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Background: In Bundelkhand region, 15–18% patients who are attended in the emergency setting comprises poisoning and 60–70% of which are agriculture-based poisons due to its easy accessibility. Aims and Objectives: The aim of this study was to see spectrum of poisoning in Bundelkhand region. Materials and Methods: The prospective non-randomized study was done in Maharani Laxmi Bai Medical College, Jhansi, between December 2020 and October 2022, including 500 patients applied for treatment of different poisoning. Results: In our study, total 500 cases of poisoning were taken. As per found data, majority of patients were found in 17–30 years of age group 202 (40.4%) followed by 31–40 years of age group 157 (31.4%). Minimum 19 (3.8%) cases were found in 61–70 years of age group and 0 case in >70 years of age group. Majority of patients were found male, i.e., 281 (56.2%) and the rest 219 (43.8%) were females. According to finding of our study, maximum mortality rate was found due to Stone hair dye, i.e., 100% followed by Celphos 35.54%, Insecticidal 26.92%, and Alcoholic intoxication 22.22%. As per our study, major cause of taking poison, maximum number of patients were found in marital discord 108 (21.6%) followed by family problems, i.e., 75 (15%), which is similar to separation/death of family member, that is, 74 (14.8%). Conclusion: Concerned authorities should think about substitute of aluminum phosphide, which would be less toxic for human being and concerned authority should ban availability of aluminum phosphide (Celphos) in market.

The flow problem discussed in this research is an investigation of compressible viscous fluid in an unstable 2D MHD laminar driven vortex and stable boundary layer flow, passing a heated stretched sheet at varying speeds via a porous medium exposed to a magnetic field with viscous dissipation, thermal diffusion, thermal radiation, chemical reaction and Dufour effects. With the aid of similarity transformations, PDEs that come out in governing equations of this formulations are converted into non-linear sets of ODEs. Well-defined bvp4c technique used to numerically solve these converted equations. With use of various graphs, the consequences of different factors on the distributions of velocity, temperature and concentration were examined numerically and graphically. Physical parameters for this issue are also discussed.

This paper presents a broadband optical receiver that employs multiple bandwidth extension techniques in analog front-end (AFE) and has efficient digital clock and data recovery (CDR). The AFE is implemented exclusively with inverter-based stages. It consists of a shunt feedback transimpedance amplifier followed by a continuous time linear equalizer (CTLE) and variable gain amplifier (VGA). High RF value, $400\Omega $ , was employed to have better sensitivity at the cost of narrow bandwidth. Total AFE bandwidth is extended by 5.5X with CTLE peaking, series inductances between each AFE stage, and active inductor loads in the CTLE output and VGA stages. Quarter-rate, phase-locked loop (PLL) based digital CDR is implemented for clocking. The resolution of a digitally controlled oscillator (DCO) is optimized at 9-bit to balance jitter and hardware cost from the CDR. Multi-phase clock generation is accomplished by a delay locked loop (DLL). Fabricated in 28nm CMOS, the 42.7Gb/s optical receiver achieves an optical modulation amplitude (OMA) sensitivity of −3.6dBm at a bit error rate (BER) $\lt 10{^{\text {-12}}}$ , 10MHz CDR bandwidth, and 3.4pJ/bit energy efficiency.

Summary: Background: Only limited information exists regarding the epidemiology of Kawasaki disease (KD) in low-income and middle-income countries. The present study provides the incidence of KD during 2015–2019 in Chandigarh, north India. Our centre follows the largest KD cohort in India. Methods: Children with KD at Chandigarh diagnosed during January 2015–December 2019 were enrolled in the study. Annual incidence rates were determined using decadal growth rates of the National Census 2011. We computed the incidence of KD in children aged

Summary: Background: Transthoracic echocardiography (TTE) has traditionally been the primary method for coronary imaging in children with Kawasaki disease (KD). We aimed to evaluate coronary artery lesions (CALs) of the left circumflex artery (LCx) in KD on computed tomography coronary angiography (CTCA). Methods: Over a 9-year period (November 2013–December 2022), 225 children with KD underwent radiation-optimized CTCA on a 128-slice dual-source platform. TTE was performed on the same day, or a day prior or after CTCA. Findings: On CTCA, LCx CALs were seen in 41/225 (18.2%) patients. However, TTE detected CALs in only one third of these patients [15/41 (36.6%)]. CTCA showed 47 LCx CALs in 41 patients–aneurysms in 39 patients (40 fusiform, 2 saccular; 7 giant aneurysms), stenoses in 3, and thrombosis in 2. Thromboses and stenoses were both missed on TTE. Proximal LCx aneurysms were seen in 39 patients–of these, 12 had distal extension. Six patients had distal LCx aneurysms without proximal involvement and 2 non-contiguous multiple aneurysms. Four (9.75%) patients had isolated LCx involvement. Based on CTCA findings, treatment protocols had to be modified in 3/41 (7.3%) patients. Interpretation: This study highlights anatomical findings of LCx involvement in KD. Isolated LCx CALs were noted in 4/41 (9.75%) patients. TTE alone proved inadequate for LCx assessment in children with KD. With abnormalities detected in 18.2% of cases, including those missed by TTE, CTCA emerges as an essential imaging modality. The findings have implications for treatment planning and follow-up strategies in children with KD. Funding: None.

Herbs and spices are rich in bioactive compounds that are known to impart health benefits. Incorporation of these herbs/spices in snacks might also enhance the nutritional quality of the products. This study aimed to examine the potential nutritional benefits and loss associated with the frying of herb/spice rice crackers. Four different varieties of rice-based crackers incorporated individually with mint, green chili, red chili, and cumin were evaluated by different parameters before and after frying. The raw rice cracker incorporated with herb/spice exhibited significantly higher protein (4.19 to 5.30 %), fiber (1.78 to 1.97 %), mineral, pigment (chlorophyl 0.4 to 0.7 mg% and carotenoids 150 to 400 mg/kg), phenolic content (2.81 to 9.18 mg GAE/g), and antioxidant capacity than the control raw rice cracker (without herb/spice). The frying treatment was found to have a reduction in the nutritional value i.e., protein (3.30 to 3.82%), fiber (1.47 to 1.86), mineral and pigment content of rice crackers. Moreover, the increase in phenolic content, mineral, antioxidant capacity, and pigments of cooking oil in which rice crackers were fried confirmed the leaching of herbs/spices into the oil while frying.

Abstract The article presents a performance analysis of fully automated, in-house developed 2D ultrasound computerized tomography systems using different programming languages. The system is fully automated in four programming languages: LabVIEW, MATLAB, C and Python. It includes codes for sensors, instruments interfacing, real-time control, synchronized data acquisition, simultaneous raw data processing and analysis. Launch performance, eight performance indices and runtime performance are used for the analysis. It is found that C utilizes the least processing power and executes fewer I/O processes to perform the same task. In runtime analysis (data acquisition and real-time control), LabVIEW (365.69 s) performed best in comparison to MATLAB (623.83 s), Python (1505.54 s), and C (1252.03 s) to complete the experiment without data processing. However, in the experiment with data processing, MATLAB (640.33 s) performed best in comparison to LabVIEW (731.91 s), Python (1520.01 s) and C (1930.15 s). Python performed better in establishing faster interfacing and RAM usage. The study provides a methodology to select optimal programming languages for instrument automation-related aspects to optimize the available resources.

