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Radiotherapy is a branch of medicine which uses ionizing radiation for treatment of cancer. It can be described in two steps, viz. (I) dosimetry or the measurement of dose and (II) treatment or the delivery of dose to the patient in a planned manner. The foremost intention of this study is to unify the various steps involved in radiotherapy from the definition of dose. Considering the definition of dose as the central theme of argument, an elementary approach has been attempted to reveal the underlying string which connects all the branches in radiotherapy. Dose to the patient cannot be measured in the patient itself. The procedure is to measure it in an equivalent medium similar to the human body. Many changes were made from time to time in the field of dosimetry while choosing the medium for dose measurement experiments. With the advent of new devices and techniques, various changes and modifications have been made in the field of treatment with ionizing radiation. This study is an attempt to explain, relate and unify those changes and new advents in radiotherapy with the definition of dose.

Breast cancer is mainly formed in the tissues of the breast, and it spreads through the lymphatic system. They are mostly found in women rather than men. The breast cancer incidence has been increasing globally, with 1 in 8 women developing cancer in their lifetime. This prospective observational study was conducted to determine the Chemotherapy-Induced Nausea and Vomiting (CINV) in post-mastectomy breast cancer patients for nine months in a tertiary care hospital. Sixty patients were divided into two groups where one arm received Olanzapine, and the other received aprepitant. Both the arms were analysed for the severity of nausea and vomiting. Aprepitant (APT) is a neurokinin one receptor antagonist (NK1RA) which is used as antiemetic in the prophylaxis of CINV. Olanzapine (OLP) is a second-generation antipsychotic agent, which works by blocking the serotonin receptor. The objective of the study is to Evaluate the Safety and Efficacy of APT versus OLP in preventing CINV in breast cancer patients on Docetaxel-Adriamycin-Cyclophosphamide regimen. The OLP is more effective than APT in antiemetic therapy.

Introduction: Cancers of the kidney amount to 2% of total human cancer burden, with approximately 1,90,000 new cases diagnosed each year. Prognostic markers for RCC, such as tumor stage, grade, necrosis or microvascular invasion are important in determining appropriate follow up and selecting patients for adjuvant therapy. Aim: Aim of the study is to analyze the clinical and histopathological variables in Renal Cell Carcinoma and establish possible correlations between them, if any. The study also highlights a rare case of mucinous tubular and spindle cell carcinoma of the kidney. Materials and Methods: This is a retrospective study involving 52 cases of Renal Cell tumors diagnosed, during period of 2 years (2015-2016) Results: Clear cell, Papillary, Chromophobe Carcinomas and Oncocytomas accounted for 78.85%, 7.69%, 1.92% and 7.69% of all cases, respectively. Conclusion: Clear cell Carcinoma was the most common histological type, followed by Papillary Carcinoma. Majority of Clear cell Carcinomas were grade 2 with most common stage being PT1b. Tumour necrosis was common in Papillary Carcinomas. We had one case of Mucinous Tubular and Spindle cell Carcinoma which is a rare variant. Keywords: Histomorphology, Renal cell carcinomas.

The aim of the project is to use machine learning techniques for disease prediction, risk prediction and prediction of adverse drug reactions. The project is divided into two modules, an android app and a web app. The android app is to predict possible diseases based on the symptoms the person is showing. Along with that the reviews of common drugs from online healthcare forums such as medications.com are extracted and tf-idf is used to find out the possible adverse drug reactions the drugs may have. The web app does disease risk prediction based on phenotypic details and lab reports. As an addition to the project, location based medical help and health tips are also implemented.

Laparoscopic assisted transgastric endoscopic retrograde cholangiopancreatography (LAERCP) is used for treatment in patients after gastric bypass, where transoral access to the biliary tree is not possible. We describe our technique and experience with this procedure for our patient who had undergone Roux en y gastric bypass (RYGB). Patient underwent intra-operative cholangiography which revealed common bile duct (CBD) stones. A combined laparoscopic-endoscopic approach was attempted. A small gastrotomy with a purse-string suture was performed on the anterior wall on remanant stomach. A side-viewing scope was introduced through a 15-mm trocar on the upper left quadrant and through the gastrotomy. The jejunum was occluded to prevent air passage and small bowel distension. Endoscopic sphincterotomy and stone extraction were carried out according to standard techniques. Occlusion cholangiogram confirmed CBD clearance. There was no procedure-related complication, and the patients were discharged on the second postoperative day. The patient was doing well at 1-year follow-up. Biliary obstruction can occur many years after gastric bypass with or without cholecystectomy. Our findings suggest that gastric bypass patients may be at a higher risk of symptomatic cholelithiasis with CBD stones. LAERCP is a reliable option for common bile duct clearance; our technique of LAERCP is technically simple and associated with low complication rate, making it appealing to surgeons trained in laparoscopy.

BACKGROUND Antitachycardia pacing (ATP) provides safe and painless termination of reentrant ventricular arrhythmias in patients with implantable cardioverter defibrillator (ICDs), improving their quality of life. Established predictors of ATP responsiveness are not well known; only longer ventricular tachycardia (VT) cycle length and higher ejection fraction have been found to predict ATP success. OBJECTIVE To investigate clinical and ECG predictors of ATP response in ICD patients with monomorphic VT. METHODS The ICD clinic database was searched for monomorphic VT events requiring ICD therapy in patients with ischemic or non-ischemic cardiomyopathy. Each patient's first ICD encounter for VT was assessed. Patient demographics, clinical characteristics, VT rate, and ATP responsiveness (always, sometimes, and never successful) were recorded. An ECG was analyzed for QRS morphology and duration. Data was assessed for predictors of ATP responsiveness. RESULTS In 527 patients, characteristics associated with always successful ATP included ACE-I/ARB therapy and slower VT rate (never successful ATP 197 ± 28 bpm, sometimes successful ATP 190 ± 27 bpm, always successful ATP 183 ± 22 bpm, P

Diffuse Large B Cell Lymphoma is the commonest subtype of Non-Hodgkin’s Lymphoma. It may present with primary nodal or extranodal involvement. Up to 40% of patients present with primary extranodal involvement, the commonest involved sites being gastrointestinal tract, testes, central nervous system, thyroid, nose, sinuses, skin, breast, bone and respiratory tract. Skeletal Muscle is a rare site of primary lymphomatous involvement. We present a case of Diffuse Large B Cell lymphoma primarily involving the skeletal muscles and breast, initially managed as a case of acute pyogenic myositis with sepsis with Multiple Organ Dysfunction Syndrome. In addition, the patient had hypercalcemia, cortical vein thrombosis, proteinuria and renal dysfunction, which were all speculated to be paraneoplastic in etiology.

