Search

Background: Glioblastoma Multiforme (GBM) is one of the most heterogeneous primary brain tumors with high mortality. In spite of the current therapeutic approaches, the survival rate remains poor, with death occurring within 12 to 15 months after the preliminary diagnosis. This warrants the need for an effective treatment modality. The Wnt/β-catenin pathway is presumably the most noteworthy pathway upregulated in almost 80% of GBM cases, contributing to tumor initiation, progression, and survival. Therefore, therapeutic strategies targeting key components of the Wnt/β-catenin cascade using established genotoxic agents like temozolomide and pharmacological inhibitors would be an effective approach to modulate the Wnt/β-catenin pathway. Recently, drug repurposing by means of effective combination therapy has gained importance in various solid tumors, including GBM, by targeting two or more proteins in a single pathway, thereby possessing the ability to overcome the hurdle implicated by chemoresistance in GBM. Objective: In this context, by employing computational tools, an attempt has been made to find out the novel combinations against the Wnt/β-catenin signalling pathway. Methods: We have explored the binding interactions of three conventional drugs - namely temozolomide, metformin and chloroquine - along with three natural compounds, viz. epigallocatechin gallate, naringenin and phloroglucinol, on the major receptors of Wnt/β-catenin signalling. Results: It was noted that all the experimental compounds showed profound interaction with two major receptors of the Wnt/β-catenin pathway. Conclusion: To the best of our knowledge, this study is the first of its kind to characterize the combined interactions of the aforementioned drugs with the Wnt/β-catenin signalling in silico, and this will putatively open up new avenues for combination therapies in GBM treatment.

Heart failure secondary to isolated pulmonary artery vasculitis is rarely described in children. We describe a 10-year-old child who presented with right heart failure symptoms, severe pulmonary hypertension, and bilateral branch pulmonary artery stenosis secondary to isolated pulmonary artery vasculitis. (Level of Difficulty: Advanced.), Central Illustration

Patients with severe acute respiratory syndrome coronavirus 2 infection may have bacterial co-infections, including pneumonia and bacteremia. Bordetella hinzii infections are rare, may be associated with exposure to poultry, and have been reported mostly among immunocompromised patients. We describe B. hinzii pneumonia and bacteremia in a severe acute respiratory syndrome coronavirus 2 patient.

Objectives: COVID-19 pandemic has led to unprecedented increase in rates of stress and burn out among healthcare workers (HCWs). Heart rate variability (HRV) has been shown to be reflective of stress and burnout. The present study evaluated the prevalence of burnout and attempted to develop a HRV based predictive machine learning (ML) model to detect burnout among HCWs during COVID-19 pandemic. Methods: Mini-Z 1.0 survey was collected from 1615 HCWs, of whom 664, 512 and 439 were frontline, second-line and non-COVID HCWs respectively. Burnout was defined as score ≥3 on Mini-Z-burnout-item. A 12-lead digitized ECG recording was performed and ECG features of HRV were obtained using feature extraction. A ML model comprising demographic and HRV features was developed to detect burnout. Results: Burnout rates were higher among second-line workers 20.5% than frontline 14.9% and non-COVID 13.2% workers. In multivariable analyses, features associated with higher likelihood of burnout were feeling stressed (OR = 6.02), feeling dissatisfied with current job (OR = 5.15), working in a chaotic, hectic environment (OR = 2.09) and feeling that COVID has significantly impacted the mental wellbeing (OR = 6.02). HCWs with burnout had a significantly lower HRV parameters like root mean square of successive RR intervals differences (RMSSD) [p

A silicon Mach Zehnder modulator (MZM) with high modulation efficiency was designed using a core-based split PN junction phase shifter. The novel design of the phase shifter improves the optical confinement, reduces the optical loss. The use of the travelling wave electrode improves the coupling between the microwave and optical mode. The proposed design achieved a high modulation efficiency of 0.75V.cm with 1.5mm phase shifter. With this modulation efficiency, an extinction ratio of 7.37dB and 1.69 × 10− 12 bit error rate was achieved at a bit rate of 90Gbps. The energy per bit transmission of the data was 3.91pJ/bit. The phase shifter in silicon MZM (PS-MZM) was analysed for its supporting transmission distance and bit rate at ITU-T recommended DWDM wavelength of 1552.5 nm. It ensures that PS-MZM is suitable for on-chip and off-chip communication data centre application in unguided (free space optics (FSO)) and guided (optical fibre) transmission medium. The proposed device can also be implemented in delay lines, switches etc.

To study the clinical, laboratory characteristics and outcomes of multisystem inflammatory syndrome in children (MIS-C) temporally related to coronavirus disease 2019 (COVID-19) in a resource-limited setting. All children meeting the World Health Organization case definition of MIS-C were prospectively enrolled. Baseline clinical and laboratory parameters were compared between survivors and non-survivors. Enrolled subjects were followed up for 4–6 weeks for evaluation of cardiac outcomes using echocardiography. The statistical data were analyzed using the stata-12 software. Thirty-one children with MIS-C were enrolled in an 11-month period. Twelve children had preexisting chronic systemic comorbidity. Fever was a universal finding; gastrointestinal and respiratory manifestations were noted in 70.9% and 64.3%, respectively, while 57.1% had a skin rash. Fifty-eight percent of children presented with shock, and 22.5% required mechanical ventilation. HSP like rash, gangrene and arthritis were uncommon clinical observations.The median duration of hospital stay was 9 (6.5–18.5) days: four children with preexisting comorbidities succumbed to the illness. The serum ferritin levels (ng/ml) [median (IQR)] were significantly higher in non-survivors as compared to survivors [1061 (581, 2750) vs 309.5 (140, 720.08), p value = 0.045]. Six patients had coronary artery involvement; five recovered during follow-up, while one was still admitted. Twenty-six children received immunomodulatory drugs, and five improved without immunomodulation. The choice of immunomodulation (steroids or intravenous immunoglobulin) did not affect the outcome. Most children with MIS-C present with acute hemodynamic and respiratory symptoms.The outcome is favorable in children without preexisting comorbidities.Raised ferritin level may be a poor prognostic marker. The coronary outcomes at follow-up were reassuring. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-021-05030-y.

