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Introduction: Stroke or Cerebrovascular accident (CVA) is a major cause of disability worldwide. The estimation of serum Total T3, Total T4 and TSH are very much essential in patients with stroke. Any disturbances in thyroid hormones may have negative influence on the outcome of acute phase of strokes. Aims And Objectives: Aims and objective was to estimate the Total T3, Total T4 and TSH of patients with acute Strokeand to compare it with age/sex matched healthy controls. Materials & Methods:This Hospital Based Case Control Study, consist of total 100 subjects out of which 50 were control ,was carried out in Jorhat Medical College & Hospital, Assam for a period of one year, from July 2017 to June 2018. Age more than 40 years of both sexes was included. Estimation for total T3, total T4, and TSH was carried out in Access 2 ImmunoAssay Systems (Beckman Coulter). Cases were selectedrandomly . Results And Observations: Out of 50 Stroke patients ,the age group of 50 - Conclusion: Nonthyroidal illness syndrome (Low T3 syndrome) is observed in the present study with decreased T3 values without alteration of T4 and TSH levels. Further studies with a large sample size should attempt to investigate whether treatment of low T3 syndrome can improve the final outcome.

Molecular testing and the development of targeted therapies have revolutionized the treatment of non-small cell lung cancer (NSCLC). Despite the advantages of molecular testing in patients with NSCLC and guideline recommendations, there is no specific standard testing method, resulting in variable testing practices based on institution protocol and access. Pharmacists can help to improve coordination of care around appropriate testing as results are important in determining the most appropriate targeted treatment course. The majority of patients with NSCLC are tested for PD-L1, EGFR, ALK, ROS1, and BRAF mutations. These biomarkers and their corresponding targeted therapies are more understood than the remaining biomarkers, such as KRAS, RET, MET exon 14 (METex14), and NTRK. Multiple new and emerging therapies target these latter biomarkers, and this article will focus on these lesser-known biomarkers. As the treatment of NSCLC becomes increasingly biomarker-driven and more therapies are added to the armamentarium for the management of NSCLC, pharmacists will be called upon to assist the oncology care team to optimize NSCLC treatment to improve patient outcomes.

BACKGROUND As defined by World Health Organization (WHO), stroke is accountable for 5 million deaths and 5 million disabled patients throughout the world. The prevalence of stroke is in rising trend in Indian subcontinent and therefore is a source of socioeconomic concern. This study was conducted to evaluate the aetiological and clinical profile in stroke patients with special reference to baseline intracranial haemorrhage (ICH) score in haemorrhagic stroke in North East India. METHODS The study was carried out among in-patients of Medicine Department at Assam Medical College and Hospital, Dibrugarh in North East India from March 2019 to February 2020. A total of 112 patients who presented with symptoms suggestive of stroke were assessed. Mean ± standard deviation was used to express continuous variables. Frequency and percentage were used to express categorical variables. Test of significance for qualitative data was assessed by chi-square test (for 2 x 2 tables). P-value less than 0.05 was taken as statistically significant. RESULTS In our study stroke was common in 40 – 60 years age group which comprised 50 % of total patients. Stroke was more common in males with a sex ratio of 1.24:1. 73.2 % of patients suffered haemorrhagic stroke and 22.3 % suffered ischemic stroke whereas 4.5 % suffered cardio-embolic stroke. Hypertension was the most prevalent and an important risk factor with 80.3 % (P = 0.001), followed by smoking with 39 % (P = 0.021), chronic alcohol consumption with 37 % (P = 0.028) and diabetes with 22 %. The most common site of haemorrhage was basal ganglia (28 %) followed by thalamus (24 %). Patients presenting with intraventricular extension, infratentorial location, low Glasgow Coma Scale (GCS) score (< 4) or having high ICH score (≥ 3) at the time of presentation were associated with increased mortality in haemorrhagic stroke (P = 0.010). CONCLUSIONS Haemorrhagic strokes (73.2 %) are the most common type. Hypertension is the most prevalent and an important risk factor (80.3 %). Basal ganglia (28 %) are the most common sites involved in haemorrhagic stroke; infratentorial location is associated with poor prognosis. Patients presenting with low GCS score (< 4) or having high ICH score (≥ 3) at the time of presentation are associated with increased mortality in haemorrhagic stroke. KEY WORDS Stroke, Hypertension, Basal Ganglia, GCS Score, ICH Score

Placenta accreta is a significant obstetric complication in which the placenta is completely or focally adherent to the myometrium. The worldwide incidence of placenta accreta spectrum (PAS) is increasing day by day, mostly due to the increasing trends in cesarean section rates. The accurate and timely diagnosis of placenta accreta is important to improve the feto-maternal outcome. Although standard ultrasound is a reliable and primary tool for the diagnosis of placenta accreta, the absence of ultrasound findings does not preclude the diagnosis of placenta accreta. Therefore, clinical evaluation of risk factors is equally essential for the prediction of abnormal placental invasion. Pregnant women with a high impression or established diagnosis of placenta accreta should be managed by a multidisciplinary team in a specialist center. Traditionally, PAS has been managed by an emergency obstetric hysterectomy. Previously, few studies suggested a satisfactory success rate of conservative management in well-chosen cases, whereas few studies recommended delayed hysterectomy to reduce the amount of bleeding. The continuously increasing trends of PAS and the challenges for its routine management are the main motives behind this literature review.

