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Background Stenotrophomonas maltophilia causes opportunistic infections in immunocompromised and patients in intensive care units (ICUs). An outbreak of S. maltophilia in ICU is described which highlights the importance of the risk of infection from contaminated medical devices and suction fluids in ventilated patients. Methods The investigation of the outbreak was carried out. Environmental sampling was done. This was followed by MALDI-TOF MS typing and recA gene-based-phylogeny. Results In February, S. maltophilia was reported from the central line blood of six patients from ICU within a span of two weeks. The peripheral line blood cultures were sterile in all patients. Relevant environmental sampling of the high-touch surface and fluids revealed S. maltophilia strains in normal saline used for suction and in the inspiratory circuit of two patients. The isolated strains from patients and environment (inspiratory fluid) showed a minimum of 95.41% recA gene sequence identity between each other. Strict cleaning and disinfection procedures were followed. Continuous surveillance was done and no further case of S. maltophilia was detected. Timely diagnosis and removal of central line prevented development of central-line associated blood stream infection. Conclusion This outbreak report illustrates that environmental sources like suction fluid and normal saline could be the source of S. maltophilia in ICU patients.

2.1. BACKGROUND: Acute myocardial ischemia has several characteristic ECG findings, including clinically detectable ST-segment deviations. However, the sensitivity and specificity of diagnosis based on ST-segment changes are low. Furthermore, ST-segment deviations have been shown to be transient and spontaneously recover without any indication the ischemic event has subsided. 2.2. OBJECTIVE: Assess the transient recovery of ST-segment deviations on remote recording electrodes during a partial occlusion cardiac stress test and compare them to intramyocardial ST-segment deviations. 2.3. METHODS: We used a previously validated porcine(BZ) experimental model of acute myocardial ischemia with controllable ischemic load and simultaneous electrical measurements within the heart wall, on the epicardial surface, and on the torso surface. Simulated cardiac stress tests were induced by occluding a coronary artery while simultaneously pacing rapidly or infusing dobutamine to stimulate cardiac function. Postexperimental imaging created anatomical models for data visualization and quantification. Markers of ischemia were identified as deviations in the potentials measured at 40% of the ST-segment. Intramural cardiac conduction speed was also determined using the inverse gradient method. We assessed changes in intramyocardial ischemic volume proportion, conduction speed, clinical presence of ischemia on remote recording arrays, and regional changes to intramyocardial ischemia. We defined the peak deviation response time as the time interval after onset of ischemia at which maximum ST-segment deviation was achieved, and ST-recovery time was the interval when ST deviation returned to below thresholded of ST elevation. 2.4. RESULTS: In both epicardial and torso recordings, the peak ST-segment deviation response time was 4.9 ± 1.1 min and the ST-recovery time was approximately 7.9 ± 2.5min, both well before the termination of the ischemic stress. At peak response time, conduction speed was reduced by 50% and returned to near baseline at ST-recovery. The overall ischemic volume proportion initially increased, on average, to 37% at peak response time; however, it recovered only to 30% at the ST-recovery time. By contrast, the subepicardial region of the myocardial wall showed 40% ischemic volume at peak response time and recovered much more strongly to 25% as epicardial ST-segment deviations returned to baseline. 2.5. CONCLUSION: Our data show that remote ischemic signal recovery correlates with a recovery of the subepicardial myocardium, while subendocardial ischemic development persists.

Renal disease has always been a challenge for the treating obstetrician. With new advances in the management of renal disease, an increasing number of patients can continue the pregnancy and with individualization have a better outcome. MATERIAL AND METHODS: To analyze the pregnancy outcomes in renal disease, a retrospective cohort observational study over 5 years at a tertiary care institute in northern India was done. All the pregnant women with pre-existing renal disease of any etiology presenting at any period of gestation who consented were included and those not consenting were excluded from the study. RESULTS: Of 62 patients enrolled, 82.26% (n = 51) were followed,17.74%(n = 11) were lost to follow up. 58.82% (n = 30) had to undergo termination of pregnancy and 41.18%(n = 21) had delivery after 28 weeks of gestation. The antenatal complications seen were hypertension in 15.69%, diabetes mellitus in 9.80%, anemia in 5.88%. Fetal complications included preterm delivery (42.85%) and small for gestational age babies(61.90%). Cesarean delivery was 85.71% and normal delivery in 14.29% of patients. CONCLUSION: Both maternal and fetal outcomes are influenced by the cause and degree of renal dysfunction. A better outcome is seen when the renal disease is under control, good antenatal follow-up, multidisciplinary approach, and timely delivery.

Under varying speed, a bearing exhibits a severely modulated signal, to which the classical techniques of time and frequency domain fails to detect. An experimental investigation exhibiting detection of bearing faults at both constant and varying speed using empirical wavelet transform (EWT) is presented. EWT employs a filter bank to decompose a non-stationary signal into different sub-bands. The selection of sub-band influences fault detection because residual noises remain unfiltered. Therefore, identification of sensitive sub-band is crucial for a detailed investigation, which is done using correlated correlation and kurtosis. Upon selection of sensitive sub-band the envelope spectrum was used to detect the presence of fault based on the frequencies noticed. The results were validated by permutation entropy. Two case studies: in-house bearing vibration signal at a constant speed and, online available bearing data set at varying speed, were performed to exhibit the promising result of the proposed approach to detect the bearing fault.

