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Portal hypertension is secondary to either cirrhotic or non-cirrhotic causes, and complicating pregnancy poses a challenge to the treating team. A systematic review was performed to determine maternal and perinatal outcomes in women with portal hypertension. Outcomes were compared among those with cirrhotic (CPH) with non-cirrhotic portal hypertension (NCPH) as well as non-cirrhotic portal fibrosis (NCPF) with extra-hepatic portal vein obstruction (EHPVO).Medline and EMBASE databases were searched for studies reporting outcomes among pregnant women with portal hypertension. Reference lists from relevant papers and reviews were hand-searched for appropriate citations. Data were extracted to describe maternal complications, obstetric and neonatal outcomes. A random-effects model was used to derive pooled estimates of various outcomes, and final estimates were reported as percentages with a 95% confidence interval (CI). Cumulative, sequential and sensitivity analysis was studied to assess the temporal trends of outcomes over the period.Information on 895 pregnancies among 581 patients with portal hypertension was included from 26 studies. Portal hypertension was diagnosed during pregnancy in 10% (95% CI 4-24%). There were 22 maternal deaths (0%, 95% CI 0-1%), mostly following complications from variceal bleeding or hepatic decompensation. Variceal bleeding complicated in 14% (95% CI 9-20%), and endoscopic interventions were performed in 12% (95% CI 8-17%) during pregnancy. Decompensation of liver function occurred in 7% (95% CI 3-12%). Thrombocytopenia was the most common complication (41%, 95% CI 23-60%). Miscarriages occurred in 14% (95% CI 8-20%), preterm birth in 27% (95% CI 19-37%), and low birth weights in 22% (95% CI 15-30%). Risk of postpartum hemorrhage was higher (RR 5.09, 95% CI 1.84-14.12), and variceal bleeding was lower (RR 0.51, 95% CI 0.30-0.86) among those with CPH compared to NCPH. Risk of various outcomes was comparable between NCPF and EHPVO.One in ten pregnancies complicated with portal hypertension is diagnosed during pregnancy, and thrombocytopenia is the most common complication. Hepatic decompensation and variceal bleeding remain the most common cause of maternal deaths, with reduced rates of bleeding and its complications reported following the introduction of endoscopic procedures during pregnancy. CPH increases the risk of postpartum hemorrhage, whereas variceal bleeding is higher among NCPH.

The IL-33/ST2 immune axis plays crucial roles in infection and immunity. A dysregulated IL-33/ST2 axis can induce autoimmune reaction and inflammatory responses. Guillain-Barré syndrome (GBS) is an acute peripheral neuropathy, mostly caused by post-infection autoimmunity. The role of IL-33/ST2 axis is not known in GBS. This study aimed to explore the role of IL-33/ST2 axis in GBS.Three single nucleotide polymorphisms (SNPs) of Il33 gene (rs16924159, rs7044343, rs1342336) and three SNPs of Il1rl1 gene (rs10192157, rs1041973, rs10206753) coding for suppressor of tumorigenicity 2 (ST2) were genotyped in 179 GBS patients and 186 healthy controls by TaqMan Allelic Discrimination Assay. Plasma levels of IL-33 and sST2 were measured in a subset of GBS patients (n = 80) and healthy controls (n = 80) by ELISA.The frequencies of CC genotype of rs10192157 (p = 0.043) and TT genotype of rs10206753 (p = 0.036) SNPs of Il1rl1 gene differed significantly between GBS patients and healthy controls. Gene-gene interaction between Il33 and Il1rl1 genes also conferred significant risk for GBS. In addition, the plasma sST2 levels were significantly elevated in GBS patients compared to healthy subjects (24,934.31 ± 1.81 pg/ml vs. 12,518.97 ± 1.51 pg/ml, p 0.001). Plasma sST2 levels showed a significant correlation with the disability scores at the peak of neurological deficit in GBS patients.The IL-33/ST2 axis is suggested to influence the immunopathogenesis of GBS. Genetic variants of Il1rl1 gene might serve as a risk determinant of GBS and plasma sST2 levels might emerge as a biomarker of severity of GBS, if replicated further by other studies.

