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Background: The safety and long-term efficacy of radiofrequency (RF) catheter ablation (CA) of paroxysmal atrial fibrillation (PAF) has been well established. Contemporary techniques to optimize ablation delivery, reduce fluoroscopy use, and improve clinical outcomes have been developed., Objective: The purpose of this study was to assess the contemporary real-world practice approach and short and long-term outcomes of RF CA for PAF through a prospective multicenter registry., Methods: Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation; ClincalTrials.gov Identifier: NCT04088071) Registry, patients undergoing RF CA to treat PAF across 42 high-volume institutions and 79 experienced operators were evaluated. The procedures were performed using zero or reduced fluoroscopy, contact force sensing catheters, wide area circumferential ablation, and ablation index as a guide with a target of 380-420 for posterior and 500-550 for anterior lesions. The primary efficacy outcome was freedom from all-atrial arrhythmia recurrence at 12 months., Results: A total of 2470 patients undergoing CA from January 2018 to December 2022 were included. Mean age was 65.2 ±11.14 years, and 44% were female. Most procedures were performed without fluoroscopy (71.5%), with average procedural and total RF times of 95.4 ± 41.7 minutes and 22.1±11.8 minutes, respectively. At 1-year follow-up, freedom from all-atrial arrhythmias was 81.6% with 89.7% of these patients off antiarrhythmic drugs. No significant difference was identified comparing pulmonary vein isolation vs pulmonary vein isolation plus ablation approaches. The complication rate was 1.9%., Conclusion: Refinement of RF CA to treat PAF using contemporary tools, standardized protocols, and electrophysiology laboratory workflows resulted in excellent short- and long-term clinical outcomes., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

The elemental composition of the lunar surface provides insights into mechanisms of the formation and evolution of the Moon 1,2 . The chemical composition of lunar regolith have so far been precisely measured using the samples collected by the Apollo, Luna and Chang'e 5 missions, which are from equatorial to mid-latitude regions 3,4 ; lunar meteorites, whose location of origin on the Moon is unknown 5,6 ; and the in situ measurement from the Chang'e 3 and Chang'e 4 missions 7-9 , which are from the mid-latitude regions of the Moon. Here we report the first in situ measurements of the elemental abundances in the lunar southern high-latitude regions by the Alpha Particle X-ray Spectrometer (APXS) experiment 10 aboard the Pragyan rover of India's Chandrayaan-3 mission. The 23 measurements in the vicinity of the Chandrayaan-3 landing site show that the local lunar terrain in this region is fairly uniform and primarily composed of ferroan anorthosite (FAN), a product of the lunar magma ocean (LMO) crystallization. However, observation of relatively higher magnesium abundance with respect to calcium in APXS measurements suggests the mixing of further mafic material. The compositional uniformity over a few tens of metres around the Chandrayaan-3 landing site provides an excellent ground truth for remote-sensing observations., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Left atrial appendage (LAA) occluder embolization is an infrequent but serious complication., Objectives: We aim to describe timing, management and clinical outcomes of device embolization in a multi-center registry., Methods: Patient characteristics, imaging findings and procedure and follow-up data were collected retrospectively. Device embolizations were categorized according to 1) timing 2) management and 3) clinical outcomes., Results: Sixty-seven centers contributed data. Device embolization occurred in 108 patients. In 70.4 % of cases, it happened within the first 24 h of the procedure. The device was purposefully left in the LA and the aorta in two (1.9 %) patients, an initial percutaneous retrieval was attempted in 81 (75.0 %) and surgery without prior percutaneous retrieval attempt was performed in 23 (21.3 %) patients. Two patients died before a retrieval attempt could be made. In 28/81 (34.6 %) patients with an initial percutaneous retrieval attempt a second, additional attempt was performed, which was associated with a high mortality (death in patients with one attempt: 2.9 % vs. second attempt: 21.4 %, p < 0.001). The primary outcome (bailout surgery, cardiogenic shock, stroke, TIA, and/or death) occurred in 47 (43.5 %) patients. Other major complications related to device embolization occurred in 21 (19.4 %) patients., Conclusions: The majority of device embolizations after LAA closure occurs early. A percutaneous approach is often the preferred method for a first rescue attempt. Major adverse event rates, including death, are high particularly if the first retrieval attempt was unsuccessful., Condensed Abstract: This dedicated multicenter registry examined timing, management, and clinical outcome of device embolization. Early embolization (70.4 %) was most frequent. As a first rescue attempt, percutaneous retrieval was preferred in 75.0 %, followed by surgical removal (21.3 %). In patients with a second retrieval attempt a higher mortality (death first attempt: 2.9 % vs. death second attempt: 24.1 %, p < 0.001) was observed. Mortality (10.2 %) and the major complication rate after device embolization were high., Competing Interests: Declaration of competing interest A. Aminian is a consultant and proctor for Boston Scientific and Abbott. I. Akin received lecture and proctoring fees from Boston Scientific for the Watchman Okkluder. J. Lund discloses a clinical advisor (proctor) role in LAAC (Abbott) and lecture fees (Abbott, Boston scientific). E. Guerios serves as proctor for LAA closure for Abbott and Lifetech Scientific. N. Amabile has received proctoring and consulting fees from Abbott Vascular and Boston Scientific. C. Skurk has received proctor honoraria from Boston Scientific and speaker fees from Boston Scientific and Lifetech Scientific. J. Harvey is proctor for Abiomed, Boston Scientific and Medtronic and part of the Speaker's bureau for Abiomed, Boston Scientific and Medtronic. He also is part of the advisory board for Avail, Boston Scientific and Medtronic. H. Sievert has received study honoraria to institution, travel expenses and consulting fees from 4tech Cardio, Abbott, Ablative Solutions, Adona Medical, Akura Medical, Ancora Heart, Append Medical, Axon, Bavaria Medizin Technologie GmbH, Bioventrix, Boston Scientific, Cardiac Dimensions, Cardiac Success, Cardimed, Cardionovum, Celonova, Contego, Coramaze, Croivalve, CSL Behring LLC, CVRx, Dinova, Edwards, Endobar, Endologix, Endomatic, Esperion Therapeutics, Inc., Hangzhou Nuomao Medtech, Holistick Medical, Intershunt, Intervene, K2, Laminar, Lifetech, Magenta, Maquet Getinge Group, Metavention, Mitralix, Mokita, Neurotronic, NXT Biomedical, Occlutech, Recor, Renal Guard, Shifamed, Terumo, Trisol, Vascular Dynamics, Vectorious Medtech, Venus, Venock, Vivasure Medical, Vvital Biomed and Whiteswell. M. Kühne received personal fees from Bayer, Böhringer Ingelheim, Pfizer BMS, Daiichi Sankyo, Medtronic, Biotronik, Boston Scientific, Johnson & Johnson, and F. Hoffmann-La Roche Ltd., as well as grants from Bayer, Pfizer, Boston Scientific, BMS, Biotronik, and Daiichi Sankyo. S. Sabir is part of the Boston Scientific WATCHMAN advisory board. J. Kim has received proctoring fees from Abbott Vascular. M. Montorfano received consultant fees from Abbott, Boston Scientific, Kardia. M. Ancona received consultant fees from Abbott. Relevant research funding went to Vanderbilt University Medical Center from Boston Scientific, Boehringer-Ingelheim, Medtronic and Atricure, where C. Ellis is practicing. He also reseves a consultant and advisor fee from Abbott Medical, Atricure, Boston Scientific, Medtronic. L. Nombela-Franco is proctor for Abbott Vascular and has received lectures fees from Boston Scientific. A. Natale has received speaker honoraria from Boston Scientific, Biosense Webster, St. Jude Medical, Biotronik, and Medtronic. He also is a consultant for Biosense Webster, St. Jude Medical, and Janssen. All other authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Percutaneous left atrial appendage occlusion (LAAO) is traditionally performed under general anesthesia with trans-esophageal echocardiography guidance. Intracardiac echo (ICE)-guided LAAO closure is increasing in clinical use. The ICE catheter is crossed into LA via interatrial septum (IAS) after the septum is dilated with LAAO delivery sheath. This step can be time-consuming and requires significant ICE catheter manipulation, which increases the risk of cardiac perforation. Pre-emptive septal balloon dilation can potentially help with ICE advancement in the LA. We sought to evaluate the effect of pre-dilation of the IAS with an 8 mm balloon on the ease of crossing the ICE catheter, fluoroscopy time for crossing, and overall procedure time., Methods: The Piedmont LAAO registry was used to identify consecutive patients who underwent LAAO. The initial 25 patients in whom balloon dilation of the IAS was performed served as the experimental cohort, and the 25 consecutive patients before that in whom balloon dilation was not performed served as controls. In the experimental group, after a trans-septal puncture, the sheath was retracted to the right atrium with a guidewire still in the LA. An 8 × 40 mm Evercoss™ over the wire balloon was inflated across the IAS. The ICE catheter was then crossed into the LA using the fluoroscopic landmark of the guide wire and the ICE imaging. The sheath was then advanced along the ICE catheter via the transseptal puncture (TSP) and the procedure continued. Follow-up compputed tomography imaging was obtained at 4-8 weeks., Results: Each group consisted of 25 patients. There were no significant differences in baseline characteristics. All procedures were performed successfully under conscious sedation and ICE guidance. There was a significant reduction in the overall procedure time, fluoroscopy time, and time for transseptal puncture to ICE in LA. There was no difference in the size of the acute residual interatrial shunt, as measured via ICE, or the size and presence of iatrogenic ASD at follow-up., Conclusion: Balloon dilation of TSP is safe and is associated with increased efficiency in ICE-guided LAAO procedures., (© 2024 Wiley Periodicals LLC.)

