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ObjectiveMucormycosis is a rapidly progressive and fulminant fungal infection mainly affecting the nose and paranasal sinuses and often requiring aggressive surgical debridement, which commonly includes inferior maxillectomy. Conventional inferior maxillectomy involves removal of the bony hard palate and its mucoperiosteum. This can lead to formation of an oroantral fistula and thereby increase the morbidity in these patients leading to prolonged rehabilitation. Subperiosteal inferior maxillectomy involves sparing of the uninvolved mucoperiosteum of the hard palate. This flap is used for closure of the oroantral fistula, which preserves the functional capabilities of the patient, such as speech, mastication and deglutination.MethodThis case series describes the experience of using the technique of mucosa-preserving subperiosteal inferior maxillectomy in five patients with mucormycosis.ResultsWith the technique used in this study, complete oronasal separation was achieved in all six patients. The overall surgery time was also decreased when compared with free tissue transfer. Patients also did not have to bear the weight of prosthesis.ConclusionMucoperiosteal palatal flap-preserving subperiosteal inferior maxillectomy is an excellent approach for all patients with mucormycosis and healthy palatal mucosa.

Immune dysregulation, neuronal inflammation, and oligodendrocyte degradation are key causes for autoimmune disorders like multiple sclerosis (MS) and various other immune dysregulated neurodegenerative complications responsible for CNS-mediated immune responses. Sirtuin (SIRT-1) is a nicotinamide adenosine dinucleotide (NAD)-dependent transcriptional protein that deacetylases and removes acetyl groups from its transcription factors like P53, FOXO, NF-Κb, PGC-1α. SIRT-1 mediates a wide range of physiological functions, including gene transcription, metabolism, neuronal apoptosis, and glucose production. SIRT-1 dysregulation targets transcription factors, and other molecular alterations such as gene expression modification influence neuronal plasticity, inhibit Th17 cells, and interleukin-1β can aggravate brain diseases. Preclinical and clinical findings show that the upregulation of SIRT-1 reduces autoimmunity, neurodegeneration, and neuroexcitation. Even though drugs are being developed for symptomatic therapies in clinical trials, there are particular pharmacological implications for improving post-operative conditions in neurodegenerative patients where intensive care is required. Understanding the SIRT-1 signaling and identifying immune-mediated neuron deterioration can detect major therapeutic interventions that could prevent neuro complications. Thus, in the current review, we have addressed the manifestations of disease by the downregulation of SIRT-1 that could potentially cause MS and other neurodegenerative disorders and provided data on existing available and effective drug therapies and disease management strategies.

Background Multiple plain radiographic methods; cross table radiographic method, modified Budin method, projected neck-shaft angle method, and trans lateral decubitus view method using Ogata-Goldsand formula, have been described in literature for measurement of femoral stem version (FSV) after total hip arthroplasty (THA). Purpose To review these multiple radiographic methods and also determine validity and accuracy of modified Budin method in Indian population. Patients and methods A literature search for different methods described for FSV measurement was performed and these methods were reviewed. In addition, for validation of modified Budin method in Indian population, data was collected for 36 THAs prospectively. A posteroanterior radiograph with patient sitting in 90° hip flexion and 30° abduction was taken 3 weeks and 6 weeks after surgery for calculating the FSV using modified Budin method. At 3 weeks, a CT scan was also done for version measurement. Intra and interobserver reliability, and reproducibility of radiographic FSV measurement, and the correlation between CT scan and radiographic FSV measurement were statistically calculated. Results All the reviewed studies demonstrated that their method is comparable to CT method for FSV measurement, except FSV measured on cross table radiographic view. However, there were only one or at most two studies of every method described except for modified Budin technique. The mean FSV in our prospective case series using ‘modified Budin’ method was 11.6° which was comparable to the mean of CT scan version measurement (12.3°). The mean difference was 0.7° which was not statistically significant (p value > 0.05). In addition, there was high intra-class correlation coefficient in radiographic FSV for both intra- and inter-observer reliability. Conclusion Multiple methods have been described and validated in literature, however, the ‘modified Budin’ view have proved multiple times to have excellent reliability and validity for easy measurement of FSV.

Citronella oil has been frequently used as an insect repellant and antibacterial agent for management of vector borne diseases. In this study, the fabrication of citronella oil microsponge loaded hydrogel (HG-COMS) was conceptualized in order to provide future insight for developing delayed release formulation. The hydrogel was characterized for drug content, drug interaction studies, spreadability, texture analysis and in vitro occlusive behaviour and results were found satisfactory. Further, in vitro antimicrobial studies were carried out to compare the antimicrobial inhibitory potential of the HG-COMS against citronella oil loaded hydrogel (HG-CO). HG-COMS formulation showed better antimicrobial efficacy than HG-CO (zone of inhibition of E. coli, P. aeruginosa and S. aureus; with P value less than 0.01, 0.001 and 0.05, respectively). In addition, the safety (irritation potential) of the oil loaded hydrogel formulation was assessed by Hen’s Egg Test Chorioallantoic Membrane (HAT-CAM) method. Mosquito repellent activity against Anopheles stephensi (malaria vector mosquito) was also performed in a net cage having blood starved female mosquitoes. The repellent potential of prepared HG-COMS (34% repellency for 6 h) was found dependent on release of CO from the microsponges as well as from the gel matrix. HET-CAM test revealed that HG-COMS (irritation score: 6.43 ± 0.77) was found very promising in comparison to HG-CO (irritation score: 12.77 ± 0.36), and was thus, considered safer for dermal use. HG-COMS showed reduced frequency of application, no skin irritation and potential for controlling A. stephensi for longer time periods. Hence, HG-COMS is found as a promising eco-friendly protective option, to minimize the burden of mosquito-transmitted diseases, especially malaria in future.

