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The virus that causes severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) belongs to the genus Beta coronavirus and the family Coronaviridae. The SARS-CoV-2 virus is a positive sense, non-segmented single-strand RNA virus that causes coronavirus disease 2019 (COVID-19), which was first reported in December 2019 in Wuhan, China. COVID-19 is now a worldwide pandemic. Globally, several newer variants have been identified; however, only a few of them are of concern (VOCs). VOCs differ in terms of infectivity, transmissibility, disease severity, drug efficacy, and neutralization efficacy by monoclonal antibodies, convalescent sera, or vaccines. VOCs reported from various parts of the world include B.1.1.7 (Alpha), B.1.351 (Beta), B.1.617/B.1.617.2 (Delta), P.1 (Gamma), and B.1.1.529 (Omicron). These VOCs are the result of mutations, with some based on spike proteins. Mutations may also cause molecular diagnostic tests to fail to detect the few VOCs, leading to a delayed diagnosis, increased community spread, and delayed treatment. We searched PubMed, EMBASE, Covariant, Stanford variants database, and CINAHL from December 2019 to February 2022 using the following search terms: Variant of Concern, SARS-CoV-2, Omicron, etc. All types of research were chosen. All research methods were considered. This review discusses the various VOCs, as well as their mutations, infectivity, transmissibility, and neutralization efficacy.

Oxygen is probably the most commonly prescribed drug in the emergency setting and is a life-saving modality as well. However, like any other drug, oxygen therapy may also lead to various adverse effects. Patients with chronic obstructive pulmonary disease (COPD) may develop hypercapnia during supplemental oxygen therapy, particularly if uncontrolled. The risk of hypercapnia is not restricted to COPD only; it has also been reported in patients with morbid obesity, asthma, cystic fibrosis, chest wall skeletal deformities, bronchiectasis, chest wall deformities, or neuromuscular disorders. However, the risk of hypercapnia should not be a deterrent to oxygen therapy in hypoxemic patients with chronic lung diseases, as hypoxemia may lead to life-threatening cardiovascular complications. Various mechanisms leading to the development of oxygen-induced hypercapnia are the abolition of ‘hypoxic drive’, loss of hypoxic vasoconstriction and absorption atelectasis leading to an increase in dead-space ventilation and Haldane effect. The international guideline recommends a target oxygen saturation of 88% to 92% in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and other chronic lung diseases at risk of hypercapnia. Oxygen should be administered only when oxygen saturation is below 88%. We searched PubMed, EMBASE, and the CINAHL from inception to June 2022. We used the following search terms: “Hypercapnia”, “Oxygen therapy in COPD”, “Oxygen-associated hypercapnia”, “oxygen therapy”, and “Hypoxic drive”. All types of study are selected. This review will focus on the physiological mechanisms of oxygen-induced hypercapnia and its clinical implications.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous group of lung diseases limiting the airflow due to narrowing of airways, chronic bronchitis and emphysema that leads to difficulties in breathing. Chronic inflammation is another important characteristic of COPD which leads to immune cell infiltration and helps in the alveolar destruction. Pathology of COPD is driven by various environmental and genetic factors. COPD is mainly associated with the inhalation of toxic agents mainly the cigarette smoke. Receptor for advanced glycation end products (RAGE) has emerged as a pattern recognition receptor and is a multiligand receptor expressed moderately in various cells, tissues and highly in the lungs throughout life. RAGE recognizes various ligands produced by cigarette smoke and its role has been implicated in the pathogenesis of COPD. RAGE ligands have been reported to accumulate in the lungs of patients with COPD. RAGE is a membrane receptor but its truncated form i.e. soluble RAGE (sRAGE) mainly functions as a contender of RAGE and inhibits various RAGE dependent cell signalling. Among the various ligands of RAGE, advanced glycation end products (AGEs) are majorly linked with COPD. Accumulated AGE triggers downstream RAGE-AGE axis in COPD. Moreover, RAGE genetics has long been known to play a vital role in the pathology of various airway diseases including COPD and this gene contains an associated locus. A reliable biomarker is needed for the management of this disease. sRAGE has an inverse correlation with the RAGE showed its importance as a valuable marker in COPD. This review is focused on the role of RAGE, sRAGE, RAGE axis and RAGE genetics in COPD.

BACKGROUND Eclampsia is a life-threatening emergency & requires proper treatment to decrease maternal morbidity & mortality. We wanted to determine the incidence of maternal mortality associated with eclampsia, modes of death in eclampsia & demographic profile of women influencing the maternal death. METHODS This retrospective longitudinal study was done in the Department of Obstetrics & Gynaecology of Malda Medical College & Hospital for a period of three years from 1 st January, 2017 to 31st December, 2019. Total maternal deaths during this period was 186 & total eclampsia deaths during this period was 62. Records of death & demographic profiles were retrieved from the Medical Record Library of aforementioned hospital. RESULTS Eclampsia accounted for 33.33% of total maternal deaths (186) with a case fatality rate of 4.092%. Commonest mode of death in eclampsia is pulmonary oedema. Eclampsia death commonly occurs in younger age & in primigravida. Eclampsia death is also common in unbooked & lower socioeconomic status. Antepartum eclampsia contributes to most of the eclamptic deaths. CONCLUSIONS Eclampsia still remains the major cause of maternal death in India in unbooked & unsupervised pregnancies & deliveries. Hence, regular antenatal check-up, strict vigilance & appropriate treatment during deliveries may reduce maternal deaths in eclampsia.

BACKGROUND An efficient utero placental vascular system is a prerequisite for successful pregnancy outcome. The site of placental attachment in the uterus may be an important determinant of placental blood flow. Centrally located placentas receive adequate blood flow from both the uterine arteries by virtue of their position. In contrast, laterally located placentas may depend on a high degree anastomosis between ipsilateral and contralateral uterine arteries. Therefore, any difficulty in collateral circulation could lead to decreased blood flow and hence thereby lead to poor obstetric outcomes. Hence this study was done to assess the obstetric outcomes and to see the association with age, parity and other demographic features. METHODS After ethical committee permission, this study was conducted in the Department of Gynaecology and Obstetrics with the help of Radiology Department of Malda Medical College. The study was carried out from 1st January 2016 to 31st December 2017. Two groups of pregnant women, one group as case and another group as control group were screened for placental localisation by USG. Fifty pregnant women with USG proved lateral placenta were included in the study group and another fifty pregnant women with central placentas in the control group. Those pregnant women who attended antenatal clinic at first trimester for registration were screened for placental localisation by USG after 24 weeks of pregnancy. All women of study group and control group were studied and followed up from 24 weeks till delivery and subsequently up to discharge of newborn babies from hospital. RESULTS Incidence of preeclampsia was high 16% (8/50) in the study group compared to control group 4% (2/50). Incidence of foetal intrauterine growth restriction (IUGR) in lateral placenta group is 20% (10/50); whereas, in central placenta group it is 6% (3/50). These are statistically significant p=0.037. In study group women, 76% were up to 25 years of age and 72% were primigravida. Socioeconomic status has little impact on placental lateralisation. CONCLUSIONS Preeclampsia and IUGR are commonly associated with lateral placental location. These two obstetric conditions may lead to poor obstetric outcomes i.e. intrauterine foetal death (IUFD), stillbirths and neonatal deaths and hence timely identification of laterally located placenta in uterus and early detection of pregnancy complications like IUGR and preeclampsia and initiation of careful prophylaxis and proper management may reduce foetal morbidity and mortality and may improve perinatal outcome and may reduce maternal morbidity and mortality.

