Search

Background The mismanagement of missing data in large clinical databases may lead to inaccurate findings. The purpose of this study was to demonstrate the effects of missing data on hand surgery research findings using an analysis of postoperative morbidity in patients undergoing hospital-based hand surgery. Methods The National Surgical Quality Improvement Program database was queried for patients undergoing common hand and upper extremity surgery between 2011 and 2016. Major and minor postoperative complications were identified. Demographics, comorbidity, and preoperative laboratory values were identified, and the percentage missing of each was tabulated. To demonstrate how missing data can alter analysis results, these variables were evaluated for an association with major complications using multivariable regression on 3 separate cohorts: (1) all patients; (2) all patients after exclusion of any patient entry with >10% of missing data; and (3) after removal of any patient entry with any missing data. Results Groups 1, 2, and 3 had 48 370, 23 118, and 6280 patients, respectively. There were 14 variables associated with increased odds of major complications in group 1, yet only 10 and 9 variables for groups 2 and 3, respectively. Six variables were associated with increased major complications across all 3 groups, whereas only 1 was associated with decreased odds of major complications across all groups. Conclusions Filtering patient cohorts according to the amount of missing patient information affected analyses of predictors for major complications associated with hospital-based hand surgery. These findings highlight the importance of considering and addressing missing data in large database studies.

Background Fixation and arthroplasty remain the mainstays of surgical treatment of degenerative and traumatic shoulder pathology. They also constitute an appreciable sum of Medicare expenditure. With continued concern for declines in Medicare reimbursement across orthopedic surgery, it is important to understand how trends in reimbursement correlate with relative procedure volumes. Our aims were to describe temporal changes in procedure volumes, physician payment, and patient charges for proximal humerus open reduction internal fixation (ORIF) and shoulder arthroplasty. Methods Using Medicare's Physician Fee Schedules from 2012 to 2017, we examined procedure volumes, number of unique surgeons performing, actual submitted patient charges, and surgeon payments from 2012 to 2017 for six shoulder procedures: proximal humerus ORIF (CPT-23615), traumatic hemiarthroplasty (HEMI) (CPT-23616), degenerative HEMI (CPT-23470), primary total shoulder arthroplasty (TSA) (CPT-23472), partial TSA revision (humeral or glenoid component, CPT-23473), and total TSA revision (CPT-23474). The reimbursement ratio was calculated by dividing surgeon payment by patient charges. Growth rates of charges and payment were adjusted for inflation using annual consumer price index inflation rates over the same time period. Results The total number of traumatic and degenerative HEMI cases fell over −60%. Similarly, the number of unique surgeons performing traumatic and degenerative HEMI fell over −53%. In contrast, the number of TSA procedures rose by +70%, whereas partial and total revision TSA rose by +62% and +88%, respectively. The number of unique surgeons rose +28% and over +73% for primary and revision TSA, respectively. There was a large gap (between 3.4 and 4.4 times) between submitted charges and surgeon payment for all years analyzed. After adjusting for inflation, Medicare payment to surgeons decreased for all types of surgery (−6% to −9%) other than ORIF, which increased +10%. Submitted patient charges during this period increased +14% and +9.7% for ORIF and revision TSA (total), respectively, but decreased by −6% for traumatic HEMI. The reimbursement ratio was ≤29% for all procedures analyzed across all years and fell the most for revision TSA (partial and total). Conclusion From 2012 to 2017, there was a sharp decline in the use of shoulder HEMI with a correspondingly high increase in TSA. After accounting for inflation, HEMI and TSA showed appreciable declines in surgeon payment over time, whereas ORIF was the only surgery with increased surgeon payment. Revision TSA saw the largest declines in the reimbursement rate. Physicians and health care policy makers must be aware of these trends to ensure both a sustainable payment infrastructure for surgeons as well as to maintain access to care for these procedures. Level of evidence Level III; Economic Study

Background: Health care agencies have framed guidelines for healthcare professionals (HCPs) to manage COVID-19 pandemic but still there is paucity of Indian data on HCPs preparedness. Aim: To assess level of perceived preparedness of healthcare professionals against COVID-19. Method: This cross-sectional study included 1218 HCPs (nurses, physicians and technicians) from government and private institutes through convenience sampling technique. Online survey was done to assess preparedness of HCPs against COVID-19, using self-structured questionnaire based on HCPs preparedness checklists released by WHO and CDC. Results: Only 42.4% HCPs considered themselves prepared for donning and doffing of PPE and around 65.8% were confident in providing direct patient care. Gender had significant difference (P

Head and neck reconstructive surgical techniques are complex; now the microvascular free tissue transfer is the most frequently used. The postreconstruction imaging interpretation is challenging due to the altered anatomy and flap variability. We aim to improve radiologists' knowledge with diverse methods of flap reconstruction for an accurate appreciation of their expected cross-sectional imaging appearance and early detection of tumor recurrence and other complication.

Background Total shoulder arthroplasty (TSA) procedures performed for proximal humerus fractures are considered to have higher complications rates and longer operative time than TSA performed for osteoarthritis (OA). However, there exists only one current procedural terminology (CPT) code for TSA, which may not accurately capture the increased work and complexity required for fracture cases. The purpose of this study was to compare TSA work relative value unit (RVU) rates per operative time performed for osteoarthritis and fracture care. Methods Data were collected through the National Surgical Quality Improvement Program (NSQIP) database for the years 2006 to 2018 to identify all patients who underwent primary TSA for either OA or fractures. Work RVU, operation time (skin incision to closure), work RVU per minute, and payment per minute were compared between the osteoarthritis and fracture TSA cohorts. Bivariate and multivariate analyses controlling for patient demographics and comorbidity were utilized to determine whether there existed a reimbursement differential between the two groups. Results The mean operation times for primary TSA for osteoarthritis and fracture were 109 minutes and 122 minutes, respectively (P Conclusion On average, TSA performed for fracture care is associated with longer operative times and may require more work compared to elective TSA for OA. These results highlight the need for more precise procedural coding to accurately capture the added effort and operative time required for TSA in the setting of fracture care. Level of Evidence Level III

Background Diabetes mellitus (DM) is a progressively increasing metabolic disorder and a significant public health burden that demands immediate global attention. However, there is a paucity of data about adherence to antidiabetic drugs among patients with type-2 (T2)DM in Uttarakhand, India. Outpatient research reported that more than 50% of patients do not adhere to the correct administration and appropriate medicine dosage. It has been reported that patients with chronic diseases who adhere to treatment may experience improvement in quality of life (QoL) and vice versa. Aim To assess the adherence to antidiabetic medication and QoL among patients with T2DM. Methods This cross-sectional descriptive study was conducted at a tertiary care hospital in Uttarakhand, India. The Medication Adherence Rating Scale and World Health Organization QoL-BREF scale were used to assess medication adherence and QoL. Results Two hundred seventy-seven patients suffering from T2DM participated in the study. Their mean age was 50.80 (± 10.6) years, 155 (56%) had a poor adherence level and 122 (44%) had a good adherence level to antidiabetic medications. After adjusting for sociodemographic factors, multiple linear regression analysis found patients who were adherent to antidiabetic medications had significantly higher mean overall perception of QoL and overall perception of health, with beta scores of 0.36 and 0.34, respectively (both P = 0.000) points compared with nonadherent patients. Conclusion There was an association between medication adherence and QoL in patients with T2DM. Hence, there is a need to plan awareness and counseling programs followed by regular follow-up to motivate patient adherence to recommended treatment and lifestyle regimens.

