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Background Preoperative laboratory tests (PLTs) are often obtained prior to outpatient surgical procedures. The objective of this study is to examine the current practice of routine PLT in low-risk patients undergoing ambulatory endoscopic sinonasal surgery (ESS) and to assess whether such testing impacts surgical outcomes. Methods Patients undergoing ambulatory ESS were identified from the 2011 to 2018 NSQIP database. Low-risk patients were defined as American Society of Anesthesiologist class 1 or 2. PLTs were grouped into hematologic, chemistry, coagulation, and liver function tests. Chi-square analyses and independent samples t-tests were conducted to compare categoric and continuous variables, respectively. Results A total of 664 cases met the inclusion criteria, of which 419 (62.1%) underwent at least one PLT. Of these, the most frequent PLT obtained was a complete blood cell count (92.4%). Major complications occurred in 1.5% of patients. There were no statistically significant differences in overall postoperative complications between those with and without PLT ( P = .264). Specifically, no significant difference was seen in the incidence of postoperative bleeding ( P = .184), urinary tract infection ( P = .444), pulmonary embolism ( P = .444), or wound infection ( P = .701). On multivariable analyses, PLT status was not significantly associated with any complication ( P = .097) or unplanned readmission ( P = .898). Conclusions Our analysis did not reveal an association between the use of PLT and postoperative morbidity or unplanned readmission in low-risk patients undergoing outpatient ESS.

Aim: The study compares and evaluates enzymatic gel Brix 3000â and Polymer bur (SS White) for caries excavation in primary molars in terms of two parameters such as pain reaction and the time taken for caries excavation. Method: 60 children aged 7-9 years who require caries removal were recruited for the study and were randomly allocated into two groups: Group-A: Enzymatic gel (Brix 3000)â, Group-B: Smart burs (SS White polymer burs). The objectives evaluated were, observed pain reaction of the child (SEM scale) during the procedure and the total time taken for caries excavation. Results: The results suggest a significant difference between among the groups Brix 3000â showed superior results compared to group B (Smart burs) i.e., use of Brix 3000â for caries excavation took less time and showed minimal pain reaction. Conclusion: We can conclude that the newer enzymatic gel Brix 3000 is a viable alternative to other minimally invasive procedures. Clinical Significance: Method practiced to minimise the treatment time and discomfort, especially in pediatric age group it becomes important factor to obtain child cooperation.

Aim: To assess the knowledge and awareness of the benefits & risk of different infant feeding practices amongst dentists. Materials and methods: The present cross-sectional study was conducted among 205 dentists by using convenience sampling method. Results: 79.8% of the participants responded that breastfeeding should be initiated within 1 hour of birth whereas only 3.8% reported it to be initiated within 24 hours of birth. Around 78.8% of the participants had the knowledge about commencement of exclusive breastfeeding for 6 months after birth. 51.4% participants knew that breastmilk can provide one third of energy between 12 and 24 months. We found that 51.0% participants responded that pumped breastmilk can be stored for 4 hours at room temperature. Conclusion: There is a generalized lack of awareness regarding infant feeding practices among general dentists and most of them are not updated about the latest recommendations.

A novel coronavirus (2019-nCoV) or Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) that affects humans has been discovered in Wuhan, China, in 2019. Its genome has been sequenced, and the genetic data was quickly made public. We discovered a novel proprotein convertase subtilisin kexin-9 (PCSK9) cleavage site in the Spike protein of the 2019-nCoV. The recent research also demonstrates that the previously found proprotein convertase 3 (PC3) or furin cleavage site, which was assumed to be unique, is already present in animal corona viruses. In this article, we suggest that the combination of the both proprotein convertase PC3 cleavage site and the PCSK9 site renders SARS-CoV-2 unique in terms of the pathogenicity, potential functional effects, and implications for the development of antiviral drugs.

The coronavirus disease 2019 (COVID-19) pandemic necessitated using telehealth to bridge the clinical gap, but could increase health disparities. This article reports on a chart review of diabetes telehealth visits occurring before COVID-19, during shelter-in-place orders, and during the reopening period. Visits for children with public insurance and for those who were non-English speaking were identified. Telehealth visits for children with public insurance increased from 26.2% before COVID-19 to 37.3% during shelter-in-place orders and 34.3% during reopening. Telehealth visits for children who were non-English speaking increased from 3.5% before COVID-19 to 17.5% during shelter-in-place orders and remained at 15.0% during reopening. Pandemic-related telehealth expansion included optimization of workflows to include patients with public insurance and those who did not speak English. Increased participation by those groups persisted during the reopening phase, indicating that prioritizing inclusive telehealth workflows can reduce disparities in access to care.

