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Aim: The frequency of severe acute malnutrition (SAM) is the highest in India. Although it should receive more attention, severe anemia is one of the comorbidities that increases mortality in children who are severely undernourished. In SAM children, the liver function test (LFT), kidney function test (KFT), and complete blood count (CBC) are deranged, but their correlation with the prognosis is not well defined. The aim was to describe the anthropometric assessment and biochemical profile of children with SAM. Methods: This cross-sectional cohort study was performed at the Departments of Paediatrics and Biochemistry at G.S.V.M. Medical College, Kanpur, and at the Department of Biotechnology at Amity University Rajasthan, Jaipur. One hundred and six patients with SAM were enrolled; 53 were grouped as complicated SAM (Group 1) (dehydration and severe dehydration) and 53 were diagnosed as non-complicated SAM (Group 2). Results: Group II had significantly higher mean values for height, weight, mid-upper arm circumference (MUAC), head circumference, and body mass index (BMI) for age percentile compared to Group I, with P-values of 0.001. Group I had a significantly lower level of hemoglobin (8.86 g/dL ± 2.21 g/dL) compared to Group II (10.0 g/dL ± 1.83 g/dL) with a P-value of 0.003. The difference in the frequency of anemia between the groups was statistically significant, with a P-value of 0.026. Anemia significantly increased the risk of complicated SAM with an odds ratio of 2.60 [95% confidence interval (CI), 1.07–6.31, P = 0.001]. Conclusions: This study suggests that there may be a significant relationship between anemia and the development of complications in high-risk children with SAM.

Background: The diagnosis of parotid swelling is challenging and investigations like imaging and needle aspiration cytology are helpful. The objective of this study was to determine the diagnostic accuracy of fine needle aspiration cytology (FNAC) as compared to the histopathology in parotid gland swelling. Methods: It was a descriptive cross sectional study carried out in the Department of ENT-Head & Neck Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu by reviewing the medical record charts of the patients who had undergone surgery for parotid lesions during the study period of seven and half years. All patients whose fine needle aspiration cytology and histopathology reports were available were included in the study. The data were presented as mean, standard deviation, ratio and percentages. Microsoft excel was used for data analysis. Results: There were 75 patients included in the study. The age ranged from nine years to 78 years and the mean age being 38.3± 17.42 years. The male to female ratio was 1:1.78. The concordance rate between fine needle aspiration cytology and histopathology was 82.7%. The sensitivity and specificity of the fine needle aspiration cytology were 80% and 95% respectively. Similarly, the positive predictive and negative predictive values were 84% and 93% respectively. The diagnostic accuracy of the fine needle aspiration cytology was 91% for the parotid swelling in our study. Conclusions: The diagnostic accuracy of fine needle aspiration cytology for parotid swellings in our study was excellent. The result of fine needle aspiration cytology is helpful in deciding management plan for parotid lesions. Keywords: Benign; cytology; histopathology; malignant; parotid.

Background: Severe acute malnutrition (SAM) is a significant public health problem in developing countries, including India, where a significant proportion of children suffer from malnutrition. Objective: This research aims to investigate the factors contributing to severe acute malnutrition (SAM). Additionally, the study seeks to explore the relationship between micronutrient levels and pro-inflammatory cytokines in SAM children with and without clinical complications. Furthermore, the effectiveness of antibiotic treatment in SAM children without complications is evaluated. Methods: The study involved three groups comprising 66 subjects each: a healthy control group, SAM children with complications, and SAM children without complications. Blood samples were collected, and various analyses were conducted, including biochemical, hematological, micronutrient, and pro-inflammatory marker quantification. The data were analyzed using SPSS version 22.0. Results: The results indicate that the levels of IL-6, CRP, and TNF-α were significantly higher in the SAM group with complications compared to both the control group and the SAM group without complications. Zinc and copper levels were significantly lower in both SAM groups compared to the control group, and a negative correlation was observed between zinc levels and inflammatory markers. The study also assessed the efficacy of antibiotic treatment in SAM children without complications by comparing their weight, height, weight-for-height, and weight-for-age at baseline and after a 15-day follow-up period. Significant improvements in these parameters were observed in both the group receiving antibiotic treatment and the group not receiving antibiotic treatment. Conclusion: The findings suggest that a combination of antibiotic treatment and nutritional support can lead to significant clinical improvements in SAM children without complications. This study has important implications for the management and treatment of SAM in India and other developing countries.

