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BackgroundOral human papillomavirus (HPV) infection has been causally linked to a subset of oropharyngeal cancers in Western populations, and both oropharyngeal cancer and oral HPV infection are increased among HIV-positive individuals. India has high incidences of oral and oropharyngeal cancers, and Indian HIV-positive men who have sex with men (MSM) may be at increased risk of developing oropharyngeal cancers. However, there is little information available on the prevalence of oral HPV in this population.MethodsWe tested 302 HIV-positive Indian MSM for oral HPV infection using L1 HPV DNA PCR with probes specific for 29 types and a mixture of 10 additional types. CD4+ level and plasma HIV viral load (VL) were measured. Participants completed an interviewer-administered questionnaire including a sexual history.ResultsThe prevalence of oral HPV was 23.7% (95% CI: 19-29%) and 2.4% of participants had oncogenic HPV types. No participants had oral HPV type 16 (HPV-16) and the prevalence of other anogenital HPV types was low. Participants with higher CD4+ levels had reduced odds of having any oral HPV infection (OR: 3.1 [1.4-6.9]) in multivariable analyses.ConclusionsThis is the first report of oral HPV among Indian HIV-positive MSM. Our results show a high prevalence of oral HPV infection consistent with studies from Western populations. However, oncogenic anogenital HPV types were relatively uncommon in our study population. It is unknown what the impact of this distribution of oral HPV will be on oropharyngeal cancers. HIV-positive MSM in India should be monitored closely for oral and oropharyngeal pre-cancer and cancer.

Abstract Crotalaria genus is extensively dispersed in tropical and subtropical provinces, and it is found to harbor antioxidant flavonoids. Response surface methodology-based optimization was carried out for the purpose of efficient extraction involving a suitable solvent which can maximize the yield along with higher total phenolic content and total flavonoid content (TFC). Optimization conditions for extraction of C.candicans flavonoids (CCF) based on variables such as solvent, solid-solvent ratio and extraction temperature were evaluated. The optimized conditions were found as Solvent i.e., Aqueous-ethanol (53.42%), Solid-solvent ratio (1:15.83 w/v) and temperature (44.42 °C) and resulted to obtain the TFC as 176.23 mg QRET/g C. candicans extract with the yield 27.42 mg CCF/g (C. candicans dry weight). LC–MS analysis of CCF, revealed the presence of seven major flavonoids. The antioxidant flavonoids were further used to functionalize the zero-valent silver (ZVAgF) and copper (ZVCuF) nanoparticles. The ZVAgF and ZVCuF were investigated using UV–Vis spectrophotometry, FT-IR spectroscopy and X-ray diffractometry to confirm the presence of the zero valent metals and possible functional groups which capped the elemental metal. Further transmission electron microscopy, dynamic light scattering method and zeta-potential studies were done to understand their respective structural and morphological properties. The efficacy of the as-prepared ZVAgF/ZVCuF as antibiofilm agents on Methicillin-resistant Staphylococcus aureus (MRSA) with the mechanism studies have been explored. The MRSA-colony count from the infection zebrafish (in vivo) model, portrayed a reduction of > 1.9 fold for ZVCuF and > twofold for ZVAgF, with no alteration in liver morphology when treated with ZVAgF, implying that the nanoparticles were safe and biocompatible.

In this article, we introduce a new class of analytic functions in the open unit disc that are closely related to functions that are starlike with respect to a boundary point. For this new class of functions, we obtain representation theorem, interesting coefficient estimates and also certain differential subordination implications involving this new class.

