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Abstract Background Vision impairment and blindness are significant global public health challenges, particularly in low- and middle-income countries, where access to eye care services remains limited. India has significantly reduced the prevalence of Blindness and Vision Impairment (VI) over the last two decades. This was achieved with the help of greater investments towards blindness control programs. The use of utility values helps in conducting economic evaluations of various eye health programs and empirically justify investing in these programs. This study aimed to estimate utility values for various childhood eye conditions in central India using the EuroQol-Five-Dimension-Youth (EQ-5D-Y) instrument. Methods This is a before and after study with data collected at two time points for few participants and at only one time point for others. This study was undertaken at Shri Sadguru Netra Chikitsalaya (SNC) and included children representing central and north India. Participants were randomly sampled in the hospital. After comprehensive eye examination, participants completed the EuroQol-Five-Dimension-Youth (EQ-5D-Y) questionnaire along with EuroQol Visual Analogue Scale (EQ VAS) measurement to elicit their health state for their condition which was repeated after six months post-intervention to measure the change in utility value. We have used Indonesian value set to analyze the preference scores of each dimension of EQ-5D-Y. Results Utility values of 16 eye conditions were estimated at baseline and seven conditions were followed up for post-intervention utility value estimation. There is a statistically significant improvement in the utility values post-intervention amongst six conditions. Blindness and Pediatric cataract had the greatest change (0.23 and 0.2 respectively) in utility value whereas mild Vision Impairment (VI) showed the least change (0.02) in the utility value post-intervention. Blindness had the lowest baseline (0.62) and post-intervention (0.85) utility value. Conclusion The utility values estimated in this study showed that generic measures such as EQ-5D-Y may be used to elicit health states for various eye conditions amongst children. These estimates are helpful in undertaking cost-utility analyses of eye health programs and interventions aimed at these eye conditions.

The present study involved the fabrication and testing of a Microchip electrophoresis (MCE) device for pulse amperometry based detection of pesticides from their mixture. We were able to separate and then quantify three distinct types of insecticides, namely Chlorpyrifos, Imidacloprid, and Fipronil using on chip MCE followed by pulsed amperometric detection. All these results were obtained with an inhouse developed potentiostat cum controller unit with a detection time of only 15 min, employing a minimal sample size of 2 μL without any preconcentration or extraction procedure. The limit of detection (LOD) was calculated as 42.69 μM, 62.61 μM, and 71.14 μM or 14.96, 16.0 and 31.09 ppm, respectively for Chlorpyrifos, Imidacloprid, and Fipronil and their respective migration times as 536 ± 6.3 s, 484 ± 1.7 s, and 604 ± 3.5 s (n = 14). The sensitivity of detection was determined as 0.03 nA/μM for Chlorpyrifos, 0.0265 nA/μM for Imidacloprid, and 0.035 nA/μM for Fipronil. In addition, the efficacy of the produced microchip was confirmed by analysing soil extract spiked with known pesticides concentrations while the recovery percentage, representing a ratio of calculated concentration to spiked concentration multiplied by hundred was found as 84.3% (±9.4%) (n = 9). Thus, integrating microchip technology with the developed analytical instruments presents significant promise for practical field applications and the analysis of diverse analytes by way of creating a library where the migration coefficient and peak detection current are needed for any analyte which can be made cationic or anionic using a suitable buffer.

Conservation agriculture (CA) practices like zero-till and residue retention along with nitrogen management is vital for improving degraded soil health and optimizing the yield potential of wheat (Triticum aestivum L.) crop. Present study was carried out during winter (rabi) seasons of 2021–22 and 2022–23 at ICAR-Indian Agricultural Research Institute, New Delhi for optimizing wheat productivity in a conservation agriculture-based cotton (Gossypium herbaceum L.)-wheat system. The experiment was laid out in a randomized complete block design (RCBD) with three replications consisting of combination of 3 different crop establishment methods, viz. permanent broad bed (PBB), permanent narrow bed (PNB) and zero-till flatbed (ZTFB) with residue (R) and without residue along with 2 doses of nitrogen (75N, 100N) and conventional tillage (CT). The CA-based practices showed overall superior response in terms of growth, yield and nutrients uptake of wheat than CT. Among them, the PBBR100N resulted in significantly higher plant height, leaf area index, dry-matter accumulation, crop growth rate, and relative growth rate compared to PNB, PBB, ZTFB and CT. This treatment led to significantly higher grain (16.2–19.4%) and straw (9.6–11.6%) yields than CT. The net returns and benefit cost ratio (23.4% and 27.9%) were also higher than that in CT. Again, in this treatment, N uptake by wheat crop was higher by 85%, P uptake by 53.1%, and K uptake by 40.1%, and available soil N, P and K by 16.1, 25.3 and 43.7%, respectively than CT. Therefore, the study suggests that the adoption of CA-based practices with broad bed in Indo-Gangetic Plains will not only enhance the productivity of wheat but also result in improved soil health by restoring soil fertility.

Coronary Artery Disease (CAD) is a key factor in several serious heart conditions, such as ischemic heart disease, myocardial infarction, and heart failure. Detecting and treating CAD early is crucial for preventing further progression of the disease. Computer-aided techniques are needed to automate the characterization of CAD conditions. In this paper, a novel approach for the automated identification of CAD utilizing improved energy estimation of electrocardiogram (ECG) signals is developed. Due to the multi-component nature of ECG and the nonlinear characteristics of energy operators, estimating their instantaneous energy may lead to cross-component interactions complicating the interpretation. To overcome this issue, variational mode decomposition with a data-driven and adaptively initialized number of modes is suggested to estimate the accurate energy of ECG beat. In this process, the instantaneous energy of each decomposed component is computed for enhanced energy estimation of each ECG beat. Multiple statistical features calculated from the localized region of ECG beat could effectively classify CAD-affected ECG beats with more than 99.80 % accuracy with an optimized ensemble classifier and a 10-fold cross validation scheme. Moreover, experimental findings have revealed the effectiveness of the proposed methodology when compared to contemporary approaches employing identical datasets.

The clinical course and sequelae of molar pregnancy pose several diagnostic and management challenges, especially conceiving after assisted reproductive technology. A review of the literature was conducted on molar pregnancy with a coexistent fetus following assisted reproductive techniques, its clinical course, and sequelae. The literature review was conducted using search terms “coexistent fetus,” “hydatidiform mole,” “twin,” “assisted conception” AND “persistent gestational trophoblastic disease (PGTD)” OR “chemotherapy” in PubMed. A literature search identified 26 reported cases conceived following assisted conception. Management guidelines for hydatidiform mole with live fetuses are very vague and do not give specificity due to the fact that it is often associated with complications and bad obstetric outcomes. It also requires continuous monitoring and follow-up in a tertiary care center anticipating disease progression to postnatal PGTD. To assess the risk of continuation of pregnancy, multicentric studies with larger sample sizes are required to have a valid finding.

In patients with ischemic brain stroke, collateral circulation plays a crucial role in selecting patients suitable for endovascular therapy. The presence of well-developed collaterals improves the patient’s chances of recovery. In clinical practice, the presence of collaterals is diagnosed on a Computed Tomography Angiography scan. The radiologist grades it on the basis of subjective visual assessment, which is prone to interobserver and intraobserver variability. Computer-based methods of collateral assessment face the challenge of non-uniform scan volume, leading to manual selection of slices, meaning that the most imperative slices have to be manually selected by the radiologist. This paper proposes a multilevel multimodal hierarchical framework for automated collateral scoring. Specifically, we propose deploying a Convolutional Neural Network for image selection based on the visibility of collaterals and a multimodal model for comparing the occluded and contralateral sides of the brain for collateral scoring. We also generate a patient-level prediction by integrating automated machine learning in the proposed framework. While the proposed multimodal predictor contributes to Artificial Intelligence, the proposed end-to-end framework is an application in engineering. The proposed framework has been trained and tested on 116 patients, with five-fold cross-validation, achieving an accuracy of 91.17% for multi-class collateral scores and 94.118% for binary class collateral scores. The proposed multimodal predictor achieved a weighted F1 score of 0.86 and 0.95 on multi-class and binary-class collateral scores, respectively. The proposed framework is fast, efficient, and scalable for real-world deployments. Automated evaluation of collaterals with attention maps for explainability would complement radiologists’ efforts. Code for the proposed framework is available at: https://github.com/rishiraj-cs/collaterals_ML_MM.

