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Objectives: To compare the depth and duration of anesthesia experienced by the patient between lignocaine and articaine anesthetic solutions and to evaluate pain perception and intraoperative anxiety by computer-controlled injection while administering these anesthetic solutions. Materials and Methods: The clinical trial was designed as a randomized, single-center, double-blinded, parallel arm, and comparative study. Examiner and study patients were blinded to treatment assignment during the study. Patients were divided into three groups based on treatment to be performed (Root Planing 30, Curettage 30, and Surgery 20) and were anesthetized with articaine in one quadrant and lignocaine in another quadrant by computer-controlled anesthetic device (WAND®). The duration of anesthesia was self-reported by the patients and was calculated by paired t-test. The pain and anxiety scores were calculated on Wong Baker's Facial Pain/Anxiety Scale' by Chi-square test. Results: Articaine had longer duration of anesthesia than lignocaine in all the three groups (P < 0.000). Articaine showed significantly lesser pain scores than lignocaine in Root Planing Group (P < 0.000). There was no significant difference in anxiety scores between different groups. Conclusion: Articaine has longer duration of anesthesia. Articaine administration was less painful than lignocaine administration.

PURPOSE: The purpose is to study the ocular surface changes among patients with diabetes mellitus (DM) and to correlate them with tear film markers such as insulin-like growth factor (IGF)-1, interleukin (IL)-1β, and tumor necrosis factor (TNF)-α levels. MATERIALS AND METHODS: The study was carried out on diabetic patients (>5 years' duration) and healthy age- and gender-matched controls with 21 individuals in each group. Schirmer's test for basal and reflex tear secretion, tear film breakup time (TBUT) for tear stability, ocular staining score (OSS) for dryness severity, ocular surface disease index (OSDI) for symptomatic assessment of dryness and conjunctival impression cytology (IC) for epithelial cell integrity, keratinization, squamous metaplasia, and goblet cell density was studied. Thirty microliters of tears were collected to test IGF-1, IL-1β, and TNF-α levels. RESULTS: Patients with DM showed significantly low Schirmer's, TBUT, and OSS values than controls. OSDI score showed moderate-severe dryness in patients with DM and only mild symptoms among controls. An abnormal IC score was seen among cases and controls. The level of TNF-α was significantly increased in patients with DM and positively correlated with Schirmer and TBUT values (P < 0.05). CONCLUSION: Dry eye is more prevalent in patients with DM compared to controls as evidenced by poor OSDI score, Schirmer, TBUT, and OSS. TNF-α in the tears of patients with DM is a useful marker that showed a good correlation with Schirmer, TBUT, and dry eye symptoms. IC could not conclusively differentiate the dry eye status in patients with DM from controls.

Background: Dental plaque, a microbial biofilm, is the primary etiological factor leading to the initiation of gingivitis and dental caries. It is therefore important to prevent it by taking effective plaque control measures. This research aimed at comparing the anti-plaque and anti-gingivitis effects of green tea (GT), GT plus ginger (GT + G), and chlorhexidine mouthwash (CHX) in children. Materials and Methods: This was a randomized clinical trial, with a sample size of 60 children between the age group of 10–14 years with plaque and gingivitis. They were randomly allocated in three different groups, depending upon the mouthwash used: Group A (GT mouthwash), Group B (GT plus ginger mouthwash), and Group C (CHX mouthwash). Plaque index and gingival index were recorded at baseline, then at interval of 15 days and 30 days after using mouthwash. Results: The mean gingival score and plaque showed a significant reduction from the baseline among all the three groups when compared with subsequent recall visits (15 days after using mouth-rinse and 30 days after using mouthwash) with P < 0.05. Conclusion: It can be concluded that the results of all three groups are comparable and hence herbal mouthwash can be used effectively as an alternative to CHX and as an adjunct to mechanical plaque control.

Aim: This study aims to find the association of neutrophil-lymphocyte ratio (N-L ratio) of COVID-19 patients admitted in an Indian setting with clinical profile and disease outcomes. Background: The COVID-19 pandemic hit in early 2020 with the presentation of varied severity of acute respiratory illness. This study tries to use N-L ratio as a predictor of adverse outcome. Methodology: The prospective single-center study considered adults patients of both the gender, diagnosed with COVID-19 infection by reverse transcription-polymerase chain reaction technique. Necessary demographic and clinical data were collected, and selected subjects were followed up until discharge or death. Individuals were classified as those who survived and those who succumbed to death. t-test was used for comparing continuous variables and Chi-square test for categorical data for comparing different parameters between the groups. Results: The study included 1977 patients with a male:female ratio of 1:0.62. Fever, dyspnea, and cough were noted as the major symptoms prevalent among patients who succumbed to death when compared to those who survived (P < 0.00001). Statistically significant variables noted between the groups were age, total leukocytes count (TLC), neutrophil, lymphocytes, all the comorbidity variables, and the asymptomatic status. Variables identified as significant predictors of disease outcomes were TLC, neutrophils, lymphocytes, and N-L ratio. Most of the subjects belonging to the mortality group required oxygen and other intensive care unit facilities when compared to the survival group (P < 0.00001). Conclusion: TLC, neutrophils, lymphocytes, and N-L ratio are noted as significant predictors of COVID-19 outcome. The mean days of viral clearance noted in COVID subjects is around 8.98 ± 3.54 days.