Global public health is seriously threatened by Antimicrobial Resistance (AMR), and there is an urgent need for quick and precise AMR diagnostic tools. The prevalence of novel Antibiotic Resistance Genes (ARGs) has increased substantially during the last decade, owing to the recent burden of microbial sequencing. The major problem is extracting vital information from the massive amounts of generated data. Even though there are many tools available to predict AMR, very few of them are accurate and can keep up with the unstoppable growth of data in the present. Here, we briefly examine a variety of AMR prediction tools that are available. We highlighted three potential tools from the perspective of the user experience that is preferable web-based AMR prediction analysis, as a web-based tool offers users accessibility across devices, device customization, system integration, eliminating the maintenance hassles, and provides enhanced flexibility and scalability. By using thePseudomonas aeruginosaComplete Plasmid Sequence (CPS), we conducted a case study in which we identified the strengths and shortcomings of the system and empirically discussed its prediction efficacy of AMR sequences, ARGs, amount of information produced and visualisation. We discovered that ResFinder delivers a great amount of information regarding the ARGS along with improved visualisation. KmerResistance is useful for identifying resistance plasmids, obtaining information about related species and the template gene, as well as predicting ARGs. ResFinderFG does not provide any information about ARGs, but it predicts AMR determinants and has a better visualisation than KmerResistance.Author summaryAMR is the capacity of microorganisms to survive or grow in the presence of drugs intended to stop them or kill them. Consequently, there is an increase in the Burden of disease, death rates, and the cost of healthcare, making it a serious global threat to both human and animal health. Next-Generation Sequencing (NGS) based molecular monitoring can be a real boon to phenotypic monitoring of AMR. Researchers face difficult challenges in terms of producing, managing, analysing, and interpreting massive amounts of sequence data. There are many tools available to predict AMR, but only a small number of them are reliable and able to keep up with the current rate of unstoppable data growth. Each tool has specific benefits and drawbacks of its own. Our research offers a comprehensive overview of the outcomes produced by three different tools, enabling users to choose the tool that best suits their requirements.

The supraorbital craniotomy through an eyebrow incision, referred to as the suprabrow approach, may be used to access intracranial lesions. Though offering good surgical exposure for anterior base cranial lesions, the suprabrow approach has a paucity of studies on its cosmetic outcomes. In this study, we aimed to assess the cosmetic outcomes of suprabrow approach using validated Scar Cosmesis Assessment Rating (SCAR) scale for the first time. Three patients underwent a suprabrow approach for resection of a suprasellar or frontal mass. Their postoperative courses were followed, with specific attention to the cosmetic outcome of their procedures. The SCAR scale was used to determine the cosmetic success of the approach. We found that all 3 patients scored ≤ 5 on the SCAR scale. All 3 resections were successful with no major postoperative complications. The only minor complication was transient hypoesthesia of the ipsilateral forehead that was noted in all 3 patients.This study quantified the positive cosmetic outcomes of a minimally invasive suprabrow approach. The suprabrow approach provides acceptable surgical exposure and access in an appropriately selected patient with anterior cranial base lesions and results in favorable cosmesis. Although transient hypoesthesia in the distribution of the ophthalmic branch of the trigeminal nerve occurs, the overall benefits of the approach and desirable cosmetic outcomes make the suprabrow approach a good technique to access intracranial lesions in appropriate cases.

Oral cancer (OC) is the sixth most common global malignancy and blazing dilemma all over India. Tobacco and alcohol consumption are the well-established risk factors for the onset of oral cancer. G...

