Search

Abstract Nilgirianthus ciliatus, extensively exploited for its pharmacological properties, is now classified as vulnerable. In vitro micropropagation offers a sustainable approach for ecological conservation and rational utilization of this biodiversity resource. This study aimed to reduce endophytes during in vitro propagation and isolating antimicrobial-resistant endophytes from N. ciliatus by employing various concentrations and exposure times of Plant Preservative Mixture (PPM). Optimal results were observed when nodal explants treated with 0.3% PPM for 8 h, followed by inoculation in Murashige and Skoog (MS) medium supplemented with 3 mg/L 6-benzylaminopurine (BAP) and 0.3% PPM. This protocol achieved 82% shoot regeneration with minimal endophytic contamination, suggesting that the duration of explant exposure to PPM significantly influences endophyte reduction. Two antimicrobial-resistant endophytes were isolated and identified as Bacillus cereus and Acinetobacter pittii through 16S rDNA sequencing. These endophytes exhibited plant growth-promoting characteristics, including amylolytic, proteolytic, lipolytic activities, indole-3-acetic acid production, phosphate solubilization, and stress tolerance. In vivo application of these endophytes as bioinoculants to N. ciliatus not only improved growth parameters but also significantly increased the levels of pharmacologically important compounds, squalene, and stigmasterol, as confirmed by High-performance thin-layer chromatography (HPTLC). This study demonstrates that PPM is a promising alternative for sustainable micropropagation of N. ciliatus. Furthermore, it highlights the potential of antimicrobial-resistant endophytes as bioinoculants to improve growth and medicinal value, offering a sustainable solution for conservation and large-scale cultivation of this species.

The prevailing practices of geopolymer concrete (GC) preparation use a high concentration of alkali activators, which is uneconomical. It is imperative to develop GC of low-concentration activators with enhanced durability for field implementation. Mechanochemical activation of geopolymer increases the reactivity of its raw materials by converting the crystalline phase to an amorphous phase. It has been illustrated in the present study that mechanochemical activation aids in achieving GC of desired properties at low concentrations of alkali activators. The mechanochemical activation of ground granulated blast furnace slag (GGBS) with sodium metasilicate was carried out to prepare GC of low (2 M) and high (12 M) alkali concentrations. The Portland slag cement-based concrete (PC) was cast to compare the durability performance of GC. The durability of the three concrete mixes was examined in terms of water absorption, the volume of permeable voids (VPV), water and chloride permeability, homogeneity, and acid resistance. The microstructural characterization of concrete samples exposed to acid were carried out by X-ray diffraction, field emission scanning electron microscope, and energy dispersive X-ray spectrometer. The results indicated that GC with a low concentration of activator exhibited lesser water absorption, VPV, and permeability, whereas it offered higher resistance to acids and chloride ion penetrability. Low-concentration GC had a dense and compact structure due to the coexistence of geopolymeric and hydration products, leading to better performance than high-concentration GC and PC. The evaluation of cost and carbon emission of PC, and GC mixes suggests GC as a sustainable alternative to traditional concrete. Although PC is economically viable, the study suggest use of GC with low alkali concentration due to its environmental benefits with a minor increase in cost.

The onset of Non Syndromic Hearing Loss (NSHL) typically occurs without any other symptoms and can vary from person to person, even within the same family. Hearing loss can be unilateral or bilateral and can range from mild to profound degrees of hearing loss. Epidermodysplasia Verruciformis (EDV) is a dermatologic condition in which patients show reduced immunologic ability to defend and eradicate certain types of Human Papillomavirus (HPV), leading to persistent infection and an increased lifetime risk of developing cutaneous dysplasia and malignancy. Both conditions have a genetic background. However, their concurrent occurrence is very rare. Therefore, a case study is presented of a four-year-old female child who visited the dermatology outpatient department with a chief complaint of hearing loss and white-coloured lesions covering her arms, neck, back, and chest for the last two years. The hearing loss was gradual, not apparent at birth, and progressed slowly to complete hearing loss. A final diagnosis of EDV with Non Syndromic Sensorineural Hearing Loss (NSSNHL) was made based on clinical and histological examination.

Background Hospital electronic patient records (EPRs) offer the opportunity to exploit large-scale routinely acquired data at relatively low cost and without selection. EPRs provide considerably richer data, and in real-time, than retrospective administrative data sets in which clinical complexity is often poorly captured. With population ageing, a wide range of hospital specialties now manage older people with multimorbidity, frailty and associated poor outcomes. We, therefore, set-up the Oxford and Reading Cognitive Comorbidity, Frailty and Ageing Research Database-Electronic Patient Records (ORCHARD-EPR) to facilitate clinically meaningful research in older hospital patients, including algorithm development, and to aid medical decision-making, implementation of guidelines, and inform policy.Methods and analysis ORCHARD-EPR uses routinely acquired individual patient data on all patients aged ≥65 years with unplanned admission or Same Day Emergency Care unit attendance at four acute general hospitals serving a population of >800 000 (Oxfordshire, UK) with planned extension to the neighbouring Berkshire regional hospitals (>1 000 000). Data fields include diagnosis, comorbidities, nursing risk assessments, frailty, observations, illness acuity, laboratory tests and brain scan images. Importantly, ORCHARD-EPR contains the results from mandatory hospital-wide cognitive screening (≥70 years) comprising the 10-point Abbreviated-Mental-Test and dementia and delirium diagnosis (Confusion Assessment Method—CAM). Outcomes include length of stay, delayed transfers of care, discharge destination, readmissions and death. The rich multimodal data are further enhanced by linkage to secondary care electronic mental health records. Selection of appropriate subgroups or linkage to existing cohorts allows disease-specific studies. Over 200 000 patient episodes are included to date with data collection ongoing of which 129 248 are admissions with a length of stay ≥1 day in 64 641 unique patients.Ethics and dissemination ORCHARD-EPR is approved by the South Central Oxford C Research Ethics Committee (ref: 23/SC/0258). Results will be widely disseminated through peer-reviewed publications and presentations at conferences, and regional meetings to improve hospital data quality and clinical services.

