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Abstract In winter, the paddy residues become wet during morning and late evening due to dew, which restricts the operation of sowing machines (Happy Seeder and Super Seeder) into paddy residues, as wet residues do not slide on furrow openers/tines. A PAU Smart Seeder (PSS) was developed and evaluated for a four-wheel tractor that can sow wheat with optimum crop establishment in combined harvested rice fields. The PSS were evaluated for its performance under varying straw load, forward speed, and rotor speed in terms of fuel consumption, field capacity, seed emergence, and grain yield. The crop establishment and wheat yield of PSS was also compared with the existing straw management machines Happy Seeder (HS) and Super Seeder (SS) under heavy paddy residue conditions. The effect of the straw load was more pronounced on dependent variables than the effect of the speed index. PSS performance was best at a forward speed of 2.6 km h−1, rotor speed of 127.5 rpm, and a straw load of 6 t ha−1. Average fuel consumption using PSS was lower than SS but higher than HS. Wheat emergence was higher by 15.6 and 25.7% on the PSS plots compared to HS and SS, respectively. Average wheat grain yield in PSS plots was significantly higher by 12.7 and 18.9% than SS and HS, respectively in one experiment, while the grain yield was similar for both PSS and HS in other experiments. PSS has a novel mechanism to manage paddy straw and simultaneously sow wheat into a heavy straw load (> 8 t ha−1) mixture of anchored and loose straw. In conclusion, PSS showed promise for in-situ management of rice straw as it eliminates most of the operational problems encountered by the existing seeders (HS and SS).

Background: Many studies have shown the beneficial effect of prophylactic lidocaine or esmolol on hemodynamic response during laryngoscopic intubation. Although many studies observed a better effect of esmolol over lidocaine, some studies have drawn an impression of equal efficacy or even no benefit with the use of either of the drugs. Aims and Objectives: The study aimed to compare the heart rate (HR) at 1 min after intubation between the patients receiving lidocaine and esmolol. Other outcome measures were to compare HR at 3 and 5 min post-intubation and to compare the mean arterial pressure at 1, 3, and 5 min after intubation. In addition, the adverse events, if any, were noted. Materials and Methods: Fifty patients, 30–45 years, either sex, Mallampati grade 1–2, of the American Society of Anesthesiologists physical status I-II, posted for elective abdominal surgery requiring direct laryngoscopic endotracheal intubation were included. Patients were randomly allocated into two groups to receive esmolol 2 mg/kg (Group E, n=25) or 2% lidocaine 2 mg/kg (Group L, n=25), intravenously. HR and mean arterial blood pressure (MAP) were recorded at 1-, 3-, and 5-min interval post-intubation. Results: The mean HR at 1-min post-intubation was considerably lower using esmolol in comparison with lidocaine (91.7±9.7 vs. 107.7±5.1, P≤0.0001). The mean HR and MAP at 3-min and 5-min post-intubation were considerably lower with the use of esmolol compared with lidocaine. Conclusion: Esmolol is better than lidocaine in attenuating the hemodynamic response of intubation.

Abstract A transparent polarisation-sensitive phase pattern changes the phase of transmitted light without absorption, whereas this change of phase depends on the polarisation of incident light. A position-localised polarisation-dependent phase pattern is imprinted onto the phase-space of atoms by using atomic state dependent velocity-selective hole burning. A phase-space localised pattern is a higher dimensional generalisation of patterns localised in the position-space. Such a pattern cannot be imaged with a lens. The imprinted pattern is localised in a unique three-dimensional subspace of the six-dimensional phase-space of atoms. The phase-space localised pattern transforms the polarisation of light transmitting through it. This pattern is tomographically imaged at room temperature by measuring the intensity of the transmitted imaging laser beam of variable frequency with a camera after its polarisation analysis. Two sub-tomographs of the imprinted phase-space localised pattern are constructed. This paper presents a concept and experiment of imprinting and imaging of a polarisation-sensitive phase pattern localised in the phase-space.

Introduction Prevention of necrotising enterocolitis (NEC) is vital for improving neonatal outcomes. Feeding own mother’s milk helps prevent NEC. Rates of own mother’s milk feeding in the East Midlands are lower than the national average and the incidence of NEC is higher. The East Midlands Neonatal Operational Delivery Network (EMNODN) has created a care bundle to improve these in babies born at

Urinary biomarkers are a promising diagnostic modality whose role was explored in nephrotic syndrome (NS). We estimated urinary apolipoprotein A1 (Apo A1) and neutrophil gelatinase-associated lipocalin (NGAL) in children with first-episode NS (FENS) and controls with a longitudinal follow-up to see the serial changes during remission. The study groups comprised 35 children with FENS and an equal number of age- and sex-matched controls. Patients were followed up at regular intervals, and 32 patients were classified as having steroid-sensitive NS (SSNS) and 3 as having steroid-resistant NS (SRNS). The mean follow-up period was 8.7 ± 4.2 months. Three patients in the SSNS group were labeled as having frequent relapses or steroid-dependent disease during follow-up. Of the three children with SRNS, two had minimal changes in the disease and one had idiopathic membranous nephropathy. The levels of Apo A1:creatinine, NGAL:creatinine, and spot urinary protein:urinary creatinine ratios were significantly higher in children with FENS compared with controls. The levels of the urine biomarkers decreased significantly at subsequent follow-up with remission. The Apo A1 and NGAL levels in SSNS patients were significantly high compared with both the controls and FENS patients. Urinary Apo A1 levels in SRNS patients were lower at initial presentation. This longitudinal study revealed changes in the urinary Apo A1 and NGAL in NS over the course of the disease.

Abstract Modification of proteins with a broad range of chemical functionalities enables the investigation of protein structure and activity by manipulating polypeptides at single amino acid resolution. Indeed, various functional groups including bulky non-canonical amino acids like strained cyclooctenes could be introduced by the unique features of the binding pocket of the double mutant pyrrolysyl-tRNA synthetase (Y306A, Y384F), but the instable nature of the enzyme limits its application in vivo. Here, we constructed a cell-free protein production system, which increased the overall enzyme stability by combining different reaction compartments. Moreover, a co-expression approach in a one-pot reaction allowed straightforward site-specific fluorescent labeling of the functional complex membrane protein cystic fibrosis transmembrane conductance regulator. Our work provides a versatile platform for introducing various non-canonical amino acids into difficult-to-express proteins for structural and fluorescence based investigation of proteins activity.

Abstract Food packaging reinforced with Zn-doped TiO2 nanoparticles with enhanced prerequisite film-forming and biodegradable traits was prepared to augment fresh food storage. Pure and tailored metal (Zinc, Copper, and Selenium) doped TiO2 nanoparticles were synthesized and analyzed through multiple characterization techniques (optical spectra, XRD patterns (X-Ray Diffraction), Dynamic Light Scattering, and Scanning Electron Microscopy). The synthesized nanoparticles were tested for their Minimum Inhibitory Concentrations, antimicrobial potential against common lethal food pathogens, and cytotoxicity. Compared to Cu- and Se-doped nanoparticles, Zn-doped TiO2 nanoparticles displayed the most potent antimicrobial activity with insignificant cytotoxicity and were incorporated into the food packaging materials. The developed nano-reinforced food packaging efficaciously augmented the freshness of plums (Oemleria cerasiformis) for 16 days (42 ± 2 °C). The physicomechanical characterization of the nano-reinforced packaging establishes its utility in food packaging applications. The developed biodegradable packaging undergoes complete decomposition within 12 days of storage in natural soil.

