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In the present work, antibiotic drug gentamicin sulfate (GS) has been loaded into alginate dialdehyde-crosslinked casein (CAS) films for wound dressing applications. The films have been characterized by Fourier transform infrared spectroscopy, X-ray diffraction analysis and scanning electron microscopy. The dynamic release of model drug GS has been investigated in the physiological fluid at 37 °C. The drug release data has been interpreted in the terms of various kinetic models such as Power function model, first order model and Schott model. The release data was found to be well fitted by Schott model. The various diffusion coefficients are also evaluated. The adsorption of model therapeutic protein BSA on the film has been investigated. The maximum adsorption is found to be 5.7 mg/cm2.The films were tested for their antibacterial and anti-fungal action. Finally, the in vivo wound healing study was carried out on Albino wistar rats.

Posterior Urethral Valves (PUV) are one of the com-monest urolgical problems seen in children and the electro-coagulation, which is the most widely preferred modality to ablate the valves, may not be feasible in small-for-date and low-birth-weight neonates as the suitable size resec-toscope/cystoscope may not available. With the availa-bility of Nd: YAG laser at our institute recently, we started performing the laser fulguration instead of electrocoagu-lation of the valves. We reviewed our experience with the emerging role of the Nd: YAG laser in the fulguration of PUV, comparing the results with a historical control group who underwent the classical electrocoagulation of the PUV. The boys (n=50) diagnosed to have PUV by VCUG were confirmed by Wolf 8.5 size cystoscope, underwent Nd: YAG laser fulguration of the valves with a bare fiber, as a day-care procedure without postoperative catheteri-zation. Historical controls (n=50) who had undergone classical electrocoagulation using 9.5 size Wolf resectos-cope served as the controls. The mean age was 1.3 y and 2.6 y in laser and electrocoagulation group respectively. The mean hospital stay of the electrocoagulation group was 3.8 d. Three patients after electrocoagulation devel-oped hematuria and 4 required refulguration whereas in the laser group 5 required refulguration and none devel-oped hematuria. In conclusion, endoscopic laser fulgura-tion of PUV is technically feasible even in neonates and small children. Laser offers excellent results that are com-parable to the time-honored electrocoagulation procedure. This has the additional advantage forfulgurating the PUV in smaller caliber urethra as this can be performed with the smaller available cystoscope that has a side channel, admitting the laser fiber.

Development of new radiation-curable materials for the application in radiation curing technology is of significant importance. Most of the commercially available radiation-curable resins are derived from synthetic raw materials. The synthesis of acrylated, epoxidised soybean oil (ESO) from ESO had been carried out by reacting acrylic acid with the oxirane group in ESO. The acrylated ESO products were characterised using a variety of analytical techniques. Thus, the oxygen value, the iodine value, the acid value and the infrared spectra of the acrylated ESO products were obtained. Pigmented acrylated ESO systems were prepared and found to cure on exposure to UV radiation. [ABSTRACT FROM AUTHOR]

UV curable systems have found wide applications in clear coatings. However, coatings containing pigment showed a degree of curing inhibition due to the absorption, scattering and reflection of the UV radiation caused by the presence of pigments in the coating film. This results in poor through-cure and consequently in poor adhesion. Thus, pigments used in the UV curable coating systems should not absorb radiation in the same region as the photo-initiators. One of the solutions to such a problem, reported in this paper, was to develop more reactive, alcohol soluble, non-heat reactive, low molecular weight cresol based, pigmented novolac epoxy acrylate systems, which have a lower absorption in the UV region. In addition, the effects of several photoinitiators having absorption in the longer wavelength region of the UV spectrum were investigated. [ABSTRACT FROM AUTHOR]

Purpose - Epoxy curing agents are used to cure epoxy resins by reacting with the epoxide groups or by promoting self-polymerisation of the epoxy by catalytic action. Application characteristics and final physical properties can be tailored by the choice of curing agent. The purpose of this study was to reduce the cost of epoxy hardeners (polyamide and Mannich base, which are commercially available) without affecting the properties of epoxy system and which are also useable as low temperature curing in flooring. Design/methodology/approach - To prepare cost effecting Mannich base curatives for low temperature working environment without significantly affecting the properties such as toughening, adhesion, chemical resistance, etc. various compositions were made by incorporating liquid epoxy resin. Findings - Mannich base curatives were prepared by using different amounts of phenol/bisphenol-A, formaldehyde and polyamines to obtain products having different amine value, viscosity and colour. Liquid epoxy resin was cured by these Mannich base hardeners prepared. Drying time of relevant thin films was observed. These curatives showed excellent curing property at low temperature as well high humid conditions. Research limitations/implications - Mannich base curatives, used in present work was synthesised from phenol, DETA and dimethylamino propylamine. Besides, it could be synthesised from other phenol derivative such as cresol, resorcinol and cardanol. In the same manner, we can use other polyamines such as ethylenediamine. Practical implications - The method provided a simple and practical solution to reducing the cost of Mannich base hardener without significantly affecting the desired properties. Originality/value - The method used to prepare Mannich-based hardener was cost affective and could find numerous applications in protective coatings. [ABSTRACT FROM AUTHOR]

In children, benign neoplasms of extrahepatic biliary ducts are extremely rare. We report a case of 3 year old girl who pre-sented with abdominal pain and jaundice for 6 months. The final diagnosis on histopathology was papillomatosis in lower common bile duct. [ABSTRACT FROM AUTHOR]

Aims: Study on prognostic significance of antenatal ultrasonography and renin angiotensin system activation in predicting disease severity in posterior urethral valves. Materials and Methods: Antenatally diagnosed hydronephrosis patients were included. Postnatally, they were divided into two groups, posterior urethral valve (PUV) and non-PUV. The studied parameters were: Gestational age at detection, surgical intervention, ultrasound findings, cord blood and follow up plasma renin activity (PRA) values, vesico-ureteric reflux (VUR), renal scars, and glomerular filtration rate (GFR). Results: A total of 25 patients were included, 10 PUV and 15 non-PUV. All infants with PUV underwent primary valve incision. GFR was less than 60 ml/min/1.73 m 2 body surface area in 4 patients at last follow-up. Keyhole sign, oligoamnios, absent bladder cycling, and cortical cysts were not consistent findings on antenatal ultrasound in PUV. Cord blood PRA was significantly higher (P < 0.0001) in PUV compared to non-PUV patients. Gestational age at detection of hydronephrosis, cortical cysts, bladder wall thickness, and amniotic fluid index were not significantly correlated with GFR while PRA could differentiate between poor and better prognosis cases with PUV. Conclusions: Ultrasound was neither uniformly useful in diagnosing PUV antenatally, nor differentiating it from cases with non-PUV hydronephrosis. In congenital hydronephrosis, cord blood PRA was significantly higher in cases with PUV compared to non-PUV cases and fell significantly after valve ablation. Cord blood PRA could distinguish between poor and better prognosis cases with PUV.

