Search

Bacterial co-infections in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia are not very common as the prevalence of co-infections with other respiratory viruses. The rate of bacterial co-infection in hospitalized patients infected with influenza is higher than 30%, whereas it is lower than 4% in hospitalized patients with SARS-CoV-2. Respiratory viral infections associated with bacterial co-infection have higher mortality and morbidity rates. The literature shows that most SARS-CoV-2 patients admitted to the hospital do not necessarily screen for bacterial infections and antimicrobial susceptibility. Therefore, clinicians' misdiagnosis of these co-infections can pose a significant risk to the lives of vulnerable patients with COVID-19. In that light, we presented a complicated case of methicillin-resistant Staphylococcus aureus.

Chikungunya virus is positive-sense single-stranded RNA virus that causes an arthropod-borne chikungunya fever, myalgia and arthralgia. Chikungunya virus belongs to the Togaviridae family, and the genus is Alphavirus. Virus-host protein interaction plays a vital role in developing vaccines and antiviral drugs. We designed the current study to establish the in-silico interaction of non-structural protein 2 (nsP2) with proteins of innate immune pathway. The nsP2 sequences of various Chikungunya virus genotypes were retrieved from National Centre for Biotechnology Institute (NCBI). The homology models of proteins were generated through a protein modeling online web server. Protein-protein interaction (PPI) between nsP2 and proteins of innate immune pathway were docked using High Ambiguity-Driven Docking (HADDOCK) webserver. The interactive residues of the bimolecular complexes were analyzed with PDBsum-Generate online webserver. Our findings revealed differentially affinity of nsP2 of various chikungunya genotypes towards key proteins of cellular innate pathway. The nsP2 of Asian genotype demonstrates relatively high interaction with interferon-beta promoter stimulator 1 (IPS-1). Similarly, nsP2 of various genotypes binds with differential affinity to tumor necrosis factor receptor-associated factor 6 (TRAF6) with the highest affinity observed for the nsP2 of the West African genotype. Bimolecular complexes of nsP2 and host proteins demonstrate the interaction of various domains of nsP2 with proteins of the innate immune pathway. Thus, it is sought that the selected panel of the proteins might be helpful to treat the viral infection as a therapeutic drug target in the future.

The history of drama in Asia is as old as the history of the world itself. In India however, according to the popular belief, the tradition of drama dates back to the prehistoric times. Due to this unique approach towards drama, that makes it a valuable divine gift for humanity, the esoteric significance of this art form has never seen decline in the cultural history of India. Drama, thus, acquires in Indian context a religious significance and represents as an art form the union of the celestial and the terrestrial. Drama (in Sanskrit Natak), in the Indian Subcontinent, has distinctive characteristic features. Essentially, as reflection of human existence, it is a combination of all the known art forms and, therefore, becomes the deepest expression of the human soul. The rise of Islamic culture and civilization in the twelfth and thirteenth centuries contributed to the amalgamation of the two great civilizations. The impact of the Muslim culture in transforming the classical features of Indian music, architecture, science, literature, etc. can by no means be undermined. By the end of the sixteenth century, the century of liberal humanism and coincidently the era of the rise of the Mughal Empire, the theatrical art had gained enormous significance in India. There is enough evidence to believe that Shakespeare’s plays were first performed in India during the reign of the Mughals (1526-1857). Later, the newly emerging colonial power, the English, in its first stronghold in India, Calcutta, established alongside other bureaucratic, political and educational institutions, the Garrison Theater. The earliest performances at this theater date back to 1770s and the first ever documented English play on the Indian soil happens to be Shakespeare’s Othello. Shakespeare’s unique dramatic structure smoothly found its place of prominence in the cultural life of India, offering new dimensions to the already existing rich local tradition and at the same time enriching its own dramatic expression. Today, all the major educational institutions of the Subcontinent cherish the tradition of mounting on stage the annual performances of Shakespeare’s plays and the cinematographic tradition has incorporated his works into its popular tradition from the very beginning of the history of the film industry in India.

