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Background: Passive immunization using egg yolk-based antibodies has been tested against oral microorganisms. Our study assessed the effect of immunoglobulin Y (IgY) formulations on Streptococcus mutans, Porphyromonas gingivalis, and Candida albicans in human subjects. Highlights: VS and UT independently searched articles using keyword combinations in four search engines; studies in English were selected. Either parallel-arm or split-mouth randomized controlled trials on healthy human subjects were considered. Ten studies remained in the selection; six studies compared the effect of IgY formulations on S. mutans, three on P. gingivalis, and one on C. albicans. Five studies (422 subjects) compared the effect of IgY formulations on S. mutans. When fixed-effect model (FEM) was applied, the risk ratio (RR) (confidence interval [CI]) was found to be 7.81 (6.00, 10.18). Three studies (167 subjects) compared the effect of IgY formulations on P. gingivalis. When FEM was applied, the RR (CI) was found to be 0.06 (−0.03, 0.15) in relation to reduction in probing depth. When FEM was applied, for percentage reduction in bleeding on probing (BOP), the RR (CI) was 1.99 (1.64, 2.41). Only one study (26 subjects) was available of IgY formulation and C. albicans; hence meta-analysis was not performed.The search was extended using Google Scholar, Semantic Scholar, cross-references and by contacting authors and researchers in the field which further yielded five articles. . Conclusions: IgY formulations were effective in the reduction of S. mutans. They were not effective on P. gingivalis in relation to probing depth but were effective in relation to reduction in BOP. No harms were reported. Evidence is of low quality due to high heterogeneity. The ROB was moderate and publication bias was low.

Objective: The aim of this work was to study the association of autoimmune thyroiditis (AIT) in the patients of latent autoimmune diabetes of adult (LADA). Materials and Methods: The subjects included were more than 30 years of age, presenting with the deranged glycemic profile. After GAD65 autoantibody testing, they were grouped into LADA positive and LADA negative groups. Simultaneously, a thyroid workup for the presence of AIT was done. Statistical Analysis: The Student’s unpaired t test and chi-square test (χ2 test) were used to test for the significance of the difference in AIT between LADA and type 2 diabetes mellitus (T2DM) subjects as applicable. A value of P < 0.05 was taken as significant. Results: A total of 77 patients were included in the study. The mean age was 48 ± 13 years and M:F ratio was 1:3. A high frequency of AIT was found in the LADA group (80%) when compared to the true T2DM group (35%). Mean values of both anti-thyroid peroxidase antibody (anti-TPO) and anti-thyroglobulin antibody (anti-TG) antibodies were found to be significantly different between LADA and T2DM. Percentage positivity for anti-TPO, anti-TG, as well as combined anti-TPO and anti-TG were also found to be significantly different. Conclusion: Based on the significant association of AIT with LADA found in our study, we recommend all AIT patients to undergo simultaneous screening for LADA for a multimodal treatment.

Aims: The aim of the study was to compare the clinical efficacy of platelet-rich fibrin (PRF) and connective tissue grafting in the treatment of gingival recession (GR) using pouch and tunnel (P and T) technique. Materials and Methods: A total of 40 Class I or Class II GR defects in 17 patients were randomized treated with P and T with PRF (Group I, n = 20) and P and T with CTG (Group II, n = 20). The parameters measured were plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), horizontal gingival recession (HGR), vertical gingival recession (VGR), width of attached gingiva (WAG), width of keratinised gingiva (WKG), gingival thickness-mid buccal (GTMB), and gingival thickness interdental papilla (GTIP). Postsurgical discomfort level (PSDL), hypersensitivity score (HS), and patient esthetic score (PES) were recorded using visual analog scale (VAS). The PI, GI, PPD, CAL, HGR, VGR, WAG, WKG, GTMB, and GTIP were assessed at pretreatment (baseline) and 1-, 3-, and 6-month posttreatment. The PSDL, HS, and PES were assessed at baseline, day 10, 1, 3, and 6-month posttreatment. Results: P and T with PRF and CTG resulted in root coverage of 73.75% ± 7.80% and 70.83% ±8.26%, respectively. Patient response and acceptance for the surgical treatment modality showed less discomfort and better esthetics in Group I as compared to Group II. Conclusions: PRF treated sites were comparable to the gold standard CTG with better patient acceptance and a lesser invasive approach in terms of graft procurement.

AIM: To establish a rabbit model with chronic condition of retinal neovascularization (RNV) induced by intravitreal (IVT) injection of DL-2-aminoadipic acid (DL-AAA), a retinal glial (Müller) cell toxin, extensive characterization of DL-AAA induced angiographic features and the suitability of the model to evaluate anti-angiogenic and anti-inflammatory therapies for ocular vascular diseases. METHODS: DL-AAA (80 mmol/L) was administered IVT into both eyes of Dutch Belted rabbit. Post DL-AAA delivery, clinical ophthalmic examinations were performed weekly following modified McDonald-Shadduck Scoring System. Color fundus photography, fluorescein angiography (FA), and optical coherence tomography (OCT) procedures were performed every 2 or 4wk until stable retinal vascular leakage was observed. Once stable retinal leakage (12wk post DL-AAA administration) was established, anti-vascular endothelial growth factor (VEGF) (bevacizumab, ranibizumab and aflibercept) and anti-inflammatory (triamcinolone, TAA) drugs were tested for their efficacy after IVT administration. Fluorescein angiograms were scored before and after treatment following a novel grading system, developed for the DL-AAA rabbit model. RESULTS: Post DL-AAA administration, eyes were presented with moderate to severe retinal/choroidal inflammation which was accompanied by intense vitreous flare and presence of inflammatory cells in the vitreous humor. Retinal hemorrhage was restricted to the tips of neo-retinal vessels. FA revealed maximum retinal vascular leakage at 2wk after DL-AAA injection and then persisted as evidenced by stable mean FA scores in weeks 8 and 12. Retinal vascular angiographic and tomographic features were stable and consistent up to 36mo among two different staggers induced for RNV at two different occasions. Day 7, mean FA scores showed that 1 µg/eye of bevacizumab, ranibizumab, aflibercept and 2 µg/eye of TAA suppress 65%, 90%, 100% and 50% retinal vascular leakage, respectively. Day 30, bevacizumab and TAA continued to show 66% and 44% suppression while ranibizumab effect was becoming less effective (68%). In contrast, aflibercept was still able to fully (100%) suppress vascular leakage on day 30. On day 60, bevacizumab, ranibizumab and TAA showed suppression of 7%, 12%, and 9% retinal vascular leakage, respectively, however, aflibercept continued to be more effective showing 50% suppression of vascular leakage. CONCLUSION: The DL-AAA rabbit model mimics RNV angiographic features like RNV and chronic retinal leakage. Based on these features the DL-AAA rabbit model provides an invaluable tool that could be used to test the therapeutic efficacy and duration of action of novel anti-angiogenic formulations, alone or in combination with anti-inflammatory compounds.

