Optimising safe margins in shoulder surgeries: a cadaveric study on brachial plexus nerves with anthropometric and movement correlation.

PURPOSE: Shoulder surgeries, vital for diverse pathologies, pose a risk of iatrogenic nerve damage. Existing literature lacks diverse bone landmark-specific nerve position data. The purpose of this study is to address this gap by investigating such relationships. METHOD: This cadaveric study examines axillary, radial and suprascapular nerves' relation with acromion, coracoid and greater tuberosity of the humerus (GT). It also correlates this data with humeral lengths and explores nerve dynamics in relation to arm positions. RESULTS: The mean distance from the axillary nerve to (i) GT was 4.38 cm (range 3.32-5.44, SD 0.53), (ii) acromion was 6.42 cm (range 5.03-7.8, SD 0.694) and (iii) coracoid process was 4.3 cm (range 2.76-5.84, SD 0.769). Abduction brought the nerve closer by 0.36 cm, 0.35 cm and 0.53 cm, respectively. The mean distance from radial nerve to (i) GT was 5.46 cm (range 3.78-7.14, SD 0.839), (ii) acromion was 7.82 cm (range 5.4-10.24, SD 1.21) and (iii) tip of the coracoid process was 6.09 cm (range 4.07-8.11 cm, SD 1.01). The mean distance from the suprascapular nerve to the acromion was 4.2 cm (range 3.1-5.4, SD 0.575). The mean humeral length was noted to be 27.83 cm (range 25.3-30.7, SD 1.13). There was no significant correlation between these distances and humeral lengths. CONCLUSION: It is essential to exercise caution to avoid axillary nerve damage during the abduction manoeuvre, as its distance from the greater tuberosity and tip of the coracoid process has shown a significant reduction. The safe margins, in relation to the length of the humerus and consequently the patient's stature, exhibit no significant variation. In situations where the greater tuberosity (GT) and the border of the acromion are inaccessible due to reasons such as trauma, the tip of the coracoid process can serve as a dependable bone landmark for establishing a secure surgical margin.

Biomarkers for Early Cancer Detection: A Landscape View of Recent Advancements, Spotlighting Pancreatic and Liver Cancers.

Cancer is one of the leading causes of death worldwide. Early cancer detection is critical because it can significantly improve treatment outcomes, thus saving lives, reducing suffering, and lessening psychological and economic burdens. Cancer biomarkers provide varied information about cancer, from early detection of malignancy to decisions on treatment and subsequent monitoring. A large variety of molecular, histologic, radiographic, or physiological entities or features are among the common types of cancer biomarkers. Sizeable recent methodological progress and insights have promoted significant developments in the field of early cancer detection biomarkers. Here we provide an overview of recent advances in the knowledge related to biomolecules and cellular entities used for early cancer detection. We examine data from the CAS Content Collection, the largest human-curated collection of published scientific information, as well as from the biomarker datasets at Excelra, and analyze the publication landscape of recent research. We also discuss the evolution of key concepts and cancer biomarkers development pipelines, with a particular focus on pancreatic and liver cancers, which are known to be remarkably difficult to detect early and to have particularly high morbidity and mortality. The objective of the paper is to provide a broad overview of the evolving landscape of current knowledge on cancer biomarkers and to outline challenges and evaluate growth opportunities, in order to further efforts in solving the problems that remain. The merit of this review stems from the extensive, wide-ranging coverage of the most up-to-date scientific information, allowing unique, unmatched breadth of landscape analysis and in-depth insights.

Accuracy of trained technicians in screening orbital and adnexal diseases at rural vision centers in South India.