Testosterone plays a vital role in the development of boys. There is a lack of age-specific reference data for testosterone representing a gap in our abilities to differentiate physiological deviations from pathological conditions such as delayed or precocious puberty, anatomical aberrations such as hypospadias or epispadias, micro-penis or buried-penis and disorders of sex development., Objective: To establish age-specific reference values for serum testosterone in boys aged 1-14 years and generate centile curves to predict testosterone levels by age., Materials and Methods: Serum testosterone levels were measured in 1398 boys aged 1-14 years using chemiluminescent microparticle immunoassay. The Generalized Additive Models for Location, Scale, and Shape framework was used to generate centile curves (3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th percentiles) for testosterone as a function of age., Results: The study revealed an age-dependent increase in serum testosterone (correlation coefficient:0.6; p ≤ 0.001). Serum testosterone remain low with minimal inter-individual variability until the onset of puberty, which is marked by a steep rise in levels. The inter-percentile range is widened significantly during puberty, indicating high variability in testosterone and co-existence of pre-pubertal boys with those already into puberty., Conclusions: The centile curves and reference values will bridge the literature-gap and serve as a critical tool in clinical practice. The findings also underscore the relevance of personalized assessment in view of individual variability in testosterone levels and the timings of the onset of puberty., Competing Interests: Conflict of interest None., (Copyright © 2025 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the "APASL ACLF Research Consortium (AARC)" was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia-Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the 'Golden Therapeutic Window', the 'transplant window', and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The 'Kyoto APASL Consensus' presented below carries the final recommendations along with the relevant background information and areas requiring future studies., (© 2025. The Author(s).)

Objective: Many neonatal units have started using Chlorhexidine gluconate for neonatal skin antisepsis. However, there is in-vitro evidence of inhibition of neurite growth. The current study aimed to compare two methods of its local application, for the extent of systemic absorption and antiseptic efficacy., Study Design: Parallel group, blinded, randomised trial, at a Level III, neonatal intensive care unit. Between December 2020 to July 2022, neonates from 28 to 34 weeks gestation, were randomized to local skin antisepsis by either- (a) 1% aqueous chlorhexidine (CHG aq) followed by cleansing off the residual agent with sterile water swab (Cleansing group) or (b)1% CHG aq followed by air drying (No cleansing group). The outcome measures were the proportion of post antisepsis skin swabs with no/insignificant growth, and the plasma chlorhexidine levels., Results: Of the total of 457 enrollments (Cleansing: n = 230; No Cleansing: n = 227), 216 (93.91%) in "Cleansing" vs. 221 (97.36%) in "No cleansing" (risk difference -3.45%, 95% CI -7.2 to 0.28%; p = 0.072) had no/insignificant growth post-antisepsis. The lower bound of the confidence interval crossed the pre-specified non-inferiority limit of 5%. The median (IQR) plasma chlorhexidine levels were not significantly different between the two groups (7.9 (5.6, 17.9)) ng/mL in Cleansing vs. 6.5 (4.6, 17.7) in No cleansing groups (p = 0.437)., Conclusion: Cleansing with sterile water after application of chlorhexidine in preterm neonates was not shown to be non-inferior compared to no cleansing, for skin antisepsis efficacy. Systemic absorption occurred to a similar extent despite cleansing off the residual agent., Trial Registration Number: CTRI/2020/10/028719., Competing Interests: Competing interests: The authors declare no competing interests. Study approval statement: This study protocol was reviewed and approved by the Institutional Ethics Committee of the All India Institute of Medical Sciences, New Delhi with approval number IECPG-429/26.08.2020, RT-20/ 23.09.2020 and was prospectively registered in Clinical Trials Registry- India (CTRI) with registration number CTRI/2020/10/028719. Consent to participate statement: Written informed consent was obtained from parents/legal guardians for the neonates to participate in the study., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Schwannomas are considered benign soft tissue tumors that originate from Schwann cells. Oral Schwannomas are rare and account for only 1% of all Schwannomas. Cellularschwannoma (CS) is a rare histological variant of schwannoma, characterized by high cellularity and cellular atypia. We present a case of localized growth of palatal mucosa that imitated the features of malignant peripheral nerve sheath tumor (MPNST) on histopathological examination; it was differentiated from MPNST by the correlation of clinical, histopathological, and immunohistochemical features., Competing Interests: The authors have declared that no conflict of interest exists., (Copyright: © Journal of Dentistry.)

Introduction: Pelvi-Ureteric Junction Obstruction (PUJO) is a common cause of hydronephrosis (HDN) in children. While ultrasonography (USG) is useful for initial assessment and grading of hydronephrosis, it cannot differentiate obstructive from non-obstructive cases. Renal Dynamic Scintigraphy (RDS) confirms the diagnosis but involves ionizing radiation exposure. Ureteric jets using colour Doppler USG have been proposed for diagnosing obstructive HDN., Objective: Our study aimed to evaluate Ureteric Jet Frequency (UJF) and Relative Jet Frequency (RJF) in unilateral PUJO before and after furosemide (Lasix) administration, assessing their diagnostic and post-operative utility., Materials and Methods: Children (<14 years) with unilateral HDN underwent USG and RDS for PUJO diagnosis. Pyeloplasty was performed based on standard criteria. UJF and RJF were assessed before and after furosemide administration (0.5 mg/kg) by colour Doppler USG. The non-obstructed side was taken as the control. Follow-up included repeat RDS and ureteric jet assessment., Results: Fifty-two cases were included. UJF (pre- and post-Lasix) was significantly lower in the obstructed side compared to the non-obstructed side at baseline and post-pyeloplasty (p < 0.0001). However, the baseline UJF difference between cases and controls was not significant (p > 0.05). UJF and RJF (pre- and post-Lasix) increased postoperatively. The UJF difference decreased postoperatively (p < 0.05). (attached Table) CONCLUSION: UJF and RJF are useful for diagnosing and monitoring unilateral PUJO. The effect of furosemide on UJF needs to be assessed using additional studies with larger sample sizes to understand if it can affect UJF in a way similar to that noted in diuretic scintigraphy., Competing Interests: Conflict of interest None to declare., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background Type 2 diabetes mellitus (T2DM) is a worldwide health issue impacting millions of individuals. In recent years, bone has been identified as an endocrine organ that regulates glucose metabolism by the release of osteocalcin, an osteoblast-specific hormone, which affects fat accumulation and blood glucose levels. Osteocalcin has been associated with insulin sensitivity and glucose control. Objective The study investigates the relationship between circulating osteocalcin levels with glycemic control parameters and insulin resistance in T2DM patients. Methods A total of 234 subjects were recruited, including T2DM patients (n=117) and age-sex-matched controls (n=117). Fasting blood samples were collected to measure fasting blood sugar (FBS), insulin, glycated hemoglobin (HbA1c), and osteocalcin levels. Osteocalcin levels were determined using an enzyme-linked immunosorbent assay. Insulin resistance was calculated using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Results The levels of osteocalcin in T2DM patients were significantly lower (7.07 ± 3.80 ng/mL) than in healthy controls (20.41 ± 13.50 ng/mL, p<0.0001). A significant negative correlation was observed between osteocalcin and HbA1c (r=-0.710, p<0.01), as well as between osteocalcin and FBS (r=-0.676, p<0.01). T2DM patients also showed significantly higher insulin resistance, as evidenced by their elevated HOMA-IR scores (4.39 ± 1.95 vs. 3.62 ± 1.82, p=0.002). There was a negative correlation between osteocalcin and HOMA-IR (r=-0.324, p=0.0001). Conclusion This study shows that osteocalcin levels are significantly reduced in patients with T2DM and demonstrate a negative correlation with HbA1c, FBS, and insulin resistance., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethical Committee of King George's Medical University issued approval 125th ECMIIB-Ph.D/P1. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tiwari et al.)