The aim of this study was to explore acute and chronic toxicity as well as antiasthmatic potential of the ayurvedic formulation Nayopayam Kashayam on experimental animals. The present study was targeted for the study of its toxicity profile along with its antiasthmatic activity. The acute toxicity study was carried out using OECD 425 CPCSEA guideline in albino wistar rats. Oral acute toxicity study was performed at 2000mg/kg orally, which was considered as limit dose. The chronic toxicity study was carried out with administration of Nayopayam Kashayam at three therapeutic equivalent doses i.e. TED (45mg/kg, orally), TEDx5 (225 mg/kg, orally) and TEDx10 (450 mg/kg, orally) for 90 days. Further, antiasthmatic study was carried out using histamine-induced bronchospasm in guinea pig model. The results of acute toxicity studies showed that drug did not create any signs and symptoms of toxicity and no mortality was shown to an oral dose of 2000 mg/kg in rats. The results of chronic toxicity study showed that the drug even at level as high as dose of TEDx10 had no significant effect at all on hematological and body weight parameters, however mild to moderate unfavorable changes in kidney and liver were indicated. The experiential changes were not seen at the lower dose levels. The drug also showed a marked decrease in hiccups of asthma during antiasthmatic study. Hence, it is suggested that the Nayopayam Kashayam, prepared as per the traditional method, is secured/safe for utilization and treatment of asthma at the therapeutic dose level.

With the rapid evolution of technology, almost every business is now online connecting them to the widest and narrow corners of the world. Therefore, instead of physical security, their online security is a pivotal concern the business which all depends on the web applications security. Web application attacks and their risks have become normal since past many years, and the security of web applications has received increased attentions at present. Many attacks work on real time and mostly prevention mechanisms focus on prevention and detection of these attacks on the web applications. This research focuses on giving attention to the top 10 threats that organizations need to know and to ensure the web applications are protected from these risks and attacks.

OBJECTIVE The aim of this study was to compare the performance of angiogenesis-specific 68Ga-RGD2 PET/CT with Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) in assessing disease activity and treatment response in rheumatoid arthritis (RA). METHODS This was a prospective study comparing the performance of 68Ga-RGD2 PET/CT and DAS28-ESR in 30 RA patients. All of them underwent 68Ga-RGD2 PET/CT scan from head to toe and clinical examination at the baseline. A repeat scan and clinical examination were done in 27 patients after 3 months of treatment with disease-modifying antirheumatic drugs ± steroids. Three PET parameters, that is, PJC (PET-positive joint count), aSUVmax (average SUVmax), and hSUVmax (highest SUVmax), of positive joints were compared with the DAS28-ESR for disease activity assessment and response evaluation. RESULTS Among the 3 PET parameters, PJC showed a significant correlation with the DAS28-ESR (0.64, P < 0.01). A significant change was observed with treatment in the DAS28-ESR and PET parameters of 27 patients at follow-up. There was significant correlation between percentage changes in DAS28-ESR and scan parameters such as PJC (0.689, P < 0.001), aSUVmax (0.712, P < 0.001), and hSUVmax (0.555, P = 0.003) values. The absolute change in aSUVmax value could accurately discriminate (area under the curve, 0.98; P = 0.001) European League Against Rheumatism responders from nonresponders. CONCLUSIONS 68Ga-RGD2 PET/CT is a promising tool for objective assessment of disease activity and treatment response in patients with RA.

In the era of hybrid organic devices, solution-processed metal-embedded polymer multilayer structures are potential candidates for transparent electrode applications. Here, an organic–inorganic–org...

Necrotizing fasciitis is severe inflammation of the muscle sheath that leads to necrosis of the subcutaneous tissue and adjacent fascia. The disease entity is more commonly described in adults and the literature seems quite sparse with respect to children and even lesser in neonates. Monomicrobial infection with necrotizing fasciitis in Neck following insect bite is rare and even rarer in neonates. 07 day old neonate had history of rapid onset discoloration and swelling of the Right side of Neck following an insect bite which was followed fever and irritability and eventually black discoloration. The neonate was irritable with excessive crying, had tachycardia, tachypnea and was febrile. There was a diffuse swelling in the right side of neck with multiple patchy areas of tissue necrosis in form of blackening of the skin over the swelling Management: Necrotizing fasciitis was identified early and the neonate prepped for surgery. All the biochemical parameters were WNL. CRP was raised. Empirical treatment with Cefotaxime, Clindamycin and cloxacillin started and neonate taken for local debridement. All necrotic tissue was removed including tail of parotid. Over next 5 days serial debridement and wound wash with Hydrogen peroxidase, Betadine, saline and metronidazole was done. The edges of the wound became healthy with no new slough formation and necrotic tissue. An early diagnosis and definitive management with both surgery and antibiotics is the key to a reduce mortality in the neonates. It needs to be followed up with good local wound care.

Numerous studies on vibration-based techniques for fault diagnosis of wind turbine gearboxes operating under nonstationary conditions have been reported. In spite, a review on vibration-based condition monitoring and fault diagnosis techniques for gearboxes of wind turbines operating under nonstationary conditions is unavailable. Thus, the objective of this review is to discuss filtering, decomposition, entropy, and cyclostationary analysis techniques, as well as summarizing the remaining issues. This review will discuss various vibration-based diagnostic approaches developed for wind turbine gearboxes under nonstationary conditions, including both simulation and experimental approaches. Studies on dynamic models of gear systems and advanced signal-processing techniques developed for nonstationary conditions are reviewed. Additionally, the importance of multi-sensor and cointegration based approaches is discussed, and intelligent classification methods that have been used to distinguish healthy and faulty gear systems are also reviewed. Finally, the remaining research challenges are outlined.

