reporting outcomes in more than 10 LT recipients were included for analysis. LT vs non-LT patients with COVID-19 infection were compared for all-cause mortality, which was the primary outcome studied. We also evaluated the relation between the timing of COVID-19 infection post-LT (< one year vs > one year) and mortality. Findings: Eighteen articles reporting 1,522 COVID-19 infected LT recipients were included for the systematic review. The mean age (standard deviation [SD]) was 60·38 (5·24) years, and 68·5% were men. The mean time (SD) to COVID-19 infection was 5·72 (1·75) years. Based on 17 studies (I2 = 7·34) among 1,481 LT recipients, the cumulative incidence of mortality was 17·4% (95% confidence interval [CI], 15·4–19·6). Mortality was comparable between LT (n = 610) and non-LT (n = 239,704) patients, based on four studies (odds ratio [OR], 0·8 [0·6–1·08]; P = 0·14). Additionally, there was no significant difference in mortality between those infected within one year vs after one year of LT (OR, 1·5 [0·63–3·56]; P = 0·35). The cumulative incidence of graft dysfunction was 2·3% (1·3–4·1). Nearly 23% (20·71–25) of the LT patients developed severe COVID-19 infection. Before infection, 71% and 49% of patients were on tacrolimus and mycophenolate mofetil, respectively. Immunosuppression was modified in 55·9% (38·1–72·2) patients after COVID-19 infection. Interpretation: LT and non-LT patients with COVID-19 have a similar risk of adverse outcomes. Funding: None.

Clinicians are often very sceptical about applying automatic image processing approaches, especially deep learning-based methods, in practice. One main reason for this is the black-box nature of these approaches and the inherent problem of missing insights of the automatically derived decisions. In order to increase trust in these methods, this paper presents approaches that help to interpret and explain the results of deep learning algorithms by depicting the anatomical areas that influence the decision of the algorithm most. Moreover, this research presents a unified framework, TorchEsegeta, for applying various interpretability and explainability techniques for deep learning models and generates visual interpretations and explanations for clinicians to corroborate their clinical findings. In addition, this will aid in gaining confidence in such methods. The framework builds on existing interpretability and explainability techniques that are currently focusing on classification models, extending them to segmentation tasks. In addition, these methods have been adapted to 3D models for volumetric analysis. The proposed framework provides methods to quantitatively compare visual explanations using infidelity and sensitivity metrics. This framework can be used by data scientists to perform post hoc interpretations and explanations of their models, develop more explainable tools, and present the findings to clinicians to increase their faith in such models. The proposed framework was evaluated based on a use case scenario of vessel segmentation models trained on Time-of-Flight (TOF) Magnetic Resonance Angiogram (MRA) images of the human brain. Quantitative and qualitative results of a comparative study of different models and interpretability methods are presented. Furthermore, this paper provides an extensive overview of several existing interpretability and explainability methods.

Background & Objectives: Worldwide, 60 to 90% of school children have experienced dental caries with higher prevalence in Asian and Latin American countries and poor dental and oral health and untreated oral disease can have a significant impact on quality of life according to WHO report. The objectives of the study were to assess the prevalence of dental caries both in deciduous and permanent teeth and to compare total decayed, filled teeth surfaces among primary school children of Kathmandu from both government and private schools and to find the percentage of first permanent molars affected with dental caries.Materials & Methods: A cross sectional study was conducted among two Government and two Private Primary School Children in Kathmandu district. Total sample were 468 children. Required permission were obtained from concerned authorities. WHO accepted indices for assessing caries designed by Henry T Klein, Carrole E Palmer and Knutson J.W was used. SPSS 20 version software was used for data analysis. Results: Among 468 primary school children examined, 224 were from Government and 244 were from Private school. The prevalence of dental caries was 62 % and more deciduous teeth were decayed. The decayed, filled teeth surfaces in Private and Government school was statistically significant (p=0.000) but gender wise prevalence was statistically insignificant (p=0.303). Among 1st Permanent Molars teeth examined 85% were decayed.Conclusion: This pilot study shows prevalence of dental caries more in deciduous teeth. Among the permanent teeth affected, first permanent molars are in high number.

