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Objective: Pharmacogenomics plays an important role in drug metabolism. A stable anticoagulation is important for primary and secondary prevention of cardioembolic stroke and cerebral venous sinus thrombosis (CVST). We report the role of cytochrome P450 (CYP2C9*2/*3) and vitamin K epoxide reductase subunit 1 (VKORC1) genotypes and acquired causes in maintaining stability of anticoagulation following acenocoumarin in cardioembolic stroke and CVST. Methods: The study comprised 157 individuals with cardioembolic stroke and CVST who were on acenocoumarin. Their comorbidities, comedication, and dietary habits were noted. Prothrombin time and international normalized ratio (INR) were measured during follow-up, and the coagulation status was categorized as stable (>50% occasions in therapeutic range) and unstable (>50% below and above therapeutic range). Genotyping of VKORC1, CYP2C9*2, and CYP2C9*3 was done by polymerase chain reaction-restriction fragment length polymorphism. Bleeding and embolic complications were noted. The predictors of unstable INR were evaluated using multivariate analysis. Results: INR was stable in 47.8% and unstable in 52.2% of patients. Patients with mutant genotypes required low dose of acenocoumarin. The predictors of unstable INR were metallic valve (odds ratio [OR] 4.07, 95% confidence interval [CI] 1.23-13.49, P = 0.02), use of digoxin (OR 0.031, 95% CI 0.13-0.74, P = 0.09), proton pump inhibitor (OR 0.23, 95% CI 0.06-0.91, P = 0.037), sodium valproate (OR 0.22, 95% CI 0.05-0.85, P = 0.029), and CYP2C9*2 genotype (OR 5.57, 95% CI 1.19-26.06, P = 0.02). Conclusions: Variant genotypes of VKORC1, CYP2C9*2, and CYP2C9*3 required lower dose of acenocoumarin, and CYP2C9*2 was associated with unstable INR. Comedication is a modifiable risk factor that needs attention. [ABSTRACT FROM AUTHOR]

A diagnosis of autism typically depends on clinical assessments by highly trained professionals. This high resource demand poses a challenge in low-resource settings. Digital assessment of neurodevelopmental symptoms by non-specialists provides a potential avenue to address this challenge. This cross-sectional case-control field study establishes proof of principle for such a digital assessment. We developed and tested an app, START, that can be administered by non-specialists to assess autism phenotypic domains (social, sensory, motor) through child performance and parent reports. N = 131 children (2–7 years old; 48 autistic, 43 intellectually disabled and 40 non-autistic typically developing) from low-resource settings in Delhi-NCR, India were assessed using START in home settings by non-specialist health workers. The two groups of children with neurodevelopmental disorders manifested lower social preference, greater sensory interest and lower fine-motor accuracy compared to their typically developing counterparts. Parent report further distinguished autistic from non-autistic children. Machine-learning analysis combining all START-derived measures demonstrated 78% classification accuracy for the three groups. Qualitative analysis of the interviews with health workers and families of the participants demonstrated high acceptability and feasibility of the app. These results provide feasibility, acceptability and proof of principle for START, and demonstrate the potential of a scalable, mobile tool for assessing neurodevelopmental conditions in low-resource settings. Autism is diagnosed by highly trained professionals– but most autistic people live in parts of the world that harbour few or no such autism specialists and little autism awareness. So many autistic people go undiagnosed, misdiagnosed, and misunderstood. We designed an app (START) to identify autism and related conditions in such places, in an attempt to address this global gap in access to specialists. START uses computerised games and activities for children and a questionnaire for parents to measure social, sensory, and motor skills. To check whether START can flag undiagnosed children likely to have neurodevelopmental conditions, we tested START with children whose diagnoses already were known: Non-specialist health workers with just a high-school education took START to family homes in poor neighbourhoods of Delhi, India to work with 131 two-to-seven-year-olds. Differences between typically and atypically developing children were highlighted in all three types of skills that START assesses: children with neurodevelopmental conditions preferred looking at geometric patterns rather than social scenes, were fascinated by predictable, repetitive sensory stimuli, and had more trouble with precise hand movements. Parents' responses to surveys further distinguished autistic from non-autistic children. An artificial-intelligence technique combining all these measures demonstrated that START can fairly accurately flag atypically developing children. Health workers and families endorsed START as attractive to most children, understandable to health workers, and adaptable within sometimes chaotic home and family environments. This study provides a proof of principle for START in digital screening of autism and related conditions in community settings. [ABSTRACT FROM AUTHOR]

This paper presents a Computer‐aided design (CAD) model for a‐IGZO thin film transistors (TFTs) by adapting SPICE level‐61 RPI a‐Si: H (Hydrogenated Amorphous Silicon) TFT model and level‐62 RPI Poly‐Si (Poly Silicon) TFT model. This work provides a complete understanding of SPICE level‐61 and 62 model parameters, which must be tuned for a‐IGZO TFT simulation. The adapted SPICE models of level‐61 and level‐62 could model all regions of operation of the TFT, that is, above‐threshold and below‐threshold regions. Adapted RPI poly‐Si model also shows the kink effect in ZnO thin film transistors (TFTs) due to the recombination of electron–hole pairs in the channel via boundary trap states present in the poly‐Si TFTs thereby increasing the drain current in the transistors above pinch‐off region. The extracted performance parameters of the adapted models were found to be contiguous with experimental results. The maximum deviation in the subthreshold slope is approximately 5 mV/decade for level‐61 a‐Si TFT, and for level‐62 poly‐Si TFT, deviation in the subthreshold slope is even less, that is, 0.2 mV/decade. The experimental and simulated characteristics, extracted on‐to‐off ratio, negative bias reverse saturation current, and threshold voltage were almost similar. However, an average deviation of 2.4% and 2.27% was observed in the output characteristics of the adapted level‐61 and level‐62 models, respectively. [ABSTRACT FROM AUTHOR]

Introduction: Covid-19 patients can have both regional and global ventricular dysfunction. We aim to study the spectrum of myocardial involvement in Covid-19 patients on echocardiography. Methods: This is a single center, observational study where wall motion abnormality patterns were studied in Covid-19 patients along with global and regional longitudinal strain analysis (GLS). Results: 30 Covid-19 patients were included in the study, with a mean age of 35.3±6.4 years. Echocardiography revealed characteristic wall motion abnormality involving hypokinesia of anterolateral and apical segments, which produced an operculum like appearance in all patients. Strain derived ejection fraction(EF) was lower in 4 chamber as compared to 2 chamber indicating regional myocardial dysfunction. Reduced GLS values in presence of normal EF indicates global systolic function impairment. Endocardial effacement was also noted in these segments along with stretching of interventricular septum. Conclusion: Specific myocardial involvement pattern can be detected on echocardiography, thus helping in diagnosis of Covid myocarditis. [ABSTRACT FROM AUTHOR]

Due to its significant role in neurodegeneration, Cyclin‐dependent kinase 5 (CDK5) has emerged as a potential target for addressing neuropathological disorders, including Alzheimer's disease (AD). The application of CDK5 inhibitors has demonstrated promise in the treatment of AD. This prompted us to model this interesting target using a computational workflow named Docking‐based Comparative Intermolecular Contacts Analysis (dbCICA). Approaches including 3D‐QSAR, genetic algorithm, and pharmacophore modeling were employed to discover new CDK inhibitors. [ABSTRACT FROM AUTHOR]