Abstract Redox active electrolyte supercapacitors differ significantly from the conventional electrolytes based storage devices but face a long term stability issue which requires a different approach while designing the systems. Here, we show the change in layered double hydroxides (LDHs) systems with rare earth elements (lanthanum) can drastically influence the stability of two dimensional LDH systems in redox electrolyte. We find that the choice of rare earth element (lanthanum) having magnetic properties and higher thermal and chemical stability has a profound effect on the stability of La–Co LDHs electrode in redox electrolyte. The fabricated hybrid device with rare earth based positive electrode and carbon as negative electrode having redox electrolyte leads to long stable high volumetric/gravimetric capacity at high discharge rate, demonstrates the importance of considering the rare earth elements while designing the LDH systems for redox active supercapacitor development.

Antimicrobial resistance (AMR) continues to be a serious global public issue. Unnecessary and inappropriate use of antimicrobials has been identified as a major contributing factor for AMR. Implementation of antimicrobial stewardship programs (ASPs) is valued as a key strategy to combat AMR. Although ASP is a key intervention to improve appropriate use of antibiotics, there is limited experience and research to describe its implementation in low-income countries such as Nepal. Grande International Hospital (GIH) is the first health organization in Nepal to implement and sustain a multidisciplinary ASP and infection control program. Challenges faced in implementing ASP include lack of acceptance from physicians, lack of knowledge regarding antibiotic prescribing, lack of staff for ASP activities, limitations in diagnostic testing to inform ASP, and limitations in antibiotic choice due to antibiotic unavailability. Our ASP includes the following components: an ASP committee, an antibiotic prescribing reference guide with dosage recommendations, inpatient formulary restriction system, educational outreach and programming for physicians and other stakeholders, and periodic review and revision of the program and reference guide. The ASP provided opportunities to address several knowledge gaps across our healthcare institution including improved knowledge and competency regarding rational use of antibiotics, access to quality medicines and better care to patients. It is our hope that, by describing the challenges and opportunities we experienced while implementing our ASP, we can support and encourage other institutions to adapt and implement ASPs in Nepal and other resource-limited settings.

The scientific community believes that high-quality, bulk layered, semiconducting single crystals are crucial for producing two-dimensional (2D) nanosheets. This has a significant impact on current cutting-edge science in the development of next-generation electrical and optoelectronic devices. To meet this ever-increasing demand, efforts have been made to manufacture high-quality SnS2 single crystals utilizing low-cost CVT (chemical vapor transportation) technology, which allows for large-scale crystal production. Based on the chemical reaction that occurs throughout the CVT process, a viable mechanism for SnS2 growth is postulated in this paper. Optical, XRD with Le Bail fitting, TEM, and SEM are used to validate the quality, phase, gross structural/microstructural analyses, and morphology of SnS2 single crystals. Furthermore, Raman, TXRF, XPS, UV–Vis, and PL spectroscopy are used to corroborate the quality of the SnS2 single crystals, as well as the proposed energy level diagram for indirect transition in the bulk SnS2 single crystals. As a result, the suggested method provides a cost-effective method for growing high-quality SnS2 single crystals, which could lead to a new alternative resource for producing 2D SnS2 nanosheets, which are in great demand for designing next-generation optoelectronic and quantum devices.

Clinical findings of foreign body aspiration, generally, are subtle. Scrutinous clinical suspicion is always recommended. Here, we present a rare case of an adult male, who under the influence of alcohol had aspirated a row of his artificial denture without his conscience of where his denture got missing and presented to our outpatient department with non-specific symptoms. With clinical examination and advanced diagnostics, he was successfully managed with rigid bronchoscopy. With the advancement in diagnostic techniques and our widened knowledge of the condition, utmost early detection has been possible and our case report reinforces the need for a low threshold for foreign body aspiration suspicion, especially in adults with dentures, and the use of rigid bronchoscopy as a plausible tool for the prompt management of the aspiration.

Objective: It has been explored that Vitamin D play role in various non-skeletal disorders including Diabetes Mellitus. The present study was designed with the aim to assess association among control, pre-diabetic and diabetic with vitamin D and association between lipid profile and vitamin D. Materials and Methods: A total of 109 subjects were recruited for the cross-sectional study including 37 as control, 41 pre-diabetic and 31 diabetic. A clinical examination was done for all the groups including fasting samples (12hrs) for lipid parameters, serum 25 (OH) vitamin D level and (HbA1/C). Results: It was found that in control subjects 37.9% have the sufficient vitamin D3 level whereas 17.1% subjects in pre-diabetic, 16.6% in diabetic with good glycemic control and no subject was found to have sufficient vitamin D3 level in diabetic with poor glycemic control. The mean vitamin D3 levels was highest in control i.e. -26.53±11.99 ng/ml followed by 20.23±4.12ng/ml in pre-diabetics,19.07±8.01ng/ml in diabetics with good glycemic control and 12.92±6.77ng/ml in diabetics with poor glycemic control. HBA1/c and serum vitamin D3level share a significant association (P-value< 0.01).Total cholesterol (P-value< 0.0), serum triglyceride (P-value< 0.01), serum LDL cholesterol (P-value< 0.01) and serum VLDL (P-value< 0.01) had inverse association with vitamin D levels. HDL cholesterol has no effect with vitamin D. Conclusion: The present study showed vitamin D3 deficiency as a risk factor for worsening glycemic control and dyslipidemia.

