Search

Background: Diabetes Mellitus(DM) is a long-term metabolic condition. Even within the normal range of HbA1c, non-diabetic cases have shown a positive connection between HbA1c and CVD. This study aimed to evaluate the relationship between glycemic control (HbA1c) and serum lipid profile. Materials and Methods: Between April 2020 and August 2020, a cross-sectional study was carried out on 100 T2DM patients who visited OPD (Diabetes clinic) at the rural health training center of RCSM, GMC in Kolhapur, Maharashtra, India. Fasting blood sugar (FBS), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TGs), LDL and HbA1c were all measured by the American Diabetes Association's criteria to define DM. The assays were performed according to the manufacturers’ instructions. Results: The mean age of the cases was 56.67 ± 5.67 years with male preponderance. The mean duration of diabetes in the present study was 6.72 ± 4.56. We found a significant positive correlation between total cholesterol levels and HbA1c in the present study. (r=0.555; p value0.05). Conclusion: In the current investigation, there was a significant association between Hb1Ac and total cholesterol levels. HbA1c can predict dyslipidemia in addition to a valid glycemic index, and early identification of dyslipidemia can be used to stop the progression of CVD in people with T2DM.

Bharat Gurnani,1 Radhika Natarajan,2 Madhuvanthi Mohan,2 Kirandeep Kaur3 1Department of Cataract, Cornea and Refractive Surgery, ASG Eye Hospital, Jodhpur, Rajasthan, 342008, India; 2Department of Cornea and Refractive Surgery, Sankara Nethralaya Medical Research Foundation, Chennai, Tamil Nadu, 600006, India; 3Department of Pediatric Ophthalmology and Strabismus, ASG Eye Hospital, Jodhpur, Rajasthan, 342008, IndiaCorrespondence: Bharat Gurnani, Department of Cornea and Refractive Surgery, ASG Eye Hospital, Jodhpur, Rajasthan, 342008, India, Tel +919080523059, Email drgurnanibharat25@gmail.comAbstract: Pythium insidiosum, an Oomycete, causes severe keratitis that endangers vision. Its clinical, morphological, and microbiological characteristics are often indistinguishable from those of fungal keratitis, earning it the moniker “parafungus”. Distinctive clinical hallmarks that set it apart from other forms of keratitis include radial keratoneuritis, tentacles, marginal infiltration, and a propensity for rapid limbal spread. The therapeutic approach to Pythium keratitis (PK) has long been a subject of debate, and topical and systemic antifungals and antibacterials have been tried with limited success. Approximately 80% of these eyes undergo therapeutic keratoplasty to salvage the eye. Hence, there is a need to innovate for alternative and better medical therapy to safeguard these eyes. The resistance of Pythium to standard antifungal treatments can be attributed to the absence of ergosterol in its cell wall. Cell walls of plants and algae have cellulose as an essential constituent. Cellulose imparts strength and structure and acts as the “skeleton” of the plant. Fungal and animal cell walls typically lack cellulose. The cellular architecture of Pythium shares a similarity with plant and algal cells through the incorporation of cellulose within its cell wall structure. Inhibitors targeting cellulose biosynthesis (CBI), such as Indaziflam, Isoxaben, and Quinoxyphen, serve as critical tools for elucidating the pathways of cellulose synthesis. Furthermore, the enzymatic action of cellulase is instrumental for the extraction of proteins and DNA. To circumvent this issue, we hypothesize that CBI’s and cellulase enzymes can act on the Pythium cell wall and may effectively treat PK. The available literature supporting the hypothesis and proof of concept has also been discussed. We have also discussed these drugs’ molecular mechanism of action on the Pythium cell wall. We also aim to propose how these drugs can be procured and used as a potential medical management option for this devastating entity.Keywords: Pythium insidiosum, keratitis, cellulose biosynthesis inhibitors, cellulase enzyme, antifungals

Background: There is scarcity of literature exploring the risk factors for Heterotopic Ossification (HO) after Total Hip Replacement (THR) being performed for comminuted proximal femur fractures. HO occurring after THR usually involves the lateral side. HO occurring between the pubis and femur has rarely been reported, and if occurring, have not been reported to be joining the femur and pelvis. Case details: We present a case of HO occurring in a 60 year old gentleman after THR was done for a comminuted proximal femoral fracture. The HO was noted to be joining the medial aspect of the femur shaft to the pelvis. This bridging HO was found to restrict the range movements of the hip and adversely impact the functional outcome of the THR. Conclusion: This report is a lesson for orthopaedic surgeons performing THR following proximal femoral fractures to avoid leaving behind any loosely attached fracture fragments as they could increase the risk of HO.