GNE gene-specific c.2179G>A(p.V727M) is a key alteration reported in patients with hereditary inclusion body myopathy (HIBM) and represents an ethnic founder mutation in the Indian cohort. However, the underlying role of this mutation in pathogenesis remains largely unknown. Thus, in this study, we aimed to access possible mechanisms of V727M mutation that could be leading to myopathy. We evaluated various in silico tools to predict the effect of this mutation on pathogenicity, structural or possible interactions, that could induce myopathy. Our results propose that V727M mutation could induce deleterious effects or pathogenicity and affect the stability of GNE protein. Analysis of differential genes reported in the V727 mutant case suggests that it can affect GNE protein interaction with Myc-proto-oncogene (MYC) transcription factor. Our in silico analysis also suggests a possible interaction between GNE ManNac-kinase domain with MYC protein at the C-terminal DNA-binding domain. MYC targets reported in skeletal muscles via ChIP-seq suggest that it plays a key role in regulating the expression of many genes reported differentially expressed in V727M-mutated HIBMs. We conclude that V727M mutation could alter the interaction of GNE with MYC thereby altering transcription of sialyltransferase and neuromuscular genes, thus understanding these effects could pave the way for developing effective therapies against HIBM.

A flow boiling experimental investigation was performed to examine the heat transfer coefficient of water and water-TiO2 nanofluid. During investigation, the Reynolds number varied from 8000 to 24,000, pressure from 1 to 2.5 bar, and volumetric concentration of nanofluid from 0.05 to 0.20%. Supplied heat flux was 143 kWm−2. Experimental results of water were in good agreement with CFD investigation and Chen correlation. It was noticed that the HTC of water and water-TiO2 nanofluid enhanced with the enhancement in Reynolds number and pressure. HTC of water-TiO2 nanofluid was greater than the water and enhanced with the enhancement in volumetric concentration. The highest increment in the HTC of water-TiO2 nanofluid in comparison to water was noticed for Reynolds number 24,000, concentration 0.20%, and pressure 2.5 bar which was 76.7%. Correlations of the HTC of titania nanofluid were developed. To optimize the HTC of water-TiO2 nanofluid desirability function approach was utilized.

Objective Deficiency of adenosine deaminase 2 (DADA2) is a potentially fatal monogenic syndrome characterized by variable manifestations of systemic vasculitis, bone marrow failure, and immunodeficiency. Most cases are diagnosed by pediatric care providers, given the typical early age of disease onset. This study was undertaken to describe the clinical phenotypes and treatment response both in adults and in children with DADA2 in India. Methods A retrospective analysis of pediatric and adult patients with DADA2 diagnosed at various rheumatology centers across India was conducted. Clinical characteristics, diagnostic findings, and treatment responses were analyzed in all subjects. Results In total, 33 cases of DADA2 were confirmed in this cohort between April 2017 and March 2020. Unlike previous studies, nearly one-half of the confirmed cases presented during adulthood. All symptomatic patients exhibited features of vasculitis, whereas constitutional symptoms and anemia were more common in pediatric patients. Cutaneous and neurologic involvement were common, and 18 subjects had experienced at least one stroke. In addition, the clinical spectrum of DADA2 was expanded by recognition of novel features in these patients, including pancreatic infarction, focal myocarditis, and diffuse alveolar hemorrhage. Treatment with tumor necrosis factor inhibitors (TNFi) was initiated in 25 patients. All of the identified disease manifestations showed marked improvement after initiation of TNFi, and disease remission was achieved in 19 patients. Two cases were complicated by tuberculosis infection, and 2 deaths were reported. Conclusion This report presents the first case series of patients with DADA2 from India, diagnosed by adult and pediatric care providers. The findings raise awareness of this syndrome, particularly with regard to its presentation in adults.

There is another general wellbeing emergencies undermining the world with the rise and spread of 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The infection started in bats and was transmitted to people through yet obscure go-between creatures in Wuhan, Hubei territory, China in December 2019. There are more than 48,15,484 infected cases all around the globe. This can be transmitted from one to another very quickly only by coughing or sneezing or direct contact with infected person. World Health Organization also has stated that there is no future course of this virus is available till now. As a preventive measure the complete stop on outgoings i.e. lockdown is surrendered. The lockdown all over the country or all around the globe is becoming a huge crisis for the economy and of countries the life cycle of the humans. The lockdown has affected all the businesses, works, private sectors as well as government sectors. The impact of lockdown on the pharmaceutical industries can be a great boon if its taken positively. Keywords: coronavirus, SARS-CoV 2, wuhan, transmitted, crisis, lockdown, impact.

Objective:The aim of this study was to identify factors associated with acceptability and efficacy of yoga training (YT) for improving cognitive dysfunction in individuals with schizophrenia (SZ).Methods:We analysed data from two published clinical trials of YT for cognitive dysfunction among Indians with SZ: (1) a 21-day randomised controlled trial (RCT, N = 286), 3 and 6 months follow-up and (2) a 21-day open trial (n = 62). Multivariate analyses were conducted to examine the association of baseline characteristics (age, sex, socio-economic status, educational status, duration, and severity of illness) with improvement in cognition (i.e. attention and face memory) following YT. Factors associated with acceptability were identified by comparing baseline demographic variables between screened and enrolled participants as well as completers versus non-completers.Results:Enrolled participants were younger than screened persons who declined participation (t = 2.952, p = 0.003). No other characteristics were associated with study enrollment or completion. Regarding efficacy, schooling duration was nominally associated with greater and sustained cognitive improvement on a measure of facial memory. No other baseline characteristics were associated with efficacy of YT in the open trial, the RCT, or the combined samples (n = 148).Conclusions:YT is acceptable even among younger individuals with SZ. It also enhances specific cognitive functions, regardless of individual differences in selected psychosocial characteristics. Thus, yoga could be incorporated as adjunctive therapy for patients with SZ. Importantly, our results suggest cognitive dysfunction is remediable in persons with SZ across the age spectrum.