Background: Environmentally sustainable diets are represented in the EAT‐Lancet recommendations developed by the Lancet Commission on Planetary Health in 2019. Very few studies have compared Indian diets with the EAT‐Lancet recommendations. The present study performed such a comparison using primary dietary consumption data from adults in north and south India. Methods: Data from 8762 adults (52.4 ± 11.7 years) residing in Sonipat and Vizag India were collected on sociodemographic characteristics, wealth index (household assets) and dietary intake (food frequency questionnaire: nine food groups). The quantity consumed and energy from each food group was compared with the EAT‐Lancet recommendations. We investigated the likelihood of deficit or excess in consumption compared to the EAT‐Lancet recommendations by different sociodemographic factors. Results: Half of the participants were women and half resided in rural areas. Vegetables and fruits were consumed in lower quantity, whereas dairy and added fats were consumed in higher quantity than recommended by the EAT‐Lancet recommendations. For whole grains, female gender and poorest wealth index were the factors associated with deficit or no consumption, whereas, for vegetables and fruits, it was poorest wealth index and residence in rural areas (p < 0.05, all). Rural residence and poorest wealth index were associated with excess consumption of dairy and added fats (p < 0.05, all). Conclusions: The diets of the study participants were mainly plant‐based, and high in dairy but lacking in nutrient‐rich foods such as vegetables and fruits. Appropriate policy actions for making healthy sustainable diets and micronutrient‐rich foods available and affordable to all with a particular focus on the poor and rural populations are warranted. Very few studies have compared Indian diets with the EAT‐Lancet dietary recommendations. The present study performed such a comparison using primary dietary consumption data, finding that Indian diets were mainly plant‐based, being high in dairy but lacking in nutrient‐rich foods such as vegetables and fruits. Highlights: Compared with the EAT‐Lancet recommendations, Indian diets were deficit in fruits and vegetables consumption but exceeded in dairy and added fats.Female gender, rural residence and poorest wealth index were associated with lower nutrient rich foods consumption.To ensure sustainable and healthy diets in India, the EAT‐Lancet recommendations should be adopted considering Indian Council of Medical Research guidelines.Urgent policy actions are needed to make healthy and sustainable diets locally available accessible and affordable to all. [ABSTRACT FROM AUTHOR]

Introduction: Achilles tendinopathy [AT] is a functional problem characterised by swelling and pain above the Achilles tendon insertion region. In individuals with AT, PRP or platelet-rich plasma can be used as an alternative modality of treatment with an aim to lessen the discomfort and enhance functional recovery. We assessed the available data supporting the effectiveness of PRP in treating chronic AT. Materials and methods: We did a literature search for randomised controlled trials [RCTs] that contrasted the effectiveness of PRP with that of eccentric exercise and placebo injections as treatment for AT in databases such as the Cochrane Library, Web of Science, PubMed, and EMBASE. The Visual analogue scale [VAS] score, Victorian Institute of Sports Assessment-Achilles [VISA-A] score, and Achilles tendon thickness were used to measure the results. We used the RevMan 5.3.5 software for statistical analysis. Results: We included five RCTs in this meta-analysis. There was no significant difference in the VISA-A between the PRP and placebo groups at 12 weeks, 24 weeks and 1 year after treatment. However, at 6 weeks after treatment, PRP exhibited better efficacy than the placebo treatment. Two studies in our meta-analysis included VAS scores and tendon thickness. There was no significant difference in VAS scores at 6 weeks and 24 weeks after treatment. However, VAS scores at 12 weeks and tendon thickness were significantly different. Conclusion: PRP injection is an effective treatment for chronic AT. It has a unique potential for increasing function and reducing discomfort in AT patients. [ABSTRACT FROM AUTHOR]

Aim and objectives: To assess the comparative evaluation of chest radiograph and high-resolution computed tomography in diagnosis of interstitial lung disease. Materials and method: This cross-sectional study was carried out in the department of Radio-diagnosis, RMCH, Bareilly. X-ray chest PA view and High-Resolution Computed Tomography was done for all the included patients. Results: Female predominance was observed in our study. It was observed that more number of patients with reticular opacities, nodular opacities, septal thickening, honeycombing, traction bronchiectasis and mosaic attenuation were detected in HRCT method compared to X-ray method, the difference amongst the two methods was statistically significant (P<0.05). Conclusion: Clinical indicators of interstitial lung disease (ILD) are frequently ignored, and its respiratory symptoms are frequently mistaken for those of more prevalent pulmonary disorders like COPD, which delays diagnosis. As a result, HRCT is crucial for the diagnosis, treatment, and follow-up of diffuse lung diseases cases. [ABSTRACT FROM AUTHOR]

Background: Thyroid dysfunction is the leading endocrine disorder worldwide. Iodine deficiency disorders, which were once the major etiology of thyroid dysfunctions, now have been succeeded by autoimmune thyroid diseases with the rise in aberrant salt ionization protocols. This study endeavors to access the level of thyroid autoantibodies viz. anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (TGA), and anti-thyroid stimulating hormone receptor (TRAb) in individuals with subnormal thyroid profiles. Methods: This hospital-based cross-sectional study was conducted at the Department of Clinical Biochemistry, Tribhuvan University for a period of six months. Using non-probability (purposive) sampling method, a total of 60 patients were enrolled with subnormal thyroid profiles to include the population who have not yet started medication. Thyroid hormones (free T3, free T4, TSH) and thyroid antibodies (anti-TPO, TGA, and TRAb) were measured. For non-parametric data, Chi-square test and Kruskal-Wallis test were used. Spearman's correlation was done to determine the association between variables. Results: Out of 60 participants, the majority of the population between 25 and 44 years were diagnosed with thyroid dysfunction with female preponderance. Among all, 40% (n = 24) had subclinical hyperthyroid states while, 60% (n = 36) had subclinical hypothyroid states, and 75% (n = 45) of the total exhibited positive thyroid antibodies. In subclinical hypothyroid patients with TSH above 10 µIU/ml, anti TPO (58.5%) and TGA (66.7%) positivity were highly prevalent. On the other hand, TRAb was exclusively positive in hyperthyroid condition (50% among the group) which is by far the first of its kind reported in Nepal. Conclusion: The rise in autoimmune thyroid disease among the Nepalese population infers that addressing iodine deficiency simply through salt iodinization may not be adequate to deal with the rising burden of thyroid disorders, especially in iodine-depleted areas. Also, the increasing prevalence of thyroid autoantibodies positivity in subclinical hypothyroidism in the Nepalese population accounts for the arduous screening and monitoring of autoimmune thyroid disorders in Nepal. [ABSTRACT FROM AUTHOR]

Objective. The association between Polycystic Kidney Disease (PKD) and susceptibility to developing oncogenicity states remains controversial, and no consensus has yet been reached. Large-scale studies on this association are also lacking. Therefore, we identified the risk of developing cancer in PKD patients. Methods. Patients diagnosed with PKD between 2000 and 2010 were enrolled in the National Health Insurance Research Database (NHIRD)-derived Longitudinal Health Insurance. Patients with antecedent cancer, end-stage renal disease, or those diagnosed with cancer within one year were excluded. Using a Standardized Incidence Ratio (SIR), we compared the patterns of cancer incidence in PKD patients and the general population. Results. The entire cohort was observed for 8,014 people, and a total of 1820 PKD patients were included, and after a median follow-up of 4.43 years, 82 patients developed cancer. Though the risk of overall cancers was comparable between PKD patients and the general population, the PKD patients exhibited a higher risk of kidney malignancy (SIR 3.72, 95% CI 1.60∼7.33). The female PKD patients were at a higher risk of lung and mediastinal cancer (SIR: 2.83, 95% CI 1.03∼6.16). The subgroup analysis revealed a significantly higher risk of kidney cancer in the patients aged <65 years (SIR 7.39, 95% CI 1.99∼18.93) than those elderly patients, especially in the females (SIR 9.81, 95%1.10∼35.41, p < 0.05). The multivariate analysis showed significant risk factors for cancer among the PKD population, including 1-year age (HR 1.04; 95% CI 1.02–1.06; p < 0.001), male gender (HR 1.85; 95% CI 1.14–3.00; p = 0.012), and chronic liver disease (HR 2.03; 95% CI 1.31–3.13; p < 0.001). Conclusion. PKD patients may be more susceptible to developing renal, lung, and mediastinal cancer than the control population, which might be attributed to PKD genetic instability. [ABSTRACT FROM AUTHOR]

