June 2021

Multiple system atrophy (MSA) may be difficult to distinguish clinically from other disorders, particularly in the early stages of the disease. A careful medical history and meticulous neurological examination remain the cornerstone for the accurate diagnosis of MSA. We report a case of 50 years old male patient with cerebellar ataxia, right side hemiplegia, dysphagia, aphasia, and constipation. MRI revealed atrophy with the abnormal signal intensity of pons, middle cerebellar peduncles, and olivary nucleus features indicating atrophy of the olivopontocerebellar pathway. Cruciform T2 hyperintense signal in pons extending along the middle cerebellar peduncles bilaterally giving ``hot cross bun’’ sign with T2 hyperintensities in the medulla & bilateral cerebellar hemisphere with mild cerebellar atrophy possibility of Multiple system atrophy (MSA-C type).

Background: A lot of patients report to OMFS OPD for dental extraction and other minor surgical procedures with co-morbidities, of which patients under anti-thrombotic drugs form a major number. Even though post-operative bleeding and the blood parameters leading to it had been investigated, there is a lacuna in the literature regarding the difficulties faced by these patients for getting their treatment done. Method: A cross sectional comparative study was conducted between two groups who reported for minor oral surgical procedures comparing number of visits, number of days of hospital stay, number of bystanders, between patients under antithrombotic medication (250 patients) with ASA I patients (250 patients). Results: Our study showed that patients under anti-thrombotic drugs required anything from 3 to 9 visits while ASA I patients only needed only a single visit. 19 patients required hospitalisation for heparinisation and required 3-5 days of hospital stay. Number bystanders for patients under anti-thrombotic drugs ranged from 2-3 which added to the number visits lead to 6-27 days of loss of manpower days. Conclusion: Number of visits and number of bystanders needed to get a minor oral surgical procedure done by a patient on antithrombotic medication puts him/her in difficulties and causes loss of manpower days. Which in a country like India is a matter of concern. Hence a definite protocol for the management of these patients is required to ease the difficulty and burden.

Background: The incidence of COVID-19 is at risk in patients with comorbid hypertension and diabetes mellitus, male sex, and active smokers. Cancer is associated with immunosuppressive reactions, cytokine overload, suppression of proinflammatory agent induction, and impaired dendritic cell maturation.Based on another study at a hospital in Wuhan, it was found that cancer patients from the epicenter of the viral epidemic had a higher risk of being infected with SARS-CoV-2. Based on the Based on the description above, the researchers wanted to know the co-incidence of COVID-19 in cancer patients at H. Adam Malik Hospital and USU Hospital Medan. Methods: This study is a descriptive study to assess the co-incidence of COVID-19 in cancer patients at H. Adam Malik Hospital and USU Hospital Medan. The sample of this study were all cancer patients at H. Adam Malik Hospital and USU Hospital Medan who met the inclusion criteria. Data classified into categories or code to make it easier to tabulate data.All data is processed and displayed in a frequency distribution table with the help of statistical software. Results: It was found that from 891 patients, the average age of COVID-19 patients with cancer was 44 years while 12 patients (1.34%) experienced COVID-19 and Cancer Coincidence. The most cases were breast cancer patients with 3 cases. Conclusion: It was found that 12 patients (1.34%) had COVID-19 and cancer with the most cases were breast cancer, 3 cases and most of them have COVID-19moderate degree.

It is commonly held that language is the psyche of a people, a strong tool for transmitting knowledge and in the effective communication of feelings and the expounding of cultural realities. African dramatists and novelists in the likes of Bole Butake and Alobwede d’Epie have been able to use a non-African language, the English language, in their works to transmit African cultural realities to both African and non-Africa readers. The question is whether African cultural realities, as seen in the plays and novels of these African writers, can effectively be transmitted through a ‘non-African’ language without distorting cultural realities. In Lake God and The Lady with a Beard, Butake and Alobwede make use of African rhetoric to express the feelings of the dramatis personae and the characters, and to send through the message they convey. The purpose of the present article is to exemplify, in two representative write-ups, the central place of linguistic expressions, the verbal art as an artistic response to the written word of Bole Butake and Alobwede d’Epie. The writers use English linguistic elements as tools to expound the cultural values of the Noni and the Bakossi cultural heritages in Lake God and The Lady with a Beard, two linguistic communities found in the Northwest and Southwest Regions of Cameroon.

The study explores the concept of eco-theology and its development in the 20th century. It also presents some of the key figures associated with eco-theological development and their contributions. The article is developed from a doctoral study defence lecture done on June 12, 2018, at MF-Norwegian School of Theology, Religion and Society. The article revisits some of the experiences of the researcher during a field study in Kenya.

