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Introduction: Cardiothoracic surgery is a complex and highly specialized medical field requiring precise surgical techniques and meticulous patient management. One critical aspect of this type of surgery is the accurate placement of the endobronchial double-lumen tube (DLT), which facilitates lung isolation and one-lung ventilation (OLV) during the procedure. Proper positioning of the DLT is essential to ensure adequate oxygenation, prevent complications, and optimize surgical access. Objective: This study aimed to compare the accuracy of positioning of the left DLT by the auscultation method versus the lung ultrasound technique in patients undergoing cardiothoracic surgery in both supine and lateral positions. Material and methods: A prospective, observational, and cross-sectional study was conducted in a single group of 62 patients based on the eligibility criteria. After general anesthesia, a DLT was inserted and rotated until resistance. Placement was confirmed by auscultation, ultrasound, and fibreoptic bronchoscopy. The evaluation process was done initially in a supine position, followed by a lateral position. Results: After insertion of the left DLT, initially evaluated in the supine position, sensitivity and specificity for auscultation were found to be 65.2% and 37.5%, respectively, sensitivity and specificity for ultrasonography were 82.6% and 75%, respectively. The accuracy of lung ultrasound at 80.7% (69.2%-88.6%) was higher than the accuracy of auscultation at 58.1% (45.7%-69.5%). This was followed by evaluation in lateral position, where sensitivity and specificity for auscultation were found to be 76.1% and 25% respectively, sensitivity and specificity for ultrasonography were 95.7% and 62.5%, respectively. The accuracy of lung ultrasound at 87.1% (76.6%-93.3%) was higher than the accuracy of auscultation at 62.9% (50.5%- 73.8%). Conclusion: Lung ultrasound is a superior method for assessing lung isolation and determining Double Lumen Tube position as compared to auscultation.

Acute Promyelocytic Leukemia (APL) is an aggressive form of Acute Myeloid Leukemia (AML), a cancer of the bone marrow. APL causes accumulation of promyelocytes in the peripheral blood and bone marrow and is associated with translocation t(15; 17). The diagnosis of APL can be made with the help of a complete blood count, peripheral blood film examination, bone marrow, and flow cytometry. Immunophenotypically, APL is characterized by positivity for CD117 and cMPO, bright positivity for CD33 and CD13, and negative for CD34 and HLA-DR. Here, we present four cases suspected of acute leukemia on peripheral blood film and bone marrow examination and diagnosed as APL in flow cytometric analysis.

Nanoemulsions - colloidal dispersions of nanoscale droplets in a continuous phase, have garnered significant attention in recent years due to their versatile properties and wide-ranging applications. This review paper presents a comprehensive overview of nanoemulsions production methods focusing on their formulation strategies, functional properties and different applications in food processing. Various low and high energy methods such as phase inversion, high pressure homogenization, ultrasonication and microfluidization etc., are reviewed to produce nanoemulsions with diverse characteristics and functionalities. Scale-up potential and practical challenges of each production method are also discussed. Various properties of nanoemulsions stability, drug solubility, bioavailability and targeted delivery are highlighted. Furthermore, their potential applications in food and beverage sectors including encapsulation of bioactive compounds, packaging, preservation and new product formulation have been elaborated along with real world examples at commercial stage. This review will contribute to providing knowledge about gastrointestinal fate of nanoemulsions, toxicity and safety by in-vitro and in-vivo testing as well as other research evidences. Regulatory aspects and public perception on use of nanoemulsions are also covered. Nevertheless, nanoemulsion presents immense potential for addressing various challenges in food industry. Continued research efforts in formulation design, ingredient selection, its compatibility with food constituents as well as the associated safety issues should be undertaken to unlock new opportunities towards scalability and commercialization.

