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Introduction: In the backdrop of escalating healthcare costs and an increasing focus on resource optimization, this audit study delves into the realm of anesthesia management, specifically exploring the application of low-flow anesthesia (LFA). The primary objective was to assess adherence to hospital standards and evaluate the economic implications of LFA (

Abstract Background Blood-based transcriptional gene signatures for tuberculosis (TB) have been developed with potential use to diagnose disease. However, an unresolved issue is whether gene set enrichment analysis of the signature transcripts alone is sufficient for prediction and differentiation or whether it is necessary to use the original model created when the signature was derived. Intra-method comparison is complicated by the unavailability of original training data and missing details about the original trained model. To facilitate the utilization of these signatures in TB research, comparisons between gene set scoring methods cross-data validation of original model implementations are needed. Methods We compared the performance of 19 TB gene signatures across 24 transcriptomic datasets using both rrebuilt original models and gene set scoring methods. Existing gene set scoring methods, including ssGSEA, GSVA, PLAGE, Singscore, and Zscore, were used as alternative approaches to obtain the profile scores. The area under the ROC curve (AUC) value was computed to measure performance. Correlation analysis and Wilcoxon paired tests were used to compare the performance of enrichment methods with the original models. Results For many signatures, the predictions from gene set scoring methods were highly correlated and statistically equivalent to the results given by the original models. In some cases, PLAGE outperformed the original models when considering signatures’ weighted mean AUC values and the AUC results within individual studies. Conclusion Gene set enrichment scoring of existing gene sets can distinguish patients with active TB disease from other clinical conditions with equivalent or improved accuracy compared to the original methods and models. These data justify using gene set scoring methods of published TB gene signatures for predicting TB risk and treatment outcomes, especially when original models are difficult to apply or implement.

Abstract Typical plant membranes and storage lipids are comprised of five common fatty acids yet over 450 unusual fatty acids accumulate in seed oils of various plant species. Plant oils are important human and animal nutrients, while some unusual fatty acids such as hydroxylated fatty acids (HFA) are used in the chemical industry (lubricants, paints, polymers, cosmetics, etc.). Most unusual fatty acids are extracted from non-agronomic crops leading to high production costs. Attempts to engineer HFA into crops are unsuccessful due to bottlenecks in the overlapping pathways of oil and membrane lipid synthesis where HFA are not compatible. Physaria fendleri naturally overcomes these bottlenecks through a triacylglycerol (TAG) remodeling mechanism where HFA are incorporated into TAG after initial synthesis. TAG remodeling involves a unique TAG lipase and two diacylglycerol acyltransferases (DGAT) that are selective for different stereochemical and acyl-containing species of diacylglycerol within a synthesis, partial degradation, and resynthesis cycle. The TAG lipase interacts with DGAT1, localizes to the endoplasmic reticulum (with the DGATs) and to puncta around the lipid droplet, likely forming a TAG remodeling metabolon near the lipid droplet-ER junction. Each characterized DGAT and TAG lipase can increase HFA accumulation in engineered seed oils.

Abstract Background Currently, there are more than two million people in prisons or jails, with nearly two-thirds meeting the criteria for a substance use disorder. Following these patterns, overdose is the leading cause of death following release from prison and the third leading cause of death during periods of incarceration in jails. Traditional quantitative methods analyzing the factors associated with overdose following incarceration may fail to capture structural and environmental factors present in specific communities. People with lived experiences in the criminal legal system and with substance use disorder hold unique perspectives and must be involved in the research process. Objective To identify perceived factors that impact overdose following release from incarceration among people with direct criminal legal involvement and experience with substance use. Methods Within a community-engaged approach to research, we used concept mapping to center the perspectives of people with personal experience with the carceral system. The following prompt guided our study: “What do you think are some of the main things that make people who have been in jail or prison more and less likely to overdose?” Individuals participated in three rounds of focus groups, which included brainstorming, sorting and rating, and community interpretation. We used the Concept Systems Inc. platform groupwisdom for our analyses and constructed cluster maps. Results Eight individuals (ages 33 to 53) from four states participated. The brainstorming process resulted in 83 unique factors that impact overdose. The concept mapping process resulted in five clusters: (1) Community-Based Prevention, (2) Drug Use and Incarceration, (3) Resources for Treatment for Substance Use, (4) Carceral Factors, and (5) Stigma and Structural Barriers. Conclusions Our study provides critical insight into community-identified factors associated with overdose following incarceration. These factors should be accounted for during resource planning and decision-making.

Introduction: Sports offer numerous health benefits, contributing to growth, development, physical fitness, and mental well-being. However, injuries are an inevitable part of sports, affecting both professional athletes and casual participants. The incidence of sports-related injuries has risen significantly due to increased participation, heightened competitiveness, inadequate injury prevention techniques, improper sporting gear, insufficient training, and overuse. Method: ology: A comprehensive literature search was performed in multiple databases such as PUBMED and SCOPUS. Relevant studies on therapeutic uses of platelet-rich plasma (PRP) in sports injuries were included. The findings provide a comprehensive overview of the topic. Results: Platelet-Rich Plasma (PRP) is a regenerative, minimally invasive, non-surgical procedure that accelerates healing by utilizing concentrated bioactive factors from the body. PRP has shown promising results in treating conditions such as patellar tendonitis, Achilles tendonitis, tennis elbow, partial rotator cuff tears, ligament tears, and mild to moderate arthritis. Following a PRP injection, athletes typically undergo a short period of rest from sports activities while attending rehabilitation therapy. This approach helps optimize healing and ensures an optimal outcome. Conclusion: PRP has shown great promise as a treatment modality for sports injuries. While further research is needed to optimize PRP protocols and understand its mechanisms of action in sports injuries, it holds significant potential for enhancing the recovery and rehabilitation of athletes, ultimately contributing to improved outcomes in the field of sports medicine.

Lung cancer is a leading cause of cancer-related death worldwide that needs updated therapies to contrast both the serious side effects and the occurrence of drug resistance. A panel of non-small cell lung cancer (NSCLC) cells were herein employed as cancer models. Eight structurally related gold(I) and gold(III) complexes with NHC and halides or triphenylphosphane ligands were investigated as lung cancer cell growth inhibitors. As expected, gold compounds with PPh3 were found to be more cytotoxic than homoleptic [(NHC)2-Au(I)]X or heteroleptic NHC-Au(I)X or NHC-Au(III)X3 complexes. Mixed ligand gold(I) compounds exhibiting the linear NHC-AuPPh3 (compound 7) or the trigonal NHC-Au(Cl)PPh3 (compound 8) arrangements at the central metal were found to be the best lung cancer cytotoxic compounds. Analysis of the TrxR residual activity of the treated cells revealed that these compounds efficiently inhibit the most accredited molecular target for gold compounds, the TrxR, with compound 8 reaching more than 80% activity reduction in lung cells. Some of the current cancer lung therapy protocols consist of specific lung cancer cell cytotoxic agents combined with antifolate drugs; interestingly, the herein gold compounds are both TrxR and antifolate inhibitors. The human DHFR was inhibited with IC50 ranging between 10–21 µM, depending on substrate concentrations, proceeding by a likely allosteric mechanism only for compound 8.

