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Abdominal tuberculosis, particularly affecting the hepatobiliary system, presents a diagnostic challenge due to its rarity and its tendency to mimic neoplastic conditions. Tuberculosis of the gallbladder, especially in the absence of pulmonary infection, is exceedingly rare. We present a case of isolated tubercular cholecystitis in a 41-year-old female initially suspected to have neoplastic etiology. Radiological imaging revealed thickened gallbladder wall with heterogenous enhancement extending into the subcutaneous plane. Histopathological examination post-cholecystectomy confirmed tubercular etiology with epithelioid cell granulomas and focal necrosis, alongside the presence of acid-fast bacilli. Such cases pose diagnostic dilemmas due to overlapping clinical and radiological features with gallbladder carcinoma. This report emphasizes the importance of considering tuberculosis in differentials, particularly in endemic regions like India, even without pulmonary symptoms. Treatment involves postoperative administration of anti-tubercular drugs, with the preoperative diagnosis being challenging and rarely achieved due to the avoidance of invasive procedures like fine needle aspiration in suspected carcinoma cases. The rarity of isolated gallbladder tuberculosis underscores the necessity for comprehensive diagnostic evaluations and awareness among clinicians in endemic regions.

The inferior vena cava (IVC) is an uncommon site for primary pathologies and secondary involvement is also infrequent, but involvement of the IVC can often drastically change management. It is therefore important to be cognizant of IVC pathologies. This review discussed common and rare neoplastic and non-neoplastic pathologies of the IVC as well as pathology mimics. Primary and secondary neoplasms can lead to tumour extension or bland thrombus formation and it is often important to distinguish between these two entities. It is also important to be aware of pseudo-lesions for accurate diagnosis. Inferior vena cava filter placement and endovascular treatment of the aorta are commonly performed procedures that can be associated with devastating complications, which are luckily infrequent. The calibre of the IVC also has its own clinical significance. Inferior vena cava pathologies, although rare, have a dramatic impact on the patient’s outcome and knowledge of these pathologies is prudent. Contribution: Understand the principles of IVC imaging, the common as well as the rare primary and secondary IVC tumours, differentiate between tumour thrombus and bland thrombus, and recognise IVC lesion mimics and life-threatening pathologies involving the IVC.

ABSTRACT: The spin-chill process at poultry processing plants involves the immersion of chicken carcasses in cold water (

The embryology of the inferior vena cava (IVC) is complex, involving the sequential appearance and regression of multiple segments that ultimately form the IVC. Any alteration in this process during embryogenesis can result in congenital anomalies of the IVC. This study aimed to recognise common as well as rare anomalies of the IVC and associated veins, and their clinical implications. The anomalies tend to have diverse appearances based on the timing and segments involved. The development of the IVC is intertwined with the development of other veins like the renal vein, azygos vein and portal vein, and these veins may also be anomalous. Additionally, IVC anomalies are associated with various other congenital anomalies including cardiac anomalies, the recognition of which may be important for patient care. The IVC tends to have multiple normal variants and anomalies because of a complex process involving multiple segments contributing to the adult IVC. Knowledge of these variants is crucial for preoperative planning of procedures. Contribution: This study would help in understanding the embryogenesis of the IVC and correlation with the imaging appearances and the clinical implications of each of these common as well as rare types of congenital anomalies.

