Search

There are various factors which affect the success rate of tympanic membrane (perforation) closure, including age of the patient, size of the perforation, duration of the ear discharge, the presence or absence of infective discharge at the time of surgery. Our aim was to observe the effect of presence of discharge from the ear on the success (outcome) of tympanoplasty. This is prospective study which was conducted on 300 cases with 150 patients each in dry and wet ear group. The study was conducted on patients of age 12–65 years and of either sex presenting with chronic otitis media. Ear discharge for less than 10 years, 78% in dry ear group and 81% in wet ear group. Around 64% had complaint of decreased hearing for

Salivary gland lesions comprise for about 2–6.5% of all head and neck neoplasms in adults. They are accessible for FNAC (Fine Needle Aspiration Cytology). The risk of fistula formation and/or tumour implantation are low compared to surgical biopsy. FNAC can also provide a distinction between asalivary and non-salivary lesion, benign and malignant lesions. 67 patients were studied prospectively over 5 years. FNAC was performed pre-operatively and histopathological examination post-operatively in patients who underwent surgery and were willing to participate in the study. 59.7% of the lesions were non-neoplastic and 58.2% were neoplastic (37.3% benign and 20.8% malignant). Pleomorphic adenoma was the most common benign neoplasm while mucoepidermoidand adenoid cystic carcinoma both were the most frequent malignant lesion. Among the non-neoplastic lesions, the most number of cases were of chronic sialadentis. In our study, FNAC has a sensitivity of 94.54% specificity of 80.95% for neoplastic lesions. It was seen that FNAC was a useful diagnostic tool in the evaluation of salivary gland lesions because of its simplicity, excellent patient compliance and rapid diagnosis. This cost effective tool is invaluable in planning the surgical management of the patient.

The objective of the study was to assess endoscopic coblation adenoidectomy and conventional cold curettage adenoidectomy in terms of safety and efficacy in pediatric patients. Study included 40 pediatric patients, aged between 4-17 years. 20 patients underwent cold curettage adenoidectomy and 20 underwent Coblation adenoidectomy. The 2 procedures were compared on various parameters like duration of surgery, intra-operative blood loss, and post -operative pain. To further the comparison, follow -up Nasal Endoscopy was done after 1 week and after 1 month to assess for injury to peripheral tissues and completeness of removal of adenoids. There was statistically significant difference, favouring Coblation adenoidectomy in terms of lesser intra-operative blood loss (mean blood loss of 19 mL Vs 28.5 mL) and lesser post -operative pain measured on Visual Analogue Scale (median VAS score of 2 Vs 2.67). Shorter duration of surgery (mean operative time of 10.3 min Vs 15.5 min) was the only parameter in favour of conventional cold curettage method. Injury to peripheral tissue and residual adenoid were seen in patients who underwent curettage adenoidectomy. The overall advantages of Coblation adenoidectomy when compared with cold curettage adenoidectomy are less intra-operative bleeding, less post -operative pain, completeness and preciseness of adenoid removal with minimal injury to adjacent tissues. For these reasons, Coblation adenoidectomy should be the standard technique adopted for adenoidectomy.

The objective of the study was to study the outcomes of interlay type 1 tympanoplasty in large central perforations in terms of graft uptake, hearing improvement and complications. Study included 150 symptomatic patients having large central perforation in tympanic membrane willing for surgery who later underwent tympanoplasty with or without cortical mastoidectomy. All the patients selected for study, were assessed for subjective and objective evaluation pre-operatively and then post-operatively after 4 months. The study was conducted at tertiary health care hospital. Type I tympanoplasty with Interlay technique for large central perforations is superior. The Interlay technique in Type I tympanoplasty has high success both in terms of graft uptake as well as ABG closure. In the view of the advantages it offers, it should be preferred over the other conventional techniques in patients with large central perforations for better results.

Amongst various differential diagnoses possible for intra-oral (palatal) mass, possibility of fibro-lipoma is extremely rare but documented in literature, and hence should be a consideration. Such patient requires thorough evaluation and step-wise approach to treat. This case study documents for a 30-year-old male patient presenting with such mass and chief complaints of post nasal drip, nasal obstruction (right side>left side) and intermittent headache for 3 years. After radiological and endoscopic examination, the mass was surgically removed in toto via dual route (trans-oral and endoscopic). Lipomas are uncommon tumors in the oral cavity, and palate being the rarest amongst them as is our case. It would be strongly advocated to keep lipoma in the differential diagnosis when evaluating a palatal mass. Also, it is worth mentioning and recommending that a careful radiological examination of large lesions arising from the palate is a must before approaching for surgery.

Al/p-CIAS Schottky diodes were fabricated by depositing aluminium (Al) on different flash evaporated copper–indium–aluminium–diselenide (CIAS) films of varying thickness. Further, all diodes were annealed at 573 K for an hour. The influence of p-CIAS film thickness and the thermal annealing of Al/p-CIAS Schottky diode were investigated by observing current–voltage (I–V) and capacitance–voltage (C–V) characteristics at room temperature. Various diode parameters, such as ideality factor (η), barrier height (ϕbo) and series resistance (Rs) were calculated using Cheung’s and Norde methods. ϕbo found to increase with annealing as well as with increase in the film thickness. However, the value of η and Rs decreases with annealing and CIAS thickness. The effective density of states (Nv), acceptor density of states (NA) and barrier height have been calculated from C–V measurements. Values obtained from CV analysis were well matched with I–V results. The value of Nv decreases and the value of NA increases with the increase in the film thickness. Using I–V and C–V parameters, energy band gap for the prepared Al/p-CIAS diodes has been reconstructed.

Background & Aims The effect of pregnancy on inflammatory bowel disease (IBD) remains poorly understood. We aimed to monitor intestinal inflammation using fecal calprotectin (FC) in pregnant women and their babies during early life. Methods Pregnant women with or without IBD and their infants were prospectively enrolled. FC levels were measured at each trimester of pregnancy and in babies throughout the first 3 years of life. Repeated-measures analysis was applied to investigate changes in FC levels while adjusting for confounders. The FC levels were correlated with the bacterial abundance in both mothers and babies. Results Six hundred and fourteen fecal samples from 358 mothers (98 with IBD) and 1005 fecal samples from 289 infants (76 born to IBD mothers) were analyzed. Pregnant Patients with IBD maintained higher FC levels through pregnancy compared with controls (P = 7.5 × 10–54). FC gradually increased in controls and declined in Patients with IBD throughout pregnancy (P for interaction = 5.8 × 10–7). Babies born to mothers with IBD presented with significantly higher FC levels than those born to controls up to 3 years of age, after adjusting for sex, delivery mode, feeding behavior, and antibiotics exposure (2 weeks to 3 months of age, P = .015; 12–36 months of age, P = .00003). Subdoligranulum, Roseburia, Fusicatenibacter, and Alistipes negatively correlated, and Streptococcus, Prevotella, Escherichia-Shigella, and Bifidobacterium positively correlated with maternal FC levels at T3. Faecalibacterium, Bifidobacterium, and Alistipes showed negative correlations, and Streptococcus were positively correlated with FC levels within 3 months of birth. Conclusions Pregnancy is associated with decreased inflammatory activity in mothers with IBD. Higher FC levels in babies born to mothers with IBD suggest subclinical inflammation in early life, the long-term consequences of which are uncertain.

