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Abstract The circadian clock of cyanobacteria, which predicts daily environmental changes, typically includes a standard oscillator consisting of proteins KaiA, KaiB, and KaiC. However, several cyanobacteria have diverse Kai protein homologs of unclear function. In particular, Synechocystis sp. PCC 6803 harbours, in addition to a canonical kaiABC gene cluster (named kaiAB1C1), two further kaiB and kaiC homologs (kaiB2, kaiB3, kaiC2, kaiC3). Here, we identify a chimeric KaiA homolog, named KaiA3, encoded by a gene located upstream of kaiB3. At the N-terminus, KaiA3 is similar to response-regulator receiver domains, whereas its C-terminal domain resembles that of KaiA. Homology analysis shows that a KaiA3-KaiB3-KaiC3 system exists in several cyanobacteria and other bacteria. Using the Synechocystis sp. PCC 6803 homologs, we observe circadian oscillations in KaiC3 phosphorylation in vitro in the presence of KaiA3 and KaiB3. Mutations of kaiA3 affect KaiC3 phosphorylation, leading to growth defects under both mixotrophic and chemoheterotrophic conditions. KaiC1 and KaiC3 exhibit phase-locked free-running phosphorylation rhythms. Deletion of either system (∆kaiAB1C1 or ∆kaiA3B3C3) alters the period of the cellular backscattering rhythm. Furthermore, both oscillators are required to maintain high-amplitude, self-sustained backscatter oscillations with a period of approximately 24 h, indicating their interconnected nature.

We present a case of a 31-year-old male who presented to the emergency department with a history of abdominal pain localized to the lower abdomen. The patient had undergone splenectomy 2 years ago for splenic injury following a road traffic accident. Computerized tomography showed multiple well-defined, homogeneously enhancing soft tissue density nodules of varying sizes distributed throughout the abdomen and pelvis. A diagnosis of splenosis was made based on imaging findings and history. Abdominal splenosis is an uncommon entity of which radiologists need to be aware, and this case serves to shed further light on this condition.

Background: Cerebral venous sinus thrombosis (CVST) is a rare, treatable cause of stroke. Even though CVST has an established medical treatment, 15% of patients remain refractory to treatment. These patients may be candidates for endovascular treatment (EVT), yet the selection of patients remains a challenge. The study aims to understand the profile and outcome of patients treated with EVT and the type of procedure associated with good outcomes. Methods: This is a single-center, retrospective analysis of CVST patients who underwent EVT from 2009 till 2022. Patients who received only medical management were excluded. Modified Rankin Scale (mRS) ≤2 at 3 months was taken as the primary outcome. Secondary outcomes assessed were hospital stay, death, recurrence, mRS ≤ 2 at discharge, and angiographic recanalization. Results: Fifty-two patients were included. Twenty-eight (53.8%) were males; the mean age was 33.3 ± 12.3 years. Headache (n = 44, 84.6%) predominated among the symptoms. The common risk factors were anemia (n = 13, 25.5%) and hyperhomocysteinemia (n = 13, 25.5%). Worsening of sensorium (n = 21, 40.3%) and non-improvement of symptoms (n = 15, 28.8%) were the common indications for the procedure. Twenty-five (48.1%) people underwent in situ thrombolysis (IST). Death occurred in eight (15.3%) patients. Thirty-six (73.5%; 36/49) patients had a good outcome at 3 months. IST had a significantly better outcome (mRS ≤ 2, n = 20, 80%) compared to other procedures (P = 0.04). Hospital stay was lesser in the IST subgroup, but without statistical significance. Midline shift >5 mm (odds ratio [OR] 6.8 [1.5–30.9], P = 0.01) and Glasgow Coma Scale

Introduction: This study aimed to ascertain the accuracy of clinical examination for the determination of pleural puncture sites as compared to the use of ultrasonography in patients with pleural effusion. Material and Methods: A single-centre, prospective, observational study was carried out amongst 115 patients with pleural effusion in a tertiary care hospital in western India. Patients were subjected to clinical assessment for determination of pleural puncture sites and the same were confirmed with ultrasonography. All physicians were blinded to the marking of the previous physician to prevent any influence on their assessment. Results: The study had 345 physician observations. The overall accuracy of the clinical examination was 94.8%. Multivariate logistic regression of the factors responsible for the accuracy of clinical examination demonstrated a significant role of higher body mass index (BMI) (OR-1.19) and lower zone pleural effusions (OR-4.99) when adjusted for age, gender, side of effusion, and experience of examining doctors. When the effusions were classified according to their location, lower zone pleural effusions and loculated pleural effusions had an error rate of 15.9% and 8.33%, respectively. Conclusion: An ultrasound is the standard of care to assess all pleural effusions and guide the best point for aspiration.

Objectives: This study compares the bacterial susceptibility to three different provisional restorations manufactured with different laboratory techniques, i.e., heat cure, CAD/CAM, and 3D printing. Materials and Methods: Totally, 45 health patients with age group of 30–60 years undergoing complete veneer crown treatment were selected for the study and divided into three groups with 15 samples in each as Group I: the crowns were made from polymethyl methacrylate polymer fabricated by the conventional heat cure method, Group 2: the crowns were made from polymethyl methacrylate fabricated by subtractive manufacturing CAD/CAM method, and Group 3: the crowns were made from oligomers fabricated by additive manufacturing 3D printing. The samples were examined for bacterial adherence at scanning electron microscope. The colony-forming units (CFUs) were calculated, and statistically analyzed. Results: It has been determined that the digitally fabricated provisional restorations prove to be superior in terms of surface topography than to the conventionally fabricated provisional restorations. Conclusion: The study concludes that 3D-printed provisional restorations are more precise with reduced bacterial susceptibility than milled ones.

