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Purpose: To study the long-term efficacy and safety of local application of imiquimod 5% and fluorouracil 1% creams in complex eyelid basal cell carcinomas (BCCs). Methods: A retrospective, non-comparative study in biopsy-proven, complex (involving canthi or >50% of eyelid length) eyelid BCC patients who were medically unfit for surgical procedures. All patients were medically treated with either of the creams using fixed-dose regimens for a minimum of 3 months. All received oral vitamin C 500 mg QID for 3 months as an adjunct for collagen healing. A minimum of “post-treatment” follow-up of 12 months was observed. Results: Of total 30 patients, imiquimod 5% and fluorouracil 1% were used in 16 and 14 patients, respectively. The mean age of our patients was 70.5 years. The co-morbidities included – severe coronary artery disease using blood-thinners ( n = 19), poorly controlled diabetes ( n = 12), poorly controlled hypertension ( n = 6), on nebulization ( n = 3), and tuberculosis with pulmonary fibrosis ( n = 2). Complete clinical tumor resolution was noted in 10 and 8 patients over 12 and 16.5 weeks, respectively, in imiquimod and fluorouracil groups. Periocular skin erythema, chemical conjunctivitis, and skin depigmentation were seen in all the patients of imiquimod group. On the other hand, the local side-effect profile in fluorouracil patients was limited. Conclusion: The medical treatment of complex eyelid BCC is a useful alternative to surgery in the elderly with significant co-morbidities. It provides a promising long-term relief with a tolerable side-effect profile. A prospective, randomized, double-blinded trial would provide stronger evidence for the efficacy of these drugs.

Summary Background The WHO End TB Strategy requires drug susceptibility testing and treatment of all people with tuberculosis, but second-line diagnostic testing with line-probe assays needs to be done in experienced laboratories with advanced infrastructure. Fewer than half of people with drug-resistant tuberculosis receive appropriate treatment. We assessed the diagnostic accuracy of the rapid Xpert MTB/XDR automated molecular assay (Cepheid, Sunnyvale, CA, USA) to overcome these limitations. Methods We did a prospective study involving individuals presenting with pulmonary tuberculosis symptoms and at least one risk factor for drug resistance in four sites in India (New Delhi and Mumbai), Moldova, and South Africa between July 31, 2019, and March 21, 2020. The Xpert MTB/XDR assay was used as a reflex test to detect resistance to isoniazid, fluoroquinolones, ethionamide, amikacin, kanamycin, and capreomycin in adults with positive results for Mycobacterium tuberculosis complex on Xpert MTB/RIF or Ultra (Cepheid). Diagnostic performance was assessed against a composite reference standard of phenotypic drug-susceptibility testing and whole-genome sequencing. This study is registered with ClinicalTrials.gov , number NCT03728725 . Findings Of 710 participants, 611 (86%) had results from both Xpert MTB/XDR and the reference standard for any drug and were included in analysis. Sensitivity for Xpert MTB/XDR detection of resistance was 94% (460 of 488, 95% CI 92–96) for isoniazid, 94% (222 of 235, 90–96%) for fluoroquinolones, 54% (178 of 328, 50–61) for ethionamide, 73% (60 of 82, 62–81) for amikacin, 86% (181 of 210, 81–91) for kanamycin, and 61% (53 of 87, 49–70) for capreomycin. Specificity was 98–100% for all drugs. Performance was equivalent to that of line-probe assays. The non-determinate rate of Xpert MTB/XDR (ie, invalid M tuberculosis complex detection) was 2·96%. Interpretation The Xpert MTB/XDR assay showed high diagnostic accuracy and met WHO's minimum target product profile criteria for a next-generation drug susceptibility test. The assay has the potential to diagnose drug-resistant tuberculosis rapidly and accurately and enable optimum treatment. Funding German Federal Ministry of Education and Research through KfW, Dutch Ministry of Foreign Affairs, and Australian Department of Foreign Affairs and Trade.

Ferritin is a known inflammatory biomarker in COVID-19. However, many factors and co-morbidities can confound the level of serum ferritin. This current metaanalysis evaluates serum ferritin level in different severity levels in COVID-19. Studies evaluating serum ferritin level in different clinical contexts (COVID-19 vs. control, mild to moderate vs. severe to critical, non-survivor vs. survivor, organ involvement, ICU and mechanical ventilation requirement) were included (total 9 literature databases searched). Metaanalysis and metaregression was carried out using metaphor “R” package. Compared to control (COVID-19 negative), higher ferritin levels were found among the COVID-19 patients [SMD −0.889 (95% C.I. −1.201, −0.577), I2 = 85%]. Severe to critical COVID-19 patients showed higher ferritin levels compared to mild to moderate COVID-19 patients [SMD 0.882 (0.738, 1.026), I2 = 85%]. In meta-regression, high heterogeneity was observed could be attributed to difference in “mean age”, and “percentage of population with concomitant co-morbidities”. Non-survivors had higher serum ferritin level compared to survivors [SMD 0.992 (0.672, 1.172), I2 = 92.33%]. In meta-regression, high heterogeneity observed could be attributed to difference in “mean age” and “percentage of male sex”. Patients requiring ICU [SMD 0.674 (0.515 to 0.833), I2 = 80%] and mechanical ventilation [SMD 0.430 (0.258, 0.602), I2 = 32%] had higher serum ferritin levels compared to those who didn't. To conclude, serum ferritin level may serve as an important biomarker which can aid in COVID-19 management. However, presence of other co-morbid conditions/confounders warrants cautious interpretation.

Four-wheeler automotive vehicle is the basic need of people in today’s life all over the world. But the noise coming from the exhaust system is highly affecting the human health. Among all the noise produce in vehicle, exhaust system noise is maximum. Muffler is one such acoustic filter used for reducing this exhaust noise. Hybrid muffler is one type of muffler which combines the properties of both reactive muffler and dissipative muffler and it operates at wide frequency range. In this study an already existing muffler (Reactive type muffler) used in 91bhp, 6000 RPM four-cylinder petrol engine was optimized to hybrid muffler. Aerodynamic and acoustic performance parameters were the main performance parameter and were determined by CFD analysis and acoustic analysis. The existing reactive muffler of the four-cylinder petrol engine could be replaced by the hybrid muffler. Here the mufflers were designed in ANSYS design modular and analyses were performed in ANSYS Fluent and COMSOL software. CFD analysis was performed for the existing muffler and three other newly designed muffler by considering inlet velocity boundary condition at inlet velocity 40 m/s and 80 m/s. It was observed that increase in pressure drop (aerodynamic performance) in model 4, model 3 and model 2 is around 38%, 33.2% and 29% respectively. Again, from acoustic analysis the transmission loss (TL) in model 4 was observed to be 47 dB whereas in other models it was around 20 dB. Further it was observed that the sound pressure level from model 1 at the exit is around 75–78 dB whereas in model 4 it was observed to be around 45–50 dB at the exit. Hence from both the analysis it is concluded that model 4 which is hybrid type muffler is the most optimized muffler.