Background: It has been over a year since the declaration of novel coronavirus disease (COVID-19) as pandemic by World Health Organization on March 11, 2020. Although mortality in India is low, as compared to western countries, the steady increase in the number of cases is still a worrying sign. The objectives of this study were to identify and quantify the association between sociodemographic and clinical characteristics with mortality among patients, suffering from COVID-19 at a tertiary care hospital in Udaipur, Rajasthan. Material and Methods: This retrospective observational study involved 824 patients hospitalized for COVID 19 at a tertiary hospital in Udaipur, who were discharged or had died. Electronic health records of the patients were accessed to retrieve the sociodemographic information (age, gender, residence, religion, socioeconomic status), history of exposure, clinical characteristics on admission, comorbidities, and outcomes (recovery or death). The Cox regression model was used to calculate associations between mortality and baseline characteristics in the form of hazard ratios (HRs). Results: Mortality in this study was found to be 5.82%. The mean age of the patients was 48.14 ± 16.2 years. The median time from time of admission to discharge was 8 days (interquartile range (IQR) 5–11), whereas the median time to death was 5 days (IQR 4–10). The variables found to be associated with higher mortality were age (HR 1.17; 95% confidence interval (CI) 1.15–1.24), residing in urban area (HR 1.29; 95% CI 1.17–2.15), diabetes mellitus (HR 1.3; CI 1.02–5.57), and patients having both diabetes and hypertension (HR 2.4; CI 1.69–3.14). Conclusion: Sociodemographic variables and comorbidities impact the mortality among COVID 19 patients. The variables most clearly associated with a greater hazard of death were older age, urban area, diabetes, and having both diabetes and hypertension.

Age is one of the strongest risk factors for severe illness from COVID-19. By integrating human lung transcriptomes with experimental data on SARS-CoV-2, the authors pinpoint specific age-associated factors that could contribute to the heightened severity of COVID-19 in older populations.

Mutations in the MLL4 gene can cause Kabuki syndrome, whose underlying molecular mechanisms are unclear. Here, the authors show that Mll4 epigenetically regulates the transcriptional program leading to the formation of GHRH-neurons in the developing mouse hypothalamus.

Background: Epilepsy is the second most common neurological disorder, and it may have a significant effect on sexual functions in epileptic patients. Materials and Methods: Sexual dysfunctions were assessed in 146 male patients suffering from generalized tonic-clonic seizure (GTCS) with a seizure-free interval of at least 1 year. Out of 146 patients enrolled, 46 patients had a psychiatric impairment and were excluded from the study, after applying the General Health questionnaire12 (GHQ12) scale and detailed psychiatric evaluation. The remaining patients were evaluated for the presence of sexual dysfunction by applying Arizona Sexual Experience scale (ASEX). Sixty-six patients scoring more than 19 as a cutoff score on the ASEX scale were further interviewed by a psychiatrist, and a diagnosis of sexual dysfunction was made as per ICD 10 Diagnostic criteria. Results: Sexual dysfunction was diagnosed in 66% (n = 66) of the patients. Erectile dysfunction was the most common sexual disorder diagnosed in 36% of the patients (n = 36) followed by premature ejaculation in 26% (n = 26) and decreased libido (hypoactive sexual desire) seen in 4% (n = 4) of the patients. In patients with sexual dysfunction, a significant association was observed with the duration of epilepsy and type of therapy (mono/polytherapy) (P value < 0.05). Erectile dysfunction and hypoactive desire were more common in patients taking polytherapy, whereas premature ejaculation was more common in patients on monotherapy. Conclusion: Significant impairment of sexual functions was observed in male epileptics with GTCS. A high index of suspicion should be kept in mind by the practicing clinician on diagnosing and treating sexual dysfunction in them.

Background and Objectives: The COVID-19 pandemic has a major bearing on mental health. This study was aimed to study the level of stress among the medical and dental students amidst this crisis. Materials and Methods: A questionnaire was mailed to students pursuing medical and dental undergraduate and postgraduate degrees across India. It included sociodemographics, psychological status, academic activities, online classes, information about COVID-19, and the Perceived Stress Scale (PSS). Results: The overall response rate was 86%. 9.8% of students had low, 74.4% had moderate, and 15.8% had high stress according to PSS. The major worry was uncertain future (41.8%); academic inadequacies/delays (27.78%), apprehension of self-health (26.78%), and family's health (21.13%). 52.7% of participants experienced a lack of motivation; 74% were frustrated/irritable and 46.3% experienced loneliness. Their access to information about COVID-19 was from family and friends (71.42%); news (64.48%), social media sites (62.79%), Internet (36.87%), and newspapers (34.71%). Females were more stressed (P value = 0.000) with ages 21–25 years (P value = 0.000). The students who were motivated, frustrated/irritable, or lonely had high stress (P value

Background and objectives: Epidural Volume Extension (EVE) involves instillation of normal saline into the epidural space soon after an intrathecal injection, with the aim to augment the sensory block height. Its clinical relevance lies in the possibility of using reduced intrathecal dose and yet achieving the desired sensory block level. Intrathecal dose is a known determinant of the level of sensory block. Whether EVE is dependent on intrathecal dose is not known. Methods: We conducted a randomized, controlled, double-blind study to compare the maximum sensory level (Smax) achieved with or without application of EVE to two different reduced intrathecal doses. Eighty four adult male patients of ASA status I or II with body weight between 50–70 kg and height in the range of 150–180 cm, scheduled for orthopedic lower limb surgery using combined spinal epidural anesthesia were randomized to receive, either intrathecal dose (5 or 8 mg) with or without EVE, in accordance to group allocation. Results: Smax was lowered by application of EVE to 5 mg intrathecal bupivacaine (T8.9 ± 4.3 vs. T6.4 ± 1.9 with and without EVE respectively; p = 0.030). Smax was similar when EVE was applied to 8 mg intrathecal bupivacaine than without it (T5.8 ± 1.8 vs. T6.4 ± 2.2 respectively; p = 0.324). Conclusion: EVE should not be applied to 5 mg plain bupivacaine during a combined spinal epidural block in patients undergoing lower limb orthopedic surgery as it may result in a decrease in the maximum sensory level.

