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In this study, we report a high incidence of New Delhi metallo-β-lactamase (NDM)-producing and ampicillin-catabolizing bacteria within carbapenem-resistant bacterial populations in the waters of two important rivers, Mahananda and Karala, bisecting two most populous towns, Siliguri and Jalpaiguri, respectively, in the northern West Bengal, India. Isolates producing NDM belonged to four genera, Acinetobacter, Escherichia, Proteus, and Pseudomonas; among which few were phylogenetically determined as putatively novel species. Class 1 integrons with the frequent presence of aadA and aac(6')-Ib gene cassettes in 50% of NDM-bearing isolates are indicative of possible selective pressures generated out of unregulated use of streptomycin, in agriculture practiced by the cultivators and tea planters living in locales drained by these two rivers, in their up- and downstream, and amikacin in the most crowded government-sponsored "sadar" and district hospitals of Siliguri and Jalpaiguri. NDM-delivering bacteria in rivers have genuine consequences for city inhabitants who are dependent on public water and sanitation facilities. Standard reconnaissance of antibiotic resistance, consolidating ecological sampling just as the assessment of clinical isolates, should be set up as a need.

Cannabis use and Psychosis are closely associated. Polysubstance use is prevalent among cannabis users. However, previous literature majorly examined the relationship between only cannabis use and ...

Emphysematous cystitis (EC) is a rare complicated urinary tract infection characterized by gas formation within the wall of the urinary bladder. Although EC has multifactorial etiology, commonly seen in elderly, diabetic and female sex; most of the cases of EC present along with emphysematous pyelonephritis (EPN) and full-blown urosepsis. We present a case of EC with EPN presented with features of sepsis managed conservatively. Furthermore, we reviewed the literature of published cases reports of EC with or without EPN from 1999 to 2019 (20 Years). From eligible 113 case reports, data of clinical presentation, demographic profile, risk factors, diagnostic methods, treatment, and prognosis were analyzed.

Introduction: Burns are medicolegally importance as they are commonest cause of unnatural death in India. Burn is an important factor in suicide and homicide all over world. Burns remain a significant public health problem in low/middle-income countries, contributing to substantial morbidity and mortality Aims &Objectives: To find out how thermal burn affect incidence, age, habitat, marital status, manner of death and its medico legal consequence. Materials and Methods: This retrospective study was carried out in a tertiary care hospital during 2014 to 2018 to assess the pattern of burn deaths amongst females brought for Medico-legal Autopsy from various police stations of Patna district under F.M.T department of N.M.C, Patna in the State of Bihar. Total 540 female burn cases brought for autopsy were included in study. Results: The highest numbers of victims were in the age group of 21 to 30 years (42.23%). Majority of the cases were from rural areas 75.19% and 81.85% of the victims were married. Mostly manner of death is accidental 57.40%. Majority of the burn victims death of the studied case were Hindu. Conclusion: Married females of productive age group belonging to rural areas are worst affected in burn injuries. Awareness campaigns targeting safety precautions, opportunities for basic health education and a change in mindset of society towards females are necessary to curb this menace of burn injuries. Keywords: Burn, Female, Nature of Death, Bihar.

Background: The Affiliate Stigma Scale (ASS) is a widely used tool to measure affiliate stigma in the caregivers of individuals with various types of mental illnesses. However, the Hindi adaptation of this scale with evident psychometric properties is not available. This study aimed to adapt the ASS in the Hindi language and, further, to validate it in the Indian setting. Methods: Translation and back-translation methods were used to translate the original items of the ASS to the Hindi language. After completion of translations and linguistic adaptation process, the Hindi translated version of the ASS, WHO Quality of Life-BREF (WHOQOL-BREF), General Health Questionnaire-12 (GHQ-12), and Hospital Anxiety and Depression Scale (HADS) were administered to 140 caregivers of persons with mental illness. Purposive sampling method was adopted. The age range of the participants was 17–60 years. Psychometric properties, as well as the factor structures of the scale, were evaluated. Results: The Hindi version of the ASS has adequate internal consistencies ( r = 0.87–0.93) and test–retest reliability ( r = 0.78, P < 0.001). The concurrent validity of this scale was also high, as the correlation coefficients among the Hindi version of the ASS, WHOQOL-BREF, GHQ-12, and HADS were ranging from 0.23 to 0.35. The exploratory factor analysis revealed three underlying factors, namely, cognition, affect, and behavior. Conclusions: The Hindi version of the ASS is a reliable and valid psychometric tool to measure affiliate stigma in caregivers of patients with mental illness.