Duloxetine hydrochloride (trade name Cymbalta) is marketed as a single enantiomer (S)-N-methyl-3-(naphthalen-1-yloxy)-3-(thiophen-2-yl)propylaminium chloride, C18H20NOS+·Cl−, which is twice as effective as the (R)-enantiomer in serotonin uptake. Here, we report the crystal structure of duloxetine hydrochloride in its racemic form (space group Pna21), where it shows significant differences in the molecular conformation and packing in its extended structure compared to the previously reported (S)-enantiomer crystal structure. Molecules of this type, comprising aromatic groups with a single side chain terminated in a protonated secondary amine, are commonly found in active antidepressants. A Cambridge Structural Database survey of molecules with these features reveals a strong correlation between side-chain conformation and the crystal packing: an extended side chain leads to molecules packed into separated layers of hydrophobic and ionic hydrophilic phases. By comparison, molecules with bent side chains, such as racemic duloxetine hydrochloride, lead to crystal-packing motifs where an ionic hydrophilic phase is encapsulated within a hydrophobic shell.

Purpose: The treatment and outcome of tibial stress fractures concomitant with knee osteoarthritis (OA) are complicated. The aim of this study was to evaluate the functional and radiological outcome of total knee arthroplasty with long tibial stem as a treatment for patients having knee OA and tibial stress fracture. Methods: Patients who were diagnosed to have proximal tibia stress fracture along with knee OA at our institution between June 2013 and November 2018 were included in our study. All patients underwent total knee arthroplasty with long tibial stem. Preoperative and postoperative functional assessments were done according to range of movement of the knee joint, knee society score and knee injury and OA outcome score. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables. Results: Twelve patients were included in the study. All patients were found to have stress fractures in the proximal half of tibia and extra-arthrosis. Four patients had non-union/delayed union, and 8 patients had acute fractures. The average preoperative range of movement was 88.1°, which improved to 116.3° at 3 months following surgery. It was found that the fracture has healed in all cases. Mean knee society score improved from 32.9 preoperatively to 89.3 at 1 year follow-up. Knee injury and OA outcome score improved from a mean score of 28.3 preoperatively to 81.1 at 1 year follow-up. Conclusion: Stress fractures can occur in the proximal tibia in patients with knee OA. Total knee arthroplasty with tibial stem provides a suitable solution for both conditions. Additional plating or bone graft is unlikely to be required.

Influenza D virus (IDV) is the most recent addition to the Orthomyxoviridae family and cattle serve as the primary reservoir. IDV has been implicated in Bovine Respiratory Disease Complex (BRDC), and there is serological evidence of human infection of IDV. Evolutionary changes in the IDV genome have resulted in the expansion of genetic diversity and the emergence of multiple lineages that might expand the host tropism and potentially increase the pathogenicity to animals and humans. Therefore, there is an urgent need for automated, accurate and rapid typing tools for IDV lineage typing. Currently, IDV lineage typing is carried out using BLAST-based searches and alignment-based molecular phylogeny of the hemagglutinin-esterase fusion (HEF) gene sequences, and lineage is assigned to query sequences based on sequence similarity (BLAST search) and proximity to the reference lineages in the tree topology, respectively. To minimize human intervention and lineage typing time, we developed IDV Typer server, implementing alignment-free method based on return time distribution (RTD) of k-mers. Lineages are assigned using HEF gene sequences. The server performs with 100% sensitivity and specificity. The IDV Typer server is the first application of an RTD-based alignment-free method for typing animal viruses.

Polynuclear heterobimetallic coordination cages in which different metal cations are connected within a ligand scaffold are known to adopt a variety of polyhedral architectures, many of which display interesting functions. Within the extensive array of coordination cages incorporating Fe(II) centres reported so far, the majority contain low-spin (LS) Fe(II), with high-spin (HS) Fe(II) being less common. Herein, we present the synthesis and characterisation of a new tetradecanuclear heterobimetallic [Fe8Pd6L8](BF4]28 (1) cubic cage utilising the metalloligand approach. Use of the tripodal tris-imidazolimine derivative (2) permitted the formation of the tripodal HS Fe(II) metalloligand [FeL](BF4)2·CH3OH (3) that was subsequently used to form the coordination cage 1. Magnetic and structural analyses gave insight into the manner in which the HS environment of the metalloligand was transferred into the cage architecture along with the structural changes that accompanied its occupancy of the eight corners of the discrete cubic structure.

Ensuring a consistent crystal structure over a wide temperature range can be desirable behaviour in organic devices. This study investigates a layered crystal system formed by hydrogen-bonded chloro-s-triazine rings functionalised with alkyl or fluoroalkyl chains between the layers. When substituted with N-propyl groups (C3), the crystal undergoes a thermally-induced phase transition where the chains are ordered and bent below 170 K and disordered and extended above 175 K. Replacement with fluorinated N-propyl chains (C3-F) produces the same layered crystal but successfully suppresses the phase transition. The hydrocarbon and fluorocarbon analogues were found to be incompatible and unable to form co-crystals from solution or with mechanical mixing. Both effects were ascribed to more attractive C-F…F-C and C-H…F-C interactions in the fluorinated analogue. Long perfluoroalkanes are well known for controlling assembly in the solid state, but this study suggests that short-chain fluoroalkanes can exert strong control over the assembly and stability of an organic crystal.

