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Background: Endotracheal intubation is an essential resuscitative procedure in the emergency setting. Airway assessment parameters such as the Mallampati classification are difficult to perform in an emergency setting. As point-of-care ultrasound (POCUS) assessment of airway parameters does not require patients to perform any mandatory action, ultrasound may become the potential first-line noninvasive airway assessment tool in the emergency department (ED). The use of POCUS in the ED has not been sufficiently studied. Using POCUS in airway assessment for predicting difficult intubation may be the next step in successful airway management. Methodology: The study was an observational study conducted at the ED of the All India Institute of Medical Sciences (Rishikesh). The treating emergency physician recorded the patient history and systemic examination along with an indication for intubation. The POCUS assessment of airway parameters pre-epiglottis to epiglottic vocal cord ratio (Pre-E/E-VC), tongue thickness, hyomental distance, and distance from skin to the hyoid bone was performed by the study investigator. During laryngoscopy, Cormack-Lehane (CL) grading was assessed. The data was entered and analyzed. Results: Seventy patients who required intubation in the ED were enrolled in the study. Among the study population, 48.6%, 28.6%, 14.3%, 1.4%, and 7.1% were classified with the following CL grading: 1, 2a, 2b, 3a, and 3b, respectively. At a cutoff of ≥ 1.86, Pre-E/E-VC predicts difficult laryngoscopy (AUC 0.835) with a sensitivity of 83% and a specificity of 94%. At a cutoff of ≥ 5.98 cm, tongue thickness predicts difficult laryngoscopy (AUC 0.78) with a sensitivity of 83% and a specificity of 88%. At a cutoff of hyomental distance ≤ 6 cm, it predicts difficult laryngoscopy with a sensitivity of 83% and a specificity of 88%. All parameters can act as a promising tool for predicting difficult laryngoscopy, with the single best parameter being Pre-E/E-VC. Conclusion: Assessment of the airway with POCUS may be helpful to the emergency physician when the clinical airway assessment parameters fail to predict difficult laryngoscopy as most patients requiring intubation are uncooperative. Assessment of the parameters in our study Pre-E/E-VC, tongue thickness, and hyomental distance can act as a promising tool for predicting difficult laryngoscopy in the emergency scenario. [ABSTRACT FROM AUTHOR]

Endolymphatic sac tumour (ELST) is a rare low grade malignant epithelial tumour of the petrous temporal bone, thought to arise from papillary epithelium of the endolymphatic sac. They may occur sporadically or in association with Von-Hippel Lindau disease. ELST is extremely rare neoplasm with benign histopathological appearance and clinically destructive behaviour. Because of the rarity of this tumour, it can easily be confused with other tumours such as paraganglioma, middle ear adenoma, metastatic carcinomas or choroid plexus papilloma. We report here a rare case of ELST with review of literature and discuss the differentiating features of ELST from its mimickers, showing a papillary configuration. [ABSTRACT FROM AUTHOR]

Objectives: Coronavirus disease-2019 (COVID-19) disease has overwhelmed the healthcare infrastructure worldwide. The shortage of intensive care unit (ICU) beds leads to longer waiting times and higher mortality for patients. High crowding leads to an increase in mortality, length of hospital stays, and hospital costs for patients. Through an appropriate stratification of patients, rational allocation of the available hospital resources can be accomplished. Various scores for risk stratification of patients have been tried, but for a score to be useful at primary care level, it should be readily available at the bedside and be reproducible. ROX index and CURB-65 are simple bedside scores, requiring minimum equipment, and investigations to calculate. Methods: This retrospective, record-based study included adult patients who presented to the ED from May 1, 2020 to November 30, 2020 with confirmed COVID-19 infection. The patient's clinical and demographic details were obtained from the electronic medical records of the hospital. ROX index and CURB-65 score on ED arrival were calculated and correlated with the need for hospitalization and early (14-day) and late (28-day) mortality. Results: 842 patients were included in the study. The proportion of patients with mild, moderate and severe disease was 46.3%, 14.9%, and 38.8%, respectively. 55% patients required hospitalization. The 14-day mortality was 8.8% and the 28-day mortality was 20.7%. The AUROC of ROX index for predicting hospitalization was 0.924 (p < 0.001), for 14-day mortality was 0.909 (p < 0.001) and for 28-day mortality was 0.933 (p < 0.001). The AUROC of CURB-65 score for predicting hospitalization was 0.845 (p < 0.001), for 14-day mortality was 0.905 (p < 0.001) and for 28-day mortality was 0.902 (p < 0.001). The cut-off of ROX index for predicting hospitalization was ≤18.634 and for 14-day mortality was ≤14.122. Similar cut-off values for the CURB-65 score were ≥1 and ≥2, respectively. Conclusion: ROX index and CURB-65 scores are simple and inexpensive scores that can be efficiently utilised by primary care physicians for appropriate risk stratification of patients with COVID-19 infection. [ABSTRACT FROM AUTHOR]

In the present study, ethanolic extract of Clerodendrum serratum roots was investigated for its potential to reverse some features of bronchial asthma in ovalbumin-induced murine model of asthma. Clerodendrum serratum commonly called bharangi, (family Solanaceae) is a well-known anti-allergic drug in Asian folk system of medicines. In the present work, pharmacological studies are done to provide scientific evidence for therapeutic potential of plant in allergic asthma. Asthma was induced in experimental rats with allergen suspension of ovalbumin and aluminum hydroxide followed by treatment with dexamethasone (2.5 mg/kg, po) or C. serratum root extract (0.53 and 5.3 mg/kg, b. w., po). Biomarkers of inflammatory response including cell counts, immunoglobulin E, cytokines such as interleukin (IL) -4, -5, -1ß, tumor necrosis factor-a (TNF-a), leukotriene (LTD-4), and nitrite concentration in blood as well as bronchial (BAL) fluid were tested. Lung functions in asthmatic and treated animals were evaluated as breathing rate and tidal volume. Treatment with C. serratum extract markedly (p < 0.001, p < 0.01, and p < 0.05) diminished infiltration of inflammatory cells, IgE, cytokines, and nitrites in blood serum and bronchial fluid. Improvement in lung functions (p < 0.05) of asthmatic animals after CSE treatment also supports our findings. Results of the study suggest therapeutic potential of C. serratum in allergic asthma that can be related to ability of plant to attenuate response of inflammatory cells and thereby, production of inflammatory and proinflammatory cytokines in airways. [ABSTRACT FROM AUTHOR]

Robot-assisted surgeries are associated with steep positions which provide free operative field to surgeons; however, it becomes more challenging to the anaesthesiologists. In robot-assisted surgery, the patient is not usually accessible after docking in of robot, so monitors, circuits and tubes should be tightly secured and confirmed before handing over the patient to the surgeons. We report a patient with partial left axillary artery occlusion in a patient posted for robot-assisted radical cystectomy. [ABSTRACT FROM AUTHOR]

MURCS syndrome is a more severe form of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, an acronym meaning aplasia/hypoplasia of Müllerian ducts (MU), congenital renal agenesis/ectopia (R), and cervical somite dysplasia (CS). A common presentation is primary amenorrhea in adolescent females. An anesthetist must consider the benefits and limitations of both regional and general anesthesia for these patients based on site of surgery and severity of malformations. We report successful anesthetic management of a 21-year-old female with MURCS syndrome scheduled for a creation of neovagina under spinal anesthesia using ultrasound guidance. [ABSTRACT FROM AUTHOR]