Aim: To assess HER2/neu expressions and correlate with E-cadherin and Serum HER2 level in gastric carcinoma. Method: 31 gastric biopsies and 1 resected specimen were taken in the study with patient details and stained with H and E for histopathological details following Lauren's classification. Immunohistochemistry for HER2 and E-cadherin expression was conducted followed by serum HER2/neu ELISA. Result: Adenocarcinoma with 61% diffuse, 29% intestinal, and 10% other type were observed with predominant HER2 immunoexpression in intestinal-type than in diffuse-type adenocarcinoma. Other observations marked 44% as 3+/positive and 56% as 2+/equivocal in intestinal type while 26% cases as 3+/positive, 69% as 2+/equivocal, and 1% as 1+/negative were observed in diffuse type. The data presented 33% membranous positivity and 67% both membranous + cytoplasmic positivity in intestinal type while 2% showed membranous positivity, 47% both membranous + cytoplasmic, and 42% only cytoplasmic positivity in diffused type. On comparing the localization pattern of HER2 and E-cadherin, 25% of cases showed membranous staining while 50% of cases showed membranous with cytoplasmic staining for both. No cytoplasmic HER2 staining as well as no any staining for E-cadherin was shown by 6% cases. Conclusion: Thus, it can be concluded that cytoplasmic expression of HER2 in gastric adenocarcinoma (mainly diffuse type) may be due to shedding of its extracellular domain, leading to loss of membranous E-cadherin expression on immunohistochemistry. The loss of membranous expression of E-cadherin and increased serum HER2 ELISA were correlated well with these findings.

Objective The objective of this paper was (1) to study the prevalence of latent autoimmune diabetes in adult (LADA) in the region of north-eastern Uttar Pradesh, India, based on the positivity for glutamic acid decarboxylase 65 (GAD65) antibodies and (2) to compare the glycemic profile between GAD65-positive and GAD65-negative subjects. Materials and Methods The subjects were of more than 30 years of age, with either recently diagnosed pre-diabetes/diabetes presenting with the hemoglobin A1c (HbA1c) level of ≥5.7% or already diagnosed cases of type 2 diabetes mellitus (T2DM) who had no requirement of insulin therapy for at least 6 months from the time of their diagnosis. All the patients were natives of north-eastern Uttar Pradesh. The GAD65 test was done by the enzyme-linked immunosorbent assay. Further, the glycemic status of GAD-positive and GAD-negative subjects were compared on the basis of fasting blood sugar (FBS), fasting insulin (FI), and homeostatic model assessment for insulin resistance (HOMA-IR). The “unpaired t-test” was used to compare and assess the significance of differences between the glycemic profile of GAD65-positive and GAD65-negative subjects using the GraphPad Prism Scientific Software, San Diego, CA, United States. The p-value of

Ectopic meningiomas are very rare tumour entities that account for approximately 1-2% of all meningiomas and appear extracranially mostly in the head and neck region. Usually they create diagnostic confusion in an ectopic site with other soft tissue neoplasms, mostly peripheral nerve sheath tumors, myogenic tumours and vascular tumours, more so, with morphological variants like fibroblastic, angiomatous, etc. that may not show the meningothelial cells conspicuously. Here authors report one such case of a 55-year-old female, presenting with a slowly growing non tender left temporal mass since childhood that was thought to be a myogenic tumour on Computed Tomography (CT) scan but on microscopy was a transitional meningioma with mixed fibroblastic and meningothelial pattern. Hence, ectopic meningioma is one of the imperative diagnosis that a pathologist should keep in mind while dealing with soft tissue neoplasms of the head and neck region.

Abstract Background Men who have sex with men (MSM) have been disproportionately affected by HIV-1 since the beginning of the AIDS pandemic, particularly in the USA and Europe. Compared to men who have sex with women (MSW), MSM have a distinct fecal microbiome regardless of HIV-1 infection. However, it is unclear whether the MSM-associated gut microbiome affects the susceptibility and progression of HIV-1 infection. We studied fecal microbiome profiles, short-chain fatty acids, and blood plasma inflammatory cytokines of 109 HIV-1 seroconverters (SC) from the early, 1984–1985 phase of the HIV-1 pandemic in the Multicenter AIDS Cohort Study (MACS) before and after HIV-1 infection compared to 156 HIV-1-negative MACS MSM (negative controls [NC]). Results We found that family Succinivibrionaceae, S24-7, Mogibacteriaceae, Coriobacteriaceae, and Erysipelotrichaceae were significantly higher (p

Introduction: Glaucoma is most common cause of irreversible blindness in the world. Hence, awareness about the disease, importance of drugs effect and its side-effects and accurate method of eye drop instillation is very crucial. Aim: To assess Knowledge, Attitude and Practice (KAP) at the medication, doctor and patient level in clinical practice. Materials and Methods: It was a cross-sectional, descriptive, questionnaire based study conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India, for duration of two years from July 2020 to June 2022. It included 290 patients diagnosed with glaucoma. They were asked to demonstrate method of instillation of eye drop to assess correct method and to cover a few aspects of questionnaire regarding medication instillation. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21.0. The p-value was determined for questions in the questionnaire using Chi-square test. The p-value

Data heterogeneity is a pressing issue and is further compounded if we have to deal with data from textual documents. The unstructured nature of such documents implies that collating, comparing and analysing the information contained therein can be a challenging task. Automating these processes can help to unleash insightful knowledge that otherwise remains buried in them. Moreover, integrating the extracted information from the documents with other related information can help to make more information-rich queries. In this context, the paper presents a comprehensive review of text extraction and data integration techniques to enable this automation process in an ecological context. The paper investigates into extracting valuable floristic information from a historical Botany journal. The purpose behind this extraction is to bring to light relevant pieces of information contained within the document. In addition, the paper also explores the need to integrate the extracted information together with other related information from disparate sources. All the information is then rendered into a query-able form in order to make unified queries. Hence, the paper makes use of a combination of Machine Learning, Natural Language Processing and Semantic Web techniques to achieve this. The proposed approach is demonstrated through the information extracted from the journal and the information-rich queries made through the integration process. The paper shows that the approach has a merit in extracting relevant information from the journal, discusses how the machine learning models have been designed to classify complex information and also gives a measure of their performance. The paper also shows that the approach has a merit in query time in regard to querying floristic information from a multi-source linked data model.

Background: Traditional infection prevention (IP) methods for outbreak detection often rely on geotemporal clustering confined to single locations. We recently developed the Enhanced Detection System for Healthcare-Associated Transmission (EDS-HAT), which combines whole-genome sequencing (WGS) surveillance and machine learning of the electronic health record (EHR). Our retrospective research findings show potential transmissions averted and cost savings using EDS-HAT in real time. Here, we describe the process and initial findings from EDS-HAT real-time implementation. Methods: Real-time whole-genome sequencing surveillance began on November 1, 2021. Patient cultures positive for select bacterial pathogens who were hospitalized for ≥3 days or had a recent healthcare exposure in the prior 30-days were collected. Isolates were deemed genetically related if ≤15 single-nucleotide polymorphisms (SNPs) were identified for all organisms except Clostridioides difficile (≤2 SNPs). Clusters were manually investigated by both research and IP teams, and interventions were performed by the IP team. Data on collection, analysis, notification, and intervention dates were gathered. Results: As of January 11, 2022, 413 isolates had undergone whole-genome sequencing. Among them, 18 unique patient isolates were genetically related to ≥1 other isolate, comprising 7 clusters (range, 2–6 patients). Notable findings include a Pseudomonas aeruginosa cluster possibly related to a shared bronchoscope, a pseudo-outbreak of Serratia marcescens related to autopsy blood culture practice, and a cluster of vancomycin-resistant Enterococcus faecium on a shared transplant unit. Only 1 cluster of 2 isolates of Klebsiella pneumoniae had no known possible transmission routes. The median turnaround time from patient’s culture date to IP notification was 19 days (range, 13–28), with noted delays over the winter holiday. Concusions: Real-time WGS can identify small clusters including potentially interruptible transmission routes. Rapid turnaround time, coordination between clinical and genomic laboratories, and a robust IP team are key factors in implementing a WGS surveillance program. Real-time WGS surveillance has the potential to reduce costs for hospitals, improve patient safety, and save lives.