Abstract Background Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease characterised by decline in lung function. We evaluated trajectories of forced vital capacity (FVC) and diffusing capacity (DLco) in a cohort of patients with IPF. Methods Patients with IPF that was diagnosed or confirmed at the enrolling centre in the previous 6 months were enrolled into the IPF-PRO Registry between June 2014 and October 2018. Patients were followed prospectively, with lung function data collected as part of routine clinical care. Mean trajectories of FVC and DLco % predicted in all patients and in subgroups by characteristics assessed at enrolment were estimated using a joint model that accounted for factors such as disease severity and visit patterns. Results Of 1002 patients in the registry, 941 had ≥ 1 FVC and/or DLco measurement after enrolment. The median (Q1, Q3) follow-up period was 35.1 (18.9, 47.2) months. Overall, mean estimated declines in FVC and DLco % predicted were 2.8% and 2.9% per year, respectively. There was no evidence that the mean trajectories of FVC or DLco had a non-linear relationship with time at the population level. Patients who were male, white, had a family history of ILD, were using oxygen, or had prior/current use of antifibrotic therapy at enrolment had greater rates of decline in FVC % predicted. Patients who were male or white had greater rates of decline in DLco % predicted. Conclusions Data from the IPF-PRO Registry suggest a constant rate of decline in lung function over a prolonged period, supporting the inexorably progressive nature of IPF. A graphical abstract summarising the data in this manuscript is available at: https://www.usscicomms.com/respiratory/IPF-PRORegistry_LungFunctionTrajectories . Trial registration NCT01915511.

We investigated the use of metallic silver as a catalyst for flash sintering on hydroxyapatite/zirconia (HZ) composites. Adding 3 wt% of silver to the ceramic powder reduced the flash onset temperature (from 1084 °C to 925 °C) and also the electric field (from 300 V cm−1 to 150 V cm−1) used in the process. We attribute this behaviour to the formation of a silver percolation path that acts as a heat source, accelerating the thermal runaway. As a result, both the flash temperature and the required electric field were reduced. Furthermore, the results suggest that the temperatures along the percolation paths are high enough to reach the boiling point of silver, forming a gaseous phase that leaves the sample.

Boiling is used for the thermal management of high-energy-density devices and systems. However, sudden thermal runaway at boiling crisis often results in catastrophic failures. Machine learning is a promising tool for in-situ monitoring of boiling-based systems for preemptive control of boiling crisis. A carefully acquired and well-labeled dataset is a primary requirement for utilizing any data-driven learning framework to extract valuable descriptors. Here, we present a comprehensive dataset of boiling acoustics presented in our recent work [1]. We collect the audio files through meticulously controlled near-saturated pool boiling experiments under steady-state conditions. To this end, we connect a high-sensitivity hydrophone to a pre-amplifier and a data acquisition unit for accurate and reliable acquisition of acoustic signals. We organize the audio files into four categories as per the respective boiling regimes: background or natural convection (BKG, 2−5W/cm2), nucleate boiling (NB, 8−140W/cm2), excluding those at higher heat flux values preceding the onset of boiling crisis or the critical heat flux (Pre-CHF, ≈145W/cm2), and transition boiling (TB, uncontrolled). Each audio file label provides explicit information about the heat flux value and the experimental conditions. This dataset, consisting of 2056 files for BKG, 13367 files for NB, 399 files for Pre-CHF, and 460 files for TB, serves as the foundation for training and evaluating a deep learning strategy to predict boiling regimes. The dataset also includes acoustic emission data from transient pool boiling experiments conducted with varying heating strategies, heater surface, and boiling fluid modifications, creating a valuable dataset for developing robust data-driven models to predict boiling regimes. We also provide the associated MATLAB® codes used to process and classify these audio files.

Weed control poses substantial difficulties for winter season onion (Allium cepa L.) cultivation in the north-western Indo-Gangetic Plains, primarily due to the constrained efficacy of the existing herbicides. To address this issue, a 2-year field study was conducted to assess the efficacy of pre- and post-emergence herbicides (pendimethalin, ethoxysulfuron, imazethapyr, and quizalofop-p-ethyl) individually and in combination with crop residue mulch for weed control in winter onion. The results revealed that using herbicides or mulches in isolation did not provide satisfactory weed control. However, the integration of natural mulch with pendimethalin followed by quizalofop-p-ethyl application proved to be the most effective weed control strategy, resulting in the least reduction in bulb yield (10.3%) compared to other treatments. On the contrary, combinations of pendimethalin with ethoxysulfuron or imazethapyr showed adverse effects on the onion crop and inflicted the highest yield losses among all treatments (78.6 and 83.4%, respectively). However, the combination of pendimethalin with quizalofop-p-ethyl coupled with crop mulch resulted in season-long weed control and over 80% bulb yield (36.58 t/ha) gains compared to the weed-free condition. These findings emphasize the efficacy of combining herbicides and mulches as an integrated weed management strategy for onions. By adopting such integrated approaches, farmers could improve weed control while maintaining bulb yield and quality, reducing the risks associated with herbicide resistance, and promoting sustainable onion production in the north-western Indo-Gangetic Plains.

Effective noise reduction is essential because it can influence the health and well-being of living organisms significantly, both physically and psychologically. This necessitates the use of appropriate absorbing materials to minimize the negative impact of noise. In recent years, there has been growing interest in using jute, coir and natural fibre-based acoustic materials in architectural and interior applications due to their exceptional acoustic properties, eco-friendliness, cost-effectiveness and widespread availability. The study focuses on analysing the effects of some scrutinised testing parameters of jute, coir and jute-coir blended non-woven fabric samples on noise reduction coefficient through observing sound absorption coefficient. The sound absorption coefficient was measured using the impedance tube method as per the ASTM E-1050 standard. The mean value of the sound absorption coefficient observed at frequencies 250 Hz, 500 Hz, 1000 Hz, and 2500 Hz was used to calculate the noise reduction coefficient. A three-factor & three-level Box–Behnken experimental design was used for designing research and non-woven jute, coir and jute coir blended fabric sample planning. The experimental work showed that with an increase in non-woven jute fabric sample thickness from 15 mm to 45 mm, blending jute 50 % with coir 50% and non-woven fabric samples tested by creating air gaps (15 mm to 30 mm) resulted in higher sound absorption coefficient and improved noise reduction coefficient. The experimental findings and statistical analysis revealed that blending jute with coir and increasing the thickness of non-woven fabric led to a significant improvement in the acoustic performance of the tested samples. However, increasing the air gap resulted in only a marginal improvement in acoustic performance.

