Miracle-dz/UniFAR-FTUs huggingface dataset:
Integration of Telemedicine for Home-Based End-of-Life Care in Advanced Cancer Patients during Nationwide Lockdown: A Case Series

Dignified death is a basic human right that has been widely overlooked in countries like India. During nationwide lockdown, it is extremely challenging to provide quality end-of-life care (EOLC) to all patients with a poor system for dignified death. Telemedicine, whose feasibility for community-based EOLC in rural settings has already been established, was a useful tool for us to overcome these barriers. Adding a widely used smartphone-based application for video calls along with voice calls and text messages made the process more dynamic and convenient. Here, we share our experience with three patients with advanced malignancy in providing EOLC during COVID-19 lockdown. A well-planned study for the utility of this service for a larger cancer patient population from different sociocultural and demographic backgrounds is warranted in the future.
Efficacy of ultrasound guided quadratus lumborum block as postoperative analgesia in renal transplantation recipients: A randomised double blind clinical study

Background and Aims: Postoperative pain following renal transplantation is moderate to severe. Quadratus lumborum block (QLB) is a new block that can provide effective analgesia following abdominal and retroperitoneal surgeries. This study aimed to evaluate the analgesic efficacy of QLB for postoperative analgesia in patients undergoing renal transplantation. Methods: Patients were randomised into two groups of 30 each. In group A (block group), 20 mL of 0.25% bupivacaine and group B (placebo group), 20 mLof normal saline were injected. In the postoperative room, an intravenous patient controlled analgesia (IVPCA) pump with fentanyl was started in both the group. The postoperatively recorded parameters were numerical rating scale (NRS) pain score at rest and on movement and coughing, total fentanyl consumption, sedation score, postoperative nausea vomiting, limb weakness, paralytic ileus, and any other block-related complication. Data were analysed using SPSS software version 22.0. Categorical data were analysed using the Chi-square method. Student t test or Mann–Whitney U test was applied for the continuous data. Numerical data with normal distribution were displayed as mean (standard deviation), abnormal distribution was displayed in the median (interquartile range) values, and as a percentage for categorical variables. Results: Fentanyl consumption, numerical rating score, and sedation score were significantly less in group A when compared to group B at 1, 4, 8, 12, and 24 h (P < 0.001). Conclusion: Type-1 QLB significantly reduces fentanyl consumption and NRS pain score at 1,4,8,12, and 24 h in the postoperative period in renal transplant recipients.
Retrospective analysis of patients with severe maternal morbidity receiving anaesthesia services using 'WHO near miss approach' and the applicability of maternal severity score as a predictor of maternal outcome

Background and Aims: Risk stratification of severely morbid obstetric patients receiving anaesthesia services can be helpful in improving maternal outcomes. This study was undertaken to analyse these patients using the WHO near-miss (NM) approach and to assess the applicability of maternal severity score (MSS) to predict maternal mortality. Methodology: This is a one-year retrospective cohort analysis at a tertiary care centre. Of all the obstetric patients receiving anaesthesia, those with 'potentially life-threatening conditions' (PLTC) were identified. Amongst women with PLTC, those fulfilling the WHO NM criteria were grouped into either maternal near miss (MNM) or maternal death (MD) depending on final survival outcome. The MSS was assessed upon admission to post-anaesthesia ICU. The cases of “near miss” were compared to maternal death to determine the factors and WHO NM criteria significantly associated with mortality. Area under ROC curve (AUROC) was used to assess the accuracy of MSS to predict maternal mortality. Results: Of the 4351 anaesthetised obstetric patients, 301 were PLTC, 59 MNM and 11 MD. Obstetric haemorrhage was the commonest PLTC with the highest risk for MNM and MD. Preoperative organ dysfunction, referral from other centres, intra-uterine fetal death (IUFD) and WHO cardiovascular and respiratory NM criteria were significantly associated with mortality. MSS had excellent accuracy for the prediction of mortality (AUROC was 0.986 and 95% CI 0.966–0.996). Conclusion: Haemorrhage is the leading cause of MNM and MD. MSS is reliable in stratifying the severity of maternal morbidity and in predicting maternal mortality. Thus it can be used as an effective prognostic tool.
Whole-body and Single-Photon Emission Computed Tomography/Computed Tomography Postpeptide Receptor Alpha Radionuclide Therapy Images of Actinium 225-Tetraazacyclododecanetetraacetic Acid–Octreotide as a Primary Modality of Treatment in a Patient with Advanced Rectal Neuroendocrine Tumor with Metasta