Background Central adrenal insufficiency from drug-drug interaction between steroids and HIV anti-retroviral medications is a well-documented phenomenon in the literature, but in clinical practice making this diagnosis can prove challenging. Clinical Case 58-year-old woman with well-controlled HIV on dolutegravir and cobicistat/darunavir, type 2 diabetes mellitus, and chronic kidney disease presented to our emergency department with 3 days of polyuria, polydipsia, headaches, nausea, and decreased appetite. She also noticed that her glucose readings have been much higher than usual. 5 days prior to presentation, she received a 40 mg triamcinolone acetonide injection into her right subacromial bursa for chronic shoulder pain. For diabetes, she had been on the same dosage of weekly dulaglutide with good control. Initial laboratory evaluation revealed elevated serum glucose of 763 mg/dl (70 - 140 mg/dL) without an elevated anion gap, sodium of 124 mEq/L (135 - 145 mEq/L) and potassium of 5.9 mmol/L (3.6 - 5.2 mmol/L). Morning cortisol was sent as part of the workup for hyponatremia and returned low at 1.2 ug/dL (4 - 20 ug/dL). A 250 mcg cosyntropin stimulation test was performed, with baseline cortisol at 1.3 ug/dL and one-hour post-stimulation cortisol of 8.8 ug/dL. Pre-stimulation ACTH was < 5. 0 pg/mL (10 - 60 pg/mL). A synthetic glucocorticoid panel were sent on the 11th day after her injection and detected triamcinolone acetonide at 3.3 mcg/dL (cutoff: 0.1 mcg/dL) in urine and 0.85 mcg/dL (cutoff: 0.1 mcg/dL) in serum. She was diagnosed with iatrogenic adrenal insufficiency from intra-articular triamcinolone injection, the effect of which had been potentiated by her HIV medications cobicistat and dolutegravir (both CYP3A4 inhibitors). She was started on hydrocortisone and experienced improvement in appetite and fatigue. A plasma renin activity assay was elevated at 7.66 ng/mL/h (0.25 - 5.82 ng/ml/h) with 15 ng/dL of aldosterone (3 - 16 ng/dL). While awaiting the ACTH result, we discussed the possibility of primary adrenal insufficiency given persistent hyponatremia despite improved glucose control. However, given recent normal cross-sectional abdominal imaging, the history of steroid exposure, and lack of opportunistic infections in the past, central adrenal insufficiency remained the leading diagnosis. Further workup, including urine anion gap, eventually determined the cause of her hyponatremia to be a type 4 RTA likely related to her longstanding history of diabetes. The patient was discharged home on hydrocortisone with plan for repeat stimulation test in 6 weeks. Conclusion 1. Keep primary adrenal insufficiency in mind in a patient with HIV who presents with hyponatremia and low cortisol. 2. Steroid injections carry risks of significant hyperglycemia and iatrogenic adrenal insufficiency in patients receiving cobicistat and integrase inhibitor. Presentation: No date and time listed

Furin, a pro-protein convertase, plays a significant role as a biological scissor in bacterial, viral, and even mammalian substrates which in turn decides the fate of many viral and bacterial infections along with the numerous ailments caused by cancer, diabetes, inflammations, and neurological disorders. In the wake of the current pandemic caused by the virus SARS COV-2, furin has become the center of attraction for researchers as the spike protein contains a polybasic furin cleavage site. In the present work, we have searched for novel inhibitors against this interesting human target from FDA-approved antivirals. To enhance the selection of new inhibitors we employed Kohonen’s artificial neural network-based self-organizing maps for ligand-based virtual screening. Promising results were obtained which can help in drug repurposing and network pharmacology studies addressing the errors generated due to promiscuity/polypharmacology. We found 15 existing FDA antivirals having the potential to inhibit furin. Among these, six compounds have targets on many important human proteins (LDLR, FCGR1A, PCK1, TLR7, DNA, and PNP) also. These 15 drugs inhibiting furin could be studied in patients infected with many viruses including SARS COV-2. We also propose two promising candidate FDA drugs GS-441524 and Grazoprevir (MK-5172) for repurposing as inhibitors of furin. The best results were observed with GS-441524.

In this paper, we relate the topological definitions of specification property and distributional chaos defined for uniformly continuous self-maps on noncompact, nonmetrizable spaces. We prove that a uniformly continuous surjective self-map acting on a uniformly locally compact Hausdorff uniform space with topologically weak specification property and a pair of distal points is topologically distributionally chaotic of type 1. This extends the result due to Oprocha and Štefánková [2008]. As a consequence, we get that uniformly continuous surjective self-map on a uniformly locally compact totally bounded Hausdorff uniform space with topological shadowing, topological mixing, and a distal pair is topologically distributionally chaotic of type 1.

India is responsible for the supply of diagnostic neutral beam systems for ITER to diagnose its helium ash during the deuterium-tritium plasma phase using the charge exchange recombination spectroscopy technique. Considering the many first of its kind in terms of technologies and beam development aspects, ITER Indian domestic agency has adopted a strategy of developing the technology and beam experimentation in parallel. On the beam development front three test beds, namely, the ROBIN (Rf Operated Beam source in India for Negative ion research), the TWIN (TWo rf driver-based Indigenously built Negative ion source), and the INTF (INdian Test Facility) are presently in their various phases of operation, optimization, and setting up at IPR, respectively. Experiments related to plasma production, beam production, and acceleration up to 30 keV in volume and surface mode have been performed on ROBIN. The maximum negative hydrogen ion current density to a tune of 27 mA/cm

"Vote" means to choose a candidate from a list. By casting the votes, the Citizens choose a candidate from a list. Eliminating the bogus vote by linking the voting machine with Aadhaar card as well as Pan Card is the goal of the project. In this system, voting is based on Aadhaar and PAN databases. Since all the data is stored in the database of a particular place of a booth, such voting system is more efficient.

