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Abstract Taro is a tropical plant and an underutilized root crop that has a good source of carbohydrate. Taro tuber contains 70%–80% of starch on dry basis. This review highlights the extraction of taro starch, latest advancements in the modification such as physical, chemical and enzymatic modification of taro starch. Furthermore, after modification of taro starch, molecular weight and amylopectin branch chain length distribution, granular shape, percentage crystallinity, swelling and solubilization, pasting and thermal properties and in vitro digestibility of taro starch were significantly affected. Additionally, researchers have explored novel methods to modify the physicochemical characteristics of taro starch, enhancing its functionality as a thickening, gelling, and stabilizing agent in various food formulations. However, fabrication of nanoparticles from taro starch was also studies. Various health benefits of taro starch have been reported in this study. One significant health benefit of taro starch is its potential to improve blood sugar management. Furthermore, the versatility of taro starch in food applications has expanded, ranging from traditional staples to modern convenience foods. Its gluten‐free nature makes it an attractive option for individuals with gluten sensitivity or celiac disease. Taro starch is increasingly incorporated into bakery products, snacks, noodles, and as a thickening agent in soups and sauces. The unique sensory attributes and nutritional profile of taro starch contribute to the development of novel, health‐conscious food products that cater to evolving consumer preferences.

Keratinocytes play an integral role in the human epidermis, serving as a barrier between the internal and external environment. They are immune-competent cells involved in both innate and adaptive cutaneous immune responses, crucial for maintaining skin integrity. Keratinocytes are essential for epidermal repair, facilitating proliferation and re-epithelialization following injury. They secrete pro-inflammatory markers such as cytokines and chemokines, which promote the recruitment of inflammatory cells like polymorphs and macrophages to the site of skin injury. The immune response mediated by keratinocytes involves signaling molecules like tumor necrosis factor (TNF), interleukin (IL)-1β, and IL-6. Langerhans cells respond to factors secreted by keratinocytes, migrating towards draining lymph nodes to activate T cells and initiate an adaptive immune response. Additionally, keratinocytes express Toll-like receptors (TLRs), enabling them to detect molecular patterns of pathogens. Recent studies have focused on understanding these interactions of keratinocytes to develop therapeutic strategies for managing various skin diseases. Genetic defects in keratinocytes underlie conditions like psoriasis. We also discuss the role of keratinocytes and the effect of neuro-endocrinal signaling and interventions, associated corticosteroidogenic pathways, and response to UV radiations to maintain a state of homeostasis. This article underlines and improves our understanding of the immune function of keratinocytes, which is crucial for developing more effective therapies against skin diseases.

The increasing global awareness of environmental sustainability and the urgent need to reduce plastic waste have driven significant interest in the valorization of agricultural by-products. This study explores the potential of fruit and vegetable waste and by-products valorization using green and novel technology such as supercritical, microwave, ultrasound, high hydrostatic pressure and cold plasma technology for developing sustainable food packaging solutions. By utilizing components such as pectin from citrus peels, starch from potato skins, and fibers from banana peels, innovative biodegradable and compostable packaging materials can be produced. These materials not only reduce reliance on petroleum-based plastics but also enhance the circular economy by repurposing waste that would otherwise contribute to environmental pollution. The research highlights various processing methods, including extraction, blending with biopolymers, and composite formation, to convert by-products into films, coatings, and moulded packaging. The resulting products exhibit desirable properties such as biodegradability, flexibility, mechanical strength, and, in some cases, antimicrobial and antioxidant activities, which can extend the shelf life of food products. Moreover, nanotechnology application in fruits and vegetables-based packaging is also discussed. Despite the promising benefits, challenges such as cost, scalability, and consumer acceptance remain. Addressing these issues through continued research, supportive policies, and industry collaboration is crucial for the widespread adoption of these sustainable packaging solutions. This study underscores the potential of agricultural by-products in creating eco-friendly food packaging, contributing to waste reduction and environmental sustainability.

Spigelian hernias are difficult to detect and palpate during physical examination due to their deeper location. They can be asymptomatic or present with acute complications such as incarceration, strangulation, or bowel obstruction. Here we present a case of a 58-year-old female with history of palpable swelling over the left iliac fossa region with abdominal distension. A computed tomography with oral contrast revealed features suggestive of incarcerated Spigelian hernia with small bowel obstruction, which was later managed with laparoscopic ventral hernia repair and repair of seromuscular tear of the small bowel. Computed tomography is the gold standard for diagnosing the condition and assessing bowel status. Conservative treatment is not effective due to the high likelihood of complications, and surgery is the mainstay of management. The approach to surgery depends on the patient's characteristics, the type of hernia, and the surgeon's experience. Mesh repair is advocated regardless of approach.

Abstract Background Optimum planting date and appropriate fertilizer module are essential facets of chrysanthemum cultivation, to enhance quality yield, and improve soil health. A field-based study was undertaken over multiple growing seasons in 2022 and 2023, where six different planting dates, viz., P1:June 15, P2:June 30, P3:July 15, P4:July 30, P5:August 15 and P6:August 30 and two fertilizer modules, FM1:Jeevamrit @ 30 ml plant−1 and FM2:NPK @ 30 g m−2 were systematically examined using a Randomized Block Design (factorial), replicated thrice. Results P6 planting resulted in early bud formation (44.03 days) and harvesting stage (90.78 days). Maximum plant height (79.44 cm), plant spread (34.04 cm), cut stem length (68.40 cm), flower diameter (7.83 cm), stem strength (19.38˚), vase life (14.90 days), flowering duration (24.08 days), available soil N (314 kg ha−1), available P (37 kg ha−1), available K (347 kg ha−1), bacterial count (124.87 × 107 cfu g−1 soil), actinomycetes count (60.72 × 102 cfu g−1 soil), fungal count (30.95 × 102 cfu g−1 soil), microbial biomass (48.79 µg g−1 soil), dehydrogenase enzyme (3.64 mg TPF h−1 g−1 soil) and phosphatase enzyme (23.79 mol PNP h−1 g−1 soil) was recorded in P1 planting. Among the fertilization module, minimum days to bud formation (74.94 days) and days to reach the harvesting stage (120.95 days) were recorded with the application of NPK @30 g m−2. However, maximum plant height (60.62 cm), plant spread (23.10 cm), number of cut stems m−2 (43.88), cut stem length (51.34 cm), flower diameter (6.92 cm), stem strength (21.24˚), flowering duration (21.75 days), available soil N (317 kg ha−1), available P (37 kg ha−1) and available K (349 kg ha−1) were also recorded with the application of NPK @300 kg ha−1. Maximum vase life (13.87 days), OC (1.13%), bacterial count (131.65 × 107 cfu g−1 soil), actinomycetes count (60.89 × 102 cfu g−1 soil), fungal count (31.11 × 102 cfu g−1 soil), microbial biomass (51.27 µg g−1 soil), dehydrogenase enzyme (3.77 mg TPF h−1 g−1 soil) and phosphatase enzyme (21.72 mol PNP h−1 g−1 soil) were observed with the application of Jeevamrit @ 30 ml plant−1. Conclusion Early planting (P1) and inorganic fertilization (NPK @ 30 g m−2) resulted in improved yield and soil macronutrient content. The soil microbial population and enzymatic activity were improved with the jeevamrit application. This approach highlights the potential for improved yield and soil health in chrysanthemum cultivation, promoting a more eco-friendly and economically viable agricultural model.