Purpose: To report the computed tomography features of a case with complete luxation of the globe after a road traffic accident. Case Report: A 35-year-old male presented with pain, loss of vision, and bleeding from the left eye 48 hr after a road traffic accident. The ophthalmic examination of the left upper and lower eyelids showed edema with subcutaneous hematoma, crepitus, and complete blepharoptosis. On retracting the eyelids, the left eyeball was not visible and the patient was not able to perceive light. The left temporal region appeared filled with a soft, palpable globular structure situated beneath the temporalis muscle. A non-contrast computed tomography (NCCT) of the head and orbits showed a comminuted and displaced fracture of the floor, medial, and lateral orbital walls in addition to a displaced tripod fracture of the left zygomatic bone. The intact left eyeball was seen below the temporalis muscle without any optic nerve or extraocular muscle attachment. The virtual reality reconstruction highlighted a contributory supero-temporal defect in the bony orbit, which appeared large enough to accommodate the intact eyeball. Conclusion: The computed tomography of the orbits provided a detailed location of the luxated eyeball and provided guidance in further management of the case.

As the first and only presenting feature of acute myeloid leukemia (AML), unilateral proptosis in children is uncommon. We report the cases of two girls who had no systemic clinical manifestations of AML. Orbital imaging showed space-occupying infiltrating lesions without surrounding bone erosion. Incisional biopsy and immunohistochemistry were diagnostic for myeloid sarcoma. Systemic workup and bone marrow examination showed features of AML. Systemic chemotherapy was administered to both children, who responded well to the treatment. Myeloid sarcoma should be kept in the differentials of the children presenting with isolated proptosis. Immunohistochemistry may provide an accurate diagnosis and early treatment may lead to a prompt recovery with a good prognosis.

Introduction Obesity has been considered as one of the independent risk factors for a severe form of coronavirus disease-2019 (COVID-19) and relationship between obesity, critical illness, and infection is still poorly understood. We herein discuss clinical course and outcome of critically ill obese patients with COVID-19 admitted to critical care unit. Materials and methods We retrospectively analyzed data of critically ill obese patients hospitalized with COVID-19 over a span of 6 months. Management was guided according to the institutional protocol. Collected data included demographic parameters (age, sex, comorbidities, and body mass index (BMI)), complications, inflammatory markers (interleukin (IL)-6, Ferritin), length of mechanical ventilation, length of intensive care unit (ICU) stay, and inhospital death. Results There was no appreciable difference in terms of demographics, inflammatory markers, predictors of mortality scores, and comorbidity indices between the survivors and nonsurvivors. Among outcome analysis, there was a statistically significant difference between ventilator days between survivors and nonsurvivors (p = 0.003**). Conclusion Obesity itself is a significant risk factor for severe COVID-19 infection; however, if efficiently managed and in a protocol-determined manner, it can have a favorable outcome. How to cite this article Kaur M, Aggarwal R, Ganesh V, Kumar R, Patel N, Ayub A, et al. Clinical Course and Outcome of Critically Ill Obese Patients with COVID-19 Admitted in Intensive Care Unit of a Single Center: Our Experience and Review. Indian J Crit Care Med 2021;25(12):1382–1386.

Introduction: Face Detection is used in many different steams like video conferencing, human-computer interface, face detection, and in the database management of image. Therefore, the aim of our paper is to apply Red Green Blue (RGB) and Hue Saturation Value (HSV) color models in detecting the single, including multiple images of any face. Each color model HSV, Ycbcr and TSL are individually performed with the RGB color model to detect from the single and multiple images, the region of the face. Methods: The morphological operations are performed in the face region to a number of pixels as the proposed parameter to check either an input image contains face region or not. Canny edge detection is also used to show the boundaries of a candidate face region, in the end, the face can be shown detected by using bounding box around the face. Results: The reliability model has also been proposed for detecting the faces in single and multiple images. The results of the experiments reflect that the algorithm been proposed performs very well in each model for detecting the faces in single and multiple images and the reliability model provides the best fit by analyzing the precision and accuracy. Moreover Discussion: The calculated results show that HSV model works best for single faced images whereas YCbCr and TSL models work best for multiple faced images. Also, the evaluated results by this paper provides the better testing strategies that helps to develop new techniques which leads to an increase in research effectiveness. Conclusion: The calculated value of all parameters is helpful for proving that the proposed algorithm has been performed very well in each model for detecting the face by using a bounding box around the face in single as well as multiple images. The precision and accuracy of all three models are analyzed through the reliability model. The comparison calculated in this paper reflects that HSV model works best for single faced images whereas YCbCr and TSL models work best for multiple faced images.

To assess feasibility and clinical significance of tracking mania and depression in community college students before and after early identification and intervention.From Affective Illness to Recovery: STudent Access to Rapid Treatment (FAIRSTART) is an early intervention program to provide diagnostic therapeutic consultation, short-term care, and community ongoing care referral for 18-28 year-old outpatient community college students (mean age 22.9±4.0 years) experiencing manic symptoms. Over three years, 54 FAIRSTART participants (70% with DSM-IV bipolar I/II/not otherwise specified disorder, BDI/II/NOS) were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation (ADE) and followed (range: one-time consult to 4.3±3.6 visits over 3-6 month follow-up) with the STEP-BD Clinical Monitoring Form.38/54 patients (70%) had BDI/II/NOS, 11 unipolar depression (20%), 1 psychosis spectrum disorder (2%), 2 dysthymia/persistent depressive disorder (4%), and 2 incomplete intake with mood disorder diagnosis undetermined (4%). Average illness duration was 9.1±5.3 years. Among the 38 BD I/II/NOS patients, depression (SUM-D, t(30)=6.5; p0.001) and mania (SUM-M, t(30)=4.7; p0.001) scores improved significantly from baseline to last visit, with 17 (44.7%) reporting recovery by time transitioned from FAIRSTART to community care (after 4.3±3.6 visits).Short-term, early intervention in community college students with mood symptoms appeared feasible and yielded significant improvements in depression and mania scores. However, additional studies, with longer-term follow-ups, larger sample sizes, and comparison to current care standards, are needed to determine this early intervention program's impact on trajectory of mania symptoms in transitional age young adult populations.

Background and aims Randomized clinical trials have proven the efficacy and safety of Food and Drug Administration (FDA) approved anti-obesity medications (AOMs) for long-term use. It is unclear whether these outcomes can be replicated in real-world clinical practice where clinical complexities arise. The aim of this study was to evaluate the effectiveness and side effects of these medications in real-world multidisciplinary clinical practice settings. Methods We reviewed the electronic medical records (EMR) of patients with obesity who were prescribed an FDA-approved AOM for long-term use in academic and community multidisciplinary weight loss programs between January 2016 and January 2020. Intervention We assessed percentage total body weight loss (%TBWL), metabolic outcomes, and side effect profile up to 24 months after AOM initiation. Results The full cohort consisted of 304 patients (76% women, 95.2% White, median age of 50 years old [IQR, 39-58]). The median follow-up time was 9.1 months [IQR, 4.2-14.1] with a median number of 3 visits [IQR, 2-4]. The most prescribed medication was phentermine/topiramate extended-release (ER) (51%), followed by liraglutide (26.3%), bupropion/naltrexone sustained-release (SR) (16.5%), and lorcaserin (6.2%). %TBWL was 5.0%, 6.8%, 9.3%, 10.3%, and 10.5% at 3, 6, 12, 18, and 24 months. 60.2% of the entire cohort achieved at least 5% TBWL. Overall, phentermine/topiramate-ER had the most robust weight loss response during follow-up, with the highest %TBWL at 12 months of 12.0%. Adverse events were reported in 22.4% of patients. Only 9% of patients discontinued the medication due to side effects. Conclusions AOMs resulted in significant long-term weight loss, that was comparable to outcomes previously reported in clinical trials.

