A new enigma: doping in E-sports.

Electronic sports (e-sports) is a growing entity that is estimated to be valued at USD $200 billion by the end of 2023. With the rapid rate of growth, it will come to a point that e-sports will need to be regulated including regulatory mechanisms of fair play, which includes sports doping. With the emergence of substances that provides unfair advantages in terms of concentration, staying awake and preventing anxiety including tremors, there is a need to regulate doping in e-sports. However, due to the nature of the sport, it might not be as straightforward to regulate as other sports.

The elevation of a unique population of Corynosoma strumosum (Acanthocephala: Polymorphidae) from the Caspian seal, Pusa caspica, in the Caspian Sea to Corynosoma neostrumosum n. sp.

An isolated population of 700 specimens initially described as Corynosoma strumosum (Rudolphi, 1802) Lühe, 1904 and currently reassigned to Corynosoma neostrumosum n. sp. was collected from one young male Caspian seal, Pusa caspica (Gmelin) in the southern land-locked Caspian Sea in April 2009. Collected worms were morphologically unique compared with those reported by other observers in open waters, especially in shape and distribution of proboscis hooks and trunk spines, dorso-ventral differences in proboscis hooks and their organization, the baldness of anterior proboscis, consistently smaller size of trunk and testes, larger eggs, the rough egg topography, epidermal micropores, and variations in the female gonopore. Molecular data from the internal transcribed spacer region of rDNA and the mitochondrial cox1 gene was also provided to supplement the morphological study of the new species.

Residual Pattern of Chlorantraniliprole, Thiamethoxam, Flubendiamide and Deltamethrin in Tomato Fruit and Soil.

Tomato, Lycopersicon esculentum L. is grown widely as an important day-to-day demand vegetable. The crop is attacked by various polyphagous insect pests like tomato fruit borer, stink bug, cabbage looper, flea beetle, aphids, whitefly, two-spotted spider mite, etc., and oligophagous insects like leaf-miner, five-spotted hawkmoth, etc. To combat the damage and yield loss, various chemical insecticides were sprayed on tomatoes under field conditions. The residual pattern of insecticides like chlorantraniliprole, thiamethoxam, flubendiamide, and deltamethrin residues was studied following applications of chlorantraniliprole 18.5% SC (Coragen) @ 30 g a.i./ha, thiamethoxam 25% WG (Actara) @ 50 g a.i./ha, flubendiamide 39.35 M/M SC (Fame) @ 48 g a.i./ha and deltamethrin 2.8% EC (Decis 100) @ 12.5 g a.i./ha using Reverse Phase High-Performance Liquid Chromatography (RP-HPLC). Fruit samples were collected at 0 (1 h after application), 1, 2, 3, 5, 7 days and at harvest time. All the residues of insecticides such as chlorantraniliprole (0.09 mg kg- 1), thiamethoxam (0.03 mg kg- 1), flubendiamide (0.02 mg kg- 1), and deltamethrin (0.01 mg kg- 1) were persisted up to 5th day. There were no residues found at harvest time. The residues of chlorantraniliprole and deltamethrin persisted up to 3rd day of spraying whereas the residues of flubendiamide and thiamethoxam were not detected on the same day in the soil.

Revision of Corynosoma australe Johnston, 1937 (Acanthocephala: Polymorphidae) from a North American population using novel SEM images, Energy Dispersive X-ray Analysis, and molecular analysis.