Objective: To find out differences in the presentation, management and outcomes of COVID-19 infected STEMI patients compared to age and sex-matched non-infected STEMI patients treated during the same period. Methods: This was a retrospective multicentre observational registry in which we collected data of COVID-19 positive STEMI patients from selected tertiary care hospitals across India. For every COVID-19 positive STEMI patient, two age and sex-matched COVID-19 negative STEMI patients were enrolled as control. The primary endpoint was a composite of in-hospital mortality, re-infarction, heart failure, and stroke. Results: 410 COVID-19 positive STEMI cases were compared with 799 COVID-19 negative STEMI cases. The composite of death/reinfarction/stroke/heart failure was significantly higher among the COVID-19 positive STEMI patients compared with COVID-19 negative STEMI cases (27.1% vs 20.7% p value = 0.01); though mortality rate did not differ significantly (8.0% vs 5.8% p value = 0.13). Significantly lower proportion of COVID-19 positive STEMI patients received reperfusion treatment and primary PCI (60.7% vs 71.1% p value=< 0.001 and 15.4% vs 23.4% p value = 0.001 respectively). Rate of systematic early PCI (pharmaco-invasive treatment) was significantly lower in the COVID-19 positive group compared with COVID-19 negative group. There was no difference in the prevalence of high thrombus burden (14.5% and 12.0% p value = 0.55 among COVID-19 positive and negative patients respectively) Conclusions: In this large registry of STEMI patients, we did not find significant excess in in-hospital mortality among COVID-19 co-infected patients compared with non-infected patients despite lower rate of primary PCI and reperfusion treatment, though composite of in-hospital mortality, re-infarction, stroke and heart failure was higher.

Yu Hsia,1,2 Maharajan Sivasubramanian,1 Chia-Hui Chu,1 Yao-Chen Chuang,1,3 Yiu-Kay Lai,2 Leu-Wei Lo1 1Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan; 2Institute of Biotechnology, National Tsing Hua University, Hsinchu, Taiwan; 3Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, TaiwanCorrespondence: Leu-Wei Lo, Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, 35, Keyan Road, Zhunan Town, Miaoli County 350, Zhunan, Taiwan, Tel +886-37-206-166 Ext 37115, Fax +886-37-586-440, Email lwlo@nhri.edu.tw Yiu-Kay Lai, Institute of Biotechnology, National Tsing Hua University, No. 101, Section 2, Kuang-Fu Road, Hsinchu, 300044, Taiwan, Tel +866-35-742-745, Email lslyk@life.nthu.edu.twBackground: Cancer multidrug resistance (MDR) is an important factor that severely affects the chemotherapeutic efficacy. Among various methods to bypass MDR, usage of cytokines, such as tumor necrosis factor alpha (TNFα) is attractive, which exerts antitumor effects of immunotherapeutic response and apoptotic/proinflammatory pathways. Nevertheless, the challenges remain how to implement targeted delivery of TNFα to reduce toxicity and manifest the involved signaling mechanism that subdues MDR.Methods: We synthesized a multifunctional nanosytem, in which TNFα covalently bound to doxorubicin (Dox)-loaded pH-responsive mesoporous silica nanoparticles (MSN) through bi-functional polyethylene glycol (TNFα-PEG-MSN-Hydrazone-Dox) as a robust design to overcome MDR.Results: The salient features of this nanoplatform are: 1) by judicious tailoring of TNFα concentration conjugated on MSN, we observed it could lead to a contrary effect of either proliferation or suppression of tumor growth; 2) the MSN-TNFα at higher concentration serves multiple functions, besides tumor targeting and inducer of apoptosis through extrinsic pathway, it inhibits the expression level of p-glycoprotein (P-gp), a cell membrane protein that functions as a drug efflux pump; 3) the enormous surface area of MSN provides for TNFα functionalization, and the nanochannels accommodate chemotherapeutics, Dox; 4) targeted intracellular release of Dox through the pH-dependent cleavage of hydrazone bonds induces apoptosis by the specific intrinsic pathway; and 5) TNFα-PEG-MSN-Hydrazone-Dox (MSN-Dox-TNFα) could infiltrate deep into the 3D spheroid tumor model through disintegration of tight junction proteins. When administered intratumorally in a Dox-resistant mouse tumor model, MSN-Dox-TNFα exhibited a synergistic therapeutic effect through the collective performances of TNFα and Dox.Conclusion: We hereby develop and demonstrate a multifunctional MSN-Dox-TNFα system with concentration-tailored TNFα that can abrogate the drug resistance mechanism, and significantly inhibit the tumor growth through both intrinsic and extrinsic apoptosis pathways, thus making it a highly potential nanomedicine translated in the treatment of MDR tumors.Graphical Abstract: Keywords: cytokine cancer therapy, tumor necrosis factor alpha, mesoporous silica nanoparticle, pH-responsive controlled release, intrinsic/extrinsic apoptosis pathways, cancer multidrug resistance

Everything around us is made up of atoms and molecules. The properties of quantum atoms are sought to understand the behavior of a particular object. But with the advent of research, it was discovered that there is a quantity smaller than the molecular size. The nanoscale measures a fraction of a billionth of a meter. The atom of an object measures 0.1 nm. Since atoms are the building blocks of matter, at the nanoscale one can combine these atoms to create new materials. The proposed model displays the properties of these nano-scale elements in modern medical applications. The nano-scale research of matter is fascinating because it is the basic phase in which atoms are held together. Therefore, by manipulating material at this level, one can create many different types of objects. This proposed model calculates the operation requirements and expects the results. Based on the operational requirements, the proposed model provides the suggestions. This will be helpful for the medical researchers to identify the proper medical treatments based on the microbiological requirements.