ABSTRACT Healthcare-associated infections (HAIs) cause mortality, morbidity, and waste of health care resources. HAIs are also an important driver of antimicrobial resistance, which is increasing around the world. Beginning in November 2016, we instituted an initiative to detect outbreaks of HAIs using prospective whole-genome sequencing-based surveillance of bacterial pathogens collected from hospitalized patients. Here, we describe the diversity of bacteria sampled from hospitalized patients at a single center, as revealed through systematic analysis of bacterial isolate genomes. We sequenced the genomes of 3,004 bacterial isolates from hospitalized patients collected over a 25-month period. We identified bacteria belonging to 97 distinct species, which were distributed among 14 groups of related species. Within these groups, isolates could be distinguished from one another by both average nucleotide identity (ANI) and principal-component analysis of accessory genes (PCA-A). Core genome genetic distances and rates of evolution varied among species, which has practical implications for defining shared ancestry during outbreaks and for our broader understanding of the origins of bacterial strains and species. Finally, antimicrobial resistance genes and putative mobile genetic elements were frequently observed, and our systematic analysis revealed patterns of occurrence across the different species sampled from our hospital. Overall, this study shows how understanding the population structure of diverse pathogens circulating in a single health care setting can improve the discriminatory power of genomic epidemiology studies and can help define the processes leading to strain and species differentiation. IMPORTANCE Hospitalized patients are at increased risk of becoming infected with antibiotic-resistant organisms. We used whole-genome sequencing to survey and compare over 3,000 clinical bacterial isolates collected from hospitalized patients at a large medical center over a 2-year period. We identified nearly 100 different bacterial species, which we divided into 14 different groups of related species. When we examined how genetic relatedness differed between species, we found that different species were likely evolving at different rates within our hospital. This is significant because the identification of bacterial outbreaks in the hospital currently relies on genetic similarity cutoffs, which are often applied uniformly across organisms. Finally, we found that antibiotic resistance genes and mobile genetic elements were abundant and were shared among the bacterial isolates we sampled. Overall, this study provides an in-depth view of the genomic diversity and evolutionary processes of bacteria sampled from hospitalized patients, as well as genetic similarity estimates that can inform hospital outbreak detection and prevention efforts.

Pneumonia has been directly responsible for a huge number of deaths all across the globe. Pneumonia shares visual features with other respiratory diseases, such as tuberculosis, which can make it difficult to distinguish between them. Moreover, there is significant variability in the way chest X-ray images are acquired and processed, which can impact the quality and consistency of the images. This can make it challenging to develop robust algorithms that can accurately identify pneumonia in all types of images. Hence, there is a need to develop robust, data-driven algorithms that are trained on large, high-quality datasets and validated using a range of imaging techniques and expert radiological analysis. In this research, a deep-learning-based model is demonstrated for differentiating between normal and severe cases of pneumonia. This complete proposed system has a total of eight pre-trained models, namely, ResNet50, ResNet152V2, DenseNet121, DenseNet201, Xception, VGG16, EfficientNet, and MobileNet. These eight pre-trained models were simulated on two datasets having 5856 images and 112,120 images of chest X-rays. The best accuracy is obtained on the MobileNet model with values of 94.23% and 93.75% on two different datasets. Key hyperparameters including batch sizes, number of epochs, and different optimizers have all been considered during comparative interpretation of these models to determine the most appropriate model.

The segmentation of lungs from medical images is a critical step in the diagnosis and treatment of lung diseases. Deep learning techniques have shown great promise in automating this task, eliminating the need for manual annotation by radiologists. In this research, a convolution neural network architecture is proposed for lung segmentation using chest X-ray images. In the proposed model, concatenate block is embedded to learn a series of filters or features used to extract meaningful information from the image. Moreover, a transpose layer is employed in the concatenate block to improve the spatial resolution of feature maps generated by a prior convolutional layer. The proposed model is trained using k-fold validation as it is a powerful and flexible tool for evaluating the performance of deep learning models. The proposed model is evaluated on five different subsets of the data by taking the value of k as 5 to obtain the optimized model to obtain more accurate results. The performance of the proposed model is analyzed for different hyper-parameters such as the batch size as 32, optimizer as Adam and 40 epochs. The dataset used for the segmentation of disease is taken from the Kaggle repository. The various performance parameters such as accuracy, IoU, and dice coefficient are calculated, and the values obtained are 0.97, 0.93, and 0.96, respectively.

Brain tumor diagnosis at an early stage can improve the chances of successful treatment and better patient outcomes. In the biomedical industry, non-invasive diagnostic procedures, such as magnetic resonance imaging (MRI), can be used to diagnose brain tumors. Deep learning, a type of artificial intelligence, can analyze MRI images in a matter of seconds, reducing the time it takes for diagnosis and potentially improving patient outcomes. Furthermore, an ensemble model can help increase the accuracy of classification by combining the strengths of multiple models and compensating for their individual weaknesses. Therefore, in this research, a weighted average ensemble deep learning model is proposed for the classification of brain tumors. For the weighted ensemble classification model, three different feature spaces are taken from the transfer learning VGG19 model, Convolution Neural Network (CNN) model without augmentation, and CNN model with augmentation. These three feature spaces are ensembled with the best combination of weights, i.e., weight1, weight2, and weight3 by using grid search. The dataset used for simulation is taken from The Cancer Genome Atlas (TCGA), having a lower-grade glioma collection with 3929 MRI images of 110 patients. The ensemble model helps reduce overfitting by combining multiple models that have learned different aspects of the data. The proposed ensemble model outperforms the three individual models for detecting brain tumors in terms of accuracy, precision, and F1-score. Therefore, the proposed model can act as a second opinion tool for radiologists to diagnose the tumor from MRI images of the brain.

Purpose: To analyze the impact of ophthalmic webinars on the resident's learning experience during the COVID-19 pandemic (CP). Methods: This cross-sectional nationwide study was carried out for 1 month during CP and included a total of 382 ophthalmic residents. A questionnaire was sent through various social media platforms. Results: Residents expressed a decline in their clinical exposure (74%; 220), thesis work (58%; 218), and acquisition of the knowledge and skills (42.5%; 161) during CP. Benefits of webinars as perceived by the residents included gain in additional knowledge (77%; 286), feedback on queries (56%; 209), access to multiple speakers (50%; 191), and topics (30%; 110). Nearly 75% (291) of residents endorsed webinars as good to the very good academic tool, and 54% (202) preferred to continue attending webinars in the post-CP phase. However, connectivity/download/data issues (54%; 200) followed by loss of personal touch (53%; 188), lengthy or irrelevant topic (37%; 134), and poor transmission quality (33%; 121) were major deterrents against the webinar. Conclusion: The current study generated overall mixed responses from the ophthalmic postgraduate residents in favor of webinars. In the present format, webinars bear enormous potentials to supplement the traditional learning tools by providing uninterrupted learning experiences. However, they are still limited by their pedagogical and technical issues.