Agriculture sector being the backbone of the Indian economy always receives prioritized attention by the policy makers and planners. The age old debate between energy-water nexus has received a renewed thrust due to emergence of solarized irrigation systems for the agriculture sector in the country. The present study, develops a model innovatively by combining a bottom-up approach with top-down data to understand the future water and energy requirements for agriculture sector under three scenarios till 2030 for five major agrarian states, namely Haryana, Punjab, Maharashtra, Rajasthan and Tamil Nadu. Estimates are made to understand the benefits accrued due to solarlization of existing pumps as well as by use of energy efficient pumps. Results indicate that around INR 76 billion could be saved by all the five states together due to reduction of electricity subsidy alone if such transitions are realized. Other benefits are viewed in terms of reduction in energy costs, reduction in CO2 emissions, and efficient use of water for irrigation.

Abstract Inspired by massive parallelism, an increase in internet-of-things devices, robust computation, and Big-data, the upsurge research in building multi-bit mem-transistors is ever-augmenting with different materials, mechanisms, and state-of-the-art architectures. Herein, we demonstrate monolayer WS2-based functional mem-transistor devices which address nonvolatility and synaptic operations at high temperature. The ionotronic memory devices based on WS2 exhibit reverse hysteresis with memory windows larger than 25 V, and extinction ratio greater than 106. The mem-transistors show stable retention and endurance greater than 100 sweep cycles and 400 pulse cycles in addition to 6-bit (64 distinct nonvolatile storage levels) pulse-programmable memory features ranging over six orders of current magnitudes (10−12–10−6 A). The origin of the multi-bit states is attributed to the carrier dynamics under electrostatic doping fluctuations induced by mobile ions, which is illustrated by employing a fingerprint mechanism including band-bending pictures. The credibility of all the storage states is confirmed by obtaining reliable signal-to-noise ratios. We also demonstrate key neuromorphic behaviors, such as synaptic plasticity, near linear potentiation, and depression, rendering it suitable for successful implementation in high temperature neuromorphic computing. Furthermore, artificial neural network simulations based on the conductance weight update characteristics of the proposed ionotronic mem-transistors are performed to explore the potency for accurate image recognition. Our findings showcase a different class of thermally aided memories based on 2D semiconductors unlocking promising avenues for high temperature memory applications in demanding electronics and forthcoming neuromorphic computing technologies.

ABSTRACTCOVID-19 pandemic has triggered psychological stress such as anxiety and depression among people around the globe. Due to the nature of the job, healthcare professionals (HCPs) are at high risk of infection and are facing social stigma as well. This research was conducted with the objective to evaluate the psychological influence of the COVID-19 pandemic among HCPs in Yemen and the coping strategies adopted thereof. A web-based, as well as face-to-face cross-sectional study was carried out from July to December 2021 among HCPs of Yemen. The generalized anxiety disorder (GAD-7), patient health questionnaire (PHQ-9), and Brief-COPE scales were applied for the evaluation of anxiety, depression, and coping strategies. A total of 197 HCPs participated in the study where 28.4% and 43.1% had anxiety and depression respectively. The prevalence of both anxiety and depression in the majority were found of the minimal to none and mild categories (71.6% vs. 56.9% respectively). The respondents who had received training on COVID-19 had statistically significant lower GAD-7 scores than those who did not (6.32 vs. 8.02 respectively). A significant statistical difference was observed between physicians versus nurses regarding depression based on the working area (p

Background: This research aimed to evaluate the clinico-epidemiological profile and short-term outcomes of patients admitted to the emergency department of a tertiary hospital. Materials and Methods: This prospective observational cross-sectional study was conducted between January 1, 2021, and June 30, 2022, in the Emergency Department of a tertiary hospital. Patients of either gender of any age attending the emergency department with acute poisoning were included. These cases were analyzed for their epidemiological profiles, poisoning characteristics, and various clinical variables influencing patient outcomes. Results: Out of a total of 236 patients, 190 patients (80.5%) were aged more than 18 years. Comorbidities were present in 32 (13.5%) patients, and psychiatric illness was the most common comorbidity. The intention of poisoning was suicidal in 185 patients (78.4%) and accidental in 51 patients (21.6%). Organophosphate was the most common poisoning seen in 55 patients (23.3%), followed by drug ingestion seen in 44 patients (18.6%). Twenty-eight patients (11.8%) were transferred to the intensive care unit. Nineteen patients (8.1%) required mechanical ventilation. There were ten deaths (4.2%) in the study population. Aluminum phosphide poisoning was associated with the highest mortality rate, followed by organophosphate poisoning. Conclusions: This study indicates that most poisoning cases involved young people, mainly males. Organophosphorus poisoning was one of the most common poisonings, followed by the ingestion of drugs in this part of the world. Aluminum phosphide had the highest fatality rate.

Abstract Background and Aim Coronavirus disease 2019 (COVID‐19) is a major public health problem causing significant morbidity and mortality worldwide. Apart from respiratory symptoms, gastrointestinal symptoms like nausea, vomiting, diarrhea, and abdominal discomfort are quite common among COVID‐19 patients. The gastrointestinal tract can be a potential site for virus replication and feces a source of transmission. Thus, ignorance of enteric symptoms can hinder effective disease control. The objective of this study is to see the gastrointestinal manifestation of the disease and its effect on morbidity and mortality. Methods This observational cross‐sectional retrospective study was carried out among 165 laboratory‐confirmed COVID‐19 patients in primary health care of Gorkha, Nepal from March 1, 2021 to March 1, 2022. A systematic random sampling method was adopted while data were entered and analyzed by Statistical Package for Social Sciences version 21. Results Of 165 patients, 97 patients (58.78%) had enteric involvement. Among gastrointestinal symptoms, diarrhea in 67 patients (40.6%) and nausea and/or vomiting in 66 patients (40%) were the most common symptoms, followed by abdominal pain in 27 patients (16.4%) and anorexia in 19 patients (11.5%). Of the majority of cases with gastrointestinal involvement, 63 (63%) were below 50 years of age. Many of the patients who received vaccination had gastrointestinal symptoms (79%). Complications like acute respiratory distress syndrome, shock, and arrhythmia developed in 9.7% of patients, with the death of eight patients. COVID‐19 vaccination was associated with 4.32 times higher odds of having gastrointestinal involvement in subsequent COVID‐19 infection. Conclusions Diarrhea followed by nausea/vomiting was among the most common gastrointestinal symptoms affecting younger age groups in our study. Enteric symptoms were more common among vaccinated people rather than among nonvaccinated ones.

