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Abstract The generation of patterns by breaking the spatial symmetry in external confinement is a captivating area of physics. The emergence of patterns is a fundamental inquiry spanning various disciplines such as nonlinear optics, condensed matter physics, and fluid dynamics. The article investigates the generation of a variety of patterns in a one-dimensional binary mixture of Bose–Einstein condensate forming quantum droplets. By solving the extended Gross–Pitaevskii equation in the presence of tilted and driven engineered bi-chromatic optical lattices (BOL), the out-of-equilibrium dynamics of droplets under strong dc and ac fields are illustrated. Under the influence of a dc field, a stripe-like pattern emerges in the temporal domain, while the scenario with ac fields demonstrates temporal periodic and bi-periodic oscillations of density waves. The width and period of formed patterns are directly correlated with the strength of ac and dc fields. Moreover, temporal modulation of the BOL potential depth yields various harmonics in the oscillations of the condensate density pattern. Through Fast Fourier Transform (FFT) analysis, it is confirmed that these harmonics encompass multiple and combinational frequencies, suggesting potential applications in generating desired frequency combs within quantum droplets. We have also carried out a thorough numerical stability check of the obtained solutions and found them sufficiently stable.

Coinfection with Dengue fever and Scrub Typhus presents significant diagnostic and therapeutic challenges, particularly in pediatric cases. We report a 6-year-old girl with fever, headache, maculopapular rash, and a vesicular lesion on the knee that progressed to a black eschar. She developed generalized edema, oral bleeding, decreased urine output, and renal dysfunction. Laboratory tests revealed anemia, leukocytosis, thrombocytopenia, elevated serum urea and creatinine, hypoalbuminemia, and hyponatremia. The Weil-Felix test was positive for OXK titer 1:320, and Dengue IgM antibodies were detected, complicating the diagnosis. Treatment with doxycycline, azithromycin, and local care for the eschar led to clinical improvement. This case highlights the importance of considering coinfection in febrile illnesses and emphasizes the need for accurate and timely diagnosis for effective management.

Consecutive suspected acute coronary syndrome (ACS) cases were categorized into three groups: Group-1 (ST-depression), Group-2 (T-inversion), and Group-3 (remaining cases). Group-3 was subclassified into isoelectric horizontal ST-segment with sharp ST-T-angle (IHST) positive and IHST negative groups. They underwent serial high-sensitive Troponin-I testing. ACS incidence was 77.96 %, with 33.02 %, 15.96 %, and (15.04 %, 35.96 %) of patients in Groups 1, 2, and 3 (IHST positive, IHST negative), respectively. The presence of IHST exhibited higher sensitivity than T-inversion and greater specificity than ST-depression in detecting ACS. The presence of IHST sign additionally detected 15.04 % of ACS. The presence of IHST was significant among group-3 (p = 0.008) as well as the overall ACS cases (p = 0.048).

Background Various graft materials have been used for closure of small tympanic membrane perforations with varying success rates. This study was done to compare the success rates of endoscopic fat plug myringoplasty (EFPM) and chemical cauterization for managing small TM perforations. Methodology This was a prospective study conducted in ENT Department of a teaching hospital of western Gujarat from November 2020 to December 2022. 50 patients with small central dry perforation were randomly divided into 2 groups. 25 patients in Group A underwent endoscopic fat plug myringoplasty (EFPM) and 25 in Group B underwent trichloroacetic acid (TCA) application (chemical cauterization). At the end of 3 months (last follow-up) the perforation closure rates and hearing improvement were compared between the two groups. Results Out of 50 participants, 20 (40%) were males and 30 (60%) females. 36% participants belonged to 31-40 years of age group. The perforation closure with EFPM was significantly higher than chemical cauterization (92% vs 64%, p=0.0168) measured at 3 months follow-up. Similarly, the post operative hearing improvement was significantly better with EFPM that with chemical cauterization (p=0.0168). Conclusions EFPM is an effective method for managing small central tympanic membrane perforations. It is a day-care procedure and success rate is equal or even better than other modalities of managing small TM perforations. This method should be used more often.

Intro: Improving the American healthcare system has consistently predominated the domestic policy agenda in the United States for decades. However, physicians have traditionally played a small role in the U.S. legislative process despite their direct observations of the obstacles that cost, access, and quality can have on their patients and their care. The goal of this study was to examine the relationship between physician political ideological preferences and health policy reform options. Methods: We conducted a cross-sectional survey of 3,001 currently practicing U.S. physicians to predict how self-identification as liberal, moderate, or conservative impacted a physician’s policy preferences under the domains of cost, access, and quality. Results: A total of 536 (18.8%) out of 3,001 physicians responded to the survey. Overall, 32% of physicians identified as liberal, 43% as moderate, and 22% as conservative. Conclusion: Liberal-identifying physicians favored traditionally liberal reform ideas (a national health plan or public option), while conservative physicians preferred conservative policies (free market optimization). However, variation within political groups and domains of healthcare suggest that no single reform policy will be unanimously supported by every physician within a political group. Nonetheless, physicians are unanimously dissatisfied with the state of our current system, and physician-supported healthcare reform should be a national priority.

Background: Perinatal asphyxia (PA) is a neonatal emergency causing multi-organ dysfunction, and neurological insult called hypoxic-ischemic encephalopathy (HIE). The traditional focus is on neuroprotection. However, the immature cardiovascular system simultaneously undergoes tremendous hypoxic-ischemic insult especially during the secondary phase of HIE. The hemodynamic consequences, comprehensive cardiac assessment, and care are often overlooked in bedside practice. Objective: The objective is to quantitatively document myocardial dysfunction in neonates with PA using electrocardiography (ECG), echocardiography, and cardiac enzymes (creatinine kinase-MB [CK-MB], B-type natriuretic peptide [BNP], and troponin I). Design and Methods: This was a single center, case–control prospective study. Sixty-four neonates with PA were enrolled. Myocardial function was assessed by clinical, ECG, echocardiography, and biomarkers assay. The same number of healthy neonates was taken as control. Results: 15 (23.4%) had mild, 28 (43.7%) moderate, and 21 (32.8%) severe HIE in the case arm. Abnormal ECG was observed in 42 (65.6%), of which 20 (47.6%) had Grade I, 13 (30.9%) Grade II, 8 (19.04%) Grade III, and 1 (2.38%) had Grade IV changes. Serum levels of CK-MB, BNP and Troponin I were raised in 29 (45.3%), 30 (46.8%) and 10 (15.6%) neonates, respectively. Echocardiographic parameters such as ductal shunting pattern, mitral and tricuspid regurgitation, pulmonary hypertension, and systolic and diastolic ventricular function were significantly abnormal in cases versus controls as demonstrated by P value. Conclusion: Abnormal ECG, echocardiography, and cardiac enzymes in PA are markers and prognosticators of cardiac injury affecting overall outcomes in neonates with PA. Early detection can help in better management and survival of these neonates.

