Search

Abstract The present study was aimed at showing the importance of HPV DNA status and the clinical history of the patients required by the cytologist for accurate reporting. A total of 1250 symptomatic women who attended the gynaecology outpatient department of the Mahavir Cancer Sansthan and Nalanda Medical College, Patna, for pap smear examinations were screened and recruited for the study. Due to highly clinical symptoms out of the negative with inflammatory smears reported, one hundred and ten patients were randomly advised for biopsy and HPV 16/18 DNA analysis by a gynaecologist to correlate negative smears included in the study. Pap smear reports revealed that 1178 (94.24%) were negative for intraepithelial lesions (NILM) with inflammatory smears, 23 (1.84%) smears showed low-grade squamous intraepithelial lesions (LSIL), 12 (0.96%) smears showed high-grade squamous intraepithelial lesions, and 37 (2.96%) smears showed an atypical squamous cell of undetermined significance (ASC-US). A biopsy of 110 out of 1178 (NILM) patients revealed that 15 (13.63%) women had cervical cancer, 29 women had CIN I, 17 women had CIN II + CIN III, 35 women had benign cervical changes, and 14 women had haemorrhages. On the other hand, HPV 16/18 DNA was detected as positive in 87 out of 110. The high positivity of HPV in biopsied cases where frank cervical cancer and at-risk cancer were also observed in the negative smear-screened patients reveals that the HPV status and clinical history of the patients will be quite helpful to the cytologist for accurate reporting, and suggests that a negative HPV DNA result may be a stronger predictor of cervical cancer risk than a negative Pap test.

Background: The coronavirus disease 2019 (COVID-19) pandemic outbreak created a challenge to manage the health, especially the mental health of various care providers involved in treating the patients infected with the virus. Previously published literature has shown a significant effect of the pandemic on the psychological health of healthcare workers (HCWs) globally; so, this study aimed to describe the psychological health outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among Indian HCWs. Methods: An extensive literature search was conducted in databases including PubMed and Google Scholar. The search was restricted from the COVID-19 outbreak until June 2022. Cross-sectional studies and other studies (telephonic interviews and survey-based studies) reported the prevalence of anxiety and depression among frontline HCWs since the onset of the COVID-19 pandemic. All the studies were critically evaluated by two individual authors in terms of screening and methodological quality evaluation. A total of 16 studies were included in the final meta-analysis. Results: The prevalence of depression among n = 12231 participants of 14 studies was 0.37 CI 95% [0.28–0.48]; the prevalence of anxiety among n = 9467 participants of 12 studies was 0.39 CI 95% [0.29–0.49]. The results of the overall meta-analysis indicate that 37% and 39% of HCWs in this study experienced mild-to-severe depression and anxiety, respectively. During the COVID-19 pandemic, a significant number of HCWs developed mental health issues, with a reported prevalence of depression (37%) and anxiety (39%). Conclusion: Frontline HCWs’ mental health should get full consideration during public health emergencies, screening should be actively conducted, and specific steps should be taken to lower the fear associated with the risk of infections.

Key Clinical Message Shiitake mushroom‐induced flagellate dermatitis is a rare but important condition to consider in patients presenting with pruritic skin lesions following mushroom ingestion, especially in regions where such cases are uncommon. Early recognition and appropriate management with oral and topical steroids are crucial for effective symptom resolution and preventing complications. Clinicians should be aware of the characteristic rash and the temporal relationship between mushroom consumption and rash onset. Educating patients about the risks associated with consuming raw or undercooked shiitake mushrooms is essential to prevent recurrence.

Background: Diabetic nephropathy represents a significant microvascular complication of diabetes, characterized by extracellular matrix accumulation, loss of cell-cell junctions, microalbuminuria, and diminished creatinine clearance. Despite its prevalence, therapeutic options dedicated to this condition are currently lacking. Natural products like bioflavonoids have garnered attention for their potential therapeutic benefits. The present study aimed to evaluate the efficacy of a bioflavonoid combination, including ginger extract, soy extract, and hesperetin, in a diabetic rat model. Methods: Diabetes was initiated in the rat pups via intraperitoneal injection of streptozotocin on the fifth postnatal day. After six weeks, rats exhibiting blood sugar levels exceeding 160 mg/dL were allocated into diabetic control and treatment groups, with eight animals each. A subset of rats received citrate buffer as a control. The treatment group received the bioflavonoid combination orally for twenty-four weeks. Various parameters, including glycemic levels, urinary parameters, antioxidant status, mRNA expression via Western blot, gel zymography, and immunohistochemistry, were assessed at the study's conclusion. Results: The bioflavonoid combination demonstrated significant reductions in hyperglycemia and various urinary parameters compared to controls. Notably, it modulated MMP-9/TIMP-1 expression, upregulated GLUT-4, and downregulated TGF-β. Additionally, the combination enhanced total antioxidant capacity, indicating potential antioxidative benefits. Conclusions: This study highlights the therapeutic potential of a bioflavonoid combination (ginger extract, soy extract, and hesperetin) in improving renal function in diabetic nephropathy. By modulating key factors such as MMP-9/TIMP-1, TGF-β, and GLUT-4, this combination presents a promising avenue for further exploration in managing diabetic nephropathy. These findings underscore the importance of natural products as potential therapeutic agents in addressing diabetic complications.

Introduction: The objective of this work is to design a new kind of AHFP phantom to determine if this phantom is a realistic representation of actual cervical cancer patients. This can serve as a stand-in for the dosimetry quality assurance of a real patient. Material and Methods: An anthropomorphic heterogeneous female pelvic phantom was designed which was made of paraffin wax, a female pelvic bone, water, gauze, polyvinyl chloride (PVC) and polymerized siloxanes. The AHFP phantom was scanned using a CT scanner (Toshiba Alexion 16 multi–Slice CT scanner) at 120kVp and 250mAs with a slice thickness of 2mm to assess how accurately the resulting phantom product simulates a real patient. The CT images were transferred to the Eclipse treatment planning system for dosimetry analysis. Results: The AHFP phantom's CT numbers and relative electron densities of the uterus, bladder, rectum, muscles, fat, bones, and cavities were found close to real patients. The mean percentage variations between planned and measured doses of all RapidArc QA plans were of 2.14 % and standard deviation of 0.543 (t=0.135, p= 0.447; p>0.05) for homogeneous phantom¸ and 7.57% & standard deviation 2.358 (t=4.674, p=0.00094; p< .05) for AHFP phantom. Conclusion: It is concluded that the existing algorithms in TPS for dosimetry are working fine for homogeneous phantoms, but it does not work good for heterogeneous (AHFP) phantom. Therefore, patient-specific absolute dosimetry should be performed using a heterogeneous phantom that closely resembles the actual human body in terms of both density and design.

With the progress in two distinct areas of nanotechnology and aptamer identification technologies, the two fields have merged to what is known as aptamer nanotechnology. Aptamers have varying properties in the biomedical field include their small size, non-toxicity, ease of manufacturing, negligible immunogenicity, ability to identify a wide range of targets, and high immobilizing capacity. Nevertheless, aptamers can utilize the distinct characteristics offered by nanomaterials like optical, magnetic, thermal, electronic properties to become more versatile and function as a novel device in diagnostics and therapeutics. This engineered aptamer conjugated nanomaterials, in turn provides a potentially new and unique properties apart from the pre-existing characteristics of aptamer and nanomaterials, where they act to offer wide array of applications in the biomedical field ranging from drug targeting, delivery of drugs, biosensing, bioimaging. This review gives comprehensive insight of the different aptamer conjugated nanomaterials and their utilization in biomedical field. Firstly, it introduces on the aptamer selection methods and roles of nanomaterials offered. Further, different conjugation strategies are explored in addition, the class of aptamer conjugated nanodevices being discussed. Typical biomedical examples and studies specifically, related to drug delivery, biosensing, bioimaging have been presented.