BackgroundHigh parenting stress (PS) in members of the general population during the COVID-19 pandemic was exacerbated by work-, family-, and child-related factors. However, the negative effects of PS on the mental health and work participation of healthcare workers (HCWs) have received limited attention. This study aimed to examine the proportion of severe PS among HCWs and identify its contributory factors.MethodsThis cross-sectional survey was conducted in two COVID-19-care hospitals attached to medical colleges in India between November 1 and December 24, 2021, following the delta variant-driven second wave of COVID-19. The study recruited 662 HCW parent and child dyads (aged 1.5–18 years) and assessed workplace, family, and child-related characteristics. The Parenting Stress Scale (PSS) and Child Behavior Checklist (CBCL) were used to identify severe PS and child behavioral issues, respectively. Univariable and multivariable logistic regression analyzes were used to identify the significant and independent risk factors associated with severe PS, respectively.ResultsEqual proportions of medical and paramedical HCWs completed the survey [mean age: 36.96 ± 5.89; female: 466 (70%)]. The median PSS score of HCWs was 33 [interquartile range (IQR): 28–39], and 23% (155/662) of the HCW parents experienced severe PS. The independent predictors of severe PS included the female sex [adjusted odds ratio (aOR): 3.31; 95% confidence interval (CI): 1.74–6.29], HCWs with >15-day postings in COVID-19 care (aOR: 3.74; 95% CI: 1.53–9.16), having children with behavioral issues (aOR: 3.49; 95% CI: 1.29–9.48), HCWs at the Dehradun center (aOR: 2.25; 95% CI: 1.24–4.10), having an HCW spouse simultaneously working in COVID-19 care (aOR: 1.88; 95% CI: 1.01–3.49), and HCWs with joint families (aOR: 1.93; 95% CI: 1.17–3.18).ConclusionOverall, 23% of the cohort of HCWs continued to experience severe PS after the second COVID-19 wave driven by the delta variant in India. Routine screening of HCWs for PS using the PSS or similar measures, anticipatory guidance for parenting, and targeting at-risk HCWs with appropriate supportive measures may help reduce the incidence of severe PS and optimize the participation of HCWs in the fight against current and future pandemic-like situations.

Heterozygous mutations in SNRPB, an essential core component of the five small ribonucleoprotein particles of the spliceosome, are responsible for cerebrocostomandibular syndrome (CCMS). We show that Snrpb heterozygous mouse embryos arrest shortly after implantation. Additionally, heterozygous deletion of Snrpb in the developing brain and neural crest cells models craniofacial malformations found in CCMS, and results in death shortly after birth. RNAseq analysis of mutant heads prior to morphological defects revealed increased exon skipping and intron retention in association with increased 5′ splice site strength. We found increased exon skipping in negative regulators of the P53 pathway, along with increased levels of nuclear P53 and P53 target genes. However, removing Trp53 in Snrpb heterozygous mutant neural crest cells did not completely rescue craniofacial development. We also found a small but significant increase in exon skipping of several transcripts required for head and midface development, including Smad2 and Rere. Furthermore, mutant embryos exhibited ectopic or missing expression of Fgf8 and Shh, which are required to coordinate face and brain development. Thus, we propose that mis-splicing of transcripts that regulate P53 activity and craniofacial-specific genes contributes to craniofacial malformations. This article has an associated First Person interview with the first author of the paper.

Objective Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis. The aim of the study was to quantitatively evaluate blood–brain barrier (BBB) perfusion changes in TBM patients using dynamic contrast-enhanced (DCE) MR perfusion. Methods and Material Thirty untreated patients of TBM and 10 healthy controls were prospectively evaluated by conventional imaging and DCE MR perfusion. Mean permeability indices—Ktrans and Ve—were calculated from multiple regions of interest (ROIs) placed in basal cisterns and comparison was done between the patients and controls. Results The permeability indices were significantly higher (where p < 0.001) in cisterns of TBM patients who showed basal meningeal enhancement when compared with healthy controls. Significant differences in permeability were observed between “enhancing” cases and controls as well as in “enhancing” cases when compared with the “non-enhancing” cases. However, no significant difference was observed in the mean cisternal value between “non-enhancing” cases and the controls. Ktrans with a cutoff value of > 0.0838 had 81.6% sensitivity and 78.6% specificity in differentiating cases and controls while Ve mean value with a cutoff value of 0.0703 showed 86.8% sensitivity and 91.4% specificity in predicting the permeability difference between the cases and controls. Conclusion DCE MR perfusion is useful in the quantitative measurement of disruption of BBB and perfusion alterations in patients of TBM.

