Search

Abstract Background Multimorbidity is associated with significant out-of-pocket expenditures (OOPE) and catastrophic health expenditure (CHE), especially in low- and middle-income countries like India. Despite this, there is limited research on the financial burden of multimorbidity in outpatient and inpatient care, and cross-state comparisons of CHE are underexplored. Methods We conducted a cross-sectional analysis using nationally representative data from the National Sample Survey 75th Round ‘Social Consumption in India: Health (2017–18)’, focusing on patients aged 30 and above in outpatient and inpatient care in India. We assessed multimorbidity prevalence, OOPE, CHE incidence, and CHE intensity. Statistical models, including linear, log-linear, and logistic regressions, were used to examine the financial risk, with a focus on non-communicable diseases (NCDs), healthcare facility choice, and socioeconomic status and Epidemiological Transition Levels (ETLs). Results Multimorbidity prevalence in outpatient care (6.1%) was six times higher than in inpatient care (1.1%). It was most prevalent among older adults, higher MPCE quintiles, urban patients, and those with NCDs. Multimorbidity was associated with higher OOPE, particularly in the rich quintile, patients seeking care from private providers, low ETL states, and rural areas. CHE incidence was highest in low ETL states, private healthcare users, poorest quintile, males, and patients aged 70 + years. CHE intensity, measured by mean positive overshoot, was greatest among the poorest quintile, low ETL states, rural, and male patients. Log-linear and logistic regressions indicated that multimorbidity patients with NCDs, those seeking private care, and those in low ETL states had higher OOPE and CHE risk. The poorest rural multimorbidity patients had the greatest likelihood of experiencing CHE. Furthermore, CHE intensity was significantly elevated among multimorbidity patients with NCDs (95% CI: 19.29–45.79), patients seeking care in private, poorest, and from low ETL states (95% CI: 7.36–35.79). Conclusions The high financial burden of OOPE and CHE among multimorbidity patients, particularly those with NCDs, highlight the urgent need for comprehensive health policies that address financial risk at the primary care level. To alleviate the financial burden among multimorbidity patients, especially in low-resource settings, it is crucial to expand public healthcare coverage, incorporate outpatient care into financial protection schemes, advocate for integrated care models and preventive strategies, establish standardized treatment protocols for reducing unnecessary medications linked to polypharmacy, and leverage the support of digital health technologies.

Abstract Background Cardiac myxomas are the most common primary benign tumors of the heart usually presenting as an oval mass attached to the interatrial septum. Mild heterogenous enhancement is typically seen upon contrast administration. Myxomas are benign, however can present with embolic episodes necessitating prompt diagnosis and treatment. Case presentation A middle-aged woman presenting with acute ischemic stroke was detected to have a complex cystic mass in the left atrium on echocardiography. Further evaluation with cardiac magnetic resonance imaging narrowed a differential diagnosis to hemangioma, hemangioendothelioma, sarcoma, hydatid cysts, bronchogenic cysts, and cystic variant of cardiac myxoma. CTA demonstrated arterial supply from the left circumflex artery supplying the lesion. Following surgical excision, histopathology analysis suggested a cystic cardiac myxoma with secondary degeneration. Conclusion Cystic masses in the heart are challenging to diagnose due to similar imaging characteristics, and misdiagnosis may lead to further major downstream complications such as stroke, hemorrhage, and hemodynamic alterations causing syncope. Therefore, surgical excision of a cystic cardiac mass is justified to establish a definitive histopathological diagnosis and prevent further downstream complications. We hereby report a rare case of cystic cardiac myxoma in the left atrium showing intense progressive enhancement in CMR and CTA in a middle-aged woman presenting with acute stroke. This case highlights an exceedingly rare variant of cystic cardiac myxoma.

Partial cavopulmonary shunt is an established procedure for patients with abnormal right ventricular (RV) physiology. Late failure of the Glenn shunt is usually due to further progression of the primary disease process. However, there may be surprises, as in our patient. We report an 8-year-old child who was diagnosed with tricuspid valve (TV) dysplasia with borderline RV hypoplasia. He underwent TV repair with a right cavopulmonary shunt. He presented with features of heart failure after 6 years of the surgery. An echocardiographic evaluation suggested a restrictive filling pattern of the RV with preserved size and function. Computed tomography and cardiac magnetic resonance imaging revealed a normal pericardial thickness with no evidence of myocardial involvement. Despite the contradicting clinical and imaging features, endomyocardial biopsy confirmed a diagnosis of desmin cardiomyopathy. Restrictive cardiomyopathy may remain an elusive diagnosis despite extensive imaging. In our case, the altered loading conditions due to a cavopulmonary shunt further masked pathophysiological hemodynamic changes.

Background: Distal end radius fractures are common injuries treated in orthopedic practice, with varying treatment modalities influencing outcomes. Aims and Objectives: The study was designed to compare the outcomes between open reduction and internal fixation (ORIF) with plating and K-wires plus casting in patients treated for distal end radius fractures. Materials and Methods: One hundred patients with distal end radius fractures were included and divided into two groups: Group A (ORIF with plating) and Group B (K-wires plus casting), with 50 patients in each group. Parameters included were healing time, complication rates, functional recovery, patient satisfaction scores, pain levels during recovery, and the time to return to daily activities. Results: Group A demonstrated a shorter average healing time (8 weeks) compared to Group B (9 weeks). Complication rates showed 5% malunion and 4% delayed union in Group A, against 12% and 6%, respectively, in Group B. Functional recovery was higher in Group A, with 93% grip strength and 88% range of motion recovery. Patient satisfaction was also higher in Group A (8.5 out of 10) compared to Group B (7.5 out of 10). Pain levels during recovery were lower in Group A, and the time to return to daily activities was shorter (8 weeks for Group A versus 10 weeks for Group B). Conclusion: The study suggests that ORIF with plating offers better outcomes in terms of healing time, complication rates, functional recovery, patient satisfaction, pain management, and quicker return to daily activities than K-wires plus casting for distal end radius fractures.

Abstract Construction and global infrastructure depend on cement production. It is one of the biggest carbon emitters, making it an aspect of environmental sustainability and climate change mitigation. Each stage of cement production releases CO2 and other greenhouse gasses. About 8% of worldwide CO2 emissions come from the cement sector, making it a major contributor. Different supplementary cementitious materials (SCMs) like fly ash (FA), silica fume (SF), and slag are used to partially replace traditional raw materials like limestone, reducing the environmental impact. This study investigated the use of supplementary cementitious materials, specifically FA and alccofine (AF), as partial replacements for cement in concrete to reduce environmental impact. The study first identified an optimal replacement percentage for FA (20%, 30%, and 40%) by weight of cement. Subsequently, using the optimal FA percentage, AF was added at varying percentages (5%, 10%, and 15%) by weight of cement. The study evaluated the mechanical properties of the concrete mixtures, including workability, compressive strength, split tensile strength, and flexural strength. Durability, measured by water sorptivity and rapid chloride penetrability tests, was also assessed. The microstructural properties of the concrete were analyzed to understand their influence on performance. As a result of the significant environmental implications of producing and using concrete for all activities, an in-depth life cycle assessment (LCA) was conducted. Additionally, artificial neural networks were employed to predict the compressive strength of the concrete. The study concluded that incorporating FA and AF in concrete mixtures is a promising approach to producing more environmentally friendly concrete.

Abstract Diabetic Retinopathy (DR) and Diabetic Macular Edema (DME) are vision related complications prominently found in diabetic patients. The early identification of DR/DME grades facilitates the devising of an appropriate treatment plan, which ultimately prevents the probability of visual impairment in more than 90% of diabetic patients. Thereby, an automatic DR/DME grade detection approach is proposed in this work by utilizing image processing. In this work, the retinal fundus image provided as input is pre-processed using Discrete Wavelet Transform (DWT) with the aim of enhancing its visual quality. The precise detection of DR/DME is supported further with the application of suitable Artificial Neural Network (ANN) based segmentation technique. The segmented images are subsequently subjected to feature extraction using Adaptive Gabor Filter (AGF) and the feature selection using Random Forest (RF) technique. The former has excellent retinal vein recognition capability, while the latter has exceptional generalization capability. The RF approach also assists with the improvement of classification accuracy of Deep Convolutional Neural Network (CNN) classifier. Moreover, Chicken Swarm Algorithm (CSA) is used for further enhancing the classifier performance by optimizing the weights of both convolution and fully connected layer. The entire approach is validated for its accuracy in determination of grades of DR/DME using MATLAB software. The proposed DR/DME grade detection approach displays an excellent accuracy of 97.91%.

