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Introduction: N95 Filtering Face-piece Respirators (FFRs) prevent the spread of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection and protect medical personnel. It is considered as one of the essential protective equipment. An increased demand for N95 FFRs during the Coronavirus Disease 2019 (COVID-19) pandemic has resulted in shortage crisis for the care of cases arising in hospitals. Therefore, this situation generated the need to implement alternatives like four mask policy that allows reuse of N95 FFRs in settings with limited resources. Aim: To find out the burden of bacterial isolates on N95 FFRs after reuse. Materials and Methods: The present study was a prospective study conducted at Govt. R.D.B.P. Jaipuria hospital, Jaipur, Rajasthan, India, from May 2021 to October 2021 on 526 used N95 FFRs after multiple or extended use by 96 hospital personnel who attended Outpatient Department (OPD) services. Swab samples were collected from both external as well as internal surface of the mask after each use and further subcultured to identify any microorganism present on them. Results: Growth of Gram positive bacilli, and micrococci were found on 499 samples out of total 526 samples. Other bacteria like Pseudomonas spp. and other gram negative were also observed in 19 samples. Furthermore, it was also observed that bacterial load on reused N95 FFRs was mainly commensal flora. Conclusion: Mainly commensal floras were found over internal and external surface of used N95 FFRs. This proves that four mask policy is optimum for judicious use of N95 FFRs and resulted in saving of funds for other more emergency works mainly in OPD settings. [ABSTRACT FROM AUTHOR]

Multiple visits are needed to achieve euthyroidism on levothyroxine in newly detected primary hypothyroidism. We aimed to develop a levothyroxine dose estimation algorithm for primary hypothyroidism. Adults with newly diagnosed hypothyroidism were enrolled prospectively, first in the training cohort, followed by the validation cohort separated by time and person. We developed a predictive algorithm from Training Cohort and validated the model in Validation Cohort. Training Cohort: In this cohort, 358 subjects (259 women and 99 men) were enrolled. The median duration needed to achieve euthyroidism was 4±0.5 months. The mean levothyroxine daily dose was 60.5±34.1 μg. Data of euthyroid subjects within 6 months of treatment initiation and age range 18–65 years were used for algorithm development. In the multivariable linear regression algorithm, pretreatment serum thyrotropin level, and sex formed the best-fit predictive model (adjusted R2 0.73, p-value <0.001). Validation Cohort: Eighty-four subjects (61 women and 23 men) were enrolled and started on an estimated levothyroxine dose derived from the developed prediction model. On the first follow-up on treatment, 34/50 participants achieved euthyroidism (68%) at 1.5 months. In conclusion, the proposed prediction model for levothyroxine dose estimation effectively achieves early euthyroidism in two-third subjects in the age range of 18–65 years. [ABSTRACT FROM AUTHOR]

Background: Nursing staff plays a major role in the delivery of insulin to hospitalized patients. We aimed at studying the adequacy of desired knowledge related to insulin in nursing staff in a tertiary care government-funded teaching hospital in India. Methods: A cross-sectional descriptive design study was conducted to assess the basic insulin-related knowledge in nursing staff by a self-administered questionnaire. Results: A total of 101 nursing staff accepted to participate in the study and returned the completed questionnaire. Forty-one participants were female and 60 were male. Almost 80% of participants denied as trained for diabetes management in hospitalized patients in their nursing curriculum. Eighty-seven participants were comfortable giving insulin. Only two participants could identify basal and bolus insulin as the type of insulin needed to manage hyperglycemia. Twenty-five participants could identify the strengths of insulin vials available in India and only 8 could correctly mention the colour code of the corresponding insulin syringe. Only 15 participants could correctly identify the commonly used routes of inulin administration. Thirty participants could identify all the correct subcutaneous injection sites, however, at least one wrong site was chosen by 78 participants and 8 participants did not answer. A similar deficit in knowledge was seen in hypoglycemia management, glucose monitoring, insulin storage, expiry of inulin and injection techniques. Conclusion: This study shows a significant deficit in basic insulin-related knowledge in nursing staff. There is a need for continuous medical education of nursing staff to stay updated on Diabetes management. [ABSTRACT FROM AUTHOR]

This paper presents a study on batch sorption of methylene blue dye from aqueous solution onto Ginkgo biloba sorbent, a waste material produced during the Fall season in many parts of the world. Batch kinetics, equilibrium, and thermodynamic studies were conducted to evaluate the effect of contact time (0–150 min), sorbent dose (0.5–3.0 g/L), pH (2–11), temperature (30–50°C), initial MB concentration (10–30 mg/L), and particle size (177 μm—590 μm) on the methylene blue dye sorption. More than 99% removal of methylene blue was observed within 120 minutes. A Lagergren pseudo-first-order model, a pseudo-second-order model, and intraparticle diffusion models fitted well to the kinetics experimental data. Langmuir and Freundlich isotherm models also fitted well with the observed equilibrium data. Additionally, removal of methylene blue increased with increase in solution pH. Higher sorption capacity (∼20 mg/g) was observed with smaller particle size (170 μm) as compared to larger particle sizes (590 μm). Thermodynamic parameters such as ∆G°, ∆H°, and ∆S° indicated that the sorption process was feasible, spontaneous, and endothermic in nature. The study shows that Ginkgo biloba leaves have the potential to be an efficient sorbent for the removal of methylene blue from surface water samples. [ABSTRACT FROM AUTHOR]

Elevated concentrations of fluoride ions (F−) in natural groundwater are a worldwide problem. Discarded oyster shells were ground to ≤100 µm particle size to produce oyster shell powder (OS). A subset of the OS was heated to produce calcined oyster shell (COS). A subset of the COS was further treated with 1 M phosphoric acid to produce phosphoric-acid-treated oyster shell (POS). OS and COS were combined with phosphoric acid (1.6 mM and 3.2 mM) to produce OS + P (oyster shell with phosphoric acid) and COS + P (calcined oyster shell with phosphoric acid). OS and COS removed 46% and 50% (10 g/L of sorbent dose) but POS, OS + P and COS + P removed 96%, 100% and 76% (1 g/L of sorbent dose) when the initial concentration of fluoride was 10 mg/L. The sorption kinetics of POS, OS + P and COS + P followed second-order reaction rates, and sorption isotherms of all sorbents were well-described by the Freundlich sorption isotherm. These results indicate that oyster shells can be an effective sorbent for fluoride removal, with the added benefit of re-use of a waste product. [ABSTRACT FROM AUTHOR]

Objectives: Many patients with hypothyroidism complain of persistent residual symptoms, despite optimal treatment, although the similar prevalence is seen in patients with documented absence of thyroid disorder in primary health-care setup. We aimed to investigate symptomatic relief in new cases of primary hypothyroidism and compare with controls with other chronic conditions. Methods: This prospective case-control follow-up study enrolled patients from July 2014 to May 2015 in an endocrine outpatient clinic of a tertiary hospital. Controls were age- and gender-matched ambulatory individuals with well-controlled other chronic diseases and no major comorbidity. Thyroid symptom questionnaire (TSQ) was administered at pretreatment to all the cases and then they were started on levothyroxine (LT). At euthyroidism, TSQ was readministered. For controls, TSQ was administered only once. TSQ was measured on Likert scale 1-4 for lack of energy, dry skin, constipation, aches and pains, cold intolerance, poor memory, depression, weight gain, tiredness after walking, and difficulty in getting up (DGU). P < 0.05 was considered statistically significant. Results: A total of 194 cases (147 females and 47 males) and 259 controls (187 females and 72 males) were analyzed. A significant difference in the symptoms prevalence was seen between controls and pretreatment cases, except for DGU, and between subclinical and overt hypothyroidism. Pretreatment serum thyroid-stimulating hormone in cases correlated significantly with all their pretreatment symptoms score. All symptoms prevalence decreased significantly posttreatment. At euthyroidism, the mean symptoms score in posttreatment cases was similar or lower than the controls. Conclusion: LT effectively improves the symptoms of hypothyroidism in newly diagnosed cases of primary hypothyroidism. The residual symptoms need an alternation explanation other than hypothyroidism. [ABSTRACT FROM AUTHOR]