Renal cell carcinoma (RCC) developing in a transplant recipient is about 5–20 times higher than the general population. It is more common in native kidneys than graft kidney, and incidence varies between 0.3% and 4.8%. Clear cell and papillary types are more frequently reported. Most RCC of allograft recipient is usually low-grade with favorable prognosis. We present a case of papillary RCC with sarcomatoid differentiation (SD) in a native kidney of renal transplant (RT) recipient. The coexistence of sarcomatoid variant with papillary RCC, as in our case, makes it a high grade (WHO/ISUP grade 4) and portends a poor prognosis. Relative aggressiveness and rarity of this variant histology in transplant recipients prompted us to report this case and carry out an extensive search of the available literature.

18F-2-fluoro-2-deoxy-D-glucose ([18F]-FDG) positron emission tomography (PET) CT has proven useful in the evaluation of high-grade glioma and is also useful as a predictor of the degree of malignancy in newly diagnosed brain tumors. It is commonly accepted that high-grade gliomas are characterized by increased FDG uptake, whereas the low-grade glioma demonstrates reduced or absent FDG uptake. [18F]-FDOPA is an amino acid PET tracer which is a marker of the proliferative activity of brain tumors and demonstrates positive uptake in all grades of brain tumors; however, the degree of tracer uptake is significantly higher in high-grade tumors as compared to low-grade tumors. Here, we discuss a case where both FDG and DOPA PET/CT scans raised suspicion of low-grade glioma; however, the final histopathology report confirmed WHO grade IV Glioblastoma.

Background: Hospital staff has been constant and at the forefront to provide treatment services to the patient with risk of COVID-19 infection. The fear and uncertainty forced by the COVID-19 pandemic have become a risk for physical and psychological health among health care professionals.Aim: To explore the stress, anxiety, depression, and quality of life among hospital staff working in general and mental health hospitals during the outbreak of the COVID-19 pandemic.Methods: The present survey was an online study among hospital staff in India. We received a total of 373 responses by the stipulated time from hospital staff - participants with written consent diverted for further study. Socio-demographic datasheet, quality of life (QOL- BREF), depression, anxiety, and stress scale (DASS-21) were included in the Google form.Results: The results showed 2.4% of depression, 6.3% of anxiety, and 5.9% of stress among hospital staff. Nursing staff, physicians, and lab technicians had higher stress, anxiety, and depression. The result also revealed 4.3% physical, 16.6% psychological, 65.4% social, and 21.7% environmental health had a poor level of QOL in hospital staff.Conclusion: Healthcare workers are stressed, anxious, and depressive while working in the COVID-19 pandemic situation. To sustain and develop quality in healthcare services, physical and psychological wellness programs can enhance mental health and quality of life among hospital staff.

Introduction: Anderson-Hynes pyeloplasty has been gold standard in the management of pelviureteric junction obstruction (PUJO). It has evolved from open to laparoscopic and now robotic surgery. Open surgery has its drawback of long incision and scar mark, significant post-operative pain and long hospital stay. The main limitation of laparoscopic surgery had been the difficulty in endosuturing. Robotic surgery has incorporated the minimal access method of laparoscopy and endowrist movement of open surgery to overcome the challenge of intracorporeal suturing. Here, we present our initial experience of robotic pyeloplasty. Patients and Methods: A total of 30 patients underwent robot-assisted laparoscopic pyeloplasty (RALP) over 19 months. Diagnosis of PUJO was made by computed tomography urography, diuretic renogram and retrograde pyelogram in selected patients. All patients underwent RALP by colon reflecting approach. Post-operative evaluation was done by DTPA scan at 3- and 6-month follow-up. Data were analysed after a mean follow-up of 11 months. Results: The mean operative time was 148 min and the mean hospital stay was 3.5 days. While 93% of the patients showed objective improvement in their drainage pattern on DTPA renogram, 90% of the patients were symptom-free at the end of 6 months. Conclusions: Robotic pyeloplasty is a safe and easily conquerable technique with comparable outcomes in the hands of surgeons who are beginners in this technique.