There are multiple causes of pleuro-pericardial effusion (PPEF) and more so in a patient with end-stage renal disease (ESRD). Postcardiac injury syndrome (PCIS) is a loosely defined term for occurrence of pericardial and/or pleural effusion (PLEF), low-grade fever, with or without systemic upset, which occurs after myocardial infarction (MI), and other cardiac interventions. PPEF is one of its salient manifestations. We report occurrence of PCIS, presenting as pericardial effusion and massive PLEF, after insertion of cardiac pacemaker in a patient with ESRD, on maintenance hemodialysis (MHD). It was successfully managed with a short course of oral steroids.

The flow volume loop (FVL) is a graphic display of airflow against lung volumes at different levels obtained during the maximum inspiratory and expiratory maneuver. It is a simple and reproducible method of lung function assessment. A narrative review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, EMBASE, Ovid MEDLINE and CINAHL databases were queried and reviewed for studies pertinent to the various FVLs abnormalities and their mechanisms from January 2020 to December 2020. We used the following search terms; flow-volume loop, upper airway obstruction, Obstructive airway disease, and spirometry. Assessing the shape of the flow-volume loop is particularly helpful in diagnosing and localizing upper airway obstruction. They are also helpful in identifying bronchodilator response to treatment. Characteristic FVLs is also seen in patients with obstructive or restrictive lung disorders. Spirometry should be interpreted using the absolute values for flows and volumes as well as the flow volume and volume time curves.

Tuberculous pseudoaneurysm of the descending thoracic aorta is quite rare, life-threatening, and fatal if not diagnosed in time. This lesion exposes patients to a very high risk of unpredictable rupture. We describe a case of tuberculous pseudoaneurysm of the aorta in association with tuberculosis of the spine (Pott's spine). A 73-year-old man presented with a 2-month history of back pain. Chest roentgenography and contrast-enhanced computed tomography showed a descending thoracic aortic pseudoaneurysm with destruction of the fourth and fifth thoracic vertebrae (T4-T5). We suspected that the pseudoaneurysm was due to direct extension of tuberculous vertebral osteomyelitis. The patient was managed with antituberculous chemotherapy. The post–antitubercular therapy course was uneventful and he remained well 12 months after completion of treatment.

To find the prevalence of obstructive sleep apnoea (OSA) in patient of metabolic syndrome (MS). This is a prospective study conducted in the Department of Pulmonary Medicine at IGMC, Shimla. Total 54 patients (32 males and 22 females) with MS who fulfilled inclusion criteria were enrolled for the study over a period of 1 year. The patients who had symptoms of OSA were subjected to overnight polysomnography. In this study, total prevalence of OSA was 90.74%. Male and female prevalence were 93.75% and 86.36%, respectively. The prevalence of hypertension was 59.25% and 24.49% of the patients were diabetic. An increased neck circumference (corrected for height) has been suggested as a better sign of obstructive sleep apnoea than other clinical indices. We compared male patient of non-OSA with severe OSA and found significant difference in high-density lipoprotein and triglyceride level. All patients of metabolic syndrome should be screened for OSA because of sheer high prevalence of this disease. Whether the treatment of OSA can have positive impact on MS patients needs to be further studied in Indian settings.

PURPOSE The aim of the current work was to report the effect of imatinib on pregnancy in patients with chronic myeloid leukemia (CML). METHODS Data were collected between January 1998 and December 2014. One hundred four patients met inclusion criteria, and we report the results of 104 pregnancies—conceived by the participant or partner—while being on imatinib therapy for CML. RESULTS Fifty-eight patients were male and 46 were female. Eighty-three patients, 20 patients, and one patient were had CML in the chronic phase, accelerated phase, or blast phase, respectively. Of 46 female patients, 21 underwent abortion (spontaneous, n = 36.9; elective termination, n = 8.6%). In the case of full-term pregnancy in the female partners of male patients with CML, all outcomes were uneventful. Of 46 female patients, 25 had full-term pregnancy outcomes. During the pre–imatinib era (total n = 6), patients were treated with hydroxyurea, interferon-alpha, and therapeutic leukapheresis. A total 10 of 19 pregnant patients continued on imatinib until their delivery and experienced the following outcomes: normal full-term deliveries (n = 7), preterm delivery (n = 1), omphalocele (n = 1), and craniosynostosis (n = 1). Of those who discontinued imatinib after counseling (n = 9), eight patients had full-term normal delivery, of which two patients required leukapheresis and one patient expired. All patients who continued on imatinib while pregnant were in complete cytogenetic response and major molecular response (MMR) before pregnancy, during pregnancy, and postpregnancy. Of nine patients who discontinued imatinib, two lost MMR during the third trimester and all of these patients were in complete cytogenetic response and MMR before pregnancy. CONCLUSION It is clear that there is no standard of care for the best treatment of CML in the case of pregnancy. Interferon and/or leukapheresis will be included as treatment options. Patients can have normal pregnancies even with the administration of imatinib at the risk of congenital anomalies, intervention for which can be done after birth.

Background: Postpartum haemorrhage is the most important cause of maternal mortality which is near about 13% in developed countries and 34% in developing countries. When postpartum haemorrhage is not controlled even after aggressive medical management, immediate surgical intervention is needed which includes bilateral internal iliac artery ligation, B-Lynch compression sutures, hysterectomy as a last resort. Bilateral internal iliac artery ligation is much quicker and having lesser risk of uterine necrosis as compare to B-Lynch suture. That’s why a study was conducted to evaluate and compare the role of bilateral internal iliac artery ligation with B-Lynch compression sutures.Methods: A prospective observational study was conducted in the department of obstetrics and gynaecology in Burdwan medical college and hospital for a period of 3 years from 1st July 2019 to 30th June 2022. Out of total 62 cases of intractable postpartum haemorrhage, 31 cases underwent bilateral internal iliac artery ligation (group A) and another 31 cases underwent B-Lynch compression sutures (group B).Results: In this study, most of the women were in the age group of 21-30 years. both in group A and group B. Risk factors for postpartum haemorrhage in both groups were pre-eclampsia, abruption, placenta previa, nonprogress of labour, multiple pregnancy. Blood products requirements were much more in group B than group A. Hysterectomy needed in 12.9% cases of group A and 29.03% cases of group B. In terms of maternal outcome, out of total maternal death, 37.5% cases were under group A, 62.5% cases were under group B.Conclusions: In our study, need for hysterectomy was less in cases of bilateral internal iliac artery ligation compared with B-Lynch compression sutures. So, bilateral internal iliac artery ligation should be early resort to prevent hysterectomy in cases of atonic postpartum haemorrhage with low parity. As bilateral internal iliac artery ligation is a life saving procedure, every obstetrician must be able to perform it and should have proper knowledge of retroperitoneal anatomy to avoid injury of iliac veins and ureter.

