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Introduction: The present inquiry seeks to investigate whether the current regimens of QSEs (Quadriceps-Strengthening Exercises) aggravate the disease while mitigating symptoms. Materials and methods: A comparative study was conducted on 32 patients with medial compartment osteoarthritis of knees. While the neutral group of 16 patients was constituted of those with an anatomical-lateral-femoro-tibial-angle (aFTA) 176-180º, varus group comprised an equal number of patients with an aFTA >180º. A home-based 12-week strength-training program involving weekly visitsto hospital for supervised sessions was administered. The outcome measures were visual-analog-scale (VAS), medial patello-femoral joint tenderness (MPFJT), time-up-and-go-test (TUGT), stair-climb test, step test, WOMAC, IKDC scores, aFTA, hip-knee-ankle (HKA) angle, lateral-tibio-femoral-joint-separation (LTFJS), and horizontal-distance-from-centre-of-knee-to-Mikulicz-line. Results: There was a significant increase in quadriceps strength (p

Omkar Shinde,1 Aditi Jhaveri,1 Ajinkya M Pawar,1 Mohmed Isaqali Karobari,2,3 Kulvinder Singh Banga,1 Suraj Arora,4 Anuj Bhardwaj,5 Anastasia Gabriella Djuanda,6 Dian Agustin Wahjuningrum6 1Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, Maharashtra, 400034, India; 2Department of Restorative Dentistry and Endodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh, 12211, Cambodia; 3Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences University, Chennai, Tamil Nadu, 600077, India; 4Department of Restorative Dental Sciences, King Khalid University, Abha, 61421, Saudi Arabia; 5Department of Conservative Dentistry and Endodontics, College of Dental Sciences and Hospital, Indore, 453331, India; 6Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlingga, Surabaya City, East Java, 60132, IndonesiaCorrespondence: Mohmed Isaqali Karobari, Department of Restorative Dentistry & Endodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh, 12211, Cambodia, Email dr.isaq@gmail.com Dian Agustin Wahjuningrum, Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlingga, Surabaya City, East Java, 60132, Indonesia, Email dian-agustin-w@fkg.unair.ac.idIntroduction: COVID-19 has had a new challenge on dental workers, radically altering clinical and personal management. The cross-sectional survey sought to examine and comprehend the influence of COVID-19 on Indian dentistry practitioners.Methods: A 38-item questionnaire-based survey was communicated to Indian dental practitioners through a web-based form (Google form). The questionnaire was categorized into four sections: (i) Personal protective equipment (PPE), (ii) dental treatments, (iii) auxiliary management, and (iv) personal impact. The findings were examined and studied in order to comprehend the repercussions of COVID-19. The questionnaire was completed by 513 of the 1129 dentists to whom it was delivered.Results: For the current questionnaire, a response rate that we received was 45.44%. When compared to the pre-pandemic era, the use of PPE has increased dramatically (95.7%). The use of PPE alleviated dental practitioners’ and patients’ doubts about viral transmission. The epidemic prompted the Ministry of Health and Family Welfare (MoHFW) to issue specific recommendations for dental treatments, which were followed by 92.5% of dentists. The majority of dentists reported a considerable impact on both financial and mental health concerns. Teleconsulting and distant learning gained greater prominence. The COVID-19 epidemic affected the lives of dental professionals both within and outside of the dental setting, as well as the auxiliary.Conclusion: COVID-19 has left a trail of devastation in its aftermath. Dentists were affected both emotionally and professionally. Dentists rapidly and uniformly followed the revised recommendations.Keywords: auxiliary, COVID-19, dentist, distance learning, mental health, mouthwashes, PPE, psychological impact, rubber dam, tele consulting

