#Arjun Raina

[cinematic-explorations]

Arundhati Roy in “Which Annie Gives It Those Ones. Screenplay by Roy, which won a National Award for “Best Screenplay” in 1989. Shah Rukh Khan played a minor role in the film with four lines. The screenplay was written and acted in English. The movie was only broadcast once, at midnight, on Doordarshan. 

Source article written by Anupama Chopra, published Feb. 3, 2020.

(via Movies Ahead Of Their Time: In Which Annie Gives It Those Ones)

[shaadiwish]

These amazing Celebrity Weddings Of 2022 That Left Us Awestruck! For More Such Trends And Ideas, Stay Tuned With ShaadiWish.

[devanshxraina]

location: early rise gym closed for @arjunshekhawat

Devansh worked on his pull up reps glancing to the side where another familiar face happened to be working out. Dr. Shekhawat. The one who had apparently been his father's doctor in the last couple of months before he passed. Apparently this guy was everything Devansh's parents wanted him to be. He respected his parents, he went ahead and got a medical degree and overall just exceeded everyone's expectations. While Devansh pretty much squashed everyone's expectations with the life he'd chosen to lead. Her mother still raved about this man and apparently how he'd helped his father try to cut down on the typical oily Indian foods that had always been the older man's weakness. But for Devansh--he'd known Arjun when he was younger and so for him, it was pretty annoying to constantly hear his mother go on and on about how great he was.

"Something tells me that if my father was still alive, he'd also say you probably workout better than me too," Devansh commented after hopping down from the pull ups and moving to where the other man was. "I don't know if you remember me at all but uh we went to high school together, and I guess you've been my father's doctor in the past? Anil Raina?"

[edu-information]

Shah Rukh Khan Dances to Tesher’s ‘Young Shah Rukh’, Priyanka Chopra-Nick Jonas Groove to ‘Sapnein Mei’. Watch Now!

The wedding of Anant Ambani and Radhika Merchant became the talk of the town last week, with its star-studded affair captivating audiences worldwide. Even though the celebrations have concluded, glimpses of the extravagant festivities continue to surface online, offering a peek into the glamour and grandeur that defined the event.

Social media influencer Orry, known for his close ties with the Ambani family and frequent interactions with Bollywood celebrities, recently shared an exclusive vlog from the Ambani baraat on his YouTube channel. This 13-minute video captures some of the most memorable moments that weren't seen elsewhere.

From Karan Johar, Varun Dhawan, and Madhuri Dixit showcasing their dance moves to Ananya Panday, Sara Ali Khan, Shanaya Kapoor, Manushi Chhillar, Janhvi Kapoor, Arjun Kapoor, Vedang Raina, Atlee, Khushi Kapoor, Kriti Sanon, and many other stars gracing the occasion, the video is a star-studded affair in itself. It features spontaneous performances, including an impromptu stage moment with Ranveer, Arjun, and Varun joining Yo Yo Honey Singh for a lively mini-concert during the baraat.

The highlight of the vlog includes Priyanka Chopra and Nick Jonas charming everyone with their dance routines to popular Bollywood hits like “Sapne Mein Milti Hai,” “Chikni Chameli,” and “Mujhse Shaadi Karogi.” Nita Ambani, the groom's mother, also captivates the audience with her dance alongside Sara Ali Khan to “London Thumakda.” The arrival of global icon Kim Kardashian adds to the glamour, as she mingles with other esteemed guests.

Moreover, the festivities featured electrifying mini-concerts by Rema, Luis Fonsi, Tesher, and AP Dhillon, with Salman Khan visibly enjoying AP Dhillon’s performance. Notably, Shah Rukh Khan took to the stage, grooving to Tesher’s “Young Shah Rukh,” creating a memorable moment. The entertainment continued with performances by Mika and Daler Mehndi, who were joined by the groom himself.

Adding to the star-studded affair, American stylist Law Roach was also spotted, dancing exuberantly with the baraat members. The entire celebration was a testament to opulence and festivity, culminating in the union of Anant Ambani and Radhika Merchant in Mumbai on July 12.

As the vlog continues to circulate, it serves as a delightful reminder of the extravagant and joyous moments shared during this spectacular wedding celebration.

[ld-sportz-15]

Video Viral: Dhoni-Raina को देख Arjun Tendulkar ने झुकाया सिर | #CskNews

[advpulse]

Royal Enfield’s popular adventurer gets a performance boost and full carbon fiber treatment. Follow the link for details!

