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Objective Vesical Imaging Reporting and Data System (VIRADS) score was developed to standardize the reporting and staging of bladder tumors on pre-operative multiparametric magnetic resonance imaging (mpMRI). It helps in avoiding unnecessary repeat transurethral resection of bladder tumor (Re-TURBT) in high-risk non-muscle-invasive bladder cancer (NMIBC) patients. This study was done to determine the validity of VIRADS score prospectively for the diagnosis of muscle-invasive bladder cancer. Methods This study was conducted from March 2019 to March 2020 at Sawai Mansingh Medical College and Hospital, Jaipur, Rajasthan, India. Patients admitted with the provisional diagnosis of bladder tumor were included as participants. All these patients underwent a 3 T mpMRI to obtain a VIRADS score before they underwent a TURBT and these data were analysed to evaluate the correlation of pre-operative VIRADS score with muscle invasiveness of the tumor in final biopsy report. Results A cut off of VIRADS ≥4 for prediction of detrusor muscle invasion yielded a sensitivity of 79.4%, specificity of 94.2%, positive predictive value (PPV) of 90%, negative predictive value (NPV) of 87.5%, and diagnostic accuracy of 86.37%. A cut off of VIRADS ≥3 for prediction of detrusor muscle invasion yielded a sensitivity of 91.2%, specificity of 78.8%, PPV of 73.8%, NPV of 93.2%, and accuracy of 83.7%. The receiver operating curve (ROC) showed the area under the curve (AUC) to be 0.922 (95% confidence interval: 0.862–0.983). Conclusions VIRADS score appears to be an excellent and effective preoperative radiological tool for the prediction of detrusor muscle invasion in bladder cancer.

Background/Aims: Intestinal tuberculosis (ITB) is difficult to diagnose due to poor sensitivity of definitive diagnostic tests. ITB may be associated with concomitant pulmonary tuberculosis (PTB) which may remain undetected on chest X-ray. We assessed the role of contrast enhanced computed tomography (CECT) chest in detecting the prevalence of active PTB, and increasing the diagnostic yield in patients with suspected ITB. Methods: Consecutive treatment naïve patients with suspected ITB (n=200) who underwent CECT chest (n=88) and had follow-up duration>1 year were recruited in this retrospective study (February 2016 to October 2018). ITB was diagnosed in the presence of caseating granuloma, positive acid fast stain or culture for Mycobacterium tuberculosis on biopsy, presence of necrotic lymph nodes (LNs) on CT enterography or positive response to anti-tubercular therapy. Evidence of active tuberculosis on CECT-chest was defined as presence of centrilobular nodules with or without consolidation/miliary nodules/thick-walled cavity/enlarged necrotic mediastinal LNs. Results: Sixty-five of eighty-eight patients (mean age, 33.8±12.8 years; 47.7% of females) were finally diagnosed as ITB (4-caseating granuloma on biopsy, 12-necrotic LNs on CT enterography, 1-both, and 48-response to anti-tubercular therapy) and 23 were diagnosed as Crohn’s disease. Findings of active TB on CECT chest with or without necrotic abdominal LNs were demonstrated in 5 and 20 patients, respectively. No patient with Crohn’s disease had necrotic abdominal LNs or active PTB. Addition of CECT chest in the diagnostic algorithm improved the sensitivity of ITB diagnosis from 26.2% to 56.9%.Conclusions: Addition of CECT chest significantly improves the sensitivity for definite diagnosis in a patient with suspected ITB.

Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.

BACKGROUND Dynamic contrast-enhanced magnetic resonance imaging (MRI) of the liver in pediatric Fontan patients often shows peripheral reticular areas of hypoenhancement, which has not been studied in detail. OBJECTIVE To semiquantitatively score the hepatic MR perfusion abnormality seen in pediatric Fontan patients, and to correlate the perfusion abnormality with functional clinical and hemodynamic parameters. MATERIALS AND METHODS All children (

Background: Long-term Arteriovenous Fistula (AVF) survival has been shown to be adversely impacted by the presence of previous Tunnelled Vascular Catheters (TVC). We analysed the effect of previous TVCs and their location (ipsilateral versus contralateral) on the successful function of upper limb AVFs in the first 12-months after creation. Methods: We retrospectively reviewed clinical data on patient9s first upper limb AVFs, created between January 2013 and December 2017. We analysed the rates of successful AVF function (successful cannulation using 2 needles for ≥50% sessions over a 2-week period) at 6- and 12- months post creation, time to AVF maturation, and rates of assisted maturation. Results: 287 patients with first AVFs were identified, of which 142 patients had a previous TVC (102 contralateral, 40 ipsilateral) and 145 had no previous TVC. The No TVC group had higher rate of AVF function at both 6-months (68.6% vs 54.3%, OR 1.84, 95% CI 1.00-3.39, p=0.05) and 12-months (84.3% vs 63.5%, OR 3.10, 95% CI 1.53-6.26, p=0.002) compared to the TVC group. The Contralateral TVC group had higher rate of AVF function at 6-months (59.6% vs 40%, OR 2.21, 95% CI 1.01-4.88, p=0.05), but not at 12-months (65.9% vs 57.6%, OR 1.42, 95% CI 0.62-3.25, p=0.40) compared to the Ipsilateral TVC group. The median time to AVF maturation in the Contralateral and Ipsilateral TVC groups were 121.5 and 146 days respectively (p=0.07). Assisted maturation rates were lower in No TVC group compared to the TVC group (12.4% vs 27.9%, p=0.007), but similar between the Contralateral and Ipsilateral TVC groups (28.7% vs 25.7 %, p= 0.74). Conclusions: Previous TVC use was associated with poorer AVF function at 6- and 12-months, with a higher rate of assisted maturation. The presence of an ipsilateral TVC was associated with lower successful AVF use at 6-months, compared to contralateral TVC.

Objective To describe the utility of wrist circumference in the identification of cardiometabolic risk in overweight and obese children. Methods A cross-sectional study was conducted in the obesity clinic of a tertiary care referral hospital over a two year period. All children and adolescents aged 5–17 years with nutritional overweight and obesity were recruited. Data pertaining to chronological age, sex, risk factors and family history were collected. Clinical assessment of anthropometry: Weight, height, body mass index (BMI), Tanner’s stage, wrist circumference, blood pressure, waist circumference and triceps skinfold thickness done as per standard criteria. Biochemical assessment of blood glucose, serum insulin, lipid profile, and Homeostatic Model for Insulin Resistance performed after 12 h of fasting. Results We recruited 118 subjects (mean age 10.9 years, 71.1% males, 87.3% obese and 12.7% overweight); 30 (25.4%) had metabolic syndrome. The mean z scores of wrist circumference of children who presented with and without metabolic syndrome was 2.7 ± 0.8 and 2.1 ± 0.7, respectively (p Conclusions Wrist circumference with 97th percentile as a cut-off is a useful tool to identify metabolic syndrome amongst overweight and obese children and adolescents.