Sickle cell anemia is a common disease in Oman country. In this disease, sickle-shaped cells are formed. These cells interrupt blood vessels and cause a reduction in oxygen transportation. It was founded that henna (Lawsonia inermis) can prohibit the formation of sickle cells. The Lawsone (2-Hydroxy-1,4-Naphthoquinone) is the constituents of henna which is responsible for the anti-sickling activity, by increasing the oxygen affinity of red blood cells. Hena has the anti-sickling activity which is proved by incubating aqueous and methanolic henna extracts with sickle cell disease patient's whole blood. Then for reduction to oxygen tension 2%, sodium bisulphite was added. Therefore, the percentage of sickled cells to normal red blood cells was observed at 30 minutes intervals. Henna proved a delay in the sickling process in 84% of the tested samples. Both extracts(aqueous and methanolic henna) can delay sickling for about an hour.

In this article, we discussed about type, preparation and evaluation of liposomes. The term liposome means body of lipid and it basically consisting of one or more phospholipid bilayers. liposomes are a mostly useful in reproduction, reagent, and gear in various scientific regimentation, including mathematics and theoretical physics, chemistry, colloid science, biochemistry, biology etc. these are one amongst the various drug delivery system used to target the drug to particular tissue because liposomes structure similar to lipid bilayer and cell membrane.

Recently, there has been active research in finding robotized solutions for the treatment of atrial fibrillation (AF) by augmenting catheter systems through the integration of force sensors at the tip. However, limited research has been aimed at providing automatic force control by also integrating actuation of the catheter tip, which can significantly enhance safety in such procedures. This article solves the demanding challenge of miniaturizing both actuation and sensing for integration into flexible catheters. Fabrication strategies are presented for a series of novel soft thick-walled cylindrical actuators, with embedded sensing using eutectic gallium–indium. The functional catheter tips have a diameter in the range of 2.6–3.6 mm and can both generate and detect forces in the range of

Introduction This study was conducted to assess fluid responsiveness in critically ill patients to avoid various complications of fluid overload. Material and methods This study was done in an ICU of a tertiary care hospital after approval from the institute ethical committee over 18 months. A total of 54 consenting adult patients were included in the study. Patients were hemodynamically unstable requiring mechanical ventilation, had acute circulatory failure, or those with at least one clinical sign of inadequate tissue perfusion. All patients were ventilated using tidal volume of 6-8 mL/kg, RR-12-15/minutes, positive end expiratory pressure (PEEP)-5 cm of water, and plateau pressure was kept below 30 cm water. They were sedated throughout the study. The arterial line and the central venous catheter were placed and connected to Vigileo-FloTrac transducer (Edward Lifesciences). Patients were classified into responder and nonresponder groups on the basis of the cardiac index (CI) after fluid challenge of 10 mL/kg of normal saline over 30 minutes. Pulse pressure variation (PPV), stroke volume variation (SVV), and systolic pressure variation (SPV) were assessed and compared at baseline, 30 minutes, and 60 minutes. Results In our study we found that PPV and SVV were significantly lower among responders than nonresponders at 30 minutes and insignificant at 60 minutes. Stroke volume variation was 10.28 ± 1.76 in the responder compared to 12.28 ± 4.42 (p = 0.02) at 30 minutes and PPV was 15.28 ± 6.94 in responders while it was 20.03 ± 4.35 in nonresponders (p = 0.01). We found SPV was insignificant at all time periods among both groups. Conclusion We can conclude that initial assessment for fluid responsiveness in critically ill mechanically ventilated patients should be based on PPV and SVV to prevent complications of fluid overload and their consequences. How to cite this article Kumar N, Malviya D, Nath SS, Rastogi S, Upadhyay V. Comparison of the Efficacy of Different Arterial Waveform-derived Variables (Pulse Pressure Variation, Stroke Volume Variation, Systolic Pressure Variation) for Fluid Responsiveness in Hemodynamically Unstable Mechanically Ventilated Critically Ill Patients. Indian J Crit Care Med 2021;25(1):48-53.

