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In order to enhance the development efficiency of thick and complex carbonate reservoirs in the Middle East, a case study was conducted on M oilfield in Iraq. This study focused on reservoir characterization, injection-production modes, well pattern optimization, and other related topics. As a result, key techniques for the high-efficiency development of thick carbonate reservoirs were established. The research findings include the following: (1) the discovery of hidden "low-velocity" features within the thick gypsum-salt layer, which led to the development of a new seismic velocity model; (2) the differential dissolution of grain-supported limestones is controlled by lithofacies and petrophysical properties, resulting in the occurrence of "porphyritic" phenomena in core sections. The genetic mechanism responsible for reversing petrophysical properties in dolostones is attributed to "big hole filling and small hole preservation" caused by dense brine refluxing; (3) fracture evaluation technology based on anisotropy and dipole shear wave long-distance imaging was developed to address challenges associated with quantitatively assessing micro-fractures; (4) through large-scale three-dimensional physical models and numerical simulations, it was revealed that water–oil displacement mechanisms involving "horizontal breakthrough via hyper-permeability" combined with vertical differentiation due to gravity occur in thick and heterogeneous reservoirs under spatial injection-production modes; (5) a relationship model linking economic profit with well pattern density was established for technical service contracts in the Middle East. Additionally, an innovative stepwise conversion composite well patterns approach was introduced for thick reservoirs to meet production ramp-up requirements while delaying water cut rise; (6) a prediction technology for the oilfield development index, considering asphaltene precipitation, has been successfully developed. These research findings provide robust support for the efficient development of the M oilfield in Iraq, while also serving as a valuable reference for similar reservoirs' development in the Middle East. [ABSTRACT FROM AUTHOR]

Abstract Background Virtual reality (VR) and augmented reality (AR) are emerging technologies that can be used for cardiopulmonary resuscitation (CPR) training. Compared to traditional face-to-face training, VR/AR-based training has the potential to reach a wider audience, but there is debate regarding its effectiveness in improving CPR quality. Therefore, we conducted a meta-analysis to assess the effectiveness of VR/AR training compared with face-to-face training. Methods We searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, China National Knowledge Infrastructure, and Wanfang databases from the inception of these databases up until December 1, 2023, for randomized controlled trials (RCTs) comparing VR- and AR-based CPR training to traditional face-to-face training. Cochrane's tool for assessing bias in RCTs was used to assess the methodological quality of the included studies. We pooled the data using a random-effects model with Review Manager 5.4, and assessed publication bias with Stata 11.0. Results Nine RCTs (involving 855 participants) were included, of which three were of low risk of bias. Meta-analyses showed no significant differences between VR/AR-based CPR training and face-to-face CPR training in terms of chest compression depth (mean difference [MD], -0.66 mm; 95% confidence interval [CI], -6.34 to 5.02 mm; P = 0.82), chest compression rate (MD, 3.60 compressions per minute; 95% CI, -1.21 to 8.41 compressions per minute; P = 0.14), overall CPR performance score (standardized mean difference, -0.05; 95% CI, -0.93 to 0.83; P = 0.91), as well as the proportion of participants meeting CPR depth criteria (risk ratio [RR], 0.79; 95% CI, 0.53 to 1.18; P = 0.26) and rate criteria (RR, 0.99; 95% CI, 0.72 to 1.35; P = 0.93). The Egger regression test showed no evidence of publication bias. Conclusions Our study showed evidence that VR/AR-based training was as effective as traditional face-to-face CPR training. Nevertheless, there was substantial heterogeneity among the included studies, which reduced confidence in the findings. Future studies need to establish standardized VR/AR-based CPR training protocols, evaluate the cost-effectiveness of this approach, and assess its impact on actual CPR performance in real-life scenarios and patient outcomes. Trial registration CRD42023482286.

Background: Gestational Diabetes Mellitus (GDM) is a Glucose tolerance disorder first diagnosed during pregnancy. WHO recommend that all pregnant women or at least women with predisposing risk factors should be screened at the beginning of the 3rd trimester of pregnancy with the Oral Glucose Tolerance Test (OGTT). Here, blood glucose level is screened 2hrs after giving a 75g oral glucose load. This is recommended for both screening and diagnosis. Not many studies have been done regarding the outcome of GDM mothers in India. Objective: 1. To describe the Obstetric profile of the mothers 2. To assess the outcome of GDM among the Mothers 3. To determine the neonatal outcome of GDM. Methodology: Study setting: The study was carried out at Kasturba Medical College Hospital, Attavar, and District Lady Goschen Hospital, Mangalore. Study design: Hospital based retrospective study. Study population: Pregnant women admitted to above mentioned hospitals with GDM and the new born. Inclusion criteria: All women diagnosed with GDM and have delivered in District Lady Goschen Hospital or KMCH Attavar. Sample size was 266. Results: Our study concluded that 24.8% of the women with GDM also had Pregnancy Induced Hypertension, which is comparable to the study done in Qatar where they found 19.2% of the women with GDM suffered from PIH. We also found that 15.8% of the women suffered from Pre-Eclampsia, over twice the percentage of people surveyed in the Qatari study. However the amount of babies suffering from Macrosomia was only 6.8% as opposed to 10.3% according to the aforementioned study and 19.3% as was found in a study in Poznan, Poland. Conclusion: No significant association was found between obstetric profile and antenatal & postpartum complications.

