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The sixth most common malignant disease is renal cell carcinoma (RCC), which accounts for almost 90% of all cases. The probability of recovery can be greatly increased by early detection of kidney tumors. Imaging techniques are the most sought out non-invasive diagnostic techniques in recent times. In this review, the current method of image processing involves rapid identification of the tumor from CT scans by a combination of pre-processing, segmentation, feature extraction and classification methods. Machine learning (ML) techniques such as support vector machines (SVM), random forests (RF), artificial neural networks (ANN), convolutional neural networks (CNN), and Deep learning models can be used to analyze abdominal CT images for renal cancer detection. On the other hand, a probabilistic neural network (PNN) can also be used as a feedforward neural network that uses a probabilistic methodology by accurately classifying the class probability estimates. Various types of RCCs were defined in the histological study and diagnosed using various imaging methods such as ultrasound, MRI, CT, PET and angiography in the radiological part. Machine learning algorithms are used to identify tumors, extract relevant data from medical images, and help interpret imaging results. When these algorithms are integrated with medical imaging data such as computed tomography (CT) images, renal cancer detection models become more accurate. By being trained on labeled data sets, these algorithms can identify renal cancer. A detailed review has been done and after comparing the accuracy of several algorithms, CNN is considered to be the most suitable algorithm for identification of RCC., {"references":["1.\tBray, F., Ferlay, J., Soerjomataram, I., Siegel, R.L., Torre, L.A. and Jemal, A., 2018. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 68(6), pp.394-424.","2.\tUdager, A.M. and Mehra, R., 2016. Morphologic, molecular, and taxonomic evolution of renal cell carcinoma: a conceptual perspective with emphasis on updates to the 2016 World Health Organization Classification. Archives of pathology & laboratory medicine, 140(10), pp.1026-1037.","3.\tRao A, Wiggins C, Lauer RC. Survival outcomes for advanced kidney cancer patients in the era of targeted therapies. Ann Transl Med. 2018 May;6(9):165. doi: 10.21037/atm.2018.04.44. PMID: 29911113; PMCID: PMC5985277.","4.\tDeja S, Litarski A, Mielko KA, Pudełko-Malik N, Wojtowicz W, Zabek A, Szydełko T, Młynarz P. Gender-Specific Metabolomics Approach to Kidney Cancer. Metabolites. 2021 Nov 10;11(11):767. doi: 10.3390/metabo11110767. PMID: 34822425; PMCID: PMC8624667.","5.\tGharaibeh, M., Alzu'bi, D., Abdullah, M., Hmeidi, I., Al Nasar, M.R., Abualigah, L. and Gandomi, A.H., 2022. Radiology imaging scans for early diagnosis of kidney tumors: a review of data analytics-based machine learning and deep learning approaches. Big Data and Cognitive Computing, 6(1), p.29.","6.\tAurna, N.F., Yousuf, M.A., Taher, K.A., Azad, A.K.M. and Moni, M.A., 2022. A classification of MRI brain tumor based on two stage feature level ensemble of deep CNN models. Computers in Biology and Medicine, 146, p.105539.","7.\tBarragán-Montero, A., Javaid, U., Valdés, G., Nguyen, D., Desbordes, P., Macq, B., Willems, S., Vandewinckele, L., Holmström, M., Löfman, F. and Michiels, S., 2021. Artificial intelligence and machine learning for medical imaging: A technology review. Physica Medica, 83, pp.242-256.","8.\tCastiglioni, I., Rundo, L., Codari, M., Di Leo, G., Salvatore, C., Interlenghi, M., Gallivanone, F., Cozzi, A., D'Amico, N.C. and Sardanelli, F., 2021. AI applications to medical images: From machine learning to deep learning. Physica Medica, 83, pp.9-24.","9.\tBehura, A., 2021. The cluster analysis and feature selection: Perspective of machine learning and image processing. Data Analytics in Bioinformatics: A Machine Learning Perspective, pp.249-280.","10.\tUhm, K.H., Jung, S.W., Choi, M.H., Shin, H.K., Yoo, J.I., Oh, S.W., Kim, J.Y., Kim, H.G., Lee, Y.J., Youn, S.Y. and Hong, S.H., 2021. Deep learning for end-to-end kidney cancer diagnosis on multi-phase abdominal computed tomography. NPJ precision oncology, 5(1), p.54."]}

Primary squamous cell carcinoma of pancreas is a rare malignant neoplasm. It has been reported as case reports only, hence clinical information is limited. Here, we present a case of primary squamous cell carcinoma of pancreas in a 47-year-old female with a background history of chronic pancreatitis. Patient was treated with systemic chemotherapy; however, she did not respond to the treatment protocol. Follow-up CT scan showed increase in the size and extension of the lesion. It is an aggressive tumor and does not respond well to chemotherapy or radiotherapy.