Background: Gall bladder carcinoma is endemic in North India along the Ganges belt. Most of the cases usually present in late stage when prognosis is poor. That mandates a necessity for proper screening in these areas for gall bladder lesions. Tumor markers CA 19-9 and CA 125 have been studied in various GI cancers and may also help in the screening, diagnosis and evaluation of gall bladder carcinoma. Aims: To assess serum CA19-9 and serum CA125 in patients with gall bladder lesions and find out a cut off value for diagnosis of carcinoma gallbladder. Methods and Material: Study included 118 cases, with female: male ratio of 4:1.Out of it, 91 (77 %) cases were benign and 27 (23 %) were malignant. Patients' sera was collected and analyzed for CA19-9 and CA 125 by CMIA method. Results: The Mean (SD) value of CA19-9 for benign and malignant cases was found to be 12.86 (17.54) and 625.35(186.52) U/ml. For CA 125 it was found to be 17.98(13.69) and 239.63(73.72) U/ml respectively. The difference was statistically significant (P< 0.001). When Mean - 2SD value of malignant lesions were taken as cut off a value of CA 19-9 and CA 125 were found be 252.31 U/ml & 92.19U/ml respectively, found to be significant to suggest /diagnose a case of carcinoma gall bladder along with clinicoradiological findings. Taking these value as cut off Sensitivity & Specificity for CA 19-9 and CA 125 in detecting malignant cases were found to be 100% & 98.90% and 100% & 94.50% respectively. Conclusions: It is concluded that both serum CA 19-9 and serum CA 125 may act as a good adjunct for diagnosis of cases of carcinoma gallbladder along with imaging studies. However, changes in CA19-9 are more significant than CA 125.

Objectives: Chemerin is a proinflammatory adipokine whose role in metabolic syndrome and insulin resistance is well known. Chemerin has shown to carry a good prognostic/predictive value in patients of Coronary Artery Diseases (both chronic as well as acute) in the studies done in the US and Europe. However, no such study has been reported from India. Hence, this study was undertaken to evaluate Chemerin in patients of Acute Coronary Syndrome (ACS) and assess their role in cardiodiabetic patients. Materials and Methods: We included seventy cases of ACS and further subdivided them into two groups - (1) with co-existing diabetes mellitus (ACS-DM) (n = 33) and (2) without co-existing DM (ACS-NDM) (n = 37). Thirty healthy age and sex matched controls were included for comparison. Chemerin levels were measured by ELISA, hs C Reactive Protein (hs CRP) by turbidimetric assay, Creatine Kinase MB (CK-MB) by immunoinhibition (IFCC method) and Troponin I (Trop I) by Chemiluminescent Microparticle immunoassay. All the data were analyzed using Social Science Statistics Calculators. Results: Serum Chemerin levels were highest in ACS-DM (0.80 ± 0.61 ng/ml) as compared to ACS-NDM (0.42 ± 0.22 ng/ml) and controls (0.25 ± 0.10 ng/ml). On comparison, the difference amongst all was statistically significant. Furthermore, Chemerin showed a positive correlation with all the three parameters of ACS – hs CRP, CK- MB and Trop I. Conclusion: Chemerin levels are markedly elevated in ACS patients, more so in those with coexisting diabetes [cardio diabetics]. Chemerin is a novel biomarker of ACS.

Abstract Fluid overload is a common complication in patients with cirrhosis. B-type natriuretic peptide (BNP) is a marker of increased blood volume, commonly used in heart failure, that has been shown to be elevated in patients with liver disease. This study examined if BNP levels can be used to determine prognosis and predict worsening of ascites in patients with cirrhosis without concomitant heart disease. A retrospective study was performed at a large urban hospital in Chicago, Illinois and included 430 patients with cirrhosis who had BNP levels ordered during their hospital stay. Patients with clinical heart failure, arrhythmias or pulmonary hypertension were excluded. The primary outcome was 90-day mortality and the secondary outcome was a requirement for therapeutic paracentesis in the 90 days following BNP results. 53 patients (12%) had BNP levels ≥ 300 pg/mL. They had significantly increased serum levels of creatinine, bilirubin, and International Normalized Ratio (INR) when compared to those with BNP

The Indian Association of Pathologists and Microbiologists (IAPM) and Indian Society of Gastroenterology (ISG) decided to make a joint consensus recommendation for handling, processing, and interpretation of SI biopsies for the diagnosis and management of celiac disease (CD) recognizing the inhomogeneous practice of biopsy sampling, orientation, processing, and interpretation. A modified Delphi process was used to develop this consensus document containing a total of 42 statements and recommendations, which were generated by sharing the document draft, incorporating expert's opinion, followed by three cycles of electronic voting as well as a full-day face-to-face virtual ZOOM meeting and review of supporting literature. Of the 42 statements, 7 statements are on small intestinal (SI) biopsy in suspected patients of CD, site and the number of biopsies; 7 on handling, fixative, orientation, processing, and sectioning in pathology laboratories; 2 on histological orientation; 13 statements on histological interpretation and histological grading; 3 on the assessment of follow-up biopsies; 2 statements on gluten-free diet (GFD)-nonresponsive CD; 4 on challenges in the diagnosis of CD; 2 statements each on pathology reporting protocol and training and infrastructure in this area. The goal of this guideline document is to formulate a uniform protocol agreed upon both by the experienced pathologists and gastroenterologists to standardize the practice, improve the yield of small bowel biopsy interpretation, patients' compliance, overall management in CD, and generate unified data for patient care and research in the related field.

In recent clinical practice the molecular diagnostics have been significantly empowered and upgraded by the use of Artificial Intelligence and its assisted technologies. The use of Machine leaning and Deep Learning Neural network architectures have brought in a new dimension in clinical oncological research and development. These algorithm based software system with enhanced digital image analysis have emerged into a new branch of digital pathology and contributed immensely towards precision medicine and personal diagnostics. In India, gastric cancer is one of the most common cancers in males as well as in females. Various molecular biomarkers are associated with gastric cancer development and progression of which HER2 protein, a transmembrane tyrosine kinase (TK) receptor of epidermal growth factor receptors (EGFRs) family is of prime importance. The EGF receptor expression in gastric cancer is linked with its prognostics and theragnostics. These expressions are assessed by immunohistochemistry (IHC) and molecular techniques such as Fluorescence in-situ hybridization (FISH), as per recommendations for HER2 targeted immunotherapy. These have motivated the software giants like Google Inc. to produce innovative state of art technologies mimicking human traits such as learning and problem solving skill sets. This field is still under development and is slowly evolving and capturing global importance in recent times. A literature search on PubMed was performed to access updated information for this manuscript.

Portal hypertensive vasculopathy (PHV) represents an increase in the pressure in the portal circulation. This increased pressure leads to changes in the mucosa that can be appreciated endoscopically as well as histopathologically. Lesions can be observed in the entire gastrointestinal tract (GIT) including stomach, duodenum, jejunum and colon. The histological changes are appreciated mainly in the mucosal and submucosal blood vessels. A knowledge of these lesions as well as the changes helps in separating them from other close differentials with specific treatment to be instituted. The pathogenesis of the hemodynamic changes is not well-understood. The underlying factor is increased portal pressure. Studies indicate, that besides increased portal pressure other factors in combination led to the observed changes. Portal hypertensive gastropathy (PHG) is seen in the gastric body and fundus, while varices are noted in the cardia and fundus. Changes may be seen in the small intestine and throughout the colon with anorectal varices. Histopathological changes include dilated, congested and ectatic capillaries and edema in the lamina propria besides a large spectrum of other histopathological changes. Mucosal capillaries with thick irregular wall show absence of red blood cells in the lumen. Thickening of the vessel wall serves as a better marker than the vascular diameter when portal hypertension (PHT) is considered. Long standing cases may show fibrosis in lamina propria. At times, these changes may lead to occult gastrointestinal bleeding. Important differentials need to be ruled out in all the cases as the treatment and the outcome of all differs. Endoscopically or histopathologically if the mucosal changes are observed they should not be overlooked and a detailed work-up must be carried out.