Mutations in EFTUD2 are responsible for the autosomal dominant syndrome named MFDM (mandibulofacial dysostosis with microcephaly). However, it is not clear how reduced levels of EFTUD2 cause abnormalities associated with this syndrome. To determine if the mouse can serve as a model for uncovering the etiology of abnormalities found in MFDM patients, we used in situ hybridization to characterize expression of Eftud2 during mouse development, and used CRISPR/Cas9 to generate a mutant mouse line with deletion of exon 2 of the mouse gene. We found that Eftud2 was expressed throughout embryonic development, though its expression was enriched in the developing head and craniofacial regions. Additionally, Eftud2 heterozygous mutant embryos had reduced EFTUD2 mRNA and protein levels. Moreover, Eftud2 heterozygous embryos were born at the expected Mendelian frequency, and were viable and fertile despite being developmentally delayed. In contrast, Eftud2 homozygous mutant embryos were not found post-implantation but were present at the expected Mendelian frequency at embryonic day (E) 3.5. Furthermore, only wild-type and heterozygous E3.5 embryos survived ex vivo culture. Our data indicate that Eftud2 expression is enriched in the precusor of structures affected in MFDM patients and show that heterozygous mice carrying deletion of exon 2 do not model MFDM. In addition, we uncovered a requirement for normal levels of Eftud2 for survival of pre-implantation zygotes.

Background: Falciparum malaria has been constantly associated with high morbidity and mortality for a long time. Vivax malaria, which was once thought to be a relatively benign condition, is appearing in its more malignant form, with severity gradually becoming a serious concern. Aim: This study is aimed to find out and compare the clinical and pathological manifestations of vivax and falciparum malaria in pediatric age group in Uttarakhand. Setting and Design: A prospective study was carried out at a tertiary care hospital of a medical college in Uttarakhand, India. Material and Methods: This study was done for a period of 2 years, from December 2010 to November 2012. Patients of 18 years age or below from Uttarakhand and nearby regions, who were smear positive or antigen positive were included in the study. Statistical Analysis: p value was calculated using Pearson Chisquare with Yates correction by DAG stat software. Result: Eighty Five patients were found to be suffering from malaria. 61 (71.8%) had vivax malaria, while 24 (28.2%) patients suffered from falciparum. Larger majority of malaria patients in both the groups happened to be males. The detailed study of morbidity profile clearly establishes that the complication related severity, earlier attributed to only falciparum is equally seen in vivax. Thrombocytopenia was the commonest finding in both. Other complications seen in both groups were those of cerebral malaria, severe anemia, ARDS, renal failure, malarial hepatitis, leucocytopenia, pancytopenia, shock with multiorgan dysfunction and hemoglobinuria. Even the mortality in the two groups was of the same order as p value calculated for the difference between the two species was well above 0.05. Conclusion: Vivax malaria is an important cause of mortality and morbidity. The severity of illness is almost similar in both vivax and falciparum malaria.

Tracheomalacia is a rare condition characterized by weakness of tracheobronchial cartilaginous bridges. Severe weakness results in tracheal collapse during inspiration, obstructing normal airflow. Tracheomalacia may also be associated with esophageal atresia, tracheoesophageal fistula, and gastroesophageal reflux. Aortopexy is an established surgical procedure for treatment of severe tracheomalacia. A 2-month-old boy was scheduled for aortopexy. He had already undergone repair of tracheoesophageal fistula and had failed multiple attempts at extubation. Intraoperative flexible fiberoptic bronchoscopy was performed to guide the amount and direction of aortopexy for assuring the most effective tracheal decompression. Since tracheomalacia is best assessed in a spontaneously breathing patient, it was an anesthetic challenge to maintain an adequate depth of anesthesia while allowing the patient to breathe spontaneously. Throughout the intraoperative period, SpO 2 remained ≥96%. Following the procedure, the trachea was extubated and patient was able to breathe normally.

Kasabach-Merritt syndrome is characterised by giant haemangioma, thrombocytopenia and coagulopathy. Triggering of disseminated intravascular coagulation along with the need for massive blood transfusion is the major intraoperative complication. A 1-month-old boy was scheduled for excision and split skin grafting of a giant haemangioma over the left thigh. Investigations revealed severe anaemia with thrombocytopenia that was uncorrected despite multiple blood transfusions. Other treatment modalities were also unsuccessful and the neonate was taken up for excision of the haemangioma in order to correct the consumptive coagulopathy. Standard anaesthesia was administered and all appropriate measures to reduce blood loss were instituted. Massive blood transfusion was required but the intraoperative and post-operative period was uneventful and followed by a significant improvement in the haemoglobin and platelet counts in the post-operative period.