Purpose: Advanced imaging is essential to diagnose pulmonary embolism (PE) in pregnancy, but there are associated maternal and fetal radiation risks. The purpose of this study was to evaluate the 10-year trend in advanced imaging utilization for the evaluation of suspected PE in pregnancy., Methods: The authors evaluated pregnant women with advanced imaging using CT pulmonary angiography (CTPA) or lung scintigraphy (LS) for evaluation of suspected PE presenting to two tertiary hospitals from 2007 to 2016. The rate of imaging was evaluated relative to positive PE rate and local pregnancy rate. positive PE was defined as a new acute PE finding on any advanced imaging within 3 days of first advanced imaging test. Local pregnancy rates were defined per 1,000 pregnancies in the county serviced by both hospitals. Chi-square testing was used to evaluate statistical significance (P < .05) in the utilization trend of advanced imaging and relative to local pregnancy rates and evaluations positive for PE., Results: A total of 707 pregnant patients were identified, of whom 92.5% (n = 654) underwent CTPA and 7.5% (n = 53) underwent LS. Regression analysis showed an average increase of 5.2 advanced imaging studies per year (P < .001), with 61 and 105 studies performed in 2007 and 2016, respectively. Additionally, there was an average increase of 0.08 (P < .001) advanced imaging studies per 1,000 local pregnancies per year, doubling from 0.7 in 2007 to 1.4 in 2016 (P < .001). Finally, there was a decrease of 0.004 (P = .009) in advanced imaging positive for PE, from 3% (2 of 61) in 2007 to 0% (0 of 100) in 2016., Conclusions: Advanced imaging utilization increased by 72% over the 10-year window, driven by higher use of CTPA. Although the detection rate of PE on advanced imaging has decreased, the utilization rate among pregnant patients doubled during this period. These results highlight the need to consider the radiation risks and costs of advanced imaging in specific patient populations., (Copyright © 2023. Published by Elsevier Inc.)

Atrial fibrillation (AF) and heart failure are common overlapping cardiovascular disorders. Despite important therapeutic advances over the past several decades, controversy persists about whether a rate control or rhythm control approach constitutes the best option in this population. There is also considerable debate about whether antiarrhythmic drug therapy or ablation is the best approach when rhythm control is pursued.  A brief historical examination of the literature addressing this issue will be performed. An analysis of several important clinical outcomes observed in the prospective, randomized studies, which have compared AF ablation to non-ablation treatment options, will be discussed. This review will conclude with recommendations to guide clinicians on the status of AF ablation as a treatment option when considering management options in heart failure patients with atrial fibrillation., (© 2023 Wiley Periodicals LLC.)

