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This article discusses the management of fetal cardiac resuscitation during fetal cardiac intervention (FCI) in cases of severely obstructed left heart and a restrictive or intact atrial septum. The study reports on five fetal cases that underwent cardiac compressions, including one fetus that required resuscitation after ventricular fibrillation. The authors describe their institutional resuscitation strategy, which involves using ultrasound guidance to assess the depth and quality of compressions. The article also highlights the success of cardiac compressions in restoring normal sinus rhythm in all five fetuses. The authors recommend standardized dilutions of resuscitative drugs for fetal resuscitation during FCI. [Extracted from the article]

Cotton grown in the United States are day‐length insensitive annuals and are grown under long‐day summers. Photoperiod sensitivity, present in tropical wild and landraces endemic to the center of origin and diversity, is a major barrier for the introgression of tropical gene pool into the US cotton. Previously, we mapped the major photoperiod response locus Gb_Ppd1 on chromosome D06 of Pima cotton (Gossypium barbadense L.). In the current study, an F2 population of 2112 gametes was used to fine map the Gb_Ppd1 locus. Two sequence‐tagged‐site and nine kompetitive allele‐specific polymerase chain reaction (KASP) markers were developed and the Gb_Ppd1 locus was fine mapped to 1.1 cM region flanked by novel markers 17‐KASP‐8, 17‐KASP‐10, and 15‐PR‐10A. The closely linked markers identified 2.10 Mb region in the G. barbadense genome that contained 18 putative gene sequences. A candidate gene Gbar_D06G014560 showed high homology to VASCULAR PLANT ONE ZINC FINGER PROTEIN 1 involved in photoperiodism in Arabidopsis. We evaluated the diagnostic polymorphisms for the flanking markers on a diversity panel of 91 Pima accessions. These markers would be useful in marker‐assisted selection of photoperiod response in cotton breeding. Further, quantitative gene expression analysis indicated that the CONSTANS (CO)/FLOWERING LOCUS T (FT) system is conserved in the photoperiod response pathway in Pima cotton, while CO and FT are likely not the causal genes underlying flowering time at the Gb_Ppd1 locus. The Gb_Ppd1 gene may be an upstream regulatory sequence in the FT gene pathway that controls photoperiodism in photoperiod‐sensitive cotton by affecting the CO/FT interaction under long‐day‐length conditions. Core Ideas: The major effect photoperiod response locus (Gb_Ppd1) of Pima cotton was fine mapped to a 1.1 cM region flanked by new markers 15‐PR‐10A and 17‐KASP‐10.Targeted genomic mapping of Gb_Ppd1 locus identified 18 putative genes in 2.10 Mb region of Gossypium barbadense genome.Candidate gene analyses identified a homolog of VASCULAR PLANT ONE ZINC FINGER PROTEIN 1 as a candidate gene for Gb_Ppd1 locus.Quantitative expression analysis indicated that the CO/FT system in the photoperiod response pathway is likely conserved in Pima cotton, while CO is likely not the causal gene at the Gb_Ppd1 locus. [ABSTRACT FROM AUTHOR]

Objective: The extent of parotidectomy in the management of regional metastatic disease is controversial. This systematic review aimed to appraise data from studies evaluating superficial and total parotidectomy in metastatic cutaneous squamous cell carcinoma and cutaneous malignant melanoma of the head and neck. Method: A systematic search of PubMed, Embase and Cochrane Library was performed. The protocol was registered with Prospero (CRD42020217962). Results: A total of five studies evaluated cutaneous malignant melanoma. Only one compared outcomes of superficial and total parotidectomy: they found higher parotid area recurrence following superficial parotidectomy. Seven studies reported outcomes following cutaneous squamous cell carcinoma; some studies found higher regional recurrence and reduced survival in total parotidectomy, but there was likely selection bias in these studies. Others found no difference in survival between superficial and total parotidectomy. Conclusion: The effect of the extent of parotidectomy on outcomes is unclear in cutaneous malignant melanoma and cutaneous squamous cell carcinoma. This systematic review highlights the need for well-designed studies to direct better care. [ABSTRACT FROM AUTHOR]

