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Understanding the factors that influence students' results in hybrid learning environments is becoming increasingly important in today's educational environment. The goal of this research is to examine factors that influence students' academic performance as well as their level of participation in blended learning environments. A comprehensive study was conducted with 330 interested participants from the prestigious government polytechnics of the state of Karnataka in order to achieve this goal. Our data acquisition approach relied on the administration of a meticulously crafted survey questionnaire. The conceptual framework underpinning this study seamlessly integrates Transactional Distance Theory (TDT) principles with valuable insights derived from prior research. The Welch test and one-way ANOVA (Analysis of Variance) are two statistical approaches that we used selectively to reinforce our research which produced surprising results. These findings underscore the pivotal role played by certain specific factors. The geographical location of learners and the medium through which they pursue their studies have emerged as critical determinants significantly influencing academic performance. Aspects like the frequency of login activities and active engagement in forum discussions have been found to exert a positive influence on learners' academic performance. In contrast, the duration of sleep did not show a significant impact on performance. These insights bear tangible implications for teachers and policymakers who are dedicated to the enhancement of the quality of BL programs with the ultimate goal of enriching the overall educational experience.

Introduction: Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) are risk factors for COVID-19 infection. Patients with kidney disease also have other co-morbidities like hypertension, diabetes mellitus, cardiovascular disease that are risk factors for poor outcome in COVID-19 infections. Severe COVID-19 has multiorgan involvement including AKI. Compared to normal population, renal failure patients with COVID-19 have extensive lung involvement, need more ventilator support, and have higher mortality. Aim: To assess outcome (mortality, recovery) and association between factors (age, gender, co-morbidities), biochemical parameters with mortality in COVID-19 patients requiring haemodialysis. Materials and Methods: It was a retrospective observational study wherein, data was collected, entered and analysed with Statistical Package for the Social Sciences (SPSS) version 19.0 using medical records of all COVID-19 patients who had renal failure (AKI or CKD) requiring haemodialysis. The study period was from June-September 2020 at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India. Results: Out of total 68 COVID-19 positive patients, mean age of presentation was 55.08 years and with 75% of the study population were males. Most patients presented with severe COVID-19 illness with tachypnoea and hypoxia. The AKI occurrence and mortality was noted in 44.1% and 47%, respectively. It was noted that medication usage was higher for corticosteroids, oseltamivir, vitamin C, zinc therapy. Conclusion: In the present single centre study involving COVID19 patients requiring haemodialysis, it was noticed that severe COVID-19 illness, presence of AKI, chronic respiratory illness and high inflammatory markers were associated with higher mortality

The present day school system curtails children’s natural growth and interferes with their freedom to explore. It is here that teachers have an opportunity to engage meaningfully with the student community, and make them and society aware of the importance to explore and become self-determined and autonomous learners. Sustained engagement of students in an online class is only possible with continuous efforts from teachers. Constructivist Digital Learning Heutagogy could be the effective solution to break the monotony in online classes, and also to break away from teacher-centric classes and to bring about constructive engagement among the learners in online classes. Online education has very much changed the needs of education. Today we need an education system which is self-driven and facilitated by a teacher or a more knowledgeable other. The study throws light on CDLH (Constructivist Digital Learning Heutagogy) Model. Four-week training (how to teach with the use of the CDLH Model) was given to TGT mathematics teachers and then an intervention at six months will be provided by the same mathematics teachers to their students to assess the psychological indicators like Positive Emotions (Expression, Emotion Management, Expressing Gratitude), Academic Achievement (Focus and Persistence), Learning Engagement (Love of Learning) and Positive Relationship (Peer Relationships and Empathy) taught by the CDLH Model. CDLH model has been validated and tested for reliability (PLS SEM software) in the pilot test conducted. Results revealed that learning through constructivist Digital Learning Heutagogy supported academic achievement, learning engagement and positive emotions, whereas it also showed that the peer relationship was not supported by the intervention. Very importantly it helped to break the monotony of the class.

BackgroundDuring the second wave of the COVID-19 pandemic in India, the Ministry of Ayush conducted a community study to provide therapeutic care to patients with asymptomatic, mild, and moderate COVID-19 in home isolation based on the empirical evidence generated on the efficacy of AYUSH-64 in COVID-19.ObjectiveTo document disease characteristics, care-seeking behavior, and outcomes in patients with asymptomatic, mild, or moderate COVID-19 in home isolation who used AYUSH-64 for COVID-19.MethodsCross-sectional analysis of the data generated through a community study conducted in India from 08 May to 31 August 2021 was performed to study the disease characteristics, care-seeking behavior during home isolation, clinical outcomes, adverse events, and the association between various risk factors and clinical recovery during the study period. The data were collected through semi-structured questionnaires, available in electronic data collection format at the baseline, 7, 14, and 21 days. A logistic regression was performed to explore the relationship between relevant variables and clinical recovery.ResultsData from 64,642 participants were analyzed for baseline assessment, and final analysis was done for 49,770 participants. The mean age of the enrolled participants was 38.8 ± 11.7 years, and 8.4% had co-morbidities. AYUSH-64 was utilized as an add-on to the standard care by 58.3% of participants. Comparable clinical outcomes were observed in participants utilizing AYUSH-64 either as a standalone or as an add-on to standard care, in terms of clinical recovery, disease progression, the requirement for oxygen supplementation, hospitalization, ICU admission, and need for ventilator support. Younger age, having no co-morbidities or substance abuse, and having been vaccinated were associated with early clinical recovery than those who were older and not vaccinated.ConclusionsThe study findings suggest that AYUSH-64 use, either standalone or as an adjunct to standard care, in asymptomatic, mild, or moderate COVID-19 is associated with good clinical outcomes. Ayush services and interventions can be effectively integrated into the mainstream public health architecture to serve public health goals.

Background: This pandemic has resulted in physical and emotional exhaustion among everyone, especially among community healthcare workers (CHWs), resulting in increased burnout and poor sleep quality. This pandemic has increased responsibilities for Accredited Social Health Activist (ASHA) workers and Auxiliary Nurse Midwife (ANM) at the grassroots. Previous studies have shown that infectious diseases like SARS and MERS directly affect sleep. With the COVID-19 pandemic, burnout and poor sleep among healthcare workers are expected to increase. Aim: To determine the prevalence of burnout and sleep quality among community health workers Settings: and Design: This Cross-sectional study was conducted from February to April 2020 in Urban Primary Health care centres of Guntur city, Andhra Pradesh. Methods and material: Copenhagen Burnout Inventory scale (CBI) with a 5-point Likert scale and Pittsburgh Sleep Quality Index (PSQI) Questionnaire were used among four hundred and ten study participants. Descriptive statistics and the Chi-square test were used; a p-value of ≤0.05 is considered significant. Results: The prevalence of personal burnout was 16.8%, while work-related and pandemic-related burnouts were 10.5% and 25.4%, respectively. The prevalence of poor sleep quality was 35.09%. Fear of contracting the virus was present among 38.3%. Fear of infecting the family members because of their exposure was reported by 36.6% of the respondents; 71.7% and 79.3% reported receiving support from the organisation and colleagues, respectively. Conclusions: The provision of necessary equipment, regular check-ups and timely interventions will minimise the risk of stress and burnout.