Background: Women with Gestational diabetes mellitus face a lot of challenges when it comes to breast feeding. Breast feeding self efficacy is an important factor for improving breast feeding outcomes. Objectives: To know the effect of educational intervention on breast feeding efficacy in immediate postpartum period among women with gestational diabetic mellitus using breast feeding self-efficacy scale short form (BSES-SF). Methodology: A randomized control trial was conducted between May 2022 to August 2023 in a tertiary care hospital in Mangalore. Ethics committee approval was obtained. Clinical trial registry was done (CTRI/2023/03/051176). 108 women with Gestational diabetes mellitus were enrolled in this study. Study participants were divided into control and intervention group. Intervention group were shown an informative video on breast feeding practices and techniques while both the groups were educated using flipcharts on essential newborn care. Breast feeding efficacy was scored in both the groups at admission, after intervention within 48 hours puerperium using breast feeding self-efficacy scale short form (BSES-SF) and results were analyzed. Results: The mean age group of the study was 30.15 ± 5.12. The demographic details in both the groups were comparable. The mean BSES-SF scores were 45.13 pre-intervention vs 55.15 post-intervention in the intervention group (p =

Background: Perinatal mortality is a sensitive indicator of maternal and child health care. However, there is no universal perinatal death (PND) audit system in India. Objective: To identify the impact of the proposed model of PND audit on health care delivery in two districts of Karnataka. Methodology: Hospitals with maternal and child care facilities which met inclusion criteria in Dakshina Kannada (DK- high performing) and Koppal (low performing) districts were included after institutional ethics committee approval and permission from Mission Director, National Health Mission, Directorate of Heath and Family Welfare Services, Government of Karnataka. The healthcare delivery system was analyzed in both districts. A PND audit system was designed. All neonatal deaths during the study period were analyzed by an expert committee (Local senior pediatricians and obstetricians). Following variables were studied: (i) Documentation and reporting systems in these hospitals; (ii) Role of health care personnel in documentation and reporting (iii) Existing system of audit, if any. Doctors feedback, in-depth interviews, death certification analysis, risk analysis, PND reporting format, expert committee feedback, medical social worker feedback, data from district health office were recorded and analysed. The changes in documentation, information yield, reporting of PND, time taken for submitting death report and changes in infrastructure in facilities in the two time periods of 6 months was analysed. Results: Significant changes were recorded in documentation of care delivered in the facility specially in Koppal district. There was an increase in reporting of PND in the second half. The PND audit assisted in preventability of death assertion. Improved data resulted in better performance of expert committee, thereby reducing the proportion of unclassified segment of neonatal deaths. There was significant improvement in infrastructure in the health facilities. Conclusion: Auditing perinatal deaths had a positive impact at point of care resulting in improved documentation, reporting and infrastructure upgradation.

Background: Analyzing preterm deaths is crucial due to the significant contribution of preterm babies to neonatal mortality rates. However, there is no universal perinatal death (PND) audit system in India Objective: To analyze the preterm deaths in two districts of Karnataka with study model of PND audit Methodology: Hospitals with maternal and child care facilities which met inclusion criteria in Dakshina Kannada (DK), high performing and Koppal (KPL),low performing districts were included after institutional ethics committee approval and permission from Mission Director, National Health Mission, Directorate of Heath and Family Welfare Services, Government of Karnataka. A PND audit system was designed. Personnel with training in medico-social history taking were utilized for data accumulation. Causal analysis of death as certified by independent expert panels and certifying physician was carried out and was compared for functionality. To determine optimality of care, facilities were categorized depending upon available levels of maternity and neonatal care. Preterm deaths during the one-year study period with complete data were analyzed. Results: 119 preterm deaths in DK and 97 preterm deaths in KPL were analyzed. In utero transfer was 81.5 % in DK and 11.3% in KPL. More preterm deliveries were documented in public hospitals in both districts. Deaths of preterm babies in private hospitals at KPLwas 41.2% against 27.8% private deliveries. In KPL 22.6% babies died at home despite delivering in hospitals. Risk factor documentation was poor in both districts. Expert committee review increased preventability assertion from 7.5 to 11.7% in DK, 2 to 62.8% in KPL. Conclusion: Auditing perinatal deaths and analysing preterm deaths resulted in identification of specific deficiencies in healthcare system. DK had reasonably good facilities but KPL had serious concerns. The study model enhanced the preventability assertion in preterm deaths

Background: Fetal growth restriction (FGR) is defined as fetuses whose estimated fetal weight or abdominal circumference is below the 10th percentile for gestational age. As Africa and South Asia account for 60-85% of these births, it becomes important to study the predictive factors of fetal growth restriction in preterm birth. Objective: To study the socio-demographic and obstetrics factors as predictive factors of fetal growth restriction in preterm birth. Methodology: This was a case-control study. The sample size was 10 (four mothers with a preterm baby with fetal growth restriction and six mothers with a preterm baby without fetal growth restriction). Through a proforma the socio-demographic, obstetric, neonatal details, and ultrasound readings were collected. The results were summarized using mean and standard deviations. Results: The average gestational age was 32.5 weeks in cases and 32.7 weeks in controls. In this study, oligohydramnios (0.011) and history of abortion (0.011) were seen more in mothers with fgr in preterm birth compared to those in mothers with non-fgr in preterm birth babies. Conclusion: Oligohydramnios and history of abortion were the predictors of fetal growth restriction in preterm birth.