Background: A training program for Management of Animal-bite as per NRCP (National Rabies Control Program) guidelines & Snakebite of Medical Officer was conducted in the Tertiary Healthcare Centre. Evaluation of such training has been rarely reported. Objective: The objective of this study was to reflect on the quality of this training program regarding knowledge assessment and feedback. Methodology: A pre-test and post-test cross-sectional assessment of knowledge of medical officers working at health facilities of Bhopal district of Madhya Pradesh government, who attended one-day training program at AIIMS Bhopal in 2023, were conducted through the same questionnaire having 18 single-answer multiple choice questions. Anonymous feedback was also taken through a semi-structured questionnaire. Data were analyzed using R statistical software. The Chi-square test and Wilcoxon signed-rank test was used to compare the pre-and post-test proportions of correct responses and scores, respectively. Results: Out of a total of 54 participants, 64.8% were males. The median (IQR) age was 41 (31,52) years. The majority of the participants (68.5%) had the qualification of MBBS, 14.8% had PG degree, and the rest, 16.6%, had BAMS degree. Median (IQR) pre and post-test scores were9.0 (9.0, 12.0) and 15 (12, 16.0) respectively. All participants agreed that the training was very useful for the patient care and gave positive feedback related to the management of training. Conclusion: This training was very useful in terms of improvement of knowledge is concerned. More Tertiary Healthcare institutions should take the initiative to conduct such training programs for capacity building of Medical Officers working at community level.

Background: Warranting adequate sexual and reproductive health (SRH) among the youth population in India is challenging. While the Government has undertaken several measures to improve SRH services, gaps exist in terms of availability of these services at the health centre. Objective: To assess utilization of SRH services and explore the associated factors among youth population in rural area of Central India. Methodology: An explanatory sequential mixed method study was conducted which included collection and analysis of quantitative data pertaining to the utilization of SRH services from 236 youth (aged 15-24 years) selected through multistage cluster sampling. This was followed by 29 in-depth interviews conducted among the various stakeholders. Quantitative data was entered using MS Excel and analyzed using R v-4.1.0. The notes and audio recordings from the interviews were transcribed manually and thematic analysis was done. Results: Out of 236 youths, only 90 (38.1%) had ever availed SRH services, of whom 85.5% had visited the SRH clinic in the past 12 months. The most common reason to visit a government health facility was cited as a pregnancy test while in the case of private health facility the reasons were STD treatment, pregnancy tests, and abortions. Except the request for contraceptive services and adequate response to questions by clients, the services provided by the facilities were reported to be inadequate. Further exploration summarized the barriers and facilitators of the health care services under the themes of training, logistics, ARSH clinic, adolescent health days, and community awareness. Conclusion: Among the various influences of SRH, the healthcare system is a fundamental aspect; which seems to address inadequately the varied needs of the rural youth. Future efforts must focus on community awareness and involvement of all stakeholders to uplift SRH services, so as to have positive impact on their sexual health.

Transition-metal-doped semiconductor nanocrystals have received significant attention because of their attractive features deeming them invaluable in various technological fields including optoelectronics, bio-photonics, and energy conversion, to name a few. Of particular, these interests are two-dimensional materials with useful optical and magnetic properties combined with their large surface areas opening up new applications in biotechnology. These applications range from multimodal optical and magnetic bioimaging and sensing to measuring the weak magnetic field due to brain waves using their magneto-optic properties stemming from the exchange interaction between the transition metal dopants and the carrier spins. These magnetic 2D materials could also significantly advance the field of spintronics. In this work, we report on a study of the magnetic and magneto-optic properties of colloidal two-dimensional (2D) copper-doped CdSe nanoplatelets (NPLs) that are synthesized using a high-temperature colloidal technique. We carried out optical and circularly polarized magneto-photoluminescence spectrometry to investigate the magnetism in our solution-processed nanostructures doped with copper ion impurities. At cryogenic temperatures, two excitonic features are observed for doped NPLs, which are more prominent compared to the undoped NPLs. Furthermore, the excitonic circular polarization (CP) is recorded as a function of the applied magnetic field (B) and temperature (T). The detailed analysis provides a picture of the magneto-optical behavior of the doped 2D NPLs in the presence of paramagnetic copper ions. This work paves the way for significant advances in bio/nanophotonics where tunable optical and magnetic properties of doped nanoplatelets can be leveraged to make more efficient, flexible, and low-cost devices.

Background Context: Both Transforaminal (TF) and Interlaminar (IL) endoscopic approaches are established techniques of decompression for lumbar compressive radiculopathy. In the absence of adequate literature, there is always some dilemma in selecting the approach for endoscopic decompression leading to long learning curves and high chances of inadequate decompression, iatrogenic instability, dural tear, or dysesthesia. Hence authors propose a new surgical nomenclature and algorithm for selection of endoscopic approach. Methods: This retrospective study included 396 of 626 consecutive patients who met the inclusion criteria, who underwent either TF (n=302) or IL (n=202) full endoscopic spine surgery. MRI findings of every patient were classified as per FAPDIS (Facet angle, Anterior pathology, Posterior pathology, Dorsal, Inferior, and Superior migration) algorithm. Inter-observer variations were calculated. The targeted nomenclature was used to define the selection of endoscopic TF or IL approach for symptomatic nerve root decompression. All patients were followed up for preop and postop 6 months VAS and Oswestry Disability Index score for validation of FAPDIS algorithm. Results: Median age: 46.8 years; Sides and levels operated 330 single-level ipsilateral, 54 multiple-level ipsilateral, 6 single-level bilateral, and 6 multiple-level bilateral. Interobserver agreement in the selection of TF approach was 0.873 and IL approach was 0.882. Interobserver variability was also calculated for each FAPDIS factor, selection of P3 and P4 pathology was the main reason for disagreement. All other FAPDIS factors show good to excellent correlation. The overall VAS score decreased from a preoperative value of 9 to 1 at 6 months follow-up (p-value < 0.001), and the overall Oswestry Disability Index score improved from 89 to 12 (p-value

Tetralogy Of Fallot (TOF), one of the most prevalent cyanotic congenital heart diseases in children. Single step corrective surgery, early on in life, provides a fair expectation of favourable outcome in these individuals. However, complex, and skilled anaesthetic management is required by experienced team of healthcare providers. Preoperative surgical preparation, intraoperative key anaesthesia principles and postoperative care intensive care unit are all perioperative considerations in these patients. This article reports challenges faced in the perioperative anaesthesic management of a 3-year-old child having uncorrected TOF, who underwent Waterston shunt and later Intracardiac Repair (ICR). He presented with postoperative complication like cyanotic spell, gastrointenstinal bleeding, sepsis; but later recovered successfully.

