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Type III effectors (T3Es) are major determinants of Xanthomonas virulence and targets for resistance breeding. XopJ2 (synonym AvrBsT) is a highly conserved YopJ-family T3E acquired by X. perforans, the pathogen responsible for bacterial spot disease of tomato. In this study, we characterized a new variant (XopJ2b) of XopJ2, which is predicted to have a similar three-dimensional (3D) structure as the canonical XopJ2 (XopJ2a) despite sharing only 70% sequence identity. XopJ2b carries an acetyltransferase domain and the critical residues required for its activity, and the positions of these residues are predicted to be conserved in the 3D structure of the proteins. We demonstrated that XopJ2b is a functional T3E and triggers a hypersensitive response (HR) when translocated into pepper cells. Like XopJ2a, XopJ2b triggers HR in Arabidopsis that is suppressed by the deacetylase, SOBER1. We found xopJ2b in genome sequences of X. euvesicatoria, X. citri, X. guizotiae, and X. vasicola strains, suggesting widespread horizontal transfer. In X. perforans, xopJ2b was present in strains collected in North America, Africa, Asia, Australia, and Europe, whereas xopJ2a had a narrower geographic distribution. This study expands the Xanthomonas T3E repertoire, demonstrates functional conservation in T3E evolution, and further supports the importance of XopJ2 in X. perforans fitness on tomato. [Figure: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

The emergence of plant pathogens is often associated with waves of unique evolutionary and epidemiological events. Xanthomonas hortorum pv. gardneri is one of the major pathogens causing bacterial spot disease of tomatoes. After its first report in the 1950s, there were no formal reports on this pathogen until the 1990s, despite active global research on the pathogens that cause tomato and pepper bacterial spot disease. Given the recently documented global distribution of X. hortorum pv. gardneri, our objective was to examine genomic diversification associated with its emergence. We sequenced the genomes of X. hortorum pv. gardneri strains collected in eight countries to examine global population structure and pathways of emergence using phylodynamic analysis. We found that strains isolated post-1990 group by region of collection and show minimal impact of recombination on genetic variation. A period of rapid geographic expansion in X. hortorum pv. gardneri is associated with acquisition of a large plasmid conferring copper tolerance by horizontal transfer and coincides with the burgeoning hybrid tomato seed industry through the 1980s. The ancestry of X. hortorum pv. gardneri is consistent with introduction to hybrid tomato seed production and dissemination during the rapid increase in trade of hybrid seeds. [Figure: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

Abstract Background Bacterial spot of pepper (BSP), caused by four different Xanthomonas species, primarily X. euvesicatoria (Xe), poses a significant challenge in pepper cultivation. Host resistance is considered the most important approach for BSP control, offering long-term protection and sustainability. While breeding for resistance to BSP for many years focused on dominant R genes, introgression of recessive resistance has been a more recent focus of breeding programs. The molecular interactions underlying recessive resistance remain poorly understood. Results In this study, transcriptomic analyses were performed to elucidate defense responses triggered by Xe race P6 infection by two distinct pepper lines: the Xe-resistant line ECW50R containing bs5, a recessive resistance gene that confers resistance to all pepper Xe races, and the Xe-susceptible line ECW. The results revealed a total of 3357 upregulated and 4091 downregulated genes at 0, 1, 2, and 4 days post-inoculation (dpi), with the highest number of differentially expressed genes (DEGs) observed at 2 dpi. Pathway analysis highlighted DEGs in key pathways such as plant-pathogen interaction, MAPK signaling pathway, plant hormone signal transduction, and photosynthesis – antenna proteins, along with cysteine and methionine metabolism. Notably, upregulation of genes associated with PAMP-Triggered Immunity (PTI) was observed, including components like FLS2, Ca-dependent pathways, Rboh, and reactive oxygen species (ROS) generation. In support of these results, infiltration of ECW50R leaves with bacterial suspension of Xe led to observable hydrogen peroxide accumulation without a rapid increase in electrolyte leakage, suggestive of the absence of Effector-Triggered Immunity (ETI). Furthermore, the study confirmed that bs5 does not disrupt the effector delivery system, as evidenced by incompatible interactions between avirulence genes and their corresponding dominant resistant genes in the bs5 background. Conclusion Overall, these findings provide insights into the molecular mechanisms underlying bs5-mediated resistance in pepper against Xe and suggest a robust defense mechanism in ECW50R, primarily mediated through PTI. Given that bs5 provides early strong response for resistance, combining this resistance with other dominant resistance genes will enhance the durability of resistance to BSP.

Background: Development of obscured fingerprints on a diverse range of surfaces is a crucial aspect of forensic investigations. Aims and Objectives: In this particular study, the utilization of Syzygium cumini (L.) Skeels (Jamun) seed powder was examined for the purpose of revealing hidden fingerprints on a variety of surfaces, including both permeable and impermeable substrates. Materials and Methods: The seed powder was extracted using a simple process and was analysed using multiple analytical techniques. The efficacy of the jamun seed powder in developing latent fingerprints was evaluated. Results: The findings of this investigation demonstrate that the jamun seed powder was capable of producing fingerprint patterns of exceptional quality and clarity on numerous surfaces. Conclusion: This research highlights the potential use of jamun seed powder as a practical and effective alternative for the development of hidden fingerprints in forensic investigations, while also providing cost-effectiveness.

BackgroundGlaucoma is the leading cause of permanent blindness. Primary angle closure glaucoma (PACG) is diagnosed only after the onset of symptoms and can result in irreversible blindness despite the standard intraocular pressure (IOP) reduction therapy. The identification of potential biomarkers associated with prognosis will help improve disease management. This study aimed to identify mechanisms associated with disease progression, potential biomarkers, and therapeutic targets of PACG.MethodsThe clinical data assessment of IOP, cup/disc ratio (CDR), Retinal Nerve Fiber Layer (RNFL) thickness of control, and PACG group were collected and analyzed for significant differences. The ATP levels were estimated, and targeted metabolomic analysis was performed on aqueous humor and cytokines in plasma. The pathways obtained from the metabolomics data set were compared with those obtained for data sets from the literature. Clinical parameters were correlated with cytokine levels. Targeted metabolomic analysis of cell culture supernatant from TNFα-treated N9 microglia was carried out, and overlap analysis was performed with data obtained from PACG patients.ResultsElevated IOP, CDR, ATP, cytokines, and reduced RNFL thickness were found in PACG compared to controls. Analysis of PACG and TNFα-treated N9 microglial cell culture supernatant shows activation of immuno-metabolites. The metabolic pathways of PACG, TNFα, and ATP-treated microglia from the literature show considerable overlap. Biomarker analysis identified clinical parameters, ATP, cytokines, and immuno-metabolites.ConclusionThis study shows an association between elevated levels of ATP, cytokines, immuno-metabolism, and potential microglial inflammation with disease progression, rendering these levels potential biomarkers. P2 receptors, cytokines, and IDO1/2 could be potential therapeutic targets.

