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Osteoblastomas are benign neoplasm of the bone that is characterized by clinical and histological similarity to osteoid osteomas. They are larger (>1.5–2 cm) and tend to affect the axial skeleton. Patients typically present commonly in the second or third decades of life with a male predilection. The flare phenomenon in osteoblastoma is a rare but known entity showing florid multifocal periostitis. Few cases have been reported in the literature. Focally aggressive osteoblastomas also present with flare phenomenon mediated by prostaglandin-induced inflammation. We report a strikingly unusual case of an osteoblastoma of the spine in a 23-year-old male patient who presented in our outpatient department with complaints of low backache, weight loss, intermittent stiffness, and fever for the past year. The patient was HLA-B27 positive, diagnosed as ankylosing spondylitis, and clinical symptoms were attributed to sacroiliitis. However, his fever and weight loss, while on treatment, were unexplained. Roentgenogram, computed tomography, and magnetic resonance imaging of the patient depicted a large bone tumor centered at the junction of the right pedicle and transverse process of L5 vertebra, associated with severe reactive marrow edema, periosteal reaction, periostitis, and sclerosis in the posterior vertebral elements also extending into the L4 vertebra. The lesion was suspected to be osteoblastoma with close imaging differential as osteosarcoma. CT-guided biopsy proved osteoblastoma with acute local toxic flare.

The extra-abdominal deep fibromatoses also called as desmoid tumor (DT) are rare musculoaponeurotic, histologically benign tumoral soft tissue lesions which are locally aggressive with high rate of recurrence and no metastatic potential. Here, we describe a rare case of postoperative paraspinal fibromatosis in female child after aciurgy of intraspinal cervical meningioma. The lesion was incidentally detected in routine follow-up study and showed significant interval growth over a period of 1 year. Surgical resection was performed after histopathological confirmation; however, recurrence was observed. Hitherto only seven cases of postoperative paraspinal fibromatosis have been reported in the literature. To the best of authors’ knowledge, this report is the first case of postoperative fibromatosis in cervical spine after resection of meningioma. The aim of the case report is to emphasize the clinical scenario for suspicion of fibromatosis, magnetic resonance imaging clues, and multidisciplinary treatment strategy which has shifted toward initial active surveillance.

Over 800 million people worldwide play volleyball, either recreational or competitive. Even though all throwing athletes suffer from upper extremity injuries caused by overuse, volleyball additionally involves certain prototypical throwing biomechanics, not seen in other overhead sports. Complex biomechanics and the balanced interplay between the glenohumeral and scapulothoracic muscles ensure velocity and torque displacement in spike and jump-serve maneuvers (formerly known as smash) which are exclusive to volleyball. In this case report, we have described in detail the entity of isolated infraspinatus atrophy secondary to suprascapular nerve neuropathy.

Glomangiomas (glomus tumors) are benign vascular tumors commonly located at the distal extremities, are usually subungual lesions, and account for 2% of all soft-tissue tumors. Patients with digital glomus tumors present with hypersensitivity to cold, paroxysmal severe pain, and point tenderness. These tumors are infrequent in the knee area, and when seen are superficial, usually have a diameter of less than 1 cm, which make their radiological diagnosis arduous. We report a noteworthy, unusual case of a large glomus tumor in the popliteal fossa showing biceps femoris infiltration, in a 51-year-old female patient who experienced severe intermittent posterior knee pain for the past 2 years. Magnetic resonance imaging revealed a large popliteal inhomogeneous soft-tissue lesion with irregular margins insinuating the posterolateral musculature mimicking soft-tissue sarcoma. Histopathology revealed a glomus tumor.

The absence of hallucal sesamoids is an uncommon and incidental entity, bilateral absence is rare, and few cases of symptomatic patients have been reported in literature. Most patients present with metatarsalgia limited to plantar aspect of the great toe, with aggravation of pain on walking and relief at rest. We present a unique case of ipsilateral symptomatic hypoplastic medial hallucal sesamoid and asymptomatic absence of medial sesamoid at the contralateral foot.