Background: Non-alcoholic fatty liver disease (NAFLD) also referred as metabolic as metabolic (dysfunction) associated fatty liver disease. Type 2 diabetes mellitus (T2DM) is a major cause in progression of NAFLD and non-alcoholic steatohepatitis (NASH). The aim of the present study is to assess the activity of liver enzymes in T2DM in North Indian population. Method: This was a cross-sectional descriptive study clinic-based study in patients with T2DM. A total of 612 participants (226 healthy controls and 386 T2DM) were recruited. Body mass index (BMI), activity of liver enzymes including alanine and aspartate aminotransferase (ALT, AST) along with alkaline phosphatase (ALP) was measured. Fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) along with total protein (TP) and albumin were also measured. Quantitative variables were expressed as mean ± SD, while qualitative variables as frequencies (%). Pearson/Spearman correlation test, unpaired t-test, Chi-squared test was used to assess the correlation, association and significant differences between study groups respectively. A P-value of

SARS-CoV-2–infected patients are reported to show immunocompromised behavior that gives rise to a wide variety of complications due to impaired innate immune response, cytokine storm, and thrombo-inflammation. Prolonged use of steroids, diabetes mellitus, and diabetic ketoacidosis (DKA) are some of the factors responsible for the growth of Mucorales in such immunocompromised patients and, thus, can lead to a life-threatening condition referred to as mucormycosis. Therefore, an early diagnosis and cell-based management cosis is the need of the hour to help affected patients overcome this severe condition. In addition, extended exposure to antifungal drugs/therapeutics is found to initiate hormonal and neurological complications. More recently, mesenchymal stem cells (MSCs) have been used to exhibit immunomodulatory function and proven to be beneficial in a clinical cell-based regenerative approach. The immunomodulation ability of MSCs in mucormycosis patient boosts the immunity by the release of chemotactic proteins. MSC-based therapy in mucormycosis along with the combination of short-term antifungal drugs can be utilized as a prospective approach for mucormycosis treatment with promising outcomes. However, preclinical and in mucormyIn mucormycosis, the hyphae of clinical trials are needed to establish the precise mechanism of MSCs in mucormycosis treatment.

Exosomes are nano-vesicles of endosomal origin inherited with characteristics of drug delivery and cargo loading. Exosomes offer a diverse range of opportunities that can be exploited in the treatment of various diseases post-functionalization. This membrane engineering is recently being used in the management of bacteria-associated diabetic foot ulcers (DFUs). Diabetes mellitus (DM) is among the most crippling disease of society with a large share of its imposing economic burden. DM in a chronic state is associated with the development of micro- and macrovascular complications. DFU is among the diabetic microvascular complications with the consequent occurrence of diabetic peripheral neuropathy. Mesenchymal stromal cell (MSC)-derived exosomes post-tailoring hold promise to accelerate the diabetic wound repair in DFU associated with bacterial inhabitant. These exosomes promote the antibacterial properties with regenerative activity by loading bioactive molecules like growth factors, nucleic acids, and proteins, and non-bioactive substances like antibiotics. Functionalization of MSC-derived exosomes is mediated by various physical, chemical, and biological processes that effectively load the desired cargo into the exosomes for targeted delivery at specific bacterial DFUs and wound. The present study focused on the application of the cargo-loaded exosomes in the treatment of DFU and also emphasizes the different approaches for loading the desired cargo/drug inside exosomes. However, more studies and clinical trials are needed in the domain to explore this membrane engineering.

Abstract A young girl inhaled a pointed iron nail into the right main bronchus. However, both rigid bronchoscopy and oesophagoscopy failed to locate the nail. Surprisingly, it was detected in the abdomen by C‐arm and was expelled uneventfully while defecating two days later.

