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In this paper, simulation, and performance comparison of a switched reluctance motor (SRM) for a classical asymmetric bridge converter and an improved reduced switch converter topology are provided. In an improved converter, switches are shared by adjacent phases, and one diode is connected in series with each phase winding to avoid reversal of current. Double-phase magnetization is adopted for the analysis of both converter topologies. The performance of both converter topologies are demonstrated using a proportional plus integral (PI) based hysteresis current controller and dynamic load on a 7.5 kW, 8/6 pole, 4- phase SRM. Improved reduced switch converter topology uses half the number of switches as compared to the classical asymmetric bridge converter. According to the simulation results, an improved converter offers superior starting and average torque with less speed settling time. An improved converter reduces the most serious problem of torque ripple in SRM by 50% compared to the classical topology. The reduced switches lower the winding losses and improve the efficiency of the drive system.

Introduction: Fine needle aspiration cytology of head and neck region is well-accepted as a diagnostic procedure. It is a safe, simple, rapid, cost-effective, and minimally invasive way of diagnosing inflammatory, noninflammatory and neoplastic lesions. Aim : To study the role of FNAC in diagnosing head & neck lesions in the paediatric age group. Material and Method: This is the hospital-based study of 120 lesions of the head and neck region belonging to the age group of 0-18 years. Cytological results are interpreted and analyzed according to anatomical site and then categorized based on interpretation. Result: Out of 120 cases 20 % cases belong to the age group 0-5yrs, 24.16% belong to 6-10yrs & 55.83% belong to the 11-18yrs age group. According to the anatomical distribution of lesions maximum cases accounting for 81.67% are lymph node lesions followed by thyroid lesions, miscellaneous, and then least salivary gland lesions which account for 2.5%. In the lymph node, thyroid, salivary gland, and miscellaneous lesions predominant lesions are respectively reactive lymphoid hyperplasia (71.42%), thyroiditis (42.85%), sialadenitis (33.34%) &epidermal cyst (40%) Conclusion: FNAC in resource-limited settings, healthcare providers should realize the importance of FNAC as an initial screening tool for superficial lesions in paediatric population. The presumptive diagnosis after FNAC of palpable lesions in paediatric age group avoids the unnecessary definitive operative procedure. Thus, FNAC is an easy, simple, rapid, and cost-effective diagnostic procedure for paediatric age group.

Background: During the COVID-19 pandemic prolonged lockdowns, school closures requiring online education support, and uncertainty about examinations caused stress in students. Aim: To estimate the levels of depression, anxiety, stress, and fear of COVID-19 in adolescent students of Jamnagar and its relationship with possible predictors. Materials and Methods: This is a cross-sectional study using a proportionate probability sampling method during the third wave of COVID-19 of 4423 adolescent students of Jamnagar, Gujarat. The Fear of COVID-19 Scale (FCV-19S) and Depression, Anxiety, and Stress Scale-21 (DASS-21) measured the main construct. T-tests for two independent samples and multiple linear regression analysis were used to assess the relationship. Results: Among the adolescent students, 14.81% had moderate fear, while severe fear was found in 3.37%. Moderate or severe depression was observed in 1.31% and 0.16% of students, respectively; severe and extremely severe anxiety was present in 0.65% and 0.11% of students; and stress was found to be moderate in 0.23%. Depression was associated with education, anxiety with education, gender, and a history of COVID-19 in the family and stress with a history of COVID-19 infection in the family and fear of COVID-19 with gender, standard of class, geographical area, socioeconomic class, and father’s education. Conclusion: In our study, the students having a higher fear of COVID-19 were found to have higher depression, anxiety, and stress. The factors associated with a lower level of psychological impact can be used to formulate the interventions needed for the betterment of adolescent mental health.

Background: The internet is a vital part of present-day society. Internet use for education has increased in recent years. During the COVID pandemic, schools were closed and education was delivered through online methods, which led to a further increase in internet use, especially in adolescents, leading to internet addiction in some. Aim: To estimate the prevalence of internet addiction and poor quality of sleep in adolescent students of Jamnagar. Materials and Methods: This cross-sectional study was carried out between January 2022 to March 2022 and included 1778 adolescent students of Jamnagar, Gujarat. The internet addiction test was used to measure the level of internet addiction, and the short Pittsburgh sleep quality index was used to measure the quality of sleep. Data analysis was conducted using the Chi-square test, Mann-Whitney U test, and multiple logistic regression techniques. Results: In our study, 17.8% of participants had mild internet addiction, 3.2% of participants had moderate-to-severe internet addiction, and 79% of participants were average internet users. Associated variables with internet addiction were male gender, residence at home, duration of internet usage in years, daily hours spent online, and monthly expenditure on internet recharge. Furthermore, 27.2% of participants had poor quality of sleep. Female gender, secondary school education, residence at the hostel, and internet addiction were predictors of poor quality of sleep. Conclusion: Students were found to have a high prevalence of internet addiction. The internet usage increased amid the COVID-19 pandemic. Internet addiction was significantly associated with poor quality of sleep in adolescents.

Hemophilia A is usually a congenital bleeding disorder, which manifest in males due to its X linked recessive pattern of inheritance. It commonly presents with bruises, uncontrolled bleeding post minor trauma or post circumcision, knee swelling etc. Acquired hemophilia is a rare condition and could be associated with autoimmune diseases. We discuss this rare condition of acquired hemophilia in a female patient who presented with common manifestations but in unlikely host.