Aim of the Study: Despite having ample literature in hepatorenal syndrome-acute kidney injury (HRS-AKI) in decompensated cirrhosis patients, there is a scarcity of data on acute-on-chronic liver failure-acute kidney injury (ACLF-AKI). We compared terlipressin infusion with bolus in ACLF-AKI patients., Material and Methods: Patients with ACLF (as per the CANONIC study) were screened for AKI as per the 2015 ICA-AKI criteria. If after 48 h of volume expansion with albumin, serum creatinine (sCr) did not improve, patients were randomized into two groups: Terli-infusion (Terli-I) 2 mg/day and Terli-bolus (Terli-B) 1 mg q6h. If sCr did not decrease < 25% of pretreatment value after 48 h, the terlipressin dose was increased to a maximum of 12 mg/day. The primary outcome was taken as regression (full or partial response), stable/no response and progression of AKI to higher stages and secondary outcomes were taken as 28-day and 90-day mortality., Results: After screening 136 patients with ACLF-AKI, Terli-I ( n = 50) and Terli-B ( n = 50) with mean sCr 2.4 and 2.1 mg/dl respectively were enrolled. The regression of AKI (full response 37 vs. 27, partial response 3 vs. 9, p = 0.5), stable (2 vs. 5, p = 0.6), progression of AKI (8 vs. 7, p = 0.2) were present in Terli-I and Terli-B respectively. No significant difference was found in 28-and 90-day mortality. In Terli-B, mean terlipressin dose was 8 vs. 4 mg, p < 0.008 with more side effects, 15 vs. 0, p < 0.01 than Terli-I respectively., Conclusions: Terlipressin infusion is more effective than bolus doses in regression of acute kidney injury and better tolerated in acute-on-chronic liver failure-AKI patients., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Clinical and Experimental Hepatology.)

In developing/underdeveloped countries there is still a great burden of adverse drug reaction (ADR), morbidity and mortality because of poor regulations and implementation of preventive measures. These countries try to copy/follow guidelines from international bodies like American Urology Association (AUA), European Association of Urology (EAU), AGS, UMC and WHO irrespective of their country of origin and success in implementation. Although recommendations of these organizations are obligatory, yet these are taken as the gold standard for good clinical practices. This manuscript highlights difference in view point of various apex health organizations in formulating health policies for prevention, diagnosis, treatment and ADR monitoring for urological disorders. Lacking role of regulatory bodies in implementation of existing policies may lead to potentially inappropriate medication and produce a great economic burden. This analysis has prompted us to recommend that these apex bodies should have better coordination in producing a single value document, make it mandatory part of curricula in medical schools for better awareness, awareness campaigns and separate reporting column in ADR form., Competing Interests: We declare no competing interests., (© 2023 The Author(s).)

The present study aimed to produce, characterize, and apply pullulanase from Aspergillus flavus (BHU-46) for fruit juice processing, assessing its enzymatic properties and impact on juice quality. Pullulanase was produced via solid-state fermentation using wheat bran as the substrate. Purification and characterization included specific activity, molecular weight, pH and temperature optima, and substrate specificity. The enzyme was immobilized in sodium alginate beads and used for clarifying mosambi, apple, and mango juices. Parameters such as yield, clarity, reducing sugar, total soluble solids (TSS), total phenol, and enzymatic browning were evaluated pre-and post-treatment. The purified pullulanase had a specific activity of 652.2 U/mg and a molecular weight of 135 kDa. Optimal pH values were 6.5 and 10, with maximum activity at 50 °C. Pullulanase showed a high affinity for pullulan and starch, indicating Pullulanase type II classification. Immobilized pullulanase improved yield, clarity, reducing sugar, TSS, and total phenol in fruit juices. The highest yield and clarity were observed in mosambi juice. Additionally, the enzyme reduced enzymatic browning, increasing the lightness of the juice. This study provides a significant contribution to the juice processing industry and represents the first report on the application of pullulanase for fruit juice processing., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2023. Published by Elsevier B.V.)

Pullulanases are the most important industrial group of enzymes in family 13 glycosyl hydrolases. They hydrolyze either α-1,6 and α-1,4 or both glycosidic bonds in pullulan as well as other carbohydrates to produce glucose, maltose, and maltotriose syrups, which have important uses in food and other related sectors. However, very less reports are available on pullulanase production from native strains because of low yield issues. In line with the increasing demands for pullulanase, it has become important to search for novel pullulanase-producing microorganisms with high yields. Moreover, high production costs and low yield are major limitations in the industrial production of pullulanase enzymes. The production cost of pullulanase by using the solid-state fermentation (SSF) process can be minimized by selecting agro-industrial waste. This review summarizes the types, sources, production strategies, and potential applications of pullulanase in different food and other related industries. Researchers should focus on fungal strains producing pullulanase for better yield and low production costs by using agro-waste. It will prove a better enzyme in different food processing industries and will surely reduce the cost of products., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Naik, Kumar, Goyal, Dutt Tripathi, Mishra, Joakim Saris, Kumar, Rizwanuddin, Kumar and Rustagi.)