This case report is about a 55-year-old female who presented with wandering unilateral edema in the sequence of the left breast (for 7 days) followed by left upper limb (for 1 month), followed by the left nape of the neck (for 1 day), followed by left scalp (for 1 day), followed by left-sided face (for 3 days), followed by right-sided face (for 2 days). Edema progressed from one site to another site in the above sequence with the overlapping period of only 12–24 h and later subsided completely from its previous site. In the patient's language edema was moving from site to site like a slow wave moving forward. The patient took multiple consultations but could not get any relief. The patient was evaluated according. Serum total eosinophil count found 3100/cumm (30.1% of total leucocyte count) and diagnosed with angioedema. The patient was completely recovered by steroid and antihistaminic. To the best of our knowledge, this is the first case reporting wandering unilateral edema like a wave.

Patients presenting with pain in lower back and paresthesia in lower limbs may have tethered cord causing the symptomology. Tethered cord may be associated with intradural tumors causing symptoms due to progressive increase in size. Association of tethered cord with single intradural tumor is a common occurrence but, to date, only one case has been reported of tethered cord associated with intradural lipoma and epidermoid cyst. The authors would like to present a similar case in a middle-aged patient.

The human urinary microbiome is thought to affect the development and progression of urinary tract infections (UTI), particularly recurrent UTIs in aging populations of women. To understand the possible interactions of urinary pathogens with commensal bacteria inhabiting the aging bladder, we conducted an initial functional assessment of a representative set of urinary lactobacilli that dominate this niche in postmenopausal women. We created a repository of urinary bladder bacteria isolated via Enhanced Quantitative Urinary Culture (EQUC) from healthy postmenopausal women, as well as those with a culture-proven recurrent UTI (rUTI) diagnosis. This repository contains lactobacilli strains from eight different species. As many other lactobacilli are known to inhibit human pathogens, we hypothesized that some urinary lactobacilli will have similar abilities to inhibit the growth of typical uropathogens and thus, provide a link between the urinary microbiome and the predisposition to the rUTI. Therefore, we screened the urinary lactobacilli in our repository for their ability to inhibit model uropathogens in vitro. We observed that many urinary isolates strongly inhibit model strains of gram-negative Escherichia coli and Klebsiella pneumoniae but demonstrate less inhibition of gram-positive Enterococcus faecalis. The observed inhibition affected model strains of uropathogens as well as clinical and multidrug-resistant isolates of those species. Our preliminary analysis of inhibition modes suggests a combination of pH-dependent and cell-dependent inhibition. Overall, inhibition strongly varies among species and strains of urinary lactobacilli. While the strength of the inhibition is not predictive of health outcomes in this limited repository, there is a high level of species and strain diversity that warrants future detailed investigations.

Objectives To describe the outcomes of pregnancies in antiphospholipid antibody (aPL)-positive patients since the inception of the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking Registry.Methods We identified persistently aPL-positive patients recorded as ‘pregnant’ during prospective follow-up, and defined ‘aPL-related outcome’ as a composite of: (1) Preterm live delivery (PTLD) at or before 37th week due to pre-eclampsia (PEC), eclampsia, small-for-gestational age (SGA) and/or placental insufficiency (PI); or (2) Otherwise unexplained fetal death after the 10th week of gestation. The primary objective was to describe the characteristics of patients with and without aPL-related composite outcomes based on their first observed pregnancies following registry recruitment.Results Of the 55 first pregnancies observed after registry recruitment among nulliparous and multiparous participants, 15 (27%) resulted in early pregnancy loss

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.

Macrophages in the vascular wall ingest and clear lipids, but abundant lipid accumulation leads to foam cell formation and atherosclerosis, a pathological condition often characterized by tissue stiffening. While the role of biochemical stimuli in the modulation of macrophage function is well studied, the role of biophysical cues and the molecules involved in mechanosensation are less well understood. Here, we use genetic and pharmacological tools to show extracellular oxidized low-density lipoproteins (oxLDLs) stimulate Ca2+ signaling through activation of the mechanically gated ion channel Piezo1. Moreover, macrophage Piezo1 expression is critical in the transduction of environmental stiffness and channel deletion suppresses, whereas a gain-of-function mutation exacerbates oxLDL uptake. Additionally, we find that depletion of myeloid Piezo1 protects from atherosclerotic plaque formation in vivo. Together, our study highlights an important role for Piezo1 and its respective mutations in macrophage mechanosensing, lipid uptake, and cardiovascular disease.

Coronavirus disease (COVID-19) has showed high transmission across the continents due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) with total infected cases of around ~ 44 million people. This communicable virus that initiated from the Wuhan city of China in the month of December 2020 has now spread to 189 different countries with 1.1 million fatalities worldwide (till 28 Oct, 2020). The World Health Organization (WHO) declared this outbreak as Public Health Emergency of International Concern in January, 2020. The infection spreads mainly due to contact with infected droplets or fomites, highlighting flu like symptoms initially, which may further progress into severe pneumonia and respiratory failure, often observed in elderly patients with prehistory of other diseases. The diagnosis is based on detection of viral antigen, human antibody and viral gene (RT-PCR). Further, various other diagnostic tools including X-ray, CT-scan are used for imaging purpose, recently artificial intelligence based imaging (contactless scanning) gained popularity. Generally testing of existing drugs (repurposing) and development of new molecules are the main strategies adopted by researchers. However, as per initial findings, various drugs, monoclonal antibody and plasma therapy were found to show effectiveness against COVID-19. Further, many vaccine candidates have entered or will soon enter phase III clinical testing. This disease has further challenged the global economy. Thus, this review uniquely compares the strategies adopted by developed and developing countries worldwide including protective measures like lockdown, continuous testing, utilizing latest tools (artificial intelligence) in curbing this infection spread.

