A lecture on endometrial hyperplasia and carcinoma, exploring the etiology, clinical features, types, investigations, management and treatment options and prognosis.
This was presented to undergraduate medical students at Livingstone Central Teaching Hospital, Livingstone, Zambia, department of Obstetrics and Gynecology by Nghitukuhamba T.E Kalipi (final year student) Cavendish University Zambia, School of Medicine.
A presentation I gave on Pediatric Fluid Therapy, with the main focus around perioperative fluid therapy in the Pediatric population. This lecture was delivered to my colleagues in the department of Anesthesia, and it was invigilated by consultant Anesthetist, Dr. Anatolly Kravchenko at the Intermediate Hospital Katutura.
I presented the use of Mini-Mental State Exam and Montreal Cognitive Assessment in Psychiatry as part of an academic presentation during my Psychiatry rotation on 22/03/2024 to an audience that consisted of my fellow medical interns, medical students, medical officers, and Psychiatric consultants.
A presentation I gave on Pediatric Fluid Therapy, with the main focus around perioperative fluid therapy in the Pediatric population. This lecture was delivered to my colleagues in the department of Anesthesia, and it was invigilated by consultant Anesthetist, Dr. Anatolly Kravchenko at the Intermediate Hospital Katutura.
I presented the use of Mini-Mental State Exam and Montreal Cognitive Assessment in Psychiatry as part of an academic presentation during my Psychiatry rotation on 22/03/2024 to an audience that consisted of my fellow medical interns, medical students, medical officers, and Psychiatric consultants.
This lecture was presented to nursing students undertaking their bridging course at Nursing Training Institute of Technology (NTIT), Eenhana, Campus, Ohangwena Region, Namibia.
It discusses the transport system in humans, touching on topics like the heart, blood vessels, lymphatic system, and immunity in Biology. The resources used were the Namibian Namcol new curriculum for grade 10-11 ordinary level biology text book.
It was presented by myself, Dr. Nghitukuhamba Tangi Elikana Kalipi
MBChB, Bsc HB.
This is a lecture on Intravenous Induction Agents. It explores the different classes of induction agents, ranging from barbiturates to non-barbiturate agents. It also discusses the various indications and contraindications of such agents, the doses and different antidotes, and the expected adverse effects.
This lecture was presented to undergraduate medical students at University Teaching Hospital (UTH), Lusaka, Zambia, department of Anaesthesia by Nghitukuhamba Tangi Elikana Kalipi (6th year medical student) at Cavendish University Zambia, School of Medicine.
Moderated by Dr. Chanda
This is a lecture on Refractive Errors, discussing the etiology, clinical features, the different types, diagnosis, treatment and management options.
This was presented to undergraduate medical students at University Teaching Hospital (UTH), Lusaka, Zambia, department of Opthalmology by Nghitukuhamba Tangi Elikana Kalipi (6th year medical student) at Cavendish University Zambia, School of Medicine.
This is a lecture on Lymphoma, exploring the different types and subtypes of Lymphomas. It also discusses the epidemiology, stages, clinical features, diagnosis, treatment and prognosis.
This was presented to undergraduate medical students at University Teaching Hospital (UTH), department of Cancer Disease Hospital by Nghitukuhamba Tangi Elikana Kalipi (6th year medical student) at Cavendish University Zambia, School of Medicine.
This is a lecture exploring the various options of induction and augmentation of labour, discussing the indications, contraindications and pre-requisites for induction and augmentation of labour. Diving deeper into the the types such as non-pharmacological, pharmacological and other methods used.
This was presented to undergraduate medical students at Livingstone Central Teaching Hospital, Livingstone, Zambia by Nghitukuhamba Tangi Elikana Kalipi (final year medical student) at Cavendish University Zambia, School of Medicine.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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4. 2. Endometrial hyperplasia
Endometrial hyperplasia is a condition in which the endometrium becomes
abnormally thick.
It is an estrogen dependent condition, and long-term unopposed estrogen,
particularly around the time of menopause often leads to various types of
endometrial hyperplasia.