Patients with cirrhosis are advised to undergo hepatocellular carcinoma (HCC) surveillance every 6 months. Routine surveillance is associated with early tumor detection and improved survival. However, surveillance is underutilized. We aimed to characterize the uptake of HCC surveillance in cirrhotic patients following the implementation of interventional programs. We performed a comprehensive literature search of major databases (from inception to October 2020). Surveillance was defined as having an abdominal sonogram every 6 months. Nine studies were included for meta-analysis which involved 4550 patients. The etiology of liver cirrhosis was largely due to hepatitis C or B (n=2023), followed by alcohol (n=857), and nonalcoholic steatohepatitis (n=432). Patients enrolled in surveillance programs were 6 times more likely to undergo abdominal sonography when compared with standard of care (odds ratio=6.00; 95% confidence interval: 3.35-10.77). On subgroup analysis, clinical reminders were associated with a 4 times higher rate of HCC surveillance compared with standard of care (odds ratio=3.80; 95% confidence interval: 2.25-6.39). Interventional programs significantly improve the rate of HCC surveillance. This is clinically impactful and should be considered as a means for improving surveillance rates.

EUS-guided liver biopsy (EUS-LB) has gained momentum in recent years, especially with availability of newer needle designs. Given the emerging comparative data on EUS-LB with second-generation needles and percutaneous LB (PC-LB), we conducted a systematic review and meta-analysis to compare the safety and efficacy of the two techniques. We searched multiple databases from inception through November 2021 to identify studies comparing outcomes of EUS-LB and PC-LB. Pooled estimates were calculated using a random-effects model, and the results were expressed in terms of pooled proportions and odds ratio (OR) along with relevant 95% confidence intervals (CIs). Five studies with 748 patients were included in the final analysis. EUS-LB was performed in 276 patients and PC-LB in 472 patients. Across all studies, PC-LB had an overall higher diagnostic accuracy than EUS-LB, 98.6% confidence interval (CI: 94.7-99.7) versus 88.3% (49.6-98.3), OR: 1.65, P = 0.04. On assessing data from randomized controlled trials, there was no difference between the two. While pooled diagnostic adequacy and overall adverse events were not significantly different between PC-LB and EUS-LB, the former was superior in terms of the mean number of complete portal tracts (CPT) and total specimen length. PC-LB and EUS-LB produce similar results. PC-LB allows obtaining longer samples and more CPT. Further studies are needed to see if these trends hold up as more providers begin to perform EUS-LB.

In indirect drive inertial confinement fusion (ICF) implosions hydrodynamic instability growth at the imploding capsule ablator-DT fuel interface can reduce fuel compressibility and inject ablator into the hot spot hence reducing hot spot pressure and temperature. As a mitigation strategy, a gentle acceleration of this interface is predicted by simulations and theory to significantly reduce this instability growth in the early stage of the implosion. We have performed high-contrast, time-resolved x-ray refraction enhanced radiography (RER) to accurately measure the level of acceleration as a function of the initial laser drive time history for indirect-drive implosions on the National Ignition Facility. We demonstrate a transition from no acceleration to 20±1.8 μm ns^{-2} acceleration by tweaking the drive that should reduce the initial instabilities by an order of magnitude at high modes.

Inertial confined fusion experiments at the National Ignition Facility have recently entered a new regime approaching ignition. Improved modeling and exploration of the experimental parameter space were essential to deepening our understanding of the mechanisms that degrade and amplify the neutron yield. The growing prevalence of machine learning in fusion studies opens a new avenue for investigation. In this paper, we have applied the Gradient-Boosted Decision Tree machine-learning architecture to further explore the parameter space and find correlations with the neutron yield, a key performance indicator. We find reasonable agreement between the measured and predicted yield, with a mean absolute percentage error on a randomly assigned test set of 35.5%. This model finds the characteristics of the laser pulse to be the most influential in prediction, as well as the hohlraum laser entrance hole diameter and an enhanced capsule fabrication technique. We used the trained model to scan over the design space of experiments from three different campaigns to evaluate the potential of this technique to provide design changes that could improve the resulting neutron yield. While these data-driven model cannot predict ignition without examples of ignited shots in the training set, it can be used to indicate that an unseen shot design will at least be in the upper range of previously observed neutron yields.