Backgroung: Applying the ethics in practice is more essential than just learning it. Any sought of misconductto the patient is not just an ethical issue but it will also degrade the professionalism and it brings a sense ofinsecurity in patients and this will slow down the progress of treatment. So it is not only important to avoidthe ethical issues and misconduct but it is also necessary to stand against ethical issues that happen within theorganization that may done by colleagues or higher authorities without any dilemma. Objective: This studyaims to find out the difficulties and dilemmas of the physiotherapist in ethical decision making and disclosingthe misconduct of their colleagues without any hesitation. Methodology: A close ended questionnaire wasused to assess the willingness of the student physiotherapist to expose the misconduct which might bean internal or external disclosure. The questionnaire consisted of two clinical scenarios which were mostlikely to arise in a work place. Each scenario consisted of 5 questions that rated the severity, likelihood ofconfronting, internal disclosure, external disclosure to the association and external disclosure to media. Thescoring was based on five point likert scale. It was a study that was done with convenient sampling method.The questionnaire was given to 100 Physiotherapy students in Chennai of both the sexes who were willingto participate in the study. Result: From the statistical analysis, there is a significant difference obtained forthe likelihood of reporting the manager’s misconduct than colleague’s misconduct. Also their willingnessto report internally within the organization is greater than that of reporting externally to the associationand to the media. Conclusion: Ethics being a part of Physiotherapy curriculum, these students have wellunderstood the ethical and professional behavior and have good ethical acceptance. Hence we conclude thatthe students do understand the seriousness of any misconduct of a therapist to the patient and are willing toexpose any misconduct they encounter to the internal or external environment.

Aim: To refine and contextually adapt a postpartum lifestyle intervention for prevention of type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (GDM) in Bangladesh, India, and Sri Lanka.Materials and Methods: In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with women with current diagnosis of GDM, and health care professionals involved in their management, to understand relevant local contextual factors for intervention optimization and implementation. This paper describes facilitators and barriers as well as feedback from participants on how to improve the proposed intervention. These factors were grouped and interpreted along the axes of the three main determinants of behavior–capability, opportunity, and motivation. IDIs and FGDs were digitally recorded, transcribed, and translated. Data-driven inductive thematic analysis was undertaken to identify and analyze patterns and themes.Results: Two interrelated themes emerged from the IDIs and FGDs: (i) The lifestyle intervention was acceptable and considered to have the potential to improve the existing model of care for women with GDM; and (ii) Certain barriers such as reduced priority of self-care, and adverse societal influences postpartum need to be addressed for the improvement of GDM care. Based on the feedback, the intervention was optimized by including messages for family members in the content of the intervention, providing options for both text and voice messages as reminders, and finalizing the format of the intervention session delivery.Conclusion: This study highlights the importance of contextual factors in influencing postpartum care and support for women diagnosed with GDM in three South Asian countries. It indicates that although provision of postpartum care is complex, a group lifestyle intervention program is highly acceptable to women with GDM, as well as to health care professionals, at urban hospitals.

Routine large-scale assessment of the awareness of iron-deficiency anaemia (IDA), a rampant public health challenge in India, is lacking. We conducted a study, among adolescent girls attending government schools in Srikakulam district, South India, to ascertain the awareness of IDA and identify key socio-economic correlates of IDA awareness. We collected biometric, demographic and survey data, from 148 randomly selected schoolgirls, from one urban and one rural school, and conducted t-tests and discriminant function analyses. Participants (mean age of 13.48 (1.08) years; mean body mass index (BMI) of 17.53 (0.21) kg/m2) scored a mean of 24.63 (4.21) out of a possible 41 (rural–urban (95%CI) = (−2.9, −0.2)). Discriminant function loadings revealed age (0.79), mother’s education (0.43) and occupation (0.59), father’s occupation (0.59), number of female siblings (0.36) and BMI (0.78) to be key determinants of IDA awareness. The low scores on IDA awareness and the high proportion of underweight participants highlight the need for targeted health education and nutrition interventions.

Actinomycosis is a chronic disease characterized by multiple abscesses, granulomas, tissue destruction, extensive fibrosis and formation of sinuses. We report a case of 45 year old female with primary cutaneous actinomycosis of right upper extremity, which is a very rare site of occurrence. The patient was treated successfully with extended period antimicrobial treatment with Doxycycline (spacing) and Cefixime.

BACKGROUND Cancer of uterine cervix is a dreadful cause of mortality amongst genital tract malignancies in Indian women and it is an important preventable disease provided it is detected early. There is excellent evidence that invasive cancer of uterine cervix develops from carcinoma in situ/dysplasia. Therefore, the eradication of precancerous epithelial changes is possible by cytologic screening. The aim of the study was to correlate efficacy of pap smears in the diagnosis of cervical dysplasia. MATERIALS AND METHODS A prospective study was conducted by a detailed examination of cervical smears of patients at M.S. Ramaiah Teaching Hospital and their correlation with histopathological findings. RESULTS A total of 2584 pap smears were studied during this period, out of which 249 smears were within normal limits, 2211 were nonneoplastic and 124 were neoplastic. Out of 124 neoplastic smears, 80 cases showed CIN-I features, 16 cases showed CIN- II features and 09 cases showed CIN-III features. CONCLUSION Pap smear is an effective screening procedure in diagnosing cervical lesions. It can be recommended as the first line investigation in the diagnosis of cervical dysplasia.