The delivery of low-carbon buildings (LCBs) in high-rise, high-density cities is still hindered by various common and interdependent constraints. However, a study that developed innovative strategies to address the common constraints to delivering LCBs focusing on traditional high-rise, high-density cities could not be identified in the previous literature. Therefore, this study aimed to identify potential strategies for accelerating the delivery of LCBs in high-rise, high-density cities by addressing relevant common constraints that were identified in recent studies. Accordingly, potentially relevant strategies were identified through eight semi-structured interviews with well-experienced experts in industry and academia. Consequently, 71 strategies were identified under six categories, i.e., policy implementation, building energy/carbon data utilisation, awareness raising/training, technology advancement, incentives, and organisational level commitments. This also required closer collaboration with different stakeholders/stakeholder classes in implementing these strategies, who were, therefore, also identified. An SNA-based analysis was also conducted to explore the connections between constraints and strategies. The strategies related to energy/carbon policy development, standardisation, codes and certifications, mandatory regulations, financial incentives, and technology adoption showed the ability to address a majority of the driving constraints related to policies and technologies. These study findings will assist policymakers and other relevant stakeholders in the arena of the project and asset management in accelerating the delivery of LCBs by adopting an innovative approach to prioritise potential strategies in order to suitably address and synergise the complex interdependencies among the constraints.

Megha Mohan,1 Gagan Bajaj,1 Apramita Deshpande,2 Malavika Anakkathil Anil,1 Jayashree S Bhat1 1Department of Audiology & Speech-Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India; 2Wabi Sabi Speech and Language Clinic, Vadodara, IndiaCorrespondence: Gagan BajajDepartment of Audiology & Speech-Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, IndiaTel +91-9886461351Email gagan.bajaj@manipal.eduPurpose: Language development in children aged 3– 6 years is shaped by their pre-linguistic abilities, communication patterns and play behaviors along with parental communicative roles. Little is known about how these aspects are distributed among children with receptive expressive language disorder (CWRELD) in comparison to typically developing children (CWTDL). The present research explores these differences between the two groups using a video-based analysis with a belief that an understanding of these aspects may facilitate age-appropriate speech and language acquisition in children with language delay.Methods: A video-based analysis of parent–child interactions was carried out for 10 children each with receptive expressive language disorder and typical language development, respectively. The two groups were compared for the child’s turn-taking skills, eye contact span, autonomous instances, communication patterns, play behaviors and parental communication roles.Results: Children with receptive expressive language disorder exhibited significantly fewer proportion of turns and autonomous instances along with a greater proportion of eye contact to objects than the parent. Majority of the children with language delay were at the “Requester” or “Early communicators” stage and demonstrated either “Exploratory” or “Functional play” behaviors. Most of the typically developing children were at the “Partner stage” of communication and exhibited “Functional”, “Constructive” or “Symbolic Play”. Parents of children with language delay mostly exhibited “Helper” type communicative roles while parents from typically developing groups showed “Partner” type communicative profile.Conclusion: A quantitative planning and monitoring of pre-linguistic skills, determination of communicative patterns and play behaviors is important for clinicians working with children having a language delay. Assessing and modifying parental communicative roles are also crucial. Understanding the distribution of these research variables among CWRELD in comparison to CWTDL may help clinicians in planning precise treatment goals, monitoring specific linguistic progress, ensuring better parental participation and delivering better outcomes during language therapy.Keywords: receptive expressive language disorder, pre-linguistic skills, communication stages, play behaviors, parental communication roles, parent–child interaction

Reduction of bicyclo[3.3.0]octane-3,7-dione yields a mixture of the endo-3,endo-7-diol and endo-3, exo-7-diol (C8H14O2) isomers (5 and 6). These form (5)2·(6) co-crystals in the monoclinic P21/n space group (with Z = 6, Z′ = 1.5) rather than undergoing separation by means of fractional recrystallization or column chromatography. The molecule of 5 occupies a general position, whereas the molecule of 6 is disordered over two orientations across a centre of symmetry with occupancies of 0.463 (2) and 0.037 (2). Individual diol hydroxy groups associate around a pseudo-threefold screw axis by means of hydrogen bonding. The second hydroxy group of each diol behaves in a similar manner, generating a three-dimensional hydrogen-bonded network structure. This hydrogen-bond connectivity is identical to that present in three known helical tubuland diol–hydroquinone co-crystals, and the new crystal structure is even more similar to two homologous aliphatic diol co-crystals.

