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Objective: This study, aimed at investigating the knowledge and attitude of resident doctors about ADR reporting in a tertiary care teaching hospital. Methods: This was a cross-sectional, observational, questionnaire-based study conducted in Shri Krishna Hospital and Medical Research Centre, 550 bed tertiary care teaching rural hospital attached to Pramukhswami medical college, Karamsad, Gujarat. Results: 50 questionnaire forms were analysed, giving a response rate 86.20%. Of the respondents 56% were men, remaining were women. Mean age of the respondents was 25+1.05 y. All but one resident have heard the term ‘pharmacovigilance,’ but 34 out of 50 were able to define it accurately. Twenty participants preferred email for ADR reporting while 14 preferred direct contacts for ADR reporting. Telephone is liked by 9 participants. All residents admitted the importance of pharmacovigilance in unison. Majority of the residents (96%) were in view to teach pharmacovigilance actively to students. Seventeen out of 50 residents were aware about Pharmacovigilance Program of India, a program by Government of India for pharmacovigilance and ADR reporting. 28 residents did not know about any such program. Three residents opined that no specific national program is running and India is following a program undertaken by WHO. The most preferred method of ADR reporting by residents is email/website followed by direct contact. Twenty were in favour of the first method, while 14 preferred the later method. Nine residents selected the telephone method as method of ADR reporting. Conclusion: Today’s residents are future’s consultants. So it is the need of the hour to stimulate residents to report ADRs.

Flow characteristics of an adiabatic spiral and a helical capillary tube in a CO2 transcritical system are numerically simulated. A homogeneous two-phase flow model is developed using the mass, ene...

Adolescents, pregnant women and mothers of children under 2 years of age are in stages of life characterized by higher nutritional demands. The study measured the dietary diversity of 17,680 adolescent girls, pregnant women and mothers of children under age 2 years in the eastern Indian states of Bihar, Chhattisgarh and Odisha using data from the Swabhimaan baseline survey conducted in 2016. The association of women’s mean Dietary Diversity Scores with socioeconomic, health and nutrition service indicators was assessed. The sampled population was socioeconomically more vulnerable than the average Indian population. There was not much variation in the types of foods consumed daily across target groups, with diet being predominantly cereal (98%) and vegetable (83%) based. Nearly 30% of the mothers had low Dietary Diversity Scores, compared with 25% of pregnant women and 24% of adolescent girls. In each target group, more than half of the respondents were unable to meet the Minimum Dietary Diversity score of at least five of ten food groups consumed daily. Irrespective of their background characteristics, mean Dietary Diversity Scores were significantly lower in Bihar than in Chhattisgarh and Odisha for all target groups. Having at least 6 years of education, belonging to a relatively rich household and possessing a ration card predicted mean dietary diversity. Project interventions of participatory women’s group meetings improved mean Dietary Diversity Scores for mothers and adolescent girls. Considering the association between poverty and dietary diversity, the linkage between girls and women and nutrition-focused livelihoods and supplementary nutrition programmes needs to be tested.

Thermodynamic analysis including energetic and exergetic analysis is carried out employing Engineering Equation Solver for the five modified cycles: dual expansion cycle, internal heat exchanger cycle, work recovery cycle, work recovery with internal heat exchanger cycle and vortex tube expansion cycle. Contours are developed to study the effect of gas cooler temperatures and evaporator temperatures on the system performance and optimum gas cooler pressure. The modified cycle with work recovery turbine offers relatively higher COP and higher exergetic efficiency with lower compressor discharge pressure. The exergy loss in compressor, gas cooler, throttle valve and vortex tube (VT) are considerably higher than that in internal heat exchanger (IHX), evaporator and turbine. It is observed that COP of modified cycle with VT is slightly less than that with IHX, whereas the cycle with work recovery turbine brings the highest COP with the improvement of 25% at the gas cooler exit temperature of 305 K and evaporator temperature of 248 K.