Introduction: Pain during childbirth is a special experience of a woman that vary from one individual to another, that is caused by uterine contractions and cervical dilatation during labour. Nature and level of pain influence by various physiology, psychology and environmental factors. Thus, pain relief during childbirth is essential therefore, the delivery period will be uneventful. Non-pharmacological pain relief measures: Controlling pain without harm to mother, non-pharmacological measures assure in reducing labour pain with less or even no harm to the mother and fetus. These measures include sensory stimulation measures eg. breathing technique, aromatherapy and music therapy that provides sensory input to the brain to promote relaxation, enhance positive thoughts and transmission of nociceptive stimuli of pain during labour and cutaneous stimulation measures include back massage, changing position, heat and cold application, transcutaneous electrical nerve stimulation, hydrotherapy and acupressure that work as to stimulation of nerves by using skin manipulation in an attempt to reduce pain impulses to the brain. Conclusion: The major aspects of midwifery care are supporting women during labour pain thus, they must understand the choices of the mother's for manage with labour pain. However, non-pharmacological measures are helpful for decelerating pain and discomfort during labour which is easy to given and cost-effective. Key Words: Breathing technique, aromatherapy and music therapy, back massage, changing position, application of heat and cold, Transcutaneous electrical nerve stimulation, acupressure and hydrotherapy.

Objective: Burden of head-and-neck cancer is disproportionately bigger in India and can be regarded as “tip of iceberg” situation. Postoperatively, head-and-neck cancer patients report tremendous challenges conversely, affects quality of their life. Oncology nurses contribute significantly in supportive care issues encountered by patients in the postoperative period. However, there is a paucity of the literature on effect of nurse-led postsurgical education program on quality of life (QOL) of head-and-neck cancer patients. Methods: In this pilot randomized controlled, parallel group trial, 64 head-and-neck cancer patients; who were electively planned for surgery were randomized in experimental (n1 = 32) and control group (n2 = 32). In the experimental group, participants received structured nurse-led postsurgical education program through virtual mode and control group participants received standard of care. The QOL as an outcome variable was assessed through face-to-face interview at baseline on first postoperative day and postoperative day-4, 15, and 30 follow-ups by using standardized instruments, i.e., EORTC QLQ-C30 and H and N35 questionnaire. Results: The experimental group had a significant improvement in global health (P = 0.02), role functioning (P = 0.02), emotional functioning (P = 0.01), swallowing (P = 0.01), and opening mouth (P = 0.02). Postoperative pain and speech problems were most distressing symptoms in participants of both groups. Conclusions: The nurse-led postsurgical virtual education programme was found effective to improve the selected domains of QOL and may be used as an adjuvant intervention for head-and-neck cancer patients.

Diabetes mellitus is a group of metabolic diseases in which the person has high blood glucose level, either due to inadequate insulin secretion or because the body’s cells do not respond properly to the insulin or both.

Background During infectious outbreaks like COVID-19, it is essential that every healthcare personnel (HCP) strictly adheres to infection prevention and control (IPC) policies. To boost IPC measures, training to reinforce preventive practices, which are pertinent to needs and encompass the expectations of the HCP, is indispensable. Thus, these expectations of the HCP should be explored. Methods In this cross-sectional descriptive survey, we used convenience sampling technique to ask the participants to list their expectations on of covid-19 IPC training paper based forms. Using the category construction approach, we organised the expectations and grouped the participants on the basis of their work and place of work to analyse the association using the chi-square test. Results Many participants expected to learn about the use of PPE and masks, hand hygiene, physical distancing, cleaning and disinfection, basic precautions for personal protection during the training. Expectations also included various administrative queries, sample collection and clinical skills for diagnosis and management. There was significant association of many categories of expectations with the nature and place of work in the hospital. Conclusion When planning IPC training, these expectations of the HCP may be carefully addressed. Information about causative agent, transmission and clinical aspects may will give a contextual meaning to IPC training. Some important preventive measures, which few participants expected to learn must be analysed in detail to understand the attitude of the HCP towards them. Efforts to appraise the HCP for the importance of these measures and promoting its practice may play a vital role to curb the spread of infectious diseases.

Objectives This systematic review aims to evaluate and summarise the findings of all relevant studies which identified the effect of early vs delayed parenteral nutrition (PN), early PN vs early supplemental PN and early PN vs standard care for critically ill adults. Methods The literature search was undertaken using PubMed, Embase, Medline, Clinical Key, and Ovid discovery databases. The reference lists of studies published from 2000 till June 2020 were hand searched. Result On screening 2088 articles, a total of five RCTs with 6,277 patients were included in this review. Only one clinical trial compared early PN and late PN; the results reported significantly shorter periods in intensive care unit (ICU) stay (p=0.02) and less ICU related infections (p=0.008) in the late PN group compared to the Early PN group. Two trials compared total parenteral nutrition (TPN) and enteral nutrition (EN) +TPN groups. Both found a significantly longer hospital stay duration (p Conclusion The supplemental PN patients had shorter ICU stay and lower mortality rates than TPN. However, these findings should be interpreted carefully as included studies have different initiation timing of nutritional support, and the patients’ diagnosis varied.

Background Total Elbow Arthroplasty (TEA) has demonstrated promising functional outcomes for the treatment of complex distal humerus fractures. In many other joints, arthroplasty for trauma is associated with increased risks for acute postoperative complications. The purpose of this investigation is to identify the in-hospital and 30-day postoperative complications for TEA performed because of distal humerus fracture vs. arthritis, and to determine whether acute fracture is associated with differences in complications after TEA. Methods The American College of Surgeons National Surgical Quality Improvement Program was used to identify patients who underwent TEA from 2006 to 2018. Patients who were diagnosed with distal humerus fractures were identified and compared with patients without acute fracture. Patients without fracture were further divided into those undergoing TEA for Rheumatoid Arthritis (RA) vs. osteoarthritis (OA). Demographic data, length of hospital stay, readmission rate, reoperation rate, and postoperative complications within 30 days were analyzed by univariate analysis. Multivariable logistic regression was used to isolate the effect of acute fracture on postoperative complications and readmission. Results Six hundred fourty-six patients underwent TEA, and 149 (23.1%) had undergone TEA for distal humerus fracture. Patients undergoing TEA for fracture had an overall adverse event rate of 13.42% compared to a complication rate of 12.47% in patients undergoing primary elective TEA (P = .76). On univariate analysis, patients who underwent TEA for fracture were not significantly more likely to require reoperation within 30 days (1.34% vs. 4.63% for RA and 4.11% for OA, P = .24) or require readmission within 30 days (5.37% vs. 4.63% for RA and 4.88% for OA, P = .52). Multivariable logistic analysis found that TEA for fracture was not independently associated with readmission, reoperation, major complications, or minor complications. Increasing age is associated with increased risk of minor complications. Female gender is associated with decreased risk of major complication, and higher ASA classification was associated with increased odds of readmission. Conclusions Acute fracture is not an independent risk factors for major complications, reoperation, or readmissions in patients undergoing TEA. Level of Evidence Level III; Retrospective Case-Control Study.