Blunt trauma abdomen with abdominal wall herniation with bowel perforation is an acute emergency condition. Road traffic accidents causing blunt trauma are common in a youngster like in our case. Once the patient is resuscitated, ultrasonography and Computed tomography must be done. Early surgical exploration with mesh or primary repair of the defect is the mainstay of management. We have a case of a 25-year-old male with blunt trauma abdomen and anterior wall hernia following a road traffic accident who was managed with emergency exploratory laparotomy as computed tomography suggested anterior abdominal wall herniation of bowel content.

Objectives: To identify optimal planting time for maximizing growth and flowering, and assess the impacts of various fertilization techniques on plant growth and soil health in chrysanthemum. Methods: The investigation was conducted at Dr. Y.S. Parmar University of Horticulture and Forestry in Nauni, Solan, Himachal Pradesh, India from 2022 to 2023. The study aimed to investigate the impact of various planting times and fertilization schedules on the yield, quality, and soil health characteristics of chrysanthemum. Different planting times from 15 June to 30 August under organic and inorganic fertilization regimes were evaluated. Data related to vegetative growth, flowering, soil chemical and biological properties were recorded. Results: Planting on 15 June along with inorganic fertilization resulted in improved vegetative characters like plant height (74.37 cm) and plant spread (30.56 cm), flowering characters like cut flower stem length (64.07 cm), stem strength (10.40°), flower diameter (11.80 cm) and duration of flowering (22.50 days) and soil chemical properties like available N, P, K (326.53, 40.36 and 359.48 kg/ha, respectively). However, planting on June 15 combined with organic fertilization led to enhancement in soil microbiological properties, including bacterial count (138.33 cfu/g soil), fungal count (31.75 cfu/g soil), actinomycetes count (62.46 cfu/g soil), microbial biomass (52.62 µg/g soil) as well as vase life (19.70 days). Conclusion: In the present study, it was found that planting time and fertilization significantly impacted chrysanthemum growth, yield and soil properties. The 15 June planting with inorganic fertilization boosted growth, yield and macronutrient content, while organic fertilization on the same date enhanced soil microflora. Flowering was influenced by planting time and organic fertilization showed promise as an alternative to chemical fertilization. Optimizing planting schedules and using organic fertilizers would lead to sustainability and offer economically viable alternatives to conventional crop management.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors involving the gastrointestinal tract, arising from the interstitial cells of Cajal. GIST comprises about 1% of all GI tumors. Rectal GISTs are rare and comprise of approximately 5% of all GISTs and only 0.1% of rectal tumors are found to be GISTs. Rectal GISTs may be diagnosed incidentally or present with symptoms, including defecation problems, bleeding, and/or pain. We report a case of a 46-year-old male with rectal GIST metastasized to the liver and bilateral lung parenchyma managed by Imatinib Mesylate (IM) regimen. Rectal GIST although being rare, must be considered as a differential diagnosis in a patient presenting with defecatory problems with bleeding.

Nanomaterials (NMs) have revolutionized food packaging by offering unique properties such as enhanced barrier functions, antimicrobial activity, and prolonged shelf life. However, concerns over the potential adverse effects of these materials on human health and the environment have prompted extensive research. This review explores the toxicological implications of NMs used in food packaging, focusing on their migration mechanisms, interactions with biological systems, and environmental impact. NMs, due to their small size and high surface area-to-volume ratio, can migrate from packaging materials into food under various conditions, potentially leading to human exposure through ingestion. Studies have highlighted the ability of certain NMs, such as silver nanoparticles (AgNPs), titanium dioxide nanoparticles (TiO2 NPs), and zinc oxide nanoparticles (ZnO NPs), to induce oxidative stress, inflammation, genotoxicity, and cellular dysfunction in vitro and in vivo. Furthermore, the environmental release of NMs during manufacturing, use, and disposal stages poses risks to ecosystems and human health. This review synthesizes current knowledge, identifies research gaps, and discusses regulatory challenges associated with the safe use of NMs in food packaging. Future research directions are proposed to enhance the understanding of NM toxicity, improve risk assessment methodologies, and develop sustainable packaging alternatives. By addressing these issues, stakeholders can effectively manage the risks while harnessing the benefits of nanotechnology in food packaging innovation.

In modern research, nanotechnology is of great interest having certain advantageous and enormous applications in various fields. Among different metal oxides, titanium dioxide (Titania) stands out among metal oxides due to its advantageous properties such as being cost-effective, non-toxic, thermally and chemically stable, biocompatible, and having a suitable band gap for solar energy conversion. It exists in three allotropic forms and can be synthesized using chemical, physical, or biological methods, with biological approaches being particularly favored for their eco-friendliness and cost-effectiveness. The multifunctional characteristics of titania enables its use in diverse industrial and research applications, including food packaging, wastewater treatment, degradation of pollutants, energy storage, and more. The review provides an overview of synthesis methods and extensive applications of titania across different life sciences and industries.

Gastrointestinal (GI) cancers account for one-fourth of the global cancer incidence and are incriminated to cause one-third of cancer-related deaths. GI cancer includes esophageal, gastric, liver, pancreatic, and colorectal cancers, mostly diagnosed at advanced stages due to a lack of accurate markers for early stages. The invasiveness of diagnostic methods like colonoscopy for solid biopsy reduces patient compliance as it cannot be frequently used to screen patients. Therefore, minimally invasive approaches like liquid biopsy may be explored for screening and early identification of gastrointestinal cancers. Liquid biopsy involves the qualitative and quantitative determination of certain cancer-specific biomarkers in body fluids such as blood, serum, saliva, and urine to predict disease progression, therapeutic tolerance, toxicities, and recurrence by evaluating minimal residual disease and its correlation with other clinical features. In this review, we deliberate upon various tumor-specific cellular and molecular entities such as circulating tumor cells (CTCs), tumor-educated platelets (TEPs), circulating tumor DNA (ctDNA), cell-free DNA (cfDNA), exosomes, and exosome-derived biomolecules and cite recent advances pertaining to their use in predicting disease progression, therapy response, or risk of relapse. We also discuss the technical challenges associated with translating liquid biopsy into clinical settings for various clinical applications in gastrointestinal cancers.

Administration of anesthesia is essential in surgical procedures, ensuring patient unconsciousness and safety. Traditional Depth of Anesthesia (DoA) assessment methods rely heavily on the clinical expertise of anesthesiologists and patient physiological responses, which can vary widely due to age, weight, and ethnicity. This variability poses significant challenges in maintaining appropriate anesthesia levels and making timely decisions in critical situations. To address these challenges, we propose XAI-VSDoA, an explainable AI model using vital signs designed to augment DoA assessment by providing accurate predictions and interpretable insights. In this work, we experimented with various machine learning classifiers, including XGBoost, CatBoost, LightGBM, Random Forest, ResNet, and Feed-forward Neural Networks. Among these, the XGBoost model achieved the highest accuracy, with 99.34% on the University of Queensland dataset and 93.07% on the VitalDB dataset. Statistical testing confirmed that XGBoost outperformed the other models. We employed explainable AI techniques such as LIME and SHAP to identify the top 10 features significantly influencing the model’s predictions, ensuring the model’s transparency and reliability. These methods consistently highlighted the same influential features, reinforcing the model’s interpretability. Our proposed scheme demonstrated exceptional performance using numeric vital signs, with XAI techniques validating the key features. This interpretability boosts confidence in the model, enhancing its utility to augument and support the clininal observations of anethesiologiss in anesthesia management. Our findings underscore the potential of XAI-VSDoA as a valuable tool for clinical use, enhancing patient safety and decision-making in anesthesia.