Hexavalent chromium (Cr[VI]) is a widespread environmental pollutant in air and water that is primarily attributed to industrial pollution. The current maximum contaminant levels (MCLs) for drinking water from the World Health Organization and the U.S. Environmental Protection Agency (0.05 and 0.1 mg/L, respectively) were set based on contact dermatitis and warrant further toxicological investigation. While Cr(VI) is neurotoxic and accumulates in the brain, most animal studies only report whole-brain Cr, leaving large knowledge gaps. Few studies consider differences between ages or sexes, and fewer consider essential metal dyshomeostasis. We sought to investigate where Cr accumulates in the brain, considering sex and age differences, following a 90-day drinking water exposure to current MCLs. Here, we report Cr levels in six brain regions of rats exposed to drinking water Cr(VI). We observed Cr only accumulated in the hippocampus, and only in older females. We further assessed changes to essential metals in the hippocampus, observing opposite effects across sexes and between young rats compared to older rats. In sum, our data indicate drinking water Cr(VI) selectively targeted the hippocampus, with geriatric females accumulating the most Cr, and induced significant essential metal dyshomeostasis even in tissues lacking evident Cr accumulation.

We are facing a critical aging crisis, with geriatric populations (65+) growing to unprecedented proportions and ~4 million people (a 6.5-fold increase) expected to become centenarians by 2050. This is compounded by environmental pollution, which affects individuals of all ages and contributes to age-related diseases. As we have a limited understanding of how environmental pollutants affect older populations distinctly from younger populations, these longer-lived geriatric populations present a key knowledge gap. To address this knowledge gap, we employ a “Toxic Aging Coin” approach: heads consider how age impacts chemical toxicity, and tails consider how chemicals act as gerontogens—or how they accelerate biological aging. We employed this approach to investigate hexavalent chromium (Cr[VI]) impacts on female rats exposed to 0.05 or 0.1 mg Cr(VI)/L in drinking water for 90 days; these are the maximum contaminant levels (i.e., the highest levels permitted) from the World Health Organization and U.S. Environmental Protection Agency, respectively. During exposure, rats performed a battery of behavior assays to assess grip strength, locomotor coordination, anxiety, spatial memory, sociability, and social novelty preference. We observed age differences in Cr(VI) neurotoxicity, with grip strength, locomotor function, and spatial memory in middle-aged females being particularly affected. We further compared these results in females to results in males, noting many sex differences, especially in middle-aged rats. These data emphasize the need to consider age and sex as variables in toxicology and to revisit drinking water regulations for Cr(VI).

Hereditary platelet delta (δ)-storage pool deficiency is a rare condition in which there are fewer dense granules in platelets disrupting primary hemostasis. It can cause a mild–moderate bleeding tendency with normal coagulation studies; hence, it is an underdiagnosed diagnostic challenge. The authors present three patients with hereditary platelet delta (δ)-storage pool deficiency who had heavy menstrual bleeding, excessive bleeding following surgery, mucocutaneous bleeding, and a bleeding score greater than or equal to 6. These cases reveal the susceptibility of underdiagnosing platelet disorders and the significance of utilizing a bleeding assessment tool to help guide further workup with transmission electron microscopy to visualize the fewer dense granules in platelets. Although bleeding is typically moderate, it can be severe in certain scenarios, like after mucosal surgeries, and can lead to death, highlighting the importance of the condition’s recognition and prophylactic treatment.

Introduction:The management of subglottic and tracheal stenosis is challenging for any ENT surgeon. The treatment choice depends on the site, severity of stenosis, patient symptoms, and surgeon preferences. The various options for the management include endoscopic balloon dilatation, various types of laryngotracheoplasty, resection anastomosis, and insertion of a silicon T-tube. Compared to the above, silicon T-tube stenting is a better alternative, as it is a onetime procedure, easy to perform with fewer chances of complications. Shiann Yann lee technique is a form of laryngotracheoplasty with long-term stenting using silicon T-tube. This article analyzed our silicon T-Tube insertion result in patients with subglottic and tracheal stenosis using this technique.Materials and Methods:In this retrospective study, we included a total of 21 patients with subglottic and tracheal stenosis who underwent silicon T-Tube insertion. Data regarding the site of stenosis, procedure, complications, and outcome were analyzed.Results:Out of 21 patients, nine patients had subglottic stenosis (42.8%), 8 had cervical tracheal stenosis (38.09%), 3 had thoracic tracheal stenosis (14.28%), and 1 (4.7%) had combined subglottic and cervical tracheal stenosis. Out of 21 patients,7 (33.3%) have undergone successful removal of silicon T-Tube so far, one death due to medical reasons, and 13 patients (61.9%) are still on Silicon tube on regular follow-up. They are comfortable with the tube in situ.Conclusions:Silicon T-Tube for benign acquired laryngotracheal stenosis with Shiann Yann Lee's technique is effective, safe with less complication, and good acceptability and tolerance by the patient.

Background: Neonatal sepsis is the second most common cause of neonatal mortality in India. Early detection and proper treatment of sepsis are important in reducing neonatal mortality. The emergence of antibiotic resistance among pathogens that infect newborns is of great concern. Hence, this study was done to identify the bacterial agents causing neonatal septicemia along with their antibiotic sensitivity pattern. Methods: This was a prospective study carried out at neonatal intensive care unit of a tertiary care teaching hospital of western Gujarat, India, from October 2018 to August 2020. 2739 neonates were admitted with probable sepsis during the study period. 299 neonates with positive blood cultures were recruited for the study. Antibiotic sensitivity of organisms was noted and compared with other studies. Results: Out of 299 blood culture proven sepsis, most common organism was Klebsiella pneumoniae, isolated in 98 patients (32.7%), followed by coagulase negative staphylococcus aureus in 90 patients (30.2%). Candida was the third most common organism isolated in 45 (15.1%) patients. Other bacteria isolated were Enterococcus in 33 (11.1%), Staphylococcus aureus in 17 (5.6%), Escherichia coli in 7 (2.3%), Acinetobacter spp in 6 (2%) and Pseudomonas in 3 (1%) patients. Gram positive bacteria were isolated in 140 (46.8%) patients, while, gram negative bacteria and fungus were isolated in 114 (38.2%) and 45 (15%) patients respectively. Klebsiella demonstrated maximum sensitivity to Meropenem (95%) and Piperacillin-Tazobactam (73.1%), while it showed high resistance to ampicillin (97.9%) and Cefoperazone (95.9%). Among non-beta lactam antibiotics, Klebsiella showed maximum sensitivity to colistin (100%) and Vancomycin (80%), while showed high resistance to Aminoglycosides and Quinolones. CONS showed maximum sensitivity to Cefoperazone (81.4%) and Cefotaxim (62.4%), but they showed high resistance to Ampicillin (86.5%) and Meropenem (86.9%). Among non-beta lactam antibiotics, CONS showed maximum sensitivity to Linezolid (100%) and Vancomycin (98%), while showed high resistance to Aminoglycosides and Quinolones. Conclusions: The most common organism isolated was Klebsiella and it showed high resistance to 1st, 2nd and 3rd line antibiotics (Ampicillin, Aminoglycosides, Cefoperazone and Quinolones). Due to the emergence of antibiotic resistance in NICU, it is important to know antibiotics sensitivity and resistant pattern of various organisms for neonatal sepsis.

A full-term male neonate presented on the 11th day of life with late-onset multisystem inflammatory syndrome-neonate (MIS-N) (cardioneurological compromise). Immediate anti-inflammatory modulation led to a gradual recovery of neurological and coronary lesions. However, temporal evaluation unmasked silent myocardial dysfunction in echocardiography validated further by elevated biomarkers, myocardial fibrosis in cardiac magnetic resonance imaging, and abnormal strain study persisting till 16 months of follow-up. This revealed a hitherto unknown and rare progression of MIS-N into dilated cardiomyopathy.