Background Road traffic injuries kill more people in India than in any other country in the world, and these numbers are rising with increasing population density and motorization. Official statistics regarding road traffic injuries are likely subject to underreporting. This study presents results of a surveillance program based at a public tertiary hospital in Hyderabad, India. Methods All consenting patients who presented to the casualty ward after a road traffic injury over a 9-month period were enrolled. Interviews were performed and data abstracted from clinical records by trained research assistants. Data included demographics, injury characteristics, risk factors, safety behaviors, and outcomes. Results A total of 5,298 patients were enrolled; their mean age was 32.4 years (standard deviation 13.8) and 87.3% were men; 58.2% of patients were injured while riding a motorcycle or scooter, 22.5% were pedestrians, and 9.2% used motorized rickshaws. The most frequent collision type was skid or rollover (40.9%). Male victims were younger than female victims and were overrepresented among motorized 2-wheeler users. Patients were most frequently injured from 1600 to 2400. A total of 27.3% of patients were admitted. Hospital mortality was 5.3%, and 48.2% of deaths were among motorized 2-wheeler users. Conclusion This is one of the few prospective, hospital-based studies of road traffic injury epidemiology in India. The patient population in this study was similar to prior hospital-based studies. When compared to government surveillance systems, this study showed motorized 2-wheeler users to be more frequently represented among the overall population and among fatalities. Further research should be done to develop interventions to decrease mortality associated with 2-wheeled vehicles in India.

Aims Hydroxychloroquine (HCQ) has shown to have significant immunomodulatory effects in the treatment of systemic lupus erythematosus (SLE). Current studies show favorable effects of HCQ on traditional cardiac risk factors in patients with SLE. This review examined the effects of HCQ on serum low-density lipoprotein (LDL) level in patients with SLE. Methods A systematic search of seven major literature search databases from their inception until 3 April, 2017 identified nine studies. Random-effects pooled mean difference with corresponding 95% confidence intervals (CI) were estimated. Heterogeneity was measured by I2. Publication bias was assessed by visual inspection of funnel plots. Sensitivity analysis examined whether HCQ effect on serum total cholesterol level was similar to the main analysis. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the overall quality of evidence. Results Pooled study participants were 559 patients from eight observation studies (two before-after studies; six case-control studies) examining the effects of HCQ on serum LDL. Pooled study participants' characteristics were as follows: mean age 45.719, female 95.262%, and prednisone use 58.366%. HCQ reduced mean LDL levels by 24.397 mg/dL (95% CI 8.921–39.872; P = 0.002). The number of studies identifying statin use was too few to perform meta-regression analysis of statin use. Heterogeneity was extensive (I2 = 94.739%). Symmetrical funnel plot visualized no evidence of publication bias. Conclusion HCQ was associated with serum LDL level reduction by mean 24.397 mg/dL in patients with SLE. Future prospective studies are need to fully characterize the treatment effect.

Gallstone ileus is a diagnosis of rarity, and a proximal site of obstruction in a young patient is even rare. Of the three cases in our experience, we found two cases of gallstone ileus (GSI) with typical epidemiology and presentation, one had combination of multiple rare associations. We report such a case, suspected to have gallstone ileus on ultrasound and confirmed diagnosis on computed tomography. Presence of biliary-enteric fistula, old age, and obstructive features, as in typical cases, was a bigger asset for diagnosis, but it was difficult to entertain diagnosis of GSI in young girl in absence of a demonstrable biliary-enteric fistula, with uncommon association of choledochal cyst and sickle cell disease. A very surprising finding, dilated major papilla, could however explain the pathogenesis which has also been reported in the past. Although differential opinions regarding management exist, we decided to follow two-stage surgery as our institute protocol. A minimal access approach has been immensely helpful in accurate diagnosis, and expedative management with early recovery has been proven in the past studies which we agreed with our experience.

Background The management of patients who develop common bile duct calculi post gastric bypass is complicated as transoral access to the biliary tree is not possible. Majority of the patients may require a lap/open cbd exploration. We here describe our technique of accessing the cbd laparoscopically via the ampulla of vater. Methods Between January 2014 and January 2019 12 patients developed CBD calculi. 7 of them had undergone Roux en y gastric bypass (RYGB) and 5 of them had undergone mini gastric bypass (MGB). A combined laparoscopic-endoscopic approach was attempted. A small gastrotomy with a purse-string suture was performed on the anterior wall on remanant stomach. A side viewing scope was introduced through a 15 mm trocar on the upper left quadrant and through the gastrotomy. The duodenum was occluded to prevent air passage and small bowel distension. Endoscopic sphincterotomy and stone extraction were carried out according to standard techniques. Occlusion cholangiogram confirmed CBD clearance. There was no procedure-related complication, and the patients were discharged on the second postoperative day. The patient is doing well at 6-months follow up. Results The detection of CBD calculi was on an average after 3 years post gastric bypass. All patients were managed as per the described technique and the mean hospital stay was 3 days. Seven patients underwent simultaneous cholecystectomy. Two patients had cholecystectomy more than 2 years previously. Our technique involves access to the bypassed stomach via a laparoscopically placed 15 mm port. We observed no major complications. No minor complications except, port site infection for one patient was observed in our series. Conclusions The formation of gallstones post gastric bypass is a known entity and they can migrate into the CBD. Management of these presents a unique dilemma. LAERCP (Laproscopic ERCP) is a reliable option for common bile duct clearance; our technique of LAERCP is technically simple and associated with low complication rate, making it appealing to surgeons trained in laparoscopy.