Abstract Background Idiopathic pulmonary fibrosis (IPF) is characterized by the accumulation of extracellular matrix in the pulmonary interstitium and progressive functional decline. We hypothesized that integration of multi-omics data would identify clinically meaningful molecular endotypes of IPF. Methods The IPF-PRO Registry is a prospective registry of patients with IPF. Proteomic and transcriptomic (including total RNA [toRNA] and microRNA [miRNA]) analyses were performed using blood collected at enrollment. Molecular data were integrated using Similarity Network Fusion, followed by unsupervised spectral clustering to identify molecular subtypes. Cox proportional hazards models tested the relationship between these subtypes and progression-free and transplant-free survival. The molecular subtypes were compared to risk groups based on a previously described 52-gene (toRNA expression) signature. Biological characteristics of the molecular subtypes were evaluated via linear regression differential expression and canonical pathways (Ingenuity Pathway Analysis [IPA]) over-representation analyses. Results Among 232 subjects, two molecular subtypes were identified. Subtype 1 (n = 105, 45.3%) and Subtype 2 (n = 127, 54.7%) had similar distributions of age (70.1 +/- 8.1 vs. 69.3 +/- 7.6 years; p = 0.31) and sex (79.1% vs. 70.1% males, p = 0.16). Subtype 1 had more severe disease based on composite physiologic index (CPI) (55.8 vs. 51.2; p = 0.002). After adjusting for CPI and antifibrotic treatment at enrollment, subtype 1 experienced shorter progression-free survival (HR 1.79, 95% CI 1.28,2.56; p = 0.0008) and similar transplant-free survival (HR 1.30, 95% CI 0.87,1.96; p = 0.20) as subtype 2. There was little agreement in the distribution of subjects to the molecular subtypes and the risk groups based on 52-gene signature (kappa = 0.04, 95% CI= -0.08, 0.17), and the 52-gene signature risk groups were associated with differences in transplant-free but not progression-free survival. Based on heatmaps and differential expression analyses, proteins and miRNAs (but not toRNA) contributed to classification of subjects to the molecular subtypes. The IPA showed enrichment in pulmonary fibrosis-relevant pathways, including mTOR, VEGF, PDGF, and B-cell receptor signaling. Conclusions Integration of transcriptomic and proteomic data from blood enabled identification of clinically meaningful molecular endotypes of IPF. If validated, these endotypes could facilitate identification of individuals likely to experience disease progression and enrichment of clinical trials. Trial registration NCT01915511

A field experiment was conducted during rainy (kharif) seasons of 2020–21 and 2021–22 at the research farm of ICAR-Indian Agricultural Research Institute, New Delhi to assess the effects of nitrogen and residual sulphur (S) on maize crop in the 11th year of a long-term conservation agriculture (CA)-based maize (Zea mays L.)-Indian mustard [Brassica juncea (L.) Czern.] cropping system. The CA-based practice CA3 [ZT maize (ZTMz) + mustard residue (MsR) + brown manuring (BM) – ZT mustard (ZTMs) + maize residue (MzR)] resulted in greater maize plant height and dry weight than other CA and CT systems except CA4 [ZTMz + mungbean residue (MbR) – ZTMs + MzR – ZTMb + MsR], which had comparable plant height and dry weight. The CA3 increased maize dry weight by 9% and 11.7% over CT in 2020–21 and 2021–22, respectively. On the contrary, CA4 exhibited highest root length, root mass, and root volume densities in both years, and CA3 was comparable. It gave significantly higher grain yield than other treatments except CA3 and CA2 (ZTMz + MsR- ZTMs + MzR), which were comparable. The 100% and 75% recommended dose of N gave comparable grain yield under all CA-based treatments, indicating a saving of 25% N (~37.5 kg N/ha), mainly under CA practices. This highlights N economization over times in CA system. The 100% and 50% S applied to mustard could not show any significant residual effect on maize grain, stover and biological yields. Interactions between CA practices and N treatments for grain yield was significant but between CA and residual S, treatments were statistically similar. Thus, this study underscores the importance of CA framework for enhancing yield and income through better N and S management/savings in maize-mustard system.

Objective: The objective of this study was to investigate if intrauterine infusion of granulocyte colony-stimulating factor (G-CSF) or platelet-rich plasma (PRP) can improve endometrial parameters and the pregnancy rate in patients undergoing fresh embryo transfer with normal endometrial thickness. Materials and Methods: We conducted a retrospective observational study, at one of the assisted reproductive technique centers in central India. Data were collected from the institutional record system which was established as per the standard protocols. Data on a total of 225 patients who had an endometrial thickness >7 mm without any adjunct and underwent fresh embryo transfer in their first in vitro fertilization cycle during the past 2 years were collected and were categorized into three groups: Group A who had received intrauterine infusion of G-CSF (n = 75), Group B who received intrauterine infusion of PRP (n = 75), and Group C who (control group) received no intervention (n = 75). Results: The implantation rate was significantly higher in Group A (37.24%) than in Groups B and C (21.91% and 21.37%, respectively). No significant difference was found in the clinical pregnancy rate among Groups A, B, and C (50.68%, 40.54%, and 37.84%, respectively). Endometrial thickness increased significantly in Group A by approximately 2.3 mm. No significant change in other endometrial parameters in the three groups. The number of biochemical pregnancies was higher in the G-CSF group compared to the other two groups. Conclusion: Intrauterine infusion of G-CSF in women receiving fresh embryo transfer with normal endometrial thickness can increase endometrial thickness and the implantation rate without affecting other endometrial parameters and the cumulative pregnancy rate.

Hydatidiform mole with the coexisting live fetus is a rare entity occurring in 0.005%–0.01% of all pregnancies. With the introduction of assisted reproductive techniques (ARTs), a significant rise in the incidence of multiple pregnancies has been reported. Here, we report two cases of molar pregnancies with a coexisting live fetus conceived following assisted conception. In our first case, pregnancy was continued and delivered a term live infant. The second case was aborted at 16 weeks' gestation due to maternal complications. These two patients needed chemotherapy due to persistent gestational trophoblastic disease. The rarity of this condition poses several diagnostic and management challenges, especially conceiving after ART the decision of termination for such couples.

The noise optimization using suitable absorbing materials is imperative due to significant impact on living beings by influencing various physiological and psychological factors. The research investigating the acoustic characteristics of woven fabrics compared to nonwoven and other fabrics are very limited. This research investigates the acoustic characteristics of woven jute fabric in relation to fabric structural variables. The research is designed to fulfil the existing gap on acoustic characteristics of woven jute fabrics. The focus was on the effect of woven jute fabric structural parameters such as weft yarn linear density, weft density and number of weft float over warp on sound absorption coefficient and noise reduction coefficient. The sound absorption coefficient was measured using impedance tube method as per ASTM E1050 standard. Noise reduction coefficient was measured from the mean value of sound absorption coefficient observed at 250 Hz, 500 Hz, 1000 Hz and 2500 Hz. A Box–Behnken experimental design was adopted for research design and woven jute sample planning. The experimental work revealed that the plain woven jute samples prepared with 40 tex weft yarn consisting of 8 weft threads/cm showed higher mean values of sound absorption coefficient and noise reduction coefficient compared to twill and satin weave. The experimental results and statistical analysis showed that the effect of number of weft yarn float over warp and weft yarn linear density is significantly influencing sound absorption coefficient and noise reduction coefficient whereas the effect of weft density is found not significant.

Background and objectiveAutomated machine learning or autoML has been widely deployed in various industries. However, their adoption in healthcare, especially in clinical settings is constrained due to a lack of clear understanding and explainability. The aim of this study is to utilize autoML for the prediction of functional outcomes in patients who underwent mechanical thrombectomy and compare it with traditional ML models with a focus on the explainability of the trained models.MethodsA total of 156 patients of acute ischemic stroke with Large Vessel Occlusion (LVO) who underwent mechanical thrombectomy within 24 h of stroke onset were included in the study. A total of 34 treatment variables including clinical, demographic, imaging, and procedure-related data were extracted. Various conventional machine learning models such as decision tree classifier, logistic regression, random forest, kNN, and SVM as well as various autoML models such as AutoGluon, MLJAR, Auto-Sklearn, TPOT, and H2O were used to predict the modified Rankin score (mRS) at the time of patient discharge and 3 months follow-up. The sensitivity, specificity, accuracy, and AUC for traditional ML and autoML models were compared.ResultsThe autoML models outperformed the traditional ML models. For the prediction of mRS at discharge, the highest testing accuracy obtained by traditional ML models for the decision tree classifier was 74.11%, whereas for autoML which was obtained through AutoGluon, it showed an accuracy of 88.23%. Similarly, for mRS at 3 months, the highest testing accuracy of traditional ML was that of the SVM classifier at 76.5%, whereas that of autoML was 85.18% obtained through MLJAR. The 24-h ASPECTS score was the most important predictor for mRS at discharge whereas for prediction of mRS at 3 months, the most important factor was mRS at discharge.ConclusionAutomated machine learning models based on multiple treatment variables can predict the functional outcome in patients more accurately than traditional ML models. The ease of clinical coding and deployment can assist clinicians in the critical decision-making process. We have developed a demo application which can be accessed at https://mrs-score-calculator.onrender.com/.

