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The main purpose of this article is to provide a critical analysis of published research on these heat transfer surfaces. Important experimental methods and numerical procedures are explained, and many types of vortex generators are described. The phenomenon of flow attributed to vortex generators mounted, connected, pierced, or placed inside surfaces that transmit heat was also examined. In addition, recommendations for applying vortex generator (VGs) technology to improve air-side heat transfer are provided, as well as information on the thermal performance of newly proposed VG heat transfer surfaces. The performance of air-side heating surfaces can often be significantly improved through the use of vortex generators. However, their effectiveness can be greatly affected by many factors, including fluid flow rate, pipe geometry (diameter, shape, pitch, in-line or staggered configuration), fin type, and geometry of the vortex generator (height, length, shape, angle of attack, etc.). Circular fin-tube heat exchangers generally perform worse in terms of thermal-hydraulic efficiency than flat-tube-fin and oval-tube-fin heat-exchanging devices, and more recently, suggested vortex generators. Most current heat exchanger optimization methods focus only on thermal-hydraulic performance.

Abstract In the present work, hybrid composites made of Al2214 alloy with B4C and graphite were produced by using a liquid metallurgical process. Al2214 alloy was utilized to create hybrid composites that had 1.5–6 wt% of B4C particles and a constant 3 wt% of graphite particles. Microstructural analysis using scanning electron microscope (SEM), energy dispersion spectroscopy (EDS), and X‐ray diffraction (XRD) was done on the produced composites. The density, hardness, ultimate, yield strength, and elongation as a percentage were carried out using ASTM E8 for tensile and E10 standard for hardness test. The wear behavior of Al2214‐B4C and graphite composites was examined as per ASTM G99 standard using a wear testing device under a variety of loads and rotation speeds. Graphite and boron carbide particles were equally dispersed throughout the Al2214 alloy, according to SEM photographs. Graphite and B4C particles were detected in the Al2214 alloy by EDS and XRD analyses. The density of Al alloy composites was decreased by adding dual particles to the matrix. The Al2214 alloy's hardness, ultimate strength, yield strength, and wear resistance were all enhanced by the inclusion of dual particles, which increased these properties by 15.4%, 40.4%, and 46.7%, respectively. The presence of hybrid particles in the Al2214 alloy was revealed by EDS and XRD patterns. The density of Al alloy composites was decreased by adding dual particles to the matrix. Tensile force micrographs provided further evidence of the unique fracture behaviors shown by the Al2214 alloy and its composites. In order to examine the wear mechanisms and different morphologies of worn surfaces, scanning electron micrographs were taken.

Abstract Today's industries need to be more productive, especially those that shape and machine materials. As a result, engineers and scientists are seeking for cutting tool materials and technologies that have high hot hardness, chemical stability, wear resistance, and toughness while also improving tool life or contact time. Cryogenic treatment of cutting tools has been proven to be a good way for increasing the contact time of any cutting tool material. This study presents the results of turning alloy steel (EN24 grade) using P20 grade carbide inserts under various conditions under continuous machining. Cutting speeds varied from 100 to 500 m/min (in increments of 100 m/min), with feed rates ranging from 0.1 to 0.4 mm/rev in stages of 0.1 mm/rev and a constant radial depth of cut of 1.5 mm were considered under dry machining conditions. Cryogenic treated/coated inserts are better than other inserts in terms of tool life for optimized parameters such as cutting speed 100 m/min, feed rate 0.1 mm/rev, and depth of cut 1.5 mm, according to the study's findings. Under similar conditions of cutting speed, feed rate, and depth of cut, coated/cryotreated inserts had a tool life increase of about 97.5% over uncoated/untreated inserts, a 50.58% increase over uncoated/crytreated inserts, and a 23.89% increase over coated and untreated inserts, respectively.