Background: Suicide, commonly defined as “an act of self-destruction, initiated and committed by a person who is aware of the fatal outcome and has substantial socioeconomic and cultural influences. The current suicide rate in India is 10.6/100,000 population. Doctors play an active part in the treatment and prevention of patients with suicide attempts, and their therapeutic endeavors may interrupt the ongoing suicidal process. The aims and objectives of this study were to assess the Opinions and Attitudes of the postgraduates of the various clinical departments towards suicide and to find out for any differences among postgraduates of Surgical and Medical groups who manage the consequences of the chosen methods of the suicidal attempts of the patients. Postgraduates of psychiatry were not included. Materials and Methods: It was a cross-sectional study done on various nonpsychiatric postgraduates between October and November 2019 in R L Jalappa Hospital, a constituent unit of Sri Devaraj Urs Academy of Higher Education and Research, who are assessed using structured and validated instruments, the Suicide Opinion Questionnaire, and Attitudes to Suicide Prevention Scale. Results: The majority of both the Surgical and allied science groups with the Medicine and allied science group nonpsychiatric postgraduates had a negative disposition towards suicide attempters and negative attitudes towards suicide prevention strategies and there was no statistical difference among them. Conclusion: There must be training for non-psychiatric specialists towards suicide regularly and change in their respective PG training curriculum towards the approach of patients with self-injurious behaviors.

Acute myocardial infarction during pregnancy is a very uncommon condition; atherosclerotic coronary artery disease is by far the most common cause of an acute coronary syndrome in the general population. The causes of an acute coronary syndrome in the pregnant patient are wide and varied. This has important implications with respect to the diagnosis of the etiology and the subsequent management of the cause of the acute coronary syndrome. There are a number of diagnostic tools for the diagnosis of coronary artery disease but it is important to understand their role in pregnant patients. Spontaneous coronary artery dissection is one of the most common causes of acute coronary syndrome in pregnant patients. Understanding its pathophysiology and knowing the natural history of this condition is paramount in the management of this condition. The article also lists the various therapeutic modalities available to the clinician faced with an acute coronary syndrome in the pregnant patient. Finally, we discuss the delivery of the baby and post partum care of these complex patients. Keywords: Pregnancy, Acute myocardial infarction, Spontaneous coronary artery dissection

Acute myocardial infarction during pregnancy is a very uncommon condition, atherosclerotic coronary artery disease is by far the most common cause of an acute coronary syndrome in the general population. The causes of an acute coronary syndrome in the pregnant patient are wide and varied. This has important implications with respect to the diagnosis of the etiology and the subsequent management of the cause. There are a number of diagnostic tools for the diagnosis of coronary artery disease but it is important to understand their role in pregnant patients. Spontaneous coronary artery dissection is one of the most common causes of acute coronary syndrome in pregnant patients. Understanding its pathophysiology and knowing the natural history of this condition is paramount in the management of this condition. The article also lists the various therapeutic modalities available to the clinician. Finally, we discuss the delivery of the baby and post partum care of these complex patients.

Background: There are few studies dealing with the diversity in people's knowledge and attitude toward mental health problems. Materials and Methods: This is a descriptive cross-sectional study, conducted in Sri RL Jalappa Hospital and Research Centre, Tamaka, Kolar. The relatives of all patients who visited the hospital served as the study population. A total of 300 consecutive individuals fulfilling the inclusion criteria were chosen for the study. The participants were interviewed using the public perceptions of mental illness questionnaire after obtaining a written informed consent. Results: Majority (39%) of the participants agreed that mental illness is caused by brain disease. On the other hand, one-fifth thought mental illness was God's punishment. About 22% thought that people with mental health problems are largely to blame for their own condition and one-third felt that someone with a mental illness was usually dangerous. The study also identified the magnitude of the stigma attached to mental illness. Almost half (46%) of the participants said they would not want people to know about it if they had a mental illness. Less than one-fifth thought someone could recover from mental illness and only 11% was aware that mental health services were available in the community. Conclusion: The present study concludes that the understanding of the nature of mental illness, its implications for social integration and management remains poor among the general public. Hence, the need for well-coordinated public education, mental health awareness programs and increased accessibility of effective mental health services.

Background. The association between economic status and kidney disease is incompletely explored even in countries with higher economy (HE); the situation is complex in lower economies (LE) of South Asia and Southeast Asia (SA and SEA). Methods. Fifteen countries of SA and SEA categorized as HE and LE, represented by the representatives of the national nephrology societies, participated in this questionnaire and interview-based assessment of the impact of economic status on renal care. Results. Average incidence and prevalence of end-stage kidney disease (ESKD) per million population (pmp) are 1.8 times and 3.3 times higher in HE. Hemodialysis is the main renal replacement therapy (RRT) (HE-68%, LE-63%). Funding of dialysis in HE is mainly by state (65%) or insurance bodies (30%); out of pocket expenses (OOPE) are high in LE (41%). Highest cost for hemodialysis is in Brunei and Singapore, and lowest in Myanmar and Nepal. Median number of dialysis machines/1000 ESKD population is 110 in HE and 53 in LE. Average number of machines/dialysis units in HE is 2.7 times higher than LE. The HE countries have 9 times more dialysis centers pmp (median HE-17, LE-02) and 16 times more nephrologist density (median HE-14.8 ppm, LE-0.94 ppm). Dialysis sessions >2/week is frequently followed in HE (84%) and 10% in all the HE countries except Taiwan, 10%–20% in the majority of LE countries. Conclusion. Economic disparity in SA and SEA is reflected by poor dialysis infrastructure and penetration, inadequate manpower, higher OOPE, higher dialysis dropout rates, and lesser renal transplantations in LE countries. Utility of RRT can be improved by state funding and better insurance coverage.

