Search

Abstract The use of novel active ingredients for the functional modification of chitosan nanoformulations has attracted global attention. In this study, chitosan has been functionalized via histidine to craft novel chitosan–histidine nanoformulation (C–H NF) using ionic gelation method. C–H NF exhibited elite physico-biochemical properties, influencing physiological and biochemical dynamics in Tomato. These elite properties include homogenous-sized nanoparticles (314.4 nm), lower PDI (0.218), viscosity (1.43 Cps), higher zeta potential (11.2 mV), nanoparticle concentration/ml (3.53 × 108), conductivity (0.046 mS/cm), encapsulation efficiency (53%), loading capacity (24%) and yield (32.17%). FTIR spectroscopy revealed histidine interaction with C–H NF, while SEM and TEM exposed its porous structure. Application of C–H NF to Tomato seedling and potted plants through seed treatment and foliar spray positively impacts growth parameters, antioxidant-defense enzyme activities, reactive oxygen species (ROS) content, and chlorophyll and nitrogen content. We claim that the histidine-functionalized chitosan nanoformulation enhances physico-biochemical properties, highlighting its potential to elevate biochemical and physiological processes of Tomato plant.

Ultraviolet communication (UVC) is a promising technology due to its ability to operate in non-line-of-sight (NLOS) mode thereby eliminating the pointing acquisition and tracking (PAT) requirement as needed by infrared and visible light communications. However, NLOS UVC suffers from very high attenuation and turbulence-induced fading when operated over a long distance. Due to these limitations, the existing literature on the NLOS UVC is mostly restricted to short-distance communications only. Therefore, this paper addresses these challenges by proposing an outdoor subcarrier-intensity-modulation (SIM) based multi-relay cooperative communication system employing the best relay selection and decode-and-forward (DF) relaying protocol. The turbulence-induced fading is modelled using lognormal distribution under weak atmospheric turbulence conditions. We derive novel closed-form analytical expressions of outage probability and ergodic capacity. Correctness of the derived analytical expressions is validated through numerical simulations.

Since its sudden outbreak in December 2019 in Wuhan, A pandemic of SARS-CoV-2 has been announced. Vitamin C is a water-soluble vitamin with anti-oxidant and immunity-boosting properties. Vitamin C acts as a nutritional supplement profoundly impacting the immune response to the second or third wave of the coronavirus disease (COVID-19). Vitamin C efficacy as an adjuvant treatment for inflammation and symptoms associated with COVID-19 infection should be investigated further. This report sheds light on the available information on the current clinical trials and pharmacotherapy related to COVID-19. Information available on Pubmed, EMBASE, Scopus, Web of Science databases and EU clinical trials regarding the use of therapeutic agents in patients with COVID-19 was used to perform analysis. Data was taken from 18 clinical trials available in the U.S. National Library of Medicine. All trials that are active, completed, or in the process of recruiting are included in data. Because of majority of clinical trials are still ongoing, specific results and high-quality clinical evidence are lacking. Before being standardised for use, the protocol must undergo large randomised clinical studies using a variety of existing medications and potential therapies. The pivotal role played by vitamins C in maintaining our immune system, is quite apparent. This review is an attempt to summarize the available information regarding the use of vitamin C as an adjuvant therapy in COVID-19 patients.

Background: Blood D-lactate levels increase in short bowel syndrome (SBS) and may lead to neurological manifestations. Clinical Description: A 5-year-old boy, postoperative case of SBS, presented with loose stools, generalized weakness, and lethargy for 2 days. The child had undergone significant intestinal resection in the past. On examination, he had some dehydration, and was drowsy, but arousable. Remaining examination was normal. Metabolic abnormalities detected included metabolic acidosis (pH of 7.1, HCO3 7 mmol/L), high anion gap (20 mmol/l), and normal lactate levels (2 mmol/L). Other baseline investigations were normal. He was treated as a case of acute gastroenteritis with some dehydration and metabolic acidosis and improved. He was discharged after 5 days. After 2 months, he was readmitted with drowsiness and unsteady gait. This time there was no diarrhea or dehydration. Investigations again revealed severe metabolic acidosis, high anion gap, and normal lactate levels. Management: We considered SBS induced D-lactate encephalopathy but were unable to prove it by assay due to unavailability of tests. The child was kept nil per orally and given bicarbonate infusion, on which he showed dramatic improvement. He was also given a low carbohydrate diet and oral metronidazole. The family was counseled at discharge 5 days later regarding dietary modifications and microsupplementation. The patient had 6 admissions for D-lactic encephalopathy over 4 years that coincided with dietary lapse. Conclusion: D-lactate acidosis is an underrecognized condition and its diagnosis and management is challenging. A high index of suspicion should be kept in patients with history of intestinal resection presenting with acute encephalopathy and unexplained metabolic acidosis.

