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Simple Summary: The treatment for advanced and metastatic esophagogastric malignancies has historically required time-intensive multi-agent chemotherapy regimens, where patients spend time away from home to engage in therapy administrations and supportive care. With the addition of immunotherapies to the standard of care, the authors completed this study to estimate the time spent in health care across various systemic treatment regimens. The authors estimated the time toxicity, or the days spent in health care facilities, due to cancer diagnosis and treatment with immunotherapy- and chemotherapy-based treatment regimens for esophagogastric cancers. (1) Background: The purpose of this study was to evaluate the time toxicity, or time spent in health care, of immunotherapy- versus chemotherapy-based regimens for metastatic esophageal and gastric cancers. (2) Methods: A literature search was conducted, and 18 phase III clinical trials of immune checkpoint inhibitors were selected for analysis. Health care days were calculated based on the number of days associated with receiving therapy and the adverse events reported in the clinical trials. Both the number of health care days and the median overall survival were compared among chemotherapy-only, immunotherapy-only, and chemo-immunotherapy regimens across this cohort of drug registration trials. (3) Results: The estimated median number of health care days was 37 (range of 7–52) days, or 1.2 (range of 0.2–1.7) months, compared to a median survival of 10.2 months across these 18 studies. For the chemotherapy-only regimens, the median number of health care days was 39 (range of 21–51) days, and for chemo-immunotherapy, it was 39 (range of 30–52) days. The immunotherapy-only regimens had fewer days, a median of 28 (range of 24–41), p < 0.05, compared to the other two arms. (4) Conclusions: The chemo-immunotherapy regimens did not add time toxicity compared to chemotherapy alone. The immunotherapy-only regimens had lower time toxicity compared to chemotherapy alone. In the setting of decreased time toxicity and improved overall survival, further development of immunotherapy-based regimens could improve outcomes in advanced esophageal and gastric cancers. [ABSTRACT FROM AUTHOR]

Mature cystic teratoma is a benign ovarian tumor that usually presents in reproductive-age females. This tumor usually presents with pain abdomen, bloating, and a lump. Hereby, we describe a case of an ovarian dermoid presented with features of intestinal obstruction secondary to ileo-dermoid fistula formation. A 55-year-old postmenopausal female presented with lower abdominal pain, nausea, vomiting, and the feeling of a lump in the abdomen. On evaluation and imaging, it was diagnosed as a large ovarian dermoid (with malignant transformation) with multiple fistulous communications with ileal loops. The patient was managed by laparotomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy, bowel resection, and anastomosis. The patient was discharged in good condition. The rupture of malignant ovarian dermoid followed by enterodermoid fistula formation and intestinal obstruction is rare. Complete cytoreduction and bowel repair should be considered for optimal results. [ABSTRACT FROM AUTHOR]

In this paper, we have introduced a novel five-dimensional (5D) hyperchaotic system by extending the well-known Lorenz system. The dynamical properties of the system are analysed by calculating the Lyapunov exponents, graphing the phase portraits, bifurcation diagrams, the time series and by finding the Kaplan–Yorke dimension. The equilibrium points of the system have been calculated and the stability analysis of these equilibrium points is discussed. Hybrid function projective synchronisation has been carried out between the identical systems using the scheme of adaptive control. Suitable controllers have been designed to attain the desired synchronisation between the systems using Lyapunov stability theory. The theoretical results have been validated by performing numerical simulations using the MATLAB. [ABSTRACT FROM AUTHOR]

Smart transportation systems have been the focus of research due to the development of smart cities. However, existing vehicular networks are not sufficient enough to fulfill the vision of futuristic smart cities due to limited flexibility, scalability, poor connection, and insufficient intelligence. These technological hurdles make the role of Software-Defined Networking (SDN) very important to improve the overall performance of the existing vehicular networks considering the unique properties of SDN such as Decoupling of network planes and Real-time network programming. This leads to the development of Software-Defined Vehicular Networks (SDVNs). SDVNs help to realize the development of smart transportation systems which further helps to optimize the vision of truly smart cities. However, the security remains a consistent concern due to the increased mobility, larger attack surface, and improvised future attack vector. This work includes the different design components, and offers a detailed survey to understand different security issues including the architectural and functional ones. Additionally, multiple security solutions are discussed including Service-based, Infrastructure-based, and Application-based solutions. Furthermore, the work also covers the possible challenges in the development of SDVNs based on Improved Architectural Development, Holistic Integration, Effective Orchestration, Environmental Volatility Handling, Global Network Management, Efficient Components/Technologies Integration, Diverse Security Offerings, and Design Issues' Maintenance. Lastly, the work highlights the resultant opportunities based on Application, Open Research, Network Management, Device Configuration, Traffic Management, QoS, and Efficient Routing. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) is a significant cause of morbidity worldwide, especially in the low and middle-income countries like India and is found to be more common in the rural areas. Delays in diagnosis and initiation of treatment along with lower treatment adherence and completion rates have increased the morbidity and mortality of TB in the rural areas. The collation of information accumulated through the assessment of people's Knowledge, Attitude, and Practices (KAP) towards TB, helps in charting new health programs for the public, identifying lacunae, and devising interventions based on these lacunae which in turn will help us to achieve the vision of a "TB free India” by 2025. Aim: To find out KAP and any association amongst them regarding TB among the study subjects. Materials and Methods: This was a cross-sectional study conducted on patients attending Outpatient Department (OPD) at the Rural Health Training Centre (RHTC) attached to NCR Institute of Medical Sciences, Meerut, Uttar Pradesh, India, during January 2021 to April 2021. From a sample of 106 patients data of KAP regarding TB was collected via a structured questionnaire which was predesigned and pretested. Pearson’s Chi-square test was used to ascertain the association between subjects' KAP about TB. A p-value <0.05 was taken as the predictor of statistical significance. Results: Out of 106 patients, 72 (67.92%), 80 (75.47%) and 52 (49.06%) had adequate KAP respectively. Participants having adequate knowledge showed positive attitude and good practices and this association was found to be statistically significant. Conclusion: The study results reflect that having adequate knowledge of the disease transforms into good practices and a positive attitude towards a person suffering from the said disease as well as helps the people to have a positive frame of mind in case they themselves contract the disease. Health education and behaviour change communication hence needs to be scaled up in rural communities to prevent, detect and treat tuberculosis in order to achieve a TB free India. [ABSTRACT FROM AUTHOR]