Objective To evaluate knowledge, practices, and beliefs of US patients receiving prescription opioids regarding opioid storage, disposal, and diversion. Design Internet-based, cross-sectional survey conducted between September and October 2018. Fisher's exact tests and Kendall's Tau-c were used to assess associations with storage and disposal outcomes. Participants Patients aged ≥18 years with acute (n=250) or chronic noncancer (n=250) pain were prescribed an oral opioid within 90 days of the survey. Results Mean (SD) patient age was 48 (14.7) years, 57.2% were female, 82.6% lived with ≥1 person in the home, and 28.0% had remaining/unused pills. One-third of all patients received safe opioid storage (35.2%) and/or disposal (31.4%) counseling from a healthcare provider, while 50.0% received neither storage nor disposal information. Only 27.4% of all patients stored their opioids in a locked location, and 17.9% of those with remaining/unused pills disposed of their medication. Patients who received any opioid counseling were more likely to keep their medication in a locked location compared with those who did not (42.4% vs 12.4%, respectively; P

Textiles are known to be the best substrates for growing a variety of microorganisms efficiently at appropriate temperatures and humidity in contact with the human body. Currently, increasing public concern about hygiene has been driving many investigations about antimicrobial surface modification of textiles. The present research reports on the synthesis and characterization of nanosized copper oxide nanoparticles (CuONPs) and their application on cotton fabric to increase the bactericidal and hydrophobic properties. The synthesized materials have been subjected to spectroscopic and microscopic characterizations to help in understanding their structure, morphology, size, and composition. Further, upon dispersion of the nanoparticles onto the fabric, its hydrophobicity and mechanical properties were evaluated using electron microscopy and universal testing machine. Treated cotton fabric exhibits higher tensile strength (32 MPa) than the untreated one (27 MPa), whereas copper nanoparticle-coated cotton fabric shows a fair hydrophobicity. Moreover, CuONPs-treated and untreated cotton fabrics have been analyzed for bactericidal activity against various gram-negative and gram-positive strains. Finally, the CuONPs-coated cotton fabric displays greater antibacterial activity against E. coli and exhibits superior antimicrobial activity even after 30 cycles of washing, indicating that the CuONPs-coated cotton fabric has a higher potential to be employed as a medical textile to avoid cross-infection within a clinical environment.

High voltage bushing is one of the key components of Indian Test Facility. It is designed to provide 100 kV electrical isolation to all high voltage feedlines from the electrically grounded vessel....

Pediatric wide-awake local anesthesia no-tourniquet technique (WALANT) hand surgery is feasible for the treatment of the spectrum of pediatric hand surgeries, which can include traumatic injuries and congenital hand differences. The key component for success is identifying the appropriate patient for this technique, with the typical patient frequently being10 years of age. The discussion with the patient and adequate preparation for maximum efficiency become key for patient and surgeon comfort. Here we describe a practical approach for successfully performing this valuable technique for the pediatric population.

Security emergency responses (SERs) are utilized by hospitals to ensure the safety of patients and staff but can cause unintended morbidity. The presence of racial and ethnic inequities in SER utilization has not been clearly elucidated.To determine whether Black and Hispanic patients experience higher rates of SER and physical restraints in a non-psychiatric inpatient setting.Retrospective cohort study.All patients discharged from September 2018 through December 2019.Race and ethnicity, as reported by patients at time of registration.The primary outcome was whether a SER was called on a patient. The secondary outcome was the incidence of physical restraints among patients who experienced a SER.Among 24,212 patients, 18,755 (77.5%) patients identified as white, 2,346 (9.7%) as Black, and 2,425 (10.0%) identified with another race. Among all patients, 1,827 (7.6%) identified as Hispanic and 21,554 (89.0%) as non-Hispanic. Sixty-six (2.8%) Black patients had a SER activated during their first admission, compared to 295 (1.6%) white patients. In a Firth logit multivariable model, Black patients had higher adjusted odds of a SER than white patients (adjusted odds ratio (aOR) 1.37 [95% confidence interval: 1.02, 1.81], p = 0.037). Hispanic patients did not have higher odds of having a SER called than non-Hispanic patients. In a Poisson multivariable model among patients who had a SER called, race and ethnicity were not found to be significant predictors of restraint.Black patients had higher odds of a SER compared to white patients. No significant differences were found between Hispanic and non-Hispanic patients. Future efforts should focus on assessing the generalizability of these findings, the underlying mechanisms driving these inequities, and effective interventions to address them.