Background Mammography is the primary imaging modality for diagnosing breast cancer in women more than 40 years of age. Digital breast tomosynthesis (DBT), when supplemented with digital mammography (DM), is useful for increasing the sensitivity and improving BIRADS characterization by removing the overlapping effect. Ultrasonography (US), when combined with the above combination, further increases the sensitivity and diagnostic confidence. Since most of the research regarding tomosynthesis has been in screening settings, we wanted to quantify its role in diagnostic mammography. The purpose of this study was to assess the performance of DM alone vs. DM combined with DBT vs. DM plus DBT and ultrasound in diagnosing malignant breast neoplasms with the gold standard being histopathology or cytology. Results A prospective study of 1228 breasts undergoing diagnostic or screening mammograms was undertaken at our institute. Patients underwent 2 views DM, single view DBT and US. BIRADS category was updated after each step. Final categorization was made with all three modalities combined and pathological correlation was done for those cases in which suspicious findings were detected, i.e. 256 cases. Diagnosis based on pathology was done for 256 cases out of which 193 (75.4%) were malignant and the rest 63 (24.6%) were benign. The diagnostic accuracy of DM alone was 81.1%. Sensitivity, Specificity, PPV and NPV were 87.8%, 60%, 81.3% and 61.1%, respectively. With DM + DBT the diagnostic accuracy was 84.8%. Sensitivity, Specificity, PPV and NPV were 92%, 56.5%, 89% and 65%, respectively. The diagnostic accuracy of DM + DBT + US was found to be 85.1% and Sensitivity, Specificity, PPV and NPV were 96.3%, 50.7%, 85.7% and 82%, respectively. Conclusion The combination of DBT to DM led to higher diagnostic accuracy, sensitivity and PPV. The addition of US to DM and DBT further increased the sensitivity and diagnostic accuracy and significantly increased the NPV even in diagnostic mammograms and should be introduced in routine practice for characterizing breast neoplasms.

Photonics 10(2), 99 (2023). doi:10.3390/photonics10020099, Published by MDPI, Basel

Bacteria employ numerous resistance mechanisms against structurally distinct drugs by the process of multidrug resistance. A study was planned to discover the antibacterial potential of a graphene oxide nanosheet (GO), a graphene oxide–zinc oxide nanocomposite (GO/ZnO), a graphene oxide-chitosan nanocomposite (GO–CS), a zinc oxide decorated graphene oxide–chitosan nanocomposite (GO–CS/ZnO), and zinc oxide nanoparticles (ZnO) alone and in a blend with antibiotics against a PS-2 isolate of Pseudomonas aeruginosa. These nanocomposites reduced the MIC of tetracycline (TET) from 16 folds to 64 folds against a multidrug-resistant clinical isolate. Efflux pumps were interfered, as evident by an ethidium bromide synergy study with nanocomposites, as well as inhibiting biofilm synthesis. These nanoparticles/nanocomposites also decreased the mutant prevention concentration (MPC) of TET. To the best of our knowledge, this is the first report on nanomaterials as a synergistic agent via inhibition of efflux and biofilm synthesis.

BackgroundRecent studies on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reveal that Omicron variant BA.1 and sub-lineages have revived the concern over resistance to antiviral drugs and vaccine-induced immunity. The present study aims to analyze the clinical profile and genome characterization of the SARS-CoV-2 variant in eastern Uttar Pradesh (UP), North India.MethodsWhole-genome sequencing (WGS) was conducted for 146 SARS-CoV-2 samples obtained from individuals who tested coronavirus disease 2019 (COVID-19) positive between the period of 1 January 2022 and 24 February 2022, from three districts of eastern UP. The details regarding clinical and hospitalized status were captured through telephonic interviews after obtaining verbal informed consent. A maximum-likelihood phylogenetic tree was created for evolutionary analysis using MEGA7.ResultsThe mean age of study participants was 33.9 ± 13.1 years, with 73.5% accounting for male patients. Of the 98 cases contacted by telephone, 30 (30.6%) had a travel history (domestic/international), 16 (16.3%) reported having been infected with COVID-19 in past, 79 (80.6%) had symptoms, and seven had at least one comorbidity. Most of the sequences belonged to the Omicron variant, with BA.1 (6.2%), BA.1.1 (2.7%), BA.1.1.1 (0.7%), BA.1.1.7 (5.5%), BA.1.17.2 (0.7%), BA.1.18 (0.7%), BA.2 (30.8%), BA.2.10 (50.7%), BA.2.12 (0.7%), and B.1.617.2 (1.3%) lineages. BA.1 and BA.1.1 strains possess signature spike mutations S:A67V, S:T95I, S:R346K, S:S371L, S:G446S, S:G496S, S:T547K, S:N856K, and S:L981F, and BA.2 contains S:V213G, S:T376A, and S:D405N. Notably, ins214EPE (S1- N-Terminal domain) mutation was found in a significant number of Omicron BA.1 and sub-lineages. The overall Omicron BA.2 lineage was observed in 79.5% of women and 83.2% of men.ConclusionThe current study showed a predominance of the Omicron BA.2 variant outcompeting the BA.1 over a period in eastern UP. Most of the cases had a breakthrough infection following the recommended two doses of vaccine with four in five cases being symptomatic. There is a need to further explore the immune evasion properties of the Omicron variant.

