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Introduction: Opioid use is an epidemic that plagues the United States. Patients frequently present to the emergency department (ED) after opioid toxicity, which can lead to respiratory failure, apnea, and death. Although there is an effective antidote, naloxone, the current guidelines surrounding postnaloxone administration monitoring are loosely defined. Case Report: We present a case in which an individual was administered naloxone after an intentional opioid overdose and was monitored for four hours, as is standard in our institution. He remained in the ED for additional workup following this observation period and subsequently experienced signs of severe respiratory depression, requiring bag-valve-mask ventilation, naloxone, and admission. Had he been discharged, as is typical after a four-hour observation period, the consequences could have been fatal. We present multiple theories as to why his opioid toxidrome may have presented in a delayed manner, including ingestion of fentanyl analogues and variability in metabolization of both opioids and naloxone. We also explore alternative overdose antidote products approved by the US Food and Drug Administration, which may impact post overdose care. Conclusion: This case suggests that the correct amount of time to monitor patients after naloxone administration may be longer than originally thought. Our aim in this article was to further the discussion regarding the most appropriate observation period in cases of opioid toxicity. [ABSTRACT FROM AUTHOR]

Background: Mouse double minute‐2 homolog (MDM2) plays a key role in downregulating p53 activity in hematologic malignancies, and its overexpression is associated with poor outcomes. Methods: This phase 1 study assessed the safety and efficacy of different dosing regimens of the MDM2 inhibitor milademetan as monotherapy and in combination with azacitidine (AZA) in patients with relapsed or refractory acute myeloid leukemia or high‐risk myelodysplastic syndromes. Results: Seventy‐four patients (monotherapy, n = 57; milademetan‐AZA combination, n = 17) were treated. The maximum tolerated dose of milademetan was 160 mg once daily given for the first 14–21 days of 28‐day cycles as monotherapy and on Days 5–14 in combination with AZA. Dose‐limiting toxicities were gastrointestinal, fatigue, or renal/electrolyte abnormalities. Treatment‐emergent adverse events related to milademetan occurred in 82.5% and 64.7% of participants in the monotherapy and AZA combination arms, respectively. Two participants (4.2%) in the monotherapy arm achieved complete remission (CR), and 1 (2.1%) achieved CR with incomplete blood count recovery (CRi). Two participants (13.3%) achieved CRi in the combination arm. New TP53 mutations, detected only during milademetan monotherapy, were found pre‐existing below standard detection frequency by droplet digital polymerase chain reaction. Interpretation: Milademetan was relatively well tolerated in this population; however, despite signals of activity, clinical efficacy was minimal. [ABSTRACT FROM AUTHOR]

During cellular senescence, persistent growth arrest and changes in protein expression programs are accompanied by a senescence-associated secretory phenotype (SASP). In this study, we detected the upregulation of the SASP-related protein dipeptidyl peptidase 4 (DDP4) in human primary lung cells rendered senescent by exposure to ionizing radiation. DPP4 is an exopeptidase that plays a crucial role in the cleavage of various proteins, resulting in the loss of N-terminal dipeptides and proinflammatory effects. Interestingly, our data revealed an association between severe coronavirus disease 2019 (COVID-19) and DDP4, namely that DPP4 levels increased in the plasma of patients with COVID-19 and were correlated with age and disease progression. Although we could not determine the direct effect of DDP4 on viral replication, mechanistic studies in cell culture revealed a negative impact on the expression of the tight junction protein zonula occludens-1 (ZO-1), which contributes to epithelial barrier function. Mass spectrometry analysis indicated that DPP4 overexpressing cells exhibited a decrease in ZO-1 and increased expression of pro-inflammatory cytokines and chemokines. By investigating the effect of DPP4 on the barrier function of human primary cells, we detected an increase in ZO-1 using DPP4 inhibitors. These results provide an important contribution to our understanding of DPP4 in the context of senescence, suggesting that DPP4 plays a major role as part of the SASP. Our results provide evidence that cellular senescence, a hallmark of aging, has an important impact on respiratory infections. [ABSTRACT FROM AUTHOR]

Case Presentation: An 8-month-old infant presented to a general emergency department with chief complaints of rhinorrhea, decreased activity, and fever. A point-of-care lung ultrasound (LUS) was performed at bedside with potential early findings of pneumonia. Based on these findings on LUS, a chest radiograph (CXR) was ordered and performed with no acute findings. He was discharged without antibiotics based on these findings; unfortunately, he returned two days later with worsening symptoms requiring chest tube placement, mechanical ventilation, and prolonged hospitalization for complicated bacterial pneumonia. Discussion: Pneumonia is a major cause of pediatric morbidity and mortality worldwide. Despite evidence supporting the utilization of LUS for the diagnosis of pediatric pneumonia, CXR remains the default imaging for clinical decision-making in most settings. In this case, earlier antibiotics and higher reliance on LUS for clinical decision-making may have prevented the morbidity associated with this hospitalization. [ABSTRACT FROM AUTHOR]

