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Congenital melanocytic nevi, as the name suggests, are present since birth. They are called giant congenital melanocytic nevus (GCMN) when the size exceeds >20 cm in diameter. Due to its unsightly appearance, there is major psychosocial impact on the patient and the family. GCMN in due course of time may give rise to malignant melanoma not only in the GCMN but also in the leptomeninges. Clinical variants of GCMN include nevus spilus type, which is a rare variant. In addition to that with time, GCMN may continue to be affected with benign nodules. We present a rare case of a nevus spilus type of GCMN with classic proliferative nodules associated with intraparenchymal melanosis in brain, leading to seizures.

Banana is a staple food for millions of individuals, especially in regions with tropical and subtropical climates. Nevertheless, the cultivation of banana is under significant threat from Fusarium wilt, a harmful biotic stress transmitted through the soil and caused by Fusarium oxysporum f. sp. cubense (Foc). This disease has the potential to devastate and infect almost all the varieties of bananas, especially with the emergence of Foc race 4. This study investigates the possibility of Streptomyces rochei AMBEAROOT2, isolated from the banana, used as a biocontrol agent against Fusarium wilt in banana. The molecular characterization of ten Foc isolates identified Fusarium oxysporum f. sp. cubense TFOC6 as the most virulent and confirmed as race 4. S. rochei AMBEAROOT2 exhibited significant mycelial inhibition (62.3%) of F. oxysporum f. sp. cubense TFOC6 and plant growth-promoting characteristics, including indole-3-acetic acid, biofilm formation, and exopolysaccharide synthesis. Gas Chromatography-Mass Spectroscopy analysis identified metabolites produced by S. rochei AMBEAROOT2, with molecular docking investigations revealed strong binding affinities of compounds viz., 3-phenyl-3-p-tolyl-1-(2,4,6-trimethyl-phenyl)-propane-1-one, 19-acetoxy-4,4-dimethyl-, oxime, Androst-5-en-3-one, and Pyrano [4,3] benzopyran-1,9-dione to key virulence proteins (Catalase-peroxidase, Kynureninase, Penta functional AROM polypeptide, and Ribose phosphate pyrophosphokinase) of Foc. In greenhouse conditions, micro-propagated banana plantlets treated with S. rochei AMBEAROOT2 demonstrated enhanced growth, improved physiological traits, and higher levels of defense enzymes compared to those inoculated with F. oxysporum f. sp. cubense TFOC6 alone. It also induced systemic resistance and a 100% decrease in the incidence of Fusarium wilt. In conclusion, S. rochei AMBEAROOT2 showed potential antifungal activities, promoted plant growth, and could be used to manage wilt disease in banana after field evaluation.

Bullous pemphigoid (BP) is an autoimmune condition characterized by tense subepidermal blisters commonly seen in old age. Vitiligo is another autoimmune disease associated with loss of melanocytes. Very few cases of coexistence of vitiligo and BP are reported. A split skin graft (SSG) is a surgical option for stable vitiligo. BP over the SSG is a rare occurrence. We present the case of an elderly individual who developed BP at the site of SSG for vitiligo. Postmanagement of BP the lesion healed with recurrence of vitiligo patch at the same site. This case highlights that surgical intervention without ascertaining the stability of the disease activity may not only preclude the patient to the development of the primary disease but also lead to development of other autoimmune illnesses at the surgical site due to unmasking of the epitope to already circulating antibodies.

The Andaman and Nicobar Islands are rimmed by discontinuous fringing reef that is in general wider on western margin vs the eastern margin. This study characterizes the facies updip from the modern fringing reefs to the present shoreline of south Andaman and Swaraj Dweep, and describes in detail the coral terraces/carpets within and above the inter-tidal zone representing the Holocene Fringing reef. Field studies, satellite, and drone datasets have been utilized to map different facies, that include: coralgal boundstone, biodetrital-grainstone, beachrock, and coralgal rudstone. Multiple exposed microatolls as well as coral terraces (coral carpets) of Acropora and Porites (dated 8.7-8.4 ka BP) have been identified within the intertidal zone (Radhanagar Beach, Swaraj Dweep) indicating that Holocene fringing reef have down-stepped offshore to the current location of modern fringing reefs owing to either tectonics or eustasy. The eustatic sea-level fluctuations are relatively well established for the Holocene and we compute the tectonic uplift rates utilizing the stream-power-incision and linear-inversion model. A tectonic uplift rate of ~ 0.05 mm/yr (for Swaraj Dweep) during the past 100 ka is estimated, while taking into account a wide range of erodibility indexes and response time intervals. It is identified that the computed uplift rate is an amalgamation of the coseismic deformation along with the interseismic and aseismic surface deformation. Thus, not all exposed coral terraces/microatolls are exposed due to coseismic deformation (for example uplift in parts of Andaman due to earthquake in 2004). The average long-term uplift rates are a magnitude lower than the eustatic sea-level fall rates during Holocene, thus, we suggest that most of the Holocene fringing reefs are exposed due to eustatic sea-level fall and down-stepped to the current location of the modern fringing reefs. This would entail that the eustatic sea-level change rates would play a significant role in determining future of the modern fringing reef (catch-up vs keep up vs give up), and the coastal morphology of south Andaman and Swaraj Dweep, with implications for coastal inundation and stability in the scenario of climate change.