In multiple sclerosis (MS), a subset of chronic active white matter lesions are identifiable on magnetic resonance imaging by their paramagnetic rims, and increasing evidence supports their association with severity of clinical disease. We studied their potential role in differential diagnosis, screening an international multicenter clinical research-based sample of 438 individuals affected by different neurological conditions (MS, other inflammatory, infectious, and non-inflammatory conditions). Paramagnetic rim lesions, rare in other neurological conditions (52% of MS vs 7% of non-MS cases), yielded high specificity (93%) in differentiating MS from non-MS. Future prospective multicenter studies should validate their role as a diagnostic biomarker. ANN NEUROL 2020;88:1034-1042.

Background/Aims: Predictors of short-term outcome of intravenous (IV) steroid therapy in acute severe ulcerative colitis (ASUC) have been well described, but the impact of cytomegalovirus (CMV) infection as a predictor of outcome remains debatable. We investigated the role of quantitative CMV polymerase chain reaction (PCR) as a predictor of short-term outcome in patients with ASUC.Methods: Consecutive patients with ASUC satisfying Truelove and Witts criteria hospitalized at All India Institute of Medical Sciences (AIIMS) from May 2016 to July 2019 were included; all received IV steroid. The primary outcome measure was steroid-failure defined as the need for rescue therapy (with ciclosporin or infliximab) or colectomy during admission. AIIMS’ index (ulcerative colitis index of severity > 6 at day 1+fecal calprotectin > 1,000 μg/g at day 3), with quantitative CMV PCR on biopsy samples obtained at initial sigmoidoscopy were correlated with the primary outcome.Results: Thirty of 76 patients (39%) failed IV corticosteroids and 12 (16%) underwent surgery. Patients with steroid failure had a significantly higher mucosal CMV DNA than responders (3,454 copies/mg [0–2,700,000] vs. 116 copies/mg [0–27,220]; P< 0.01). On multivariable analysis, mucosal CMV DNA load > 2,000 copies/mg (odds ratio [OR], 10.2; 95% confidence interval [CI], 2.6–39.7; P< 0.01) and AIIMS’ index (OR, 39.8; 95% CI, 4.4–364.4; P< 0.01) were independent predictors of steroid-failure and need for colectomy. The combination correctly predicted outcomes in 84% of patients with ASUC.Conclusions: High mucosal CMV DNA ( > 2,000 copies/mg) independently predicts failure of IV corticosteroids and short-term risk of colectomy and it has an additional value to the established markers of disease severity in patients with ASUC.

Objective It is recognised that advanced maternal age is associated with adverse pregnancy outcomes. It is less known what the psychological impact of having a pregnancy in later maternal age is. This study aimed to establish whether women having children over 50 experience challenges with regards to their mental well-being during the pregnancy and thereafter. Study design 17 women delivered aged ≥ 50 at our maternity unit in a central London hospital between 2014 and 2020. Of these, one had died of metastatic ampullary carcinoma two years following delivery, one declined taking part, and two we were unable to get hold of, leaving 13 women in the study. Two validated questionnaires were used to survey the women: (i) Warwick-Edinburgh Mental Well-being Scale (WEMWBS), (ii) Parenting Daily Hassles Scale (PDHS). We analysed the questionnaire data using their individual scoring systems. Results The WEMWBS showed a median score of 60 out of a possible 70 (range: 45–70), indicating a high level of mental well-being among these women. The PDHS results indicated that reported hassles were overall low in both frequency and intensity for the mothers. Conclusion Women giving birth over 50 have often experienced long, emotional and financially-burdensome journeys in order to fall pregnant, usually involving assisted reproductive techniques (ART), with multiple antenatal and delivery complications thereafter. As a result, they are extremely happy and grateful to have the child, and are often in better socioeconomic positions that can help with the stress that comes with child-caring.

Aim: We conducted this network meta-analysis to compare the efficacy and safety of targeted pharmacotherapies and fecal microbial transplantation (FMT). Patients & methods: Nineteen studies were included and there was only one head-to-head randomized controlled trial (adalimumab vs vedolizumab). Results: All interventions, including FMT, were superior to a placebo in inducing clinical remission (except adalimumab – odds ratio 1.66; 95% CI: 0.97–2.85), clinical response and endoscopic remission. FMT was comparable with other agents in achieving all efficacy outcomes. Infliximab was ranked highest in inducing clinical remission (surface under the cumulative ranking, 0.8). There was no difference in safety outcomes between FMT and other targeted therapies. Conclusion: FMT is as efficacious and as safe as other targeted therapies in inducing clinical remission, clinical response and endoscopic remission. Further studies to assess the long-term benefits are needed in order to reach a definitive conclusion.

Sarcopenic dysphagia (SD) is swallowing difficulty associated with loss of generalized skeletal muscles and swallowing-related muscles. Diagnostic criteria for SD were suggested, yet there is a variability in instruments and cut-offs used. The aim of the current review is to critically evaluate tools used in diagnosis of sarcopenic dysphagia in the elderly. Comprehensive review of the literature was performed. Studies were qualitatively evaluated for the diagnostic tools used to make a diagnosis of "sarcopenic dysphagia" and compared to the known diagnostic criteria for SD and other accepted measures. Fourteen studies (N = 10,282) were selected from a search yield of 331 de-duplicated studies. Ninety-three percent of studies (13/14) were conducted in Japan. All subjects included were over the age of 65 years old (mean, 76.5 years). Various tools were used to assess sarcopenia including handgrip strength (14/14 of studies), followed by skeletal muscle mass/index (7/14), tongue pressure, gait speed, and calf circumference in 5/14 studies. The most commonly tool used for dysphagia and/or swallowing dysfunction was the food level intake scale (5/14 of studies) followed by the functional oral intake scale (3/14). The 100-mL water swallow test was used in 2 of the 14 included SD studies. Fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, EAT-10 questionnaire, and standardized swallow assessment were each used in only one SD study. Further research is required to validate SD diagnostic tools, establish cut-offs in different populations, and investigate their role in screening of dysphagia and swallowing dysfunction in the elderly.

While celiac disease (CeD) is considered to affect primarily the small intestine, pathological changes in other parts of the gastrointestinal tract (GIT) are also known to occur. IgA anti-tissue transglutaminase-2 antibody (anti-TG2 Ab) deposits at the site of involvement is one of the methods to establish CeD-related tissue pathology. To explore the utility of IgA anti-TG2 Ab deposits in pan-gastrointestinal mucosal biopsies as evidence of CeD-related pathologies. Forty-two treatment-naive patients with CeD and 45 patients with irritable bowel syndrome were included as cases and controls, respectively. Mucosal biopsies were collected from the esophagus, stomach, duodenum, and rectosigmoid regions at baseline from cases and controls, and additionally after 6-months of gluten-free diet in cases. All biopsies were evaluated for histological changes and subjected to dual-color immunohistochemical staining for identifying IgA anti-TG2 Ab deposits. Significantly higher number of patients with CeD had lymphocytic esophagitis (9.7% vs. 0%, P = 0.05), lymphocytic gastritis (35% vs. 8.8%, P