Agriculture plays a fundamental role in India's economy, supporting 70% of rural households. While often perceived as non-productive, agricultural waste harbors materials potentially beneficial to humans through the creation and utilization of biochar in the production and processing of agricultural goods. This study conducts a comprehensive exploration into the advantages and risks associated with biochar application, considering its role as a soil amendment, bioremediation agent, and its broader implications for human health and the environment. Biochar, primarily composed of stable carbon, was initially proposed as a soil amendment to sequester carbon. Efficient resource utilization has emerged as a viable means to address global environmental challenges associated with waste disposal. This review delineates diverse agricultural waste types and sources, identifies related environmental risks, and advocates for government-led measures aligned with circular economy principles to manage such waste. Furthermore, it offers insights into potential management strategies, policy considerations, and practical approaches, fostering sustainable agriculture practices and environmental conservation in India.

Introduction: Systemic Lupus Erythematosus (SLE) is a complex, multisystem autoimmune disorder characterized by extensive inflammation that affects nearly all organ systems in the body. It is primarily mediated by auto-antibodies and immune complexes, and it predominantly affects women more than men. This study employs an in-silico approach to identify key genes potentially involved in the pathogenesis of SLE. Objectives: To identify key genes potentially involved in SLE pathogenesis using in-silico approach. Methods: High-throughput sequencing dataset GSE97264, from the Gene Expression Omnibus (GEO) database, which contains RNA transcriptome data from CD8+ T-cells of 18 SLE patients and 14 healthy controls was utilized for the analysis. Differentially expressed genes (DEGs) were identified using the Bioconductor DESeq2 package in R platform. Gene Ontology (GO) and pathway enrichment analyses were performed using the ToppGene suite. Motif analysis of the genes’ promoter regions was conducted using HOMER software. Protein-protein interaction (PPI) and Reactome functional interaction (FI) networks were created using Cytoscape plugins StringApp and ReactomeFIViz, and analysed to identify hub genes. Results: Our analysis identified 931 DEGs, with 577 upregulated and 354 downregulated. GO and pathway enrichment analyses indicated that upregulated genes were associated with immune responses, including cytokine production and receptor activation. Motif analysis identified key regulatory motifs linked to immune regulation in upregulated genes and T-cell activation in downregulated genes. PPI and FI networks analyses revealed 29 cell cycle-associated hub genes, with 10 genes—CDK1, TPX2, BIRC5, CCNA2, BUB1, BUB1B, AURKA, KIF2C, PLK1, and CDCA8—common to both biological networks, suggesting their crucial role in SLE pathogenesis. Conclusion: This study suggests that dysregulation of the identified 10 genes may impact immune responses and contribute to the autoimmune-like conditions observed in SLE. Several of these genes are also implicated in other autoimmune diseases, highlighting their potential as SLE biomarkers. Despite their known roles in other immune-related diseases involving CD8+ T cells, their direct association with SLE had not been previously established. This novel finding underscores the potential of these genes as therapeutic targets and may contribute to the development of diagnostic tools.

Seed storage is a critical concern for farmers and seed banks, as it can significantly impact the quality of seeds over time. Present study was carried out during rainy (kharif) season of 2020–21 at ICAR-Indian Agricultural Research Institute, New Delhi to understand the physiological and biochemical factors determining seed vigour traits in relation to maturity and storage periods in rice (Oryza sativa L.) varieties. In the freshly harvested seeds, early and mid-maturity group varieties exhibited higher germination percentage and seed vigour indices compared to late and very late maturity varieties. However, with increasing storage duration, germination percentage and vigour gradually decreased in the early and mid-maturity groups, while late and very late groups showed an increase up to 8 months of storage, followed by a decline after 12 months. Catalase activity (CAT) and Super oxide dismutase activity (SOD) remained stable across maturity groups and storage periods, while peroxidase activity (POD) varied significantly in fresh seeds but not during storage. Hydrogen peroxide activity (H2O2) and α-amylase content exhibited variations among maturity groups and storage periods. The study emphasizes the crucial role of maturity group selection in seeds, both for immediate sowing and long-term storage.