Gene therapy is the treatment of abnormal or mutated genes present in cells through the addition of healthy genes or replacement/deletion/site-specific modification of faulty genes. Deoxyribonucleic acid, messenger ribonucleic acid (RNA), small interference RNA, microsomal RNA and antisense oligonucleotides are the genetic materials implicated in gene therapy. They are inserted into the diseased cells using viral or non-viral vectors through an in vivo or ex vivo transduction. Gamma retrovirus, lentivirus, herpesvirus, adenovirus and adeno-associated virus are common viral vectors, while transposons, cationic polymers, dendrimers and cell-penetrating peptides or liposomes are common non-viral vectors. Allologous or autologous T cells, haematopoietic stem cells and chimeric antigen receptor T cells are used for ex vivo gene transduction. Conventional gene therapy of inserting new genetic material shows toxicity such as off-target effects, altered immune responses, inflammatory reactions and possible oncogenic transformation in the recipient. Newer gene editing techniques such as zinc-finger nuclease, transcription activator-like effector nucleases and clustered regularly interspaced short palindromic repeats allow the site-specific correction or control of expression of mutated genes present in cells. Until August 2020, 23 gene-based medicines received approval from drug regulatory agencies in various countries and 362 were in development. Single-gene disorders have shown encouraging results, but evidence of using gene therapy in polygenic and common age-related diseases is still required. Recently, the horizon of gene therapy widened to include COVID vaccines and as an adjunct to chemotherapy. If we could overcome its limitations such as immunogenicity, mutagenicity and high costs, gene therapy can be the medicine of the next generation.

Abstract Background CHARGE syndrome is a relatively common cause of deafness and blindness resulting from failure to form the primordia of specific organs due to deficient contribution of neural crest cell derivatives. The majority of CHARGE syndrome cases are caused by heterozygous mutations in CHD7 on chromosome 8q21. Those with CHARGE syndrome without CHD7 mutation typically do not have an identified genetic defect. 7q11.23 duplication syndrome is associated with mild facial dysmorphism, heart defects, language delay, and autism spectrum disorder. In the current literature, 7q11.23 duplication has not been associated with CHARGE syndrome, retinochoroidal colobomas, or significant ear abnormalities. Case presentation We describe a patient with 7q11.23 duplication syndrome and clinical CHARGE syndrome with no variant in CHARGE-associated genes. Conclusions This case highlights the still incomplete understanding of the pathogenesis of CHARGE syndrome and raises the possibility of a dose-sensitive effect of genes in the 7q11.23 critical region on neural crest differentiation and fate.

Purpose: The purpose of this study was to diagnose CME with the help of optical coherence tomography (OCT) after uneventful cataract surgery to prevent visual deterioration. Methods: This study was conducted on 120 patients, who underwent manual small-incision cataract surgery with posterior chamber intra-ocular lens implantation. Follow-up was performed after the first week, sixth week, and 12th week post-operatively. Detailed examination was performed at each visit along with measurements of central macular thickness using OCT. Statistical analysis was performed using SPSS 22.0. Result: The mean age of the patients was 61.85 ± 11.41 years having female preponderance. The pre-operative mean best corrected visual acuity (BCVA) was found to be 0.05 ± 0.04, whereas the mean post-operative BCVA was found to be 0.65 ± 0.17 at the first week, 0.66 ± 0.17 at the sixth week, and 0.67 ± 0.17 at the 12th week follow-up. The post-operative mean macular thicknesses at the first week, sixth week, and 12th week post-operatively were documented to be 221.66 ± 8.49 μm, 224.60 ± 8.75 μm, and 219.17 ± 8.22 μm, respectively. Conclusion: A sub-clinical increase in macular thickness occurs even after uncomplicated cataract surgery. The maximum increase was observed after 6 weeks of surgery, which returns to near normal values within 3 months. Comparison of central macular thicknesses pre-operatively and post-operatively at the first week, sixth week, and 12th week suggests a significant correlation.