Aim This study aims to determine whether a resource- and culturally appropriate lifestyle intervention programme in South Asian countries, provided to women with gestational diabetes (GDM) after childbirth, will reduce the incidence of worsening of glycaemic status in a manner that is affordable, acceptable and scalable. Methods Women with GDM (diagnosed by oral glucose tolerance test using the International Association of the Diabetes and Pregnancy Study Groups criteria) will be recruited from 16 hospitals in India, Sri Lanka and Bangladesh. Participants will undergo a repeat oral glucose tolerance test at 6 ± 3 months postpartum and those without Type 2 diabetes, a total sample size of 1414, will be randomly allocated to the intervention or usual care. The intervention will consist of four group sessions, 84 SMS or voice messages and review phone calls over the first year. Participants requiring intensification of the intervention will receive two additional individual sessions over the latter half of the first year. Median follow-up will be 2 years. The primary outcome is the proportion of women with a change in glycaemic category, using the American Diabetes Association criteria: (i) normal glucose tolerance to impaired fasting glucose, or impaired glucose tolerance, or Type 2 diabetes; or (ii) impaired fasting glucose or impaired glucose tolerance to Type 2 diabetes. Process evaluation will explore barriers and facilitators of implementation of the intervention in each local context, while trial-based and modelled economic evaluations will assess cost-effectiveness. Discussion The study will generate important new evidence about a potential strategy to address the long-term sequelae of GDM, a major and growing problem among women in South Asia. (Clinical Trials Registry of India No: CTRI/2017/06/008744; Sri Lanka Clinical Trials Registry No: SLCTR/2017/001; and ClinicalTrials.gov Identifier No: NCT03305939).

IntroductionThe development of type 2 diabetes mellitus disproportionately affects South Asian women with prior gestational diabetes mellitus (GDM). The Lifestyle InterVention IN Gestational diabetes (LIVING) Study is a randomised controlled trial of a low-intensity lifestyle modification programme tailored to women with previous GDM, in India, Bangladesh and Sri Lanka, aimed at preventing diabetes/pre-diabetes. The aim of this process evaluation is to understand what worked, and why, during the LIVING intervention implementation, and to provide additional data that will assist in the interpretation of the LIVING Study results. The findings will also inform future scale-up efforts if the intervention is found to be effective.Methods and analysisThe Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) methodological approach informed the evaluation framework. Michie’s Behaviour Change Theory and Normalisation Process Theory were used to guide the design of our qualitative evaluation tools within the overall RE-AIM evaluation framework. Mixed methods including qualitative interviews, focus groups and quantitative analyses will be used to evaluate the intervention from the perspectives of the women receiving the intervention, facilitators, site investigators and project management staff. The evaluation will use evaluation datasets, administratively collected process data accessed during monitoring visits, check lists and logs, quantitative participant evaluation surveys, semistructured interviews and focus group discussions. Interview participants will be recruited using maximum variation purposive sampling. We will undertake thematic analysis of all qualitative data, conducted contemporaneously with data collection until thematic saturation has been achieved. To triangulate data, the analysis team will engage in constant iterative comparison among data from various stakeholders.Ethics and disseminationEthics approval has been obtained from the respective human research ethics committees of the All India Institute of Medical Sciences, New Delhi, India; University of Sydney, New South Wales, Australia; and site-specific approval at each local site in the three countries: India, Bangladesh and Sri Lanka. This includes approvals from the Institutional Ethics Committee at King Edwards Memorial Hospital, Maharaja Agrasen Hospital, Centre for Disease Control New Delhi, Goa Medical College, Jawaharlal Institute of Postgraduate Medical Education and Research, Madras Diabetes Research Foundation, Christian Medical College Vellore, Fernandez Hospital Foundation, Castle Street Hospital for Women, University of Kelaniya, Topiwala National Medical College and BYL Nair Charitable Hospital, Birdem General Hospital and the International Centre for Diarrhoeal Disease Research. Findings will be documented in academic publications, presentations at scientific meetings and stakeholder workshops.Trial registration numbersClinical Trials Registry of India (CTRI/2017/06/008744); Sri Lanka Clinical Trials Registry (SLCTR/2017/001) and ClinicalTrials.gov Registry (NCT03305939); Pre-results.

Dysfunctional uterine bleeding (DUB) is abnormal genital tract bleeding based in the uterus and found in the absence of demonstrable . S tructural or organic pathology. It occurs more frequently in anovulatory than ovulatory cycles. Dysfunctional uterine bl eeding is most often the result of endocrinological dysfunction which responds well to conservative treatment. Ormeloxifene (also known as centchroman) is one of the selective estrogen receptor modulators, or SERMs, a class of medications which acts on the estrogen receptor. It is a non - steroidal, non - hormonal oral contraceptive which is taken once in a week. Ormeloxifene is suitable for the treatment of DOB, in all age groups with effective therapeutic efficacy and with least side effects

BACKGROUND: Pterygium is a fairly common condition in a tropical country like India with average incidence being 5.2%. Surgery being offered as a treatment for pterygium does not, at present, have a universally accepted indication based on the size. This study was done to make an attempt to define the indication for surgical exicision of pterygium. AIMS: To find out an association between increasing size of pterygium and degree of induced corneal astigmatism and to assess if corneal astigmatism induced by pterygium affects best corrected visual acuity (BCVA) and thus making it an indication for pterygium excision surgery. SETTINGS AND DESIGN: Hospital Out Patient Departmen t (OPD) based prospective clinical cross sectional study on patients with unilateral pterygium. METHODS AND MATERIAL : 33 patients were included in this study who had unilateral pterygium of varying sizes. Evaluation was done using slit - lamp beam for size o f pterygium in millimetre from the limbus, ketatometry using Bausch and Lomb keratometer, autorefractometer objective refraction readings, visual acuity and BCVA using Snellens chart. STATISTICAL ANALYSIS USED: Chi - square - test, Karl - Pearson correlation coe fficient, Kruskal - Wallis - co - efficient using SPSS statistics 22.0 . RESULTS: 33 people having unilateral pterygium were divided into three groups on the basis of size of the pterygium - ≤2mm, 2.1 - 3mm, >3mm. The co - relation coefficient between the astigmatism induced to BCVA was maximum for the 3rd group with pterygium size >3mm and was statistically significant. CONCLUSION: Pterygium induces ‘with the rule’ astigmatism. Surgery is indicated in patients of pterygium size >3mm as the astigmatism induced affects the BCVA

Study design Retrospective study. Purpose The aim of the study was to study the impact and outcome of conservative management and surgical intervention in cases of postoperative discitis. Overview of literature Postoperative discitis is a rare but often misdiagnosed cause of failed back syndrome. There is paucity of literature regarding management guidelines of postoperative discitis. Methods The study was carried out over a period of 6 years. Eighteen patients with postoperative discitis were included in the study. Results Conservative management with antibiotics, analgesics and bed rest were started in all the study cases. Posterior transpedicular fixation after re-exploration debridement and curettage of disc space granulation tissue was conducted in five patients in whom conservative management failed. Conclusions Early diagnosis and appropriate management is the key to effective treatment of postoperative discitis. Conservative management leads to excellent results in majority of cases. Surgical intervention with posterior interbody fusion and debridement is helpful when conservative treatment fails.