The SARS‐CoV‐2 is a new coronavirus responsible for the COVID‐19 disease and has caused the pandemic worldwide. A large number of cases have overwhelmed the healthcare system worldwide. The COVID‐19 infection has been associated with a heightened risk of thromboembolic complications. Various mechanisms are leading to the high thrombotic risk in COVID‐19 patients such as inflammation, endotheliitis, hyperviscosity, and hypercoagulability. We searched PubMed, EMBASE, and CINAHL from January 2020 to December 2020. We used the following search terms: COVID‐19, coagulopathy, and thrombosis. We reviewed the epidemiology, clinical features, mechanisms, and treatment of COVID‐19‐associated coagulopathy.

Background: Relaparotomy is the term which defines operations performed within 60days after the initial surgery. Ralaparotomy following caesarean section may happen and that’s why a study was done to evaluate the risk factors, indications, procedures done during relaparotomy after caesarean section.Methods: A retrospective observational study was conducted in the department of obstetrics and gynaecology in burdwan medical college and hospital for a period of 3years from 1June 2019 to 31 May 2022. Total 32 cases required relaparotomy following caesarean section.Results: In this study, there were 25,527 caesarean deliveries out of 56,145 total deliveries over 3years time period. Among caesarean deliveries 32 cases underwent relaparotomy (0.12%). In most of the cases relaparotomies were due to intraperitoneal haemorrhage, rectus sheath hematoma, postpartum haemorrhage. Indications of cesarean section were severe preeclampsia, non-progress of labour, abruption, post cesarean section with scar tenderness, meconium-stained liquor with fetal distress. Most of the women were in the age group of 20-30 years. Resuturing of the bleeding points were done in most of the cases.Conclusions: As a lifesaving procedure, decision of relaparotomy should be taken as soon as possible. Proper hemostasis need to be ensured before closure of abdomen, as intraperitoneal haemorrhage is the most common indications for relaparotomy.

The enduring epidemic outbreak which started in Wuhan city of China, in December 2019 caused by the 2019 novel coronavirus (COVID- 19) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created a dangerous and deadly Public Health disaster of International apprehension, with cases confirmed in several countries. This novel community health trouble is frightening the universe with clinical, psychological, emotional, collapse of health system and economical slowdown in each and every part of the world infecting nearly 200 countries. A highly virulent and pathogenic COVID-19 viral infection with incubation period ranging from two to fourteen days, transmitted by breathing of infected droplets or contact with infected droplets, belongs to the genus Coronavirus with its high mutation rate in the Coronaviridae. The likely probable primary reservoir could be bats, because genomic analysis discovered that SARSCoV-2 is phylogenetically interrelated to SARS-like bat viruses. The transitional resource of origin and transfer to humans is not known, however, the rapidly developing pandemic has confirmed human to human transfer. Approximately 1,016,128 reported cases, 211,615 recovered cases and 53,069 deaths of COVID-2019 have been reported to date (April 2, 2020). The symptoms vary from asymptomatic, low grade pyrexia, dry cough, sore throat, breathlessness, tiredness, body aches, fatigue, myalgia, nausea, vomiting, diarrhea, to severe consolidation and pneumonia, acute respiratory distress syndrome (ARDS) and multiple organ dysfunction leading to death with case fatality rate ranging from 2 to 3%.

Effective and reliable venous access is one of the cornerstones of modern medical therapy in oncology. The focus of this prospective observational research is to study the various indications of a peripherally inserted central catheter (PICC) in different solid and hematological malignancies and the various complications and outcomes in the pediatric and adult cancer patients. This study was conducted in a prospective observational study design and collected data of patients with a diagnosis of any cancer, at a tertiary care oncology hospital in Ahmadabad, Gujarat, India, during a 2-year period. The PICC was inserted in 352 patients and most commonly used in hematological conditions (n = 295, 83.8%), followed by solid malignancies 57 (16.2%). In the hematological malignancy group, acute myeloid leukemia (48.01%) was the most common indication, and in the solid malignancies group, osteosarcoma (n = 9, 2.55%) was the most common indication for PICC insertion. PICCs were inserted most commonly in the left side of the venous system in 70.7% cases. The complications in the PICC study group included infections (12.5%), thrombosis (4.82%), catheter blockage (4.82%), arrhythmias (4%), premature catheter removal (3%), bleeding (2.55%), and pneumothorax (2.55%). The median days of the PICC use in situ were 152 days. To conclude from our study, PICCs are most commonly indicated in malignancies that are requiring long-term chemotherapy, such as hematological malignancy, especially acute myeloid leukemia, and solid malignancies, usually osteosarcoma, and these catheters are associated with complications such as infection, thrombosis, catheter blockage, arrhythmia, bleeding, and pneumothorax. The most disturbing aspect of the treatment of a cancer patient is multiple painful venipunctures made for administration of cytotoxic agents, antibiotics, blood products, and nutritional supplements. From this study, we can infer that PICC lines can be used for various malignancies that require long-term chemotherapy.

Reviewed the etiologies, pathophysiologic mechanisms, detection and clinical significance of pulsus paradoxus in various conditions.We searched PubMed, EMBASE, and the CINAHL from inception to June 2017. We used the following search terms: Pulsus paradoxus, pericardial effusion, acute asthma, ventricular interdependence and so forth. All types of study were chosen.Legendary physician Sir William Osler truly said that "Medicine is learned by the bedside and not in the classroom." Bedside history taking and physical examination should be an integral component of clinical teaching curriculum imparted to medical students. Pulsus paradoxus is a valuable physical sign seen in many clinical conditions. Pulsus paradoxus is defined by an inspiratory fall in systolic blood pressure of greater than 10 mm Hg. Two prototype examples of pulsus paradoxus are cardiac tamponade and acute asthma. Exaggerated swings of intrapleural pressure, bi-ventricular interactions and increase afterload of the left ventricle are few of the pathophysiological mechanisms involved in the causation of pulsus paradoxus. The sensitivity of pulsus paradoxus in the diagnosis of cardiac tamponade is very high. In acute asthma, it also correlates with the severity of airflow obstruction.