Congenital malformations of the seminal vesicles (SVs) are rare and are often associated with abnormalities of the ipsilateral upper tracts as embryologically both the ureteral buds and SVs arise from the mesonephric ducts. The triad of SV cysts, ipsilateral renal agenesis, and ejaculatory duct obstruction is known as the Zinner syndrome. We herein present the case of Zinner syndrome with hematuria as the mode of presentation. A 52-year-old gentleman presented with complaints of gross and painless hematuria for 3 months. An initial ultrasound revealed absent right kidney with a cystic structure abutting the urinary bladder. Cystoscopic examination revealed a high bladder neck. Magnetic resonance imaging of the abdomen revealed an absent right kidney and a large tubular structure in the region of the right ureter extending up to right SV with blood content and stones within. It was distally seen communicating with one of the cysts of the right SV. The cystic structure was removed with a robot-assisted laparoscopic approach. The console time was 110 min with minimal blood loss. Postoperative course was uneventful. Histopathology of the cyst wall revealed chronic inflammation. The patient is doing well on 6 months follow-up. This case was unique in terms of it presenting with a large intra-abdominal cyst with sharp stones within, probably first of its kind to be ever reported. Surgery is mandated for such symptomatic cysts and the daVinci robot with its minimally invasive approach offers the perfect platform for treating such challenging cases.

Abstarct Background/Objective Mild and moderate traumatic brain injury (TBI) is a neglected field especially with reference to its association with cognitive, behavioral, and emotional sequelae. The present study aimed to investigate the association of affective symptoms and clinical factors with neurocognitive functioning in complicated mild and moderate TBI patients. Materials and Methods The sample comprised 39 complicated mild and moderate TBI patients with age range of 18 to 59 years. The study was conducted in the Department of Neurosurgery, Banaras Hindu University, Varanasi. The patients were assessed with the neurocognitive tests, Rivermead Post Concussion Symptom Questionnaire, and Hospital Anxiety and Depression Scale. Statistical Analysis Partial correlations and zero order correlations were used to test the relationships between variables. Results The injury-related factors, namely level of consciousness and Glasgow Coma Scale were found to be associated with divided attention and memory dysfunction (p < 0.05), respectively. Anxiety was found to be associated with impairment on all domains of neurocognitive function (p < 0.05) except divided attention. Depressive symptoms were found to be correlated with all the neurocognitive functions (p < 0.05) except focused and divided attention, whereas head injury symptoms correlated with impairment on focused and divided attention (p < 0.05). Conclusion Present study highlights the need to acknowledge affective symptoms along with clinical factors in the planning of the rehabilitation programs for such patients in rural scenario.

New onset refractory status epilepticus (NORSE), is a rare, neurological condition characterised by prolonged periods of refractory epileptic seizure with no readily identifiable cause in otherwise healthy individuals. Anatomical imaging like MRI and serology is usually unremarkable. In patients who have underlying etiology as auto-immune encephalitis without any evidence of auto-antibodies FDG PET may help in early diagnosis and treatment response as it tends to accumulate in the neuronal tissue whenever there is increased blood flow, metabolic demand or increased electrical activity which reverts back with clinical recovery.

FTLD (Frontotemporal lobar degeneration) is a clinically and pathologically heterogeneous group of degenerative disorders, characterized by predominantly asymmetric degeneration of frontal and temporal lobes with selective neuronal loss and gliosis. The disease presents with variable degrees of impairment in behavior, language, executive control, and motor symptoms with progressive loss of cognition. On the basis of presenting clinical symptoms, FTLD is further divided into behavioral variant, nonfluent/agrammatic variant primary progressive aphasia (PPA), semantic variant PPA, logopenic variant PPA, progressive supranuclear palsy, and corticobasal ganglionic degeneration. Here we illustrate the utility of FDG PET with statistical parametric analysis for evaluation of these patients.

Pratyaksha (direct perception), Anumana (inference), Aptopadesha (testimony), and Yukti (reasoning) are the tools that helps for the diagnosis of the disease. To fulfill this purpose Atura-Pariksha (examination of patients), Dravya Pariksha (examination of medicinal drug and preparations), and Roga-Rogi Pariksha (examination of the patient and disease), etc. are a very important tool. The concept of Sara is described under Dashavidha Atura Pariksha (tenfold examination), and it is an important concept in both Swastha-rakshana (maintenance of health) and Aturasya Vikara Prashamana (treatment of disease). The concept of Sara is explained by different Acharyas elaborately in their own way. In spite of tremendous success in modern medical science, the incidence of diseases are increasing enormously. A sedentary lifestyle and improper dietary habits has led to the emergence of several health problems, including Type 2 Diabetes Mellitus (T2DM), and it is emerging as a major disease affecting mankind with many complications. Hence present study has been undertaken to understand Sara because all persons vary from one another in many ways, and a personalized approach to patient care should be adopted to plan appropriate therapeutics. Dietary factors, lifestyle, and psychological factors are involved in the aetiology of Madhumeha (T2DM). The Twak Sara, Shukra Sara, Asthi Sara, and Majja Sara persons are more prone to develop Madhumeha (T2DM). The Meda Sara and Mamsa Sara are less prone to develop Madhumeha (T2DM). We don’t find the Rakta Sara individuals in our study.