Crowdfunding has emerged as a market-based solution to give frontline complex public service employees the opportunity to acquire resources by advertising project proposals for donor patrons on crowdfunding platforms. However, whether crowdfunded resources can improve offline service outcomes, and if so, how and when, remains murky. Focusing on the context of public education crowdfunding and applying theories from crowdfunding and services marketing literature, the authors conceptualize that the combination of two factors—namely, teachers’ request for resources meant to satisfy unmet heterogeneous (i.e., diverse and evolving) intellectual needs of students and donors’ screening and approval (i.e., crowd screening) of promising projects—helps improve student academic achievement. Collating novel panel data from DonorsChoose and California Department of Education, the authors show that (1) crowdfunded resources positively affect student academic achievement, (2) student academic achievement improves with the increase in the heterogeneity of intellectual needs that crowdfunded resources likely satisfy, (3) crowd screening of project proposals plays a critical role in the offline effectiveness of crowdfunded resources, and (4) crowd screening effectiveness depends on the type of project.

Background The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. Results The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n=55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR=3.0; 95% confidence interval [CI], 1.3–7.0); nursing management support of the trial (OR=2.6; 95% CI, 1.1–6.5); performance of a dummy run (OR=2.6; 95% CI, 1.1–6.1); nursing colleagues seeing the value of the intervention(s) (OR=2.1; 95% CI, 0.9–5.7); and site investigators' belief in the effectiveness of the intervention (OR=3.2; 95% CI, 1.2–9.4). Conclusions ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork. Clinical trial registration ClinicalTrials gov NCT03853824.

Thoracentesis is tapping of pleural fluid from the pleural cavity for either diagnostic or therapeutic purposes. These are the frequently encountered procedures in the medical practices. Many conditions warrant sending the cases of pleural effusion cases for intervention. Most of the cases had been tried blindly first in their respective departments but failed because of various reasons. It had been documented regarding the advantages and disadvantages of blind and ultrasonography (USG) guided procedures. The aim of the study was to highlight the advantages and benefits of USG guided thoracentesis. We carried out USG guided thoracentesis of fifty cases in our radiology section who were referred to us by various departments. There were 19 female (38%) and 31 male (62%) patients. All these candidates had failed in blind procedures, when tried first. All these cases underwent USG guided thoracentesis with almost negligible complications. These were found to be having pleural fluid collection due to different underlying pathologies. There was no major complication in any of the cases who underwent thoracentesis. We reiterate by this study that USG guided procedures in thoracentesis should be the first choice in the tapping of pleural fluid. This is a quick, affordable, and without any discomfort to the patient.

Background: Menarche, among Adolescence girls, signifies the adaptation to womanhood as it is associated with pubertal changes and beginning of the capacity to reproduce. This is a period of gonadal development and growth spurt. Menstrual hygiene is crucial to healthy reproductive system and in return to good physical health and wellbeing. Therefore, enhanced awareness regarding menstruation and related hygiene, right from adolescence may escalate safe practices that are helpful in alleviating the distress of millions of women. Aim: To assess the knowledge and practices related to menstruation and menstrual hygiene among adolescent girls of selected schools of District Ambala, Haryana A descriptive cross sectional study was conducted in selected schools of Mullana and Barara District Ambala, Haryana. Materials and Methods: Total enumeration sampling technique was used to enroll 192 adolescent girls from class 9 to class 12 from selected schools after obtaining written informed consent from parents and verbal consent from girls. Ethical clearance was obtained from Institute Ethics committee. Doubts of the participants were cleared after data collection. Results: Among 192 girls, nearly half girls were aware of menstrual hygiene and reported use of sanitary nepkins and 40.1% girls were aware of the symptoms of poor menstrual hygiene. . Conclusion: There is a need to implement an education program for adolescent girls on menstruation and menstrual hygiene to ensure healthy menstrual practices. Keywords: Menstruation, Menstrual Hygiene, Menses, Sanitary pads, Dysmenorrhea, Vaginal discharge

Wnt signaling plays an essential role in the initiation and progression of various types of cancer. Besides, the Wnt pathway components have been established as reliable biomarkers and potential targets for cancer therapy. Wnt signaling is categorized into canonical and noncanonical pathways. The canonical pathway is involved in cell survival, proliferation, differentiation and migration, while the noncanonical pathway regulates cell polarity and migration. Apart from its biological role in development and homeostasis, the Wnt pathway has been implicated in several pathological disorders, including cancer. As a result, inhibiting this pathway has been a focus of cancer research with multiple targetable candidates in development. In this review, our focus will be to summarize information about ongoing and completed clinical trials targeting various Wnt pathway components, along with describing current and emerging Wnt targeted therapies. In addition, we will discuss potential opportunities and associated challenges of inhibiting Wnt signaling for cancer therapy.

Background: To assess respiratory function in cervical chronic compressive myelopathy (CCM) patients in pre-operative period, post-operative period and to compare pre-operative status with post-operative status. Aims and Objectives: 1. To assess respiratory function in cervical CCM patients in pre-operative period. 2. To assess respiratory function in cervical CCM patients in post-operative period, following relief of compression. 3. To compare, pre-operative status with post-operative status. Materials and Methods: A prospective study was done in 50 patients with cervical CCM due to either cervical disc disease or ossified posterior longitudinal ligament (OPLL) who were operated. None of the patients included in the study had any clinical signs & symptoms of respiratory dysfunction. Spirometry was performed in pre-operative and postoperative period after 3 months and results were analyzed. Forced vital capacity (FVC), forced expiratory volume in first second (FEV1), ratio of mean FEV1 to FVC (FEVI: FVC%) and peak expiratory flow rate (PEFR) were calculated. Results: Majority of the patients were in their fourth decade of life with male predominance. Thirty-six patients (72%) presented with prolapsed intervertebral disc and 14 patients (28%) had ossified posterior longitudinal ligament (OPLL). Patients were operated depending upon the pathology. The present study showed that there was significant reduction in preoperative FVC, FEV1, PEFR values as compared with predicted values and they showed significant improvement in post-operative period after surgical relief of compression. Conclusion: Significant yet occult respiratory dysfunction in form of impairment of various lung capacities exists in patients with cervical CCM. An objective evaluation of this occult respiratory dysfunction is essential to prognosticate, prevent respiratory complications and to improve post-operative respiratory rehabilitation. Institution of incentive spirometry as a routine in all cervical CCM cases will be of benefit in preventing respiratory complications.