Background and Objectives: In India, it is estimated that there are 40 million people suffering from Hepatitis B virus (HBV). Quantification of the viral burden is an important laboratory tool in the management. However, widespread use of different HBV-DNA assays is still affected by the high cost and variable diagnostic precision. The present study was conducted to evaluate the diagnostic precision and co-relation of ALT levels with HBV-DNA by Truenat®-PCR. Materials and Methods: In this prospective cross-sectional study a total of 567 serums were collected from patients by rapid HBsAg, and processed for liver function tests (LFT). The viral HBV-DNA amplification detection was carried out through by Truenat®-PCR test. Results: Out of 567 samples, 452 samples were found to be positive by both rapid and Truenat®-PCR and 106 were negative for HBV-DNA followed by 9 invalid. High ALT level found in 73% of positive patients who had HBV-DNA level (>100000 copies/ml) which is significantly higher in 447 patients as compared to those have below ≤100000 copies/ml. Conclusion: Truenat®-PCR technique is a highly sensitive and can be performed with low resources for effective control of HBV infection. Evaluation of HBV-DNA levels and serum ALT levels showed a significant proportion of patient harbored ongoing viral replication and disease progression.

Background: Hereditary angioedema (HAE) is a rare genetic disease. Patients with type II HAE have normal or elevated C1-inhibitor (C1-INH) levels but C1-INH protein is dysfunctional. C1-INH function requires careful sample handling and technical expertise and may account for the lack of diagnosed patients with type II HAE in resource-limited countries. Objective: We sought to assess the diagnostic performance of elevated C1-INH levels in diagnosing type II HAE. Methods: All patients with confirmed type II HAE in Hong Kong and India were analyzed. Diagnosis was confirmed by persistent low C1-INH function and/or pathogenic SERPING1 gene mutations. Their C1-INH levels were compared with those of matched controls. Results: A total of 31 (14 Chinese, 17 Indian) patients with type II HAE and 31 matched controls were analyzed. Overall, 77.4% (24/31) of patients with type II HAE had elevated C1-INH levels compared with 38.7% (12 of 31) of controls (odds ratio, 2.00; 95% CI, 1.34-2.98; P = .017). C1-INH levels in patients with type II HAE were significantly higher than in controls (52.2 ± 20.0 mg/dL vs 29.1 ±3.6 mg/dL; P < .001). Findings were consistent when C1-INH values in the Chinese and Indian subgroups were analyzed separately. Receiver-operating characteristic curve demonstrated excellent performance for elevated C1-INH levels to diagnose patients with type II HAE with an area under the curve of 0.953 (95% CI, 0.941-0.992; P < .001). Positive and negative predictive values of both a low C4 and an elevated C1-INH level for patients with type II HAE were 100% and 82.9%, respectively. Conclusions: Low C4 and elevated C1-INH levels may be considered as a screening tool for type II HAE, especially in countries where C1-INH function testing is not readily available.

Chemical-induced neurotoxicity is increasingly recognized to accelerate the development of neurodegenerative disorders (NDs), which pose an increasing health burden to society. Attempts are being made to develop drugs that can cross the blood–brain barrier and have minimal or no side effects. Nobiletin (NOB), a polymethoxylated flavonoid with anti-oxidative and anti-inflammatory effects, has been demonstrated to be a promising compound to treat a variety of NDs. Here, we investigated the potential role of NOB in sodium arsenate (NA)-induced deregulated miRNAs and target proteins in human neural progenitor cells (hNPCs). The proteomics and microRNA (miRNA) profiling was done for different groups, namely, unexposed control, NA-exposed, NA + NOB, and NOB groups. Following the correlation analysis between deregulated miRNAs and target proteins, RT-PCR analysis was used to validate the selected genes. The proteomic analysis showed that significantly deregulated proteins were associated with neurodegeneration pathways, response to oxidative stress, RNA processing, DNA repair, and apoptotic process following exposure to NA. The OpenArray analysis confirmed that NA exposure significantly altered miRNAs that regulate P53 signaling, Wnt signaling, cell death, and cell cycle pathways. The RT-PCR validation studies concur with proteomic data as marker genes associated with autophagy and apoptosis (HO-1, SQSTM1, LC-3, Cas3, Apaf1, HSP70, and SNCA1) were altered following NA exposure. It was observed that the treatment of NOB significantly restored the deregulated miRNAs and proteins to their basal levels. Hence, it may be considered one of its neuroprotective mechanisms. Together, the findings are promising to demonstrate the potential applicability of NOB as a neuroprotectant against chemical-induced neurotoxicity.

Abstract Streamlined data-driven drug discovery remains challenging, especially in resource-limited settings. We present ZairaChem, an artificial intelligence (AI)- and machine learning (ML)-based tool for quantitative structure-activity/property relationship (QSAR/QSPR) modelling. ZairaChem is fully automated, requires low computational resources and works across a broad spectrum of datasets. We describe an end-to-end implementation at the H3D Centre, the leading integrated drug discovery unit in Africa, at which no prior AI/ML capabilities were available. By leveraging in-house data collected over a decade, we have developed a virtual screening cascade for malaria and tuberculosis drug discovery comprising 15 models for key decision-making assays ranging from whole-cell phenotypic screening and cytotoxicity to aqueous solubility, permeability, microsomal metabolic stability, cytochrome inhibition, and cardiotoxicity. We show how computational profiling of compounds, prior to synthesis and testing, can inform progression of frontrunner compounds at H3D. This project is a first-of-its-kind deployment at scale of AI/ML tools in a research centre operating in a low-resource setting.

Bhardwaj et al., have explored the proteomes of SARS-CoV and SARS-CoV-2, and have demonstrated the amyloid formation of viral proteins, in vitro, through diverse biophysical techniques.

Objectives: Previously, yoga volitional breathing with low inspiration to expiration ratios (i/e) (as in bhramari pranayama) improved cognition and reduced state anxiety. This study compared the effects of low, high and equal i/e ratio breathing on affect and attention. Material and Methods: Affect, vigor and attention were assessed in forty healthy participants (group mean age± SD; 22.58±3.83; M:F= 2.33:1) while breathing with three different i/e regulated by a visual metronome on separate days viz., (i) low i/e (28:72), (ii) equal i/e (50:50), (iii) high i/e (72:28) compared to control, without conscious breath modification. Assessments were: (i) brief mood introspection scale (BMIS), (ii) global vigor and affect scale (GVAS), (iii) Spielberger's state trait anxiety inventory-state (STAI-S) and a six letter cancellation test to assess sustained attention. Data were analyzed with repeated measures analysis of variance with Bonferroni adjusted post-hoc tests. Results: Pleasant feelings increased after low and equal i/e. Low i/e also increased positive feelings whereas equal i/e decreased scores in the cancellation test for sustained attention. All three breathing practices and the control session decreased state anxiety and increased vigor. High i/e breathing alone did not decrease negative feelings. For all the breath ratios the breath frequency cue was set at twelve breaths per minute. Conclusion: In summary, varying breath phase ratios influenced positive and pleasant feelings but did not influence state anxiety or vigor. Understanding the mechanisms underlying the findings would be improved with concurrent physiological assessments.

