Search

Blunt abdominal trauma is one of the leading causes of trauma-related deaths in children. The commonly affected organs include the spleen, liver and kidneys, followed by uncommon ones such as the pancreas and intestine. Isolated duodenal injury is very rare and, at times, poses a diagnostic challenge due to the paucity of clinical symptoms and signs. Hence, delayed presentation is not uncommon. In this write-up, five such cases are presented with emphasis on their clinical presentation, diagnosis, management and outcome.

Phytolith content and its preservation in soils form a robust tool for paleoecological reconstruction. Post-depositional processes, however, influence the preservation of phytolith assemblages in soils thus making the paleoecological inferences biased. Here we evaluated the preservation of phytoliths in a Late Quaternary loess-paleosol sequence (LPS) from Kashmir Valley, northwest Himalaya. The soil micromorphological study, physicochemical parameters, phytolith morphometry, and phytolith translocation rates were employed to assess phytolith preservation and absence (not recorded) in the various litho-units of the Wanihama LPS. The comparison of phytolith content and soil physio-chemical parameters including pH, electrical conductivity, available N, P, K, organic carbon, extractable Fe, Zn, Mn and Cu do not show any significant correlation. This suggests that soil physicochemical parameters have a minor role in regulating the preservation of phytoliths in the LPS. The depth distribution of phytoliths exhibits an inconsistent pattern and phytolith content doesn't decrease systematically with depth. The phytolith content usually follows the loess-paleosol stratigraphy, with low concentrations in loess units and high concentrations in paleosols indicating that phytolith assemblages in the LPS have not been altered or translocated as a result of pedogenic processes. The micromorphological observations suggest weak pedogenesis and the sequence does not seem to be significantly mixed by bioturbation activities. This is augmented by the low translocation rate of

One of the main environmental factors that limits plant performance and lowers production is soil salinity, such as NaCl stress. Therefore, to cultivate salt-tolerant crops, it is essential to understand the physiological aspects of plant to NaCl stress and use the natural genetic resource linked with salt tolerance. Rice is relatively a salt-sensitive crop that shows a significant variation in metabolic activities towards NaCl salt stress. In this view, the present investigation was carried out to find the NaCl stress tolerance of rice (ASD-16) variety. The whole experiment was accomplished in pot culture under varying NaCl concentrations (0, 25, 50, 75, and 100mM). The salt stress was imposed on the 13th days after sowing and sampling were done after five days of treatment i.e, 18th DAS. Salt stress results in a decline in growth traits, biomass production, and also reduction in carotenoids and soluble protein contents were observed with hike in NaCl treatments. However, Chlorophyll a, b, (a+b), proline contents, were found to be increased under increasing NaCl concentrations. Thus, enhancing pigment constituents and osmolytes accumulation provides salinity stress tolerance to rice seedlings.

There is substantial evidence of the dynamic interplay between surficial geomorphic processes and active tectonics in the Zanskar Shear Zone (ZSZ), northwest Himalaya, India. The ZSZ is a result of tectonic conversion with a SW–NE orientation that began in the Late Cretaceous and became stronger in the Early Miocene as a result of the collision of the Indian and Eurasian plates. Earlier studies have addressed its tectonic activity and metamorphic activation. However, the contribution of active tectonics to the geomorphic evolution of the region is less understood. Using the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) Global Digital Elevation Model (GDEM) and Google Earth Imagery, various geomorphic features viz., alluvial fans, triangular facets, wineglass valleys, mountain fronts, knickpoints, and river terraces were identified and delineated. The study area was divided into three river sections viz., Suru, Doda, and Tsarap, running along or occasionally cutting across the strike of the ZSZ. The longitudinal river profiles suggest a relatively higher degree of tectonic activity along the Doda River, followed by the Tsarap and Suru Rivers. This spatial variation in the tectonic activity is also evident from the mountain front sinuosity index, wineglass valley index, triangular facets, and the morphometry of alluvial fans. Both the geomorphic features and morphometric parameters provide evidence of relative variation in the ZSZ activity along the Suru, Doda, and Tsarap River sections. Therefore, the present geomorphic evaluation suggests that the surficial (Quaternary) geomorphology documents the tectonic activity and its spatial variations along the ZSZ.