Introduction: Aneurysmal bone cysts (ABC’s) are expansile, tumour-like vascular lesion. They are more commonly seen in the metaphyseal region of long bones. They are benign lesion although malignant transformation has been reported. Usually presents in the first three decades of life. Common presentation is pain, swelling, or fracture. Proximal femur with ABC’s is a rare entity and with physeal extension is even sparse. Case Report: A 13- year-. old female presented in the orthopaedic emergency with complaints of pain in the right hip region following a trivial fall. Following trauma, the patient was unable to stand or walk. On examination, there was tenderness in Scarpa’s triangle, straight leg raise test was not possible and limb was in external rotation. Plain radiography revealed an inter-trochanteric fracture with cystic lesion in the proximal femur extending till until epiphysis. MRI of the proximal femur showed an air fluid level with septations and soft- tissue oedema suggestive of aneurysmal bone cyst ABC’s. The patient was managed by intra-lesional curettage with fibular strut grafting along with cancellous bone graft and fixation by Uni-planar external fixator. Conclusion: Pathological Fractures fractures of proximal femur management is are a challenge for an orthopaedic surgeon due to its location and biomechanical factors. Treatment of proximal femur ABC’s should be case dependent. In our opinion, aneursymal bone cyst of the proximal femur with physeal extension can be managed by external fixation along with extensive curettage and bone graft. Keywords: Aneurysmal bone cyst, proximal femur, external fixation

This study was done to measure the outcomes of hearing aid (HA) and cochlear implantation (CI) in case of congenital non syndromic severe to profound sensorineural hearing loss (SNHL) by using aided audiometry (AA), categories of auditory perception (CAP) score and speech intelligibility rating (SIR) scale. The objectives were to find out the effective management options available for bilateral severe to profound SNHL, to study the impact of age of CI on language development and to study the outcome of HA and CI. Patients with congenital severe to profound SNHL were included in the study. Initially the case history of the participants was taken then they underwent audiological tests to confirm hearing loss. To assess the outcomes of HA and CI, they were initially fitted with high gain digital behind the ear HA, then underwent auditory verbal therapy for twelve months, after that AA, CAP and SIR test done to measure the outcomes of HA and similar hierarchy followed for CI. The results showed that with HA, the benefit is very limited whereas with CI the benefit is significant. The average SIR score of HA and CI are 1 and 3.16 and average CAP score are 0.83 and 7.8 respectively. The study shows that the CI is one of the most effective management options available for severe to profound SNHL and found that early intervention followed by early detection of hearing loss helps in achieving better speech and language skills.

A library of indolinedione–coumarin hybrid molecules was rationally designed and synthesized against hyperuricemia. All of the synthesized hybrid molecules were tested to check their inhibitory activity against xanthine oxidase enzyme by using a spectrophotometric assay. The results revealed that the compound showed IC50 values within the range of 6.5–24.5 µM amongst which compound K-7 was found to be endowed with the most potent IC50 value against xanthine oxidase enzyme. Kinetic studies were also performed to check the mode of inhibition of most potent compound K-7, which revealed its mixed-type inhibition behavior. Structure-activity relationships revealed that electron-donating groups and small alkyl chains between the two active scaffolds might be beneficial in inhibiting xanthine oxidase enzyme. It was also shown that various electrostatic interactions stabilized the compound K-7 within the active site of xanthine oxidase enzyme, which confirmed that it can completely block its catalytic active site. Thus, K-7 is regarded as a potent xanthine oxidase inhibitor and can be served as a promising molecular architectural unit for anti-hyperuricemic drug design.

Studies worldwide have shown that the available vaccines are highly effective against SARS-CoV-2. However, there are growing laboratory reports that the newer variants of concerns (VOCs e.g. Alpha, Beta, Delta etc) may evade vaccine induced defense. In addition to that, there are few ground reports on health workers having breakthrough infections. In order to understand VOC driven breakthrough infection we investigated 14 individuals who tested positive for SARS-CoV-2 after being administered a single or double dose of Covishield (ChAdOx1, Serum Institute of India) from the city of Varanasi, which is located in the Indian state of Uttar Pradesh. Genomic analysis revealed that 78.6% (11/14) of the patients were infected with the B.1.617.2 (Delta) variant. Notably, the frequency (37%) of this variant in the region was significantly lower (p

Nose to brain delivery of resveratrol can be a very useful method to overcome the limitations possessed by conventional delivery approaches namely, hepatic metabolism, low bioavailability and half-life of resveratrol, and presence of blood-brain barrier (BBB). The objective of this research work was to develop and optimize the resveratrol-loaded NLCs and coating these carriers with chitosan to increase the residence time of the formulation into the nasal cavity and enhanced permeation across the nasal mucosa. Three CQAs (Particle size, Entrapment efficiency, and PDI), and CMAs (Solid: total lipid concentration, surfactant concentration, and bioactive amount) were selected and the formulation was optimized using the Box-Behnken design (BBD) approach. The optimized batch was evaluated for physicochemical characteristics such as particle size (168.24 ± 8.24 nm), PDI (0.151 ± 0.003), and entrapment efficiency (77.42 ± 3.76 %). This optimized batch was coated with chitosan, which produced coated NLCs with a particle size of 317.7 ± 15.9 nm, and PDI was 0.089 ± 0.009. The morphological study using TEM confirmed the spherical shape, size, and surface coating of the NLCs. Furthermore, both the uncoated and coated particles were analyzed for in vitro resveratrol release, ex vivo diffusion study, and antioxidant assay. NLCs was founded to show sustained in vitro release characteristic, and enhanced bioactive diffusion across the nasal mucosa compared to the bioactive solution of resveratrol. The antioxidant assay revealed that the antioxidant property of resveratrol was intact in the formulation, and a slight increase in antioxidant activity of the formulation was also observed which may be due to the presence of sesame oil in the formulation. These results indicated that the chitosan-coated NLCs can be used to deliver therapeutic moieties more efficiently via the nose to brain drug delivery.