Nitrogen (N) is an essential element required for the growth and development of all plants. On a global scale, N is agriculture’s most widely used fertilizer nutrient. Studies have shown that crops use only 50% of the applied N effectively, while the rest is lost through various pathways to the surrounding environment. Furthermore, lost N negatively impacts the farmer’s return on investment and pollutes the water, soil, and air. Therefore, enhancing nitrogen use efficiency (NUE) is critical in crop improvement programs and agronomic management systems. The major processes responsible for low N use are the volatilization, surface runoff, leaching, and denitrification of N. Improving NUE through agronomic management practices and high-throughput technologies would reduce the need for intensive N application and minimize the negative impact of N on the environment. The harmonization of agronomic, genetic, and biotechnological tools will improve the efficiency of N assimilation in crops and align agricultural systems with global needs to protect environmental functions and resources. Therefore, this review summarizes the literature on nitrogen loss, factors affecting NUE, and agronomic and genetic approaches for improving NUE in various crops and proposes a pathway to bring together agronomic and environmental needs.

BACKGROUND: Globally, 36.9 million people are living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. Like in chronic disease, many individuals may engage in self-initiated behaviors in HIV that are useful to maintain health, quality of life and perceptions of wellbeing. All these behaviors form the part of self-care activities. METHODOLOGY: This is a hospital-based cross-sectional descriptive study carried out in a large tertiary care center. A total of 120 consecutive HIV-positive patients were included in the study. RESULTS: While 99% (101) of participants told that good diet is necessary to maintain health, only 42.2% (43) told that adherence to treatment is important. With respect to satisfactory knowledge regarding different attributes of self care, majority (79.4%) had knowledge regarding diet to be taken to stay healthy while only 37.3% had knowledge regarding precautions to be taken while preparing food, 28.4% in case suffering from diarrhea, skin problems (11.8%), fever (61.8%), cough (19.6%), vomiting (11.8%), and headache (45.6%) which were very low. With regard to overall knowledge status, 22.5% (95% confidence interval 14.9–31.89) had satisfactory score while 77.5% had unsatisfactory score. The test of significance revealed that there is statistically significant relation of knowledge regarding self-care with that of education and duration of HIV positivity. CONCLUSION: Findings showed low awareness regarding self-care to be taken, leading to low percentage of overall satisfactory knowledge level among respondents which is a matter of concern. This knowledge which is often neglected and is therefore vital for an HIV-positive person to be able to take care of himself at the right time and take the right actions to prevent the progression of the disease and improve the quality of life.

Purpose: Currently, there are an estimated 4.95 million blind persons and 70 million vision impaired persons in India, out of which 0.24 million are blind children. Early detection and treatment of the leading causes of blindness such as cataract are important in reducing the prevalence of blindness and vision impairment. There are significant developments in the field of blindness prevention, management, and control since the “Vision 2020: The right to sight” initiative. Very few studies have analyzed the cost of blindness at the population level. This study was undertaken to update the information on the economic burden of blindness and visual impairment in India based on the prevalence of blindness in India. We used secondary and publicly available data and a few assumptions for our estimations. Methods: We used gross national income (GNI), disability weights, and loss of productivity metrics to calculate the economic burden of blindness and vision impairment based on the “cost of illness” methodology. Results: The estimated net loss of GNI due to blindness in India is INR 845 billion (Int$ 38.4 billion), with a per capita loss of GNI per blind person of INR 170,624 (Int$ 7,756). The cumulative loss of GNI due to avoidable blindness in India is INR 11,778.6 billion (Int$ 535 billion). The cumulative loss of GNI due to blindness increased almost three times in the past two decades. The potential loss of productivity due to vision impairment is INR 646 billion (Int$ 29.4 billion). Conclusion: These estimates provide adequate information for budgetary allocation and will help advocate the need for accelerated adoption of all four strategies of integrated people-centered eye care (IPCEC). Early detection and treatment of blindness, especially among children, is very important in reducing the economic burden; thus, there is a need for integrating primary eye care horizontally with all levels of primary healthcare.

Background: There exists a wide range of variations in skin tone around the world, with Asian and Indian subjects showing a greater susceptibility toward pigmentation disorder. Objective: This study was carried out with the objective to assess the clinical and dermoscopic findings among different types of melasma in a single center of Central India. Materials and Methods: A cross-sectional study was carried out among patients with clinical features of melasma attending the outpatient department at multispecialty hospital with a sample size of 100. A prestructured pro forma was used to collect the baseline data. Clinical and dermatological examination was done after taking a detailed history. Clinical pattern of melasma such as centrofacial, malar, and mandibular was noted. The areas of melasma were examined using a contact polarized Dermlite DL4 3rd Gen Dermoscope attached to an iPhone. Results: The mean age of study participants was 38.15 years with a standard deviation of 6.93. Seventeen percentage were of male gender. Thirty-one percentage of the female patients had a history of oral contraceptive pill (OCP) usage, and 22% of the female patients had a history of menstrual abnormalities. Fitzpatrick skin Type IV was the most commonly affected skin type. Centrofacial type of melasma is the most common clinical type and reticuloglobular pattern is the commonly seen pattern on dermoscopy. The color of dermoscopy was predominantly brown in malar (52.2%) and mandibular (57.1%) and mixed in Centrofacial (45.7%), which was followed by 26.1%–28.6% mixed color in malar and andibular types and 41.4% brown color in centrofacial type. The difference in the color of dermoscopy (P = 0.48), presence of telangiectasia on dermoscopy (P = 0.23), pattern of dermoscopy (P = 0.15), and mean Melasma Severity Index scores with different clinical types was not statistically significant. Similarly, the association between different clinical types of melasma with duration of sun exposure (P = 0.33) and topical photo protection (P = 0.34) was also not statistically significant. Conclusion: Our study findings concluded that melasma is common in women in the age group of 27–56 years range. Exposure to sunlight and the hormonal changes (due to OCP usage) were those among the various factors influencing the development of melasma. Centrofacial melasma was the most common pattern seen in our study group. Epidermal melasma features on dermoscopy were reticuloglobular patterns with a brownish hue, while the features of dermal melasma were irregular patterns with a bluish hue and mixed melasma had irregular patchy brown pigmentation. Perifollicular globules and telangiectasia were also seen.

A field experiment was conducted to evaluate the impacts of a 12-year old conservation agriculture (CA)- based pigeon pea-wheat system on weeds, wheat crop, and resource use during winter (rabi) 2021–22. Results indicated that surface retention of residue irrespective of ZT permanent bed and N dose led to significant reduction in weed interference at 60 DAS. CA-based systems reduced weed density and dry weight considerably than CT. CA- based systems led to significantly higher wheat grain yield (by 11.6–14.9%) and net B:C (by 24.0 –28.0%) than CT, and PFBR100N and PBBR100N were slightly superior to others. PBBR100N and PBBR75N had lower irrigation water use and significantly higher irrigation water productivity than CT. Contrast analysis showed that wheat yield and water productivity were comparable between 75% N and 100% N in CA, indicating a saving of 25% N under CA.