A numerical study has been carried out on the spiral capillary tube for the CO2 transcritical cycle. The model is based on the basic principles of conservation of mass, momentum, and energy. The results of this model are validated with earlier published test results. The effect of various geometric parameters like tube diameter, length, roughness, and pitch on the mass flow rate, cooling capacity, and COP has been calculated. The mass flow rate of the tube is mostly influenced by the internal tube diameter, as the diameter increases by 28%, the mass flow increases by 88%. A minor change in mass is observed with a change in pitch and surface roughness, as the pitch increases from 300 to 700 mm, and surface roughness increases by 14%, the mass flow rate and cooling capacity increase only by 2% and 1%, respectively. Similarly, the influence of various operating factors like gas cooler pressure, evaporator temperature, and gas cooler temperature is evaluated. A significant change in mass is observed with the change in gas cooler temperature, as the gas cooler temperature increases by 5%, the mass flow rate, cooling capacity, and COP decrease by 19%, 40%, and 33%, respectively. Relatively less variation in mass flow rate is observed with the change in evaporator temperature. As the evaporator temperature increases by 12%, the mass flow rate decreases by nearly 5.5%, and cooling capacity decreases by 18%. Energy and exergy analyses of a CO2 transcritical system are carried out.

Retention period is the most important phase of orthodontic treatment, which is often neglected. Bonded retainers have advantages compared to conventional removable retainers in that they are invisible from the front, require less patient cooperation, and provide long-term (as long as 10 years) or even permanent retention. 1 Stabilization of bonded retainer prior to its bonding is of key importance. In the present paper, we have designed a more simple and innovative method of stabilizing the retainer wire by just holding the retainer with a prefabricated retainer holding clip, followed by the bonding procedure of lingual retainer.

A detailed literature review on the flow characterization of the capillary tubes is presented in this paper. The flow behavior is reviewed for straight, helically, and spirally coiled capillary tubes at different operating and geometric conditions by considering various aspects in the tube. This paper summarizes experimental and numerical study on the adiabatic and nonadiabatic straight and coiled capillary tubes at different geometries conditions. The vital information of the range of the tube geometry and operating conditions are discussed, which can be utilized for further studies on the capillary tube. Various methodologies with generalized correlations are indicated. It has been observed that there are even more studies need to do with environmentally friendly refrigerants with various practical aspects in the capillary tube. It would be interesting to find the coiling effect on the design and simulation of the capillary tube. In addition to that more experimental and numerical studies need to explore the nonadiabatic coiled capillary tube. It would be fascinating to study the metastable condition in the capillary tube and set suitable relations to present its effect on the mass flow rate.

Flow behaviour of a capillary tube in the transcritical CO2 cycle is predicted based on homogeneous and separated two-phase flow models. Five different empirical correlations of void fraction available in open literature are used to predict the flow behaviour by separated two-phase model. Fauske [1] void fraction correlation matches reasonable well with homogeneous flow model with the discrepancy in capillary tube prediction as around 2%. It is observed that the homogeneous flow model is sufficient enough and recommended to predict the capillary tube flow in a transcritical CO2 system used for capillary tube modelling due to its simplicity and relatively lesser computations.

A comparative study has been carried out on the adiabatic straight and helical capillary tube, using a CO2 and R22 refrigerant. The numerical model for CO2 and R22 is developed using the basic principles of conservation of mass, momentum, and energy. The effect of coiling in the helical capillary tube is compared with a straight capillary tube for CO2 and R22 refrigerant. Compared with the straight capillary tube, the percentage reduction in mass flowrate in the helical capillary tube is calculated with a change in coil diameter, tube diameter, and length. As the coil diameter increases from 30 mm to 150 mm, the percentage reduction in mass is from 5.8% to 2.2% in CO2, and 5% to 1.6% in R22. For helical capillary tube with 50 mm coil diameter, as the tube diameter increases from 1 to 1.5 mm, the percentage reduction in mass flowrate with CO2 refrigerant is from 2.65% to 4.96%, however, for R22 it is from 2.43% to 4.24%. Similarly, as the capillary tube length increases from 1.3 m to 1.8 m, the percentage reduction in mass with CO2, with 50 mm coil diameter is 4.44–4.55%. However, the percentage reduction in mass with R22 is 3.71–3.85%. Moreover, compared with the straight capillary tube, the percentage reduction in length in a helical capillary tube with coil diameter 50 mm is 16% for CO2 and 9% for R22 refrigerant.