Chest wall reconstruction poses significant challenges. One of those challenges is choosing the correct material for reconstruction. There is debate on using prosthetic materials versus autologous tissues and rigid versus nonrigid materials. This article showcases the novel use of fascia lata for chest wall reconstruction in children.

Cancer is the top cause of death worldwide, and machine learning (ML) has made an indelible mark on the field of early cancer detection, thereby lowering the death toll. ML-based model for cancer diagnosis is done using two forms of data: gene expression data and microarray data. The data on gene expression levels includes many dimensions. When dealing with data with a high dimension, the efficiency of an ML-based model is decreased. Microarray data is distinguished by its high dimensionality with a greater number of features and a smaller sample size. In this work, two ensemble techniques are proposed using majority voting technique and weighted average technique. Correlation feature selection (CFS) is used for feature selection, and improved grey wolf optimizer (IGWO) is used for feature optimization. Support vector machines (SVMs), multilayer perceptron (MLP) classification, logistic regression (LR), decision tree (DT), adaptive boosting (AdaBoost) classifier, extreme learning machines (ELMs), and K-nearest neighbor (KNN) are used as classifiers. The results of each distinct base learner were then combined using weighted average and majority voting ensemble methods. Accuracy (ACC), specificity (SPE), sensitivity (SEN), precision (PRE), Matthews correlation coefficient (MCC), and F1-score (F1-S) are used to assess the performance. Our result shows that majority voting achieves better performance than the weighted average ensemble technique.

Lacustrine sediments, due to their widespread abundance across continents, are valuable archives of the past climate changes. The Kashmir Valley in the northwestern Himalaya, India situated at the interface of Western Disturbances and Indian Summer Monsoon moisture sources preserves undisturbed lacustrine deposits that serve as a valuable archive of past climate conditions. The spatio-temporal variability of these two monsoon moisture sources have been responsible for the Holocene climate perturbations and paleolimnological processes in the Kashmir Himalaya. The global and regional climate shifts aided by the anthropogenic forcings raises the need for a better understanding of the Holocene climate shifts and paleolimnological processes. We studied the available literature on lacustrine proxy records in order to understand the Holocene paleolimnological changes and to decipher paleoclimate, productivity and anthropogenic influences in the Kashmir valley. The analysis of the lake proxy records revealed significant changes in the regional paleoclimate conditions, lacustrine productivity and swings between drier and wetter phases. Furthermore, the region experienced a significant increase in the monsoonal precipitation during the early Holocene, followed by a progressive decline in the monsoonal rains and subsequent decreased lake water-levels and accelerated eutrophication during the late Holocene and recent times. In order to better comprehend the Holocene climate variability and its regional coherence, we compared these lake records with the regional Himalayan lakes and have elaborated about how paleolimnological processes respond to the shifting tropical-subtropical monsoon dynamics. The response of paleolimnological processes to a number of brief wet (Holocene Climate Optimum, Roman Warm Period and dry (Dark Age Cold Period and Little Ice Age) events has not been thoroughly investigated from this region, despite these events having been extensively observed from other lake systems in the Indian Himalaya. We suggest that several other lacustrine sites should be explored to generate high fidelity paleolimnology records with a stronger chronological framework to investigate the response of lacustrine processes to these short-term wet and drier phases.

Drought is one of the environmental stressors that limits plant growth, production, and is a great threat to the rising population and security throughout the globe. In the present work, we aimed to check the impact of drought stress given at different days interval drought (DID) on proso millet and its tolerance capability. The pot culture experiment was conducted and drought stress was given at 3 DID, 5 DID, and 7 DID respectively, and sampling was done on 15, 30, and 60 DAS, and unstressed plants were irrigated regularly. Drought stress results in decreased protein contents in both the roots and shoots of P. miliaceum on all sampling days. However, with increasing drought intensity and duration there was a tremendous increase in amino acids, and proline contents as well. Therefore, increasing osmolytes like proline with an increased drought period proves the role of proline in stress tolerance of proso millet and helps it to survive by maintaining osmotic potential, water influx, and detoxifying ROS. Thus, proso millet can be cultivated in drought-prone areas, and used for the breeding program.