Materiovigilance is regulatory system to study and follow incidents that might result from using medical devices. To trail the occurrence of untoward effects associated with medical devices as well as to document and prevent their recurrence; the Indian Pharmacopeia Commission initiated Materiovigilance program in India (MvPI) in 2015. Classical texts of Ayurveda include substantial description of devices intended for various therapeutic purposes such as Panchakarm (penta-bio purification procedures), Surgeries and for management of gynecological conditions etc. The implemented program of Materiovigilance does not include Ayurveda devices and thus there is need for documentation, systematic classification of Ayurveda devices and development of Ayurveda Materiovigilance (AMv).In this review, relevant information from classical texts of Ayurveda, latest published information related to Materiovigilance and information of medical devices from classical texts of Ayurveda has been scrutinized along with systematic correlation and applied interpretation of the collected data. It is observed that Materiovigilance has been well documented in Ayurveda in context of twenty six surgical and diagnostic devices; eleven mostly utilized pharmaceutical instruments five Panchakarma instruments and five home devices. For regulation of quality of Ayurveda medical devices, their manufacturing, standard utilization, reporting and prevention of medical device associated errors; it is the need of hour to create and implement regulation in the form of AMv. The Ayurveda literature highlights that the ancient seers of Ayurveda were well aware regarding Materiovigilance in their own way. However in view of modern era and mainstreaming of Ayurveda heritage, critical revision, updating, systematically categorization of Ayurveda devices, development and implementation of AMv regulation is the need of hour.

Myelin oligodendrocyte glycoprotein antibody associated disease (MOG-AD) is a CNS demyelinating disease, typically presenting with optic neuritis, transverse myelitis, and/or ADEM-like syndromes. The positive predictive value (PPV) of MOG-IgG testing by live cell-based assay was reported to be 72% in a study performed at the Mayo Clinic using a cut-off of 1:20. PPV may vary depending upon the tested population, thus supporting further investigation of MOG-IgG testing at other centers. In this real-world institutional cohort study, we determined the PPV of serum MOG-IgG for clinically defined MOG-AD in our patient population. The Massachusetts General Brigham Research Patient Data Registry database was queried for patients with positive serum MOG-IgG detection, at least once, between January 1, 2017 and March 25, 2021. All were tested via the MOG-IgG1 fluorescence-activated cell sorting assay (Mayo Laboratories, Rochester, MN). MOG-IgG positive cases were reviewed for fulfillment of typical MOG-AD clinical features, determined by treating neurologists and study authors. Of 1,877 patients tested, 78 (4.2%) patients tested positive for MOG-IgG with titer ≥1:20, and of these, 67 had validated MOG-AD yielding a PPV of 85.9%. Using a ≥1:40 titer cutoff, 65 (3.5%) tested positive and PPV was 93.8%. Three MOG positive cases had a prototypical multiple sclerosis diagnosis (RRMS n = 2, titers 1:20 and 1:40; PPMS n = 1; 1:100). The treating diagnosis for one RRMS patient with a 1:40 titer was subsequently modified to MOG-AD by treating neurologists. Validated diagnoses of the remaining positive patients without MOG-AD included: migraine (n = 2, titers 1:20, 1:100), inclusion body myositis (n = 1, titer 1:100), autoimmune encephalitis (n = 2, titers 1:20, 1:20), hypoxic ischemic brain injury (n = 1, titer 1:20), IgG4-related disease (n = 1, titer 1:20), and idiopathic hypertrophic pachymeningitis (n = 1, titer 1:20). In our cohort, the PPV for MOG-IgG improved utilizing a titer cut-off of ≥1:40. The presence of positive cases with and without demyelinating features, emphasizes a need for testing in the appropriate clinical context, analysis of titer value and clinical interpretation.

Epidermal growth factor receptor (EGFR) belongs to the family of tyrosine kinase that is activated when a specific ligand binds to it. The EGFR plays a vital role in the cellular proliferation process, differentiation, and apoptosis. In the case of cancer, EGFR undergoes uncontrolled auto-phosphorylation that results in increased cellular proliferation and decreased apoptosis, causing cancer promotion. From the literature, it shows that pyrimidine is one of the most commonly studied heterocycles for its antiproliferative activity against EGFR inhibition. The authors have collated some interesting results in the heterocycle-fused pyrimidines that have been studied using different cell lines (sensitive and mutational) and in animal models to determine their activity and potency. It is quite clear that the fused systems are highly effective in inhibiting EGFR activity in cancer cells. Therefore, the structure–activity relationship (SAR) comes into play in determining the nature of the heterocycle and the substituents that are responsible for the increased activity and toxicity. Understanding the SAR of heterocycle-fused pyrimidines will help in getting a better overview of the molecules concerning their activity and potency profile as future EGFR inhibitors.

The objective of this study was to develop SSR profiles of potato (Solanum tuberosum L.) hybrids for genetic fidelity purpose. The multi-coloured flesh potato hybrids and interspecific somatic hybrids-derived progenies were for the study conducted at ICAR-CPRI, Shimla during 2019–20. A total of 165 potato genotypes were analysed using two well-known potato SSR markers (STU6SNRN and STIIKA). High polymorphism was observed in STIIKA (PIC: 0.93) than STU6SNRN (PIC: 0.82), and higher number of alleles were observed in STIIKA (23) than STU6SNRN (7). In STU6SNRN, alleles size 174, 179, 182, 190 and 200 bp were predominant whereas in STIIKA, alleles size 191, 195, 198, 201, 221, 223, 231, 242, 245 and 256 were observed frequently in more than 50% of the genotypes. Diversity analysis showed a clear distinction among the genotypes based on the Jaccard dissimilarity coefficient by the Neighbour-joining tree method using the DARwin software. SSR fingerprints would be valuable resources to strengthen genetic fidelity of these hybrids and identification of true-to-type clones.

A disequilibrium between immunosuppressive Tregs and inflammatory IL-17–producing Th17 cells is a hallmark of autoimmune diseases, including multiple sclerosis (MS). However, the molecular mechanisms underlying the Treg and Th17 imbalance in CNS autoimmunity remain largely unclear. Identifying the factors that drive this imbalance is of high clinical interest. Here, we report a major disease-promoting role for microRNA-92a (miR-92a) in CNS autoimmunity. miR-92a was elevated in experimental autoimmune encephalomyelitis (EAE), and its loss attenuated EAE. Mechanistically, miR-92a mediated EAE susceptibility in a T cell–intrinsic manner by restricting Treg induction and suppressive capacity, while supporting Th17 responses, by directly repressing the transcription factor Foxo1. Although miR-92a did not directly alter Th1 differentiation, it appeared to indirectly promote Th1 cells by inhibiting Treg responses. Correspondingly, miR-92a inhibitor therapy ameliorated EAE by concomitantly boosting Treg responses and dampening inflammatory T cell responses. Analogous to our findings in mice, miR-92a was elevated in CD4+ T cells from patients with MS, and miR-92a silencing in patients’ T cells promoted Treg development but limited Th17 differentiation. Together, our results demonstrate that miR-92a drives CNS autoimmunity by sustaining the Treg/Th17 imbalance and implicate miR-92a as a potential therapeutic target for MS.