Background: The cognitive model of auditory hallucinations posits that the beliefs or appraisal of the voices plays an important role in the determination of consequent reactions. These beliefs are explored effectively through “Beliefs About Voices Questionnaire-Revised (BAVQ-R).” However, Hindi adaptation and psychometric evaluation of this tool are yet to be done. Hence, the present study aimed at translating the BAVQ-R in Hindi language and assessing the psychometric properties of the same. Methodology: The original version was translated in Hindi language using translation–back-translation method. This translated version of BAVQ-R was then administered to 51 schizophrenia patients with a history of active auditory hallucinations. All the participants were selected from Central India Institute of Mental Health and Neuro Sciences, Rajnandgaon (Chhattisgarh), using purposive sampling technique. Initially, the informed consent was taken from the patients, followed by the administration of the Hindi version of BAVQ-R and Psychotic Symptom Rating Scale (PSYRATS). Finally, the psychometric properties, e.g., internal consistency reliability, divergent validity, and convergent validity were calculated. Results: The internal consistency reliability was within the range of 0.6–0.94, as indicated by Cronbach's alpha. The divergent validity was high as malevolent voices and engagement feelings and behavior towards the voices were negatively correlated (r = −0.56, P < 0.01), and benevolent voices significantly negatively correlated with resistance feeling and behavior towards the voices (r = −0.74, P < 0.01). Convergent validity was measured by correlating the subscales of BAVQ-R with the dimensions of PSYRATS. Pearson's correlation indicated significant associations between the dimensions of the two scales. Conclusion: The Hindi version of BAVQ-R has good psychometric properties. The tool has good internal consistency along with high divergent and convergent validity.

PURPOSE To study the imaging patterns of Posterior cortical atrophy (PCA) and Dementia with Lewy bodies (DLB) on fluoro-deoxyglucose positron emission tomography computed tomography ([F]FDG PET/CT), identify areas of overlap and differences and to develop a prediction model to assist in diagnosis using univariate and multivariate analysis. METHODS A retrospective analysis of 72 patients clinically suspected of having posterior dementia was done. All patients underwent [FF]FDG PET/CT of the brain and dopamine transporter imaging with [[Tc]TRODAT-1 SPECT scan on separate days. The patients were divided into PCA with normal TRODAT uptake (n=34) and DLB with abnormal TRODAT uptake (n=38). The FDG PET/CT uptake patterns were recorded and areas of significant hypometabolism by z score analysis were considered as abnormal. Receiver operator characteristics (ROC) curve analysis was used to determine cutoff z scores and binary logistic regression analysis was used to determine the Odds ratio of being in the predicted groups. RESULTS Significantly hypometabolism was found in parieto-temporo-occipital association cortices and cingulate cortices in PCA patients. DLB patients showed significantly reduced uptake in the visual cortex. No significant difference was found between z score of occipital association cortex which showed hypometabolism in both groups. The cut-off z-score values derived from the ROC curve analysis were as follows- parietal association (cut-off-3, sensitivity-65.6%, specificity - 68.7%), temporal association (cut-off-2, sensitivity-78%, specificity-75%) and posterior cingulate (cut-off-0.5, sensitivity-93.7%, specificity-40.6%), their respective Odds ratio (with 95% confidence interval) for being in the PCA group as derived from univariate logistic regression were 3.66 (1.30-10.32), 10.71 (3.36-34.13) and 7.85 (1.57-39.17). The cut-off z score of primary visual cortex as derived from ROC curve was zero with sensitivity of 87.5%, specificity of 71.9%, and the Odds ratio for being the in the DLB group was 24.7 with 95% confidence interval of 5.99-101.85. CONCLUSION [F]FDG PET may be useful as a non-invasive diagnostic modality in differentiating the two posterior cortical dementias, despite significant overlap. Primary visual cortical hypometabolism can serve as an independent diagnostic marker for DLB, even in the absence of TRODAT imaging.

The present study focuses on exploring the prevalence and relationship of stigma, stress, anxiety, and depression among patients with epilepsy. This hospital-based study consisted of 200 patients diagnosed with epilepsy using a purposive sampling selected from the outpatient department of the Central Indian Institute of Mental Health and Neuro Sciences, Dewada, Chhattisgarh, India. Patients were assessed through a sociodemographic datasheet, Stigma Scale of Epilepsy, and Depression Anxiety Stress Scales. The result of the study reveals that patient with epilepsy perceived 25% of high stigma 61.0% of stress, 55.0% of anxiety, and 47.5% of the extremely severe level depression. In regression analysis, overall perceived stigma strongly contributes 32.9% to the variance on stress, anxiety, and depression in epileptic patients. The present study helps mental health professionals to understand the problems faced by patients with epilepsy and to create awareness about the same in society so that patients diagnosed with epilepsy are not ostracized.