Micro/nano-contaminants have been the focal pollutants in environmental science, which includes several nanomaterials, nanocomposites, fibers, glass, plastics etc. Micro/nano size pollutants are more harmful than macro pollutants due to their size. Therefore, there is an urgent need for research on the possible fate of glass particles in the environment, especially in plant and soil systems. Here, the synthesized nano-glass (NG) from the waste windshield and analyzed its uptake and effect on the wheat (Triticum aestivum L.) plant system in a hydroponic solution. The findings provided direct evidence that NG reduced the germination % with increasing NG concentrations as 100, 96, 92, and 92% for 10, 20, 30, and 40 mg L−1. The lowest root and shoot height (15.40 and 22.42 cm) was achieved in the 40 mg L−1 NG treatment. Decrement in fresh and dry wt. with a maximum reduction of chlorophyll a, b and total content (6.19, 4.98, and 11.17 mg g−1 fresh wt.) was obtained at 40 mg L−1 at 21 days. Rhodamine B was used for fluorescence imaging in seedlings to detect NG movement, Results showed that NG moves via xylem tissues of root part to other parts of the plant. Based on the currently limited or no data and uncertainty regarding the actual impact of NG on soil and plant systems, suggested considerations to address key knowledge gaps are delineated. Further studies are required as a flora build-up of NG can have both environmental influence and consequences on agronomic sustainability and food safety.

Esthetic demands for correction of irregularities of dentition are becoming a prime concern even in patients above the age of 40 years. Severe periodontitis, being insidious, if present simultaneously, complicates the situation. Periodontally compromised adult patients requiring the treatment for malaligned teeth are encountered very frequently in daily practice, and the correction of these requires a combined perio-ortho interdisciplinary approach. The present case report deals with a 5-year follow-up of a case whose prime concern was rotated anterior teeth in the maxillary arch. However, along with this, severe periodontitis was also present. Open flap debridement along with osseous grafting was done wherever required, followed by fixed adjunctive orthodontic treatment. After the completion of orthodontic treatment, a fixed retainer in the form of splinting was given and the entire treatment met the esthetic along with functional demands of the patient. Early 6 months followed by yearly follow-ups reflected clinical and radiographic improvements in the dentition.

Abstract Abiotic and biotic stresses adversely affect plant growth and development and eventually result in less yield and threaten food security worldwide. In plants, several studies have been carried out to understand molecular responses to abiotic and biotic stresses. However, the complete circuitry of stress-responsive genes that plants utilise in response to those environmental stresses are still unknown. The protein phosphatase 2A (PP2A) gene has been known to have a crucial role in abiotic and biotic stresses; but how it regulates the stress response in plants is still not known completely. In this study, we constructed gene co-expression networks of PP2A genes with stress-responsive gene datasets from cold, drought, heat, osmotic, genotoxic, salt, and wounding stresses to unveil their relationships with the PP2A under different conditions of stress. The graph analysis identified 13 hub genes and several influential genes based on closeness centrality score (CCS). Our findings also revealed the count of unique genes present in different settings of stresses and subunits. We also formed clusters of influential genes based on the stress, CCS, and co-expression value. Analysis of cis-regulatory elements (CREs), recurring in promoters of these genes was also performed. Our study has led to the identification of 16 conserved CREs.

Abstract Cis-ciscis(N)(N)Arabidopsis thaliana(N)(N)(N)(N)

Implementing countrywide lockdown measures in India, from March 2020 to May 2020 was a major step to deal with the COVID -19 pandemic crisis. The decision of country lockdown adversely affected the urban migrant population, and a large section of them was compelled to move out of the urban areas to their native places. The reverse migration garnered widespread media attention and coverage in electronic as well as print media. The present study focuses on the coverage of the issue by print media using descriptive natural language text mining. The study uses topic modelling, clustering, and sentiment analysis to examine the articles on migration issues during the lockdown period published in two leading English newspapers in India- The Times of India and The Hindu. The sentiment analysis results indicate that the majority of articles have neutral sentiment while very few articles show high negative or positive polarity. Descriptive topic modelling results show that transport, food security, special services, and employment with migration and migrants are the majorly covered topics after employing Bag of Words and TF-IDF models. Clustering is performed to group the article titles based on similar traits using agglomerative hierarchical clustering.

