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Introduction: Primary thyroid lymphoma is defined as a lymphoma involving only the thyroid gland, or thyroid gland with regional lymph nodes without contiguity or metastasis to other areas at the time of diagnosis. Hashimoto’s thyroiditis is a known risk factor for the disease. It responds well to chemotherapy but since it is a rare clinical entity, the diagnosis is often missed, thereby subjecting the patient to extensive surgery. Case report: A 69 years old male presented with rapidly progressive swelling in front of neck for 10 days associated with dysphagia, odynophagia and dyspnoea. He had right lobe thyromegaly with multiple cervical lymphadenopathy with ultrasonographic risk stratification of TIRADS 5. Diagnosis was clinched by core biopsy report on immunohistochemistry as Diffuse Large B Cell Non-Hodgkin’s Lymphoma. Positron emission tomography computerized scan revealed 18-fluorodeoxyglucose avid grossly enlarged thyroid lobes and isthmus with multiple bilateral cervical lymph nodes. Documenting the stage of disease as III E, he was managed with Chemo-immunotherapy consisting of RCVP regime with complete remission. Conclusion: Primary thyroid lymphoma with extra-thyroid involvement can be rapidly progressing and life threatening. However, timely investigation leads to correct diagnosis, appropriate curative medical management and can avoid unwarranted surgery.

Supplementary Table S3 in our recent publication [...]

Microorganisms have significant potential to control fungal contamination in various foods. However, the identification of strains that exhibit robust antifungal activity poses challenges due to highly context-dependent responses. Therefore, to fully exploit the potential of isolates as antifungal agents, it is crucial to systematically evaluate them in a variety of biotic and abiotic contexts. Here, we present an adaptable and scalable method using a robotic platform to study the properties of 1022 isolates obtained from maple sap. We tested the antifungal activity of isolates alone or in pairs on M17 + lactose (LM17), plate count agar (PCA), and sucrose–allantoin (SALN) culture media against Kluyveromyces lactis, Candida boidinii, and Saccharomyces cerevisiae. Microorganisms exhibited less often antifungal activity on SALN and PCA than LM17, suggesting that the latter is a better screening medium. We also analyzed the results of ecological interactions between pairs. Isolates that showed consistent competitive behaviors were more likely to show antifungal activity than expected by chance. However, co-culture rarely improved antifungal activity. In fact, an interaction-mediated suppression of activity was more prevalent in our dataset. These findings highlight the importance of incorporating both biotic and abiotic factors into systematic screening designs for the bioprospection of microorganisms with environmentally robust antifungal activity.

Oral health is an Integrating oral health education into medical curricula and is increasingly recognized as important for health-care professionals. Oral health education in medical education is significant. The relationship between systemic diseases and oral health is significant. Poor oral health can contribute to the development or exacerbation of various systemic conditions, whereas systemic diseases can also manifest symptoms in the oral cavity.

Medicinal herbs are being widely accepted as alternative remedies for preventing various diseases especially in India and other Asian countries. However, most plant-based herbal medicines are not yet being scientifically accepted worldwide. “Tinospora cordifolia (Willd.) Miers ex Hook.F. & Thomson”, one of the most promising plant species of Tinospora known as “Giloy” or Guduchi that is used in several traditional medicines in treating diseases e.g., metabolic and immune disorders, diabetes, heart diseases, cancer, and infectious diseases, has been widely investigated. Varieties of bioactive phytochemical constituents isolated from the stem, root and whole plant of T. cordifolia have been identified. In the last two decades, the diverse pharmacological activities of T. cordifolia have been continuously studied. Due to its therapeutic efficacy in immune modulation, it could be effective in viral and other diseases treatment as well. A medicinal plant could be well-suited not only for the treatment of target site but also for boosting the body's immune system. As an alternate source of medication, medicinal herbs are continuously showing better compatibility with the human body with minimal side effects than other therapies. Keeping this in mind, the present review highlights the pharmacological potential of T. cordifolia against various diseases.

Endotracheal intubation, frequently required during management of refractory status epilepticus (RSE), can be facilitated by anesthetic medications; however, their effectiveness for RSE control is unknown. We performed a single-center retrospective review of patients admitted to a neurocritical care unit (NCCU) who underwent in-hospital intubation during RSE management. Patients intubated with propofol, ketamine, or benzodiazepines, termed anti-seizure induction (ASI), were compared to patients who received etomidate induction (EI). The primary endpoint was clinical or electrographic seizures within 12 h post-intubation. We estimated the association of ASI on post-intubation seizure using logistic regression. A sub-group of patients undergoing electroencephalography during intubation was identified to evaluate the immediate effect of ASI on RSE. We screened 697 patients admitted to the NCCU for RSE and identified 148 intubated in-hospital (n = 90 ASI, n = 58 EI). There was no difference in post-intubation seizure (26 % (n = 23) ASI, 29 % (n = 17) EI) in the cohort, however, there was increased RSE resolution with ASI in 24 patients with electrographic RSE during intubation (ASI: 61 % (n = 11/18) vs EI: 0 % (n = 0/6), p =.016). While anti-seizure induction did not appear to affect post-intubation seizure occurrence overall, a sub-group of patients undergoing electroencephalography during intubation had a higher incidence of seizure cessation, suggesting potential benefit in an enriched population.

Acinetobacter baumannii is widely recognized as a human opportunistic pathogen in nosocomial infections. The proliferation of multidrug-resistant strains of A. baumannii has presented an array of difficulties for clinical anti-infective therapies and diagnostic procedures, owing to the existence of numerous variations. The development of therapy utilizing CRISPR/Cas9 for treatment and diagnosis necessitates an in-depth study of potential off-target consequences. The objective of this work is to assess potential off-target effects associated with a single guide RNA (sgRNA) designed to identify several variants present in A. baumannii. The current investigation involved the identification of Cas12 nuclease-specific protospacer adjacent motif (PAM) and downstream target sequences. This was achieved by utilizing computational tools and software to analyze conserved sections of the A. baumannii siderophore protein gene. Further, the in-silico expression vector was created with the SnapGene software. A total of 24 potential off-target sequences were identified in these sequences with 100% query identity with 96 different A. baumannii strains. In addition, a target-specific oligonucleotide single-guide RNA (sgRNA) template was synthesized by appending an additional nucleotide 'G' to the 5′ end. This research uses A. baumannii as an example of a problem that affects all treatments and diagnosis procedures to illustrate the significance of screening off-targets in different variants of a pathogen. Our findings may impact the safety and effectiveness of CRISPR/Cas9, which may have wider implications for additional targets that are currently being used therapeutically.