Abstract Exposure to particulate matter less than 2.5 µm in diameter (PM2.5) is a cause of concern in cities and major emission regions of northern India. An intensive field campaign involving the states of Punjab, Haryana and Delhi national capital region (NCR) was conducted in 2022 using 29 Compact and Useful PM2.5 Instrument with Gas sensors (CUPI-Gs). Continuous observations show that the PM2.5 in the region increased gradually from

Multiple meningiomas (MMs) tend to be benign with uniform histology. It is uncommon to find sporadic MMs having different histological features in the same patient. In this case series, of the four patients diagnosed with MM, two patients had different histopathology. An updated review of literature was then performed, providing the different histopathology in those cases. The first case was unique as the patient had an intradiploic meningioma with an intraparenchymal meningioma. Histology found in these cases represented WHO Grade I meningioma. After performing a literature search, it is likely that these tumors do not arise from clonal expansion, but rather have an independent origin.

OBJECTIVES/GOALS: Immediate negative impact of the COVID pandemic on CTSA T trainees and K scholars was reported in 2020 to be lack of access to research facilities, clinics, human subjects, and team members, and a need for homeschooling. In this study we examined in more detail the perceived impact of the COVID pandemic on training and career development three years later. METHODS/STUDY POPULATION: CTSA T trainees and K scholars were surveyed in May-June 2023 to assess the impact of the COVID-19 pandemic on training and career development. Data were included from 309 T trainees and K scholars appointed in 2018-2023 at 50 institutions, with good representation from states that were heavily impacted by COVID. Respondents included 76 past and 64 current T trainees, and 56 past and 113 current K scholars. There were no significant differences in race, ethnicity, or gender between T and K respondents. Significantly more K scholars reported both being married or in a committed relationship, and having children. Survey items included the same questions asked in the 2020 survey, plus additional new questions. Results compare impact for T trainees and K scholars. RESULTS/ANTICIPATED RESULTS: K scholars were more negatively impacted for access to clinic/human subjects, home environment, child care, access to staff, increased clinical responsibilities, and other hospital service. T trainees and K scholars reported higher positive impact than in 2020, for having more time to think/write and develop new research ideas. About 2/3 of respondents reported returning to research full-time by April 2021, and the remaining by August 2021. Lasting changes in career progression or research direction were reported as both positive and negative (48%), negative (25%), or positive (10%). Most (2/3) respondents in faculty positions reported that a time extension was available for promotion and/or tenure. Additional in-depth analysis will be presented, based on qualitative analysis of open-ended questions. DISCUSSION/SIGNIFICANCE: Despite research shutdowns in response to the COVID-19 pandemic that lasted for about a year, CTSA T trainees and K scholars were remarkably resilient. They were able to continue some research activities and professional development activities, and developed strategies to maintain productivity and minimize impact on their training duration.

Introduction Rapid population ageing and associated health issues such as frailty are a growing public health concern. While early identification and management of frailty may limit adverse health outcomes, the complex presentations of frailty pose challenges for clinicians. Artificial intelligence (AI) has emerged as a potential solution to support the early identification and management of frailty. In order to provide a comprehensive overview of current evidence regarding the development and use of AI technologies including machine learning and deep learning for the identification and management of frailty, this protocol outlines a scoping review aiming to identify and present available information in this area. Specifically, this protocol describes a review that will focus on the clinical tools and frameworks used to assess frailty, the outcomes that have been evaluated and the involvement of knowledge users in the development, implementation and evaluation of AI methods and tools for frailty care in clinical settings.Methods and analysis This scoping review protocol details a systematic search of eight major academic databases, including Medline, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ageline, Web of Science, Scopus and Institute of Electrical and Electronics Engineers (IEEE) Xplore using the framework developed by Arksey and O’Malley and enhanced by Levac et al and the Joanna Briggs Institute. The search strategy has been designed in consultation with a librarian. Two independent reviewers will screen titles and abstracts, followed by full texts, for eligibility and then chart the data using a piloted data charting form. Results will be collated and presented through a narrative summary, tables and figures.Ethics and dissemination Since this study is based on publicly available information, ethics approval is not required. Findings will be communicated with healthcare providers, caregivers, patients and research and health programme funders through peer-reviewed publications, presentations and an infographic.Registration details OSF Registries (https://doi.org/10.17605/OSF.IO/T54G8).

Introduction The high incidences of both the developmental delay among young children and the mental health problems of their caregivers are major threats to public health in low-income and middle-income countries. Parental training interventions during early childhood have been shown to benefit early development, yet evidence on strategies to promote caregiver mental health remains limited. In addition, evidence on the optimal design of scalable interventions that integrate early child development and maternal mental health components is scarce.Methods and analysis We design a single-blind, factorial, cluster-randomised controlled, superiority trial that will be delivered and supervised by local agents of the All China Women’s Federation (ACWF), the nationwide, government-sponsored social protection organisation that aims to safeguard the rights and interests of women and children. We randomise 125 villages in rural China into four arms: (1) a parenting stimulation arm; (2) a caregiver mental health arm; (3) a combined parenting stimulation and caregiver mental health arm and (4) a pure control arm. Caregivers and their children (aged 6–24 months at the time of baseline data collection) are selected and invited to participate in the 12-month-long study. The parenting stimulation intervention consists of weekly, one-on-one training sessions that follow a loose adaptation of the Reach Up and Learn curriculum. The caregiver mental health intervention is comprised of fortnightly group activities based on an adaptation of the Thinking Healthy curriculum from the WHO. Primary outcomes include measures of child development and caregiver mental health. Secondary outcomes include a comprehensive set of physical, psychological and behavioural outcomes. This protocol describes the design and evaluation plan for this programme.Ethics and dissemination This study received approval from the Institutional Review Board of Stanford University (IRB Protocol #63680) and the Institutional Review Board of the Southwestern University of Finance and Economics in Chengdu, Sichuan, China. Informed oral consent will be obtained from all caregivers for their own and their child’s participation in the study. The full protocol will be publicly available in an open-access format. The study findings will be published in economics, medical and public health journals, as well as Chinese or English policy briefs.Trial registration number AEA RCT Registry (AEARCTR-0010078) and ISRCTN registry (ISRCTN84864201).

Background: Stress, anxiety and depression are common nowadays with having debilitating effects on the affected person. Doctors face a lot of stress owing to various reasons. This stress affects them on a personal level and a professional level too. Methods: Fifty one faculty members willingly participated in the study. A self-reported depression anxiety stress scale (DASS)-42 along with a semi-structured pro forma was distributed amongst the faculty members of a medical college and hospital at Rajpura. Results: Most of the participants were female (60.8%) and married (86.3%). Majority were from the age group of 30–39 years (49%). Half of the faculty experience mild (25.5%)-to-moderate (25.5%) levels of depressive symptoms, about one-third reported moderate (33.3%) anxiety symptoms and about 43.1% reported mild stress symptoms. Conclusions: High extent of depression, anxiety and stress is present in faculty of a medical college. The contributory factors related to this stress, anxiety and depression need to be studied further. Mental health and working environment of the faculty need to be addressed.