Introduction: Color stability and surface roughness are important factors affecting the longevity of any restorative material, as a rough surface structure can lead to staining and discoloration. Aim: The aim of this study was to evaluate the effects of application of two over-the-counter whitening toothpastes (Colgate Optic White and Close-up) on the color stability of different esthetic restorative materials (resin composite and conventional glass-ionomer). Materials and Methods: Using Mylar strips, 120 specimens were created from each restorative material (resin composite and conventional glass-ionomer). Baseline color measurement was done. This was followed by brushing the specimens according to the groups were brushed with the different whitening toothpastes. Before measuring color, the samples were washed. Results: A significant color change was observed between the two restorative materials. The color change was significantly higher with Colgate Optic White than Close-up toothpaste. Furthermore, composite material showed higher color stability than glass-ionomer cement (GIC). Conclusion: When used for 2 min twice day for 15 days, the whitening toothpastes Colgate Optic White and Close UP do create noticeable changes in the color. Furthermore, composites showed higher favorability for color stability than GIC.

The migration of chemical compounds from packaging polymers to food presents a multifaceted challenge with implications for food safety and public health. This review explores the interaction between packaging materials and food products, focusing on permeation, migration, and sorption processes. The different migration mechanisms of contact migration, gas phase migration, penetration migration, set-off migration, and condensation/distillation migration have been discussed comprehensively. The major migrating compounds are plasticizers, nanoparticles, antioxidants, light stabilizers, thermal stabilizers, monomers, oligomers, printing inks, and adhesives, posing potential health risks due to their association with endocrine disruption and carcinogenic effects. Advanced analytical methods help in the monitoring of migrated compounds, facilitating compliance with regulatory standards. Regulatory agencies enforce guidelines to limit migration, prompting the development of barrier coatings and safer packaging alternatives. Furthermore, there is a need to decipher the migration mechanism for mitigating it along with advancements in analytical techniques for monitoring the migration of compounds.

Key Clinical Message Foreign body ingestion is common in pediatric age group however can be found in any age group with intellectual disability and neurodevelopmental delay. There is usually a delay in presentation and interventions following foreign body ingestion in patients with neurodevelopmental delay, leading to increased morbidity, mortality, and complications owing to inability of such patients giving relevant history. Most ingested foreign bodies naturally pass through the digestive tract without untoward effects. Only a few patients may require surgical interventions. Principle of management should be to reduce anxiety among patients and their visitors. Speedy recovery is enhanced so that they can return to their familiar environment soon. Abstract Foreign body ingestion is common in pediatric populations and may be found in any age group with intellectual disability and neurodevelopmental delay. As the patient cannot give a clear and relevant history, there is usually a delay in presentation and interventions following foreign body ingestion in patients with neurodevelopmental delay, leading to increased morbidity, mortality, and complications. Most foreign bodies pass through the digestive system without any complications, and very few require surgical intervention. The goal should be to reduce anxiety among patients and their visitors and to enhance speedy recovery so that they can return to their familiar environment soon. Here we report a case of Acute intestinal obstruction secondary to ingestion of the head portion of a doll which was managed with emergency laparotomy with enterotomy and removal of foreign body in a 16 years female with Autism Spectrum Disorder.

Environmental problems caused by plastic pollution are among the most pressing issues of our time. In recent years, metagenomics has become a powerful tool for understanding the microbial communities responsible for plastic biodegradation. In this review, recent developments and trends in metagenomics are discussed, and a comprehensive overview of the metagenomic methodology, analysis, and comparison of plastic-degrading bacteria is provided. In addition, the environmental consequences of plastic degradation are discussed, such as the impact on soil, water, and air quality, as well as the potential health risks posed by ingesting and inhaling microplastics. Possible solutions to the plastic degradation problem, such as using biodegradable materials and implementing recycling programs, are also explained. This review highlights the potential impact of metagenomics on the development of sustainable solutions to plastic pollution.

Modeling the arrivals and prices of agricultural commodities is an essential requirement for farmers, consumers, and governmental organizations to make informed decisions. This is particularly important for perishable commodities such as vegetables, where spoilage can lead to significant losses for farmers and have a ripple effect on supply and demand dynamics. Volatility in the arrivals and prices of vegetables like onion is a serious issue affecting the common person in different ways. The study attempts to employ different time series models like the autoregressive integrated moving average (ARIMA), Artificial neural network (ANN), hybrid, and ensemble empirical mode decomposition (EEMD) techniques to analyze the pattern and trend of onions in Chandigarh and Delhi markets. From the results of the study, the amount of volatility in the data was found to range from medium to high among the markets. Decomposition techniques such as EEMD-ARIMA and EEMD-ANN performed better for the study data with the least mean absolute percentage error (MAPE) values, such as 17.74 and 6.78% for arrivals and 9.76 and 10.24% for prices at Chandigarh and Delhi markets, respectively. The EEMD techniques exceled in handling the non-linearity and non-stationarity by decomposing the data into different intrinsic modes and a residual, providing a better understanding of the fluctuation levels of data.

BACKGROUND: Ventral hernia (primary and incisional) is one of the most frequently encountered problems by the General Surgeon. The enhanced view totally extraperitoneal (eTEP) technique for inguinal hernia was first described by J Daes, which was later used in ventral hernia repair for the first time by Belyansky et al. We applied the same technique for ventral hernia repair to see its feasibility in the context of our country. MATERIALS AND METHODS: It is a single-center prospective observational study of a patient who underwent eTEP (with or without TAR) by a single surgeon between September 2019 and May 2020 and followed up for 12 months. Patient demographics, hernia characteristics, operative details, perioperative complications, and satisfaction scores using the Likert scale were collected for data analysis. RESULTS: The study included 42 patients with 66% of female among them. The mean age was 51 ± 12.97 years, the mean BMI was 29.88 ± 2.16 kg/m2, and the mean ASA of patients was 1.5. Incisional hernia (74%) was the most common diagnosis. The mean operative time was less for the primary hernia (125.45 min) than for the incisional hernia (138.35 min). Intraoperative complications were seen in three (7%) of all the patients. Postoperative length of hospital stay was 1.8 days on average. Postoperative pain was low with only one of the patients having chronic pain while none had a recurrence on follow-up. All the patients were satisfied. CONCLUSION: eTEP is a feasible, cheap, and safe alternative MIS option as it has less morbidity and does not carry an extra cost of mesh in comparison to conventional procedures.

Introduction: The trend of varicose vein disease seems to be rising globally and its treatment options and outcome vary from the institution by institution. Management of the disease has also changed from high ligation, stripping, avulsion, and sclerotherapy to minimally invasive endovenous thermal ablation. Methods: A retrospective observational study was carried out to find out the treatment methods and outcome of lower limb varicose vein disease at the cardiothoracic vascular surgery unit of the surgery department of B.P. Koirala Institute of Health Science from February 2019 to February 2020. The medical record of the patients was studied, relevant data entered and analyzed in statistical package for social sciences statistical software. Results: Total registered patient during the study period were 46; which included 29(63%) male and 17(37%) female with mean age 38.41±10.12. Saphenous femoral junction reflux was seen in 38(82.60%) cases, saphenous popliteal junction reflux was seen in nine (19.60%) cases while perforator reflux was seen in 37(80.40%) cases. Saphenous femoral junction ligation, saphenous popliteal junction ligation was performed in 36(78.30%) and 7(15.20%) cases respectively. Stripping of the greater saphenous vein was done in 35(76.10%) cases, and 9(19.60%) cases were managed conservatively. Only 5(10.90%) cases developed infection, and none of the cases were found with recurrence or nerve injury. All the cases remained satisfied during the management course. Conclusions: Saphenous femoral junction reflux was seen common and saphenous femoral junction ligation was performed on majority of the cases. Only 10% cases developed infection and all patients were satisfied during management course. Early surgical management of the disease overcomes complications and improves in the quality of life of the patients.

