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Background Defects in the production or action of erythropoietin (EPO) are important contributing factors in anemia. However, the exact impact of aging on levels of EPO and its role in the development of geriatric anemia is still underexplored. Moreover, the specific pattern of EPO in etiological subcategories such as nutritional anemia (NA), anemia of chronic disease (ACD), and unexplained anemia (UA) is not entirely known. Objective The aim of the study was to determine the serum EPO levels in geriatric anemia and compare them across NA, ACD, UA, and NA with ACD. Materials and Methods Ninety anemic geriatric patients (cases) along with 30 non-anemic geriatric controls were evaluated for serum EPO levels. A correlation between S.EPO and inflammatory markers was also done. Results Serum EPO levels were higher in cases as compared to controls (P < 0.00). After adjusting for outliers, the reference range of EPO in controls was the same as in normal young adults (2.21–20.95 mU/mL). The majority (37/58, 63.7%) of NA patients had increased S.EPO levels (highest among all four subcategories and controls). S.EPO also correlated inversely with high-sensitivity CRP (hsCRP) and serum ferritin (SF), reinforcing that the inflammatory state suppresses S.EPO levels. Conclusion Geriatric anemic patients have elevated S.EPO as compared to non-anemic controls (observed reference range similar to young adults). Raised EPO levels were detected more frequently in NA, while they were the lowest in UA.

Abstract Background Mucormycosis in the setting of COVID-19 has given rise to the concept of “epidemic within a pandemic.” Once known to be a rare fungal disease, mucormycosis has now been regrouped under emerging pathogens. It has got special affinity for the immunocompromised, which is one of the main reasons for the flare up of the fungus during the second wave of COVID. The burden of the disease was felt globally, and India is facing the major brunt owing to our population and healthcare services ratio. Objective In our study, we have made an attempt to evaluate the clinical and radiological findings in patients of rhino-orbito-cerebral mucormycosis (ROCM) and to formulate a management protocol which will benefit such patients in forthcoming years. Methods This is a retrospective single-center study in Northern India. A total of 350 patients, affected by ROCM, were included in the study. Medical records of these patients were reviewed. Their clinical manifestations, nasal endoscopic findings, microbiological and radiological records, extent of disease, treatment profile, surgical interventions, and outcomes were analyzed. Nasal swab which was sent for KOH mount/fungal culture revealed broad aseptate filamentous fungi branching at right angles. All patients received intravenous amphotericin B and had undergone extensive surgical debridement endoscopically. The maxillary sinus was the commonest paranasal sinus involved followed by the ethmoid sinuses. Tissue sent for histopathological examination confirmed mucormycosis, except for 3 cases. Results The commonest presenting symptoms were cheek swelling with ophthalmoplegia, diminution of vision, and headache. The mean duration of follow-up was 8 months. The maxillary sinus was found to be involved in around 71% of the cases followed by the ethmoids and sphenoid. Thirty percent of the cases had visual complaints including diplopia and vision loss, whereas the palate was involved in around 35%. Nine patients had no perception of light in one eye on presentation, whereas 21 patients had perception of light only; 24 patients could count fingers close to face, and the rest had ambulatory vision. Three patients presented with facial palsy. All patients had favorable outcome except six who succumbed due to cerebral involvement and uncontrolled blood glucose levels. Conclusion A definite management protocol was formulated for ROCM which requires a multidisciplinary approach.

Objective: The objective of this study was to investigate the relationship between Vitamin D levels, radiographic severity, and functional status in patients with primary knee osteoarthritis (OA). Materials and Methods: A cross-sectional study was conducted on 71 patients with primary knee OA. Clinical and radiological evaluations were performed to confirm the diagnosis of knee OA. Vitamin D levels were measured, and radiographic severity was assessed using the Kellgren–Lawrence grading system. Functional status was evaluated using Lequesne’s indices. Statistical analyses were conducted to compare variables between patients with deficient Vitamin D levels (