Background Type 2 diabetes mellitus (T2DM) is characterized by low insulin production or resistance. Adiponectin, a hormone produced by adipocytes, is essential for regulating glucose metabolism and is correlated with insulin decrease. Aim The aim of this study is to estimate the levels of adiponectin in T2DM patients and their relationship with various metabolic markers (glycated hemoglobin (HbA1c), fasting blood sugar (FBS), fasting insulin, lipid profile, and anthropometric variables in an Indian cohort. Methods This study was conducted at King George's Medical University (KGMU), India, from October 2022 to October 2024. The study (case-control) included 234 subjects: T2DM patients and age-sex-matched healthy controls. Diagnosis of T2DM followed American Diabetes Association criteria. Data collection involved medical history, anthropometric measurements, blood pressure, and biochemical assessments including FBS, HbA1c, lipid profiles, insulin levels, and insulin resistance. Serum adiponectin levels were estimated using an ELISA kit. Results T2DM patients had a significantly higher HbA1c value (7.82±0.96%) compared to controls (5.31±0.39%, p<0.001). Insulin resistance was also significantly higher in T2DM patients (4.31±0.95) than in controls (3.62±0.82, p=0.002). Adiponectin levels were significantly lower in T2DM patients (6.87±3.73 µg/mL) compared to controls (10.18±5.16 µg/mL, p<0.001). Low levels of adiponectin were correlated with HbA1c (r=-0.58, p<0.001), FBS (r=-0.51, p<0.001), and total cholesterol (r=0.38, p<0.001). Adiponectin levels also were correlated with BMI (r=-0.33, p<0.001). Conclusion Lower adiponectin levels in T2DM patients correlate with HbA1c and increased insulin resistance, suggesting that adiponectin may be a biomarker for diabetes management and risk assessment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. King George's Medical University issued approval Ref. Code: 125th ECMIIB-Ph.D/P1. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tiwari et al.)

During face mask ventilation, invariably, some air enters the esophagus rather than the airways; this results in gastric insufflation while the esophagus is intact or loss of tidal volume in patients with a cervical esophagostomy (Cx-esophagostomy)., Objective: The objective of the study was to report the indigenous use of an electrocardiography (ECG) electrode in successfully occluding the Cx-esophagostomy to prevent inadvertent loss of tidal volume., Materials and Methods: Twenty-nine observations were recorded on 27 patients (mean age: 10.9 months; male:female = 2.6:1). The oral cavity, pharynx, and Cx-esophagostomy were cleared of saliva. Peristomal area was cleaned with dry gauze and dried with alcohol. Latex-free, 50 mm, ECG electrode was pasted symmetrically over the Cx-esophagostomy. The efficacy of the electrode was assessed using a five-point algorithm: (i) collapse of reservoir bag, (ii) chest expansion, (iii) ballooning of electrode, (iv) cotton-wisp test, and (v) change in compliance with manual compression of the electrode. Subgroup analysis was conducted for laterality and health of Cx-esophagostomy., Results: Study cohort: Cx-esophagostomy was located on the left in 58.26% ( n = 17/29) patients. The health of Cx-esophagostomies was graded from I to IV ( n = 9, 16, 3, and 1, respectively). The collapse of the reservoir bag and chest rise indicated successful ventilation. Ballooning of the electrode with each breath was observed in 79% (23/29) patients. Partial separation of the electrode from the skin (exaggerated with each breath) was observed in 10.3% (3/29) patients (Group I: n = 1, Group III: n = 1, and Group IV: n = 1). This was related to poor local preparation or pooling of saliva ( n = 1; Group I: resolved with procedural re-application of a fresh electrode) and underlying skin condition ( n = 2; Groups III and IV: resolved only temporarily with re-application). The cotton-wisp test was positive in two additional patients (1 each in Groups II and III) and was related to the pooling of saliva. No change in compliance was observed with manual compression of the electrode. No difference in success was observed between left and right Cx-esophagostomies. Overall success with this technique was 82.8% with a potential for 100% in those with peristomal health graded I-III., Conclusions: The ECG electrode is a technically simple, cost-effective, and widely available device, instrumental in addressing the problem of air leak through Cx-esophagostomy during face mask ventilation before intubation., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Indian Association of Pediatric Surgeons.)

The stability-indicating approach for tavaborole quantification was developed and validated to establish a precise, linear, accurate, and robust HPLC method. The development section includes optimizing the detection wavelength, the mobile phase ratio, and the type of column used to achieve the best possible separation and sensitivity for analysis. The chromatographic conditions were established, considering peak symmetry, resolution, and retention time. The mobile phase composition, comprising a buffer: acetonitrile (75 : 25, %v/v), with an injection volume of 15 μL, showed suitable elution and recovery at 265 nm. A constant column oven temperature of 35 °C and a 1 mL min -1 flow rate were maintained. The pH of the buffer was changed to 3.0 by using orthophosphoric acid. Linearity was observed from 5 to 1000 ppm ( r 2 = 1.00000). The capacity (retention) factor ( k ) of 3.43 was observed, indicating significant interaction and good separation. Forced degradation (FD) or stress tests were performed for chemical and physical photolytic stress conditions, and the results observed were within the specified limits. The stability in the analytical solution was observed for up to 35 hours at 5 °C, confirming the stability of the solution. Validation of the developed HPLC method confirmed the system's suitability, precision, linearity, accuracy, FD, robustness, and results. All validation criteria for the technique were within acceptable limits.

Background: Bacterial vaginosis (BV) is a common clinical manifestation of a perturbed vaginal ecology associated with adverse sexual and reproductive health outcomes if left untreated. The existing diagnostic modalities are either cumbersome or require skilled expertise, warranting alternate tests. Application of machine-learning tools to heterogeneous and high-dimensional multi-omics datasets finds promising potential in data integration and may aid biomarker discovery., Objectives: The present study aimed to evaluate the potential of the microbiome and metabolome-derived biomarkers in BV diagnosis. Interpretable machine-learning algorithms were used to evaluate the utility of an integrated-omics-derived classification model., Methods: Vaginal samples obtained from reproductive-age group women with (n = 40) and without BV (n = 40) were subjected to 16S rRNA amplicon sequencing and LC-MS-based metabolomics. The vaginal microbiome and metabolome were characterized, and machine-learning analysis was performed to build a classification model using biomarkers with the highest diagnostic accuracy., Results: Microbiome-based diagnostic model exhibited a ROC-AUC (10-fold CV) of 0.84 ± 0.21 and accuracy of 0.79 ± 0.18, and important features were Aerococcus spp., Mycoplasma hominis, Sneathia spp., Lactobacillus spp., Prevotella spp., Gardnerella spp. and Fannyhessea vaginae. The metabolome-derived model displayed superior performance with a ROC-AUC of 0.97 ± 0.07 and an accuracy of 0.92 ± 0.08. Beta-leucine, methylimidazole acetaldehyde, dimethylethanolamine, L-arginine and beta cortol were among key predictive metabolites for BV. A predictive model combining both microbial and metabolite features exhibited a high ROC-AUC of 0.97 ± 0.07 and accuracy of 0.94 ± 0.08 with diagnostic performance only slightly superior to the metabolite-based model., Conclusion: Application of machine-learning tools to multi-omics datasets aid biomarker discovery with high predictive performance. Metabolome-derived classification models were observed to have superior diagnostic performance in predicting BV than microbiome-based biomarkers., (© 2024 European Academy of Dermatology and Venereology.)