Murlidhar Rajagopalan,1 Sunil Dogra,2 Kiran Godse,3 Bikash Ranjan Kar,4 Sai Krishna Kotla,5 Shekhar Neema,6 Abir Saraswat,7 Swapnil Deepak Shah,8 Nina Madnani,9,10 Vidyadhar Sardesai,11 Rajiv Sekhri,12 Sachin Varma,13 Sandeep Arora,14 Pallavi Kawatra15 1Department of Dermatology, Apollo Hospital, Chennai, India; 2Department of Dermatology Venereology & Leprology Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India; 3DY Patil University School of Medicine, Navi Mumbai, India; 4Department of Dermatology, IMS and SUM Hospital, Bhubaneshwar, Odisha, India; 5Department of Dermatology, Yashodha Hospital, Secunderabad, India; 6Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India; 7Indushree Skin Clinic, Lucknow, India; 8Department of Dermatology, Ashwini Rural Medical College, Solapur, India; 9Hinduja Hospital, Mumbai, India; 10Sir. H. N. Reliance Hospital, Mumbai, India; 11Bharati Vidyapeeth Medical College, Pune, India; 12Fortis Hospital, Noida, India; 13Skinvita Clinic, Kolkata, West Bengal, India; 14Army College of Medical Sciences, New Delhi, India; 15Novartis, Mumbai, IndiaCorrespondence: Murlidhar Rajagopalan, Department of Dermatology, Apollo Hospital, Chennai, India, Email docmurli@gmail.comPurpose: The primary objective of the study was to understand the therapeutic inertia in treatment and management of plaque psoriasis among dermatologists, along with determining the preferred treatment choices for management of plaque psoriasis; it also included the resulting treatment satisfaction among patients. The secondary objective was to identify the gaps in terms of knowledge and attitude among dermatologists and the expectations of patients.Patients and Methods: A multicentre, cross-sectional quantitative survey was conducted among dermatologists and patients with moderate to severe plaque psoriasis across India. The interviews were conducted either face to face or via telephone between September and November 2020, using structured and validated questionnaires based on specific themes. The data obtained were statistically analysed, wherever applicable.Results: Overall, 207 adult patients with moderate-to-severe plaque psoriasis and 303 dermatologists were interviewed. Post experiencing symptoms, 44% of the patients visited general physicians for treatment and there was an average 7.8-month delay by the patients to consult a dermatologist. Approximately one-fourth of patients used home remedies before seeking medical help. One-third of dermatologists used the Psoriasis Area and Severity Index (PASI) for assessing the disease severity. Majority of dermatologists preferred combination therapy for their patients. The lack of quick resolution and side effects were the major reasons for changing the treatment. Overall, only 35% of the patients complied to current treatment. Satisfaction with existing forms of therapies was highest for mild plaque psoriasis (62%) as confirmed by dermatologists, while 52% of the overall patients were satisfied with their therapy. Majority of the patients (64%) affirmed living with plaque psoriasis impacted their lives.Conclusion: This first-of-its-kind survey in India highlighted the gaps in terms of the disease journey between dermatologists and patients. The survey emphasises the need for shared decision-making and may benefit dermatologists in suggestive modifications of the treatment algorithm and disease management in clinical settings.Keywords: therapeutic inertia, psoriasis, adherence, treatment expectations, treatment goals, diagnosis

Shaik Mohamed Asif,1 Khalil Ibrahim Assiri,1 Hussain Mohammed Al Muburak,1 Fawaz Abdul Hamid Baig,2 Saeed Abdullah Arem,1 Suraj Arora,3 Shaik Mohammed Shamsudeen,1 Mansoor Shariff,4 Shaheen Shamsuddin,5 Anas Abdullah Mohammed Lahiq4 1Department of Diagnostic Science and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia; 2Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia; 3Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia; 4Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia; 5Department of Orthodontics, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi ArabiaCorrespondence: Shaik Mohamed Asif, Department of Diagnostic Science and Oral Biology, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia, Tel +966 557361821, Email masif020@gmail.comPurpose: Dentists face a great deal of professional stress, in dental school and in practice. Their personal, as well as professional lives, get affected negatively by stress and poor mental health. This study aims to evaluate anxiety and depression among dentists of Abha in kingdom of Saudi Arabia.Materials and Methods: A cross-sectional study was carried out among 246 registered dentists of Abha to assess anxiety and depression. Participants willing to participate, and completely filled questionnaire were included in study. Data regarding demography, work-related characters, lifestyle and self-reported physical and mental status were collected. Mental status was measured by using pre validated questionnaire Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS). Data were analyzed using Statistical Package for Social Sciences (SPSS 20) by IBM. Descriptive statistics, Pearson correlation, independent t test and one way ANOVA were used to analyze the data at the significant interval of p≤ 0.05.Results: Different levels of anxiety and depression were noticed both in males and female dentist. There was no statistical difference in the mean scores between males and females. There was a statistical difference of anxiety and depression scores noticed among dentist working in government institution, with five to ten years of experience. Habits of smoking were shown to significantly affect the risk of anxiety and depression scores.Conclusion: Dentist due to nature of the practice are prone for anxiety and clinical depression. Stress coping methods should be included in dental curriculum which would indirectly improve professional abilities and personal life.Keywords: anxiety, dentists, depression