Abstract Background and Aims Ayurveda is a traditional medicine that originated in the Indian subcontinent, and its use remains widespread in the Indian subcontinent, especially for managing noncommunicable diseases (NCDs). It is also becoming increasingly popular in the Organization for Economic Co‐operation and Development (OECD) countries as complementary and alternative medicine. Qualitative research studies have been conducted in various OECD countries to explore the experiences, perceptions, and perspectives of Ayurvedic practitioners and patients with NCDs regarding the usage of Ayurveda for managing these conditions. However, to date, no systematic review on this topic has been published. Therefore, this systematic review aims to synthesize the experiences, perceptions, and perspectives of Ayurvedic practitioners and patients with NCDs on the usage of Ayurveda for managing these conditions in OECD countries. Methods The systematic review will be conducted in accordance with the joanna briggs institute systematic review guideline on qualitative evidence. We will include qualitative research studies conducted among Ayurvedic practitioners or adult patients with NCDs in any OECD member country to explore experiences, perceptions, or perspectives regarding the usage of Ayurveda for managing NCDs. MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), AMED, and Web of Science will be searched to identify published studies. EthOS and ProQuest Dissertations and Theses will be searched to identify unpublished studies. No date or language restrictions will be applied. Initially, a narrative synthesis will be conducted. Where possible, study findings will be pooled using the meta‐aggregation approach.

Key Clinical Message Chronic kidney disease (CKD) and tuberculoma are two distinct medical conditions. Nonetheless, they can be related in very rare cases. The purpose of this case report is to consider screening tests such as IGRA (interferon gamma release assay) and TST (tuberculin skin test), for tuberculosis in CKD patients with a risk of infection, thereby increasing the awareness of tuberculoma in CKD and ensuring early treatment which would eventually decrease the morbidity and mortality rates in such patients. Abstract Chronic kidney disease (CKD) associated with tuberculoma represents one of the rarest conditions occurring worldwide. Among tuberculous patients, only 1% show central nervous system involvement. We present a case of a 45‐year‐old male with CKD who presented with a seizure and was diagnosed to have tuberculoma.

Objective This study explored multistakeholder perspectives on existing adolescent-specific tobacco control policies and programmes, to advance India’s transition towards a tobacco-free generation.Design Qualitative semi-structured interviews.Setting Interviews were conducted with officials involved in tobacco control at the national (India), state (Karnataka), district (Udupi) and village level. Interviews were audio recorded, transcribed verbatim and analysed thematically.Participants Thirty-eight individuals representing national (n=9), state (n=9), district (n=14) and village (n=6) levels, participated.Results The study findings highlighted the need to strengthen and amend the existing Tobacco Control Law (2003) provisions, particularly in the vicinity of schools (Sections 6a and 6b). Increasing the minimum legal age to buy tobacco from 18 to 21 years, developing an ‘application’ for ‘compliance and monitoring indicators’ in Tobacco-Free Educational Institution guidelines were proposed. Policies to address smokeless tobacco use, stricter enforcement including regular monitoring of existing programmes, and robust evaluation of policies was underscored. Engaging adolescents to co-create interventions was advocated, along with integrating national tobacco control programmes into existing school and adolescent health programmes, using both an intersectoral and whole-societal approach to prevent tobacco use, were recommended. Finally, stakeholders mentioned that when drafting and implementing a comprehensive national tobacco control policy, there is a need to adopt a vision striving toward a tobacco-free generation.Conclusion Strengthening and developing tobacco control programmes and policies are warranted which are monitored and evaluated rigorously, and where adolescents should be involved, accordingly.

Overviews synthesising the results of multiple systematic reviews help inform evidence-based clinical practice. In this first of two companion papers, we evaluate the bibliometrics of overviews, including their prevalence and factors affecting citation rates and journal impact factor (JIF). We searched MEDLINE, Epistemonikos and Cochrane Database of Systematic Reviews (CDSR). We included overviews that: (1) synthesised reviews; (2) conducted a systematic search; (3) had a methods section; and (4) examined a healthcare intervention. Multivariable regression was conducted to determine the association between citation density, JIF and six predictor variables. We found 1218 overviews published from 2000 to 2020; the majority (73%) were published in the most recent 5-year period. We extracted a selection of these overviews (n = 541; 44%) dated from 2000 to 2018. The 541 overviews were published in 307 journals; "CDSR" (8%), "PLOS ONE" (3%) and "Sao Paulo Medical Journal" (2%) were the most prevalent. The majority (70%) were published in journals with impact factors between 0.05 and 3.97. We found a mean citation count of 10 overviews per year, published in journals with a mean JIF of 4.4. In multivariable analysis, overviews with a high number of citations and JIFs had more authors, larger sample sizes, were open access and reported the funding source. An eightfold increase in the number of overviews was found between 2009 and 2020. We identified 332 overviews published in 2020, which is equivalent to one overview published per day. Overviews perform above average for the journals in which they publish.

Abstract A transparent polarisation sensitive phase pattern exhibits a position and polarisation dependent phase shift of transmitted light and it represents a unitary transformation. A quantum ghost image of this pattern is produced with hyper-entangled photons consisting of Einstein-Podolsky-Rosen (EPR) and polarisation entanglement. In quantum ghost imaging, a single photon interacts with the pattern and is detected by a stationary detector and a non-interacting photon is imaged on a coincidence camera. EPR entanglement manifests spatial correlations between an object plane and a ghost image plane, whereas a polarisation dependent phase shift exhibited by the pattern is detected with polarisation entanglement. In this quantum ghost imaging, the which-position-polarisation information of a photon interacting with the pattern is not present in the experiment. A quantum ghost image is constructed by measuring correlations of the polarisation-momentum of an interacting photon with polarisation-position of a non-interacting photon. The experiment is performed with a coincidence single photon detection camera, where a non-interacting photon travels a long optical path length of 17.83 m from source to camera and a pattern is positioned at an optical distance of 19.16 m from the camera.

Background: The craniovertebral junction (CVJ) is a crucial region of the spine designed for optimal movements of head and is also a frequent site for various pathological processes. The importance of knowing the CVJ parameters in normal population cannot be overstated when instrumentation and correction of deformities in this region is so frequently being performed. There is paucity of data defining the craniometrics of CVJ osteology in Indian population on the literature search. Accordingly, we present a study in an attempt to quantitate the normal craniometric indices for anatomically normal CVJ in Indian population and compare them with the existing literature from other regions. Aims and Objectives: The aims of this study were to quantitate the normal craniometric indices for anatomically normal CVJ in Indian population and compare them with the existing literature from other regions. Materials and Methods: Two hundred and forty computed tomography (CTs) belonging to Indians were looked at over a 6-month period retrospectively. These patients had normal CVJs and were ordered imaging for other health reasons. A total of eight parameters were analyzed for each CT. Results: There were 166 (69.2%) males and 74 (30.8%) females in our study. The values (in mm) were as follows: anterior atlantodental interval (AADI), 1.78±0.42; PADI (posterior atlantodental interval), 18.12±1.97; distance of tip of odontoid process to chamberlain’s line, –2.73±2.63; distance of tip of odontoid process to McGregor’s line, –2.29±2.79; distance of tip of odontoid process to McRae’s line, –5.91±1.4; Clivus-canal angle, 160.82°±7.14°; basion dens interval, 5.6±1.45; and powers ratio, 0.71±0.07. No patient had an odontoid process extending beyond the McRae’s line. Males were more likely to have higher AADI and PADI values than females. Our study shared significant differences between the other studies (even the studies where an Indian population was used) except one. The AADI, from our study, did not vary significantly when compared to the AADI from a Chinese study. Conclusion: Due to the significant differences from our study and the available literature, a greater compilation of studies belonging to different races will be required to understand the flexibility of the CVJ metrics.