Infertility is a global issue of concern in the modern era, affecting 8%–12% of couples globally. Although the etiology of infertility is varied and difficult to determine, a good proportion of cases can be attributed to male. The most common cause of male infertility is oligozoospermia. Oligozoospermia is a decrease in sperm concentration below 15 million sperm/ml in semen ejaculate. Shukra Kshaya is a similar clinical condition mentioned in Ayurveda in which the Shukra Dhatu is diminished both qualitatively and quantitatively. Ayurveda has specified many therapeutic interventions and practices, including the Panchakarma procedure, Basti Karma, for the strengthening of Shukra Dhatu as well as the management of Shukra-Dusht. Mustadi Yapana Basti (MYB) was chosen for this study because of its significant Vatahara, Rasayana, and Vajikarana characteristics. A total of 05 patients who were diagnosed with oligozoospermia were managed with MYB for 15 consecutive days without any internal medications. The Shukra Kshaya assessment questionnaire was used in conjunction with objective parameters to determine the improvement. Data were collected twice before and after therapy. After the treatment, all five participants exhibited significant improvement in sperm count from a mean of 10.4–55. In this case series, all the patients demonstrated clinical improvement in symptoms of Shukra kshaya as well as in associated laboratory parameters. Basti treatment significantly improved all symptoms of Shukra Kshaya, as well as semen parameters (sperm count, sperm active motility, and semen volume) and serum testosterone. The reported cases demonstrate that MYB is a therapeutic option for the comprehensive care of men with a diagnosis of oligozoospermia.

Purpose: To analyze the demographics and clinical outcomes of posterior chamber phakic intraocular (IOL) implantation for refractive amblyopia in children and adolescents. Methods: A prospective interventional study was performed on children and adolescents with amblyopia at a tertiary eye care center from January 2021 to August 2022. Twenty-three eyes of 21 anisomyopic and isomyopic amblyopia patients operated for posterior chamber phakic IOL (Eyecryl phakic IOL) as a treatment for amblyopia were included in the study. Patient demographics, pre- and postoperative visual acuity, cycloplegic refraction, anterior and posterior segment examination, intraocular pressure, pachymetry, contrast sensitivity, endothelial count, and patient satisfaction scores were evaluated. Patients were followed up at day 1, 6 weeks, 3 months, and 1 year after surgery, and visual outcomes and complications were documented. Results: The mean age of patients was 14.16 ± 3.49 years (range: 10–19 years). The mean intraocular lens power was − 12.20 diopter spherical (DS) in 23 eyes and − 2.25 diopter cylindrical (DC) in four patients. The mean unaided distant visual acuity (UDVA) and best-corrected visual acuity (BCVA) were 1.39 ± 0.25 and 0.40 ± 0.21 preoperatively on the log of minimum angle of resolution (logMAR) chart. Postoperatively, the visual acuity improved by 2.6 lines in 3 months period and maintained till 1 year. Postsurgery, contrast sensitivity in the amblyopic eyes significantly improved, and the average endothelial loss recorded was 5.78% at 1 year, which was statistically insignificant. Patient satisfaction score was statistically significant, with 4.736/5 recorded on the Likert scale. Conclusion: Posterior chamber phakic IOL is a safe, effective, and alternative method for treating amblyopia patients who are noncompliant with glasses, contact lenses, and keratorefractive procedures.

Taro mucilage is a cost-effective, eco-friendly, and water-soluble edible viscous polysaccharide, which possesses diverse techno-functional properties including gelling and anti-microbial. Therefore, the objective of this study was to formulate and evaluate the efficacy of taro mucilage nanohydrogel for the shelf-life enhancement of fresh-cut apples. Taro mucilage was extracted using cold water extraction, and the yield of mucilage was found to be 2.95 ± 0.35% on a dry basis. Different concentrations of mucilage (1, 2, 3, 4, and 5%) were used to formulate the nanohydrogel. A smaller droplet size of 175.61 ± 0.92 nm was observed at 3% mucilage, with a zeta potential of −30.25 ± 0.94 mV. Moreover, FTIR data of nanohydrogel revealed the functional groups of various sugars, uronic acids, and proteins. Thermal analysis of nanohydrogel exhibited weight loss in three phases, and maximum weight loss occurred from 110.25 °C to 324.27 °C (65.16%). Nanohydrogel showed shear-thinning fluid or pseudo-plastic behavior. Coating treatment of nanohydrogel significantly reduced the weight loss of fresh-cut apples (8.72 ± 0.46%) as compared to the control sample (12.25 ± 0.78%) on the 10th day. In addition, minor changes were observed in the pH for both samples during the 10 days of storage. Titrable acidity of control fresh-cut apples measured 0.22 ± 0.05% on day 0, rising to 0.42 ± 0.03% on the 10th day, and for coated fresh-cut apples, it was observed to be 0.24 ± 0.07% on the 0th day and 0.36 ± 0.06% on 10th day, respectively. Furthermore, the total soluble solids (TSS) content of both control and coated fresh-cut apples measured on the 0th day was 11.85 ± 0.65% and 12.33 ± 0.92%, respectively. On the 10th day, these values were significantly increased (p < 0.05) to 16.38 ± 0.42% for the control and 14.26 ± 0.39% for the coated sliced apples, respectively. Nanohydrogel-coated fresh-cut apples retained antioxidant activity and vitamin C content as compared to the control sample. Taro mucilage nanohydrogel-based edible coating showed distinct anti-microbial activity against psychrotrophic, aerobic, and yeast molds. In summary, taro mucilage nanohydrogel can be used as a cost-effective natural coating material for the shelf-life enhancement or freshness maintenance of fresh-cut apples.

IntroductionCD40 gene single-nucleotide polymorphisms (SNPs) have been associated with susceptibility and development of coronary artery abnormalities (CAAs) in children with Kawasaki disease (KD) in Japanese, Chinese, and Taiwanese populations. However, data on SNPs of the CD40 gene in patients with KD from the Indian subcontinent are not available. We studied the CD40 gene polymorphisms and its expression in children with KD from North India.MethodsSNPs of the CD40 gene (rs4810485, rs1535045) were studied using Sanger sequencing. CD40 expression was studied by flow cytometry. Meta-analysis was carried out to assess the role of both SNPs of the CD40 gene in KD. GRADEpro GDT software (v.3.2) was used to assess the “certainty of evidence.”ResultsForty-one patients with KD and 41 age-, sex-matched febrile controls were enrolled. However, none of the alleles and genotypes of the CD40 gene were found to be associated with KD. CD40 expression was higher in KD and in KD with CAAs compared to controls, but it failed to reach statistical significance. In a meta-analysis, the T allele of rs153045 was found to be significantly associated with KD (OR = 1.28; 95% confidence interval (: 1.09–1.50; p = 0.002). The GRADE of evidence for this outcome, however, is of “ very low certainty.”ConclusionThe present study found no association between SNPs (rs4810485 and rs153045) and susceptibility to KD. This could be a reflection of a modest sample size. CD40 expression was higher in KD and in KD with CAAs. In the meta-analysis, the T allele of rs153045 was significantly associated with KD. Our study confirms a significant genetic heterogeneity in KD among different ethnicities.