Background Lack of treatment of novel Coronavirus disease led to the search of specific antivirals that are capable to inhibit the replication of the virus. The plant kingdom has demonstrated to be an important source of new molecules with antiviral potential. Purpose The present study aims to utilize various computational tools to identify the most eligible drug candidate that have capabilities to halt the replication of SARS-COV-2 virus by inhibiting Main protease (Mpro) enzyme Methods We have selected plants whose extracts have inhibitory potential against previously discovered coronaviruses. Their phytoconstituents were surveyed and a library of 100 molecules was prepared. Then, computational tools such as molecular docking, ADMET and molecular dynamic simulations were utilized to screen the compounds and evaluate them against Mpro enzyme. Results All the phytoconstituents showed good binding affinities towards Mpro enzyme. Among them laurolitsine possesses the highest binding affinity i.e. -294.1533 kcal/mol. On ADMET analysis of best three ligands were simulated for 1.2 ns, then the stable ligand among them was further simulated for 20 ns. Results revealed that no conformational changes were observed in the laurolitsine w.r.t. protein residues and low RMSD value suggested that the Laurolitsine-protein complex was stable for 20 ns. Conclusion Laurolitsine, an active constituent of roots of Lindera aggregata, was found to be having good ADMET profile and have capabilities to halt the activity of the enzyme. Therefore, this makes laurolitsine a good drug candidate for the treatment of COVID-19.

Background: Revascularization of subacute or chronic internal carotid artery occlusion is technically feasible in some patients but carotid revascularization procedure needs to be optimized to improve the clinical success of the procedure. Objective: To describe our experience using intravascular ultrasound (IVUS) as adjunct to carotid revascularization procedure in patients with subacute or chronic internal carotid artery occlusion. Materials and Methods: Endovascular recanalization was attempted in 7 patients with symptomatic internal carotid artery occlusions between 3 and 11 days of symptoms onset. Distal protection device was deployed in all the patients followed by advancement of IVUS catheter (Eagle Eye Gold, 20 MHZ Digital, s5 Imaging System, Volcano Corp.) to obtain gray-scale and virtual histology (VH) images at regions of interest. IVUS images used to categorize occlusion content as: dark green- fibrous; yellow/green- fibrofatty; white- calcified; red- necrotic lipid core plaque on images. Intravascular thrombus was diagnosed an echolucent, homogeneous, well-delineated, diaphragm-like intraluminal structure. Results: The occlusion was recanalized successfully in all of 7 patients with median age 67.4±7.5 years. IVUS demonstrated intravascular thrombus in 5 of 7 patients. Fibrous and fibrofatty constituents of plaque were seen in 5 of the 7 patients in whom VH was done. Calcification and lipid necrotic core each were seen in 3 of 5 patients.5 patients with large thrombus burden on IVUS were treated using aspiration thrombectomy. Six of seven patients underwent stent placement and one patient underwent primary angioplasty. 5 of 7 patients had modified Rankin Scale of 0-2 at follow up (3 weeks to 4 months post procedure). Conclusions: IVUS provided valuable information to optimize carotid revascularization procedure in patients with subacute or chronic internal carotid artery occlusion.

Background: Histamine (H) 2 blockers led to a significant increase of the relative bioavailability of nimodipine and therefore may change tolerability of nimodipine in patients with aneurysmal subarachnoid hemorrhage (SAH). Objective: To determine the effect of H2 blockers on outcome of SAH patients being treated with nimodipine on outcomes. Methods: We analyzed data from Cerner Health Facts® which collected data from participating facilities from January 1st, 2000 to July 1st, 2018. We identified SAH patients who underwent endovascular or surgical treatment for intracranial aneurysm and received nimodipine with or without H2 blockers. Outcome was defined by discharge destination and classified into none to minimal disability, moderate to severe disability, or death. Results: A total of 815 (54.8%) of 1488 SAH patients received H2 blockers in addition to nimodipine. There were no differences in rates of cerebral ischemia (8.8% versus 9.8%) or performance of angioplasty (3.8% versus 3.7%) between patients who did or did not receive H2 blockers. There were no differences in rates of intubation/mechanical ventilation (26.0% versus 29.3%) or intra-procedural cerebral infarction (3.4% versus 2.8%) between the two groups. There was no difference in in hospital mortality rates (10.9% versus 10.2%) or none to minimal disability (41.8% versus 38.2%) between patients who did or did not receive H2 blockers. Conclusions: H2 blockers are frequently used with nimodipine in SAH patients and did not appear to adversely affect rates of death or disability. The finding does not support any clinically significant interaction between H2 blockers and nimodipine in SAH patients.