Aim: To compare the role of single intravenous (IV) bolus of lignocaine and dexamethasone on pain score and quality of recovery score (QoR40) after laparoscopic cholecystectomy. Setting and Design: The study was conducted at the postoperative recovery area, This was a double-blind randomized controlled study Materials and Methods: Seventy patients 18–60 years of age, American Society of Anesthesiologists physical status Class I and II, who underwent elective laparoscopic cholecystectomy, were enrolled in this study after approval from the Institutional Ethics Committee. Patients were randomly allocated to two groups. Group 1 received: 2 mg/kg lignocaine diluted to 10 ml with normal saline, and Group 2 received 0.1 mg/kg IV dexamethasone diluted to 10 ml with normal saline. Global QoR-40 is a 40-item questionnaire that provides a global score and subscores across five dimensions: psychological support, comfort, independence, pain, and emotions. It was assessed on a preoperative day as baseline to assess patient's basic quality of life and at 24 h postoperative. Visual analog scale (VAS) static and dynamic, total analgesic consumption in a day, nausea and vomiting, and antiemetic per day were assessed. Statistical Analysis Used: Student's t-test, Chi-square test, Fisher's exact, Levene's test were used for statistical analysis. Results: Dexamethasone group had higher Global QoR-40 than lignocaine group 187.94 versus 182.85. Among dimensions of QoR-40, dexamethasone had statistically better physical comfort, physical independence, and pain relief as compared to lignocaine. Dexamethasone group had lower VAS compared to lignocaine group. Similarly, there was less fentanyl consumption in dexamethasone group (364.08 ± 127.31) in the postoperative period when compared to the lignocaine group (412.31 ± 147.8). Conclusions: Preoperative administration of a single dose of dexamethasone enhanced QoR after laparoscopic cholecystectomy as compared to lignocaine bolus dose. [ABSTRACT FROM AUTHOR]

Context:Carica papayaLinn. (Caricaceae) leaf (CPL) juice has long been traditionally used in ethnomedicine for dengue fever. Objective:The study examines the effects of standardized CPL aqueous extract (SCPLE) on platelet count, extramedullary haematopoiesis (EMH), and immunomodulation in cyclophosphamide (CP)-induced animal model of thrombocytopenia. Materials and methods:The extract was analyzed for myricetin, caffeic acid,trans-ferulic acid, and kaempferol using HPTLC for standardization followed by UPLC-qTOF/MS fingerprinting for metabolite signature. The effects of SCPLE (50 and 150 mg/kg p.o.) on proliferative response of platelet count and total leucocyte count (TLC) were observed up to 14 days in Wistar rat. However, delayed-type hypersensitivity (DTH), haemagglutination titre (HT), andin vivocarbon clearance were examined as immunomodulatory parameters in albino mice at 150 mg/kg p.o. against CP. Results:The quantitative HPTLC estimation of SCPLE showed the presence of myricetin, caffeic acid,trans-ferulic acid, and kaempferol up to 280.16 ± 5.99, 370.18 ± 6.27, 1110.86 ± 2.97, and 160.53 ± 2.48 (μg/g), respectively. Twenty-four metabolites were identified using UPLC-qTOF/MS. Oral administration of SCPLE (150 mg/kg) in thrombocytopenic rats exhibited significant (p < 0.01) increase in thrombocytes (1014.83 × 103cells/mm3), DTH response (0.16 ± 0.004), and phagocytic index (63.15% increase) as compared to CP-induced thrombocytopenia group. Histopathological studies showed minimal fibrosis in spleen histology. Discussion and conclusions:Results suggest CPL can mediate the release of platelets providing the means for the treatment and prevention of dengue. [ABSTRACT FROM PUBLISHER]

Background and Aims: Pectoral nerve block (Pecs) using local anesthetic (LA) agent is a newer analgesic technique for breast surgeries. This study further evaluates the effect of addition of dexmedetomidine to LA agent on total duration of analgesia and postoperative morphine consumption. Material and Methods: A total of 60 American Society of Anesthesiologist Grade I and II female patients with age ≥18 years, scheduled for oncological breast surgery, were enrolled in the study. Patients were randomized into two equal groups of 30 each. Group R (n = 30) received ultrasound (US)-guided Pecs block with 30 ml of 0.25% ropivacaine. Group RD (n = 30 patients) received US-guided Pecs block with 30 ml of ropivacaine 0.25% and dexmedetomidine 1 μ/kg body weight. Duration of analgesia and total postoperative morphine consumption was noted in 24 h period. Unpaired t-test and Chi-square test were used for statistical analysis. Results: A statistically highly significant increase in total duration of analgesia (in minutes) was recorded in Group RD as compared to Group R (469.6 ± 81.5 in Group RD and 298.2 ± 42.3 in Group R) (P = 0.000). Total postoperative morphine consumption in mg was also statistically significantly lower in Group RD as compared to Group R (14.8 ± 2.4 in Group RD and 21.6 ± 3.1 in Group R) (P = 0.000). No patient under study reported any adverse effects. Conclusion: Addition of 1 μ/kg dexmedetomidine to 0.25% ropivacaine for Pecs block increases the duration of analgesia and decreases postoperative morphine consumption. [ABSTRACT FROM AUTHOR]

Ethno-pharmacological relevance Kanakasava is an Indian traditional Ayurvedic formulation containing Datura ( Datura metel ), Vasaca ( Adhatoda vasica ), Dhataki ( Woodfordia fruticosa ) and Grape ( Vitis vinifera ) extracts as major constituents and used to treat pulmonary diseases including coughing, breathing difficulty and asthma. The present study was designed to assess the safety and therapeutic efficacy of Kanakasava against ovalbumin-induced bronchial asthma and related airway inflammation in rats due to lack of evidence based therapeutic efficacy data. Material and methods Male wistar rats were sensitized with allergen (ovalbumin, 40 mg/rat+aluminum hydroxide, 2.0 mg/rat) and treated orally with standard dexamethasone (2.5 mg/kg, b.w.) or Kanakasava (1.23 and 2.46 ml/kg, b.w.) from day 1 to day 28. Inflammatory markers, including cell counts and cytokines such as interleukins (IL-4, IL-5, IL-1β), tumor necrosis factor (TNF-α), leukotriene (LTD-4), immunoglobulin (IgE), nitric oxide and nitrite levels in both blood and broncheo alveolar lavaged fluid (BALF) were analyzed. Abdominal mesentery was studied histologically for mast cell degranulation, whereas lung functions were investigated by spirometer. Method was also developed to quantify gallic acid and ethyl gallate content in Kanakasava by HPTLC for its quality control. Results None of the rats exhibited mortality and Kanakasava was found to be safe at the tested doses. Treatment with Kanakasava significantly (P<0.01) reversed elevated levels of IgE, cytokines, nitrites and influx of eosinophils and neutrophils in blood and BALF. These findings were further supported by the significant improvement in lung functions (P<0.01) and suppression (P<0.01) of degranulation of mast cells. The content of gallic acid and ethyl gallate in Kanakasava was found to be 1.94% and 0.98%, respectively. Conclusion These findings demonstrated the preventive effect of Kanakasava in allergen induced model of asthma providing scientific basis for its traditional use in Ayurveda, since long time. [ABSTRACT FROM AUTHOR]

Background: Fruits of Vitis vinifera L., commonly known as grapes, are largely consumed worldwide because of their high nutritional and medicinal benefits. Context and purpose: The present study investigated effects of V. vinifera fruits in ovalbumin-induced animal model of bronchial asthma. Methods: Male wistar rats (except group 1) were sensitized with allergen (ovalbumin, 40 mg/rat + aluminum hydroxide, 2 mg/rat). Groups of sensitized animals were treated orally with either vehicle (0.4 mL/kg), standard dexamethasone (2.5 mg/kg) or alcoholic extract of V. vinifera dried fruits (31 and 42.5 mg/kg) from day 1 to 28 (n = 6 for all groups). Inflammatory markers including cell counts, cytokines such as interleukin (IL)-4, IL-5, IL-1ß, tumor necrosis factor, immunoglobulin E (IgE), leukotrienes and nitrite levels in both blood/serum and bronchoalveolar fluid were analysed. Breathing rate and tidal volume as lung function parameters were examined by spirometer. Lung tissues were studied for histamine content and histopathology. Results: Treatment of sensitized animals with dexamethasone or two doses of V. vinifera fruits extract inhibited recruitment of inflammatory cytokines, IgE, nitrites and circulating cells particularly eosinophils in blood/serum and bronchoalveolar fluid (p < 0.001, p < 0.01 and p < 0.05). Dexamethasone and V. vinifera fruits extract treatment also normalized lung functions and histamine levels compared to ovalbumin-sensitized controls (p < 0.05 and p < 0.01). Moreover, both drugs exhibited protection against airway inflammation in lung histology. Conclusion: Results of study demonstrate the effectiveness of V. vinifera fruits in allergic asthma possibly related to its ability to inhibit cellular response and subsequent production of inflammatory cytokines. [ABSTRACT FROM AUTHOR]

