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Background and Aims: Perineural catheters inserted through the costoclavicular (CC) technique of infraclavicular brachial plexus are helpful for postoperative analgesia. This trial compared postoperative local anaesthetic (LA) consumption in an ultrasound (US)-guided perineural catheter inserted by the CC technique with the conventional lateral sagittal (LS) technique. Methods: Eighty American Society of Anesthesiologists (ASA) I/II patients scheduled for upper limb orthopaedic surgery were randomly assigned to receive a perineural catheter by either the CC technique (Group CC) or LS technique (Group LS). Postoperatively, all patients received patient-controlled regional analgesia (PCRA): bolus-only regime with 0.125% bupivacaine 6 ml and a lock-out interval of 20 minutes. The primary outcome was the 24 h LA consumption. The secondary outcomes were time of activation of PCRA, pain scores, patient satisfaction scores, and block-related complications. Categorical variables are presented as frequency, while continuous variables are expressed as mean [standard deviation (SD)] or median [interquartile range (IQR)]. An independent t-test or Mann–Whitney U-test was used to compare these continuous variables. A P value less than 0.05 was considered to be statistically significant. Results: Patients in Group CC required less LA 24 h postoperatively (P < 0.001) and more time to activate PCRA (P = 0.003). The mean 24 h LA requirement was 83.35 (SD: 31.92) in Group CC as compared to 121.40 (SD: 48.51) ml in Group LS. They also reported better satisfaction scores (P = 0.001). Pain scores were comparable at all time points. Postoperatively, one patient in Group CC complained of paraesthesia, which subsided on removal of the catheter. Conclusion: Patients receiving post-operative analgesia by the CC catheter require lesser 24 h LA and report better satisfaction than those receiving analgesia through the LS technique.

Background: Development of obscured fingerprints on a diverse range of surfaces is a crucial aspect of forensic investigations. Aims and Objectives: In this particular study, the utilization of Syzygium cumini (L.) Skeels (Jamun) seed powder was examined for the purpose of revealing hidden fingerprints on a variety of surfaces, including both permeable and impermeable substrates. Materials and Methods: The seed powder was extracted using a simple process and was analysed using multiple analytical techniques. The efficacy of the jamun seed powder in developing latent fingerprints was evaluated. Results: The findings of this investigation demonstrate that the jamun seed powder was capable of producing fingerprint patterns of exceptional quality and clarity on numerous surfaces. Conclusion: This research highlights the potential use of jamun seed powder as a practical and effective alternative for the development of hidden fingerprints in forensic investigations, while also providing cost-effectiveness.

Background: In the dynamic medical landscape, anesthesiology plays a pivotal role in ensuring patient safety and comfort during surgeries. Central to this is endotracheal intubation, a critical procedure for securing the airway under anesthesia. Innovations such as King Vision and Airtraq video laryngoscopes offer enhanced glottis visualization and Cormack Lehane scores compared to direct laryngoscopy, with a shorter learning curve. This study aims to assess King Vision and Airtraq’s efficiency in terms of laryngoscopy time, Cormack and Lehane grading, and single-attempt success rate, the number of intubation attempts and endotracheal intubation duration. Methodology: We conducted a study involving 90 patients, aged 20–40 years, undergoing elective surgeries in Departments of General Surgery, ENT, and Gynecology under General Anesthesia. They were divided into two groups, Group K (King Vision) and Group A (Airtraq). Anesthesiologists with at least 40 prior intubations using both devices performed intubations. Preoperative assessments included Alprazolam and Ranitidine, fasting for 8 h, and vital sign monitoring. Anesthesia induction comprised fentanyl, propofol, and succinylcholine, with Macintosh laryngoscopy as a backup. Anesthesia maintenance included nitrous oxide, oxygen, isoflurane, and rocuronium, while parameters were diligently recorded. Results: Our results indicate comparable age and gender distributions between Airtraq and King Vision groups, as well as no differences in Mallampati grading. Kings Vision showed significantly faster laryngoscopy and quicker intubation. Most patients required only one intubation attempt in both groups. Cormack and Lehane grading was unaffected by device choice. Conclusion: Our study shows that both Airtraq and King Vision perform similarly across patient characteristics, but King Vision offers faster laryngoscopy and intubation times, ideal for urgent airway management.

Abstract Background Professionalism among nurses plays a critical role in ensuring patient safety and quality care and involves delivering competent, safe, and ethical care while also working with clients, families, communities, and healthcare teams. Aims and objectives To assess the level of nursing professionalism and the factors affecting professionalism among nurses working at a tertiary care center in India. Methods A descriptive cross-sectional study was conducted from October 2022 to March 2023 using a total enumeration sampling technique. Following institutional ethics committee approval, standardized tools were administered consisting of Nursing Professionalism Scale and socio-demographic, personal, and organizational characteristics. Results A total of 270 nurses participated, with a response rate of 93.7%. The mean age of the participants was 27.33 ± 2.75 years, with the majority being female (82.6%) and belonged to the age group of 23–27 years (59.6%). More than half of the nurses exhibited high professionalism (53%), with the highest and lowest median scores for professional responsibility (29.0) and valuing human beings (13.0) respectively. Multivariate regression analysis demonstrated that, compared with their counterparts, nurses with a graduate nursing qualification (AOR = 4.77, 95% CI = 1.16–19.68), up-to-date training (AOR = 4.13, 95% CI = 1.88–9.06), and adequate career opportunity (AOR = 33.91, 95% CI = 14.48–79.39) had significant associations with high nursing professionalism. Conclusion/Implications for practice The majority of the nurses had high professionalism, particularly in the domains of professional responsibility and management. Hospitals and healthcare institutions can use these findings to develop policies and prioritize opportunities for nurses to attend conferences and workshops to enhance their professional values, ultimately leading to improved patient care outcomes. Patient and public contribution No patient or public contribution.

The nucleolar enzyme sirtuin 7 (SIRT7) promotes cancer progression in certain malignancies, likely in part by controlling ribosome biosynthesis. Recently, we discovered that SIRT7 destabilizes the cyclin dependent kinase inhibitor 2A (CDKN2A, known as ARF) within the nucleolus, aiding cancer progression. We propose that targeting nucleolar SIRT7 offers promise for new anti-cancer therapies.