PurposeTo advance the usage of CXRs as a viable solution for efficient COVID-19 diagnostics by providing large-scale annotations of the abnormalities in frontal CXRs in BIMCV-COVID19+ database, and to provide a robust evaluation mechanism to facilitate its usage.Materials and MethodsWe provide the abnormality annotations in frontal CXRs by creating bounding boxes. The frontal CXRs are a part of the existing BIMCV-COVID19+ database. We also define four different protocols for robust evaluation of semantic segmentation and classification algorithms. Finally, we benchmark the defined protocols and report the results using popular deep learning models as a part of this study.ResultsFor semantic segmentation, Mask-RCNN performs the best among all the models with a DICE score of 0.43 ± 0.01. For classification, we observe that MobileNetv2 yields the best results for 2-class and 3-class classification. We also observe that deep models report a lower performance for classifying other classes apart from the COVID class.ConclusionBy making the annotated data and protocols available to the scientific community, we aim to advance the usage of CXRs as a viable solution for efficient COVID-19 diagnostics. This large-scale data will be useful for ML algorithms and can be used for learning radiological patterns observed in COVID-19 patients. Further, the protocols will facilitate ML practitioners for unified large-scale evaluation of their algorithms.Data Availability StatementThe data associated with this work is available here : Radiologists’ Annotations on COVID-19+ X-rays https://osf.io/b35xu/ via @OSFramework andhttp://covbase4all.igib.res.in/.

Mobile banking is now an important and evolving medium for executing banking transactions. It has a huge potential in a developing country such as India. Our study explores the important antecedents of the mobile banking adoption intention of Indian customers and proposes a comprehensive framework by extending the traditional technology acceptance model (TAM). Along with the two constructs provided by TAM, four customer-oriented constructs have also been measured for this purpose. The conceptual model has been verified empirically, with the data mobilized with the help of a survey from 203 future mobile banking service users. The structural equation modeling (SEM) technique has been undertaken to establish the effect of the antecedents on mobile banking adoption intention. The results demonstrate that, together with the constructs of TAM, viz. perceived usefulness and perceived ease of use, as well as all other relevant behavioral factors, namely subjective norms, personal innovativeness, trust, and self-efficacy have exerted a statistically significant positive effect on the mobile banking adoption intention of customers. The study provides an empirical foundation, which can be useful to banking and mobile services by helping companies to formulate their marketing strategies.

Background: The area immediately around the pituitary, the sellar and parasellar region is an anatomically complex area that represents a crucial crossroads for important adjacent structures. A number of diseases that affect the pituitary-hypothalamic axis can have profound clinical, endocrinological as well as neurological consequences. Aim of the study was to identify the MR imaging characteristics of sellar and suprasellar masses, to correlate the MRI findings with histopathological findings and to calculate the diagnostic accuracy of MR imaging. Methods: We reviewed the records of 116 patients with sellar and suprasellar masses for which preoperative MR imaging films or reports were available. Radiological appearances were correlated with intraoperative findings and post-operative histopathology. Results: Majority of patients in this study belonged to the age group 21-40 years. Most common mass lesion operated was pituitary macroadenoma comprising 58% of the total cases. The accuracy, sensitivity and specificity of MRI in diagnosing macroadenomas are 86%, 88%, and 83% respectively. MR was 93% accurate, 85% sensitive and 95% specific in diagnosing craniopharyngioma. MR was 93% accurate, 80% sensitive and 95% specific in diagnosing meningioma. Conclusions: MRI is the modality for characterizing sellar and suprasellar lesions, morphology of lesions, nature of contrast material enhancement and extent of lesions. Hence MRI is the modality of choice for diagnosing sellar and suprasellar masses with high accuracy, sensitivity and specificity.