BACKGROUND: Diabetes and prediabetes are always on the rise over the past decade, but little is known about the development of type 2 diabetes mellitus dysfunction in young adults. The study was conducted in prediabetic and diabetic patients in order to belong to an anti-inflammatory hormone adiponectin and pro-inflammatory marker uric acid (UA) in these patients and also to determine the role of these markers in future cardiovascular disease (CVD) risk. MATERIALS AND METHODS: This case–control study was conducted at Rama Medical College and Hospital, Kanpur. Out of 400 participants recruited, 140 subjects were control, 140 were prediabetics, and the remaining 120 were controlled. The detailed history of the patients regarding age, gender, height, weight, and family history regarding obesity and other chronic illnesses was taken. Patients with medical complications or diseases and conditions that may affect levels of inflammatory markers were excluded from the study. The data analysis was done using SPSS 16 and the results were presented as mean ± standard deviation where P < 0.05 has been considered as statistically significant. RESULTS: The adiponectin level was found significantly decreased and C-reactive protein and UA levels were increased in both study groups (prediabetes and diabetes) while comparison was done with control group. Similarly, basic parameters including waist/hip ratio, body mass index, glycated hemoglobin, and fasting blood glucose were increased. CONCLUSION: The study showed that prediabetes and diabetes are diseases of inflammatory origin with a high level of pro-inflammatory molecules. These medications are not only potent risk factors for prediabetes and diabetes but also mediate significant future CVD risk in these patients.

In this paper, we consider cooperative horizontal and vertical underwater visible light communication (UWVLC) systems employing best relay selection. In the vertical UWVLC system, the source is placed at the sea surface and the destination is placed at a depth of 60 m. The link between the source and the destination is modeled as concatenated layers considering inhomogeneous environmental conditions. The underwater parameters change with depth, causing a variable refractive index, which leads to non-uniform optical turbulence. The horizontal communication link is analyzed for two different levels of turbulence at 10 m and 50 m depths. Turbulence is modeled using a log-normal distribution, whose statistical parameters depend on the temperature and salinity at different depths. We have also taken into account the path losses caused by absorption and scattering, and carried out a comprehensive performance comparison between the horizontal and the vertical UWVLC systems. Insights show that compared to horizontal links, vertical links need an extra relay in order to achieve the same level of matching performance. Moreover, it is shown that the horizontal system’s outage performance improves with depth.

MAS, which is currently grouped under secondary or acquired haemophagocytic lymphohistiocytosis (sHLH), is a rare and fatal disorder that results from excess activation of T-cells and macrophages. Though the pathogenesis of MAS is poorly understood, various proinflammatory cytokines like interleukins (IL-1, IL-6), tumor necrosis factor α (TNF α), interferons are thought to play significant roles. MAS is associated with various clinical features such as non-remitting fever, bleeding, cytopenias, splenomegaly, hepatic dysfunctions, increased levels of triglyceride, ferritin and decreased levels of albumin and fibrinogen. Early diagnosis and interventions are crucial to reduce mortality risk but diagnosis is not often easy due to persistence of wide range of features that overlap with other rheumatic diseases, most commonly sJIA (systemic juvenile idiopathic arthritis). Corticosteroids and cyclosporins are commonly used for MAS treatment. Intravenous immunoglobulins, biologic agents like IL-1 blockers (anakinra, canakinumab), IL-6 blockers (tocilizumab) are also frequently used. Moreover there is still the need of genetic and immunohistological study in order to understand the exact mechanism of the syndrome development and establishment of novel therapies with lesser toxicities.

Cytokine release syndrome (CRS) is a life threatening toxicity associated numerous immunotherapeutic techniques involving monoclonal antibodies, bispecific antibodies and adoptive T cell therapies. It is also referred as infusion reaction that results in release of large amount cytokines (Like IL-6, IFN-r, INF) from the target cells. Cytokines when released in excessive amounts into the circulation produces systemic symptoms like nausea, shills, fever, rashes, headache, hypotension, dyspenea etc. Most of the patients present mild to moderate symptoms which can be managed easily but some patients show life threatening symptoms. Studies have shown that immunosuppressive agents like corticosteroids and tocilizumab can reverse the toxicity of CRS, however such immunosuppression may limit the immunotherapeutic efficacy. Therefore specific precautions must be considered in such patients to present exacerbation of the complication. Thus this review is based on the overview of CRS which include etiology, mechanism and management of CRS, so that immunotherapeutic benefits can be maximized with minimum risk of complication.