The field experiments were conducted during 2017-19 at the ICAR-Indian Agricultural Research Institute, New Delhi, India. The main aim of the study was to find out a suitable cropping system that can replace the existing rice-wheat cropping system to realize higher productivity and profitability. Four cropping systems, viz. rice (Oryza sativa L.) - mustard (Brassica juncea L.) - mungbean (Vigna radiata L.), maize (Zea mays L.) - mustard-mungbean, maize - potato (Solanum tuberosum L.) - onion (Allium cepa L.) and fodder maize+ cowpea (Vigna unguiculata L.) - wheat (Triticum aestivum L.) -mungbean, were evaluated in a randomized complete block design with four replications. Results suggested that the highest system productivity was obtained from the maize-potato-onion cropping system, recording almost 150% higher system productivity over the maize-mustard-mungbean and rice-mustard-mungbean cropping systems. The next best cropping system was fodder maize + cowpea -wheat-mungbean, recording significantly higher system productivity than maize-mustard-mungbean and rice-mustard-mungbean cropping systems. The highest gross and net returns was also recorded from the maize-potato-onion cropping system, being significantly higher than all other cropping systems in the first year, and statistically at par with the fodder maize + cowpea - wheat- mungbean cropping system in the second year. Overall, the highest productivity and net returns was recorded from the maizepotato- onion cropping system, and can potentially be an option to replace the existing rice-wheat cropping system of the Indo-Gangetic Plains.

Direct-seeded rice (DSR) can be a resource-efficient alternative to puddled transplanted rice (PTR), but weeds and nematodes pose severe challenges. Conservation agriculture (CA)-based DSR may inhibit/influence weeds/nematodes, which can be further intensified by adopting better weed control. Hence, this experiment was undertaken. Five CA-based DSR practices involving zero tillage, residue retention, brown manuring, and superimposed with four weed control/herbicide options were compared with PTR in a split-plot design replicated three times. All DSRs encountered more weeds and plant parasitic nematodes (PPNs) than PTR. Root-knot nematodes (RKN) infested five among 14 weeds present in rice and was first time found in Dinebra retroflexa. A CA-based zero till (ZT)DSR+ mungbean residue – ZT wheat + rice residue – ZT mungbean+wheat residue system reduced weeds significantly. It reduced RKN galls in Echinochloa colona, Echinochloa crusgalli, and rice plants by 72, 58, and 56%, respectively. In soil too, RKN and other PPNs, namely, Tylenchorhynchus brevilineatus and Pratylenchus thornei were reduced by 39%, 32%, and 26%, respectively, which gave a 6.3–22.7% higher yield in this CA practice than other DSRs. Pyrazosulfuron-ethyl, cyhalofop-butyl, and bispyribac-Na applied sequentially reduced weeds and PPNs, increased rice yield by 176.1%, and were at below detectable levels in soil, rice grains, and straw, and were safe for rotational crops. The above ZT-based triple cropping with residue supplemented with herbicides through better weed and nematode control would be an alternative to PTR in the North-wester Indo-Gangetic Plains of India and in similar agroecologies of the tropics/sub-tropics. This study would help farmers and policymakers to design integrated weed and nematode management modules using tillage, crop residue, and herbicides/pesticides for higher DSR yield and income.

Oncogenic osteomalacia secondary to glomus tumor is extremely rare. Localization of causative tumors is critical as surgical resection can lead to a complete biochemical and clinical cure. We present a case of oncogenic osteomalacia treated with resection of glomus tumor. A 39-year-old woman with a history of chronic sinusitis presented with chronic body ache and muscle weakness. Biochemical evaluation revealed elevated alkaline phosphatase hypophosphatemia, increased urinary phosphate excretion, low calcitriol, and FGF23 was unsuppressed suggestive of oncogenic osteomalacia. Diagnostic studies showed increase uptake in multiple bones. Localization with MRI of paranasal sinuses revealed a sinonasal mass with concurrent uptake in the same area on the octreotide scan. Surgical resection of the sinonasal mass was consistent with the glomus tumor. The patient improved both clinically and biochemically postoperatively. Along with the case of oncogenic osteomalacia secondary to a glomus tumor, we have also discussed in detail the recent development in the diagnosis and management of oncogenic osteomalacia.

Photosynthesis, crop health and dry matter partitioning are among the most important factors influencing crop productivity and quality. Identifying variation in these parameters may help discover the plausible causes for crop productivity differences under various management practices and cropping systems. Thus, a 2-year (2019–2020) study was undertaken to investigate how far the integrated crop management (ICM) modules and cropping systems affect maize physiology, photosynthetic characteristics, crop vigour and productivity in a holistic manner. The treatments included nine main-plot ICM treatments [ICM1 to ICM4 – conventional tillage (CT)-based; ICM5 to ICM8 – conservation agriculture (CA)-based; ICM9 – organic agriculture (OA)-based] and two cropping systems, viz., maize–wheat and maize + blackgram–wheat in subplots. The CA-based ICM module, ICM7 resulted in significant (p < 0.05) improvements in the physiological parameters, viz., photosynthetic rate (42.56 μ mol CO2 m–2 sec–1), transpiration rate (9.88 m mol H2O m–2 sec–1) and net assimilation rate (NAR) (2.81 mg cm–2 day–1), crop vigour [NDVI (0.78), chlorophyll content (53.0)], dry matter partitioning toward grain and finally increased maize crop productivity (6.66 t ha–1) by 13.4–14.2 and 27.3–28.0% over CT- and OA-based modules. For maize equivalent grain yield (MEGY), the ICM modules followed the trend as ICM7 > ICM8 > ICM5 > ICM6 > ICM3 > ICM4 > ICM1 > ICM2 > ICM9. Multivariate and PCA analyses also revealed a positive correlation between physiological parameters, barring NAR and both grain and stover yields. Our study proposes an explanation for improved productivity of blackgram-intercropped maize under CA-based ICM management through significant improvements in physiological and photosynthetic characteristics and crop vigour. Overall, the CA-based ICM module ICM7 coupled with the maize + blackgram intercropping system could be suggested for wider adoption to enhance the maize production in semiarid regions of India and similar agroecologies across the globe.

5-fluorouracil (5FU) and capecitabine are fluoropyrimidine anti-neoplastic drugs commonly used in the treatment of different types of cancer. Hereditary dihydropyrimdine deaminase (DPD), thymidylate synthase mutations and drug overdose may lead to life-threatening toxicities. Uridine triacetate (UTA) is an emergency treatment for overdoses and early onset, severe or life-threatening toxicities from fluoropyrimidines. It is approved for use in adults and children within 96 h of last fluoropyrimidine administration. We present the case of a 64-year-old male treated with 5-FU and oxaliplatin as adjuvant systemic therapy for stage IIIA rectal cancer who developed delayed central nervous system toxicity 18 days after initiating chemotherapy. He had rapidly worsening encephalopathy and ataxia. Laboratory workups, MRI brain and EEG were negative. He was started on UTA with concerns of 5-FU toxicity due to the life-threatening nature of his condition even beyond the recommended 96-h time cut-off. He had rapid improvement in clinical status and resolution of encephalopathy. DPD deficiency testing later resulted as heterozygous for IVS14+1G>A allele indicating enzyme deficiency. This report demonstrates the importance of identifying delayed side effects with fluoropyrimidine therapy and potential treatment for reversing these effects. We also did an extensive literature review and obtained reports from the uridine triacetate clinical trials on patients receiving UTA after the 96-h cut-off. Based on our experience and previous published reports, a patient developing life-threatening delayed 5-FU toxicity should also be considered for UTA on a case-by-case basis.