West Nile virus (WNV) is a single-stranded RNA arbovirus of Flavivirus genus that is endemic to the United States and known to cause neuroinvasive disease. Diagnosis is confirmed by the presence of WNV-specific IgM antibodies within serum or cerebrospinal fluid (CSF). Radiologically, it presents as hyperintense T2 signal within deep brain structures (ie, thalami and mid-brain) with or without cerebral peduncle and substantia nigra involvement. On diffusion-weighted imaging, restricted diffusion is reported in basal ganglia and disseminated throughout the white matter. In this report, we describe the imaging findings for 2 cases of WNV from our institution; a 56-year-old female and a 34-year-old female. Increased vigilance for WNV is warranted, particularly in immunosuppressed patients presenting with a clinical picture of viral meningoencephalitis despite initial negative magnetic resonance imaging or CSF analysis. A high suspicion for WNV disease should prompt repeat imaging or laboratory workup.

Background: There are various approaches to perform an ultrasound guided Quadratus Lumborum Block (QLB). The lateral, posterior, anterior or trans muscular and subcostal paramedian are the various approaches described for performing a QLB. Each of these blocks are aimed to achieve a maximum spread with high volume and low concentration of local anesthetics. Case report: In this novel approach a curvilinear ultrasound probe was used with the patient lying in supine position. The probe was placed longitudinally in the mid axillary line to visualize Quadratus Lumborum Muscle (QLM) in the coronal plane. The needle was then introduced from cranial to caudal direction and catheters were inserted in the Anterior Thoracolumbar Fascia (ATLF) up to a distance of 4−5 cm in 24 patients for an anterior approach to acetabulum fractures. The needle tip and the Local Anesthetic (LA) spread was visible in all patients. All patients except 4 had excellent perioperative pain relief considering stable hemodynamics and VAS 2−3/10 for the first 48 hours. All patients received 1 g intravenous paracetamol each 8 hours. VAS in postoperative period was 2−3/10, in 20/24 patients. In the postoperative period, 4 patients complained of persistent pain, requiring intravenous fentanyl boluses and multimodal analgesia. Mean VAS score was 2.87 from 0−12 hours, 3.14 from 12−24 hours and 3.35 from 24−48 hours. There were no block-related complications in any patient. Conclusion: The supine midaxillary coronal approach to anterior QLB is an effective and feasible approach to QLB which can be performed in supine position. Resumo: Justificativa: Existem várias abordagens para a realização do Bloqueio do Quadrado Lombar (BQL) guiado por ultrassom. Diversas abordagens são descritas para a realização do BQL: paramediana lateral, posterior, anterior ou transmuscular e subcostal, todas com o objetivo de obter a máxima dispersão da solução injetada, usando-se alto volume e baixa concentração de anestésico local. Relato de caso: Nesta nova abordagem, a sonda de ultrassom curvilínea foi usada com o paciente em decúbito dorsal. A sonda foi posicionada longitudinalmente na linha axilar média para visualizar o Músculo Quadrado Lombar (MQL) no plano coronal. A agulha foi introduzida na direção cranial-caudal, e foram inseridos cateteres na Fáscia Toracolombar Anterior (FTLA) até uma distância de 4−5 cm, em 24 pacientes a serem submetidos à correção de fratura do acetábulo pela via anterior. O bisel da agulha e a dispersão do Anestésico Local (AL) eram visíveis em todos os pacientes. Os 24 pacientes, com exceção de quatro, apresentaram excelente analgesia perioperatória, baseando-se na estabilidade hemodinâmica e nos escores EVA de 2−3/10 nas primeiras 48 horas. Todos os pacientes receberam 1 g de paracetamol intravenoso a cada 8 horas. O escore EVA no período pós-operatório foi de 2−3/10, em 20 dos 24 pacientes. No período pós-operatório, quatro pacientes apresentaram queixa de dor persistente, necessitando de bolus de fentanil por via intravenosa e analgesia multimodal. O escore médio da EVA no pós-operatório foi 2,87 entre 0−12 horas; 3,14 entre 12−24 horas e 3,35 entre 24−48 horas pós-operatórias. Não houve complicações relacionadas ao bloqueio em nenhum paciente. Conclusão: A abordagem supina axilar média coronal para BQL anterior é eficaz e viável para BQL, e pode ser realizada com os pacientes em decúbito dorsal.

In this paper, we define weak θm− contraction mappings and give a new class of Picard operators for such class of mappings on a complete metric space. Also, we obtain some new results on the existence and uniqueness of attractor for a weak θm− iterated multifunction system. Moreover, we introduce (α, β, θm)− contractions using cyclic (α, β)− admissible mappings and obtain some results for such class of mappings without the continuity of the operator. We also provide an illustrative example to support the concepts and results proved herein.

Idiopathic nephrotic syndrome (NS) is one of the most common kidney diseases of childhood. In this study, we assessed urine Vitamin-D binding protein (VDBP) and neutrophil gelatinase-associated lipocalin (NGAL) levels as a predictor of steroid responsiveness in idiopathic NS. This cross-sectional study included children with steroid-resistant NS (SRNS) (n = 28), steroid-sensitive NS (SSNS) (n = 28), and healthy controls (n = 28). Urine levels of VDBP and NGAL were measured using a commercially available ELISA kit and normalized to urine creatinine (Cr). Urine microalbumin (MALB) was measured using nephelometer, and MALB/Cr was calculated. Urine Vitamin-D binding protein (uVDBP) and urine neutrophil gelatinase-associated lipocalin (uNGAL) levels were statistically significantly higher (P < 0.001) in patients with SRNS (701.12 ± 371.64 ng/mL and 28.42 ± 15.40 ng/mL, respectively) than in patients with SSNS (252.87 ± 66.34 ng/mL and 8.86 ± 5.54 ng/mL, respectively) and normal controls (34.74 ± 14.10 ng/mL and 6.79 ± 1.32 ng/mL, respectively). Estimated glomerular filtration rate shows a significant negative correlation with MALB/Cr, uVDBP, and uNGAL. However, uVDBP and uNGAL showed a much higher discriminatory ability for differentiating SRNS from MALB/Cr. uVDBP and uNGAL at the cutoff value of 303.81 and 13.1 ng/mL, respectively, yielded the optimal sensitivity (82% and 86%) and specificity (78% and 89%) to distinguish SRNS from SSNS. Urine levels of VDBP and NGAL can predict steroid responsiveness in patients with idiopathic NS.