Spur cell anemia is acquired hemolytic anemia seen in patients with advanced liver disease, particularly in the setting of alcoholism, and warrants urgent liver transplant evaluation. We describe the case of a 58-year-old female with alcoholic cirrhosis who presented with worsening liver disease, profound anemia poorly responsive to blood transfusions, and multiple spur cells on the peripheral smear. She underwent a liver transplant, which led to the resolution of hematologic abnormalities and the need for transfusions. Our case highlights the significance of spur cell anemia as a harbinger of poor prognosis in patients with advanced liver disease and its reversibility with liver transplantation

Introduction: A meniscal tear is the most common injury to the knee, and commonly occurring from both athletic events and activities of daily living. The diagnosis of a meniscal tear may require Magnetic Resonance Imaging (MRI), which is costly. In remote and rural parts of our country, MRI is not available so ultrasonographic examination of knee can be used as diagnostic tool to overcome financial burden to such population groups. Aim: To correlate the accuracy of Ultrasonography (USG) and MRI for diagnosing meniscal tears and also to correlate the specificity, sensitivity, and predictive values of USG for meniscal tears in comparison with MRI. Materials and Methods: It was an observational study. It included 50 patients who presented to our institute with complain of acute or chronic knee pain and restriction of movement with clinical signs and symptoms of meniscal tear with history of trauma. All patients underwent ultrasonographic examination of knee along with MRI and arthroscopy. The statistical analysis was done by using Statistical Package for Social Sciences (SPSS) 22.0 software. Accuracy, sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated based on detection of meniscal tear. Results: This study comprised of 50 patients: 45 were males and 5 were females whose median age was 29 years. Upon combining both medial and lateral menisci, USG showed mean accuracy of 72%, mean sensitivity of 48.6% and mean specificity of 85.7%. MRI showed mean accuracy of 76%, mean sensitivity of 50% and the mean specificity of 90.6%. Conclusion: According to this study, USG has shown reasonable accuracy, sensitivity, specificity, PPV and NPV in comparison to MRI in detecting meniscal lesions.This study has proved that USG can be a good negative test for meniscal tear as we can exclude normal meniscus from abnormal, thus patient with normal meniscus could be prevented from undergoing costly MRI as their initial investigation. So, it can be used as an effective diagnostic screening tool.

Declared as a pandemic by WHO on March 11, 2020, COVID-19 has brought about a dramatic change in the working of different laboratories across the country. Diagnostic laboratories testing different types of samples play a vital role in the treatment management. Irrespective of their size, each laboratory has to follow strict biosafety guidelines. Different sections of the laboratory receive samples that are variably infectious. Each sample needs to undergo a proper and well-designed processing system so that the personnel involved are not infected and also their close contacts. It takes a huge effort so as to limit the risk of exposure of the working staff during the collection, processing, reporting or dispatching of biohazard samples. Guidelines help in preventing the laboratory staff and healthcare workers from contracting the disease which has a known human to human route of transmission and high rate of mortality. A well-knit approach is the need of the hour to combat this fast spreading disease. We anticipate that the guidelines described in this article will be useful for continuing safe work practices by all the laboratories in the country.

The measurement of creatine kinase muscle brain (CK-MB) by the method of immunoinhibition has various drawbacks, which are posing as a hindrance in its role as a sensitive diagnostic indicator. A 2-month-old infant presented with symptoms of difficulty in breathing and cough. A chest X-ray done showed an incidental finding of a cardiac anomaly, and ultrasonography cranium showed a well-defined cystic lesion seen in the frontal horn of the bilateral lateral ventricle and signs of a resolving hemorrhage. The CK-MB level (761U/L) was greatly exceeding the CK levels (427U/L). This raise in CK-MB may be due to the presence of CK-BB or macro-CK in the plasma. Electrophoresis of the CK enzyme is, therefore, the best way to resolve the shortcomings of immunoinhibition. Macro-CK and CK-BB should hence also be kept in mind when the physician makes a diagnosis on the basis of such a laboratory report.

Rhabdomyosarcoma (RMS) is a rare soft tissue tumour, accounting for 3% of all childhood cancers. RMS can arise virtually anywhere in the body, as it originates in embryonal mesenchyme. Embryonal Rhabdomyosarcoma (ERMS) and Alveolar Rhabdomyosarcoma (ARMS) are the most prevalent subtypes of RMS but arise through diverse biological mechanisms. RMS generally presents as an expanding mass that tends to be very painful and causes symptoms related to the compression of structures present nearby. Metastases of such tumours are common and can occur in bone, lungs and other organs leading to pain, difficulty with respiration, pleural effusion, anaemia, thrombocytopenia, and neutropenia. In the present report, two unusual presentations of ERMS have been reported. First case is of a 28-year-old adult male who presented in surgical Outpatient Department (OPD) with recurrent episodes of painful acute urinary retention since one year. Another case was of a six-year-old girl presenting with aural fullness and serosanginous discharge from right ear, ear pain and decreased hearing since two years. Since five year survival rate of such tumour is less than 30%, therefore, an awareness of the typical signs and symptoms, radiological features, histomorphological features in a case of paediatric and adult ERMS can help a pathologist to consider this tumour in the differential diagnoses, even at unusual sites.

ObjectiveWe used SARS-CoV-2 whole-genome sequencing (WGS) and electronic health record (EHR) data to investigate the associations between viral genomes and clinical characteristics and severe outcomes among hospitalized COVID-19 patients.MethodsWe conducted a case-control study of severe COVID-19 infection among patients hospitalized at a large academic referral hospital between March 2020 and May 2021. SARS-CoV-2 WGS was performed, and demographic and clinical characteristics were obtained from the EHR. Severe COVID-19 (case patients) was defined as having one or more of the following: requirement for supplemental oxygen, mechanical ventilation, or death during hospital admission. Controls were hospitalized patients diagnosed with COVID-19 who did not meet the criteria for severe infection. We constructed predictive models incorporating clinical and demographic variables as well as WGS data including lineage, clade, and SARS-CoV-2 SNP/GWAS data for severe COVID-19 using multiple logistic regression.ResultsOf 1,802 hospitalized SARS-CoV-2-positive patients, we performed WGS on samples collected from 590 patients, of whom 396 were case patients and 194 were controls. Age (p = 0.001), BMI (p = 0.032), test positive time period (p = 0.001), Charlson comorbidity index (p = 0.001), history of chronic heart failure (p = 0.003), atrial fibrillation (p = 0.002), or diabetes (p = 0.007) were significantly associated with case-control status. SARS-CoV-2 WGS data did not appreciably change the results of the above risk factor analysis, though infection with clade 20A was associated with a higher risk of severe disease, after adjusting for confounder variables (p = 0.024, OR = 3.25; 95%CI: 1.31-8.06).ConclusionsAmong people hospitalized with COVID-19, older age, higher BMI, earlier test positive period, history of chronic heart failure, atrial fibrillation, or diabetes, and infection with clade 20A SARS-CoV-2 strains can predict severe COVID-19.