Background: Autoimmune pulmonary alveolar proteinosis (aPAP) results from impaired macrophage-mediated clearance of alveolar surfactant lipoproteins. Whole lung lavage has been the first-line treatment but recent reports suggest the efficacy of granulocyte–macrophage colony-stimulating factor (GM-CSF). We aimed to review the efficacy and safety of nebulised GM-CSF in aPAP. Methods: We conducted a systematic review and meta-analysis searching Embase, CINAHL, MEDLINE and Cochrane Collaborative databases (1946–1 April 2022). Studies included patients aged >18 years with aPAP receiving nebulised GM-CSF treatment and a comparator cohort. Exclusion criteria included secondary or congenital pulmonary alveolar proteinosis, GM–CSF allergy, active infection or other serious medical conditions. The protocol was prospectively registered with PROSPERO (CRD42021231328). Outcomes assessed were St George's Respiratory Questionnaire (SGRQ), 6-min walk test (6MWT), gas exchange (diffusing capacity of the lung for carbon monoxide (DLCO) % predicted) and arterial–alveolar oxygen gradient. Results: Six studies were identified for review and three for meta-analysis, revealing that SGRQ score (mean difference −8.09, 95% CI −11.88– −4.3, p

The rapid growth of various industries has led to a significant, alarming increase in recalcitrant pollutants in the environment. Hazardous dyes, heavy metals, pesticides, pharmaceutical products, and other associated polycyclic aromatic hydrocarbons (such as acenaphthene, fluorene, fluoranthene, phenanthrene, and pyrene) have posed a significant threat to the surroundings due to their refractory nature. Although activated carbon has been reported to be an adsorbent for removing contaminants from wastewater, it has its limitations. Hence, this review provides an elaborate account of converting agricultural waste into biochar with nanotextured surfaces that can serve as low-cost adsorbents with promising pollutant-removing properties. A detailed mechanism rationalized that this strategy involves the conversion of agrowaste to promising adsorbents that can be reduced, reused, and recycled. The potential of biowaste-derived biochar can be exploited for developing biofuel for renewable energy and also for improving soil fertility. This strategy can provide a solution to control greenhouse gas emissions by preventing the open burning of agricultural residues in fields. Furthermore, this serves a dual purpose for environmental remediation as well as effective management of agricultural waste rich in both organic and inorganic components that are generated during various agricultural operations. In this manner, this review provides recent advances in the use of agrowaste-generated biochar for cleaning the environment.

The European Green Deal is a political milestone aiming to promote a carbon-neutral economy in the European Union. Decarbonizing the complex food sector requires the unified interaction among effective climate policies, economic instruments, and initiatives involving multiple stakeholders. Despite increasing efforts to highlight the importance of innovations and finance to achieve sustainable food supply chains (FSC), comprehensive information about related opportunities and barriers to mitigating emissions in the food sector is still under-explored. To cover this gap, this paper applies an existing industrial policy framework under the lens of the EU FSC to identify potential strategies that should help achieve the needed financial means and innovation actions, as well as to gauge political alignment across FSC stages. Methodologically, the pillars proposed in the framework are linked to multi-stakeholders’ initiatives engaged in achieving net-zero emissions. The paper highlights three main implications of the identified interlinkages. First, political directionality related to the food sector should be more comprehensively tailored to account for the specificities of all stages of the FSC. Second, research and development projects shall likewise cover all stages, instead of emphasizing only food production and agricultural systems. Finally, multiple stakeholders are crucial as promoters of technology and innovation towards a green economy. Nevertheless, initiatives should be integrated into political discussions in order to promote civil awareness, sustainable food and services demand, aligned to political guidelines.

This report describes a case of bilateral cervicogenic headache treated with cooled radiofrequency ablation (RFA). The case is considered to review a longstanding cervicogenic headache and the use of cooled RFA of cervical facet joint as a treatment of choice. In this case, a 50-year-old female patient with intermittent dull aching bilateral headache in occipital, temporal, and cervical region for 20 years was diagnosed with bilateral greater occipital neuralgia. She underwent cooled RFA of unilateral right-sided 3rd occipital nerve (cervical 2/3 facet joint) with minimal or no side effects and 100% pain reduction at 24 h of follow-up. After 4 weeks of follow-up, the patient reported a single incident where she experienced pain that settled with medication and had a lower intensity as compared to that which was experienced before the procedure. Cooled RFA of the cervical facet joint in challenging cases can be a line of treatment to alleviate pain with lower side effects and potential for long-term efficacy.

Abstract Sleep is one of the essential bio-makers for human health. Poor sleep is associated with reduced cognitive performance. With most smartphone users in India being college students, the focus is now on exploring smartphone usage’s impact on students’ sleep. Umpteen news articles in India have reported binge-watching, social media use during the night, and other mobile phone-related interruptions as causes of improper sleep and irregular sleep patterns. However, such studies may involve bias while self-reporting and are limited to a one-time exercise. To understand the reality, we need to accurately quantify the sleep duration, patterns, mobile usage before and after bedtime, number and duration of interruptions. In this first-of-its-kind study in India, we infer novel insights into the sleep patterns of a cohort of 40 college students. We implement a mobile sensing-based approach for the study by installing a custom-developed mobile app on all phones. We extract sleep activity and infer the sleep duration, bed-in and wake-up times, and interruption duration from the sensor data collected from the phone’s built-in sensors. The study brings about new insights into college student sleep patterns and, interestingly, shows that students have a regular sleep cycle and good sleep quality. Only one-fourth of the students revealed irregular sleep patterns, and we did not observe any mobile-related interruptions 30 min past bedtime.

Abstract It is shown that the phenomenon of negative temperature essentially occurs in Bose-Einstein condensate due to the realization of the upper bound energy state utilizing a combination of expulsive harmonic oscillator and optical lattice potentials. We study the existence of quantum droplets at negative temperature and droplet-to-soliton crossover in the binary Bose-Einstein condensate mixture in the presence of bi-periodic optical lattices and expulsive-BOL confinements. Based on the beyond mean field approximation, we employ the extended Gross-Pitäevskii equation and calculate the exact analytical form of wavefunction solutions for BOL, expulsive-BOL confinements. An interesting transition of quantum droplets from positive to negative temperatures and the droplet-to-soliton crossover by modulating the disorder in BOL potential are illustrated. The affirmation of such crossover is performed by exploring the profile of atomic condensate density which smoothly transits from being a flat top density in optical lattice confinement to a bright soliton for BOL trap. Further, we confirm the crossover by exploring the energy per particle and the variation in the root mean square size of the condensate with respect to the potential depth of the BOL trap. Eventually, all of this aid us to construct a phase diagram in a space between the amplitude of BOL potential depth and particle number which reveals the formation of droplet and soliton phases. In expulsive-BOL confinement, it is seen that the impact of the expulsive trap is insignificant on atomic condensate density in the droplet phase and it becomes prominent in the soliton region. Further, the variation of total energy reveals that the amplitude of the expulsive oscillator strengthens the droplet phase and leads to an increase in the negative temperature of the considered system.

