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A subset of AML patients are unfit for 7+3 induction at the time of diagnosis. Present case highlights the use of azacitidine and venetoclax in a patient with intermediate risk AML with WT-1 mutation,deemed unfit for intensive induction in view of poor general condition and comorbid illness. After venetoclax and azacitidine patient was negative for measurable residual disease but developed cerebellar toxicity after high dose cytarabine. He underwent successful matched sibling allogeneic stem cell transplant and is presently on routine follow up. This case report suggest possible role of this combination even in young patients unfit for intensive induction.

Introduction: Sleep is indispensable. The sleep habits changes with age and is influenced by external factors. The nationwide enforcement of complete lockdown lead to home confinement of all the students as classes in colleges were suspended on orders of the Government of India. Aim: To find out changes in the sleep pattern and quality in different phases of life of the students namely from school days, to college days and during the period of home confinement during COVID-19 pandemic. Materials and Methods: A questionnaire in the form of online form was shared with the students of MBBS first year in four Government medical colleges of Madhya Pradesh during nationwide lockdown on 1st May, 2020. The information about sleep pattern, usual bed time, average duration of sleep, sleep quality and student’s perception about adequate sleep during college days and during lockdown period was recorded. The statistical analysis was done by Wilcoxon signed rank test, and Chi-square test. The satisfaction with sleep quality was recorded on a five point Likert’s scale as very dissatisfied, dissatisfied, neither satisfied nor dissatisfied, satisfied and very satisfied. Results: A total 760 students participated in the present study. During usual college days among all participants, majority 373 (49.1%) of them had night owl type of sleep pattern. Maximum number of students 358 (47.10%) had morning lark type of sleep pattern during school days. The highest percentage of students 271 (35.7%) with no fixed pattern of sleep was observed during the period of home confinement due to lockdown. A total of 383 (50.4%) students reported that their average duration of night sleep during usual college days was six to seven hours per day. A total of 698 (91.8%) students reported that they are able to take adequate sleep at home during lockdown period. A statistically significant association was found between sleep pattern during college days and gender of participants (p-value

The coronavirus disease 2019 (COVID-19), the pandemic that originated in China has already spread into more than 190 countries, resulting in huge loss of human life and many more are at the stake of losing it; if not intervened with the best therapeutics to contain the disease. For that aspect, various scientific groups are continuously involved in the development of an effective line of treatment to control the novel coronavirus from spreading rapidly. Worldwide scientists are evaluating various biomolecules and synthetic inhibitors against COVID-19; where the nucleic acid-based molecules may be considered as potential drug candidates. These molecules have been proved potentially effective against SARS-CoV, which shares high sequence similarity with SARS-CoV-2. Recent advancements in nucleic acid-based therapeutics are helpful in targeted drug delivery, safely and effectively. The use of nucleic acid-based molecules also known to regulate the level of gene expression inside the target cells. This review mainly focuses on various nucleic acid-based biologically active molecules and their therapeutic potentials in developing vaccines for SARS-CoV-2.

The world is passing through a very difficult phase due to the coronavirus disease 2019 (COVID-19) pandemic, which has disrupted almost all spheres of life. Globally, according to the latest World Health Organization report (10 August 2020), COVID-19 has affected nearly 20 million lives, causing 728 013 deaths. Due to the lack of specific therapeutic drugs and vaccines, the outbreak of disease has spawned a corpus of contagious infection all over the world, day by day, without control. As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a very rapid infection rate, it is essential to develop a novel ameliorative and curative strategy as quickly as possible. Convalescent plasma (CP) therapy is a type of adaptive immunity that has already been found to be effective in confronting several infectious diseases from the last two decades. For example, CP therapy was used in the treatment of viral-induced diseases like SARS-CoV epidemics, Middle East respiratory syndrome coronavirus (MERS-CoV) pandemics, Ebola epidemics and H1N1 pandemic. In this review, we have mainly focused on the therapeutic role of CP therapy and its neutralizing effect to fight against the COVID-19 outbreak.

We report the growth and polarization switching properties of epitaxial ferroelectric–superconducting heterostructure PbZr0.52Ti0.48O3 (PZT) (100 nm)/YBa2Cu3O7−δ (YBCO) (100 nm) thin films for non-volatile ferroelectric random access memory elements. The epitaxial nature of the heterostructure is verified using the reciprocal space mapping data with the superconducting phase transition temperature (Tc) of nearly 25 K far below the Tc of as-grown YBCO under the same condition. The significant remanent polarization (Pr) ∼ 45 µC/cm2 at 1 kHz can switch from one state to another using 1 μs pulse. The devices meet the basic criteria of memory elements, such as high resistance ∼10 GΩ at 8 V, a butterfly-like capacitance–voltage (C/V) loop, significant polarization, a sharp change in the displacement current, long-time charge retention, and small fatigue at room temperature.