United Nations Framework Convention on Climate Change highlights the significance of carbon storage and emission in forests towards climate change mitigation. The aim of this study was to quantify the tree biomass and carbon density (carbon storage) in the tropical dry forest of the Chinnar Wildlife Sanctuary of Kerala located in the Southern Western Ghats, India. We investigated the species-wise contribution of carbon (C) storage, as well as the species-wise and plot-wise correlation between carbon and other dendrometric variables. We also analysed the girth (diameter) wise distribution of carbon and tree density in the study region. The study was conducted in eight selected sample plots of the region, each with an area of 0.1 hectare. Species-specific volume and specific gravity relationship coupled with suitable regression equation were used to estimate biomass. Tree carbon was assumed to be 47% of the biomass. The results showed that the average biomass and carbon density of the vegetation were 64.13 t ha-1 and 30.46 t-C ha-1, respectively. Among the 32 species identified, Tamarindus indica L. (17%), Hardwickia binata Roxb. (14%), Terminalia arjuna (Roxb. ex DC.) Wight & Arn (10%) and Pleiospermium alatum (Wight & Arn.) Swingle (10%) were dominant as for carbon storage. The correlation analysis showed that basal area is a good predictor of tree biomass and carbon, while the role of tree density and tree diversity remain uncertain in determining carbon storage. With respect to diametric class distribution, tree density showed a reverse J-shaped pattern indicating the sustainable regeneration of the analysed forest, where the small- (diameter at breast height 3-9 cm) to medium-sized trees (diameter at breast height 10-69 cm) were found to contribute to more than 50% of biomass and carbon in the forest. The study provides useful information for carbon mitigation strategies in a tropical dry forest in the Southern Western Ghats.

Induction motors (IM) used for various industrial applications operate with lagging power factor. Electrical distribution agency insists high power factor operation and it gives incentives on operating a system closer to unity. This paper presents a novel reactive power compensation using IM driven by nine switch ac-dc-ac converter for a high power factor operation at the point of common coupling (PCC). The nine switch converter (NSC) with leading power factor operation delivers reactive power to the PCC. Thus, reactive power required for another load at PCC is compensated. Modified sinusoidal pulse width modulation is developed for NSC to operate the active front end rectifier and an inverter simultaneously to feed three-phase IM. A closed loop proportional integral control technique is developed to achieve desired VAR compensation. As per the required VAR compensation, front end rectifier voltage is modified. This is achieved by phase shifting of front end rectifier modulation reference by an angle δ with respect to utility phase voltage. The PCC phase voltage is continuously sensed to track instantaneous phase angle θ using synchronous reference frame phase lock loop. The analysis of VAR compensator is presented in the d-q reference frame. The proposed system is simulated in MATLAB for VAR compensation at PCC with 5.4 hp induction motor drive to test the performance of VAR control loop. To validate the feasibility of the proposed system an experimental prototype is developed with 1 hp induction motor drive. Gate pulses are generated using digital signal controller dsPIC33EP256MU810. The simulation and experimental results proved the feasibility of the proposed VAR compensation system.

The COVID-19 pandemic is a global challenge that impacted 200+ countries. India ranks in the second and third positions in terms of number of reported cases and deaths. Being a populous country with densely packed cities, SARS-CoV-2 spread exponentially. India sequenced ≈0.14% isolates from confirmed cases for pandemic surveillance and contributed ≈1.58% of complete genomes sequenced globally. This study was designed to map the circulating lineage diversity and to understand the evolution of SARS-CoV-2 in India using comparative genomics and population genetics approaches. Despite varied sequencing coverage across Indian States and Union Territories, isolates belonging to variants of concern (VoC) and variants of interest (VoI) circulated, persisted, and diversified during the first seventeen months of the pandemic. Delta and Kappa lineages emerged in India and spread globally. The phylogenetic tree shows lineage-wise monophyletic clusters of VoCs/VoIs and diversified tree topologies for non-VoC/VoI lineages designated as ‘Others’ in this study. Evolutionary dynamics analyses substantiate a lack of spatio-temporal clustering, which is indicative of multiple global and local introductions. Sites under positive selection and significant variations in spike protein corroborate with the constellation of mutations to be monitored for VoC/VoI as well as substitutions that are characteristic of functions with implications in virus–host interactions, differential glycosylation, immune evasion, and escape from neutralization.

