The peritoneal cavity is widely used as the destination of choice for cerebrospinal fluid (CSF) shunts. Various alternative distal sites have been used, particularly in the presence of certain contraindications, which include the cardiac atria, for ventriculoatrial (VA) shunt, or the pleural cavity for ventriculopleural (VPL) shunt.[1] Each procedure is associated with its own set of complications and the choice of selection of the distal site of CSF drainage is often based on surgeon's preference along with patient's factors.[2] While the historical literature describes pleural effusion and pneumothorax as complications of a VPL shunt, there is paucity of data justifying the application of one technique over the other. We report a rare case of postoperative pneumothorax in a case of VPL shunt being further complicated by pneumocephalus.

We are living in an unprecedented difficult time due to the infectious COVID-19 pandemic, a global emergency. During the on-going pandemic, most allergy/immunology care could be postponed/delayed or handled through virtual care. Seven experts from different parts of India deliberated on this subject in 3 weekly webinars (May 10, 17, and 24, 2020) charted out consensus-based approach for diagnosis and management of patients suffering with allergic respiratory diseases in India during this COVID-19 pandemic. This publication includes these recommendations.

INTRODUCTION: Allergic bronchopulmonary aspergillosis (ABPA) is an immunologically mediated lung disease, predominantly in patients with asthma and is caused by hypersensitivity to colonized dimorphic fungus Aspergillus, commonly Aspergillus fumigatus. Early diagnosis with recognition and treatment of chest radiographic infiltrates appears to prevent progression to end stage fibrosis. Many cases are mistreated as pulmonary tuberculosis or recurrent pneumonia and are deferred for specific treatment of ABPA. AIM AND OBJECTIVES: This study aims to know the clinical, radiological, and immunological profile of patients diagnosed with ABPA reporting to the Institute of Respiratory Disease, SMS College, Jaipur and Mahatma Gandhi Medical College, Jaipur. MATERIALS AND METHODS: Hospital-based prospective, observational, cross-sectional study was conducted in 48 Patients having history of bronchial asthma, pulmonary infiltrate/shadows on chest X-ray were subjected to routine investigations, immunological tests including modified skin prick test with specific IgE against A. fumigatus and specific precipitins against A. fumigatus. RESULT: In this study, maximum predominance with age group of 21–40 years irrespective of sexpattern. Maximum patients were having bronchial asthma of 2–10 years duration. Cough, breathlessness, and wheezing were main clinical features. In 80% cases, total eosinophilic counts were more than 1000.58.4% sputum were fungal culture positive, maximum for A. fumigatus. All cases showed modified kinprick test positivity against A. fumigatus. Maximum patients high-resolution computed tomography chest had central bronchiectasis. 37% cases had raised total serum IgE (range 1000–5000). Specific IgE against A. fumigatus were positive in 24 patients. 87.5% patients were positive for specific precipitins. CONCLUSION: In this study, ABPA was found more commonly in people with chronic asthma of productive age group, i.e., 20–40 years and farmers by occupation. Most of the people were diagnosed as having pulmonary tuberculosis and deferred specific treatment for a long time. More knowledge about ABPA to physicians could possibly cut short the time between suffering, diagnosis, and proper treatment of these patients.

Influenza, a common cause of acute respiratory infections, is an important health problem worldwide, including in India. Influenza is associated with several complications; people with comorbidities and the elderly are at a higher risk for such complications. Moreover, the influenza virus constantly changes genetically, thereby worsening therapeutic outcomes. Vaccination is an effective measure for the prevention of influenza. Despite the availability of global guidelines on influenza vaccination in adults, country-specific guidelines based on regional variation in disease burden are required for better disease management in India. With this aim, the Indian Chest Society and National College of Chest Physicians of India jointly conducted an expert meeting in January 2019. The discussion was aimed at delineating evidence-based recommendations on adult influenza vaccination in India. The present article discusses expert recommendations on clinical practice guidelines to be followed in India for adult influenza vaccination, for better management of the disease burden.