Background: Iodine Deficiency Disorder is major public health problem causing increased perinatal mortality, mental retardation and goiter and all these morbidities are preventable. Most effective and inexpensive mode to prevent IDD is consumption of iodized salt. Objectives: To estimate the proportion of households using adequately iodized salt in Begusarai district, to assess the knowledge of households on consumption and storage of salt and to estimate Total Goitre Rate (TGR). Material and Methods: Community- based cross sectional study carried out on 412 household from 30 cluster in Begusarai district using cluster sampling technique. Children (6-12 years) were examined clinically for goitre status and sample of household salt was collected for testing iodine content. Iodine content estimation was done both quantitatively by titration and qualitatively by MBI kit. Statistical analysis was performed using SPSS version 22. Result: The respondents were mainly female (92.8%) of mean age 34 years. Three- fifth (61.6%) participants used packaged crushed salt for cooking purpose, followed by packaged crystal (30.5%). Only 12.1 % of the respondents gave affirmative answer for presence of label and logo. Storage of salt in container with lid was 78.5%. The proportion of household using adequately iodized salt was 78%. The sensitivity MBI kit was 61% and the Total goiter rate was 9.3%. Conclusion: The Begusarai district falls in mild public health problem for IDD as TGR is more than 5% and even after many decades of effort towards achieving an adequately salt iodization of more than 90%, it is 79% only.

Heart failure decompensations accounts for over one million hospitalizations annually and are the most common cause of US hospital admission in patients over 65. While this results in a reduced quality of life for patients, hospital admissions within 30 days of discharge for heart failure are not reimbursed, making this patient population incredibly expensive for hospitals to treat. US expenditure on heart failure exceeds $30 billion annually and is projected to rise by 127% to nearly $70 billion by 2030 as the population ages. Scheduling a follow up appointment within one week of discharge has been shown to reduce rates of readmission. This quality improvement initiative is aimed at improving post-discharge follow up rates in a tertiary referral hospital. The affiliated follow up clinic uses a different electronic medical record (EMR) system, so a system of cross-communication is key. The initial intervention introduced an EMR order that, once placed in the inpatient setting, created an appointment request in the follow up clinic. The cardiology consult nurse practitioner was assigned and educated about the task of entering this follow up order. With this intervention, an increase the number of confirmed follow up appointments scheduled by discharge for patients admitted with acute decompensated heart failure was expected. The initial intervention of introducing an EMR order resulted in a median of 18 patient referrals per month over a period of 5 months. The intervention of introducing a dedicated nurse practitioner the task of placing the order resulted in an increase to 25 orders in the next month. Similarly, the percentage of completed referrals increased from 29% over 5 months to 44% in the last month when a dedicated nurse practitioner was tasked with placing the order for follow up. In recognizing the delicate process of discharging patients with heart failure decompensations, a unified process to organize follow up in a tertiary referral hospital was necessary to communicate with the affiliated clinic. This initial intervention shows promise that continuity of care can be established in an intricate medical system. Further interventions include better equipping the cardiology clinic with personnel to accommodate for the bolus of new post-discharge follow up appointments.