A 39-year-old-woman with a past medical history of type 2 diabetes mellitus (T2DM) on oral hypoglycemic agents presented to the emergency room with nausea, vomiting, shortness of breath, and altered mental status. Seven days prior to presentation, she was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Laboratory workup on presentation confirmed the diagnosis of diabetic ketoacidosis (DKA) (blood glucose 523 mg/dl, beta-hydroxybutyrate 8.91 mmol/l, pH 6.9, bicarbonate 11 mEq/l, anion gap 25 mEq/l, and HbA1c 10.8%). She was managed for DKA with hydration and insulin drip and discharged home. However, to our surprise, at the 2-week follow-up visit, she was found to have positive antibodies for zinc transporter 8 (ZnT8) (samples were collected on day of presentation). The rest of her antibodies associated with T1DM were negative. She was therefore started on a basal-bolus regimen and managed as type 1 diabetes mellitus (T1DM). Our case illustrates that there is an increased risk of T1DM following infection with SARS-CoV-2.

Hypothyroidism is a common medical condition and is often easily managed with excellent outcomes, when treated adequately. Compliance with levothyroxine (LT4) therapy is often compromised because of the need for a daily and lasting schedule. Overt rhabdomyolysis due to under-treatment or non-compliance is a rare occurrence. We report a case of rhabdomyolysis leading to acute kidney injury (AKI) on chronic kidney disease (CKD) requiring hemodialysis (HD) in a 68-year-old Caucasian male due to non-compliance with levothyroxine (LT4) therapy. Our patient 'ran out of levothyroxine' for approximately 4 weeks and developed gradually progressive muscle pain. The diagnosis of severe AKI due to rhabdomyolysis was made based on oliguria, elevated creatinine kinase (CK), and renal failure. Resuming the home dose of LT4 failed to correct CK levels, and there was a progressive decline in renal function. Although increasing doses of LT4 and three cycles of HD improved CK levels, they remained above baseline at the time of discharge. The patient recovered gradually and required HD for 4 weeks. CK levels normalized at 6 weeks. Through this case report, we highlight that non-compliance with LT4 therapy can lead to life-threatening complications such as renal failure and hence the need to educate patients on the significance of compliance with LT4 therapy should be addressed.

Objective Interstitial lung disease (ILD) is a major cause of morbidity and mortality in connective tissue diseases (CTDs). We aimed to assess the effect of rituximab ± mycophenolate mofetil (MMF) compared with MMF on pulmonary function and prednisone dosage in patients with CTD‐related ILD (CTD‐ILD). Methods This retrospective study included 83 patients from Stanford and Centre Hospitalier de l’Universite de Montreal. Fifteen patients received rituximab ± MMF (rituximab group), and 68 patients received MMF only (control group). Results Median ILD duration at the start of treatment was longer in the rituximab group at 47 months (range: 4‐170) versus 6.5 months (range: 0‐164) in controls. Forced vital capacity (FVC) decreased by 3.0% (range: 11%‐21%) after treatment in the rituximab group, whereas it increased by 2.0% (range: 14%‐25%) in the control group (p = 0.025). Diffusing capacity of carbon monoxide (DLCO) decreased by 3.0% (range: 10%‐12%) after treatment in the rituximab group, whereas it increased by 4.5% (range: 30%‐36%) in the control group (p = 0.046). Mixed model analysis controlling for ILD duration, baseline DLCO, systemic sclerosis, pulmonary hypertension, and prednisone use showed no significant difference in FVC or DLCO between groups at 6 months or 1 year. The average daily prednisone dose score decreased after treatment in the rituximab group, whereas it remained unchanged in the control group (p = 0.017). Conclusion Rituximab ± MMF did not significantly change pulmonary function compared with MMF alone, but it did result in a relative decrease in average daily prednisone dose in a population with recalcitrant CTD‐ILD.

Purpose: To determine the effect of previous renal stone surgery on result and complications of percutaneous nephrolithotomy (PCNL). Materials and Methods: Total 300 patients were enrolled in the study. We enrolled 100 surgery-naive cases (those with no history of any renal surgery) as control and labeled them as Group A. Group B comprised 100 cases who had PCNL in the past. Group C constituted 100 patients who had open renal stone surgery in the past. Stones were classified using Guy's stone score. PCNL was performed by standard technique in prone position and technical features encountered during operation and outcomes were compared between groups. Complications were graded using modified Clavien grading system. Results: There were no differences between the three groups in age, gender, body mass index, stone burden, and stone opacity. Multiple calyceal stones and distorted pelvicalyceal system anatomy were more in Group C, but stone score showed no statistically significant difference from other groups. The mean operative time (68.91 ± 21.27 min) and fluoroscopy time (264.40 ± 74.90 s) were longer in Group C, but there was no statistically significant difference between the groups. Multiple access was significantly more common in Group C compared to the other two groups (P < 0.001). Access location too did not show any statistically significant difference between the groups. Postoperative complications were more in previous stone surgery patients, but did not show statistically significant difference. Conclusion: PCNL is a safe and effective treatment modality for patients with renal stones regardless of history of previous PCNL or open renal surgery.

Weeds that occur in repeated flushes pose major challenges to direct-seeded rice (DSR). Zero till (ZT) DSR with crop residue influences weed interference considerably and can be substitutive to resource-intensive puddled transplanted rice (PTR). Field experiments were conducted at ICAR-Indian Agricultural Research Institute during 2018–19 involving conservation agriculture (CA)-based DSRs and weed control/herbicides treatments to appraise weed interference and productivity under an eight-year old CA-based rice-wheat system (RWS). All DSRs encountered more weeds than PTR. A double ZT system without residue [~ZTDSR-ZT wheat (ZTW); C1] had highest density and dry weight of grassy weeds, but a triple ZT system without residue [~ZTDSR-ZTW-ZT mungbean (ZTMB); C4] had highest density and dry weight of broad-leaved and sedge weeds. However, a triple ZT system with three crops residue [~ZTDSR + mungbean residue-ZTW + rice residue-ZTMB + wheat residue; C5)] could reduce weed interference significantly and led to 9.3% and 21.8% higher rice yield than C1 and C4, respectively. The application of pyrazosulfuron-ethyl 0.025 kg/ha pre-emergence followed by (fb) cyhalofop-butyl 0.100 kg/ha at 20 days after sowing (DAS), fb bispyribac-Na 0.025 kg/ha at 25 DAS (W4) led to significant reduction in grassy, broad-leaved and sedge weeds densities by 92.5, 96.6 and 67.7%, respectively. The triple ZT system with rice, wheat and mungbean residues (C5) combined with application of pyrazosulfuron-ethyl fb cyhalofop-butyl fb bispyribac-Na (W4) gave almost similar rice yield with PTR (C6). This may be recommended for adoption in Indo-Gangetic Plains (IGP) of India and in similar agro-ecologies of the tropics/sub-tropics.

Weeds are the major constraint to achieving higher wheat yield in Afghanistan. To evaluate weed interference and its impact on wheat, a field experiment was undertaken during winter season in 2014–15 at Afghanistan National Agricultural Science and Technology University (ANASTU), Kandahar. Seven weed control treatments comprising isoproturon 0.75 and 1.0 kg/ha at 35 days after sowing (DAS), sulfosulfuron 20 and 25 g/ha at 35 DAS, isoproturon + 2,4-D 0.75 + 0.5 kg/ha at 35 DAS (tank-mix), weed-free check and weedy check were laid out in a randomized complete block design with three replications. Results showed that grassy weeds constituted 62.7% of the total weeds and were mostly dominant. All herbicides/weed control treatments influenced weed interference, wheat crop growth and yield significantly. Sulfosulfuron 25 g/ha at 35 DAS resulted in significant reduction in weed density by 95.2% (i.e. weed control efficiency) and dry weight by 95.1% (i.e. weed control index), respectively. This treatment led to significant improvements in wheat growth (Leaf area index, dry matter accumulation) and grain (4.6 t/ha) and biological yields (10.6 t/ha), and was superior to other herbicide treatments. It increased wheat grain and biological yields by 24.3% and 17.8%, respectively, compared to weedy check. Therefore, the application of sulfosulfuron 25 g/ha at 35 DAS may be recommended for better weed control and higher wheat yield in Kandahar, Afghanistan, and in similar agro-ecologies of the tropics and sub-tropics.

