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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.

In the present study silver nano-particles were synthesised by green synthesis method using fenugreek leaves extract, provides necessary bioactive for reduction of silver ions to silver nanoparticles. The sharp bands of silver nanoparticles were observed around 432 nm. Synthesis process was further optimized for pH, extraction temperature, Ag ion concentration, extract volume and extraction time on the basis of absorbance and average particles size respectively. FTIR analysis showed presence of corresponding peaks of O–H stretching and N–H amide groups. FESEM images revealed the structure and morphology of spherical AgNPs of average size 30 nm. The antibacterial activity of thus synthesized AgNPs was then tested against S. aureus, E. coli, P. aeruginosa and V. cholera and found synthesized AgNPs have higher inhibitory action against P. aeruginosa compared to other bacteria. The larger size of nano-particles is less active than smaller size of nano-particles due to small surface area.

We describe a modified technique of intraoperative optical coherence tomography (iOCT)-guided removal of post-laser-assisted in situ keratomileusis (LASIK) epithelial ingrowth with interface ethyl alcohol and mitomycin C application to prevent a recurrence. Epithelial ingrowth was visualized as hyperreflective deposits in the interface on iOCT, and the location and extent were noted at the beginning of the procedure. A simple dimple-down maneuver was performed to help identify the circumference of the LASIK flap. iOCT helped to delineate the flap edge and ensure dissection in the correct plane with complete removal of epithelial cell nests. Real-time visualization of the interface helped in on-table decision making regarding the extent of lifting the flap to encompass the entire region of hyperreflective epithelial ingrowth, as well as the need for additional interventions to ensure complete flap apposition at the end of surgery. All patients gained an uncorrected visual acuity of 20/20–20/25 with no recurrence.

It has been proven that Internet of Things (IoT) platforms can improve the performance and efficiency of a wide range of processes. With the acceptance of IoT as a major part of the technology of Industry 4.0, the notion of leveraging the Internet in industries to enable automation and reconfigure existing industrial processes has greatly evolved. By introducing smart technology and intelligent processes, the Industrial Internet of Things (IIoT) is committed to bringing high operational efficiency, enhanced productivity, and effective management to industrial assets. Despite this, the reliance of IIoT on central architecture presents numerous challenges, including the security and maintenance of smart devices, privacy issues owing to third-party participation, and massive computations conducted by a central entity, all of which prevent its widespread adoption in businesses. Emerging blockchain technologies have the potential to transform IIoT platforms and applications. A distributed and decentralized approach followed by blockchain might offer interesting solutions to the challenges raised by IIoT. Furthermore, 5G networks are expected to deliver excellent solutions to meet the demands of decentralized systems, with a focus on application-specific vulnerabilities. Blockchain and IIoT, enabled by 5G, is a viable option to fully explore the potential of contemporary industry. In this context, this article analyzes and examines recent achievements to highlight the major obstacles in blockchain–IIoT convergence and presents a framework for potential solutions. A well-organized literature review by analyzing the existing work in three primary areas: blockchain consensus algorithms used in existing IoT and IIoT applications, blockchain for 5G-enabled IoT networks, and blockchain in industry have been performed, with major findings summarized in each area. Directions for the future are also provided and intend to assist researchers in understanding the full potential of these innovations.

Purpose To study the demography, incidence, symptoms, histopathology, postoperative complications and recovery in operated patients of spinal tumor. Overview of Literature Primary spinal cord tumors (SCT) are an uncommon entity. According to their location, spinal tumors are conveniently classified as extradural (ED) and intradural (ID), although some can be both inside and outside the dura. ID tumors can be intradural extramedullary (IDEM) or intramedullary SCT (IMSCT). Methods This is a retrospective study of 122 patients with spinal tumors who were surgically treated at the department of neurosurgery from 2014 to 2019 over a period of 5 years. Study Design This is a retrospective study. Results Out of 122 patients, there were 19 patients with ED tumor, 73 had IDEM, and 30 had IMSCT. As many as 73 patients were males and the rest of the 49 patients were females. Mean age at time of surgery was 40.79 years. The thoracic region of spinal canal was most frequently involved (64; 52.4%). The common clinical symptom was motor weakness (90 cases; 73.77%). Majority of the patients had symptoms for duration of 6 to 12 months. Schwannomas were the most common tumor among IDEM and extradural location. Ependymomas were the most common type in IMSCT. We observed significant improvement in most of our cases. Four patients deteriorated at 3 months follow- up. Conclusions There was a higher male:female ratio for all spinal cord tumors except meningiomas. There was also a higher proportion of nerve sheath tumors, and a lower proportion of meningiomas and neuroepithelial tumors. These results are similar to other studies from Asian countries.