Objectives: This study aimed to evaluate the safety and efficacy of therapeutic plasma exchange (TPE) in pediatric acute liver failure (PALF)., Methods: All children aged 2-18 years with PALF were included. The intervention cohort included a subset of PALF patients undergoing complete three sessions of TPE, whereas the matching controls were derived by propensity score matching from the patient cohort who did not receive any TPE. Propensity matching was performed based on the international normalized ratio (INR), grade of hepatic encephalopathy (HE), age, bilirubin, and ammonia levels. The primary outcome measure was native liver survival (NLS) in the two arms on day 28., Results: Of the total cohort of 403 patients with PALF, 65 patients who received TPE and 65 propensity-matched controls were included in analysis. The 2 groups were well balanced with comparable baseline parameters. On day 4, patients in the TPE group had significantly lower INR (P = 0.001), lower bilirubin (P = 0.008), and higher mean arterial pressure (MAP) (P = 0.033) than controls. The NLS was 46.15% in the TPE arm and 26.15% in the control arm. The overall survival (OS) was 50.8% in the TPE arm and 35.4% in the control arm. Kaplan-Meier survival analysis showed a significantly higher NLS in patients receiving TPE than controls (P = 0.001). On subgroup analysis, NLS benefit was predominantly seen in hepatitis A-related and indeterminate PALF., Conclusion: TPE improved NLS and OS in a propensity-matched cohort of patients with PALF. Patients receiving TPE had lower INR and bilirubin levels and higher MAP on day 4., (© 2024 Wiley Periodicals LLC.)

Aims: GDNF plays a crucial role in the stimulation of recovery, neuroplasticity and synaptic reorganization after spinal cord injury providing neuroprotection and neuroregeneration. Plasma GDNF levels are upregulated in cases of spina bifida owing to the intrauterine damage of the exposed spinal cord. Our aim was to compare the plasma GDNF levels in patients of spina bifida with non-spina bifida cases and assess the correlation with neurological impairment at one year of follow up., Methods: Single centre prospective analysis of cases of spina bifida from 2020 to 2022 at presentation and after one year of follow up post-surgery. Cases with hernia and hydrocele without any other disorders were recruited into the control group. Plasma GDNF levels were assessed with immunoassay kits and compared with neurological involvement., Results: 85 cases were included in the study. GDNF levels were elevated in cases compared to controls (mean 6.62 vs 1.76) with significant p value (<0.01). Same was observed for open and closed defects (mean 7.63 vs 4.86: p < 0.01). At follow up of 52 cases post-surgery cases with neurogenic bladder with abnormal urodynamic studies, sphincter involvement and motor impairment had significantly elevated baseline levels of GDNF compared with those who did not have this neurological impairment (p < 0.01)., Discussion: The neurotrophic factor up-regulation can reflect an endogenous attempt at neuroprotection against the biochemical and molecular cascades triggered by the spinal cord damage. This upregulation can be represented as important biochemical markers of severe spinal cord damage and can be associated with severity of spine injury in MMC patients. Our results are in keeping with these findings, that, there were increased levels of plasma GDNF levels in cases of spinal dysraphism compared to control population. Also, the type of lesion reflecting the severity whether a closed or an open dysraphism, showed significant difference in levels between them suggesting, yet again, more damage in open defect as expected. The levels were higher with involvement of bladder, sphincter and lower limb power., Conclusion: There is significant elevation of plasma GDNF levels in cases of spina bifida and this elevation is proportional to the degree of spinal damage and hence the neurological impairment. GDNF levels are a good predictor for assessing the severity of the lesion and thus the outcome in these cases. Additional prospective and long-term studies with a larger cohort are needed for a better understanding of neurotrophin pattern modulation in MMC., Competing Interests: Conflict of interest None to declare., (Copyright © 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

The present study aimed to determine diagnostic performance of dried blood spot (DBS) for the detection of Hepatitis B surface antigen (HBsAg) and Hepatitis C virus antibodies (anti-HCV) using CLIA at 3 different laboratories across India. DBS can serve as a simple and convenient alternative to plasma/serum for HBsAg detection. However for anti-HCV, site-specific validation of the assay is warranted., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Nanotechnology has provided nanostructure-based delivery of drugs, among which nanocrystals have been investigated and explored for feasible topical drug delivery. Nanocrystals are nano-sized colloidal carriers, considered pure solid particles with a maximum drug load and a very small amount of stabilizer. The size or mean diameter of the nanocrystals is less than 1 μm and has a crystalline character. Prominent synthesis methods include the utilization of microfluidic- driven platforms as well as the milling approach, which is both adaptable and adjustable. Nanocrystals have shown a high capacity for loading drugs, utilization of negligible amounts of excipients, greater chemical stability, lower toxic effects, and ease of scale-up, as well as manufacturing. They have gained interest as drug delivery platforms, and the significantly large surface area of the skin makes it a potential approach for topical therapeutic formulations for different skin disorders including fungal and bacterial infections, psoriasis, wound healing, and skin cancers, etc. This article explores the preparation techniques, applications, and recent patents of nanocrystals for treating various skin conditions., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Nanosizing is widely recognized as an effective technique for improving the solubility, dissolution rate, onset of action, and bioavailability of poorly water-soluble drugs. To control the execution and behavior of the output product, more advanced and valuable analytical techniques are required., Objective: The primary intent of this review manuscript was to furnish the understanding of imaging and non-imaging techniques related to nanosizing analysis by focusing on related patents. In addition, the study also aimed to collect and illustrate the information on various classical (laser diffractometry, photon correlation spectroscopy, zeta potential, laser Doppler electrophoresis, X-ray diffractometry, differential scanning calorimeter, scanning electron microscopy, transmission electron microscopy), new, and advanced analytical techniques (improved dynamic light scattering method, Brunauer-Emmett- Teller method, ultrasonic attenuation, biosensor), as well as commercial techniques, like inductively coupled plasma mass spectroscopy, aerodynamic particle sizer, scanning mobility particle sizer, and matrix- assisted laser desorption/ionization mass spectroscopy, which all relate to nano-sized particles., Methods: The present manuscript has taken a fresh look at the various aspects of the analytical techniques utilized in the process of nanosizing, and has achieved this through the analysis of a wide range of peer-reviewed literature. All summarized literature studies provide the information that can meet the basic needs of nanotechnology., Results: A variety of analytical techniques related to the nanosizing process have already been established and have great potential to weed out several issues. However, the current scenarios require more relevant, accurate, and advanced analytical techniques that can minimize the time and deviations associated with different instrumental and process parameters. To meet this requirement, some new and more advanced analytical techniques have recently been discovered, like ultrasonic attenuation technique, BET technique, biosensors, etc. Conclusion: The present overview certifies the significance of different analytical techniques utilized in the nanosizing process. The overview also provides information on various patents related to sophisticated analytical tools that can meet the needs of such an advanced field. The data show that the nanotechnology field will flourish in the coming future., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Throughout the past several centuries, herbal constituents have been the subject of scientific interest and the latest research into their therapeutic potential is underway. Genistein is a soy-derived isoflavone found in huge amounts in soy, along with the plants of the Fabaceae family. Scientific studies have demonstrated the beneficial effects of genistein on various health conditions. Genistein presents a broad range of pharmacological activities, including anticancer, neuroprotective, cardioprotective, antiulcer, anti-diabetic, wound healing, anti-bacterial, antiviral, skin, and radioprotective effects. However, the hydrophobic nature of genistein results in constrained absorption and restricts its therapeutic potential. In this review, the number of nanocarriers for genistein delivery has been explored, such as polymeric nanoparticles, nanostructured lipid carriers, solid lipid nanoparticles, liposomes, micelles, transferosomes, and nanoemulsions and nanofibers. These nano-formulations of genistein have been utilized as a potential strategy for various disorders, employing a variety of ex vivo, in vitro , and in vivo models and various administration routes. This review concluded that genistein is a potential therapeutic agent for treating various diseases, including cancer, neurodegenerative disorders, cardiovascular disorders, obesity, diabetes, ulcers, etc., when formulated in suitable nanocarriers., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Introduction: Emulgel dosage form is an advanced form of transdermal drug delivery. It is a combination of emulsion and gel in a definite ratio. Emulsions are incorporated into the gel with proper mixing. The emulsion present in emulgel can be either oil/water or water/oil, which is thickened by mixing it with a gelling agent., Materials and Methods: On the basis of the solubility of lornoxicam in various oils, a surfactant and a co-surfactant were selected for further research. For the preparation of emulgel, the emulsion was prepared with Smix (surfactant and co-surfactant) in a ratio of 1:2. The prepared emulsion was incorporated into different concentrations of carbapol 934 in a 1:1 ratio to make a homogenous emulgel., Results: The emulgel was inspected visually to see if it had any phase behaviour, spreadability, or grittiness by applying it to a slide. All formulations were evaluated for pH, physical properties, drug content, spreadability, extrudability, swelling index, viscosity, and centrifugation. Franz diffusion cell was used to perform in-vitro release of formulation with the help of egg membrane. Among all formulations, F3 showed 83% release after 6 hours and showed acceptable physical properties like homogeneity, colour, consistency, pH value, spreadability, extrudability, and drug content., Discussion: Thus, emulgel can be regarded as a more feasible drug delivery system for hydrophobic drugs (lornoxicam) than the currently marketed formulation. Optimized emulgel formulation consists of a microemulsion of lornoxicam, 1% of carbopol 934, propylene glycol, sodium benzoate, lemon grass oil, glycerin, and distilled water. In the in-vitro release studies, pH 7.4 phosphate buffer emulgel formulation (F3) showed 83% after 6 hours. Emulgel was found to be stable under stable conditions., Conclusion: The emulgel of the poorly water-soluble drug (lornoxicam) was formulated. The components and their optimum ratio for the formulation of microemulsion were obtained by solubility studies and droplet size analysis. Thus, microemulsion can be regarded as a more feasible dose delivery system for lornoxicam than the currently marketed tablet, capsule, and injection formulations. Optimized microemulsion of lornoxicam was incorporated into the gel base. Therefore, it may be concluded that emulgel of lornoxicam can be used as a controlledrelease dosage form of the drug for local application in rheumatoid arthritis., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Salivary gland neoplasms account for 3% of all head and neck tumours. Pleomorphic adenoma (PA) is the most common salivary gland tumour that mainly occurs in the parotid gland, followed by minor salivary glands of the oral cavity, however, the occurrence of PA inside the jaw bones is exceedingly rare and very few cases have been reported in the literature. Inside jaw bones these lesions tend to imitate large osteolytic lesions encompass a diagnostic challenge. An exhaustive review of the literature revealed only 10 cases of central pleomorphic adenoma. We present a rare case of primary PA that occurred inside the mandible and was provisionally diagnosed as ameloblastoma.