Adrenal ganglioneuromas (GNs) are very rare tumours that originate from neural crest cells. Most of the time, they are diagnosed incidentally as they are usually non-functional and remain asymptomatic. Nowadays, they are being detected more often due to better availability of imaging facilities such as computed tomography (CT)/magnetic resonance imaging (MRI). Minimally invasive adrenalectomy (laparoscopic or robotic) remains the standard of care for such lesions. Hereby, we report a case of a 15-year-old young girl with right adrenal incidentaloma which was diagnosed on CT with the features suggestive of GN. She underwent robot-assisted excision of the mass with adrenal-sparing surgery. Histopathology revealed benign GN and no adjuvant treatment was required. As GN is not known for recurrence or metastasis, minimal invasive adrenal-sparing surgery should be a preferred modality of choice.

Carcinoma penis is a rare malignancy which mostly occurs after the sixth decade of life. It is managed surgically and partial penectomy is the most common procedure done in carcinoma involving the distal penis. Partial penectomy provides the opportunity of preservation of sexual function and enables the patient to micturate in standing position. The conventional technique of neourethra creation in partial penectomy is slitting the urethra dorsally. We propose an alternative approach to neourethra formation. Technique involves ventral slitting of the urethra followed by suturing which begins at the ventral aspect and continued in a parachute fashion toward the dorsal end. This new technique will help primary physicians and surgeons in providing better surgical results in caring for patients with carcinoma penis.

RAZOR (Randomized Open versus Robotic Cystectomy) trial is a phase 3 randomized control trial comparing robot-assisted laparoscopic radical cystectomy with open radical cystectomy for the treatment of bladder cancer published by Parekh et.al. Three-year follow-up analysis of this trial showed that there was no difference in overall survival, progression-free survival, and local or distant recurrence in both the group. The present report will discuss this landmark trial in brief in the context of the advantage and feasibility of robotic radical cystectomy in the developing world.

Background: There are rich state-based epidemiological evidences on dementia in India, which shows that neurodegenerative disorders are one of the major public health problems. However, inconsistencies and variability have been observed among the findings of most of the reported studies. Objectives: This meta-analysis was conducted to estimate the overall prevalence of dementia in India. Methods: Databases of several web sources, namely EBSCOhost, PubMed, PsycINFO, and Google Scholar were explored for searching the studies that had previously observed the prevalence of dementia in India. Retrieved articles were systematically selected using specific inclusion and exclusion criteria. The quality of the included studies was assessed through guidelines of strengthening the reporting of observational studies in epidemiology, and the risk of bias was assessed using the guidelines of Quality in Prognosis Studies. Meta-analysis was computed using R software (3.5.3) with “metaphor” package. Results: The present meta-analysis included 20 epidemiological studies consisting of 86,312 persons, out of which a total number of 1193 persons reported to have dementia across several states of India. The results of the meta-analysis indicated the number of elderly that suffer from dementia amounts to 20 per 1000 population (95% confidence interval: 0.02–0.03). The prevalence was higher in older age groups (75 years and above) as compared to those below 75 years of age. However, the prevalence rates were similar for males and females and rural and urban population. Conclusion: Dementia is a common neuropsychiatric condition in the Indian elderly population. Further, evidence-based national survey is needed to estimate the exact prevalence of the disease in the country.

Highlights • Iatrogenic superior mesenteric artery (SMA) injury is rare and underreported. • We hereby present a case of SMA injury during robot assisted laparoscopic nephrectomy. • SMA got clipped and cut due to inability to identify it because of dense perinephric adhesion. • It was repaired by end to end anastomosis., Introduction Superior mesenteric artery (SMA) injury is very peculiar to left sided renal surgery. Although it is rare only, most of it is unreported. We report a case of SMA injury during robot assisted laparoscopic nephrectomy, which was managed successfully by end to end anastomosis. Case presentation A 19-year-old male patient was undergoing robot assisted laparoscopic simple nephrectomy for pyelonephritic kidney. Because of dense adhesion, SMA was inadvertently clipped and cut. It was recognised intraoperatively and an end to end anastomosis was done by laparotomy. Discussion SMA injury is rarely encountered in surgical practice. Most of it occurs following trauma. Iatrogenic SMA injury occurs in case of distorted local anatomy either due to adhesion or bulky tumor in left renal fossa and vicinity. Conclusion One should be cautious about proximity of SMA and its possible injury during left nephrectomy and it should be repaired as soon as possible.