An effective micro-level air quality management plan requires high-resolution monitoring of pollutants. India has already developed a vast network of air quality monitoring stations, both manual and real time, located primarily in urban areas, including megacities. The air quality monitoring network consists of conventional manual stations and real time Continuous Ambient Air Quality Monitoring Stations (CAAQMS) which comprise state-of-the-art analysers and instruments. India is currently in the early stages of developing and adopting economical portable sensor (EPS) in air quality monitoring systems. Protocols need to be established for field calibration and testing. The present research work is an attempt to develop a performance-based assessment framework for the selection of EPS for air quality monitoring. The two-stage selection protocol includes a review of the factory calibration data and a comparison of EPS data with a reference monitor, i.e. a portable calibrated monitor and a CAAQMS. Methods deployed include calculation of central tendency, dispersion around a central value, calculation of statistical parameters for data comparison, and plotting pollution rose and diurnal profile (peak and non-peak pollution measurement). Four commercially available EPS were tested blind, out of which, data from EPS 2 (S2) and EPS 3 (S3) were closer to reference stations at both locations. The selection was made by evaluating monitoring results, physical features, measurement range, and frequency along with examining capital cost. This proposed approach can be used to increase the usability of EPS in the development of micro-level air quality management strategies, other than regulatory compliance. For regulatory compliance, additional research is needed, including field calibration and evaluating EPS performance through additional variables. This proposed framework may be used as starting point, for such experiments, in order to develop confidence in the use of EPS., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Percutaneous left atrial appendage occlusion (LAAO) is contraindicated in presence of left atrial appendage (LAA) thrombus. It is often difficult to separate LAA sludge from an organized thrombus on transesophageal echocardiography. The inability to differentiate sludge from thrombus leads to patients not receiving LAAO despite contraindication to long-term anticoagulation. Retrospective 6-month follow-up outcomes are reported on patients undergoing LAAO in presence of LAA sludge cleared by isoproterenol. This study showed no increased risk of transient ischemic attack/stroke in the 6 months following LAAO in the presence of LAA sludge, which was cleared with isoproterenol. This study suggests a role for isoproterenol in differentiating sludge from thrombus., Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Serodiagnosis of surra, caused by Trypanosoma evansi, is still based on native antigens purified from bloodstream form of T. evansi grown in rodents. In order to investigate prospective diagnostic possibilities as an alternative for native antigens, we cloned, expressed 26 kDa calflagin protein containing 218 amino acids from T. evansi (Indian Strain) in Escherichia coli. The potential of recombinant calflagin (rCLF) protein as diagnostic antigen was evaluated in immunoblot and indirect ELISA using experimentally infected equine serum samples from 0 to 84 days post infection. The antibodies against T. evansi were detected with rCLF antigen in serum samples of experimentally infected equines as early as 10 days and 14 days post infection, using immunoblot and ELISA respectively. No cross-reactivity was observed with rCLF antigen in ELISA with different serum samples of equines positive for Equine herpesvirus 1, Burkholderia mallei, and Theileria equi infections. Several immunoreactive regions ranging from 10 to 28 kDa were detected using distinct T. evansi isolates (pony, cattle, donkey and camel origin) indicating presence of multiple calflagin family members in a single trypanosome. Indirect immunofluorescence antibody test with anti-CLF rabbit hyperimmune serum showed localisation of native immunogenic protein near attachment of flagellum. The rCLF protein was found to be a potential diagnostic candidate for distinguishing T. evansi positive and negative equine serum sample, suggesting that it could be used for serological surveys in animals for surra. In addition, it could be used with other potential diagnostic candidates to improve the diagnostic efficiency., Competing Interests: Conflict of interest statement The corresponding author on behalf of all authors of the manuscript declare that they have no competing interests., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The modernization of crematoria and replacement of existing fuel requirements for better air quality is a key challenge in view of the associated religious beliefs in India where conventional open pyre funeral practices are followed. Unlike developed nations, the lack of appropriate site selection criteria, combustion efficient crematorium oven designs, and pollution control devices at these facilities necessitates formulation of appropriate policy measures to reduce emissions. The existing practices do not address such localized sources that affects the micro air pollution patterns owing to their marginal contribution in the total air pollution load of the city. The present study is thus an attempt to estimate emissions from 51 cremation grounds identified in NCT of Delhi. The study considers both particulate and gaseous pollutants which are released due to burning of fuels like wood, CNG, and cow dung. It is estimated that cremation activities contributed 393 tons/year of PM 2.5 , 142 tons/year of NO x , 29 tons/year of SO 2 , and 2686 tons/year of CO in year 2019. The maximum load was emitted from Central district as only Nigambodh Ghat crematoria receives on an average 60 bodies per day. Furthermore, air quality impact zone around crematoria has been demarcated using dispersion modelling considering crematorium with minimum and maximum number of bodies burnt in a day. The study also suggests control measures for reduction of pollution from cremation activities and delineates a buffer zone that could aid policymakers in establishing a site selection criterion to prevent the immediate population from likely exposure., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Literature suggests that the COVID-19 pandemic has resulted in poor sleep quality, especially among the infected population. However, literature regarding the effect of COVID-19 pandemic and SARS-CoV-2 infection on occurrence of insomnia, restless legs syndrome and dream enactment behavior is either scarce or unavailable., Methods: This study was planned to assess the effect of SARS-CoV-2 infection on the occurrence of insomnia, restless legs syndrome (RLS) and dream enactment behavior (DEB). For this cross-sectional study, a questionnaire comprising of items related to demographic details, past medical history, and information related to SARS-CoV-2 infection was distributed through social media. Insomnia was diagnosed using clinical criteria. RLS, DEB, sleep quality, depression and anxiety were assessed using a validated questionnaire. Information regarding the use of hypnotic medications was also gathered., Results: Of the 1596 respondents, 37.2% reported disturbed sleep while insomnia was reported by 22.6% respondents. 27.3% of respondents reported RLS and 17.4% suffered DEB. The odds of insomnia were greater among males (OR = 1.27; 95% CI: 1.03-1.58; P < 0.02) and among those who had SARS-CoV-2 infection (OR = 1.76; 95% CI = 1.42-2.19; P < 0.001). Similarly, SARS-CoV-2 infection was also associated with increased odds of RLS (OR = 2.48; 95% CI = 1.98-3.11; P < 0.001) and DEB (OR = 1.58; 95%CI = 1.21-2.06; P < 0.001). Insomnia, RLS and DEB were more frequent among respondents who required oxygen therapy, those who experienced loss of taste and/or smell, depression and anxiety. Prevalence of insomnia, DEB and RLS was higher than said prevalence among respondents with no history of SARS-CoV-2 infection, but lower than that of those with positive history of SARS-CoV-2 infection. 5.3% of respondents reported taking hypnotic medications before infection, 7% during infection and 5.3% after infection., Conclusion: SARS-CoV-2-infection-related factors in association with environmental factors have increased the prevalence of insomnia, DEB and RLS among subjects having infection. SARS-CoV-2-associated immunological changes, hypoxia and neurotropism may play a role in occurrence of insomnia, DEB and RLS., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Psychiatry.)