Abstract Background The aim of this study is to explore the treatment strategies being followed for patients with obstructing colorectal cancer (OCRC) at our institute and to know the management outcomes. Methods This study included 28 patients who were diagnosed with obstructing colorectal cancer (OCRC) either preoperatively or intraoperatively over a period of 5 years. Results Most were in the younger age group with mean age of 49.78 ± 15.96 years with 1/4th of the patients being younger than 40. There was no difference in incidence of OCRC among genders. It was found to be common in rural areas of the eastern Nepal, 16(57%) patients from such areas. 21.4% patients had complete bowel obstruction at presentation. The investigating modalities used were abdominal X-ray, ultrasonoghraphy of abdomen/pelvis, abdominal CT-scan, colonoscopy, serum CEA, punch biopsy and Faecal occult blood test. The anatomical shift to the right was observed with 54% lesions in the proximal colon. Majority were in advanced stage (stage 3:53.6%, stage 4:32.1%) with histologically adenocarcinoma (100%) and a higher incidence of synchronous lesion (28.6%). Patients averaged 13.82 days in the hospital with post-operative mortality rate of 3.6%. The 1-year and 2-years disease free survivals were 89.3% and 82.1% while overall survivals were 92.8% and 82.1% respectively. Conclusion In developing countries like ours, relatively younger patients present to health center with obstructive colorectal cancer with anatomical shift to the right sided lesions. The treatments provided at our center and their outcomes are not inferior to that of the developed world.

Background: Penetrating chest trauma can have lethal consequences. Anterior chest wall penetrating injury can cause fatal lacerations over the chest wall, lungs, pericardium, and the heart. There are few reports on these kinds of injuries and operative management. Purpose: To describe a case of penetrating chest trauma with right atrium ruptured, after a fall from height. The patient was successfully managed with prompt resuscitation and definitive surgical intervention. Case presentation: A 48-years-old gentleman presented with history of fall from height and right sided penetrating chest injury. The patient had a penetrating injury to the right-fourth intercostal space in parasternal region. Chest X-ray showed massive right-sided hemothorax and chest tube drained more than 1700 ml upon insertion. Emergency right thoracotomy was performed, after initial resuscitation with fluids and blood transfusion in the emergency department. He had injury to the intercostal arteries, lacerations of the pericardium and the right atrium ruptured, which was managed successfully with definitive repair. Conclusion: Survival is rare after penetrating chest trauma with right atrium ruptured if not intervened on time. Prompt diagnosis and resuscitation, along with the definitive surgical repair were the key elements for successful management of the patients.

PURPOSEWe aimed to evaluate the relative contribution of susceptibility weighted imaging (SWI) in the detection of common bile-duct (CBD) stones in comparison to the conventional MRI protocol containing magnetic resonance cholangiopancreatography (MRCP), balanced turbo field echo (BTFE), and T2-weighted spin-echo imaging techniques.METHODSMRI data containing MRCP, BTFE, T2-weighted imaging, and abdominal SWI were independently evaluated by 2 sets of experienced radiologists in 44 patients with confirmed CBD stones. Endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound where available, was used as the reference gold standard. Evaluation was performed for the visualization of CBD stones in each of the MRI techniques. Relative contribution of SWI was classified into one of four categories for each case: (1) no contribution to CBD stone visualization; (2) same as conventional techniques; (3) improved diagnostic confidence; and (4) critical for diagnosis. Stone size was also assessed.RESULTSInter-rater agreement coefficient for CBD stone visualization was found to be “good” in MRCP (0.77), “very good” in SWI (0.94) and BTFE (0.84), and moderate in T2-weighted imaging (0.54). CBD stones were visualized with SWI in 86.4% and 82%, with MRCP in 70.5% and 70.5% cases, with BTFE in 73% and 61.4% cases, with T2-weighted imaging in 45.5% and 52.3% cases by reviewers 1 and 2, respectively. SWI did not contribute to CBD stone visualization in 2.3% (1/44); was the same as conventional techniques in 31.8% (14/44) cases; improved diagnostic confidence in 34.1%; and was critical for diagnosis in 20.5% cases.CONCLUSIONSWI has the potential to serve as a strong adjunct to conventional MRI protocols used for CBD stone evaluation with very small scan-time penalty.

The study targets to establish a factorial association of oral microbiome alterations (oral dysbiosis) with betel quid chewing habits through a comparison of the oral microbiome of Betel quid chewers and non-chewing individuals. Oral microbiome analysis of 22 adult individuals in the Delhi region of India through the 16S sequencing approach was carried out to observe the differences in taxonomic abundance and diversity. A significant difference in diversity and richness among Betel Quid Chewers (BQC) and Betel Quid Non-Chewers (BQNC) groups was observed. There were significant differences in alpha diversity among the BQC in comparison to BQNC. However, in the age group of 21-30 years old young BQC and BQNC there was no significant difference in alpha diversity. Similar result was obtained while comparing BQC and Smoker-alcoholic BQC. BQ smoker-chewers expressed significant variance in comparison to BQC, based on cluster pattern analysis. The OTU-based Venn Diagram Analysis revealed an altered microbiota, for BQ chewing group with 0-10 years exposure in comparison to those with 10 years and above. The change in the microbial niche in early chewers may be due to abrupt chemical component exposure affecting the oral cavity, and thereafter establishing a unique microenvironment in the long-term BQC. Linear discriminant analysis revealed, 55 significant features among BQC and Alcoholic-Smoker BQC; and 20 significant features among BQC and Smoker BQC respectively. The study shows the abundance of novel bacterial genera in the BQC oral cavity in addition to the commonly found ones. Since the oral microbiome plays a significant role in maintaining local homeostasis, investigating the link between its imbalance in such conditions that are known to have an association with oral diseases including cancers may lead to the identification of specific microbiome-based signatures for its early diagnosis.

Global food waste is the biggest issue owing to food spoilage. According to the world food program, approx. 35 million people worldwide suffer from acute malnutrition. Despite this, modern civilization has a significant problem with pollution spurred by synthetic plastics (SPs). So, natural polymers are essential in reducing food spoilage and pollution from this planet. Therefore, biodegradable/edible films and coatings have drawn much attention. This review paper primarily emphasizes and addresses a historical perspective, various types of natural polymers (NPs) and their application in food packaging industries, environmental concerns, and application of cold plasma technology and nanotechnology prospects of biodegradable polymers employed in the production of biodegradable and edible packaging. In this study, polysaccharides and proteins are natural polymers that have been considered. Currently, biodegradable/edible food packaging materials are gaining popularity these days because of the pollutants produced by improper disposal of plastic packaging, and their usage has increased. However, natural polymers have advantageous properties for the development of food packaging because they are biodegradable, biocompatible, and have minimal toxicity properties. However, various modern technology such as cold plasma technology and nanotechnology application has been induced in packaging technology to modify film properties such as mechanical, physical, chemical, and barrier. Consequently, polysaccharides and proteins may be combined to produce a wide range of composite films with excellent mechanical and biological properties, making them suitable for food packaging.