Purpose: To assess the agreement between the diagnosis made by trained technicians at vision centers (VC) and oculoplasty specialists at the base hospital, in patients referred from VC to the orbit and oculoplasty clinic of a tertiary eye care hospital in south India. Methods: This was a retrospective study that compared the findings of VC technicians and the specialists of the orbit and oculoplasty services in a base hospital. A total of 384 patients referred from 17 VCs between May 2021 and May 2022 were included. The diseases were categorized according to the site of involvement as diseases of the eyelids (43%), diseases of the lacrimal system (37.3%), orbital diseases (15.6), and others (4.1%). The mean age of the patients was 35.9 years and 50.6% were females. Medical records of all referred patients who attended the orbit clinic were analyzed. Results: Of the 384 patients, 378 (98.67%) were confirmed to have o. r: bital and adnexal diseases. There was an overall 80% agreement between the diagnosis made by trained VC technicians and oculoplasty specialists; the kappa coefficient was 0.78 (95% confidence interval [CI]: 0.76 to 0.80), with a P value < 0.001. The agreement was the highest for diseases of the lacrimal system (90.9%, kappa coefficient 0.87), followed by eyelid pathologies (80%, kappa coefficient: 0.77). Of these, 54.8% of patients were managed with surgical procedures. Conclusion: There is good agreement between the findings of VC technicians and oculoplasty specialists. Trained technicians can help in the early detection and referral to higher centers. They also help to make sure adherence to treatment and periodic evaluation, especially in resource-constraint settings.

Assessment of parental awareness about pediatric visual problems by Knowledge-Attitude-Practice survey in South India.

Purpose: To find out parents' knowledge, attitude, and treatment practice (KAP) toward pediatric eye problems and to assess the effect of demographic factors such as gender, age, educational status, and number of children on KAP. Methods: A cross-sectional descriptive study was conducted in a hospital setting. Two hundred parents were randomly selected for the questionnaire. All parents had children who were included in Systematic Pediatric Eye Care Through Sibling Screening Strategies (SPECSSS) study. A survey with 15 questions on KAP of pediatric eye diseases was prepared and administered to parents coming to a tertiary eye hospital with varied experience and education qualifications. Results: The mean age of 200 patients was 9.6 (3.4) years, with the majority of them male (n = 110; 55.0%). The majority of the children (n = 91, 45.5%) were between the age group of 6-10 years. Knowledge of visual problems among parents was of a good grade in 9% only. The attitude of the parents toward the visual problem was positive at 17%, and the responses regarding the practice were of excellent grade at 46.5% and good at 26.5%. Analysis suggests that the level of knowledge and practice were not significantly associated with the demographic factors (p > 0.05). The positive attitude toward the visual problems of the children was associated with education of the parents (p < 0.05) and the father occupation (p < 0.05). Conclusion: Knowledge about pediatric eye diseases was poor among parents and it was significantly affected by education and occupation of parents. The parents have positive attitude toward enhancing their attitude in treatment.

Comparison of Accuracy of Freestyle Libre Pro and Medtronic iPro2 Continuous Glucose Monitoring Systems in Pregnancy.

There are limited data on head-to-head performance of Freestyle Libre Pro (FSL-Pro) and blinded Medtronic iPro2 continuous glucose monitoring system in pregnancy. In this prospective observational study, women with hyperglycemia in pregnancy (n = 42) underwent simultaneous FSL-Pro and Medtronic iPro2 sensor insertion and self-monitoring of blood glucose using Contour Plus meter (reference). The overall mean absolute relative difference (MARD) for iPro2 and FSL-Pro systems were 8.0% ± 9.2% and 19.0% ± 12.7%, respectively. At hypoglycemic range, both sensors performed less accurately (MARD: 18.0% and 16.8%, respectively), whereas iPro2 showed higher accuracy at euglycemic (8.2% and 19.3%, respectively) and hyperglycemic (6.8% and 18.0%, respectively) ranges. On Bland-Altman analysis, iPro2 and FSL-Pro underestimated glucose by 0.01 and 1.09 mmol/L, respectively. The ISO criteria were fulfilled for 88.5% and 44.9% of all values, respectively. To conclude, iPro2 was more accurate; however, both sensors demonstrated inaccuracy at hypoglycemic range, highlighting the need for refinements in the current generation of sensors to address this problem.

Identification of simple sequence repeat markers linked to heat tolerance in rice using bulked segregant analysis in F2 population of NERICA-L 44 × Uma.