Purpose: There are no established imaging biomarkers that predict response during chemoradiation for patients with locally advanced non-small cell lung carcinoma. At our institution, proton therapy (PT) patients undergo repeat computed tomography (CT) simulations twice during radiation. We hypothesized that tumor regression measured on these scans would separate early and late responders and that early response would translate into better outcomes. Methods and Materials: Patients underwent CT simulations before starting PT (CT0) and between weeks 1 to 3 (CT1) and weeks 4 to 7 (CT2) of PT. Primary tumor volume (TVR) and nodal volume (NVR) reduction were calculated at CT1 and CT2. Based on recursive partitioning analysis, early response at CT1 and CT2 was defined as >= 20% and >= 40%, respectively. Locoregional and overall progression-free survival (PFS), distant metastasis-free survival, and overall survival by response status were measured using Kaplan-Meier analysis. Results: Ninety-seven patients with locally advanced non-small cell lung carcinoma underwent definitive PT to a median dose of 66.6 Gy with concurrent chemotherapy. Median TVR and NVR at CT1 were 19% (0-79%) and 19% (0-75%), respectively. At CT2, they were 33% (2-98%) and 35% (0-89%), respectively. With a median follow-up of 25 months, the median overall survival and PFS for the entire cohort was 24.9 and 13.2 months, respectively. Compared with patients with TVR and NVR <20% at T1 and <40% at T2, patients with TVR and NVR >= 20% at CT1 and >= 40% at CT2 had improved median locoregional PFS (27.15 vs 12.97 months for TVR >= 40% vs <40%, P < .01, and 25.67 vs 12.09 months for NVR >= 40% vs <40%, P < .01) and median PFS (22.7 vs 9.2 months, P < .01, and 20.3 vs 7.9 months, P < .01), confirmed on multivariate Cox regression analysis. Conclusions: Significantly improved outcomes in patients with early responses to therapy, as measured by TVR and NVR, were seen. Further study is warranted to determine whether treatment intensification will improve outcomes in slow-responding patients. (C) 2019 Published by Elsevier Inc.

Patients with a history of radiation pneumonitis (RP) requiring steroids have generally been excluded from immuno-oncology (IO) trials of PD-1/PDL-1 monoclonal antibodies for safety concerns. The risk of IO-associated pneumonitis (IOP) in this group of patients (pts) is therefore unknown. We evaluated the frequency of IOP in pts who had prior RP. We evaluated all pts with non-small cell lung carcinoma (NSCLC) treated at our institution between 2011 and 2018 who were diagnosed with RP and at a later point received IO. Demographics, tumor characteristics, steroid use and outcomes were extracted from the electronic medical record. Median overall survival (mOS), median progression free survival (mPFS), and median time to treatment failure (mTTF) from the start of IO were estimated from Kaplan-Meier curves. We identified 29 pts: median age at diagnosis 63 yrs, 51.7% male, none had received prior targeted therapies. IO treatments were: atezolizumab (2), durvalumab (2), nivolumab (12), and pembrolizumab (13). Median time from RP diagnosis to start of IO was 14.2mo (2.2-75 mo). 23 pts (79%) had experienced prior grade ≥2 RP requiring steroids. Only 2 of the 29 pts (6.9%) developed IOP. Both pts had required steroids for prior RP and both received durvalumab; one pt was on prednisone ≥10mg at the start of IO. Both required steroid treatment of IOP, are still on IO and have not progressed (censored at 8.3mo and 9.9mo). OS and PFS after IO are similar (Table 1) whether or not pts required treatment for RP or were on prednisone ≥ 10 mg (or steroid equivalent) at the start of IO.Table 1IO outcomes based on RP history and steroid use at start of IORP Grade ≥ 2 n=23 (95% CI)RP Grade < 2 n=6 (95% CI)Prednisone ≥ 10mg n=7 (95% CI)Prednisone < 10mg n=22 (95% CI)All patients n = 29 (95% CI)mPFS (mo)5.44 (2.1-12.6)12.95 (0.95-)6.16 (2-)5.44 (2.1-)6.16 (2.4-)mOS (mo)6.6 (3.93-13.8)NR14.3 (5.3-)8 (3.4-16.8)8 (5.3-15)mTTFa (mo)2.3 (1.9-4.8)2.3 (1.9-)4.4 (2-)2.3 (1.9-10.9)2.75a (2-7)an=28: 1 pt lost to follow up after start of IO Open table in a new tab an=28: 1 pt lost to follow up after start of IO In our cohort, the incidence of IOP after RP is low and similar to the rate of pneumonitis reported with pembrolizumab in pts with prior exposure to thoracic radiation.