The discovery of human obesity-associated genes can reveal new mechanisms to target for weight loss therapy. Genetic studies of obese individuals and the analysis of rare genetic variants can identify novel obesity-associated genes. However, establishing a functional relationship between these candidate genes and adiposity remains a significant challenge. We uncovered a large number of rare homozygous gene variants by exome sequencing of severely obese children, including those from consanguineous families. By assessing the function of these genes in vivo in Drosophila, we identified 4 genes, not previously linked to human obesity, that regulate adiposity (itpr, dachsous, calpA, and sdk). Dachsous is a transmembrane protein upstream of the Hippo signalling pathway. We found that 3 further members of the Hippo pathway, fat, four-jointed, and hippo, also regulate adiposity and that they act in neurons, rather than in adipose tissue (fat body). Screening Hippo pathway genes in larger human cohorts revealed rare variants in TAOK2 associated with human obesity. Knockdown of Drosophila tao increased adiposity in vivo demonstrating the strength of our approach in predicting novel human obesity genes and signalling pathways and their site of action. This study set out to identify novel gene variants that may contribute to human obesity, by combining human exosome sequencing analyses with systematic functional screening in Drosophila. This identifies a number of novel obesity-associated genes which control adiposity in flies, and uncovers a potential role for the Hippo signaling pathway in obesity. [ABSTRACT FROM AUTHOR]

Silver nanomaterials (AgNMs) ubiquitously known for their biological applications are studied here in terms of their shape-dependent antibacterial and anti-biofilm effect. Chemically synthesized nano-cubes (AgNCs) with size range around 150–200 nm were compared for their biological activity with commercial nano-sphere (AgNS) of comparable size (~160 nm). The antibacterial activity against both Escherichia coli and Staphylococcus aureus showed higher activity for nano-cubes compared with nano-spheres.The synergistic role of AgNMs with antibiotic ampicillin was also found promising. A four times enhancement and an increase of nearly 25% of antibiotic activity at 0.0625 mg ml–1 concentration was found with 0.05 mg ml–1 of AgNCs in agar and broth media, respectively. Anti-biofilm effect towards E. coli and S. aureus was also evaluated. AgNCs showed equal importance in biofilm disruption with 20% inhibition activity, which was yet again found better in-comparison with AgNSs. The study shows that AgNCs with distinct faces and edges could show efficient anti-bacterial effect and so such intelligently designed material could pave path for imminent medical challenges. [ABSTRACT FROM AUTHOR]

Background: Staphylococcus aureus (S. aureus) and its resistant form methicillin-resistant S. aureus (MRSA) is one of the most common nosocomial pathogens causing a wide range of infections in humans. The anterior nares are the main ecological niche for S. aureus. Nasal carriage of S. aureus acts as an important reservoir of infection among the colonised healthcare workers and they transmit the infection to the community. The aim of the present study was to estimate the nasal colonisation of S. aureus (with special reference to MRSA) in healthcare workers (doctors and nursing staff) and its antibiotic susceptibility pattern. Methods: A descriptive study was planned in the Department of Microbiology, JLN Medical College, Ajmer (Rajasthan, India) after due approval from the institutional ethics committee. A total of 170 healthcare workers of either sex aged between 18 to 60 years were screened for S. aureus. Identification was done using standard microbiological techniques, by studying their morphology, colony and biochemical characteristics. MRSA was detected by cefoxitin disc diffusion test, oxacillin disc diffusion test, minimum inhibitory concentration (MIC) of oxacillin by E-test and oxacillin screen agar test. The observations were described in proportions and Chisquared test was used to find independence. Statistical significance was considered at 5 %. Results: Among 170 samples, 159 (93.53 %) samples (50 doctors and 109 nursing staff) had staphylococci colonisation. Among these 159 isolates, 34 (21.38 %) were S. aureus. Further, 8 (5.03 %) S. aureus isolates were resistant to both cefoxitin and oxacillin and had oxacillin MIC values ≥ 4 µg/mL and were considered MRSA. All the MRSA were detected in the nursing staff (males: 5.50 %, females: 1.83 %). All S. aureus and MRSA isolates were found sensitive to linezolid, vancomycin and mupirocin (minimum inhibitory concentration ≤ 4 µg/mL). Conclusion: Screening and treatment of healthcare workers colonised with MRSA should be an important component of hospital infection control policy. These measures will prevent spread of infection to patients and the community and thereby reduce the morbidity, mortality and healthcare costs associated with nosocomial infections. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 as COVID-19 virus has affected the entire world and so to the cancer care and health-care facility. Cancer cervix is one of the common malignancies among women in developing and underdeveloped countries. Various challenges are being faced by patients and health-care providers to deliver optimal treatment under prescribed time frame. Faster delivery of whole treatment is desirable in the current pandemic. Overall treatment time in cancer cervix has prognostic value. Adoption of altered fractionation to delivered external beam radiation therapy could be a method for faster delivery of whole treatment. Altered fractionation such as hyperfractionation (HFX), hypofractionation, and accelerated fraction alone or with HFX has already been experimented for the past three decades. The total duration of treatment has been significantly reduced without addition of much toxicity. Few studies had also highlighted the feasibility of addition of chemotherapy to such fractionation schedule. However, prospective studies are still warranted to generate data to further support its use in the future. [ABSTRACT FROM AUTHOR]