BackgroundIn Southeast Asia, treatment is recommended for all patients with post-kala-azar dermal leishmaniasis (PKDL). Adherence to the first-line regimen, twelve weeks of miltefosine (MF), is low and ocular toxicity has been observed with this exposure period. We assessed the safety and efficacy of two shorter-course treatments: liposomal amphotericin B (LAmB) alone and combined with MF.Methodology/principal findingsAn open-label, phase II, randomized, parallel-arm, non-comparative trial was conducted in patients with parasitologically confirmed PKDL, 6 to ≤60 years. Patients were assigned to 20 mg/kg LAmB (total dose, in five injections over 15 days) alone or combined with allometric MF (3 weeks). The primary endpoint was definitive cure at 12 months, defined as complete resolution of papular and nodular lesions and >80% re-pigmentation of macular lesions. Definitive cure at 24 months was a secondary efficacy endpoint. 118/126 patients completed the trial. Definitive cure at 12 months was observed in 29% (18/63) patients receiving LAmB and 30% (19/63) receiving LAmB/MF (mITT), increasing to 58% and 66%, respectively, at 24 months. Most lesions had resolved/improved at 12 and 24 months for patients receiving LAmB (90%, 83%) and LAmB/MF (85%, 88%) by qualitative assessment. One death, unrelated to study drugs, was reported; no study drug-related serious adverse events were observed. The most frequent adverse drug reactions were MF-related vomiting and nausea, and LAmB-related hypokalaemia and infusion reactions. Most adverse events were mild; no ocular adverse events occurred.Conclusions/significanceBoth regimens are suitably safe and efficacious alternatives to long-course MF for PKDL in South Asia.Trial registrationCTRI/2017/04/008421.

Rose is a commercially significant floricultural crop that has been used for various industrial as well as decoration purposes. Along with the beautification of rose flowers, their leaves are enriched with different biologically active compounds having various therapeutic uses. The current study was performed on the phytochemical and antioxidant activity of aqueous extracts of rose leaves. In our study, we found there are consequential variations observed in all the parameters, viz., total chlorophyll, carotenoids, total anthocyanin, total phenol, flavonoids, and antioxidant activity, among all the varieties. Among the ten varieties, Thelma Barlow revealed the maximum phenolic content (35.19 mg/g FW), flavonoids content (15.97 mg/g FW), 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging activity of IC50 value (206.86 ± 0.49 µg/mL), and 2,2′-azinobis (3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) (301.62 ± 2.31 µg/mL). The variety Grand Amore presented the highest values for total chlorophyll (1.41 mg/g FW) and carotenoids (36.29 mg/g FW) content compared to other varieties. Also, a comparative correlation was studied amongst the phytochemicals such as anthocyanin content, total phenolic content, flavonoids, and antioxidant activities. Amongst the different rose varieties, Grand Amore and Thelma Barlow contain higher antioxidant potential, owing to their greater phytochemical activity. From our findings, we collectively concluded that fresh rose leaves contain potentially higher phenolic and flavonoid content, i.e., are responsible for higher antioxidant activity, which can be utilized for various pharmacological as well as food industries.

Abstract Many plants possess immense pharmacological properties because of the presence of various therapeutic bioactive secondary metabolites that are of great importance in many pharmaceutical industries. Therefore, to strike a balance between meeting industry demands and conserving natural habitats, medicinal plants are being cultivated on a large scale. However, to enhance the yield and simultaneously manage the various pest infestations, agrochemicals are being routinely used that have a detrimental impact on the whole ecosystem, ranging from biodiversity loss to water pollution, soil degradation, nutrient imbalance and enormous health hazards to both consumers and agricultural workers. To address the challenges, biological eco-friendly alternatives are being looked upon with high hopes where endophytes pitch in as key players due to their tight association with the host plants. The intricate interplay between plants and endophytic microorganisms has emerged as a captivating subject of scientific investigation, with profound implications for the sustainable biosynthesis of pharmaceutically important secondary metabolites. This review delves into the hidden world of the "secret wedlock" between plants and endophytes, elucidating their multifaceted interactions that underpin the synthesis of bioactive compounds with medicinal significance in their plant hosts. Here, we briefly review endophytic diversity association with medicinal plants and highlight the potential role of core endomicrobiome. We also propose that successful implementation of in situ microbiome manipulation through high-end techniques can pave the way towards a more sustainable and pharmaceutically enriched future.

Abstract Chemokine receptors constitute an important subfamily of G protein-coupled receptors (GPCRs), and they are critically involved in a broad range of immune response mechanisms. Ligand promiscuity among these receptors makes them an interesting target to explore multiple aspects of biased agonism. Here, we comprehensively characterize two chemokine receptors namely, CXCR4 and CXCR7, in terms of their transducer-coupling and downstream signaling upon their stimulation by a common chemokine agonist, CXCL12, and a small molecule agonist, VUF11207. We observe that CXCR7 lacks G-protein-coupling while maintaining robust βarr recruitment with a major contribution of GRK5/6. On the other hand, CXCR4 displays robust G-protein activation as expected but exhibits significantly reduced βarr-coupling compared to CXCR7. These two receptors induce distinct βarr conformations even when activated by the same agonist, and CXCR7, unlike CXCR4, fails to activate ERK1/2 MAP kinase. We also identify a key contribution of a single phosphorylation site in CXCR7 for βarr recruitment and endosomal localization. Our study provides molecular insights into intrinsic-bias encoded in the CXCR4-CXCR7 system with broad implications for drug discovery.

Abstract Exposure to benzene and other volatile organic compounds (VOCs) like toluene, ethylbenzene, o-, m-, and p-xylene (BTEX) at a fuel station is hazardous for the workers. This study aims to estimate the health risk for worker due to the exposure of BTEX after implementation of vapour recovery system (VRS) at fuel stations. Air samples were collected using low-flow sampling pump as per NIOSH method by using Tenax (sorbent) tubes and charcoal (sorbent) tubes. Target compounds were extracted using acetone and analysed by gas chromatography equipped with flame ionization detector (FID). The cancer risk (CR) and hazard quotient (HQ) were estimated to assess the cancer and non-cancer risk following the United States of Environmental Protection Agency (USEPA) updated methodology. The average concentration of VOCs at the fuel station is found in the order toluene > benzene > xylene > ethylbenzene which may be attributed to the composition of fuel (petrol/diesel). Benzene is the most carcinogenic among BTEX, which is found to be 217 ± 9 µg m−3 and 158 ± 9 µg m−3 in the month of November 2021 using Tenax sorbent and charcoal sorbent tubes, respectively. The high concentration observed using Tenax sorbent may be attributed to its high adsorption efficacy than charcoal due to larger surface area and porosity. The 7-month average CR value of benzene was 9 × 10−4 using Tenax sorbent and exceeds the acceptable range of 1 × 10−6. CR of benzene exposure at the fuel station under study is also compared with that of outdoor ambient air exposure. Benzene measurement data for the same duration was taken from nearby online monitoring station of Delhi Pollution Control Committee (DPCC) PUSA to estimate CR value for outdoor ambient air benzene exposure. The value of HQ for benzene was observed > 1 which exceeds the acceptable value and hence increased the non-cancer health risk also. Hazard index (HI) value for BTEX is also greater than 1 which indicates adverse health effects of benzene and other VOCs at the fuel station. The high CR and HQ values for benzene are a matter of concern for fuel station workers.