Context: Over the past few decades, transradial access has been increasingly utilized for neurointerventional procedures including carotid angioplasty and stent placement (CAS). Objective: To compare the outcomes of CAS performed via transradial approach with those performed using transfemoral approach within the same institution. Methods: We analyzed all the elective CAS procedures performed at our institute in the last 48 months and divided the procedures based on initial approach (transradial or transfemoral). Both approaches were used by same interventionalists to minimize inter-operator variability. We compared the rates of technical failure; hemorrhagic complications classified as major (hemoglobin decrease >5 g/dL or intracranial hemorrhage with deficits), minor (hemoglobin decreases 3-5 g/dL or intracranial hemorrhage without residual deficits), or insignificant; and any stroke and/or death within 1-month post procedure. Results: A total of 120 elective CAS procedures were performed at our institution; 84 patients (70%) were initiated as transfemoral and 36 patients (30%) were initiated as transradial approach. There were 6 (16%) CAS procedures initiated as trans-radial but later switched to transfemoral due to anatomical and/or technical difficulties. Similarly, 1(1.2%) procedure was switched to transradial from transfemoral. So finally, 89 (74%) patients had transfemoral approach and 31 (26%) patients had transradial approach to CAS. The median age was similar between the two groups (66.5 years versus 67.3 years).The rates of major hemorrhagic complications were 2 (2.2 %) and 0 (0%) in CAS performed using tranfemoral and tranradial approaches, respectively. The rate of any stroke and/or death within 30 days post procedure was 5 (5.6 %) and 1 (3.2 %) in CAS performed using transfemoral and transradial approaches, respectively.The median fluoroscopy time was 36.1 minutes and 34.4 minutes using transfemoral and transfemoral approaches, respectively (p =0.72). Conclusions: Transradial approach is comparable to transfemoral approach for performance of CAS in regard to clinical endpoints although the rates of technical failure remain relatively high in patients in whom CAS was initiated from transradial approach.

Conflict between patient and health care professionals is increasing over time. Traditionally, the medical profession has been considered the most honourable profession and the professionals are held with great esteem as they are considered next to God. Unfortunately, there seems to have been developed a distinct discord between the patient and the health care professional relationship with disturbing incidents catching the headlines. These conflicts range from simple disagreements to major violence against the very people who are trying to undertake patient’s care. Ultimately, it is in the best interest of both the patient and the health care professional to have a harmonious relationship based on utmost trust which is the very keynote of mutual understanding resulting in the benefit both of them. Authors are now trying with deep sincerity for mitigation of distrust and exploring possible resolution strategies to apply in clinical practice in order to overcome them.

Introduction: Sleeve fracture (SF) represents an unusual type of patellar fracture and has been reported mainly in children or adolescents. Superior pole fracture in adults is a very rare occurrence because the enthesis of the adult patella is more resilient to avulsion injury as compared to an immature pediatric skeleton. Due to the rarity of these fractures in adults and vague radiographic findings, the chances of missing the fracture are very high. Case Report: An 18-year-old boy presented to our outpatient department with a history of fall while trying to jump across a wall 6 months ago. At the time of presentation, the patient mainly complained of loss of active extension of the knee in the sitting position and a palpable gap over the upper part of the patella. After radiographic evaluation, a diagnosis of SF was made. The patient was managed surgically, and thereafter, early rehabilitation was done. After 10 weeks post-surgery, the patient was free from any pain, had a full range of motion, and was able to walk without support. Conclusion: Adults presenting with acute injury to knee with limitation of extension and palpable gap over the superior pole of the patella, a differential diagnosis of SF must be suspected and should be ruled out by clinical examination and relevant investigations. Keywords: Sleeve fracture, patella, superior pole, adult.

Salinity stress inhibits plant growth by affecting morphological, photosynthesis, antioxidant phenomena, and nitrogen metabolism, among other physiological and biochemical processes. In this study, the effects of pre-soaking Wheat and Mung grains in aqueous extract of Cissus quadrangularis on growth, and antioxidant activity of salt-treated plants, were investigated. The pre-soaking of grains in extract demonstrated a significant enhancement in growth parameters. The activity of superoxide dismutase (SOD), guaiacol peroxidise (GPOX), and ascorbate peroxidase (APX), catalase (CAT) increased with increasing the concentration of C. quadrangularis extract up to 3%w/v while decreasing when at a higher concentration of 10%w/v. The estimation of bioactive compound Proline also observes higher concentrations at 3%w/v under treatment with different salt stress. Therefore, the study suggested that seed priming with plant extract is an effective technique to improve the growth of Wheat and Mung seedlings under salt stress conditions.