Background: Acute kidney injury (AKI) in cirrhosis is important complication with poor outcomes. And infections are common cause for acute decompensation. Infections in cirrhosis lead to acute deterioration of hemodynamics leading to precipitation of AKI., Aim: To study predictors of mortality in patients with infection-associated AKI in cirrhosis., Methods: This was a prospective, observational study conducted at tertiary care centre from January 2018 till April 2019. Total 119 participants with cirrhosis of liver presenting with AKI were included into the study. AKI was defined as per international club of Ascites-AKI criteria 2015. Patients were grouped into infection AKI and non-infection AKI. Non-infection AKI included patients with diuretic induced AKI and pre-renal AKI. Logistic regression analysis was used to determine predictors of mortality at 28-d., Results: Out of 119 patients, alcohol ( n = 104) was most common etiology of cirrhosis. The infection AKI included 67 (56%) patients and non-infection AKI ( n = 52) included pre-renal AKI in 36 (30%) and diuretic-induced AKI in 16 (14%) patients. Infection AKI had significantly higher bilirubin, higher international normalized ratio (INR), low serum sodium, higher total leukocyte count (TLC) and higher prevalence of hepatic encephalopathy (HE) as compared to non-infection AKI. Infection AKI had higher progression of AKI (19/67 vs 2/52; P = 0.01) and 28-d mortality (38/67 vs 4/5; P ≤ 0.01) as compared to non-infection AKI. At 28-d, non-survivors ( n = 42) had significantly higher bilirubin, higher INR, low serum sodium, higher TLC and higher prevalence of HE as compared to survivors ( n = 77). On subgroup analysis of Infection AKI group, on multivariate analysis, serum bilirubin as well as presence of HE were independent predictors of 28-d mortality. There was no significant difference of mortality at 90-d between two groups., Conclusion: Infection AKI in cirrhosis has a dismal prognosis with higher 28-d mortality as compared to non-infection AKI. Serum bilirubin and presence of HE predict 28-d mortality in infection AKI., Competing Interests: Conflict-of-interest statement: There are no conflicts of interest to report., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

Urban air pollution and exposure-related health impacts are being noticed and discussed very intensely in India. On the other hand, source-specific control is the primary focus for policymakers; however, diverse and complex sources make it difficult to immediately see the action and consequent impacts on better air quality. Many cities across the world have witnessed high air pollution levels at traffic junctions, more so in all Indian cities. Site-specific air pollution reduction can be a promising solution for managing the pollution level at highly polluted locations. CSIR-National Environmental Engineering Research Institute, India, has designed and developed Wind Augmentation and purifYing Unit (WAYU) to remove particulate and gaseous pollutants from urban hot spots such as traffic locations. In the present study, the authors attempted to evaluate the performance of two different designs of WAYU for the removal of particulate matters from polluted air at different traffic locations in Delhi City, the national capital territory of India. The performance analyses show that the current design of WAYU removes PM 10 and PM 2.5 concentrations in the range of 34-49% and 19-25%, respectively from the inlet air. The total PM collected from all WAYU devices was 34.19 kg from 120,557 operating hours' at all the sampling sites. The PM removal rate depends on the size-segregated particulate matter pollution load in the ambient air., Supplementary Information: The online version contains supplementary material available at 10.1007/s13762-021-03641-3., Competing Interests: Conflict of interestThe authors declare no conflict of interest., (© Islamic Azad University (IAU) 2021.)

Critical assessment of spatio-temporal variations in pollution levels is a crucial step for identifying and prioritizing air pollution hotspots (APH) in urban areas. There is no universally accepted methodology for defining and delineating air pollution hotspot which can be source-specific, pollutant-specific and time-specific. The present research article is an attempt to develop a protocol for identifying APH for any pollutant within a city where-in three criteria-based innovative methodology has been derived. The three criteria are frequency of exceedance (% of days), scale of exceedance and consistency in exceedance (consecutive number of days) to the specified standards that need to be met continuously for at least three years. The suggested methodology has been applied on a three-year database (2018-2021) of 37 continuous ambient air quality stations to identify PM 2.5 specific APH. The analysis indicates 11 APH in April, 9 in May, 2 in June and almost the entire city during the October-February months. Given prioritization of implementation of control actions, the identified APH during summer has been further physically examined to map source activity types and their suitability for ambient air quality monitoring stations as per the guidelines. The APH can be the priority areas for the implementation of control actions by urban local bodies. The management of air pollution at these priority areas would be more effective instead of city-scale management practice, which is difficult to implement and monitor., Competing Interests: Declaration of competing interest The authors have no competing financial interests/personal relationships that could have apeared to influence the work reported in the paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Pullulanases are the significant industrial group in the 13 glycosyl hydrolases category, known as the α-amylases family. There are very few reports on pullulanase from fungal sources. Based on the above research gap, the present study was undertaken to explore the endophytic fungi for their pullulanase-producing capabilities., Results: A total of 126 endophytes were isolated from Tradescantia pallida, Zea mays, and Trifolium alexandrinum. Aspergillus, Penicillium, and Ganoderma species recovered highest from the stem of Tradescantia palida. Fusarium was dominant in the stem and leaf of Zea mays. Penicillium, Aspergillus, Ganoderma, Cladosporium, Fusarium, and Alternaria were recovered from the Trifolium alexandrium. The Shannon index in Tradescantia pallida was highest in leaves while in Zea mays and Trifolium alexandrinum, it is highest in the stem. The Simpson's index is highest in the case of Zea mays stem and root. Species richness was indicated by Menhinick's index, and it was found that this value was highest in the roots of Trifolium alexandrinum. As per our knowledge, no comparative data is available on the endophytic diversity of the above plants taken for the study. Out of 126 endophytes, only 2.38% produced pullulanase while 7.94% produced amylase. The recovery of pullulanase-producing endophytic fungi was very less. But the importance of pullulanase is high as compared to amylase because it has both α-1,6 and α-1,4 hydrolyzing ability. Therefore, the most promising isolates were identified by ITS sequence analysis. Based on spore chain morphology, isolates BHU-25 and BHU-30 were identified as Penicillium sp. and Aspergillus species, respectively. This is the first report of pullulanase from endophytic Aspergillus and Penicillium., Conclusion: Endophytes Aspergillus sp. and Penicillium sp. produce pullulanase enzyme. This is the first report of pullulanase from endophytic Aspergillus and Penicillium., (© 2021. The Author(s).)