/Objective: The extent of exocrine pancreatic insufficiency (EPI) in the paediatric population with acute pancreatitis (AP) is unknown. The primary objective was to use a 6 h stable-isotope breath test to determine the prevalence of EPI in children with AP. The secondary objective was to determine the diagnostic ability of a 4 h abbreviated breath test in the detection of EPI. 13C-mixed triglyceride (MTG) breath test was used to measure fat digestibility in 12 children with AP and 12 normal children. EPI was diagnosed based on a cumulative dose percentage recovery (cPDR) cut-off value < 26.8% present in literature. To reduce the test burden, the diagnostic accuracy of an abbreviated 4 h test was evaluated, using a cPDR cut-off that was the 2.5th percentile of its distribution in control children. The cPDR of cases was significantly lower than that of controls (27.71 ± 7.88% vs 36.37 ± 4.70%, p = 0.005). The cPDR during acute illness was not significantly different to that at 1 month follow up (24.69 ± 6.83% vs 26.98 ± 11.10%, p = 0.52). The 4 h and 6 h breath test results correlated strongly (r = 0.93, p < 0.001) with each other. The new 4 h test had 87.5% sensitivity and 93.8% specificity for detecting EPI. Two-thirds (66.7%) of this sample of children with AP had EPI during admission, which persisted at 1 month follow up. The 4 h abbreviated 13C-MTG breath test has good diagnostic ability to detect EPI in children and may improve its clinical utility in this age group. [ABSTRACT FROM AUTHOR]

Keeping up with the global scenario, diabetes prevalence is on rise in India. Inadequate glycemic control is a major cause of diabetes-related morbidity and mortality. The conventional standards of care (SOC) in diabetes, including self-monitoring of blood glucose and measurement of glycated hemoglobin, have supported achievement of glycemic control, yet there are a few limitations. With the use of current technologies and metrics, such as continuous glucose monitoring (CGM) and standardized CGM data reporting, the continuous real-time glucose levels can be measured, and importantly, the percentage of time above, below, and within the target glucose range can be calculated, which facilitates patient-centric care, a current goal in diabetes management. International consensus recommendations endorse the incorporation of CGM and CGM data reporting in SOC for diabetes management. The guidelines provide time in range (TIR) thresholds for different patient populations and different types of diabetes. However, extrapolation of these global guidelines does not aptly cover the Indian population, which has diverse diet, culture, and religious practices. In this context, a consensus meeting was held in India in 2021 with experts in the field of diabetes care. The purpose of the meeting was to develop consensus recommendations for TIR thresholds for different patient profiles in India. Those expert recommendations, together with an evidence-based review, are reported here. The aim of this agreement is to aid clinicians across India to routinely use CGM and CGM data reports for optimizing individualized diabetes care, by implementing clinical targets for TIR. [ABSTRACT FROM AUTHOR]

A study was conducted to evaluate the growth performance of L.vannamei in various salinities with different Plant and Animal protein resources by replacing the Fishmeal in experimental diets. The experiment was conducted in triplicates by choosing the diets with Fishmeal as the control diet and the treatments by replacing the Fishmeal with alternative Plant protein resources, i.e., Cottonseed meal, Sunflower meal and Animal protein resource Acetus indicus meal, Mysid meal with crude protein levels of 25%, 30% and 35% in three replicates. Treatments were conducted in various salinities in 0 ppt, 5 ppt, 15 ppt and 25 ppt. Postlarvae of L. vannamei were stocked in aquarium tanks (60×30×40 cm) with an average size of 2.5 gr. for 63 days. Better growth performance was recorded significantly (<0.05) with Fishmeal as FCR 1.45, when fed with FM30 diet and followed by Mysid meal diet (CD = 0.246) at 25 ppt salinity with 1.5 FCR and SGR recorded as 1.8 with MM30. [ABSTRACT FROM AUTHOR]