Dependence on tobacco, like many other drug dependencies, is a complex behavior with both genetic and environmental factors contributing to the variance. The heritability estimates for smoking in twin studies have ranged from 46 to 84%, indicating a substantial genetic component to smoking. Candidate gene studies have detected functional polymorphisms in genes coding for the cytochrome P450 enzymes, and variations in these genes that lead to more rapid nicotine metabolism have been implicated in smoking. Similarly, smoking has been associated with polymorphisms in dopaminergic genes that may influence the dopamine receptor number and/or function. Animal experiments have localized specific subunits of the nicotinic receptors that may mediate the reinforcing properties of nicotine and have investigated their role in nicotine dependence. However, environmental factors have also been found to contribute to the risk of initiation and persistence of smoking. We review the scientific evidence that supports a role for genetic influences on smoking, discuss the specific genetic and neurobiological mechanisms that may mediate susceptibility to nicotine dependence, identify possible gene/environmental interactions that may be important in understanding smoking behavior, and suggest directions for future research. Insights into the genetic contributions to smoking can potentially lead to more effective strategies to reduce smoking.

Tobacco use represents a rare confluence of interesting circumstances. Elements of inheritable risk combine with powerful neuropharmacology and a ubiquitous environmental exposure and result in an epidemic that claims over 430,000 lives and costs us over $100 billion annually. It is the single most important remediable public health problem in the United States. Most smokers want to quit smoking and a simple advice from a physician can increase the likelihood of doing so. Moreover, there are a number of pharmacologic and behavioral therapies that are proven to be effective in smoking cessation. Yet, there is an apparent reluctance among physicians to address smoking cessation, perhaps due to a sense of frustration or low self-efficacy. Physicians play an important role in smoking cessation, and intensive interventions are necessary to improve their participation and efficacy. Teaching practical smoking cessation techniques within medical school curricula, with an opportunity for standardized practice and self-evaluation, may be an effective strategy to improve physician practice in this area. Since most smokers try their first cigarette before the age of 18, and youth smoking is on the rise, targeted interventions aimed at preventing initiation and encouraging cessation of smoking among youth are needed. For all tobacco users, a better understanding of the pharmacology and physiology of nicotine addiction may translate into targeted and individualized treatment and prevention strategies, which may improve success rates dramatically. To better control this epidemic, and to meet the nation's public health goals for the year 2010 [145], local tobacco control interventions need to be multifaceted and well integrated into regional and national efforts [146]. Because of the physician's unique societal role with respect to tobacco, doctors may indeed find it possible to impact public opinion and significantly reduce the toll of tobacco by acting at the public health and public policy levels [147]. Those interested in engaging in the public health debate can do more than relay facts about tobacco and health. Involvement in tobacco-control issues provides the opportunity to impact the environmental influences promoting smoking among patients, and is likely to be synergistic with efforts to help smokers quit within the office. Physicians who take steps to engage in local public health initiatives are likely to magnify the effects of their efforts at the bedside [148, 149].

Of 613 children evaluated in a village in Haryana 94 (15.3%) were observed to have chronic suppurative otitis media (CSOM). Fifty eight (61.7%) children had hearing impairment. CSOM contributed to 71.6% of the hearing impaired (58/81). On analysis of association of CSOM with literacy and socio-economic status of mothers, and age, sex, and upper respiratory tract infections (URI) in children positive correlation was observed only with URIs (P

In the recent time microfinance has received increased attention among the researchers and financial service providers, as a good alternative in the rural credit market. Various studies revealed that microfinance is a powerful instrument for poverty alleviation, enabling the poor to accumulate the assets, boost their incomes, and reduce their economic vulnerability. There are various opinions about the micro credit demand in India. M-CRIL, a leading micro-credit rating agency provides a conservative estimate for the annual demand at Rs. 480 billion based on 60-70 million poor families with an average household credit demand of Rs. 8,000 (less than $160). In the growing market, to meet this huge demand we require the systems and approaches with comprehensive financial inclusiveness. Within this context, the Self-Help Groups (SHGs) movement in India and particularly the SGSY, SHG-Bank Linkage Programme (SBLP) of the National Bank of Rural and Agriculture Development (NABARD), various MFIs and community based organizations present the rich experience. The present paper explores the role of and performance of various delivery models of microfinance in India. Further the paper explores some issues like outreach, impact, efficiency, sustainability and financial inclusions.