AIM To evaluate the morphology and associated cardiovascular abnormalities in patients with an anomalous subaortic course of brachiocephalic vein on multidetector computed tomography (CT) angiography. MATERIAL AND METHODS A retrospective study was performed at a tertiary referral institute to identify patients with subaortic brachiocephalic vein on multidetector CT (MDCT) angiography using dual source CT scanner between January 2014 and July 2021. The morphology of the subaortic brachiocephalic vein along with the cardiovascular anatomy and associated anomalies were evaluated. RESULTS Out of 4349 patients who had undergone MDCT angiography for evaluation of congenital heart diseases, we identified 126 (2.9%) patients with subaortic brachiocephalic vein. The subaortic brachiocephalic vein was left-sided in 125 patients while a right-sided subaortic brachiocephalic vein was identified in a patient with left isomerism. Common cardiovascular associations included tetralogy of Fallot (109/126; 88.1%), double outlet right ventricle (8/126; 6.3%) and common arterial trunk (5/126; 3.9%). The presence of a right aortic arch was seen in 78/126 (62%) patients. Some degree of right ventricular outflow obstruction was present in 119/126 (94.4%) patients; pulmonary stenosis was seen in 78 (62%) patients while pulmonary atresia was seen in 41 (32.5%) patients. CONCLUSION A subaortic brachiocephalic vein can coexist with various complex congenital heart diseases, most commonly tetralogy of Fallot and commonly associated with right aortic arch and pulmonary stenosis/atresia. It is important to identify this anomalous course of brachiocephalic vein before performing surgical procedures or venous catheterization to avoid potential complications.

Background Prevalence of both degenerative severe aortic stenosis (AS) and transthyretin cardiac amyloidosis (ATTR-CA) increases with age. Dual disease (AS+myocardial ATTR-CA) occurs in si...

A D-shaped photonic crystal fiber (PCF)-based plasmonic sensor is proposed for detecting refractive index (RI) variations within the range of 1.33–1.38. The center hollow core has formed using Bezier curves, which confines light within the core by the principle of photonic band gaps. An analyte is injected into a core to adjust its refractive index. Light propagating in the air core is affected by the analyte filled in the core, causing plasmon waves to be produced on the metal surface. On top of this structure, a chemically stable gold (Au) metal layer is placed as a plasmonic material. Numerical studies are carried out using the finite element method (FEM). The gold layer thickness is optimized and obtained an average sensitivity of 5600 nm/RIU. The sensor’s sensitivity is enhanced by sandwiching graphene between an analyte and a gold film. The average sensitivity of the sensor increases by 2000 nm/RIU after graphene is incorporated, having reached 7600 nm/RIU according to the results obtained. The sensor can efficiently detect slight variations in the analyte indices and, thus, it is used in various chemical and biosensing applications.

Aims : The utility of beta-blocker therapy in infants with heart failure (HF) due to significant left-to-right shunt lesions is not known. The study aimed to assess the efficacy and safety of propranolol in infants with HF due to moderate-to-large ventricular septal defect (VSD). Methods : The prospective randomized trial included 80 infants with HF and moderate-to-large VSD, randomly allocated to receive either conventional therapy alone (n = 40) or propranolol plus conventional therapy (n = 40). The primary endpoint was a composite of all-cause mortality, hospitalization for HF and/or chest infection, and referral for surgery. The secondary clinical outcomes were the individual components of the composite endpoint. In addition, the patients were followed up to detect safety outcomes, for example, bronchospasm, bradyarrhythmia, and worsening HF symptoms. Results : The addition of propranolol therapy to the conventional medications did not result in significant improvement in the primary composite endpoint (32.50% vs. 52.50%; P = 0.07). There was a trend toward improvement, but the study is underpowered for this important question. However, propranolol therapy significantly decreased the risk of hospitalization (12.50% vs. 32.50%; P = 0.03) and worsening of Ross HF class (5.41% vs. 28.21%; P = 0.01) as compared to conventional therapy (estimated number needed to treat = 5). Propranolol did not result in any significant safety concerns in these infants except bronchospasm in an infant. Conclusions : Propranolol therapy in infants with significant left-to-right shunt may prevent worsening in HF symptoms and hospitalization and is well tolerated. However, it does not reduce mortality or need for surgery.