The damage caused by high temperature is one of the most important abiotic stress affecting rice production. Reproductive stage of rice is highly susceptible to high temperature. The present investigation was undertaken to identify polymorphic microsatellite markers (SSR) associated with heat tolerance. The rice cultivars NERICA- L 44 (heat tolerant) and Uma (heat susceptible) were crossed to generate F1 and F2 populations. The F2 population was subjected to heat stress at >38°C and the 144 F2 plants were evaluated for their tolerance. The results note that the mean of the F2 population was influenced by the tolerant parent with regards to the traits of plant height, membrane stability index, photosynthetic rate, stomatal conductance, evapotranspiration rate, pollen viability, spikelet fertility and 1000 grain weight. Ten each of the extremely susceptible and tolerant plants were selected based on the spikelet fertility percentage. Their DNA was pooled into tolerant and susceptible bulks and Bulked Segregant Analysis (BSA) was carried out using 100 SSR markers to check for polymorphism. The survey revealed a polymorphism of 18% between the parents. RM337, RM10793, RM242, RM5749, RM6100, RM490, RM470, RM473, RM222 and RM556 are some of the prominent markers that were found to be polymorphic between the parents and the bulks. We performed gene annotation and enrichment analysis of identified polymorphic markers. Result revealed that the sequence specific site of that chromosome mostly enriched with biological processes like metabolic pathway, molecular mechanism, and subcellular function. Among that RM337 was newly reported marker for heat tolerance. Expression analysis of two genes corresponds to RM337 revealed that LOP1 (LOC_Os08g01330) was linked to high temperature tolerance in rice. The results demonstrate that BSA using SSR markers is useful in identifying genomic regions that contribute to thermotolerance.

Lacrimal Sac Rhinosporidiosis: Clinical Profile and Gram Stain as a Method of Preoperative Diagnosis.

PURPOSE: To describe the clinical profile of lacrimal sac rhinosporidiosis and to introduce a method for preoperative microbial identification of rhinosporidiosis using Gram stain. METHODS: This is a prospective study, carried out from January 2016 to January 2022. This series included 18 patients with clinical suspicion of lacrimal sac rhinosporidiosis. All patients underwent a comprehensive eye check-up. Mucopurulent discharge collected by a sterile swab after applying pressure over the sac area and Gram staining was done. All patients underwent dacryocystectomy. The sac contents were sent for histopathology, and rhinosporidiosis was confirmed. RESULTS: A total of 18 patients over a period of 6 years with suspicion of lacrimal sac rhinosporidiosis were included. There were 11 (61.1%) male patients. Ten patients (55.5 %) had a history of either regular or occasional bathing in stagnant water. Nontender doughy swelling over the lacrimal sac region was the most common presentation. Gram staining of the mucopurulent discharge revealed thick-walled sporangia with endospores suggestive of rhinosporidiosis in all these cases. All patients underwent dacryocystectomy. Hematoxylin and eosin sections confirmed the diagnosis. Two patients had recurrence within 6 months after surgery. CONCLUSION: Regurgitation of pus mixed with whitish granular particles or blood is highly suspicious of rhinosporidiosis. In clinically suspected cases, microbial diagnosis using Gram stain is an economical, office procedure, which helps the surgeon to plan for the surgery and for better counseling.

Retarded Charge Recombination to Enhance Photocatalytic Performance for Water-Free CO2 Reduction Using Perovskite Nanocrystals as Photocatalysts.

Femtosecond transient absorption spectral (TAS) investigations were performed to understand the carrier relaxation mechanism for perovskite nanocrystals Cs1-xFAxPbBr3 (CF, x = 0.45) and CsPbBr3 (CS), which served as efficient photocatalysts for splitting of CO2 into CO and O2 in the absence of water. Upon light irradiation for 12 h, formation of deep trap states was found for both CS and CF samples with spectral characteristics of the TAS photobleach (PB) band showing a long spectral tail extending to the long wavelength region. The charge recombination rates at the shallow surface states, bulk states, and deep-trapped surface state were found to be significantly retarded for the CF sample than for the CS sample, in agreement with the photocatalytic performances for CO product yields of the CF catalyst being greater by a factor of 3 compared to those of the CS catalyst.

Is menstruation a valid reason to postpone cardiac surgery?

Background: Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss. Aims: The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation. Settings and Design: A prospective, matched case-control study which included sixty women of reproductive age group undergoing OHS. Patients and Methods: The surgical blood loss was compared between women who were menstruating (group-M; n = 25) and their matched controls, i.e., women who were not menstruating (group-NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup-P) and perioperative period (subgroup-PO) was compared to determine the effect of OHS on menstrual blood loss. Results: The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr-M = 245.6 ± 120.1 ml vs gr-NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr-P = 36.8 ± 4.8 ml vs gr-PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr-P = 4.2 ± 0.6 days vs gr-PO = 4.4 ± 0.6 days, P value = 0.10). Conclusion: Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.