This study aims to identify generative AI (GenAI) applications and develop a roadmap for the near, mid, and far future. Structural topic modeling (STM) is used to discover latent semantic patterns and identify the key application areas from a text corpus comprising 2,398 patents published between 2017 and 2023. The study identifies six latent topics of GenAI application, including object detection and identification; medical applications; intelligent conversational agents; image generation and processing; financial and information security applications; and cyber-physical systems. Emergent topic terms are listed for each topic, and inter-topic correlations are explored to understand the thematic structures and summarize the semantic relationships among GenAI application areas. Finally, a technology roadmap is developed for each identified application area for the near, mid, and far future. This study provides valuable insights into the evolving GenAI landscape and helps practitioners make strategic business decisions based on the GenAI roadmap.

Effective planning, management, and control of industrial plants and processes have exploded in popularity to enhance global sustainability in recent decades. In this arena, computational predictive models have significantly contributed to plant performance optimization. In this regard, this research proposes an Improvised Grey Wolf Optimizer (IGWO) aided Artificial Neural Network (ANN) predictive model (IGWO-ANN Model-1 to 4) to predict the performance (permeate flux) of desalination plants accurately. For this, the proposed models investigated experimental inputs four: salt concentration & feed flow rate, condenser & evaporator inlet temperatures of the plant. Besides, mean squared error (MSE) and the regression coefficients (R2) have been used to assess the models' accuracy. The proposed IGWO-ANN Model-4 shows strong optimization abilities and provides better R2 = 99.3 % with minimum errors (0.004) compared to existing Response Surface Methodology (RSM) (R2 = 98.5 %, error = 0.100), ANN (R2 = 98.8 %, error = 0.060), GWO-ANN (R2 = 98.8 % error = 0.008), models. The proposed models are multitasking, multilayers, and multivariable, capable of accurately analyzing the desalination plant's performance, and suitable for other industrial applications. This study yielded a promising outcome and revealed the significant pathways for the researchers to analyze the desalination plant's performance to save time, money, and energy.

Rapidly evolving bacterial pathogens pose a unique challenge for long-term plant disease management. In this study, we investigated the types and rate of mutations in bacterial populations during seasonal disease epidemics. Two phylogenetically distinct strains of the bacterial spot pathogen, Xanthomonas perforans, were marked, released in tomato fields, and recaptured at several time points during the growing season. Genomic variations in recaptured isolates were identified by comparative analysis of their whole-genome sequences. In total, 180 unique variations (116 substitutions, 57 insertions/deletions, and 7 structural variations) were identified from 300 genomes, resulting in the overall host-associated mutation rate of ∼0.3 to 0.9/genome/week. This result serves as a benchmark for bacterial mutation during epidemics in similar pathosystems. [Graphic: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

Naturalistic driving studies (NDS) are an increasingly popular method to research driving behavior. They often result in large amounts of data varying in source and format (videos, spatial, and time-series data). Traditional data processing systems and analytical methods are not equipped to handle the large influx of data, often ranging from terabytes to petabytes. Previously, big data analytics platforms have been designed to address specific use cases of intelligent transport systems such as traffic flow prediction, transportation planning, and traffic safety. Similarly, there is a need for robust data systems for storing, mining, visualizing, and analyzing big naturalistic data. This paper presents a comprehensive cloud-based AI platform, Deep Insight, designed for data management, modeling, and enhanced annotations of naturalistic driving data. The platform capitalizes on Amazon Web Services, hosting a repository of public and privately collected NDS datasets with tool integration for data annotation and machine learning modeling that permits data analysis and inference. This end-to-end framework provides effective and reliable tools for storing, processing, annotating, and modeling NDS datasets. Additionally, the platform hosts a metric dashboard for benchmarking and displaying the performance of diverse analytical models using a standard dataset. The authors present a case study classifying a driver's head movement to demonstrate this framework’s workflow using Deep Insight and integrated tools. This cloud-based platform offers a wide range of cost, access, scalability, and security benefits, supporting goals to create a one-stop, standardized destination for analyzing naturalistic driving data and studying driver behavior.

Movement-specific vehicle classification and counting at traffic intersections is a crucial component of various traffic management activities. In this context, with recent advancements in computer-vision-based techniques, cameras have emerged as a reliable data source for extracting vehicular trajectories from traffic scenes. However, classifying these trajectories by movement type is quite challenging, as characteristics of motion trajectories obtained this way vary depending on camera calibrations. Although some existing methods have addressed such classification tasks with decent accuracies, the performance of these methods significantly relied on the manual specification of several regions of interest. In this study, we proposed an automated classification method for movement-specific classification (such as right-turn, left-turn and through movements) of vision-based vehicle trajectories. Our classification framework identifies different movement patterns observed in a traffic scene using an unsupervised hierarchical clustering technique. Thereafter, a similarity-based assignment strategy is adopted to assign incoming vehicle trajectories to identified movement groups. A new similarity measure was designed to overcome the inherent shortcomings of vision-based trajectories. Experimental results demonstrated the effectiveness of the proposed classification approach and its ability to adapt to different traffic scenarios without any manual intervention.

ABSTRACTQuickly understanding the genomic changes that lead to pathogen emergence is necessary to launch mitigation efforts and reduce harm. In this study, we tracked in real time a 2022 bacterial plant disease outbreak in U.S. geraniums (Pelargonium × hortorum) caused by Xhp2022, a novel lineage of Xanthomonas hortorum. Genomes from 31 Xhp2022 isolates from seven states showed limited chromosomal variation and all contained a single plasmid (p93). Time tree and single nucleotide polymorphism whole-genome analysis estimated that Xhp2022 emerged within the last decade. The phylogenomic analysis determined that p93 resulted from the cointegration of three plasmids (p31, p45, and p66) found sporadically across isolates from previous outbreaks. Although p93 had a 49 kb nucleotide reduction, it retained putative fitness genes, which became predominant in the 2022 outbreak. Overall, we demonstrated, through rapid whole-genome sequencing and analysis, a recent, traceable event of genome reduction for niche adaptation typically observed over millennia in obligate and fastidious pathogens.IMPORTANCEThe geranium industry, valued at $4 million annually, faces an ongoing Xanthomonas hortorum pv. pelargonii (Xhp) pathogen outbreak. To track and describe the outbreak, we compared the genome structure across historical and globally distributed isolates. Our research revealed Xhp population has not had chromosome rearrangements since 1974 and has three distinct plasmids. In 2012, we found all three plasmids in individual Xhp isolates. However, in 2022, the three plasmids co-integrated into one plasmid named p93. p93 retained putative fitness genes but lost extraneous genomic material. Our findings show that the 2022 strain group of the bacterial plant pathogen Xanthomonas hortorum underwent a plasmid reduction. We also observed several Xanthomonas species from different years, hosts, and continents have similar plasmids to p93, possibly due to shared agricultural settings. We noticed parallels between genome efficiency and reduction that we see across millennia with obligate parasites with increased niche specificity.