Introduction: To assess knowledge, experiences, perceptions and barriers of healthcare professionals regarding oral palliative care. Material and methods: The study involved 150 participants working at a tertiary healthcare institute in India. The data collection tool was pretested and self-administered with sections on demographics, knowledge, attitude and practices, patient referral, perspectives, and barriers to oral palliative care. Results: The majority of participants 142 (94.6%) believed that palliative care patients need oral care, 85 (68.6%) participants had treated palliative care patients with dental problems. However, 60 (40%) had not received formal training for assessment and referral of patients with oral problems; 95 (63.4%) had never used tools to assess oral conditions of palliative care patients. According to 69 (46%), the best method to maintain oral hygiene is rinsing with saline and 81 (54%) expected physicians to be responsible for oral care of palliative care patients. The main challenges in providing oral care were lack of proper guidelines listed by 117 (78%) and lack of formal training indicated by 60 (40%) respondents. Conclusions: This study highlighted the need for effective assessment of the mouth and appropriate oral care. Training of healthcare professionals, educating families and patients with oral palliative care are necessary to effectively manage oral symptoms. An appropriate patient follow-up and care delivery system should be structured at comprehensive cancer centres, which can improve the quality of life and compliance of patients. There is a need for the development of assessment tools and referral practices for providing relief, comfort and consolation to patients and families.

Objective of the present study was to investigate the effect of chromium polynicotinate supplementation on the visual acuity and macular thickness of the diabetic macular edema in patients with non-proliferative diabetic retinopathy through a prospective, interventional comparative case series study, was performed in 120 patients.

Recent developments in three-dimensional (3D) printing technology offer immense potential in fabricating scaffolds and implants for various biomedical applications, especially for bone repair and regeneration. As the availability of autologous bone sources and commercial products is limited and surgical methods do not help in complete regeneration, it is necessary to develop alternative approaches for repairing large segmental bone defects. The 3D printing technology can effectively integrate different types of living cells within a 3D construct made up of conventional micro- or nanoscale biomaterials to create an artificial bone graft capable of regenerating the damaged tissues. This article reviews the developments and applications of 3D printing in bone tissue engineering and highlights the numerous conventional biomaterials and nanomaterials that have been used in the production of 3D-printed scaffolds. A comprehensive overview of the 3D printing methods such as stereolithography (SLA), selective laser sintering (SLS), fused deposition modeling (FDM), and ink-jet 3D printing, and their technical and clinical applications in bone repair and regeneration has been provided. The review is expected to be useful for readers to gain an insight into the state-of-the-art of 3D printing of bone substitutes and their translational perspectives., Graphical Abstract

Introduction: There is lack consensus on superiority of transparent vs. pressure dressing for prevention of post-cardiac catheterization pain, discomfort and hematoma. Therefore, we conducted this systematic review and meta-analysis of available RCTs on this subject. Methods: We performed a systematic search of RCTs published between in 2000-2019 in English language using databases including PubMed Medline, EMBASE, CINAHL, Cochrane Library, ERMED Journals, Clinical trials database, DELNET, Google Scholar and Discovery Search. Studies conducted on adult patients with femoral dressing after cardiac catheterization measuring pain, discomfort, hematoma as intended outcomes have been included. Data extraction, critical appraisal, assessment of risk bias was done and decisions on quality were made on mutual consensus. Mantel-Haenszel (MH) and odds ratio for dichotomous variables was calculated by Review Manager 5.3 software. Results: Out of all identified studies, only 5 studies comprising 664 patients fulfilled the inclusion criteria and met the quality assessment. Incidence of discomfort (25, 333) were significantly less in transparent dressing group as compared to pressure dressing group (149, 331); odds ratio 0.10, 95% confidence interval [CI] 0.06-0.15; I2 = 0%, P= 0.00. Four studies reported significantly lower number of pain cases in transparent dressing (17, 203) as compared to pressure dressing (57, 201); odds ratio 0.13, 95% confidence interval [CI] 0.03-0.59; I2 = 47%, P= 0.01). However, incidence of hematoma did not reveal any significant difference between two groups. Conclusion: Transparent dressing is a better option in patients with femoral/groin dressing after cardiac catheterization as it is more effective in prevention of pain and discomfort.

Introduction: Relative value units (RVUs) are integral to the U.S. physician compensation system used by the Centers for Medicare & Medicaid Services. The use of 'work RVUs' (herein, wRVUs) is intended to reimburse physicians according to the amount of expertise and effort needed to safely and effectively perform a procedure. Our purpose was to determine: 1) the number of wRVUs/hour generated by common sports medicine surgical procedures; and 2) how patient characteristics, surgical approach, and practice setting are associated with the number of wRVUs/hour. This analysis was performed to infer whether wRVUs are assigned appropriately according to the factors on which they are purported to be based.Methods: We queried the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database for common sports medicine surgical procedures performed in 2018. Data from 19,877 patients (8,258 women) with a mean age of 48 years (range, 18-90) who underwent a surgical sports medicine procedure were analyzed. Work RVUs and operative time were used to calculate work RVUs/hour for each surgical procedure. Univariate and multivariate analyses were used to assess correlations between patient characteristics and wRVUs/hour.Results: Knee chondroplasty generated the most mean (± standard deviation) wRVUs/hour at 22 ± 0.5, whereas 'open tenodesis of biceps tendon, long head' generated the least at 9.6 ± 0.25 wRVUs/hour. Factors associated with a greater mean number of wRVUs/hour were younger patient age, female sex, arthroscopic approach, and outpatient setting. Arthroscopic procedures also generated more wRVUs/hour than the same procedures performed through an open approach. wRVUs were not correlated with case complexity or surgical time.Conclusion: wRVUs/hour in surgical sports medicine procedures vary widely depending on the procedure type, patient characteristics, surgical approach, and practice setting.