Background: Inflammation has several effects in the geriatrics with reference to iron deficiency anemia (IDA), anemia of chronic disease (ACD), and unexplained anemia (UA). Whether hyperinflammation is part of their pathogenesis or just incidental is unknown. Data are limited regarding inflammatory patterns in IDA, ACD, and UA in anemic geriatrics and inflammation as a component of UA. There is little known about the overlap of inflammation between ACD and UA. Objective: The study was undertaken to find the proportion of anemic geriatric patients, aged ≥60 years with raised serum levels of inflammatory markers and their study within IDA, ACD, and UA. Materials and Methods: Seventy-five anemic geriatric patients were evaluated for raised serum levels of inflammatory markers: high sensitive C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) along with serum ferritin (SF). Results: Raised markers were seen in 94.7% of anemic geriatric patients.IL-8 was raised most frequently followed by TNF-α, IL-6, hsCRP, and SF. No distinct inflammatory profile could be elicited between ACD and UA. The hyperinflammatory profile irrespective of the underlying etiology of geriatric anemia suggests that aging per se is pro-inflammatory state. Conclusion: Geriatric anemia can be thought to develop on background of subclinical low-grade inflammation along with superimposed nutritional deficiencies or chronic diseases.

Purpose: Outcome of topography-guided excimer laser ablation in conjunction with accelerated, high-fluence cross-linking in corneal ecstatic disease using the NIDEK CXIII equipped with CATz algorithm from the FinalFit software—”Bharat Protocol.” Methods: Retrospective case record review of 30 eyes of 17 patients of stage 1-3 keratoconus who underwent the procedure was performed. Data collected were for visual acuity, distortion-induced eye pain, and keratometry. Pachymetry, lower order and higher order aberrations, spherical aberrations, and topographic cylinder were documented from by Scheimpflug imaging (Pentacam 70700: Oculus, Wetzlar, Germany). Results: At a minimum follow-up of 6 months (range 6.2–13 months), there was significant improvement in UCVA (P < 0.00001), BCVA (P = 0.0061), decrease in Kmax (P = 0.0349), Ksteep (P < 0.0411), Kflat (P = 0.0099), and pachymetry (P = 0.0001). Significant improvement was also seen in distortion-induced eye pain (27/30 to 2/30; P < 0.00001). A more than two-line improvement in UCVA and BCVA was seen in 23/30 and 17/30 cases, respectively. Ectasia was stabilized in all cases at the last follow-up, and no complications were seen. Conclusions: The “Bharat” Protocol to arrest keratectasia progression and improve corneal regularity is a safe and efficacious alternative as a keratoconus management option. This is the first such study on Nidek Platform for the same.

Introduction: COVID-19, is a highly contagious disease caused by Novel Corona Virus SARS-Cov-2. After initial infection, most patients recover completely, but in some patients, symptoms may persist for variable duration. This study was planned to evaluate different persistent symptoms of long COVID among the people of Northern India, who had asymptomatic or mild disease during active infection stage. Methods: A cross sectional study was done in Chandigarh, India, during August 2021 to June 2022. A total of 647 recovered COVID-19 patients, who had suffered of COVID almost ≥3 months back were included in the study. A self-designed questionnaire was developed for the survey. Participants were followed up till 3 months. Results: Out of 647 subjects enrolled, 27.5% had some post-COVID symptoms. Among symptomatic, 55.1% were males and 44.9% were females. Post-COVID headache was significantly more common in females. Sleep disturbances and history of pain and pressure that spreads to arms were significantly more common among non-smokers. Sleep disturbances and change of appetite were significantly more common among non-alcohol users. Chest discomfort and change of appetite were found to be significantly more common among non-hypertensive subjects. Symptoms of chest discomfort, sleep disturbances, anxiety, feeling of sadness on daily basis and forgetfulness was significantly more common among subjects without underlying heart disease, while weakness among patients with underlying lung disease. Poor concentration was found to be significantly more common among patients without underlying lung disease and that in the age group 26-50 years, followed by 51-75 years and 76-100 years. Conclusion: This study attempted to assess the prevalence of post COVID complications among the asymptomatic and mild COVID patients. From the clinical point of view, physicians should be aware of the symptoms, signs, and biomarkers present in patients previously affected by COVID-19 to promptly assess, identify and halt long COVID-19 progression, minimize the risk of chronic effects and to re-establish pre-COVID-19 health.