Divya Sarva-Kalp-Kwath (SKK) is a poly-herbal ayurvedic medicine formulated using plant extracts of Boerhavia diffusa L. (Nyctaginaceae), Phyllanthus niruri L. (Euphorbiaceae), and Solanum nigrum L. (Solanaceae), described to improve liver function and general health. In the present study, we have explored the hepatoprotective effects of SKK in ameliorating carbon tetrachloride (CCl4) induced liver toxicity using in-vitro and in-vivo test systems. Chemical analysis of SKK using Liquid Chromatography-Mass Spectroscopy (LC-MS-QToF) and High-Performance Liquid Chromatography (HPLC) revealed the presence of different bioactive plant metabolites, known to impart hepatoprotective effects. In human hepatocarcinoma (HepG2) cells, co-treatment of SKK with CCl4 effectively reduced the hepatotoxicity induced by the latter. These effects were confirmed by studying parameters such as loss of cell viability; release of hepatic injury enzymatic biomarkers- aspartate aminotransferase (AST), and alkaline phosphatase (ALP); and changes in reactive oxygen species and in mitochondrial membrane potentials. In-vivo safety analysis in Wistar rats showed no loss in animal body weight, or change in feeding habits after repeated oral dosing of SKK up to 1,000 mg/kg/day for 28 days. Also, no injury-related histopathological changes were observed in the animal's blood, liver, kidney, heart, brain, and lung. Pharmacologically, SKK played a significant role in modulating CCl4 induced hepatic injuries in the Wistar rats at a higher dose. In the 9 weeks' study, SKK (200 mg/kg) reduced the CCl4 stimulated increase in the release of enzymes (ALT, AST, and ALP), bilirubin, total cholesterol, and uric acid levels in the Wistar rats. It also reduced the CCl4 stimulated inflammatory lesions such as liver fibrosis, lymphocytic infiltration, and hyper-plasticity. In conclusion, SKK showed pharmacological effects in improving the CCl4 stimulated liver injuries in HepG2 cells and in Wistar rats. Furthermore, no adverse effects were observed up to 10× higher human equivalent dose of SKK during 28-days repeated dose exposure in Wistar rats. Based on the literature search on the identified plant metabolites, SKK was found to act in multiple ways to ameliorate CCl4 induced hepatotoxicity. Therefore, polyherbal SKK medicine has shown remarkable potentials as a possible alternative therapeutics for reducing liver toxicity induced by drugs, and other toxins.

In this paper, we present the results of our investigation relating particle dynamics and non-commutativity of space–time by using Dirac's constraint analysis. In this study, we re-parameterise the time t=t(τ) along with x=x(τ) and treat both as configuration space variables. Here, τ is a monotonic increasing parameter and the system evolves with this parameter. After constraint analysis, we find the deformed Dirac brackets similar to the κ-deformed space–time and also, get the deformed Hamilton's equations of motion. Moreover, we study the effect of non-commutativity on the generators of Galilean group and Poincare group and find undeformed form of the algebra. Also, we work on the extended space analysis in the Lagrangian formalism. We find the primary as well as the secondary constraints. Strikingly on calculating the Dirac brackets among the phase space variables, we obtain the classical version of κ-Minkowski algebra.

Purpose: Wrist has a complex anatomy and undergoes complex injuries. Scaphoid fracture is one of such injuries. It is the most common fracture in carpal bone. Most of the scaphoid fractures are missed on initial X-rays. Magnetic resonance imaging (MRI) is considered as a gold standard for diagnosing scaphoid fractures. Ultrasonography (USG) is emerging as a good alternative to make an early diagnosis of scaphoid fractures. Our aim is to throw light upon the role of USG in detection of scaphoid fractures. Methods: The study was centered upon 114 patients in the age range 10–65 years, with traumatic wrist injury and were clinically suspected to have scaphoid fractures. Patient with non-traumatic history, bilateral wrist injury and late presentation were excluded. X-rays, USG using high frequency probe and MRI were done for all patients. MRI was considered to be the gold standard test. Patients were followed up at 6 weeks. Results: Of the 114 patients, X-ray could diagnose scaphoid fractures in 48 patients, 30 of which were confirmed by MRI. USG results were positive in 74 patients, of which MRI was positive in 67 patients. The accuracy of scaphoid fracture detection with USG was 98.04% in comparison to X-ray (20.58%), which was statistically significant. Conclusion: USG provides a more accurate and reliable method of making an early diagnosis of scaphoid fracture than X-rays. It is non-invasive, non-expensive and allows better visualisation of cortical disruption. Keywords: Scaphoid fractures, Ultrasonography, High frequency