Background: The SDM-Q-9 is a widely used and reliable tool for assessing patient involvement in shared decision-making. However, there is a dearth of validated information regarding this tool among the Indian population. Therefore, the current study aimed to evaluate the validity and reliability of the Hindi version of the SDM-Q-9 questionnaire in Indian oncology patients. Method: ology: This study was conducted between August 2022 to March 2023 at a tertiary cancer care hospital in India. The sample comprised 150 patients. The scale was initially translated into the Hindi language and later back-translated by experts. Item characteristics were measured using the difficulty index, corrected item-total item correlation, and internal consistency. Factor analysis was conducted using both exploratory factor analysis and confirmatory factor analysis to validate the scale in SPSS v.27 and IBM AMOS v.26. Results: The Cronbach alpha value was found to be significantly good (0.841), indicating high internal consistency. Additionally, the Kaiser-Mayer-Olkin value was 0.825, which suggested that the sample adequacy was satisfactory. Bartlett's test (x2 = 461.209 (df = 36), p = 0.000) also showed that the data were suitable for factor analysis. EFA resulted in an uni-factorial model extraction similar to the developed version, with acceptable model fit indices including CFI (0.861), GFI (0.891), AGFI (0.818), RMSEA (0.122), SRMR (0.119), and TLI (0.815). The CFA resulted in better model fit indices. Conclusion: The study suggests that the Hindi version of the SDM-Q-9 questionnaire is a suitable tool for measuring patient-reported involvement in clinical decision-making among Indian oncology patients.

Introduction: Diabetes Mellitus (DM) is traditionally known as silent disease. Diabetes is no more restricted in urban areas only but is also established at rural areas as well. It is one of the leading cause of long term morbidity and a major health hazard in a developing country like India, therefore, it is pertinent to ind its associated risk factors.Objectives:To study the clinical presentation and risk factors associated with type2 diabetes mellitus patients attending SGT hospital. Method: It was a hospital based case control study done in medicine department of Tertiary Care Hospital, Gurugramusing the purposive sampling. There were 800 participants including 400 cases of type 2 diabetes mellitus and 400controls (age and gender matched).Information was collected on sociodemographic variables and risk factors using a pre-tested structured interview schedule.Results: The mean age among cases was 55.20+ 8.54 years and among control group was 53.96+9.29 years. The difference between education status and occupation of study subjects was found to be signiicant. Pain and numbness was the most common symptom which was 70.75%. On assessing risk factors, physical activity, the habit of smoking, family history and Body mass Index (BMI) had a positive association. Conclusion: The indings of the study revealed that a high proportion of risk factors such as family history of diabetes, literacy status, occupation, BMI, smoking and physical activity were prevalent in the type 2DM subjects.

Introduction: Anemia is the most common nutritional deficiency disorder in the world. Its Prevalence is inordinately higher among developing nations, because of unfavorable socio- demographic factors and indigent access to healthcare services. Therefore, it is pertinent to find the prevalence of anemia and its associated factors. Objective: To find out prevalence and socio- demographic factors associated with anaemia among females of age group 10-45 years in a rural population of Gurugram, Haryana. Method: A cross sectional study was conducted in villages under PHC Garhi Harsaru in Gurugram, Haryana among 452 females of age group 10-45 years by two stage random sampling technique. Results: The mean age of the study subjects was 25 ± 6.39 years. The overall prevalence of anemia among women of age group of 10-45 years was found to be 62.39%. Joint family, lower literacy, and low socioeconomic status were found to be statistically significant risk factors for anaemia among study subjects. Conclusion: The prevalence of anemia was very high; therefore attempts should be made to sensitize the rural population through health and nutrition education, information, education and communication (IEC) and appropriate behaviour change communication (BCC) activities.

According to the World Bank, Climate-smart agriculture encompasses the comprehensive management of landscapes, including land under cultivation, livestock, woodland areas, and aquatic resources, addressing the interconnected issues of food security and climate change. United Nations Population Fund or UNFPAs Population dashboard shows India’s population at 1406.6 million with an annual average rate of population increase at 0.9% from 2020-25. To meet this food demand, it is imperative for India to adapt sustainable agricultural practices. The IPCC (Inter-governmental panel on climate change) report has pointed out that climate change has affected food security due to global warming and extremes of temperatures around the World. In light of these facts, India faces the unique challenge of developing a path of enhancing the country’s food supply, ensuring water availability while minimizing agricultural GHGs (Greenhouse emissions) which are estimated to be 14% of its total GHG emissions. In the 2021 Global Climate Risk Index (CRI), India was ranked 7th, with a CRI score of 16.67. This paper aims at understanding the theoretical and conceptual framework of climate smart agriculture and presents an insight into how the objectives of food sufficiency, change in climatic conditions and greenhouse gas emissions are being met in India through policies, institutions and financial models.

Abstract In recent times Gallbladder cancer (GBC) incidences increased many folds in India and are being reported from arsenic hotspots identified in Bihar. The study aims to establish association between arsenic exposure and gallbladder carcinogenesis. In the present study, n = 200 were control volunteers and n = 152 confirmed gallbladder cancer cases. The studied GBC patient’s biological samples-gallbladder tissue, gallbladder stone, bile, blood and hair samples were collected for arsenic estimation. Moreover, n = 512 gallbladder cancer patients blood samples were also evaluated for the presence of arsenic to understand exposure level in the population. A significantly high arsenic concentration (p

Background and Objectives: Alloimmunization can lead to difficulty in arranging compatible, antigen-negative blood units for the patients. Alloimmunization by coexisting “c” and “E” antibodies, though common, is frequently missed. Both “c” and “E” antigens are highly immunogenic and have the potential to cause hemolytic disease of newborn and hemolytic transfusion reactions. The objective of this study is to discuss different clinical scenarios of concomitant and singular presence of anti-c and anti-E along with the diagnostic approach and transfusion management in resource-limited settings. Methods: Column agglutination gel technology in low ionic strength solution phase was used for initial antibody identification. Detailed immunohematological workup was done by the use of select cells (c+, E− and c−, E+) and adsorption elution studies using a commercially available acid elution kit. Results: Out of 16 patients, detailed immunohematological workup was available for 14 patients, whereas two patients were lost to follow-up. Among 14 patients, 12 had CCDee (R1R1) phenotype, whereas two patients had CcDee phenotype (possible R1r) with anti-E antibody. In 12 patients with R1R1 phenotype, 6/12 (50%) had dual coexisting anti-c and E, whereas 3/12 (25%) had only anti-c and 3/12 (25%) had only anti-E. In R1R1 patients having anti-E, coexisting anti-c was found in 6/9 (66.66%) of patients. Conclusion: The study emphasizes the use of both “c” and “E” negative red cells (R1R1) in R1R1 patients having either anti-c or anti-E. Thus, in India, there is a need to develop our own red cell panels having an adequate representation of indigenous antigens and phenotypes.

