Search

Agricultural poisons (insecticides and pesticides) are the most common types of poison implicated in the morbidity and mortality associated with acute poisoning. Suicidal ingestion is more frequent than accidental or homicidal poisonings. Pyrethroids are considered relatively safer than other insecticides. Lambda-cyhalothrin (LCH) belongs to the fourth-generation, type II synthetic pyrethroid. To the best of our knowledge, fatalities after LCH exposure have not yet been reported in the literature. Here, we describe a case of LCH poisoning in a 54-year-old male farmer after an accidental pipe burst in a sprayer while spraying in the field. The patient died 10 days after poisoning due to severe neurotoxicity resulting in bilateral parieto-occipital and brainstem infarcts. The histopathological features of the brain associated with LCH poisoning have been discussed in this report.

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disorder. Though corticosteroids are the cornerstone of therapy, the Janus kinase inhibitor abrocitinib has shown promise in recent clinical trials for the treatment of AD.To assess the overall efficacy and safety of abrocitinib in moderate to severe AD.All randomized controlled trials (RCTs) evaluating the efficacy and safety of abrocitinib in moderate to severe AD were included in the meta-analysis.The pooled analysis revealed a significant proportion of patients achieving Investigator's Global Assessment (IGA) response (RR = 3.52, 95% CI; 2.78-4.46,This meta-analysis showed that abrocitinib had a significant beneficial effect and tolerable adverse effect profile in patients of AD. Dose regimens of 200 and 100 mg seemed to have similar benefits. However, long-term trials are needed for corroboration.Key pointsAbrocitinib is emerging as a potential treatment option for moderate to severe atopic dermatitis.The pooled analysis from 4 RCTs demonstrated significant effectiveness of abrocitinib in both physician and patient-reported outcomes like IGA, EASI, and PP-NRS. The drug was also well-tolerated across the trials.The number needed to treat (NNT) for all efficacy outcomes was low suggesting clinically desirable benefits with the use of abrocitinib.

BACKGROUND Tumour-induced osteomalacia (TIO) or oncogenic osteomalacia is a rare variant of paraneoplastic syndrome secondary to a small benign phosphaturic mesenchymal tumour that secretes phosphaturic substances. Complete tumour excision is often curative. However, the localization of these offending tumours has always remained a challenge because of their small size, slow-growing nature, and presence in atypical locations. We performed a systemic review and meta-analysis on the sensitivity and specificity of F-18 FDG PET/CT and Ga-68 DOTA-SSTR PET/CT to detect tumours causing osteomalacia. METHODS Pub Med, SCOPUS, the Cochrane Library and Web of Science were searched for articles on F-18 FDG and Ga-68 DOTA-SSTR PET/CT in the detection of culprit tumours in TIO till September 2020. Both retrospective and prospective studies having three or more patients were included. The methodological quality of included studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies-2 checklist. A random-effect model was used for the statistical pooling of sensitivity and specificity. Pooled data were presented with 95% confidence intervals (95% CI) and displayed using Forest plots. Heterogeneity was expressed using the I2 statistic. RESULTS The pooled sensitivity of Ga-68 DOTA-SSTR PET/CT in detecting the culprit tumour derived from all included studies is 86% (95% CI: 79-91%). There is moderate statistical heterogeneity among the included studies (I2 = 72.7%). The pooled sensitivity of F-18 FDG PET/CT in detecting the offending tumour derived from all included studies is 73% (95% CI: 61-84%) with moderate statistical heterogeneity among the included studies (I2 = 45.4%). CONCLUSION In the detection of offending tumours in TIO, Ga-68 DOTA-SSTR PET/CT has better sensitivity than F-18 FDG PET/CT and should be used as first-line imaging modality due to very high sensitivity.

The current management of COVID-19 is mostly limited to general supportive care and symptomatic treatment. Ivermectin is a broad-spectrum anti-parasitic drug used widely for the treatment of onchocerciasis and lymphatic filariasis. Apart from its anti-parasitic effect it also exhibits antiviral activity against a number of viruses both in vitro and in vivo. Hence, we conducted this systematic review and meta-analysis to assess the currently available data on the therapeutic potential of ivermectin for the treatment of COVID‐19 as add on therapy. A total of 629 patients were included in the 4 studies and all were COVID-19 RT-PCR positive. Among them, 397 patients received ivermectin along with usual therapy. The random effect model showed the overall pooled OR to be 0.53 (95%CI: 0.29 to0.96) for the primary outcome (all-cause mortality) which was statistically significant (P=0.04). Similarly, the random effect model revealed that adding ivermectin led to significant clinical improvement compared to usual therapy (OR=1.98, 95% CI: 1.11 to 3.53, P=0.02). However, this should be inferred cautiously as the quality of evidence is very low. Currently, many clinical trials are on-going, and definitive evidence for repurposing this drug for COVID-19 patients will emerge only in the future.

