Broad ligament ectopic pregnancy: a dilemma to diagnose

Broad ligament ectopic pregnancy is a rare and serious form of extrauterine pregnancy with a high risk of maternal mortality. There are no specific clinical features. Ultrasonography may help in diagnosis but definitive diagnosis is made only during surgery. A 20-year-old woman with previous 2 abortions presented with acute abdomen. She had no history of amenorrhoea but there was history of two episodes of bleeding in the last month at an interval of 14 days, each episode lasting for two-three days. The last episode of bleeding was 10 days back. Her urine pregnancy test was done and it was positive. There was marked abdominal tenderness with guarding and rigidity. Per vaginal examination revealed marked tenderness in the right fornix and cervical motion tenderness, uterus size could not be assessed due to tenderness.  It was diagnosed as a case of ruptured ectopic pregnancy. Since she was haemodynamically unstable, emergency laparotomy was done. She had a right sided broad ligament ectopic pregnancy which had ruptured. The tissue was completely removed and haemostatic sutures were taken. High index of clinical suspicion, early diagnosis and prompt surgery is the key to management

Optical quality ZnSe films and low loss waveguides on Si substrates for mid-infrared applications

Zinc Selenide (ZnSe) is a promising mid-infrared waveguide material with high refractive index and wide transparency. Optical quality ZnSe thin films were deposited on silicon substrates by RF sputtering and thermal evaporation, and characterized and compared for material and optical properties. Evaporated films were found to be denser and smoother than sputtered films. Rib waveguides were fabricated from these films and evaporated films exhibited losses as low as 0.6 dB/cm at wavelengths between 2.5 µm and 3.7 µm. The films were also used as isolation/lower cladding layers on Si with GeTe4 as the waveguide core and propagation losses were determined in this wavelength range

Fabrication and characterization of high-contrast mid-infrared GeTe₄ channel waveguides

We report the fabrication and characterization of high index contrast (Δn ~ 0.9) GeTe4 channel waveguides on ZnSe substrate for evanescent-field based biosensing applications in the mid-infrared spectral region. GeTe4 films were deposited by RF sputtering and characterized for their structure, composition, transparency and dispersion. The lift-off technique was used to pattern the waveguide channels. Waveguiding between 2.5-3.7 µm and 6.4-7.5 µm was demonstrated and mode intensity profile and estimated propagation losses are given for the 3.5 µm wavelength

Knowledge, anxiety and the use of hydroxychloroquine prophylaxis among health care students and professionals regarding COVID-19 pandemic

Introduction:  Data regarding knowledge and attitude about COVID-19, the prevalence of acceptance of hydroxychloroquine prophylaxis and anxiety amidst COVID-19 pandemic among health care students/professionals in India is scarce.Material and methods: A cross-sectional study was conducted during May 2020, using an online survey via Google forms. A self-administered validated structured questionnaire was applied, which comprised 28 questions among health care students/professionals at a tertiary care centrein North India.Results: A total of 956 respondents were included (10.2% nurses, 45.2% medical students, 24.3% paramedical students, 11.7% resident doctors and 8.6% consultant doctors). Overall knowledge score was 9.3/15; the highest for preventive practices (4/5), followed by clinical knowledge (2.7/5) and the use of personal protective equipment (PPE) (2.6/5). The overall score was the highest in consultant doctors (10.8) while the lowest in nurses (8.5) and paramedical students (8.4) (p < 0.001). Less than half of the respondents had knowledge about the correct sequence of doffing PPE and the use of N95 mask. About 21.8% of the participants experienced moderate to severe anxiety; higher among nurses (38%), followed by paramedical students (29.3%); and anxiety was higher when knowledge score was low (27.6% vs 14.7%); both factors were independent predictors on multivariate analysis (p < 0.001). Only 18.1% of the respondents applied HCQ prophylaxis — the highest proportion constituted consultants (42.7%), and the least — paramedical students (5.2%); (p < 0.001) and HCQ use was more frequently used if they had a family member of extreme age group at home (23.3% vs 12.2%; p < 0.001). Conclusions: The knowledge about correct PPE usage is low among all groups of HCWs and students, and there is a high prevalence of anxiety due to COVID-19. The lower COVID-19 knowledge scores were significantly associated with a higher likelihood of anxiety and inadequate use of HCQ prophylaxis. The appliance of HCQ prophylaxis had no significant association with anxiety levels of the respondents

Issues in the Differential Diagnosis of Uterine Low-grade Endometrioid Carcinoma, Including Mixed Endometrial Carcinomas: Recommendations from the International Society of Gynecological Pathologists

This article provides practical recommendations developed from the International Society of Gynecological Pathologists Endometrial Carcinoma Project to address 4 issues that may arise in the diagnosis of uterine corpus low-grade endometrioid carcinoma: (1) The distinction between atypical hyperplasia and low-grade endometrioid carcinoma. (2) The distinction between low-grade endometrioid carcinoma and serous carcinoma. (3) The distinction between corded and hyalinized or spindle cell variants of low-grade endometrioid carcinoma and carcinosarcoma. (4) The diagnostic criteria for mixed endometrial carcinomas, a rare entity that should be diagnosed only after exclusion of a spectrum of tumors including morphologic variants of endometrioid carcinoma, dedifferentiated endometrial carcinoma, carcinosarcoma, and endometrial carcinomas with ambiguous morphology

High-grade Endometrial Carcinomas: Morphologic and Immunohistochemical Features, Diagnostic Challenges and Recommendations

