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Regional weather and climate are generally impacted by global climatic phenomenon′s. Understanding the impact of global climate phenomenon′s on an atmospheric branch of the hydrological cycle is crucial to make advances in skillful precipitation forecast. The present study adopts a multiscale approach based on wavelets for unravelling the linkages between teleconnections and atmospheric moisture transport over homogeneous regions of Indian sub-continent. We investigated linkages between atmospheric moisture transport quantified as monthly integrated water vapor transport (IVT) during 1951–2022 over selected homogeneous regions and eight large scale climate oscillations using wavelet and global wavelet coherence. Our results indicate significant heterogeneity in linkages across different regions and across multiple timescales. In particular, the Indian Ocean Dipole (IOD) influence monthly IVT at intra-annual to inter-annual scale over all regions. The El Niño–Southern Oscillation (ENSO) have strong connection to monthly IVT at inter-annual scale whereas over west central region both IOD and ENSO strongly influence IVT at inter-decadal scale. While the Atlantic Multi-Decadal Oscillation and Pacific Decadal Oscillation have an impact on IVT in the north-east and southern regions, the Arctic Oscillation and North Atlantic oscillation have a strong inter-annual connection to IVT, majorly in the northwest and hilly regions. Overall, the methodology offers an effective approach for capturing the dynamics of atmospheric moisture transport in time–frequency space and provide a practical reference for prediction of atmospheric moisture transport linked precipitation over different regions of Indian subcontinent. [ABSTRACT FROM AUTHOR]

Background and Aim: While European Society of Pediatric Gastroenterology Hepatology and Nutrition advocates a no‐biopsy pathway for the diagnosis of celiac disease (CeD) in children if IgA anti‐tissue transglutaminase antibody (anti‐tTG ab) titer is ≥10‐fold upper limit of normal (ULN) and have a positive IgA anti‐endomysial antibody (EMA); the data for anti‐tTG Ab titer‐based diagnosis of CeD in adults is still emerging. We planned to validate if IgA anti‐tTG Ab titer ≥10‐fold predicts villous abnormalities of modified Marsh grade ≥2 in Asian adult patients with CeD. Methods: We recruited 937 adult patients with positive anti‐tTG Ab from two databases, including AIIMS Celiac Clinic and Indian National Biorepository. The diagnosis of definite CeD was made on the basis of a positive anti‐tTG Ab and the presence of villous abnormalities of modified Marsh grade ≥2. Results: Of 937 adult patients with positive anti‐tTG Ab, 889 (91.2%) showed villous abnormalities of modified Marsh grade ≥2. Only 47.6% of 889 adults with CeD had anti‐ tTG Ab titers of ≥10‐fold. The positive predictive value (PPV) and specificity of anti tTG Ab titer ≥10‐fold for predicting modified Marsh grade ≥2 were 99.8% and 98%, respectively. At anti‐tTG Ab titer ≥11‐fold, specificity and PPV were 100% for predicting villous abnormalities of modified Marsh grade ≥2. Conclusions: Approximately 50% of adults with CeD may benefit from the no biopsy pathway, reducing the health burden and risks of gastroscopy/anesthesia. [ABSTRACT FROM AUTHOR]

The unprecedented sea ice loss in the Arctic is due to its stronger surface warming than other parts across the globe, resulting in far‐flung effects on weather and climate at different spatial and temporal scales. We investigate how Arctic Sea ice and Indian summer monsoon rainfall (ISMR) are associated at seasonal scale and when preconditioned by Arctic Oscillation (AO) phases. This study also examines the potential predictability using correlation and composite analysis. The results indicate a significant decline in sea ice extent (SIE) at a rate of 0.055 Mkm2/year (p < 0.05). The strong association between SIE and precipitation in the Indian region is confirmed by correlation values ranging from −0.6 to 0.6 (p < 0.05). The spatial patterns of seasonal SIE and precipitation association remain consistent for 1979–2021. We found that the prevailing AO phases influence the association of sea ice with ISMR precipitation. The high correlation between SIE and ISMR anomalies suggests that Arctic Sea ice could be a reliable predictor for ISMR. [ABSTRACT FROM AUTHOR]

Background and Aim: Celiac disease (CeD) has now become a global disease with a worldwide prevalence of 0.67%. Despite being a common disease, CeD is often not diagnosed and there is a significant delay in its diagnosis. We reviewed the impact of the delay in the diagnosis on the severity of manifestations of CeD. Methods: We reviewed clinical records of 726 consecutive patients with CeD from the Celiac Clinic database and the National Celiac Disease Consortium database. We extracted specific data including the demographics, symptoms at presentation, time of onset of symptoms, time to diagnosis from the onset of the symptoms, and relevant clinical data including fold‐rise in anti‐tissue transglutaminase antibody (IgA anti‐tTG Ab) and severity of villous and crypt abnormalities as assessed using modified Marsh classification. Results: The median duration between the onset of symptoms and the diagnosis of CeD was 27 months (interquartile range 12–60 months). A longer delay in the diagnosis of CeD from the onset of symptoms was associated with lower height for age, lower hemoglobin, higher fold rise in IgA Anti tTG titers, and higher severity of villous and crypt abnormalities. About 18% of patients presented with predominantly non‐gastrointestinal complaints and had a longer delay in the diagnosis of CeD. Conclusions: There is a significant delay in the diagnosis of CeD since the onset of its symptoms. The severity of celiac disease increases with increasing delay in its diagnosis. There is a need to keep a low threshold for the diagnosis of CeD in appropriate clinical settings. [ABSTRACT FROM AUTHOR]