Background: Pregnancy induced hypertensive (PIH) disorders are a significant cause of adverse maternal and fetal outcomes, especially in developing areas of the world. Objective of this study to compare the maternal and fetal outcomes of PIH patients with normotensive control in central India Materials & Methods: This is a prospective study conducted in the department obstetrics and Gynaecology, GRMC, Gwalior, India. 122 women with PIH admitted for delivery were included in the study. Outcomes of PIH were assessed in terms of feto-maternal complications. All the quantitative data were statistically analyzed by chi-quire test and P-value. Results: Majority (56.6%) of the study subjects were between 21 to 25 years, mostly from rural areas (55.7%) and belonged to lower socio-economic status (74.5%). The highest proportion of them (73.7%) had >37 wk of gestational age and also primigravida (74.5%). Anaemia and edema was significantly associated with PIH patients. LSCS, IUGR and PROM were more common in PIH group, whereas GDM, BOH and decreased foetal movement were common in control group. LBW babies, me conium Stained Liquor, maternal and foetal mortality were significantly higher in PIH. Conclusions: Pregnancy-related hypertensive disorders are common and adversely impact maternal and fetal outcomes. Efforts should be made at both the community and hospital levels to increase awareness regarding PIH and reduce its associated morbidity and mortality. [ABSTRACT FROM AUTHOR]

Dementia of vascular origin is a distinct variety with a heterogeneous neuropsychological profile. Very few studies have compared the behavioral dysfunction in the large vessel and small vessel vascular dementia (VaD) and studied the association between executive dysfunction and behavioral dysfunction documented in these patients, between the white matter load in small vessel disease (SVD) and the behavioral dysfunction. 76 patients having a modified Hachinski Ischemic Scale score of ≥ 4 were recruited and categorized into a small vessel and large vessel VaD. The Neuropsychiatric Inventory (NPI) score ≥ 4 per domain for defining clinically relevant symptoms and the Clinical Dementia Rating Scale (CDR) for evaluating the severity of dementia were used. Behavioral and Psychological Symptoms of Dementia (BPSD) were present in 66.67% of patients with SVD and 53.57% of those having large vessel disease. Apathy, euphoria, and disinhibition were more common in SVD, while appetite alterations were more common in large vessel disease. Behavioral dysfunction was also associated with executive dysfunction in both the VaD subtypes and with white matter loads in SVD. We conclude that different VaD subtypes have different behavioral profiles. This might help in understanding the underlying pathophysiology, diagnosis and thus better management of this disorder. [ABSTRACT FROM AUTHOR]

Objective: The study investigated adherence with MMF treatment among patients attending rheumatology clinics at University Hospitals Coventry and Warwickshire NHS Trust (UHCW) with Autoimmune inflammatory rheumatic diseases (AIIRDs). Methods: This retrospective study collated hospital pharmacy data in patients who requested the prescription for MMF between January 2015 and December 2018. Clinical data were obtained from paper and electronic notes. Data were analysed using Microsoft Excel. Ethical approval was obtained through Coventry University. Results: We recruited 144 patients into this study with age range from 18 to 91 years, including 100 females and 44 males. There were 112 White patients, 22 of South Asian origin, 3 East Asian and 4 black patients. SLE (56), scleroderma (18), mixed connective tissue disease (15), myositis (13), vasculitis (13) were the commonest diagnoses. Overall adherence with Mycophenolate mofetil was 62%. The adherence rates were below 80% for all age groups with ∼60% of patients having adherence levels of >60%. Poor adherence with MMF correlated with 3‐fold increase in risk of flares compared to good adherence (p = 0.002). We also found a significant difference between Asian patients (mean adherence 47%) and White patients (mean adherence 65%, p < 0.001). Conclusion: Adherence with MMF has improved considerably compared to historical studies, although these remain suboptimal. Certain population groups such as young adults, elderly and Asian patients continue to have lower adherence and higher risk of flares. Strategies are needed to improve adherence levels overall and specifically in the high‐risk groups to reduce risk of flares and organ damage. [ABSTRACT FROM AUTHOR]

Aims To perform an integrated comparative analysis of metabolic pathway to understand coenzyme Q10 (CoQ10) production in Agrobacterium tumefaciens. Methods and results Comparative analysis of the CoQ10 metabolic pathway in 10 organisms using a genome to KEGG orthology program (G2KO) and the KEGG database elucidated the completeness of the production pathway in A. tumefaciens. The specific roles of the key precursors and the enzymes in the metabolic network were subsequently confirmed using pathway inhibitors and enhancers. While the use of fosmidomycin and glyphosate was found to inhibit CoQ10 production by 54.54% to 99%, the supplementation of polyprenyl pyrophosphate of the methylerythritol 4-phosphate pathway and 4-hydroxybenzoate precursor of the shikimate pathway did increse the production of CoQ10 by 2.3-fold. Conclusions The present study provides a comprehensive understanding of the CoQ10 biosynthetic pathway in A. tumefaciens , which would assist rational metabolic engineering strategies for augmenting CoQ10 biosynthesis. [ABSTRACT FROM AUTHOR]

Aims: To study the respiratory variation of right atrial (RA) pressures at baseline and during atrioventricular nodal reentry tachycardia (AVNRT). Methods: Of the 23 patients screened, 16 participants with typical AVNRT were included in the study. After ensuring adequate hydration, baseline RA pressures were measured as the height of 'a' and 'v' waves. The patients were asked to take deep breaths, and the measurements were taken in both inspiration and expiration. Results: Of the 16 participants, 14(87.5%) showed a normal fall in the height of 'a' and 'v' waves with inspiration, 1(6.25%) showed no change and 1(6.25%) showed a rise in height at baseline, p <0.01. During induced AVNRT, the 'a' and 'v' wave heights increased in 8(50%), remained same in 6(37.5%) and showed a normal fall in 2(12.5%), p = 0.07 for 'a' waves and p = 0.09 for 'v' waves. When the magnitude and direction of change in 'a' and 'v' wave height at baseline was compared with AVNRT, it showed a significant difference with 13(81.25%) participants demonstrating positive Pseudo-Kussmaul's sign, p <0.01. Mean age was numerically higher in those with a more considerable inspiratory rise in RA pressures but was not statistically significant, χ2(2) = 3.1, p = 0.21. Conclusions: Pseudo-Kussmaul's sign does occur in a substantial number of patients during AVNRT. Clinical appreciation of this phenomenon is possible in half to three-fourth of patients, provided the mean RA pressures are low enough for the variation to be visible in the neck. [ABSTRACT FROM AUTHOR]

BACKGROUND: In multi-transfused thalassemia patients, serological phenotyping fails to test patient's actual blood group antigen profile due to the presence of donor red blood cell (RBC) in the circulation. This limitation of serological tests can be overcome by genotype determination using the polymerase chain reaction (PCR)-based methods. The aim of this study is to compare the serological phenotyping of Kell, Kidd, and Duffy blood group systems with molecular genotyping in the normal blood donors and multi-transfused thalassaemia patients. MATERIALS AND METHODS: Blood samples from 100 normal blood donors and 50 thalassemia patients were tested using standard serological techniques and PCR-based methods for Kell (K/k), Kidd (Jka/Jkb), and Duffy (Fya/Fyb) blood group systems. The results were compared for concordance. RESULTS: Genotyping and phenotyping results were 100% concordant for normal blood donors whereas those for thalassemia patients showed 24% discordance. The frequency of alloimmunization in thalassemia patients was 8%. The results of genotyping were used to provide Kell, Kidd, and Duffy matched blood for transfusion therapy to thalassemia patients. CONCLUSION: The actual antigen profile in multitransfused thalassaemia patients can be reliably determined using genotyping. This would benefit in providing better antigen matched transfusion therapy to such patients hence reducing the rate of alloimmunization. [ABSTRACT FROM AUTHOR]

Context: The Upanishads are primary texts of Yoga philosophy and practices. Various Yoga Upanishads have given detailed description of various yogic practices along with their spiritual and physical benefits. This study aims to assess the effect of one Pranayama practice from Trishikhbrahmana Upanishad on sleep quality in adults. Aim: The aim of the study was to assess the effect of a Pranayama technique (described in the Trishikhbrahmana Upanishad) on sleep quality in adults. Settings and Design: An experimental study was conducted on volunteer participants from North India. Subjects and Methods: A pretest-posttest control group study was designed where the participants (n = 30) were randomized into study (n = 15) and control (n = 15) groups. The study group was given the Pranayama intervention for 30 days whereas the control group was not given any intervention throughout the study. The sleep quality was assessed by using the Pittsburgh Sleep Quality Index (PSQI). Statistical Analysis Used: GraphPad Instat Software was used to carry out independent t-test. The mean and standard deviation were also calculated. Results: The results showed a significant improvement in the postglobal PSQI score in the study group (P < 0.001) whereas there was no significant change in the pre- and postglobal PSQI score in the control group (P = 0.941). Conclusion: The results suggest that the Pranayama technique from the text and its effects are true in improving the sleep quality in adults but future studies with a larger sample size and some other physiological parameter assessments may further support the textual claim. [ABSTRACT FROM AUTHOR]

