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Graves' disease (GD) is the most common cause of hyperthyroidism in iodine-sufficient areas. It is important to distinguish GD from other causes of hyperthyroidism for optimal management. Thyroid stimulating hormone receptor antibody (TRAb) test is a commonly used test for this purpose. However, the sensitivity for this test in routine clinical practice may be affected by various factors leading to fallacies in diagnosis. Materials and Methods: A retrospective study was performed to assess the utility of an automated electrochemiluminescence TRAb immunoassay (Roche) in differentiating GD from non-Graves' disease (NGD) in routine clinical practice. Results: In 227 subjects, 146 had GD and 81 had NGD. Total T3, Total T4, Free T4, and TRAb were significantly higher in people with GD in comparison to NGD. The area under the receiver operating characteristics (ROC) curve for the assay was 0.96 (95% CI: 0.926 to 0.984, P < 0.0001). The optimal threshold for the test derived from the ROC was 3.37 IU/L, which is more than the cut-off of 1.75 IU/L suggested by the manufacturer. The sensitivity/specificity of TRAb in the diagnosis of GD at presentation was 98.4%/62.9% at 1.75 IU/L and 91.2%/90.12% at 3.37 IU/L, respectively. Conclusion: The TRAb test is a sensitive test to differentiate between subjects with GD and NGD presenting with hyperthyroidism. However, the cutoff (1.75 IU/L) as per the kit manufacturer may lead to a lower specificity for diagnosis. A modified cut-off of 3.37 IU/L should be considered for optimizing the diagnostic efficacy of the test. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic caused by the novel coronavirus (SARS-CoV-2) has caused significant morbidity and mortality across the globe. It has resulted in compromised care for patients with chronic diseases. Thyroid diseases are highly prevalent in the world, both in iodine-deficient and -sufficient areas. Viruses can cause thyroid diseases by the direct invasion of the gland, by triggering immune mechanisms, and by the effects of antiviral drugs on the gland. Although there is no signal of a pathogenic mechanism of thyroid diseases by SARS-CoV-2 to date, the high prevalence of thyroid diseases in people affected by this pandemic makes it prudent to study the association between these diseases and to formulate a management plan in the resource-limited setting. In this brief review, we have tried to discuss the relationship between the virus and diseases of the thyroid gland and the management challenges in patients with hypothyroidism, hyperthyroidism, Graves' orbitopathy, and thyroid nodules including cancer. We have also tried to incorporate the advantages and limitations of telemedicine for thyroid disease in the era of a pandemic. [ABSTRACT FROM AUTHOR]

Carbon fiber reinforced plastic (CFRP), widely used in aircraft structures is susceptible to accidental low velocity impacts during manufacture or while in service. The damage due to impact, though small initially, can progress due to fatigue loading to cause final fracture. In this study, the CFRP laminates subjected to three different energy levels of low velocity impact were tested under constant amplitude and aircraft fatigue spectrum loading conditions till it reached the failure state. The infrared thermography NDT technique was used to understand the damage distribution across the specimen after fatigue loading of impacted specimens. The cooling response curve of specimens was obtained by the active thermography technique for different experimental conditions, namely, heat transfer by the transmission or reflection mode and impacted or un-impacted surface facing camera. The cooling response obtained when the impact damage as well as heating was on the rear surface provided a good correlation with the damage volume quantified through X-ray CT image processing. The temperature rise observed by passive thermography technique at the fiber/ply breakage during static residual strength tests was found to be proportional to the load drop and extent of pre-existing damage. [ABSTRACT FROM AUTHOR]

Modern constitutional power is organized to secure ever-expanding state control over vast swathes of social and cultural life. Though religion is classically thought to be a domain of human experience that is to be left independent of state power, it is in fact deeply structured by contemporary government. Against this background, this paper examines the manner in which the Indian constitutional state exercises its power over religion and religious practices. It does so by arguing that the epistemic forms through which control is exercised over Indian religious practices operate to misunderstand, distort and flatten out local conceptions of religion, spirituality and ethical striving. That is, by following classic decisions on the bounds of religious freedom as decided by the Indian Supreme Court, it is argued that religion understood primarily as traditions of continued inter-generational practice are transformed in judicial description as practices founded in an imagined doctrinal foundation. This judicial transformation of religion is presented as being counter-intuitive to the nature of religious experience of almost all religious traditions in the Indian sub-continent. And in turn, this is presented as a challenge to secure the allegiance and consent of the Indian people to the ever-widening reach of state power over religion in contemporary India. [ABSTRACT FROM AUTHOR]

Red blood cells (RBC) are anucleated atypical cellular architecture with a plasma membrane envelope where the glycoproteins are oriented along the lipid bilayer. RBC proteins are classified as peripheral and integral proteins based on its location along plasma membrane. The present study explored the extraction efficiency of various detergents such as Triton X100, Sodium dodecyl sulphate (SDS), Cetypyridinium chloride (CPC), alone and its combinations along with protease inhibitor cocktail for RBC membrane proteins analyzed in an elctrophoretogram. The study showed that RBC protein extraction was much better in combination of Triton X100 and SDS as evident by increased number of protein bands in coomassie brilliant blue R stained SDS gel, compared to CPC combined Triton X100 lysis buffer. The study hence showed that RBC proteins can be extracted with combination of non-ionic detergent and anionic detergent. [ABSTRACT FROM AUTHOR]

This paper describes a new approach that uses a small-scale rig, high-speed optical diagnostics, and the Krylov-based dynamic mode decomposition data analysis technique to elucidate the mechanisms that drive tangential combustion instabilities in full-scale combustors, e.g., liquid rocket engines. The developed rig uses a single injector to supply gaseous reactants whose mean flow direction is perpendicular to the excited, transverse, acoustic oscillations with frequencies equivalent to those encountered in full-scale engines. The strongly coupled fluid mechanics, combustion dynamics, and acoustic oscillations were studied using synchronized, high-speed (10 kHz) particle image velocimetry; OH-planar laser induced fluorescence; CH* chemiluminescence; and dynamic pressure measurements. Each dataset was analyzed with the dynamic mode decomposition method to determine the approximate, complex frequencies and mode shapes of the system's least-stable modes. The results of this analysis suggest that the fluid dynamics are heavily influenced by shear layer instabilities and helical vortices, signs of which appear in multiple modes with a similar convective velocity. From the fluorescence data, a 168 Hz mode identified near the observed combustion instability frequency suggests a linkage between the transverse acoustic oscillations and the oscillations of the vortex breakdown bubble. This study also suggested that a better description of the driving mechanism might be obtained in the future by simultaneously analyzing all the measured datasets by the dynamic mode decomposition. [ABSTRACT FROM AUTHOR]

