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Addiction is a very common habitual psychological or physiological disorder in this modern era. It is a condition of dependence on any substances or drugs. It harms human beings along with its social consequence. Sudden withdrawal of addicted drugs produces different types of psychosomatic disorders. Addiction is not only about drug addiction or alcohol addiction or substance addiction. In the Ayurvedic view, overuse of any aspect and every aspect is considered an addiction. Addictions influence the physical, emotional and psychological behaviour of an individual with a wrong effect. Tobacco and alcohol are the most widely consumed psychotropic drugs which are used worldwide. The common use of both increases the risk of noncommunicable diseases to many folds. Ayurvedic texts have described different types of De-addiction treatment which can be applied in this context along with replacement therapy with medicines described in the Madatyaya chapter of Charaka Samhita Chikitsa sthana. The main aim of this review article is to compile and evaluate the concept of tobacco addiction and its management. All the descriptions of addiction mentioned in different Ayurvedic texts were critically analyzed and discussed to check their relation.

Objective: Comparison between bovine-derived demineralized bone matrix (DMBM) and iliac crest graft over long term for secondary alveolar bone grafting (SABG) in patients with unilateral cleft lip and palate (UCLP) in terms of radiological and clinical outcomes. Design: Prospective, randomized, parallel groups, double-blind, controlled trial. Setting: Unit of Oral and Maxillofacial Surgery, Oral Health Science Centre, Postgraduate Institute of Medical Education & Research, Chandigarh. Participants: Twenty patients with UCLP. Interventions: Patients were allocated into group I (Iliac crest bone graft) and group II (DMBM) for SABG. Outcomes were assessed at 2 weeks, 6 months, and then after mean follow-up period of 63 months. Outcomes Measures: Volumetric analysis of the grafted bone in the alveolar cleft site was done through cone beam computed tomography using Cavalieri principle and modified assessment tool. Clinical assessment was performed in terms of pain, swelling, duration of hospital stay, cost of surgery, alar base symmetry, and donor site morbidity associated with iliac crest harvesting. Results: Volumetric analysis through Cavalieri principle revealed comparable bone uptake at follow-up of 6 months between group I (70%) and group II (69%). Modified assessment tool showed no significant difference between horizontal and vertical bone scores over short- and long-term follow-up. In group II, there was higher cost of surgery, but no donor site morbidity unlike group I. Conclusions: Demineralized bone matrix proved analogous to iliac crest bone graft as per volumetric analysis over shorter period. However, although statistically insignificant, net bone volume achieved was lower than the iliac crest graft at longer follow-up.

Background: Cardiovascular disease is one of the major causes of mortality in chronic obstructive pulmonary disease (COPD) patients. Both microalbuminuria (MAB) and raised serum C-reactive protein (CRP) levels have strong association with cardiovascular events as they reflect generalized endothelial vascular dysfunction. The objectives of the study are (i) to assess the prevalence of MAB and serum CRP levels in stable COPD patients and (ii) to find out the relationship of MAB and serum CRP with clinical and physiological parameters in COPD patients. Methods: This comparative cross-sectional study was carried out on COPD patients attending OPD at Institute of Respiratory Diseases, Jaipur during the year from 2019 to 2020. Forty stable COPD patients and 40 healthy controls were enrolled in the study. Spot urinary albumin/creatinine ratio, serum CRP levels, smoking history, spirometry, blood gases, body mass index, and BMI, Obstruction (FEV1% predicted), Dyspnea (mMRC grading), Exercise Capacity (6 MWD) (BODE) index were assessed. Results: Out of 40 cases, 23(56%) had MAB and 38 (95%) had serum CRP levels >3 mg/L. There was a negative correlation between forced expiratory volume in one second (FEV1), partial pressure of oxygen in arterial blood (PaO2) levels and 6 MWD with both MAB levels and S.CRP levels respectively. There was a positive correlation between BODE Index and modified British Medical Research Council grading with both MAB levels and serum C reactive protein (S.CRP) levels respectively. There was a positive correlation between BODE index and modified British Medical Research Council grading with both MAB and S.CRP levels. Conclusion: COPD patients of varying severity should be screened regularly with MAB and serum CRP levels to determine the risk and progression of cardiovascular consequences so that adequate decision of interventional strategies can be taken out to prolong survival in COPD patients.

Influenza, a common cause of acute respiratory infections, is an important health problem worldwide, including in India. Influenza is associated with several complications; people with comorbidities and the elderly are at a higher risk for such complications. Moreover, the influenza virus constantly changes genetically, thereby worsening therapeutic outcomes. Vaccination is an effective measure for the prevention of influenza. Despite the availability of global guidelines on influenza vaccination in adults, country-specific guidelines based on regional variation in disease burden are required for better disease management in India. With this aim, the Indian Chest Society and National College of Chest Physicians of India jointly conducted an expert meeting in January 2019. The discussion was aimed at delineating evidence-based recommendations on adult influenza vaccination in India. The present article discusses expert recommendations on clinical practice guidelines to be followed in India for adult influenza vaccination, for better management of the disease burden.