Introduction and Aim: The prevalence of thyroid disorders all over the world is on the rise. However, the diagnosis is complicated among the elderlies due to factors such as non-specific clinical manifestations and interacting medications. The aim of the study is to estimate the prevalence and type of thyroid dysfunction among the elderly. Materials and Methods: The cross-sectional study was undertaken in the Department of General Medicine of a tertiary care teachinghospital. The study included 100 subjects aged above 60 years, of both genders. Data for clinical examination and biochemical tests such as T3, T4, TSH and lipid profile were collected. Reports of USG/FNAC, performed in cases of thyroid nodule, were also checked.Results:The prevalence of thyroid disorders was 22% of the study population. Overt and subclinical hypothyroidism were observed among 4% and 17% respectively, with 1% having hyperthyroidism. Subclinical hypothyroidism was more common among women. No specific trend was observed with increasing age.TPO antibodies were positive among 73% of the cases. Patients with thyroid dysfunction had higher values of triglycerides, total cholesterol and LDL. The proportion of dyslipidemia was significantly higher among elderly with thyroid dysfunction as compared to people with no thyroid dysfunction (90.90% Vs 24.35%, P value < 0.001). Conclusion: Thyroid dysfunction in the elderly is common. Strong clinical suspicion of thyroid diseases in elderly patients presenting with non-specific symptoms is needed. This would aid in the diagnosis of thyroid disorders among the elderly.

Sepsis causes life-threatening complications with the highest burden of death and medical expenses in hospitals worldwide. Despite the progression of targeted therapies for sepsis, the challenge of early diagnosis of sepsis-related biomarkers remains. The analysis of the TNF-α and sTREM-1 in biological fluids provides essential information for effective treatments. In this work, we report developing an electrochemical immunosensor for the rapid detection of TNF-α and sTREM-1 proteins in human plasma samples. First, using the electrospinning process, cerium oxide nanofibers were synthesized. Subsequently, the antibodies corresponding to the targeted proteins are immobilized onto the surface-functionalized working electrodes using NHS/EDC chemistry. The proposed immunosensor’s performance in a biological fluid was assessed using an analytical electrochemistry approach. The limit of detection for the electrochemical immunosensors was 0.51 and 0.41 pg/mL for TNF-α and sTREM-1, respectively, with high selectivity and sensitivity for the use as a point of care device.

OBJECTIVE To noninvasively assess myelin status in chronic white matter lesions of multiple sclerosis (MS), we developed and evaluated a simple classification scheme based on T1 relaxation time maps derived from 7-tesla postmortem and in vivo MRI. METHODS Using the MP2RAGE MRI sequence, we classified 36 lesions from 4 postmortem MS brains as "long-T1," "short-T1," and "mixed-T1" by visual comparison to neocortex. Within these groups, we compared T1 times to histologically derived measures of myelin and axons. We performed similar analysis of 235 chronic lesions with known date of onset in 25 MS cases in vivo and in a validation cohort of 222 lesions from 66 MS cases, investigating associations with clinical and radiological outcomes. RESULTS Postmortem, lesions classified qualitatively as long-T1, short-T1, and mixed-T1 corresponded to fully demyelinated, fully remyelinated, and mixed demyelinated/remyelinated lesions, respectively (p ≤ 0.001). Demyelination (rather than axon loss) dominantly contributed to initial T1 prolongation. We observed lesions with similar characteristics in vivo, allowing manual classification with substantial interrater and excellent intrarater reliability. Short-T1 lesions were most common in the deep white matter, whereas long-T1 and mixed-T1 lesions were prevalent in the juxtacortical and periventricular white matter (p = 0.02) and were much more likely to have paramagnetic rims suggesting chronic inflammation (p

Objective Rheumatoid arthritis (RA) is an autoimmune disease involving the synovial lining of the major joints. Current therapies have noteworthy side effects. Our study involved in silico evaluation of Ehretia laevis (E. laevis) phytoconstituents targeting tumor necrosis factor-α (TNF-α). Methods Molecular docking studies performed to investigate the binding pattern of the plant E. laevis phytoconstituents along with the crystal structure of TNF-α (PDB ID: 2AZ5) using AutoDock Vina followed by a study of interacting amino acid residues and their influence on the inhibitory potentials of the active constituents. Further the pharmacokinetic profile and toxicity screening carried out using SwissADME and pkCSM. Results The docked results suggest that lupeol (− 9.4 kcal/mol) and α-amyrin (− 9.4 kcal/mol) has best affinity towards TNF-α compared to standard drug thalidomide (− 7.4 kcal/mol). The active chemical constituents represents better interaction with the conserved catalytic residues, leading to the inhibition/blockade of the TNF-α-associated signaling pathway in RA. Furthermore, pharmacokinetics and toxicity parameters of these phytochemicals were within acceptable limits according to ADMET studies. Conclusion The binding potential of phytoconstituents targeting TNF-α showed promising results. Nonetheless, it encourages the traditional use of E. laevis and provides vital information on drug development and clinical treatment.

Objectives The aim of this study was to review the clinical profile, management, and outcome of solid tumors in the head-and-neck region in children at our institute. Methods We retrospectively reviewed children with head-and-neck solid tumors who were treated jointly under the departments of Pediatric Surgery and Otorhinolaryngology at our institute between 2016 and 2019. Results In the study period, 10 children (6 males, 4 females) with a median age of 9.5 years (range 5 days-16 years) were treated by our unit. The patients had four tumors arising from the parotid, 2 from nose/naso-pharynx, 1 each from the tongue, submandibular gland, para-pharyngeal space, and infratemporal fossa. A majority (90%) of the patients underwent complete surgical excision of the tumor, preserving the loco-regional neurovascular structures to minimize postoperative morbidity. Malignant lesions were seen in 4 patients (2 rhabdomyosarcoma, 1 primitive neuro-ectodermal tumor, 1 mucoepidermoid carcinoma) and 6 patients had benign pathology (3 pleomorphic adenoma, 2 mature teratoma, 1 schwanomma). Additional therapy with chemotherapy and local radiotherapy was required in 3 out of 4 patients with malignant pathology. The median follow-up duration is 15 months. At last follow-up, all patients are alive and 9 out of 10 patients (90%) are disease-free. Conclusion Our experience highlights rare and difficult tumors in the head-and-neck region in children. These tumors are not commonly managed by the pediatric surgeon in routine practice. The paper outlines the multi-modality management of these tumors, which is essential for an optimal outcome.

We provide the South Asian Declaration, containing the consensus guidelines for coronavirus disease 2019 (COVID-19) vaccination in cancer patients.

Pancreatitis is as common in children as it is in adults, though causes and accepted imaging strategies differ in children. In this narrative review we discuss the epidemiology of childhood pancreatitis and key imaging features for pediatric acute, acute recurrent, and chronic pancreatitis. We rely heavily on our collective experience in discussing advantages and disadvantages of different imaging modalities; practical tips for optimization of ultrasound, CT, and MRI with MRCP in children; and image interpretation pearls. Challenges and considerations unique to imaging pediatric pancreatitis are discussed, including timing of imaging, role of secretin-enhanced MRCP, utility of urgent MRI, severity prediction, autoimmune pancreatitis, and best methods for serial imaging. We suggest a methodical approach to pancreatic MRI interpretation in children and have included a sample structured report, and we provide consensus statements according to our experience imaging children with pancreatitis.