BackgroundDiabetes mellitus is an independent risk factor for postoperative complications. It has been reported that insulin-treated diabetes is associated with increased postoperative mortality compared to non-insulin-treated diabetes after cardiac surgery; however, it is unclear whether this finding is applicable to non-cardiac surgery.ObjectiveWe aimed to assess the effects of insulin-treated and non-insulin-treated diabetes on short-term mortality after non-cardiac surgery.MethodsOur study was a systematic review and meta-analysis of observational studies. PubMed, CENTRAL, EMBASE, and ISI Web of Science databases were searched from inception to February 22, 2021. Cohort or case-control studies that provided information on postoperative short-term mortality in insulin-treated diabetic and non-insulin-treated diabetic patients were included. We pooled the data with a random-effects model. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to rate the quality of evidence.ResultsTwenty-two cohort studies involving 208,214 participants were included. Our study suggested that insulin-treated diabetic patients was associated with a higher risk of 30-day mortality than non-insulin-treated diabetic patients [19 studies with 197,704 patients, risk ratio (RR) 1.305; 95% confidence interval (CI), 1.127 to 1.511; p < 0.001]. The studies were rated as very low quality. The new pooled result only slightly changed after seven simulated missing studies were added using the trim-and-fill method (RR, 1.260; 95% CI, 1.076–1.476; p = 0.004). Our results also showed no significant difference between insulin-treated diabetes and non-insulin-treated diabetes regarding in-hospital mortality (two studies with 9,032 patients, RR, 0.970; 95% CI, 0.584–1.611; p = 0.905).ConclusionVery-low-quality evidence suggests that insulin-treated diabetes was associated with increased 30-day mortality after non-cardiac surgery. However, this finding is non-definitive because of the influence of confounding factors.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021246752, identifier: CRD42021246752.

Colonic microbiota play important roles in the development of colorectal cancer. We aim to characterise the mucosa-associated microbiota in the tumour as well as the matched non-neoplastic mucosa from patients with colorectal cancer. Microbiota profiling in these samples was done using high-throughput 16S rRNA amplicon sequencing. Our results showed that the microbiota richness and diversity were similar between the tumour and non-neoplastic mucosae. Linear discriminant analysis effect size (LEfSe) analysis identified Fusobacterium and Campylobacter as the key genera of the tumour while Brevundimonas as the key genus of the non-neoplastic mucosa. In patients with shorter survival period, the relative abundance of Fusobacterium and Campylobacter was significantly higher in the tumour. Besides, regardless of the sites, tumour showed higher abundance of Fusobacterium. On the other hand, the relative abundance of Brevundimonas was significantly lower in the tumour. When validated with quantitative ddPCR, we found the absolute numbers of both Fusobacterium and F. nucleatum were significantly higher in the carcinoma from patients with shorter survival period, conventional type of adenocarcinoma in the distal portion of the large intestine (descending colon, sigmoidal colon, and rectum). In conclusion, our study showed a compositional alteration in the mucosa-associated microbiota in the tumour, which may contribute to the progression of colorectal cancer.

A low grade graphite run-of-mine (r.o.m) ore from eastern India was studied for its amenability to beneficiation by flotation technique. The petrography studies indicate that the ore primarily consists of quartz and graphite with minor quantity of mica. It analyzed 89.89% ash and 8.59% fixed carbon. The ore was crushed in stages followed by primary coarse wet grinding to 212 μm (d80). Rougher flotation was carried out in Denver flotation cell to eliminate gangue as much as possible in the form of primary tailings with minimal loss of carbon. Diesel & pine oil were used as collector and frother respectively. Regrinding of rougher concentrate to150 μm (d80) was resorted to further liberate the graphite values and was followed by multi-stage cleaning. This two-stage grinding approach involving a primary coarse grinding and regrinding of rougher float followed by its multi-stage cleaning was found to yield required grade of concentrate for applications such as refractories, batteries and high temperature lubricants. This approach is supposed to retain the flake size of coarse, free and liberated graphite, if available, during primary coarse grinding and rougher flotation stage with minimal grinding energy costs as against the usual practice of single stage grinding in the case of many ores. A final concentrate of 8.97% weight recovery with 5.80% ash and 92.13% fixed carbon could be achieved.

In the present paper we examine the effects of viscous dissipation, Joule heating and heat source/sink on non-Darcy MHD natural convection heat transfer flow over permeable horizontal circular cylinder in a porous medium. The boundary layer equations, which are parabolic in nature, are normalized into non-similar form and then solved numerically with the well-tested, efficient, implicit, stable Keller-box finite difference scheme. A parametric study illustrating the influence of Darcy parameter (Da), Forchheimer parameter (Λ), Grashof number(Gr), heat source/sink parameter (Ω) and viscous dissipation parameter (Ec) on the fluid velocity, temperature as well as local skin-friction and Nusselt numbers is conducted Increasing Forchheimer inertial drag parameter (Λ) retards the flow considerably but enhances temperatures. Increasing viscous dissipation parameter(Ec) is found to elevate velocities i.e. accelerate the flow and increase temperatures. Increasing heat source/sink parameter (Ω) is found to elevate velocities and increase temperatures. Increasing the Grashof number (Gr) is found to elevate the velocity and decrease the temperatures. Local skin friction number is found to be increases with increasing heat source/sink parameter (Ω) where as Local Nusselt number is found to decrease with increasing heat source/sink parameter (Ω).

The flow and heat transfer of Casson fluid from a permeable isothermal sphere in the presence of slip condition in a non-Darcy porous medium is analyzed. The sphere surface is maintained at a constant temperature. The boundary layer conservation equations, which are parabolic in nature, are normalized into non-similar form and then solved numerically with the well-tested, efficient, implicit, stable Keller-box finite-difference scheme. Increasing the velocity slip parameter is found to decrease the velocity and boundary layer thickness and increases the temperature and the boundary layer thickness. The velocity decreases with the increase the non-Darcy parameter and is found to increase the temperature. The velocity increases with the increase the Casson fluid parameter and is found to decrease the temperature. The Skin-friction coefficient and the local Nusselt number is found to decrease with the increase in velocity and thermal slip parameters respectively.