Auto immune disorders have a wide range of presentations. Often, they are missed due to difference in their spectrum of presentations. Hence any slight suspicion of autoimmunity should be thoroughly ruled out. Multiple system involvement like joints, renal, vascular events simultaneously presenting should always rise a suspicion of autoimmunity and prompt investigations should be paged that could be effectively contributing to decrease mortality and morbidity of the patient. Thorough history, if possible, pedigree charts should be evaluated for any clues of autoimmunity. All first-degree relatives of the patient should also be evaluated for any possibility of autoimmune diseases.

In Nepal, over 1 million individuals have tested positive for SARS-CoV-2. We sought to describe the frequency of nonrecovery from this infection at 6 months and associated symptoms. We conducted a retrospective cohort study of 6142 women who had positive and negative PCR tests for this infection 6 months previously at 3 institutions in Kathmandu. In telephone interviews women provided information on 22 symptoms and their intensities, health status and history, and functional status. Of 3732 women who had tested PCR positive, 630 (16.9%) reported that they were unrecovered. These 630 unrecovered women were distinguished statistically from the 3102 recovered women by more frequent histories of allergies, rheumatoid disease, BCG immunization, Covid vaccination, strep throat and recent URIs, and both weight gain and weight losses of more than 5 kg in the 6 months following testing, and stressful events in the preceding year. Fatigue, pain, difficulty remembering, shortness of breath, heat and cold intolerance and unrefreshing sleep were reported in 41.9% to 10.5% of these 630 unrecovered women. Six months after confirmed SARS-CoV-2 infection 16.9% of Nepali women have long-COVID manifested as an immune, metabolic, and hormonal systems disruptive and dysfunction syndrome.

Objective: The aim of the present study was to find a correlation of serum Suppression of tumorigenicity 2 (ST2) levels with severity of diastolic dysfunction on echocardiography and cardiac magnetic resonance imaging (CMRI) in heart failure with preserved ejection fraction (HFpEF) patients. Methods: Fifty patients aged ≥18 years fulfilling diagnostic criteria for HFpEF were included. ST2 levels, 2D echocardiography and CMRI were performed. Left ventricular ejection fraction, E/A, Septal E/E’, left atrial volume index (LAVI), tricuspid regurgitation (TR), assessment of diastolic dysfunction, T1 mapping in milliseconds and late gadolinium enhancement (LGE) in percentage were noted. The primary outcome measure was to study correlation of ST2 levels with severity of diastolic dysfunction, whereas the secondary outcome measures were to study correlation of ST2 levels with native T1 mapping and LGE on CMRI. Results: ST2 levels showed statistically significant and positive correlation with E/E’ (r = 0.837), peak TR velocity (r = 0.373), LAVI (r = 0.74), E/A (r = 0.420), and T1 values in milliseconds (r = 0.619). There was no statistically significant correlation between ST2 level and LGE in % (r = 0.145). The median ST2 levels in patients with E/E’ > 14 and E/E’ ≤ 14 were 110.8 and 36.1 respectively (p-value < 0.05). The mean ST2 levels were significantly higher in patients who had diastolic dysfunction grade III (126.4) and New York Heart Association class IV (133.3). Conclusions: Evaluation of ST2 adds important information to support the diagnosis of left ventricular diastolic dysfunction in patients with HFpEF.

Ovarian tumors are common neoplasia in women. Ovarian carcinoma accounts for the 7 cause of mortality and morbidity in females. Surface epithelial tumors are the most common type of ovarian tumor. Mucinous tumors comprise 20% to 25% of the ovarian neoplasms. Brenner tumor of the ovary consist of 1-2% of all ovarian neoplasms and is usually benign. About 30% of Brenner tumors coexist with an ovarian mucinous neoplasm, a well-recognized combination that has been rarely reported. Accurate diagnosis and exclusion of malignancy are essential in large ovarian tumors, especially in tumors with solid components. We describe a case of an incidentally diagnosed Brenner tumor in a sizeable mucinous cystadenoma of the ovary to inform the clinicians about the co-occurrence of such a tumor so they remain vigilant in ruling out malignancy for better management as well as prognostication.

COVID has drastically impacted organ donation across the world, leading to untold misery for thousands of patients who have been waiting for organs. Early rules on the use of organs from COVID positive or affected donors were stringent due to the fear of spread of disease or thrombotic complications in patients who received these organs. However much has changed in the past two years. Most of our adult population has either been infected with COVID, or has received two doses of vaccine, or both. The current variant, despite being more infective, is associated with mild disease, especially in those who have been vaccinated Our armamentarium against severe COVID has improved dramatically in the past year- we have effective vaccines, monoclonal antibodies for treatment of mild COVID in high risk patients and post exposure and antiviral prophylaxis and treatment which can substantially reduce the risk of severe COVID requiring ICU admission. The risk of transmission of COVID infection has to be balanced against the risk of patients dying with end organ disease. We will have to learn to live with COVID- this also means investigating whether organs from donors who are, or have been COVID positive can be used with acceptable risk –benefit in selected patients with end stage organ failure. This document is a summary of evidence and information regarding donor screening for SARS-CoV-2 and considerations for organ acceptance from donors with a history of COVID-19.

Graft loss and rejections (acute/chronic) continue to remain important concerns in long-term outcomes in kidney transplant despite newer immunosuppressive regimens and increased use of induction agents. Global guidelines identify the risk factors and suggest a framework for management of patients at different risk levels for rejection; however, these are better applicable to deceased donor transplants. Their applicability in Indian scenario (predominantly live donor program) could be a matter of debate. Therefore, a panel of experts discussed the current clinical practice and adaptability of global recommendations to Indian settings. They also took a survey to define risk factors in kidney transplants and provide direction toward evidence- and clinical experience-based risk stratification for donor/recipient and transplant-related characteristics, with a focus on living donor transplantations. Several recipient related factors (dialysis, comorbidities, and age, donor-specific antibodies [DSAs]), donor-related factors (age, body mass index, type – living or deceased) and transplantation related factors (cold ischemia time [CIT], number of transplantations) were assessed. The experts suggested that immunological conflict should be avoided by performing cytotoxic cross match, flow cross match in all patients and DSA-(single antigen bead) whenever considered clinically relevant. HLA mismatches, presence of DSA, along with donor/recipient age, CIT, etc., were associated with increased risk of rejection. Furthermore, the panel agreed that the risk of rejection in living donor transplant is not dissimilar to deceased donor recipients. The experts also suggested that induction immunosuppression could be individualized based on the risk stratification.