Assessment of EUS-guided fine-needle tissue acquisition by macroscopic on-site evaluation (MOSE) is gathering attention. Studies report good diagnostic parameters with MOSE; however, the overall data are limited. We conducted this systematic review and meta-analysis to report on the pooled diagnostic assessment parameters of EUS-guided tissue acquisition by MOSE using fine-needle biopsy sampling (FNB).Multiple databases were searched (from inception to December 2021), and studies that reported on the diagnostic assessment of EUS-guided tissue acquisition by MOSE were selected. Pooled diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were calculated by standard meta-analysis methods following the random-effects model. Heterogeneity was assessed by IFourteen studies were included in the analysis, and 1508 lesions were biopsy sampled in 1489 patients undergoing EUS-guided tissue acquisition. MOSE definition included a visible core of tissue with opacity and "wormlike" features of adequate size and length (≥4 mm). The pooled accuracy of FNA and/or FNB specimens in yielding a pathologic diagnosis by MOSE was 91.3% (95% confidence interval [CI], 88.6-93.3; IExcellent pooled diagnostic accuracy parameters were demonstrated in EUS-guided tissue acquisition by FNB using the MOSE method.

Background Crohn’s disease (CD) is a chronic progressive condition that is complicated by intestinal or colonic stricture in nearly 30% of cases within 10 years of the initial diagnosis. Endoscopic balloon dilation (EBD) is associated with a risk of perforations and recurrence rates of up to 60% at 5 years. Endoscopic stenting has been used as an alternative to EBD, but data on its safety and efficacy are limited. We conducted a systematic review and meta-analysis to assess the outcomes of endoscopic stenting in CD-related strictures. Methods A systematic and detailed search was run in January 2022 with the assistance of a medical librarian for studies reporting on outcomes of endoscopic stenting in CD-related strictures. Meta-analysis was performed using random-effects model, and results were expressed in terms of pooled proportions along with relevant 95% confidence intervals (CIs). Results Nine studies with 163 patients were included in the final analysis. Self-expanding metal stents (SEMS) including both partial and fully covered were used in 7 studies, whereas biodegradable stents were used in 2 studies. Pooled rate of clinical success and technical success was 60.9% (95% CI, 51.6-69.5; I2 = 13%) and 93% (95% CI, 87.3-96.3; I2 = 0%), respectively. Repeat stenting was needed in 9.6% of patients (95% CI, 5.3-16.7; I2 = 0%), whereas pooled rate of spontaneous stent migration was 43.9% (95% CI, 11.4-82.7; I2 = 88%). Pooled incidence of overall adverse events, proximal stent migration, perforation, and abdominal pain were 15.7%, 6.4%, 2.7%, and 17.9%, respectively. Mean follow-up period ranged from 3 months to 69 months. Discussion Endoscopic stenting in CD-related strictures is a safe technique that can be performed with technical ease, albeit with a limited clinical success. Postprocedure abdominal pain and proximal stent migration are some of the common adverse events reported.