9530 Background: Treatment with PD-1 inhibitor-based therapy has significantly improved survival in patients with metastatic melanoma over the past decade. Many of these patients achieve complete metabolic response (CMR) by FDG-PET/CT and electively stop treatment. However, the outcomes of patients who relapse after CMR remain uncertain. In this study, we attempt to further characterize metastatic melanoma patients who relapsed following elective discontinuation of anti-PD-1 based therapy due to CMR. Methods: We performed a single-center, retrospective analysis on a cohort of patients with metastatic or unresectable melanoma from 2012 to 2021 who were treated with anti-PD-1 monotherapy (pembrolizumab or nivolumab) or combination ipilimumab/nivolumab (I/N), with or without local therapies (surgery or radiation therapy). Patients who achieved a CMR from treatment were identified. CMR was defined as no evidence of metabolically active disease on full-body 18F-FDG-PET/CT and no evidence of new intracranial metastasis on MRI brain. Multiple clinical variables and survival outcomes were assessed. Results: Among 386 advanced stage melanoma patients analyzed, 87 achieved a CMR followed by elective treatment cessation with a median anti-PD-1 therapy duration of 10.4 months. 19/87 patients had brain metastasis at baseline. 17/87 patients had disease relapse with a median time to relapse from CMR of 12.1 months. Of those 17 patients, 8 received I/N, 9 received anti-PD-1 monotherapy, and 2 required local therapies to obtain CMR. 7/17 patients were able to achieve CMR again following resumption of anti-PD-1 monotherapy (n = 6) and BRAF/MEK targeted therapy (n = 1). 10/17 patients relapsed in the brain with 7 of those patients having no history of brain metastasis at baseline. Median overall survival after relapse from CMR was 34.1 months. The most common cause of death following relapse from CMR was brain metastasis progression (n = 5). Conclusions: A small proportion of metastatic melanoma patients who achieve complete metabolic (CMR) following treatment with anti-PD-1 therapy develop disease relapse. We found that relapse in the brain is common, regardless of baseline involvement at time of therapy, and is a common cause of mortality suggesting the importance of intracranial surveillance following treatment cessation. Ongoing studies are warranted to identify clinicopathologic factors that predict relapse to better inform patients and providers who elect to stop anti-PD-1 therapy.

Branched-chain amino acids (BCAAs) belong to the group of essential amino acids having diverse physiological and metabolic roles. The controversy regarding impact of BCAAs supplements in improving the metabolic health still remains in spite of the sufficient understanding regarding pathogenesis of metabolic disorders. Several basic and clinical studies have advocated the use of BCAAs, besides that, a high risk of metabolic disorders, type 2 diabetes mellitus (T2DM) and insulin resistance (IR) has been associated with increased BCAA plasma level. In this review, the current understanding of the functional impact of BCAAs supplementation in the development and physiology of metabolic disorders will be critically analyzed. Furthermore, the effects of impaired BCAA metabolism based on metabolomic and proteomic studies in human and animal models will be discussed which may open a new vista in the management of metabolic disorders in near future.

Numerical studies on straight and spiral capillary tubes are addressed for the CO2 and R22 refrigerant. A homogenous, one-dimensional steady-state adiabatic flow model is developed using fu...

India's state of Bihar has suboptimal quality of pre-service training for auxiliary nurse midwives. To address this, state government of Bihar implemented a blended training model to supplement conventional classroom teaching with virtual training. A 72-hour virtual training package with updated content on key maternal and newborn health practices was developed for final year students and broadcasted from one instructor location simultaneously to two auxiliary nurse midwives training centres. This pre-post intervention study compared skills of two auxiliary nurse midwife student cohorts. Eighty-five students from pre-intervention cohort of academic year 2012-13, received only conventional teaching during the final year. The 51 students in the post-intervention cohort from successive academic year 2013-14, received a combination of the both conventional and virtual training. The two cohorts were objectively assessed on identified midwifery skills. A passing score was set at achieving 75% or higher. The students exposed to blended learning scored 32.57 points (p = 0.001) more than their counterparts, who received only conventional teaching. In the post-intervention cohort, 55% students (N = 28) passed as compared to none in the pre-intervention cohort. We found blended learning approach effectively improved access to quality training, and identified key midwifery skills of auxiliary nurse midwife students from remote locations.