In the western arid regions, where monsoon seasons often include regular and extended dry spells, agricultural practices need to be tailored to these challenging conditions. This research aimed to understand the effects of foliar urea application and different irrigation scheduling on crop productivity, profitability, and quality in arid region, and was conducted over two consecutive Kharif seasons of 2020 and 2021. The use of 2% urea at flowering + pod formation stages resulted in a notable improvement in yield parameters, number, weight, and buildup of dry matter. Improvement in these parameters led to significantly higher moth bean yield, by a margin of 20 – 22% as compared to other treatments. On the basis of pooled mean of two years, foliar spray of 2% urea at flowering + pod formation stages improved the protein content by 6 to 7%, protein productivity by 27–31%, physical water productivity by ∼20% and net monetary returns by 31–34% as compared to single foliar application. Similarly, irrigation at branching + pod formation stages registered higher growth parameters, grain yield (8%), profitability (13%), nutrient uptake, and residual soil fertility in moth bean as compared to other irrigation treatments. In conclusion, it is recommended that the application of urea (2%) by foliar spray at the flowering + pod formation stages and the modification of irrigation to the branching stage + pod formation stage, from the existing recommendation (flowering + pod formation), were more profitable and productive during early, prolonged dry spells with high temperatures, which are more typical in western dry regions for moth beans. Notably, it assists in fulfilling the protein needs of the vegetarian populace of western Rajasthan, India, where moth beans play a vital role in the diet.

Abstract Improving the efficiency of bifunctional electrocatalysts is a decisive challenge in the area of long‐lasting rechargeable zinc‐air batteries. Enhancing the catalysts' performance is crucial for advancing zinc‐air batteries. Transition‐metal oxides have emerged as promising non‐precious, noble‐metal‐free catalysts. Herein, a unique precursor directed approach is introduced for preparing a cobalt ferrite@nitrogen doped carbon nanohorns (CoFe2O4@N‐CNHs) nanohybrid catalyst in a single step annealing process involving stoichiometric amounts of single‐source cobalt and iron molecular precursors and carbon nanohorns (CNHs) under an argon/ammonia (Ar/NH3) atmosphere. This procedure enables a simultaneous CoFe2O4 ferrite synthesis and nitrogen functionalization of CNHs. The precious metal free nanohybrid CoFe2O4@N‐CNHs‐30% containing 30% of carbon presents an oxygen reduction reaction (ORR) half wave potential and onset potential comparable to the standard ORR catalyst 20% Pt/C. CoFe2O4@N‐CNHs‐30% also establishes superior oxygen evolution reaction (OER) performance with a low overpotential and a small Tafel slope than benchmark OER catalyst RuO2. Furthermore, the rechargeable zinc‐air battery with the CoFe2O4@N‐CNHs‐30% nanohybrid as air electrode demonstrates steadier and more durable charge–discharge cycles, and outstanding energy density relative to the state‐of‐the‐art 20% Pt/C‐RuO2 catalyst.

Abstract Background Perianal fistulas (PF) affect one-third patients with Crohn’s disease (CD) with limited therapeutic options. There is dearth of literature on safety and efficacy of bone marrow-derived mesenchymal stromal cells (BMSCs) in this population. Methods An open-label, phase I/II, single-arm study was conducted involving local administration of human allogeneic bone marrow-derived mesenchymal stromal cells in perianal fistula of patients with Crohn’s disease refractory to standard therapies. Clinical severity and biomarkers were assessed at baseline and periodically until week 104 , and MRI at week 24 and 104. Primary and secondary objectives were to assess safety and efficacy respectively. Fistula remission was complete closure of fistula openings with

Abstract Background Wheat rusts are important biotic stresses, development of rust resistant cultivars through molecular approaches is both economical and sustainable. Extensive phenotyping of large mapping populations under diverse production conditions and high-density genotyping would be the ideal strategy to identify major genomic regions for rust resistance in wheat. The genome-wide association study (GWAS) population of 280 genotypes was genotyped using a 35 K Axiom single nucleotide polymorphism (SNP) array and phenotyped at eight, 10, and, 10 environments, respectively for stem/black rust (SR), stripe/yellow rust (YR), and leaf/brown rust (LR). Results Forty-one Bonferroni corrected marker-trait associations (MTAs) were identified, including 17 for SR and 24 for YR. Ten stable MTAs and their best combinations were also identified. For YR, AX-94990952 on 1A + AX-95203560 on 4A + AX-94723806 on 3D + AX-95172478 on 1A showed the best combination with an average co-efficient of infection (ACI) score of 1.36. Similarly, for SR, AX-94883961 on 7B + AX-94843704 on 1B and AX-94883961 on 7B + AX-94580041 on 3D + AX-94843704 on 1B showed the best combination with an ACI score of around 9.0. The genotype PBW827 have the best MTA combinations for both YR and SR resistance. In silico study identifies key prospective candidate genes that are located within MTA regions. Further, the expression analysis revealed that 18 transcripts were upregulated to the tune of more than 1.5 folds including 19.36 folds (TraesCS3D02G519600) and 7.23 folds (TraesCS2D02G038900) under stress conditions compared to the control conditions. Furthermore, highly expressed genes in silico under stress conditions were analyzed to find out the potential links to the rust phenotype, and all four genes were found to be associated with the rust phenotype. Conclusion The identified novel MTAs, particularly stable and highly expressed MTAs are valuable for further validation and subsequent application in wheat rust resistance breeding. The genotypes with favorable MTA combinations can be used as prospective donors to develop elite cultivars with YR and SR resistance.

Abstract Despite the availability of various drugs for benign prostatic hyperplasia (BPH), alpha(α)-blockers are the preferred first-line treatment. However, there remains a scarcity of direct comparisons among various α-blockers. Therefore, this network meta-analysis (NMA) of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of α-blockers in the management of BPH. A comprehensive electronic search covered PubMed, Embase, Ovid MEDLINE, and Cochrane Library until August 2023. The primary endpoints comprised international prostate symptom score (IPSS), maximum flow rate (Qmax), quality of life (QoL), and post-void residual volume (PVR), while treatment-emergent adverse events (TEAEs) were considered as secondary endpoints. This NMA synthesized evidence from 22 studies covering 3371 patients with six kinds of α-blockers with 12 dose categories. IPSS has been considerably improved by tamsulosin 0.4 mg, naftopidil 50 mg and silodosin 8 mg as compared to the placebo. Based on the p-score, tamsulosin 0.4 mg had the highest probability of ranking for IPSS, PVR, and Qmax, whereas doxazosin 8 mg had the highest probability of improving QoL. A total of 297 adverse events were reported among all the α-blockers, silodosin has reported a notable number of TEAEs. Current evidence supports α-blockers are effective in IPSS reduction and are considered safer. Larger sample size with long-term studies are needed to refine estimates of IPSS, QoL, PVR, and Qmax outcomes in α-blocker users.