Similar to the global scenario, pneumococcal diseases are a significant health concern in India. Pneumococcal diseases occur frequently among adults and are largely preventable through vaccines. Globally, several guidelines and recommendations are available for pneumococcal vaccination in adults. However, owing to wide variations in the disease burden, regulatory landscape, and health-care system in India, such global guidelines cannot be unconditionally implemented throughout the country. To address these gaps, the Indian Chest Society and National College of Chest Physicians of India jointly conducted an expert meeting in January 2019. The aim of the discussion was to lay down specific evidence-based recommendations on adult pneumococcal vaccination for the country, with a view to further ameliorate the disease burden in the country. This article presents an overview of the closed-door discussion by the expert members on clinical practice guidelines to be followed for adult pneumococcal vaccination in India.

Retroperitoneoscopic pyeloplasty is considered as one of the acceptable approaches for pelviureteric junction obstruction (PUJO) in children. Some consider it better than the open and laparoscopic approaches; but it has its own technical challenges. To analyse technical aspects in the initial learning curve of retroperitoneoscopic pyeloplasty for pelviureteric junction obstruction (PUJO) in children and to discuss certain tips and tricks. We retrospectively evaluated the data of consecutive 10 pelviureteric junction obstruction cases undergone retroperitoneal pyeloplasty in 2 years duration (January 2016 to December 2017). All patients had undergone ultrasound kidney ureter bladder (KUB), intravenous pyelography (IVP) and Ethylene dicysteine (EC) scan. A single surgeon operated on all the patients and placed a DJ stent intraoperatively. Postoperatively, the patients underwent an EC scan and IVP at 6 months. The patient records and operative videos were assessed. The average patient age was 8.4 ± 2.31 years (5–11 years). Intraoperatively, two patients had crossing vessels and the rest 8 had intraluminal narrowing. The mean operating time was 207.5 ± 36.15 min (150–285 min) and mean hospital stay was 3 ± 1.49 days (2–7 days). The postoperative course was uneventful in almost all except one who developed perinephric collection and had to undergo pigtail drainage. On follow up, all patients showed improved drainage at the PUJ except one. Retroperitoneoscopic pyeloplasty for pelviureteric junction obstruction can be optimally practiced by understanding the technical difficulties associated with it and the corresponding tips to ease the procedure. The advantages of going retroperitoneoscopically can be achieved and utilised in full for the benefit of the patient.

Aim: Despite a vast array of research in heart failure (HF), no bibliometric analysis has been conducted for HF. Therefore, we sought to identify in-depth characteristics of 100 most cited publications in HF. Materials & methods: Two independent reviewers searched the Scopus Library Database using a variety of keywords to extract the top 100 articles. Results: Majority (36%) of top 100 cited articles were published between 2001 and 2005. The total number of citations ranged from 6294 to 1003. Females had less than a quarter representation in both first and senior author position. More than three-fourths (86%) of the articles were funded. Conclusion: Our analysis highlights focal areas of research activity in order to guide HF specialists toward impactful research areas.

This chapter highlights on the design, operation, and comparative analysis of different types of wind turbine systems with respect to steady state and transient phenomenal activities under rapid wind speed variations. Here, Type I, which is fixed speed induction generator based, and Type II, which is DFIG based, variable speed operated systems are initially compared. In the next part, Type III wind turbine system is presented, which uses DFIG; later, it is compared with the Type IV WT system, which uses permanent magnet synchronous generator. This chapter provides a comparative overview on existing wind power systems including an analytic discussion of key principles and innovations for wind turbines. In this energy conversion system, various designs of wind turbines, pitch angle controlled based variable speed wind turbines governed by help of electronic power converters, were preferred. This scope of dynamic simulation-based study is implemented using MATLAB Simulink to convey the feasibility of the proposed wind turbine models.

Introduction: Oral methotrexate (MTX) is the first-line therapy for patients with rheumatoid arthritis (RA). However, not all RA patients respond to MTX. In this study, we will determine the risk factors associated with MTX failure. Methods: This retrospective study was conducted in tertiary care hospital in Pakistan. Data of 612 patients who were diagnosed with RA from June 2019 to January 2021 were retrieved from the medical record room. After inclusion, patients were divided into two groups; respondent and non-respondent. Their characteristics and demographics were compared. Results: Out of the total 612 patients, 112 (18.3%) were labelled as non-respondent to MTX. Non-respondents had a higher predominance of females (86.6% vs. 60.2%; p-value: 0.001), participants with body mass index (BMI) >25 kg/m2 (54.4% vs. 22.4%; p-value