Aim: To assess the gender-based parities and disparities at work place experienced by female dentists of Vadodara, India. Materials and Methods: In-depth face-to-face qualitative semi-structured interviews in English were conducted among 12 female dentists of Vadodara. Female dentists working with one/more male colleague or auxiliary were selected through purposive sampling. Interviews were conducted as per Kvale's principles and recorded using a digital voice recorder. Transcribed data was analyzed using Giorgi's phenomenological analysis. Results: The recurring themes identified were: (a) Striking work–family balance (b) Dependence on male authority for instating work discipline (c) Male dentists' hostility to “woman in power” concept (d) Male dentists' superiority in technical skills (e) privileges for women dentists. Conclusions: There is a need to improve the work environment of women dentists. Social support, sensitivity among male colleagues, and generous institutional policies will enable increased contribution from women to the profession.

Pott's disease is the most common granulomatous spine infection caused by tubercle bacilli and is a common site of osseous tuberculosis, accounting for 50–60% of cases. The delay in establishing diagnosis and management results in complications such as spinal cord compression and spinal deformity. The aim of this narrative review is to discuss the perioperative concerns in patients for spine surgery. The literature source for this review was obtained via PubMed, Medline, Google Scholar, Cochrane database of systematic reviews, and textbooks until December 2019. On the literature search, we could not retrieve any review article specifically discussing the perioperative concerns of spinal tuberculosis. Therefore, the aim of the present narrative review is to discuss the perioperative concerns of patients for spine surgery along with the specific concerns related to spinal tuberculosis.

Integrated Gasification Combined Cycle (IGCC) is a promising technology for effective control of green-house gas emission through CO2 capture pre-combustion process. This article describes the relative advantage of a novel energy efficient process configuration for desorption and compression of CO2 (previously absorbed by physical solvent Di-Methyl-Ether of poly-Ethylene-Glycol (DMEPEG)). DMEPEG is a blend of several polymeric chain length (n = 3 to 9) of CH3-O-[C2H4O]n-CH3 which is a polar organic liquid solvent.Desorption of dissolved CO2 from solvent at highest possible pressure is helpful to minimize the power consumption for subsequent compression of CO2. This article quantifies the effect of heating the DMEPEG solvent to 120 °C for CO2 desorption (compared to CO2 desorption at 35 °C) on the regeneration (desorption) of CO2 at various pressure stages.CO2 desorption performance of DMEPEG solvent is assessed using ProTreat® simulation software. Depressurization of 4.455 kmol/s DMEPEG solvent (with dissolved gas) beginning at 120 °C results in desorption of 2.077 kmol/s CO2 capture (91.4 kg/s) out of initially dissolved 2.194 kmol/s CO2 (94.66%). Solvent heating upto 120 °C (instead of 35 °C) can compress the 97.1 kg/s CO2 from 3 barA to 34.7 barA consuming 6 MW (instead of 8.15 MW) power for CO2 compression, thus resulting in 15% saving for CO2 compression upto 120 barA consuming 14.1 MW power consumption.

Acid gas removal from syngas is an important process step upstream of its further processing for combustion or further processing of syngas. Integrated Gasification Combined Cycle (IGCC) power plant or chemical production (such as urea or petrochemicals, etc.). The process of absorbing the H2S in Di-Methyl-Ether of poly-Ethylene-Glycol (DMEPEG) solvent and the process of enriching the DMEPEG solvent with dissolved H2S has been described in literature (including the publications by the Author). This publication describe the process of stripping out the dissolved H2S from the DMEPEG solvent using a thermal stripper designed using the rate based mass transfer simulations carried out using ProTreat software.Basic process design and equipment size is described in this publication. 20 MW heat input is needed to strip out 19.13 kmol/s H2S from the 1.136 kmol/s DMEPEG solvent thus resulting in overall heat consumption of 30.7 GJ/Ton H2S capture.Limitations of this process design are also described. Various options of packed tower configuration have been suggested for tower internals resulting in similar performance.

Gagging is a common problem encountered in clinical prosthodontic practice. In many cases gagging is of psychologic nature and should be treated before denture procedures are completed, so that the patient will be comfortable with well-constructed prostheses. Effective management of gag reflex includes a wide array of techniques ranging from use of common salt on the tip of tongue, acupressure, distraction, relaxation, pharmacotherapy and desensitization. This case report discusses how a holistic approach for gagging prevention and use of training denture base can facilitate denture wearing for a known potential gagger and also highlights how palateless denture helped overcome gagging in a patient with thick ropy saliva in another case.

Introduction: A healthy society is indicated by not merely the absence of disease or low mortality/morbidity status but rather the different dimensions of health of the population of a society. The sound maternal health status is always the intention of any nation as it reflects many dimensions of the society. However, in India, there is a huge gap in the services offered and utilised at rural and urban areas. The considerable efforts by government by which the foundation of healthcare sector of the nation be made strong cannot deliver the fruitful results. The present study aims to assess the utilisation of maternal health services and the factors associated with it.Methodology: The present study was undertaken in Waghodia taluka of Vadodara district. The Waghodia taluka has four primary health centres (PHCs). The duration of the study was 9 months. The proportionate stratified sampling was used to assess the utilisation of maternal health services in four PHCs. The sample of the study was 1333. The study design was a prospective cohort study as the sample were followed up to determine their category of utilisation of antenatal care services. The data were analysed using SPSS version 21. Results: Nearly 65.3% of the pregnant women have utilised the antenatal services in an ideal manner, 28.5% in the moderate utilisation category and 6.2% in the undesirable category. There is an association between the predisposing factors such as age of respondent, education of respondent and her husband, occupation of respondent and her husband and level of autonomy of the respondent. The need factors are also statistically significantly associated with the category of utilisation of antenatal services. The majority of the pregnant women with hypertension and diabetes are utilising the services in an ideal manner. Conclusion: The majority of the pregnant women in rural area of Vadodara are utilising the antenatal services in an ideal manner, but the focus should be on the pregnant women who are unable to utilise these services properly. The proper utilisation of antenatal services by the pregnant women would help in the sustainable development of our country.