Abstract Aluminum metal matrix composite (AMMC) is employed in all engineering applications, most notably as a substitute for conventional metals in the fields of defense, automotive, and aerospace. AMMC should have a wide variety of structural, mechanical, thermal, wear, and corrosion qualities that may require mutually exclusive features at an optimal level to achieve this. The current research focuses on the stir casting process for producing SiC and cenosphere reinforced Al7075 alloys. The response surface method's (RSM) face‐centered central composite design (CCD) was used to design the number of experimental trials, and a response surface technique was enforced to forecast the optimum combination of processing variables in the wear process. The SiC reinforcement improved the wear resistance of Al7075‐SiC‐cenosphere composites substantially. Overall, the experiments show that Al7075‐6 wt% SiC‐5 wt% cenosphere has excellent tribological properties. The hybrid Al7075/SiC/Cenosphere composites were shown to be effective, fit, and suitable in the ideal wear process parameters (load of 10 N, sliding distance of 1000 m, and sliding velocity of 1.5 m/s) for lowering wear rate (0.38035 × 10−3 mm3/m) at 6wt% SiC reinforced composite. This suggests that the combination of SiC and cenosphere improves the wear resistance of AMMC.

Abstract In present research the fracture behavior of carbon fabric‐epoxy composites (CE composites) was evaluated with the addition of 0.1, 0.2, 0.5, and 0.75 weight percentages of carbon nano tubes (CNTs) at different temperatures. The CE composites with different wt.% of CNT were fabricated using land layup method and cured by hot pressing. The fracture toughness of fabricated composites was evaluated in mode–I condition at different temperature. From the results it was shown that the highest fracture toughness was observed at 0.75 wt.% of reinforcement of CNT functional fillers. The fracture toughness of 0.75 wt.% CNT filled CE composites was increased by 19.73% compared to unfilled CE composites. The fracture toughness of CNT filled CE composites diminishes with increase in temperature and the composite filled with 0.75 wt.% CNT exhibits better fracture toughness than the unfilled CE composite at all the temperatures. The fracture toughness was improved by 57.76% and 71.65% at 40 and 60°C, respectively, at 0.75 wt.% reinforcement of CNT fillers. The fractured surfaces of composites were analyzed using Scanning Electron Microscope (SEM) to study the filler contribution to enhance the fracture toughness and failure mechanism of composites.

Epoxy resins, prized for their versatile properties, are derived from bio-based materials, contributing to sustainability and eco-friendliness in both production and application. This study focuses on the application of gradient boosting machine learning techniques in the field of machining to predict the surface roughness and also the contour based experimental validation of the numerical results. The turning experiments, conducted via Taguchi's L27 array, aimed to explore the effects of depth of cut, feed rate, and spindle speed. Higher spindle speeds, lower feed rates, and shallower cuts led to smoother surfaces in turned jute/basalt epoxy composites. Machine learning models (Gradient Boosting Machine, AdaBoost, and XGBoost) were then used to predict surface roughness. Amongst these, XGBoost outperformed GBM and AdaBoost, exhibiting maximum and average prediction errors of 3.78 % and 2.24 %, respectively. XGBoost accurately predicted 2D surface roughness contours that closely matched experimental contours for training and test cases. Taguchi's Orthogonal Matrix identified minimum surface roughness values as 0.773 μm (experimental), 0.800 μm (GBM), 0.880 μm (AdaBoost), and 0.774 μm (XGBoost). All were achieved at 1500 rpm spindle speed, 0.05 mm/rev feed rate, and 0.3 mm depth of cut.

Introduction: Arteriovenous (AV) malformations (AVMs) are rare vascular developmental orders containing an arterial network draining directly into one or more veins without a capillary bed, accounting for 1.5% of total vascular anomalies. Clinical presentations include pulsating mass, pain, ulceration, bleeding, tissue necrosis, enlargement of draining vein, and venous hypertension and/or cardiac failure. Treatment modalities include surgical excision, coil embolization, and sclerotherapy. Surgical excision offers an opportunity for cure but is associated with a risk of injury to vital structures, causing permanent impairment. Due to the high-risk nature of the lesion, it is important to study the clinical presentation and management of peripheral AVM for better management of these patients. Objectives: The objective was to study the presentation, management, and postoperative outcomes in terms of recurrence and functional status of the limb after surgical management of AVMs. Patients and Methods: It was a retrospective study done for 5 years (2018–2023). Thirteen patients who underwent surgical excision of peripheral AVM were included. Recurrence and functional status were assessed by clinical evaluation during follow-up outpatient department visits. Conclusion: The mean age of presentation is 33 years, with male preponderance (70%). Seven patients had upper limb AVMs (four had forearm involvement, while the rest had elbow region involvement). Six patients had lower limb AVMs, out of which four patients had involvement of the thigh region, one had in the knee, and the other in the calf. All patients complained of difficulty in performing daily activities due to the lesion. Nine patients underwent direct surgical excision, and four patients underwent AVM embolization before surgery (three patients had coil embolization, and one had onyx embolization). The mean duration of stay in the hospital was 5 days. Three patients were advised body contour stockings at follow-up. Two patients had recurrence (one after 6 months of surgical excision and the other had prior coil embolization), and one patient (had preembolization) had continued difficulty in walking postprocedure. The rest of the patients did not develop recurrence/functional impairment. There was no postoperative mortality. Thus, surgical excision offers a chance at cure with durable, functional outcomes in patients with peripheral AVMs.

