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Aims and Objectives: The incidence of postoperative liver dysfunction is high in patients undergoing double-valve replacement – mitral and aortic valve replacement (DVR). This study aims to evaluate N-acetylcysteine’s free radical scavenging property (NAC) to prevent postoperative liver dysfunction in these patients, thus affecting overall clinical outcomes. Methods: A single-center, prospective, randomized, double-blinded interventional study of 60 patients divided into two groups of 30 each. Group N received prophylactic intravenous NAC, and Group C received volume-matched 5% dextrose. Data comprised demographics, liver function tests (LFT), renal function tests (RFT), vasoactive-inotropic scores (VIS) score, and C-reactive protein (CRP) at various time intervals. Postoperative parameters such as ventilation duration, length of stay in ICU (LOS-ICU), length of hospital stay (LOHS), atrial fibrillation (AF), acute kidney injury (AKI) requiring hemodialysis, and mortality were noted. Statistical analysis was performed with the Student’s t-test and Chi-square test (SPSS 22 software). Results: All postoperative LFT parameters (total bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT), and alkaline phosphatase (ALP)) were significantly lower (P < 0.05) at 24, 48, and 72 hours in Group N compared to Group C. RFT and VIS scores were lower in Group N; however, were not statistically significant except for Serum Creatinine at 48 hours (P = 0.0478). Ventilation duration (P = 0.0465) and LOS-ICU (P = 0.0431) were significantly lower in Group N. Other outcomes like AF, LOHS, and mortality were lower in Group N but were not statistically significant. Conclusion: Our study showed that prophylactic administration of NAC in patients undergoing DVR is associated with a reduction in the incidence of postoperative liver dysfunction with a positive impact on postoperative outcomes.

Abstract The present study describes an eco‐friendly NBS‐assisted regioselective synthesis of new 5‐acylfunctionalized 5‐acylfunctionalized 2‐(1H‐pyrazol‐1‐yl)thiazoles by condensation of 3,5‐dimethyl‐1H‐pyrazole‐1‐carbothioamide with unsymmetrical 1,3‐diketones under solvent‐free conditions. The structural elucidation of the newly synthesized compounds was accomplished using various spectroscopic techniques viz. FTIR, NMR and mass spectrometry. All the newly synthesized compounds were examined for their in vitro antimicrobial potential against both pathogenic gram positive and gram negative bacterial and fungal species as well as anthelmintic activity against Pheretima posthuma earthworms. The results of antimicrobial activity revealed that all tested compounds 3 a–j showed excellent antimicrobial potential particularly against S. aureus. It was also observed that compounds 3 e and 3 i (MIC=62.5 μg/mL) showed greater potency against E. coli, whereas compounds 3 a and 3 h (MIC=50 μg/mL and 62.5 μg/mL) demonstrated better activity against P. aeruginosa and compound 3 i (MIC=62.5 μg/mL) exhibited superior activity against S. pyogenus when compared to standard drug Ampicillin (MIC=100μg/mL). Compound 3 e and 3 j revealed remarkable antifungal and anthelmintic activities. To find out binding interactions of target compounds with target proteins and pharmacokinetic parameters of the compounds, in silico investigations involving molecular docking studies and ADMET predictions were also performed.

Introduction: Children with beta thalassemia are on regular blood transfusions, which could result in iron deposition in the liver causing decreased synthesis of Vitamin D-25OH. There are limited publications on the association of Vitamin D deficiency with blood transfusion-dependent thalassemia in the Nepalese population. This study aims to determine the prevalence of Vitamin D deficiency among blood transfusion-dependent beta-thalassemia patients. Methods: This was a descriptive cross-sectional study conducted among beta-thalassemia major patients under 15 years of age, receiving regular blood transfusion, from July 17, 2022, to July 16, 2023, after ethical approval obtained from Ethical Review Committee, Kanti Children’s Hospital (reference number 155). Data were collected using convenience sampling, and descriptive analyses were performed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) 2024. Results: A total of 127 blood transfusion-dependent beta-thalassemia major patients were included in the study, of whom 82 (64.56%) were male. Among these patients, 104 (81.88%) were aged between 5 and 14 year. Almost one-third 41 (32.28%) had Vitamin D insufficiency, and a quarter, 34 (26.77%), had Vitamin D deficiency. Ten percent of the children were underweight, and a quarter were stunted. Conclusions: Children with blood transfusion dependent beta thalassemia major are at a greater risk for Vitamin D deficiency and iron overload

Aim: The present study examined the effect of bonding the pericervical dentin using resin-modified glass-ionomer cement (RMGIC), nanohybrid composite (Endure Nano), and Biodentine on the fracture resistance of root-filled mandibular premolars. Methods: Twenty-four human single-rooted mandibular premolars were decoronated, cleaned, and shaped with ProTaper Universal till size F3. The roots were obturated with gutta-percha using a single-cone technique. The teeth were randomly grouped into four groups of n = 6 each. After removing the 3 mm coronal gutta-percha in Groups I, II, and III, the intra-orifice barriers of RMGIC, nanohybrid composite (Endure Nano), and Biodentine were placed, respectively. Group IV served as the control. The fracture resistance of the specimens was analyzed using the universal testing machine. The derived data were statistically evaluated using one-way ANOVA and post hoc Tukey’s honestly significant difference test. Results: A significantly high fracture strength was exhibited by specimens of Group I, followed by Groups II and III, respectively. The lowest fracture strength was shown by the control group. Conclusion: Within the limitation of the present study, the fracture resistance of an endodontically treated tooth was significantly influenced by the type of intra-orifice barrier.