Introduction: Logistic regression is the classical statistical model that is incorporated to predict a binary outcome variable. These models have theoretical assumptions of independence of predictor variables and linearity of association with the outcome in the logarithmic scale. Alternative models developed in the machine learning context like Naïve Bayes model with similar assumptions and Bayesian Network (BN) model can be used for binary prediction. Aim: To compare the predictive performance of logistic regression, Naïve Bayes and BN model in predicting the recurrence of Breast cancer. Materials and Methods: The dataset was procured from UCI Machine Learning repository on recurrence of breast cancer. The study was done on retrospective data from December 2021 to July 2022. The sample size was boosted with the bootstrapping with logistic regression model. The dataset was split into training (70%) and testing (30%) dataset for internal validation. The effect estimates of the potential prognostic variables were estimated using multiple logistic regression model. Naïve Bayes and BN model was also learnt from the training dataset. The indices of predictive accuracy were estimated for the models in both training and testing dataset. Results: Degree of malignancy and side of affected breast were found to be significant predictors of recurrence of breast cancer. BN model had the least misclassification rate and the best sensitivity in comparison to other models in spite of imbalance in outcome variable. Conclusion: BN model performed the best in comparison to logistic regression model when the assumptions of logistic regression model were violated and there is imbalance in proportion of outcome.

Background: Exploration of cerebrospinal fluid (CSF) amino acids and the impact of dietary intake on central levels may provide a comprehensive understanding of the metabolic component of Alzheimer’s disease. Objective: The objective of this exploratory study was to investigate the effects of two diets with varied nutrient compositions on change in CSF amino acids levels in adults with mild cognitive impairment (MCI) and normal cognition (NC). Secondary objectives were to assess the correlations between the change in CSF amino acids and change in Alzheimer’s disease biomarkers. Methods: In a randomized, parallel, controlled feeding trial, adults (NC, n = 20; MCI, n = 29) consumed a high saturated fat (SFA)/glycemic index (GI) diet [HIGH] or a low SFA/GI diet [LOW] for 4 weeks. Lumbar punctures were performed at baseline and 4 weeks. Results: CSF valine increased and arginine decreased after the HIGH compared to the LOW diet in MCI (ps = 0.03 and 0.04). This pattern was more prominent in MCI versus NC (diet by diagnosis interaction ps = 0.05 and 0.09), as was an increase in isoleucine after the HIGH diet (p = 0.05). Changes in CSF amino acids were correlated with changes in Alzheimer’s disease CSF biomarkers Aβ42, total tau, and p-Tau 181, with distinct patterns in the relationships by diet intervention and cognitive status. Conclusion: Dietary intake affects CSF amino acid levels and the response to diet is differentially affected by cognitive status.

Background Neonatal pneumonia remains a significant contributor to infant mortality in India and responsible for increased prevalence of infant deaths globally. Objective To identify risk factors associated with neonatal pneumonia and its mortality in India. Study design A systematic review was conducted including both analytic study designs and descriptive study designs, which reported a quantitative analysis of factors associated with all the three types of pneumonia among neonates. The search was conducted from August to December, 2016 on the following databases; CINAHL, EMBASE, Ovid MEDLINE, PubMed, ProQuest, SCOPUS, Web of Science, WHO IMSEAR and IndMED. The search was restricted to Indian setting. Participants The population of interest was neonates. Outcomes The outcome measures included risk factors for incidences and mortality predictors of neonatal pneumonia. These could be related to neonate, maternal and pregnancy, caregiver, family, environment, healthcare system, iatrogenic and others. Results A total of three studies were included. For risk factors, two studies on ventilator-associated pneumonia were included with 194 neonates; whereas for mortality predictors, only one study with 150 neonates diagnosed with pneumonia was included. 11 risk factors were identified from two studies: duration of mechanical ventilation, postnatal age, birth weight, prematurity, sex of the neonate, length of stay in NICU, primary diagnosis, gestational age, number of re-intubation, birth asphyxia, and use of nasogastric tube. Metaanalysis with random-effects model was possible only for prematurity (250 mm Hg was found to be the single most significant predictor of mortality due to pneumonia in neonates. Conclusion The study found scant evidence from India on risk factors of neonatal pneumonia other than ventilator-associated pneumonia. Electronic Supplementary Material Supplementary material is available in the online version of this article at 10.1007/s13312-021-2374-4