Introduction: Acinetobacter spp. has emerged as an important hospital-acquired and opportunistic agent due to its survival capability in adverse conditions, saprophytic presence, and increasing resistance to antimicrobials. The irrational use of antibiotics, along with biofilm formation, plays an important role in producing Extensively Drug-resistant (XDR) and MultidrugResistant (MDR) Acinetobacter species, especially Acinetobacter calcoaceticus-baumannii complex (Acb complex), in the hospital environment, contributing to morbidity and mortality. Aim: To detect biofilm production among Acinetobacter species isolated from various clinical samples received from Intensive Care Units (ICUs) as well as their antibiotic sensitivity pattern. Materials and Methods: A cross-sectional study was conducted in the Microbiology Department at Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India from January 2022 to April 2023. Patients of all age groups and both genders were included in the study after obtaining informed consent. Clinical specimens, including endotracheal secretions, endotracheal tips, pus, urine, sputum, tissue, and other body fluids, were collected from ICUs where Acinetobacter spp. was detected. A total of 223 cases were included. The specimens were collected using clean, leak-proof, sterile containers with proper aseptic precautions. Antimicrobial susceptibility testing was performed according to the guidelines set by the Clinical and Laboratory Standards Institute (CLSI) in 2022 and identifies MDR and XDR strains. The biofilm production of isolates was determined using a quantitative adherence assay. The data generated was entered into Microsoft excel, and statistical analysis was conducted using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) statistical software version 28.0. The results were then presented as descriptive statistics. Results: Among the 223 Acinetobacter spp. isolates, 159 (71.3%) were identified as Acb complex (Acinetobacter calcoaceticusbaumannii complex), followed by A.lwofi with 39 (17.5%) isolates and A. haemolyticus with 16 (7.2%) isolates. Acinetobacter showed resistance, in descending order of frequency, to amoxicillin+clavulanic acid (211 isolates, 94.6%), ciprofloxacin (211 isolates, 94.6%), trimethoprim-sulfamethoxazole (208 isolates, 93.3%), cefotaxime (198 isolates, 88.8%), cefepime (187 isolates, 83.8%), gentamycin (178 isolates, 79.8%), amikacin (152 isolates, 68.2%), piperacillin-tazobactam (68 isolates, 30.5%), imipenem (72 isolates, 32.3%), meropenem (71 isolates, 31.8%), polymyxin B (12 isolates, 5.4%), and colistin (2 isolates, 0.9%). The maximum antibiotic resistance was observed in Acb complex, with 208 (93.3%) strains being MDR producers and 32 (14.3%) strains being XDR producers. Biofilm production was observed in 214 isolates (95.9%), with 127 (56.9%) exhibiting strong biofilm production 63 (28.2%) showing moderate biofilm production, and 24 (10.8%) showing weak biofilm production. All MDR strains were found to produce biofilm, and out of those, 127 (61.1%) exhibited strong biofilm production. Among the XDR strains, all 32 (100%) were found to produce strong biofilm. Conclusion: In conclusion, Acinetobacter spp. has a high propensity for developing MDR, and the formation of biofilms further aids the organism in surviving under strenuous conditions, making it difficult to treat. Therefore, regular surveillance of Hospital-acquired Infections (HAI), the prevention of misuse and overuse of antibiotics, prescribing antibiotics based on antibiogram patterns, formulating antibiotic policies, and implementing bundle care approaches for the prevention of HAI are crucial in preventing antibiotic resistance.

Lamotrigine (Ltg), an anticonvulsant drug, targets initiation factor 2 (IF2), compromises ribosome biogenesis and causes toxicity to Escherichia coli. However, our understanding of Ltg toxicity in E. coli remains unclear. While our in vitro assays reveal no effects of Ltg on the ribosome-dependent GTPase activity of IF2 or its role in initiation as measured by dipeptide formation in a fast kinetics assay, the in vivo experiments show that Ltg causes accumulation of the 17S precursor of 16S rRNA and leads to a decrease in polysome levels in E. coli. IF2 overexpression in E. coli increases Ltg toxicity. However, the overexpression of initiator tRNA (i-tRNA) protects it from the Ltg toxicity. The depletion of i-tRNA or overexpression of its 3GC mutant (lacking the characteristic 3GC base pairs in anticodon stem) enhances Ltg toxicity, and this enhancement in toxicity is synthetic with IF2 overexpression. The Ltg treatment itself causes a detectable increase in IF2 levels in E. coli and allows initiation with an elongator tRNA, suggesting compromise in the fidelity/specificity of IF2 function. Also, Ltg causes increased accumulation of ribosome-binding factor A (RbfA) on 30S ribosomal subunit. Based on our genetic and biochemical investigations, we show that Ltg compromises the function of i-tRNA/IF2 complex in ribosome maturation.

Background: During the neonatal life cycle, various dermatological conditions are common. In comparison to the skin of adults, neonates' skins are more susceptible to infections in the first week of their lives. These infections often lead to many dermatological skin complications and create worrisome among parents. Hence, it is crucial to diagnose and manage such affected neonates at the earliest. This study aimed to highlight and estimate the occurrence of numerous dermatoses and assess various skin changes that occurred physiologically and pathologically in neonates. Methodology: In this cross-sectional observational study, 474 neonates were enrolled in the neonatal intensive care unit. The whole newborn skin surface, comprising the palms and soles, scalp, mucous membranes, genitalia, hair, and nails, was scrutinized under adequate light, and all changes that occurred over the skin were observed and recorded. The sample size estimation was undertaken from the references that have the least prevalent cutaneous dermatosis: hypertrichosis desquamation and napkin dermatosis. A statistical analysis like the Chi-square test was performed to associate the type of dermatosis with the parameters of age, gender, delivery type, and birth weight. Results: Of the total 474 cases, 90 (18.98%) had single dermatosis, while the remaining 384 (81.01%) had more than one form of dermatosis. Among the 384 cases, sebaceous gland hyperplasia (SGH) in 105 (22.15%), Epstein pearls in 50 (10.54%), erythema toxicum neonatorum (ETN) in 40 (8.43%), physiological desquamation in 25 (5.27%), lanugo hair in 20 (4.21%), miliaria in 22 (4.64%), salmon patch in 13 (2.74%), cradle cap/seborrheic dermatitis in 6 (1.26%), vernix caseosa in 12 (2.53%), transient neonatal pustular melanosis in 13 (2.74%), congenital melanocytic nevus in 20 (4.21%), hemangioma in 15 (3.16%), neonatal acne in 5 (1.05%), napkin dermatitis in 10 (2.10%), cutis marmorata in 6 (1.26%), milia in 2 (0.42%) intertrigo 3 (0.63%), collodion baby in 2 (0.42%), and neonatal occipital alopecia in 2 (0.42%) neonates each and others, respectively. Conclusion: The findings from the present study were representative of a specific racial/geographic distribution and will assist in adding or comparing the prevalence of neonatal dermatosis with other geographic regions as the array of dermatological characterizations in neonates varies as per time and place. This study aims to provide insight into the future implications in the neonatal dermatology domain and avoid further skin complications.

Metabolic syndrome affects more than one in three adults and is associated with increased risk of diabetes, cardiovascular disease, and all-cause mortality. Muscle insulin resistance is a major contributor to the development of the metabolic syndrome. Studies in mice have linked skeletal muscle sarcoplasmic reticulum (SR) phospholipid composition to sarcoplasmic/endoplasmic reticulum Ca2+-ATPase activity and insulin sensitivity. To determine if the presence of metabolic syndrome alters specific phosphatidylcholine (PC) and phosphatidylethanolamine (PE) species in human SR, we compared SR phospholipid composition in skeletal muscle from sedentary subjects with metabolic syndrome and sedentary control subjects without metabolic syndrome. Both total PC and total PE were significantly decreased in skeletal muscle SR of sedentary metabolic syndrome patients compared with sedentary controls, particularly in female participants, but there was no difference in the PC:PE ratio between groups. Total SR PC levels, but not total SR PE levels or PC:PE ratio, were significantly negatively correlated with BMI, waist circumference, total fat, visceral adipose tissue, triglycerides, fasting insulin, and homeostatic model assessment for insulin resistance. These findings are consistent with the existence of a relationship between skeletal muscle SR PC content and insulin resistance in humans.

Conventionally intensive tillage and sowing practices, and existing cereal crop-based system has been declining soil fertility resulting in poor grain yield and quality. In order to enhance system-based productivity and it becomes necessary to diversify cereal crop through legume-based cropping system with conservation technology-based tillage and crop sowing method. Hence, a study was carried out during 2018–2022 under Farmer First Project (FFP) at Morena district in Madhya Pradesh (Rajmata Vijayaraje Scindia Krishi Vishwa Vidyalaya, Gwalior, Madhya Pradesh) to collate the wheat (Triticum aestivum L.)-based four cropping systems with rainy (kharif) season crops i.e. pearl millet [Pennisetum glaucum (L.) R. Br.], pigeonpea [Cajanus cajan (L.) Millsp.], greengram [Vigna mungo (L.) Hepper] and clusterbean [Cyamopsis tetragonoloba (L.) Taub] and two crop sowing methods, viz. conventionally tilled and permanent broad-bed furrow irrigation were used. Significantly greater improvements were recorded in grain yield of wheat-based cropping systems, net returns, wheat equivalent yield, system protein production, water productivity, net energy gains, energy productivity and soil physico-chemical properties, while saving cultivation cost, total water- use and energy input under permanent broad bed-furrow over conventional tillage and sowing method. Likewise, system-based wheat equivalent yield, system protein productivity, additional net returns, net energy gains, energy productivity and parameters of soil physico-chemical properties were significantly enhanced with pigeonpea-wheat as compared to pearl millet-wheat cropping system. The results of experiment had suggested that cropping system of wheat based can be made more productive and remunerative with the inclusion of legume crops in rainy season and sowing of crop with permanent broad-bed furrow irrigation method.