Respectful maternity care is the universal right of every woman all around the world but recent evidences show that women receive disrespectful care and face abuse during facility-based childbirth. It creates a negative impression of the institutional delivery and indirectly contributes to increases in the maternal morbidity and mortality rate; hence, this narrative review was conducted to identify the various forms of mistreatment, determinants and prevalence of disrespectful maternity care in India. (i) To explore the status of mistreatment of women during childbirth. (ii) To assess the factors responsible for mistreatment experienced by women. Keywords searches of PubMed, Google scholar, manual searches of other relevant journals and references lists of primary articles. Quantitative studies and mixed-method studies on women's experiences of factors responsible for mistreatment during labor were explored, study result revealed that factors affecting respectful maternity care (RMC) include age, religion, income etc., Various types of mistreatments experienced by women during labur were physical abuse (9.3%), nondignified care (14.25%), nonconfidential care (33.95%), neglect/ignore (9.35%), verbal abuse (19.72%), discrimination (7.36%), threats to with hold treatment (8.15%), lack of information (26.2%), delivered alone (9.25%), choice of position denied (10.5%), requested payment of bribe (46.3%), unnecessary separation from baby (4.3%), nonconsented care (49.05%). Mistreatment during labor is common in India and is commonly found in the form of verbal abuse, physical abuse, discrimination, threats to with hold treatment, lack of information, ignored, delivered alone, choice of position denied, companion not allowed, requested payment or bribe, unnecessary separation from body etc., Health care personal plays a major role for providing RMC and in preventing mistreatment during childbirth. They must be aware about the mistreatment during childbirth and its consequences such as increasing maternal mortality rate and decrease no. of institutional delivery.

Glioblastoma multiforme (GBM) is known as the most aggressive and prevalent brain tumor with a high mortality rate. It is reported in people who are as young as 10 years old to as old as over 70 years old, exhibiting inter and intra tumor heterogeneity. There are several genomic and proteomic investigations that have been performed to find the unexplored potential targets of the drug against GBM. Therefore, certain effective targets have been taken to further validate the studies embarking on the robustness in the field of medicinal chemistry followed by testing in clinical trials. Also, The Cancer Genome Atlas (TCGA) project has identified certain overexpressed targets involved in the pathogenesis of GBM in three major pathways, i.e., tumor protein 53 (p53), retinoblastoma (RB), and receptor tyrosine kinase (RTK)/rat sarcoma virus (Ras)/phosphoinositide 3-kinase (PI3K) pathways. This review focuses on the compilation of recent developments in the fight against GBM thus, directing future research into the elucidation of pathogenesis and potential cure for GBM. Also, it highlights the potential biomarkers that have undergone extensive research and have promising prognostic and predictive values. Additionally, this manuscript analyses the advent of gene therapy and immunotherapy, unlocking the way to consider treatment approaches other than, or in addition to, conventional chemo-radiation therapies. This review study encompasses all the relevant research studies associated with the pathophysiology, occurrence, diagnostic tools, and therapeutic intervention for GBM. It highlights the evolution of various therapeutic perspectives against GBM from the most conventional form of radiotherapy to the recent advancement of gene/cell/immune therapy. Further, the review focuses on various targeted therapies for GBM including chemotherapy sensitization, radiotherapy, nanoparticles based, immunotherapy, cell therapy, and gene therapy which would offer a comprehensive account for exploring several facets related to GBM prognostics.

The pathogenesis of COVID-19 is complicated by immune dysfunction. The impact of immune-based therapy in COVID-19 patients has been well documented, with some notable studies on the use of anti-cytokine medicines. However, the complexity of disease phenotypes, patient heterogeneity and the varying quality of evidence from immunotherapy studies provide problems in clinical decision-making. This review seeks to aid therapeutic decision-making by giving an overview of the immunological responses against COVID-19 disease that may contribute to the severity of the disease. We have extensively discussed theranostic methods for COVID-19 detection. With advancements in technology, bioinformatics has taken studies to a higher level. The paper also discusses the application of bioinformatics and machine learning tools for the diagnosis, vaccine design and drug repurposing against SARS-CoV-2.

In modern times, the use of electricity has increased many times and so has the incidence of high-voltage electrical injuries. The incidence of high-voltage electrical injuries is much higher in developing countries when compared to developed countries, lack of proper transmission systems being the cause. Electric burn injuries lead to debilitating morbidity to the affected patients and are often deadly. In such cases with exposed vessels in the neck, major flaps such as the deltopectoral flap or forehead flap or free flaps increase the hospital stay or two-staged procedures and hence increase the morbidity of such patients. Here, we present a case of a young male patient who sustained an electric injury to his foot, neck, and shoulder, which was managed with the platysma flap and parascapular flap with no donor site morbidity.

Oral cancer is the malignant neoplasm involving the oral cavity. The treatment of oral cancer is surgery, radiotherapy, and adjuvant chemotherapy. Oral mucositis is the most common side effect when radiotherapy treatment for oral cancer is indicated. High.grade oral mucositis results in the delay of the radiotherapy treatment and increases the cost of maintenance. The preventive measures for radiation.induced mucositis include maintaining oral hygiene, treatment of xerostomia, diet modifications, and low.level laser therapy. This article provides a guide for the practicing oncologists about the current treatment, advances in treatment, and alternative medicine for improving radiation.induced mucositis.

Background: Accurate dosimetry is crucial in radiotherapy to ensure optimal radiation dose delivery to the tumor while sparing healthy tissues. Traditional dosimetry techniques using homogeneous phantoms may not accurately represent the complex anatomical variations in cervical cancer patients, highlighting the need to compare dosimetry results obtained from different phantom models. Purpose: The aim of this study is to design and evaluate an anthropomorphic heterogeneous female pelvic (AHFP) phantom for radiotherapy quality assurance in cervical cancer treatment. Materials and method: Thirty RapidArc plans designed for cervical cancer patients were exported to both the RW3 homogeneous phantom and the anthropomorphic heterogeneous pelvic phantom. Dose calculations were performed using the anisotropic analytic algorithm (AAA), and the plans were delivered using a linear accelerator (LA). Dose measurements were obtained using a 0.6 cc ion chamber. The percentage (%) variation between planned and measured doses was calculated and analyzed. Additionally, relative dosimetry was performed for various target locations using RapidArc and IMRT treatment techniques. The AHFP phantom demonstrated excellent agreement between measured and expected dose distributions, making it a reliable quality assurance tool in radiotherapy. Results: The results reveal that the percentage variation between planned and measured doses for all RapidArc quality assurance (QA) plans using the AHFP phantom is 10.67% (maximum value), 2.31% (minimum value), and 6.89% (average value), with a standard deviation (SD) of 2.565 (t = 3.21604, p = 0.001063). Also, for the percentage of variation between homogeneous and AHFP phantoms, the t-value is −11.17016 and the p-value is p < 0.05. We can see that the outcomes differ significantly due to the influence of heterogeneous media. Also, the average gamma values in RapidArc plans are 0.29, 0.32, and 0.35 (g ≤ 1) and IMRT plans are 0.45, 0.44, and 0.42 (g ≤ 1) for targets 1, 2, and 3, respectively. Conclusion: The AHFP phantom results show more dose variability than homogenous phantom outcomes. Also, the AHFP phantom was found to be suitable for QA evaluation.