[smvdu]

SMVDU Mechanical Engineering Students Visited Baglihar Hydro Electric Power Project

 As part of imparting industrial exposure to students of Mechanical Engineering, Shri Mata Vaishno Devi University (SMVDU) a one day industrial visit was organized with active support of Prof. M. Eswaramurthy, Head, School of Mechanical Engineering (SME) and Mr. BK Bhatia, Training and Placement Officer, SMVDU to Baglihar Hydro Electric Power Project, Chanderkote Ramban for students of 3rd and 4th year Mechanical Engineering.  The event was coordinated by the faculty members of SME, SMVDU, namely Dr. Balbir Singh, Dr. Ankush Raina, Dr. Mir Irfan Ul Haq, and Dr. Amit Kumar Sinha also accompanied the students. The students were briefed about the various technical, economic and maintenance aspects of the Baglihar Project. The students interacted with various technical officials in various units of the project. Also a question answer session was held at the end of the visit. A discussion was also held to carry out interships, joint projects with JKPDC for imparting better industrial exposure to students inline with NEP2020. Throughout the session, the students were guided and briefed by Er. Mitten Raina and Er. Arjun Khajuria. The coordinator thanked the officers of JKPDC, TPO and the administration of SMVDU for making this event a success.     

[bananatags]

All new movies 2016 in hindi

Gippy Grewal, Karishma Kotak, Rishaan DuttaĪishwarya Rai, Randeep Hooda, Richa Chadha Sharman Joshi, Meera Chopra, Vishal KarwalĮmraan Hashmi, Nargis Fakhri, Prachi Desai, Gautam Gulati, Kunaal Roy Kapur, Lara Dutta, Karanvir SharmaĪrunoday Singh, Mahie Gill, Anchal Dwivedi, Pallavi Joshi, Anupam KherĪrvind Swamy, Himanshu Sharma, Ekavali Khanna Manoj Bajpayee, Jimmy Sheirgill, Divya Dutta, Kitu Gidwani, Prosenjit Chatterjee, Sachin Khedekar, Nikita Thukral, Vishal Singh, Parambrata Chatterjee Sunny Leone, Tanuj Virwani, Nyra Banerjee Jimmy Shergill, Aashi Rawal, Sharvil Patel, Mann Patel, Ugam Khetani, Stuti Dwivedi, Deah Tandon, Hardil Kanaba Nadiadwala Grandson Entertainment, UTV Motion Pictures Tiger Shroff, Shraddha Kapoor, Sudheer Babu, Sunil Grover Vir Das, Boman Irani, Ram Kapoor, Neha Dhupia, Lisa Haydon Randeep Hooda, Akshay Oberoi, Rajneesh Duggal, Piaa Bajpai Swara Bhaskar, Ratna Pathak, Pankaj Tripathi, Sanjay Suri Shah Rukh Khan, Waluscha de Sousa, Sayani Gupta, Shriya Pilgaonkar Naseeruddin Shah, Vipin Sharma, Vinay ForrtĪlok Chaturvedi, Joydip Mukhopadhyay, Megh Pant, Priya Raina, Chandrahas Tiwari Patralekha, Tara Alisha Berry, Gaurav Arora Kareena Kapoor, Arjun Kapoor, Amitabh Bachchan, Jaya Bachchan John Abraham, Shruti Haasan, Nathalia Kaur Sidharth Malhotra, Alia Bhatt, Fawad Khan, Rishi Kapoor, Sukant Goel Gaurav Pandey, Ashish Tyagi, Neha Chaterji Zoya Rathore, Sapan Krishna, Vaidhei Singh, Megha Verma, Ravi Thakur, Milan Singh Himesh Reshammiya, Farah Karimi, Monica Dogra, Naseeruddin Shah, Shekhar Kapur Priyanka Chopra, Anuj Aggarwal, Prakash Jha, Rahul BhattĪbhimanyu Singh, Sandeepa Dhar, Ravi Kishan, Pankaj Tripathi, Sanjay Mishra, Akhilendra Mishra Vicky Kaushal, Sarah Jane Dias, Raghav Chanana Manish Paul, Sikander Kher, Pradhuman Singh, Sugandha Ram Raima Sen, Ashish Vidyarthi, Salim Diwan, Karuna Pandey, Vineet Kumar SinghĪnuj Sachdeva, Nidhi Subbaiah, Manit Joura Sonam Kapoor, Shabana Azmi, Shekhar Ravjiani Girish Kumar, Navneet Kaur Dhillon, Benaf Dadachandji, Yash Pandit Krishna Chaturvedi, Ruhi Singh, Javed Jaffrey, Lisa Ray Rajneesh Duggal, Nidhi Subbaiah, Arjun Bijlani Pulkit Samrat, Yami Gautam, Urvashi Rautela, Rishi Kapoor, Bharti Singh, Shreyas Pardiwalla Sunny Deol, Soha Ali Khan, Aanchal Munjal, Daina Khan, Shivam Patil, Rishabh Arora, Abhilash KumarĪditya Roy Kapoor, Katrina Kaif, Tabu, Ajay Devgn, Aditi Rao Hydari, Akshay Oberoi, Lara Dutta, Rahul Bhatt Mawra Hocane, Harshvardhan Rane, Anurag Sinha, Shraddha Das Tushar Kapoor, Vir Das, Sunny Leone, Shaad Randhawa, Riteish Deshmukh, Gizele Thakral, Bruna Abdullah Tushar Kapoor, Aftab Shivdasani, Mandana Karimi, Meghna Naidu, Darshan Jariwala, Krushna Abhishek, Claudia Ciesla, Riteish Deshmukh, Gizele Thakral, VJ Andy, Danny Saru Sugandha Garg, Siddhant Behl, Sadhana Singh, Anuritta K Jha, Samir Sharma Prince Shah, Shashank Singh, Mantra Mugdha, Kirti Adarkar, Bachchan Pachera, Shaneel SinhaĪkshay Kumar, Nimrat Kaur, Purab Kohli, Ferena Wazeir, Gunjan Malhotra Shabana Azmi, Juhi Chawla, Divya Dutta, Zarina Wahab, Jackie Shroff, Arya Babbar, Richa Chadha Sultan has grossed over ₹631.25 crore (US$83 million) worldwide, and is the 7th highest-grossing Indian film of all time.Īmitabh Bachchan, Farhan Akhtar, Aditi Rao Hydari, Manav Kaul, Neil Nitin Mukesh, John Abraham, Murali Sharma, Avtar Gill The highest-grossing Bollywood films released in 2016, by worldwide box office gross revenue, are as follows:ĭangal grossed over ₹2,209.3 crore (US$290 million) worldwide, and is currently the highest-grossing Indian film of all time.