Introduction The incidence of renal tumours is increasing and anatomic imaging cannot reliably distinguish benign tumours from renal cell carcinoma. Up to 30% of renal tumours are benign, with oncocytomas the most common type. Biopsy has not been routinely adopted in many centres due to concerns surrounding non-diagnostic rate, bleeding and tumour seeding. As a result, benign masses are often unnecessarily surgically resected. 99mTc-sestamibi SPECT/CT has shown high diagnostic accuracy for benign renal oncocytomas and other oncocytic renal neoplasms of low malignant potential in single-centre studies. The primary aim of MULTI-MIBI is to assess feasibility of a multicentre study of 99mTc-sestamibi SPECT/CT against a reference standard of histopathology from surgical resection or biopsy. Secondary aims of the study include obtaining estimates of 99mTc-sestamibi SPECT/CT sensitivity and specificity and to inform the design and conduct of a future definitive trial.Methods and analysis A feasibility prospective multicentre study of participants with indeterminate, clinical T1 renal tumours to undergo 99mTc-sestamibi SPECT/CT (index test) compared with histopathology from biopsy or surgical resection (reference test). Interpretation of the index and reference tests will be blinded to the results of the other. Recruitment rate as well as estimates of sensitivity, specificity, positive and negative predictive value will be reported. Semistructured interviews with patients and clinicians will provide qualitative data to inform onward trial design and delivery. Training materials for 99mTc-sestamibi SPECT/CT interpretation will be developed, assessed and optimised. Early health economic modelling using a decision analytic approach for different diagnostic strategies will be performed to understand the potential cost-effectiveness of 99mTc-sestamibi SPECT/CT.Ethics and dissemination Ethical approval has been granted (UK HRA REC 20/YH/0279) protocol V.5.0 dated 21/6/2022. Study outputs will be presented and published nationally and internationally.Trial registration number ISRCTN12572202.

Abstract Background Associations between community-level risk factors and COVID-19 incidence have been used to identify vulnerable subpopulations and target interventions, but the variability of these associations over time remains largely unknown. We evaluated variability in the associations between community-level predictors and COVID-19 case incidence in 351 cities and towns in Massachusetts from March to October 2020. Methods Using publicly available sociodemographic, occupational, environmental, and mobility datasets, we developed mixed-effect, adjusted Poisson regression models to depict associations between these variables and town-level COVID-19 case incidence data across five distinct time periods from March to October 2020. We examined town-level demographic variables, including population proportions by race, ethnicity, and age, as well as factors related to occupation, housing density, economic vulnerability, air pollution (PM2.5), and institutional facilities. We calculated incidence rate ratios (IRR) associated with these predictors and compared these values across the multiple time periods to assess variability in the observed associations over time. Results Associations between key predictor variables and town-level incidence varied across the five time periods. We observed reductions over time in the association with percentage of Black residents (IRR = 1.12 [95%CI: 1.12–1.13]) in early spring, IRR = 1.01 [95%CI: 1.00–1.01] in early fall) and COVID-19 incidence. The association with number of long-term care facility beds per capita also decreased over time (IRR = 1.28 [95%CI: 1.26–1.31] in spring, IRR = 1.07 [95%CI: 1.05–1.09] in fall). Controlling for other factors, towns with higher percentages of essential workers experienced elevated incidences of COVID-19 throughout the pandemic (e.g., IRR = 1.30 [95%CI: 1.27–1.33] in spring, IRR = 1.20 [95%CI: 1.17–1.22] in fall). Towns with higher proportions of Latinx residents also had sustained elevated incidence over time (IRR = 1.19 [95%CI: 1.18–1.21] in spring, IRR = 1.14 [95%CI: 1.13–1.15] in fall). Conclusions Town-level COVID-19 risk factors varied with time in this study. In Massachusetts, racial (but not ethnic) disparities in COVID-19 incidence may have decreased across the first 8 months of the pandemic, perhaps indicating greater success in risk mitigation in selected communities. Our approach can be used to evaluate effectiveness of public health interventions and target specific mitigation efforts on the community level.

Apart from all the gloominess, the COVID-19 Pandemic has a silver lining of bringing a renaissance as Ayurveda and integrated medicine are becoming a choice for acute as well as infective diseases. Here we report outcomes of a preliminary work, the randomized controlled trial (CTRI/2021/02/031256) of Madhav Rasayan Plus, an Ayurveda formulation as adjuvant in moderate COVID-19 patients. Madhav Rasayan Plus is a herbomineral formulation beneficial for respiratory, coagulative and other systemic complements of COVID-19. Forty patients with moderate COVID-19 disease were included in two parallel groups (n = 20/group). The Intervention group (Treatment) received Madhav Rasayan Plus tablets (250 mg) twice a day for 15 days, along with standard care (SOC), while the control group received SOC alone. The intervention group significantly improved symptoms of COVID-19 like cough, breathlessness, fatigue and gastric disturbances. There was also statistically significant reduction in inflammatory markers like CRP and Ferritin. Tissue level markers like creatinine phosphokinase and NT- Pro BNP were found restored after treatment. The requirement of supplemental oxygen in the control group (6 days) was reduced by 2.5 times compared to the intervention group (2.4 days). There was also reduced hospital stay and reduced requirement of ICU in comparison with the control group. Also, the indices of fatigue severity score, disturbed sleep cycle score and quality of life revealed better and holistic recovery in the intervention group. This study reveals that COVID-19 and such infective diseases with vital complications can be better dealt with integrated management as immunomodulation and protection of tissues and vital organs are strengths of Ayurveda.

Physaria fendleri is a burgeoning oilseed crop that accumulates the hydroxy fatty acid (HFA), lesquerolic acid, and can be a non-toxic alternative crop to castor for production of industrially valuable HFA. Recently, P. fendleri was proposed to utilize a unique seed oil biosynthetic pathway coined “triacylglycerol (TAG) remodeling” that utilizes a TAG lipase to remove common fatty acids from TAG allowing the subsequent incorporation of HFA after initial TAG synthesis, yet the lipase involved is unknown. SUGAR DEPENDENT 1 (SDP1) has been characterized as the dominant TAG lipase involved in TAG turnover during oilseed maturation and germination. Here, we characterized the role of a putative PfeSDP1 in both TAG turnover and TAG remodeling. In vitro assays confirmed that PfeSDP1 is a TAG lipase and demonstrated a preference for HFA-containing TAG species. Seed-specific RNAi knockdown of PfeSDP1 resulted in a 12%–16% increase in seed weight and 14%–19% increase in total seed oil content with no major effect on seedling establishment. The increase in total oil content was primarily due to ~4.7% to ~14.8% increase in TAG molecular species containing two HFA (2HFA-TAG), and when combined with a smaller decrease in 1HFA-TAG content the proportion of total HFA in seed lipids increased 4%–6%. The results are consistent with PfeSDP1 involved in TAG turnover but not TAG remodeling to produce 2HFA-TAG. Interestingly, the concomitant reduction of 1HFA-TAG in PfeSDP1 knockdown lines suggests PfeSDP1 may have a role in reverse TAG remodeling during seed maturation that produces 1HFA-TAG from 2HFA-TAG. Overall, our results provide a novel strategy to enhance the total amount of industrially valuable lesquerolic acid in P. fendleri seeds.