Streptococcus agalactiae glyceraldehyde 3-phosphate dehydrogenase (GAPDH), encoded by gapC, is a glycolytic enzyme that is associated with virulence and immune-mediated protection. However, the role of GAPDH in cellular cytokine responses to S. agalactiae, bacterial phagocytosis and colonization of the female reproductive tract, a central host niche, is unknown. We expressed and studied purified recombinant GAPDH (rGAPDH) of S. agalactiae in cytokine elicitation assays with human monocyte-derived macrophage, epithelial cell, and polymorphonuclear leukocyte (PMN) co-culture infection models. We also generated a S. agalactiae mutant that over-expresses GAPDH (oeGAPDH) from gapC using a constitutively active promoter, and analyzed the mutant in murine macrophage antibiotic protection assays and in virulence assays in vivo, using a colonization model that is based on experimental infection of the reproductive tract in female mice. Human cell co-cultures produced interleukin (IL)-1β, IL-6, macrophage inflammatory protein (MIP)-1, tumor necrosis factor (TNF)-α and IL-10 within 24 h of exposure to rGAPDH. PMNs were required for several of these cytokine responses. However, over-expression of GAPDH in S. agalactiae did not significantly affect measures of phagocytic uptake compared to an empty vector control. In contrast, oeGAPDH-S. agalactiae showed a small but statistically significant attenuation for persistence in the reproductive tract of female mice during the chronic phase of infection (10–28 days post-inoculation), relative to the vector control. We conclude that S. agalactiae GAPDH elicits production of multiple cytokines from human cells, and over-expression of GAPDH renders the bacterium more susceptible to host clearance in the female reproductive tract. One-sentence summary: This study shows Streptococcus agalactiae glyceraldehyde 3-phosphate dehydrogenase, an enzyme that functions in glycolysis, gluconeogenesis and virulence, modifies phagocytosis outcomes, including cytokine synthesis, and affects bacterial persistence in the female reproductive tract.

Gastrointestinal Stromal Tumours (GISTs) are rare tumours of the Gastrointestinal Tract (GIT), consisting of

Abstract Motivated by the importance of antiferromagnetic skyrmions as building blocks of next-generation data storage and processing devices, we report theoretical and computational analysis of a model for a spin-orbit coupled correlated Hund’s insulator magnet on a triangular lattice. We find that two distinct antiferromagnetic skyrmion crystal (AF-SkX) states can be stabilized at low temperatures in the presence of external magnetic field. The results are obtained via Monte Carlo simulations on an effective magnetic model derived from the microscopic electronic Hamiltonian consisting of Rashba spin-orbit coupling, as well as strong Hund’s coupling of electrons to classical spins at half-filling. The two AF-SkX phases are understood to originate from a classical spin liquid state that exists at low but finite temperatures. These AF-SkX states can be easily distinguished from each other in experiments as they are characterized by peaks at distinct momenta in the spin structure factor which is directly measured in neutron scattering experiments. We also discuss examples of materials where the model as well as the two AF-SkX states can be realized.

Objectives: The direct correlation between Echocardiographic non-coronary calcium score (ECS) and lesion severity on invasive coronary angiography (ICA) is not reported. The aim of the present study was to find the correlation between ECS and Gensini score. Methods: One hundred seventy patients aged ≥18 years posted for clinically indicated ICA were included. All the patients underwent standard transthoracic echocardiography. ECS and Gensisni scores were calculated. The primary outcome measure was to find a correlation of ECS with Gensini score, whereas the secondary outcome measure was to correlate ECS with traditional risk factors for coronary artery disease. The Chi-square/Fisher exact test was used to compare qualitative variables. Spearman’s correlation analysis was used for assessing the correlation between ECS score and the Gensini score. Receiver-operating characteristic curve analysis was performed to detect the cut-off value of the ECS score. Results: The correlation of total ECS with Gensini score was positive and statistically significant (r = 0.550, p-value 1 detected CAD with 56.5% sensitivity, 79.5% specificity. Eight-nine percent of patients who had ECS >1, had Gensini score ≥18, whereas 44.3% of patients who had ECS ≤1, had Gensini score ≥18. The patients with ECS >1 had significantly higher Gensini scores than the patients with ECS ≤1. Conclusions: The correlation of total ECS with Gensini score was positive and statistically significant.