Paclitaxel-induced photodermatitis is extremely rare despite the frequent use of paclitaxel-trastuzumab combination chemotherapy. A 70-year-old woman with infiltrating intraductal breast cancer developed photodermatitis after ten treatment courses of weekly paclitaxel-trastuzumab combination chemotherapy. Withdrawal of paclitaxel and sun avoidance led to its resolution. A combined effect of solar radiation and enhanced porphyrin synthesis is speculated for photodermatitis in paclitaxel. However, the issue of aberrant porphyrin biosynthesis being causal or an epiphenomenon remains unsettled as elevated porphyrins synthesis does not necessarily cause photosensitivity in all treated cases. The relevant literature on paclitaxel-induced photodermatitis and pathomechanism involved is reviewed.

Central serous chorioretinopathy (CSCR) is a common disease of the middle-aged population with largely unknown etiology. We report the case of CSCR in a 37-year-old patient following an episode of angioedema who presented with sudden diminution of vision in the left eye 2 days following an episode of angioedema, which had been managed with a short course of steroids and antihistamines. On evaluation, he was found to have subretinal fluid at the macula in the affected eye, suggestive of CSCR. The patient was conservatively managed. The patient had recovery of symptoms with conservative management over a long period. The association of angioedema and its treatment as an underlying cause of CSCR needs to be explored. To the best of our knowledge, this is the first such case to be reported worldwide.

Recent results have shown that electrochemical energy storage devices can change their characteristics near the magnetic field environment. Mostly, this change is attributed to the magnetically res...

Introduction: Increasing bacterial resistance and the non-availability of newer antimicrobial agents have necessitated the re-evaluation of old antimicrobial agents. Although an old antibiotic, Fosfomycin gives a ray of hope as it has a unique property of not sharing structural similarity with other antibiotics and with no cross-resistance. Aim: To retrospectively evaluate the invitro activity of Fosfomycin against Extended-Spectrum Beta-Lactamase (ESBL) producing and Carbapenem Resistant Enterobacteriaceae (CRE). Materials and Methods: The study period was from December 2018 to November 2019. Antibiotic sensitivity was carried out according to the Clinical and Laboratory Standards Institute (CLSI) guidelines using the automated Vitek-2 Compact (Bio-Merieux, France). Fosfomycin susceptibility was determined by E-test (Biomereiux, India). The interpretive criteria according to CLSI for Fosfomycin is given only for E.coli and not for other Enterobacteriaceae, hence the results were interpreted as per CLSI criteria given for E. coli (i.e., susceptibility at a Minimum Inhibitory Concentration (MIC) of ≤64 μg). Results: Overall, 91.07% (102/112) isolates were susceptible to Fosfomycin with 91.67% (88/96) susceptibility for ESBL producing Enterobacteriaceae and 87.5% (14/16) for CRE. Fosfomycin has shown good invitro activity against ESBL producers as well as CRE. Conclusion: Fosfomycin showed promising results as a re-emerging antibiotic for the treatment of Urinary Tract Infection (UTI) because of its unique mechanism of action, low incidence of resistance, oral availability with single-dose administration and little tendency to display cross-resistance to other antibiotics.

Postoperative atrial fibrillation (POAF) after cardiac surgery remains a highly prevalent and costly condition that negatively impacts patient quality of life and survival. Numerous retrospective studies, meta-analysis, and review papers have been reported identifying POAF risk based on patients' risk factors and clinical biomarkers. In this narrative review, the authors report significant variations among selected pre- and perioperative biomarkers used to predict POAF incidence in patients without a history of atrial fibrillation (AF). POAF prediction based on B-type natriuretic peptide, N-terminal pro B-type natriuretic peptide, C-reactive protein, interleukin-6, creatinine, and plasminogen activator inhibitor-1 differs significantly among different studies, thereby limiting their clinical utility to predict POAF risk with high accuracy. Conversely, soluble vascular endothelial cells adhesion molecule-1, soluble CD40 ligand, Galectin-3, and aldosterone show promise for better POAF prediction. However, the current datasets for these selected biomarkers are not of sufficient size to validate the broad clinical application specifically for patients with no prior history of AF.