Objectives This study sought to compare the efficacy of ivabradine and amiodarone in the management of postoperative junctional ectopic tachycardia (JET) after cardiac surgery in children. Background JET is a serious arrhythmia occurring in children after cardiac surgery and requires aggressive management. Amiodarone has been conventionally used in its treatment. Recent studies have reported the utility of ivabradine in this regard. Methods In this open-label randomized controlled trial, 94 children (age ≤18 years) who developed postoperative JET were allocated to receive either amiodarone or ivabradine. The primary endpoint was restoration of normal sinus rhythm. Results Sinus rhythm was achieved in 43 out of the 46 patients (93.5%) in the amiodarone group and 46 out of the 48 patients (95.8%) in the ivabradine group (mean difference of treatment effect: 2.3%; 95% confidence interval: −6.7% to 11.5%). The median (interquartile range) time taken to achieve sinus rhythm conversion was similar in both the groups: 21.5 (17–30.2) hours versus 22 (13.4–38.5) hours (p = 0.36)]. The time taken to rate control of JET was significantly less in the amiodarone group: median 7.0 (5.5–9.5) hours versus 8.0 (5.8–10.8) hours (p = 0.02)]. No drug-related adverse events were observed in the ivabradine group. Conclusions Oral ivabradine is not inferior to intravenous amiodarone in converting postoperative JET to sinus rhythm. There was no difference in time taken to sinus rhythm conversion between the groups, although the rate control was earlier in patients who received amiodarone. Monotherapy with ivabradine may be considered as an alternative to amiodarone in the management of postoperative JET. (Comparison of Two Drugs, Ivabradine and Amiodarone, in the Management of Junctional Ectopic Tachycardia, an Abnormality in Cardiac Rhythm in Patients Under 18 years Who Undergo Cardiac Surgery: CTRI/2018/08/015182 )

Silicon Mach-Zehnder modulator (SMZM)is fit to high-contrast optical modulation in wide ranges ofspectral along 50 Gbaud symbol rates. Some times itsefficiency is lower in wavelength about 1.31 μm than 1.55μm, it can decrease the Phase Shifter (PS) efficiency andoccupies large amount of data rates. In this manuscript,the plus-shaped PN junction Phase Shifter (PS) isproposed. The major aim of the proposed work is to createan optimum CD type plus-shaped PS including lesser VπL.Silicon MZM including proposed PS can satisfy thehigher-speed data transmission requirement on theapplications of inter with intra data centre. The objectiveof this method is to increase the modulation efficiency(ME) by decreasing the optical loss for higher-speed datarate (DR). To get greater efficiency of modulation, the Pdoped region width and the thickness of doped regions arediffer under slabs. The simulation analysis of circuit-levelis executed in the proposed PS acquired at travelling waveelectrode (TWE) silicon Mach Zehnder modulator. In 80Gbps, the 12.39 dB maximal extinction ratio along8.67×10-8 bit error rate (BER) was acquired in VπLπ of1.05 V.cm for 3.5 mm PS length. The measured intrinsicbandwidth of 3 dB denotes ~38 GHz, whereas thetransmission energy per bit denotes 1.71pJ/bit. Moreexamines are carried out to recognize the maximalcommunication distance using proposed PS under SMZMfor the requirements of data centre.

Introduction In 2017, the American College of Cardiology/American Heart Association revised guidelines for diagnosis and management of hypertension in adults. The regional impact of the updated guidelines on the prevalence of hypertension in India is unknown. Methods Data from nationally representative Indian households were analyzed to estimate the regional prevalence of hypertension according to the old and the new guidelines in men (age 18-54 years) and women (age 18-49 years). The old guidelines defined hypertension as a systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg or treatment. The new guidelines define hypertension as a systolic blood pressure of ≥130 mmHg or diastolic blood pressure of ≥80 mmHg or treatment. We calculated the increase in the prevalence of hypertension among the states and union territories of India (hereafter "states"). Results Among 679,712 participants (85.6% women), the median age was 31 years (interquartile range 24, 40) and was comparable among men and women (33 vs. 31 years, respectively). The overall weighted prevalence according to old and new guidelines was 18.5% (95% CI 18.2, 18.7) and 43.0% (95% CI 42.8, 43.3), respectively. There was a significant increase in hypertension prevalence, both among men and women, and across all regions. The northeast region of the country had the highest prevalence. Conclusion The overall prevalence of hypertension significantly increases with the new compared to the old guidelines, however, the regional heterogeneity of prevalence of hypertension is maintained.

Environment, food, and disease have a selective force on the present and future as well as our genome. Adaptation of livestock and the environmental nexus, including forest encroachment for anthropological needs, has been proven to cause emerging infectious diseases. Further, these demand changes in meat production and market systems. Meat is a reliable source of protein, with a majority of the world population consumes meat. To meet the increasing demands of meat production as well as address issues, such as current environmental pollution, animal welfare, and outbreaks, cellular agriculture has emerged as one of the next industrial revolutions. Lab grown meat or cell cultured meat is a promising way to pursue this; however, it still needs to resemble traditional meat and be assured safety for human consumption. Further, to mimic the palatability of traditional meat, the process of cultured meat production starts from skeletal muscle progenitor cells isolated from animals that proliferate and differentiate into skeletal muscle using cell culture techniques. Due to several lacunae in the current approaches, production of muscle replicas is not possible yet. Our review shows that constant research in this field will resolve the existing constraints and enable successful cultured meat production in the near future. Therefore, production of cultured meat is a better solution that looks after environmental issues, spread of outbreaks, antibiotic resistance through the zoonotic spread, food and economic crises.

Background: Admissions for acute myocardial infarction (MI) have declined significantly during the COVID-19 pandemic. The changes in the presentation, management, and outcomes of MI during the pandemic period are not well recognized, and data from low- and middle-income countries are limited. Methods: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with MI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We sought to determine the changes in the number of admissions, management practices, and outcomes. Findings: We included 41,832 consecutive adults with MI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India with the North zone reporting greater decline (-44·8%) than the South zone (-27·7%). The weekly average decrease in MI admissions in 2020 which peaked around the mid- study period, correlated negatively with the number of COVID cases (r = -0·48; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume, and teaching programs. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. However, the in-hospital mortality rates did not differ. Interpretation: The magnitude of reduction in MI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing MI admissions during the pandemic. Funding Statement: The study is funded by cardiological society of India. Declaration of Interests: Nothing to declare for all the authors. Ethics Approval Statement: Individual participating centres either obtained an ethical approval from respective Institutional ethics committees or a no objection certificate from the administration.