[Display omitted] • Pd/HY catalyst (Si/Al 2.5-30) prepared and assessed for hydroalkylation reaction. • Pd/HY5 (Si/Al ∼ 2.5) demonstrated the highest activity and selectivity for CHB. • Kinetic model has been developed for the hydroalkylation of benzene on Pd/HY5. • Ratio of acid to exposed metal sites of Pd/HY are optimized to maximize CHB yield. • Pd/HY5 offer excellent platform to develop cost effective hydroalkylation catalyst. Bifunctional Palladium (Pd) supported Y-zeolite, with SiO 2 /Al 2 O 3 ratios 5, 12, 30 and 60, prepared by impregnation method were used for hydroalkylation of benzene. It is found that the reaction condition and catalyst composition influence the hydroalkylation activity and cyclohexylbenzene (CHB) selectivity. CHB selectivity of a hydroalkylation catalyst can be determined by the destiny of the intermediate cyclohexene formed by partial hydrogenation of benzene on the metal site of the catalyst. That is, if the intermediate cyclohexene hydrogenates to cyclohexane on the metal site, the selectivity for CHB decreases whereas, if the intermediate cyclohexene is alkylated with benzene on the acid sites, the selectivity for CHB increases. Thus, there is a requirement of optimum balance of exposed metal and acid sites of the catalyst for enhancing CHB selectivity. At 42.2% of benzene conversion, Pd (0.2 wt%)/HY5 (SiO 2 /Al 2 O 3 = 5) catalyst gave a CHB selectivity of 75% in comparison to 70.3% for the best patented catalyst. Furthermore, a kinetic model has been developed for the hydroalkylation of benzene, assuming dissociative, non-competitive addition of hydrogen. Finally, the developed kinetic model along with experimental data was used to study the effect of mole ratio of acid sites to exposed metal sites of Pd/HY catalyst system for hydroalkylation reaction. Based on these results, the ratio of number of acid sites to exposed metal sites can be tuned to maximize CHB yield. [ABSTRACT FROM AUTHOR]

In clinical practice, every year approximately 150,000 children are referred with short stature (SS) based on a cut-off of fifth percentile. The most important endocrine and treatable cause of SS is growth hormone deficiency (GHD). The lack of reliable data on the prevalence of GHD in India limits estimation of the magnitude of this problem. The diagnosis and treatment of GHD are hurdled with various challenges, restricting the availability of growth hormone (GH) therapy to only a very limited segment of the children in India. This review will firstly summarize the gaps and challenges in diagnosis and treatment of GHD based on literature analysis. Subsequently, it presents suggestions from the members at advisory board meetings to overcome these challenges. The advisory board suggested that early initiation of the therapy could better the chances of achieving final adult height within the normal range for the population. Education and awareness about growth disorders among parents, regular training for physicians, and more emphasis on using the Indian growth charts for growth monitoring would help improve the diagnosis and treatment of children with GHD. Availability of an easy-to-use therapy delivery system could also be beneficial in improving adherence and achieving satisfactory outcomes. [ABSTRACT FROM AUTHOR]

She recalls, whatever she can, the 25 months of in-patient treatment including psychotropic drugs, electroconvulsive therapy, cold blanket treatments (if you may call it a treatment), and seclusion. Marsha Linehan's memoir came out in January 2020 and seems to be the first nontechnical book from the "developer of dialectical behavior therapy (DBT)" as the book officially describes her. [Extracted from the article]

A detailed reaction network has been constructed for ethanol dehydration in H-ZSM-5 using periodic density functional theory (DFT) calculations with dispersion corrections. Apart from the direct conversion of ethanol to diethyl ether or ethene, where novel mechanisms have been explored, the decomposition of diethyl ether to ethene has also been investigated. Thermodynamic and kinetic parameters were computed using statistical thermodynamics for all elementary steps. By coupling this microkinetic model to a plug-flow reactor model, macroscopic predictions of conversion and selectivity have been obtained at different operating conditions. The results of these simulations have been validated for H-ZSM-5 at different temperatures where experimental data are available. Both theory and experiment show an increase in ethene selectivity with increasing temperature and the experimental conversion agrees very well with the theoretical one. A reaction path analysis for ethanol dehydration in H-ZSM-5 shows that at temperatures above 500 K ethene is mainly produced via the direct dehydration of ethanol, while at temperatures lower than 500 K the reaction path via diethyl ether contributes significantly to ethene formation. [ABSTRACT FROM AUTHOR]

Influence of dealumination of zeolite ZSM-22 (Si/Al ratio of 45) by treating it with oxalic acid on its catalytic performance in n-hexadecane hydroisomerization reaction was studied. This reaction is an attempt in the direction of green and sustainable source of diesel via improving the cold-flow properties of deoxygenated vegetable oils. Pt (0.5 wt%) on ZSM-22 treated with 1 M oxalic acid afforded highest yields of the mono-branched paraffins. This improved is attributed to selective removal of active sites on external surface of zeolite crystals (responsible for undesired cracking reactions) using the bulkier dealuminating agent, oxalic acid. Thus, pore-mouth key-lock mechanism was brought to play the role to cause high selectivity to mono-branched isomers. Preferential external site deactivation was inferred from mesitylene cracking results. Effects of operating parameters such as temperature, and space velocity on product distribution also were studied. Also, kinetics of the reactions involved too has been in brief reported. [ABSTRACT FROM AUTHOR]

