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Background and purpose: To compare the efficacy, safety, and immunogenicity of recombinant insulin aspart 100 U/mL manufactured by BioGenomics Limited (BGL-ASP) with innovator NovoRapid® in type 2 diabetes mellitus patients (T2 DM). Experimental approach: This was a multicenter, open-label, randomized, parallel-group study in T2 DM patients, on premix human insulin therapy ± oral anti-diabetics. Besides self-monitored plasma glucose, fasting and post-prandial plasma glucose (FPG and PPG) were tested at baseline, week 12, and week 24. Anti-insulin aspart antibodies measured immunogenicity at 12 and 24 weeks. Findings/Results: 160 patients out of 320 patients randomly received BGL-ASP and the remaining patients received NovoRapid®. The changes in glycated hemoglobin (HbA1c) from baseline to weeks 12 and 24 for the BGL-ASP group were -0.8 ± 0.83 and -0.8 ± 0.81, respectively, while for the NovoRapid®group was -0.8 ± 1.01 and -0.9 ± 0.89, respectively. Changes in FPG and PPG were comparable between the treatment groups after 12 weeks and 24 weeks. The incidence of detectable antibodies at baseline, weeks 12, and 24 were comparable between treatment groups. Eighteen (11.3%) patients in the BGL-ASP group and 23 (14.4%) in the NovoRapid®group reported adverse events. Conclusion and implications: BGL-ASP and NovoRapid®were comparable and equally effective in lowering HbA1c, FPG, and PPG levels, with similar immunogenicity and safety profiles.

Abstract Marek’s disease virus (MDV) integrates its genome into the telomeres of host chromosomes and causes fatal lymphomas in chickens. This integration is facilitated by telomeric repeat sequences (TMRs) at the ends of the viral genome, and is crucial for MDV-induced lymphomagenesis. The SB-1 vaccine virus is commonly used in commercial bivalent vaccines against MDV and also contains TMRs at its ends. Here, we demonstrate that SB-1 efficiently integrates its genome into the chromosomes of latently infected T cells. Deletion of the TMRs from the SB-1 genome did not affect virus replication, but severely impaired virus integration and genome maintenance in latently infected T cells and in chickens. Strikingly, the reduced integration and maintenance of latent SB-1 significantly impaired vaccine protection. Taken together, our data revealed that the TMRs facilitate SB-1 integration and that integration and/or maintenance of the latent viral genome is critical for vaccine protection.

Background: COVID-19 is a world pandemic with clinical manifestation from mild subclinical infection to severe illness. Literature suggests an evident correlation between the ABO blood group, Rhesus blood group, and COVID-19 in the recent past. The role of blood group in disease susceptibility and severity of COVID-19 varies in different geographical locations, as ABO blood group distribution varies among the human population with the impact of migration. Although various research have been done globally, scientific evidence with respect to the south Indian population remains limited, emphasizing the need for the present study to analyze the association of COVID-19 and blood groups in Tamil Nadu. Aim: The aim of this study was to analyze the potential susceptibility of COVID-19 among the blood groups (ABO and Rh type) in Tamil Nadu population. Materials and Methods: This was a noninterventional retrospective case–control study, with 500 patients who tested positive for COVID-19 being taken as the “cases,” while another 500 who tested negative were taken as the “controls.” The medical records, including the blood group and Rh factor, were collected from the government-recognized testing centers (Government Medical Hospital and Primary Health Centers, Tiruvallur, and Frontier Lifeline Hospital, Chennai) in Tamil Nadu, who came for COVID-19 screening by reverse transcriptase–polymerase chain reaction. The data were analyzed to associate its correlation with different blood groups. Results: Blood Group A showed significantly higher distribution among the cases (P = 0.030), and blood Groups O and B were significant among the controls (P = 0.026 and P = 0.000, respectively). Blood Group AB did not show any significant differences between the groups (P = 0.374). The odds ratio for AB, A, O, and B Groups for Rh (positive and negative) were shown to be 0.659, 0.591, 0.472, and 0.262, respectively, suggesting increased susceptibility toward Rh positive factor. Conclusion: In our study, blood Group A was found to be the most susceptible and blood Group O to be the least susceptible to COVID-19 in the Tamil Nadu population. In addition, the Rh positive factor showed more inclination toward COVID susceptibility than the Rh negative factor. ABO blood group may be considered a potential nonmodifiable and secondary risk factor for COVID-19 contributing to the disease pathobiology at immunological, biochemical, and physiological levels. Still, the intensity of their role and their exact mechanism in its association requires further exploration to validate the current findings.

Abstract Objective To assess asymptomatic rates and severity of SARS‐CoV‐2 infection in people with epilepsy and their healthcare workers in a long‐term care facility which had implemented weekly surveillance testing between April 2020 and June 2022. Methods Questionnaires focused on objective and subjective COVID‐19 symptoms for people with epilepsy residing in and their healthcare workers at the Chalfont Centre for Epilepsy in June 2022. Demographic information, comorbidities, and seizure frequency were gathered from medical records. We also collected responses on objective and subjective COVID‐19 symptoms from healthcare workers who participated in a prospective study assessing the reaction to COVID‐19 vaccinations (SAFER). Results Fifty‐five out of 89 (62%) residents tested positive at least once on weekly PCR testing for SARS‐CoV‐2 during the period of interest; 20 of those (37%) were asymptomatic. In comparison, of those 63 healthcare workers who tested positive at least once on weekly testing during the same period, only four (6%) were asymptomatic. Of the 159 healthcare workers who also participated in the SAFER study, 41 tested positive at least once, and seven (17%) were completely asymptomatic during infection with SARS‐CoV‐2. Significance People with epilepsy living in a long‐term care facility were more likely to present with asymptomatic SARS‐CoV‐2 infections than healthcare workers at the same facility. Despite possible bias in the reporting of subjective symptoms due to management‐by‐proxy, there is no evidence that vulnerable people living in an epilepsy long‐term care facility showed reduced resilience towards infections. Plain Language Summary People with epilepsy living in care home facilities had a surprisingly high degree of asymptomatic infections with SARS‐CoV‐2. Very few residents had severe or fatal outcomes. This is in stark contrast to the widely reported bad outcomes for people without epilepsy in other care homes. People with epilepsy reported significantly less symptoms than their healthcare workers. No changes in seizure frequency during or after infection were observed.

Pod borer [Helicoverpa armigera (Hubner)] is a major biotic constraint to global pigeonpea production. The farmers largely apply synthetic insecticides to control this pest in pigeonpea. The study was conducted to quantify yield losses and estimate economic thresholds for H. armigera. The late maturing cultivar, IPA-203 was infested with different larval densities to determine the insect density-yield loss relationships. The yield response was variable and grain yield declined with increasing larval density from 1–5/plant. Yield loss of 4.56 kg/ha was evident for each unit increase in larval population. Economic threshold estimates indicated that the control measures for pod borer in IPA 203 cultivar should be initiated at an insect density of ≈1 larva/2 plants or at 3% pod damage to avoid the economic crop losses. The damage potential and economic threshold estimates are prerequisite for integrated pest management and reducing production costs (Alves et al. 2017). Present results indicated that relatively low infestations of H. armigera can cause significant yield reduction in pigeonpea hence intensive monitoring and timely control measures are necessary. Based on present economic threshold estimates, the farmers could decide the timing and kind of control measures to be initiated against pod borer in late pigeonpea cultivars to avert the economic losses.