Background: There are very few epidemiological studies on the prevalence of hypertension and its risk factors among women in the rural population. This cross-sectional study was carried out to determine the same in a rural community. This study was carried out in a rural population of Maharashtra in a rural field practice area of a Medical college with which the author is affiliated. The present study is thus a novel effort to measure the burden related to hypertension and related sociodemographic factors in a rural setting among women aged >30 years. Materials and Methods: A random sample of 220 women of 30 years and above were selected from a rural area. The study participants were selected using simple random sampling technique using lottery method. Numbers were allotted to every individual. All the women were then listed. This became the sampling frame. An individual was taken as the sampling unit. The pre-tested pro forma was used to collect the data by trained doctors. Results: Maximum participants in the study were from age group 30–39 years (33.6%), followed by 40–49 years (23.2%). Mean and standard deviation (SD) of age among study participants was found to be 47.7 ± 13.4 years. A total of 155 (70.5%) of the study participants used tobacco in one or the other smokeless form. About 29.5% of the study participants never used tobacco in the lifetime. The most common form of smokeless tobacco consumption was Mishri (71.6%) followed by tobacco which was used by 27% of the participants. Supari was also consumed by few of the participants. About 51.4% of the participants consumed >5 g (World Health Organization recommended level) of salt per day. All the participants consumed extra salt in the form of pickle/papad/table salt over and above that consumed in meals. About 8.2% of the study participants were found to be underweight while 21.2% were overweight. 3.2% of the study participants were in Grade I obesity and only one (0.4%) was in morbid obesity category. 70% of the study participants who had waist-hip ratio ≤ 0.85, whereas 30% of them had ratio > 0.85. Nearly 52% of the study participants gave a positive family history of hypertension among first-degree relatives. Only 22 (68.7%) of those participants diagnosed with hypertension were taking antihypertensive drugs and nearly half of these participants 12 (54.5%) were taking regular medication. 34.1% of participants had systolic blood pressure (BP) >140 than mmHg (isolated systolic hypertension) while 37.2% had diastolic BP >90 mmHg (isolated diastolic hypertension). The mean systolic BP calculated was 130 mmHg with SD 20.7 with 95% confidence interval (CI) of mean to be 127.5–132.8 mmHg, whereas diastolic BP was 83 mmHg with SD 11.1 with 95% CI of mean to be 81.7–84.6 mmHg. The overall prevalence of hypertension among the study participants was calculated to be 23.6% with 95% CI to be 18.2–26.8 mmHg. Conclusion: Prevalence of systolic hypertension in rural community was 34.1% and of diastolic hypertension 37.2% with an overall prevalence of 23.6%. Significant associations were found between the presence of hypertension and various sociodemographic variables using Chi-square test. Furthermore, there was a significant association between hypertension and consumption of smokeless tobacco, low physical activity level.

Background: The aim of this study was to identify the effects of smoking on bone healing and other complications encountered in the treatment and follow-up of distal femur fracture. Materials and Methods: A total of 54 patients with AO Type B and C distal femur fracture were included during the study. All the patients were treated with distal locking compression plating. Functional outcome was recorded on the basis of the American knee society scoring system. Results: The mean radiological union time and incidence of postoperative infection were significantly higher in smokers as compared to nonsmokers. Total American knee society score was similar in both the groups. Conclusion: Smoking cessation should be advised following fracture fixation.

Psoriasis is a chronic inflammatory skin disease characterized by circumscribed, red, thickened plaques with overlying silvery white scales. It is associated with the release of pro-inflammatory mediators that lead to the development of edema and distress. Here we show the anti-inflammatory and anti-psoriatic efficacies of a neutraceutical sea buckthorn oil (SBKT) derived from the fruit pulp of Hippophae rhamnoides. Chemical analysis of the SBKT showed the presence of 16 major saturated, mono-, and polyunsaturated fatty acids components, imparting significant nutritional values. Efficacy of the SBKT in modulating psoriasis and associated inflammation was first tested in vitro using human monocytic (THP-1) cells. SBKT induced cytotoxicity at a dose of ≥25 µl/ml. Treatment of the lipopolysaccharide-stimulated THP-1 cells with SBKT subdued the enhanced release of intracellular reactive nitrogen species and expression of NF-κB protein, in a concentration-dependent manner. This was accompanied by a reduction in the release of downstream pro-inflammatory cytokines: Interleukin-1ß and interleukin-6. Tumor necrosis factor-α released in the stimulated THP-1 cells were also inhibited by SBKT dose of 5 µl/ml. In vivo oral and topical treatment with SBKT in the Carrageenan-stimulated paw edema model, showed a significant decrease in paw volume and edema. In the 12-O tetradecanoyl phorbol 13-acetate (TPA) stimulated CD-1 mice psoriasis-like model, concurrent oral and tropical SBKT treatments substantially reduced ear edema and ear biopsy weights. Histopathologically, significant reduction in ear epidermal thickness and skin lesion scores was observed in the SBKT-treated animals. In conclusion, SBKT showed anti-inflammatory and anti-psoriasis-like efficacies in healing chemical-induced inflammation and psoriasis. The possible mode of action of SBKT was found through inhibition of reactive nitrogen species, and downregulation of NF-κB protein and pro-inflammatory cytokines. Thus, the present data suggest that Sea buckthorn oil can be used as an anti-inflammatory and anti-psoriatic nutraceutical.