Though systemic corticosteroid is used for treatment of COVID 19, questions regarding the appropriate dose, duration and type of corticosteroid use still remain unanswered. This study aimed to address, whether choice of systemic corticosteroid significantly influences the clinical outcome of COVID 19 patients.Studies reporting the comparison between clinical outcome of dexamethasone and methylprednisolone in treatment of COVID 19 were searched from inception till April, 2021. Random-effect model was used. Odd's ratio (OR) and 95% confidence interval was expressed. I2 statistics used for test of heterogeneity.Three studies with 373 patients (160 in dexamethasone group and 213 in methyl prednisolone group) were included. Though, statistically significant reduction in all-cause mortality with methyl prednisolone group in comparison to dexamethasone group (OR=1.80, 95%CI: 1.08 to 3.01, P=0.02) estimated, sub group analysis of observational studies did not support the finding (OR=1.60, 95% CI: 0.88 to 2.92, P=0.12). No significant difference in terms of need for invasive ventilator or intensive care unit (ICU) between the 2 groups. The grade of evidence was very low for both the outcomes. Conclusion and Relevance: In the present context, both dexamethasone and methyl prednisolone are equally effective in the management of COVID 19.

Group B Streptococcus (GBS) or Streptococcus agalactiae is an uncommon causative agent of urinary tract infection (UTI). We present a series of seven cases of UTI due to GBS from a tertiary care hospital of Eastern India, highlighting its emerging role in a hitherto less commonly described clinical entity., An increased awareness is needed for accurate identification of urinary tract infection due to Group B Streptococcus (GBS). All catalase‐negative, bile‐esculin negative, gram‐positive cocci obtained on cystine lactose electrolyte deficient medium should be sub‐cultured to a blood agar medium to examine for specific hemolytic property enabling identification of GBS.

Introduction Healthcare workers (HCWs) are vulnerable to getting infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Preventing HCWs from getting infected is a priority to maintain healthcare services. The therapeutic and preventive role of ivermectin in coronavirus disease 2019 (COVID-19) is being investigated. Based on promising results of in vitro studies of oral ivermectin, this study was conducted with the aim to demonstrate the prophylactic role of oral ivermectin in preventing SARS-CoV-2 infection among HCWs at the All India Institute of Medical Sciences (AIIMS) Bhubaneswar. Methods A prospective cohort study was conducted at AIIMS Bhubaneswar, which has been providing both COVID and non-COVID care since March 2020. All employees and students of the institute who provided written informed consent participated in the study. The uptake of two doses of oral ivermectin (300 μg/kg/dose at a gap of 72 hours) was considered as exposure. The primary outcome of the study was COVID-19 infection in the following month of ivermectin consumption, diagnosed as per Government of India testing criteria (real-time reverse transcriptase polymerase chain reaction [RT-PCR]) guidelines. The log-binomial model was used to estimate adjusted relative risk (ARR), and the Kaplan-Meier failure plot was used to estimate the probability of COVID-19 infection with follow-up time. Results Of 3892 employees, 3532 (90.8%) participated in the study. The ivermectin uptake was 62.5% and 5.3% for two doses and single dose, respectively. Participants who took ivermectin prophylaxis had a lower risk of getting symptoms suggestive of SARS-CoV-2 infection (6% vs 15%). HCWs who had taken two doses of oral ivermectin had a significantly lower risk of contracting COVID-19 infection during the following month (ARR 0.17; 95% CI, 0.12-0.23). Females had a lower risk of contracting COVID-19 than males (ARR 0.70; 95% CI, 0.52-0.93). The absolute risk reduction of SARS-CoV-2 infection was 9.7%. Only 1.8% of the participants reported adverse events, which were mild and self-limiting. Conclusion Two doses of oral ivermectin (300 μg/kg/dose given 72 hours apart) as chemoprophylaxis among HCWs reduced the risk of COVID-19 infection by 83% in the following month. Safe, effective, and low-cost chemoprophylaxis has relevance in the containment of pandemic alongside vaccine.