Ayurveda is an ancient medical science that deals with the of the human being as well as measures to treat diseases. There are two main purpose of Ayurveda, first being to maintain the healthy status of the healthy people and the second one is to cure the disease of the unhealthy person. For the diagnosis of the disease, ancient have given much importance of knowledge obtained by (direct perception), (inference), (testimony), and (reasoning) during the examination of the patient for a successful treatment. To fulfill this purpose, Atura-Pariksha (examination of patients) (examination of medicinal drug and preparations) and Roga-Rogi (examination of the patient and disease) etc. are a very important tool. The concept of is described under (tenfold examination), and it is an important concept in both (maintenance of health) and (treatment of disease). The concept of is explained by different elaborately in their own way. The process of adopting from is well explained in the classics. To evaluate the significance of in (T2DM) patients. Assessment of status and biochemical parameters in (T2DM) patients. might be an important tool for the assessment of the strength of patient and also helpful for proper planning of treatment.

Purpose The aims of this study were to evaluate Tc-TRODAT-1 SPECT imaging patterns and to assess their correlation with disease severity in clinically diagnosed patients of Parkinson disease (PD). Methods The study included 241 patients with clinically diagnosed idiopathic Parkinson disease who underwent Tc-TRODAT-1 SPECT/CT scan. Binding ratios were calculated for each striatum, caudate, and putamen individually, by drawing region of interest. Occipital cortex region of interest was taken for background correction. Correlation of binding ratio with increasing clinical stage was derived, as described by modified Hoehn and Yahr scale. Results Median binding ratio was least in the contralateral putamen for all stages of modified Hoehn and Yahr. A statistically significant negative correlation was found between increasing disease severity and binding ratio in all subregions of striatum. Patients were clinically categorized into postural instability and gait disorder group and tremor-dominant PD group. No significant asymmetry was found between the left and right striatum in patients belonging to postural instability and gait disorder group and in those with bilateral tremors without lateralization. Conclusions Tc-TRODAT-1 SPECT is useful in early detection and in assessing disease severity of PD. A significant asymmetry with the contralateral side being affected more than the ipsilateral side can be attributed to tremor-dominant patients. The binding ratio of the ipsilateral striatum may serve useful as a marker of remaining functional dopaminergic neuronal reserve in the striatum.

A Gram-stain-positive, spore-forming bacterium, EAG3T, capable of growing on 3-nitropropionic acid as the sole source of carbon, nitrogen and energy, was isolated from the anterior gut of an earthworm (Eisenia fetida) reared at the Centre of Floriculture and Agribusiness Management of the University of North Bengal at Siliguri (26.7072° N, 88.3558° E), West Bengal, India. The DNA G+C content of strain EAG3T was 42.5 mol%. Strain EAG3T contained MK-7 and MK-8 as predominant menaquinones. The predominant polar lipids were phosphatidylglycerol, diphosphatidylglycerol and phosphatidylethanolamine. The major cellular fatty acids were 13-methyltetradecanoic acid, (9Z)−9-hexadecen-1-ol, 12-methyltetradecanoic acid and 14-methylpentadecanoic acid. The draft genome of strain EAG3T, distributed in 57 contigs, was found to be 3.8 Mb. A total of 3811 potential coding sequences or genes were predicted, including 3672 protein-coding and 108 RNA-coding ones together with 31 pseudogenes. One hundred and thirty-five genes encoded hypothetical proteins with no meaningful homologies with known proteins. The EAG3T genome encompassed two nitronate monooxygenase and one methylmalonate-semialdehyde dehydrogenase (CoA acylating) homologues. 16S rRNA gene sequence-based phylogeny revealed that the closest relative of strain EAG3T was Bacillus methanolicus NCIMB 13113T (95.7 % similarity). Phylogenetic, physiological and biochemical characteristics differentiated strain EAG3T from B. methanolicus, as well as from the other close taxonomic relatives Planococcus rifietoensis M8T, Bhargavaea cecembensis DSE10T, Planomicrobium flavidum ISL-41Tand Fermentibacillus polygoni IEB3T, with which strain EAG3T had 93.3–94.2 % 16S rRNA gene sequence similarities. The new isolate, therefore, was considered as representing a novel genus of family Bacillaceae , for which the name Pradoshia eiseniae gen. nov., sp. nov. is proposed, with EAG3T (=LMG 30312T=JCM 32460T) as the type strain.