Abstract This paper attempts to analyse India’s foreign policy towards Afghanistan in the post-9/11 era. While the 9/11 attacks marked the beginning of a new epoch in world politics, the ensuing US-led military intervention in Afghanistan offered India a much needed opportunity to re-establish diplomatic ties with Kabul. Since then, India has remained cautious in its approach toward Afghanistan by relying more on assistance-driven foreign policy measures rather than on engaging militarily in the war-torn country. However, the question remains as to what extent India has been able to create strategic space for itself in Afghanistan, given the fact that India had to shut down its embassy and consulates in Afghanistan in August 2021 when the Taliban regained control of the country? Or, has India’s policy been too reliant on soft power that India failed to capitalise on the opportunity created by the overthrow of the Taliban regime in late 2001?

Background: The safety of the male circumcision depends on many factors, including the surgeon, type of anesthesia, and associated complications. The scientific knowledge regarding safe MC is not so prevalent among masses. Aims and Objectives: To study the level of awareness regarding circumcision amongst parents and highlight factors linked to parental satisfaction. Materials and Methods: Information regarding various factors was gathered with the help of structured questionnaire-based evaluation of parental knowledge and experience. This was followed by clinical examination by a pediatric surgeon for assessment of cosmetic outcome, complications and need for additional surgical procedure. Results: Most circumcisions were performed by non-surgeons beyond neonatal period. Majority of the procedures were done under local anesthesia and around 17% procedures were done by quacks without anesthesia. More than 20% parents were dissatisfied with the procedure. Around 80% parents considered perioperative period mildly to moderately stressful. The overall complication rates were higher than usual with need for surgical correction in more than 40% patients. Conclusion: There is lack of awareness regarding safe MC practices in general public. MC by inexperienced people contributes to higher complication rates and need for redo, which in turn is related to parental dissatisfaction.

Introduction: As a result of the coronavirus disease (COVID-19) pandemic, more than 28 million planned surgeries worldwide could be cancelled leading to patients facing long waiting period for their treatment. The outbreak of COVID-19 caused by severe acute respiratory syndrome coronavirus (SARS CoV-2) has spread to more than 220 countries around the world and has almost stopped all routine surgical work. In children, the delay in the management of surgical diseases could result in significant morbidity and mortality. Material and Method: Herein, we describe our experience with the management of Paediatric Surgical patients at our centre which is a tertiary level hospital catering to both COVID-19 positive and Non-COVID patients in all specialties. Observation and Results: During the COVID-19 pandemic, 69.41% fewer paediatric surgical patients underwent surgery relative to the corresponding period 1 year earlier. However, the number of emergency cases performed increased during the COVID pandemic by 62.12%, mostly involving, urological and gastrointestinal emergencies. Conclusion: As we gain experience in effective protocol-based management, which can be revised based on the evolving scientific evidence. It will be appropriate to resume the elective work in selected patients, following the appropriate level of precautions.

Food habits and oral hygiene are critical attributes for physiochemical environment of the oral cavity. Consumption of intoxicating substances such as betel nut ('Tamul'), alcohol, smoking and chewing tobacco may strongly influence the oral ecosystem including commensal microbes. Therefore, a comparative assessment of microbes in the oral cavity between individuals consuming intoxicating substances and non-consumers may indicate the influence of these substances. Oral swabs were collected from consumers of intoxicating substances and non- consumers of Assam, India, microbes were isolated by culturing on Nutrient agar and identified by phylogenetic analysis of their 16S rRNA gene sequences. The risks of consumption of intoxicating substance on occurrence of microbes and health conditions were estimated using binary logistic regression. Mostly pathogens and opportunistic pathogens were found in the oral cavity of consumers and oral cancer patients which included Pseudomonas aeruginosa, Serratia marcescens, Rhodococcus antrifimi, Paenibacillus dendritiformis, Bacillus cereus, Staphylococcus carnosus, Klebsiella michiganensis and Pseudomonas cedrina. Enterobacter hormaechei was found in the oral cavity of cancer patients but not in other cases. Pseudomonas sp. were found to be widely distributed. The risk of occurrence of these organisms were found in between 0.01 and 2.963 odds and health conditions between 0.088 and 10.148 odds on exposure to different intoxicating substances. When exposed to microbes, the risk of varying health conditions ranged between 0.108 and 2.306 odds. Chewing tobacco showed a higher risk for oral cancer (10.148 odds). Prolonged exposure to intoxicating substances conduce a favorable environment for the pathogens and opportunistic pathogens to colonize in the oral cavity of individuals consuming intoxicating substances.