Background: Pregnancy associated breast cancer (PABC) is a rare entity and defined as breast cancer diagnosed during pregnancy or one-year post-partum. There is sparse data especially from low and middle-income countries (LMIC) and merits exploration. Methods: The study (2013–2020) evaluated demographics, treatment patterns and outcomes of PABC. Results: There were 104 patients, median age of 31 years; 43 (41%) had triple-negative disease, 31(29.8%) had hormone-receptor (HR) positive and HER2 negative, 14 (13.5%) had HER2-positive and HR negative and 16(15.4%) had triple positive disease. 101(97%) had IDC grade III tumors and 74% had delayed diagnosis. 72% presented with early stage (24, EBC) or locally advanced breast cancer (53, LABC) and received either neoadjuvant (n = 49) or adjuvant (n = 26) chemotherapy and surgery. Trastuzumab, tamoxifen, and radiotherapy were administered post-delivery. At a median follow up of 27 (IQR:19–35) months, the estimated 3-year event-free survival (EFS) for EBC and LABC was 82% (95% CI: 65.2–100) and 56% (95% CI: 42–75.6%) and for metastatic 24% (95% CI: 10.1%–58.5%) respectively.Of the 104 patients, 34 were diagnosed antepartum (AP) and 15 had termination, 2 had preterm and 16 had full-term deliveries(FTDs). Among postpartum cohort (n = 70), 2 had termination, 1 had preterm, 67 had FTDs. 83(including 17 from AP) children from both cohorts were experiencing normal milestones. Conclusion: Data from the first Indian PABC registry showed that the majority had delayed diagnosis and aggressive features(TNBC, higher grade). Treatment was feasible in majority and stage matched outcomes were comparable to non-PABCs.

Abstract Objective No relapse risk prediction tool is currently available to guide treatment selection for multiple sclerosis (MS). Leveraging electronic health record (EHR) data readily available at the point of care, we developed a clinical tool for predicting MS relapse risk. Methods Using data from a clinic‐based research registry and linked EHR system between 2006 and 2016, we developed models predicting relapse events from the registry in a training set (n = 1435) and tested the model performance in an independent validation set of MS patients (n = 186). This iterative process identified prior 1‐year relapse history as a key predictor of future relapse but ascertaining relapse history through the labor‐intensive chart review is impractical. We pursued two‐stage algorithm development: (1) L1‐regularized logistic regression (LASSO) to phenotype past 1‐year relapse status from contemporaneous EHR data, (2) LASSO to predict future 1‐year relapse risk using imputed prior 1‐year relapse status and other algorithm‐selected features. Results The final model, comprising age, disease duration, and imputed prior 1‐year relapse history, achieved a predictive AUC and F score of 0.707 and 0.307, respectively. The performance was significantly better than the baseline model (age, sex, race/ethnicity, and disease duration) and noninferior to a model containing actual prior 1‐year relapse history. The predicted risk probability declined with disease duration and age. Conclusion Our novel machine‐learning algorithm predicts 1‐year MS relapse with accuracy comparable to other clinical prediction tools and has applicability at the point of care. This EHR‐based two‐stage approach of outcome prediction may have application to neurological disease beyond MS.

Coronavirus Disease 2019, caused by the virus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), is a pandemic first discovered in Wuhan, China which has claimed over 1.7 million lives to date across the globe as of 24 December 2020. As the virus spreads across the world affecting millions of patients, there has been a massive movement to discover readily available and effective treatment options including vaccines. One of the limiting factors in treating the disease is its varied presentation and effect in patients, ranging from asymptomatic patients to those left in intensive care units, intubated and fighting for their lives. There are numerous clinical trials and small-scale studies underway to investigate potential treatment options. However, very few studies and drugs demonstrated efficacy while many more are under investigation, leaving care teams dependent on supportive care coupled with experimental treatment options. In this review, we summarize the various treatment options explored to treat COVID-19, discussing possible the mechanisms of fighting the virus.

Abstract Objective Serum neurofilament light (sNfL) is a promising new biomarker in multiple sclerosis (MS). We explored the relationship between sNfL and health outcomes and resource use in MS patients. Methods MS patients with serum samples and health‐outcome measurements collected longitudinally between 2011 and 2016 were analyzed. sNfL values were evaluated across age and gender. Data were analyzed using correlation with log‐transformed sNfL values. Results A total of 304 MS patients with a mean age of 32.9 years, average EDSS of 1.6 (SD = 1.5) and baseline sNfL of 8.8 (range 1.23–78.3) pg/mL were studied. Baseline sNFL values increased with age and were higher in females. Baseline sNfL correlated with baseline Multiple Sclerosis Quality of Life physical composite (mean = 49.4 (9.1), P = 0.035) and baseline EDSS (P = 0.002). Other PRO measures at baseline did not show a significant relationship with baseline sNfL. Average of baseline and follow‐up sNfL correlated with MSQoL physical‐role limitations (mean = 48.9 (10.8), P = 0.043) and social‐functioning (mean = 52.3 (7), P = 0.034) at 24‐month follow‐up. We found a trend for numerically higher sNfL levels in nonpersistent patients compared to those who were persistent to treatment (11.13 vs. 8.53 pg/mL, P = 0.093) measured as average of baseline and 24‐month values. Baseline NfL was associated with number of intravenous steroid infusions (mean = 0.2; SD = 3.0, P = 0.013), whereas the average of baseline and 12 months NfL values related to inpatient stays at 12 months (mean = 0.2; SD = 3.0 P = 0.053). Conclusion Serum NfL is a patient‐centric biomarker that correlated with MS patient health‐outcomes and healthcare utilization measures in a real‐world cohort.

Background: Potts shunt has been suggested as an effective palliative therapy for patients with pulmonary artery hypertension (PAH) not associated with congenital heart disease. Materials and methods: This is a prospective single-center study performed to assess outcomes of Potts shunt in patients with PAH who are in functional class III or IV. Results: 52 patients in functional class III/IV with pulmonary arterial hypertension without significant intra or extracardiac shunt on maximal medical therapy were evaluated and counseled for undergoing Potts shunt/patent ductus arteriosus (PDA) stenting. 16/52 patients (13 females) consented for the procedure; 14 patients underwent surgical creation of Potts, and 2 underwent transcatheter stenting of PDA, which physiologically acted like a Potts shunt. Standard medical therapy was continued in patients who did not consent for the procedure. 12/16 patients survived the procedure. Patients who did not survive the procedure were older, with severe right ventricular systolic dysfunction, and functional class IV. Patients who survived the procedure were followed up in the pulmonary hypertension clinic. The Median follow-up was 17 months (1–40 months). 11/13 patients discharged after the operation showed sustained clinical, echocardiographic, and biochemical improvement, which reduced need for pulmonary vasodilator therapy in 10/13 patients. There was one death in the follow-up period 16 months post-surgery due to lower respiratory tract infection. Conclusion: Potts shunt is feasible in patients with PAH without significant intra or extracardiac shunts. It can be done safely with an acceptable success rate. Patient selection, preoperative stabilization, and meticulous postoperative management are essential. It should be performed at the earliest sign of clinical, echocardiographic, or laboratory deterioation for optimal outcomes.Long-term follow-up is required to see a sustained improvement in functional class and the need for a lung transplant in the future.