Etiology
It develops in women of 40-50 years.
Unopposed estrogen appears to be the primary factor, among other numerous
factors.
Estrogen causes endometrial cells to proliferate when it is unopposed by
progesterone.
6. Endometrial hyperplasia continued..
Protective factors
Multiparity.
Normal weight.
Combined oral contraceptive use.
Progesterone therapy.
Menopause <49 years.
Hysterectomy.
Intrauterine device use (Cu-IUD and LNG-IUS).
Smoking.
7. Endometrial hyperplasia continued..
Diagnosis and investigation
FBC, DC, urea and creatinine, electrolytes, RBS, LTFS.
Urinalysis
ECG and X-ray
There is no classic symptom for premalignant lesions, but the constant
feature is abnormal perimenopausal uterine bleeding. Diagnosis is made by
uterine curettage and histology.
Accidental diagnosis is made during investigation of infertility, DUB, PCOS or
excised specimen of the uterus.
TVUSS.
Hysteroscopy.
8. Endometrial hyperplasia continued..
Histological subtypes of endometrial hyperplasia
Simple hyperplasia: Thickened endometrium, dilated glands with
outpouchings and invaginations. The stroma is more dense and cellular.
Complex hyperplasia: Thickened endometrium, crowded irregular glands
with reduced stroma.
Atypical hyperplasia: Endometrial glands have cytologic atypia with enlarged
and hyperchromatic nuclei.
Carcinoma-in-situ: Lesions with severe cytologic and glandular architectural
abnormalities.
9. Endometrial hyperplasia continued..
Management
1. Preventive treatment.
2. Definitive treatment.
1. Preventive treatment
To maintain ideal body weight.
Screening of at risk women with periodic endometrial sampling.
Reduce use of estrogen alone. COCPs reduce the risk.
2. Definitive treatment
Depends on: Age of the patient and the histological subtype.
Cyclic progestogen therapy (for 6-9 months).
Ovulation induction in cases of PCOS.
Hysterectomy with bilateral salpingo-oophorectomy.
10. 3. Endometrial carcinoma
These are tumours that originate from the lining of the uterus
(endometrium).
Incidence
It is the most common gynaecological malignancy in the UK (95/100000
women).
Life-time risk of developing cancer is 1/46.
Mean age of diagnosis is 62 years, although 25% of endometrial cancer occur
before menopause.
The incidence has risen due to high life expectancy and improvement in
diagnostic modalities.
11. Endometrial carcinoma continued..
Etiology and risk factors
Unopposed estrogen stimulation (PCOS, ovarian tumours) and estrogen
therapy.
Age >62 years.
Nulliparity.
Late menopause >52 years.
Obesity.
Diabetes.
Tamoxifen therapy (SERM).
Family history of colorectal, ovarian, urothelial and endometrial cancer
(Lynch II syndrome).
Endometrial hyperplasia (25% progress to cancer).
12. Endometrial carcinoma continued..
Protective factors
Hysterectomy.
Combined oral contraceptives.
Progestin-based contraceptives, including injectables.
Intrauterine devices, including Cu-IUD and LNG-IUS.
Pregnancy.
Smoking.
14. Endometrial carcinoma continued..
Mechanisms of spread
Direct spread (Myometrium, parametrium, cervix etc).
Lymphatic spread (pelvic, para-aortic, and rarely inguinal and femoral nodes).
Hematogenous spread (involving the lungs, liver, bones and brain).
Clinical features
Symptoms: Postmenopausal bleeding (75%), abnormal uterine bleeding in
premenopausal women, abdominal pain, urinary dysfunction, bowel and
respiratory symptoms, watery and offensive PV discharge (due to pyometra). Less
than 5% remain asymptomatic.
Signs: Varying degree of pallor, bleeding or discharge from cervical os on
speculum examination, and bulky uterus on bimanual pelvic examination. In
some women, pelvic examination is completely normal.
15. Endometrial carcinoma continued..
Diagnosis and investigation
FBC, DC, urea and creatinine, electrolytes, RBS, LTFS.