Soil salinity has become a hot debate and has gained a great scientific interest towards global food security for an increasing population. Because salinity has numerous negative effects on crop physiology and results loss of productivity. Various attempts to overcome salinity have led to detrimental effects. However, scientists have been recruited to use certain eco-friendly techniques to increase stress tolerance in plants by rising the emission rate. One of them, which is naturally present in certain plant species, is Salicylic acid, a well-known growth regulator. Since plant hormones can monitor plant development and growth, they also serve as a strong protector against various abiotic stresses. But their concentration decreases beyond the level of protection when exposed to abiotic stressors such as NaCl stress. Thus, by increasing the amount of endogenous SA, externally supplied SA has found considerable beneficial effects on plant stress resistance. SA introduces many physiological, biochemical, and molecular modifications to plants under salt stress that include immunity. Evidence of external application of SA under salt stress tolerance in plants is discussed in this review. In addition, low SA concentrations have also been addressed and its cross-talk with other regulators.

Augmented-pressure distal loop colostogram (APDC) is the most important diagnostic investigation to delineate the detailed anatomy to plan the reparative management of anorectal malformations. APDC is generally considered safe, with a very low complication rate. Herein, we present an unreported complication of APDC, manifesting as acute abdomen, due to retained contrast in distal loop. The patient was managed with evacuation of retained contrast from distal loop. We recommend evacuating the contrast from the distal loop following APDC.

Esophageal lung is a type of Group-II communicating bronchopulmonary foregut malformations (CBPFM) usually diagnosed beyond neonatal period during investigation for recurrent respiratory symptoms and persistent radiographic features suggesting pneumonia or bronchiectasis. In our case, we noticed bronchiectasis and disproportionately severe volume loss in an infant with associated multisystem anomalies in the absence of “significant” lower respiratory tract symptoms. A detailed evaluation with repeat imaging confirmed a Group-II CBPFM, a congenital pathology instead of an infective cause. Pneumonectomy is a more prudent option instead of undertaking major airway reconstruction for the dysplastic “dysfunctional” tissue. Amongst the various associated anomalies reported till now, the associated rib and renal anomalies noted by us have not been described earlier to the best of our knowledge.

Non-alcoholic fatty disease (NAFLD) is amongst the leading causes of chronic liver disease worldwide. The prevalence of NAFLD in the Middle East is 32%, similar to that observed worldwide. The clinicians in this region face several challenges in diagnosing and treating patients with NAFLD. Additionally, there are no national or regional guidelines to address the concerns faced with current treatment options. Silymarin, derived from milk thistle, provides a rational and clinically proven approach to hepatoprotection. This article focuses on addressing regional diagnostic challenges and provides clear guidance and potential solutions for the use of Silymarin in the treatment of NAFLD in the Middle East. Both clinical and preclinical studies have highlighted the efficiency of Silymarin in managing NAFLD by reducing liver disease progression and improving patient symptoms and quality of life, alongside being safe and well tolerated. An expert panel of professionals from the Middle East convened to establish a set of regional-specific diagnostics. A consensus was established to aid general physicians to address the diagnostic challenges in the region. In conclusion, Silymarin can be considered beneficial in treating NAFLD and should be initiated as early as possible and continued as long as necessary.

The treatment and outcome of respiratory virus infections differ. SARS-CoV-2, as well as other respiratory viruses such as influenza virus (A and B) and respiratory syncytial virus (RSV), require simultaneous, cost-effective, and rapid differential detection. We used a gold standard five-target single-step RT-PCR to detect influenza viruses, RSV, and SARS-CoV-2, and this method can be extended to detect influenza virus subtypes. As a result, this five-target single-step RT-PCR method is ideal for differentiating respiratory viruses. The 5’ nuclease activity of Taq DNA polymerase is used in the real-time reverse transcription PCR assay. The Taq man fast viral 1-step enzyme is a 4× Master mix and five-target primer probe mix that detects influenza A, influenza B, SARS-CoV-2 ORF1ab, respiratory syncytial viruses A/B and actin. When compared with TaqMan TM and Invitrogen superscript TM III Platinum and the Meril Kit for SARS-CoV-2, the assay demonstrated 100% sensitivity, specificity, and amplification efficiency of 90.1% for target genes. In conclusion, our one-tube multiplex RT-PCR assay offers a rapid and reliable method for the simultaneous detection of influenza A/B, RSV, and SARS-CoV-2 from nasopharyngeal swabs. This assay has the potential to enhance diagnostic capabilities and improve public health responses during respiratory outbreaks, enabling timely interventions and informed decision making.