Key Clinical Message A 26‐year‐old male patient admitted to the hospital ward with experience of repetitive syncopes for a year. The patient was diagnosed with sick sinus syndrome. The aim of this clinical report is to highlight the variability of anatomical findings associated with polysplenia pattern. Abstract This case report presents a 26‐year‐old male patient who presented to the medical ward with a complaint of repeating blackouts for a year. The patient was then diagnosed with sick sinus syndrome, and further investigations revealed left isomerism, polysplenia, and no congenital heart defects. Holter monitoring, ultrasonography, electrocardiography, and computed tomography were used to confirm the diagnosis. The patient underwent DDDR pacemaker implantation for the treatment of SA node dysfunction. The report highlights the variability of anatomical findings associated with polysplenia pattern and the various types of heartbeat disruptions that may occur in the atrial appendages of the left side isomerism.

Introduction: Succinylcholine is a muscle relaxant of choice for paediatric intubation due to its fast onset and ultrashort duration of action but it is associated with unwanted side-effects. Rocuronium bromide can be used alternatively to avoid those unwanted side-effects because of its fast onset and intermediate duration of action. Aim: To compare two doses of rocuronium bromide with succinylcholine in terms of intubating conditions, duration of action, haemodynamic variations, and complications to get a better alternative dose of rocuronium bromide in children undergoing elective surgeries. Materials and Methods: The present randomised, double-blinded clinical trial study was conducted in the Department of Anaesthesiology, Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India from January 2021 to October 2022. Ninety American Society of Anaesthesiology (ASA) Grade-I-II children of both sexes of 1-10 years age, undergoing elective surgery were equally divided into three groups. Group-R9 (n=30) and Group-R12 (n=30) received rocuronium bromide 0.9 mg/kg and 1.2 mg/kg, respectively while Group-S (n=30) received succinylcholine 1.5 mg/kg. Comparative evaluation of intubating conditions was done around 60 seconds in all three groups and duration of action, haemodynamic variations, and complications were noted. All data were entered in a microsoft excel sheet and results were expressed as percentages, mean Standard Deviation (SD), chi-square test, and Analysis of Variance (ANOVA) test where the difference was considered statistically significant if the p-value

IntroductionOverreliance on habit is linked with disorders, such as drug addiction and obsessive-compulsive disorder, and there is increasing interest in the use of repetitive transcranial magnetic stimulation (rTMS) to alter neuronal activity in the relevant pathways and for therapeutic outcomes. In this study, we researched the brains of ephrin-A2A5−/− mice, which previously showed perseverative behavior in progressive-ratio tasks, associated with low cellular activity in the nucleus accumbens. We investigated whether rTMS treatment had altered the activity of the dorsal striatum in a way that suggested altered hierarchical recruitment of brain regions from the ventral striatum to the dorsal striatum, which is linked to abnormal habit formation.MethodsBrain sections from a limited number of mice that underwent training and performance on a progressive ratio task with and without low-intensity rTMS (LI-rTMS) were taken from a previous study. We took advantage of the previous characterization of perseverative behavior to investigate the contribution of different neuronal subtypes and striatal regions within this limited sample. Striatal regions were stained for c-Fos as a correlate of neuronal activation for DARPP32 to identify medium spiny neurons (MSNs) and for GAD67 to identify GABA-ergic interneurons.Results and discussionContrary to our hypothesis, we found that neuronal activity in ephrin-A2A5−/− mice still reflected the typical organization of goal-directed behavior. There was a significant difference in the proportion of neuronal activity across the striatum between experimental groups and control but no significant effects identifying a specific regional change. However, there was a significant group by treatment interaction which suggests that MSN activity is altered in the dorsomedial striatum and a trend suggesting that rTMS increases ephrin-A2A5−/− MSN activity in the DMS. Although preliminary and inconclusive, the analysis of this archival data suggests that investigating circuit-based changes in striatal regions may provide insight into chronic rTMS mechanisms that could be relevant to treating disorders associated with perseverative behavior.

Glass fiber-reinforced polymers (GFRPs) are widely used in domestic applications such as doors, windows, and furniture, where drilling is a common machining process. The surface roughness of drilled hole walls is a critical factor, particularly in fastening applications, where smooth finishes are essential. This study explores the influence of drilling parameters on the surface roughness of GFRPs reinforced with different types of eggshell fillers viz.,un-carbonized, carbonized, and hybrid along with an unfilled variant. The research employs a Central Composite Design within the Response Surface Methodology (RSM) framework to investigate the effects of material type, spindle speed, feed rate, and point angle on surface roughness. Material type and point angle were treated as categorical variables, while spindle speed and feed rate were continuous, each with four levels, resulting in 16 experimental runs. The results showed that surface roughness values varied from 3.04 to 4.99μm, depending on the specific combination of drilling parameters. Statistical analysis using Analysis of Variance (ANOVA) confirmed that spindle speed and feed rate significantly impact surface roughness, with roughness increasing at higher speeds and feeds. Notably, the carbonized eggshell-filled GFRP variant achieved the lowest surface roughness. The study also developed a highly accurate regression model, validated through experimental data. The novel use of different variants of eggshell fillers in GFRPs provides a sustainable and effective way to enhance material properties. Further, conducting the drilling studies to observe the outcomes, offers potential industrial applications in the production of high-quality, durable composite materials.

Cerebral venous sinus thrombosis (CVST) is a relatively uncommon but important cause of stroke-like disease, accounting for fewer than 1% of all strokes. CVST is more common in females and infants. CVST patients are most common in the third decade, with a female-to-male ratio of 5:1.5. The incidence of CVST has been found to be high in developing countries, particularly in South-East Asia. Headache is the most prevalent clinical sign of CVST, occurring in 88% to 93% of patients, followed by a seizure in 37% to 71%, focal neurological deficit in 20% to 54%, and isolated increased intracranial pressure in 23%.[1] A 34-year-old male came to the tertiary care hospital with complaints of headache, vomiting, and vertigo for 1 day. Headache is insidious, progressive, nonradiating, holocephalic, severe in intensity and associated with vertigo and dizziness, and giddiness, he also complained about nausea and vomiting (10–12 episodes/day) containing food and water. The patient had no family history but has been chronic tobacco chewer for 10 years. Past medical history revealed that he was admitted to the hospital before for the same complaints and he also had right lower vein deep-vein thrombosis 6 months back. His magnetic imaging resonance reports and protein S and C deficiency reports revealed that he was suffering from CVST. He was prescribed with anticoagulants and other supportive treatments that include antiemetic, analgesics, and multivitamins, which cause faster and better recovery of patients.