Abstract Youth at familial risk for bipolar disorder (BD-risk) and major depressive disorder (MDD-risk) have aberrant reward processing, a core feature of these mood disorders. Whether BD risk differentiates from MDD risk in reward processing merits further study. We compared neural activation and connectivity during anticipation and outcome of monetary gain and loss during fMRI using the Monetary Incentive Delay (MID) Task among BD-risk (n = 40), MDD-risk (n = 41), and healthy comparison youth (HC) (n = 45), in the absence of any lifetime or current history of psychopathology [mean age 13.09 ± 2.58, 56.3% female]. Participants completed the MID task at baseline and were followed for behavioral and clinical outcomes over 4.37 ± 2.29 years. Region-of-interest (ROI) analyses conducted using anatomically defined thalamus, ventrolateral prefrontal cortex, nucleus accumbens, and putamen seeds showed that relative to MDD-risk and HC, BD-risk had decreased activation of the thalamus during anticipation of monetary gain [F(2,118) = 4.64, p = 0.01 (FDR-corrected p = 0.04)]. Psychophysiological interaction analyses revealed that BD-risk had less connectivity between the thalamus and left middle frontal gyrus (Z > 3.1, p 3.1, p 3.1, p 3.1, p

Background and Aims: Vasoactive intestinal peptide (VIP) is a neuropeptide involved in the regulation of feeding behavior and circadian rhythms, metabolism, and immunity. Previous studies revealed the homeostatic effects of VIP signaling on the gut microbiota. VIP-deficient mice demonstrate a gut microbiota dysbiosis characterized by reduced α-diversity and decreased relative abundance (RA) of Gram-positive Firmicutes. However, the mechanism by which VIP signaling affects changes in the microbiota is unknown. Methods: To investigate the role of the 2 cognate G protein-coupled receptors for VIP (VPAC1 and VPAC2) in VIP-mediated homeostasis of the microbiota, fecal samples from VPAC1- and VPAC2-deficient, heterozygous, and wild-type littermate mice were assessed via targeted amplicon sequencing. Their microbiota profiles were additionally compared with microbiota from VIP-deficient, heterozygous, and wild-type littermates, where genotype-dependent changes in the composition and predicted function of each cohort were compared. Results: While wild-type mice in each line differed in α-diversity and β-diversity, consistent changes in both metrics were observed in VIP-deficient and VPAC1-deficient mice. This includes a dramatic reduction in α-diversity, increased RA of Proteobacteria and Bacteroidetes, and decreased RA of Lachnospiraceae, Ruminococcaceae, Muribaculaceae, and Rikenellaceae. Specific amplicon sequence variants and predicted functions found to differ significantly based on VIP or VPAC1 genotype were concordant in their directions of change. Multiplatform predicted functional profiling suggested a defective VIP-VPAC1 axis was associated with reduced amino acid degradation along with reduced quinol and quinone biosynthesis. Furthermore, alterations in predicted functions include increased sugar degradation, nitrate reduction, and fatty acid biosynthetic pathways, among other changes. Conclusion: We conclude that VIP signaling through VPAC1 is critical for the maintenance of normal function of the gut microbiota.

Background and Aims: This study assessed the applicability of C-MAC videolaryngoscope (VL) D-blade for awake intubation in patients with laryngeal tumour. The primary study objective was to determine the rate of successful intubation in the first attempt. The other parameters recorded were number of attempts required for intubation, duration of different stages of intubation, haemodynamics, ease of intubation and patient comfort on visual analogue scale (VAS) postoperatively. Methods: Thirty patients were studied. Patients were sedated with dexmedetomidine and fentanyl as a slow bolus (over 20 min) and Ramsay sedation score was assessed. Topicalisation of the oropharynx, tonsillar pillars and base of the tongue was done with lignocaine 10% spray. Four ml of 4% lignocaine using MADgic atomiser was used for anaesthetising the glottis and the tracheal lumen. Results: Successful intubation was achieved in 86.6% patients in first attempt and 13.3% in two attempts. Total time for all intubations was less than 30 seconds. Fremantle score was F-1-C-MAC D-blade (easy intubation with full view) in 60% patients, while 23.3% had F-2-C-MAC D-blade (full view and either required more than one attempt or a modified technique), 13.3% had P-1-C-MAC D-blade (partial view with easy intubation) and 3.3% had P-2-C-MAC D-blade (partial view and required more than one attempt or a modified technique). The VAS score for anaesthesiologist's ease and for patient's experience was 85.83 ± 7.20 and 86.66 ± 14.46, respectively. Conclusion: C-MAC VL D-blade-assisted awake intubation is an effective and safe method to manage the airway of patients with laryngeal tumour once adequate topicalisation is ensured before the procedure.

Background: Recently, moxifloxacin (MFX)-resistant results of Mycobacterium tuberculosis (Mtb) obtained by GenoType MTBDRsl (second-line line probe assay [SL-LPA]) have been stratified to determine their resistance level; however, its accuracy has not been well studied. Therefore, the study aimed to evaluate the diagnostic accuracy of SL-LPA, with phenotypic drug susceptibility testing (pDST) and whole-genome sequencing (WGS) for the detection of MFX-resistant Mtb and their resistance level. Methods: A total of 111 sputum samples were subjected to SL-LPA according to the diagnostic algorithm of the National Tuberculosis Elimination Program. Results were compared with pDST of MFX (at critical concentration [CC, 0.25 μg/ml] and clinical breakpoint [CB, 1.0 μg/ml] using BACTEC mycobacterial growth indicator tube-960), and WGS. Results: At CC, SL-LPA and pDST yielded concordant results of MFX for 104 of 111 (94%). However, at CB, 23 of 30 (77%) isolates carrying gyrA mutation known to confer low-level resistance to MFX were scored as susceptible by pDST. Among 46 Mtb isolates carrying gyrA mutations known to confer high-level resistance to MFX, 36 (78%) isolates yielded concordant results, while 10 (22%) isolates were scored as susceptible at CB by pDST. WGS identified gyrA mutations in all isolates suggested by SL-LPA. Conclusion: It is concluded that the stratification of MFX-resistant results by SL-LPA/genotypic method is not very well correlated with pDST (at CB), and hence, pDST may not be completely replaced by SL-LPA. gyrA D94G and gyrAA90V are the most prevalent mutations in MFX-resistant Mtb.