Superabsorbent hydrogels (SAH's) refer to hydrophilic polymer networks (organic or inorganic) , that can absorb and retain huge amounts of water in their three-dimensional networks as high as 500–1500 g/g. Use of polysaccharides as backbone for synthesis of superabsorbent hydrogels has attracted substantial interest pertaining to their high hydrophilicity, non-toxicity, biodegradability, biocompatibility and natural origin that makes them suitable candidate for various applications such as drug delivery, soil conditioning, bio-sensing, food encapsulation, sustained release of fertilizers etc.. Their water absorbing and retaining properties can be controlled by the type of hydrophilic monomer and/or polymer used, synthetic methodology, the degree of cross-linking and the nature of the swelling medium. Further the porosity in the hydrogels decides their fate for different applications. This review is targeted to update and discuss some important aspects of synthesis, characterization and applications of SAH's based on some important natural polymers and their application in different fields. It is expected that the interest in these types of hydrogel will continue to grow as value-added materials.

Rambiara River basin, a sub-basin of the Upper Indus, is dotted with fluvial and glacial geomorphic landforms. The presence of large number of glacial landforms like moraines, cirques, aretes, U-shaped valleys, etc. reflects the enormous erosive power of the past glaciers. During the Last Glacial Maximum (LGM), glaciers on average were 200 m thick and extended more than 10 km from the present-day cirque marks. Rock glaciers outnumber the clean glaciers that cover an area of 0.22 and 1.25 km2, respectively, in the basin. Glacial lakes are the prominent features in the higher reaches of the basin and occupy an area ranging from 0.01 to 0.70 km2. Downstream, the river is characterized by large channel width, anomalous sinuosity, braided pattern, and the presence of unpaired fluvial terraces. The large channel width depicts the enormous discharge from the glacial- and snow-melt during the Late Pleistocene when glaciers covered most of the Pir Panjal. After LGM, the glacier cover and the river discharge significantly decreased as highlighted by a large number of braided bars and the narrow stream to which the river is reduced. The warming trends observed across the Himalayas encompassing the Pir Panjal Range since the last century has further contributed significantly to the glacier recession in the basin.

Sequestrum formation is a known complication of osteomyelitis. This is usually a source of chronic non resolving infection and inflammation. We present a rare case of pelvic sequestrum following septic arthritis of hip joint invading into the urinary bladder mimicking a bladder calculus and leading to hydroureteronephrosis.

In nature, plants are always subjected to various abiotic stresses such as drought, salinity, high temperatures and so on. Among these drought is a worldwide problem, responsible for limiting the growth, physiology and productivity of plants, thus has become a challenge for global food security towards growing population. Proso millet (Panicum miliaceum L.) belonging to family Poaceae grows under wide environmental conditions and different soil profile. In this view, an experiment was conducted to investigate the range of tolerance and change of metabolic activities of Proso millet under drought stress. The control plants were irrigated regularly and treated plants were irrigated at 3, 5, 7, day intervals up to 60day interval drought (DAS). The root and leaf samples were collected on 30 DAS, 45 DAS and 60 DAS respectively for morphological and biochemical analysis. It was found that with increasing duration of water deficit, tremendous increases of antioxidants activities were recorded at all growth stages compared to control on 7DID at 60DAS. Furthermore, a decreased rate of growth, biomass and chlorophyll content was recorded in treated plants than control. Therefore, it can be concluded that proso millet has affinity to survive under prolonged drought stress and can help to understand the mechanism of photosynthetic efficacy for improving crop productivity.