[alwaysfirst]

National Games: Sajan Prakash wins gold medal in 200m butterfly swimming

Oct 06, 2022 10:20 IST Gandhinagar (Gujarat) , October 6 (AF): Sajan Prakash overcame an abdominal strain to win the gold medal in the men's 200m butterfly with a new meet record at the National Games 2022 in Gujarat on Wednesday. Olympian Sajan Prakash, representing Kerala, clocked 1:59.56 in the final to win the gold, beating his own National Games record set at the previous edition in Kerala. This is Sajan Prakash's second gold medal at the National Games 2022 after the men's 100m butterfly. Meanwhile, Hashika Ramachandra anchored the Karnataka 4x200m freestyle relay team to triumph to climb the podium at the Sardar Patel Aquatics Complex here for the fourth time in this edition but it was her incredible victory in the 200m butterfly final that set the venue alight. Ramachandra dug deep into the reserves of her energy to slip past Astha Choudhury and touch the wall in 2 minutes 19.12 seconds for her third National Games record, including one as part of the relay team, in four days. Hrutika Shriram stayed on course to repeat the golden hat-trick by winning the women's 10m platform event. Though she was self-admittedly not at her best, she did her dives well enough to pick up her second gold in three days and her 10th crown in four editions of the National Games. For a while, it looked like there would be a surprise gold for Gujarat in the swimming pool. Their gambit of fielding Aryan Nehra and Anshul Kothari in the first two legs of the 4x200m Freestyle worked well, giving rise to hopes in the hearts of the home fans. Karnataka's S Siva and Aneesh S Gowda, however, packed too much power in the next two to win by a comfortable margin. There was delight for Gujarat at the Riverfront Sports Development complex in Ahmedabad where rising Gujarat tennis player Zeel Desai helped the state retain the women's singles gold in defending champion Ankita Raina's absence. The third-seeded Zeel Desai led Karnataka's Sharmada Balu 6-2, 3-2 when the latter retired with an ankle injury. Tamil Nadu's Manish Sureshkumar also benefited from the physical discomfort and rib pain Maharashtra's Arjun Kadhe faced after winning the opening set. He could not maintain the same tempo after taking a medical time-out in the second set and Manish Sureshkumar pounced on the opportunity to win 2-6, 6-1, 6-3. Tamil Nadu's Sunayna Kuruvilla staged a dramatic comeback to win the women's singles gold. Urvashi Joshi of Maharashtra won the first two games 11-9 and 11-7 but Sunayna found her rhythm to turn the final on its head. She conceded just 13 points in winning three games to romp home the winner. The lawn bowls competition drew to a close at the Kensville Golf and Country Club near Ahmedabad with Assam's Sunil Bahadur beating Soumen Banerjee (Jharkhand) 16-9 in the men's singles final. Navneet Singh, Ayush Bharadwaj, Apurv Ashutosh Sharma and Abhishek Chug teamed up to beat West Bengal by the skin of their teeth, 15-14, in the Fours final. The Assam Pair of Tania Choudhary and Nayanmoni Saikia beat Lovely Choubey and Rupa Rani Tirkey of Jharkhand 17-10 while Manu Kumari Pal, Jaya and Pinki surprised Jharkhand's Sarita Tirkey, Anamika Lakra and Kavita Kumari 18-9 to win the Triples gold. (AF) Read the full article