In the current scenario, because of government policies, environmental factors, and technological improvements, there is a rapid growth in renewable energy sector. The current concerning factor is ...

Accumulating evidence suggests that the sympathetic nervous system (SNS) overactivity plays a crucial role in age-related increase in the risk for cardiovascular diseases such as hypertension, myocardial infarction, stroke and heart diseases. Previous studies indicate that neuroinflammation in key brainstem regions that regulate sympathetic outflow plays a pathogenic role in aging-mediated sympathoexcitation. However, the molecular mechanisms underlying this phenomenon are not clear. While senescent cells and their secretory phenotype (SASP) have been implicated in the pathogenesis of several age-related diseases, their role in age-related neuroinflammation in the brainstem and SNS overactivity has not been investigated. To test this, we isolated brainstems from young (2-4 months) and aged (24 months) male C57BL/6J mice and assessed senescence using a combination of RNA-in situ hybridization, PCR analysis, multiplex assay and SA-β gal staining. Our results show significant increases in p16Ink4a expression, increased activity of SA-β gal and increases in SASP levels in the aged brainstem, suggesting age-induced senescence in the brainstem. Further, analysis of senescence markers in glial cells enriched fraction from fresh brainstem samples demonstrated that glial cells are more susceptible to senesce with age in the brainstem. In conclusion, our study suggests that aging induces glial senescence in the brainstem which likely causes inflammation and SNS overactivity.

INTRODUCTION: Rates of severe obesity in adolescents have increased at an alarming rate. Unfortunately, there are limited successful treatments for severe obesity in adolescents. Metabolic and bariatric surgery (MBS) is the most effective treatment available for adolescents with Class 2 and above severe obesity and has demonstrated variable degrees of sustained long-term weight loss which leads to resolution of multiple associated conditions and an improved quality of life. AREAS COVERED: We discuss the current landscape of MBS in adolescents and evidence to support its long-term safety and efficacy. A literature search through PubMed, ResearchGate and HOLLIS Harvard Library Online Catalog was performed from the date of inception until 3/15/2021. A combination of the following keywords was used: Pediatric metabolic/bariatric surgery; long term outcomes of Pediatric metabolic/bariatric surgery, perioperative assessment, pediatric metabolic/bariatric surgery barriers; attitudes toward metabolic/bariatric surgery. EXPERT OPINION: MBS is emerging as a safe and effective treatment strategy for adolescents with severe obesity, with recent studies demonstrating durable and sustainable weight loss. There remains an urgent need for longitudinal studies to assess durability of weight loss. Obesity stigma and bias, limited access to tertiary care centers, and skepticism around the treatment of obesity poses a major challenge.

Purpose: In chronic lymphocytic leukemia (CLL), the T-cell receptor (TCR) repertoire is skewed and tumor-derived antigens are hypothesized as drivers of oligoclonal expansion. Ibrutinib, a standard treatment for CLL, inhibits not only Bruton tyrosine kinase of the B-cell receptor signaling pathway, but also IL2-inducible kinase of the TCR signaling pathway. T-cell polarization and activation are affected by ibrutinib, but it is unknown whether T cells contribute to clinical response. Experimental Design: High-throughput TCRβ sequencing was performed in 77 longitudinal samples from 26 patients with CLL treated with ibrutinib. TCRβ usage in CD4+ and CD8+ T cells and granzyme B expression were assessed by flow cytometric analysis. Antitumor cytotoxicity of T cells expanded with autologous CLL cells or with antigen-independent anti-CD3/CD28/CD137 beads was tested. Results: The clonality of the TCR repertoire increased at the time of response. With extended treatment, TCR clonality remained stable in patients with sustained remission and decreased in patients with disease progression. Expanded clonotypes were rarely shared between patients, indicating specificity for private antigens. Flow cytometry demonstrated a predominance of CD8+ cells among expanded clonotypes. Importantly, bulk T cells from responding patients were cytotoxic against autologous CLL cells in vitro and selective depletion of major expanded clonotypes reduced CLL cell killing. Conclusions: In patients with CLL, established T-cell responses directed against tumor are suppressed by disease and reactivated by ibrutinib. See related commentary by Zent, p. 4465

Scaling up of photonic devices is the current research of interest to meet the alarming demand growth in the data centres. The efficiency of the modulator is determined by the performance of the phase shifter. In this paper, a plus-shaped PN junction phase shifter is designed and analysed. This design improved the modulation efficiency and reduced optical loss for high-speed data operation. The width of the P doped region and thickness of thedoped regions in the slabs are varied to obtain high modulation efficiency. The circuit-level simulation analysis was performed on the proposed phase shifterimported in a travelling wave electrode silicon Mach Zehnder modulator. At 80 Gbps, a maximum extinction ratio of 12.39 dB with a bit error rate of 8.67×10-8 was obtained at VπLπ of 1.05 V.cm for the length of the phase shifter of 3.5 mm. The calculated intrinsic 3 dB bandwidth is ~38 GHz and the energy per bit transmission is 1.71pJ/bit.Further analysis was performed to identify the maximum communication distance supported by this proposed phase shifter design in the silicon Mach Zehnder modulator for the data centre requirements.