In cotton, most agronomic traits are controlled by polygenes. In this study, 110 F6 recombinant inbred lines (RILs), derived from Upland cotton cross NC05AZ06 x NC11‐2100, were used to develop a linkage map and to identify quantitative trait loci (QTL) for six fiber quality traits, three yield traits, and plant height. These RILs were genotyped using the CottonSNP63K array and phenotyped for fiber quality, yield traits, and plant height in 2‐year field trials. Analysis of variance revealed significant (p < 0.05) differences among RILs for all traits studied, and the heritability estimates were moderate (30%–60%) to high (> 60%). Both positive and negative correlations were observed for fiber quality and yield traits. A total of 3,774 polymorphic SNP markers were used to develop a genetic map with an average marker density of 1.54 SNP/cM. Thirty QTL for fiber quality traits, yield traits, and plant height were detected on 15 different chromosomes, explaining 6.80%–20.02% of the phenotypic variance (PVE). Of these, 14 were major QTL (PVE > 10%), and three major QTL were detected in both years. Candidate gene analysis in the major QTL detected in both years and plant height QTL with PVE of 20.02% revealed five putative genes for fiber quality traits and one putative gene for plant height. The linkage map and identified QTL along with the candidate genes in the study could serve as additional breeding resources for Upland cotton genetic improvement. Core Ideas: A RIL population derived from accessions with maximum allele diversity was used for QTL mapping of fiber quality and yield traits, and plant height in cotton.Broad sense heritability of the 10 agronomic traits studied ranged from moderate (30%–60%) to high (>60%) values.Thirty QTL, including 14 major QTL, of which 3 major stable QTL, were detected for fiber quality and yield traits, and plant height. [ABSTRACT FROM AUTHOR]

Shreya K Gowda,1 Enzo Errichetti,2 Vishal Thakur,1 Maitreyee Panda,3 Siddhartha Dash,4 Akash Agarwal,3 Madhusmita Sethy,5 Pavithra Ayyanar,5 Biswanath Behera1 1Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, OD, India; 2Institute of Dermatology, Department of Medicine, University of Udine, Udine, Italy; 3Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, OD, India; 4Department of Dermatology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, OD, India; 5Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, OD, IndiaCorrespondence: Biswanath Behera, Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, 751019, India, Email biswanathbehera61@gmail.comIntroduction: Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are primary scarring alopecias that pose diagnostic challenges clinically, where trichoscopy features may provide benefit in delineating these two cicatricial alopecia, and also helps in assessing the evolution and therapeutic response. To date, there are few reviews on dermoscopic findings in differentiating these two alopecias.Methods: A systematic literature review was conducted using the PubMed and Google Scholar databases. The search terms included for scalp DLE were ‘lupus’ OR ‘discoid lupus’ OR “scalp lupus” and for scalp LPP were “lichen planopilaris” OR “scalp follicular lichen planus” OR “lichen planus follicularis” and were combined with “dermoscopy” OR “dermatoscopy” OR “videodermoscopy” OR “video dermatoscopy” OR “trichoscopy”. The differences in the prevalence of dermoscopic features in scalp DLE and LPP were calculated using the Chi-square test.Results: Of 52 articles, 36 (17 LPP, 19 DLE) were eligible for quantitative analysis. We found predominant peripilar tubular casts and perifollicular erythema with the presence of arborizing vessels in the vicinity of these changes, indicating early LPP. In contrast, follicular red dots, speckled brown pigmentation, and hair diameter variability indicated active DLE. Shiny white areas were common in both the groups in late stages. The target pattern of distribution of blue-grey dots, milky red areas, and irregular white fibrotic dots were seen in LPP, and pink-white background, follicular plugs, perifollicular and interfollicular scale, rosettes, chrysalides, and red spider on yellow dots were detected in DLE. Features such as yellow dots and blue-grey structureless areas were nonspecific and did not have a major role in differentiating DLE from LPP.Conclusion: This article provides a comprehensive review of the literature and delineates the trichoscopic differences and peculiarities of scalp DLE and LPP, including the correlation of dermoscopic features with histopathological findings.Keywords: scalp discoid lupus erythematosus, lichen planopilaris, trichoscopy, dermoscopy, primary cicatricial alopecia