Background Vasodilator-stimulated phosphoprotein (VASP) mediates focal adhesion, actin filament binding and polymerization in a variety of cells, thereby inhibiting cell movement. Phosphorylation of VASP via cAMP and cGMP dependent protein kinases releases this "brake" on cell motility. Thus, phosphorylation of VASP may be necessary for epithelial cell repair of damage from allergen-induced inflammation. Two hypotheses were examined: (1) injury from segmental allergen challenge increases VASP phosphorylation in airway epithelium in asthmatic but not nonasthmatic normal subjects, (2) regular in vivo β2-agonist use increases VASP phosphorylation in asthmatic epithelium, altering cell adhesion. Methods Bronchial epithelium was obtained from asthmatic and non-asthmatic normal subjects before and after segmental allergen challenge, and after regularly inhaled albuterol, in three separate protocols. VASP phosphorylation was examined in Western blots of epithelial samples. DNA was obtained for β2-adrenergic receptor haplotype determination. Results Although VASP phosphorylation increased, it was not significantly greater after allergen challenge in asthmatics or normals. However, VASP phosphorylation in epithelium of nonasthmatic normal subjects was double that observed in asthmatic subjects, both at baseline and after challenge. Regularly inhaled albuterol significantly increased VASP phosphorylation in asthmatic subjects in both unchallenged and antigen challenged lung segment epithelium. There was also a significant increase in epithelial cells in the bronchoalveolar lavage of the unchallenged lung segment after regular inhalation of albuterol but not of placebo. The haplotypes of the β2-adrenergic receptor did not appear to associate with increased or decreased phosphorylation of VASP. Conclusion Decreased VASP phosphorylation was observed in epithelial cells of asthmatics compared to nonasthmatic normals, despite response to β-agonist. The decreased phosphorylation does not appear to be associated with a particular β2-adrenergic receptor haplotype. The observed decrease in VASP phosphorylation suggests greater inhibition of actin reorganization which is necessary for altering attachment and migration required during epithelial repair.

Despite the widespread use of tobacco and marijuana by cocaine abusers, it remains unclear whether combined tobacco and marijuana smoking is more harmful than tobacco smoking alone in cocaine abusers. We investigated the differences in medical symptoms reported among 34 crack cocaine abusers who did not smoke tobacco or marijuana (C), 86 crack cocaine abusers who also smoked tobacco (C + T), and 48 crack abusers who smoked both tobacco and marijuana (C + T + M). Medical symptoms were recorded using a 134-item self-report instrument (MILCOM), and drug use was assessed using the Addiction Severity Index (ASI). After controlling for clinical and demographic differences, the C + T + M group reported significantly more total symptoms on the MILCOM as well as on the respiratory, digestive, general, and nose/throat subscales than the C + T or C groups. The C + T group reported higher total and respiratory and nose/throat symptoms than the C group. HOwever, the C group had the highest number of mood symptoms among the three groups. The C + T and C + T + M groups were comparable in number of cigarettes smoked and ASI scores. Although tobacco smoking is associated with higher reports of medical problems in crack abusers, smoking both marijuana and tobacco seems to be associated with greater medical problems than smoking tobacco alone. Tobacco smoking was not related to changes in cocaine use. Also, marijuana smoking does not appear to be associated with a reduction in tobacco or cocaine use.