PURPOSE: To study functional changes in vision and morphological changes on optical coherence tomography (OCT) scans in patients where intravitreal therapy (IVT) with injections has been delayed due to COVID-19 pandemic lockdown. METHODS: Retrospective cross-sectional study included 77 eyes with the diagnosis of exudative age-related macular degeneration (eAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO), regularly receiving IVT with anti-vascular endothelial growth factor (Anti-VEGF) injections or dexamethasone implant and were not able to receive the injections as intended due to lockdown. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), and qualitative morphological features on OCT were analyzed pre- and post-therapy break off. RESULTS: The mean duration of IVT break-off was 57 days. Mean BCVA logarithm of minimum angle of resolution (logMAR) worsened from 0.33 (20/42) to 0.35 (40/44) (P = 0.02) and mean CFT increased from 297.90 μm to 402.16 μm (P < 0.01), from pretherapy break-off to return visit. Worsening of the visual acuity was seen across all the three disease cohorts, significantly more in the eyes with eAMD. CONCLUSION: Marginal decline in the visual acuity and worsening of the OCT features were observed as a result of delay in the IVT injections of DME, eAMD and RVO patients.

Stereotactic radiotherapy (SRT) is the standard of care treatment for brain metastases (METS) today. Nevertheless, there is limited understanding of how posttreatment lesional volumetric changes may assist prediction of lesional outcome. This is partly due to the paucity of volumetric segmentation tools. Edema alone can cause significant clinical symptoms and, therefore, needs independent study along with standard measurements of contrast-enhancing tumors. In this study, we aimed to compare volumetric changes of edema to RANO-BM-based measurements of contrast-enhancing lesion size. Patients with NSCLC METS ≥10 mm on post-contrast T1-weighted image and treated with SRT had measurements for up to seven follow-up scans using a PACS-integrated tool segmenting the peritumoral FLAIR hyperintense volume. Two-dimensional contrast-enhancing and volumetric edema changes were compared by creating treatment response curves. Fifty NSCLC METS were included in the study. The initial median peritumoral edema volume post-SRT relative to pre-SRT baseline was 37% (IQR 8–114%). Most of the lesions with edema volume reduction post-SRT experienced no increase in edema during the study. In over 50% of METS, the pattern of edema volume change was different than the pattern of contrast-enhancing lesion change at different timepoints, which was defined as incongruent. Lesions demonstrating incongruence at the first follow-up were more likely to progress subsequently. Therefore, edema assessment of METS post-SRT provides critical additional information to RANO-BM.

Research has shown that obesity increases the risk for type 2 diabetes mellitus (Type 2 DM) by promoting insulin resistance, increases serum estrogen levels by the upregulation of aromatase, and promotes the release of reactive oxygen species (ROS) by macrophages. Increased circulating glucose has been shown to activate mammalian target of rapamycin (mTOR), a significant signaling pathway in breast cancer pathogenesis. Estrogen plays an instrumental role in estrogen-receptor-positive breast cancers. The role of ROS in breast cancer warrants continued investigation, in relation to both pathogenesis and treatment of breast cancer. We aim to review the role of obesity in breast cancer pathogenesis and novel therapies mediating obesity-associated breast cancer development. We explore the association between body mass index (BMI) and breast cancer incidence and the mechanisms by which oxidative stress modulates breast cancer pathogenesis. We discuss the role of glutathione, a ubiquitous antioxidant, in breast cancer therapy. Lastly, we review breast cancer therapies targeting mTOR signaling, leptin signaling, blood sugar reduction, and novel immunotherapy targets.

Garlic contains sulfur volatiles that cause a bad odor after consumption. The objective of this study was to understand how yogurt and its components cause deodorization. Raw and fried garlic samples were mixed with various treatments and measurements of volatiles were conducted using a selected-ion flow-tube mass spectrometer. Frying garlic significantly reduced almost all sulfur volatile compounds. Raw garlic was deodorized more than fried garlic by all of the treatments. Fat, protein and water significantly reduced the concentration of sulfur-based volatiles in garlic. At the same concentration, either fat or protein produced higher deodorization, depending on the hydrophobicity of the volatile. Whey protein, casein and their complex all caused deodorization. Increasing the pH to 7 or heating changed the structure of the proteins and decreased the deodorization of the volatiles, showing the importance of proteins for deodorization. As the quantity of fat increased, the deodorization of the volatiles also increased. Foods with higher fat or protein content can be formulated to offer a potential solution to reduce the unpleasant odor associated with garlic consumption.