The technological advances in ECMO have changed to enhance safety, accessibility and facilitate its use, contributing to decreased morbidity and improved survival of patients requiring ECMO support. Major advances in ECMO deployment paralleled advances in conventional CPB including cannulas, pumps, oxygenator bubble detectors and heparin bonded circuits which decrease platelet activation, circuit clotting and prolong the circuit life. It is likely that further such advances will diminish complication rates, facilitate more widespread adoption of the technology in middle- and high-income countries, and improve outcomes from refractory heart, lung, and multiorgan failure.

Pheochromocytoma is a tumor arising out of embryological neural crest, being a tumor of adrenal medulla secreting predominantly norepinephrine as well as epinephrine(about 20% cases) leading to frequent surges of vasopressor catecholamines leading to systemic hypertension, hypertensive emergencies and associated cardiac, neurological, and renal sequalae. Though somewhat rare in pediatric age group, it remains an important etiological factor to think about when there is intractable hypertension or rapid swings of blood pressures leading to headaches and palpitations with family history of hypertension or as a part of familial endocrine neoplasia. Treatment remains laproscopic or open surgical resection under general anesthesia, however perioperative care remains a challenge for the anesthesiologist, intensivist requiring adequate medical control of hypertension with alpha blockers such as phenoxybenza- mine before undertaking anesthetic induction and important monitoring measures instituted during intraoperative and postoperative period for close monitoring of blood pressure and intravascular volume status as well as hemodynamics. We review a case report with literature review regarding perioperative management of pheochromocytoma.

Nitric Oxide (NO), a lipophilic gas synthesised by the enzyme Nitric Oxide Synthase (NOS) from the substrate arginine, is an important biomolecule that mediates cellular signaling. It has a wide spectrum of biological functions including immunomodulation, inflammation, microbial and tumour eradication. Cells of the immune system such as macrophages on activation by cytokines and microbial antigens eradicate a number of microbes or parasites as well as tumour cells by releasing a number of effector molecules which also includes NO. However, this versatile molecule is shown to have dual roles. In lower concentration, this is beneficial and regulates the physiological processes in the body whereas at higher concentrations it is harmful, not only to the microbes or tumor cells but can produce undesirable effects on the host cells too. This suggests that NO has both protective and toxic roles that occur parallel in the body depending upon cellular microenvironment. Therefore, it is very essential to have the knowledge of the physiological processes involved in signaling cascades of NO since it might have novel clinical applications when therapeutic potential of NOS inhibitors and NO donors are to be considered.

Introduction: Among the most advanced public health promotion and disease prevention programs, the newborn screening is of paramount importance, seeking timely detection, diagnosis and treatment of genetic disorders which may otherwise lead to serious consequences upon the health of newborn. Aim: To evaluate the prevalence of Inborn Error of Metabolism (IEM) disorders among neonates of various ethnic or racial groups from east, west, north and south, zones of India through newborn screening. Materials and Methods: A cross-sectional, population based prospective study was conducted at PreventiNe Life Care Laboratories, Navi Mumbai, Maharashtra, India. Study was conducted for a period of three years from October 2012 to November 2015. Mass screening of newborn blood samples was done via TMS/GCMS/Enzyme assay/HPLC/ELISA technique. The blood and urine samples were used for analysis. The samples have been collected from 150 locations through various hospitals across India. Samples obtained were categorised zone wise (east, west, north, south zones of India). For analysis of blood, samples were collected by heel prick method. Results: In the present study, 2.9% prevalence (of the total 70,590 samples analysed, 2053 cases were found positive) of IEM was observed. Of these positive cases, 13% (279 of 2053 positive cases) cases belonged to eastern zone, 24% (493 of 2053 positive cases) were from northern zone, 38% (793 of 2053 positive cases) were from southern zone and 23% (488 of 2053 positive cases) were from western zone. Among these, the highest prevalent disorder was found to be G6PD deficiency, with 1.3% (923 positive of 70,590) cases reported followed by haemoglobinopathies, 0.5% (360 positive of 70,590) and congenital hyperplasia with 0.34% (239 positive of 70,590) cases of the total newborns, screened. Conclusion: The newborn screening is expanding its wings throughout the world. The outcome of present data offers a unique opportunity to explore the birth prevalence of inborn metabolic disorders in the current population. Understanding the birth prevalence of these disorders in India from its various zones will definitely improve the short term and long term medical needs faced by affected communities.

Natural Killer (NK) cells are potent cytotoxic effector cells for cancer therapy and also for keeping severe viral infections in check. Since, they represent only 10% of the lymphocytes and are often dysfunctional, there are technical challenges in obtaining sufficient numbers of functionally active NK cells from a patient’s blood. Recent advances in therapeutic regimen of NK cells are intended to enhance NK cell activity and targeting strategies. With recent advances in the field of NK cell biology and translational research, it seems that over the next few years, NK cell immunotherapy will move to the forefront of cancer immunotherapy. The current review focuses on recent developments in NK cell immunotherapy including various approaches i.e. augmentation of AntibodyDependent Cell-Mediated Cytotoxicity (ADCC), manipulation of receptor-mediated activation, and adoptive immunotherapy with ex vivo-expanded NK cells, Chimeric Antigen Receptor (CAR)-engineered, or engager-modified NK cells.