Purpose: The Australian Genomics Cardiovascular Disorders Flagship was a national multidisciplinary collaboration. It aimed to investigate the feasibility of genome sequencing (GS) and functional genomics to resolve variants of uncertain significance (VUS) in the clinical management of patients and families with cardiomyopathies, primary arrhythmias, and congenital heart disease (CHD). Methods: Between April 2019 and December 2021, 600 probands meeting cardiovascular disorder criteria from 17 cardiology and genetics clinics across Australia were enrolled in the Flagship and underwent GS. The Flagship adopted a tiered approach to GS analysis. Tier 1 analysis assessed genes with established clinical validity for each cardiovascular condition. Tier 2 analysis assessed lesser-evidenced research-based genes. Tier 3 analysis assessed the functional impact of VUS that remained after tier 1 and tier 2 analysis. Results: Overall, a pathogenic or likely pathogenic variant was identified in 41% of participants with a cardiomyopathy, 40% with an arrhythmia syndrome, and 15% with a familial CHD/CHD+Extra Cardiac Anomalies. A VUS outcome ranged from 13% for arrhythmias to 34% for CHD/CHD+Extra Cardiac Anomalies participants. Tier 2 research analysis identified a likely pathogenic/pathogenic variant for a further 15 participants and a VUS for an additional 15 participants. Conclusion: The Flagship successfully facilitated a model of care that harnesses clinical GS and functional genomics for the resolution of VUS in the clinical setting. This valuable data set can be used to inform clinical practice and facilitate research into the future.

Rapid industrialization, mining, and other anthropogenic activities have poisoned our environment with heavy metals, negatively impacting all forms of life. Heavy metal pollution causes physiological and neurological disorders, as heavy metals are endocrine disrupters, carcinogenic, and teratogenic. Therefore, it becomes mandatory to address the challenge of heavy metal contamination on a global scale. Physical and chemical approaches have been employed for pollutant removal and detoxification, but these methods cannot be adopted universally due to high cost, labor intensiveness, and possible negative impact on natural microflora. Phytoremediation is one of the preferred and safest approaches for environmental management due to its high efficiency and low cost of investment. The plant can uptake the pollutants and heavy metals from water and soil through an intense root network via rhizofiltration and process via phytostabilization, phytovolatilization, and accumulation. At a cellular level, the phytoremediation process relies on natural mechanisms of plant cells, e.g., absorption, transpiration, intracellular storage, and accumulation to counter the detrimental effects of pollutants. It is widely accepted because of its novelty, low cost, and high efficiency; however, the process is comparatively slower. In addition, plants can store pollutants for a long time but again become a challenge at the end of the life cycle. The current review summarizes phytoremediation as a potential cure for heavy metal pollutants, released from natural as well as anthropogenic sources. It will provide insight into the advancement and evolution of advanced techniques like nanoremediation that can improve the rate of phytoremediation, along with making it sustainable, cost-effective, and economically viable.

The IoT devices placed in remote locations require a battery replacement very often, which is not a convenient option. Backscatter communication can resolve this problem, as backscatter communication is a data transmission in which an RF signal incident from the gateway is used for energy harvesting, and this energy will be employed for data transmission. In this paper, a hybrid contention-based TDMA scheme is proposed, which provides slots to devices by dividing them into groups, and then contention is employed in groups to acquire a slot; if a device is not able to transmit during harvest, then transmit (HTT) period, then it can transmit in variable sub frame and the devices which are not able to completely transmit during HTT period can reserve subframes. The proposed hybrid scheme is compared with the TDMA scheme for average transmission delay.The proposed scheme provides scalability. The difference between the average transmission delay of TDMA and the proposed hybrid scheme is from 6 to 20 s, depending on the number of devices added and when traffic is generated.

Abstract Loss of function in the tumor suppressor gene TP53 is the most common alteration seen in human cancer. In mice, P53 deletion in all cells leads predominantly to the development of T-cell lymphomas, followed by B-cell lymphomas, sarcomas and teratomas. In order to dissect the role of P53 in the hematopoietic system, we generated and analyzed two different mouse models deficient for P53. A pan-hematopoietic P53 deletion mouse was created using Vav1-Cre based deletion; and a B-cell-specific deletion mouse was created using a CD19-Cre based deletion. The Vav1-P53CKO mice predominantly developed T-cell malignancies in younger mice, and myeloid malignancies in older mice. In T-cell malignancies, there was accelerated thymic cell maturation with overexpression of Notch1 and its downstream effectors. CD19-P53CKO mice developed marginal zone expansion in the spleen, followed by marginal zone lymphoma, some of which progressed to diffuse large B-cell lymphomas. Interestingly, marginal zone and diffuse large B-cell lymphomas had a unique gene expression signature characterized by activation of the PI3K pathway, compared with wild type marginal zone or follicular cells of the spleen. This study demonstrates lineage specific P53 deletion leading to distinct phenotypes secondary to unique gene expression programs set in motion.

Abstract Background Treatment of brain tumors, epilepsy, or hemodynamic abnormalities requires a craniotomy to access the brain. Nearly 1 million craniotomies are performed in the US annually, which increase to ~ 14 million worldwide and despite prophylaxis, infectious complications after craniotomy range from 1 to 3%. Approximately half are caused by Staphylococcus aureus (S. aureus), which forms a biofilm on the bone flap that is recalcitrant to antibiotics and immune-mediated clearance. However, the mechanisms responsible for the persistence of craniotomy infection remain largely unknown. The current study examined the role of IL-10 in promoting bacterial survival. Methods A mouse model of S. aureus craniotomy infection was used with wild type (WT), IL-10 knockout (KO), and IL-10 conditional KO mice where IL-10 was absent in microglia and monocytes/macrophages (CX3CR1 Cre IL-10 fl/fl ) or neutrophils and granulocytic myeloid-derived suppressor cells (G-MDSCs; Mrp8 Cre IL-10 fl/fl ), the major immune cell populations in the infected brain vs. subcutaneous galea, respectively. Mice were examined at various intervals post-infection to quantify bacterial burden, leukocyte recruitment, and inflammatory mediator production in the brain and galea to assess the role of IL-10 in craniotomy persistence. In addition, the role of G-MDSC-derived IL-10 on neutrophil activity was examined. Results Granulocytes (neutrophils and G-MDSCs) were the major producers of IL-10 during craniotomy infection. Bacterial burden was significantly reduced in IL-10 KO mice in the brain and galea at day 14 post-infection compared to WT animals, concomitant with increased CD4+ and γδ T cell recruitment and cytokine/chemokine production, indicative of a heightened proinflammatory response. S. aureus burden was reduced in Mrp8 Cre IL-10 fl/fl but not CX3CR1 Cre IL-10 fl/fl mice that was reversed following treatment with exogenous IL-10, suggesting that granulocyte-derived IL-10 was important for promoting S. aureus craniotomy infection. This was likely due, in part, to IL-10 production by G-MDSCs that inhibited neutrophil bactericidal activity and TNF production. Conclusion Collectively, these findings reveal a novel role for granulocyte-derived IL-10 in suppressing S. aureus clearance during craniotomy infection, which is one mechanism to account for biofilm persistence.