lt;bgt;Background:lt;/bgt; Genitourinary tuberculosis is one of the most common forms of extra-pulmonary tuberculosis. Owing to a myriad of clinical presentations and discrepancies in the diagnostic modalities, patients usually present late, which results in a high number of them requiring surgical intervention. The present study aims to retrospectively analyze the role of surgery in genitourinary tuberculosis.lt;brgt;lt;bgt;Patients and method:lt;/bgt; All patients diagnosed with genitourinary tuberculosis at our centre between October 2017 and September 2019 were included in the study. The mode of presentation, duration of symptoms, investigations performed, treatment received, and follow-up were studied.lt;brgt;lt;bgt;Results:lt;/bgt; Out of 25 patients diagnosed with genitourinary tuberculosis (GUTB), there were 15 (60%) males and 10 (40%) females. The mean age of presentation was 40.84 years. Nineteen (76%) patients underwent surgical intervention, and many patients required more than one surgical procedure. A reconstructive procedure was carried out in seven patients. At a median follow-up of 12 months, all patients did well, showing no relapse.lt;brgt;lt;bgt;Conclusion:lt;/bgt; Surgery, along with antitubercular treatment, is the key to the management of GUTB presenting with structural damage. However, surgery can be ablative or reconstructive, depending on various factors discussed in the present study. This preserves or restores the optimal function of the genitourinary system affected by the mycobacterium bacilli.

Aim: To elucidate the patterns of characteristic hypometabolism on 18F- fluorodeoxyglucose( 18F-FDG) positron emission tomography/computed tomography (PET/CT) in multisystem atrophy (MSA) and their correlation with the patterns of uptake on dopamine transporter imaging with 99mTc TRODAT-1 SPECT. Material and Methods: A retrospective analysis of 67 patients with clinically diagnosed MSA was performed. All the subjects underwent 99mTc TRODAT-1 SPECT and 18F-FDG PET/CT scanning on two separate days. The 99mTc-TRODAT-1 scans were analyzed visually for asymmetry and rostro-caudal gradient. The FDG uptake patterns were recorded, and areas of hypometabolism that were two standard deviations from the mean were considered abnormal. Results: All the subjects had an abnormal pattern of FDG uptake on PET scan, both on a visual inspection and semiquantitative analysis. In MSA-P subjects (n = 29), diffuse predominant hypometabolism of the globus pallidus-putamen complex was noted, with relative sparing of the caudate nuclei. In MSA-C subjects (n = 25), characteristic hypometabolism was noted in the cerebellum and brainstem. In mixed subtypes (n = 13), variable involvement of the basal ganglia, cerebellum, and brainstem was noted with frontoparietal hypometabolism. A statistically significant difference between MSA-P and MSA-C for gradient reduction and asymmetry with gradient reduction was observed. Conclusion: Dopamine transporter imaging with 99mTc TRODAT-1 SPECT not only helps in confirmation of parkinsonian disorders but also demonstrates varying patterns of distribution in different subtypes of MSA. Characteristic patterns of hypometabolism in 18F-FDG PET may help in the differentiation of the subtypes of MSA in the presence of clinically overlapping symptoms.

Introduction:- The motive of this study is to introduce a modied technique of 'pin in plaster.' that is a favourable treatment option for unstable fractures of the distal radius. This study was shown to narrated a modied technique using 'pin in plaster' that is a favorable treatment option for unstable fractures of the distal radius. A fracture of the distal radius is one of the most customary types of fracture, in the pediatric population fracture was 24% and up to 20% in the elderly, male-to-female ratio of one to four in older age groups. Methods:- 54 patients with fractures of the distal radius were followed for one year postoperatively. Patients were debarred if they had type B fractures according to AO classication, multiple injuries, or pathological fractures and were treated more than seven days after injury. Radiographic parameters, tilt and height including radial inclination, were measured pre-and postoperatively. Results:- The radial height was 10.2 mm at the sixth month postoperatively, and the average radial tilt was 10.6° of volar. Three patients of pin tract infection were recorded. There were no cases of pin loosening. Total 73 patients underwent surgery, and three cases of radial nerve irritation were recorded at the time of cast removal. All radial nerve palsies resolved at the six-month follow-up. Conclusion:- Our modied technique is successfully restoring anatomic congruity and maintaining the reduction in fractures of the distal radius.