Aim: The aim of this study was to determine the serum carboxy-terminal cross-linking telopeptide fragments of type-2 collagen (sCTX-II) level in normal healthy young and middle-aged individuals. Materials and Methods: Normal healthy adults were included as the participants in this study (175 participants). The age, gender, weight, and height of individuals were recorded. Venous samples (5 ml) were collected for the estimation of the sCTX-II level by ELISA kit. Results: The mean sCTX-II level was recorded as 400.42 ± 208.08 pg/ml. The mean sCTX-II level among males was recorded as 406.49 ± 220.79 pg/ml, and in females, it was 382.34 ± 157.88 pg/ml), and the difference is not statistically significant (P = 0.50). The sCTX-II value was recorded as 389.11 ± 199.79 pg/ml in the age group of 19–29 years, 430.45 ± 231.71 pg/ml in the age group of 30–39 years, and 424.12 ± 223.35 pg/ml in the age group of 40–49 years; however, this difference was not statistically significant (P = 0.524). The CTX-II value in the underweight category was 365.55 ± 197.09 pg/ml; in the normal body mass index (BMI) category, it was 404.58 ± 225.29 pg/ml; in the overweight category, the BMI was 392.99 ± 193.79 pg/ml; and in obese BMI category, the value was 417.32 ± 186.79 pg/ml. Our results revealed that the sCTX-II level is independent of age (F = 0.64, P = 0.524), gender (t = 0.66, P = 0.50), and BMI (F = 0.15, P = 0.92). Conclusion: We concluded that the sCTX-II level does not get affected by age, gender, and BMI in the general population. The sCTX-II estimation can be used to differentiate the cases of knee osteoarthritis from the normal population as it is independent of age, gender, and BMI. The sCTX-II value in young and middle-aged healthy populations is reported. However, a multicentric study with stringent subject selection criteria is needed to corroborate the results of this pilot study.

ABSTRACT Characterization of the oral microbiota profile through various studies has shown an association between the microbiome and oral cancer; however, stage-specific determinants of dynamic changes in microbial communities of oral cancer remain elusive. Additionally, the influence of the intratumoral microbiota on the intratumoral immune system remains largely unexplored. Therefore, this study aims to stratify microbial abundance in the early-onset and subsequent stages of oral cancer and analyze their influence on clinical-pathological and immunological features. The microbiome composition of tissue biopsy samples was identified using 16S rRNA amplicon sequencing, while intratumoral and systemic immune profiling was done with flow cytometry and immunohistochemistry-based analysis. The bacterial composition differed significantly among precancer, early cancer, and late cancer stages with the enrichment of genera Capnocytophaga, Fusobacterium, and Treponema in the cancer group, while Streptococcus and Rothia were enriched in the precancer group. Late cancer stages were significantly associated with Capnocytophaga with high predicting accuracy, while Fusobacterium was associated with early stages of cancer. A dense intermicrobial and microbiome-immune network was observed in the precancer group. At the cellular level, intratumoral immune cell infiltration of B cells and T cells (CD4+ and CD8+) was observed with enrichment of the effector memory phenotype. Naive and effector subsets of tumor-infiltrating lymphocytes (TILs) and related gene expression were found to be distinctly associated with bacterial communities; most importantly, highly abundant bacterial genera of the tumor microenvironment were either negatively correlated or not associated with the effector lymphocytes, which led to the conclusion that the tumor microenvironment favors an immunosuppressive and nonimmunogenic microbiota. IMPORTANCE The gut microbiome has been explored extensively for its importance in the modulation of systemic inflammation and immune response; in contrast, the intratumoral microbiome is less studied for its influence on immunity in cancer. Given the established correlation between intratumoral lymphocyte infiltration and patient survival in cases of solid tumors, it was pertinent to explore the extrinsic factor influencing immune cell infiltration in the tumor. Modulation of intratumoral microbiota could have a beneficial effect on the antitumor immune response. This study stratifies the microbial profile of oral squamous cell carcinoma starting from precancer to late-stage cancer and provides evidence for their immunomodulatory role in the tumor microenvironment. Our results suggest combining microbiome study with immunological signatures of tumors for their prognostic and diagnostic application.

The study of nonlocal nonlinear systems and their dynamics is a rapidly increasing field of research. In this study, we take a closer look at the extended nonlocal Kadomtsev–Petviashvili (enKP) model through a systematic analysis of explicit solutions. Using a superposed bilinearization approach, we obtained a bilinear form of the enKP equation and constructed soliton solutions. Our findings show that the nature of the resulting solitons, such as the amplitude, width, localization, and velocity, can be controlled by arbitrary solution parameters. The solutions exhibited both symmetric and asymmetric characteristics, including localized bell-type bright solitons, superposed kink-bell-type and antikink-bell-type soliton profiles. The solitons arising in this nonlocal model only undergo elastic interactions while maintaining their initial identities and shifting phases. Additionally, we demonstrated the possibility of generating bound-soliton molecules and breathers with appropriately chosen soliton parameters. The results of this study offer valuable insights into the dynamics of localized nonlinear waves in higher-dimensional nonlocal nonlinear models.

Background: The knowledge that preservation of clitoral sensation is essential for future sexual satisfaction gave rise to sensation-preserving clitoral reduction surgery. We present our results of sensation-preserving clitoral reduction procedure in the small group of patients. Aims and Objectives: To show our technique and result of sensation-preserving clitoral reduction surgery. Materials and Methods: This is a retrospective study of cases with clitoromegaly, over a 5-year period, in which sensation-preserving clitoral reduction procedure was done by us at our centre. Demographics, indication for clitoral reduction, operative procedure, operative time, any intraoperative difficulty or problem, anaesthesia type, post-operative stay and outcome were analysed. Pre-operative and post-operative evaluation for clitoral viability done in all the cases, and evaluation for clitoral sensory testing and vibratory sensory testing done in selected cases. Results: A total of eight cases were operated in the last 5 years. Five were due to congenital adrenal hyperplasia. Immediate post-operative period was uneventful in all. Cosmetic appearance and viability were satisfactory in all the cases. In five cases, clitoral sensory testing and vibratory sensory testing were done, an average degree of sensation of 3.2 at the labia minora and 4.7 at the clitoris and an average values clitoral vibratory sensory testing for the introitus, clitoris, labia and thigh were 3.56, 1.61, 5.08 and 5.83, respectively. Conclusions: Clitoral enlargement in girls is a rare problem. Sensation-preserving ventral clitoral reduction surgery leads to preservation of neurovascular bundles leads to acceptable cosmesis and preserved sensation.