Intracanal instrument separation thwarts the ongoing treatment process adding to woes of the dentist as well as the patient because it trammels the cleaning, shaping and filling of root canals. This captiously affect the outcome of endodontic treatment by building more impediments, thus compromising the prognosis. Therefore clinicians must be aware of the possibility of instrument fracture in endodontic practice to stave off this mishap. This article quotes narrative review accentuating the techniques for retrieval of intracanal separated instruments along with factors influencing its removal. (Different techniques for removal of Gutta Percha from root canal system has been discussed in detail in part 1 by the same author).

Isolated bilateral sixth nerve palsies are rare, particularly in the setting of trauma. Most post-head injury cases with bilateral abducens palsy involve either basal skull fractures, particularly clival fractures. We present a case of bilateral abducens palsy after closed head injury in a young male who presented to the emergency department and a comprehensive literature review based on our clinical case. A Medline search for bilateral abducens palsy in closed head injury showed 89 results. Articles were excluded if crush head injury, non-traumatic bilateral abducens nerve palsy, associated vascular malformations were reported. After thorough search and filtering of those articles, fifty-one publications were found which reported and discussed about traumatic bilateral abducens palsy with closed head injury. In these 51 articles, a total of 139 cases were recorded. Several theories have been postulated to explain mechanisms of abducens nerve injury in trauma both in immediate and delayed settings. In our case, patient presented with immediate onset of bilateral abducens palsy. On imaging, clival fracture was seen in CT brain, which can be attributed for the nerve injury. Cases with retroclival extradural haematoma had higher chances of multiple cranial nerve injuries. Cases with multiple basal skull fracture involving petrous temporal bone fracture had higher chances of facial nerve injury. Along with bilateral involvement, the poorer outcome for recovery can be related with the severity of the adduction deficit. Our case showed no improvement in bilateral abduction during follow-up at 6 months. Clinical presentation of traumatic bilateral abducens nerve palsy is rare following closed head trauma and is usually associated with other injuries which are incompatible with life. It can be associated with other nerve injuries depending on basal skull fractures.

For successful endodontics, major emphasis is placed on judicious instrumentation, microbial control and complete obturation of the root canal system. During retreatment of previously endodontically treated teeth, one may encounter variety of different materials, which must be removed before these objectives can be achieved. The intent of this article is to present various methods for Gutta Percha removal from the root canal system to aid in re-treatment attempts. Gutta Percha is the most commonly used obturating material, so, therefore this article deals with various techniques available for its removal in retreatment cases.

Background: Prostate carcinoma is leading cause of cancer related deaths amongst men. This study evaluated expression of ER, PR, HER-2/neu in Prostatic carcinoma and its correlation with Gleason score and other clinical parameters. Methods: 50 histopathologically proven PCa cases were subjected to IHC for ER, PR, HER-2/neu. Result: Most common age group involved was 61-80years. Retention of urine was most frequent complaint. Most prominent Gleason score was (3+4) and group grade was 2. ER expression in tumor epithelial cells was 24% and in stromal cells was 36%. PR expression in stromal cells was 32%. HER-2/neu Cytoplasmic positivity was seen in 6% cases. It was seen that with increase in Gleason grade, ER, PR, HER-2/neu positivity was decreased. Conclusion: ER, PR, HER-2/neu can be used as biomarkers in PCa management.

The beginning of year 2020 has brought with it mass destruction of mankind in form of novel coronavirus, named as CoVID-19. Declared as pandemic by World Health Organization (WHO), CoVID-19 has its origin in bats and pangolin from which it was probably transferred to human. Subsequent human to human transmission has been seen by respiratory droplets, fomites and oral-fecal route. The disease has caused widespread deaths in America, China, France and Italy followed by many European and Asian countries. CoVID-19 targets the human lungs and multiplies in alveoli using host machinery. Interstitial edema and alveolar edema at later stages cause alveoli collapse and difficulty in breathing. Severe cases may pave to systemic inflammatory response that has fatal response in body. Unfortunately, researchers are still struggling for potential vaccine or promising drug to combat the disease. WHO has issued guidelines suggesting regular hand washing, social distancing, wearing masks and quarantination as the best ways to prevent infection. This review gives an overview of the novel CoVID-19, conditions and immune response of human body related with it. © 2021 World Research Association. All rights reserved.

BACKGROUND Oral and maxillofacial pathology, is the very foundation of dentistry. It is a branch of dentistry where research meets clinical practice with the use of histopathology, cytopathology, haematology, immunohistochemistry, clinical biochemistry, microbiology, molecular science, forensic odontology, and a lot more, making it a unique and rare branch in its own way. It acts as a backbone of dental science, by investigating the causes, processes, and effects of the disease affecting the oral and maxillofacial region. Therefore, this branch requires timely up-gradation to analyse health data, research findings and treatment techniques to offer a diagnostic and therapeutic recommendation for individual patients. The application of digital technology in oral pathology is on the verge of becoming a standard of care, thereby eliminating the need for practising pathology on a conventional microscope. Globally, pathological laboratories need to be more efficient than before. Therefore, automation and digitalization are required to not only increase the efficiency, growth, quality, and capacity but also to standardise the processes. The purpose of this article is to introduce the readers, the incorporation of new ideas and technologies in the lab for a better and faster diagnosis, and would also like to explain the concept of standardizing the method of recording and maintaining the dental or medical records of the patients, and also standardizing the lab reports. KEY WORDS Innovation, Robotics, Digitalization, Artificial Intelligence, Upgradation, Maxillofacial Region

Dilated cardiomyopathy is a subset of cardiomyopathies defined by reduced ejection fraction of less than 45% and a dilated left ventricle. While dilated cardiomyopathy is common, its etiology is not always readily evident. Paraquat is used as an herbicide worldwide and is one of the main causes of fatal poisoning in underdeveloped countries in Asia, Central America, and the Pacific Islands. The most commonly affected organs are the lungs and kidneys. However, experimental research has shown that Paraquat can affect the heart indirectly through increased vascular permeability. In vivo animal studies have shown that paraquat poisoning causes myocardial contractile dysfunction by decreased fractional shortening and cardiac remodeling. We report the first case in published literature of a 52-year-old Hispanic man with dilated cardiomyopathy strongly associated with Paraquat exposure. It is important to obtain detailed medical history and proper diagnostic work-up including work, social, and family history, and echocardiography, baseline EKG, lab work, and ischemia cardiac testing as it can lead to improved diagnostic evaluation of possible etiologies of the commonly seen dilated cardiomyopathies and help identify less well-known etiologies as seen in our patient.