In this article, we study the effect of various environmental factors on intra-atomic frequency comb (I-AFC) based quantum memory. The effect of the environment is incorporated as random fluctuations and non-uniformity in the parameters such as comb spacing and the optical depth, of the frequency comb. We found that the I-AFC is viable for photon storage even for very large fluctuations in the parameters of the frequency comb, which makes I-AFC a robust platform for photon storage. Furthermore, we show that the non-uniform frequency combs without any fluctuations in the comb parameters can also yield efficient quantum memory. Since the intra-atomic frequency combs found in natural atomic systems are often non-uniform, our results suggest that a large class of these systems can be used for I-AFC based efficient quantum memory.

Discrete-time quantum walks are known to exhibit exotic topological states and phases. Physical realization of quantum walks in a lossy environment may destroy these phases. We investigate the behaviour of topological states in quantum walks in the presence of a lossy environment. The environmental effects in the quantum walk dynamics are addressed using the non-Hermitian Hamiltonian approach. We show that the topological phases of the quantum walks are robust against moderate losses. The topological order in one-dimensional split-step quantum walk persists as long as the Hamiltonian respects exact [Formula: see text]-symmetry. Although the topological nature persists in two-dimensional quantum walks as well, the [Formula: see text]-symmetry has no role to play there. Furthermore, we observe topological phase transition in two-dimensional quantum walks that is induced by losses in the system.

We propose a passive all optical device capable of transforming the orbital angular momentum (OAM) state of light conditioned over the polarization states. The efficiency of this device is ensured due to its linear optical nature. As applications of this device, we show CNOT and SWAP operations between polarization and OAM qubits, non-interferometric OAM mode sorter and generalized Pauli X operation on a four-dimensional subspace of OAM.

Some of the most prominent theoretical predictions of modern times, e.g., the Unruh effect, Hawking radiation, and gravity-assisted particle creation, are supported by from the fact that various quantum constructs like particle content and vacuum fluctuations of a quantum field are observer-dependent. Despite being fundamental in nature, these predictions have not yet been experimentally verified because one needs extremely strong gravity (or acceleration) to bring them within the existing experimental resolution. In this Letter, we demonstrate that a post-Newtonian rotating atom inside a far-detuned cavity experiences strongly modified quantum fluctuations in the inertial vacuum. As a result, the emission rate of an excited atom gets enhanced significantly along with a shift in the emission spectrum due to the change in the quantum correlation under rotation. We propose an optomechanical setup that is capable of realizing such acceleration-induced particle creation with current technology. This provides a novel and potentially feasible experimental proposal for the direct detection of noninertial quantum field theoretic effects.

Introduction: To mitigate the spread of the pandemic coronavirus infection (COVID-19), governments across the world have adopted "lockdowns" which have confined many individuals to their homes. This disrupts normal life routines, elements of which are important circadian cues. The pandemic is also associated with new stressors, altered roles, and uncertainties about health and economic security, which are also likely to affect sleep. The current study is an online survey of sleep experience, routines, physical activity, and symptoms of anxiety and depression, to study the alterations associated with the lockdown., Materials and Methods: The survey was conducted in early May 2020 using a questionnaire circulated through social media platforms. Questions related to demographic characteristics, current and previous sleep schedules, routine, and working patterns. Insomnia (Insomnia Severity Index - 4), Stress (Perceived Stress Scale - 4), anxiety and depressive symptoms (Patient Health Questionnaire - 4) and physical activity (International Physical Activities Questionnaire) were assessed using standardized instruments., Results: A total of 958 valid responses were received. Compared to the prelockdown period, there was a shift to a later bedtime and waking time, with a reduction in night-time sleep and an increase in day-time napping. These effects were visible across occupational groups, but mostly affected working individuals except health professionals. Sleep quality deteriorated across groups. Reductions in sleep duration were associated with depressive symptoms., Conclusions: The COVID-19 lockdown is associated with changes in sleep schedule and in the quantity and quality of night-time sleep. Although these changes are associated with elevated rates of emotional symptoms, it is unclear from these cross-sectional results, whether sleep deterioration produces psychological distress, or vice versa., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Psychiatry.)

Government has implemented various scattered and un-quantified control actions in Delhi city to reduce the air pollution levels; however, it still exceeds the National Ambient Air Quality Standards (NAAQS). The present study has been designed to assess the air quality status, identify Air Quality Control Region (AQCR), and evaluate control strategies in the city. Out of eight selected locations, ambient PM 10 , PM 2.5 , and NO 2 concentrations were found exceeding the daily as well as annual standards at selected AQCR with peak levels during post-monsoon than winter and summer. Anand Vihar was found to be most polluted and thus, selected as an AQCR. AERMOD performed satisfactorily in predicting pollutant concentration during winter and summer having an index of agreement in the range 0.54-0.80. PM 10 and PM 2.5 can be reduced substantially by increasing frequency of efficient mechanized cleaning of roads and sprinkling of water on the roads. Progressive decrease in NO 2 concentrations can be achieved by restricting entry of truck in the study area through alternate path. The cumulative impact of all selected control strategies indicates a substantial decrease in air pollution within AQCR. The study also suggests a policy framework to manage the urban air quality through local scale air quality guidelines.

Introduction: Open comminuted distal femur fractures are notorious for septic or aseptic non-union. The recommended fixed angle distal femur locking plate in such situations can lead to a septic non-union due to its extensive approach and further periosteal stripping. Supracondylar nails, though have a minimally invasive approach, are not suitable for type C2 and C3 (AO/ASIF) fractures. A monolateral fixator as damage control followed by plating may be recommended. But if wound healing is delayed it results in difficult articular reduction, poor alignment and a stiff knee. We therefore used ilizarov circular external fixators (ICEF) for such open fractures (type C1, C2 and C3) and analysed its radiological and functional outcomes., Materials and Methods: 25 male patients, with a mean age of 31.04 ± 6.62 years (range, 22-44 years), with open grade III type C distal femoral fractures were treated with ICEF. There were 7 fractures of type C1and C3 each, 11 were of type C2. Articular reduction and compression was achieved with inter-fragmentary screws through minimal open technique by extending the open wound and then stabilising the fracture with ICEF. The main outcomes evaluated were union, range of motion, final shortening, Knee Society scoring and ASAMI scoring system for radiological and functional outcomes., Results: The mean follow-up period was 19.12 ± 1.14 months. All fractures except two united at a mean period of 30 ± 3.02 weeks, without the need of bone grafts. The bony assessment (according to ASAMI score) was excellent in 8 cases (33.33%), good in 9 cases (37.5%) and fair in 5 cases (20.83%), while there were 2 poor clinical end results. The functional results were excellent in 6 cases (25%), good in 9 cases (37.5%) fair in 6 cases (25%) poor in 3 cases (12.5%). The complications included shortening, extension lag and pin tract infections., Conclusion: With the encouraging results, the use of ICEF with minimal internal fixation in grade III open comminuted distal femur fractures as a primary definitive treatment is a valuable alternative.