Background: Drug-resistant tuberculosis is a major public health problem throughout the world and accounts for substantial morbidity and mortality rates in India, too. Early diagnosis is the corner stone of tuberculosis treatment. State-level and cluster-wise variations in drug resistance is a possibility and should be regularly checked in from time to time. Materials and Methods: The present prospective cohort study (January 2019 to May 2022) was conducted in Darbhanga Medical College and Hospital on drug-resistant pulmonary tuberculosis patients. Sputum specimens were collected from designated centers. Rapid molecular drug-resistance testing (genotypic tests) and growth-based drug-susceptibility testing (DST) (phenotypic tests) were performed in the National Tuberculosis Elimination Program certified Laboratory. Results: A total of 268 patients with drug-resistant pulmonary tuberculosis were included in the study group. The treatment outcomes revealed as cured in 100 (37.31%); treatment completed in 43 (16.04%); died in 56 (20.89%); treatment failed in 22 (8.21%); loss of follow up in 34 (12.69%); and transferred out in 13 (4.85%) drug-resistant pulmonary tuberculosis patients. Adverse events were recorded in 199 (74.25%) of the drug-resistant pulmonary tuberculosis patients. Conclusions: Drug-resistant pulmonary tuberculosis patients are a matter of concern and need to be addressed.

Loess deposits and intercalated palaeosols are widespread in the Quaternary record, and these have been extensively used to gain insights into continental paleoclimatic and paleo-environmental conditions and changes. Especially over Eurasia, loess geoarchives play an important role for our understanding of past changes. Loess covers almost 500 km2 of the Kashmir Valley in north-western India, it occurs dominantly in plateau positions, but also on terraces and sometimes forms slope deposits with thicknesses ranging from several to more than 20 m. For the time being, however, the timing of the initiation of the loess accumulation, the provenance, the grain size composition and also the paleo-environment have not been studied systematically and yet only little quantitative data is available. Yet it is clear that deposition rates are at least comparable to European loess, and that the presence of multiple palaeosols intercalated in the loess can provide valuable information on the history of the region. The limited available data hinders regional and continental correlation, and tapping its value as archive of past environmental changes in this sensitive region with influence from Westerlies and the Indian Monsoon. However, several characteristic palaeosol patterns can be traced throughout the Kashmir valley, which provide stratigraphic information. Several studies investigate physical and chemical properties of the loess-paleosol sequences and conclude to its aeolian origin and recording of past climates. The intensity of soil formation phases is traced through various proxies in low resolution and yet without conclusive age control. Here we review the exiting literature, available data, and interpretations from loess-palaeosol sequences in the Kashmir Valley. These are placed in the context of our own observations and loess from the Indian subcontinent.

Background: There is a paucity of literature regarding the microbial etiology of community-acquired pneumonia (CAP) in India. The current study was aimed to study the microbial etiology of hospitalized adults with CAP. Methods: The study was conducted in a 700-bedded North Indian hospital. Consecutive adults admitted with CAP over a period of 2 years from 2013 to 2015 were recruited for the study, and apart from clinical evaluation underwent various microbiological studies in the form of blood culture, sputum culture, urinary antigen for pneumococcus and Legionella, serology for Mycoplasma and Chlamydia and real-time reverse transcriptase polymerase chain reaction for influenza viruses. Radiographic studies were performed in all patients and repeated as required. The patients were treated with standard antibiotic/antiviral therapy and outcomes were recorded. Results: A total of 225 patients (median age: 59 years) were enrolled. Streptococcus pneumoniae was the most common organism found (30.5%), followed by Legionella pneumophila (17.5%), influenza viruses (15.4%), Mycoplasma pneumoniae (7.2%), Chlamydia pneumonia (5.5%), Mycobacterium tuberculosis (4.8%), Klebsiella pneumoniae (4.8%), methicillin-resistant Staphylococcus aureus (3.5%), Pseudomonas aeruginosa (3.1%), methicillin-sensitive S. aureus (1.7%), and Acinetobacter sp. (0.8%) with 4% of patients having multiple pathogens etiologies. High Pneumonia Severity Index score correlated with the severity and outcome of the CAP but was not predictive of any definite etiological pathogen. In-hospital mortality was 8%. Conclusion: Streptococcus pneumoniae, Legionella, and influenza constitute the most common etiological agents for north Indian adults with CAP requiring hospitalization. Appropriate antibiotic therapy and preventive strategies such as influenza and pneumococcal vaccination need to be considered in appropriate groups.