Background Over the past decade, there have been ongoing concerns over declining surgeon compensation for lower extremity arthroplasty. We aimed to determine changes in surgeon payment, patient charges, and overall reimbursement rates for patients undergoing unicompartmental arthroplasty (UKA) and both primary and revision total knee (TKA) and hip (THA) arthroplasty. Methods Using Medicare data from 2012 to 2017, we determined inflation-adjusted changes in annual surgeon payment (professional fee), patient charges, and reimbursement rate (payment-to-charge ratio) for UKA and primary/revision TKA and THA. Both nonweighted and weighted (by procedure frequency/volume) means were calculated. Results Inflation-adjusted surgeon payment decreased for all procedures analyzed, with primary TKA (−17%) and THA (−11%) falling the most. Payment for UKA increased the most (+30%). There was a small increase in charges for THA revision (+2.2%, +2.1%, and +3.2% for acetabulum only, femur only, and both components, respectively). Charges for primary TKA (−3.7%) and THA (−1.5%) decreased slightly. The reimbursement rate for all procedures fell with UKA (−15%), TKA (−14%), and THA (−10%) falling the most. After weighting by procedure frequency/volume and combining all surgeries, average charges fell slightly (−0.7%), whereas surgeon payment (−13%) and reimbursement rate (−12%) fell more sharply. Conclusion Although patient charges have grown in pace with the inflationary rate for primary and revision TKA and THA, surgeon payment and reimbursement rates have fallen sharply. The orthopedic community needs to be aware of these financial trends to communicate to payers and health care policy makers the importance of protecting a sustainable payment infrastructure.

Introduction: There is a scarcity of literature about the burden of hemodialysis patients’ caregivers. Caregivers often receive little attention, and the primary focus is always on the patients. Frequent hospitalizations and factors associated with the disease can lead to depression and reduce the caregiver’s quality of life. Objective: The study aimed to determine the burden of caregivers of patients undergoing hemodialysis at a tertiary care hospital. Materials and Methods: This cross-sectional analytical study was conducted in a tertiary care hospital in northern India. A total of 110 caregivers who were providing care to their patients for more than 3 months were selected by purposive sampling method. The study data were collected by self-prepared demographic questionnaire to collect basic information regarding patients and caregivers, and the level of burden was assessed by a revised Zarit Burden Interview (ZBI) standardized on a 5-point scale. Descriptive and inferential (the Chi-square and Fisher exact test, 1-way ANOVA test) statistics were used for data analysis. Results: The mean±SD age of caregivers was 37±13 years. Nearly half of caregivers, 50 (45.46%), reported mild to moderately burdened, while 15 (13.63%) caregivers had moderate to severely burdened. The caregivers were mild to moderately burdened as the mean burden score was 25±12. There was no significant association between the levels of burden scores and selected sociodemographic variables of the participants. Conclusion: It was found that caregivers of hemodialysis patients experienced moderate burden while caring and being with the patient, which may alter their health and quality of life.

Purpose: To analyze graduating U.S. orthopaedic resident case logs to determine temporal trends in knee and shoulder arthroscopic case volumes, as well as changes in the variability of caseload volumes since the implementation of Accreditation Council for Graduate Medical Education (ACGME) minimum case requirements (“case minimums”) in 2013. Methods: We abstracted ACGME-published case log data for all U.S. orthopaedic surgery residents who graduated from 2007 to 2013 (before implementation of case minimums) and from 2014 to 2019 (after implementation). Using a case–control study design, we compared mean numbers of arthroscopic knee and shoulder cases reported per resident between the 2 time periods by using unpaired 2-tailed t tests. P values < .05 were considered significant. Results: The mean number of arthroscopy knee cases reported by residents decreased from 164 before implementation of case minimums to 107 after implementation (P < .001). The mean number of shoulder cases decreased similarly from 98 to 66 (P < .001). Among residents with caseload volumes in the 90th percentile (“high-volume caseloads”) the decrease was greatest, with 38% fewer knee cases and 41% fewer shoulder cases logged. The ratio of the number of cases in the 90th percentile of caseload to the number in the 10th percentile decreased significantly after implementation of case minimums (P < .001). Conclusions: After implementation of ACGME case minimums in 2013, the numbers of arthroscopic knee and shoulder cases reported by graduating U.S. orthopaedic surgery residents decreased significantly. The disparity between the number of cases that constitutes a high-volume caseload and the number that constitutes a low-volume caseload narrowed, suggesting greater uniformity in resident exposure to these procedures across training programs. Level of Evidence: Level III, retrospective comparative study.

To investigate associations between clinical and demographic parameters and Constant-Murley (CM) scores after subacromial balloon placement for massive, irreparable rotator cuff tears and to evaluate implant survival, shoulder function, and patient satisfaction.We prospectively analyzed patients with rotator cuff tears deemed irreparable on preoperative magnetic resonance imaging for whom nonoperative therapy was unsuccessful and who underwent balloon placement from 2014 to 2017 with minimum 1-year follow-up. Shoulder function was assessed using the CM score and the 12-Item Short Form Health Survey.The study included 51 patients (22 women and 29 men) with a mean age at surgery of 63 years (range, 50-78 years). The mean follow-up period was 36 months (range, 24-56 months). The postoperative acromiohumeral interval and total preoperative CM score predicted the postoperative CM score at final follow-up. The implant survival rates were 92% at 6 and 12 months, 90% at 2 years, and 87% at 3 and 4 years. Five patients underwent reverse total shoulder arthroplasty, and 1 underwent latissimus dorsi tendon transfer. Postoperatively, mean CM scores (± standard deviation) improved for range of motion (from 11 ± 5.4 to 34 ± 6.8) and strength (from 13 ± 5.4 to 28 ± 12) (P.01 for both). The total CM score improved from 27 ± 7.4 preoperatively to 77 ± 15 postoperatively (P.01). The physical and mental component summary scores on the 12-Item Short Form Health Survey improved from 27 ± 5.0 to 51 ± 6.5 (P = .02) and from 44 ± 15 to 56 ± 8.0, respectively (P.01). Thirty-eight patients reported excellent satisfaction, 8 were satisfied, and 5 were dissatisfied. Of the patients, 50 (98%) exceeded the minimal clinically important difference (≥10.4) and patient acceptable symptom state (≥44).At mean 3-year follow-up, subacromial balloon spacer placement for massive, irreparable rotator cuff tears was associated with a significant improvement in shoulder function, limited need for revision surgery, and high patient satisfaction. A greater postoperative acromiohumeral interval and lower preoperative CM score predicted a lower postoperative CM score at final follow-up.Level IV, retrospective cohort study and treatment study.

Introduction: Nicotine effectiveness has been tested in multiple forms to stop tobacco use. However, the evidence remains inconclusive for the efficacy of a single nicotine intervention. This study aims to test the efficacy of a nurse-led video-assisted nicotine replacement therapy (NRT) to standard NRT on tobacco addiction and cessation among tobacco users. Design: Randomised controlled trial (RCT) comparing two study groups (41/group) with blinded follow-up at two and four weeks. A video-assisted nurse-led NRT and routine standard treatment groups are compared. A weekly call reminder was placed to the video-assisted nurse-led group to take nicotine gum/lozenge and to attend follow-up regularly. Measures: Primary endpoints at two and four weeks were self-reported addiction status and tobacco cessation. A standardized urine cotinine test was performed to validate self-reported addiction status at five weeks. Results: Addiction status was significantly (p < 0.001) improved in the video-assisted nurse-led NRT group. A significant improvement was observed in importance (p < 0.001) to quit tobacco at two weeks of follow-ups. The participants in the nurse-led group enable to boost their readiness (p < 0.001) to quit tobacco at the second and fourth-week follow-ups. There was a significant reduction in urine cotinine levels at 5th week (OR: 2.79, CI 1.26–6.18) in the nurse-led NRT group. Conclusions: A video-assisted nurse-led nicotine replacement therapy found effective in reducing tobacco use. Developing culturally appropriate material and technology use can be a cost-effective means to curb the problem of tobacco and substance abuse.