p53 is a hallmark tumor suppressor due in part to its role in cell cycle progression, DNA damage repair, and cellular apoptosis; its protein activity interrelates with the Sirtuin family of proteins, major regulators of the cellular response to metabolic, oxidative, and genotoxic stress. In the recent years, mammalian Sirtuin 7 (SIRT7) has emerged as a pivotal regulator of p53, fine-tuning its activity in a context dependent manner. SIRT7 is frequently overexpressed in human cancer, yet its precise role in tumorigenesis and whether it involves p53 regulation is insufficiently understood. Depletion of SIRT7 in mice results in impaired embryo development and premature aging. While p53 activity has been suggested to contribute to tissue specific dysfunction in adult Sirt7−/− mice, whether this also applies during development is currently unknown. By generating SIRT7 and p53 double-knockout mice, here we show that the demise of SIRT7-deficient embryos is not the result of p53 activity. Notably, although SIRT7 is commonly considered an oncogene, SIRT7 haploinsufficiency increases tumorigenesis in p53 knockout mice. Remarkably, in specific human tumors harboring p53 mutation, we identified that SIRT7 low expression correlates with poor patient prognosis. Transcriptomic analysis unveils a previously unrecognized interplay between SIRT7 and p53 in epithelial-to-mesenchymal transition (EMT) and extracellular matrix regulation with major implications for our understanding of embryonic development and tumor progression.

Hypernatremia is a frequent and potentially life-threatening condition in hospitalized patients. It is a disorder of water metabolism and is usually defined as a plasma sodium concentration above 145 mEq/L. The treatment of severe cases of hypernatremia might be challenging in patient with feeding jejunostomy. The average person’s GI tract secretes and reabsorbs around 7 L of gastrointestinal fluid (including 3-5 L originating above the pylorus alone). These 7 L of gastrointestinal fluid will significantly dilute whatever we consume or infuse. However, this dilution of enteral feed may be bypassed in by feeding jejunostomy. There are very few cases reported on extreme hypernatremia. We present a case of severe hypernatremia in patient with feeding-jejunostomy, managed successfully with the recommended correction.

Background and Aims: Surgical procedure commonly performed in the advanced pediatric age group includes urogenital surgery, adenotonsillectomy, etc., Aim: The aim of this study is to determine the effect of single-dose gabapentin 15 mg/kg on acute pain in the immediate postoperative period in patients aged 8–14 years undergoing surgeries under general anesthesia. Material and Methods: After the approval from the institutional ethical committee, 60 American Society of Anesthesiologists (ASA) I and II patients aged 8–14 years undergoing urogenital surgeries (orchidopexy/urethroplasty) under general anesthesia were included in this study. The patients were assigned into one of the two treatment groups. Patients in group I received oral gabapentin 15 mg/kg dissolved in 5 mL of honey 2 h before surgery, while patients in group II received 5 mL honey orally 2 h before surgery. Results: A total of 60 patients participated. Patients in group I had lower consumption of fentanyl perioperatively (intraoperatively: 1.36 ± 0.70 mcg/kg; postoperatively: 2.36 ± 0.795 mcg/kg) than group II (intraoperatively: 1.8 ± 0.6 mcg/kg; postoperatively: 2.9 ± 0.47 mcg/kg). The differences in the two groups were significant. The time to first rescue analgesia was greater in group I (3.03 ± 0.60 h) than in group II (2.26 ± 0.57 h). There was an increase in sedation score in the treatment group. Conclusion: Our clinical study demonstrates that a 15 mg/kg single preemptive oral dose of gabapentin might reduce the requirement of analgesics perioperatively in pediatric urogenital surgery but might also be associated with undesirable effects such as increased sedation.

Background and Aims: Hip replacement surgery is a commonly performed surgery with the aim of improving mobility in patients suffering from hip conditions. Though the modified suprainguinal approach of fascia iliaca block (SFIB) is commonly used, the analgesic efficacy is moderate and is associated with quadriceps weakness. The pericapsular nerve group (PENG) block has been used to block the sensory articular branches of the hip joint in various hip surgeries. This study aimed to compare SFIB with PENG block in terms of pain relief, opioid consumption and their adverse effects in patients undergoing primary total hip arthroplasties. (THA). Methods: Seventy ASA I/II patients undergoing primary THA were enrolled in this double-blinded, randomized trial. Patients were randomly allocated to one of the two groups: Group P: ultrasound (US)-guided PENG block and Group S: patients received the US-guided SFIB. Results: Postoperatively, there was statistically significant difference in numerical rating scale (NRS) scores at all-time intervals. Total morphine consumption in 24 hours and 48 hours was statistically more in SFIB group. Five patients had quadriceps weakness in the SFIB group. There was no difference in any other adverse effects. Conclusion: US-guided PENG block significantly reduces perioperative morphine consumption and pain scores in THA patients when compared to SFI block. It is not associated with quadriceps weakness as seen in SFIB.

Abstract Current study signifies the use of nanoparticles as alternative in plant disease management to avoid harmful effect of pesticide and fungicide residue. Synthesis of nanoparticles (Ni0.5Al0.5Fe2O4) by hydrothermal method and studied their X-ray diffraction analysis (XRD), Raman spectra, and UV spectra and further successfully evaluated for antifungal activity against a soil and seed borne pathogenic fungus (Fusarium oxysporum).Among various pests, fungal pathogens are the main cause of crop destruction and we developed nanoparticles (Ni0.5Al0.5Fe2O4) which is successfully evaluated for antimycotic activity against dry rot (F. oxysporum) of ginger which causes 50–70% losses in the ginger plant. In vitro and in vivo analysis designated that the nanoparticles (Ni0.5Al0.5Fe2O4) has shown an excellent antifungal activity against F. oxysporum at 0.5 mg/ml concentration. Similarly, no disease incidence was recorded when Ni0.5Al0.5Fe2O4 nanoparticles used at 0.5 mg/ml concentration under in vivo conditions. In plants various environmental stresses (biotic and abiotic) leads to excessive production of reactive oxygen species (ROS) causing progressive oxidative damage and ultimately leads to cell death. The role of ROS in nanoparticles (Ni0.5Al0.5Fe2O4) represents by reduction in the growth inhibition of F. oxysporum. We speculated in light of these results that the cytotoxic effect of Ni0.5Al0.5Fe2O4 nanoparticles on F. oxysporum may be mediated through ROS. We can suggest the role of nanoparticles (Ni0.5Al0.5Fe2O4) gives a promising result as a fungicidal activity and could be a novel family of future new generation fungicide.