The 2014 extreme flooding in Kashmir, with the peak discharge exceeding 115,000 cfs and the Jhelum River overflowing its banks, was triggered by the complex interplay of atmospheric disturbances causing widespread extreme rainfall for 7 days preceding the event. We used multisource data in GIS environment; satellites, hydro-meteorological, socioeconomic and field data, to assess the role of various factors in the flooding. The event was aggravated by the geomorphic setup of the Valley. Tributaries in the south, characterized by high gradient, decreased time of runoff concentration and increased flood peakedness with short lag, almost simultaneously discharge enormous volumes of floodwaters into the Jhelum around Sangam. Owing to the flat gradient of the Jhelum from Sangam downstream (

Introduction: Traumatic brain injury (TBI) is a major cause of death and disability throughout the world. Commonly used predictors of outcome both individually or in combination include age, Glasgow Coma Scale score, pupillary reactivity, early hypoxia, and hypotension. Most of the studies previously done to examine risk factors for mortality in severe TBI were done in the setting of polytrauma. Aims and Objectives: The aim and objective of this study was to do an in-depth analysis of various factors associated with the management and outcome of patients with isolated TBI admitted in an Intensive Care Unit (ICU). Materials and Methods: A total of seventy adult patients who were admitted to Intensive Critical Care Unit (ICU) with isolated TBI were selected during a 12-month period from January 2016 to December 2016. This is a prospective analytical study and parameters studied included age, sex, cause of admission classified by type of trauma, premorbid functional status, acute and chronic comorbidities, brain noncontrast computed tomography scan data, Glasgow Coma Scale (GCS), hemodynamic status, respiratory status, and mechanical ventilation, blood gases, serum electrolytes, serum glucose, hemoglobin, leukocyte and platelet counts, renal function, and urinary output. Results: The study population consisted of 46 (65.7%) males and 24 (34.2%) females. The mean age was 35.5 years (range, 18–65 years). The most common mode of trauma was road traffic accident (43.6%) followed by fall from height (35.7%). Statistically insignificant relationship (P < 0.05) was seen with sex and mode of injury among survivors and nonsurvivors; however, 61.9% of patients with age ≥40 years died (P < 0.005). Among clinical parameters at admission to ICU, low GCS, hypotension (mean arterial pressure ≤80 mmHg), hypoxia (pO2 ≤60 mmHg, spO2 ≤90 mmHg), and nonreacting pupils were significantly associated with increased mortality (P < 0.05). Conclusion: Isolated TBI still continues to have a good amount of morbidity and mortality which perhaps can be reduced by strict adherence to guidelines of management.

In an exertion to isolate natural non-harmful mosquitocidal bacteria, 158 samples of soil were collected from various habitats of Himalayan valley Kashmir. A total of 450 bacteria were screened for mosquitocidal activities against three epidemiological disease causing vectors: Aedes aegypti, Culex quinquefasciatus and Anopheles stephensi larvae/pupae. Out of 450 bacteria screened, none had shown pupicidal activity. However, two isolates KS2-15 and KS2-13 exhibited mosquito larvicidal activity against C. quinquefasciatus (LC50: 1.36 × 103 spores/mL; 1.41 × 103 spores/mL respectively) and A. stephensi (LC50: 2.14 × 103 spores/mL; 2.11 × 103 spores/mL correspondingly). These two isolates were identified, morphologically, biochemically and comparative investigation of 16S rRNA gene sequences, as Lysinibacillus sphaericus (previously Bacillus sphaericus). Sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis of spore crystal mixture of each strain revealed two major bands of around 51.4 kDa and 41.9 kDa. PCR of mosquitocidal toxin genes showed the presence of binA and binB genes in both the strains. Comparative amino acid sequence analysis revealed that the BinA (41.9 kDa) and BinB (51.4kDa) proteins of KS2-13 and L. sphaericus 2362 differ by 3 (K89E, E104A, Y176D) and 6 (A69S, K70N, I110T, N248H, H314L and L317F) amino acids respectively. Similarly BinA and BinB proteins of KS2-15 and L. sphaericus 2362 strains vary by 1(E104A) and 3 (H109P, N248H and P274S) amino acids respectively. The varied amino acid sequences could be reason for the difference in activity. These two strains can act as good candidates for insecticidal formulation. Moreover, we reported for the first time the isolation of mosquitocidal Lysinibacillus strains from Kashmir valley.