Somatostatin receptor-targeted alpha radionuclide therapies have been introduced including actinium-225 labeled tetraazacyclododecanetetraacetic acid–octreotide (Ac-225 DOTATATE) for advanced metastatic neuroendocrine tumors (NET). Very limited data are available on the posttherapy imaging using Ac-225 DOTATATE therapy in metastatic NET. We present Ac-225 single-photon emission computed tomography/computed tomography images of a 72-year-old patient diagnosed as a case of advanced rectal NET treated primarily with Ac-225 DOTATATE.
Multiple Caregiving Role with the Novel Challenge of COVID-19 Pandemic: A Crisis Situation

Caregivers of cancer patients in the COVID-19 pandemics have been faced with new complexities and challenges related to their patient's care. It has added tremendous stress to the previous multiple caregiving roles. We present the journey of a caregiver of cancer survivor who had played multiple care giving roles for the past 10 years. With the added challenge of the pandemic the caregiver faced severe psychological distress concerning his caregiving role. This was addressed to a large extend with counseling and empathy. Communication is an important measure to relieve the distress and address the complexities faced by caregivers.
A randomized split mouth clinical study to compare the clinical outcomes of subepithelial connective graft and acellular dermal matrix in Miller's Class I recession coverage therapy

Background: According to the American Association of Periodontology, subepithelial connective tissue graft (SCTG) is one the most reliable surgical technique available for the treatment of gingival recession (GR) with Miller's Class I defect. However, due to its various disadvantages, alternate grafts such as acellular dermal matrix (ADM) grafts have been introduced for recession coverage. The present study compares the clinical outcome of these two grafts in treating Miller's Class I GR. Materials and Methods: All the 15 patients participated in the study who had totally 30 bilateral Miller's Class I GR were divided randomly into SCTG group and ADM group each containing 15 defects. In the SCTG group, coronally advanced flap (CAF) with SCTG was performed, and in ADM group, CAF with ADM was done. Clinical parameters were measured on the day of surgery (baseline) and after 6 months. Data collected were statistically analyzed using paired and unpaired t-tests. Results: The analysis of the data collected at the baseline and 6 months later showed that there were no statistically significant differences in the recorded clinical parameters such as probing pocket depth, clinical attachment loss, and GR depth. ADM group showed a better color match than the SCTG group, while SCTG group achieved more keratinized tissue width than ADM group. Conclusion: From the outcome of the current study, we can conclude that ADM is an efficient substitute for SCTG for treating Miller's Class I GR. However, additional studies with greater number of samples and lengthier follow-up periods are necessary to validate the present inference.
A hospital-based cross-sectional study on suicidal poisoning in Western Uttar Pradesh

Background and Aims: Poisoning is most common method of committing suicide in India. Objectives of this study to assess prevalence of suicidal poisoning among all poisoning cases, its socio-demographic profile and its reasons in all admitted cases of suicidal poisoning in hospital. Methods: A cross-sectional study was conducted on cases of poisoning of any age group admitted in the Chhatrapati Shivaji Subharti Hospital, Meerut. Poisoning cases with history or evidence of suicide were further interviewed. A semi-structured interview schedule in Hindi was used to collect data. Microsoft Excel 365 and R software version 3.6. 0 were used for data entry and analysis respectively. Results: Among total 135 poisoning cases admitted in hospital, 126 provided consent and included in the study. Prevalence of suicidal poisoning was 77.7% (98). Most common age group involved was 11-20 years (36.7%) and 21-30 years (35.7%) and most of the participants were males (59.2%). Most suicidal poisoning cases took Aluminum Phosphide (31.6%), followed by Organophosphates (20.4%) as poison. Most frequent reasons for suicide as described by participants were 'Family quarrel or family unhappiness' (29.6%), 'failure in examination or interview or business' (23.5%), 'ill treatment by spouse or in laws' (16.3%) and 'unemployment' (9.2%). Conclusion: Our study shows that consuming Agriculture poisons (Aluminum Phosphide and Organophosphates) are most common (52%) poisons consumed by suicidal poisoning cases. Agriculture poisons (Aluminum Phosphide and Organophosphates) are easily available in markets in India. There should be some restriction on their purchase to reduce suicidal incidences.
Persistence of Lambda-cyhalothrin on Pea (Pisum sativum L.)