This review of challenging diagnostic issues concerning high-grade endometrial carcinomas is derived from the authors' review of the literature followed by discussions at the Endometrial Cancer Workshop sponsored by the International Society of Gynecological Pathologists in 2016. Recommendations presented are evidence-based, insofar as this is possible, given that the levels of evidence are weak or moderate due to small sample sizes and nonuniform diagnostic criteria used in many studies. High-grade endometrioid carcinomas include FIGO grade 3 endometrioid carcinomas, serous carcinomas, clear cell carcinomas, undifferentiated carcinomas, and carcinosarcomas. FIGO grade 3 endometrioid carcinoma is diagnosed when an endometrioid carcinoma exhibits >50% solid architecture (excluding squamous areas), or when an architecturally FIGO grade 2 endometrioid carcinoma exhibits marked cytologic atypia, provided that a glandular variant of serous carcinoma has been excluded. The most useful immunohistochemical studies to make the distinction between these 2 histotypes are p53, p16, DNA mismatch repair proteins, PTEN, and ARID1A. Endometrial clear cell carcinomas must display prototypical architectural and cytologic features for diagnosis. Immunohistochemical stains, including, Napsin A and p504s can be used as ancillary diagnostic tools; p53 expression is aberrant in a minority of clear cell carcinomas. Of note, clear cells are found in all types of high-grade endometrial carcinomas, leading to a tendency to overdiagnose clear cell carcinoma. Undifferentiated carcinoma (which when associated with a component of low-grade endometrioid carcinoma is termed "dedifferentiated carcinoma") is composed of sheets of monotonous, typically dyscohesive cells, which can have a rhabdoid appearance; they often exhibit limited expression of cytokeratins and epithelial membrane antigen, are usually negative for PAX8 and hormone receptors, lack membranous e-cadherin and commonly demonstrate loss of expression of DNA mismatch repair proteins and SWI-SNF chromatin remodeling proteins. Carcinosarcomas must show unequivocal morphologic evidence of malignant epithelial and mesenchymal differentiation

Mid-infrared Integrated photonic devices for biosensing

This thesis describes the realisation of devices and techniques based on evanescent field sensing using planar optical waveguides for mid-infrared (MIR) absorption spectroscopy, to provide bio-chemical sensing capabilities for medical diagnostics. The fundamental vibrations of bio-chemical molecules occur in the MIR region, where their absorption is orders of magnitude stronger than their overtone bands in the near-infrared making it suitable for highly sensitive and specific absorption spectroscopy. Realisation of waveguides is an essential step towards mass-producible and low-cost integrated lab-on-chip devices. Two chalcogenide compositions were used to make waveguides, germanium telluride (GeTe4) as waveguide core and zinc selenide (ZnSe) as waveguide lower cladding. Two approaches were followed for waveguide fabrication: GeTe4 waveguides on bulk ZnSe and GeTe4 waveguides on thin films ZnSe deposited on Si. High contrast (Δn ~ 0.9) GeTe4 channel waveguides on ZnSe were fabricated using photolithography and lift-off. Waveguiding was demonstrated for the wavelength range between 2.5 and 9.5 μm for GeTe4 channel waveguides on bulk ZnSe substrates. GeTe4 waveguides fabricated on Si with ZnSe isolation layers were characterised for waveguiding and propagation losses in the wavelength range between 2.5 and 3.7 μm. ZnSe rib waveguides were also fabricated on oxidised Si by photolithography and dry etching and were characterised for propagation losses in the wavelength region of 2.5-3.7 μm. Absorption spectroscopy of liquid mixtures absorbing in the MIR was performed on the surface of the waveguide and the results were compared with a theoretical model

High contrast mid-infrared chalcogenide waveguides for biosensing applications

Mid-infrared spectral band from 2 µm - 20 µm is ideal for label-free biosensing as the fundamental vibrations of many significant biomolecules take place in this region. Mid-infrared absorption spectroscopy using FTIR has been exploited for the last few decades to provide sensing capabilities for biomedical diagnostics. However, the sensitivity and the detection limit of the sample under test can be tremendously improved by using the evanescent field based integrated planar waveguide devices. In this paper, we present the fabrication and characterization results of chalcogenide waveguides transparent in the mid-infrared region for such applications. GeTe4 waveguides on ZnSe substrates were fabricated using lift-off technique. Lift-off resist was used to create the patterns on ZnSe substrate using photolithography and GeTe4 was deposited on these patterned samples using RF sputtering. The lift-off resist was stripped off to obtain the desired channels. The waveguides were characterized in both mid wave (2.5 µm - 3.7 µm) and long wave (6.4 µm - 7.5 µm) spectral bands using optical parametric oscillator-based laser source and quantum cascade laser, respectively [1]. Fig. 1 (a) and (b) show the cross-section and top view of the infrared camera images of the output facet of a GeTe4 channel waveguide showing light guidance at lambda = 3.5 µm and lambda = 6.5 µm, respectively

Using electrical resistance asymmetries to infer the geometric shapes of foundry patterned nanophotonic structures

While silicon photonics has leveraged the nanofabrication tools and techniques from the microelectronics industry, it has also inherited the metrological methods from the same. Photonics fabrication is inherently different from microelectronics in its intrinsic sensitivity to 3D shape and geometry, especially in a high-index contrast platform like silicon-on-insulator. In this work, we show that electrical resistance measurements can in principle be used to infer the geometry of such nanophotonic structures and reconstruct the micro-loading curves of foundry etch processes. We implement our ideas to infer 3D geometries from a standard silicon photonics foundry and discuss some of the potential sources of error that need to be calibrated out to improve the reconstruction accuracy.Comment: 14 pages (single side), 8 figures. Comments welcome !!