Various cancer cell-associated intrinsic and extrinsic inputs act on YAP/TAZ proteins to mediate the hyperactivation of the TEAD transcription factor-based transcriptome. This YAP/TAZ-TEAD activity can override the growth-limiting Hippo tumor-suppressor pathway that maintains normal tissue homeostasis. Herein, we provide an integrated summary of the contrasting roles of YAP/TAZ during normal tissue homeostasis versus tumor initiation and progression. In addition to upstream factors that regulate YAP/TAZ in the TME, critical insights on the emerging functions of YAP/TAZ in immune suppression and abnormal vasculature development during tumorigenesis are illustrated. Lastly, we discuss the current methods that intervene with the YAP/TAZ-TEAD oncogenic signaling pathway and the emerging applications of combination therapies, gut microbiota, and epigenetic plasticity that could potentiate the efficacy of chemo/immunotherapy as improved cancer therapeutic strategies.

This article considers the iterative approach for finding the Moore–Penrose inverse of a matrix. A convergence analysis is presented under certain conditions, demonstrating that the scheme attains third-order convergence. Moreover, theoretical discussions suggest that selecting a particular parameter could further improve the convergence order. The proposed scheme defines the special cases of third-order methods for β=0,1/2, and 1/4. Various large sparse, ill-conditioned, and rectangular matrices obtained from real-life problems were included from the Matrix-Market Library to test the presented scheme. The scheme’s performance was measured on randomly generated complex and real matrices, to verify the theoretical results and demonstrate its superiority over the existing methods. Furthermore, a large number of distinct approaches derived using the proposed family were tested numerically, to determine the optimal parametric value, leading to a successful conclusion.

Yellow mosaic disease caused by Tomato leaf curl New Delhi virus (ToLCNDV) causes 100 percent losses in ridge gourd under epidemic conditions, particularly in the tropics and sub-tropics of India. Plant breeding approaches led by the marker-assisted selection have gained increased momentum in virus resistance breeding to hasten the development of resistant varieties. In the present study, an effort has been made to identify molecular markers linked to yellow mosaic disease resistance loci in an F2 population derived from a cross between susceptible ‘Arka Prasan’ and resistant ‘IIHR-Sel-1’ of ridge gourd. All the molecular markers were amplified in parents, and one polymorphic marker clearly distinguished the contrasting parents. The primers LaRGAP 63 produced a polymorphic DNA fragment that co-segregated with yellow mosaic disease reaction phenotypically in the F2 population. The identified marker will be helpful to the breeders for introgression of resistance loci into the elite background.

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.

Abstract Background Practice based research and learning networks (PBRLNs) are groups of learning communities that focus on improving delivery and quality of care. Accurate data from primary care electronic medical records (EMRs) is crucial in forming the backbone for PBRLNs. The purpose of this work is to: (1) report on descriptive findings from recent frailty work, (2) describe strategies for working across PBRLNs in primary care, and (3) provide lessons learned for engaging PBRLNs. Methods We carried out a participatory based descriptive study that engaged five different PBRLNs. We collected Clinical Frailty Scale scores from a sample of participating physicians within each PBRLN. Descriptive statistics were used to analyze frailty scores and patients’ associated risk factors and demographics. We used the Consolidated Framework for Implementation Research to inform thematic analysis of qualitative data (meeting minutes, notes, and conversations with co-investigators of each network) in recognizing challenges of working across networks. Results One hundred nine physicians participated in collecting CFS scores across the five provinces (n = 5466). Percentages of frail (11-17%) and not frail (82-91%) patients were similar in all networks, except Ontario who had a higher percentage of frail patients (25%). The majority of frail patients were female (65%) and had a significantly higher prevalence of hypertension, dementia, and depression. Frail patients had more prescribed medications and numbers of healthcare encounters. There were several noteworthy challenges experienced throughout the research process related to differences across provinces in the areas of: numbers of stakeholders/staff involved and thus levels of burden, recruitment strategies, data collection strategies, enhancing engagement, and timelines. Discussion Lessons learned throughout this multi-jurisdictional work included: the need for continuity in ethics, regular team meetings, enhancing levels of engagement with stakeholders, the need for structural support and recognizing differences in data sharing across provinces. Conclusion The differences noted across CPCSSN networks in our frailty study highlight the challenges of multi-jurisdictional work across provinces and the need for consistent and collaborative healthcare planning efforts.

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.

Malhi et al. conduct a high-throughput screen to identify inhibitors of respiratory syncytial virus (RSV). They find that statins inhibit post-entry events in the replicative cycle of RSV through a combination of cholesterol and isoprenoid-mediated effects, the latter involving a loss of Rho GTPase activity via disruption of protein prenylation.

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.