Background The high focus states of India have higher maternal and neonatal mortality rates as compared to the national average. The quality of pre-service education (PSE) in nursing midwifery institutions in these states was found to be suboptimal. In 2013, Government of India implemented the PSE strengthening program across all public sector nursing midwifery institutions. The program focused on strengthening educational processes, training infrastructure, institutional management and clinical site practices by implementing a set of performance standards. Objective To evaluate the effect of PSE strengthening program on institutional performance and maternal neonatal health (MNH) related competences of nursing midwifery students and faculty. Design Single group pre-post intervention study. Settings 15 sampled public sector nursing midwifery institutions in the states of Madhya Pradesh and Odisha, India. Participants Final-year students and faculty involved in teaching MNH subjects. Methods Performance of 15 sampled institutions was assessed at baseline, midline and endline using the performance standards. Additionally, competences of 232, 295 and 298 students and 64, 62 and 63 faculty members at baseline, midline and endline respectively were assessed on six MNH related practices using objective structured clinical examination (OSCE). Results None of the institutions met 70% standards during baseline. At endline, 13 of the 15 institutions met these standards. The mean OSCE scores of students and faculty at baseline was 17.1 (SD: 8.0) and 23.5 (SD: 14.3) out of 76 respectively. It significantly increased to 66.4 (SD: 8.0) and 71.1 (SD: 5.2) during the endline. The proportion of students and faculty found competent (achieved 75% in OSCE) also significantly increased from none at baseline to 91% and 98% respectively, at endline. Conclusion The combination of attributes included in the PSE strengthening program may have contributed to improvements in institutional performance as well as MNH related competences of nursing midwifery students and faculty.

Solar heat gain through windows is a significant factor in determining the cooling load of buildings. External shading devices are extensively used in buildings to reduce the cooling load. However, use of shading devices reduces illuminance level inside the room which in turn increases the use of artificial lighting. A case study is carried out to study the impact of four different types of shading devices on solar gain, cooling load, lighting gain and illuminance level in four rooms facing west facade at hostel building located in coastal area near Mumbai. A computerized simulation tool (IES ) is used to carry out the investigations. The results indicate that egg-crate and diagonal fins shading devices perform better compared to other shading devices. Peak cooling load is reduced by about 28% with egg-crate shading device with 500 lx illuminance level.

Air gets heated while passing through the desiccant wheel in a hybrid air conditioning system and needs to be cooled before passing to cooling coil. This hot air can be an effective heat source for the air source heat pump to heat the water. The present work includes experimental investigation of the dehumidifier integrated hybrid R-407C air source water heat pump under different air temperature to achieve hot water. The results exhibit that heating capacity increases by 15% by increasing the air-source temperature from 30 to 45 °C. End loop COP of the system is reduced by 25%.

Helically coiled capillary tubes flow is characterized for transcritical CO 2 refrigerant numerically, developing theoretical model established on fundamental equations of mass, energy and momentum considering homogeneous two phase flow. Various friction factors models are compared, present in the open literature. The results obtained from the present model are fairly matches with the simulation results Mori & Nakayama and Schmidt friction factors agree reasonable well with mean average error of 2.2% and 5.7% for R744, respectively. The present model may be used to design helical capillary tubes working with CO 2 refrigerant.

Objective: Researchers have started proposing the use of natural refrigerants like CO 2 and N 2 O in place of CFCs and HCFCs. The cycles using these refrigerants operate in transcritical region. Thus, there is a scope of combined power generation with cooling. This has been analyzed in this work. Methods: The energetic and exergetic analysis are carried out on transcritical CO 2 and N 2 O combined power and refrigeration cycles. The equations thus generated for COP and exergetic efficiency are studied for their behavioral dependence on various influencing parameters like evaporator temperature, gas cooler outlet temperature, gas heater pressure and turbine inlet temperature. In the entire analysis the standard property code is used in the program for evaluation of properties. Findings: For a comparison, the Grassmann diagrams for both CO 2 based and N 2 O based combined power and refrigeration cycles have been presented at a given operating condition. It is noticed that the performances of transcritical N 2 O combined power cycle is better than transcritical CO 2 combined power cycle as it has higher COP and exergetic efficiency under all operating conditions. It is also found that there exists an optimum evaporator temperature at which the exergetic efficiency attains maximum value. Specific exergy loss is found more for throttle valve and compressor. Application: The natural gas based combined power and refrigeration cycle can be used in large applications like cooling and heating in ships or large ice plants etc.