Due to shading conditions, solar photovoltaic (PV) arrays deliver less power compared to ideal operating conditions. Moving clouds, nearby telecom towers, and trees, among other things, are the basic causes that come under partial shading conditions (PSCs). Furthermore, PV array characterization carries multiple maximum power points (MPP) on the P–V characteristics. Distinguish the electrical connections of PV modules present in literature to show the diminishing effect of PSCs. In the present manuscript, existing Series–parallel (SP), bridge-link (BL), honey-comb (HC), total-cross-tied (TCT), and proposed Game Theory (PGT) puzzle-based rearrangements of PV array systems are employed and analysed during shading instances. The PGT puzzle-based arrangement shows higher shade-dispersion capability, which accounts for power enhancement (PE), improved fill factor (FF), and minimum power loss (PL). Over all, the considered performance indices are identified based on the behaviour of global and local maxima power point (LMPP and GMPP) locations on the obtained power–voltage (P–V) curves behaviour. The experimental system is developed and tested to obtain the performance of PGT higher side as 52.92ImVm, 59.67ImVm, 52.65ImVm, and 44.1ImVmcompared to existing approaches.

Dengue is an emerging illness in India, where it is endemic in some areas and sometimes causes yearly epidemics. Each dengue outbreak starts with high death and morbidity, which has a significant socioeconomic impact. As of September 30, 2022, India had 63,280 dengue cases, according to information provided by the National Centre for Vector Borne Diseases Control. North India is most severely impacted by each outbreak. In Uttar Pradesh, the state with the most population in India, there have been 2060 confirmed cases of dengue and 1 mortality till September 2022 reported. Patients are being reported from semi-urban, rural, and urban areas. It is essential to properly monitor disease cases through disease surveillance in order to ensure prompt case management if dengue outbreak control is to be achieved. An efficient diagnostic approach for early diagnosis is urgently required to reduce the severity of the sickness, the length of the hospital stay, and clinical consequences.

Abstract This paper discusses the umbrella optimizing technique (UOT), a novel approach to track maximum power point (MPP) of a solar photovoltaic (PV) system under partial shading conditions (PSCs).Since PSCs have a direct impact on the power generated by PV modules, many researchers have developed a variety of maximum power point tracking (MPPT) approaches to address this issue. Perturb and Observe (P&O) is a traditional method for tracking the maximum power of a PV module under PSCs. The fundamental issue with this traditional technique is that the algorithm misleads the step size and chases the wrong direction under PSCs to track MPP. The proposed algorithm finds the maximum power peak among several observed peaks caused by partial shading of a PV module. At each instance, the proposed algorithm checks for local or global peaks and adjusts the duty cycle of the inverse SEPIC DC–DC converter accordingly.In experimental study, UOT shows better performance in terms of tracking efficiency, tracking time, output power and output current.It exhibits a power boost of 3.39–4.14% with 9.09–16.66% faster tracking in different PSCs. A comparison of different optimization techniques illustrates that the UOT has higher tracking performance.

Abstract Inborn errors of immunity (IEI) are a heterogeneous group of monogenic disorders that include primary immunodeficiency’s and other disorders affecting different aspects of the immune system. Next-Generation Sequencing (NGS) is an essential tool to diagnose IEI. We report our 3-year experience in setting up facilities for NGS for diagnosis of IEI in Chandigarh, North India. We used a targeted, customized gene panel of 44 genes known to result in IEI. Variant analysis was done using Ion Reporter software. The in-house NGS has enabled us to offer genetic diagnoses to patients with IEI at minimal costs. Of 121 patients who were included pathogenic variants were identified in 77 patients. These included patients with Chronic Granulomatous Disease, Severe Combined Immune Deficiency, leukocyte adhesion defect, X-linked agammaglobulinemia, Ataxia Telangiectasia, Hyper-IgE syndrome, Wiskott Aldrich syndrome, Mendelian susceptibility to mycobacterial diseases, Hyper-IgM syndrome, autoimmune lymphoproliferative syndrome, and GATA-2 deficiency. This manuscript discusses the challenges encountered while setting up and running targeted NGS for IEI in our unit. Genetic diagnosis has helped our patients with IEI in genetic counselling, prenatal diagnosis, and accessing appropriate therapeutic options.

Antimicrobial Resistance (AMR) is a condition which occurs, when pathogens evolve and no longer respond to antibiotics, making infections more difficult to treat and leads to death. Apart from the truth that antibiotics have increased the life expectancy of human, AMR is a serious threat. AMR is a major public health threat declared by World Health Organisation (WHO) since 2014. During the different waves of the pandemic, patients with Coronavirus Disease-2019 (COVID-19) infection caused by the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) accounted for the majority of hospital admissions, frequently necessitating an antibiotic upon admission. Among hospitalised patients with COVID-19 infection, a major cause of mortality was mainly due to secondary infections, which was due to overuse of antibiotics and poor infection control procedures which may lead to rapid emergence of Multidrug Resistance (MDR). Before COVID-19 pandemic, AMR was estimated to kill around 700,000 people yearly that are predicted to increase upto 10 million by 2050. Before COVID-19 pandemic, there was lower incidence of hospital associated infections across world. AMR was surprisingly prevalent in patients with bacterial co-infections during the first 18 months of the COVID-19 pandemic. The latest update as per WHO guidance for antibiotic stewardship, which does not recommend antibiotic therapy or prophylaxis for patients with mild/moderate COVID-19 unless signs and symptoms of a bacterial infection. Now, the researchers must consider secondary bacterial infection rate, MDR isolation rate, and high mortality among COVID-19 with secondary infection. This shows the urgent need for surveillance, reinforcement of infection control practices and strict antimicrobial stewardship to combat increasing AMR.

Abstract Germline ATM gene variations result in phenotypic heterogeneity characterized by a variable degree of disease severity. We retrospectively collected clinical, genetic, and immunological data of 26 cases with A-T. Clinical manifestations included oculocutaneous telangiectasia (100%), ataxia (100%), fever, loose stools or infection (67%), cerebellar atrophy (50%), nystagmus (8%), dysarthria (15.38%), and visual impairment (8%). Genetic analysis confirmed ATM gene variations in 16 unrelated cases. The most common type of variation was stopgain variants (56%). Immunoglobulin profile indicated reduced IgA, IgG, and IgM in 94%, 50%, and 20% cases, respectively. T cell lymphopenia was observed in 80% of cases among those investigated. Unusual presentations included an EBV-associated smooth muscle tumour located in the liver in one case and Hyper IgM syndrome-like presentation in two cases. Increased immunosenescence was observed in T-cell subsets (CD4+CD57+ and CD8+CD57+). T-cell receptor excision circles (TRECs) were reduced in 3/8 (37.50%) cases.