Sharada H Gowda,1 Ranjit Philip,2 Mark F Weems3 1Department of Pediatrics and Division of Neonatology, Baylor College of Medicine, Houston, TX, USA; 2Department of Pediatrics, Division of Cardiology, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN, USA; 3Department of Pediatrics, Division of Neonatology, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN, USACorrespondence: Mark F Weems, University of Tennessee Health Science Center, Department of Pediatrics, Division of Neonatology, 853 Jefferson Ave, Rout Bldg E201, Memphis, TN, 38163, USA, Tel +1 901-448-5950, Fax +1 901-448-1691, Email mweems@uthsc.eduAbstract: “What we know is little, and what we are ignorant of is immense”; the last words of Laplace still apply to the diagnosis and management of the patent ductus arteriosus (PDA). Despite decades of research, we are searching for the right approach to care for patients with PDA. Nuances of myocardial structural changes and cardiopulmonary interactions with prolonged exposure to excess pulmonary blood flow have played an important role in decision-making. The availability of medical treatments with poor efficacy and, historically, surgical ligation as the only available definitive therapy further widened the gap between observation and definitive closure. As more extremely low birth weight neonates born at earlier gestational ages survive, we are faced with a population whose physiological immaturity and structural alignment of the myocardium predisposes them to myocardial dysfunction and dysregulated vascular tone. Therefore, it may be time to replace historical approaches with a more precise patient-centric therapeutic model. A comprehensive serial echocardiography assessment of the heart function, hemodynamic significance, and clinical context with respect to pulmonary insufficiency and gut perfusion aids the neonatologist in making PDA management decisions. A targeted approach balances risks and benefits of therapy, avoids treatment for infants likely to have early spontaneous closure, and limits prolonged exposure to the pathologic PDA shunt in high-risk infants. There is significant variability in the diagnosis and treatment of the PDA, both within and across centers. This review highlights the clinical obstacles contributing to the variability and illustrates the need for a standardized approach to PDA diagnosis and management.Keywords: preterm, neonate, echocardiogram, neonatology, cardiology, shunt

Road traffic in metropolitan cities is increasing at enormous rates resulting in congestion. Vehicles rendering emergency services like ambulances, fire engines, law enforcement vehicles, etc., act as lifelines and should be looked into with the highest priorities on the road. Such emergency vehicles (EmVs / EVs) are seen stuck many times in traffic, especially during peak hours of the day. The vehicles that block the EmVs on the road are unaware of the arrival of the same. Hence this work proposes a system that uses a central server that receives the location of the EmV and shares it with the civilian vehicles around. This is achieved through pinpointed accuracy systems like the Indian Regional Navigation Satellite System (IRNSS), Global Positioning System (GPS), and Global System for Mobile Communication (GSM), etc., The objective here is to help the EmVs reach their target location earlier thus saving lives.

Care delivery in neonatology is dependent on an interprofessional team. Collaborative learning and education amongst professionals can lead to successful management of critically ill patients. This focused BEME review synthesized the components, outcomes, and impact of such interprofessional education (IPE) programs in neonatal medicine. The authors systematically searched four online databases and hand-searched MedEdPublish up to 10 September 2020. Two authors independently screened titles, abstracts, full-texts, performed data extraction and risk of bias assessment related to study methodology and reporting. Discrepancies were resolved by a third author. We reported our findings based on BEME guidance and the STORIES (STructured apprOach to the Reporting in health education of Evidence Synthesis) statement. We included 17 studies on IPE in neonatal medicine. Most studies were from North America with varying learners, objectives, instruction, and observed outcomes. Learners represented nurses, respiratory therapists, neonatal nurse practitioners, patient care technicians, parents, early interventionists, physicians, and medical trainees amongst others. Risk of bias assessment in reporting revealed poor reporting of resources and instructor training. Bias assessment for study methodology noted moderate quality evidence with validity evidence as the weakest domain. IPE instruction strategies included simulation with debriefing, didactics, and online instruction. Most studies reported level 1 Kirkpatrick outcomes (76%) and few reported level 3 or 4 outcomes (23%). Challenges include buy-in from leadership and the negative influence of hierarchy amongst learners. This review highlights IPE program components within neonatal medicine and exemplary practices including a multimodal instructional approach, asynchronous instruction, an emphasis on teamwork, and elimination of hierarchy amongst learners. We identified a lack of reporting on program development and instructor training. Future work should address long term knowledge and skill retention and impact on patient outcomes and organizations. [ABSTRACT FROM AUTHOR]