Ghosh et al. show that a lens protein βA1-crystallin inhibits PTP1B activity, regulating the metabolism of retinal astrocytes. They find that knockdown of βA1-crystallin exacerbates the streptozotocin-induced diabetic retinopathy-like phenotype in mice, suggesting the possibility that the interaction between βA1-PTP1B may be targeted for diabetic retinopathy.

Natural anti-inflammatory nutraceuticals may be useful in preventing rheumatoid arthritis from worsening. Resveratrol (RV) and chia seed oil, having antioxidant potential, can assist in avoiding oxidative stress-related disorders. This investigation developed and evaluated resveratrol-loaded chia seed oil-based nanoemulsion (NE) gel formulations through in vitro and in vivo studies. The physical stability and in vitro drug permeability of the chosen formulations (NE1 to NE10) were studied. The optimized RV-loaded nanoemulsion (NE2) had droplets with an average size of 37.48 nm that were homogeneous in shape and had a zeta potential of −18 mV. RV-NE2, with a permeability of 98.21 ± 4.32 µg/cm2/h, was gelled with 1% carbopol-940P. A 28-day anti-arthritic assessment (body weight, paw edema, and levels of pro-inflammatory mediators including TNF-α, IL-6, IL-1β, and COX-2) following topical administration of RV-NE2 gel showed significant reversal of arthritic symptoms in arthritic Wistar rats induced by Freund’s complete adjuvant injection. Therefore, RV-NE2 gel demonstrated the potential to achieve local therapeutic benefits in inflammatory arthritic conditions due to its increased topical bioavailability and balancing of pro-inflammatory mediators.

The complete chloroplast genome (cp) of Ocimum tenuiflorum L. subtype Krishna Tulsi was sequenced and assembled using Illumina paired-end sequencing data. The cp genome is 151,758 bp in length, including a large single copy (LSC) region of 82,794 bp, a small single-copy region (SSC) of 17,592 bp, and a pair of inverted repeated (IR) region of 25,686 bp. The cp genome of Krishna Tulsi encodes 129 genes, including 90 protein-coding, 31 transfer RNA (tRNA), and eight ribosomal RNA (rRNA) genes. While the overall GC content was 37.9%, it is 36.0%, 31.8%, and 43.1% in the LSC, SSC, and IR regions, respectively. Phylogenetic analysis based on chloroplast genome sequences of 17 species from Lamiaceae revealed that O. tenuiflorum subtype Krishna Tulsi is clustered with other Ocimum species, and forms a clade with genera from family Lamiaceae.

COVID-19 has put forward a conundrum that needs to be addressed together by every system worldwide. Traditional medical systems need to be incorporated to the battle against COVID. The time-tested and experiential wisdom in these streams of knowledge are to be utilized.. All India Institute of Ayurveda, New Delhi, took one of the initial steps in this respect, bringing together the exponents of Ayurveda all over the world to contribute their ideas in understanding, preventing and managing COVID-19. The meeting was conducted on May 5, 2020, 3:00 p. m. and included representatives from the Ministry of AYUSH, the national institutes, research bodies, and international organizations of Ayurveda. The program had six sessions, which encompassed the current understanding of the disease, the clinical presentations, Ayurvedic analysis of the same, methods of salutogenesis, disease prevention and cure that can be implemented in this scenario, and considerations while applying the Ayurvedic wisdom to other parts of the world. The meeting was broadcasted live on Facebook as well as YouTube.

Introduction: COVID-19/SARS-CoV-2 has become a major concern for whole humanity, it is rising rapidly and the condition is worsening. With a huge transmission rate, it has become an important requirement of this times to hatch out a safe and effective treatment for COVID-19. Main clinical findings–All the 5 cases of Doctors pursuing MD education in Ayurveda at All India Institute of Ayurveda were having varied variety of symptoms fever, sore throat, fatigue being common along with rest others like dyspnea, hemoptysis, cough, palpitations, pain in abdomen and calf muscles. Diagnosis: All the cases were diagnosed as COVID-19 positive. Intervention: All of the cases were given Ayurveda treatment chiefly comprising of SamshamniVati, AYUSH Kwatha, Chyawanprash along with Steam Inhalation with Ajwain (Tachyspermumammi) and nasal application of Anu Taila along with a specific daily (Dinacharya) and dietary (Ahara ) regimen. Outcome: All the patients recovered completely without any post-complications assessed after a follow-up period of 1 month. Conclusion: It was found that Ayurveda is a safe and effective treatment for mild to moderate COVID-19 patients. A lead can be taken from these cases and Ayurveda can be conjugated with the main stream modern medical treatment modalities for curing this pandemic with an integrated approach.

Introduction: SARS-CoV-2, a global pandemic that caused significant morbidity and mortality worldwide, even in the second wave. Multiple factors influence the disease burden including the vicious circulating virus characteristics, complications, limitations of the existing medicine, aggravation of the disease, and comorbidities in older people. In the present scenario, effective traditional treatment modalities should be scientifically applied to reduce massive disasters. Objectives: Here is the necessity to develop an appropriate treatment protocol from the field of Ayurvedic medicine. Diagnosis: It is a case study of a confirmed case of COVID-19/SARS-CoV-2 with uncontrolled diabetic history. Significant Clinical Findings: Presented intermittent fever, cough, headache, and dyspnea, along with symptoms associated with diabetes mellitus. Interventions: The case was successfully managed with Ama pachana (~carminative), Agnideepana (digestive), Jwara hara Oushdha, and simultaneously Prameha (~diabetes mellitus). Outcomes: The entire treatment course competed with a minimum number of hospitals stay compared with the national average. Ayurvedic management has a significant positive impact on the mental and physical quality of life. Both physical and mental scores got improved by more than 50% in this case. Marked radiological improvement noted, in this case, is associated with excellent quality of life after treatment. Conclusion: Ayurvedic management can be used in multiple levels preventive, curative, and restorative aspects.