We describe a population of the acanthocephalan Corynosoma australe Johnston, 1937 (Polymorphidae) from a California sea lion Zalophus californianus (Lesson, 1828) in California using novel scanning electron microscopy (SEM) images, Energy Dispersive x-ray analysis (EDXA), and molecular analysis for the first time. The taxonomic history of C. australe is replete with accounts using only line drawings some of which proved erroneous. The distribution of ventral spines on the female trunk has been the primary distinction between C. australe and Corynosoma obtuscens Lincicome, 1943, its junior synonym; being continuous in the latter but discontinuous posteriorly in the former species. The distribution of ventral spines is invariably discontinuous in males. Our redescription and SEM images help to resolve this issue further validating the synonymy. Morphological variability has been documented between our California population and others from various host species in California, South Australia, South Shetlands, and the Argentinian coast. Our SEM images document features not previously detectable in line drawings, erroneously reported or missed in previous accounts. The EDXA spectra show high levels of calcium and phosphorous and low levels of sulfur characteristic of C. australe. EDXA for other species of Corynosoma Lühe, 1904 provide support for the diagnostic distinction of C. australe. EDXA spectra were shown to be species specific and have diagnostic value in the taxonomy of the Acanthocephala. Our molecular analysis used amplification of 18S of ribosomal DNA and cytochrome c oxidase 1 (Cox1) gene. Phylogenetic analyses for Cox1 gene revealed a close relationship between Corynosoma hannae Zdzitowiecki, 1984 and C. australe. The phylogenetic trees confirmed that the isolates belonged to C. australe. The haplotype network inferred by Cox1 with C. australe sequences revealed that haplotypes clearly separated from each other and formed clusters related to samples from the Northern Hemisphere (the USA and Mexico), and the second from the Southern Hemisphere (Argentina, Brazil and Peru).

Evaluation of the Quality of Undergraduate Full Veneer Crown Preparations at a UK Dental Teaching Hospital.

OBJECTIVES: To determine the quality of full veneer crown preparations produced by supervised undergraduate students at a UK dental teaching hospital. METHODS: One hundred and eighty-five scanned digital dies between October 2019 and March 2021 were obtained. Using cross-sections in four planes, the total angle of convergence, abutment height, margin design and margin depth were evaluated. Statistical comparisons were made by plane, location, material-type, tooth-type, and inter- and intra-arch positions. RESULTS: Across all preparations the mean total angle of convergence was 24.8° ± 11.7°. and mean abutment height was 3.6 mm ± 1.0 mm. Mandibular and molar teeth were significantly more tapered (P ⟨0.001) and exhibited significantly shorter abutment heights (P ⟨0.001). Chamfer margins were the most frequently observed and mean margin depths ranged from 0.49-1.06 mm. The compliance to recommended taught parameters were 28.1%, 42.7%, 34.1% and 6.5% for total angle of convergence, abutment height, margin design and margin depth, respectively. CONCLUSIONS: The findings from this study suggest that compliance to taught parameters is poor, especially for molar teeth, and demonstrates the use of digital software in guiding future research and teaching.

Synthesis and in silico studies of some new pyrrolidine derivatives and their biological evaluation for analgesic and anti-inflammatory activity.

BACKGROUND: An array of commercially viable intermediate molecules necessary for the synthesis of a variety of bioactive molecules are chemically synthesized by pyrrolidine and its derivatives, which play a significant role in drug design and development process. AIM: The aim of the present research work was to explore the synthesis of some new pyrrolidine derivatives and to perform their in silico studies and finally evaluation of analgesic and anti-inflammatory activity. OBJECTIVE: The purpose of this study was to synthesis new pyrrolidine derivatives, examine how they affected the COX-1 and COX-2 enzymes computationally, and to screen their in vivo analgesic and anti-inflammatory activity on laboratory animals. METHOD: The new pyrrolidine derivatives were synthesized by condensing N-(3-acetylphenyl)-2-(pyrrolidin-1-yl)acetamide with substituted aniline in ethanol in the presence of catalytic amounts of glacial acetic acid. The structures of novel pyrrolidine derivatives were characterised using IR, NMR, and mass spectroscopy. Several molecular properties of the newly synthesized derivatives were calculated in order to evaluate the nature of the drug-like candidate. A specific reference cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzyme was used to dock the newly synthesized pyrrolidine derivatives. RESULTS: From the observed data, it was noted that amongst all newly synthesized compounds, A-1 and A-4 exhibited the highest anti-inflammatory and analgesic effects, respectively. CONCLUSION: On the basis of findings of present research, it was concluded that A-1 and A-4 might be utilized as a promising new lead compound for Non-Steroidal Anti-Inflammatory Drug (NSAIDs) development.