Introduction: Frequency of flaps in asterixis is not uniform and varies among the patients. However, this flap frequency has not been given much importance in the literature. Neither it alters the grade of severity of Hepatic Encephalopathy (HE), nor has it been included in any of the scoring systems determining the severity of liver disease such as the Child Turcotte Pugh (CTP) and Model for End stage Liver Disease (MELD) scores. Aim: To study the correlation between frequency of flaps in asterixis and severity of the liver disease in patients with HE. Materials and Methods: Patients with decompensated cirrhosis and HE with asterixis had their flap frequency (per 30 seconds) counted at the time of their discharge, after clinical stabilisation. CTP and MELD scores were also calculated and the correlation between number of flaps and CTP and MELD scores was studied. A total of 63 such patients were followed up for a period of 12 months. We also studied whether patients with increasing number of flaps have a poorer clinical outcome, as suggested by re-hospitalisation. Results: The correlation between number of flaps and CTP score was non-significant (rs =0.02, p=0.87). Correlation between number of flaps and MELD score was also non-significant (rs =0.16, p=0.20). A 13% of patients with 15 flaps/30s. A total of 27 patients were re-hospitalised out of which 12 (44.4%) had worsening HE, 5 (18.5%) had Spontaneous Bacterial Peritonitis (SBP) and worsening HE, 6 (22.2%) had worsening ascites and 4 (14.8%) had acute kidney injury. Conclusion: There was no significant correlation between number of flaps and CTP and MELD scores. However, higher number of flaps was an independent predictor for rehospitalisation.

Ginger cultivated with limited organic manures will produce low yields and would require different nutrient combinations for increased nutrition availability for higher productivity. The combination of organic nutrient sources was expected to increase and improve the growth and yield of ginger rhizome. Research experiments were conducted at Krishi Vigyan Kendra, Ranipool, East Sikkim, India to study the effect of different organic nutrient sources on yield and quality of ginger for three consecutive summer seasons (2013-15) under field conditions aimed to assess the effect of different combinations of organic sources on growth, yield, quality and profitability of ginger rhizome. The study revealed that a single organic soil nutrient source does not significantly influence the growth and yield of ginger rhizomes. The combination of two nutrient sources significantly influenced all parameters of the growth and yield of ginger rhizome. The combination of 50% pig manure + 50% poultry manure gave the best response to all the vegetative growth parameters, viz. plant height (109.0 cm), tillers per plant (16.3 nos.), number of leaves per tiller (17.9 nos.), size of leaves (30.9 cm2) but combination of 50% FYM + 50% rural compost showed the significant effect on finger length (39.3 cm), finger width (29.9 cm), finger weight (563.5 g), fresh yield (16.0 t/ha), cured rhizome yield (3.3 t/ha), net return (` 324.30 × 103 ha) and benefit:cost ratio (3.0), oleoresin content (5.26%), essential oil (3.96%) and crude fibre (4.95%) in rhizome over the other treatment combinations.