[dare-g]

Dancing Othello (2002)

[stock-dehko]

Bhoot Police, Hungama 2, Mimi, Shiddat and Shaadistan to see direct premiere on Disney+ Hotstar : Bollywood News

Bhoot Police, Hungama 2, Mimi, Shiddat and Shaadistan to see direct premiere on Disney+ Hotstar : Bollywood News

Last year, the theatres were closed and makers of several projects resorted to the direct-to-digital premiere. Amid the second wave of COVID-19 in 2021, theatres are still closed in many states and makers are skeptical to push their films ahead. Instead, many have opted to premiere their films. Disney+ Hotstar premiered a slate of big films on its platform and is planning the same, this year as…

[wowhealthfitness20]

Bolly Buzz: Ayushmann Khurrana to star in Junglee Pictures' ‘Doctor G’; Arjun Rampal not given a clean chit by the NCB | Hindi Movie News

Bolly Buzz: Ayushmann Khurrana to star in Junglee Pictures’ ‘Doctor G’; Arjun Rampal not given a clean chit by the NCB | Hindi Movie News

From Hrithik Roshan’s ex-wife, Sussanne Khan booked after a raid on a nightclub in Mumbai to Ayushmann Khurrana signing Junglee Pictures‘ ‘Doctor G’, here are all the top headlines of the day. In our latest segment, Bolly Buzz, we bring you all the juicy gossips and news which grabbed everyone’s attention from the world of entertainment. In a raid conducted at a club in Andheri, the police…

[goalhofer]

2020 Olympics India Roster

Archery

Atanu Das (Ranchi)

Pravin Jadhav (Sarade)

Tarundeep Rai (Namchi)

Deepika Das (Ranchi)

Athletics

Rahul Rohila (Mumbai)

Sandeep Kumar (Mahendragarh)

I.T. Thodi (Malappuram)

Avinash Sable (Mandwa)

J.M. Pillyalil (Manjeri)

P.A.A. Jacob (Delhi)

Naganathan Pandi (Chennai)

JCO Soundararajan Rajiv (Lalgudi)

Sgt. Noah Tom (Chakkittapara)

Sman Muhammed Anas-Yahiya (Nilamel)

Rahul Rohilla (Haryana)

Gurpreet Singh (Patiala)

Alex Antony (Thiruvananthapuram)

Sarthak Bhambri (Delhi)

JCO Neeraj Chopra (Khandra)

Sgt. Shivpal Singh (Varanasi)

Tajinderpal Singh-Toor (Khosa Pando)

Neeraj Chopra (Khandra)

Shivpal Singh (Mumbai)

Murali Sreeshankar (Palakkad)

Priyanka Goswami (Uttar Pradesh)

Bhawna Jat (Kabra)

Kamalpreet Kaur (Mumbai)

Dutee Chand (Jajpur)

Subha Venkatesan (Thiruvembur)

Dhanalakshmi Sekar (Gundur)

Revathi Veeramani (Madurai)

Kamalpeet Kaur (Kabarwala)

Seema Punia-Antil (Khewda)

Annu Rani (Bahadurpur)

Boxing

JCO Amit Panghal (Mayna)

JCO Manish Kaushik (Bhiwani)

Vikas Yadav (Bhiwani)

Ashish Kumar (Dhahotu)

Maj. Satish Kumar (Ranikhet)

Lovlina Borgohain (Golaghat)

Pooja Rani-Boora (Nimriwali)

Mangte Kom (Kangathei)

Simranjit Kaur-Baatth (Chakar)

Equestrian

Fouaad Mirza (Bangalore)

Fencing

Chadalavada Devi (Chennai)

Gymnastics

Pranati Nayak (Jhargram)

Sailing

K.C. Ganapathy (Mumbai)

Varun Thakkar (Mumbai)

Vishnu Saravanan (Mumbai)

Nethra Kumanan (Vadapalani)