Introduction: IgA nephropathy (IgAN) is the most common form of glomerulonephritis across the world. Oxford classification defines criteria and effects of endocapillary hypercellularity on E score but the reproducibility of the same is debatable. Hence, there is a need for an objective marker that could establish a gold standard in assessing endocapillary hypercellularity. Methods: Forty biopsies of proven IgAN were taken and grouped into two groups based on the presence or absence of endocapillary hypercellularity (n = 20 each). These biopsies were then stained by CD68 immune stain and the glomerular macrophages were quantified. Mean serum creatinine, presence of hypertension, degree of proteinuria and haematuria at the time of biopsy were also recorded and the correlation between these parameters and endocapillary hypercellularity was also studied. Results: Mean glomerular CD 68+ cell count was significantly higher in glomeruli showing endocapillary hypercellularity. Utilising the objective cutoff values of 0.6 CD68+ per glomerulus, more than 8 glomerular CD68+ cells in the entire biopsy and/or around 4 CD68+ cells in the most inflamed glomerulus, endocapillary hypercellularity can be predicted with a sensitivity of 70-80% and specificity of 70%. After regrouping the biopsies based on the cutoff values obtained from the receiver operating curve analysis the mean urine RBC count per high power field showed a significant correlation with endocapillary hypercellularity. Conclusion: Glomerular CD68+ macrophage count seems to be a promising approach in assessing endocapillary hypercellularity. Further studies with emphasis on correlation with the clinical outcome are needed to validate its utility as an objective tool. [ABSTRACT FROM AUTHOR]

Postmenopausal bleeding is one of the common presenting complaints in the gynecological outpatient department. The common causes of which are atrophic endometritis, vaginitis, estrogen therapy, cancer endometrium, and cancer cervix. Hereby, we present a rare case of a 65-year-old female presented with postmenopausal bleeding who had history of trauma 1 year back with pelvic bone fracture. The cause of postmenopausal bleeding, in this case, is abnormal bony protrusion secondary to malunited pelvic fracture causing laceration of the right lateral vaginal wall. The case was managed by local osteotomy and vaginal wall repair. [ABSTRACT FROM AUTHOR]

The human gut is colonized by trillions of bacteria as well as other microorganisms, collectively referred to as the "gut microflora." This microflora plays an important role in metabolism as well as immunity, and alterations in its normal composition and pattern of colonization can disturb the development and functioning of the immune system, predisposing the individual to several diseases. Neonates acquire their gut microflora from the mother as well as the surroundings, and as the infant grows, the gut microflora undergoes several changes, ultimately acquiring an adult-like composition. Characterization of the gut microflora of healthy infants is important to protect infants from infectious diseases. Furthermore, formulation of prebiotics and probiotics for boosting infant immunity in a specific population also requires prior knowledge of the normal gut microflora in a healthy infant in that population. To this end, several studies have been performed on Western infants; however, the gut microflora of Indian infants is as yet insufficiently studied. Moreover, there has been no comparative analysis of the development and characteristics of the infant gut microflora between the two populations. In this review, we discuss the development and maturation of the infant gut microflora and its effect on immunity, as well as the factors affecting the patterns of colonization. In addition, we compare the patterns of colonization of gut microflora between Western and Indian infants based on the available literature in an attempt to identify the extent of similarity or difference between the two populations. [ABSTRACT FROM AUTHOR]