BACKGROUND: Thoracoscopic oesophageal mobilisation during a minimally invasive oesophagectomy (MIE) is most commonly performed with the patient placed in the lateral decubitus position (LDP). The prone position (PP) for thoracoscopic oesophageal mobilisation has been proposed as an alternative. MATERIALS AND METHODS: This was a retrospective, comparative study designed to compare early outcomes following a minimally invasive thoracolaparoscopic oesophagectomy for oesophageal cancer in LDP and in PP. RESULTS: During the study period, between January 2011 and February 2014, 104 patients underwent an oesophagectomy for cancer. Of these, 42 were open procedures (transhiatal and transthoracic oesophagectomy) and 62 were minimally invasive. The study group included patients who underwent thoracolaparoscopic oesophagectomy in LDP (n = 23) and in PP (n = 25). The median age of the study population was 55 (24-71) years, and there were 25 males. Twentyone (21) patients had tumours in the middle third of the oesophagus, 24 in the lower third, and 3 arising from the gastro-oesophageal junction. The most common histology was squamous cell cancer (85.4%). The median duration of surgery was similar in the two groups; however, the estimated median intraoperative blood loss was less in the PP group [200 (50-400) mL vs 300 (100-600) mL; P = 0.01)]. In the post-operative period, 26.1% patients in the LDP group and 8% in the PP group (8%) developed respiratory complications. The incidence of other post-operative complications, including cervical oesophagogastric anastomosis, hoarseness of voice and chylothorax, was not different in the two groups. The T stage of the tumour was similar in the two groups, with the majority (37) having T3 disease. A mean of 8 lymph nodes (range 2-33) were retrieved in the LDP group, and 17.5 (range 5-41) lymph nodes were retrieved in the PP group (P = 0.0004). The number of patients with node-positive disease was also higher in the PP group (19 vs 10, P = 0.037). CONCLUSION: MIE in the PP is an effective alternative to LDP. The exposure obtained is excellent even without the need for a complete lung collapse, thereby obviating the need for a doublelumen endotracheal tube. A more meticulous dissection can be performed resulting in a higher lymph nodal yield. [ABSTRACT FROM AUTHOR]

The treatment of type 2 diabetes is a challenging problem. Most subjects with type 2 diabetes have progression of beta cell failure necessitating the addition of multiple antidiabetic agents and eventually use of insulin. Intensification of insulin leads to weight gain and increased risk of hypoglycemia. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of antihyperglycemic agents which act by blocking the SGLT2 in the proximal tubule of the kidney. They have potential benefits in terms of weight loss and reduction of blood pressure in addition to improvements in glycemic control. Further, one of the SGLT2 inhibitors, empagliflozin has proven benefits in reducing adverse cardiovascular (CV) outcomes in a CV outcome trial. Adding SGLT2 inhibitors to insulin in subjects with type 2 diabetes produced favorable effects on glycemic control without the weight gain and hypoglycemic risks associated with insulin therapy. The general risks of increased genital mycotic infections, urinary tract infections, volume, and osmosis-related adverse effects in these subjects were similar to the pooled data of individual SGLT2 inhibitors. There are subsets of subjects with type 2 diabetes who may have insulin deficiency, beta cell autoimmunity, or is prone to diabetic ketoacidosis. In these subjects, SGLT2 inhibitors should be used with caution to prevent the rare risks of ketoacidosis. [ABSTRACT FROM AUTHOR]

Dispersion corrected periodic density functional theory (DFT) is used to construct a microkinetic model for 1-butanol dehydration in H-ZSM-5. The latter is applied to determine the effect of reaction conditions on dehydration rates, product selectivity and dominant reaction pathway. The consecutive reaction scheme of 1-butanol dehydration to ether followed by ether decomposition offers lower energy barriers as compared to the direct conversion of 1-butanol to 1-butene. The direct dehydration of 1-butanol to 1-butene occurs via an E2 (anti) elimination at low 1-butanol partial pressure and shifts to a 1-butanol assisted 1,2-syn-elimination with increasing 1-butanol partial pressure. The ether formation reaction proceeds via an SN2-type nucleophilic substitution mechanism, involving substitution of the –OH 2 group of the protonated alcohol by 1-butanol, while ether decomposition predominantly occurs via a 1,2-syn-elimination mechanism. The effect of reaction conditions viz. reaction temperature, site time, 1-butanol and water partial pressure is studied. The reaction conditions govern the coverage of key surface species which in turn has a significant role in determining the dominant reaction mechanism and product selectivity. Under industrially relevant conditions, the presence of water has no significant effect on 1-butanol conversion and product selectivity. A higher reaction temperature, higher site time and lower 1-butanol partial pressure favor a higher 1-butene selectivity. [ABSTRACT FROM AUTHOR]

Graves' disease is the most common cause of hyperthyroidism in children. Most children and adolescents are treated with anti-thyroid drugs as the initial modality. Studies have used Methimazole, Carbimazole and Propylthiouracil (PTU) either as titration regimes or as block and replacement regimes. The various studies of anti-thyroid drug (ATD) treatment of Graves' disease in pediatric patients differ in terms of the regimes, remission rate, duration of therapy for adequate remission, follow up and adverse effects of ATD. Various studies show that lower thyroid hormone levels, prolonged duration of treatment, lower levels of TSH receptor antibodies, smaller goiter and increased age of child predicted higher chance of remission after ATD. A variable number of patients experience minor and major adverse effects limiting initial and long term treatment with ATD. The adverse effects of various ATD seem to more in children compared to that of adults. In view of liver injury including hepatocellular failure need of liver transplantation associated with PTU, the use has been restricted in children. The rate of persistent remission with ATD following discontinuation is about 30%. Radioactive iodine therapy is gaining more acceptance in older children with Graves's disease in view of the limitations of ATD. For individual patients, risk-benefit ratio of ATD should be weighed against benefits of radioactive iodine therapy and patient preferences. [ABSTRACT FROM AUTHOR]

A rapid, selective and sensitive ultra-performance liquid chromatography method has been developed for the detection and quantification of tocopherols and retinol in human plasma. Alpha-tocopherol, gamma-tocopherol and retinol are assayed using fluorescence detection. Excitation/emission wavelengths are 295/330 nm and 325/470 nm for the analysis of both tocopherols and retinol, respectively. Retinol acetate is employed as the internal standard. The reversed-phase method incorporates gradient elution with a mobile phase consisting of methanol and acetonitrile. Separation of vitamin compounds is achieved using a bridged ethyl hybrid C18 column. The retention times for retinol, retinol acetate, gamma-tocopherol and alpha-tocopherol are 1.6, 1.8, 3.9 and 4.3 min, respectively. The limits of quantification for retinol, gamma-tocopherol and alpha-tocopherol were 0.02, 0.02 and 0.1 µg/mL, respectively. The assay method is suitable for the analysis of tocopherols and retinol in human plasma. The method may be applied following the ingestion of foods fortified with these fat-soluble vitamins. [ABSTRACT FROM PUBLISHER]

The article provides an overview of glycemic equipoise, highlighting the cardiovascular outcome of trial designs.