Amyloid is an amorphous, fibrillar material formed from various abnormally folded proteins that deposits locally or systemically. Over 95% of cases have been attributed to light chain deposition (AL) or transthyretin deposition (ATTR) amyloidosis. The basic investigations in the evaluation of cardiac amyloidosis include the electrocardiogram, echocardiography and cardiac biomarkers. Echocardiography in a patient with cardiac amyloidosis shows biatrial enlargement, biventricular hypertrophy, diastolic dysfunction, interatrial septal thickening, valvular thickening, a glistening appearance of the interventricular septum, and pericardial effusion. Magnetic resonance imaging can help distinguish amyloidosis from other causes of infiltrative/restrictive cardiomyopathy, from example, sarcoidosis, hemochromatosis, and Fabry disease based on characteristic enhancement patterns in these diseases. The latest Expert Consensus recommends that serum/urine immunofixation electrophoresis along with a serum free light chain assay must be done in all the cases of suspected cardiac amyloidosis. If the light chain assays are positive, we proceed with tissue diagnosis for confirmation of AL amyloidosis. If the screening assays are negative for monoclonal gammopathy, the next step is to obtain cardiac scintigraphy. If the nuclear scan is negative, but the index of suspicion remains high, an endomyocardial biopsy can be done. Once amyloid is demonstrated in histopathologic specimens, it must be typed to distinguish between AL and ATTR. The ideal method for this is tandem mass spectrometry, although this may not be widely available. It has a sensitivity of 88% and specificity of 96% higher than other techniques 23. In resource-poor settings, immunohistochemistry or immunoelectron microscopy can allow this distinction, although with lesser sensitivity.

Introduction: The prognostic significance of steroid receptors in bladder cancer remains controversial. This study was designed to determine the expression status of androgen receptor (AR), estrogen receptors (ERα and Erβ), and its potential role in predicting survival in patients with nonmuscle invasive bladder cancer (NMIBC). Methods: Sixty patients of NMIBC were screened and 57 (41 males and 16 females) were included in our study. The tissue microarray slides were evaluated by pathologists blinded to the clinical information. Association of distribution of steroid receptors with stage, grade, progression, and recurrence was seen. Results: The mean age of the population was 60.9 ± 9.3 years. Pathologically, majority of the patients were Ta (Ta: T1 stage 61.4% vs. 38.6%). Nine (15.8%) of the tumors stained positive for AR while one (1.8%) tumor stained positive for ERα and 36 (63.2%) tumors stained for ERβ. A higher proportion of male NMIBC stained positive for AR (19.5% vs. 6.2%, P = 0.420) while ERβ positivity was higher in females (58.5% vs. and 75%,P = 0.247). AR-negative tumors showed higher recurrence (20/48%–42%) as compared to AR-positive tumors (2/9%–22%). ERβ-positive tumors showed higher recurrence (15/36%–42% vs. 7/21%–33%, P = 0.179). Progression-free survival (PFS) was found to be significantly lower for ERβ-negative group (log-rank test P = 0.035). Conclusion: AR and ERβ positivity is found in NMIBC patients while ERα shows minimal staining in NMIBC patients. Although it did not reach a statistical significance, a higher proportion of AR-negative and ERβ-positive tumors recurred as compared to AR-positive and ERβ-negative patients. PFS was significantly lower in ERβ-negative group. Further exploratory studies on larger sample sizes are required to validate these findings in NMIBC patients.

BackgroundProtein hydrolysates derived from food sources contains enormous number of peptides which are composed of amino acid possessess various bioactive properties. However, the use of protein hydrolysates as a nutraceutical is hindered due to their unpleasant flavour. The study aims to enhance the biological activity and palatability of protein hydrolysates.MethodologyIn the present study, soybean protein hydrolysate (SPH) was prepared using alcalase for 4 h (control). Modification of hydrolysis (MPH) was carried out by reiterating the hydrolysis of the supernatant obtained after 2 h of hydrolysis using an enzyme to 50% of alcalase during each successive hydrolysis. Samples were characterised by their physio-chemical and functional properties. Furthermore, the effect of modification on the protein digestibility and bitterness intensity using e-tongue was studied. The suppressive effect on retrogradation of corn starch was analysed using texture profile analysis.ResultsThe results demonstrated increased protein content by 1.6 and 1.9% in MPH compared to SPH and UNH, respectively. MPH showed 1.5- and 1.6-fold higher DH% than SPH before and after gastrointestinal digestion (p SPH > MPH. Nevertheless, MPH displayed significantly higher functional properties (p ≤ 0.05). The hardness of retrograded corn starch was significantly reduced in the MPH (1.21N) than SPH (1.55 N) and UNH (1.81N) compared to control (1.71N) during 7-day storage at 4°C (p ≤ 0.05). E-tongue analysis of MPH showed a 4-fold reduction in bitterness than SPH.ConclusionModification of hydrolysis of soybean has demonstrated its significance in improved DH% functional properties and palatability. In addition, improved protein digestibility with promising benefits in deferral action on retrogradation of starch over the traditional process of hydrolysis was observed. The outcome of this study contributes to the potential utilisation of MPH as an ingredient in the formulation of nutraceutical products.

Abstract Titanium and its alloys exhibit a favorable integration of characteristics, including notable strength and high resistance to corrosion. However, they are deficient in terms of wear resistance and thermal conductivity, among other properties. The aforementioned limitations impose constraints on the utilization of these alloys across diverse applications. Currently, various strategies involving the utilization of composite materials are being implemented in order to address and mitigate these previously mentioned limitations. The utilization of micro- or nano-sized reinforcements has been employed to improve the characteristics of the metal matrix. Diverse techniques are employed to uniformly distribute the reinforcement within the matrix, thereby generating titanium metal matrix composites (TMCs). The use of TMCs has become increasingly prevalent in diverse sectors, including defense, automotive, aerospace, and biomedical, owing to their remarkable characteristics, which encompass lower weight, higher specific strength, and compatibility with biological systems. The present study discusses various manufacturing techniques, including spark plasma sintering (SPS), additive manufacturing, and vacuum melting. This study further examines different reinforcements that are considered in the production of TMCs. The current study also investigates the effects of reinforcements on properties such as mechanical and tribological characteristics. The study demonstrated that the incorporation of reinforcements resulted in enhanced properties.

Abstract Purpose The optimal management of primary renal leiomyosarcomas is unknown owing to its rarity and minimal available information about their primary, adjuvant treatment and clinical outcomes. This study systematically reviews treatment evidence and effects in terms of survival for leiomyosarcomas arising primarily from kidney, renal pelvis and renal vessels. Method PubMed and Embase databases were searched from inception to March 2023, with manual searches of reference lists. Two investigators independently reviewed the studies reporting management and survival outcomes of renal leiomyosarcomas. Results A total of 85 publications met inclusion criteria, reporting on 188 cases. The median age was 55.5 years, predominantly female [52.7%]. Pain was the most common presenting symptom [41.5%], and most tumors were high grade [45.8%]. Complete surgical resection with negative margins forms definitive treatment. The median disease-free survival and overall survival (OS) for all reviewed patients were 24 months [95%CI 4.1–43.9] and 42 months [95%CI 32.5–51.4], respectively. The OS of 1 year, 2 year, 3 year and 5 year was 78.8%, 64.4%, 53.8% and 38.9%, respectively. On univariate analysis, favorable factors for OS included tumor size ≤ 5 cm, low-grade histology, tumors of renal vascular origin and non-metastatic disease at presentation. Neoadjuvant or adjuvant treatment with either radiotherapy or chemotherapy has been shown to improve OS (NR vs. 36 months, p 5 cm in size. Conclusion Radical nephrectomy with en bloc tumor resection with negative margins forms the mainstay of treatment for renal leiomyosarcomas. Adjuvant radiotherapy or chemotherapy appears to improve OS. To validate this treatment strategy, prospective multicentric efforts are required to acquire reliable data from randomized trials.

Context: Clinical research plays a vital role in advancing medical knowledge and improving patient care. As regulatory bodies strive to ensure the integrity and safety of clinical trials, the US Food and Drug Administration (USFDA) conducts inspections to evaluate compliance with established regulations. Aims: To examine the USFDA’s inspections and non-compliance actions taken against clinical research organizations (CROs) over a 13 years period. Methods: The study utilizes a comprehensive dataset compiled from publicly available records, including inspection reports, warning letters, and other regulatory documents issued by the USFDA. Through systematic data collection and analysis, this study seeks to shed light on the frequency and nature of non-compliance findings, identify common areas of concern, and evaluate the effectiveness of regulatory actions. Results: The study reveals patterns and trends in the USFDA’s inspections, highlighting key compliance challenges faced by CROs. These challenges include issues related to study protocols, informed consent, data integrity, adverse event reporting, and adherence to good clinical practice (GCP) guidelines. Furthermore, this analysis explores the USFDA’s warning letters to assess their impact on CROs’ compliance efforts. Conclusions: The findings of this retrospective analysis can inform CROs, and other stakeholders about the areas of greatest concern in clinical research compliance. The study contributes to the ongoing efforts to enhance the quality and integrity of clinical trials, ultimately benefiting patient safety and the credibility of the research enterprise.