Areca nut and slaked lime, with or without tobacco wrapped in Piper betle leaf, prepared as betel quid, is extensively consumed as a masticatory product in many countries across the world. Betel Quid can promote the malignant transformation of oral lesions as well as trigger benign cellular and molecular changes. In the oral cavity, it causes changes at the compositional level in oral microbiota called dysbiosis. This dysbiosis may play an important role in Oral Cancer in betel quid chewers. The abnormal presence and increase of bacteria Fusobacterium nucleatum, Capnocytophaga gingivalis, Prevotella melaninogenica, Peptostreptococcus sp., Porphyromonas gingivalis, and Streptococcus mitis in saliva and/or other oral sites of the cancer patients has attracted frequent attention for its association with oral cancer development. In the present review, the authors have analysed the literature reports to revisit the oncogenic potential of betel quid and oral microbiome alterations, evaluating the potential of oral microbiota both as a driver and biomarker of oral cancer. The authors have also shared a perspective that the restoration of local microbiota can become a potentially therapeutic or prophylactic strategy for the delay or reversal of lip and oral cavity cancers, especially in high-risk population groups.

Natural farming, popularly known as zero budget natural farming, is an innovative farming approach. It is low input based, climate resilient, and low cost farming system because all the inputs (insect repellents, fungicides, and pesticides) are made up of natural herbs and locally available inputs, thereby reducing the use of artificial fertilizers and industrial pesticides. It is becoming increasingly popular among the smallholder farmers of Himachal Pradesh. Under the natural farming system, 3 to 12 crops are cultivated together on the same area, along with leguminous crops as intercrop in order to ensure that no piece of land is wasted and utilized properly. This article focuses mainly on the different cropping systems of natural farming and comparing the economics of natural farming (NF) with conventional farming (CF) systems. Study shows that farmers adopted five major crop combinations under natural farming system, i.e., vegetables-based cropping system (e.g., tomato + beans + cucumber and cauliflower + pea + radish), vegetables-cereals-based cropping system, and other three more cropping systems discussed in this article. The results indicated that a vegetable-based cropping system has 19.68% more net return in Kharif season and 24.64% more net return in Rabi season as compared to conventional farming vegetable-based monocropping system. NF maximizes land use and reduces the chance of crop yield loss. NF has resulted in increased returns especially in the vegetable cropping system where reduction in cost was 30.73 per cent (kharif) and 11.88 per cent (rabi) across all crop combinations in comparison to CF. It is found in study that NF was cost savings from not using chemical fertilizers and pesticides, as well as higher benefit from intercrops.

Peritoneal flap mesh hernioplasty is a technique to deal with complex ventral hernias in which primary closure of the defect is not attainable. We are here presenting a case report of a 50-year-old gentleman with huge complex ventral hernia with loss of domain. The patient also had overlying ulcerated and blackish colored skin. Botulinum toxin was infiltrated into the muscles of anterior abdominal wall and was followed by peritoneal flap mesh hernioplasty after one month. The final outcome was complete closure of the midline with a healthy skin with no evidence of abdominal compartment syndrome. There was no evidence of early recurrence on follow up. Owing to the favorable outcome in this case, suitability of peritoneal flap mesh hernioplasty technique in treatment of complex ventral hernia could be explored further where closure of the primary defect is difficult.

The study was conducted in 12 different private and commercial broiler flocks for one year. Out of 23906 broiler birds examined, 1714 were clinically found to be naturally affected with gout, the incidence and mortality of gout being 7.17% and 4.37% respectively. The highest prevalence of this disease was recorded during colder months (833, 9.68%, 439, 7.06%) followed by summer (384, 5.40%) and lowest in rainy season (58, 2.92%). Of the susceptible age of first three weeks, the incidence was more during second week (9.96%), followed by first (7.63%) and third week (6.01%) of age. Out of the 12 flocks which were screened for gout 10 flocks were of cob breed (83.34%), one flock of Hubbard (8.33%) and one of Kasila breed (8.33%). The birds affected with gout had a significant (P=0.01) increase in serum uric acid (34.42 ± 1.10). The levels of serum creatinine were significantly (P>0.01) increased (2.14 ± 0.02). The mean values of TLC and PCV in the affected birds were significantly (P>0.01) high. TEC and Hb were also significantly (P>0.05) higher than control birds.

Introduction: Acute kidney injury (AKI) episodes in postrenal transplant are important determinants of short- and long-term graft survival. Renal allograft recipients (RARs) are more vulnerable for AKI and differ in risk factor, etiology, and outcome compared to community-setting AKI. The aim of this study was to evaluate the spectrum and the impact of AKI episode on RARs. Materials and Methods: This was a single-center, prospective observational study on 72 RARs (live and cadaveric) with a total of 93 AKI episodes, who were admitted with AKI (as defined by Kidney Disease Improving Global Outcome [KDIGO] criteria) between October 2016 and September 2018 and were followed for 3 months after AKI episodes. Results: A total of 93 AKI episodes occurred in 72 RARs during the study period. The mean age was 36.32 ± 12.03 years and mean serum creatinine at AKI episode was 2.59 ± 0.85 mg/dl. The etiologies of AKI were infections (n = 67, 72.04%), biopsy-proven rejection (n = 10, 10.75%), calcineurin inhibitor toxicity (n = 9, 9.67%), biopsy-proven acute tubular necrosis (n = 3, 3.22%), recurrence of native kidney disease (n = 2, 2.15%), and miscellaneous causes (n = 2, 2.15%). The majority (n = 53, 57.98%) of AKI episodes developed in the 1st year of transplant, 14 (15.05%) between 1st and 2nd year posttransplant, while the rest 26 (27.95%) beyond 2 years. Sixty-nine (74.2%) AKI episodes were in the KDIGO Stage 1, 18 (19.4%) were in Stage 2, and 6 (6.5%) episodes were in Stage 3. At 3 months of follow-up, various factors associated with nonrecovery of renal functions, including multiple AKI episode (P = 0.006), AKI requiring dialysis (P = 0.027), AKI Stage II or III (P = 0.003), and noninfectious etiology (P = 0.027). Overall, AKI had significant impact on renal allograft function at 3 months (P = 0.045). Pulmonary infection (P = 0.016) and need for dialysis (P = 0.001) were associated with increased risk of mortality in RARs after AKI. Conclusion: AKI in RARs had significant impact on renal allograft function and recovery.

A 66-year-old male presented with chief complaints of anorexia associated with mild dull, intermittent epigastric pain for 6 months. The patient was a known diabetic on oral hypoglycemic and on routine checkup was found to have deranged liver function profile. On radiology, an ill-defined hypoechoic enhancing lesion involving head, neck, and uncinate process of pancreas was noted. Whipple's pancreaticodudenectomy was done and reported as IgG4-related autoimmune pancreatitis. Later, IgG (slightly) and IgG4 were found to be markedly raised. We report this case to highlight the importance of IgG4 evaluation prior to major surgery in uncertain pancreatic mass.