Introduction: Head injury is one of the most common outcomes of any kind of trauma becoming the major cause of morbidity and mortality worldwide. The critical element in the treatment of patients with severe head injuries is to prevent the progression of the condition and secondary insult to brain cells. Various protocols are followed for the treatment of severe head injury starting from conservative medical management to surgical approaches like DC/hemicraniectomy (DC). The DC is a surgical method of removal of part of skull bone so that the brain parenchyma gets space to expand and the Intracranial Pressure (ICP) can get reduced. There are various factors that contribute to the outcome of DC. Aim: To determine the various factors that affect the outcome of DC/hemicraniectomy. Materials and Methods: A retrospective descriptive study was conducted in the Institute of Gandhi Medical College and associated Hamidia hospital, Madhya Pradesh, India from May 2017 to April 2021. Hundred patients with moderate to severe head injury who underwent primary DC were included in this study. The variables such as age, preoperative GCS, the timing of surgery, preoperative pupillary reaction, and MidLine Shift (MLS) were compared in terms of survival/death and favourable/ unfavourable outcomes using the chi-square test. Results: The mean age of participants was 45±14 years. Statistical analysis showed significant results for the variables like age, preoperative the Glasgow Coma Scale (GCS), timing of the surgery, pupillary reaction at presentation, and preoperative MLS in terms of survival/death and favourable/ unfavourable outcomes. Conclusion: Younger age group, better preoperative GCS, early surgery, reactive pupils at presentation, and less preoperative MLS have positive outcome benefits with the DC/ hemicraniectomy to reduce the raised ICP.

Abstract Background Labial adhesion is the fusion of the labia minora or majora. The literature reports conservative management. However, the situation may be different in our setup, where management differs due to prevailing circumstances. The present study was conducted to evaluate labial adhesion presentation, management, and outcome in our center. Methods It was a retrospective observational study from January 2015 to January 2020. The patients were evaluated for age at presentation, presenting symptoms, type of adhesions, treatment, recurrence, and follow-up. The treatment included the manual release of labial adhesion and Mupirocin ointment application for 15 days. They were advised to attend the outpatient department after 1 month for evaluation and later on in case of any problem. Results The total number of patients was 150, of which 104 (69.33%) were from rural backgrounds. The complaint was of the absent vaginal opening in all patients. Seventeen (11.33%) were advised ultrasonography of the abdomen elsewhere to look for the presence of internal genital organs. The local examination revealed poor hygiene in 65 (43.33%) patients. The patient with thick adhesions has minor erythema after the release of adhesions. Ten (6.66%) patients had a recurrence managed by repeat release with no recurrence. Conclusion Despite being a benign entity, labial adhesion may be a cause of severe concern. Manual separation and antibiotic ointment may be a viable first option in its management with minimal recurrence. Maintenance of local hygiene may be needed to prevent a recurrence. The overall outcome is excellent.

Abstract Background To better understand the impact of the COVID-19 pandemic on hospital healthcare, we studied activity in the emergency department (ED) and acute medicine department of a major UK hospital. Methods Electronic patient records for all adult patients attending ED (n = 243,667) or acute medicine (n = 82,899) during the pandemic (2020–2021) and prior year (2019) were analysed and compared. We studied parameters including severity, primary diagnoses, co-morbidity, admission rate, length of stay, bed occupancy, and mortality, with a focus on non-COVID-19 diseases. Results During the first wave of the pandemic, daily ED attendance fell by 37%, medical admissions by 30% and medical bed occupancy by 27%, but all returned to normal within a year. ED attendances and medical admissions fell across all age ranges; the greatest reductions were seen for younger adults in ED attendances, but in older adults for medical admissions. Compared to non-COVID-19 pandemic admissions, COVID-19 admissions were enriched for minority ethnic groups, for dementia, obesity and diabetes, but had lower rates of malignancy. Compared to the pre-pandemic period, non-COVID-19 pandemic admissions had more hypertension, cerebrovascular disease, liver disease, and obesity. There were fewer low severity ED attendances during the pandemic and fewer medical admissions across all severity categories. There were fewer ED attendances with common non-respiratory illnesses including cardiac diagnoses, but no change in cardiac arrests. COVID-19 was the commonest diagnosis amongst medical admissions during the first wave and there were fewer diagnoses of pneumonia, myocardial infarction, heart failure, cellulitis, chronic obstructive pulmonary disease, urinary tract infection and other sepsis, but not stroke. Levels had rebounded by a year later with a trend to higher levels of stroke than before the pandemic. During the pandemic first wave, 7-day mortality was increased for ED attendances, but not for non-COVID-19 medical admissions. Conclusions Reduced ED attendances in the first wave of the pandemic suggest opportunities for reducing low severity presentations to ED in the future, but also raise the possibility of harm from delayed or missed care. Reassuringly, recent rises in attendance and admissions indicate that any deterrent effect of the pandemic on attendance is diminishing.

Introduction: Dermatophytosis are presenting for longer durations and at atypical sites and are quite persistent. If changes in the Cell-Mediated Immunity (CMI) will be studied then, it will help to set treatment guidelines for the management of dermatophytosis to certain extent, considering the current changes in the resistance to dermatophytosis. There is paucity in literature regarding the CMI to Trichophyton antigen in dermatophytosis patients in the geographical region of Vidarbha, Maharashtra, India. Aim: To assess the CMI to intradermal Trichophyton antigen in dermatophytosis patients and to study its adverse reaction in these patients. Materials and Methods: The present prospective cross-sectional case-control study will be conducted on patients of dermatophytosis attending Skin Outpatient Department (OPD) in Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, Wardha, Maharashtra, India, during January 2022 to January 2023 (13 months). Patients will be enrolled following fulfillment of study’s eligibility criteria. Clearance has been acquired from the Institutional Ethical Committee (IEC). Participants will be required to sign a written informed consent form in their native language. A detailed history will be collected and cutaneous examination will be done before conducting the study. The area for intradermal injection will be marked. For the study 0.1 mL, Intradermal Trichophyton antigen will be injected in the patient’s forearm. Patient will be called after 48 hours to check for the CMI response (delayed response).

Introduction: Hollow viscus perforation is a significant cause of surgical mortality. Various attempts have been made to identify high-risk patients preoperatively and optimize and manage such patients more aggressively. This study aimed to evaluate the predictors of outcome in patients undergoing emergency laparotomy for perforation peritonitis. Methods: This retrospective cross-sectional study was conducted on perforation peritonitis cases admitted to the Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, India. The association between preoperative patient variables with postoperative complications, anastomotic leaks, need for intensive care unit (ICU) admission, and 30-day mortality were evaluated. Results: Tachycardia at the time of admission (t = 2.443, p = 0.020), hypotension (χ2 = 18.214, p =

Introduction: Cervical spondylosis is an age-related degenerative condition of cervical spine that leads to compression of exiting nerve roots and in more severe cases compression of spinal cord, giving rise to symptoms of radiculopathy and myelopathy, respectively. Till date there have been various studies on the management of cervical spondylosis, some supporting the conservative line of management whereas others favouring the surgical approach. But still there is no clear consensus about which line of management is better than the other. Aim: To assess the role of surgical and non surgical modalities in the management of cervical spondylosis using the American Spinal Injury Association (ASIA) and Visual Analog Scale (VAS) scores. Materials and Methods: The present prospective interventional study was conducted on a total sample of 100 patients presenting in Outpatient Department (OPD) of Department of General Surgery, Hamidia Hospital, Bhopal, Madhya Pradesh, India, who were diagnosed to have cervical spondylosis, between November 2018 to July 2020. Patients were divided into two groups based on the mode of intervention i.e. surgical and non surgical groups. Preintervention and Postintervention scores were recorded according to ASIA scale (which included sensory and motor score) and VAS for pain score. The significance of change in these scores was determined by using Paired t-test. The data was analysed using XLSTAT version 2021.5.1. Results: Total 100 patients included initially, 14 patients were lost to follow-up. The remaining 86 patients were evaluated and included in the final analysis. Out of these 86 patients, 80 were managed conservatively and six underwent surgical management. Under the conservative group, the mean preinterventional motor score was found to be 43.3±5.99 which improved to 45.7±4.78 postinterventional (p