Introduction: The HLH-2004 trial established the diagnostic criteria for hemophagocytic lymphohistiocytosis (HLH), a severe hyperinflammatory condition. It typically develops due to inappropriate macrophage activation. Our objective was to assess the spectrum of hemophagocytic syndrome presentations by identifying hemophagocytic activity in the bone marrow, and to unravel the etiopathogenesis of this condition. Material and methods: A retrospective study was carried out in the Department of Pathology in a tertiary care hospital reporting the clinical and laboratory findings of patients who had been previously diagnozed with hemophagocytosis in the bone marrow. The parameters in the diagnostic criteria of HLH of the same patients were documented and analyzed. Results: The characteristics of the 32 patients who presented with hemophagocytosis in the bone marrow were documented. Persistent fever was the most frequent presentation. Mild to moderate anemia (69%), severe leucopenia (59%), and mild to moderate thrombocytopenia (63%) were other frequent findings. The incidence of primary HLH was found to be only 3%; 87% had hyperferritinemia, 78% had bicytopenia, 59% had hypertriglyceridemia, and 53% had splenomegaly. Infections followed by malignancies were shown to be the most frequent cause of secondary HLH, while the prognosis for malignancy-associated HLH appeared to be poor. Conclusions: Based on the findings of this study, conclusions about the clinical symptoms and etiologies of HLH may be drawn, which will assist in early identification. Hence, all subjects with a clinical suspicion of HLH should be thoroughly investigated for a possible etiology. [ABSTRACT FROM AUTHOR]

In this paper, a novel all-metallic probe-fed antenna is proposed for L5, L1, and S bands for Navigation with Indian Constellation (NavIC) applications, and it can be used for tracking applications. The proposed antenna dimensions are 30mm x 80mm x 8mm (0.11λ x 0.31λ x 0:03λ) electrical size calculated at 1176.45MHz (L5). The radiating plane has a comb like structure where there are 8 slots which are of identical size 24mm x 1mm and a short slot with 6mm x 1 mm. The ground plane is 30mm offset with respect to the radiating plane (top plane). Usually, a high dielectric substrate antenna can resonate at lower frequencies keeping the size of the antenna electrically small, but without substrate the proposed antenna resonates at lower frequencies keeping the antenna size electrically small. The proposed design is electrically compact and economical, and the dielectric loss in the antenna is zero as the antenna is designed with copper alone, which gives a strong impression that a substrate free antenna can resonate at lower frequencies. So, from this method it can also make the antenna light weight. [ABSTRACT FROM AUTHOR]

An inequality due to T. J. Rivlin from 1960 states that if P(z) is a polynomial of degree n having no zeros in |z| < 1, then max |z|=r |P(z)| = (1 + r 2)n max |z|=1 |P(z)| for 0 = r = 1. In this paper, we prove some generalizations of the above Rivlin's inequality which sharpens Rivlin's inequality as a special case. Some important consequences of these results are also discussed and some related inequalities are obtained. [ABSTRACT FROM AUTHOR]

Naturally occurring bioactive molecules are known for their diverse biological applications such as antimicrobial, anticancer, anti-inflammatory, and analgesic activities. Also, some of the natural products act as medicinal drugs. Further, bioactive cell-permeable molecule embelin has been reported for its diverse biological activities such as antimalarial, anticancer, and anti-inflammatory in the literature. With the continuation of our research work on biologically active molecules, based on structural activity relationship and docking studies of embelin and its derivatives, we have reported target-specific anticancer and antimalarial activities of embelin and its analogs. Also, it has been reported in many recent research articles that embelin and its derivatives are known to possess medicinal properties. This review mainly highlights recent reports on broad-spectrum biological activities of the embelin and its analogs to date. [ABSTRACT FROM AUTHOR]

The multiorgan deleterious effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) are now well known. Although COVID-19 disease is a hypercoagulable state and thrombotic complications occur in about one-third of critically ill patients with COVID-19, thrombosis is not typically a presenting symptom. We report the case of a patient presented with the complaints of abdominal pain due to renal vein thrombosis as the first feature of the COVID-19. [ABSTRACT FROM AUTHOR]

In this paper, we prove the well-known Erdős–Lax inequality [4] in a sharpened form. As a consequence, another widely used inequality due to Ankeny and Rivlin [1] gets sharpened. These results may be useful in various applications that required the Erdős–Lax and the Ankeny–Rivlin inequalities. [ABSTRACT FROM AUTHOR]

In this paper, we discuss the necessary and sufficient conditions for a polynomial P(z) to have all its zeros inside the open unit disc. These results involve two associated polynomials namely, the derivative of the reciprocal polynomial of P(z) and the reciprocal of the derivative of P(z). We also derive some generalizations of the classical Theorem of Laguerre. [ABSTRACT FROM AUTHOR]