Freestanding (suspended) graphene films, with high electron mobility (up to ~200,000 cm2V−1s−1), good mechanical and electronic properties, could resolve many of the current issues that are hampering the upscaling of graphene technology. Thus far, attempts at reliably fabricating suspended graphene devices comprising metal contacts, have often been hampered by difficulties in exceeding sizes of 1 µm in diameter, if using UV lithography. In this work, area of suspended graphene large enough to be utilized in microelectronic devices, have been obtained by suspending a CVD graphene film over cavities, with top contacts defined through UV lithography with both wet and dry etching. An area of up to 160 µm2 can be fabricated as backgated devices. The suspended areas exhibit rippling of the surfaces which simultaneously introduces both tensile and compressive strain on the graphene film. Finally, the variations of the Fermi level in the suspended graphene areas can be modulated by applying a potential difference between the top contacts and the backgate. Having achieved large area suspended graphene, in a manner compatible with CMOS fabrication processes, together with enabling the modulation of the Fermi level, are substantial steps forward in demonstrating the potential of suspended graphene-based electronic devices and sensors.

Objectives: It is difficult to capture the severity of synovial inflammation on imaging. Herein we hypothesize that diffusion tensor imaging (DTI) derived metrics may delineate the aggregation of the inflammatory cells and expression of inflammatory cytokines and dynamic contrast-enhanced (DCE) imaging may provide information regarding vascularity in the inflamed synovium. Patients and methods: Patients with knee arthritis (>3-months duration) underwent conventional (T2-weighted fast spin echo and spin echo T1-weighted images) as well as DTI and DCE MRI and thereafter arthroscopic guided synovial biopsy. DCE and DTI metrics were extracted from the masks of the segments of the inflamed synovium which enhanced on post-contrast T1-weighted MRI. These metrics were correlated with immunohistochemistry (IHC) parameters of inflammation on synovium. Statistical analysis: Pearson’s correlation was performed to study the relationship between DTI- and DCE-derived metrics, IHC parameters, and post-contrast signal intensity. Linear regression model was used to predict the values of IHC parameters using various DTI and DCE derived metrics as predictors. Results: There were 80 patients (52 male) with mean age 39.78 years and mean disease duration 19.82 months. Nineteen patients had tuberculosis and the rest had chronic undifferentiated monoarthritis (n = 31), undifferentiated spondyloarthropathy (n = 14), rheumatoid arthritis (n = 6), osteoarthritis (n = 4), reactive arthritis (n = 3), ankylosing spondylitis (n = 2), and juvenile idiopathic arthritis (n = 1). Fractional anisotropy (FA), a metric of DTI, had significant correlation with number of immune cells (r = 0.87, p < 0.01) infiltrating into the synovium and cytokines (IL-1β, r = 0.55, p < 0.01; TNF-α, r = 0.42, p < 0.01) in all patients and also in each group of patients and adhesion molecule expressed on these cells in all patients (CD54, r = 0.51, p < 0.01). DCE parameters significantly correlated with CD34 (blood flow, r = 0.78, p < 0.01; blood volume, r = 0.76, p < 0.01) in each group of patients, a marker of neo-angiogenesis. FA was the best predictor of infiltrating inflammatory cells, adhesion molecule and proinflammatory cytokines. Amongst the DCE parameters, blood volume, was best predictor of CD34. Conclusion: DTI and DCE metrics capture cellular and molecular markers of synovial inflammation in patients with chronic inflammatory arthritis.

The design and construction of polyoxometalate (POM)-templated silver clusters have received increasing attention, not only due to their aesthetic structures but also to their wide applications in chromatic materials, magnetism, electronics, and fluorescence. Among various POM-templated silver clusters, asymmetrically-wrapped POM–silver clusters have unusual structures: POMs have exposed surfaces and an asymmetrically-connected silver shell, which endows the clusters with distinctive properties, such as redox and electrocatalytic activities. This review summarizes recent developments in this field, highlighting the syntheses, structures, and properties of the asymmetrically-wrapped POM–silver clusters. The formation mechanisms, challenges, and perspectives of such clusters are also discussed. We believe that this review will motivate the development of the asymmetrical templation effect of POM in silver clusters.

Background Near-patient access to appropriate tests is a major obstacle for the efficient diagnosis of tuberculosis (TB) and associated drug resistance. Methods We recently developed the “TB Concentration & Transport” kit for bio-safe, ambient-temperature transportation of dried sputum on Trans-Filter, and the “TB DNA Extraction” kit for DNA extraction from Trans-Filter for determining drug resistance by DNA sequencing. In the present study, we evaluated the compatibility of Kit-extracted DNA with Hain's line probe assays (LPAs), which are endorsed by National TB programmes for the detection of drug resistance in sputum collected from presumptive multidrug-resistant TB patients (n=207). Results Trans-Filter-extracted DNA was seamlessly integrated with the LPA protocol (Kit-LPA). The sensitivity of Kit-LPA for determining drug resistance was 83.3% for rifampicin (95% CI 52–98%), 77.7% for isoniazid (95% CI 52–94%), 85.7% for fluoroquinolones (95% CI 42–100%) and 66.6% for aminoglycosides (95% CI 9–99%), with a specificity range of 93.7% (95% CI 87–97) to 99.1% (95% CI 95–100) using phenotypic drug susceptibility testing (DST) as a reference standard. A high degree of concordance was noted between results obtained from Kit-LPA and LPA (99% to 100% (κ value: 0.83–1.0)). Conclusions This study demonstrates successful integration of our developed kits with LPA. The adoption of these kits across Designated Microscopy Centres in India can potentially overcome the existing challenge of transporting infectious sputum at controlled temperature to centralised testing laboratories and can provide rapid near-patient cost-effective “Universal DST” services to TB subjects residing in remote areas.

Abstract Isolated duodenal injury is rare as they are usually associated with other visceral injuries. Diagnosis of a duodenal injury is difficult, and its management is challenging. Hence, it is important to timely recognize such injuries for better outcome.

Leiomyomas are benign uterine smooth muscle neoplasms with varied morphology that are well known to undergo secondary changes. Cotyledonoid dissecting leiomyoma is a rare and distinct form of leiomyoma that poses a diagnostic challenge for clinicians, radiologists, and pathologists and can be confused with malignant uterine neoplasms. Only a few cases have been reported so far in the literature. Here we report a case of a cotyledonoid dissecting leiomyoma in a 60-year-old woman, emphasize its gross and histological features, and provide a review of the literature.

Von Recklinghausen’s disease (VRD) is a hereditary disease that occurs because of mutation in NF1 gene located on chromosome 17. About 25% of VRD patients are reported to suffer from gastrointestinal lesions varying from hyperplasia of the gut neural tissue, endocrine tumors of the duodenum and the periampullary region, and gastrointestinal stromal tumors. Herein, we describe a case of ampullary neuroendocrine tumor with unique histology and immunohistochemistry in a 35-year-old male patient with VRD, detailed review of literature.

We report the case of a 5-year-old male child presenting with seizures for 4 months. Magnetic resonance imaging (MRI) revealed a cortical-based solid cystic lesion in the right parietal lobe. Histopathological examination showed a tumour comprised of spindled glial fibrillary acid protein (GFAP) positive neoplastic cells interspersed with bizarre pleomorphic cells showing nuclear pseudoinclusions and intermingled dysplastic ganglion cells variably immunopositive for synaptophysin, chromogranin, Neu-N and immunonegative for neuron filament protein (NFP). This report highlights the occurrence of the rare composite pleomorphic xanthoastrocytoma-ganglioglioma and the vagaries of immunohistochemical analysis in highlighting neuronal differentiation in such a case setting. In addition, to the best of our knowledge this is the youngest patient till date to present with this entity.