Dyslipidemias are the most important coronary artery disease (CAD) risk factor. Proper management of dyslipidemia is crucial to control the epidemic of premature CAD in India. Cardiological Society of India strived to develop consensus-based guidelines for better lipid management for CAD prevention and treatment. The executive summary provides a bird's eye-view of the ‘CSI: Clinical Practice Guidelines for Dyslipidemia Management’ published in this issue of the Indian Heart Journal. The summary is focused on the busy clinician and encourages evidence-based management of patients and high-risk individuals. The summary has serialized various aspects of lipid management including epidemiology and categorization of CAD risk. The focus is on management of specific dyslipidemias relevant to India-raised low density lipoprotein (LDL) cholesterol, non-high density lipoprotein cholesterol (non-HDL-C), apolipoproteins, triglycerides and lipoprotein(a). Drug therapies for lipid lowering (statins, non-statin drugs and other pharmaceutical agents) and lifestyle management (dietary interventions, physical activity and yoga) are summarized. Management of dyslipidemias in oft-neglected patient phenotypes-the elderly, young and children, and patients with comorbidities-stroke, peripheral arterial disease, kidney failure, posttransplant, HIV (Human immunodeficiency virus), Covid-19 and familial hypercholesterolemia is also presented. This consensus statement is based on major international guidelines (mainly European) and expert opinion of lipid management leaders from India with focus on the dictum: earlier the better, lower the better, longer the better and together the better. These consensus guidelines cannot replace the individual clinician judgement who remains the sole arbiter in management of the patient.

Indians have a pattern of atherogenic dyslipidaemia characterised by not so high LDL-C but elevated small, dense LDL-C, elevated triglyceride levels and low HDL-C levels. In addition, different lipid-lowering drugs exhibit pharmacokinetic variability in Indians, which may have implications on the optimum doses required to achieve the desired LDL-C levels. Currently the management of dyslipidaemia in Indians are based on the landmark trials, which largely included western population. This review focusses on major clinical trials of lipid lowering drugs with special reference to the Indian population.

BackgroundRapid screening tools such as the WHO well-being Index (WWBI), Six-item screener (SIS), and the CLOX-1 test can be used to assess overall mental health and cognition, respectively. We sought to evaluate mental health with cognition in individuals with chronic diseases and stable vital signs presenting to the Emergency Department (ED).MethodsAn observational study in the ED with 279 participants was conducted.ResultsChronic diseases were more prevalent among 51–70 years (43.4%) and diabetes was most common (58.8%). Fever (22.6%) and GI bleeding (32.6%) presentation were high. Participants with low WWBI had low SIS compared to the ones with higher scores (83.3% vs. 17.7%, p

Bilothorax, an exudative pleural effusion due to the accumulation of bile. It is also called cholethorax or thoracobilia and was initially reported in 1971. Here, we report a rare case of an elderly male presenting with bilateral bilothorax due to esophageal rupture. A 78-year-old man with multiple medical ailments presented to the emergency room (ER) with a severe episode of vomiting accompanied by a popping sound, respiratory distress, and right sided chest pain. The patient had tachycardia, BP of 101/89 mm Hg, and tachypnea. Computed tomography scan of the chest and abdomen revealed air adjacent to the esophagus, suggesting perforation, atelectasis of right lung, and bilateral pleural effusion (R > L). However, an esophagram did not reveal any perforation. Right-sided chest tube drained dark green bilious fluid. The day after admission, he experienced hemodynamic compromise and hypoxemia requiring intubation, along with fluids and inotropes support. Diagnosis of bilateral bilothorax complicated by hypoxemic respiratory failure with septic shock was made. Cultures were drawn, and empiric antibiotics were started. Nuclear hepatobiliary scan (HIDA) was performed to rule out a hepatobiliary fistula. Results showed reflux activity in the stomach, and distal esophageal leak was identified. Gastrojejunal stenting was performed. However, after prolonged intubation, the family decided on terminal extubation, and he died while receiving hospice care. This case highlights the rarity of bilateral bilothorax, where the HIDA scan played a crucial role in identifying an esophageal leak as the underlying cause, despite normal esophagram results. This condition necessitates prompt diagnosis and aggressive therapeutic interventions.