PURPOSE: The purpose of the study was to report a small case series of patients with iridoschisis seen at our hospital over a period of 5 years. METHODS: Retrospective review of all those files over the past 5 years whereby the diagnosis of iridoschisis/iris atrophy/iris fibrils in anterior chamber (AC) was made. RESULTS: In our case series, the average age at presentation was 49 years (range: 23–85 years). The pathology was bilateral in 57% of patients in our series. Our most common presentations were angle closure glaucoma and cataract. Younger individuals can also manifest iridoschisis. CONCLUSION: The iridoschisis can be an incidental finding, and gonioscopy should be performed in all the cases, as occludable or synechiael angle closure may be present in these cases.

Objective To determine the frequency of premalignant and malignant lesions in cervical polyps in order to examine whether cervical polyps need to be removed routinely and also to appraise its association with cervical smear cytology and endometrial pathologies. Methods We retrospectively re-examined the hospital records of 299 cases over a period of 5 years. All patients were segregated into perimenopausal and postmenopausal groups according to their menopausal status. The groups were compared in terms of histological results of cervical polyp biopsy, endometrial pathologies, and cervical smear cytology. Pearson’s χ2 test and Fisher’s exact test were used for statistical analysis, and a P-value of

Background and Aim Lymph node dissection in gastric cancer had been controversial, but recent data have led us to the conclusion that D‐2 dissection should be the standard of care for potentially curable advanced gastric carcinoma. In this study, we present our single‐institution experience of D‐2 lymph node dissection. Methods From January 2013 to September 2018, 115 patients of gastric cancer were treated with D‐2 gastrectomy, 91 of whom met the criteria for study analysis. Data were statistically described as frequencies and percentages where appropriate. Survival curves were plotted using the Kaplan–Meier method, and Cox regression was used to assess the risk among groups. A P value 55 years. Overall recurrence free survival rates were 26 and 28% for 55 years, respectively, with a P value of 0.570. On multivariate analysis, positive distal margin and multivisceral resection had a statistically significant hazard ratio. Conclusions This retrospective study conducted in our institute on patients with gastric cancer undergoing D‐2 lymphadenectomy has shown that the addition of D‐2 lymph node dissection, when performed at high‐volume centers, have acceptable morbidity and mortality rates. This can be seen from our grades of postoperative surgical complications, 90‐day mortality, and overall 5‐year survival., D‐2 lymph node dissection, when performed at high‐volume centers, have acceptable morbidity and mortality rates as shown by our grades of postoperative surgical complications, 90‐day mortality, and overall 5‐year survival. Multivisceral resection and positive distal margin had a statistically significant hazard ratio.

Background and Aim Carcinoma of the stomach is one of the leading causes of mortality worldwide. Surgery for gastric cancer in the form of total or distal gastrectomy is definitive treatment. Feeding jejunostomy (FJ) though improves postoperative nutritional status and outcome, it is not devoid of its complications. In this study, we present the outcomes of nasojejunal (NJ) feeding and FJ and complications associated with them. Materials and Methods It is both retrospective and prospective observational study in patients with gastric cancer undergoing surgery. Patients were divided into two groups: those who underwent FJ and those who underwent NJ route of feeding placed intraoperatively. Results A total of 279 patients of gastric cancer who underwent surgery were taken into study, of which, 165 were male and 114 females. FJ was done in 42 and NJ in 237 patients, respectively. Gastrectomy + NJ was done in 128 patients, gastrectomy + FJ in 27 patients, gastrojejunostomy + NJ in 109 patients, and FJ in 15 patients. We had three patients of bile leaks in FJ group, of which one patient had intraperitoneal leak who needed re-exploration; rest of the two had peri-FJ external leaks, who were managed conservatively. Most of the complications of NJ group were minor. Conclusion Our study of 279 patients in gastric cancer has shown that FJ is sometimes associated with major complications with increased hospital stay and morbidity when compared with NJ tube feeding without any difference in nutritional outcomes. Hence, NJ route of postoperative enteral nutrition can be considered as an alternative to FJ wherever feasible in view of its technical safety and minor complications and morbidity.

Infrared thermography lends countless applications in biology and veterinary science. The popularity of the use of infrared imaging in the detection and mitigation of animal diseases has increased ...

The diagnosis of neurocysticercosis in pregnancy is challenging, even in endemic areas, as other neurological conditions with similar manifestations are common. Obstetricians and physicians may be reluctant to do neuroimaging in pregnancy and often the availability is limited in endemic areas. Management of neurocysticercosis depends on the symptomatology. In those presenting with features of increased intracranial pressure early treatment is necessary, taking into consideration the gestational age and the maternal condition at presentation. Presence of intraventricular cysts causing obstructive hydrocephalus necessitates their removal due to the risk of intracranial hypertension which could be life-threatening, particularly peripartum. We report a case of a woman with intraventricular neurocysticercosis, who presented in the third trimester, and described the management dilemmas that were encountered. The differential diagnoses and other aspects of the medical and surgical management of neurocysticercosis in pregnancy are also discussed.