A Quasi Experimental Study to Assess the Effectiveness of Chromotherapy on Level of Stress During Pregnancy Among High Risk Primigravida Mother At Selected Hospital of Delhi for the partial fulfilment of the equirement for the degree of master of nyrsing at Nightingale Institute of Nursing, under Chaudhary Charan Singh University of Meerut, Uttar Pradesh the year 2019-2020. This study was conducted on 40 high risk primigravida mother having stress during pregnancy at hindu rao hospital , Delhi. The objective of the study was to evaluate the effectiveness of chromotherapy on the level of stress during pregnancy among high risk primigravida mother in experimental group. The research approach for the study was quantitative in nature. The research design used was quasi experimental pre-test post-test research design. The sample was selected by purposive sampling technique. Descriptive and inferential statistics were used for the data analysis. The mean post test of high risk primigravida mother is 24.4 in experimental group is less than the control group mean post test is 58.35.The obtained mean difference was found to be statistically significant at 0.05 level. The calculated unpaired “t” value is 14.02 at 0.05 level of significance which is higher than the table value at df (38). The fisher exact test value obtained to find out association between post score of high risk primigravida mother receiving chromotherapy with demographic variable, on computation it was found that there was no significant association between post test score of high risk primigravida mother in experimental group with demographic variables at 0.05 level of significance. This study concluded that administration of chromotherapy was effective in reducing level of stress during pregnancy among high risk primigravida mother at selected hospital of Delhi.

SARS-CoV-2, previously known as 2019-nCoV, also known as COVID-19, belonging to the group of coronaviruses, originated in Wuhan, Hebei, China, is responsible for acute respiratory disease. In March 2020 WHO declared COVID-19 as pandemic. Previous outbreaks of coronavirus group were SARS in 2002-2003 and MERS in 2012. In the initial phase of the pandemic, this disease affected mainly the elderly, immunocompromised patients and patients with underlying chronic diseases. COVID-19 has shown many presentations, primarily being pulmonary symptoms, but has shown gastrointestinal implications such as hepatic injury by serum markers and histologic evaluation. We present here a case of liver abscess in COVID-19 positive patient that was managed with minimal invasive procedures.

Pain management is necessary for optimal post-operative care in surgical patients. Abdominal wall blocks like Transversus Abdominis plane (TAP) block are new hallmark of multimodal pain strategy for post-operative analgesia. Study Objective: To compare the ultrasound-guided subcostal TAP block and port site infiltration using 0.25% levobupivacaine for post-operative analgesia. Primary objective is to compare the duration and quality of analgesia between two groups. Secondary objective is to study the hemodynamic parameters and adverse effects like Hypotension and nausea and vomiting. Design: Randomized Comparative Study. Patients and Interventions: We enrolled sixty adult patients, divided into two groups. Group A received ultrasound guided bilateral subcostal TAP block with 10ml of 0.25% levobupivacaine and Group B received port site infiltration with 0.25% levobupivacaine, 5ml at each 4 ports before extubation. Measurements: The post-operative pain was assessed by visual analog score(VAS). VAS more than 4 or when patient complained of pain, injection tramadol 1mg kg-1 was given as first rescue analgesic drug. VAS score was assessed at 15minutes, 30minutes, 1hour, 1.5hours, 2hours, 4hours and 6hours after extubation and the time to first rescue analgesic dose were recorded. The data was statistically analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Qualitative variables were correlated using Chi-Square test. Results: Postoperative VAS score in Group A were significantly reduced at 15 minutes, 30minutes, 1hour, 2hours, 4hours and 6hours (P < 0.001). The time taken to administer the first rescue analgesic dose was more in the Group A (1.93 ± 0.45) in comparison to Group B (1.2 ± 0.25) with P value < 0.001. Conclusion: The duration and quality of analgesia with ultrasound guided subcostal TAP Block was better than port site infiltration.

Introduction: Vengeance is a poison for society and for the individual who harbours it. Positive motivation (Benevolence) leads to rewards and negative motivation (Revenge & Avoidance) towards pain. When considering school students, revenge motivation leads to many serious crimes viz, harassment, genocide, etc. Recent studies show the need for students to develop “Socio-Emotional Learning” (SEL). For a health society, students need to shed off Revenge and develop Benevolence Motivation. Aim: This study aimed to understand if the HELP (Heartfulness Experience Life’s Potential) program helps to reduce Revenge and Avoidance motivation along with developing Benevolence. Methodology: A prospective observational study was conducted on Junior College Students, willing to participate in the HELP program (n=3084). Participants were asked to fill up a questionnaire, comprising of socio-demographic details and transgression-related interpersonal motivations inventory (TRIM-18) scale. Data was conferred using inferential and descriptive statistics. SPSS version 21, paired “t’ test was used to compare the mean between baseline and end-line data. Results: The Analysis depicts that altogether students’ Revenge & Avoidance motivation levels have reduced significantly (p<0.05) and their Benevolence motivation level has increased significantly (p<0.05). Conclusion: There are several reasons that can be attributed to these effective results. The Cleaning practice helps remove the emotional baggage, and subsequently, the practice of Heartfulness meditation helps to stabilize one’s thinking process. Pranahuti cultivates, positive thinking and reshapes the character and personality of an individual. Hence, we conclude that integrating the HELP program in the school’s curriculum might help in the development of a strong and healthy society.