Cancer trends and burden among Armed Forces personnel, veterans and their families: Cancer registry data analysis from tertiary care hospital.

Background: Cancer incidence is rising across the globe. The incidence and patterns of various cancers among Armed Forces Personnel and Veterans is not known. We did the analysis of registry data maintained at our hospital. Methods: A retrospective analysis was performed of all patients registered at our hospital cancer registry between 01st January 2017 and 31st December 2019. Patients were registered with unique identification number. Baseline demographics and cancer subtype data were retrieved. Patients with histopathologically proven diagnosis and age ≥18 years were studied. Armed Forces Personnel (AFP) were defined as those who are in active service, and Veterans as those who had retired from service at the time of registration. Patients with Acute and Chronic Leukemias were excluded. Results: New cases registered were 2023, 2856 and 3057 in year 2017, 2018, 2019 respectively. AFP, Veterans and dependents among them were 9.6%, 17.8%, and 72.6% respectively. Haryana, Uttar Pradesh and Rajasthan represented 55% of all cases with male to female ratio 1.14:1 and median age was 59 years. The median age among AFP was 39 years. Among AFP as well as veterans, Head and Neck cancer was the most common malignancy. Cancer incidence was significantly higher in adults >40 years as compared to <40 years. Conclusion: Seven percent rise per year of new cases in this cohort is alarming. Tobacco-related cancers were the most common. There is an unmet need to establish a prospective centralized Cancer Registry to better understand the risk factors, outcomes of treatment and strengthen the policy matters.

External control arms in oncology: current use and future directions.

Although randomized control trials allow for a comparison of treatment arms with minimal concern for confounding by known and unknown factors, a randomized study is not feasible in certain disease settings. When a randomized design is not possible, incorporating external control data into the study design can be an effective way to expand the interpretability of the results of an experimental arm by introducing the ability to carry out a formal or an informal comparative analysis. This paper provides an introduction to the concepts of external controls in oncology trials, followed by a review of relevant and current research on this topic. The paper also focuses on general considerations for designing a trial that may incorporate external control data, followed by case studies of the marketing applications submitted to the Food and Drug Administration that included external control data.

Gigahertz Nano-Optomechanical Resonances in a Dielectric SiC-Membrane Metasurface Array.

Optically and vibrationally resonant nanophotonic devices are of particular importance for their ability to enhance optomechanical interactions, with applications in nanometrology, sensing, nano-optical control of light, and optomechanics. Here, the optically resonant excitation and detection of gigahertz vibrational modes are demonstrated in a nanoscale metasurface array fabricated on a suspended SiC membrane. With the design of the main optical and vibrational modes to be those of the individual metamolecules, resonant excitation and detection are achieved by making use of direct mechanisms for optomechanical coupling. Ultrafast optical pump-probe studies reveal a multimodal gigahertz vibrational response corresponding to the mechanical modes of the suspended nanoresonators. Wavelength and polarization dependent studies reveal that the excitation and detection of vibrations takes place through the metasurface optical modes. The dielectric metasurface pushes the modulation speed of optomechanical structures closer to their theoretical limits and presents a potential for compact and easily fabricable optical components for photonic applications.

New perspectives of Microsentis wardae Martin & Multani, 1966 (Acanthocephala: Neoechinorhynchidae) from Gillichthys mirabilis Cooper in California, with scanning electron microscopy images and energy dispersive X-ray analysis.