India bears a significant portion of the worldwide burden of chronic and terminal illnesses. Nevertheless, there is a dearth of a standardized approach in delivering optimal end-of-life care (EOLC) to a substantial proportion of patients who have reached the terminal phase of their lives. Health-care providers are urged by health-care professionals to be aware of the cultural and spiritual beliefs and practices that can shape patients' and their families' perspectives on EOLC. They should also emphasize the importance of providing support for religious and cultural practices and involving family members in the EOLC process. Holistic care is discussed as an approach that considers the physical, emotional, spiritual, and social aspects of a patient's well-being. Healthcare providers must address ethical and legal issues when delivering EOLC and prioritize personalized care that respects patients' choices. Language and communication barriers in multicultural EOLC are identified as significant challenges. In a nutshell, the authors discuss the importance of incorporating cultural and spiritual practices in bereavement support to help patients and their families process grief and celebrate the patient's life and legacy. Overall, this article provides a comprehensive overview of the importance of cultural and spiritual awareness in EOLC for elderly patients. It emphasizes the necessity for health-care providers to deliver inclusive and culturally sensitive care, ultimately enhancing the quality of life for both individuals and their loved ones. The significance of cultural and spiritual awareness in improving EOLC for older individuals is underscored in this context.

Hepatocellular carcinoma (HCC) is primary hepatic malignancy with a high incidence of recurrence. The risk of recurrence directly correlates to patient’s overall prognosis. Management of advanced HCC involves a combination of surgical resection, locoregional therapy, and systemic treatment. Distant metastases are rare, and intraventricular cardiac metastases are even more infrequent. This brief review details an illustrative case of cardiac metastasis after curative treatment of primary HCC and then summarizes the literature on risk factors, treatment options, and patient prognosis in the setting of distant metastases from HCC. Prognosis of metastasis to the heart is generally poor, and available evidence emphasizes the importance of maintaining regular posttreatment screening for metastases in patients with HCC. Given the variable presentation and high risk of recurrence, it is critical to have individualized multimodality treatment plans.

Oral fungal infections are frequently encountered in clinical practice, and with the advent of the Coronavirus disease 2019 (COVID-19) pandemic, their incidence has quite increased. Increased emergence of oral candidal and non candidal infections is evident in patients with uncontrolled diabetes, patients on steroids or antibiotic therapies, and immunocompromised and immunosuppressed individuals. Also, habits of smoking and alcohol consumption, intake of carbohydrate-rich food, and salivary dysfunction have many times influenced the colonisation of fungal infections in the oral cavity. Aspergillosis once considered exotic is now more prevalent than before and presents itself in two forms: non invasive or invasive form, which has led to the rapid dissemination of the disease. Hence, a timely diagnosis of such lesions is important to prevent their invasion into other parts of the body. This article discusses a rare case report of Aspergillosis occurring in the oral cavity at the site of the extraction socket in a 50-year-old woman, who is a known diabetic without any history of COVID-19 infection. Aspergillosis unlike other fungal infections of the oral cavity has been reported more in immunocompetent individuals. Here, we report a unique case limited to the oral cavity in an immunocompromised patient.

Abstract The sustainability of the rice–wheat system is threatened due to the deterioration of soil health and emergence of new challenges of climate change caused by low nutrient use efficiency and large scale burning of crop residues. The conservation agriculture based on tillage intensity, crop residue retention and raising green manuring (GM) crops during the intervening period between wheat harvest and rice establishment offers opportunities for restoration of phosphorus (P) dynamics and stimulate phosphatase activities within the macro-and micro-aggregates. Phosphorus and phosphatase activities in the soil aggregates affected by different residue management practices remain poorly understood. Thus, soil samples were obtained after a five-year field experiment to identify the effect of tillage, green manure and residue management on aggregate-associated phosphorus fractions. Four main plot treatments in rice included combination of wheat straw and GM were conventional till puddled transplanted rice (PTR) with no wheat straw (PTRW0), PTR with 25% wheat stubbles retained (PTRW25), PTR without wheat straw and GM (PTRW0 + GM), and PTR with wheat stubbles and GM (PTRW25 + GM). Three sub-plots treatments in the successive wheat crop were conventional tillage (CT) with rice straw removed (CTWR0), zero tillage (ZT) with rice straw removed (ZTWR0) and ZT with rice straw retained as surface mulch (ZTWR100). Results of the present study revealed significantly higher phosphorus fractions (HCl-P, NaHCO3-Pi and NaOH-Po) in treatment PTRW25 + GM and ZTWR100 compared with PTRW0/CTWR0 within both macro- and micro-aggregates. The total phosphorus (P), available P, alkaline phosphatase and phytin-P were significantly higher under ZTWR100 than CTWR0. The principal component analysis identified NaOH-Po, NaHCO3-Pi and HCl-P as the dominant and reliable indicators for evaluating P transformation within aggregates under conservation agriculture-based practices.

ObjectiveTo evaluate the efficacy of corneal neurotisation using sural nerve graft coaptation of the contralateral supratrochlear nerve in unilateral neurotrophic keratopathy and corneal anesthesia. Corneal neuralization has emerged as a potential option in the treatment of neurotropic keratopathy, however not free from the predicament. We evaluated the long-term outcome of corneal neurotisation in the treatment of unresponsive unilateral neurotropic keratopathy using surgical variations to mimic and expedient the surgical procedure.MethodsA Prospective interventional study involving patients with unilateral neurotrophic keratopathy (NK) who did not respond to medical measures was conducted. The study parameters evaluated were best-corrected visual acuity improvement, ocular surface evaluation parameters [tear break-up time (TBUT), Schirmer's 1, and ocular surface staining scores (corneal and conjunctival staining)], central corneal sensation (Cochet Bonnet esthesiometer), sub-basal nerve fiber length (SBNFL), and sub-basal nerve fiber density (SBNFD) determined by central confocal microscopy at recruitment and during follow-up at 1-month, 3-month, 6-month, 9-month and 12-month respectively, following corneal neurotization.ResultsEleven eyes of 11 patients with unilateral neurotrophic keratopathy (NK) who underwent corneal neurotisation were studied. The mean follow-up was 10.09±2.31months (range, 6-12). Mean best corrected visual acuity in log MAR at baseline, 1.35±0.52 improved significantly to 1.06±0.76 (P = 0.012) at 3 months and continued to 0.55±0.60 (P = 0.027) at 12 months. There was a significant reduction in NK grade severity and improvement in the ocular surface as early as 1 month, and central corneal sensations (P = 0.024) as soon as 3 months. Mean corneal SBNF improved from 3.12±1.84 mm/mm2 to 4.49±1.88 at 1 month (P = 0.008), 13.31±3.61 mm/mm2 (P = 0.028) at 12 months. Mean central corneal SBNFD evident at 6 months was 1.83±2.54no/mm2 (P = 0.018) and 4.90±3.12no/mm2 (P = 0.028) at 12 months.ConclusionThis study substantiates the routine practice of corneal neurotisation by simplifying the intricacies observed during the procedure.

Tuberculosis is caused by Mycobacterium tuberculosis and is an ancient disease causing major morbidity and mortality worldwide. Though tuberculosis affects lungs in the majority of the cases but can affect other organs including the oral cavity as a primary site. Oral lesions can be seen in both primary and secondary forms of tuberculosis. The present article reports a case of a primary oral tubercular ulcer of buccal mucosa in a 36-year-old female, which based on clinical features was provisionally diagnosed as squamous cell carcinoma. The diagnosis of oral tuberculosis was confirmed by histopathology, blood and immunological investigations. The patient then was kept on Antitubercular Therapy (ATT) and the lesion showed healing markedly. Thus, oral tubercular lesions are rare and are difficult to diagnose, so every chronic, abnormal looking lesion should be examined cautiously for early diagnosis and prompt treatment.