The polymerization of 1,4-benzenediboronic acid (BDBA) on mica to form a covalent organic framework (COF-1) reveals a dramatic increase in crystallinity when physically confined by exfoliated graphene. COF-1 domains formed under graphene confinement are highly geometric in shape and on the order of square micrometers in size, while outside of the exfoliated flakes, the COF-1 does not exhibit long-range mesoscale structural order, according to atomic force microscopy imaging. Micro-Fourier transform infrared spectroscopy confirms the presence of COF-1 both outside and underneath the exfoliated graphene flakes, and density functional theory calculations predict that higher mobility and self-assembly are not causes of this higher degree of crystallinity for the confined COF-1 domains. The most likely origin of the confined COF-1's substantial increase in crystallinity is from enhanced dynamic covalent crystallization due to the water confined beneath the graphene flake.

Background Single coronary artery (SCA) is a rare anomaly, usually diagnosed incidentally during coronary artery angiogram. Individuals with this anomaly mostly remain asymptomatic while some present with symptoms such as chest pain, dyspnoea and even sudden death. The origin and the proximal course of anomalous coronary artery are the main prognostic factors. Several classification systems have been proposed based on the site of origin and anatomical distribution of anomalous artery. Coronary computed tomography angiography has become the reference method for such an assessment noninvasively. Herein, we report a series of two cases of SCA diagnosed on CT angiography. In one case it was single left coronary artery associated with other congenital cardiac anomalies, whereas in other it was single right coronary artery and was an isolated anomaly. Case presentation Our first case was of a 19-year-old female who presented with chest pain and dyspnoea. Transthoracic Echocardiography (TTE) features were suggestive of Tetralogy of Fallot (TOF) with infective endocarditis. Cardiac CT angiography revealed the presence of a large SCA arising from left aortic sinus with absence of normal origin of right coronary artery (RCA). This artery was dividing into and supplying different coronary arterial territories with pre-pulmonic course of RCA. The patient underwent Aortic valve replacement with pulmonary Commissurotomy and improved in post-operative period. Our second case was of a 50-year-old man with complaints of breathlessness and normal ECG and Echocardiography examination findings. Coronary CT angiography revealed the presence of SCA arising from right aortic sinus and supplying the territories of both RCA and Left coronary artery (LCA). The patient was managed conservatively with emphasis on aggressive control of risk factors. Conclusions SCA is a rare anomaly and may lead to catastrophic life threatening complications. The accurate delineation of the origin and course of the anomalous vessel is of paramount importance while planning surgical intervention. Management usually involves a multi-disciplinary approach with cardiologists and cardiac surgeons aiming for deciding an individual plan based on presentation and anatomy of each case.

Objectives: The performance of shear wave elastography (SWE) for peripheral nerve pathology, predominantly compressive neuropathy, has been studied with the median nerve, sciatic nerve, and tibial nerve. However, studies for ulnar nerve are limited in literature. The aim of the study was to study the performance of SWE for ulnar nerve in arm by analyzing the correlation of elasticity value by two transducers of the same ultrasound system. Material and Methods: This was a prospective observational study. Elasticity of ulnar nerve was measured in the mid-arm and supracondylar region in longitudinal and transverse planes with two different transducers of the same ultrasound system. The reliability of measurement was assessed by interclass correlation of values obtained. Results: Ninety-two ulnar nerve measurement sets were analyzed. The ages of the patients ranged from 14 years to 76 years, with a median age of 50. The SWE values obtained by two probes showed a weak interclass correlation coefficient value Conclusion: Quantitative SWE measurements of the ulnar nerve in the arm by two transducers showed a weak interclass correlation. It should be used with caution as a diagnostic tool with a universally acceptable cut off values.

Anterior neck masses are common and such patients commonly present to ultrasonography units for further evaluation of underlying pathology. We encountered an atypical case of pulsatile anterior neck swelling in a 45-year-old lady. Evaluation of the swelling using neck ultrasonography and color doppler study revealed that the mass was of vascular origin and contrast-enhanced computed tomography of neck confirmed the presence of an aberrant high riding innominate artery. Knowledge of such variants is of great importance and should be reported by the concerned radiologist. Lack of knowledge of such variants may lead to inadvertent surgical complications during procedures and can be life-threatening to the patient.