Fully developed, sexually mature small male and female acanthocephalans, Microsentis wardae Martin & Multani, 1966 (Neoechinorhynchidae) reaching only 2.25 mm and 2.42 mm, respectively, were collected from the rectum of longjaw mudsuckers, Gillichthys mirabilis Cooper, in the salty marches of Anaheim Bay and San Diego Bay, California. Our specimens were half the size of those reported in the original description from the same host in Scammon's Lagoon over 700 km to the south. The ratio of proboscis and receptacle size to trunk size was markedly higher in our specimens compared to the larger specimens measured in the original description. The anatomy of all structures in our specimens from Anaheim Bay was comparable to that of the larger Scammon's Lagoon specimens that have apparently realized more growth in the Scammon's Lagoon. We have observed more structures that are not reported in the original description, especially evident from our scanning electron microscopy images, which are not possible to observe in the original line drawings. In our specimens, the micropores were unusually widely spaced and the energy dispersive X-ray analysis showed longitudinal hook sections with high levels of sulphur and phosphorus and moderate levels of calcium, but the whole hooks showed highest levels of sodium and magnesium - the biochemical hook signature of this species. Sequences of the small subunit (18S) of the nuclear ribosomal DNA were generated and compared with acanthocephalan sequences available from GenBank. As M. wardae comprises a monotypic genus, therefore, phylogenetic analyses inferred from the 18S gene showed its relationship with other species of closely related genera of Eoacanthocephala. This is the first report of molecular data of M. wardae.

Implication and utility of DAS-28 squeeze in rheumatoid arthritis: an Indian experience.

The purpose of this study was to compare and correlate disease activity score including 28 joints counts (DAS-28) Squeeze with DAS-28 and clinical disease activity index (CDAI) to assess disease activity (DA) in rheumatoid arthritis (RA) patients. A total of 100 RA patients were included in the study. All subjects were evaluated for disease activity using the DAS-28 Squeeze, DAS-28, and CDAI. Spearman's rho (ρ) was calculated to determine the correlation between DAS-28 Squeeze, DAS-28, and CDAI. Cross-tabulation was performed to compare and calculate the kappa coefficient for the link between two indices. For each scale, Cronbach's alpha was also calculated to test dependability. The average age of the study group was 43.9±11.3. The mean scores on the DAS-28 Squeeze, DAS-28, and CDAI were, respectively, 3.58±1.06, 5.06±1.56, and 22.81±14.92. p=0.001 indicated a significant correlation between DAS-28 Squeeze and DAS-28 (ρ=0.986) and CDAI (ρ=0.939) for DAS-28 Squeeze. There was a considerable correlation between all three measures at various DA levels. Cronbach's alpha for DAS-28 Squeeze, DAS-28, and CDAI were respectively 0.716, 0.663, and 0.734. DAS-28 Squeeze exhibited a substantial positive association with DAS-28 and CDAI for assessing disease activity and appears to be a more useful and reliable method than DAS-28 and CDAI for monitoring disease activity in RA patients.

Comparison of the COVID-19 mortality occurring in hospitals and those brought in dead within Malaysia.

BACKGROUND: Measuring the success of the control of COVID-19 in any country includes a review of the mortality especially to compare the deaths of those dying in hospitals and those brought in dead (BID). The objective of this study was to compare the death groups with the demographic factors that influenced the type of death. METHODS: This was a case-control study (1:1 ratio) looking at COVID-19 secondary public data from March 2020 to February 2021. Data such as the basic demographic data and comorbidities were analysed descriptively and then using a binary-logistic regression analysis to compare the independent variables against the outcome of BID. From the database, 120 cases were included as BID (4 excluded due to insufficient information) and 120 patients from the 1006 who passed away in hospital were randomly selected as comparators. The data was analysed in SPSS v21.0. RESULTS: The mean age for the BID was 59.59 (SD: 18.74), with more males (70.8%) than females (29.2%), of which 61.7% were Malaysians, 46.7% from the state of Sabah, and 64.2% having at least one co-morbidity (50% of them had hypertension). A univariate binary logistic regression analysis yielded factors such as age, nationality, and presence of any co-morbidities that are favourable to be included into the multivariate analysis. From the final analysis, the only factor that distinguished the BID from those dying in the hospital was being a foreigner (AOR: 4.32 [95%CI: 2.02-9.24], p<0.001). CONCLUSIONS: This concluded that foreigners in Malaysia were likely to die from COVID-19 outside of the hospital compared to Malaysians. Amongst the reasons that needed to be addressed were cost, accessibility issues regarding medical care, and the testing policies in Malaysia.