Land use pattern simply means the layout or arrangement of uses of land. The land may be used for agriculture, forest, settlement, pastures etc. The nature of land use pattern depicts the mode of transformations and sophistication of human civilization with the advancement of science and technology. Keeping in mind the significance of land use studies, this paper aims to analysis the changes in land use pattern in Uttar Dinajpur district of West Bengal during 2000-01 and 2014-15. The study is completely based on secondary sources of data. The data has been analysed through simple statistical techniques. The study reveals that, in the last fourteen years the scenario of land use pattern in the district were significantly changed. There has been an increase of 2210 hectares area under land put to non-agricultural uses, which constitutes about 10.6 per cent of the total area. A positive trend has been noticed for net sown area, which is about 88.2 per cent out of the total geographical area and considered as the highest in the entire West Bengal. The study highlights that there has been a conversion of barren and uncultivable land to non-agricultural use as well as transformation of the current fallow land and unculturable waste land to cultivated land. Hence, the change in the land use pattern in the district is the outcome of rapid population growth.

Background: prostate cancer is the second most frequent cancer worldwide, with a very high rate of progression despite treatment. The most aggressive form of the disease is known as castration-resistant prostate cancer, which carries a poor prognosis. Castration resistant prostate cancer (PC) patients are a niche of patients affected by progressive prostate cancer despite androgen deprivation therapy (ADT) and a serum testosterone value < 50 mg/dl. Androgen receptor targeted therapy (ARTT) as it has been shown for Enzalutamide and Abiraterone in phase III clinical trials, has high efficacy in patients with metastatic castration resistant prostate cancer (mCRPC), leading to improved overall survival. Methods: we reviewed available literature regarding the combination of enzalutamide antihormonal drug and ablative radiation therapy for the treatment of metastatic castration-resistant prostate cancer. This combination treatment is safe and effective, with few adverse events. This dual treatment may enhance the effects of second-line hormonal therapy, as radiotherapy renders cancer cells more prone to immune-mediated cytotoxicity. Moreover, radiotherapy exerts its effect both on directly irradiated cells and on other distant tissues, with an abscopal effect, already demonstrated in other solid tumors. Results: in the available literature, the combination of radiation therapy and enzalutamide has prolonged both overall survival and progression-free survival, with a positive impact also on locoregional recurrence and distant metastases.

Tania or, Xanthosoma sagittifolium (L.) Schott, native to northern South America and a fast-growing herb from the Liliopsid family Araceae, has been intentionally introduced in many regions of the globe as an alien species - to be used as a food crop and fodder. There it subsequently became invasive. Within India, the plant is already been reported from Karnataka, Kerala, Tamil Nadu, Andhra Pradesh and erstwhile undivided district of Bardhaman in West Bengal. Here, some insights into existing nomenclature of the species, knowledge on food uses, potential pathway causes for invasion and needs for immediate application of necessary control measures are being discussed with the anticipation that this study may be helpful to policymakers for the management of this alien plant species before it becomes invasive in West Bengal, India and in the East Bardhaman district of West Bengal, in particular.

Today, young people in India use internet and social network more than any middle-aged person. Now days, students are easily getting diverted from the studies because of social networking sites like Orkut, Twitter, Facebook, etc. more time is spending in these kinds of social sites by the youth. Though there is a risk of losing privacy and safety, the youngsters give more importance to such sites as they give chance for getting in contact with classmates, friends and people with common likes and dislikes. Social media has been an important factor in the lives of the people all over the world and providing people a much easy needed connect from shopping to electronic mails, education and business tool. The Social networking sites are giving a window of opportunity for people to connect with parents, relatives and friends who are at a distance or beyond geographical boundaries and reconnect with their old friends, colleagues and mates. It also helps people to make new friends, share content, pictures, audios, videos amongst them. The sample size of the study is 100. A questionnaire is designed to find out the various factors of social media that have impact on youngster’s perception of society. The current research also analyses the advantages and disadvantages of social media and the role of parents and teachers in prevention of misuse of social media.

Dental enamel is the hard tissue that once formed it is not remodeled, unlike other hard tissues such as bone. Because of its non remodeling nature, alterations of enamel during its formation are permanently recorded on the tooth surface. One such developmental defect of the enamel is Molar Incisor Hypomineralization (MIH). MIH is the condition of demarcated enamel opacities of various sizes and color of systemic origin affecting one or more first permanent molars (FPMs), frequently associated with permanent incisors. The affected teeth could undergo post eruptive breakdown (PEB) under the influence of masticatory forces due to soft and porous enamel, that subsequently results in atypical cavities or even complete coronal disintegration. MIH is common, and as such it should be diagnosed and managed in primary care wherever possible. Early diagnosis can lead to more effective and conservative management. This article aims to give an overview of MIH, from its etiology to treatment options in young patients.