Background: As future practitioners, undergraduate medical students have a key role in the antimicrobial stewardship program (ASP). However, at present, there are not much data about their knowledge and perception of antibiotic resistance and ASP. Methods: This was a cross-sectional questionnaire-based survey administered to the prefinal- and final-year undergraduate medical students of a tertiary care institution. Results: One hundred and ninety-seven students participated in our study constituting 70% response rate. The mean difference in knowledge score between prefinal- and final-year students was 0.77 (95% confidence interval: 0.30–1.24, P = 0.0016). Thirty-seven (39.7%) prefinal- and 57 (54.8%) final-year students knew the correct definition of antimicrobial stewardship. Majority of the participants, i.e., 66 (70.9%) prefinal-year and 80 (76.9%) final-year students perceived antibiotic resistance as a public health problem. Principal component analysis revealed the greater role of attitude-related questions. Conclusion: Good knowledge and positive attitude are paramount for the effective implementation of the antibiotic stewardship program. Our study revealed that the knowledge gap exists among the undergraduate students about the rational use of the antibiotic stewardship program. It was also revealed that the role of attitude plays a more significant role than knowledge for the proper understanding of the program. A sustained effort is required to make them aware of the rational use of antibiotics by incorporating the knowledge and practice of the ASP into their study curriculum.

Many key biologics are scheduled to lose their patent by the year 2020, which will provide the opportunity to other biopharmaceutical companies to develop the similar biologics. Biosimilar or similar biologic used has increased in the recent year following the approval of the first biosimilar in early 2000. India is one of the leading manufacturers of similar biologics. India has developed a new guideline in 2012 for the pre- and post-marketing approval of similar biologics.

Many anti-inflammatory drugs like, tocilizumab, N-acetylcystiene and etolizumab has been repurposed for the management of COVID-19 with variable success. Colchicine exhibits anti-inflammatory activity by tubulin disruption and inhibition of leucocyte-mediated inflammatory activities like production of superoxide and release of various cytokines which are central to the pathophysiology of COVID-19. So, this systematic review and meta-analysis assessed the currently available data on the use of colchicine for the treatment of COVIDLJ19. A total of 3 studies (2 RCTS and 1 observational study) including 402 patients were included out of which 194 patients received colchicine. The random effect model showed the overall pooled OR to be 0.32 (95%CI: 0.18 to 0.56) for the primary outcome (Clinical deterioration) which was statistically significant (p

Background Healthcare workers (HCWs) are vulnerable to getting infected withSARS-CoV-2. Preventing HCWs from getting infected is a priority to maintain healthcare services. The therapeutic and preventive role of ivermectin in COVID-19 is being investigated. Based on promising results of in vitro studies of oral ivermectin, this study was conducted with the aim to demonstrate the prophylactic role of oral ivermectin in preventing SARS-CoV-2 infectionamong HCWs at All India Institute of Medical Sciences (AIIMS), Bhubaneswar.Methods A prospective cohort study was conducted at AIIMS Bhubaneswar, which provides both COVID and Non-COVID care since March 2020. All employees and students of the institute who provided written informed consent participated in the study.Uptake of two-doses of oral ivermectin (300 μg/kg at a gap of 72 hours) was considered as exposure. The primary outcome of the study was COVID-19 infection in the following month of ivermectin consumption diagnosed by RTPCR as per Government of India testing criteria guidelines.The log-binomial model was used to estimate adjusted relative risk, and the Kaplan-Meier failure plot was used to estimate the probability of COVID-19 infection with follow-up time.Results Of 3892 employees, 3532 (90.8%) participated in the study. The ivermectin uptake was 62.5% and 5.3% for two-doses and single-dose, respectively. Participants who took ivermectin prophylaxis had a lower risk of getting symptoms suggestive of SARS-CoV-2 infection(6% vs 15%). HCWs who had taken two-doses of oral ivermectin have a significantly lower risk of contracting COVID-19 disease during the following month (ARR 0.17; 95% CI, 0.12-0.23). Females had a lower risk of contracting COVID-19 than males (ARR 0.70 95% CI, 0.52-0.93). The absolute risk reduction of SARS-CoV-2 infection was 9.7%. Only 1.8% of the participants reported adverse events, which were mild and self-limiting.Conclusion and relevance Two-doses of oral ivermectin (300 μg/kg given 72 hours apart) as chemoprophylaxis among HCWs reduces the risk of COVID-19 infection by 83% in the following month. Safe, effective, and low-cost chemoprophylaxis have relevance in the containment of pandemic alongside vaccine.

Background Ivermectin is one among several potential drugs explored for its therapeutic and preventive role in SARS-CoV-2 infection. The study was aimed to explore the association between ivermectin prophylaxis and the development of SARS-CoV-2 infection among healthcare workers. Methods A hospital-based matched case-control study was conducted among healthcare workers of AIIMS Bhubaneswar, India, from September to October 2020. Profession, gender, age and date of diagnosis were matched for 186 case-control pairs. Cases and controls were healthcare workers who tested positive and negative, respectively, for COVID-19 by RT-PCR. Exposure was defined as the intake of ivermectin and/or hydroxychloroquine and/or vitamin-C and/or other prophylaxis for COVID-19. Data collection and entry was done in Epicollect5, and analysis was performed using STATA version 13. Conditional logistic regression models were used to describe the associated factors for SARS-CoV-2 infection. Results Ivermectin prophylaxis was taken by 76 controls and 41 cases. Two-dose ivermectin prophylaxis (AOR 0.27, 95% CI, 0.15–0.51) was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month. Those involved in physical activity (AOR 3.06 95% CI, 1.18–7.93) for more than an hour/day were more likely to contract SARS-CoV-2 infection. Type of household, COVID duty, single-dose ivermectin prophylaxis, vitamin-C prophylaxis and hydroxychloroquine prophylaxis were not associated with SARS-CoV-2 infection. Conclusion Two-dose ivermectin prophylaxis at a dose of 300 μg/kg with a gap of 72 hours was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month. Chemoprophylaxis has relevance in the containment of pandemic.