Objective: To explore Rasayana herbs ascribed in Ayurveda classics and their contemporary appraisal for Rasayana potential. Data Source: Classical Ayurvedic review of Rasayana herbs were done from three distinguished Ayurveda classics (Charaka Samhita, Sushruta Samhita and Ashtang Hridaya) known as Brithattrayi. The contemporary review of those classical herbs was done from PubMed and other reputed databases. Review Methods: The classical Ayurveda review was done manually from Charaka Samhita, Sushruta Samhita and Ashtanga Hridaya. The single herbs mentioned in specifically dedicated Rasayana chapters of these classics (Charaka Chikitsa 1, Sushruta Chikitsa 27, 28, Ashtanga Hridaya Uttarsthana 39) were gathered. The botanical identity of the herbs were taken from “The plant list.org”. The contemporary review of those classical herbs mentioned as Rasayana in Ayurveda classics were done from PubMed and other databases. The searching key was Latin name of drug/herb+Rasayana activity. Results: Total 39 herbs were enumerated in Brihattrayi, among them 21 are in Charaka Samhita, 12 in Sushruta Samhita and 21 are from Ashtanga Hridaya, few of them are Bhallataka, Mandukaparni, Guduchi, Varahikanda, Soma, Tuvaraka, Vacha and Bhringaraja. Most of the herbs mentioned as Rasayana are evaluated scientifically for their antioxidant, immunomodulatory and nootropic potential. These reported activities of herbs support their Rasayana property. Conclusion: These studies indicate that daily damage of cells leads to early ageing and occurrence of many diseases. Rasayana herbs through their anti-oxidant, immunomodulatory and nootropic potential protect the damage which contribute towards health and longevity.

Background and Aim: Multicentric Castleman's disease (MCD) is a rare lymphoproliferative disorder manifesting as multiple lymphadenopathy, multiorgan involvement, and inflammatory symptoms. This study aims at highlighting some unique features of MCD in Indian patients. Materials and Methods: These 17 patients from review of 78 cases of Castleman's disease (CD) diagnosed. Besides routine tissue sections were stained for Human Herpes Virus 8 latency associated nuclear antigen (HHV8-LANA) by immunohistochemistry (IHC) and Epstein Barr virus latent membrane protein (EBV-LMP) or Epstein Barr Virus by in situ hybridization (EBER-ISH). Result: The cases included Plasma cell variant (11 cases), mixed MCD (4 cases) and two concurrent MCD with large B cell lymphoma in HIV positive patients. Median age of disease onset was 47 years and female predominance was seen. Out of 15 MCD uncomplicated by lymphoma, 5 had POEMS (Polyneuropathy, organomegaly, endocrinopathy, myeloma protein, skin changes) and one also had TAFRO (Thrombocytopenia, anasarca, fever, marrow reticulin fibrosis, organomegaly, normal or slightly elevated immunoglobulin) syndrome. Out of 10 MCD without lymphoma, 2 cases showed few EBV positive large cells, both have features of POEMS. All 17 MCD cases were negative for HHV8-LANA IHC. Two HIV patients with MCD had large cell lymphoma, intrasinusoidal pattern, of which one was EBV positive. Though four relapses were seen, none died from disease. One of the two patients complicated by lymphoma died from disease. Conclusion: Indian patients with MCD show female preponderance and are negative for HHV8 but show EBV positive cells. This makes a case for role of EBV in etiopathogenesis of MCD in India.

Background: Dental caries is one of the most prevalent posteruptive bacterial infections worldwide, characterized by a progressive demineralization process that affects the mineralized dental tissues. Although the decline of dental caries prevalence can be attributed to the widespread use of dentifrices that contain fluoride, yet there is a need for an advanced alternative nonfluoride remineralizing dentifrice. Yet, there is a need for an advanced alternative nonfluoride remineralizing dentifrice. Aim: The aim of this study was to evaluate and compare the remineralizing effect of nonfluoride-based and herbal-based pediatric dentifrice in demineralized primary teeth with an ideal in vitro method of pH cycling and evaluating the values under Polarized Light Microscope (Olympus BX43) using image analysis software (ProgRes, Speed XT core3). Materials and Methods: A total of 30 tooth samples were collected and placed in the demineralizing solution for 96 h to produce a demineralized lesion of approximately 100 μm, and then cut longitudinally into 60 sections that were randomly assigned to two groups with 27 samples each, Group A – nonfluoride-based dentifrice (Mee Mee®), Group B – herbal-based dentifrice (Mamaearth™), after which they were subjected to pH cycling for 7 days along with dentifrice slurry preparation. The sections were evaluated under the polarizing light microscopy for remineralizing efficacy. The lesion depth was measured and tabulated to be sent for statistical analysis. Results: The mean demineralization value for nonfluoride and herbal-based dentifrice groups were 7.8730 μm and 28.3174 μm, respectively. Hence, it can be inferred that since lesion depth measured was lesser in nonfluoride than herbal-based dentifrice, remineralization has occurred in the nonfluoride-based dentifrice group. Conclusion: Nonfluoride-based dentifrice showed significant results in remineralizing the demineralized lesion, while herbal-based dentifrice showed poor efficiency in remineralizing the demineralized lesion.

Ultrasound (US) lexicon of the Breast Imaging Reporting and Data System (BI-RADS) defines an echogenic breast mass as a lesion that is hyperechoic in comparison with subcutaneous adipose tissue. However, at sonography, only 0.6 to 5.6% of breast masses are echogenic and the majority of these lesions are benign. approximately, 0.5% of malignant breast lesions appear hyperechoic. The various benign pathologic entities that appear echogenic on US are lipoma, hematoma, seroma, fat necrosis, abscess, pseudoangiomatous stromal hyperplasia, galactocele, etc. The malignant diagnoses that may present as hyperechoic lesions on breast US are invasive ductal carcinoma, invasive lobular carcinoma, metastasis, lymphoma, and angiosarcoma. Echogenic breast masses need to be correlated with mammographic findings and clinical history. Lesions with worrisome features such as a spiculated margin, interval enlargement, interval vascularity, or association with suspicious microcalcifications on mammography require biopsy. In this article, we would like to present a pictorial review of patients who presented to our department with echogenic breast masses and were subsequently found to have various malignant as well as benign etiologies on histopathology.

Objective: Abernethy malformation (congenital extrahepatic portosystemic shunt) is a rare anomaly of the splanchnic venous system. Though rare, it is an important cause of pulmonary artery hypertension (PAH) which is often missed. All patients with PAH should be carefully evaluated for presence of Abernethy malformation before labelling them as Idiopathic PAH. Methods: This is a retrospective analysis of prospectively collected data. We reviewed the data of all patients referred to our center for evaluation of PAH. 10 patients were diagnosed to have an extrahepatic portocaval malformation. We reviewed their presentation, diagnosis, catheterization data, intervention and their outcome along with review of literature. Results: 10/104 patients with pulmonary hypertension and no intra or extracardiac shunt were found to have extrahepatic portocaval shunt (EHPCS). 3 patients had EHPCS type 1 and 7 had type 2 EHPCS. 6/7 patient with EHPCS type 2 underwent closure of the shunt. There was no procedure related complication. There was one death 3 months post procedure and one patient who was advised surgical closure was lost to follow up. Closure of the shunt resulted in normalization of the pulmonary artery pressures in 4/5 patients. Conclusion: Congenital portosystemic malformations form an important and potentially treatable cause of pulmonary hypertension.