The main aim of the present study is to assess the present ecological status of Bhomra wetland with respect to the fisheries and associated ecosystem services and to prescribe some climate-smart adaptation technologies in changing climate. The analysis showed increasing temperature (Kendall's tau = 0.60, p

Abstract Background Osteosarcoma is a type of bone cancer that predominantly affects young individuals, including children and adolescents. The disease progresses through heterogeneous genetic alterations, and patients often develop pulmonary metastases even after the primary tumors have been surgically removed. Ubiquitin-specific peptidases (USPs) regulate several critical cellular processes, such as cell cycle progression, transcriptional activation, and signal transduction. Various studies have revealed the significance of USP37 in the regulation of replication stress and oncogenesis. Methods In this study, the Cancer Genome Atlas (TCGA) database was analyzed to investigate USP37 expression. RNA sequencing was utilized to assess the impact of USP37 overexpression and depletion on gene expression in osteosarcoma cells. Various molecular assays, including colony formation, immunofluorescence, immunoprecipitation, and DNA replication restart, were employed to examine the physical interaction between USP37 and PCNA, as well as its physiological effects in osteosarcoma cells. Additionally, molecular docking studies were conducted to gain insight into the nature of the interaction between USP37 and PCNA. Furthermore, immunohistochemistry was performed on archived tissue blocks from osteosarcoma patients to establish a correlation between USP37 and PCNA expression. Results Analysis of the TCGA database revealed that increased expression of USP37 was linked to decreased progression-free survival (PFS) in osteosarcoma patients. Next-generation sequencing analysis of osteosarcoma cells demonstrated that overexpression or knockdown of USP37 led to the expression of different sets of genes. USP37 overexpression provided a survival advantage, while its depletion heightened sensitivity to replication stress in osteosarcoma cells. USP37 was found to physically interact with PCNA, and molecular docking studies indicated that the interaction occurs through unique residues. In response to genotoxic stress, cells that overexpressed USP37 resolved DNA damage foci more quickly than control cells or cells in which USP37 was depleted. The expression of USP37 varied in archived osteosarcoma tissues, with intermediate expression seen in 52% of cases in the cohort examined. Conclusion The results of this investigation propose that USP37 plays a vital role in promoting replication stress tolerance in osteosarcoma cells. The interaction between USP37 and PCNA is involved in the regulation of replication stress, and disrupting it could potentially trigger synthetic lethality in osteosarcoma. This study has expanded our knowledge of the mechanism through which USP37 regulates replication stress, and its potential as a therapeutic target in osteosarcoma merits additional exploration.

Aims and method This review aims to clarify the evidence on the effectiveness of telepsychiatry following the COVID-19 pandemic. We conducted a literature review of three databases (Cochrane Library, PubMed and PsycINFO), using the terms virtual consultation/telepsychiatry/video consultation AND psychiatry/mental illness. Results We identified 325 eligible papers and conducted a thematic analysis resulting in five themes: patient and clinical satisfaction, diagnostic reliability, outcomes, technology and professional guidance. The most significant factors linked to effectiveness of telepsychiatry were patient and clinician satisfaction and adequate technology to facilitate examination of the patient. Clinical implications The consistent diagnostic reliability, satisfactory clinical outcomes and patient satisfaction linked to telepsychiatry favour its continued use once the pandemic ends. The main barrier is reluctance among clinicians and lack of professional guidance. We recommend education on the uses of telepsychiatry among clinicians, and the provision of professional guidance for its use from medical bodies and organisations.

Background: Impulse-control disorders and related behaviors (ICD-RB) and restless leg syndrome (RLS) are common in Parkinson’s disease (PD) patients, but their relationship and independence from dopaminergic therapy are not well understood. This study aims to determine the correlation between ICD-RBs and RLS and the significant psycho-behavioral profile of RLS patients in the presence of ICD-RBs.Methods: The study screened PD patients visiting a neurology outpatient department for addictive behaviors, alcohol and substance abuse, and ICDs using the QUIP questionnaire. RLS was diagnosed based on the criteria set by the International RLS study group. The cohort was divided into groups based on the presence of ICDs and RLS.Results: 48.6% of the 72 PD patients in the study displayed at least one Impulse Control Disorder-Related Behavior (ICD-RB), with 57.1% showing compulsive medication use, 17.1% showing compulsive eating, 11.4% showing compulsive buying, 11.4% displaying gambling disorder, and 2.8% displaying hypersexuality. In addition, 26.3% of patients in the cohort had Restless Legs Syndrome (RLS), with 68.4% of these patients displaying at least one ICD-RB. Among patients with RLS and ICD-RBs, gambling was the most commonly observed behavior, displayed by 30.7% of patients, while 36.8% displayed co-occurring compulsive eating. Only one patient showed more than one ICD-RB, which included both gambling and compulsive medication use.Conclusion: The study concludes that 11% of PD patients can have co-occurrence of RLS and ICD-RBs, and this behavioral profile may be due to circadian fluctuation in dopamine release in a hyper-dopaminergic state. Long-term dopaminergic treatment or degenerative processes may be the cause of both RLS and ICD-RBs in PD patients.

Protein–protein interactions (PPIs) are involved in an extensive variety of biological procedures, including cell-to-cell interactions, and metabolic and developmental control. PPIs are becoming one of the most important aims of system biology. PPIs act as a fundamental part in predicting the protein function of the target protein and the drug ability of molecules. An abundance of work has been performed to develop methods to computationally predict PPIs as this supplements laboratory trials and offers a cost-effective way of predicting the most likely set of interactions at the entire proteome scale. This article presents an innovative feature representation method (CAA-PPI) to extract features from protein sequences using two different encoding strategies followed by an ensemble learning method. The random forest methodwas used as a classifier for PPI prediction. CAA-PPI considers the role of the trigram and bond of a given amino acid with its nearby ones. The proposed PPI model achieved more than a 98% prediction accuracy with one encoding scheme and more than a 95% prediction accuracy with another encoding scheme for the two diverse PPI datasets, i.e., H. pylori and Yeast. Further, investigations were performed to compare the CAA-PPI approach with existing sequence-based methods and revealed the proficiency of the proposed method with both encoding strategies. To further assess the practical prediction competence, a blind test was implemented on five other species’ datasets independent of the training set, and the obtained results ascertained the productivity of CAA-PPI with both encoding schemes.

Abstract In recent years, diets rich in fibres have become more popular due to their well-documented beneficial health effects. This has driven exploration of novel dietary fibres from various bioresources. Apple pomace, an industrial waste rich in fibres was used in this study to extract the insoluble dietary fibres. The effect of various extraction methods (hot water, acid, and alkali) on the physico-chemical, structural and functional properties, and prebiotic activity of dietary fibres was evaluated. Hot water extraction resulted in highest yield of dietary fibres in comparison to other methods (p