We report an uncommon case of pyogenic liver abscess due to Stenotrophomonas maltophilia in an apparently immune-competent individual, the timely recognition of which could avoid a potentially fatal course of infection in the patient. A 45-year-old man, with history of moderate alcohol intake since the last 10 years, was admitted with intense right-sided upper abdominal pain and right-sided chest pain of 10-days duration. Culture of the ultrasound-guided liver aspirate sample yielded a pure growth of S. maltophilia identified by the VITEK-2™ automated microbial identification system. Treatment with parenteral levofloxacin and oral trimethoprim-sulfamethoxazole along with pigtail catheter drainage and other appropriate supportive management led to resolution of the abscess with no recurrence of infection at two months follow-up. Physicians need to be aware that S. maltophilia infections may not be restricted to hospitalized patients as a low-virulence opportunistic pathogen, but may occur as an important emerging pathogen in community-acquired infections as well.

Though Convalescent plasma therapy (CPT) is being used for management of COVID-19, the evidence is still equivocal. So, we carried out this study to evaluate the currently available data to provide evidence about CPT in COVD-19 patients. RCTs and observational studies with sample size with more than 5 were included in the analysis. Out of 196 studies, 12 studies were selected for systematic review and meta-analysis was carried out for 6 studies having a control arm. For dichotomous values, risk ratio (RR) and 95% confidence interval was expressed.All-cause mortality, clinical improvement by day 7 and viral detection by day 7 were the defined outcome measures before starting of data extraction.For 6 studies (2 RCTs and 4 observational studies) with 474 patients, the overall pooled RR for all-cause mortality was 0.61 (95%CI: 0.37 to 0.99. P= 0.04). Only RCTs and only observational studies for all-cause mortality showed pooled RR of 0.60 (95% CI: 0.33 to 1.10, P=0.10) and 0.48 (95% CI: 0.17 to 1.36, P= 0.17) respectively. There was risk of bias in the studies due to randomization process and confounding. Sensitivity analysis was carried out only for observational studies. The overall pooled RR for clinical improvement by day 7 and viral detection by day 7 were 1.12 (95%CI: 0.96 to 1.31, P=0.16) and 0.19 (95%CI: 0.09 to 0.60, P0.0001).Though the review suggests modest utility of CPT in reducing all-cause mortality, improving clinical outcome, and early viral clearance, it should be interpreted cautiously.

BackgroundIvermectin is one among several potential drugs explored for its therapeutic and preventive role in COVID-19 infection. The study was aimed to explore the association between ivermectin prophylaxis and development of COVID-19 infection among healthcare workers.MethodsA hospital-based matched case-control study was conducted among healthcare workers of AIIMS Bhubaneswar, India, from September to October 2020. Profession, gender, age and date of diagnosis were matched for 186 case-control pairs. Cases and controls were healthcare workers who tested positive and negative, respectively, for COVID-19 by RT-PCR. Exposure was defined as the intake of ivermectin and/or hydroxychloroquine and/or vitamin-C and/or other prophylaxis for COVID-19. Data collection and entry was done in Epicollect5, and analysis was performed using STATA version 13. Conditional logistic regression models were used to describe the associated factors for COVID-19 infection.ResultsIvermectin prophylaxis was taken by 77 controls and 38 cases. Two-dose ivermectin prophylaxis (0.27, 95% CI, 0.15-0.51) was associated with 73% reduction of COVID-19 infection among healthcare workers for the following one month, those who were involved in physical activity (3.06 95% CI, 1.18-7.93) for more than an hour/day were more likely to contract COVID-19 infection. Type of household, COVID duty, single-dose ivermectin prophylaxis, vitamin-C prophylaxis and hydroxychloroquine prophylaxis were not associated with COVID-19 infection.ConclusionTwo-dose ivermectin prophylaxis at a dose of 300 μg/kg with a gap of 72 hours was associated 73% reduction of COVID-19 infection among healthcare workers for the following one-month. Further research is required before its large scale use.