Background: Acute upper-limb ischemia (AULI) is a sudden loss of perfusion to the affected limb. The annual incidence of AULI has been reported as 1.3 cases/100,000 patients. It can be due to vaso-occlusive or vasospastic disorders. It is often the result of thromboembolic disease, trauma, or iatrogenic factors. AULI has multiple modalities of treatment including surgical and nonsurgical options. Materials and Methods: Our study is a retrospective study where patients who have been conservatively treated at a single center between January 2015 and January 2018 were followed up for 5 years. Results: The analysis included 31 patients (61.3% males), with a mean age of 57 years. Only three patients presented within 6 h, and 16 patients presented more than 12 h after symptom onset. Of the 31 patients, 19% had a cardiac source of embolus, 65% had arterial thrombosis, and 16% had other etiologies. The axillary and brachial arteries were noted to be the most affected sites. All the patients underwent conservative management with anticoagulation. Results of this study showed that patients had amputation-free survival with improvement in clinical symptoms and functional outcomes at 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years. None of the patients required a surgical intervention for revascularization. At the end of 5 years of follow-up, two patients underwent partial amputations of one or more fingers, and limb salvage was achieved in all the patients. Most of the patients improved in terms of limb functionality from Grade 3 or Grade 4 at the time of presentation to Grade 1 according to functionality grading. Conclusion: Patients treated with conservative management for AULI have good amputation-free survival and good functional outcomes after 5 years as per our study.

Abstract Micron‐sized graphite particles additions to Al2011 alloy were investigated to know their impact on mechanical properties. The stir cast method was used to manufacture the Al2011 alloy with 2 and 4 wt% of graphite particles reinforced composites. The microstructural analysis and mechanical properties of the synthesized composites were tested. Scanning electron microscope (SEM) and energy dispersive spectroscopy (EDS) spectrums were used to characterize the microstructure of the samples that were obtained from the casting. SEM micrographs indicated the homogeneous distribution of particles and the EDS patterns confirmed the presence of graphite particles. Al2011 alloy hardness was decreased with the addition of graphite particles. Further, with the addition of 2 and 4 wt% of graphite particles in the Al2011 alloy, the ultimate tensile and yield strengths of composites were increased with increase in elongation. SEM micrographs of tensile fractured surfaces were used to study the various fractured behaviors in the Al2011 alloy‐graphite composites.