Rationale Asthmatic airway remodelling is characterized by myofibroblast hyperplasia and subbasement membrane collagen deposition. We hypothesized that cytokines and growth factors implicated in asthmatic airway remodelling are increased in bronchoalveolar lavage (BAL) fluid of asthmatics after segmental allergen challenge (SAC), and that these growth factors and cytokines increase alpha-smooth muscle actin (alpha-SMA) and collagen III synthesis by human lung fibroblasts (HLFs). Methods Transforming growth factor (TGF)-beta1, TGF-beta2, IL-4 and IL-13 levels were measured in BAL fluid from 10 asthmatics and 9 non-asthmatic controls at baseline and then 1 day, 1 week and 2 weeks after SAC. Confluent cultures of HLFs were stimulated by exogenous addition of TGF-beta1, TGF-beta2, IL-4 or IL-13 (concentration range 0.01-10 ng/mL) over 48 h. Collagen III was measured in culture supernates and alpha-SMA in cell lysates by Western blot. Results At baseline, there was no difference in BAL fluid concentrations of TGF-beta1, IL-4 and IL-13 between asthmatics and controls; however, non-asthmatics had higher concentrations of total TGF-beta2. In asthmatics, BAL fluid concentrations of all four factors increased significantly 1 day after SAC. TGF-beta1, TGF-beta2 and IL-13 concentrations returned to baseline by 1 week after SAC, but BAL fluid IL-4 concentration remained elevated for at least 2 weeks. TGF-beta1, TGF-beta2 and IL-4 significantly increased alpha-SMA in fibroblasts, but only IL-4 caused corresponding increases in collagen III synthesis. IL-13 had no direct effects on collagen III synthesis and alpha-SMA expression. Conclusions Because IL-4 caused a dose-dependent increase in alpha-SMA and collagen III synthesis, it may be an important cytokine mediating asthmatic airway remodelling. TGF-beta1 and TGF-beta2 may also play a role in airway remodelling by stimulating phenotypic change of fibroblasts to myofibroblasts. Additionally, collagen III synthesis appears to be independent of myofibroblast phenotype and is apparently regulated by different growth factors and cytokines.

Tobacco smoking is the most important preventable cause of death and disease. Despite an increased awareness of the addictive nature of smoking and availability of effective treatments, smoking continues to be widespread among individuals with psychiatric disorders. Moreover, mental health professionals remain reluctant to address smoking among their patients for a variety of reasons. Recent research has provided a wealth of data that have shaped the concept of tobacco smoking as a chronic addictive disorder and also demonstrated the efficacy of smoking cessation interventions. This paper reviews the important factors that contribute to smoking and the various pharmacological and psychosocial interventions for smoking cessation from a biopsychosocial perspective. It also makes recommendations for the rational use of these interventions to treat nicotine dependence in individuals with psychiatric disorders.

Objective The approach and credibility of future physicians and nurses as treatment providers for smoking- and tobacco-related diseases may be influenced by their smoking habits. We compared smoking habits among medical and nursing students, and examined whether these habits changed during the course of education for each cohort. Method Over 1,100 medical and nursing students from a university were surveyed in year 2000 using a questionnaire that included the Fagerstrom test for nicotine dependence (FTND). Results A total of 397 medical students and 126 nursing students completed the survey. Significantly fewer medical students (3.3%) smoked compared to nursing students (13.5%). Also, significantly more nursing students were former smokers (17.8%) than medical students (9.8%). The severity of nicotine dependence, as indicated by the total FTND score as well as scores on five of the six items on the FTND, was significantly lower among medical students compared to nursing students. Smoking or quit rates did not differ across class years in both groups; however, unlike nursing students, time since quitting significantly differed across class years for medical students. Although smoking habits appear to change little during the course of education for both medical and nursing students, many smokers may have quit just prior to entering medical school but not nursing school. Conclusions The findings confirm the continuing decline in smoking among medical students in the United States; however, increased efforts to promote tobacco education and intervention among nursing students seem necessary. Nevertheless, both groups appear to have the potential to be credible advisors to patients and public regarding smoking cessation.

