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A 75-year-old nonsmoker and nonalcoholic female, known to have squamous cell carcinoma of the head and neck metastasized to the lungs, was found to have a mass at the right hilar/infra-hilar region and an unusual pattern of increased mild diffuse 18-fluorodeoxyglucose (18-FDG) uptake at the right mid-lower lobe location without any lung parenchymal abnormalities (confirmed by low dose CT scan of PET-CT). It was suspected to be the lymphangitic spread of the neoplasm; however, spectral detector CT (SDCT) imaging performed later not only confirmed the presence of a mass invading the right inferior pulmonary vein but showed a large area of significantly decreased perfusion in the right middle and lower lung lobes, leading to a change in the diagnosis to right pulmonary venous occlusion.

Background: Data pertaining to dual malignancies in the geriatric population are not only sparse but also heterogeneous. The present study evaluated the pattern of care for geriatric dual malignancy patients at a tertiary care center. MATERIALS AND METHODS: We retrospectively collected data from all dual malignancy patients of and above the age of 65 years registered in the radiation oncology department of a single tertiary care center. Results: 456 geriatric cancer patients were registered between January 2019 and July 2021,out of which 48 patients had dual malignancy (10.5%). The distribution of index malignancy was six (12.5%) patients each of carcinoma oropharynx and prostate. Thirty-two (66.7%) patients developed metachronous malignancies. The mean difference in the development of the second malignancy was 3.4 years. Eleven (22.9%) patients developed carcinoma lung as a second malignancy. The primary treatment received by 38 (79.2%) patients was radical. Conclusion: Geriatric patients with synchronous malignancies pose a therapeutic challenge and the decision is achieved by a multidisciplinary approach.

Purpose: To assess the visual and clinical outcomes after bilateral implantation of the novel extended depth of focus (EDOF) (AcrySof IQ Vivity) intraocular lens (IOL) using a micromonovision strategy. Methods: This was a prospective interventional study at a tertiary care center. Twenty patients (40 eyes) underwent bilateral implantation of AcrySof IQ Vivity IOL. Twelve weeks postoperatively, both uncorrected vision and corrected vision were assessed. Uniocular and binocular defocus curves with and without correction were noted subjectively as well as objectively on I-trace. Contrast sensitivity was assessed with a FACT (Functional Acuity Contrast Testing) machine, and objective parameters like modulation transfer function and Strehl ratio were also measured on I-Trace. Subjective quality of vision using a subjective questionnaire was also evaluated. Results: The mean binocular postoperative uncorrected distance visual acuity in LogMAR was -0.03 ± 0.09, the uncorrected intermediate visual acuity was 0.03 ± 0.09, and the uncorrected near visual acuity was 0.28 ± 0.18. All defocus curves were smooth and broad with the uncorrected defocus curve (with the micromonovision strategy) better than the corrected defocus curve. The subjective depth of focus (DOF = 3.73) was more than objective DOF (1.93) (P < 0.05). Photopic contrast was better than mesopic at all frequencies. All aberrations increased at 5 mm pupil size compared to 3 mm pupil size and were statistically significant, except for the total eye spherical aberration, which shows no significant difference at 3 mm and 5 mm pupil size (P = 0.27). Spectacle independence for distance, intermediate, and near was achieved in 100%, 94.7%, and 94.7% cases in this study, respectively. Conclusions: Using the micromonovision strategy, the visual performance of this novel EDOF IOL was outstanding both subjectively and objectively.

Introduction: Traumatic hemothorax is accounted for about 20% of traumatic chest injuries. Although majority can be managed with the timely placement of intercostal tube (ICT) drainage, the remaining pose a challenge owing to high complication rates associated with retained hemothorax. Although various treatment modalities including intrapleural instillation of fibrinolytics, radioimage guided drainage, VATS guided evacuation and thoractomy do exist to address the retained hemothorax, but indications along with timing to employ a specific treatment option is still unclear and ambiguous. Methods: Patient with residual hemothorax (>200 mL) on ultrasonography after 48 h of indwelling ICT was randomized into either early video-assisted thoracic surgery (VATS) or conventional approach cohort. Early VATS cohort was subjected to video-assisted thoracoscopic evacuation of undrained blood along with normal saline irrigation and ICT placement. The conventional cohort underwent intrapleural thrombolytic instillation for 3 consecutive days. The outcome measures were the duration of indwelling ICT, removal rate of tube thoracostomy, length of hospital stay, duration of intensive care unit (ICU) monitoring, need for mechanical ventilation, incidence of pulmonary and pleural complications, and requirement of additional intervention to address undrained hemothorax and mortality rate. Results: The early VATS cohort had shorter length of hospital stay (7.50 ± 0.85 vs. 9.50 ± 3.03, P = 0.060), reduced duration of indwelling ICT (6.70 ± 1.25 vs. 8.30 ± 2.91, P = 0.127) with higher rate of tube thoracostomy removal (70% vs. 30%, P = 0.003) and lesser need of additional interventions (0% vs. 30%, P = 0.105). Thoracotomy (3 patients) and image-guided drainage (4 patients) were additional interventions to address retained hemothorax in the conventional cohort. However, similar length of ventilator assistance (0.7 ± 0.48 vs. 0.60 ± 1.08, P = 0.791) and prolonged ICU monitoring (1.30 ± 1.06 vs. 0.90 ± 1.45, P = 0.490) was observed in early VATS cohort. Both the cohorts had no mortality. Conclusion: VATS-guided early evacuation of traumatic hemothorax is associated with shorter length of hospital stay along with abbreviated indwelling ICT duration, reduced incidence of complications, lesser readmissions, and improved rate of tube thoracostomy removal. However, the duration of ventilator requirement, ICU stay, and mortality remain unchanged.

Introduction: Colorectal Cancer (CRC) has been primarily considered a disease of the elderly, but recent data have shown an alarming rise among young people. It has also been suggested that young age is associated with aggressive histopathological characteristics and advanced stages of the disease at diagnosis. Aim: To assess and compare the clinical and pathological characteristics of patients with rectal cancer diagnosed at ages over and below 45 years. Materials and Method: This prospective cross-sectional study was conducted between January 2020 and August 2022 in the Departments of Surgical, Medical, Radiation Oncology, Surgical Gastroenterology, and General Surgery at All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakand, India. All patients underwent a biopsy from the representative site for histological documentation of the disease. They then underwent treatment (surgery/chemotherapy/radiotherapy) as required. All the data were categorised into two groups: an early-onset group (age

Introduction Evidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk (HR) feet in people with diabetes across India.Research design and methods A cross-sectional national-level project ‘Save the Feet and Keep Walking’ campaign was conducted by the Research Society for the Study of Diabetes in India (RSSDI) from July 10, 2022 to August 10, 2022. A modified version of 3 min foot examination was used to assess the foot problems. Around 10 000 doctors with RSSDI membership were trained online to conduct foot screening and provided a standardised monofilament for detection of loss of protective sensation. People with diabetes aged >18 years who visited the clinics during the study period were examined for foot problems. Data were collected online using the semi-structured questionnaire. A total of 33 259 participants with complete information were included for the final analysis. The foot at risk was categorised based on International Working Group on the Diabetic Foot guidelines 2023.Results Nearly 75% of the participants were aged above 45 years. Around 49% had diabetes duration >5 years and uncontrolled diabetes (hemoglobin A1c >8%). Presence of history of foot ulcer (20%), lower limb amputation (15.3%), foot deformities (24.5%) and absence of diminished dorsal pedis and posterior tibial pulses (26.4%) was noted in the study participants. Around 25.2% of them had HR feet and highly prevalent among males. Diabetic kidney and retinal complications were present in 70% and 75.5% of people with HR feet. Presence of heel fissures (OR (95% CI) 4.6 (4.2 to 5.1)) and callus or corns (OR (95% CI) 3.6 (3.3 to 4.0)) were significantly associated with HR feet.Conclusions One-fourth of people with diabetes were found to have HR feet in India. The findings are suggestive of regular screening of people with diabetes for foot problems and strengthening of primary healthcare.