BACKGROUND AND OBJECTIVES: Women with unilateral early-stage breast cancer are increasingly choosing contralateral prophylactic mastectomy (CPM) despite the absence of survival benefits and increased risk of surgical complications. Data are lacking on whether this trend extends to women with clinically locally advanced non-metastatic (cT4M0) cancer. This study aims to estimate national CPM trends in women with unilateral cT4M0 breast cancer. METHODS: Women aged ≥ 18 years, who underwent mastectomy during 2004–2014 for unilateral cT4M0 breast cancer were identified using the National Cancer Database and grouped as all locally advanced (T4), chest wall invasion, skin nodule/ulceration, or both (T4abc), and inflammatory (T4d) cancer. Poisson regression for trends and logistic modeling for predictors of CPM were performed. RESULTS: Of 23,943 women, 41% had T4abc disease and 35% T4d. Cumulative CPM rates were 15%, 23% and 18%, for the T4abc, T4d and all T4 groups, respectively. Trend analysis revealed a significant upsurge in CPM demonstrating 12% annual growth for T4abc tumors, 8% for T4d and 9% for all T4 (all P < 0.001). CONCLUSIONS: Increasing numbers of women with unilateral cT4M0 breast cancer, are undergoing CPM. This rising trend warrants further research to understand stakeholders’ preferences in surgical decision-making for women with locally advanced breast cancer.

Background: Tracheostomy is a common surgical procedure used to achieve a secure airway in patients in elective as well as emergency conditions. Our study accounts for our first-hand experience with the procedure in our tertiary multi-speciality hospital.Methods: It is a four year (January 2017 to February 2021) retrospective study in which all the 246 cases of tracheostomies were taken into account which were performed during this study period in the department of otorhinolaryngology (ENT), Surat Municipal Institute of Medical Education and Research (SMIMER), Surat (India). The patients were thoroughly followed up until the final outcome of the tracheostomy was established. Results: A total of 246 tracheostomies were performed, 63.82% of which were in men. The mean patient age was 42 years. The majority (76%) were elective, performed for various indications, while the remaining 24% were emergency tracheostomies. All tracheostomies were performed by otorhinolaryngologists. Complications relating to tracheostomy were documented in 40 patients (16%) intra-operatively and/or post-operatively which included bleeding, surgical emphysema, granulations along the stomal site and rarely shock. The mean time to decannulation was 13.48 days.Conclusions: Our study takes into account and discusses the findings of all the 246 tracheostomies which were performed during the study period of 4 years. Elective cases form the majority although there is a significant case series of emergency tracheostomies performed for a range of pathologies.

In this paper, we report a simple method to extract thickness and refractive index of thin-film from experimentally measured reflectivity spectra using teaching-learning based optimization (TLBO) algorithm. The algorithm finds thickness and refractive index by fitting an experimentally measured reflectivity spectra with theoretically ones generated by transfer matrix approach. The value of refractive index as a function of wavelength is determined by considering sellmeier dispersion relation. The algorithm is implemented by means of an interactive numerical simulation using LabVIEW as a programming tool. To check the effectiveness of the self-developed program, it is tested on different thin-film samples prepared from some commonly used optical materials such as MgF2, Al2O3 and SiO2 using electron beam evaporation technique. The values of thicknesses and refractive index spectra for different thin-film samples obtained by TLBO algorithm are verified using standard spectroscopic ellipsometry measurements. It is found that there is an excellent agreement between the results obtained by the TLBO algorithm and those by ellipsometry. It is also demonstrated that a simple reflectivity measurements give the valuable information about the thickness and dispersive refractive index over a range of wavelengths, which are obtained by our self-developed simulation program based on TLBO algorithm.

The multilayered anti-reflection coating (ARC) has been designed and implemented on the facets of edge-emitting laser diode in order to achieve ultra-low reflectivity over a broad wavelength range for suppression of optical feedback in the laser cavity. The design of the multilayer ARC has been obtained by a self-developed program based on genetic algorithm (GA) to achieve low-reflectivity of the order of 0.1 % over a spectral width of 50 nm around the central lasing wavelength of 818 nm and successfully implemented on the laser-diode facets. The effects of facets coating on the optical power emission and the spectral response of the lasers have been investigated. It is demonstrated that the simple design of multilayered ARC obtained using a self-developed GA can successfully reduce the optical feedback from the cavity and prevent the lasing action from the structure, which can be very useful for the fabrication of superluminescent Light Emitting Diodes (SLEDs).

Pheochromocytoma, a rare catecholamine-secreting tumor, typically manifests itself with paroxysmal hypertension, tachycardia, headache, and diaphoresis. Less often, symptoms related to substantial hemodynamic compromise and cardiogenic shock occur. We report the case of a 66-year-old woman who presented with abdominal pain. Examination revealed a large right adrenal mass, cardiogenic shock, and severe heart failure in the presence of normal coronary arteries. Within days, the patient's hemodynamic status and left ventricular ejection fraction improved markedly. Results of imaging and biochemical tests confirmed the diagnosis of pheochromocytoma-induced takotsubo cardiomyopathy. Medical therapy and right adrenalectomy resolved the patient's heart failure, and she was asymptomatic postoperatively. We recommend awareness of the link between pheochromocytoma and takotsubo cardiomyopathy, and we discuss relevant diagnostic and management principles.