The question, whether an open system dynamics is Markovian or non-Markovian can be answered by studying the direction of the information flow in the dynamics. In Markovian dynamics, information must always flow from the system to the environment. If the environment is interacting with only one of the subsystems of a bipartite system, the dynamics of the entanglement in the bipartite system can be used to identify the direction of information flow. Here we study the dynamics of a two-level system interacting with an environment, which is also a heat bath, and consists of a large number of two-level quantum systems. Our model can be seen as a close approximation to the 'spin bath' model at low temperatures. We analyze the Markovian nature of the dynamics, as we change the coupling between the system and the environment. We find the Kraus operators of the dynamics for certain classes of couplings. We show that any form of time-independent or time-polynomial coupling gives rise to non-Markovianity. Also, we witness non-Markovianity for certain parameter values of time-exponential coupling. Moreover, we study the transition from non-Markovian to Markovian dynamics as we change the value of coupling strength.

Foxtail millet porridge was prepared using germinated grains and milk and was evaluated for its storage stability after thermal processing at ultra-high temperatures (UHT) of 142 °C for 5 s and retort processing temperatures of 121.5 °C for 15 min. Various physical, chemical, and microbial changes of the porridge were studied for a storage period of 180 days at 25 ± 1 °C. Using consumer perception and survival analysis, the predicted shelf life of the UHT treated and retort processed foxtail millet porridge samples stored at 25 ± 1 °C was found to be 186 ± 9 days and 245 ± 15 days, respectively. Also, data from consumer liking, profiling, physical, chemical, and microbial parameters showed significant changes (P < 0.05) in the thermally treated packaged porridge samples over time. As the consumer overall acceptability decreased, the detection of positive attributes (thick and uniformly colored texture and appearance; grainy mouth texture; caramel taste and aroma) in the porridge decreased, while the detection of negative attributes (uneven, decolored, and curdled texture and appearance; sticky mouth texture; cooked, sour and off smell; cooked, sour and off taste) increased. The present study could establish a significant difference (P < 0.05) in the storage induced properties of UHT and retort processed porridge samples. The analytical evaluation of foxtail millet porridge found that UHT treated porridge was better in quality, but consumers preferred retort processed porridge. PRACTICAL APPLICATION: The quality and sensory attributes, evaluated for UHT treated and retort processed porridge samples during the storage period of 180 days, were found to be contradictory. Based on the results of CATA sensory analysis, the shelf life of UHT treated and retort processed porridge samples was predicted to be more than 6 months. Therefore, both UHT treatment and retort processing can be effectively applied to prepare a ready to eat milk based porridge using germinated foxtail millet grains., (© 2018 Institute of Food Technologists®.)

Competing Interests: There are no conflicts of interest.

Background: Untreated Perthes disease can lead to osteoarthritis by the fourth decade. The treatment is conservative for children <6 years, operative within the age group of 6-9 years. Late onset Perthes, older than 9 years or more, are notorious with the aggressive course with poor outcome. However, literature do not come to a consensus between conservative and operative management. This study evaluates the clinical and radiological outcome of varus derotation osteotomy (VDRO) in Perthes disease presenting late with age 8 years or more., Materials and Methods: 15 children (13 males and 2 females) with the mean age of 9.4 years belonging to modified Elizabethtown classification Stage IB, IIA, IIB treated with open wedge VDRO between 2008 and 2014 were included in this study. Seven patients (46.67%) were of >10 years of age at presentation. All patients had limitation of abduction and internal rotation. Eight patients (53.33%) had pain at the hip and 12 patients (80%) had limp. Mean time between diagnosis and corrective surgery was 3 weeks., Results: The evaluation was done using caput index (CI) and epiphyseal quotient (EQ) and articulotrochanteric distance radiologically, range of motion and Harris Hip Score for clinical outcome. All the measurements were carried out on pre- and postoperative X-rays after 3 years followup and compared with the contralateral normal hip. After a mean followup period of 3.4 years, we noted the statistically significant difference between pre- and postoperative values. We noted that all (100%) children in Stage IB, IIA and 50% children in Stage IIB achieved satisfactory results. There was a significant change ( P = 0.000) in CI among all the patients after surgery. The final EQ after 3 years of VDRO was 0.606 and was significant ( P = 0.0000)., Conclusion: In our opinion, based on the encouraging short term radiological and clinical outcomes, VDRO may be regarded as a treatment procedure for late presenting Perthes disease in stage IB, IIA, IIB., Competing Interests: There are no conflicts of interest.

Objective: The objective of this study was to compare the relative efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteric stones., Patients and Methods: This was a prospective study performed between December 2014 and February 2016. A total of 123 adult patients (>18 years of age) presenting with distal ureteric stones sized 6-10 mm were randomized to treatment with tamsulosin 0.4 mg once daily (Group A) or tadalafil10 mg once daily (Group B). Therapy was given for a maximum of 4 weeks. The stone expulsion rate was the primary endpoint. Time to stone expulsion, number of colic episodes, analgesic use, number of hospital visits for pain, endoscopic treatment, and adverse effects of the drugs were noted. Statistical analyses were done using Fisher's exact test and Chi-square test., Results: A total of 61 patients were included in tamsulosin group and 62 patients in tadalafil group. A statistically insignificant difference was found for stone clearance rate between both groups as a whole (Group A-73.77%, Group B-69.35%, P = 0.690) as well as when we considered both subgroups (A1-78.05%, B1-75.0%, P = 0.802; A2-65.0%, B2-55.6%, P = 0.741). All the primary and secondary outcome measures were more in favour of stones ≤8 mm size than stones >8 mm size. No statistical difference was found for adverse drug effects except for retrograde ejaculation, which was significantly high in tamsulosin group ( P < 0.001)., Conclusion: This study showed that although tamsulosin is more effective for stone clearance than tadalafil, but this difference was not significant ( P = 0.690)., Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

We show that the evolution of two-component particles governed by a two-dimensional spin-orbit lattice Hamiltonian can reveal transitions between topological phases. A kink in the mean width of the particle distribution signals the closing of the band gap, a prerequisite for a quantum phase transition between topological phases. Furthermore, for realistic and experimentally motivated Hamiltonians, the density profile in topologically nontrivial phases displays characteristic rings in the vicinity of the origin that are absent in trivial phases. The results are expected to have an immediate application to systems of ultracold atoms and photonic lattices.