Subclinical hypothyroidism (SCH) is the most prevalent thyroid disorder in the Indian population. Since the last publication of the 2015 Indian Thyroid Society guideline on SCH, many significant clinical and scientific advances have occurred in the field. The aim of this guideline is to inform clinicians, researchers, and health policymakers about published evidence related to the diagnosis and management of SCH in adults. The specific clinical questions addressed in this consensus are based on the inputs from the task force of experts in the field of endocrinology and thyroid disease. The consensus statements are derived based on the latest published articles and evidence in SCH. A well-defined grading system has been followed for the critical appraisal of evidence and grading strength of recommendations. The guideline includes recommendations on the prevalence, causes, consequences, screening, diagnosis, and treatment of SCH. Other aspects detailed are the role of levothyroxine, its impact on the timing of treatment, and its benefits on various SCH consequences and populations. Therefore, these evidence-based recommendations are developed to inform clinical decision-making in the management of SCH in adults. While in some cases individualization of treatment is a necessity, these recommendations can provide standards of optimal care for patients with SCH. [ABSTRACT FROM AUTHOR]

For a polynomial p z of degree n , it follows from the maximum modulus theorem that max z = R ≥ 1 p z ≤ R n max z = 1 p z . It was shown by Ankeny and Rivlin that if p z ≠ 0 for z < 1 , then max z = R ≥ 1 p z ≤ R n + 1 / 2 max z = 1 p z . In 1998, Govil and Mohapatra extended the above two inequalities to rational functions, and in this paper, we study the refinements of these results of Govil and Mohapatra. [ABSTRACT FROM AUTHOR]

Thyroid disease is the second most common endocrine disorder encountered in pregnant women with substantial maternal and fetal implications. Therefore, assessing thyroid status during pregnancy is essential for initiating treatment in newly diagnosed individuals and adjusting doses for those already under treatment. To initiate proper and timely treatment evidence-based recommendations are required for clinical decision-making in managing thyroid disorders in pregnant and postpartum women. Keeping this in mind, task force consisted of experts in the fields of endocrinology and thyroid disease was constituted and various published data and guidelines were explored to address screening, diagnosis, and management of hypothyroidism, thyrotoxicosis, GD, thyroid nodules, and post-partum thyroiditis and their related complications during pregnancy. This document provides much-required insights and useful, practical, and accurate guidance that aids a practicing clinician. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has revealed a range of disease phenotypes in infected patients with asymptomatic, mild, or severe clinical outcomes, but the mechanisms that determine such variable outcomes remain unresolved. In this study, we identified immunodominant CD8 T-cell epitopes in the spike antigen using a novel TCR-binding algorithm. The predicted epitopes induced robust T-cell activation in unexposed donors demonstrating pre-existing CD4 and CD8 T-cell immunity to SARS-CoV-2 antigen. The T-cell reactivity to the predicted epitopes was higher than the Spike-S1 and S2 peptide pools in the unexposed donors. A key finding of our study is that pre-existing T-cell immunity to SARS-CoV-2 is contributed by TCRs that recognize common viral antigens such as Influenza and CMV, even though the viral epitopes lack sequence identity to the SARS-CoV-2 epitopes. This finding is in contrast to multiple published studies in which pre-existing T-cell immunity is suggested to arise from shared epitopes between SARS-CoV-2 and other common cold-causing coronaviruses. However, our findings suggest that SARS-CoV-2 reactive T-cells are likely to be present in many individuals because of prior exposure to flu and CMV viruses. [ABSTRACT FROM AUTHOR]

Studies were planned to assess the detrimental effect of Cd induced stress on morphological growth and yield attributes of rice plant. Therefore, this experiment was conducted during 2019 at Lovely Professional University, Punjab, India. The focusable part of the study were based upon the morphological and yield attributing characters like plant height, leaves numbers, total number of tillers and productive tillers, length of panicle, numbers of spikelets/ panicle, weight of spikelets/panicle and test weight. Reduction in all the parameters were recorded as the externally imposed CdCl2 concentrations increased gradually from 100 to 300 ppm. Growth inhibition due to cadmium induced stress also expressed in terms of per cent reduction among the treatments and found that maximum reduction of plant height and number of leaves recorded at 30 days after sowing (DAS) was 28.39 and 44.53%, while the reduction in total number of tillers was 46.34% at 60 DAS. However, per cent reduction in length of panicle, number of spikelets/panicle and test weight were 25.1, 36.6, 4.68 and 18.06 %, respectively at 120 DAS. The externally induced stress of CdCl2 made remarkable changes into the morphological features as well as yield attributes of rice plant results yield loss. While further studies are essential to know the efficiency of partitioning of CdCl2 into the different parts of plant because it is a carcinogenic/mutagenic compound. [ABSTRACT FROM AUTHOR]