Vitamin D plays an important role in glucose tolerance by stimulating insulin secretion and evidences suggest a contradictory result on the association between vitamin D status and risk of developing gestational diabetes mellitus (GDM). The present updated meta-analysis has been undertaken to find out the joined effect of vitamin D status on the risk of effect GDM considering previously published articles. Data were collected through literature search using electronic databases to retrieve relevant published research articles using various combinations of the following keywords, “vitamin D,” “vitamin D deficiency,” “cholecalciferol,” “25-hydroxyvitamin D,” “25(OH) D,” “gestational diabetes mellitus,” and “GDM.” A total of 36 studies including 7,596 GDM cases and 23,377 non-GDM controls were involved in this study. Overall, pooled meta-analysis showed that pregnant women diagnosed with GDM have 18% higher risk of GDM risk when compared with controls [odds ratio (OR) = 1.18, 95% confidence interval (CI) 1.10–1.25; P = 0.00] with high heterogeneity (I2 = 73.29). The mean difference was also significantly different between cases and controls (OR = −0.18, 95% CI − 0.22 to − 0.14; P = 0.00). Subgroup analysis showed significant results with age more than 30 years, Asian and European regions, and case–control, cross-sectional, and nested case–control study design. Low concentration of vitamin D is associated with the development of GDM. Although in future more studies especially systematically designed clinical trials based on vitamin D supplementation with large sample size on different population are needed to elucidate the exact concentration of vitamin D during pregnancy as well as before and after pregnancy.

Introduction: Tonsillectomy is one of the common ENT surgical procedures. Post-tonsillectomy haemorrhage remains a frequent complication which can be potentially life-threatening. The objective of the present study was to calculate the prevalence of haemorrhage following a tonsillectomy at a tertiary care centre. Methods: It was a descriptive cross-sectional study performed by medical chart review of the patients who underwent tonsillectomy from January 2018 to December 2019 at the department of ENT- Head and Neck Surgery of Tribhuvan University Teaching Hospital. Ethical approval was obtained from the institutional review committee (Ref:-282(6-11) E2 076/077). Convenient sampling method was used. All patients of any age who had tonsillectomy for recurrent tonsillitis or tonsillar hypertrophy with or without obstructive sleep apnoea and no missing information on chart review were included in the study. Data were entered in MS-Excel 2007 and analyzed in rate and percentage. Results: Ten (5.18%) out of a total of 193 patients who underwent tonsillectomy had a post tonsillectomy haemorrhage. All 10 (100%) were adults patients, operated for recurrent tonsillitis, and used electrocautery. It was common in male patients 7 (70%). All of the haemorrhages was between a third and sixth postoperative day and were mild in severity. Conclusions: The prevalence of post-tonsillectomy haemorrhage was high at our centre during the study period of two years. It was common in adults, males and surgery done for recurrent tonsillitis using electrocauterization.

The application of natural fibers such as Jute/bagasse with glass fiber hybrid advanced composites has gained increasing interest both in many areas of engineering and technology. Hybrid plates of two compositions, i.e., Jute fiber mat-chopped glass fiber and Chopped Bagasse-glass fiber mat with epoxy as a matrix were fabricated using hand lay-up technique and their mechanical properties were evaluated. Tensile strength (TS), tensile modulus (TM), elongation at break (Eb%) and hardness of the composite samples were evaluated as per ASTM standards. Moisture absorption capacity for the above two compositions have been found out by hygrometric principle and it was concluded that the water absorption increased as the weight% of natural reinforcement increased. Degradation test has been carried out by burying the samples for different period (15–30 days) in the soil and it was found that as the weight% of natural fiber reinforcement increased the degradation rate increased. Tensile strength was found to be increased (11%) by alkali (NaOH) treatment of the natural fiber. The composite specimens were also immersed in the water for 24 hours and decrement in the tensile strength was noted. Microscopic examinations were carried out to analyse the interfacial characteristics of materials, internal structure of the fractured surfaces and material failure morphology by using Scanning Electron Microscope (SEM).

Abstract In search of affordable, flexible, lightweight, efficient and stable supercapacitors, metal oxides have been shown to provide high charge storage capacity but with poor cyclic stability due to structural damage occurring during the redox process. Here, we develop an efficient flexible supercapacitor obtained by carbonizing abundantly available and recyclable jute. The active material was synthesized from jute by a facile hydrothermal method and its electrochemical performance was further enhanced by chemical activation. Specific capacitance of 408 F/g at 1 mV/s using CV and 185 F/g at 500 mA/g using charge-discharge measurements with excellent flexibility (~100% retention in charge storage capacity on bending) were observed. The cyclic stability test confirmed no loss in the charge storage capacity of the electrode even after 5,000 charge-discharge measurements. In addition, a supercapacitor device fabricated using this carbonized jute showed promising specific capacitance of about 51 F/g, and improvement of over 60% in the charge storage capacity on increasing temperature from 5 to 75 °C. Based on these results, we propose that recycled jute should be considered for fabrication of high-performance flexible energy storage devices at extremely low cost.