The present study was aimed to investigate the relation between nuclear factor kappa beta (NFκB) activation and downstream up-regulation of vascular endothelial growth factor (VEGF) in diabetic retinopathy (DR). Moreover the study was intended to evaluate the role of VEGF gene single nucleotide polymorphisms (SNPs) in DR occurrence and to investigate the functional relevance of VEGF gene SNPs in terms of VEGF expression in DR. Serum level of VEGF, VEGF R1 (receptor 1), VEGF R 2 (receptor 2) and NFκB (p50/65) activity was measured by enzyme linked immune sorbent assay. Genotyping and allelic composition of different SNPs i.e., rs2010963, rs3025039, rs1570360 and rs 2071559 were investigated by Taqman SNP genotyping assay. VEGF, NFκB p50/p65, and VEGF R1 & R2 gene expressions were quantified by real time quantitative polymerase chain reaction. Increased NFκB p50/p65 activity and expressions were observed in non proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) subjects compared to type 2 diabetes mellitus without retinopathy (DNR) group. Significantly elevated levels of serum VEGF and highest VEGF expression were found among PDR subjects compared to DNR or NPDR subjects. CC genotype and C allele of rs2010963 and TT genotype and T allele of rs3025039 were significantly over represented among PDR subjects compared to DNR group. Increased activation of NFκβ in NPDR and PDR subjects might involve increased up regulation of VEGF. VEGF SNPs i.e., rs2010963 C allele and rs3025039 T allele might be associated with PDR occurrence and in turn regulates VEGF expression among PDR subjects.

Mullerian duct malformation delineate a group of congenital anomalies that result from arrested development or incomplete fusion of the mesonephric ducts. Uterine anomalies have been related to infertility, recurrent pregnancy loss, prematurity and other obstetric complications which results in raised perinatal mortality and morbidity. These malformations can also be asymptomatic with women having normal reproductive outcome. A suspicion of uterine anomaly should be borne in mind in obstetric complications like non progress of labour, malpresentations and retained placenta. Most of the vaginal abnormalities present with menstrual abnormalities and coital difficulties. The Purpose is to study the reproductive outcome in women with congenital anomalies of Genital tract.

American Society of Anaesthesiologists (ASA) physical status can provide a better grading outcome for predicting the incidence of intra- and postoperative complications in surgical patients 1 .Silverman-Holt aggregate preoperative evaluation (SHAPE™) score in which 1 to 5 severity score is assigned for each major organ system, based on information learned from the patient history and physical examination, overcomes limitations of ASA grading 2 .

According to International Diabetes Federation (IDF), India has the largest number of diabetic patients of about 50.8 million and it can be expected that by 2030 it would rise to 89 million if current unhealthy lifestyle is continued. The current method which is widely used for measuring blood glucose levels involves needles for pricking which is painful and can cause discomfort to the patient. We aim at designing a cost-effective glucometer which non-invasively measures blood glucose level using optical methods with acceptable error. After comparison of different optical methods, Near Infrared (940nm) type of measurement in reflectance mode was selected. The device was calibrated using invasive values and regression analysis was carried out for error-reduction. Arduino UNO was used for programming to quantify the glucose levels according to different conditions.

Acute puerperal uterine inversion is a rare complication of third stage of labour. When it occurs it is life threatening obstetric emergency and usually associated with post-partum hemorrhage and shock. Condition should be recognized immediately, managed promptly and aggressively will result in minimal maternal morbidity and mortality. Once diagnosis of inversion of uterus is made, measures should be undertaken to manage acute blood loss and potential shock which are major causes of maternal mortality in inversion of uterus.

1. Professor, Department Of Ophthalmology, Regional Institute Of Ophthalmology Medical College, Kolkata 2. PhD Scholar, Department Of Ophthalmology, PGMER. 3. PhD scholar, Department Of Ophthalmology, PGMER. 4. PhD scholar, Department Of Ophthalmology, PGMER. 5. Director of Medical, Regional Institute Of Ophthalmology Medical College, Kolkata 6. Director Of Medical Education, Department of Ophthalmology, Government of Tripura.

Purpose To examine the feasibility and impact of a health care provider's (HCP) physical activity (PA) prescription on the PA of patients on preventive care visits. Methods Consenting adult patients completed health and PA questionnaires and were sequentially assigned to intervention groups. HCPs prescribed PA using a written prescription only (PO), written prescription and exercise toolkit (PT), or written prescription and Active Living Guide (PALG). Follow-up questionnaires were completed at 1 and 3 months post. Results In the 24 patients (age 57 [10.01] years; body mass index (BMI) 33.4 [7.6]; 14 females, 10 males; 9 PO, 6 PT, 9 PALG) who returned questionnaires at baseline and 3 months, PA increased (p = .04) from baseline (3.5 [2.0]) to 3 months (4.3 [1.7]). Between-group analyses revealed that PT improved (p = .01) from baseline (3.0 [1.1]) to 3 months (4.8 [0.4]); PO and PALG did not. Among the 22 patients who returned questionnaires at 3 time points, PA increased (p = .01) from 1 month (3.7 [1.3])...