We analyzed the relation of pretreatment anthropometric measures and serum thyrotropin (TSH) with the levothyroxine requirement. Children (3-18 years) brought to endocrine clinic with newly diagnosed acquired primary hypothyroidism were enrolled consecutively and prospectively with follow-up (July 2014 to April 2016). Children were started on levothyroxine, and dose was adjusted at regular intervals until achieved euthyroidism (serum TSH 0.4 to 4.5 mIU/L). The relationship of age, gender, height, weight, and serum TSH with levothyroxine dose was analyzed by univariate and multivariate regression analysis. Data of 51 children (42 girls and 9 boys) was used for the analysis. Age, weight, height, and serum TSH had significant correlation with levothyroxine daily dose based on weight (D/W) and dose based on BSA (D/BSA). Log10 TSH and gender explained ∼60% absolute levothyroxine daily requirement. The final model built with height and serum TSH predicted ∼85% of D/W and ∼80% of D/BSA.Conclusion: Pretreatment height and serum TSH can be used to determine levothyroxine dose needed to achieve euthyroidism in a newly diagnosed acquired primary hypothyroidism in children. What is Known: • The starting dose of levothyroxine is currently recommended based on the age of children. What is New: • In pediatric population, the effect of age on levothyroxine daily dose requirements can be explained by pretreatment height. • Pretreatment serum TSH level is an important predictor of levothyroxine daily dose in children with newly diagnosed primary hypothyroidism. [ABSTRACT FROM AUTHOR]

Objectives: The recommended starting dose of levothyroxine (LT4) in primary hypothyroidism is 1.6 μg/kg body weight and is based on presumption of minimal residual thyroid function in autoimmune hypothyroidism. This study aimed at finding the range and determining factors for LT4 dose in long-standing hypothyroidism. Methods: A cross-sectional study of individuals with primary autoimmune hypothyroidism on LT4 replacement was done between March 2015 and January 2016. Individuals enrolled were euthyroid based on recent serum thyroidstimulating hormone. The inclusion criteria included LT4 intake in the morning empty stomach, maintenance of at least 1-h food gap, not on medications known to hamper LT4 absorption within 4 h of dosing, diagnosis of hypothyroidism at least for 1 year, and on a minimum 25 μg LT4. P < 0.05 was considered statistically significant. Results: A total of 346 individuals (290 women and 56 men; 214 premenopausal and 76 postmenopausal women) were enrolled. The mean duration of hypothyroidism and age were 5.7 years and 42.1 years, respectively. The range and mean of absolute LT4 daily dose (ADD), LT4 dose based on body weight (D/W), and LT4 dose based on ideal body weight (D/IBW) were 25-200 μg daily and 77.1 μg, 0.3-2.82 μg/kg and 1.21 μg/kg, and 0.42-3.5 μg/kg and 1.58 μg/kg, respectively. Duration of hypothyroidism was significant predictors of ADD, D/W, and D/IBW. Gender-based difference in ADD and D/IBW was explained by gender difference in anthropometry. Conclusion: Long-standing primary autoimmune hypothyroidism has variable dose requirement of LT4 for achieving euthyroidism and may be dependent on the degree of residual functional thyroid. Duration of hypothyroidism was significant positive predictor for either ADD, D/W, or D/IBW. [ABSTRACT FROM AUTHOR]

This is the first comprehensive study that details the synthesis of stable acyclic trisubstituted [3]dendralenes and deciphers their structural requisite for a successful diene transmissive Diels-Alder (DTDA) reaction by employing two different dienophiles and eventually generating a small repository of complex molecules, thus exemplifying how substituted [3]dendralenes could be deployed in diversity-oriented synthesis with high selectivities. A balance of reactivity and stability was struck by prudent selection of the position and nature of functional groups on these [3]dendralenes. Upon tandem Diels-Alder reactions with several symmetrical as well as unsymmetrical dienophiles, these dendralenes afforded diversity-oriented quick access to many polycyclic complex motifs possessing several functional groups and multiple stereogenic centers. Thus, the full potential of the dendralenes could be harnessed. The reactions proceeded under mild conditions with step and atom economy and were highly regio- and stereoselective besides being excellent yielding. The DTDA sequence resulted in the generation of four new carbon-carbon bonds, two new rings, and 3-7 stereogenic centers. The key feature of the method is that we could rapidly generate complexity along with functional and structural diversity from a trivial acyclic substrate with no stereogenic centers. [ABSTRACT FROM AUTHOR]

Electrochromism or electrochromic contrast in electropolymerized thin films of dioxythiophenes based conjugated polymers is known to be sensitive to the structure of monomer and the polymerizing conditions. However in our studies we found that it is also sensitive to the electrode surface wherein a significantly high electrochromic contrast is observed in the electropolymerized thin films of poly(3,4-ethylenedioxythiophene), PEDOT deposited on platinum (71%) as compared to that on indium tin oxide, ITO, coated glass surface (54%). This is attributed to the formation of more conjugated polymer on the metallic surfaces as confirmed by narrow and red shifted absorption peak for PEDOT on platinum compared to broad and blue shifted peak on ITO in the UV–vis absorption spectra. This difference in the electrochromic properties of electropolymerized PEDOT thin films on the two surfaces is investigated by studying their electrochemical growth using UV–vis absorption, Raman spectroscopy and atomic force microscopy techniques. These results suggest the deposition of more conjugated polymer in the initial stages of growth (≤3 mC/cm 2 ) on both the substrates whereas it continues the same way into the intermediate stages (up to ∼15 mC/cm 2 ) only on platinum, thereby, resulting in higher electrochromic contrast on platinum. The coloration efficiency of PEDOT thin film was also found to be improved on platinum (465 cm 2 /C) compared to that on ITO (230 cm 2 /C). Moreover, we observed that the EC contrast of electropolymerized PEDOT thin films on platinum was found to be insensitive to polymerizing solvent that is generally not the case when polymerized on ITO. The cyclic stability of PEDOT-Pt films are better compared to that of PEDOT-ITO which is attributed to the improved reversibility of these films with respect to potential switching. [ABSTRACT FROM AUTHOR]

The synthesis of a new alkylmethylimidazolium ionic liquid wherein the alkyl group is functionalized with dihexylphosphine oxide moiety at the terminal position has been achieved in four steps from 1-methylimidazole. This hybrid ionic liquid effectively catalyzed the nucleophilic fluorination of primary alkyl mesylates under mild conditions using CsF as the fluoride source with a faster rate compared to butylmethylimidazolium mesylate. The hybrid catalyst was recycled 5 times without compromising the yield and purity of the product. The nucleophilic fluorination has been used for the synthesis of diethyl 2-(5-fluoropentyl)-2-methyl malonate, a precursor of 18 F isotopomer of an apoptosis imaging agent and the protected form of O -(2′-fluoroethyl)- l -tyrosine, a 18 F isotopomer of a tumor imaging agent. [ABSTRACT FROM AUTHOR]