Background: Haemoptysis is a common symptom of lung cancer. However its correlation with the histological proven cases of lung malignancy is poorly understood. This study describes the pattern and prevalence of haemoptysis in lung malignancy related to various histopathological types. Materials and Methods: This is a retrospective study conducted in MGMCH, Jaipur in 100 patients of histopathologically proven cases of lung cancer between July 2016 to July 2017 showing profile of haemoptysis and its correlation with various histopathological types of lung malignancy Results: Of 100 patients of lung cancer, 82% were males and 18% females. Prevalence of haemoptysis was 29% out of which 62.06% of cases were having mild, 34.50% moderate and 3.4% severe haemoptysis. The most common histological type of lung cancer was squamous cell carcinoma (59%) followed by small cell(28%), adenocarcinoma(10%) , large cell carcinoma(1%) and poorly differentiated (2%). Majority of cases of haemoptysis (72.4%) were squamous cell carcinoma, 24.13% small cell and 3.4% adenocarcinoma. Conclusion – Haemoptysis is not an uncommon symptom in lung cancer present in about 1/3 rd cases and majority complains of mild haemoptysis. Most common(3/4 th ) is squamous cell carcinoma. -------------------------------------------------------------------------------------------------------------------------------------Date of Submission: 08-06-2019 Date of acceptance: 25-06-2019 --------------------------------------------------------------------------------------------------------------------------------------

Proton therapy (PT) is increasingly being used in locally advanced non-small cell lung cancer (NSCLC), but is there currently a limited understanding of its radiation-induced lung injury pattern that can cofound radiologic interpretation. Here we characterize imaging of radiation-induced lung injury on CT (computed tomography) and FDG-PET (18F-deoxy-glucose-positon emission tomography) following PT. After institutional IRB approval, longitudinal imaging from adult NSCLC patients undergoing PT over a 5-year period at our institution were retrospectively analyzed by two thoracic radiologists. Tumor size and FDG standard uptake value max (SUVmax) were recorded. In addition, early (<12 months after PT) and late (>12 months) radiation-induced lung injuries were quantified (0-3 Likert score), including consolidation, ground glass, interlobular septal thickening, bronchiectasis and pleural effusion, on all serial imaging. 19 consecutive locally advanced NSCLC patients (mean age 69.3 yrs) had PT during the study period and had serial images available for review. The mean imaging follow-up period from PT start was 30 months. Five patients developed local failure. In the remaining 14 patients, tumor size and FDG avidity steadily decreased over time (mean SUVmax = 10.8 at baseline and 2.5 at 12 months). Ground glass and interlobular septal thickening presented as early changes, increasing through months 6-12 and 9-12 respectively but generally resolved by 24 months. 68% of patients developed a pleural effusion (< 2 years), increasing in severity over the 1st 18 months. Consolidation consistently increased in severity throughout the observation period (max >48 months) Among 11 tumors, 8 achieved maximum severity in late changes of band-like or mass-like consolidation within 24 months and then typically plateaued. Late development of a pleural effusion, mass-like fibrosis, increased tumor caliber and increased FDG avidity were associated with local tumor recurrence. Radiation-induced lung injury follows a predictable temporal pattern on CT. Knowledge of expected timeline of the imaging findings may prevent unnecessary imaging and/or biopsies. We are currently analyzing a larger cohort of 100 NSCLC patients to compare post radiation changes in local recurrence and local control.