Abstract Background Intrinsic pathway of apoptosis is generally mediated by BCL-2 (B cell lymphoma 2) family of proteins; they either induce or inhibit the apoptosis. Overexpression of BCL-2 in cancer cell may lead to delay in apoptosis. BCL-w is the pro-survival member of the BCL-2 family. BCL2L2 gene is present on chromosome number 14 in humans, and it encodes BCL-w protein; BCL-w protein is 193 amino acids residues in length. Interactions among the BCL-2 proteins are very specific. The fate of cell is determined by the ratio of pro-apoptotic proteins to pro-survival proteins. BCL-w promotes cell survival. Studies suggested that overexpression of BCL-w protein is associated with many cancers including DLBCL, BL, colorectal cancers, gastric cancers, and many more. The cause of overexpression is translocations or gene amplification which will subsequently result in cancerous activity. Process For in-silico analysis, BCL2L2 gene was retrieved from UniProt (UniProt ID: Q92843). 54 missense variants have been collected in BCL-w proteins from COSMIC database. Different tools were used to detect the deleteriousness of the variants. Result In silico mutational study reveals how the non-synonymous mutations directly affect the protein’s native structure and its function. Variant mutational analysis with PolyPhen-2 revealed that out of 55 variants, 28 of the missense mutations was probably damaging with a score ranging from 0.9 to 1, while 24 variants were benign with a score ranging from 0 to 0.4. Conclusions This in silico work aims to determine how missense mutations in BCL-w protein affect the activity of the protein, the stability of the protein, and to determine the pathogenicity of the variants. Prediction of pathogenicity of variants will reveal if the missense mutation has a damaging effect on the native structure of protein or not. Prediction of protein stability will reveal whether the mutation has a stabilizing or destabilizing effect on the protein.

Rhizosphere is the battlefield of beneficial and harmful (so called phytopathogens) microorganisms. Moreover, these microbial communities are struggling for their existence in the soil and playing key roles in plant growth, mineralization, nutrient cycling and ecosystem functioning. In the last few decades, some consistent pattern have been detected so far that link soil community composition and functions with plant growth and development; however, it has not been studied in detail. AM fungi are model organisms, besides potential role in nutrient cycling; they modulate biochemical pathways directly or indirectly which lead to better plant growth under biotic and abiotic stress conditions. In the present investigations, we have elucidated the AM fungi-mediated activation of plant defense responses against Meloidogyne graminicola causing root-knot disease in direct seeded rice (Oryza sativa L.). The study describes the multifarious effects of Funneliformis mosseae, Rhizophagus fasciculatus, and Rhizophagus intraradices inoculated individually or in combination under glasshouse conditions in rice plants. It was found that F. mosseae, R. fasciculatus and R. intraradices when applied individually or in combination modulated the biochemical and molecular mechanisms in the susceptible and resistant inbred lines of rice. AM inoculation significantly increased various plant growth attributes in plants with simultaneous decrease in the root-knot intensity. Among these, the combined application of F. mosseae, R. fasciculatus, and R. intraradices was found to enhance the accumulation and activities of biomolecules and enzymes related to defense priming as well as antioxidation in the susceptible and resistant inbred lines of rice pre-challenged with M. graminicola. The application of F. mosseae, R. fasciculatus and R. intraradices, induced the key genes involved in plant defense and signaling and it has been demonstrated for the first time. Results of the present investigation advocated that the application of F. mosseae, R. fasciculatus and R. intraradices, particularly a combination of all three, not only helped in the control of root-knot nematodes but also increased plant growth as well as enhances the gene expression in rice. Thus, it proved to be an excellent biocontrol as well as plant growth-promoting agent in rice even when the crop is under biotic stress of the root-knot nematode, M. graminicola.

Background Ultrasound-guided erector spinae plane (ESP) block has been used to provide lumbar analgesia. The craniocaudal spread of local anesthetic in this block can be unpredictable in patients with kyphosis due to backward curvature of the spine, which might prevent longitudinal spread. Case This is a case of a 33-year-old male (60 kg) diagnosed with type 3b kyphosis of the thoracolumbar region at the level of L1 who underwent extended pedicle subtraction osteotomy. ESP block was administered at two different levels, one at T12 (above the angle of the kyphosis L1) and another at L3 (below the angle of kyphosis L1), as the curvature of kyphosis can hinder the longitudinal spread of local anesthetic. Conclusions Two-level ESP block results in better craniocaudal spread of local anesthetic in a patient undergoing kyphosis correction surgery.

Parathyroid adenomas weighing more than 3.5 g are reported variously as “atypical”, “large” or “giant” parathyroid adenomas. All such adenomas are rare variants accounting for no more than 1.5% of all parathyroid adenomas. Large parathyroid adenomas are often associated with more severe form of the disease, including osteitis fibrosa cystica (OFC) and share many biochemical, histological, and molecular features of both benign and malignant parathyroid neoplasms, and are considered a distinct clinical entity. However, the pathogenesis of oversized parathyroid adenomas and the often-associated skeletal phenotype remains unclear. We present 5 cases of primary hyperparathyroidism (PHPT) with OFC, an uncommon manifestation of contemporary PHPT, associated with larger parathyroid adenomas, seen in the Bone and Mineral Disorders Clinic of the Henry Ford Health in the last 30 years to illustrate the critical role of vitamin D nutrition in the pathogenesis of both the OFC and adenoma size. The estimated prevalence of OFC was very low 0.2%, 5 of the >3000 surgically confirmed cases of PHPT seen during this time. The mean ± SD values were: age: 36.8 ± 22.1 years (4 of the 5 10 years of follow-up. Because OFC is a very rare in the West, but very common areas of endemic vitamin D deficiency, we also examined the relationship between vitamin D nutrition, as assessed by serum 25-hydroxyvitamin D level, and parathyroid adenoma weight as well as prevalence of OFC in two large secularly diverse cohorts of patients with PHPT (Detroit, USA and Chandigarh, India). Based on this relationship and the relative prevalence of OFC in these two large cohorts, we propose that vitamin D nutrition (and perhaps calcium nutrition) best explains both the adenoma size and prevalence of OFC.