Epilepsy is a neurological condition characterized by temporary disruptions in the brain's electrical activity. This disorder can significantly impact the quality of life for those affected, leading to limitations on driving and employment opportunities. The seriousness of epilepsy is further emphasized by the risk of SUDEP (sudden unexpected death in epilepsy). Additionally, individuals with epilepsy commonly experience memory problems and emotional disorders. In this article, we present a bibliometrix analysis of epilepsy research, examining influential articles, keywords, authors, institutions, and countries. Our analysis focuses on research articles published from 2015 to 2023.The findings of our analysis reveal that China and India are the leading countries in terms of epilepsy publications and total citations. Furthermore, we propose a framework that encompasses technology, enablers, and barriers, providing valuable insights into the future trajectory of epilepsy research. Various factors can contribute to the development of epilepsy, including neurotransmitter imbalances, tumors, strokes, brain damage resulting from illnesses or injuries, or a combination of these causes. To gather scientific papers related to epilepsy seizures, we employed the Scopus database and extracted information such as titles, authors, contributing institutes, source journals, times cited, and countries. For data analysis, we used the R package (Bibliometricx R package), VOSviewer, and SciMAT facilitated co-authorship and co-occurrence analyses, allowing us to visualize the results. By shedding light on the current state of epilepsy research and identifying emerging trends, the aim of this study is to provide guidance for future investigations in understanding, managing, and treating epilepsy more effectively.

Introduction: Urothelial Carcinoma (UC) is a disease with significant mortality, estimated to be the ninth most common cause of cancer worldwide and the thirteenth most common cause of death from cancer. It has a significant impact on public health and will continue to do so due to the high prevalence of smoking. To combat the growth of urothelial cancer, awareness regarding primary prevention must be underscored, and smoking cessation programs need to be encouraged and supported. Aim: The aim of this study is to determine the expression of Human Epidermal Receptor 2 (HER2)/neu in UC and its association with age, size, type, grade, and invasion of the tumour. Materials and Methods: This cross-sectional study was conducted at the Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research (a tertiary care centre) in Amritsar, Punjab, India, from January 1st, 2019, to December 31st, 2020. Fifty histopathologically proven cases of UC were examined. HER2/neu expression was studied using immunohistochemistry, and its correlation with age, size, type, grade, and invasion was analysed. The findings of the study were statistically analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0, a statistical program for Microsoft Windows. Results: A total of 50 patients were analysed for the study (40 males and 10 females, with a mean age of 60.4 years at presentation). Nineteen cases were low-grade, and 31 cases were high-grade, with high-grade cases being more invasive. Thirteen cases showed HER2/neu expression, of which 11 were high-grade, indicating a statistically significant relationship between grade and HER2/neu expression. Similarly, expression was higher in cases with lamina propria and muscularis propria invasion. Out of the 34 cases showing lamina propria invasion, 10 cases were positive for HER2/neu expression, constituting 29.4%. Among the 42 cases involving muscularis propria in the biopsy, 16 cases showed muscularis propria invasion by the tumour, with four cases (25%) being positive for HER2/neu expression. Conclusion: The expression of HER2/neu increases with grade and shows more positive expression in high-grade invasive tumours involving lamina propria or muscularis propria. This indicates that HER2/neu protein overexpression is associated with aggressive disease and serves as a negative prognostic marker. Targeted therapy against HER2/neu may prove to be beneficial in such patients.

Key Clinical Message Schwannomas are rare tumors in the orbit, typically originating from various nerves and presenting diagnostic challenges. We present a unique case of a unilateral orbital schwannoma arising from the supraorbital nerve. A 55‐year‐old female presented with a painless, slowly growing mass in the right superior orbit, causing proptosis. Visual acuity remained unimpaired, and clinical examination revealed a well‐defined mass in the superior orbit. A provisional diagnosis of an orbital dermoid or cyst was made, leading to excision biopsy. The histopathological examination confirmed a diagnosis of benign schwannoma. Schwannomas in the orbit, particularly those arising from the supraorbital nerve, are uncommon and often challenging to diagnose. Early surgical intervention is crucial to prevent complications associated with tumor growth. This case underscores the need to consider schwannomas as a differential diagnosis for slow‐growing orbital masses in adults and emphasizes the importance of timely management to prevent vision‐threatening complications.

BackgroundThe burden of communicable, non-communicable diseases and reproductive maternal, newborn, child & adolescent health in India, reflects the necessity to develop tailored solutions. The plethora of MedTech innovations has provided healthcare facilities with more effective, affordable and accessible healthcare for people across the country. However, in spite of the Make-in-India scheme in the country, the indigenously developed healthcare technology is far from making an impact on the healthcare system.ObjectiveTo present a roadmap for MedTech innovations for their successful deployment into the public healthcare system.MethodologyIn addition to the literature review, recommendations were included from several stakeholders such as innovators, manufacturers, policymakers, subject matter experts, funding organizations, State health officials etc.Results and conclusionThe journey of healthcare innovation from need identification to ideation, to prototyping and validation has paved the way towards the de novo design that caters to unmet needs. Innovations at the advanced technology readiness level (TRL 7/8 and above) demand a holistic and multidisciplinary approach which includes clinical validation, regulatory approval and Health technology assessment. The deployment of healthcare technology into the public healthcare system must consider resources (e.g., time, staff, budget, investment policies), ethical concerns (privacy, security, regulations, ownership), governance (policy, accountability, responsibility etc.), and Skills (capabilities, culture, etc.). The technologies are considered for field trials before the uptake in the public health system. Technology can be a key tool in achieving Universal Health Coverage but its use has to be strategic, judicious, and cognizant of issues around privacy and patient rights.

Background: Thyroid dysfunctions, hypothyroidism and hyperthyroidism, can lead to mood disorders like depression and mania. Conversely, depressive disorders are associated with subtle variations in thyroid hormone levels. Objectives: The objective of the study was to examine the prevalence and characteristics of thyroid dysfunction in patients with Depressive disorders. Methodology: A cross-sectional study was conducted on patients diagnosed with depressive disorders who presented to outpatient and inpatient setting in the psychiatry department. Consecutive sampling method was used till the calculated sample size of 82 patients was reached. Diagnosis of depressive disorder was done as per the International Classification of Diseases, 10th revision (ICD-10). Hamilton depression rating scale (HAM-D) was administered to assess the severity of depressive symptoms. Thyroid Dysfunction was diagnosed based on the morning (8 AM) serum levels of T3, T4 and TSH levels. Data analysis was done using statistical package for the social sciences (version 24), and results were presented as mean and percentages. Results: Among 82 patients with depression, the prevalence of thyroid dysfunction was 15% (12), and subclinical hypothyroidism was the most common type with prevalence of 11% (9), followed by hypothyroidism. There was no significant association between the severity of depressive episode and the type of thyroid dysfunction (x2-14.208, df-9, p-.115). Conclusion: Prevalence of thyroid dysfunction is higher in depressive disorders. Regular monitoring of Thyroid functions tests should be considered during follow up to prevent relapse of symptoms.