Background: Association of psoriasis with other autoimmune diseases remains an ongoing research subject. Objectives: To investigate the association of psoriasis with other autoimmune disorders. Materials and Methods: We studied 80 (M: F 57:23) psoriasis patients aged 13–75 years for concurrent autoimmune disorders. After clinical examination, hemogram, fasting blood sugar, HbA1c, thyroid function tests, anti-TPO antibody, rheumatoid factor, anti-tTG antibody, anti-CCP antibody, ANA, anti-dsDNA antibody, anti-Ro antibody, and fecal calprotectin were estimated. Results: Mild-to-moderate and severe psoriasis was present in 86.3% and 13.8% patients, respectively. Psoriatic arthritis was present in 3.8% patients, all of whom also had severe psoriasis. Only 37 (46.3%) patients had clinical and/or sero-abnormality suggestive of autoimmune disorders; vitiligo in 3.8%, type-1 diabetes mellitus (DM) in 1.3%, and type-2 DM in 6.3% patients. Sero-positivity reflecting subclinical autoimmunity was noted for anti-CCP antibodies (in 2.5%), rheumatoid factor (in 2.5%), hypo- or hyper-thyroidism (in 8.8%), anti-TPO antibodies (in 5.0%), anti-tTG antibody (in 1.3%), ANA (in 5.0%), anti-dsDNA antibody (in 2.5%), and anti-Ro antibody in 11.3% patients. Elevated fecal calprotectin levels suggestive of inflammatory bowel disease (IBD) occurred in 11.2% of 27 patients. Multiple abnormalities happened in 2.5% patients. Conclusion: Apparently psoriasis patients seem to have a predilection for other autoimmune disorders particularly for vitiligo, diabetes mellitus, autoimmune thyroiditis, rheumatoid arthritis, and IBD. However, association between psoriasis and other autoimmune disorders at best remains tenuous for want of strong evidence. Nevertheless, screening for them will improve overall management of these patients. Cross-sectional study design and small number of study subjects remain important limitations.

From the origin of ancient Vedas or Shastras; there was an awareness of artificial intelligence but in different meanings. In present scenario, one has to perform a lot of research for the production of works relating with artificial intelligence. Basically, artificial intelligence is a huge group of skills from advanced machines used for finding the solutions of different fields i.e. in pharma fields or non-pharma fields. The problem of heart failure or heart attack is very big health issue which is assisted with more than 23 million peoples worldwide. Heart failure can be held due to the vasoconstriction or improper pumping mechanism of ventricles. Heart failure heart logic device is a new tsunami in the healthcare system for cardiac devices. This device is in two different forms which are as (ICD) implantable cardioverter defibrillator and other oneiscardiac resynchronization therapy defibrillator (CRT-D). Heart logic heart failure diagnostic device contains multiple sensors to track physiological functioning of the heart. There are Heart sound sensors which checks signs of elevated filling pressure and weakened ventricular contraction. There are also a sensor for checking pulmonary edema. Respiration sensor is used to monitor the rapid shallow breathing system which is associated with shortness of breath. Heart rate sensors check the heart rate and arrhythmia conditions. This device can predict heart failure events weeks before they happen. This artificial intelligence assisted device is showing the sensitivity in more than 70% of peoples to save the valuable lives of the human beings

Corona viruses belong to the genus Corona virus with its high mutation rate in the Coronaviridae. In this review article, the focus is on current status of research against SARS-CoV-2, various mobile apps launched to diagnose COVID-19 infection and status of prospective therapies available against COVID-19 virus in this early stage of COVID-19 outbreak.

PURPOSE: To describe a case of unilateral isolated traumatic posterior corneal ectasia characterized by advanced multi-modal diagnostic tests. METHODS: Case report and literature review. RESULTS: Following blunt trauma to the left eye, a 34-year-old woman presented with persistently blurry vision. Central corneal thickness was 300 µm, compared to 519 µm in the right eye. Scheimpflug tomography revealed significant corneal thinning in a defined inferotemporal region with corresponding elevation of the posterior corneal surface. Posterior corneal ectasia was confirmed with anterior segment optical coherence tomography. Wavefront aberrometry demonstrated increased higher order aberrations in the affected eye. Vision remained stable during 4.5 years of follow-up with a final visual acuity of 20/50 maintained with spectacle correction only. CONCLUSIONS: A unique case of unilateral post-traumatic posterior corneal ectasia was presented. The multi-modal imaging provided a detailed characterization of the structural characteristics of the cornea, guided management, and allowed for differentiation from other corneal pathologies at an early stage. [ Journal of Refractive Surgery Case Reports . 2021;1(2):e31–e35.]

Optimal crop emergence is an important trait in crop breeding for genotypic screening and for achieving potential growth and yield. Emergence is conventionally quantified manually by counting the sub-sections of field plots or scoring; these are less reliable, laborious and inefficient. Remote sensing technology is being increasingly used for high-throughput estimation of agronomic traits in field crops. This study developed a method for estimating wheat seedlings using multispectral images captured from an unmanned aerial vehicle. A machine learning regression (MLR) analysis was used by combining spectral and morphological information extracted from the multispectral images. The approach was tested on diverse wheat genotypes varying in seedling emergence. In this study, three supervised MLR models including regression trees, support vector regression and Gaussian process regression (GPR) were evaluated for estimating wheat seedling emergence. The GPR model was the most effective compared to the other methods, with R2 = 0.86, RMSE = 4.07 and MAE = 3.21 when correlated to the manual seedling count. In addition, imagery data collected at multiple flight altitudes and different wheat growth stages suggested that 10 m altitude and 20 days after sowing were desirable for optimal spatial resolution and image analysis. The method is deployable on larger field trials and other crops for effective and reliable seedling emergence estimates.

Malignant otitis externa (MOE) is a relatively rare complication of Otitis externa with a tendency to spread to other parts of temporal bone and skull base. Pseudomonas aeruginosa is the most common pathological agent. It generally occurs in the elderly with poorly controlled diabetes. In this report we present a case of MOE with atypical initial presentation causing immense conundrum in deciphering the diagnosis early.