Background : Human telomerase is a multi subunit ribonucleoprotein enzyme concerned with telomeric lengthening and homeostasis in man. This enzyme has been found to be elevated in inflammatory conditions like rheumatoid arthritis and silica injury lung. Since chronic periodontitis is also an inflammatory condition where immune cells and cytokines mediate tissue destruction, we set out to evaluate telomerase in gingival tissue samples from healthy subjects and chronic periodontitis patients by reverse transcriptase polymerase chain reaction. Materials and Methods : Gingival biopsies were obtained from eight healthy subjects and eight chronic periodontitis patients. Reverse transcriptase polymerase chain reaction (RTPCR) was carried out to evaluate telomerase gene expression in the samples. Results : None of the healthy gingival tissue samples expressed the telomerase gene while all the chronic periodontitis samples expressed it. The severe chronic periodontitis samples expressed the gene more intensely than the moderate chronic periodontitis samples. Conclusion : Various mechanisms have been explained to account for telomerase elevation in chronic periodontitis .This study helps us understand the role of telomerase in the pathogenesis of periodontal disease. It could be concluded that telomerase could be used as a marker to assess the severity of inflammation in chronic periodontitis.

Background: Glycosylation of altered tumor cell in relation to cellular heterogeneity in human intracranial tumors remains relatively unexposed. Serum protein-bound carbohydrate, L-Fucose is reported to be overexpressed during tumor progression by many investigators. Therefore, there is a need to determine the diagnostic, prognostic, functional significance of glycoprotein elevations in various cases of tumors. Objective: The objective of the present study was to evaluate the clinical utility of serum L-fucose in patients with brain tumor. Materials and Methods: Serum glyco-conjugate levels were estimated in 99 patients with brain tumors. Estimation of L-fucose was carried out colorimetrically by the method of Winzler using cysteine hydrochloride. Results: There was a significant increase in L-fucose level in most of the patients. In the posttreatment cases, the L-fucose levels were apparently low compared to preoperative values. Conclusion: Our results showed that the rise in serum L-fucose may be used as a general marker for brain tumors in addition to other markers.

Metaplastic carcinomas of the breast are malignant breast neoplasms composed of a mixture of both epithelial and mesenchymal elements. The rarity of this tumor is exemplified by the fact that it accounts for only about 0.2% of all breast carcinomas. It can present histologically with diverse differentiation and the exact histogenesis of these tumors is unknown. The present case is reported for its rarity and for the presence of transitional cell differentiation along with the other usual components of metaplastic carcinoma. Transitional cell differentiation in a metaplastic carcinoma has not been documented in the literature. Besides this, it highlights the importance of special stains and immunohistochemistry in evaluating these carcinomas and the need for early diagnosis and excision of these tumors as these carcinomas generally have a poorer prognosis as compared to breast carcinomas without metaplasia, with the tumor size having an important bearing on the outcome of this condition.

Purpose: To retrospectively study the records and reports available at the District Blindness Control Society (DBCS), Yavatmal in terms of target fixation, performance and utilisation of manpower and equipment. Methods: All the available records, reports, correspondence, and proceedings of meetings from 1981-98 were scrutinized and analyzed. Results: The performance records and reports showed that over the last 10 years the target achievement of DBCS is close to 100%. However, the fixed facility (District hospital/Tertiary hospital where cataract surgeries are being performed under strict aseptic conditions) performance does not match the targets. The district mobile unit camp performance achieved 35-40% of the target in the last quarter of the financial year. Conclusion: The target fixation is irrational and needs improvement, and it is necessary for the program managers in the district to undertake analysis of the available data to ensure performance improvement

This paper describes a refresher training and continuing education programme in clinical and community ophthalmology for para-medical ophthalmic assistants (PMOAs) conducted by the Lions Aravind Institute of Community Ophthalmology. The course participants included 60 PMOAs working either in district hospitals, primary health centres or mobile units from the districts in Maharashtra. Each training programme was spread over 43 hours in 4 days and included lectures, practical demonstrations, and hands-on training in the outpatient, inpatient, and operation theatre of the training institution. Participants were given exposure to outreach activities in an eye camp and a satellite eye centre resembling a district hospital. The PMOAs found the training to be useful and it was seen that areas like patient counselling, instrument and equipment maintenance, and assistance in the operation theatre for newer surgical procedures which were lacking in the basic training were fulfilled in this training programme. Regional Institutes of Ophthalmology, upgraded medical colleges, and other eye-care institutions which have facilities and manpower could organise similar refresher and continuing education programmes for PMOAs so that they could be utilised more efficiently in the blindness-control activities in the country.

Background and objectiveWe conducted a network meta analysis (NMA) to compare different kinds of laparoscopic cholecystectomy [LC] (single port [SPLC], two ports [2PLC], three ports [3PLC], and four ports laparoscopic cholecystectomy [4PLC], and four ports mini-laparoscopic cholecystectomy [mini-4PLC]).MethodsPubMed, the Cochrane library, EMBASE, and ISI Web of Knowledge were searched to find randomized controlled trials [RCTs]. Direct pair-wise meta analysis (DMA), indirect treatment comparison meta analysis (ITC) and NMA were conducted to compare different kinds of LC.ResultsWe included 43 RCTs. The risk of bias of included studies was high. DMA showed that SPLC was associated with more postoperative complications, longer operative time, and higher cosmetic score than 4PLC, longer operative time and higher cosmetic score than 3PLC, more postoperative complications than mini-4PLC. Mini-4PLC was associated with longer operative time than 4PLC. ITC showed that 3PLC was associated with shorter operative time than mini-4PLC, and lower postoperative pain level than 2PLC. 2PLC was associated with fewer postoperative complications and longer hospital stay than SPLC. NMA showed that SPLC was associated with more postoperative complications than mini-4PLC, and longer operative time than 4PLC.ConclusionThe rank probability plot suggested 4PLC might be the worst due to the highest level of postoperative pain, longest hospital stay, and lowest level of cosmetic score. The best one might be mini-4PLC because of highest level of cosmetic score, and fewest postoperative complications, or SPLC because of lowest level of postoperative pain and shortest hospital stay. But more studies are needed to determine which will be better between mini-4PLC and SPLC.