Key Clinical Message The etiology of neural tube defects is multifactorial, with a wide interplay of genetic and environmental factors. However, periconceptional folic acid should be supplemented in antenatal care. Abstract We described a case of neural tube defects (NTDs), specifically occipital encephalomeningocele, in a child born to a mother who received folic acid supplementation. A wide interplay of genetic and environmental factors exists in its causation. Although folic acid confers advantage, the relationship with the causation of NTDs still remains unclear.

Software-as-a-service (SaaS) is a license for access to a specific cloud application through the Internet. However, these services are delayed and sometimes totally disrupted because of the Internet’s unavailability that provides opportunities for a lot of attacks. Research into the security of the cloud focuses mainly on prohibiting malicious users from using the cloud to launch attacks, such as those currently done by botnets, including launching a DDoS attack, sending spam, etc. Because SaaS uses computational power from both servers of cloud computing providers and machines of customers, we argue that SaaS may be elaborately exploited in an unprecedented way as an attack vector for botnets. The previous research work has developed a novel framework for detecting the attacks with the aid of a deep learning approach (Doriguzzi-Corin et al., 2020). Although the attack node in the network has been identified, they were not diminished. An enhanced and powerful adversary model is to be provided as a solution to this problem. Hence, this paper intends to develop a novel framework for attack node mitigation using a secure SaaS Framework. The main contribution of this paper provides an attack detection process that takes place in Deep Belief Network (DBN), in which the weight, as well as activation function, are fine-tuned with Median Fitness oriented Sea Lion Optimization algorithm (MFSLnO). If DBN detects an attack node, the control is transferred to a lightweight bait approach that reliably mitigates the most common attack nodes without disrupting regular connections will be deployed. The performance of the proposed work yielded the best results over the traditional models with a packet loss ratio of 16% and throughput of 89%.

Optic Nerve Head Melanocytoma (ONHM) is a rare benign pigmented tumour of the uveal tract, seen commonly at the optic nerve head. The tumour is associated with a few ocular and systemic conditions. It usually remains stationary and rarely (1-2%) undergoes a malignant transformation. With the progressive understanding of its benign nature with advancing imaging modalities, observation with regular follow-up is the mainstay of treatment. A 35-year-old female, presented with complaints of foreign body sensation in both eyes. She was a known case of graves’ disease under treatment with anti-thyroid drugs and beta blockers. Ocular examination revealed classic signs of thyroid eye disease. The left eye fundus revealed a large, black, globular tumour in the optic nerve head obscuring the entire disc and Ultrasound B scan revealed a tumour at the optic nerve head with high echogenicity. Optical Coherence Tomography (OCT) through the mass revealed a dome-shaped elevation with obscuration of underlying details due to heavy pigmentation, with no signs of subretinal exudation or edema. Thyroid profile was within normal limits. A diagnosis of left eye ONHM was made. The patient was started on tapering doses of systemic steroids and was regularly followed up to monitor the tumour growth for 18 months. This is the first reported case of ONHM co-existing with thyroid eye disease and this association could be coincidental or embryological. This case highlights the need for ophthalmologists to be familiar with this benign condition and for regular careful follow-up of such patients.

Background Various risk factors for tumors such as smoking, alcohol consumption, diet, and radiation, etc., were already identified. ABO blood group antigens are also present on epithelia, endothelia, and neurons. Recent evidence suggested the role of ABO antigens in the pathogenesis of certain malignancies. Materials and Methods A retrospective observational study was conducted in a tertiary care neurosurgical center in North India from January 2016 to December 2018. The hospital information system was used to obtain patient information while the blood center information system was used to collect blood group information. Brain tumors were majorly divided into cavernoma, glioma, meningioma, neuroma, pituitary adenoma, schwannoma, and others. Results We found a total of 1,970 patients with brain tumors admitted during our study period. Most patients had glioma (33.55%), followed by pituitary adenoma (20.05%) and neuroma (2.23%). B blood group individuals had more prevalence of cavernoma, glioma, meningioma, pituitary adenoma, schwannoma, and others followed by O, A, and AB. Only association of O blood group with neuroma tumor was found statistically significant. Conclusions Our patient population had blood group distribution similar to our general population and no significant association was observed by blood group antigens and brain tumors. Although neuroma was significantly associated with blood group O but the prevalence of neuroma in our patient population is very low hence large sample study is required to draw a firm conclusion regarding this association.