Crotamiton (CRT) is a commonly approved drug prescribed for the scabies treatment in many countries across the globe. However, poor aqueous solubility and low bioavailability, and side effects restrict its use. To avoid such issues, an appropriate carrier system is necessary which can address the aforementioned challenges for attaining enhanced biopharmaceutical attributes. The current study intends to provide a detailed account on the development and evaluation of CRT-loaded microemulsion (ME) hydrogel formulation containing tea tree oil (TTO) for improved drug delivery for scabies treatment in a safe and effective manner. Pseudo-ternary phase diagrams were constructed with TTO as the oily phase, and Cremophor®EL was used as the surfactant in a mass ratio 2:1 with co-surfactants (mixture of phospholipid 90G and Transcutol®P), and aqueous solution as the external phase. The optimized drug-loaded ME formulation was evaluated for skin penetration, retention, compliance, and dermatokinetics. The nonirritant behavior of the formulation was revealed by skin histopathology, which showed no changes in normal skin histology. In comparison to the conventional product, dermatokinetic experiments revealed that CRT has greater penetration and distribution in the epidermis of the mice skin. The findings imply that the proposed lipid-based ME hydrogel can aid in the resolution of CRT issues by providing a better and safer delivery option to epidermis and deeper epidermis in substantial quantities.

The hydro-alcoholic extract of Withania coagulans fruits was investigated for preliminary phytochemical screening and characterized by high-performance thin-layer chromatography. Column chromatography of the hydro-alcoholic extract of W. coagulans eluted with four different combinations of ethyl acetate and methanol yielded four fractions (WCF01, WCF02, WCF03, and WCF04). One of these fractions, WCF02, significantly (P < 0.05) inhibited in vitro α-amylase and α-glucosidase activity with IC50 values of 104.71 μg/mL and 70.79 μg/mL, respectively. WCF02 further reduced blood glucose levels in comparison to control in the starch tolerance test. The extract showed a relative dose-dependent effect. It was observed that none of the extracts could delay the peak blood glucose that was achieved after 60 min of carbohydrate challenge, but these blunted the glycemic peak.

PURPOSEWe tested low axillary sampling (LAS) and sentinel node biopsy (SNB) performed in the same patient to predict axillary nodal status post–neoadjuvant chemotherapy (NACT) in women undergoing elective breast surgery, clinically N0 after NACT.PATIENTS AND METHODSA total of 751 women clinically node negative post-NACT underwent LAS (excision of lymph node [LN] and fat below first intercostobrachial nerve). Of these women, 730 also underwent SNB by dual technique (methylene blue plus radioisotope). SNB (defined as targeted plus palpable LNs) and LAS specimens were distinctly examined for metastasis. All patients underwent completion axillary lymph node dissection. Post-NACT, 290 (38.6%) of 751 women had residual positive lymph nodes on pathology.RESULTSThe median clinical tumor size was 5 cm (range, 1-15 cm), and 533 (71%) of patients were N1 or N2 at presentation. Targeted sentinel node (SN) identification was 85.7% (626 of 730; median, two LNs); SN with palpable nodes was found in 95.2% (695 of 730; median, five LNs); LAS node was identified in 98.5% (740 of 751; median, seven LNs). In all but one case, the SN was found within the LAS specimen. The false negative rate (FNR) of SNB (blue, hot, and adjacent palpable nodes) was 19.7% (47 of 238; one-sided 95% CI upper limit, 24.0), compared with an FNR of 9.9% for LAS (29 of 292; one-sided 95% CI upper limit, 12.8; P < .001). If SNB was confined to blue/hot node, excluding adjacent palpable nodes, the FNR was 31.6% (74 of 234; one-sided 95% CI upper limit, 36.6). The FNR could be brought down to < 8.8% if three or more LNs were identified by LAS.CONCLUSIONLAS is superior to SNB in identification rate, FNR, and negative predictive value in predicting node-negative axilla post-NACT. LAS can be safely used to predict negative axilla with < 10% chance of leaving residual disease.

PURPOSE The role of axillary conservation after neoadjuvant chemotherapy (NACT) is debatable. We routinely carry out complete axillary lymph node dissection (ALND). This study was conducted to understand the pathologic axillary complete response (pAxCR) after NACT. MATERIALS AND METHODS We evaluated a prospective database of patients with breast cancer who underwent surgery after NACT in the year 2017 at our institution. NACT was administered to downstage locally advanced breast cancer or facilitate breast-conservation surgery. RESULTS Of 793 patients who underwent surgery after NACT, 97(12.2%) had cN0 disease, 407 (51.3%) had cN1, 262 (32%) had cN2, and 27 (3.4%) had cN3 at presentation. Eighty-eight patients (11.1%) had cT1-2 primary tumor stage, and 623 patients (78.6%) had cT3-4 primary tumor stage; primary tumor stage details were unavailable for 82 patients (10.3%). The median age was 46 years (range, 21-74 years). On histopathology, the overall pAxCR rate was 52.8%. In the cN1 and cN2 settings, 58.7% and 36.6% of patients achieved ypN0 status, respectively. The overall pathologic complete response rate was 22.64% (161 of 711 patients). On univariable analysis, cN stage, histologic grade, hormone receptor status, NACT duration, and lymphovascular invasion were significantly associated with pAxCR (P

Globally, the psychological health of the people is being affected due to the COVID-19 pandemic. Given the fact that numerous systematic reviews already exist on yoga and mental health, it becomes vital to undertake an overview on the same. The objective of the overview was to summarise the evidence from different systematic reviews of distinct yoga interventions used to improve mental health and recommend yoga practices for the same. The protocol was registered on PROSPERO (CRD42020185221). MEDLINE via Pubmed, Cochrane Database of Systematic Reviews and Google Scholar were searched for relevant literature. Search terms used were “Yoga practice, mental health and systematic review”. Reviews from earliest possible date till May 2020, including those examining the effects of any single or combination of yoga interventions on mental health reported on children, youth and adults were selected. The Assessment of Multiple Systematic Reviews (AMSTAR) tool was used to evaluate the evidence of the included reviews. Out of the 90 reviews found, eight unique reviews were selected for the overview. Overall, 243 studies were analyzed, with an overlap of only 6 studies across the reviews. Out of 8 reviews, only 2 were of high quality and the rest were of moderate quality. Owing to heterogeneity of the included studies, only descriptive analysis was possible. The results of the review indicate moderate to positive effects of yoga on the mental health parameters. Practicing yoga (physical postures, Bhramary Pranayam, mindfulness meditation, sahaj yoga and laughter therapy) can be beneficial to improve psychological health of the people during the COVID-19 pandemic.