Tight regulation of immunotolerance at fetomaternal interface facilitates the survival of allogeneic embryo. Natural Killer (NK) cells are immune cells capable of lysing the target cells via the release of cytolytic granules containing perforin, granzyme and granulysin. Besides the peripheral circulation, NK cells are also present in the uterine mucosa. In contrast to peripheral NK (pNK) cells, uterine NK (uNK) cells are not the killer cells, rather they provide a suitable microenvironment in the pregnant uterus making it compatible to the growing foetus and promoting normal placentation, vascular remodeling and trophoblast infiltration, all of which are essential for healthy pregnancy. Although, uNK cells are loaded with cytolytic factors which can lyse the trophoblasts if activated, the control mechanisms mediated by balance between activating and inhibitory receptors block the cytolytic function of these uNK cells. Intensive research has elucidated the roles of NK cells in normal and abnormal pregnancy outcomes, such as recurrent spontaneous abortion. Much of the facts are still to be unraveled to fully understand the underlying mechanisms and to introduce newer and potential treatment modalities to support healthy pregnancy.

An important component of the innate immune system, the natural killer cells that originate from the lymphoid cell lineage, hold tremendous potential as an effective therapeutic tool to combat a variety of cancers. Their vast capability to kill altered cells such as opsonized cells (antibody coated), tumour cells, genotoxically changed cells without affecting the healthy cells of the body, make them an effective therapeutic agent for various types of cancers. Besides, through interplay and molecular crosstalk via several cytokines, they also augment the adaptive immune response by, promoting the differentiation, activation and recruitment of component cells of the system. With the current advance knowledge of Natural Killer (NK) cells, their receptor-ligand interactions involved in functional regulation, various mechanistic approaches involving the role of cytokines led to desired modulation of NK cell activity in a tailor-made manner, for triggering clinically relevant responces. Several strategies have been adopted by researchers, to augment the efficacy of NK cells. Still many challenges exist for increasing the therapeutic relevance of these cells.

We report successful separation of PYGOPAGUS twins. Meticulous planning and multidisciplinary approach are the core aspects in the management of Pygopagus conjoined twins. Early elective separation versus delayed separation of the conjoined twins improves the survival from 40% to 80% . Preoperative assessment of sickle cell disease, cross-circulation and organ sharing between twins proved valuable for planning sedation and analgesia and allowing detailed scripting of the complex anesthetic induction sequence, airway management, complex neurological monitoring and post operative intensive care related issues. Fusion of lower back, spinal cord , nerve roots , and rectal and genitourinary tract was a major surgical challenge related to potentially adverse neurological outcomes, bladder /bowel dysfunction and intact long term survival. Post operative critical care issues such as pain , prone ventilation, sickle cell sequalae, cerebrospinal fluid leak and meningitis, wound infection and colostomy care, nutrition, and other potential complications are discussed in detail in this report. We emphasize the role of pediatric intensive care, preoperative planning with multidisciplinary team, and staged surgical intervention and a good postoperative care in the successful management of complicated variants.

Emperipolesis is an uncommon biological process, in which a cell penetrates another living cell. Unlike in phagocytosis where the engulfed cell is killed by lysosomal enzymes of the macrophage, the cell exists as viable cell within another in emperipolesis and can exit at any time without any structural or functional abnormalities for either of them. This process can either be physiological or pathological and may be a pathognomonic feature of certain diseases. Histiocytes and Megakaryocytes are involved in Emperipolesis normally but tumour giant cells in Hodgkin’s disease and Rosai-Dorfman disease are pathologic conditions in which this process is seen. We report a mini review as this process is rare and not much reported in the literature.

Dentistry is most importantly and foremost a healing profession. In today’s world, it is very necessary to understand the importance of being eco-friendly in every facet of our lives, including dental practice which has a huge impact on the environment due to the large amount of metallic waste generated by various dental procedures along with excessive use of water and electricity, which specifically emphasis the thrust to move towards ‘Green dentistry’. Green dentistry is an innovative way of dental practice which is environment friendly and at the same time conserves money and time by reducing waste, conserving energy and decreasing pollution with the use of latest techniques and procedures. Green dentistry therefore, protects the environment and mankind from the hazards of rapid urbanisation in developing countries. The authors wish to emphasize the practice of eco-friendly, green dentistry in a developing country like India which needs to conserve resources and curb environmental pollution.