The green oak leaf roller moth, Tortrix viridana, is one of the main defoliators of deciduous oaks in the Mediterranean region. Although aerial applications of Btk-based insecticides represent the most effective method to control the larval populations of this pest at a large spatial scale, the optimal time window for sprayings has not yet been defined. Accordingly, experimental trials were conducted in a Quercus pubescens forest district in Sardinia (Italy) involving both large-scale aerial treatments and small-scale applications from the ground. The aim of our work was to study how different larval development stages and/or sprouting phenological phases of the host trees affect Btk efficacy. Aerial sprayings were conducted in 2003 and 2004 in two different areas of about 300 ha, selected according to altitude and exposure to simulate three different application timings against different larval instars and sprouting phenological phases. From-the-ground applications were carried out in 2021 in a Q. pubescens forest stand by applying Btk-based insecticides at different timings, and the overall Q. pubescens phenological stage and the distribution of T. viridana larval development stages were assessed accordingly. The effectiveness of Btk applications was evaluated by estimating larval mortality 7, and 14 days after aerial applications, and 7, 14 and 21 days after ground applications. Defoliation due to T. viridana was also evaluated at the end of larval development in all years. In both 2003 and 2004, the average larval mortality due to Btk exceeded 80 % two weeks after aerial applications across all application timings. Damage caused by T. viridana varied with Btk application timing, with the later applications showing a higher defoliation than other timings. In ground application experiments, larval mortality significantly increased when Btk was sprayed against a larval population primarily composed of IV instars, which were feeding on sprouts with leaves that were spread out and had not fully developed internodes, thus resulting in a significative reduction of insect damage. Our findings indicate that, in accordance with the strict synchrony between the larval development and the oak flushing, the optimal timing for Btk application against T. viridana can be defined based on the bud burst phenological phase. In particular, the prevalence of sprout with expanding leaf surface allowing insecticidal droplet interception and the simultaneous presence of susceptible larval instars (within the IV), resulted in an increased treatment efficacy.

Thermal maturity assessments of hydrocarbon-generation potential and thermal history rarely consider how upper-plate structures developing during subduction influence the trajectories of accreted sediments. Our thermomechanical models of subduction support that thrusts evolving under variable sedimentation rates and décollement strengths fundamentally influence the trajectory, temperature, and thermal maturity of accreting sediments. This is notably true for the frontal thrust, which pervasively partitions sediments along a low- and a high-maturity path. Our findings imply that interpretations of the distribution of thermal maturity cannot be detached from accounts of the length and frequency of thrusts and their controlling factors. Our approach takes these factors into consideration and provides a robust uncertainty estimate of maximum exposure temperatures as a function of vitrinite reflectance and burial depth. As a result, our models reduce former inconsistencies between predicted and factual thermal maturity distributions in accretionary wedges.

Introduction: Chronic Low Back Pain (CLBP) is a disabling musculoskeletal condition with a high prevalence in developing and developed countries. There are many treatment modalities but none of them provides a satisfactory and consistent cure. Recently focus has shifted to neuromodulation to cure chronic pains. The U.S. Food and Drug Administration (FDA) approved the use of Repetitive TMS (rTMS) in the management of Pain in 2013. Since then, centres across the world have been using Transcranial Magnetic Stimulation (TMS) as a noninvasive modality for the treatment of various pain conditions. rTMS is a variation of TMS where stimulation is provided in sessions to create long-term excitation in the brain cortex. Evidence on the effectiveness of rTMS for CLBP is scarce due to limited rigorous clinical trials. This study is the first of its kind undertaken in India to critically analyze the role of rTMS in the treatment of CLBP. Materials & Methods: In this single institutional prospective, single-blind study, we enrolled 40 patients of CLBP sharing similar clinical profiles. They were divided into a test group and a sham group. In the test group patients were given rTMS in addition to conventional treatment while in the sham group, patients were taken through the procedure of rTMS without actually being administered it. A figure-of-eight-shaped coil was used focusing on the Left M1 area and Dorsolateral prefrontal cortex to administer the rTMS by a trained physician. Visual Analogue Scores (VAS) were noted before and after the procedure. Each patient was continuously monitored during the procedure for any side effects. Subsequently, they were interviewed and followed up for 6 months. At the end of 6 months, data was compiled and conclusions were drawn. Result: In our study, we found that 90 per cent of patients in the test group reported a reduction in VAS score by 30 per cent reduction while the remaining had a 20 per cent reduction in pain scores. 90 per cent of subjects in the sham group reported a marginal improvement in VAS score which can be attributed to the placebo effect. Most patients in the test group reported an improvement in quality of life at the end of six months. None of the patients suffered any untoward side effects during or after the procedure. Conclusion: Based on our study we conclude that rTMS is a safe procedure and it can be used as a modality in treating CLBP with satisfactory outcomes. Although the sample size was small, it is the first study of its kind undertaken in India to evaluate the role of rTMS-based neuromodulation in treating this chronic disabling condition. However, to be accepted as a standard of care for CLBP it will require further multi-institutional robust clinical trials with long-term follow-up.