There is a dynamic balance between demineralization and remineralization in the oral cavity that determines the occurrence of dental caries. If the demineralization phase continues for a long period of time, there is mineral loss beneath a relatively intact enamel surface leading to the initial carious lesions known as “white spot lesions” Remineralization of such early carious lesions may be possible with a variety of remineralizing agents, fluoride being the cornerstone in caries prevention. The goal is to manage non cavitated lesions non invasively through remineralization in an attempt to prevent disease progression and improve aesthetics, strength, and function. Hence, the purpose of this review is to have an in-depth knowledge of the various remineralizing agents aiming to treat early carious lesions.

Introduction: Fracture of the distal radius is the most common fracture. Mal-union of the distal radius has been associated with pain, stiffness, weak grip strength and carpal instability even after the fracture has healed. There are multiple treatment options in the treatment of distal radius fractures, including closed reduction and cast immobilization, percutaneous K-wire fixation (kapandji intra-focal pinning, trans-radial styloid pinning, pinning via the Lister’s tubercle or trans-ulnar pinning), fixation with volar or dorsal plates (locking or non-locking), bridge plating, use of an external fixator by means of ligamentotaxis to realign fracture displacement. Still there are treatment controverses as there is no single definitive modality which is considered the standard of care. Material and Method: This randomized prospective comparative study had 56 patients with fractures of distal radius (Frykman type I-VIII) were included in the study. All the patients were randomly divided into two groups. In the group A, patients were treated by closed reduction percutaneous K-wire application with below elbow slab application, while in the group B, patients were treated by closed reduction and below elbow cast application. All the patients were followed up and functionally evaluated by the demerit scoring system of Gartland and Werley (1951) at 6 weeks, 12 weeks and 6 months. Results: Out of 56 patients in this study, 30 patients were females and 26 were males. Mean age with standard deviation of group A and group B was 40.66±16.72 and 48.81±14.65 respectively. In group A and group B, fracture distribution according to FRYKMAN classification, type I-II fracture was 33.3% and 54.5% and type VII-VIII fracture was 17.9% and 4.5 % respectively. 36 had intra-articular fracture and the remaining 20 patients had extra-articular fracture. According to Gartland and Werley demerit scoring, at 6 month follow up, 40%+48.6% patients had excellent and good results in group A as compared to 47.6%+38.1% patients in group B. Comparable number of patients had deformity in both the groups i.e 12 in group A and 10 in group B. Finger stiffness was found in 3 patients in group A and 2 patients in group B. In group A 11 patients had arthrithis as compared to group B had 15 patients. Median nerve compression was found in 1 patient in each group. Conclusion: Closed reduction and k-wire stabilization is marginally superior to closed reduction and Cast application in terms of final functional outcomes. CR and casting can be an easy, non-invasive and safe option to treat fractures of distal radius if patients are carefully chosen.

Background: Trabeculectomy is the most common surgical treatment for glaucoma in which a filtering fistula is created with the aim of lowering the intraocular pressure (IOP). A slow healing response of the surgical wound is important for a successful surgery and Beta irradiation is a rapid, effective and simple treatment to slow down this healing process. This study, evaluates the intraocular pressure lowering effect of beta irradiation as an adjunct to trabeculectomy in Nigerians. Methods: A retrospective study of patients aged ≥ 21years with preoperative IOP ≥ 21mmHg who underwent trabeculectomy with beta irradiation for glaucoma between 2012 and 2017 and had a minimum of 2 years follow up at Eleta Eye Institute and Ojulowo Eye Clinic in Ibadan, Nigeria. Seventy-one eyes of 54 patients were analyzed. They underwent trabeculectomy with adjunct beta irradiation which was administered intraoperatively on the conjunctiva overlying the bleb area as a single dose of 2,400cGy using a strontium-90 probe. All the 54 patients were operated on by the same surgeon. Results: 64.8% of the patients were males and the mean age for the patient was 45±3.7. 66.2% eyes had preoperative VA ≤ 6/18 while 91.5% eyes were able to maintain the pre-operative VA three months post operation. Mean preoperative IOP was 25.0±4.6mmHg, 10.5±2.3mmHg at 1 month post operation and 14.5±3.5mmHg at 2 years post operation. There was a statistically significant difference in the preoperative and postoperative IOP after 2 years, P value <0.05 Conclusion: Trabeculectomy with beta irradiation gives a good control of intraocular pressure and is recommended in patients at risk of developing post-operative conjunctival fibrosis.