Background & Objectives: The objective of the study was to assess the oral health related knowledge, attitude and practices of bachelors level nursing college students in Kathmandu district.Materials & Methods: Data was collected using pre-designed questionnaire among 251 nursing students of three colleges comprising of 43 closed ended questions adopted from various studies. Twenty five questions related to knowledge, 8 questions of attitude and 10 of practice were asked. Prior to conducting the study permission was obtained from institutional review board of Kantipur Dental College and from the Campus Chief of the nursing colleges.Results: Majority of respondents had good oral health knowledge including functions of teeth (94.0%), mineral important for tooth formation (98.4%), vitamin necessary for growth and development of teeth (91.2%), dental caries (90.4%), gingival diseases (96.4%) and treatment for malocclusion (90.8%). Almost half of the participants did not know about treatment options for gum disease, consequences of irregular teeth and causes of oral cancer. Majority of the participants showed good attitudes towards oral health with 99.2% giving equal importance to their teeth like their general health. 78.9% of the participants brush twice daily with 98% using toothbrush and toothpaste among whom 65.7% uses soft bristle toothbrushes. Conclusion: It was seen that oral health related knowledge, attitude and practice of nursing students was adequate but further improvements can be encouraged and facilitated.

The present investigation is designed to study the stereotypes about male sexuality, in men with sexual dysfunction and normal controls. The sample of the study is composed of 25 men with sexual dysfunction and 25 men as normal controls. The normal control is matched with the control group in terms of age, education, marital status and religion. Data was collected using the Stereotypes about Male sexuality scale (Snell, 1990) and Socio-Demographic Clinical Data Sheet (SDCDS). The descriptive survey method was used as the research design. The data collected were analysed by employing the statistical techniques such as arithmetic mean, standard deviation, Karl Pearson's coefficient of correlation and ‘t’ – test. The result indicates that men with sexual dysfunction had significantly higher stereotype belief about male sexuality in comparison to normal controls.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The management of water resources in large rivers basins commonly involves challenges and complexities that are not found or are less common in smaller basins [...]

Background: This paper explores the role that Ayurveda can play in the management of Iron Deficiency Anaemia, a major nutritional deficiency disorder affecting people across the globe. Methodology: Forty (40) patients suffering from Iron deficiency anaemia as per WHO guidelines, between the age group of 20 to 60 yrs of either sex participated in the study. Study was a randomized, controlled, open label clinical study. Patients were randomly divided into two groups: Group D (n = 20) received Dhārī avaleha 10 g twice a day after food. Group K (n = 20) received capsules Kasīsa bhasma 125 mg thrice a day. Both interventions were administered for 30 days and the subjects were followed up for next 30 days with placebo capsules to assess the sustainability of the effects. Assessments were done at baseline, 30th and 60th days. Primary outcome measure was hemoglobin estimation (Hb) and secondary outcome measures were the other hematological parameters such as Red blood cell (RBC) indices, total RBC count, Packed Cell volume (PCV) and Peripheral Blood smear study. Results: Both interventions produced significant improvements (P < 0.001). Kasīsa bhasma was better compared to dhārī avaleha in terms of primary (P < 0.0001) and secondary outcomes. Comparison of outcomes from base line – 30th day, base line – 60th day and 30th – 60th day showed significant (P < 0.0001) improvement in both the groups in parameters such as haemoglobin, MCV and MCH. Hence improvements sustained during placebo intervened sustainability period also. Conclusions: Study effectively shows that Kasīsa bhasma is better then Dhātrī avaleha. Improvements by both interventions were sustained even during the sustainability period.

Large river basins present significant challenges for water resource planning and management. They typically traverse a wide range of hydroclimatic regimes, are characterized by complex and variable hydrology, and span multiple jurisdictions with diverse water demands and values. They are often data-poor and in many developing economies are characterized by weak water governance. Rapid global change is seeing significant changes to the pressures on the water resources of large basins, exacerbating the challenge of sustainable water management. Diverse technologies have long supported water resource planning and development, from data collection, analytics, simulation, to decision-making, and real-time operations. In the last two decades however, a rapid increase in the range, capability, and accessibility of new technologies, coupled with large reductions in cost, mean there are increasing opportunities for emerging technologies to significantly “disrupt” traditional approaches to water resources management. In this paper, we consider the application of ‘disruptive technologies’ in water resources management in large river basins, through a lens of improving water security. We discuss the role of different actors and institutions for water management considering a range of emerging disruptive technologies. We consider the risks and benefits associated with the use of these technologies and discuss the barriers to their widespread adoption. We obverse a positive trend away from the reliance solely on centralized government institutions and traditional modeling for the collection and analysis of data, towards a more open and dynamic ‘data and knowledge ecosystem’ that draws upon data services at different levels (global to local) to support water planning and operations. We expect that technological advances and cost reductions will accelerate, fueling increased incremental adoption of new technologies in water resources planning and management. Large-basin analytics could become virtually free for users with global, regional, and national development agencies absorbing the costs of development and any subscription services for end users (e.g., irrigators) to help improve water management at user level and improve economic productivity. Collectively, these changes can help to ‘democratize’ water management through improved access to data and information. However, disruptive technologies can also be deployed in top-down or centralized processes, and so their use is sometimes contested or misunderstood. Increased attention therefore needs to be given to ensuring equity in technology access, and to strengthening the governance context for technology deployment. Widespread adoption of disruptive technologies will require adjustments to how water professionals are trained, increased adaptiveness in water resources planning and operations, and careful consideration of privacy and cybersecurity issues.