Chronic kidney disease (CKD) is characterized by loss of kidney function and generally it is associated with several alterations in pulmonary functions, including restriction, obstruction, and impaired diffusion capacity. It became challenging to maintain oxygenation in a CKD patient associated with COVID 19 on non-invasive ventilation (NIV). In patients with end stage renal disease (ESRD), several factors likes, fluid overload, anaemia, immune suppression, extraosseous calcification, malnutrition, electrolyte imbalance, and acid-base disorder affecting the lungs indirectly. Here we are reporting NIV failure in two COVID 19 patients during dialysis. Both patients were stable on NIV before starting dialysis and underwent oxygen desaturation and shifted to invasive mechanical ventilation during hemodialysis. The possible mechanism of the oxygen desaturation is alveolar hypoventilation in the absence of hypercapnia, which may be due to the removal of CO2 from the body by some route (dialysate) other than the lungs.

Bacopa monnieri is the main source of pharmaceutically important bacosides; however, the low content of these molecules in planta remains a limiting factor for fulfilling the industrial requirement. The accumulation of secondary metabolites can be enhanced in plants upon inoculation with endophytes. In this study, we isolated and analyzed the culturable endophytes associated with different plant parts. By analyzing their impact on plant growth parameters (in vitro and in vivo) and Bacoside A content, we found few candidates which increased bacoside accumulation significantly. Finally, two promising endophytes namely Bacillus subtilis (OK070745) and Klebsiella aerogenes (OK070774) were co-cultivated with B. monnieri cuttings singly and in combination mode to clarify their effect on bacoside biosynthesis and their accumulation in B. monnieri shoot. Consortium-inoculated plants significantly enhanced the plant biomass and Bacoside A content with respect to single inoculation. The results of real-time quantitative (RT-PCR) revealed significant accumulation of bacoside biosynthetic pathway transcripts (HMGCR, PMVK, FDPS, SQS, and β-AS) in the case of plants inoculated with microbial combination, while the single inoculation of B. subtilis diverted the plant’s machinery toward the synthesis of phenylpropanoid genes like CCR, CAD, CHS, and HST. In addition, higher expression of MYB 2 and WRKY 1 transcription factors in combinational treatment points out their probable role in better physiological and developmental processes. Altogether, this is the first study on B. monnieri-endophyte interaction showing improvement in the accumulation of bacoside A by modulating various genes of metabolic pathway and thus suggests an effective “green approach” for augmenting in planta production of pharmaceutically important bacosides.

Abstract The study is of great relevance with present day pandemic era where mushrooms have immunity enhancing properties and they convert agro-wastes into protein rich food. India is having a youth population of about 750 million and mushroom cultivation has good potential to contribute in national income as well as enhanced immunity. The key aspects undertaken during research were the spawn production, cultivation methodology, and the suitability of various factors affecting the production and yield attributes of Pleurotus eryngii under ambient conditions in subtropical areas. Study includes yield enhancing substrate, sterilization method, spawn and substrate quantity in the growing of King Oyster i.e. Pleurotus eryngii in subtropical zones. Paddy straw was found to be the best substrate giving the highest biological efficiency and producing maximum number of fruiting bodies which is otherwise burnt by farmers in India and it is a major cause of air pollution. Whereas, maize straw showed fastest spawn run and pin head emergence out of six tested substrates and supplements. But, due to the unavailability of paddy straw in this region, the other straws resulting in optimum yields are to be recommended. Chemical steeping of substrate with chlorine water at 0.4% + carbendazim at 2% + dichlorovos at 0.1% of water used for soaking showed best results in terms of biological efficiency whereas, water and aerated steam treatment of substrate at 85 °C-90°C for about 60–90 min supported the results in leaching of nutrients and thus, biological efficiency gets lower. Out of four spawn rates used, spawn rate of 5% was found significantly best resulting in maximum biological efficiency, fastest mycelial run, primordial initiation and highest average fruit body weight. All the experiments were found statistically significant except the experiment that was performed for evaluating the optimum quantity of substrate for bag preparation. There was not much difference in the obtained yields with respect to increase in the amounts of substrate. So, growing this mushroom from the obtained best results will result in better production with higher income even for the marginal farmers in subtropical zones of world.

INTRODUCTION: Elderly COVID-19 patients admitted to the intensive care unit (ICU) are at high risk of an inflammatory syndrome, hypercatabolic reaction, malnutrition, and physical immobilization. This may result in loss of muscle mass and pulmonary infection leading to prolonged ventilatory support. Factors responsible for muscle mass loss in ICU are (1) microcirculatory disturbances, (2) presence of systemic inflammatory response syndrome (SIRS), (3) sepsis (4) drugs (corticoids, neuromuscular blockers) having inhibitory activity on the nervous system, neuromuscular junction and muscle itself. Mechanism of muscle atrophy in critically ill elderly patients include an imbalance between protein synthesis and degradation. Interventions to manage muscle atrophy for the patients admitted to ICU is also extrapolated to mechanically ventilated COVID-ARDS patients. PURPOSE: Early recognition of factors contributing to intensive care unit acquired weakness (ICUAW) in COVID-19 patients, inflammation, high catabolic phase, steroid use, and paralysis. The potential interventions to target these specific mechanisms and ameliorate muscle dysfunction in COVID-19 patients. CONCLUSIONS:Intensive care unit acquired weakness (ICUAW) in critically ill COVID-19 patients is due to severity of illness, co-morbidities, muscle unloading, or ICU treatments, a systemic reaction circulating within the body, or combinations therein. Furthermore, the availability of a culture model of ICUAW could facilitate in expediting the diagnosis of ICUAW and fast track the discovery of putative treatments. We recommend NIV or HFNC ventilation or early weaning from invasive mechanical ventilation in critically ill COVID-19 elderly patients.

Background: COVID-19 pandemic has been declared as a public health emergency of international concern by the World Health Organization. Being highly contagious in nature, it has become a major concern for healthcare profession. Aims and Objectives: The aim of the study is to assess the medical students' awareness regarding risk perception, disease transmission, and prevention of COVID-19 and to study their source of information and activities affected by lockdown. Materials and Methods: We conducted an online, descriptive cross-sectional study in April–May 2020, using WhatsApp Messenger. Medical students of 1st-year and 3rd-year (posted in community medicine department) in Government Medical College, Haldwani, were approached through convenience sampling. Frequencies and proportions were computed for descriptive purposes. Chi-square test was utilized for statistical significance. Results: A total 244 1st-year and 3rd-year medical students, consisting of 106 (43.4%) males and 138 (56.6%) females, have participated in the study with a mean age of 20.8 (standard deviation 1.66) years. Overall, more students from either batch and gender found the disease very dangerous. TV was the most frequent source of information for their awareness. Almost similar frequency of students felt their social activities/visits affected during the lockdown period. Majority of students were aware about the important clinical features of COVID-19. Most of them agreed upon various modes of transmission severe acute respiratory syndrome coronavirus 2. The most frequently reported source of transmission was going to crowded spaces and exposure to coughing and sneezing. All students agreed for hand washing and avoiding contact with an infected person as the prevention method for COVID-19. Only about one-fourth of the students reported correct distance to be maintained between people. Conclusion: There is a need for regular educational interventions and training programs on infection control practices for COVID-19 to minimize the risk of transmission to healthcare students.