Diabetes mellitus is the most common cause of chronic kidney disease worldwide. The prevalence of nondiabetic renal disease (NDRD) among patients with type 2 diabetes mellitus (T2DM) varies widely. This study aimed to evaluate the renal biopsies performed on type 2 diabetic patients for suspicion of NDRD and to correlate clinicopathological findings. All T2DM patients aged > 18 years were included in this study, who had renal biopsy performed for the following reasons: recent-onset nephrotic syndrome, unexplained rapid deterioration of renal function, proteinuria not accompanied by retinopathy, and unexplained hematuria. Renal biopsy was analyzed by light microscopy and immunofluorescence. Based on biopsy findings, the patients were grouped into three: (i) isolated NDRD, (ii) NDRD ± diabetic nephropathy (DN), and (iii) isolated DN. A total of 140 patients were enrolled in this study. Recent-onset nephrotic syndrome was the most common indication for biopsy, followed by the presence of active urine sediment. Forty-two percent of the patients had isolated DN, while NDRD was seen in 34% and DN ± NDRD in 24%. Focal segmental glomerulosclerosis (FSGS) and IgA nephropathy were the most common causes of isolated NDRD, while chronic tubulointerstitial nephritis (CTIN) was common in NDRD plus DN. Short duration of diabetes, absence of diabetic retinopathy, and lower glycated hemoglobin were predictive of NDRD. NDRD was seen in 58% of the patients with atypical presentations. FSGS and CTIN were common in NDRD diseases. Judicious use of biopsy in diabetic patients with atypical presentation may help in the diagnosis of NDRD.

Tetanus is a rare, severe, and potentially life-threatening disease caused by Clostridium tetani, which accounted 58,900 deaths worldwide in 2013.1 Usually tetanus is generalized, rarely it can be localized also. 20-30% of cases will not have any puncture wound. In this case report, we present a case of tetanus with rare manifestation (localized tetanus presented with trismus without any puncture wound). Multiple rare associations like tetanus presenting with trismus, tetanus occurring in the absence of puncture wound strengthens the need for reporting this case which if left unnoticed would have been detrimental to the patient.

INTRODUCTION: Obesity, a chronic non-communicable disease, as indicated by the World Health Organization (WHO), is one of the most rapidly growing health problems worldwide. Obesity affects the respiratory functions and impairs the gas exchange, leading to alterations in pulmonary function tests (PFT).Younger generation and medical students are no exception in regards to the detrimental effects of obesity.Forced vital capacity (FVC),Forced Expiratory st Volume in 1 second (FEV ), Peak Expiratory Flow Rate (PEFR) are reliable pulmonary function tests to diagnose any 1 respiratory disorder.In this study,FVC,FEV ,PEFR of medical students were assessed to find their relationship with Body 1 Mass Index (BMI). MATERIALS AND METHODS:A institution based cross-sectional observational study was done in Dept.of Physiology,Jorhat Medical College including the undergraduate medical students.Sample size was calculated as 160 using EpiTools Software.Height in centimeters,weight in kilograms and digital spirometry of 160 students were recorded. In case of more than two variables, P values were calculated using Anova Test and p value < 0.05 was considered significant. RESULTS: FVC,FEV ,PEFR all were decreased in overweight and obese students compared to 1 normal weight students and our observation was statistically significant in case of FEV and PEFR by Anova test (p value: 1 0.0335 and 0.0428 respectively. CONCLUSION: Changing of life style that includes performing regular physical exercises,yoga,meditation,sticking to a routine time table for sports,study and sleeping hours and regular health check up in the form of Height,Weight, Spirometry could be beneficial for the students to prevent obesity related pulmonary ailments.

Introduction:diabetes mellitus is a metabolic disorder prevalent worldwide . Oxidative stress has been the Cause of complications which arises gradually due to prolonged hyperglycemia. Vitamin c being a potent antioxidant is well consumed in diabetes mellitus. Methods:Serum samples of diabetes mellitus type 2 patients from jorhat medical college of Assam were tested to estimate ascorbate levels using spectrophotometer. Whole blood samples were tested to estimate glycated hemoglobin levels in d-10 biorad hplc machine. A total of 58 patients and equal numbers of age and sex matched apparently healthy controls were included. Results:significantly lower levels of ascorbate were recorded in diabetic cases compared to controls. Newly diagnosed cases had lesser serum ascorbate levels compared to patients who were on treatment with oral hypoglycemic drugs and insulin. Conclusion:the study was done to look for any alteration in serum ascorbic acid levels in diabetes mellitus patients. Patients newly diagnosed had lesser vitamin c levels compared to patients already on medications. It is found that vitamin c is significantly lower in diabetic patients with or without medications compared to healthy controls.

Gastric cancer (GC) is common in the northeast and southern parts of India. Radical surgery is the cornerstone of treatment and offers the only chance for cure. This study was conducted to assess the outcomes of all resectable gastric cancers that presented to our tertiary cancer center in Northeast India. All patients undergoing upfront surgery for gastric cancer with curative intention between 2012 and 2017 were included in the study. A total of 116 patients who underwent upfront radical gastrectomy were included in the study. Males (58.6%) were more common than females (41.4%). Mean age at presentation was 56.12 years (range 26–89). The most common mode of presentation was pain abdomen (53.8%). The most common location of tumor was the distal part (81%) followed by the proximal part (10.3%). The most commonly done procedure was distal radical gastrectomy (56.9%) followed by subtotal gastrectomy (32.8%). Median number of lymph nodes isolated was 14. Fifty-four patients received adjuvant chemotherapy while 32 patients received adjuvant chemoradiation (CTRT). At a median follow-up of 14 months (range, 2–78 months), overall 5-year survival was 23.75% (mean survival 33.77 months, median survival 24 months). The 5-year survival for stages I–III was 100%, 26.25%, and 11.25%, respectively (P < 0.001). Though perioperative chemotherapy has a role in gastric cancer, it is not the substitute for radical D2 gastrectomy which is still the gold standard treatment especially in high-volume centers.