Background Interstitial lung diseases (ILDs) are the group of chronic disorders with incomprehensible mechanisms. Deregulation of immunological mechanisms may play significant role in ILDs progression. Regulatory elements such as microRNA (miRNAs), long-noncoding RNAs (lncRNAs), and the cross-regulation between miRNAs and lncRNAs towards competing endogenous RNAs (ceRNAs) activity are significant for disease diagnosis and monitoring. Systematic investigation and analyses of these regulatory elements can provide potential biomarkers for ILDs. Method and results Current analysis explored the role of these regulatory elements as therapeutic/biomarker targets, and outlines the biological functions, differential expression and pathways association of the most significant ncRNAs. In total, ten potential pathways related to ILDs and their associations with miRNAs and lncRNAs were identified. A total of 2701 miR-pathways, 669 lncRNAs-pathways and 4568 miRNA-lncRNA associations related to ILDs were implicated. The miRNAs and lncRNAs which are having higher genetic interactions with target genes/pathways/ceRNAs pairs were detected as promising candidates in our analysis. These results were also validated using literature-based knowledge. Analysis of miRNAs expression data indicated that few miRNAs may be used as ILDs or its subclass biomarkers. lncRNAs associated with miRNAs, and immunologically relevant pathways interactions were also proposed as biomarkers. Conclusion The proposed miRNAs, lncRNAs and ceRNAs may be explored as potential biomarkers/therapeutic targets to assess ILDs pathogenesis and progression. The study indicated the significant impact of ncRNAs and their target interactions to provide the new directions for ILDs diagnosis and monitoring through non-invasive interventions.

Introduction To determine whether Computed Tomography Perfusion (CTP) can predict treatment response and prognosis in non-small cell lung cancers (NSCLC). To determine which one of the perfusion parameter correlated best with treatment outcome. Methods Sixteen patients with NSCLC underwent CTP before and after completion of chemo-radiotherapy. Patients with complete and partial response were grouped as responders and patients with stable and progressive disease were grouped as non-responders. Pre and post-treatment whole tumour perfusion parameters (blood flow - BF, blood volume - BV, mean transit time - MTT and permeability surface area product - PS) were compared between responders and non-responders. Results Responders had higher baseline BF and PS values than non-responders; P = 0.047, 0.028 respectively. On 1 year follow up, patients with even 2.65% increase in PS value from baseline developed metastasis while patients with decrease in PS value by 24% did not develop metastasis (P = 0.05). Greater decrease in BF values (17%) were noted among responders than non-responders (2.4%) following chemoradiation, though the results were not statistically significant (P > 0.05). Conclusions Tumours with higher baseline BF and PS respond well to chemo-radiation. Changes in the PS values can predict the development of metastasis and hence, the long term outcome.

Skin metastases from colorectal carcinoma are rare and signal advanced disease. Skin metastasis refers to growth of cancer cells in the skin originating from an internal cancer. In most cases, cutaneous metastasis develops after the initial diagnosis of the primary internal malignancy and late in the course of the disease. In very rare cases, skin metastasis may occur at the same time or before the primary cancer has been discovered and may be the prompt for further thorough investigation. The incidence of skin metastasis varies but is somewhere between 3-10% in patients with a primary malignant tumor. Most common ones are melanoma (45%), breast cancer (30%), nasal sinus cancers (20%), cancer of the larynx and cancer of the oral cavity (12%) cases. Here we present a case of 39-year-old man presented to us with multiple subcutaneous lesions over the chest and forehead. Fine needle aspiration cytology of skin nodules revealed metastatic adenocarcinoma features. Further imaging of the abdomen with computed tomography (CT) revealed circumferential narrowing of caecum and ascending colon. The patient was managed with palliative right hemicolectomy in view of constipation and palliative chemotherapy as systemic treatment. An extensive review of the English literature did not reveal extensive data on metastatic subcutaneous nodules leading to diagnosis of colon cancer.

Background: Effective and reliable venous access is among the cornerstones of modern medical therapy in oncology. Materials and Methods: This was a prospective observational study of collected data of patients with a diagnosis of any cancer, at a tertiary care oncology hospital in Ahmadabad, Gujarat, India, during a 2-year period. Results: A Hickman catheter was inserted in 200 patients and most commonly used in solid malignancies (n = 103; 51.5%), followed by hematologic conditions (n = 93; 48.5%). Among solid malignancies, hepatoblastoma (n = 21; 10.5%) was the most common indication, whereas in hematologic malignancies acute lymphoblastic leukemia was the most common indication (n = 56; 28%) for Hickman catheter insertion. Hickman catheters were inserted most commonly in the right side (n = 170; 85%) of the venous system. The various complications in the Hickman study group in descending order were 28 patients (14%) developed arrhythmias, 15 patients (7.5%) developed infection, 12 patients (6%) developed bleeding, 8 patients (4%) developed pneumothorax, 7 patients (3.5%) developed catheter blockage, and 6 patients (3%) required premature catheter removal. The median time of Hickman catheter in situ was 207 days. Conclusions: The most disturbing aspect of treatment of patients with cancer is multiple painful venipunctures made for administration of cytotoxic agents, antibiotics, blood products, and nutritional supplements. The focus of this prospective observational research was to study the various indications for Hickman catheter in different solid and hematologic malignancies as well as the various complications and outcomes in pediatric and adult cancer patients.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and pathogenic coronavirus responsible for the pandemic coronavirus disease 19 (COVID-19). It has significant impact on human health and public safety along with negative social and economic consequences. Vaccination against SARS-CoV-2 is likely the most effective approach to sustainably control the global COVID-19 pandemic. Vaccination is highly effective in reducing the risk of severe COVID-19 disease. Mass-scale vaccination will help us in attaining herd immunity and will lessen the negative impact of the disease on public health, social and economic conditions. The present pandemic stimulated the development of several effective vaccines based on different platforms. Although the vaccine is safe and efficacious, rare cases of thrombosis and thrombocytopenia following the use of vaccination with the ChAdOx1 CoV-19 vaccine (AstraZeneca, University of Oxford, and Serum Institute of India) or the Ad26.COV2.S vaccine (Janssen/Johnson & Johnson) have been reported globally. This review focussed on the definition, epidemiology, pathogenesis, clinical features, diagnosis, and management of vaccine associated thrombosis.