Nephrotoxicity is one of the major limiting factors for vancomycin use. The most common histological patterns of kidney injury are acute tubulointerstitial nephritis and acute tubular necrosis. Patients who develop acute tubulointerstitial nephritis are prone to develop acute kidney injury with vancomycin rechallenge and, in most cases, present alone or as a part of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). The purpose of the review study is to identify biopsy-proven vancomycin-associated-tubulointerstitial nephritis in literature, determine possible underlying pathophysiology and identify the consequences of vancomycin rechallenge in such patients.

ABSTRACT: Canopy covers can be measured using destructive (visual) and non-destructive methods (spectral indices, photogrammetry, visual assessment, and quantum sensor). The precision of crop cover estimation, however, is dependent on the selection of appropriate methods. Studies were conducted at the Indian Grassland and Fodder Research Institute, Jhansi to compare the forage crops canopy cover estimated using photogrammetry software (Canopeo and SamplePoint) and visual assessments. Assessments were performed in three summer crops (corn, cowpea, and sorghum), two winter crops (Egyptian clover, and oats), and bare ground condition. For each plot, three nadir images (directly above the canopy) were captured using digital cameras from a height of 1.5 m above the soil surface between 10 AM to 2 PM on bright sunny days. The results indicated that the relationships between visual assessment and Canopeo (regression coefficient, (R2 = 0.96), visual assessment and SamplePoint (0.96), and Canopeo and SamplePoint (0.98) were linear when data were pooled across all the crops. SamplePoint and Canopeo is further, appropriate for cowpea (Pearson coefficient (R = 0.99 and 0.94), oats (0.92 and 0.97), and sorghum (0.46 and 0.51), respectively. SamplePoint and Canopeo are not suitable for berseem (-0.15) and corn (-0.61), respectively, due to dead residues after the first harvest in berseem and taller corn might have influenced the image quality. Therefore, the stage of the crop, the height of the crop, and dead residues around the plants can greatly influence the estimation of crop cover. In conclusion, the results indicated that this photogrammetry software can be used for non-destructive crop canopy measurement with the above-mentioned precautions in the forage crops tested. • Forage canopy cover is estimated generally by visual scoring, and the outcome varies widely from person to person. • Photogrammetry methods (Canopeo and SamplePoint) were positiviely correlated with visual scoring for cowpea, oats, and sorghum. • However, Canopeo and SamplePoint may not suitable for taller crops like corn and ratoon crops like berseem.

Background. Platelet-rich plasma (PRP) and its derivatives are used in several aesthetic, dental, and musculoskeletal procedures. Their efficacy is primarily due to the release of various growth factors (GF), interleukins, cytokines, and white blood cells. However, the PRP preparation methods are highly variable, and studies lack consistency in reporting complete procedures to prepare PRP and characterize PRP and its derivatives. Also, all the tissue-specific (in vivo and in vitro) interactions and functional properties of the various derivatives/factors of the PRP have not been taken into consideration by any study so far. This creates a potential space for further standardization of the PRP preparation methods and customization of PRP/PRP derivatives targeted at tissue-specific/pathology specific requirements that would enable efficacious and widely acceptable usage of PRP as main therapy, rather than being used as adjuvant therapy. The main objective of our study was to investigate the variability in PRP preparation methods and to analyze their efficacy and reliability. Method. This study considered articles published in the last 5 years, highlighting the variability in their PRP preparation methods and characterization of PRP. Following the PRISMA protocol, we selected 13 articles for the study. The selected articles were assessed using NHLBI quality assessment tool. Results. We noted differences in (1) approaches to producing PRP, (2) extent of characterization of PRP, (3) small scale and large-scale preparation methods, (4) in vitro and in vivo studies. Conclusion. We identified two studies describing the procedures which are simple, reproducible, economical, provide a good yield of platelets, and therefore can be considered methods for further tissue-specific and pathology-specific standardizations of PRP and its derivatives. We recommend further randomized studies to understand the full therapeutic potential of the constituents of PRP and its derivatives.

The Coronavirus Disease 2019 (COVID-19) pandemic has rapidly progressed, resulting in significant global morbidity and mortality. Predominantly affecting the respiratory tract, it has been found to be associated with extrapulmonary manifestations such as coagulopathies. We hereby report a case of an elderly man with no predisposing risk factors or history of hypercoagulable disorder who presented with acute onset abdominal pain and was diagnosed with portal vein thrombosis and splenic infarct two weeks following mild COVID-19. Incidentally, the patient was also noted to have aortic thrombosis. The patient was treated with therapeutic anticoagulation with complete resolution in his symptoms. Our case highlights a high risk of coagulopathy following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Background: Pulmonary hypertension is a complication of chronic lung diseases (PH-CLD) associated with significant morbidity and mortality. Management guidelines for PH-CLD emphasize the treatment of the underlying lung disease, but the role of PH-targeted therapy remains controversial. We hypothesized that treatment approaches for PH-CLD would be variable across physicians depending on the type of CLD and the severity of PH.Methods and Results: Between May and July 2020, we conducted an online survey of PH experts asking for their preferred treatment approach in seven hypothetical cases of PH-CLD of varying severity. We assessed agreement amongst clinicians for initial therapy choice using Fleiss' kappa calculations. Over 90% of respondents agreed that they would treat cases of severe PH in the context of mild lung disease with some form of PH-targeted therapy. For cases of severe PH in the context of severe lung disease, over 70% of respondents agreed to use PH-targeted therapy. For mild PH and mild lung disease cases,

ABSTRACT After emerging in China in late 2019, the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread worldwide, and as of mid-2021, it remains a significant threat globally. Only a few coronaviruses are known to infect humans, and only two cause infections similar in severity to SARS-CoV-2: Severe acute respiratory syndrome-related coronavirus, a species closely related to SARS-CoV-2 that emerged in 2002, and Middle East respiratory syndrome-related coronavirus, which emerged in 2012. Unlike the current pandemic, previous epidemics were controlled rapidly through public health measures, but the body of research investigating severe acute respiratory syndrome and Middle East respiratory syndrome has proven valuable for identifying approaches to treating and preventing novel coronavirus disease 2019 (COVID-19). Building on this research, the medical and scientific communities have responded rapidly to the COVID-19 crisis and identified many candidate therapeutics. The approaches used to identify candidates fall into four main categories: adaptation of clinical approaches to diseases with related pathologies, adaptation based on virological properties, adaptation based on host response, and data-driven identification (ID) of candidates based on physical properties or on pharmacological compendia. To date, a small number of therapeutics have already been authorized by regulatory agencies such as the Food and Drug Administration (FDA), while most remain under investigation. The scale of the COVID-19 crisis offers a rare opportunity to collect data on the effects of candidate therapeutics. This information provides insight not only into the management of coronavirus diseases but also into the relative success of different approaches to identifying candidate therapeutics against an emerging disease. IMPORTANCE The COVID-19 pandemic is a rapidly evolving crisis. With the worldwide scientific community shifting focus onto the SARS-CoV-2 virus and COVID-19, a large number of possible pharmaceutical approaches for treatment and prevention have been proposed. What was known about each of these potential interventions evolved rapidly throughout 2020 and 2021. This fast-paced area of research provides important insight into how the ongoing pandemic can be managed and also demonstrates the power of interdisciplinary collaboration to rapidly understand a virus and match its characteristics with existing or novel pharmaceuticals. As illustrated by the continued threat of viral epidemics during the current millennium, a rapid and strategic response to emerging viral threats can save lives. In this review, we explore how different modes of identifying candidate therapeutics have borne out during COVID-19.