To evaluate erythrocyte redox state and its surrogates in patients with different stages of diabetic retinopathy and their association with cellular metabolic derangement developed in retinal microvascular cells.Sixty type 2 diabetic patients with nonproliferative diabetic retinopathy (NPDR), 85 patients with proliferative diabetic retinopathy (PDR), and 70 patients with diabetes but without retinopathy were considered as diabetic control (DC) for the study. In addition, 65 normal individuals without diabetes were enrolled as healthy control in this study. Erythrocyte oxidized nicotinamide adenine dinucleotide phosphate / reduced nicotinamide adenine dinucleotide phosphate (NADP / NADPH), oxidized nicotinamide adenine dinucleotide / reduced nicotinamide adenine dinucleotide (NAD / NADH) glutathione, plasma and vitreous lactate, and pyruvate levels were determined by enzymatic reaction-based spectrophotometric assay for the patients and individuals.Erythrocyte NADP+ to NADPH ratio to NADPH ratio was found to be significantly higher among NPDR and PDR patients compared with DC subjects (P0.0001). Erythrocyte-reduced glutathione was significantly decreased in patients of NPDR (P = 0.0004) and patients of PDR (P = 0.0157) compared to DC. Erythrocyte NAD to NADH ratio was also significantly decreased in patients of NPDR (P0.0001) and PDR (P0.0001) compared to DC subjects. Lactate to pyruvate ratio of plasma was elevated significantly in patients with NPDR compared with DC (P0.0001) and those having PDR (P = 0.0046). In the vitreous fluid, the lactate to pyruvate ratios were found to be significantly lower in normal individuals without diabetes compared with patients having PDR (P0.0001).Hyperglycemia-mediated erythrocyte redox state alterations might be a potential risk factor for the development of NPDR in poorly controlled diabetic subjects.

Human lymphocyte antigen alloimmunization to filter leukoreduced (F-LR) platelets occurs in about 18% of immunosuppressed thrombocytopenic hematology/oncology patients and represents a significant challenge for effective chemotherapy. In a dog platelet transfusion model, we have evaluated other methods of preventing alloimmune platelet refractoriness and demonstrated that successful methods in our dog model are transferable to man. In the present study, donor/recipient pairs were dog lymphocyte antigen DR-B incompatible (88% of the pairs), and recipient dogs received up to 8 weekly treated transfusions from a single donor (a highly immunogenic stimulus), or until platelet refractoriness. Continued acceptance of F-LR platelets occurred in 6 of 13 recipients (46%), but neither γ-irradiation (γ-I; 0 of 5) nor Mirasol pathogen reduction (MPR; 1 of 7) treatment of donor platelets prevented alloimmune platelet refractoriness. Combining γ-I with F-LR was associated with only 2 of 10 (20%) recipients accepting the transfused platelets. Surprisingly, F-LR platelets that then underwent MPR were accepted by 21 of 22 (95%) recipients (P < .001 vs F-LR + γ-I recipients). Furthermore, 7 of 21 (33%) of these accepting recipients demonstrated specific tolerance to 8 more weekly donor transfusions that had not been treated. In addition, platelet concentrates prepared from F-LR + MPR whole blood were also nonimmunogenic; that is, 10 of 10 (100%) recipients accepted donor platelets. Overall, 31 of 32 (97%) recipients accepted F-LR + MPR platelets; none developed antibodies to donor lymphocytes. These data are the highest rate of acceptance for platelet transfusions reported in either animals or man. This approach to platelet transfusion may be particularly important when supporting patients with intact immune systems, such as in myelodysplastic syndromes.

Background: Eales disease (ED) is an idiopathic, inflammatory, venoocclusive disorder of peripheral retina resulting in retinal angiogenesis and vitreous hemorrhage. The objective of the present study is to investigate the expression and activation of gelatinase associated with the retinal neovascularization in ED and the relation between the levels of gelatinase and the cytokine tumor necrosis factor-α, known to upregulate matrix metalloproteinase (MMP) expression on various cells. Methods: Vitreous and serum samples from 19 patients with ED who underwent retinal surgery were estimated for levels of MMP-2, MMP-9, tissue inhibitor of metalloproteinase-1, tissue inhibitor of metalloproteinase-2, and tumor necrosis factor-α by enzyme-linked immunosorbent assay method. Matrix metalloproteinase-2 and MMP-9 activities in serum and vitreous samples were evaluated by gelatin zymography method. Vitreous samples from 16 patients with macular hole undergoing vitrectomy were used as controls. Results: Among the 2 gelatinase examined in vitreous and serum samples, only level and activity of MMP-9 were significantly higher in serum (P = 0.0001) and vitreous (P = 0.0002) samples of patients with ED than those of control subjects. Simultaneously, a positive correlation was found between intraocular tumor necrosis factor-α and MMP-9 concentration (Spearman correlation coefficient, r = 0.7040, P = 0.0023) in patients with ED. Conclusion: Increase in MMP-9 activity and its concentration in serum and vitreous of patients with ED compared with that of control subjects and correlation between intraocular levels of MMP-9 and tumor necrosis factor-α in patients with ED seem to provide a plausible explanation for inflammation-mediated angiogenesis during the development of this condition.

Ketosis-prone diabetes (KPD) is heterogeneous. Longitudinal follow-up revealed that patients with "A-β+" KPD (absent autoantibodies and preserved β-cell function) segregated into 2 subgroups with distinct evolution of β-cell function and glycemic control. Generalized linear analysis demonstrated that the variable that most significantly differentiated them was presence of a clinically evident precipitating event for the index diabetic ketoacidosis (DKA). Hence, we performed a comprehensive analysis of A-β+ KPD patients presenting with "provoked" compared with "unprovoked" DKA. Clinical, biochemical, and β-cell functional characteristics were compared between provoked and unprovoked A-β+ KPD patients followed prospectively for 1 to 8 years. Human leukocyte antigen class II allele frequencies were compared between these 2 groups and population controls. Unprovoked A-β+ KPD patients (n = 83) had greater body mass index, male preponderance, higher frequency of women with oligo-/anovulation, more frequent African American ethnicity, and less frequent family history of diabetes than provoked A-β+ KPD patients (n = 64). The provoked group had higher frequencies of the human leukocyte antigen class II type 1 diabetes mellitus susceptibility alleles DQB1*0302 (than the unprovoked group or population controls) and DRB1*04 (than the unprovoked group), whereas the unprovoked group had a higher frequency of the protective allele DQB1*0602. β-Cell secretory reserve and glycemic control improved progressively in the unprovoked group but declined in the provoked group. The differences persisted in comparisons restricted to patients with new-onset diabetes. "Unprovoked" A-β+ KPD is a distinct syndrome characterized by reversible β-cell dysfunction with male predominance and increased frequency of DQB1*0602, whereas "provoked" A-β+ KPD is characterized by progressive loss of β-cell reserve and increased frequency of DQB1*0302 and DRB1*04. Unprovoked DKA predicts long-term β-cell functional reserve, insulin independence, and glycemic control in KPD.