Cetuximab immunotherapy targeting the epidermal growth factor receptor (EGFR) has been used to treat nasopharyngeal cancer (NPC) with some success. Therefore, combining an immune adjuvant to boost the immune microenvironment may improve its clinical efficacy. Herein, we investigate the immune-stimulatory effects of Poly-ICLC (a TLR3 agonist) in enhancing cetuximab-based immunotherapy and correlate these responses with FcɣRIIIa (V158F) or TLR3 single nucleotide polymorphisms (SNPs- L412F and C829T) expressed on immune effector cells. We observed high levels of TLR3 mRNA in NPC cells; and both TLR3 and EGFR expression were unaffected by Poly-ICLC treatment. Cetuximab plus Poly-ICLC significantly enhanced NK-mediated ADCC through up-regulation of CD107a and Granzyme B expression. This effect was independent of FcɣRIIIa-V158F and TLR3-L412F or TLR3-C829T polymorphisms expressed on NK cells. Additionally, IFN-ɣ expression and secretion were doubled following cetuximab plus poly-ICLC treatment; compared to either treatment alone. This effect was independent of TLR3 polymorphisms. Consequentially, adaptive immune responses were also seen with increased DC maturation (CD83), co-stimulatory molecules expression (CD80 and CD86) and increased frequency of EGFR-specific CD8 + T cells following Poly-ICLC treatment. The percentage of CD80+ CD83+ and CD83+ CD86+ DC was highest in the Poly-ICLC plus cetuximab group, compared to either treatment alone. These results demonstrate the effectiveness of Poly-ICLC in enhancing both cetuximab-mediated innate and adaptive anti-tumor immunity against NPC, which is independent of FcɣRIIIa-158, TLR3-L412F or TLR3-C829T polymorphisms. Additionally, Poly-ICLC does not downregulate EGFR expression on NPC cells and hence, will not dampen cetuximab anti-tumor activity.

Background: Attempted suicide is a common clinical problem in a general hospital setting. It has a serious clinical and socio-economical impact too. Aims: To study the psychosocial, psychiatric, and personality profile of the first suicide attempters in a general hospital. Settings and Design: Cross-sectional, hospital-based, descriptive study. Materials and Methods: All the consecutive cases of first suicide attempt ( n=100) treated in a general hospital were studied to know the clinical profile. Variables related to socio-demographic characteristics, family background, suicide characteristics, psychiatric morbidity, and comorbidity were analyzed. Risk-Rescue rating was applied to know the medical seriousness of the suicide attempt. Presumptive stressful life event scale was utilized to calculate life events score. Structured clinical interview (MINI Plus) and semi-structured clinical interview (IPDE) were used for axis-I and axis-II (personality) diagnoses. The results were analyzed using appropriate statistical measures. Results: Family history of psychiatric illnesses (31%) and suicide (11%) were noted. Insecticides and pesticides were the most common agents (71%) employed to attempt suicide. Interpersonal difficulties (46%) were the most frequent stressor. Overall medical seriousness of the suicide attempt was of moderate lethality. 93% of the suicide attempters had at least one axis-I and/or axis-II psychiatric disorder. Most common diagnostic categories were mood disorders, adjustment disorders, and substance-related disorders, with axis-I disorders (89%), personality disorders (52%), and comorbidity of psychiatric disorders (51.6%). Conclusion: Individuals who made first suicide attempt were young adults, had lower educational achievement; overall seriousness of the suicide attempt was of moderate lethality, high prevalence of psychiatric morbidity, personality disorders, and comorbidity, and had sought medical help from general practitioners.