Rotavirus is a major cause of severe acute gastroenteritis in infants and young children worldwide. It is responsible for 40% of childhood hospitalization. It has been estimated that about 23% of diarrhoeal death occurs due to the rotavirus infection in India. To study the epidemiology of rotavirus infection in children less than 5 years of age at a tertiary care teaching hospital. A total of 240 stool samples were collected from children

Aims: Breath frequency can alter cerebral blood flow. The study aimed to determine bilateral middle cerebral arterial hemodynamics in high-frequency yoga breathing (HFYB) and slow frequency alternate nostril yoga breathing (ANYB) using transcranial Doppler sonography. Methods: Healthy male volunteers were assessed in two separate trials before, during, and after HFYB (2.0 Hz for 1 min, n = 16) and ANYB (12 breaths per minute for 5 min, n = 22). HFYB and ANYB were separately compared to breath awareness (BAW) and to control sessions. Statistical Analysis: The data were analyzed using repeated-measures ANOVA with Bonferroni adjusted post hoc tests. Results: During HFYB there was a decrease in end-diastolic velocity (EDV) and mean flow velocity (MFV) (P < 0.01 for left and P < 0.05 for right middle cerebral arteries; MCA) with an increase in pulsatility index (PI) for the right MCA (P < 0.05). During ANYB, there was a bilateral decrease in peak systolic velocity (P < 0.05 for left and P < 0.01 for right MCA), EDV (P < 0.01) and MFV (P < 0.01 for left and P < 0.001 for right MCA) and an increase in PI (P < 0.01). During BAW of the two sessions there was a decrease in lateralized flow and end-diastolic velocities (P < 0.05) and an increase in PI (P < 0.05). Conclusions: Changes in peak flow velocities and pulsatility indices during and after HFYB, ANYB, and BAW suggest decreased cerebrovascular blood flow and increased flow resistance based on different mechanisms.

Riboflavin (Vitamin B2) is an essential vitamin and a microbial metabolite produced by some lactic acid bacteria (LAB). This investigation aims to study the overproduction of riboflavin in selected Lactiplantibacillus plantarum strain by using the one factor at a time (OFAT) tool coupled with the Fuzzy Inference System (FIS) and its validation through fermentative production in semi-defined media. Out of three Lactiplantibacillus strains used in this study, the maximum riboflavin producing strain was selected based on its ability to grow and produce higher levels of riboflavin. In results, Lactiplantibacillus plantarum strain MTCC 25432 was able to produce 346 µg/L riboflavin in riboflavin deficient assay medium and was investigated further. By using the OFAT–fuzzy FIS system, casamino acid in the range of 5–20 g/L, GTP 0.01–0.04 g/L, sodium acetate 5–15 g/L, and glycine 5–15 g/L were used to predict their effect on riboflavin production. The conditions optimized with modeling showed a 24% increment in riboflavin production (429 µg/L) by Lactiplantibacillus plantarum MTCC 25432 vis-a-vis the unoptimized counterpart (346 µg/L). In conclusion, an FIS-based predictive model was effectively implemented to estimate the riboflavin within an acceptable limit of 3.4%. Riboflavin production enhancing effects observed with various levels of sodium acetate, casamino acid, and GTP could be useful to re-design matrices for riboflavin production.

Abstract Background Lumbar canal stenosis (LCS) is a degenerative spinal disease of elderly people, and it not only impairs the mechanical activity but also alters the economic and mental status of the patients indirectly. This is single-center observational prospective study conducted for 2 years and included 30 consecutive operated patients of multilevel LCS patients and excluded the patients with single-level LCS, with primary LCS or with grade II subluxation. We analyzed the various measurement indices used for the surgical outcome assessment as ED-5D 5L and OLBPDI (Oswestry low back pain disability index). Statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 21.0 statistical Analysis Software. The independent t test, post hoc analysis, Wilcoxon signed rank statistic test and RM-ANOVA test were also applied. Result Most patients have improvement in pain and all the components of HRQoL (health-related quality of life) after surgery, which was further improved in mean follow-up of 1 year. Our study also suggested that the patients with higher anxiety/depression have higher pain intensity and low HRQoL, which was persistent in postoperative period (p

Pressure swing adsorption (PSA) is a widely used technology to separate a gas product from impurities in a variety of fields. Due to the complexity of PSA operations, process and instrument faults can occur at different parts and/or steps of the process. Thus, effective process monitoring is critical for ensuring efficient and safe operations of PSA systems. However, multi-bed PSA processes present several major challenges to process monitoring. First, a PSA process is operated in a periodic or cyclic fashion and never reaches a steady state; Second, the duration of different operation cycles is dynamically controlled in response to various disturbances, which results in a wide range of normal operation trajectories. Third, there is limited data for process monitoring, and bed pressure is usually the only measured variable for process monitoring. These key characteristics of the PSA operation make process monitoring, especially early fault detection, significantly more challenging than that for a continuous process operated at a steady state. To address these challenges, we propose a feature-based statistical process monitoring (SPM) framework for PSA processes, namely feature space monitoring (FSM). Through feature engineering and feature selection, we show that FSM can naturally handle the key challenges in PSA process monitoring and achieve early detection of subtle faults from a wide range of normal operating conditions. The performance of FSM is compared to the conventional SPM methods using both simulated and real faults from an industrial PSA process. The results demonstrate FSM’s superior performance in fault detection and fault diagnosis compared to the traditional SPM methods. In particular, the robust monitoring performance from FSM is achieved without any data preprocessing, trajectory alignment or synchronization required by the conventional SPM methods.

The work of forecasting solar power is becoming more crucial with directives to regulate the quality of the power and increase the system’s reliability as photovoltaic (PV) sites are being integrated into the architecture of power systems at an increasing rate. This study proposes a metaheuristic model for short-term photovoltaic power forecasting that includes shuffled frog leaping algorithm (SFLA), principal component analysis (PCA), and generalized regression neural network (GRNN). In this model, GRNN is implemented to analyze the input parameters after the dimension reduction process, and its parameters get optimized with the help of the SFLA, which has the advantage of fast convergence speed as well as searching ability, whereas PCA techniques are implemented to diminish the dimension of meteorological conditions. This hybrid model achieves day-ahead short-term forecasting, as shown in an experimental case of a Bhadla Solar Park installed in Gujarat, India. The accuracy of the proposed model obtained a mean absolute error (nMAE) of 2.3325, and a root mean square error (RMSE) of 129.425. Similarly, the error in forecasting obtained by the proposed method results in nMAE = 2.977 and RMSE = 160.92. The output results obtained surpassed all other hybrid models used for comparison in this study.