Backgroud Many U.S. health care institutions have adopted compensation models based on work relative value units (wRVUs) to standardize payments and incentivize providers. A major determinant of payment and wRVU assignments is operative time. We sought to determine whether differences in estimated operative times between the Centers for Medicare & Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP) contribute to payment and wRVU misvaluation for the most common shoulder/elbow procedures. Methods We collected data on wRVUs, payments, and operative times from CMS for 29 types of isolated arthroscopic and open shoulder/elbow procedures. Using regression analysis, we compared relationships between these variables, in addition to median operative times reported by NSQIP (2013-2016). We then determined the relative valuation of each procedure based on operative time. Results Seventy-nine percent of CMS operative time were longer than NSQIP time (R2 = 0.58), including, but not limited to, shoulder arthroplasty and arthroscopic shoulder surgery. The correlation between payments and operative times was stronger between CMS data (R2 = 0.61) than NSQIP data (R2 = 0.43). Similarly, the correlation between wRVUs and operative times was stronger when using CMS data (R2 = 0.87) than NSQIP data (R2 = 0.69). Nearly all arthroscopic shoulder procedures (aside from synovectomy, debridement, and decompression) were highly valued according to both datasets. Per NSQIP, compensation for revision total shoulder arthroplasty ($10.14/min; 0.26 wRVU/min) was higher than that for primary cases ($9.85, 0.23 wRVU/min) and nearly twice the CMS rate for revision cases ($5.84/min; 0.13 wRVU/min). Conclusions CMS may overestimate operative times compared to actual operative times as recorded by NSQIP. Shorter operative times may render certain procedures more highly valued than others. Case examples show that this can potentially affect patient care and incentivize higher compensating procedures per operative time when less-involved, shorter operations have similar patient-reported outcomes.

Despite our growing knowledge about the COVID pandemic, not much concern has been focused upon the effective pain management in pediatric patients suffering from this SARS CoV2 virus. Symptoms with pain like myalgia (10%-40%), sore throat (5%-30%), headache (14%-40%) and abdominal pain (10%) are common in children suffering from COVID. (3-5) We conducted a systematic review regarding analgesia for COVID positive pediatric patients. Cochrane, PubMed, and Google scholar databases were searched for relevant literature. Owing to the novel status of COVID-19 with limited literature, we included randomized controlled trials (RCTs), observational studies, case series and case reports in the descending order of consideration. Articles in languages other than English, abstract only articles and non-scientific commentaries were excluded. The Primary outcome was evaluation of pain related symptoms and best strategies for their management. Our review revealed that a multidisciplinary approach starting from non-pharmacological techniques like drinking plenty of water, removing triggers like inadequate sleep, specific foods and psychotherapy including distraction, comfort and cognitive behavioural strategies should be used. Pharmacological approaches like acetaminophen, NSAIDS, spasmolytics etc. can be used if non-pharmacological therapy is inadequate. As per the current strength of evidence, acetaminophen and ibuprofen can be safely administered for pain management in children with COVID-19. Undertreated pain is a significant contributor to increased morbidity and poor prognosis. Integration of evidence based non-pharmacotherapies in the multidisciplinary pain management will contribute towards improved functioning, early recovery and better quality care for pediatric patients suffering from COVID.

Background: The significance of Candida in pulmonary secretions is unclear, and usually is regarded as colonization, not contributing to symptoms or disease. Yet, in our experience, Candida seemed associated with chronic sputum, mucus plugging, atelectasis, and poor outcome. Objective: The aim of this study is to describe the clinical findings of patients with Candida in pulmonary (sputum or bronchoscopy) secretions and the significance of Candida. Methods: Retrospective study of inpatients and outpatients referred for pulmonary consultation with Candida in pulmonary secretions. Clinical parameters and estimates of whether Candida was likely clinically significant, were determined. Results: 82 inpatients and 11 outpatients were identified, of which 61 (66%) had atelectasis and 68 (73%) bronchoscopies. Of patients having bronchoscopies, 56 (82%) had mucus, and 43 (63%) mucus plugging. Of the inpatients death (or probable death) occurred in 43 (63%), 42 (98%) of which were from definite or probable respiratory failure, with 13 (31%) likely related to mucus plugging, 16 (38%) possibly from mucus plugging, 6 (14%) unknown, and 7 (17%) not due to mucus plugging. Candida was felt likely clinically significant in 57 patients (61%), uncertain significance in 23 (25%), and not significant in 13 (14%). All outpatients had exacerbations, including 7 (64%) within a year. Conclusion: Patients requiring pulmonary consultation with Candida in pulmonary secretions often have chronic sputum production, exacerbations, mucus plugging, atelectasis, and death from respiratory failure. Candida was likely clinically significant in most patients. Recommendations to consider Candida in pulmonary secretions as colonization should be reconsidered.

Background Misuse and overuse of antimicrobials is one of the world's most pressing public health problems. Nurses are important members of healthcare team and thus it is essential to know behaviour of antibiotics use among budding nurses. Aim & objective To assess prevalence and practices of self-medication with antibiotic among undergraduate nursing students. Methods and material This cross-sectional descriptive study was conducted on 216 randomly selected undergraduate nursing students studying at a tertiary care teaching hospital in Uttarakhand. Data was collected using a valid and reliable questionnaire for self-medication practices with antibiotics and were analysed by using descriptive statistics. Results Prevalence of self-medication with antibiotics was 78.7% and among them 53.5% practiced it for 2–3 times in past one year. Azithromycin (37.5%) and Amoxicillin (30.1%) were commonly used antibiotics, primarily for the treatment of sore throat (30.6%) and fever (27.1%). The main reasons for self-medication were adequate knowledge of antibiotics use (39.4%), and to save time (30.6%) c which necessitate educating them with risks and harms of inappropriate use of antimicrobials. Furthermore, sensitizing the pharmacists for not advising and selling antibiotics without medical prescription.

The number of Coronavirus Disease-19 (COVID-19) cases are on a rise globally due to the highly contagious nature of its causative agent Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). Physiological and Immunological changes during pregnancy may put pregnant women at increased risk for severe COVID-19 respiratory infection which may require Intensive care. Along with medical management, physiotherapy interventions namely patient education, relaxation, breathing exercises, positioning in bed, and mobility exercises are an integral part of acute care set up. The aim of this report is to share our experience as a frontline physiotherapist working as an integral part of the medical team in a dedicated COVID-19 Government Tertiary Care Hospital in Mumbai. It highlights physiotherapy management of a COVID-19 patient, in her 24th week of gestation, in an Acute Care Set Up.