Urinalysis
ECG and X-ray
Mainstays of diagnosis:
Endometrial biopsy.
TVUSS.
Hysteroscopy.
Other modalities used
MRI
CT
PET scan
16. Endometrial carcinoma continued..
Staging of endometrial carcinoma (FIGO Staging, 2009).
Stage Description
I
IA
IB
Tumour confined to uterine body
Less than 50% myometrial invasion
More than 50% myometrial invasion
II Tumour invades cervical stroma, but does
not extend beyond the uterus
III
IIIA
IIIB
IIIC
Local or regional spread of tumour
Invades serosa of uterus
Invades vagina and/or parametrium
Metastases to pelvic and/or para-aortic
nodes
IV
IVA
IVB
Tumour invades bladder ± bowel ± distant
metastases
Tumour invades bladder and/or bowel
mucosa
Distant metastases, including
intraabdominal metastases and/or inguinal
lymph nodes
17. Endometrial carcinoma continued..
Management
1. Preventive treatment.
2. Curative treatment.
1. Preventive treatment
Maintain ideal body weight.
Restrict the use of estrogen after menopause in non-hysterectomized women.
Patient education on the significance of irregular PV bleeding in
perimenopausal and postmenopausal period.
Screening of high risk women.
18. Endometrial carcinoma continued..
2. Curative treatment
Surgery: Mainstay of treatment for endometrial carcinoma.
Stage I:
Total abdominal hysterectomy (extrafascial) with bilateral salpingo-
oophorectomy.
Vaginal hysterectomy (in patients with uterovaginal prolapse or extreme
obesity).
Laparoscopic hysterectomy with bilateral salpingo-oophorectomy and lymph
node sampling (common iliac, external iliac, internal iliac, obturator and
para-aortic).
Stage II:
Radical hysterectomy with bilateral salpingo-oophorectomy with pelvic and
para-aortic lymphadenectomy.
Combined radiation and surgery.
19. Endometrial carcinoma continued..
Radiotherapy: Used in women who are unfit for surgery, with significant medical
comorbidities, surgically inoperable disease.
The type of radiotherapy used depends on the staging on the disease.
Combination therapy (Radiotherapy and surgery) has a high degree of success.
Radiotherapy 4-6 weeks postoperatively reduces local recurrence, but does
not improve survival.
Brachytherapy for local disease (vaginal vault radiotherapy).
Brachytherapy combined with external beam radiotherapy for locally
advanced disease (stage III).
Chemotherapy: Used in advanced and recurrent cases or in metastatic lesions.
Combination chemotherapy is commonly used.
Drugs include Adriamycin, cisplatin, carboplatin, paclitaxel and
cyclophosphamide.
20. Endometrial carcinoma continued..
Hormone treatment: Used in women not fit for surgery, or those who prefer to
spare fertility.
Progestogens such as 17-hydroxyprogesterone caproate (1g/week, IM),
medroxyprogesterone acetate (1g/week, IM or 150 mg/day PO) or megesterol
acetate (160 mg/day PO). Taken for 3 consecutive months, if responsive,
therapy is continued for longer duration with reduced doses.
Follow-up of patients
Every 4 months for the first 2 years, then every 6 months for the next 2 years
and thereafter, yearly follow-up.
Follow-up includes evaluation of symptoms, clinical examination and chest X-
ray (annually).
21. Endometrial carcinoma continued..
Prognosis
Overall 5 year survival is 80%.
Poor prognostic features include advanced age, grade 3 tumours, type 2
histology, deep myometrial invasion, lymphoreticular space invasion, nodal
involvement and distant metastases.
Stage 5-year survival (%)
I 88
II 75
III 55
IV 16
22. References
Kenny, L.C., Myers, J.E. (2016). Gynaecology by Ten Teachers. 20th Ed, CRC Press,
NW.
Dutta, D.C. (2020). DC Dutta’s Textbook of GYNECOLOGY. 8th Ed, The Health
Sciences Publisher, New Delhi.