Background: Adolescents and young adults in the United States (US) have experienced a significant increase in drug overdose mortality rates in the last two decades. During the Coronavirus disease 2019 (COVID-19) pandemic, they experienced a lack of access to substance use disorder treatment, stay-home orders, school closure, social isolation, increased psychological distress, and financial strain. Few studies have examined the impact of the pandemic on monthly trends in drug-overdose mortality among youth by race/ethnicity. This study estimates differential changes in monthly drug overdose mortality among youth in the US by age, sex, and race/ethnicity. Methods: Monthly deaths from the final 2018-2020 national mortality data and the 2021 provisional mortality data were used, and monthly population estimates were obtained from the Census Bureau. We calculated age-specific monthly drug overdose deaths per one million population and used log-linear regression models to estimate monthly percent increases in mortality rates from January 2018 through October 2021. Results: Drug-overdose deaths among individuals aged 15-34 increased by 36.5% from 2019 (21,152 deaths) to 2020 (28,879 deaths). From February 2020 to May 2020, the drug-overdose mortality rate increased by 62% for males, 53% for females, 79% for Blacks, 62% for American Indians/Alaska Natives (AIANs), 57% for Hispanics, 56% for non-Hispanic Whites, and 47% for Asians. From January 2018 to October 2021, the average monthly drug-overdose mortality rate increased by 2.69% per month for Blacks, 2.54% for AIANs, 2.27% for Hispanics, 1.37% for Asians, and 0.81% for non-Hispanic Whites. Increases in drug-overdose mortality were more rapid among males than females and among youth aged 15-24 than youth aged 25-34. Conclusion and Global Health Implications: During the peak months in 2020 and 2021, the COVID-19 pandemic had a disproportionate impact by race/ethnicity on trends in drug overdose mortality among the youth. Drug overdose mortality rates increased faster among Blacks, Hispanics, AIANs, and Asians compared to non-Hispanic Whites. Copyright © 2022 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Background: The COVID-19 pandemic has had a substantial adverse impact on the health and well-being of populations in the United States (US) and globally. Although COVID-19 vaccine disparities among US adults aged ≥18 years are well documented, COVID-19 vaccination inequalities among US children are not well studied. Using the recent nationally representative data, we examine disparities in COVID-19 vaccination among US children aged 5-17 years by a wide range of social determinants and parental characteristics. Methods: Using the US Census Bureau’s Household Pulse Survey from December 1, 2021 to April 11, 2022 (N=86,335), disparities in child vaccination rates by race/ethnicity, socioeconomic status, health insurance, parental vaccination status, parental COVID-19 diagnosis, and metropolitan area were modeled by multivariate logistic regression. Results: During December 2021–April 2022, an estimated 40.1 million or 57.2% of US children aged 5-17 received COVID-19 vaccination. Vaccination rates were lowest among children of parents aged 25-34 (34.9%) and highest among children of parents aged 45-54 (69.2%). Children of non-Hispanic Black parents, divorced/separated and single individuals, parents with lower education and household income levels, renters, not-employed parents, the uninsured, and parents without COVID-19 vaccination or with COVID-19 diagnoses had significantly lower rates of vaccination. Controlling for covariates, Asian and Hispanic children aged 5-17 had 134% and 47% higher odds of receiving vaccination than their non-Hispanic White counterparts. Children of parents with a high school education had 47% lower adjusted odds of receiving vaccination than children of parents with a master’s degree or higher. Children with annual household income

Introduction: The donor vigilance program is intended to collect and assess information on unexpected or undesirable effects or reactions resulting from blood donation. In this report, we discuss the analysis of the blood donor adverse reactions (DARs) reported in the National Blood Donor Vigilance Programme of India during the first 2 years of implementation. Materials and Methods: DAR reporting form prepared and approved by the National Executive Committee of the Haemovigilance Programme of India was used to capture the data by the blood centers and submitted to Donor-Vigil software prepared and hosted by the official website of the National Institute of Biologicals. Data reported for the years 2016 and 2017 were reviewed, analyzed, and validated by independent transfusion medicine experts. Results: During this period, a total of 19,98,101 donations denominator data were reported, in which 1,622,600 (80.9%) were valid. A total of 6091 DARs were reported, out of which 3980 (65.35%) were found valid. Only validated numerator and denominator data were included in the analysis. Generalized DARs were the most common type of DARs reported (83.7%), followed by “others” type (7.7%), localized (7.6%), allergic (0.4%), and complications related to apheresis (0.4%). The overall DAR rate was 2.45/1000 blood donations, which was higher in apheresis donations (3.07/1000) as compared to whole blood donations (2.39/1000). The DARs rates were higher in females (3.5/1000) compared to male donors (2.3/1000) and in the first time (2.5/1000) compared to repeat donors (2.15/1000). Conclusion: In this report, we concluded that younger age, first time, and female donors are more prone to DARs as compared to older age, repeat, and male donors. During the analysis of the data, we found some limitations, which can be improved by upgrading the reporting form and conducting regular continuing medical education (CMEs) of participant blood centers.

The lacrimal sac compression by an anterior ethmoidal mucocele is unusual. The ethmoidal mucocele may masquerade as lacrimal sac mucocele and may lead to disastrous consequences if treated along the lines of lacrimal mucocele. We present a case of an 18-year-old female presenting with a mass lesion over the medial canthal area causing a dilemma in diagnosis.

In an epoch marked by escalating apprehensions regarding the depletion of resources and the destruction of the environment, the notion of closed-loop supply chains (CLSCs) has garnered recognition as a viable and sustainable resolution. The present study examines the interdependent connection between environmental conservation and economic advancement by analysing the recycling and re-manufacturing procedures inside closed-loop supply chains. This paper utilises an extensive case study to investigate the crucial significance of closed-loop supply chains in the processes of recycling and re-manufacturing materials and components. Through a comprehensive examination of the complex relationship between environmental benefits and economic advantages, this study reveals the diverse and nuanced effects that arise from the implementation of closed-loop systems in contemporary supply chain management. The study utilises a mixed-methods methodology, incorporating both quantitative and qualitative studies. The study used quantitative data to measure the extent to which recycling and re-manufacturing processes contribute to the decrease of raw material usage, energy consumption, and greenhouse gas emissions. The study highlights the capacity of closed-loop supply chains to promote circular economy concepts, reduce waste output, and mitigate the environmental impact of companies. This study provides valuable insights that may be utilised by practitioners, politicians, and corporations to make well-informed decisions that prioritise both environmental protection and economic growth in their supply chain strategy.