Background: Achillea millefolium L. is traditionally important medicinal herb used for the treatment of various ailments from the centuries. Recent studies showed its biological activities on hay fever, hepato-biliary disorders, and as appetite enhancing drug. It is also reported to be used for the treatments of skin inflammations, wounds, cuts, and abrasions. Aim: To investigate preliminary pharmacognostical, phytochemical, and molecular parameters of aerial parts of the drug. Materials and methods: A. millefolium was identified and collected from the Himalaya region. The material is properly dried, macro-and microscopic evaluation, phytochemical and molecular studies as per the standard quality control and WHO guidelines. Results: The leaves are pinnately lobed, inflorescence compound corymbose. Nonglandular trichomes are uni-seriate, multicellular, and smooth walled; glandular trichomes are bicellular, present throughout the aerial parts. The endodermis is evident in the stem and leaf mesophyll is equifacial. The partial genome sequence analysis showed similarity toward studied species, which can clearly distinguish it from other species of the genus Achillea. The best chromatographic separation was observed with ascentis express C18, 2.7 μm, 100 mm × 4.6 mm. The flavonoids and phenolic acids have shown maximum absorbance at 330 nm. The system suitability parameters such as theoretical plate, tailing factor, and resolution met the acceptance criteria with United States pharmacopeia (USP). Conclusion: The findings of this study will be helpful for the precise identification of the raw drug of A. millefolium from its closely allied species. [ABSTRACT FROM AUTHOR]

Intestinal-type adenocarcinoma (ITAC) is the second most frequent sinonasal adenocarcinoma. High incidence of these tumors was seen among workers with occupational wood dust exposure, particularly of hardwood dusts. Furthermore, ITACs associated with dust exposure were diagnosed mostly in men (85-95%) and predominantly in the ethmoid sinus. This contrasts with sporadic ITACs that are more frequent in women and often arise in the maxillary antrum. ITAC had striking histomorphologic and immunophenotypic similarities with colorectal adenocarcinomas, but on the level of molecular pathologic mechanisms, these tumors have their own specific features different from gastrointestinal tumors. A 58-yearold female came with the chief complaints of difficulty in breathing and left-sided nasal obstruction for the past 1 month. On local examination, nasal septum was deviated to the right side on visualizing the left nasal cavity showed a polypoidal growth occupying the entire nasal cavity. Paranasal sinuses with contrast computed tomography (CT) showed a chronic granulomatous lesion in the left nasal cavity with surrounding inflammatory changes involving the ipsilateral sinuses. This patient was planned for functional endoscopic sinus surgery and specimen was sent for histopathological diagnosis. Contradictory to CT scan result, on gross and histopathology, the lesion was diagnosed to be intestinal type of sinonasal adenocarcinoma. [ABSTRACT FROM AUTHOR]

If P (z) = a n ∏ j = 1 n (z - z j) is a complex polynomial of degree n having all its zeros in | z | ≤ K , K ≥ 1 then Aziz (Proc Am Math Soc 89:259–266, 1983) proved that 0.1 max | z | = 1 | P ′ (z) | ≥ 2 1 + K n ∑ j = 1 n K K + | z j | max | z | = 1 | P (z) |. In this paper we sharpen the inequality (0.1) and further extend the obtained result to the polar derivative of a polynomial. As a consequence we also derive two results on the generalization of Erdös–Lax type inequality for the class of polynomials having no zeros in the disc | z | < K , K ≤ 1 . [ABSTRACT FROM AUTHOR]

Let p (z) = ∑ j = 0 n a j z j be a polynomial of degree n. Further, let M (p , R) = max | z | = R ≥ 1 | p (z) | , and ‖ p ‖ = M (p , 1) . Then according to the well-known Bernstein inequalities, we have ‖ p ′ ‖ ≤ n ‖ p ‖ and M (p , R) ≤ R n ‖ p ‖ . It is an open problem to obtain inequalities analogous to these inequalities for the class of polynomials satisfying p(z) ≡ znp(1/z). In this paper we obtain some inequalites in this direction for polynomials that belong to this class and have all their coefficients in any sector of opening γ, where 0 ≤ _ γ < π. Our results generalize and sharpen several of the known results in this direction, including those of Govil and Vetterlein [3], and Rahman and Tariq [12]. We also present two examples to show that in some cases the bounds obtained by our results can be considerably sharper than the known bounds. [ABSTRACT FROM AUTHOR]

Anaplastic multiple myeloma (AMM) is a rare and aggressive variant of plasma cell neoplasm. It is relatively treatment resistant when compared to conventional myeloma. It can arise de novo or transform from a preexisting plasma cell myeloma. Morphologically, AMM is recognized by the presence of immature plasma cells and pleomorphic, multilobated cells. Here, we present three cases of AMM. [ABSTRACT FROM AUTHOR]