Vitamin B12 (cobalamin) is a cobalt-containing compound that acts as an essential co-factor for various enzymes involved in the metabolic processes of the living cells. The constructed FRET Sensor for Vitamin Anemia Linked (SenVitAL) displayed marginal FRET efficiency. Here, we report the development of a molecular SenVitAL containing enhanced cyan fluorescent protein (ECFP) and venus as FRET pair to improve the FRET efficiency for optical imaging and screening of already developed sensor by our group. The sensor is the improved version of previously reported SenVitAL and consists of ECFP/venus as FRET pair instead of the originally used pair CFP/YFP. To increase the physiological range of vitamin B12 measurement, affinity mutants were created. Compared to the wild type, SenVitAL-5 with W44Q mutation has higher affinity and displayed large dynamic detection range (0.10–480 µM) in response to vitamin B12 binding. For cell-based monitoring and dynamic measurement of vitamin B12 flux rates, SenVitAL-5 was successfully expressed in cytosol of yeast and mammalian cells. Changes in the emission intensities of the two fluorophores were detected using confocal microscopy in both cell types in response to vitamin B12. With the addition of 50 µM extracellular vitamin B12 to the cells, the emission intensity of venus increased and that of ECFP decreased over the time. Furthermore, the results show that the variant SenVitAL-5 measures the vitamin B12 in a concentration-dependent manner, showing the resulting increase in the FRET ratio and thus confirming its utility as an ideal fluorescent indicator for the detection of vitamin B12 in eukaryotic systems in real time. [ABSTRACT FROM AUTHOR]

Cross-linked polydimethylsiloxane (PDMS) films and surfaces obtained by thermal cross-linking of commercially available Sylgard 184 are widely utilized in many areas of science, due to superior thermal stability, low dielectric constant, transparency and biocompatibility. Cross-linked PDMS surfaces are weakly hydrophobic and several experiments, particularly the ones that utilize capillary-driven microscale flow require the modulation of the surface wettability. A well-known strategy to achieve the same is by exposing the Sylgard 184 surface to UV/ozone (UVO) treatment at room temperature. Depending on the duration of exposure, the wettability drops from hydrophobic to a near-complete wetting (water contact angle ~10°), due to the formation of a surface oxide layer. However, under normal atmospheric conditions, these surfaces recover their hydrophobicity over a period of time due to diffusive migration of the uncrosslinked oligomers to the surface, and formation of a hydrophobic dimethyl silicone layer. We explore the hydrophobic recovery process as a function of cross-linker concentration and UVO exposure time and show how a partially or fully recovered PDMS stamp may influence subsequent nanopatterning, including the possible creation of features with different morphology using a single stamp. [ABSTRACT FROM AUTHOR]

Background: We studied the effects of oral gabapentin and intravenous (I.V.) dexamethasone given together or separately 1 h before the start of surgery on intraoperative hemodynamics Postoperative analgesia and postoperative nausea vomiting (PONV) in patients undergoing gynaecological procedure. Materials and Methods: Patients were randomly divided into three groups: Group 1 (gabapentin, n = 46) received 400 mg gabapentin, Group 2 (dexamethasone, n = 46) received 8 mg dexamethasone and Group 3 (gabapentin plus dexamethasone, n = 46) received both 400 mg gabapentin and 8 mg dexamethasone I.V. 1 h before the start of surgery. Standard induction and maintenance of anesthesia were accomplished. Visual analog scale for pain was recorded for 12 h. Side effects were noted. Results: Hemodynamics at various time interval (0, 5, 10, 15, 20, 25 and 30 min) of laryngeal mask airway insertion and PONV were found significantly lower in Group 3 than in Group 1 and Group 2 (P < 0.05). The average time to first postoperative analgesic requirement at (visual analogue score >3) was significantly longer in Group 3 (510.00 ± 61.64 min) than in Group 1 (352.83 ± 80.61 min) and in Group 2 (294.78 ± 60.76 min), (P < 0.05). Conclusion: The present study concludes that the combination of oral Gabapentin and I.V. dexamethasone has significantly less hemodynamic changes, better postoperative analgesia and less incidence of PONV than individual administration of each drug. [ABSTRACT FROM AUTHOR]

Odontogenic cysts are derived from odontogenic apparatus which may develop before or after the formation of tooth. Most of these are developmental in origin. However, non-odontogenic cysts also exist in the jaw. Among the odontogenic cysts the most prevalent are periapical cyst followed by dentigerous and Odontogenic Keratocyst (OKC). OKC was also termed as Keratocystic Odontogenic Tumour (KCOT), well-known for its aggressive behaviour, varied origin, debated development and tendency to recur has been the focus of much research and discussion since four decades. It arises either from epithelial rests of the dental lamina or the tooth primordium and is generally aggressive and invasive, while dentigerous cysts are common odontogenic cysts that are related to the crown of the impacted tooth and known to arise from reduced enamel epithelium. It is rare to find both these entities occurring simultaneously in the same patient. Multiple OKC are generally associated with nevoid basal cell carcinoma syndrome, and accounts to the mutation in the PTCH, a tumour suppressor gene. However, this case reports a non-syndromic variant. A 13- year-old female patient with multiple cysts in the jaw that were evaluated, diagnosed and treated adequately based on clinical, radiographic and histopathological examination has been discussed. [ABSTRACT FROM AUTHOR]