Despite policy thrusts and initiatives, driving consumer behaviour towards sustainable consumption is a challenging task. The paper in this context carries out a detailed analysis of consumer behaviour in the Indian context with a specific thrust on sustainable consumer behaviour. The paper builds on the theoretical conception of the ‘Value Belief Norm (VBN)’ framework developed by Stern et al. (1999) and adapts and expands the same in the Indian context by employing exploratory factor analysis. Based on consumption behaviour patterns, the study classifies Indian millennials into five different categories such as aware consumers, conscious consumers, consumers under transition, unwilling consumers, and rejecters respectively, which help to map the heterogeneities present among the Indian millennials in terms of their consumer behaviour. In addition, it emerges from the study that Indian millennials are more concerned about the environmental dimension of consumption than social and economic dimensions, which has clear policy implications in terms of creating awareness and sensitising people.

Introduction Brunner's gland hamartomas (BGH) are rare benign lesions with an incidence of

Introduction This study was conducted with an objective to analyze prevalence and risk factors associated with co-infection of hepatitis B virus (HBV) and hepatitis C virus (HCV) in HIV-positive patients with reference to their CD4+ T cell status. Materials and methods HIV-positive patients visiting the HIV clinic for CD4+ T cells testing at B.P. Koirala Institute of Health Sciences were tested for Hepatitis B and Hepatitis C. Data regarding age, gender, mode of HIV transmission, duration of HIV diagnosis, antiretroviral therapy status, antiretroviral therapy duration, hepatitis B or C status, and CD4+ T cells count were collected via face-to-face interview, and hospital records. The data were entered in Microsoft Excel 2019 v16.0 (Microsoft, WA, USA) and statistical analysis was performed by using statistical package for social sciences, IBM SPSS® v21 (IBM, Armonk, New York). Results Out of 474 HIV-positive patients, HIV-HBV, HIV-HCV, and HIV-HBV-HCV co-infections were seen in 2.95% (14/474), 18.14% (86/474), and 2.53% (12/474) respectively. The primary route of infection was intra-venous drug use (IVDU) in those co-infected with HBV only (8, 57.14%), HCV only (46, 53.49%), and both HBV and HCV (8, 66.67%). HIV patients infected via IVDU were 2.40 times more likely to have HIV-HCV co-infection as compared to those infected via sexual route (AOR 2.40, 95% CI: 1.49,3.86). Similarly, HIV patients with CD4+ T cells count less than 350 cells/mm3 were more likely to have HIV-HBV-HCV co-infection as compared to those with CD4 count equal to and more than 350 cells/mm3 (AOR 13.84, 95% CI: 2.90,66.10). Conclusion HIV-positive patients are at high risk of hepatitis B and/or hepatitis C co-infection. Intravenous drug use, and lower CD4+T cells count are the most important risk predictors of co-infection. All HIV-positive patients should be carefully screened with hepatitis B and hepatitis C tests during their follow-up.

Objective: To determine the prevalence of MDR-TB and find out the incidence of drug resistance using molecular diagnostic method. Line probe assay (LPA) is based on the principle of multiplex PCR is used to detect MTB (Mycobacterium tuberculosis) complex as well as its sensitivity to rifampicin and isoniazid. Method: This is a hospital-based prospective observational study. The sputum of MDR-TB suspected patients was subjected to Ziehl-Neelsen staining and smear positive samples were analyzed by LPA. Decontamination and digestion of the samples was done using the NALC- NaOH method (as defined in RNTCP guidelines). DNA extraction was done from the decontaminated samples using Geno Lyse kit. After DNA extraction, detection of MTB complex and rifampicin and/or INH resistance was done with the help of line probe assay (LPA) using GenoType ® MTBDRplus version 2.0. Results: Out of the 156 smear-positive sputum samples, 140 samples had LPA valid results. The most common age group of positive TB samples in this study was 30-40 years (26.42%). Twenty-five samples (17.85%) were found to be rifampicin resistant and 22 (15.71%) samples were found resistant to isoniazid. Sixteen patients (11.42%) were detected MDR. Nine patients (6.42%) were monoresistant to rifampicin and six patients (4.28%) were monoresistant to isoniazid. “Sputum positive retreatment cases” had the highest detection rate for MDR TB. Conclusion: Line probe assay is an economical and time saving method for the detection of MDR-TB and serves as a lifesaving tool for early diagnosis and treatment. This calls for a widespread national use of this assay. The detection of around 10% ZN-positive patients, who were not showing MTB complex in LPA may be a hidden iceberg for non-tubercular mycobacteria.

Triple A syndrome (Allgrove syndrome) is characterized by a triad of specific features, namely, alacrimia, adrenal insufficiency, and achalasia cardia. It is a rare autosomal recessive disorder. In the present study, an 18-year-old boy was presented with complaints of decreased tears, darkening of the skin, difficulty in walking and standing up from sitting position, and difficulty in swallowing liquids. Adrenal insufficiency, alacrimia, achalasia, and neurological manifestations were confirmed with relevant laboratory investigations. His condition improved with steroids and artificial teardrops. However, a vigilant eye of the clinician for clinical clues of syndromic manifestation will help in early diagnosis and proper management.

Introduction: Father-and-child-health risk relationship is poorly studied and understood. We examine the impact of father's physical and mental health status and sociodemographic characteristics on the physical and mental outcomes of U.S. children 0?17 years of age. Methods: The 2011?2012 National Survey of Children's Health (N=75,879) was analyzed to estimate prevalence and odds of poor physical and mental health among children according to father's physical and mental health status and sociodemographic characteristics. Results: Overall, 3.2% of U.S. children had poor physical health; and 6.0% of U.S. children had emotional or behavioral problems. The adjusted odds of having poor overall health was 3.1 times higher among children of fathers with poor overall health. Children of fathers with poor mental health had 2.6 times higher adjusted odds of having poor mental health. Discussion: Results underscore the significant role of fathers in the physical and mental well-being of children. Engaging fathers in child health may provide a potential opportunity to reduce mental and emotional health problems among children.

