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ng, sleep quality, and mental alertness in the study population. The experimental group population displayed good tolerability to the test product and it was reported as safe and beneficial by the study participants.  Conclusion The study outcomes suggest that Ashwagandha root extract was efficient in improving the QoL, sleep quality, and mental alertness as self-assessed by the elderly participants. The recommended dose used in this study could be effective for the elderly population. Copyright © 2020, Kelgane et al.Synchronous cancers are multiple cancers that develop within six months of the initial diagnosis while metachronous cancers are those that develop more than six months after the initial diagnosis. A combination of three cancers is seen with several patients, which leads to a bad prognosis, and that of synchronous cancers is worse than that of metachronous cancers. Herein, we describe the case of a 62-year-old woman with multiple metachronous head and neck cancers. Copyright © 2020, I Awad et al.Three-dimensional (3D) printing has revolutionized medical training and patient care. Clinically it is used for patient-specific anatomical modeling with respect to surgical procedures. 3D printing is heavily implemented for simulation to provide a useful tool for anatomical knowledge and surgical techniques. Fused deposition modeling (FDM) is a commonly utilized method of 3D printing anatomical models due to its cost-effectiveness. A potential disadvantage of FDM 3D printing complex anatomical shapes is the limitations of the modeling system in providing accurate representations of multifaceted ultrastructure, such as the facets of the lumbar spine. In order to utilize FDM 3D printing methods in an efficient manner, the pre-printing G-code assembly must be oriented according to the anatomical nature of the print. This article describes the approach that our institution's 3D printing laboratory has used to manipulate models' printing angles in regard to the print bed and nozzle, according to anatomical properties, thus creating quality and cost-effective anatomical spine models for education and procedural simulation. Copyright © 2020, Damon et al.A 52-year-old woman presented with orbital cellulitis and sixth cranial nerve palsy as a result of striking the tail of a stingray while swimming. Her ophthalmologic and neurologic examination showed injury of the conjunctiva, corneal abrasion without mention of foreign body, contusion of the eyelid, and isolated lateral gaze palsy and ptosis in the right eye. Orbital magnetic resonance (MR) imaging and MR venography showed orbital cellulitis, superior and lateral rectus edema, and thrombosis of the superior ophthalmic vein on the right eye. She was treated appropriately, and her physical examination showed significant improvement within three months. Copyright © 2020, Ozunal et al.Introduction Parenting style plays a major role in child development by influencing cognitive, social-emotional development, academic performance, and behavioral problems. These characteristics are fairly stable right into adulthood. The influence of risk factors in children on the parenting style of mothers and fathers has not been studied in developing countries. Aims and methods The aim of this study is to determine the parenting style of mothers and fathers of children (3-12 years) born with and without high risk and to analyze the influence of this on parenting style. This is an analytical, cross-sectional, comparative study. Sixty-four out of 90 parents of children who have been newborn intensive care unit (NICU) graduates, with moderate to severe risk factors at birth as per the National Neonatology Forum guidelines of India, and 73 parents of children without risk factors at birth were enrolled. A parenting style and dimension questionnaire was used. The commonest parenting style in mothers and fathers and a correlation between parenting style and risk factors in children at birth were identified. Results Baseline characteristics were comparable between the high-risk and non-high-risk groups. Eighty percent of mothers and 70% of fathers followed the authoritative parenting style. There was no significant correlation between risk factors and gender, family type or socioeconomic status and the parenting style. Lack of follow-through was the only factor that was significantly present in fathers of children born without risk factors. Conclusion Authoritative was the most common parenting style, with no significant difference between parenting in the high-risk and non-high-risk groups. Adopting the appropriate parenting style will optimize developmental outcomes. Further studies are required to look at the influence of proactive positive parenting practices. Copyright © 2020, Rangarajan et al.Active learning improves self-reported engagement and satisfaction in medical education. Audience response systems are one mechanism of encouraging participation, especially in a setting in which learners in varying educational levels are present. Three fellowships participated in this educational quality improvement project where Poll Everywhere® was incorporated into didactics. Attendees were invited to complete a 4-question retrospective pre-post satisfaction survey. Incorporation of the Poll Everywhere® audience response system resulted in a shift in more favorable satisfaction scores and self-perceived attentiveness compared to the pre-intervention responses. Copyright © 2020, Castillo et al.Aim In our study, we aimed to evaluate the duration and rate of the union of adult humerus diaphysis fractures treated with a functional brace. Methods Forty-six adult patients admitted to our hospital with