Abstract Biosimilar insulin analogues are increasing market access for diabetic patients globally. Scientific establishment of biosimilarity is cornerstone of this key change in the medical landscape. BGL-ASP is a biosimilar insulin aspart developed by BioGenomics Limited, India. BioGenomics has considered a stepwise approach in generating the totality of evidence required to establish similarity with reference product. Insulin aspart is a recombinant rapid-acting human insulin analogue utilised in the treatment of type-1 and type-2 diabetes mellitus. The single amino acid substitution at position B28 where proline is replaced with aspartic acid results in a decreased propensity to form hexamers, thus increasing the absorption rate on subcutaneous administration compared to native insulin. In order to establish the safety and efficacy of BGL-ASP, the critical quality attributes (CQAs) of BGL-ASP are identified based on the impact created on biological activity, pharmacokinetic/pharmacodynamic (PK/PD), immunogenicity and safety. The CQAs of insulin aspart are related to product structure, purity and functionality and are characterised using a series of state-of-the-art orthogonal analytical tools. The primary protein sequence, the secondary, tertiary and quaternary structure are found to be highly similar for BGL-ASP and reference product. The product related impurities of insulin aspart and the assay content are determined using high performance liquid chromatography (HPLC) based analysis and is similar for BGL-ASP and reference insulin aspart sourced from United States of America (US), Europe Union (EU) and India. The safety, efficacy and immunogenicity of BGL-ASP is also found to be comparable with reference product and is confirmed through the clinical trials conducted as recommended by International Council for Harmonisation of Technical Requirements of Pharmaceuticals for Human Use (ICH) and European Medicines Agency (EMA) guidelines. The data encompassed in this study demonstrates that reference insulin aspart and BGL-ASP are highly similar in terms of structural, physicochemical, and biological properties, thus confirming its safety and efficacy for usage as potential alternative economical medicinal treatment for diabetes mellitus.

Abstract Objective The aim of this study was to describe the epilepsy phenotype in a large international cohort of patients with KBG syndrome and to study a possible genotype–phenotype correlation. Methods We collected data on patients with ANKRD11 variants by contacting University Medical Centers in the Netherlands, an international network of collaborating clinicians, and study groups who previously published about KBG syndrome. All patients with a likely pathogenic or pathogenic ANKRD11 variant were included in our patient cohort and categorized into an “epilepsy group” or “non‐epilepsy group”. Additionally, we included previously reported patients with (likely) pathogenic ANKRD11 variants and epilepsy from the literature. Results We included 75 patients with KBG syndrome of whom 26 had epilepsy. Those with epilepsy more often had moderate to severe intellectual disability (42.3% vs 9.1%, RR 4.6 [95% CI 1.7–13.1]). Seizure onset in patients with KBG syndrome occurred at a median age of 4 years (range 12 months – 20 years), and the majority had generalized onset seizures (57.7%) with tonic–clonic seizures being most common (23.1%). The epilepsy type was mostly classified as generalized (42.9%) or combined generalized and focal (42.9%), not fulfilling the criteria of an electroclinical syndrome diagnosis. Half of the epilepsy patients (50.0%) were seizure free on anti‐seizure medication (ASM) for at least 1 year at the time of last assessment, but 26.9% of patients had drug‐resistant epilepsy (failure of ≥2 ASM). No genotype–phenotype correlation could be identified for the presence of epilepsy or epilepsy characteristics. Significance Epilepsy in KBG syndrome most often presents as a generalized or combined focal and generalized type. No distinctive epilepsy syndrome could be identified. Patients with KBG syndrome and epilepsy had a significantly poorer neurodevelopmental outcome compared with those without epilepsy. Clinicians should consider KBG syndrome as a causal etiology of epilepsy and be aware of the poorer neurodevelopmental outcome in individuals with epilepsy.

Background: Fine needle aspiration cytology (FNAC) is very useful for the pre-operative diagnosis of breast cancer. The efficacy of FNAC to determine the prognosis in breast carcinomas has to be explored. Aims: The present study is designed to determine the prognostic role of FNAC by correlation of the cytological features of Invasive Ductal carcinoma of Breast (IDC) with the axillary lymph nodal metastasis, which is a known prognostic marker. Materials and Methods: A total of 68 cases of IDC of breast diagnosed on FNAC with subsequent modified radical mastectomy in our hospital were included in the study group. Both FNAC and histopathology slides were retrieved for all the cases. The FNAC smears were assigned cytological grades according to Robinson's grading system. The histopathological sections of axillary lymph nodes were assessed for metastasis. Correlation was done between cytological grade and lymph nodal metastasis. Results: Cytological grading of IDC and axillary lymph nodal metastasis showed a statistically significant correlation (P

Background: To standardize the reporting pattern across various institutions, recently the international system for reporting serous fluid cytology (ISRSFC) was introduced. The objective of the present study was to classify serous fluids into various categories as per the ISRSFC, derive the risk of malignancy for each category and determine the diagnostic efficacy of fluid cytology when ISRSFC was applied. Methodology: Cross-sectional study involving 235 cases of serous effusion over a duration of two years. All the cases were reclassified as per ISRSFC into five categories. Descriptive statistics was derived. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was determined in 74 cases wherein final diagnosis was confirmed by clinical findings, radiology, or cell block. Results: Out of total 235 cases of fluid examined, distribution of cases in the diagnostic categories were as follows, 11 (4.6%) in nondiagnostic (ND), 208 (88.51%) in negative for malignancy (NFM), 5 (2.12%) in atypia of undetermined significance (AUS), 2 (0.85%) in suspicious for malignancy (SFM) and 9(3.82%) in malignant (MAL)category. Out of 208 cases of NFM, mesothelial cells were seen in only 8 (3.8%) cases. The risk of malignancy was 0% each in ND and NFM, 40% in AUS, 100% each in SFM and MAL. Sensitivity and specificity of fluid cytology was 100% and 96.6% respectively while PPV and NPV was 81.81% and 100 % respectively. Conclusion: ISRSFC is easy to apply and has high diagnostic efficacy. Most of the serous effusions fall in negative for malignancy category. Mesothelial cells are not important for specimen adequacy.