ABSTRACT The complexity and duration of tuberculosis (TB) treatment contributes to the emergence of drug resistant tuberculosis (DR-TB) and drug-associated side effects. Alternate chemotherapeutic agents are needed to shorten the time and improve efficacy of current treatment. In this study, we have assessed the antitubercular activity of NSC19723, a benzaldehyde thiosemicarbazone molecule. NSC19723 is structurally similar to thiacetazone (TAC), a second-line anti-TB drug used to treat individuals with DR-TB. NSC19723 displayed better MIC values than TAC against Mycobacterium tuberculosis and Mycobacterium bovis BCG. In our checkerboard experiments, NSC19723 displayed better profiles than TAC in combination with known first-line and recently approved drugs. Mechanistic studies revealed that NSC19723 inhibits mycolic acid biosynthesis by targeting the HadABC complex. Computational studies revealed that the binding pocket of HadAB is similarly occupied by NSC19723 and TAC. NSC19723 also improved the efficacy of isoniazid in macrophages and mouse models of infection. Cumulatively, we have identified a benzaldehyde thiosemicarbazone scaffold that improved the activity of TB drugs in liquid cultures, macrophages, and mice. IMPORTANCE Mycobacterium tuberculosis, the causative agent of TB is among the leading causes of death among infectious diseases in humans. This situation has worsened due to the failure of BCG vaccines and the increased number of cases with HIV-TB coinfections and drug-resistant strains. Another challenge in the field is the lengthy duration of therapy for drug-sensitive and -resistant TB. Here, we have deciphered the mechanism of action of NSC19723, benzaldehyde thiosemicarbazone. We show that NSC19723 targets HadABC complex and inhibits mycolic acid biosynthesis. We also show that NSC19723 enhances the activity of known drugs in liquid cultures, macrophages, and mice. We have also performed molecular docking studies to identify the interacting residues of HadAB with NSC19723. Taken together, we demonstrate that NSC19723, a benzaldehyde thiosemicarbazone, has better antitubercular activity than thiacetazone.

Introduction: Preeclampsia is a pregnancy disorder with gestational hypertension and proteinuria, it affects maternalfoetal vasculature. The risk of preeclampsia increases upon exposure to different genetic mutations, environmental changes, obesity, gestational diabetes mellitus, multifoetal gestations, and hydatidiform mole. Preeclampsia affects the mother and foetus; its pathogenesis is complex involving inflammation, stress, and molecular factors. Aim: To measure the circulatory levels of Endothelin-1 (ET-1), Glutathione (GSH), Interleukin-6 (IL-6), and Tumor Necrosis Factor-a (TNF-a) by Enzyme Linked Immunosorbent Assay (ELISA) kit (sandwich) in preeclamptic women and healthy controls. Materials and Methods: The present study was a casecontrol study carried out in the Department of Biochemistry at Government Institute of Medical Science (GIMS), Greater Noida, and Santosh Medical College, Ghaziabad, Uttar Pradesh, India, from November 2018 to November 2020. The demographic data was recorded, and blood samples were studied. Preeclamptic women (cases, n=90) were grouped as group A: with BP 140/90- 149/99 mmHg, group B: with BP 150/100-159/109 mmHg, and group C: with BP 160/110 mmHg along with controls (n=70). The normotensive pregnant women without family history of preeclampsia were included as controls. The competitive ELISA principles were used to quantify ET-1, GSH, IL-6, and TNF-a levels. One-way Analysis of Variance tests (ANOVA) and Tukey Posthoc Test was carried out to compare the clinical characteristics, ET-1, GSH, IL-6, and TNF-a between the cases and controls. Results: The demographic data of age, gestational age, and Body Mass Index (BMI) were not significantly different between cases and control. The ET-1 levels were significantly (p-value=0.042) higher in groups (A: 116±79.4, B: 99.2±72, C: 159±96) than controls (54±49). In contrast, GSH levels were low in preeclampsia. In addition, cases had elevated IL-6 and TNF-a levels (IL-6; groups A: 112.3±49.3, B: 127±17.5, C: 324±52.9, and control 40.3±13, TNF-a; groups A: 241±179, B: 200.9±196, C: 391±299 and controls: 167±104). GSH levels decreased with the rise in Blood Pressure (BP), while IL-6 increased significantly with an increase in BP. Conclusion: Every 10 mmHg increase in BP led to increasing in IL-6 levels. The ET-1 and TNF-alpha levels were increased in all three groups when compared to controls. Similarly, the GSH levels were decreased. Thus, the present study provided evidence that links oxidative stress, inflammation, and a potent vasoconstrictor ET-1 with altered antioxidants (GSH) that led to the pathophysiology of preeclampsia.

Probiotics are known as the live microorganisms that, upon adequate administration, elicit a health beneficial response inside the host. The probiotics are known as immunomodulators and exhibit anti-tumor properties. Advanced research has explored the potential use of probiotics as the oral vaccines without the latent risks of pathogenicity. Probiotic-based oral vaccines are known to induce mucosal immunity that prevents the host from several enteric infections. Probiotic bacteria have the ability to produce metabolites in the form of anti-inflammatory cytokines, which play an important role in the prevention of carcinogenesis and in the activation of the phagocytes that eliminate the preliminary stage cancer cells. This review discusses the advantages and disadvantages of using the oral probiotic vaccines as well as the mechanism of action of probiotics in colon cancer therapy. This review also employs the use of “PROBIO” database for selecting certain probiotics with immunomodulatory properties. Furthermore, the use of several probiotic bacteria as anti-colon cancer adjuvants has also been discussed in detail. Because the current studies and trials are more focused on using the attenuated pathogens instead of using the probiotic-based vaccines, future studies must involve the advanced research in exploiting the potential of several probiotic strains as adjuvants in cancer therapies.

Probiotics are known as the live microorganisms which upon adequate administration elicit a health beneficial response inside the host by decreasing the luminal pH, eliminating the pathogenic bacteria in the gut as well as producing short chain fatty acids (SCFA). With advancements in research; probiotics have been explored as potential ingredients in foods. However, their use and applications in food industry have been limited due to restrictions of maintaining the viability of probiotic cells and targeting the successful delivery to gut. Encapsulation techniques have significant influence on increasing the viability rates of probiotic cells with the successful delivery of cells to the target site. Moreover, encapsulating techniques also prevent the live cells from harsh physiological conditions of gut. This review discusses several encapsulating techniques as well as materials derived from natural sources and nutraceutical compounds. In addition to this, this paper also comprehensively discusses the factors affecting the probiotics viability and evaluation of successful release and survival of probiotics under simulated gastric, intestinal conditions as well as bile, acid tolerant conditions. Lastly applications and challenges of using encapsulated bacteria in food industry for the development of novel functional foods have also been discussed in detail too. Future studies must include investigating the use of encapsulated bacterial formulations in in-vivo models for effective health beneficial properties as well as exploring the mechanisms behind the successful release of these formulations in gut, hence helping us to understand the encapsulation of probiotic cells in a meticulous manner.

Background and Objectives: The C Willis or Cw antigen is a low-incidence antigen of Rh system. The antibody against the Cw antigen (anti-Cw) is an IgG antibody which may occur naturally or may be immune in nature. The identification of Cw antibody is important since it has the potential to cause hemolytic disease of the newborn as well as hemolytic transfusion reaction. This study was conducted with the aim of determining the prevalence of Cw antibody in multitransfused thalassemic patients enrolled in a Regional Blood Transfusion Center (RBTC) of North India. Methods: A retrospective descriptive observational study was conducted at the Department of Immunohematology and Blood Transfusion, LHMC and Associated Hospitals. All transfusion-dependent thalassemic (TDT) patients and non-TDT (NTDT) patients enrolled in the RBTC of the hospital till December 2018 were included in the study. Antibody screening was performed in all recipients before each transfusion. The prevalence of anti-Cw was estimated. Results: A total of 567 thalassemic patients (including TDT and NTDT) were registered in RBTC, LHMC till December 2018. On pretransfusion antibody screening and identification, 3 out of 567 thalassemic patients were found to have alloimmunization against Cw antigen. The prevalence of anti-Cw in multitransfused thalassemics was 0.53%. Conclusion: The prevalence of anti-Cw is variable in different populations and it is not a very commonly reported antibody in patients with thalassemia. One should be aware of the approach to transfusion in thalassemic patients who develop Cw alloimmunization.