Objective(s) Our objective was to investigate the motivators and barriers associated with the individual or family decision to participate in cerebral palsy research. Based on this information, we offer suggestions to increase the likelihood of participation in future CP studies. Methods A digital survey was administered to stakeholders affected by cerebral palsy across the US. Our analysis focused on variables related to personal interests, travel, and study-specific elements. Statistical tests investigated the effects of responder type, cerebral palsy type, and Gross Motor Function Classification System level on travel and study-specific element variables. Recommendations were informed by responses reflecting the majority of respondents. Results Based on 233 responses, we found that respondents highly valued research participation (on average 88.2/100) and compensation (on average 62.3/100). Motivators included the potential for direct benefit (62.2%) and helping others (53.4%). The primary barriers to participation were schedule limitations (48.9%) and travel logistics (32.6%). Schedule limitations were especially pertinent to caregivers, while individuals with more severe cerebral palsy diagnoses reported the necessity of additional items to comfortably travel. Conclusions Overall, we encourage the involvement of stakeholders affected by cerebral palsy in the research process. Researchers should consider offering flexible study times, accommodating locations, and compensation for time and travel expenses. We recommend a minimum compensation of $15/hour and a maximum time commitment of 4 hours/day to respect participants’ time and increase likelihood of research participation. Future studies should track how attitudes toward research change with time and experience.

Closely spaced promoters in tandem formation are abundant in bacteria. We investigated the evolutionary conservation, biological functions, and the RNA and single-cell protein expression of genes regulated by tandem promoters in E. coli. We also studied the sequence (distance between transcription start sites 'dTSS', pause sequences, and distances from oriC) and potential influence of the input transcription factors of these promoters. From this, we propose an analytical model of gene expression based on measured expression dynamics, where RNAP-promoter occupancy times and dTSS are the key regulators of transcription interference due to TSS occlusion by RNAP at one of the promoters (when dTSS ≤ 35 bp) and RNAP occupancy of the downstream promoter (when dTSS > 35 bp). Occlusion and downstream promoter occupancy are modeled as linear functions of occupancy time, while the influence of dTSS is implemented by a continuous step function, fit to in vivo data on mean single-cell protein numbers of 30 natural genes controlled by tandem promoters. The best-fitting step is at 35 bp, matching the length of DNA occupied by RNAP in the open complex formation. This model accurately predicts the squared coefficient of variation and skewness of the natural single-cell protein numbers as a function of dTSS. Additional predictions suggest that promoters in tandem formation can cover a wide range of transcription dynamics within realistic intervals of parameter values. By accurately capturing the dynamics of these promoters, this model can be helpful to predict the dynamics of new promoters and contribute to the expansion of the repertoire of expression dynamics available to synthetic genetic constructs.

We performed whole genome sequencing on SARS-CoV-2 from 59 vaccinated individuals from southwest Pennsylvania who tested positive between February and September, 2021. A comparison of mutations among vaccine breakthrough cases to a time-matched control group identified potential adaptive responses of SARS-CoV-2 to vaccination.

Dentinal hypersensitivity or cervical dentinal sensitivity is one of the commonest clinical problems. The aim of this randomized controlled trial was to evaluate the effectiveness of a single chair side application of 100% pure calcium sodium phosphosilicate (NovaMin®) in reducing dentin hypersensitivity following ultrasonic scaling as evaluated on a visual analogue scale (VAS). The study included 50 subjects who were selected based on an evaluation of dentinal hypersensitivity on a VAS carried out using a metered air blast from a three-way syringe and divided into two groups (n = 25/group); i.e., the test group (Group A) received the NovaMin® paste and the control group (Group B) received a placebo paste made from pumice. All the 50 subjects included in the study were had VAS scores of 3 or more. The NovaMin® powder mixed with distilled water was applied. Dentinal hypersensitivity was reassessed immediately and after 1, 2 and 4 weeks after the procedure. Results showed that the percentage reduction of dentinal hypersensitivity following a single application of NovaMin® in powder form was about 76.38% immediately, 67.72% one week postoperatively, 52.76% two weeks postoperatively and 26.78% four weeks postoperatively. It can be concluded from the results of the current clinical study demonstrated that a single chair side application of NovaMin® in powder form has a significant and immediate reduction in dentinal hypersensitivity, which lasted nearly for four weeks.

Purpose: Failure of rapid re-epithelialization within 10–14 days after corneal injury, even with standard supportive treatment, is referred to as persistent corneal epithelial (CE) defect (PED). Though an array of genes regulates reepithelization, their mechanisms are poorly understood. We sought to understand the network of genes driving the re-epithelialization in PED. Method: After obtaining informed consent, patients underwent an ophthalmic examination. Epithelial scrapes and tears samples of six PED patients and six individuals (control) undergoing photorefractive keratectomy (PRK) were collected. RNA isolation and quantification were performed using either the epithelial scrape taken from PED patients or from HCLE cells treated with control tears or tears of PED patients. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to detect the expression of a few important genes in CE homeostasis, inflammation, and cell–cell communication, viz., Kruppel-like factor 4 (KLF4), GPX4, IL6, TNFα, STING, IL8, desmoglein, and E-cadherin, among others. Their expressions were normalized with their respective housekeeping genes and fold changes were recorded. KLF4 localization and MMPs activity was carried out via immunofluorescence and zymography, respectively. Results: KLF4, a transcription factor important for CE homeostasis, was upregulated in tears-treated HCLE cells and downregulated in PED patients compared to the healthy PRK group. Cell–cell communication genes were also upregulated in tears-treated cells, whereas they were downregulated in the PED tissue group. Genes involved in proinflammation (IL6, 282-fold; TNFα, 43-fold; IL8, 4.2-fold) were highly upregulated in both conditions. MMP9 activity increased upon tears treatment. Conclusions: This study suggests that tears create an acute proinflammatory milieu driving the PED disease pathology, whereas the PED patients scrapes are an indicator of the chronic stage of the disease. Interferons, pro-inflammatory genes, and their pathways are involved in PED, which can be a potential target for inducing epithelialization of the cornea.

Pancreatic and gastric heterotopias are rare congenital anomalies which have been reported throughout the length of the gastrointestinal tract. Combined gastric and pancreatic heterotopias, although very rare, have been described mainly in the duodenum followed by jejunum with ileum being a rare site. The reported incidence of this combined heterotopias is low, ranging from

Gap junctions between neurons serve as electrical synapses, in addition to conducting metabolites and signaling molecules. During development, early-appearing gap junctions are thought to prefigure chemical synapses, which appear much later. We present evidence for this idea at a central, glutamatergic synapse and provide some mechanistic insights. Loss or reduction in the levels of the gap junction protein Gjd2b decreased the frequency of glutamatergic miniature excitatory postsynaptic currents (mEPSCs) in cerebellar Purkinje neurons (PNs) in larval zebrafish. Ultrastructural analysis in the molecular layer showed decreased synapse density. Further, mEPSCs had faster kinetics and larger amplitudes in mutant PNs, consistent with their stunted dendritic arbors. Time-lapse microscopy in wild-type and mutant PNs reveals that Gjd2b puncta promote the elongation of branches and that CaMKII may be a critical mediator of this process. These results demonstrate that Gjd2b-mediated gap junctions regulate glutamatergic synapse formation and dendritic elaboration in PNs.

Merkel cell carcinoma (MCC) is a highly aggressive cutaneous neuroendocrine carcinoma, frequently associated with distant metastasis. However, recurrence of MCC manifesting with only pancreatic involvement is exceedingly rare. A 53-year-old man presented to our institution with abdominal discomfort 3 months after initial resection of chest wall MCC. Imaging revealed lesions in the pancreas and peripancreatic lymph nodes. Pathology obtained through endoscopic ultrasound confirmed recurrence of MCC. He underwent chemotherapy with cisplatin and etoposide, resulting in a complete resolution of the pancreatic lesions. Unfortunately, he passed away from sudden cardiac arrest while being in remission from MCC. Immunohistochemistry is crucial in differentiating MCC from primary pancreatic glandular and neuroendocrine tumors. While there are no definitive guidelines in the management of pancreatic lesions associated with MCC, checkpoint inhibitor immunotherapy is increasingly being used.