Background: Functional lymphatics at the peritumoral site is mainly responsible for lymphovascular invasion (LVI) in breast cancer. Marginal adipose tissue invasion (ATI) leads to larger area of contact between peritumoral lymphatics and may increase chances of LVI. Objectives: To investigate whether ATI of cancer cells at the tumour margin influenced lymph node status and prognosis in patients with invasive ductal carcinoma of the breast. Materials and methods: Cross sectional study involving 33 cases of invasive ductal carcinoma diagnosed over a duration of three years. Clinicopathologic prognostic parameters in 33 cases with marginal ATI was were compared 10 patients without ATI. The value of the combination of ATI and peritumoral lymphatic vessel invasion (LVI) was also assessed. Chi square was applied to assess the statistical significance at p

With an emphasis on classifying diseases of sugarcane leaves, this research suggests an attention-based multilevel deep learning architecture for reliably classifying plant diseases. The suggested architecture comprises spatial and channel attention for saliency detection and blends features from lower to higher levels. On a self-created database, the model outperformed cutting-edge models like VGG19, ResNet50, XceptionNet, and EfficientNet_B7 with an accuracy of 86.53%. The findings show how essential all-level characteristics are for categorizing images and how they can improve efficiency even with tiny databases. The suggested architecture has the potential to support the early detection and diagnosis of plant diseases, enabling fast crop damage mitigation. Additionally, the implementation of the proposed AMRCNN model in the Android phone-based application gives an opportunity for the widespread use of mobile phones in the classification of sugarcane diseases.

Problem considered: Cervical cancer is a major public health problem among women worldwide and it is the second most common cancer among women in India. The present study was conducted to assess awareness, attitudes, and practices towards cervical cancer and its prevention among rural women in southern India. Methods: This community-based study was carried out from January to December 2017 among 1100 married women aged 20–65 years residing in southern Karnataka, India. A household survey was undertaken, and eligible women were interviewed using a pre-designed questionnaire. The socio-demographic details of the women and their awareness, attitude, and practices towards cervical cancer prevention and screening were documented. The association of women's knowledge adequacy with their socio-demographic factors was evaluated and is expressed as odds ratios with 95% confidence intervals. Results: About 67% of the participants had heard the term “cervical cancer” earlier and 47.9% of them were aware that cervical cancer is preventable. Poor genital hygiene (41.4%) and early age at sexual intercourse (35.4%) were the commonly quoted risk factors for cervical cancer. Only 35.7% of participants had adequate awareness regarding cervical cancer screening and it was significantly associated with their age, education level, employment, and socio-economic status. The majority (99%) of women had a favorable attitude toward cervical cancer screening though it failed to translate into practices. Conclusions: Despite a favorable attitude, awareness and practice towards cervical cancer prevention were suboptimal. Periodic awareness programs and ensuring access to cervical cancer screening are crucial in this context.

Fetus in fetu is a rare congenital anomaly with fewer than 200 cases reported worldwide. It is a part of spectrum of anomalous embryogenesis. We report a case of an 18-month old boy with abdominal distension. Ultrasonography, X-ray, and computed tomography (CT) scan revealed a retroperitoneal mass suggestive of fetus in fetu. with evidence of organogenesis and a vertebral column, which differentiates it from an organized teratoma. The mass was resected in toto.

Orbital Apex Syndrome (OAS) is a spectrum of Orbital Apex Disorder (OAD) in which progressive vision loss occurs due to the involvement of oculomotor nerve at the orbital apex, resulting in optic neuropathy and ophthalmoplegia. Generally patients represents with the associated symptoms related to the structures involved, specifically the orbital fissure, orbital appex or cavernous sinus, collectively known as OAD. The present study reports a case of in 38-year-old female patient, detected to have carcinoma bronchus on further evaluation. The patient presented with bilateral progressive blurring of vision, diplopia, and headache. The Magnetic Resonance Imaging (MRI) brain and orbits revealed thickening of the intracanalicular portion of the right optic nerve, thickening of the intracranial portion of bilateral bilateral optic nerves, a soft tissue intensity lesion at the planum sphenoidale, pituitary gland with out a bright spot, nodular thickening of infundibulum, and thickening of the bilateral cavernous sinus showing near homogeneous postcontrast enhancement. A Chest X-ray (CXR) followed by High Resolution Computed Tomography (HRCT) thorax confirmed a soft tissue density mass lesion with spiculated margins in the posterior segment of the right upper lobe, along with an abrupt termination of the posterior segmental bronchus. Fibreoptic bronchoscopy revealed narrowing of the right upper lobe segmental bronchus. Bronchial lavage fluid revealed features of adenocarcinoma. A whole-body Positron Emission Tomography (PET) scan performed elsewhere showed a welldefined hypermetabolic, heterogeneously enhancing soft tissue in the posterior segment of the right upper lobe and at the right orbital apex. Tissue diagnosis could not be confirmed as the patient’s health deteriorated. The MRI brain and orbits with contrast is the most important modality in evaluating OAD. The OAS is rarely reported as the first symptom of an occult lung carcinoma.

BackgroundIn alignment with the Measles and Rubella (MR) Strategic Elimination plan, India conducted a mass measles and rubella vaccination campaign across the country between 2017 and 2020 to provide a dose of MR containing vaccine to all children aged 9 months to 15 years. We estimated campaign vaccination coverage in five districts in India and assessed campaign awareness and factors associated with vaccination during the campaign to better understand reasons for not receiving the dose.Methods and findingsCommunity-based cross-sectional serosurveys were conducted in five districts of India among children aged 9 months to 15 years after the vaccination campaign. Campaign coverage was estimated based on home-based immunization record or caregiver recall. Campaign coverage was stratified by child- and household-level risk factors and descriptive analyses were performed to assess reasons for not receiving the campaign dose. Three thousand three hundred and fifty-seven children aged 9 months to 15 years at the time of the campaign were enrolled. Campaign coverage among children aged 9 months to 5 years documented or by recall ranged from 74.2% in Kanpur Nagar District to 90.4% in Dibrugarh District, Assam. Similar coverage was observed for older children. Caregiver awareness of the campaign varied from 88.3% in Hoshiarpur District, Punjab to 97.6% in Dibrugarh District, Assam, although 8% of children whose caregivers were aware of the campaign were not vaccinated during the campaign. Failure to receive the campaign dose was associated with urban settings, low maternal education, and lack of school attendance although the associations varied by district.ConclusionAwareness of the MR vaccination campaign was high; however, campaign coverage varied by district and did not reach the elimination target of 95% coverage in any of the districts studied. Areas with lower coverage among younger children must be prioritized by strengthening the routine immunization programme and implementing strategies to identify and reach under-vaccinated children.

Objectives This article assesses the treatment outcomes in the patients diagnosed with arteriovenous malformations (AVMs) treated with stereotactic radiosurgery. Materials and Methods We retrospectively analyzed 30 patients diagnosed with AVM treated between 2010 and 2018.The median age at presentation was 30 years (range: 14–60 years). The median planning target volume (PTV) was 6.8 mL (range: 0.9–54 mL). The median dose prescribed was 18 Gy (range: 16–24 Gy). Modified radiosurgery-based AVM grading score was calculated for all the patients. Results The median follow-up of the entire cohort was 60 months (range: 24–96 months). The obliteration rates for patients followed up for 3 and 5 years were 75 and 86.1%, respectively. Age (< 35 years; p = 0.007) and PTV (< 7 mL; p = 0.04), had better obliteration rates. Three patients had hemorrhage, from the AVM after irradiation. None of them were fatal. Conclusion Stereotactic radiosurgery is a preferred noninvasive treatment modality with acceptable morbidity.