Background Cerebral malaria is a common presentation of severe Plasmodium falciparum infection and remains an important cause of death in the tropics. Key aspects of its pathogenesis are still incompletely understood, but severe brain swelling identified by magnetic resonance imaging (MRI) was associated with a fatal outcome in African children. In contrast, neuroimaging investigations failed to identify cerebral features associated with fatality in Asian adults. Methods Quantitative MRI with brain volume assessment and apparent diffusion coefficient (ADC) histogram analyses were performed for the first time in 65 patients with cerebral malaria to compare disease signatures between children and adults from the same cohort, as well as between fatal and nonfatal cases. Results We found an age-dependent decrease in brain swelling during acute cerebral malaria, and brain volumes did not differ between fatal and nonfatal cases across both age groups. In nonfatal disease, reversible, hypoxia-induced cytotoxic edema occurred predominantly in the white matter in children, and in the basal ganglia in adults. In fatal cases, quantitative ADC histogram analyses also demonstrated different end-stage patterns between adults and children: Severe hypoxia, evidenced by global ADC decrease and elevated plasma levels of lipocalin-2 and microRNA-150, was associated with a fatal outcome in adults. In fatal pediatric disease, our results corroborate an increase in brain volume, leading to augmented cerebral pressure, brainstem herniation, and death. Conclusions Our findings suggest distinct pathogenic patterns in pediatric and adult cerebral malaria with a stronger cytotoxic component in adults, supporting the development of age-specific adjunct therapies.

The Harmonized Diagnostic Assessment of Dementia for Longitudinal Aging Study in India (LASI-DAD) is a population-representative, prospective cohort study of late-life cognition and dementia. It is part of an ongoing international research collaboration that aims to measure and understand cognitive impairment and dementia risk by collecting a set of cognitive and neuropsychological assessments and informant reports, referred to as the Harmonized Cognitive Assessment Protocol (HCAP). LASI-DAD provides nationally representative data drawn from a subsample of the ongoing Longitudinal Aging Study in India (LASI). One of LASI-DAD's distinctive features is its rich geriatric assessment, including the collection of venous blood samples and brain imaging data for a subsample of respondents. In this paper, we discuss the methodological considerations of developing and implementing the HCAP protocol in India. The lessons we learned from translating and applying the HCAP protocol in an environment where illiteracy and innumeracy are high will provide important insights to researchers interested in measuring and collecting data on late-life cognition and dementia in developing countries. We further developed an innovative blood management system that enables us to follow the collection, transportation, assay, and storage of samples. Such innovation can benefit other population surveys collecting biomarker data.

Background of the study: Hypothyroidism is known to affect electrolyte, fat, protein and carbohydrate metabolism. Though the effects of thyroid hormones on lipid profile has been well established, the effects on electrolytes and certain minerals like calcium, magnesium and phosphorus is not clear and the underlying mechanisms responsible for these changes are not well understood. Aim and objectives: The objective was to find out the effects of hypothyroidism on certain electrolytes and minerals levels. Materials and methods: The study was carried out in Dept. of Physiology in collaboration with Medicine, Endocrinology and Biochemistry.100 cases of overt hypothyroidism of both genders aged 25-60 years were chosen,100 age and sex matched healthy controls were chosen. Blood samples were collected from them and serum TSH, total T3, T4, sodium, potassium, calcium, magnesium and phosphorus levels were measured. The values of the above parameters of cases and controls were compared and statistical analysis was made. Results: It was found that the levels of serum sodium, potassium and calcium were significantly decreased in cases than the controls. Serum magnesium and phosphorus were significantly elevated in cases than controls. Conclusion: From this study we were able to conclude that higher the TSH levels, higher will be serum magnesium and phosphorus in the blood and lower will be serum sodium, potassium and calcium levels.

Background: Type 2 diabetes mellitus (DM) is a common chronic disease with increasing prevalence worldwide. Prolonged uncontrolled hyperglycemia, dyslipidemia are major risk factor for its complication like neuropathy. Since there is no definite treatment for diabetic neuropathy, this study aims to evaluate the effect of resveratrol on diabetic neuropathy in high fat diet with low dose streptozotocin induced type-2 DM model in wistar albino rats.Methods: First type 2 diabetic rat model was established. Wistar albino rats, fed with high-fat diet (HFD) rendered diabetic with streptozotocin, were divided into 6 groups, disease control (DC) treated with vehicle, standard control (SC) which received metformin, test groups treated with 5, 10, and 20 mg/kg b.w. of resveratrol and combination of half dose of metformin and resveratrol (10 mg/kg) (TC). A group of six normal animals served as normal control (NC), another six as HFD control. Fasting plasma glucose, lipid profile were measured one week after induction of diabetes. The animals were then treated orally for 2 weeks after which the same parameters were repeated. Behavioral biomarkers for neuropathy are measured in 4 weeks and 6 weeks of treatment. The in-vivo results were analyzed by one way ANOVA followed by Tukey’s multiple comparison test for biochemical parameters and Kruskal Wallis test followed by Dun’s multiple comparison test for behavioral biomarkers.Results: Increase in fasting plasma glucose (FPG), deranged lipid profile, increased neuropathy in DC compared to NC, HFD control while a significant decrease in FBG, improved pain behavior with SC, test groups (p