Introduction: Deliberate self-harm (DSH) is one of the leading causes of death and a major public health problem worldwide. According to the World Health Organization, DSH has increased by 60% over the past 50 years, of which 90% of victims had a psychiatric disorder. Aims and Objectives: The aim is to analyze the frequency, type, and lethality of DSH in bipolar affective disorder (BPAD) patients. Materials and Methods: This study included 150 patients diagnosed to have BPAD. Specially designed sociodemographic pro forma was used to record basic profile. DSH inventory was administered on BPAD patients who presented with DSH to analyze the type and lethality. Diagnosis of BPAD was made according to the International Classification of Diseases, tenth revision. Data were recorded, compiled, and analyzed using frequency and percentage with the IBM SPSS Statistics for Windows, Version 24.0. Results: The frequency of DSH was found to be 33%, out of which 38 (35%) patients had manic episode and 11 (30%) patients had depressive episode. The most common type of DSH was found to be cutting self with sharp or blunt objects and consumption of poison with frequency of 12 (24.5%) each. The second most common DSH was banging head, which was present in (11) 22.4% of patients. Conclusion: BPAD is associated with increased risk of DSH compared to the general population. The most common type of DSH was cutting self with sharp objects followed by consumption of poison. Patients who presented with DSH in depressive episode and severe mania had more lethal modes of DSH.

Background: Headache is one of the commonly reported symptoms of coronavirus disease-2019 (COVID-19) illness. A number of studies have been done so far focusing on headache associated with COVID-19 with variable incidence and characteristics. Material and Methods: This study is a prospective study conducted on 120 patients with confirmed COVID-19 illness. Critically ill and ventilated patients were excluded. Demographic data, COVID illness symptom profile, headache characteristics were documented. Patients were followed up at 2 weeks and 4 weeks. For the statistical analysis, Statistical Package for the Social Sciences (SPSS), version 24.0 was used. Results: 120 COVID-19 positive cases were included in the study with a mean age of 54.59 ± 14.89 years (range 21-84 years) with male-to-female ratio of 3:2. 78.33% (94) of patients had various comorbidities. 43.33% (52) cases were diabetic. The presenting symptoms were fever (65%), cough (53.33%), shortness of breath (35%) and myalgia (31.66%). 26 (21.66%) patients reported headache during the COVID illness. 18 (15%) cases had headache attributed as secondary to COVID-19 illness. Out of them, 12 cases were new onset with no past history of headache and 6 cases had a significant change in previous headache episodes. COVID-19 illness precipitated headache episodes similar to past headache type in 8 cases. Headache was the presenting symptom in 8 (6.66%) patients with COVID-19 being detected in the regular hospital screening protocol. Conclusion: Headache was a common symptom in COVID-19 patients. New onset headaches or change in past headache type in patients in the setting of ongoing pandemic should be screened for COVID-19.

Reversible cerebral vasoconstriction syndrome (RCVS) is a clinicoradiological syndrome characterized by segmental vasoconstriction of cerebral arteries with resolution in most patients within 1 to 3 months. It has been known to be a benign uniphasic reversible illness but cases of fulminant RCVS with mortality have also been reported. The symptoms can be varied with presentations like transient ischemic attack (TIA), ischemic stroke (IS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and posterior reversible encephalopathy syndrome (PRES). We report a postpartum female with RCVS with radiological features of ICH, SAH, atypical PRES, and atypical clinical presentation as well. RCVS can be frequently missed unless there is a high index of suspicion. Hence clinicians should be aware of the typical and the atypical presentation of RCVS along with the radiological findings with the potential complications. Early suspicion and detection in the emergency help in recovery and reducing morbidity.

Purpose: This study aimed to share our experience in the hospital cornea retrieval program as a new eye bank. Methods: This was a retrospective study conducted in a tertiary care institute from August 26, 2019 to March 22, 2020. The medical and eye bank records were analyzed for hospital mortality, mortuary records, and donors approached. The corneal collection was divided between Voluntary (received from voluntary calls), HCRP (cornea received from hospital deaths), and Medico-Legal Cases (received from MLC deaths in hospital) to see the trend of donation and utilization over time. Results: During the study period, 154 corneas (77 pairs) were collected. The HCRP provided a major source of corneas 58.4% (90 corneas) as compared to voluntary 19.5% (30 corneas) and MLC 22.1%(34 corneas). There were younger tissues in MLC than HCRP donors, and older tissues in Voluntary donors, and the difference was statistically significant. There was no significant difference in the quality of optical grade tissues and the utilization of corneas for transplants between the three groups. Post hoc analysis showed more non-optical tissues in the voluntary donations (P = 0.004), maximum donors with medical contraindications in the HCRP group (P = 0.001), and time-lapse in corneal retrieval in MLC cases (P = 0.0001). Of these 154 corneas, 78 (50.6%) were assessed as suitable for transplantation, of which 59 (75.6%) tissues were optical grade tissues. The overall utilization was 39.6%. Conclusion: HCRP is indeed challenging for a new eye bank, but proper understanding and implementing strategies may help for good utilization of tissues.

Background and Aims: This study aims to evaluate the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) in paediatric lower abdominal surgeries. Methods: Randomised, prospective trial. Forty patients, aged 2–10 years with the American Society of Anesthesiologists Score of I and II scheduled for elective lower abdominal surgery were included in the study. Interventions: Patients were randomised into two groups as control group and ESPB group. Ultrasound-guided erector spinae plane block at L1 vertebral level was performed preoperatively using 0.5 ml/kg 0.25% bupivacaine (max 20 ml) for the patients in ESPB group. Analgesic requirements and time to first analgesic requirement were recorded and Face, Legs, Activity, Cry and Consolability (FLACC) scores for pain were recorded at 0, 1, 2, 3, 6, 12 and 24 h postoperatively. Results: Forty patients were included in the final analyses. Significant difference was determined between the groups on post-operative morphine requirement and FLACC scores at 3 h and 6 h postoperatively (P < 0.05). Significant difference was also determined in time to first dose of rescue analgesia between the groups (P < 0.05). Conclusions: This study shows that the ESPB provides adequate post-operative analgesia in paediatric patients undergoing lower abdominal surgery.