Chest wall reconstruction poses significant challenges. One of those challenges is choosing the correct material for reconstruction. There is debate on using prosthetic materials versus autologous tissues and rigid versus nonrigid materials. This article showcases the novel use of fascia lata for chest wall reconstruction in children.

Prostatic adenocarcinoma is the most common type of cancer in men, with subsequent lesions most commonly occurring in the lymph nodes, bones, and lungs.1,2 We discuss the clinical case of a 59-year-old man who presented after radical prostatectomy for prostate cancer with a unilateral metastasis in the right testis. Metastases to the testis are uncommon, occurring in less than 4% of cases.2,3 This kind of metastasis is usually unilateral, manifesting as a palpable testicular mass, and rarely involves both the testis and the epididymis.1,2 Secondary neoplasms of the testis are found in around 2.5% of autopsies, including nonneoplastic fatalities.2 Most secondary testicular metastases develop from distant primary locations, the most prevalent of which are the lung, prostate, and gastrointestinal tract.2 Testicular metastases can occur in up to 4% of all prostate cancer cases and are frequently discovered by chance following orchiectomy therapy for advanced disease.4 In general, advanced prostate cancer metastases to the pelvic lymph nodes, bones, lungs, and liver are common; however, few of these patients have clinically evident testicular metastasis.4,5 Secondary neoplasms of the testis are uncommon, with a reported rate of 0.02-2.5%, except leukemia and lymphoma infiltration.2,3 The prostate is the most common site of testicular metastases (15%), followed by the lung, melanomas, skin, colon, and kidney.1,2 However, most testicular metastases of prostate cancer were discovered after examining a significant number of testes from patients who had tumors removed during therapeutic orchiectomies.2,4 Lung cancer (43%), malignant melanoma (20%), pancreatic cancer (10%), and prostate cancer (10%) are among cancers that can spread to the testes.4,5 However, the great majority of metastases are lesions detected by chance following an autopsy or bilateral orchiectomy for Prostatic Cancer hormonal treatment.3 A testicular tumor revealing clinical recurrence is highly unusual. Bubendorf et al.1 discovered testicular metastases in just 0.5% of 1,589 prostate carcinoma autopsy reports. He also suggests a backward metastatic channel through prostate veins in addition to the typical hematogenous tumor spread via the vena cava. Overall, four routes have been hypothesized for the propagation of the lesions to the testis: retrograde venous extension, retrograde lymphatic extension, arterial embolism, and through the lumen of the vas deferens.1 Patients with symptomatic isolated post-prostatectomy testicular metastases can live for a surprisingly long time after orchidectomy without further development. This phenomenon may be linked to cytoreduction.1,2 The ability to manage the malignant process locally is an undeniable clinical benefit for patients undergoing orchiectomy. Given that this method of treatment is easy, safe, and associated with few problems, all patients with isolated prostatic cancer testicular metastases should be considered candidates for metastasectomy.4,5 The histological features of prostate cancer testicular metastases are similar to those of original prostate tumors; however, histology may show a more aggressive phenotype with a significant probability of future disease spreading and, thus, worse survival.3,4 Weitzner4 found that patients with newly diagnosed testicular metastases from prostate cancer had a median survival of roughly 12 months.1,2 Other studies, on the other hand, have documented survival of more than two years without biochemical relapses. As a result, the predictive impact of testicular metastases from prostate cancer is yet unknown, owing to the rarity of the incidence.2 Testicular metastasis from prostate carcinoma is an uncommon manifestation of advanced disease.2 It often presents with testicular pain, swelling, or a palpable mass and can mimic primary testicular neoplasms. Clinicians should maintain a high index of suspicion, especially in patients with a history of prostate carcinoma. Prompt diagnosis through imaging studies and histopathological confirmation is essential for appropriate management and prognosis.3,4 This case underscores the importance of considering testicular metastasis in the differential diagnosis of testicular masses, particularly in patients with a history of prostate carcinoma. A multidisciplinary approach is crucial for optimal management and improving patient outcomes. Early recognition and timely intervention are paramount in managing metastatic disease and improving quality of life. Figure 1 refers to a 59-year-old male patient presented to our hospital with an elevated serum prostate-specific antigen (PSA) level of >100 ng/ml. He had been on regular follow-up with urology for surveillance of prostate cancer recurrence. He had undergone a radical prostatectomy two years ago with Gleason grade group 5. Scrotal ultrasound showed a hypoechoic mass involving the right testicle with increased vascularity, suggesting a neoplastic lesion. Hence, the patient was planned for a bilateral orchidectomy. The patient underwent bilateral inguinal orchiectomy without any complications. Macroscopic examination of the right resected testis revealed a solid yellowish-white tumor of 0.5 × 0.5 cm. Histopathological analysis showed that the right testis was infiltrated by metastatic adenocarcinoma. Immunohistochemical examination revealed that tumor cells were diffusely positive for PSA and Alpha (α)-methylacyl-CoA racemase (AMACR). The patient was diagnosed with right testicular metastasis of Prostatic Carcinoma. The patient had an uneventful postoperative recovery. The patient was scheduled for regular follow-up appointments to monitor disease progression. Serial PSA levels and imaging studies were planned to look for disease status. Figure 1 A – Gross view of the right orchidectomy showing a small nodular metastatic deposit in tunica albuginea from the prostate cancer; B, C and D are photomicrographs of the tumor and testicle parenchyma; B – shows normal testicular seminiferous tubules along with presence of metastatic tumor deposit in the wall of testis (Tunica albuginea) (H&E x100); C – These tumor cells are immunopositive for prostate specific antigen (PSA 40X); D – The tumor cells are also positive for Alpha-methylacyl-CoA racemase (AMACR 200X).:

Calvarial haemangiomas are benign, vascular tumours of the skull involving parietal and frontal bones. Mostly these lesions remain asymptomatic, and present with cosmetic deformity, headache, uncommon neurological symptoms and reported as case reports and case series. The radiological appearance can range from sessile growing intradiploically to globular and the lesions may extend outwards or inwards after eroding the outer and inner tables of the skull. “Sunburst appearance” and “Wagon-wheel sign” are classical radiological findings but the lesions may present simply as a lytic expansile or even sclerotic calvarial mass. Because of varied clinical presentation and atypical radiological characteristics, the final diagnosis can be clinched by histology only. In selected cases where these lesions are not cosmetically acceptable, en bloc resection with tumour free margins followed by cranioplasty is the treatment of choice. Most reports of calvarial haemangiomas in literature are in the form of case reports.

Due to their ability to wipe out pathogens, botanical medicines have been historically used to effectively combat severe ailments throughout time immemorial. Furthermore, owing to the limitations of current medical approaches, investigators have begun looking into generating fresh formulations that have enhanced antioxidant and antimicrobial capabilities. These activities of combination generated from the fruit and seed of medicinal plants were collected in this investigation from different geographical areas for determining antioxidant and antimicrobial activity. One of the medicinal plants, i.e., Zanthoxylum armatum, belongs to the family Rutaceae and has medicinal values as mentioned in the literature. The objective of our study is to analyse the antimicrobial and antioxidant potential of formulations (fruits and seeds with different proportions) from district Bageshwar (location Shama Dura) against specific pathogens. In order to achieve the objective, fruits and seeds of Zanthoxylum armatum were examined through Fourier-transform infrared spectroscopy (FTIR) and estimated in vitro for their synergistic antibacterial potential against three pathogenic microorganisms: Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus using disc-diffusion assays. In addition, antioxidant activity was also performed using 2,2-diphenylpicrylhydrazyl (DPPH) and estimating its phenolic and total flavonoid content. The results of these studies showed that the maximum zone of inhibition was observed in formulation (40:60; 9–11 mm), whereas the least was observed in formulation (20:80; 3–4 mm) against different bacterial strains. In addition, the formulated samples of fruit and seed combinations may have shown higher antioxidant activity (86.37%), total phenolic (416.2 mg GAE/g) and total flavonoid (166.4 mg rutin/g) content. In contrast, FTIR was used to detect the presence of functional groups in the formulated fruit and seed of Zanthoxylum armatum. According to the aforesaid finding, the formulation shows strong antibacterial and antioxidant action without compromising cell viability.