Skin metastasis is an infrequent manifestation in oncology, with reported incidence of about 1.3% in cervical cancer. When present, it usually signals advanced disease with very limited, mostly palliative treatment options. Here we present a patient who was diagnosed with cervical cancer at an early stage and later recurred twice with skin lesions of different morphologies.

Background: Antibiotics are known to improve clinical parameters in patients with periodontitis, so they should be capable of enhancing the surgical treatment outcome by improving clinical parameters when given adjunctively following periodontal flap surgery. Methods: Thirty subjects with moderate to severe periodontitis were randomly divided into three groups: Group I: 10 patients without antibiotic prescription after flap surgery, Group II: 10 patients prescribed with metronidazole 400 mg t.i.d. for 14 days, and Group III: 10 patients prescribed with doxycycline 200 mg o.d. as booster dose followed by successive doses of 100 mg o.d. for 21 days. Plaque index (PI), gingival index (GI), pocket probing depth (PPD), and clinical attachment level (CAL) were recorded at baseline, 2 weeks, and 2 months. The mean values and standard deviation values for each parameter were calculated using analysis of variance. Group comparison was done using paired t- and unpaired t-tests. Results: Reduction in PI, GI, PPD, and CAL after 2 weeks and 3 months from baseline in all the three groups was seen; intergroup comparison showed more reduction in PPD and GI and more gain in CAL in Groups II and III after 3 months when compared with Group I. No statistical difference was seen between Groups II and III. Conclusion: Within the limits of this study, it can be concluded that antibiotic administration as an adjunct to conventional flap surgery helps in improving clinical parameters.

Background: Extracts of medicinal plant like lemongrass offer a new choice for optional antimicrobial therapy against various oral microorganisms. The objective of this study was to assess, verify, and compare the antimicrobial effectiveness of locally administered 2% lemongrass gel and 10% doxycycline hyclate gel as an adjunct to scaling and root planing (SRP) in treating chronic periodontitis. Method: This is a double-blind parallel arm randomized controlled study. Forty subjects were randomly divided into Group A and B for 2% lemongrass gel and 10% doxycycline hyclate gel, respectively. The clinical assessments of Gingival Index (GI), Plaque Index (PI), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL) together with microbial colony counts for Porphyromonas gingivalis, Actinomyces naeslundii, and Prevotella intermedia were done at baseline, 1st month, and 3rd month follow-ups. Results: The results showed there was a significant reduction in the mean scores of GI, PPD, and CAL clinical indices from baseline to the 1st and 3rd month follow-ups in both the 2% lemongrass gel and 10% doxycycline gel groups (p < 0.05). Similarly, there was significant reduction in mean CFU scores for all periodontal pathogens from baseline to 1st and 3rd month follow-ups in both the 2% lemongrass gel and 10% doxycycline gel groups (p < 0.05). Conclusions: It could be concluded that the local delivery of 2% lemongrass gel as an adjunct to scaling and root planing is effective and comparable to 10% doxycycline gel in the treatment of chronic periodontitis.

Skin cancer is the most commonly diagnosed and reported malignancy worldwide. To reduce the death rate from cancer, it is essential to diagnose skin cancer at a benign stage as soon as possible. To save lives, an automated system that can detect skin cancer in its earliest stages is necessary. For the diagnosis of skin cancer, various researchers have performed tasks using deep learning and transfer learning models. However, the existing literature is limited in terms of its accuracy and its troublesome and time-consuming process. As a result, it is critical to design an automatic system that can deliver a fast judgment and considerably reduce mistakes in diagnosis. In this work, a deep learning-based model has been designed for the identification of skin cancer at benign and malignant stages using the concept of transfer learning approach. For this, a pre-trained VGG16 model is improved by adding one flatten layer, two dense layers with activation function (LeakyReLU) and another dense layer with activation function (sigmoid) to enhance the accuracy of this model. This proposed model is evaluated on a dataset obtained from Kaggle. The techniques of data augmentation are applied in order to enhance the random-ness among the input dataset for model stability. The proposed model has been validated by considering several useful hyper parameters such as different batch sizes of 8, 16, 32, 64, and 128; different epochs and optimizers. The proposed model is working best with an overall accuracy of 89.09% on 128 batch size with the Adam optimizer and 10 epochs and outperforms state-of-the-art techniques. This model will help dermatologists in the early diagnosis of skin cancers.

Introduction: Information Technology (IT) has influenced all fields including healthcare and Medical Education (ME). The present generation of students have grown up in an IT enriched atmosphere and are comfortable with most IT tools and gadgets. Aim: To understand the perception of first year MBBS students regarding role of IT in ME. Materials and Methods: A cross-sectional, questionnaire based study was carried out on 250 first year MBBS students from August 1st, 2019 to August 31st, 2019 over a period of one month. A questionnaire containing three sections was administered to the students before the starting of IT module in foundation year. The responses to the items of the questionnaire were assessed on the basis of the student responses on the likert scale. Results: The study revealed that students acknowledged the utility of IT for academic purposes and were primed for its inclusion as an essential component of the medical curriculum. The students conceded to browsing internet on their computers and smartphones for social media handles. However, when it came to teaching methods, students were not comfortable with the idea of replacing traditional teaching methods with e-learning. Also, students were more comfortable in reading hard copies instead of e-books. Conclusion: It was concluded that there is a need to amalgamate the traditional teaching methods with the innovative e-learning platforms in such a way that they become mutually inclusive and facilitate the learning process. Also, ME practices need to be continuously re-evaluated to make the educational process more effective for learners, teachers and for the society in general.

Phyllodes tumour is a rare tumour of the breast constituting less than 1% of all breast tumours. Malignant Phyllodes Tumour (MPT) accounts for only 10-30% of all phyllodes tumours. Heterologous sarcomatous differentiation in a MPT is an infrequent phenomenon, with the cases reported showing differentiation mostly towards liposarcoma, fibrosarcoma, angiosarcoma, osteosarcoma, or chondrosarcoma. MPTs with rhabdomyosarcomatous differentiation are scarcely seen with only three confirmed cases documented till date to the best of the knowledge after a thorough search of literature. Here, authors present a case of 45-year-old female who presented with a well-defined rapidly growing lump in the right breast for last one year. A core needle biopsy performed showed a sarcomatous picture on histology. Complete excision was subsequently done. On microscopy, most of the areas showed fibrosarcomatous changes with frequent mitoses. Some of the foci showed large pleomorphic cells in diffuse sheets that were polygonal with densely abundant eosinophilic cytoplasm and vesicular nucleus with prominent nucleoli (rhabdomyoblasts). Myogenin was diffusely positive on Immunohistochemistry (IHC). A diagnosis of MPT with rhabdomyosarcomatous differentiation was made. This case is reported here for its unusual presentation and to make pathologists aware of this rare heterologous differentiation of MPT.

With so many things around us continuously producing and processing data, be it mobile phones, or sensors attached to devices, or satellites sitting thousands of kilometres above our heads, data is becoming increasingly heterogeneous. Scientists are inevitably faced with data challenges, coined as the 4 V’s of data - volume, variety, velocity and veracity. In this paper, we address the issue of data variety. The task of integrating and querying such heterogeneous data is further compounded if the data is in unstructured form. We hence propose an approach using Semantic Web and Natural Language Processing techniques to resolve the heterogeneity arising in data formats, bring together structured and unstructured data and provide a unified data model to query from disparate data sets.