Context Familial partial lipodystrophy (FPL), Dunnigan variety is characterized by skeletal muscle hypertrophy and insulin resistance besides fat loss from the extremities. The cause for the muscle hypertrophy and its functional consequences is not known. Objective To compare muscle strength and endurance, besides muscle protein synthesis rate between subjects with FPL and matched controls (n = 6 in each group). In addition, we studied skeletal muscle mitochondrial function and gene expression pattern to help understand the mechanisms for the observed differences. Methods Body composition by dual-energy X-ray absorptiometry, insulin sensitivity by minimal modelling, assessment of peak muscle strength and fatigue, skeletal muscle biopsy and calculation of muscle protein synthesis rate, mitochondrial respirometry, skeletal muscle transcriptome, proteome, and gene set enrichment analysis. Results Despite increased muscularity, FPL subjects did not demonstrate increased muscle strength but had earlier fatigue on chest press exercise. Decreased mitochondrial state 3 respiration in the presence of fatty acid substrate was noted, concurrent to elevated muscle lactate and decreased long-chain acylcarnitine. Based on gene transcriptome, there was significant downregulation of many critical metabolic pathways involved in mitochondrial biogenesis and function. Moreover, the overall pattern of gene expression was indicative of accelerated aging in FPL subjects. A lower muscle protein synthesis and downregulation of gene transcripts involved in muscle protein catabolism was observed. Conclusion Increased muscularity in FPL is not due to increased muscle protein synthesis and is likely due to reduced muscle protein degradation. Impaired mitochondrial function and altered gene expression likely explain the metabolic abnormalities and skeletal muscle dysfunction in FPL subjects.

Postoperative analgesia is crucial for the early and effective recovery of patients undergoing surgery. Although postoperative multimodal analgesia is widely practiced, opioids such as fentanyl are still one of the best analgesics. The analgesic response of fentanyl varies widely among individuals, probably due to genetic and nongenetic factors. Among genetic factors, single nucleotide polymorphisms (SNPs) may influence its analgesic response by altering the structure or function of genes involved in nociceptive, fentanyl pharmacodynamic, and pharmacokinetic pathways. Thus, it is necessary to comprehensively ascertain if the SNPs present in the aforementioned pathways are associated with interindividual differences in fentanyl requirement. In this study, we evaluated the association between 10 candidate SNPs in 9 genes and 24-hour postoperative fentanyl dose (primary outcome) and also with postoperative pain scores and time for first analgesia (secondary outcomes).A total of 257 South Indian women, aged 18-70 years, with American Society of Anesthesiologists (ASA) physical status I-III, undergoing major breast surgery under general anesthesia, were included in the study. Patients were genotyped for candidate SNPs using real-time polymerase chain reaction. All patients received a standardized intravenous fentanyl infusion through a patient-controlled analgesic (PCA) pump, and the 24-hour postoperative fentanyl dose requirement was measured using PCA.The median 24-hour postoperative fentanyl requirement was higher in rs1799971 carriers (G/G versus A/A + A/G-620 μg [500-700] vs 460 μg [400-580]) with a geometric mean (GM) ratio of 1.91 (95% confidence interval [CI], 1.071-1.327). The median 24-hour pain scores were higher in rs4680 carriers (A/G + A/A versus G/G-34 [30-38] vs 31 [30-38]) with a GM ratio of 1.059 (95% CI, 1.018-1.101) and were lower in rs1045642 carriers (A/A + A/G versus G/G-34 [30-38] vs 30 [30-34]) with a GM ratio of 0.936 (95% CI, 0.889-0.987). The median time for first analgesic was lower in rs734784 carriers [C/C versus T/T + C/T-240 minutes (180-270) vs 240 minutes (210-270)] with a GM ratio of 0.902 (95% CI, 0.837-0.972). Five of 9 clinical factors, namely, history of diabetes, hypertension, hypothyroidism, anesthesia duration, and intraoperative fentanyl requirement were associated with different outcomes individually (P.05) and were used to adjust the respective associations.The SNP opioid receptor mu-1 (OPRM1) (rs1799971) was associated with higher postoperative fentanyl requirement in South Indian patients undergoing major breast surgery. Twenty-four hour postoperative pain scores were higher in catechol-O-methyl transferase (COMT) (rs4680) carriers and lower in ATP binding cassette subfamily B member 1 (ABCB1) (rs1045642) carriers, whereas time for first analgesic was lower in potassium channel subunit 1 (KCNS1) (rs734784) carriers. However, these exploratory findings must be confirmed in a larger study.