Background: Hydatid disease is a parasitic zoonosis caused by Echinococcus granulosus. Dog and other carnivores are the definitive hosts, which harbor adult worm. Humans are the accidental and dead-end hosts that acquire the infection by ingestion of eggs released from the intestinal tract of these carnivores, mainly dogs. The primary organ of echinococcosis in humans is the liver and lung, while the kidney is the third most commonly involved organ. Occurrence of hydatid disease of kidneys in isolation or with multiple organ involvement and their management has been reported and well described. The concurrent hydatidosis and pregnancy are an unusual clinical condition and poses a clinical challenge. Case Details: In this study, we present a case of 36-year-old woman with symptomatic hydatid disease of the right kidney during the first trimester of pregnancy. A multidisciplinary team discusses the pros and cons of hydatid during pregnancy with the patient. After taking informed consent from the patient, she was effectively managed by medical termination of pregnancy followed by robot-assisted laparoscopic pericystectomy. Conclusion: The co-occurrence of symptomatic renal hydatid and pregnancy is quite unusual. Medical or surgical management of hydatid during pregnancy can have some detrimental effect on the fetus. Hence these patients could be managed with medical termination of pregnancy followed by robot-assisted nephron-sparing surgery. Robot-assisted surgery for the renal hydatids is safe and effective, and has a shorter learning curve.

OBJECTIVE: Surgical treatment for female urethral stricture is varied and lacks consensus. Dorsal and ventral approaches of urethroplasty have comparable success rate with debatable limitations. We describe modifications in dorsal onlay graft urethroplasty to mitigate the surgical limitations and improve functional outcomes. MATERIAL AND METHODS: We retrospectively analyzed 8 patients with strictures treated with dorsal onlay urethroplasty at our center. The inclusion criteria were American Urology Association (AUA) score >20, calibration 24 cmH(2)O, and urethroscopic visualization of the stricture. Surgical modifications included dorsal plane dissection away from the clitoris; limited lateral urethral dissection; omitting graft quilting onto the clitoris, and urethral slitting directly at the stricture site (for mid and proximal strictures), sparing the meatus and using canoe-shaped grafts for distal strictures. Success was defined as improvement in the AUA scores and Qmax >12 mL/s, without requiring any further intervention. RESULTS: The mean age was 50.5±10.6 years. Statistically significant improvements in mean AUA score [14.5±2.20 (p=0.012)], Qmax [23.63±2.44 (p=0.012)], post-void residual urine [107.88±40.37 (p=0.012)], and sexual function scores [6.833±2.23 (p=0.027)] were noted at a mean follow-up of 3 months. Distal strictures were more common. Mean urethral caliber was 9.62 Fr. No cases of de novo incontinence or sexual dissatisfaction were reported. CONCLUSION: In our experience, the dorsal onlay technique works well, but without a comparative evidence for ventral onlay, it is difficult to conclude that one is preferred over the other.

The Corona Virus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) was...

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a newly emerging, highly transmissible, and pathogenic coronavirus in humans that has caused global public health emergencies and economic crises. To date, millions of infections and thousands of deaths have been reported worldwide, and the numbers continue to rise. Currently, there is no specific drug or vaccine against this deadly virus; therefore, there is a pressing need to understand the mechanism(s) through which this virus enters the host cell. Viral entry into the host cell is a multistep process in which SARS-CoV-2 utilizes the receptor-binding domain (RBD) of the spike (S) glycoprotein to recognize angiotensin-converting enzyme 2 (ACE2) receptors on the human cells; this initiates host-cell entry by promoting viral-host cell membrane fusion through large-scale conformational changes in the S protein. Receptor recognition and fusion are critical and essential steps of viral infections and are key determinants of the viral host range and cross-species transmission. In this review, we summarize the current knowledge on the origin and evolution of SARS-CoV-2 and the roles of key viral factors. We discuss the structure of RNA-dependent RNA polymerase (RdRp) of SARS-CoV-2 and its significance in drug discovery and explain the receptor recognition mechanisms of coronaviruses. Further, we provide a comparative analysis of the SARS-CoV and SARS-CoV-2 S proteins and their receptor-binding specificity and discuss the differences in their antigenicity based on biophysical and structural characteristics.

The impact of COVID-19 on surgical practice is worldwide. Controversy is there regarding dissemination of coronavirus by surgical smoke during laparoscopic surgery; hence, laparoscopic surgeries are being used with great cautions. We propose the use of a simple device, which can be prepared cheaply with material readily available in our hospitals, to manage the surgical plume generated during laparoscopic procedures. With proper management of the surgical plume with the above-proposed device, the concerns regarding aerosol generation can be alleviated and all the benefits of laparoscopy can be extended to our patient in need of a surgery that cannot be delayed.