Background: Emergency Department of National Trauma Center Nepal Center is the only specialized trauma care hospital in Nepal, in operation since 2012. Traumatic injury is one of the major causes for mortality worldwide. This study aims to see the epidemiology, pattern of injuries and outcome of the patients presenting to the emergency room.Methods: After getting ethical approval, we included all patients presenting to the Emergency Department with at least one injury, between Jan 2018 to Dec 2020. Informations on age, gender, mechanism of injury and outcome was abstracted for all patients presenting to the emergency department. Data were extracted from hospital database with the permission of hospital authority.Results: Total of 49991 patients presented to emergency department with different types of injuries. Among them 7792 (14.0%) needed hospital admission. Fall and road crashes comprised almost 80% of admitted cases. Mortality was 2.1% of admitted patients, mostly with head injuries followed by multiple injuries. Conclusions: Among the patient visiting the trauma center during the study period most common mechanism of the injury were fall and road crash with head and neck injury. Majority of the patients were only managed in the ward without surgery.Keywords: Emergency care; triage; trauma care system; unintentional injury

BACKGROUND: The first national severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurvey in India, done in May-June, 2020, among adults aged 18 years or older from 21 states, found a SARS-CoV-2 IgG antibody seroprevalence of 0·73% (95% CI 0·34-1·13). We aimed to assess the more recent nationwide seroprevalence in the general population in India. METHODS: We did a second household serosurvey among individuals aged 10 years or older in the same 700 villages or wards within 70 districts in India that were included in the first serosurvey. Individuals aged younger than 10 years and households that did not respond at the time of survey were excluded. Participants were interviewed to collect information on sociodemographics, symptoms suggestive of COVID-19, exposure history to laboratory-confirmed COVID-19 cases, and history of COVID-19 illness. 3-5 mL of venous blood was collected from each participant and blood samples were tested using the Abbott SARS-CoV-2 IgG assay. Seroprevalence was estimated after applying the sampling weights and adjusting for clustering and assay characteristics. We randomly selected one adult serum sample from each household to compare the seroprevalence among adults between the two serosurveys. FINDINGS: Between Aug 18 and Sept 20, 2020, we enrolled and collected serum samples from 29 082 individuals from 15 613 households. The weighted and adjusted seroprevalence of SARS-CoV-2 IgG antibodies in individuals aged 10 years or older was 6·6% (95% CI 5·8-7·4). Among 15 084 randomly selected adults (one per household), the weighted and adjusted seroprevalence was 7·1% (6·2-8·2). Seroprevalence was similar across age groups, sexes, and occupations. Seroprevalence was highest in urban slum areas followed by urban non-slum and rural areas. We estimated a cumulative 74·3 million infections in the country by Aug 18, 2020, with 26-32 infections for every reported COVID-19 case. INTERPRETATION: Approximately one in 15 individuals aged 10 years or older in India had SARS-CoV-2 infection by Aug 18, 2020. The adult seroprevalence increased approximately tenfold between May and August, 2020. Lower infection-to-case ratio in August than in May reflects a substantial increase in testing across the country. FUNDING: Indian Council of Medical Research.

Purpose Most of the intramedullary spinal cord lesions have a component of insidious myelopathic changes at the time of diagnosis. Among the spinal cord lesions, intramedullary neoplasms are rare (25%). They represent 4 to 10% of all central nervous system tumors. But due to involvement of tracts, they are associated with significant neurological symptoms. Their imaging features can help early diagnosis and predict prognosis. We aim to narrow down differential diagnoses of intramedullary lesions based on imaging findings. Materials and Methods This retrospective study included 40 patients as a sample that underwent magnetic resonance imaging spine at our institution (on 3T machine). Patient population had varied clinical complaints, ranging from headache, nausea, vomiting, motor weakness, bladder and bowel involvement, progressive paraparesis to paraplegia. Lesions were evaluated site, size, margin, associated cysts, signal intensity, enhancement, and associated syringohydromyelia. Results This study obtained majority of the lesions to be ependymoma (15) and astrocytoma (11), followed by infection (4), hemangioblastoma (3), and metastasis (2). Five patients were either lost to follow-up or not operated on. Conclusion Most of the intramedullary lesions were malignant and were showing postcontrast enhancement. Ependymomas were more frequently present in cervical region, central in location with well-defined margins and focal postcontrast enhancement. Among the total of 15 ependymomas, three cases were associated with neurofibromatosis-2. Ependymomas were more frequently associated with syringohydromyelia and peripheral hemorrhage (cap sign). Astrocytoma was more frequently seen in children, thoracic and eccentric in location with ill-defined margins. Enhancement in astrocytoma was dependent on the grade of tumor. Metastasis was a differential, with imaging characteristics dependent on type of primary. Intramedullary granuloma due to infection can also be confusing mimics of neoplasm. High-velocity signal loss due to flow voids is seen in the hemangioblastomas.