Background The increasing incidence of breast cancer necessitates the need to explore alternate screening strategies that circumvent the setbacks of conventional techniques especially among population that report earlier age at diagnosis. Serum autoantibodies is one such potential area of interest. However, their ubiquitous presence across cancer types limits its applicability to any one specific type of cancer. This review was therefore carried out to explore and consolidate available evidence on autoantibodies for early detection of breast cancer and to identify those that demonstrated a higher sensitivity. Methods A diagnostic test accuracy (DTA) review was carried out to ascertain serum autoantibodies that could be used for early detection of breast cancer among women. All relevant articles that investigated the role of autoantibodies in early detection of breast cancer were included for the review. MEDLINE, Scopus, ProQuest, Ovid SP, and Cochrane Library were searched extensively for eligible studies. Quality of the included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. RevMan 5.3 was used for exploratory and MetaDTA 2019 for hierarchical analyses. The review helped identify the most frequently investigated autoantibodies and a meta-analysis further consolidated the findings. Results A total of 53 articles were included for the final analysis that reported over a 100 autoantibodies that were studied for early detection of breast cancer in women. P53, MUC1, HER2, HSP60, P16, Cyclin B1, and c-Myc were the most frequently investigated autoantibodies. Of these P53, MUC1, HER2, and HSP60 exhibited higher summary sensitivity measures. While the individual pooled sensitivity estimates ranged between 10 and 56%, the panel sensitivity values reported across studies were higher with an estimated range of 60–87%. Conclusion Findings from the review indicate a higher sensitivity for an autoantibody panel in comparison to individual assays. A panel comprising of P53, MUC1, HER2, and HSP60 autoantibodies has the potential to be investigated as an early detection biomarker for breast cancer.

Parasitic infestation in marine fish requires urgent attention, especially those that infect economically important fishes, which affect their aesthetic quality and palatability. Ectoparasites in Indian Mackerel, Rastrelliger kanagurta (Cuvier, 1817), have not been studied well. Morphological and seasonal study of ectoparasites in R. kanagurta from the Thiruvananthapuram coast was conducted during March-August 2018. The study investigated three parasitic groups: Trichodinids, Digenean cysts (Centrocestus Looss, 1899), and Cymothoids (Norileca indica Milne Edwards, 1840 and Nerocila phaiopleura Bleeker, 1857) from R. kanagurta during the present study. Of the 240 fishes examined, the Trichodinids and digeneans showed 100% prevalence on the gill samples. Seasons had no significant effect on trichodinids and digeneans prevalence. However, parasitic Cmothoids fluctuated significantly according to the season. They showed greater prevalence during the pre-monsoon (45%) and least in monsoon (25%) due to environmental parameters like rainfall, salinity, and temperature. Trichodinids parasitized gills of R. kanagurta showed increased mucus production, paleness in the gills, and multifocal whitish areas. The Cymothoid infested fish showed lesions with the erosion of the epidermis and underlying dermis at the site of attachment. The noticeable changes were observed in the gill epithelium due to the encystment of digeneans. The Trichodinid ciliates and Heterophyid digenean cysts (Centrocestus Looss, 1899) are reported for the first time in R. kanagurta.

Tacit Knowledge Sharing (TKS) becomes vital for new knowledge creation. Knowledge creation process encourages the view of knowledge as a public good while knowledge appropriation process encourages...