Bronchial asthma is a chronic lung disorder, that affects an estimated 262 million people worldwide, thereby, causing a large socio-economic burden. Drug molecules from natural sources have exhibited a good promise in providing an alternative therapy in many chronic ailments. Solasodine, a glycoalkaloid has received an immense interest due to its large pharmacological and industrial value, however, its usefulness in asthma control has not been investigated till date. In this work, solasodine was tested for its ability to reverse several characteristics of bronchial asthma induced by intraperitoneal injection of ovalbumin (OVA) and aluminium hydroxide in experimental rats. Treating asthmatic animals with solasodine (1 mg/kg b.w. or 10 mg/kg b.w.) or dexamethasone (2.5 mg/kg b.w.) reversed OVA-induced airway hyperresponsiveness, infiltration of inflammatory cells and histamine levels in the airways. Furthermore, as compared to OVA-control rats, allergen-induced elevated levels of IgE, nitrites, nitric oxide, and pro-inflammatory mediators, including TNF-α, IL-1β, LTD-4, and Th2-cytokines, particularly, IL-4, IL-5 were remarkably reduced in both bronchoalveolar lavage fluid and blood. These findings are supported by significant protection offered by various treatments against OVA-induced airway inflammation and mast cell degranulation in mesenteric tissues. Further, In-silico molecular docking studies performed to determine inhibitory potential of solasodine at IL-4 and IL-5, demonstrated strong affinity of phytocompound for these receptors than observed with antagonists previously reported. Results of current study imply that solasodine has therapeutic promise in allergic asthma, presumably due to its ability to prevent mast cell degranulation and consequent generation of histamine and Th2-associated cytokines in airways. • Solasodine was tested against OVA-induced rat model of bronchial asthma. • Solasodine oral treatment reversed airway hyperresponsiveness in asthmatic animals. • Solasodine oral treatment inhibited mast cell degranulation in asthmatic animals. • Th2 cytokines were reduced after treating asthmatic animals orally with solasodine. • Solasodine exhibited affinity for IL-4 and IL-5 receptors. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of fluid preloading is in doubt, so co-loading has been attempted to reduce the incidence of spinal anaesthesia induced hypotension in caesarean patients. Aim: To compare crystalloid preloading, colloid preloading and colloid co-loading for prevention of maternal hypotension in caesarean delivery. Settings and Design: Study conducted in tertiary level hospital on 90 ASA I/II term parturients posted for elective caesarean section. Patients were randomly allocated to three Groups. Materials and Methods: Group A (n=30) was given 10 ml/kg of 6% hydroxyethyl starch (HES) 20 minutes prior to spinal anaesthesia, Group B (n=30) was given 10 ml/kg of 6% HES by rapid infusion in 10 minutes immediately after spinal anaesthesia and Group C (n=30) was given 10 ml/kg of Ringer's Lactate 20 minutes prior to spinal anaesthesia. Intraoperatively, Heart rate, systolic, diastolic and mean arterial pressure were recorded every five minutes. Episodes of hypotension were recorded and treated with bolus of 5 mg of ephedrine and total amount of ephedrine was noted. Adverse effects, if any were recorded. Statistical Analysis: ANNOVA for Quantitative Analysis and chi-Square test and Z-test for Qualitative Analysis. Results: Baseline parameters were similar in all the three Groups. Heart rate decreased from the baseline in all the three Groups, however, mean heart rate was highest in Group C. Heart rate was statistically similar in Groups A and B. MAP decreased in all three Groups from baseline, however, highest fall was recorded in Group C whereas, MAP was statistically similar in Groups A and B. Incidence of hypotension was 66.66% in Group C as compared to 36.66% in Groups A and 40% in Group B respectively. Group C patients received 5.33±4.54 mg of ephedrine as compared to 2.00±2.82 mg in Group A and 2.33±3.14 mg in Group B. Thus, the incidence of hypotension and ephedrine consumption was significantly higher in Group C as compared to Groups A and B whereas, this difference was statistically not significant among Groups A and B. Conclusion: Colloid preloading and co-loading are equally effective and both are superior to crystalloid preloading for prevention of maternal hypotension in caesarean section patients. [ABSTRACT FROM AUTHOR]

Frequency corresponding to the energy difference between designated levels of an atom provides precise reference for making a universally accurate clock. Since the middle of the 20th century till now, there have been tremendous efforts in the field of atomic clocks making time the most accurately measured physical quantity. National Physical Laboratory India (NPLI) is the nation's timekeeper and is developing an atomic fountain clock which will be a primary frequency standard. The fountain is currently operational and is at the stage of complete frequency evaluation. In this paper, a brief review on atomic time along with some of the recent results from the fountain clock will be discussed. [ABSTRACT FROM AUTHOR]

National Physical Laboratory India has developed a cesium atomic fountain frequency standard. The fountain has now become operational and is ready for complete frequency evaluation. In this paper, we report for the first time, the preliminary results obtained with this fountain, which include Ramsey fringes, frequency stability analysis, with an H-maser, and magnetic field mapping in the atomic flight region. [ABSTRACT FROM PUBLISHER]

This study is aimed at exploring the utility of thermoanalytical methods in the characterization of various polymorphs and solvates of nevirapine. The different forms obtained by recrystallization of nevirapine from various solvents showed morphological differences in SEM. The presence of polymorphic forms is suggested by single sharp melting endotherm different from original sample in DSC and no mass loss in TG, while appearance of desolvation peak in TG indicated the formation of solvates. The higher desolvation temperatures of all the solvates than their respective boiling point indicate tighter binding of solvent. The changes in the crystal lattice were demonstrated by X-ray powder diffraction studies. The enthalpy of fusion rule indicated the existence of monotropy in polymorphic pairs I/O and II/O, while I/II is enantiotropically related. The enthalpy of solution, an indirect measure of the lattice energy of a solid, was well correlated with the crystallinity of all the solid forms obtained. The magnitude of Δ H was found to be −14.26 kJ mol for Form V and −8.29 kJ mol for Form O, exhibiting maximum ease of molecular release from the lattice in Form V. The transition temperature was found to be higher than the melting of both the forms except for polymorphic pair I/II providing complementary evidence for the existence of monotropy as well as enantiotropy in these polymorphic pairs. [ABSTRACT FROM AUTHOR]

The present study is focused on estimation of transition temperature and stability of various forms of lamivudine. The forms were recrystallized from variety of solvents and preliminarily identification on the basis of SEM revealed existence of three forms (Forms I, II, III). DSC scans of Forms I and III show that these are metastable and undergo heat mediated transformation to Form IH and Form IIIH, respectively. Form II is phase pure with single sharp melting endotherm at 178.6 °C. The thermal events are visually observed by hot stage microscopy. Enthalpy of solution of the forms is endothermic and magnitude varies in the order Form II > Form IL > Form IIIL suggesting Form IIIL to be least crystalline which is well correlated with XRPD data. The transition temperature of the polymorphic pairs IL/IH and IIIL/IIIH derived from enthalpy of solution and solubility data revealed monotropy whereas enantiotropy exists in IIIH/II. The slurry experiments showed Form II to be thermodynamically most stable. Forms IL and IIIL though stable in water are converted to Form II in ethanol, acetonitrile, and propanol after 1 day. Form IIIL is converted to Form IL in water after 7 days and the observation is of importance as this instability can effect the pharmaceutical preparations whereas Form IL shows a balance between stability and solubility. [ABSTRACT FROM AUTHOR]