Introduction: Fever is a common symptom with multifactorial etiologies. In tropical country like India, most of the cases of acute febrile illness are due to seasonal viral diseases and vector-borne infections. Aim: To know the causes of acute onset fever in immunocompetent adults and to study the prevalence of neutropaenia. Materials and Methods: A cross-sectional study was done on 403 patients presenting with Acute Febrile Illness (AFI) of <14 days duration admitted to a tertiary care hospital, Pune, Maharashtra, India from January 2019 to January 2020. Total Leukocyte Count (TLC), Absolute Neutrophil Count (ANC) and investigations for dengue, malaria, leptospirosis, enteric fever, atypical infections like brucella, rickettsia and relevant body fluid cultures were done. The categorical and continuous variables were expressed as frequency, percentage, and standard deviation. Results: Out of 403 patients, 214 were males (53.1%) and 189 females (46.9%) with mean age of 28.57±11.26 years. Cause of fever was found in 254 (63%) patients. Dengue fever was the most common cause in 221 (54.8%) followed by Acute Undifferentiated Febrile Illness (AUFI) in 149 (37%). Transient neutropaenia was present in 38.5% cases, mostly with dengue. Only 5.2% patients with AFI required antibiotics. Conclusion: Dengue fever, the most common cause of AFI chiefly affecting young adults. Neutropaenia in AFI in immunocompetent adult is transient and benign. Antibiotics are not required in majority of the cases of AFI without organ specific aetiologies. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: MRI is generally performed to assess response to Neo-adjuvant systemic therapy (NAST) in breast cancer. OBJECTIVE: To assess role of MRI in determining the probability of having residual disease in patients undergoing NAST. We also evaluated synchronous cancers diagnosed following MRI. METHODS: This is a retrospective study which included all patients who had pre-and post-NAST MRI between June 2014 and December 2019. Data on demographics, tumour characteristics and pathology were collected and analysed. Pre- and post-MRI probability were calculated and depicted on nomograms. RESULTS: The study included 205 patients. Overall pre-MRI probability of having residual disease was 55% (OR:1.2). The post-MRI probability was 78% (95% CI 72–83%; OR:3.5) if MRI showed residual disease and 23% (95% CI 16–31%, OR:0.3) if imaging showed complete response. The absolute benefit was higher in TNBC and HR-HER2. Additional cancers were identified in 8.78% of patients. CONCLUSION: MRI is beneficial in evaluating response to NAST specifically in TNBC and HR-HER2 cancers. Pre- and post-MRI probabilities of residual disease depicted on nomograms are a useful tool for clinicians. MRI can potentially impact the treatment decisions by identification of synchronous cancers. [ABSTRACT FROM AUTHOR]