Objective Neodymium-doped yttrium aluminium garnet (Nd: YAG) laser is a non-invasive and effective means to deal with posterior capsule opacification. Although it is safe, it may have some complications. The purpose of this study was to evaluate the efficacy of Nd: YAG laser capsulotomy in terms of visual outcomes. Methodology This retrospective study was carried out at the eye department of Shaheed Mohtarma Benazir Bhutto Medical College, Lyari and Sindh Government Lyari General Hospital, Karachi, by using a convenient sampling technique. The duration of the study was six months from 1st January 2020 to 30th June 2020. 50 eyes of patients older than 20 years of age of either gender with posterior capsule opacification after cataract surgery for more than 6 months of duration, capsular fibrosis, and visual distortion due to wrinkling were included in the study. Results Our results show that in a total of 50 patients, the mean age was 59.08±5.84 years, of which, 20 (40%) were males. Out of 50 patients, 22 right while 28 left eyes were selected for Nd: YAG laser capsulotomy. None of the patients showed elevated intraocular pressure (IOP) after the 1st week. Mean IOP was 16.84±3.63 mm of Hg on the 1st day and mean IOP after 1st week was 12.48±2.01 mm of Hg. Iritis was observed in 5 (10.0%) patients on the 1st day and 4 (8.0%) patients on the 1st week. Raised IOP was observed in 10 (20.0%) cases whereas cystoid macular edema was observed in only 1 (2%) patients on the 1st day and 1st week after laser therapy. Conclusion The study predicted that Nd: Yag laser posterior capsulotomy gives excellent results in terms of visual acuity. Complications that were associated with the Nd: Yag laser capsulotomy was a rise in intraocular pressure, cystoid macular edema, iritis, and IOL pitting.

Breast masses are uncommon in children and adolescents. Ectopic breast tissue is further uncommon and may be present in locations such as the face, back, and thigh. A 12-year-old female child presented with a hard, nonmobile lump in the right breast. On exploration by submammary incision, the lump was found to be below the pectoralis major muscle and had no communication with the overlying orthotopic breast tissue. Histopathological examination revealed a well-encapsulated biphasic lesion, with features characteristic of a phyllodes tumor. We report a hitherto unreported case of aberrant breast tissue lying under the pectoralis muscle and containing phyllodes tumor.

Background: Interstitial lung disease (ILD) is a complex and heterogeneous group of acute and chronic lung diseases of several known and unknown causes. While clinical practice guidelines (CPG) for idiopathic pulmonary fibrosis (IPF) have been recently updated, CPG for ILD other than IPF are needed. Methods: A working group of multidisciplinary clinicians familiar with clinical management of ILD (pulmonologists, radiologist, pathologist, and rheumatologist) and three epidemiologists selected by the leaderships of Indian Chest Society and National College of Chest Physicians, India, posed questions to address the clinically relevant situation. A systematic search was performed on PubMed, Embase, and Cochrane databases. A modified GRADE approach was used to grade the evidence. The working group discussed the evidence and reached a consensus of opinions for each question following face-to-face discussions. Results: Statements have been made for each specific question and the grade of evidence has been provided after performing a systematic review of literature. For most of the questions addressed, the available evidence was insufficient and of low to very low quality. The consensus of the opinions of the working group has been presented as statements for the questions and not as an evidence-based CPG for the management of ILD. Conclusion: This document provides the guidelines made by consensus of opinions among experts following discussion of systematic review of evidence pertaining to the specific questions for management of ILD other than IPF. It is hoped that this document will help the clinician understand the accumulated evidence and help better management of idiopathic and nonidiopathic interstitial pneumonias.

Leiomyoma of the urinary bladder in the pediatric age group is one of the rarest tumors with only 2 case reports in the English literature. Rhabdomyosarcoma is the commonest tumor at this site in this age group. It needs to be distinguished from rhabdomyosarcoma by histomorphology for appropriate treatment and management. We report the third case of urinary bladder leiomyoma arising in a 6-year-old boy with a short review of the literature.

Objectives: To determine the frequency of complications in parotid surgery at tertiary care hospital Hyderabad. Study Design: Cross-sectional study. Setting: Liaquat University, Hyderabad in the Department of General Surgery. Period: August 2016 to December 2017. Methods: We performed retrospective analysis of 43 patients undergoing parotidectomy. All patients undergoing parotidectomy during this time period were followed up for any post-operative complications. Results: A total of 43 patients met or criteria and were reviewed for the study. Amongst them there 31 males and 12 females. 79% of patients had benign parotid tumor while 20.9% had malignant lesion of parotid. Out of 43 patients, 41.8% (n=18) patients presented with post-operative complications. The most common complication after parotidectomy was facial palsy. Facial palsy was found in 18.6% (n=8) patients. Upon follow-up and treatment, 5 patients improved whereas patients had permanent facial palsy. Conclusion: Most of the lesions of parotid are of benign aetiology, superficial lobe is most commonly involved. Few complications are involved with parotidectomies and facial nerve palsy is the most common complications. With surgical expertise and use of nerve detector, its incidence can be reduced. Other complications of the surgery should be managed at the earliest to prevent damage.