Immunotherapies such as checkpoint blockade therapies are known to enhance anti-melanoma CD8+ T cell immunity, but only a fraction of patients treated with these therapies achieve durable immune response and disease control. It may be that CD8+ T cells need help from other immune cells to generate effective and long-lasting anti-tumor immunity or that CD8+ T cells alone are insufficient for complete tumor regression and cure. Melanoma contains significant numbers of B cells; however, the role of B cells in anti-melanoma immunity is controversial. In this study, B16 melanoma mouse models were used to determine the role of B cells in anti-melanoma immunity. C57BL/6 mice, B cell knockout (KO) C57BL/6 mice, anti-CD19, and anti-CXCL13 antibody-treated C57BL/6 mice were used to determine treatment efficacy and generation of tumor-specific CD8+ T cells in response to PD-L1 blockade alone or combination with TLR-7/8 activation. Whole transcriptome analysis was performed on the tumors from B cell depleted and WT mice, untreated or treated with anti-PD-L1. Both CD40-positive and CD40-negative B cells were isolated from tumors of TLR-7/8 agonist-treated wild-type mice and adoptively transferred into tumor-bearing B cell KO mice, which were treated with anti-PD-L1 and TLR-7/8 agonist. Therapeutic efficacy was determined in the presence of activated or inactivated B cells. Microarray analysis was performed on TLR-7/8-treated tumors to look for the B cell signatures. We found B cells were required to enhance the therapeutic efficacy of monotherapy with anti-PD-L1 antibody and combination therapy with anti-PD-L1 antibody plus TLR-7/8 agonist. However, B cells were not essential for anti-CTLA-4 antibody activity. Interestingly, CD40-positive but not CD40-negative B cells contributed to anti-melanoma immunity. In addition, melanoma patients’ TCGA data showed that the presence of B cell chemokine CXCL13 and B cells together with CD8+ T cells in tumors were strongly associated with improved overall survival. Our transcriptome data suggest that the absence of B cells enhances immune checkpoints expression in the tumors microenvironment. These results revealed the importance of B cells in the generation of effective anti-melanoma immunity in response to PD-1-PD-L1 blockade immunotherapy. Our findings may facilitate the design of more effective anti-melanoma immunotherapy.

Background: The early detection of oral potentially malignant disorder can reduce the transformation risk to oral squamous cell carcinoma, thereby reducing cancer morbidity and mortality. Aim: To obtain epidemiological information of oral leukoplakia (OL) and distribution of this disease in Patna. Subjects and Methods: Data were collected and analyzed for prevalence of OL among gender, age group, various oral sites, habits, and clinical and histopathological basis. Results: The overall prevalence shows high incidence of homogenous leukoplakia along with mild dysplasia in middle age male persons. Conclusion: Appropriate steps should be taken for early intervention, as it is the key to effective prevention.

Abstract Oxysterols play vital roles in the human body, ranging from cell cycle regulation and progression to dopaminergic neurogenesis. While naïve human mesenchymal stem cells (hMSCs) have been explored to have neurogenic effect, there is still a grey area to explore their regenerative potential after in vitro differentiation. Hence, in the current study, we have investigated the neurogenic effect of 22(R)-hydroxycholesterol (22-HC) on hMSCs obtained from bone marrow, adipose tissue and dental pulp. Morphological and morphometric analysis revealed physical differentiation of stem cells into neuronal cells. Detailed characterization of differentiated cells affirmed generation of neuronal cells in culture. The percentage of generation of non-DA cells in the culture confirmed selective neurogenic potential of 22-HC. We substantiated the efficacy of these cells in neuro-regeneration by transplanting them into Parkinson’s disease Wistar rat model. MSCs from dental pulp had maximal regenerative effect (with 80.20 ± 1.5% in vitro differentiation efficiency) upon transplantation, as shown by various behavioural examinations and immunohistochemical tests. Subsequential analysis revealed that 22-HC yields a higher percentage of functional DA neurons and has differential effect on various tissue-specific primary human MSCs. 22-HC may be used for treating Parkinson’s disease in future with stem cells.

Background: The present study was conducted to assess risk factors and prevalence of potentially malignant disorders (PMDs) among Indian population. Materials and Methods: 1280 Indian population of both genders were enrolled. Habits such as smoking bidi, cigarette, consumption of tobacco such as in the form of zarda, chaini khaini, pan masala, arecanut, and alcohol were recorded. Risk factors and prevalence rate of disorders were recorded. Results: There were 750 (58.6%) males and 530 (41.4%) females. Speckled leukoplakia was seen among 470 (36.7%), oral lichen planus (OLP) in 246 (19.2%), oral submucous fibrosis (OSMF) in 274 (21.4%), erythroplakia in 120 (9.3%), and oral squamous cell carcinoma (OSCC) in 107 (8.3%) participants. Maximum cases of speckled leukoplakia (162) was seen in the age group of 31–40 years, OLP (99) in 41–50 years, OSMF (95) in 31–40 years, erythroplakia (48) in 21–30 years, OSCC (44) in 41–50 years. Conclusion: Risks factors associated with PMDs were found to be tobacco and arecanut. There was higher prevalence of leukoplakia. Age group of 31–40 years had higher cases and most common site was buccal mucosa and vestibule.

Background: Protective role of estrogen in COVID-19 was speculated once the epidemiological studies reported increased susceptibility of estrogen-deficient population – males and postmenopausal females to severe disease category and involvement of angiotensin-converting enzyme 2 receptors and renin–angiotensin–aldosterone system in pathophysiology. Materials & Methods: An open-label randomized controlled trial was planned to assess the efficacy of short-course oral estradiol in preventing the clinical progression to severe disease and reduce case-fatality rate and the hospital stay duration in estrogen-deficient postmenopausal women. The intervention group (n = 40) received 2 mg per day of estradiol valerate per orally for 7 days along with the standard care, while the control group (n = 40) received only the standard care. Results: A significant difference was observed in the rate of reverse transcriptase–polymerase chain reaction negativization in the intervention versus control group at day 5 and day 7 of admission (42.5% vs. 15%, P = 0.007; 72.5% versus 50%, P = −0.026). No significant difference was noted in the duration of hospitalization (P = 0.213). A significant decrease was noted in the mean values of inflammatory biomarkers – D-dimer, lactate dehydrogenase, and C-reactive protein on day 5 in the intervention group. Interleukin-6 also showed a declining trend on day 5 in the intervention group, while a rising trend was noted in the control arm. Only one case (2.5%) in the intervention group while seven in the control group (17.5%) progressed to the moderate category; however, the difference was not statistically significant (P = 0.057). Conclusion: Oral estradiol in postmenopausal females can be a novel and efficient option for managing nonsevere COVID-19 infection.