MPS II is an X linked recessive lysosomal storage disorder with multi-system involvement and marked molecular heterogeneity. In this study, we explored the clinical and molecular spectrum of 144 Indian patients with MPS II from 130 unrelated families. Clinical information was collected on a predesigned clinical proforma. Sanger method was employed to sequence all the exons and exon/intron boundaries of the IDS gene. In cases where causative variation was not detected by Sanger sequencing, MLPA and RFLP were performed to identify large deletions/duplications and complex rearrangements. Cytogenetic microarray was done in one patient to see the breakpoints and extent of deletion. In one patient with no detectable likely pathogenic or pathogenic variation, whole-genome sequencing was also performed. Novel variants were systematically assessed by in silico prediction software and protein modelling. The pathogenicity of variants was established based on ACMG criteria. An attempt was also made to establish a genotype-phenotype correlation. Positive family history was present in 31% (41/130) of patients. Developmental delay and intellectual disability were the main reasons for referral. Macrocephaly, coarse facies and dysostosis were present in almost all patients. Hepatosplenomegaly, joint contractures and short stature were the characteristic features, seen in 87% (101/116), 67.8% (74/109) and 41.4% (41/99) patients respectively. Attenuated phenotype was seen in 32.6% (47/144) patients, while severe phenotype was seen in 63% (91/144) patients. The detection rate for likely pathogenic or pathogenic variants in our cohort is 95.5% (107/112) by Sanger sequencing, MLPA and RFLP. We also found two variants of unknown significance, one each by Sanger sequencing and WGS. Total of 71 variants were identified by Sanger sequencing and 29 of these variants were found to be novel. Amongst the novel variants, there was a considerable proportion (51%) of frameshift variants (15/29). Almost half of the causative variants were located in exon 3,8 and 9. A significant genotype-phenotype correlation was also noted for both known and novel variants. This information about the genotype spectrum and phenotype will be helpful for diagnostic and prognostic purposes. [ABSTRACT FROM AUTHOR]

Error-free progression through mitosis is critical for proper cell division and accurate distribution of the genetic material. The anaphase-promoting complex/cyclosome (APC/C) ubiquitin ligase regulates the progression from metaphase to anaphase and its activation is controlled by the cofactors Cdc20 and Cdh1. Additionally, genome stability is maintained by the spindle assembly checkpoint (SAC), which monitors proper attachment of chromosomes to spindle microtubules prior to cell division. We had shown a role for Tank Binding Kinase 1 (TBK1) in microtubule dynamics and mitosis and here we describe a novel role of TBK1 in regulating SAC in breast and lung cancer cells. TBK1 interacts with and phosphorylates Cdc20 and Cdh1 and depletion of TBK1 elevates SAC components. TBK1 inhibition increases the association of Cdc20 with APC/C and BubR1 indicating inactivation of APC/C; similarly, interaction of Cdh1 with APC/C is also enhanced. TBK1 and TTK inhibition reduces cell viability and enhances centrosome amplification and micronucleation. These results indicate that alterations in TBK1 will impede mitotic progression and combining TBK1 inhibitors with other regulators of mitosis might be effective in eliminating cancer cells. • Tank Binding Kinase 1 (TBK1) regulates mitotic spindle assembly checkpoint. • TBK1 interacts with and phosphorylates Cdc20 and Cdh1. • Association of Cdc20 and Ch1 with APC is affected by TBK1. • Inhibition of TBK1 can lead to centrosome amplification and growth arrest. • Inhibitors TBK1 and the mitotic kinase TTK co-operate to induce growth arrest. [ABSTRACT FROM AUTHOR]

Introduction: Protein-Energy Malnutrition (PEM) and prevalence of under-weight children in India, is an important health concern. Aim: To evaluate the effect of Oral Nutritional Supplement (ONS) on growth, overall nutrient intake and frequency of illness in nutritionally at-risk Indian children. Materials and Methods: In this prospective, randomised, gender-stratified, controlled, parallel group, open label study, 216 children (aged 4-6 years with weight-for-age z-score between -2 and -1) were randomised (1:1) to receive either 45 g of ONS {Test product+Dietary advice (T+D)} or control group {Dietary advice only (D-only)} for three months. Primary endpoints included weight-for-age z-score and weight gain in terms of g/kg/day from baseline to three months. Secondary endpoints included change in height-for-age z-scores; frequency of illness, change in dietary nutrient intake and Protein/Energy (P/E) ratio from baseline through three months. Safety endpoint included Adverse Events (AEs). PROC MIXED was used to perform Repeated Measures Analysis Of Variance (RMANOVA) based on the changes in z-scores. The z-scores changes within the group from baseline to the end of three months End-of-Study (EOS) were compared using paired t-test. Results: At baseline, the mean (SD) weight-for-age z-scores were similar in both the groups {1.50 (0.309) and -1.49 (0.312) in T+D and D-only groups, respectively}. At the EOS, only T+D group showed significant mean (SD) change from baseline in weight-for-age z-score compared to the D-only group {0.59 (0.296), p<0.001 vs. 0.04 (0.267), p=0.0974}. Mean rate of weight gain (g/kg/day) was significantly higher in T+D group vs. D-only group (1.12 vs. 0.26, p<0.0001). At baseline, height-for-age z-scores were similar in both the groups {-1.36 (0.668) vs -1.37 (0.638) in T+D and D-only groups, respectively}. At EOS, the mean (SD) change from baseline in height-for-age z-score was -0.02 (0.198), p=0.2389 in T+D group and -0.15 (0.171), p<0.001 in the D-only group. However, the change was not proportionate to weight-for-age z-score. Total absolute number of illness episodes was less in T+D group vs. D-only group (9 vs. 13). Improvement in dietary nutrient intake (carbohydrate, fat, protein and energy) and P/E ratio was significantly higher (p<0.001) in T+D group vs. D-only group. Overall, 8.3% children in T+D group experienced at least one treatment-emergent AE. Conclusion: The ONS helps to improve growth, nutrient intake and reduces frequency of illness in nutritionally at-risk children. [ABSTRACT FROM AUTHOR]