Abstract Globally, the reserves of heavy crude oil are seven times more abundant than that of light crude, and yet, they are underutilized because of their high viscosity and density, which is largely due to the presence of large amounts of asphaltenes. Biotransformation of heavy oil asphaltenes into smaller metabolites can be used for reducing their viscosity. Several microorganisms capable of asphaltene biodegradation have been reported but only few have been characterized for its biotransformation. In the present study, a 9-membered microbial consortium was isolated from an oil contaminated soil. About 72% and 75% asphaltene biotransformation was achieved by growing cells at shake flask level and in a 1.5 l bioreactor, respectively. A representative structure of asphaltene was constructed based on LC–MS, 1H-NMR, 13C-NMR, FT-IR, ICPMS and elemental analysis (CHNS) of n-heptane purified asphaltene from Maya crude oil. Biotransformation of asphaltene, as analyzed by performing 1H-NMR, FT-IR and elemental analysis, resulted in 80% decrease in S and N when compared to the control along with incorporation of oxygen in the structure of asphaltene. About 91% decrease in the viscosity of the Maya crude oil was observed after two weeks when oil: aqueous phase ratio was 1:9. The results suggest that the isolated microbial consortium can be used for biological upgradation of heavy crude oil. To our knowledge, this is the first report where a microbial consortium resulted in such high asphaltene biotransformation.

BackgroundReports of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome from developing countries are sparse. Recognizing PFAPA is often challenging in these regions due to a higher incidence of infectious illnesses and significant resource constraints. Herein, we present our experience from North India regarding the diagnosis and management of PFAPA syndrome.MethodsWe reviewed cases of non-monogenic periodic fever syndrome diagnosed at our center from January 2011 to December 2021. A total of 17 children who fulfilled the Marshall criteria for PFAPA syndrome were included. Data regarding basic clinical features, treatment/outcome, and performance of the recently proposed Eurofever/PRINTO and Takeuchi criteria were analyzed.ResultsBesides recurrent fever, the triad of oral aphthae, pharyngitis, and adenitis was noted in only 18% of patients. Episodes of exudative pharyngitis/tonsillitis were documented in 24%. These figures were lower than the values reported from developed countries. The Takeuchi and Eurofever/PRINTO criteria were fulfilled in 76% and 71% cases, respectively. In addition to antipyretics and supportive care, intermittent steroid therapy was the main treatment modality used. Additional treatment with colchicine (n = 3) and thalidomide (n = 1) was used successfully in a few patients. Before the diagnosis of PFAPA, all patients had received multiple courses of antimicrobials (without microbiological confirmation). These included multiple courses of antibacterials for fever, pharyngotonsillitis, and/or cervical adenitis in all patients and antivirals for fever and aphthous stomatitis in a patient. Empiric antitubercular therapy had also been administered in two patients.ConclusionsA significant proportion of patients with PFAPA seem to remain undiagnosed in the Indian subcontinent. Increased awareness and improvement in basic healthcare facilities are crucial in enhancing the recognition of PFAPA, which would eliminate the unprecedented scale of undesirable antimicrobial use in such children.

Papillon–Lefèvre syndrome (PLS) is a rare autosomal recessive disorder characterized clinically by palmoplantar keratoderma, periodontitis, and recurrent pyogenic infections. Liver abscess is rarely reported in patients. The use of corticosteroids for the treatment of liver abscess akin to chronic granulomatous disease (CGD) has not been reported previously. Here, we report 2 cases of liver abscess in PLS that responded to corticosteroids.

ObjectivesBlau syndrome (BS) is a rare autoinflammatory disease characterized by arthritis, dermatitis, and granulomatous uveitis in early childhood. The study presents the clinical experience of patients with BS at a tertiary care centre in Chandigarh, North India.MethodsAnalysis of the clinical profile of patients of BS with NOD2 gene mutations under follow-up was carried out.ResultsDiagnosis of BS was genetically confirmed in 11 patients (10 children and one adult; six male and five female patients) from 10 families. The median age of onset of symptoms was 12 months (range, 4 months–4 years), while the age at diagnosis ranged from 2.3 to 26 years. The classic triad of arthritis, dermatitis, and uveitis was present in 6/11 (54.5%) patients. The frequency of arthritis, dermatitis, and uveitis was 100%, 81.8%, and 72.7%, respectively. The median age at diagnosis of ocular symptoms was 4 years (range, 2–26 years). Family history was noted in six families. Renal involvement was observed in two children. All patients in our cohort had the R334W variant in NOD2 gene. An asymptomatic carrier sibling with R334W mutation was identified in one family. Methotrexate was used as a first-line agent in all children. Adalimumab, which was commenced in five patients with uveitis, resulted in significant improvement in four patients. The total follow-up duration of the present cohort is 1,063.8 patient-months.ConclusionsThe possibility of BS should always be considered in patients with arthritis and early ocular involvement. Uveitis is often progressive and refractory to currently available therapies. Systemic involvement appears to remain a significant cause of morbidity and mortality.

Although the placenta has robust defense mechanisms that protect the fetus from a viral infection, some viruses can manipulate or evade these mechanisms and disrupt physiology or cross the placental barrier. It is well established that the Zika virus is capable of vertical transmission from mother to fetus and can cause malformation of the fetal central nervous system (i.e., microcephaly), as well as Guillain-Barre syndrome in adults. This review seeks to gather and assess the contributions of translational research associated with Zika virus infection, including maternal-fetal vertical transmission of the virus. Nearly 200 inhibitors that have been evaluated in vivo and/or in vitro for their therapeutic properties against the Zika virus are summarized in this review. We also review the status of current vaccine candidates. Our main objective is to provide clinically relevant information that can guide future research directions and strategies for optimized treatment and preventive care of infections caused by Zika virus or similar pathogens.

To address inborn errors of immunity (IEI) which were underdiagnosed in resource-limited regions, our centre developed and offered free genetic testing for the most common IEI by Sanger sequencing (SS) since 2001. With the establishment of The Asian Primary Immunodeficiency (APID) Network in 2009, the awareness and definitive diagnosis of IEI were further improved with collaboration among centres caring for IEI patients from East and Southeast Asia. We also started to use whole exome sequencing (WES) for undiagnosed cases and further extended our collaboration with centres from South Asia and Africa. With the increased use of Next Generation Sequencing (NGS), we have shifted our diagnostic practice from SS to WES. However, SS was still one of the key diagnostic tools for IEI for the past two decades. Our centre has performed 2,024 IEI SS genetic tests, with in-house protocol designed specifically for 84 genes, in 1,376 patients with 744 identified to have disease-causing mutations (54.1%). The high diagnostic rate after just one round of targeted gene SS for each of the 5 common IEI (X-linked agammaglobulinemia (XLA) 77.4%, Wiskott–Aldrich syndrome (WAS) 69.2%, X-linked chronic granulomatous disease (XCGD) 59.5%, X-linked severe combined immunodeficiency (XSCID) 51.1%, and X-linked hyper-IgM syndrome (HIGM1) 58.1%) demonstrated targeted gene SS should remain the first-tier genetic test for the 5 common X-linked IEI.

Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency (PID). CVID is a heterogenous condition and clinical manifestations may vary from increased susceptibility to infections to autoimmune manifestations, granulomatous disease, polyclonal lymphoproliferation, and increased risk of malignancy. Autoimmune manifestations may, at times, be the first and only clinical presentation of CVID, resulting in diagnostic dilemma for the treating physician.Autoimmune cytopenias (autoimmune haemolytic anaemia and/or thrombocytopenia) are the most common autoimmune complications seen in patients with CVID. Laboratory investigations such as antinuclear antibodies, direct Coomb’s test and anti-platelet antibodies may not be useful in patients with CVID because of lack of specific antibody response. Moreover, presence of autoimmune cytopenias may pose a significant therapeutic challenge as use of immunosuppressive agents can be contentious in these circumstances. It has been suggested that serum immunoglobulins must be checked in all patients presenting with autoimmune cytopenia such as immune thrombocytopenia or autoimmune haemolytic anaemia.It has been observed that patients with CVID and autoimmune cytopenias have a different clinical and immunological profile as compared to patients with CVID who do not have an autoimmune footprint. Monogenic defects have been identified in 10-50% of all patients with CVID depending upon the population studied. Monogenic defects are more likely to be identified in patients with CVID with autoimmune complications. Common genetic defects that may lead to CVID with an autoimmune phenotype include nuclear factor kappa B subunit 1 (NF-kB1), Lipopolysaccharide (LPS)-responsive beige-like anchor protein (LRBA), cytotoxic T lymphocyte antigen 4 (CTLA4), Phosphoinositide 3-kinase (PI3K), inducible T-cell costimulatory (ICOS), IKAROS and interferon regulatory factor-2 binding protein 2 (IRF2BP2).In this review, we update on recent advances in pathophysiology and management of CVID with autoimmune cytopenias.

Deficiency of adenosine deaminase type 2 (DADA2) was first described in 2014 as a monogenic cause of polyartertitis nodosa (PAN), early onset lacunar stroke and livedo reticularis. The clinical phenotype of DADA2 is, however, very broad and may involve several organ systems. Apart from vasculitis, children may present with i) Hematological manifestations (ii) Lymphoproliferation and iii) Immunodeficiencies. Patients with DADA2 can have variable patterns of cytopenias and bone marrow failure syndromes. Patients with DADA2 who have predominant haematological manifestations are associated with ADA2 gene variants that result in minimal or no residual ADA2 activity. Lymphoproliferation in patients with DADA2 may range from benign lymphoid hyperplasia to lymphoreticular malignancies. Patients may present with generalized lymphadenopathy, splenomegaly, autoimmune lymphoproliferative syndrome (ALPS) like phenotype, Hodgkin lymphoma, T-cell large granular lymphocytic infiltration of bone marrow and multicentric Castleman disease. Immunodeficiencies associated with DADA are usually mild. Affected patients have variable hypogammaglobulinemia, decrease in B cells, low natural killer cells, common variable immunodeficiency and rarely T cell immunodeficiency. To conclude, DADA2 has an extremely variable phenotype and needs to be considered as a differential diagnosis in diverse clinical conditions. In this review, we describe the evolving clinical phenotypes of DADA2 with a special focus on haematological and immunological manifestations.

The unforgiving pace and complexity of modern life has greatly challenged our ability to live healthier and fully in the present moment. Industrialization, globalization, and competition in each sector lead to emotional stress and strain in life which is dangerous at the physical and mental levels. As per the classics of Ayurveda, chinta (stress) and atichintan (overthinking) are the causes of Rasavaha srotodushti which lead to many diseases. Shirodhara is an important healing technique of Ayurveda that has neuro-immuno-physio-psychological effects on the human body. Several studies have been carried out to evaluate the efficacy of Shirodhara in many diseases. A 35-yearold female patient with sleep deprivation, loss of concentration, and irritable mood symptoms was admitted to the hospital. She was assessed on the basis of the Profile Of Mood Score (POMS) questionnaire, Serum Cortisol (Sr. Cortisol), Dehydroepiandrosterone (DHEA). The patient was treated by Shirodhara with sesame oil for 14 days continuously. Results were assessed by biomarkers of stress and by POMS score. At the end of Shiroadhara, there was significant improvement found in presenting complaints as well as on the POMS Score and Stress biomarkers. During or after the treatment, no adverse events were observed.

Hereditary angioedema (HAE) is an uncommon disorder with a global prevalence of approximately 1 in 10,000 to 1 in 50,000 population. This disease is grossly underrecognized in India because of lack of awareness and/or lack of diagnostic facilities. Clinical manifestations include swelling over face, eyes, lips, hands, feet, and genitals, abdominal pain, and life-threatening laryngeal edema. HAE should be suspected in all patients who present with angioedema without wheals and who do not respond to antihistamines and/or steroids. C1 levels, C1-INH levels, and C1-INH function should be checked in all patients suspected to have HAE. C1q levels should be assessed in patients with suspected autoimmune-mediated acquired angioedema. Management of HAE constitutes the treatment of acute attack and short-term and long-term prophylaxis. Because of lack of all first-line recommended medications, the management of HAE in India is a challenging task. Patients are managed using fresh frozen plasma (acute treatment), tranexamic acid, and attenuated androgens (prophylaxis). Even though attenuated androgens have been shown to be effective in the prevention of attacks of HAE, the side effect profile especially in children and in females is a serious concern. Hence, the treatment needs to be individualized considering the risk-benefit ratio of long-term prophylaxis. In this review, we provide an overview of diagnostic strategy for patients with HAE and the current treatment concepts with emphasis on currently available treatment options in resource-constrained settings.

The presented work in this paper deals with various step sizes used in incremental conductance (INC) related to the maximum power point tracking (MPPT) technique. In the solar photovoltaic system, the variable step size selection method for INC is proposed and compared. The MATLAB/Simulink and hardware setup are used for assessing and analyzing step size methods. The variable step size (DVS), fixed step size (DFS) are comprehensively studied and compared. This DVS method is having a lower ON delay time $\left ({{T_{d_{ON}}} }\right)$ as 148 msec as regard to 164 msec in the DFS method. On the other hand, the lowest peak-peak oscillations in load current as 0.04 amp for DVS as compared to 0.5A for the DFS method, lower peak current as 1.96A for DVS as compare to 2.37A for the DFS method. In this way, the performance of the DVS method is found superior as it is analyzed and compared with the DFS algorithm.