Polyurethane/multi-walled carbon nanotube nanodielectric thin films of 25 μm thick were prepared by solution grown method. The microstructure of the nanodielectric was examined by scanning electron microscopy. The MWCNTs are observed to be dispersed in PU matrix well apart from a few of clusters. The MWCNTs/polymer nanodielectrics characterized with decrease in energy band gap and crystallinity. The analysis of dielectric properties of the composite samples of different weight ratio was studied by measuring the permittivity and tangential loss at room temperature. The frequency dependent permittivity obeys the percolation theory. Further, it has been observed that the dielectric properties of PU and PU nanodielectric are unaffected by UV-irradiation. XRD characteristics confirm the formation of PU/MWCNTs nanodielectrics. [ABSTRACT FROM AUTHOR]

Polyurethane (PU)/Polysulfone (PSF)/Multi Wall Carbon Nanotubes (CNTs) hybrid nanocomposite films were prepared by solution grown method with different wt% of functionalized CNTs. The structural and thermal properties of PU, PSF and PU + PSF + CNTs nanocomposite films were studied by various techniques such as scanning electron microscopy (SEM), X-ray diffraction (XRD), FTIR and TGA/DTG. The dispersion of CNTs in polymer was studied by SEM spectra, which indicates the presence of CNTs on the surface of the polymeric material. XRD results show the increases of crystallinity with different weight percentage of CNTs in polymer matrix. FTIR spectra reveal the position of different chemical bonds in pure and hybrid nanocomposite films. TGA and DTG show that the thermal stability of hybrid nanocomposite is better than PU and PSF due to reinforcement of CNTs in PU-PSF matrix. Surface charge decay study represents the charge stability in hybrid nanocomposite is due the localization of charge carriers in deeper traps. [ABSTRACT FROM AUTHOR]

In this article, the author focuses on the spinal surgery in patients with significant osteoporosis. It mentions that spinal fixation surgery occurs in patients with osteoporosis for a variety of indications such as spondylolisthesis, vertebral fractures, and vertebral deformities. It also mentions a study regarding the efficacy of use of fenestrated pedicle screws augmented by polymethylmethacrylate (PMMA) in the vertebral bodies.

Abstract: A novel route to a chiral functionalized [3]dendralene attached to a (−)-menthol auxiliary has been developed, which involves a dimethylsulfonium methylide mediated olefination of a substituted ethenylidene phosphonoacetate (−)-menthyl ester, followed by a Horner–Wordsworth–Emmons reaction with 4-bromobenzaldehyde. The chiral [3]dendralene was reactive enough to undergo intermolecular Diels–Alder cyclodimerization to give the highly substituted cyclohexene with very high regio- and diastereoselectivity. [Copyright &y& Elsevier]

We have studied transmission of holes by a multiband-multichannel model. We combined the effective Hamiltonians of the k-p approach with the multichannel transfer matrix approach. We have shown that using an orthonormal basis derived from quadratic eigen value problem, the important flux conservation requirement was rigorously satisfied. For calculation of transport properties of multichannel-multilayered systems, we employed the finite periodic systems theory. The transmission amplitudes matix, which like the scattering matix contains entire information on the scattering process described by the model Hamiltonian. By obtaining transmission amplitudes one can easily determine transmission coefficients, and specific transport properties such as the channel interference characteristics and global quantities such as the Landauer conductance as function of the incoming Fermi energy and the heterostructure parameters. We studied all amplitudes of heavy and light holes at the same time. This study has benefit of identifying inter and intra-band hole transitions. [ABSTRACT FROM AUTHOR]

Abstract: Microgel–clay composite particles were prepared by one-step surfactant–free precipitation polymerization. Laponite nanoparticles present in the reaction mixture become encapsulated during the microgel formation process. Microgel–clay composites based on poly(N-vinylcaprolactam-co-acetoacetoxyethyl methacrylate) containing different amount of incorporated clay nanoparticles were synthesized. The clay content was varied from 2 wt% to 18 wt%. The extremely high incorporation efficiency of the clay nanoparticles into microgels was detected. The size of the hybrid microgels was decreased from 700 nm to 100 nm by increase of the clay concentration in the reaction mixture. Obtained hybrid microgels exhibit negative surface charge and excellent colloidal stability. Microgel–clay composite particles display temperature-sensitive behaviour in water. The swelling degree of the hybrid microgels decreases with increase of the clay loading. Microgel–clay composite particles exhibit temperature-controlled uptake of the cationic dye, Methylene blue, and can be used as scavenger systems in aqueous media. [ABSTRACT FROM AUTHOR]

Flavivirus vaccines based on ChimeriVax technology contain the nonstructural genes of the yellow fever vaccine and the premembrane and envelope genes of heterologous flaviviruses, such as Japanese encephalitis andWest Nile viruses. These chimeric vaccines induce both humoral and cell-mediated immunity. Mice were vaccinated with yellow fever, chimeric Japanese encephalitis virus (YF/JE), or chimeric West Nile virus (YF/WN) vaccines, followed by a secondary homologous or heterologous vaccination; the hierarchy and function of CD8+ T cell responses to a variable envelope epitope were then analyzed and compared with those directed against a conserved immunodominant yellow fever virus NS3 epitope. Sequential vaccination with heterologous chimeric flaviviruses generated a broadly cross-reactive CD8+ T cell response dependent on both the sequence of infecting viruses and epitope variant. The enhanced responses to variant epitopes after heterologous vaccination were not related to preexisting antibody or to higher virus titers. These results demonstrate that the sequence of vaccination affects the expansion of cross-reactive CD8+ T cells after heterologous chimeric flavivirus challenge. [ABSTRACT FROM AUTHOR]

Abstract: The reactions between dimethylsulfonium methylide and 1,3-diene- or 1,3,5-triene-1,1-dioates under specific conditions enable the highly regioselective tandem ylide addition–eliminative olefination to provide 1,3-butadien-2-yl- or 1,3,5-hexatriene-2-yl-malonates. Alkylation at malonate methine carbon of 1,3-butadien-2-ylmalonates with a suitable alkyl halide having in-built functionalities for a dienophile generation led to quick assembly of precursors for type 2 intramolecular Diels–Alder reaction. Syntheses of functionalized bicyclo[n.3.1] alkenes (n=5 or 6) with the double bond at the bridgehead position have been achieved via the IMDA. An asymmetric version of this reaction has been developed using a MacMillan''s imidazolidinone catalyst, which provided a bicyclo[5.3.1] alkene with very high enantioselectivity. In situ methylation at malonate methine carbon of 1,3,5-hexatriene-2-yl-malonates followed by intermolecular Diels–Alder reaction with N-methylmaleimide provided the cycloadduct with complete regiocontrol and high diastereoselectivity. [Copyright &y& Elsevier]