Background: Amongst pediatric patients, oesophageal foreign bodies (OFBs) are relatively common clinical problem. Majority pass harmlessly through gastrointestinal tract, some can cause complications or morbidities. Our study considered and reviewed our experience in managing OFBs in pediatric patients, with emphasis on the management and outcomes of complicated cases.Methods: 77 cases of OFBs (diagnosis established), upto 12 years of age admitted at our tertiary hospital between January 2015 to December 2020 (duration of 6 years) were reviewed and analysed. On the basis of our analysis accounting demographic data, presenting symptoms, workup investigation, management, complications and outcomes, results and conclusions were derived.Results: Amongst cases, 43 were male and 34 female. Mean age for our cases was 5.4 years. 56 cases (72.7%) cases presented in the hospital within first 24 hours. Commonest foreign body found in 64 cases (83.1%) was coin. Most cases had history of witnessed ingestion. Commonest presentation was asymptomatic (with history of witnessed ingestion), followed by complaint of vomiting and drooling of saliva. Most patients were discharged within 48 hours post-operatively except for 2 patients who presented intra-operatively with edematous inflamed mucosa with slight charring on oesophagoscopy where foreign body was button battery (cell). Follow-up period ranged from 2 to 8 months and all patients had complete recovery without any sequelae.Conclusions: Our experience of 6 years with 77 pediatric patients with OFBs having various presentations have been reviewed, analysed and concluded here. All the patients had complete recovery without any sequelae.

Background: Fine-needle aspiration cytology (FNAC) is one of the most important pre-operative procedures used in the primary diagnosis of thyroid swelling. Even if non-surgical and non-invasive techniques can provide a diagnosis, the ultimate answer rests in the histopathological examination of the surgically excised thyroid tissue. A correlation of both FNAC and HPE though can help predict outcomes and may be helpful to avoid unnecessary surgical procedures for benign conditions. The purpose of this study was to establish a cyto-histological correlation and to evaluate accuracy of FNAC in diagnosing thyroid lesions.Methods: The study was carried out over a period of three years between September 2017 to September 2020 prospective study in which 38 cases were taken who eventually underwent thyroid surgery. A cyto-histological correlation was made between the pre-operative FNAC and the post-operative HPE report. These reports were correlated and conclusions drawn after statistical analysis.Results: Cyto-histological correlation was done and overall accuracy was 94.7%. Majority of cases were non-neoplastic, peak age of incidence was in third and fourth decade and there was female predominance.Conclusions: It was observed that FNAC is a very reliable test having high sensitivity, specificity and accuracy in diagnosing thyroid swellings which is also a simple, safe and cost effective modality in investigation.

Copper Indium Gallium Diselenide (CIGS) is a chalcogenide composite from I-II-IV group. It is widely used as an absorber layer having absorption coefficient α ∼ 10-5 cm-1 for fabrication of solar modules. In present study CIGS thin films were deposited by flash evaporation technique at different substrate temperature. Thin Films of 200 nm thickness were deposited on soda lime glass at different temperatures viz. Room temperature (RT), 200 °C, 225 °C, 250 °C, 275 °C, and 300 °C. The effect of substrate temperature on texture orientation was investigated. The thin films of two different thickness i.e. 200 nm was annealed at 400 °C in forming gas (N2: H2) atmosphere. The effect of annealing on the texture orientation was studied. The crystallite size of CIGS thin films in as deposited and annealed condition was measured using X-Ray diffraction. It was found that in CIGS thin films texture quality and crystallite size is enhanced by annealing treatment.

Recently Cu2ZnSnS4, i.e. Copper Zinc Tin Sulphide (CZTS), has emerged as a potential candidate for low-cost solar photovoltaics (PV) material because of it is relatively non-toxic and ingredient elements are earth abundant. However, achieving phase controlled, stoichiometric film of CZTS using low-cost technique is the key issue in development of CZTS based solar cell. Here, we report a study on structural and optical properties of CZTS films grown by dip-coating in view of its application as an absorber in thin film solar cells. The films were deposited by dipping glass substrates into the solution prepared by dissolving cation metal salts and thiourea in methanol. It is followed by drying the films in air at fixed temperature. The dip coated films were then annealed at 623 K, 723 K and 823 K. The influence of annealing on various structural and optical properties of the films were investigated by means of X-ray diffraction (XRD), Raman scattering spectroscopy, Scanning electron microscopy (SEM) and Diffused reflection spectroscopy. It was observed that the film annealed at 823 K shows good quality Kesterite structure of CZTS with preferred orientation of (112), (220) and (312) planes as revealed by the XRD pattern. The diffuse reflection spectra confirm the direct band-gap of 1.42 eV, which is very close to the optimum value for the semiconductor material as an absorber in solar-cells. Raman scattering with two different excitation wavelengths showed that other binary phases including the parasitic phases such as ZnS were not present. It also confirmed the characteristics signature of dominant CZTS phase in the film.

Background: Improper disposition of expired and left over medicine is real concern to people and ecosystem of earth. To reduce this burden, it is paramount important to create awareness, better belief and has virtuous practice among medical professionals about disposal of these expired and left over medicines. Aim and Objectives: The study was conducted to evaluate the knowledge, attitude, and practice (KAP) utility of out of date medications and left over medications disposal among health-care providers at a tertiary care teaching hospital. Materials and Methods: This was a cross-sectional, single center study conducted among health-care providers of tertiary care teaching hospital in western part of India. Participants willing to give consent were allowed to participate in the study and briefed on the aims and objectives of the study. Participants were given pre-validated questionnaire, which was consisted of total 15 questions of KPA regarding the disposal of expiry medications. The questionnaires was collected and assessed for their completeness. The data were recorded in Microsoft Excel Worksheet and analyzed by using appropriate statistical tests. Results: Out of 170 total participants, 78 (45.9%), 84 (49.4%), and 08 (4.7%) were of doctors, nurses, and pharmacists, respectively. 71 (41.8%) could give a relevant definition of expiration date of medicine. 156 (91.7%) participating staff felt that it is not safe to use medicine after its expiry date. 115 (67.7%) participants thought that medicine can be prescribed zero day before its expiry date. 56 (32.9%) staff agreed that expiry or unused medicine should be disposed in yellow color garbage bag. 73 (42.9%) participants agreed that they disposed the expiry medicines in toilet, sink, trash bin, or by any mean. 47 (35.6%) have disposed into trash bin, 41 (31%) into toilet followed by 21 (15.9%) into sink. Conclusion: Inappropriate disposal of expiry medicine has harmful effects on ecosystem of our planet and there need for effective drug disposal policy and program such as drug take away in United State of America.