Abstract Introduction Prostate-specific antigen (PSA) is a reliable biomarker for identification of prostate cancer, although a biopsy is still the gold standard for detecting prostate cancer. Similar to higher PIRADS lesions on MRI, the maximal standard uptake value (SUV max) on PSMA PET is linked to a higher likelihood of prostate cancer. Can an mpMRI in conjunction with PSMA PET Scan accurately predict prostate cancer and further trigger omission of biopsy similar to other solid organ urological malignancies? Methods Ga-68 PSMA PET and mpMRI were performed for each patient who was a part of this retrospective study. The PET-positive lesion's maximum standardized uptake value (SUVmax) was recorded. Prostate biopsies were performed on patients who had PSMA PET avid lesions and a PIRADS score of 4 or 5. Robot-assisted radical prostatectomy (RARP) was afterward performed on patients who had cancer on their prostate biopsy. The prostatectomy specimen's histopathological information was recorded. Cutoff values and correlations between the variables were determined using the ROC curves and Pearson's correlation test. Result On the basis of suspicious DRE findings or elevated PSA, 70 men underwent mpMRI and PET scans. PIRADS 4 patients had a median (IQR) SUVmax of 8.75 (11.95); whereas, PIRADS 5 patients had an SUVmax of 24.5 (22). The mean SUVmax for patients whose biopsies revealed no cancer was 6.25 ± 1.41. With an AUC of 0.876 on the ROC curve, it was found that there was a significant positive correlation between the results of the mpMRI and PET scans and those of the histopathological investigation. A SUVmax ≥ 8.25 on PSMA PET for a PIRADS 4/5 lesion on mpMRI will aid in correctly predicting malignancy, with a sensitivity of 82.8% and specificity of 100%. Conclusion The findings of this study were positive and indicated that patients with a high suspicion of prostate cancer on mpMRI and PSMA PET (PIRADS ≥ 4 and SUVmax ≥ 8.25). This study substantiates the fact that a combination of mpMRI and PSMA PET can accurately predict localized prostate cancer.

Abstract Corn-leaf aphid (CLA-Rhopalosiphum maidis) is a major insect pest of barley (Hordeum vulgare) causing yield loss upto 30% under severe infestation. Keeping in view of the availability of very few sources of CLA resistance in barley, the present investigation was framed to assess the genetic diversity and population structure of 43 wild barley (H. vulgare subsp. spontaneum) genotypes using eight microsatellite markers against R. maidis. Three statistical methods viz. multivariate-hierarchical clustering, Bayesian clustering and PCoA, unanimously grouped genotypes into three subpopulations (K = 3) with 25.58% (SubPop1-Red), 39.53% (SubPop2-Green) and 34.88% (SubPop3-Blue) genotypes including admixtures. Based on Q ≥ 66.66%, 37.20% genotypes formed a superficial “Mixed/Admixture” subpopulation. All polymorphic SSR markers generated 36 alleles, averaging to 4.5 alleles/locus (2–7 range). The PIC and H were highest in MS31 and lowest in MS28, with averages of 0.66 and 0.71. MAF and mean genetic diversity were 0.16 and 89.28%, respectively. All these parameters indicated the presence of predominant genetic diversity and population structure amongst the studied genotypes. Based on AII, only 6 genotypes were found to be R. maidis resistant. SubPop3 had 91.66% (11) of the resistant or moderately resistant genotypes. SubPop3 also had the most pure genotypes (11), the least aphid infestation (8.78), and the highest GS (0.88), indicating its suitability for future R. maidis resistance breeding initiatives.

Nowadays, hulless barley (Hordeum vulgare L.) is gaining importance as a raw material for food industry due to its highly nutritive value. Non-availability of high yield and disease resistant varieties has restricted its production in marginal areas over the last two decades. Therefore, an experiment was conducted during 2017–18 and 2018–19 at the Seed and Research Farm of ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana to characterized 11 exotic hulless barley genotypes and 4 Indian barley cultivars for morpho-physiological characters and stripe rust resistance. Seedling resistant test for stripe rust was done at Regional Station (ICAR-Indian Institute of Wheat and Barley Research), Flowerdale, Shimla, Himachal Pradesh. Highly significant genotypic differences were found for morpho-physiological traits during analysis of variance. Genotype DWRNB28 showed a good combination of desirable traits, viz. early maturity (118 days), dwarf plant height (64.4 cm) and high 1000-grain weight (55.2 g). Maximum number of tillers per meter (149) was observed in DWRNB17. Genotype DWRNB25 was found resistant to maximum pathotypes (6S0, 7S0, and Q) at the seedling stage. DWRNB23 and DWRNB25 with pooled ACI=0 and ACI=0.04 respectively, were found immune to stripe rust in field conditions. These promising genotypes can be utilized as donor parents for the development of high-yielding and stripe-rust-resistant hulless barley varieties.

BackgroundRecurrent and unpredictable seizures characterize epilepsy, a neurological disorder affecting millions worldwide. Epilepsy diagnosis is crucial for timely treatment and better outcomes. Electroencephalography (EEG) time-series data analysis is essential for epilepsy diagnosis and surveillance. Complex signal processing methods used in traditional EEG analysis are computationally demanding and difficult to generalize across patients. Researchers are using machine learning to improve epilepsy detection, particularly visual feature extraction from EEG time-series data.ObjectiveThis study examines the application of a Gramian Angular Summation Field (GASF) approach for the analysis of EEG signals. Additionally, it explores the utilization of image features, specifically the Scale-Invariant Feature Transform (SIFT) and Oriented FAST and Rotated BRIEF (ORB) techniques, for the purpose of epilepsy detection in EEG data.MethodsThe proposed methodology encompasses the transformation of EEG signals into images based on GASF, followed by the extraction of features utilizing SIFT and ORB techniques, and ultimately, the selection of relevant features. A state-of-the-art machine learning classifier is employed to classify GASF images into two categories: normal EEG patterns and focal EEG patterns. Bern-Barcelona EEG recordings were used to test the proposed method.ResultsThis method classifies EEG signals with 96% accuracy using SIFT features and 94% using ORB features. The Random Forest (RF) classifier surpasses state-of-the-art approaches in precision, recall, F1-score, specificity, and Area Under Curve (AUC). The Receiver Operating Characteristic (ROC) curve shows that Random Forest outperforms Support Vector Machine (SVM) and k-Nearest Neighbors (k-NN) classifiers.SignificanceThe suggested method has many advantages over time-series EEG data analysis and machine learning classifiers used in epilepsy detection studies. A novel image-based preprocessing pipeline using GASF for robust image synthesis and SIFT and ORB for feature extraction is presented here. The study found that the suggested method can accurately discriminate between normal and focal EEG signals, improving patient outcomes through early and accurate epilepsy diagnosis.

Migrasomes are signaling organelles that form in retraction fibers of migrating cells. Here authors show that migrasomes form by a two-stage process: an initial local membrane swelling matures and is stabilized by recruited tetraspanin proteins.

The current study describes a new diagnostic method for the rapid and accurate detection of Tilletia indica, the pathogen accountable for causing Karnal bunt (KB) disease in wheat. This method uses quantitative real-time polymerase chain reaction (qPCR) and a primer set derived from glyceraldehyde 3-phosphate dehydrogenase (GAPDH) gene of T. indica to identify the presence of the pathogen. The qPCR assay using this primer set was found highly sensitive, with a limit of detection (LOD) value of 4 pg of T. indica DNA. This level of sensitivity allows for the detection of the pathogen even in cases of different growth stages of wheat, where no visible symptoms of infection on the wheat plants can be seen by naked eyes. The study also validated the qPCR assay on ten different wheat cultivars. Overall, this study presents a valuable molecular tool for rapid, specific and sensitive detection of KB fungus in wheat host. This method has practical applications in disease management, screening of wheat genotypes against KB and can aid in the development of strategies to mitigate the impact of Karnal bunt disease on wheat production.