Celiac disease (CeD) is a systemic, immune-mediated enteropathy, which is triggered by gluten protein in genetically susceptible individuals. CeD, once thought to be an uncommon disease, is now recognized to affect approximately 40-60 million people globally. While CeD is now well reported from a few Asian countries such as India, China, Pakistan, and Middle Eastern countries; it is still believed to be uncommon in the rest of Asia. Gluten-related diseases other than CeD, like non-celiac gluten sensitivity (NCGS) are also emerging globally. CeD and NCGS may present with either intestinal or extra-intestinal symptoms, and a proportion of them have overlapping symptoms with irritable bowel syndrome. Hence, many of them are misdiagnosed as having irritable bowel syndrome in clinical practice. In this review, we discuss the emergence of CeD and other gluten-related disorders, both globally and in Asia, the overlapping manifestations between gluten-related disorders and irritable bowel syndrome, and the challenges associated with diagnosis and management of CeD in Asia.

Patients with celiac disease (CeD) can commonly present with symptoms of dyspepsia. We conducted a systematic review and meta-analysis of the present literature to assess the prevalence of CeD in patients diagnosed with dyspepsia. We searched MEDLINE and EMBASE databases for the keywords: celiac disease, coeliac disease, anti-gliadin, tissue transglutaminase antibody, anti-endomysial antibody, dyspepsia and functional gastrointestinal disorder. All the studies published from January 1991 till May 2021 were included. Diagnosis of CeD was based on the European Society of Pediatric Gastroenterology, Hepatology and Nutrition guidelines. A random-effects model was used to pool the data. Twenty-one studies screening 10,275 patients with dyspepsia were included. The pooled seroprevalence of CeD based on a positive anti-tissue transglutaminase antibody and/or anti-endomysial antibody was 4.8% (95% CI [2.8, 6.7%], I2 = 87.7%). The pooled biopsy-confirmed CeD prevalence was 1.5% (95% CI [1.0, 1.9%]; I2 = 59.8%) in these patients. Both seroprevalence (Odds ratio: 1.8; 95% CI [0.8, 4.0%]; I2 = 0%) and prevalence of biopsy-confirmed CeD (Odds ratio: 1.4; 95% CI [0.8, 2.4]; I2 = 0%) were not higher in patients with dyspepsia compared to controls. There was a moderate risk of selection bias and significant heterogeneity in the pooled results. The pooled prevalence of CeD in patients with dyspepsia was 1.5% and it was not significantly higher than the general population. These results do not support screening of patients with dyspepsia for CeD.

While the small intestine is the main site of disease, many other organs are affected by celiac disease (CeD). Dental enamel defects (DED) are common in patients with CeD, and these are one of the indicators of CeD, even when no other symptom of CeD is present. Data on dental and oral cavity manifestations in Asian patients with CeD are scanty. The purpose of the current study was to evaluate dental and oral manifestations in Asian patients with CeD. We recruited 118 patients with biopsy-confirmed CeD (36 treatment naive and 82 on follow-up for at least 1 year on gluten-free diet [GFD]) and 40 controls. Diagnosis was made as per the standard criteria. Oral and dental manifestations were evaluated by a dental surgeon. The DED were evaluated according to Aine’s criteria. Overall higher number of patients with CeD (66.9%), both treatment naive (69.4%) and those on GFD (65.8%) had DED in comparison to controls (20%) (odds ratio, 8.1, 95% confidence interval [CI] 3.4–19.2; p

BACKGROUND Cutaneous involvement by classic Hodgkin lymphoma (CHL) is an extraordinarily rare phenomenon in the current era. To date, no single large case series of cutaneous involvement by Hodgkin lymphoma has ever been reported in the literature. METHODS A comprehensive search for cases designated "skin" and "Hodgkin" was performed at different institutions between 1990 and 2020. Twenty-five cases were identified, and each case was independently reviewed by at least three board-certified dermatopathologists and/or hematopathologists. RESULTS All cases represented examples of systemic CHL with secondary skin dissemination. A single lesion, usually a tumor, nodule or infiltrative plaque was observed in 56% of cases and multiple lesions were present in 28% of cases. Most patients (86%-12/14) had a diagnosis of stage IV disease at first diagnosis. The interval between the clinical (first) diagnosis of HL and the development of skin lesions ranged between 6 and 108 months (average 33.75 months). Comprehensive histopathologic evaluation of these cases (at the initial diagnosis) revealed a diagnosis of classic HL not otherwise specified (NOS) in 60% of cases (15/25), nodular sclerosis type in 24% (6/25), mixed cellularity in 12% (3/25), and lymphocyte depleted in 4% (1/25). CONCLUSIONS We provide documentation of a large series of CHL with secondary skin involvement in association with CHL with additional clinical, morphologic, and immunophenotypic features.

Tibial plateau fracture have been a challenge to treat as these fractures are associated with severe damage to the soft tissue envelope and significant communition and bone loss. This may be due to high speed velocity accidents or fall from height. There exist no gold standard approach in treating these fractures, each case may vary in terms of soft tissue injury, communition and association of neurovascular status. This study was conducted by department of orthopaedics at Government Medical College Ernakulam from February 2018 to January 2020, during this period 30 patients managed by internal fixation was evaluated for their functional outcome. The patients were assigned into two groups; those treated with locking plate and another being the Non locking group. Follow up range was 10-24 months, average being 17.4.This study revealed locking plates to be superior in terms of knee scores, radiological outcomes and post-operative pain.

OBJECTIVE. The Fontan procedure has significantly improved the survival in children with a functional single ventricle, but it is associated with chronically elevated systemic venous pressure that leads to multisystemic complications. Imaging plays an important role in assessing these complications and guiding management. The pathophysiology, imaging modalities, and current surveillance recommendations are discussed and illustrated. CONCLUSION. Significant improvement in survival of patients with Fontan circulation is associated with ongoing cardiac and extracardiac comorbidities and multisystemic complications. The liver and intestines are particularly vulnerable to damage. In addition, this patient population has been shown to be at increased risk of certain malignancies such as hepatocellular carcinoma and neuroendocrine tumors. Familiarity with imaging findings of Fontan-associated liver disease and other abdominal complications of the Fontan circulation is essential for radiologists because we are likely to encounter these patients in our general practice.