Thirty five and 70 g a.i. ha−1 of lambda-cyhalothrin was applied to a pea crop, revealed a half life of 4 days. At harvest, the residues on pod cover were 0.10 and 0.25 mg kg−1 from the normal and double the normal dose, respectively, and below detectable limit (<0.002 mg kg−1) in grains.
Awareness of human papillomavirus and its vaccine among patients attending primary care clinics at King Saud University Medical City

Objectives: We aimed to assess the awareness, attitudes, and practice regarding human papillomavirus (HPV) and its vaccine among women attending primary care clinics in Riyadh. Methods: This cross-sectional study included 326 women aged 18–60 years who attended primary care clinics between June 2014 and June 2015. The participants completed a validated, self-administered questionnaire. Data collected included sociodemographic information (e.g., age, marital status, education, and employment), knowledge of HPV and its vaccine, and attitudes regarding HPV vaccine acceptance. Results: Among the respondents, 59.4% were married, and 43.6% had received a university education. The study population had a marked lack of information regarding HPV infection and vaccination. Only 32.8% of the women knew that HPV is transmitted sexually, while 21% knew that it could cause cervical cancer. A quarter of the participants were aware of the protective vaccine against HPV. There were no statistically significant differences in participants' knowledge levels, according to age, marital status, educational level, and occupational status. The doctors, the media, and the friends were the primary sources of information to 5.6%, 7.7%, and 24.5% of the participants, respectively. Conclusion: Overall awareness of HPV and its vaccine and cervical cancer screening is low among Saudi women. There is a need for formulating preventive strategies and effective awareness programs for better HPV-related education, vaccine availability, and the importance of cervical cancer screening.
A cross-sectional study of association of serostatus and extra-articular manifestations in patients with rheumatoid arthritis in a teaching hospital

Background: Rheumatoid arthritis (RA) is an autoimmune disease, which mistakenly attacks the joints and induces the inflammatory changes that thicken the joints (the synovium) resulting in swelling and pain in and around the joints. It causes pain, joint deformity, and also affects the quality of life. The joint is affected symmetrically. It also can affect body systems, such as the cardiovascular, respiratory systems, or other systems, which manifest as extra-articular manifestations. Extra-articular manifestations of RA are documented less in India hence this study was undertaken to correlate RA with extra-articular manifestations as well as its relationship with serostatus in patients with extra-articular manifestations. Materials and Methods: Sixty patients (age between 18–60 years) attending Medicine/Rheumatology outpatient department were included in the study (12 months) who fulfilled the 2010 RA classification criteria laid down by American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) for RA. All the subjects underwent a thorough history, clinical examination, and laboratory investigations. The relevant data were analyzed with appropriate statistical methods after 12 months' duration. Results: Nearly 68.33% of the subjects were found to have extra-articular manifestations mostly in the age group of 31–40 years with prevalence higher in the female. In the seropositive patients, early morning stiffness (EMS) constitutes 63.82% of the total extra-articular manifestations in the patients followed by anemia (38.29%) and peripheral neuropathy (34.04%). On the other hand, in the seronegative cases, EMS (61.53%) followed by anemia (23.07), peripheral neuropathy (15.38%), and keratoconjunctivitis sicca (15.38%). Extra-articular manifestations in seropositive patients have a statistically significant relationship with the increase in the duration of the disease. Conclusion: Extra-articular manifestations need to be looked carefully as it is associated with more severe disease. Seropositivity and extra-articular manifestations both usually indicate that the RA is more severe and may affect the quality of life.
Perception, knowledge, and practice of endodontists and general dental practitioners toward evidence-based practice and factors associated with it—A cross-sectional study