In this paper, we implement the semi‐analytical schemes, namely, local fractional homotopy perturbation Sumudu transform method (LFHPSTM) and local fractional homotopy analysis Sumudu transform method (LFHASTM), for finding the approximate analytical solutions of local fractional Laplace equations under different initial conditions on Cantor sets. The novelty of the work lies in the application of these suggested schemes which were never used to solve the local fractional Laplace equation. The Laplace equation mainly contributes to electrostatistics, mechanical engineering, and theoretical physics. This equation also helps in formulation of the electrostatic problem of a rod under a torsion load. Moreover, it helps in handling potential field problems also. These aspects enhance the significance of getting a solution of the local fractional Laplace equation in fractal media. The suggested methods are copulation of local fractional homotopy perturbation method and local fractional homotopy analysis method with the local fractional Sumudu transform, respectively. The computational process indicates that the schemes are very efficient to obtain nondifferentiable solutions for given equations in a smooth way. Moreover, the solution analysis depicts that both the local fractional hybrid homotopy schemes are in a good agreement with each other. These methods depict the accuracy and efficiency of the implemented methods in view of correspondence with solutions obtained with other methods in previous works. The numerical simulations for obtained results are discussed for various values of order of a local fractional derivative. The 3D graphs on the Cantor set are constructed with the help of Matlab software. [ABSTRACT FROM AUTHOR]

In this work, we have investigated perovskite-based solar cells (PSCs) with seven different organic hole transport layers (HTLs), which include spiro-2,2’,7,7’-Tetr- akis-(N, N-di-4-methoxyphenylamino) −9,9’-spirobifluorene (OMeTAD), poly(triaryl amine) (PTAA), poly (3,3”’-dialkyl- quaterthiophene) (PQT), poly (3, 4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS), poly (3-hexylthioph- ene-2,5-diyl) (P3HT), Poly [2-methoxy-5-(2’-ethylhexyloxy)-1,4-phenylene vinylene] (MEH-PPV), and n-Propyl Bromide (nPB). This article reports the impact of several device parameters, such as perovskite layer defect density, and thickness, on the solar cell performance. We examined the device performance for the PSC device architecture, i.e., fluorine-doped tin oxide (FTO)/TiO2/CH3NH3PbI3/HTLs/Au. For this study, numerical simulation has been performed and optimized for optimum absorber layer thickness and defect density. In this study, we report the power conversion efficiency (PCE) with various HTLs, such as 10.01% for MEH-PPV, 13.94% for PEDOT:PSS, 14.75% for P3HT, 15.42% for PQT, 15.74% for NPB, 17.08% for PTAA, and 17.11% for spiro-OMeTAD at an optimized thickness of 300 nm. It is asserted that there is an enhancement in the photovoltaic performance observed while using spiro-OMeTAD and PTAA as HTL. PSC using spiro-OMeTAD as HTL shows exceptional performance compared to other HTLs. Other parameters obtained for PSC using spiro-OMeTAD are ${V}_{OC}$ of 1.10 V, ${J}_{SC}$ of 20.772 mA/cm2, FF of 0.74%, and PCE of 17.11%. The elicited simulation results suggest that spiro-OMeTAD is the most promising candidate for HTL to fabricate low-cost, highly efficient, and low-temperature processed hybrid PSC. [ABSTRACT FROM AUTHOR]

Background: Bi-spectral index (BIS) has been traditionally used to monitor the depth of anesthesia, with the forehead being the usual site for electrode placement. When the manufacturer-recommended site is itself an operative field or the placement interferes with the surgery, the search for an alternative position of electrode placement is warranted. In our endeavor to do so, we conducted this study to compare BIS scores derived from frontal and supralabial electrode placement. Methods: A cross-sectional study was conducted on a group of 50 patients using two BIS Quatro sensors attached to the frontal and supralabial regions of each patient and connected to two different sets of monitors. BIS values, electromyography (EMG) values, and signal quality index (SQI) were noted from both sites every 15 min during the maintenance phase of anesthesia. Collected data were analyzed using the Bland-Altman analysis. Results: Data analysis of BIS values showed negative bias at most time points with a minimum negative bias of 0.2 with a limit of agreement of -3.67/3.27 and a maximum negative bias of 1.14 with a limit of agreement of -7.61/5.33. The overall 95% limit of agreement for pooled BIS data ranged from -6.63 to 6.1. Conclusion: BIS sensor placement at the supralabial site can be used as an alternative to the frontal placement in scenarios where the frontal position is the surgical site or is inaccessible during the maintenance of general anesthesia as in neurosurgery with particular emphasis on skin preparation and proper positioning of BIS electrodes to improve the signal quality. [ABSTRACT FROM AUTHOR]

BACKGROUND- The laparoscopic cholecystectomy procedure is typically carried out under general anaesthesia, but regional techniques, such as low thoracic isobaric spinal anaesthesia, have been used to manage patients with significant medical problem like coexisting systemic disease, who are deemed to be high risk in general anaesthesia. Segmental spinal anaesthesia has great outcomes in terms of post-operative discomfort, the need for analgesics, relatively fewer complications, and shorter hospital stays. Thus the aim of this study to avoid and minimize the risk of general anaesthesia who does not have any significant comorbidity. So it might be a substitute for a standard laparoscopic cholecystectomy. MATERIAL AND METHODS- Total 60 adult patient with ASA1 &II, 18-60 years,with normal coagulation profile, is divided into 2 groups. Group IS (Isobaric)--given 2.5 ml of isobaric preservative free bupivacaine 0.5% (levobupivacaine) + 0.5 mg of Fentanyl at T9- T10/T10-T11 into sub arachnoid space. Group GA -- given general anaesthesia using propofol, fentanyl citrate and atracurium besylate. After intubation, ventilation was controlled and balanced anaesthesia was continued with isoflurane. After completion, neuromuscular block was anatagonized neostigmine methyl-sulfate and glycopyrrolate at the end of surgery. RESULTS- Isobaric spinal anaesthesia showed good control in intraoperative as well as postoperative pain control as compared to general anaesthesia. In few patients, there were minor degrees of nausea, vomiting, abdominal pain, shoulder pain, patient anxiety or itching which were treated with standard medication like fentanyl and midazolam. All patients can resume oral intake on the day of surgery. CONCLUSIONS- In conclusion, this study provide evidence that segmental spinal anaesthesia can be used in place of general anaesthesia in healthy individuals also. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of an online, video-based, structured, educational module in increasing awareness in women with polycystic ovary syndrome (PCOS). Material and Methods: Patients with PCOS were assessed for baseline awareness about PCOS, quantified as "awareness score", using a validated questionnaire. Topics assessed included factual and conceptual knowledge of the disease and awareness of behaviour-related lifestyle modification and therapy compliance in PCOS. An educational video module was shown to the participants which covered normal menstrual physiology, symptomatology, pathophysiology and natural history of PCOS, a comparative animation of healthy versus unhealthy lifestyle, indications of pharmacological intervention, and role of treatment adherence. The questionnaire was re-administered after exposure to the educational module, and effectiveness of the teaching method was evaluated by comparing pre and post test scores. Results: The total number of subjects was 41. Baseline knowledge was "fair" in 17.1%, "moderate" in 48.8% and "good" in 34.1%. Significant increase in awareness scores was noted among participants regarding PCOS after exposure to the learning module from 15.09±4.31 to 18.60±3.85 (p<0.00001) with a large effect size (Cohen's d=0.85). Most (48.8%) of the respondents had baseline awareness in the "moderate" range (scores between; 11-17) whereas post intervention scores improved to the "good" category for 63.4% of the women. Conclusion: The educational module was effective in significantly increasing knowledge about PCOS. Patient education is likely to help reinforce the message about lifestyle modification and continued compliance and may aid in promoting a patient-driven healthcare model in PCOS. [ABSTRACT FROM AUTHOR]