Data privacy has to be guaranteed for enhanced system security especially in some sensitive domains such as in banking systems. Blockchain is frequently used in these systems due to its high security level. however, public blockchain has a major concern about privacy which is the ability to discover addresses of nodes in the blockchain. Thus, private blockchain is preferred since they guarantee full privacy since the blockchain is not open. In addition, they guarantee easier deployment and faster computation. However, the security level lower than the public blockchain. Our contribution in this paper is to enhance the privacy of banking transactions (so use the private blockchain), reduce the cost of complexity (use the private blockchain), guarantee enhanced security level (use the public blockchain via network virtualization). Our proposal is a hybrid private-public blockchain solution for enhanced data privacy and guaranteed security. We propose a hybrid blockchain structure that applies the special properties of the blockchain physically and increases the general blockchain characteristics by default. Currently, all the advanced systems do not need physical devices and use virtual devices that have the same functions but with higher capabilities than them. We propose the use of a virtual network because of its advantages as it is cost-effective, reduces the business burden, better operating time, faster resource deployment, and economic and efficient use of energy

Voice is an integral part of human attribute known as speech. A person with voice problem may present with hoarseness, voice fatigue, breathy voice etc. change of voice is just a symptom, but dysphonia is a diagnosis. This study was carried out in the department of ENT, C. U. Shah medical college and hospital. A total 100 cases were studied. Patients (both male and female) presenting with hoarseness of voice were studied.We found total of 178 complaints from 100 patients. Few patients had two or more than two complaints at the time of examination. Change of voice was the commonest presenting symptom in 92 cases(92%). Other complaints included vocal fatigue(10%) and two cases had aphonia.

The current search trend is entering the Cloud of Things. CoT aims to provide integrated and ubiquitous IoT services with IoT functions. However, realistic and time-consuming smart services require CoT architecture, which is energy efficient. This article explores architecture, sites and CoT implementation in the healthcare sector. It reviews the need for further efforts to achieve an energy-efficient CoT framework in the healthcare sector, taking into account energy efficiency, delay and quality of service. Researchers from academia and industry have begun exploring applications of blockchain technologies for healthcare. These applications include smart contracts, fraud detection, and authentication. In addition, as highlighted in this research report, there are many health care applications that have not been addressed by research into block chain experiments. In the health sector in particular progressively associated with data and correspondence innovation administrations One of the main administrations is far off patient observing, which permits medical care suppliers to follow, analyze and allude patients without remaining in the emergency clinic .The benefit of reducing sensing technologies is the ability to wirelessly transfer normal data to remote servers or install it on the patient's body. One of these technologies is called Wireless Body Area Network (WBAN).This survey explores clinical diagnosis, legal compliance, fraud prevention, and improving patient care.

It is about a 42 year old male patient diagnosed with a Thoracic Duct Cyst at the left neck who underwent successfully and uncomplicated removal of it. Analyze strategy of treatment, diagnosis, operative technique and literature review. It is extremely rare only a few cases have been reported in bibliography. A neck ultrasound can identify the lesion, also CT scan MRI can improve diagnosis. Pathology report can give finally the diagnosis-Gold standard. Special care should be given to avoid hemorrhage during the operation and complication associated with duct ligation. Radiotherapy and Cyst-venous anastomosis have been reported as alternative treatment. Regular follow up is necessary to diagnose early any kind of complication. Finally operation and further management needs to be done by a experience and well trained team.

Introduction: Rhabdomyosarcoma is an extremely aggressive malignant tumor that rarely occurs in adults. Its orbital location represents only 9% of all damage to the head and neck. Case presentation: We report the clinical case of orbital rhabdomyosarcoma in a 23-year-old male patient who presented with progressive right exophthalmos with cervical lymphadenopathy. The introduction of a treatment combining chemotherapy based on ifosfamide, vincristine and actinomycin, and orbital radiotherapy of 66 Gy according to the intensity modulation technique (IMRT), made it possible to obtain a complete remission with a 12 month follow-up. Conclusion: Orbital rhabdomyosarcoma is a rare tumor in adults. Early care improves the vital and functional prognosis.

Introduction: Chronic laryngitis is a very common problem seen in our ENT out patient department on a daily basis .Most patient presents with hoarseness as a chief symptom followed by sore throat ,dysphagia and cough .While large number of patients respond to anti reflux medication ,there are some groups who continues to report of long term voice distortion despite treatment .Objective: We divided the patients in two cohorts to compare the effect of steam inhalation and short term oral steroids in patients of chronic laryngitis. Material and methods: This is a prospective study done on 50 patients randomly divided into two groups .One group was offered steam inhalation while other group was given short term steroids .Findings were recorded and compared after one week of treatment. Conclusion: Though both the group showed good outcome but short term steroids surely takes the upper hand in hoarseness treatment and improvement in voice.