The performance of piezoelectric-based stick-slip actuators is intricately influenced by the interplay between key design and operating parameters such as the electrical driving signal, mechanical architecture, inertia, and frictional contact. Fostering an interdisciplinary approach towards a holistic understanding of their dynamic behavior is crucial to maximise an actuator's performance. Therefore, considering the significant role of friction, this research investigates its effect and interaction with the operating frequency on the actuator's performance, using dynamic finite element analysis as a proof of concept. The analysis is supported by experimental verification using various material couplings in an actuator prototype. The study reveals that at low operating frequencies, actuator with a low-friction interface achieve greater displacements compared to those with higher friction. Interestingly, at elevated frequencies, the displacements become comparable across interfaces with different friction coefficients. The findings suggest that both load capacity and displacement can be enhanced by selecting material pairs with higher friction coefficients at higher frequencies, while those with lower friction coefficients would be more promising for precise positioning, with low initiation frequencies. Therefore, this research introduces a novel approach for optimizing actuator performance by tuning contact dynamics across the operating frequency spectrum, offering insights into the design and development of piezoelectric-based stick-slip actuators.

Gallbladder cancers are the most common biliary tract malignancies in the world. Adenocarcinoma constitutes the most common histology in gallbladder cancer. Neuroendocrine neoplasms of the gallbladder account for about 0.5% of all neuroendocrine neoplasms and 2.1% of all gallbladder tumors. They are rare tumors and present with non-specific symptoms such as abdominal pain, weight loss, anorexia, and obstructive jaundice, and, therefore, are often challenging to diagnose and treat. Mixed neuroendocrine-non-neuroendocrine neoplasm is a subtype of neuroendocrine neoplasm. To add to the literature, we report a rare case of a patient who presented with pain in the abdomen and non-bilious vomiting and was diagnosed with mixed neuroendocrine-non-neuroendocrine gallbladder cancer, identified by immunohistochemistry, and treated with palliative chemotherapy. Due to non-specific symptoms, patients may present at an advanced stage. Further, immunohistochemistry may assist in clinching the diagnosis.

Background and Aims: Thoracic continuous spinal anaesthesia (TCSA) is emerging as the sole anaesthetic for major abdominal surgery due to its better perioperative outcomes. This study was designed to evaluate block characteristics and outcomes in 'opioid-free' and 'opioid-based' TCSA. Methods: After ethical approval, trial registration and written informed consent, 50 adult patients undergoing major abdominal surgery were randomised into 'opioid-free' (bupivacaine alone) and 'opioid-based' (bupivacaine with fentanyl) groups. After confirmation of T4-L1 dermatome level of spinal anaesthesia, sedation by intravenous (IV) midazolam (0.02–0.05 mg/kg), ketamine (0.25 mg/kg) and dexmedetomidine (bolus dose of 1 μg/kg IV over 10 min followed by 0.2–0.7 μg/kg/h infusion) were started. The primary outcome measured was postoperative pain scores for 72 h in both groups. The secondary objectives were rescue opioid requirement, and the dose of bupivacaine required to achieve T4 level. Data were compared using the two-sided Student t-test, Mann-Whitney and Fisher's exact tests. Results: The 'opioid-based' group performed significantly better compared with the 'opioid-free' group concerning pain scores at rest at 0 h (P = 0.023), 18 h (P = 0.023) and 24 h (P = 0.016) postoperatively, decreased intrathecal bupivacaine requirement [(induction (P = 0.012) and maintenance (P = 0.031)], postoperative rescue fentanyl requirement (P = 0.018) and patient satisfaction (P = 0.032) at the cost of increased postoperative nausea and vomiting (P = 0.049). Conclusion: The 'opioid-based' TCSA provided better postoperative analgesia with significantly lesser postoperative pain scores when compared to the 'opioid-free' group in patients undergoing major abdominal surgery.

Workflow Scheduling is a huge challenge in cloud paradigm as many number of workflows dynamically generated from various heterogeneous resources and task dependencies in each workflow varies from each other. Therefore, if a workflow with more number of dependencies is not scheduled onto an appropriate Virtual Machine i.e. with low processing capacity which leads to delay in executing workflows and it results in increase of makespan, cost, energy consumption. In order to effectively schedule complex workflows i.e. with more task dependencies, we propose a novel multi objective workflow scheduling algorithm using Deep reinforcement Learning. Initially, priorities of all workflows calculated based on their dependencies and then calculated priorities of VMs based on electricity cost at datacenters to map workflows onto precise VMs. These priorities are fed to scheduler which uses Deep Q-Network model to dynamically schedule tasks by considering both priorities of tasks and VMs. Extensive simulations carried out on workflowsim by considering realtime scientific workflows (Montage, cybershake, Epigenomics, LIGO). Our proposed MOPWSDRL compared against existing state of art approaches i.e. Heterogeneous Earliest First Deadline, Cat Swarm Optimization, Ant Colony Optimization. Results revealed that our proposed MOPDSWRL outperforms existing state of art algorithms by minimizing makespan, energy consumption.

Purpose: Swallow-related motion of the larynx is most significant in the cranio-caudal directions and of` short duration. Conventional target definition for radical radiation therapy includes coverage of the whole larynx. This study longitudinally examined respiration- and swallow-related laryngeal motions using cine-magnetic resonance imaging. We further analyzed the dosimetry to organs at risk by comparing 3D-conformal radiation therapy (3D-CRT), volumetric modulated arc therapy (VMAT), and intensity modulated radiation therapy (IMRT) techniques. Methods: Fifteen patients with T1-2 N0 glottic squamous cell carcinomas were prospectively recruited for up to 3 cine-MRI scans on the Elekta Unity MR-Linear accelerator, at the beginning, middle, and end of a course of radical radiation therapy. Swallow frequency and motion of the hyoid bone, cricoid and thyroid cartilages, and vocal cords were recorded during swallow and rest. Adapted treatment volumes consisted of gross tumor volume + 0.5-1 cm to a clinical target volume with an additional internal target volume (ITV) for personalized resting-motion. Swallow-related motion was deemed infrequent and was not accounted for in the ITV. We compared radiation therapy plans for 3D-CRT (whole larynx), VMAT (whole larynx), and VMAT and IMRT (ITV for resting motion). Results: Resting- and swallow-related motions were most prominent in the cranio-caudal plane. There were no significant changes in the magnitude of motion over the course of radiation therapy. There was a trend of a progressive reduction in the frequency of swallow. Treatment of partial larynx volumes with intensity modulated methods significantly reduced the dose to carotid arteries, compared with treatment of whole larynx volumes. Robustness analysis demonstrated that when accounting for intrafraction swallow, the total dose delivered to the ITV/planning target volume was maintained at above 95%. Conclusions: Swallow-related motions are infrequent and accounting for resting motion in an ITV is sufficient. VMAT/IMRT techniques that treat more conformal targets can significantly spare critical organs at risk such as the carotid arteries and thyroid gland, potentially reducing the risk of carotid artery stenosis-related complications and other long-term complications.