Abstract Background Urinary tract infection (UTI) is one of the frequently diagnosed infectious diseases which is caused mainly by Escherichia coli. E. coli confers resistance against the two major classes of antibiotics due to the production of extended spectrum β-lactamase enzymes (ESBL), biofilm, etc. Biofilm produced by uropathogenic E. coli (UPEC) protects from host immune system and prevent entry of antimicrobial compounds. The main objective of this cross-sectional study was to determine the correlation of biofilm production and antibiotic resistance as well as to characterize the pgaA and pgaC genes responsible for biofilm formation among uropathogenic ESBL producing E. coli. Methods A total of 1977 mid-stream urine samples were examined and cultured for bacterial strain identification. ESBL was detected by combined disc method following CLSI whereas biofilm formation was analyzed by semi-quantitative method. Furthermore, the pgaA and pgaC genes responsible for biofilm formation in UPEC were detected by multiplex PCR. All the statistical analyses were done via IBM SPSS Statistics 21 where Pearson’s correlation test were used to determine correlation (−1 ≥ r ≤ 1). Results E. coli was the predominant causative agent, which accounted 159 (59.3%) of the Gram-negative bacteria, where 81 (50.9%) E. coli strains were found to be ESBL producers. In addition, 86 (54.1%) E. coli strains were found to be biofilm producers. Both the pgaA and pgaC genes were detected in 45 (93.7%) the UPEC isolates, which were both biofilm and ESBL producers. Moreover, there was a positive correlation between biofilm and ESBL production. Conclusion The analyses presented weak positive correlation between biofilm and ESBL production in which biofilm producing UPEC harbors both pgaA and pgaC genes responsible for biofilm formation.

Glioblastoma multiforme (GBM) is an aggressive brain tumor with high mortality rates. Due to its invasiveness, heterogeneity, and incomplete resection, the treatment is very challenging. Targeted therapies such as tyrosine kinase inhibitors (TKIs) have great potential for GBM treatment, however, their efficacy is primarily limited by poor brain distribution due to the presence of the blood–brain barrier (BBB). This review focuses on the potential of TKIs in GBM therapy and provides an insight into the reasons behind unsuccessful clinical trials of TKIs in GBM despite the success in treating other cancer types. The main section is dedicated to the use of promising drug delivery strategies for targeted delivery to brain tumors. Use of brain targeted delivery strategies can help enhance the efficacy of TKIs in GBM. Among various drug delivery approaches used to bypass or cross BBB, utilizing nanocarriers is a promising strategy to augment the pharmacokinetic properties of TKIs and overcome their limitations. This is because of their advantages such as the ability to cross BBB, chemical stabilization of drug in circulation, passive or active targeting of tumor, modulation of drug release from the carrier, and the possibility to be delivered via non-invasive intranasal route.

Cortical laminar necrosis (CLN) is a radiological and neuropathological finding which requires thorough evaluation for hypoxic, metabolic, infective, and toxic causes. Hypoxic, metabolic, and toxic etiologies for CLN have been frequently reported in past, but infective causes have never been systematically enumerated and limited literature is available for the same. We describe a case of tubercular meningitis (TBM) presenting clinically with focal visual seizures and radiologically as CLN. It was also challenging to rule out other etiologies for CLN before attributing it to TBM. To emphasize, CLN as a radiological finding needs an approach and detailed evaluation for etiological diagnosis.

Plants are constantly confronted by a multitude of biotic stresses involving a myriad of pathogens. In crops, pathogen infections result in significant agronomical losses worldwide posing a threat to food security. In order to enter plant tissues and establish a successful infection, phytopathogens have to surpass several physical, and chemical defense barriers. In recent years, post-translational modification (PTM) mechanisms have emerged as key players in plant defense against pathogens. PTMs allow a highly dynamic and rapid response in front of external challenges, increasing the complexity and precision of cellular responses. In this review, we focus on the role of SUMO conjugation (SUMOylation) in plant immunity against fungi, bacteria, and viruses. In plants, SUMO regulates multiple biological processes, ranging from development to responses arising from environmental challenges. During pathogen attack, SUMO not only modulates the activity of plant defense components, but also serves as a target of pathogen effectors, highlighting its broad role in plant immunity. Here, we summarize known pathogenic strategies targeting plant SUMOylation and, the plant SUMO conjugates involved in host-pathogen interactions. We also provide a catalog of candidate SUMO conjugates according to their role in defense responses. Finally, we discuss the complex role of SUMO in plant defense, focusing on key biological and experimental aspects that contribute to some controversial conclusions, and the opportunities for improving agricultural productivity by engineering SUMOylation in crop species.

Sarothrocera lowii White, 1846 is the only species belonging to the genus Sarothrocera (Coleoptera: Cerambycidae: Lamiinae). Both the sexes of S. lowii were collected from Medziphema, Nagaland, northeastern India, during surveys in 2016. Earlier, Ghate et al. (2012) and Kumawat et al. (2015) reported this species from Manipur and Arunachal Pradesh, respectively, based on female specimens. This paper describes detailed characters of male S. lowii with comments on the female, along with the genitalia descriptions of both sexes for the first time. The species is a new report from Nagaland, India, adding to the known distribution.