Rheumatoid arthritis (RA) is defined as a chronic autoimmune inflammatory disorder that causes damage to limb joints and progressive injuries to secondary organs. Medical practitioners prescribe Methotrexate (MTX) as standard care medicine for treating RA. However, the long-term application of MTX has shown to have adverse health-related effects. Divya Amvatari Ras (DAR), an Indian Ayurvedic herbo-mineral formulation, has been described in ancient texts to provide relief from RA inflammation associated distress. Therefore, in the present study, we explored the biocompatibility, anti-inflammatory, and anti-arthritic efficacy of DAR using in vivo and in vitro disease models. Using carrageenan (CA)-stimulated Wistar rat paw edema model, we showed a reduction in inflammation-induced paw edema at human equivalent dose of DAR. Anti-rheumatic efficacy of DAR was studied using collagen-antibody cocktail (C-Ab) Induced Arthritis (CAIA) mouse model. The onset of RA in the CAIA mice was determined using parameters such as the increase in arthritis score, and induction of disease associated lesions in the ankle and knee joints, and increase in mechanical and thermal hyperalgesia. Treatment of CAIA animals with a human equivalent dose of DAR significantly reversed the RA-associated pathogenesis. These effects were comparable with the standard of care RA drug, MTX. DAR acted at multiple levels of inflammation associated with RA to reduce progressive pathogenesis. Animal serum biochemistry showed DAR was capable of ameliorating RA induced increase in liver enzyme Alanine Aminotransferase (ALT) and pro-inflammatory cytokine interleukin 6 (IL-6). In the lipopolysaccharide stimulated THP-1 cells, DAR was found to inhibit the release of IL-6, IL-1β, TNF-α, and upstream inflammatory gene regulatory protein, NFκB. The study endorsed the anti-arthritic and anti-inflammatory activity of the Indian Traditional herbo-mineral medicine, DAR. These results also confirm that DAR was highly biocompatible and would show minimal health-related side effects than those associated with standard of care MTX. Taken together, we show that the DAR could be utilized as a promising alternative or complementary therapy for treating rheumatoid arthritis.

Introduction: Reduced susceptibility of carbapenems against enterobacterial strains have emerged as an important public health problem worldwide. Infection caused by Carbapenem Resistant Enterobacteriaceae (CRE) can affect severely ill patients, and their colonisation of human gut, endangers population at large in communities, and in hospitals. Aim: To determine the prevalence and risk factors associated with faecal carriage of CRE. Materials and Methods: A cross-sectional study was conducted on a total of 156 random stool samples collected from hospitalised patients of surgery wards. CRE were determined by antibiotic susceptibility testing against carbapenems as per Clinical Laboratory Standards Institute (CLSI) guidelines (2017) for a period of eight months from February to September, 2018, in a tertiary care hospital, Chidambaram, Tamil Nadu, India. Those strains appeared to be meropenem resistant were further tested with imipenem, a battery of biochemical test, modified Carbapenem Inactivation Method test (mCIM), Modified Hodge Test (MHT) and Epsilometer (E-test) to detect Extended Spectrum of β-Lactamases (ESBL). Confirmed carbapenem resistant isolates were also put through molecular analysis to detect the gene responsible for carbapenemase production. Risk factors associated with faecal carriage of CRE were comparatively analysed. Results: Out of a total 156 faecal samples, 222 Enterobacteriaceae isolates were obtained, and 21 isolates from 17 samples were CRE positive, with a prevalence of 10.89% phenotypically. Out of total phenotypically confirmed CRE, 23.8% (5/21) exhibited CRE gene. blaNDM-1 was the most frequent detection followed by blaVIM, blaOXA-48 and blaKPC, while no isolate was positive for blaIMP. One CRE isolate co-harboured blaNDM-1, blaOXA-48 and blaKPC and three CRE isolates co-harboured blaVIM and blaNDM-1. Length of hospital stay and haemorrhoids were discovered, as independent predisposing risk factors for CRE faecal carriage by multivariate regression analysis. Conclusion: We found high prevalence of faecal carriage of CRE during a non-outbreak situation from surgery wards. Hospitalised patients should be considered a population at risk. Enforcing robust surveillance system, antibiotic stewardship and maintaining unprecedented hygiene are the need of the hour to curb CRE.

Introduction: Blood stream infections are the common infectious consequence in neutropenic patients suffering from the hematological malignancies. These infections are usually caused by a diverse group of microbes. Material and methods: A pair of blood culture was executed in the febrile neutropenic patients suffering from hematological disorders, to observe the microbiology of the blood stream infections. Identification and antimicrobial susceptibility testing were performed as per standard microbiological procedures. Results: In the present study, 27% of blood culture positivity (27/100) was observed among the enrolled febrile neutropenic patients. Gram-positive cocci including Staphylococcus aures (n=15), Coagulase negative staphylococci (n=8), Enterococcus fecalis (n1) were the predominance in comparison to Gram negative microbes (one each isolate of Klebsiella pneumonaie, Escherichia coli, Pseudomonas aeruginosa). All the isolated Gram-positive microbes were sensitive to vancomycin and linezolid. 65.2% of isolated Staphylococci were methicillin resistant (15/23). One MDR Klebsiella pneumoniae strain was also isolated, having a susceptibility to only carbapenem and polymyxin B. Conclusion: Blood culture and susceptibility testing should be performed in each case of febrile neutropenia as blood stream infections among these patients are caused by a divergent group of microbes having a varied susceptibility pattern.