Therapeutic vaccination is one of the most effective immunotherapeutic approaches, second only to immune checkpoint inhibitors (ICIs), which have already been approved for clinical use. Head and neck squamous cell carcinomas (HNSCCs) are heterogenous epithelial tumors of the upper aerodigestive tract, and a significant proportion of these tumors tend to exhibit unfavorable therapeutic responses to the existing treatment options. Comprehending the immunopathology of these tumors and choosing an appropriate immunotherapeutic maneuver seems to be a promising avenue for solving this problem. The current review provides a detailed overview of the strategies, targets, and candidates for therapeutic vaccination in HNSCC. The classical principle of inducing a potent, antigen-specific, cell-mediated cytotoxicity targeting a specific tumor antigen seems to be the most effective mechanism of therapeutic vaccination, particularly against the human papilloma virus positive subset of HNSCC. However, approaches such as countering the immunosuppressive tumor microenvironment of HNSCC and immune co-stimulatory mechanisms have also been explored recently, with encouraging results.

The vast use of corticosteroids (CCSs) globally has led to an increase in CCS-induced neuropsychiatric disorders (NPDs), a very common manifestation in patients after CCS consumption. These neuropsychiatric disorders range from depression, insomnia, and bipolar disorders to panic attacks, overt psychosis, and many other cognitive changes in such subjects. Though their therapeutic importance in treating and improving many clinical symptoms overrides the complications that arise after their consumption, still, there has been an alarming rise in NPD cases in recent years, and they are seen as the greatest public health challenge globally; therefore, these potential side effects cannot be ignored. It has also been observed that many of the neuronal functional activities are regulated and controlled by genomic variants with epigenetic factors (DNA methylation, non-coding RNA, and histone modeling, etc.), and any alterations in these regulatory mechanisms affect normal cerebral development and functioning. This study explores a general overview of emerging concerns of CCS-induced NPDs, the effective molecular biology approaches that can revitalize NPD therapy in an extremely specialized, reliable, and effective manner, and the possible gene-editing-based therapeutic strategies to either prevent or cure NPDs in the future.

BackgroundObesity is significantly associated with renal cell carcinoma. Surgery is the preferred treatment for demarcated lesions of renal cell carcinoma; however, obesity increases the complexity of surgical outcomes. Minimally invasive surgical techniques are preferred over open partial nephrectomy (OPN), but controversy remains regarding the most efficacious technique in patients with obesity. ObjectiveThis study aims to determine whether minimally invasive partial nephrectomy (MIPN) or OPN better preserves renal function and investigate short- and long-term renal outcomes in patients with obesity undergoing a partial nephrectomy. MethodsWe conducted a retrospective chart review of 242 adult patients aged ≥18 years who underwent MIPN or OPN between January 1, 2005, and December 31, 2016, at the University of Arkansas for Medical Sciences. Using creatinine as a measure of kidney function, patients’ preoperative levels were compared with their postoperative levels in 2-time frames: short (3-6 months postsurgery) or long (>6 months). The primary outcome was the change in creatinine values from preoperative to >6 months postoperatively in patients with obesity. Secondary outcomes included the change in creatinine values from preoperative to 3 to 6 months postoperatively in patients with obesity who underwent MIPN versus OPN. We also analyzed the creatinine values of nonobese patients (BMI 6 months after MIPN (n=20), the odds of patients with obesity having a decrease or no change in creatinine values was 1.24 times higher than those who had OPN (n=13; OR 1.24, 95% CI 0.299-6.729; P=.80). At 3 to 6 months after MIPN (n=27), the odds were 0.62 times lower than those after OPN (n=17; OR 0.62, 95% CI 0.140-2.753; P=.56). In the nonobese group, at 3 to 6 months after undergoing minimally invasive surgery (n=18), the odds of having a decrease or no change in creatinine values was 4.86 times higher than those who had open surgery (n=21; OR 4.86, 95% CI 1.085-21.809; P=.04). At more than 6 months after MIPN (n=14), the odds were 4.13 times higher than those after OPN (n=11; OR 4.13, 95% CI 0.579-29.485; P=.16). ConclusionsWe observed a nonstatistically significant preservation of renal function in patients with obesity who underwent OPN at 3 to 6 months postoperatively. Conversely, after 6 months, the same was true for MIPN, indicating the long-term benefit of MIPN. In the nonobese group, MIPN was favored over OPN.

Mechanical or biological aortic valves are incorporated in physical cardiac simulators for surgical training, educational purposes, and device testing. They suffer from limitations including either a lack of anatomical and biomechanical accuracy or a short lifespan, hence limiting the authentic hands-on learning experience. Medical schools utilize hearts from human cadavers for teaching and research, but these formaldehyde-fixed aortic valves contort and stiffen relative to native valves. Here, we compare a panel of different chemical treatment methods on explanted porcine aortic valves and evaluate the microscopic and macroscopic features of each treatment with a primary focus on mechanical function. A surfactant-based decellularization method after formaldehyde fixation is shown to have mechanical properties close to those of the native aortic valve. Valves treated in this method were integrated into a custom-built left heart cardiac simulator to test their hemodynamic performance. This decellularization, post-fixation technique produced aortic valves which have ultimate stress and elastic modulus in the range of the native leaflets. Decellularization of fixed valves reduced the valvular regurgitation by 60% compared to formaldehyde-fixed valves. This fixation method has implications for scenarios where the dynamic function of preserved valves is required, such as in surgical trainers or device test rigs.

Interleukin-2 can induce an anti-tumour response, but is associated with toxicity. Here, the authors demonstrate that an engineered interleukin-2 promotes intratumoral T regulatory cell depletion while enhancing effective anti-tumour CD8+ T cell responses that result in potent tumor suppression.

Aims and Objectives: The aim of the study is to detect the pattern of genetic mutation, i.e., Inh A or Kat G or both (Inh A and kat G) in isoniazid (INH) monoresistant mycobacteria and to correlate with the pattern in multidrug-resistant (MDR) isolates. Materials and Methods: In this study, a quantitative research approach was used. The research design was descriptive observational study. The study was conducted at the Department of Respiratory Medicine, JLN Medical College, Ajmer, Rajasthan, and Intermediate Referral Laboratory, State TB Demonstration Centre, Ajmer. A total of 298 samples found to have resistant strains of Mycobacterium tuberculosis were enrolled with purposive sampling. Results: The mean age of patients was 40.27 ± 13.82 years. There were 250 (83.9%) males, while 48 (16.1%) were females. One hundred ninety-two (64.4%) were resistant for INH only, while the rest were resistant to both INH as well as rifampicin (MDR-tuberculosis). The most common mutation in INH monoresistance was kat G (125; 65.1%) as compared to inh A (54; 28.1%) and both inh A and kat G (13; 6.7%). Among kat G mutations, the most common gene pattern was the absence of WT (S315T) and the presence of MUT1 (S315T1). Conclusion: Knowledge about mutation patterns of different INH resistant strains is important in the present era where there is a provision of separate regimens for INH monoresistant TB. Since these mutations are very closely related to high- or low-degree resistance to INH, the therapeutic regimens cannot be generalized.

Purpose: To study the demographic details, risk factors, microbiological profile, and clinical outcomes of pediatric infectious keratitis cases in North India. Methods: This retrospective case series included review of medical records of pediatric patients (0–16 years) diagnosed with infectious keratitis in a tertiary care center of North India during December 2011 to January 2017 was done. Demographic details, predisposing factors, microbiological investigations, and clinical outcomes were analyzed. Results: In this time period, 104 eyes of 104 children had a diagnosis of infectious keratitis. Culture was obtained for all 104 eyes and was positive in eighty eight eyes (84.2%). The most common causative factor was trauma, seen in 77 eyes (74%). Bacteria was the most common agent isolated in culture (54.2%) followed by fungi (40.8%) and acanthamoeba (2.1%). Successful healing of the keratitis with appropriate medical treatment occurred in 84 (80.7%) eyes, while 13 (12.5%) eyes required therapeutic keratoplasty. Of the 80 eyes with documentation of both preliminary and final visual acuity, improvement of two lines was seen in 35 eyes (43.7%), stayed the same in and worsened in 17 eyes (21%). Mean time to resolution of infection on medical treatment for bacteria was 23.65 ± 4.78 days, fungi 32 ± 5.19 days, and acanthamoeba 53.67 ± 4.78 days. Conclusion: Gram positive organism is the most common etiological agent of keratitis in children in our study population which is in contrast to pediatric infective keratitis study conducted by Aruljyothi et al. in South India (2011--2013). Though less in number than bacterial keratitis, fungus also remains an important causative agent. Along with early diagnosis and immediate medical intervention, it is important to identify regional profile of organisms and risk factors for good visual and anatomical outcome.