Background/Aims: Exclusive enteral nutrition (EEN), an established modality for pediatric Crohn’s disease (CD) is seldomly utilized in adults. The present study reports the outcome of EEN in adult CD patients at a tertiary care hospital in India.Methods: This was a retrospective analysis of CD patients who received EEN as a sole modality/adjunct to other treatment. The primary and secondary outcomes changed in Crohn’s Disease Activity Index (CDAI), and clinical response (decline in CDAI > 70), respectively, at 4 and 8 weeks. Subgroup analysis evaluated response across different phenotypes, EEN formulations and prior treatment. Linear mixed effect model was created to assess the predictors of EEN response.Results: Thirty-one CD patients received EEN over median duration of 4 weeks (range, 2–6 weeks). CDAI showed a significant improvement post EEN at 4 (baseline 290 [260–320] vs. 240 [180–280], P= 0.001) and 8 weeks (baseline 290 [260–320] vs. 186 [160–240], P= 0.001), respectively. The cumulative clinical response rates at 4 and 8 weeks were 37.3% and 80.4% respectively. The clinical response rates at 8 weeks across B1 (n = 4), B2 (n = 18) and B3 (n = 9) phenotypes were 50%, 78.8% and 100% respectively (log-rank test, P= 0.093). The response rates at 8 weeks with polymeric (n = 8) and semi-elemental diet (n = 23) were 75% and 82.6%% respectively (log-rank test, P= 0.49). Baseline CDAI (odds ratio, 1.008; 95% confidence interval, 1.002–1.017; P= 0.046) predicted response to EEN.Conclusions: EEN was effective in inducing clinical response across different phenotypes of CD. Baseline disease activity remained the most important predictor of clinical response to EEN.

Background Acute Stanford type A aortic dissection (TAAD) is a life-threatening condition. Surgery is usually performed as a salvage procedure and is associated with significant postoperative early mortality and morbidity. Understanding the patient’s conditions and treatment strategies which are associated with these adverse events is essential for an appropriate management of acute TAAD. Methods Nineteen centers of cardiac surgery from seven European countries have collaborated to create a multicentre observational registry (ERTAAD), which will enroll consecutive patients who underwent surgery for acute TAAD from January 2005 to March 2021. Analysis of the impact of patient’s comorbidities, conditions at referral, surgical strategies and perioperative treatment on the early and late adverse events will be performed. The investigators have developed a classification of the urgency of the procedure based on the severity of preoperative hemodynamic conditions and malperfusion secondary to acute TAAD. The primary clinical outcomes will be in-hospital mortality, late mortality and reoperations on the aorta. Secondary outcomes will be stroke, acute kidney injury, surgical site infection, reoperation for bleeding, blood transfusion and length of stay in the intensive care unit. Discussion The analysis of this multicentre registry will allow conclusive results on the prognostic importance of critical preoperative conditions and the value of different treatment strategies to reduce the risk of early adverse events after surgery for acute TAAD. This registry is expected to provide insights into the long-term durability of different strategies of surgical repair for TAAD. Trial registration ClinicalTrials.gov Identifier: NCT04831073.

Objectives: We present the survey data on molecular testing and its implications among lung cancer specialists in the South Asian Association for Regional Cooperation (SAARC) region. Material and Methods: An online survey Google form was developed that could be completed in Results: We had 354 responders from 8 SAARC countries, 58.9% (209/354) being medical oncologists, and 30.1% (107/354) radiation oncologists. Nearly 50% of responders were seeing patients in the second wave of coronavirus disease 2019 and 89% had seen reduction in their lung cancer patients during first wave. Biomarker testing in advanced lung cancer using next-generation sequencing as the preferred method was more among medical oncologists (76%) as compared to all the other specialists (24%); (Pearson Chi-square = 0.006). The practice of waiting for the molecular testing report before starting first line treatment was 55.4% in corporate/private hospitals as compared to 27% in the government/charity hospital sectors (Pearson Chi-square = 0.015). A total of 89.6% responders believed that targeted therapy has resulted in improved overall survival in advanced lung cancer. Conclusion: Educational activities need to be strengthened so that lung cancer specialists follow comprehensive NGS testing in appropriate settings, as shown by medical oncologists

Objectives Secondary Infertility is a major concern worldwide, accounting for about 40% of female infertility due to lifestyle factor. Secondary Infertility is having a close proximity to a disorder Vandhyatwa explained in Ayurvedic classics, due to a variety of causes. Several Ayurvedic interventions are advised such as Panchakarma (∼purification therapy) for vitiated Doshas in female reproductive organs, Snehapana (∼oral intake of medicated oil) followed by Virechana (∼purgation) to produce quality ovum. Other internal medications like Phalaghrita, Ashokarishta, Kanchanara guggulu etc. have a probable mode of action with enhancing the perceptibility of endometrium for implantation. Correlating fallopian tubes with the Artavavaha Srotas, its block is compared with the Sanga Srotodushti (obstructive pathology occurring in channels)of this Srotas. By virtue of the purification therapy and internal medication working synergistically might remove the Srotodustht. Case presentation A 30 year old female with a history of eight years post marital infertility was treated with Panchakarma along with Ayurvedic medicines after being diagnosed as infertility due to tubal blockage for a period of 16 weeks. Conclusions After 16 weeks of treatment, she reported with amenorrhoea and found Urine Pregnancy Test positive. Subsequently, confirmed the pregnancy by USG, as single live intrauterine foetus of Sonic Gestational Age – 8 weeks 5 days.

Theranostic nanoparticles (NPs) can reach their target tissue only by passing through blood. However, the influence of NPs on blood is still not well understood. Understanding the effects of NPs on the functioning of blood is critical for successful translation of this novel drug delivery paradigm. In this article, we examined the potential effect of NPs on blood components using four physically and chemically diverse NPs such as carbon nanotube (CNT), magnesium (Mg), silver (Ag), and copper oxide (CuO) NPs. The interaction of different NPs on blood was studied under similar conditions and the effect was assessed by determining the total protein, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), cholesterol, and electrolytes such as Na+, K+, and Cl- concentrations in blood. The concentration of total protein, AST, Na+, and Cl- did not show any significant change in blood when exposed to the NPs. On the other hand, the concentration of ALT and ALP declined for Ag and CuO NPs. Cholesterol levels declined significantly when exposed to CNT, Mg, and CuO NPs. K+ in blood increased over 24 h for Mg NPs but remained consistent for other NPs. Such an increase in K+ induced by Mg NPs can be attributed to the direct interaction of the NPs with the RBCs and other components in blood, resulting in hemolysis. Overall, the results suggest that physical and chemical natures of NPs are critical factors influencing the interaction between NPs and blood components.

ERAS protocols may reduce length of stay and return to full functional recovery after cytoreductive surgery and HIPEC. Prehabilitation programs and post-operative goal directed pathways, along with other essential components of ERAS are discussed with supporting evidence.

Gadolinium-based contrast agents (GBCAs) have been used to improve image quality of MRI examinations for decades and have an excellent overall safety record. However, there are well-documented risks associated with GBCAs and our understanding and management of these risks continue to evolve. The purpose of this review is to discuss the safety of GBCAs used in MRI in adult and pediatric populations. We focus particular attention on acute adverse reactions, nephrogenic systemic fibrosis and gadolinium deposition. We also discuss the non-GBCA MRI contrast agent ferumoxytol, which is increasing in use and has its own risk profile. Finally, we identify special populations at higher risk of harm from GBCA administration.