Background: Parkinson's disease (PD) is the second-most common neurodegenerative disorder known primarily by its motor symptomatology. These motor manifestations are also hypothesised to affect the respiratory muscular function of PD patients contributing to restrictive pattern of ventilatory dysfunction. Previous reports attempting to detect these abnormalities through spirometric assessments have been inconclusive. Attempts at reversal of the restrictive abnormalities by levodopa therapy too, have yielded conflicting results. Objectives: This study aims to classify spirometric abnormalities in asymptomatic PD patients after levopopa withdrawal and document changes after levodopa replacement. Methods: Thirty-six non-smoker PD patients without pre-existing respiratory abnormalities were enrolled. Their standard spirometric values- FEV1, FVC and FEV1/FVC, were noted before and after their morning levodopa dose. Results: Nineteen patients had abnormal PFT values at baseline - 14 restrictive and 5 obstructive defects. Fourteen patients showed improvement in their pulmonary performances after dopamine administration with 6 showing complete reversibility. Statistically significant improvement in the post-levodopa FVC values was seen in patients with restrictive disorder (P value=0.04) but not for obstructive disorders. Discussions: This pilot study characterised that 39% of PD patients had restrictive ventilatory defects prior to morning dopamine administration. Of these, 40% showed improvement after levodopa administration. Conclusion: Restrictive defects are common in PD patients which are evident on routine spirometric screening. These defects are reversible on levodopa administration.

Background and Aims: Various methods have been used to check vocal cord movements as a routine before awakening the patient at the end of thyroidectomy to rule out recurrent laryngeal nerve (RLN) palsy; out of which, fibreoptic-assisted visualisation via laryngeal mask airway (LMA) being the most desirable. Methods: Thirty patients of either sex, aged 18-65 years, American Society of Anaesthesiologists (ASA) grade I/II, scheduled for thyroidectomy under general anaesthesia (GA) were included and were randomised to receive either fibreoptic assisted (FB) or LMA CTrach-assisted (CT) visualisation of laryngeal structures at the end of thyroidectomy. The primary outcome was grade of view of laryngeal structures and secondary outcomes were time taken to achieve optimal view of laryngeal structures, ease of visualisation, hemodynamic parameters, and complications. Results: In the fibreoptic group, we obtained comparable optimal laryngeal view i.e., grade 1 and 2 in all (100%) patients in comparison to 14 (93.33%) in LMA CTrach group. The “time taken to achieve the optimal view” was significantly lower in the CTrach group when compared to Fibreoptic group (220.67 ± 95.98 vis-a-vis 136.67 ± 68.98). The ease of visualisation of laryngeal structures was comparable (P = 0.713) and the baseline haemodynamic parameters were comparable between the 2 groups and at various designated intervals. In total, 6.66% and 26.66% patients in group FB and CT group, respectively, required manoeuvres. However, difference was statistically significant (P < 0.05). Conclusion: Both Fibreoptic-assisted and LMA CTrach-assisted visualization of laryngeal structures in thyroidectomy are equally efficacious in terms of the optimal laryngeal view obtained and ease of visualisation. However, the time taken to achieve optimal laryngeal view was lesser with LMA CTrach.

Summary: With new emerging SARS-CoV-2 strains and their increased pathogenicity, diagnosis has become more challenging. Molecular diagnosis often involves the use of nasopharyngeal swabs and subsequent real-time PCR-based tests. Although this test is the gold standard, it has several limitations; therefore, more complementary assays are required. This protocol describes how to identify SARS-CoV-2 protein from patients' nasopharyngeal swab samples. We first introduce the approach of label-free quantitative proteomics. We then detail target verification by triple quadrupole mass spectrometry (MS)-based targeted proteomics.For complete details on the use and execution of this profile, please refer to Bankar et al. (2021).

The new severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) is the etiological agent of Coronavirus disease 2019 (COVID-19), which becomes an eventual pandemic outbreak. Lack of proper therapeutic management has accelerated the researchers to repurpose existing drugs with known preclinical and toxicity profiles, which can easily enter Phase 3 or 4 or can be used directly in clinical settings. Vitamins are necessary nutrients for cell growth, function, and development. Furthermore, they play an important role in pathogen defence via cell-mediated responses and boost immunity. Using a computational approach, we intend to identify the probable inhibitory effect of all vitamins on the drug targets of COVID-19. The computational analysis demonstrated that vitamin B12 resulted in depicting suitable significant binding with furin, RNA dependent RNA polymerase (RdRp), Main proteases (Mpro), ORF3a and ORF7a and Vitamin D3 with spike protein and vitamin B9 with non structural protein 3 (NSP3). A detailed examination of vitamins suggests that vitamin B12 may be the component that reduces virulence by blocking furin which is responsible for entry of virus in the host cell. Details from the Molecular Dynamics (MD) simulation study aided in determining vitamin B12 as a possible furin inhibitor.

Accumulating evidence suggests the critical role of miR-590–5p in various aspects of cellular homeostasis, including cancer. Furthermore, we and others have recently demonstrated that miRNA-590–5p acts as an oncogene in some cancers while it acts as a tumor-suppressor in others. However, the role of miR-590–5p in oncogenesis is more complex, like a double-edged sword. Thus, this systematic review introduces the concept, mechanism, and biological function of miR-590–5p to resolve this apparent paradox. We have also described the involvement of miR-590–5p in crucial cancer-hallmarks processes like proliferation, invasion, metastasis, and chemo radioresistance. Finally, we have presented the possible genes/pathways targets of miR-590–5p through bioinformatics analysis. This review may help in designing better biomarkers and therapeutic targets for cancers.

