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Type 2 leprosy reaction (T2LR), or Erythema Nodosum Leprosum (ENL), often poses a therapeutic challenge to clinicians and commonly requires long courses of steroids for control. While immunosuppressants are known to achieve control and lower steroid dependence in T2LR, the prospect of managing a severe T2LR in conjunction with COVID-19, with the concern of worsening COVID-19 with long-term immunosuppression has not previously been encountered. We report a case of severe T2LR treated with oral steroids and methotrexate, with COVID-19 infection acquired during hospital stay, and a favourable outcome achieved despite the continued use of immunosuppressants. We discuss the possible reasons for this both in terms of the drug pharmacodynamics and the immunological profile of T2LR.

The knowledge of breast cancer risk factors and screening practices in a community is largely influenced by the practising gynaecologist in that area. We assessed the understanding and knowledge of gynaecologists about breast cancer: screening, risk factors, clinical signs, management and common benign breast diseases. This cross-sectional study was carried out in Uttar Pradesh, India, from April to September 2017. One hundred and fifty-two gynaecologists were assessed using a self-designed and validated questionnaire to assess the knowledge of risk factors, clinical signs, screening practices and management of breast cancer as well as common benign breast diseases. Further, the results were compared based on their education: undergraduates (UGs; no residency experience in obstetrics and gynaecology) versus postgraduates (PGs; residency experience in obstetrics and gynaecology). 67 and 82.2% of gynaecologists possess excellent to very good knowledge of risk factors and clinical signs of breast cancer, respectively. The knowledge of PGs seems to be better than UGs (p

The core of every microprocessor, digital signal processor (DSP), and data processing application-specific integrated circuit(ASIC) is its data path. At the hearts of data paths and addressing units are arithmetic units, such as a comparators , adders, and multipliers. In this paper, a 4-input decimal adder has been developed using 90 nm CMOS technology. The schematic of decimal adder is designed and simulated for its behavior using DSCH-3.1 The layout of simulated adder is created using Verilog based netlist file which is further simulated using Micro wind 3.1 to analyze the performance. The result shows that designed decimal adder has consumed 0.603mW power. Keywords-Adders, ALU,ASIC, Carry Look Ahead Adders, CMOS, Decimal Addition, DSP .