Aim: The aim of the study was to highlight the etiology, spectrum of presentation, and management of isolated penile trauma in boys. Methods: A retrospective review of boys treated for isolated penile trauma between January 2015 and June 2019 at a tertiary-level hospital. Results: Nine children were admitted over 4½ years. Etiology: The mechanism of penile injury (PI) was penile hair tourniquet (n = 5), postcircumcision (n = 2), dog bite (n = 1), and scald injury (n = 1). Extent of injury includes complete urethral transection at corona (n = 4); loss of urethral plate in a case of hypospadias (n = 1); complete loss of glans (n = 1); penile transection at corona (n = 1); total penile amputation (n = 1); and deep partial-thickness burns of penile shaft and adjacent suprapubic skin (n = 1). Management: One patient absconded. The remaining patients were managed as follows: calibration of urethral meatus (n = 1); penile burn was managed with dressing and antibiotics; coring of glans with urethral end–end anastomoses (n = 4); Bettocchi's quadrangular lower abdominal flap phalloplasty (n = 1); and Bracka's staged urethroplasty (n = 1). Complications include wound infection following trauma (n = 4), postsurgical infection (n = 3), urethrocutaneous fistula (n = 2), and reapplication of penile hair tourniquet (n = 1). Conclusion: Isolated PI in boys is not uncommon. Most are preventable if the parents are apprized and watchful. The clinician should also be vigilant regarding child maltreatment. A staged approach tailored to the type of injury provides a satisfactory outcome.

Nowadays, high-performance concrete is employed in the building sector all over the world. For a strong and durable construction, high performance appears to be a better option. These specially designed types of concrete are made using both conventional and unique materials to fulfill a combination of performance requirements. The objective of this experiment is to investigate the behaviour of short and long columns made of high-performance concrete (HPC). In this study, HPC was manufactured by essential denominators such as cement, fine aggregate, coarse aggregate, water, and mineral admixtures such as metakaolin and fly ash at different replacement levels. The high-performance concrete (HPC) was designed with compressive strength (CS) of about 60 N/mm2. The mixture was developed under the guidelines in modified ACI 211.4R-93. All combinations have the same 0.30 water binder ratio (W/B) and are utilized to achieve improved workability with the addition of a superplasticizer for a chemical admixture, namely, CERAPLAST 300. Seven proportions are cast with 0%, 5%, 7.5%, and 10% replacement of cement with metakaolin and another set of specimens with 5%, 7.5%, and 10% replacement with metakaolin along with a constant 10% replacement of fly ash. For the investigation of strength properties, specimens (cube, prism, and cylinders) such as compressive strength (CS) (3, 7, 28, 56, and 90 days), flexural (FS) and tensile strength (STS) (28 days) and modulus of elasticity were cast (28 days). Totally 14 columns, 7 for short and long columns, were cast, each cured for 28 days. These specimens have been tested in the 1000 kN loading frame. All small columns were tested with concentrated compression, whereas long columns were investigated with little concentration and uniaxial bending. The compressive strength of HPC with 7.5 percent metakaolin and 10 percentage fly ash (MR6) is 59 MPa, 7.34% greater than the compressive strength of reference concrete.

Different biodegradable waste may indeed be processed by biodigesters to generate biogas, a clean and sustainable source of energy. Different digesters are classified according to their digestive process, which is either aerobic or anaerobic. The rate at which organic waste is loaded, the temperature, the amount of dilution, etc., all affect the size of the digesters. A biodigester typically needs a relatively steady atmosphere as well as ongoing agitation. Additionally, it necessitates a large land area. Although it has numerous advantages, the nature of the feedstock is the main factor on which the potential of biogas production depends, as well as the design of the reactor and operational parameters. Though many authors attempted to establish the effect of various factors on the process of biodigestion of food waste, very few studies on reactor design to achieve maximum biogas production were reported. The current study focuses on the use of a reactor with multiple stages that requires a smaller footprint to increase the rate of gas production from solid substrates. In the study, an experiment was attempted to determine the effect of substrate composition, food waste size, and multiple stages inside the reactor on biogas production. It has been found from the results that agricultural and environmental sustainability associated with livestock waste can reduce pollution risk considerably through biodigestion. It has also been found that stages inside the reactor do have an effect on gas production, which has been increased by up to 30%.

The experiment was carried out to estimate genetic variability among thirty-five genotypes of oilseed Brassica, including 20 F2s/F3 populations derived through interspecific hybridization and 15 parents, during rabi 2015-16 and 2016-17. Pooled analysis showed that considerable variability was observed among F2s/F3s and parents for all the fourteen characters. Variation due to “location x treatment” was significant only for secondary branches & oil content. The estimates of GCV and PCV were comparatively higher for plant height, primary & secondary branches/plant, number of siliquae per plant, siliqua length, seeds per siliqua, test weight, seed yield per plant and oil yield per plant. High estimates of heritability were recorded for all the characters. The estimates of genetic advance (GA) were also recorded high for number of siliquae per plant and plant height. Number of siliquae per plant showed high heritability (92.4 %) together with high genetic advance (219.1%) and genetic advance as percentage of mean (78.8). Traits like siliquae per plant and plant height might be considered as high potential traits for effective selection for further crop improvement in Brassica spp.

Background: Meconium ileus (MI) is defined as an intestinal obstruction caused by the impaction of inspissated meconium in the terminal ileum. In this study, we have evaluated the nonoperative management of patients of simple MI without fluoroscopic support –an important requisite of the Noblett's criteria. Besides this, surgical management in cases of failed conservative management and complicated MI was also assessed. Materials and Methods: This was a retrospective observational study. Various clinical and radiological parameters were evaluated. Conservative management included the use of water-soluble contrast diatrizoate meglumine and diatrizoate sodium. In case of nonpassage of meconium in 24 h from first intervention, exploratory laparotomy with ileostomy was performed. All complicated MI underwent exploratory laparotomy with creation of stoma as and when needed. Results: The duration of this study was 6½ years. Twenty-five neonates of MI were admitted. Of these, 22 had simple MI and remaining three had complicated MI. Eighteen neonates responded to the conservative management. In four neonates, who did not respond, exploratory laparotomy was performed. All three neonates having complicated MI underwent exploratory laparotomy. One patient expired in follow-up. Conclusion: MI is an important neonatal emergency, which needed immediate attention of a pediatric surgeon. Proper evaluation of the patient, careful application of principals of conservative management, and timely surgical intervention may fetch satisfactory results.

This article investigates the dust ion acoustic multi-shock wave excitations in weakly relativistic multi-component plasma by assuming nonthermal, nonextensive electrons and positrons, relativistic ion fluid having kinetic viscosity and immobile dust. Burgers equation is derived to investigate such excitations by applying the reductive perturbation method. The exponential functions are directly implemented to determine the novel multi-shock wave solution of Burgers equation. The dust ion acoustic (DIA) multi-shock wave excitations are investigated systematically to reveal the effects of parameters, namely, viscosity coefficient of ions, positron to electron density ratio, immobile dust to electron density ratio, ion to electron temperature ratio, electron to positron temperature ratio, and relativistic streaming factor of ions in the presence of nonthermal, nonextensive, and concurrently acting nonthermal and nonextensive electrons as well as positrons. It is found that the amplitudes and widths of not only single, but also multi-shock wave compressive and rarefactive electrostatic potential structures are changed with the influence of all plasma parameters. The obtained results may be useful to analyze the nature of DIA multi-shock wave phenomena in various astrophysical as well as space environments (particularly, in pulsar relativistic winds with supernova ejecta) and future studies in plasma laboratory.