BackgroundThe duration of initial corticosteroid therapy in newly diagnosed Idiopathic nephrotic syndrome (INS) is about 3 months. Our study was designed to test the feasibility of a shorter duration of corticosteroid therapy in newly diagnosed INS who show a quicker response.MethodsPatients who responded within 10 days (Group A) received 8 weeks of corticosteroid therapy as compared to 12–14 weeks of standard therapy in those who responded between >10 days to 28 days (Group B), and follow up for 52 weeks. The primary endpoint is time to first relapse after treatment completion. (NCT03878914, March 18, 2019)ResultsA total of 33 children with INS were enrolled and the follow-up data were analyzed. The clinical and laboratory characteristics of patients in both groups were similar. No significant difference was found in time to first relapse [65(14.5, 159) days for Group A vs. 28(17, 61.5) days for Group B, P = 0.371], the incidence of frequently relapsing nephrotic syndrome [6/18 (33.3%) vs. 5/10(50%), P = 0.644] or requirement for alternative immunosuppressant [4/18 (22.2%) vs. 1/10 (10%), P = 0.769]. Group A received similar corticosteroid dose compare with Group B (3511 ± 2421 mg/m2 vs. 4117 ± 2556 mg/m2, P = 0.524). Frequency and severity of corticosteroid-related complications was similar in both groups.ConclusionsThe time to first relapse and the number of relapses per patient were comparable between the two groups. However, more patients in Group A relapsed and the mean total dose of prednisolone for the study period was very similar between the two groups.

Surface flood (SF) method is used to irrigate cotton in India, which results in huge wastage of water besides leaching of nutrients. This necessitates the adoption of efficient management strategies to save scarce water without compromising the yield. Therefore, a 2-year field investigation was conducted under two climatic regimes (Faridkot and Abohar) to study the effect of sub-surface drip fertigation (SSDF) on seed cotton yield (SCY), water productivity, nitrogen use efficiency (NUE), and economic parameters in comparison with SF and surface drip fertigation (SDF). The field experiment had a total of eight treatments arranged in a randomized complete block design. Three levels of sub-surface drip irrigation [(SSDI); i.e., 60%, 80%, and 100% of crop evapotranspiration (ETc)] and two N fertigation levels [100% recommended dose of nitrogen (RDN; i.e., 112.5 kg N ha-1) and 75% RDN] made up six treatments, while SF (Control 1) and SDF at 80% ETc (Control 2), both with 100% of RDN, served as the controls. Among irrigation regimes, the SSDI levels of 80% ETc and 100% ETc recorded 18.7% (3,240 kg ha-1) and 21.1% (3,305 kg ha-1) higher SCY compared with SF (2,728 kg ha-1). Water use efficiency under SF (57.0%) was reduced by 34.2%, 40.8%, and 38.2% compared with SSDI’s 60 (76.5%), 80 (80.3%), and 100% ETc (78.8%), respectively. Among fertigation levels, NUE was higher by 19.2% under 75% (34.1 kg SCY kg-1 N) over 100% RDN (28.6 kg SCY kg-1 N), but later it also registered 11.9% higher SCY, indicating such to be optimum for better productivity. SSDF at 80% ETc along with 112.5 kg N ha-1 recorded 26.6% better SCY (3455 kg ha-1) and 18.5% higher NUE (30.7 kg SCY kg-1 N) over SF. These findings demonstrate that the application of SSDF could save irrigation water, enhance SCY, and improve the farmers’ returns compared with SF. Therefore, in northwestern India, SSDF at 80% ETc along with 112.5 kg N ha-1 could be a novel water-savvy concept which would be immensely helpful in enhancing cotton productivity.

Bilateral radial dysplasia is a rare condition and usually associated with familial malformation syndromes and spectrum of cardiac anomalies. These patients often require corrective orthopedic surgeries in early age. Radial dysplasia associated with cardiac abnormalities is particularly seen in certain syndromes such as Holt-Oram (HOS) syndrome and TAR (thrombocytopenia, anemia, and radial aplasia) syndrome. We report a successful management of twelve months old male child with rare combination of bilateral radial dysplasia with isolated patent ductus arteriosus (PDA), for corrective orthopedic surgery. A comprehensive approach, which includes an extensive preoperative evaluation and pre-defined perioperative hemodynamic goals for PDA, plays a pivotal role in its perioperative management.

The present study provides details about the usefulness of chlorination in the recovery effluents of sewage, and to make it useable for irrigation purposes. Chlorination is one of the effective simplified, and cost-effective traditional methods for disinfection. The study was done for the period of March, 2019 to February, 2020. The disinfection process was optimized by adding sodium hypochlorite to the secondary treated effluents with the help of jar apparatus at a mixing speed of 100 rpm. To optimize the various process variables such as dose, and contact time, several concentrations of NaOCl (0.5, 1, 1.5, 2, 2.5, 3.0) ppm were carefully chosen at different time intervals of 15, 30, and 60 min respectively, which were centered on the foregoing studies. The factors like seasonal variation on MPN index of total coliforms (TCs), CR ∗ T concept, and effect of pH on log elimination of TCs, outcome of pH with rate constant (k), and results of pH against dilution coefficient (n) was also studied. The Chick–Watson, Rennecker–Marinas, Collin–Selleck, and modified Selleck models have shown good reliability to the experimental data of chlorine disinfection to be fit into these kinetic models for the treatment of sewage wastewater. The upgraded CR ∗ T values were attained by using disinfection models. Among these four models, the kinetic modeling by Collin–Selleck, and Selleck–White was investigated as the best modeling to be fitted more finely to the chlorination experimental data to count for the effectiveness of NaOCl. The selected indicator organism in the optimization process of chlorine was Total coliforms (TCs). The residual chlorine and most probable number per log unit (Log) for TCs were measured before the start and after the termination of the disinfection process. The World Health Organization (WHO) standard for pathogenic removal from wastewater, and to irrigate the crops is 3- to 4-log and the chlorine residual under 1 mg/l limit was accomplished.