Abstract Background Comparative bioavailability of cannabinoids following their administration by dosing routes has been studied previously, but there are no quantitative reports of distribution of Δ 9 THC, nor its metabolites, across various brain regions following intranasal (i.n.) administration. The aim of the present study was to determine the time course of Δ 9 THC transport from nose to brain and to quantify the distribution of Δ 9 THC and its metabolites in four brain regions. Methods Δ9THC was formulated as a lipophilic nano-emulsion and instilled i.n. to three groups of adult mice and euthanized after 2, 4, and 8 h. Brains were dissected into 4 regions. Sensitive analytical methods (HPLC-MS) were utilized to quantify levels of Δ 9 THC and metabolites in brain regions and peripheral tissues. Data was expressed as mean concentrations (± SEM) of Δ 9 THC and metabolites in brain regions, blood, plasma, urine, and liver. Two-way analysis of variance was performed followed by post hoc multiple comparisons. Results Peak concentrations of Δ 9 THC were reached at 2 h in the brain (15.9 ng/mg), blood (4.54 μg/mL), and plasma (4.56 μg /mL). The percentage of administered dose of Δ 9 THC transported to the brain (5.9%) was greater than in blood (1.7%), plasma (1.6%), urine (0.4%), and liver (0.1%). Concentrations of Δ9THC and its THC-COOH metabolite in the liver reached their highest levels at 8 h. Discussion The present study is the first to report the uptake and distribution across brain regions of Δ 9 THC and its principal metabolites following i.n. administration. The systemic bioavailability (absorption into the blood) of intranasal Δ 9 THC was 1.7% of the administered dose, much lower than that reported by others after oral ingestion (7–10%) and inhalation (20–35%), but those prior studies did not measure the transport of Δ 9 THC into brain regions. Others have reported Δ 9 THC in the whole brain following i.n. instillation in a different species (rats) to be twice (5.9%) that following i.p. injections, while metabolites of Δ 9 THC in rat brain were lower after i.n. administration. Conclusions The intranasal route of a Δ 9 THC nanoformulation is an effective way to deliver cannabinoids to the brain, especially in those who cannot take the medication orally. Going forward, a metered dosing nasal spray will provide accurate and consistent doses.

Reports of the expansion of the Asia malaria vector Anopheles stephensi mosquito into new geographic areas are increasing, which poses a threat to the elimination of urban malaria. Efficient surveillance of this vector in affected areas and early detection in new geographic areas is key to containing and controlling this species. To overcome the practical difficulties associated with the morphological identification of immature stages and adults of An. stephensi mosquitoes, we developed a species-specific PCR and a real-time PCR targeting a unique segment of the second internal transcribed spacer lacking homology to any other organism. Both PCRs can be used to identify An. stephensi mosquitoes individually or in pooled samples of mixed species, including when present in extremely low proportions (1:500). This study also reports a method for selective amplification and sequencing of partial ribosomal DNA from An. stephensi mosquitoes for their confirmation in pooled samples of mixed species.

Abstract Secondary neurologic decline (ND) after traumatic brain injury (TBI) is independently associated with outcome, but robust predictors of ND are lacking. In this retrospective analysis of consecutive isolated TBI admissions to the R. Adams Cowley Shock Trauma Center between November 2015 and June 2018, we aimed to develop a triage decision support tool to quantify risk for early ND. Three machine learning models based on clinical, physiologic, or combined characteristics from the first hour of hospital resuscitation were created. Among 905 TBI cases, 165 (18%) experienced one or more ND events (130 clinical, 51 neurosurgical, and 54 radiographic) within 48 h of presentation. In the prediction of ND, the clinical plus physiologic data model performed similarly to the physiologic only model, with concordance indices of 0.85 (0.824–0.877) and 0.84 (0.812–0.868), respectively. Both outperformed the clinical only model, which had a concordance index of 0.72 (0.688–0.759). This preliminary work suggests that a data-driven approach utilizing physiologic and basic clinical data from the first hour of resuscitation after TBI has the potential to serve as a decision support tool for clinicians seeking to identify patients at high or low risk for ND.

Background: Supraclavicular brachial plexus blocks (SCBPB) are routinely placed prior to anaesthetic induction for post-operative pain relief after prolonged orthopaedic oncosurgery, since patients are required to remain awake for sensorimotor evaluation of block. If the window period after surgery but before anesthesia-reversal is employed for administering SCBPB, it bestows the quadruple advantage of being painless, not augmenting surgical bleed, longer post-operative analgesia and reduced opioid-related side effects. The problem spot is assessing SCBPB-efficacy under general anesthesia. Methods: This prospective, single-centric, observational cohort study included 30 patients undergoing upper limb orthopaedic oncosurgery under general anesthesia. Perfusion index (PI) was assessed using two separate units of Radical-7™ finger pulse co-oximetry devices simultaneously in both the upper limbs and PI ratios calculated. Skin temperature was noted. Results: After successful block, PI values in blocked limb suddenly increased after 5 min, progressively increasing for next 10 min, whereas PI failed to increase further above that attained post anaesthetic-induction in unblocked limb. PI values in the blocked limb were 4.32, 4.49, 4.95, 7.25, 7.71, 7.90, 7.94, 7.89, and 7.93 at 0, 2, 3, 5, 10, and 15 min post block-institution at reversal and 2 min, 5 min post-reversal, respectively. PI ratios at 2, 3, 5, 10, and 15 min post block-administration in the blocked limb, taking PI at local anaesthetic injection as denominator were 1.04, 1.15, 1.67, 1.78, and 1.83, respectively. Correlation between PI and skin temperature in the blocked limb gave a repeated measures correlation coefficient of 0.79. Conclusion: Monitoring trends in PI and PI-ratio in the blocked limb is a quantitative, non-invasive, inexpensive, simple, effective technique to monitor SCBPB-onset in anaesthetised patients.

In the last decade, the increase of active and passive earth observation satellites has provided us with more remote sensing data. This fact has led to enhanced interest in the fusion of different satellite data since some of the satellites have properties complementary to others. Fusion techniques can improve the estimation in areas of interest by using the complementary information and inferring unknown parameters. They also have the potential to provide high-resolution detailed classification maps. Thus, we propose a neural network, which combines and analyzes the data obtained from synthetic aperture radar (SAR) and optical sensors to provide high-resolution classification maps. The neural network employs a novel activation function to construct a neural network explainability method termed as inverse mapping for prominent feature analysis. By applying inverse mapping to the data fusion neural network, we can understand which input features are the prominent contributors for which classification outputs. Inverse mapping realizes backward signal flow based on teacher-signal backpropagation dynamics, which is consistent with its forward processing. It performs the contribution analysis of the data pixel by pixel and class by class. In this article, we focus on earthquake damage detection by dealing with SAR and optical sensor data of the 2018 Sulawesi earthquake in Indonesia. The fusion-based results show increased classification accuracy compared to the results of independent sensors. Moreover, we observe that inverse mapping shows reasonable explanations in a consistent manner. It also indicates the contributions of features different from straightforward counterparts, namely, pre- and post-seismic features, in the detection of particular classes.

Cervical cancer remains a health burden in our country and is the 2nd most common cancer in Indian women. Effective screening can reduce the incidence as well as the morbidity and mortality of this disease. Cervical cytology and the more recent human papilloma virus (HPV) DNA test are the two main pillars of screening. Liquid based cytology has improved the cytological preparations and has shown certain advantages while advancements in molecular techniques for detection of high-risk HPV DNA/RNA has opened up new frontiers. These technological advancements have led to the changes in screening practices and paradigms and are evolving at a rapid pace. This article gives an overview of the screening modalities currently available, the technological advancements, recent updates of the screening guidelines and the future directions.