The pathophysiology and molecular mechanisms underlying cerebral malaria (CM) are still poorly understood. Recent neuroimaging studies demonstrated that brain swelling is a common feature in CM and a major contributor to death in pediatric patients. Consequently, determining the precise mechanisms responsible for this swelling could open new adjunct therapeutic avenues in CM patients. Using an MRI scanner with a higher resolution than the ones used in previous reports, we identified two distinct origins of brain swelling in both adult and pediatric patients from India, occurring in distinct parts of the brain. Our results support the hypothesis that both endothelial dysfunction and microvascular obstruction by Plasmodium falciparum-infected erythrocytes make independent contributions to the pathogenesis of CM, providing opportunities for novel therapeutic interventions., The mechanisms underlying the rapidly reversible brain swelling described in patients with cerebral malaria (CM) are unknown. Using a 1.5-Tesla (T) magnetic resonance imaging (MRI) scanner, we undertook an observational study in Rourkela, India, of 11 Indian patients hospitalized with CM and increased brain volume. Among the 11 cases, there were 5 adults and 6 children. All patients had reduced consciousness and various degrees of cortical swelling at baseline. The latter was predominately posterior in distribution. The findings on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps were consistent with vasogenic edema in all cases. Reversibility after 48 to 72 h was observed in >90% of cases. DWI/ADC mismatch suggested the additional presence of cytotoxic edema in the basal nuclei of 5 patients; all of these had perfusion parameters consistent with vascular engorgement and not with ischemic infarcts. Our results suggest that an impairment of the blood-brain barrier is responsible for the brain swelling in CM. In 5 cases, vasogenic edema occurred in conjunction with changes in the basal nuclei consistent with venous congestion, likely to be caused by the sequestration of Plasmodium falciparum-infected erythrocytes. While both mechanisms have been individually postulated to play an important role in the development of CM, this is the first demonstration of their concurrent involvement in different parts of the brain. The clinical and radiological characteristics observed in the majority of our patients are consistent with posterior reversible encephalopathy syndrome (PRES), and we show for the first time a high frequency of PRES in the context of CM. IMPORTANCE The pathophysiology and molecular mechanisms underlying cerebral malaria (CM) are still poorly understood. Recent neuroimaging studies demonstrated that brain swelling is a common feature in CM and a major contributor to death in pediatric patients. Consequently, determining the precise mechanisms responsible for this swelling could open new adjunct therapeutic avenues in CM patients. Using an MRI scanner with a higher resolution than the ones used in previous reports, we identified two distinct origins of brain swelling in both adult and pediatric patients from India, occurring in distinct parts of the brain. Our results support the hypothesis that both endothelial dysfunction and microvascular obstruction by Plasmodium falciparum-infected erythrocytes make independent contributions to the pathogenesis of CM, providing opportunities for novel therapeutic interventions.

Diabetes Mellitus (DM) is a metabolic disorder characterized by relative or absolute deficiency of insulin, resulting in hyperglycemia. Subcutaneous insulin and Oral Hypoglycaemic Agents (OHA) constitute the main treatment option for DM. Insulin is administered by injection or continuous infusion to control glucose levels mainly in Type I diabetes. Newer routes both oral and non oral, for insulin administration are current direction of insulin research as insulin injection therapy is burdensome and painful for many patients. Inhalational insulin is an attractive alternative for systemic administration of insulin given its accessibility and large alveolar-capillary network of lungs for drug absorption. Afrezza, inhaled insulin has been recently approved by Food and Drug Administration (FDA). It is a new, quicker acting inhalable insulin with a different and safer pharmacokinetic profile in comparison to previously failed inhaled form of insulin.