Three different pre-treatment methods, that is, alkali hornification, water hornification, and alkali treatment, are evaluated for the improvement in durability of agave natural fiber-reinforced polymer composites under the hygrothermal aging conditions. The composite specimens were prepared following the standard test procedures laid for moisture diffusion analysis. To analyze the effect of different treatment conditions, the standard test specimens were subjected to different hygrothermal aging conditions in the accelerated environments. After four subsequent hornification cycles, the alkali hornification resulted in about 27% lower water retention value in the agave fibers. Under similar conditions, water hornification leads to a meager 6% loss of water retention. Under the direct exposure to water, the alkali-hornified composites had a mass gain of 4.1%, 4.3%, and 4.7%, respectively, at 25°C, 50°C, and 75°C. The mass gain of alkali-treated composites was 4.3%, 4.5%, and 5.1%. and water hornification resulted in a mass gain of 5.5%, 5.9%, and 6.1% at similar temperatures. Under the humidity conditions, the alkali-hornified composites had a mass gain of 0.9%, 1.3%, and 1.1%, respectively, at 25°C, 50°C, and 75°C. The mass gain of alkali-treated composites was 0.6%, 1.05%, and 1.2%. and water hornification resulted in the mass gain of 0.66%, 1.07%, and 1.3% at similar temperatures. The present study reveals the influence of fiber pre-treatment methods on moisture durability of agave natural fiber composites. The results are further supported through microstructural investigations.

Abstract Background Post-Covid retropharyngeal mucormycosis is a rare presentation, and no case has been reported in literature until date. Case presentation A-32-year-old female post Covid presented to our OPD with history of dysphagia and with a history of steroid intake. Radiology confirmed it as retropharyngeal abscess. Endoscopic-guided aspiration was done. HPE (histopathological examination) revealed classic broad aseptate hyphae of mucormycosis. Patient was managed conservatively with broad-spectrum antifungal. Conclusion Retropharyngeal mucormycosis is a rare entity in Covid era. Rapid diagnosis and management are needed to save life of an individual, or results could be fatal.

Introduction and Objective: HoLEP is a an underutilized, minimally invasive approach for the management of benign prostatic hyperplasia. Its steep learning curve and lack of realistic simulation platforms with incorporated objective metrics has hindered the adoption of this technique. A recent systemic review of the endoscopic enucleation of the prostate defined a steep learning curve impacting surgical and intraoperative metrics [1]. Few studies have also demonstrated a significant impact of this steep learning curve on patient-reported outcomes and complications [2,3]. Our aim is to demonstrate the design and validation of a high-fidelity non-biohazardous hydrogel platform fabricated to specifications attained through expert consensus. Methods: Validation was completed in 3 phases: Phase 1, Delphi methodology to gain consensus from an expert panel of endourologists. Consensus (>80% agreement) over 3 rounds defined 81 essential elements. Phase 2, Prototype development: these essential items were incorporated into prototypes fabricated using a combination of hydrogel molding and 3D printing. Phase 3: Validation comparing 6 experts (>100 HoLEP cases) and 6 novices (85%) satisfaction. Experts outperformed novices in enucleation time (15.1 vs 47.5 min p=0.001), weight of adenoma resected (75.5 vs 49 g p=0.04) and developed global evaluation too (27 vs 15.8 p=0.001). All experts agreed the model could provide a safe training alternative, be used to evaluate trainee performance, and trial new approaches in a risk-free environment. Conclusions: This is the first consensus-based approach to design and provide initial validation of a non-biohazardous HoLEP simulation with incorporated evaluation metrics capable of supplementing HoLEP training. The model has the ability to create high-fidelity tissue textures which provides realistic tactile feedback, tissue planes and laser-tissue interactions which is not replicated in virtual reality simulations, thereby further bolstering its realism and use as a training model. Further validation studies are required to establish its effectiveness as a training platform. Sources: Enikeev, D., Morozov, A., Taratkin, M., Misrai, V., Rijo, E., Podoinitsin, A., ... & Herrmann, T. R. (2021). Systematic review of the endoscopic enucleation of the prostate learning curve. World Journal of Urology, 39(7), 2427-2438.3. 1. Shah, H. N., Sodha, H. S., Kharodawala, S. J., Khandkar, A. A., Hegde, S. S., & Bansal, M. B. (2008). Influence of prostate size on the outcome of holmium laser enucleation of the prostate. BJU international, 101(12), 1536-1541.2. Peyronnet, B., Robert, G., Comat, V., Rouprêt, M., Gomez-Sancha, F., Cornu, J. N., & Misrai, V. (2017). Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and holmium lasers. World Journal of Urology, 35(6), 973-983.

