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Abstract Helicoverpa armigera is a highly devastating and polyphagous pest attacking on different field crops. Effective management of this pest is essential for sustainable agriculture. While traditional chemical pesticides are widely used for their immediate results and ease of application, nanoemulsions offer a promising alternative, paving the way for advanced, efficient pesticide formulations.The current research aimed to develop oil-in-water (O/W) chlorantraniliprole stable nanoemulsion using combinations of different solvents (butanol, dimethyl sulfoxide and toluene), tween- 80 (non-ionic surfactant) and sodium laurel sulfonate (anionic co-surfactant) to reduce the dose and increase toxicity of chlorantraniliprole as targeted pesticide. Ultrasonication, a high energy emulsification method, is adopted to obtain the particle size in nanometre (nm). The nano size of emulsion is confirmed by Dynamic light scattering (62.43 nm), Scanning electron microscopy (55 ± 5 nm), X-ray diffraction (42.9 nm), and Transmission electron microscopy (22.5 ± 2.5 nm), Stability of synthesized nanoemulsion is confirmed via, centrifugation, freeze thaw cycle, heating cooling test, and zeta potential. Moreover, the toxicity of chlorantraniliprole nanoformulations is evaluated against H. armigera and compared with commercially available chlorantraniliprole formulation (18.5 SC). Chlorantraniliprole nanoemulsion formulation is 3.3 times more toxic than commercial formulation using topical application method (3rd instar larvae) and 2.2 times more toxic than commercial formulation using diet incorporation method (1st instar larvae). Consequently, this cutting-edge research holds great potential for revolutionizing targeted pesticide delivery systems, paving the way for more effective and precise pest management in agriculture.

The study “Effect of Different Nitrogen Doses on Performance of Baby Corn under Local Conditions in Kushma, Parbat, Nepal” was conducted from February 2023 to July 2023 at Mudikuwa, Phalewas-04, Parbat district. Employing a Single Factorial Randomized Complete Block Design, the experiment included eight nitrogen treatments (0, 75, 115, 150, 190, 225, 260, and 300 kg/ha) with three replications. The field was divided into 24 plots, each measuring 2 meters by 2 meters, with a plant spacing of 40 cm by 20 cm. Standard baby corn cultivation practices were followed under open field conditions. Data on growth and yield parameters were collected, showing that the highest plant height, leaf number, and leaf length were recorded at 300 kg/ha, while the lowest were observed at 0 kg/ha (control). The longest cobs were found at 260 kg/ha, and the shortest at 0 kg/ha, although cob length differences among treatments were not statistically significant. The largest cob diameter was observed at 190 kg/ha, and the smallest at 0 kg/ha. The maximum number of cobs was recorded at 300 kg/ha, statistically similar to the 150, 190, and 225 kg/ha treatments. The optimum nitrogen dose for maximum cob weight was 150 kg/ha, with no significant yield increase beyond this dose. The highest harvest index was recorded at 190 kg/ha, statistically similar to the 150 kg/ha and higher doses. Overall, baby corn performed well with 150 kg/ha of nitrogen, proving to be economically viable.

Traditional, petroleum-based plastics are known to linger in the environment for years due to their non-biodegradability and non-sustainability, eventually fragmenting into microplastics and contaminating waterways and agricultural systems. Therefore, many researchers have focused on bio-based and biodegradable polymers, such as polylactic acid (PLA). Biochar, a byproduct of the bio-fuel production process, has been investigated as a filler to reduce the amount of PLA used and improve mechanical properties. This research focuses on effect of biochar amount on PLA composites and the impact of individual additives consisting of polyethylene glycol, STRUKTOL® (a plasticizer), and cork particles. It was found that the cork-based composites (51–54 MPa) improved tensile strength more than both of the plasticizer-based composites (41–46 MPa). While the scanning electron microscopy images showed some aggregation in the 10 wt% biochar composite, the cork composites (1 and 3 wt%) showed slightly less aggregation than other composites. Additionally, analysis revealed high carbon (81%) and fixed carbon (74%) concentrations, respectively, in the hardwood-derived biochar, indicating potential for carbon sequestration.