The flow characteristics of CO2 refrigerant are numerically studied for an adiabatic spirally coiled capillary tube employing choked flow conditions. The mass, momentum and energy conservation equations are used to develop a numerical model. The existing model is verified with the published results. The choked flow behavior at various geometric parameters viz. tube diameter and spiral pitch is studied. Similarly, the influence of these parameters on the mass flow rate through the tube is observed. A significant change in mass flow rate is due to a change in tube diameter, whereas a minimal variation is observed with the change in surface roughness and spiral pitch. Moreover, it is observed that the coiling effect has a significant influence on the flow behavior of the spiral capillary tube. As the pressure decreases, from unchoked to the choked pressure in the evaporator by 63.46%, the mass flow rate increases by 9.46% only. The capillary tube choking is circumvented by increasing spiral pitch, tube diameter and decreasing the length of the tube. A unique nomogram is developed that gives the best understanding of choked and unchoked flow conditions, that graphical representation is useful to design the spirally coiled capillary tube. By using that, the choked length is identified for the known mass flow rate, even more, the choked mass flow rate is known for a given tube length. Moreover, for the given tube length and evaporator temperature, a nomogram is useful to the known choked values of mass flow rate and exit values of the evaporator pressure and quality of refrigerant.

Over 70 million women of reproductive age are undernourished in India. Most poverty alleviation programs have not been systematically evaluated to assess impact on women’s empowerment and nutrition outcomes. National Rural Livelihoods Mission’s poverty alleviation and livelihoods generation initiative is an opportune platform to layer women’s nutrition interventions being tapped by project Swabhimaan in three eastern Indian states—Bihar, Chhattisgarh and Odisha. A cross-sectional baseline survey covering 8755 mothers of children under-two years of age, one of the three primary target groups of program are presented. Standardized questionnaire was administered and anthropometric measurements were undertaken from October 2016 to January 2017. 21 indicators on women’s empowerment, Body Mass Index and Mid-upper Arm Circumference for nutrition status, food insecurity indicators as per the Food Insecurity Experience Scale and selected indicators for assessing women’s access to basic health services were included. National Rural Livelihoods Mission operates in contexts with stark social and gender inequalities. Self-help group members exhibited better control on financial resources and participation in community activities than non-members. Using Body Mass Index, at least 45% mothers were undernourished irrespective of their enrolment in self-help groups. Higher proportion of self-help group members (77%-87%) belonged to food insecure households than non-members (66%-83%). Proportion of mothers reporting receipt of various components of antenatal care service package varied from over 90% for tetanus toxoid vaccination to less than 10% for height measurement. Current use of family planning methods was excruciatingly low (8.2%-32.4%) in all states but positively skewed towards self-help group members. Participation in monthly fixed day health camps was a concern in Bihar. Layering women’s nutrition interventions as stipulated under Swabhimaan may yield better results for women’s empowerment and nutrition status under National Rural Livelihoods Mission. While this opportunity exists in all three states, Bihar with a higher proportion of matured self-help groups offers more readiness for Swabhimaan implementation.

I gave an introduction to our team on rounds, “Liliana* is a 9-year-old female who presented with fevers and status epilepticus due to influenza encephalitis, now working on oral intolerance.” I paused. “Actually, before we go in, I believe Liliana would feel overwhelmed with all of us in the room. Would it be possible for only the essential personnel to come in?” “Of course,” responded Dr Agrawal, the attending pediatrician, “How is she doing?” “She is still not eating or interacting much. But, I finally got her in contact with her mom in Honduras last night. It almost broke my heart.” Dr Agrawal, the upper level resident, and I then put on the personal protective equipment of gowns, face masks, and gloves before proceeding into the room. Liliana was a thin, withdrawn girl lying in bed with a nasogastric tube in place and her “sitter” from the shelter at the bedside. The upper level resident stated in Spanish, “Liliana, good morning. How are you feeling?” No answer. She looked at us with a blank stare. “Are you hungry?” Silence. “Does anything hurt?” She turned her back to us in bed. The upper level resident noticed the doll … Address correspondence to Neeraj Agrawal, MD, Department of Pediatrics, Section of Hospital Medicine, Texas Children’s Hospital, 1102 Bates Ave, FC 1860, Houston, TX 77030. E-mail: nagrawal{at}bcm.edu