Background: Current investigation was done to study the role of HRCT chest in the diagnosis and characterization of interstitial lung diseases, yield of transbronchial lung biopsy and role of multidisciplinary approach of diagnosis.Methods: We prospectively analyzed clinical features and radiological findings in 38 patients of ILD. Radiological diagnosis on HRCT was made in every case depending on type of predominant abnormality and pattern of involvement. Following this, TBLB was done in every case.Results: ILD was diagnosed in all cases on HRCT. Most common ILD type was UIP (31.5%) followed by sarcoidosis (21%) and NSIP (15.7%). Other ILD subtypes encountered were, RB-ILD, AIP and acute silicosis. In 68.4% cases, there was definitive diagnosis on TBLB. Out of which in 15.7% cases, HRCT and TBLB diagnosis were different. In 15.3% cases, TBLB gave diagnosis of only non- specific ILD.Conclusions: HRCT can detect ILD in 100% cases & can characterize ILD into various patterns. But, HRCT alone without clinical correlation and pathology can cause diagnostic confusion in many cases. However, multidisciplinary approach by engaging clinician, radiologist and pathologist can lead to accurate diagnosis in many cases of ILD. TBLB is a safe, minimally invasive procedure which can establish correct diagnosis in many cases especially in broncho-centric diseases.

Background: Head and Neck squamous cell carcinomas (HNSCC) have proven to be inherently resistant to systemic treatments; with limited treatment option after progression on systemic chemotherapy in HNSCCs Immunotherapy has a role to play with improved results. Methods: All 7 patients with advanced, metastatic-HNSCCs, received Inj. Nivolumab 240mg flat dose or 3mg per kg, intravenously every 2 weekly along with low dose capecitabine 500mg twice a day, were prospectively assessed. Patient’s clinical, hematological and staging characteristics were described and Clinical Benefit Rate (CBR) was calculated. Results: Total 7 patients received the combined metronomic chemo-immunotherapy (CMCI). Majority of patients were belonging to ECOG-PS 1(66%), with all patients being in stage IV disease. Three, three &one patient received Immunotherapy as 5th, 3rd and 4th line of therapy respectively. Nivolumab and low dose Capecitabine was used in all 7 patients. CBR was seen in 71.42% (5/7) patients, one patient died due hepatitis and hepatic encephalopathy, and one patient was having progressive disease, and one patient with stable disease discontinued of treatment because of financial constraints and kept on capecitabine alone. Majority tolerated therapy well with no grade 3/4 Immune related adverse events (IRAEs). One patient required supportive therapy with packed red cell transfusion and Albumin infusions. Conclusions: To conclude nivolumab along with metronomic chemotherapy with low dose capecitabine was very well tolerated and exhibited antitumor activity with CBR of 71% in extensively pretreated patients with HNSCCs. Additional studies of Nivolumab and metronomic chemotherapy and immuno-immuno combination therapy in these diseases are ongoing. Citation Format: Irappa Madabhavi, Malay Sarkar, Pham Nguyen Quy, Apurva Patel. Combined metronomic chemo-immunotherapy in head and neck cancers: An experience from the developing and resource poor country [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P101.

BACKGROUND Cytological evaluation of effusion fluid has become integral part of management especially in suspected malignant cases. Conventional Cytosmear (CS) is relatively simple, but sometimes become challenging to differentiate between reactive mesothelial cells and malignant cells. Hence, Cell Block (CB) preparation is increasingly gaining popularity for management, though it is time consuming, costly and little more cumbersome. MATERIALS AND METHODS All the fluid samples received in the departmental laboratory were divided into two parts for Leishman-Giemsa and Papanicolaou (PAP) stained conventional cytosmear and Haematoxylin-Eosin stained cell block preparation. Diagnoses obtained by CS and CB method were statistically analysed. RESULTS Out of total 115 fluid samples, 84 were pleural fluid, 24 ascitic fluid and 7 pericardial fluids. 9 cases in pleural fluid and 6 cases in ascitic fluid were false-negative by CS, which were proved to be malignant by CB method. So, additional 13.1% yield were obtained by CB method to diagnose malignant cases. CONCLUSION CB is superior to CS for diagnosis of malignant effusions and hence it should be used in adjunct to CS in difficult or suspected malignant cases for better yield.

Capturing of the best-focused image using focus measure function (FMF) from a stack of images acquired at different focus distances is a crucial step in automatic microscopy development. Detection of bacilli present in Ziehl-Neelsen (ZN) stained sputum smears conventional microscope (CM) images is critical to disease diagnosis. Studies have revealed that the performances of FMFs are sensitive to image contents and background noise. In this article, 24 diverse FMFs were implemented on 31 stacks of CM's field of view images acquired from three different microscopes to determine the best-focused one. Seven FMFs achieved the accuracies of greater than 90%. Accuracy, focus error, and false maxima were calculated for each FMF, and overall score and ranking were also calculated for better interpretation. Preprocessing techniques such as filtering and image distortions (noise, contrast, saturation, illumination, etc.) were performed to evaluate the robustness of every FMF. Gaussian derivative, steerable filters, Tenengrad, and Hemli and Scherer's mean FMFs were identified as the most robust and accurate functions with the accuracy >90%. These FMFs have a relatively less focus error and false maxima rate. Full widths at half maximum of these four FMFs were also computed to determine their efficacy for the optimization process. These four FMFs can be implemented for automated capturing of the image from ZN-stained sputum smear slide. Gaussian derivative FMF can also be used effectively for both CM and fluorescence microscope's field of view image stacks to determine the best-focused one from each stack. © 2017 International Society for Advancement of Cytometry.

Objectives Reviewed the epidemiology, clinical characteristics, mechanisms, and treatment of tuberculosis associated chronic obstructive pulmonary disease. Data source We searched PubMed, EMBASE, and the CINAHL from inception to June 2016. We used the following search terms: Tuberculosis, COPD, Tuberculosis associated COPD, and so forth. All types of study were chosen. Results and Conclusion Chronic obstructive pulmonary disease (COPD) and tuberculosis are significant public health problems, particularly in developing countries. Although, smoking is the conventional risk factor for COPD, nonsmoking related risk factors such as biomass fuel exposure, childhood lower-respiratory tract infections, chronic asthma, outdoor air pollution, and prior history of pulmonary tuberculosis have become important risk factors of COPD, particularly in developing countries. Past history of tuberculosis as a risk factor of chronic airflow obstruction has been reported in several studies. It may develop during the course of tuberculosis or after completion of tuberculosis treatment. Developing countries with large burden of tuberculosis can contribute significantly to the burden of chronic airflow obstruction. Prompt diagnosis and treatment of tuberculosis should be emphasized to lessen the future burden of chronic airflow obstruction.

Soft tissue sarcomas (STSs) are heterogeneous disorders comprises myriad subtypes originated from mesenchymal stem cells. Synovial sarcomas (SSs) are belligerent malignant tumours included in this group affecting extremities of patients’ age ranging between 15 and 35 years. SS taking place in head and neck region is rare event and primary laryngeal involvement is even rarer happening. There are 20 odd published cases documented in world literature so far. Here we are presenting primary laryngeal SS occurred in 31 year old male patient initially mimicking laryngeal carcinoma as patient was chronic smoker and classic symptom of hoarseness of voice.