Fine needle aspiration cytology is an important diagnostic tool in cytopathology. There are many challenges and pitfalls encountered in intraoral salivary gland cytopathology as tumours of these glands show morphological diversity and overlapping features. There are often variable solid-cystic components, metaplastic or necrotic changes, fibrosis, hyalinisation and haemorrhage accounting for heterogeneity of these tumours. The tumour profile of intraoral salivary gland is quite different from the major salivary glands and needs special attention. A low-grade malignant tumour may sometimes mimic a benign neoplasm or a non-neoplastic lesion resulting in a false negative diagnosis. Moreover, misinterpretation and failure to recognize subtle morphological and architectural patterns of cells also pose diagnostic challenges. In this chapter, we intend to highlight the key cytopathological features of intraoral salivary gland tumours and tumour-like lesions with emphasis to overcome diagnostic challenges and pitfalls to avoid misdiagnosis which will aid in planning further management and treatment.

Purple urine bag syndrome (PUBS) is a very rare phenomenon strongly associated with long-term indwelling catheterization that results in an increased risk of urinary tract infection. The color change in the urine bag results from the altered metabolism of tryptophan into color pigments by certain bacteria which produce sulfates and phosphates enzymes. Although it is benign in nature, PUBS results in greater anxiety among patients and their families. The most important risk factors include long-term catheterization, female gender, chronic constipation, old age and bed-bound patients. Here, we present a case of PUBS in a middle-aged woman with a history of the neurogenic bladder that needed long-term catheterization along with chronic constipation.

Background Peutz-Jeghers syndrome is an autosomal dominant disease characterized by mucocutaneous pigmentation and hamartomatous polyps in the gastrointestinal tract (GIT). There have also been cases of extra GIT polyps such as the renal pelvis, urinary bladder, lungs and nares. Bladder hamartoma is an extremely rare finding, with only 12 cases described in the literature up to now. The rarity of the condition necessitates a comprehensive compilation of managements up to now so as to provide a better tool for the treatment of such conditions in the future. Case presentation A twenty-year-old male, known to have Peutz-Jeghers syndrome, presented to us complaining of obstructive urinary symptoms. A urethrogram done showed a filling defect at the base of the urinary bladder. The mass was resected transurethrally, and histopathology revealed a hamartoma of the bladder. The patient has since remained tumor-free on follow-up. Conclusions Transurethral resection of the bladder mass proved to be an effective therapy in this patient with no recurrence on the patient’s follow-up till now. There is still, however, a dearth of knowledge regarding the management of bladder hamartomas owing to the extreme rarity of the case.

Endothelial inflammation and damage are the main drivers of cardiovascular risk/disease. Endothelial repair is mediated in part by recruitment of bone marrow endothelial progenitor/endothelial colony forming cells (EPC/ECFC). People with HIV (PWH) have increased cardiovascular risk and the impact of infection in endothelial repair is not well defined. The low frequencies and challenges to in vitro isolation and differentiation of EPC/ECFC from PBMCs had made it difficult to study their role in this context. We hypothesized that HIV driven inflammation induces phenotypic changes that reflects the impact of infection. To test this hypothesis, we evaluated expression of markers of trafficking, endothelial differentiation, and angiogenesis, and study their association with biomarkers of inflammation in a cohort of PWH. In addition, we investigated the relationship of circulating endothelial progenitors and angiogenic T cells, a T cell subset with angiogenic function. Using a flow cytometry approach, we identified two subsets of circulating progenitors LIN4-CD45-CD34+ and LIN4-CD45dimCD34+ in PWH. We found that the phenotype but not frequencies were associated with biomarkers of inflammation. In addition, the percentage of LIN4-CD45dimCD34+ was associated with serum levels of lipids. This data may provide a new tool to better address the impact of HIV infection in endothelial inflammation and repair.

The present work focus on the comparison between open and closed loop battery charging techniques for lithiumion (Li-ion) battery. Conventional types of open loop charging technologies like pulse charging, constant current-constant voltage (CC-CV) and multi stage charging etc. uses fixed battery parameters to decide the battery charging current. Effect of temperature variation during charging is generally not taken in to account in the case of open loop charging techniques. Temperature must be kept in certain range to enhance the effective battery life time. Charging current in closed loop technique depends on the temperature feedback. Present work compares between open loop CC-CV and close loop constant temperature-constant voltage (CT-CV) battery charging techniques in terms of charging voltage, charging current, battery state of charge (SOC) and battery temperature rise for different initial SOC level. Model is simulated in MATLAB/Simulink environment and study reveals that there is about 24% improvement in charging time as compared to the CC-CV charging technique.