BackgroundIn 2015, an earthquake killing 9,000 and injuring 22,000 people hit Nepal. The Tribhuvan University Teaching Hospital (TUTH), a reference tertiary hospital, was operational immediately after the earthquake. We studied the profile of earthquake victims admitted in TUTH and assessed what factors could influence hospital length of stay.MethodsAn earthquake victim dataset was created based on patient records, with information on sex, age, date of admission and discharge, diagnosis, and surgical intervention. We performed an initial descriptive overview of the earthquake victims followed by a time-to-event analysis to compare length of hospital stay in different groups, using log rank test and cox regression to calculate Hazard Ratios.ResultsThere were in total 501 admitted victims, with the peak of admissions occurring on the fifth day after the earthquake. About 89% had injury as main diagnosis, mostly in lower limbs, and 66% of all injuries were fractures. Nearly 69% of all patients underwent surgery. The median length of hospital stay was 10 days. Lower limb and trunk injuries had longer hospital stays than injuries in the head and neck (HR = 0.68, p = 0.009, and HR = 0.62 p = 0.005, respectively). Plastic surgeries had longer hospital stays than orthopaedic surgeries (HR = 0.57 p = 0.006). Having a crush injury and undergoing an amputation also increased time to discharge (HR = 0.57, p = 0.013, and HR = 0.65 p = 0.045 respectively).ConclusionsHospital stay was particularly long in this sample in comparison to other studies on earthquake victims, indirectly indicating the high burden TUTH had to bear to treat these patients. To strengthen resilience, tertiary hospitals should have preparedness plans to cope with a large influx of injured patients after a large-scale disaster, in particular for the initial days when there is limited external aid.

Diagnostic, operative and cardiovascular procedures require the knowledge of variation of blood vessels of the genitourinary system. During routine dissection in an approximately 60 years old male cadaver in the Department of Anatomy, Government Medical College, Amritsar, we came across multiple vascular anomalies involving renal and testicular arteries and veins. The right kidney was supplied by three renal arteries i.e. superior, middle and inferior which originated from abdominal aorta separately; Right testicular artery originated from inferior renal artery instead of abdominal aorta. Venous drainage comprised of three renal veins and a superior polar vein which drained into IVC, right testicular vein instead of draining into IVC drained into inferior renal vein. The left kidney was supplied by three renal arteries i.e. superior, inferior and the one which originated from posterolateral aspect of aorta above the superior renal artery. Venous drainage of left kidney comprised of two renal veins which joined to form single renal vein which received left testicular vein and coursed behind the aorta to drain into IVC thus constituting retro aortic left renal vein. Further, the outgoing and the clinical and surgical implications of these variants are discussed.

We report the effect of humidity and temperature on the dielectric and impedance properties of lead-free potassium tantalum niobium oxide (KTN). It illustrates large dielectric constant ∼4500 at 1 kHz, low tangent loss in dry condition, which drastically changes under humidity condition. The nature and magnitude of dielectric constant and tangent loss were moderately different in both heating and cooling conditions. A series of phase transitions from rhombohedral to orthorhombic (below room temperature), and orthorhombic to tetragonal (∼185 °C) and tetragonal to Cubic (390 °C) have been obtained respectively over a wide range of temperature with a significant change in magnitude and nature in transition temperature during cooling mode. A detail transport properties have been carried out based on Impedance spectra, Modulus spectra, Nyquist Plot, and ac conductivity to establish a microstructure-property relation. The activation energy of the charge carriers determined that mainly electronic charge carriers contribute to transport properties in the low-temperature range while oxygen vacancies and cations near the high-temperature ferroelectric phase transition. The effect of moisture on room temperature capacitance, tangent loss, and impedance have been discussed.

(1) Background: Withania somnifera Dunal (Ashwagandha) is a widely used medicinal herb in traditional medicinal systems with extensive research on various plant parts. Surprisingly, seeds of W. somnifera have never been investigated for their therapeutic potential. (2) Methods: W. somnifera seeds were extracted for fatty acids (WSSO) using super critical fluid extraction, and was analyzed by gas chromatography. Its therapeutic potential in psoriasis-like skin etiologies was investigated using a 12-O tetradecanoyl phorbol 13-acetate (TPA)-induced psoriatic mouse model. Psoriatic inflammation along with psoriatic lesions and histopathological scores were recorded. WSSO was also tested on murine macrophage (RAW264.7), human epidermoid (A431), and monocytic (THP-1) cells, stimulated with TPA or lipo poly-saccharide (LPS) to induce pro-inflammatory cytokine (IL-6 and TNF-α) release. NFκB promoter activity was also measured by luciferase reporter assay. (3) Results: Topical application of WSSO with concurrent oral doses significantly reduced inflammation-induced edema, and repaired psoriatic lesions and associated histopathological scores. Inhibition of pro-inflammatory cytokines release was observed in WSSO-treated A431 and THP-1 cells, along with reduced NFκB expression. WSSO also inhibited reactive nitrogen species (RNS) in LPS-stimulated RAW264.7 cells. (4) Conclusion: Here we show that the fatty acids from W. somnifera seeds have strong anti-inflammatory properties, along with remarkable therapeutic potential on psoriasis-like skin etiologies.