INTRODUCTION: The movement and steadiness of the shoulder joint is due to both the dynamic and static stabilisers. Recurrent anterior shoulder instability is common due to the Bankart lesion or the Hill Sachs lesion. The bone loss and soft tissue failure due to these lesions causing instability is well compensated by Latarjet procedure which acts by triple blocking effect of the bone graft, the sling effect of the conjoint tendon of subscapularis and the ligament of the coracoacromial ligament stump. MATERIALS AND METHODS: Middle-aged patients with recurrent anterior shoulder dislocation and a mid-range instability on clinical assessment with an isolated glenoid bone loss of 20% or Bankart lesion with engaging Hill Sachs lesion were selected for the study. The surgical procedure included a subscapularis split to expose the glenoid. The coracoid graft harvested was prefixed with Kirschner wires and placed flush over the glenoid ensuring no medial or lateral overhang and fixed with 4.0mm cancellous screws with the washer. The functional outcome was measured with the ROWE score and ASES score and the movements were evaluated. RESULTS: A total of 24 patients fulfilled the inclusion criteria. Post-operatively at final follow-up, the mean ROWE score was 97.08 ±8.45 and the mean ASES score was 94.4±9.10. One patient had screw breakage as a complication and another had restriction of movement which was managed with physiotherapy. CONCLUSION: Open Latarjet is an effective procedure for recurrent anterior shoulder instability in non-athletic middle-aged patients as a excellent functional outcome was achieved with this technique. We therefore recommend open Latarjet as an alternative to arthroscopic treatment in developing countries where patient affordability and the availability of the resources are the issues.

Suraj Arora,1 Shahabe Abullais Saquib,2 Nilofar Attar,3 Sandeep Pimpale,4 Khwaja Saifullah Zafar,5 Priyanka Saluja,6 Anshad M Abdulla,7 Shaheen Shamsuddin8 1Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha 61321, Saudi Arabia; 2Periodontics and Community Dental Sciences, College of Dentistry, Research Center for Advanced Materials Science, King Khalid University, Abha 61321, Saudi Arabia; 3Department of Periodontics, Government Dental College and Hospital, Mumbai, Maharashtra, India; 4Department of Periodontics, Nair Dental College and Hospital, Mumbai, Maharashtra, India; 5Department of Basic Medical Sciences (Emergency Medical Service), College of Applied Medical Sciences, King Khalid University, Abha 61321, Saudi Arabia; 6Department of Conservative Dentistry and Endodontics, JCD Dental College Vidyapeeth, Sirsa, Haryana 125055, India; 7Department of Pediatric Dentistry & Orthodontics, College of Dentistry, King Khalid University, Abha 61321, Kingdom of Saudi Arabia; 8Orthodontics and Dentofacial Orthopedics, Department of Preventive Dental Sciences, College of Dentistry, King Khalid University, Abha 61321, Kingdom of Saudi ArabiaCorrespondence: Priyanka SalujaDepartment of Conservative Dentistry and Endodontics, JCD Dental College Vidyapeeth, Sirsa 125055, Haryana, IndiaTel +91 9463872774Email priyanka.salujaarora@gmail.comPurpose: The current scenario of the COVID-19 pandemic has forced dentists to prepare themselves by updating their knowledge and receive training to face the present and after effects of COVID-19. The present survey was thus conducted to assess the knowledge, risk perception, attitude, and preparedness of the dentists in India about COVID-19.Materials and Methods: A cross-sectional online survey was carried out among registered dentists in India. A self-administered, anonymous, questionnaire comprising of 25 close-ended questions was circulated to gather the relevant information. A total of 765 dentists submitted a response, out of which 646 complete responses were included in the statistical analysis. Pearson’s Chi-square test was used for inter-group statistical comparison.Results: The majority (80.8%) of the dentists had a fair knowledge about the characteristics of COVID-19. Nearly 60.7% and 49.7% of the dentists had taken infection control training and special training for COVID-19, respectively. Nearly 50% of the dentists had the perception that COVID-19 is very dangerous. Only 41.8% of the dentists were willing to provide emergency services to patients. Most of the dentists had an opinion that there is a need to enhance personal protective measures. During the survey, it was found that varied technological advances are offered to dentists to ensure good clinical practice. They also concurred that there was a need to standardize the tools and measures available to carry out dental practices.Conclusion: In the present study, Indian dentists have presented satisfactory knowledge with adequate preparedness as the majority of them had a fair level of knowledge with significantly higher knowledge among female respondents and those with post-graduation studies. Dentists should make judicious utilization of all the precautionary measures to safely practice dentistry. As we are going through an evolutionary phase where new advances are expected to evolve, dentists will definitely emerge successfully out from the crisis of the COVID-19 pandemic.Keywords: corona virus, healthcare workers, dentistry, Asian, awareness