Local-Field Effects in Linear Response Properties within a Polarizable Frozen Density Embedding Method.

In this work, we present a polarizable frozen density embedding (FDE) method for calculating polarizabilities of coupled subsystems. The method (FDE-pol) combines a FDE method with an explicit polarization model such that the expensive freeze/thaw cycles can be bypassed, and approximate nonadditive kinetic potentials are avoided by enforcing external orthogonality between the subsystems. To describe the polarization of the frozen environment, we introduce a Hirshfeld partition-based density-dependent method for calculating the atomic polarizabilities of atoms in molecules, which alleviates the need to fit the atomic parameters to a specific system of interest or to a larger general set of molecules. We show that the Hirshfeld partition-based method predicts molecular polarizabilities close to the basis set limit, and thus, a single basis set-dependent scaling parameter can be introduced to improve the agreement against the reference polarizability data. To test the model, we characterized the uncoupled and coupled response of small interacting molecular complexes. Here, the coupled response properties include the perturbation of the frozen system due to the external perturbation which is ignored in the uncoupled response. We show that FDE-pol can accurately reproduce both the exact uncoupled polarizability and the coupled polarizabilities of the supermolecular systems. Using damped response theory, we also demonstrate that the coupled frequency-dependent polarizability can be described by including local field effects. The results emphasize the necessity of including local-field effects for describing the response properties of coupled subsystems, as well as the importance of accurate atomic polarizability models.

Basaloid squamous cell carcinoma of gingiva: A rare case report.

Basaloid squamous cell carcinoma (BSCC) is an exceptional, aggressive variant of squamous cell carcinoma (SCC) because of its unique histological feature and an ominous clinical behavior. Recently, it has been recognized as a high-grade SCC. The most preferential site of occurrence is the upper aerodigestive tract. Because of its aggressive behavior and tendency to metastasize, BSCCs are considered to have poor prognosis. We present a BSCC case in a 60-year-old male, which was clinically diagnosed as an aggressive inflammatory lesion with a differential diagnosis of granulomatous lesion, involving the mandibular anterior gingiva. Till now, only 17 cases of BSCC with gingival involvement have been reported in the literature. Here, we present one additional case of BSCC involving gingiva.

Bacterium isolated from coffee waste pulp biosorps lead: Investigation of EPS mediated mechanism.

Kleibsiella pneumoniae Kpn555, isolated from coffee waste pulp showed high level of tolerance to lead with a minimum inhibitory concentration of 900 mg/L. On its growth in nutrient broth supplemented with lead, brown clumps were visualised at the bottom of the flask. On scanning and transmission electron microscopic studies the brown clumps were corroborated to be bacterial cells with lead biosorbed on the cell surface and accumulated inside the cytoplasm. Biochemical and FT-IR analysis of the extracellular polymeric substance produced on exposure to lead revealed its chemical nature as glycolipid with protein moieties. Purified EPS (100 mg/L) could remove 50% of lead from aqueous solution (200 mg/L). Isolation of plasmid from Klebsiella pneumoniae Kpn555 revealed the presence of a plasmid of size 30-40 kb. This capability of the bacteria was proven to be plasmid mediated as the Escherichia coli DH5α cells transformed with the plasmid of Klebsiella pneumoniae Kpn555 also could tolerate 900 mg/L of lead and form brown clumps. This study shows that these bacteria, aided by EPS could serve as an effective agent for the removal of lead from contaminated water environmental samples.

Association between mother's behaviour, oral health literacy and children's oral health outcomes: A cross-sectional study.

INTRODUCTION: Parents' infant and early childhood oral health knowledge is of paramount importance, because oral health behaviours are the exclusive domain of parents during the early years of life. Studies exploring the association between mother's behaviour, oral health literacy and children's oral health outcomes are scarce. AIM: To evaluate the association between mother's behaviour, oral health literacy and children's dental caries experience. MATERIALS AND METHODS: A cross-sectional study was conducted among one hundred pre-school children aged 2-6 years and their mothers from pre-schools in Bangalore, India. Data regarding their demographics, mother's knowledge, attitude and practice (KAP) was collected through a questionnaire. Mother's oral health literacy was assessed with Rapid Estimate of Adult Literacy in Dentistry-30 (REALD-30) scale. Caries experience of the children was recorded using Decayed Missing Filled Teeth (DMFT) Index. Data was entered into excel sheet and analysed using statistical package for SPSS 22.0. RESULTS: : The mean KAP, REALD-30 and DMFT scores were 13.17 ± 4.57, 17.68 ± 5.85, 2.61 ± 2.21, respectively. In this study, REALD-30 score negatively correlated with DMFT score and positively correlated with KAP score. In a linear regression, KAP and REALD-30 scores showed a highly significant association with dental caries. CONCLUSION: Mother's behaviour and oral health literacy influenced caries experience of the children. Therefore, improving the behaviour and oral health literacy of the mothers is the key to influence child's oral health.