Background In the PARADIGMS Study, fingolimod demonstrated superior efficacy versus interferon (IFN) β-1a and comparable overall incidence of adverse events but slightly higher rate of serious adverse events in patients with paediatric-onset multiple sclerosis (PoMS). Here, we report the health-related quality of life (HRQoL) outcomes from PARADIGMS.Methods Patients with PoMS (N=215; aged 10–

The aim of present study was to identify simple sequence repeat (SSR) markers linked to potato somatic hybrid progenies. A total of 50 breeding lines (parents and progenies) were analyzed using 59 simple sequence repeat (SSR) markers. Of which, SSR marker STM0003 clearly distinguished the parents i.e. somatic hybrid P8 (Solanum tuberosum dihaploid C-13 + wild species S. pinnatisectum) and potato cv. Kufri Jyoti, and their progenies (MSH-14/112, MSH-14/113, MSH-14/114, MSH-14/115, MSH-14/116, MSH-14/122 and MSH-14/123). STM0003 showed three distinct alleles (103, 132 and 144 bp), where both P8 and progenies contained 103 and 144 bp, and Kufri Jyoti had 132 and 144 bp alleles. On the other hand, STI0001 distinguished progenies namely MSH/17-16 (Kufri Garima × Crd10), MSH/17-25 (Kufri Garima × P10) and MSH/17- 27 (Kufri Jyoti × Crd 16) with respect to their parents, and STI0001 contained six alleles (169, 172, 175, 178, 184 and 188 bp). The study suggests that STM0003 and STI0001 are diagnostic markers to identify these somatic hybrid derived progenies and parents.

Conventional tillage practices in Thar Desert of Rajasthan are posing a serious threat of natural resource degradation due to soil erosion induced by high temperature and winds. A 2-year study was conducted to explore the efficient tillage and nutrient management practices evaluate the effects of these practices on groundnut crop performance and resource use efficiency. It consisted 18 treatment combinations; 3 tillage practices, viz. T1 - minimum tillage, T2 - deep tillage, and T3 - conventional tillage main plots; and six fertilizer management practices, viz. F0 - no fertilization, F1 -recommended dose of NK fertilizer, F2 - recommended dose of NPK fertilizer (RDF), F3 - RDF + PSB @2.5 kg/ha, F4 - F3+ AMF @2 kg/ha, and F5 - F3+ AMF @4 kg/ha as sub plots. The highest LAI, crop growth rate and relative growth rate was recorded with deep tillage (T2) and F5 treatment combination. Deep tillage (T2) produced significant at par yields (pod and haulm) with conventional tillage (2981 and 4878 kg/ha). Higher water use efficiency of 4.72% and 13.25% were recorded with T3 compared to T2 and T1, respectively. Fertilizer management practices F5 and F4 recorded significantly at par and higher yields (pod, kernel, haulm and biological) compared to other combinations. The F5 treatment notable increased 16.7% and 90.2% water and nutrient use efficiency over RDF (6.69 kg/ha mm and 14.95 kg/kg), respectively. In Thar Desert, deep tillage along with chemical fertilizers and bio-inoculants found best management practices in terms of productivity and resource use efficiency.

BackgroundT-cell/NK-cell non-Hodgkin’s lymphoma (T/NK-NHL) is an uncommon heterogeneous group of diseases. The current classification of T/NK-NHL is mainly based on histopathology and immunohistochemistry. In practice, however, the lack of unique histopathological patterns, overlapping cytomorphology, immunophenotypic complexity, inadequate panels, and diverse clinical presentations pose a great challenge. Flow cytometric immunophenotyping (FCI) is a gold standard for the diagnosis, subtyping, and monitoring of many hematological neoplasms. However, studies emphasizing the role of FCI in the diagnosis and staging of T/NK-NHL in real-world practice are scarce.MethodsWe included T-cell non-Hodgkin’s lymphoma (T-NHL) patients evaluated for the diagnosis and/or staging of T/NK-NHL using FCI between 2014 and 2020. We studied the utility of FCI in the diagnosis and subtyping of T/NK-NHL and correlated the FCI findings with the results of histopathology/immunohistochemistry. For correlation purposes, patients were categorized under definitive diagnosis and subtyping, inadequate subtyping, inadequate diagnosis, and misdiagnosis based on the findings of each technique.ResultsA total of 232 patients were diagnosed with T/NK-NHL. FCI findings provided definitive diagnoses in 198 patients and subtyping in 187/198 (95.45%) patients. The correlation between FCI and histopathological/immunohistochemistry results (n = 150) demonstrated an agreement on the diagnosis and subtyping in 69/150 (46%) patients. Of the remaining cases, the diagnosis and subtyping were inadequate in 64/150 (42.7%), and 14/150 (9.33%) were misdiagnosed on histopathology/immunohistochemistry results. FCI provided definitive diagnosis and subtyping in 51/64 (79.7%) patients. Among these, 13 patients diagnosed with peripheral T-cell lymphoma not-otherwise-specified were reclassified (angioimmunoblastic T-cell lymphoma (AITL)-11 and prolymphocytic leukemia-2) on FCI. It corrected the diagnosis in 14 patients that were misdiagnosed (6 B-cell NHL (B-NHL), 3 Hodgkin’s lymphoma, 1 acute leukemia, and 1 subcutaneous panniculitis-like T-cell lymphoma) and misclassified (3 T-NHL) on histopathological results. AITL was the commonest T-NHL misclassified on histopathological results. FCI also confirmed the definite involvement in 7/83 (8.4%) and 27/83 (32.5%) bone marrow (BM) samples reported as suspicious and uninvolved, respectively, on histopathological evaluation.ConclusionAITL was the most frequently diagnosed T/NK-NHL in this study. FCI provided a distinct advantage in detecting BM involvement by T/NK-NHL, especially in patients with low-level involvement. Overall, our study concluded that FCI plays a critical role in the diagnosis, subtyping, and staging of T/NK-NHL in real-world practice.

Potato is one of the most important food crops in the world. Late blight, viruses, soil and tuber-borne diseases, insect-pests mainly aphids, whiteflies, and potato tuber moths are the major biotic stresses affecting potato production. Potato is an irrigated and highly fertilizer-responsive crop, and therefore, heat, drought, and nutrient stresses are the key abiotic stresses. The genus Solanum is a reservoir of genetic diversity, however, a little fraction of total diversity has been utilized in potato breeding. The conventional breeding has contributed significantly to the development of potato varieties. In recent years, a tremendous progress has been achieved in the sequencing technologies from short-reads to long-reads sequence data, genomes of Solanum species (i.e., pan-genomics), bioinformatics and multi-omics platforms such as genomics, transcriptomics, proteomics, metabolomics, ionomics, and phenomics. As such, genome editing has been extensively explored as a next-generation breeding tool. With the available high-throughput genotyping facilities and tetraploid allele calling softwares, genomic selection would be a reality in potato in the near future. This mini-review covers an update on germplasm, breeding, and genomics in potato improvement for biotic and abiotic stress tolerance.