Twelve patients who satisfied the clinical criteria of Tolosa-Hunt syndrome (THS), underwent axial computerised tomography (CT) scan of the head. Two patients had abnormalities detected in the cavernous sinus on the affected side which supported the clinical diagnosis. This coupled with steroid responsiveness and long-term asymptomatic follow-up firmly established the diagnosis of THS. We discuss the computerised tomographic findings seen in THS and the relevance of using accurate imaging techniques as the first line of investigation in these cases

Objective : To analyze the profile of pulmonary tuberculosis patients with respect to gender and its implications in tuberculosis control. Setting: DOTS center at a tertiary, teaching hospital in South India. Materials and Methods : A retrospective study was undertaken by screening medical records of 446 patients with pulmonary tuberculosis. Data studied included age, gender, and sputum smear status. Patients with comorbid conditions were excluded. No other data were considered. Results : The male to female ratio in patients of pulmonary tuberculosis was 2:1, which was also maintained when smear positive and smear negative were studied separately. The ratio of smear positive to smear negative patients was statistically significant at 4.4:1. A large proportion of patients (65-68%) were in the young and reproductive age group. Approximately, one-fifth patients were in the geriatric age group. Conclusion : The observation that two-thirds of all female smear-positive patients were found in the young and reproductive age group has strong implications in tuberculosis control strategies because of higher chances of mother to child transmission and higher probability of complications because of attendant antenatal and postnatal morbidity. Geriatric patients comprise another significant group because of higher chances of default, complications, inconvenience, and existence of other comorbid conditions.

Objectives: To assess relevance of spot morning spot (SMS) method of smear microscopy in tuberculosis control by directly observed treatment short course (DOTS). Materials and Methods : Screening of smear microscopy results of 546 cases of pulmonary tuberculosis at our DOTS centre. Results: Among 546 cases, 82% had all three samples positive for AFB, 98% had either morning sample or spot and morning sample positive. 2% had second spot sample positive. Conclusion: Examination of third sample, especially second spot sample, does not add significantly to the diagnostic yield. Examination of one spot and early morning samples were able to correctly diagnose 98% cases. This has strong implications in DOTS strategies.

Malignant mesothelioma is one of the rare tumors of pleura. One such case in a 57-year-old male, who presented with hemorrhagic pleural effusion and had no history of asbestos exposure, is reported here. The rarity, unusual presentation, and implications are discussed.

Abstract Background Phyto-remedies for diabetic control are popular among patients with Type II Diabetes mellitus (DM), in addition to other diabetic control measures. A number of plant species are known to possess diabetic control properties. Costus pictus D. Don is popularly known as “Insulin Plant” in Southern India whose leaves have been reported to increase insulin pools in blood plasma. Next Generation Sequencing is employed as a powerful tool for identifying molecular signatures in the transcriptome related to physiological functions of plant tissues. We sequenced the leaf transcriptome of C. pictus using Illumina reversible dye terminator sequencing technology and used combination of bioinformatics tools for identifying transcripts related to anti-diabetic properties of C. pictus. Results A total of 55,006 transcripts were identified, of which 69.15% transcripts could be annotated. We identified transcripts related to pathways of bixin biosynthesis and geraniol and geranial biosynthesis as major transcripts from the class of isoprenoid secondary metabolites and validated the presence of putative norbixin methyltransferase, a precursor of Bixin. The transcripts encoding these terpenoids are known to be Peroxisome Proliferator-Activated Receptor (PPAR) agonists and anti-glycation agents. Sequential extraction and High Performance Liquid Chromatography (HPLC) confirmed the presence of bixin in C. pictus methanolic extracts. Another significant transcript identified in relation to anti-diabetic, anti-obesity and immuno-modulation is of Abscisic Acid biosynthetic pathway. We also report many other transcripts for the biosynthesis of antitumor, anti-oxidant and antimicrobial metabolites of C. pictus leaves. Conclusion Solid molecular signatures (transcripts related to bixin, abscisic acid, and geranial and geraniol biosynthesis) for the anti-diabetic properties of C. pictus leaves and vital clues related to the other phytochemical functions like antitumor, anti-oxidant, immuno-modulatory, anti-microbial and anti-malarial properties through the secondary metabolite pathway annotations are reported. The data provided will be of immense help to researchers working in the treatment of DM using herbal therapies.