Shooting

Angad Singh-Bajwa (Chandigarh)

Saurabh Chaudhary (Kalina)

Mairaj Khan (Khurja)

Sgt. Deepak Kumar (Delhi)

Divyansh Singh-Panwar (Jaipur)

MCPO Sanjeev Rajput (Jagadhri)

Aishwary Singh-Tomar (Ratanpur)

Abhishek Verma (Panipat)

Manu Bhaker (Goria)

Yashaswini Deswal (New Delhi)

Apurvi Chandela (Jaipur)

Anjum Moudgil (Chandigarh)

Rahi Sarnobat (Kolhapur)

Tejaswini Sawant (Kolhapur)

Elavenil Valarivan (Cuddalore)

Table Tennis

Achanta Kamal (Chennai)

Sathiyan Gnanasekaran (Chennai)

Manika Batra (Delhi)

Sutirtha Mukherjee (Naihati)

Wrestling

Ravi Dahiya (Nahri)

Bajrang Punia (Jhajjar)

JCO Deepak Punia (Jhajjar)

Vinesh Phogat (Bhiwani)

Anshu Malik (Nidani)

Sonam Malik (Madina)

Seema Bisla (Rohtak)

Badminton

B. Sai Praneeth (Palakollu)

Satwiksairaj Rankireddy (Amalapuram)

Chirag Shetty (Mumbai)

P.V. Sindhu (Hyderabad)

Field Hockey

Dilpreet Singh (Butala)

Rupinder Singh (Faridkot)

Surender Kumar (Karnal)

Manpreet Singh-Sandhu (Jalandhar)

Hardik Singh (Khusropur)

Gurjant Singh (Amirstar)

Simranjeet Singh (Jalandhar)

Mandeep Singh (Jalandhar)

Harmanpreet Singh (Amritsar)

Lalit Upadhyay (Varanasi)

P.R. Sreejesh (Kizhakkambalam)

Sumit Sumit (Sonipat)

Shanglakpam Sharma (Imphal East)

Shamsher Singh (Attari)

Varun Kumar (Dalhousie)

Birendra Lakra (Lachchada)

Amit Rohidas (Saunamara)

Vivek Prasad (Itarsi)

Navjot Kaur (Kurukshetra)

Gurjit Kaur (Amritsar)

Deep Ekka (Lulkidhi)

Monika Malik (Haryana)

Sharmila Devi (Hisar)

Nikki Pradhan (Hesal)

Savita Punia (Jodkhan)

Nisha Warsi (Sonipat)

Vandana Katariya (Roshnabad)

Udita Duhan (Hisar)

Lalremsiami Hmar (Mizoram)

Navneet Kaur (Shahabad Markanda)

Sushila Chanu-Pukhrambam (Imphal)

Rani Rampal (Shahabad Markanda)

Salima Tete (Simdega)

Neha Goyal (Sonipat)

Golf

Anirban Lahiri (Palm Beach Gardens, Florida)

Udayan Mane (Bangalore)

Aditi Ashok (Bengaluru)

Diksha Dagar (Jhajjar)

Judo

Shushila Likmabam (Imphal)

Rowing

Arjun Lal (Nayabas)

Arvind Singh (Bulandshahr)

Swimming

Srihari Nataraj (Bangalore)

Sajan Prakash (Idukki)

Maana Patel (Ahmedabad)

Tennis

Sumit Nagal (Delhi)

Sania Mirza (Hyderabad)

Ankita Raina (Pune)

Weightlifting

Saikhom Chanu (Nongpok Kakching)

[rsbhati970]

IPL 2021 Team List And Complete Squads Of All The Teams

The IPL 2021 auction recently closed. The IPL 2021 schedule and date have not been determined. But according to some media reports, the IPL 2021 schedule will be released shortly after the end of the ongoing series of tests between India and Britain, which will end on March 8. 

Here is IPL Teams List and Complete Squad after auction-

1. Chennai Super Kings

MS Dhoni (c), Suresh Raina, Ravindra Jadeja, Dwayne Bravo, Sam Curran, Faf Du Plessis, Deepak Chahar, Josh Hazlewood, Ruturaj Gaikwad, Narayanan Jagadeesan, Lungi Ngidi, Shardul Thakur, Ambati Rayudu, R Sai Kishore, Mitchell Santner, Karn Sharma, Imran Tahir, KM Asif, Krishnappa Gowtham, Moeen Ali, Cheteshwar Pujara, Harishankar Reddy, Bhagath Verma, C Hari Nishanth.