Brucella endocarditis is a rare but a severe complication of brucellosis, observed in less than 2% of cases. It is the main cause responsible for up to 80% of deaths in brucellosis. Herein, we present a case of brucella endocarditis that developed on a native aortic valve, but presented to us with fever for several months and acute neurological symptoms. This case report signifies the importance of considering brucella endocarditis as one of the differentials in patients presenting with Pyrexia of Unknown Origin (PUO) and Central Nervous System (CNS) manifestations. [ABSTRACT FROM AUTHOR]

Objectives: Lead is one of the most toxic heavy metal prevalent in the environment, which affects almost all major organs including heart, brain, intestines, kidneys as well as reproductive organs. It has been known that serum iron deficiency is associated with increased serum lead levels as lead is a particularly pernicious element to iron metabolism. Lead is also known to freely cross the placenta too; hence, this study was planned to determine any association between antenatal iron deficiency anemia (IDA), raised blood lead levels (BPb), and adverse pregnancy outcomes. Materials and Methods: This was an observational study done on 99 antenatal women with IDA and 41 nonanemic antenatal women. Lead levels were assessed in these 140 antenatal women and they were followed for adverse pregnancy outcomes. Chi-square test was used to find a difference in quantitative variables and Pearson's correlation test was used to assess association between BPb and hemoglobin levels. Results: We found that in 11 out of 99 (11.11%) women with IDA, BPb levels were high as compared to high BPb levels in only 1 out of 41 (2.4%) women without IDA and the high BPb levels ranged from 4 μg/dl–16.9 μg/dl with a mean BPb of 8.1 μg/dl. The difference in BPb among anemic and nonanemic antenatal women was significant (P < 0.05) and there was a negative dose effect relationship between BPb levels and hemoglobin levels. This difference in antenatal outcomes among women with and without high BPb levels was also significant with increased incidence of pre-eclampsia, FGR, and preterm deliveries in women with raised BPb levels. The incidence of NICU admission was also higher in the neonates of mothers with high BPb levels. Conclusions: We propose screening of high-risk women based on their social, occupational, environmental, and personal factors, with serum lead levels in the preconception period itself. All public and personal measures must be taken to reduce lead consumption and exposure in the preconception and antenatal period. [ABSTRACT FROM AUTHOR]

The enzyme methyl-coenzyme M reductase (MCR) plays an important role in mediating global levels of methane by catalyzing a reversible reaction that leads to the production or consumption of this potent greenhouse gas in methanogenic and methanotrophic archaea. In methanogenic archaea, the alpha subunit of MCR (McrA) typically contains four to six posttranslationally modified amino acids near the active site. Recent studies have identified enzymes performing two of these modifications (thioglycine and 5-[S]-methylarginine), yet little is known about the formation and function of the remaining posttranslationally modified residues. Here, we provide in vivo evidence that a dedicated S-adenosylmethionine-dependent methyltransferase encoded by a gene we designated methylcysteine modification (mcmA) is responsible for formation of S-methylcysteine in Methanosarcina acetivorans McrA. Phenotypic analysis of mutants incapable of cysteine methylation suggests that the S-methylcysteine residue might play a role in adaption to mesophilic conditions. To examine the interactions between the S-methylcysteine residue and the previously characterized thioglycine, 5-(S)-methylarginine modifications, we generated M. acetivorans mutants lacking the three known modification genes in all possible combinations. Phenotypic analyses revealed complex, physiologically relevant interactions between the modified residues, which alter the thermal stability of MCR in a combinatorial fashion that is not readily predictable from the phenotypes of single mutants. High-resolution crystal structures of inactive MCR lacking the modified amino acids were indistinguishable from the fully modified enzyme, suggesting that interactions between the posttranslationally modified residues do not exert a major influence on the static structure of the enzyme but rather serve to fine-tune the activity and efficiency of MCR. The unusual post-translational modifications of the enzyme methyl-coenzyme M reductase have no major impact on the static structure of the enzyme, but instead serve to fine-tune its activity and efficiency of catalysis. [ABSTRACT FROM AUTHOR]