Objectives: To report the expanded neurological presentations and oncological associations of tripartite motif-containing protein 46 (TRIM46)-IgG seropositive patients.Methods: Archived sera/cerebrospinal fluid (CSF) were evaluated by tissue-based immunofluorescence assay to identify patients with identical axon initial segment (AIS)-specific staining pattern. Phage immunoprecipitation sequencing (PhIP-Seq) was used to identify the putative autoantigen.Results: IgG in serum (17) and/or CSF (16) from 25 patients yielded unique AIS-specific staining on murine central nervous system (CNS) tissue. An autoantibody specific for TRIM46 was identified by PhIP-Seq, and autoantigen specificity was confirmed by transfected COS7 cell-based assay. Clinical information was available for 22 TRIM46-IgG seropositive patients. Fifteen were female (68%). Median age was 67 years (range 25-87). Fifteen (68%) patients presented with subacute cerebellar syndrome (six isolated; nine with CNS accompaniments: encephalopathy (three), brainstem signs (two), myelopathy (two), parkinsonism (one)). Other phenotypes included limbic encephalitis (three), encephalopathy with/without seizures (two), myelopathy (two). Eighteen (82%) had cancer: neuroendocrine carcinomas (9; pancreatic (3), small-cell lung (4), oesophagus (1), endometrium (1)), adenocarcinomas (6; lung (2), ovarian (2), endometrial (1), breast (1)), sarcoma (2) and gastrointestinal tumour (1). Neurological symptoms in three followed immune checkpoint inhibitor (ICI) administration.Conclusions: This study supports TRIM46-IgG being a biomarker of paraneoplastic CNS disorders and expands the neurological phenotypes, oncological and ICI-related adverse event associations. [ABSTRACT FROM AUTHOR]

Background: Oncology patients and physicians value empathy because of its association with improved health outcomes. Common measures of empathy lack consistency and were developed without direct input from patients. Because of their intense engagement with health care systems, oncology patients may have unique perspectives on what behaviors signal empathy in a clinical setting.Methods: As part of a cross-sectional study of patient perspectives on clinician empathy at an academic cancer center in the northeastern United States, the authors solicited up to 10 free-text responses to an open-ended question about what clinician behaviors define empathy.Results: The authors categorized open-ended responses from 89 oncology patients into 5 categories representing 14 themes. These categories were relationship sensitivity, focus on the whole person, communication, clinician attributes, and institutional resources and care processes. Frequently represented themes, including listening, understanding, and attention to emotions and what matters most, aligned with existing measures of empathy; behaviors that were not well represented among existing measures included qualities of information sharing and other communication elements. Patients also associated clinician demeanor, accessibility, and competence with empathy.Conclusions: Oncology patients' perspectives on empathy highlight clinician behaviors and attributes that may help to refine patient experience measures and may be adopted by clinicians and cancer centers to enhance patient care and outcomes. High-quality communication skills training can promote active listening and paying attention to the whole person. A system-level focus on delivering empathic care may improve patients' experiences and outcomes.Lay Summary: Oncology patients' responses to an open-ended question about empathic clinician behavior have revealed insights into a variety of behaviors that are perceived as demonstrative of empathy. These include behaviors that imply sensitivity to the clinician-patient relationship, such as listening and understanding and attention to the whole person. Participants valued caring communication and demeanor and clinician accessibility. Perspective taking was not common among answers. Many existing measures of clinical care quality do not include the behaviors cited by patients as empathic. These results can inform efforts to refine quality measures of empathy-associated behaviors in clinical practice. Cancer centers can use skills training to improve elements of communication. [ABSTRACT FROM AUTHOR]

Background Understanding viral kinetics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is important to assess risk of transmission, manage treatment, and determine the need for isolation and protective equipment. The impact of viral load in asymptomatic infected children is important to understand transmission potential. We sought to determine whether children deemed to be asymptomatic had a difference in the polymerase chain reaction (PCR) cycle threshold (Ct) value of respiratory samples from symptomatic children with SARS-CoV-2 infection. Methods This was a retrospective cross-sectional study to compare PCR Ct values of children who tested positive for SARS-CoV-2 by respiratory samples collected over a 4-month period at a large tertiary care children's hospital. Results We analyzed 728 children who tested positive for SARS-CoV-2 by reverse-transcription PCR (RT-PCR) from a respiratory sample over a 4-month period and for whom data were available in the electronic medical record. Overall, 71.2% of infected children were symptomatic. The mean Ct value for symptomatic patients (Ct mean, 19.9 [standard deviation, 6.3]) was significantly lower than for asymptomatic patients (Ct mean, 23.5 [standard deviation, 6.9]) (P <.001; 95% confidence interval, 2.6–4.6). The mean PCR Ct value was lowest in children <5 years of age. Conclusions In this retrospective review of children who tested positive by RT-PCR for SARS-CoV-2, the mean Ct was significantly lower in symptomatic children and was lowest in children <5 years of age, indicating that symptomatic children and younger children infected with SARS-CoV-2 may have a higher viral load in the nasopharynx compared to asymptomatic children. Further studies are needed to assess the transmission potential from asymptomatic children. [ABSTRACT FROM AUTHOR]

Androgen deprivation therapy (ADT) used for prostate cancer (PCa) management is associated with metabolic and anthropometric toxicity. Metformin given concurrent to ADT is hypothesized to counteract these changes. This planned interim analysis reports the gastrointestinal and genitourinary toxicity profiles of PCa patients receiving ADT and prostate/pelvic radiotherapy plus metformin versus placebo as part of a phase 2 randomized controlled trial. Men with intermediate or high-risk PCa were randomized 1:1 to metformin versus placebo. Both groups were given ADT for 18-36 months with minimum 2-month neoadjuvant phase prior to radiotherapy. Acute gastrointestinal and genitourinary toxicities were quantified using CTCAE v4.0. Differences in ≥ grade 2 toxicities by treatment were assessed by chi-squared test. 83 patients were enrolled with 44 patients randomized to placebo and 39 randomized to metformin. There were no significant differences at any time point in ≥ grade 2 gastrointestinal toxicities or overall gastrointestinal toxicity. Overall ≥ grade 2 gastrointestinal toxicity was low prior to radiotherapy (7.9% (placebo) vs. 3.1% (metformin), p = 0.39) and at the end of radiotherapy (2.8% (placebo) vs 3.1% (metformin), p = 0.64). There were no differences in overall ≥ grade 2 genitourinary toxicity between treatment arms (19.0% (placebo) vs. 9.4% (metformin), p = 0.30). Metformin added to radiotherapy and ADT did not increase rates of ≥ grade 2 gastrointestinal or genitourinary toxicity and is generally safe and well-tolerated. [ABSTRACT FROM AUTHOR]

Objectives: To explore how physicians in neurology, family medicine, internal medicine, and emergency medicine characterize clinical empathy.Methods: Physicians (N = 94) were asked to describe up to 10 examples of empathic physician behavior. Data were analyzed using template analysis.Results: Physicians' descriptions of clinical empathy patterned into three themes: Clinical Performance and Professionalism, Interpersonal Communication, and Clinician Orientation. Clinical Performance and Professionalism sub-themes included physician competency and accessibility; intersection with institutional resources; and spending/making/taking time with patients. Interpersonal Communication sub-themes involved information sharing; verbal and nonverbal approaches; interpersonal sensitivity; physician self-disclosure; and attention to emotion. Clinician Orientation encompassed general physician demeanor and internal thoughts and feelings that might be unobservable by patients. Physicians varied widely in the themes they mentioned in their definition of empathy.Conclusion: Physicians hold diverse notions of clinical empathy. These extend beyond traditional affective and cognitive empathy definitions to include structural elements like team-based care and accessibility after hours. Communication behaviors were perceived as important for demonstrating empathy. Some physician descriptions of empathy may not be perceptible to patients.Practice Implications: Training physicians to engage in behaviors that both they and patients perceive as empathic may lead to higher patient and physician satisfaction. [ABSTRACT FROM AUTHOR]