We analyzed the risk factors and outcomes of antenatally diagnosed congenital diaphragmatic hernia (CDH) from a tertiary-care children’s hospital following in-utero transfer. A total of 41 antenatally detected cases of CDH were included; 30 were live-born and 11 were still-born. The primary outcome was postnatal survival. The secondary outcome was the probable factor affecting survival. No medical termination of the pregnancy was done. The mean gestational age at diagnosis was 23 weeks. The diagnostic accuracy of antenatal ultrasonography was 40/41 (97.5%). Lung-to-head ratio (LHR) was 1 in 10 cases (survived 8), and LHR was not recorded in 11 cases (survived 4). Overall survival was 14/41 (34.1%). Survival in fetuses with polyhydramnios was 0% (n=3; survived 0), associated anomalies were 33.3% (n=3; survived 1), and liver herniation was 22.2% (n=9; survived 2). Postnatally, significant risk factors included a low Apgar score, the need for ventilation, and neonatal intensive care unit (NICU) management. Survival in live-born cases was 14/30 (46.6%) and in operated cases was 14/19 (73.6%). We concluded that antenatal ultrasound had a high accuracy rate for detecting CDH. Antenatal risk factors affecting outcomes were low LHR, maternal polyhydramnios, liver herniation, and associated malformations. Postnatal risk factors included a low Apgar score, NICU admission, and a need for ventilation. The overall survival rate, as well as the survival rates for live-borns and those undergoing surgery, were 34.1%, 46.6%, and 73.6%, respectively. This data will guide clinicians in counseling the families of antenatally diagnosed CDH.

This study aims to scrutinize the phenolic secondary metabolites in the polar peel decocture of Malus domestica var Maharaji via hyphenated techniques along with the study of the antibacterial, anti-candida, and tyrosinase inhibitory potential of bioactive compound-rich fractions. Preliminary phenolics go over was performed together with thin layer chromatography before the polar decocture was subjected to hyphenated techniques. FTIR investigation revealed the C-O bonds as in phenols, O-H bond stretch, and vibrations of alcohols and carboxylic acids as well as portrayed the C-H and >C=O stretches among other functional groups all of which are representative of phenolic and polyphenolic compounds. GC-MS perusal demonstrated the presence of bioactive compounds like Quercetin (13.04%), Ascorbic acid (6.48%), p-Coumaric acid (6.17%), Caffeic acid (5.69 %), Mallic acid (5.44%), Apigenin (5.28%), Citric acid (5.15%), Gallic acid (4.38%), Cyanidin (3.52%), and Ferulic acid (3.51%). Kirby-Bauer method followed by the resazurin microtiter assay technique (REMA) for MIC/MBC against six MTCC bacterial strains and one yeast, all producing stubborn opportunistic infection in humans, was used to assess the antibacterial property of all the bioactive rich fractions. Some fractions comparatively revealed a good activity index (AI) against tested microbes. MIC concentrations for bacteria ranged from 15-24 mg/ml while a lower MBC value recorded was 18 mg/ml. Methanol fraction revealed significant tyrosinase inhibitory activity by revealing IC50 of 980.98 µg/ml when L-Tyrosine was substrate and IC50 of 830.68 µg/ml when L-DOPA was substrate when juxtaposed to standard kojic acid that revealed IC50 of 128.822 µg/ml when L-Tyrosine was substrate and IC50 of 149.43 µg/ml when L-DOPA was substrate. The bioactive compounds possessed by the fractions, may be synergistically, turned out to be more effective in the diphenolase reaction and kojic acid acts more effectively in the monophenolase one. It was inferred that peel phenolics of this malus variety have a lot of therapeutic potential in the context of bacterial infections and pigmentation disorders.

Abstract Gallbladder cancer (GBC) is a lethal disease with surgical resection as the only curative treatment. However, many patients are ineligible for surgery, and current adjuvant treatments exhibit limited effectiveness. Next-generation sequencing has improved our understanding of molecular pathways in cancer, sparking interest in microRNA-based gene regulation. The aim of the study is to identify dysregulated miRNAs in GBC and investigate their potential as therapeutic tools for effective and targeted treatment strategies. GBC and control tissue samples were sequenced for miRNA expression using the Illumina HiSeq platform. Biological processes and related pathways were determined using the Panther and Gene Ontology databases. 439 significantly differentially expressed miRNAs were identified; 19 of them were upregulated and 29 were downregulated. Key enriched biological processes included immune cell apoptosis, endoplasmic reticulum (ER) overload response, and negative regulation of the androgen receptor (AR) signaling pathway. Panther analysis revealed the insulin-like growth factor (IGF)-mitogen activated protein kinases (MAPK) cascade, p38 MAPK pathway, p53 pathway, and FAS (a subgroup of the tumor necrosis factor receptor) signaling pathway as highly enriched among dysregulated miRNAs. Kirsten rat sarcoma virus (KRAS), AR, and interferon gamma (IFN-γ) pathways were identified among the key pathways potentially amenable to targeted therapy. We concluded that a combination approach involving miRNA-based interventions could enhance therapeutic outcomes. Our research emphasizes the importance of precision medicine, targeting pathways using sense and anti-sense miRNAs as potential therapies in GBC.

Abstract Objective This study aims to describe our technique and review our experience with synchronous robotic bilateral nephrectomy for large kidneys in ADPKD with the da Vinci XI and da Vinci Single Port platforms (Intuitive Surgical, Sunnyvale, CA). Materials and Methods We performed a retrospective review of all robotic bilateral nephrectomy cases from January 2020 to present at a high‐volume robotic single centre. Demographic data and perioperative details including preoperative CT scans, indication for nephrectomy and renal function were collected. We also collected post‐op course data and final specimen data details. Results Fourteen cases were included. Patient demographics, indications for surgery and specimen data are outlined in Table 1. The largest kidney removed has a measurement of 32 cm in the largest dimension on preoperative imaging. Median operating time from incision to closure was 299 min (IQR 260, 339). Median estimated blood loss was 75 cc (IQR 50, 187.5). Two patients were transfused intraoperatively. Median pre‐ and post‐operative Hgb was 11.0 and 9.6, respectively. Median length of stay was 3 days (IQR 2, 3.5). There were no intraoperative complications and no open conversions. Post‐operative complications included one incisional hematoma and one superficial wound infection. One patient was admitted to the surgical ICU post operatively for ventilatory support. Two patients were readmitted within 30 days of surgery. Conclusion The robotic approach to bilateral native nephrectomy for ADPKD should be considered when native nephrectomies are indicated. The operative times and outcomes are favourable compared with prior series, and this technique works even for very large kidneys.

Background: Hypertension is a major public health problem in India, affecting a significant proportion of the population. Drug utilization research is important for assessing the rationality of drug treatment and for identifying areas for improvement. This study examined the drug utilization pattern of antihypertensive drugs in hypertensive patients at an Outpatient Department (OPD) in Udaipur, Rajasthan, India, based on JNC-8 classification. Materials and Methods: The observational cross-sectional study included 300 hypertension patients aged above 25 attending the hypertension clinic. Exclusions were made for inpatients, age < 25, uncertain diagnosis, pregnant/lactating mothers, and patients subsequently admitted after OPD visits. Results: The majority of affected patients were above 60 years old, with most having hypertension for 2-5 years, often accompanied by Type II Diabetes Mellitus. Oral administration was the primary drug delivery route. On average, patients received 1.93 antihypertensive drugs per encounter (range: 1 to 4), with an average of 5.82 drugs per encounter (range: 1 to 12). Losartan (72%) and amlodipine (46%) were the most prescribed drugs, with Angiotensin Receptor Blockers (ARBs) being the most prescribed drug class (79.3%), followed by Calcium Channel Blockers (CCBs) at 46.6%. The most common therapy was a two-drug combination (44.6%), followed by single-drug therapy (33%). Approximately 26.3% of prescriptions indicated potential drug interactions. Conclusions: This study provides valuable baseline data on the prescribing pattern of antihypertensive drugs. Rational prescribing practices are being followed, with the majority of patients being prescribed a combination of two or three antihypertensive drugs. However, there is a need to educate patients about the risks associated with uncontrolled high blood pressure and the benefits of lifestyle changes.