The opinion of general practitioners in Malaysia on newly imposed third party health administrator policies in primary care.

BACKGROUND: Third Party Health Administrators (TPA) has become an integral part in the field of funding healthcare for most parts in the world. Although they ensure access to medical care when out-of-pocket payment is required, TPAs have been found to impose unreasonable dictation in medicine prescriptions that undercuts doctors remuneration including paying very low medical consultation fees, types/methods of treatment and modalities for their policy holders. The objective of this study was to get the opinion of Malaysian doctors regarding the newly imposed policies and rates that these companies have forcibly dictated towards private primary care General Practitioners (GPs). MATERIALS AND METHODS: This was a cross sectional study, conveniently sampling private GPs currently practicing in Malaysia. A self-developed online questionnaire was sent out to the members via social media with the assistance of the Malaysian Medical Association the affiliates of Federation of Private Medical Practitioners Associations of Malaysia and Medical Practitioners Coalition Association of Malaysia. Data was collected from April to July 2021. A series of 7 short questions were asked in the survey to yield a higher response rate. A population to proportion sample size was calculated and a minimum of 365 responses were required. All data collected were collated and analysed in the SPSS v21.0 RESULTS: From a total of 7,000 GPs, 491 GPs (134.52% of intended sample size) responded to the questionnaire. The largest portion of respondents were from Selangor (21.79%). A total of 65.58% of the GPs felt that the RM 15 consultation fee dictated by the TPAs was unfair, 71.08% felt it was unfair that TPA overwrote certain investigations done or medicines given as over-treatment, 90.84% felt that TPAs had no jurisdiction to dictate the number of days of medication patients needed for chronic medical conditions, 95.52% did not agree that TPAs fix the price of each medication, 54.58% agreed that marking up medications from 5-15% of the original purchase price was fair and 68.64% agreed that they would boycott TPAs that were unreasonable with their dictation/demands. CONCLUSION: GPs generally disagreed with many new policies imposed by TPAs. These new policies might hinder the screening, management and early detection of chronic non communicable diseases here in Malaysia.

Parental control on handphone access and usage among Malaysian children.

INTRODUCTION: Parental control for a child's handphone access is important to ensure online safety. This study was to determine parental control on handphone access and the usage amongst Malaysian children. MATERIALS AND METHODS: A cross-sectional survey was conducted electronically between April 2017 and March 2018 among parents with children above 2 years of age, who owned a handphone. The 10-item questionnaire included questions about rules applied to the use of handphones, education on cybersafety, the characteristics and activities of their youngest children who had full-time access to a handphone, and parental perceptions of their children's usage of handphones. A total of 215 parents were included. RESULTS: From this, 92% controlled their children's handphones use by setting rules. The commonest rules were limiting the time of handphone usage (77%) and being aware of whom the child was communicating with (77%). The majority (94%) educated their children on cybersafety, and the commonest discussed topic was not to communicate with strangers (93%). The children's average age of first handphone ownership was 10.6 (SD: 3.6) years, and the use of the handphone averaged 17.4 (SD: 18.5) hours a week. Despite the rules and education provided, only a quarter of parents were confident of their children's capability to manage their own safety when using handphones (27%). CONCLUSION: In summary, Malaysian parents did control their children's handphone usage.

Prevalence and barriers of reporting needle-stick injures amongst government pharmacists working in Perak, Malaysia.

