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Abstract We show that there are four chiral W $$ \mathcal{W} $$ -algebra extensions of so 2 3 $$ \mathfrak{so}\left(2,3\right) $$ algebra and construct them explicitly. We do this by a simple identification of each of the inequivalent embeddings of a copy of sl 2 ℝ $$ \mathfrak{sl}\left(2,\mathbb{R}\right) $$ in the so 2 3 $$ \mathfrak{so}\left(2,3\right) $$ algebra and the maximal subalgebra h $$ \mathfrak{h} $$ that commutes with it. Then using the standard 2d chiral CFT techniques we find the corresponding W $$ \mathcal{W} $$ -algebra extensions. Two of the four resultant W $$ \mathcal{W} $$ -algebras are new, one of which may be thought of as the conformal bms 3 $$ {\mathfrak{bms}}_3 $$ algebra valid for finite values of its central charge.

The latest Conference of the Parties (COP) demonstrated that development and 'Climate change’ are inextricably intertwined, making them the primary fields to be tackled in addressing rational global tendencies. Since the beginning of urbanization, asphalt, and concrete have supplanted natural vegetation, which has led to an increase in energy demand. This increase has accelerated the urban heat island (UHI) effect and paved the way for a rise in building energy consumption. In addition to that, the increased impervious surfaces capture more solar radiation, increasing Land Surface Temperature (LST). Increasing Greenspace, where vegetation changes have been monitored with the help of the Normalised Difference Vegetation Index (NDVI) since the early 1980s, has been suggested as a strategy for urban areas in response to increasing urbanization and forecasts of more frequent heatwaves under a climate change scenario. The present study focuses on using remotely sensed data of MODIS to evaluate the relationship between, Urban Greenspace and UHI for the city of Gandhinagar, Gujarat. For the detection of relation as well as change, Land Surface Temperature (oC) and Precipitation rate (mm/day) were incorporated. This study compared UHI and NDVI for an annual average for the years 2003 and 2018. In the entire study period, a considerable change in land use was observed with a significant increase in build-up area. Correlation among the variables depicted a significant negative relation between NDVI (r = −0.76) and LST and Precipitation (r= −0.38). The linear trend showed a significant drop in precipitation in recent years. For a better understanding of continuous time series data, cross-wavelet transformation was used. The result of the wavelet transformation revealed a substantial coherence period and phase relationship between the variables. The finding of the study states that rapid urbanization is the chief contributor to the changes in the Land Surface Temperature.

Integrating unmanned aerial vehicles (UAVs) with terrestrial networks can enable high-speed communication in various applications. UAVs can serve as aerial base stations (ABSs), offering several benefits to the existing terrestrial networks, such as enhanced coverage, increased capacity, rapid deployment, and mobile communication support. However, this integration presents various technical challenges, including coordination, interference management, and dynamic allocation of resources. To address these key challenges, in this paper, we maximize the network utility by jointly optimizing the scheduling and cell association, transmit power of all base stations, and ABS deployment locations in the presence of co-channel interference. A two-stage approach is proposed to obtain a solution. In the first stage, we propose a heuristic solution by using the clustering algorithm to determine the initial ABS locations and user scheduling while ignoring the co-channel interference. In the second stage, we utilize the solution obtained in the first part and develop an interference-aware iterative scheme to jointly optimize user scheduling, resource allocation, and ABS placement. Given the non-convex nature of this problem, we employ the successive convex approximation technique to approximate the non-convex objectives and constraints. Numerical results show the proposed approach's insights and effectiveness over other schemes. Specifically, our proposed approach provides an average of 25% improvement over the benchmark schemes.