Purpose Fingertip injuries are common in the industrial and factory workers as well as in the domestic settings. Loss of pulp hampers daily life activities. Functional and aesthetic aspects are important in fingertip reconstruction. The bone is usually exposed along with soft tissue loss. Therefore to reconstruct the pulp flap with adequate bulk is required. Methods We are reporting a case series of 12 patients with the injury over the volar aspect of distal phalanx of the index or middle finger. In all cases laterally based thenar flap was chosen. The flap donor site was closed primarily in most of cases, while 4 patients required skin graft. The flap was detached in between 2-3 weeks. Functional assessment was done using static and dynamic 2-point discrimination and range of motion at each joint. The aesthetic outcome was assessed through questionnaire. The results were analyzed using the unpaired t-test (SSPS version 21). Results Partial necrosis occurred in 2 cases while rest of flaps survived successfully. Static 2-point discrimination ranged from 6-10 mm with mean 8.6 mm and dynamic 2-point discrimination ranged from 8-10 mm with mean 8.9 mm. Mean satisfaction score was (4.0±0.55). Conclusion Thenar flap is a good choice for reconstruction of the finger pulp as it provides the bulk with good functional and aesthetic outcome.

Diabetes has been associated with poor healing and prior literature has shown worse functional outcomes in diabetic patients undergoing both open and arthroscopic shoulder surgery. However, the effects of diabetes on perioperative complications for patients undergoing non-arthroplasty type shoulder procedures are not well defined. The purpose of this study was to analyze the effects of diabetes on 30-day complications following non-arthroplasty shoulder surgery.The American College of Surgeons National Surgical Quality Improvement Program was used to identify patients who underwent open and arthroscopic shoulder procedures (excluding arthroplasty) from 2011 to 2018. Diabetic patients were identified and compared to a non-diabetic cohort. Demographic data and postoperative complications within 30 days were analyzed. Multivariable regression was used to determine the effect of diabetes on shoulder surgery.We identified 99,970 patients who underwent shoulder surgery in our cohort and 13.9% (13,857 patients) of these patients were diabetics. Within the diabetic cohort, 4,394 (31.7%) were insulin dependent. Diabetics were more likely to be older, female, and have a higher body mass index (P 0.01). Diabetics had a higher rate of associated medial comorbidities (P 0.05). Diabetics were less likely to be smokers and on average had shorter surgeries (P 0.05). Univariate analysis showed that diabetes was associated with increased risk for infectious and other major and minor complications; however, multivariate regression revealed that diabetes was only independently associated with infection (OR 1.33, P = 0.38).While diabetes is associated with increased likelihood of infection following shoulder surgery, absent commonly associated comorbidities, they are not at increased risk for other 30-day postoperative complications.

Background The coronavirus disease 2019 (COVID-19) pandemic has taken the world by storm, especially the health care system. Medical practitioners of all specialties are being assigned to treat patients of COVID-19. In this article, two authors (T.V. and N.G.) from the Department of Neurosurgery who were deployed in the COVID-19 testing ward between April 25 and May 31, 2020 share their experience. Methods A prospective observational study was conducted including all those who were admitted in this ward. The patients were studied according to their demographic profiles, diagnoses, admitting departments, travel history, and presence/absence of COVID-19–related symptoms. Relevant history regarding occupation, contact with patient with known COVID-19, and comorbid illness was noted. Those who tested positive for COVID-19 were studied further. The data from the institute’s official record were updated until August 14, 2020. Results During the study period, there were 256 admissions in the ward, of whom 148 (92 male, 56 female) were patients and 108 were patients’ attendants/relatives. Most patients were admitted under the departments of internal medicine (33, 22.3%) and general surgery (19, 12.8%). Of 148 patients, 46 (31.1%) were admitted as they were planned for a surgery/intervention. Among 148 patients, 29 (19.6%) had history of travel to or were residents of a red zone, 4 (2.7%) had history of contact with a confirmed case of COVID-19, whereas 6 (4.1%) were health care workers. One hundred four patients (70.2%) showed no COVID-19–related symptoms. Thirty-four patients (22.9%) had associated comorbid conditions. Eight patients (5 male, 3 female) with mean age of 37.6 years (range 4–69 years) tested positive for COVID-19. Conclusions The authors share their experience and their institute’s protocol in various facets during this war against COVID-19 pandemic. Preadmission and presurgical testing of patients is important in preventing the spread of the disease amongst health care workers.

Coronavirus disease-19 (COVID-19) has affected people of various age groups with symptoms ranging from asymptomatic or mild to severe respiratory failure, with mild symptoms requiring little or no medical intervention whereas severe symptoms requiring hospitalisation and prompt medical management. The following case report illustrates about recovery of a patient with severe symptoms of COVID-19 in a COVID dedicated tertiary care hospital run by the Municipal Corporation of Greater Mumbai. Physiotherapy has long been a part of multidisciplinary team in management of patients with severe respiratory illnesses. The report mainly presents about the Physiotherapy management undertaken for the above-mentioned patient parallelly to the Medical management aiding in recovery of the patient.

Objectives: The aim of the study is to understand antibiotic prescribing patterns and to understand knowledge of antibiotic resistance amongst the doctors working at public health facilities of a northern Indian state. Methodology: A cross-sectional study among doctors of the civil hospitals of Haryana state of India was conducted 2019. Data were collected by self-administered questionnaire from a total of 215 doctors posted at the 22 district hospitals. Results: The response rate was 98%. Doctors (66%) perceived antibiotic resistance as a very important global problem, a very important problem in India (68%) and as an important problem in their hospital (31%). Experience in years was significantly associated with considering hand hygiene (OR, 5.78; 95% CI, 1.6420.3; P = 0.005) and treatment of bacteria as per susceptibility report of the organism (OR, 0.54; 95% CI, 0.310.93; P = 0.03).Surgeons reported piperacillin-tazobactam (17%), cloxacillin (17%), and cephazolin (12.05%) and others (54.2%) as the first choice of antibiotics for infection after surgery. Doctors (52.3%) reported that they started antibiotics 12 hours before surgery; 15 (17%) prescribed antibiotics 6 hours before surgery; and 23 (27%) 1 day before the surgery. Time for stopping antibiotics after surgery, as reported by participants, was 1 day (15%), 23 days (35%), 57 days (44%), respectively. A total of 71 (83%) doctors thought that surgical incision could lead to post-surgical site infection. Conclusion: Findings of study can be utilized to enhance education on antimicrobial prescribing, antimicrobial surveillance, and prescribing patterns among doctors in our settings.