Background: Evidence-based practice is the cornerstone of dentistry and especially endodontics. Diagnosis, treatment planning, and treatment with recent advancement based on evidence would be a great help for the patent satisfaction and treatment prognosis; hence, the aim of present study was to explore difference between perception, knowledge, and practice of endodontists and general dental practitioners (GDPs) towards evidence-based practice and factors associated with it. Materials and Methods: The present study is a cross-sectional descriptive questionnaire study conducted among specialists in the subject of conservative and endodontic dentistry and GDPs working in private clinics in Modinagar city, Uttar Pradesh. The study was conducted in October 2019. In the present study, a close-ended questionnaire was prepared to determine the perception and practice of dental specialists. Results: The majority of endodontists (31 [35.22%]) belonged to the age group of 36–45 years of age while most of the GDPs (32 [36.36%]) belonged to 25–35 years of age group. The majority of endodontists were females (56[63.64%]) and most of the GDPs were males (50 (56.81]). More endodontists (47 [53.42]) had a positive perception of evidence-based practice than GDPs (15[16.42]). Practice toward evidence was fair among most of the endodontists (49 [55.68%]) and GDPs (54 [61.36%]). Conclusion: There was a more positive perception regarding evidence-based practice among endodontists than GDPs, knowledge was high among endodontists regarding evidence-based practice and practice was also good among endodontists. Factors associated with perception, knowledge, and practice among endodontists and GDPs were age in years, gender, year of practice, number of endodontic patients treating per month.
Socioclinical profile of patients seeking treatment for cancer in a Teaching hospital in east Delhi, India

Background: Prevalence of cancer in urban India is seeing a discernible increase due to lifestyle modifications and adverse environmental exposures. The pattern of cancer incidence varies from one region to another within a large country like India. Aim and Objectives: This study was conducted to understand the socioclinical profile of the patients attending a tertiary care hospital in east Delhi for the treatment of cancer. Methods: Patients above the age of 18 years, who had been diagnosed with cancer, were recruited for our study and their socioclinical details were elicited. After 3 months they were reassessed and their treatment and side-effect profile were studied. Results: Majority of our patients were diagnosed with cancers of the oral cavity and were married men in age group of 40–60 years, residing in the National Capital Region. Patients diagnosed with breast cancer were more likely to receive chemotherapy and suffer from side effects of treatment like nausea, anorexia, and loss of weight. Conclusion: Physicians need to be aware of these complications and should incorporate a proper counselling mechanism before treatment is started in such patients. Family physicians play a defining role in the palliative management since he remains a trusted face in his community and can provide professional and psychotherapeutic support.
The Utility of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Differentiated Thyroid Cancer Patients with Biochemical Recurrence and Negative Whole-Body Radioiodine Scintigraphy and Evaluation of the Possible Role of a Limited Regional Scan

Purpose of the Study: 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is used in the management of recurrent differentiated thyroid cancer (DTC) patients presented with rising thyroglobulin (Tg) or anti-Tg antibody (Atg) levels and negative whole-body I-131 scan (WBS). We aimed to evaluate the utility of regional or limited PET/CT in a large population preset with variable Tg/(ATg) levels. Materials and Methods: In a retrospective study, we analyzed 137 PET/CT done on DTC patients presented with raised Tg/Atg and negative WBS. Retrospective evaluation of other available clinical information was done. Results: One hundred and thirty-seven patients aged 8–72 years (41 ± 17.7 years) were included in the study. Eighty-nine (64.9%) patients had positive findings on 18F-FDG PET-CT. It included thyroid bed recurrence, cervical, mediastinal lymphadenopathy, lung, and bone lesions. In addition, 36 patients had metabolically inactive lung nodules detected on CT. Serum Tg and female sex were the only predictors for a positive PET scan. In most (97.1%) of the patients, the disease was limited to the neck and thoracic region. Conclusions: PET/CT is an excellent imaging modality for evaluating DTC patients presented with biochemical recurrence. It not only finds the disease in more than 80% of the patients but also detects distant metastatic disease, which precludes regional therapies. Lesions were noted mostly in the neck and thoracic region with very few distant skeletal metastases (4/137 patients). In most of the patients, routine vertex to mid-thigh imaging could be avoided.
Consumption of Black Cutworms, Agrotis ipsilon (Lepidoptera: Noctuidae), and Alternative Prey by Common Golf Course Predators