COVID-19 involves a number of organ systems and can present with a wide range of symptoms. From how the virus infects cells to how it spreads between people, the available research suggests that these patterns are very similar to those seen in the closely related viruses SARS-CoV-1 and possibly Middle East respiratory syndrome-related CoV (MERS-CoV).

Objective: American College of Graduate Medical Education (ACGME) recommends ongoing care of 10 patients per resident however its implication is unclear. We hypothesized EMR quality to vary based on patient load and call status. Methods: We conducted a double-blind, single-center, retrospective observational study between 2017 and 2019 to investigate the quality and accuracy of resident documentation using the Responsible Electronic Documentation (RED) Checklist, a validated scoring system. Results: A total of 234 independent charts were analyzed and 80 met scoring criteria. Average patients per residents was 4, 9.1, 7.2, and 5.5 on “call” day (D0), “post-call” day (D1), “mid-call” day (D2), and “pre-call” day (D3), respectively. Mean RED checklist scores were 68.1%, 57%, 68.6%, and 72.1% on the above call status. The difference in score between D3 and D1 was statistically significant ( P = .00042). There was a negative correlation between score and number of patients per resident ( r = −0.286, P = .010). Conclusion: EMR documentation quality is directly impacted by patient load and resident call status with the lowest documentation quality on post-call day, correlating with patient load.

ABSTRACT: Objective: Giant parathyroid adenomas (GPAs) are a rare type of parathyroid adenoma (PA) weighing >2 to 3 g. The objective of this manuscript is to report a case of giant parathyroid adenoma and highlight the risk of postoperative hypocalcemia. Methods: We describe the presentation and work-up of a woman with GPA confirmed with histopathology as well as management of postoperative hypocalcemia. Results: A 66-year-old Caucasian female with chronic fatigue was found to have elevated calcium levels at 13.7 mg/dL (normal, 8.9 to 10.2 mg/dL) and elevated parathyroid hormone levels at 1,240 pg/mL (normal, 12 to 72 pg/mL). Contrast enhanced computed tomography scan of the neck showed a 5.6 cm heterogeneous mass posterior to the right thyroid. The patient underwent right parathyroidectomy and histopathology confirmed the diagnosis of a giant parathyroid adenoma (GPA) weighing 28.7 g. Postoperatively, the patient developed hypocalcemia secondary to hungry bone syndrome and was treated aggressively with intravenous calcium supplementation. At 4 weeks postoperatively, she had normal calcium levels without any calcium supplementation. Conclusion: GPAs are a rare variant of PA, and could be a distinct clinical entity with features different from both PA and parathyroid carcinoma. We further postulate that the risk of postoperative hypocalcemia secondary to hungry bone syndrome could be higher among patients with GPA compared to patients with PA. These hypotheses needs to be validated with further studies. Abbreviations: CT computed tomography GPA giant parathyroid adenoma HBS hungry bone syndrome PA parathyroid adenoma PTH parathyroid hormone

Better understanding of repulsive buying behaviour has positive contribution to the country’s economic state and also towards the quality of product and services. In the recent years the consumer is showing a kind of revulsion in its buying behaviour. Repulsive buying behaviour in consumer is repugnance for product i.e. a strong feeling of distaste for the product. The product is repelled by the consumer if it doesn’t match the social status of the consumer, in case celebrity endorsing the product is not followed or admired by the consumer, adding to this are unresolved issues and complaints of customers which deteriorate the image of the marketer. The products are overloaded with wasteful features or are against the culture and religion of consumer or maybe are not according to the planning of consumer are not entertained by the consumer. It also proves that once customer has faced dissatisfaction by the usage of product or has no knowledge about the usage of product it turns off the consumer from the product.

We have introduced a polymer precursor into molten magnesium and then in-situ pyrolyzed to produce castings of metal matrix composites (P-MMCs) containing silicon-carbonitride (SiCNO) ceramic particles. Stress-rupture measurements of as-cast P-MMCs was performed at 350 °C (0.69TM) to 450 °C (0.78TM) under dead load condition corresponding to tensile stress of 2.5 MPa to 20 MPa. The time-to-fracture data were analyzed using the classical Monkman–Grant equation. The time-to-fracture is thermally activated and follows a power-law stress exponent exhibiting dislocation creep. Fractography analysis revealed that while pure magnesium appears to fracture by dislocation slip, the P-MMCs fail from the nucleation and growth of voids at the grain boundaries. Keywords: Stress-rupture, Polymer derived ceramics, Magnesium, Dispersion strengthened alloys, High temperature, Light-weight materials

A 71-year-old male with history of DeBakey type-1 aortic dissection and repair with dacron graft three months prior to presentation was brought to the emergency room with complaints of high-grade fevers, chills, and shortness of breath. Chest X-ray revealed right lower lobe infiltrates and widened superior mediastinum. A follow-up CT chest with contrast showed fluid collection around the aortic graft. He was started on intravenous broad-spectrum antibiotics, and a TEE was done for further evaluation of periaortic fluid collection which showed findings to suggest periaortic abscess. The patient underwent surgical drainage of the abscess and was found to have an abscess around the surgical aortic graft which was drained followed by two weeks of antibiotic treatment. The patient was discharged to a rehabilitation facility and remained asymptomatic at three-month follow-up appointment. Type-1 aortic dissection is a medical emergency requiring acute surgical intervention, and despite significant advancements in diagnosis and management, the immediate and long-term complications remain high leading to increased risk of mortality. Our patient developed spontaneous periaortic abscess three months postoperatively requiring intensive antibiotic therapy along with surgical drainage. Our case emphasizes the importance of early diagnosis and management of late complications of periaortic abscess in patients with aortic dissection repair.

Objective. Fatty liver is a rising global health concern, significantly increasing the burden of health care cost. Nonalcoholic fatty liver disease (NAFLD) has a correlation with metabolic syndrome and its complications. Method. We reviewed the literature regarding the mechanisms of developing NAFLD through AGE-RAGE signaling. Results. NAFLD, metabolic syndrome, and production of advanced glycation end-products (AGEs) share many common risk factors and appear to be connected. AGE induces production of the receptor for AGE (RAGE). AGE-RAGE interaction contributes to fat accumulation in the liver leading to inflammation, fibrosis, insulin resistance, and other complications of the fatty liver disease. The immune system, especially macrophages, has an important defense mechanism against RAGE pathway activities. Conclusion. Soluble form of RAGE (sRAGE) has the capability to reduce inflammation by blocking the interaction of AGE with RAGE. However, sRAGE has some limitations, and the best method of usage is probably autotransplantation of transfected stem cells or monocytes, as a precursor of macrophages and Kupffer cells, with a virus that carries sRAGE to alleviate the harmful effects of AGE-RAGE signaling in the settings of fatty liver disease.

An 85-year-old male referred to the Gastroenterology (GI) clinic with three-month history of failure to thrive and three-week history of nausea, vomiting, and melanotic stools. Ulcerative mass obstructing gastric outlet was found on endoscopy and on follow-up CT abdomen a homogeneous submucosal mass in the gastric antrum was identified. Radiological diagnosis of giant gastric lipoma was established and patient was evaluated for surgery and, however, was rendered unfit for surgery due to his comorbid conditions. Patient was taken for endoscopic resection of the mass. On endoscopy, only partial resection was achieved due to the size of the mass, but endoloops were deployed at the stalk at the end of the procedure in hope of limiting blood supply to the lesion. On six-week follow-up endoscopy, patient's mass had completely disappeared with limited scar tissue at the site.