Fernando J Martinez,1 Klaus F Rabe,2 Brian J Lipworth,3 Samir Arora,4 Martin Jenkins,5 Ubaldo J Martin,6 Colin Reisner6,7 1Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA; 2Department of Pneumonology, LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany; 3Division of Molecular and Clinical Medicine, Scottish Centre for Respiratory Research, Ninewells Hospital, University of Dundee, Dundee, Scotland, UK; 4Aventiv Research Inc., Columbus, OH, USA; 5Global Medicines Development, AstraZeneca, Cambridge, UK; 6Research and Development, AstraZeneca, Gaithersburg, MD, USA; 7R&D Biopharmaceuticals, AstraZeneca, Morristown, NJ, USACorrespondence: Fernando J MartinezJoan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th Street, Room M-522, Box 130, New York, NY 10065, USATel +1646 962 2748Email fjm2003@med.cornell.eduBackground: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends a short-acting bronchodilator or single long-acting bronchodilator as an initial pharmacological treatment for GOLD category A patients with COPD. We pooled data from the PINNACLE-1, -2, and -4 studies to evaluate the efficacy and safety of the dual bronchodilator fixed-dose combination glycopyrrolate/formoterol fumarate metered dose inhaler (GFF MDI), formulated using co-suspension delivery technology, in GOLD category A patients with moderate-to-very severe COPD.Materials and Methods: PINNACLE-1, -2, and -4 were Phase III, randomized, double-blind, parallel-group, multicenter studies (NCT01854645, NCT01854658, and NCT02343458). Patients received 24 weeks’ treatment with GFF MDI 18/9.6 μg, glycopyrrolate (GP) MDI 18 μg, formoterol fumarate (FF) MDI 9.6 μg, or placebo MDI twice daily. GOLD category A patients were identified based on a COPD Assessment Test score of 1), peak change from baseline in FEV1 within 2 hrs post-dose, and adverse events (AEs).Results: The pooled intent-to-treat population comprised 729 GOLD category A patients. GFF MDI significantly improved morning pre-dose trough FEV1 at Week 24 versus GP MDI, FF MDI, and placebo MDI (least squares mean [LSM] differences 54 mL, 62 mL, and 188 mL, respectively; all p≤0.0053), and peak FEV1 at Week 24 versus GP MDI, FF MDI, and placebo MDI (LSM differences 124 mL, 104 mL, and 307 mL, respectively; all p