The COVID-19 outbreak caused by the SARS Corona virus 2 (SARS-CoV-2), that appeared in Wuhan, China in December 2019 evolved into a pandemic and caused a devastating effect in all aspect of life. The aim of this study is to determine the impact of Covid-19 on the management of spine patients requiring surgery and to observe the functioning of a trauma center in a pandemic situation.A retrospective study was performed at National Trauma Center, Kathmandu, Nepal from January 1 2019 to February 28 2020(Pre-Covid period) and March 1 2020 to April 30 2021(Covid Period) . All patients undergoing spine surgery were included and details regarding demographics, diagnosis, surgical procedures were obtained and compared between pre- covid and covid period and also between complete lockdown period and partial lockdown period of the covid duration.The mean age of the patients undergoing surgery in the Pre covid period was (40.4 ± 14.51) years and covid period was (38.9 ± 14.00) years. The number of spine surgeries performed during the pre covid period was 295 whereas the number decreased to 197 in the covid period. The total number of non traumatic spine surgery in the pre covid period was 22.03% of the total spine surgery cases where as it decreased to 11.68% in the covid period. Similarly out of the total cases instrumented surgery was 91.86% in the pre covid period whereas it was 97.97% in the covid period. While analyzing the spine surgery done in the COVID period we found that most of the cases of surgery done in the complete restriction period was of traumatic spine only (97.77%) where as in the limited restriction period non traumatic spine surgery was also increased with traumatic spine surgery accounting for 85.52% of the total spine surgery cases.The COVID pandemic has had a direct impact on traumatic and non-traumatic spine surgeries performed in this center.

There are several bacteria called superbugs that are resistant to multiple antibiotics which can be life threatening specially for critically ill and hospitalized patients. This article provides up-to-date treatment strategies employed against some major superbugs, like methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, vancomycin-resistant Enterococcus, multidrug-resistant Pseudomonas aeruginosa, and multidrug-resistant Escherichia coli. The pathogen-directed therapeutics decrease the toxicity of bacteria by altering their virulence factors by specific processes. On the other hand, the host-directed therapeutics limits these superbugs by modulating immune cells, enhancing host cell functions, and modifying disease pathology. Several new antibiotics against the global priority superbugs are coming to the market or are in the clinical development phase. Medicinal plants possessing potent secondary metabolites can play a key role in the treatment against these superbugs. Nanotechnology has also emerged as a promising option for combatting them. There is urgent need to continuously figure out the best possible treatment strategy against these superbugs as resistance can also be developed against the new and upcoming antibiotics in future. Rational use of antibiotics and maintenance of proper hygiene must be practiced among patients.

Cloud computing is a paradigm to provide services to end-users through the Internet. The availability of services to end-users is dependent on various factors such as the availability of computing resources as well as the number of users to access those services. To manage the real-time fluctuating workload cloud providers use elasticity mechanisms. Elasticity is one of the important characteristics of cloud computing that dynamically allocates computing resources to manage the fluctuating workload. The failure of allocation/de-allocation of computing resources at the right moment leads to SLA violation, degradation of services performance, maximum power consumption, minimum throughput, and maximum response time. To address these challenges, we have proposed a hybrid approach to perform horizontal elasticity. The proposed approach uses both reactive and proactive approaches for provisioning/de-provisioning of computing resources. The simulation results of the proposed model show that performance of system has improved in terms of CPU utilization, response time, and throughput.

In this paper, the experimental analysis of two types of corrugated plate solar collector (CPSC) using water as working fluid has been done. Two similar designs and dimensions of CPSC but different materials of absorber plates have been investigated, the collector1 is copper and collector 2 is aluminium. The performance of energy, exergy and total heat loss coefficient of CPSC were analysed and compared. Thermal performance of CPSC depends on many parameters such as outlet collector temperature, absorber plate temperature, temperature difference, inlet collector temperature, atmospheric temperature, mass flow rate (MFR), solar radiation, wind speed and absorber plate material. The three MFR values of 0.0167 kg/s, 0.025 kg/s and 0.033 kg/s were considered in this experimental setup. The thermal performances of these two types of solar collectors were investigated. Also, a comparison between the performance of these two types of solar collector at various MFR was done. Experimental results show that the use of copper-based CPSC could improve the thermal efficiency compared to the use of aluminium based CPSC. The maximum energy and exergy of copper and aluminium based CPSC was found at MFR 0.033 kg/s. Results show that as the water MFR is increased from 0.0167 kg/s to 0.033 kg/s, the thermal efficiency of collector made of copper and aluminium increases.