Senescence is a cell fate that contributes to multiple aging-related pathologies. Despite profound age-associated changes in skeletal muscle (SkM), whether its constituent cells are prone to senesce has not been methodically examined. Herein, using single cell and bulk RNA-sequencing and complementary imaging methods on SkM of young and old mice, we demonstrate that a subpopulation of old fibroadipogenic progenitors highly expresses p16(Ink4a) together with multiple senescence-related genes and, concomitantly, exhibits DNA damage and chromatin reorganization. Through analysis of isolated myofibers, we also detail a senescence phenotype within a subset of old cells, governed instead by p2(Cip1). Administration of a senotherapeutic intervention to old mice countered age-related molecular and morphological changes and improved SkM strength. Finally, we found that the senescence phenotype is conserved in SkM from older humans. Collectively, our data provide compelling evidence for cellular senescence as a hallmark and potentially tractable mediator of SkM aging.

Radioactive trivalent chromium (51Cr3+) is a known radiopharmaceutical used to tag plasma proteins, platelets and also for estimation of blood volume. Nevertheless, there exist insufficient reports with limited sample sizes concerning its clearance from blood and its biodistribution after intravenous administration. This study focused to understand clearance rate of 51Cr3+ from blood and analyze its biodistribution. For biodistribution, six adult New Zealand white albino rabbits were injected with 51Cr3+ through their marginal vein. Percentage clearance of 51Cr3+ from blood was calculated by recording radioactive counts obtained at 1, 58, 61, 120, 180 and 240 minutes post-administration in thirty-three adult New Zealand white albino rabbits. For evaluating 51Cr3+ biodistribution, organs were surgically removed from the rabbits and weighed. Radioactivity of the organs and urine were counted in a nucleonix gamma-ray spectrometer with a NaI scintillation detector. Data were expressed as cps/g. Average clearance of 51Cr3+ was 34% from the first to the 58 minute. Subsequent measurements for hourly clearance at 120, 180 and 240 minutes showed percentage reduction of radioactivity of 33, 14 and 8, respectively. Minimal specific activities were found in the muscle and brain. Spleen, lungs, liver and kidneys exhibited moderate radioactivity. Urine tracer-concentrations were found to be ten times more than that of plasma. From this study, it has been observed that clearance of 51Cr3+ from blood was faster initially which slowed down progressively and there displayed moderate uptake of 51Cr3+ by certain organs. Understanding pharmacokinetics of 51Cr3+ is relevant for its potential use as a diagnostic tool.

The study's main aim is to examine the impact of organisational culture on occupational stress by comparing the IT sectors in India and the UK. The paper adopts the application of Denison’s model for studying the organisational culture, whereas role conflict, role ambiguity, role overload and role stress are considered to discuss occupational stress. Through snowball, convenience, purposive and quota sampling techniques, 62 respondents (31 from India and 31 from the UK) were targeted to attain a qualitative perspective through a semi-structured questionnaire. Results showed that there is an impact of organisational culture on occupational stress. Moreover, the impact is mainly evident in the Indian IT sector than the UK IT sector. Moreover, considering the impact of organisational culture on occupational stress, overall employees experience occupational stress, role overload, role conflict, role ambiguity and role stress. In contrasting economies, Indian IT sector employee’s experience role conflict, role overload, role ambiguity and role stress, whereas UK IT sector employees’ experience role ambiguity.

The present study examines the impact of job satisfaction on occupational stress of IT employees working in both developed and developing economies (India and the UK). Generally, occupational stress is considered to have the negative impact on the individual as well as the organization's performance. The study has adopted the application of the Spector JSS survey to consider the job satisfaction of the employees using the five-point Likert scale. The role conflict, role ambiguity, role overload, and role stress are considered in relation to occupational stress. Quantitative approach has been adopted by combining area cluster sampling, purposive and convenience sampling to gather 200 quantitative responses (100 from India and 100 from the UK) through questionnaire and analyzed through IBM SPSS 24.0. The results demonstrated that there is a significant impact of job satisfaction on the occupational stress in the IT sector of the UK and India.