Background: Non-invasive assessment methods to assess liver fibrosis are important tools where FibroScan or liver biopsy is not accessible. This study aims to assess the efficacy and performance of the fibrosis index based on four factors (FIB-4) and aspartate transaminase-to-platelet ratio index (APRI) to evaluate liver fibrosis against FibroScan for the stages of liver fibrosis in obese type-2 diabetic patients. Methods: This was a cross-sectional study conducted in a tertiary care center in Bihar, India, and the patients were enrolled within two years. During the study period, 80 patients with a confirmed diagnosis of type-2 diabetes mellitus were selected. Laboratory blood testing and FibroScan were performed in all patients with T2DM. APRI and FIB-4 were calculated using a standard formula involving laboratory parameters. Result: The performance of FIB-4 scores is nearly similar to APRI, with the area under the curve (AUC) 0.753, (95% CI) (0.711-0.795) (p

Background: Cysticercosis is a parasitic infection caused by the larval form of the tapeworm Taenia solium, typically characterized by cystic formations within various human tissues, most commonly found in the brain and orbit. However, cysticercosis occurring in the craniofacial region, aside from the cerebral and orbital regions, is considered atypical. Case Presentation: In this report, we present an unusual case of a patient who presented with lateral neck swelling. Upon thorough evaluation, the patient was diagnosed with solitary cysticercosis of the sternocleidomastoid muscle (SCM). This case is exceptional due to its infrequency and highlights the importance of considering parasitic infections in the assessment of neck swelling cases. Effective management of this medical condition is achievable through medical interventions. High-resolution sonography has proven to be a reliable diagnostic tool and is valuable for ongoing surveillance. Conclusion: This case report emphasizes the significance of timely identification and proper treatment of cysticercosis, even in atypical anatomical sites such as the SCM.

MobiScout is an iOS application designed to monitor users' driving habits and physiological conditions on the road. This app offers a cost-effective, next-generation solution for data collection and analysis in naturalistic driving studies. MobiScout captures real-time data, encompassing physiological information, using sensors on mobile phones, smartwatches, and Bluetooth-enabled OBD equipment. The software records data such as speed, braking, pulse rate, and acceleration, while the phone's camera captures both the interior and exterior views of the car. Data can either be streamed to cloud storage in real-time or stored locally in areas without WIFI. The acquired data serves to enhance our understanding of typical traffic behavior, driver performance, and surrounding conditions.

Abstract Purpose: To report a case of a rare disease entity Posterior Microphthalmos Pigmentary Retinopathy Syndrome (PMPRS) in a 47-year-old female with a brief review of literature. Case Report: A 47-year-old woman presented with a history of defective vision with an associated difficulty in night vision. Clinical workup was done, which included a thorough ocular examination showing diffuse pigmentary mottling of fundus, ocular biometry showing short axial length with normal anterior segment dimensions, electroretinography showing extinguished response, optical coherence tomography showing foveoschisis, and ultrasonography showing thickened sclera–choroidal complex. Findings were consistent with those reported by other authors with PMPRS. Conclusion: Posterior microphthalmia with or without other ocular and systemic associations should be suspected in cases with high hyperopia. It is mandatory to carefully examine the patient at presentation and close follow-ups are needed to maintain visual function.

Sufficient high-quality traffic data are a crucial component of various Intelligent Transportation System (ITS) applications and research related to congestion prediction, speed prediction, incident detection, and other traffic operation tasks. Nonetheless, missing traffic data are a common issue in sensor data which is inevitable due to several reasons, such as malfunctioning, poor maintenance or calibration, and intermittent communications. Such missing data issues often make data analysis and decision-making complicated and challenging. In this study, we have developed a generative adversarial network (GAN) based traffic sensor data imputation framework (TSDIGAN) to efficiently reconstruct the missing data by generating realistic synthetic data. In recent years, GANs have shown impressive success in image data generation. However, generating traffic data by taking advantage of GAN based modeling is a challenging task, since traffic data have strong time dependency. To address this problem, we propose a novel time-dependent encoding method called the Gramian Angular Summation Field (GASF) that converts the problem of traffic time-series data generation into that of image generation. We have evaluated and tested our proposed model using the benchmark dataset provided by Caltrans Performance Management Systems (PeMS). This study shows that the proposed model can significantly improve the traffic data imputation accuracy in terms of Mean Absolute Error (MAE) and Root Mean Squared Error (RMSE) compared to state-of-the-art models on the benchmark dataset. Further, the model achieves reasonably high accuracy in imputation tasks even under a very high missing data rate (>50%), which shows the robustness and efficiency of the proposed model.

This study assessed the impact of age-related cognitive and visual declines on stop-controlled intersection stopping and scanning behaviors across varying roadway, traffic, and environmental challenges.Real-world driver data, collected from drivers’ personal vehicles using in-vehicle sensor systems, was analyzed in 68 older adults (65–90 years old) with and without mild cognitive impairment (MCI) and with a range of age-related visual declines. Driver behavior, environmental characteristics, and traffic characteristic were examined across 2,596 approaches at 173 stop-controlled intersections. A mixed-effects logistic regression modeled stopping behavior as a binary response (full stop or rolling/no-stop).Overall, drivers who scanned more on intersection approaches (OR = 0.77) or had more visual decline (OR = 2.28) were more likely to make full stops at a stop-controlled approach. Drivers with a contrast sensitivity logMAR score > 0.8 showed the greatest probability of making a full stop compared across all drivers. Drivers without MCI were ∼ 5 times more likely to come to a full stop when they scanned more (23 % versus 5 % when they scanned less) compared to drivers with MCI, who were only twice as likely to stop (14 % versus 6 % when they scanned less). Drivers were more likely to fully stop on two-lane roadways (1.5 %), during night (2.0 %), and at intersections with opposing vehicles (10.4 %).Findings illuminate how driver strategies interact with underlying impairment. While drivers with visual decline adopt strategies that may improve safety, when drivers with MCI adopt strategies it did not result in the same degree of improvement in stopping which may result in greater risk.