Coccidioides sp. and Treponema pallidum can both cause infections of the central nervous system if untreated. We describe a case of an immunocompetent patient living in an endemic region for Coccidioides who presented with headaches and diplopia and was found to have co-infection of coccidioidal meningitis and neurosyphilis. We highlight the importance of evaluation for CNS co-infections as they may be underdiagnosed, especially in endemic areas for coccidioidomycosis.

The essential requirement for an efficient optical modulator is to have high modulation efficiency at a high data rate. The performance of the phase shifter determines the efficiency of the modulator. In this paper, a corrugated PN junction phase shifter on a silicon waveguide is designed and analysed. Doped horizontal slabs of corrugated structure are designed to produce multiple PN junctions to maximise the index change that influences the optical modulation. With the travelling wave electrode, the optical group and RF effective index are matched to obtain high-speed modulation. The optimised design is imported in a silicon Mach Zehnder modulator, and circuit-level simulation analysis is performed. At 70Gbps, a maximum extinction ratio of 10.57dB with a bit error rate of 1.94 × 10− 6 is obtained at Vπ L of 0.75V.cm for the phase shifter length of 1.5mm. The energy per bit transmission is calculated to be 3.3pJ/bit. Further analysis is performed to identify the maximum communication distance supported by this proposed phase shifter design in the silicon Mach Zehnder modulator for the data centre requirements.

The common phenomenon expected from any anti-cancer drug in use is to kill the cancer cells without any side effects to non-malignant cells. Doxorubicin is an anthracycline derivative anti-cancer drug active over different types of cancers with anti-cancer activity but attributed to unintended cytotoxicity and genotoxicity triggering mitogenic signals inducing apoptosis. Administration of doxorubicin tends to both acute and chronic toxicity resulting in cardiomyopathy (left ventricular dysfunction) and congestive heart failure (CHF). Cardiotoxicity is prevented through administration of different cardioprotectants along with the drug. This review elaborates on mechanism of drug-mediated cardiotoxicity and attenuation principle by different cardioprotectants, with a focus on Hsp27 as cardioprotectant by prevention of drug-induced oxidative stress, cell survival pathways with suppression of intrinsic cell death. In conclusion, Hsp27 may offer an exciting/alternating cardioprotectant, with a wider study being need of the hour, specifically on primary cell line and animal models in conforming its cardioprotectant behaviour.

Objective To study the impact of coronavirus disease 2019 (COVID-19) pandemic on the utilization of pediatric cardiac care services and to determine the role of teleconsultation services in delivering healthcare in this subset of population. Methods It was a retrospective, observational study. All children who attended pediatric cardiology outpatient/teleconsultation services or were admitted to pediatric cardiology ward between April 1, 2019 to July 31, 2019 and April 1, 2020 to July 31, 2020, were recruited in the study. Data for patients who underwent surgery or catheter intervention for congenital heart disease were also recorded and analyzed. Comparisons were drawn between the statistics during the two time-periods. Results Physical outpatient services were discontinued and were replaced by teleconsultations from April 2020. Inpatient admissions during COVID-19 pandemic (n = 66) decreased by two-thirds as compared to the admissions during similar period in 2019 (n = 189). Similarly, the percentage decrease during these 4 mo of pandemic were 84% for catheter interventions, 90% for total congenital heart disease (CHD) surgeries, and 40% for emergency CHD surgeries. The number of patients availing successful teleconsultation was 1079, which was only 15% of the total number of patients attending physical outpatient services (n = 7176) during the corresponding period in the year 2019. During the pandemic, systematic teleconsultation and local evaluation and investigations aided in better management of patients with CHD. Conclusions The utilization of cardiovascular services for CHD has reduced significantly during COVID-19 pandemic, for both out- and inpatient care. Teleconsultation services have streamlined the follow-up care to some extent and have helped in noncontact triaging of these patients for further care.

Aim To evaluate the imaging features and associations in patients with supravalvar aortic stenosis on multidetector computed tomography (CT) angiography. Materials and methods We retrospectively reviewed all CT angiography studies performed for evaluation of congenital heart diseases at our institution through the period from January 2014 to June 2020. Cases with supravalvar aortic stenosis were identified and classified as syndromic and nonsyndromic based on history, physical examination, and relevant investigations. The type and extent of vascular involvement and associated cardiovascular abnormalities were characterized. Results Supravalvar aortic stenosis was identified in 26/3926 (0.66%) patients (22 males and 4 females; Age range: 2 months to 20 years). Discrete stenosis was seen in 14/26 (53.8%) patients, while diffuse involvement of the ascending aorta to varying degrees was seen in the remaining 12 (46.2%) patients. About 15/26 (57.7%) patients had pulmonary involvement at some level, namely, infundibular, valvar, supravalvar, or peripheral pulmonic stenosis while 15/26 (57.7%) patients had coronary arterial involvement either in the form of stenosis, occlusion, or ectasia. Aortic valvular abnormality including thickening, partial fusion, and adhesion of leaflet edges to the sinutubular junction causing reduced coronary inflow was seen in 15/26 (57.7%) patients. Associated ventricular septal defect, patent ductus arteriosus, and mitral valvular prolapse were seen in four (15.4%), five (19.2%), and two (7.7%) patients respectively. Conclusion Supravalvar aortic stenosis is a rare abnormality showing associated pulmonary arterial involvement, coronary arterial involvement, aortic valvular abnormalities, and associated congenital cardiac defects in the majority of cases, which may influence surgical outcomes.