Two new cylindrically symmetric inhomogeneous string cosmological models are investigated in presence of magnetic field. We have assumed that F12 is the only non-vanishing component of electromagnetic field tensor Fij . The Maxwell's equations show that F12 is the function of x alone whereas the magnetic permeability μ is the function of x and t both. To get the deterministic solution, it has been assumed that the metric coefficients are separable in the form as A = f(x)ℓ(t), B = g(x)k(t), C = g(x)υ(t). Also, the Einstein field equations have been solved with string source in which magnetic field is absent. Some physical and geometric aspects of the models in presence and absence of magnetic field are discussed. [ABSTRACT FROM AUTHOR]

Cylindroma is a benign skin adnexal tumor of eccrine differentiation. Clinically, they are disfiguring lesions that can mimic a malignancy. Cylindromas can be single or multiple and commonly involve the scalp (turban tumor) and face. Multiple cylindromas can have a syndromic association as seen in Brooke-Spiegler syndrome and familial cylindromatosis. We present a case of non familial cylindroma of the face that clinically mimicked a basal cell carcinoma. The histopathology was confirmatory. Herein we also highlight the utility of a simple and inexpensive histochemical stain Periodic Acid Schiff in supporting the diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: High glucose causes increased matrix synthesis by glomerular mesangial cells and angiotensin II (Ang II) has been shown to mediate this effect of glucose. These studies investigate whether inhibition of Ang II formation can block high glucose-induced increase in mesangial matrix. Human mesangial cells were incubated with 25mM glucose (HG) along with captopril, an ACE inhibitor, to block Ang II formation. In other experiments, cells were nucleofected with siRNA to knockdown angiotensinogen (Agt), the precursor of Ang II, and then exposed to high glucose. Captopril blocked high glucose-induced increase in Ang II levels in the cell media (extracellular) but failed to inhibit it in the cell lysate (intracellular). Moreover, captopril treatment did not block the stimulatory effect of high glucose on TGF-β1 and fibronectin. In contrast, knockdown of the Agt gene prevented high glucose-induced increase in both extracellular and intracellular Ang II levels, and was accompanied by normalization of TGF-β1 and fibronectin. These data suggest that intracellular Ang II may play an important role in the mediation of the high glucose effect on matrix and that ACE inhibitors may not be effective in blocking intracellular Ang II formation in mesangial cells. [Copyright &y& Elsevier]

Abstract: Reaction of dimethylsulfoxonium methylide with a β-silylmethylene malonate gives diversified products, cyclopropane, cyclobutane or allyl and homoallyl silanes depending upon the stoichiometry of the reactants and reaction conditions. Contrary to this, reaction of a β-arylmethylene malonate gives only the cyclopropane product. The product(s) formed are unique and the silicon group played a crucial role either by assisting and/or by participating in the process. [Copyright &y& Elsevier]

Abstract: This study investigates whether angiotensin converting enzyme (ACE) inhibitors can block high glucose-induced increase of angiotensin II (Ang II) levels in cultured rat mesangial cells. Incubation of cells with high glucose for 5 days increased Ang II in the cell media (extracellular) and cell lysates (intracellular) by ∼1.5-fold and ∼2.2-fold, respectively. Captopril blocked high glucose-induced increase in extracellular Ang II levels but not in intracellular Ang II levels. Since the inability of captopril to inhibit intracellular Ang II in intact cells could be explained by failure of the drug to enter the cells, further studies were performed using lysates from cells pre-treated with high glucose for 5 days. Addition of captopril to cell lysates was indeed able to inhibit Ang I conversion to Ang II but only partially. These findings suggest the involvement of non-ACE mechanisms in Ang II formation from Ang I in mesangial cells. [Copyright &y& Elsevier]

Abstract: A highly regio- and stereoselective [Pd(allyl)Cl]2 catalyzed Heck reaction of aryl iodides and electronically neutral terminal olefins generated in situ by fluoride induced protiodesilylation of alkenylsilanol derivatives under mild conditions has been developed. The products, viz. terminally substituted styrenes and (E)-1,4-diaryl-1-butenes were obtained in very good yields. The dibenzylbutyrolactone lignan skeletons have been prepared employing two regio- and stereoselective Bu3SnH-mediated radical cyclization routes. [Copyright &y& Elsevier]

Recent evidence suggests that the intrarenal renin-angiotensin system (RAS) may play an important role in the development of glomerular changes associated with diabetic nephropathy. In this study, the glomerular RAS was examined in male Sprague-Dawley rats made diabetic with streptozotocin (STZ), and the findings compared with those obtained in control nondiabetic rats. In diabetic rat glomerular extracts, angiotensinogen and angiotensin II (ANG II) levels were increased significantly by 2.2- and 1.9-fold, respectively, compared with nondiabetic controls. No significant differences in ANG I and angiotensin-converting enzyme (ACE) levels were observed between these groups. The HPLC analysis of the glomerular extracts demonstrated that exogenous ANG I was converted into various ANG peptides including ANG II, ANG(1-9), and ANG(1-7). A significant increase in formation of ANG II from exogenous ANG I was observed in STZ rats compared with control rats. Preincubation of glomerular extracts with captopril resulted in a 20-30% decrease in ANG II conversion from exogenous ANG I in diabetic and control rats. The possible role of ANG(1-9) in formation of ANG II was examined by FIPLC. Exogenous ANG(1-9) in glomerular extracts was converted into ANG II, this conversion being significantly higher in STZ rats than in control rats. These findings provide new information that ANG(1 -9) is produced in rat glomerular extracts, can be converted to ANG H, and that this conversion is also stimulated in diabetic rat glomeruli. Thus this study demonstrates that in diabetic rats, glomerular ANG II levels are increased due to an increase in angiotensinogen and an increase in the formation of ANG II. [ABSTRACT FROM AUTHOR]

B7 costimulation plays a major role in herpes simplex virus (HSV) immunity. Effects of immunoregulatory cytokines (interferon-&gamma; [IFN-&gamma;] and interleukin-10 [IL-10]) and HSV antigens on B7-1 (CD80) and B7-2 (CD86) expression on monocytes during HSV-2 infection were investigated using flow cytometry. Our results demonstrate that HSV-2 infection effects the expression of B7 isoforms (B7-1 and B7-2) on monocytes in two ways, with opposing outcomes. It abrogates the IFN-&gamma; upregulation of B7-1 and B7-2 and also augments expression of B7-1 and B7-2 on monocytes through an IFN-&gamma; independent mechanism. The clinical significance of these opposing effects may be related to the pathogenesis of recurrent HSV disease in immunocompetent hosts. [Copyright &y& Elsevier]

Role of viral genes in modulating T helper 1 (Th1) and T helper 2 (Th2) balance is of principal interest in the study of cytomegalovirus (CMV) immunity. Murine CMV (MCMV) mutants were used to explore a possible mechanism for the ability of virus to induce a predominant Th1 response and to suppress Th2 response by examining the production of Th1 (IFN-γ, IL-2) and Th2 (IL-4, IL-10) cytokines by the splenocytes of mice infected with wild type (WT) and MCMV mutants. Results (n=6) show that as compared with WT, the MCMV mutant with specific disruption of M43 gene upregulates the production of IL-4 (P=0.0002) and to a lesser extent IL-10 (P=0.015) at 14 days post infection. This indicates that M43 gene may play a role in suppressing Th2 (IL-4) production, especially in the later stage of infection. The IL-4 and IL-10 production during infection with M43 mutant occurs in the presence of a strong IFN-γ (Th1) response, overriding the cross-regulatory effects of these cytokines within the Th1/Th2 paradigm and suggesting that the predominant response during CMV infection is still a Th1 type response. [Copyright &y& Elsevier]