Summary: A lack of diversity in genomics for health continues to hinder equitable leadership and access to precision medicine approaches for underrepresented populations. To avoid perpetuating biases within the genomics workforce and genomic data collection practices, equity, diversity, and inclusion (EDI) must be addressed. This paper documents the journey taken by the Global Alliance for Genomics and Health (a genomics-based standard-setting and policy-framing organization) to create a more equitable, diverse, and inclusive environment for its standards and members. Initial steps include the creation of two groups: the Equity, Diversity, and Inclusion Advisory Group and the Regulatory and Ethics Diversity Group. Following a framework that we call “Reflected in our Teams, Reflected in our Standards,” both groups address EDI at different stages in their policy development process.

BackgroundThe anti-seizure medication vigabatrin (VGB) is effective for controlling seizures, especially infantile spasms. However, use is limited by VGB-associated visual field loss (VAVFL). The mechanisms by which VGB causes VAVFL remains unknown. Average peripapillary retinal nerve fibre layer (ppRNFL) thickness correlates with the degree of visual field loss (measured by mean radial degrees). Duration of VGB exposure, maximum daily VGB dose, and male sex are associated with ppRNFL thinning. Here we test the hypothesis that common genetic variation is a predictor of ppRNFL thinning in VGB exposed individuals. Identifying pharmacogenomic predictors of ppRNFL thinning in VGB exposed individuals could potentially enable safe prescribing of VGB and broader use of a highly effective drug.MethodsOptical coherence topography (OCT) and GWAS data were processed from VGB-exposed individuals (n = 71) recruited through the EpiPGX Consortium. We conducted quantitative GWAS analyses for the following OCT measurements: (1) average ppRNFL, (2) inferior quadrant, (3) nasal quadrant, (4) superior quadrant, (5) temporal quadrant, (6) inferior nasal sector, (7) nasal inferior sector, (8) superior nasal sector, and (9) nasal superior sector. Using the summary statistics from the GWAS analyses we conducted gene-based testing using VEGAS2. We conducted nine different PRS analyses using the OCT measurements. To determine if VGB-exposed individuals were predisposed to having a thinner RNFL, we calculated their polygenic burden for retinal thickness. PRS alleles for retinal thickness were calculated using published summary statistics from a large-scale GWAS of inner retinal morphology using the OCT images of UK Biobank participants.ResultsThe GWAS analyses did not identify a significant association after correction for multiple testing. Similarly, the gene-based and PRS analyses did not reveal a significant association that survived multiple testing.ConclusionWe set out to identify common genetic predictors for VGB induced ppRNFL thinning. Results suggest that large-effect common genetic predictors are unlikely to exist for ppRNFL thinning (as a marker of VAVFL). Sample size was a limitation of this study. However, further recruitment is a challenge as VGB is rarely used today because of this adverse reaction. Rare variants may be predictors of this adverse drug reaction and were not studied here.

Objectives: Pentraxin 3 (PTX3) is a biomarker, associated with the pathogenesis of Periodontitis and coronary artery disease (CAD) individually, but their role in patients with both diseases remains unclear. The current study aims to evaluate the association of PTX in patients with concomitant periodontitis and CAD. Materials and Methods: In a case–control study, 240 participants were selected and divided into four groups. Nonperiodontitis + noncardiac = 60 patients, periodontitis + noncardiac (P + NC) = 60 patients, nonperiodontitis + cardiac (NP + C) = 60 patients, periodontitis + cardiac (P + C) = 60 patients. Demographic variables, cardiac and periodontal parameters were recorded. PTX was evaluated in the subgingival plaque and atheromatous plaque samples using real-time quantitative polymerase chain reaction and compared between the groups. The results were statistically analyzed. Results: Among the demographic variables, age showed a significant difference between the groups. Systolic and diastolic blood pressure, low-density lipoprotein, and random blood sugar were significantly higher in NP + C and P + C groups (P ≤ 0.05). The plaque index, probing pocket depth, and clinical attachment loss were significantly higher in P + NC and P + C groups (P ≤ 0.05). PTX was significantly elevated in P + C group (P = 0.000). Pearson's correlation revealed a significant correlation between the periodontal parameters and PTX in both the cardiac and oral samples. Conclusion: PTX3 levels were elevated in CAD patients with periodontitis suggesting the influence of periodontal inflammation in the progression of CAD. PTX3 may serve as a diagnostic and prognostic tool for both periodontitis and CAD. This study could provide an understanding and awareness about the potential role of PTX3 in both periodontitis and CAD.

Abstract Sanjay M. Desai Objectives Epithelial ovarian cancer (EOC) is a heterogeneous, essentially peritoneal disease. Standard treatment consists of staging, cytoreductive surgery (CRS), and adjuvant chemotherapy. In this study, we intended to assess the effectiveness of single-dose intraperitoneal (IP) chemotherapy in optimally debulked advanced EOC patients. Materials and Methods A prospective randomized study of 87 patients with advanced EOC was done from January 2017 to May 2021 in a tertiary care center. Patients who underwent primary and interval cytoreduction received a single dose of IP chemotherapy for 24 hours after being divided into four groups: group A, IP cisplatin; group B, IP paclitaxel; group C, IP paclitaxel and cisplatin; and group D, saline. Pre- and postperitoneal IP cytology was assessed along with possible complications. Statistical Analysis Logistic regression analysis was used to assess for intergroup significance in cytology and complications. Kaplan–Meir analysis was done to assess disease-free survival (DFS). Results Of 87 patients, 17.2% of patients had FIGO stage IIIA, 47.2% had IIIB, and 35.6% had IIIC. Also, 22 (25.3%) patients were in group A (cisplatin), 22 (25.3%) patients in group B (paclitaxel), 23 (26.4%) in group C (cisplatin and paclitaxel), and 20 (23%) in group D (saline). Cytology samples taken during staging laparotomy were positive, and 48 hours post-IP chemotherapy, 2 (9%) of 22 samples in cisplatin group and 14 (70%) of 20 samples in saline group were positive; all of the post-IP samples in groups B and C were negative. No major morbidity was noted. In our study, DFS in saline group was 15 months, while in IP chemotherapy group it was 28 months and was statistically significant based log-rank test. However, there was no significant difference in DFS between different IP chemotherapy groups. Conclusion Complete or optimal CRS in advanced EOC does have a possibility of microscopic peritoneal residue. Adjuvant locoregional strategies should be considered to prolong DFS. Single-dose normothermic IP chemotherapy can be offered to the patients with minimal morbidity, and its prognostic benefits are comparable to hyperthermic IP chemotherapy. Future clinical trials are required to validate these protocols.