In today's globalized world citizenship is considered as method of inclusion which acts as a status of a person, and that status brings along with it, exclusive rights and obligations. Often the concept of citizenship is generally confused with that of nationality, but nationality is associated with membership of a community on the basis of cultural similarities whereas citizenship is membership of a state. Right of citizenship brings with it bundle of other rights, it is used as a sorting device for allocating human population to a particular state. Citizenship acts as a filter in two ways: states are obligated to admit their nationals into their territory and they may levy restrictions (e.g. visa requirements) on other nationals. Citizenship is neither a purely subjective nor purely objective criteria. It is not subjective as there is no sense of belonging and neither is it objective because it cannot be inferred by looking at the person's circumstances. Citizenship is more of a discriminating concept than a concept that ties people. It marks a boundary between outsiders and insiders, this boundary may be flexible or rigid and may keep changing, but it still exists as a demarcation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to assess the effect of dexmedetomidine on intraocular pressure (IOP) as an additive in peribulbar injections in glaucoma surgeries.Methods: A prospective, randomized, double-blind, parallel assignment interventional study was conducted for patients undergoing glaucoma surgeries at a tertiary eye care hospital in North India. Patients were randomized to two groups, Dexmed group and Placebo group. In the Dexmed group, dexmedetomidine (0.4 μg/kg body weight) was given as an additive along with peribulbar block. The primary outcome was change in IOP pre- and postperibulbar injections (IOP before the block, and after 5 and 15 min of the block). Secondary outcome measures were onset of block, adverse effects (bradycardia, hypotension, respiratory depression, and level 4 sedation), and surgeon satisfaction.Results: A total of 104 patients were randomized, 52 each in the Dexmed group and Placebo group. The percentage decrease in IOP was significantly more in the Dexmed group than in the Placebo group both at 5 and 15 min' post block (P < 0.05). At 5 min, the mean percent decrease in IOP in Dexmed group was -10.48, whereas it was 2.85 in the Placebo group. At 15 min, the mean percent decrease in IOP was -22.59 and -9.42 in the Dexmed and Placebo group, respectively. There was no significant difference between the two groups in the onset of block and adverse effects. Surgeon satisfaction was significantly greater in the Dexmed group than the Placebo group (P < 0.05).Conclusion: Dexmedetomidine lowers IOP significantly in patients undergoing glaucoma surgeries with safe hemodynamic changes and sedative effect. [ABSTRACT FROM AUTHOR]

This work presents the shear-based attenuation of vibration of an annular sandwich plate using two different shear mode piezoelectric fiber composite (PFC) actuators namely Shear Actuated Fiber Composite (SAFC) and Balanced Laminate of PFC (BLPFC). A conventional shear mode monolithic piezoelectric (PZT5H) actuator is also used, and a comparative study on the shear actuation capabilities of all three shear actuators is performed to address the best one for shear-based control of the annular sandwich plate. Every actuator is used in the form of an actuator laminate that is inserted at the core of the sandwich plate in the form of the patches, where a fruitful arrangement of the patches and a shear-based control strategy are presented for effective attenuation of vibration of the sandwich plate according to the velocity feedback control law. First, the effective properties of the actuator laminate are determined using the Uniform Field Method. Next, a closed-loop finite element model of the sandwich plate is developed based on the layer-wise shear deformation theory. Subsequently, the suitability of the present arrangement of shear actuator patches and the shear-based control strategy are substantiated. This arrangement of the actuator patches is further optimized for every shear actuator, and the corresponding shear actuated resonant displacement-amplitudes of the sandwich plate are evaluated. These results reveal lesser actuation capability of the SAFC than that of the PZT5H while the BL-PFC is the best one for shear-based attenuation of vibration of the annular sandwich plate. [ABSTRACT FROM AUTHOR]

Introduction: Quantitative analysis of cardiac biomarkers, troponin I and CPK-MB, estimates the extent of myocardial injury while extent of benefit from coronary collateral circulation (CCC) to protect myocardium during acute myocardial infarction (AMI) needs validation. We analysed if the extent of collaterals had impact on baseline biomarkers at the time of coronary angiogram. Methods: We analysed 3616 consecutive patients who presented with AMI and underwent invasive coronary angiography (CAG) with intent to revascularisation with biomarkers assessment at the time of CAG. CCC to Infarct related artery (IRA) were graded as per Rentrop grading viz. poorly-developed CCC (Grade 0/1 as Group A) and well-developed CCC (Grade 2/3 as Group B). Results: Both groups (A and B) were matched for demographics, traditional risk factors, SYNTAX 1 Score, time to CAG from onset of angina and eGFR. 36.59% of patients had Non-ST segment elevation myocardial infarction (NSTEMI) as compared to 63.41% ST -segment elevation infarction (STEMI). Overall Troponin I (P =0.01, P =0.01) and CPK MB (P =0.00, P =0.002) values were lower in group B in both NSTEMI and STEMI groups respectively. Troponin I and CPK-MB were significantly lower in group B [with NSTEMI for SVD (Single vessel disease) (P =0.05) and DVD (Double vessel disease) (P =0.04),but not for TVD (Triple vessel disease) and with STEMI in SVD (P =0.01), DVD (P =0.01) and TVD (P =0.001)]. Conclusion: Patients with well-developed coronary collaterals had a lower rise in biomarkers in AMI as compared to those with poor collaterals amongst both NSTEMI and STEMI groups. [ABSTRACT FROM AUTHOR]

Forensic DNA fingerprinting is the most believed method of the criminal investigation. With the advancement in technology, the method has become more and more sensitive and the technology now uses advanced method and new generation faster multiplex amplification systems. Most of these improvements in the technique are after the extraction of DNA. Despite automation in DNA extraction, still, the basic process of lysis of cells is an integral part of the analysis. We present here the comparison of DNA extraction results with and without using the proteinase k enzyme. [ABSTRACT FROM AUTHOR]

This article compares various herbal cosmetic brands to find their popularity ranking. The study was to understand consumer perception of Herbal products. The demand of herbal cosmetics is increasing rapidly thanks to their skin friendliness and lack of side effects. The best thing of the herbal cosmetics is that it is purely made by the herbs and shrubs and therefore provide the body with nutrients and other useful minerals. The herbal cosmetics are capable for treating various skin ailments like dry skin, anti-ageing, skin protection, and other acne problems too. The herbal brand not only beautify our skin but also hair. The method used was a survey-based questionnaire. This research was carried out in diferent zones of Kanpur. According to the survey it was found that Ayur Herbals was the most popular brand. Therefore, we can conclude that there is not at all shortage in the demand for herbal products in the market. The consumers concern towards health risk and harmful effect of chemical products forcing them to switch over to natural products. There is high favorability of Ayur Herbals products among its users. People mostly used Ayur Herbals brand products. [ABSTRACT FROM AUTHOR]

Objective To compare the synovial phenylalanine/tyrosine (Phe/Tyr) ratio between ReA/uSpA and RA and OA by NMR spectroscopy. Methods Paired SF and serum of 30 patients with ReA/uSpA were collected and analysed using a 1D 1H Carr Purcell Meiboom Gill NMR spectra recorded on 800 MHz NMR spectrometer equipped with a TCI Cryoprobe (at 300 K). Phe and Tyr were quantified. SF from 25 patients with RA fulfilling ACR classification criteria and 21 patients with OA were taken as inflammatory and non-inflammatory controls. Results The synovial Phe/Tyr ratio was significantly higher in ReA/uSpA compared with RA and OA. Synovial Phe/Tyr ratios were comparable in RA and OA patients. Compared with serum, the Phe/Tyr was significantly higher in the SF in ReA/uSpA. The Phe/Tyr ratio was also found to be positively correlated between serum and SF samples, with a regression coefficient (r2) of 0.287. Conclusions This NMR-based metabolomics study demonstrates that the synovial Phe/Tyr ratio is specifically elevated in ReA/uSpA. [ABSTRACT FROM AUTHOR]