A stereoselective total synthesis of (+)-carpamic acid 1 has been achieved from the σ-symmetric 3-[dimethyl(phenyl)silyl]glutaric anhydride 11 featuring its asymmetric desymmetrisation using oxazolidinone 12. The dimethyl(phenyl)silyl group is not only acting as a masked hydroxy group but also stereodirects ester enolate methylation and facilitates the Curtius reaction of the β-silyl-amide 23. A highly stereoselective hydrogenation of the imine 10 is the key step in the construction of the all cis-2,3,6-trisubstituted piperidine. [Copyright &y& Elsevier]

Accumulation of mesangial matrix in diabetic nephropathy is caused by increased synthesis and decreased degradation. We have previously demonstrated that incubation in high-glucose medium decreases mesangial cell collagenase activity (Diabetes 44:929-935, 1995). Because angiotensin II (AII) is involved in the pathogenesis of diabetic nephropathy, the present studies were performed to determine if AII mediates glucose-induced 1) inhibition of mesangial collagenase activity, 2) mesangial matrix accumulation, and 3) in-crease in transforming growth factor (TGF)-beta1 secretion in mesangial cells. The direct effect of high glucose on AII generation in mesangial cells was also determined. Primary mesangial cells from normal Sprague-Dawley rats were used in all studies. Collagenase activity in cell medium was determined using three methods: 1) zymography; 2) quantitative assay using fluoresceinated gelatin as substrate; and 3) a new enzyme-linked immunosorbent assay (ELISA) that specifically measures 72-kDa collagenase (MMP-2), the principal collagenase synthesized by mesangial cells. Matrix accumulation was estimated by immunoperoxidase assay on cell layers using anti-glomerular basement membrane (GBM) antibodies. TGF-beta1 and AII levels were determined by ELISA. Exposure of mesangial cells to 30 mmol/l glucose (high glucose) vs. 5 mmol/glucose (normal glucose) for 5 days resulted in a significant decrease in collagenase activity (25%) that was normalized by 10(-4) mol/l losartan, a type 1 angiotensin II (AT1) receptor antagonist. High glucose increased anti-GBM binding compared with normal glucose; this effect of glucose was reversed by losartan. Incubation of cells with 30 mmol/l glucose increased total TGF-beta1 secretion, which was also normalized by losartan. Addition of AII (10(-6) mol/l) for 24 h to the culture medium inhibited collagenase activity by 33%; losartan (10(-4) mol/l) blocked this inhibition of enzyme activity. Also, AII decreased collagenase (MMP-2) levels but stimulated TGF-beta1 secretion in mesangial cells. Finally, glucose increased mesangial AII generation in a concentration-dependent manner, with incubation in 30 mmol/l glucose increasing AII by 25% compared with 5 mmol/l glucose. We conclude that glucose increases AII production by mesangial cells, which results in stimulation of TGF-beta1 secretion, decreased matrix degradation, and increased matrix accumulation. These effects of AII are mediated by the AT1 receptor. [ABSTRACT FROM AUTHOR]

The hydrolytic stability of norcantharidine derived conformationally constrained diamides in acidic media is solely governed by the type of amide. Tertiary diamides underwent smooth acid catalyzed hydrolysis due to anchimeric assistance whereas other diamides were stable. This was corroborated from conformational proximity of the amide groups for anchimeric assistance based on single crystal X-ray structure analysis. Theoretical calculations on the diamide structures also predict the similar proximity of the diamides in those conformations. Thus norcantharidine based diamides could probably serve as promising systems for delayed release of certain types of drugs which possess secondary amine component as exemplified by the release of m -chlorophenylpiperazine at a pH range of 1–2. Image 1 • Norcantharidine derived tertiary diamides hydrolyzed easily under acid catalysis. • Their primary, secondary and mixed diamides do not hydrolyze easily. • Hydrolysis of tertiary diamides occurred due to NGP of proximal amide carbonyls. • Hydrolysis of tertiary diamides has been supported by X-ray structure & calculations. • These tertiary diamides could serve for delayed release of certain types of drugs. [ABSTRACT FROM AUTHOR]

Feature selection is an important component of the machine learning domain, which selects the ideal subset of characteristics relative to the target data by omitting irrelevant data. For a given number of features, there are 2n possible feature subsets, making it challenging to select the optimal set of features from a dataset via conventional feature selection approaches. We opted to investigate glaucoma infection since the number of individuals with this disease is rising quickly around the world. The goal of this study is to use the feature set (features derived from fundus images of benchmark datasets) to classify images into two classes (infected and normal) and to select the fewest features (feature selection) to achieve the best performance on various efficiency measuring metrics. In light of this, the paper implements and recommends a metaheuristics-based technique for feature selection based on emperor penguin optimization, bacterial foraging optimization, and proposes their hybrid algorithm. From the retinal fundus benchmark images, a total of 36 features were extracted. The proposed technique for selecting features minimizes the number of features while improving classification accuracy. Six machine learning classifiers classify on the basis of a smaller subset of features provided by these three optimization techniques. In addition to the execution time, eight statistically based performance metrics are calculated. The hybrid optimization technique combined with random forest achieves the highest accuracy, up to 0.95410. Because the proposed medical decision support system is effective and ensures trustworthy decision-making for glaucoma screening, it might be utilized by medical practitioners as a second opinion tool, as well as assist overworked expert ophthalmologists and prevent individuals from losing their eyesight. [ABSTRACT FROM AUTHOR]

[Display omitted] • A novel feature selection approach for breast cancer prediction is proposed. • Feature selection was based on the three soft-computing algorithms. • The Bacterial foraging algorithm and the Emperor penguin algorithm are implemented. • Hybrid of Bacterial foraging algorithm and Emperor penguin algorithm is proposed. • Nine performance metrics are computed for six machine learning classifiers. Feature selection is one of the crucial data preprocessing techniques for improving the performance of machine learning (ML) models. Recently, metaheuristic feature selection algorithms have become popular because they select optimal features for ML problems. This paper presents three feature selection strategies based on metaheuristic algorithms: Bacterial Foraging (BFOA), Emperor Penguin (EPO), and a hybrid (hBFEPO) combining BFOA and EPO. The baseline algorithms have been investigated for feature selection in other ML tasks, but not for breast cancer classification. A hybrid of these two has been used for the first time. These strategies were initially tested on the COVID-19 dataset. After achieving satisfactory results, these strategies are evaluated on the WDBC Breast Cancer dataset. The performance of our models on WDBC is compared with recent eighteen state-of-the-art studies. The results indicate that the hBFEPO model outperforms other models, achieving 100% precision and specificity, 98.49% accuracy, 95.43% sensitivity, a 95.99% F1-score, and a 99.60% AUC. [ABSTRACT FROM AUTHOR]