Abstract Background Lectin receptor-like kinases (Lec-RLKs), a subfamily of RLKs, have been demonstrated to play an important role in signal transduction from cell wall to the plasma membrane during biotic stresses. Lec-RLKs include legume lectin-like proteins (LLPs), an important group of apoplastic proteins that are expressed in regenerating cell walls and play a role in immune-related responses. However, it is unclear whether LLPs have a function in abiotic stress mitigation and related signaling pathways. Therefore, in this study, we examined the possible role of LLPs in Arabidopsis thaliana (AtLLPs) under various abiotic stresses. Results The study was initiated by analyzing the chromosomal localization, gene structure, protein motif, peptide sequence, phylogeny, evolutionary divergence, and sub-cellular localization of AtLLPs. Furthermore, the expression profiling of these AtLLPs was performed using publicly accessible microarray datasets under various abiotic stresses, which indicated that all AtLLPs were differently expressed in both root and shoot tissues in response to abiotic stresses. The cis-regulatory elements (CREs) analysis in 500 bp promoter sequences of AtLLPs suggested the presence of multiple important CREs implicated for regulating abiotic stress responses, which was further supported by expressional correlation analysis between AtLLPs and their CREs cognate transcription factors (TFs). qRT-PCR analysis of these AtLLPs after 2, 6, and 12 h of cold, high light, oxidative (MV), UV-B, wound, and ozone stress revealed that all AtLLPs displayed differential expression patterns in most of the tested stresses, supporting their roles in abiotic stress response and signaling again. Out of these AtLLPs, AT1g53070 and AT5g03350 appeared to be important players. Furthermore, the mutant line of AT5g03350 exhibited higher levels of ROS than wild type plants till 12 h of exposure to high light, MV, UV-B, and wound, whereas its overexpression line exhibited comparatively lower levels of ROS, indicating a positive role of this gene in abiotic stress response in A. thaliana. Conclusions This study provides basic insights in the involvement of two important representative AtLLPs, AT1g53070 and AT5g03350, in abiotic stress response. However, further research is needed to determine the specific molecular mechanism of these AtLLPs in abiotic stress mitigation and related signaling pathways in A. thaliana.

In this paper, two techniques for sentiment classification are proposed: Gujarati Lexicon Sentiment Analysis (GLSA) and Gujarati Machine Learning Sentiment Analysis (GMLSA) for sentiment classification of Gujarati text film reviews. Five different datasets were produced to validate the machine learning-based and lexicon-based methods’ accuracy. The lexicon-based approach employs a sentiment lexicon known as GujSentiWordNet, which identifies sentiments with a sentiment score for feature generation, while in the machine learning-based approach, five classifiers are used: logistic regression (LR), random forest (RF), k-nearest neighbors (KNN), support vector machine (SVM), naive Bayes (NB) with TF-IDF, and count vectorizer for feature selection. Experiments were carried out and the results obtained were compared using accuracy, precision, recall, and F-score as performance evaluation criteria. According to the test results, the machine learning-based technique improved accuracy by 3 to 10% on average when compared to the lexicon-based approach.

Perioperative management of pregnant women with cardiac disease is challenging. The physiological cardiac changes that occur during late pregnancy leads to haemodynamic stress to the patient with the cardiac disease during and immediately after parturition. Pregnant women with severe valvular disease do not tolerate haemodynamic changes associated with pregnancy. The choice of anaesthesia technique either general anaesthesia or regional anaesthesia is depending on the haemodynamic goals, cardiac status of the patient, and mode of delivery. A 23-year-old female patient was planned for elective caesarean section for safe confinement. She was an operated case of Balloon Mitral Valvuloplasty (BMV). General anaesthesia was preferred due to the severity of mitral stenosis. Incorporation of epidural analgesia with general anaesthesia provided intraoperatively haemodynamic stability during laryngoscopy, intubation, and extubation. Also, postoperatively analgesia could be achieved due to epidural top-ups. Ultimately, a good perioperative outcome has been achieved due to haemodynamic stability which reduces perioperative morbidity and mortality of the patient.

Quinolines are a prominent heterocyclic motif and crucial building blocks in creating physiologically active compounds. Due to the fast development of novel medicines with a quinoline nucleus, numerous research papers have been published in a short amount of time. Therefore, to comprehend the present state of the quinoline nucleus in medicinal chemistry science, it is necessary to combine new information with older data. So far, several traditional synthesis techniques have been reported in the literature to synthesize this scaffold. Pfitzinger, Gould–Jacob, Friedlander, Skraup, Doebner–von Miller, and Conrad–Limpach are examples of old synthetic methods. However, they need expensive and demanding conditions, such as high temperature, the use of non-biodegradable chemical compounds degrade the ecosystem, create irritation or harm as pollutants, and represent a threat to the environment. However, traditional synthesis processes need a difficult and time-consuming apparatus set-up, resulting in high costs and pollutants. As a result, scientists are presently developing new and innovative techniques to decrease the use of chemicals, solvents, and catalysts, which are detrimental to both humans and the environment. Therefore, we have attempted to shed light in this current review on various reactions to produce quinolines and their derivatives using various green synthetic methods.

Abstract Recent theoretical and experimental results show that one-dimensional (1D) weakly interacting atomic Bose-Bose mixtures with repulsive interspecies mean field (MF) interaction are stabilized by attractive quadratic beyond-mean-field (BMF) effects into self-bound quantum droplet (QD) in free space. Here, we construct an exact analytical model to investigate the structure and dynamics of QDs in presence of external harmonic confinement by solving the 1D extended Gross–Pitäevskii equation (eGPE) with temporal variation of MF and BMF interactions. The model provides the analytical form of wavefunction, phase, MF and BMF nonlinearities. The generation of QDs and interesting droplet to soliton transition in presence of regular/expulsive parabolic traps by taking the comparable MF and BMF interactions are illustrated. We derive the phase diagram of the droplet-soliton phase transition between amplitude of MF, BMF interactions and harmonic oscillator frequency. The strength and form of oscillator frequency are identified as key parameter for tuning the compression, fragmentation and transport of droplets. Finally, the stability of the obtained solutions are confirmed from Vakhitov–Kolokolov (VK) criterion and are found stable.

Background: Chest X-ray (CXR) is a routine, noninvasive test advised in a plethora of pediatric non-cardiac conditions such as bronchopneumonia, respiratory distress, failure to thrive, suspected tuberculosis, and for preoperative anesthesia clearance. Finding of cardiomegaly (CM) on CXR is a common cause of referral to a pediatric cardiologist. The question lies in its significance: whether CM in CXR corroborates with cardiac disease (s), structural or functional. Materials and Methods: The data of 229 children (median age: 6 months), referred to pediatric cardiology unit for echocardiography with CXR depicting CM over a period of 2 years (June 2019 to July 2021), were retrospectively reviewed. Clinical and laboratory findings, CXR, and echocardiography were analyzed for all children to determine the positive predictive value of CM in CXR to detect cardiac disease. Echocardiography was taken as gold standard to reach the cardiac diagnosis. Results: True CM was noted in 85% (Group A), whereas 15% had false CM (Group B). Group A comprised structural heart defect in 71.7% and ventricular dysfunction in 13.3%. Less common causes were severe anemia, hypertensive heart failure, arrhythmogenic cardiomyopathy, diphtheritic cardiomyopathy, multisystem inflammatory syndrome in children, pericardial effusion, thiamine deficiency, and severe idiopathic pulmonary arterial hypertension. In Group B, the most common reasons for false diagnosis were expiratory film (n = 18), thymic shadow (n = 12), and chest deformity and mediastinal mass (n = 2 each). Conclusion: CM in CXR strongly correlates with cardiac involvement and has a high positive predictive value. Combining clinical, laboratory, and CXR interpretation enables the pediatrician to achieve a rapid functional diagnosis. Medical stabilization can be initiated with this knowledge pending the availability of echocardiography in resource-limited areas. Detailed evaluation at a pediatric cardiac center should be completed to reach a final diagnosis in all such patients. In the absence of congenital heart disease, known acquired causes leading to cardiac compromise should be actively looked for.