Various strategies have been applied to reduce the initial burst of drug release and sustain release from poloxamer-based thermoresponsive gels. This work focussed on investigating different formulation approaches to minimise the initial burst of release and sustain the release of the small hydrophilic drug bupivacaine hydrochloride from poloxamer-based thermoresponsive gels. Various in situ gel formulations were prepared by varying the polypropylene oxide (PPO)/polyethylene oxide (PEO) ratio and by adding additives previously described in the literature. It was observed that increasing the PPO/PEO ratio from 0.28 to 0.30 reduced the initial burst release from 17.3% ± 1.8 to 9.1% ± 1.2 during the first six hours and extended the release profile from 10 to 14 days. Notably, the inclusion of sodium chloride (NaCl 0.4% w/w) further reduced the initial burst release to 1.8% ± 1.1 over the first 6 h. Meanwhile, physical blending with additive polymers had a negligible effect on the burst release and overall release profile. The findings suggest that extended release of bupivacaine hydrochloride, with reduced initial burst release, can be achieved simply by increasing the PPO/PEO ratio and the inclusion of NaCl.

Introduction: Onychomycosis is a fungal disease of the nail apparatus caused by dermatophytes, non-dermatophytes and yeasts. Although onychomycosis is rarely life threatening, its high incidence and the associated morbidity makes it an important public health problem. This study was aimed to find the prevalence of onychomycosis among clinically suspected patients attending the outpatient department of Dermatology and Venereology. Methods: A descriptive cross-sectional study was done in a total of 200 clinically suspected cases of onychomycosis attending the Dermatology outpatient department of a tertiary care hospital within the period of one year from 1st September 2019 to 31st August 2020. Ethical approval (Reference: 150320196) was taken and convenience sampling was done. Data were analyzed using Statistical Package for Social Sciences version 19. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 200 clinically suspected cases prevalence of onychomycosis was found to be 40 (20%) (Confidence Interval = 19.94-20.06) by both direct microscopy and culture. Onychomycosis was commonest among age group of 21-40 years and more predominant among male patients 60 (65.21%). The fingernails were frequently involved i.e., 58 (63%) cases followed by toenails 34 (21%). Dermatophytes were the most common type of fungal infection accounting for 25 (62.5%). Conclusions: The study highlighted dermatophytes as the most common clinical pattern of onychomycosis and Trichophyton rubrum as the most common aetiological agent causing onychomycosis.

Introduction: Methicillin-Resistant Staphylococcus aureus exhibit multiple drug resistance phenotypes. Colonizers harboring Methicillin-Resistant Staphylococcus aureus are often associated with its outbreaks in both hospital and community settings. This study was done to determine the prevalence of nasal carriage rate of Methicillin-Resistant Staphylococcus aureus among basic science MBBS and BDS students of Kathmandu Medical College. Methods: A descriptive cross-sectional study was done in Kathmandu Medical College from March 5 to June 5 2020. Ethical clearance was obtained from the Institutional Review Committee with reference no. 040320201. A convenient sampling method was used, and the sample size was calculated with a prevalence of 50%. Two hundred students studying MBBS and BDS were enrolled. The nasal swab was collected and processed using standard microbiological methods. The data obtained were computed and analyzed using Statistical Package for Social Sciences 16.0 Version. Results: Among 200 participants, 9 (4.5%) were found to be nasal carriers of Methicillin-Resistant Staphylococcus aureus. Conclusions: Colonization of anterior nares by Methicillin-Resistant Staphylococcus aureus in apparently healthy individuals is a cause of concern. Education regarding Methicillin-Resistant Staphylococcus aureus, its carrier and significance, and its screening must be included early on in MBBS and BDS.

Introduction: Intestinal parasitic infestation is one of the major health problems in developing countries like Nepal. This study was done to determine the prevalence rate of intestinal parasitic infestation among school children in Duwakot VDC, Bhaktapur, Nepal. Methods: A descriptive cross-sectional study was done in 194 public school children of Duwakot village development committee from August to October, 2019. Ethical clearance was obtained from the Institutional Review Committee (reference no. 1207201915). Simple random sampling was done. One hundred and ninety-four public school children individuals of 6 to 14 years of age were enrolled. Collected stools were examined for the presence of parasites macroscopically and microscopically. Microscopic examination was carried out by direct wet mount using normal saline (0.9%) and Lugol’s iodine (0.5%) mount. The data obtained were computed and analyzed using Statistical Package for the Social Sciences version 16.0. Results: A total of 194 stool samples were collected from school children and examined. The prevalence of intestinal parasitosis was 26 (13.40%). The commonest organism was Giardia lamblia in 22 (11.34%) cases. Among helminthic infection, 2 (1.03%) cases each were infected by Hymenolepis nana and Hookworm respectively. Conclusions: The prevalence rate of intestinal parasite infestation in Nepal shows considerable decline in recent years. However, more effort is required by public health resources to minimize the problem further.

Nicotine replacement therapy (NRT) is widely used to limit the withdrawal symptoms associated with cigarette smoking cessation. However, the available NRT formulations are limited by their short release profiles, requiring frequent administrations along with local side effects. Thus, the objective of this study is to develop an NRT formulation that offers prolonged, sustained nicotine release. Thermoresponsive in situ gelling systems containing nicotine were prepared using poloxamer 407 (P407) and poloxamer 188 (P188). The system was optimized using a three-factor, two-level full factorial design (23). A formulation composed of P407 (20% w/w), P188 (5% w/w), and loaded with nicotine (0.5% w/w) exhibited sol-to-gel transition at a suitable temperature close to physiological temperature (30 °C). The rheological analysis demonstrated a Newtonian-like flow at room temperature, suggesting ease of administration via injection, and semisolid gel status at physiological temperature. The optimized formulation successfully sustained nicotine in vitro release over 5 days following single administration. The findings suggest that poloxamer based in situ gelling systems are promising platforms to sustain the release of nicotine.

Intervention by human expert has turned out to be essential for computerized analysis systems desiring to be approved by medical regulatory bodies. Further, to validate the performance of automated diagnosis systems, interobserver variability analysis is critically important. The purpose of this article is twofold: (i) firstly to perform interobserver variability analysis of two experienced Radiologists interpreting lesion boundary in brain magnetic resonance images; (ii) secondly, to evaluate the performance of recently proposed automated lesion segmentation model with that of the two experienced Radiologists who performed manual delineations of lesion boundary. Experiments were conducted on the database consisting of 80 real-time brain images with glioma tumor acquired using magnetic resonance imaging (MRI). Extensive statistical analysis such as the two tailed T-test, analysis of variance (ANOVA) test, Mann-Whitney U test, regression and correlation tests, etc. are performed to compare the lesions detected manually by experts and that by the automated method. Furthermore, three quantitative measures namely, dice similarity index, Jaccard coefficient, and Hausdorff distance are used to evaluate the automated lesion detection method. The experimental results show that the lesion boundaries detected by the automated method are very close to the manual delineations provided by the expert Radiologists. It is concluded that the automated systems for brain lesion detection can be utilized as a part of routine clinical practice to help the medical professionals in determining the exact location and area of lesions in brain MRI images.