Background & objectives: Dengue virus (DENV) is the causative agent of dengue fever (DF) and dengue hemorrhagic fever (DHF). It has four distinct serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) based on their antigenic properties. Mostly, the immunogenic epitopes are present in the envelope (E) protein of the virus. Heparan sulfate (HS) acts as a receptor and interacts with the E protein of the virus thus facilitating the entry of dengue virus into human cells. This study focuses on epitope prediction on the E protein of the DENV serotype. The non-competitive inhibitors of HS were designed using bioinformatics. Methods: In the present study, epitope prediction of the E protein of DENV serotypes was performed using the ABCpred server and IEDB analysis resource. The interactions of HS and viral E proteins (PDB ID: 3WE1 and PDB ID:1TG8) were evaluated through AutoDock. Subsequently, non-competitive inhibitors were designed to bind the E protein of DENV better than HS. All the docking results were validated by re-docking the ligand-receptor complexes and superimposing them onto their co-crystallized complexes using AutoDock and visualizing them in Discovery Studio. Results: The result predicted B-cell and T-cell epitopes on the E protein of DENV serotypes. The designed HS ligand 1 (non-competitive inhibitor) demonstrated potential binding with the DENV E protein, thereby inhibiting HS-E protein binding. The re-docked complexes were superimposed entirely onto the native co-crystallized complexes (low root mean square deviation values), which validates the docking protocols. Interpretation & conclusion: The identified B-cell and T-cell epitopes of the E protein and non-competitive inhibitors of HS (ligand 1) could be used in the designing of potential drug candidates against the dengue virus.

Improving the bit error rate (BER) in dense wireless medical sensor networks (WMSNs) using small areas is challenging. Ensuring the relay of big data in healthcare, such as human virus vaccine signs, is always a huge challenge. This paper proposes a new potent hierarchical algorithm (PHA) for controlling several vaccine types in real-time using a uniquely challenging laboratory before being recommended and authorized. This healthcare research paper offers a new medical application in the virus testing communication of several separate and independent patient groups (subnets), exploiting a smart laboratory. The health data aggregator (HDA) nodes of the patients are wirelessly connected to a relay network (RN) via the central node (CN). We develop an efficient communication scheme, improving BER values versus signal-to-noise ratio (SNR), proposing a PHA that requires three main creation stages. The first stage is responsible for collecting big medical data. In the second and third stages, we use coding approaches based on network coding (NC) and low-density parity-check code (LDPC). The proposed PHA reduces BER in deep fading environment receivers for different creating parameters. This paper introduces an innovative approach to tracking the evolution of virus vaccines by integrating IoMT, Big Data, and Artificial Intelligence (AI). This integration enables identifying and selecting the optimal and most effective vaccine.

Introduction: Myocardial bridge (MB) is usually defined as the segment of the coronary artery (epicardial) which passes intramurally. In the early days, it was not having any clinical importance, but later studies showed the presence of it in the left anterior descending (LAD) artery can be associated with myocardial infarction and cardiac death suddenly. Material and Methods: The aim of this study was mostly to assess the profile of patients with the MB on coronary angiography and to evaluate its association with atherosclerotic disease in the coronary artery at a tertiary care hospital in Rajasthan. In this study, evaluation was done (retrospectively) of the angiographic reports of the patients, and the prevalence of MB was seen totally, individually, or in combination with LAD, left circumflex, and right coronary artery. Results: Out of all 140 patients, 125 (89%) were males, and 15 (11%) were females. Among 140, the mean age of the patients having MB was 55.51 years. Out of 140 patients, 46% (65 patients) had diabetes, 41% (58 patients) had hypertension, and 42% (59 patients) were found to be smoker. Conclusion: The prevalence of MB in our study is similar to what is reported in the literature. The most common location of the MB was the mid-LAD segment.

Background: Anemia is the most common nutritional disease in pregnancy with significant adverse maternofetal outcome. The objective of the present study is to study the impact of COVID-19 pandemic on the pregnancy outcomes of women with severe anemia. Methodology: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at LHMC and SSK Hospital, Delhi. The study included all antenatal women admitted at a gestational age of >26 weeks (third trimester) with severe anemia and hemoglobin level of 7 g/dL. In our study, a total of 4031 women were included as cases during study period (July to December 2022) and 6659 women as controls from pre-COVID-19 period (July to December 2019). Results: In present study, a total of 4031 women delivered during study period as compared to 6659 in control period. In the present study, the prevalence of anemia was observed to be 74.7% in the study group and 51.6% in the control group (P < 0.001). Mean hemoglobin level was significantly lower in study group as compared to the control groups P

Introduction: Transgenders (TGs) are one of the vulnerable groups in our society. Trans people experience substantial health disparities and barriers to appropriate health care services that keep them from achieving the highest possible health status. Methodology: The study was conducted over the course of 12 months at the Transgender Shelter Home. Focus group discussion (FGD) took place with 6–12 participants and the researcher acted as moderator. The questions were asked under four domains; sociodemographic variables, behavioral variables, medical and health status variables, and access and utilization of dental services barrier variables. Transcripts were coded and data analysis was concurrent with data collection to allow to know new insights. The data analysis was done by MAXQDA software 2022.0.0. It is being developed and distributed by VERBI Software based in Berlin, Germany. Results: The barriers and facilitators explored were categorized at three levels: (1) the personal level, relating to those barriers and facilitators that the individual faced for their oral health care, and the perspectives regarding the delivery of care; (2) the inter-personal level; and (3) the system level, for identifying the wider elements and their influence. Discussion: Social stigma and marginalization have been linked to adverse health effects, including personal attributes, structural and environmental factors, and personal perceptions of stigmatization. Conclusion: It is evident that lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities have specific but varied health care needs, and the greatest way to treat these necessities is via exposure to professional, health care coverage.

Precise surface classification is essential for glacial health monitoring, where normalized indices have traditionally been used. These indices are created empirically for a specific sensor. The transferability of these indices to other sensors can be affected by differences in spectral and spatial resolution. Thus, it is essential to evaluate the transferability of an index before applying it to a new sensor to ensure accuracy and reliability. However, as the number of satellites, sensors, and observation bands increases, there is a need for automated methods for determining application-specific normalized indices. In this article, we propose using all the bands of multispectral optical sensors to generate multiple normalized indices and determining application-specific indices using inverse mapping. We use these normalized indices for pixel-by-pixel surface classification using neural networks. First, we employ all the bands for generating normalized indices and then eliminate low-spatial-resolution bands to evaluate classification performance by using only high-spatial-resolution indices. We apply this method to a glacial region and observe 81.98% and 84.81% overall accuracy compared to the ground truth data for the two classifications, respectively. We then apply inverse mapping dynamics to the classification results to determine prominent indices useful for glacier classification. The results show that although some of the determined indices are not traditional indices, they are still useful for classification due to the relative differences between various land types. The proposed method has the potential to automate normalized index determination, thereby eliminating the need for empirical band assessment methods and making the index development process more efficient.