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.

Babesiosis is a zoonosis and an important blood-borne human parasitic infection that has gained attention because of its growing infection rate in humans by transfer from animal reservoirs. Babesia represents a potential threat to the blood supply because asymptomatic infections in man are common, and blood from such donors can cause severe disease in certain recipients. Extracellular vesicles (EVs) are vesicles released by cells that contain a complex mixture of proteins, lipids, glycans, and genetic information that have been shown to play important roles in disease pathogenesis and susceptibility, as well as cell–cell communication and immune responses. In this article, we report on the identification and characterization of EVs released from red blood cells (RBCs) infected by two major human Babesia species—Babesia divergens from in vitro culture and those from an in vivo B. microti mouse infection. Using nanoparticle tracking analysis, we show that there is a range of vesicle sizes from 30 to 1,000 nm, emanating from the Babesia-infected RBC. The study of these EVs in the context of hemoparasite infection is complicated by the fact that both the parasite and the host RBC make and release vesicles into the extracellular environment. However, the EV frequency is 2- to 10-fold higher in Babesia-infected RBCs than uninfected RBCs, depending on levels of parasitemia. Using parasite-specific markers, we were able to show that ~50%–60% of all EVs contained parasite-specific markers on their surface and thus may represent the specific proportion of EVs released by infected RBCs within the EV population. Western blot analysis on purified EVs from both in vivo and in vitro infections revealed several parasite proteins that were targets of the host immune response. In addition, microRNA analysis showed that infected RBC EVs have different microRNA signature from uninfected RBC EVs, indicating a potential role as disease biomarkers. Finally, EVs were internalized by other RBCs in culture, implicating a potential role for these vesicles in cellular communication. Overall, our study points to the multiple functional implications of EVs in Babesia–host interactions and support the potential that EVs have as agents in disease pathogenesis.

Abstract Purpose: To report the computed tomography features of a case with complete luxation of the globe after a road traffic accident. Case Report: A 35-year-old male presented with pain, loss of vision, and bleeding from the left eye 48 hr after a road traffic accident. The ophthalmic examination of the left upper and lower eyelids showed edema with subcutaneous hematoma, crepitus, and complete blepharoptosis. On retracting the eyelids, the left eyeball was not visible and the patient was not able to perceive light. The left temporal region appeared filled with a soft, palpable globular structure situated beneath the temporalis muscle. A non-contrast computed tomography (NCCT) of the head and orbits showed a comminuted and displaced fracture of the floor, medial, and lateral orbital walls in addition to a displaced tripod fracture of the left zygomatic bone. The intact left eyeball was seen below the temporalis muscle without any optic nerve or extraocular muscle attachment. The virtual reality reconstruction highlighted a contributory supero-temporal defect in the bony orbit, which appeared large enough to accommodate the intact eyeball. Conclusion: The computed tomography of the orbits provided a detailed location of the luxated eyeball and provided guidance in further management of the case.

Abstract Background Worldwide, iron deficiency anaemia in pregnancy is a significant problem which can be especially problematic when delivery is by caesarean section, a procedure associated with significant blood loss. Optimising iron stores pre-delivery remains an overarching goal. We aim to measure the incidence of iron deficiency anaemia in patients undergoing elective caesarean section at our institution and determine any associated predictors, as well as adverse outcomes. Methods A retrospective, observational cohort study of patients presenting for elective caesarean section over a two-year period. Patient data was collected from hospital electronic records. Iron deficiency anaemia was defined a haemoglobin

Water scarcity is increasing in the world, which is limiting crop production, especially in water-limited areas such as Southern High Plains of the United States. There is a need to adopt the irrigation management practices that can help to conserve water and sustain crop production in such water-limited areas. A 2-year field study was conducted during the summers of 2019 and 2020 to evaluate the effect of deficit irrigation levels and cultivars on root distribution pattern, soil water depletion, and water use efficiency (WUE) of cucumber (Cucumis sativus). The experiment was conducted in a split-plot design with four irrigation levels [100%, 80%, 60%, and 40% crop evapotranspiration (ETc)] as main plot factor and two cultivars (Poinsett 76 and Marketmore 76) as subplot factor with three replications. Results showed that root length density (RLD) was unaffected by the irrigation levels in 2019. In 2020, the RLD was comparable between 100% and 80% ETc, and it was significantly higher in 100% ETc than both 60% Eand 40% ETc. Root surface area density (RSAD) was not significantly different between 100% and 80% ETc, and it was significantly lower in both 60% and 40% ETc than 100% ETc in both years. Soil water depletion was the highest in 40% ETc followed by 60% and 80% ETc, and it was least in 100% ETc in both years. Evapotranspiration (ET) was the highest in 100% ETc followed by 80%, 60%, and 40% ETc. The WUE was not statistically different among the irrigation treatments. However, numerically, WUE was observed in the following order: 80% ETc > 100% ETc > 60% ETc > 40% ETc. The RLD, RSAD, soil water depletion, and ET were not significantly different between ‘Poinsett 76’ and ‘Marketmore 76’. However, fruit yield was significantly higher in ‘Poinsett 76’ than ‘Marketmore 76’, which resulted in higher WUE in Poinsett 76. It can be concluded that 80% ETc and Poinsett 76 cultivar can be adopted for higher crop water productivity and successful cucumber production in SHP.