Our objective was to learn the possible effects of fixed orthodontic therapy on the periodontium of the extraction sites adjacent to canines and first molars. This was a prospective cohort study.Sixty-two systemically healthy subjects were selected. The study was divided into the period of oral hygiene instructions and the period of active orthodontic treatment. Plaque index, gingival index, probing pocket depth, and clinical attachment loss were recorded for the canines and first molars at baseline, after 1 month of orthodontic therapy, and every 3 months until the completion of the orthodontic treatment.There was a statistically significant increase in all clinical parameters (plaque index, gingival index, probing pocket depth, and attachment loss; P 0.05) on the first molars compared with the canines. Significant increases in attachment loss were noted in both the canines (baseline, 0.06 ± 0.01 mm; end of treatment, 0.17 ± 0.02 mm) and the molars (baseline, 0.07 ± 0.01 mm; end of treatment, 0.20 ± 0.02 mm).Attachment loss cannot be explained solely by the effect of plaque or the banding of teeth. Other factors such as tooth extractions adjacent to the canines, tooth movement, and occlusal trauma may have contributing roles in the loss of periodontal support in adolescent patients.

HLA-B27 is having strong association to ankylosing spondylitis (AS) and other inflammatory diseases collectively known as seronegative spondyloarthropathy. In literature, although the evidence for association between AS and periodontitis as well as AS and HLA-B27 are there but the association of aggressive periodontitis in HLA-B27 positive patient with AS are not there. We hypothesize that there may be a common pathogenesis in aggressive periodontitis and ankylosing spondylitis in HLA-B27 patient. A 27-years-old female presented with the features of generalized aggressive periodontitis and difficulty in walking. On complete medical examination, ankylosing spondylitis was diagnosed with further positive HLA-B27 phenotype and negative rheumatic factor. This report may open up a new link to explore in the pathogenesis of aggressive periodontitis.

The increased prevalence of cardio-metabolic disorders worldwide prompted the exploration of new strategies for its treatment. Peroxisome Proliferator activated receptor (PPAR) play major role in regulation of lipid as well as glucose metabolism and thus, natural PPARγ activators seem to be drug of choice. Aims In the present work, we studied norbixin which is a natural apocarotenoid derivative for its agonistic activity for PPAR γ followed by in vivo studies for amelioration of cardio-metabolic syndrome (CMetS). Main methods The methods include computational studies, TR-FRET binding analysis and in vivo studies on high fat diet induced rats. Key findings Molecular docking and molecular dynamics (MD) simulation studies showed that norbixin could be embedded into hydrophobic pocket of PPARγ and stable hydrogen bonding interactions were found with residues Glu273, Tyr327, Ser289, His323, His449 and Tyr473 of PPARγ. These results were substantiated by significant in vitro PPAR agonistic activity of norbixin in TR-FRET binding assay studies. The experimental results of norbixin in high fat diet induced CMetS in rats further confirmed that norbixin decreased insulin resistance (IR), hyperglycemia and dyslipidemia. These results were accompanied by reduced inflammatory marker hs-CRP as well as decreased oxidative stress and arterial pressure. The histopathology of heart sections also showed that norbixin could prevent the abnormal fibrotic changes in heart. Furthermore, PPARγ protein expressions were increased, whereas NF-κB expression was decreased by norbixin treatment in western blot studies. Significance These results validate norbixin as a novel PPARγ agonist and prove therapeutic potential of norbixin in treatment of CMetS.