Purpose: To report clinical characteristics of Demodex blepharokeratoconjunctivitis affecting young patients. Methods: This is a retrospective review of 14 patients with the history of chronic red eyes with corneal involvement. All patients were diagnosed with ocular demodicosis based on the results of eyelash sampling. All patients were treated with 50% tea tree oil lid scrubs and two doses of oral ivermectin (200 mcg/kg). Results: The median age of patients at diagnosis was 27 years (range: 11–39 years). The duration of symptoms ranged from 2 months to 20 years. Rosacea was present in only three patients. Four patients had best corrected visual acuity less than 20/60. Allergic conjunctivitis (n = 7) and viral keratitis (n = 5) were the most common misdiagnosis previously made. Cylindrical dandruff was present in only six patients and eyelashes were clean in rest of them. Inferior vascularization was present in eight eyes, superior in seven eyes, and corneal scars were present in 12 eyes. Four patients had steroid-related complications. All patients, except one responded to tea tree oil treatment and 13 patients were off steroids after 3 weeks of starting the treatment. Conclusion:Demodex infestation of eyelids can lead to chronic blepharokeratoconjunctivitis in healthy pediatric and young adult patients who otherwise have good hygiene, which can often be overlooked or misdiagnosed. Viral keratitis and allergic conjunctivitis are common misdiagnoses and demodicosis can be confirmed by simple epilation. Early diagnosis and treatment can prevent long-term steroid use and its related complications.

Hibiscus sabdariffa calyces were used to extract the polyphenolic compounds with three different solvents (water, methanol, and ethanol). The augmentation of temperature from 23 °C to 90 °C caused an adverse effect to polyphenols through thermal degradation and reduced antioxidant activity. Methanol and ethanol were more effective solvents than water for extracting polyphenolic compounds. The storage stability study at -30 °C for ten weeks showed that the antioxidant activity of extracts significantly decreased after 6 weeks; however, total phenolic content did not change significantly. Delphinidin 3-O-sambubioside chloride and cyanidin 3-O-sambubioside chloride were found to be the most abundant polyphenolic compounds in all three extracts. Potassium hydroxycitrate (180.14 µg/mg) was extracted from H. sabdariffa calyces, which is the highest reported value so far. Therefore, H. sabdariffa serves as a potential source for extracting potassium hydroxycitrate and phenolic compounds which are important for food and pharmaceutical applications.

Physicians in training may experience harassment and discrimination from supervisors, consultants, colleagues, or patients and families. Instances of discrimination towards students may impact students’ self-esteem, self-efficacy, and ultimately performance. In this particular time, many institutions are looking to enhance their curriculum regarding bias. More tools are needed to help students feel empowered to respond professionally when they encounter challenging situations. This study was designed to assess the impact of a training intervention in addressing biased patient statements. The training was strategically placed prior to clinical interactions. The authors’ intention was to present discriminatory statements by patients as one of the many difficult clinical situations that students are being trained to navigate. The authors developed a clinical rubric for decision-making in flowchart style to mimic the decision trees used in diagnostic or treatment decisions. They then created a workshop to help learners use the flowsheet. The workshop was delivered to third-year medical students as part of “Junior Bootcamp,” a day-long session of events to orient students to the clinical experiences of the M3 year. The workshop was delivered in the summer of 2019. Respondents indicated that they were more likely to be able to appropriately respond to discriminatory comments after completing the workshop. They also felt that they were more likely to be able to engage in respectful dialogue with a patient and to debrief with a faculty member. Fewer participants felt that they were likely to use the flowchart. Findings indicate that the workshop was useful to participants. It may be especially useful to educators dealing with the COVID pandemic because it is scalable and easily delivered remotely. Further studies are needed to determine if introducing this topic in the clinical years of medical school leads to improved skill in addressing instances of bias that come from patients and families.

Aims: Scientific biological evaluation of standardized extracts is becoming one of the central needs for the globalization of customary medication in current times. And to validate the presence of active constituents in crude medicinal extracts, analytical techniques like HPLC and HPTLC are the most suitable authentication systems. In the current study we aimed to standardize and evaluate Clerodendrum serratum (L.) Moon (Verbenaceae). For its unique anti-inflammatory and anti-arthritic properties. Evaluation and analysis of the plant, therefore, offers a new platform for the development of the herbal drug and could prove to be a safe and cost effective treatment for arthritis management.Methods: The aqueous extract of C. serratum, a common plant in the Southeastern Asian region, was used for phytochemical investigation and standardization by HPTLC and HPLC. The standardized HPLC method was further validated by using ICH guidelines. The standardized extract was investigated for anti-inflammatory and anti-arthritic activity. Complete Freund’s adjuvant (CFA) model was performed to evaluate the activity. Paw diameter, joint diameter, arthritic score, and body weight was accepted as a parameter for the evaluation of biological activity.Results: HPTLC method revealed the presence of ursolic acid with an Rf value of 0.38 and the amount quantified was 0.03% w/w. The presence of the bioactive phytochemical was further analyzed and confirmed by HPLC for which the validation was done successfully in accordance with ICH guidelines. The assay content for ursolic acid was found to be 0.059% with relative standard deviation (RSD)

Corneoscleral tunnel infection is a potentially sight threatening complication of cataract surgery. Microbiological investigations are mandatory and early surgical intervention helps in achieving favourable outcomes. Fungal infection of tunnel incisions can pose a diagnostic and therapeutic challenge. We report a case of post-operative tunnel infection with curvularia. Prompt surgical intervention and intensive topical therapy helped attain a good tectonic as well as visual recovery.

Abstract Background Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual. Case presentation In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still’s disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication. Conclusion An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. Although leprosy has been declared eliminated, it should not be forgotten and physicians should have it in mind to make it a differential diagnosis whenever relevant.

Anti – Mia antibody is antibody reacting with Mi III phenotype of the Miltenberger (Mi) subsystem. It is rarely reported in the West, however, it is common in Chinese and South East Asian populations. Very few cases have been reported in India. Here, we report 4 cases of the Anti - Mia antibody picked up on antibody screening of samples (which was performed using Asia ID-Diacell I-II-III Asia (Mia +) 3 cell panel). Patients: In all the four cases, ICT was positive. Antibody screening and Identification was done with 3 cell panel (ID-Diacell I-II-III (Asia)) and 11 cell panel (ID-DiaPanel) respectively. Antibody screening showed reaction in “Asia” cell (carrying Mia Antigen) of 3 cell panel. Antibody identification by 11 cell panel was negative ruling out antibodies of Rh, Kell, Duffy, Kidd, Lewis, P, Lutheran and MNS systems. Reaction with the “Asia” cell suggested the presence of Anti-Mia antibody which was confirmed by obtaining the same result when screening was repeated with 2 different lots of 3 cell panel. Discussion and Conclusion: The Miltenberger (Mi) subsystem comprises of a group of phenotypes of red cells that carry low frequency antigens associated with the MNSs blood group system. The Anti- Mia antibody was first described in 1951 in the serum of Mrs Miltenberger. Anti- Mia antibody is clinically significant and can cause Hemolytic disease of newborn (HDN) and mild to moderate haemolytic transfusion reactions (HTR). Most of the antibody screening and identification panels used in India are imported and represent the Western population. They do not have representation of the Mia antigen on their red cells. This leads to missing out of the Anti- Mia antibody which may cause HDN and HTR leading to significant consequences. Thus, the Mia antigen should be incorporated in our screening panels.