Background Patients with headand neck cancer (HNC) are at high risk for malnutrition before and during chemoradiation treatment. Many will also require tube feeding to address declines in energy intake, weight, and quality of life (QOL) caused by the impact of treatment on gastrointestinal (GI) symptoms. Blenderized tube feeding (BTF) may ameliorate these adverse conditions. Methods In this open-label, prospective pilot study, 30 patients with HNC who required feeding tube placement were recruited to switch from standard commercial formula after 2 weeks to a commercially prepared BTF formula. Weight, body mass index (BMI), GI symptoms, and QOL scores were tracked for 6 weeks from the first week of feeding tube placement. Results Of the 16 patients who completed the 6-week assessment period, weights and BMI scores for 15 patients trended upward. For most patients, QOL and oral intake increased and GI symptoms decreased over the 6-week period, particularly during weeks 3 and 4, when the impact of treatment is particularly exacting on patients with HNC. Conclusion BTF effectively mitigated weight loss, GI symptoms, QOL scores, and total energy intake in this group of patients with HNC who received tube feeding for 6 weeks.

The widespread deficiencies of micronutrients have been reported in soils of India in the recent past due to intensive cultivation practices and the use of chemical fertilizers which are free of micronutrients. The adoption of integrated nutrient management technique may ameliorate micronutrients deficiencies by adding micronutrients and through their mobilization from unavailable to available forms and also increase their uptake by crops. To study the effect of integrated nutrient management on transformations of micronutrients fraction, a 2 years’ field experiment was conducted at the research farm of the Department of Soil Science, PAU, Ludhiana. Under this experiment, farmyard manure, poultry manure, press mud, and rice straw compost were added in combination with different levels of fertilizers. Soil samples were analyzed for micronutrient fractions, and the yield of the wheat crop was estimated for determining uptake. The results revealed that integrated nutrient management significantly affected transformations of micronutrients. All the micronutrients reported a higher residual fraction than other fractions under all the treatments whereas WS + EX (water-soluble plus exchangeable) fraction had the lowest content. In addition, the integrated use of manures and fertilizers helped in the redistribution of micronutrients fractions from unavailable forms to plant-available pools. The biological uptake of micronutrients by wheat had a strong and positive correlation with SpAD (specifically adsorbed) fraction (r = 0.72, 0.62, 0.71, and 0.77 for Zn, Cu, Fe, and Mn, respectively) indicating the major contribution of SpAD towards WS + EX fraction which is easily absorbed by plants. The addition of different manures enhanced fractions of Zn, Cu, Fe, and Mn in soil and contributed significantly to the uptake of micronutrients by wheat crop.

Eating disorders and overweight are notable health issues, which are increasing day by day among young adults. Therefore, the study was conducted to evaluate the extent and type of eating disorders among college girls. A sample of 500 college girls in the age group of 18-25 years was randomly selected from five colleges of Ludhiana city, Punjab. Eating disorders were assessed by using Eating Attitude Test (EAT) questionnaire and subjects were categorized into two groups - With Eating Disorders (WED) and Without Eating Disorders (WOED). Prevalence of eating disorders among college girls on basis of EAT scale was 46 percent with higher mean scores of oral control (15.86±6.29) followed by dieting (13.17±8.47), bulimia, and food preoccupation (3.86±1.98). The correlation coefficient showed positive associations of eating disorders with body mass index. This study suggested formulating nutrition and health fitness clubs in colleges to create awareness and practices regarding diet, exercise, and yoga.

The shift towards an obese phenotype in celiac disease (CD) patients increases risk of morbidity and mortality. Bariatric surgery (BS) is the gold standard treatment for obesity. Few studies have explored the role of BS in patients with CD. This study aimed to assess the effectiveness and safety of BS in this population. This is a retrospective matched case-control (1:5) study of adult patients with confirmed CD who underwent BS at our institution from 1998 to 2018. Demographics, operative data, post-operative outcomes, complications, and nutritional parameters were collected. Seventy-eight patients (mostly Caucasian females) were included. Thirteen had confirmed CD and were compared with 65 controls. The most common type of BS was the RYGB. The percent of total body weight loss (%TWL) was similar for both groups at 6, 12, 18, 24, and 36 months, with the highest weight loss being at 12 months: %TWL 28.4 (20.2–38.4) for CD, n=13; vs. 29.1 (19.6–39.3) for non-CD, n=49; p=0.8. Obesity-associated co-morbidities greatly and comparably improved in both groups. Patients with CD had no complications after BS. Post-BS malodorous and oily stools were more common among patients with CD (23.1% vs. 4.6%, p=0.03). Micronutrient deficiencies were common and comparable among both groups with iron and vitamin D being the most common deficiencies. Gluten-free diet (GFD) non-adherence post-operatively was associated with a higher incidence of post-BS abdominal pain (60.0% vs. 0.0%, p=0.012). BS is safe and effective in patients with CD. Close monitoring is necessary to ensure compliance with GFD and vitamin supplementation. • Bariatric surgery leads to significant weight loss in celiac disease (CD) patients. • Mid- and long-term weight loss does not differ between patients with and without CD. • Obesity-associated co-morbidities significantly improve after surgery in CD patients. • The incidence of post-surgical complications is not higher in CD patients.

Purpose To describe the incidence and morphological characteristics of posterior polar cortical disc defect (PPCDD) sign observed during phacoemulsification in posterior polar cataract (PPC). Setting Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. Design Prospective case series. Methods Sixty-seven eyes of 56 patients with PPC undergoing phacoemulsification were evaluated. Outcome measures were the incidence and characteristics of the intraoperative PPCDD sign, as well as its relation to the intraoperative surgical dynamics and posterior capsule (PC) dehiscence. Results Of the 67 eyes evaluated, the PPCDD sign was seen in 86.5% of eyes (58/67). Among these, 93.1% of eyes (54/58) showed a complete disc defect, whereas 6.9% of eyes (4/58) had a partial disc defect with incomplete margins. In the majority of cases (89.6%; 52/58), the PPCDD sign was seen after epinuclear plate and plaque aspiration. Among the 9 eyes that did not show the PPCDD sign, en bloc separation of the plaque and cortical matter from the PC was observed in 2 eyes, the plaque remained adherent to the PC till the end of cortical fiber aspiration in 3 eyes, and intraoperative PC rupture (PCR) was observed during the plaque separation in 4 eyes. The incidence of PCR in eyes without PPCDD sign was significantly higher (44.4% vs 0%; P Conclusions The visualization of intraoperative PPCDD sign during phacoemulsification in PPC is suggestive of an intact PC and associated with a significantly lower rate of intraoperative PCR as compared with eyes without the PPCDD sign.

Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.