Effective classroom instruction requires monitoring student participation and interaction during class, identifying cues to simulate their attention. The ability of teachers to analyze and evaluate students’ classroom behavior is becoming a crucial criterion for quality teaching. Artificial intelligence (AI)-based behavior recognition techniques can help evaluate students’ attention and engagement during classroom sessions. With rapid digitalization, the global education system is adapting and exploring emerging technological innovations, such as AI, the Internet of Things, and big data analytics, to improve education systems. In educational institutions, modern classroom systems are supplemented with the latest technologies to make them more interactive, student centered, and customized. However, it is difficult for instructors to assess students’ interest and attention levels even with these technologies. This study harnesses modern technology to introduce an intelligent real-time vision-based classroom to monitor students’ emotions, attendance, and attention levels even when they have face masks on. We used a machine learning approach to train students’ behavior recognition models, including identifying facial expressions, to identify students’ attention/non-attention in a classroom. The attention/no-attention dataset is collected based on nine categories. The dataset is given the YOLOv5 pre-trained weights for training. For validation, the performance of various versions of the YOLOv5 model (v5m, v5n, v5l, v5s, and v5x) are compared based on different evaluation measures (precision, recall, mAP, and F1 score). Our results show that all models show promising performance with 76% average accuracy. Applying the developed model can enable instructors to visualize students’ behavior and emotional states at different levels, allowing them to appropriately manage teaching sessions by considering student-centered learning scenarios. Overall, the proposed model will enhance instructors’ performance and students at an academic level.

The low attendance rate for cancer screening tests in Poland is a major healthcare concern that requires specific analysis and the development of implementation recommendations for prevention, and both actions are likely to benefit culturally similar countries. Four female cancers account for approximately 20% of all cancer cases—breast cancer, cervical cancer, endometrial cancer, and ovarian cancer—suggesting that gynecologists have a significant preventative role. Of the four, breast cancer and cervical cancer are among the 10 most common malignant neoplasms globally, regardless of gender, occur only in women and are known to have effective screening measures. Our research aims to create a screening model that combines cervical cancer and breast cancer to maximize health outcomes for women at risk of both cancers. In the study protocol, we have created a model that maximizes benefits for patients with minimal additional costs to the health care system. To achieve the set goal, instead of regular clinical breast exams as recommended by the gynecological societies, we proposed an ultrasound examination, during which palpation may also be performed (in the absence of elastography). We present a scheme for such a protocol that takes into consideration all types of prevention in both cancers, and that emphasizes breast ultrasound as the most frequently missing element. Our study includes a discussion of the strengths and weaknesses of our strategy, and the crucial need for infrastructure and education for the successful implementation of the program. We conclude that our model merits consideration and discussion among health-care decision makers, as the screening changes we propose have significant potential benefits for the female population.

In presence of abnormal neurological features, infective etiology should be kept as one of the differential diagnoses. This case report was about 38 years old male patient who presented with fever with blister-like rashes in centripetal distribution over the body and myoclonus. CSF examination showed the presence of varicella-zoster Ig M antibodies. Diagnosis of chickenpox induced myoclonus was made. Appropriate treatment recovered the patient completely. This case report highlighted the clinical spectrum of chickenpox as well as the possible pathogenesis and diagnostic, therapeutic approach of this uncommon entity.

Introduction: The COVID-19 pandemic has had a devastating worldwide effect on mental health. Recent studies correlate the spreading of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with symptoms of depression, most prominent in postpartum women. Our systematic literature review scope is to identify the risk factors and predictors for postpartum depression (PPD) and describe the steps that should be taken to help postpartum women. This study will help clinicians, researchers, and policymakers to elucidate the predictors of PPD during this pandemic and prevent these adverse outcomes in future crises. Methods: We conducted a systematic search by employing databases PubMed, Google Scholar, Scopus, and Embase to identify articles published before March 2021. About 463 publications were generated during our search process and from those, 36 were reviewed, summarized, and synthesized. Studies qualified the criteria if they (1) utilized qualitative or quantitative design, (2) explored the risk factors for PPD, and (3) were written in English. Quality evaluation of each study was achieved by using criteria set by Lincoln and Guba. Results: Prevalence of depression symptoms ranged from 7% to 80.8% in postpartum women during the SARS-COV 2 pandemic. The risk factors for PPD were classified into 6 major categories: socio-demographic, psychological, pre-existing pathology, metabolic factors, previous events of miscarriage, and media misinformation. Conclusion: It is extremely vital to care for women’s mental health during pregnancy and after childbirth during these unprecedented times. This review urges the need to design adequate interventions for this vulnerable population to prevent negative consequences of PPD.

Background: Analysis of placental genes could unravel maternal-fetal complications. However, inaccessibility to placental tissue during early pregnancy has limited this effort. We tested if exosomes (Exo) released by human placenta in the maternal circulation harbor crucial placental genes.Methods: Placental alkaline phosphate positive exosomes (ExoPLAP) were enriched from maternal blood collected at the following gestational weeks; 6–8th (T1), 12–14th (T2), 20–24th (T3), and 28th−32nd (T4). Nanotracking analysis, electron microscopy, dynamic light scattering, and immunoblotting were used for characterization. We used microarray for transcriptome and quantitative PCR (qPCR) for gene analysis in ExoPLAP.Results: Physical characterization and presence of CD63 and CD9 proteins confirmed the successful ExoPLAP enrichment. Four of the selected 36 placental genes did not amplify in ExoPLAP, while 32 showed regulations (n = 3–8/time point). Most genes in ExoPLAP showed significantly lower expression at T2–T4, relative to T1 (p < 0.05), such as NOS3, TNFSF10, OR5H6, APOL3, and NEDD4L. In contrast, genes, such as ATF6, NEDD1, and IGF2, had significantly higher expression at T2–T4 relative to T1. Unbiased gene profiling by microarray also confirmed expression of above genes in ExoPLAP-transcriptome. In addition, repeated measure ANOVA showed a significant change in the ExoPLAP transcriptome from T2 to T4 (n = 5/time point).Conclusion: Placental alkaline phosphate positive exosomes transcriptome changed with gestational age advancement in healthy women. The transcriptome expressed crucial placental genes involved in early embryonic development, such as actin cytoskeleton organization, appropriate cell positioning, DNA replication, and B-cell regulation for protecting mammalian fetuses from rejection. Thus, ExoPLAP in maternal blood could be a promising source to study the placental genes regulation for non-invasive monitoring of placental health.