This work presents an investigation on the quality of parts manufactured using fused deposition modeling (FDM), which is influenced by a large number of different elements. Some of which are based on the materials used in the production of the part, though others are rather pertinent to the process parameters. The manufacturing process and filament formulation has also a significant impact on the cost of the final product, as well as its physical, mechanical, and thermal properties. As the result, judicious combination of parameters can effectively act toward fine-tuning FDM toward three-dimensional printing (3DP) of pieces with quality fit-for-application. In this sense, the use of design of experiments (DOEs) is often needed for the purpose. Printing process parameters, including layer height, wall thickness, temperature, printing velocity, and tool path, have been discussed, in the understanding that 3DP time increases with decreasing layer thickness, and in turn increases production time and overall cost. A specific account is given on recent developments increasingly and more thoroughly focused on recognizing the impact of the process parameters and raw materials on the final product.

This research focuses on hybrid woven fibre metal laminates (HWFMLs), specifically on the innovative hybridization of natural woven fibres (NWFs) with aluminium diamond microexpandable mesh (Al-DMEM) in thin laminates. More specifically, it investigates the effect on the mechanical and water absorption properties of incorporating basalt (B), jute (J), banana (Bn) fibres, and Al-DMEM as reinforcing materials in a traditional epoxy resin. Several stacking sequences were compared and discussed. The basalt-banana-aluminium-banana-basalt (BBnABnB) (five layers) laminate exhibited remarkable compressive strength (25.7 MPa), interlaminar shear strength (25.2 MPa), Izod impact strength (2.98 J), tensile strength (42.8 MPa), and tensile modulus (3.1 GPa). Other laminates, despite their limited tensile strain, still offered advantages in other loading modes. In particular, basalt-jute-aluminium-jute-basalt (BJAJB) (five layers) laminate showed notable performance with a compressive strength of 16.70 MPa and interlaminar shear strength of 20.85 MPa. In comparison, the basalt-aluminium-basalt (BAB) (three layers) demonstrated compressive strength equal to 6.87 MPa and interlaminar shear strength (ILSS) equal to 9.07 MPa.

Silicon photonics is a rapidly developing field that offers cost-effective biosensors with improved sensitivity and the potential for interconnecting with other electronic devices for instant disease diagnosis. The Mach Zehnder interferometer architecture (MZI) is a key technology for biosensors, as it detects changes in refractive index (RI) caused by the presence of biomolecules. In this study, a silicon-polymer double-slot waveguide-based MZI was designed, with a small mode area and a large evanescent field to enhance light-analyte interaction. The waveguide was optimized by converting a normal slot waveguide into a double-slot waveguide with varying slot widths. In transmission spectrum, the wavelength shift was measured for both normal and disease samples. Additionally, the loss at a specific wavelength was analyzed to understand the impact of the biomolecule on the sensor performance. The results show that this sensor has a high sensitivity of 2.39 X10^5 nm/RIU, making it a promising candidate for biosensing applications.

A feasible alternative to classic chemical synthesis, the phyto-mediated production of silver nanoparticles (AgNPs) utilizing aqueous flower petal extract of Cassia alata as a reducing agent is reported for the first time. Characterization of synthesized AgNPs was carried out using various techniques viz., ultraviolet-visible spectroscopy (UV-Vis), X-ray powder diffraction (XRD), high-resolution transmission electron microscope (HRTEM), Fourier transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM) with energy dispersive X-ray analysis (EDX). The results of the FTIR research conducted in this study show different bond stretches with varying durations, which can be seen at various faraway points. AgNPs are mainly spherical and vary in size from 20 to 100 nm, according to TEM images. The highest X-ray energy surge, at 3 keV, is visible in the EDX spectrum. The XRD pattern showed that four diffraction peaks could be assigned to the 111, 200, 220, and 311 planes of the face-centered cubic crystalline silver, respectively, at 32.05, 46.27, 55.25, and 57.39°. Optimization of production parameters including pH, metal ion concentration, and substrate concentrations were studied. In addition, the bioactivity was evaluated against Trichophyton rubrum, Aspergillus fumigatus, Candida albicans, Epidermophyton floccosum, and Mucor sp. using the agar diffusion method. Furthermore, their antioxidant properties were assessed using 2,2-diphenyl-1-picryl-hydrazyl-hydrate assay and ferric ion reducing antioxidant power tests. MTT assay was performed using human fibroblast cell line (L929) to determine the cell viability and cytotoxicity through increased metabolism of the tetrazolium salt.