Competing Interests: There are no conflicts of interest.

There are both fundamental and practical motivations for studying whether quantum entanglement can exist in macroscopic systems. However, multiparty entanglement is generally fragile and difficult to quantify. Dicke states are multiparty entangled states where a single excitation is delocalized over many systems. Building on previous work on quantum memories for photons, we create a Dicke state in a solid by storing a single photon in a crystal that contains many large atomic ensembles with distinct resonance frequencies. The photon is re-emitted at a well-defined time due to an interference effect analogous to multi-slit diffraction. We derive a lower bound for the number of entangled ensembles based on the contrast of the interference and the single-photon character of the input, and we experimentally demonstrate entanglement between over two hundred ensembles, each containing a billion atoms. We also illustrate the fact that each individual ensemble contains further entanglement.Multipartite entanglement is of both fundamental and practical interest, but is notoriously difficult to witness and characterise. Here, Zarkeshian et al. demonstrate multipartite entanglement in an atomic frequency comb storing a single photon in a Dicke state spread over a macroscopic ensemble.

Competing Interests: There are no conflicts of interest.

Background: Amebic liver abscess (ALA) is a common and serious problem in our country. There are only a few controlled trials on the efficacy and advantages of combination therapy with percutaneous needle aspiration and pharmacotherapy, over pharmacotherapy alone for amebic liver abscess., Material and Methods: This study was conducted to compare the efficacy of two different treatment modalities i.e. drug treatment alone vs. drug treatment and aspiration of abscess cavity in patients with small (up to 5 cm) and large (5 cm to 10 cm) size ALA. This is one of the largest single center, prospective, randomized studies comparing the efficacy of aspiration in ALA., Results: (i) Mean body temperature, liver tenderness, total leukocyte count (TLC), serum alanine aminotransferase (ALT) and liver span were significantly decreased in the aspiration group on days 8 and 15 as compared to non-aspiration group especially in large abscess (5 cm to 10 cm). (ii) Abscess cavity maximum diameter decreased significantly in aspiration group on days 8 and 15, and 1 month & 3 months in large abscess (5cm to 10 cm)., Conclusions: (i) Needle aspiration along with metronidazole hastens clinical improvement especially in large (5 cm up to 10 cm) cavities in patients with ALA. (ii) Aspiration is safe and no major complications occurred. (iii) Hence, combination therapy should be the first choice especially in large ALA (5 cm to 10 cm).

Burkholderia mallei is the causative agent of glanders which is a highly contagious and fatal disease of equines. Considering the nature and severity of the disease in equines, and potential of transmission to human beings, glanders is recognised as a 'notifiable' disease in many countries. An increasing number of glanders outbreaks throughout the Asian continents, including India, have been noticed recently. In view of the recent re-emergence of the disease, the present study was undertaken to estimate the prevalence of glanders among indigenous equines from different parts of India. Serum samples were analysed by complement fixation test (CFT) and ELISA for the detection of B mallei specific antibodies. A total of 7794 equines, which included 4720 horses, 1881 donkeys and 1193 mules were sampled from April 2011 to December 2014 from 10 states of India. Serologically, 36 equines (pony=7, mules=10, horses=19) were found to be positive for glanders by CFT and indirect-ELISA. The highest number of cases were detected in Uttar Pradesh (n=31) followed by Himachal Pradesh (n=4) and Chhattisgarh (n=1). Isolation of B mallei was attempted from nasal and abscess swabs collected from seropositive equines. Four isolates of B mallei were cultured from nasal swabs of two mules and two ponies. Identity of the isolates was confirmed by PCR and sequencing of fliP gene fragment. The study revealed circulation of B mallei in northern India and the need for continued surveillance to support the eradication.

Background and Aims: Preliminary data suggests lower serum hepatitis B surface antigen level is associated with more severe liver fibrosis in HBeAg positive patients. We evaluated the association of HBsAg level with biochemical, virological, and histological features in asymptomatic patients with chronic HBV infection., Methods: HBsAg levels were measured at baseline in 481 asymptomatic, treatment naive patients with chronic HBV infection. Subjects were followed-up prospectively (median, 12; range, 8-36 months). Phases of HBV infection were defined after regular monitoring of HBV-DNA and transaminases. Liver histology was scored using the METAVIR system., Results: HBeAg positive (n, 126) patients were significantly younger than HBeAg negative (n, 355), median age 26 vs 30 years; P < 0.01. HBV genotype could be determined in 350 patients, 240 (68.57%) had genotype D and 100 (28.57%) had genotype A. HBsAg level had modest correlation with serum HBV DNA(r = 0.6 vs 0.4 in eAg positive & negative respectively). HBeAg + ve patients with fibrosis score ≥ F2 showed significantly lower median serum HBsAg levels and serum HBV DNA levels compared with patients with F0-F1 score (median, range; 4.51, 2.99-6.10 vs 5.06, 4.13-5.89, P < 0.01) and (8.39, 3.85-10.60, P < 0.01) respectively. Significant inverse correlation of HBsAg level was found with liver fibrosis in eAg positive group (r = -0.76; P < 0.001). HBsAg level cut off value 4.7 log10 IU/ml predicted moderate to advance fibrosis (F ≥ 2) with 92% sensitivity, 85% specificity & 91% negative predictive value., Conclusion: Lower HBsAg level might reflect the status of advanced liver fibrosis in HBeAg positive chronic hepatitis B subjects.