Introduction: Staphylococcus aureus is one of the commonest cause of nosocomial infections. Resistant Staphylococcus aureus strain has become a matter of concern. This study was done to find out the prevalence of Staphylococcus aureus from different clinical samples. Methods: The descriptive cross-sectional study was carried out in the Clinical Microbiology laboratory from January 2019 to June 2019. Ethical approval was received from the Institutional Review Committee (Ref: 28122018010). Six hundred sixty-six sample size was calculated. Convenient sampling was done. Staphylococcus aureus was identified on the basis of its microscopy and morphological characteristics followed by catalase and coagulase test. Antibiotic sensitivity test of misolated pathogens was done using Muller Hinton Agar by Kirby-Bauer method. Statistical analysis was done by Excel 2018, point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Out of the 666 bacteria isolated from clinical specimens, 133 (19.96%) were Staphylococcus aureus at 95% confidence interval (129.91-136.01%). Seventy nine (78.95%) of which is isolated from pus and wound infections. Out of 133 Staphylococcus aureus, 70.64% were Methicillin-Resistant Staphylococcus aureus. Conclusions: This study provides valuable information regarding the high prevalence of Staphylococcus aureus from pus and wound infections. The alarming number of Methicillin-Resistant Staphylococcus aureus is worrisome finding. Antibiotics like Vancomycin and Linezolid which has not developed resistance should be cautiously used only in Methicillin-Resistant Staphylococcus aureus cases.

Introduction: Acinetobacter species are short, stout, gram-negative coccobacilli, generally considered to be a relatively low-grade pathogen. However, its resistance towards multiple classes of antibiotics through an array of resistance mechanisms including its ability to form biofilm has led to its emergence as an important pathogen in hospital settings. This study was done to determine the prevalence of biofilm former and Extended-spectrum Beta-Lactamase producer among Acinetobacter species. Methods: A descriptive cross-sectional study was done in the clinical microbiology laboratory, Kathmandu Medical College from January to June 2019. Convenient sampling method was used. Ethical approval was taken from the Institutional Review Committee, Ref no. 2812201805. Preliminary identification followed by characterization of Acinetobacter species was done. Antibiotic susceptibility test was done using the Kirby-Bauer method following Clinical and Laboratory Standards Institute guidelines. Extended-spectrum Beta-Lactamase was detected by combined disc method and Biofilm detection was done using congo red agar method. Statistical Package for Social Sciences 16.0 version statistical software package was used for statistical analysis. Point estimate at 95% Confidence Interval was calculated along with frequencyand proportion for binarydata. Results: Among 108 Acinetobacter species, 86 (79.7%) Acinetobacter calcoaceticus-A. baumannii complex was seen. Seventy-eight (72%) of the isolates were multidrug-resistant, 34 (31%) of the isolates were Extended-spectrum Beta-Lactamase producer and only 10 (9.3%) of the isolates, were biofilm producers. Conclusions: Multidrug-resistant Acinetobacter spp. with the ability to produce Extended-spectrum Beta-Lactamase is prevalent in our hospital settings. Strict compliance with infection control practices is necessary to curb its spread.

We report a 40-year-old diabetic female with acute headache and case of skull base defect causing pneumocephalus. The highlights of the present case are acute clinical presentation, extensive radiological findings, and rare skull base defect in frontoethmoidal recess.

Introduction: Breast cancer is the commonest cause of death among middle aged women. BRCA1 associated tumors carry a poor prognosis. Angiogenesis is considered necessary for tumor growth and for its metastasis. Hypoxia stimulates HIF-1α which then activates transcription of various proangiogenic cytokines like VEGF. In the present study we examined HIF-1α expression, sVEGF levels and BRCA1 mutations and their relation with clinicopathological parameters. We also determined whether the angiogenic markers have different role in angiogenesis in BRCA1 related cancers as compared to sporadic breast cancers. Materials and Methods: The study was conducted on 50 cases of breast cancer specimens. Histopathological typing and grading was done followed by immunohistochemistry for BRCA1 and HIF-1α. VEGF was done in the serum by ELISA. Results: All the tumors were infiltrating ductal carcinoma NOS. 16 cases were reported grade II and 34 cases as grade III. On immunohistochemistry, 27 cases showed BRCA1 positivity and HIF-1α was positive in 39 cases. sVEGF levels were increased in 21 cases (42%). BRCA1 positivity, HIF-1α expression and increased VEGF levels were significantly associated with higher grade and lymph node metastasis. There was significant correlation of BRCA1 positivity with increased HIF-1α expression (P = 0.009) and increased sVEGF levels (P = 0.005). Conclusion: Our findings suggest that BRCA 1 positive tumors have unique molecular profile and different mechanism of tumorigenesis. Such tumors are associated with increased HIF-1α expression and VEGF levels.

Persons with intellectual disability (ID) are at higher risk of developing metabolic syndrome and have lower level of physical fitness as compared to normal population. The study was carried out to examine the impact of yoga and physical exercises on overweight children with ID. The results demonstrated significant reduction in waist circumference and blood pressure, significant increase in the value of high-density lipoprotein and reduction in the value of LDL in both the groups.

Iliac crest bone grafting is very common associated procedure in various bone fixation surgery. We report here successful use of Transversalis fascia plane (TFP) block for iliac crest bone harvesting in a Polytrauma patient with difficult airway.