INTRODUCTION: Needle-stick injuries (NSIs) are common amongst healthcare workers including pharmacists. Studies have reported a range of 0-5.65 per 1,000 pharmacists handling vaccinations that suffered at least one incident of NSI. The objective of this study was to determine the prevalence of NSI and the barriers encountered in reporting it amongst government pharmacists working in Perak. MATERIALS AND METHODS: This was a cross-sectional study conducted amongst all government pharmacists in Perak. We excluded those who did not consent or were unreachable electronically. The researchers provided an online link that was forwarded to all heads of departments in Perak via social media. The respondents answered their demographic details, questions assessing their knowledge of NSI transmissible diseases, needle-stick handling practices, detail experiences of them suffering an NSI (all self-developed questionnaires), and their barriers in reporting an NSI (validated questionnaire). All responses were auto-tabulated in an excel sheet. A sample size of 516 pharmacists was needed for this study. A respondent was deemed to have inadequate knowledge when they answered any question wrongly about NSI knowledge-related questions and inappropriate practice in needle handling when respondents answered any questions wrongly for questions assessing practices. RESULTS: A total of 524 pharmacists participated. The overall prevalence of NSI was 23.1% (n=121), of which, those with contaminated NSI were 10.3% (n=54, 95%CI: 7.9-13.30). Twothirds of the participants (66.6%) had inadequate knowledge and nearly all of them were unable to describe the appropriate needle-handling practices (94.7%). Amongst the reported barriers were "not knowing whose duty it was to report an NSI" (45.5%) and "busy schedules" (44.7%). CONCLUSION: One in every five pharmacists in the state of Perak had a history of NSI, and 1 in every 10 had sustained a contaminated NSI. The barriers to reporting a NSI were mainly due to uncertainty about whose responsibility to report the incident and being too busy to report it.

Psychological impact amongst patients with COVID-19 in Perak state.

INTRODUCTION: Psychological distress had been documented since the beginning of the COVID-19 outbreak in 2019. The aim of the study is to describe the psychological impact among those who were hospitalized for COVID-19 infection within 6 months after being discharged from the hospital. The psychological impact in this study is defined as depression, anxiety, and stress. MATERIALS AND METHODS: This was a cross-sectional study conducted from July 2020 till August 2021 in a regional state hospital, north of Malaysia. All patients requiring hospitalization for COVID-19 were approached within the first 2 weeks after admission to administer the Depression, Anxiety and Stress Scale - 21 Items (DASS-21) scale. Follow-up phone calls were made within 3 months of discharged to enquire about the DASS-21 items as well as the Impact of Event Scale-Revised (IES-R) scale items. Participants above the age of 18 and technology savvy to answer an online questionnaire were recruited for the study. We excluded participants with a known history of psychotic disorder from the study. We utilised the DASS-21 to screen for depression, anxiety, and stress, as well as the IES-R to identify symptoms of post-traumatic stress disorder. Participants could answer the questionnaires in either English or Bahasa Malaysia. For comparison of two categorical data, a chi-square was applied. A univariate analysis was first conducted and all variables with a p ≤0.3 was then entered into the multivariate analysis for the final output. Other than the univariate analysis, all other p values <0.05 were considered to be statistically significant. All data collected were tabulated and analysed in the SPSS v21.0 system. RESULTS: A total of 306 out of 696 COVID-19 patients responded. The mean age for the participants was 31.69 (SD:11.19) years old. From the total, 54.2% were ladies, 78.8% were Malay, 50.7% were unmarried, 55.2% had higher education, and 67.6% were employed at the time of the survey. We found 20.5% of the participants were depressed, 38.9% had moderate anxiety, and 17.3% were stressed. From the total, 31.7% of the participants were deemed to have had some symptoms of post-traumatic stress disorder (PTSD) ranging from mild to severe. From the final multivariate analysis, it was found that depression (p=0.02) had a 2.78 times likeliness of having PTSD, anxiety (p<0.001) had a 3.35 times likeliness of having PTSD and stressed patients (p=0.02) 2.86 times likeliness of having PTSD when compared to those without PTSD. CONCLUSION: Patients reported to suffer from symptoms of PTSD and might benefit from psychological interventions to mitigate the impact in the long run.