Background Effort is invested in maintaining sterility of the operating field, but less attention is paid to potential healthcare associated infection (HAIs) sources through patient contact by non-scrubbed healthcare providers (HCPs). A single microbiological assessment of hands can provide a good assessment of the potential dynamic transmission of microorganisms. The aim of this study was to identify and quantify the microbial growth on the hands of HCPs in the operating theatres of Chris Hani Baragwanath Academic Hospital. Methods A prospective, contextual and descriptive study design was followed. Seventy-five samples were collected using convenience sampling from an equal number of surgeons, anaesthetists and nurses. Specimens were taken using agar plates and underwent semi-quantitative analysis. Results All hands of HCPs displayed growth, of which 82% grew commensals and 80% grew pathogens. Twelve commensal microorganisms and 27 pathological microorganisms were noted. Two or more organisms were cultured on 76% of HCPs’ hands. Comparisons of commensal, pathological and combined levels of contaminationamong the three groups were not statistically significant (p=0.266, p=0.673, p=0.180). There was no significant difference between the growth of combined microorganisms (p=0.927)and pathological microorganisms (p=0.499) among the groups.Surgeons had significantly more commensal growth (p=0.019) than anaesthetists and nurses. There was no statistically significant difference between sexes (p=0.611). Conclusion It was concerning that 100% of the hands of HCPs who were about to commence with the surgical list had microbial growth. These HCPs could have already been in contact with patients and equipment in the theatre environment. Microorganisms cultured on hands are a source of cross-transmission which may result in HAIs. Institutions require the implementation of a multidimensional model to amend guidelines, implement guidelines and increase awareness of hand hygiene.

Prcis The vessel density and perfusion density generated by optical microangiography is significantly affected by the signal strength. Gender, hypertension, diabetes and axial length did not have any statistically significant effect on these measurements. Purpose To assess the effect of subject-related factors (age, gender, systemic hypertension, diabetes and axial length) and machine related factor (signal strength) on vessel density (VD) and perfusion density (PD) generated by optical microangiography (OMAG) in peripapillary and macular regions. Methods In an observational, cross-sectional study of 200 eyes of 100 healthy individuals (age: 18-80▒y), mean and sectoral VD and PD were calculated on disc and macular scans. Effect of subject-related and machine-related factors on VD and PD parameters were evaluated using multivariate mixed effect models. Results Mean (±standard deviation) peripapillary and macular VD of the study population was 18.56±1.11▒mm-1 and 20.59±1.85▒mm-1 respectively. Mean peripapillary and macular PD was 46.43±3.22% and 37.61±3.26% respectively. Sex, hypertension, diabetes and axial length did not have any statistically significant effect on the OMAG measurements (P>0.05 for all associations). However, the signal strength (SS) had significant effect on the OMAG measurements. Mean peripapillary and macular VD on scans with SS of 10 was 1.4▒mm-1 and 3.79▒mm-1 greater respectively than that on scans with SS of 7. Mean peripapillary and macular PD on scans with SS of 10 was 4.43% and 7.85% greater respectively than that on scans with SS of 7. Conclusion Significant association exists between SS of the scan and the optical coherence tomography angiography (OCT-A) measurements generated by OMAG even when the scans had acceptable SS as recommended by the manufacturer (≥7). This needs to be considered while interpreting OCT-A measurements.

Background and Aims SLE patients have 40% to 70% life time risk of developing lupus nephritis (LN). In LN patients rate of end-stage renal disease is 10%, remaining constant in the last 30 years, even after the emergence of various immunosuppressive therapy. SLE is an example of classical antibody-mediated disease and hence treatment with B cell depleting agent (like the use of Rituximab ) appears to be a promising approach for this unwinnable disease from the Roman era. The aim of this study was to analyze the outcome in terms of - no renal response (NRR), complete renal response (CRR) or partial renal response (PRR) at week 24 after rituximab treatment initiation in refractory LN. CRR considered, if serum creatinine (S Cr) level returned to baseline, with a decline in the 24 hour urinary protein to < 500 mg/day. PRR defined as stabilization (+/-25%), or improvement of S Cr, plus a 50% decrease in 24 hour urinary protein (which was < 3.5 gm/day). NRR considered, if participant did not achieve either a CRR or PRR. Method It is a single center prospective observational study, comparing short term (24 week) outcomes in resistant lupus nephritis patients of >18 year age group with weekly (total 4) dose of rituximab therapy. The study was conducted on 25 refractory lupus nephritis patients admitted in Nephrology Department (not responding to conventional immunosuppressive drugs like cyclophosphamide, MMF). Repeat renal biopsy was performed, all baseline investigations were done. Injection Rituximab 375 mg/m2 weekly 0,1,2,3 week along with premedication treatment were given to every patient. The clinical outcome was assessed monthly post-treatment. Results In the study maximum patients were of class IV, n=21 (84 %). Sustained (6 months post treatment) CRR was achieved in n=6 (24%) patients, n=7 (28%) patients achieved PRR, rest n=12 (48%) patients had NRR. Mean blood absolute CD-19 count was significantly negatively correlated with response to rituximab treatment ( p< 0.001) .Mean absolute CD-19 count was 2.33/microliter in CRR, 2.14/microliter in PRR group and 21.25 / microliter in NRR group . No significant side effects of rituximab were observed. Limitations –Small sample size, single center study, long term follow up not considered. Conclusion In refractory LN patients, 24 weeks after Rituximab treatment