For p-polarized light incident on an interface between an ordinary dielectric and an epsilon-near-zero (ENZ) material, an enhancement of the component of the electric field, normal to this interface, has been shown to occur. This local field enhancement holds great promise for amplifying nonlinear optical processes and for other applications requiring ultrastrong local fields in epsilon-near-zero based technologies. However, the loss associated with the imaginary part of the dielectric constant of an epsilon-near-zero material can greatly suppress the field enhancement factor. In this study, we analyze, using density matrix formalism, the field enhancement factor for a saturable two-level system that exhibits second- and third-order nonlinearities. We show that, in such a system, an almost lossless ENZ response can arise as a consequence of saturable nonlinearity and that the local field enhancement factor can be readily controlled dynamically by adjusting the intensity of the incident electromagnetic wave. Our findings provide for the first time a pathway to design a material exhibiting an external field responsive epsilon-near-zero behavior for applications in nonlinear photonics.

This paper examines whether the 1997 Asian financial crisis affected the renewable energy/carbon dioxide (CO2) emissions relationship differently when compared to the 2008 global financial crises. Using the Dynamic Panel Data Model, we examine separately the impact of the 1997 crisis and the 2008 crises on the stated relationship for annual data between the 1987–2018 period for a group of high, upper-middle, and lower middle-income countries. Our findings suggest that the results were crisis and country specific. For the overall sample, the relationship between the two variables was positive (and significant post-1997 and pre-2008 crises) but negative post-2008 crisis. In contrast, the positive relationship remained unchanged for the lower middle-income subsample through the two crises. We also find evidence that the 1997 Asian crisis altered the relationship differently than the 2008 financial crisis especially for the upper and middle-income groups. Clearly, reduction of CO2 emissions may not be guaranteed even if host countries adopt renewable energy sources since country income levels and the nature of the crisis may matter. Future research may consider how the degree of pollution controls and differential costs of renewable energy adoption in countries may alter this relationship.

In the present times, the demand for sophisticated encryption methods has escalated, especially for securing data transmission in vulnerable environments. These methods leverage diverse algorithms to fortify the integrity of communication channels. Quantum mechanics plays a pivotal role in two specific areas: quantum key distribution and property-based cryptography, both of which contribute to establishing secure communication protocols. This study focuses on conducting a comparative evaluation of classical and quantum cryptography, employing various cryptography algorithms. The objective is to ascertain the optimal algorithm within each realm classical and quantum cryptography for ensuring robust security.

Urban heat islands (UHIs) increase the energy consumption of cities and impact the health of its residents. In light of the correlation between energy consumption and health and UHI variations observed at a local level within the canopy layer, satellite-derived land surface temperatures (LSTs) may be insufficient to provide comprehensive information about these deleterious effects. For both LST and air temperatures to be collected in a spatially representative and continuous manner, and for the process to be affordable, on-ground temperature and humidity sensors must be strategically placed. This study proposes a strategy for placing on-ground sensors that utilizes the spatial variation of measurable factors linked to UHI (i.e., seasonal variation in LSTs, wind speed, wind direction, bareness, and local climate zones), allowing for the continuous measurement of UHI within the canopy layer. As a representative city, Pune, India, was used to demonstrate how to distribute sensors based on the spatial variability of UHI-related variables. The proposed method may be helpful for any city requiring local-level observations of UHI, regardless of the climate zone. Further, we evaluate the placement of low-cost technology sensors that use LoRaWAN technology for this purpose, in order to overcome the problem of high costs associated with traditional in-situ weather stations.

The process of urbanisation has dramatically increased in India in recent years. The Government of India launched Smart City Mission in 2015 which was intended to transform 100 cities into smart cities. The focus of our research is one such city in India on its path to smartification. Pune’s smart city mission focuses on techno-infrastructural development to increase mobility and digital connectivity. Social-cultural and historical indicators are not considered an integral part of this development. Given this, does the smart city mission of Pune privilege the techno-infrastructural development of a city over its social and cultural development? In this paper, we identify museums and heritage sites in Pune as signifiers of a city's culture and analyse metro development plans through GIS to understand whether the museums' current geography mentioned above and heritage sites require alignment with Pune’s planned smart city mission. The research shows that the quest to ‘upgrade’ and ‘modernise’ is not adequately aligned with the role of key historic-cultural institutions such as museums and heritage sites. The case of Pune city shows that, without careful and inclusive development plan, a full roll-out of the smart city project will exclude a large number of historical and cultural spaces such as museums and heritage sites from emerging as an integral part of smart cities across the country and render them peripheral to modern urban life.

ABSTRACT Background: Majority of patients with large size HCC (>10 cm) are not offered surgery as per Barcelona Clinic Liver Cancer (BCLC) criteria and hence, their outcomes are not well studied, especially from India, owing to a lower incidence. Aim: To analyze outcomes of surgery for large HCCs. Methods: This retrospective observational study included all patients who underwent surgery for large HCC from January 2007 to December 2017. The entire perioperative and follow up data was collected and analyzed. Results: Nineteen patients were included. Ten were non-cirrhotic; 16 were BCLC grade A; one BCLC grade B; and two were BCLC C. Two cirrhotic and three non-cirrhotic underwent preoperative sequential trans-arterial chemoembolization and portal vein embolization. Right hepatectomy was the most commonly done procedure. The postoperative 30-day mortality rate was 5% (1/19). Wound infection and postoperative ascites was seen in seven patients each. Postoperative liver failure was seen in five. Two cirrhotic and two non-cirrhotic patients had postoperative bile leak. The hospital stay was 11.9±5.4 days (median 12 days). Vascular invasion was present in four cirrhotic and five non-cirrhotic patients. The median follow-up was 32 months. Five patients died in the follow-up period. Seven had recurrence and median recurrence free survival was 18 months. The cumulative recurrence free survival was 88% and 54%, whereas the cumulative overall survival was 94% and 73% at one and three years respectively. Both were better in non-cirrhotic; however, the difference was not statistically significant. The recurrence free survival was better in patients without vascular invasion and the difference was statistically significant (p=0.011). Conclusion: Large HCC is not a contraindication for surgery. Vascular invasion if present, adversely affects survival. Proper case selection can provide the most favorable survival with minimal morbidity.