Abstract Background Patients with tuberous sclerosis complex (TSC) face an increased risk of maternal health complications and worsening disease manifestations during pregnancy. There are no established consensus guidelines that address the management of pregnancy in patients with TSC and healthcare providers rely on their individual experiences and preferences to derive treatment decisions. We sought to obtain provider opinion of pregnancy related maternal complications in patients with TSC, and the common evaluation and management strategies used to address these issues. Methods We conducted a cross-sectional survey of healthcare providers with diverse areas of expertise related to the multisystem nature of involvement in TSC. Descriptive analyses were used to analyze our three primary variables: (1) provider recognition of maternal risks/complications; (2) provider recommendations before and during pregnancy; and (3) provider/clinic protocols. Results We received responses from 87 providers from 11 countries, with 40.7% (n = 35) seeing > 30 TSC patients yearly. The majority of providers (n = 70, 88.6%) deemed that a patient with TSC needed expert care beyond the standard of care for a typical pregnancy, with over 25% of providers reporting that they have seen lymphangioleiomyomatosis (LAM) exacerbation, seizures, and preterm labor in pregnant patients with TSC. Providers who managed patients treated with mTOR inhibitors (mTORi) also agreed that mTORi use should be stopped prior to pregnancy (n = 45, 68.2%) but there was uncertainty about when to stop the mTORi (one month 28.9%, two months 11.1%, three months 42.2%, and 6–12 months 2.2%). Additionally, there were mixed opinions on restarting mTORi in response to disease progression during pregnancy. When asked about provider or clinic specific protocols, 71.6% (n = 53) of providers stated that they do not have a clear protocol for management decisions for patients with TSC before or during pregnancy. Conclusion Healthcare providers recognize that patients with TSC are at an increased risk for maternal health complications during pregnancy. However, there are wide inter-individual variances in practice, especially pertaining to decisions regarding mTORi use. There is a critical need to better understand the implications of pregnancy for patients with TSC, and to draft consensus recommendations to guide management decisions.

Schistosomiasis, which affects a large number of people worldwide, is among the most overlooked parasitic diseases. The disease is mainly prevalent in sub-Saharan Africa, southeast Asian countries, and South America due to the lack of adequate sanitation. The disease is mainly associated with poor hygiene, sanitation, and contaminated water, so it is also known as a disease of poverty. Three Schistosoma species (S. mansoni, S. japonicum, and S. haematobium) cause significant human infections. Co-infections with Schistosoma and other parasites are widely common. All these parasites may cause intestinal or urogenital schistosomiasis, where the disease may be categorized into the acute, sensitized, and chronic phases. The disease is more prevalent among school children, which may cause anemia and reduce development. Chronic infections frequently cause significant liver, intestinal, and bladder damage. Women exposed to contaminated water while performing normal duties like washing clothes might acquire urogenital schistosomiasis (UGS), which can cause tissue damage and raise the risk of blood-borne disease transmission, including human immunodeficiency virus (HIV) transmission. Praziquantel (PZQ) is the World Health Organization (WHO)-prescribed treatment for individuals who are known to be infected, but it does not prevent further re-infections with larval worms. Vaccine development and new molecular-based diagnosis techniques have promised to be a reliable approach to the diagnosis and prevention of schistosomiasis. The current review emphasizes the recent advancement in the diagnosis of schistosomiasis by molecular techniques and the treatment of schistosomiasis by combined and alternative regimes of drugs. Moreover, this review has also focused on the recent outbreak of schistosomiasis, the development of vaccines, and their clinical trials.

We describe a case of imported ocular dirofilariasis in Australia, linked to the Hong Kong genotype of Dirofilaria sp., in a migrant from Sri Lanka. Surgical extraction and mitochondrial sequences analyses confirmed this filarioid nematode as the causative agent and a Dirofilaria sp. not previously reported in Australia.

Gut microbiota dysbiosis has been a serious risk factor for several gastric and systemic diseases. Recently, gut microbiota’s role in aging was discussed. Available preclinical evidence suggests that the probiotic bacteria Lactiplantibacillus plantarums (LP) may influence the aging process via modulation of the gut microbiota. The present review summarized compelling evidence of LP’s potential effect on aging hallmarks such as oxidative stress, inflammation, DNA methylation, and mitochondrial dysfunction. LP gavage modulates gut microbiota and improves overall endurance in aging animal models. LP cell constituents exert considerable antioxidant potential which may reduce ROS levels directly. In addition, restored gut microbiota facilitate a healthy intestinal milieu and accelerate multi-channel communication via signaling factors such as SCFA and GABA. Signaling factors further activate specific transcription factor Nrf2 in order to reduce oxidative damage. Nrf2 regulates cellular defense systems involving anti-inflammatory cytokines, MMPs, and protective enzymes against MAPKs. We concluded that LP supplementation may be an effective approach to managing aging and associated health risks.