Abstract The combination of Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) and endocrine therapy (ET) is the standard of care for hormone receptor-positive (HR + ), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC). Currently, there are no robust biomarkers that can predict response to CDK4/6i, and it is not clear which patients benefit from this therapy. Since MBC patients with liver metastases have a poorer prognosis, developing predictive biomarkers that could identify patients likely to respond to CDK4/6i is clinically important. Here we show the ability of imaging texture biomarkers before and a few cycles after CDK4/6i therapy, to predict early response and overall survival (OS) on 73 MBC patients with known liver metastases who received palbociclib plus ET from two sites. The delta radiomic model was associated with OS in validation set (HR: 2.4; 95% CI, 1.06–5.6; P = 0.035; C-index = 0.77). Compared to RECIST response, delta radiomic features predicted response with area under the curve (AUC) = 0.72, 95% confidence interval (CI) 0.67–0.88. Our study revealed that radiomics features can predict a lack of response earlier than standard anatomic/RECIST 1.1 assessment and warrants further study and clinical validation.

Aim and objectives The aim of this study is to propose a new clinical classification for gynecomastia management based on our experience.

Introduction: Cancer impacts not only people living with cancer but also their caregivers. In hospital, caregivers always have pressure on them and their personal and private lives are disrupted during the caring process. Aim: To identify the various factors affecting the Quality Of Life (QOL) among caregivers of cancer patients. Materials and Methods: This quantitative study with an exploratory research design was conducted in oncology Outpatient Department (OPD) of All India Institute of Medical Sciences, Rishikesh, India, from November 2019 to February 2020. A total of 256 caregivers of cancer patients, who were visiting various oncology units were included. Data regarding caregiver’s sample characteristics, clinical variables and caregiver’s Oncology Quality of Life questionnaire (CarGOQoL) were collected. Statistical analysis was done using Chi-square test and Fisher-exact tests were used to study variables. Results: Majority, 94 (37%) belonged to 41-50 years age group, 143 (56%) were females, and 142 (56%) lived in rural areas. Patients’ diagnoses were breast cancer in 94 (37%), Stage-III in 133 (52%), symptoms lasting more than 6-12 months in 103 (40%), and were partial dependent in 172 (67%). A total of 123 (48%) of caregivers scored less in the CarGOQoL questionnaire, so about half of the caregivers had a poor QOL. Caregiver coping (43%) and the private life domain were enormously affected in 193 (37%). Significant relationships with caregivers’ QOL were seen for variables like female gender (p-value=0.037), educational level of patients (p-value=0.018), caregivers with co-morbidities (p-value=0.05), and the number of earning members in the family (p-value=0.022). Conclusion: Care burden always has an impact on the caregiver’s overall QOL. It mainly affected their psychological well-being, burdens, and private lives. Therefore, comprehensive attention should be given to patients as well as caregivers.

Abstract Linear antenna arrays (LAAs) play a critical role in smart system communication applications such as the Internet of Things (IoT), mobile communication and beamforming. However, minimizing secondary lobes while maintaining a low beamwidth remains challenging. This study presents an enhanced synthesis methodology for LAAs using the Adaptive Naked Mole Rat Algorithm (ANMRA). ANMRA, inspired by mole-rat mating habits, improves exploration and exploitation capabilities for directive LAA applications. The performance of ANMRA is assessed using the CEC 2019 benchmark test functions, a widely adopted standard for statistical evaluation in optimization algorithms. The proposed methodology results are also benchmarked against state-of-the-art algorithms, including the Salp Swarm Algorithm (SSA), Cuckoo Search (CS), Artificial Hummingbird Algorithm (AHOA), Chimp Optimization Algorithm (ChOA), and Naked Mole Rat Algorithm (NMRA). The results demonstrate that ANMRA achieves superior performance among the benchmarked algorithms by successfully minimizing secondary lobes and obtaining a narrow beamwidth. The ANMRA controlled design achieves the lowest Side Lobe Level (SLL) of − 37.08 dB and the smallest beamwidth of 74.68°. The statistical assessment using the benchmark test functions further confirms the effectiveness of ANMRA. By optimizing antenna element magnitude and placement control, ANMRA enables precise primary lobe placement, grating lobe elimination, and high directivity in LAAs. This research contributes to advancing smart system communication technologies, particularly in the context of IoT and beamforming applications, by providing an enhanced synthesis methodology for LAAs that offers improved performance in terms of secondary lobe reduction and beamwidth optimization.

Abstract Deep learning (DL) models can harness electronic health records (EHRs) to predict diseases and extract radiologic findings for diagnosis. With ambulatory chest radiographs (CXRs) frequently ordered, we investigated detecting type 2 diabetes (T2D) by combining radiographic and EHR data using a DL model. Our model, developed from 271,065 CXRs and 160,244 patients, was tested on a prospective dataset of 9,943 CXRs. Here we show the model effectively detected T2D with a ROC AUC of 0.84 and a 16% prevalence. The algorithm flagged 1,381 cases (14%) as suspicious for T2D. External validation at a distinct institution yielded a ROC AUC of 0.77, with 5% of patients subsequently diagnosed with T2D. Explainable AI techniques revealed correlations between specific adiposity measures and high predictivity, suggesting CXRs’ potential for enhanced T2D screening.

BackgroundMR-Linac allows for daily online treatment adaptation to the observed geometry of tumor targets and organs at risk (OARs). Manual delineation for head and neck cancer (HNC) patients takes 45-75 minutes, making it unsuitable for online adaptive radiotherapy. This study aims to clinically and dosimetrically validate an in-house developed algorithm which automatically delineates the elective target volume and OARs for HNC patients in under a minute.MethodsAuto-contours were generated by an in-house model with 2D U-Net architecture trained and tested on 52 MRI scans via leave-one-out cross-validation. A randomized selection of 684 automated and manual contours (split half-and-half) was presented to an oncologist to perform a blind test and determine the clinical acceptability. The dosimetric impact was investigated for 13 patients evaluating the differences in dosage for all structures.ResultsAutomated contours were generated in 8 seconds per MRI scan. The blind test concluded that 114 (33%) of auto-contours required adjustments with 85 only minor and 15 (4.4%) of manual contours required adjustments with 12 only minor. Dosimetric analysis showed negligible dosimetric differences between clinically acceptable structures and structures requiring minor changes. The Dice Similarity coefficients for the auto-contours ranged from 0.66 ± 0.11 to 0.88 ± 0.06 across all structures.ConclusionMajority of auto-contours were clinically acceptable and could be used without any adjustments. Majority of structures requiring minor adjustments did not lead to significant dosimetric differences, hence manual adjustments were needed only for structures requiring major changes, which takes no longer than 10 minutes per patient.

Objective Indian hospitals (especially government-run public sector hospitals) have a nonexistent antimicrobial stewardship program (AMSP). After successfully initiating AMSPs in tertiary care hospitals of India, the Indian Council of Medical Research envisages implementing AMSP in secondary care hospitals. This study is about the baseline data on antibiotic consumption in secondary care hospitals. Materials and Methods It was a prospective longitudinal observational chart review type of study. Baseline data on antibiotic consumption was captured by a 24-hour point prevalence study of antibiotic usage and bacterial culture rate. The prescribed antibiotics were classified according to the World Health Organization (WHO) Access, Watch, and Reserve classification. All data were collated in Microsoft Excel and summarized as percentages. Results Out of the 864 patients surveyed, overall antibiotic usage was 78.9% (71.5% in low-priority areas vs. 92.2% in high-priority areas). Most of the antibiotic usage was empirical with an extremely low bacterial culture rate (21.9%). Out of the prescribed drugs, 53.1% were from the WHO watch category and 5.5% from the reserve category. Conclusion Even after 5 years of the launch of the national action plan on AMR (NAP-AMR) of India, AMSP is still non-existent in small- and medium-level hospitals in urban cities. The importance of trained microbiologists in the health care system is identified as a fulcrum in combating antimicrobial resistance (AMR); however, their absence in government-run district hospitals is a matter of grave concern and needs to be addressed sooner than later.