Human MIA40, an intermembrane space (IMS) import receptor of mitochondria harbors twin CX9C motifs for stability while its CPC motif is known to facilitate the import of IMS bound proteins. Site-directed mutagenesis complemented by MALDI on in vivo hMIA40 protein shows that a portion of MIA40 undergoes reversible S-glutathionylation at three cysteines in the twin CX9C motifs and the lone cysteine 4 residue. We find that HEK293T cells expressing hMIA40 mutant defective for glutathionylation are compromised in the activities of complexes III and IV of the Electron Transport Chain (ETC) and enhance Reactive Oxygen Species (ROS) levels. Immunocapture studies show MIA40 interacting with complex III. Interestingly, glutathionylated MIA40 can transfer electrons to cytochrome C directly. However, Fe–S clusters associated with the CPC motif are essential to facilitate the two-electron to one-electron transfer for reducing cytochrome C. These results suggest that hMIA40 undergoes glutathionylation to maintain ROS levels and for optimum function of complexes III and IV of ETC. Our studies shed light on a novel post-translational modification of hMIA40 and its ability to act as a redox switch to regulate the ETC and cellular redox homeostasis.

Pyrexia of unknown origin (PUO) has been a diagnostic challenge for decades. Hepatic hemangioma (HH) is not a common differential diagnosis of PUO. It is the most common benign hepatic tumor, commonly asymptomatic and incidentally detected, or can present with vague abdominal pain. PUO is a rare presenting feature. We describe a case of 38-year-old lady presenting with PUO. With no other identifiable source of fever despite exhaustive investigations, a giant hemangioma in right lobe of liver detected on abdominal ultrasonography was deemed to be the cause of PUO. The patient had sudden decrease in hemoglobin while undergoing workup, which on imaging showed a bleeding hemangioma and right hepatectomy was performed. Patient had an uneventful recovery and her PUO also resolved after surgery. HH should be considered a rare diagnosis of exclusion for PUO after a standard algorithmic approach does not reveal any other cause.

Background Epigenome‐wide association studies for cardiometabolic risk factors have discovered multiple loci associated with incident cardiovascular disease (CVD). However, few studies have sought to directly optimize a predictor of CVD risk. Furthermore, it is challenging to train multivariate models across multiple studies in the presence of study‐ or batch effects. Methods and Results Here, we analyzed existing DNA methylation data collected using the Illumina HumanMethylation450 microarray to create a predictor of CVD risk across 3 cohorts: Women's Health Initiative, Framingham Heart Study Offspring Cohort, and Lothian Birth Cohorts. We trained Cox proportional hazards‐based elastic net regressions for incident CVD separately in each cohort and used a recently introduced cross‐study learning approach to integrate these individual scores into an ensemble predictor. The methylation‐based risk score was associated with CVD time‐to‐event in a held‐out fraction of the Framingham data set (hazard ratio per SD=1.28, 95% CI, 1.10–1.50) and predicted myocardial infarction status in the independent REGICOR (Girona Heart Registry) data set (odds ratio per SD=2.14, 95% CI, 1.58–2.89). These associations remained after adjustment for traditional cardiovascular risk factors and were similar to those from elastic net models trained on a directly merged data set. Additionally, we investigated interactions between the methylation‐based risk score and both genetic and biochemical CVD risk, showing preliminary evidence of an enhanced performance in those with less traditional risk factor elevation. Conclusions This investigation provides proof‐of‐concept for a genome‐wide, CVD‐specific epigenomic risk score and suggests that DNA methylation data may enable the discovery of high‐risk individuals who would be missed by alternative risk metrics.

Abstract Background Alzheimer’s disease (AD) is characterized not only by cognitive and functional decline, but also often by the presence of neuropsychiatric symptoms. Apathy, which can be defined as a lack of motivation, is one of the most prevalent neuropsychiatric symptoms in AD and typically leads to a worse quality of life and greater burden for caregivers. Treatment options for apathy in AD are limited, but studies have examined the use of the amphetamine, methylphenidate. The Apathy in Dementia Methylphenidate Trial (ADMET) found that treatment of apathy in AD with methylphenidate was associated with significant improvement in apathy in two of three outcome measures, some evidence of improvement in global cognition, and minimal adverse events. However, the trial only enrolled 60 participants who were followed for only 6 weeks. A larger, longer-lasting trial is required to confirm these promising findings. Methods The Apathy in Dementia Methylphenidate Trial 2 (ADMET 2) is a phase III, placebo-controlled, masked, 6-month, multi-center, randomized clinical trial targeted to enroll 200 participants with AD and apathy. Participants are randomly assigned 1:1 to 20 mg methylphenidate per day prepared as four over-encapsulated tablets or to matching placebo. The primary outcomes include (1) the mean difference in the Neuropsychiatric Inventory Apathy subscale scores measured as change from baseline to 6 months, and (2) the odds of having a given rating or better on the modified AD Cooperative Study Clinical Global Impression of Change ratings at month 6 compared with the baseline rating. Other outcomes include change in cognition, safety, and cost-effectiveness measured at monthly follow-up visits up to 6 months. Discussion Given the prevalence of apathy in AD and its impact on both patients and caregivers, an intervention to alleviate apathy would be of great benefit to society. ADMET 2 follows on the promising results from the original ADMET to evaluate the efficacy of methylphenidate as a treatment for apathy in AD. With a larger sample size and longer follow up, ADMET 2 is poised to confirm or refute the original ADMET findings. Trial registration ClinicalTrials.gov, NCT02346201 . Registered on 26 January 2015.

Abstract Background Zika virus is an emerging pathogen of global importance. It has been responsible for recent outbreaks in the Americas and in the Pacific region. This study assessed five different mosquito species from the temperate climatic zone in Australia and included Aedes albopictus as a potentially invasive species. Methods Mosquitoes were orally challenged by membrane feeding with Zika virus strain of Cambodia 2010 origin, belonging to the Asian clade. Virus infection and dissemination were assessed by quantitative PCR on midgut and carcass after dissection. Transmission was assessed by determination of cytopathogenic effect of saliva (CPE) on Vero cells, followed by determination of 50% tissue culture infectious dose (TCID50) for CPE positive samples. Additionally, the presence of Wolbachia endosymbiont infection was assessed by qPCR and standard PCR. Results Culex mosquitoes were found unable to present Zika virus in saliva, as demonstrated by molecular as well as virological methods. Aedes aegypti, was used as a positive control for Zika infection and showed a high level of virus infection, dissemination and transmission. Local Aedes species, Ae. notoscriptus and, to a lesser degree, Ae. camptorhynchus were found to expel virus in their saliva and contained viral nucleic acid within the midgut. Molecular assessment identified low or no dissemination for these species, possibly due to low virus loads. Ae. albopictus from Torres Strait islands origin was shown as an efficient vector. Cx quinquefasciatus was shown to harbour Wolbachia endosymbionts at high prevalence, whilst no Wolbachia was found in Cx annulirostris. The Australian Ae. albopictus population was shown to harbour Wolbachia at high frequency. Conclusions The risk of local Aedes species triggering large Zika epidemics in the southern parts of Australia is low. The potentially invasive Ae. albopictus showed high prevalence of virus in the saliva and constitutes a potential threat if this mosquito species becomes established in mainland Australia. Complete risk analysis of Zika transmission in the temperate zone would require an assessment of the impact of temperature on Zika virus replication within local and invasive mosquito species.