Introduction: Hansen’s disease is an infectious granulomatous disorder with Mycobacterium leprae being the causative agent. Mycobacterium Leprae is an acid-fast bacillus which grows slowly inside host cells mainly neural Schwann cell as well as cutaneous macrophages. Aim: To study the efficacy of Slit Skin Smear (SSS) and Fite Faraco stain on histopathology for diagnosis in leprosy. Materials and Methods: The present cross-sectional study carried out on patients clinically diagnosed as Leprosy attending dermatology OPD in AVBRH, Sawangi, Wardha, Maharashtra, India from sepetember 2017 to August 2019. A total of 88 patients who gave informed consent to participate in study and their clinical features were recorded including number, size and location of lesions and loss of sensation. Any contiguous cutaneous nerve or peripheral nerve trunk enlargement was noted and were classified according to the Ridley-Jopling Classification. SSS and Fite Faraco stain on histopathology specimens was done. The quantitative variables were compared using Kruskal Wallis Test and qualitative variables were correlated using Chi-square test/Fisher’s-Exact test. Results: Out of 88 (n=88) clinically diagnosed leprosy cases enrolled in this study, 2, 17, 15, 6, 20, 25 and 3 cases were diagnosed as indeterminate, Tuberculoid Leprosy (TT), Borderline Tuberculoid Leprosy (BT), Mid Borderline leprosy (BB), Borderline Lepromatous Leprosy (BL), Lepromatous Leprosy (LL) and pure neural leprosy, respectively. Mycobacterium leprae detection by SSS was possible in 21.59% cases while detection by Fite Faraco staining on tissues sections was possible in 11.36% cases. There were 10 (11.36%) cases in which Mycobacterium leprae was detected by SSS but not by Fite Faraco, while in 7 (7.95%) cases. Mycobacterium leprae was detected by Fite Faraco staining but not by slit skin smear microscopy. The difference in detection by the two methods was found statistically significant with p-value 0.002. On comparison-slit skin smear had sensitivity of 26.47% whereas Fite Faraco had 23.53%. The specificity Fite faraco staining was 100% while that of SSS was found to be 95%. Conclusion: On comparison of efficacy of SSS and Fite faraco staining on tissue sections, SSS had the highest detection rate and sensitivity in diagnosing leprosy whereas Fite Faraco was found to be more specific.

DNA holds great potential for species identification and efforts to create a DNA database of all animals and plants currently contains >7.5 million sequences representing ~300,000 species. This promise of a universally applicable identification tool suggests that morphologically based tools and taxonomists will soon not have utility. Here we demonstrate that DNA-based identification is not reliable without the contributions of taxonomic experts. We use ambrosia beetles (Xyleborini), which are known for great diversity as well as global invasions and damage, as a test case. Recent xyleborine introductions have caused major economic and ecological losses, thus timely species identifications of new invaders are necessary. This need is hampered by a paucity of identification tools and a fauna that is only moderately documented. To help alleviate deficiencies in their identification, we created COI and CAD DNA barcode databases (490 and 429 specimens), representing over half of the known fauna of Southeast Asia (165/316 species). Taxonomic experts identified species based on original descriptions and type specimens. Tree, distance, and iterative methods were used to assess the identification and delimitation of species. High intra- and interspecific COI distances were observed for congeneric species and attributed to the beetle's inbreeding system. Neither of the two markers provided 100% identification success but with the neighbor-joining tree-based method, 80% of species were identified by both genes. As for species delimitation, an obvious barcode gap between intra- and interspecific differences was not observed. Correspondence between distance-based groups and morphology-based species was poor. In a demonstration of iterative taxonomy, we constructed parsimony-based phylogenies using COI and CAD sequences for two genera. Although not all clades were resolved or supported, we provided better explanations for species boundaries in light of morphological and DNA sequence differences. Confident species identifications demonstrated 10–12% COI and/or >2–3% CAD. Involvement of taxonomic experts from the start of this project was essential for the creation of a stable foundation for the DNA identification of xyleborine species. In general, their role in DNA barcoding cannot be underestimated and is further discussed.

Genital warts (condyloma acuminata) are benign, proliferative tumours which occur in the genital, anal, perineal and/or perianal areas. These warts are caused by Human Papilloma Virus (HPV). They are double-stranded DNA viruses which replicate in squamous epithelial cells. Many types of HPV has been recognised but 6 and 11 HPV types accounts almost 75-90% of genital warts cases. Many medical and ablative treatment modalities are available like topical podophyllin, imiquimod, cryotherapy, but recurrence is still a problem in many patients. Recently, a concept of combination treatment has been practiced and it was found to be better than monotherapy because of the synergistic effect of both the compounds. There are studies on the use of combination of cryotherapy with topical podophyllin and various other combinations but to achieve complete clearance of genital warts with no recurrence is still a challenge for the dermatologists. Thus, a combination treatment was needed to overcome this problem. So, a thought was given to use a combination of two modalities having different mechanism of action for treating genital warts. We hereby report a case of multiple giant genital warts in an immunocompetent female in whom complete clearance of lesions was achieved by a combination of Cryotherapy and 5% Imiquimod cream within six weeks of treatment.

The bark beetles (Coleoptera: Curculionidae: Scolytinae) are widely recognized as one of the most damaging groups of forest pests. The present article documents the insect predators associated with bark beetles infesting blue pine, Pinus wallichiana A. B. Jacks (Pinaceae), in Kashmir Himalaya. Three species of bark beetles, such as Ips stebbingi Strohmeyer, 1908, Polygraphus major Stebbing, 1903, and Pityogenes scitus Blandford, 1893, are here reported as preyed upon by the following four species of predatory beetles: Thanasimus himalayensis Stebbing, 1914 (Cleridae), Niponius canalicollis Lewis, 1901 (Histeridae), Platysoma rimarium Erichson, 1834 (Histeridae), and Corticeus flavipennis Motschulsky, 1859 (Tenebrionidae). Brief diagnoses with photographs of all the pests and their predators have been provided. P. rimarium is also redescribed. A significant number of predators observed in the galleries of bark beetles and on the infested host material support that predators play a major role in the regulation of bark beetle populations and, therefore, has great relevance to ecological pest management strategies in the forests. Keywords: Corticeus flavipennis, Niponius canalicollis, Platysoma rimarium, Thanasimus himalayensis

Background: Congenital pouch colon (CPC) or congenital short colon is an entity found mainly in Indian subcontinent. In CPC, colon is replaced with partially or completely abnormal pouch connected to the genitourinary tract by a fistula (colovesical). Management protocol is different in different institute. In this article, we are sharing our three stage standard management approach; principle and technique of coloplasty in cases in which colon length is not adequate for pull through and their follow-up. This study aims to show the result of coloplasty in complete CPC. Materials and Methods: This is retrospective observational study, of 5 years duration. The medical record of these patients was reviewed for demographic information, clinical features, investigations performed, operative notes, post-operative events and the outcome of surgery. Results: Total of 626 ARM cases were managed in 5 years duration in which 64 were of pouch colon. The age of presentation was 1–15 days. In fifty patients who completed their, all stage in that 34 patients were in which coloplasty were done in rest of 16 cases excision of CPC and colonic pull through done in view of adequate colonic length (type III and IV) for pull through. In 34 patient in which coloplasty were done showed satisfactory cosmetic and functional out came after stoma closer in follow-up. Conclusions: Properly created coloplasty and three stage procedure for complete pouch colon give better result and less complications. Excision of pouch is not requiring in all cases of CPC.