Background Interlocking intramedullary nail is used for almost all types of femoral shaft fractures worldwide because of its better mechanical stability. In countries like India with limited healthcare infrastructure, the use of Kuntscher nail (K-nail) in Winquist type I and type II isthmic fractures is still debated. Therefore, we conducted this study to compare the functional outcome, radiation exposure, and cost of the implant between closed reduction and internal fixation of Winquist type I and II fractures in the middle one-third shaft region by K-nail and intramedullary locked nails (IMILN), respectively. Methods This was a hospital-based non-blinded randomized trial which included 56 patients with closed Winquist type I and II femoral shaft fractures of the middle one-third femoral shaft (isthmic and paraisthmic zone). All the patients were either treated by K-nail or IMILN. The patients were followed up every three weeks for the initial six months and quarterly thereafter. Per operative duration of surgery and radiation exposure by C-arm was documented and assuming scattered radiation 20%, radiation exposure to the surgeon was calculated and patients were assessed clinically and radiologically for union. Results The patients were divided into two groups: group I (K-nail, n = 25) and group II (IMILN, n = 31). In groups I and II, the patients achieving radiological union were 88% (n = 22/25) and 84% (n = 27/31) at six months' duration, respectively. The mean duration for the radiological union was 3.65 ± 0.55 months in group I (K-nail) and 3.76 ± 0.59 months in group II (IMILN), respectively. There was no statistically significant difference in the duration of the union (p = 0.4963). The average number of C- arm exposures was 16.36 ± 3.18 in group I as compared to 27.29 ± 4.01 in group II, and the mean scattered radiation was 5.0 ± 1.63 in group I and 6.61 ± 4.06 in group II. This difference was statistically significant. Conclusion Kuntscher intramedullary nailing can provide comparable rates of union as is achieved with interlocking intramedullary nailing with an advantage of less radiation exposure and duration of surgery, provided the patient selection is proper (isthmic and paraisthmic zone).

Multiple Sclerosis (MS) is a severe brain and spinal cord condition with a diverse autoimmune response and a wide variety of demyelination symptoms that primarily affect young adults. The primary reason for this disease is inflammation of white and grey matter caused by increased production of proinflammatory cytokines, which further damages the progenitor oligodendrocytes and appears to induce hypertrophy of the astrocytes and gliosis. Overexpression of the JAK/STAT signaling pathway contributes directly to physiological and pathological results in motor neuron diseases. Cytokines such as IL-17, IL-6, IL-12, TNF-α, and INF-ϒ use JAK/STAT signaling to trigger self-reactive CD4+ T-cells and differentiate them into Th1 phenotypes that overactivate immune reactions in the brain. Similarly, PPARγ plays a critical role in regulating the immune response by providing an anti-inflammatory effect by inhibiting macrophage and cytokine production activation. PPARγ also mediates the intrinsic molecular process of the T-cell, which selectively regulates the differentiation of Th17. Various studies indicate the neuroprotective function of PPARγ agonists by attenuating the JAK/STAT mediated activation of glial cells, inhibiting interleukin, and the differentiation of Th1 cells. Therefore, to maintain the brain's immune system, both PPARγ and JAK/STAT oppositely regulate each other. Dysregulation in JAK/STAT and PPARγ signaling contributes to several physiological changes leading to neurological disorders, including MS. Based on the above view, we have summarized the combined role of JAK/STAT-PPARγ signaling in MS and explored potential therapeutic strategies for disease improvement by the use of pathway modulators.

Posterior circulation ischemic stroke constitutes one-fourth of all ischemic strokes. Even though such strokes are less common than the anterior circulation strokes, a higher rate of death or disability may be seen. Clinical factors like initial Glasgow Coma Scale, National Institutes of Health Stroke Scale, and patient-related factors such as age, gender, or underlying atherosclerotic disease affect the outcome. Modalities of treatment pursued after the stroke, including intravenous vs intra-arterial thrombolysis, also affect the outcome of the patients. Most of the death occurs during the first month of the stroke, though disabilities are usually severe and long-lasting. However, survivors of the stroke continue to improve functionally even after 5 years of the event, as shown in some of the studies. In this chapter, we discuss the mechanism of posterior circulation stroke, risk of recurrent stroke, outcomes of basilar artery stroke, differences in outcomes of symptomatic stenosis from asymptomatic stenosis, early ( 3 months) outcome, death or disability related to stroke, and effect of posterior circulation stroke on cognition and behavior of the stroke survivors.

Background: Nutrition is one of the most essential things of life. It plays a crucial role in body growth,development and maintenance of health. The objective of this study is the study of the impact of the mid-daymeal scheme on the nutritional status of school children (6-12 years) in Varanasi District.Methodology: This study was conducted for 320 students of class 1-8 at five government primary schoolsin two educational blocks in Varanasi district. Simple random sampling was used for selection of children.The variables of the study were the height and weight of selected students.Results: The results of the study indicated that the nutritional status of MDM children. The study undertakenon a representative and adequate sample of Varanasi revealed that as per Waterlow classification, around 45per cent of children were found to be normal as per their weight for age and 72.8 per cent of children werefound to be normal as per their height for age. The prevalence of wasting and stunting in these children washigh (55 % wasted and 27 % of stunted), with boys and girl suffering almost equally. The observations of thepresent study suggest that the distribution of height of boys were found shorter than boys of WHO standardsby -1.8 cm to -6.4 across all ages. The maximum difference was found in age group of 13 years. The weightof boys increased with in age from 6 to 14 years. The weight in the age group 6 to 14 years ranged from 19.5kg to 50.4 kg in boys.Conclusion: The overall findings of the study revealed that the mean weight of boys and girls was foundshorter than boys and girls of WHO standards. There was no significant difference in the prevalence ofstunting and wasting for both boys and girls

Breast cancer is the most prominent, frequently diagnosed and leading cause of death among women. Estrogen is an agonist of estrogen receptor alpha (ER-α), expressed in mammary glands and is responsible for initiating many signalling pathways that lead to differentiation and development of breast tissue. Any mutations in these signalling pathways result in irregular growth of mammary tissue, leading to the development of tumour or cancer. All these observations attract the attention of researchers to antagonize ER-α receptor either by developing selective estrogen receptor modulators or by selective estrogen receptor degraders. Therefore, this article provides a brief overview of various factors that are responsible for provoking breast cancer in women and design strategies recently used by the various research groups across the world for antagonizing or demodulating ER-α.