The main objective of this study was to determine the prevalence of non-albicans Candida among the patients attending a tertiary care hospital in Kathmandu, Nepal. Candida spp. isolated from different clinical samples (sputum, urine, vaginal swab, blood, endotracheal (ET) secretion, pus) from 250 patients between the period of February 2013 and December 2015 were included in the study. Of those 250 patients, 20% were immunocompromised. Sabouraud dextrose agar was used for the isolation of Candida spp. and the identification was performed on the basis of colony morphology, Gram’s stain, India ink preparation, germ tube test, temperature tolerance test, characteristic color change in CHROMagar, chlamydospore production, sugar fermentation test and sugar assimilation test. Out of total 300 Candida spp., majority were isolated from sputum (43.33%) followed by urine (40%) and vaginal swab (6.67%). Of total 151 (50.33%) non-albicans Candida, the most common species isolated were C. tropicalis (62.25%) followed by C. glabrata (23.84%). High prevalence of non-albicans Candida among the patients attending a hospital in Kathmandu, Nepal was noted.

Introduction: Polycystic Ovarian Syndrome (PCOS) is the most common metabolic syndrome in women of reproductive age group with incidence of approximate 3.7% in Northern India. It is characterised by chronic anovulation, polycystic morphology of the ovaries and hyperandrogenism and predisposes women to Gestational Diabetes Mellitus (GDM), Type 2 Diabetes Mellitus, dyslipidemia, hypertension and coronary vascular disease later in life. Aim: To study correlation of Anti-mullerian Hormone (AMH) with fasting plasma glucose, serum fasting insulin, triglyceride and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) in PCOS and normally ovulating women. Materials and Methods: This was a hospital based observational study conducted in the Department of Gynaecology for a period of 1 year from 2017 to 2018. The study included 40 PCOS and 40 normally ovulating women of similar age. After taking consent, history and examination, ultrasonological evaluation of ovaries was done in order to identify PCOS and normally ovulating women. A fasting sample was tested for serum fasting insulin, fasting plasma glucose, triglyceride and HOMA-IR were calculated. A blood sample was tested for serum AMH, androgens (DHEAS, Testosterone), Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) levels on day 2 of menstrual cycle for all the women. Statistical analysis was done by using IBM SPSS version 25.0. Results: BMI, Serum AMH, fasting insulin, fasting plasma glucose, HOMA-IR, triglyceride, androgens (Testosterone and DHEAS) were high in PCOS women as compared to normally ovulating women (p-value

Chondrosarcoma is a mesenchymal tumor composed of tumor cells producing cartilage. It is more common in older age and often affects the axial skeleton. We report a rare case of chondrosarcoma mimicking a sellar and suprasellar mass with parasellar extension. A 40 yr woman presented with decreasing visual acuity and headache. Magnetic resonance (MR) image revealed a cystic sellar and suprasellar mass with parasellar extension showing mild enhancing solid component. It favored the diagnosis of craniopharyngioma. The patient underwent trans-sphenoidal partial resection of the tumor resulting in removal of the sellar mass. However, the suprasellar mass could not be excised completely due to limited surgical field. The pathologic diagnosis was chondrosarcoma. Eight months after the operation, pterional approach was performed to remove the remaining mass. Intraoperative findings confirmed that the mass originated from dorsum sellae.

In today’s lifestyle it is unthinkable to have a day without coming into contact with electronic devices such as cell phones, laptops, tablets, Televisions and now LEDs. In the whole world people are relying heavily on these technological tools for entertainment and for communication with friends, family, and at school and work. All these devices emit Electro-Magnetic Radiations (EMR) which are harmful for human beings as they cause many harmful effects including Cancer. Data gathered from 13 participating countries was pooled and analyzed by the International Agency for Research on Cancer (IARC), to determine whether there were any links between use of mobile phones and head and neck cancers in adults. Based largely on these data, IARC has now classified electromagnetic radiofrequency fields as possibly carcinogenic to humans (Group 2B), a category in which harmful pesticide like DDT has been kept. Thus, we need a solution which can be imbibed in our day to day lives to reduce EMR level at our residences and workplace. Yagya is a non-conventional solution suggested in Indian scriptures to save from harmful cosmic waves. Hence, in the present study, Yagya was conducted as an intervention to find its impact on the indoor EMR flux. Five case studies were performed in NCR Delhi. It was observed that after the performance of Yagya there was a significant decrease in the indoor EMR level indicating a utility of Yagya as non-conventional solution for reducing indoor EMR level.

Introduction: Gestational Diabetes Mellitus (GDM) is an important public health concern due to its association with adverse foetomaternal outcome. Steadily increasing prevalence necessitates screening and early treatment of women at risk of developing the disease in order to reduce threats to maternal and foetal health. Aim: To find out Fasting Plasma Glucose (FPG) in the pregnant women at first antenatal visit and to correlate it with Oral Glucose Tolerance Test (OGTT) with 75 gm glucose at 24-28 weeks of gestation. Materials and Methods: It was a hospital based prospective study conducted on 246 antenatal patients (

Chromobacterium violaceum is ubiquitous in the environment of tropical and subtropical regions but the infections caused by this organism are rare and the urinary tract infections caused by it are even rarer. Due to the propensity for hematogenous spread leading to fatal sepsis, the infections caused by Chromobacterium violaceum have high mortality rate (65–80%) with death occurring in as less as one week of acquiring infection. So, prompt proper treatment is necessary for successful treatment of the infections but, due to the rarity of the infections caused by the organism, there is limited awareness among the clinicians regarding the infections caused by this organism. Here, we reported a case of urinary tract infection caused by Chromobacterium violaceum in a 84-year-old male, who was a kidney patient, and another case of bacteremia caused by the same bacterium in a road traffic accident patient (22-year-old male), both of which were managed with the timely suitable treatment.