Objective: Weight and age are traditionally used to decide levothyroxine (LT4) dose. The objective of study was to reanalyze the relationship of all the anthropometric measures and serum thyrotropin (TSH) with the LT4 requirement to achieve euthyroidism. Study Design: Study was prospective done at a single center (May 2014 to January 2016) in children brought to pediatric Endocrine clinic with newly diagnosed acquired primary hypothyroidism and being treatment naïve. Children were started on LT4, and dose adjusted at regular intervals to achieve normal range serum TSH (0.4 to 4.5 mIU/L). The relationship of age, gender, height, weight, body surface area (BSA), lean muscle mass (LBM) and baseline serum TSH with LT4 dose needed to achieve euthyroidism were assessed by multivariate regression analysis. Results: A total of 43 children (35 girls and 9 boys) completed the study. Mean LT4, LT4 based on weight (D/W), LT4 based on BSA (D/BSA) and LT4 based on LBM (D/LBM) were 68.75 ± 31.82 µg, 2.4 ± 1.6 µg/kg, 66.3 ± 38.7 µg/m2, and 2.8 ± 1.8 µg/ kg respectively. Age, weight, height, BSA, LBM, serum TSH and TSH_1 (values above 100 mIU/L were assigned 100 mIU/L) had significant correlation with D/W, D/BSA and D/LBM. TSH_1 and gender explained 73% of variability in LT4 requirement. Height and serum TSH constituted the best fit model in multivariate regression analysis. The model Adjusted R2 was 0.852, 0.837 and 0.857 for D/W, D/BSA and D/LBM respectively. Conclusion: Height and baseline serum TSH can be used to determine LT4 dose in newly diagnosed acquired hypothyroidism in children. [ABSTRACT FROM AUTHOR]

A series of different fluorine-substituted compounds is synthesized by fluorination of primary alkyl mesylates using a new alkylmethylimidazolium ionic liquid as effective catalyst. [ABSTRACT FROM AUTHOR]

Phosphonate (I) is olefinated in a Horner-Wadsworth-Emmons reaction by para-bromobenzaldehyde followed by a highly diastereoselective and spontaneous Diels-Alder dimerization. [ABSTRACT FROM AUTHOR]

• A soft-computing and machine learning based medical decision support system is proposed for breast cancer disease classification. • Two soft-computing algorithms eagle strategy optimization (ESO) algorithm and the gravitational search optimization (GSO) algorithm are employed for the first time for this problem. A novel intelligent classification approach based on these two algorithms for breast cancer infection is also proposed. • 12 experiments have been performed using three soft-computing algorithms(for feature selection) and 6 state-of-the-art machine learning classifier(for classification).WDBC dataset is used for the method evaluation. • We have been able to attain astonishing results with accuracy up to 98.9578%, sensitivity up to 0.9696, specificity up to 1.000, precision 1.000, F1- score up to 0.9696, and an AUC 0.9980(close to maximum i.e., 1.0000). Feature selection, which picks the optimal subset of characteristics related to the target data by deleting unnecessary data, is one of the most important aspects of the machine learning area. A major part of big data preprocessing is feature selection (reduction). There are 2n alternative feature subsets for every n features, making it difficult to choose the best set of features from a dataset using typical feature selection techniques. Consequently, the present study proposes and suggests a unique feature selection method based on the Eagle Strategy(ESO) Optimization, Gravitational Search Optimization (GSO) algorithm, and their hybrid algorithm. We chose this infection as our subject of investigation since the number of women with breast cancer is increasing rapidly on a global scale. After lung cancer, which affects more women than any other kind of cancer, breast cancer is the second leading cause of cancer mortality. The goal of this study is to categorize breast cancer into two groups using the benchmark feature set (Wisconsin Diagnostic Breast Cancer (WDBC)) and to choose the fewest features (feature selection) to achieve maximum accuracy. This work also provides a hybrid technique for finding important features that combines two algorithms, ESO and the GSO algorithm, while reducing insignificant characteristics (features) and complexity. Soft computing technologies and machine learning algorithms provide a framework for prognostic research by classifying data instances as relevant or irrelevant depending on cancer severity. Thus, this work presented a new approach for classifying breast cancer tumors. In this research, we coupled soft computing methodologies—our implemented algorithms are applied for the first time to this problem—with artificial intelligence-based machine learning strategies to create a prediction model. The efficacy of our suggested technique was evaluated using WDBC breast cancer data sets, and the findings show that our proposed hybrid algorithm performs very well in breast cancer classification. We have been able to attain astonishing results with accuracy up to 98.9578%, sensitivity up to 0.9705, specificity up to 1.000, precision up to 1.000, F1-score up to 0.9696, and an AUC up to 0.9980 (close to maximum, i.e., 1.0000). Our study's goal is to incorporate our findings into a valid clinical prediction system, allowing visual science specialists to make more accurate and effective judgments in the future. Furthermore, our suggested technology might be used to detect a wide range of diseases. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a distinctive medical condition characterized by loss of memory, orientation, and cognitive impairments, which is an exceptionally universal form of neurodegenerative disease. The statistical data suggested that it is the 3rd major cause of death in older persons. Butyrylcholinesterase (BChE) and acetylcholinesterase (AChE) inhibitors play a vital role in the treatment of AD. Coumarins, natural derivatives, are reported as cholinesterase inhibitors and emerges as a promising scaffold for design of ligands targeting enzymes and pathological alterations related to AD. In this regard, the 3D QSAR pharmacophore models were developed for coumarin scaffold containing BChE and AChE inhibitors. Several 3D QSAR pharmacophore models were developed with FAST, BEST, and CEASER methods, and finally, statistically robust models (based on correlation coefficient, cost value, and RMSE value) were selected for further analysis for both targets. The important features ((HBA 1, HBA 2, HY, RA (BChE) HBA 1, HBA 2, HY, PI, (AChE)) were identified for good inhibitory activity of coumarin derivatives. Finally, the selected models were applied to various database compounds to find potential BChE and AChE inhibitors, and we found 13 for BChE and 1 potent compound for AChE with an estimated activity of IC50 < 10 µM. Further, the Lipinski filters, and ADMET analysis supports the selected compounds to become a drug candidate. These selected BChE and AChE inhibitors can be used in the treatment of AD. [ABSTRACT FROM AUTHOR]

In the case of communicable diseases, such as COVID-19, effective and quick testing techniques make it easier to identify a contaminated person, so that he or she can be easily isolated. To predict COVID-19-infected individuals through chest computed tomography scans, this study suggests an effective feature selection technique incorporated in clinical decision support system that may be used for testing. After pre-processing, we retrieved 213 features from the chest computed tomography images of a public data set with 2482 images. Then, in a two-step process, the most significant features for recognizing the difference between COVID patients and healthy individuals are selected. Initially, the Chi-square test selects 75% of the initial extracted features, which are then forwarded to three nature-inspired computing algorithms: the cuckoo search optimization algorithm, a teaching–learning-based optimization algorithm, and a hybrid of these two for further optimization. The finally selected reduced feature set and five machine learning classifiers are then employed to classify these computed tomography images. Twenty-four experiments using fivefold and tenfold cross-validation have been performed to find the best values for eight statistical efficiency evaluation metrics. Our suggested approach achieves a notable accuracy of 95.99%, the best mean intersection over union of 0.9655, and the highest area under curve of 0.9966. XGBoost delivers more effective, promising, and comparable results when compared to other ML classifiers. Our suggested testing approach will benefit frontline workers and the state by providing routine and cost-effective testing, and faster results. [ABSTRACT FROM AUTHOR]