Background: Mucormycosis (black fungus) is an aggressive, life-threatening infectious disease-causing infiltration and by destroying the surrounding bone and soft tissue through vascular thrombosis and subsequent tissue infarction that may reach the brain with fatal complications. Its outbreak has been assessed around the clock during the recent pandemic as post COVID-19 sequelae. Aims: To assess the risk factors, oral signs and symptoms, investigations, treatment and rehabilitation strategies amongst COVID-19 associated mucormycosis patients in a tertiary care hospital. Methods and Material: An observational, pilot study was carried out amongst 30 active or recent COVID-19 associated mucormycosis patients reporting in the Department of Dentistry of a tertiary care hospital in Bhopal over a period of 6 months. Statistical analysis was done using Kolmogorov-Smirnov test using the Statistical Package for Social Sciences, Version 16 software. Results: Study was done on 30 patients (80% males and 20% females) and their median age was 46 years. Predominant risk factor present was diabetes mellitus (90%) and steroid therapy (60%). Prime oral manifestations were toothache (90%), mobile teeth (83%), draining sinus (53%), palatal ulceration (43%) and para-sinusal pain (37%). Conclusions: Mucormycosis can cause serious oro-facial morbidity and mortality in COVID-19 patients. The current management strategy requires early diagnosis, prompt treatment and oral rehabilitation.

Background: The identification of nearby neurovascular structures is a vital part of dental implant treatment planning. Commonly two implants are placed in the mandibular inter foraminal region to support the overdenture. Placing dental implants in this region is considered relatively safe. The purpose of this study was to employ cone beam computed tomography (CBCT) on a representative sample of Northeast Indians to find out the location and distribution of lingual foramen in the anterior mandible. Study Design: A total of 104 CBCT scans were performed using the Cranex 3D CBCT system. Three Oral and Maxillofacial Radiologists agreed on a visibility grade for assessing the lingual foramen using a 3-point scale. The number and presence of foramina were noted. On cross-sectional pictures, the distance in millimeters between the crest of the alveolar ridge and the superior cortical margin of the foramen was determined. Furthermore, the analysis of the distribution of lingual foramina in terms of frequency and percentages was performed. Results: Scan results showed that the lingual foramen was clearly visible in 65.4% of cases, somewhat visible in 12.5% of scans, and not visible at all in 22.1% of cases. Half of the people in the study had two foramina, whereas 27.9 percent had one and 22.1 percent had none. The mean distance from the crest of the alveolar ridge was 10.84 mm in males whereas 9.91 mm in females Conclusion: The Northeast Indian population exhibits an unusually high prevalence of lingual foramen in the anterior portion of the mandible. This research will aid in the precise pre-operative identification of the position and number of lingual foramina prior to surgical treatments involving the midline of the mandible.

Background: Disorders of sexual development (DSD) encompass a group of congenital conditions characterized by diverse genotypic and phenotypic variations. Ovotesticular (OT) DSD is a distinctive subtype within this spectrum. Among the array of DSD, OT-DSD stands as one of the most infrequent anomalies, with reported prevalence rates as scarce as 1 in 83,000. This study aims to elucidate the clinical, hormonal, cytogenetic, surgical, and histopathological characteristics of OT disorder of sex development (OT-DSD) within a tertiary center in North India. Methodology: A retrospective analysis was conducted, involving a comprehensive review of records pertaining to OT-DSD patients from the years 2018 to 2022, all of whom were incorporated into the study. Results: The mean age of presentation in this study was 10 years, spanning from 6 to 15 years. Predominantly, the affected individuals were male, with a solitary patient representing the female category. Clinical manifestations displayed a spectrum encompassing genital ambiguity, inguinal swelling, and primary amenorrhea. The karyotypes observed were 46,XX in four patients and 46,XY in one patient. A holistic assessment, inclusive of clinical evaluation, hormonal assays, pelvic ultrasonography, and surgical intervention when necessary, was administered to all patients. Among these cases, three patients were reared as males, their gender assignment driven by external genital appearance and sociocultural influences. Notably, none of the patients manifested gonadal tumors during the course of the study. Conclusion: In cases of ambiguous genitalia, the consideration of OT-DSD should be integral to the differential diagnosis, underscoring the significance of heightened clinical awareness and informed decision-making.

Background: Elderly population in India is growing around 3% annually and is supposed to triple by 2050 than that at the time of 2011 census, according to a country report published by the UN Population Fund (UNFPA, 2017). A better quality of life (QOL) of the elderly has become a major public health challenges of the 21st century, so timely emphasis on maintenance of physical health and psychological issues is crucial. Therefore, the aim of the present study is to measure QOL among the elderly population and to find out the association with sociodemographic factors. Materials and Methods: This is a cross-sectional study done among the elderly population of an urban health training center. The study includes the World Health Organization Quality of Life Questionnaire-Brief version and a questionnaire for sociodemographic variables. Univariate and multivariate analyses were used to determine associations and P value. Results: The overall QOL scores ranged between 52 and 110, with a mean score of 78.59 ± 12.6. Good QOL was observed among 64.9%of the elderly, excellent was observed among 19.8%; and the rest 15.3% had fair/average, while none of the elderly had poor QOL. Determinants significantly associated with QOL with P < 0.05 are age, educational status, professional status, marital status, and behavior of children with them and the elderly with comorbidities. Conclusion: This study shows the association of multiple factors with QOL among the elderly. Factors such as age, educational status, professional status, marital status, and behavior of children with them and the elderly with comorbidities significantly affect the QOL of the elderly. Hence, strengthening the health-care system, increase in level of education, encouraging social interaction, social security systems, and better environmental infrastructure could potentially increase QOL of the elderly population.

Background: Heart rate varies during breathing and the heart rate variability (HRV) facilitates the autonomic homeostatic capacity. The maximum HRV was observed at around 10 s of prolonged respiration as per HRV biofeedback literature. However, there is a gap in understanding the variations in HRV by different respiration lengths during simple Bhramari practice. Objective: To assess the effect of various respiration lengths (8, 10, 12, and 14 s) on HRV during the simple Bhramari (humming) practice. Methodology: A total of 118 individuals (67 males, 51 females) signed up for the study based on convenience sampling at a wellness center. A randomized (simple permutation) within-subject crossover design with repeated measures was used to measure their HRV during the simple Bhramari practice. The results were analyzed with one-way ANOVA and paired samples t-test. Results: The results indicate that, unlike the 10 s of respiration during HRV biofeedback breathing, maximum HRV during humming happens between 12 and 14 s of long breathing. Conclusions: The unique findings of the study demonstrate the maximization of HRV between the respiration lengths of 12 and 14 s. Future work should explore expanding the research to a broader group of participants, including individuals with chronic conditions and other demographic variables and mantra chanting.

The use of Spinal Anaethesia in Pediatric patient is still practiced with apprehension at most of the centers. With increasing reservations of practicing general anaestheia with respect to later cognitive functions, spinal anaesthesia is definitely a better alternative. We share the management of two anticipated difficult airway cases using the neuraxial block.