Bio-composites have lately established wide applicability in various industrial sectors such as automobile, construction, packaging, and coatings. Due to their global abundance, natural fibers and starch have been one of the most tested raw materials to be utilized as bio-composite reinforcements. This investigation aims to fabricate corn starch (CS) reinforced vetiver cellulose fibers (VCF) composites using the solution casting method. For the VCF reinforcement, alpha (α)-cellulose was synthesized from the vetiver roots and post-converted into nano-cellulose using the ball milling technique. Various compositions comprising 0, 5, 10, 15, and 20% (by weight) of this α-cellulose were inserted as reinforcement to commercially available CS matrix. The fabricated composite specimens were put to tensile, water absorption capacity, Fourier-transform infrared spectroscopy, and contact angle determination tests to evaluate the film properties. Crystallinity and failure morphology analysis of the composites was captured using the X-Ray Diffraction and scanning electron microscopy techniques, respectively. Results reveal that the incorporation of VCF in the CS matrix domain enhances the mechanical properties of bio-composites. Furthermore, the water absorption capacity decreased, and the contact angle increased; thereby predicting the composite’s potential application as a lightweight food packaging material.

Background: The spread of COVID-19 infection paved way to many admissions into hospitals worldwide exhausting the healthcare systems. A simple test for immediate stratification of risk in patients with infection by COVID 19 virus is important. Aim in this study was to know the prognostic value of neutrophil to lymphocyte ratio (NLR) in determination of the severity of infection in COVID-19 infected patients. Methods: This study was conducted in a tertiary care institute, Mandya. Clearance from Institutional Ethical committee was taken. Data from 108 COVID-19 infected hospitalized patients between April 2021 and June 2021 were collected retrospectively from hospital records. Patients in the study were grouped into two groups as Intensive Care Unit (ICU) and Ward (Non ICU) patients, based on admission into ICU. The patient’s demographic characteristics, comorbidities, clinical manifestations, medications used and investigations done initially during admission were noted from the hospital files for both groups. Chi-square test/ Fisher's exact test was used for comparison of categorical outcomes. Statistical significance was noted if P value < 0.05. Results: Of 108 patients, 25 patients (23.15%) had ICU admission. Patients aged >55years had more ICU admission (44%) than non-ICU admissions (22.89%). In patients

This article presents a study on the tensile properties of knitted fabrics commonly employed in polymeric matrix textile composites. The key mechanical parameters investigated include stress (Pa), strain, Young's modulus (Pa), and work of rupture (J). The knitted fabrics were developed using the Cixing Knitting System software and subsequently manufactured using a double jersey (electronic) flat knitting machine. The primary objective of this research was to explore the impact of various factors on the mechanical behavior of these knitted fabrics. The factors studied were wale and course directions, float stitch density, loop length (cm), and the type of synthetic knitting yarns used (100% polyester and 100% polyamide) along with different combinations of knitting yarns (100% cotton and 67% polyester/33% cotton hybrid). The adopted ASTM D 5034 standard, Response Surface Methodology (RSM), and Analysis of Variance (ANOVA) were employed to evaluate the mechanical performance of these fabric structures. The findings of the study revealed that the statistical adjustment of the data set for stress, strain, Young's modulus, and work of rupture in knitted fabric structures significantly reduced the standard deviations for mechanical responses. This information holds particular significance as it pertains to the frequent use of these knitted fabric structures as reinforcement in textile-reinforced composite materials. Overall, this study sheds light on the mechanical behavior in structures of knitted fabrics used in polymeric matrix composites, providing valuable insights for the design and optimization of advanced textile-based materials.

Deep learning practices in the agriculture sector can address many challenges faced by the farmers such as disease detection, yield estimation, soil profile estimation, etc. In this paper, disease classification for the sugarcane plant and the experimentation involved thereby is thoroughly discussed. Experimental results include the performances of the well-known existing transfer learning techniques and proposed ensemble deep learning based architecture that incorporates stack ensemble of two networks with one having level-wise spatial attention helping to provide better generalization. A Self-created database of sugarcane leaf diseases is introduced to the research community through this paper. It involves 5 categories with a total of 2569 images. Here, it is observed that best performing transfer learning method, MobileNet-V2 shows an accuracy of around 84% with the lowest number of parameters whereas ensemble model reaching to 86.53% with less epochs and with acceptable number of parameters.

Changes to structural and functional connectivity can give rise to neurodegeneration and neurodevelopmental diseases. Here the authors investigate molecular and connectomic patterns in 13 different neurological, psychiatric and neurodevelopmental diseases from the ENIGMA consortium.

Epilepsy is a brain network disorder with associated genetic risk factors. Here, the authors show that spatial patterns of transcriptomic vulnerability co-vary with structural brain network alterations in focal and generalized epilepsy.

Context: The lesions of nasal cavity and paranasal sinuses provides problem in their diagnosis, prognosis and management because of limited anatomical space and certain unusual clinicopathological features. Aims: The present study was undertaken to study the incidence & frequency of various non-neoplastic and neoplastic lesions. It also aimed to describe the histomorphologic features of lesions of nasal cavity and paranasal sinuses. Settings and Design: This is a simple retrospective observational study. Methods and Materials: The material for present study was obtained as excisional biopsy of the lesions. The specimens were received in 10% formalin along with requisition form which also included the clinical data. The material was processed as routine histopathological examination. Special stains were done wherever required. Results: Total 62 cases were analyzed. The lesions were classified as non-neoplastic and neoplastic. The non-neoplastic lesions were classified according to classification given by Friedman and Osborn. Tumors of nasal cavity and paranasal sinus were classified according to WHO classification and observations compared with other studies. Conclusions: Non-neoplastic lesions were more common than neoplastic lesions. Sinonasal polyps were the most common lesions in the present study (50%). The age incidence ranges from 1st decade to 7th decade. There was slight female preponderance. The incidence of malignant tumours was slightly more than the benign tumours. Thus categorizing the sinonasal lesions according to histopathological features into various types helps clinicians to know the clinical presentation, the best management, clinical outcome and prognosis of the disease. Keywords: Histopathology, Nasal, paranasal, Sinonasal, Polyp, WHO

Purpose: Breast fine needle aspiration cytology (FNAC) has a long history of providing accurate, rapid and cost-effective diagnosis of palpable breast lesions. Recently, International Academy of Cytology (IAC) at Yokohama proposed a new reporting system for breast cytology, in order to bring uniformity across the globe. Any new classification system needs to be validated for its practical applicability. Objectives: This study was conducted to categorize the breast lesions as per this classification and further determine the diagnostic efficacy and risk of malignancy in each category. Material and Methods: This was a cross sectional observational analytical study. All the cases presenting to cytology OPD from January 2020 up to December 2022, (N=296) with breast lesions for FNAC were included in the study. All the cases were divided into five categories as per the newly proposed IAC Yokohama reporting system. The risk of malignancy for each category was determined and diagnostic efficacy was evaluated. Results: The sample were distributed as follows: insufficient material 4.39%, benign 66.21%, atypical 10.47%, suspicious for malignancy 1.35% and malignancy 17.56%. Histopathology was obtained in 88 cases, out of which 82 (93.18%) showed concordant diagnosis. The sensitivity and specificity were 85.71% and 98.11% respectively. Risk of malignancy (ROM) in each category was as follows-benign (0.01%), atypia (71.4%), suspicious (100%) and malignancy (96.66%) respectively. Conclusion: The high efficacy of FNAC obtained in the present study, when IAC Yokohama reporting system was applied, confirms the usefulness of this scheme in reporting breast lesions. A risk-based stratification is essential in the present era to guide and alert the clinician about the subsequent management plan and the ROM.