MEDICAL IMAGE

Background and Aims Acute kidney injury (AKI) is rare in women during pregnancy and puerperium. Although sepsis remains the predominant cause of AKI in pregnancy in developing countries, pre-eclampsia and eclampsia are important causes and can be life threatening. The primary focus of this study was to analyze the clinical profile as well as maternal and fetal outcomes of AKI in pregnant females with pre-eclampsia and eclampsia. Method A prospective study of patients admitted with pre-eclampsia or eclampsia and AKI in Gauhati Medical College Hospital from June 2018 to June 2019. Clinical profiles and outcome data were recorded. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results A total of 26 cases were recorded. The mean maternal age at delivery was 27.5 ± 5.1 years. At least one recorded preexisting medical condition, including hypertension, diabetes mellitus, or chronic kidney disease was present in 5 cases (19.2%). Cesarean section was performed in 9 cases (34.6%). Eighteen patients (69.2%) developed AKI in third trimester and 6 (23.1%) within 12 weeks postpartum. Four patients (15.4%) were treated with dialysis. Four women (15.4%) died and 2 (7.7%) remained dialysis dependent 12 weeks after delivery. Low birth weight ( Conclusion AKI in pregnancies with pre-eclampsia or eclampsia can not only lead to maternal mortality and morbidity but also poor perinatal outcomes. Preeclampsia or eclampsia presenting with AKI early during gestation had worse fetal outcomes.

BACKGROUND: The RV144 phase 3 vaccine trial in Thailand demonstrated that ALVAC-HIV (vCP1521) and AIDSVAX® B/E administration over six months resulted in a 31% efficacy in preventing HIV acquisition. In this trial, we assessed the immunologic impact of an additional vaccine boost to the RV144 regimen at varying intervals between the priming vaccine series and the boost. METHODS: RV306 is a double-blind, placebo-controlled, randomized clinical trial conducted in three clinical sites in Thailand. HIV-uninfected volunteers aged 20–40 randomly received the primary RV144 vaccine series at months 0, 1, 3, and 6, with no additional boost (Group I), additional AIDSVAX® B/E and ALVAC-HIV (vcp1521) at month 12 (Group II), AIDSVAX® B/E alone at month 12 (Group III), AIDSVAX® B/E and ALVAC-HIV at month 15 or 18 (Groups IVa or IVb), or placebo and were followed for 24 months. A randomization schedule was centrally generated with fixed sized strata for RIHES Chiang Mai (n=60) and combined Bangkok clinics (n=300). Primary outcomes were to assess the safety and tolerability of these vaccination regimens and characterize and compare cellular and humoral immune responses between the RV144 series alone and late boosts at different timepoints. Safety and tolerability outcomes were assessed by evaluating local and systemic reactogenicity and adverse events in all participants. Primary immunogenicity outcomes were evaluated by comparing peak humoral responses (HIV-specific IgG and IgA ELISA) and cellular responses (HIV-specific intracellular cytokine staining and polyfunctionality) two weeks post final vaccination among per-protocol participants who completed all vaccinations. This trial is registered at (ClinicalTrials.gov (NCT01931358); clinical follow up is now complete. FINDINGS: Between 28 October 2013 and 29 April 2014, 367 participants were enrolled, of whom 27 were assigned active vaccination in Group I, 102 in Group II, 101 in Group III, 52 in Group IVa, 51 in Group IVb, and 34 combined placebo across all groups. Late boosting did not induce vaccine-related serious adverse events. There were no significant differences in the occurrence or severity of local or systemic reactogenicity across active groups. Groups with late boosts (Groups II, III, IVa, and IVb) had increased peak plasma IgG binding antibody levels against gp70 V1V2 relative to Group I vaccine recipients with no late boost (gp70V1V2 92TH023 adjusted p < 0·02 for each; gp70V1V2 Case A2 adjusted p month 15 (Group IVa) > month 12 (Groups II+III) > no late boost (Group I). Groups with late boosts had increased both functionality and polyfunctionality scores relative to vaccine recipients with no late boost (all adjusted p < 0·05, except for polyfunctionality score in Group I vs in Group IVb p < 0·01). INTERPRETATION: Taken together, these results suggest that additional boosting of the RV144 regimen with longer intervals between the primary vaccination series and late boost improved immune responses and may improve the efficacy of preventing HIV acquisition. FUNDING: US National Institute of Allergy and Infectious Diseases (NIAID) and U.S. Department of the Army.

Purpose: The aim of this study is to determine which parameter of Cirrus and RTVue optical coherence tomography (OCT) has the highest ability to discriminate between early, moderate, and advanced glaucoma. Simultaneously, to compare the performance of the two OCT devices in terms of their ability to differentiate the three stages of glaucoma. Further, to analyze the macular parameters of both devices and compare them with the conventional retinal nerve fiber layer (RNFL) parameters. Methods: One hundred and twenty eyes (30 healthy and 90 glaucomatous [30 mild, 30 moderate, and 30 advanced glaucoma]) of 65 participants (15 healthy, 50 glaucomatous [15 mild, 15 moderate, and 20 advanced glaucoma]) underwent Cirrus and RTVue OCT scanning on a single visit. Results: Average RNFL thickness and superior RNFL thickness of both the devices and inferior (ganglion cell complex [GCC] of RTVue device best differentiated normals from all stage glaucomatous eyes (P > 0.05). Cirrus average RNFL thickness and superior RNFL thickness performed better than other parameters (P < 0.05) in differentiating early glaucoma from moderate and advanced. In differentiating advanced from early and moderate glaucoma, RTVue average, superior, and inferior RNFL thickness and inferior GCC parameters had the highest discriminating ability (P < 0.05). Conclusion: Overall, average RNFL thickness had the highest ability to distinguish different stages of the disease. No significant difference was found between RTVue and Cirrus OCT device in different severity levels. No significant difference was observed between RNFL and macular parameters in different stages of glaucoma.