A high-quality genome sequence from an Indian isolate of Blumeria graminis f. sp. tritici Wtn1, a persistent threat in wheat farming, was obtained using a hybrid method. The assembly of over 9.24 million DNA-sequence reads resulted in 93 contigs, totaling a 140.61 Mb genome size, potentially encoding 8480 genes. Notably, more than 73.80% of the genome, spanning approximately 102.14 Mb, comprises retro-elements, LTR elements, and P elements, influencing evolution and adaptation significantly. The phylogenomic analysis placed B. graminis f. sp. tritici Wtn1 in a distinct monocot-infecting clade. A total of 583 tRNA anticodon sequences were identified from the whole genome of the native virulent strain B. graminis f. sp. tritici, which comprises distinct genome features with high counts of tRNA anticodons for leucine (70), cysteine (61), alanine (58), and arginine (45), with only two stop codons (Opal and Ochre) present and the absence of the Amber stop codon. Comparative InterProScan analysis unveiled “shared and unique” proteins in B. graminis f. sp. tritici Wtn1. Identified were 7707 protein-encoding genes, annotated to different categories such as 805 effectors, 156 CAZymes, 6102 orthologous proteins, and 3180 distinct protein families (PFAMs). Among the effectors, genes like Avra10, Avrk1, Bcg-7, BEC1005, CSEP0105, CSEP0162, BEC1016, BEC1040, and HopI1 closely linked to pathogenesis and virulence were recognized. Transcriptome analysis highlighted abundant proteins associated with RNA processing and modification, post-translational modification, protein turnover, chaperones, and signal transduction. Examining the Environmental Information Processing Pathways in B. graminis f. sp. tritici Wtn1 revealed 393 genes across 33 signal transduction pathways. The key pathways included yeast MAPK signaling (53 genes), mTOR signaling (38 genes), PI3K-Akt signaling (23 genes), and AMPK signaling (21 genes). Additionally, pathways like FoxO, Phosphatidylinositol, the two-component system, and Ras signaling showed significant gene representation, each with 15–16 genes, key SNPs, and Indels in specific chromosomes highlighting their relevance to environmental responses and pathotype evolution. The SNP and InDel analysis resulted in about 3.56 million variants, including 3.45 million SNPs, 5050 insertions, and 5651 deletions within the whole genome of B. graminis f. sp. tritici Wtn1. These comprehensive genome and transcriptome datasets serve as crucial resources for understanding the pathogenicity, virulence effectors, retro-elements, and evolutionary origins of B. graminis f. sp. tritici Wtn1, aiding in developing robust strategies for the effective management of wheat powdery mildew.

Context: The concept of the revascularization technique mainly depends on root canal sterilization, the presence of a template (blood clot), and coronary filling, which prevents marginal leakage. Successful disinfection is carried out by using triple antibiotic paste (TAP) as an intracanal medication due to its excellent antimicrobial activity, but its use is associated with discoloration of the tooth crown, the development of bacterial resistance, and allergic reactions. Aims: To evaluate the antibacterial efficacy of triple organic paste vs TAP against strains of Enterococcus faecalis, Streptococcus mutans, and Candida albicans. Methods and material: Natural products were divided into six groups and further divided into 18 subgroups. Minimum inhibitory concentration (MIC) was determined for each group using the trial and error method, and results were obtained after incubation for 24 hours at 37°C. Antibacterial efficacy was determined by zone of inhibition and compared with TAP (control group) individually against E. faecalis, S. mutans, and C. albicans. The values were recorded and subjected to statistical analysis by one-way analysis of variance (ANOVA) and Tukey's post hoc test. Results: All the subgroups have shown significant zone of inhibition values against E. faecalis, S. mutans, and C. albicans, except for the subgroup IC, where no statistically significant values were found when compared with the control group. Conclusion: Most of the combinations of natural products have shown better antibacterial efficacy when compared with TAP, suggesting its use to overcome the disadvantages of TAP. Further clinical studies are required for evaluating the antibacterial efficacy in vivo.

Corn-leaf aphid (CLA), Rhopalosiphum maidis (Fitch) (Hemiptera: Aphididae) is a serious economic pest of barley worldwide. Breeding for aphid resistance in plants is considered a cost-effective and environmentally safe approach for aphid control, compared to the use of chemical pesticides. One of the challenges in breeding for aphid resistance is the identification of resistant plant genotypes, which can be achieved through the use of molecular markers. In the present study, a set of aphid specific 10 simple-sequence repeats (SSR) markers were used to investigate genetic diversity and population structure analyses in 109 barley genotypes against R. maidis. Three statistical methods viz., multivariate hierarchical clustering based on Jaccard’s similarity coefficient, principal coordinate analysis (PCoA) and the Bayesian approach were utilized to classify the 109 barley genotypes. The analyses revealed four subpopulations i.e., SubPop1, SubPop2, SubPop3 and SubPop4 with 19, 46, 20 and 24 genotypes including admixtures, respectively and represented 17.43%, 42.2%, 18.34% and 22.01% genotypes of the total population size, respectively. The studied SSR markers produced 67 polymorphic bands, with an average of 6.7 and ranging from 3 to 12 bands. Heterozygosity (H) was found to be highest in SSR28 (0.64) and lowest in SSR27 (0.89). The observed genetic diversity index varied from 0.10 to 0.34 (with an average of 0.19). Major allele frequency varied from 74.08% to 94.80%. On an average, 87.52% of the 109 barley genotypes shared a common major allele at any locus. Based on the Aphid Infestation Index (AII), only 2 genotypes were found to be resistant against CLA. SubPop2 also had lowest mean aphid population (28.83), widest genetic similarity index (0.60-1.00) and highest genetic similarity coefficient (0.82), which highlighted its potential for inclusion in future CLA resistance breeding programs.

Karnal bunt (KB; Tilletia indica) is the prime quarantine concern for quality wheat production throughout the world. The most effective approach to dealing with this biotic stress is to breed KB-resistant wheat varieties, which warrants a better understanding of T. indica genome architecture. In India, the North Western Plain Zone is the prime hot spot for KB disease, but only limited efforts have been made to decipher T. indica diversity at the genomic level. Microsatellites offer a powerful and robust typing system for the characterization and genetic diversity assessment of plant pathogens. At present, inadequate information is available with respect to the development of genome-derived markers for revealing genetic variability in T. indica populations. In current research, nine complete genome sequences of T. indica (PSWKBGH_1, PSWKBGH_2, PSWKBGD_1_3, RAKB_UP_1, TiK_1, Tik, DAOMC236408, DAOMC236414, and DAOMC236416) that exist in the public domain were explored to know the dynamic distribution of microsatellites. Comparative genome analysis revealed a high level of relative abundance and relative density of microsatellites in the PSWKBGH_1 genome in contrast to other genomes. No significant correlation between microsatellite distribution for GC content and genome size was established. All the genomes showed the dominance of tri-nucleotide motifs, followed by mono-, di-, tetra-, hexa-, and penta-nucleotide motifs. Out of 50 tested markers, 36 showed successful amplification in T. indica isolates and produced 52 different alleles. A PCR assay along with analysis of the polymorphic information content (PIC) revealed 10 markers as neutral and polymorphic loci (PIC 0.37). The identified polymorphic SSR loci grouped a geographically distinct T. indica population of 50 isolates representing seven Indian regions (Jammu, Himachal Pradesh, Punjab, Haryana, Uttarakhand, Uttar Pradesh, and Rajasthan) into four distinct clusters. The results of the analysis of molecular variance identified 94% genetic variation within the population and 6% among the population. Structure analysis also confirmed the existence of four genetically diverse groups containing admixtures of T. indica isolates across populations. In nutshell, the current study was successful in identifying novel, neutral and polymorphic microsatellite markers that will be valuable in offering deep insight into the evolutionary relationship and dynamics of the T. indica population for devising effective KB management strategies in wheat.