Background: Dermatophytosis has been a common contagious disease and remain an important public health problem among people worldwide and particularly in developing countries. This study was done in order to know prevalence of keratinophilic fungi in the soil samples of Ajmer region and its clinical correlation. Materials and Methods: Five samples (5gm each) of garden soil were collected from each of the randomly selected 10 sites of Ajmer region in sterile polythene bags & pH of soil was recorded. All samples were processed in the laboratory using hair bait technique and incubated at 28 + 2?C for 3-4 weeks. Fungi grown were subcultured onto Sabourauds Dextrose Agar (SDA) with chloramphenicol & SDA with cycloheximide and identified using standard mycological procedures. Results: Out of 50 soil samples cultured 28 (56%) samples were positive for keratinophilic fungi. 64.28% were dermatophytes and 12.8% were non-dermatophytic fungi. The predominant isolate among dermatophytes was Trichophyton spp. (64.28%) where as Aspergillus spp. (12.8%) was the commonest non-dermatophyte. Conclusion: In our hospital, dermatophytic infection including Tinea corporis is one of the most common clinical presentations of skin infection. Trichophyton spp. is commonest causative agent of Tinea corporis. Interestingly Trichophyton spp. was the most commonly isolated dermatophyte in our study suggesting soil as a source of dermatophytic infections. Keywords: Dermatophytosis, Dermatophytic, Keratinophilic fungi.

Background/Aims: Crohn’s disease (CD) and intestinal tuberculosis (ITB) remain “difficult-to-differentiate” diseases. We have previously documented peripheral blood frequency of CD4+CD25+FOXP3+ T-regulatory cells (Treg) as a biomarker to differentiate CD and ITB. We tried to validate these results in a larger cohort of CD and ITB patients. Methods: Seventy treatment naïve patients of CD (n = 23) and ITB (n = 47) (diagnosed by standard criteria) were recruited prospectively from October 2016 to May 2017. Patients with history of antitubercular therapy in the past were excluded. The frequency of Treg cells in peripheral blood was determined by flow cytometry, and compared between CD and ITB patients. Results: Similar to our previous study, frequency of Treg cells in peripheral blood was significantly increased in ITB as compared to CD patients (40.9 [interquartile range, 33–50] vs. 24.9 [interquartile range, 14.4–29.6], P< 0.001). Further, the receiver operating characteristics curve also showed good diagnostic accuracy with an area under the curve (AUC) of 0.77 (95% confidence interval, 0.65–0.89) and a FOXP3+ cutoff value of > 31.3% had a sensitivity and specificity of 83% and 82.6% respectively, to differentiate ITB from CD. Even for the indeterminate cases (n = 33), Treg cell frequency had similar diagnostic accuracy with an AUC of 0.85 (95% confidence interval, 0.68–0.95) and a cutoff of 32.37% had sensitivity and specificity of 87% and 95% respectively, to differentiate ITB from CD. Conclusions: The current findings validate that the increased frequency of CD4+CD25+FOXP3+ Treg in the peripheral blood can be used as a biomarker with high diagnostic accuracy to differentiate ITB from CD.

Context The detection of low‐level persistent or relapsed B‐cell neoplasms, particularly post‐therapy, can be challenging, often requiring multiple testing modalities. Objective Here we investigate the utility of CD19‐based selection of neoplastic B‐cells (CD19S) as an enrichment strategy to improve the detection rate of cytogenetic abnormalities in post‐therapy samples of B‐cell neoplasms, especially those with low‐level disease. Design In a cohort largely comprised of post‐therapy B‐ALL and CLL samples, we performed fluorescence in situ hybridization (FISH) analysis on CD19‐selected cells (CD19S FISH) in 128 specimens from 88 patients, and on non‐selected cells (NS FISH) in a subset of cases. The FISH findings were compared with the concurrent flow cytometry (FC) results in all samples and molecular analysis in a subset. Results CD19S FISH was able to detect cytogenetic aberrations in 86.0% of post‐therapy samples with evidence of disease as determined by routine or MRD FC, compared to 59.1% of samples by NS FISH. CD19S FISH detected significantly higher percentages of positive cells compared to NS FISH (p, A systematic comparison of CD19‐selected (CD19S) FISH versus non‐selected FISH analysis establishes superiority (qualitative and quantitative) of the former modality in detecting post‐therapy persistence or relapse of B‐cell neoplasms. CD19S FISH can complement flow cytometric evaluation for the detection of low‐level involvement in B‐cell neoplasms and particularly in the detection of post‐therapy recurrent/emerging small subclones. Flow cytometry detection of

AimsDespite clinical evidence of liver involvement in patients with coeliac disease (CeD), there is a lack of a method to prove this association.MethodsOf 146 treatment-naive patients with CeD, 26 had liver dysfunction. Liver biopsies and corresponding small intestinal biopsies were obtained from these 26 patients. Multicolour immunohistochemical and immunofluorescence confocal microscopic studies were performed on paraffin-embedded tissue to detect the IgA/anti-TG2 deposits. Follow-up liver biopsies were taken after a gluten-free diet.ResultsTwenty-six out of the 146 patients (17.8%) with suspected coeliac-associated liver disease on histological examination revealed irregular sinusoidal dilatation in 15 (57.6%), steatohepatitis in 4 (15.3%), non-specific chronic hepatitis in 3 (11.5%), autoimmune hepatitis in 2 (7.6%) biopsies, including cirrhosis in one of them, irregular perisinusoidal fibrosis and changes of non-cirrhotic portal fibrosis in one biopsy each (3.8%). IgA/anti-tTG deposits were observed in 22 (84.6%) liver biopsies by dual immunohistochemistry technique, and in 24 (92.3%) by confocal immunofluorescence technique and in all corresponding duodenal biopsies (100%). Overall, IgA/anti-tTG deposits showed 100% sensitivity, 77% specificity and 85% positive predictive value for establishing an association of extraintestinal pathology and CeD using archived tissues. Follow-up liver biopsies could be obtained in five patients; four of them showed not only resolution of the histological lesions but disappearance of IgA/anti-tTG co-localisation.ConclusionsData of the present study adds to the body of evidence that liver lesions in patients with CeD are disease related and may have been caused by a similar pathogenic mechanism that causes intestinal changes.

COVID-19 and its sequelae are primarily known to affect the respiratory system. However, it can have varied manifestations affecting other systems as well. COVID-19 can lead to reactivation of tuberculosis whichcan have unusual extrapulmonary presentations as well. Coinfection of COVID-19 and tuberculosis is a risk factor for poor outcome. Here, we describe a series of two cases of COVID-19 with tuberculosis. In the first case, a patient who had apparently recovered from COVID-19 presented only a week later with polyserositis, and ultimately was diagnosed to be a case of disseminated tuberculosis. In the second case, the patient presented with COVID-19 and TB together. Clinicians must be aware and vigilant for this coinfection and complication in COVID-19 recovered patients even if they were of mild/ asymptomatic category. How to cite this article:Daga MK, Kumar N, Mawari G, Chand S, Aarthi J, Raghu RV, Sachdeva K. COVID-19 and TuberculosisCoinfection: A Report of Two Cases. Int J Preven Curat Comm Med. 2021;7(1):20-24. DOI: https://doi.org/10.24321/2454.325X.202103