Nanocosmetics have attracted a considerable audience towards natural care due to their low cost, target-specific delivery, and reduced toxicity compared to chemical-based cosmetics. Nanofomulations, including nanoemulsions, nanotubes, and polymeric carriers, have become next-generation products explored for the multifaced applications of nanotechnology in skin care. The rise in the cosmetic industry demands innovative and personalized products designed using nanocarriers for better targeting and improving patient compliance. Furthermore, nanocosmetics increase the efficiency of skin permeation active ingredient entrapment, providing better UV protection. Moreover, it offers controlled drug release, targeting active sites and enhancing physical stability. Further, overcoming the drawback of penetration problems makes them sustainable formulations for precision medicine. Skincare nourishment with nanocosmetics using Indian spices helps to maintain, beautify, and rejuvenate human skin. Nanophytopharmaceuticals extracted from plants, including alkaloids, flavonoids, antioxidants, and volatile oils, are essential phyto-products for skin care. Nano herbals and nanocosmetics are a growing market and gift of nature that nourishes and cures skin ailments like acne, pemphigus, anti-aging, albinism, psoriasis, and fungal infections. The emerging concern is highlighted in the investigation of nanoformulation toxicity and safety concerns in skin care. Further, it helps to manifest research, development, and innovation in expanding the scope of herbal industries., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Currently, fungal infections are becoming more prevalent worldwide. Subsequently, many antifungal agents are available to cure diseases like pemphigus, athlete's foot, acne, psoriasis, hyperpigmentation, albinism, and skin cancer. Still, they fall short due to pitfalls in physiochemical properties. Conventional medications like lotion, creams, ointments, poultices, and gels are available for antifungal therapy but present many shortcomings. They are associated with drug retention and poor penetration problems, resulting in drug resistance, hypersensitivity, and diminished efficacy. On the contrary, nanoformulations have gained tremendous potential in overcoming the drawbacks of conventional delivery. Furthermore, the potential breakthroughs of nanoformulations are site-specific targeting. It has improved bioavailability, patient-tailored approach, reduced drug retention and hypersensitivity, and improved skin penetration. Nowadays, nanoformulations are gaining popularity for antifungal therapy against superficial skin infections. Nanoformulations-based liposomes, niosomes, nanosponges, solid lipid nanoparticles, and potential applications have been explored for antifungal therapy due to enhanced activity and reduced toxicity. Researchers are now more focused on developing patient-oriented target-based nano delivery to cover the lacunas of conventional treatment with higher immune stimulatory effects. Future direction involves the construction of novel nanotherapeutic devices, nanorobotics, and robust methods. In addition, for the preparations of nanoformulations for clinical studies, animal modeling solves the problems of antifungal therapy. This review describes insights into various superficial fungal skin infections and their potential applications, nanocarrier-based drug delivery, and mechanism of action. In addition, it focuses on regulatory considerations, pharmacokinetic and pharmacodynamic studies, clinical trials, patents, challenges, and future inputs for researchers to improve antifungal therapy., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Phagosome maturation arrest (PMA) imposed by Mycobacterium tuberculosis ( Mtb ) is a classic tool that helps Mtb evade macrophage anti-bacterial responses. The exclusion of RAB7, a small GTPase, from Mtb -phagosomes underscores PMA. Here we report an unexpected mechanism that triggers crosstalk between the mitochondrial quality control (MQC) and the phagosome maturation pathways that reverses the PMA. CRISPR-mediated p62/SQSTM1 depletion ( p62 KD ) blocks mitophagy flux without impacting mitochondrial quality. In p62 KD cells, Mtb growth and survival are diminished, mainly through witnessing an increasingly oxidative environment and increased lysosomal targeting. The lysosomal targeting of Mtb is facilitated by enhanced TOM20 + mitochondria-derived vesicles (MDVs) biogenesis, a key MQC mechanism. In p62 KD cells, TOM20 + -MDVs biogenesis is MIRO1/MIRO2-dependent and delivered to lysosomes for degradation in a RAB7-dependent manner. Upon infection in p62 KD cells, TOM20 + -MDVs get extensively targeted to Mtb -phagosomes, inadvertently facilitating RAB7 recruitment, PMA reversal and lysosomal targeting of Mtb . Triggering MQC collapse in p62 KD cells further diminishes Mtb survival signifying cooperation between redox- and lysosome-mediated mechanisms. The MQC-anti-bacterial pathway crosstalk could be exploited for host-directed anti-tuberculosis therapies.