Patients with obesity may experience less patient-centered care. We assessed whether medical students' implicit/explicit weight-related attitudes and perceptions of normative attitudes are associated with patient-centered care for patients with obesity.Third and fourth year medical students (N = 111) at one medical school completed a survey and participated in a patient care scenario with a standardized patient with obesity. Encounters were coded for patient-centered behavior. Predictors of patient-centered behaviors were assessed.Student perceptions that negative attitudes about patients with obesity are normative in medical school were significantly associated with poorer patient-centered behaviors, including lower attentiveness (b=-0.19, p = 0.01), friendliness (b=-0.28, p0.001), responsiveness (b=-0.21, p = 0.002), respectfulness (b=-0.17, p = 0.003), interactivity (b=-0.22, p = 0.003), likelihood of being recommended by observers (b=-0.34, p0.001), and patient-centeredness index scores (b=-0.16, p = 0.002). Student reported faculty role-modeling of discrimination against patients with obesity predicted lower friendliness (b=-0.16, p = 0.03), recommendation likelihood (b=-0.22, p = 0.04), and patient-centeredness index score (b=-0.12, p = 0.03).Negative normative attitudes and behaviors regarding obesity in the medical school environment may adversely influence the quality of patient-centered behaviors provided to patients with obesity.Efforts to improve patient-centered communication quality among medical trainees may benefit from intervention to improve group normative attitudes about patients with obesity.

The efficacy and safety of a fluid-filled intragastric balloon (IGB) for weight loss in patients with cirrhosis on the liver transplantation (LT) waiting list is unknown. We enrolled stable compensated patients with body mass index >35 kg/m2 and on the waiting list for IGB placement endoscopically for a maximum of 6 months. A total of 8 patients (7 men) aged mean ± SD, 56 ± 4.6 years with Model for End-Stage Liver Disease-sodium (MELD-Na) scores 14.1 ± 3.4 experienced weight reduction (146 ± 22.2 kg versus 127 ± 21.6 kg [P = 0.005] with IGB in place and 130 ± 24.6 kg [P = 0.014] at 6 months), with a total body weight loss of 12.2% ± 8.8% with IGBs in place and 10.9% ± 8.9% at 6 months. Body fat decreased from 48.6% ± 5.8% to 40.6% ± 6.4% (P = 0.001) and lean mass increased from 51.3% ± 6% to 59.4% ± 6.4% (P = 0.001). No change in MELD-Na scores occurred (P = 0.770). Early balloon retrieval was attributed to accommodative symptoms (n = 2) and liver decompensation (n = 1). Mallory Weiss tears (n = 3), but no portal hypertensive bleeding, occurred. Liver decompensation and/or hepatocellular carcinoma (HCC) developed in 3 patients. A total of 4 patients with LT ± sleeve gastrectomy maintained overall weight loss. Of 4 patients who did not receive transplants, 2 experienced weight regain. IGB results in short-term weight loss in patients with cirrhosis awaiting LT, with body fat loss without lean mass loss. Adverse effects were common. Decompensation and HCC did occur, with uncertainty of the relation to weight loss, and thus careful patient selection and close follow-up are required.

COVID – 19 is a global pandemic caused by a coronavirus named SARS CoV -2. A large family of viruses that causes severe respiratory diseases known as Coronavirus (CoVs) show symptoms such as common cold and range to more rare and severe respiratory diseases such SARAS i.e Severe Acute Respiratory Syndrome and MERS i.e Middle East Respiratory Syndrome detected for the first time in 2003 and 2012, respectively. It is expected to be a zoonotic virus transmitted via bats categorically, from genus Rhinolophus and closely related animals to humans. As this life threatening pandemic started from the Wuhan city of China, and the examination about this disease is still in continuity. It is very important to explore all possible scientific key points regarding this disease to eradicate such a dangerous issue from the society and to save the human race on earth. Literature available till now confirmed that the ABO blood group system showed significant relationship with various diseases. Now, scientific communities were working on different aspects of COVID-19 disease. But by keeping in mind about the severity of this disease and the relationship of blood group system of humans with infectious disease we conducted this study. Present review is designed to explore the relationship of COVID-19 alongwith other disease with the ABO blood group and Von Willebrand Factor. This study will provide information about the scientific evidences regarding the role of blood group antigens in prognosis of COVID-19 alongwith other disease and this can be significant for future research.

Background : Microalbuminuria (defined as urinary albumin excretion of 30-300 mg/day, or 20-200 µg/min) is an earlier sign of vascular damage. It is a marker of general vascular dysfunction and nowadays is considered a predictor of worse outcomes for both kidney and heart patients. Microalbuminuria could be taken also, as an indicator of insulin resistance and of the increased renal and cardiovascular risk associated with metabolic syndrome. Renal involvement is a pivotal development in diabetes and microalbuminuria is generally the first clinical sign of renal dysfunction in diabetics. It is demonstrated that cardiovascular and renal risk is elevated even in the high normal range of microalbuminuria (below 30 mg/day). Material and method; The cross sectional study was conducted in department of biochemistry and medicine in Guru Gobind Singh Medical College and Hospital, Faridkot. 50 patients, who suffering with diabetes and hypertensive were enrolled for study. Result; Out of 50 diabetes and hypertensive patients, 31 males and 19 females. The p values are not significant so all the 3 methods can be used for detecting microalbumin in diabetic and hypertensive patients. In our study we found that microalbumin by antigen antibody method as provided by point of care instrument (ICHROMA) gives sensitivity of 88% and specificity of 80.1%. Albumin creatinine ratio by laboratory method is cheap and simple method with sensitivity of 86.0% but specificity of 42.8% Conclusion: Albumin creatinine ratio by dye based strip method is a good marker to detect microalbumin in early detection of nephropathy in diabetic and hypertensive individuals. Microalbuminuria by antigen antibody reaction detection by ichroma provides good sensitivity and specificity. On the other hand ACR by lab method cannot substitute ACR by strip due to its low specificity.

Coronavirus disease 2019 (COVID-19), after initially being detected in Wuhan, China in late 2019, quickly spread to most regions of the world, meeting World Health Organization criteria for a pandemic. Social distancing along with other measures implemented to control spread had a drastic impact on the provision of healthcare including deferred elective procedures and surgeries as well as delayed care and evaluation for emergent diagnoses such as heart attacks and strokes. In the home nutrition practice, patients began to delay routine laboratory tests and were canceling or deferring annual visits. Our group soon began to rapidly deploy telehealth to meet the needs of the home nutrition patients. Telehealth is not a new concept with descriptions of healthcare being provided at a distance with the use of telephone in the 1870s. However, widespread adoption has been limited because of regulation (licensure, prescriptions, credentialing, and privileges), lack of reimbursement, as well as adoption and availability of technology needed to carry out telehealth visits. As regulations and limits on reimbursements were waived during COVID-19 pandemic, our home nutrition practice began to evaluate core components of the care we provide for our patients and assess which could be successfully transitioned to telehealth. In addition to the history and regulation of telehealth, the current manuscript provides details regarding successful implementation of telehealth visits such as change management, selection of telehealth platform, scheduling and logistics, as well as carrying out the virtual visit including history and physical exam.