Rectal metastasis from primary ovarian cancer is a rare condition. In this case report, we present a case of 45-year-old female presented with chief complaint of pain abdomen and vomiting and with on and off history of per rectal bleeding. On examination, patient was pallor, hemoglobin level of 5.5 for which she was admitted. On per rectal examination, there was circumferential rectal growth around 7 cm from anal verge. Imaging was suggestive of ovarian lesion with rectal growth. Biopsy and immunohistochemistry of rectal growth was suggestive of metastatic well-differentiated papillary adenocarcinoma probably of ovarian origin. In view of its rare presentation, we want to report this case.

Ocular amylodosis, although a rare entity, is known to affect the conjunctiva, extraocular muscles, orbit, lacrimal gland, and skin around the eyes. Intraocular deposition of amyloid mainly confines to the vitreous and cornea. In this report, we describe two cases of intraocular amyloidosis presenting as multiple iris and anterior chamber cysts. Histopathological examination with special stain like Congo Red and Transmission Electron Microscopy confirmed the diagnosis of amyloidosis. Systemic investigations ruled out systemic association confirming the diagnosis of primary ocular amyloidosis.

Introduction: An intracapsular fracture of the neck of the femur in the young adult is a difficult injury to manage. Although internal fixation is the standard treatment for young adults, controversy remains concerning the mode of fixation, the approach to be used (closed vs open), method of reduction, time to fixation, post-operative protocols. Avascular necrosis can occur following this injury because of disruption of the femoral head blood supply. Some believe that emergent fracture reduction is necessary to minimize the risk of avascular necrosis. Objective: In a developing country like ours with many cases presenting late to the hospital after injury, there are very few studies assessing the outcome in such cases. So we did a prospective study to assess the functional outcome in patients with neck of femur fractures presenting after 48hrs to the hospital. Methods: This is a prospective study with patients below the age of sixty years with displaced neck of femur fractures (Garden’s grade 3 and 4) presenting after 48 hrs treated with closed reduction and fixation with cannulated cancellous screws. Patients were followed up periodically for a minimum period of 3 years. Results: 28 patients participated in the study of which 18 were males and 10 female patients. Average time to surgery was 2.5days +/-0.3days. Time to union is 15.8 +/- 4.2 weeks. AVN developed in 4(14.2%) and non-union in 3 (10.7%) cases. Functional outcome with Harris Hip score was excellent-good in 22 (78.5%) cases. Conclusion: Accurate reduction with establishment of the smooth curve between the head and neck of femur and accurate placement of screws in the neck with guarded weight bearing protocols in cases with posterior comminution can give good results with this fracture irrespective of the delay in surgery.

Background Pulmonary hypertension is a disorder which worsens systemic diseases. One of the important underlying pathology is end stage chronic kidney disease The aim of this study was to assess the incidence of unexplained PHT, and to relate this to the cardiovascular status and arteriovenous fistula characteristics in ESKD patients on maintenance hemodialysis Methods: 159 patients with end stage kidney disease on maintenance hemodialysis were evaluated, 103 were excluded. Clinical, laboratory parameters were recorded. Systolic Pulmonary artery pressure and cardiac functions were evaluated by echocardiography. Flow across arteriovenous fistula was assessed by Doppler sonography. Patients were divided between the group with and without pulmonary hypertension. It was a cross sectional study. Result: Out of 159 patients, 56 patients who fulfilled inclusion criteria were evaluated, 36% had systolic pulmonary artery pressure of 35 mm Hg, mean age was 52.42 ± 9.12 years, 71.4% were males, and mean duration of end stage kidney disease was 33.66 ±11.56 months. Pulmonary hypertension patients were exposed to longer duration of hemodialysis therapy (p=0.0001) as compared to the patients with no pulmonary hypertension group, they also had a longer duration of functional Arterio venous fistula (p=0.0001), and flow across Arterio venous fistula was significantly more in pulmonary hypertension group (p=0.022), and these also had higher cardiac output (p=0.0001). Patients with Pulmonary hypertension were significantly more anemic, had more hypoalbuminemia and more interdialytic weight gain. Conclusions: Pulmonary hypertension is frequent in end-stage kidney disease patients on maintenance hemodialysis. It appears to be a late complication of hemodialysis with surgically created AVF with implications on cardiovascular status. Keywords: Arterio venous fistula (AVF), End-stage kidney disease (ESKD), Maintenance hemodialysis (MHD), pulmonary hypertension (PHT).Systolic pulmonary artery pressure (sPAP)

Gastric outlet obstruction (GOO) occurs when there is mechanical obstruction impending gastric emptying. GOO has both benign and malignant aetiologies. In this paper we want to discuss, clinical presentation and management of malignant GOO. This is a retrospective observational study of 5 years in patients presenting with malignant GOO. Study was conducted in Dr. B. Borooah Cancer Institute, Guwahati, India. Patients with malignant GOO who were operated were included in this study. Chi-square test was used to evaluate association between categorical values. Independent t test and one-way ANOVA (analysis of variance) was used for continuous variables. A p value