Pregnancy being an immune compromised state, coronavirus disease of 2019 (COVID-19) disease poses high risk of premature delivery and threat to fetus. Plasma metabolome regulates immune cellular responses, therefore we aimed to analyze the change in plasma secretome, metabolome, and immune cells with disease severity in COVID-19 positive pregnant females and their cord blood. COVID-19 reverse transcriptase-polymerase chain reaction positive pregnant females (n = 112) with asymptomatic (Asy) (n = 82), mild (n = 21), or moderate (n = 9) disease, healthy pregnant (n = 18), COVID-19 positive nonpregnant females (n = 7) were included. Eighty-two cord blood from COVID-19 positive and seven healthy cord blood were also analyzed. Mother's peripheral blood and cord blood were analyzed for untargeted metabolome profiling and cytokines by using high-resolution mass spectrometry and cytokine bead array. Immune scan was performed only in mothers' blood by flow cytometry. In Asy severe acute respiratory syndrome coronavirus 2 infection, the amino acid metabolic pathways such as glycine, serine, l-lactate, and threonine metabolism were upregulated with downregulation of riboflavin and tyrosine metabolism. However, with mild-to-moderate disease, the pyruvate and nicotinamide adenine dinucleotide (NAD + ) metabolism were mostly altered. Cord blood mimicked the mother's metabolomic profiles by showing altered valine, leucine, isoleucine, glycine, serine, threonine in Asy and NAD + , riboflavin metabolism in mild and moderate. Additionally, with disease severity tumor necrosis factor-α, interferon (IFN)-α, IFN-γ, interleukin (IL)-6 cytokine storm, IL-9 was raised in both mothers and neonates. Pyruvate, NAD metabolism and increase in IL-9 and IFN-γ had an impact on nonclassical monocytes, exhausted T and B cells. Our results demonstrated that immune-metabolic interplay in mother and fetus is influenced with increase in IL-9 and IFN-γ regulated pyruvate, lactate tricarboxylic acid, and riboflavin metabolism with context to disease severity., (© 2023 Wiley Periodicals LLC.)

Introduction: Liver transplant is a life-saving treatment, but due to the limited availability of suitable liver donors, ABO-incompatible liver transplants (ABOi-LT) are conducted to increase the availability of liver donors. Perioperative desensitization for ABOi-LT is an established strategy to circumvent the risk of graft rejection. A single prolonged session can be performed to achieve the desired titers to avoid using multiple immunoadsorption (IA) columns or off-label reuse of single-use columns. This study retrospectively assessed the effectiveness of a single prolonged plasmapheresis session using IA as a desensitization strategy in live donor liver transplant (LDLT)., Materials and Methods: This retrospective observational study conducted at a center for liver diseases in North India on six ABOi-LDLT patients who underwent single prolonged IA sessions in the perioperative period from January 2018 to June 2021., Results: Median baseline titer in patients was 320 (64, 1024). The median plasma volume adsorbed was 7.5 volumes (4, 8) per procedure, with a mean procedure time of 600 min (310-753). The reduction in titer ranged from 4 log to 7 log reduction per procedure. Two patients developed transient hypotension during the procedure, which was managed successfully. The median duration of pre-transplant hospital stay was 1.5 days (1, 3)., Conclusion: Desensitization therapy helps overcome the ABO barrier and decreases the waiting period before a transplant when ABO identical donors are unavailable. A single prolonged IA session reduces the cost of additional IA columns and hospital stay, thus making it a cost-effective approach to desensitization., (© 2023 Wiley Periodicals LLC.)

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) viral load (VL) estimation is essential for the management of both HBV and HCV infections. Due to a longer turnaround time for VL estimation, many patients drop out from the cascade of care. To achieve the global goals of reducing morbidity and mortality due to HBV/HCV and moving towards their elimination by 2030, molecular diagnostic platforms with faster and random ( i.e. single sample) access are needed., Aim: To evaluate the performance of the recently launched NeuMoDx 96 random access system with the conventional COBAS ® AmpliPrep/COBAS TaqMan system for HBV and HCV VL estimation., Methods: Archived once-thawed plasma samples were retrieved and tested on both platforms. Correlation between the assays was determined by linear regression and Bland-Altman analysis. The study included samples from 186 patients, 99 for HBV of which 49 were true infected HBV cases (hepatitis B surface antigen, anti-hepatitis B core antibody, and HBV DNA-positive) and 87 for HCV assay in which 39 were true positives for HCV infection (anti-HCV and HCV RNA-positive)., Results: The median VL detected by NeuMoDx for HBV was 2.9 (interquartile range [IQR]: 2.0-4.3) log 10 IU/mL and by COBAS it was 3.70 (IQR: 2.28-4.56) log 10 IU/mL, with excellent correlation (R 2 = 0.98). In HCV, the median VL detected by NeuMoDx was 4.9 (IQR: 4.2-5.4) log 10 IU/mL and by COBAS it was 5.10 (IQR: 4.07-5.80) log 10 IU/mL with good correlation (R 2 = 0.96)., Conclusion: The overall concordance between both the systems was 100% for both HBV and HCV VL estimation. Moreover, no genotype-specific bias for HBV/HCV VL quantification was seen in both the systems. Our findings reveal that NeuMoDx HBV and HCV quantitative assays have shown overall good clinical performance and provide faster results with 100% sensitivity and specificity compared to the COBAS AmpliPrep/COBAS TaqMan system., Competing Interests: Conflict-of-interest statement: The authors declare having no conflict of interest that pertains to this work., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Dysmenorrhea (menstrual or periodic pain) is a discomfort that occurs during painful periods. It is the first and most prominent reason for female lower abdominal pain. Most adolescent girls consider it a curse due to the periodic occurrence of painful cramps and bleeding. The pathogenesis of painful periods is most likely because of increased prostanoids, notably prostaglandins, produced by the cyclooxygenase pathway (PGs). Misuse of synthetic medications leads to the development of medication resistance and deposits toxic residues in the body; thus, there is a critical need for safe and effective alternatives. In recent decades, herbal treatment approaches have found extensive applications in the treatment of various ailments. Herbal therapies are an alternate source, which include several bioactive chemicals, and recent improvements in our understanding of the value of herbal therapy methods have caused a sharp rise in their production. The main focus of this review was to study herbal treatment options; the recent studies conducted on herbal therapies and various experimental investigations on dysmenorrhea and herbal therapy methods have been studied, and randomized controlled trials and animal models have been discussed describing the anti-inflammatory properties of some potential herbal medicines that can be used as treatment options for dysmenorrhoea. This review aimed to present herbal treatments that can be used as alternative traditional synthetic medications and oral hormonal contraceptives in the treatment of painful menstruation., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Isolated liver lobe devascularization is a very rare case, with conflicting literature regarding management. We describe a very unusual case of traumatic isolated right lobe devascularization of the liver with its attendant management challenges. An eight-year-old boy with a history of road traffic accidents presented with abdominal pain. Although the child was hemodynamically stable on presentation, extended focused assessment with sonography in trauma was positive. Contrast-enhanced computed tomography (CECT) scan of the torso revealed a nonenhancing right lobe of the liver involving segments 5-8 and the gross hemoperitoneum. Nonoperative management was tried. There were persistent high-grade fever spikes, for which prophylactic antibiotics were started, but the fever workup was negative. Abdominal drains were inserted to drain fluid and relieve distress. Output was noted to be bilious on day 21 of injury. Diagnostic laparoscopy on day 22 revealed hypertrophied left lobe of the liver with an absent (autolyzed) right lobe. The subsequent ward course was uneventful, and the child was discharged in stable condition. Thus, the indication of surgery in such cases is clinical deterioration, not radiological findings. Management should be in a dedicated trauma center with immediate operating room availability., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sehgal et al.)