Introduction: Carotid body tumors (CBTs), also known as paragangliomas or chemodectomas, are rare neuroendocrine neoplasms that arise near the carotid bifurcation within glomus cells derived from the embryonic neural crest. The reported incidence of CBTs is 1–2 cases per 1 lakh cases. Surgery is the mainstay of treatment. Objectives: The objective of this study was to report our experience and describe the presentation, surgical approach, postoperative complications, and outcomes of surgical treatment. Materials and Methods: It is a single-institution experience where a retrospective analysis of 6 cases with CBTs of patients who were candidates for surgery from June 2018 to June 2021 with a mean follow-up period of 24 months was done. Results: The mean age was 37 years, with a female predominance of 66%. The mean size of the tumor was 4.4 ± 1 cm. Four (66%) cases were presented with pain and pulsating neck swelling, and 2 (33%) cases were incidentally detected. All the cases were unilateral tumors. Neck ultrasound was done in all cases as a primary investigation. Magnetic resonance imaging was performed in 5 (87.5%) cases, which revealed tumors having near circumferentially encasing the internal carotid artery (ICA). No cases were malignant. All cases were surgically approached through transcervical vertical incision. Four cases (66%) and 2 (33%) cases were classified as Shamblin's type II and III, respectively. Two (33%) cases needed special maneuvers such as division of the posterior belly of digastric and nasal intubation for the extra length of ICA. No major complications occurred. One patient (16.6%), as the tumor could not be dissected from the adventitia of ICA so, had to resect it, and primary end-to-end anastomosis was done. External carotid artery ligation was performed in 1 (16.6%) case. Minor postoperative complications such as hoarseness of voice occurred in 2 (33%) patients. No operative mortality occurred. Conclusion: We found a predominance of women and pain as the most common presenting complaint. Resection of CBTs by surgeons with experience in vascular reconstruction is recommended. Early surgical management is recommended to avoid neurological deficit or vascular reconstruction due to a Shamblin's class III tumor. Preferred approach was caudo–cranial during dissection. Cranial nerve injury continues to be the most common complication.

Background: Hemodialysis patients require a vascular access that is both reliable and long lasting. Several variables, including population changes and comorbidities, have impacted patency rates. This study analyzes multiple parameters and estimates the patency rates and complications of brachioaxillary arteriovenous (AV) prosthetic grafts used for dialysis access in a single center. Materials and Methods: This was a prospective single-center study conducted at the Ramaiah Medical College Hospital in Bengaluru. This study comprised 92 patients with chronic renal failure who had brachioaxillary AV prosthetic graft surgery for dialysis access between 2018 and 2022. We monitored cases for up to 2 years for complications, and the primary and secondary graft patency rates were reported. Results: Seventy-five percent of the participants were male, with a mean age of 60. Diseases including hypertension (72.9% prevalence), diabetes (38.2%), and coronary artery disease (20.7% prevalence) were also very common. The present investigation found that thrombosis was the most frequent problem, followed by stenosis. In this study, the primary graft patency rates after 1 year and 2 years were 60.5% and 48%, respectively, whereas the secondary graft patency rates at 1 year and 2 years were 69% and 58%, respectively. Conclusion: The outcomes of this study regarding graft patency and complication rates compare favorably with other published data. Therefore, the authors consider brachioaxillary AV to be the optimal HD route when no acceptable forearm veins are available for creating AV fistulas.

Purpose: Antegrade superficial femoral artery (SFA) access for peripheral artery disease reduces the time, radiation, and contrast required as compared with contralateral common femoral access (CFA). However, this technique remains underutilized and understudied in the treatment of SFA, popliteal and tibial disease, and there remains limited data on the safety and efficacy of antegrade SFA access. Materials and Methods: An observational review of lower extremity peripheral arterial interventions was conducted from January 2014 to July 2021. Interventions necessitating CFA access such as iliac, common femoral, or deep femoral artery revascularization were excluded. In addition, interventions potentially requiring large sheaths were excluded. Relevant demographic and treatment variables including postoperative complications were abstracted. Results: We identified 482 patients, who underwent revascularization of the SFA, popliteal and tibial arteries. Antegrade SFA access was chosen in all these patients. Access was attained either through ultrasound or fluoroscopy guidance in 94.6% of patients. The overall rate of complications was low (access site complications, hematoma, pseudoaneurysm, etc.). Conclusions: Percutaneous antegrade SFA access can be performed safely and remains an effective alternative to retrograde CFA access with significantly less complications and is also associated with lesser utilization of fluoroscopy and contrast.