Introduction: Platelet-rich fibrin (PRF) is a term for autologous platelet concentrates generated from the patient's own blood (PRF). PRF and its derivatives (L-PRF, A-PRF, i-PRF) have been used for delicate tissue restoration in a variety of dental procedures. The quantity of leucocytes and other growth factors in PRF of healthy and post-COVID-19 people differs, according to the literature, and these influence wound tissue healing. Materials and Methods: Thirty healthy volunteers and 30 post-COVID-19 volunteers (age range 24–60 years). For PRF preparation, a REMI PR-23 table centrifuge and a blood collection kit consisting of a 19G needle and 10 ml blood collection tubes were used. The analysis was performed by dividing the subject groups into three test groups (Group 1 – post-COVID-19, 0–30 days; Group 2 – post-COVID-19, 31–90 days; Group 3 – normal patients). Group 1, 2 and 3 consisted of 23, 7 and 30 patients, respectively. Results: The result was statistically significant between the normal and posted COVID-19 patient groups (P = 0.00). Not much statistical significance was found between post-COVID-19 patients from 0–30 days to 31–90 days (P = 0.370). Considering the limitations of the study, our findings imply that typical patients' PRF clots or membranes comprise the majority of platelets and half of the leucocytes present in the first blood collection. Conclusion: Within the fibrin network, platelet growth factors are stuck, but the PRF clot or membrane of the post-COVID-19 patients contains a reduced/negligible number of leucocytes. Thus, the growth factors which is released are also less. Therefore, usage of PRF in post-COVID-19 patients for periodontal regenerative therapies should be avoided, at least for the first 60 days, to replenish the reduced leucocyte count and growth factors in the blood.

Introduction: Coronavirus disease 2019 (COVID-19), an extremely contagious pandemic, caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), originated from Wuhan, Hubei province, in China in December 2019. From April 2020, pediatric epicenters in Europe and the USA reported a new clinical spectrum called “pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2” or “multisystem inflammatory syndrome in children,” respectively. The unique feature was immune-mediated multiorgan dysfunction in response to previous COVID exposure. This case series aims to prospectively analyze the incidence, severity, and patterns of cardiac involvement in sick neonates exposed to perinatal SARS-CoV-2 in India. Methods: Twelve neonates presenting with very early-onset multi-inflammatory syndrome in neonates (MIS-N) at two tertiary care centers in India were included. Their clinical profiles, echocardiography findings, and treatment details were recorded. Results: Clinical presentations varied from loss of fetal movement, perinatal depression, prematurity, unusual respiratory distress syndrome, cardiogenic shock, arrhythmias, and multi-organ dysfunction. Echocardiographic markers were severe pulmonary hypertension, significant valvular regurgitation, cardiomegaly, biventricular dysfunction, neonatal coronary artery aneurysms, intracardiac thrombus, pericardial effusion, and arrhythmias. All babies, except one, had positive COVID IgG antibody and high inflammatory markers. Two mothers had antenatal primary contact with COVID patients 4–6 weeks prior to delivery, while 3 (25%) had documented mild COVID infection. All neonates were started on immunosuppressive therapy. Clinical stabilization and declining inflammatory markers were observed within 48–96 h of targeted therapy. All neonates (except one) recovered and were discharged in a stable condition. Follow-up available up to 9 months demonstrated persistent clinical, laboratory, and echocardiographic recovery in all survivors. Conclusion: Infection of pregnant mothers during community transmission during the two COVID-19 waves in India appears to have caused significant immune dysregulation and cardiac damage in neonates. Echocardiography detected significant damage to coronary arteries, pulmonary arterial hypertension, intracardiac thrombus, ventricular dysfunction, and incompetence of valve apparatus in MIS-N. Aggressive immunomodulators with antiplatelet drugs proved lifesaving. Echocardiography is an inexpensive, readily available imaging modality. It should be utilized to save this fragile, extremely special cohort.

Introduction: As a depolarising Neuromuscular Blocking Drug (NMBD), succinylcholine is a muscle relaxation of choice during intubation due to its fast onset effect and ultrashort duration of action. But, it is associated with complications like bradycardia, asystole, hyperkalaemia, myalgia, an increase in intraocular pressure and masseter spasm in children. Rocuronium bromide is an intermediate-acting non depolarising muscle relaxant with faster onset of action. So, it can be used as an alternative for intubation to avoid unwanted side-effects of succinylcholine. Aim: To compare two doses of rocuronium bromide with succinylcholine in terms of intubating conditions, duration of action, haemodynamic variations and complications associated with muscle relaxant. Materials and Methods: A randomised double blinded clinical trial will be planned after taking prior permission from ethical committee. A total 90 children of age between 1-10 years with American Society of Anaesthesiologists (ASA)-I and ASA-II would be equally divided into three groups. Group S would receive succinylcholine 1.5 mg/kg while Group R9 and R12 would receive rocuronium bromide 0.9 mg/kg and 1.2 mg/kg, respectively. Comparative evaluation of intubating conditions would be done around 60 seconds in all three groups. Also, the duration of action, haemodynamic parameters and complications would be observed. Conclusion: At the end of study, one can compare the two doses of rocuronium bromide against succinylcholine which provides the same intubating conditions without haemodynamic variations and complications.

Abstract Background S-domain receptor-like kinases (SD-RLKs) are an important and multi-gene subfamily of plant receptor-like/pelle kinases (RLKs), which are known to play a significant role in the development and immune responses of Arabidopsis thaliana. The conserved cysteine residues in the extracellular domain of SD-RLKs make them interesting candidates for sensing reactive oxygen species (ROS), assisting oxidative stress mitigation and associated signaling pathways during abiotic stresses. However, how closely SD-RLKs are interrelated to abiotic stress mitigation and signaling remains unknown in A. thaliana. Results This study was initiated by examining the chromosomal localization, phylogeny, sequence and differential expression analyses of 37 SD-RLK genes using publicly accessible microarray datasets under cold, osmotic stress, genotoxic stress, drought, salt, UV-B, heat and wounding. Out of 37 SD-RLKs, 12 genes displayed differential expression patterns in both the root and the shoot tissues. Promoter structure analysis suggested that these 12 SD-RLK genes harbour several potential cis-regulatory elements (CREs), which are involved in regulating multiple abiotic stress responses. Based on these observations, we investigated the expression patterns of 12 selected SD-RLKs under ozone, wounding, oxidative (methyl viologen), UV-B, cold, and light stress at different time points using semi-qRT-PCR. Of these 12 SD-SRKs, the genes At1g61360, At1g61460, At1g61380, and At4g27300 emerged as potential candidates that maintain their expression in most of the stress treatments till exposure for 12 h. Expression patterns of these four genes were further verified under similar stress treatments using qRT-PCR. The expression analysis indicated that the gene At1g61360, At1g61380, and At1g61460 were mostly up-regulated, whereas the expression of At4g27300 either up- or down-regulated in these conditions. Conclusions To summarize, the computational analysis and differential transcript accumulation of SD-RLKs under various abiotic stresses suggested their association with abiotic stress tolerance and related signaling in A. thaliana. We believe that a further detailed study will decipher the specific role of these representative SD-RLKs in abiotic stress mitigation vis-a-vis signaling pathways in A. thaliana.