Lodderomyces elongisporus is a rare cause of invasive fungal infections. Most phenotypic tests that are routinely used for identification of yeasts fail to identify this organism. However, chromogenic media for yeasts, MALDI-TOF MS and DNA sequencing can be used for correct identification. We report a case of fungemia complicated by infective endocarditis and intracerebral bleeding in a pediatric patient with previous cardiac surgery.

The COVID-19 virus has made a huge impact on people’s lives ever since the outbreak happened in December 2019. Unfortunately, the COVID-19 virus has not completely vanished from the world yet, and thus, global agitation is still increasing with mutations and variants of the same. Early diagnosis is the best way to decline the mortality risk associated with it. This urges the necessity of developing new computational approaches that can analyze a large dataset and predict the disease in time. Currently, automated virus diagnosis is a major area of research for accurate and timely predictions. Artificial intelligent (AI)-based techniques such as machine learning (ML) and deep learning (DL) can be deployed for this purpose. In this, compared to traditional machine learning techniques, deep Learning approaches show prominent results. Yet it still requires optimization in terms of complex space problems. To address this issue, the proposed method combines deep learning predictive models such as convolutional neural network (CNN), long short-term memory (LSTM), auto-encoder (AE), cross-validation (CV), and synthetic minority oversampling techniques (SMOTE). This method proposes six different combinations of deep learning forecasting models such as CV-CNN, CV-LSTM+CNN, IMG-CNN, AE+CV-CNN, SMOTE-CV-LSTM, and SMOTE-CV-CNN. The performance of each model is evaluated using various metrics on the standard dataset that is approved by The Montefiore Medical Center/Albert Einstein College of Medicine Institutional Review Board. The experimental results show that the SMOTE-CV-CNN model outperforms the other models by achieving an accuracy of 98.29%. Moreover, the proposed SMOTE-CV-CNN model has been compared to existing mortality risk prediction methods based on both machine learning (ML) and deep learning (DL), and has demonstrated superior accuracy. Based on the experimental analysis, it can be inferred that the proposed SMOTE-CV-CNN model has the ability to effectively predict mortality related to COVID-19.

The current research focuses on the silver nanoparticles (AgNPs) synthesis from the Cassia alata aqueous leaf extract. Various production parameters like pH (4, 5, 6, 7, 8, 9, and 10), metal ion concentration (1, 2, 3, 4, and 5 mM), and substrate (leaf extract) concentration (0.5, 1, 1.5, 2 and 2.5 mL) were optimized. UV-visible spectroscopy was used to identify the production by scanning the wavelength from 200 to 800 nm. Visual color change from light green to brown was designated as prior confirmation of the AgNP production. Physical characterization of AgNPs was carried out using scanning electron microscopy, Fourier-transform infrared spectroscopy, X-ray energy-dispersive spectroscopy, and X-ray diffraction. Furthermore, the obtained AgNPs show significant antibacterial activity for Staphylococcus aureus, Pseudomonas sp. Klebsiella sp., Proteus sp., and Enterobacter sp. The antioxidant potential was determined by α,α-diphenyl-β-picrylhydrazyl assay and cytotoxicity by (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) tetrazolium reduction assay on human lung cancer cell lines (A549). AgNPs confirmed potent antibacterial activity against skin infections, demonstrating their medicinal significance and are therefore crucial for creating a medicinal formulation with antibacterial properties.

In response to the survey among early career pediatric cardiologists from India and the accompanying editorial, we invited comments and suggestions from thought leaders and senior functionaries in the field. We have summarized the thoughts and suggestions as a mini-symposium.