BACKGROUND COVID 19 has been labelled as a global pandemic by the World Health Organization (WHO). The sudden rise in death toll and devastation associated with it has put the entire infrastructure, economy and health sector to test. The only way for the prevention and control of this infectious disease is rapid and accurate screening of masses. Public Health Authorities mainly use antibody testing in hot spots using a mix of RT-PCR and antibody testing nasopharyngeal and orpharyngeal swabs. Considering the potential risk factors, constraints of time, cost and manpower, mass screening for COVID is not possible through nasopharyngeal and oropharyngeal swabs alone. Hence, to search an alternate method to diagnose for the initial screening of patients is the need of the hour globally. Saliva can also be used as one of the diagnostic modalities for coronavirus, helping in the rapid testing of individuals at home or at hospital. The article intends to explain the evidence regarding the reliability of saliva as a diagnostic specimen in COVID-19 patients and demonstrates the association and potential of detecting novel coronavirus in saliva of patients and how its implication in future can aid in diagnosis as a non - invasive diagnostic modality. KEY WORDS COVID 19, Throat Swab, Nasopharyngeal Swab, Saliva, Diagnostic Fluid

Mohamed Ibrahime Asif,1 Rahul Kumar Bafna,1 Namrata Sharma,1 Ananya Kaginalkar,1 Rajesh Sinha,1 Tushar Agarwal,1 Prafulla Kumar Maharana,1 Manpreet Kaur,1 Priya Taank,2 Jeewan S Titiyal1 1Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; 2Department of Ophthalmology, Command Hospital, Pune, 411040, IndiaCorrespondence: Namrata SharmaDepartment of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, IndiaTel +91 9810856988Fax +91 11-26588919Email namrata.sharma@gmail.comPurpose: To describe the outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) in congenital hereditary endothelial dystrophy (CHED) and to evaluate the role of microscope integrated optical coherence tomography (Mi-OCT) during the surgery.Design: Retrospective data analysis.Methods: A retrospective study from the medical records of all those patients who were diagnosed with CHED and underwent DSAEK at our centre from 2015 were evaluated. All patients underwent Mi-OCT-guided standard DSAEK procedure. Intra-operative difficulties, visual outcomes and graft survival were recorded.Results: A total of 48 eyes of 29 patients with a mean age of 9.87 ± 8.2 years and mean follow-up of 17.3 months were evaluated. Thirty-nine eyes underwent primary DSAEK and 9 eyes underwent PKP. Three eyes who underwent PKP had failed graft for which they underwent DSAEK. The mean preoperative Snellen’s visual acuity was 1.71 ± 0.66 and the mean preoperative central corneal thickness was 1.10 ± 0.174 mm. Intraoperatively, all the grafts were attached which was confirmed using Mi-OCT. Graft detachment was seen in the immediate postoperative period in 10.4% (4 eyes) of primary DSAEK, out of which DM scoring was not performed in 2 eyes. Following DSAEK, cornea cleared at four-week follow-up in 89.7% eyes and in all the eyes the cornea cleared at six-week follow-up.Conclusion: Primary DSAEK could be a preferred option over PKP for CHED with early presentation and in those eyes with failed primary PKP. Mi-OCT is a very useful tool in these eyes for various intraoperative procedures, thereby improving the outcomes of the procedure.Keywords: DSAEK, CHED, Mi-OCT

Severe irritability and temper outbursts are risk factors for the onset of serious and lifelong mood disorders. In treating children and adolescents with severe irritability, clinicians should evaluate and address safety issues before acute stabilization of symptoms. Then, clinicians can initiate interventions to prevent the onset or relapses of the undesired behavior and its functional consequences. This review summarizes primary, secondary, and tertiary relapse prevention strategies, with an emphasis on strategies that build resilience in youth that mitigate the onset, recurrence, and progression of emotion dysregulation.

Aims: In this study we are evaluating the outcome in management of distal radius fracture by closed reduction and percutaneous 5 k-wire fixation in both young and elderly patients in most types of distal radius fracture types where closed reduction is possible and where ulna is intact or reconstruct able.Material and Methods: A total of 50 patients with distal end radius fractures associated with or without other fracture were treated in in the department of Orthopaedics at all hospitals attached to SMS Medical College & Hospital, Jaipur. The patients were treated with closed reduction and 5 k-wire (1.8mm) fixation under anaesthesia. Clinical scoring system of green and o’brein modified by Cooney and Sarmiento’s modification of Lindstorm criteria was recorded.Results: The most commonly encountered complications were superficial pin tract infection (25.5%) and extensor tendon tethering (6.4%) which were less serious complications and resolved completely on removal of k –wires. Cooney modification of Green and O‘ Brien‘s score was showed higher excellent case (84%) than good (10%) and fair (6%)Conclusion: According to our study perfect closed reduction and five k-wire fixation technique is a versatile tool which provides functional outcomes better than conventional k-wire fixation and volar plating in distal end radius fractures.

In this chapter, we have report a list of synthesis methods (including both synthesis steps & heating conditions) used for thin film fabrication of perovskite ABO3 (BiFeO3, BaTiO3, PbTiO3 and CaTiO3) based multiferroics (in both single-phase and composite materials). The processing of high quality multiferroic thin film have some features like epitaxial strain, physical phenomenon at atomic-level, interfacial coupling parameters to enhance device performance. Since these multiferroic thin films have ME properties such as electrical (dielectric, magnetoelectric coefficient & MC) and magnetic (ferromagnetic, magnetic susceptibility etc.) are heat sensitive, i.e. ME response at low as well as higher temperature might to enhance the device performance respect with long range ordering. The magnetoelectric coupling between ferromagnetism and ferroelectricity in multiferroic becomes suitable in the application of spintronics, memory and logic devices, and microelectronic memory or piezoelectric devices. In comparison with bulk multiferroic, the fabrication of multiferroic thin film with different structural geometries on substrate has reducible clamping effect. A brief procedure for multiferroic thin film fabrication in terms of their thermal conditions (temperature for film processing and annealing for crystallization) are described. Each synthesis methods have its own characteristic phenomenon in terms of film thickness, defects formation, crack free film, density, chip size, easier steps and availability etc. been described. A brief study towards phase structure and ME coupling for each multiferroic system of BiFeO3, BaTiO3, PbTiO3 and CaTiO3 is shown.

To study the ophthalmic clinical profile and the management outcomes of children having Goldenhar syndrome (GS). Retrospective review of included children fulfilling the diagnostic criteria of GS was performed. The demography, ophthalmic features, systemic anomalies, and treatment outcomes were recorded manually from patient files. An ENT, pediatrics, cardiology, and orthopedics consultation was sought for all GS patients before taking up for any ophthalmic surgical procedure. The anatomical (ocular surface and eyelid) and functional {vision and extraocular movements (EOM)} factors were exclusively studied. We ensured a minimum postoperative follow-up of 12 months, and our data were compared with the major studies featuring ‘ophthalmic features’ of GS. Totally 30 children (females = 18, 60%) were included with a median presenting age of 48 months. Twenty-seven (90%) had unilateral ophthalmic involvement with major features being upper eyelid coloboma (n = 25, 75.76%), lipodermoid (n = 18, 54.55%), and limbal dermoid (n = 10, 30.3%). Diminution of visual acuity was recorded in 22 (73.3%), while five (16.7%) had limitation of EOM. Systemically, the prominent features included hemifacial hypotrophy (100%), auricular anomalies (80%), cardiac anomalies (10%), and scoliosis (6.67%). The eyelid colobomas were repaired with the direct closure ± cantholysis technique or using a Tenzel’s flap. All children had satisfactory anatomical and functional outcomes after ophthalmic surgical interventions without any significant complications. The tailored ophthalmic surgical intervention(s) provides satisfactory restoration of anatomy and functionality of the eye. These children need specific multi-discipline consultations for the holistic management and complete care.

