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Objectives: The aim of the study was to assess patients belonging to four main molecular subtypes (Luminal A, Luminal B, HER2 neu positive and Triple negative) and their treatment plans with a view to compare their early surgical complications and the final outcomes specific to the surgical procedure adopted and molecular subtype. Methods: A Cross-sectional observational study at a Tertiary care center in central UP in a two-year period with Inclusion Criteria and Exclusion Criteria. Data Collection was carried out from the patients, diagnostic confirmation to rule out any exclusion criteria was performed. Clinical staging was done using the standard TNM criteria. All the specimens were subjected to immune-histochemical evaluation for surrogate molecular subtyping to see later the early surgical outcomes. Results: Mean age ranged from 47.57±9.57 (Group III) to 50.67±8.08 (Group II) years and BMI ranged from 23.71 (Group IV) to 26.38 kg/m2 (Group II). Neoadjuvant chemotherapy use was reported in 15.6% of Luminal A group, 33.3% of Luminal B group, 40% of Her2 negative and 52.2% of Triple negative group cases. Statistically, there was a significant difference among groups with respect to use of neoadjuvant chemotherapy. Breast conservation therapy was the preferred surgical intervention in majority of cases with Luminal A (60%) and Luminal B subtype (66.7%) whereas MRM was preferred in 54.3% of Her2 negative and 65.2% of Triple negative cases. MRM was performed in 36% of Luminal A cases. Primary surgical intervention failure (BCS) was seen in 1 (4%) case with Luminal A subtype. In this patient, mastectomy was performed as the corrective measure. Surgical site infection was noted in 1 (4%) case in Luminal A group only. Seroma formation was noted in 4 (16%) of Luminal A, 8 (22.9%) of Her2 negative and 2 (8.7%) of Triple negative patients. No case of flap necrosis was noted. Follow-up duration ranged from 15 days to 36 months. Median duration of follow-up was 6 months. No mortality was noticed in any group. Conclusion: Different surgical management strategies suggested that breast conservative surgery was more feasible in Luminal A cases whereas MRM was the preferred mode of surgery in other molecular subtypes. Within the limitations of short duration of follow-up, there was no significant difference among different molecular subtypes with respect to late complications and survival. Further studies with longer duration of follow-up and larger sample size are recommended.

Objectives: The aim of the study was to predict the outcome and mortality of patients with sepsis in a tertiary care hospital using defined scores such as APACHE II, SAPS II, and SOFA scores. Methods: This prospective and observational study was carried out in intensive care units (ICUs) setup of multispecialty hospital in Western Maharashtra. Sample size was 90 patients with sepsis who were admitted to ICU (surgical) directly or indirectly, during the duration of 1 1/2 month. The study was approved by the Institutional Ethical Committee and written informed consent from all the patients or their guardians/legal representatives. The detailed history, clinical examination, and all the relevant laboratory investigations were done including blood culture. The parameters as mentioned in APACHEII, SAPS II, and SOFA scores were recorded daily. For statistical analysis, Chi-square test, Fisher’s exact test, MannWhitney test, and Binary Logistic Regression were used. SPSS software was used for analysis. Results: Out of these 90 patients, 64 (71.1%) were males and 26 (28.8%) were females. Mean age of the study population was 61.86 years. Mean duration of stay in the ICU was found out to be 3.33 days. Culture positivity was found in 53 cases (58.8%). Gram-negative organisms were responsible for 37 (69.8%) cases while Gram-positive organisms were responsible for 16 (30.1%) cases. Statistics of various variables among cases and other detailed results were studied. SOFA score (p=0.046) and APACHE II score (p=0.00042) have been found to be statistically significant predictors of “Death”; higher the SOFA score and APACHE II score-more probability of patient dying. However, mortality as per SAPS II (p=0.202) was not found to be statistically significant predictor of death. Conclusions: APACHE II, SAPS II, and SOFA scores can be used for prediction of mortality by using appropriate statistical tests. People of older age, male gender, and preexisting chronic health conditions are chiefly prone to develop Septic shock; hence, prevention strategies should be targeted at these susceptible populations. The epidemiology of Septic shock in developing countries warrants greater attention in the future studies.