Background: Urinary NGAL (neutrophil gelatinase-associated lipocalin) levels have been shown to predict renal damage in various medical conditions. The present study was conducted to study the role of urinary NGAL levels in children with bladder exstrophy-epispadias complex post single-stage total reconstruction (SSTR) as markers of early renal function reduction., Methods: Urine samples were collected from children with bladder exstrophy before SSTR (Group A, n = 11), 5 years post SSTR (Group B, n = 40) and controls (Group C, n = 41) and stored at - 20 °C. NGAL levels were estimated using double antibody sandwich ELISA., Results: Mean NGAL levels in Groups A, B and C were 1.39, 34.24 and 2.58 ng/ml, respectively. Mean NGAL levels among Group B subjects with glomerular filtration rate (GFR) ≥ 80 ml/min/1.73 m 2 body surface area (BSA) was 29.8 ng/ml, while it was 31.74 ng/ml in those with GFR < 80 ml/min. Urine samples were also evaluated 6 months post SSTR. Mean NGAL at 6 months was 6.76 ng/ml, while at 12 months it was 30.3 ng/ml, remaining > 30 ng/ml at 18 and 24 months. Dimercaptosuccinic acid (DMSA) scans did not show any scarring, and GFR on diethylenetriamine pentaacetate (DTPA) scans remained stable., Conclusions: Increasing levels of urinary NGAL following bladder-exstrophy and epispadias complex repair suggest that NGAL detects the earliest signs of renal damage even before any deterioration is observed in DMSA and/or DTPA-GFR scans. Further studies with an adequate sample size and periodic measurement of NGAL need to be performed before any definitive conclusion can be drawn., (© 2022. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Competing Interests: There are no conflicts of interest.

Objective: To summarize the available evidence and to quantitatively evaluate the global results of different waterproofing layers in substantiating the UCF repair., Material and Methods: After defining the study protocol, the review was conducted according to the PRISMA guidelines by a team comprising experts in hypospadiology, systematic reviews and meta-analysis, epidemiology, biostatistics and data science. Studies published from 2000 onwards, reporting on the results of UCF closure after hypospadias repair were searched for on PUBMED, Embase and Google Scholar. Study quality was assessed using Joanna Briggs Checklist (JBI) critical appraisal tool. The results with different techniques were compared with the two samples independent proportions test with the help of Microsoft Excel, MedCalc software and an online calculator., Results: Seventy-three studies were shortlisted for the synthesis; the final analysis included 2886 patients (71 studies) with UCF repair failure in 539. A summary of various dimensions involved with the UCF repair has been generated including time gap after last surgery, stent-vs-no stent, supra-pubic catheterization, suture material, suturing technique, associated anomalies, complications, etc. The success rates associated with different techniques were calculated and compared: simple catheterization (100%), simple primary closure (73.2%), dartos (78.8%), double dartos flaps (81%), scrotal flaps (94.6%), tunica vaginalis (94.3%), PATIO repair (93.5%), biomaterials or dermal substitutes (92%), biocompatible adhesives (56.5%) and skin-based flaps (54.5%). Several techniques were identified as solitary publications and discussed., Conclusions: Tunica vaginalis and scrotal flaps offer the best results after UCF closure in the synthesis. However, it is not possible to label any technique as ideal or perfect. Almost all popular waterproofing layers have depicted absolute (100%) success sometimes. There are a vast number of other factors (patient's local anatomy, surgeon's expertise and technical perspectives) which influence the final outcome., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: The aim of our study is to present our experience in the management and outcome of Wilms tumor with intracaval thrombus., Materials and Methods: All children with Wilms tumor with intracaval thrombus who presented to us from July 2000 to December 2017 were reviewed retrospectively. We evaluated the tumor stage, management, and outcomes in these patients., Results: Thirty-four patients were included in the study. The median age of presentation was 48 months (11 to 84 mo). Preoperative chemotherapy was given in 32 (94%), with a median duration of 8 weeks. Intracaval thrombus completely resolved in 9 (26%) children after neoadjuvant chemotherapy. Surgical intervention for residual inferior vena cava (IVC) thrombus was performed in 32 patients. The median follow-up was 30 months (5 to 150 mo). At the last follow-up, 24 patients (70%) were alive and disease free. The 5-year overall survival (OS) and event-free survival were 67% (95% confidence interval, 50% to 84%) and 59% (95% confidence interval, 42% to 76%). The OS in children with nonmetastatic disease (94%) was significantly higher than those with metastases (29%; P <0.01). The OS in children with complete resolution of IVC thrombus (100%) was significantly higher than those with persistent thrombus (48%; P =0.025). Analysis of survival outcomes in children with nonmetastatic disease (stage III) revealed no significant difference on comparison with cohort with stage III disease with absence of IVC thrombus. The P -value was 0.224 and 0.53 for 5-year OS and event-free survival, respectively., Conclusion: The management of Wilms tumor can be complicated by the presence of caval thrombus. Patients with metastasis have a significantly poor outcome. Patients in whom, there is complete resolution of intracaval thrombus on neoadjuvant chemotherapy have a significantly higher OS., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Gastric surface mucosal cells are responsible for the uptake and secretion of 99mTcO4, a feature that has been used in imaging heterotopic gastric mucosa. We used the same principle to look for gastric mucosal viability in this case of pure esophageal atresia admitted for cervical stomal closure after a previous isoperistaltic gastric tube (IGT) replacement procedure. 99mTcO4 scintigraphy was done after encountering a failure to maneuver the esophagoscope through the IGT. The study was helpful in assessing the loss of gastric mucosal viability in an intervening segment of the IGT., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Hepatitis B surface antigen (HBsAg) seroconversion is sometimes observed in hepatitis B reactivation (rHBV), probably due to immune resetting and differentiation., Aims: To investigate sequential immune differentiation and abrogation of tolerance in patients with rHBV who achieved HBsAg seroconversion., Methods: We included 19 patients with chronic hepatitis B (CHBV; HBV DNA log10 3-8 ), 67 with rHBV (raised ALT [>5XULN], HBV DNAlog10 4-8 ) and 10 healthy controls. Immune differentiation, tolerance and functional status of CD4, CD8, T regulatory cells (Tregs), B cells and follicular T helper (Tfh) cells were assessed at baseline and 24 weeks., Results: At 24 weeks, 81% rHBV (n = 67) lost HBV DNA and HBeAg (41%), and 12 (19%) lost HBsAg and made anti-HBs titers >10 IU/ml. rHBV patients had higher Th1/17, T EM , Tfh, Tfh1/17, plasma and ATM B cells, and lower Tregs, Th2, Th17 and TEMRA expression. rHBV showed lower PD1, TIM3, LAG3, SLAM and TOX compared to CHBV. There was a significant increase in CD8, CD8EM, Tfh, Tfh1/17 and plasma B cells in seroconverters than non-seroconverters. At 24 weeks, we also observed increased plasma B cell frequency in seroconverters. While non-seroconverters showed higher expression of PD1, TIM3, LAG3, SLAM and TOX on CD4/CD8 T cells, blockade of PD1, TIM3, LAG3 and CTLA4 significantly enhanced IFN-γ, TNF-α, IL-4 and IL-21 expression on CD4/CD8 and Tfh cells in non-seroconverters., Conclusions: Non-seroconverters have increased inhibitory markers on CD4/CD8 T cells. There is a critical play of CD8, Tfh and B cells and subsets in seroclearance, along with checkpoint molecules as a potential therapy for non-seroconverters in HBV infection., (© 2022 John Wiley & Sons Ltd.)