Background Unlike perianal fistula, long‐term outcomes of nonperianal fistulae (NPF) in Crohn's disease (CD) are not clear. We aimed to compare the outcomes of medical and surgical therapies in patients with NPF. Methods We retrospectively analyzed the records of patients of CD with NPF who were prospectively followed from January 2005 to December 2018. Results Of the 53 patients with NPF [mean age at presentation:29 ± 14 years; 54.7% male; median duration of follow‐up: 47 months (interquartile range [IQR]:26–76 months)], enteroenteric fistula (37.8%) was the most common presentation. Of 22 patients treated with anti‐tumor necrosis factor (TNF) therapy, complete response was achieved in 40.9% (n = 9). Overall probability of maintaining response was similar between the anti‐TNF and surgical groups (95.2% vs 82.4%; 71% vs 76%; and 63% vs 69%% [P = 0.8] at 1, 2, and 3 years, respectively), with only 13.6% of patients treated with biologicals requiring surgery over 56 months. Twenty‐one patients required upfront surgery (small bowel or ileocolonic resection with/without diversion; 28.5% emergent), with 47.6% postoperative recurrence over 36 months, of which nine patients required biologicals (77.7% response to anti‐TNF therapy). Long‐term outcome was comparable between medically and surgically treated patients; 6.4% developed tuberculosis on anti‐TNF therapy. Two patients (3.7%) developed malignancy (one ‐ enteroenteric, one ‐ colovesical). Conclusion Anti‐TNF therapy appears to be as effective as surgery in this retrospective analysis of patients with NPFCD, and it may be indicated in the absence of abscess and other complications. These patients are at higher risk of fistula‐associated malignancy, which requires a lower threshold for suspicion, especially over the long term in the presence of nonresponse to medical therapy., This multicenter study evaluated the treatment outcomes and complications following surgery and anti‐tumor necrosis factor (TNF) therapy in patients with nonperianal fistulizing Crohn's disease (CD) and shows that both surgery and medical therapy are equally effectivea

Aims: To quantify the relative percentage change in the patients with periodontitis after employing the scaling and root planning (SRP) therapy and determine the association in the improvements in clinical parameters of biochemical oxidative stress (OS) markers, total antioxidant capacity (TAOC), and malondialdehyde (MDA). Study Design: In this cross sectional study, two groups of patients were clinically evaluated and their biochemical parameters were quantified and statistically compared. Place and Duration of Study: Departments of Biochemistry and Periodontology, M. A. Rangoonwala Dental College, Pune and Department of Biochemistry, Grant Govt. Medical College, Mumbai. The study was carried out between May 2010 and July 2012. Methodology: Individuals with generalized chronic periodontitis (n = 86; CAL ≥ 3mm American Academy of Periodontology 1999 criteria) were clinically (Gingival index, plaque index, probing depth, clinical attachment level) and biochemically (TAOC, MDA) evaluated. The SRP therapy was performed and a follow-up was done after 3 months. The mean values of clinical and biochemical study parameters and their relative percentage change were evaluated thoroughly. Results: Individuals with chronic periodontitis showed improved clinical and biochemical oxidative stress (OS) markers. After the SRP therapy, significant improvement (p ˂ 0.05) was found in both clinical and biochemical parameters from their corresponding pre-treatment values. The relative percentage change in clinical parameters ranged between 14.5% to 38.7%, and those of TAOC and MDA were -10.3% and 34.71% respectively. Further, the relative % change in TAOC and MDA showed significant correlation (p ˂ 0.05) to those of PI, PD, and CAL. Conclusion: On conducting the SRP therapy, improvement in clinical parameters and biochemical OS parameters is noticed in the individuals with periodontitis. The relative percentage change can be used as a tool for therapy outcome assessment.

Neonatal hemochromatosis is a rare condition that causes neonatal liver failure, frequently resulting in fetal loss or neonatal death. It is thought that most cases of neonatal hemochromatosis are caused by gestational alloimmune liver disease (GALD), with neonatal hemochromatosis being a phenotype of GALD rather than a disease process. Extrahepatic siderosis in the pancreas, myocardium, thyroid and minor salivary gland is a characteristic feature of neonatal hemochromatosis. There is also sparing of the reticuloendothelial system with no iron deposition in the spleen. Hepatic and extrahepatic siderosis seen in neonatal hemochromatosis is from iron dysregulation secondary to liver damage rather than iron deposition causing the liver damage. The presence of extrahepatic siderosis in the pancreas and thyroid is diagnostic of neonatal hemochromatosis and can be detected noninvasively by multi-echo gradient recalled echo (GRE) T2*-weighted sequence of MRI within hours of birth. This helps to expedite the treatment in the form of intravenous immunoglobulin and exchange transfusion, which improves the survival in these babies. The finding of hepatic siderosis is nonspecific and does not help in the diagnosis of neonatal hemochromatosis because it is seen with other causes of advanced liver disease.

Hepatocellular carcinoma (HCC) is rare in children and there is limited data on its imaging features. To describe imaging features of pediatric HCC and correlate them with clinical and laboratory findings. We retrospectively reviewed imaging in all pediatric HCC cases seen between January 2000 and January 2019. Imaging features defined in LI-RADS (Liver Imaging Reporting and Data System) and tumor extent by PRETEXT (pretreatment extent of disease) criteria were noted by two radiologists. Patient charts were reviewed to collect clinical features, alpha-fetoprotein (AFP) level and pathology findings. Of the 15 children (7 boys, 8 girls; mean age: 11.8 years, age range: 6–17 years) included in the study, 12/15 had computed tomography, 9/15 had magnetic resonance imaging and 9/15 had ultrasound exams available for review. Pathological types of HCC included classic (11/15, 73%), fibrolamellar (3/15, 20%) and mixed cholangiocarcinoma-HCC (1/15, 7%). Eighty percent occurred de novo in normal liver and 67% showed elevated AFP levels. Arterial phase hyperenhancement was seen in 83% of cases, washout in 86%, capsule in 50% and tumor-in-vein in 33%. The mean tumor size was 9.8 cm and 40% were multifocal on imaging. Staging revealed PRETEXT II tumors in 47%, III in 20% and IV in 33%. There were no PRETEXT I tumors. The two most common PRETEXT annotation factors were portal vein and caudate lobe involvement in 71% and 43% of cases, respectively. Fibrolamellar HCC demonstrated central scar, normal AFP levels and normal background liver. Pediatric HCC are large heterogeneous tumors, as reflected by high PRETEXT staging, and commonly include portal vein and caudate involvement. This affects resectability of these tumors at presentation. Central scar, normal AFP level and normal liver background may help differentiate fibrolamellar HCC from other types of HCC.