The work is undertaken to evaluate the effect of Tween 80 on the complexing ability of β-cyclodextrins to encapsulate the poorly soluble antiretroviral agent, nevirapine. The phase solubility diagram indicates 1:1 stoichiometry and is supported by electronspray ionization mass spectrometry. The complexes were characterized by DSC, FT-IR, and XRD in the solid state. The ternary systems were autoclaved before being lyophilized for the best results. Proton NMR suggests that the methyl pyridine ring of the drug is involved in inclusion and enters from the wider side of the cavity which was confirmed by COESY NMR. Solution calorimetry, a direct method to determine the thermodynamic parameters, was used to determine the complexation constant ( K) and other thermodynamic properties. The process is associated with negative ∆ H and positive ∆ S indicating a stable inclusion complex. The value of K follows the order β-CD < HP-β-CD < M-β-CD. The molar enthalpy of solution in autoclaved solid formulation is less endothermic as compared to additive molar enthalpy of solution obtained by summation of enthalpy of solution of individual components suggesting synergistic interaction between the drug and its constituents. A threefold increase of the in vitro permeability flux was observed for binary systems which was elevated to fourfold for autoclaved ternary complexes. [ABSTRACT FROM AUTHOR]

The present study reports the identification and characterization of different crystal modifications of 5-Flurouracil. The drug was found to exist in five polymorphic and one solvatomorphic form. The lyophillization method was employed to reduce the crystallanity of commercial sample which resulted in Form VI. SEM was used to clarify the crystalline shapes characteristic of the drug and its crystal modifications. The melting temperature determined from DSC studies suggests them to be different crystal form while TGA reveals Form III to be acetonitrile solvate. Some major differences were found in the FTIR spectra of various forms. Appearance of new peaks in the XRD pattern reveals formation of new forms which are crystalline in nature. The further differentiation of polymorphic forms was performed by determining the enthalpy of solution in the given solvent which is based on differences in the lattice energy. Significant differences in the heat of solution of various modifications were observed. Acetonitrile solvate was found to be most crystalline and form prepared by lyphollizaiton was found to be least crystalline. Of all the methods, heat of solution provides the quantitative estimation which confirms the presence of different crystal modifications. [ABSTRACT FROM AUTHOR]

Asthma is an airways inflammatory disease and the most common chronic disease of childhood, which causes most hospital visits and placing a heavy financial burden on families and communities. Interleukins 4, 5 and 13, play a central role in the pathogenesis of asthma. Given the importance of oral hygiene in asthmatic patients and IL-4 and 5 are involved in the inflammatory process of periodontitis, the effect of chlorhexidine as mouthwash on asthma attacks in children on serum cytokines is necessary. In this study, 375 children with asthma were divided into two groups using or non-using chlorhexidine. Blood samples were taken and cytokines were measured by ELISA. From 375 patients, 17 patients were excluded. In this study, 171 males and 187 females participated and there were 180 patients in asthma group and 178 patients in asthma/Chlorhexidine group. The levels of IL-4, IL-5 and IL-13 had no significant difference (p > 0.05) between Asthma and Asthma/Chlorhexidine groups. Using chlorhexidine as mouthwash in children with asthma had no effect on the type 2 cytokines and may not trigger an asthma attack via allergo-inflammatory mechanism. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) reports that Asia and Africa have the highest Chronic Liver Disease (CLD) mortality rate. Cirrhosis, responsible for 22.2 fatalities per 100,000 people, is India's 10th most common cause of mortality. The increasing prevalence of chronic liver disease necessitates a study to identify predictive factors for patients who visit the emergency department. Identifying elements that enhance the predictive value of mortality in unstable patients with CLD complications is important in emergency departments. This study aims to determine Clinical and Laboratory Parameters as mortality predictors in adult chronic liver disease patients. Methodology: The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Patients with chronic liver disease above 18 years of age who satisfied the inclusion criteria were clinically evaluated. Clinical and demographic details were collected, and data was analyzed. Results: Two hundred thirty-six patients were enrolled. The mean age was 50.77 ± 14.26 years. 78.4% of the participants were men. Abdominal distension, affecting 59.7% of patients, was the most common presenting ailment, followed by melena and hematemesis, affecting 41.9% and 32.6%, respectively. The mean stay in the emergency department was 10.29 ± 8.10 h. Refractory septic shock, the leading cause of mortality, accounts for 69.2% of all deaths, alongside grade 4 hepatic encephalopathy and massive Upper Gastrointestinal (UGI) bleeding, as identified in our study. Factors such as altered mental sensorium, high respiratory rate, low SpO2, increased heart rate, low systolic blood pressure, low diastolic blood pressure, and low Glasgow Coma Scale (GCS) on Emergency Department (ED) arrival are significantly associated with mortality. Conclusions: Chronic liver disease, a prevalent condition in India, most commonly seen in middle aged men and lower socioeconomic groups. The parameters independently associated with mortality in our study were presence of altered mental sensorium, Glasgow coma scale, Child Pugh class and need for ICU admission. Understanding the presentation pattern, and mortality predictors can help ED physicians in managing acute events and follow-ups. [ABSTRACT FROM AUTHOR]

Asthma is a common respiratory disease, and immune system dysregulation has direct relevance to asthma pathogenesis. Probiotics and prebiotics have immunomodulatory effects and can regulate immune responses and may attenuate allergic reactions. Therefore, in this study, we explored the role of probiotics and prebiotics in regulating acute airway inflammation and the TLR4/NF-kB pathway. Allergic asthma model of BALB/c mice was produced and treated with probiotics (LA-5, GG, and BB-12) and prebiotics (FOS and GOS). Then AHR, BALF cells count, EPO activity, IL-4, 5, 13, 17, 25, 33, as well as IFN-γ, total and OVA-specific IgE, IgG1, Cys-LT, LTB4, LTC4, and TSLP levels were measured. Also, the GTP/GOT assay was performed and gene expression of Akt, NLR3, NF-kB, PI3K, MyD88, TLR4, CCL11, CCL24, MUC5a, Eotaxin, IL-38, and IL-8 were determined. Finally, lung histopathological features were evaluated. Treatment with probiotics could control AHR, eosinophil infiltration to the BALF and reduce the levels of immunoglobulins, IL-17, GTP and also decrease mucus secretion, goblet cell hyperplasia, peribronchial and perivascular inflammation and also, EPO activity. It could reduce gene expression of TLR4 and CCL11. On the other hand, IL-38 gene expression was increased by both probiotic and prebiotic treatment. Treatment with probiotics and prebiotics could control levels of IL-4, 5, 13, 25, 33, leukotrienes, the gene expression of AKT, NLR3, NF-κB, MyD88, MUC5a. The prebiotic treatment could control peribronchial inflammation and PI3K gene expression. Both of the treatments had no significant effect on the GOT, TSLP and IL-8, eotaxin and CCL24 gene expression. Probiotics and prebiotics could induce tolerance in allegro-inflammatory reactions and alter immune responses in allergic conditions. Probiotics could also modulate cellular and humoral immune responses and prevent allergic disorders. [ABSTRACT FROM AUTHOR]