Background: The pattern of post-stroke aphasia in speakers of Bengali language has not previously been reported in the literature. Furthermore, the inter-relationship between age, gender, and level of education and aphasia typology has remained unsettled thus far. Aims: To investigate the incidence and type of aphasia in first-ever acute stroke patients who were speakers of Bengali language. Methods & Procedures: Bengali version of Western Aphasia Battery was used for language assessment in our study participants. Lesion localization was done by using magnetic resonance imaging(3T) for ischemic stroke (if not contraindicated) and computed tomography for hemorrhagic stroke. Among 515 screened cases of first-ever acute stroke, 208 presented with aphasia. Language assessment was done between 7 and 14 days in all study participants. Outcomes & Results: The incidence of post-stroke aphasia in our sample was found at 40.39%. Types of aphasia were – Broca's (38.5%) followed by global (27.9%); Wernicke's (12.5%); transcortical motor (9.6%); anomic (4.3%); transcortical sensory (3.8%); isolation (1.9%); and conduction (1.4%). Mean number of years of formal education was significantly higher in fluent aphasia group in comparison with non-fluent group (10.51 years versus 7.01 years, p = 0.003). In logistic regression analysis, location of lesion (posterior perisylvian) (p = 0.007, OR = 5.406, 95% CI, 1.602–18.240) and education (p = 0.044, OR = 1.097, 95% CI, 1.003–1.199) were two independent predictors favoring fluent aphasia. Conclusions: Aphasia among post-stroke Bengali patients is quite frequent. The commonest type of aphasia in our sample was Broca's aphasia. Bengali-speaking people with higher education were more likely to present fluent aphasia. [ABSTRACT FROM AUTHOR]

Because it is indicative of reproductive isolation, the amount of genetic introgression across secondary contact zones is increasingly considered in species delimitation. However, patterns of admixture at range margins can be skewed by the regional dynamics of hybrid zones. In this context, we posit an important role for phylogeographic history: hybrid zones located within glacial refugia (putatively formed during the Late-Pleistocene) should be better defined than those located in post-glacial or introduced ranges (putatively formed during the Holocene and the Anthropocene). We test this hypothesis in a speciation continuum of tree frogs from the Western Palearctic (Hyla), featuring ten identified contacts between species spanning Plio-Pleistocene to Miocene divergences. We review the rich phylogeographic literature of this group and examine the overlooked transition between H. arborea and H. molleri in Western France using a multilocus dataset. Our comparative analysis supports a trend that contacts zones resulting from post-glacial expansions and human translocations feature more extensive introgression than those established within refugial areas. Integrating the biogeographic history of incipient species, i.e. their age since first contact together with their genetic divergence, thus appears timely to draw sound evolutionary and taxonomic inferences from patterns of introgression across hybrid zones. [ABSTRACT FROM AUTHOR]

Tonsillectomy is an age old procedure in ENT practice. Though traditional dissection method is gold standard, we surgeons are trying different techniques like electrocautery, coblation, harmonic scalpel (HS) mainly to improve surgical convenience, to decrease operative time, post operative pain, intra and post operative bleeding and fast return to normal life. In this particular study we are comparing coblation and HS as surgical tool in tonsillectomy. It is a prospective double-blind randomized controlled trial where information was compared between two groups of coblation and HS tonsillectomy. A total number of 128 patients were compared over operation time, intra-operative blood loss, postoperative pain, time needed to regain the normal diet and activity and postoperative haemorrhage. We found statistically significant differences in operation time (p < 0.001) and intra operative blood loss (p < 0.001). Secondary haemorrhage rate was far better in HS (1.5%) group compared to coblation (7.8%). Whereas postoperative pain, time needed to go back to the normal diet and activity were better in HS group but the difference is not significant. This study revealed a significantly less operative time and intra-operative and post operative blood loss in harmonic scalpel tonsillectomy in comparison with coblation method. These findings addressed HS tonsillectomy as an advanced method. [ABSTRACT FROM AUTHOR]

The present study was conducted to characterize the semen quality parameters in roosters of three genetic groups viz. Rhode Island Red (RIR), Punjab Red and RIR X local cross. The roosters for each genetic group were also evaluated for fertility rate. There was no significant difference in color, pH and abnormalities among different genetic groups. RIR X local cross had significant higher (p<0.01) ejaculate volume (0.51±0.02 ml vs. 0.27±0.01 and 0.30±0.01ml), sperm concentration (2804.70±114.61 vs. 1826.10±77.66 and 2133.50±81.18X106 sperms/ml), sperm motility % (66.60±2.12 vs. 55.38±1.82 and 51.95±1.84), sperm viability % (72.43±2.06 vs. 64.67±1.88 and 51.25±1.89) and HOST % (64.59±2.61 vs. 58.55±1.17 and 47.09±2.11) than RIR and Punjab Red respectively. Interestingly, RIR X local cross had significant lower (p<0.01) partially damaged sperm % (36.96±2.81 vs. 41.84±1.78 and 48.98±1.89) and fully damaged sperm % (14.15±3.39 vs. 26.27±1.93 and 31.25±2.46) than RIR and Punjab Red respectively indicating desirable performance. The fertility rate for RIR X local cross was also found to be higher than Punjab Red and RIR respectively. Sperm traits were significantly positively correlated among groups with high correlation between fertility rate and sperm traits. It can be concluded that the selection of roosters on the basis of sperm function tests for artificial insemination may improve fertility rate and thereby may reduce maintenance cost of large number of cocks. [ABSTRACT FROM AUTHOR]

Introduction: Fine Needle Aspiration Cytology (FNAC) is an initial diagnostic test that has been found to be simple and cost effective but it is associated with pitfalls due to difference in correlations between FNAC and Histopathological Examination (HPE). Methods: A study was undertaken with a total of 112 patientspresenting with thyroid nodule who underwent thyroid surgeries. Preoperative FNAC and postoperative HPE were evaluated to calculate sensitivity, specificity, positive and negative predictive value and accuracy. Results: In our study we found sensitivity to be 81.48%, specificity 95.29%, positive predictive value 84.61%, Negative predictive value 94.18% and accuracy to be 91.16%. Conclusion: Thus we can conclude that FNAC is a simple, safe and cost-effective diagnostic modality in the investigation of Thyroid nodule with high specificity and accuracy. [ABSTRACT FROM AUTHOR]

The clinical phenotype of leucine-rich glioma-inactivated protein 1 (LGI1) and contactin-associated proteinlike 2 (CASPR2) autoimmunity is well defined in adults. Data for children are limited (<10 cases). Among 13,319 pediatric patients serologically tested for autoimmune neurological disorders (2010-2017), 264 were seropositive for voltage-gated potassium channel-complex-IgG (radioimmunoprecipitation). Only 13 (4.9%) were positive by transfected cell-binding assay for LGI1-IgG (n = 7), CASPR2-IgG (n = 3), or both (n = 3). This is significantly less than in adults. Encephalopathy, seizures, and peripheral nerve hyperexcitability were common, as was coexisting autoimmunity. No faciobrachial dystonic seizures or cancers were identified. Functional neurologic disorders were frequently the initial diagnosis, and immunotherapy appeared beneficial. Ann Neurol 2018;84:473-480. [ABSTRACT FROM AUTHOR]

Background: The subjective sensation of dry mouth, xerostomia, is a well-recognized problem in adults, however, relatively little attention has been paid to this issue in children. Xerostomia commonly occurs as an adverse effect of drugs in asthma and leukemia, which alter the composition and flow of saliva and systemic diseases, including diabetes. It decreases the oral pH and significantly increases the development of plaque and dental caries.Aim: This study aims to evaluate and compare the dental caries status and salivary properties of children aged 5-14 years undergoing treatment for acute lymphoblastic leukemia, type 1 diabetes mellitus, and asthma - in vivo.Materials and Methods: The study was divided into two parts: Part I: Oral examination was performed and dental caries status Decayed, Missing, Filled Teeth/ decayed, extraction, filled teeth (DMFT/deft) was noted and Part II: Salivary analysis was performed by GC Saliva-Check BUFFER kit to check for hydration, viscosity, pH of saliva, salivary flow, and buffering capacity.Statistical Analysis: All statistical analysis was performed using the SPSS 21 statistical software version. Inferential statistics were performed using Chi-square test and ANOVA. Post hoc pairwise comparison was done using Post hoc Tukey's test.Results: The prevalence of mean DMFT/deft with regard to salivary properties was highest in leukemic patients followed in descending order by diabetic and asthmatic patients.Conclusions: Leukemic patients had significantly higher caries and decreased salivary properties while asthmatic patients showed the least caries prevalence and best salivary properties. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to determine which parameter of Cirrus and RTVue optical coherence tomography (OCT) has the highest ability to discriminate between early, moderate, and advanced glaucoma. Simultaneously, to compare the performance of the two OCT devices in terms of their ability to differentiate the three stages of glaucoma. Further, to analyze the macular parameters of both devices and compare them with the conventional retinal nerve fiber layer (RNFL) parameters.Methods: One hundred and twenty eyes (30 healthy and 90 glaucomatous [30 mild, 30 moderate, and 30 advanced glaucoma]) of 65 participants (15 healthy, 50 glaucomatous [15 mild, 15 moderate, and 20 advanced glaucoma]) underwent Cirrus and RTVue OCT scanning on a single visit.Results: Average RNFL thickness and superior RNFL thickness of both the devices and inferior (ganglion cell complex [GCC] of RTVue device best differentiated normals from all stage glaucomatous eyes (P > 0.05). Cirrus average RNFL thickness and superior RNFL thickness performed better than other parameters (P < 0.05) in differentiating early glaucoma from moderate and advanced. In differentiating advanced from early and moderate glaucoma, RTVue average, superior, and inferior RNFL thickness and inferior GCC parameters had the highest discriminating ability (P < 0.05).Conclusion: Overall, average RNFL thickness had the highest ability to distinguish different stages of the disease. No significant difference was found between RTVue and Cirrus OCT device in different severity levels. No significant difference was observed between RNFL and macular parameters in different stages of glaucoma. [ABSTRACT FROM AUTHOR]