The clinical presentation of celiac disease has evolved significantly over the last few decades. Previously defined as a malabsorption syndrome in pediatric patients, now it is considered an autoimmune disorder with diverse systemic manifestations among all age groups. We report a case of 56-year-old male presented with pedal edema and gradually progressive abdomen distention for the last 3 months. Serological evaluation and duodenal biopsy reports were suggestive of celiac disease. The patient was advised gluten-free diet, after 12 weeks, the patient became asymptomatic with the resolution of ascites and peripheral edema. According to the literature, there are few reports of protein-losing enteropathy as an initial presentation of celiac disease. The possibility of celiac disease should be considered even in the setting of atypical symptoms.

The evaluation of Secondary hypertension is laborious, expensive and of low yield, though screening of reversible causes, is important to prevent target organ damage. Hypertension secondary to hydronephrosis is rarely described in clinical studies. We herein report a 37-year-old male with a history of resistant hypertension. Initial evaluation for a secondary cause of hypertension was negative. CT abdomen showed unilateral hydronephrosis (Right). After surgical correction, his blood pressure begins to normalize in 3 weeks with a reduction in antihypertensive drugs. The patient was off medications at 6 months of follow-up. The relief of obstruction was parallel to the normalization of blood pressure, which suggest a causal link between hydronephrosis and hypertension. Our case illustrates hydronephrosis as an important cause in the evaluation of hypertension.

It is desirable to improve spatiotemporal control of light generated by synchrotron user facilities or table-top X-ray sources. Here the authors demonstrate manipulation of hard X-rays using microelectro mechanical systems (MEMS) oscillators on timescales of 300 ps, approaching the synchrotron pulse width.

Background: Vitamin D is an important vitamin required to maintain normal skeletal as well as nonskeletal functions. The daily supplementation of vitamin D not only have poor adherence to the regimen but also of doubtful efficacy in deficient patients. Objectives: The aim of this study was to compare the effect of oral high-dose vitamin D regimens (60,000 IU weekly) and daily low-dose vitamin D regimen of 1000 IU in mitigating symptoms and increase in serum levels of vitamin D in patients with hypovitaminosis D. Materials and Methods: A total of 90 patients aged 18–60 years with vitamin D deficiency (serum levels < 30 ng/mL) were enrolled. A total of 38 subjects received 60,000 IU of vitamin D weekly with 500 mg/day calcium and 40 subjects received a dose of 1000 IU of vitamin D daily with 500 mg/day calcium for 10 weeks. Baseline and follow-up total serum vitamin D levels and improvement in symptoms were measured within and between groups. Results: For high-dose vitamin D (60,000 IU weekly), the increase in mean serum vitamin D levels from baseline was 28.33 ng/mL over 10 weeks' treatment period; whereas for the low-dose group (1000 IU daily) the mean increment in serum vitamin D was 6.79 ng/mL for the same period. The mean difference in increase in serum vitamin D between two groups was highly significant (P < 0.001). In both the groups, decrease in myalgia as evaluated on visual analog scale was observed after 10 weeks. Conclusions: High-dose vitamin D (60,000 IU weekly) regimen rapidly normalized 25(OH) D levels and ensure symptomatic relief earlier than daily dosing of 1000 IU vitamin D for same duration.

Purpose: Early onset opacification of the lens (cataract) has been observed to be on the rise globally. This study was conducted to determine the various types of presenile cataract and to determine the probable risk factors associated with the occurrence of presenile cataract. Materials and Methods: Patients in the age group of 18–40 years attending the Out-Patient Clinic of the Ophthalmology Department who were found to have presenile cataract were recruited as cases. An equal number of consecutive patients of the same age group were included in the control group. Those who gave consent to participate in the study were interviewed through a preformed questionnaire and underwent a complete ocular examination and set of blood investigations. The type of cataract was noted, data obtained were compiled, and examination and investigations done were documented and analyzed using frequency distribution and Chi-squared test. Results: In total, 90 cases and 90 controls that fulfilled the inclusion criteria were recruited. Most common type of cataract was found to be posterior subcapsular cataract. Presenile cataract was observed to be significantly associated with tobacco intake (P = 0.035), hypercholesterolemia (P = 0.002), fuel exposure (P = 0.004), and lower socioeconomic status (P =

Colors are added to food items to make them more attractive and appealing. Food colorants therefore, have an impressive market due to the requirements of food industries. A variety of synthetic coloring agents approved as food additives are available and being used in different types of food prepared or manufactured worldwide. However, there is a growing concern that the use of synthetic colors may exert a negative impact on human health and environment in the long run. The natural pigments obtained from animals, plants, and microorganisms are a promising alternative to synthetic food colorants. Compared to animal and plant sources, microorganisms offer many advantages such as no seasonal impact on the quality and quantity of the pigment, ease of handling and genetic manipulation, amenability to large scale production with little or no impact on biodiversity etc. Among the microorganisms algae, fungi and bacteria are being used to produce pigments as food colorants. This review describes the types of microbial food pigments in use, their benefits, production strategies, and associated challenges.

oronavirus (COVID-19) has caused marked impact on graduate medical education for all medical specialties. Radiation Oncology and the American Board of Radiology have also had to rapidly adapt to converting education and examinations to virtual platforms. We describe our small pilot experience in transitioning our in-person mock oral examinations to a virtual platform. Survey-based assessment revealed excellent feedback regarding ease of use and educational usefulness. Our mock oral examinations pilot experience adds to evidence that virtual mock oral examinations are an important considerationfor Radiation Oncology education and a feasible alternative to an in-person oral examination.