Inflammatory response to malaria pathogen Plasmodium falciparumcan be triggered by infected red blood cell-derived extracellular vesicles (EVs). This study shows these EVs contain functional microRNA-Argonaute 2 complex that modulates gene expression and alter vascular barrier properties.

Background: The hope that genomic biomarkers would dramatically and immediately improve care for common, complex diseases has been tempered by slow progress in their translation beyond bioinformatics. We propose a novel use of genomic information where the goal is to improve estimator precision in a randomized trial. We analyze the potential precision gains from the popular MammaPrint genomic signature and clinical variables in simulations of randomized trials analyzed using covariate adjustment. Methods: We apply an estimator for the average treatment effect in the trial that adjusts for prognostic baseline variables to improve precision [1]. This precision gain can be translated directly into sample size reduction and corresponding cost savings. We conduct simulation studies based on resampling genomic and clinical data of breast cancer patients from four publicly available observational studies. Results: Separate simulation studies were conducted based on each of the four data sets, with sample sizes ranging from 115 to 307. Adjusting only for clinical variables provided gains of −1%, 5%, 6%, 17%, compared to the unadjusted estimator. Adjusting only for the MammaPrint genomic signature provided gains of 2%, 4%, 4%, 5%. Simultaneously adjusting for clinical variables and the genomic signature provided gains of 2%, 6%, 7%, 16%. The differences between precision gains from adjusting for genomic plus clinical variables, versus only clinical variables, were −1%, 0%, 1%, 3%. Conclusions: Adjusting only for clinical variables led to substantial precision gains (at least 5%) in three of the four data sets, with a 1% precision loss in the remaining data set. These gains were unchanged or increased when sample sizes were doubled in our simulations. The precision gains due to incorporating genomic information, beyond the gains from adjusting for clinical variables, were not substantial.

Solid Hepatic Mesenchymal Hamartoma (HMH) rarely occurs in adults. We report two cases of solid adult HMH. A 62-year-old female with right upper abdominal pain on Computed Tomography (CT) scan revealed a well defined heterogeneously enhancing solid mass lesion in segment VII of liver along with non-enhancing central necrotic areas. Percutaneous biopsy and intraoperative frozen section were inconclusive and conventional right hepatectomy was done. Final histopathology was solid HMH. Another 63-year-old female with right upper abdominal pain had cirrhotic liver, choledocholithiases, cholelithiases, mild ascites and a right lobe lesion with calcifications on CT scan. Ultrasound guided biopsy showed fibrocollagenous tissue. She was operated for a right hepatectomy and choledochoduodenostomy. Final histopathology revealed solid HMH. Though solid adult HMH is rare, it should be considered in differential diagnosis of solid/cystic/focal or multifocal liver lesions and surgical resection to negative margins is the treatment of choice.

Introduction: India accounts for 25% of the total global TB burden, and a third of the “missing cases” that do not get diagnosed or notified. When health professional in India think of TB, they often order non-specific tests while TB can only be confirmed by microbiological tests such as sputum smear microscopy, Gene Xpert, and cultures. This study was conducted to study the role of image guided biopsy in all suspected Tuberculosis Spine cases, in terms of establishing diagnosis and to study the sensitivity and specificity of diagnostic procedures (biopsy as well as culture methods). Also, the researchers compared the available investigations results of CBNAAT, BACTEC, HPE & AFB Stain. Methodology: The present study was conducted at the Department of Orthopaedics of our institute. It was a prospective study carried out from January 2015 to June 2016. 53 patients presented to us were suspected spinal tuberculosis on Clinico- radiological ground and were posted for bone biopsy. Results: In our study, mean age of the patients is 42.5±14.3 (Range 14–73 years). Out of 53, 34 patients (64.15 %) were male and 19 (35.85 %) were female. Patients have usually presented in early destructive stage of the disease (Type 2) (30/53). We have used USG guided aspiration (04/53), CT guided biopsy (22.64%) and in majority of cases IITV guided biopsy (37/53). 4 of 53 cases were excluded, as they were inconclusive due to inadequate sample obtained during biopsy. Diagnosis was established in 38 out of 53 patients (70.71 %). Sensitivity and specificity of Z-N stain were 42.1%, and 90.9%, of HPE were 81.5% and 90.9%; of BACTEC were 89.4% and 100% respectively. Conclusion: In the present study, it is observed that no single diagnostic modality is having a good negative predictive value. Hence, a combination of diagnostic battery is required for precise diagnosis and better results. The result of BACTEC culture and CBNAAT has detected a maximum of 38 cases. While the result of Z-N microscopy and histopathology has detected small number of cases. As culture takes long incubation time for results, the CBNAAT can be applied for rapid detection of Pott's disease.

Autoimmune Pancreatitis (AIP) presents in two forms - Type I or lymphoplasmacytic sclerosing pancreatitis and Type II or idiopathic ducto-centric pancreatitis (IDCP). AIP II is rare in south Asia and, especially so, in India. Most patients have either Idiopathic Chronic Pancreatitis (ICP) or alcohol related chronic pancreatitis. AIP Type I has been described in India. We herein report a patient who had features of ICP on imaging, for whom surgery was performed to relieve chronic pancreatic pain. However, the pathologic features revealed AIP Type II or IDCP.