PURPOSE To study the current profile of secondary glaucoma in all age groups of patients presenting to a tertiary eye care hospital in Northern India Materials and methods: In this retrospective study, files of 5725 patients who were newly diagnosed to have glaucoma in our tertiary eye care centre from January 2014 to December 2016 were reviewed. Detailed data were collected from patient's records, including history, best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp biomicroscopy findings, gonioscopy, and fundus findings. Demographic data, aetiology, and management in all these patients were also noted. RESULTS Out of 5820 patients who visited glaucoma outpatient department (OPD) in a tertiary eye care hospital during 1 January 2014 to 31 December 2016, 5725 patients were diagnosed to have glaucoma by the glaucoma specialists. Five thousand three hundred and six patients (92.68%) were diagnosed to have primary glaucoma and 419 patients (7.32%) were diagnosed to have secondary glaucoma. The leading causes of secondary glaucoma were found to be neovascular glaucoma (17.42%), trauma (14.80%), post-keratoplasty (13.60%), post-cataract surgery (13.13%), and lens-induced glaucoma (12.41%). Secondary glaucoma was found to be an important cause of visual morbidity with 71.17% eyes presenting with BCVA 30 mm Hg in 62% eyes and 72% with cup-to-disc ratio of ≥0.7:1. CONCLUSION Secondary glaucoma is an important cause of visual morbidity. Timely diagnosis and prompt management are essential to prevent irreversible visual loss due to secondary glaucoma.

Summary Background Human monoclonal antibodies that potently and broadly neutralise HIV-1 are under development to prevent and treat HIV-1 infection. In this phase 1 clinical trial we aimed to determine the safety, tolerability, and pharmacokinetic profile of the broadly neutralising monoclonal antibody VRC07-523LS, an engineered variant of VRC01 that targets the CD4 binding site of the HIV-1 envelope protein. Methods This phase 1, open-label, dose-escalation clinical trial was done at the National Institutes of Health Clinical Center in Bethesda, MD, USA. Individuals were recruited from the greater Washington, DC, area by IRB-approved written and electronic media. We enrolled healthy, HIV-1-negative adults aged 18–50 years. Inclusion criteria were good general health, measured through clinical laboratory tests, medical history, and physical examination. Participants self-selected into one of seven open groups during enrolment without randomisation. Four groups received a single intravenous dose of 1, 5, 20, or 40 mg/kg of VRC07-523LS, and one group received a single 5 mg/kg subcutaneous dose. Two groups received three doses of either 20 mg/kg intravenous VRC07-523LS, or 5 mg/kg subcutaneous VRC07-523LS at 12-week intervals. The primary outcome was the safety and tolerability of VRC07-523LS, assessed by dose, route, and number of administrations. This study is registered with ClinicalTrials.gov, NCT03015181. Findings Between Feb 21, 2017, and September 13, 2017, we enrolled 26 participants, including 11 (42%) men and 15 (58%) women. Two (8%) participants withdrew from the study early: one participant in group 1 enrolled in the study but never received VRC07-523LS, and one participant in group 6 chose to withdraw after a single administration. One (4%) participant in group 7 received only one of the three scheduled administrations. 17 participants received intravenous administrations and 8 participants received subcutaneous administrations. VRC07-523LS was safe and well tolerated, we observed no serious adverse events or dose-limiting toxic effects. All reported local and systemic reactogenicity was mild to moderate in severity. The most commonly reported symptoms following intravenous administration were malaise or myalgia in three (18%) participants and headache or chills in two (12%) participants. The most commonly reported symptoms following subcutaneous administration were pain and tenderness in four participants (50%) and malaise or headache in three (38%) participants. Interpretation Safe and well tolerated, VRC07-523LS is a strong and practical candidate for inclusion in HIV-1 prevention and therapeutic strategies. The results from this trial also indicate that an HIV-1 broadly neutralising monoclonal antibody engineered for improved pharmacokinetic and neutralisation properties can be safe for clinical use. Funding National Institutes of Health.

Background: The RV144 phase 3 vaccine trial in Thailand demonstrated that ALVAC-HIV (vCP1521) and AIDSVAX® B/E administration over six months resulted in a 31% efficacy in preventing HIV acquisition. Subsequent boosting of RV144 vaccine recipients 6 to 8 years later improved the magnitude and quality of immune responses, expanding subdominant memory B cells. Methods: RV306 is a double-blind, placebo-controlled, randomized clinical trial of the primary RV144 vaccine series with additional AIDSVAX® B/E with or without ALVAC-HIV boosting at months 12, 15, or 18 in healthy volunteers. Findings: Late boosting was safe, and improved antigen-specific plasma IgG responses to HIV-1 envelope and the first and second variable loops (V1V2), an inverse correlate of HIV risk in RV144, without increasing HIV-specific plasma IgA, a direct correlate of risk. Late boosting improved Tier 1 neutralization and HIV-1 envelope-specific CD4+ T cell polyfunctionality, an independent correlate contributing to RV144 vaccine efficacy. Late boosting was also required to maintain antigen-specific CD4+ T cell proliferation. Interestingly, increasing the interval between priming and boosting improved several humoral and cellular immune responses. Interpretation: Taken together, these results suggest that additional boosting of the RV144 regimen with longer intervals between the primary vaccination series and late boost improved immune responses and may improve the efficacy of preventing HIV acquisition. Funding Statement: Cooperative Agreement # W81XWH-18-2-0040 in collaboration with the US Army and DAIDS/NIAID/NIH. Declaration of Interests: J. T., and C. D. are employees of Sanofi Pasteur. S.P. was an employee of Sanofi Pasteur during the conduct of this study and analysis. F. S. is an employee of Global Solutions for Infectious Diseases. All other authors report no potential conflicts. The opinions expressed herein are those of the authors and do not represent the official position of the US Army or the Department of Defense. Trade names are used for identification purposes only and do not imply endorsement. Ethics Approval Statement: The study was approved by ethical review boards at the Walter Reed Army Institute of Research, Thai Ministry of Public Health, Royal Thai Army Medical Department, Faculty of Tropical Medicine, Mahidol University, Chiang Mai University, and Chulalongkorn University Faculty of Medicine. This study was conducted in accordance with Good Participatory Practice principles.