Background: Diabetes mellitus is a common chronic disease. One of the pathophysiology is found to be oxidative stress. This study aims to evaluate the effect of resveratrol on oxidative stress in high fat diet (HFD)/streptozotocin induced diabetic rats.Methods: Wistar albino rats, fed with HFD rendered diabetic with streptozotocin, were divided into 6 groups, namely the diabetic control treated with vehicle (DC), standard control which received metformin (SC), test groups treated with 5,10, and 20 mg/kg b.w. of resveratrol and combination of half dose of metformin and resveratrol (10 mg/kg)(TC). A group of six normal animals served as normal control (NC), another six as HFD control. Fasting blood glucose, lipid profile and serum MDA and SOD were measured one week after induction of diabetes. The animals were then treated orally for 2 weeks after which the same parameters were repeated. The in-vivo results were analysed by one way ANOVA followed by Tukey’s multiple comparison test.Results: The DC group demonstrated a increase in the fasting blood glucose compared to NC, HFD control while a significant decrease in the fasting blood glucose was observed with SC, Test groups (p

Thyroiditis is a very rare cause of fever of unknown origin (FUO). Thyroiditis presenting as only fever and weight loss is very rare. We present a case of FUO, which was later on confirmed as thyroiditis on thyroid scintigraphy.

A systematic experimental investigation was conducted using lab processed low carbon 0.08C-2.0Mn-Cr-Mo steel microalloyed with Ti/Nb to evaluate the influence of initial hot-rolled microstructures on the kinetics of austenite formation and decomposition after cold-rolling and subsequent annealing. Coiling temperature as a major hot rolling parameter was used to obtain different types of hot-rolled microstructures. Dilatometer and continuous annealing simulator were employed for austenite formation studies and annealing simulations, respectively. It was found that the coiling temperature affects the processes occurring during heat treatment in continuous annealing lines of full hard material: ferrite recrystallization, austenite formation during continuous heating and austenite decomposition during cooling. A decrease in coiling temperature accelerates the recrystallization of ferrite and nucleation of austenite, which results in formation of refined ferrite-martensite structure. The effect of initial hot rolled structure on final mechanical properties after continuous annealing was also investigated.

Austenite formation during intercritical annealing was studied in a cold-rolled dual-phase (DP) steel based on a low-carbon DP780 composition processed in the mill. Two heating rates, 10 and 50 K/s, and a range of annealing temperatures from 1053 K to 1133 K (780 °C to 860 °C) were applied to study their effects on the progress of austenitization. The effect of these process parameters on the final microstructures and mechanical properties was also investigated using a fixed cooling rate of 10 K/s after corresponding annealing treatments. It was found that the heating rate affects the austenite formation not only during continuous heating, but also during isothermal holding, and the effect is more pronounced at lower annealing temperatures. Faster heating delays the recrystallization kinetics of the investigated steel. The rate of austenite formation and its distribution are strongly influenced by the extent of overlapping of the processes of recrystallization and austenitization. It appeared that the heating rate and temperature of intercritical annealing have a stronger effect on the final tensile strength (TS) of the DP steel than holding time. Both higher annealing temperatures and long holding times minimize the strength difference caused by a difference in heating rate.

A two-dimensional phase field model was employed to examine the evolution of interdiffusion microstructures in ternary Ni–Cr–Al solid-to-solid diffusion couples containing fcc-γ and γ + β (fcc + B2) alloys. Alloys of varying compositions and volume fractions of the second phase (β) were examined to simulate the dissolution kinetics of the β phase (i.e., recession of γ + β two-phase region) observed in γ vs. γ + β diffusion couples. Simulation results showed that the rate of recession of γ + β two-phase region was dependent on the composition of the single-phase γ alloy and the volume fraction of the β phase in the two-phase alloy of the couple. Specifically, the higher the Cr and Al content in the γ alloy and the higher the volume fraction of β in the γ + β alloy lower is the rate of dissolution. Although the volume fraction played a role, the concentration gradients of Al and Cr in the γ phase (e.g., between the matrix of γ + β alloy and single-phase γ alloy) also influenced the recession of the β phase. Simulated results were found to be in good agreement with the experimental observations in ternary Ni–Cr–Al solid-to-solid diffusion couples containing γ and γ + β alloys.

Evolution of interdiffusion microstructures was examined for binary Ni–Al solid-to-solid diffusion couples using two-dimensional (2D) phase-field simulation. Utilizing semi-implicit Fourier-spectral solutions to Cahn–Hilliard and Allen–Cahn equations, multiphase diffusion couples of fcc Ni solid solution γ vs. L12 Ni3Al solid solution γ′, γ vs. γ + γ′, γ + γ′ vs. γ + γ′ with sufficient thermodynamic and kinetic database, were simulated with alloys of varying compositions and volume fractions of second phase (e.g., γ′). Chemical mobility as a function of composition was used in the study with constant gradient energy coefficient, and their effect on the final interdiffusion microstructure was examined. The microstructures were characterized by the type of boundaries formed, i.e. Type 0, Type I, and Type II, following various experimental observations in literature and thermodynamic considerations. Volume fraction profiles of alloy phases present in the diffusion couples were measured to quantitatively analyze the formation or dissolution of phases across the boundaries. Kinetics of dissolution of γ′ phase was found to be a function of interdiffusion coefficients that can vary with composition and temperature.