Background: This study examines trends and inequalities in US maternal mortality from indirect obstetric causes (ICD-10 codes: O98-O99) and specific chronic conditions by maternal race/ethnicity, socioeconomic status, nativity/immigrant status, marital status, place and region of residence, and cause of death. Methods: National vital statistics data from 1999 to 2017 were used to compute maternal mortality rates by sociodemographic factors. Rate ratios and log-linear regression were used to model mortality trends and differentials. Results: During 1999-2017, maternal mortality from indirect causes showed an upward trend; the annual rates increased by 11.2% for the overall population, 12.9% for non-Hispanic Whites, and 9.4% for non-Hispanic Blacks. The proportion of all maternal deaths due to indirect causes increased from 12.0% in 1999 to 26.9% in 2017. Maternal mortality from CVD increased sharply over time, from 0.40/100,000 live births in 1999 to 1.82 in 2017. During 2013-2017, compared to non-Hispanic Whites, non-Hispanic Blacks had 83% higher, Hispanics 51% lower, and Asian/Pacific Islanders 55% lower mortality from indirect causes. Non-Hispanic White women with

Background: Despite the previous long-term decline and a recent increase in maternal mortality, detailed social inequalities in maternal mortality in the United States (US) have not been analyzed. This study examines trends and inequalities in US maternal mortality by maternal race/ethnicity, socioeconomic status, nativity/immigrant status, marital status, area deprivation, urbanization level, and cause of death. Methods: National vital statistics data from 1969 to 2018 were used to compute maternal mortality rates by sociodemographic factors. Mortality trends by deprivation level were analyzed by using censusbased deprivation indices. Rate ratios and log-linear regression were used to model mortality trends and differentials. Results: Maternal mortality declined by 68% between 1969 and 1998. However, there was a recent upturn in maternal mortality, with the rate increasing from 9.9 deaths/100,000 live births in 1999 to 17.4 in 2018. The large racial disparity persisted over time; Black women in 2018 had a 2.4 times higher risk of maternal mortality than White women. During 2013-2017, the rate varied from 7.0 for Chinese women to 42.0 for non-Hispanic Black women. Unmarried status, US-born status, lower education, and rural residence were associated with 50-114% higher maternal mortality risks. Mothers in the most-deprived areas had a 120% higher risk of mortality than those in the most-affluent areas; both absolute and relative disparities in mortality by deprivation level widened between 2002 and 2018. Hemorrhage, pregnancy-related hypertension, embolism, infection, and chronic conditions were the leading causes of maternal death, with 31% of the deaths attributable to indirect obstetric causes. Conclusions and Global Health Implications: Despite the steep long-term decline in US maternal mortality, substantial racial/ethnic, socioeconomic, and rural-urban disparities remain. Monitoring disparities according to underlying social determinants is key to reducing maternal mortality as they give rise to inequalities in social conditions and health-risk factors that lead to maternal morbidity and mortality. Copyright © 2021 Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Background: Despite having one of the highest Gross Domestic Product (GDP) per capita levels, United States (US) ranks lower in subjective well-being, including happiness and life satisfaction, compared with European countries. Studies of the impact of happiness and life satisfaction on life expectancy and mortality in the US are limited or non-existent. Using a national longitudinal dataset, we examined the association between levels of happiness/life satisfaction and US life expectancy and all-cause mortality. Methods: We analyzed the 2001 National Health Interview Survey (NHIS) prospectively linked to 2001-2014 mortality records in the National Death Index (NDI) (N=30,377). Cox proportional hazards regression was used to model survival time as a function of happiness, life satisfaction, and sociodemographic and behavioral covariates. Results: Life expectancies at age 18 among adults with high levels of happiness and life satisfaction were, respectively, 7.5 and 8.9 years higher compared to those with low levels of happiness and life satisfaction. In Cox models with 14 years of mortality follow-up, all-cause mortality risk was 82% higher (hazard ratio [HR]=1.82; 95% CI=1.59,2.08) in adults with little or no happiness, controlling for age, and 36% higher (HR=1.36; 95% CI=1.17,1.57) in adults with little/no happiness, controlling for sociodemographic, behavioral and health characteristics, when compared with adults reporting happiness all of the time. Mortality risk was 107% higher (HR=2.07; 95% CI=1.80,2.38) in adults who were very dissatisfied with their life, controlling for age, and 39% higher (HR=1.39; 95% CI=1.20,1.60) in adults who were very dissatisfied, controlling for all covariates, when compared with adults who were very satisfied. Conclusions and Global Health Implications: Adults with higher happiness and life satisfaction levels had significantly higher life expectancy and lower all-cause mortality risks than those with lower happiness and satisfaction levels. These findings underscore the significance of addressing subjective well-being in the population as a strategy for reducing all-cause mortality. Key words: • Inequalities • Disparities • Happiness • Life satisfaction • Life expectancy • Mortality • Longitudinal • Social determinants Copyright © 2020 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Objective: Despite the long-term decline, heart disease has remained the leading cause of death in the United States (US) over the past eight decades, accounting for 23% of all deaths in 2017. Although psychological distress has been associated with cardiovascular disease mortality, the relationship between different psychological distress levels and heart disease mortality in the US has not been analyzed in detail. Using a national longitudinal dataset, we examined the association between levels of psychological distress and US heart disease mortality. Methods: We analyzed the Kessler 6-item psychological distress scale as a risk factor for heart disease mortality using the pooled 1997-2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N=513,081). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates. Results: In Cox models with 18 years of mortality follow-up, the heart disease mortality risk was 121% higher (hazard ratio [HR]=2.21; 95% CI=1.99,2.45) in adults with serious psychological distress (SPD) (p