Tube implants have been in vogue for over three decades. Its inception has brought a paradigm shift in the management of secondary glaucomas, where the only option earlier was cyclodestructive procedure. From the time of its innovation, however, it was restricted primarily to patients who were at a high risk of failure from conventional glaucoma filtration surgery. But the indications at present encompass a wide variety of secondary and primary glaucomas. Glaucoma drainage implants (GDIs), both valved and non-valved, are available. This chapter focuses on the possible indications of GDIs in the current glaucoma management.

A male patient underwent an uneventful cataract surgery. He developed fungal postoperative endophthalmitis by Scedosporium apiospermum species. This fungus is a common cause of endogenous endophthalmitis in immunocompromised patients with poor visual outcomes. We report this case to share our experience of managing fulminant postoperative endophthalmitis with an iris fungal ball in an immunocompetent patient caused by S. apiospermum.

Diabetes Mellitus is considered to be a cardiovascular disease equivalent. The risk of CVD in DM is manifold, and the implications of the disease becomes even more grave when young diabetics die of cardiovascular diseases. The escalating number of young diabetics emphasises the need for early diagnosis and intervention when necessary to halt the progression of CVD. The present study is a novel attempt to assess the prevalence of CVD in young diabetics in upper Assam with poor glycemia and dyslipidemia with the aims and objectives to study the glycemic status and lipid profile in young diabetics and to study the CVD risk and involvement. It is a hospital based observational study carried over a period of 1 year which showed A total of 42.7% of cardiovascular outcomes, of which Left Ventricular diastolic Dysfunction + Concentric LVH was found in 53.2% cases, Left Ventricular Diastolic Dysfunction alone was found in 21.8%, Concentric LVH alone was found in 25%. HbA1c level was found to be statistically extremely significant with the Cardiovascular Disease outcomes, with Left Ventricular Diastolic Dysfunction (p value 0.0007) and with Concentric LVH (p value 0.003). This was a hospital based observational study conducted in upper Assam among the patients with diabetes diagnosed at an early age of 25 years and below, to identify the presence of cardiovascular risks in young diabetes and the relation with glycemic status.

Ebstein’s anomaly, a rare congenital heart disease, has an extremely variable natural history, depending on variety of pathological features. We here describe a case of a patient with Ebstein’s anomaly who had an uneventful vaginal delivery of a healthy term baby. The anomaly was diagnosed during childhood, was not associated with other cardiac anomalies, cyanosis or pre-excitation and the echocardiographic degree of severity was low.

Background: The study in terms of pattern of illness and seasonal variation in a defined region is an important way to improve the quality of health services delivered to the community. The study objective was to describe the morbidity profile of patients attending the outpatient department (OPD) of urban health and training centre (UHTC) under the Dept. of Community Medicine of a teaching hospital during the year . Methods: This retrospective cross-sectional study was conducted for the duration of one year. The Data were collected from the OPD registers of medical officers from January 2015 to December 2015. Patients who had come to the centre for follow up visits were excluded from the study. Results: A total of 74,276 patients were included in the study after exclusion (39,627 males and 34,649 females). Adults (>14 years) constituted about 79.19%. Overall, respiratory disorders were the major complaints (17.17%), followed by external causes of morbidity and digestive disorders. In case of children, major diseases were wound injury, malnutrition, diseases of ear, nose and throat and skin infection. The prevalence of diseases like hypertension and diabetes were reported less in this study . Conclusions: The study gives an outline of the morbidity profile of patients attending an urban health training centre over a period of one year. This knowledge would help the health care providers and administrators to plan and deliver, enhanced and high quality services as per the community need.

BACKGROUND SLE (systemic lupus erythematous) is an autoimmune disease, which can lead to damage to any organ in the body mediated by tissue binding autoantibodies. It is not that uncommon in North Eastern part of India. Mainly, the female sex in their reproductive age group are affected. Of all the complications, neuropsychiatric complication is also a common manifestation of SLE. The aim of the study is to- 1. Find the incidence of peripheral neuropathy in SLE patients. 2. Its association with morbidity. MATERIALS AND METHODS Patients were enrolled from 1st September 2010 to 31st August 2011 who attend the Department of Medicine, Assam Medical College, Dibrugarh. A total of 73 patients were enrolled. All patients were above 12 years of age. SLE was diagnosed by 1997 updated ACR criteria. Peripheral neuropathy was diagnosed via nerve conduction velocity test. RESULTS Of the 73 patients, 39 patients had evidence of peripheral neuropathy. Of the 39 patients, 28 patients were asymptomatic. The remaining 11 symptomatic patients mainly complained of pins and needles in their feet and 2 additionally complained of tingling sensation in the lower limbs. CONCLUSION From the study, it is seen that the sural nerve is the most common nerve to be affected in SLE. So, doing Nerve Conduction Study (NCS) on the sural nerve singly could be taken as a screening test to diagnose peripheral neuropathy in SLE patients. But, as the number of patients in the study was less, a study with larger number of patients would be required to confirm that the sural nerve is the most common nerve to be affected in SLE.