A three year fixed plot field experiment was conducted during rabi seasons of 2011 to 2014 at Research Farm of ICAR Research Complex for NEH Region, Sikkim Centre to study the effect of organic mulches and vermicompost on productivity, profitability and energetics of mustard under popcorn (Zea mays everta)-mustard (Brassica campestris) cropping system. The results revealed that crop residue and/or forest litter mulching exhibited significant effect on yield attributes, yields, economics and energetics of mustard. Among the mulches, application of tree leaf mulch (TLM) @ 5 t/ha recorded the significantly higher seed yield (1.05 t/ha), net returns (19.86×103 `rs./ha) and net rupees per rupees invested (NRPRI) (1.87) over other mulching materials including control. Systematic energy analysis also showed that the maximum values of gross energy output (59.69 GJ/ha) and net energy output (52.85 GJ/ha) was recorded with TLM @ 5 t/ha, whereas energy productivity (0.54 kg/MJ) was higher with rice residue mulch (RRM) @ 5 t/ha followed by maize residue mulch (MRM) @ 5 t/ha. Among the different levels of vermicompost (VC), application of VC @ 1.5 t/ha recorded the highest seed yield (1.05 t/ha) and net return (15.38 × 103 rs./ha) followed by VC @ 1.0 t/ha and control (no vermicompost). However, NRPRI was higher with VC @ 1.0 t/ha (1.62) followed by VC @ 1.5 t/ha. With regards to the energy budgeting, among the various levels of VC, application of VC @ 1.5 t/ha recorded 2.1% and 18.9% higher energy use efficiency (EUE) over VC @ 1.0 t/ha and control, respectively.

Background and Objectives: Depression has acknowledged and well documented, is common among orthopaedic inpatients may be associated with functional outcomes. Authors aimed to investigate the role, prevalence and associating factors of depression disorder in orthopaedic inpatients. Materials and Methods: A cross-sectional study is designed among patients that admitted at SAIMS, Indore. Four hundred twenty six orthopedic patients were recruited for study. The demographic and clinical measurements were recorded. Levels of depression were assessed by using Zung’s depression scale. Results: Depressive disorder was identified in 87.6% indoor patients significantly (p

Abstract Background Meningitis following neurosurgical procedure is a well-recognized and potentially fatal complication. The Indian literature on microbiological epidemiology is scarce. The aim of our study was to know clinical, microbiological profile and treatment outcomes of patients with neurosurgical meningitis at our center. Methods This was a retrospective observational cohort study of 25 culture-proven neurosurgical meningitis cases performed at the Apollo Speciality Hospital, Chennai, India, between January 2009 and May 2012. Results In our study, nine patients had skull fracture and cerebrospinal fluid leak, nearly 50% of the patients underwent craniotomy, and five patients had endoscopic surgery while 64% of the patients required shunt placement or drains. Only nine patients (36%) had definite clinical signs of meningitis and mean duration of onset of symptoms from surgery was 11.12 days. A total of 18 patients (72%) had gram-negative bacterial meningitis and majority (83.3%) was due to carbapenem-resistant organisms. Predominant isolate was Pseudomonas aeruginosa (44.4%), and the second most common isolate was Acinetobacter baumannii (33.3%). Among cases of gram-negative bacterial meningitis, patients who had carbapenem-resistant isolates were given combination antimicrobials (carbapenem/cefepime tazobactam with colistin/gentamicin) as per susceptibility via intravenous and intrathecal through the drain (extraventricular or lumbar). Only five patients (27.7%) had a complete cure. Conclusion Gram-negative organisms, mainly Pseudomonas and Acinetobacter, are predominant pathogen in neurosurgical meningitis in our center. While treating multidrug-resistant gram-negative meningitis, device removal and a combination of antimicrobial agents via both intravenous and intraventricular routes are crucial to achieve cure.