Complete agenesis of the dorsal pancreas (ADP) is an exceedingly rare congenital anomaly, compatible with life. The first case was reported in 1911 and so far around 100 cases have been reported in the world literature. Majority of the patients with this anomaly are asymptomatic or associated with abdominal pain, hyperglycemia, diabetes mellitus, and acute or chronic pancreatitis. We present a case report of a 34-year-old male with ADP, diagnosed incidentally during radiological evaluation for abdominal pain. Magnetic resonance cholangiopancreatography confirmed the absence of neck, body, and tail of the pancreas along with duct of Santorini and the minor duodenal papilla. Because of its rarity of occurrence, clinical awareness of the ADP can expand the differential diagnosis and improve patient management in pertinent light of the world literature. [ABSTRACT FROM AUTHOR]

Diabetes and Alzheimer disease (AD), two age related diseases, are on the rise across the globe. Recent studies have demonstrated diabetes as a major risk factor for AD. Disturbances in insulin signaling pathway appear to be the connecting link between the two illnesses. In the present study, we characterized a non-transgenic streptozotocin induced type 1 diabetic rat model and the effect of treatment with insulin. Five weeks of insulin deficient diabetes significantly reduced the insulin degrading enzyme activity and increased glycogen synthase kinase (GSK)-3a levels. Treatment with insulin resulted in suppression of GSK-3a levels, one of the major modulators of Aß synthesis. These findings strengthen intranasal insulin treatment as a therapeutic modality in reducing the AD-like features in the brain. [ABSTRACT FROM AUTHOR]

The storage capacity of an activated carbon bed is studied using a 2D transport model with constant inlet flow conditions. The predicted filling times and variation in bed pressure and temperature are in good agreement with experimental observations obtained using a 1.82 L prototype ANG storage cylinder. Storage efficiencies based on the maximum achievable V/V (volume of gas/volume of container) and filling times are used to quantify the performance of the charging process. For the high permeability beds used in the experiments, storage efficiencies are controlled by the rate of heat removal. Filling times, defined as the time at which the bed pressure reaches 3.5 MPa, range from 120 to 3.4 min for inlet flow rates of 1.0 L min–1and 30.0 L min–1, respectively. The corresponding storage efficiencies, ηs, vary from 90% to 76%, respectively. Simulations with L/Dratios ranging from 0.35 to 7.8 indicate that the storage efficiencies can be improved with an increase in the L/Dratios and/or with water cooled convection. Thus for an inlet flow rate of 30.0 L min–1, an ηsvalue of 90% can be obtained with water cooling for an L/Dratio of 7.8 and a filling time of a few minutes. In the absence of water cooling the ηsvalue reduces to 83% at the same L/Dratio. Our study suggests that with an appropriate choice of cylinder dimensions, solutions based on convective cooling during adsorptive storage are possible with some compromise in the storage capacity. [ABSTRACT FROM AUTHOR]

The author expresses his opinion on Empagliflozin being a glorified diuretic as well as having an optimized diuretic regime by presenting diuretic and anti-diuretic hypothesis studies.

Background: The association between pancreatic disease and primary hyperparathyroidism (PHPT) is controversial. We attempt to suggest a causal correlation and characterize the nature of pancreatic disease in PHPT. Methods: This study is a retrospective review of the medical records of patients who were diagnosed with PHPT and presented with pancreatic disease between 1 May 2000 and 30 May 2005 at Christian Medical College, Vellore. Results: During the period of 5 years, there were 1284 patients with pancreatic disease and 101 patients with PHPT admitted to our hospital, accounting for 0.42 and 0.03%, respectively, of the total hospital inpatient admissions of 302 883. Of them, 13 patients had both pancreatic disease and PHPT accounting for 1% of all admissions for pancreatic disease and 12% of admissions for PHPT. Patients admitted with PHPT have a 28-fold increased risk of developing pancreatitis compared with patients admitted without parathyroid disease. The ages of the patients ranged from 22 to 52 years with a median age of 37 years. There were 9 male and 4 female patients. The mean calcium values among patients with PHPT and pancreatic disease were significantly higher than patients with PHPT without pancreatic involvement. Conclusion: The data suggest a causal association between the pancreatic disease and PHPT. This may be correlated to the higher calcium values. Until more information is available, it would be prudent to check serum calcium in all patients presenting with unexplained pancreatic disease. [ABSTRACT FROM AUTHOR]

The authors comment on the use of triple fixed drug combinations (FDC) to support medication adherence among patients with type 2 diabetes. Topics covered include the various FDC involving two drugs that have been approved by the U.S. Food and Drug Administration (USFDA), innovations in FDC in diabetes in India, timing of administration of oral antidiabetic drug (OAD) FDC in relation to food and caution in the use of FDC.