Wheat stem rust, caused by Puccinia graminis f. sp. tritici (Pgt), has re-emerged as one of the major concerns for global wheat production since the evolution of Ug99 and other virulent pathotypes of Pgt from East Africa, Europe, Central Asia, and other regions. Host resistance is the most effective, economic, and eco-friendly approach for managing stem rust. Understanding the virulence nature, genetic diversity, origin, distribution, and evolutionary pattern of Pgt pathotypes over time and space is a prerequisite for effectively managing newly emerging Pgt isolates through host resistance. In the present study, we monitored the occurrence of stem rust of wheat in India and neighboring countries from 2016 to 2022, collected 620 single-pustule isolates of Pgt from six states of India and Nepal, analyzed them on Indian stem rust differentials, and determined their virulence phenotypes and molecular genotypes. The Ug99 type of pathotypes did not occur in India. Pathotypes 11 and 40A were most predominant during these years. Virulence phenotyping of these isolates identified 14 Pgt pathotypes, which were genotyped using 37 Puccinia spp.-specific polymorphic microsatellites, followed by additional phylogenetic analyses using DARwin. These analyses identified three major molecular groups, demonstrating fewer lineages, clonality, and long-distance migration of Pgt isolates in India. Fourteen of the 40 recently released Indian wheat varieties exhibited complete resistance to all 23 Pgt pathotypes at the seedling stage. Twelve Sr genes were postulated in 39 varieties based on their seedling response to Pgt pathotypes. The values of slow rusting parameters i.e. coefficient of infection, area under disease progress curve, and infection rates, assessed at adult plant stage at five geographically different locations during two crop seasons, indicated the slow rusting behavior of several varieties. Six Sr genes (Sr2, Sr57, Sr58, Sr24, Sr31, and Sr38) were identified in 24 wheat varieties using molecular markers closely linked to these genes. These findings will guide future breeding programs toward more effective management of wheat stem rust.

Objectives: The goal of the current research was to assess marginal sealing abilities of 2 commercial pit and fissure sealants. Materials and Methods: A total of 30 premolar teeth were equally classified into 2 groups: Group A-application of Embrace-WetBond sealant and Group B-application of Fissurit F, Voco sealant. After sealant placement, samples were preserved in artificial saliva for 48 hours prior to thermocycling. Later, samples were submerged for 24 hours in a 2% methylene blue solution. The amount of microleakage based on the quantity of dye penetration at interface between the tooth substance and sealant was compared under an optical stereomicroscope. The obtained data were statistically analysed for the dye penetration scores in both groups. Result: It was observed that 8 samples from Group A (53%) had no dye penetration (Grade 0), whereas 4 samples from Group B (26%) showed Grade 0 penetration. In 5 out of 15 samples (33%) from Group B, the dye penetration was the greatest (Grade 3; P = 0.012). Conclusion: It was concluded that Embrace-WetBond had lesser microleakage compared to group 2-Fissurit F, Voco sealant.

Diagnosis of scrub typhus is difficult, because of its non-specific clinical features and a lack of reliable serological assays. This study assessed real time PCR detection of the 47 kDa gene along with routine IgM ELISA for confirmatory diagnosis of scrub typhus. This observational study was conducted between March 2021 and February 2023. Real time PCR detection of the 47 kDa gene was used as a diagnostic assay. Confirmed scrub typhus cases were defined by IgM ELISA and/or real time PCR positivity. A total of 105 children (0–18 years of age) were enrolled, 30 (28.57%) of whom were confirmed to have scrub typhus, according to IgM ELISA and/or real time PCR positivity. The clinical symptoms of scrub typhus positive children included fever, diarrhea, abdominal pain, breathing difficulties, lymphadenopathy, rash, headache, edema, seizure, and poor intake. Good statistical correlations were observed among real time scrub positivity, high grade fever of 8.2 days’ duration, the presence of eschar and thrombocytopenia. Non-specific respiratory symptoms; cough, and cold were more severe in patients with scrub typhus. The real time PCR test showed good specificity in discriminating scrub typhus from enteric fever, a common pediatric disease. Detection of the 47 kDa gene with real time PCR has good sensitivity and specificity. The number of days between fever onset and sampling, as well as the administration of antibiotics before sampling, influence the performance of real-time PCR.

Background/Aims Intestinal tuberculosis (ITB) is difficult to diagnose due to poor sensitivity of definitive diagnostic tests. ITB may be associated with concomitant pulmonary tuberculosis (PTB) which may remain undetected on chest X-ray. We assessed the role of contrast enhanced computed tomography (CECT) chest in detecting the prevalence of active PTB, and increasing the diagnostic yield in patients with suspected ITB. Methods Consecutive treatment naïve patients with suspected ITB (n=200) who underwent CECT chest (n=88) and had follow-up duration>1 year were recruited in this retrospective study (February 2016 to October 2018). ITB was diagnosed in the presence of caseating granuloma, positive acid fast stain or culture for Mycobacterium tuberculosis on biopsy, presence of necrotic lymph nodes (LNs) on CT enterography or positive response to anti-tubercular therapy. Evidence of active tuberculosis on CECT-chest was defined as presence of centrilobular nodules with or without consolidation/miliary nodules/thick-walled cavity/enlarged necrotic mediastinal LNs. Results Sixty-five of eighty-eight patients (mean age, 33.8±12.8 years; 47.7% of females) were finally diagnosed as ITB (4-caseating granuloma on biopsy, 12-necrotic LNs on CT enterography, 1-both, and 48-response to anti-tubercular therapy) and 23 were diagnosed as Crohn’s disease. Findings of active TB on CECT chest with or without necrotic abdominal LNs were demonstrated in 5 and 20 patients, respectively. No patient with Crohn’s disease had necrotic abdominal LNs or active PTB. Addition of CECT chest in the diagnostic algorithm improved the sensitivity of ITB diagnosis from 26.2% to 56.9%. Conclusions Addition of CECT chest significantly improves the sensitivity for definite diagnosis in a patient with suspected ITB.

Human efforts to grow abundant food through the persistent use of resource-intensive farming practices have resulted in declining soil health, and deterioration of ecosystem functions and services. Conservation agriculture (CA) has emerged as a practice to minimize the impacts of conventional resource-exhaustive and energy-intensive agriculture. Minimum soil disturbance, permanent soil cover, and diversification are the key components of CA. Tillage through conventional practices on the other hand has detrimental effects on the soil and environment as it requires deep inversion of soil with instruments such as mouldboard plow, disc plow etc. leaving very less organic matter in soil after establishment of crop. Even though, CA advocates many benefits over conventional agriculture in terms of soil and water conservation, the consequent changes in moisture and temperature regimes due to reduced tillage and surface cover would likely going to influence the biological activity, including insect pests and their natural enemies which dwell within these agroecosystems. The changed crop conditions under CA may favor particular insect communities and their ecological niches. The adoption of such practices may lead to decrease in insect pests with major activity on the crop canopy. However, the activity of the insect pests that spend their maximum life span at the soil surface or beneath the soil surface may increase. Recent insect-pest outbreaks in North-Western India and imbalances reported in Indo-Gangetic Plains point to the need for a better understanding of the inter-relationships between tillage intensity, residue retention, and insect pest population dynamics. The current review analyzes the existing state of knowledge of these dynamics and presents the scenarios that may emerge as CA get more acceptance. This review will help to develop countermeasures to improve performance and ecosystem services of Conservation agriculture (CA) based cropping systems.

Betel vine (Piper betel L.) is referred to as “Paan” in India. It is the most significant and profitable commercial crop and is cultivated as a significant cash crop due to its high benefit cost ratio (2.3). Fresh betel leaves found rich source of phyto-nutrients and vitamins viz., proteins, minerals, fibre, carbohydrates, vitamin A and vitamin B1. Uttar Pradesh region is favourable for better cultivation of betel vine. There are a few areas in Uttar Pradesh that are well-known for growing betel leaves, such as Bundelkhand, Varanasi, and Unnao. Betel vine farming is labour and capital intensive and best suited to small-scale farmers with a stable source of work and income. The main challenges associated with betel vine cultivation are lack of quality planting material, disease and pest infestation, lack of market, and natural calamities. Leaf rot, wilt, and leaf spot are the major diseases that significantly affect the quality and productivity of betel leaves. But due to its perishable nature and price fluctuations, this is one of the biggest marketing challenges faced by betel vine farmers. Establishing a market intelligence system to forecast prices in advance and simultaneously exploring the export market may be beneficial for realising a higher return on betel vine cultivation. Young farmers are excited to cultivate the betel vine and promote it as a cash crop for gainful employment in Uttar Pradesh. The Government of Uttar Pradesh has launched a scheme to promote the quality production of betel vine leaves.