Introduction: Haptoglobin (Hp), an acute phase protein, is a plasma inflammatory marker. It is important in both infectious and non infectious illnesses. When intravascular haemolysis occurs, the dead red blood cells are discharged into the circulation and link to Hp to form the haemoglobin (Hb)-haptoglobin (Hb-Hp) complex that is recognised by the macrophage scavenger receptor CD163. The Hp1 and Hp2 are its two alleles. The Hp2 is formed by a partial duplication of the Hp1 gene. The Hp1 has five exons, but Hp2 has seven exons owing to the duplication of Hp1 third and fourth exon. There are three genotypes of Hp: Hp1-1, Hp2-1, and Hp2-2. The encoded products of genotypes are attached to haemoglobin with varying degrees of affinity: Hp1-1 has the most affinity, Hp2-1 has medium affinity, and Hp2-2 has the lowest affinity. Hp allelic and genotypic variation differs amongst populations and different geographic regions of the world. Aim: To study the haptoglobin 2-2 genotype in type 2 diabetes and cardiovascular patients in north Indian population. Materials and Methods: It was a case-control study and a total of 200 participants were recruited randomly including 50 participants of type 2 Diabetes Mellitus (DM), 50 participants of Cardiovascular Disorders (CVD), 50 participants with Cardiovascular Disorders With type 2 Diabetes Mellitus (CVDWDM) and 50 normal healthy controls from Punjab Institute of Medical Sciences (PIMS) Hospital and clinics and Aashirwad laboratory of Jalandhar, Punjab, India in February 2021 to January 2022. Anthropometric variables were determined by using standard methods and biochemical parameters were measured by commercial available kits. Allele specific Polymerase Chain Reaction (PCR) or Amplification Refractory Mutation System (ARMS) PCR was used to detect Hp genotypes. Data were represented as mean±Standard Deviation and the statistical difference i.e. p

Coronavirus infectious disease-19 caused by Severe acute respiratory distress syndrome-coronavirus-2 has emerged to be an emergency global health crisis for more than a year. And, as the disease has spread, a number of new clinical features have been observed in these patients. Immunosuppression caused by this disease results in an exacerbation of pre-existing infections. While corticosteroids are considered a life-saving therapeutic intervention for this pandemic, they have proved to be a double-edged sword and their indiscriminate use has produced some deleterious results. Recently, in the backdrop of this expression, a notable rise in invasive fungal infections has been identified even in the post-remission phase. Mucormycosis, Aspergillosis, and Candidiasis are the three most common opportunistic fungal infections among those observed. COVID-19 patients with diabetes mellitus are already at a higher risk of developing such secondary infections due to impaired immunity. Here we present a rare case report of a 50-year old male diabetic mellitus patient diagnosed with dual fungal infections (Aspergillosis along with Mucormycosis) leading to maxillary sinusitis as a post-COVID manifestation. To our knowledge, this is the first such case reported till date.

Neurofibromatosis type 1 (NF1) or Von Recklinghausen disease comes under a group of multisystem hereditary syndromes called phakomatoses. It presents with skin, ophthalmic, bony, and systemic manifestations. We present a photographically well-documented case series of NF in a family (n = 3). Skin manifestations were present in all the patients. The ophthalmic manifestations were Lisch nodules (100% of eyes), subcutaneous neurofibroma of eyelids (33% of eyes), mechanical ptosis (33% of eyes), and mechanical ectropion (16.5% of eyes). We report the rare occurrence of multiple solitary neurofibromas causing mechanical ptosis and mechanical ectropion.

Objective: The epidemic of novel coronavirus disease 2019 (COVID-19) has led to the development of several vaccine candidates which has been progressing at an unprecedented rate. Health-care professionals are somewhere standing between their professional commitments and personal well-being, amid concerns about the safety and efficacy of the vaccine. The present survey was conducted to analyze their approach toward vaccination. Materials and Methods: An online questionnaire-based cross-sectional survey was conducted among 250 health-care professionals comprised of Medical, Dental, Ayurveda, Physiotherapy doctors, and nursing staff working at a tertiary care hospital in Gurugram city. A self-administered 10-item questionnaire in the Google document format was developed to assess their perception and attitude toward vaccination. The present survey was carried out for 2 months from November to December 2020. The responses recorded were subjected to the statistical analysis using the Chi-square test and the level of statistical significance was set at P ≤ 0.05. Results: Among all participants, 72 (28.8%) were male and 178 (72.2%) were female. Of all, 60.4% of the health-care professionals somewhat or completely agreed to accept a vaccine as soon as it is available. Nursing staff reported more likely to accept COVID-19 vaccination than the other health-care professionals. Majority of the HPs (44%) were found to be concerned about the rapidity in the development of vaccine. Conclusion: The overall attitude toward vaccination was positive but specific concerns regarding COVID-19 vaccine are prevalent. Thus, to maintain the benefits of vaccination programs and for its successful implementation, understanding and addressing their vaccine hesitancy will be crucial.

Abstract A transparent polarisation sensitive phase pattern makes a polarisation dependent transformation of quantum state of photons without absorbing them. Such an invisible pattern can be imaged with quantum entangled photons by making joint quantum measurements on photons. This paper shows a long path experiment to quantum image a transparent polarisation sensitive phase pattern with hyper-entangled photon pairs involving momentum and polarisation degrees of freedom. In the imaging configuration, a single photon interacts with the pattern while the other photon, which has never interacted with the pattern, is measured jointly in a chosen polarisation basis and in a quantum superposition basis of its position which is equivalent to measure its momentum. Individual photons of each hyper-entangled pair cannot provide a complete image information. The image is constructed by measuring the polarisation state and position of the interacting photon corresponding to a measurement outcome of the non-interacting photon. This paper presents a detailed concept, theory and free space long path experiments on quantum imaging of polarisation sensitive phase patterns.

Abstract Strategies promoting efficient water use and conserving irrigation water are needed to attain water security to meet growing food demands. This meta-analysis study evaluated the effect of deficit irrigation (DI) strategy on eight vegetables to provide a quantitative estimate of yield and water productivity (WP) responses under variable soil textures, climates, and production systems (open-field and greenhouse). This study analyzed 425 yield and 388 WP comparisons of different DI levels to full irrigation (FI), extracted from 185 published studies representing 30 countries. Moving from the highest (> 80%FI) to the lowest ( 65%FI) accompanied by gains in WP may be justifiable in the light of anticipated water restriction.

Background: To assess respiratory function in cervical chronic compressive myelopathy (CCM) patients in pre-operative period, post-operative period and to compare pre-operative status with post-operative status. Aims and Objectives: 1. To assess respiratory function in cervical CCM patients in pre-operative period. 2. To assess respiratory function in cervical CCM patients in post-operative period, following relief of compression. 3. To compare, pre-operative status with post-operative status. Materials and Methods: A prospective study was done in 50 patients with cervical CCM due to either cervical disc disease or ossified posterior longitudinal ligament (OPLL) who were operated. None of the patients included in the study had any clinical signs & symptoms of respiratory dysfunction. Spirometry was performed in pre-operative and postoperative period after 3 months and results were analyzed. Forced vital capacity (FVC), forced expiratory volume in first second (FEV1), ratio of mean FEV1 to FVC (FEVI: FVC%) and peak expiratory flow rate (PEFR) were calculated. Results: Majority of the patients were in their fourth decade of life with male predominance. Thirty-six patients (72%) presented with prolapsed intervertebral disc and 14 patients (28%) had ossified posterior longitudinal ligament (OPLL). Patients were operated depending upon the pathology. The present study showed that there was significant reduction in preoperative FVC, FEV1, PEFR values as compared with predicted values and they showed significant improvement in post-operative period after surgical relief of compression. Conclusion: Significant yet occult respiratory dysfunction in form of impairment of various lung capacities exists in patients with cervical CCM. An objective evaluation of this occult respiratory dysfunction is essential to prognosticate, prevent respiratory complications and to improve post-operative respiratory rehabilitation. Institution of incentive spirometry as a routine in all cervical CCM cases will be of benefit in preventing respiratory complications.