Background: Activated coagulation cascade is implicated in urticaria pathogenesis marked by high plasma D-dimer, a marker of fibrinolysis, levels correlating with high urticaria activity score (UAS) and poor therapeutic outcome. Methods: Quantitative plasma D-dimer levels and coagulation parameters in 100 (male:female ratio 1:3) Indian patients with chronic spontaneous urticaria and age- and gender-matched healthy controls were compared. The clinicoepidemiologic features of chronic urticaria were then compared among patients with normal (≤0.2 mg/L) and elevated (≥0.3 mg/L) plasma D-dimer levels. Results: Plasma D-dimer in 23% patients and 4% controls and prothrombin time and activated partial thromboplastin time in 63% and 5% patients, respectively, were significantly higher compared with 58% and 1% of controls, respectively. About 18 of 72 (25%) patients with high UAS of ≥16–42 were compared with 5 of 28 (17.8%) patients with UAS7 of ≤15. Patients with elevated plasma D-dimer levels had significantly more systemic symptoms (86.9% vs. 81.8%) compared with patients with normal plasma D-dimer levels. Conclusion: A subset of patients with chronic urticaria have elevated plasma D-dimer levels and exhibit higher UAS7 and systemic symptoms that may influence long-term prognosis and therapeutic choices. Small number of patients, a cross-sectional nature of study, lack of treatment outcome measures, information on self-medication, and unavailability of specific parameters for coagulation pathway activation remain few limitations of this study.

Reoperative aortic root replacement, following prior biologic or mechanical valved conduit aortic root prosthesis, presents a technical challenge. The rapid-deployment aortic valve prosthesis is an approved alternative to traditional bioprosthetic aortic valve replacement. We present three clinical cases in which rapid-deployment aortic valve prostheses were utilized in lieu of reoperative full aortic root replacement. All three patients recovered uneventfully. The rapid-deployment valve insertion in a prior surgical aortic root prosthesis is a safe option to avoid reoperative full aortic root replacement.

Objective To evaluate 18F-fluorodeoxyglucose (FDG) PET/CT in the assessment of disease activity, extent of the disease and response to therapy in relapsing polychondritis. Methods Twenty-five patients (9 men, 16 women) with a mean age of 38.2 years (s.d. 13.7; range 18–62), diagnosed to have relapsing polychondritis according to Damiani and Levine’s modification of McAdam’s criteria, who underwent PET/CT examination were included. Ten patients underwent a second PET/CT examination after therapy or during follow-up. Clinical symptoms and auxiliary examination findings were recorded. PET/CT findings were reviewed and correlated with the clinical symptoms. Results The major symptoms were aural pain (n = 21), nasal pain (n = 10), stridor (n = 5), cough (n = 9), fever (n = 8) and laryngeal tenderness (n = 8). The initial PET/CT was positive in 23/25 patients. PET/CT revealed involvement of auricular (n = 14), nasal (n = 8), laryngeal (n = 7), tracheobronchial (n = 6) and Eustachian (n = 3) cartilages with a mean maximum standardized uptake value (SUVmax) of 4.1 (s.d. 2.5; range 1.7–12.7). Fair correlation of aural/nasal pain/stridor with FDG avidity of cartilage involvement on PET/CT was noted. The key finding was detection of asymptomatic large airway involvement in seven patients (28%). Re-examination PET in 10 patients revealed complete therapeutic response (n = 5), partial response (n = 1), stable disease (n = 1), progressive disease (n = 1) and disease recurrence (n = 2). Conclusion FDG PET/CT is a useful tool for the assessment of the disease activity and extent. It identified activity in clinically inaccessible sites that are of clinical significance. It is also useful in assessing treatment response and finding relapse.

Psoriasis is now recognized as an immune-mediated inflammatory dermatosis with increased risk for metabolic syndrome, its individual components, and cardiovascular disease. We quantitatively estimated malondialdehyde (MDA), lipoprotein-a (LP-a), lipoprotein ratios, comprehensive lipid tetrad index (CLTI), and atherogenic index (AI), and evaluated cardiovascular risk in 132 (M:F 94:38) patients with psoriasis aged 20–79 years with chronic plaque psoriasis and equal number of age and gender-matched controls. Lipoprotein ratios, CLTI and AI were calculated using standard formulae. Cardiovascular 10-year risk was graded by Framingham risk score (FRS) as low, intermediate and severe. Mild-to-moderate and severe psoriasis was present in 125 (94.7%), and 7 (5.3%) patients, respectively, and 19 (14.39%) patients had psoriatic arthritis. Statistically significant differences were noted for LDL, LDL/HDL, non-HDL/HDL, MDA, LP-a, AI and CLTI. There was a significantly positive correlation between PASI with LP-a (p = 0.003, r = 0.25) and AI (p = 0.012, r = 0.22). Serum levels of MDA correlated positively with LP-a (p

Background Primary central nervous system lymphoma (PCNSL) is an uncommon extranodal non-Hodgkin lymphoma. This tumor is common in the fifth to seventh decade and is located commonly in the periventricular region and in the cerebral hemisphere. Corpus callosum is a rare site. We report a case of diffuse large B cell lymphoma with corpus callosum and contralateral side involvement in immunocompetent patient. Case presentation A 50-year-old male was admitted with complaints of headache with one episode of generalized seizure. On examination, the patient was neurologically intact. CEMRI (contrast-enhanced magnetic resonance imaging) brain showed heterogenous enhancing mass lesion in the left frontal and basifrontal region with involvement of rostrum and body of corpus callosum with patchy areas of diffusion restriction and choline peak on MRS (magnetic resonance spectroscopy). Intraoperatively yellowish brown tumor was seen in the left basifrontal and frontal region with involvement of corpus callosum and extension to opposite side. Microscopic and IHC (immunohistochemistry) examination was suggestive of diffuse large cell lymphoma. Postoperative period was uneventful. The patient received chemoradiotherapy in postoperative period. The patient is asymptomatic 6 months after surgery. Conclusion Primary CNS lymphoma is a rare tumor, and corpus callosum with contralateral side involvement is rare.