Background Structured reporting has the advantages of reducing ambiguity in written radiology reports with greater uniformity and comparability of reports amongst different institutes. It has multiple facets: structured format, structured content, and standardized language. While structured reporting initiative has been used in various radiology subspecialties such as oncology, cardiothoracic, abdominal and interventional radiology; skeletal dysplasia is a domain that remains largely untouched by this concept. Purpose To evaluate the impact of structured reporting in skeletal dysplasia. Methods and Materials This was an ethically approved pragmatic clinical trial. A defined number (75) of clinically diagnosed and/or genetically confirmed skeletal dysplasia radiographs were evaluated by two radiologists (reader A and reader B) with 5-and 7-years' experience in general radiology, respectively. A pre-defined structured reporting format for skeletal dysplasia was used as an interventional tool. Both the readers interpreted the radiographs before and after the training session. In addition to diagnosis, diagnostic confidence was noted using a semiquantitative scale. Improvement in diagnostic accuracy and diagnostic confidence after training were assessed. McNemar's test was used to assess the statistical significance of difference in proportion of correct diagnoses in pre- and post-education phases. An interrater reliability analysis using the Kappa statistic was performed to determine interobserver agreement between readers both in pre- and post-education phases. Results In the post-education phase, the proportion of accurate diagnosis improved from 48% (36/75) to 64% (48/75) for reader A, and from 44% (33/75) to 60% (45/75) for reader B as compared with the pre-education phase. Amongst the cases with a correct radiologic diagnosis, an increase in diagnostic confidence was noted in 18 cases for reader A, and 15 cases for reader B. In none of the cases, there was a reduction in diagnostic confidence after training. A McNemar's test determined that there was a statistically significant difference in the proportion of correct diagnoses in pre- and post-education phases, p

Background: Pazopanib hydrochloride (PZB) is a protein kinase inhibitor approved by the United States Food and Drug Administration and European agencies for the treatment of renal cell carcinoma and other renal malignancies. However, it exhibits poor aqueous solubility and inconsistent oral drug absorption. In this regard, the current research work entails the development and evaluation of the extrudates of pazopanib hydrochloride by the hot-melt extrusion (HME) technique for solubility enhancement and augmenting oral bioavailability. Results: Solid dispersion of the drug was prepared using polymers such as Kollidon VA64, hydroxypropylmethylcellulose (HPMC), Eudragit EPO, and Affinisol 15LV in a 1:2 ratio by the HME process through a lab-scale 18 mm extruder. Systematic optimization of the formulation variables was carried out with the help of custom screening design (JMP Software by SAS, Version 14.0) to study the impact of polymer type and plasticizer level on the quality of extrudate processability by measuring the torque value, appearance, and disintegration time as the responses. The polymer blends containing Kollidon VA64 and Affinisol 15LV resulted in respective clear transparent extrudates, while Eudragit EPO and HPMC extrudates were found to be opaque white and brownish, respectively. Furthermore, evaluation of the impact of process parameters such as screw rpm and barrel temperature was measured using a definitive screening design on the extrude appearance, torque, disintegration time, and dissolution profile. Based on the statistical outcomes, it can be concluded that barrel temperature has a significant impact on torque, disintegration time, and dissolution at 30 min, while screw speed has an insignificant impact on the response variables. Affinisol extrudates showed less moisture uptake and faster dissolution in comparison to Kollidon VA64 extrudates. Affinisol extrudates were evaluated for polymorphic stability up to a 3-month accelerated condition and found no recrystallization. PZB–Extrudates using the Affinisol polymer (Test formulation A) revealed significantly higher bioavailability (AUC) in comparison to the free Pazopanib drug and marketed formulation.

Abstract Background Keratoconjunctivitis sicca or dry eye disease (DED) is a multifactorial disorder underpinned by a complex inflammatory cycle. Introduction of topical cyclosporine has been a significant advance in the management of DED. In recent years advancements in formulation technology have led to development of micellar nano-particulate (MNP) cyclosporine formulations that promise better penetration into ocular target tissues and potential for reduced ocular surface irritation. Methods We compared two dosing regimes of a proprietary MNP cyclosporine emulsion with the widely marketed topical cyclosporine formulation Restasis™ in a multicenter parallel-group randomised trial in patients with DED. Patients were randomised to one of 3 treatment groups with 90 patients eligible for the per protocol analysis: 30 in the higher dose test arm A; 32 in the lower dose test arm B; and 28 in the Restasis™ control arm C. All scored efficacy endpoints were tested for significance by comparing the mean change in scores from baseline in the test groups with that in the control group at 12 weeks, using the Student’s t test. Wilcoxon’s rank sum test was used to test individual symptom scores and clinician’s global evaluation of treatment grades. Results Corneal fluorescein staining score, the primary efficacy endpoint, decreased by 6.8 ± 4.0, 5.7 ± 3.9, and 4.6 ± 3.6 points in the 3 groups respectively, indicating superior efficacy in test arm A in comparison to control arm C (p = 0.0026). Schirmer’s tear test, conjunctival lissamine staining score, ocular surface disease index, and individual dry eye symptom scores also favoured higher dose MNP cyclosporine over Restasis™. The study failed to differentiate the treatment arms in terms of clinician’s global evaluation of treatment, use of tear substitutes, best corrected visual acuity or safety and toleration. Conclusion The results indicate that the dose of 1 drop of a 0.05% w/v ophthalmic emulsion of MNP cyclosporine administered topically twice daily yields better outcomes at 12 weeks than the lower dose tested in the study, and is more efficacious than an equivalent dose of Restasis™, the active control used in the study. Trial registration This trial was registered in the Clinical Trials Registry of India on 29/03/2019, and was assigned registration number CTRI/2019/03/018319.

Treatment of wastewater has been a hotspot of research since ages. Emerging technologies and methodologies have been postulated to resolve the issue worldwide. Almost 97.2% of our earth is covered with water bodies, out of which 12,500 water bodies are situated in India. As per the statistics, nearly 70% water bodies are polluted in Southern Asia. Presence of emerging pollutants exacerbate the quality of flowing water. Amongst all possible ways, microbial bioremediation has been considered one of the most thriving methods to treat wastewater. This research will manifest about the isolation of B. subtilis from soil followed by its characterisation and action in treatment of wastewater which was collected from industry. From the study, it was concluded that B. subtilis holds the potential of degradation. Significant decrease in values of BOD and COD were achieved.

The Acanthamoeba genus comprises the free-living amoebae that are ubiquitously present as opportunistic pathogens. They cause serious human diseases—for instance, Acanthamoeba keratitis (AK), granulomatous amoebic encephalitis (GAE), cutaneous acanthamoebiasis and disseminated infections. The traditional method for classifying Acanthamoeba was based on the morphological examination of cysts. However, this method was less consistent as the morphology of cysts changes with the culture conditions. After the advent of molecular techniques, genotyping is considered an essential tool in accurately identifying Acanthamoeba at the species level and is further helpful in classification up to the sub-genotype level. The most recommended and currently used methods for Acanthamoeba genotyping are 18S and 16S rDNA gene sequencing. Based on these two genes, Acanthamoeba is classified into 23 genotypes. Out of these, it is the T4 genotype that is most commonly associated with clinical disease and isolation from environmental samples. The T4 genotype contains more than ten species within it. Differences in geographical distribution, virulence, pathogenesis and drug susceptibility profile have been observed among different genotypes. However, whether such differences exist within sub-genotypes/species under T4 is yet unknown. In the present study, 11 Acanthamoeba isolates, which were already characterized as the T4 genotype by the hypervariable region of diagnostic fragment 3 (DF3) of the 18S rDNA, were sub-genotyped using the 16S rDNA mitochondrial sequence. Nine of these were isolated from patients with AK and two from water samples. Phylogenetic analysis of these isolates attributed them to four sub-genotypes (T4a (n = 6), T4b (n = 1), T4Neff (n = 2) and T4d (n = 2)). The study highlights the potential use of 16S in the sub-genotyping of Acanthamoeba T4. The 16S rDNA sequences of two isolates, one from an Acanthamoebic keratitis (AK) patient and one environmental, were found to group with A. mauritaniensis (T4d). This group was believed to be a non-pathogenic environmental Acanthamoeba and the identification of the AK isolate may be confirmed by whole-genome sequencing.