Background and Aims: Forero et al. described two approaches of erector spinae (ES) plane block: superficial and deep to erector spinae muscle. We hypothesised that the superficial technique would not lead to optimum analgesia as the drug would have to cross one more muscle layer. We aimed to compare the techniques in terms of analgesia and sensory blockade in patients undergoing modified radical mastectomy (MRM). Methods: Forty American Society of Anesthesiologists (ASA) I/II female patients in age group 18–60 years undergoing unilateral MRM were included in this prospective study. Group D patients received 20 mL 0.2% ropivacaine deep to erector spinae at the T4 level. Group S patients received 20 mL 0.2% ropivacaine superficial to erector spinae. Sensory level of block, perioperative opioid consumption, and adverse effects were noted. Results: Twenty four hours morphine consumption was less in group D: 5.47 ± 1.1 mg and in group S was 7.66 ± 0.74 mg (P < 0.001). The sensory spread was more in deep group in the posterior axillary and mid axillary line. There were no reported adverse effects in either group. Conclusion: Injection of drug deep to ES muscle provides more cranio-caudal blockade of posterior and lateral chest wall, hence providing better analgesia following breast surgery. Injection of the drug superficial to the muscle leads to inferior analgesia.

Introduction: Asthma is a heterogenic disease, commonly divided into allergic and nonallergic asthma. It affects people of all age group and is associated with impaired lung function. Previously, it was thought that asthma is a disease of developed countries but at present, world scenario has changed and its prevalence in developing countries is rapidly increasing. Asthma shows large geographical variations in terms of prevalence, severity and mortality. Aim: To establish the prevalence of allergic and nonallergic asthma in adults of Kumaun region of Uttarakhand (India) and to evaluate whether the peripheral blood cell count is associated with the severity of lung impairment in both the subtypes (allergic and nonallergic) of asthma. Materials and Methods: This cross-sectional study was carried out jointly in Department of Physiology and Department of Respiratory Medicine, Government Medical College, Haldwani, Uttarakhand (India), during the period from October 2015 to January 2017. A total of 125 patients of both sexes age above 18 years, who attended the OPD of Respiratory Medicine and diagnosed asthma by the physician were enrolled in the study. The patients associated with tuberculosis, worm infestations, other allergic diseases and systemic diseases were excluded. History of Allergic Rhino-Conjunctivitis (ARC) was used for allergic sensitisation and to define allergic asthma. Classification of severity of airflow limitation was done according to Global Initiative for Asthma (GINA) guidelines. Absolute Leukocyte Counts was determined by using the formula: Absolute leukocyte count=Differential leukocyte count/100×Total leukocyte count. One-way ANOVA followed by Tukey HSD post-hoc analysis and Chi-square was done. Level of statistical significance was set at p-value

Microorganisms inhabiting the supraglacial ice are biotechnologically significant as they are equipped with unique adaptive features in response to extreme environmental conditions of high ultraviolet radiations and frequent freeze-thaw. In the current study, we obtained eleven strains of Pseudomonas from the East Rathong supraglacial site in Sikkim Himalaya that showed taxonomic ambiguity in terms of species affiliation. Being one of the most complex and diverse genera, deciphering the correct taxonomy of Pseudomonas species has always been challenging. So, we conducted multilocus sequence analysis (MLSA) using five housekeeping genes, which concluded the taxonomic assignment of these strains to Pseudomonas antarctica. This was further supported by the lesser mean genetic distances with P. antarctica (0.73%) compared to P. fluorescens (3.65%), and highest ANI value of ~99 and dDDH value of 91.2 of the representative strains with P. antarctica PAMC 27494. We examined the multi-tolerance abilities of these eleven Pseudomonas strains. Indeed the studied strains displayed significant tolerance to freezing for 96 hours compared to the mesophilic control strain, while except for four strains, seven strains exhibited noteworthy tolerance to UV-C radiations. The genome-based findings revealed many cold and radiation resistance-associated genes that supported the physiological findings. Further, the bacterial strains produced two or more cold-active enzymes in plate-based assays. Owing to the polyadaptational attributes, the strains ERGC3:01 and ERGC3:05 could be most promising for bioprospection.

In this work, carbon dots (CDs) were synthesized by a one-step hydrothermal method using citric acid and ethylene diamine, and covalently functionalized with antibodies for the sensing of progesterone hormone. The structural and morphological analysis reveals that the synthesized CDs are of average size (diameter 8–10 nm) and the surface functionalities are confirmed by XPS, XRD and FT-IR. Further graphene oxide (GO) is used as a quencher due to the fluorescence resonance energy transfer (FRET) mechanism, whereas the presence of the analyte progesterone turns on the fluorescence because of displacement of GO from the surface of CDs effectively inhibiting FRET efficiency due to the increased distance between donor and acceptor moieties. The linear curve is obtained with different progesterone concentrations with 13.8 nM detection limits (R2 = 0.974). The proposed optical method demonstrated high selectivity performance in the presence of structurally resembling interfering compounds. The PL intensity increased linearly with the increased progesterone concentration range (10–900 nM) under the optimal experimental parameters. The developed level-free immunosensor has emerged as a potential platform for simplified progesterone analysis due to the high selectivity performance and good recovery in different samples of spiked water.

Pre-transplant compatibility work-up has evolved tremendously from conventional CDC only to CDC with more sensitive FCXM testing with bead-based assays (LMX and SAB). Detection of alloantibodies is one of the major objective in work-up algorithm. Conventionally cell-based tests were used, if both are negative, hospital usually proceeds for transplantation. If one of the screening tests (CDC/FCXM) is or both (CDC and FCXM) screening tests are positive, antibody identification is performed on Luminex platform to determine DSA by virtual cross-match. However, cell-based tests have their limitations. Here, we described a case which could have gone unnoticed if HLA bead-based assay was not there and could have triggered AMR (Antibody mediated rejection) as detected antibody (DRB1*07:01; BCM is 16416) was DSA.