Current adenoma detection rate (ADR) benchmarks for colonoscopy in individuals positive for a fecal immunochemical test (FIT) are ≥45% in men and ≥35% in women. These are based on weak, low-quality evidence. We performed a meta-analysis to ascertain the pooled ADR in FIT-positive colonoscopy.Major databases like PubMed, EMBASE, and Web of Science were searched in October 2021 for studies reporting on ADR of colonoscopy in a FIT-positive population. Meta-analysis was performed by standard methodology using the random-effects model. Heterogeneity was assessed by IThirty-four high-quality studies that included more than 6 million asymptomatic average-risk individuals were analyzed; 2,655,345 individuals completed a screening FIT test. The pooled FIT screening rate was 69.8% (95% CI, 62.8-76.1), the pooled FIT positivity rate was 5.4% (95% CI, 4.3-6.9), and the colonoscopy completion rate was 85% (95% CI, 82.8-86.9). The pooled ADR was 47.8% (95% CI, 44.1-51.6), pooled advanced ADR was 25.3% (95% CI, 22-29), and the pooled colorectal cancer detection rate was 5.1% (95% CI, 4.4-5.9). The pooled ADR in men was 58.3% (95% CI, 52.8-63.6) and in women was 41.9% (95% CI, 36.4-47.6). The pooled ADR with qualitative FIT assessment was 67.7% (95% CI, 50.7-81), with 1-stool sample FIT was 52.8% (95% CI, 48.8-56.8), and at a cutoff threshold of 100 ng hemoglobin/mL was 52.1% (95% CI, 47-57.1). Based on time-period cumulative analysis, the ADR improved over time from 30.5% (95% CI, 24.6-37.2) to 47.8% (95% CI, 44.1-51.6).This meta-analysis supports the current ADR benchmarks for colonoscopy in FIT-positive individuals. Excellent pooled ADR parameters were demonstrated with qualitative assessment of 1 stool sample at a test cutoff value of 100 ng hemoglobin/mL, and ADR per endoscopist improved over time.

Electron tubes continue to provide the highest speeds possible for recording dynamics of hot high-energy density plasmas. Standard streak camera drive electronics and CCD readout are not compatible with the radiation environment associated with high DT fusion yield inertial confinement fusion experiments >1013 14 MeV DT neutrons or >109 n cm−2 ns−1. We describe a hardened x-ray streak camera developed for the National Ignition Facility and present preliminary results from the first experiment on which it has participated, recording the time-resolved bremsstrahlung spectrum from the core of an inertial confinement fusion implosion at more than 40× the operational neutron yield limit of the previous National Ignition Facility x-ray streak cameras.

Background and Aims Several methods with variable efficacy have been proposed for difficult biliary cannulation in ERCP. We assessed the comparative efficacy of different strategies for difficult biliary cannulation through a network meta-analysis combining direct and indirect treatment comparisons. Methods We identified 17 randomized controlled trials (2015 patients) that compared the efficacy of different adjunctive methods for difficult biliary cannulation (needle-knife techniques, pancreatic guidewire-assisted technique, pancreatic-assisted technique, and transpancreatic sphincterotomy) either with each other or with persistence with the standard cannulation techniques. The success rate of biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) were the outcomes of interest. We performed pairwise and network meta-analysis for all treatments and used Grading of Recommendations Assessment, Development and Evaluation criteria to appraise quality of evidence. Results Low-quality evidence supported the use of transpancreatic sphincterotomy over persistence with standard cannulation techniques (risk ratio [RR], 1.29; 95% confidence interval [CI], 1.05-1.59) and over any other adjunctive intervention (RR, 1.21 [95% CI, 1.01-1.44] vs pancreatic guidewire-assisted technique, RR, 1.19 [95% CI, 1.01-1.43] vs early needle-knife techniques, RR, 1.47 [95% CI, 1.03-2.10] vs pancreatic stent-assisted technique) for increasing the success rate of biliary cannulation. No other significant results were observed in any other comparisons. Based on the network model, transpancreatic sphincterotomy (P-score, .97) followed by early needle-knife techniques (P-score, .62) were ranked highest in terms of increasing the success rate of biliary cannulation. Early needle-knife techniques outperformed persistence with standard cannulation techniques in terms of decreasing PEP rate (RR, .61; 95% CI, .37-1.00), whereas both early needle-knife techniques and transpancreatic sphincterotomy led to lower PEP rates as compared with pancreatic guidewire-assisted technique (RR, .49 [95% CI, .23-.99] and .53 [95% CI, .30-.92], respectively). Conclusions Transpancreatic sphincterotomy increases the success rate of biliary cannulation as compared with persistence with the standard cannulation techniques. Early needle-knife techniques and transpancreatic sphincterotomy are superior to other interventions in decreasing PEP rates and should be considered in patients with difficult cannulation.