Mesenteric ischemia is an uncommon condition, and we need to have a high index of suspicion to diagnose and manage this condition. Predisposing conditions such as myocardial infarction, portal hypertension, pancreatitis, inflammatory bowel disease, post-operative states, trauma, and hypercoagulable states such as DVT, pregnancy, and neoplasms should always be accounted for before diagnosing this condition. In emergency situations, surgical exploration is warranted. Here, we present a case of 57-year-old male, known case of DVT RT lower limb, on anticoagulants, presented with the complaints of epigastric pain, absolute constipation, and abdominal distention of 3 days duration. He was investigated and managed by exploratory laparotomy with peritoneal lavage and resection of gangrenous bowel with proximal jejunostomy and distal ileostomy.

Objective: The present study was planned with an aim to study the profile of surrogate markers of molecular subtypes using the expression pattern of ER, PR, and HER2/NEU receptors in operable breast cancer so that most effective and advantageous treatment can be offered for better surgical outcomes. Methods: A cross-sectional observational study was carried out in one of the tertiary care centers in Central UP. All patients presenting to the center with early and locally advanced breast cancer with age bracket between 18 and 75 years during 2-year period and willing to participate in the study were included in the sample size. Clinical staging was done using the standard TNM criteria and all the specimens were subjected to immunohistochemical evaluation for surrogate molecular subtyping Results: Out of 94 cases enrolled in the study, a total of 32 (34.4%) were identified as luminal A, 3 (3.2%) were identified as luminal B, 35 (37.6%) were identified as HER2 positive, and remaining 23 (24.7%) were identified as triple negative. Statistically, there was no significant difference among groups with respect to age (p=0.958) and BMI (p=0.332). However, there was a significant difference among groups with respect to clinical stage (p=0.031), clinical nodal involvement (p=0.014), pathological staging (p=0.006), and pathological nodal involvement (p=0.023). Among those with nodal involvement, all the cases had involvement of one node except for one patient in Group I who had involvement of thrMost of the luminal A cases (81.3%) were clinically Stage 1 or 2. All the luminal B cases were clinically Stage 2 or 3 (100%). Almost half (48.8%) of Her2-negative cases were Stage 3 or 4. Majority of triple-negative cases were Stage 3 or 4 (65.2%). Clinically, nodal involvement was seen to be maximum in Her2-negative and triple-negative groups (54.3% and 52.2% of cases, respectively). Pathologically, most of the luminal A (83.9%), Her2 negative (81.8%), and all the luminal B cases were Stage 2. Pathologically, nodal involvement was seen in 16.1% of luminal A, 42.4% of Her2-negative, and 50% of triple-negative cases. Conclusion: The findings of the present study provided a glimpse of expression pattern of ER, PR, and HER2/NEU receptors in operable breast cancer based on which most effective and advantageous treatment can be offered for better surgical outcomes.

Simple or complicated inguinal hernias are the common inguinal lumps of any surgical emergency or outpatient settings. However, inguinal hematoma, abscess, enlarged inguinal lymph node, undescended testis, lipoma, or encysted hydrocele of the spermatic cord are few relatively less common entities seen in inguinal region whereas inguinal supernumerary pectineus bursa, preperitoneal lipoma, pedunculated uterine fibromyoma, angioma of uterine ligament, inguinal endometriosis, aneurysm of femoral artery, saphena varix, and thrombophlebitis are extremely uncommon entities of the groin region. We present an interesting case in which patient presented with painful firm lump in inguinal region and the history and clinical examination was consistent with the diagnosis of an incarcerated inguinal hernia but intraoperative findings amazed us and subsequently histopathological analysis labeled it a dermoid cyst.