Stereotactic radiosurgery (SRS) has revolutionized the initial management of patients with brain metastases. It delivers focused, highly conformal, ionizing radiation to a target delineated using high-resolution imaging with minimal toxicity to adjacent brain structures. The most common late-delayed radiation effect of SRS is the development of brain radionecrosis (RN), which is often associated with the presence of different degrees of neurologic deficits. MF-SRS (2-5 fractions) has been used as an alternative to SF-SRS, with the aim to reduce the incidence of late radiation induced toxicity while maintaining high LC rates. The aim of this retrospective study was to evaluate the acute toxicity, local control, PFS, OS and incidence of RN in patients who received SF-SRS or MF-SRS for brain metastases. In this mono-institutional analysis, ninety consecutive patients with one or two brain metastases treated with SF or MF-SRS, were included. Endpoints of the analysis were radiation-induced brain necrosis and local control (LC), progression-free survival (PFS) in SF and MF-SRS. 90 patients were eligible and treated with SRS from June 2017 to June 2020 and retrospectively analyzed. 63 patients had lung cancer, 18 breast cancer, 5 renal cancer and 4 other cancer. Metastases were treated with Linac based radiotherapy, using VMAT technique. A total of 98 lesions were treated: 82 patients had single metastasis, while 8 patients had two metastases. Patients' median age was 65 years (range 40-80). Median follow up was 20 months (range 8-36 months). Patients were divided into two groups. Group A (35 patients) received a single fraction with a dose ranged from 21 Gy to 24 Gy; Group B (55 patients) received 3 fractions with a dose ranged from 24 Gy to 27 Gy. Size limits were metastases <2cm in longest diameter, largest tumor <4 ml in volume. 6 patients (7%) experienced toxicity grade 1 on the RTOG scale, consistent with minor neurological findings, such as headache but with ability to carry out normal activity without medication. 2 patients (2%) experienced toxicity grade 2 requiring home care and medication, including steroids. Every patient undergoing to perfusion and spectroscopic MRI before SRS and then every 3 months. At first follow up (3 months) 70% of patients had CR and 30% had SD, no PD. The 1-year local control rates were 80% in the SF-SRS group and 92.7% in the MF-SRS group. The 1-year PFS cumulative rate was 85.7%, 83.3% in the group A and 87% in the group B. The 1-year OS cumulative rate was 54.4%, while 51.4% in the group A and 56.4% in the group B. 7 patients (20%) undergoing SF-SRS and 5 (9%) subjected to MF-SRS experienced brain RN; the 1-year incidence rate of RB was 16.6% and 6.4%, respectively. MF-SRS at a dose of 27 Gy or 24 Gy in 3 daily fractions seems to be an effective and safety treatment modality for brain metastases, associated with better local control and a reduced risk of radiation-induced RN as compared with SF-SRS at dose ranged from 21 Gy to 24 Gy.

They Indian economy has seen an increase in the recent years due to the increase in the contribution of working women with in the economy. A decade ago, working women in India were much less in number due to which the laws in regard to maternity benefits were not as protective and safeguard as seen today. Thus amendment had to be brought fourth year of 2017 in order to protect enhance the position of working women within their organization. One of the crucial change that changed the dynamic of the protection provided to women under the maternity benefit act was that the duration of leave granted to them, which was brought forth in 2017 amendment was that the maternity leave was granted to women was increased, previously to the amendment had only 12 weeks of maternity benefits but with the passage of time it felt the need to enhance it so as to support the women and thus it was increased of 26weeks. After this increase India has become one of the few nations of the world to provide such support for the enhancement of women Employment. It is of outcome importance to have laws that safeguard the interest of women in today competitive and cut throat working environment by means of having laws such as maternity benefit act.

India is the largest democratic country in the world, with a population size of 165crores. The Indian women, however, face innumerable problems at home and in society since their childhood. The most common and unfortunate trait of Indian society is that the girls need only basic levels of education and awareness so that they teach their children after their marriage. The girls in India are encouraged to learn dance, music, child education and an art of cooking at home. The hidden talents of the Indian women are buried under the disguise of House Wife. The present study explores the factors which inhibit the growth and the prospects of women in India. It urges the strong need of the constitutional amendments which facilitate the growth of the women in the areas of education, sports, industry, science and technology.

Many countries around the world are trying to diversify sources of national income, and one of the best ways to increase that income is through tourism. Cultural heritage is one of the most important resources to support income from tourism. Saudi Arabia has an important tangible and intangible cultural heritage that faces the challenge of making it acceptable as a valuable cultural resource. Heritage sites as the main source of cultural tourism should be seen as an essential contribution to any tourism development plan, especially in law. The findings of this research show that heritage development is the result of heritage management and the tools it uses. The relationship between the national and local levels is critical to the management of cultural heritage in Saudi Arabia. This management directs through written laws and guidelines within specific definitions that are established mainly at the national level. Furthermore, definitions or laws are not the only mechanisms for the control, development, or management of heritage. Other important requirements must be considered. For example, the power of societies and the level of individual and public awareness are other mechanisms that can positively or negatively affect heritage.

Cet article porte sur la recherche d’un code spécial dans la cité de Malemba. L’objectif majeur est de savoir comment la cité a procédé pour trouver une solution adéquate au blocage de la communication entre les sourds muets et les personnes qui utilisent le mode d’expression verbal.