Introduction: The messaging application 'WhatsApp' is used in clinical practice, often for communication between a medical trainee and a consultant. We designed this study to find the interrater reliability of the data transmitted through this application and validating its use in urological practice. Materials and Methods: Clinical details and computerized tomographic (CT) images of 30 patients visiting the urology emergency were posted in a closed WhatsApp group involving three consultants (SKD, APS, and KC). The CT images were posted in the WhatsApp group as Whole Image (WI) and Image of Interest (IOI) format and rated on a scale of 1–5. The consultants formulated a provisional diagnosis and initial management strategy. The interrater reliability of these responses was analyzed in the study. Results: Mean WI rating ranged from 3.03 ± 0.61 to 3.73 ± 0.64 (Cronbach alfa [α]-0.494, P = 0.006). Mean IOI rating ranged from 3.4 ± 0.56 to 4.13 ± 0.73 (α-0.824, P < 0.0001). For diagnosis, the proportion of observed agreement (P0) was 83.3% for SKD and APS, 76.6% for SKD and KC, and 73.3% for APS and KC. For management, P0 was 86.6% for APS and KC, 86.6% for SKD and APS, and 80% for SKD and KC. Conclusions: WhatsApp Messenger serves to transmit good quality pictures of CT scan images. A reasonable diagnosis and management strategy can be formulated using this app with fair inter-rater reliability.

Tufted angioma and kaposiform hemangioendothelioma are considered to represent two ends of the spectrum of benign vascular neoplasms that predominantly present during infancy or early childhood. We report a rare case of a 5-month-old infant with complicated vascular neoplasm involving the pericardial cavity and skin over cervical region, masquerading as infective pericarditis with cellulitis. The patient responded dramatically to therapy with oral prednisolone and sirolimus, with a significant reduction of size of skin lesions and complete resolution of pericardial effusion over 8 weeks. The report also highlights the importance of a multidisciplinary team in managing such complicated cases.

Introduction: Multiple studies have been published recently assessing feasibility of robot-assisted partial nephrectomy (RAPN) for moderate to highly complex renal masses. Some studies have even compared partial nephrectomy (PN) performed through various modalities such as open PN (OPN) versus RAPN and laparoscopic PN (LPN) versus OPN. The primary aim of this review was to analyze perioperative outcomes such as warm ischemia time (WIT), duration of surgery, estimated blood loss (EBL), complications, blood transfusion, length of stay, and margin status following RAPN for complex renal masses. Another objective was to compare perioperative outcomes following various surgical modalities, i.e., OPN, LPN, or RAPN. Methods: Literature search was conducted to identify studies reporting perioperative outcomes following RAPN for moderate (Radius, Endophytic/Exophytic, Nearness, Anterior/posterior location [RENAL] score 7–9 or Preoperative Aspects of Dimension used for anatomic classification [PADUA] score 8–9) to high complexity renal masses (RENAL or PADUA score ≥ 10). Meta-analysis of robotic versus OPN and robotic versus LPN was also performed. Study protocol was registered with PROPSERO (CRD42019121259). Results: In this review, 22 studies including 2,659 patients were included. Mean duration of surgery, WIT, and EBL was 132.5–250.8 min, 15.5–30 min, and 100–321 ml, respectively. From pooled analysis, positive surgical margin, need for blood transfusion, minor and major complications were seen in 3.9%, 5.2%, 19.3%, and 6.3% of the patients. No significant difference was noted between RAPN and LPN for any of the perioperative outcomes. Compared to OPN, RAPN had significantly lower EBL, complications rate, and need for transfusion. Conclusions: RAPN for moderate to high complexity renal masses is associated with acceptable perioperative outcomes. LPN and RAPN were equal in terms of perioperative outcomes for complex masses whereas, OPN had significantly higher blood loss, complications rate, and need for transfusion as compared to RAPN.

Nanotechnology is a rapidly evolving field that has the potential to revolutionise food systems and counter the present-day challenge of food security. It envisages taking agriculture from the era of indiscriminate natural resource use and environmental degradation to the brave new world of advanced systems with enhanced material use efficiency and targeted applications to reduce crop losses caused due to abiotic-biotic stresses as well as to give due considerations to the environment. To manage plant diseases and insect pests, pesticides are inevitably used in agriculture. However, the higher dosage of these chemicals on a per hectare basis has resulted in many environmental and health hazards. To tackle the conventional pesticide related issues, a new field of science called nanotechnology has led to the development of nanopesticides that have less active ingredients, but better efficiency. The nanopesticides contain the carrier molecule or the active nanosized ingredient with a very high surface area to the volume property that provides them unique exploitable-advantages. Several formulations, viz., nanoemulsions, nanosuspensions, nanogels, metal compound-based nanopesticides, have been developed for different modes of action and vivid applications. The biggest advantage comes due to the small size of the particles that help in properly spreading the ingredients on the pest surface and, thus, producing a better action than conventional pesticides. The use of nanoparticles in the form of nanopesticides, nanofertilisers, and nano delivery systems is on the increase day by day due to their higher efficiency and reduced dosage requirements. However, human beings and other organisms are also getting exposed to the nano-entities during the application or afterwards. The interactions of these engineered nano-entities with biological systems are relatively unknown thus far. Therefore, before their wider usage in crop production and protection, a better understanding of their interactions, and adverse effects, if any, is also crucial for a sustainable transition.

Abstract Background Leiomyosarcomas of urinary bladder constitute rare malignant sarcomas with very few cases reported in literature. Case presentation Here, we present a case of bladder leiomyosarcoma in a well-preserved female. She failed to respond to standard chemotherapy and had a rapidly downhill course with unusual metastases in anastomotic site and peritoneum soon after surgery. Despite multimodality management including resection of primary and metastatic site, systemic therapy and pelvic radiotherapy, our patient had dismal prognosis with an overall survival of 1.7 years. Conclusion Leiomyosarcomas of bladder are aggressive tumors and have a very poor prognosis; thus, future research should focus on optimizing more effective treatment regimes.

Aphids are one of the most important insect pests of wheat crop in all wheat growing regions of the world. Amongst various aphid species, the corn leaf aphid (Rhopalosiphum maidis F.) is considered one of the most destructive insect pests of wheat in the North Western Plains region of India. Transcriptome profiling of highly susceptible wheat Triticum durum genotype, A-9-30-1 and tolerant wheat Triticum aestivum genotype, HD2967 was performed to investigate aphid-host interactions. The results obtained from differential gene expression analysis of R. maidis on the highly susceptible genotype, A-9-30-1 plants, when compared with the tolerant genotype, HD2967, showed that 212 genes were significantly upregulated and 1009 genes were significantly downregulated. Our findings demonstrated that the genes associated with defense were significantly higher in response to R. maidis on HD2967 as compared to A-9-30-1. Additionally, various genes with physiological attributes were expressed during aphid attack. Based on gene ontology classification, three classifications, such as, cellular components (CC), molecular function (MF), and biological processes (BP) of sequences were identified. KEGG enrichment analysis revealed that twenty-five pathway genes were differentially expressed during the infestation of wheat with R. maidis. Notable changes were observed in A-9-30-1 and HD2967 transcriptomic profiling after infestation. The results obtained in the present study will help to elucidate the mechanism governing host-pest interaction and may lead to the development of new methods for increasing the resistance level of wheat against R. maidis, including over-expression of defense-related genes.