Background: In Type 2 diabetes (T2D) mellitus, chronic hyperglycemia and hyperinsulinemia with resultant increased advanced glycosylated end products cause the acceleration of the brain aging in its structure and functions. This complication increases the risk of memory and cognitive dysfunctions. Aims and Objectives: This study was aimed to compare the memory and cognitive functions between controlled and uncontrolled T2D mellitus patients. Materials and Methods: The study is undertaken in the Department of Physiology, Velammal Medical College Hospital, Madurai. 100 known T2D mellitus patients aged between 30 and 50 years of both sexes are included after obtaining informed written consent. Patients with conditions and factors affecting memory and patients with defective hearing and speech are excluded from the study. Recent hemoglobin A1c (HbA1c), fasting blood sugar (FBS), and postprandial blood sugar (PPBS) values are collected from their hospital records. Cognition and memory assessment is done using Mini-Mental State Examination (MMSE) by 30-point questionnaire. Results: The average MMSE score of uncontrolled diabetes mellitus is less than the average MMSE score of controlled diabetes mellitus patients (HbA1c

Baker's cyst is a pocket of fluid that forms a lump behind the knee. It is also called a popliteal cyst. It is usually the result of a problem with the knee joint, such as arthritis or a cartilage tear. Both the condition can cause the knee to produce too much of synovial fluid, which can leads to a baker's cyst. It tends to occur in adults from ages 35 to 70 years and above. It is common in women than in men due to inflammatory knee joint diseases such as osteoarthritis, rheumatoid arthritis etc. Popliteal cyst in adults are often secondary to degenerative or inflammatory joint disease or joint injury, they usually communicate with the adjacent knee space, especially in older patients with knee pathology communicating cyst contains synovial fluid. In children, popliteal cysts are usually a primary process, arising directly from the gastrocnemius-semimembranosus bursa, they do not communicate with the joint space. Symptoms may include; visible swelling or protrusion on the back of the knee (which can be painful or painless), constant and prolonged knee pain, and tightness at the back of the knee or simply a feeling of tenderness at the back of the knee. It can be diagnosed on by physical examination, x-ray, ultrasound, Doppler study, MRI, CT and Arthrogram. Treatment may include painkillers, R.I.C.E principles, aspiration of excess fluid with corticosteroid injection directly on the swelling. Arthroscopy surgery is done to repair any knee damage. So it is important for the nurses, nursing students to be aware of those cysts to care the client efficiently and effectively. This case report was to discuss regarding bakers cyst and its management.

Objective Older patients may regard some medications, particularly psychotropic medications, as discretionary compared with what they perceive as more "essential" nonpsychiatric medications. Patients' concerns about psychotropic medication costs under Medicare Part D may reinforce these impressions. Design The authors examined which Medicare prescription drug plans (PDPs) would be least expensive for beneficiaries considering the costs of 1) all medications; and 2) only nonpsychiatric medications. Setting The authors collected data from the PDP online comparison tool provided by the Centers for Medicare and Medicaid Services (CMS). Participants Hypothetical Medicare beneficiaries. Measurements The authors examined four clinical scenarios from older outpatients with both chronic medical and psychiatric conditions (including psychosis, bipolar disorder, depression, and dementia with behavioral disturbances). Results The authors examined data from all 160 plans available in CMS PDP regions in May 2007. There were frequent discrepancies in the least expensive PDPs within region, depending on considering the costs of all medications, or just nonpsychiatric medications. In the clinical scenarios, patients selecting a PDP based on nonpsychiatric medications alone would pick an unnecessarily more expensive plan 74%–100% of the time (when they took any brand name medication), suggesting that excluding psychiatric medications from PDP choices may be excessively costly. However, brand name psychotropic medications significantly increased the costs of the least expensive plans. The latter finding might persuade patients to avoid taking needed psychiatric medication due to cost. Conclusion This research highlights the complexity that patients with psychiatric and cognitive disorders face when choosing a Medicare PDP. Policymakers and clinicians should be aware of the tradeoffs that beneficiaries with psychiatric disorders face when making PDP plan choices.

Vinod Kumar Verma,1 Suguna Ratnakar Kamaraju,1 Ravindranath Kancherla,1 Lakshmi K Kona,1 Syed Sultan Beevi,1 Tanya Debnath,1 Shalini P Usha,1 Rammohan Vadapalli,2 Ali Syed Arbab,3 Lakshmi Kiran Chelluri11Department of Transplant Biology, Immunology and Stem Cell Laboratory, Global Hospitals, 2Department of Imageology, Vijaya Radiology Centre, Hyderabad, India; 3Department of Biochemistry and Molecular Biology, Georgia Regents University, Augusta, GA, USAAbstract: Fluorescent magnetic iron oxide nanoparticles have been used to label cells for imaging as well as for therapeutic purposes. The purpose of this study was to modify the approach to develop a nanoprobe for cell selection and imaging with a direct therapeutic translational focus. The approach involves physical coincubation and adsorption of superparamagnetic iron oxide nanoparticle-polyethylene glycol (SPION-PEG) complexes with a monoclonal antibody (mAb) or a set of antibodies. Flow cytometry, confocal laser scanning microscopy, transmission electron microscopy, iron staining, and magnetic resonance imaging were used to assess cell viability, function, and labeling efficiency. This process has been validated by selecting adipose tissue-derived cardiac progenitor cells from the stromal vascular fraction using signal regulatory protein alpha (SIRPA)/kinase domain receptor (KDR) mAbs. These markers were chosen because of their sustained expression during cardiomyocyte differentiation. Sorting of cells positive for SIRPA and KDR allowed the enrichment of cardiac progenitors with 90% troponin-I positivity in differentiation cultures. SPION labeled cardiac progenitor cells (1×105cells) was mixed with gel and used for 3T magnetic resonance imaging at a concentration, as low as 12.5 µg of iron. The toxicity assays, at cellular and molecular levels, did not show any detrimental effects of SPION. Our study has the potential to achieve moderate to high specific cell selection for the dual purpose of imaging and therapy.Keywords: noninvasive molecular imaging, PEGylated nanoprobe, cardiomyocyte, cytotoxicity, apoptosis