Vague graphs (VGs), belonging to the FGs family, have good capabilities when faced with problems that cannot be expressed by FGs. When an element’s membership is not clear, neutrality is a good option that can be well-supported by a VG. The previous definition limitations in irregular-FG have led us to offer new definitions in VGs. So, in this paper, we introduce the concepts of strongly edged irregular vague graphs (SEIVGs), strongly edged totally irregular vague graphs (SETIVGs), and perfectly regular vague graphs (PRVGs) with several examples. A comparative study between SEIVGs and SETIVGs is presented. Finally, an application of vague influence digraph has been presented.

Syzygium cumini L. (ver Jamun; BlackBerry) is a native, evergreen multipurpose tree species of India. Besides being a fruit tree and for agroforestry in different regions, it is medicinally important too. This study aimed to determine genetic diversity using molecular and phytochemical markers in sixteen genotypes of Indian S. cumini from different agro-ecological zones. The present study used a combination of ISSR markers and the HPLC technique to explore these genotypes. The results showed a wide genetic diversity range based on the similarity coefficient values observed in S. cumini sixteen accessions from different sites. Four primary phenolic acids were discovered in all the accessions; caffeic acid (CA) was found in high concentrations. The intraspecific association between molecular and phytochemical characteristics was the primary goal of this investigation. By employing gene-specific markers for the route of secondary metabolites (polyphenols) production, it further investigated the progressive research of diversity analysis of polyphenol content in S. cumini accessions, which may also expand its nutraceutical and pharmaceutical utilization.

Background Toxoplasmosis gondii is ubiquitously present on earth and infection, including congenital infection, is common. Neurological, developmental, and ocular effects can be devastating in the congenital toxoplasmosis population. At present, there is no standard, nation-wide neonatal screening for this disease in the United States. Case Presentation A 17-month-old Caucasian female presented to our institution by way of referral for macular scarring. She was diagnosed with intrauterine growth retardation and born with low birth weight and microcephaly at an outside institution, but no systemic workup was conducted at that time. On ocular examination, she was found to have nystagmus and extensive multifocal chorioretinal pigmented scars involving the macula and peripheral retina in both eyes with fibrous vitreous strands extending between scars in the right eye. Toxoplasmosis immunoglobulin G was found to be highly positive. Magnetic resonance imaging of the brain showed supratentorial intracranial calcifications. Conclusions Our patient presented with severe chorioretinal lesions, microcephaly, and nystagmus with a positive immunoglobulin G toxoplasmosis titer. She did not receive any evaluation, including TORCH infectious panel workup, on being born with low birth weight and microcephaly. There are currently no national programs in place for toxoplasmosis to be included in routine neonatal screening, despite the grave sequelae of congenital infection or that studies in other countries have shown cost-effectiveness in early screening and treatment.

Abstract Background As the number of children with Zika virus-related complications grows, the long-term developmental trajectory and its effects on families are unknown. We present the first known case of congenital Zika syndrome seen at our institution with significant fundus findings. Case presentation A 3-day-old Hispanic baby girl presented with severe microcephaly of 24 cm and temperature instability at birth. Her mother had traveled to Honduras early in pregnancy and testing of amniotic fluid was positive for Zika virus via polymerase chain reaction. A dilated fundus examination was significant for bilateral severe colobomatous chorioretinal atrophy of the macula and pigmentary changes. Neonatal magnetic resonance imaging revealed diffuse lissencephaly with decreased brain volume, atrophic corpus callosum and brainstem, periventricular calcifications, and ventriculomegaly of the lateral ventricles. Conclusions Our patient, who presented with the first known case of congenital Zika syndrome in Northern Florida, demonstrated profound bilateral colobomatous chorioretinal atrophy of the macula. The ophthalmologic findings along with severe microcephaly emphasize the neurotropism of the Zika virus, and ultimately are indicative of poor developmental and visual prognosis for affected infants. With the increased prevalence of Zika virus, ophthalmologists should be aware of the associated findings and the importance of an eye-screening examination with a dilated fundus examination within 1 month of life of infants in which congenital Zika syndrome is suspected. A multidisciplinary care approach is essential for the care of affected infants and their families.