Aims and Objectives: To study the characteristics, severity of airflow limitation and prescription pattern in TOPD patients in India. Introduction: There is a paucity of data reported from India on the TOPD phenotype and understanding of the disease process. Methods: A semi-structured questionnaire was prepared by Respiratory Research Network of India and was filled by the investigator at the study sites across India. Results: 103 patients were identified as having post TOPD 9 (8.7%) had mild disease, 39 (37.9%) had moderate, 37 (35.9%) severe and 18 (17.5%) were diagnosed as very severe TOPD. Significant negative correlation (r= -0.499, p value =0.021) was observed between duration of TOPD and patients with severe TOPD. The Pearson Chi square test showed a significance association (p value=0.033) between occurrence of post-TOPD and affected left middle zone. Reversibility was observed in 24 (23.3%) patients and fixed airflow obstruction was observed in 79 (76.7%) patients respectively. Prescription pattern showed that, LAMA alone was prescribed to 5 (5%), LABA and LAMA combination to 10 (10%), LABA and ICS combination to 20 (20%), LAMA and ICS to 5 (5%), LAMA, LABA and ICS combination to 60 (60%) cases. Mild disease was most commonly prescribed with LABA+ICS (66.66 %), moderate with LAMA+LABA+ICS (77%), severe with LABA+ICS (32.35%) and very severe cases with LAMA+LABA+ICS (83.3%). %). Hence the treatment regime was not in accordance with the GINA or GOLD guidelines. Conclusion: The current study emphasis on the importance of screening of post-TOPD. This study presented the association of post-TOPD on the lung function and the prescription pattern currently followed for the treatment of post-TOPD.

Pulmonary embolism is a common emergency in the hospital setting. Main line of treatment is anticoagulant therapy. However, patients with right ventricular dysfunction are the subgroup with increased mortality and may have better outcome with initial treatment with thrombolytic therapy. The study was done to see the outcome of thrombolytic therapy in angiographically proved patients of pulmonary embolism.We performed systemic workup of patients suspected of pulmonary embolism(PE). Diagnosis of PE was ruled out in patients with low probability of PE, as defined by Wells score and negative d dimer asssay. All patients were subjected to echocardiography. Those showing findings suggestive of PE, with right ventricular dysfunction, with or without hypotension, were subjected to pulmonary arteriography. Patients having evidence of PE were subjected to thrombolysis. Repeat angiography was done after the thrombolysis to see the effect of thrombolysis and fall in pulmonary artery pressures.:27 consecutive patients with angiographically proved PE were thrombolized. Mean age was 45.8±15.2 years. 18 were male and 9 were female. Average systolic and mean pulmonary artery pressure before thrombolysis was 71.2±14.4 and 47.5±10.5 mm Hg. Angiographic success was seen in 22 patients (81.5%). Average systolic and mean pulmonary pressure after thrombolysis was 47.1 ±21.7 and 29.4±16.5 mm Hg. Three patients with unsuccessful thrombolysis were successfully subjected to trans catheter thrombus extraction. One patient died during thrombolysis. None of the patients had major bleeding complications.Thrombolysis is effective in majority of patients with pulmonary embolism with right ventricular dysfunction. The bleeding risk is low.

We present a 48-year-old male patient with extensive lower-limb swelling and chronic kidney disease. Angiography revealed evidence of thrombus in the iliacs and the inferior vena cava was not visualized. Angioplasty of the entire length of the inferior vena cava is a challenging procedure. Surgery is rarely an option. Extensive skill and patience are needed and stenting is usually advised. In many cases, plain angioplasty may be done with favorable results.

Immunotherapy is the treatment that either boosts the patient’s immune system or uses human-made versions of the normal parts of the immune system to kill lymphoma cells or slow their growth. A forty-eight-year-old lady with neck nodes, axillary nodes, weight loss and fever diagnosed to have Diffuse Large B-Cell Lymphoma (DLBCL) in December 2009 was treated with 6 cycles of R-CHOP, and her treatment was completed in May 2010. After 2 years in July 2012, the patient developed similar symptoms and received salvage chemotherapy with R-DHAP, and her treatment was completed in January 2013. After one and a half years, in August 2014, the patient again had relapsed DLBCL. She was treated with R-ICE 4-cycles and rendered disease-free following allogeneic HSCT in June 2015. But in December 2016, the patient again developed isolated axillary lymphadenopathy and relapsed DLBCL was confirmed by HPR and IHC. This time, the patient was unwilling to go on chemotherapy, but after counselling about the new drug, Nivolumab, she became convinced, and her treatment was started with 3mg per kg every 2 weeks. After 4 cycles, she had a complete response and is now being treated with the same treatment without any symptoms of the disease or any adverse drug reactions. Nivolumab was well tolerated and exhibited antitumor activity in extensively pretreated patients with relapsed or refractory B- cell lymphomas. Additional studies are ongoing to learn more about the use of Nivolumab in these diseases.

Despite improvement in survival in diffuse large B-cell lymphoma (DLBCL) with the introduction of rituximab, central nervous system (CNS) relapse continues to represent a clinical challenge. In diffuse large B-cell lymphoma (DLBCL), the incidence of CNS relapse is only ∼5% in unselected cohorts. Immunotherapy is the treatment that either boosts the patient’s own immune system or uses man-made versions of the normal parts of the immune system to kill lymphoma cells or slow their growth. We are presenting a thirty-eight year old man who, presented with neck nodes, axillary nodes, altered sensorium, abnormal body movements, unconsciousness, weight loss and, fever, with a past history of DLBCL in May 2008, treated with 6 cycles of CHOP and completed in November 2008. After 9 years in April 2018, the patient developed similar symptoms and treated with salvage chemotherapy with R-DHAP which was completed in September 2018. Post-treatment PET-CT showed partial metabolic response and we started external beam radiotherapy to initial bulky disease. After completion of radiotherapy, the patient was very reluctant for any type of therapy and went home. After one month he presented to us with persistent vomiting, abnormal body movements and, altered sensorium. On examination, his Glasgow Coma Scale (GCS) was E2V3M2 and he was admitted in Intensive Care Unit. The patient was managed with mannitol, dexamethasone, antiepileptics, antibiotics and other supportive care medicines. His brain magnetic resonance imaging (MRI) was showing multiple heterogeneously enhancing lesions with surrounding vasogenic oedema and his cerebrospinal fluid analysis was positive for malignant cells. He was managed with triple intrathecal chemotherapy with methotrexate 12 mg, Cytarabine 50 mg, and Hydrocortisone 50 mg along with other supportive care medicines, and after 4–5 days he regained consciousness and he was able to talk and understand verbal commands. In view of improvement in general condition and performance status, we started biweekly triple intra-thecal therapy, and Inj. Nivolumab 3 mg per kg q 2 weekly. From the second cycle, we started Lenalidomide 10 mg once a day for 21 days with 7 days gap along with 2 weekly nivolumab and biweekly triple IT chemotherapy. After one month his CSF analysis was negative for malignant cells. Now he is on regular treatment with weekly IT chemotherapy, 2 weekly nivolumab and 3 weeks on and one week off lenalidomide. After 2 months of treatment, his MRI Brain was showing. At the time of submission of this article, he has completed the fifth cycle of immunotherapy and two cycles of lenalidomide. He was able to manage his daily ADL and able to walk with a stick. The patient tolerated immunotherapy, triple IT therapy and lenalidomide very well without much intolerable side effects. Therefore, we concluded that nivolumab and lenalidomide was well tolerated and exhibited antitumor activity in extensively pretreated patients with relapsed or refractory sanctuary site CNS B- cell lymphomas. Additional studies of Nivolumab and lenalidomide in these diseases are ongoing.