The removal of noise from signals obtained through the health monitoring systems in gas turbines is an important consideration for accurate prognostics. Several filters have been designed and tested for this purpose, and their performance analysis has been conducted. Linear filters are inefficient in the removal of outliers and noise because they cause smoothening of the sharp features in the signal which can indicate the onset of a fault event. On the other hand, non-linear filters based on image processing methods can provide more precise results for gas turbine health signals. Among others, the weighted recursive median (WRM) filter has been shown to provide greater accuracy due to its weight adaptability depending on the signal type. However, sampling data at high rates is possible which needs hardware implementation of the filter. In this paper, the design, simulation and implementation of WRM filters on the FPGA (Field Programmable Gate Arrays) platforms Vivado Design Suite by Xilinx and Quartus Pro Lite Edition 19.3 has been performed. The architectural detail and performance result with the FPGA filters when subjected to abrupt and gradual fault signal is presented.

Summary: Digital technology is having a major impact on many areas of society, and there is equal opportunity for impact on science. This is particularly true in the environmental sciences as we seek to understand the complexities of the natural environment under climate change. This perspective presents the outcomes of a summit in this area, a unique cross-disciplinary gathering bringing together environmental scientists, data scientists, computer scientists, social scientists, and representatives of the creative arts. The key output of this workshop is an agreed vision in the form of a framework and associated roadmap, captured in the Windermere Accord. This accord envisions a new kind of environmental science underpinned by unprecedented amounts of data, with technological advances leading to breakthroughs in taming uncertainty and complexity, and also supporting openness, transparency, and reproducibility in science. The perspective also includes a call to build an international community working in this important area. The Bigger Picture: Digital technology is having a major impact on many areas of society, and there is equal opportunity for impact on science in addressing grand scientific challenges. This is particularly true in the environmental sciences as we seek to understand the complexities of the natural environment under climate change. This perspective reports on the outcomes from a summit in this area, attended by 42 researchers selected as leading experts operating at the interface between digital technology and the environmental sciences. The key output of this workshop was the Windermere Accord, a collective statement around what is required to achieve a transformative effect through digital technology based around four key pillars of investigation, namely using technology to tame uncertainty; growing advocates and champions to enable, empower, and influence; embracing a new open and transparent style of science; and enabling integration and sophisticated treatment of feedbacks in complex environmental systems. These pillars all feed into the decision-making processes and are supported by a growing community. Looking forward, the accord also identified a pathway with particular emphasis on building an international, cross-disciplinary community to address the key challenges and achieve the real opportunities around digital technology and the environment.

Metformin is a biguanide that is used as first-line treatment of type 2 diabetes mellitus and is effective as monotherapy and in combination with other glucose-lowering medications. It is generally well-tolerated with minimal side effects and is affordable. Although the safety and efficacy of metformin have been well-established, there is discussion regarding whether metformin should continue to be the first choice for therapy as other anti-hyperglycemic medications exhibit additional advantages in certain populations. Despite a long-standing history of metformin use, there are limited cardiovascular outcomes data for metformin. Furthermore, the available studies fail to provide strong evidence due to either small sample size or short duration. Recent data from glucagon-like peptide-1 receptor agonist and sodium-glucose cotransporter-2 inhibitor cardiovascular and renal outcomes trials demonstrated additional protection from diabetes complications for some high-risk patients, which has impacted the guidelines for diabetes management. Post-hoc analyses comparing hazard ratios for participants taking metformin at baseline versus not taking metformin are inconclusive for these two groups. There are no data to suggest that metformin should not be initiated soon after the diagnosis of diabetes. Furthermore, the initiation of newer glycemic-lowering medications with cardiovascular benefits should be considered in high-risk patients regardless of glycemic control or target HbA1c. However, cost remains a major factor in determining appropriate treatment.

Background: Mycophenolic acid (MPA) is a broad-acting immunomodulating agent that may be therapeutically beneficial for the treatment of immune-mediated diseases in canine patients.Objectives: To determine the suppressive effects of MPA on T-cell proliferation, and to assess the feasibility of a canine-specific q24 h modified-release MPA formulation (OKV-1001b).Animals: Fifteen healthy purpose-bred male beagle dogs.Methods: Two nearly identical open-label fifteen-day studies were conducted in which dogs were randomized to receive mycophenolate mofetil (MMF; 10 mg/kg q12h), or two doses of OKV-1001b (270 mg and 180 mg; q24h). Serial pharmacokinetic (PK) and pharmacodynamic (PD) samples were collected on Days 1, 8, and 15. MPA plasma concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), while an ex vivo T-cell proliferation assay assessed PD effects. Dogs were continuously monitored for evidence of side effects and gastrointestinal tolerability.Results: MPA induced inhibition of T-cell proliferation was observed following administration of all MPA preparations in a clear concentration-dependent manner. The PK/PD relationship was maintained across all days and time-points. Data generated herein suggest that MPA plasma concentrations above 600 ng/mL achieve at least 50% inhibition of T-cell proliferation.Conclusions and Clinical Importance: MPA holds therapeutic potential for treating dogs with immune-mediated disease, but clinical trials will be necessary to determine its safety and efficacy in naturally occurring disease. Likewise, q24h oral modified release MPA preparations that maintain MPA plasma concentrations between 600 and 1,000 ng/mL are warranted for further studies in client-owned dogs.

Introduction: Intra-abdominal masses present as a conundrum to clinicians. It is essential to determine their pathology before therapy can be instituted. The use of minimally invasive procedures like image-guided Fine Needle Aspiration Cytology (FNAC) and biopsy can help to avoid diagnostic laparotomy and is especially important for the diagnosis of impalpable and deep-seated lesions. Aim: To find out the pathological spectrum of abdomino-pelvic masses with use of guided FNAC or biopsy. Materials and Methods: This was a prospective study conducted over a period of January 2018 to June 2019 in a Tertiary Care Hospital in Greater Noida. In patients presenting with intra-abdominal or pelvic masses, detected clinically or radiologically, image-guided FNAC and/or biopsy was performed along with standard radiologic examination, and the slides were examined. Ultrasonography (USG) was used in 56 cases (96.6%) and Computed Tomography (CT) for the remaining 2 cases. The results were analysed using descriptive statistics. Results: The 58 patients presenting with intra-abdomino-pelvic masses had a mean age of 49 years and consisted of 30 (51.7%) males. The most common site involved was liver (19 cases, 32.7%) followed by gastrointestinal tract (7 cases, 12.1%), urinary bladder (6 cases, 10.3%), gall bladder and ovary (5 cases, 8.6% each), kidney, prostate, uterus and lymph node (3 cases, 5.2% each) and miscellaneous abdomino-pelvic masses (4 cases, 6.9%). Malignant and premalignant lesions were detected in 50 (86.2%) patients, of which 29 cases (50%) were primary, 20 (34.5%) were metastatic and 1 (1.72%) was premalignant. Six benign (10.35%) and 2 non-neoplastic (3.45%) lesions were detected. Malignancies were found most commonly in the liver, comprising 31.0% of the study group. Adenocarcinoma was the most commonly detected primary (15 cases, 25.8%) as well as secondary metastatic malignancy (12 cases, 20.7%). Radio-pathological correlation was found to be 79.3% for the study and varied according to the site, from zero in prostatic lesions to 100% in renal and uterine lesions. Radiologic concordance was observed in 100% non-neoplastic, 66.7% benign and 72.4% malignant lesions. Conclusion: Image-guided FNAC and biopsy are simple, rapid and inexpensive methods of arriving at a definite diagnosis, as radiology alone proves to be inadequate or erroneous in most of the cases.