Jojoba (Simmondsia chinensis) is an oil yielding desert shrub popularly known as desert gold. Jojoba based industries, mainly works in two sectors: lubricant and cosmetics. The high cost of jojoba products could be lowered down by selecting the best raw material. So, we made our hypothesis to select the best raw material separately for cosmetics and lubricant industries. The purpose of the study was the comprehensive comparative phytochemical characterization of fifteen different accessions of jojoba oil using Spectrophotometer, Atomic Absorption Spectroscopy (AAS) and Gas Chromatography – Mass Spectrometry (GC–MS). GC and MS identified 10 fatty acids (myristic, palmitic, palmitoleic, oleic, linoleic, arachidic, 11-eicosenoic, heneicosanoic, tricosanoic and nervonic acids). Differences were found in most of the parameters and correlation analysis was done to compare all biochemical traits with respect to oil yield. Accessions Q-104 was found to be the best for cosmetics, as it shows a high concentration of fatty acids (linoleic, oleic, arachidic, 11-eicosenoic and palmitic acids) together with good oil yield. Accessions Clone-64 was found to be the best for the lubricant purpose as it showed the good oil yield, lower elements, and phosphorus content. We concluded that accession Q-104 and Clone-64 could be used commercially for cosmetic and lubricant industry, respectively. Further, these accessions could be used for the genetic breeding program. Keywords: AAS, Biochemical traits, Biofuel, Desert shrub, GC–MS, Jojoba

Background: Simvastatin (SMV), a new locally delivered drug of class statins, is a specific competitive inhibitor of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. Statins, besides having lipid-lowering abilities, also have pleiotropic effects like host modulation and bone regeneration. The present study was designed to investigate the effectiveness of SMV, 1.2 mg, in an indigenously prepared biodegradable controlled-release gel as an adjunct to scaling and root planing (SRP). Materials and Methods: A total of 60 sites, with pocket depth ≥5 mm, two from each of 30 patients after SRP, were categorized into two treatment groups, for subgingival placement of placebo (Gp 1) or SMV (Gp 2). Clinical parameters were recorded at baseline and at 1, 3 and 6 months comprising plaque index, gingival index, probing pocket depth (PPD) and clinical attachment level (CAL). The osseous changes were evaluated radiographically by measuring vertical gain, INFRA 1 and angle of the defect, INFRA 2 from baseline to 6 months. Results: All subjects tolerated the drug, without any post-application complication. The treatment improved the periodontal condition in both the groups but significant reductions in PPD (p= 0.04), and INFRA 1 (p= 0.000), along with gain in CAL (p= 0.02) and INFRA 2 (p= 0.000) were observed in Gp 2. In one site, an unexpected 5 mm decrease in INFRA 1 was found. Conclusion: Local drug delivery of SMV enhanced the beneficial effect of SRP, in pocket reduction, gain in CAL and bone fill.