This study was done to identify the effect that environmental noises have on consonant perception of individuals with normal hearing sensitivity. The objectives were to find out the effect of white noise and environmental noises on consonant identification and to find the effect of noises on consonant features. Adult with normal hearing in both ears whose mother tongue was Odia were included. Initially the participants underwent pure tone audiometry, speech audiometry, immittance audiometry to confirm their normal hearing, good speech identification scores and normal middle ear function. For consonant identification test, the presentation level was 40 dB sensation level with reference to speech recognition threshold for all subjects. Consonant identification test was carried out in white noise and real environmental noises (traffic noise, classroom noise, park noise, restaurant noise) at 0 dB signal to noise ratio (SNR) and at + 5 dB (SNR). The results showed that at + 5 dB SNR condition all subjects were able to get 80% and above consonant identification (CI) scores irrespective of type of noise used for stimulus while at 0 dB SNR, the mean scores ranged from 75.5% (restaurant noise) to 84% (traffic noise). At + 5 dB SNR only in restaurant noise the CI scores were low as compared to those in white noise. At 0 dB SNR, the scores were low for both the test conditions of park noise and that of restaurant noise. Different types of noisy environments can affect consonant perception which can affect speech intelligibility.

Purpose: Early onset opacification of the lens (cataract) has been observed to be on the rise globally. This study was conducted to determine the various types of presenile cataract and to determine the probable risk factors associated with the occurrence of presenile cataract. Materials and Methods: Patients in the age group of 18–40 years attending the Out-Patient Clinic of the Ophthalmology Department who were found to have presenile cataract were recruited as cases. An equal number of consecutive patients of the same age group were included in the control group. Those who gave consent to participate in the study were interviewed through a preformed questionnaire and underwent a complete ocular examination and set of blood investigations. The type of cataract was noted, data obtained were compiled, and examination and investigations done were documented and analyzed using frequency distribution and Chi-squared test. Results: In total, 90 cases and 90 controls that fulfilled the inclusion criteria were recruited. Most common type of cataract was found to be posterior subcapsular cataract. Presenile cataract was observed to be significantly associated with tobacco intake (P = 0.035), hypercholesterolemia (P = 0.002), fuel exposure (P = 0.004), and lower socioeconomic status (P =

This study was a cross-sectional descriptive type of study, conducted at Pediatrics department of Rajshahi Medical College Hospital from July 2014 to June 2016. A total 382 children were enrolled by purposive sampling among which 219 (57.3%) male, 163 (42.7%) female. The aim of this study was identify demographic as well as social status of malnourished children in tertiary care hospital. In this study the prevalence of underweight 42% (moderate & severe), wasting 34% (moderate & severe), and stunting 24% (moderate & severe) were found. Considering various Socio-demographic characteristics - maternal factors, paternal factors, socioeconomic status, and residential status had significant association with nutritional status of the children. Beside these various risk factors- birth weight, exclusive breast feeding, colostrum feeding, timing of weaning practices, type of complementary feeding and associated morbidities also had significant association with nutritional status of the children. The degree of malnutrition was found to more prevalent in the early age of children. Among the studied children more than half (60.5%) lived in rural area and rest of them lived in urban area (36.6%), semi urban area (2.9%) respectively. Children more than half (53%) were from lower class family. Rest of them was middle class (40.6%) and upper class (6.3%) family. Education level of the majority (59.4%) mother were primary to SSC, (22.5%) were below primary and (18.1%) were HSC and above. Education level of the majority ie.40.6% father were below primary, 39.8% were primary to SSC and 19.6% were HSC and above.TAJ 2017; 30(1): 56-60

Activated carbon from oak tree is used as adsorbent for the removal of noxious anionic dye sunset yellow. The prepared adsorbent is characterized using X-ray diffraction, Scanning Electron microscopy equipped with Energy-Dispersive X-ray spectroscopy and Fourier transform infrared spectroscopy. In addition to this, parameters like initial concentration, adsorbent dosage, contact time, pH, and particle size on the uptake of SY dye from wastewater is well investigated and optimized. For maximum adsorption, the initial concentration of 10 mg/L; adsorbent dose of 0.25 g; pH =1; contact time = 35 min and particle size = 150–250 μ m is found to be optimal value. The adsorption isotherm data at different adsorbent dosage of 0.05–0.25 g is in agreement with the Langmuir isotherm having Qmax = 5.8377–30.1205 mg/g. On the other hand, models like, Group Method of Data Handling and multiple linear regression were used to forecast the removal efficiency of noxious anionic dye sunset yellow and from results, it is specified that the GMDH model possess a high performance than MLR model for forecasting removal percentage of SY dye. Hence, activated carbon from oak tree can be efficiently used as adsorbent for the removal of SY dye from wastewater.