Summary: Background: There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19). Methods: We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up. Findings: Among 372 KT which included 38(10·21%) ABO-incompatible, 12(3·22%) sensitized, 64(17·20%) coexisting donors with COVID-19 history and 20 (5·37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9·1%) with 1(0·26%) death censored graft loss, and 4(1·07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106–350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0·14(0·03–0·59); p-value = 0·0071], and use of thymoglobulin use compared to other induction strategies [HR = 0·17(0·03–0.95); p-value = 0·044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1·74–65·83); p-value = 0·011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40–145) days (overall), and ranged from 88(40–137), 65(42–120), 110(49–190), and 127(64–161) days in World Health Organization ordinal scale ≤ 3, 4, 5, and 6–7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity. Interpretation: Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19. Funding: Sanofi

Abstract Background The expression of recombinant proteins triggers a stress response which downregulates key metabolic pathway genes leading to a decline in cellular health and feedback inhibition of both growth and protein expression. Instead of individually upregulating these downregulated genes or improving transcription rates by better vector design, an innovative strategy would be to block this stress response thereby ensuring a sustained level of protein expression. Results We postulated that the genes which are commonly up-regulated post induction may play the role of signalling messengers in mounting the cellular stress response. We identified those genes which have no known downstream regulatees and created knock outs which were then tested for GFP expression. Many of these knock outs showed significantly higher expression levels which was also sustained for longer periods. The highest product yield (Yp/x) was observed in a BW25113ΔcysJ knock out (Yp/x 0.57) and BW25113ΔelaA (Yp/x 0.49), whereas the Yp/x of the control W3110 strain was 0.08 and BW25113 was 0.16. Double knock out combinations were then created from the ten best performing single knock outs leading to a further enhancement in expression levels. Out of 45 double knock outs created, BW25113ΔelaAΔyhbC (Yp/x 0.7) and BW25113ΔcysJΔyhbC (Yp/x 0.64) showed the highest increase in product yield compared to the single gene mutant strains. We confirmed the improved performance of these knock outs by testing and obtaining higher levels of recombinant asparaginase expression, a system better suited for analysing sustained expression since it gets exported to the extracellular medium. Conclusion Creating key knock outs to block the CSR and enhance expression is a radically different strategy that can be synergistically combined with traditional methods of improving protein yields thus helping in the design of superior host platforms for protein expression.

Background: Atrioventricular plane displacement (AVPD) reflects global left ventricular function despite left ventricular asymmetry as it is determined in four different regions of left ventricle. The limitations of agreement between left ventricular ejection fraction (LVEF) and AVPD are not close enough for these two measurements to be interchangeable. There is reason to question whether AVPD provides the same information as LVEF. Aim: The aim of this study was to assess relations of AVPD with LVEF and clinical findings in patients left ventricular failure (LVF). Materials and Methods: One hundred patients aged ≥18 years with coronary artery disease admitted with LVF were included in this cross sectional study. Echocardiographic examination was performed. Left ventricular AVPD was evaluated by M mode, in the four and two chamber views. Primary aim was to compare AVPD with LVEF by echocardiography. Secondary outcome measures were comparison of AVPD with traditional risk factors, clinical features, and pro-B-type natriuretic peptide (BNP) levels. Comparison of qualitative and quantitative variables was done by using Chi-square test/Fisher's exact test and unpaired t-test. Pearson's correlation was used to study correlation. Results: Mean AVPD was significantly lower in patients with severe LVEF as compared to mild, and moderate LVEF. Correlation of AVPD with LVEF, pro BNP, septum, anterior, lateral and posterior wall hypokinesia was 0.895. 0.841, 0.898, 0.911, 0.893 and 0.907 respectively. Conclusions: Mean AVPD was significantly lower in patients with severe LVEF. Mean AVPD positively correlated with LVEF, pro BNP, septum, anterior, lateral and posterior wall hypokinesia.

Background Myocardial injury in patients with COVID‐19 is associated with increased mortality during index hospitalization; however, the relationship to long‐term sequelae of SARS‐CoV‐2 is unknown. This study assessed the relationship between myocardial injury (high‐sensitivity cardiac troponin T level) during index hospitalization for COVID‐19 and longer‐term outcomes. Methods and Results This is a prospective cohort of patients who were hospitalized at a single center between March and May 2020 with SARS‐CoV‐2. Cardiac biomarkers were systematically collected. Outcomes were adjudicated and stratified on the basis of myocardial injury. The study cohort includes 483 patients who had high‐sensitivity cardiac troponin T data during their index hospitalization. During index hospitalization, 91 (18.8%) died, 70 (14.4%) had thrombotic complications, and 126 (25.6%) had cardiovascular complications. By 12 months, 107 (22.2%) died. During index hospitalization, 301 (62.3%) had cardiac injury (high‐sensitivity cardiac troponin T≧14 ng/L); these patients had 28.6%, 32.2%, and 33.2% mortality during index hospitalization, at 6 months, and at 12 months, respectively, compared with 4.1%, 4.9%, and 4.9% mortality for those with low‐level positive troponin and 0%, 0%, and 0% for those with undetectable troponin. Of 392 (81.2%) patients who survived the index hospitalization, 94 (24%) had at least 1 readmission within 12 months, of whom 61 (65%) had myocardial injury during the index hospitalization. Of 377 (96%) patients who were alive and had follow‐up after the index hospitalization, 211 (56%) patients had a documented, detailed clinical assessment at 6 months. A total of 78 of 211 (37.0%) had ongoing COVID‐19–related symptoms; 34 of 211 (16.1%) had neurocognitive decline, 8 of 211 (3.8%) had increased supplemental oxygen requirements, and 42 of 211 (19.9%) had worsening functional status. Conclusions Myocardial injury during index hospitalization for COVID‐19 was associated with increased mortality and may predict who are more likely to have postacute sequelae of COVID‐19. Among patients who survived their index hospitalization, the incremental mortality through 12 months was low, even among troponin‐positive patients.