Background A woman enters the fertility period and then eventually comes a phase when her ovaries start to malfunction. It is challenging to pinpoint the exact age at which menopause begins for each woman.Objectives The present study was conducted to assess the socio demographic factors life style factors menstrual and reproductive factors among postmenopausal women and to determine the association of these factors with the menopausal age.Methods The present hospital based cross-sectional study was conducted including 330 women aged 45-65 years visiting the Obstetrics and Gynaecology Outpatient Department OPD at a teaching hospital. The interview proforma comprised questions regarding socio-demographic profile lifestyle factors menstrual and reproductive factors. Statistical tests like Chi-square test and logistic regression analysis were applied. Frequency percentage Odds ratio OR with their respective 95 confidence interval was calculated and P value lt0.05 was considered as statistically significant.Results In present study 63.03 of women attained menopause before the age of 45 years. The odds of developing early menopause le45 years among urban women were higher compared to rural women OR 3.39 95 CI 2.12-5.43. Among married women odds of developing early menopause le45 years were 4.19 times higher as compared to unmarried widowed divorcee and separated females. The odds of developing early menopause among women who attained menarche at the age of le13 years were 52 lower than those who attained menarche at gt13 years of age. The odds of developing early menopause le45 years among women with parity le 3 were 3.14 times 95 CI 1.68-5.85 higher as compared to women having parity gt5.Conclusion In this study area of residence marital status socio-economic class body mass index BMI history of addiction age at menarche age at first delivery and parity were associated with natural menopause age indicating that social lifestyle and reproductive factors may have an impact on menopausal age.

Pulmonary disease represents a substantial global health burden. Increased air pollution, especially fine particulate matter (PM2.5) is the most concerned proportion of air pollutants to respiratory health. PM2.5 may carry or combine with other toxic allergens and heavy metals, resulting in serious respiratory allergies and anaphylactic reactions in the host. Available treatment options such as antihistamines, steroids, and avoiding allergens/dust/pollutants could be limited due to certain side effects and immense exposure to air pollutants, especially in most polluted countries. In this mini-review, we summarized how PM2.5 triggers respiratory hyperresponsiveness and inflammation, and the probiotic Lactiplantibacillus plantarum supplementation could minimize the risk of the same. L. plantarum may confer beneficial effects in PM2.5-associated pulmonary inflammation due to significant antioxidant potential. We discussed L. plantarum’s effect on PM2.5-induced reactive oxygen species (ROS), inflammatory cytokines, lipid peroxidation, and DNA damage. Available preclinical evidence shows L. plantarum induces gut-lung axis, SCFA, GABA, and other neurotransmitter signaling via gut microbiota modulation. SCFA signals are important in maintaining lung homeostasis and regulating intracellular defense mechanisms in alveolar cells. However, significant research is needed in this direction to contemplate L. plantarum’s therapeutic potential in pulmonary allergies.

Background: Rheumatoid arthritis with a patella fracture in an elderly presents technical challenges for an arthroplasty surgeon. The compromised extensor mechanism may entail a poor functional outcome in post arthroplasty period. Case report: We present a report of a 68-year-old female with pre-existing rheumatoid arthritis presenting with an acute patella fracture with patella tendon tear for management. A single stage primary knee arthroplasty with primary fixation of lower pole fracture patella with repair of extensor mechanism was done. Discussion: A staged surgery was avoided to allow for early rehabilitation. The functional outcomes are comparable to an arthroplasty for knee arthritis without a fracture.

Abstract Background Systemic sclerosis (SSc) is a rare, complex, connective tissue disorder. Interstitial lung disease (ILD) is common in SSc, occurring in 35–52% of patients and accounting for 20–40% of mortality. Evolution of therapeutic options has resulted in a lack of consensus on how to manage this condition. This Delphi study was initiated to develop consensus recommendations based on expert physician insights regarding screening, progression, treatment criteria, monitoring of response, and the role of recent therapeutic advances with antifibrotics and immunosuppressants in patients with SSc-ILD. Methods A modified Delphi process was completed by pulmonologists (n = 13) and rheumatologists (n = 12) with expertise in the management of patients with SSc-ILD. Panelists rated their agreement with each statement on a Likert scale from − 5 (complete disagreement) to + 5 (complete agreement). Consensus was predefined as a mean Likert scale score of ≤ − 2.5 or ≥ + 2.5 with a standard deviation not crossing zero. Results Panelists recommended that all patients with SSc be screened for ILD by chest auscultation, spirometry with diffusing capacity of the lungs for carbon monoxide, high-resolution computed tomography (HRCT), and/or autoantibody testing. Treatment decisions were influenced by baseline and changes in pulmonary function tests, extent of ILD on HRCT, duration and degree of dyspnea, presence of pulmonary hypertension, and potential contribution of reflux. Treatment success was defined as stabilization or improvement of signs or symptoms of ILD and functional status. Mycophenolate mofetil was identified as the initial treatment of choice. Experts considered nintedanib a therapeutic option in patients with progressive fibrotic ILD despite immunosuppressive therapy or patients contraindicated/unable to tolerate immunotherapy. Concomitant use of nintedanib with MMF/cyclophosphamide can be considered in patients with advanced disease at initial presentation, aggressive ILD, or significant disease progression. Although limited consensus was achieved on the use of tocilizumab, the experts considered it a therapeutic option for patients with early SSc and ILD with elevated acute-phase reactants. Conclusions This modified Delphi study generated consensus recommendations for management of patients with SSc-ILD in a real-world setting. Findings from this study provide a management algorithm that will be helpful for treating patients with SSc-ILD and addresses a significant unmet need.