Vascular complications in acute pancreatitis are common and seen in 25% of cases. While it is common to have venous thrombosis in the Superior Mesenteric Vein (SMV), portal vein, and splenic vein, thrombosis of extra-splanchnic vessels such as Inferior Vena Cava (IVC) and left renal vein due to acute pancreatitis is a rare entity, with more adverse outcomes. A 48-year-old male presented with severe epigastric pain, vomiting, and constipation for seven days. Outside Ultrasonography (USG) report was suggestive of acute pancreatitis. His serum amylase, serum lipase, and D-dimer levels were raised. Computed Tomography (CT) of abdomen and pelvis revealed acute necrotising pancreatitis with peripancreatic fluid collection and thrombosis of splenic vein, left renal vein, and IVC. Thrombosis in pancreatitis can occur due to pancreatic proteolytic enzymes which can cause intimal injury. An enlarged pancreas, walled-off necrosis, and pancreatic pseudocyst can compress veins, resulting in venous stasis. Pancreatitis has a systemic hypercoagulable or prothrombotic state. The patient was given symptomatic treatment along with an injection (inj.) of clexaine and monocef. He showed improvement in 10 days and was symptomatically well on follow-up. Early detection of these findings and targeted treatment for the same is crucial to prevent morbidity and mortality of such patients.

The most common congenital renal fusion anomaly is the horseshoe kidney (HSK) occurring in about 1 in 600–700 individuals in the Indian population. HSKs are associated with problems such as renal stones, obstruction of uretero-pelvic junction causing stasis, and infection due to ectopic location of the kidneys, malrotation of the kidneys, and vascular changes. In general, normally developed kidneys have more incidents of renal cell carcinoma (RCC) as compared to HSKs. The major issue arises during surgery of HSK due to their altered anatomy and aberrant blood supply. We present a case of HSK with RCC located in the isthmus of a 43-year-old woman.

Marek’s disease (MD) is a highly infectious lymphoproliferative disease in chickens with a significant economic impact. Mardivirus gallidalpha 2, also known as Marek’s disease virus (MDV), is the causative pathogen and has been categorized based on its virulence rank into four pathotypes: mild (m), virulent (v), very virulent (vv), and very virulent plus (vv+). A prior comparative genomics study suggested that several single-nucleotide polymorphisms (SNPs) and genes in the MDV genome are associated with virulence, including nonsynonymous (ns) SNPs in eight open reading frames (ORF): UL22, UL36, UL37, UL41, UL43, R-LORF8, R-LORF7, and ICP4. To validate the contribution of these nsSNPs to virulence, the vv+MDV strain 686 genome was modified by replacing nucleotides with those observed in the vMDV strains. Pathogenicity studies indicated that these substitutions reduced the MD incidence and increased the survival of challenged birds. Furthermore, using the best-fit pathotyping method to rank the virulence, the modified vv+MDV 686 viruses resulted in a pathotype similar to the vvMDV Md5 strain. Thus, these results support our hypothesis that SNPs in one or more of these ORFs are associated with virulence but, as a group, are not sufficient to result in a vMDV pathotype, suggesting that there are additional variants in the MDV genome associated with virulence, which is not surprising given this complex phenotype and our previous finding of additional variants and SNPs associated with virulence.

Radiation-induced (RI) changes such as radiation-induced cavernous malformations (RICMs) and radiation-induced cranial neuropathy (RICN) manifest as late delayed complications and can be seen on post-treatment imaging. Cavernous malformations (CMs) are vascular malformations that are made up of dilated, thin-walled capillary spaces without intervening brain parenchyma. Cranial nerve damage due to radiation exposure is a rare consequence of radiation therapy (RT). We present a case of intracerebral CMs/hemorrhagic vasculopathy and left seventh and eighth nerve complex cranial neuropathy 14 years following RT to the brain for tectal glioma.

Objective: To elucidate the effects of single and paired-pulse TMS on seizure activity at electrographic and clinical levels in people with and without epilepsy. Methods: A cohort of 35 people with epilepsy, two people with alternating hemiplegia of childhood (AHC) with no epilepsy, and 16 healthy individuals underwent single or paired-pulse TMS combined with EEG. Clinical records and subject interviews were used to examine seizure frequency four weeks before and after TMS. Results: There were no significant differences in seizure frequency in any subject after TMS exposure. There was no occurrence of seizures in healthy individuals, and no worsening of hemiplegic attacks in people with AHC. Conclusions: No significant changes in seizure activity were found before or after TMS. Significance: This study adds evidence on the safety of TMS in people with and without epilepsy with follow-up of four weeks after TMS.

Abstract We report new genetic diagnoses of Dravet syndrome in a group of adults with complex epilepsy of unknown cause, under follow‐up at a tertiary epilepsy center. Individuals with epilepsy and other features of unknown cause from our unit underwent whole‐genome sequencing through the 100 000 Genomes Project. Virtual gene panels were applied to frequency‐filtered variants based on phenotype summary. Of 1078 individuals recruited, 8 (0.74%) were identified to have a pathogenic or likely pathogenic variant in SCN1A. Variant types were as follows: nonsense (stopgain) in five (62.5%) and missense in three (37.5%). Detailed review of childhood history confirmed a phenotype compatible with Dravet syndrome. Median age at genetic diagnosis was 44.5 years (range 28‐52 years). Tonic‐clonic seizures were ongoing in all despite polytherapy including valproate. All had a history of fever sensitivity and myoclonic seizures, which were ongoing in two (25%) and three (37.5%) individuals, respectively. Salient features of Dravet syndrome may be less apparent in adulthood, making clinical diagnosis difficult. Regardless of age, benefits of a genetic diagnosis include access to syndrome‐specific treatment options, avoidance of harmful drugs, and monitoring for common complications.

Leptomeningeal disease (LMD) is a serious complication of metastatic solid tumors with a poor prognosis. Here, by using single-cell RNA sequencing of cerebrospinal fluid, the authors report genomic and immune correlates of response to immunotherapy in two cohorts of patients with LMD treated with immune checkpoint inhibitors.

Leiomyosarcoma (LMS) is a smooth muscle-derived malignant mesenchymal tumour. Primary LMS arising from the ovarian vein is uncommon. A 51-year-old female presented with left loin pain and was diagnosed with a LMS arising from the gonadal vein. The patient refused any treatment. Early detection and timely diagnosis of retroperitoneal masses will improve the prognosis and survival rate in these patients. CT imaging plays an important role in diagnosis. Contribution: Retroperitoneal leiomyosarcoma of vascular origin is a rare entity. CT plays crucial role in diagnosing them by demonstrating the extent of the tumor along the gonadal vein. Early detection and timely diagnosis of retroperitoneal masses will improve the prognosis and survival rate in these patients.