Method has been developed and validated by using spectrophotometric and chromatographic hyphenated techniques for the simultaneous estimation of Doxofylline (DOXO), Montelukast (MONT) and Levocetir...

Tacrine is a known Acetylcholinesterase (AChE) inhibitors having hepatotoxicity as main liability associated with it. The present study aims to reduce its hepatotoxicity by synthesizing tacrine linked triazole glycoconjugates via Huisgen’s [3+2] cycloaddition of anomeric azides and terminal acetylenes derived from tacrine. A series of triazole based glycoconjugates containing both acetylated (A-1 to A-7) and free sugar hydroxyl groups (A-8 to A-14) at the amino position of tacrine were synthesized in good yield taking aid from molecular docking studies and evaluated for their in vitro AChE inhibition activity as well as hepatotoxicity. All the hybrids were found to be non-toxic on HePG2 cell line at 200 μM (100 % cell viability) as compared to tacrine (35 % cell viability) after 24 hours of incubation period. Enzyme kinetic studies carried out for one of the potent hybrids in the series A-1 (IC50 0.4 μM) revealed its mixed inhibition approach. Thus, compound A-1 can be used as principle template to further explore the mechanism of action of different targets involved in Alzheimer’s disease (AD) which stands as an adequate chemical probe to be launched in an AD drug discovery program.

Arsenic pollution and climate change are two major global challenges that have threatened the aquatic environment and to a certain extent led to extinction of aquatic animals. Concerted and accelerated scientific efforts are in progress to restrict the ill- impacts of pollution and climate change in the aquatic ecosystem. In this context, we have conducted a study to delineate the effect of omega-3 fatty acids i.e., eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in mitigating arsenic pollution and temperature stress in Pangasianodon hypophthalmus. Four isocaloric and iso‑nitrogenous diets were prepared viz. control feed (no supplementation), and three treatment groups with combined level of EPA + DHA at 0.2, 0.4 and 0.6%. Fish were reared under arsenic (2.65 mg L−1) and elevated temperature (34 °C) (As+T) stress for 105 days with eight different treatment groups in triplicates. Growth performance, oxidative stress enzymes, stress biomarkers, immunity, lipid profile, bioaccumulation of the arsenic in fish tissues and bacterial infection in terms of cumulative mortality and relative percent survival were altered on exposure of arsenic and temperature stress. Supplementation of combinatorial mixture of EPA + DHA at the rate of 0.2 and 0.4% in the diet led to improved growth performance, anti-oxidative status, immunity of the fish and reduced the infection against Aeromonas hydrophila. Neurotransmitter enzyme, HSP 70 and Vitamin C were significantly enhanced (p

In the present study, the bioaccumulation of chromium, manganese, cobalt, copper, zinc, selenium, arsenic, strontium, cadmium, tin, antimony and lead in tissues of thirty marine fish species collected from New Ferry Whorf, Sassoon dock and Versova fishing harbour in Mumbai, India, were analysed. The bioaccumulation patterns of these twelve elements were determined to assess pollution biomarkers based on cellular and oxidative stresses. Catalase, superoxide dismutase and glutathione-s-transferase, glycolytic enzymes viz. lactate dehydrogenase and malate dehydrogenase, protein metabolism enzymes viz. aspartate transferase and alanine transferase, and lipid peroxidation were significantly higher in muscle and gill tissues. The activities of the neurotransmitter enzyme acetylcholine esterase in muscle and brain tissues was inhibited due to pollution. This study suggested that biochemical attributes such as oxidative stress enzymes, cellular biomarkers, neurotransmitter enzymes and metal and metalloid contamination could be successfully employed, even at low concentrations, as reliable biomarkers for biomonitoring of contaminated marine ecosystems.

Tuberculosis (TB) is primarily associated with decline in immune health status. As gut microbiome (GM) is implicated in the regulation of host immunity and metabolism, here we investigate GM alteration in TB patients by 16S rRNA gene and whole-genome shotgun sequencing. The study group constituted of patients with pulmonary TB and their healthy household contacts as controls (HCs). Significant alteration of microbial taxonomic and functional capacity was observed in patients with active TB as compared to the HCs. We observed that Prevotella and Bifidobacterium abundance were associated with HCs, whereas butyrate and propionate-producing bacteria like Faecalibacterium, Roseburia, Eubacterium and Phascolarctobacterium were significantly enriched in TB patients. Functional analysis showed reduced biosynthesis of vitamins and amino acids in favour of enriched metabolism of butyrate and propionate in TB subjects. The TB subjects were also investigated during the course of treatment, to analyse the variation of GM. Although perturbation in microbial composition was still evident after a month's administration of anti-TB drugs, significant changes were observed in metagenome gene pool that pointed towards recovery in functional capacity. Therefore, the findings from this pilot study suggest that microbial dysbiosis may contribute to pathophysiology of TB by enhancing the anti-inflammatory milieu in the host.