Intracellular colonization and persistent infection by the kinetoplastid protozoan parasite, Trypanosoma cruzi, underlie the pathogenesis of human Chagas disease. To obtain global insights into the T. cruzi infective process, transcriptome dynamics were simultaneously captured in the parasite and host cells in an infection time course of human fibroblasts. Extensive remodeling of the T. cruzi transcriptome was observed during the early establishment of intracellular infection, coincident with a major developmental transition in the parasite. Contrasting this early response, few additional changes in steady state mRNA levels were detected once mature T. cruzi amastigotes were formed. Our findings suggest that transcriptome remodeling is required to establish a modified template to guide developmental transitions in the parasite, whereas homeostatic functions are regulated independently of transcriptomic changes, similar to that reported in related trypanosomatids. Despite complex mechanisms for regulation of phenotypic expression in T. cruzi, transcriptomic signatures derived from distinct developmental stages mirror known or projected characteristics of T. cruzi biology. Focusing on energy metabolism, we were able to validate predictions forecast in the mRNA expression profiles. We demonstrate measurable differences in the bioenergetic properties of the different mammalian-infective stages of T. cruzi and present additional findings that underscore the importance of mitochondrial electron transport in T. cruzi amastigote growth and survival. Consequences of T. cruzi colonization for the host include dynamic expression of immune response genes and cell cycle regulators with upregulation of host cholesterol and lipid synthesis pathways, which may serve to fuel intracellular T. cruzi growth. Thus, in addition to the biological inferences gained from gene ontology and functional enrichment analysis of differentially expressed genes in parasite and host, our comprehensive, high resolution transcriptomic dataset provides a substantially more detailed interpretation of T. cruzi infection biology and offers a basis for future drug and vaccine discovery efforts.

Objective: To estimate the biochemical parameters which are responsible for the causation of biliary calculi, with risk factor correlation in Kolar district, Karnataka. Materials and Methods: Clinically diagnosed and postoperatively collected gall stones were analyzed to find their chemical composition, such as cholesterol, triglycerides and bilirubin and to evaluate the risk factors which were responsible for the causation of biliary calculi. Out of 4256 surgical admissions in our institute, gall stones were removed from fifty patients who presented with acute abdomen, who were confirmed to have calculus cholecystitis on sonography and these were selected for this study. A detailed history was taken from the patients to analyze the risk factors. The stones were analyzed for their composition; the serum of the patients was collected for analysis of fasting lipid and other serum parameters. Statistical analysis was done by using the SPSS package to find out the descriptive parameters. Results: The highest incidence was seen in patients in the age group of 41-50 years. The female to male ratio was 2.57:1. Among the risk factors, hyperlipidaemia was observed in 64% of the cases, 40% had a sedentary life style, 30% had a history of high fatty diet intake and 12% were on OCP’s. The biochemical analysis of the stones showed 68% patients to have mixed stones, with bilirubin being the major constituent of these stones. Bile culture was positive in 68% of the patients, with E.coli being the most common type of organism observed. Chronic cholecystitis was the most common histopathological finding. Conclusion: Only few studies have been done, which have considered the clinical, epidemiological and the biochemical analysis of gall stone in the south Indian urban population. This study adds to the knowledge of the gall stone risk factors in the rural parts of south India. However, more studies with respect to the pathogenesis of gall stones with more number of patients has to be done, to further conclude the gall stone analysis and the risk factors.

Maternal morbidity and mortality in low and middle income countries has remained exceedingly high. However, information on bacterial and viral maternal infections, which are important contributors to poor pregnancy outcomes, is sparse and poorly characterised. This review aims to describe the epidemiology and aetiology of bacterial and viral maternal infections in low and middle income countries.

There have been very few systematic reviews looking at maternal infections in the developing world, even though cutting maternal mortality by three quarters is United Nation’s Millennium Development Goal number five. This systematic review has two aims. The first is to present the prevalence of parasitic infections in the developing world over the last 30 years and the second is to evaluate the quality and distribution of research in this field.

Deepa R Anijeet, Prasad Palimar, Clive O PeckarDepartment of Ophthalmology, Warrington and Halton NHS Trust, UKAim: To compare the incidences of endophthalmitis after cataract operations before and after introduction of intracameral vancomycin at the end of surgery.Methods: A retrospective analysis was performed of presumed infectious endophthalmitis after cataract surgery from January 1, 1998 to December 31, 2008. From January 2001, the practice of using intracameral vancomycin at the end of cataract surgery was introduced. The period before introduction of intracameral vancomycin is considered as period A and that after as period B. The incidences of presumed or culture-proven endophthalmitis during periods A and B were compared.Results: A total of 16,606 cataract surgeries were performed during the study period. The incidence of endophthalmitis per 1000 cataract surgeries was 3.0 during period A and 0.08 during period B. This reduction was statistically significantly (Chi-squared test 36.6, P value < 0.0001). The relative risk of developing endophthalmitis without intracameral vancomycin prophylaxis was 38. The absolute risk reduction was 292 cases of endophthalmitis per 100,000 cataract surgeries.Conclusions: Intracameral vancomycin significantly reduced the incidence of postoperative endophthalmitis after cataract surgery. There is a universal need to adopt this mode of microbial prophylaxis to reduce the burden of endophthalmitis after cataract surgery.Keywords: endophthalmitis, intracameral vancomycin, cataract surgery

OBJECTIVE: Women with drug refractory neurogenic mixed incontinence (NMI) have limited minimally invasive treatment options and require reconstructive surgery. We examined efficacy of a combination of day case intradetrusor (ID) botulinum toxin (BTX-A) bladder injections and transobturator (TOT) or tension free vaginal tape (TVT). MATERIALS AND METHODS: Eleven women who are pharmacotherapy intolerant or who have drug refractory NMI were treated. Two opted for open surgery and the remaining 9 received 1000 units of Dysport diluted in 30 mL saline cystoscopically at 30 ID sites followed by TOT in 6 or TVT in 3 as a day case combination treatment. Patient demographics, pre and post treatment videocystometrogram (VCMG), pad test and International Committee on Incontinence Questionnaire (ICIQ) scores were recorded. At 6 weeks (repeat ICIQ, pad test and patient satisfaction), at 3 and 12 months (VCMG) and 'current' (ICIQ and patient satisfaction) was recorded. RESULTS: The mean age was 56.7 years (range 41 to 78) with a mean follow up of 19.1 months (range 7 to 33). All women were continent at 3 and 12 months. Quality of life (ICIQ scores) improved at 6 weeks (p > 0.001) and remained stable up to the last follow up (p > 0.001). Eight women have stopped using pads. At 3 months, there was significant improvement in MDP (p > 0.014) and MCC (p = 0.002). Anticholinergics were discontinued in 7 with global high satisfaction with the treatment BTX-A injections were repeated in 4 (mean 13.5 months). CONCLUSION: Anticholinergic refractory women with NMI can be effectively treated as a day case with combination of ID BTX-A injections and TVT or TOT.

Uncertainty influences a decision maker's choices when making sequential capital investment decisions. With the possibility of extremely negative cash inflows, firms may need to curtail operations significantly. Traditional Net Present Value analysis does not allow for efficient management of these problems. In addition, firm managers may behave irrationally by accepting negative Net Present Value projects in the short term. This paper presents a Monte Carlo simulation based model to provide policy insights on how to incorporate extreme cash flows and manager irrationality scenarios into the capital budgeting process. This paper presents evidence that firms with irrational managers and experiencing extremely negative cash flows may, under certain conditions, reap long term rewards associated with the acceptance of negative Net Present Value projects in the short term. These benefits are largest if cost ratios (discount rates) are small, or investment horizons are high. We argue that acceptance of short term negative Net Present Value projects implies the purchase of a long term real option which can generate positive long term cash flows under certain conditions.