Dravet syndrome (DS) is a developmental and epileptic encephalopathy associated with variants in the voltage-gated sodium channel alpha 1 subunit (SCN1A) gene in around 90% of individuals. The core phenotype is well-recognized, and is characterized by seizure onset in infancy, typically with prolonged febrile seizures, followed by the emergence of multiple seizure types that are frequently drug-resistant, developmental delay, and intellectual disability. Comorbidities are common and include autism spectrum disorder, gait impairment, scoliosis, and sleep disorder. Feeding difficulties and weight loss are frequently reported by DS caregivers, and negatively impact quality of life, yet have received little attention. Here we report an adult with DS who developed reduced food and fluid intake in adolescence, resulting in weight loss and malnutrition. No underlying cause for her feeding difficulties was identified, and she subsequently required insertion of a percutaneous endoscopic gastrostomy. We review the occurrence of feeding difficulties in people with DS and discuss potential mechanisms.

Abstract Objective Resistance to antiseizure medications (ASMs) is one of the major concerns in the treatment of epilepsy. Despite the increasing number of ASMs available, the proportion of individuals with drug‐resistant epilepsy remains unchanged. In this study, we aimed to investigate the role of rare genetic variants in ASM resistance. Methods We performed exome sequencing of 1,128 individuals with non‐familial non‐acquired focal epilepsy (NAFE) (762 non‐responders, 366 responders) and were provided with 1,734 healthy controls. We undertook replication in a cohort of 350 individuals with NAFE (165 non‐responders, 185 responders). We performed gene‐based and gene‐set‐based kernel association tests to investigate potential enrichment of rare variants in relation to drug response status and to risk for NAFE. Results We found no gene or gene set that reached genome‐wide significance. Yet, we identified several prospective candidate genes – among them DEPDC5, which showed a potential association with resistance to ASMs. We found some evidence for an enrichment of truncating variants in dominant familial NAFE genes in our cohort of non‐familial NAFE and in association with drug‐resistant NAFE. Interpretation Our study identifies potential candidate genes for ASM resistance. Our results corroborate the role of rare variants for non‐familial NAFE and imply their involvement in drug‐resistant epilepsy. Future large‐scale genetic research studies are needed to substantiate these findings.

Moyamoya Syndrome (MMS) is a progressive disease with typical angiographic ‘moyamoya’ alterations. Here, the authors discuss a case of 16-year-old male patient who developed MMS after being diagnosed with β-thalassaemia major. This patient was detected with heterozygous mutations in the β-globin gene and underwent splenectomy at the age of 12 years. Four years postsplenectomy he presented with paresis of the right upper limb. Magnetic Resonance Imaging (MRI) showed infarction and stenosis of the internal carotid artery with the collateral vessel’s formation. Recurrence of stroke and progression of the vasculopathy were seen. Till now, only a few cases of MMS have been linked to thalassaemia major.

Abstract Low-frequency 1q21.1 distal deletion and duplication copy number variant (CNV) carriers are predisposed to multiple neurodevelopmental disorders, including schizophrenia, autism and intellectual disability. Human carriers display a high prevalence of micro- and macrocephaly in deletion and duplication carriers, respectively. The underlying brain structural diversity remains largely unknown. We systematically called CNVs in 38 cohorts from the large-scale ENIGMA-CNV collaboration and the UK Biobank and identified 28 1q21.1 distal deletion and 22 duplication carriers and 37,088 non-carriers (48% male) derived from 15 distinct magnetic resonance imaging scanner sites. With standardized methods, we compared subcortical and cortical brain measures (all) and cognitive performance (UK Biobank only) between carrier groups also testing for mediation of brain structure on cognition. We identified positive dosage effects of copy number on intracranial volume (ICV) and total cortical surface area, with the largest effects in frontal and cingulate cortices, and negative dosage effects on caudate and hippocampal volumes. The carriers displayed distinct cognitive deficit profiles in cognitive tasks from the UK Biobank with intermediate decreases in duplication carriers and somewhat larger in deletion carriers—the latter potentially mediated by ICV or cortical surface area. These results shed light on pathobiological mechanisms of neurodevelopmental disorders, by demonstrating gene dose effect on specific brain structures and effect on cognitive function.

Abstract Background The alphabaculoviruses are lethal pathogens of lepidopteran caterpillars including a polyphagous and globally recognized pest, Helicoverpa armigera (Hubner) infesting economically important agriculture crops worldwide. The biological and molecular characterizations of indigenous nucleopolyhedrovirus of the genus Alphabaculovirus isolated from H. armigera in chickpea fields are described. Results The virulence of virus isolate was tested in 3rd instar H. armigera larvae, and LC50 (median lethal concentration) was estimated to be 2.69 × 104 OBs ml−1. The ST50 (median survival time) was 4 days post-inoculation, when the 3rd instar H. armigera larvae were inoculated by OB (occlusion body) concentration equivalent to LC90. An average incubation period of the virus isolate in 3rd instar ranged between 4 and 6 days post-inoculation. The OBs of a virus isolate appeared irregular in shape and variable in size with diameter ranging from 0.57 to 1.46 μm on the longest edge and average of 1.071 ± 0.068 μm (mean ± SE). On the basis of phylogenetic analysis of polh, pif-1, and lef-8 genes, the isolate was found to be a member of the genus Alphabaculovirus. The isolate showed a genetic affinity with species of group II Alphabaculoviruses and appeared to be a group II NPV. Conclusions On the basis of molecular phylogeny and associated host insect, this indigenous isolate was designated as HearNPV-IIPR05 isolate, which could be a potential candidate for the biological control of H. armigera infesting legumes and other commercial crops.

Objectives: The aim of this study was to evaluate outcomes, survival, patterns of recurrence, and morbidity in both early and recurrent operable cervical cancer patients following radical hysterectomy, pelvic lymph node dissection, and adjuvant radiotherapy. Materials and Methods: This was a prospective analysis of 55 patients of stage IA–IIA and recurrent operable cervical cancer treated with radical hysterectomy, pelvic lymphadenectomy, and adjuvant radiotherapy from 2014 to 2017. Overall survival (OS), disease-free survival (DFS), morbidity, and mortality rates were the end points of this study. Survival analysis was performed using the Kaplan–Meir method. Results: The median age of the study group was 45 years (range 18–68 years). The most common presentation was stage IB2 disease in 34.5% of patients. Fifty (90%) patients had squamous histology, whereas 5 (9.1%) had adenocarcinoma. Upfront radical hysterectomy was performed in 90.9% of patients, whereas 9.1% underwent surgery for recurrent cervical cancer. The most common indication for adjuvant radiotherapy was lymph node involvement, followed by parametrium involvement in 20% and 13% patients, respectively. Median follow-up period was 48 months (range 6–60 months). The OS and DFS rates were 85.0% and 81.8%, respectively. The most frequent complication encountered was paralytic ileus in 4 (7.2%) patients. Conclusion: Radical hysterectomy with pelvic lymphadenectomy for early cervical cancer has a favorable survival outcome with acceptable long-term morbidity.