Context: In the recent years, a two-way correlation has been postulated between periodontitis and systemic conditions. One such condition is diabetes mellitus (DM). Several studies have demonstrated a close relationship between DM and chronic periodontitis. Aims: To assess the effect of periodontal therapy and scaling and root planing (SRP) on the metabolic control in type 2 DM patients with chronic periodontitis based on the estimation of glycated hemoglobin (HbA1c). Settings and Design: A prospective, comparative, clinical study was performed on 50 patients suffering from type 2 DM with moderate, generalized chronic periodontitis. The study period was 6 months. Type 2 moderately controlled diabetic patients with glycated hemoglobin values within the range of 6-8% were selected. Patients with major diabetic complications, history of any antibiotic intake or periodontal treatment within the last 4 months, and smoking habits were excluded. Materials and Methods: The parameters recorded were gingival index (GI), plaque index (PI), sulcus bleeding index (SBI), probing pocket depth (PPD), clinical attachment level (CAL), and glycated hemoglobin. The recordings were done at baseline and 6 months after scaling and root planing procedures. HbA1c was measured by NycoCard Reader. Statistical Analysis Used: Karl-Pearson coefficient test, Z-test, and paired t-test. Results: Reductions in all the clinical parameters were observed and were found to be statistically significant (P < 0.005). Conclusions: Scaling and root planing resulted in a statistically significant reduction in the clinical parameters and HbA1c. So, periodontal treatment should be included in the management of diabetic patients.

Background : Temporomandibular joint is one of the most complex of all synovial joints. There are certain abnormal conditions like traumatic irreparable condylar injuries, idiopathic condylar resorption, TMJ ankylosis that require surgical removal of the affected condyle affecting its form and function, so reconstruction of TMJ is required to restore the same. The principle used in transport distraction osteogenesis is a classic Illiazarov technique used in reconstruction of large osseous defects. The aim of this clinical study was to evaluate the use of transport distraction osteogenesis in the reconstruction of ramus-condyle unit of the temporomandibular joint by using an indigenously designed internal distraction device.

Context: Intracameral mydriatic solution can eliminate the disadvantages of repeated eye drop instillation regimen and provide adequate mydriasis for phacoemulsification with added advantages. Aims: Evaluating the role of intracameral irrigating solution (0.5% lignocaine + 0.001% epinephrine) in initiating and maintaining the pupillary mydriasis during phacoemulsification. Secondary aims were to observe the effect of surgical time, nucleus density and ultrasound time on mydriasis during the procedure. Settings and Design: The study is a prospective interventional case series, conducted at tertiary care institution. Materials and Methods: Thirty patients underwent phacoemulsification under topical anesthesia for visually significant cataract. Pupillary dilatation was achieved by intracameral irrigation of mydriatic solution alone. Pupillary diameter was measured serially during surgery and ultrasound time and total surgical time were noted. Statistical Analysis Used: Paired samples student-t test was done to compare means. Spearman correlation coefficient was used to study the effect of various parameters on mydriasis. Results: Thirty eyes completed the study. The pupil size increased from 2.1 mm (Range 2-3.5 mm SD ± 0.32) to 6.9 mm (Range 5-9 mm SD ± 1.02) in 30 seconds time after intracameral mydriatic solution delivery, and was 7.0 mm (Range 3.5 - 9 mm SD ± 0.20) at the end of surgery. Duration of surgery, grade of nucleus and ultrasound time had statistically insignificant effect on mydriasis. Conclusions: Intracameral solution containing 0.5% lignocaine and 0.001% epinephrine provides rapid mydriasis which is adequate for safe phacoemulsification and is unaffected by other parameters.

Introduction: Irrational use of Topical Corticosteroid (TC) is quite common in India due to unrestricted availability and use of TC not only by general public but also by physicians and chemists due to quick relief of symptoms in different dermatological conditions. Aim: The present study was conducted to evaluate and analyse the prevalence of misuse of TC and the causes behind misuse of TC among patients in a dermatology outpatient department in New Delhi. Materials and Methods: This was a cross-sectional observational questionnaire based study conducted over a period of 5 months (1st June 2015 to 30th November 2015). Patients were questioned and assessed for misuse of TCs in terms of indication, dose, frequency, duration and source of recommendation of TC. Results: During the study period, 256 (11.77%) patients presented with inappropriate use of TC out of 2174 patients attending OPD of dermatology unit of a government hospital. A total of 250 patients presented with adverse effects of TC resulting from the misuse of these drugs. There were 60%female patients and 20-29 years (38%) was the most common age group affected. We found fungal infection (38%) was the most common reason of abuse followed by facial acne (29%) and lightening of skin colour (8.4%). Friends and family (33.2%) were found to be the most influencing factors for misuse of TC. Betamethasone (72.8%) was the most commonly used TC preparation and tinea incognito (26.4%) followed by facial acne (25.6%) were the most common side effect experienced. Conclusion: Outcome of the misuse of TC could be dreadful and the cause for same lies at all levels- patients, family, physicians and the regulatory authorities.