A colostomy is one of the most popular techniques used as a protective maneuver for a distal anastomosis and/or temporary fecal diversion loop colostomy is used mainly for fecal diversion so as to protect the distal bowel. We report a new simple technique for the creation of mucosal spur in between the proximal and distal stoma without using either a tube or skin flap. The essence of this technique is the creation of mucosal spur by placing two additional sutures in the bridge in between the proximal and distal stoma. The placement of sutures creates the spur and helps in defunctioning of distal stoma. Seventeen patients were operated by this technique over a period of 1 year. The creation of the mucosal spur was excellent. There was no requirement of a tube or skin flap in any of the patients in the follow-up. There was no problem of loss of spur over a period. This is a simple technique, which needs few additional sutures apart from the necessary sutures needed for maturation of colostomy.

Lactococcus lactis plays a critical role in food, dairy and health sectors. In food and dairy industries, it is found in production processes of various fermented products such as sausages, pickled vegetables, beverages such as beer and wine, breads, soymilk kefir, sour milk, butter, cream, fresh cheese and different types of cheeses, like Cheddar, Colby, Cottage cheese, Camembert, cream cheese, Roquefort and Brie. Additionally, there is an increasing interest towards the possible health benefits of the probiotic activity of this organism which generally is species and strain specific and depends upon the survival in gastrointestinal tract with sufficient number. Certain strains have the ability to produce antimicrobial peptide called nisin which exhibits preservative potential. Therefore, application of bacteriocinogenic Lactococcus lactis in food and dairy sectors to preserve foods as a natural way and contributing health promoting attributes due to probiotic activity would definitely fulfil today’s consumer demands. This paper aimed to review the adaptation, antibiotic resistance, therapeutic and preservation potential of bacteriocinogenic and probiotic Lactococcus lactis.

Aim of the study: Vitamin D receptor (VDR) expression and serum vitamin D scores in oral premalignant lesions and oral cancer have not been widely analyzed. The role of vitamin D supplementation in advanced oral cancer for improving quality of life (QOL) is also a matter of research. Material and methods: Vitamin D receptor expression and vitamin D scores were analyzed in normal oral mucosa (n = 95), leukoplakia (n = 23) and oral cancer (n = 87). 45 patients with advanced oral cancer subjected to chemoradiation were evaluated for the effect of vitamin D supplementation on most observable QOL parameters such as oral mucositis, swallowing performance and overall QOL. Results: Vitamin D receptor expression was increased in oral neoplastic lesions. Vitamin D scores were significantly lower in cases compared to healthy controls (p = 0.002). Vitamin D supplementation significantly reduced the therapy-related toxicities in advanced cancer, thus reducing morbidity and improving QOL. Conclusions : Vitamin D receptor expression is increased in premalignant lesions and oral cancer. Vitamin D insufficiency and deficiency are prevalent in patients with oral neoplastic lesions. Vitamin D supplementation has a role in reducing treatment-related toxicities, especially in advanced cancer.

Introduction: Locally advanced Head and Neck Squamous Cell Carcinoma (HNSCC) is a diverse group of patients and the treatment needs to be individualised. Although Concurrent Chemoradiotherapy (CTRT) remains the standard of care, not all patients are suitable to receive the same. Accelerated Fractionated Radiotherapy (AFRT) is one of the treatment options in these patients and may achieve equivalent therapeutic ratio. Aim: To compare outcomes of patients of HNSCC treated with concurrent CTRT versus AFRT in a prospective randomised trial. Materials and Methods: A total of 322 patients of Stage IIIIV (AJCC, 6th Edition), HNSCC of oropharynx, larynx and hypopharynx were randomised to receive either definitive CTRT or AFRT. Radiotherapy (RT) dose was 70 Gray (2 Gray, 5 fractions per week over 7 weeks) to the primary and nodes and 46-60 Gray to the elective neck nodes. RT was delivered 5 fractions per week along with concurrent cisplatin 35-40 mg/m2 weekly in the CTRT arm. In the AFRT arm, RT was delivered as 6 fractions per week of 2 Gray each over 6 weeks. Acute and late toxicities were graded as per RTOG morbidity scoring. Kaplan Meier method was used for survival analysis. Results: Patients characteristics were balanced between CTRT arm and AFRT arm (161 patients each). Median overall treatment time for CTRT and AFRT arms were 43 and 49 days respectively. A 5-year actuarial locoregional control, diseasefree survival and overall survival was 32% vs. 42%; 28% vs. 35% and 30% vs. 35% respectively for CTRT vs. AFRT arm. Need of Ryle’s tube feeding (p=0.001), acute mucositis (p=0.015), late subcutaneous toxicity (p=0.05) and late xerostomia (p=0.042) rates were higher for CTRT arm. Conclusion: AFRT was associated with comparable clinical outcome as compared to CTRT in patients of HNSCC, albeit with reduced acute and late toxicities.

Pulmonary embolism (PE) is common and guidelines recommend outpatient care only for PE patients with low predicted mortality. Outcomes for patients with intermediate-to-high predicted mortality managed as outpatients are unknown. Electronic records were analysed for adults with PE managed on our ambulatory care unit over 2 years. Patients were stratified into low or intermediate-to-high mortality risk groups using the Pulmonary Embolism Severity Index (PESI). Primary outcomes were the proportion of patients ambulated, 30-day all-cause mortality, 30-day PE-specific mortality and 30-day re-admission rate. Of 199 PE patients, 74% were ambulated and at 30 days, all-cause mortality was 2% (four out of 199) and PE-specific mortality was 1% (two out of 199). Ambulated patients had lower PESI scores, better vital signs and lower troponin levels (morning attendance favoured ambulation). Over a third of ambulated patients had an intermediate-to-high risk PESI score but their all-cause mortality rate was low at 1.9% (one out of 52). In patients with intermediate-to-high risk, oxygen saturation was higher and pulse rate lower in those who were ambulated. Re-admission rate did not differ between ambulated and admitted patients. Two-thirds of patients with intermediate-to-high risk PE were ambulated and their mortality rate remained low. It is possible for selected patients with intermediate-to-high risk PESI scores to be safely ambulated.

The recent advancements in forward genetics have expanded the applications of mutation techniques in advanced genetics and genomics, ahead of direct use in breeding programs. The advent of next-generation sequencing (NGS) has enabled easy identification and mapping of causal mutations within a short period and at relatively low cost. Identifying the genetic mutations and genes that underlie phenotypic changes is essential for understanding a wide variety of biological functions. To accelerate the mutation mapping for crop improvement, several high-throughput and novel NGS based forward genetic approaches have been developed and applied in various crops. These techniques are highly efficient in crop plants, as it is relatively easy to grow and screen thousands of individuals. These approaches have improved the resolution in quantitative trait loci (QTL) position/point mutations and assisted in determining the functional causative variations in genes. To be successful in the interpretation of NGS data, bioinformatics computational methods are critical elements in delivering accurate assembly, alignment, and variant detection. Numerous bioinformatics tools/pipelines have been developed for such analysis. This article intends to review the recent advances in NGS based forward genetic approaches to identify and map the causal mutations in the crop genomes. The article also highlights the available bioinformatics tools/pipelines for reducing the complexity of NGS data and delivering the concluding outcomes.

Pulmonary agenesis is a very rare condition with poor prognosis. Although the condition is a congenital malformations, delayed presentation is also seen. A female neonate with left pulmonary agenesis presented to us with severe respiratory distress. She was initially misdiagnosed as a case diaphragmatic hernia at another hospital and referred to us for further management. Clinical examination and further investigations confirmed the diagnosis of left pulmonary agenesis. The child improved on medical management and is asymptomatic up to 6 months of follow-up.