Introduction: The knowledge of the effect of sociodemographic and disease-related factors on health-related quality of life (HRQoL) among people living with HIV/AIDS (PLWHA) is important for planning comprehensive health-care services for them. Material and Methods: Two hundred PLWHA on antiretroviral therapy (ART) volunteered to complete a self-reported World Health Organization's Quality of Life‒HIV brief questionnaire (WHOQoL-HIV-BREF) that examines six domains each with four items (physical, psychological, level of independence, social, environmental, and spiritual) with 25 facets and additional 5 facets specific to PLWHA (symptoms of HIV, social inclusion, forgiveness, worries about the future, and death and dying). Results: Only 135 questionnaires from 73 (53.3%) men and 63 (46.7%) women (male: female – 1.14:1) aged 20–82 years (mean ± standard deviation: 42.9 ± 10.5 years) were found complete. Eighty-five (63%) individuals were aged 41–60 years, 78 (57.8%) individuals were matriculates, graduates, or postgraduates, 76 (56.3%) respondents were married, and 38 (28.1%) were widows/widowers. Staying-alone workers comprised 43 (31.8%) individuals. Overall health and HRQoL were rated satisfactory (n = 85.2%) and good/very good (n = 74.8%) by a significantly greater number of individuals (P = 0.001). Pearson's Chi-squared test showed no statistically significant (P > α) associations between good HRQoL and variables such as age >40 years, gender, education, marital status, duration of disease, disclosure of serostatus to family, ART for >3 years, and CD4 >200 cells/mL. Conclusion: Regular ART can result in adequate control of immunosuppression and no comorbidities in a majority of PLWHA, family and social acceptance, and financial security can result in overall good HRQoL in all six domains within the WHOQoL-HIV-BREF. The study is limited by its cross-sectional study design and small sample size.

Abstract Background Hyaluronic acid (HA) promotes cancer metastasis; however, the currently approved treatments do not target HA. Metastatic renal carcinoma (mRCC) is an incurable disease. Sorafenib (SF) is a modestly effective antiangiogenic drug for mRCC. Although only endothelial cells express known SF targets, SF is cytotoxic to RCC cells at concentrations higher than the pharmacological-dose (5-µM). Using patient cohorts, mRCC models, and SF combination with 4-methylumbelliferone (MU), we discovered an SF target in RCC cells and targeted it for treatment. Methods We analyzed HA-synthase (HAS1, HAS2, HAS3) expression in RCC cells and clinical (n = 129), TCGA-KIRC (n = 542), and TCGA-KIRP (n = 291) cohorts. We evaluated the efficacy of SF and SF plus MU combination in RCC cells, HAS3-transfectants, endothelial-RCC co-cultures, and xenografts. Results RCC cells showed increased HAS3 expression. In the clinical and TCGA-KIRC/TCGA-KIRP cohorts, higher HAS3 levels predicted metastasis and shorter survival. At > 10-µM dose, SF inhibited HAS3/HA-synthesis and RCC cell growth. However, at ≤ 5-µM dose SF in combination with MU inhibited HAS3/HA synthesis, growth of RCC cells and endothelial-RCC co-cultures, and induced apoptosis. The combination inhibited motility/invasion and an HA-signaling-related invasive-signature. We previously showed that MU inhibits SF inactivation in RCC cells. While HAS3-knockdown transfectants were sensitive to SF, ectopic-HAS3-expression induced resistance to the combination. In RCC models, the combination inhibited tumor growth and metastasis with little toxicity; however, ectopic-HAS3-expressing tumors were resistant. Conclusion HAS3 is the first known target of SF in RCC cells. In combination with MU (human equivalent-dose, 0.6–1.1-g/day), SF targets HAS3 and effectively abrogates mRCC.

In the recent upsurge in environmental concerns, business sustainability has become more prominent than ever. Organizations worldwide are expected to function sustainably, causing the least negative impact on the environment and promoting harmony among the firm, environment, and society. Most firms report their actions related to sustainability in corporate social responsibility (CSR) reports. This research aims to understand and analyze contemporary trends in CSR reports by Fortune 500 companies using text mining. It compares how the focus of sustainability reports varies across countries and industries along key dimensions of sustainability (i.e., environmental, economic, social, and government). Findings from the study suggest variations in the focus of sustainability reports based on various factors, such as country of origin and company size, sector, and tenure, on the Fortune 500 list. Thus, it helps to gain a deeper understanding of the company’s motivations for focusing on various dimensions of corporate sustainability.

Bacterial spot caused by Xanthomonas euvesicatoria is a major disease of pepper (Capsicum annuum L.) in warm and humid production environments. Use of genetically resistant cultivars is an effective approach to manage bacterial spot. Two recessive resistance genes, bs5 and bs6, confer non-race-specific resistance against bacterial spot. The objective of our study was to map these two loci in the pepper genome. We used a genotyping-by-sequencing approach to initially map the position of the two resistances. Segregating populations for bs5 and bs6 were developed by crossing susceptible Early CalWonder (ECW) with near-isogenic lines ECW50R (bs5 introgression) or ECW60R (bs6 introgression). Following fine-mapping, bs5 was delimited to a ~535 Kbp interval on chromosome 3, and bs6 to a ~666 Kbp interval in chromosome 6. We identified 14 and 8 candidate resistance genes for bs5 and bs6, respectively, based on predicted protein coding polymorphisms between ECW and the corresponding resistant parent. This research enhances marker-assisted selection of bs5 and bs6 in breeding programs and is a crucial step towards elucidating the molecular mechanisms underlying the resistances.

Background: The TNM stage is the widely accepted tool to predict prognosis in breast cancer cases, but it deals with a limited range of factors and ignores patient-specific conditions, pathological or genotype characteristics and treatments. The purpose of this study was to evaluate if and how different clinical (tobacco chewing, age etc) and pathological (lymphovascular and perineural invasion etc) variables influence the disease free survival. Material and Methods: This study involves North Eastern Indian population. Data of 101 patients with locally advanced breast cancer diagnosed in the time period of January to December 2018 was probed and they were followed up till March 2020. Association between various clinicopathological risk factors and disease free survival was assessed using univariate and multivariate models. Survival estimates were computed using the Kaplan-Meier method and differences between survival times were assessed by means of the Log rank test. Multivariate analyses were carried out using Cox’s proportional hazards model. Results: During follow up period 14 patients developed metastasis. There was significantly reduced disease free survival seen trough Kaplan Meier plots in patients having tumor size >6 cm, N2/ N3 stage, triple negative receptor status, tobacco chewing and positive perineural invasion. Multivariate analysis revealed that stage (N2, N3) and positive perineural invasion are two independent variables which adversely affect the survival. Conclusion: Bottom line of the study is that, disease free survival in LABC patients is significantly reduced with higher stage (N2, N3) and positive perineural invasion as revealed by multivariate analysis. Three other factors which adversely affect DFS are tobacco chewing, tumor size > 6cm and triple negative hormone receptor status according to univariate analysis.