Cancer patients with fractures are rarely assessed or treated for osteoporosis: a population-based study.

Among 4238 cancer and 16,418 cancer-free individuals with incident major non-traumatic fractures (hip, clinical vertebral, forearm, humerus), post-fracture osteoporosis care was equally poor for both groups, whether assessed from bone mineral density (BMD) testing, initiation of osteoporosis therapy or either intervention (BMD testing and/or osteoporosis therapy). INTRODUCTION: Most individuals sustaining a fracture do not undergo evaluation and/or treatment for osteoporosis. Cancer survivors are at increased risk for osteoporosis and fracture. Whether cancer survivors experience a similar post-fracture "care gap" is unclear. Using population-based databases, we assessed whether cancer patients are evaluated and/or treated for osteoporosis after a major fracture. METHODS: From the Manitoba Cancer Registry, we identified cancer cases (first cancer diagnosis between 1987 and 2013) and cancer-free controls with incident major non-traumatic fractures (from provincial physician billing claims and hospitalization databases). The outcomes were performance of BMD testing (from the BMD Registry), initiation of osteoporosis therapy (from drug dispensation database) or either intervention (BMD testing and/or osteoporosis therapy) in the 12 months post-fracture. RESULTS: There were 4238 cancer and 16,418 cancer-free individuals who sustained a fracture after the index date (cancer diagnosis) and were followed for at least 1 year post-fracture. Subsequent BMD testing was performed in 11.0% of cancer cases versus 11.5% non-cancer controls (P = 0.43), osteoporosis treatment in 22.9% cancer cases versus 21.8% non-cancer controls (P = 0.15), and either testing or treatment in 28.9% cancer cases versus 28.4% non-cancer controls (P = 0.53). Predictors of BMD testing and/or initiation of therapy were similar for non-cancer and cancer patients. Post-fracture interventions were consistently used more frequently among women, older patients (age 50 years or older), those who sustained fractures in a later calendar period, and (for treatment) after vertebral fracture. Cancer-specific variables (cancer type, years from cancer diagnosis to fracture, specialty of care provider) showed only weak and inconsistent effects. CONCLUSIONS: A large care gap exists among cancer patients who sustain a fracture, similar to the general population, whereby the evaluation or treatment for osteoporosis is seldom conducted. Care maps may need to be developed for cancer populations to improve post-fracture care.

Early Infliximab in Crohn's is associated with decreased intestinal surgery and similar health care costs.

BACKGROUND: Using Infliximab early in Crohn's disease can provide a window of opportunity in children for restoration of growth and achievement of puberty. We aimed to compare clinical outcomes and costs of a retrospective pediatric Crohn's disease (pCD) cohort treated with early use Infliximab (EUI) within 12 months compared with later use Infliximab (LUI). METHODS: Retrospective review of all children with pCD commenced on Infliximab was undertaken in a tertiary Australian pediatric center. RESULTS: pCD progressing to Infliximab was identified in 70 children: 38 (54%) in the EUI cohort versus 32 (46%) in the LUI cohort. Intestinal surgery had a higher risk of occurring in EUI when compared with LUI (2 (5%) versus 9 (28%), HR 5.67 (95% CI 1.21-26.38); p = .027). No patients in EUI underwent intestinal surgery post Infliximab commencement compared with 3 (9%) in LUI (p = .09). Escalation of Infliximab in luminal Crohn's disease was not significantly different in EUI when compared with LUI (3 (10.3%) versus 9 (39.1%) (p = .1)). EUI was more frequently used than LUI in 2015-2018 (27 (71%) versus 14 (44%)) p = .029, with the inverse occurring in 2010-2014 (11 (29%) versus 18 (56%)). Hospital admissions per person per year in EUI and LUI were 43 (0.23 visits/person/year) versus 84 (0.67 visits/person/year); IRR 2.51 (95% CI 0.9-7.01); p = .078). Health costs were not significantly different between cohorts. CONCLUSION: EUI in pCD is associated with an increased likelihood of being diagnosed in more recent years, less intestinal surgery and a trend toward decreased hospital admissions than LUI.