Introduction: Indoor air pollution-associated health risk is substantially higher than outdoor. Incense smoke represents a group of multiple hazardous air pollutants including particulate matter. Bipolar air ionizers have been one of the most escalated indoor air cleaning options in recent years. Albeit, removal efficiency against incense smoke and potential byproduct ozone have been little understood due to limited studies.Method: The present study assessed a portable needlepoint technology-based bipolar air ionizer’s removal efficacy against incense smoke in unventilated glass boxes (size 0.16 m3). A series of experiments were performed in order to estimate the average efficiency. The total removal efficacy of bipolar air ionizer (BAI eff.) was estimated by using empirical equations of the particulate matter PM2.5 (BAI eff. pm2.5) and PM10 removal (BAI eff.pm10). Particulate matter was used as the marker of incense smoke in this study. The concentration of particulate matter, potential byproduct ozone, relative humidity, and the temperature was monitored by a customized sensor-based air quality monitor.Results: The tested bipolar air ionizer showed a significant decline in incense smoke. The average reduction in PM2.5 and PM10 concentration was observed by 74%–75%. The overall efficacy (BAI eff) against incense smoke particulate proportion was 90% ± 10% compared to the control. Byproduct ozone was not exceeded abnormally. However, the marginal elevation in temperature and humidity (up to 5°C or 21%) and humidity (1.8%) were observed when the bipolar air ionizer was conducted.Discussion: Incense smoke consists of multiple hazardous air pollutants including volatile organic compounds and carcinogens. Incense smoke may be the major source of household pollution. A portable bipolar air ionizer could be an auxiliary air cleaning option where incense burning practices are common.

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Tuberous sclerosis complex (TSC) is characterized by multisystem, low-grade neoplasia involving the lung, kidneys, brain, and heart. Lymphangioleiomyomatosis (LAM) is a progressive pulmonary disease affecting almost exclusively women. TSC and LAM are both caused by mutations in TSC1 and TSC2 that result in mTORC1 hyperactivation. Here, we report that single-cell RNA sequencing of LAM lungs identified activation of genes in the sphingolipid biosynthesis pathway. Accordingly, the expression of acid ceramidase (ASAH1) and dihydroceramide desaturase (DEGS1), key enzymes controlling sphingolipid and ceramide metabolism, was significantly increased in TSC2-null cells. TSC2 negatively regulated the biosynthesis of tumorigenic sphingolipids, and suppression of ASAH1 by shRNA or the inhibitor ARN14976 (17a) resulted in markedly decreased TSC2-null cell viability. In vivo, 17a significantly decreased the growth of TSC2-null cell–derived mouse xenografts and short-term lung colonization by TSC2-null cells. Combined rapamycin and 17a treatment synergistically inhibited renal cystadenoma growth in Tsc2+/– mice, consistent with increased ASAH1 expression and activity being rapamycin insensitive. Collectively, the present study identifies rapamycin-insensitive ASAH1 upregulation in TSC2-null cells and tumors and provides evidence that targeting aberrant sphingolipid biosynthesis pathways has potential therapeutic value in mechanistic target of rapamycin complex 1–hyperactive neoplasms, including TSC and LAM.

The term “pulmonary renal syndrome” describes a clinical syndrome which is characterised by the presence of both diffuse alveolar haemorrhage and glomerulonephritis. It encompasses a group of diseases with distinctive clinical and radiological manifestations, as well as different pathophysiological processes. The most common diseases implicated are anti-neutrophil cytoplasm antibodies (ANCA)-positive small vessel vasculitis and anti-glomerular basement membrane (anti-GBM) disease. Prompt recognition is required as respiratory failure and end-stage renal failure can rapidly occur. Treatment includes a combination of glucocorticoids, immunosuppression, plasmapheresis and supportive measures. The use of targeted treatments has significantly reduced mortality. Thus, an understanding of pulmonary renal syndrome is essential for the respiratory physician.