Introduction: Carcinoma esophagus has heterogeneous and changing epidemiology and clinicopathological characteristics. A thorough literature search revealed a knowledge gap regarding esophageal cancers in this sub-Himalayan region. Materials and Methods: This prospective, descriptive, observational study was conducted at a tertiary institute in the sub-Himalayan region, including 119 patients from January 2021 to December 2022. Patients above 18 years of age with histologically proven cancer esophagus and giving their informed consent were recruited. The aim was to study the clinicopathological characteristics of adult patients with carcinoma esophagus. Descriptive data were collected, and statistical analysis was done using the SPSS version 23 software. Results: The mean age of presentation was 58.55 ± 10.76 years, with the male-to-female ratio of 1.70:1 and rural-to-urban distribution of 2.05:1. Distribution was higher at higher altitudes. The majority of patients consumed large amounts of hot beverages on a regular basis (83.2%). The disease was more common in the lower (V) and upper lower (IV) socioeconomic status. Progressive dysphagia (Grade III to V in 96.6%), loss of appetite, and unintentional significant weight loss were the common presenting symptoms. The most common involved subsite was middle thoracic (53.4%), followed by lower thoracic (40.5%), upper thoracic (28.4%), and cervical esophagus (12.1%). Only 12.6% of patients presented as Stage II, the rest were in a higher stage. All patients were having squamous cell carcinoma except one case (0.8%) of adenocarcinoma and small-cell carcinoma and two cases (1.6%) of NET. The mean primary delay was 1.73 ± 0.90 months, and the mean secondary delay was 1.02 ± 0.77 months. Conclusion: Our results align with the published literature with additional observations of changes in disease distribution with altitudes. However, a following study is required for trend analysis and develop policies for the primary prevention and early detection of carcinoma esophagus.

Background and Objective: The ovary is considered one of the complex organs with respect to histology, embryology, steroidogenesis, as well as tumor incidence. In order to attain a better knowledge of the disease mechanism, the current research highlights a correlation between the pathological and clinical features of epithelial ovarian carcinoma. The aim of this research is to evaluate the oncological and clinicopathological results of patients who were diagnosed with ovarian cancer (OC) in a tertiary care center situated in the Sub-Himalayan region. Materials and Methods: Seventy patients with OC registered at the department of surgical oncology, obstetrics and gynecology, and medical oncology between January 2019 and December 2021 had been estimated in this prospective and retrospective observational research. Age, histological type, stage at presentation, and treatment pattern were the characteristics examined in the patients. Results: The patients' average age was 48.18 ± 12.309 years, having a maximum age of 74 years as well as the minimum age of 21 years. The most frequent symptom was abdominal pain (30%). Hypertension was the most commonly seen comorbidity in 7 (10%) patients. Most of the patients had high-grade serous carcinoma in 40 (56.1%) patients. Neoadjuvant chemotherapy and adjuvant type of chemotherapy were given to 30 (42.9%) patients. After 3 months, follow-up imaging showed that there was no residual disease in 51 (72.8%) patients, and the disease progression was seen in 8 (11.4%) patients. Conclusion: Because of their clinical correlation, behavioral predictability, as well as proper management of patient care, the right clinicopathological detection of ovarian tumors is extremely important.

Background: Yoga is an emerging intervention causing improvement in physical, mental, and spiritual well-being. Its role in improving outcomes in patients with amputation was investigated. Methodology: Patients with traumatic lower limb amputation (n = 50) were enrolled and randomized to the Yoga group (n = 26) against control (n = 24). Sociodemographic details, quality of life (QOL) (World Health Organization QOL-BREF), Depression anxiety stress scale (DASS), Rosenberg self-esteem scale, and amputee body image score were applied at baseline, 6,–18 weeks of amputation. Results: Sociodemographic and clinical variables were comparable between groups. At 18 weeks, the Yoga group had better QOL (P = 0.005) than the control group. Symptoms of depression (0.02) and anxiety (

Data Privacy has increasingly become a matter of concern in the era of large public digital respositories of data. This is particularly true in healthcare where data can be misused if traced back to patients, and brings with itself a myriad of possibilities. Bring custodians of data, as well as being at the helm of disigning studies and products that can potentially benefit products, healthcare professionals often find themselves unsure about ethical and legal constraints that undelie data sharing. In this review we touch upon the concerns, leal frameworks as well as some common practices in these respects.

Introduction: Acute large traumatic wounds require temporary dressing prior to the definitive soft tissue reconstruction, as the physiological derangement during the immediate postinjury period delays the definitive surgical intervention. Selecting an ideal dressing material from numerous available synthetic dressings and skin substitutes poses a challenge. Although amniotic membrane (AM) scaffold has a definitive role in promoting wound healing in burns and chronic wounds, however, its efficacy in acute large traumatic wound is lacking. The present trial aimed to evaluate the safety and efficacy of AM in wound bed preparation before the definitive soft-tissue reconstruction in acute large traumatic wounds. Methods: Sixty patients with acute large traumatic wounds (>10 cm × 10 cm) were divided into two groups (conventional dressing and AM dressing) using simple mixed block randomization. Wounds were assessed using the Bates Jensen Score at various timelines for the signs of early wound healing. The primary outcome was to evaluate the time taken for the wound bed preparation for definitive soft-tissue reconstruction. The secondary outcome was the pain assessment and complications, if any. Results: There was significant reduction in the wound exudate as well as peripheral tissue edema in the intervention group (P = 0.01). AM dressing was significantly less painful (P = 0.01). The incidence of wound infection and need for debridement was decreased in the intervention group. However, the time interval to definitive soft-tissue coverage was statistically insignificant and comparable in both the groups. No adverse reactions were seen in either group. Conclusion: AM dressings are safe and efficacious with significant reduction in wound exudates and peripheral edema. However, these dressings do not hasten the wound maturation as compared to conventional dressings. AM dressings can be used as a less painful alternative to conventional dressing in the management of large acute posttraumatic wounds.

Background: Pancreatic carcinoma carries a dismal prognosis. Late disease presentation at an advanced stage contributes to poor survival. Objectives: The objective of the present study was to describe the clinical presentation and treatment outcomes of patients with pancreatic cancer at our institution. Materials and Methods: This was a retrospective study conducted in the Department of Surgery at the All India Institute of Medical Sciences, Rishikesh (Dehradun, Uttarakhand); a tertiary care hospital in the sub-Himalayan region of India. We included the data of 203 consecutive patients with pancreatic cancer, with both resectable and unresectable disease, who were treated at our institute from January 2017 to February 2020. The clinicodemographic profile and management outcomes were analyzed. Results: Of the 203 patients, 125 (61.6%) were male; the mean age was 58 years (range, 35-78). Common presenting symptoms included jaundice in 65 (32%), and abdominal pain in 39 (19.2%). On contrast-enhanced computer tomography scan, the tumor originated most commonly in the pancreatic head (111 [54.7%]); adenocarcinoma was the tissue diagnosis in 200 (98.5%) cases. The disease was unresectable in 167 (82.3%) patients. There were 36 (17.7%) patients with resectable tumors who underwent Whipple's procedures. In the 167 patients with advanced pancreatic malignancy, the median overall survival was 12.8 months (95% Confidence Interval (CI), 8.4-14.4), while that for the 36 patients with resectable disease who underwent pancreaticoduodenectomy was 20.2 months (95% CI, 18.4-24.2). Conclusion: Less than 20% of patients with pancreatic cancer have localized disease and can be offered “curative” surgery. There is an unmet need to develop novel strategies to extend survival. Possible approaches include early diagnosis and the use of neoadjuvant treatments in an attempt to increase the number of resectable cases.