Background: Infertility affects close to 10%–15% of all couples in reproductive age group. A myriad of life style variables including consumption of alcohol, smoking along with increased exposure to electromagnetic waves emitting from cell phones and personal computers for prolonged durations, have had a negative impact on the quality of semen in males. Materials and Methods: This cross-sectional study was conducted on 250 male patients under evaluation for infertility. Physical and macroscopic examination was carried out followed by in detail microscopic examination according to the World Health Organization 2010 guidelines. Results: Fertility scoring was done for all 250 subjects and 67.2% of cases were found to be fertile, 14.4% were subfertile, and 18.4% of cases were found to be infertile. Among the 168 fertile subjects, majority 75.6% of cases were young in the age group of 20–30 years, 85.1% of cases did not consume alcohol, and 86.3% of cases did not smoke. Among the 46 infertile subjects, majority 54.3% of cases were in the age group of 20–30 years, 84.8% of cases consumed some amount of alcohol, and 54.3% of cases had a history of tobacco smoking. Majority 64.1% of the subjects having a combination of all three lifestyle factors were found to be infertile, whereas only 2.6% of such subjects were found to be fertile. Conclusion: This study shows that the consumption of alcohol and cigarette smoking has a significant deleterious effect on the process of sperm production and male reproductive potential; therefore, counseling regarding this negative impact needs to be focused upon by all clinicians and infertility specialists while handling such cases.

Central retinal artery occlusion is an established and potentially blinding ocular condition. It is the most common presentation of the spectrum comprising retinal arterial occlusive diseases. The presence of a hemicentral retinal artery is an anatomical variation and few reports on its occlusion are noted in literature. Here, we present the case of a 45-year-old male who was diagnosed with hemiretinal artery occlusion occurring secondary to an embolus from the carotid artery. He was also noted to have systemic hypertension at presentation along with dyslipidemia. The visual acuity loss improved over a follow-up period of 1 week post presentation before the patient was lost to follow-up. This case report highlights the role of a thorough systemic evaluation and prompt referral to an internist of the patient presenting with retinal arterial occlusive disease. It also showcases an uncommon presentation retinal arterial occlusion that may occur as an anatomical variant much as the case of a hemiretinal vein occlusion.

Background: This retrospective study was to understand the clinico-epidemiologic and therapeutic aspects of pemphigus patients attending our clinic. Methods: We analyzed charts of 143 (M: F; 51:92) pemphigus patients having variable severity recorded between 2009 and 2019. Therapies were customized based on patient's age, disease severity, comorbidities, compliance prospects, and affordability. The patients were monitored monthly and as needed for therapeutic outcome in terms of disease control, reduced hospitalization, remission/relapse, and drug toxicity. Results: These patients were aged 15 to 86 years, the majority, 68 (47.5%), was 41 to 60 years of age. The pemphigus vulgaris in 83.9% patients was the commonest variant. Treatment regimens were; dexamethasone-cyclophosphamide-pulse (DCP) therapy in 51.2%, dexamethasone-azathioprine-pulse (DAP) therapy in 11%, dexamethasone-pulse (DP) therapy in 5.5%, rituximab in 24.4%, IVIg in 5.5% patients, and oral corticosteroids with or without adjuvant. Remission occurred after 2–17 (mean 5.8) DCP doses; 14 and 7 patients achieved remission for ≥2 y and ≥5 y, respectively. Rituximab was effective to treat both new and relapsed cases (n = 31). Additional treatment with another adjuvant prolonged remission in seven patients relapsed 12–16 months after treatment with rituximab alone. Overall, oral corticosteroids alone and DAP therapy showed unsatisfactory response. Adverse effects seen in 41.9% of patients were mainly corticosteroids related. Conclusion: The overall clinico-epidemiologic spectrum of pemphigus and therapeutic efficacy of DCP, DAP, or corticosteroids in this study was in sync with the literature. Combining rituximab and corticosteroids plus an immunomodulator initially (phase-1), followed by immunomodulator alone for one year (phase-2) will improve long-term (phase-3) therapeutic outcome. IVIg was effectively useful in patients with concurrent infections.

This article presents a synthetic distracted driving (SynDD1) dataset for machine learning models to detect and analyze drivers' various distracted behavior and different gaze zones. We collected the data in a stationary vehicle using three in-vehicle cameras positioned at locations: on the dashboard, near the rearview mirror, and on the top right-side window corner. The dataset contains two activity types: distracted activities [1–3], and gaze zones [4–6] for each participant and each activity type has two sets: without appearance blocks and with appearance blocks, such as wearing a hat or sunglasses. The order and duration of each activity for each participant are random. In addition, the dataset contains manual annotations for each activity, having its start and end time annotated. Researchers could use this dataset to evaluate the performance of machine learning algorithms for the classification of various distracting activities and gaze zones of drivers.

Crash frequency and crash severity are two major aspects of transportation safety. In this paper, we propose a decision-making scheme combining statistical analysis and optimization modeling to be used in transportation safety study. We conduct a safety analysis, a travel speed analysis, and an optimization analysis to develop a two-stage decision scheme to minimize crash frequency while mitigating crash severity, using data collected in urban environments in Lincoln, Nebraska. In the safety analysis and the travel speed analysis, we study the impact of lane width and other related road geometric design parameters on annual crash frequency and vehicle travel speed using count models and linear regression models, respectively. In the optimization analysis, the proposed two-stage stochastic programming model determines the lane width and other road geometric design parameters in the first stage, and then the posted road speed limit in the second stage for each scenario. To mitigate crash severity, we use a chance constraint to restrict a certain percentile of the vehicle travel speed to comply with the posted road speed limit. This two-stage decision scheme is shown to be effective for the data collected in Lincoln, Nebraska, when restricting the vehicle travel speed of up to two positive standard deviations from the mean travel speed to be under the posted speed limit. The application of a stochastic programming model that utilizes regression analysis results serves as an innovative decision scheme that effectively connects statistical analysis and optimization studies in road geometric design for transportation safety. Its objective is to minimize crash frequency while simultaneously mitigating crash severity. This methodology has extensive potential for application in various environments to assist in the reduction of both crash frequency and crash severity.