Kimberly Page,1,2 Fares Qeadan,1,2 Clifford Qualls,2 Karla Thornton,1 Sanjeev Arora1 1Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; 2Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USACorrespondence: Kimberly PageDepartment of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 98131, USATel +1505-272-2520Email Pagek@salud.unm.eduAbstract: Propensity score analysis is a statistical approach to reduce bias often present in non-randomized observational studies. In this paper we use this method to re-analyze data from a study that assessed whether patients receiving HCV treatment from providers in Project ECHO had different clinical outcomes than patients treated by specialists from an academic medical center (UNM HCV clinic) but in which treatment assignment was not randomized. We modeled the best estimated probability of treatment assignment, and then assess differences overall SVR and SVR in patients with genotype 1 infection by treatment arm using Stabilized Inverse Probability of Treatment Weights (SIPTW). Results show that after adjustment for SIPTW, HCV treatment outcomes were significantly better for the ECHO patients compared to the UNM HCV clinic patients. Higher proportions of patients treated by primary care providers achieved SVR and SVR with genotype 1 compared to those treated at UNM HCV clinic with 15.1% and 16.3% absolute differences, respectively. These results indicate that previously published results (showing no differences) were biased, and resulted in an underestimation of the treatment effect of ECHO on HCV treatment.Keywords: propensity scoring, ECHO, hepatitis C virus, treatment

Minimal residual disease (MRD) assessment is a known surrogate marker for survival in multiple myeloma (MM). Here, we present a single institutions experience assessing MRD by NGS of Ig genes and the long-term impact of depth of response as well as clonal diversity on the clinical outcome of a large population of MM patients; 482 MM patients at the University of California, San Francisco (UCSF) diagnosed from 2008 to 2020 were analyzed retrospectively. MRD assessment was performed by NGS. PFS curves were plotted by the Kaplan-Meier method. In the newly diagnosed group, 119 of 304, achieved MRD negativity at the level of 10-6 at least once. These patients had a prolonged PFS versus patients who were persistently MRD positive at different levels (p > 0.0001). In the relapsed disease group, 64 of 178 achieved MRD negativity at 10-6, and PFS was prolonged versus patients who remained MRD positive (p = 0.03). Three categories of MRD dynamics were defined by artificial intelligence: (A) patients with ≥3 consistently MRD negative samples, (B) patients with continuously declining but detectable clones, and (C) patients with either increasing or a stable number of clones. Groups A and B had a more prolonged PFS than group C (p

Brian J Lipworth,1 David J Collier,2 Yasuhiro Gon,3 Nanshan Zhong,4 Koichi Nishi,5 Rongchang Chen,4 Samir Arora,6 Andrea Maes,7 Shahid Siddiqui,8 Colin Reisner,7,8 Ubaldo J Martin8 1Scottish Centre for Respiratory Research, Ninewells Hospital, University of Dundee, Dundee, Scotland, UK; 2William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; 3Itabashi Hospital, Nihon University School of Medicine, Itabashi, Tokyo, Japan; 4Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 5Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan; 6Aventiv Research Inc., Columbus, OH, USA; 7Pearl – a member of the AstraZeneca group, Morristown, NJ, USA; 8AstraZeneca, Gaithersburg, MD, USA Background: COPD is a major global cause of mortality and morbidity. PINNACLE-4 evaluated the efficacy and safety of GFF MDI (glycopyrrolate/formoterol fumarate metered dose inhaler) in patients from Asia, Europe, and the USA with moderate-to-very severe COPD. Methods: In this double-blind, placebo-controlled, Phase III study, patients were randomized to treatment with GFF MDI 18/9.6 µg, glycopyrrolate (GP) MDI 18 µg, formoterol fumarate (FF) MDI 9.6 µg, or placebo MDI (all twice daily) for 24 weeks. Lung function, patient-reported outcomes (symptoms and health-related quality of life), and safety were assessed. Results: Of the 1,756 patients randomized, 1,740 patients were included in the intent-to-treat population (mean age 64.2 years, 74.1% male, and 40.2% Asian). GFF MDI significantly improved morning predose trough FEV1 at Week 24 (primary endpoint) vs placebo MDI, GP MDI, and FF MDI (least squares mean differences: 165, 59, and 72 mL, respectively; all P