Abstract We construct classical theories for scalar fields in arbitrary Carroll spacetimes that are invariant under Carrollian diffeomorphisms and Weyl transformations. When the local symmetries are gauge fixed these theories become Carrollian conformal field theories. We show that generically there are at least two types of such theories: one in which only time derivatives of the fields appear and the other in which both space and time derivatives appear. A classification of such scalar field theories in three (and higher) dimensions up to two derivative order is provided. We show that only a special case of our theories arises in the ultra-relativistic limit of a covariant parent theory.

Osteochondrosis is a developmental condition affecting the endochondral ossification. It is commonly idiopathic however can be due to vascular anomalies, dietary conditions, hormonal irregularity, or overuse trauma. Osteochondrosis occurring in the inferior pole of the scapula is an extremely rare condition and is referred to as roca disease. A higher degree of suspicion is required especially in a young patient with atraumatic shoulder pain and additional unconventional MRI sequences focusing on the inferior pole of scapula can be taken to rule out such conditions. We report a case of Roca disease in a 16-year male who presented with right shoulder pain. This is the third case report of roca disease in the English literature according to our knowledge and the first case report to demonstrate extensive MRI imaging features with a normal radiograph. Imaging, particularly MRI, plays a pivotal role in the diagnosis of this extremely rare entity. Also, the inferior pole of the scapula is usually not included in routine shoulder MRI imaging thus close scrutiny with additional MRI sequences should be done to diagnose such a rare entity.

Objective:The objective of this clinical study was to assess the predicted software models and clinical models and to compare the stage models of both the groups so as to evaluate the efficacy of tooth movement with clear aligner.Methods:The sample size included 10 cases with mild anterior crowding treated with aligner therapy. The predicted software models were superimposed on the clinical stereolithography (STL) models at various stages by using the MeshLab software. The predicted software models showing orthodontic tooth movement were compared with the actual movement achieved clinically.Results:The results of the present study have shown that when a comparison was made on the basis of irregularity scores in both the groups, it was seen that the irregularity score was higher at 2.55 at T4, 1.65 at T6, and 1.0 at T8 in the clinical STL group at each stage, whereas it was 2.0 at T4, 0.90 at T6, and 0.25 at T8 in the software model group. In addition, in comparing the mean accuracy of these three stages, the analysis of data showed that the mean accuracy is 62.5% at T4, 68.8% at T6, and 78.1% at T8.Conclusion:The predicted software models do not accurately reflect the patient’s tooth position. There is an overestimation by predicted software as compared with actual clinically achieved tooth position. There is a need of overcorrection to be built in the treatment planning stage itself and execution of the anticipated end result.

Idiopathic Pulmonary Fibrosis (IPF) is a severe fibrotic lung disease characterized by excessive collagen deposition and progressive decline in lung function. Th2 T cell-derived cytokines including IL-4 and IL-13 have been shown to contribute to inflammation and fibrotic remodeling in multiple tissues. Interleukin-31 (IL-31) is a newly identified cytokine that is predominantly produced by CD4 Th2 T cells, but its signaling receptor IL-31RA is primarily expressed by non-hematopoietic cells. However, the potential role of the IL-31-IL31RA axis in pulmonary inflammation and fibrosis has remained largely unknown. To determine the role of IL-31RA deficiency in pulmonary fibrosis, wildtype, and IL-31RA knockout mice were treated with bleomycin and measured changes in collagen deposition and lung function. Notably, the loss of IL-31 signaling attenuated collagen deposition and lung function decline during bleomycin-induced pulmonary fibrosis. The total lung transcriptome analysis showed a significant reduction in fibrosis-associated gene transcripts including extracellular matrix and epithelial cell-associated gene networks. Furthermore, the lungs of human IPF showed an elevated expression of IL-31 when compared to healthy subjects. In support, the percentage of IL-31 producing CD4+ T cells was greater in the lungs and PBMCs from IPF patients compared to healthy controls. Our findings suggest a pathogenic role for IL-31/IL-31RA signaling during bleomycin-induced pulmonary fibrosis. Thus, therapeutic targeting the IL-31-IL-31RA axis may prevent collagen deposition, improve lung function, and have therapeutic potential in pulmonary fibrosis.