2. Delhi Capitals

Shreyas Iyer (c), Rishabh Pant, Shikhar Dhawan, Prithvi Shaw, Ishant Sharma, Ravichandran Ashwin, Ajinkya Rahane, Axar Patel, Amit Mishra, Avesh Khan, Marcus Stoinis, Shimron Hetmyer, Kagiso Rabada, Anrich Nortje, Praveen Dubey, Lalit Yadav, Chris Woakes, Steve Smith, Umesh Yadav, Ripal Patel, Vishnu Vinod, Lukman Meriwala, M Siddharth, Tom Curran, Sam Billings.

3. Kolkata Knight Riders

Eoin Morgan (c), Dinesh Karthik, Nitish Rana, Shubman Gill, Rinku Singh, Rahul Tripathi, Kamlesh Nagarkoti, Kuldeep Yadav, Lockie Ferguson, Pat Cummins, Prasidh Krishna, Sandeep Warrier, Shivam Mavi, Varun Chakravarthy, Andre Russell, Tim Seifert, Sunil Narine Shakib Al Hasan, Sheldon Jackson, Harbhajan Singh, Vaibhav Arora, Karun Nair, Ben Cutting, Venkatesh Iyer, Pawan Negi.

4. Mumbai Indians

Rohit Sharma (c), Quinton De Kock, Suryakumar Yadav, Ishan Kishan, Chris Lynn, Amolpreet Singh, Saurabh Tiwary, Aditya Tare, Kieron Pollard, Hardik Pandya, Krunal Pandya, Anukul Roy, Jasprit Bumrah, Trent Boult, Rahul Chahar, Jayant Yadav, Dhawal Kulkarni, Mohsin Khan, Adam Milne, Nathan Coulter-Nile, Piyush Chawla, James Neesham, Yudhvir Singh, Marco Jansen, Arjun Tendulkar.

5. Punjab Kings

KL Rahul (c), Chris Gayle, Mayank Agarwal, Nicholas Pooran, Mandeep Singh, Sarfaraz Khan, Deepak Hooda, Prabhsimran Singh, Mohammed Shami, Chris Jordan, Darshan Nalkande, Ravi Bishnoi, Murugan Ashwin, Arshdeep Singh, Harpreet Brar, Ishan Porel, Jhye Richardson, Riley Meredith, Dawid Malan, Shahrukh Khan, Moises Henriques, Jalaj Saxena, Utkarsh Singh, Saurabh Kumar, Fabian Allen.

6. Rajasthan Royals

Sanju Samson, Ben Stokes, Jofra Archer, Jos Buttler, Riyan Parag, Shreyas Gopal, Rahul Tewatia, Mahipal Lomror, Kartik Tyagi, Andrew Tye, Jaydev Unadkat, Mayank Markande, Yashasvi Jaiswal, Anuj Rawat, David Miller, Manan Vohra Chris Morris, Shivam Dube, Mustafizur Rahman, Chetan Sakariya, KC Cariappa, Liam Livingstone, Kuldip Yadav, Akash Singh.

7. Royal Challengers Bangalore

Virat Kohli (c), AB De Villiers, Yuzvendra Chahal, Devdutt Padikkal, Navdeep Saini, Washington Sundar, Mohammed Siraj, Kane Richardson, Adam Zampa, Josh Philippe, Shahbaz Ahmed, Pavan Deshpande, Daniel Sams, Harshal Patel, Kyle Jamieson, Glenn Maxwell, Sachin Baby, Rajat Patidar, Daniel Christian, Mohammed Azharuddeen, Suyash Prabhudessai, KS Bharat.

8. SunRisers Hyderabad

David Warner (c), Kane Williamson, Manish Pandey, Priyam Garg, Virat Singh, Jonny Bairstow, Wriddhiman Saha, Shreevats Goswami, Abdul Samad, Abhishek Sharma, Vijay Shankar, Mohammad Nabi, Mitchell Marsh, Jason Holder, Rashid Khan, Bhuvneshwar Kumar, T Natarajan, Sandeep Sharma, Khaleel Ahmed, Siddharth Kaul, Basil Thampi, Shahbaz Nadeem, Kedar Jadhav, Mujeeb Ur Rahman, Jagadeesha Suchith.

[25000yearcycle]

Unmasking the Surgical Mask

Unmasking the Surgical Mask: Does It Really Work?   

by  Crystal  Phend,                    Senior Staff Writer, MedPage Today             October 5, 2009         

For a century, the surgical mask has been the symbol of a safe and sanitary medical environment. The problem: researchers don't really know if that's true.

With the H1N1 influenza pandemic spreading every day, experts are still debating what type of mask to wear and how much protection that mask truly provides, particularly for those at the front lines of transmission  --  healthcare workers.