Pigmented neurofibroma is a rare variant of neurofibroma commonly associated with neurofibromatosis 1 of diffuse type. Histopathologic examination is essential to differentiate it from other pigmented lesions. We report here a case of pigmented neurofibroma of skin, which was diagnosed after histopathology, histochemistry and immunohistochemistry. We also review the pertinent literature to highlight the differential diagnoses.

Background: Hypertrophic scarring may be a cause of failure after transcanalicular laser dacryocystorhinostomy (DCR) surgery. This hypertrophic scarring results from tissue charring and excessive coagulation, which may be caused by the high laser energy. We have evaluated the use of low energy settings to prevent hypertrophic scarring, for a successful outcome. Aims: To perform and evaluate transcanalicular laser DCR using low energy 810 nm diode laser. Design: Interventional, non-comparative, case series. Materials and Methods: Patients with nasolacrimal duct obstruction and chronic dacryocystitis, who needed DCR, and were fit for surgery under local anesthesia, were recruited to undergo transcanalicular laser DCR using a 810 nm diode laser. The outcome was measured by the patency of the lacrimal passage, as indicated by the relief in the symptoms and the patency on syringing at the last follow-up. The surgical time and surgical complications were noted. Statistical Analysis Used: Descriptive analysis. Results: The study included 94 patients. The average age was 30.1 years (range 15 - 69 years). Seventy (74.4%) patients were female. Eight patients had failed external DCR. Per-operative patency of the passage was obtained in all the patients. Average surgical time was seven minutes (5 - 18 minutes). At the end of the study period of one year, a successful outcome was seen in 85 patients (90.5%). There were eight patients of previous failed DCR surgeries, and six of them achieved a cure at the end of follow-up. Conclusions: Transcanalicular Laser DCR can be safely performed using a low power 810 nm diode laser. The surgery is elegant, minimally invasive, allows fast rehabilitation, and has an excellent success rate.

Background: Throughout history, menopause has been regarded as a transition in a woman’s life. With the increase in life expectancy, women now spend more than a third of their lives in menopause. During these years, women may experience intolerable symptoms both physically and mentally, leading them to seek clinical advice. It is imperative for healthcare providers to improve the quality of life by reducing bothersome menopausal symptoms and preventing disorders such as osteoporosis and atherosclerosis. The current treatment in the form of hormone replacement therapy (HRT) is sometimes inadequate with several limitations and adverse effects. Objective and rationale: The current review aims to discuss the need, efficacy, and limitations of current HRT; the role of other ovarian hormones, and where we stand in comparison with ovary-in situ; and finally, explore towards the preparation of an HRT model by regeneration of ovaries tissues through stem cells which can replicate a functional ovary. Search methods: Four electronic databases (MEDLINE, Embase, Web of Science and CINAHL) were searched from database inception until 26 April 2018, using a combination of relevant controlled vocabulary terms and free-text terms related to ‘menopause’, ‘hormone replacement therapy’, ‘ovary regeneration’, ‘stem cells’ and ‘ovarian transplantation’. Outcomes: We present a synthesis of the existing data on the efficacy and limitations of HRT. HRT is far from adequate in postmenopausal women with symptoms of hormone deprivation as it fails to deliver all hormones secreted by naïve ovarian tissue. Moreover, the pharmacokinetics of synthetic hormones makes them substantially different from natural ones. Not only does the number and type of hormones given in HRT matter, but the route of delivering and their release in circulation are also imperative. The hormones are delivered either orally or topically in a non-physiological uniform manner, which brings along with it several side effects. These identify the need for a hormone delivery system which replicates, integrates and reacts as per the requirement of the female body. Wider implications: The review outlines the strengths and weaknesses of HRT and highlights the potential areas for future research. There is a tremendous potential for research in this field to understand the collective roles of the various ovarian hormones and to devise an auto-regulated hormone delivery system which replicates the normal physiology. Its clinical applications can prove to be transformative for postmenopausal women helping them to lead a healthy and productive life.