Abstract Background Injury is a major cause of mortality and morbidity of young people and the cost-effectiveness of many injury prevention programs remains uncertain. This study aimed to analyze the costs and benefits of an injury awareness education program, the P.A.R.T.Y. (Prevent Alcohol and Risk-related Trauma in Youth) program, for juvenile justice offenders in Western Australia. Methods Costs and benefits analysis based on effectiveness data from a linked-data cohort study on 225 juvenile justice offenders who were referred to the education program and 3434 who were not referred to the program between 2006 and 2011. Results During the study period, there were 8869 hospitalizations and 113 deaths due to violence or traffic-related injuries among those aged between 14 and 21 in Western Australia. The mean length of hospital stay was 4.6 days, a total of 320 patients (3.6%) needed an intensive care admission with an average length of stay of 6 days. The annual cost saved due to serious injury was $3,765 and the annual net cost of running this program was $33,735. The estimated cost per offence prevented, cost per serious injury avoided, and cost per undiscounted and discounted life year gained were $3,124, $42,169, $8,268 and $17,910, respectively. Increasing the frequency of the program from once per month to once per week would increase its cost-effectiveness substantially. Conclusions The P.A.R.T.Y. injury education program involving real-life trauma scenarios was cost-effective in reducing subsequent risk of committing violence or traffic-related offences, injuries, and death for juvenile justice offenders in Western Australia.

Abstract Background In soybean somatic embryo transformation, the standard selection agent currently used is hygromycin. It may be preferable to avoid use of antibiotic resistance genes in foods. The objective of these experiments was to develop a selection system for producing transgenic soybean somatic embryos without the use of antibiotics such as hygromycin. Results When tested against different alternate selection agents our studies show that 0.16 μg/mL glufosinate, 40 mg/L isopropylamine-glyphosate, 0.5 mg/mL (S-(2 aminoethyl)-L-cysteine) (AEC) and the acetolactate synthase (ALS) inhibitors Exceed® and Synchrony® both at 150 μg/mL inhibited soybean somatic embryo growth. Even at the concentration of 2 mg/mL, lysine+threonine (LT) were poor selection agents. The use of AEC may be preferable since it is a natural compound. Unlike the plant enzyme, dihydrodipicolinate synthase (DHPS) from E. coli is not feed-back inhibited by physiological concentrations of lysine. The dapA gene which codes for E. coli DHPS was expressed in soybean somatic embryos under the control of the CaMV 35S promoter. Following introduction of the construct into embryogenic tissue of soybean, transgenic events were recovered by incubating the tissue in liquid medium containing AEC at a concentration of 5 mM. Only transgenic soybeans were able to grow at this concentration of AEC; no escapes were observed. Conclusion Genetically engineered soybeans expressing a lysine insensitive DHPS gene can be selected with the non-antibiotic selection agent AEC. We also report here the inhibitory effects of glufosinate, (isopropylamine-glyphosate) (Roundup®), AEC and the ALS inhibitors Exceed® and Synchrony® against different tissues of soybean

Abstract Background The Arabidopsis ortholog of the 30 kD subunit of the mammalian Cleavage and Polyadenylation Specificity Factor (AtCPSF30) is an RNA-binding endonuclease that is associated with other Arabidopsis CPSF subunits (orthologs of the 160, 100, and 73 kD subunits of CPSF). In order to further explore the functions of AtCPSF30, the subcellular distribution of the protein was examined by over-expressing fusion proteins containing fluorescent reporters linked to different CPSF subunits. Results It was found that AtCPSF30 by itself localizes, not to the nucleus, but to the cytoplasm. AtCPSF30 could be found in the nucleus when co-expressed with AtCPSF160 or AtCPSF73(I), one of the two Arabidopsis orthologs of CPSF73. This re-directing of AtCPSF30 indicates that AtCPSF30 is retained in the nucleus via interactions with either or both of these other CPSF subunits. Co-expression of AtCSPF30 with AtCPSF100 altered the location, not of AtCPSF30, but rather of AtCPSF100, with these proteins residing in the cytoplasm. Deletion of plant-specific N- or C-terminal domains of AtCPSF30 abolished various of the interactions between AtCPSF30 and other CPSF subunits, suggesting that the plant CPSF complex assembles via novel protein-protein interactions. Conclusion These results suggest that the nuclear CPSF complex in plants is a dynamic one, and that the interactions between AtCPSF30 and other CPSF subunits are different from those existing in other eukaryotes.

Abstract Background The polyadenylation of mRNA is one of the critical processing steps during expression of almost all eukaryotic genes. It is tightly integrated with transcription, particularly its termination, as well as other RNA processing events, i.e. capping and splicing. The poly(A) tail protects the mRNA from unregulated degradation, and it is required for nuclear export and translation initiation. In recent years, it has been demonstrated that the polyadenylation process is also involved in the regulation of gene expression. The polyadenylation process requires two components, the cis-elements on the mRNA and a group of protein factors that recognize the cis-elements and produce the poly(A) tail. Here we report a comprehensive pairwise protein-protein interaction mapping and gene expression profiling of the mRNA polyadenylation protein machinery in Arabidopsis. Results By protein sequence homology search using human and yeast polyadenylation factors, we identified 28 proteins that may be components of Arabidopsis polyadenylation machinery. To elucidate the protein network and their functions, we first tested their protein-protein interaction profiles. Out of 320 pair-wise protein-protein interaction assays done using the yeast two-hybrid system, 56 (~17%) showed positive interactions. 15 of these interactions were further tested, and all were confirmed by co-immunoprecipitation and/or in vitro co-purification. These interactions organize into three distinct hubs involving the Arabidopsis polyadenylation factors. These hubs are centered around AtCPSF100, AtCLPS, and AtFIPS. The first two are similar to complexes seen in mammals, while the third one stands out as unique to plants. When comparing the gene expression profiles extracted from publicly available microarray datasets, some of the polyadenylation related genes showed tissue-specific expression, suggestive of potential different polyadenylation complex configurations. Conclusion An extensive protein network was revealed for plant polyadenylation machinery, in which all predicted proteins were found to be connecting to the complex. The gene expression profiles are indicative that specialized sub-complexes may be formed to carry out targeted processing of mRNA in different developmental stages and tissue types. These results offer a roadmap for further functional characterizations of the protein factors, and for building models when testing the genetic contributions of these genes in plant growth and development.