Flavonoids play a significant role in mitigating the production of reactive oxygen species (ROS) and subsequent oxidative stress. In the present study we aimed to evaluate the cytoprotective and antioxidant defense mechanism of flavonoid fraction from Carica papaya L. (FFCP) leaf in human PBMC. For this investigation, the human PBMCs were lotted into three groups viz., negative control, positive control (treated with H 2 O 2), and experiment group (pretreated with FFCP and challenged with H 2 O 2). The cytoprotective mechanism was evaluated by assessing the intracellular ROS and Ca2+ mobilization, membrane and DNA damages, antioxidant enzymes, and Nrf2 activation. In-silico analysis was employed for assessing the interactions of flavonoids in FFCP with the Nrf2 binding pocket of Keap 1 protein. The results of the experiment unveiled that FFCP protected the human PBMCs from H 2 O 2 induced oxidative damages such as lipid peroxidation, LDH leakage, DNA breakage, reduced the intracellular ROS and Ca2+ mobilization as compared to positive control. FFCP pretreatment effectively improved the activity of key antioxidant enzyme markers, such as SOD (1.66 ± 0.032-fold increase), CAT (2.24 ± 0.09-fold increase), GPx (1.94 ± 0.05-fold increase), and GR (1.81 ± 0.14-fold increase). Furthermore, the FFCP modulated the Nrf2 gene expression (a 2.38 ± 0.25 -fold) and its translocation into the nucleus as compared to the positive control. In-silico analysis enunciated that all flavonoids exhibited strong affinity with the Nrf2 binding pocket of Keap1 protein via stable hydrogen bonding and hydrophobic interactions. These observations suggest that FFCP is a natural source of bioactive compounds with nutraceutical benefits for combating oxidative stress-associated diseases by protecting the cells from oxidative stress induced damages as well as by instigating antioxidant defense mechanisms. [Display omitted] • Flavonoid fraction of Carica papaya L. (FFCP) protected the human PBMCs from oxidative damages- Lipid peroxidation, LDH leakage and DNA damage. • FFCP pretreatment effectively reduced the intracellular calcium mobilization and ROS production induced by oxidative stress. • FFCP pretreatment enhanced the activity of key antioxidant enzymes under oxidative stress. • FFCP upregulated the expression and translocation of Nrf2 transcription factor into nucleus. • Flavonoids in FFCP exhibited good binding affinity with the Nrf2 binding pocket of Keap 1 • All flavonoids exhibited good ADME properties. [ABSTRACT FROM AUTHOR]

Pristine and Bi3+doped NiWO 4 nanoparticles are synthesized by direct chemical precipitation method. The structural and optical properties are investigated using various characterization techniques. Optical absorption studies confirm dual direct-indirect bandgap nature of pure and Bi3+ doped NiWO 4 nanoparticles. Doping with Bi3+ ion modifies the structural and optical parameters of NiWO 4 sample. These variations in parameters influence the luminescence and photocatalytic properties of NiWO 4 nanoparticles. The lowest doping concentration of Bi3+ leads to high PL emission and this property can be used in luminescence applications. The higher concentration of Bi3+ ions leads to the quenching of PL. The sample with the highest dopant concentration shows the lowest PL intensity and improved photocatalytic activity. Indirect chemical probe method reveals that OH. is the main active species involved in the photocatalytic decolouration of dyes. The degradation of dyes follows pseudo-first-order kinetics. Current work constitutes the first report on the effect of Bi3+ doping on the structural and optical properties, and photocatalytic activity of NiWO 4 nanoparticles. Image 1 • First report on the effect of Bi doping on the structural and optical properties of NiWO 4 nanoparticles. • Pure and Bi3+ doped NiWO 4 show direct-indirect bandgap nature. • Modifications of structural and optical properties of NiWO 4 depend on Bi3+ ion concentration. • Bi-doping can create NiWO 4 phosphors of high PL intensity for fabricating NUV light excited LEDs. • Photocatalytic activity of NiWO 4 can be enhanced by doping suitable concentration of Bi. [ABSTRACT FROM AUTHOR]

We studied the effect of cobalt doping on structural and optical properties of NiWO 4 nanoparticles. Different compositions of cobalt-doped NiWO 4 were synthesized using direct chemical precipitation method. X-ray diffraction patterns of Ni 1-x Co x WO 4 nanoparticles revealed variation in average crystallite size and micro-strain without any change in the standard crystal structure. Transmission electron microscopy studies showed a deviation of particles size and morphology of the samples with a change in dopant concentration. Raman and Fourier transformed infrared spectroscopy also confirmed the standard NiWO 4 profiles at different doping ratios. UV-VIS-NIR spectroscopy gave the information related to the bandgap tuning with the change in dopant concentration. It is also confirmed dual direct-indirect nature of bandgap in Ni 1-x Co x WO 4 nanoparticles. Photoluminescence emission spectroscopic studies displayed variation in emission spectra and colour with cobalt doping. Image 1 • Ni 1-x Co x WO 4 nanoparticles are prepared by a simple, eco-friendly chemical precipitation route. • First report for the investigation of structural and optical properties of Ni 1-x Co x WO 4. • The results of the optical studies confirmed the direct-indirect band gap nature of Ni 1-x Co x WO 4. • Ni 1-x Co x WO 4 phosphor can be suitable for lighting applications. [ABSTRACT FROM AUTHOR]

This article discusses the perceptions, attitudes, and barriers to effective obesity care among people with obesity (PwO) and healthcare professionals (HCPs) in India. The study found that the majority of PwO and HCPs recognized obesity as a disease, but many PwO assumed self-responsibility for weight loss. Lack of exercise and unhealthy eating habits were identified as major barriers to weight loss. The study also highlighted the importance of initiating weight management discussions and addressing weight stigma. The authors suggest the need for a multidisciplinary approach and increasing awareness about obesity. [Extracted from the article]

A letter to the editor is presented in response to the article related to relapsing myelopathy as the initial manifestation of primary central nervous system angiitis.

The article presents the case of a 21-year-old man who exhibited an increased frequency of intermittent tonic spasms, as well as an history of fever and extensive cutaneous lesions in the body, scalp and nails. Key issues discussed include background information on the patient and the diagnosis of his condition as moderate mental retardation with sebopsoriasis, dysmorphic face and tonic convulsions.

• Regulation of NMDA receptor GluN2B-Ser1303 phosphorylation studied in vivo. • Activation of L-type voltage gated calcium channel and NMDA receptor both cause increase in phospho-GluN2B-Ser1303. • Effects of both NMDA receptor and L-type voltage gated calcium channel are mediated through CaM kinases. • Phospho-GluN2B-Ser1303 is under dynamic regulation by phosphatases and kinases. Calcium influx through N-methyl-D-aspartate receptors (NMDAR) and voltage-gated calcium channels (VGCC) play major roles in postsynaptic signaling mechanisms. NMDAR subunit GluN2B is phosphorylated at Ser1303. Phosphorylation at this site is a prominent event in cell culture systems as well as in vivo. However, the functional significance of phosphorylation at this site is not completely understood. In this study, we compared the effect of calcium signaling through NMDAR and VGCC on the phosphorylation status of GluN2B-Ser1303 in the rat in vivo. VGCC was activated by intraperitoneal (IP) injection of the activator, BayK8644 and NMDAR was activated by intracerebroventricular (ICV) injection of NMDA in separate experimental groups. We found that the level of phospho-GluN2B-Ser1303 in the cortex and in the hippocampus increased in response to activation of either channel. The effects could be prevented by prior ICV administration of the specific blockers of these channels such as MK-801 for NMDAR and nifedipine for VGCC. The effect was also blocked by pretreatment with ICV administration of KN-93 indicating that it is mediated through CaM kinase. Both during NMDAR activation and VGCC activation, cell survival associated signals such as phospho-AKT and phospho-CREB showed decrease, consistent with activation of cell death pathways during these treatments. We conclude that under in vivo conditions, calcium influx through either NMDAR or VGCC activates CaM kinase, which in turn phosphorylates GluN2B-Ser1303. [ABSTRACT FROM AUTHOR]