Extramedullary hematopoiesis (EMH) is a rare entity most often associated with primary myelofibrosis, chronic myeloproliferative neoplasms, chronic hemolytic states, such as thalassemia, sickle cell anemia and certain solid tumors. Various theories have been postulated as the mechanism for occurrence of EMH. Iron deposition and/or fatty infiltration along with increased density of liver and spleen may be observed on imaging. Also, organs may show diffuse involvement or mass like foci of hematopoiesis on imaging. Treatment includes transfusion, surgery, hydroxyurea and radiation. In this review we narrate the clinicopathological features, radiological imaging and treatment strategies of non hepatosplenic Extramedullary hematopoiesis.

Abstract Introduction Brain metastases (BM) are associated with dismal prognosis as they cause significant morbidity and affect the quality of life of patients. Management of BM depends on the following factors: age, patient performance, size and the number of lesions, location of the tumor, comorbidities, primary tumor type, and extracranial disease burden. In the present study, the pattern of occurrence, clinical characteristics, treatment outcome of brain metastases, and factors, tumor characteristics, and treatment that may impact BM patients’ overall survival were analyzed. Methods Retrospective analysis of medical records of 116 patients with histologically proven primary site solid tumors with brain metastases was done in the present study. Clinicoradiological and pathological parameters were documented. The relationship between variables and outcome was assessed by univariate analysis using the Cox proportional regression model to reach a significance of p < 0.05, to determine independent predictors of overall survival. Results One hundred sixteen patients of BM from various solid malignancies were included. Age ranged from 18 to 81 years (median 53.5). One hundred four patients received WBRT with a dose range of 8–40Gy/1–15fr, 7 received SRS with a dose of 18–24Gy depending on the size of the metastatic lesion, and 2 received SRT 27–33Gy/3fr. At the time of final analysis, 47 patients with BM had expired, 60 were lost to follow-up, and 9 were alive. Median survival was 8.25 (0.5–32.5 months) months. Female gender (χ 2 = 8.423; p = 0.015), RPA I (χ 2 = 9.353; p = 0.05), and metachronous BM (χ 2 = 3.793; p = 0.03) were associated with better survival. Patients with age 41–50 years, adenocarcinoma lung histology, and supratentorial location survived more than 2 years but did not show any statistical significance. Conclusion Brain metastases portend a very dismal prognosis. Certain clinicoradiological and pathologic factors have been identified to affect survival. More prospective multicentric trials, with a larger sample size, need to be conducted to assess the benefit of radiation in patients with limited life expectancy and identify prognostic and predictive factors for survival.

Pediatric chordomas are rarely described in the literature with most cases being managed surgically followed by adjuvant radiotherapy for local control. We present a case of an 18-year-old female with thoracic chordoma causing significant mass effect resulting in tracheal deviation, esophageal compression, and splaying of the great vessels. Ultrasound-guided anterior left transcervical percutaneous biopsy of the neck with surgical pathology immunohistochemistry confirmed the presence of chordoma. The patient underwent extensive palliative debulking followed by radiation therapy leading to clinical improvement. This case demonstrated that an ultrasound-guided percutaneous biopsy is an essential procedure in the diagnosis and treatment of chordoma, which led to successful treatment when followed by surgery and radiation.

Objectives To explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks’ gestation in England and Wales.Design Population based cohort study.Setting England and Wales, comprising routine data for births and hospital records.Participants Babies alive at the onset of care in labour at 22 weeks+0 days to 22 weeks+6 days and at 23 weeks+0 days to 24 weeks+6 days for comparison purposes between 1 January 2018 and 31 December 2021.Main outcome measures Percentage of babies given survival focused care (active respiratory support after birth), admitted to neonatal care, and surviving to discharge in 2018-19 and 2020-21.Results For the 1001 babies alive at the onset of labour at 22 weeks' gestation, a threefold increase was noted in: survival focused care provision from 11.3% to 38.4% (risk ratio 3.41 (95% confidence interval 2.61 to 4.45)); admissions to neonatal units from 7.4% to 28.1% (3.77 (2.70 to 5.27)), and survival to discharge from neonatal care from 2.5% to 8.2% (3.29 (1.78 to 6.09)). More babies of lower birth weight and early gestational age received survival focused care in 2020-21 than 2018-19 (46% to 64% at

Presents corrections to the paper, (Corrections to “Multi Objective Prioritized Workflow Scheduling Using Deep Reinforcement Based Learning in Cloud Computing”).

Abstract Background There are many ways that students and trainees learn to talk about patients. The way trainees and physicians use language during clinical care is important, as labeling patients can have adverse effects on patient safety. Communication is considered a core competency by The Accreditation Council on Graduate Medical Education (ACGME). Past research has shown that participants in narrative medicine curricula report developing stronger communication skills however it is not clear how these workshops motivated trainees to use language differently during patient care. To explore this, we interviewed second-year residents in academic year 19–20 about their experiences both in participating in narrative medicine workshops and giving patient care. Methods The framing context for this constructivist thematic analysis is a series of narrative medicine workshops facilitated for interns in an internal medicine residency program at a large academic medical center during the 18–19 academic year. We developed a semi-structured interview study that allowed residents to reflect on their experiences in these workshops. Eighteen out of 60 residents (30%) were interviewed. Results We found that sessions regarding language use in patient care shaped how interns thought about and used language during clinical work, a finding that arose spontaneously during interviews. Conclusions Our research suggests that workshops aimed specifically at addressing the use of language in healthcare can have meaningful impact on trainees. Our study makes a unique contribution to the scholarship by suggesting that training in narrative medicine can lead to a change in the way that trainees use language during their clinical work.

Abstract Background Healthcare workers (HCWs) are at high risk of SARS-CoV-2 infection. Effective use of personal protective equipment (PPE) reduces this risk. We sought to determine the prevalence and predictors of self-reported access to appropriate PPE (aPPE) for HCWs in the UK during the COVID-19 pandemic. Methods We conducted cross sectional analyses using data from a nationwide questionnaire-based cohort study administered between December 2020-February 2021. The outcome was a binary measure of self-reported aPPE (access all of the time vs access most of the time or less frequently) at two timepoints: the first national lockdown in the UK in March 2020 (primary analysis) and at the time of questionnaire response (secondary analysis). Results Ten thousand five hundred eight HCWs were included in the primary analysis, and 12,252 in the secondary analysis. 35.2% of HCWs reported aPPE at all times in the primary analysis; 83.9% reported aPPE at all times in the secondary analysis. In the primary analysis, after adjustment (for age, sex, ethnicity, migration status, occupation, aerosol generating procedure exposure, work sector and region, working hours, night shift frequency and trust in employing organisation), older HCWs and those working in Intensive Care Units were more likely to report aPPE at all times. Asian HCWs (aOR:0.77, 95%CI 0.67–0.89 [vs White]), those in allied health professional and dental roles (vs those in medical roles), and those who saw a higher number of COVID-19 patients compared to those who saw none (≥ 21 patients/week 0.74, 0.61–0.90) were less likely to report aPPE at all times. Those who trusted their employing organisation to deal with concerns about unsafe clinical practice, compared to those who did not, were twice as likely to report aPPE at all times. Significant predictors were largely unchanged in the secondary analysis. Conclusions Only a third of HCWs in the UK reported aPPE at all times during the first lockdown and that aPPE had improved later in the pandemic. We also identified key determinants of aPPE during the first UK lockdown, which have mostly persisted since lockdown was eased. These findings have important implications for the safe delivery of healthcare during the pandemic.