Meera Mohan, Aasiya Matin, Faith E Davies Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA Abstract: The proteasome inhibitor (PI) “bortezomib” has now been in routine clinical practice for over a decade. It is now considered an important backbone therapy for all stages of the disease, and data continue to grow to support its use in newly diagnosed patients, relapsed and relapsed/refractory disease, maintenance therapy, high risk, and renal failure. Much has been learnt about the most clinically effective way of delivering therapy, with patients often benefiting more from a triplet bortezomib combination compared to a doublet combination. It is well tolerated and can be administered in the outpatient setting with manageable toxicity. The key to good results is managing side effects so that patients remain on therapy with minimal interruptions. Therefore, proactive management of peripheral neuropathy and thrombocytopenia is advised using dose delay and reduction strategies. The recent introduction of second- and third-generation PIs with different chemical and biological properties has resulted in a plethora of new clinical studies and has confirmed the ongoing role of this class of drugs in future myeloma therapy. Keywords: multiple myeloma, proteasome inhibitor, bortezomib, treatment

Aim: This study aims to study the estrus induction, ovulation, and conception rate of delayed puberty in buffaloes heifers by feeding a herbal plants Aegle marmelos (bael/bili/bhel leaf) and Murraya koenigii (Curry leaf). Materials and Methods: Totally, 24 buffalo heifers with delayed puberty were selected for the present study and divided randomly in four equal groups (n=6). Before experiment, all animals were dewormed with albendazole at 10 mg/kg body weight to prevent them from the stress of parasitism. In the present experiment, four group taken and Group I (n=6) treated with A. marmelos, Group II (n=6) treated with M. koenigii, Group III (n=6) treated with mixture of A. marmelos and M. koenigii and fed for 9 days. Group IV (n=6) considered as control and fed with concentrate only. The blood samples were collected from all the animals on day 0 (before treatment), 4, 9 (during treatment), on the day of estrus and day 8 after the onset of estrus. The 10 ml blood was collected from the jugular vein of all the experimental animals for estimation of serum calcium, inorganic phosphorus, and progesterone (P4). The estrus response, ovulation, conception rate along with serum calcium, inorganic phosphorus, and progesterone level were determined by the standard protocol. Results: From Group III 4 heifers, from Group II 3 heifers, and from Group I and IV (Control) 2 heifers each, exhibited the estrus. The estrus response was recorded as 33.33%, 50.00%, 75.00%, and 33.33% in Group I, Group II, Group III, and Group IV, respectively. In treatment Group III, serum calcium found significantly more (p

Pricing is one of the major factors that affects ridership and revenue of the bikeshare systems. This paper examines bikeshare users' sensitivity to changes in price and preferences on service by conducting an intercept survey at Capital Bikeshare (CaBi) stations. Monadic price testing approach was used to design survey questions and elicit responses on sensitivity of users to price changes in fare products. Ordered logit regression results indicated that higher household income groups and ‘White’ users are less sensitive to price compared to other income groups and other races/ethnicities, respectively. An illustrative application of the demand curves is presented, which showed that low-income groups are more sensitive to price than the middle and high-income groups. White users were found to be approximately 20% less price sensitive than other races for both casual users purchasing single-trips and annual members. The price elasticities revealed that females are about 30% and 10% more price sensitive than males for single-trip fare (STF) and annual membership, respectively. Also, sightseeing trips are 30% less price sensitive than work trips for STF purchasers. An illustrative application of income-based elasticities indicated that reducing the STF to $1.50 from the current $2.00 per trip and annual membership to $73.00 (from $85 per year) were found to improve both ridership and revenue. It is expected that the contributions from this study would provide insights and guidance on evaluating future pricing policy changes at various bikeshare systems.

Automobiles for our roadways are increasingly using advanced driver assistance systems. The adoption of such new technologies requires us to develop novel perception systems not only for accurately understanding the situational context of these vehicles, but also to infer the driver’s awareness in differentiating between safe and critical situations. This manuscript focuses on the specific problem of inferring driver awareness in the context of attention analysis and hazardous incident activity. Even after the development of wearable and compact multi-modal bio-sensing systems in recent years, their application in driver awareness context has been scarcely explored. The capability of simultaneously recording different kinds of bio-sensing data in addition to traditionally employed computer vision systems provides exciting opportunities to explore the limitations of these sensor modalities. In this work, we explore the applications of three different bio-sensing modalities namely electroencephalogram (EEG), photoplethysmogram (PPG) and galvanic skin response (GSR) along with a camera-based vision system in driver awareness context. We assess the information from these sensors independently and together using both signal processing- and deep learning-based tools. We show that our methods outperform previously reported studies to classify driver attention and detecting hazardous/non-hazardous situations for short time scales of two seconds. We use EEG and vision data for high resolution temporal classification (two seconds) while additionally also employing PPG and GSR over longer time periods. We evaluate our methods by collecting user data on twelve subjects for two real-world driving datasets among which one is publicly available (KITTI dataset) while the other was collected by us (LISA dataset) with the vehicle being driven in an autonomous mode. This work presents an exhaustive evaluation of multiple sensor modalities on two different datasets for attention monitoring and hazardous events classification.