Background: High triglycerides (TG) and low High density Lipoproteins (HDL) are established coronary risk predctors (ratio of 3:1 being associated with definite increase in coronary risk). The TG/HDL ratio has also been established as a predictor of major cardio vascular events, insulin resistance and metabolic syndrome. However, the utility of the same in predicting worsening of peripheral vascular disease remains under-researched. Aims and Objectives: We aim at establishing TG/HDL ratio as a predictor of peripheral arterial disease in diabetic patients and to also explore the role of triglycerides and lipid lowering agents, in general, in modifying this risk. Materials and Methods: We carried out a cross sectional study enrolling Diabetes Mellitus patients with symptoms suggestive of peripheral vascular disease. We included 304 patients and analyzed their TG levels and TG/HDL ratios stratified as per age, gender and medical history. Relevant statistical analysis was carried out. Results: There was a difference in TG levels in men and women who developed serious peripheral vascular events with women having significantly elevated TG levels in comparison to men. The TG/HDL ratio was also found to be 8.06 in women and 7.88 in men. This was statistically significant in comparison to the control group. Conclusion: TG/HDL-C ratio, also known as atherogenic index, which is easily obtained by routine biochemical evaluation can be used to prognosticate incidence of peripheral arterial disease in addition to cardiovascular risk. This would serve as an easy Outpatient prognosticating and predictive factor for further assessment and patient education.

Objective: The objective of the study was to analyze and evaluate the possible factors in the long-term patency of arteriovenous (AV) access for hemodialysis (HD). Materials and Methods: This was a cross-sectional study recruiting patients from January 2019 to December 2019. All patients who have a working HD vascular access, either AV fistula (AVF) or AV graft which has been working for at least 2 years were included and collected demographic data along with other parameters such as timing of creation, interventions, dialysis sessions, and antiplatelet therapy among others. Results: We included 81 patients with AV access patent more than 2 years; 22.5% were aged >65 years, 39.6% were diabetic, 68.5% were hypertensive, and 26.1% had vascular disease. Analysis revealed that the patient factors such as current tobacco usage and side of creation and technical factors such as maturation time, number of dialysis sessions, and single-center dialysis have a significant effect on the patency of the AV access, while the factors such as past tobacco usage, diabetes, hypertension, use of jugular catheter before access creation, and cannulation technique could not establish any statistical effect on the patency of AV access. Conclusion: There is a complex interaction of factors that may affect the patency of an individual AV access. These need to be carefully considered when selecting surgical site or technique, adjuvant treatments, and follow-up protocols for AVFs.

Ashutosh Ojha, 1 Utkarsh Ojha, 2 Harsh Ojha, 3 Abhinaya Chandrashekar, 2 Raihan Mohammed, 4 Rudra Trivedi, 1 Sharvari Ugaonkar, 1 Manan Desai, 1 Ramesh Sreevidya, 1 Pratiksha Sahu 1 1Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM’s Narsee Monjee Institute of Management Studies, Mumbai, India; 2Faculty of Medicine, Imperial College London, London, UK; 3Department of Life Sciences, University of Warwick, Warwick, UK; 4Department of Medicine, University of Cambridge, Cambridge, UKCorrespondence: Utkarsh OjhaImperial College School of Medicine, Imperial College London, London SW7 2AZ, UKTel +44 7759667685Email utkarsh.ojha13@imperial.ac.ukObjective: To understand doctors’ attitude to and awareness of AYUSH therapies for the treatment of diabetes mellitus (DM).Methods: This qualitative study, using a usage-and-attitude survey, was conducted in secondary centers across Mumbai, India. The study surveyed 77 physicians, including those specializing in diabetes.Results: The majority of doctors were aware of Ayurveda (69%) and Homeopathy (52%). Some doctors were aware of Unani (34%) and Siddha (32%). Most doctors (60%) thought that Ayurveda was effective in some way. Almost all doctors (97%) thought that allopathic medicine was effective for DM. The majority of doctors (68%) had not recommended AYUSH therapies as an adjunct to modern medicines. Approximately half of the doctors (52%) believed that AYUSH therapies posed a safety concern for patients and 46% thought that AYUSH therapies could not be used to manage any form of DM. A large group of doctors thought that the main barrier preventing AYUSH therapies from being integrated into current allopathic management of DM was the lack of strong scientific evidence and clinical trials.Conclusion: The majority of doctors are aware to some degree of Ayurveda and homeopathic forms of treatment. The majority believe that AYUSH therapies pose a safety concern for patients and have no role in treatment for any form of DM. The most common barrier preventing AYUSH therapies from becoming a mainstream treatment option for DM is the lack of scientific evidence. From this sample, it seems that greater efforts are required to conduct research into the efficacy and safety of AYUSH therapies to ensure that doctors are able to provide holistic care for patients with DM.Keywords: diabetes mellitus, complementary medicine, public health, governmental policy, patient care