Background: D. montana (Roxb.) is a medicinal plant cultivated throughout Eastern Asia, comprises several biologically active compounds, such as steroids, naphthoquinones, polyphenols, and flavonoids. Earlier reports revealed that D. montana has been used for anti-inflammatory, antiviral, anticancer, inhibitor of prostaglandin synthesis, hypolipidemic, and antileukemic agent. However, the anxiolytic activity of D. montana yet not explained. Therefore, the objective of this study is to investigate the anxiolytic effect of the methanolic extract of powder extracted from D. montana (Roxb.) leaves. Method: The anxiolytic activity was evaluated in an open-field test (OFT), hole board test (HBT) and elevated plus maze test (EPM). The rats received an oral pre-treatment of methanolic extract of Diospyros montana (MDM) (50, 100, 200 mg/kg; p.o.) for 7 days and the anxiolytic activity were estimated in experimental rat models. Result: MDM (100 and 200 mg/kg) and diazepam increased behaviour parameters in hole board test in terms of head-dip, a ratio of head-dip/sniffing, and decreased sniffing activity. Further, MDM (100 and 200 mg/kg) and diazepam increased behavioural performance in the EPM and OFT test paradigm. Treatment with MDM (100 and 200 mg/kg) and diazepam increased serotonin level and mRNA expression of the 5-HT2A receptor in the amygdala of experimental rats. In an additional set of experiments, in OFT, HBT and EPM studies, flumazenil attenuated the anxiolytic effect of the minimum effective dose of MDM (100 mg/kg), suggesting the mechanism mediated by the GABAA receptor. Furthermore, MDM-100 mg/kg has shown a lack of sedative-like effect relative to diazepam (6 mg/kg, p.o.) in the OFT and EPM test paradigm. Conclusion: The present findings indicate that anxiolytic effect of MDM may involve GABA and serotonin mediated mechanisms, and MDM can be a potential therapeutic agent for the management of anxiety illustrated in fig-11.

Kawasaki disease (KD) is a medium vessel vasculitis with predilection to cause coronary artery abnormalities. KD is now the most common cause of acquired heart disease in developed countries. Thrombocytosis is consistently found in patients with KD, usually in 2nd to 3rd week of illness. Thrombocytopenia has occasionally been reported in the acute phase of KD. An increase or decrease in platelet number in patients with KD was initially considered to be a benign phenomenon. However, recent literature on platelet biology in KD has suggested that platelets are not only increasing but are rather activated. This phenomenon has been found to increase the risk of thrombosis in these patients. Similarly a fall in platelet counts during acute stage of KD has also been found to be associated with increased severity of disease. In this review, we update on the current best understanding about pathogenic role of platelets in patients with KD. Keywords: Aspirin, CD40 ligand, Kawasaki disease, Platelet derived microparticles, Platelets, Thrombosis

Hereditary angioedema (HAE) is an uncommon genetic disorder characterized by recurrent episodes of edema involving subcutaneous tissue and submucosa. The pathogenesis of HAE reflects an intricate coordinated regulation of components of complement, kinin and hemostatic pathway. Till date, mutations in 4 different genes have been identified to cause HAE which includes serine protease inhibitor G1 (SERPING1), factor XII (F12), plasminogen (PLG) and angiopoietin 1 (ANGPT 1). These mutations lead to increased bradykinin 2 receptor mediated signalling via increased production of bradykinin except mutations in ANGPT1 gene that disturbs the cytoskeletal assembly of vascular endothelial cells. In this review we aim to summarize the recent advances in the pathogenesis and genetics of HAE. We also provide an overview of possible future prospects in the identification of new genetic defects in HAE. Keywords: Angiopoietin 1, C1 inhibitor, Factor XII, Genetics, Hereditary angioedema, Plasminogen

Common variable immunodeficiency disorders (CVID), a heterogeneous group of inborn errors of immunity, is the most common symptomatic primary immunodeficiency disorder. Patients with CVID have highly variable clinical presentation. With the advent of whole genome sequencing and genome wide association studies (GWAS), there has been a remarkable improvement in understanding the genetics of CVID. This has also helped in understanding the pathogenesis of CVID and has drastically improved the management of these patients. A multi-omics approach integrating the DNA sequencing along with RNA sequencing, proteomics, epigenetic and metabolomics profile is the need of the hour to unravel specific CVID associated disease pathways and novel therapeutic targets. In this review, we elaborate various techniques that have helped in understanding the genetics of CVID. Keywords: Common variable immunodeficiency (CVID), Epigenome, Genetics, Next generation sequencing (NGS), Transcriptome

Primary Immunodeficiency Diseases (PIDs) are increasingly being reported across the World. Several advances have been made in the diagnostic and therapeutic research related to PIDs. With increasing awareness, the field of PIDs has rapidly evolved in Asia as well. In this review, we summarize the progress that has been made in the field of PIDs in Asian countries; major limitations and challenges faced by the clinicians working in this field in Asia; difference in spectrum of PIDs in Asia from rest of the World; current state of diagnostic and treatment facilities available in various countries in Asia and the future prospects of these diseases in the continent. Keywords: Asia, Genetic diagnosis, Hematopoietic stem cell transplant, Intravenous immunoglobulin, Primary immunodeficiency diseases

Activated Phosphoinositide 3-kinase δ syndrome (APDS) is a newly recognised primary immunodeficiency disease. It has currently been a hot topic of clinical research and new data are emerging regarding its pathogenesis, clinical manifestations and treatment. Patients with APDS syndrome have significant autoimmune manifestations and lymphoproliferation. It is important to differentiate APDS from the usual polygenic CVID in view of the availability of targeted therapy like mTOR inhibitors such as Rapamycin and selective PI3Kδ inhibitors. We provide a comprehensive review on this interesting disorder focusing light on its etiology, genetic research and emerging therapy. Keywords: Activated phosphoinositide 3-kinase δ syndrome (APDS), Gain of function, Immunodeficiency, Lymphadenopathy, Lymphoproliferation, p110δ-activating mutation causing senescent T cells

Introduction: In this current era of the pandemic, when the Covid-19 pandemic rapidly spread across the world, the population at a large scale suffered from fear, worry, and certain concern regarding himself/herself as well as for their families especially adults and children. A significant level of stress also developed in health care providers. Many people all over the world are suffering from loneliness, anxiety, and disturbed mental health issues during lockdown, quarantines, and isolation. Mental health is one of the important factors for overall health. No vaccination or treatment available for COVID-19 till today. The only approach is the preventive and promotive approach. Psychological issues also hamper our physical health and level of immunity. Objective: In this study, an attempt has been made to critically review the role of yoga against the current pandemic. Data Source and Review Methods: References are searched from various authoritative texts and worldwide accepted scientific databases concerning the effect of yoga in the different body systems, immune system as well as on mental health. Result: The psychophysical approach which helps in reducing the mental issue maintains mental health and reduces stress as well as boosts our immunity against communicable diseases like COVID-19 is Yoga. Discussion: Yoga is cost-effective, may be practiced as a self-care treatment against physical and mental health issues, enhance self-efficacy and self-confidence. Yoga may be effective as a supportive adjunct in some medical conditions. Conclusion: This review summarizes the effects of yoga interventions against the current pandemic as well as helps to understand the preventive and health promotive aspect of yoga on various components of mental and physical health.