Hierachical nanosheets of Co3O4 can deliver specific capacitance of ∼402 F g–1, which is 50% higher than that obtained using simpler disc shaped (∼230 F g–1) or conventional solid structures (∼150 F g–1). A simple question is then asked: should the particles showing other morphologies be discarded? As the electrode material is to be used in green or renewable energy technologies, the carbon footprint of each particle morphology was determined using the life cycle assessment (LCA) studies. The results led to inferences, which were strikingly different from those generally expected. It was seen that simpler morphologies, prepared using easier synthesis protocols, had five-times lower CO2 footprints than hierarchical morphology (nanosheets). The results become extremely critical for proposing their large scale industrial use. They clearly indicate that the choice of nanostructured metal oxides in energy storage devices will have to be relooked from the aspect of their own environmental impacts. Particles wit...

Background: Most therapeutic modalities for common warts remain unsatisfactory. Objectives: To evaluate efficacy and safety of intralesional MMR (measles, mumps, rubella virus) vaccine in the treatment of common warts in adults. Patients and Methods: There were 110 (M:F = 61:49) patients aged 19–62 years having 1–211 warts over dorsal hands, feet, palms, soles, and periungual skin for 1–252 months. MMR vaccine 0.25 mL was injected intralesionally in the largest wart and repeated at 2-week interval until complete clearance or maximum of five doses. The outcome was evaluated as complete clearance, excellent, good, or unsatisfactory response on visual analog scale at every visit and at 4 and 8 weeks, thereafter by comparing baseline clinical photograph. Likert scale was used for patient satisfaction level assessment similarly. Results: Only 51 patients completed the study and 42 (82.4%) of them showed complete clearance of warts and 9 (17.6%) patients showed good or unsatisfactory response. In 4 (7.8%) patients, the warts subsided completely after one dose itself. The four patients showing excellent response after five doses initially also continued to improve during follow-up period of 8 weeks. Except for injection site pain, no adverse effects were noted. There was no recurrence of warts among cured who were also very much satisfied from treatment. Conclusion: Despite variable results, intralesional MMR vaccine immunotherapy appears another possible safe and effective treatment option for common warts in a set of adult patients with advantages of regression of distant warts, no significant adverse effects and low recurrence. However, well-designed, controlled studies for minimum effective dose and treatment schedule are highly desirable to make any recommendation.

Background: We studied clinico-epidemiological features of 945 patients with vitiligo with an objective to delineate epidemiological and clinical aspects of vitiligo from this part of the country. Materials and Methods: The medical records of patients with vitiligo attending outpatient clinic over a 5-year period from January 2013 to December 2017 were analyzed retrospectively for this descriptive, observational study. Results: There were 449 men and 496 women (m:f 1:1.1) aged between 2 and 83 years (mean 24.4 years) and having vitiligo for 1 week to 64 years (mean 5.1 years). The majority, 478 (50.6%) patients were aged ≤20 years and 248 (26.2%) were children aged ≤12 years. The age at the onset was between 6 months and 82 years (mean 20.5 years), and the majority 674 (71.3%) patients had it before 25 years of age. The consultation time was within 5 years in 692 (73.2%) patients. A family history of vitiligo was present in 150 (15.9%) patients. The majority 871 (92.2%) patients had involvement of up to 10% body surface area and vitiligo vulgaris in 562 (59.5%) and focal vitiligo in 117 (18.7%) patients were the most common clinical types. An association with other systemic disorders was in 124 (13.1%) patients and predominately included thyroid abnormalities and diabetes mellitus. Conclusions: Our observations are essentially consistent with the literature. There was no difference in clinico-epidemiological features of vitiligo. Patients with an affected first-degree family member had early onset, but difference was not statistically significant. Screening for concurrent thyroid disorders appears important. However, our inferences remain limited by single center, retrospective, observational, and cross-sectional nature of the study.

An efficient Sonogashira coupling protocol is developed for tetra-alkynylation at the bay and peri-positions of the perylene-monoimide (PMI) dye in its PMI(Br)4 form. The absorption band for these PMI dyes covered from the visible to Near-infrared (NIR) region and PMI(NMe2)4 is found to exhibit a record-breaking Stokes-shifted NIR emission with good photovoltaic properties.

Background: This study evaluated the efficacy and safety of intralesional bleomycin in the treatment of common warts in 50 (32 men, 18 women) patients aged between 14 and 80 (mean ± SD, 28.5 ± 13.27) years. Methods: The warts were present over dorsal hands, feet, palms, soles and periungual skin for 1 month to 10 years. They were infiltrated with bleomycin (1 mg/ml) till blanching. The total cumulative dose did not exceed 2 mg in one session. The treatment was repeated after paring of eschar at 2 weeks in case there was no or partial response. The patients were reviewed at 4, 12 and 24 weeks for cure, adverse effects or recurrences and outcome satisfaction levels. Results: Complete cure without recurrence occurred in 40 (80%) patients and partial response occurred in 7 (14%) patients at the end of the 24-week study period. Three patients did not complete follow-up. No major systemic or local adverse effects other than injection site pain for 2–3 days were noted. All cured patients were very satisfied (Likert scale 5). Conclusion: Intralesional bleomycin appears to be an effective and safe treatment for common warts including palmoplantar and periungual warts. It carries the advantage of low dose, no significant adverse effects and high patient satisfaction. Small number of patients, lack of a control group, comparing different bleomycin concentrations and a short follow-up are a few limitations of this study. Better designed studies are warranted for this useful treatment modality.