The pandemic made it critical for political leaders to intensify measures in fight against Covid-19 and one such measure was building trust among public through communication. With exponential growth in reach of social media, while state political leaders have progressively used internet for election campaigns, limited studies have explored as to how leaders use this medium to communicate during crisis, what kind of information do they share and what are common issues addressed. This paper, using qualitative research design, analyses Indian political leaders’ communication on Twitter. Sentiment Analysis was carried to identify and extract subjective information in leaders’ communication using 29 Indian political leaders, where in 12.128 tweets were extracted. Subjectivity scores depicted more than half of leaders had shared fact-based information, and Polarity scores indicated that almost 90% of leaders shared positive or neutral information thus leading to an inference that leaders share more of facts based and positive or neutral information rather than statements in form of opinions.

Dilated cardiomyopathy is a subset of cardiomyopathies defined by reduced ejection fraction of less than 45% and a dilated left ventricle. While dilated cardiomyopathy is common, its etiology is not always readily evident. Paraquat is used as an herbicide worldwide and is one of the main causes of fatal poisoning in underdeveloped countries in Asia, Central America, and the Pacific Islands. The most commonly affected organs are the lungs and kidneys. However, experimental research has shown that Paraquat can affect the heart indirectly through increased vascular permeability. In vivo animal studies have shown that paraquat poisoning causes myocardial contractile dysfunction by decreased fractional shortening and cardiac remodeling. We report the first case in published literature of a 52-year-old Hispanic man with dilated cardiomyopathy strongly associated with Paraquat exposure. It is important to obtain detailed medical history and proper diagnostic work-up including work, social, and family history, and echocardiography, baseline EKG, lab work, and ischemia cardiac testing as it can lead to improved diagnostic evaluation of possible etiologies of the commonly seen dilated cardiomyopathies and help identify less well-known etiologies as seen in our patient.

Obesity and hyperlipidemia are known to be risk factors for various pathological disorders, including various forms of infectious respiratory disease, including the current Coronavirus outbreak termed Coronavirus Disease 19 (COVID-19). This review studies the effects of hyperlipidemia and obesity on enhancing the inflammatory response seen in COVID-19 and potential therapeutic pathways related to these processes. In order to better understand the underlying processes of cytokine and chemokine-induced inflammation, we must further investigate the immunomodulatory effects of agents such as Vitamin D and the reduced form of glutathione as adjunctive therapies for COVID-19 disease.

Abstract Background Rheumatoid arthritis is known to produce deformity of the joints and muscles which can affect the handwriting of an individual significantly. Examination of such handwriting specimens can become a challenging task for the document examiners. This can affect the accuracy of their opinions upon the related cases. Thus, the present study was conducted to determine the effects of rheumatoid arthritis on handwriting characteristics qualitatively and statistically. The study also included qualitative analysis and comparison of line quality defects of copied writings and writings affected by rheumatoid arthritis. Results Handwriting characteristics were analyzed qualitatively and statistically in old writings vs affected writings. All these handwriting characteristics were also analyzed qualitatively in copied writings vs affected writings. The results of the study showed significant deteriorating effects of rheumatoid arthritis on almost all handwriting characteristics, except for characteristics such as slant, retouching, and overwriting. The pictorial appearance of letters in the writings executed before and after the onset of illness was even observed to appear different altogether in case of some individuals with severely affected writings. Moreover, the analysis of copied writings indicated the execution of writing by a different person. Handwriting characteristics such as slant, spacing, and alignment were observed to show insignificance in analyzing differences between copied and genuine writings affected by the illness. Conclusion It has been concluded that rheumatoid arthritis causes deterioration of letters, tremor, disturbed rhythm, and a huge variation in other handwriting characteristics. The copied writings have also presented line quality defects like artificial tremor, hesitations, retouching, and unnatural pen lifts at all wrong places. The determination of these peculiarities may assist the document examiners in the differentiation of copied and affected writings.

The main aim of this paper is to improve the quality of recycled coarse concrete aggregates by using the carbonation technique. The aggregates are tested for physical properties and microstructural analysis. The concrete produced using these treated aggregates is tested for Non-destructive, Mechanical and Durability properties and the results are compared for control concrete, recycled aggregate concrete, and carbonated recycled aggregate concrete. A total of three mix combinations named NAC (using 100% natural coarse aggregate), RAC (using 100% recycled coarse aggregate) and CRAC (using 100% carbonated recycled coarse aggregate) were prepared using w/c ratio of 0.48. It has been found that by using the carbonated recycled concrete aggregates (CRCA), RAC’s non-destructive, mechanical and durability properties can be improved because of the method of carbonation. The compressive strength of the 100% RAC shows a decrement of 24.52% as compared to the 100% NAC. Whereas the compressive strength of the 100% CRAC shows an increase of 21.05% as compared to the 100% RAC, but it shows a decrement of 8.63% as compared to the 100% NAC. It not only refines the properties of RCA but also reduces the greenhouse effect which is originated by CO2 emissions.