Abstract Turfgrass ecosystems contain a variety of generalist predators that may contribute to the regulation of pest insect populations. The black cutworm, Agrotis ipsilon (Hufnagel) (Lepidoptera: Noctuidae), is frequently a pest of short-mown golf course greens and fairways and may be a candidate for management by conservation biological control tactics. However, little is known about the susceptibility of different instar A. ipsilon to the many species of carabids, staphylinids, and spiders that inhabit greens, fairways, and roughs. These ecosystems also contain nonpest arthropods that could serve as alternative prey for generalist predators and help bolster their populations. In these laboratory experiments, 12 species of predators, commonly found on golf courses, were evaluated for their ability to consume five different instars of A. ipsilon and for their feeding voracity. The palatability of five potential alternative prey items, to a subset of predators, was also tested. All predator species tested were able to consume at least one instar of A. ipsilon. Two of the most common predators found on golf courses, Amara impuncticollis (Say) (Coleoptera: Carabidae) and Philonthus sp. (Coleoptera: Staphylinidae), could consume all A. ipsilon instars and were also among the most voracious predators tested. In addition, all five alternative prey items were readily eaten by the predator species that were tested. These results suggest that these generalist predators play a role in the regulation of A. ipsilon larval populations on golf courses and that several nonpest arthropod taxa could contribute to attracting and maintaining predator populations.
Mechanisms of Foxp3+ Regulatory T cell enrichment and High Endothelial Venule formation in tumours

Foxp3+ Regulatory T cells (Tregs) constitute a major immunosuppressive cell type within tumours. Here, they impinge on anti-tumour immune responses. Modalities aimed at subverting the accumulation and / or suppressive action of Tregs could revolutionise cancer immunotherapies in the future. By use of the 3-methylcholanthrene (MCA) model of chemical carcinogenesis, I investigated mechanisms of Treg enrichment in tumours. While a large proportion of intra-tumoural Tregs expressed the TH1 transcription factor, T-bet, there was no role for T-bet-expressing Tregs in tumour control. Additionally, sequestration of Interleukin-2 (IL-2) in the tumour microenvironment (TME) did not represent a mechanism by which Tregs exert dominance at this site. However, the majority of intra-tumoural Tregs expressed CD69, a molecule implicated in retaining T cells at the site of antigen. Furthermore, CD69-expressing Tregs possessed superior suppressive capacity relative to CD69 negative Tregs. Therefore, the consequence of CD69 expression on Tregs may be the retention of tumour-infiltrating super-suppressive Tregs, thereby ensuring Treg dominance within the TME. By use of the Foxp3DTR mouse model, previous data demonstrated the development of ectopic High Endothelial Venules (HEV) within MCA-induced tumours following depletion of Treg. HEV demonstrated an absolute concordance with increased numbers of T cells inside tumours and reduced tumour growth. I investigated the mechanisms supporting development of HEV in tumours in the absence of Tregs. I have eliminated a role for B lymphocytes, instead pinpointing CD8+ T cells as key drivers of HEV development in tumours. Ectopic formation of HEV in Treg depleted tumours is Tumour Necrosis Factor (TNF) receptor (TNFR) signalling dependent, and Lymphotoxin (LT) β receptor (LTβR) signalling independent. Furthermore, the proportion of TNFα-producing T cells in the tumour correlated with density of tumour HEV. These data suggest that intra-tumoural development of HEV following Treg depletion is driven by T cell derived TNFα signalling via TNFR(s).