The COVID-19 pandemic prompted health systems to rapidly adopt telehealth for clinical care. We examined the impact of demography, subspecialty characteristics, and broadband availability on the utilization of telehealth in pediatric populations before and after the early period of the COVID-19 pandemic.Outpatients scheduled for subspecialty visits at sites affiliated with a single quaternary academic medical center between March-June 2019 and March-June 2020 were included. The contribution of demographic, socioeconomic, and broadband availability to visit completion and telehealth utilization were examined in multivariable regression analyses.Among visits scheduled in 2020 compared to 2019, in-person visits fell from 23,318 to 11,209, while telehealth visits increased from 150 to 7,675. Visits among established patients fell by 15% and new patients by 36% (P.0001). Multivariable analysis revealed that completed visits were reduced for Hispanic patients and those with reduced broadband; high income, private non-HMO insurance, and those requesting an interpreter were more likely to complete visits. Those with visits scheduled in 2020, established patients, those with reduced broadband, and patients older than 1 year were more likely to complete TH appointments. Cardiology, oncology, and pulmonology patients were less likely to complete scheduled TH appointments.Following COVID-19 onset, outpatient pediatric subspecialty visits shifted rapidly to telehealth. However, the impact of this shift on social disparities in outpatient utilization was mixed with variation among subspecialties. A growing reliance on telehealth will necessitate insights from other healthcare settings serving populations of diverse social and technological character.

Oral Cancer; especially Oral Squamous Cell Carcinoma (OSCC) is the eighth most common cancer all over the globe and most common neoplasm in India. Due to the tobacco addiction pattern in Indians specially Guajarati’s are well known for high consumption of tobacco in non-smoking form may have the high-risk for developing oral cancer. Apart of this, Human papilloma virus(HPV) might be one of the cause for developing oral cancer hence, the proposed study was carried out for 50 primary OSCC subjects from January 2018 to October 2018. Tumour specimens were HPV-genotyped by type specific PCR method. Statistical analyses were performed by Fisher’s exact test. The present study identified 4% HPV infection frequency in advanced staged OSCC Indian subset, where One OSCC stage IV patient observed with HPV 16 infection and one OSCC stage III patient with HPV 18. Our finding differs with rest of the population, as the region have high amount of consumption of tobacco. Current study need to be validated in larger sample size to get the clear view for association of HPV with oral cancer.

Oral Cancer; especially Oral Squamous Cell Carcinoma (OSCC) is the eighth most common cancer all over the globe and most common neoplasm in India. Due to the tobacco addiction pattern in Indians specially Guajarati’s are well known for high consumption of tobacco in non-smoking form may have the high-risk for developing oral cancer. Apart of this, Human papilloma virus(HPV) might be one of the cause for developing oral cancer hence, the proposed study was carried out for 50 primary OSCC subjects from January 2018 to October 2018. Tumour specimens were HPV-genotyped by type specific PCR method. Statistical analyses were performed by Fisher’s exact test. The present study identified 4% HPV infection frequency in advanced staged OSCC Indian subset, where One OSCC stage IV patient observed with HPV 16 infection and one OSCC stage III patient with HPV 18. Our finding differs with rest of the population, as the region have high amount of consumption of tobacco. Current study need to be validated in larger sample size to get the clear view for association of HPV with oral cancer.

The present study is undertaken to investigate the ion irradiation impact on the structural properties of α-Al2O3 which is one of the potential insulator used for ITER-like reactors. 300 keV Ar6+ ion beam with varying fluence is used to irradiate Al2O3 polycrystalline material in bulk form. Structural damage to α-Al2O3 due to ion irradiation is investigated by grazing incidence XRD (GIXRD), micro-RAMAN and photoluminescence spectroscopy. Further, the surface morphology of irradiated and pristine samples is studied using atomic force microscopy. GIXRD data reveal the radiation induced damage at low fluence and structural improvement at higher fluence up to 1 × 1016 ions/cm2. Annealing effect is explained by temperature rise during irradiation and due to partial grain growth of Al2O3 at 1 × 1016 ions/cm2. It is important to note that there is no sign of amorphization even at the highest fluence 1 × 1016 ions/cm2 used in this study. The explanation is supported by the Raman characterization results. Detailed peak assessment of photoluminescence spectra is presented. Photoluminescence characterization results are corroborated with XRD results. The present study reveals the radiation hardness of polycrystalline Al2O3 material in the low energy ion regime.