Abstract Background Captive rearing is often critical for animals that are vulnerable to extinction in the wild. However, few studies have investigated the extent to which captivity impacts hosts and their gut microbiota, despite mounting evidence indicating that host health is affected by gut microbes. We assessed the influence of captivity on the gut microbiome of the Brown Kiwi (Apteryx mantelli), a flightless bird endemic to New Zealand. We collected wild (n = 68) and captive (n = 38) kiwi feces at seven sites on the north island of New Zealand. Results Using bacterial 16 S rRNA and fungal ITS gene profiling, we found that captivity was a significant predictor of the kiwi gut bacterial and fungal communities. Captive samples had lower microbial diversity and different composition when compared to wild samples. History of coccidiosis, a gut parasite primarily affecting captive kiwi, showed a marginally significant effect. Conclusions Our findings demonstrate captivity’s potential to shape the Brown Kiwi gut microbiome, that warrant further investigation to elucidate the effects of these differences on health.

Purpose: To study the clinical presentation, radiological features, diagnosis, and treatment response in subconjunctival and atypical orbital myocysticercosis. Methods: Retrospective analysis of diagnosed subconjunctival and atypical (strabismus, diplopia, and blepharoptosis) orbital myocysticercosis was performed. A diagnostic criterion (2 of the 3) among clinical features, radiological findings, and treatment response was used in our study. A minimum of “post-treatment” follow-up of 12 months was observed. Results: Thirty-five patients were included with a mean age of 16 years having male predominance (n = 22, 62.8%). All had a unilateral presentation, with 24 (68.6%) patients having subconjunctival cysticercosis, of which 22 were located in close proximity of the rectus muscle insertion. At presentation, 10 patients had diplopia, 7 had strabismus, and 6 had face turn. Pseudo Duane's and pseudo-Brown's syndrome were noted in 5 and 4 patients, respectively. Radiologically, single muscle myositis without scolex was seen in 12 (34.3%) cases. All patients first received medical treatment, and surgical intervention (cyst removal) was attempted after treatment failure. Complete resolution of symptoms was noted in 22 (after medical treatment only) and in 8 (after surgery). Conclusion: In the majority, the subconjunctival cysticercosis is found in proximity to the rectus muscle insertion, as a part of orbital myocysticercosis. In atypical scenarios, a satisfactory response to medical treatment can be considered as diagnostic of cysticercosis.

BackgroundReports of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome from developing countries are sparse. Recognizing PFAPA is often challenging in these regions due to a higher incidence of infectious illnesses and significant resource constraints. Herein, we present our experience from North India regarding the diagnosis and management of PFAPA syndrome.MethodsWe reviewed cases of non-monogenic periodic fever syndrome diagnosed at our center from January 2011 to December 2021. A total of 17 children who fulfilled the Marshall criteria for PFAPA syndrome were included. Data regarding basic clinical features, treatment/outcome, and performance of the recently proposed Eurofever/PRINTO and Takeuchi criteria were analyzed.ResultsBesides recurrent fever, the triad of oral aphthae, pharyngitis, and adenitis was noted in only 18% of patients. Episodes of exudative pharyngitis/tonsillitis were documented in 24%. These figures were lower than the values reported from developed countries. The Takeuchi and Eurofever/PRINTO criteria were fulfilled in 76% and 71% cases, respectively. In addition to antipyretics and supportive care, intermittent steroid therapy was the main treatment modality used. Additional treatment with colchicine (n = 3) and thalidomide (n = 1) was used successfully in a few patients. Before the diagnosis of PFAPA, all patients had received multiple courses of antimicrobials (without microbiological confirmation). These included multiple courses of antibacterials for fever, pharyngotonsillitis, and/or cervical adenitis in all patients and antivirals for fever and aphthous stomatitis in a patient. Empiric antitubercular therapy had also been administered in two patients.ConclusionsA significant proportion of patients with PFAPA seem to remain undiagnosed in the Indian subcontinent. Increased awareness and improvement in basic healthcare facilities are crucial in enhancing the recognition of PFAPA, which would eliminate the unprecedented scale of undesirable antimicrobial use in such children.

Servitization refers to firms that sell an “outcome-as-a-service”, rather than just a physical product. In this study, we first examine how servitization has enabled companies such as Netflix to disrupt industries and transition from offering finite products to delivering relatively abundant services? Second, as firms embark upon servitization, value propositions become much less related to scarcity. This leads to the second research question: what are the value propositions for consumers when the paradigm shifts from ownership to usership? For both these questions, we highlight examples such as Netflix, Amazon Web Services (AWS), and Philips to emphasize on value propositions for the consumer as enhanced customer experience through customization, convenience, and co-creation. Further, we expand on the considerations warranted that include the role of technology, data, and analytics, distribution models for physical versus digital products, and challenges in creating servitization in business models.