Widely used precious metal (i.e., Pt, or Pd) electrocatalysts need to be replaced with other cost-effective and earth-abundant materials for economical water splitting applications. Recently, two-dimensional (2D) transition metal dichalcogenides (MoS2, VS2, WS2, etc.) have emerged as ideal electrocatalysts for the hydrogen evolution reaction (HER) due to their tunable physicochemical properties and rich catalytic active sites. In this regard, we propose a strategy to achieve improved HER performance of VS2 by fabricating a hybrid material with transition metal (Zn and Cd)-based sulfides. A facile hydrothermal approach is employed to prepare a VS2/ZnS/CdS hybrid catalyst that exhibits remarkable electrocatalytic performance for the HER in acidic media with a small overpotential of 86 mV at 10 mA/cm2 and a Tafel slope of 74.4 mV/dec. This inferred the Volmer–Heyrovsky mechanism with electrochemical desorption of hydrogen as the rate-limiting step. High performance is attributed to the abundance of catalytically active sites and the synergistic interactions between the materials. Theoretical calculations reveal that the VS2/ZnS/CdS hybrid shows favorable HER activity owing to its low hydrogen adsorption free energy of about 0.35 eV. We believe that this work on designing 2D VS2/ZnS/CdS will offer a new pathway to discover an efficient H2 generation electrocatalyst.

Impedance spectroscopy is a valuable tool for the analysis of the ionic conductivity of both solid and liquid state materials. Chalcogenide glasses are well known for their high ionic conductivity nature and wide compositional flexibility. As the GeSbSe material has high glass forming ability, it is expected that the materials can be doped with a high amount of foreign element (in the present case Ag). For all of these reasons, the GeSbSe materials can be expected as a potential candidate for solid state electrolyte for ionic batteries. The ionic conductivity behavior of Agx(Ge16Sb12Se72)100-x chalcogenide glasses were studied using impedance a primary tool.In the present article, you will find the impedance data of Agx(Ge16Sb12Se72)100-x chalcogenide glass system. From the impedance data, real and imaginary parts of conductivities were extracted and plotted as a function of applied frequency. The interpretation of the current article data were given in “Percolation behavior of Ag in Ge16Sb12Se72 glassy matrix and its impact on corresponding ionic conductivity” [1]. Keywords: Impedance spectroscopy, Ionic conductivity, Random-walk model, Chalcogenide glasses

Background. The association between economic status and kidney disease is incompletely explored even in countries with higher economy (HE); the situation is complex in lower economies (LE) of South Asia and Southeast Asia (SA and SEA). Methods. Fifteen countries of SA and SEA categorized as HE and LE, represented by the representatives of the national nephrology societies, participated in this questionnaire and interview-based assessment of the impact of economic status on renal care. Results. Average incidence and prevalence of end-stage kidney disease (ESKD) per million population (pmp) are 1.8 times and 3.3 times higher in HE. Hemodialysis is the main renal replacement therapy (RRT) (HE-68%, LE-63%). Funding of dialysis in HE is mainly by state (65%) or insurance bodies (30%); out of pocket expenses (OOPE) are high in LE (41%). Highest cost for hemodialysis is in Brunei and Singapore, and lowest in Myanmar and Nepal. Median number of dialysis machines/1000 ESKD population is 110 in HE and 53 in LE. Average number of machines/dialysis units in HE is 2.7 times higher than LE. The HE countries have 9 times more dialysis centers pmp (median HE-17, LE-02) and 16 times more nephrologist density (median HE-14.8 ppm, LE-0.94 ppm). Dialysis sessions >2/week is frequently followed in HE (84%) and 10% in all the HE countries except Taiwan, 10%–20% in the majority of LE countries. Conclusion. Economic disparity in SA and SEA is reflected by poor dialysis infrastructure and penetration, inadequate manpower, higher OOPE, higher dialysis dropout rates, and lesser renal transplantations in LE countries. Utility of RRT can be improved by state funding and better insurance coverage.

Antibiotics used to treat bacterial infections can become ineffective over time or result in the emergence of antibiotic resistant pathogens. With the advent of nanotechnology, silver nanoparticles (AgNPs) have gained significant attention as a therapeutic agent due to the well-known antimicrobial properties of silver. However, there are concerns and limited literature on the potential cytotoxicity of nanoparticles at effective antimicrobial concentrations. AgNPs prepared from silver nitrate with glucose reduction were characterized by surface plasmon resonance, dynamic light scattering, zeta potential analysis and transmission electron microscopy. The cytotoxicity of AgNPs towards human gingival fibroblasts over 7 days was determined using cell proliferation assays and confocal microscopy. AgNP MIC and antibacterial effects alone and in combination with 11 antibiotics were determined against a panel of nine microbial species including gram-positive and gram-negative bacterial species. AgNPs concentrations ≤ 1 μg/mL were non-cytotoxic but also showed no antibacterial effects. However, when combined with each of eleven antibiotics, the biocompatible concentration of AgNPs (1 μg/mL) resulted in significant inhibition of bacterial growth for multiple bacterial species that were resistant to either the antibiotics or AgNPs alone. This study presents a promising strategy with further testing in vivo, to develop novel antimicrobial agents and strategies to confront emerging antimicrobial resistance.

Aiming to elucidate the system-wide effects of the alcohol-induced increase in the content of cytochrome P450 2E1 (CYP2E1) on drug metabolism, we explored the array of its protein-protein interactions (interactome) in human liver microsomes (HLM) with chemical crosslinking mass spectrometry (CXMS). Our strategy employs membrane incorporation of purified CYP2E1 modified with photoreactive crosslinkers benzophenone-4-maleimide and 4-(N-succinimidylcarboxy)benzophenone. Exposure of bait-incorporated HLM samples to light was followed by isolating the His-tagged bait protein and its crosslinked aggregates on Ni-NTA agarose. Analyzing the individual bands of SDS-PAGE slabs of thereby isolated protein with the toolset of untargeted proteomics, we detected the crosslinked dimeric and trimeric complexes of CYP2E1 with other drug-metabolizing enzymes. Among the most extensively crosslinked partners of CYP2E1 are the cytochromes P450 2A6, 2C8, 3A4, 4A11, and 4F2, UDP-glucuronosyltransferases (UGTs) 1A and 2B, fatty aldehyde dehydrogenase (ALDH3A2), epoxide hydrolase 1 (EPHX1), disulfide oxidase 1α (ERO1L), and ribophorin II (RPN2). These results demonstrate the exploratory power of the proposed CXMS strategy and corroborate the concept of tight functional integration in the human drug-metabolizing ensemble through protein-protein interactions of the constituting enzymes.