Introduction: Surgical complication following esophageal atresia repair is one of the several factors known to influence the final outcomes. Early identification of such complications may help in timely institution of therapeutic measures and translate into improved prognosis., Objective: The objective of this study was to evaluate the role of procalcitonin in early prediction of the adverse events after surgery in patients of esophageal atresia and the temporal relationship with clinical manifestations and other inflammatory biomarkers such as C-reactive protein (CRP)., Materials and Methods: This was a prospective study on consecutive patients of esophageal atresia ( n = 23). Serum procalcitonin and CRP levels were assessed at baseline (prior to surgery) and on postoperative days (POD) 1, 3, 5, 7, and 14. The trends in the biomarker values and temporal relationships of deviation in trend with the clinical and conventional laboratory parameters and patient outcomes were analyzed., Results: Baseline serum procalcitonin was elevated ( n = 23; 1.7 ng/ml: min: 0.07 ng/ml-max: 24.36 ng/ml) in 18/23 (78.3%) patients. Procalcitonin nearly doubled on POD-1 ( n = 22; 3.28 ng/ml: min: 0.64 ng/ml-max: 16.51 ng/ml) followed by a gradual decline. CRP was also elevated on POD-1 (three times the baseline) and depicted a delayed peak at POD-3. POD-1 procalcitonin and CRP levels correlated with survival. POD-1 procalcitonin cutoff at 3.28 ng/ml predicted mortality with a sensitivity and specificity of 100% and 57.9% ( P = 0.05). Serum procalcitonin and CRP were higher for patients who sustained complications, so was the time required for hemodynamic stabilization. Procalcitonin (baseline and POD-5) and CRP (POD-3 and POD-5) values correlated with the clinical course after surgery. Baseline procalcitonin cutoff at 2.91 ng/ml predicted the possibility of a major complication with a sensitivity of 71.4% and a specificity of 93.3%. POD-5 procalcitonin cutoff at 1.38 ng/ml predicted the possibility of a major complication with a sensitivity of 83.3% and a specificity of 93.3%. Patients who sustained major complications depicted a change in serum procalcitonin trend 24-48 h ahead of clinical manifestation of an adverse event., Conclusions: Procalcitonin is a good indicator to identify the adverse events in neonates after surgery for esophageal atresia. The procalcitonin levels in patients who sustained a major complication depicted a reversal in trend 24-48 h of clinical manifestation. POD-1 procalcitonin correlated with survival while the baseline and POD-5 serum procalcitonin predicted the clinical course., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Indian Association of Pediatric Surgeons.)

Objective: A systematic review and meta-analysis of the studies evaluating the utility of the Testicular Work-up for Ischemia and Suspected Torsion (TWIST) score in establishing or excluding the diagnosis of testicular torsion (TT) is herewith presented in an attempt to quantify the available evidence., Methods: The study protocol was outlined in advance. The review has been conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The PubMed, PUBMED Central, PMC databases & Scopus followed by Google (Scholar & search engine) were systematically interrogated with the keywords TWIST score, testis and testicular torsion. Fourteen sets of data (n = 1940) from 13 studies were included; data from 7 studies (giving a detailed score-wise break-up) (n = 1285) were dis-integrated and re-integrated to tweak the cut-offs for low and high risk., Results: For every 4 patients presenting to the Emergency Department (ED) with acute scrotum, one patient will eventually be diagnosed with TT. The mean TWIST score was higher in patients with testicular torsion (5.13 ± 1.53 vs 1.50 ± 1.40 for those without TT). TWIST score can be used to predict testicular torsion at cut-off of 5 with a sensitivity, specificity, PPV, NPV, and accuracy of 0.71 (0.66, 0.75; 95%CI), 0.97 (0.97, 0.98; 95%CI), 90.2%, 91.0%, and 90.9% respectively. While the slider for cut-off was shifted from 4 to 7, there was a rise in specificity and PPV of the test with a corresponding decline in sensitivity, NPV, and accuracy. The sensitivity witnessed a sharp decline from 0.86 (0.81-0.90; 95%CI) @ cut-off 4 to 0.18 (0.14-0.23; 95%CI) @ cut-off 7. The area under the SROC curve for cut-off 5 was more than that for cut-offs 4, 6 & 7. TWIST cut-off of 2 may be used to predict the absence of testicular torsion with a sensitivity, specificity, PPV, NPV, and accuracy of 0.76 (0.74, 0.78; 95%CI), 0.95 (0.93, 0.97; 95%CI), 97.9%, 56.5%, and 80.7%, respectively. While the cut-off is lowered from 3 to 0, there is a corresponding rise in the specificity and PPV, while the sensitivity, NPV, and accuracy are compromised. The sensitivity witnesses a sharp decline from 91 to 35%. The area under the SROC curve for cut-off 2 was more than that for cut-off @ 0, 1 or 3. The sum of sensitivity and specificity of TWIST scoring system to ascertain the diagnosis of TT is more than 1.5 for cut-off values 4 & 5 only. The sum of sensitivity and specificity of TWIST scoring system to confirm the absence of TT is more than 1.5 for cut-off values 3 & 2 only., Conclusion: TWIST is a relatively simple, flexible, and objective tool which may be swiftly administered even by the para-medical personnel in the ED. The overlapping clinical presentation of diseases originating from the same organ may prevent TWIST from absolutely establishing or refuting the diagnosis of TT in all the patients with acute scrotum. The proposed cut-offs are a trade-off between sensitivity and specificity. Yet, the TWIST scoring system is immensely helpful in the clinical decision-making process and saves time-lag associated with investigations in a significant majority of patients., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Paragangliomas are neuroendocrine tumors similar to pheochromocytomas but arising from extra adrenal site. It is a very rare tumor in an intraoral site, we found a single case of intraoral paraganglioma in a literature, and hence as per our best knowledge this is only the second case of paraganglioma presented in an intraoral location. We present here a case report of paraganglioma on the ventral surface of the tongue. A 37 years old lady presented with a large asymptomatic swelling on the ventral surface of the tongue from one year. The past medical history and familial history were non relevant to the swelling. Surgical excision was performed and histopathological examination of the specimen revealed the diagnosis of extra adrenal paraganglioma. The case is being presented here for its rarity in an intraoral location., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Oral and Maxillofacial Pathology.)