Bicyclists are vulnerable road users who are at a greater risk for injury and fatality during crashes. Additionally, the “near-miss” incidents they experience during regular trips can increase the perceived risk and deter them from riding again. This paper aims to use naturalistic bicycling data collected in Johnson County, Iowa to: 1) study the effect of factors such as road surface type, parked vehicles, pavement markings and car passing events on cyclists’ physiological stress and 2) understand the effect of daytime running lights (DRL) as an on-bicycle safety system in providing comfort to cyclists and highlight of their presence on the road to other vehicles. A total of 37 participants were recruited to complete trips over two weekends, one weekend with DRL and the other without DRL. Recruitment was specifically targeted toward cyclists who expressed discomfort riding in traffic. Data were collected using a front forward facing camera, GPS, and a vehicle lateral passing distance sensor mounted on the bicycle and a Empatica E4 wrist band (providing physiological data such as electrodermal activity; EDA) worn by the cyclist. Data from those sources were cleaned, processed, merged, and aggregated into time windows depicting car passing and no car passing events. Mixed effects models were used to study the cyclists’ skin conductance response (phasic EDA) and baseline skin conductance level (tonic EDA). Car passing, parked vehicles, and roads with dashed centerline markings were observed to increase the cyclists stress. The use of DRL had negligible impact on cyclist stress on roads.

Abstract Glaucoma of which primary open angle glaucoma (POAG) constitutes 75%, is the second leading cause of blindness. Elevated intra ocular pressure and Nitric oxide synthase (NOS) dysfunction are hallmarks of POAG. We analyzed clinical data, cytokine profile, ATP level, metabolomics and GEO datasets to identify features unique to POAG. N9 microglial cells are used to gain mechanistic insights. Our POAG cohort showed elevated ATP in aqueous humor and cytokines in plasma. Metabolomic analysis showed changes in 21 metabolites including Dimethylarginine (DMAG) and activation of tryptophan metabolism in POAG. Analysis of GEO data sets and previously published proteomic data sets bins genes into signaling and metabolic pathways. Pathways from reanalyzed metabolomic data from literature significantly overlapped with those from our POAG data. DMAG modulated purinergic signaling, ATP secretion and cytokine expression were inhibited by N-Ethylmaleimide, NO donors, BAPTA and purinergic receptor inhibitors. ATP induced elevated intracellular calcium level and cytokines expression were inhibited by BAPTA. Metabolomics of cell culture supernatant from ATP treated sets showed metabolic deregulation and activation of tryptophan metabolism. DMAG and ATP induced IDO1/2 and TDO2 were inhibited by N-Ethylmaleimide, sodium nitroprusside and BAPTA. Our data obtained from clinical samples and cell culture studies reveal a strong association of elevated DMAG, ATP, cytokines and activation of tryptophan metabolism with POAG. DMAG mediated ATP signaling, inflammation and metabolic remodeling in microglia might have implications in management of POAG.

Abstract Background Circadian rhythms regulate several physiological and developmental processes of plants. Hence, the identification of genes with the underlying circadian rhythmic features is pivotal. Though computational methods have been developed for the identification of circadian genes, all these methods are based on gene expression datasets. In other words, we failed to search any sequence-based model, and that motivated us to deploy the present computational method to identify the proteins encoded by the circadian genes. Results Support vector machine (SVM) with seven kernels, i.e., linear, polynomial, radial, sigmoid, hyperbolic, Bessel and Laplace was utilized for prediction by employing compositional, transitional and physico-chemical features. Higher accuracy of 62.48% was achieved with the Laplace kernel, following the fivefold cross- validation approach. The developed model further secured 62.96% accuracy with an independent dataset. The SVM also outperformed other state-of-art machine learning algorithms, i.e., Random Forest, Bagging, AdaBoost, XGBoost and LASSO. We also performed proteome-wide identification of circadian proteins in two cereal crops namely, Oryza sativa and Sorghum bicolor, followed by the functional annotation of the predicted circadian proteins with Gene Ontology (GO) terms. Conclusions To the best of our knowledge, this is the first computational method to identify the circadian genes with the sequence data. Based on the proposed method, we have developed an R-package PredCRG ( https://cran.r-project.org/web/packages/PredCRG/index.html ) for the scientific community for proteome-wide identification of circadian genes. The present study supplements the existing computational methods as well as wet-lab experiments for the recognition of circadian genes.

Abstract Background The global concern over antimicrobial resistance (AMR) is gathering pace. Low- and middle-income countries (LMICs) are at the epicentre of this growing public health threat and governmental and healthcare organizations are at different stages of implementing action plans to tackle AMR. The South Indian state of Kerala was one of the first in India to implement strategies and prioritize activities to address this public health threat. Strategies Through a committed and collaborative effort from all healthcare related disciplines and its professional societies from both public and private sector, the Kerala Public Private Partnership (PPP) has been able to deliver a state-wide strategy to tackle AMR A multilevel strategic leadership model and a multilevel implementation approach that included developing state-wide antibiotic clinical guidelines, a revision of post-graduate and undergraduate medical curriculum, and a training program covering all general practitioners within the state the PPP proved to be a successful model for ensuring state-wide implementation of an AMR action plan. Collaborative work of multi-professional groups ensured co-design and development of disease based clinical treatment guidelines and state-wide infection prevention policy. Knowledge exchange though international and national platforms in the form of workshops for sharing of best practices is critical to success. Capacity building at both public and private institutions included addressing practical and local solutions to the barriers e.g. good antibiotic prescription practices from primary to tertiary care facility and infection prevention at all levels. Conclusion Through 7 years of stakeholder engagement, lobbying with government, and driving change through co-development and implementation, the PPP successfully delivered an antimicrobial stewardship plan across the state. The roadmap for the implementation of the Kerala PPP strategic AMR plan can provide learning for other states and countries aiming to implement action plans for AMR.

Background: Association between alcohol consumption, alcohol use disorder, and clinical features of psoriasis patients has not been adequately studied in the Indian context. Objectives: To study the frequency of alcohol consumption, alcohol use disorder, and its association with age, gender, duration, and severity of psoriasis. Materials and Methods: One hundred and forty-six (M: F 6.3:1) patients completed the Alcohol Use Disorder Identification Test (AUDIT) questionnaire by World Health Organization (WHO). Excessive drinkers, occasional drinkers, and abstainers were defined. AUDIT provided a measure of alcohol consumption, its dependence, and its impact on daily life. The severity of psoriasis was graded as mild, moderate, and severe. Results: Seventy-four (50.7%) patients were aged ≤40 years and 51.4% of patients had the disease for 8) and had more severe psoriasis compared to patients having AUDIT score 8) and significantly severe psoriasis compared to 67.1% abstainers. Whether increased alcohol consumption is a consequence or a risk factor for chronicity of psoriasis needs large linear studies for confirmation.