Health-care settings have an important responsibility toward environmental health and safety. The operating room is a major source of environmental pollution within a hospital. Inhalational agents and nitrous oxide are the commonly used gases during general anesthesia for surgeries, especially in the developing world. These greenhouse gases contribute adversely to the environmental health both inside the operating room and in the outside atmosphere. Impact of these anesthetic agents depends on the total consumption, characteristics of individual agents, and gas flows, with higher levels increasing the environmental adverse effects. The inimical impact of nitrous oxide is higher due to its longer atmospheric half-life and potential for destruction of the ozone layer. Anesthesiologist of today has a choice in the selection of anesthetic agents. Prudent decisions will help in mitigating environmental pollution and contributing positively to a greener planet. Therefore, a shift from inhalational to intravenous-based technique will reduce the carbon footprint of anesthetic agents and their impact on global climate. Propofol forms the mainstay of intravenous anesthesia technique and is a proven drug for anesthetic induction and maintenance. Anesthesiologists should appreciate growing concerns about the role of inhalational anesthetics on the environment and join the cause of environmental responsibility. In this narrative review, we revisit the pharmacological and pharmacokinetic considerations, clinical uses, and discuss the merits of propofol-based intravenous anesthesia over inhalational anesthesia in terms of environmental effects. Increased awareness about the environmental impact and adoption of newer, versatile, and user-friendly modalities of intravenous anesthesia administration will pave the way for greener anesthesia practice. [ABSTRACT FROM AUTHOR]

Introduction: Pain is the foremost complication of chronic pancreatitis (CP), affecting about 70% of patients. However, the pathophysiological understanding and management of CP-related pain is complex, likely as patients have diverse "pain phenotypes" responding differently to treatment. This study aims to develop a bedside test panel to identify distinct pain phenotypes, investigate the temporal evolution, and determine whether they can be used to predict treatment response., Method: The INPAIN study is an international, multi-center, observational, longitudinal cohort study comprised of 4 sub-studies. The studies will prospectively enroll 400 CP patients (50 without pain and 350 with pain) and 50 control subjects, conducting biannual observations for four years. The test panel is comprised of comprehensive subjective and objective assessment parameters. Statistical analysis strategies differ across the sub-studies. A model to predict treatment efficacy will be developed using various machine learning techniques, including an artificial intelligence approach, with internal cross-validation. Trajectories in pain parameters will be characterized by graphical analysis and mixed effect models., Discussion: The INPAIN study aims to comprehensively understand pain in CP through a test panel developed for routine clinical use. This tool has the potential to personalize treatments, improve clinical practice, enhance patient care, improve quality of life, and minimize treatment side effects., Competing Interests: Funding: Professor Asbjørn Mohr Drewes initiated this research project. Researchers behind this study declare no conflicts of interest. This study is economically supported by the INPAIN study sponsored by Aalborg University Hospital (“ForskningsKUBE”). This grant will be used to cover expenses related to equipment and salary for study personnel. Various funds will be applied to cover any additional financial expenses. Conflict of interest: The involved researchers will conduct the trial of general scientific interest without personal financial gain., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

In eubacteria, Holliday junction (HJ) resolvases (HJRs) are crucial for faithful segregation of newly replicated chromosomes, homologous recombination and repair of stalled/collapsed DNA replication forks. However, compared with the Escherichia coli HJRs, little is known about their orthologs in mycobacterial species. A genome-wide analysis of Mycobacterium smegmatis identified two genes encoding putative HJRs, namely RuvC (MsRuvC) and RuvX (MsRuvX); but whether they play redundant, overlapping, or distinct roles remains unknown. Here, we reveal that MsRuvC exists as a homodimer while MsRuvX as a monomer in solution, and both showed high-binding affinity for branched DNAs compared with unbranched DNA species. Interestingly, the DNA cleavage specificities of MsRuvC and MsRuvX were found to be mutually exclusive: the former efficiently promotes HJ resolution, in a manner analogous to the E. coli RuvC, but does not cleave other branched DNA species; whereas the latter is a versatile DNase capable of cleaving a variety of branched DNA structures, including 3' and 5' flap DNA, splayed-arm DNA and double-stranded DNA with 3' and 5' overhangs but lacks the HJ resolution activity. Point mutations in the RNase H-like domains of MsRuvC and MsRuvX pinpointed critical residues required for their DNA cleavage activities, and also demonstrated uncoupling between DNA-binding and DNA cleavage activities. Unexpectedly, we found robust evidence that MsRuvX possesses a double-strand/single-strand junction-specific endonuclease and single-stranded DNA exonucleolytic activities. Combined, our findings highlight that the RuvC and RuvX DNases play distinct complementary, and not redundant, roles in the processing of branched DNA structures in M. smegmatis., Competing Interests: Conflict of interest The authors declare that they have no conflicts of interest with the contents of this article., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)