Abhinaya Chandrashekar, Jenanan MohanImperial College London Faculty of Medicine, Imperial College London, London, UKCorrespondence: Abhinaya ChandrashekarImperial College London Faculty of Medicine, Imperial College London, London SW7 2DD, UKEmail abhinaya.c.shekar@gmail.comAbstract: Doctors are required to work in teams every day at every stage in their careers. In the United Kingdom (UK), with a drive towards an integrated healthcare system, teamwork has become a major focus amongst healthcare professionals and their skill set must reflect this. For doctors, the art of teamwork needs to be developed from the early stages of training, in order to minimise fragmentation of care and its detrimental impact on patients. The World Health Organisation emphasises the importance of doctors adopting a multi-disciplinary team approach, yet amongst medical students, collaborative work is often disregarded. Fundamentally, the system that produces future doctors overlooks the importance of teamwork. Therefore, the undergraduate curriculum must be reshaped to embed teamwork within its principles. Future doctors will thus be equipped with lifelong abilities to collaborate closely amongst peers in order to deliver care holistically. Adapting medical school curricula across the UK will present inevitable challenges and these must be understood, in order to generate strategies that cultivate a culture of teamwork amongst the doctors of the future.Keywords: teamwork, team-based learning, curriculum, undergraduate, medical education

Ashutosh Ojha,1 Utkarsh Ojha,2 Raihan Mohammed,3 Abhinaya Chandrashekar,2 Harsh Ojha41Shobhaben Pratapbhai Patel School Of Pharmacy & Technology Management, SVKM’s Narsee Monjee Institute of Management Studies, Mumbai, India; 2Faculty of Medicine, Imperial College London, London, UK; 3Department of Medicine, University of Cambridge, Cambridge, UK; 4Department of Life Sciences, University of Warwick, Coventry, UKAbstract: According to the World Health Organization, 422 million adults worldwide live with diabetes mellitus (DM), a significant portion of whom have type 2 diabetes. The discovery of insulin as a key regulator of glucose metabolism has revolutionized our understanding of DM and provided several therapeutic avenues. Most studies have so far predominantly focused on the role of insulin in type 2 diabetes. However, the balance between insulin and glucagon is essential in ensuring glucose homeostasis. In this review, we begin by evaluating the principal differences between insulin and glucagon with regard to their mechanism and control of their secretion. Next, we discuss their mode of action and effects on metabolism. We further explore how the two hormones impact the natural history of type 2 diabetes. Finally, we outline how current and emerging pharmacological agents attempt to exploit the properties of insulin and glucagon to benefit patients with type 2 diabetes.Keywords: type 2 diabetes mellitus, insulin, glucagon, glucose