Phytosterols are a group of lipophilic steroid alcohols found in plants, which have been shown to lower cholesterol when supplemented in the diet. A commercial phytosterol preparation was added to milk in the form of an oil-in-water emulsion. For the preparation of an emulsion, diacetyl tartaric acid ester of mono- and diglycerides was used as an emulsifier and butteroil was used as a source of fat. Three emulsion formulations, i.e. A (8% phytosterols), B (10% phytosterols) and C (12% phytosterols), were prepared in which the levels of emulsifier (6.5%) and butteroil (10%) were kept constant, and each emulsion was added to milk at a rate of 5% (w/w). Based on sensory evaluation, B-emulsion formulation was selected for fortification of milk. The phytosterol content of the fortified milk determined by reverse-phase high-performance liquid chromatography was 410.8 mg/100 g. No significant loss in the initial content of phytosterol was observed after 1 week of storage. Sensory and physicochemical analyses indicated that significant differences were not observed between control and fortified milk samples up to 7 days of refrigerated storage. The present study suggests that it is feasible to add phytosterol as a functional ingredient in milk in the form of water-soluble emulsion to enhance health benefits of consumers. Two servings of such fortified milk per day provide almost the entire recommended daily requirement of phytosterol.

Edward M Kerwin,1 Thomas M Siler,2 Samir Arora,3 Patrick Darken,4 Earl St Rose,4 Colin Reisner4,5 1Clinical Research Institute of Southern Oregon, Medford, OR, USA; 2Midwest Chest Consultants, St Charles, MO, USA; 3Aventiv Research, Columbus, OH, USA; 4Pearl – a member of the AstraZeneca Group, Morristown, NJ, USA; 5AstraZeneca, Gaithersburg, MD, USA Purpose: This study investigated the efficacy, safety, and pharmacokinetics of the inhaled corticosteroid/long-acting β2-agonist fixed-dose combination budesonide/formoterol fumarate (BFF) metered dose inhaler (MDI), compared with the monocomponents budesonide (BD) MDI and formoterol fumarate (FF) MDI, in patients with moderate-to-severe COPD. Materials and methods: In this Phase IIb, randomized, double-blind, four-period, five-treatment, incomplete-block, crossover study (NCT02196077), all patients received BFF MDI 320/9.6 μg and FF MDI 9.6 μg, and two of either BFF MDI 160/9.6 μg, BFF MDI 80/9.6 μg, or BD MDI 320 μg twice daily for 28 days. The primary efficacy endpoint was forced expiratory volume in 1 second area under the curve from 0 to 12 hours on Day 29. Secondary efficacy endpoints included additional lung function assessments, and evaluation of dyspnea and rescue medication use. Safety was monitored throughout. The systemic exposure to budesonide and formoterol was assessed on Day 29. Results: Overall, 180 patients were randomized. For forced expiratory volume in 1 second area under the curve from 0 to 12 hours on Day 29, all BFF MDI doses showed significant improvements versus BD MDI 320 μg (least squares mean differences 186–221 mL; all p

Tayana Soukup,1 Benjamin W Lamb,2 Sonal Arora,3 Ara Darzi,3 Nick Sevdalis,1 James SA Green4,5 1Health Service and Population Research Department, Centre for Implementation Science, King’s College London, London, UK; 2Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; 3Department of Surgery and Cancer, Center for Patient Safety and Service Quality, Imperial College London, 4Whipps Cross University Hospital, Barts Health NHS Trust, 5Faculty of Health and Social Care, London South Bank University, London, UK Abstract: In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs – including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don’ts) when setting up MDT-driven cancer care. Keywords: cancer MDT, MDM, cancer meeting, patients with cancer

In this paper numerical solution of the unsteady plane incompressible viscous jet impinging on to an infinite flat surface are presented for Re=450. In the present study, all calculations have been done by using Dufort Frankel scheme and over relaxation scheme. Result and graphs have been obtained by using MATLAB programming. The obtained results explain the flow of water after exhaling from nozzle and the streamlines and vorticity of flow ofwater after striking with flat infinite surface. The solutions obtained by proposed method indicate that this approach is easy to implement and computationally very attractive and the results of our investigation are in qualitative agreement with those available in the literature [1, 9]. This method is capable of greatly reducing the size of calculations while still maintaining high accuracy of the numerical solution.