Presence of functional endometrial tissue anywhere outside the uterine mucosa is called endometriosis. It is hormone dependent and almost exclusively it affects the women of reproductive age. Abdominal scar endometriosis is a rare condition and it is due to deposition of endometriotic tissue in the wound site during various obstetric or gynecological operative procedures. Scar endometriosis followed by lower segment caesarean section (LSCS) is very rare and presents with co-menstrual pain and bleeding. Our case presented with active bleeding from abdominal LSCS scar during menstruation which is extremely a rare presentation. Wide excision and histo-pathological examination confirm the diagnosis. A 28-year-old lady with previous history of LSCS 2 years back presented with complaining of swelling and bleeding from the previous LSCS scar during menstruation, persisting for 4-5 days, repeatedly in every menstrual cycle for last 6 months. On examination a swelling with active bleeding from it was noted over the previous LSCS scar. Routine investigation and coagulation profile was with in normal limit and on ultrasonography a firm mass was noted. After wide excision and histo-pathological Examination, the diagnosis was confirmed. Co-menstrual swelling, pain and bleeding from the previous LSCS scar should not be neglected and may be due to scar endometriosis.

Placenta increta, one type of morbidly adherent placenta, is characterized by entire or partial absence of the decidua basalis, and by the incomplete development of the fibrinoid or Nitabuch’s layer and villi actually invading the myometrium. When the internal os is covered partially or completely by placenta, it is described as a placenta previa. Simultaneously these two complications occurring in a post LSCS scarred uterus is a very rare scenario and anticipated frequently to cause catastrophic obstetric outcome. A 32-years-old woman of second gravida, para 1, with previous history of LSCS 7 years back, with living issue one, admitted in our hospital at 35 weeks 5 days gestation with asymptomatic placenta previa with placenta increta. The case was diagnosed effectively by ultrasonography. Intra-operatively, compression sutures and bilateral uterine artery ligature was tried to control hemorrhage which were failed and a quick decision of caesarean hysterectomy was done. Preserving both ovaries, total hysterectomy was the only option to save the mother in our case. Other options attempting to preserve uterus could have ended up with grave consequences in this case. This was a very rare case of asymptomatic placenta previa with placenta increta in a post LSCS scarred uterus and it was successfully managed by judicious caesarean hysterectomy.

Background: Premature rupture of membrane is the unconstrained break of layer before the beginning of labor and can happen any gestational age even at 42 weeks of growth. Around 2-30 % of all pregnancy will encounter PROM and prompts 33% of preterm birth. The analysis of PROM is to a great extent clinical and is normally proposed by a history of watery vaginal discharge and affirmed on sterile speculum assessment. This examination was led to decide the occurrence, to discover the age, equality dispersion, gestational age dissemination, presentation of PROM and plan the line of the management.Methods: The cases selected in this study were those who had spontaneous rupture of membrane after 28 weeks of gestation but before the onset of labor pain. The study period was of one year from 1st January 2019 to 31st December 2019. The study was conducted in the labor room complex of Coochbehar Govt. Medical College and Hospital, WB India. The patients were admitted in the labor room through emergency. All datas were collected from labor room log book.Results: Total no. of deliveries were 10900 and total no of PROM were 545.Incidence of PROM is 5% in the present study. Maximum no of cases were in the age group between 20-29yr (63%). PROM mainly occurs in primigravida (50.45%). And low rupture of membrane was 91.8%. Cephalic is the commonest presentation (85%) in PROM and the incidence of caesarean section is 24.95%.Conclusions: PROM is the obstetric emergency and once the PROM is diagnosed it is important to weigh the risk of PROM and prematurity and make the right choice of conservative management and active management. If there is chance of maternal morbidity pregnancy should be terminated considering the maternal wellbeing first and then that of the fetus.

Aims & Objective: Hematological toxicity is common in patients with cervical cancer treated with concurrent chemo radiotherapy (CT-RT), so the purpose is to assess this hematological toxicity and correlate the toxicity with the dose and volume of bone marrow included in the field of radiation. Materials & Methods: Twenty-five patients with histologically proven cervical cancer attending to our cancer center from July 2008-August 2009 were the subjects of this study. Patients were treated on 6 MV linear accelerator with a radical intent with concurrent chemotherapy using cisplatin 50 mg weekly. The planning CT was done for all the patients before the treatment and contouring of the pelvic bone marrow apart from other organs at risk was done. Hematological toxicity was assessed using RTOG common toxicity criteria weekly during and at 2 weeks after the completion of the treatment. Results: A total of 25 patients on CT-RT treatment were assessed. Sixteen patients were in locally advanced stage. The variation in HB, TLC, Platelets, and ANC counts from the baseline to 2 weeks after chemo radiotherapy were assessed. Grade II anemia was observed in 12 and Grade III in 2 patients. There were no toxicity as far as WBC and platelets were considered. There was also no correlation between the volume of bone marrow included in the field of irradiation and appearance of anemia. Conclusion: CT-RT for cervical cancer is safe and is associated with minimal hematological toxicity in the form of anemia. The toxicity is same for different volumes of bone marrow included in the field of irradiation with both conventional as well as 3DCRT technique. The toxicity observed is probably contributed by Cisplatin. Citation Format: Irappa Madabhavi, Ragavendra Sagar, Apurva Patel, Malay Sarkar. Correlation of hematological toxicity with the bone marrow radiation dose and volume during concurrent chemo radiation in patients with cervical cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference on Radiation Science and Medicine; 2021 Mar 2-3. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(8_Suppl):Abstract nr PO-054.