The present study was designed to explore the anthocyanin profile and antioxidant activities in Indian rose varieties (Rosa × hybrida). Among fifty varieties, Ashwini recorded the highest total phenolic content (427.59 ± 3.47 mg GAE/100 g) along with the highest FRAP (397.15 ± 0.82 µmol trolox/g) and DPPH free radical scavenging activity (93.47 ± 0.19%) on a fresh weight basis. A significant positive correlation was observed between total anthocyanin content, total phenolic content, and antioxidant activities. Four distinct clusters were formed according to total anthocyanins, total phenols, and antioxidant activities; white- and yellow-colored varieties were most distant from red ones. Principal component analysis revealed that variable total anthocyanin content contributed to the maximum variation among the fifty rose varieties studied. Highly anthocyanin-rich rose varieties were characterized by high-performance liquid chromatography coupled with a photodiode array detector (HPLC-PAD), which identified two major components of anthocyanins, i.e., cyanidin 3,5-di-O-glucoside and pelargonidin 3,5-di-O-glucoside. Cyanidin 3,5-di-O-glucoside was the predominant anthocyanin in red- and pink-colored varieties, whereas pelargonidin 3,5-di-O-glucoside was the major one in the orange variety. The maximum cyanidin 3,5-di-O-glucoside content was recorded in variety Ashwini (497.79 mg/100 g), whereas the maximum pelargonidin 3,5-di-O-glucoside content was recorded in Suryakiran (185.43 mg/100 g). It is suggested that the rose varieties with high anthocyanin content and antioxidant activity can be exploited as a potential source of nutraceuticals in the food industry.

Release of nucleophosmin (NPM) from nucleoli following stress promotes rapid stabilization of the tumor suppressor p53 (TP53, best known as p53). Nucleoplasmic NPM binds to the ubiquitin ligase mouse double minute 2 (MDM2) and prevents MDM2-dependent p53 degradation. We recently demonstrated that sirtuin 7 (SIRT7) activates this pathway by directly deacetylating NPM following ultraviolet irradiation, indicating tumor-suppressive functions of SIRT7.

Idiopathic pulmonary fibrosis (IPF) represents the most aggressive form of pulmonary fibrosis (PF) and is a highly debilitating disorder with a poorly understood etiology. The lung epithelium seems to play a critical role in the initiation and progression of the disease. A repeated injury of lung epithelial cells prompts type II alveolar cells to secrete pro-fibrotic cytokines, which induces differentiation of resident mesenchymal stem cells into myofibroblasts, thus promoting aberrant deposition of extracellular matrix (ECM) and formation of fibrotic lesions. Reactivation of developmental pathways such as the Wnt-β-catenin signaling cascade in lung epithelial cells plays a critical role in this process, but the underlying mechanisms are still enigmatic. Here, we demonstrate that the membrane-associated protein NUMB is required for pathological activation of β-catenin signaling in lung epithelial cells following bleomycin-induced injury. Importantly, depletion of Numb and Numblike reduces accumulation of fibrotic lesions, preserves lung functions, and increases survival rates after bleomycin treatment of mice. Mechanistically, we demonstrate that NUMB interacts with casein kinase 2 (CK2) and relies on CK2 to activate β-catenin signaling. We propose that pharmacological inhibition of NUMB signaling may represent an effective strategy for the development of novel therapeutic approaches against PF.

Abstract Background Harnessing the halotolerant characteristics of microalgae provides a viable alternative for sustainable biomass and triacylglyceride (TAG) production. Scenedesmus sp. IITRIND2 is a fast growing fresh water microalga that has the capability to thrive in high saline environments. To understand the microalga’s adaptability, we studied its physiological and metabolic flexibility by studying differential protein, metabolite and lipid expression profiles using metabolomics, proteomics, real-time polymerase chain reaction, and lipidomics under high salinity conditions. Results On exposure to salinity, the microalga rewired its cellular reserves and ultrastructure, restricted the ions channels, and modulated its surface potential along with secretion of extrapolysaccharide to maintain homeostasis and resolve the cellular damage. The algal-omics studies suggested a well-organized salinity-driven metabolic adjustment by the microalga starting from increasing the negatively charged lipids, up regulation of proline and sugars accumulation, followed by direction of carbon and energy flux towards TAG synthesis. Furthermore, the omics studies indicated both de-novo and lipid cycling pathways at work for increasing the overall TAG accumulation inside the microalgal cells. Conclusion The salt response observed here is unique and is different from the well-known halotolerant microalga; Dunaliella salina, implying diversity in algal response with species. Based on the integrated algal-omics studies, four potential genetic targets belonging to two different metabolic pathways (salt tolerance and lipid production) were identified, which can be further tested in non-halotolerant algal strains.

Demand for more attractive and high quality food is growing every day. The increasing interest in functional foods and nutraceuticals has exaggerated exploration into new foods that have positive effects on human wellbeing. Even more we see edible flowers as a new way of nutritional health. Edible flowers are non-poisonous, giving any dish new colour, texture and freshness, and apart from the “alluring” factor, they are potential sources of phytochemicals. Various phytochemicals such as flavonoids, anthocyanins, carotenoids and phenolics are responsible for health promoting effects of edible flowers. Novel evidence regarding the composition and health benefits of edible flowers is imperative and epitomizes an ample cause for their ingestion. However, due to short blossoming period or most of the flowers are consumed by local people as food and medicine. There have been few attempts to use edible flowers, but remaining are still unexplored and need to be exploited in order to attain food and nutritional security and to upsurge the work opportunities for rural people. Hence, to accomplish this, the present review article was aimed to present the research work on edible flowers such as various species of edible flowers, nutritional and phytochemical composition, health benefits of edible flowers, traditional usage, pre and post-harvest technology, functional food products incorporated with edible flowers, marketing and toxicological aspects. This article helps to popularize the edible flowers among consumers and food industry which are very potent source of nutraceutical compounds.