Major health agencies, including the World Health Organization, the CDC, and others, have offered confusing and sometimes contradictory guidelines.

Moreover, those guidelines differ for healthcare workers and ordinary citizens worried about the spread of H1N1. Even among healthcare professionals, there are different guidelines for medical wards and operating rooms.

Still, most healthcare professionals have concluded that, at the very worst, a mask can't hurt, even if it may provide a false sense of safety.

The notion of covering the nose and mouth for infection control actually dates back more than a century to the period when German physician Carl Flügge discovered that exhaled droplets could transmit tuberculosis.

The modern surgical mask, successor to the crude gauze strips those early doctors and nurses employed, is still primarily designed to prevent the passage of relatively large particles, such as sputum droplets and hair.

A high tech version  --  the so-called N95 respirator  --  seals tightly around mouth and nose and is made of material certified to block 95% of particles 0.3 μm or larger in diameter, roughly the size of a single virus. There's something resembling agreement that, worn properly, these do their job.

Conflicting Guidelines

CDC recommends surgical masks as part of the overall arsenal deployed against seasonal flu, but along with the Institute of Medicine, CDC has recommended only N95 respirators for protection against H1N1  --  in part, because animal studies suggest airborne transmission of the virus via small particles.

Not so for the World Health Organization or the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, and the American College of Occupational and Environmental Medicine.

They collectively recommended regular surgical masks except in high risk circumstances, such as during open suctioning of airway secretions and other procedures that could "aerosolize" the H1N1 virus.

There's a good reason for this lack of consensus: a dearth of quality evidence in a scientific arena dominated by anecdote and laboratory experiment.

"Some of these practices that have been in place for decades haven't been subjected to the same strenuous investigation that, for instance, a new medicine might be subjected to," Mark Rupp, MD, president of the Society for Healthcare Epidemiology of America, told MedPage Today.

Masks, he noted, "are fairly innocuous, relatively cheap, and so people are not really very interested in going through the extensive investigation that would be required."

Conflicting Evidence

In the past two weeks, researchers have released results from the first two randomized clinical trials investigating efficacy of masks and respirators in protecting healthcare workers from respiratory infection.

Did they settle the issue?

Hardly. In fact, their conflicting results simply added fuel to the debate, according to CDC's Arjun Srinivasan, MD.

The first reports came in August, during IOM deliberations over standards for healthcare workers' personal protective equipment, when C. Raina MacIntyre, MBBS, PhD, of the University of New South Wales in Sydney, Australia, presented preliminary results of her randomized clinical trial.

That study involved nearly 2,000 emergency and respiratory ward nurses and physicians in Beijing who were cluster-randomized to wear surgical masks, fit-tested N95 respirators, or non-fit tested N95 respirators during all work hours for four consecutive weeks during the cold and flu season.

Having been through the SARS scare in 2003, the Chinese are regarded as very serious about mask use in the hospital and outside.

At the Interscience Conference on Antimicrobial Agents and Chemotherapy in September, MacIntyre presented the dramatic results: Consistent use of N95 respirators prevented 75% of respiratory infections, while consistent surgical mask use was no better than low use for prevention of clinical respiratory illness (6.7% versus 9.2%, P=0.159) or of influenza-like illness (0.6% versus 1.3%, P=0.336).

The case against old-fashioned surgical masks seemed clear.

"To me it would not seem justifiable to ask healthcare workers to wear surgical masks," MacIntyre said in an interview.

Then another shocker. A second head-to-head study appeared, this time in the Journal of the American Medical Association. It's conclusion: surgical masks were just as good as N95 respirators.

The 478 emergency department, medical unit, and pediatric nurses in this Canadian study who were randomized to use a surgical mask when providing care to patients with febrile respiratory illness during the flu season caught seasonal flu at about the same rate as those who wore fit-tested, N95 respirators (23.6% versus 22.9%, P=0.86).

For H1N1 influenza, surgical masks again met noninferiority criteria versus the N95 respirator (8.0% versus 11.9%, P=0.18).

Design may have accounted for the discrepancy between the trials, at least in part, suggested Srinivasan, who co-authored an editorial accompanying the JAMA study with an IOM committee member colleague.

"These types of studies are very difficult to do," he told MedPage Today.

The driving factor in effectiveness is how frequently and intensely the wearer is exposed to infection, he said. So one possibility is that masks may have been enough for Canadian nurses in generally lower risk settings, but not for the high-risk Chinese healthcare workers.

In Surgery: Masks Unmasked

Lack of evidence has also plagued surgical masks in their traditional setting, and where their use is still nearly universal: the operating room.