Abstract Software usability is usually used in reference to the hierarchical software usability model by researchers and is an important aspect of user experience and software quality. Thus, evaluation of software usability is an essential parameter for managing and regulating a software. However, it has been difficult to establish a precise evaluation method for this problem. A large number of usability factors have been suggested by many researchers, each covering a set of different factors to increase the degree of user friendliness of a software. Therefore, the selection of the correct determining features is of paramount importance. This paper proposes an innovative metaheuristic algorithm for the selection of most important features in a hierarchical software model. A hierarchy-based usability model is an exhaustive interpretation of the factors, attributes, and its characteristics in a software at different levels. This paper proposes a modified version of grey wolf optimisation algorithm (GWO) termed as modified grey wolf optimization (MGWO) algorithm. The mechanism of this algorithm is based on the hunting mechanism of wolves in nature. The algorithm chooses a number of features which are then applied to software development life cycle models for finding out the best among them. The outcome of this application is also compared with the conventional grey wolf optimization algorithm (GWO), modified binary bat algorithm (MBBAT), modified whale optimization algorithm (MWOA), and modified moth flame optimization (MMFO). The results show that MGWO surpasses all the other relevant optimizers in terms of accuracy and produces a lesser number of attributes equal to 8 as compared to 9 in MMFO and 12 in MBBAT and 19 in MWOA.

Experimental and numerical investigations are performed to assess the durability of Palmyra natural fiber composites under hydrothermal ageing conditions. The effect of alkali and stearic acid pretreatments is analyzed on the moisture uptake. The natural fiber composite specimens were subjected to accelerated ageing under water and humidity conditions at controlled temperatures between 0°C-75°C. The 4% stearic acid treatment lead to a remarkable reduction in moisture diffusivity. The coefficient of moisture diffusion of different specimens of is calculated using edge correction factor for rectanguloid specimens. The methods presented here can be used to assess and improve the hydrothermal durability of Palmyra fiber composites.

Although rare, sulfamethoxazole-induced urolithiasis has been reported in patients taking trimethoprim-sulfamethoxazole (TMP/SMX). We present the case of a 79-year-old female who formed sulfamethoxazole stones in the setting of chronic indwelling catheterization with recurrent urinary tract infections (UTIs). The patient was a recurrent stone former with five prior stone composition analyses over a 10-year period varying from calcium phosphate to calcium oxalate, to struvite. We highlight the need for further investigation of this phenomenon given the frequent use of TMP/SMX in stone formers with recurrent infections.

It has only been a quarter of a century since the discovery of adult stem cells at the human corneo-scleral limbus. These limbal stem cells are responsible for generating a constant and unending supply of corneal epithelial cells throughout life, thus maintaining a stable and uniformly refractive corneal surface. Establishing this hitherto unknown association between ocular surface disease and limbal dysfunction helped usher in therapeutic approaches that successfully addressed blinding conditions such as ocular burns, which were previously considered incurable. Subsequent advances in ocular surface biology through basic science research have translated into innovations that have made the surgical technique of limbal stem cell transplantation simpler and more predictable. This review recapitulates the basic biology of the limbus and the rationale and principles of limbal stem cell transplantation in ocular surface disease. An evidence-based algorithm is presented, which is tailored to clinical considerations such as laterality of affliction, severity of limbal damage and concurrent need for other procedures. Additionally, novel findings in the form of factors influencing the survival and function of limbal stem cells after transplantation and the possibility of substituting limbal cells with epithelial stem cells of other lineages is also discussed. Finally this review focuses on the future directions in which both basic science and clinical research in this field is headed.

In Indian settings pulmonary tuberculosis remains the most common diagnosis in a patient presenting with constitutional symptoms, hemoptysis and lung opacities. We describe a case report of a fifty-year-old woman who was receiving empirical anti-tubercular drugs for a metastatic illness to lungs arising from a primary angiosarcoma in the right atrium. This rare entity was misdiagnosed and typical echocardiographic findings suggested this diagnosis.