• Wastewater-based surveillance has focused almost exclusively on urban areas. • Rural-urban public health surveillance and healthcare service disparities persist. • Recent research identifies pathways for implementing rural wastewater surveillance. The sampling and analysis of sewage for pathogens and other biomarkers offers a powerful tool for monitoring and understanding community health trends and potentially predicting disease outbreaks. Since the early months of the COVID-19 pandemic, the use of wastewater-based testing for public health surveillance has increased markedly. However, these efforts have focused on urban and peri‑urban areas. In most rural regions of the world, healthcare service access is more limited than in urban areas, and rural public health agencies typically have less disease outcome surveillance data than their urban counterparts. The potential public health benefits of wastewater-based surveillance for rural communities are therefore substantial – though so too are the methodological and ethical challenges. For many rural communities, population dynamics and insufficient, aging, and inadequately maintained wastewater collection and treatment infrastructure present obstacles to the reliable and responsible implementation of wastewater-based surveillance. Practitioner observations and research findings indicate that for many rural systems, typical implementation approaches for wastewater-based surveillance will not yield sufficiently reliable or actionable results. We discuss key challenges and potential strategies to address them. However, to support and expand the implementation of responsible, reliable, and ethical wastewater-based surveillance for rural communities, best practice guidelines and standards are needed. [Display omitted] [ABSTRACT FROM AUTHOR]

The present study deals with locally rotationally symmetric (LRS) Bianchi type II cosmological model representing massive string. The energy-momentum tensor for such string as formulated by Letelier (Phys. Rev. D 28:2414, ) is used to construct massive string cosmological model for which we assume that the expansion ( θ) in the model is proportional to the shear ( σ). This condition leads to A= B, where A and B are the metric coefficients and m is proportionality constant. For suitable choice of constant m, it is observed that in early stage of the evolution of the universe string dominates over the particle whereas the universe is dominated by massive string at the late time. Our model is in accelerating phase which is consistent to the recent observations of type Is supernovae. Some physical and geometric behavior of the model is also discussed. [ABSTRACT FROM AUTHOR]

Loss/alteration of Smell and taste sensation is common in CoViD-19 infection. We conducted present study to find out the frequency, onset and severity of these lost sensations and their recovery in mild, moderate and severe COVID 19 positive patients in our setup. A questionnaire based study on 574 COVID-19 positive patients admitted in a dedicated COVID hospital between September–November, 2020 were followed up until their sensations recovered completely or maximum for two months. Fever was the most common symptom reported. Loss of smell and taste sensation is seen in 200 (34.84%) and 269 (46.86%) patients respectively; 163 (28.4%) developed both. Males were affected significantly more than females (p = 0.030 and 0.027). Approximately 1/4th patients [49 (24.5%) and 55 (20.45%)] reported loss of smell and taste sensation as their first symptom. Most common taste sensation lost was salty 191 (71.0%). Loss of smell sensation is seen maximally in mild cases and the difference among mild, moderate and severe cases is statistically significant (p = 0.00001); while the difference in loss of taste among all three grades of severity is statistically insignificant (p = 0.0770). Most of the patients [smell (142; 71%) and taste (198; 73.6%)] recovered after 2 weeks of onset of lost sensations while 96.5% (193/200) and 98.1% (264/269) patients reported complete recovery of smell and taste sensations after two months of onset. Present study shows that high percentage of COVID-19 positive patients develop loss of either one or both of smell and taste sensations but recovery is fast and complete in most of them. [ABSTRACT FROM AUTHOR]

• A feature selection strategy which selects the optimal subset of features, by employing GSOA, from the original set is developed, in which the elimination of extraneous features takes place which enhances the classification performance and reduces the computational cost. This improves glaucoma detection while lowering model training computational costs and execution time. The performance is evaluated on the customized dataset of public and private images. • Further in this research, we discuss the application of machine learning in anticipating diseases,thus expanding the field of medical services and bringing in the most recent technology. It is demonstrated how to use the suggested technique, and a comprehensive analysis of different parameters is given. To determine the most effective presentation, various efficiency assessment criteria for many machine learning classifiers were implemented. The parameters included are accuracy, sensitivity,specificity, ROC curves and many more. • Through this study, we offer the best features(selected through soft-computing approach) to researchers, a reliable and effective system of support for medical professionals, and a software-based tool for the human race to slow down this infection spreading through early, quick, and accurate identification of this infection. It might be used in locations with a shortage of qualified medical workers like doctors and nurses. It can also be altered to work with wearable and portable medical devices. • For the detection of this infection from retinal fundus images, our proposed method outperforms existing techniques. This testing procedure will be advantageous for doctors and the state because it is significantly less expensive than other diagnostic instruments used by medical professionals to detect the disease. In addition, owing to its high performance, the proposed medical prediction system can be used to develop mobile applications that aid physicians in the early diagnosis of glaucoma. The process of feature selection (FS) is vital aspect of machine learning (ML) model's performance enhancement where the objective is the selection of the most influential subset of features. This paper suggests the Gravitational search optimization algorithm (GSOA) technique for metaheuristic-based FS. Glaucoma disease is selected as the subject of investigation as this disease is spreading worldwide at a very fast pace; 111 million instances of glaucoma are expected by 2040, up from 64 million in 2015. It causes widespread vision impairment. Optic nerve fibres can be degraded and cannot be replaced later in this disease. As a starting point, the retinal fundus images of glaucoma infected persons and healthy persons are used, and 36 features were retrieved from these images of public benchmark datasets and private dataset. Six ML models are trained for classification on the basis of the GSOA's returned subset of features. The suggested FS technique enhances classification performance with selection of most influential features. The eight statistical performance evaluating parameters along with execution time are calculated. The training and testing have been performed using a split approach (70:30), 5-fold cross validation (CV), as well as 10-fold CV. The suggested approach achieved 95.36 % accuracy. Due to its auspicious performance, doctors might use the suggested method to receive a second opinion, which would also help overburdened skilled medical practitioners and save patients from vision loss. [ABSTRACT FROM AUTHOR]

Hereditary hearing loss accounts for nearly 60% of deafness in developed countries and about 30% of them are syndromic. Pierre Robin Syndrome is one such condition. The patient with this syndrome usually presnts with triad of micrognathia, glossoptosis and cleft palate. Hearing loss is mostly conductive but there can be sensorineural hearing loss also. Here we present a case of Pierre Robin Syndrome who presented with congenital hearing loss. He also had bilateral serous otitis media. He underwent cochlear implant surgery and was prescribed antihistaminics and steroid spray for middle ear effusion. Therefore, proper clinical evaluation is required. [ABSTRACT FROM AUTHOR]

Background: The burden of noncommunicable diseases and their risk factors has rapidly increased worldwide, including in India. Innovative management strategies with electronic decision support and task sharing have been assessed for hypertension, diabetes mellitus, and depression individually, but an integrated package for multiple chronic condition management in primary care has not been evaluated.Methods: In a prospective, multicenter, open-label, cluster-randomized controlled trial involving 40 community health centers, using hypertension and diabetes mellitus as entry points, we evaluated the effectiveness of mWellcare, an mHealth system consisting of electronic health record storage and an electronic decision support for the integrated management of 5 chronic conditions (hypertension, diabetes mellitus, current tobacco and alcohol use, and depression) versus enhanced usual care among patients with hypertension and diabetes mellitus in India. At trial end (12-month follow-up), using intention-to-treat analysis, we examined the mean difference between arms in change in systolic blood pressure and glycated hemoglobin as primary outcomes and fasting blood glucose, total cholesterol, predicted 10-year risk of cardiovascular disease, depression score, and proportions reporting tobacco and alcohol use as secondary outcomes. Mixed-effects regression models were used to account for clustering and other confounding variables.Results: Among 3698 enrolled participants across 40 clusters (mean age, 55.1 years; SD, 11 years; 55.2% men), 3324 completed the trial. There was no evidence of difference between the 2 arms for systolic blood pressure (Δ=-0.98; 95% CI, -4.64 to 2.67) and glycated hemoglobin (Δ=0.11; 95% CI, -0.24 to 0.45) even after adjustment of several key variables (adjusted differences for systolic blood pressure: - 0.31 [95% CI, -3.91 to 3.29]; for glycated hemoglobin: 0.08 [95% CI, -0.27 to 0.44]). The mean within-group changes in systolic blood pressure in mWellcare and enhanced usual care were -13.65 mm Hg versus -12.66 mm Hg, respectively, and for glycated hemoglobin were -0.48% and -0.58%, respectively. Similarly, there were no differences in the changes between the 2 groups for tobacco and alcohol use or other secondary outcomes.Conclusions: We did not find an incremental benefit of mWellcare over enhanced usual care in the management of the chronic conditions studied.Clinical Trial Registration: URL: https://www.Clinicaltrials: gov. Unique identifier: NCT02480062. [ABSTRACT FROM AUTHOR]