Purpose or ObjectiveThere has been growing interest in use of MRI in lung cancer radiotherapy.This study aims to evaluate the changes seen in lung cancer volume and position on MRI during a course of radiotherapy, and compare this with the current standard of practice, serial cone-beam CT (CBCT). Material and MethodsPatients with histologically or cytologically confirmed lung cancer receiving more than 12 fractions of radiotherapy, either alone or with concurrent chemotherapy, were enrolled in a prospective study of serial CBCT and MRI in during-treatment (Day 1, Day 11, & Day 21) scans.Timematched CBCT and MRI primary gross tumour volumes (GTVp) were manually delineated by a single observer on MIM software.Derived parameters (volume, & centre of mass (COM)) were analysed descriptively and using Bland-Altman plots and linear regression.Results 20 patients with 23 GTVp were eligible for inclusion.60 CBCT/MRI scan pairs were analysed.Mean (± standard deviation) CBCT vs MRI volume change compared to baseline (Day 1) were 81% (±17) vs 80% (±29), and 70% (±31) vs 72% (±46) for Day 11 and Day 21 respectively.CBCT contours were on average 23% larger than paired MRI contours.MRI vs CBCT demonstrated a systematic bias of -0.92 mL, with absolute volume of CBCT being greater than MRI.Bland-Altman analysis demonstrated CBCT and MRI were not equivalent imaging modalities.No significant regression was found in during-treatment CBCT or MRI (p=0.65).No significant difference in slope of tumour regression was found between CBCT and MRI.A significant (> 0.5 cm) COM shift was observed from Day 1 to Day 21, at 0.54 (±0.42) vs 0.66 (±0.41) cm for CBCT vs MRI respectively.

Locally-advanced non-small cell lung cancer (LA-NSCLC) patients are treated with chemoradiotherapy (CRT); however, approximately 15-20% of these patients develop significant morbidity with radiation pneumonitis (RP). Proton beam therapy (PBT) may reduce this risk. Currently, the most acceptable dosimetric predictors assume homogenous underlying lung function. We hypothesize that the risk of RP is correlated with dose to more highly ventilated portions of the lung, and PBT could be used to protect these areas of higher function. This study correlates the radiation dose in the low and high ventilation portions of the lung with RP outcome for patients treated with proton radiotherapy. This was a case-control retrospective study. 30 patients with LA-NSCLC treated between 2011 and 2016 with CRT were retrospectively identified, of whom 15 exhibited RP (graded using CTCAE v4.0) after PBT, and 15 were negative controls (matched based on age, smoking , tumor location and total dose). None received prior lung radiation and all satisfied institutional dosimetric constraints (V5<60%, V20Gy <37%, Mean lung dose < 20 Gy ). The inhale and exhale simulation CT scans were deformed using clinically validated deformable registration Advanced Normalization Tools . The 3D lung ventilation maps were derived from the deformation matrix and partitioned into low, medium and high ventilation zones for dosimetric analysis. A two-tailed student’s t test was used to correlate dose in each ventilation zone with risk of RP. The typical dose parameters V5 (37.2 ± 6.1 Gy vs 32.6 ± 7.3 Gy) and V20 (30.4 ± 5.7 Gy vs 27.2 ± 5.4 Gy) were higher for pneumonitis patients, though not statistically significant (p = 0.073, 0.127, respectively). In the low ventilation portion of the lung, similar dose distribution was observed for V20 between the RP (9.6± 2.7 %) and non-RP (9.7± 2.3 %) groups (p=0.914). V5 was also not significantly different (11.9±2.8 % vs 12.1± 2.7 %, p = 0.856). However, in the high-ventilation portions of the lung, RP group had higher V5 (12.5 ± 2.4 % vs. 9.3 ± 4.0 %, p = 0.012) and V20 (10.1 ± 2.4 % vs. 7.3 ± 3.6 %, p = 0.018). Furthermore, the mean dose in the high-ventilation portions of the lung of the RP patients was significantly higher than that of the non-RP patients (16.8 ± 4.4 Gy vs. 11.7 ± 6.1 Gy, p=0.015), while the mean dose in the low-ventilation portion of the lung did not show such differentiation (16.3 ± 5.0 Gy vs. 15.6 ± 4.2 Gy, p = 0.683). There is accruing data demonstrating that radiation dose to the functional high ventilated lung might serve as a predictor of RP. Our data supports these findings and is additionally the first study to demonstrate this in a cohort of patients treated with PBT. This is particularly promising given the greater ability to control dose to low versus high-ventilated portions of the lung using PBT compared to photon based RT . Further work will be needed to validate these findings in a larger cohort and compare these results in patients treated with photons.