Introduction: Clinically, subcoracoid impingement is characterized by pain at the anterior aspect of the shoulder that is induced by adduction, internal rotation and forward flexion. This position leads to narrowing of the Coraco-Humeral Interval (CHI)-that is, the space between the coracoid process and the lesser tuberosity of the humerus. Structures in the rotator interval are at greatest risk for impingement which includes the Subscorapularis tendon, tendon of the long head of the biceps, and the middle gleno-humeral ligament. This may result in Rotator interval pathologies such as subscapularis tear and long head of biceps tendon subluxation or fraying. Aim: To study the prevalence of radiological evidence of reduced Coraco-Humeral Interval (CHI) in patients with clinically evident Subcoracoid impingement and to examine the presence of Subscapularis tears in these patients. Materials and Methods: Twenty four patients (6 males, 18 females, average age 52.83 years) were included in this prospective study who were diagnosed to have rotator cuff tears clinically. Nine of these patients were clinically found to have concomitant subcracoid impingement. All patients were subjected to MRI of shoulder. Measurement of the CHI was done in images with humerus in maximal internal rotation. Presence of subscapularis tear was examined intraoperatively. Statistical evaluation of the data was performed using Student's t-test and Fisher’s exact test and the results were applied to two cohorts of patients. One cohort consisted of patients who had a CHI value of less than 5.5mm and the other cohort had a CHI value greater than 5.5mm. Average CHI values in patients with and without a subscapularis tear were determined. Results: Nine patients who had clinical subcoracoid impingement were found to have an average CHI of 5.33mm. All nine of them had an associated tear of subscapularis with long head of Biceps tendon subluxation and/or fraying. Remaining 15 patients had an average CHI of 10.48 and they did not have either signs of Subcracoid impingement or subscapularis tear but had a tear elsewhere (Supraspinatus or Infraspinatus). Difference between these two groups was found highly significant (p-value

Vertebral osteomyelitis also known as discitis/pyogenic spondylitis refers to inflammation of the vertebral disc space. It is commonly seen in men and adults more than 50 years of age. Fungal osteomyelitis is a rare scenario compared to its bacterial counterpart. Spinal epidural abscess is a dangerous complication associated with vertebral osteomyelitis. Here, we report two cases of vertebral osteomyelitis caused by Candida tropicalis in patients with renal disorders (stage 5 chronic kidney disease and nephropathy). One of the case discussed here presented with spinal epidural abscess. Both the patients were started on antifungal therapy. One patient responded to treatment while the other was lost to follow up.

PURPOSE: To determine risk factors for poor visual outcome in postoperative and posttraumatic endophthalmitis in a large referral center in south central India. METHODS: In this prospective observational series the authors examined 388 patients of postoperative (n= 206) and posttraumatic (n= 182) endophthalmitis at the L V Prasad Eye Institute in Hyderabad, India between 1991 and 1997.The analysis was confined to 236 patients-128 (62.1%) postoperative and 108 (59.3%) posttraumatic patients who were followed for a minimum period of 3 months. A detailed protocol was followed. Chi-square and logistic regression analysis were used to determine risk factors for visual outcome worse than 6/18 and worse than 6/120. RESULTS: Postoperative endophthalmitis: In univariate analysis the features associated with poor visual acuity (grouped as < 6/18 and < 6/120) included intracapsular cataract surgery, poor presenting visual acuity, presence of vitreous cells, inability to visualise the optic disc on indirect ophthalmoscopy, presence of vitreous membranes on ultrasonography, and a culture-positive vitreous biopsy. In the multivariate analysis, visual acuity of < light perception (LP) at presentation was associated with a 3-month postoperative visual acuity of < 6/18, with an odds ratio of 5.85 [ 1.25 - 27.42, 95% CI], and vitreous membranes seen on ultrasonography was associated with a final visual acuity of < 6/120, with an odds ratio of 2.47 [1.05 - 5.83, 95% CI]. Posttraumatic endophthalmitis: In univariate analysis the features associated with poor visual acuity (grouped as < 6/18 and < 6/120) included a retained intraocular foreign body (IOFB), trauma by needle (hypodermic or sewing), poor presenting visual acuity, inability to visualise the optic disc on indirect ophthalmoscopy, presence of vitreous membranes on ultrasonography, and a culture-positive vitreous biopsy. In multivariate analysis, IOFB was associated with a 3-month follow-up visual acuity of < 6/18, with an odds ratio of 5.90 [1.85 - 18.78, 95% CI], and trauma by a needle (hypodermic or sewing) and retained IOFB was associated with a final visual acuity of < 6/120, with an odds ratio of 4.47 [1.22 - 16.38, 95%CI] and 3.76 [1.36 - 10.37, 95% CI] respectively. CONCLUSION: This is the largest, single-centre, prospective study on risk factors for poor visual outcome in postoperative and posttraumatic endophthalmitis. The independent risk factor for 3-month follow-up visual acuity of < 6/18 was the presenting visual acuity of ≤LP in postoperative endophthalmitis and a retained IOFB in posttraumatic endophthalmitis. The independent risk factor for 3-month visual acuity of