Purpose: To analyze the anatomical and functional ophthalmic parameters after the surgical removal of various intraorbital foreign bodies. Methods: A retrospective analysis of medical records was performed featuring detailed history, ophthalmic examination, orbital computed tomographic scans, treatment details, and outcomes. The analyzed anatomical factors included extraocular movements, the position of the eyeball (proptosis, dystopia, and enophthalmos), and fullness of orbital sulci. The functional assessment was based on visual acuity, pupillary reactions, and diplopia. The outcomes were defined as complete, partial, and failure after a minimum follow-up of 1 year. Results: Of 32 patients, the organic and inorganic intraorbital foreign bodies were surgically removed from 18 (56.25%) and 14 (43.75%) orbits, respectively. At presentation, anatomically the extraocular movement restriction, proptosis/dystopia/enophthalmos, and orbital sulcus fullness were noted in 26 (81.25%), 24 (75%), and 15 (46.88%), respectively. Functionally, diminished visual acuity, diplopia, and pupil abnormalities were seen in 27 (84.38%), 14 (43.75%), and 8 (25%), respectively. After intraorbital foreign body removal at a mean follow-up of 14 months, the improvement of anatomical factors (same sequence) were observed in 8 (30.77%), 20 (83.33%), and 12 (80%), respectively. In functional factors (same sequence), the improvement was noted in none (0%), 13 (92.86%), and 5 (62.5%), respectively. Hence, the majority of patients (n = 20, 62.5%) achieved partial success, while 8 (25%) had complete success. Four (12.5%) had treatment failure despite similar management protocols. Conclusion: The anatomical outcomes are better than the functional outcomes after surgical removal of the intraorbital foreign bodies. The visual acuity does not improve considerably after the surgical removal of intraorbital foreign bodies. Overall, the wooden intraorbital foreign bodies have poorer anatomical and functional prognosis.

Purpose: To assess the ability of wide field Swept Source OCTA (SS-OCTA) imaging to detect morphological variations in Serpiginous Choroiditis (SC) and Serpiginous Like Choroiditis (SLC) in response to treatment and also analyze these findings quantitatively using Image J software. Methods: Retrospective observational case series of nine eyes with clinical diagnosis of active SC and SLC, who underwent SS-OCTA and fundus autofluorescence (FAF) imaging at baseline and each follow up visit till 6 months. Morphological analysis was done by two independent graders and quantitative analysis to measure the size and intensity of lesion was done using publicly available Image J software at baseline and each follow up visit. Design: Retrospective observational case series. Results: Using SS-OCTA, all the active lesions followed a characteristic healing pattern. Active lesions appear well defined hypo flow void patches and as healing progressed, lesion became more ill-defined and iso-hyper- intense. Significant increase in mean intensity of the lesion could be apparent after 1 and 6 month of treatment. There was reduction in the size of lesions during follow up however this difference was not statistically significant. Conclusion: SS-OCTA could be a useful noninvasive tool to study the treatment response in SC/SLC both morphologically as well as quantitatively. Quantitative parameters need to be designed in further research studies to aid in uniform management and follow up of uveitis cases.

Introduction: Demodex mite is an external parasite which is implicated in various ocular conditions like anterior blepharitis, posterior blepharitis, meibomian gland dysfunction, chalazia and others. Although demodex has been shown to be a causative agent of chalazia, occurrence of a solitary inflammatory nodule due to demodex infestation has not been reported in literature. Case: Our case describes the occurrence of an upper eyelid mass in a 62-year-old female which was found to have an associated demodex infestation. Conclusion: This is the first report of demodex infestation presenting as a nodular eyelid mass. This parasite needs to be considered in the differential diagnosis of eyelid masses as this condition requires specific management.

Background: Early detection of malignant lesions is critical key stone for the successful management of breast cancer. Conventional B-mode ultrasound although could not replace the histopathology which is still gold standard, plays an important role in the diagnostic pathways by using the Breast Imaging Reporting and Data System (BIRADS) lexicon (standardized by American College of Radiology [ACR]). Although characterization of solid breast masses by sonography has improved greatly since the early 1990s, specificity remains low and a large number of biopsies result in benign diagnosis. Strain elastography and strain ratio (SR) are recent techniques which may help in increasing the specificity of ultrasound. Methods: The present study was a pilot study aimed to establish a correlation between B-mode ultrasound and strain elastography in differentiating benign and malignant breast masses and to compare the results of B- mode ultrasound and Strain Elastography with fine-needle aspiration cytology/ biopsy findings. It was a prospective study conducted in the Department of Radio-diagnosis of Rajindra Hospital, Patiala. A total of 40 patients who presented with the complaint of palpable breast lump were evaluated with B-Mode Ultrasonography (USG) and Strain elastography (using elastography score [ES] and SR). Results: The study group (40 patients with breast lumps) comprised 38 (95%) female patients and 2 (5%) male patients. Among the group 29 were benign and 11 were malignant. Fibroadenoma followed by fibrocystic disease was the most common benign pathologies and invasive ductal carcinoma followed by Ductal Carcinoma in situ was the most common malignant pathologies. Sensitivity, specificity, and diagnostic accuracy of B-Mode USG in diagnosing palpable breast lump are 72.7%, 86.2%, and 82.5%, respectively, while that of strain elastography in diagnosing palpable breast lump are 81.8%, 93.10%, and 90.0%, respectively. Using strain ratio (SR) only the sensitivity, specificity, and diagnostic accuracy was found to be 93.1%, 100%, and 95% better than B-Mode USG and shear elastography alone separately and combined. The mean SR for a benign mass is 2.00±0.97 and for a malignant mass is 5.40±1.55. Conclusion: Ultrasound elastography (using ES) has a higher sensitivity, specificity and diagnostic accuracy in differentiating benign and malignant breast masses then B mode USG (using BIRADS). Using SR alone has shown better sensitivity, specificity, and diagnostic accuracy but its standalone or in combination diagnostic application has to be followed up with further studies.

In this review, we examine the role for parenteral nutrition (PN) for nutritional support of patients with advanced, incurable cancer with an emphasis on bridging the divide between expectations and reality. As the rates of cancer have continued to rise worldwide, the utility of PN has continued to be studied. Due to multiple reasons, high-quality research studies have been scarce, and much of the data is based on observational studies. The recent trend appears to support the use of PN in carefully selected patients. Importantly, the effect on quality of life also should be considered when deciding to initiate PN. PN can be a supportive lifeline for patients with advanced, incurable cancer. The medical team should consider each patient individually to decide if PN should be offered. It is of paramount important for the medical team to engage in shared decision-making with the patient and caregiver(s) to ensure that PN is aligned with their goals and wishes.