Sumit Arora,1 Suresh K Swaminathan,2 Ameya Kirtane,2 Sanjeev K Srivastava,1 Arun Bhardwaj,1 Seema Singh,1 Jayanth Panyam,2 Ajay P Singh1,3 1Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, Mobile, Alabama, USA; 2Department of Pharmaceutics, The University of Minnesota, Minneapolis, USA; 3Department of Biochemistry and Molecular Biology, College of Medicine, University of South Alabama, Mobile, Alabama, USA Abstract: MicroRNAs are small (18–22 nucleotide long) noncoding RNAs that play important roles in biological processes through posttranscriptional regulation of gene expression. Their aberrant expression and functional significance are reported in several human malignancies, including pancreatic cancer. Recently, we identified miR-150 as a novel tumor suppressor microRNA in pancreatic cancer. Furthermore, expression of miR-150 was downregulated in the majority of tumor cases, suggesting that its restoration could serve as an effective approach for pancreatic cancer therapy. In the present study, we developed a nanoparticle-based miR-150 delivery system and tested its therapeutic efficacy in vitro. Using double emulsion solvent evaporation method, we developed a poly (D,L-lactide-co-glycolide) (PLGA)-based nanoformulation of miR-150 (miR-150-NF). Polyethyleneimine (a cationic polymer) was incorporated in PLGA matrix to increase the encapsulation of miR-150. Physical characterization of miR-150-NF demonstrated that these nanoparticles had high encapsulation efficiency (~78%) and exhibited sustained release profile. Treatment of pancreatic cancer cells with miR-150-NF led to efficient intracellular delivery of miR-150 mimics and caused significant downregulation of its target gene (MUC4) expression. Inhibition of MUC4 correlated with a concomitant decrease in the expression of its interacting partner, HER2, and repression of its downstream signaling. Furthermore, treatment of pancreatic cancer cells with miR-150-NF suppressed their growth, clonogenicity, motility, and invasion. Together, these findings suggest that PLGA-based nanoformulation could potentially serve as a safe and effective nanovector platform for miR-150 delivery to pancreatic tumor cells. Keywords: PLGA nanoparticles, miR-150, MUC4, invasion, migration

Rahat Kumar,1 Simran Chhatwal,1 Sahiba Arora,2 Sita Sharma,3 Jaswinder Singh,1 Narinder Singh,1 Vikram Bhandari,1 Ashok Khurana41Department of Pharmacology, 2Department of Biochemistry, 3Department of Obstetrics and Gynecology, 4Department of Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IndiaIntroduction: Type 2 diabetes mellitus is a chronic disorder characterized by chronic hyperglycemia, with long term macrovascular and microvascular complications. The treatment is lifestyle management, exercise, weight control, and antihyperglycemic drugs such as sulfonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and meglitinide. Recently, a direct association between high levels of C-reactive protein and serum adenosine deaminase levels in patients with uncontrolled diabetes with long-term complications has been seen. This study was conducted to assess the antihyperglycemic, lipid-lowering, anti-inflammatory, and improving glycemic control of garlic in type 2 diabetes patients with obesity.Materials and methods: This was an open-label, prospective, comparative study, conducted on 60 patients having type 2 diabetes mellitus and obesity. The patients were divided into two groups of 30 each, of either sex. Group 1 was given metformin tablets, 500 mg twice a day (BD)/three times a day (TDS), after meals, and group 2 was given metformin tablets, 500 mg BD/TDS, after meals, along with garlic (Allium sativum) capsules, 250 mg BD. Patients were routinely investigated for fasting and postprandial blood glucose, glycosylated hemoglobin (HbA1c), serum adenosine deaminase levels and lipid profile (serum cholesterol, high-density lipoprotein cholesterol, triglycerides and low-density lipoprotein cholesterol) at the start of the study. Patients were followed up for 12 weeks, with monitoring of fasting and postprandial blood glucose at 2 week intervals, and monitoring of the other parameters at the end of study. Data obtained at the end of the study was statistically analyzed using Student's t test.Results: It was observed that both metformin alone and metformin with garlic reduced fasting blood glucose and postprandial blood glucose significantly, with a greater percentage reduction with metformin plus garlic; however, change in HbA1c levels was not significant. A fall in total cholesterol, triglyceride, and low-density lipoprotein and an increase in high-density lipoprotein were more pronounced in patients treated with metformin plus garlic. Similarly, a fall in C-reactive protein and adenosine deaminase levels was greater in patients taking metformin with garlic than in patients taking only metformin.Conclusion: Garlic has been shown to have antihyperglycemic and lipid-lowering properties. The additional lowering of C-reactive protein and serum adenosine deaminase levels with garlic suggests that garlic can be a valuable agent in providing good glycemic control and the prevention of long-term complications.Keywords: C-reactive protein, metformin, Allium sativum