Crohn’s disease (CD) follows a relapsing and remitting course incurring cumulative bowel damage over time. The question of whether or not the timing of the initiating biologic therapy affects long-term disease progression remains unanswered. Herein, we calculated rates of change in the Lemann index—which quantifies accumulated bowel damage—as a function of the time between the disease onset and initiation of biologic therapy. We aimed to explore the impact of the earlier introduction of biologics on the rate of progression of long-term cumulative bowel damage. Medical records of CD patients treated during 2009–2014 at The Mount Sinai Hospital were queried. Inclusion criteria were two comprehensive assessments allowing calculation of the index at t1 and t2: two time-points ≥ 1 year apart. Patients with biologics introduced before or within 3 months at inclusion (t1) were defined as Bio-pre-t1 and those who did not as Bio-post-t1. The rate of disease progression was calculated as the change in the index per year during t1–t2. A total of 88 patients were studied: 58 Bio-pre-t1 and 30 Bio-post-t1. Among the 58 Bio-pre-t1 cases, damage progressed in 29 (50%), regressed in 20 (34.5%), and stabilized in 9 (15.5%). Median time to initiation of biologics among patients whose index improved was nominally shorter compared to that in patients whose index progressed (8 vs. 15 years). Earlier introduction of biologics tended to correlate with the slower rate of progression (ρ = 0.241; p = 0.069). Earlier introduction of biologics tended to correlate with the slower progression of bowel damage in CD, reflected by the reduced rate of Lemann index progression.

Background: As per World Trade Organisation (WTO), from the year 2005, India granted product patent recognition to all new chemical entities (NCEs). This may affect the new drug approvals in India. The purpose of this study was to compare the new drug approvals in India with the United States (US) and the European Union (EU) regions. Methods: We obtained information about regulatory approval of new drugs in the US, EU, or India of last 5 years (from 2011 through 2015) from the publicly accessible databases of three regulatory agencies. For the drug products identified, the drugs were classified into fourteen main Anatomical Therapeutic Chemical (ATC) groups, review classification and approval date. Results: There were 509 new drugs approved from 2011 through 2015 by one or more of the three regulatory agencies. Total 182 new drugs were approved in US during the period of 2011 to 2015, with an average of 36.4 new drugs approved per year. For the same period a total of 257 new drugs were approved in the EU, with an average of 51.4 new drugs approved per year and in India a total of 70 new drugs were approved, with an average of 14 new drugs approved per year. There were more number of new drug approvals in antineoplastic and immunomodulating agents (L) ATC group in all the three regions (US= 66; EU= 61 and India= 17). Conclusions: For new drugs approved between 2011 and 2015, India has lagged behind the US and the EU in approval of new drugs. There was no difference in the patterns of new drug approvals with respect to the therapeutic areas.

Background: The U.S Food and Drugs Administration (FDA) is the world's leading drug regulatory authority. There are reports of more product pipelines in oncology therapy area. The objective of this study was to see the overall trends of new drug approvals by the U.S. FDA in last 5 years and find the therapeutic areas with higher new drug approvals. Methods: New drug approvals data obtained from publicly available databases of the U.S. FDA from 2011 through 2015. For the drug products identified, the drugs were classified into fourteen main Anatomical Therapeutic Chemical (ATC) groups, single or combination products, New Drug Application (NDA) chemical types, review classification and approval date. Results: There were 182 new drugs approved from 2011 through 2015 by the U.S. FDA with a mean of 36.4 approvals per year. Out of these 182 new drug approvals, 149 (81.87%) approvals were for new molecular entity (NME) and 33 (18.13%) for biologics license application (BLA). There were more number of new drug approvals in antineoplastic and immunomodulating agents (L) ATC group (n=66; 36.26% of total new drug approvals). Conclusions: For new drugs approved between 2011 and 2015, the U.S. FDA was first to approve majority of new drugs. There was upward trend of new drug approvals in antineoplastic therapeutic area.

BackgroundThe Model for End‐stage Liver Disease (MELD) has been used as a prognostic tool since 2002 to predict pre‐transplant mortality. Increasing proportions of transplant candidates with higher MELD scores, combined with improvements in transplant outcomes, mandate the need to study surgical outcomes in patients with MELD scores of ≥40.MethodsA retrospective longitudinal analysis of United Network for Organ Sharing (UNOS) data on all liver transplantations performed between February 2002 and June 2011 (n= 33 398) stratified by MELD score (60 years, obesity, peri‐transplantation intensive care unit hospitalization with ventilation, and multiple comorbidities.ConclusionsLiver transplantation in recipients with MELD scores of ≥40 offers acceptable longterm survival outcomes. Futility predictors indicate the need for prospective follow‐up studies to define the population to gain the highest benefit from this precious resource.

Article history: Received on: 29/10/2014 Revised on: 12/12/2014 Accepted on: 21/01/2015 Available online: 28/03/2015 Objective: To compare the efficacy and safety of different oral and parenteral iron preparations in patients with anemia. Methods: An observational, prospective study in patients of anemia in pregnancy and chronic kidney disease (CKD) receiving iron sucrose, oral ferrous ascorbate and ferrous sulfate were included. Demographic details, clinical history, baseline hemoglobin, anemia indices data were recorded in a case record form. The patients were followed up monthly for 12 weeks and observed for clinical and haematological improvement and adverse drug reactions (ADRs). The data was analyzed using paired t-test, unpaired t-test and Fisher`s exact test. Results: Out of 232 patients, 84 received iron sucrose, 62 ferrous ascorbate and 86 ferrous sulfate. Oral and parenteral iron preparations significantly (P

Background: This study was aimed to assess the knowledge regarding basic aspects of conduct of clinical trial and associated regulatory as well as ethical issues before and after and educational intervention in form of a workshop on Good Clinical Practice (GCP). Methods: One day workshop on “Good Clinical Practice” was planned which included important ethical and regulatory issues regarding clinical research. Various resource persons from industry and academia were chosen to address the workshop. Total 60 participants were enrolled for this one day workshop. Pre-workshop questionnaire of 15 questions were distributed before the actual topic started. Each participant had to fill the questionnaire form and return it within 15 minutes. Again at the end of workshop, post-workshop questionnaire containing the same questions were distributed and the participants were asked to fill the form. Sequence of questions was changed in post workshop questionnaire. Comparison between answers in pre and post workshop questionnaire was done. The primary outcome was knowledge, which was evaluated using the Wilcoxon signed rank test. Results: In Pre workshop, out of 60, total 28 (46.66%) participants had answered all 15 questions, while 30 (50%) participants had skipped to answer one question “Define GCP.” 2 out of 6 (3.33%) participants had not answered 4 and 5 questions out of 15, respectively. Total 45 out of 60 (75%) participants in post workshop answered all questions. All 15 (100%) questions were answered correctly in post workshop as compared to 11 (73.3%) questions in pre workshop. So, in post-workshop, there were significant (P

Indian medical heritage flows in two distinctive but mutually complimenting streams. The oral tradition being followed by millions of housewives and thousands of local health practitioners is the practical aspect of codified streams such as Ayurveda, Siddha, Unani. These oral traditions are head based and take care of the basic health needs of the people using immediately available local resources. Majority of these are plant based remedies, supplemented by animal and mineral products. Many of the practices followed by these local streams can be understood and evaluated by the codified stream such as Ayurveda. These streams are not static, historical scrutiny of their evolution shows the enriching phenomena at all times. Thus we have more than 7000 species of higher and lower plants and hundreds of minerals and animal product used in local health tradition to manage hundreds of disease conditions. A pertinent question that arises here is that in which basis these systems got enriched. Is it just trial error method over a point of time which gave rise to this rich tradition, is it an intuitive knowledge born out of close association with nature. One of the reasons for this attitude can be, that one is always made to believe that the science means that which can be explained by western models of logic and epistemology. The world view being developed and adopted by the dominant western scientific paradigm never fits in to the world view being followed and practiced by the indigenous traditions. This is well accepted by us due to the last 200 yrs of political and cultural domination by western and other alien forces.