Introduction Patients with ischemic heart disease are on antiplatelet drugs or injectable heparin when referred for a coronary artery bypass grafting (CABG) surgery. Hence, they have an increased tendency for bleeding during the procedure. We conducted a study to estimate the actual amount of blood loss both during sternotomy and entire off-pump CABG procedure (OPCAB). Methods The present study was conducted in the accrual period between July 2017 till June 2019 at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, enrolling 50 consecutive patients who fulfilled the inclusion criteria. Blood loss was estimated using gravimetric method by weighing the blood soaked mops and gauzes used during the entire procedure. Results The average blood loss during sternotomy and at the end of the CABG was estimated in 50 patients and it was found to be 294 ml and 797 ml respectively. Patients with left main coronary artery disease (LMCA) who were on intravenous heparin pre-operatively bled 6.3% more than nonLMCA patients who were only on aspirin prior to surgery. Patients who received 1 and 2 grafts bled 53% (p<0.0128) and 5% (p<0.036) lesser respectively than the average of the study population and statistically significant difference was found (p≤ 0.001). Patients who received 3 and 4 grafts bled about 4% and 16% respectively more than the average (p≥0.01). Conclusion Inevitable use of antiplatelet drugs and heparin in the pre-operative period increases blood loss during surgery. Subset of females, patients with LMCA disease and those who required 3 or 4 bypass grafts had a significantly increased amount of blood loss at the end of surgery in the study population. [ABSTRACT FROM AUTHOR]

The present study deals with the resequencing of cultivars, Suvin and BCS-23-18-7 belonging to Gossypium barbadense which are distinctly differing in fiber qualities and seed cotton yield using Illumina Hiseq2500 sequencer. A total of 2,604,107 single nucleotide polymorphism (SNP) and 592,364 insertion and deletions (INDELs) were identified when compared with G. barbadense reference genome. Among the 14,075 preferentially expressed genes of agronomically important traits of cotton, we have identified 33,637 markers in the genic regions. Comparing between the variants of Suvin and BCS-23-18-7, among the 4,929 preferentially expressed genes in fiber, only 1,128 genes have 2,453 variants and of these 1,512 variants are non-synonymous types, leading to change at the protein level. In order to validate the presence of these markers in the expressed genes could tag the expression and/or phenotypic variation bought by alleles of Suvin/BCS-23-18-7, among 51 fiber elongation genes, ten genes that had high effect SNPs were utilized for real-time PCR, which showed an extended period of expression up to 15 days post-anthesis (DPA) in Suvin. Hence, utilization of such markers for the construction of SNP array / linkage maps would provide greater value to quantitative trait loci (QTL) mapping instead of random genomic markers. [ABSTRACT FROM AUTHOR]

OBJECTIVE: In the coronavirus disease 2019 (COVID-19) pandemic, a spectrum of sequelae affecting different organs has been reported. Of these, the ones affecting the thyroid gland have been reported, especially in the adults. CASE REPORT: We present previously healthy twin adolescents with no history of thyroid disease, presenting with signs and symptoms of hypothyroidism after recovery from mild COVID-19 infection. Their investigations were consistent with auto-immune thyroiditis with primary hypothyroidism, showing markedly elevated thyroid-stimulating hormone (TSH), suppressed FT4 levels, positive anti-thyroid peroxidase antibody and anti-thyroglobulin antibody titres. They were treated accordingly and showed quick clinical improvement in symptoms. CONCLUSIONS: This case report demonstrates that COVID-19 infection can be temporally associated with primary hypothyroidism in genetically predisposed children adding more to the growing list of sequelae especially in children. [ABSTRACT FROM AUTHOR]

In Budd-Chiari Syndrome (BCS) there is narrowing and obstruction of the veins of the hepatic veins. Patients have upper quadrant abdominal pain, hepatomegaly and/or ascites. Authors hereby, discuss a case report of a 20-year-old male with history of abdominal pain, progressive distension of abdomen and mild jaundice for two months. He had hepatic vein thrombosis as well as lupus anticoagulant and was positive for anti beta 2-glycoprotein I antibody indicative of antiphospholipid syndrome. The patient was worked up for hypercoagulable states in view of unusual site of venous thrombus. Patient recovered after being treated with prolonged anticoagulation and hepatic vein stenting. The link between antiphospholipid syndrome and BCS is well documented in the literature, but occurrence of BCS due to primary antiphospholipid syndrome is rare. Early identification, treatment of underlying cause can prevent chronic BCS and liver cirrhosis. [ABSTRACT FROM AUTHOR]