Background: The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines.Methods: A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed.Results: Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid (Fresenius Kabi, Australia) and ClinOleic (Baxter Healthcare, Australia) preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed.Conclusions: The 2017 PN formulations and guidelines developed by the 2017 Neonatal Parenteral Nutrition Consensus Group offer concise and practical instructions to clinicians on how to implement current and up-to-date evidence based PN to the NICU population. [ABSTRACT FROM AUTHOR]

Objective: To evaluate Patient Reported Outcomes of intra/interdialytic symptoms and to optimize the ideal conductivity settings maintained for minimal symptom expressions. Materials and Methods: A prospective observational study, carried out in a south Indian tertiary care teaching hospital. Patient Reported Outcomes Kidney Disease Quality of Life (KDQOLTM) 35 Symptom List Questionnaire was administered to each patient to determine inter/intradialytic symptoms coupled with sodium conductivity measurement during hemodialysis. Results: Of the 126 study populations, 97 consented were involved, the mean age was 50±11 years, with male predominance of 79%. Of the 31 parameters studied, 9 correlated significantly to conductivity showing some relationship (p<0.05). Muscle cramps, muscle soreness, fatigue, trouble sleeping and nausea were least at population conductivity mean of 14.4 mS/m and peaked at the extremes of mean conductivity range of 13.2 and 15.1 mS/m. Whereas hypotensive symptoms and hot & cold spells were lowest at higher extreme of mean conductivity and peaks at lower end due to sodium removal & hyponatremia. Conclusion: The change in sodium conductivity with response to sodium gradient was associated with significant increases in inter/intra-dialytic symptom rates associated with symptoms like cramps, soreness, fatigue, nausea and trouble sleeping are least severe around a conductivity of 14.5 mS/m. [ABSTRACT FROM AUTHOR]

A 40-year-old gentleman presented with a history of multiple swellings involving his face, scalp, left axilla, back, and right thigh for the past 8 years. For the last 6 months, he developed intermittent low-grade fever, anorexia, weight loss, and gradually worsening breathlessness. On evaluation, the patient was found to have abnormally elevated absolute eosinophil count. Workup for the etiology of eosinophilia was unrewarding. All investigations related to an underlying myeloproliferative disorder were negative. Hence, a clinical possibility of angiolymphoid hyperplasia with eosinophilia (ALHE) was kept which was confirmed on histopathology. In the absence of other causes of hypereosinophilia, a clinical diagnosis of "associated hypereosinophilic syndrome" secondary to ALHE was made. He was managed with oral corticosteroids. The absolute eosinophil count reduced markedly, while the swellings showed a more gradual response, shrinking in size by about 50% following two months of therapy. The index case thus highlights a rather unusual presentation of ALHE. [ABSTRACT FROM AUTHOR]

Background: The extraction of tooth being the most common procedure in oral surgery should be pain free with limited dosage and limited needlepricks. Articaine being unique among amide local anesthetics contains a thiophene group, which increases its liposolubility, and an ester group which helps biotransformation in plasma. Because of the high diffusion properties, it can be used as a single buccal infiltration to extract a maxillary tooth. Aim and Objective: Objective of the study was to compare the efficacy of single buccal infiltration of 4% articaine with that of 2% lignocaine for maxillary first molar extraction. Methodology: A triple blind randomized controlled study was carried on 100 patients of age group 18-60 years who required maxillary first molar extraction, visiting the Department of Oral and Maxillofacial surgery. They were included in the study after obtaining informed consent. Buccal infiltration of 1.8 ml of anesthetic solution was given randomly to 100 patients with appropriate blinding of the cartridges. Objective signs were checked. If any additional injection was given, it was noted as type and number of rescue injection given. Postoperatively VAS score and surgeon's quality of anesthesia was noted. Duration of anesthesia was measured every 5 minutes for 50 minutes from infiltration. Results: Out of 50 patients in group A (Articaine), in 44 patients extraction was done without the need of additional injection whereas in group B(Lignocaine), 29 patients require additional infiltration on the palatal side. The VAS score values for group A were also significantly less in comparison with group B. The mean duration of anesthesia for Group A being (71.70 ± 17.82 min) in 44 patients who only received buccal infiltration. Interpretation and Conclusion: The efficacy of single buccal injection of articaine is comparable to buccal and palatal injection of lignocaine. [ABSTRACT FROM AUTHOR]