Objective: Coronavirus disease 2019 (COVID-19) infection evolved as a worst nightmare across entire humanity especially for health care workers along with all stakeholders of the society ever since the beginning of year 2020. Vaccination campaign is one of the most successful public health interventions and a cornerstone for the prevention of communicable infectious diseases. To have a baseline data and to form the basis for further vaccination drive, we carried out this study with an objective to understand the perception and COVID-19 vaccine hesitancy among health care workers (HCWs). Methods: A correctional study was carried out at one of the multispecialty hospital in North India where COVID-19 vaccination for HCWs was planned and 675 HCWs were taken into the study. Data were collected by means of personal interview using pretested semi-structured questionnaire and Epi Info version 6 was used for analysis. Results: The mean age of the participants was 32.78 years. Majority were male (89.48%), working in government sector (87.7%) and paramedic (88.15%). While 94.67% were accepting vaccine voluntarily while remaining were not confident enough on their own, only 26.96% were ready to take vaccine even on payment. The overall awareness scores of study participants were calculated and found that 79.56% of them had poor awareness level while only 20.44% had satisfactory awareness level. The association of awareness score was statistically significant with job profile (designation), gender, and prior COVID-19 positivity of study participants. Conclusion: The decision of vaccine prioritization to HCWs and frontline workers will boost the morale and spirit of warriors high in future. This study was a preliminary attempt to check any vaccine hesitancy factors among HCWs and act accordingly. Although almost all had volunteered for vaccine, the knowledge about vaccine was poor in majority of HCWs as the time period was recent to vaccine rollout and detailed research findings were not yet out about vaccine. All measures to be taken including intensive information education and communications activities targeting HCWs and general population on regular basis to upgrade the knowledge on vaccine issues. A strong communicating policy in an era of misinformation is highly recommended as social media plays an important role in spreading true as well as false messages jeopardizing the entire gains of successful vaccination and attainment of herd immunity. HCWs to act as role model for general public and patients which would in turn increase the vaccine acceptance among them.

Objective: Urinary calculi are the third most common affliction of the urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. This study was carried out to assess the safety, efficacy, and compare structural and functional outcome after treating the patients of the upper ureteric calculus with Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureterorenoscopy (URS). Methods: A prospective study was conducted on patients with the upper ureteric stone of size 0.5–1.5 cm. A total of 50 patients were included in the study by means of systematic random sampling so as to get 25 patients in each category of ESWL and URS for the treatment of their upper ureteric calculi. Results: The age ranged from 15 years to 55 years. There were 36 males and 14 females in the study of 50 patients, 43 (86%) presented with pain, followed by 4 (8%) presented with hematuria. Twenty-eight (56%) of the patients had stone in the range of 0.5–1.0 cm, and 22 (44%) of the patients had stone in the range of 1.0–1.5 cm. Sixteen (32%) patients had stone within 2 cm of the pelvi-ureteric junction, and 13 (26%) had stone within 2 cm of the sacroiliac joint. Twenty-one (42%) patients had stone in between these two. Of the 50, 25 patients (50%) underwent shock wave lithotripsy, 25 patients (50%) underwent URS. In the ESWL group, 21 (84%) patients were stone-free after single sitting of ESWL. Four patients (16%) who required Re ESWL, after repeat ESWL two became stone-free however 2 (8%) patient of 1.0–1.5 cm category required secondary procedure, that is, URS and became stone free. To achieve stone-free 1.24 procedure was required per patients. Of the 25 patients in the ESWL group, 2 (8%) patient (one steinstrass case and one poor fragmentation case) required secondary procedure. They underwent URS. Both the patient belonged to 1.0–1.5 cm group. URS was done using semirigid ureteroscope using pneumatic Lithoclast. In our study, two patients of each 0.5–1.0 cm and 1.0–1.5 cm category did not become stone free. These four patients were subjected to ESWL and became stone free. Conclusion: The management of the ureteral stone should be decided on individual basis, based on stone size, location, symptoms, obstruction, and the availability of the instruments. For stones of 0.5–1.0 cm, ESWL is the treatment of choice for the upper ureteric stones, with very low Re- ESWL (1.12 sittings) without any requirement of ancilliary procedure. URS may be used for the upper ureteric stones but requirement of ancilliary procedure is high 11.11%. For stones between 1.1 cm and 1.5 cm, ESWL is the preferred modality of treatment for the upper ureteric stones.