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

Abstract Missed fractures are the most common diagnostic error in emergency departments and can lead to treatment delays and long-term disability. Here we show through a multi-site study that a deep-learning system can accurately identify fractures throughout the adult musculoskeletal system. This approach may have the potential to reduce future diagnostic errors in radiograph interpretation.

Background Prognosis of gallbladder cancer (GBC) has not changed in the past 20 years. Comprehensive genomic profiling (CGP) carries potential to determine the actionability for multiple targets, including ERBB2, ERBB3, MET, ROSI, FGFR, and PIK3. This study evaluates the role of CGP and targeted therapies. Methods This is a multicenter, prospective, single-arm study. All consecutive patients of unresectable and/or metastatic GBC of age ≥18 years were enrolled. Hybrid capture-based CGP was performed by Foundation Medicine CDx. All patients received first-line chemotherapy with gemcitabine–cisplatin regimen. Patients with ERBB2/3 amplification received trastuzumab with capecitabine or nab-paclitaxel, and patients with MET amplification were treated with crizotinib. For ERBB2/3 mutations, lapatinib plus capecitabine regimen was used. Results Fifty patients were studied with a median age of 56 years (range 26–83) and a male-to-female ratio of 1:1.6. ERBB2 and ERBB3 amplification was seen in 9 (18%) and 2 (4%) patients, respectively. Four patients with ERBB2 amplification received trastuzumab and/or lapatinib, showed partial response, and maintained response beyond 12 weeks. One patient had mixed response, whereas two patients progressed on trastuzumab and lapatinib. Three patients with ERBB3 mutations showed response to lapatinib–capecitabine. One patient with MET amplification responded to crizotinib for 4 weeks. PIK3 mutations were present in 14% of cases and were independent of ERBB aberrations. Conclusion GBC is enriched in 28% of patients with ERBB2 and ERBB3 amplifications and/or mutations. Responses are seen with lapatinib in concurrent ERBB2 mutation and amplification. ERBB3 mutation showed response to lapatinib. MET and PIK3 are new findings in GBC, which may be targeted.

Online learning makes sequence of decisions with partial data arrival where next movement of data is unknown. In this paper, we have presented a new technique as multiple times weight updating that update the weight iteratively for same instance. The proposed technique analyzed with popular state-of-art algorithms from literature and experimented using established tool. The results indicate that mistake rate reduces to zero or close to zero for various datasets and algorithms. The overhead running cost is not too expensive and achieving mistake rate close to zero further strengthens the proposed technique. The present work includes bound nature of weight updating for single instance and achieve optimal weight value. This proposed work could be extended to big datasets problems to reduce mistake rate in online learning environment. Also, the proposed technique could be helpful to meet real life challenges.

Background: Association of psoriasis with other autoimmune diseases remains an ongoing research subject. Objectives: To investigate the association of psoriasis with other autoimmune disorders. Materials and Methods: We studied 80 (M: F 57:23) psoriasis patients aged 13–75 years for concurrent autoimmune disorders. After clinical examination, hemogram, fasting blood sugar, HbA1c, thyroid function tests, anti-TPO antibody, rheumatoid factor, anti-tTG antibody, anti-CCP antibody, ANA, anti-dsDNA antibody, anti-Ro antibody, and fecal calprotectin were estimated. Results: Mild-to-moderate and severe psoriasis was present in 86.3% and 13.8% patients, respectively. Psoriatic arthritis was present in 3.8% patients, all of whom also had severe psoriasis. Only 37 (46.3%) patients had clinical and/or sero-abnormality suggestive of autoimmune disorders; vitiligo in 3.8%, type-1 diabetes mellitus (DM) in 1.3%, and type-2 DM in 6.3% patients. Sero-positivity reflecting subclinical autoimmunity was noted for anti-CCP antibodies (in 2.5%), rheumatoid factor (in 2.5%), hypo- or hyper-thyroidism (in 8.8%), anti-TPO antibodies (in 5.0%), anti-tTG antibody (in 1.3%), ANA (in 5.0%), anti-dsDNA antibody (in 2.5%), and anti-Ro antibody in 11.3% patients. Elevated fecal calprotectin levels suggestive of inflammatory bowel disease (IBD) occurred in 11.2% of 27 patients. Multiple abnormalities happened in 2.5% patients. Conclusion: Apparently psoriasis patients seem to have a predilection for other autoimmune disorders particularly for vitiligo, diabetes mellitus, autoimmune thyroiditis, rheumatoid arthritis, and IBD. However, association between psoriasis and other autoimmune disorders at best remains tenuous for want of strong evidence. Nevertheless, screening for them will improve overall management of these patients. Cross-sectional study design and small number of study subjects remain important limitations.

Pemphigus vegetans is a rare variant of pemphigus vulgaris characterized by pustules and/or papillomatous vegetations, preferentially affecting intertriginous and periorificial areas. It has two subtypes: Hallopeau variant and Neumann variant. Cerebriform tongue, a morphology with typical pattern of sulci and gyri over dorsum of the tongue, is a well-known sign in pemphigus vegetans. We are presenting an unusual case of pemphigus vegetans with extensive involvement of mucosae, trunk, extremities including both extensors and flexural areas with verrucous paronychia and fissured tongue. During clinical exam we recognized multiple cutaneous vesicles, erosions and ulcers on mucosal sites. Clinical, histopathological, and direct and indirect immunofluorescence findings were compatible with pemphigus vegetans. Patient had completed her family so treated with intravenous dexamethasone-cyclophosphamide pulse (DCP) regimen with excellent response.

Background: Associations among thyroid dysfunction, thyroid autoimmunity, and clinical features including age, gender, disease duration, and severity of psoriasis is less studied. Objectives: To study frequency of thyroid dysfunction and thyroid autoimmunity and examine association among thyroid dysfunction, thyroid autoimmunity, and clinical features including gender, age, duration, and severity of psoriasis. Material and Methods: The medical records of 290 (m:f 2.15:1) patients aged 13–75 years with plaque psoriasis were analyzed for thyroid dysfunction and thyroid autoimmunity. Thyroid dysfunction was defined as 10% variation in any thyroid hormone levels. Thyroid autoimmunity was diagnosed from presence of antithyroid peroxide (anti-TPO) antibodies. Results: The majority, 57.9% patients, was aged ≥41 years (Type-2 psoriasis) and duration of disease was

Background: Dengue is a viral fever commonly seen in the Southeast Asia. It is spread by Aedes mosquito and is health menace, in our country. Dengue during pregnancy can affect the mother and the fetus. This study was done to study the effect of dengue fever on the fetomaternal outcome. Aim and Objectives:The aim was to study the effect of dengue during pregnancy on fetomaternal outcome. Materials and Methods: A prospective observational study was done to include the patients who were diagnosed with dengue using enzyme-linked immunosorbent assay based test, for a period of 2 years. Results: A total of 31 cases of dengue were diagnosed during a period of 2 years. Nine patients required platelet transfusions. Five patients were admitted to the intensive care unit (ICU) and nine newborns were admitted to neonatal ICU (NICU). Conclusion: Dengue during pregnancy leads to obstetric complications such as preterm labor, oligohydramnios, and NICU admissions.