Introduction  Dysembryoplastic neuroepithelial tumor (DNET) is a rare cause of intractable epilepsy, which has excellent results in terms of seizure control after surgical resection. We present one such case, because of its rarity, to highlight the effect of tumor removal on seizure control, particularly DNET. Materials and Methods/Case Summary  A 9-year-old male patient presented with sudden onset of partial seizures for the past 6 months. There were five episodes. In each episode, the patient engaged in irrelevant talk, followed by deviation of mouth to left and twitching movements. The episode lasted 5 minutes and there was no loss of consciousness. There was no aura or tongue bite, and in one of the episodes, the patient lost consciousness. There was no other significant positive history. On examination, the child was consciously alert, without focal neurological deficit or features of meningitis. There was no papilledema. The patient was on phenytoin sodium, phenobarbitone and clobazam. Magnetic resonance imaging (MRI) of brain was done with and without contrast. MRI revealed a lesion approximately 4.1 × 3.6 × 3.2 cm in the right medial temporal lobe. It was hypointense to brain on T1 and fluid-attenuated inversion recovery (FLAIR), and hyperintense on T2-weighted images. Diffusion restriction was present and there was minimal contrast uptake. There was no evidence of mass effect or midline shift After discussing the risks and benefits with parents, the patient underwent preanesthetic checkup, and was taken up for craniotomy and excision of tumor. Gross total excision was done. The child was started orally on day 1 postoperatively and ambulated. There were no further seizure episodes. The patient was continued on phenytoin and clobazam, and phenobarbitone was tapered gradually. At 6 months, the child was seizure-free. Conclusions  DNET are rare tumors occurring early in life and presenting with intractable seizures. Surgical resection offers a good and safe chance for long-term seizure control. [ABSTRACT FROM AUTHOR]

Evidence indicates that anxiety disorders arise from an imbalance in the functioning of brain circuits that govern the modulation of emotional responses to possibly threatening stimuli. The circuits under consideration in this context include the amygdala's bottom-up activity, which signifies the existence of stimuli that may be seen as dangerous. Moreover, these circuits encompass top-down regulatory processes that originate in the prefrontal cortex, facilitating the communication of the emotional significance associated with the inputs. Diverse databases (e.g. , Pubmed, ScienceDirect, Web of Science, Google Scholar) were searched for literature using a combination of different terms e.g. , "anxiety", "stress", "neuroanatomy", and "neural circuits", etc. A decrease in GABAergic activity is present in both anxiety disorders and severe depression. Research on cerebral functional imaging in depressive individuals has shown reduced levels of GABA within the cortical regions. Additionally, animal studies demonstrated that a reduction in the expression of GABA A/B receptors results in a behavioral pattern resembling anxiety. The amygdala consists of inhibitory networks composed of GABAergic interneurons, responsible for modulating anxiety responses in both normal and pathological conditions. The GABA A receptor has allosteric sites (e.g. , α / γ , γ / β , and α / β) which enable regulation of neuronal inhibition in the amygdala. These sites serve as molecular targets for anxiolytic medications such as benzodiazepine and barbiturates. Alterations in the levels of naturally occurring regulators of these allosteric sites, along with alterations to the composition of the GABA A receptor subunits, could potentially act as mechanisms via which the extent of neuronal inhibition is diminished in pathological anxiety disorders. • The neurotransmitter GABA and its receptors play a vital role in the development of anxiety. • Downregulation of GABA signaling in the brain contributes to anxiety. • GABAergic medications have shown anti-anxiety potential. • Positive allosteric modulators of GABA receptors are the future of anxiolytic drugs. [ABSTRACT FROM AUTHOR]

Monoamine oxidase (MAO) enzymes over see the concentration of neurotransmitters and intracellular amines in the brain and peripheral tissues by catalysing their oxidative deamination and represents a crucial target in drug designing for the management of neurological and psychiatric disorders. Present study is an effort to present an economical fast high throughput screening easy method to identify indole analogues as potent MAO inhibitors, using different computational techniques. CoMSIA field-based 3D-QSAR models have been developed by applying the partial least squares regression algorithm that exhibit satisfactory predictive and descriptive capability with statistical parameters R² (0.9557) and Q² (0.8529). Generated model (s) helped in explaining the key descriptors firmly related with MAO inhibitory activity and are used to generate library of 1853 indole derivatives. Library is evaluated and has resulted in the identification of 30 indole derivatives with high docking scores (−9.978 to −7.136) in comparison to the antidepressant standard drug Isocarboxazid (−7.125). Further, these compounds have been scrutinized through drug-likeliness profiles and Desmond's molecular dynamics simulations studies for 100 ns. Further in vitro and in vivo studies on these molecules might provide us with new drug candidate for the treatment of depression with high therapeutic index. [ABSTRACT FROM AUTHOR]

Introduction: Aspirated foreign bodies continue to present challenges to otorhinolaryngologists. Removal of impacted airway foreign bodies via conventional methods can at times pose difficulty. This may be related to the location and type of foreign body, experience of the surgeon and anesthetist, and the availability of appropriate instruments. In adults, especially in edentulous patients, a swallowed denture usually gets lodged in the esophagus and entrance into the airway is uncommon. Case Report: We report a case of an uncommon foreign body (3-toothed artificial denture plate) impacted in the trachea of a 40-year-old male following an acute episode of an epileptic attack in which conventional methods of foreign body removal had failed. It was eventually removed via a direct laryngoscopy and tracheotomy technique. Conclusion: This type of impaction of a large denture in the trachea is uncommon and late presentation after aspiration is even more rare. This unusual case of a foreign body in the airway is interesting due to its rarity, mode of entry, site of impaction, variable clinical presentation, and method of removal; and hence, prompted the authors to report this case. [ABSTRACT FROM AUTHOR]

Background A spinal epidural arachnoid cyst (SEAC) is a rare clinical entity. We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities, and outcome of SEACs. Methods A literature search was performed by using the databases PubMed/Medline, PubMed Central, Embase, Cochrane Library, Ovid MEDLINE, and Ovid Medline In-Process. A total of 170 articles were found on literature search. We found 575 cases of SEAC since 1904 for inclusion in the review including three cases which were operated by us. We studied the patient characteristics, clinical features, and management strategies, and evaluated their outcome. Results The average age of presentation was 30 years with a male:female ratio of 1.03:1. They are commonly seen in the thoracic region (42.3%). The length of cyst was more than two vertebral levels in 85.81%. Mean symptom duration was 29 months, with most common presentation being that of compressive myelopathy. A good clinical outcome was present in symptomatic patients who had a shorter symptom duration and underwent complete surgical excision of the SEAC. Age, sex, length of lesion, and presence of dural defect did not have a bearing on the surgical outcome. Conclusion For thoracic compressive myelopathy in a young patient, SEAC should be kept as a differential diagnosis. Surgical complete excision of the cyst with meticulous closure of the dural defect is the standard in management for a good clinical outcome. [ABSTRACT FROM AUTHOR]

Context: Zingiber officinale Roscoe (Zingiberaceae) rhizome, known commonly as ginger is extensively used in Indian traditional system of medicine for treatment of various disorders. The ethanolic Z. officinale extract is reported to have various activity such as antidiabetic, antihyperlipidemic and antioxidant activity in experimental animals. Objective: To evaluate anti-obesity effect of aqueous Z. officinale extract in murine model of high fat diet (HFD)- induced obesity. Materials and Methods: Male Wistar rats fed with HFD (20 g/day/rat, p.o) for a period of 42 days were used to induce obesity. Aqueous Z. officinale extract (20 mg/kg b.w.) administered orally to HFD fed rats from day 8 to 50 days for a period of 42 days. Body weight gain, serum lipids, insulin and leptin parameters were measured. Results: Oral feeding of the aqueous Z. officinale extract (20 mg/kg) to HFD-induced obese rats for a period of 42 days resulted in significant reduction in body weight gain, insulin, leptin, lipids as compared to rats fed HFD alone. Further, the extract also showed significant increase in high density lipoprotein (HDL-C) levels. Discussion and Conclusion: These results show that aqueous Z. officinale extract possess significant anti-obesity potential. [ABSTRACT FROM AUTHOR]