Abstract Aim To study the various presentations and manifestations of complicated rhinosinusitis in COVID era- ranging from bacterial rhino sinusitis to invasive fungal rhino sinusitis. Methods Design-A retrospective observational study was carried out from March 2020 to May 2021. Setting-Tertiary care hospital subjects—all COVID-positive patients who had paranasal sinus involvement. Methods-Patients were evaluated based on their symptomatology profile. Fungal stains and culture were carried out for all. They underwent Magnetic resonance Imaging and Computed Tomography scan on case-to-case basis, apart from routine nasal endoscopy. All were managed both medically and surgically depending upon their diagnosis. The natural course including outcomes, was studied, documented and analyzed. Results Out of 496 patients presenting with sinonasal disease, 126 were COVID-positive, 16 patients had complicated rhino sinusitis, of which 4 patients had complicated rhinosinusitis with intraorbital, intracranial or combined complications. All patients were managed successfully with combined medical and surgical approach. Twelve patients had invasive mucormycosis with overall mortality rate of 37%. Conclusion Complicated sinusitis was encountered in COVID-positive patients either when they were being actively treated for COVID-19 or as part of post-COVID sequalae. Though rhino-orbito-cerebral mucormycosis constituted the major disease burden in such patients but the possibility of bacterial rhino sinusitis with or without complications must also be kept in mind while evaluating such patients. We must remember every complicated rhinosinusitis in COVID-positive patient may not be mucor and manage appropriately.

Context: Pulmonary hypertension (PH) is a condition characterized by an increase in pulmonary artery pressure, leading to morbidity and poor survival. In India, the high prevalence of certain diseases contributes to the burden of PH. To address this, this study provides epidemiological data and clinical characteristics of pulmonary artery hypertension. Materials and Methods: A cross-sectional study was conducted at a tertiary cardiac care hospital, recruiting 964 patients with severe pulmonary arterial hypertension (PAH). Patient data were obtained through a detailed history and physical examination, including 12-lead electrocardiogram, two-dimensional echocardiography, coronary angiography, right heart catheterization, and hematological and serological investigations. Results: The majority of patients (28.94%) were in the age group of 31–40 years, with a female preponderance in PAH disease. Idiopathic PAH (IPAH) was the most common type, accounting for 69.78% of all cases. The most common comorbid conditions were hypertension (48.55%) and Type-2 diabetes mellitus (44.81%). Dyspnea on exertion (98.34%) and edema of extremities (91.18%) were the most common symptoms. The mean survival rate was 50.98 months, with Type 1 PAH having the worst survival rate of 47.56 months. The statistical analysis showed a significant association between smoking and PAH. Conclusion: This study provides epidemiological data and clinical characteristics of PAH patients in India, emphasizing the need for early diagnosis, prompt management, and smoking cessation programs. The high prevalence of IPAH and female preponderance was also observed in this study. These findings can help in the development of targeted interventions and management strategies for PH patients in India.

Abstract Background Polycythemia refers to a condition of an abnormal increase in the red blood cell (RBC) mass. In men with a hematocrit > 60% or women with a hematocrit > 55%, there is 99% likelihood that the RBC mass is elevated. WHO uses a hemoglobin concentration > 16.5 g/dl in men or 16.0 g/dl in women to define an elevated RBC mass, in its criteria for the diagnosis of polycythemia vera. Congenital cardiac anomalies presenting as polycythemia are very rare in adults. Case presentation In this case report, the patient presented with non-specific complaint and had an incidental finding of secondary polycythemia, ultimately diagnosed as secondary to AORPA. Our patient, a 43-year-old male, presented to our emergency with focal onset seizures without impairment of consciousness involving left upper and lower limbs. On routine investigations, the patient was found to have grade III clubbing and hemoglobin of 19.8 g/dl with elevated Erythropoietin levels. Further workup of secondary polycythemia revealed anomalous origin of the right pulmonary artery (AORPA) from the ascending aorta with tortuous patent ductus arteriosus (PDA) and pulmonary hypertension. Secondary polycythemia, in our patient, was due to right to left shunt causing Eisenmenger phenomenon, following pulmonary hypertension, making it one of the rarest presentation in adults. Conclusion In the evaluation of secondary polycythemia, possibility of underlying asymptomatic cardiopulmonary shunt must be considered, though rare.

Background: During October 2020, Delta variant was detected for the first time in India and rampantly spread across the globe. It also led to second wave of pandemic in India which affected millions of people. However, there is limited information pertaining to the SARS-CoV-2 strain infecting the children in India. Methods: Here, we assessed the SARS-CoV-2 lineages circulating in the pediatric population of India during the second wave of the pandemic. Clinical and demographic details linked with the nasopharyngeal/oropharyngeal swabs (NPS/OPS) collected from SARS-CoV-2 cases (n = 583) aged 0–18 year and tested positive by real-time RT-PCR were retrieved from March to June 2021. Results: Symptoms were reported among 37.2% of patients and 14.8% reported to be hospitalized. The E gene CT value had significant statistical difference at the point of sample collection when compared to that observed in the sequencing laboratory. Out of these 512 sequences 372 were VOCs, 51 were VOIs. Most common lineages observed were Delta, followed by Kappa, Alpha and B.1.36, seen in 65.82%, 9.96%, 6.83% and 4.68%, respectively in the study population. Conclusion: Overall, it was observed that Delta strain was the leading cause of SARS-CoV-2 infection in Indian children during the second wave of the pandemic. We emphasize on the need of continuous genomic surveillance in SARS-CoV-2 infection even amongst children.

Abstract Background Firearm injury is a leading cause of death among children. Safer firearm storage practices are associated with a reduced risk of childhood suicide and unintentional firearm death. However, these practices are underutilized. The objective of this study was to characterize parental attitudes and beliefs related to firearm storage and identify facilitators and barriers to safer storage practices. Methods Semi-structured, qualitative interviews were conducted to identify motivations for using different storage methods among parents who kept firearms in southern Connecticut. The constant comparative method was used to code interview transcripts and derive themes directly from the data. Results Twenty participants completed the study. 60% were male, 90% were white, and all were between 32 and 53 years old. 85% of participants stored firearms locked, 60% unloaded, 65% kept ammunition locked or did not keep ammunition in their home, and 45% stored ammunition separate from firearms. The following themes were identified: (1) firearm storage must be compatible with a specific context of use; (2) some parents engage in higher-risk storage because they believe it is adequate to reduce the risk of injury; (3) firearm practices are influenced by one’s social network and lived experience; (4) parents who own firearms may be amenable to changing storage practices; and (5) parents’ conceptualization of firearm injury prevention is multimodal, involving storage, education, and legislation. Conclusions Parents who keep firearms value convenience and utility, which may be at odds with safer storage practices; however, some may be amenable to adopting safer practices. Family and peer relationships, education, and legislation represent important facilitators of storage practices. Understanding parental attitudes and beliefs on firearm storage may inform future interventions to improve storage practices.