Background: COPD is a complex respiratory disorder with high morbidity and mortality rates. Even with the current conventional diagnostic methods, including circulating inflammatory biomarkers, underdiagnosis rates in COPD remain as high as 70%. Our study was a comparative cross-sectional study that aimed to address the diagnostic challenges by identifying future biomarker candidates in COPD variants. Methods: This study used a label-free plasma proteomics approach that combined mass spectrometric data with bioinformatics to shed light on the functional roles of differentially expressed proteins in the COPD lung microenvironment. The predictive capacity of the screened proteins was assessed using Receiver Operating Characteristic (ROC) curves, with Western blot analysis validating protein expression patterns in an independent cohort. Results: Our study identified three DEPs—reticulocalbin-1, sideroflexin-4, and liprinα-3 that consistently exhibited altered expression in COPD exacerbation. ROC analysis indicated strong predictive potential, with AUC values of 0.908, 0.715, and 0.856 for RCN1, SFXN4, and LIPα-3, respectively. Validation through Western blot analysis confirmed their expression patterns in an independent validation cohort. Conclusions: Our study discovered a novel duo of proteins reticulocalbin-1, and sideroflexin-4 that showed potential as valuable future biomarkers for the diagnosis and clinical management of COPD exacerbations. [ABSTRACT FROM AUTHOR]

Background: COPD is a complex respiratory disorder with high morbidity and mortality rates. Even with the current conventional diagnostic methods, including circulating inflammatory biomarkers, underdiagnosis rates in COPD remain as high as 70%. Our study was a comparative cross-sectional study that aimed to address the diagnostic challenges by identifying future biomarker candidates in COPD variants. Methods: This study used a label-free plasma proteomics approach that combined mass spectrometric data with bioinformatics to shed light on the functional roles of differentially expressed proteins in the COPD lung microenvironment. The predictive capacity of the screened proteins was assessed using Receiver Operating Characteristic (ROC) curves, with Western blot analysis validating protein expression patterns in an independent cohort. Results: Our study identified three DEPs—reticulocalbin-1, sideroflexin-4, and liprinα-3 that consistently exhibited altered expression in COPD exacerbation. ROC analysis indicated strong predictive potential, with AUC values of 0.908, 0.715, and 0.856 for RCN1, SFXN4, and LIPα-3, respectively. Validation through Western blot analysis confirmed their expression patterns in an independent validation cohort. Conclusions: Our study discovered a novel duo of proteins reticulocalbin-1, and sideroflexin-4 that showed potential as valuable future biomarkers for the diagnosis and clinical management of COPD exacerbations. [ABSTRACT FROM AUTHOR]

Bochdalek hernia is the most frequent congenital diaphragmatic hernia which occurs due to a defect in the posterior attachment of the diaphragm when there is a failure of closure of the pleuroperitoneal membrane in utero. It rarely presents for the first time in adults. We report one such case of a 23-year-old male patient who presented with an acute abdomen. Chest X-ray showed air under diaphragm and he was taken up for an emergency laparotomy. Intraoperatively an organoaxial volvulus of the stomach was found in a bochdaleks hernia with a focal gangrene of the stomach fundus with perforation and peritonitis. However, there was no breach of pleural cavity. A sleeve resection of the gangrenous portion of the stomach was performed and the diaphragmatic defect was repaired. Patient made an uneventful postoperative recovery. Gastric gangrene with perforation as a manifestation of the adult bochdalek hernia is indeed rare. A concomitant pneumothorax occurs along with this condition which requires an intercostal drainage tube prior to the laparotomy. We report this case for its unique presentation without pneumothorax. [ABSTRACT FROM AUTHOR]

The authors reflect on the possible use of bariatric surgery in treating endocrine disorders. They note that studies revealed that bariatric surgery is cost effective in patients with high obesity related health costs like diabetes. They cite the increase of bariatric procedures performed in the U.S. from 13,365 in 1998 to nearly 150,000 in 2007.

A letter to the editor is presented which discusses the case of 16-year-old boy with mania and was diagnosed with moyamoya disease.

Introduction: The second diabetes attitudes wishes and needs (DAWN2) study is a multinational observational study, which took place in 17 countries including India, and aimed to provide a holistic assessment of diabetes care and management among people with diabetes (PWD), family members (FM), and healthcare professionals (HCPs). It explored potential drivers leading to active management of diabetes and assessed barriers to the same. Hypoglycemia is an inevitable complication and barrier to tight glycemic control in patients with diabetes. Objectives: This abstract describes the frequency and type of hypoglycemic episodes among PWD, and concerns regarding hypoglycemia among PWD, FM and HCP, in the Indian cohort of DAWN2. Materials and Methods: DAWN used a cross-sectional study design to collect different aspects of diabetes care. Information about hypoglycemia in DAWN2 study was analyzed from randomly chosen Indian subjects, and collected by questionnaires from face to face interviews with PWD, HCP and FM. Descriptive statistics were used to report the data. Results: All qualified PWD were analyzed according to these subgroups: (T1 [type 1 diabetes]: n = 78; T2 non-med [type 2 diabetes not on medication]: n = 100; T2 non-insulin med [type 2 diabetes on medications other than insulin]: n = 170 and T2 insulin med [type 2 diabetes on insulin with or without medication]: n = 152) were included in the analysis. Among persons with T1 diabetes, 41 % reported self-treated episodes of hypoglycemia in a frequency of less than 1 per month compared, to 49% with T2 diabetes on insulin. 29% people with T1 diabetes reported similar self-treated episodes several types per month (or once a week) compared to 17% in T2 diabetes on insulin. The mean frequency of severe hypoglycemia in last 12 months among these PWD was as follows: T1 diabetes: 2.2, T2 non-med: 2.6, T2 non-insulin med: 2.4 and T2 insulin med: 3.2. Roughly one-quarter of T1 PWD (26%) and one-third of T2 insulin med PWD (32%) reported that they could often or always tell by their symptoms that their blood sugar is low. About one-quarter of FMs (22-26%) reported that the person they live with had low blood sugar symptoms at least once a week or several times a month. FMs insulin med indicated that the person they live with has had on average 2.3 severe low blood sugar episodes in the past 12 months. One-third of FMs insulin med (32%) were also able to often or always recognize by the symptoms that the person they live with is having a low blood sugar episode. More than one-quarter of FMs felt they have to help with low blood sugar events at least once a week or several times a month (27-28%) whereas, between 25% and 32% of FMs only feel that they are at the best somewhat confident of dealing with these type episodes. Conclusion: Around one-third of Indians with type 1 diabetes experienced self-reported episodes of hypoglycemia several times a month (or more than once a week). Only a third of FM of persons with diabetes could recognize symptoms of hypoglycemia. Only a third of FM of patients with diabetes felt they were only somewhat confident of dealing with hypoglycemic episodes. This highlights a major lacuna in existing insulin therapy, in diabetes education of both PWD and FM, in hypoglycemia awareness training, and in self-management of hypoglycemia in India. Necessary skills need to be imparted to all stake holders in diabetes care. [ABSTRACT FROM AUTHOR]