Checklist to aid young physicians managing obstetric emergencies in rural India: a quality improvement initiative.

BACKGROUND: The decision to admit or refer a patient presenting with an obstetric emergency is extremely crucial. In rural India, such decisions are usually made by young physicians who are less experienced and often miss relevant data points required for appropriate decision making. In our setting, before the quality improvement (QI) initiative, this information was recorded on loose blank sheets (first information sheets (FIS)) where an initial clinical history, physical examination and investigations were recorded. The mean FIS completeness, at baseline, was 73.95% (1-5 January 2020) with none of the FIS being fully complete. Our objective was to increase the FIS completeness to >90% and to increase the number of FIS that were fully complete over a 9-month period. METHODS: With the help of a prioritisation matrix, the QI team decided to tackle the problem of incomplete FIS. The team then used fishbone analysis and identified that the main causes of incomplete FIS were that the interns did not know what to document and would often forget some data points. Change ideas to improve FIS completeness were implemented using Plan-Do-Study-Act (PDSA) cycles, and ultimately, a checklist (referred to as antenatal care (ANC) checklist) was implemented. The study was divided into six phases, and after every phase, a few FIS were conveniently sampled for completeness. RESULTS: FIS completeness improved to 86.34% (p<0.001) in the post implementation phase (1 Feb to 31 August 2020), and in this phase, 69.72% of the FIS were documented using the ANC checklist. The data points that saw the maximum improvement were relating to the physical examination. CONCLUSION: The use of ANC checklist increased FIS completeness. Interns with no prior clinical and QI experience can effectively lead and participate in QI initiatives. The ANC checklist is a scalable concept across similar healthcare settings in rural India.

Establishing the practice of birth companion in labour ward of a tertiary care centre in India-a quality improvement initiative.

BACKGROUND: Birth companion is a key component for providing respectful maternity care and has been recommended by WHO and Government of India. It is a low-cost beneficial intervention that is vital in improving quality of care during labour and delivery. LOCAL PROBLEM: Despite the available evidence on benefits of birth companion, there was no policy on allowing birth companion at our hospital in the past. METHODS AND INTERVENTIONS: We aimed to establish the practice of allowing birth companions in all eligible women in labour ward from existing 0% to 50% in 6 weeks' duration. This study was conducted in the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi. A quality improvement (QI) team was formed, and after obtaining the baseline data, problems were analysed using fish bone chart. A new policy of allowing birth companion was made and efforts made to sensitise and train the doctors and nurses posted in labour ward. Changed ideas were executed in multiple plan-do-study-act (PDSA) cycles. Simple interventions such as dress code for birth companions, curtains for ensuring privacy, display of posters and frequent reminders on WhatsApp groups were planned . RESULTS: The median value of women accompanied by birth companion marginally increased to 25% after the first PDSA cycle. Implementation of further changed ideas led to increase in median, which reached 66.6%. Thereafter, there was a decline, but by the end of 6 months, it was possible to attain the goal and sustain it. CONCLUSIONS: Simple steps of QI methodology can be used to address the prevalent problems in our healthcare. Implementation of any new practice comes with major challenges, but we could achieve our goal because of a motivated team working together on multiple changed ideas applied sequentially in PDSA cycles.

Mucormycosis occurring in an immunocompetent patient: a case report and review of literature.