Agricultural research has been traditionally driven by linear approaches dictated by hypothesis-testing. With the advent of powerful data science capabilities, predictive, empirical approaches are possible that operate over large data pools to discern patterns. Such data pools need to contain well-described, machine-interpretable, and openly available data (represented by high-scoring Findable, Accessible, Interoperable, and Reusable—or FAIR—resources). CGIAR's Platform for Big Data in Agriculture has developed several solutions to help researchers generate open and FAIR outputs, determine their FAIRness in quantitative terms1, and to create high-value data products drawing on these outputs. By accelerating the speed and efficiency of research, these approaches facilitate innovation, allowing the agricultural sector to respond agilely to farmer challenges. In this paper, we describe the Agronomy Field Information Management System or AgroFIMS, a web-based, open-source tool that helps generate data that is “born FAIRer” by addressing data interoperability to enable aggregation and easier value derivation from data. Although license choice to determine accessibility is at the discretion of the user, AgroFIMS provides consistent and rich metadata helping users more easily comply with institutional, founder and publisher FAIR mandates. The tool enables the creation of fieldbooks through a user-friendly interface that allows the entry of metadata tied to the Dublin Core standard schema, and trial details via picklists or autocomplete that are based on semantic standards like the Agronomy Ontology (AgrO). Choices are organized by field operations or measurements of relevance to an agronomist, with specific terms drawn from ontologies. Once the user has stepped through required fields and desired modules to describe their trial management practices and measurement parameters, they can download the fieldbook to use as a standalone Excel-driven file, or employ via free Android-based KDSmart, Fieldbook, or ODK applications for digital data collection. Collected data can be imported back to AgroFIMS for statistical analysis and reports. Development plans for 2021 include new features such ability to clone fieldbooks and the creation of agronomic questionnaires. AgroFIMS will also allow archiving of FAIR data after collection and analysis from a database and to repository platforms for wider sharing.

A 42-year-old male patient presented with profound impairment of vision in both eyes, just as he was recovering from COVID-19. A known diabetic and hypertensive, he suffered from COVID-19 pneumonia further complicated by ARDS, septicaemia and acute kidney injury. His vision on presentation was finger counting close to face bilaterally with multiple, yellowish lesions at the posterior pole. Based on the clinical findings and previous blood culture report, it was diagnosed as candida retinitis and treated with oral and intravitreal anti-fungals. The lesions were regressing at follow-up. This is a post COVID-19 presumed candida retinitis case report.

The term “smart lab” refers to a system that provides a novel and flexible approach to automating and connecting current laboratory processes. In education, laboratory safety is an essential component of undergraduate laboratory classes. The institution provides formal training for the students working in the labs that involve potential exposure to a wide range of hazards, including chemical, biological, and physical agents. During the laboratory safety lessons, the instructor explains the lab safety protocols and the use of personal protective equipment (PPE) to prevent unwanted accidents. However, it is not always guaranteed that students follow safety procedures throughout all lab sessions. Currently, the lab supervisors monitor the use of PPE, which is time consuming, laborious, and impossible to see each student. Consequently, students may unintentionally commit unrecognizable unsafe acts, which can lead to unwanted situations. Therefore, the aim of the research article was to propose a real-time smart vision-based lab-safety monitoring system to verify the PPE compliance of students, i.e., whether the student is wearing a mask, gloves, lab coat, and goggles, from image/video in real time. The YOLOv5 (YOLOv5l, YOLOv5m, YOLOv5n, YOLOv5s, and YOLOv5x) and YOLOv7 models were trained using a self-created novel dataset named SLS (Students Lab Safety). The dataset comprises four classes, namely, gloves, helmets, masks, and goggles, and 481 images, having a resolution of 835 × 1000, acquired from various research laboratories of the United Arab Emirates University. The performance of the different YOLOv5 and YOLOv7 versions is compared based on instances’ size using evaluation metrics such as precision, F1 score, recall, and mAP (mean average precision). The experimental results demonstrated that all the models showed promising performance in detecting PPE in educational labs. The YOLOv5n approach achieved the highest mAP of 77.40% for small and large instances, followed by the YOLOv5m model having a mAP of 75.30%. A report detailing each student’s PPE compliance in the lab can be prepared based on data collected in real time and stored in the proposed system. Overall, the proposed approach can be utilized to make laboratories smarter by enhancing the efficacy of safety in research settings; this, in turn, will aid the students in establishing a health and safety culture among students.

Ocrelizumab is a humanized CD20 monoclonal antibody which was approved for management of Relapsing Remitting Multiple Sclerosis (RRMS) and Primary Progressive Multiple Sclerosis (PPMS) in 2017. We present 2 patients, a 67-year-old woman with history of PPMS and a 42-year-old woman with RRMS, who were started on ocrelizumab and were diagnosed with invasive ductal cell breast carcinoma after 2 years of ocrelizumab infusion followed by discontinuation of the drug. Large trials conducted for ocrelizumab showed malignancies in a total of 4 cases with RRMS in OPERA 1 trial conducted over 2 years from 2011 to 2013 (breast cancer, renal cell carcinoma, and melanomas) and in 11 cases with PPMS seen in ORATORIO trial conducted in 2017. There are currently no other published case reports of breast cancer in setting of ocrelizumab use for MS outside of large trials on literature review.