Interdiffusion in hypothetical ternary single-phase and two-phase diffusion couples are examined using a phase-field model by numerically solving the nonlinear Cahn-Hilliard and Ginzburg-Landau equations. For diffusion couples assembled with a regular single-phase solution, constant chemical mobilities were used to examine the development of concentration profiles including uphill diffusion and zero-flux plane. Zero-flux plane for a component was observed to develop for a diffusion couple at the composition that corresponds to the activity of that component in one of the terminal alloys. Experimental thermodynamic parameters and composition-dependent chemical mobilities were used to examine the morphological evolution of the interphase boundary in solid-to-solid, two-phase diffusion couples. Instability at the interphase boundary was introduced initially (t=0) by a small compositional fluctuation at the diffuse interface, and its evolution varied largely as a function of terminal alloys and related composition-dependent chemical mobility.

Solid-state diffusion is a subject of great interest for many intellectual merits and practical applications. It also provides excellent educational studies with cross-fertilization of science and technology. This paper examines the importance of multicomponent-multiphase interdiffusion with specific examples from materials and coatings for components in advanced energy production systems, including gas turbines and nuclear reactors. Results and analysis from laboratory experiments are presented in terms of interdiffusion fluxes, integrated interdiffusion coefficients, effective interdiffusion coefficients, and average multicomponent interdiffusion coefficients. Applications are highlighted for materials and coatings for components in advanced energy production technologies. Additional consideration is given to the refined approach to assess composition-dependent interdiffusion coefficients in multicomponent alloys.

World of sports have been rocked by doping scandals every now and then and World Anti-Doping Agency(WADA) has banned several offending drugs at different times to counter this menace. Meldonium is the recent addition to the long list of drugs banned by WADA to prevent its misuse among the athletes. Meldonium is a carnitine synthesis inhibitor and has been approved by some European countries for the management of cardiac diseases like angina pectoris and congestive cardiac failure. Apart from these, it has numerous other indications like bronchial asthma, bronchitis and retinopathies. It had also been used by athletes across the world because of its presumptive role in increasing the performance.

Evolution of interdiffusion microstructures was examined in ternary Ni-Cr-Al solid-tosolid diffusion couples using two-dimensional (2D) phase field simulation. Utilizing Cahn-Hilliard and Allen-Cahn equations, multiphase diffusion couples containing of fcc-γ and B2-β solid solution phases were simulated with alloys of different compositions and phase contents. Chemical mobility as a function of composition with constant gradient energy coefficients was used in the simulation. Simulated microstructures in γ+β/γ and γ+β/γ+β diffusion couples were compared with the experimental microstructures reported in literature. As observed experimentally, the model predicted the recession of γ+β region in the γ+β/γ couple and a stationary interface in γ+β/γ+β couple. Concentration profiles developed across the diffusion couples demonstrated that the interdiffusion occurs in the γ phase as well as in the γ+β region. Formation of single-phase γ and β layers near the interface of γ+β/γ+β couples was also investigated using the volume fraction profile obtained from the simulated microstructure.

A mechanism-based methodologies to model microstructural evolution and predict lifetime of oxidation resistance coatings and TBCs using phase-field simulation is presented wherein only fundamental properties of materials such as free energy, atomic mobility and elastic constants are employed. Phase field approach to simulate critical phenomena associated with TBC failure, namely sintering of ytrria-stabilized zirconia (YSZ) topcoat, (t’→f+m) phase transformations in YSZ topcoat, high temperature oxidation (i.e., growth of thermally grown oxide, TGO) of bond coats, multicomponent-multiphase interdiffusion between bond coats and superalloy substrate, and fracture at the YSZ/TGO and TGO/bond coat interfaces are presented based on available literature. Results from simulation of microstructure evolution due to multiphase-multicomponent interdiffusion between bond coat and superalloy substrates are highlighted with an emphasis on composition-dependent interdiffusion. Specifically, a phase field model has been utilized to simulate and predict interdiffusion behavior and evolution of microstructure in multi-phase diffusion couples of binary and ternary systems, e.g. Ni-Al and Ni-Cr-Al. The model was capable of predicting composition profiles, diffusion paths and dissolution kinetics of the second phase, which were in good agreement with the experimental results reported in the literature.Copyright © 2009 by ASME

A diffuse interface model was devised and employed to investigate the effect of thermotransport (a.k.a., thermomigration) process in single-phase and two-phase alloys of a binary system. Simulation results show that an applied temperature gradient can cause significant redistribution of constituent elements and phases in the alloy. The magnitude and the direction of the redistribution depend on the initial composition, the atomic mobility and the heat of transport of the respective elements. In two-phase alloys, the thermomigration effect can cause the formation of single-element rich phases at the cold and hot ends of the alloy (i.e., demixing).