Despite availability of effective treatments for nicotine addiction, smoking remains prevalent with serious health consequences. Most smokers recognize the ill effects of smoking but are unable to quit. Nicotine addiction may be viewed as any other chronic illness that results from exposure to a recognizable agent (tobacco) and manifests with a well-documented set of signs and symptoms. Much like any chronic disease, both environmental and genetic factors determine the occurrence and severity of this affliction. There has been recent focus on uncovering the genetic basis of nicotine addiction. In this article, we have attempted to briefly review the current evidence for the role of genetics in smoking as well as comment on available pharmacotherapeutic options for treating nicotine dependence.

Disseminated Mycobacterium avium intercellulare (MAI) infection is rare in non-AIDS patients. We report a 60-year-old woman with chronic lung disease who developed vertebral osteomyelitis due to MAI. She was treated successfully with combined therapy consisting of rifampin, ethambutol, and clarithromycin.

Background: Tobacco use remains the most preventable cause of death and disability in the United States. Public opinion regarding tobacco use is not only an important barometer of the likelihood of effective tobacco-control legislation, but also identifies ongoing public health educational needs. Because > 63,000 children become new smokers annually in Pennsylvania, we chose to evaluate the statewide public health tobacco perspective in order to help tailor future public policy interventions. Study design and setting: Registered voters were randomly contacted in a statewide telephone survey. To reduce response bias, an independent polling firm conducted the 643 structured interviews. Results: Most respondents were > 45 years old (55%), female (54%), and had at least some college education (62%). Twenty-eight percent (95% confidence interval [CI], 25 to 32%) were current tobacco users, and 38% (95% CI, 34 to 42%) had lost family members or friends to smoking-related disease. Ninety-two percent (95% CI, 90 to 94%) expressed “concern” about adolescent tobacco use, but only 46% (95% CI, 42 to 50%) believed that government needed to do more. Of respondents opposed to government involvement, 65% (95% CI, 61 to 68%) believed it was an improper role for government, or that there are more important non-health government priorities. When framed more personally, 80% (95% CI, 77 to 83%) indicated that elected officials have a responsibility to “dedicate a significant portion of tobacco settlement” to prevention. Still, 28% (95% CI, 25 to 32%) would oppose laws restricting smoking in establishments frequented by youth. Conclusions: Prior public health education initiatives have been effective in shaping the tobaccorelated health concerns of Pennsylvania voters. As expected, the overwhelming majority of respondents are concerned about youth tobacco use and agree that money should be spent on tobaccocontrol initiatives. In contrast, many are reluctant to support “government” involvement in what is still seen as a personal issue. Future public health initiatives should focus on this dichotomy and should highlight the utility of an integrated policy approach to tobacco control. (CHEST 2002; 122:295–298)

It is generally accepted that the micro-finance sector emerged as an answer to financial market failures. In this context, the paper examines the basic idea on which micro-finance is built and sees how it is different from the mainstream financial service providers. The present paper therefore, deals with the theoretical framework of microfinance including definition, economics and mechanism of group lending, gender aspects and limitations of microfinance. One of the major features of microfinance is group lending where the concept of joint-liability helps in mitigating problems caused by adverse selection and moral hazard. Other important mechanisms, besides group lending, are the use of dynamic incentives, collateral substitutes, and regular repayment schedules, the targeting of women and social programmes which, according to theory, play a significant role. The paper also discusses about the relation between the models of Joint Liability Group lending. There has been considerable debate over whether micro-finance can reach the ‘poorest of the poor’ and it has also been highlighted in the paper. The micro-finance programme is ideologically designed to achieve women's contribution to family welfare and assist poor women to obtain socio-economic empowerment, but often the positional vulnerability of the women is exploited at the time of repayment. Thus the paper also highlights the limitations of micro-finance forwarded by Ohio School of Development Finance which stated that debt is not an effective tool for helping most of poor people to enhance their economic conditions as they operate in small farms or micro enterprises.