New avenues for research have opened, which assess the influence of systemic disease on periodontium and vice versa. To find the correlation between polycystic ovary syndrome (PCOS) and periodontium by assessing clinical parameters [plaque index (PI), probing depth, periodontal disease index (PDI)] and the anthropological parameter [body mass index (BMI)] and to find the correlation between body mass index and periodontal disease index in subjects with and without PCOS. Sixty females comprising 30 with PCOS and 30 without PCOS were selected. Clinical, anthropological, and radiological assessment was done. Double blinding was incorporated. There was a statistically highly significant difference in mean age, mean PI, and mean PDI (P < 0.001) in PCOS group when compared to those without PCOS group by unpaired t-test for inter-group analysis. A statistically significant difference was found in mean probing depth and mean BMI (P < 0.05) in PCOS group when compared to those without PCOS group by unpaired t-test for inter-group analysis. No statistically significant correlation was found between mean PDI and mean BMI in PCOS and non-PCOS group subjects using Spearman's rank correlation. Women suffering from PCOS may be at a heightened risk for developing periodontal disease as our study re-establishes this association with respect to some periodontal parameters. With such a result, general practitioners/gynecologists can be encouraged to refer cases of PCOS to periodontists for early detection, prevention of periodontal disease, and maintenance of periodontal health. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The aim of our study is to compare the effectiveness of autologous serum therapy (AST) with histaglobulin in patients of chronic urticaria. MATERIALS AND METHODS: This was a prospective, comparative, randomized controlled, single-blinded study. Based on inclusion and exclusion criteria, patients were selected and divided into two groups by randomization. Autologous serum skin test was done in each patient irrespective of their groups. Group A (n = 30) received AST and Group B (n = 30) received histaglobulin. Patients' assessment was done every week for urticaria activity score (UAS) for 8 weeks. STATISTICAL ANALYSIS: We used Mann–Whitney test to compare the means between two groups. Wilcoxon signed-rank test was used to compare pre- and posttreatment UAS scores. RESULTS: Both therapies reduced UAS significantly (P = 0.01) at 8 weeks, and the reduction was observed every week. AST reduced UAS more than histaglobulin. However, within intergroup, difference was not significant. All patients had reduced severity of urticaria; however, complete remission (UAS = 0) was observed in three patients of Group A. CONCLUSION: Group A (AST) showed statistically significant improvement than Group B (histaglobulin), but both showed a reduction in UAS with a longer treatment-free interval. [ABSTRACT FROM AUTHOR]

Pulmonary agenesis, a rare congenital condition, is incompatible with life when present bilateral, while unilateral agenesis is usually detected in infancy or early childhood. Rare asymptomatic patients may reach adulthood undiagnosed, with signs mimicking common conditions presenting as radiopaque hemithorax with ipsilateral mediastinal shift. Here, we describe a case of a young lady, with history of consanguinity, who presented with complaints, suggestive of lower respiratory tract infection, and was investigated and diagnosed to be a case of right-side pulmonary agenesis with large ostium secondum atrial septal defect. Our present case emphasizes the importance of presence of pulmonary agenesis with cardiac congenital anomaly, remaining asymptomatic until adulthood, particularly in patients born of parents with consanguineous marriages. [ABSTRACT FROM AUTHOR]

Background Post–kala-azar dermal leishmaniasis (PKDL) is a dermal complication of visceral leishmaniasis. Oral miltefosine (MF) is the first-line treatment for PKDL patients in South Asia. This study assessed the safety and effectiveness of MF therapy after 12 months of follow-up to explore more precise data. Methods In this observational study, 300 confirmed PKDL patients were enrolled. MF with the usual dose was administered to all patients for 12 weeks and followed up for 1 year. Clinical evolution was recorded systematically by photographs at screening and at 12 weeks, 6 months, and 12 months after treatment onset. Definitive cure consisted of disappearance of skin lesions with a negative PCR at 12 weeks or with >70% of lesions, disappearing or fading at 12-month follow-up. Patients with reappearing clinical features and any positive diagnostics of PKDL during the follow-up were considered as nonresponsive. Results Among 300 patients, 286 (95.3%) completed 12 weeks of treatment. The per-protocol cure rate at 12 months was 97%, but 7 patients relapsed and 51 (17%) were lost to 12-month follow-up, resulting in a final cure rate of only 76%. Eye-related adverse events were noted in 11 (3.7%) patients and resolved in most (72.7%) within 12 months. Unfortunately, 3 patients had persistent partial vision loss. Mild to moderate gastrointestinal side effects were seen in 28% patients. Conclusions Moderate effectiveness of MF was observed in the present study. A significant number of patients developed ocular complications, and thus MF for treatment for PKDL should be suspended and replaced with a safer alternative regimen. [ABSTRACT FROM AUTHOR]

Summary The molecule Hedgehog is well known as an organizer of tissue morphogenesis. A recent report now demonstrates that it also plays the role of a gut hormone, orchestrating the nutrient response during fly development. [ABSTRACT FROM AUTHOR]

Since 1984 the diagnosis of ankylosing spondylitis (AS) has been based upon the modified New York (mNY) criteria with mandatory presence of radiographic sacroiliitis, without which the diagnosis is not tenable. However, it may take years or decades for radiographic sacroiliitis to develop delaying the diagnosis for long periods. It did not matter in the past because no effective treatment was available. However, with the availability of a highly effective treatment, namely, tumour necrosis factor-α inhibitors (TNFi), the issue of early diagnosis of AS acquired an urgency. The Assessment of SpondyloArthritis International Society (ASAS) classification criteria published in 2009 was a significant step towards this goal. These criteria described an early stage of the disease where sacroiliitis was demonstrable only on MRI but not on standard radiograph. Therefore, this stage of the disease was labelled “nonradiographic axial SpA” (nr-axSpA). But questions have been raised if, in search of early diagnosis, specificity was compromised. The Federal Drug Administration (FDA, USA) withheld approval for the use of TNFi in patients with nr-axSpA because of issues related to the specificity of these criteria. This review attempts to clarify some of these aspects of the nr-axSpA-AS relationship and also tries to answer the question whether ASAS classifiable radiographic axial spondyloarthritis (r-axSpA) term can be interchangeably used with the term AS. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Molluscum contagiosum (MC) being a common benign cutaneous viral infection caused by a poxvirus. Topics include most common virus subtype affecting children where the individual lesion being shiny, pearly white, hemispherical, papule with a central umbilication; and eosinophilic at the base and turn basophilic in the dermis suggestive of Henderson–Paterson bodies.