Abstract Unilateral and bilateral variation in the course and elongation of the cervical (extracranial) part of the internal carotid artery (ICA) leading to its tortuosity, kinking and coiling or looping is not a rare condition, which could be caused by both embryological and acquired factors. Patients with such variations may be asymptomatic in some cases; in others, they can develop cerebrovascular symptoms due to carotid stenosis affecting cerebral circulation. The risk of transient ischemic attacks in patients with carotid stenosis is high and its surgical correction is indicated for the prevention of ischemic stroke. Detection of developmental variations of the ICA and evaluation of its stenotic areas is very important for surgical interventions and involves specific diagnostic imaging techniques for vascular lesions including contrast arteriography, duplex ultrasonography and magnetic resonance angiography. Examination of obtained images in cases of unusual and complicated variations of vascular pattern of the ICA may lead to confusion in interpretation of data. Awareness about details and topographic anatomy of variations of the ICA may serve as a useful guide for both radiologists and vascular surgeons. It may help to prevent diagnostic errors, influence surgical tactics and interventional procedures and avoid complications during the head and neck surgery. Our present study was conducted with a purpose of updating data about developmental variations of the ICA. Dissections of the main neurovascular bundle of the head and neck were performed on a total 14 human adult cadavers (10 – Africans: 7 males & 3 females and 4 – East Indians: all males). Two cases of unilateral congenital elongation of the cervical part of the ICA with kinking and looping and carotid stenoses were found only in African males. Here we present their detailed case reports with review of the literature.

Abstract Shed cells or disrupted parts of the biofilm may enter the circulation causing serious and very hard to treat biofilm-associated infections. The activity of antimicrobial agents against the shed cells/disrupted biofilms is largely unknown. Methods We studied the in vitro susceptibility of intact and disrupted biofilms of thirty clinical isolates of methicillin-resistant and methicillin–susceptible Staphylococcus aureus (MRSA and MSSA) and Staphylococcus epidermidis to vancomycin, quinupristin/dalfopristin, and linezolid and compared it to that of the suspended (planktonic) cells. Results Bacteria in the disrupted biofilms were as resistant as those in the intact biofilms at the minimum inhibitory concentrations of the antibiotics. At higher concentrations, bacteria in the disrupted biofilms were significantly (P < 0.001) less resistant than those in the intact biofilms but more resistant than the planktonic cells. Quinupristin/dalfopristin showed the best activity against cells of the disrupted biofilms at concentrations above MICs and vancomycin, at 500 and 1,000 μg/ml, was significantly more active against the biofilms of MRSA and S. epidermidis Conclusion The difficulty of treating biofilm-associated infections may be attributed not only to the difficulty of eradicating the biofilm focus but also to the lack of susceptibility of cells disrupted from the biofilm to antimicrobial agents.

Introduction With recent developments in postoperative pain management after total knee replacement (TKR), the continuous femoral nerve block is becoming a common practice. The purpose of this study was to compare a femoral nerve block with time-tested epidural analgesia in a tertiary care setup in a developing country. Methodology A randomized control trial took place at Shifa International Hospital (SIH), Islamabad, Pakistan. Sixty patients, aged 40 to 90 years old, 12 males and 48 females, who were undergoing unilateral TKR for osteoarthritis in American Society of Anesthesiologists (ASA) physical status classes I and II, weighing between 50 and 99 kg, and fully able to understand and respond to the numeric rating scale (NRS) were included in the study. While patients belonging to ASA physical status class ≥3, with chronic opiate therapy, having allergies to local anesthetics or equipment material, or with neuromuscular disease, were excluded from the study. Ethical approval was obtained, and patients were divided into two groups, with group A given epidural and group B given a femoral nerve block for pain management postop. Data were collected. The pain was recorded using the NRS at six, 12, and 24 hours postop. Results The results for six hours and 12 hours were found to be significant. Patients in group A had a lower NRS rating postop as compared to group B and required a lesser amount of additional boluses for pain management.  Conclusion The femoral nerve block is inferior to epidural analgesia for pain management after unilateral TKR in the first 24 hours, with a greater need for extra boluses to relieve pain., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Hasan et al.)

In the current investigation, statistical approaches were adopted to hydrolyse non-edible seed cake (NESC) of Pongamia and optimize the hydrolysis process by response surface methodology (RSM). Through the RSM approach, the optimized conditions were found to be 1.17%v/v of HCl concentration at 54.12 min for hydrolysis. Under optimized conditions, the release of reducing sugars was found to be 53.03 g/L. The RSM data were used to train the artificial neural network (ANN) and the predictive ability of both models was compared by calculating various statistical parameters. A three-layered ANN model consisting of 2:12:1 topology was developed; the response of the ANN model indicates that it is precise when compared with the RSM model. The fit of the models was expressed with the regression coefficient R 2 , which was found to be 0.975 and 0.888, respectively, for the ANN and RSM models. This further demonstrated that the performance of ANN was better than that of RSM., Competing Interests: Compliance with ethical standardsThe authors declare that they have no conflict of interest.