Objective This work aimed to study the distribution of lymph nodal metastatic pattern in carcinoma gallbladder with multidetector computed tomography (CT). Materials and Methods A retrospective observational study was conducted including 80 patients with carcinoma gallbladder who underwent triple-phase CT angiography or single-phase contrast-enhanced CT scan of the abdomen between January 2019 and November 2019. Results In our study, 75 (93.7%) out of 80 cases showed metastasis to lymph nodes, with distribution as follows: periportal (69), peripancreatic (62), and aortocaval (47). The most common involved combination included all three lymph nodal groups (periportal, peripancreatic, and aortocaval), involving 40 (50%) cases. The combination of only periportal and peripancreatic lymph nodes was seen in 17 (21%) cases. Isolated periportal lymph nodes were seen in eight cases (10%) cases. The combination of only periportal and aortocaval lymph nodes was seen in four (5%) cases. Isolated peripancreatic lymph nodes were seen in three (3.7%) cases. The combination of periportal and aortocaval was seen in four (5%) cases followed by peripancreatic and aortocaval lymph nodes that was seen in two (2.5%) cases. Isolated aortocaval lymph nodes were seen in one (1.2%) case. Conclusion Periportal lymph nodes were the single most commonly involved station followed by peripancreatic and aortocaval lymph nodes. The combination of periportal, peripancreatic, and aortocaval lymph nodes was seen most commonly. The second most commonly involved combination was found to be periportal and peripancreatic lymph nodes followed by isolated periportal lymph nodes.

The compound 4-hydroxy-α-tetralone (1) has been reported to possess potent anti-tubercular, anti-diabetic and anti-leishmanial activities. In our earlier studies the compound 1 and its various semi-synthetic derivatives showed potent bioenhancing activity in combination with nalidixic acid (NAL) and tetracycline (TET) reducing the minimum inhibitory concentration (MIC) of antibiotics up to 8 folds by inhibition of ABC efflux pump. However, in gram negative bacteria, resistance nodulation division (RND) family are considered as major efflux pump responsible for multidrug resistance (MDR). Hence, the current study was carried out to access the in-silico docking potential of compound 1 and its cinnamoyl (1a), 3, 4, 5-trimethoxybenzoyl (1b) derivatives against RND efflux pump target proteins AcrA, AcrB, TolC of E. coli. The docking study showed that the test compounds have good binding affinity with target proteins. The derivative 1a showed highest interaction with AcrA followed by AcrB showing binding energies -8.7 and -8.2 kcal/mol respectively. The low molecular weight ≤500, high hydrogen bonding, high log p value (>1) with hydroxy, methoxy and aromatic group of ligands make these compounds as effective efflux pump inhibitor. In drug likeliness studies, these compounds pass the safety criteria with enhanced bioavailability and absorption, less acute oral toxicity, less hepatotoxicity. This study promises that the compound 1 and its derivatives (1a & 1b) might be RND efflux pump inhibitors providing the initial platform for development of safer and cost-effective antibacterial drug to manage MDR infections.

The early management, diagnosis, and treatment of emerging and re-emerging infections and the rising burden of non-communicable diseases (NCDs) are necessary. The Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-Cas system has recently acquired popularity as a diagnostic tool due to its ability to target specific genes. It uses Cas enzymes and a guide RNA (gRNA) to cleave target DNA or RNA. The discovery of collateral cleavage in CRISPR-Cas effectors such as Cas12a and Cas13a was intensively repurposed for the development of instrument-free, sensitive, precise and rapid point-of-care diagnostics. CRISPR/Cas demonstrated proficiency in detecting non-nucleic acid targets including protein, analyte, and hormones other than nucleic acid. CRISPR/Cas effectors can provide multiple detections simultaneously. The present review highlights the technical challenges of integrating CRISPR/Cas technology into the onsite assessment of clinical and other specimens, along with current improvements in CRISPR bio-sensing for nucleic acid and non-nucleic acid targets. It also highlights the current applications of CRISPR/Cas technologies.

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The clinical presentation, biochemical characteristics, and outcomes of patients infected with SARS-CoV-2 can vary in different populations. The purpose of the study is to assess the clinical presentation and identify predictors of mortality among patients with severe acute respiratory distress syndrome admitted to different critical care units in Nepal.An observational study was conducted among the confirmed SARS-CoV-2 patients admitted to different critical care units in seven provinces of Nepal. Retrospective data was collected for the period of three months (April 14, 2021 to July 15, 2021) in relation to the peak of the second wave of COVID-19 pandemic in Nepal. Clinical, biochemical and mortality data were collected from the admitted patients of different critical care units. Univariate logistic regression analysis was done among the selected variables at 5% significance. Final predictor variables were identified after multiple regression analysis.Out of total of 646 patients admitted to critical care units of different provinces of Nepal, there was a male predominance 420 (65%). A total of 232(35.91 %) patients were non-survivors with the majority of mortality occurring in patients50 years of age. Cough (72.3 %), shortness of breath (70.9%) and fever (56 %) were the most common presenting clinical features. Increasing age, presence of comorbidity, critical COVID-19 cases, respiratory rate, temperature, serum urea and alanine aminotransferase were identified as predictors of mortality after multiple regression analysis.Approximately 36 % of the confirmed SARS-CoV-2 patient admitted to critical care units did not survive. There was a male preponderance with most casualties occurring in patients more than 50 years of age. Cough, shortness of breath and fever were the most common presenting features. After multiple regression analysis of the identified clinical and biochemical factors, age, presence of comorbidity, respiratory rate, temperature, severity grade as per the World Health Organization classification, serum urea and alanine aminotransferase were identified as the predictors of mortality.