Abstract Marek’s disease virus (MDV) encodes a basic-leucine zipper (BZIP) protein, Meq, which is considered the major MDV oncoprotein. It has been reported that the oncogenicity of Meq is associated with its interaction with C-terminal binding protein 1 (CtBP), which is also an interaction partner of Epstein-Barr virus encoded EBNA3A and EBNA3C oncoproteins. Since both EBNA3C and CtBP interact with histone deacetylase 1 (HDAC1) and HDAC2, we examined whether Meq shares this interaction with chicken HDAC1 (chHDAC1) and chHDAC2. Using confocal microscopy analysis, we show that Meq co-localizes with chHDAC1 and chHDAC2 in the nuclei of MDV lymphoblastoid tumor cells. In addition, immunoprecipitation assays demonstrate that Meq interacts with chHDAC1 and chHDAC2 in transfected cells and MDV lymphoblastoid tumor cells. Using deletion mutants, interaction domains were mapped to the N-terminal dimerization domain of chHDAC1 and chHDAC2, and the BZIP domain of Meq. Our results further demonstrate that this interaction mediates the degradation of chHDAC1 and chHDAC2 via the proteasome dependent pathway. In addition, our results show that Meq also induces the reduction of global ubiquitinated proteins through a proteasome dependent pathway. In conclusion, our results provide evidence that Meq interacts with chHDAC1 and chHDAC2, and induces their proteasome dependent degradation.

The microbiological assessment of the air in operating theatres is critical to control hospital-acquired infections. Regular surveillance is an important tool to evaluate the quality of air and find areas requiring intervention. In this context, the present study is undertaken to assess and compare the microbial contamination levels in operation theatre by active and passive methods. All the environmental surfaces and equipment of OTs and ICU at tertiary care hospital in Vijayapur, included in the study. This study used three sampling procedures: active, passive methods for air sampling, and swabing method for surfaces and equipment. Out of 15 OTs air sampling, the passive method showed more bacterial air contamination than the active method. Statistically, a significant difference was observed with the passive method compared to the active method with p-value of 0.0336 for both bacteria and fungus growth assessment. Out of total 90 swabs collected from all the OTs surfaces and instruments, Pseudomonas species (40%), Bacillus species (40%), Klebsiella species (20%) were the common species isolated. From the 50 swabs collected from in ICUs surfaces and instruments, culture positivity was 16% for pathogenic bacteria; Pseudomonas aeruginosa (62%), Klebsiella pneumonia (25%), and Escherichia coli (13%). The present study showed that the passive method is a better monitoring tool than the active method. So we recommend using passive air sampling method compared to active method, which is easy, cheap, and no instrument is needed for sampling the air.

Cholangiocarcinoma is a rare primary malignancy of the biliary tree, which usually presents late in the course of disease with jaundice, upper right quadrant pain, and cachexia. They frequently metastasise in the lungs, liver, bones, adrenals, peritoneum, and retroperitoneal lymph nodes. The incidence of cutaneous dissemination from cholangiocarcinoma is extremely rare, with the scalp being the commonest distant site of skin metastasis. The authors report the case of a 44-year-old female with Stage IV hilar cholangiocarcinoma, who presented primarily with tender facial swelling, prompting investigation and subsequent diagnosis. To the authors’ knowledge, this case is the first report of a cholangiocarcinoma presenting as facial metastasis. It highlights the need for early characterisation of cutaneous lesions, which are likely to be of neoplastic origin using histology, immunohistochemistry, and PET-CT scans, and reminds that biliary tree neoplasms are possible primary malignancies in cases of skin metastasis, especially in the head and neck region.

Introduction: India introduced a hepatitis-B (HB) vaccine in the Universal Immunization Program in 2002–2003 on a pilot basis, expanded to ten states in 2007–2008 (phase-1), and the entire country in 2011–2012 (phase-2). We tested sera from a nationally representative serosurvey conducted duing 2017, to estimate the seroprevalence of different markers of HB infection among children aged 5–17 years in India and to assess the impact of vaccination. Methods: We tested sera from 8273 children for different markers of HB infection and estimated weighted age-group specific seroprevalence of children who were chronically infected (HBsAg and anti-HBc positive), and immune due to past infection (anti-HBc positive and HBsAg negative), and having serological evidence of HB vaccination (only anti-HBs positive). We compared the prevalence of serological markers among children born before (aged 11–17 years) and after (aged 5-10 years) introduction of HB-vaccine from phase-1 states. Results: Among children aged 5–8 years, 1.1% were chronic carriers, 5.3% immune due to past infection, and 23.2% vaccinated. The corresponding proportions among children aged 9–17 years were 1.1%, 8.0%, and 12.0%, respectively. In phase-1 states, children aged 5–10 years had a significantly lower prevalence of anti-HBc (4.9% vs. 7.6%, p

Abstract Background From 2016, the Government of India introduced the oral rotavirus vaccine into the national immunization schedule. Currently, two indigenously developed vaccines (ROTAVAC, Bharat Biotech; ROTASIIL, Serum Institute of India) are included in the Indian immunization program. We report the rotavirus disease burden and the diversity of rotavirus genotypes from 2005 to 2016 in a multi-centric surveillance study before the introduction of vaccines. Methods A total of 29,561 stool samples collected from 2005 to 2016 (7 sites during 2005–2009, 3 sites from 2009 to 2012, and 28 sites during 2012–2016) were included in the analysis. Stools were tested for rotavirus antigen using enzyme immunoassay (EIA). Genotyping was performed on 65.8% of the EIA positive samples using reverse transcription- polymerase chain reaction (RT-PCR) to identify the G (VP7) and P (VP4) types. Multinomial logistic regression was used to quantify the odds of detecting genotypes across the surveillance period and in particular age groups. Results Of the 29,561 samples tested, 10,959 (37.1%) were positive for rotavirus. There was a peak in rotavirus positivity during December to February across all sites. Of the 7215 genotyped samples, G1P[8] (38.7%) was the most common, followed by G2P[4] (12.3%), G9P[4] (5.8%), G12P[6] (4.2%), G9P[8] (4%), and G12P[8] (2.4%). Globally, G9P[4] and G12P[6] are less common genotypes, although these genotypes have been reported from India and few other countries. There was a variation in the geographic and temporal distribution of genotypes, and the emergence or re-emergence of new genotypes such as G3P[8] was seen. Over the surveillance period, there was a decline in the proportion of G2P[4], and an increase in the proportion of G9P[4]. A higher proportion of mixed and partially typed/untyped samples was also seen more in the age group 0–11 months. Conclusions This 11 years surveillance highlights the high burden of severe rotavirus gastroenteritis in Indian children