Aim of the Study: The objective of this in-vitro study was to assess the screening capabilities of three endodontic sealers, namely the BioRoot RCS, the MTA Fillapex, and Sealapex (a calcium hydroxide-based sealer), and the gutta-percha cone by using a scanning electron microscopy to the dentine walls. The results from the research are presented here. Results: ZOE exhibited more gaps in the sealing materials evaluated with the least dental sealing performance, followed by the cervical third by the MTA Fillapex, the Sealapex, and the BioRoot RCS. The ZOE, followed by Sealapex, MTA Fillapex, and BioRoot RCS, exhibited inadequate dental wall sealing capacity in the middle of the third. The third apical ZOE exhibited more deficiencies in the formation of dental walls, followed by Sealapex, MTA Fillapex, and BioRoot RCS. Conclusion: Under the constraints of the investigation, it can be stated that for the bioceramic sealer, a minimal gap was seen, with RCS of BioRoot superior to Fillapex of MTA. In the middle third, Sealapex was better adapted to the calcium hydroxide-based sealant than the MTA Fillapex sealer. MTA Filllapex had lower gap development than Sealapex in cervical or apical thirds. [ABSTRACT FROM AUTHOR]

Chorea has often been associated with lesions in the basal ganglia and in the sub thalamic nucleus. It is possible for a patient with chorea-ballismus to have hyperglycemia at the initial presentation. We hereby present a case of an 81-year-old female, who was on treatment for type 2 diabetes mellitus and presented to us with sub acute onset of abnormal movements of right side of the body. She had semi purposeful, rapid and jerky movements of right upper limb and lower limb along with abnormal tongue movements. Laboratory data showed very high blood glucose levels, urine ketones were positive and pH of arterial blood was normal. MRI brain showed hyperintensities in right basal ganglia. So, hyperglycemia induced hemichorea was considered as a possibility and she was treated with insulin. These abnormal movements decreased subsequently with treatment and patient is doing better in the follow-up visits. This presentation is extremely rare, as review of literature showed similar presentations in patients with non ketotic hyperglycemia but not reported so far in diabetic ketosis. [ABSTRACT FROM AUTHOR]

Malaria is an endemic infectious disease in India. It is often associated with other infective conditions but concomitant infection of malaria and meningitis are uncommon. We present a case of meningitis with vivax malaria infection in a 24-year-old lady. This case emphasizes the importance of high index of clinical suspicion to detect other infective conditions like meningitis when fever does not improve even after anti-malarial treatment in a patient of malaria before switching therapy suspecting drug resistance, which is quite common in this part of world. [ABSTRACT FROM AUTHOR]

Microcephaly is a frequent feature of neurodevelopmental disorders (NDDs). Our study presents the heterogeneous spectrum of genetic disorders in patients with microcephaly either in isolated form or in association with other neurological and extra-neural abnormalities. We present data of 91 patients from 87 unrelated families referred to our clinic during 2016–2020 and provide a comprehensive clinical and genetic landscape in the studied cohort. Molecular diagnosis using exome sequencing was made in 45 families giving a yield of 51.7%. In 9 additional families probable causative variants were detected. We identified disease causing variations in 49 genes that are involved in different functional pathways Among these, 36 had an autosomal recessive pattern, 8 had an autosomal dominant pattern (all inherited de novo), and 5 had an X-linked pattern. In 41 probands where sequence variations in autosomal recessive genes were identified 31 were homozygotes (including 16 from non-consanguineous families). The study added 28 novel pathogenic/likely pathogenic variations. The study also calls attention to phenotypic variability and expansion in spectrum as well as uncovers genes where microcephaly is not reported previously or is a rare finding. We here report phenotypes associated with the genes for ultra-rare NDDs with microcephaly namely ATRIP , MINPP1 , PNPLA8 , AIMP2 , ANKLE2 , NCAPD2 and TRIT1. [ABSTRACT FROM AUTHOR]

Tuberculosis of spine is common in a developing country like India. However, involvement of spine at multiple levels along with involvement of rib and tubercular breast abscess in an immunocompetent patient without any pulmonary involvement is extremely rare. Here we report a case of 53-year-old immunocompetent lady who presented with quadriparesis and MRI (magnetic resonance imaging) of spine revealed multiple lesions involving cervical, thoracic, lumbar, and sacral region without any involvement of intervertebral disc. On detailed examination she was found to have a lump in right breast. Fine needle aspiration cytology of both paravertebral collection and breast lump revealed presence of acid fast bacilli. She was put on antitubercular drug for one year and she responded well to therapy. [ABSTRACT FROM AUTHOR]