Summary Intestinal stricture, a major complication of Crohn's disease (CD), results from fibromuscular remodeling and expansion of the intestinal wall. The corresponding microanatomical alterations have not been fully described, hindering progress toward understanding their pathogenesis and devising appropriate treatments. We used tissue-specific staining and quantitative digital histomorphometry for this purpose. Serial histologic sections from 37 surgically resected ileal strictures and adjacent nonstrictured controls from patients with CD were evaluated after staining for smooth muscle actin, collagen (Sirius red), and collagen types I, III, and V. Overall mural thickening in strictures was increased 2.2 ± 0.2-fold compared with nonstrictured regions of the same specimens. The muscular layer most altered was the muscularis mucosae (MM). Compared with the internal and external layers of the muscularis propria, (MP) which were expanded 1.9 ± 0.2- and 1.3 ± 0.1-fold, respectively, the MM was expanded 17.7 ± 2.6-fold, reflecting the combined effects of architectural disarray, an 11.6 ± 1.4-fold increase smooth muscle content, and elaboration of pericellular type V collagen. In contrast, the architecture of the MP was preserved and pericellular collagen was virtually absent; rather, fibrosis in this layer was limited to expansion of the intramuscular septa by collagen types I and III. The muscular arteries and veins within the strictured submucosa frequently exhibited eccentric, luminally oriented adventitial mantles comprising hyperplastic myocytes and extracellular type V collagen. We conclude that the fibromuscular remodeling which results in CD-associated ileal strictures predominantly involves the MM and submucosal vasculature in a luminally polarized fashion and suggests that mucosal-based factors may contribute to stricture pathogenesis.

Background Standard outpatient induction dosing of infliximab (IFX) may not be effective in hospitalized ulcerative colitis (UC) patients with higher inflammatory burden and colectomy risk. Our aim was to determine whether initial IFX induction dose affects 30-day colectomy rate and other disease-related outcomes. Methods IFX-naive hospitalized UC patients receiving at least 1 inpatient 5 mg/kg (SD) or 10 mg/kg (HD) IFX induction dose were included. Baseline demographics and admission-related characteristics were documented. Propensity score based matching was used to control for provider bias introduced due to nonprotocolized choice of IFX dose. The primary outcome was 30-day colectomy; secondary outcomes included the need for an accelerated induction IFX (AD), length of stay (LOS), 90-day and 1-year colectomy, and complications. Results Of 146 (120 SD/26 HD) patients included, 25 (17.1%) underwent colectomy by 30 days, 33 (22.6%) by 90 days, and 41 (28.1%) by 1 year. In 21 propensity score matched dyads (n = 42) treated with SD or HD, colectomy rates and LOS were similar. SD patients more often needed AD (23.8% vs. 0%, P = 0.048) and AD patients progressed to colectomy more rapidly within 30 days compared to non-AD (P = 0.001). Female sex and hypoalbuminemia were associated with significantly increased odds of needing AD on both univariate and multivariate analyses. Conclusions In our propensity score based analysis, receiving accelerated IFX dosing after an initial SD infusion was associated with significantly higher 30-day colectomy rates in hospitalized acute UC patients. The most effective dosing strategy in this population remains unclear and prospective randomized studies are needed.

Urinary disorders have a specific identity both in modern and Ayurvedic system of medicine. The improper purificatory procedure results in residual accumulation of Kapha and Pitta Prakopa in Mootravaha Srotas. Hence all the Doshas collectively result in formation of Ashmari. The information regarding Ashmari is available in almost all Samhitas. The disease is prevalent irrespective of their socio-economic and cultural background. The process of stone formation is called Urolithiasis. Most calculi arise in kidney when urine becomes supersaturated with a salt that is capable of forming solid crystals. There are different treatment lines for the management of Ashmari in modern system. Management of urinary disease occupies an important place in Ayurveda. Varunamula Twak Kwatha administerd in Paneeya form, which is having Vedana Shamaka, Ashmrighna properties which leads to disintegration, dissolution, dislodgement and expulsion of stone. A 36 yrs young male presenting with history of symptoms of Mootrashmari like Teevravedana over Nabhi, Vasti, Sevani and Medra during micturition, aggravation of pain during running, jumping, walking long distance etc. since 3 days has presented here.

Background and AimsRecently, smooth muscle hypertrophy has been suggested to be a contributor to small bowel lesions secondary to Crohn’s disease [CD], in addition to inflammation and fibrosis. Here, we assess the value of magnetic resonance imaging [MRI] for the characterisation of histopathological tissue composition of small bowel CD, including inflammation, fibrosis, and smooth muscle hypertrophy.MethodsA total of 35 consecutive patients [male/female 17/18, mean age 33 years] with ileal CD, who underwent small bowel resection and a preoperative contrast-enhanced MRI examination within 1 month before surgery, were retrospectively included. Image assessment included qualitative [pattern/degree of enhancement, presence of ulcerations/fistulas/abscesses] and quantitative parameters [wall thickness on T2/T1-weighted images [WI], enhancement ratios, apparent diffusion coefficient [ADC], Clermont and Magnetic Resonance Index of Activity [MaRIA] scores). MRI parameters were compared with histopathological findings including active inflammation, collagen deposition, and muscle hypertrophy using chi square/Fisher or Mann-Whitney tests and univariate/multivariate logistic/linear regression analyses.ResultsForty ileal segments were analysed in 35 patients. Layered pattern at early-post-contrast phase was more prevalent (odds ratio [OR] = 8; p = 0.008), ADC was significantly lower [OR = 0.005; p = 0.022], and MaRIA score was significantly higher [OR = 1.125; p = 0.022] in inflammation grades 2–3 compared with grade 1. Wall thickness on T2WI was significantly increased [OR = 1.688; p = 0.043], and fistulas [OR = 14.5; p = 0.017] were more prevalent in segments with disproportionately increased muscle hypertrophy versus those with disproportionately increased fibrosis. MaRIA/Clermont scores, wall thickness on T1WI and T2WI, and ADC were all significantly correlated with degree of muscular hypertrophy.ConclusionsMRI predicts the degree of inflammation, and can distinguish prominent muscle hypertrophy from prominent fibrosis in ileal CD with reasonable accuracy (area under receiver operating characteristic curve [AUROC] > 0.7).