Background: Metabolic bone disease complicating chronic liver disease (CLD) has become a major clinical problem. Methods: Our study was a prospective case control study included 70 cases and 70 controls. Patients with CLD falling in age group of 18 to 65 years constituted cases group. They were thoroughly examined and were subjected to baseline investigations including kidney function test, serum calcium levels, serum phosphorus levels, liver function test, complete blood count, lipid profile. All subjects were subjected to Dual Energy X-ray Absorptiometry (DEXA) Scan (GE Lunar-1 Co. Prototype). Results: The prevalence of osteoporosis in our study at femur neck in the cases was 45.7% vs. 18% in the control group (p=0.001), while at L1-L2 it was 41.4% in cases vs. 15.7 %( p=0.001) in control group. No difference was found when both sites i.e. femur and L1-L2 were compared with each other (p=0.84, chi square of 0.33 in cases and p=0.58, chi square of 1.07 in case of controls).Prevalence of osteoporosis in our study in female cases and controls was higher than male counterparts both at femur and L1-L2. Peripheral DEXA and central DEXA had no difference in detecting osteoporosis among male and female sex. Conclusion: CLD is an independent risk factor for osteoporosis, hence patients who are first time diagnosed CLD should be screened for osteoporosis with central or peripheral DEXA, and subsequently managed to prevent complications and morbidity associated with osteoporosis.

Objective: Very few studies have been conducted in this part of world to identify relation between maternal serum homocysteine levels and congenital heart disease in their offsprings. With this perspective in mind, this study was carried out. Methods: Fifty women were enrolled in this study. Thirty of these had delivered neonates who were diagnosed to have congenital heart diseases. These were treated as cases. Twenty of these women had delivered neonates who did not have any congenital heart diseases and were treated as controls. For estimating the levels of plasma homocysteine, fasting blood samples were taken from the women in both groups. Results: Out of 30 cases, 14 (46.6%) had a tHcy level more than 15 μmol/l and all these women had delivered babies who were found to have congenital heart diseases. Out of controls, only 3 (15%) had a tHcy level more than 15 μmol/l. In babies with ventricular septal defects, the mean maternal plasma tHcy level was 13.30 μmol/l. In babies with Tetralogy of Fallot, the mean maternal plasma tHcy level was 40.07 μmol/l. In babies with Transposition of Great Vessels, the mean maternal plasma tHcy level was 40.93 μmol/l. In babies with Tricuspid atresia, the mean maternal plasma tHcy level was 24.89 μmol/l. Conclusions: Increased levels of maternal serum homocysteine are associated with increased risk of occurrence of congenital heart defects in their offsprings, suggesting that maternal hyperhomocysteinemia is an independent risk factor for congenital heart defects.

Purpose; Delayed presentation of lateral condylar fractures of the humerus is relatively common in the developing regions of the world. These fractures are difficult to manage because of the displacement and fibrosis around the condylar fragment secondary to the delay. There is a paucity of literature concerning the management of these fractures. An oft repeated finding is the requirement of extensive dissection around the fragment for proper reduction. The purpose of this study was to assess the efficacy of surgical management of lateral condylar fractures with delayed presentation. Methods; We assessed the results of lateral condylar fracture fixation in 20 cases with delayed presentation. Results; The lateral condylar fractures in patients with a delayed presentation can be managed surgically with good results. Conclusions; Open reduction and internal fixation should continue to be the method of choice for the management of lateral condylar fractures which report late for management.

Introduction: Limited data is available on prevalence of extrapancreatic infection, its influence on outcome of pancreatitis. Objectives: To assess the prevalence of extra-pancreatic infections in acute pancreatitis, identify risk factors for development of such infections and influence of extrapancreatic infections on outcome of pancreatitis. Methodology: Patients of acute pancreatitis admitted from June 2013 to July 2015 were recruited in the study. The patients who developed extra-pancreatic infection formed the study group while patients who didn’t develop infections were included in the control group. Both groups were followed and their final outcome was compared. Results: A total of 350 patients comprising of 158 cases and 192 controls were studied. Prevalence of extra pancreatic infections was found in 41.5% with Urinary tract infections (UTI)(14.4 followed by Biliary (10.0%), pulmonary (8.4%), Pulmonary and UTI (3.7%),Injection site infections (2.1%). Predisposing factors for development of extra pancreatic infections and subsequent outcome of acute pancreatitis was found to be influenced by duration of hospital stay (p