Objective: Understanding patients' perspectives is essential for treatment planning and assessing healthcare efficacy. This study explored the influential factors in root canal treatment (RCT) on patient satisfaction.Methods: This prospective study involved 390 eligible patients who underwent RCT at the Department of Conservative Dentistry and Endodontics, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. We collected data by assessing endodontic factors before treatment and using a post-treatment semantic differential scale questionnaire. Patients’ satisfaction was measured using a visual analogue scale (VAS) from 0 (least satisfaction) to 10 (highest satisfaction possible). Mann-Whitney U-test and Kruskal-Wallis test were employed for data analysis, and P-value

Background: Fever is defined as a rectal temperature of 100.4oF or more. It is a physiologic response characterized by an elevation of body temperature above normal variation. Fever is one of the common causes of medical consultation in children, responsible for 15%–25% of consultations in Pediatrics practice. Children with prolonged fever worry their parents and are a diagnostic challenge to pediatricians. Persistence of fever raises clinical queries towards diagnosis, especially in patients without identifiable focus. Children with a temperature of more than 38°C (100.4°F) recorded by a healthcare professional without any determined reason after at least 8 days of evaluation should be classified as having a “fever of unknown origin”. Most fevers with unknown causes usually have atypical presentations of common illnesses. Case Presentation: We reviewed the case records of 9 children admitted to our pediatric ward with prolonged fever episodes from December 2021 to October 2022. They were diagnostic challenges for clinicians. In our cases, 2 children had scrub typhus, 1 was diagnosed with acute lymphoblastic leukemia, and 1 had multidrug-resistant typhoid fever. However, 2 patients remained with a fever of unknown origin. Three children were found to have coinfections and diagnosed with enteric fever with other coinfections like dengue, leptospirosis, and urinary tract infection. Cases 1, 2, and 9 had persistent fever despite appropriate antibiotics therapy based on sensitivity patterns, hence a significant diagnosis challenge. Cases 3 and 6 had initial diagnostic deviations due to their atypical presentations, and both cases were diagnosed as scrub typhus. After extensive evaluation, case 4 was diagnosed as malignancy (acute lymphoblastic leukemia). Cases 5 and 7 posed a diagnostic challenge: The causes were not found after extensive evaluation, and there was persistent fever after 10 days of admission. Hence, they were diagnosed as “fever of unknown origin”. Conclusions: A complete history and detailed examination are essential in evaluating pediatric illnesses. We have found that there might be deviators during disease evolution. We should not settle with a single diagnosis until a good clinical response is achieved and also consider alternative diagnoses or coinfections. Common causes of prolonged fever should be ruled out first. Coinfections should also be considered if there is no clinical response to treatment in a patient. A practical, systematic, and stepwise approach can be helpful with the assessment and management of prolonged fever in the pediatric age group.

Introduction: Flipped classroom is an element of blended learning, integrating both face-to-face learning in the class through group discussion and distance learning outside the class by watching video lessons and online collaboration. The objective of the study was to introduce and assess the effectiveness of flipped classroom in teaching and learning of Conservative Dentistry and Endodontics and to understand the perspective of students about the same. Methods: Third year undergraduate dental students were randomly divided into two groups: structured interactive session group and flipped classroom group. Structured interactive session group had their class taken in the traditional manner while the flipped classroom group was given power point presentation and videos beforehand so that students came to class being prepared. The in class time was utilized for group discussions and peer exercises. Same set of questions including multiple choice questions (MCQs) and problem based questions (PBQs) validated by the faculties involved in the research was used for assessment. A questionnaire was then provided to students regarding their perception of flipped classroom method. Results: Among the 41 students, 19 students were in structured interactive session group and 22 were in flipped classroom group. The mean MCQ and PBQ score in structured interactive session group was 69.47 and 59.39 respectively whereas it was 73.17 and 66.55 respectively in flipped classroom group. Conclusions: The performance of flipped classroom group was better in both MCQs and PBQs. Students preferred flipped classroom method and were ready to accept it as their teaching learning modality.