The present study focuses on fabrication and characterisation of porous composite scaffold containing hydroxyapatite (HAP), chitosan, and gelatin with an average pore size of 250–1010 nm for improving wound repair and regeneration by Electrospinning method. From the results of X ‐Ray Diffraction (XRD) study, the peaks correspond to crystallographic structure of HAP powder. The presence of functional group bonds of HAP powder, Chitosan and scaffold was studied using Fourier Transform Infrared Spectroscopy (FTIR). The surface morphology of the scaffold was observed using Scanning Electron Microscope (SEM). The Bioactivity of the Nano composite scaffolds was studied using simulated body fluid solution at 37 ± 1°C. The biodegradability test was studied using Tris‐Buffer solution for the prepared nanocomposites [nano Chitosan, nano Chitosan gelatin, Nano based Hydroxyapatite Chitosan gelatin]. The cell migration and potential biocompatibility of nHAP‐chitosan‐gelatin scaffold was assessed via wound scratch assay and were compared to povedeen as control. Cytocompatibility evaluation for Vero Cells using wound scratch assay showed that the fabricated porous nanocomposite scaffold possess higher cell proliferation and growth than that of povedeen. Thus, the study showed that the developed nanocomposite scaffolds are potential candidates for regenerating damaged cell tissue in wound healing process. [ABSTRACT FROM AUTHOR]

Late-onset anemia is a complication of hemolytic disease of fetus and newborn. It includes late hemolytic anemia and late hyporegenerative anemia. This case report is to discuss an Rh isoimmunized infant who presented with late-onset hyporegenerative anemia. The infant had low reticulocyte count, negative direct antiglobulin test, high erythropoietin, and high ferritin levels. She was treated with repeated blood transfusions and improved after 4 months of age. The follow-up of infants with Rh isoimmune hemolytic disease is needed for identification of late-onset anemia. [ABSTRACT FROM AUTHOR]

Background: Isolated and predominant gastrointestinal presentation in coronavirus disease 2019 (COVID-19) is reported less often. With evolving evidence that gastrointestinal tract can be a portal of entry, multiplication, primary site of affliction and symptomatic manifestation, and source of infectivity through prolonged fecal shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), it is essential that isolated gastrointestinal symptoms can also be a mode of presentation of this novel virus and illness. Case description: The index case is a 10-year-old female child who presented with acute onset abdominal pain. Emergency surgery showed extensive gangrenous small bowel. The small bowel had herniated into a transmesenteric defect near the mid-ileum and was obstructed. Reverse-transcription polymerase chain reaction for SARS-CoV2 sent as preoperative work-up turned positive. The histopathology showed platelet aggregate thrombus in the venules with patent adjacent arterioles. Conclusion: This is probably the first reported case of COVID-19-related bowel gangrene. [ABSTRACT FROM AUTHOR]

Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal disease caused by dysregulated activation of macrophages against one’s blood cells. Major pathologic feature of HLH is hemophagocytosis. We present a case of HLH complicating methotrexate toxicity in a 65‑year‑old psoriatic patient with history of renal disease. Diagnosis of HLH was established as he fulfilled five out of eight HLH diagnostic criteria. This case report is presented to enlighten clinicians about the clinical entity of HLH and to suspect and recognize this rare and generally fatal disease at the earliest. [ABSTRACT FROM AUTHOR]

Extramedullary plasmacytomas are rare, constituting to about 5% of plasma cell neoplasms. Pancreatic involvement is uncommon constituting to about 2.3%. Localised solitary plasmacytomas has a good response to radiation. When they are associated with pre-existing multiple myeloma, their prognosis is poor. A case of plasmacytoma of pancreas presenting with obstructive jaundice preceding plasma cell leukaemia is presented here. The lesion was misdiagnosed by fine needle aspiration cytology as neuroendocrine neoplasm. The patient did not present with symptoms of myeloma initially. The present case highlights the significance of considering other causes of pancreatic mass than primary carcinomas. [ABSTRACT FROM AUTHOR]

Background: We examined the impact of race on the maximum tolerated doses (MTD) and final approved doses (FAD) of single-agent molecular-targeted agents (MTA) in North America/Europe (NA/EU) and Asia.Methods: We searched PubMed and regulatory databases to identify targeted drugs approved globally and compared their FAD and MTD in corresponding phase I/II studies conducted separately in NA/EU and Asia. To evaluate this further, we conducted parallel, prospective, first-in-human studies of DS-7423, a dual PI3K/mTOR inhibitor, in patients with advanced solid tumours in the US and Japan. We pooled and compared the pharmacokinetics (PK), pharmacodynamics (PD), toxicity, and efficacy between these populations.Results: 17 MTA were approved in NA/EU and Asia from 2001 to 2015. Recommended phase 2 doses (RP2D) were identical across races in 14 of 17 (80%) studies and differences were not clinically meaningful. FAD were identical across all regions. 42 and 27 patients from US and Japan, respectively, were enrolled in the phase I studies of DS-7423. Despite differences in race, body weight, and body mass index, the RP2D were 240 mg/day with no differences in toxicities, PK, PD, or efficacy.Conclusions: Conducting separate clinical trials of single-agent MTA in Caucasian and Asian populations may be redundant. [ABSTRACT FROM AUTHOR]