Isolated bilateral sixth nerve palsies are rare, particularly in the setting of trauma. Most post-head injury cases with bilateral abducens palsy involve either basal skull fractures, particularly clival fractures. We present a case of bilateral abducens palsy after closed head injury in a young male who presented to the emergency department and a comprehensive literature review based on our clinical case. A Medline search for bilateral abducens palsy in closed head injury showed 89 results. Articles were excluded if crush head injury, non-traumatic bilateral abducens nerve palsy, associated vascular malformations were reported. After thorough search and filtering of those articles, fifty-one publications were found which reported and discussed about traumatic bilateral abducens palsy with closed head injury. In these 51 articles, a total of 139 cases were recorded. Several theories have been postulated to explain mechanisms of abducens nerve injury in trauma both in immediate and delayed settings. In our case, patient presented with immediate onset of bilateral abducens palsy. On imaging, clival fracture was seen in CT brain, which can be attributed for the nerve injury. Cases with retroclival extradural haematoma had higher chances of multiple cranial nerve injuries. Cases with multiple basal skull fracture involving petrous temporal bone fracture had higher chances of facial nerve injury. Along with bilateral involvement, the poorer outcome for recovery can be related with the severity of the adduction deficit. Our case showed no improvement in bilateral abduction during follow-up at 6 months. Clinical presentation of traumatic bilateral abducens nerve palsy is rare following closed head trauma and is usually associated with other injuries which are incompatible with life. It can be associated with other nerve injuries depending on basal skull fractures.

Introduction: Benign and malignant pelvic masses can occur in different age groups, primary diagnosis and choosing the appropriate surgical procedure is very important. Ultrasound (USG) is the diagnostic test of choice in evaluating pelvic masses, while Computed Tomography (CT) scan is most helpful as a second-line study, for in-depth evaluation of the abdomen and pelvis. Aim: To compare the findings of ultrasound and CT scans of pelvic masses with definitive histopathological or laboratory findings. Materials and Methods: A cross-sectional study was conducted at Government Medical College and Rajindra Hospital, Patiala, Punjab, India, from December 2014 to September 2015. Sixty patients from Outpatient and Inpatient Department, with clinical suspicion of pelvic pathology, were evaluated sonographically and then by CT scan. Ultrasound characterisation of mass as high or low risk was done based on septae and solid part echogenicity. CT findings used to diagnose malignancy were cystic solid mass, necrosis in a solid lesion, cystic lesion with thick, irregular walls or septa, and/or papillary projections. The presence of ascites, lymphadenopathy, omental cake, peritoneal deposits, mesenteric deposits was noted to diagnose metastasis. Data was analysed using Statistical Package for Social Sciences (SPSS) version 16.0. A p-value was calculated using Chi-square test. For finding, the level of agreement between USG/CT scan and histopathology, Kappa statistic was applied. Results: Ultrasound had sensitivity of 73.7%, specificity of 80.3%, Positive Predictive Value (PPV) of 53.8% and Negative Predictive Value (NPV) of 90.7%. Computed tomography scan had a sensitivity of 78%, specificity of 95.08%, PPV of 83.3%, and NPV of 93.5%. Kappa statistics showed moderate level of agreement between USG and histopathological findings (k=0.47, p-value=0.017) and good level of agreement between CT scan and histopathological findings (k=0.68, p-value=0.001). Conclusion: Ultrasound with its good sensitivity can be used as an effective screening modality for pelvic masses. Computed tomography scan has better specificity than USG and should be used as a confirmatory investigation.

Priority effects, where arrival order and initial relative abundance modulate local species interactions, can exert taxonomic, functional, and evolutionary influences on ecological communities by driving them to alternative states. It remains unclear if these wide-ranging consequences of priority effects can be explained systematically by a common underlying factor. Here, we identify such a factor in an empirical system. In a series of field and laboratory studies, we focus on how pH affects nectar-colonizing microbes and their interactions with plants and pollinators. In a field survey, we found that nectar microbial communities in a hummingbird-pollinated shrub, Diplacus (formerly Mimulus) aurantiacus, exhibited abundance patterns indicative of alternative stable states that emerge through domination by either bacteria or yeasts within individual flowers. In addition, nectar pH varied among D. aurantiacus flowers in a manner that is consistent with the existence of these alternative stable states. In laboratory experiments, Acinetobacter nectaris, the bacterium most commonly found in D. aurantiacus nectar, exerted a strongly negative priority effect against Metschnikowia reukaufii, the most common nectar-specialist yeast, by reducing nectar pH. This priority effect likely explains the mutually exclusive pattern of dominance found in the field survey. Furthermore, experimental evolution simulating hummingbird-assisted dispersal between flowers revealed that M. reukaufii could evolve rapidly to improve resistance against the priority effect if constantly exposed to A. nectaris-induced pH reduction. Finally, in a field experiment, we found that low nectar pH could reduce nectar consumption by hummingbirds, suggesting functional consequences of the pH-driven priority effect for plant reproduction. Taken together, these results show that it is possible to identify an overarching factor that governs the eco-evolutionary dynamics of priority effects across multiple levels of biological organization.

Vaccine hesitancy is an ongoing public health concern defined as the refusal of a vaccine that is readily available. Therefore, we developed a project to explore why patients in a safety net medical center were hesitant or refused the COVID-19 vaccine. The project was conducted by healthcare learners to promote “learning by doing”. Responses were collected through a previously developed and ongoing survey among both hospitalized and ambulatory patients that had no previous history of COVID-19 infection, were currently infected, or had recovered from COVID-19. Results were analyzed using a priori power analysis and Chi-squared test. We discovered that different self-reported ethnic groups had different reasons for vaccine hesitancy; specifically, 69% of Black/African American respondents stated that their main reason for hesitancy was vaccine safety compared to 13.9% of non-Hispanic Whites (p = 0.005). Furthermore, our cohort was significantly more likely to disagree rather than agree with the statement: “getting vaccinated is important for the health of others in my community”(p = 0.016). The learners discovered that a more specific approach to vaccine education would be required to understand and overcome vaccine hesitancy in our cohort of socioeconomic and ethnically diverse groups.