We present a case of an 11-year-old boy with a double-outlet right ventricle and a right-sided aortic arch showing anomalous origin of the left subclavian artery from the ascending aorta as the first branch. This case highlights the importance of knowledge of this aberrant anatomy before planning any surgical or endovascular intervention.

Chronic kidney disease (CKD) has become recognized as an important issue affecting the health of millions around the world. It has been found to be highly prevalent in many countries, including India, accounting for massive health expenditure as well. The burden of CKD is on the rise in both developed and developing countries. The objectives were to identify and study the risk factors for CKD among patients attending Saveetha Medical College and Hospital, Chennai and to study the association between risk factors and CKD. The case-control study was conducted on 110 cases and 110 controls. A semi-structured questionnaire was used to collect information. Statistical Analysis was done using MS Excel 2007, and Chi-Square test was also used. Of the parameters studied, age, residence, family history, smoking and alcohol were found to be associated with CKD and were statistically significant (p

For a long time normal Spark ignition and Combustion ignition engines emit toxic into the atmosphere which causes many environmental problems, like global warming, ozone layer depletion. In order to minimize this introducing an alternative way is the feasible path. Alternative sources such as compressed air, solar, wind energy can be used to minimize the effect on environment. We have converted a Spark ignition engine into compressed air engine by incorporating additional setup. Some pneumatic components are used in this conversion of engine. The pollution can be reduced, because the major power source used here is compressed air. Compressed air is produced at a very low cost when compared with fossil fuel which is used extensively. This tricycle is fixed with an engine setup. This tricycle is commercialized in way that can be used for very short distance drives.

As per the survey of the World Energy monitor issue 2019 portrait that since 1975, there was a rapid growth in the energy demand around the world till now and it is mainly satisfied by fossil fuels and centralized power generation. In the future, there should be varied energy transition need to happen to decrease the usage of fossil fuel. In this regard, much research work had been going on to ensure proper energy consumption without wasting much energy. Nowadays research on coating techniques was evolved to control the waste heat emission and to reduce corrosion reduction in pipes to conserve the most energy-releasing as an unused. In that, the usage of nanoparticles as a coating material in the area of heat transfer applications were evolved to enhance its working capacity. This review paper depicts the results obtained by various researchers with the usage of nanoparticles as coating materials over the other materials to enhance the thermal and corrosion properties by exploring with diverse nanoparticle size, coating thickness, morphological characteristic detecting instruments and usage of nanoparticles in diverse applications were studied. This paper may give the researchers a basic idea to pick the valid coating materials with their properties and applications for their study in heat transfer equipment.

Production of energy and its demand due to higher consumption by growing industrial sectors and increasing population is now becoming a major issue to mankind. So, proper utilization of the available energy and to generate energy with minimum energy losses is required. To achieve that, highly efficient equipment is needed. Energy generating powerhouses like power plants, chemical industries, engines in automobiles, airplanes, ships, refrigerators and air conditioners, solar equipment are producing a huge amount of useful energies and their performance are highly relies on the energy exchanging devices like heat exchangers. To enhance its performance many researchers are doing high-end research all around the world. In that, the assimilation of nano-particles in the heat exchanging medium plays a significant role in enhancing the heat transfer rate. In this work, the silver nanoparticles as a coating material over the heat exchanging surface using the displacement reaction method was experimentally studied. The coated heat exchanging surface was taken as copper which acted as a tube side where the hot water is circulated. The silver particles are finely deposited over the copper pipe like flower-shaped dendritic structures. The copper pipe was placed inside the Chlorinated Polyvinyl Chloride (CPVC) pipe which acted as a shell side tube since it holds high thermal resistance and cheap in cost. The results depict that the heat transfer coefficient in the nano-coated surface was increased, with the increase in the mass flow rate was observed, with 95 percent enhancement compared to bare copper pipe. The entire process was observed in counter-current type of flow with higher heat transfer performance.

Bioinformatics is the discipline of employing informatics technologies on biological datasets to extract the hidden knowledge from both biology and computer science fields. Gene expression datasets are widely used in disease prediction and diagnosis especially in cancer treatment. There are many computational techniques that are available for gene expression analysis. Deep learning methods are a fragment of machine learning techniques which are based on artificial neural networks. Convolutional neural networks are the most important deep learning model that is designed for data that comes in the form of multidimensional arrays. This paper reviews the recent research works that utilize convolutional neural network deep learning methods on gene expression data analysis.

Double chambered right ventricle is a rare cardiac defect characterised by an obstructive hypertrophied muscle bundle in the right ventricle. The common associated lesions are ventricular septal defect followed by sub-aortic membrane. We report a child who had coarctation of aorta in association with double chambered right ventricle. This case is being reported for its rarity and challenges in management.

The India Hypertension Control Initiative (IHCI) is a multi‐partner initiative, implementing and scaling up a public health hypertension control program across India. A cohort of 21,895 adult hypertension patients in 24 IHCI sentinel site facilities in four Indian states (Punjab, Madhya Pradesh, Maharashtra, and Telangana), registered from January 2018 until June 2019 were assessed at baseline and then followed up for blood pressure (BP) control and antihypertensive medication use. Among all registrations, 11 274 (51%) of the patients returned for a follow‐up visit between July 2019 and September 2019. Among patients returning for follow‐up, 26.3% had BP controlled at registration, and 59.8% had BP controlled at follow‐up (p