Objectives: Brachial artery ultrasound imaging during reactive hyperemia is widely used tool for quantifying endothelium dependent vasomotion. Angiodefender device is used for non invasive determination of percentage flow mediated vasodilation (FMD). An attempt is made to study whether endothelial dysfunction determined by FMD of brachial artery predicts the presence or absence of coronary artery disease and its correlation with the severity of coronary artery disease. Methods: One hundred six patients admitted between May 2014 and April 2015 who were posted for coronary angiography diagnosed to have chronic stable angina on clinical basis and/or by exercise stress test, for evaluation of coronary artery disease were submitted to standard clinical evaluation, calculation of percentage FMD by Angiodefender device. Statistical significance of difference of categorical variables was tested using Fisher’s exact test. Sensitivity, specificity, positive predictive value and negative predictive value of FMD were studied. Results: There was no correlation between number of risk factors and percentage of FMD. Significantly higher proportion of cases with less FMD had higher prevalence of coronary artery disease and vice-versa. Significantly higher proportion of cases with positive stress test had less percentage of FMD and vice-versa. Significantly higher proportion of cases with less percentage of FMD and positive stress test had higher prevalence of obstructive coronary artery disease and vice-versa. Specificity was 100% when percentage of FMD was ≤10. Conclusions: FMD an inexpensive and non-invasive test provides information regarding extent and severity of coronary artery disease. Keywords: Coronary angiography, Coronary artery disease, Endothelial dysfunction, Flow mediated vasodilatation, Stress test

Deriphyllin has been a mainstay of asthma therapy despite its narrow therapeutic index and a large pharmacokinetic variability between patients. Here, the authors decided to report a rare case of suspected deriphyllin-induced hallucinations in adults for the first time. An 83-year-old male patient who was a known case of recent onset asthma was on tablet deriphyllin 150 mg BD and salbutamol nebulization BD. He underwent emergency drainage of subdural hematoma due to a history of fall 20 days back with head injury. Within 2 days, he improved and was discharged 3 days later with the medicines. On follow-up after 7 days, he was admitted with a chief complaint of hallucinations. After stopping tablet deriphyllin, the patient's condition drastically improved in next few days and neurology was completely normal. Drug dechallenge was positive in this case since the hallucinations subsided after discontinuation of suspected drug deriphyllin. There are no such cases published previously.

Abstract is not available for this article.

In this study, TiO2 nanofibers were prepared with Polyvinylpyrrolidone (PVP) polymer using sol-gel method via electrospinning technique. Owing to the advantages of small fiber diameter, tunable porosity, low cost, large surface to volume ratio, structure control, light-weight, and less energy consumption, electrospun nanofibers are evolving as an adaptable material with a number of applications, in this case for filtration and environmental/virus protection. Different samples of TiO2/PVP nanofibers have been prepared by changing the parameters to achieve the best result. As the polymer concentration was increased from 6 to 8 wt.% of PVP, diameter of the resultant fibers was seen to be increased, implying decrease in the pore-size of the fibers up to 1.4 nm. Surface morphology has been checked via Scanning Electron Microscope (SEM) images. Crystalline nature has been analyzed by X-ray Crystallography. Using the Bruanauer-Emmett-Teller (BET) test, surface area and porosity has been checked for the suitable application. The synthesized TiO2/PVP nanofibers have tremendous practical potentials in filtration and environmental remediation applications.

In recent years, more conservative methods of surgery of the renal artery are coming up. Hence, a precise knowledge of renal vasculature has become a necessity. Knowledge of the existence of accessory renal arteries is important; otherwise, they may get inadvertently damaged during renal surgery. Furthermore, their presence must be considered while evaluating a donor’s kidney for possible renal transplantation. The study may also be useful to clinicians performing invasive techniques, vascular surgeries, other uro-radiological procedures, and in cases of trauma. Keeping this in mind, this study was conducted on 530 adult cadavers. A total of 1060 kidneys obtained from these cadavers were dissected and accessory renal arteries were looked for; 24.99% of the specimens showed the presence of accessory renal arteries. In 20.75%, one accessory renal artery was found, and in 4.24% of specimens, two accessory renal arteries were seen.

Abstract Sexual dysfunction is commonly associated with the use of substances, in both men and women. This area requires prominent attention, particularly as the use of substances is often with the expectancy of improving an underlying sexual dysfunction or with a positive expectancy of enhancing sexual function. The chronic use of substances has a negative impact on sexual function and causes various kinds of sexual dysfunction in both men and women. In this narrative review, we look at the effect of various substances of abuse on sexual functioning and discuss management strategies in such situations.