Objective: Loss of function of the astrocyte-specific protein MLC1 leads to the childhood-onset leukodystrophy "megalencephalic leukoencephalopathy with subcortical cysts" (MLC). Studies on isolated cells show a role for MLC1 in astrocyte volume regulation and suggest that disturbed brain ion and water homeostasis is central to the disease. Excitability of neuronal networks is particularly sensitive to ion and water homeostasis. In line with this, reports of seizures and epilepsy in MLC patients exist. However, systematic assessment and mechanistic understanding of seizures in MLC are lacking.Methods: We analyzed an MLC patient inventory to study occurrence of seizures in MLC. We used two distinct genetic mouse models of MLC to further study epileptiform activity and seizure threshold through wireless extracellular field potential recordings. Whole-cell patch-clamp recordings and K+ -sensitive electrode recordings in mouse brain slices were used to explore the underlying mechanisms of epilepsy in MLC.Results: An early onset of seizures is common in MLC. Similarly, in MLC mice, we uncovered spontaneous epileptiform brain activity and a lowered threshold for induced seizures. At the cellular level, we found that although passive and active properties of individual pyramidal neurons are unchanged, extracellular K+ dynamics and neuronal network activity are abnormal in MLC mice.Interpretation: Disturbed astrocyte regulation of ion and water homeostasis in MLC causes hyperexcitability of neuronal networks and seizures. These findings suggest a role for defective astrocyte volume regulation in epilepsy. Ann Neurol 2018;83:636-649. [ABSTRACT FROM AUTHOR]

Background of the study: Enteral feeding in preterm neonates with intrauterine growth restriction (IUGR) and absent or reversed end diastolic flow (AREDF) on umbilical artery (UA) Doppler is delayed owing to an increased risk of necrotizing enterocolitis (NEC). Delaying enteral feeding with longer duration of parenteral nutrition (PN) carries an increased risk of sepsis.Objectives: To study early versus late feeding in preterm IUGR neonates for time required to attain sufficient feed volume to discontinue PN and increased risk of NEC or feed intolerance (FI).Design: Open-label randomized controlled trial.Setting: Tertiary care neonatal unit and fetal-maternal medicine unit in India.Participants: Preterm intrauterine growth restricted neonates' ≤32 weeks with AREDF on UA Doppler enrolled from 1 January 2014 to 31 July 2015.Intervention: Randomized to receive early or late feeding using mothers own or donor breast milk as per a feed initiation and advancement protocol.Primary outcome: Time in days required to attain sufficient feed volume allowing discontinuation of PN and incidence of NEC in neonates fed early versus late.Results: There were 77 eligible neonates. Sixty-two neonates were included and stratified as extreme preterm (27-29 weeks) (n = 20) and very preterm (30-32 weeks) (n = 42). Ten extreme preterm and 21 very preterm neonates were randomized to each early feeding and late feeding arm. There was a significantly faster attainment of sufficient feeds in the early feeding arm of both the stratified groups [extreme preterm: median 14 days (Interquartile range IQR: 12-15) compared with 18 days (IQR: 18-20), hazard ratio (HR): 1.59, 95% CI: 0.626-4.078; very preterm: 12 days (IQR: 10-14) as compared with 16 days (IQR 15-17), HR: 1.89, 95% CI: 1.011-3.555]. There was no difference in the incidence of NEC, FI and combined outcome of NEC and FI.Conclusion: Early feeding in preterm IUGR neonates with AREDF on antenatal UA Doppler allowed earlier discontinuation of PN, allowing birth weight to be regained earlier and did not increase the incidence of NEC and FI. [ABSTRACT FROM AUTHOR]

The paper experimentally investigates the performance and exhaust emissions of a variable compression ratio engine fueled with 100%, 90%, 70% and 50% Jatropha bio-diesel and turpentine oil. In this paper, highly viscous Jatropha biodiesel is blended with relatively low viscosity turpentine oil in various proportions resulting in effective viscosity comparable with that of standard diesel with a view to developing a new alternative fuel which is comparable equally cost effective and eliminates dependency on conventional diesel fuel. Experimental analysis is carried out on ATE Make VCRE_MF single cylinder, naturally aspired, four stroke, and variable compression ratio diesel engine to study combustion performance and emission properties via conventional diesel fuel and different blends of Jatropha biodiesel with turpentine oil. Dual biofuel blend is found to be the greatest substitute to fossil (diesel) fuel in all aspects such as emissions and performance. Experiments have been accompanied at CR (compression ratio) of 15.5:1, 17:1, 18.5:1 and 20:1. Further, dual biofuel blend (JBT 50) resulted at full load and compression ratio 20, there was 2.17% increase in brake thermal efficiency and 13.04%, 17.5%, 4.21% and 30.8% decrease in CO, HC and NOx and smoke opacity respectively while CO 2 was observed to increase by 11.04% respectively. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the incidence and prevalence of autoimmune encephalitis and compare it to that of infectious encephalitis.Methods: We performed a population-based comparative study of the incidence and prevalence of autoimmune and infectious encephalitis in Olmsted County, Minnesota. Autoimmune encephalitis diagnosis and subgroups were defined by 2016 diagnostic criteria, and infectious encephalitis diagnosis required a confirmed infectious pathogen. Age- and sex-adjusted prevalence and incidence rates were calculated. Patients with encephalitis of uncertain etiology were excluded.Results: The prevalence of autoimmune encephalitis on January 1, 2014 of 13.7/100,000 was not significantly different from that of all infectious encephalitides (11.6/100,000; p = 0.63) or the viral subcategory (8.3/100,000; p = 0.17). The incidence rates (1995-2015) of autoimmune and infectious encephalitis were 0.8/100,000 and 1.0/100,000 person-years, respectively (p = 0.58). The number of relapses or recurrent hospitalizations was higher for autoimmune than infectious encephalitis (p = 0.03). The incidence of autoimmune encephalitis increased over time from 0.4/100,000 person-years (1995-2005) to 1.2/100,000 person-years (2006-2015; p = 0.02), attributable to increased detection of autoantibody-positive cases. The incidence (2.8 vs 0.7/100,000 person-years, p = 0.01) and prevalence (38.3 vs 13.7/100,000, p = 0.04) of autoimmune encephalitis was higher among African Americans than Caucasians. The prevalence of specific neural autoantibodies was as follows: myelin oligodendrocyte glycoprotein, 1.9/100,000; glutamic acid decarboxylase 65, 1.9/100,000; unclassified neural autoantibody, 1.4/100,000; leucine-rich glioma-inactivated protein 1, 0.7/100,000; collapsin response-mediator protein 5, 0.7/100,000; N-methyl-D-aspartate receptor, 0.6/100,000; antineuronal nuclear antibody type 2, 0.6/100,000; and glial fibrillary acidic protein α, 0.6/100,000.Interpretation: This study shows that the prevalence and incidence of autoimmune encephalitis are comparable to infectious encephalitis, and its detection is increasing over time. Ann Neurol 2018;83:166-177. [ABSTRACT FROM AUTHOR]