The purpose of this paper is to present a new viewpoint on how the curricula for higher education chemistry courses can be restructured, so that students understand the various dimensions of the sustainability concept and are equipped to work chemical sciences in a profitable, clean and societal friendly way, that is synthesis of materials (which collates CHNOPS-atomic symbols) in desired architecture and disperse them after their intended use, back into their natural reservoirs. A very novel idea of "sustainable chemical science facility", encompassing a teaching module capable of imparting strong fundamental Chemistry concepts, a virtual environment for undergoing the basic industrial training and a production unit with modular reactors for resource funding is proposed here. Often research is restricted to academic qualification, and a substantial band gap exists between the microscopic realm of academic research and the macroscopic domain of industrial chemistry, which thrives on research application. This band gap can be overcome by arming young chemists with training, tools and experience to possess complete control (synthetic and functional) on the materials they produce. The conceptual facility if turned into reality will definitely be the right step towards achieving materials with sustainable functionalities. We will have learning, training and production under one roof. Students will receive theoretical, practical and real-life experience of the production in industries, making them efficiently employable at a very young age. The idea is to bridge some critical engineering concepts with core chemistry, but with a clear distinction between chemical reactor engineering and core chemistry. This paper is a brainchild of the author and is more of a policy paper, needed to be elaborately discussed in academic and industrial forums.

Introduction: We report here our success in developing a flexible RRAM stack structure by employing a low-cost method. Bare conductive commercial electric paint is used as anode against Stainless Steel (SS) foil deposited with Mn3O4 thin films forming a BCEP/Mn3O4/SS thin film stack to understand the intrinsic non-volatile resistive switching behavior of Mn3O4. Experimental: Thin film Mn3O4 is deposited on a SS (304) foil by means of potential sweep voltammetry by maintaining typical conditions. Interestingly, the pristine device is subjected to an electroforming process which exhibited a digital type bipolar resistive switching characteristics. The study of the conduction mechanism revealed that the resistive switching arises due to local effect occurring in the bulk of Mn3O4, which corresponds to the growth and annihilation of oxygen vacancy nanofilaments, and this is responsible for the change in resistance state of the RRAM between Low Resistance State (LRS) and High Resistance State (HRS) respectively. Results: In order to affirm the reliability and reproducibility of RRAM structure, the memory retention is monitored over 103 s and subsequently, the endurance test is also carried out ensuring the reproducibility over 100 cycles. Conclusion: Owing to the flexible nature of BCEP/Mn3O4/SS Foil RRAM stack structure, it is perceived to be a prime candidate for future non-volatile memory and flexible electronics applications.

BACKGROUND :Hair loss may occur due to increase in breaking of hair due to a reduction in tensile strength of hair fiber.Resistance to breakage is a function of the cortex condition affected by chemical treatments. Normally hair can stretch upto 20% of its original length before breaking if its dry and upto 50% if its wet.AIM&OBJECTIVE : To evaluate the tensile strength of scalp hair in women with alopecia.METHODS :A case control study of about 50 cases with alopecia (assessed by Ludwig scale) and 50 controls with age and sex matched subjects of above 18 years of age were included.5 – 10 samples of 15 cms hair were collected from each subject and evaluated for tensile strength of both dry and wet samples with the help of zwick/roell machine.RESULTS :This study found that tensile strength breaking point Fmax (gF) dry was statistically significantly lower in cases(82.36±24.13) compared to controls (93.66±23.08), t(98)=-2.382, p=0.02. Similarly tensile strength breaking point Fmax (gF) wet was statistically significantly lower in cases(86.10±23.38) compared to controls (94.92±16.69), t(98)=-2.171, p=0.03. In the same way our study results showed that tensile strength breaking elongation dL at Fmax(%) dry and wet didn’t show any statistical significance between the two groups(p=0.50, p=0.53 respectively).CONCLUSION:This study shows that tensile strength of hair in women with alopecia had increased breakability in both dry and wet samples when compared with controls and also statistically significant whereas elasticity of hair was not statistically significant

We present a case of 21-day-old neonate brought with history of 3 episodes of syncope. Evaluation revealed congenital long QT syndrome associated with long cycle atypical AV Wenkebaching with a long short cycle sequence related left bundle branch aberrancy. Syncope was attributed to multiple episodes of Torsades de Pointes, necessitating emergency epicardial pacemaker implantation. In addition, child was started on oral propranolol therapy. On 2 months follow up, child was stable with no ventricular high rate episodes during pacemaker interrogation.

Background: Vitiligo is an acquired, multifactorial disorder of depigmentation and is overwhelming and distressing to the patients and the care givers. Childhood vitiligo has different characteristics as compared to adult-onset vitiligo. Every parent wants to know if the disease will progress or regress. Aims and Objectives: To study the epidemiological, clinical and hematological patterns of children with vitiligo. Materials and Methods: First 50 patients with vitiligo, younger than 12 years of age, who visited the Dermatology outpatient department of Vinayaka Missions Hospital, a tertiary care center in Karaikal, between January 2015 and January 2020 were included. They were assessed for the natural history, clinical features, family history and associated abnormalities of vitiligo. Results: There were 19 boys and 31 girls (boys: girls 1:1.63) out of 50 patients. Mean age of onset of vitiligo was 5.8 years and mean duration was 1.4 years. The most common site was the head and the neck, followed by the extremities, trunk and genitalia and the most prevalent type was vitiligo vulgaris (60%). Then, it was acrofacial vitiligo (26.5%), focal vitiligo (23.7%) and segmental vitiligo (2.6%). 5 patients had a positive family history. Involvement of mucosa in 12%, Leukotrichia in 11% and Koebnerization was seen in 10% children. Body involvement is bilateral in 72% and unilateral in 28% children. Majority of patients (49%) had multiple lesions (more than 5) and most (96%) had Conclusion: In children, any depigmented/hypopigmented lesion should be evaluated and followed up properly to rule out vitiligo. The patterns and characteristics of childhood-onset vitiligo should be understood properly by Dermatologists as it presents in a different manner from adult-onset disease and its management should take several factors into consideration like extension, psychological effects on children and parents, avoidance of treatment side effects and probable association with other autoim