BackgroundThe prevalence of psychological symptoms and the co-occurrence of substance abuse disorders in adult patients with Langerhans cell histiocytosis (LCH) has not been previously explored. We aimed to use validated scales to evaluate depression and anxiety symptoms experienced by adult LCH patients.MethodsIn this cross-sectional study, all consecutive adult LCH patients seen at our national reference center between January 2012 and January 2013 were asked to complete the following instruments: the Hospital Anxiety and Depression scale (HADS); Barratt Impulsiveness Scale, Version 10 (BIS-10); and Cannabis Use Disorders Identification Test (CUDIT). Self-reported scores on these scales were used to determine the point prevalence of clinically significant psychological symptoms and substance use disorders in LCH patients. Patient profiles in terms of psychological features were assessed by principal component analysis including the HADS and BIS-10 instruments values, followed by hierarchical clustering. Fisher exact tests and Wilcoxon tests were used to examine the associations between disease-related parameters and high levels of anxiety and impulsivity.ResultsSeventy-one adult LCH patients, mainly with pulmonary LCH (PLCH), completed the evaluations. Clinically significant anxiety and depression symptoms were reported by 22 (31%) and 4 (6%) subjects, respectively. Impulsivity was detected in 14% (10/71) of the patients. Seventeen percent (12/71) of the patients used cannabis on a regular basis, with 50% of these individuals (6/12) exhibiting scores consistent with cannabis use disorder. Three derived clusters of patients were identified in the principal component analysis; these patient clusters differed in successful weaning from tobacco at the time of evaluation (p = 0.03). In univariate analyses, isolated PLCH and the use of psychotropic treatments were statistically associated with clinically significant anxiety symptoms.ConclusionsHigh levels of anxiety and impulsivity are common in adult patients with LCH. The consequences of these symptoms for the management of LCH patients warrant further evaluation.

Importance: Coronavirus 2019 pandemic (COVID 19) is caused by the Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) virus. The pandemic is affecting the livelihood of millions of people all over the world. At the time of preparing this report, the pandemic has affected 1 827 284 patients, with 113 031 deaths in 185 countries as per Johns Hopkins University. With no proven treatment for the disease, prevention of the disease in the community and healthcare setting is need of the hour. Objective: To perform a comprehensive literature search for preventive measures and experimental treatment options. In this review, we have focused our discussion on the risk of disease transmission, supportive treatment, and possible treatment options based on available evidence. Evidence Review: We performed a literature search on google scholar, PubMed, and society guidelines for literature related to COVID 19 and previous coronavirus pandemics. We included data review articles, observational studies, and controlled trials to synthesize the treatment options for COVID 19. Findings: In this article, we have extensively reviewed and discussed recommendations from various world organizations for the public and healthcare workers. We have also discussed currently available experimental treatments since there is no proven treatment for COVID 19. The best method of dealing with the current outbreak is to reduce the community spread and thus “flatten the curve.” Although Hydroxychloroquine, Remdesivir, Lopinavir/Ritonavir, and Azithromycin have been tried, passive immunity through convalescent serum and vaccine is still at an experimental stage. Patients with severe COVID 19 infections could be considered for this experimental treatment through various national randomized control trials, which may eventually lead to an evidence-based treatment strategy. Conclusions and Relevance: Awareness of currently available experimental treatment among healthcare providers and exploration of possible treatment options through evidence is need of the hour. We have discussed the most recently available literature and evidence behind experimental treatment in this article.

Abstract Magnetic resonance (MR) imaging plays an important role in the evaluation of bacterial and tuberculous spondylodiscitis and associated complications. Owing to its high sensitivity and specificity, it is a powerful diagnostic tool in the early diagnosis of ongoing infections, and thus provides help in prompt initiation of appropriate, therapy which may be medical or surgical, by defining the extent of involvement and detection of complications such as epidural and paraspinal abscesses. More specifically, MR imaging helps in differentiating bacterial from tuberculous infections and enables follow up of progression or resolution after appropriate treatment. However, other non-infectious pathology can demonstrate similar MR imaging appearances and one should be aware of these potential mimickers when interpreting MR images. Radiologists and other clinicians need to be aware of these potential mimics, which include such pathologies as Modic type I degenerative changes, trauma, metastatic disease and amyloidosis. In this pictorial review, we will describe and illustrate imaging findings of bacterial and tuberculous spondylodiscitis, their complications and non-infectious pathologies that mimic these spinal infections.