• Mitochondria is one of the basic essential components for eukaryotic life survival. • This review summarizes the potential treatment strategies that target the malfunctioning mitochondria. • The role of mitochondria in respiratory diseases is gaining much attention. Mitochondria are one of the basic essential components for eukaryotic life survival. It is also the source of respiratory ATP. Recently published studies have demonstrated that mitochondria may have more roles to play aside from energy production. There is an increasing body of evidence which suggest that mitochondrial activities involved in normal and pathological states contribute to significant impact to the lung airway morphology and epithelial function in respiratory diseases such as asthma, COPD, and lung cancer. This review summarizes the pathophysiological pathways involved in asthma, COPD, lung cancer and highlights potential treatment strategies that target the malfunctioning mitochondria in such ailments. Mitochondria are responsive to environmental stimuli such as infection, tobacco smoke, and inflammation, which are essential in the pathogenesis of respiratory diseases. They may affect mitochondrial shape, protein production and ultimately cause dysfunction. The impairment of mitochondrial function has downstream impact on the cytosolic components, calcium control, response towards oxidative stress, regulation of genes and proteins and metabolic activities. Several novel compounds and alternative medicines that target mitochondria in asthma and chronic lung diseases have been discussed here. Moreover, mitochondrial enzymes or proteins that may serve as excellent therapeutic targets in COPD are also covered. The role of mitochondria in respiratory diseases is gaining much attention and mitochondria-based treatment strategies and personalized medicine targeting the mitochondria may materialize in the near future. Nevertheless, more in-depth studies are urgently needed to validate the advantages and efficacy of drugs that affect mitochondria in pathological states. [ABSTRACT FROM AUTHOR]

Background: Cardiac injury is associated with high mortality in patients with COVID-19 infection. Electrocardiographic changes can give clues to the underlying cardiovascular abnormalities. Raised inflammatory markers like raised interleukin-6 (IL-6) are associated with arrhythmia, heart failure, and coronary artery disease. However, past studies have not highlighted the electrocardiographic abnormalities in patients with COVID-19 infection with raised IL- 6 levels. This study compared the electrocardiogram (ECG) changes in COVID-19 patients with high and normal IL-6 levels. Methods: A retrospective analysis of ECG of 306 patients with COVID-19 infection was done, out of which 250 patients had normal IL- 6 levels, whereas 56 patients had raised IL-6 levels. IL-6 levels were measured in all the patients. Detailed clinicodemographic profile of all the serial COVID-19 patients admitted with moderate to severe COVID-19 pneumonia was noted from the hospital record section. Electrocardiographic findings and biochemical parameters of all the patients were noted. Results: Out of 56 patients with raised IL-6 levels, 41 (73.2%) patients had ECG abnormalities compared to 177 (70.8%) patients with normal IL-6 levels. This difference was not statistically significant. However, ECG abnormality such as sinus tachycardia was significantly more common in patients with raised IL-6 levels than those with normal levels. Among patients with raised IL-6 levels who were discharged, 5 (16.6%) had sinus tachycardia, 2 (6.6%) had ST/T wave changes as compared to 15 (57.6%), and 10 (38.4%) who had tachycardia and ST/T wave change respectably succumbed to death. This difference was statistically significant. Conclusions: Sinus tachycardia followed by atrial fibrillation and right bundle branch block are common ECG changes in patients with COVID-19 infection with raised IL-6. The possible association of cardiac injury in patients with COVID-19 infection with coexisting raised IL-6 levels should be explored further. [ABSTRACT FROM AUTHOR]

The sequence control system for Cs atomic fountain clock is described in this paper. An electronic module to control the operational sequence of the Cesium (Cs) fountain frequency standard has been designed and developed. This control system consists of RF generation for AOMs and provides sequential control for cyclic operation of atomic fountain. In this paper, indigenously developed hardware as well as software of the module along with the computer controlled sequence of operation of the Cs fountain is described in detail. [ABSTRACT FROM AUTHOR]

Background: Dyspnea is one of the common symptoms patients present to the emergency department (ED). The broad spectrum of differentials often requires laboratory and radiological testing in addition to clinical evaluation, causing unnecessary delay. Point of care ultrasound (PoCUS) has shown promising results in accurately diagnosing patients with dyspnea, thus, becoming a popular tool in ED while saving time and maintaining safety standards. Our study aimed to determine the utilization of point of care ultrasound in patients with acute dyspnea as an initial diagnostic tool in our settings. Methodology: The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Adult patients presenting with acute dyspnea were prospectively enrolled. They were clinically evaluated and necessarily investigated, and a provisional diagnosis was made. Another EP, trained in PoCUS, performed the scan, blinded to the laboratory investigations (not the clinical parameters), and made a PoCUS diagnosis. Our gold standard was the final composite diagnosis made by two Emergency Medicine consultants (who had access to all investigations). Accuracy and concordance of the ultrasound diagnosis to the final composite diagnosis were calculated. The time to formulate a PoCUS diagnosis and final composite diagnosis was compared. Results: Two hundred thirty-seven patients were enrolled. The PoCUS and final composite diagnosis showed good concordance (κ = 0.668). PoCUS showed a high sensitivity for acute pulmonary edema, pleural effusion, pneumothorax, pneumonia, pericardial effusion, and low sensitivity for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute respiratory distress syndrome (ARDS)/acute lung injury (ALI). High overall specificity was seen. A high positive predictive value for all except left ventricular dysfunction, pericardial effusion, non-cardiopulmonary causes of dyspnea, and a low negative predictive value was seen for pneumonia. The median time to make a PoCUS diagnosis was 16 (5–264) min compared to the 170 (8–1346) min taken for the final composite diagnosis. Thus, time was significantly lower for PoCUS diagnosis (p value <0.001). Conclusion: By combining the overall accuracy of PoCUS, the concordance with the final composite diagnosis, and the statistically significant reduction in time taken to formulate the diagnosis, PoCUS shows immense promise as an initial diagnostic tool that may expedite the decision-making in ED for patients' prompt management and disposition with reliable accuracy. [ABSTRACT FROM AUTHOR]

Highlights: [•] The effect of M-β-CD and Tween 80 (0.5%, v/v) on solubility and biological performance of valsartan has been evaluated. [•] The mode of interaction, stoichiometry and other binding parameters has been determined by molecular modelling, NMR and solution calorimetry studies. [•] The VAL:M-β-CD:Tween 80 (0.5%, v/v) complex showed enhanced biological activity in comparison to drug alone. [ABSTRACT FROM AUTHOR]

Background: Endothelial dysfunction, inflammation, and hypercoagulability are hallmarks of severe COVID-19 related disease. Endothelial function can be measured non-invasively by flow-mediated dilatation in the brachial artery. We planned a study to measure it as a marker of the severity of COVID-19 disease. Objective: To evaluate the association of clinically recognizable endothelial dysfunction in COVID-19 disease and its usefulness as a marker of severe COVID-19-related disease. Methods: 20 COVID-19 patients being admitted to our unit were analyzed for endothelial dysfunction and correlated with disease severity as per computed tomography (CT) chest score. Patients with diabetes, atherosclerotic coronary artery disease, dyslipidemia, chronic renal disease, and infections other than COVID-19 were excluded. Endothelial dysfunction was measured by flow-mediated dilatation in the brachial artery. Results: The mean age was 46.4 ± 16.5 years; 70% were males. The mean CT severity score was 22 ± 8; 60% required supplemental oxygen and steroids. The incidence of endothelial dysfunction was more in patients with a computed tomography severity score of >19.5 or oxygen saturation of <93% at room air as compared to mild cases (P = 0.003). Endothelial dysfunction was more evident >7 days after onset of disease as compared to early (<7 days) disease (P = 0.016). There was negative correlation between % flow-mediated dilatation in brachial artery and severity of lung involvement and prolonged symptomatic phase. Conclusions: Endothelial dysfunction as measured by impaired brachial artery flow mediated dilatation correlates with disease severity. [ABSTRACT FROM AUTHOR]

Embelia ribes has been used as a folk medicine whole world. An aqueous extract of Embelia ribes have visceral fat accumulation and improved insulin resistance in rat model with HFD induced obesity may possibly be through down regulation of leptin, TNF-α, SREBP1γ, and PPARγ2 gene expression. The leptin might contribute to hepatic steatosis by promoting insulin resistance and also by altering insulin signaling in hepatocytes, which consequently promote increased intracellular fatty acid. Hence, drug treatment to rats with HFD prevents increase of these levels due to decrease of the body fat content. Therefore we investigated the anti-obesity effects of the aqueous extract of Embelia ribes by feeding a high-fat diet to rats for 42 weeks. Body weights at 2-6 weeks and parametrial adipose tissue weights were significantly lower in rat fed the high-fat diet containing aqueous extract of Embelia ribes than in the controls fed the high-fat diet. Our data suggest that the antiobesity effects of aqueous extract of Embelia ribes in rat fed a high-fat diet may be through down regulation of leptin, TNF-α, SREBP1γ, and PPARγ2 gene expression. [ABSTRACT FROM AUTHOR]