Redescription and molecular analysis of Pallisentis (Pallisentis) nandai Sarkar, 1953 (Acanthocephala: Quadrigyridae) in India.

Pallisentis (Pallisentis) nandai Sarkar, 1953 is a freshwater fish parasite restricted to the Indian subcontinent in the Ganga River and its tributaries. It was described from the leaffish, Nandus nandus (Hamilton) from the Ganga River delta at Calcutta. We recovered variant specimens from the same host species from the Ganga near its headwaters at Bijnor about 1500 km away. Our specimens were clearly identifiable as P. nandai but varied considerably from those in the original description, especially in the size of proboscis hooks, receptacle and lemnisci. The original description was incomplete (missing line drawings of female trunk and reproductive system, male trunk, complete proboscis, hooks and hook roots) and inaccurate (proboscis, hooks, receptacle wall), and some measurements were lumped together for both sexes. We provide a complete description and include new morphological information including the first description of para-receptacle structure in the genus Pallisentis Van Cleave, 1928, scanning electron microscopy and microscope images, molecular analysis, and energy dispersive X-ray analysis (EDXA) of hooks and spines of our specimens for the first time. Additional details of proboscis hook roots, trunk spines, micropores and micropore distribution are described. The unique metal composition of hooks (EDXA) demonstrated a considerably high but variable level of sulphur and negligible level of calcium in collar and trunk spines and hook tips, but a higher level of sulphur and calcium at the hook basal arch than at the hook tip and edge. A comparison with the EDXA pattern of another species of Pallisentis, P. Indica Mital & Lal, 1976, were considerably different. The phylogenetic position of P. nandai within Eoacanthocephala was generated to assess the molecular characterization based on 18S and ITS1-5.8S-ITS2 ribosomal DNA sequences. Maximum likelihood and Bayesian inference analyses placed P. nandai in a clade with other Pallisentis species under the family Quadrigyridae. This is the first report based on molecular evidence for P. nandai.

Effect of internet use on medical students before and after 4g internet service in india: A comparative study.

BACKGROUND: Internet is being used extensively throughout the world from last decade. In India internet service has entered into new generation called 4G. Medical students are particularly vulnerable group for problematic internet use on account of the time they spend online. This might have negative effects on their physical, psychological and social health. Hence they are more prone to internet addiction. AIMS: To compare use and effect of internet service among medical students before and after the availability of 4G service. STUDY DESIGN: Institution based cross sectional study. METHODS AND MATERIAL: Predesigned validated questionnaires were provided to the medical students in the year 2014. The questionnaire included demographics, pattern of internet use and Young's internet addiction test. Again in the year 2018 the similar procedure was carried out after introduction of 4G service. The data was collected and compared. Analysis was done using SPSS 25. STATISTICAL ANALYSIS: Descriptive statistics, Chi2 test and Mann-Whitney test was applied. RESULTS: Among 424 medical students 207 students were assessed in the year 2014 and 217 students in 2018.There was a significant change of pattern of use. Also significant increase in number of female users and severity of internet addiction in 2018. The ill effect of internet was on rise after availability of 4G service. CONCLUSIONS: The prevalence of internet addiction and its ill effect on behavior among medical students was higher after availability of 4G service in same college. So appropriate preventive and interventional strategies need to be developed in professional institutions.