A servey of weed flora studies in kharif season was conducted during year of 2017 major kharif crops were soybean blackgram, maize and rice crops of Ashok Nagar district. On the basis of result it was found that the Commelina bengalensis, Celosia argentia, Digra arvensis, Uphorbia jeniculata and Pathenium hysterophorus were the major weeds of soybean crops. Digra arvensis, Cynodon dactylon, Commelina bengalensis, Celosia argentia and Pathenium hysterophorus were the major weed of blackgram crops. Eichnoacloa crusgulli, Commelina communis, Cyprus Rotundus, Eichnoacloa, Colonum, and Eshemum, Rugosum were the major weeds of rice crop. Dactylectimium egyptium, Cynodon dectylon, Cyprus rotundus, Eclipta alba and Uhorbia hirta were the major weeds of maize crop in Ashoknagar district.

BCI (Brain computer interface) is a control and communication system which allows electrophysiological activity to control a computer or a peripheral device directly, without taking the natural route of peripheral nerves and muscles. The prime motive behind developing BCI technology was its ability to act as the only interactive link for people disabled by amyotrophic lateral sclerosis (ALS), cerebral palsy, spinal cord injury, stroke and similar neuromuscular disorders of high severity. However in the last decade, a gradual shift in BCI end-users from patients to casual (healthy) individuals has increased significantly. Because of this shift, BCI community has recognized the need for EEG based casual BCI to be more efficient and user friendly, keeping in mind the customized needs of healthy (Casual) user. So for increasing the performance of such BCIs, the selection of optimal control signal plays a very significant role. Hence, in this work, we evaluate various EEG control signals (CS) in accordance with considerations relevant to user-friendliness of casual BCIs and point up their neuro-physiological origins as well as their effectiveness in current applications. Finally, we recommend a set of parameters for selection of optimal EEG based control signal for casual BCIs and the best suitable option available among the present day control signals.

It has been well established in the literature of laser welding that computationally predicted melt pool dimensions differ with the experimentally measured melt pool dimensions. Therefore, in order to validate with the experimental results, researchers in the past performed numerical simulations by using enhanced values for viscosity and thermal conductivity of the liquid metal. The justification is that the enhanced values can take care of the flow instabilities present in the melt pool which were not accounted by the model. This indirect approach using enhanced values gave reasonable agreement with the predictions. It should be noted that in the past researchers have used randomly enhanced values for viscosity and thermal conductivity of the liquid metal without any explanation for using that particular values. In this work, a 2-D axisymmetric model is developed in-house in OpenFOAM for investigating the effect of the enhancement factor on the heat transfer and melt pool flow dynamics during the conduction mode laser spot welding process of 304 stainless steel. The melt pool characteristics, such as melt pool width and melt pool depth obtained with different enhancement factors are compared with the experimental results. The results suggest that there is an optimum enhancement factor for a particular metal for which simulations results compare well with the experimental results.

For the first time the molecular structure, vibrational, optical and nonlinear optical properties of the l-prolinium trichloroacetate (LPTCA) have been determined by B3LYP/6-31++G** level of theory and the obtained properties are well correlated with the experimental report. The factor group investigation was also made and discussed. In the continuation of theoretical studies the TD-DFT approach is applied to study the various key properties. The calculated absorption wavelength value is found at λexc=174nm (7eV). The dipole moment and first order hyperpolarizability were also calculated and found to be comparable with urea. Further, global chemical reactivity descriptors (GCRD), frontier molecular orbitals and molecular electrostatic potential (MEP) are discussed. All the properties suggest that the present material may be a good contender for optoelectronic devices.

Cluster front line demonstrations on soybean were organized in the kharif seasons of year 2015-16 different villages of Ashoknagar district by Krishi Vigyan Kendra, Ashoknagar for creating awareness among the farmers to popularize the high yielding variety of soybean. In this context, centre was conducted demonstration to assess the improved varieties of soybean JS 9560 along with existing varieties used by the farmers as local check in the district. The farmers followed the full package of practices like proper seed rate, seed treatment with biofertilizer, fertilizer application on soil test value, weed management, IPM practices etc. Result of front line demonstrations indicated that on an average of 25% more yield of soybean was found as compared to farmer’s practices.The number of productive pods per plant of JS 9560 soybean was found 52.7 and non-productive pods per plant 7.9 under package of improved practices. The economic analysis of data over the years revealed that the adoption of improved technology of soybean not only gives the opportunity of higher yield, but also provides higher benefit cost ratio i.e. 1.62 as compared to 1.37 in the farmer’s practices.