Exploratory modelling of the impact of gold mining on groundwater in a strategic water area of South Africa was undertaken. A systems dynamics (SD) model was developed to simulate the impact of gold mining on water quality, focusing on groundwater contamination risk, within the context of competing developmental priorities around water resource development and the socio-economic gains from gold mining. The model also identified interventions to minimise the impacts by the year 2040. The study area was the Blyde River Catchment (BRC), which is part of the Olifants Water Management Area in South Africa. This area is an important contributor, currently and in the future, to freshwater flows and groundwater in the Olifants River Catchment, which is one of South Africa’s most economically important catchments. The model development process included a causal loop diagram­–based problem conceptualisation, followed by the drawing of stock-flow diagrams and the determining of model parameters based on a combination of background literature, data from environmental impact assessments, and from the national Department of Water and Sanitation. The model showed the potential environmental risks of gold mine wastewater production and interventions to minimise these risks. The most effective intervention identified to reduce the risk of groundwater contamination was the development and use of synthetic-lined tailings dams. The baseline simulation result of sulphate loading of 5430 t/year can be reduced by 3070 t/year to give a simulated sulphate load of 2270 t/year in 2040 using this intervention. In comparison, the simulated wastewater recycling intervention only reduced the sulphate load to 4630 t/year and the wastewater treatment interventions to 3420 t/year. This project contributes to the exploratory modelling of an understudied region of the Olifants River Catchment that is a crucial provider of freshwater flows to the Olifants, which is threatened by increasing gold mining in the upper BRC. The SD model highlighted the importance of protecting the dolomitic aquifers in the BRC for the long term sustainability of the catchment, which is particularly important if groundwater development occurs.

This work presents the role of vehicle to grid (V2G) integration in frequency regulation of renewable based microgrid. The renewable based micro grid is consisting of intermittent nature solar photovoltaic and wind sources; diesel power generator is taken as a backup power source along with residential and industrial load. Complete system is modelled and simulated in MATLAB/Simulink environment. Different types of vehicle profiles are considered for simulation purpose. Simulations are carried out for abnormal operating conditions such as partial shading of solar photovoltaic, discontinuation of wind farm power due to high wind speed and sudden change in load demand. Simulation results shows the effectiveness of V2G integration in power control and grid frequency regulation under abrupt conditions.

Background Diagnostic thoracentesis is the initial diagnostic investigation in the workup of an undiagnosed Pleural effusion. However, a significant percentage of pleural effusions remain undiagnosed after this step and after closed pleural biopsy. Medical thoracoscopy (MT) has a high diagnostic yield in these patients. MT is now widely practised in India. This survey endeavours to study the practice of this technique by respiratory physicians in India. Methods An electronic survey called ‘Indian Thoracoscopy survey’ was prepared and conducted under the aegis of Indian Chest Society. In all there were 63 Questions in English prepared and disseminated as a “Google Form” to conduct this survey. The subjects were recruited from the e-mail lists of the three major professional surgeries that serve the interests of the respiratory physicians. The participation in the survey was voluntary and no incentive of any sort was offered to the participants. The survey link was kept open for a 3-month period. Results There were total 659 respondents, whose mean age was 41.5 years and majority of them were males (n = 564, 85.6%). The largest group of respondents practiced in corporate/private hospitals (n = 315, 47.8%). Only 311 (47.2%) respondents performed MT. Of these, 190 (61.1%) used flex-rigid/semi rigid thoracoscopes. Undiagnosed pleural effusions (N = 194; 62.4%) and recurrent pleural effusions (N = 117; 37.6%) were the most common indications for performing MT. Majority of the thoracoscopists (222, 71.4%) used conscious sedation and a combination of Midazolam and Fentanyl was the most preferred combination (n = 238; 76.5%). Most follow the manufacturer's recommendation for thoracoscope cleaning and disinfection and had safety check lists in place. Conclusion Our survey captures the practice of MT in India. MT seems to be increasing in popularity with significant numbers of respiratory physicians performing the procedure. Respondents felt that MT was a valuable investigation that was underused and more of them wanted to learn. It is safe to perform MT under conscious sedation and local anaesthesia and a boon to patients who required surgical procedures for evaluation of difficult to diagnose pleural diseases. The setup cost is significant and would not justify installation in all centres. The lack of opportunities for training is something that needs to be looked in to.

Introduction COVID-19 pandemic has resulted in a strong impact on students’ wellbeing, with associated uncertainty about the future. We conducted a cross-sectional survey to assess the psychological effects of COVID-19 on the medical education of final year students in Pakistan. Methods We conducted prospective, cross-sectional survey, as a snapshot, from June 07, 2020 till June 16, 2020, among final year medical and dental students. The 20-questions survey questionnaire was based on rating-scale items to focus on psychological symptoms, institutional preparedness for such crisis and confidence in becoming a future doctor. Descriptive statistics were calculated using Multivariate regression analysis. Results Majority of participants (n = 1753/2661, 65.9%) were female. Despite timely closure of institutes, delay in the start of the online teaching (beta coefficient 0.08, P-value 0.02) was significantly correlated with the depressive symptoms. A significant percentage of students (n = 1594, 59.9%) wanted a delay in exit exams due to intimidation. A similar proportion of students also lost confidence to be a competent doctor in future which was positively associated with male gender (beta coefficient 0.21, P-value, Highlights • COVID-19 pandemic has brought significant psychological influence on the medical education of final year students. • A significant proportion of the medical and dental institutions were not well prepared before the lockdown. • The students' preparation for their exams has been affected by the COVID-19 pandemic. • Institutes need to establishing online ‘social support group’ with the mental health team to provide supportive therapy. • Supporting students’ emotions and psychological wellbeing, and transforming current medical curricula is crucial.