With the progressions in Information and Communication Technology (ICT), the innumerable electronic devices (like smart sensors) and several software applications can proffer notable contributions to the challenges that are existent in monitoring plants. In the prevailing work, the segmentation accuracy and classification accuracy of the Disease Monitoring System (DMS), is low. So, the system doesn't properly monitor the plant diseases. To overcome such drawbacks, this paper proposed an efficient monitoring system for paddy leaves based on big data mining. The proposed model comprises 5 phases: 1) Image acquisition, 2) segmentation, 3) Feature extraction, 4) Feature Selection along with 5) Classification Validation. Primarily, consider the paddy leaf image which is taken as of the dataset as the input. Then, execute image acquisition phase where 3 steps like, i) transmute RGB image to grey scale image, ii) Normalization for high intensity, and iii) preprocessing utilizing Alpha-trimmed mean filter (ATMF) through which the noises are eradicated and its nature is the hybrid of the mean as well as median filters, are performed. Next, segment the resulting image using Fuzzy C-Means (i.e. FCM) Clustering Algorithm. FCM segments the diseased portion in the paddy leaves. In the next phase, features are extorted, and then the resulted features are chosen by utilizing Multi-Verse Optimization (MVO) algorithm. After completing feature selection, the chosen features are classified utilizing ANFIS (Adaptive Neuro-Fuzzy Inference System). Experiential results contrasted with the former SVM classifier (Support Vector Machine) and the prevailing methods in respect of precision, recall, F-measure,sensitivity accuracy, and specificity. In accuracy level, the proposed one has 97.28% but the prevailing techniques only offer 91.2% for SVM classifier, 85.3% for KNN and 88.78% for ANN. Hence, this proposed DMS has more accurate detection and classification process than the other methods. The proposed DMS evinces better accuracy when contrasting with the prevailing methods.

To assess the accuracy of craniocervical measurements for identifying craniocervical injuries and the frequency of subjective findings of craniocervical injuries on CT in pediatric patients. Case-controlled retrospective review of patients ≤ 16 years old with craniocervical junction injuries. Receiver operator curves were created for common craniocervical measurements on CT comparing patients with complete and partial craniocervical injuries to uninjured cohort. Frequency of subjective CT findings of craniocervical injury was assessed in the injured cohort. For complete disruption injuries (CD) (n = 27), C1–C2 distance (AUC = 0.90, 95%CI = 0.83–0.97), atlanto-occipital distance (AUC = 0.95–0.98, 95%CI = 0.90–1.00), and basion-dens distance (AUC = 0.90, 95%CI = 0.82–0.98) had excellent accuracy diagnosing injury. Powers ratio (AUC = 0.85, 95%CI = 0.76–0.94) had good, basion-posterior axial line (AUC = 0.74, 95%CI = 0.61–0.86) fair, and atlanto-dental distance (AUC = 0.69, 95%CI = 0.57–0.82) poor accuracy. For partial disruption injuries (PD) (n = 21), basion-dens distance (AUC = 0.75, 95%CI = 0.62–0.88) had fair accuracy diagnosing injury. Powers ratio (AUC = 0.63, 95%CI = 0.47–0.79), C1–C2 distance (AUC = 0.60, 95%CI = 0.45–0.75), atlanto-dental distance (AUC = 0.55, 95%CI = 0.39 = 0.71), atlanto-occipital distance (AUC = 0.63–0.65, 95%CI = 0.47–0.81), and basion-posterior axial line (AUC = 0.60, 95%CI = 0.44–0.76) all had poor accuracy. Eighty-one percent (n = 22) of CD and 38% (n = 8) of PD patients had non-concentric atlanto-occipital joints. One hundred percent of CD patients had ≥ 1 soft tissue finding and eighty-one percent (n = 22) had ≥ 2 findings. Seventy-three percent (n = 16) of PD patients had ≥ 1 soft tissue finding. Eighty-six percent (n = 18) of PD patients had non-concentric atlanto-occipital joints and/or soft tissue findings. Craniocervical measurements have poor accuracy for identifying craniocervical injuries in pediatric patients with incomplete craniocervical ligament disruption. Subjective findings of craniocervical injury are frequently present on CT in pediatric patients and can help increase sensitivity for identifying injury.

In this paper, an improved kinetics model of soot oxidation based on the traditional B-K model is employed to characterize the thermal regeneration process of diesel particulate filters (DPF). Cons...

Background: WHO SSC is found to be effective in reducing 57% of surgical complications and decreases surgical morbidity, mortality and sentinel events. Despite the known positive effects of using the surgical safety checklist prior to surgery, its application in practice is much less. It is important to determine the awareness and attitude of health personnel about the use of the checklist, as it can help to implement it. Objectives: The purpose of this study is to assess the awareness and attitude about the use of WHO Surgical Safety Checklist (SSC) among perioperative nurses and to determine the association between awareness and attitude about the use of WHO Surgical Safety Checklist (SSC) among perioperative nurses and their selected socio-demographic variables. Method: It was a descriptive cross-sectional study conducted on 25 perioperative nurses working at a tertiary care hospital. Data were collected using a validated self-structured socio demographic data assessment sheet, Attitude questionnaire and Awareness scale. Result: Data analysis was done using descriptive and inferential statistics. The results showed that awareness and attitude scores were independent to the age, gender, and training institute. Nurses were having significantly higher mean awareness and attitude score about use of WHO SCC i.e. 5.16±1.3 and 17.12±1.1 respectively. Most of the perioperative nurses (92%) had positive attitude towards implementing SSC to prevent errors. There was no significant correlation found between the perioperative nurses’ awareness and attitude about using WHO SCC at p

Receptor-mediated endocytosis is key in the success of targeted nanomedicines for the treatment of cancer. Various receptors have been explored for the active targeting of anticancer drugs to avoid the drawbacks of conventional anticancer drugs. This research work aimed to investigate the potential of serotonin (ST)-conjugated Vit-E nanomicelles for the targeted delivery of irinotecan hydrochloride (IRI) to human prostate cancer cells. A ST receptor-targeting conjugate was synthesized by conjugating ST and d-α-tocopheryl polyethylene glycol succinate via a two-step synthesis reaction. The developed formulation demonstrated a size of about 14 nm, a negative zeta potential of around -20 mV, a high drug encapsulation efficiency, and sustained drug release over 48 h. Cytotoxicity studies revealed that ST-conjugated, IRI-loaded nanomicelles (IRI-STNM) were not only toxic to human prostate cancer cells but also eradicate these cells present in the form of 3D spheroids. This cytotoxicity of IRI-STNM was mediated through induction of apoptosis, reactive oxygen species generation, change in mitochondrial membrane potential, and inhibition of cell migration. Further, IRI-STNM performed significantly better than the native IRI and nontargeted nanomicelles, which was led by a higher cellular uptake of IRI-STNM, indicating the role of ST in targeting of drug-loaded nanomicelles.