Objective: The objective of this study is to review the clinicoradiological profile, scheme of management and the outcome in cases of colonic atresia (CA), and ascertain an optimal approach for the treatment of CA to minimize morbidity and mortality. Design and Setting: This was a retrospective observational study carried out at a tertiary health‑care center. Duration: Total of 6 years duration (January 2011–December 2016). Materials and Methods: A retrospective analysis of 10 patients of CA managed over a 6- year period. Data related to demographics, clinical presentation, associated anomalies, radiologic, intraoperative findings, postoperative stay, complications, and outcome were analyzed. Results: There were three cases of Type II atresia involving terminal ileum, cecum, and adjacent colon. Three cases had proximal ascending colon atresia (Type IIIa [n = 2]; Type I [n = 1]) Type I [n=1], and two cases of type IIIa atresia of the hepatic flexure. Two babies had atresia involving the sigmoid colon; one had Type II atresia, while we were unable to assign a type to the other within the prevailing classification. Seven babies were initially treated with a stoma either in the ileum (n = 3), hepatic flexure (n = 2), and sigmoid colon (n = 2), whereas three were treated with a primary anastomoses. Cases treated with a primary anastomoses had lesser morbidity and a better outcome than those with an ileal or ascending colon stoma. Conclusion: Contrary to the theory of an acute antenatal vascular accident, CA may rarely result from a gradual, sequential obliteration of mesenteric vasculature. Primary anastomosis should be contemplated in proximal CA wherever possible as stomal complications, especially high stoma output can result in considerable morbidity.

Ileocolic atresia is the rarest form of all gastrointestinal atresia. Most accepted theory for Ileocolic atresia is a sequel of in-utero vascular insult. The incidence of internal hernia through a defect in the falciform ligament is extremely rare. In this case, a 2-day-old newborn baby presented with intestinal obstruction. On exploratory laparotomy ileocolic atresia was found along with the atretic terminal ileum and cecum, ascending colon and part of right transverse colon seen herniating through the defect in falciform ligament. To best of our knowledge and literature search this is the first case of Ileocolic atresia caused by intrauterine internal herniation of ileocolic segment through the falciform ligament defect.

Please see fulltext

Please see fulltext.

This congenital vascular disorder is described by a “triad” of symptoms affecting one or more limbs. The “triad” constitutes varicose veins, cutaneous hemangioma, with bone and soft tissue hypertrophy. The cutaneous hemangioma presents as a substantial port-wine stain or nevus. Varicose veins are often very numerous. Bone and soft tissue hypertrophy is variable in presentation and the affected limb may be either larger or smaller than the normal limb. This disorder is generally reported in childhood or adolescent age groups. We herein present a neglected case of Klippel Trenaunay Syndrome with all the classical clinical and radiological findings. A 30-year-old man reported with the classical triad. On clinical examination substantial port wine stain was seen and radiographs showed multiple bony outgrowths whereas MRI showed multiple varicosities displaying heterogeneous hyper intense signals on T2 Weighted Images and T1 hypo intensity with hypertrophy of soft tissue in left lower limb.

Eight isolates of Lactococcus lactis subsp. lactis were isolated and identified by phenotypic and molecular characterisation out of 23 isolates of lactic acid bacteria (LAB) from different dairy and non-dairy sources. Out of eight strains, four were obtained from dairy and four from non-dairy sources. All eight strains of L. lactis subsp. lactis were able to produce zones of inhibition against the Lactobacillus acidophilus NCDC 015. The antimicrobial agent produced by the isolates inhibited the growth of a range of related lactic acid bacteria and certain Gram positive food-borne microorganisms. The antimicrobial agent, i.e. nisin, produced by the strains was confirmed by PCR amplification of nisin gene sequences of 174 bp size. Antibiotic susceptibility test to 21 different types of antibiotics was evaluated. All the isolates were resistant to fosfomycin, cefepime, amikacin, kanamycin, neomycin, nalidixic acid, pipemidic acid, norfloxacin, sulphadiazine, colistin, polymixin, teicoplanin, nystatin, and amphotericin B but susceptible to ampicillin, erythromycin, spiramycin, spectinomycin, ciprofloxacin, rifampicin, and trimethoprim.

BackgroundMalondialdehyde (MDA) is generated during lipid peroxidation as in oxidized low‐density lipoprotein, but antibodies against oxidized low‐density lipoprotein show variable results in clinical studies. We therefore studied the risk of cardiovascular disease (CVD) associated with IgM antibodies against MDA conjugated with human albumin (anti‐MDA). Methods and ResultsIn a 5‐ to 7‐year follow‐up of 60‐year‐old men and women from Stockholm County previously screened for cardiovascular risk factors (2039 men, 2193 women), 209 incident CVD cases (defined as new events of coronary heart disease, fatal and nonfatal myocardial infarction, ischemic stroke, and hospitalization for angina pectoris) and 620 age‐ and sex‐matched controls were tested for IgM anti‐MDA by ELISA. Antibody peptide/protein characterization was done using a proteomics de novo sequencing approach. After adjustment for smoking, body‐mass index, type 2 diabetes mellitus, hyperlipidemia, and hypertension, an increased CVD risk was observed in the low IgM anti‐MDA percentiles (below 10th and 25th) (odds ratio and 95% CI: 2.0; 1.19–3.36 and 1.67; 1.16–2.41, respectively). Anti‐MDA above the 66th percentile was associated with a decreased CVD risk (odds ratio 0.68; CI: 0.48–0.98). After stratification by sex, associations were only present among men. IgM anti‐MDA levels were lower among cases (median [interquartile range]: 141.0 [112.7–164.3] versus 147.4 [123.5–169.6]; P=0.0177), even more so among men (130.6 [107.7–155.3] versus 143.0 [120.1–165.2]; P=0.001). The IgM anti‐MDA variable region profiles are distinctly different and also more homologous in their content (correlates strongly with fewer peptides) than control antibodies (not binding MDA). ConclusionsIgM anti‐MDA is a protection marker for CVD. This finding could have diagnostic and therapeutic implications.

Emerging evidence has highlighted the pivotal role of microvasculature injury in the development and progression of renal fibrosis. Angiopoietin-1 (Ang-1) is a secreted vascular growth factor that binds to the endothelial-specific Tie2 receptor. Ang-1/Tie2 signaling is critical for regulating blood vessel development and modulating vascular response after injury, but is dispensable in mature, quiescent vessels. Although dysregulation of vascular endothelial growth factor (VEGF) signaling has been well studied in renal pathologies, much less is known about the role of the Ang-1/Tie2 pathway in renal interstitial fibrosis. Previous studies have shown contradicting effects of overexpressing Ang-1 systemically on renal tubulointerstitial fibrosis when different engineered forms of Ang-1 are used. Here, we investigated the impact of site-directed expression of native Ang-1 on the renal fibrogenic process and peritubular capillary network by exploiting a conditional transgenic mouse system [Pax8-rtTA/(TetO)7 Ang-1] that allows increased tubular Ang-1 production in adult mice. Using a murine unilateral ureteral obstruction (UUO) fibrosis model, we demonstrate that targeted Ang-1 overexpression attenuates myofibroblast activation and interstitial collagen I accumulation, inhibits the upregulation of transforming growth factor β1 and subsequent phosphorylation of Smad 2/3, dampens renal inflammation, and stimulates the growth of peritubular capillaries in the obstructed kidney. Our results suggest that Ang-1 is a potential therapeutic agent for targeting microvasculature injury in renal fibrosis without compromising the physiologically normal vasculature in humans.

Type V is the rarest form of congenital pouch colon with only four cases reported till date. We report this anomaly in a 6-month-old boy. He was managed successfully with excision of distal pouch and coloplasty of proximal pouch along with abdominoperineal posterior sagittal anorectoplasty. We recommend preservation of proximal pouch in such cases.