The novel coronavirus severe acute respiratory syndrome-CoV-2 (SARS-CoV-2) is responsible for COVID-19 infection. The COVID-19 pandemic represents one of the worst global threats in the 21st century since World War II. This pandemic has led to a worldwide economic recession and crisis due to lockdown. Biomedical researchers, pharmaceutical companies, and premier institutes throughout the world are claiming that new clinical trials are in progress. During the severe phase of this disease, mechanical ventilators are used to assist in the management of outcomes; however, their use can lead to the development of pneumonia. In this context, mesenchymal stem cell (MSC)-derived exosomes can serve as an immunomodulation treatment for COVID-19 patients. Exosomes possess anti-inflammatory, pro-angiogenic, and immunomodulatory properties that can be explored in an effort to improve the outcomes of SARS-CoV-2-infected patients. Currently, only one ongoing clinical trial (NCT04276987) is specifically exploring the use of MSC-derived exosomes as a therapy to treat SARS-CoV-2-associated pneumonia. The purpose of this review is to provide insights of using exosomes derived from mesenchymal stem cells in management of the co-morbidities associated with SARS-CoV-2-infected persons in direction of improving their health outcome. There is limited knowledge of using exosomes in SARS-CoV-2; the clinicians and researchers should exploit exosomes as therapeutic regime.

The vertical aligned carbon nanotubes (CNTs)-based pillar architectures were created on laminated silicon oxide/silicon (SiO2/Si) wafer substrate at 775 °C by using water-assisted chemical vapor deposition under low pressure process condition. The lamination was carried out by aluminum (Al, 10.0 nm thickness) as a barrier layer and iron (Fe, 1.5 nm thickness) as a catalyst precursor layer sequentially on a silicon wafer substrate. Scanning electron microscope (SEM) images show that synthesized CNTs are vertically aligned and uniformly distributed with a high density. The CNTs have approximately 2–30 walls with an inner diameter of 3–8 nm. Raman spectrum analysis shows G-band at 1580 cm−1 and D-band at 1340 cm−1. The G-band is higher than D-band, which indicates that CNTs are highly graphitized. The field emission analysis of the CNTs revealed high field emission current density (4mA/cm2 at 1.2V/μm), low turn-on field (0.6 V/μm) and field enhancement factor (6917) with better stability and longer lifetime. Emitter morphology resulting in improved promising field emission performances, which is a crucial factor for the fabrication of pillared shaped vertical aligned CNTs bundles as practical electron sources.

The present article deals with filtration of seawater to remove sodium chloride (NaCl) using filter made from organized structures of carbon nanotubes (CNTs). The filter consists of hollow carbon cylinder (length ~10 cm, diameter ~1 cm), which is composed of radially aligned CNTs. This carbon hollow cylinder has been synthesized by continuous spray pyrolysis of ferrocene–benzene solution in argon atmosphere. The hollow cylinder has been turned into a water filter by closing one end and keeping a small funnel at the other. Filtration of seawater (Marina Beach, Chennai, India) has been obtained both under the self pressure of seawater column in the hollow cylinder and under the difference of pressure created by enclosing the filter in a vacuum tight container. It has been found that the efficiency of filtration is about two times higher under partial vacuum (~10–2 torr) created on the filtrate (water) side. After filtration of seawater, a deposit in the inner surface of hollow cylinder has been found. This deposit has been characterized by X-ray diffraction, transmission electron microscopy and energy dispersive X-ray analysis, and it has been found that the deposit was NaCl. The filtration leads to almost complete removal of NaCl from the seawater.

Clouston syndrome (hidrotic ectodermal dysplasia) is characterized by the clinical triad of nail dystrophy, alopecia and palmoplantar hyperkeratosis. Clouston syndrome is transmitted as an autosomal dominant trait and caused by mutations in the GJB6 gene (13g12), encoding the gap junction protein connexin 30 (C x 30). At present, there is no treatment for the disease and management is purely supportive. The life of span, patients is normal. In this report, a case of 9-year-old boy is presented who had few set of primary dentition, but surprisingly complete absence of permanent dentition which observed radiographically. In this case, anodonfa of permanent dentition was present and no alopecia which is a rare finding.