Morel-Lavallee lesion is a post-traumatic soft tissue degloving injury. This is commonly associated with sports injury caused by a shearing force resulting in separation of the hypodermis from the deeper fascia. Most common at the greater trochanter, these injuries also occur at flank, buttock, lumbar spine, scapula and the knee. Separation of the tissue planes result in a complex serosanguinous fluid collection with areas of fat within it. The imaging appearance is variable and non specific, potentially mimicking simple soft tissue haematoma, superficial bursitis or necrotic soft tissue neoplasms. If not treated in the acute or early sub acute settings, these collections are at risk for superinfection, overlying tissue necrosis and continued expansion. In this review article, we discuss the clinical presentation, pathophysiology, imaging features and differential diagnostic considerations of Morel-Lavallee lesions. Role of imaging in guiding prompt and appropriate treatment has also been discussed.

Hepatic artery pseudoaneurysm (HAP) incidence is rising due to more common use of endoscopic and percutaneous hepatic interventions. HAP is potentially fatal, as it could lead to sudden life-threatening hemorrhage. HAP can be intrahepatic or extrahepatic. On computed tomography angiogram (CTA) and magnetic resonance angiogram (MRA), HAP follows blood pool on multiphasic examination, with brisk arterial enhancement that washes out, similar to the abdominal aorta on later phases. We present a case of idiopathic giant HAP in an 82-year-old male. Currently, angioembolization is replacing surgery as the initial modality of choice for management of this condition.

Purpose: To study the long-term outcome of cataract surgery with primary intraocular lens (IOL) in children

Smoking is an important cardiovascular risk factor, however, use of smokeless tobacco has not been well studied. Smokeless tobacco use is high in countries of South and Southeast Asia, Africa and Northern Europe. Meta-analyses of prospective studies of smokeless tobacco users in Europe reported a relative risk for fatal coronary heart disease of 1.13 (confidence intervals 1.06–1.21) and fatal stroke of 1.40 (1.28–1.54) while in Asian countries it was 1.26 (1.12–1.40). Case-control studies reported significantly greater risk for acute coronary events in smokeless tobacco users (odds ratio 2.23, 1.41–3.52), which was lower than smokers (2.89, 2.11–3.96), and subjects who both chewed and smoked, had the greatest risk (4.09, 2.98–5.61). There is a greater prevalence of hypertension and metabolic syndrome in users of smokeless tobacco. Smokeless tobacco use leads to accelerated atherothrombosis similar to smoking. There is an urgent need for public health and clinical interventions to reduce smokeless tobacco addiction.

Objective: To determine use of class and type of cardioprotective pharmacological agents in patients with stable coronary heart disease (CHD) we performed a prescription audit. Methods: A cross sectional survey was conducted in major districts of Rajasthan in years 2008–09. We evaluated prescription for classes (anti-platelets, β-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), calcium channel blockers (CCB) and statins) and specific pharmacological agents at clinics of physicians in tertiary (n = 18), secondary (n = 69) and primary care (n = 43). Descriptive statistics are reported. Results: Prescriptions of 2290 stable CHD patients were audited. Anti-platelet use was in 2031 (88.7%), β-blockers 1494 (65.2%), ACE inhibitors 1196 (52.2%), ARBs 712 (31.1%), ACE inhibitors – ARB combinations 19 (0.8%), either ACE inhibitors or ARBs 1908 (83.3%), CCBs 1023 (44.7%), statins 1457 (63.6%) and other lipid lowering agents in 170 (7.4%). Among anti-platelets aspirin–clopidogrel combination was used in 88.5%. Top three molecules in β-blockers were atenolol (37.8%), metoprolol (26.4%) and carvedilol (11.9%); ACE inhibitors ramipril (42.1%), lisinopril (20.3%) and perindopril (10.9%); ARB's losartan (47.7%), valsartan (22.3%) and telmisartan (14.9%); CCBs amlodipine (46.7%), diltiazem (29.1%) and verapamil (9.5%) and statins were atorvastatin (49.8%), simvastatin (28.9%) and rosuvastatin (18.3%). Use of metoprolol, ramipril, valsartan, diltiazem and atorvastatin was more at tertiary care, and atenolol, lisinopril, losartan, amlodipine and simvasatin in primary care (p

Botryoid odontogenic cyst (BOC) is considered to be a polycystic variant of the lateral periodontal cyst (LPC) as the specimen resembled a cluster of grapes. It is a non-inflammatory odontogenic cyst. The BOCs can be unicystic or multicystic. These cysts have potential to extend in the bone and become multilocular and they have a high recurrence rate. Till now, only 73 cases of BOC have been reported. The pathogenesis of BOC is still debatable. We review different pathogenesis proposed for BOC and discuss a rare case of BOC developing from lining of an abnormally large LPC which showed aggressive behaviour in terms of growth and size.