Pediatric-onset multiple sclerosis (MS) is a predominantly relapsing-remitting neuroinflammatory disorder characterized by frequent relapses and high magnetic resonance imaging (MRI) lesion burden early in the disease course. Current treatment for pediatric MS relies on early initiation of disease-modifying therapies designed to prevent relapses and slow progression of disability. When considering the concept of MS prevention, one can conceptualize primary prevention (population- or at-risk population interventions that prevent the earliest facet of MS pathobiology and hence reduce disease incidence), or secondary prevention (prevention of disease consequence, such as reducing relapse frequency and lesion accrual, enhancing focal lesion repair, promoting CNS resilience against the more global facets of disease injury, and ultimately, preventing progression of neurological disability). Studying the pediatric MS population provides a unique opportunity to explore early-life exposures that contribute to the development of MS including perinatal and environmental risk determinants. Research is ongoing related to targeting these risk factors for potential MS primary prevention. Here we review these key risk factors, their proposed role in the pathogenesis of MS, and their potential implications for primary MS prevention.

Abstract The rate of disability accumulation varies across multiple sclerosis (MS) patients. Machine learning techniques may offer more powerful means to predict disease course in MS patients. In our study, 724 patients from the Comprehensive Longitudinal Investigation in MS at Brigham and Women’s Hospital (CLIMB study) and 400 patients from the EPIC dataset, University of California, San Francisco, were included in the analysis. The primary outcome was an increase in Expanded Disability Status Scale (EDSS) ≥ 1.5 (worsening) or not (non-worsening) at up to 5 years after the baseline visit. Classification models were built using the CLIMB dataset with patients’ clinical and MRI longitudinal observations in first 2 years, and further validated using the EPIC dataset. We compared the performance of three popular machine learning algorithms (SVM, Logistic Regression, and Random Forest) and three ensemble learning approaches (XGBoost, LightGBM, and a Meta-learner L). A “threshold” was established to trade-off the performance between the two classes. Predictive features were identified and compared among different models. Machine learning models achieved 0.79 and 0.83 AUC scores for the CLIMB and EPIC datasets, respectively, shortly after disease onset. Ensemble learning methods were more effective and robust compared to standalone algorithms. Two ensemble models, XGBoost and LightGBM were superior to the other four models evaluated in our study. Of variables evaluated, EDSS, Pyramidal Function, and Ambulatory Index were the top common predictors in forecasting the MS disease course. Machine learning techniques, in particular ensemble methods offer increased accuracy for the prediction of MS disease course.

This case report presents an instance of unilateral cataract formation and its rapid progression following topiramate-induced bilateral acute angle closure. An 18-year-old female diagnosed with acute angle closure in both eyes had started treatment on the previous day at another healthcare facility. The patient presented with complaints of pain, sudden diminution of vision, excessive watering, and photophobia (both eyes) and reported the use of topiramate for headache for 10 days. There was no past history of decreased vision, trauma, uveitis, or use of steroids. Topiramate-induced bilateral secondary angle closure attack was the presumptive diagnosis. Topiramate use was stopped, and antiglaucoma drugs, topical cycloplegic, and topical steroids were started. On 1-day follow-up, clearer cornea and peripheral anterior capsular lenticular opacity of the right eye were observed. Gonioscopy showed closed angles. Anterior segment optical coherence tomography showed forward movement of the iris-lens diaphragm and closed angles. B-scan showed ciliochoroidal effusion in the right eye and normal left eye. At 2-month follow-up, formed anterior chamber and posterior subcapsular cataract in the right eye were seen. There were no lenticular changes in the left eye. Definite progression of cataract from day-1 to 2-month follow-up was seen in the right eye. To our knowledge, this is the first report of the rapid progression of cataract following topiramate-induced secondary angle closure in a young patient warranting surgical intervention.

Abstract Objective Multiple sclerosis (MS) is an autoimmune demyelinating disorder, which is characterized by relapses and remissions. Serum neurofilament light chain (sNfL) is an emerging biomarker of disease activity but its clinical use is still limited. In this study, we aim to characterize the temporal association between sNfL and new clinical relapses and new gadolinium‐enhancing (Gd+) lesions. Methods Annual sNfL levels were measured with a single‐molecule array (SIMOA) assay in 94 patients with MS enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital (CLIMB) study. We used a multivariable linear mixed‐effects model to test the temporal association of sNfL with clinical relapses and/or new Gd+ lesions. We adjusted this model for age, disease duration, sex, and disease‐modifying therapies (DMTs) use. Results In the 3 months after a Gd+ lesion, we observed an average 35% elevation in sNfL (P

Introduction: COVID-19, caused by SARS-CoV-2 or novel corona virus is declared as a global emergency. Researchers are working hard to develop effective remedy and vaccine, but still the challenge to manage the spread and disease progression is existing. In Ayurveda, a good number of herbs are ascribed for health promotion and longevity; many of them are scientifically proven to boost immunity. Jeevaneeya mahakashaya of Charaka Samhita is such group of ten herbs enumerated for longevity and rejuvenation. However, few of the herbs of Jeevaneeya mahakashaya are endangered and not available easily. Thus, in the present article, the herbs of Jeevaneeya mahakashaya having Pratinidhi (substitutes) suggested in Bhavaprakasha Nighantu were reviewed. Objective: The objective of this study is to analyze the rationality and applicability of Jeevaneeya mahakashaya in the prevention and management of COVID-19. Data Source: The data was collected from Charaka Samhita and Bhavaprakasha Nighantu and PubMed database. Review Methods: Jeevaneeya mahakashaya and its Pratinidhi herbs were reviewed from Charaka Samhita and Bhavaprakasha Nighantu, respectively. Herbs of Jeevaneeya mahakashaya were also reviewed from PubMed data base for reported pharmacological activities beneficial in the management of COVID-19 by their botanical name. Results: The literature search revealed that the herbs enumerated in the Jeevaneeya mahakashaya were scientifically evaluated in various preclinical and clinical studies and showed anti-viral, anti-bacterial, immunomodulatory, anti-inflammatory, anti-oxidant, anti-tussive, cardio-protective, neuroprotective, nephroprotective, and hepatoprotective activity. These potential of herbs may help in CD4+ and CD8+ cell proliferation, interleukin 6, tumour necrosis factor alpha, inflammatory markers inhibition. It also protects various organs from damage, and improves respiration. Conclusion: The rational use of plants of Jeevaneeya mahakashaya may help in the prevention and management of SARS-CoV 2.

Objective: SARS COV-2 is an infectious kind of communicable disease. Where epidemiological triad is formed by environment, agent and host. Along with medical and preventive actions psychosocial intervention for people affected by COVID 19 is equally necessary. Our motive is to find out the role of Ayurveda in managing the psychosocial impact of COVID 19 pandemic. Data Source: For Ayurvedic and modern concepts references have been taken from textbooks, various websites, electronic media and articles. Review Method: Systematic review PRISMA (Preferred Reporting Items For Systematic Reviews and Meta Analyses). Result: Rasayana therapy, Panchakarama procedures, Sadvrit Palan (code of right conducts) and Aachara Rasyana mentioned in Ayurveda can help to manage psychosocial impact of covid 19. Conclusion: Thus, Ayurveda proved to be beneficial in promoting various effective strategies in managing mental and social health in COVID 19.