Introduction: Deep mycoses acquired by penetrating trauma to the skin can have varied and sometimes atypical morphological presentations resulting in diagnostic dilemmas and delay in treatment onset. Histopathology can be a useful tool in not only diagnosing but also differentiating various deep mycoses. Aims and Objectives: To observe various morphological presentations and histopathological features of deep fungal infections. Materials and Methods: A retrospective multi-centric study was conducted from 2010 to 2020 at 16 centres. The cases with diagnoses of various deep mycoses were included in the study. The patients presenting with cutaneous manifestations were included in the study. Their demographic details, history, presenting signs and symptoms, morphological presentations, histopathological features and treatment details were collected from the case sheets. Results: A total of 124 cases were found from the case records. The most common type was chromoblastomycosis (42) followed by mycetoma (28) and rhinosporidiosis (17). The mean age was 43.76 ± 5.44 years. The average duration of symptoms before presentation was between 2 months to 10 years (average 2.5 ± 1.33 years). Male to female ratio was 1:0.7. Prior history of trauma was recorded in 36 of cases. Chromoblastomycosis cases presented with verrucous to atrophic plaques with black dots on the surface and histopathology findings included pesudoepitheliomatous hyperplasia, epithelioid cell granulomas, copper penny bodies within granulomas and abscesses. Rhinosporidiosis cases had polypoid grape-like lesions in the nose and eyes most commonly with histopathology findings of abundant thick-walled sporangia in dermis packed with thousands of spores. Eumycetoma patients had pigmented, indurated swelling with multiple sinuses discharging black granules and histopathology showed dermal abscesses and foreign body granulomatous reaction with PAS-positive hyphae. Histoplasmosis patients presented with few to multiple nodulo-pustular lesions on skin and palatal ulcers while small basophilic bodies packed in the cytoplasm of histiocytes were noted in histopathology. Phaeohyphomycosis cases presented as deep-seated cystic lesions and biopsy revealed deepithelialized cysts in the dermis or hypodermis with lumen showing necro inflammatory debris and fungal hyphae. Sporotrichosis cases had erythematous, tender nodules and papules either as single lesions or as multiple lesions arranged in a linear fashion and histopathology showed pseudoepitheliomatous hyperplasia of epidermis, loose to well-defined epithelioid cell granulomas and microabscesses. Spores were found in two cases. Cryptococcosis patient had multiple umbilicated lesions resembling giant molluscum contagiosum loose epithelioid cell granulomas and medium-sized spores lying in both intra and extracellularly on histopathology. Penicilliosis patients had nodulo-pustular lesions and histopathology showed an admixture of histiocytes, epithelioid cells, plasma cells, lymphocytes and polymorphs in the dermis with the presence of yeast-like spores in the cytoplasm of histiocytes and epithelioid cells. Entomophthoromycosis cases presented with asymptomatic subcutaneous firm swelling with loss of skin pinchability. Conclusion: Though clinical findings of deep fungal infections are characteristic similar morphology and atypical presentations can be sometimes confusing. Histopathology is useful for confirming the diagnosis. Keywords: Clinical presentation, deep mycoses, histopathology, morphologies, Author(s): Subhra Dhar (corresponding author) [1]; Swetalina Pradhan [2]; Abhijit Saha [3]; Gautam Mazumder [4]; Sudip K. Ghosh [5]; Manas Biswas [6]; Abhishek De [7]; Pradip Srivastava [8]; Amrita Madnani [...]

Globally, acute kidney injury (AKI) is associated with significant mortality and an enormous economic burden. Whereas iron is essential for metabolically active renal cells, it has the potential to cause renal cytotoxicity by promoting Fenton chemistry-based oxidative stress involving lipid peroxidation. In addition, 1,25-dihydroxyvitamin D3 (calcitriol), the active form of vitamin D, is reported to have an antioxidative role. In this study, we intended to demonstrate the impact of vitamin D on iron-mediated oxidant stress and cytotoxicity of Vero cells exposed to iohexol, a low osmolar iodine-containing contrast media in vitro. Cultured Vero cells were pretreated with 1,25-dihydroxyvitamin D3 dissolved in absolute ethanol (0.05%, 2.0 mM) at a dose of 1 mM for 6 hours. Subsequently, iohexol was added at a concentration of 100 mg iodine per mL and incubated for 3 hours. Total cellular iron content was analysed by a flame atomic absorption spectrophotometer at 372 nm. Lipid peroxidation was determined by TBARS (thiobarbituric acid reactive species) assay. Antioxidants including total thiol content were assessed by Ellman’s method, catalase by colorimetric method, and superoxide dismutase (SOD) by nitroblue tetrazolium assay. The cells were stained with DAPI (4′,6-diamidino-2-phenylindole), and the cytotoxicity was evaluated by viability assay (MTT assay). The results indicated that iohexol exposure caused a significant increase of the total iron content in Vero cells. A concomitant increase of lipid peroxidation and decrease of total thiol protein levels, catalase, and superoxide dismutase activity were observed along with decreased cell viability in comparison with the controls. Furthermore, these changes were significantly reversed when the cells were pretreated with vitamin D prior to incubation with iohexol. Our findings of this in vitro model of iohexol-induced renotoxicity lend further support to the nephrotoxic potential of iron and underpin the possible clinical utility of vitamin D for the treatment and prevention of AKI.