Introduction: The distribution of the major subtypes of non-Hodgkin’s lymphoma (NHL) differs across geographic regions. This study, from the north Indian state of Punjab, has incorporated immunophenotypic findings while investigating the distribution of NHL subtypes based on World Health Organization (WHO)/ Revised European-American Classification of Lymphoid Neoplasms (REAL) system of classification. Patients and methods: Over all seventy seven cases of lymphoma over a period of one year (between April 2012 and April 2013) were diagnosed in the Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar (Punjab). Of these 30 cases (39%) were of Hodgkin’s Lymphoma (HL) and 47 cases (61%) were of Non Hodgkins lymphoma NHL. Of the total of cases of lympho-proliferative disorders, the diagnosis of NHL was done by light microscopy alone. All the cases diagnosed provisionally as NHL were taken up for immunophenotyping with Immunohistochemical (IHC) studies. There was 100 % concordance between the light microscopy and IHC studies. The individual NHL cases were classified according to the WHO/ REAL classification according to the positive or relevant negative immonophenotypic expression and tabulated to ascertain the morphological spectrum of NHL in this part of the country. Results: B-cell lymphomas formed 89.3%, whereas T-cell lymphomas formed 10.7% of the NHLs. Diffuse Large B-Cell Lymphoma (DLBCL) was the most common subtype (46.8% of all NHLs). B-cell small lymphocytic lymphoma, Mantle-Cell Lymphoma (MCL), marginal zone B-cell lymphomas (including MALT lymphomas), Diffuse, mixed small cleaved cell and largecell type and Follicular centre-cell lymphomas amounted to 17%, 12.8%, 2.1%, 2.1% and 4.3%, respectively. Among the T-cell lymphomas, T-cell lymphoblastic lymphoma, anaplastic largecell lymphomas of T/null-cell type, and Angioimmunoblastic T-cell lymphoma (AITL) accounted for 6.4%, 2.1%, and 2.1% of all NHL cases, respectively. Conclusions: The distribution of NHL subtypes in India shows disparity with those from the rest of the world. Follicular Lymphoma (FL) and MCL are less common in India compared to Europe and the USA. Peripheral T-cell lymphomas and T/NK-cell lymphomas of nasal and nasal types, which are common in many other Asian countries, are also less prevalent. T-cell lymphoblastic lymphoma and anaplastic large T/null cell lymphoma are more prevalent in India.

Introduction: Throughout the world each year, an estimated 23% of the 4 million neonatal deaths and 8% of all deaths in

The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare disorder characterised by failure of the uterus and vagina to develop properly in women who have normal ovarian function and normal external genitalia and secondary sexual characters. Mullerian agenesis accounts for approximately 10% cases of primary amenorrhoea. We report a case of 40-year-old female with MRKH syndrome with primary amenorrhea who presented with lower abdominal pain. She had well developed secondary sexual characters. Her ultrasound showed bulky and heterogeneous uterus like mass with ill defined endometrial-myometrial interface with multiple uterine fibroids. Primary amenorrhea with normal secondary sexual characters and phenotype of 44XX lead us to the diagnosis of MRKH syndrome with uterine myoma in mullerian remnant. Surgical intervention showed the presence of transverse vaginal septum with haematocolpos while the histopathology of the remnant showed adenomyosis. Because of rarity of the condition we report this case.

Introduction: Oligohydramnios presents a threat to the fetus due to increased risk of the umbilical cord getting compressed and resulting in impaired blood flow to the fetus. Aim: The objective of the study was to find out the significance of oligohydramnios during third trimester of pregnancy. Materials and Methods: A hospital based prospective study was conducted in the Department of Obstetrics and Gynaecology at Hindu Rao Hospital, Delhi. Amniotic fluid index (AFI) estimation was done on 150 pregnant women in third trimester, who were selected after screening for inclusion and exclusion criteria. Women with AFI < 5 cm were taken as cases while women with AFI > 5 cm as controls. Results: The mean maternal age was 23.58±3.43 years and maximum women were primigravida. Mean AFI among the cases was 2.97±1.95 cm. Antenatal complications like pre eclampsia, IUGR, PROM were associated with 71% of the cases. Labour was induced in 65% of the cases compared to 21% among controls. LSCS was performed in 44% of cases compared to 10% in controls with fetal distress the most common indication (85%). 73% babies born to the cases had birth weight < 2.5 kg, 55% had APGAR score < 7 and 44% had NICU admission compared to 16%, 13% and 13% respectively among controls. There were 5 intrauterine deaths and 2 stillbirths among the cases and none among the controls. Conclusion: Identification of oligohydramnios can be done by a good clinical examination and confirmed by measuring AFI on ultrasonography. Poor fetal outcome in the form of preterm, IUD, LBW, low APGAR score at 5 minute and increased chances of still birth, NICU admission and neonatal death are seen with oligohydramnios in third trimester and more so if it is detected in early third trimester. Chances of induction of labour and risk of LSCS also increase. Thus, detection of oligohydramnios helps in proper management of the cases so that maternal and perinatal outcome can be improved.

Among the different types of methionine-derived aliphatic glucosinolates (GS), sinigrin (2-propenyl), the final product in 3C GS biosynthetic pathway is considered very important as it has many pharmacological and therapeutic properties. In Brassica species, the candidate gene regulating synthesis of 3C GS remains ambiguous. Earlier reports of GSL-PRO, an ortholog of Arabidopsis thaliana gene At1g18500 as a probable candidate gene responsible for 3C GS biosynthesis in B. napus and B. oleracea could not be validated in B. juncea through genetic analysis. In this communication, we report the isolation and characterization of the gene CYP79F1, an ortholog of A. thaliana gene At1g16410 that is involved in the first step of core GS biosynthesis. The gene CYP79F1 in B. juncea showed presence-absence polymorphism between lines Varuna that synthesizes sinigrin and Heera virtually free from sinigrin. Using this presence-absence polymorphism, CYP79F1 was mapped to the previously mapped 3C GS QTL region (J16Gsl4) in the LG B4 of B. juncea. In Heera, the gene was observed to be truncated due to an insertion of a ~4.7 kb TE like element leading to the loss of function of the gene. Functional validation of the gene was carried out through both genetic and transgenic approaches. An F2 population segregating only for the gene CYP79F1 and the sinigrin phenotype showed perfect co-segregation. Finally, genetic transformation of a B. juncea line (QTL-NIL J16Gsl4) having high seed GS but lacking sinigrin with the wild type CYP79F1 showed the synthesis of sinigrin validating the role of CYP79F1 in regulating the synthesis of 3C GS in B. juncea.