Kindler's Syndrome (KS) is a rare genodermatosis with autosomal recessive mode of inheritance. The disease results from homozygous mutations on both alleles of the FERMT-1 gene (also known as KIND-1 gene) that encodes the protein Kindlin-1 (kindlerin). Clinical features include a constellation of early infantile skin blistering and mild photosensitivity, which improves with age, and progressive poikiloderma with widespread cutaneous atrophy. The differential diagnosis of Kindler syndrome include other congenital poikilodermatous and photosensitive conditions including Bloom syndrome, Cockayne syndrome, dyskeratosis congenita, epidermolysis bullosa, Rothmund-Thomson syndrome and xeroderma pigmentosum. We herein, report the presence of the Kindler's syndrome in 5 out of 7 children of consanguineous parents. To authors' knowledge, this is the first report of Kindler's syndrome involving 5 members of a family.

Background: Psoriasis is a common, chronic, disfiguring, inflammatory and proliferative condition of skin manifested by red, scaly, sharply demarcated, indurated plaques present particularly over the extensor surfaces and scalp. The disease has been found to be associated with celiac disease related antibodies with variable frequencies in different populations of the world. The subset of patients showing this association have a higher psoriasis severity and also respond well to cost effective way of gluten free diet. There is a need to work out the frequency of these antibodies in our local psoriatic patients., Methods: The study was carried out in Department of Dermatology, Military Hospital Rawalpindi from 4th June to 4th December, 2008. A total of 80 patients of both gender, aged more than 15 with a clinical diagnosis of psoriasis attending dermatology outpatient department were selected. Relevant history and thorough physical examination was performed and disease characteristics like previous treatments received and history of arthropathy were obtained. Coeliac disease related antibodies were assessed on serum by indirect immunofluorescence and data was analysed using software SPSS-13., Results: From the study of 80 patients, celiac disease related antibodies were found in none of the cases. All the severe and mild to moderate patients of psoriasis were negative for IgA antigliadin antibodies, IgG antigliadin antibodies and IgA anti-reticulin antibody., Conclusion: This study concludes that celiac disease related antibodies are not present in psoriatic patients irrespective of severity of disease in our local population.

Objective: To explore the effects of different fatty acids on the proliferation and differentiation of myoblast., Methods: C2C12, L6, 3T3-L1 cells were treated with different concentrations (200, 100, 50, 25 and 12.5 micromol/L) of palmitic acid (PA), oleic acid (OA) or linolenic acid (LA) for different time (2, 4, 6, 8 days), the cells proliferation were tested by MTT assay. In order to observe the effects of fatty acids on differentiation of myoblasts, C2C12 and L6 cells were treated with PA, OA or LA of 25 micromol/L at the 2 days before and 0, 2, 4 days after induced differentiation, then the oil red Ostaining, Giemsa staining and creatine kinase (CK) assay were used to determine the effects of fatty acids on cell differentiation or tans-differentiation., Results: The inhibitory effect of the three kinds of fatty acids on cell proliferation and their time-dependent effects and dose-dependent effects were significantly different with changes of fatty acids and cell lines. PA and OA had more significant inhibition of cell proliferation than LA, and the inhibitory effects of OA showed no significant dose dependent for the three cell lines, while LA of below 100 micromol/L showed no significant time dependent for C2C12 and L6 myoblasts. Compared with 3T3-L1, cell proliferation of C2C12 and L6 was more sensitive to inhibitory effects of fatty acids. Fatty acid exposure afer differentiation had no significant effects on differention of C2C12 and L6 myoblasts, while fatty acid exposure at 2 days before differentiation remarkably affected differentiation of the myoblasts. LA exposure could increase multinucleated myotubes and creatine kinase, and promote skeletal differentiaon of myoblasts. Conversely, PA or OA exposure induced the intracellular accumulation of lipid droplets and decreased multinucleated myotubes and creatine kinase, inhibited differentiation to skeletal cells and promoted the tans-differentiation to adipocytes of myoblast., Conclusion: Fatty acids exposure affect the proliferation and differentiation of in vitro cultured myoblasts, and its function was related to fatty acid composition, cell type and exposure time.

We report an 18-year-old woman with lichen nitidus with exclusive facial distribution., (© 2010 The Authors. Australasian Journal of Dermatology © 2010 The Australasian College of Dermatologists.)

Congenital erythropoietic porphyria (CEP) or Gunther's disease is inherited disorder of porphyrin heme synthetic pathway that usually presents early in life. A very rare form of this disease has its onset in later years of life, called late onset erythropoietic porphyria (late onset EP). Fourteen cases of late onset EP have been reported to-date. We report another case of this rare entity in a 40 years old male with associated findings of haemolysis and thrombocytopenia.

Objective: To determine the frequency of depression in adult male dermatology outpatients., Study Design: Cross-sectional study., Place and Duration of Study: Combined Military Hospital, Bahawalpur, from January to March 2007., Methodology: A consecutive sample was screened for depression by using Urdu version of General Health Questionnaire-12 (GHQ-12). The final diagnosis of depression was based on criteria of International Classification of Diseases-10., Results: Out of the 114 adult males with dermatological disorders, 39 (34.11%) had depression. The frequency and percentage of depression in dermatological conditions was 6 (100%) in psychocutaneous disorders, 2 (66.6%) in urticaria, 3 (66.6%) in pruritis, 7 (57.5%) in acne vulgaris, 4 (50%) in psoriasis, 4 (44.4%) in vitiligo, 3 (37.5%) in melasma, 1 (33.3%) each in hyperhidrosis and alopecia areata, and 9 (20.4%) in eczema. It was not recorded in leprosy and chronic fungal infections., Conclusion: Depression was frequently in adult males with dermatological disorders especially psychocutaneous disorders, urticaria, pruritis, acne vulgaris and psoriasis. Depressive symptoms should be specifically explored even at busy dermatology outdoors for early recognition and timely appropriate psychiatric referral.