Purpose: To determine visual rehabilitation of Phacoemulsification in comparison to small incision cataract surgery after implantation of rigid intraocular lens. Study Design: Quasi Experimental Study. Place and Duration of Study: Shaheed Mohtarma Benazir Bhutto Medical College Lyari and Sindh Government Lyari General Hospital, Karachi, from July 2018 to December 2019. Methods: Patients with 35 – 70 years age and diagnosed with senile cataracts and visual acuity of 22 mmHg, high ametropia, any other eye disease were excluded. Patients were divided into two groups of 80 patients each. Group I underwent Phaco-emulsification and group II had Small incision cataract surgery. For data analysis, SPSS version 20.0 was used. Frequency and percentages were calculated for qualitative data and quantitative data was presented as mean and standard deviation. Results: In a total of 160 patients operated of cataract, male to female ratio was 1:1. The range of astigmatism after 6 months in the group I was between 0.5 – 1.00 D while in the group II, it was between 0.75 – 1.75 D. Uncorrected visual acuity and best corrected visual acuity of 6/18 or better was seen in 90 and 97% group 1 while it was 85% and 95% in group II patients respectively at sixth month. Conclusion: No significant difference was seen in uncorrected and best corrected visual acuity between the two groups. Time of surgery was lesser group 2 and Astigmatism was lesser in group 1. Key Words: Phaco-emulsification, Small Incision Cataract Surgery, Visual Rehabilitation.

Lung adenocarcinoma (LUAD) is the most predominant subtype of lung cancers and is one of the leading causes of cancer related mortality worldwide. Despite the advancements in the field of cancer diagnostics and therapeutics, detection at an early stage using reliable biomarkers is an unmet clinical need for a plethora of cancers, including LUAD, thus attributing to poor prognosis. In view of this, to identify potential biomarkers and therapeutic candidate genes, the expression of all known human genes was screened in the publicly available ‘The Cancer Genome Atlas’ (TCGA) samples of LUAD patients which resulted in the identification of overexpressed genes. Further analysis of these genes across various patient sample datasets revealed that ZNF687, ODR4, PBXIP1, PYGO2, METTL3, PIGM and RAD1 are consistently more highly expressed in LUAD. Higher expression of these genes either alone or in combination is correlated with poor survival of LUAD patients. Hence, in this study we propose that these identified genes could serve as potential candidates as gene signatures or biomarkers for LUAD that require further investigation in large cohorts of LUAD samples., Bioinformatics; Cancer research; Oncology; Lung adenocarcinoma, The cancer Genome Atlas, Biomarkers, Gene expression, cBioPortal.

PURPOSE: To conduct a meta-analysis to evaluate the effect of ertugliflozin on long-term hemoglobin A1c (HbA1c), body weight and blood pressure (BP). METHODS: Online databases available were searched from their inception to February 2020. Randomized controlled trials (RCTs) comparing ertugliflozin to either placebo or an active control drug were included. Data on four efficacy outcomes were extracted, namely: HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP) and body weight. Continuous outcomes were pooled using a random-effects model and presented as weighted mean differences (WMDs) and corresponding 95% CIs. Additionally, a subgroup analysis was done to compare two doses of ertugliflozin (5 mg and 15 mg). A sensitivity analysis was also performed by eliminating studies using active drugs as controls. RESULTS: From a total of 123 search results, eight studies were included. Compared to the control group, ertugliflozin was associated with a significant decrease in SBP (WMD: −3.64 mmHg, 95% CI [−4.39,-2.90]; p

The automotive industry is now focusing on providing well-balanced commercial vehicle models based on performance and efficiency. The pressure from the environmental impacts and the increase in oil prices have led to the increased economy from both engines as well as outer car body over time. The aerodynamics of a vehicle was not substantial until the 1960s when the models were noisy and less efficient. However, with the arrival and advancement of fast-moving vehicles, it was highly essential to protect the vehicle from the effects of air drag and lift forces, which may cause loss of control at high speeds. This paper shows a comparative CFD analysis on Maruti Suzuki Alto models by highlighting the improvements done on aerodynamics in 2005 and 2012 models, respectively. The Alto is chosen as the subject of study in order to demonstrate the extent to which the fluid dynamic forces affect a commercial vehicle. The paper provides both 2D and 3D analysis on cruising conditions simulated on ANSYS® software and a qualitative study on the importance and significance of streamlining a vehicle in the present time.