Paripluta is one among the twenty Yoni Vyapads mentioned in the classics. In this disease pitta and vatadusti are considered as primary cause. It can be correlated to pelvic inflammatory disease due its resemblance of clinical features. PID is of public health issue, especially in developing countries be- cause of its high prevalence, economic and social implication. Delayed management of PID may result in higher rates of miscarriage, chronic pelvic pain, STD, progressive organ damage and long term reproductive disability due to its recurrence.

A ZMC fracture is also known as a tripod, tetrapod or quadripod fracture, trimalar fracture or malar fracture. They can account for approximately 40% of mid-face fractures. They are the second most common facial bone fracture after nasal bone injuries. For the reduction of ZMC fractures various surgical techniques including one, two and three point fixation have been used, these are based on the severity and the extent of the fracture, Several approaches are used namely lateral eyebrow, sub ciliary, intra oral incisions for fixation of ZMC fractures. At this time it remains unclear which treatment is best. This present study is aimed to compare the efficacy of one point versus two point fixation following repair of zygoma fractures in 10 patients and to compare the treatment outcomes of one point versus two point fixation.

Background: Breast cancer is the most commonly diagnosed cancer with highest mortality. It has different prognosis in Indian scenario with aggressive presentation as compared to the western population. This study was thus done to study the epidemiology and highlight these differences in clinical and prognostic factors. Materials and Method: This retrospective study was conducted to collect data on histologically proven cases of breast cancer from June 2017 to December 2019. Data pertaining to socio demographic factors, tumor factors, hormone receptor positivity and human epidermal growth factor receptor type 2 (HER2) were collected. Data was thus interpreted as frequency tables and graphs. Results: A total of 455 patients were registered in this time period. Patients presented at an early age group of 31-50 years accounting for 53.6% of patients and at a higher stage of stage III accounting for 48.5% of patients, which is in contrast to the western population. 1.5% patients were of male gender. 57.6% of patients presented with lump in left breast and upper outer quadrant was most commonly involved in 36.1% of patients. Estrogen receptor positivity was seen in 45.5% patients and HER-2/neu was positive in 35.9%. Conclusion: Lower age of presentation, higher stage at the time of presentation, lower rate of positivity in ER and slightly higher expression of HER-2/neu receptors, point towards aggressive nature of breast cancer in Indian population as compared to various studies done in western countries. Subject Area: ONCOLOGY Keywords: Breast Cancer, Age, Stage, ER, HER-2/neu

The biofilm-forming bacteria are asocciated in communities of organisms which are strongly attached to the biotic and abiotic surfaces. They cause infectious diseases among the population and are the source of contamination of medical devices or surfaces within hospitals or in different areas of industrial production. Bacterial biofilm can be formed in various materials such as glass, stainless steel, polyvinyl chloride, polystyrene, etc. Therefore, it is necessary to search materials that prevent the formation of biofilm on the surface of them.

Ayurveda is a science of life. Especially Charak Samhita is most essential text in Ayurveda. Sutra Sthana lies as nectar of knowledge, which has been stored by Acharya Charak in very beautiful way i.e. Chatushaka Methodology. These Chatushaka are the heart of the text. It is a need of time to explore the contents of Chatushaka especially Swasthya Chatushaka to achieve Positive Health i.e. complete state of physical, mental, social & spiritual well-being. Providing the nourishment of rest of Samhita. The strength of medical literatures lies in its applicability and utilization. For successful utilization of a medical literature, periodical scrutiny and evaluation is very important. There is pool of Ayurveda classical literatures found still and fulfilling the needs of mankind, but the current trend of research is not much focused on literary research. As the culture, lifestyle and other customs of people are changing along with the advancement of science, it is time to look into the ancient treasure of medical literatures, which has solution for all time.

Present paper deals with the analysis of the Delhi Metro Tunnels of Chawri bazar area. The design and construction of metro tunnels and their linings require the knowledge of displacements and stresses in the surrounding rocks due to excavation. With the use of Finite Element Method (FEM), the analysis of the tunnels has been done under various loading conditions for Hauz Khazi tunnel near Amar Cinema. A comparative study was made with various loading cases, in this study elastic solutions were considered. Hauz Khazi section has two tunnels of diameter 3m and center to center distances between the tunnels are 6.26 m. Study suggest that loading of a assumed surcharge and water pressure acting all along the periphery of the tunnels with assumed lining thickness was found to be critical for this section.