Background: College life is a crucial period and at this age, students are more likely to get involved in unhealthy lifestyle behavior like poor dietary habits, physical inactivity, and use of substances, etc. Objectives: Study objectives were to determine the lifestyle behavior of budding healthcare professions and to determine the association of bio-physical profiles with their personal profile, activity, sleep, and dietary pattern. Settings and Design: The current study adopted a cross-sectional design and carried out during May - June 2019 among 284 participants of tertiary care institute. Methods and Material: Participants were selected through a proportionate stratified sampling technique. Self-structured questionnaire and Likert scale were used to assess the lifestyle behavior of participants. Descriptive and inferential statistics were used for data analysis. Results: Majority of participants (70.7%) preferred junk food as a substitute of meal. Significant number (68.3%) of students did not exercise regularly and 30.9% have disturbed sleep pattern. One-third of them (34.5%) were in pre-hypertensive stage and alarming number of them having unacceptable body mass index (BMI) (24.7%) and waist hip ratio (28.5%). Increased BMI was significantly associated with male gender (P = 0.01) and sleep deprivation (P = 0.03). Significantly more male participants were hypertensive and pre-hypertensive (P = 0.001). Conclusions: Study data indicated that having knowledge regarding health is not enough to ensure that health professionals will follow healthy lifestyle and it is important to motivate budding health care professionals to practice healthy lifestyle with an aim of health promotion and prevention of diseases.

Relative risk and odds ratio are commonly used in the biomedical research studies; however, expression and interpretation must be done very carefully. A risk ratio and an odds ratio are used in cohort studies but only odds ratio is used in case control studies. However, relative risk or risk ratio is found to be frequently used in the interventional biomedical research studies. The relative risk and odds ratio provide important information regarding the effect of a risk factor on the outcome of interest. The relative risk and odds ratio of 1 suggests that there is no difference between two groups. A value >1 suggests increase risk, while a value

Objective (1) To report the neodymium:yttrium–aluminum–garnet (Nd:YAG) laser posterior capsulotomy rate (%) of eight rigid and foldable intraocular lens (IOL) designs in a series of 5416 pseudophakic human eyes obtained postmortem, accessioned in our center between January 1988 and January 2000. (2) To identify factors that are instrumental in reducing the incidence of posterior capsule opacification, (PCO, secondary cataract) and hence the need for Nd:YAG laser posterior capsulotomy. Design Comparative autopsy tissue analysis. Participants A total of 5416 globes with posterior chamber intraocular lens (PC-IOLs) obtained postmortem received from Lions Eye Banks between 1988 and 2000. Methods Miyake-Apple posterior photographic technique. Special reference was given to the presence or absence of Nd:YAG laser posterior capsulotomy orifice on the posterior capsule of each eye. Main outcome measures The Nd:YAG laser posterior capsulotomy rate (%) as of January 2000 was documented. In addition, the Nd:YAG laser posterior capsulotomy rate for each lens was plotted on a monthly basis for the same period, creating a computerized trend or "timeline" for each IOL style. Results Relatively high Nd:YAG laser posterior capsulotomy rates ranging from 20.3% to 33.4% were noted with four relatively older designs (high incidence of implantation between 1988 and the early 1990s). Four modern foldable IOLs manufactured from silicone and acrylic materials had significantly lower Nd:YAG laser posterior capsulotomy rates ranging from 0.9% (Alcon Acrysof) to 17.1%. The difference in Nd:YAG rates among the eight IOL designs was found to be significant ( P Conclusions By use of the six factors regarding surgical technique and IOL choice described in this article, we strongly believe that the overall incidence of PCO and hence the incidence of Nd:YAG laser posterior capsulotomy is now rapidly decreasing from rates as high as 50% in the 1980s to early 1990s. Surgical tools and IOLs are now available to bring these rates down to single digits. Careful application and use of these tools by surgeons can genuinely lead in the direction of virtual eradication of secondary cataract, the second most common cause of visual loss worldwide.

Introduction: Recently, there has been an increase in adults undergoing orthodontic treatment in both the public and the private sector. Satisfaction during and after the orthodontic treatment process has not been widely discussed so far, however, and few research studies have emphasized patient satisfaction with treatment outcome and the factors affecting patient satisfaction.Aim: To investigate factors affecting patient satisfaction with the process of orthodontic treatment in young adults.Material and methods: Fifty-eight patients (33 girls and 25 boys with a mean age of 25.05 years, SD 2.83) were included in the survey. All patients were young adults who had completed their orthodontic treatment with fixed appliances and were taken from two centers (a teaching hospital and a private practice). Data was collected using online survey forms and was analyzed using content thematic analysis. Five main factors were identified related to patient satisfaction with the process of orthodontic treatment: communication, faculty (orthodontist), physical surroundings, consultation/appointments, and impact of appliance treatment.Results: Effective communication was the most prominent factor among all five factors considered, especially detailed explanation given during treatment and making patients feel comfortable under their care. Median values were generally high for satisfaction with treatment results. There was a clear correlation ( p Conclusion: In general, young adults were observed to be satisfied with the treatment process, and good communication played a dominant role in this. Though there were many differences in working models between public and private sectors, many similarities were observed when comparing the factors between the two centers.

Triple-negative breast cancers account for approximately 15-20% of breast cancer patients. Due to lack of expression of estrogen receptor, PR and human epidermal growth factor receptor 2 in triple-negative breast cancers, there are no targeted therapies available for these cancers. Therefore, a major research priority is to find potential therapeutic targets. Androgen receptor is present in 80-90% of all breast cancers, including 55% of estrogen receptor-α-negative cancers and 12%-35% of triple-negative breast cancers. Androgen receptor stimulates growth and survival in triple-negative breast cancer cells. Treatment with bicalutamide, an androgen receptor antagonist, has a good benefit for AR triple-negative breast cancer patients. AR triple-negative breast cancer cells were treated with curcumin or bicalutamide alone or in combination of both together. Cell growth, apoptosis and Wnt signaling pathways were examined. We found that curcumin dramatically suppressed Wnt signaling pathway in AR triple-negative breast cancer cells. Curcumin treatment inhibited androgen receptor protein expression in AR triple-negative breast cancer cells. Combination treatment of curcumin and bicalutamide has a robust increase in apoptosis. Furthermore, the combination treatment suppressed the growth of AR triple-negative breast cancer cells more effectively than with the single drug alone. Our data indicate that androgen receptor inhibition is a potential therapeutic approach for AR triple-negative breast cancers. In summary, our study for the first time shows that the combination treatment of curcumin and bicalutamide is effective in AR triple-negative breast cancer cells.

Coronavirus are a common family of viruses and there are seven different types of coronaviruses including this new member of coronavirus i.e. 2019 novel coronavirus, which can make the people infected and sick. Some strains of this family of virus cause mild to moderate disease symptoms like common cold while other strains cause very severe disease like Severe Acute Respiratory Syndrome (SARS) and Middle East respiratory syndrome (MERS).(1,2) In late December, in Wuhan Hubei Province, China a number of people suffered with severe respiratory illness including a cluster of pneumonia cases. On 31 December 2019, China notified the World Health Organization (WHO) about cluster of patient with symptoms of respiratory illness of unknown cause, which were connected to an open seafood and animal market of Wuhan city, China.(3)