Purpose – The nature of farm animals in the marginalized group of people is varying hurriedly. Livestock is used to add to cash earnings and increase food security, hence helping as a vital component in the household’s source of revenue strategies, particularly at marginal planter’s level. The present study was conducted to assess the numbers of livestock farmers in the study areas, their livelihood options, the value chain of the farmers in different marketing channels and recommendation for the sustainable value chain of the livestock production cycle. Design/methodology/approach – The study precise the baseline condition of marginal livestock farmers for access to value chain activities in terms of inputs, outputs, support services, production, yield, income and enabling environment to enhance livestock farming in the study area. The study was conducted through stratified random sampling of the context using some research tools like in-depth interviews, household surveys, expert opinions and focus group discussions. Structured questionnaires were developed to address issues, such as current livestock farming practices, access to support services, capacity and income. Findings – The study revealed that this particular context is lagging behind to establish goat value chain activities in the targeted areas. The farmers do not have basic knowledge of goat farming, and the value chain actors are not working properly. The support services are not appropriate to turn the goat farming production to a standard level. Value chain of livestock and livestock products and their goals are essential to develop an idea on learning, investment, market access, sales assurance and quality. Variation in institutional contexts of end markets is linked to different types of coordination and control of enabling environment throughout the chains. Practical implications – Livestock is an integral component of the complex farming system in Bangladesh as it serves as not only a source of meat protein but also a major source of farm power services as well as employment. Strong private sector alliance along with public–private ventures can bring sustainable agriculture value chain development in these most vulnerable coastal communities in Bangladesh. Strengthening the weak financial structure, reducing power imbalances in the governance structures and low political intervention in community-level organizations, and resolving socio-cultural and environmental concerns are the major concerns on the development of value chains in Bangladesh. Originality/value – Geographical position and climatic condition of Bangladesh have made her coastal areas one of the highly productive areas for livestock production in the world. The study was conducted through qualitative and quantitative analysis, and after finding the authors recommended for sustainable value chain approach for livestock production to a marketing channel for improving the financial condition and self-employment for the communities.

Purpose – This paper is designed to assess the sustainable value chain approaches for marketing channel development opportunities for agricultural products in coastal Bangladesh to combat climate change through an approach of community-based adaptation options. Design/methodology/approach – The study was designed to select the potential value chain candidate and to analyze and establish a value chain map to benefit the crop farmers. In this connection, the resources of the whole context were evaluated. The approach uses few tools to generate three outputs, the last of which are the final list of value chains selected for in-depth assessment to design interventions as community-based adaptation practices of the study to combat climate change in the study areas. Findings – The study demonstrated that the difference in the institutional circumstances of the end markets of the agriculture products is connected to the different categories of harmonization and control of the facilitating environment throughout the supply chains. National and local networks improve the value chain in terms of the value addition of the agriculture products, technology improvement, market access and profitability of the products. Strengthening the weak financial structure, focus more on formal financial systems and resolving sociocultural and climate change-induced hazard concerns are the major concerns on the development of value chains in the countries. Apparently, guarantee for good governance, checking illegal and unregulated market contexts, proper mitigation measures to climate change are some paramount important issues for the sustainable management of livelihood, yield, income and development. Practical implications – All kinds of stakeholders of the agriculture product value chain should focus on competitiveness and productivity and look for and exploit multiple ways to add value once initial success has been attained with a single deal. Ensuring sustainability within the value chains is an important feature to cater to the challenges and changing demands of the age. Originality/value – The study will help to established a sustainable value chain approach in response to climate change, which process will help to existent opportunities for firms to manage the issue of climate risk by codeveloping and employing adaptation options that may be more preferred or accepted by consumers across the entire chain for the sustainable management of livelihood, yield, income and development.

Racism thrives in geoscience. We present an antiracism plan to support the recruitment, retention and success of Black, Indigenous, and other people of color in geoscience. Our action plan can be adapted by any organization to remove barriers to participation for all marginalized geoscientists.

Abstract Patients with triple-negative breast cancer (TNBC) who have residual disease after neoadjuvant therapy have a high risk of recurrence. We tested the impact of DNA-damaging chemotherapy alone or with PARP inhibition in this high-risk population. Patients with TNBC or deleterious BRCA mutation (TNBC/BRCAmut) who had >2 cm of invasive disease in the breast or persistent lymph node (LN) involvement after neoadjuvant therapy were assigned 1:1 to cisplatin alone or with rucaparib. Germline mutations were identified with BROCA analysis. The primary endpoint was 2-year disease-free survival (DFS) with 80% power to detect an HR 0.5. From Feb 2010 to May 2013, 128 patients were enrolled. Median tumor size at surgery was 1.9 cm (0–11.5 cm) with 1 (0–38) involved LN; median Residual Cancer Burden (RCB) score was 2.6. Six patients had known deleterious BRCA1 or BRCA2 mutations at study entry, but BROCA identified deleterious mutations in 22% of patients with available samples. Toxicity was similar in both arms. Despite frequent dose reductions (21% of patients) and delays (43.8% of patients), 73% of patients completed planned cisplatin. Rucaparib exposure was limited with median concentration 275 (82–4694) ng/mL post-infusion on day 3. The addition of rucaparib to cisplatin did not increase 2-year DFS (54.2% cisplatin vs. 64.1% cisplatin + rucaparib; P = 0.29). In the high-risk post preoperative TNBC/BRCAmut setting, the addition of low-dose rucaparib did not improve 2-year DFS or increase the toxicity of cisplatin. Genetic testing was underutilized in this high-risk population.

Topographic mapping of neural circuits is fundamental in shaping the structural and functional organization of brain regions. This developmentally important process is crucial not only for the representation of different sensory inputs but also for their integration. Disruption of topographic organization has been associated with several neurodevelopmental disorders. The aim of this review is to highlight the mechanisms involved in creating and refining such well-defined maps in the brain with a focus on the Eph and ephrin families of axon guidance cues. We first describe the transgenic models where ephrin-A expression has been manipulated to understand the role of these guidance cues in defining topography in various sensory systems. We further describe the behavioral consequences of lacking ephrin-A guidance cues in these animal models. These studies have given us unexpected insight into how neuronal activity is equally important in refining neural circuits in different brain regions. We conclude the review by discussing studies that have used treatments such as repetitive transcranial magnetic stimulation (rTMS) to manipulate activity in the brain to compensate for the lack of guidance cues in ephrin-knockout animal models. We describe how rTMS could have therapeutic relevance in neurodevelopmental disorders with disrupted brain organization.