BACKGROUND AND OBJECTIVE: The objective of the study was to compare the efficacy of intravitreal bevacizumab (IVB) as monotherapy versus combination with modified macular grid (MMG) laser photocoagulation in the primary treatment of diffuse diabetic macular edema (DDME). MATERIALS AND METHODS: A prospective randomized trial was carried out in sixty eyes with DDME after Institutional Ethical clearance. Group A received three doses of IVB at a 1-month interval. Group B received MMG in addition to IVB. Complete examination including best-corrected visual acuity (BCVA) (Snellen's), central macular thickness (CMT) using spectral domain-optical coherence tomography was carried out at 0, 1, 4, 8, 12, and 24 weeks. RESULTS: mean CMT at baseline, 12 and 24 weeks in Group A was 401 (±76), 280 (±49), and 307 (±46) and in Group B, 405 (±73), 237 (±33), and 242 (±45), respectively. Group B had significantly greater reductions (P < 0.001) from 12 weeks onward. BCVA and contrast sensitivity showed improvements with no significant difference. CONCLUSION: Combined therapy has more advantage in primary DDME by reducing CMT on longer follow-up.

Human immunodeficiency virus-1 (HIV-1)/acquired immunodeficiency syndrome (AIDS) has been shown to be associated with a constellation of neuropsychiatric disorders. The presence of depressive symptoms may obscure the evaluation of cognitive manifestation of a neurodegenerative disorder like dementia associated with AIDS. Further, it is uncommon to see catatonia in association with HIV/AIDS. In this report, we present a case who had an array of psychiatric syndromes as the initial manifestation of AIDS. The subsequent management issues are also dealt with.

Disodium phosphate catalyzed one-pot synthesis of 3,4-dihydropyrano[3,2-c]chromenes, from aldehydes, active methylene compounds malononitrile and 4-hydroxycoumarin in ethanol:water (1:1) under reflux temperature. The attractive features of this process are inexpensive, efficient, as well as user friendly. DOI: http://dx.doi.org/10.17807/orbital.v9i3.896

Objectives: Dramatic increases in opioid and drug overdose mortality have occurred in the United States (US) over the past two decades. To address this national public health crisis and identify gaps in the literature, we analyzed recent empirical trends in US drug overdose mortality by key social determinants and conducted a selective review of the recent literature on the magnitude of the opioid crisis facing different racial/ethnic, socioeconomic, and rural-urban segments of the US population. Methods: We used the 1999-2017 mortality data from the US National Vital Statistics System to analyze trends in drug overdose mortality by race/ethnicity, age, and geographic area. Log-linear regression was used to model mortality trends. Using various key words and their combinations, we searched PubMed and Google Scholar for select peerreviewed journal articles and government reports published on the opioid epidemic between 2010 and 2018. Results: Our original analysis and review indicate marked increases in drug overdose mortality overall and by race/ethnicity and geographic regions, with adolescents and young adults experiencing steep increases in mortality between 1999 and 2017. Our selective search yielded 405 articles, of which 39 publications were selected for detailed review. Suicide mortality from drug overdose among teens aged 12-19 increased consistently between 2009 and 2017, particularly among teen girls. The rise of efficient global supply chains has increased opioid prescription use and undoubtedly contributed to the opioid epidemic. Many other important contributing factors to the epidemic include lack of education and economic opportunities, poor working conditions, and low social capital in disadvantaged communities. Conclusions and Global Health Implications: Our analysis and review indicate substantial disparities in drug overdoses and related mortality, pain management, and treatment outcomes according to social determinants. Increases in drug overdoses and resultant mortality are not only unique to the US, but have also been observed in other industrialized countries. Healthcare systems, community leaders, and policymakers addressing the opioid epidemic should focus on upstream structural factors including education, economic opportunity, social cohesion, racial/ethnic disadvantage, geographic isolation, and life satisfaction. Key words: • Opioids • Drug overdose • Mortality • Pain management • Treatment • Race/Ethnicity • Social determinants • Health disparities Copyright © 2019 Singh et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objectives. We examined trends in racial/ethnic, socioeconomic, and geographic disparities in age- and cause-specific infant mortality in the United States during 1915-2017. Methods. Log-linear regression and inequality indices were used to analyze temporal infant mortality data from the National Vital Statistics System and the National Linked Birth/Infant Death files according to maternal and infant characteristics. Results. During 1915-2017, the infant mortality rate (IMR) declined dramatically overall and for black and white infants; however, black/white disparities in mortality generally increased through 2000. Racial disparities were greater in post-neonatal mortality than neonatal mortality. Detailed racial/ethnic comparisons show an approximately five-fold difference in IMR, ranging from a low of 2.3 infant deaths per 1,000 live births for Chinese infants to a high of 8.5 for American Indian/Alaska Natives and 11.2 for black infants. Infant mortality from major causes of death showed a downward trend during the past 5 decades although there was a recent upturn in mortality from prematurity/low birthweight and unintentional injury. In 2016, black infants had 2.5-2.8 times higher risk of mortality from perinatal conditions, sudden infant death syndrome, influenza/pneumonia, and unintentional injuries, and 1.3 times higher risk of mortality from birth defects compared to white infants. Educational disparities in infant mortality widened between 1986 and 2016; mothers with less than a high school education in 2016 experienced 2.4, 1.9, and 3.7 times higher risk of infant, neonatal, and post-neonatal mortality than those with a college degree. Geographic disparities were marked and widened across regions, with states in the Southeast region having higher IMRs. Conclusions and Global Health Implications. Social inequalities in infant mortality have persisted and remained marked, with the disadvantaged ethnic and socioeconomic groups and geographic areas experiencing substantially increased risks of mortality despite the declining trend in mortality over time. Widening social inequalities in infant mortality are a major factor contributing to the worsening international standing of the United States. Key words: Infant Mortality • Cause of Death • Race/Ethnicity • Socioeconomic Status • Geographic • Inequality • Trend • United States Copyright © 2019 Singh and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.