Crystalline phase pure ZSM-22 framework (bulk molar ratio ~45) has been synthesized and employed to investigate the effect of tailored Brønsted acidity on hydroisomerization of n -hexadecane. Typically, ZSM-22 framework Brønsted acidity is tailored with Group-II cations viz . Mg 2+ , Ba 2+ and Ca 2+ , by means of ion-exchange method. The physico-chemical characterization of the various samples have been performed using powder X-ray diffraction, nitrogen adsorption–desorption isotherm measurement at 77 K, inductively coupled plasma (ICP) and scanning electron microscopy (SEM) techniques. The framework acidity w.r.t. Brønsted level has been characterized and estimated using ammonia temperature programmed desorption (NH 3 -TPD) and Fourier transform infrared spectroscopy of Pyridine (Py-FTIR) as a function of temperature, respectively. Hydroisomerization of n -hexadecane is performed over Pt (~0.45 wt%)/M-H-ZSM-22 samples (in extrudate form) in an up-flow fixed bed reactor and the effect of process parameters namely temperature and WHSV have been investigated. Based on the obtained results, Pt/Ca-H-ZSM-22 framework with calcium exchange level of about 10% showed the optimum performance among all the prepared samples with maximum isomer selectivity, yield (85.8 and 77.8%, respectively) vis-à-vis Pt/H-ZSM-22 sample (79.3 and 70.5%, respectively) and more importantly branching index of 4 in favor of mono-branched isomers, at a conversion level of about 90% at 585 K. Among Group II cations, calcium exchange over ZSM-22 framework is found to be effective in enhancing selectivity in favor of mono-branched isomers. In view of this, the role of tailored acidity through Group II cation exchange for optimization of degree of branching during hydroisomerization of long chain n -paraffin is discussed. Furthermore, the relative maximization of mono-branched isomers using calcium exchange is expected to offer platform for development of hydroisomerization catalyst with minimum cetane loss. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) worldwide continues to increase, in particular in India. Early T2DM diagnosis followed by appropriate management will result in more cardiovascular event free life years. However, knowledge of the cardiovascular profile of newly diagnosed T2DM patients is still limited. The aim of this study was to understand the extent of cardiovascular disease (CVD) risk of newly diagnosed T2DM patients in India. Methods: A cross sectional observational study was conducted to evaluate clinical laboratory and socio-demographic parameters of 5,080 newly diagnosed T2DM patients (48.3 ± 12.8 years of age; 36.7% female). In addition, we determined their cardiovascular risk according to the guidelines of the Lipid Association of India (LAI) and the criteria of the QRISK3 score. Results: Of the newly T2DM diagnosed patients in India 2,007(39.5%) were classified as "High risk" and 3,073 (60.5%) were classified as "Very high risk" based on LAI criteria. On average, patients had 1.7 ± 0.9 major atherosclerotic cardiovascular disease (ASCVD) risk factors. Low HDL-C value was the most frequent major risk (2,823; 55.6%) followed by high age (2,502; 49.3%), hypertension (2,141; 42.1%), smoking/tobacco use (1,078; 21.2%) and chronic kidney disease stage 3b or higher (568; 11.2%). In addition, 4,192 (82.5%) patients appeared to have at least one cholesterol abnormality and, if the latest LAI recommendations are applied, 96.5% (4,902) presented with lipid values above recommended targets. Based on the QRISK3 calculation Indian diabetes patients had an average CVD risk of 15.3 ± 12.3%, (12.2 ± 10.1 vs. 17.1 ± 13.5 [p<0.001] for females and males, respectively). Conclusions: Newly diagnosed Indian T2DM patients are at high ASCVD risk. Our data therefore support the notion that further extension of nationwide ASCVD risk identification programs and prevention strategies to reduce the occurrence of cardiovascular diseases are warranted. [ABSTRACT FROM AUTHOR]

Abstract: Objective: : To assess if oxidative injury in intrauterine growth retarded and healthy newborns is affected by the mode of delivery and whether Apgar score as a marker of neonatal survival is dependent on lipid and protein oxidative injury assessed by measuring malondialdehyde and protein carbonylation. Methods: : 30 IUGR newborns, 15 born by normal vaginal delivery and 15 born by elective caesarean section, and 40 healthy control infants, 30 born by normal vaginal delivery and 10 born by elective caesarean section, were studied at birth. Cord blood was collected for determination of malondialdehyde and protein carbonylation. Results: : IUGR newborns had significantly elevated MDA and protein carbonylation than the control group. Apgar scores, both at 1 and 5 min, were significantly lower in the IUGR group. These were assessed by independent sample t test. Using one-way ANOVA we found that MDA and protein carbonyls levels were not statistically different in healthy control group and in IUGR subgroup born by caesarean section however they were significantly different in other groups. Linear regression analysis revealed that Apgar scores both at 1 min and 5 min were dependent on MDA in IUGR newborns. Apgar score was however not dependent on protein carbonylation in the same group. Conclusion: : Apgar score in IUGR newborns is dependent on the extent of oxidative injury and elective caesarean section minimises the same. [Copyright &y& Elsevier]