The hereditary persistence of fetal hemoglobin (HPFH) and delta beta thalassemia are heterogeneous disorders characterised by increased levels of fetal hemoglobin and high level of this Hb continues in adulthood. The distinction between these two conditions is not always possible with routine hematologic analysis and molecular characterisation of the defect is required. We encountered such a rare case of 8p thalassemia in a 10-year-old male child who presented with features of thalassemia intermedia. Hemoglobin analysis showed 100% HbF while molecular analysis revealed Asian Indian inversion-deletion GγAγ(δβ) zero thalassemia. [ABSTRACT FROM AUTHOR]

Background: Thrombocytopenia may be encountered in various hematological and nonhematological conditions and may be associated with dysplastic megakaryocytes which is a feature of myelodysplastic syndrome (MDS), even though they can be observed in non-MDS hematological conditions. Objective: To study the morphological variations of megakaryocytes on bone marrow aspiration smears in non-MDS-related thrombocytopenia in a Medical College in Bengaluru, Karnataka. Materials and Methods: It was a prospective study of 86 cases of non-MDS thrombocytopenia whose bone marrow aspirates were studied morphologically. Results: The most common cause of thrombocytopenia was acute leukemia followed by other systemic malignancies, megaloblastic anemia, and idiopathic thrombocytopenic purpura. Both dysplastic and nondysplastic features were observed in the above-mentioned conditions. The most common dysplastic feature was nuclear segmentation followed by micromegakaryocytes and hypogranular forms. Among nondysplastic features, the most common were immature forms, bare nuclei, and hypolobation. Emperipolesis and cytoplasmic vacuoles were noted in a case of pyrexia of unknown origin. Conclusion: Dysplastic megakaryocytes are common in non-MDS-related thrombocytopenia and their mere presence should not lead to the diagnosis of MDS. Hence, proper diagnosis should be made on megakaryocyte morphology, patient's clinical findings, and other hematological parameters. This understanding can improve the diagnostic accuracy for wide range of hematological disorders. [ABSTRACT FROM AUTHOR]

• We 65 extracted structural and non-structural feature sets for glaucoma prediction. • Our selected three nature-computing algorithms and two novel algorithms have been applied first time to these glaucoma datasets in combination with these characteristics. As a result, the results from this series of experiments are entirely novel. • The performance test of Bat Algorithm and Binary Cuckoo Search on two typical publicly accessible datasets demonstrates that they are highly efficient in glaucoma prediction. Extensive testing and analysis were conducted (3 machine learning and 5 soft computing techniques were tested on three combinations of two datasets). • This work adds to scientific research by suggesting a unique classifier strategy that achieves astonishing results, up to 98.95% accuracy in detecting glaucoma illness in the binary class. The suggested system's categorization accuracy is evaluated against two widely used and publicly accessible datasets. • This work provides an automated primary glaucoma screening system based on quantitative analysis of fundus pictures to aid ophthalmologists in detecting glaucoma disease more quickly and affordably. It could also be used as a second opinion. With this system, human race has been equipped with a low-cost, rapid, robust, readily implementable, and reliable intelligence system for screening this infection. As a result, the pace of eyesight loss may be minimized. Glaucoma is the second most common cause of vision loss. Manual screening of a patient's eye or screening through a fundus image of the patient's eye requires expert ophthalmologists. This screening analysis is time-consuming, requires expert human involvement, and is subject to human intra-observer variability. Thus, medical imaging professionals are working to solve these issues by investigating retinal images for glaucoma detection using artificial intelligence-based computer-aided diagnosis systems (CAD). Machine learning algorithms (for classification) and nature-inspired computing (for feature selection/reduction) embedded CAD systems can successfully identify retinal pictures and can be employed to overcome these challenges. This proposed work is a productive attempt in which we have proposed two novel two-layered approaches (BA-BCS, BCS-PSO) which are based on Particle Swarm Optimization (PSO), Binary Cuckoo Search (BCS), and Bat Algorithm (BA). We have also analyzed the performances of BA, BCS, and PSO separately. These five (single and two-layered) approaches are used to compose subsets of reduced features that can generate the maximum accuracy when forwarded to three machine learning classifiers. Benchmark publicly available datasets, ORIGA and REFUGE, and their combinations are used to validate the proposed methodology. A maximum accuracy of up to 98.95% is achieved using these approaches. Apart from this, many other trade-off solutions are also suggested for the researcher's community. This study therefore presents novel efforts with new and efficient results that are beneficial to ophthalmologists, researchers, and humanity. [ABSTRACT FROM AUTHOR]

Background: Negative pressure wound therapy has emerged as an attractive treatment modality for the management and healing of chronic ulcers. Though numerous clinical studies are available, there is a lack of biochemical and histological studies evaluating the healing of chronic wounds. Materials and Methods: In the present study, a total 60 patients were divided into two groups: Limited access dressing (LAD) group (n = 30) and conventional dressing group (n = 30). Various biochemical parameters such as hydroxyproline, total protein and antioxidants such as reduced glutathione (GSH), glutathione peroxidase (GPx), catalase (CAT) and oxidative biomarker malondialdhyde (MDA) are measured in the granulation tissue. Histologically amount of inflammatory infiltrate, angiogenesis, and collagen deposition are studied to assess wound healing. Results: Patients treated with LAD have shown significant increase in the mean (±standard deviation) hydroxyproline (77.3 ± 30.1 vs. 32.3 ± 16.18; P = 0.026), total protein (13.89 ± 9.0 vs. 8.9 ± 4.59; P = 0.004), GSH (7.4 ± 1.91 vs. 5.1 ± 1.28; P = 0.039), GPx (122.3 ± 59.3 vs. 88.7 ± 34.11; P = 0.030), CAT (1.80 ± 1.14 vs. 0.9 ± 0.71; P = 0.002) and decrease in MDA (13.4 ± 5.5 vs. 8.6 ± 3.8; P = 0.004). Histological study showed comparatively fewer inflammatory cells, increased and well organised collagen bundles, and more angiogenesis in the LAD group when compared with that with conventional dressing after 10 days of treatment. Conclusion: In the present study, we have found beneficial effect of newer intermittent negative pressure therapy in combination with moist environment (LAD) on chronic wound healing by increasing collagen deposition and angiogenesis; and reducing oxidative stress and inflammatory infiltrate. [ABSTRACT FROM AUTHOR]