Abstract Background Invadopodia are actin-based cell-membrane protrusions associated with the extracellular matrix degradation accompanying cancer invasion. The elucidation of the molecular mechanisms leading to invadopodia formation and activity is central for the prevention of tumor spreading and growth. Protein tyrosine kinases such as Src are known to regulate invadopodia assembly, little is however known on the role of protein tyrosine phosphatases in this process. Among these enzymes, we have selected the tyrosine phosphatase Shp1 to investigate its potential role in invadopodia assembly, due to its involvement in cancer development. Methods Co-immunoprecipitation and immunofluorescence studies were employed to identify novel substrate/s of Shp1AQ controlling invadopodia activity. The phosphorylation level of cortactin, the Shp1 substrate identified in this study, was assessed by immunoprecipitation, in vitro phosphatase and western blot assays. Short interference RNA and a catalytically-dead mutant of Shp1 expressed in A375MM melanoma cells were used to evaluate the role of the specific Shp1-mediated dephosphorylation of cortactin. The anti-invasive proprieties of glycerophosphoinositol, that directly binds and regulates Shp1, were investigated by extracellular matrix degradation assays and in vivo mouse model of metastasis. Results The data show that Shp1 was recruited to invadopodia and promoted the dephosphorylation of cortactin at tyrosine 421, leading to an attenuated capacity of melanoma cancer cells to degrade the extracellular matrix. Controls included the use of short interference RNA and catalytically-dead mutant that prevented the dephosphorylation of cortactin and hence the decrease the extracellular matrix degradation by melanoma cells. In addition, the phosphoinositide metabolite glycerophosphoinositol facilitated the localization of Shp1 at invadopodia hence promoting cortactin dephosphorylation. This impaired invadopodia function and tumor dissemination both in vitro and in an in vivo model of melanomas. Conclusion The main finding here reported is that cortactin is a specific substrate of the tyrosine phosphatase Shp1 and that its phosphorylation/dephosphorylation affects invadopodia formation and, as a consequence, the ability of melanoma cells to invade the extracellular matrix. Shp1 can thus be considered as a regulator of melanoma cell invasiveness and a potential target for antimetastatic drugs. Video abstract

Abstract Traditional hydropower generation is one of the most sustainable energy sources; however, the local environmental impact of hydroelectric dams and reservoirs is serious, and hydroelectric power requires high-cost turbines and generators. Because these installations utilize gravitational potential energy of massive volumes of falling water, this sort of hydropower generation is unsuitable for ubiquitous, small-scale energy production. Here, we report that wetting and evaporation of pure water from a tiny block of porous alumina generates electrical current in the direction of water transpiration. The current induced in microporous alumina is associated with mass transport of water accompanying ions that accumulate near the negatively charged surface of alumina pores. Without any pre-treatment or additives, once evaporation commences, a 3 × 3 cm2 piece of alumina can generate an open-circuit voltage as large as 0.27 V. The power generation scheme we propose here is simple, clean, and versatile, and it can be employed anywhere, as it utilizes only spontaneous capillary action of water and Coulombic interaction at the alumina-water interface, without requiring any input of heat or light.

Cardiovascular diseases are an important cause of mortality in end-stage renal disease (ESRD) and increased arterial stiffness and autonomic dysfunction have been proposed to explain part of this excess cardiovascular risk. This prospective study was designed with the aim of noninvasive assessment of the vascular function, i.e., arterial stiffness in the form of pulse wave velocity (PWV) and autonomic function in the form of baroreflex sensitivity (BRS) in ESRD patients before renal transplantation (RT) and three and six months after RT. The study was conducted in 64 patients of ESRD slated for RT in the Department of Nephrology and was being followed up during all three visits (pretransplant, three-, and six-month posttransplant). The period of patient recruitment and data collection lasted for approximately 1½ years. Although PWV did not show a significant change, the change in PWV was negatively correlated with baseline PWV, and it was statistically significant. The BRS after RT had a significant improvement as early as three months. The correlation between change in PWV and change in BRS postrenal transplant was not seen. RT improves BRS, but it is still unknown that it is through amelioration of arterial properties or neural components or/and a relative contribution of both. We suggest that the improvement in BRS postrenal transplant is probably because of the improvement in autonomic neural functions rather than the improvement in compliance of barosensitive regions of large arteries.

The most common cause of mortality in chronic kidney disease patients is cardiovascular events. Cardiovascular autonomic dysfunction is likely to contribute high incidence of cardiovascular mortality, and in addition to adrenergic overdrive in these patients, there is the presence of impaired reflex control of both sympathetic and parasympathetic outflow to the heart and vasculature. Very few studies are available which show that renal transplantation (RT) improves the baroreflex function along with improvement in cardiovascular variability parameters. This prospective study was designed for the assessment of the autonomic function, i.e., heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) in end-stage renal disease (ESRD) patients before RT and three and six months after RT and to study the effects of RT on cardiac and vascular autonomic tone and on BRS. We studied 81 ESRD patients prospectively slated for RT but only 64 patients (mean age: 33 years) completed both three and six months visits after RT for autonomic function study. Patients were evaluated in detail clinically as well as routine biochemical parameters were done on every three visits. Baroreflex function was quantified by the sequence method. Assessment of short-term HRV and BPV were done using power spectrum analysis of RR intervals and systolic BP by frequency domain analysis. The parameters of HRV after RT showed significant changes in high-frequency domain measures six months post-RT but not in low frequency. HRV in total power was also statistically significant as early as three months postrenal transplant and remained at six months. The favorable effect of RT on decreasing BPV and improving BRS is seen by as early as three months.

Inborn errors of immunity (IEI) can present with infections, autoimmunity, lymphoproliferation, granulomas, and malignancy. IEIs are due to genetic abnormalities that disrupt normal host-immune response or immune regulation. The microbiome appears essential for maintaining host immunity, especially in patients with a defective immune system. Altered gut microbiota in patients with IEI can lead to clinical symptoms. Microbial dysbiosis is the consequence of an increase in pro-inflammatory bacteria or a reduction in anti-inflammatory bacteria. However, functional and compositional differences in microbiota are also involved. Dysbiosis and a reduced alpha-diversity are well documented, particularly in conditions like common variable immunodeficiency. Deranged microbiota is also seen in Wiskott–Aldrich syndrome, severe combined immunodeficiency, chronic granulomatous disease, selective immunoglobulin-A deficiency, Hyper IgE syndrome (HIGES), X-linked lymphoproliferative disease-2, immunodysregulation, polyendocrinopathy, enteropathy, x-linked syndrome, and defects of IL10 signalling. Distinct gastrointestinal, respiratory, and cutaneous symptoms linked to dysbiosis are seen in several IEIs, emphasizing the importance of microbiome identification. In this study, we discuss the processes that maintain immunological homeostasis between commensals and the host and the disruptions thereof in patients with IEIs. As the connection between microbiota, host immunity, and infectious illnesses is better understood, microbiota manipulation as a treatment strategy or infection prevention method would be more readily employed. Therefore, optimal prebiotics, probiotics, postbiotics, and fecal microbial transplantation can be promising strategies to restore the microbiota and decrease disease pathology in patients with IEIs.

Squamous cell carcinoma of head and neck (SCCHN) is a group of cancer arising from mucosal surfaces of the head and neck. Optimal management of SCCHN requires a multidisciplinary team of surgical oncologists, radiation oncologists, medical oncologists, nutritionist, and speech-language pathologists, due to the complexity of anatomical structure and importance of functional outcome. Human papilloma virus (HPV)-related SCCHN represents a distinct subset from HPV negative SCCHN which is associated with carcinogen exposure such as cigarette smoking, betel nut use and alcohol. HPV related SCCHN responds better to concurrent chemoradiation and has better overall prognosis, compared to HPV negative SCCHN. Radiation therapy has been introduced to the treatment of SCCHN, administered concurrently with systemic chemotherapy for locoregional SCCHN, as well as a palliative measure for recurrent and/or metastatic (R/M) SCCHN. Recently, immune checkpoint inhibitors have been shown to improve overall survival in R/M-SCCHN and have been incorporated into the standard of care. Combination approaches with immune therapy and targeted therapy for biomarker enriched population based on genomics are being actively investigated and will shape the future of SCCHN treatment.