Purpose: To compare the efficacy of the microwave pulse diode laser and argon laser trabeculoplasty in primary open angle glaucoma. Study Design: Quasi experimental study. Place and Duration of Study: Shaheed Mohtarma Benazir Bhutto Medical College Lyari and Sindh Government Lyari General Hospital, Karachi, from October, 2017 to March, 2018. Material and Methods: One hundred and sixty patients, between 42 to 61 years with visual acuity of perception of light to 6/36 were enrolled. Patients diagnosed with POAG were included and patients with intraocular pressure of more than 40 mm Hg, previous glaucoma surgery or laser treatment and narrow angle on gonioscopy were excluded. Ophthalmic examination included visual acuity, slit lamp examination, fundus examination and visual field status using Humphrey perimeter. Patients were divided into two groups. Group A received microwave pulse diode laser (810) and Group B received argon laser trabeculoplasty. Average follow up period was 6 months. Success was assessed objectively by measuring intra ocular pressure and subjectively by visual acuity. Results: The average time-period for each procedure was 15 ± 5 minutes. In Group A, mean IOP at first week, first month, third month and sixth month was 20.79, 16.34, 16.21and 16.09 mm Hg respectively. While in Group B, IOP at first week, first, third and sixth month was 16.52, 15.76, 13.62, and 12.54 mm Hg at (P < 0.001 in both groups). Conclusion: Both microwave pulse diode laser and argon laser trabeculoplasty are effective in lowering intra ocular pressures in patients with primary open angle glaucoma.

Hepatoblastoma (HB), a primary liver tumor of childhood, is often accompanied by raised levels of alpha-fetoprotein (α-FP). Rarely, the beta-human chorionic gonadotropin (β-hCG) levels may also be elevated, which can cause peripheral precocious puberty (PPP). We report a case of HB with precocious puberty wherein hormonal assays showed an increase in α-FP, β-hCG, and testosterone levels, and suppression of follicle-stimulating and luteinizing hormone levels. After chemotherapy and surgery, α-FP, β-hCG, and testosterone levels normalized, and the signs of virilization did not progress further. New therapeutic approaches have made a previously reported grim prognosis of virilizing HB, more favorable now. In the assessment of PPP, the possibility of a tumoral source for the hormones should also be considered.

Context: Multiple environmental factors are associated with development of hypersensitivity pneumonitis (HP), and diagnostic algorithms for the diagnosis of HP have been proposed in recent perspectives. Aims: We analyzed the data of patients with HP from interstitial lung disease (ILD)-India registry. The analysis was performed to (1) find the prevalence of HP, (2) reclassify HP as per a recently proposed classification criterion to assess the level of diagnostic certainty, and (3) identify the causative agents for HP. Setting and Designs: This was a prospective multicenter study of consecutive, consenting adult patients with new-onset ILD from 27 centers across India (March 2012–April 2015). Materials and Methods: The diagnoses were based on prespecified working clinical criteria and multidisciplinary discussions. To assess strength of diagnosis based on available clinical information, patients with HP were subclassified into definite HP, HP with high level of confidence, and HP with low level of confidence using a recent classification scheme. Results: Five hundred and thirteen of 1084 patients with new-onset ILD were clinically diagnosed with HP and subclassified as HP with high level of confidence (380, 74.1%), HP with low level of confidence (106, 20.7%), and definite HP (27, 5.3%). Exposures among patients with HP were birds (odds ratios [OR]: 3.52, P < 0.001), air-conditioners (OR: 2.23, P < 0.001), molds (OR: 1.79, P < 0.001), rural residence (OR: 1.64, P < 0.05), and air-coolers (OR: 1.45, P < 0.05). Conclusions: About 47.3% of patients with new-onset ILD in India were diagnosed with HP, the majority of whom were diagnosed as HP with a high level of confidence. The most common exposures were birds, cooling devices, and visible molds.

Although a simple and useful pulmonary function test, spirometry remains underutilized in India. The Indian Chest Society and National College of Chest Physicians (India) jointly supported an expert group to provide recommendations for spirometry in India. Based on a scientific grading of available published evidence, as well as other international recommendations, we propose a consensus statement for planning, performing and interpreting spirometry in a systematic manner across all levels of healthcare in India. We stress the use of standard equipment, and the need for quality control, to optimize testing. Important technical requirements for patient selection, and proper conduct of the vital capacity maneuver, are outlined. A brief algorithm to interpret and report spirometric data using minimal and most important variables is presented. The use of statistically valid lower limits of normality during interpretation is emphasized, and a listing of Indian reference equations is provided for this purpose. Other important issues such as peak expiratory flow, bronchodilator reversibility testing, and technician training are also discussed. We hope that this document will improve use of spirometry in a standardized fashion across diverse settings in India.