Introduction: Over 90% of AIDS patients and 1/3rd of HIV seropositive patients are affected by Oral candidiasis. Moreover, the frequency of HIV related oral candidiasis is increased when CD4 count falls

Background: Communication is a process that allows us to interact with other people. Medical professionals need to possess good communication skills for history taking, diagnosis, and treatment. Communicative skills are hardly taught in medical schools of India. The students are expected to learn them on their own. To address this issue, we introduced communicative skills training (CST) for medical interns. Objective: Primary – To determine the effectiveness of CST in improving history taking on sensitive issues by medical interns. Secondary – To improve patients' satisfaction through improved communicative skills. Materials and Methods: This was a randomized control study carried out on medical interns at Jamnagar. The interns were randomized to either Group A or Group B. Intervention in the form of CST was given to Group A while Group B was control. The topic of CST was “eliciting sexual history.” Assessment of participants was done by pre- and post-intervention objective structured clinical examination. For ethical reasons, Group B was also given CST by experts after completion of our study but their results were not included for analysis. Results: Although mean scores increased in both the groups, (from 6.4 to 13.4 in the intervention group and from 6.5 to 7.5 in controls), the percent increase was much larger in the intervention group than controls (109% vs. 15%). Students gave a positive feedback to CST. Opinion of teachers was favoring CST. Among the patients allotted to intervention group, 83% were satisfied. Conclusion: CST imparted to medical interns helps in improving doctor–patient relationship.

Context: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Recent studies report increased the prevalence of COPD among adult females and nutrition is an important prognostic marker in COPD. Nutrition in Indian females is already a concern, further compromised by increasing the prevalence of COPD. Aims: A study correlation of six selected nutritional parameters: Body mass index, waist-hip ratio, waist-height ratio, serum albumin, hemoglobin, and Mini Nutritional Assessment (MNA) score with the severity of COPD (Global Initiative for Obstructive Lung Diseases [GOLD] categorization) in adult female patients. Settings and Design: A cross-sectional analytical study including all adult female patients diagnosed with COPD based on spirometry, attending pulmonary medicine outpatient department of a medical college between January and June 2014. Patients with pulmonary tuberculosis, acute exacerbations of COPD, and those unwilling to participate were excluded from the study. Subjects and Methods: A total of 100 patients were studied with a detailed history, physical examination, spirometry, anthropometric measurements, laboratory parameters of nutrition, and MNA questionnaire. Statistical Analysis Used: SPSS 14.01 version (IBM analytics) with Pearson's correlation coefficient and one-way analysis of variance (ANOVA) as tests of significance. Results: The study revealed that proportion of adult female COPD patients with GOLD categorization is 7% GOLD1, 40% GOLD 2, 42% GOLD 3, and 11% GOLD 4. Pearson's correlation coefficients calculated for the severity of COPD with six selected nutritional parameters showed statistically significant correlation with MNA score (correlation coefficient = −0.253, P< 0.01) and waist-height ratio. Mean MNA score in GOLD four patients (18.72) was significantly lower than that in GOLD 1 patients (22.14). MNA score decreases toward malnutrition as severity of COPD increases which is statistically significant (F = 2.353, df = 3, P< 0.05) using ANOVA. Similarly, waist-height ratio also decreased significantly with increasing severity of COPD (F = 2.582, df = 3, P< 0.05). Conclusions: The study concludes that malnutrition increases the severity of COPD. Further, it also concluded that MNA score and waist-height ratio correlate better with the severity of COPD than other nutritional parameters.

ABSTRACT The opportunistic pathogen Streptococcus agalactiae is the major cause of meningitis and sepsis in a newborn’s first week, as well as a considerable cause of pneumonia, urinary tract infections, and sepsis in immunocompromised adults. This pathogen respires aerobically if heme and quinone are available in the environment, and a functional respiratory chain is required for full virulence. Remarkably, it is shown here that the entire respiratory chain of S. agalactiae consists of only two enzymes, a type 2 NADH dehydrogenase (NDH-2) and a cytochrome bd oxygen reductase. There are no respiratory dehydrogenases other than NDH-2 to feed electrons into the respiratory chain, and there is only one respiratory oxygen reductase to reduce oxygen to water. Although S. agalactiae grows well in vitro by fermentative metabolism, it is shown here that the absence of NDH-2 results in attenuated virulence, as observed by reduced colonization in heart and kidney in a mouse model of systemic infection. The lack of NDH-2 in mammalian mitochondria and its important role for virulence suggest this enzyme may be a potential drug target. For this reason, in this study, S. agalactiae NDH-2 was purified and biochemically characterized, and the isolated enzyme was used to screen for inhibitors from libraries of FDA-approved drugs. Zafirlukast was identified to successfully inhibit both NDH-2 activity and aerobic respiration in intact cells. This compound may be useful as a laboratory tool to inhibit respiration in S. agalactiae and, since it has few side effects, it might be considered a lead compound for therapeutics development. IMPORTANCE S. agalactiae is part of the human intestinal microbiota and is present in the vagina of ~30% of healthy women. Although a commensal, it is also the leading cause of septicemia and meningitis in neonates and immunocompromised adults. This organism can aerobically respire, but only using external sources of heme and quinone, required to have a functional electron transport chain. Although bacteria usually have a branched respiratory chain with multiple dehydrogenases and terminal oxygen reductases, here we establish that S. agalactiae utilizes only one type 2 NADH dehydrogenase (NDH-2) and one cytochrome bd oxygen reductase to perform respiration. NADH-dependent respiration plays a critical role in the pathogen in maintaining NADH/NAD+ redox balance in the cell, optimizing ATP production, and tolerating oxygen. In summary, we demonstrate the essential role of NDH-2 in respiration and its contribution to S. agalactiae virulence and propose it as a potential drug target.