Mucormycosis is an opportunistic fungal infection with a high fatality rate and is the third most common fungal infection that is invasive in nature, next to candidiasis and aspergillosis. The condition is generally vasotropic and angio-invasive in nature. It gets disseminated to a wider area locally and also exhibits a distant spread. It is usually associated with medically compromised patients. However, mucormycosis in immunocompetent individuals is gaining attention as several cases have been reported throughout the world with a high incidence of such cases being reported from the Indian subcontinent. It is attributed to the poor socio-economic status and triggered by the local trauma due to unhygienic setup or poor health care. The pathway of pathogenesis is not clearly understood in immunocompetent patients and therefore becomes a matter of great concern. Here, we report one such case of mucormycosis affecting the maxillary region following tooth extraction in a 42-year-old male.

Mechanism of Photocatalytic CO2 Reduction by Bismuth-Based Perovskite Nanocrystals at the Gas-Solid Interface.

We report here a series of nontoxic and stable bismuth-based perovskite nanocrystals (PeNCs) with applications for photocatalytic reduction of carbon dioxide to methane and carbon monoxide. Three bismuth-based PeNCs of general chemical formulas A3Bi2I9, in which cation A+ = Rb+ or Cs+ or CH3NH3+ (MA+), were synthesized with a novel ultrasonication top-down method. PeNC of Cs3Bi2I9 had the best photocatalytic activity for the reduction of CO2 at the gas-solid interface with formation yields 14.9 µmol g-1 of methane and 77.6 µmol g-1 of CO, representing a much more effective catalyst than TiO2 (P25) under the same experimental conditions. The products of the photocatalytic reactions were analyzed using a gas chromatograph coupled with a mass spectrometer. According to electron paramagnetic resonance and diffuse-reflectance infrared spectra, we propose a reaction mechanism for photoreduction of CO2 via Bi-based PeNC photocatalysts to form CO, CH4, and other possible side products.

Xq27.1 Duplication Encompassing SOX3: Variable Phenotype and Smallest Duplication Associated with Hypopituitarism to Date - A Large Case Series of Unrelated Patients and a Literature Review.

BACKGROUND: Xq27.1 duplication encompassing SOX3 has been implicated in the aetiology of X-linked hypopituitarism associated with intellectual disability and neural tube defects. We describe the largest case series to date of 5 unrelated patients with SOX3 duplication with a variable clinical phenotype, including the smallest reported SOX3 duplication. CASE REPORTS: Five male patients who presented with congenital hypopituitarism (CH) were identified to have Xq27.1 duplication encompassing SOX3. The size of the duplication ranged from 323.8 kb to 11 Mb. The duplication was maternally inherited or de novo in 2 patients each (and of unknown inheritance in 1 patient). The age at presentation was variable. Three patients had multiple pituitary hormone deficiencies, whereas 2 patients had isolated growth hormone deficiency. All patients had micropenis and/or small undescended testes. Structural pituitary and/or other midline cranial abnormalities (callosal hypogenesis/absence of the septum pellucidum) were present in all patients. Two patients had a neural tube defect in addition to CH. CONCLUSIONS: This is the largest series reported to date of unrelated patients with CH in association with Xq27.1 duplication encompassing SOX3. The clinical phenotype is variable, which may be due to genetic redundancy or other unknown aetiological factors. We have expanded the phenotypic spectrum through description of the smallest Xq27.1 duplication (323.8 kb) with CH reported to date, as well as a second family with CH and a neural tube defect.

Selective fetal reduction in monochorionic twins: Preliminary experience

Objective: In complicated mono-chorionic twin pregnancies, vaso-occlusive techniques like bipolar cord coagulation (BPCC), radiofrequency ablation (RFA), interstitial laser ablation (ILA) of cord and fetoscopy guided cord coagulation with lasers are the methods proposed for selective fetal reduction. This study brings forth preliminary data of selective fetal reduction procedures at a tertiary care center in India. Material and Methods: This was a prospective observational study of 31 patients with complicated mono-chorionic twin pregnancies. Methods used were ILA, RFA and BPCC. Outcome measures included overall co-twin survival after selective feticide, survival rates with each method, miscarriage (defined as all fetal loss before 24 weeks), early fetal death (<24 hours after procedure) and late fetal death (>24 hours after the procedure) of co-twin. Results: Technical success was achieved in 30/31 (96.8%) of pregnancies. Over all take home baby rate was 63.3%. Live birth rates were 50%, 71.4% and 75% with ILA, RFA and BPCC respectively. Conclusion: Data from initial cases of selective fetal reduction in complicated mono-chorionic twins suggests that these procedures are feasible but are associated with high adverse perinatal outcome.