Background: Covidvirus emerged from China in the end of December 2019 and crippled the whole world immediately. To curb the spread of this virus, complete lockdown in India was implemented by the government. Though it helped in slowing the chain of infection but economical and educational sectors got inflicted severely due to this lockdown. Traditional method of teaching had to switch from offline learning to e-learning. Though it is 21st century and people are supposed to go hand in hand with technology, still majority of Indian students is not friendly with the advanced means of learning. Consequently, Indian students faced several issues related to e-learning programs amidst pandemic. Objectives: To find out the flipped side of e-learning faced by Indian students. Methods: One hundred and sixty-eight students (n=168) from high school to higher education were approached through snowball sampling method. A self constructed questionnaire was designed for this study to assess the issues caused by e-learning during covid pandemic. Results: Findings reveal that purchasing gadgets and internet services for attending e-learning programs are financial burden for most of the students. Technical issues produce problems in attending e-learning programs. Students stated that e-learning does not help them in study as effectively as offline learning. They also faced psychical and psychological problems due to attending e-learning programs for prolonged period. Overall findings show that students preferred offline learning over e-learning programs. Conclusion: E-learning has provided students an opportunity to learn in the pandemic but they have been dealing with several financial and health related issues. Silver linings were reported in the propagation of e-learning but it was not as flourishing as offline teachings.

Acute myeloid leukemia (AML) is a hematologic cancer with a high mortality and the FLT3 mutations are recognized as one of the most important alteration associated with AML and are related with a poor prognosis. Some studies have revealed that at diagnosis, patients with AML with FLT3 can maintain the alteration in the relapse or refractory disease, although this is not always the rule. This report is a meta-analysis review about the genetic change of FLT3 mutation in the relapsed/refractory AML scenario and if this what differs from findings at diagnosis in the same patients. A search in June/2020 was performed in PUBMED to identify studies with the terms FLT3 (title/abstract) AND “Acute Myeloid Leukemia” without a restrict date. Six articles described mutation status in both FLT3 alterations. The total of 272 patients with relapse and refractory AML were analyzed, 74 (27%) were positive for FLT3-ITD at diagnosis and 15 (5%) for FLT3-TKD. The change in mutation status occurred in 17% of patients. Mutation status change from negative to FLT3-ITD occurred in 7% of patients, FLT3-ITD to negative in 5%. From those that were FLT3-ITD positive 60 remained positive in the relapse. Our data demonstrated that 41% of patients were positive for FLT3 mutation in some point of the disease. Since one in six patients had their mutational status change in the study, reassessment should be mandatory in any case of relapse and refractoriness. If this is related with worst prognostic more studies are needed to elucidate.

Probiotics are Probiotics are live bacteria and yeast that are good for our digestive system. Probiotics are often called ‘good’ or helpful bacteria because they keep our gut healthy. Probiotics can be obtained by supplements and in some food like yogurt. Probiotic gum replenishes good bacteria and the body while we chew and freshen our breath. TYPES OF PROBIOTICS Lactobacillus Most common. ● Found in yogurt and other probiotic foods. ● Different strains can help with diarrhea and may help people who are lactose intolerant. Bifidobacterium: ● Found in some dairy products. ● May help ease symptoms of irritable-bowel syndrome and some other conditions. Saccharomyces boulardii: • Is Yeast found in Probiotic? • Appears to help fight diarrhea and other digestive problems. Streptococcus: • Streptococcus thermophilus • Streptococcus faecalis Clostridium butyricum: PROBIOTIC FUNCTION ● Treats irritable bowel syndrome. ● Treats inflammatory bowel disease. ● Treats infectious diarrhea (caused viruses, bacteria or parasites.) ● Treats diarrhea caused by antibiotics. MARKETED PROBIOTIC ● Yakult probiotic health drink= Lactobacillus casei Shirota 6.5 billion. ● Doctor’s Best digestive probiotic- a) Bifidobacterium lactis strain HN019. b) Bifidobacterium lactis strain BI-04. c) Bifidobacterium lactis strain BI-07. d) Lactobacillus acidophilus strain LA-14. e) Lactobacillus salivarius strain Ls-33. f) Lactobacillus paracasei strain Lpc-37. BIFILAC-lozenges contains • Lactobacillus sporogenes 50 million, • Streptococcus faecalis T-110 30 million, • Clostridium butyricum TO-A 2 million • Bacillus mesentericus TO-A 1 million PROBIOTIC GUM AVAILABLE ● Focus nutrition and pure probiotic gum= Refreshing sweet mint-30 pieces. Probiotic used- Ganedenbc30.

The present study aimed to evaluate immunomodulatory effects of stem and root aqueous extracts of Tinospora cordifolia (TC) in mice. TC creeped on neem plant was collected and extracts were prepared. A total of 18 Male Swiss Albino mice divided into three groups were used in the study. Group-I mice were treated with distilled water. Group-II mice treated with aqueous extract of TC stem (200 mg/kg), Group-III mice treated with aqueous extract of TC root (200 mg/kg). Physical and immunological parameters were measured at 2nd, 4th and 6th week. At the end of study mice were sacrificed under anesthesia. Thymus and Spleen was collected, weighed examined for histopathology. The result and findings of the study suggest the immune enhancement activity of stem and root aqueous extracts of TC.