Purpose – The manufacturing industry is one of the most disrupted systems as a result of the global spread of the Covid-19 pandemic. Manufacturing firms are looking for strategies and policies to deal with the situation while also meeting customer demands. This study aims to discuss and analyze the barriers that have impacted manufacturing systems during this period. Design/methodology/approach – The barriers and performance measures were extracted from the extant literature and further discussed with academic and industry experts. Based on the response of experts, a list of ten barriers and five performance measures were selected for further analysis. The interpretive ranking process (IRP) is applied to analyze the inter-relationship among the barriers with respect to performance variables. The cross-interaction matrices and the dominance profile are created to prioritize the barriers. Based on dominance value, an IRP-based manufacturing barrier evaluation model is developed for validation. Findings – The impact of the pandemic on the manufacturing industry is analyzed through the list of barriers and a structured ranking model is proposed. The research findings of the study indicate that “Financial constraints” is the most influential barrier to manufacturing due to the outbreak of Covid-19, followed by “Government imposed restrictions” and “Setbacks in logistics services.” Practical implications – The ranking of barriers and developed interpretive ranking process model would be helpful for practitioners and policymakers to formulate strategies for manufacturing organizations to deal with the pandemic situation. The finding can be beneficial as it promotes similar studies in other sectors. Originality/value – This study contributes to the manufacturing sector by developing a contextual relationship among the set of identified barriers against various performance measures. As per the author's knowledge, this is the first study that provides a relationship and ranking of manufacturing barriers due to the outbreak of Covid-19.

Wetlands are recognized as one of the most productive aquatic ecosystems. This high productivity supports its enormous biodiversity, aiding a scope for the small scale fisheries within it. Basically, these wetlands act as platforms for culture-based fisheries (CBF) i.e practice of stocking fish seeds and harvesting the grow out fishes at later. Often in tropical wetlands, the high nutrient load and high temperature enable the luxurious growth of macrophytes. Moreover, this macrophyte infestation is considered as a bottleneck for wetland managers. Facing a similar situation our studied Beledanga wetland is a macrophyte-infested wetland and the invasive Eichhornia crassipes is the most dominant macrophyte species. Owing to the macrophyte problem, Grass carp have been stocked in it as a biocontrol agent, as grass carp is a known biocontrol agent for the macrophyte infestation situation and simultaneously it will raise the fish production. To ensure maximum sustainable production from the wetland by harnessing with the available resources, it is necessary to acquire knowledge about the system’s ecological status and its ecological networks. Thus, the Ecopath based mass-balanced model is one of the best suitable tools to know about the ecological organization of this Beledanga wetland. Considering the available data (observational and literature data), this study has constructed a mass-balanced Ecopath model with 14 functional groups including all fish groups, birds, plankton, benthos and detritus. It has been found that the zooplankton and benthos are the most utilized group and the birds are the keystone group in this wetland system. This wetland possesses a lower transfer efficiency as well as a low Finn’s cycling index (0.224%). The system is found as an immature system with moderate ascendancy and system reserve (overhead). Moreover, concerning the ecologically sustainable production from this wetland more virtual mass-balanced models were developed (i) to evaluate the optimum grass carp stocking to manage the macrophyte population and (ii) to assess the impact of the Eichhornia on the system functioning. The results show that the system can harbour 1.5 times more grass carp biomass than the present without hampering sustainability. Concerning the impact of Eichhornia, it has been noticed that this macrophyte affects the maturity and transfer process of the system. Moreover, its huge biomass only accumulates more detritus in the ecosystem.

Natural killer (NK) cells lyse virus-infected cells and transformed cells through polarized delivery of lytic effector molecules into target cells. We have shown that NK cells lyse Plasmodium falciparum-infected red blood cells (iRBC) via antibody-dependent cellular cytotoxicity (ADCC). A high frequency of adaptive NK cells, with elevated intrinsic ADCC activity, in people chronically exposed to malaria transmission is associated with reduced parasitemia and resistance to disease. How NK cells bind to iRBC and the outcome of iRBC lysis by NK cells has not been investigated. We applied gene ablation in inducible erythrocyte precursors and antibody-blocking experiments with iRBC to demonstrate a central role of CD58 and ICAM-4 as ligands for adhesion by NK cells via CD2 and integrin αMβ2, respectively. Adhesion was dependent on opsonization of iRBC by IgG. Live imaging and quantitative flow cytometry of NK-mediated ADCC toward iRBC revealed that damage to the iRBC plasma membrane preceded damage to P. falciparum within parasitophorous vacuoles (PV). PV were identified and tracked with a P.falciparum strain that expresses the PV membrane-associated protein EXP2 tagged with GFP. After NK-mediated ADCC, PV were either found inside iRBC ghosts or released intact and devoid of RBC plasma membrane. Electron microscopy images of ADCC cultures revealed tight NK-iRBC synapses and free vesicles similar in size to GFP+ PV isolated from iRBC lysates by cell sorting. The titer of IgG in plasma of malaria-exposed individuals that bound PV was two orders of magnitude higher than IgG that bound iRBC. This immune IgG stimulated efficient phagocytosis of PV by primary monocytes. The selective NK-mediated damage to iRBC, resulting in release of PV, and subsequent phagocytosis of PV by monocytes may combine for efficient killing and removal of intra-erythrocytic P.falciparum parasite. This mechanism may mitigate the inflammation and malaria symptoms during blood-stage P. falciparum infection.

Introduction Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a clinico‐radiographical syndrome characterized by severe thunderclap headache and reversible multifocal arterial vasoconstriction1. RCVS can be spontaneous or related to a trigger such as vasoactive medication/supplements. There is no previous data on the association of weight loss patch formulation in the genesis of unexplained RCVS. Methods A woman in her 40s presented with five days of recurrent acute onset severe right frontal headaches after starting Thrive weight loss patch supplementation. Head CT showed right frontal lobe hemorrhage with bilateral SAHs (Figure1). Brain MRI redemonstrated hemorrhages, numerous scattered foci of restricted diffusion, and a large area of restricted diffusion in the left insular cortex (Figure 2). Cerebral angiogram showed diffuse multifocal narrowing with a ‘beads‐on‐a‐string’ appearance of the cerebral vasculature and no aneurysms (Figure 3). Thrive patch contains undisclosed amounts of sympathomimetics and vasoactive compounds. Given the history, clinical symptoms of recurrent thunderclap headaches, and angiographic findings, the diagnosis of RCVS was made. Brain MRA 3 months after discharge showed no areas of cerebrovascular focal stenosis (Figure 4). At 4 month follow up, she reported 90% improvement of her symptoms. Results We report a temporal relationship between RCVS in a woman in her 40s and usage of a Thrive weight loss patch, which contains green tea extract, L‐arginine, 5‐hydroxytryptophan (5‐HTP), and Yerba Mate. We believe this report represents the first case of RCVS triggered by a weight loss patch. Multiple compounds within the Thrive patch have vasoactive properties that may contribute to RCVS genesis. Epigallocatechin (component of green tea extract) and 5‐HTP are metabolic compounds with potent vasoactive properties. They are components of weight loss and SSRI/SNRI medications respectively. Numerous studies have documented a temporal relationship between their use and subsequent development of RCVS2,3. Resolution of RCVS is reported after their discontinuation. Only one other case in our literature review investigated a patch modality in a temporal relationship with RCVS. It reported development and resolution of RCVS six days after nicotine patch use and discontinuation4. While Thrive patch does not contain nicotine, this case provides a further avenue for exploration as to whether pharmacokinetics of a patch modality influences a patient’s presentation with RCVS, as all prior reports document oral ingestion of substances. Conclusion Clinicians should be aware of the role of weight loss patches in RCVS, and their use should be assessed in large RCVS cohorts to clarify the association described in this report.