Wahajuddin,1,2 Sumit Arora21Pharmacokinetics and Metabolism Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, 2Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Rae Bareli, IndiaAbstract: A targeted drug delivery system is the need of the hour. Guiding magnetic iron oxide nanoparticles with the help of an external magnetic field to its target is the principle behind the development of superparamagnetic iron oxide nanoparticles (SPIONs) as novel drug delivery vehicles. SPIONs are small synthetic γ-Fe2O3 (maghemite) or Fe3O4 (magnetite) particles with a core ranging between 10 nm and 100 nm in diameter. These magnetic particles are coated with certain biocompatible polymers, such as dextran or polyethylene glycol, which provide chemical handles for the conjugation of therapeutic agents and also improve their blood distribution profile. The current research on SPIONs is opening up wide horizons for their use as diagnostic agents in magnetic resonance imaging as well as for drug delivery vehicles. Delivery of anticancer drugs by coupling with functionalized SPIONs to their targeted site is one of the most pursued areas of research in the development of cancer treatment strategies. SPIONs have also demonstrated their efficiency as nonviral gene vectors that facilitate the introduction of plasmids into the nucleus at rates multifold those of routinely available standard technologies. SPION-induced hyperthermia has also been utilized for localized killing of cancerous cells. Despite their potential biomedical application, alteration in gene expression profiles, disturbance in iron homeostasis, oxidative stress, and altered cellular responses are some SPION-related toxicological aspects which require due consideration. This review provides a comprehensive understanding of SPIONs with regard to their method of preparation, their utility as drug delivery vehicles, and some concerns which need to be resolved before they can be moved from bench top to bedside.Keywords: superparamagnetic iron oxide nanoparticles, SPIONs, targeted delivery, coating, functionalization, targeting ligands, toxicity

We conducted a search for technosignatures in 2018 and 2019 April with the L-band receiver (1.15-1.73 GHz) of the 100 m diameter Green Bank Telescope. These observations focused on regions surrounding 31 Sun-like stars near the plane of the Galaxy. We present the results of our search for narrowband signals in this data set, as well as improvements to our data processing pipeline. Specifically, we applied an improved candidate signal detection procedure that relies on the topographic prominence of the signal power, which nearly doubles the signal detection count of some previously analyzed data sets. We also improved the direction-of-origin filters that remove most radio frequency interference (RFI) to ensure that they uniquely link signals observed in separate scans. We performed a preliminary signal injection and recovery analysis to test the performance of our pipeline. We found that our pipeline recovers 93% of the injected signals over the usable frequency range of the receiver and 98% if we exclude regions with dense RFI. In this analysis, 99.73% of the recovered signals were correctly classified as technosignature candidates. Our improved data processing pipeline classified over 99.84% of the ∼26 million signals detected in our data as RFI. Of the remaining candidates, 4539 were detected outside of known RFI frequency regions. The remaining candidates were visually inspected and verified to be of anthropogenic nature. Our search compares favorably to other recent searches in terms of end-to-end sensitivity, frequency drift rate coverage, and signal detection count per unit bandwidth per unit integration time.