We report an unusual case of Ewing′s sarcoma / primitive neuroectodermal tumor (PNET) of the sacral nerve plexus in a 9-year-old boy who presented with a soft tissue swelling and severe piercing pain in the lower back region. MRI of the lumbosacral spine showed a lobulated soft tissue mass with clubbed finger-like projections along the path of the sacral nerves, which had caused widening of the spinal canal and the sacral foramina (S2-S4 level). There was presacral extension and posterior scalloping of the sacral vertebrae. Histopathology of the lesion confirmed Ewing′s sarcoma / PNET of the sacral spinal nerve plexus. The patient responded favorably to chemotherapy and radiotherapy, showing clinical and radiological improvement.

Hydatid disease results from infection with larval stage of Echinococcus granulosus tapeworm. Dogs and other canines are the definitive hosts; Human beings are common accidental intermediate hosts. Liver is the most common organ to be involved in this condition. Cardiac hydatid, seen in only 0.5 to 2% cases, is a rare entity because of myocardial contractility. Larvae reach the myocardium through coronary circulation. Among various locations of cardiac hydatid, due to its rich coronary arterial supply Left ventricle (LV) myocardium is the most common site of involvement followed by interventricular septum and right ventricle. Rare locations include pericardium, right atrium and left atrium. A 50-year-old woman presented with dyspnoea for 11 months, chest X-ray showed a well defined, homogenous left paracardiac mass, which is not separable from left heart border. Transthoracic echocardiography revealed a complex multicystic mass lesion abutting antero-lateral wall of left ventricle. Contrast enhanced computed tomography showed a well-circumscribed multicystic mass lesion with honeycomb appearance arising from myocardium of anterolateral wall of left ventricle. Indirect haemagglutination test for hydatid disease was positive. At surgery the cyst was seen to arise from LV myocardium. It was incised and grape like contents were evacuated. The cavity was irrigated with scolicidal solution. Thereafter, the cyst was marsupialised. Histopathological examination revealed grape like cyst contents consistent with the diagnosis of hydatid cyst.

Giant aortic aneurysm is defined as aneurysm in the aorta greater than 10 cm in diameter. It is a rare finding since most patients will present with complications of dissection or rupture before the size of aneurysm reaches that magnitude. Etiological factors include atherosclerosis, Marfan’s syndrome, giant cell arteritis, tuberculosis, syphilis, HIV-associated vasculitis, hereditary hemorrhagic telangiectasia, and medial agenesis. Once diagnosed, prompt surgical intervention is the treatment of choice. Although asymptomatic unruptured giant aortic aneurysm has been reported in the literature, there has not been any case of asymptomatic giant dissecting aortic aneurysm reported in the literature thus far. We report a case of giant dissecting ascending aortic aneurysm in an asymptomatic young male who was referred to our institution for abnormal findings on physical exam.

Background: A new emerging complication of trans-scleral fixation of posterior chamber (PC) intraocular lens (IOL) with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture. Materials: We report a new surgical technique of trans-scleral fixation of posterior chamber intraocular lens (SF PCIOL) with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child. Results: We successfully achieved stable fixation and good centration of IOL after SF PCIOL with steel suture in these patient having inadequate posterior capsular support. Both eyes achieved best corrected visual acuity 20/40 at 18 months follow-up. Conclusions: Steel suture is a viable option for trans-scleral fixation of posterior chamber intraocular lens.

We report a 63-year-old male who had undergone left eye optical penetrating keratoplasty for central leucomatous corneal opacity 10 years earlier. The eye had clear donor graft with residual astigmatism of −6.50 diopter cylinder (DC) at 30°. The patient underwent clear corneal phacoemulsification with implantation of +6.0 D spherical equivalent AcrySof SN60T9 intraocular lens (IOL). Postoperatively, at 10 months, the patient had distance corrected visual acuity of 20/30 with −2.00 DC at 20°. AcrySof toric IOL offers an effective treatment option for post-keratoplasty high corneal astigmatism in patients with cataract.

Testicular tumors are very common among man under the age of 45 years. The case of bilateral synchronous testicular seminoma is very rare. We present a case of bilateral synchronous testicular seminoma stage-I in a 42-year old Indian male who came to our hospital with chief complaints of dull ache in the abdomen and groin, bilateral scrotal swelling and heaviness, left-sided scrotal swelling since last four years, and right-sided since last two years. He underwent bilateral orchidectomy followed by radiotherapy. In this case we throw light on this rare condition and discuss the management.