The structure of the title compound, C15H16F6N4O3, was determined using synchrotron radiation on an extremely small crystal (0.015 × 0.01 × 0.01 mm). Although the diffraction was weak, leading to high residuals and a poor data-to-parameter ratio, the data allowed ready solution and refinement to reveal the entire structure. The solid-state structure is in accordance with the absolute configuration assigned based on that of the known starting material. The compound comprises a highly substituted seven-membered N-heterocyclic cation and a trifluoromethanesulfonate counter-anion. The title compound crystallizes with two independent cations (A and B) and anions (C and D) in the asymmetric unit. Two geminal F atoms, a single F atom, a benzyl ether and an azide group are substituted on consecutive C atoms between the NH2 and CH2 units of the azepan-1-ium ring system. The seven-membered rings adopt different conformations with the principal differences occurring in the CF2CHFCH2 segments of the ring systems. The geminal F atoms on the quaternary C atom exhibit essentially identical bond angles [109 (2) and 106 (2)°] in the two independent molecules. The two molecules associate as a dimeric unit via two C—H...F interactions. An extensive series of N—H...O, N—H...F, C—H...O, C—H...N, C—H...F and C—H...π contacts generate a three-dimensional network with cations and anions linked into ABCD repeat columns along a.

Introduction: Myostaal Forte, a proprietary poly-herbal formulation, is mixture of nine herbal plant extracts which possess analgesic, anti-inflammatory and chondroprotective properties. Aim: A prospective, randomised, active controlled, 2-arm, parallel group, assessor blind study was planned to evaluate clinical efficacy and safety of Myostaal Forte in patients of knee osteoarthritis. Materials and Methods: Idiopathic knee osteoarthritis cases as per American College of Rheumatology (ACR) clinical criteria were screened and recruited. A total of sixty patients were assigned to receive Myostaal Forte TDS (n=30) or Paracetamol 650 mg TDS (n=30) for six weeks. Naproxen was rescue analgesia. Modified Western Ontario and McMaster Universities Arthritis Index (WOMAC), Visual Analogue Scale (VAS), global assessment scores determined by orthopaedic physician at baseline, two, four, six weeks and telephonically at eight weeks. Safety was assessed through laboratory investigations at baseline and six weeks, adverse events and tolerability. Data were expressed as Mean±SD and analysed by Chi-square and unpaired t-test. p0.05). No significant adverse events, changes in the laboratory parameters and excellent compliance to treatment were seen in both the groups. Conclusion: Earlier onset analgesic effect with sustained chondroprotection after treatment cessation makes Myostaal Forte, a safe and effective alternative for treatment of knee osteoarthritis.

Introduction: Patello–femoral complications are the most common complications in postoperative Total Knee Arthroplasty (TKA) patients especially overstuffing of Patello – Femoral Joint (PFJ). So, to study the effects of overstuffing of PFJ in postoperative TKA patients we put forth a new dimension - “PATELLO - FEMORAL COMPOSITE (PFC)”. This is the maximum distance between anterior cortical line of femur shaft and the anterior cortex of patella with knee in full extension. Aim: To calculate chances of overstuffing of PFJ in postoperative TKA patients and document the effect of overstuffing of PFJ on the passive knee Range of Motion (ROM) in post- op TKA patients. Materials and Methods: This was a prospective observational study which included 51 consecutive primary TKAs. Preoperative and postoperative (24 weeks) passive knee ROM was measured. Preoperative and postoperative radiological parameters {PFC, Anterior Femur Offset (AFO), Patellar thickness (PT)} was recorded using Computed Tomography (CT) Scanogram image of patient in lateral view with knee in full extension and perfect overlap of both femur condyles, using DICOM format of the CT Scanogram image on the DICOM viewer. Results: The postoperative PFC was more than its preoperativevalue in 80.39% TKAs. Patients who had increased postoperative PFC had significantly less preoperative AFO. Female patients in our study had significantly less preoperative AFO compared to males. Thus, we deduced that female patients with lesser preoperative AFO undergoing TKA had increased postoperative PFC than male patients. PFC not only accounted for the overstuffing of the PFJ because of the patellar component, but also because of the femoral component; thus was a better measure of PFJ overstuffing compared to isolated PT. Passive knee ROM in the postoperative TKA patients approximately decreased by 2 degrees for every 1 mm increase in PFC compared to its preoperative-value in the patients with PFJ overstuffing. Conclusion: We conclude that overstuffing of the PFJ in postoperative TKA is present in 80.39% patients. Higher chances of postoperative PFJ over stuffing are present in female patients and those with thinner anterior cortex of distal femur. Postoperative passive knee ROM decreases significantly in patients with postoperative PFJ overstuffing (Every 1 mm increase in the postoperative PFC, passive knee ROM decreased by approximately 2 degrees).

Orthopaedic Surgeons rarely encounter mycobacterial infections in Post Total Knee Arthroplasty (TKA) patients. We present series of two cases to create awareness among clinicians to expect the unexpected. Tuberculosis typical/ atypical is a hidden culprit in catch clinical situations when chronic infection is Suspected, but the lab investigations are negative in persistently symptomatic patients. In such situations clinicians should suspect atypical or complex mycobacterial infections and evaluate the patients accordingly. Clinical suspicion, evaluation, isolation and treatment of atypical or complex mycobacterial infections with sensitive chemotherapy, leads to complete resolution of infection and full functional rehabilitation.