Introduction: Acute Kidney Injury (AKI) is characterised by a rapid reduction in the kidney function and gets effected to varying degrees based on the aetiology. An AKI increases the chances of Chronic Kidney Disease (CKD) if not treated properly or assessed timely. Aim: To identify the common aetiologies and to assess the prognosis and outcomes of AKI in a tertiary care centre in southern India. Materials and Methods: A retrospective observational study was conducted, in a tertiary care teaching hospital over a period of six months (August 2015 to February 2016), upon receiving approval from Institutional Ethics Committee (KH IEC 392/2015). Data of patients aged ≥18 years admitted during January- December 2012 were collected from the medical records using the ICD10 code for AKI, unspecified (N17.9). Patients with renal transplantation and chronic dialysis were excluded. Age, gender, aetiology, management, and association between treatment and outcome were analysed using descriptive statistics, univariate and multivariate logistic regression and chi square test. Results: Among 528 patients, with AKI, male predominance of 72.7% (n=384) and median {Interquartile Range (IQR)} age of 56 (20) years was observed. Prevalence of AKI was found to be 8.36/1,000 people. Community Acquired-AKI (CA-AKI) and Hospital Acquired-AKI (HA-AKI) accounted for 35% (n=185) and 65% (n=343) respectively. CKD 23% (n=79) and sepsis 22.4% (n=77) were the major aetiologies among CA-AKI whereas sepsis 49.2% (n=91) and CKD 11.9% (n=22) were the majorities among the HA-AKI. Chi square test for association between treatment and outcomes (recovery) showed a statistically significant relationship with dextrose normal saline (χ²=10.96, p<0.05), sodium bicarbonate (χ²=7.63, p<0.05), dopamine (χ²=112.14, p<0.05), calcium gluconate (χ²=17.20, p<0.05) and haemodialysis (χ²=12.13, p<0.05). Complete recovery in 64% (n=341) whereas 16% (n=82) of patients died. Conclusion: Sepsis and CKD were seen to be the leading aetiologies. Male gender with AKI is more likely to develop CKD. AKI with Diabetes Mellitus (DM), sepsis or Urinary Tract Infection (UTI) might worsen the prognosis. Fluid replenishment shows to improve the prognosis. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of homeopathic medicines (in higher potencies) in normal subjects, Peripheral Pulse Analyzer (PPA) has been used to record physiologic variability parameters before and after administration of the medicine/placebo in 210 normal subjects. Methods: Data have been acquired in seven rounds; placebo was administered in rounds 1 and 2 and medicine in potencies 6, 30, 200, 1 M, and 10 M was administered in rounds 3 to 7, respectively. Five different medicines in the said potencies were given to a group of around 40 subjects each. Although processing of data required human intervention, a software application has been developed to analyze the processed data and detect the response to eliminate the undue delay as well as human bias in subjective analysis. This utility named Automatic Analysis of Intervention in the Field of Homeopathy is run on the processed PPA data and the outcome has been compared with the manual analysis. The application software uses adaptive threshold based on statistics for detecting responses in contrast to fixed threshold used in manual analysis. Results: The automatic analysis has detected 12.96% higher responses than subjective analysis. Higher response rates have been manually verified to be true positive. This indicates robustness of the application software. The automatic analysis software was run on another set of pulse harmonic parameters derived from the same data set to study cardiovascular susceptibility and 385 responses were detected in contrast to 272 of variability parameters. It was observed that 65% of the subjects, eliciting response, were common. Conclusion: This not only validates the software utility for giving consistent yield but also reveals the certainty of the response. This development may lead to electronic proving of homeopathic medicines (e-proving). [ABSTRACT FROM AUTHOR]

This research study focuses on the optimization of multi-item multi-period procurement lot sizing problem for inventory management. Mathematical model is developed which considers different practical constraints like storage space and budget. The aim is to find optimum order quantities of the product so that total cost of inventory is minimized. The NP-hard mathematical model is solved by adopting a novel ant colony optimization approach. Due to lack of benchmark method specified in the literature to assess the performance of the above approach, another metaheuristic based program of genetic algorithm is also employed to solve the problem. The parameters of genetic algorithm model are calibrated using Taguchi method of experiments. The performance of both algorithms is compared using ANOVA analysis with the real time data collected from a valve manufacturing company. It is verified that two methods have not shown any significant difference as far as objective function value is considered. But genetic algorithm is far better than the ACO method when compared on the basis of CPU execution time. [ABSTRACT FROM AUTHOR]