humeral diaphyseal fracture between January 2010 and April 2014 and treated with a functional brace were evaluated retrospectively. The demographic data, fracture type, level of fracture, and presence of bone union of the patients were evaluated from clinic records. The Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire score of the patients was registered for patients and analyzed, and its correlation with parameters such as patient age and fracture bone union time was evaluated. Results It was observed that of the patients with the mean age of 45.5 years, six (13.6%) had non-union and five had delayed bone union (10.86%). Three (6.5%) patients had radial nerve injury, and all recovered without sequelae. Out of the patients with the bone union, 12 (30%) had an angulation above give degrees, and 3 (7.5%) had radiological shortness. The mean Quick-DASH score was 6.7, and there was no statistically significant correlation with parameters such as fracture type, level, angulation, radiological shortness and radial nerve involvement (p>0.05). Conclusions A functional brace is a good treatment choice with low complication rates and has satisfactory bone union rates in humerus diaphyseal fractures. Copyright © 2020, Basa et al.Background Medical training relies on direct observations and formative feedback. After residency graduation, opportunities to receive feedback on clinical teaching diminish. Although feedback through learner evaluations is common, these evaluations can be untimely, non-specific, and potentially biased. On the other hand, peer feedback in a small group setting or lecture format has been shown to be beneficial to teaching behaviors, however, little is known if peer observation using a standardized tool followed by feedback results in improved teaching behaviors. Therefore, the objective of this study was to examine if feedback after peer observation results in improved inpatient teaching behaviors. Methods This study was conducted at a tertiary care hospital. Academic hospitalists in the Division of Hospital Medicine developed a standardized 28-item peer observation tool based on the Stanford Faculty Development Program to observe their peers during bedside teaching rounds and provide timely feedback after obs (88%). Mean scores in teaching behavior domains ranged from 2.1 to 2.7. In unadjusted and adjusted analysis, each teaching observation was followed by higher scores in learning climate (adjusted improvement = 0.09; 95% CI = 0.02-0.15; p = 0.007) and promotion of understanding and retention (adjusted improvement = 0.09; 95% CI = 0.02-0.17; p = 0.01). The standardized observation tool had Cronbach's alpha of 0.81 showing high internal validity. Conclusions Peer observation of bedside teaching followed by feedback using a standardized tool is feasible and results in measured improvements in desirable teaching behaviors. The success of this approach resulted in the expansion of peer observation to other Divisions within the Department of Internal Medicine at our Institution. Copyright © 2020, Pedram et al.Brucellosis is a multisystem zoonotic infection. Patients usually presents with fever and nonspecific systemic symptoms but may rarely present with clinical presentation of an acute abdomen. AZD9291 In this case report, we present a 32-year-old male who presented to the emergency department with symptoms of acute abdomen. Exploration revealed ileal perforation secondary to brucellosis, for which loop ileostomy was fashioned. Copyright © 2020, Noureen et al.Small cell carcinoma of the prostate (SCCP) is a rare malignancy that is considered a lethal entity of prostate cancer. Once it is diagnosed, patients characteristically experience an aggressive clinical course with poor overall survival rates, which unfortunately still holds even with modern treatments. In this report, we discuss the case of a 63-year-old African American male who initially presented to the hospital with an elevated prostate-specific antigen (PSA) level of 9.41 ng/mL and was found to have locally extensive SCCP. After one cycle of chemotherapy, the patient's symptoms worsened, and his disease continued to progress with an increased metastatic burden. In a matter of just a few months, the patient's disease progressed from a locally advanced entity to a diffusely metastatic one, showcasing the true aggressive nature of this disease. Through an extensive literature review, this case report also sheds further light on SCCP's histological characteristics, its apparent differences from adenocarcinoma of the prostate, and its aggressive nature even through treatment. Copyright © 2020, Bhandari et al.Neuroblastoma (NB) is the most common solid tumor seen in children under two years old. It has both solid and cystic forms. It generally involves the adrenal gland unilaterally. Only 10% of the NBs are as seen bilateral. Both bilateral and cystic forms of NB are a very rare entity. Magnetic resonance imaging (MRI) is a suitable imaging modality for evaluating lesions radiologically to avoid ionizing radiation exposure in children. Herein, we present the MRI findings of a bilateral cystic NB case. Copyright © 2020, Özgül et al.Mandibular canine often presents with only one root and one root canal in most of the cases. However, approximately 15% of the mandibular canines have two root canals and even less frequently two distinct roots. This article presents a case of root canal treatment in mandibular canine with two roots and two root canals. Meticulous cleaning and shaping followed by three-dimensional filling help in the successful treatment of such anatomical aberrations. Failure to do so may lead to post-treatment disease and further complications. Copyright © 2020, Bhaskar et al.