DMT1 _ Divalent Metal (Ion) Transporter 1 or SLC11A2/DCT1/Nramp2 _ transports Fe2+ into the duodenum and out of the endosome during the transferrin cycle. DMT1 also is important in non-transferrin bound iron uptake. It plays similar roles in Mn2+ trafficking. Voltage clamping showed that six other metals evoked currents, but it is unclear if these metals are substrates for DMT1. This report summarizes progress on which metals DMT1 transports, focusing on results from the authors' labs. We recently cloned 1A/+IRE and 2/-IRE DMT1 isoforms to generate HEK293 cell lines that express them in a tetracycline-inducible fashion, then compared induced expression to uninduced expression and to endogenous DMT1 expression. Induced expression increases ~50x over endogenous expression and ~10x over uninduced levels. Fe2+, Mn2+, Ni2+ and Cu1+ or Cu2+ are transported. We also explored competition between metal ions using this system because incorporation essentially represents DMT1 transport and find this order for transport affinity: Mn>?Cd>?Fe>Pb~Co~Ni>Zn. The effects of decreased DMT1 also could be examined. The Belgrade rat has diminished DMT1 function and thus provides ways of testing. A series of DNA constructs that generate siRNAs specific for DMT1 or certain DMT1 isoforms yield another way to test DMT1-based transport.

Background: Acquired Immune Deficiency Syndrome (AIDS) has piled enormous tension all over the world in recent times due to its diverting phenomenon. Recent estimates of more than 2.5 million infected HIV cases in India contribute largest number in the world. Objective: To assess the socio-demographic profile of HIV /AIDS patients attending the ART centre in Medical College; to study the trend of the mode of transmission among HIV/AIDS patient in the ART centre and to assess the risk behavior pattern among HIV/ AIDS patient in the ART center. Material and Methods: During the study period of August 2008 to July 2009, data was collected by every alternate day visit in order to take at least 50% of ART attendees in our study. Interview was taken by using predesigned, pretested questionnaire. Result: Out of 250 cases observed 169 were males and 81 were females. Maximum 98% of ART attendees had sex with heterosexual partners reveals that these people acquired this disease through heterosexual mode & 1.6% from homosexual mode and 0.4% attendees got infected by both heterosexual & homosexual modes. Conclusion: People have begun using ART center services, which reflect a change in their attitude toward HIV. The study provides us a clue to formulate an effective approach to educate people as well as the health personnel who are though of as one of the sources of discrimination.

The Tiger (Panthera tigris) population in India has undergone a sharp decline during the last few years. Of the number of factors attributed to this decline, habitat fragmentation has been the most worrisome. Wildlife corridors have long been a subject of discussion amongst wildlife biologists and conservationists with contrasting schools of thought arguing their merits and demerits. However, it is largely believed that wildlife corridors can help minimize genetic isolation, offset fragmentation problems, improve animal dispersal, restore ecological processes and reduce man animal conflict. This study attempted to evaluate the possibilities of identifying a suitable wildlife corridor between two very important wildlife areas of central India--the Kanha National Park and the Pench National Park--with tiger as the focal species. Geographic Information System (GIS) centric Least Cost Path modeling was used to identify likely routes for movement of tigers. Habitat suitability, perennial water bodies, road density, railway tracks, human settlement density and total forest edge were considered as key variables influencing tiger movement across the Kanha-Pench landscape. Each of these variables was weighted in terms of relative importance through an expert consultation process. Using different importance scenarios, three alternate corridor routes were generated of which one was identified as the most promising for tiger dispersal. Weak links--where cover and habitat conditions are currently sub-optimal--were flagged on the corridor route. Interventions aimed at augmenting the identified corridor route have been suggested using accepted wildlife corridor design principles. The involvement of local communities through initiatives such as ecotourism has been stressed as a crucial long term strategy for conservation of the Kanha-Pench wildlife corridor. The results of the study indicate that restoration of the identified wildlife corridors between the two protected areas is technically feasible.

In this overview to biomedical computing in the cloud, we discussed two primary ways to use the cloud (a single instance or cluster), provided a detailed example using NGS mapping, and highlighted the associated costs. While many users new to the cloud may assume that entry is as straightforward as uploading an application and selecting an instance type and storage options, we illustrated that there is substantial up-front effort required before an application can make full use of the cloud's vast resources. Our intention was to provide a set of best practices and to illustrate how those apply to a typical application pipeline for biomedical informatics, but also general enough for extrapolation to other types of computational problems. Our mapping example was intended to illustrate how to develop a scalable project and not to compare and contrast alignment algorithms for read mapping and genome assembly. Indeed, with a newer aligner such as Bowtie, it is possible to map the entire African genome using one m2.2xlarge instance in 48 hours for a total cost of approximately $48 in computation time. In our example, we were not concerned with data transfer rates, which are heavily influenced by the amount of available bandwidth, connection latency, and network availability. When transferring large amounts of data to the cloud, bandwidth limitations can be a major bottleneck, and in some cases it is more efficient to simply mail a storage device containing the data to AWS (http://aws.amazon.com/importexport/). More information about cloud computing, detailed cost analysis, and security can be found in references.

An asymptomatic 9-year-old boy was referred for extensive lipid exudation into the retina. He was known to have familial hypercholesterolemia. The lipids resorbed rapidly and spontaneously merely by lowering the cholesterol levels with statins. The possible mechanism of action and the potential role of expanding this therapy are briefly discussed.

A 42 year old man presented with acute bilateral uveitis and necrotizing retinitis. Systemic investigations including test for AIDS and CMV retinitis were negative. Despite oral Acyclovir, both eyes progressed rapidly to retinal detachment with loss of vision. Early recognition is necessary to diagnose the bilateral acute retinal necrosis syndrome and initiate treatment. Bilateral acute retinal necrosis (BARN) is a term first coined by Young and Bird in 1978 although the syndrome had been originally described by Urayama et al as an unilateral condition. This syndrome is characterized by the triad of acute confluent peripheral necrotizing retinitis, moderate to severe vasculitis and vitritis in an otherwise healthy individual. Rhegmatogenous retinal detachment occurs within two to three months of the onset of the disease and the second eye is involved in 36% of patients, usually within 6 weeks. We herein report a patient who presented with simultaneous BARN leading to retinal detachment in a matter of days. Also, to our knowledge this is the first report of this condition in India.

We report an unusual observation of Cryptococcal neoformans profiles engulfed by neutrophils on a routine peripheral blood smear examination in an HIV-negative young female patient who presented with perforation of large bowel following a pregnancy termination procedure by an untrained midwife.