But not for lack of study.

In fact, three large, randomized controlled trials were conducted in the 1980s to determine once and for all if surgical masks actually did prevent surgical wound infection.

Here, where bacteria were the major concern in wound infection, the enemy targets were larger and might not require the fine filtration necessary to keep a respiratory virus away, researchers theorized.

But the trials "showed absolutely no efficacy" for that original purpose, MacIntyre noted.

"Really, the surgeon might as well wear nothing on their face," she said.

Still, the CDC recommends a mask in the operating room, citing long-standing tradition and the benefits of protecting nose and mouth from splashes of blood and other bodily fluids.

MacIntyre noted that a face shield is a better option against splashes because surgeons have to wear eye protection with a mask anyway.

But mask wearing "is so inculcated into the practice of medicine that it's going to be very hard to change," said John G. Bartlett, MD, former chief of infectious diseases at Johns Hopkins.

Tradition and aesthetics play a role in the issue. Patients would not accept a surgeon who doesn't wear a mask because they are so ingrained as a symbol of a safe surgical environment, Bartlett said.

And since the masks are fairly inexpensive and easy to wear, it hasn't been worth challenging the status quo, he declared.

Nor are there likely to be more studies to decide the issue one way or the other, added Rupp. "Those studies are difficult to do because the percentage of patients who develop a surgical site infection is very, very low. So the impact of wearing a surgical mask is difficult to demonstrate," he said.

Masks for the Masses

Unlike the operating room, where it would be impossible to stop people from wearing masks, there are few places outside the hospital where it hasn't been hard to persuade people to put them on.

One of the exceptions is Asia, which has developed has a strong culture of mask use, both in medical settings and in public venues, largely as a result of the SARS epidemic in 2003, Bartlett said.

"Those people did whatever they could to try to prevent SARS," he recalled. "If it turned out that the H1N1 virus became more virulent and started to be a really serious disease, then people would be much more fastidious about how they used the disease prevention tools."

The CDC recommends that people who are ill with suspected or confirmed H1N1 flu wear face masks when at home around family members, in healthcare settings, at school until they can be taken home, and when it's necessary for them to be out and about.

However, the only high-level evidence for efficacy of masks in the community was a trial from Hong Kong -- published online last month in the Annals of Internal Medicine  --  involving flu patients who were randomized to hand hygiene alone or in combination with surgical masks.

Compared with controls, employing hand hygiene alone or with face masks tended to reduce transmission of the flu to those living in the same house, but not significantly so.

However, when these interventions were initiated within 36 hours of symptom onset, face masks plus hand hygiene reduced risk of transmission by a very significant 67%.

Although the entire benefit can't be attributed to face masks, the results suggest masks may make a difference, MacIntyre said.

Because exposure to pathogens is typically much lower for the general public than for healthcare workers, "surgical masks may be enough in the community," she said.

Rupp agreed, saying he takes a "better safe than sorry" approach. His medical center asks patients with potentially droplet-mediated infections to put on a surgical mask.

"There probably isn't a whole lot of extensive study on the use of this in clinical situation," Rupp said. "We do think it's a pretty obvious way somebody can go about containing their secretions."

N95 masks would likely provide even more protection, MacIntyre said, but there's is fairly clear consensus that they would be intolerable for someone with a respiratory illness.

"They are relatively difficult to breath through; they can be associated also with feelings of claustrophobia and kind of a suffocating sensation," Rupp added. "It's difficult enough to get them to wear a loose fitting and relatively comfortable surgical mask."

Practical Masking

Practical issues such as compliance and supply have been part of the argument for use of surgical masks rather than N95 respirators in most clinical settings.

In a New England Journal of Medicine perspective piece last week, several IOM committee members acknowledged that N95 respirators are currently in short supply.

They suggested that healthcare institutions place priority on N95 respirators in the highest-risk areas, "such as enclosed spaces in the respiratory care unit, patients' rooms, and ambulances."

While the IOM was instructed to not take these issues into consideration in its guidelines, a CDC spokesperson said that agency is making them a large factor in revision of its interim guidelines for healthcare worker respiratory protection.

In the end, however, infectious disease specialists always come back to the bigger picture.

Debate over the role of respiratory protection in preventing influenza transmission doesn't "excuse anyone from failing to implement other measures that are known to protect patients and healthcare professionals from influenza," Srinivasan's JAMA editorial concluded.

"Masks and respirators should be considered the 'last line of defense' in a hierarchy of infection control measures."

Handwashing, good etiquette when sneezing and coughing, and staying home when sick are still the keys to preventing spread of infectious disease, it said.