Pain is among the most common reasons that patients seek medical care, and inadequate assessment may result in suboptimal management. Acute pain in response to trauma or surgery can be complex, variable, and dynamic, but its assessment is often simplistic and brief. One-dimensional rating scale measures of pain severity facilitate rapid evaluation and often form the basis of treatment algorithms. However, additional features of pain should inform the selection of a treatment regimen, and can include pain qualities, duration, impact on functional capabilities, and underlying cause. Patient age, sex, psychosocial features, and comorbid conditions are also important features to consider. Use of a multidimensional tool is recommended for assessing many of these features if time permits. Additionally, clinicians often fail to recognize or consider the potentially detrimental long-term effects of acute pain. As the United States continues to experience a prescription drug crisis, a "universal precautions" approach including abuse risk assessment and abuse deterrence strategies should be implemented for patients receiving opioids. Increased efforts and research are necessary to enhance the utility of available acute pain assessment tools. Developing more comprehensive tools for patient assessment is the first step in achieving the ultimate goal of effective acute pain management. The objectives of this review are to summarize issues regarding the complexity of acute pain and to provide suggestions for its evaluation.

Background: The objective of the study was to hear the results in patients with atticoantral-chronic otitis media who undergone canal wall down mastoidectomy with different types of tympanoplasty.Methods: 86 cases of CSOM-AA were included. Patients were divided in 3 groups according to intra-operative ossicular chain status and reconstruction. Group A were patients having intact stapes superstructure and the graft kept over the stapes head covering middle ear and mastoid cavity. Group B patients were with intact superstructure of stapes and graft kept over cartilage graft kept on mobile stapes head. Group C patients were with absent superstructure of stapes with intact, mobile footplate and graft kept over autologous or homologous cartilage kept on footplate of stapes. On 10th week and 24th week after surgery, PTA was carried out to compare pre and post-operative hearing status. The study was conducted at SMIMER Hospital, Surat (a tertiary health care hospital) fromSeptember 2016 to September 2017. Results: In 86 patients, average mean preoperative AC threshold was 48.16 (±15.15) dB, mean pre-operative BC was 8.96 (±7.85) dB and mean pre-operative air bone gap was 40.11 (±12.92) dB. The mean post-operative AC threshold was 43.17 (±13.72) dB, mean post-operative BC was 11.34 (±9.44) dB and postoperative air bone gap was 32.06 (±11.62) dB. The mean air bone gap closure was 8.76 (±11.86). This hearing gain was statistically highly significant (pConclusions: Hearing improvement can be achieved with appropriate reconstruction in CWD mastoidectomy.

The organometal perovskite solar cells have shown stupendous development and have reached a power conversion efficiency (PCE) of 22.1%. However, the toxicity of lead in perovskite solar cells is a major challenge towards their incorporation into photovoltaic devices and thus needs to be addressed. Tin perovskite (CH3NH3SnI3) have attracted a lot of attention recently and could be a viable alternative material to replace lead perovskite in thin film solar cells. A detail understanding of effects of each component of a solar cell on its output performance is needed to further develop the technology. In this work, we performed a numerical simulation of a planar heterojunction tin based perovskite solar cell using SCAPS (Solar Cell Capacitance Simulator). Results revealed that thickness and defect density of the absorber material strongly influence the PCE of the device. Various types of hole transporting material (HTM) were compared and analysed to improve the performance of the solar cell. Parameters such as hole mobility and acceptor density of HTM also signified dependence on PCE of the device. These results indicate the possibility to design, fabricate and enhance the performance of tin based perovskite solar cells.

Zirconium dioxide thin films were prepared by e-beam evaporation method to study the effect of substrate temperature on the structural, surface morphology, compositional, and optical properties. X-ray diffraction measurement shows that the films grown at 400 °C substrate temperature have monoclinic crystal structure. The root mean square surface roughness of the film increases with increase in the substrate temperature. The optical transmittance spectra indicate an average 80% transmittance in the visible region of light. The optical energy band gap of ZrO2 thin film decreases from 5.68 to 5.63 eV as the substrate temperature increases from room temperature to 400 °C, respectively. Copyright © 2012 VBRI press.

Type 2 diabetes mellitus causes significant morbidity and mortality on account of its progressive nature and results in considerable burden on healthcare resources. Current treatment strategies have only limited long-term efficacy and tolerability given the progressive nature of the disease leading to inadequate glycemic control and are also associated with undesirable side effects such as weight gain, hypoglycemia and gastrointestinal distress. In the light of these existing limitations, exploring new treatment targets and new therapies have become the need of the hour at present. The incretin pathway, in particular, glucagon-like peptide (GLP-1), plays an important pathological role in the development of type 2 diabetes mellitus, and treatments targeting the incretin system have recently generated surmount interest. These can mainly be categorized into two broad classes; GLP-1 agonists/analogs (exenatide, liraglutide), and dipeptidyl peptidase- 4 inhibitors (sitagliptin, vildagliptin). The gliptins act by prolonging the action of incretins, the gut hormones which can boost insulin levels. Linagliptin is the latest dipeptidyl peptidase-4 inhibitor to complete pivotal phase III trials, which have demonstrated its superiority to its competitors based on its low therapeutic dose, long-lasting inhibition of DPP-4 activity and a good safety/tolerability profile. One of the unique characteristics of linagliptin is its primarily non-renal route of excretion. The drug has recently been approved by the US Food and Drug Administration and has been portrayed as a promising treatment option for patients in whom metformin and the other DPP-4 inhibitors are either contraindicated or require dose adjustment because of moderate to severe renal impairment.