With limited studies on spinal injuries occurring at the cervicothoracic junction, there is currently a knowledge gap regarding the correlation between morphology of injury and neurology and whether surgery provides a favorable neurological outcome. The primary objective was to determine whether the neurological deficit correlated with the severity of injury at this region of the spine.All patients with injuries at the cervicothoracic junction from December 2015 to December 2020 in a government trauma hospital were included. Patient demographics, characteristics of the injury, neurological score, imaging findings, surgery details and neurological outcomes were analyzed. All patients had a minimum follow up of 2 years.Of the total 30 patients, 23 were male and 7 female with mean age 42.4 years. 90% had fall injuries with 76.7% sustaining AO type C injury and 10% with AO B2 injury.73.4% had injury at C6-C7 level followed by 13.3% , C7-T1. Only 16.7% patients presented with intact neurology. Plain x-rays failed to detect cervicothoracic junction, injuries in 63.3% patients. Posterior stabilization was performed in 56.7%. Neurological improvement was observed in 9 patients.Though cervicothoracic junction injuries are uncommon, they are highly unstable injuries and difficult to diagnose by plain x-rays. These injuries also result in profound neurological deficit. Surgical stabilization of these injuries should be considered for a favorable neurological and functional outcome.

Background India began COVID-19 vaccination in January 2021, initially targeting healthcare and frontline workers. The vaccination strategy was expanded in a phased manner and currently covers all individuals aged 18 years and above. India experienced a severe second wave of COVID-19 during March–June 2021. We conducted a fourth nationwide serosurvey to estimate prevalence of SARS-CoV-2 antibodies in the general population aged ≥6 years and healthcare workers (HCWs). Methods and findings We did a cross-sectional study between 14 June and 6 July 2021 in the same 70 districts across 20 states and 1 union territory where 3 previous rounds of serosurveys were conducted. From each district, 10 clusters (villages in rural areas and wards in urban areas) were selected by the probability proportional to population size method. From each district, a minimum of 400 individuals aged ≥6 years from the general population (40 individuals from each cluster) and 100 HCWs from the district public health facilities were included. The serum samples were tested for the presence of IgG antibodies against S1-RBD and nucleocapsid protein of SARS-CoV-2 using chemiluminescence immunoassay. We estimated the weighted and test-adjusted seroprevalence of IgG antibodies against SARS-CoV-2, along with 95% CIs, based on the presence of antibodies to S1-RBD and/or nucleocapsid protein. Of the 28,975 individuals who participated in the survey, 2,892 (10%) were aged 6–9 years, 5,798 (20%) were aged 10–17 years, and 20,285 (70%) were aged ≥18 years; 15,160 (52.3%) participants were female, and 21,794 (75.2%) resided in rural areas. The weighted and test-adjusted prevalence of IgG antibodies against S1-RBD and/or nucleocapsid protein among the general population aged ≥6 years was 67.6% (95% CI 66.4% to 68.7%). Seroprevalence increased with age (p < 0.001) and was not different in rural and urban areas (p = 0.822). Compared to unvaccinated adults (62.3%, 95% CI 60.9% to 63.7%), seroprevalence was significantly higher among individuals who had received 1 vaccine dose (81.0%, 95% CI 79.6% to 82.3%, p < 0.001) and 2 vaccine doses (89.8%, 95% CI 88.4% to 91.1%, p < 0.001). The seroprevalence of IgG antibodies among 7,252 HCWs was 85.2% (95% CI 83.5% to 86.7%). Important limitations of the study include the survey design, which was aimed to estimate seroprevalence at the national level and not at a sub-national level, and the non-participation of 19% of eligible individuals in the survey. Conclusions Nearly two-thirds of individuals aged ≥6 years from the general population and 85% of HCWs had antibodies against SARS-CoV-2 by June–July 2021 in India. As one-third of the population is still seronegative, it is necessary to accelerate the coverage of COVID-19 vaccination among adults and continue adherence to non-pharmaceutical interventions., Manoj Murhekar and co-workers report on the seroprevalence of anti-SARS-CoV-2 antibodies in India., Author summary Why was this study done? Earlier nationwide COVID-19 serosurveys conducted in India indicated an increase in seroprevalence from 0.73% (95% CI 0.34% to 1.13%) in May–June 2020 to 6.6% (95% CI 5.8% to 7.4%) in September–October 2020 and 24.1% (95% CI 23.0% to 25.3%) in December 2020–January 2021. India began COVID-19 vaccination in January 2021, initially targeting healthcare and frontline workers. The vaccination strategy was expanded in a phased manner and currently covers all individuals aged 18 years and above. India witnessed a severe second wave of COVID-19 in March–June 2021. What did the researchers do and find? The fourth nationwide serosurvey indicated that about two-thirds of India’s population aged ≥6 years had antibodies against SARS-CoV-2 by June–July 2021. Seroprevalence increased with age, but was not different in urban slum, urban non-slum, and rural areas. Seroprevalence was significantly higher among individuals who had received 2 doses of COVID-19 vaccine compared to unvaccinated individuals. About 85% of healthcare workers working in district-level health facilities had antibodies against SARS-CoV-2. What do these findings mean? The substantial seroprevalence of anti-SARS-CoV-2 antibodies in the Indian population should provide some measure of protection against future waves of COVID-19 in the country. About one-third of the population in India did not have detectable antibodies against SARS-CoV-2 by June–July 2021. It is therefore necessary to accelerate the coverage of COVID-19 vaccination among adults.