Oral cavity metastases are considered rare and represent approximately 1% of all oral malignancies. Due to their rarity and atypical clinical and radiographic appearance, metastatic lesions are considered a diagnostic challenge. In this article we present a rare, unusual & exceptional case of left maxillary mass which on further evaluation leading to diagnosis of left breast carcinoma with metastasis to isolated left maxillary bone. Sixty five year old postmenopausal woman of low socioeconomic status with good performance status presented with a 3 months history of progressive pain and swelling in the left maxillary region. Fine Needle Aspiration Cytology (FNAC) from the maxillary mass shows invasive ductal carcinoma. On further clinical, radiographic, and histopathological examination findings from the breast lesion confirmed the diagnosis of hormone receptor positive metastatic breast carcinoma. In view of painful metastatic maxillary lesion with breast disease she was managed with a palliative radiotherapy to the maxillary lesion and palliative chemotherapy with Doxorubicin-Cyclophosphamide and bhisphosphonate-Zolendronic acid. Patient responded very well to palliative radiotherapy and chemotherapy, in view of hormone receptor positive breast cancer, now she is on Tab. Anastrazole 1 mg once a day along with monthly Zolendronic acid injection since last 13 months without any symptoms of disease evolution. A high index of clinical thought of metastatic cancer to maxilla is necessary when evaluating patients who complain of maxillary pain and swelling without a history of pain or swelling in the head and neck & non-head and neck region. To the best of our knowledge, this is the first reported case of a metastatic isolated solitary maxillary bone metastasis presenting as an early sign of breast cancer.

Background: Chronic obstructive pulmonary disease (COPD) is a lifestyle-related chronic inflammatory pulmonary disease and a major cause of morbidity and mortality globally. Osteoporosis and osteopenia are common observations in COPD and degree of the loss of bone mineral density (BMD) has been found to be proportionate to the severity of the disease. Objectives: Our objective was to study the prevalence of osteoporosis and osteopenia in stable COPD patients in Indian Sub-Himalayan population. Materials and Methods: This study was performed on 84 patients of COPD attending as outpatient in the Pulmonary Medicine Department after application of inclusion and exclusion criteria. A control group of 60 healthy controls was selected for comparison with COPD group. Spirometry was done on patients to stage the severity of COPD according to global initiative for chronic obstructive lung disease criteria. Dual-energy X-ray absorptiometry scan of the lumbar spine was done using bone densitometer to determine the severity of reduced BMD. The patients were categorized according to the World Health Organization criterion for definition of reduced BMD. Results: In the present study, a total of 45.2% patients had osteoporosis, 41.6% patients had osteopenia while the rest 13% patients had normal bone density in the COPD group. The prevalence of low bone density was about 4 times higher in COPD group as compared to control group. There were 15.48 times higher chances of low BMD in COPD patients as compared to healthy controls. Conclusions: Reduced BMD is a common comorbid entity in COPD patients which leads to increase in bone fragility and susceptibility to fracture. It is recommended that all the patients with COPD should be screened for osteoporosis to initiate the treatment for the disorder before they develop fractures.

Oxygen is an essential element for life and without oxygen humans can survive for few minutes only. There should be a balance between oxygen demand and delivery in order to maintain homeostasis within the body. The two main organ systems responsible for oxygen delivery in the body and maintaining homeostasis are respiratory and cardiovascular system. Abnormal function of any of these two would lead to the development of hypoxemia and its detrimental consequences. There are various mechanisms of hypoxemia but ventilation/perfusion mismatch is the most common underlying mechanism of hypoxemia. The present review will focus on definition, various causes, mechanisms, and approach of hypoxemia in human.

Present work is on the optimization of forging process parameters for wheel hub using numerical simulation. Aim of this paper is to reduce the loading conditions within the specified limit of 1600T and also to reduce the machining thickness. A Finite Element Method based numerical simulation is used to simulate from current design of die till finalized modified design. DEFORM 3D software was used to validate the modifications done in dies and process through simulation. The loading conditions were optimized in blocker and finisher operations with an improvement in yield by 13% using numerical simulation.

Comorbidities are common in chronic obstructive pulmonary disease (COPD). Cardiovascular comorbidity is a leading cause of morbidity and mortality in COPD patients. Low lung function is a risk factor for increased arterial stiffness, a condition that is common in COPD patients, independent of conventional cardiovascular risk factors. Arterial stiffness is an independent risk factor both for all-cause and for cardiovascular mortality, and carotid–femoral pulse wave velocity is the gold standard for the assessment of arterial stiffness. Various mechanisms proposed in the development of arterial stiffness include systemic inflammation, ageing, advanced glycation end products, renin–angiotensin–aldosterone system, increased elastolysis, and vitamin D deficiency. Early detection of arterial stiffness in COPD patients is warranted to detect cardiovascular comorbidity at the subclinical stage, which would help to prevent overt vascular events in the future. We need well-designed studies to see the impact of therapy that targets increased arterial stiffness on future cardiovascular events in COPD. This review discusses the epidemiology, diagnosis, and therapy of increased arterial stiffness in COPD patients.

Objectives To study the role of high-resolution computed tomography (HRCT) in the diagnosis of pulmonary tuberculosis (PTB) in sputum smear negative patients and to design HRCT criterion to forecast the threat of pulmonary tuberculosis. Material and methods We studied 69 patients having sputum smear negative for acid-fast bacilli (AFB) but still with clinical suspicion of PTB after taking written informed consent. We studied their medical characteristics, numerous separate HRCT-results and combination of HRCT findings to foresee the danger for PTB by utilizing univariate and multivariate investigation. Temporary HRCT diagnostic criteria were planned in view of these outcomes to find out the risk of PTB and tested these criteria on our patients. Results Chronic cough and night sweats were highly linked to a greater risk of PTB among clinical features. On HRCT chest presence of cavity, centrilobular nodules, consolidation, ground glass opacity (GGO), lymphadenopathy, main lesion in S1, S2, S6, lobular consolidation, other minute nodules and tree in bud appearance was significantly linked to an elevated risk of PTB in linear regression analysis. While cavity, centrilobular nodules, interlobular septal thickening, pleural effusion and tree-in-bud appearance was significantly linked to a greater threat of PTB in multivariate regression analysis. Positioning of the patients utilizing our HRCT indicative criteria uncovered reliable sensitivity and specificity for PTB patients determining that HRCT is a useful tool in sputum negative PTB patients. Conclusion HRCT is useful in selecting individuals with greater chances of PTB in the sputum smear-negative setting.

Purpose of study: Hemoptysis is a common emergency coming to the pulmonary medicine and general Medicine department. Massive hemoptysis has high mortality even after surgical treatment. Bronchial artery embolization is an effective alternative to surgery for controlling hemoptysis, with high success rate.