Objective This study assesses the impact of coronavirus disease 2019 (COVID-19) on the pattern of neurological emergencies reaching a tertiary care center. Materials and Methods This is a retrospective and single center study involving 295 patients with neurological emergencies mainly including acute stroke, status epilepticus (SE), and tubercular meningitis visiting emergency department (ED) from January 1 to April 30, 2020 and divided into pre- and during lockdown, the latter starting from March 25 onward. The primary outcome was number of neurological emergencies visiting ED per week in both periods. Secondary outcomes included disease severity at admission, need for mechanical ventilation (MV), delay in hospitalization, in-hospital mortality, and reasons for poor compliance to ongoing treatment multivariate binary logistic regression was used to find independent predictors of in-hospital mortality which included variables with p Results There was 53.8% reduction in number of neurological emergencies visiting ED during lockdown (22.1 visits vs. 10.2 visits per week, p = 0.001), significantly affecting rural population (p = 0.004). Presenting patients had comparatively severe illness with increased requirement of MV (p < 0.001) and significant delay in hospitalization during lockdown (p < 0.001). Poor compliance to ongoing therapy increased from 34.4% in pre-lockdown to 64.7% patients during lockdown (p < 0.001), mostly due to nonavailability of drugs (p < 0.001). Overall, 35 deaths were recorded, with 20 (8.2%) in pre-lockdown and 15 (29.4%) during lockdown (p = 0.001). Lockdown, nonavailability of local health care, delay in hospitalization, severity at admission, and need for MV emerged as independent predictors of poor outcome in stroke and delay in hospitalization in SE. Conclusion COVID-19 pandemic and associated lockdown resulted in marked decline in non-COVID neurological emergencies reporting to ED, with more severe presentations and significant delay from onset of symptoms to hospitalization.

Sarcopenia and visceral fat independently predict poor outcomes in Crohn's disease (CD). However, combined influence of these parameters on outcomes is unknown, and was investigated in the present study.This retrospective study evaluated skeletal muscle index (SMI-cross-sectional area of five skeletal muscles normalized for height), visceral and subcutaneous fat area and their ratio (VF/SC) on single-slice computed tomography (CT) images at L3 vertebrae in CD patients (CT done: January 2012-December 2015, patients followed till December 2019). Sarcopenia was defined as SMI 36.5 cmForty-four patients [age at onset: 34.4 ± 14.1 years, median disease duration: 48 (24-95) months, follow-up duration: 32 (12-53.5) months, males: 63.6%] were included. Prevalence of sarcopenia was 43%, more in females, but independent of age, disease severity, behavior and location. More patients with sarcopenia underwent surgery (31.6% vs 4%, p = 0.01). VF/SC was significantly higher in patients who underwent surgery (1.76 + 1.31 vs 0.9 + 0.41, p = 0.002), and a cutoff of 0.88 could predict surgery with sensitivity and specificity of 71% and 65% respectively. On survival analysis, probability of remaining free of surgery was lower in patients with sarcopenia (59.6% vs 94.1% p = 0.01) and those with VF/SC 0.88 (66.1% vs 91.1%, p = 0.1), and still lower in those with both sarcopenia and VF/SC 0.88 than those with either or none (38% vs 82% vs 100%, p = 0.01).Combination of sarcopenia and high visceral fat predict worse outcomes in CD than either.

Early surgical tetralogy of Fallot (ToF) repair involved patching across the pulmonic annulus (transannular patch [TAP] repair), which resulted in severe pulmonic regurgitation. Long-term outcome improvements were anticipated with modifications that preserved the pulmonic annulus (annulus-preserving [AP] repair). The objective of the present study was to evaluate the need for late reintervention in adults with AP repair and those with TAP repair.We conducted a retrospective review of adults (born 1981-1996) with childhood intracardiac ToF repairs at a tertiary care center. The primary cardiovascular outcome was need for reintervention after primary intracardiac repair of ToF. Secondary outcomes included a composite of death, heart failure, and ventricular arrhythmias.Two hundred thirty adults were included: 104 with AP repair and 126 with TAP repair. The median age at last follow up was 25 years (interquartile range [IQR] 20-28) and the median follow-up duration was 7.9 years (IQR 3.5-12). Reintervention of any type was significantly more common in the TAP group during both childhood and adulthood (72.2% TAP vs 20.2% AP, HR 5.5, 95% CI 3.4-9.0; P0.001). Pulmonary valve replacement (PVR) was almost 6 times more likely in adults with TAP repair (65.1% TAP vs 16.3% AP, HR 5.7, 95% CI 3.4-9.7; P0.001).Patients who had AP ToF repair had significantly fewer late reinterventions compared with TAP repair, with the majority of reinterventions due to PVR. More long-term follow-up is required.

Major depressive disorder (MDD) is a heterogeneous disease which is why there are currently no specific methods to accurately test the severity, endophenotype or therapy response. This lack of progress is partly attributed to the com-plexity and variability of depression, in association with analytical variability of clinical literature and the wide number of theoretically complex biomarkers. The literature accessible, indicates that markers involved in inflammatory, neuro-trophic and metabolic processes and components of neurotransmitters and neuroendocrine systems are rather strong indicators to be considered clinically and can be measured through genetic and epigenetic, transcriptomic and proteomic, metabolomics and neuroimaging assessments. Promising biologic systems/markers found were i.e., growth biomarkers, endocrine markers, oxidant stress markers, proteomic and chronic inflammatory markers, are discussed in this review. Several lines of evidence suggest that a portion of MDD is a dopamine agonist-responsive subtype. This review analyzes concise reports on the pathophysiological biomarkers of MDD and therapeutic reactions via peripheral developmental factors, inflammative cytokines, endocrine factors and metabolic markers. Various literatures also support that endocrine and metabolism changes are associated with MDD. Accumulating evidence suggests that at least a portion of MDD patients show characteristics pathological changes regarding different clinical pathological biomarkers. By this review we sum up all the different biomarkers playing an important role in the detection or treatment of the different patients suffering from MDD. The review also gives an overview of different biomarker's playing a potential role in modulating effect of MDD.

Sarcopenia predicts morbidity and mortality in adults with end-stage liver disease (ESLD) and is determined by total psoas muscle area (tPMA) measurement from computed tomography (CT) imaging. Recently developed pediatric age- and sex-specific tPMA growth curves provide the opportunity to ascertain prevalence and impact of sarcopenia in children awaiting liver transplantation (LT). This retrospective single-center study evaluated sarcopenia in children between 1 and 16 years with ESLD and a clinically indicated abdominal CT less than 3 months before first isolated LT. Sarcopenia was defined as tPMA z score less than −2 measured at the intervertebral L4-5 level. Patient demographic, biochemical, and outcome data were recorded. tPMA was compared with other measures of nutritional status using univariate and multivariate logistic analyses. Outcome measures included 1-year morbidity events and mortality after LT. CT images from 25 (64% female) children with median age of 5.50 (interquartile range [IQR], 3.75-11.33) years were reviewed. Ten children (40%) had a tPMA z score less than −2. Sarcopenia was associated with lower z scores for weight (odds ratio [OR], 0.38; P = 0.02), height (OR, 0.32; P = 0.03), and nutritional support before LT (OR, 12.93; P = 0.01). Sarcopenic children had a longer duration of pediatric intensive care unit (PICU) stay (3.50 [IQR, 3.00-6.00] versus 2.00 [IQR, 2.00-3.50] days; P = 0.03). Sarcopenia was prevalent in 40% of children with ESLD awaiting LT, and lower tPMA z score was associated with deficient anthropometrics and need for nutritional support before LT. Post-LT PICU duration was increased in children with sarcopenia, reflecting adverse outcomes associated with muscle loss. Further studies are needed to elucidate the underlying mechanisms of sarcopenia in children with ESLD.