The anti-inflammatory effects of vagus nerve stimulation are well known. It has recently been shown that low-level, transcutaneous stimulation of vagus nerve at the tragus (LLTS) reduces cardiac inflammation in a rat model of heart failure with preserved ejection fraction (HFpEF). The mechanisms by which LLTS affect the central neural circuits within the brain regions that are important for the regulation of cardiac vagal tone are not clear. Female Dahl salt-sensitive rats were initially fed with either low salt (LS) or high salt (HS) diet for a period of 6 weeks, followed by sham or active stimulation (LLTS) for 30 min daily for 4 weeks. To study the central effects of LLTS, four brainstem (SP5, NAb, NTS, and RVLM) and two forebrain sites (PVN and SFO) were examined. HS diet significantly increased the gene expression of proinflammatory cytokines in the SP5 and SFO. LLTS reversed HS diet-induced changes at both these sites. Furthermore, LLTS augmented the levels of antioxidant Nrf2 in the SP5 and SFO. Taken together, these findings suggest that LLTS has central anti-inflammatory and antioxidant properties that could mediate the neuromodulation of cardiac vagal tone in the rat model of HFpEF.

Background While there have been studies in Singapore on the prevalence and economic burden of osteoporotic hip fracture, there is a severe lack of reference data on bone mineral density and prevalence of osteoporosis. The purpose of this study is to establish the reference values for BMD and compare prevalence of osteoporotic conditions using other available reference values so as to better understand the status of bone health in Singaporean adults. Methods We carried out a population-based cross-sectional study using dual-energy x-ray absorptiometry (Hologic Discovery Wi) to measure the bone mineral density of Singaporean adults aged ≥21 years. A total of 542 participants were recruited from the large north-eastern residential town of Yishun. We computed T- scores (denoted by TSG) for each individual in the study. Similar diagnoses were also done based on T-scores provided by the densitometer (TDXA), NHANES database (TNHANES), and China (TCHN), and the differences in prevalence compared. We then compared the concordance between TSG and TDXA in the classification of osteoporosis. Osteoporosis was defined according to criteria by the World Health Organization (WHO). Results Peak lumbar spine BMD was 1.093 ± 0.168 g/cm2 in women, and 1.041 ± 0.098 g/cm2 for men. Peak whole-body BMD was 1.193 ± 0.93 g/cm2 in women at, and 1.224 ± 0.112 g/cm2 for men. Prevalence of osteoporosis based on lumbar spine was 9.3% in postmenopausal women, and 0.7% in men after 50 years of age. The percentage difference in prevalence range from 60.5–163.6%, when using reference values from TDXA, TNHANES, and TCHN. Comparing diagnosis using TDXA and TSG cut-off values, 28 versus 15 women were diagnosed as osteoporotic respectively. The kappa statistics was 0.81 for women and 0.85 for men. Conclusion: Our study shows that T-scores provided by DXA manufacturer over-diagnosed osteoporosis in Singaporeans, and the prevalence of osteoporotic conditions is not accurately represented. This over-diagnosis may result in unnecessary treatment in some individuals.

This case report describes a typical case of hemodynamically significant mid-cavitory obstruction and the well-recognized limitation of transthoracic echocardiography in diagnosing apical thrombus. It also highlights the importance of an imaging modality like CMR for unequivocal diagnosis and designing the management strategy.

Breast cancer is one of the most prevalent malignancy cancer types especially affecting women globally. EGFR is a proto onco gene as well as the first identified tyrosine kinase receptor. It plays a dynamic role in many biological tasks such as apoptosis, cell cycle progression, differentiation, development and transcription. Somatic mutation in the EGFR kinase domain derails the normal kinase activity and over expression leads to the progression of cancer especially breast cancer. EGFR is one of the well-known therapeutic targets for breast cancer. In this scenario, we attempt to identify novel potent inhibitors of EGFR. Initially, we performed structure-based virtual screening and identified four potential compounds effective against EGFR. Further, the compounds were subjected to ADME prediction as part of evaluation of the druggability and all the four compounds found to fall under satisfactory range with predicted pharmacokinetic properties. Eventually, the conformational stability of protein-ligand complex was analyzed at different time scale by using Gromacs software. Molecular dynamics simulation run of 20 ns is carried out and results were analyzed using root mean square deviation (RMSD), root mean square fluctuation (RMSF) to signify the stability of protein-igand complex. The stability of the protein-ligand complex is more stable throughout entire simulation. From the results obtained from

As we face an explosion of COVID-19 cases and deal with an unprecedented set of circumstances all over the world, healthcare personnel are at the forefront, dealing with this emerging scenario. Certain subspecialties like interventional radiology entails a greater risk of acquiring and transmitting infection due to the close patient contact and invasive patient care the service provides. This makes it imperative to develop and set guidelines in place to limit transmission and utilize resources in an optimal fashion. A multi-tiered approach needs to be devised and monitored at the administrative level, taking into account the various staff and patient contact points. Based on these factors, work site and health force rearrangements need to be in place while enforcing segregation and disinfection parameters. We are putting forth an all-encompassing review of infection control measures that cover the dynamics of patient care and staff protocols that such a situation demands of an interventional department.