Tannic acid explore a highly efficient catalytic activity for the synthesis of 12-aryl-8,9,10,12-tetrahydrobenzo[a]xanthen-11-one derivatives in excellent yields via cyclocondensation of aromatic aldehyde, β-naphthol and dimedone. Catalyst having advantages such as it is cheap and biodegradable and the protocol avoids the use of expensive catalyst and toxic solvent. We believe that this methodology is an efficient, simple, highly yielding, time saving and environmentally friendly. DOI: http://dx.doi.org/10.17807/orbital.v7i2.683

The skin punch or surgical punch is an instrument which is used almost exclusively by dermatologists. It is a circular hollow blade attached to a pencil-like handle ranging in size from 0.5 to 10 mm. It is available as a disposable, reusable, and automated instrument. The punch can be used as a diagnostic, therapeutic, and cosmetic tool in dermatology. We have used punch as a diagnostic, therapeutic, and cosmetic tool in our dermatosurgery practice in our hospital. Various original research articles, text book publications, and review articles were studied and compiled. Techniques used by various authors and our own experiences with punch have been described. This article aims at providing the novel usefulness of skin biopsy punch in dermatology as the basic punch surgery is quick and easy to learn. Complications such as bleeding and infection are minimal.

Context: Immunization, a well-known and effective method of preventing childhood illnesses is basic service under primary health care. Most surveys in India measure primary immunization coverage and quality, but no "Gender Equality." Aims: Assess "Gender Equality" in primary immunization with reference to coverage, quality, and place of immunization. Settings and Design: Cross-sectional survey in a primary health center, Pune, Maharashtra using World Health Organization 30-cluster sampling method with 14 beneficiaries (7 girls and 7 boys) to be selected from each cluster. Instead of 420 children, data collected for 345 children, as requisite numbers of children were not available in low population villages and also children whose mothers were not present during survey were excluded. Materials and Methods: Vaccination data collected from either records and/or history by mother. Children born on or between 13-09-2009 and 13-09-2010, were included. Statistical Analysis Used: SPSS 14.01 version with Chi-square as test of significance. Results: Of the study population, 171 (49.6%) were females and 174 (50.4%) males. A total of 64.1% children had immunization records with female proportion 69.0% and males 59.2%. Primary immunization coverage was 80.0%, with female proportion 82.5% and males 77.6%. One male child was completely unimmunized and remaining partially immunized, with unaware of schedule and illness of child being major reasons for partial immunization. There was no gender wise statistically significant difference observed in Primary Immunization with reference to coverage, quality, and place of immunization. Conclusions: Immunization coverage is nearing 85% benchmark with major contribution from Universal Immunization Program. Gender Equality observed in primary immunization. Preservation of immunization records by community and timely vaccinations are areas for improvement.

Introduction: The use of smartphone is increasing day by day for personal as well as professional purpose. They are becoming a more suitable tool for advancing education in developing countries. Mobile access to information and many applications are successfully harnessed in health care. Smartphones are also becoming popular as an effective educational tool. Aim: The present study was conducted to evaluate the use of smartphones as an educational tool amongst the medical students. The study also aimed at identifying the common medical application used by the students. Materials and Methods: It was an observational cross-sectional study carried out amongst medical students of private medical institute in India. A validated 16 point, structured, open-ended, questionnaire regarding ownership and use of smart phones was self-administered to 446 medical students. Data were analysed using SPSS and open ended questions were analysed by summative content analysis. Results: Among the study population, 96% owned a smartphone -Android based 72.4%, i phone 13.0%, Windows based Nokia phones 7% and Blackberry 3.6%. Common medical applications used by the students were Anatomy and Medical Dictionary in First MBBS; Medical Dictionary, Medscape and Google/Wikipedia in Second MBBS; and Medscape, Google/ Wikipedia and Prognosis/Diagnosis in Third MBBS. More than 90% students, reported to have technological skills to use smartphones, for medical education, communication and instant access during bedside teaching. Advertently, 37.2% students felt if smartphones are used for clinical purposes, they will need to spend less time with patients. Almost 79.4% felt that smartphones should be introduced in MBBS course. Conclusion: Smartphone use amongst medical students as learning aid for various medical applications is rapidly advancing. But it will be worthwhile to study whether use of smartphones has any impact on the grades of the students before introducing them in medical schools.

ABSTRACT Escherichia coli is a versatile pathogen capable of causing intestinal and extraintestinal infections that result in a huge burden of global human disease. The diversity of E. coli is reflected by its multiple different pathotypes and mosaic genome composition. E. coli strains are also a major driver of antibiotic resistance, emphasizing the urgent need for new treatment and prevention measures. Here, we used a large data set comprising 1,700 draft and complete genomes to define the core and accessory genome of E. coli and demonstrated the overlapping relationship between strains from different pathotypes. In combination with proteomic investigation, this analysis revealed core genes that encode surface-exposed or secreted proteins that represent potential broad-coverage vaccine antigens. One of these antigens, YncE, was characterized as a conserved immunogenic antigen able to protect against acute systemic infection in mice after vaccination. Overall, this work provides a genomic blueprint for future analyses of conserved and accessory E. coli genes. The work also identified YncE as a novel antigen that could be exploited in the development of a vaccine against all pathogenic E. coli strains—an important direction given the high global incidence of infections caused by multidrug-resistant strains for which there are few effective antibiotics. IMPORTANCE E. coli is a multifaceted pathogen of major significance to global human health and an important contributor to increasing antibiotic resistance. Given the paucity of therapies still effective against multidrug-resistant pathogenic E. coli strains, novel treatment and prevention strategies are urgently required. In this study, we defined the core and accessory components of the E. coli genome by examining a large collection of draft and completely sequenced strains available from public databases. This data set was mined by employing a reverse-vaccinology approach in combination with proteomics to identify putative broadly protective vaccine antigens. One such antigen was identified that was highly immunogenic and induced protection in a mouse model of bacteremia. Overall, our study provides a genomic and proteomic framework for the selection of novel vaccine antigens that could mediate broad protection against pathogenic E. coli.