There has always been a gap between research and engineering practices across almost all disciplines. The nature of these gaps are not identified; However, in order to be able to bridge these gaps a comprehensive understanding is required. In this study, in order to provide research agenda, we examine existing literature and users perception in smart lighting business. We consider two sources of data for this analysis 1-lighting research literature that reflects the research phase and 2-Amazon reviews about two smart lighting products that represent customers’ perceptions reflecting the development phase. We use text mining and analyze both data sources by topic modeling and sentiment analysis. We conducted a probabilistic aspect based sentiment analysis. One of the results of this analysis showed that while the research community is drastically concerned about energy consumption, the end users were excited about color changing ability in smart lighting products.

The recognition of online handwriting is a vital application of pattern recognition, which involves the extraction of spatial and temporal information of handwritten patterns, and understanding the handwritten text while writing on the digital surface. Although, online handwriting recognition is a mature but exciting and fast developing field of pattern recognition, the same is not true for many of the Indic scripts. Gurmukhi is one of such popular scripts of India, and online handwriting recognition issues for larger units as words or sentences largely remained unexplored for this script till date. The existing study and first ever attempt for online handwritten Gurmukhi word recognition has relied upon the widely used hidden Markov model. This existing study evaluated against and performed very well in their chosen metrics. But, the available online handwritten Gurmukhi word recognition system could not obtain more than 90% recognition accuracy in data dependent environment too. The present study provided benchmark results for online handwritten Gurmukhi word recognition using deep learning architecture convolutional neural network, and obtained above 97% recognition accuracy in data dependent mode of handwriting. The previous Gurmukhi word recognition system followed the stroke based class labeling approach, whereas the present study has followed the word based class labeling approach. Present Online handwritten Gurmukhi word recognition results are quite satisfactory. Moreover, the proposed architecture can be used to improve the benchmark results of online handwriting recognition of several major Indian scripts. Experimental results demonstrated that the deep learning system achieved great results in Gurmukhi script and outperforms existing results in the literature.

Urinary leak is a well known complication after partial nephrectomy. We describe a case of a persistent urinary leak after Robot assisted nephron sparing surgery that failed to resolve after conservative treatments and was subsequently managed with computed tomography (CT) guided percutaneous cynoacrylate glue injection.

Background: We studied clinico-epidemiological features of 945 patients with vitiligo with an objective to delineate epidemiological and clinical aspects of vitiligo from this part of the country. Materials and Methods: The medical records of patients with vitiligo attending outpatient clinic over a 5-year period from January 2013 to December 2017 were analyzed retrospectively for this descriptive, observational study. Results: There were 449 men and 496 women (m:f 1:1.1) aged between 2 and 83 years (mean 24.4 years) and having vitiligo for 1 week to 64 years (mean 5.1 years). The majority, 478 (50.6%) patients were aged ≤20 years and 248 (26.2%) were children aged ≤12 years. The age at the onset was between 6 months and 82 years (mean 20.5 years), and the majority 674 (71.3%) patients had it before 25 years of age. The consultation time was within 5 years in 692 (73.2%) patients. A family history of vitiligo was present in 150 (15.9%) patients. The majority 871 (92.2%) patients had involvement of up to 10% body surface area and vitiligo vulgaris in 562 (59.5%) and focal vitiligo in 117 (18.7%) patients were the most common clinical types. An association with other systemic disorders was in 124 (13.1%) patients and predominately included thyroid abnormalities and diabetes mellitus. Conclusions: Our observations are essentially consistent with the literature. There was no difference in clinico-epidemiological features of vitiligo. Patients with an affected first-degree family member had early onset, but difference was not statistically significant. Screening for concurrent thyroid disorders appears important. However, our inferences remain limited by single center, retrospective, observational, and cross-sectional nature of the study.

Background: Activated coagulation cascade is implicated in urticaria pathogenesis marked by high plasma D-dimer, a marker of fibrinolysis, levels correlating with high urticaria activity score (UAS) and poor therapeutic outcome. Methods: Quantitative plasma D-dimer levels and coagulation parameters in 100 (male:female ratio 1:3) Indian patients with chronic spontaneous urticaria and age- and gender-matched healthy controls were compared. The clinicoepidemiologic features of chronic urticaria were then compared among patients with normal (≤0.2 mg/L) and elevated (≥0.3 mg/L) plasma D-dimer levels. Results: Plasma D-dimer in 23% patients and 4% controls and prothrombin time and activated partial thromboplastin time in 63% and 5% patients, respectively, were significantly higher compared with 58% and 1% of controls, respectively. About 18 of 72 (25%) patients with high UAS of ≥16–42 were compared with 5 of 28 (17.8%) patients with UAS7 of ≤15. Patients with elevated plasma D-dimer levels had significantly more systemic symptoms (86.9% vs. 81.8%) compared with patients with normal plasma D-dimer levels. Conclusion: A subset of patients with chronic urticaria have elevated plasma D-dimer levels and exhibit higher UAS7 and systemic symptoms that may influence long-term prognosis and therapeutic choices. Small number of patients, a cross-sectional nature of study, lack of treatment outcome measures, information on self-medication, and unavailability of specific parameters for coagulation pathway activation remain few limitations of this study.

The most common ocular manifestation following electric shock injury is the development of cataract. Retinal manifestations can vary from development of macular holes to retinal detachments. Purtscher-like retinopathy following electrical injury has not been reported till date. We hereby present a case of a 19-year-old electrician who presented with grossly reduced vision in the right eye of 2 months following an electric shock. The fundus of the right eye showed macular ischemic degeneration, occluded vessels, cotton-wool spots, and hemorrhages. Optical coherence tomography angiography revealed presence of capillary drop-out in the para-foveal region, which was more pronounced in the deep capillary plexus. Electric shock injury can lead to a clinical picture simulating Purtscher's retinopathy. The electrical injury leads to a more extensive damage to the deep capillary plexus as compared with the superficial plexus.