Purpose: Biopharmaceutics classification system (BCS) class IV compounds, exhibits least oral bioavailability, low solubility and intestinal permeability among all pharmaceutical classes of drugs. Thus, these drugs need more compatible and efficient delivery system. Since, their solubility in various medium, remains a limitation so, polymeric nano coacervates based drug loading with modified approach for them may prove to be a solution ahead. Therefore, in present study Chitosan is opted for encapsulating the BCS class IV drug (Hydrochlorothiazide) to attain better stability, enhanced permeability and lower toxicity. Methods: For this study, Hydrochlorothiazide (HCTZ) was opted for formulating chitosan based nano-coacervate system. Results: Optimized HCTZ nanocoacervates exhibited the average particle size of 91.39 ± 0.75 nm with Poly-dispersity index score of 0.159 ± 0.01, indicating homogeneity of colloidal solution. Zeta potential and encapsulation efficiency of HCTZ nanocoacervates were recorded as -18.9 ± 0.8 mV and 76.69 ± 0.82 % respectively. Further, from TEM and SEM evaluation the average particle size for the same were found in conformity (35-50 nm), with almost spherical morphology. Also, the EDX (Electron Dispersive X-ray) spectrometry and FT – IR analysis of optimized formulation indicated the balanced chemical composition and interaction between the polymeric molecules. The HCTZ nano coacervates showed the linear diffusion profile through the dialysis membrane. Conclusion: We can conclude from the present study that the optimized HCTZ nano coacervates may prove to be a suitable potential option for effective delivery of BCS class IV drugs.

Interleukin-1 (IL-1) is an inflammatory cytokine associated with tumor invasiveness and metastasis. We recently found that baseline IL-1 in melanomas promoted resistance to immunotherapy by creating an immunosuppressive tumor microenvironment and that IL-1 produced in response to CD40 agonist also induced resistance to therapy. Here, we discuss how naturally occurring and immunotherapy-induced IL-1 in tumors causes immune suppression and resistance to immunotherapy, and we discuss targeting the IL-1 pathway to enhance the efficacy of immunotherapy.

Obesity is a pervasive global health problem needing urgent research and regulatory attention. Although synthetic anti-obesity drugs are available, they come with considerable risk of adverse effects and variable outcomes. Thus, there is a growing trend globally in using natural compounds for management of obesity. There is a considerable body of knowledge, supported by rigorous experimental data, that natural polyphenols can be effective and safer alternative for managing obesity through food and food fortification. This review documents the status of research on anti-obesity mechanisms and critically evaluates the effectiveness of natural polyphenolic compounds that are currently used for management of obesity. It summarizes different mechanisms of anti-obesity action associated with the enzymes, energy expenditure, appetite suppression, adipocyte differentiation, lipid metabolism and gut microbiota by various natural polyphenols. It also critically evaluates the in vitro, animal and clinical experimental data that support the anti-obesity potential of natural polyphenols. Most of the published data indicate that natural phenolic compounds can be effectively utilized as food or fortified foods, to manage obesity. However, there is still a need for systematic and targeted clinical studies before these natural compounds can be used as the mainstream therapy for managing obesity.

Stroke has a debilitating effect on the human body and a serious negative effect on society, with a global incidence of one in every six people. According to the World Health Organization, 15 million people suffer stroke worldwide each year. Of these, 5 million die and another 5 million are permanently disabled. Motor and cognitive deficits like hemiparesis, paralysis, chronic pain, and psychomotor and behavioral symptoms can persist long term and prevent the patient from fully reintegrating into society, therefore continuing to add to the costly healthcare burden of stroke. Regenerative medicine using stem cells seems to be a panacea for sequelae after stroke. Stem cell-based therapy aids neuro-regeneration and neuroprotection for neurological recovery in patients. However, the use of stem cells as a therapy in stroke patients still needs a lot of research at both basic and translational levels. As well as the mode of action of stem cells in reversing the symptoms not being clear, there are several clinical parameters that need to be addressed before establishing stem cell therapy in stroke, such as the type of stem cells to be administered, the number of stem cells, the timing of dosage, whether dose-boosters are required, the route of administration, etc. There are upcoming prospects of cell-free therapy also by using exosomes derived from stem cells. There are several ongoing pre-clinical studies aiming to answer these questions. Despite still being in the development stage, stem cell therapy holds great potential for neurological rehabilitation in patients suffering from stroke.

Introduction: Carbapenems are the drugs of choice for the treatment of many multidrug resistant hospital acquired infections. Resistance to carbapenems also is not uncommon and is increasingly being reported now-a-days. Though various tests like modified hodge test are available for the detection of carbapenemases, they lack sensitivity and specificity. Recently, the Carba NP test has been introduced for carbapenemase detection which has been approved and included in CLSI guidelines. Aim: To identify the prevalence of carbapenemase producing isolates and the utility of Carba NP in house as well as commercial RAPIDEC Carba NP test in the identification of these carbapenemases. Materials and Methods: All the carbapenem resistant organisms isolated during the study period from July 2018 to December 2018 were included in the study. A total of 91 isolates were identified during the study period which were further tested for carbapenemase production by both in House Carba NP test as well as commercially available RAPIDEC Carba NP (Biomerieux) as per the existing protocols. Twenty five carbapenem sensitive isolates were also tested. Klebsiella pneumoniae BAA ATCC1705 and BAA ATCC-1706 were used as controls. Results: Out of 91, carbapenem resistant strains tested, 72 were identified as carbapenemase producers. Out of them, Klebsiella pneumonia accounted for 59.7% of the total carbapenemase producing organisms followed by Pseudomonas aeruginosa (25%) and E.coli (6.9%) followed by Acinetobacter and Enterobacter which constituted less than 5%. Among enterobacteriaceae, 43 out of 59 carbapenem resistant Klebsiella were carbapenemase producers whereas all the 5 carbapenem resistant E.coli were positive for Carba NP test. Among Pseudomonas 18 out of 21 were carbapenemase producers. All the positive isolates by in-house Carba NP test were also positive by commercial RAPIDEC test and vice-versa and none of the 25 carbapenem sensitive strains tested were positive for Carba NP test by either method indicating 100% correlation between the two methods studied. Conclusion: Carba NP in house as well as commercial RAPIDEC Carba NP test were equally effective in the identification of the carbapenemase producing gram negative bacilli. Wide adaptability of these tests by various laboratories will help in the early identification of these potentially spreading carbapenemase producers, which in association with appropriate treatment and infection control practices will prevent the emergence of these strains and will decrease the mortality and morbidity.

Treatment options for metastatic melanoma are limited. Here the authors show that combining an immunostimulant adenovirus, currently in clinical trials for leukemia, with immune checkpoints blockade (ICB) results in systemic eradication of ICB resistant melanoma tumours from both skin and brain of mice.