A series of new group 2 coordination polymers, MgL ={MgL(H2O)(DMF)0.75}∞, CaL = {CaL(DMF)2}∞, SrL = {SrL(H2O)0.5}∞ and BaL = {BaL(H2O)0.5}∞, were synthesized using a flexible benzimidazolone diacetic acid linker (H2L) in which the two carboxylic acid binding sites are connected to a planar core via {–CH2–} spacers that can freely rotate in solution. In a ‘curiosity-led' diversion from group 2 metals, the first row transition metal salts Mn2+, Cu2+ and Zn2+ were also reacted with L to yield crystals of MnL = {MnL(DMF)(H2O)3.33}∞, Cu3L2 = {Cu3L2(DMF)2(CHO2)2}∞ and ZnL = {ZnL(DMF)}∞. Crystal structures were obtained for all seven materials. All structures form as two-dimensional sheets and contain six-coordinate centres, with the exception of ZnL, which displays tetrahedrally coordinated metal centres, and Cu3L2, which contains square planar coordinated metal centres and Cu paddle-wheels. In each structure, the linker adopts one of two distinct conformations, with the carboxylate groups either cis or trans with respect to the planar core. All materials were also characterized by powder X-ray diffraction and thermogravimetric analysis.

Background Dengue is one of the most common arboviral diseases prevalent worldwide and is caused by Dengue viruses (genus Flavivirus, family Flaviviridae). There are four serotypes of Dengue Virus (DENV-1 to DENV-4), each of which is further subdivided into distinct genotypes. DENV-2 is frequently associated with severe dengue infections and epidemics. DENV-2 consists of six genotypes such as Asian/American, Asian I, Asian II, Cosmopolitan, American and sylvatic. Comparative genomic study was carried out to infer population structure of DENV-2 and to analyze the role of evolutionary and spatiotemporal factors in emergence of diversifying lineages. Methods Complete genome sequences of 990 strains of DENV-2 were analyzed using Bayesian-based population genetics and phylogenetic approaches to infer genetically distinct lineages. The role of spatiotemporal factors, genetic recombination and selection pressure in the evolution of DENV-2 is examined using the sequence-based bioinformatics approaches. Results DENV-2 genetic structure is complex and consists of fifteen subpopulations/lineages. The Asian/American genotype is observed to be diversified into seven lineages. The Asian I, Cosmopolitan and sylvatic genotypes were found to be subdivided into two lineages, each. The populations of American and Asian II genotypes were observed to be homogeneous. Significant evidence of episodic positive selection was observed in all the genes, except NS4A. Positive selection operational on a few codons in envelope gene confers antigenic and lineage diversity in the American strains of Asian/American genotype. Selection on codons of non-structural genes was observed to impact diversification of lineages in Asian I, cosmopolitan and sylvatic genotypes. Evidence of intra/inter-genotype recombination was obtained and the uncertainty in classification of recombinant strains was resolved using the population genetics approach. Discussion Complete genome-based analysis revealed that the worldwide population of DENV-2 strains is subdivided into fifteen lineages. The population structure of DENV-2 is spatiotemporal and is shaped by episodic positive selection and recombination. Intra-genotype diversity was observed in four genotypes (Asian/American, Asian I, cosmopolitan and sylvatic). Episodic positive selection on envelope and non-structural genes translates into antigenic diversity and appears to be responsible for emergence of strains/lineages in DENV-2 genotypes. Understanding of the genotype diversity and emerging lineages will be useful to design strategies for epidemiological surveillance and vaccine design.

Rhinoviruses (RV) are increasingly being reported to cause mild to severe infections of respiratory tract in humans. RV are antigenically the most diverse species of the genus Enterovirus and family Picornaviridae. There are three species of RV (RV-A, -B and -C), with 80, 32 and 55 serotypes/types, respectively. Antigenic variation is the main limiting factor for development of a cross-protective vaccine against RV.Serotyping of Rhinoviruses is carried out using cross-neutralization assays in cell culture. However, these assays become laborious and time-consuming for the large number of strains. Alternatively, serotyping of RV is carried out by alignment-based phylogeny of both protein and nucleotide sequences of VP1. However, serotyping of RV based on alignment-based phylogeny is a multi-step process, which needs to be repeated every time a new isolate is sequenced. In view of the growing need for serotyping of RV, an alignment-free method based on "return time distribution" (RTD) of amino acid residues in VP1 protein has been developed and implemented in the form of a web server titled RV-Typer. RV-Typer accepts nucleotide or protein sequences as an input and computes return times of di-peptides (k = 2) to assign serotypes. The RV-Typer performs with 100% sensitivity and specificity. It is significantly faster than alignment-based methods. The web server is available at http://bioinfo.net.in/RV-Typer/home.html.