Introduction: Cholelithiasisis is a common surgical problem worldwide. Gall bladder perforation is a rare life-threatening complication with considerable mortality. This study aims to find the etiology, demography, type of perforation, and outcome of gall bladder perforation. Methods: This descriptive cross-sectional study was done on patients above 18 years of age visiting the department of surgery of B. P. Koirala Institute of Health Sciences (BPKIHS) who were diagnosed with isolated gall bladder perforation. The study was done from 1st January 2006 till 30 December 2016. Ethical approval was obtained from the Institutional Research Committee (reference number. 34/074/075). The convenient sampling method was used. Data were entered in excel sheets and analyzed. Results: Out of 49 patients included in the study, 28 (57.14%) were females and the commonest age group was 36 to 50 years 22 (44.9%) followed by 51 to 65 years 16 (32.6%). Most of the patients presented in emergency with pain in their abdomen. Diabetes mellitus was the commonest co-morbidity present in 10 (20.41%) patients. Operative management was done in 45 (91.84%) of the patient and conservative management in 4 (8.16%). After surgery of 45 patients, 43 (95.56%) improved and 2 (4.44%) expired. The most common type of perforation was Niemeier Type I in 21 (46.67%) followed by Type III 14 (31.11%). The most common histopathological diagnosis was acute cholecystitis 20 (44.44%). Conclusions: Isolated gall bladder perforation is not an uncommon complication. The most common etiological factor was acute cholecystitis with a slight female predominance. Most of the patients needed surgical intervention and they had good outcomes when diagnosed and managed on time.

Abdominal tuberculosis (ATB) continues to pose a major diagnostic challenge for clinicians due to its nonspecific clinical presentation, variable anatomical location and lack of sensitive diagnostic tools. In spite of the development of several assays till date; no single test has proved to be adequate for ATB diagnosis. In this study, we for the first time report the detection of circulating cell-free Mycobacterium tuberculosis (M. tuberculosis) DNA (cfMTB-DNA) in ascitic fluid (AF) samples and its utility in ATB diagnosis. Sixty-five AF samples were included in the study and processed for liquid culture, cytological, biochemical and molecular assays. A composite reference standard (CRS) was formulated to categorize the patients into 'Definite ATB' (M. tuberculosis culture positive, n = 2), 'Probable ATB' (n = 16), 'Possible ATB' (n = 13) and 'Non-TB' category (n = 34). Two molecular assays were performed, namely, the novel cfMTB-DNA qPCR assay targeting M. tuberculosis devR gene and Xpert MTB/RIF assay (Xpert), and their diagnostic accuracy was assessed using CRS as reference standard. Clinical features such as fever, loss of weight, abdominal distension and positive Mantoux were found to be strongly associated with ATB disease (p

Background and Objective(s). Rouviere’s sulcus (RS) is an important anatomical landmark. The aim of this study was to find the distribution of anatomical characteristics of RS seen during laparoscopic cholecystectomy in the population of our part of the world and its association with complications. Methods. This is a prospective observational study involving patients of age ≥16 years who underwent laparoscopic cholecystectomy for uncomplicated gall stone at BPKIHS between May and July 2019. Result. 230 cases were analyzed, and RS was present in 90.4%. Open sulcus type was the commonest (54%), followed by scar type (22.9%), closed sulcus type (12.5%), and slit type (10.6%), respectively. In 59.1% of cases, it was oblique to the anterior, inferior, and external edge of the liver, while in the remaining cases, it was transverse. The mean ± SD values for operative time and duration of hospital stay in the RS visible and the RS not visible groups were 29.16 ± 8.736 and 42.9 ± 23.646 minutes, and 1.26 ± 0.440 and 1.90 ± 0.910 days, respectively (p value ≤0.001). One minor complication occurred in each group: RS initially visible group and RS visible on the adhesion release group, while 3 minor complications occurred in the RS not visible group. Only one major complication occurred in the RS not visible group. Conclusion. Identification of RS by operating surgeons is a predictor of safe laparoscopic cholecystectomy.

Postpartum acute kidney injury (AKI) is one of the serious complications of pregnancy and is associated with high mortality and morbidity. We conducted this study to determine the characteristics and outcome of the most severe form of postpartum AKI requiring dialysis. This prospective, observational study was conducted in Sawai Man Singh Medical College, Jaipur. All postpartum female suffering from AKI requiring dialysis between July 2014 and December 2016 were included in the study. Demographic, clinical and laboratory data of the patients were recorded. Outcome variables included survival at hospital discharge and estimated glomerular filtration rate (eGFR) at three months of follow-up. Sixty (88.2%) out of 68 women admitted with postpartum AKI required dialysis. The mean age was 26.5 ± 4.3 years and the majority (80%) had institutional delivery. The mean sequential organ failure assessment (SOFA) score was 8.0 ± 2.9. Puerperal sepsis (n = 37, 61.6%), preeclampsia (n = 21, 35%), and antepartum hemorrhage (n = 14, 23.3%) were the most common obstetric complication associated with postpartum AKI. Maternal mortality was 28.3%. Higher SOFA score (P = 0.015, odds ratio [OR]: 1.99, confidence interval [CI]: 1.14–3.45) and diagnosis of sepsis (P = 0.048, OR: 26.3, CI: 1.03–678.3) were the independent predictors of mortality. Out of 37 patients who were followed up at three months, 51.3% had eGFR

Background and Aims: Liver biopsy may be considered in patients with hepatitis C virus (HCV) infection to assess the severity of liver injury and stage of fibrosis, thereby guiding therapeutic decisions. In addition, advanced stage also necessitates surveillance for hepatocellular carcinoma. The aim of this study was to assess whether transaminase (alanine transaminase [ALT]) levels and RNA titers correlate with the histological activity index (HAI) and fibrosis (F) stage in asymptomatic patients with incidentally detected HCV (IDHCV). Patients and Methods: Retrospective evaluation of liver biopsies was done in 113 patients with IDHCV, diagnosed during routine screening. Decision of liver biopsy was made on the basis of age, genotype, acceptable clinical, hematological, and biochemical profiles, and willingness of the patients to undergo treatment. Serum ALT levels, HCV RNA titers, and genotypes were correlated with HAI and F stage. Results: Genotyping was done in 77 of the 113 patients, of which genotype 3 was seen in 43 and genotype 1 in 25 patients. A higher fibrosis stage (Ishak's >F2) was noted in 23.8% of the biopsies. Serum ALT showed a significant correlation with the HAI score on liver biopsy (P = 0.01) but not with the stage of fibrosis (P = 0.52). HCV RNA titers did not reveal any correlation with HAI score or fibrosis stage. Conclusion: Serum transaminases and HCV RNA titers are poor predictors of disease severity and fibrosis. Since HCV shows a slow disease progression, higher stage may predict a worse prognosis irrespective of the low viral RNA load. Liver biopsy may help guide therapeutic decisions in IDHCV infection.