Background/Aims Exclusive enteral nutrition (EEN), an established modality for pediatric Crohn’s disease (CD) is seldomly utilized in adults. The present study reports the outcome of EEN in adult CD patients at a tertiary care hospital in India. Methods This was a retrospective analysis of CD patients who received EEN as a sole modality/adjunct to other treatment. The primary and secondary outcomes changed in Crohn’s Disease Activity Index (CDAI), and clinical response (decline in CDAI > 70), respectively, at 4 and 8 weeks. Subgroup analysis evaluated response across different phenotypes, EEN formulations and prior treatment. Linear mixed effect model was created to assess the predictors of EEN response. Results Thirty-one CD patients received EEN over median duration of 4 weeks (range, 2–6 weeks). CDAI showed a significant improvement post EEN at 4 (baseline 290 [260–320] vs. 240 [180–280], P=0.001) and 8 weeks (baseline 290 [260–320] vs. 186 [160–240], P=0.001), respectively. The cumulative clinical response rates at 4 and 8 weeks were 37.3% and 80.4% respectively. The clinical response rates at 8 weeks across B1 (n = 4), B2 (n = 18) and B3 (n = 9) phenotypes were 50%, 78.8% and 100% respectively (log-rank test, P=0.093). The response rates at 8 weeks with polymeric (n = 8) and semi-elemental diet (n = 23) were 75% and 82.6%% respectively (log-rank test, P=0.49). Baseline CDAI (odds ratio, 1.008; 95% confidence interval, 1.002–1.017; P=0.046) predicted response to EEN. Conclusions EEN was effective in inducing clinical response across different phenotypes of CD. Baseline disease activity remained the most important predictor of clinical response to EEN.

Diphtheria is a life-threatening infectious disease caused by Corynebacterium diphtheriae. Although the disease is seen infrequently in the postvaccination era, sporadic cases continue to occur. Cardiac involvement, in the form of myocarditis, is the most serious manifestation of diphtheria and is the most common cause of mortality in these patients. The features of diphtheritic myocarditis on cardiac magnetic resonance imaging (MRI) have not been reported previously. In this brief report, we describe the cardiac MRI and histopathologic features on endomyocardial biopsy of a patient with acute heart failure who was later diagnosed to be a case of diphtheritic myocarditis.

Abstract To compare the safety and efficacy of various surgical modalities to manage large (> 1 cm) upper ureter stones. Systematic literature search was conducted to include all randomized studies comparing various treatment options for large (> 1 cm) upper ureteric stones. This review included 13 randomized studies with 1871 patients. Laparoscopic ureterolithotomy (LUL) and percutaneous nephrolithotomy (PNL) were superior to ureteroscopy (URS) and shockwave lithotripsy (SWL) for stone-free rates and need for auxiliary treatments. LUL and PNL were equally effective for stone-free rates and the need for auxiliary treatments. According to SUCRA values for stone-free rates and the need for auxiliary treatments, LUL was the best, followed by PNL. For the duration of surgery, there was no significant difference among all the techniques on network analyses, and SWL was the best according to SUCRA values. Length of hospital stay was significantly shorter for URS than LUL and PNL from network analysis, but there was no significant difference for the rest of the comparisons. Overall complications were similar in all the groups. According to the CINeMa approach, the confidence rating ranged from “very low” to “moderate” for various comparisons. LUL followed by PNL is the most efficacious treatment modality for upper ureteric stones compared to SWL and URS in terms of stone-free rates. However, due to the poor quality of included studies, further high-quality randomized studies are needed.

Pregestational diabetes (PGDM) leads to developmental impairment, especially cardiac dysfunction, in their offspring. The hyperglycemic microenvironment inside the uterus alters the cardiac plasticity characterized by electrical and structural remodeling of the heart. The altered expression of several transcription factors due to hyperglycemia during fetal development might be responsible for molecular defects and phenotypic changes in the heart. The molecular mechanism of the developmental defects in the heart due to PGDM remains unclear. To understand the molecular defects in the 2-days old neonatal rats, streptozotocin-induced diabetic female rats were bred with healthy male rats. We collected 2-day-old hearts from the neonates and identified the molecular basis for phenotypic changes. Neonates from diabetic mothers showed altered electrocardiography and echocardiography parameters. Transcriptomic profiling of the RNA-seq data revealed that several altered genes were associated with heart development, myocardial fibrosis, cardiac conduction, and cell proliferation. Histopathology data showed the presence of focal cardiac fibrosis and increased cell proliferation in neonates from diabetic mothers. Thus, our results provide a comprehensive map of the cellular events and molecular pathways perturbed in the neonatal heart during PGDM. All of the molecular and structural changes lead to developmental plasticity in neonatal rat hearts and develop cardiac anomalies in their early life.

Microbial interactions with plant roots play an imperial role in tomato plant growth and defense against the Rhizoctonia solani. This study performed a field experiment with two antagonistic bacteria (Pseudomonas and Bacillus) inoculated in healthy and Rhizoctonia solani treated soil in tomato rhizosphere to understand the metabolic pattern and microbial function during plant disease suppression. In the present study, we assessed soil and microbial enzymes, bacterial and fungal cell forming unit (CFU), and carbon utilization profiling through Bio-Eco plates of rhizoplane samples. Antagonist bacteria and pathogen interaction significantly (p < 0.05) influenced the bacterial count, soil enzymes (chitinase and glucanase), and bacterial function (siderophore and chitinase production). These results indicated that these variables had an imperial role in disease suppression during plant development. Furthermore, the metabolic profiling showed that carbon source utilization enhanced under fruit development and ripening stages. These results suggested that carbon sources were essential in plant/pathogen/antagonist interaction. Substrates like β-methyl-D-glucoside, D-mannitol, D-galacturonic acid, N-acetyl-D-glucosamine, and phenylethylamine strongly connect with the suppuration of root rot disease. These carbon sources may help to propagate a healthy microbial community to reduce the pathogen invasion in the plant root system, and these carbon sources can be stimulators of antagonists against pathogens in the future.

This article emphasis the effective use of coals ashes in concrete which were generally dumped or used for low profile applications in early times. In meantime with profound studies, researchers started using coal ashes such as Fly Ash (FA), Coal Bottom Ash (CBA) and Pond Ash (PA) in concrete to reduce the dumped land sites to attain sustainable environment. Moreover, utilization of coal ashes in concrete overcome the risk of depletion of natural resources and also helps in to reduce the carbon emissions. Therefore, the current article presents a systematic review of 209 studies related to utilization of coal ashes which were carried out over a period of 70 years ranging from 1950 to present time. The performance of coal ashes (i.e., FA, CBA and PA) in concrete in terms of fresh properties such as water requirements and consistency of cement paste, workability of different concretes i.e., Normally Vibrated Concrete (NVC), Self Compacting Concrete (SCC) containing natural and recycled aggregates is critically evaluated and summarized. Further, the mechanical properties such as compressive strength and tensile strength and durability properties dealing from permeability consideration of concrete to chemical attack are also reviewed in this article. The different studies revealed that incorporation of FA in concrete as supplementary cementing material enhances the workability properties, mechanical strength and durable properties due to their fineness and pozzolanic effect. Similarly, CBA also gave positive results when used as fine aggregates in appropriate content in concrete.

Birds are considered as ecological indicators and most sensitive health indicators of an ecosystem. Wetlands are used by birds for various purposes such as breeding, nesting, roosting, and foraging. This study was designed to fulfill this research gap on avian diversity comparison of different wetlands in various habitats. The objective of the study was to generate information on avian diversity with seasonal variability of different wetlands of various habitats. Sampling was done in eight different wetlands from different districts of Odisha. The study was carried out during October 2015 to September 2018, and the point count method was used. A total number of 109 species of birds covering 16 order and 42 families were recorded. Maximum waterbird richness was found at Chilika (62%, N=68) and minimum species richness (15%, N=17) found at Talcher. Six species were recorded under Near Threatened category according to International Union for Conservation of Nature (IUCN 2020). The reason behind this occurrence of more numbers species in Chilika, Hirakud, and Koraput may be because of the habitat suitability and low anthropogenic pressure. The Talcher sampling site had the lowest species richness because of the highly polluted mining area with high anthropogenic pressure. Conservation of these small wetlands is also required to conserve the declining native avifauna.