Background: Synacthen stimulated salivary cortisol has been previously evaluated and found beneficial in the diagnosis of adrenal insufficiency (AI), especially in situations with altered cortisol‐binding protein (CBG) levels. Unfortunately, Synacthen is not marketed in many parts of the world whereas porcine sequence corticotrophin (Acton Prolongatum) is readily available. This study aimed to find the diagnostic accuracy of Acton prolongatum stimulated salivary cortisol test (APSST) compared to the short synacthen test (SST). Methods: Consecutive outpatients with suspected AI underwent SST initially, followed by APSST after 3 days. For APSST, saliva was collected at 0, 60 and 120 minutes after administering 30 units Acton Prolongatum intramuscularly. Serum and salivary cortisol were estimated using electrochemiluminescence assay. (Cobas e 411, Elecsys Cortisol II kits) Results: Sixty‐seven patients with clinically suspected AI were enrolled for the study. Based on SST, 35 patients were classified as having AI [primary AI (n=19) and secondary AI (n=16)] whereas 32 had normal glucocorticoid reserve. The area under receiver operator curve of 0.99 and 0.98 was observed for salivary cortisol values at 60 and 120 minutes, respectively, for APSST. A cut‐off value of 18.5 nmol/L (0.67 µg/dL) and 29.3 nmol/L (1.06 µg/dL) at 60 and 120 minutes, respectively, had a sensitivity as well as specificity of 93%‐100% in diagnosing AI. Conclusion: Salivary cortisol estimation following stimulation using intramuscular porcine ACTH (Adrenocorticotrophic hormone) (30 units) is an economical and accurate alternative to SST in the diagnosis of AI, m and its level of 30 nmol/L or more at 2 hours confirms adrenal sufficiency. [ABSTRACT FROM AUTHOR]

Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec, which provides long-lasting basal insulin coverage, and insulin aspart, which targets postprandial glycaemia. This review provides expert opinion on the practical clinical use of IDegAsp, including: dose timings relative to meals, when and how to intensify treatment from once-daily (OD) to twice-daily (BID) dose adjustments, and use in special populations (including hospitalized patients). IDegAsp could be considered as one among the choices for initiating insulin treatment, preferential to starting on basal insulin alone, particularly for people with severe hyperglycaemia and/or when postprandial hyperglycaemia is a major concern. The recommended starting dose of IDegAsp is 10 units with the most carbohydrate-rich meal(s), followed by individualized dose adjustments. Insulin doses should be titrated once weekly in two-unit steps, guided by individualized fasting plasma glucose targets and based on patient goals, preferences and hypoglycaemia risk. Options for intensification from IDegAsp OD are discussed, which should be guided by HbA1c, prandial glucose levels, meal patterns and patient preferences. Recommendations for switching to IDegAsp from basal insulin, premixed insulins OD/BID, and basal-plus/ basal--bolus regimens are discussed. IDegAsp can be co-administered with other antihyperglycaemic drugs; however, sulphonylureas frequently need to be discontinued or the dose reduced, and the IDegAsp dose may need to be decreased when sodiumglucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists are added. Considerations around the initiation or continuation of IDegAsp in hospitalized individuals are discussed, as well as in those undergoing medical procedures. [ABSTRACT FROM AUTHOR]

The article discusses various reports in the issue, including an article that describes an economical, one-step strategy to diagnose gestational diabetes mellitus (GDM), a study where GDM was diagnosed using as basis two abnormal values applying the International Association of Diabetes and Pregnancy Study Groups (IADPSG) standards, and an article on the criteria of care in the screening and diagnosis of GDM.

Nickel tungstate/tin phthalocyanine nanocomposite samples are synthesized by the solvent evaporation method. The modification of structural and optical properties of NiWO 4 by the formation of NiWO 4 /SnPc composites is studied using X-ray diffraction, transmission electron microscopy, Fourier transform infrared spectroscopy, UV–visible and photoluminescence spectroscopy. The improvement of photocatalytic property of NiWO 4 by the formation of nanocomposite is also investigated using Rhodamine blue as a model pollutant. The present work constitutes the first report of the synthesis and characterization of NiWO 4 /SnPc nanocomposites. Image 106465 • NiWO 4 /SnPc nanocomposite is synthesized by solvent evaporation method. • Structural and optical properties of NiWO 4 is modified in NiWO 4 /SnPc nanocomposite. • Tuning of bandgap of pure NiWO 4 sample by varying concentration of SnPc in the NiWO 4 /SnPc nanocomposite. • Improved luminescence property for the nanocomposite. • Enhanced photocatalytic activity of the nanocomposite. [ABSTRACT FROM AUTHOR]

To evaluate the viability of the use of butanol as a green chemical key molecule, the effects of temperature and site time on the transformation of the three butanol isomers, 1-butanol, 2-butanol and iso -butanol, towards butenes over H-ZSM-5 have been studied in search of the most promising isomer. Under dehydration conditions, 2-butanol is by far the most active and intermediate ether formation is only observed for 1-butanol. On the other hand, only isobutanol allows the direct formation of isobutene, the most valuable of the butene isomers. Hence, it is especially interesting to further stimulate the biomass derived isobutanol production, e.g. via genetic modification of appropriate microorganisms, in order to allow thereafter the formation of green drop-in isobutene upon dehydration with H-ZSM-5 in existing refineries. Due to the large potential of isobutanol, a reaction path analysis via ab-initio based microkinetic simulations is conducted for this molecule. Comparing these results with simulations on 1-butanol indicates that the shift is occurring due to a shift of the dominant reaction pathway towards the direct dehydration via anti elimination. A Gibbs free energy analysis shows that the large distortion of the transition state for isobutanol etherification renders this path far less favorable, resulting in the lack of formation of the di-alkyl ether, whilst the increased degree of substitution of the alkyl chain in isobutanol is found to promote the direct dehydration path, leading to an increase of the overall activity of isobutanol as compared to 1-butanol. [ABSTRACT FROM AUTHOR]