Context: Pediatric brain tumors are a vexing problem for the neurosurgeon due to the fragile patient cohort. We attempt to find parameters which can help us to treat and prognosticate these patients in a better way. Aims: This study aims to correlate clinical presentation, outcome, and histological grade with P53 and Ki-67 expression in primary pediatric brain tumors. Setting Design: This was a prospective, observational study. Patients and Methods: Forty-seven patients with primary brain tumors in the age group 0–18 years were included in this study. Clinical presentation was noted. Patients were operated, and specimen was sent for histopathological and immunohistochemistry examination for p53 and Ki-67. The WHO classification of 2007 was used to grade the tumors. Follow-up was done at 3 and 6 months with Glasgow outcome score. Expression of p53 and Ki-67 in different tumors was correlated with clinical presentation, tumor grade and outcome. Analysis Method: Statistical Package for Social Science version 17. P < 0.05 was considered statistically significant. Results: There was statistically significant correlation between high tumor grade and high Ki-67 levels (P = 0.000). On post hoc analysis, there was a significant difference between p53 levels in Grade 1 and Grade 4 tumors. There was statistically significant correlation between neurological deficit and higher p53 levels (P = 0.040). There was statistically significant correlation between poor outcome and higher p53 (P = 0.034) and Ki-67 (P = 0.000) levels at 3 months follow-up which continued at 6 months. Conclusions: From this study, we conclude that p53 and Ki-67 expression in pediatric brain tumors is associated with poor outcome and correlates with tumor grade. Moreover, p53 expression correlates with neurological deficit.

Nature-inspired structures as transparent conducting electrodes are exciting alternatives to conventional TCEs because they provide higher transmittance and conductivity at low temperatures on flexible substrates. The current work is focussed to develop a metal mesh structure with the help of plant leaf vein as a template. Bilayer metal mesh of thickness 85%) and electrical resistivity of the order of 10−4 Ω cm. The metal mesh TCE based on leaf vein template opens up new ways of obtaining large charge transfer resolving the junction resistance problem encountered in case of metal nanowires.

Providing medical care using the telecommunication networks holds the promise of increased access and efficiency of healthcare particularly during global emergencies like the Coronavirus disease 2019 (COVID-19) pandemic. Most of the hospital setups worldwide have put telemedicine into practice ever since the onset of the COVID-19 pandemic. This study aimed at assessing the effectiveness of Tele-otolaryngology (TO) at a tertiary care centre during the pandemic lockdown. A validated patient feedback questionnaire was developed and distributed to 2577 patients who utilised the TO mobile health service at our institute. Patient feedback-based assessment of TO effectiveness during COVID-19 lockdown was carried out. The validated questionnaire in English and Hindi was statistically robust with Cronbach's alpha value of 0.808 and 0.886 respectively. 1751 patients completed their feedback to the questionnaire. 97.5% utilised WhatsApp for TO consultation. 15.2% patients were detected of Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection with TO guidance. Up to 75% patients had a positive response to the questionnaire and 91.1% opined of savings achieved either with travel time, cost incurred or the treatment time. With respect to patient health status, 71.5% recovered, 20.1% had no change and 8.4% deteriorated with a mortality rate of 1.65%. Telehealth in otolaryngology during the COVID-19 pandemic lockdown was indispensable in managing exigencies. Redesigning of clinical protocol and technical constraints, clinician training and a validated patient feedback questionnaire would effectively bestow upon the global emergencies.

OBJECTIVE: Test the hypothesis that exercise and pharmacological cardiac stressors create different electrical ischemic signatures. INTRODUCTION: Current clinical stress tests for detecting ischemia lack sensitivity and specificity. One unexplored source of the poor detection is whether pharmacological stimulation and regulated exercise produce identical cardiac stress. METHODS: We used a porcine model of acute myocardial ischemia in which animals were instrumented with transmural plunge-needle electrodes, an epicardial sock array, and torso arrays to simultaneously measure within the heart wall, the epicardial surface, and the torso surface, respectively. Ischemic stress via simulated exercise and pharmacological stimulation were created with rapid electrical pacing and dobutamine infusion, respectively, and mimicked clinical stress tests of five three-minute stages. Perfusion to the myocardium was regulated by a hydraulic occluder around the left anterior descending coronary artery. Ischemia was measured as deflections to the ST-segment on ECGs and electrograms(BZ). RESULTS: Across eight experiments with 30 (14 simulated exercise and 16 dobutamine) ischemic interventions, the spatial correlations between exercise and pharmacological stress diverged at stage three or four during interventions (p

Objective: To assess the viability of TENS in diminishing agony and increasing function following TKR.Sample: 30 subjects (age>55years)chose based on consideration and avoidance standardsare included inthe study.Method: 30 subjects were taken in the study,chosen based on consideration and rejection models andarbitrarily assigned to each group. Group 1 and group2. Experimental group (group 1) received TENS andexercise while control group received only exercises for 20 days (6 days per week). Functional testing wasdone using a questionnaire.Results: Paired t-test was used for statistical analysis. There was huge distinction between the two groups(A & B). The experimental group has significant improvement then the observational group. The pain VASscore has more difference. There was no significant difference in ADL activities score.Conclusion: It was concluded that applying TENS along with exercises on initial days of rehabilitationshows better results and increases the recovery process.