The efficacy of antidiabetic agents for the treatment of non-alcoholic fatty liver disease (NAFLD) remains unclear.To conduct a meta-analysis to study the efficacy of pioglitazone and three novel anti-diabetic agents: glucagon-like peptide-1 (GLP-1) agonists, sodium-glucose co-transporter-2 (SGLT2) inhibitors, and dipeptidyl-peptidase-4 (DPP4) inhibitors in treating NAFLD.Online databases were searched in May 2020 for randomized clinical trials. Results from random-effects meta-analysis are presented as weighted mean differences (WMDs) or standard mean differences (SMDs) and corresponding 95% confidence intervals (CIs).Twenty-six studies (n=946 NAFLD patients) were included. Reductions in ALT were seen with all four drugs: pioglitazone (MD -38.41, p0.001), SGLT2 inhibitors (MD -16.17, p0.001), GLP-1 agonists (MD -27.98, p=0.04) and DPP-4 inhibitors (MD -7.41, p0.001). Pioglitazone (SMD -1.01; p0.001) and GLP-1 agonists (SMD -2.53, p=0.03) also demonstrated significant improvements in liver steatosis. SGLT2 inhibitors (SMD -4.64, p=0.06) and DPP-4 (SMD -2.49, p=0.06) inhibitors trended towards reduced steatosis; however, these results were non-significant.Pioglitazone demonstrates significant improvements in transaminases and liver histology in both diabetic and non-diabetic NAFLD patients. Early evidence from diabetic NAFLD patients suggests that novel antidiabetics may lead to improvements in liver enzymes and hepatic steatosis, and this should encourage further research into possible utility of these drugs in treating NAFLD.

A polyelectrolyte layer-by-layer spin assembly (PLSA) method has been developed to fabricate thin films of MPA stabilized aqueous CdTe QDs. The synthesized aqueous QDs exhibit highly negative charges on the surface facilitate the electrostatic attraction with positively charged PDDA on glass plates. The conjugation of rapid processing of spin coating method renders highly homogeneous films with controlled thickness and drastically narrows processing time to about 60 s compared to the conventional 10–30 min in LbL dipping process. The XRD analysis confirms fabricated films contain CdTe QDs with cubic zincblende structure. Photoluminescence emission studies show that the fabricated films are highly luminescent in visible region with good photoluminescence quantum yield up to 51%. Hence, the proposed deposition protocol is highly reliable and produces high quality repeatable films of QDs which find vast applications in the field photovoltaic cells, LEDs, biosensors, narrow emission lasers and optical filters.

Rationale: Interstitial lung disease (ILD) is a heterogeneous group of acute and chronic inflammatory and fibrotic lung diseases. Existing ILD registries have had variable findings. Little is known about the clinical profile of ILDs in India.Objectives: To characterize new-onset ILDs in India by creating a prospective ILD using multidisciplinary discussion (MDD) to validate diagnoses.Methods: Adult patients of Indian origin living in India with new-onset ILD (27 centers, 19 Indian cities, March 2012–June 2015) without malignancy or infection were included. All had connective tissue disease (CTD) serologies, spirometry, and high-resolution computed tomography chest. ILD pattern was defined by high-resolution computed tomography images. Three groups independently made diagnoses after review of clinical data including that from prompted case report forms: local site investigators, ILD experts at the National Data Coordinating Center (NDCC; Jaipur, India) with MDD, and experienced ILD experts at the Center fo...

This review assesses the economic impact of the novel coronavirus on China which in turn will trickle down to other major economies thereby triggering major economic losses around the globe It majorly focus on Wuhan and its industries along with various neighboring countries that will see a steep decline in revenue from certain sectors

Neonatal mastitis and abscess are an uncommon entity with an uncertain mechanism of onset. Ultrasonography can be useful in detecting early stage of abscess formation and hence in expedition of definitive treatment, as it was proved in our case, in which a diagnosis of neonatal breast abscess was made based on ultrasound examination of breast.

Introduction High-sensitivity C-reactive protein (hs-CRP) has emerged to be a very useful and reliable clinical marker of primary as well as secondary cardiovascular morbidity and mortality. Elevated hs-CRP contributes to underlying atherogenesis and worsens disease prognosis. Along with their lipid-lowering properties, statins also contribute to the alleviation of micro-inflammation and reduces pro-inflammatory markers. The aim of this study is to compare the effects of rosuvastatin and atorvastatin in lowering hs-CRP levels in statin-naive patients admitted with acute coronary syndrome (ACS). Methods In this prospective, open-label randomized trial, group A was given rosuvastatin 40 mg daily and group B was given atorvastatin 20 mg daily along with standard post-ACS therapy. Lipid profile (mg/dL), hs-CRP (mg/L) and erythrocyte sedimentation rate (ESR) (mm/Hr) were recorded and measured as the baseline (before starting therapy) and then again after four weeks. The data were analyzed using SPSS for Windows version 22.0 (IBM Corp., Armonk, NY). Results With four weeks of treatment, both group A and B showed statistically significant reduction in serum hs-CRP levels (p

Experimental modal analysis has received a lot of consideration in recent days for dynamic analysis of complicated engineering structure and machine tools. It is a process which is used to determine the inherent dynamic properties of structure such as damping, mode shapes and natural frequencies. The experimental modal analysis benefits in design of all types of structures including automotive components, aircraft components, spacecraft, computers and tennis rackets and golf clubs etc. The present study deals with the experimental investigation of free vibration of milling machine arbor. Experimental modal analysis of milling machine arbor is carried out by using laser vibrometer for measurement and impact hammer for excitation. The experimental results are compared with the numerical predictions obtained using finite element modeling software ANSYS workbench 14.5. The scope of present work is to understand and investigate the modal parameters of milling machine arbor in the form of natural frequency and mode shape for robust design.