Bacteria employ numerous resistance mechanisms against structurally distinct drugs by the process of multidrug resistance. A study was planned to discover the antibacterial potential of a graphene oxide nanosheet (GO), a graphene oxide–zinc oxide nanocomposite (GO/ZnO), a graphene oxide-chitosan nanocomposite (GO–CS), a zinc oxide decorated graphene oxide–chitosan nanocomposite (GO–CS/ZnO), and zinc oxide nanoparticles (ZnO) alone and in a blend with antibiotics against a PS-2 isolate of Pseudomonas aeruginosa. These nanocomposites reduced the MIC of tetracycline (TET) from 16 folds to 64 folds against a multidrug-resistant clinical isolate. Efflux pumps were interfered, as evident by an ethidium bromide synergy study with nanocomposites, as well as inhibiting biofilm synthesis. These nanoparticles/nanocomposites also decreased the mutant prevention concentration (MPC) of TET. To the best of our knowledge, this is the first report on nanomaterials as a synergistic agent via inhibition of efflux and biofilm synthesis.

Background/Objectives: Globally, the COVID-19 pandemic and its prevention and control policies have impacted maternal and child health (MCH) services. This study documents the challenges faced by patients in accessing MCH services, and the experiences of health care providers in delivering those services during the COVID-19 outbreak, explicitly focusing on the lockdown period in India. Methods: A cross-sectional study (rapid survey) was conducted in 18 districts from 6 states of India during March to June, 2020. The sample size included 540 MCH patients, 18 gynaecologists, 18 paediatricians, 18 district immunisation officers and 108 frontline health workers. Bivariate analysis and multivariable analysis were used to assess the association between sociodemographic characteristics, and challenges faced by the patients. Results: More than one-third of patients (n = 212; 39%) reported that accessing MCH services was a challenge during the lockdown period, with major challenges being transportation-related difficulties (n = 99; 46%) unavailability of hospital-based services (n = 54; 23%) and interrupted outreach health services (n = 39; 18.4%). The supply-side challenges mainly included lack of infrastructural preparedness for outbreak situations, and a shortage of human resources. Conclusions/Recommendations: A holistic approach is required that focuses on both preparedness and response to the outbreak, as well reassignment and reinforcement of health care professionals to continue catering to and maintaining essential MCH services during the pandemic.

Introduction: Prostatic utricle cyst (PUC) is a rare entity associated with congenital urogenital anomalies. In some cases, prostatic utricle is strikingly enlarged and present as a cystic lesion in perineum or in pelvic cavity posing diagnostic dilemma. Very few case reports are available in the published literature. Case report: We report a case of 12 year old male with complaints of post void dribbling of urine since birth and feeling of incomplete emptying. Clinical examination revealed ambiguous genitalia with perineal hypospadias and bilateral undescended testes. Ultrasound pelvis revealed a well-defined midline cystic lesion posterior to the urinary bladder with an intra-lesional calculus. MRI demonstrated a narrow communication tract between the cystic lesion and posterior urethra suggesting the possibility of PUC. Complete excision of the cyst was performed with ligation of the communicating tract and subsequent histo-pathological examination confirmed prostatic utricle cyst. Postoperative period was uneventful with complete resolution of the pre-operative symptoms. None of the symptoms recurred on follow up of the patient after three month of surgery. Conclusion: Prostatic utricle cyst should always be kept in the differential diagnosis of midline cystic lesions in young males specially if associated with uro-genital anomalies. Thorough clinical and imaging evaluation is needed to establish the diagnosis. MRI is the imaging modality of choice to differentiate utricle cyst from other midline cystic lesions of the pelvis.