Abstract While designing the anti-inflammatory agents targeting cyclooxygenase-2 (COX-2), we first identified a water loop around the heme playing critical role in the enzyme catalysis. The results of molecular dynamic studies supported by the strong hydrogen-bonding equilibria of the participating atoms, radical stabilization energies, the pKa of the H-donor/acceptor sites and the cyclooxygenase activity of pertinent muCOX-2 ravelled the working of the water–peptide channel for coordinating the flow of H·/electron between the heme and Y385. Based on the working of H·/electron transfer channel between the 12.5 Å distant radical generation and the radical disposal sites, a series of molecules was designed and synthesized. Among this category of compounds, an appreciably potent anti-inflammatory agent exhibiting IC50 0.06 μM against COX-2 and reversing the formalin induced analgesia and carageenan induced inflammation in mice by 90% was identified. Further it was revealed that, justifying its bidentate design, the compound targets water loop (heme bound site) and the arachidonic acid binding pockets of COX-2.

Background: Gliomas comprises the group of most common primary tumour of central nervous system. The current study was undertaken to evaluate the various usual and unusual radiological presentations among the patients of glioma among the Indian population. Aims and Objective: The aim of the current study was to observe the various radiological presentations of glioma occurring among the subjects. It was also intended to correlate the radiological and histopathological grading in glioma among subjects. Materials and Methods: The current study was a prospective observational study carried out among seventy-five patients admitted in a tertiary care hospital in Eastern India with provisional diagnosis of supratentorial glioma and operative biopsy confirmed to be Glioma. Result: The most common grade of tumour encountered was grade IV tumour. Of the clinical features, 70.66 % patients had hypodense lesion, 25.33% patients had iso dense and hypodense (mixed density) lesion and 3 patients had hyperdense lesion on CT Brain. On MRI in T1 Weighted images, 81.33% patients had hypointense lesion lesion on MRI T1 image. On T2 Weighted Images, 76% patients had hyperintense lesion., 77.33% demonstrated heterogenous enhancement. Ring enhancement was seen in 9 cases Minimal to no enhancement was seen in 8 cases. MRS showed maximum cases had Choline peak with altered Choline: creatinine ratio and decreased NAA peaks. Conclusion: Good imaging interpretations is crucial for planning of surgical excision and adjuvant radiotherapy. This review has been put to solve the basic problem in interpreting the Ct Scan and MRI of Glioma.

Background: Routine screening of presumptive tuberculosis (TB) patients for HIV was advised by the Treatment and Operational Guidelines of TB in India in 2016. This was in contrast to the earlier policy in which only diagnosed TB cases underwent HIV screening. Keeping this in mind, our study was carried to look at the prevalence of HIV in presumptive TB cases in a tertiary respiratory disease hospital in New Delhi, India. Materials and Methods: This prospective observational study was carried out from 2015 to 2017 in which patients (>18 years of age) attending the outpatient department diagnosed as presumptive TB were enrolled. They underwent sputum examination in Revised National TB Control Programme Designated Microscopy Centre by fluorescence microscopy/Ziehl–Neelsen staining technique for the diagnosis of PTB, and they were taken to Integrated Counselling and Testing Centre in our hospital. Fine-needle aspiration cytology from lymph nodes and pleural or ascitic fluid studies were also done as per requirement for the diagnosis of extrapulmonary tuberculosis. Pretest counseling and HIV test were performed after informed consent. Results: Forty out of 1020 enrolled patients were HIV positive (3.9%). Fifteen out of 617 patients who were not suffering from TB came out to be HIV positive (2.4%). Our strategy led to an enhanced case finding of 15/25 (60%) new HIV-positive patients. Conclusion: Routine HIV screening in presumptive TB patients is a viable model to increase the case finding of HIV patients.

Dentistry is related to the cure of oral and dental infections, so exposure and proximity of dental practitioners to oral and nasal fluids of a patient is very obvious. Before you proceed for an aerosol-generating procedure like RCT, and crown preparations, diagnosis, and screening of COVID-19 is very important, as failure may end up infecting yourself and would become a source of infection to your patient community. Due to limitations of data, medicines, and PPE shortage all around the world, screening of asymptomatic carriers of COVID-19 is very troublesome but necessary. To avoid any silent positive patient, the possible way is to ensure mandatory testing of every patient before you treat it. As the door to door surveillance of COVID-19 patients seems near to impossible in the Pandemic era for densely populated developing countries like India. The possible screening regimes include personal surveillance and contact tracing in the very first appointments. So, on the basis of the knowledge and sources we have so far, we have tried to classify the asymptomatic patients seen in the clinics and their possible screening management there. As it is said classification of a disease, is the first step toward a deep understanding of it. After screening, suspects can be sent to more resourceful places for their managements, and incidences of community spread of the disease through dental clinics can be avoided.

Angiokeratomas are rare benign mucocutaneous lesions that result from distension of subepidermal vessels, along with hyperkeratotic epidermis. Mucosal angiokeratomas are more commonly seen as a constituent of systemic variant called angiokeratoma corpus diffusum or may co-exist with similar lesion in the other sites of the body as seen in Fordyce’s or congenital forms. Solitary lesion in oral cavity is very infrequently seen and till date very few cases have been reported in literature. The biologic significance of angiokeratomas may vary greatly, which may range from lesions that have very little clinical repercussion to widespread eruptions that are a manifestation of potentially fatal, systemic, metabolic diseases therefore it is important that these lesions should be identified and evaluated to rule out underlying pathologic conditions. Hereby, authors reported a case of a 24-year-old male who presented with a unilateral swelling on dorsal tongue which gradually increased in size over 1.5 years with history of occasional bleeding and pain. It is common to see involvement of oral cavity in systemic variety but very rare in localized solitary form, therefore while considering the differential diagnosis of the swellings of tongue this entity should be taken into account.

The Glandular Odontogenic Cyst (GOC) is thought to be a developmental cyst arising from the remnants of dental lamina. This cyst has an unpredictable and a potentially aggressive behaviour, with a worldwide prevalence of 0.17%. It occurs in patients aged 40- 70 years, occurring exclusively in the anterior mandibular jaw. Here, authors presents a case of 42-year-old male patient reported to the Department of Oral Medicine and Radiology with a chief complaint of pain in the upper right back tooth region since five days. Two radiolucencies were observed in the maxillary anterior and posterior regions, as an incidental finding in the radiographic examination. Cone Beam Computed Tomography (CBCT) revealed two separate unilocular homogeneously hypodense regions with radiopaque sclerotic borders in the maxillary arch, located in the anterior and posterior regions of the maxilla, crossing the midline, which is quite rare. A final diagnosis of GOC was made based on the histopathological examination of the specimen after complete enucleation. Diagnosis of this cyst is challenging clinically and radiographically, as it can be confused with other cysts or malignancies of the jaws. Hence, diagnosis of GOC can only be based on characteristic histopathological findings.

Pyogenic Granulomas (PG) are reactive hyperplastic lesions that are formed in relation to some chronic irritation, physical trauma or hormonal factors. The PG may present in various clinical and histological forms. These often present as a smooth lobulated exophytic lesions and at times may show a marked resemblance to Peripheral Ossifying Fibroma (POF). However, the characteristic histologic presentation helps in differentiating both the lesions. Microscopically, presence of ossification in pyogenic granuloma is not common and could possibly indicate an altered response of the connective tissue stroma. The present case report shows occurrence of pyogenic granuloma in a 12-year-old female which on histological examination not only exhibited proliferating blood vessels, endothelial cells and inflammatory cells which are typical features of pyogenic granuloma but also exhibited areas of ossifications which are not frequently encountered in PG. It is important to explore the underlying aetiological factors that could lead to formation of such ossifications. It has been suggested that pyogenic granuloma and peripheral ossifying fibroma could represent part of same spectrum of focal reactive lesions. However, it is still considered that these two lesions are separate clinical entities and the histologic presentations are different and unique to both of them.