Background: Atorvastatin calcium (ATC), an anti-lipid biopharmaceutical class II drug, is widely prescribed as a cholesterol-lowering agent and is presently the world's best-selling medicine. A large number of crystalline forms of ATC have been published in patents. A variety of solid forms may give rise to different physical properties. Therefore, the discovery of new forms of this unusual molecule, ATC, may still provide an opportunity for further improvement of advantageous properties. Results: In the present work, eight new solvates (Solvate I-VIII) have been discovered by recrystallization method. Thermal behaviour of ATC and its solvates studied by DSC and TGA indicate similar pattern suggesting similar mode of entrapment of solvent molecules. The type of solvent present in the crystal lattice of the solvates is identified by GC-MS analysis and the stoichiometric ratio of the solvents is confirmed by 1HNMR. The high positive value of binding energy determined from thermochemical parameters indicates deep inclusion of the solvent molecules into the host cavity. The XRPD patterns point towards the differences in their crystallanity, however, after desolvation solvate II, III, IV, V and VIII transform to isostructral amorphous desolvated solvates. The order of crystallinity was confirmed by solution calorimetric technique as the enthalpy of solution is an indirect measure of lattice energy. All the solvates behaved endothermically following the order solvate-VIII (1-butanol solvate) < solvate-I (isoproplyate) < solvate-V (methanol solvate) < solvate-III (ethonalate) < solvate-VI (acetone ethanol solvate) < solvate-IV (t-butanol solvate) < solvate-II (THF solvate) < solvate-VII (mixed hemi-ethanol hydrate). The positive value of the heat capacity of the solvate formation provides information about the state of solvent molecules in the host lattice. The solvents molecules incorporated in the crystal lattice induced local chemical environment changes in the drug molecules which are observed in 13CP/MAS NMR spectral changes. Conclusions: Aqueous solubility of solvate-VIII was found to be maximum, however, solvate-I and VIII showed better reduction in total cholesterol and triglyceride levels as compared to atorvastatin against triton-induced dyslipidemia. [ABSTRACT FROM AUTHOR]

We discuss the design and development of the cesium fountain frequency standard at the National Physical Laboratory, India. The optical set-up of the fountain needed to capture, cool, launch and detect the cesium atoms is discussed in detail. The concept and design of physical structure of the fountain is also described. In addition, some of our recent results on cooling and trapping of cesium atoms are reported. [ABSTRACT FROM AUTHOR]

The Calvin-Bjerrum pH titration technique as modified by Irving and Rossotti has been applied to determine the stability constants of complexes of a series of thioligands, namely benzaldehyde thiosemicarbazone, pyridine-2-carbaldehyde thiosemicarbazone, and cyclopentanone thiosemicarbazone with divalent metal ions (Cu, Cd, Co, Ni, Pb, and Zn). The studies were carried out in 50% v/v dioxane-water at different temperatures (293 K, 303 K, and 313 K) keeping ionic strength at 0.1 mol KNO3. The thioligands undergo deprotonation of only one proton (-N2H-) of a thiosemicarbazone [R1R2C2=N3-N2(H)-C1(=S)N1H2]. Thermodynamic parameters, such as free energy, enthalpy, and entropy have also been evaluated. The investigations represent the first report of the solution phase studies in metal-thiosemicarbazone chemistry. [ABSTRACT FROM AUTHOR]

Extracranial pseudoaneurysms of the carotid artery are extremely uncommon lesions. Trauma, which is nowadays mostly iatrogenic, is responsible for the majority of these cases. Inflammation is uncommon etiology. Clinically, these aneurysms may present as neck swelling with expansion into adjacent structure and pressure symptoms, cerebral embolization, stroke, and rarely rupture. The treatment is usually by endovascular or open surgical techniques. Therapy must be individualized with major and prime objective being the prevention of neurological complications. We present a case of iatrogenic pseudoaneurysm of the common carotid artery resulting due to iatrogenic injury during cervical exploration at a Rural Health Center [ABSTRACT FROM AUTHOR]

Introduction: Changing demographic patterns worldwide and improvement in healthcarehas contributed to increasing visits to the emergency department byelderly patients. Geriatric patients usually have multiple co-morbidities and declining physiological functional status. This complex interplay of various factors requires a specific and curated approach from the emergency physicians.Our aim was to study the pattern and prevalence of geriatric emergencies and the profile of infectious and non-infectious causes of fever in geriatric population in our tertiary care center. Materials and Methods: This retrospective descriptive study was carried out at a tertiary care hospital of north India and included all patients aged more than 18 years who visited the emergency department over a period of six months (July 2018 to December 2018). Detailed data regarding demographic, clinical and diagnosis was obtained retrospectively from the hospital records system. The patients were divided into two groups, age less than 60 years and elderly patients more than 60 years of age for comparison. Results: A total of 24768 patients above the age of 18 years visited the emergency department over a period of six months. Out of which 5399 (27.5%) patients belonged to the geriatric age group more than 60 years of age. 2474 (45.8%) geriatric age group patientswere triaged to critical areas level one and level two as compared to 4668 (24.1%) patients aged less than 60 years. Ninety (1.8%) geriatric patients succumbed to death as compared to 77 (0.4%) patients aged less than 60 years. 651 (21.9%) geriatric patients were shifted to intensive care unit as opposed to 1038 (14.8%) patients of the younger age group.226 (4.2%) geriatric patients presented with fever in the emergency department.116 (73.4%) patients having underlying co-morbidities , had fever due to infectious causes whereas 42 (26.5%) patients had fever due to non-infectious causes. Conclusion: The clinical presentation mortality and morbidity pattern of geriatric patients differs significantly from that of younger population and requires a customized approach and dedicated emergency setups. [ABSTRACT FROM AUTHOR]

Cancer is a complex disease that causes abnormal genetic changes and unchecked cellular growth. It also causes a disruption in the normal regulatory processes that leads to the creation of malignant tissue. The complex interplay of genetic, environmental, and epigenetic variables influences its etiology. Long non-coding RNAs (LncRNAs) have emerged as pivotal contributors within the intricate landscape of cancer biology, orchestrating an array of multifaceted cellular processes that substantiate the processes of carcinogenesis and metastasis. Metastasis is a crucial driver of cancer mortality. Among these, MALAT1 (Metastasis-Associated Lung Adenocarcinoma Transcript 1) has drawn a lot of interest for its function in encouraging metastasis via controlling the Epithelial-Mesenchymal Transition (EMT) procedure. MALAT1 exerts a pivotal influence on the process of EMT, thereby promoting metastasis to distant organs. The mechanistic underpinning of this phenomenon involves the orchestration of an intricate regulatory network encompassing transcription factors, signalling cascades, and genes intricately associated with the EMT process by MALAT1. Its crucial function in transforming tumor cells into an aggressive phenotype is highlighted by its capacity to influence the expression of essential EMT effectors such as N-cadherin, E-cadherin, and Snail. An understanding of the MALAT1-EMT axis provides potential therapeutic approaches for cancer intervention. Targeting MALAT1 or its downstream EMT effectors may reduce the spread of metastatic disease and improve the effectiveness of already available therapies. Understanding the MALAT1-EMT axis holds significant clinical implications. Therefore, directing attention towards MALAT1 or its downstream mediators could present innovative therapeutic strategies for mitigating metastasis and improving patient prognosis. This study highlights the importance of MALAT1 in cancer biology and its potential for cutting back on metastatic disease with novel treatment strategies. [ABSTRACT FROM AUTHOR]