Levels of nonantigen-induced pro-inflammatory cytokines and prostaglandin in macrophages isolated from human leucocyte antigen (HLA)-matched type 1 diabetes mellitus patients, first-degree relatives and healthy controls were determined. We hypothesize that monocytes isolated from patients are sensitized or preactivated and therefore, have an altered response to in vitro stimulus compared with control groups as measured by levels of pro- and anti-inflammatory mediators. In this study, peripheral blood monocytes were differentiated to macrophages with macrophage-colony stimulating factor (M-CSF) to determine lipopolysaccharide (LPS)-stimulated tumour necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-12 and prostaglandin E-2 (PGE-2) secretion from hetero- or homozygous HLA DQB1*0201 and *0302 type 1 diabetes mellitus patients, first-degree relatives and homozygous HLA DQB1*0602 healthy controls. LPS-stimulated secretion of TNF-α, IL-1β and IL-6 was immediate and markedly higher in the HLA-DQB1*0201/*0302 type 1 diabetes patients compared with all other groups including HLA-matched healthy first-degree relatives. In DQB1*0201/*0302 diabetes patients PGE-2 secretion was delayed but increased by LPS stimulation compared with HLA-matched healthy relatives. IL-12 was not detected at any condition. These data suggest that macrophages from DQB1*0201/*0302 type 1 diabetes patients are sensitized to secrete both cytokines and PGE-2 following nonantigenic stimulation. Sensitized macrophages may be important to high-risk DQB1*0201/*0302-associated type 1 diabetes.

Background The occurrence of coronary artery disease (CAD) after heart transplantation may represent an accelerated inflammatory and thrombotic response to coronary vascular endothelial cell injury. Several common mutations involving hemostasis and cellular adhesion proteins have been associated with genetic susceptibility to native coronary heart disease. The clinical setting of heart transplantation provides a unique opportunity to examine the relative contribution of circulating (i.e., recipient) vs local vascular (i.e., donor) hemostatic components to the occurrence of CAD. Methods We performed genotyping for several common hemostatic polymorphisms among 53 cardiac transplant patients and their heart donors. Patients were observed for an average of 43 months, and the presence of transplant CAD was determined by coronary angiography. Results The development of transplant CAD did not relate to recipient hemostatic genotype, but 2 donor polymorphisms (PAI-1 4G/5G and α 2 integrin C807T) were important predictors of transplant CAD. The risk ratio (RR) of transplant CAD associated with donor PAI-1 4G/4G genotype was 2.6 (95% confidence interval [CI] 1.1–6.2) and was modified by recipient cytomegalovirus status, hyperlipidemia, diabetes, and recipient factor XIII Val34Leu genotype. The RR of transplant CAD associated with donor α 2 integrin 807 T/T genotype was 7.4 (95% CI, 2.5–22.0). Conclusions Genetic and metabolic factors contributed by both donor and recipient may interact at the level of the coronary vessel wall in the development of transplant-associated CAD, and this finding may provide additional support for the importance of local thrombotic response to endothelial injury in the pathogenesis of this disorder.

Ketosis-prone diabetes (KPD), defined by presentation with diabetic ketoacidosis (DKA), comprises 4 subgroups based on the presence or absence of islet cell autoantibodies (A(-) or A(+)) and β-cell functional reserve (β(-) or β(+)). Among A(+) KPD, autoantibody epitope reactivity to 65-kDa glutamate decarboxylase (GAD65), defined by monoclonal GAD65Ab(DPD), was associated with greater β-cell functional reserve. In a majority of healthy individuals, GAD65Ab are present in the sera but are masked by anti-idiotypic antibodies; in contrast, overtly GAD65Ab-positive patients with autoimmune type 1 diabetes patients lack these anti-idiotypic antibodies.Our objective was to determine the presence of masked and overt GAD65Ab(DPD) in relation to β-cell function and genetic risk factors in KPD patients.We investigated the associations of masked and overt GAD65Ab(DPD) with β-cell functional reserve, and their relationship with human leukocyte antigen (HLA) class II haplotypes linked to autoimmune diabetes susceptibility or resistance, in a large KPD cohort.Adult KPD patients (n = 384) were followed longitudinally in a research clinic.β-Cell function, autoantibody status, GAD65Ab epitopes, and HLA class II haplotypes were evaluated.Overall, KPD patients with β-cell functional reserve (β(+) subgroups) showed significantly higher frequency of masked GAD65Ab(DPD) than patients without β-cell functional reserve (β(-) subgroups): 112 of 144 (79%) compared with 59 of 100 (59%), respectively (P = .002). Masked or overt GAD65Ab(DPD) were also more frequent among autoantibody-positive patients with preserved β-cell functional reserve (A(+)β(+) KPD) than those lacking β-cell function (A(+)β(-) KPD): 77% compared with 55% (P = .01). The susceptibility HLA haplotypes DQA1*0301/DQB1*0302 and DQA1*0301/DQB1*0201 were associated with absence of overt or masked GAD65Ab(DPD) (odds Ratios 2.3 and 2.2, respectively).Masked GAD65Ab(DPD) are strongly associated with preserved β-cell functional reserve among patients with KPD. Absence of GAD65Ab(DPD) reactivity is associated with 2 HLA class II susceptibility haplotypes for autoimmune type 1 diabetes.