A revolutionary change to public-key cryptography can be considered as an Identity Based Cryptography (IBC) in which identity of the receiver is being used as a public key for encrypting a message and Key Generation Centre (KGC). IBC will generate and distribute the private key to each user to decrypt a message. The thought behind presenting the scheme was to improve and reduce the complexity of certificate and key management, but it also gives rise to key escrow problem, access to encrypted information to unauthorized users. The paper represents Improved Identity-Based Encryption Scheme (IIBES) for Domain Name System (DNS) security which provides confidentiality and authentication through modified identity based encryption and identity based digital signatures. The IIBES comprises key revocation mechanism for non-revoked users and also eliminates key escrow problem. Thus, the IIBES aids to implement the identity-based cryptography more safely in reality and protects DNS against cache poisoning, spoofing attack and masquerade attack. Doi: 10.28991/esj-2021-01259 Full Text: PDF

Background: A cardiac abscess is a suppurative infection involving cardiac tissues as myocardium, endocardium, and valves (native or prosthetic). The abscess could form as a direct extension of a preexisting cardiac focus such as bacterial endocarditis or from a distant septic focus leading to bacteremia. Clinical Description: We report an immunocompetent 3-year-old-child with a structurally normal heart presenting in septic shock secondary to right ventricle (RV) myocardial abscess. The abscess developed following hematogenous spread from neglected posttraumatic osteomyelitis of the left ankle and the causative organism was identified as methicillin sensitive Staphylococcus aureus. Management: Prompt action by a multidisciplinary team helped in reaching the diagnosis, effective management of septic shock, emergency open heart surgical removal of the septic mass, and concomitant lower limb arthrotomy saved the child from a bad outcome. Conclusion: This case reiterates the need for aggressive treatment of the open skeletal wound to prevent bacteremia and complications such as myocardial abscess. In a child presenting in septic shock, a quick point-of-care echocardiography is critical in ruling out possible underlying cardiac conditions such as bacterial endocarditis, myocardial abscess, or pericardial effusion. A high index of clinical suspicion is required to make a prompt diagnosis and aggressive medical and surgical intervention for good outcomes.

Aims: To study the impact of vestibular suppressant drugs (VSD) on provocative positional tests (PPT) in patients with benign paroxysmal positional vertigo (BPPV). Settings and Design: A prospective case-control observational study. Materials and Methods: Patients with a history suggestive of BPPV were tested for PPT. Patients with vertiginous symptoms and with nystagmus on PPT were classified as objective BPPV (O-BPPV, control group), while those without nystagmus with no alternate diagnosis were classified as subjective BPPV (S-BPPV, case group). Details of VSD treatment were noted in all the patients. In both groups, patients were instructed to discontinue VSD and were further assigned as the VSD and non-VSD subgroups. Patients were followed for 2 months with PPT every week. PPT positive patients were treated by vestibular rehabilitation maneuvers. Statistics: Student t-test with two-tailed, unpaired, was used for continuous scale and Chi-square test for categorical differences between the two groups. Results: 295 consecutive BPPV patients were enrolled in the study, 55 in the S-BPPV group and 240 in the O-BPPV group. Significantly higher proportion of patients in the S-BPPV group were on VSD at presentation, 80.00% vs. 53.75% (OR 2.52; 95% CI: 1.30–4.86), P = 0.006. In an unadjusted analysis of the S-BPPV group following discontinuation of VSD, PPT became positive in 79.54% of patients as compared to 18.19% in the non-VSD group (OR 35.0; 95% CI: 6.2–197.3), P < 0.001. Conclusion: A higher proportion of S-BPPV patients were receiving VSD in comparison to O-BPPV at the initial visit. The PPT converted positive four times higher after ceasing the VSD in S-BPPV patients. Study Design: Prospective case-control observational study.

Kawasaki disease (KD) is the most common pediatric vasculitis with coronary involvement feared as the most serious complication. The reported case describes a child presenting initially with atypical KD and coronary artery aneurysms. He was treated with intravenous immunoglobulin and aspirin. In spite of adequate compliance and no clinical recurrence, serial echocardiography revealed nonregression of aneurysm and new-onset moderate aortic regurgitation (AR) in the subacute phase produced by prolapse of noncoronary cusp of the aortic valve. AR without aortic root dilatation from persistent inflammation of the valve leaflets in KD is a rare phenomenon. This case demonstrates unusual cardiac manifestations of KD and reoriented our protocol for long-term surveillance in infantile KD.

BackgroundExpert knowledge is often shared among multidisciplinary academic teams at tumor boards (TBs) across the country, but these conversations exist in silos and do not reach the wider oncology community. ObjectiveUsing an oncologist-only question and answer (Q&A) website, we sought to document expert insights from TBs at National Cancer Institute–designated Comprehensive Cancer Centers (NCI-CCCs) to provide educational benefits to the oncology community. MethodsWe designed a process with the NCI-CCCs to document and share discussions from the TBs focused on areas of practice variation on theMednet, an interactive Q&A website of over 13,000 US oncologists. The faculty translated the TB discussions into concise, non–case-based Q&As on theMednet. Answers were peer reviewed and disseminated in email newsletters to registered oncologists. Reach and engagement were measured. Following each Q&A, a survey question asked how the TB Q&As impacted the readers’ practice. ResultsA total of 23 breast, thoracic, gastrointestinal, and genitourinary programs from 16 NCI-CCC sites participated. Between December 2016 and July 2021, the faculty highlighted 368 questions from their TBs. Q&As were viewed 147,661 times by 7381 oncologists at 3515 institutions from all 50 states. A total of 277 (75%) Q&As were viewed every month. Of the 1063 responses to a survey question on how the Q&A affected clinicians’ practices, 646 (61%) reported that it confirmed their current practice, 163 (20%) indicated that a Q&A would change their future practice, and 214 (15%) reported learning something new. ConclusionsThrough an online Q&A platform, academics at the NCI-CCCs share knowledge outside the walls of academia with oncologists across the United States. Access to up-to-date expert knowledge can reassure clinicians’ practices, significantly impact patient care in community practices, and be a source of new knowledge and education.

Glass fiber–cement–polyester composites with different weight percentages (wt.%) of glass fiber and cement were fabricated in the present work through hand lay-up process. Composites were made to undergo different soaking conditions viz., water soaking at room temperature, and boiling water soaking. Unsoaked (as prepared) composites, water-soaked at room temperature, and boiling water soaked samples were tested as per ASTM standards for tensile and flexural strengths. The design of experiments (DOE) based on the full factorial design (33 = L27) is applied to optimize the response variables using MINITAB-18. Results revealed that increasing the wt.% of glass fiber enhanced flexural and tensile strengths. Increasing the wt.% of cement deteriorated the tensile strength but increased the flexural strength. However, specimen subjected to water soaking conditions exhibited a decline in both tensile and flexural strengths.

The work targets to fabricate and characterize “nanoclay–epoxy composites” (NECs) by varying weight percentages (wt.%) of nanoclay. Mechanical stirrer and sonicator are used to mix nanoclay into epoxy resin. The mixture is molded to prepare specimens in accordance with ASTM standards. The addition of nanoclay increased the mechanical properties of fabricated composites. Scanning Electron Microscopy (SEM) images revealed the causes of specimen failure. Four factors viz., nanoclay wt.%, speed, load, and time at three levels are considered a wear test on a pin-on-disc machine. The design of experiments (Taguchi design) is applied for the experimentation, and analysis of variance is established through Minitab 19 software. Results revealed that the nanoclay addition improved the resistance to wear of epoxy.

The hallmark of corrected transposition is discordance at atrio-ventricular and ventriculo-arterial level and that is defined as “double discordance”. This can occur as an isolated anomaly but more commonly has associated defects; most common being ventricular septal defect followed by tricuspid valve abnormalities. Other associated defects are pulmonary stenosis, systemic and pulmonary venous anomalies, univentricular physiology, ventricular dysfunction (morphological right ventricle facing systemic circulation) and association of conduction abnormalities. Echocardiography plays a pivotal role in defining the anatomy and planning the management. In this article we are discussing about role of echocardiography in evaluation of corrected transposition, diagnosing the lesion, role in immediate post-operative period and on follow up.