• Norfloxacin a poorly aqueous soluble, synthetic fluoroquinolone molecule discovered in 1986 for the treatment of urinary tract infections. • Immensely valuable agent's enhanced bioavailability, solubility, and dissolution were all made possible through co-crystallization. • NF was shown to be in a hydrogen bond with the complimentary functional groups of the NIC, CIN, and SA in all three conditions. • The prepared co-crystals (NF-NIC, NF-CIN, NF-SA) possess improved biopharmaceutical parameters over pure API (Norfloxacin). The study aims to enhance the biopharmaceutical properties of norfloxacin, a water-insoluble antibacterial antibiotic by synthesizing its co-crystals. Co-crystallization technique resulted in the formation of three co-crystals (NF-NIC, NF-CIN, and NF-SA using three co-formers: nicotinamide, cinnamic acid, and sorbic acid, and employing liquid-assisted grinding approach. Newly prepared co-crystals were characterised using different analytical techniques and crystalline identity was revealed by the PXRD studies, which were further used to determine the crystal structure using Material studio Software. Co-crystals were sustained by hydroxyl-‑carbonyl, amide–carbonyl, and amide‑hydroxyl hydrogen bond network. Novel solid forms were assessed for their physicochemical properties, pharmacokinetics parameters and in vitro antimicrobial activity. Present study provided us with NF in co crystalline forms with significant improvement in the solubility (8 to 3-fold) and dissolution (6 to 2-fold) with simultaneous augmentation in peak plasma concentration (2 to 1.5-fold higher). [Display omitted] [ABSTRACT FROM AUTHOR]

230 © 2021 Asian Journal of Neurosurgery | Published by Wolters Kluwer - Medknow Simulation Training for Neurosurgical Residents: Need versus Reality in Indian Scenario Letter to Editor Sir, Neurosur gical training is provided at 156 training centers across India [1,2] and most of the neurosur gical training programs are based on the traditional apprenticeship model. W e have discussed the present status of simulation facilities for neurosur gical postgraduate students in India and shared our views on the challenges as well as possible solutions for the inclusion of laboratory training into the training curriculum. Laboratory training/simulation is an avenue that can augment the training prospects of neurosur gical trainees and has the capability to shorten the arduous learning curve of neurosur gery. [Extracted from the article]

Background: In this article, we describe our experience in managing one of the worst tragedies of an outbreak of methanol poisoning in the state of Uttarakhand in February 2019. It was reported that more than 100 people of Uttarakhand and neighboring districts of Uttar Pradesh succumbed to death after consuming this toxic alcohol laced with methanol. Materials and Methods: Demographic, clinical, and biochemical data were collected retrospectively from the hospital record section of the tertiary care hospital in the state of Uttarakhand. Results: Ninety-three patients of methanol poisoning were attended by the emergency medicine department of our hospital. The mean age of the patients was 38.9 ± 10.3 years. Majority of the patients were males (92/93). The most common clinical symptoms were gastrointestinal (56; 60.2%) followed by neurological (21; 22.6%) and respiratory (18; 19.3%). Most of the patients presented within 12–24 h after consumption of methanol. The mean of latent time of presentation was 4.8 ± 2.6 h. The mean values of pH, bicarbonate levels, lactate, and base deficit were 7.13 ± 0.6, 12.3 ± 6.4, 2.6 ± 0.8, and 15.6 ± 3.8 mmol/l, respectively. Acute kidney injury (26; 27.9%), blurring of vision (9; 9.6%), and sepsis (6, 6.4%) were common complications. Seven patients (7.5%) succumbed to death. Intensive alkali therapy was the main modality of treatment. Ethanol therapy was useful in patients resistant to alkali therapy. Sixteen (17.2%) patients with acute methanol poisoning were dialyzed once. Conclusion: Patients with acute methanol poisoning have varied presentations. Gastrointestinal symptoms are the most common presentation. Such outbreaks account for the heavy toll of mortality and morbidity in the society. Prompt diagnosis and a protocol based treatment can have a significant impact on the outcome of these patients. Thus, public health warning should be immediately issued with initial presentation of the casualties. [ABSTRACT FROM AUTHOR]

Abstract In flat environments, groundwater is relatively shallow, tightly associated with surface water and climate, and can have either positive and negative impacts on natural and human systems depending on its depth. A linked modelling and analysis framework that seeks to capture linkages across multiple scales at the climate/water/crop nexus in the Argentine Pampas is presented. This region shows a strong coupling between climate, soil water, and land use due to its extremely flat topography and poorly developed drainage networks. The work describes the components of the framework and, subsequently, presents results from simulations performed with the twin goals of (i) validating the framework as a whole and (ii) demonstrating its usefulness to explore interesting contexts such as unexperienced climate scenarios (wet/dry periods), hypothetical policies (e.g., differential grains export taxes), and adoption of non-structural technologies (e.g., cover crops) to manage water table depth. Highlights • We explored climate, soil water, and land use interactions in the Argentine Pampas. • A linked modelling framework was implemented to explore the climate/water/crop nexus. • The modelling framework was conceptually validated as a whole. • Simulation of interesting and complex scenarios proved the framework usefulness. • Adoption of cover crops can reduce the risk of waterlogging and flooding. [ABSTRACT FROM AUTHOR]

Context: Discharge against medical advice or leave against medical advice (DAMA or LAMA) is a global phenomenon. The magnitude of LAMA phenomenon has a wide geographical variation. LAMA reasons are an area of concern for all involved in health-care delivery system. Aims and Objectives: The study aimed to evaluate cases of LAMA retrospectively in a tertiary teaching care institute (1) to find the magnitude of LAMA cases (2) to evaluate demographic and patient characteristics of these cases. Subjects and Methods: We screened hospital record of a referral institute over 1 year after approval from IEC and ICMR, New Delhi. Patient demographics and disease characteristics were noted and statistically analyzed after compilation. Results: A total of 47,583 patients were admitted in the year 2015 through emergency and outpatient department. One thousand five hundred and fifty-six (3.3%) patients got DAMA. The mean age of patient excluding infants was 46.64 ± 20.55 years. There were 62.9% of males. Average hospital stay of these cases was 4.09 ± 4.39 days. Most of the patients (70%) belonged to medical specialties and had longer stay as compared to surgical specialties. Most of LAMA patients were suffering from infections, trauma, and malignancies. Most of the patients had LAMA from ward (62%) followed by Intensive Care Unit (ICU) (28.8%) and emergency (9.2%). In 592 (38%) of LAMA patients, the reason for leaving was not clear. The common cited reasons for LAMA were financial (27.6%) and poor prognosis (20.5%). Conclusions: About 3.3% of patients left hospital against medical advice in our retrospective analysis. Most of these cases did so from ward followed by ICU. Financial reasons and expected poor outcome played a significant role. [ABSTRACT FROM AUTHOR]

In flat plains groundwater affects agricultural production outcomes and risks. Agricultural land use decisions, however, may strongly impact groundwater levels available for production. This paper explores the scope for managing groundwater levels through land use decisions in a sub-basin of the Salado River in the Argentine Pampas, a very flat area that plays a key role in world agricultural production. A spatially distributed hydrological model implemented with MIKE SHE software was used to establish the impacts of different land uses on groundwater dynamics, and to assess the interdependencies among spatially close decision-makers sharing a water table (WT). Additionally, groundwater level changes in response to climate variability were quantified. We found land use has strong effects on WT levels both for oneself (e.g. pastures can lead to significant decreases (up to 4.5 m) in WT levels) and others, in the form of strong interdependencies that exist between farmers sharing a WT where land use decisions of one farmer effect groundwater level of neighbouring farms and vice versa. However, the effectiveness to control groundwater levels through land use decisions is subject to the rather unpredictable effects of rainfall variability. The results presented in this paper provide key insights in relation to physical and social aspects that should be considered for managing groundwater levels through land use decisions, in order to avoid negative and/or maximize positive effects on agricultural production. [ABSTRACT FROM PUBLISHER]