Co(II), Ni(II), and Cu(II) complexes with a tetradentate nitrogen donor [N4] macrocyclic ligand, viz. 6,15-dimethyl-8,17diphenyl-7,16-dihydrodibenzo[b,i][1.4.8.11]tetraazacyclotetradecine, were synthesized. Their structures were determined based on elemental analyses, molar conductance and magnetic susceptibility measurements, and IR, 1H-NMR (ligand) and electronic spectral studies. Based on analytical and molar conductance data, the complexes may be formulated as [M(L)Cl2] and [M’(L)]Cl2 (where M = Co(II) and Cu(II), and M’ = Ni(II)) due to their non-electrolytic and 1:2 electrolytic nature. Based on spectral studies, an octahedral geometry was assigned for the Co(II) complex, whereas square-planar and tetragonal geometry were proposed for the Ni(II) and Cu(II) complexes, respectively. The synthesized ligand and its complexes were screened for fungicidal activity against two pathogenic fungi (i.e., Fusarium moniliformae and Rhizoctonia solani) to assess their growth inhibiting potential.

Background : Pain perception, expression, tolerance, and the healthcare provider′s evaluation and management of pain are affected by the gender of the patient. To the best of our knowledge, there is lack of gender-based evaluation of pain during cataract surgery under topical anesthesia. Aims : This study has been initiated to evaluate and determine pain experience during cataract surgery under topical anesthesia and to study the gender-based differences of the same. Settings and Design : Hospital-based study involving cataract surgery under topical anesthesia using standard cataract surgery. It was an interventional comparative case series. Materials and Methods : One hundred and sixty patients were included in four groups, according to the gender and choice of surgery. Patients underwent either phacoemulsification with foldable intra ocular lens (IOL) or manual small incision cataract surgery with rigid IOL under topical anesthesia. Patients ranked their pain experience on VAS scale after the surgery and the surgeon recorded the ease/difficulty accordingly using a questionnaire. Statistical Analysis Used : MedCalc version 10.2.0.0 (www.medcalc.be) for windows was used to analyze the results. Analysis of variance (ANOVA) test and Kruskal-Walis test were used to analyze the data. Results : The overall visual analog scale (VAS) score was 0.8 (SD 1.3 range 0-8), with no statistical difference among the groups (P=0.5). The average surgeon′s score was 3.3 (SD 0.71 range 3-7), with no statistical difference between the groups (P=0.37).There were no sight threatening complications during the surgery in any group. Conclusions : The outcome of the study demonstrates that the patients undergoing cataract surgery under topical anesthesia perceive comparable pain and discomfort irrespective of their gender.

A 25-year-old G2P1L1 woman with 18-week pregnancy presented with right hypochondriac pain and vomiting for the past 1 week. She had borderline vitals and a diffusely tender abdomen. Ultrasound revealed a live 18-week fetus attached to the undersurface of the liver with moderate ascites. Laparotomy was carried out which revealed 500 cc of hemoperitoneum with a primary hepatic pregnancy of the right lobe of liver and bleeding from the placental site. After extracting the fetus, the placenta was left inn situ and the abdomen was packed to control the bleeding as other hemostatic measures failed. Hepatic artery embolization was done after surgery followed by relaparotomy but the abdomen had to be repacked again as the patient was unstable with uncontrollable bleeding. The patient succumbed to DIC despite adequate replacement. In retrospect, the authors conclude that embolization could have been done before surgery and partial hepatic resection attempted in the first instance.