Trisomy X syndrome is a sex chromosome aneuploidy with a variable clinical presentation at different stages of life. We present two asyndromic females with primary infertility and features of premature ovarian failure (POF). The first case was a nonmosaic trisomy X with poor ovarian reserve on pelvic ultrasound and elevated gonadotropins, while the second case was a mosaic trisomy X who had partly preserved ovarian reserve with normal gonadotropins. The 47,XXX syndrome is a relatively uncommon presentation of POF, leading to infertility and can be missed clinically because of its variable presentation. Therefore, we suggest that genetic testing should be a part of early workup in young women presenting with primary infertility and POF for detecting chromosomal aneuploidies, which will require genetic counseling and alter the management.

Selective laser sintering (SLS) is an additive manufacturing (AM) process, which is widely used for fabrication of end used products, directly from computer aided design (CAD) data. SLS process is usually used in different areas such as biomedical, automobile and aerospace industries. The major advantage of this process is that the designer can visualize and test the specimens before the full scale production of parts. Therefore, to achieve a good dimensional accuracy in order to fulfill the demands of these fields is a key parameter. Dimensional accuracy of SLS process is mainly influenced by geometry, process parameters and materials. It can only be enhanced by controlling the shrinkage of parts. Therefore, this work is carried out to analyze the effect of crucial contributing factors (i.e, laser power, bed temperature, layer thickness, scan spacing and orientation) for the shrinkage (CAD, thermal and volumetric) of duraform polyamide specimens. Face centered central composite (CCD) design is used for the collection of data. Response surface methodology (RSM) is used to monitor the effects as well as interactions of selected parameters, and for the development of regression models. Multi-response optimization of shrinkage along with composite desirability is employed for different optimized selected SLS parameters. It has been found that the laser power 41 W, bed temperature 170 °C, layer thickness 0.09 mm, scan spacing 0.15 mm and orientation 85.68 degree is a most significant optimized range of these parameters to improve the overall shrinkage measures of parts.

Background: Endometrial carcinoma is the commonest gynaecological malignancy in the western countries with a standardised incidence of 8 per 100000 women. In India and Southeast Asia, the incidence of endometrial carcinoma is low but it is increasing due to increasing prevalence of obesity, diabetes, early menarche, late menopause, late marriage and declining birth rate. The study aimed to identify the role of microsatellite instability in endometrial carcinoma. Although MSI has been studied extensively in colorectal carcinoma there have been very few studies in southeast asian region regarding association of MSI and prognosis in endometrial carcinoma. To the best of our knowledge this is first study in India. Method: A Descriptive study in which 40 patients of endometrial carcinoma were studied. MSI was detected using immunohistochemistry (MSH-1, PMS-2, MSH-2, MSH-6). Statistical Analysis was done using SPSS software and fisher exact test was used to calculate p value. p value less than.05% was considered significant. Results: Overall prevalence of microsatellite instability was 40%. Microsatellite instability was associated with higher tumor grade, myometrial invasion>50% and presented in initial stages compared to microsatellite stable tumors. Conclusion: Our study showed statistically significant association between microsatellite instability and Figo staging, tumor grade and myometrial invasion.

Plexiform schwannoma is a rare benign variant of Schwann cell tumor characterised by multinodular plexiform growth pattern. Usual location of this tumor includes trunk, head, neck and upper extremities but it may rarely be found in lower extremities. It generally affects young adults with no sex predilection. We report a case of 37 years old male who presented with gradually progressive swelling of right little finger of 28years duration that was diagnosed as giant cell tumor of tendon sheath clinically, radiologically and intraoperatively. Authors wish to discuss the case due to its clinical rarity and diagnostic difficulties due to many common histological mimickers at that site.