Context: Cognitive behavior therapy (CBT) is the treatment of choice in anxiety disorders. However, there is little evidence for the effectiveness brief CBT in social anxiety. Aims: We examined the effectiveness of a brief CBT of six sessions in patients with social anxiety disorder. Settings and Design: A single case design study baseline; post and 1 month follow-up was adopted. Materials and Methods: Seven patients with a DSM IV diagnosis of social anxiety underwent 6 weekly sessions of brief CBT. Their diagnosis was confirmed using structured diagnostic interviews. They were assessed at baseline, post and 1-month follow-up on CGI- Severity, Leibowitz Social Anxiety Scale (LSAS), Social Phobia Rating Scale, Brief Fear of Negative Evaluation, and Beck′s Depression Inventory. Statistical Analysis: Data were analyzed using the method of clinical significance. Results: Results indicated that brief CBT was effective in reducing social anxiety in all patients. Brief CBT was also effective in reducing social avoidance and self consciousness. However, brief CBT was not effective in reducing fear of negative evaluation in all patients, suggesting the need for longer duration for cognitive changes in some dysfunctional beliefs. Conclusions: This preliminary case series indicates that brief CBT may be a promising and a cost and time effective approach to managing for social anxiety.

Common complications of amebic liver abscess (ALA) include rupture into the peritoneum, thorax, and pericardium. Rupture into the duodenum is extremely rare. We report a case of ALA rupturing into the duodenum, forming a fistulous tract. To the best of our knowledge, this is the fifth endoscopically and radiologically proven case of hepatoduodenal fistula caused by liver abscess.

A field experiment was carried out during the summer seasons of 2015 and 2016 in clay loamy soil of ICAR Research Complex for Eastern Region, Patna to study the phenology, accumulation of growing degree days (GDD), heliothermal units (HTU), heat use efficiency (HUE), heliothermal use efficiency (HTUE) and performance of five sorghum cultivars including 3 hybrids (CSH 13 ,CSH16 and CSH 30) and 2 varieties (CSV 23 and SPV 462) were grown under two sowing dates viz.16th February and 3rd March in split-plot design. For our study purpose and as per package of practices, February 16 is considered as early sowing and March 3 as timely sowing condition. It was observed that GDDs and HTU reduced significantly by 45.9 oC days and 663.6 oC days hr respectively, in early sowing. The sorghum cultivars SPV 462 and CSH 13 accumulated markedly higher GDDs and HTUs. On mean basis, cv. CSH 16 produced significantly higher grain yield (5.51 tha-1) followed by CSH 13 (4.93 t ha-1). The significant reduction in grain yield was recorded in earlier sowing date than the timely sown crop. The phenothermal index gradually increases from emergence to maturity in all the tested cultivars irrespective of sowing date. Sorghum hybrid CSH 16 showed better performance in terms of HUE and HTUE followed by CSH 13 and SPV 462. Varieties giving higher yield, HUE and HTUE are identified under the varying growing environments, so as to suggest the appropriate sowing time of sorghum cultivars in middle the middle Indo-Gangetic Plains.

Objective: The primary objective of the following study was to determine and secondarily to compare the clinical and epidemiological characteristics of hospitalized patients with severe and non-severe pandemic influenza A (H1N1) during two waves from September 2009 to January 2011. Materials and Methods: A total of 274 cases were hospitalized during the first wave from September 2009 to March 2010 and from June 2010 to February 2011, 237 cases hospitalized in different hospitals of Rajkot during the second wave. Real-time reverse-transcriptase-polymerase-chain-reaction testing was used to confirm infection. Two wave′s comparison was made for factors associated with disease severity. Results: During the first wave 87 (31.8%) patients had severe disease with mortality of 81.6% while during the second wave there were 53 (22.36%) patients having severe disease with higher mortality (94.3%) than the first wave. There were more children up to 15 years of age that required intensive care during the second wave (30.2%) compared to the first wave (20.7%). First wave reported more females and cases from an urban area. Presence of co-existing condition, especially pregnancy was a significant risk factor during the first wave, but not during the second wave. All patients have received antiviral drug oseltamivir during both waves. During the second wave, 39.6% of patients with severe cases received it within 2 days of onset of illness. This was higher than the first wave (19.5%). Conclusion: Higher mortality was reported during the second wave of pandemic influenza A (H1N1) 2009 (H1N1pdm09). There were more cases among the younger age group than adults during the second wave.

On dissection of the abdomen of an adult male cadaver, in addition to the normal inferior vena cava on the right side, an unusual venous channel which connected the left renal vein with the left common iliac vein was found; (probably the left inferior vena cava). The left testicular and the left suprarenal veins were opening into the left renal vein as usual. Other than this, a retrocaval ureter was found on the right side. The works of previous authors have highlighted the incidence of a venacaval duplication and its surgical implications, but here, we are presenting a unique case of a double inferior vena cava with an anomalous retrocaval ureter. A conglomeration of such vascular malformations is of immense surgical importance, and it is indicative of a grossly defective angiogenesis. Keeping in mind the clinical relevance of the variations which were observed, an attempt was made to explain them in the light of the embryogenic development.