The increased mortality rate due to atherothrombotic events and related complications has necessitated the search for new pharmacological agents. Hyperlipidemia, thrombosis and oxidative stress are the primary underlying concerns in the pathogenesis of atherosclerosis. Metformin, although proved to be beneficial in micro and macrovascular complications of diabetes mellitus, its effects on pure cardiovascular subjects are still debatable. Hence, the aim of the present study was to investigate the effects of metformin on atherothrombotic risk factors in experimental hyperlipidemic rats. Hyperlipidemia was induced by an intra-peritoneal injection of criton X-100 (25 mg/kg). Assessment of the effects of metformin (300 mg/kg/day, 400 mg/kg/day and 500 mg/kg/day) on lipid profile, coagulation time (activated partial thromboplastin time and prothrombin time), fibrinogen level, thrombosis, lipid peroxidation, antioxidant enzymes level, plasma fluorescent oxidation products and aortic nitrite level revealed an overall improvement in the lipid profile at the dose of 400 mg/kg along with a significant reduction in oxidative stress as compared to criton X-100 treated control. Activated partial thromboplastin and prothrombin times were prolonged at all doses, while plasma fibrinogen level remained unaffected. Metformin pre-treatment also reduced endothelial cell damage in ferrous chloride induced thrombosis in carotid arteries. Thus, the results indicate a potential protective effect of metformin on atherothrombotic risk factors, as evident from an improvement in lipid profile, reduction in oxidative stress and thrombotic events.

We present the preliminary results of temperature and frequency dependent dielectric measurements on Ba(Co1/3Nb2/3)O3 (BCN) thin films. These films were prepared on indium tin oxide (ITO) coated glass substrates by the pulse laser deposition (PLD) technique. It exhibits single-phase hexagonal symmetry. These films were irradiated with Ag15+ (200 MeV) and O7+ (100 MeV) beams at the fluence 1 × 1011, 1 × 1012, and 1 × 1013 ions/cm2. On irradiating these films, its dielectric constant (ɛ′) and dielectric loss (tan δ) parameters improve compared to un-irradiated film. Compared to O7+ irradiation induced point/cluster defects Ag15+ induced columnar defects are more effective in reducing/pinning trapped charges within grains. The present paper highlights the role of swift heavy ion irradiation in engineering the dielectric properties of conductive samples to enable them to be useful for microwave device applications.

Background: Fat graft myringoplasty (FGM) is a procedure with a short learning curve, cost effective, with minimal morbidity in properly selected patients. It is useful to relieve the patient of annoyance caused by a small perforation in terms of ear discharge and hearing loss. The aim was to assess postoperative hearing improvement and investigate influence of factors like age, gender and location of perforation on audiological outcomes.Methods: This study was a prospective study done on 25 patients at a tertiary care hospital who underwent FGM. All patients had small dry central perforation. Air and Bone conduction (AC/BC) thresholds and air-bone gap (ABG) were evaluated both preoperatively and postoperatively. Results: Mean hearing improvement was 14.4762 dB in 40 yrs age group. Mean hearing improvement in females was 13.75 dB whereas it was 14.154 dB in males. Mean hearing improvement was 15 dB in posterior, 14.7 dB in inferior and 14.46 dB in anteriorly located perforation.Conclusions: FGM is effective in improving postoperative hearing thresholds hence it can be used in small dry central perforations of tympanic membrane in patients irrespective of patient variables such as age, gender, and location of perforation. As no significant statistical difference was observed in terms of gender, location or aetiology of perforation, we consider it a procedure to be recommended across all spectrums of patients.

Indium tin oxide (ITO) thin films were deposited by radio frequency (RF) magnetron sputtering onto glass substrates. The transparent and conducting ITO thin films were obtained on externally unheated glass substrate, without any post-heat treatment, and by varying the deposition process parameters such as the working pressure and the RF Power. The effect of the variation of the above deposition parameters on the structural, surface morphology, electrical, and optical properties of the thin films have been studied. A minimum resistivity of 2.36 × 10−4 Ω cm and 80% transmittance with a figure of merit 37.2 × 10−3 Ω−1 is achieved for the thin films grown on externally unheated substrate with 75 W RF power and 0.5 mTorr working pressure.

Reflectivity simulation is an essential tool for the design and optimization of optical thin films. We have developed a reflectivity simulator for non-absorbing dielectric multilayer optical thin films using LabVIEW. The name of the substrate material as well as the material and thickness of each layer of the multilayer stack are fed into the program as input parameters in a pop-up window. The program calculates reflectivity spectrum for the given range of wavelengths using layer thicknesses and dispersion data of refractive indices for the defined stack of dielectric materials. The simulated reflectivity spectra for various combinations of materials in multilayer stacks are presented and compared with the experimental results of the multilayer optical thin films grown by electron-beam evaporation technique.

Stoichiometric compound of copper indium diselenide (CuInSe2) was synthesized by direct reaction of high-purity elemental copper, indium and selenium in an evacuated quartz ampoule. The phase structure and composition of the synthesized pulverized material analyzed by X-ray diffraction (XRD) and energy dispersive analysis of X-rays (EDAX) revealed the chalcopyrite structure and stoichiometry of elements. Thin films of CuInSe2 were deposited onto organically cleaned soda lime glass substrates held at different temperatures (i.e. 300 K to 573 K) using thermal evaporation technique. CuInSe2 thin films were then thermally annealed in a vacuum chamber at 573 K at a base pressure of 10− 2 mbar for 1 h. The effect of substrate temperature (Ts) and thermal annealing (Ta) on structural, compositional, morphological, optical and electrical properties of films were investigated using XRD, transmission electron microscopy, EDAX, atomic force microscopy (AFM), optical transmission measurements and Hall effect techniques. XRD and EDAX studies of CuInSe2 thin films revealed that the films deposited in the substrate temperature range of 423–573 K have preferred orientation of grains along the (112) plane and near stoichiometric composition. AFM analysis indicates that the grain size increases with increase of Ts and Ta. Optical and electrical characterizations of films suggest that CuInSe2 thin films have high absorption coefficient (104 cm− 1) and resistivity value in the interval 10− 2–101 Ω cm influenced by Ts and Ta.

Copper indium diselenide (CuInSe2) compound was synthesized by reacting its constituent’s elements copper, indium and selenium in near stoichiometric proportions (i.e. 1:1:2 with 5% excess selenium) in an evacuated quartz ampoule. Synthesized pulverized compound material was used as an evaporant material to deposit thin films of CuInSe2 onto organically cleaned sodalime glass substrates, held at different temperatures (300–573 K), by means of single source thermal evaporation method. The phase structure and the composition of chemical constituents present in the synthesized compound and thin films have been investigated using X-ray diffraction and energy dispersive X-ray analysis, respectively. The investigations show that CuInSe2 thin films grown above 423 K are single phase, having preferred orientation of grains along the (112) direction, and having near stoichiometric composition of elements. The surface morphology of CuInSe2 films, deposited at different substrate temperatures, has been studied using the atomic force microscopy to estimate its surface roughness. An analysis of the transmission spectra of CuInSe2 films, recorded in the wavelength range of 500–1500 nm, revealed that the optical absorption coefficient and the energy band gap for CuInSe2 films, deposited at different substrate temperatures, are ∼104 cm−1 and 1.01–1.06 eV, respectively. The transmission spectrum was analyzed using iterative method to calculate the refractive index and the extinction coefficient of CuInSe2 thin film deposited at 523 K. The Hall effect measurements and the temperature dependence of the electrical conductivity of CuInSe2 thin films, deposited at different substrate temperatures, revealed that the films had electrical resistivity in the range of 0.15–20 ohm cm, and the activation energy 82–42 meV, both being influenced by the substrate temperature.