Abstract Background Dynamic-contrast-enhanced (DCE) MRI data acquired using gradient echo based sequences is affected by errors in flip angle (FA) due to transmit B1 inhomogeneity (B1inh). The purpose of the study was to evaluate the effect of B1inh on quantitative analysis of DCE-MRI data of human brain tumor patients and to evaluate the clinical significance of B1inh correction of perfusion parameters (PPs) on tumor grading. Methods An MRI study was conducted on 35 glioma patients at 3T. The patients had histologically confirmed glioma with 23 high-grade (HG) and 12 low-grade (LG). Data for B1-mapping, T1-mapping and DCE-MRI were acquired. Relative B1 maps (B1rel) were generated using the saturated-double-angle method. T1-maps were computed using the variable flip-angle method. Post-processing was performed for conversion of signal–intensity time (S(t)) curve to concentration–time (C(t)) curve followed by tracer kinetic analysis (Ktrans, Ve, Vp, Kep) and first pass analysis (CBV, CBF) using the general tracer-kinetic model. DCE-MRI data was analyzed without and with B1inh correction and errors in PPs were computed. Receiver-operating-characteristic (ROC) analysis was performed on HG and LG patients. Simulations were carried out to understand the effect of B1 inhomogeneity on DCE-MRI data analysis in a systematic way. S(t) curves mimicking those in tumor tissue, were generated and FA errors were introduced followed by error analysis of PPs. Dependence of FA-based errors on the concentration of contrast agent and on the duration of DCE-MRI data was also studied. Simulations were also done to obtain Ktrans of glioma patients at different B1rel values and see whether grading is affected or not. Results Current study shows that B1rel value higher than nominal results in an overestimation of C(t) curves as well as derived PPs and vice versa. Moreover, at same B1rel values, errors were large for larger values of C(t). Simulation results showed that grade of patients can change because of B1inh. Conclusions B1inh in the human brain at 3T-MRI can introduce substantial errors in PPs derived from DCE-MRI data that might affect the accuracy of tumor grading, particularly for border zone cases. These errors can be mitigated using B1inh correction during DCE-MRI data analysis.

BACKGROUND: Nigella sativa and its derivatives have been reported to have anti-inflammatory and bronchodilator effects, but the effects have been evaluated in only a few clinical studies. OBJECTIVES: To determine the effect of N sativa supplementation on inflammation of the airways and limitation of airflow in partly controlled asthma patients. DESIGN: Single-blind, placebo-controlled, randomized study. SETTING: Asthma and allergy clinic of a university hospital in eastern Saudi Arabia. PATIENTS AND METHODS: Patients were divided into three groups. A control group (n=24) received the placebo, while NS-1 and NS-2 groups (n=26 each) received 1 and 2 g/day of N sativa, respectively, for 3 months along with maintenance inhaled therapy. MAIN OUTCOME MEASURE(S): Asthma control test (ACT) score, fractional exhaled nitric oxide (FeNO), peak expiratory flow (PEF) variability and other pulmonary function tests, IgE, serum cytokines, and frequency of exacerbations. RESULTS: FEF25-75% and FEV1 (% predicted) increased significantly (P

India has the highest burden of Tuberculosis (TB) and multidrug-resistant TB (MDR-TB) worldwide. Innovative technology is the need of the hour to identify these cases that remain either undiagnosed or inadequately diagnosed due to the unavailability of appropriate tools at primary healthcare settings. We developed and evaluated 3 kits, namely 'TB Detect' (containing BioFM-Filter device), 'TB Concentration and Transport' (containing Trans-Filter device) and 'TB DNA Extraction' kits. These kits enable bio-safe equipment-free concentration of sputum on filters and improved fluorescence microscopy at primary healthcare centres, ambient temperature transport of dried inactivated sputum filters to central laboratories and molecular detection of drug resistance by PCR and DNA sequencing (Mol-DST). In a 2-site evaluation (n = 1190 sputum specimens) on presumptive TB patients, BioFM-Filter smear exhibited a significant increase in positivity of 7% and 4% over ZN smear and LED-FM smear (p

ObjectiveTo assess the inter-technique agreement of relative cerebral blood volume (rCBV) measurements obtained using T1- and T2*-perfusion MRI on 3T scanner in glioma patients.MethodsA total of 49 adult patients with gliomas underwent both on T1- and T2*-perfusion in the same scanning session, and rCBV maps were estimated using both methods. For the quantitative analysis; Two independent observers recorded the rCBV values from the tumor as well as contralateral brain tissue from both T1- and T2*-perfusion. Inter-observer and inter-technique rCBV measurement agreement were determined by using 95% Bland-Altman limits of agreement and intra-class correlation coefficient (ICC) statistics.ResultsQualitative analysis of the conventional and perfusion images showed that 16/49 (32.65%) tumors showed high susceptibility, and in these patients T2*-perfusion maps were suboptimal. Bland-Altman plots revealed an agreement between two independent observers recorded rCBV values for both T1- and T2*-perfusion. The ICC demonstrated strong agreement between rCBV values recorded by two observers for both T2* (ICC = 0.96, p = 0.040) and T1 (ICC = 0.97, p = 0.026) perfusion and similarly, good agreement was noted between rCBV estimated using two methods (ICC = 0.74, PConclusionsIn the current study, T1- and T2*-perfusion showed similar diagnostic performance for discrimination of grade III and grade IV gliomas; however, T1-perfusion was found to be better for the evaluation of tumors with intratumoral hemorrhage, postoperative recurrent tumors, and lesions near skull base. We conclude that T1-perfusion MRI with a single dose of contrast could be used as an alternative to T2*-perfusion to overcome the issues associated with this technique in brain tumors for reliable perfusion quantification.

Introduction: Inflammatory Bowel Disease (IBD) is a chronic, relapsing inflammatory disorder of gastrointestinal tract that encompasses chronic Ulcerative Colitis (UC) and Crohn’s Disease (CD). Traditionally, it was believed to occur mainly in western countries like North America and Europe, but now perhaps with increasing westernisation, it has become a global disease with accelerating incidence in Africa and Asian countries like India and Nepal, which has also mirrored the growth compared to its neighbouring countries, where there has been an increased detection of this disease over the past few years. Aim: To review the experience in the disease profile and management of IBD in our surgical unit. Materials and Methods: This was a retrospective analysis of prospectively maintained data from January 2009 to May 2017 at BP Koirala Institute of Health Sciences, a tertiary care centre at the Eastern region of Nepal. The patients were grouped into two periods (first: January 2009 to March 2015; second: April 2015 to May 2017). We managed 30 cases (UC-19 and CD-11) in the surgical unit. Results: Eleven vs nineteen IBD patients were managed in the first and second time periods respectively. The median age of the patient with UC was 45.1 years. The most common presenting symptom was rectal bleeding. Pancolitis and left sided colitis was each seen in 42% and 52.6% of patients, respectively. Severe to fulminant colitis was seen in 36% of patients. Seven patients requiring surgical intervention (staged restorative total proctocolectomy-6 and total proctocolectomy with end ileostomy-1), while the remaining 12 cases were managed with a non operative treatment. Similarly, the median age of patient with CD was 55 years. The most common presenting symptom was pain abdomen. Eight patients had predominant small bowel involvement, two colonic, while one patient had both small and large bowel involvement. All patients required surgical intervention for symptoms related to it. At one year of follow-up, three patients had recurrence, two requiring initiation of anti-tumour necrosis factor therapy. Conclusion: IBD is no more a rare disease in a country like Nepal. With the global rise in incidence, there has been increased detection of IBD cases at our centre (9.5 cases/ year in the second period vs 1.8 cases/year in the first period) probably due to increased awareness and establishment of a separate Gastrointestinal unit with a specialist team trained from high volume centre.