Glycerol electro-oxidation offers a green route to produce the high value added chemicals. Here in, we report the glycerol electro-oxidation over a series of multi walled carbon nano tubes supported monometallic (Pt/CNT and Pd/CNT) and bimetallic (Pt-Pd/CNT) catalysts in alkaline medium. The cyclic voltammetry, linear sweep voltammetry and chronoamperometry measurements were used to evaluate the activity and stability of the catalysts. The Pt-Pd/CNT electrocatalyst exhibited the highest activity in terms of higher current density (129.25 A/m2) and electrochemical surface area (382 m2/g). The glycerol electro-oxidation products formed at a potential of 0.013 V were analyzed systematically by high performance liquid chromatography. Overall, six compounds were found including mesoxalic acid, 1,3-dihydroxyacetone, glyceraldehyde, glyceric acid, tartronic acid and oxalic acid. A highest mesoxalic acid selectivity of 86.42% was obtained for Pt-Pd/CNT catalyst while a maximum tartronic acid selectivity of 50.17% and 46.02% was achieved for Pd/CNT and Pt/CNT respectively. It was found that the introduction of Pd into Pt/CNT lattice facilitated the formation of C3 products in terms of maximum selectivity achieved (86.42%) while the monometallic catalysts (Pd/CNT and Pt/CNT) showed a poor performance in comparison to their counterpart.

One-third of all intestinal obstructions in the newborn are caused by atresias. The most common site is the duodenum followed by jejunoileal and colonic locations. Herein we report the autopsy findings of a rare case of jejunoileal atresia associated with malrotation of gut. Autopsy performed on a 36 weeks old male fetus still birth, born of a non-consanguineous marriage, demonstrated jejunoileal atresia with apple peel deformity and malrotation of gut. Although the diagnosis was established in the prenatal period, in utero fetal demise occurred before definitive surgical intervention could be done. This case highlights the importance of early diagnosis and intervention.

Glycerol (C3H8O3), a waste product of bio‐diesel, is considered as a suitable substrate for electro‐oxidation process to generate high value added products. In this work, palladium nanoparticles supported over activated MWCNTs with loadings of 5%‐40% were prepared using chemical reduction method and further employed to explore their potential for electro‐oxidation of glycerol to produce various high‐value‐compounds. The catalysts were characterized by physiochemical methods, such as X‐ray diffraction (XRD), Brunauer‐Emmett‐Teller (BET), and Transmission electron microscopy, while the electro‐oxidation activity of the catalysts was analysed using cyclic voltammetry (CV) and chronoamperometry (CA), and the products were identified by high performance liquid chromatography (HPLC). The electrochemical surface area (SESA) and mass activity (MA) were increased from 176.98 m2 g‐1 to 282.29 m2 g‐1 and 12.22 mA/mg to 49.53 mA/mg by increasing the Pd‐loading from 5% to 20%, respectively. While the further increase to 40% Pd loading, the SESA and MA values decreased to 231.45 m2 g‐1 and 47.63 mA/mg respectively. The results found that the optimum 20% Pd‐loading showed the excellent electrochemical properties due to exceptional distribution of Pd‐metal particles over MWCNTs. HPLC analysis showed the tartronic acid, glyceric acid and glyceraldehyde as dominant products. Mechanism of the reaction has also been proposed based on product distribution.

Nickel-based heterogeneous catalysts have shown promising results in many industrial-scale catalytic reforming processes and hydrocarbon reforming reactions such as dry reforming of methane (DRM). However, it is also reported that Ni-based catalysts generally show less resistance to the carbonaceous deposition, which ultimately causes their rapid deactivation during the reaction. One possible solution to improve the coke resistance is the addition of a promoter to the catalyst, which has shown successful results to reduce the coke formation. Therefore, this study also aimed to prepare boron-promoted Ni-based catalysts and investigate their efficiency for DRM reactions. A series of different catalysts with 10% nickel and x% boron (x: 1%, 2%, 3%, and 5%) were prepared by using an ordered mesoporous silica as a support and tested in DRM. The results demonstrated that boron-promoted Ni/SBA-15 catalysts obtained significant catalytic activity for CH4 and CO2 conversions. Meanwhile, it was noticed that a lower concentration of boron (1 and 2%) was more favourable to achieve higher catalytic activity, whereas the higher concentration (3% and 5%) resulted in a comparatively lower conversion for CH4 and CO2. Evidently, the higher activity of 2% B-promoted catalyst was ascribed to the synergistic effect of high surface area and lower crystallite size that greatly improved the active sites accessibility. Moreover, the results confirmed 14% carbon deposition on unpromoted (NS) catalyst and it was reduced to 1.3% for 2% boron-promoted catalyst owing to the presence of B-OH species on catalyst surface.