Tungsten trioxide (WO3) thin films are of great interest due to their enormous and promising applications in various opto-electronic thin-film devices. We have investigated the structural, electrical, and optical properties of the WO3 thin films grown by thermal evaporation of WO3 powder and their dependence on growth condition. The WO3 thin films were grown on glass substrates at different substrate temperature varying from room temperature to 510 °C. The structural characterization and surface morphology were carried out using X-ray diffraction and atomic force microscopy, respectively. The amorphous films were obtained at substrate temperatures below 450 °C whereas films grown above 450 °C were crystalline. The surface roughness and the grain size of the films increase on increasing the substrate temperature. The electrical characterization has been carried out using four-point-probe methods. The resistivity of the films decreases significantly while the carrier concentration and mobility increase with the substrate temperature. The transparency and optical energy band-gap, Eg, of the films are found to decrease monotonically as the substrate temperature increases.

Laser diodes are by far the most varied, flexible, cheapest and the most abundant lasers. For long-term, reliable operation and for maximum optical power utilization, laser diode is coated with the anti-reflection (AR) and high-reflection (HR) coatings by means of dielectric layers on the front and the back facet, respectively. For the optimum performance, accurate monitoring and control over the reflectivity of the dielectric thin film layers at specific lasing wavelength is necessary. We have demonstrated a simple and inexpensive in-situ reflectivity measurement system for the facets-coating of laser diodes. The system relies on the measurement of dynamic optical reflectance of the growing thin film by means of intensity of a laser-beam reflected from the gallium arsenide test-substrate kept in the close vicinity of the laser diode facet being coated. The in-situ reflectivity monitoring of single layer AR film and multilayer HR films have been demonstrated and verified with ex-situ reflectivity measurements.

TiO2-ZrO2 and Zn doped TiO2-ZrO2 nanocomposites were prepared by hydrothermal method for dye sensitized solar cell (DSSC) application. The structural and optical properties were investigated by X –ray diffraction (XRD) and UV-Visible spectroscopy respectively. XRD results revealed the formation of material in nano size. The average crystallite size is 22.32 nm, 17.41 nm and 6.31 nm for TiO2, TiO2-ZrO2 and Zn doped TiO2-ZrO2 nanocomposites respectively. The optical bandgap varies from 2.04 eV to 3.75 eV. Dye sensitized solar cells were fabricated using the prepared material. Pomegranate juice was used as a sensitizer and graphite coated conducting glass plate was used as counter electrode. The I – V characteristics were recorded to measure photo response of DSSC. Photovoltaic parameter like open circuit voltage, power conversion efficiency, and fill factor were evaluated for fabricated solar cell. The power conversion efficiency of DSSC fabricated with TiO2, TiO2-ZrO2 and Zn doped TiO2-ZrO2 nanocomposites ...

The optical output power of a laser diode can be enhanced by anti-reflection (AR) and high-reflection (HR) facet coatings, respectively, at the front and back facet. AR and HR coatings also serve the purpose of protection and passivation of laser diode facets. In this work, we have designed and optimized a single layer λ /4 thick Al 2 O 3 film for the AR coating and a stack of λ /4 thick Al 2 O 3 / λ /4 thick Si bi-layers for the HR coating for highly strained InGaAs quantum-well edge emitting broad area (BA) laser diodes. Effect of the front and back facet reflectivities on output power of the laser diodes has been studied. The light output versus injected current ( L–I characteristics) measurements were carried out on selected devices before and after the facet coatings. We have also carried out the numerical simulation and analysis of L–I characteristics for this particular diode structure. The experimental results have been compared and verified with the numerical simulation.

Sympathetic blocks for viscerally mediated abdominal pain are a useful adjunct to control pain in appropriately selected patients. Complications from these blocks include infection, bleeding, puncture of nearby structures, or nerve injury. Infectious complications may be minimized by the use of sterile technique including chlorhexidine prep and the use of surgical masks by the practioners. Bleeding and inadvertent puncture of nearby organs may be decreased by utilizing blunt needles and appropriate imaging. The use of neurolytics may cause complications secondary to the inadvertent spread of the injection to nearby structures or intravascular injection. These complications may be decreased through injection of contrast during live fluoroscopy. In addition, technologies of radiofrequency ablation may help to decrease concerns of spread of neurolytics. Despite significant risks, these blocks have been shown to not only decrease pain but also increase quality of life in appropriately selected patients.

As a result of the undesired action of opioids on the gastrointestinal (GI) tract, patients receiving opioid medication for chronic pain often experience opioid-induced bowel dysfunction (OBD), the most common and debilitating symptom of which is constipation. Based on clinical experience and a comprehensive MEDLINE literature review, this paper provides the primary care physician with an overview of the prevalence, pathophysiology and burden of OBD. Patients with OBD suffer from a wide range of symptoms including constipation, decreased gastric emptying, abdominal cramping, spasm, bloating, delayed GI transit and the formation of hard dry stools. OBD can have a serious negative impact on quality of life (QoL) and the daily activities that patients feel able to perform. To relieve constipation associated with OBD, patients often use laxatives chronically (associated with risks) or alter/abandon their opioid medication, potentially sacrificing analgesia. Physicians should have greater appreciation of the prevalence, symptoms and burden of OBD. In light of the serious negative impact OBD can have on QoL, physicians should encourage dialogue with patients to facilitate optimal symptomatic management of the condition. There is a pressing need for new therapies that act upon the underlying mechanisms of OBD.

Purpose: New biomarkers for prostate cancer are needed. We determined whether a novel serum marker, total PSP94 can be used to accomplish these goals.Materials and Methods: We conducted a case-control study of 1,212 men with no previous history of prostate cancer and who underwent a prostate biopsy from 1998 to 2000 because of an increased PSA or an abnormal DRE. Serum PSP94 levels were assessed using a sandwich enzyme-linked immunosorbent assay technique. Cases were patients with prostate cancer, and controls were patients who had no evidence of cancer. Multivariate logistic regression analysis was used to determine whether or not PSP94 levels improved the predictive value for prostate cancer.Results: Of the 1,212 men 596 (49.2%) had cancer detected. The median PSP94 level was significantly lower among cases (2.60 ng/ml) than among controls (3.40 ng/ml, p