IntroductionEye-tracking research has been widely used in radiology applications. Prior studies exclusively analysed either temporal or spatial eye-tracking features, both of which alone do not completely characterise the spatiotemporal dynamics of radiologists' gaze features.PurposeOur research aims to quantify human visual search dynamics in both domains during brain stimuli screening to explore the relationship between reader characteristics and stimuli complexity. The methodology can be used to discover strategies to aid trainee radiologists in identifying pathology, and to select regions of interest for machine vision applications.MethodThe study was performed using eye-tracking data 5 seconds in duration from 57 readers (15 Brain-experts, 11 Other-experts, 5 Registrars and 26 Naïves) for 40 neuroradiological images as stimuli (i.e., 20 normal and 20 pathological brain MRIs). The visual scanning patterns were analysed by calculating the fractal dimension (FD) and Hurst exponent (HE) using re-scaled range (R/S) and detrended fluctuation analysis (DFA) methods. The FD was used to measure the spatial geometrical complexity of the gaze patterns, and the HE analysis was used to measure participants' focusing skill. The focusing skill is referred to persistence/anti-persistence of the participants' gaze on the stimulus over time. Pathological and normal stimuli were analysed separately both at the "First Second" and full "Five Seconds" viewing duration.ResultsAll experts were more focused and a had higher visual search complexity compared to Registrars and Naïves. This was seen in both the pathological and normal stimuli in the first and five second analyses. The Brain-experts subgroup was shown to achieve better focusing skill than Other-experts due to their domain specific expertise. Indeed, the FDs found when viewing pathological stimuli were higher than those in normal ones. Viewing normal stimuli resulted in an increase of FD found in five second data, unlike pathological stimuli, which did not change. In contrast to the FDs, the scanpath HEs of pathological and normal stimuli were similar. However, participants' gaze was more focused for "Five Seconds" than "First Second" data.ConclusionsThe HE analysis of the scanpaths belonging to all experts showed that they have greater focus than Registrars and Naïves. This may be related to their higher visual search complexity than non-experts due to their training and expertise.

A field experiment was conducted at Agronomy farm, of S K N College of Agriculture, Jobner (Rajasthan) during kharif season 2017 in loamy sand soil with an objective “Effect of Integrated nitrogen management on soil properties in pearlmillet [Pennisetum glaucum (L.) R. Br. Emend Stuntz]”. The experiment was laid out in factorial randomized block design with three replications, comprised eight treatments of sources of nitrogen (Control, 50% RDN through urea+ 50% RDN through vermicompost, 50% RDN through urea+ 50% RDN through FYM, 75% RDN through urea+ 25% RDN through vermicompost, 75% RDN through urea+ 25% RDN through FYM, 100% RDN through urea, 100% RDN through vermicompost and 100% RDN through FYM) and two treatments of biofertilizer (without inoculation and with Azotobacter) were applied to the pearlmillet var. RHB-173. The application of sources of nitrogen,soil organic carbon, available nitrogen, phosphorus, potassium, dehydrogenase activity and alkaline phosphataseactivity were increased significantly with the application of 75% RDN through urea+ 25% RDN through vermicompost at flowering and harvest stage.The soil organic carbon, available N, P2O5, K2O, dehydrogenase activity and alkaline phosphates activities were also increased when inoculated with biofertilizer.

Staphylococcus aureus is one of the most notorious pathogens and is frequently associated with nosocomial infections imposing serious risk to immune-compromised patients. This is in part due to its ability to colonize at the surface of indwelling medical devices and biofilm formation. Combating the biofilm formation with antibiotics has its own challenges like higher values of minimum inhibitory concentrations. Here, we describe a new approach to target biofilm formation by Gram positive bacteria. Sortase A is a transpeptidase enzyme which is responsible for tagging of around ∼22 cell surface proteins onto the outer surface. These proteins play a major role in the bacterial virulence. Sortase A recognizes its substrate through LPXTG motif. Here, we use this approach to install the synthetic peptide substrates onS. aureus. Sortase A substrate mimic, 6His-LPETG peptide was synthesized using solid phase peptide chemistry. Incorporation of the peptide on the cell surface was measured using ELISA. Effect of peptide incubation on Staphylococcus aureus biofilm was also studied. 71.1% biofilm inhibition was observed with 100 μM peptide while on silicon coated rubber latex catheter, 45.82% inhibition was observed. The present work demonstrates the inability of surface modified S. aureus to establish biofilm formation thereby presenting a novel method for attenuating its virulence.

Microplastics (MPs) are ubiquitous and constitute a global hazard to the environment because of their robustness, resilience, and long-term presence in the ecosystem. For now, the majority of research has primarily focused on marine and freshwater ecosystems, with just a small amount of attention towards the terrestrial ecosystems. Although terrestrial ecosystems are recognized as the origins and routes for MPs to reach the sea, there is a paucity of knowledge about these ecological compartments, which is necessary for conducting effective ecological risk assessments. Moreover, because of their high persistence and widespread usage in agriculture, agribusiness, and allied sectors, the presence of MPs in arable soils is undoubtedly an undeniable and severe concern. Consequently, in the recent decade, the potential risk of MPs in food production, as well as their impact on plant growth and development, has received a great deal of interest. Thus, a thorough understanding of the fate and risks MPs, as well as prospective removal procedures for safe and viable agricultural operations in real-world circumstances, are urgently needed. Therefore, the current review is proposed to highlight the potential sources and interactions of MPs with agroecosystems and plants, along with their remediation strategies.

Background: Fracture of the femur is a common, but extremely painful bone injury. Anaesthesiologists face the common problem of improper positioning of the patient while giving sitting spinal due to their extreme pain. Methods: After Institutional Ethical Committee (IEC) clearance, 60 of American Society of Anaesthesiologists (ASA) I/II patients age 18 to 80 years with fracture femur were recruited. Patients in Femoral Nerve Block (FNB) group received ultrasound-guided FNB was given with 15 mL of 1% lignocaine after visualizing the femoral nerve. Patients in the fentanyl group received injection fentanyl 1μg/kg IV. The target was to reduce the Visual Analog Scale (VAS) score less than 4. If despite the intervention, VAS was more than 4, a repeat fentanyl dose (0.5μg/kg) was given. Results: Mean VAS during positioning was 1.57 in FNB versus 2.93 in the fentanyl group (p

Background and Aims: Ultrasound (USG)-guided injection in pterygopalatine fossa is an indirect approach to block the trigeminal nerve. Trigeminal nerve block for maxillofacial surgeries may provide preemptive analgesia, reduce opioid consumption and opioid-related adverse effects. Methods: In this randomised, prospective double-blind study, 60 American Society of Anesthesiologists I/II patients, within the age group of 18–60 years scheduled for faciomaxillary surgery (fracture/pathological lesion of maxilla or mandible and cleft lip), were recruited. The patients were allocated in either of the two groups: group I: general anaesthesia (FENT group) and group II: general anaesthesia + trigeminal nerve (TNB group). Perioperative opioid consumption and postoperative pain scores were recorded. Any adverse effects like respiratory depression and nausea were also looked for. Results: Patients in group II required less intraoperative fentanyl top ups (1.17 ± 0.53 vs 2.70 ± 0.53) (P < 0.05). Postoperative opioid consumption was also less in this group (0.93 ± 0.69 vs 3.53 ± 0.68) (P < 0.05). Conclusion: USG-guided TNB reduces perioperative opioid consumption in patients undergoing faciomaxillary surgery with better patient pain scores.