Abstract Mosquitoes and other biting arthropods transmit diseases worldwide, causing over 700,000 deaths each year, and costing about 3 billion USD annually for Aedes species alone. Insect vectored diseases also pose a considerable threat to agricultural animals. While clothing could provide a simple solution to vector-borne diseases, modern textiles do not effectively block mosquito bites. Here we have designed three micro-resolution knitted structures, with five adjustable parameters that can block mosquito bites. These designs, which exhibit significant bite reduction were integrated into a computer numerical control knitting robot for mass production of bite-blocking garments with minimal human labor. We then quantified the comfort of blocking garments. Our knits enable individuals to protect themselves from insects amidst their day-to-day activities without impacting the environment.

A field experiment was conducted during 2018–19 and 2019–20 at Chaudhary Charan Singh Haryana Agricultural University, Hisar, Haryana to assess the dissipation pattern of a ready mix formulation i.e. fipronil and imidacloprid along with their metabolites in fruits of hot pepper (Capsicum annum L.). The Hot pepper variety Kranti was used for the study. Quantitative analysis was done on gas liquid chromatography (GLC) and high pressure liquid chromatography (HPLC) for fipronil and imidacloprid with their metabolites, respectively. At the suggested dose, fipronil residues were lower than 0.01 mg/kg in the studied years. However, in double doses, the total residues of fipronil were detected on the 5th (0.071 mg/kg) and 3rd (0.043 mg/kg) day for the 1st and 2nd year following drench application. Imidacloprid was detected only in the subsequent year’s trial in double doses. Residual leftovers of imidacloprid metabolite (6- CNA) were lower than 0.01 mg/kg (LOQ). No residual leftovers were present in fully ripened red chilli and harvest time samples of soil.

The hydrothermal liquefaction (HTL) technique for liquefying lignocellulose biomass feedstock is often associated with low biocrude yield and poor fuel properties. This study examined the HTL of southern yellow pine sawdust and the hydrotreatment (HYD) of produced biocrudes in an effort to address these challenges. Pine HTL treatment was performed within water and water–ethanol mixed reaction medium at 250, 300, and 350℃ temperatures using metallic iron (Fe) as a catalyst. The rising reaction temperature in a water medium and increasing ethanol content in a mixed reaction medium were found to be effective in enhancing the biocrude yield from the non-catalytic pine HTL process. Maximum non-catalytic biocrude yield of 18 wt.% was produced in water at 350℃, whereas the ethanol and water (1:1 on mass basis) mixture generated the highest biocrude yield of 34 wt.% at 300℃ without any catalyst. The iron catalyst facilitated a maximum of 29 wt.% of biocrude yield as opposed to 18 wt.% without the catalyst at 350℃ in water. The use of an iron catalyst also raised the calorific value of produced biocrudes by 2.5–14 % within 250-350℃ in both water and water–ethanol media. The catalytic and non-catalytic biocrude products were chosen to undergo HYD treatment at 400 °C under high hydrogen pressure (initial 1000 psi) using an alumina-supported cobalt-molybdenum catalyst. The HYD treatment reduced the oxygen content of upgraded oils by 36–60 % compared to the parent HTL biocrudes with 35–37 MJ/kg calorific values. The simulated distillation detected the maximum gasoline range compounds in upgraded oil from catalyst and water–ethanol conditions, whereas the GC–MS analysis revealed the production of increased aromatic hydrocarbons in all upgraded HYD oils. This work has demonstrated the potential of ethanol and inexpensive iron catalyst in enhancing the biocrude production from pine, which could be upgraded to better fuel using the HYD process.

The growing demand for renewable energy has generated interest in biofuels as alternatives to fossil fuels. Second-generation biofuels, derived from deoxygenating fats and oils, have garnered a higher level of interest from industry and academia due to their potential for direct replacement of diesel and jet fuels. Palm oil, mostly cultivated in Thailand and composed of C16 and C18 fatty acids, is a primary feedstock sought for biofuel production. Palm oil deoxygenation contains several pathways that may or may not require hydrogen gas. This study aimed to produce biofuels in different fuel ranges, such as gasoline, jet fuel, and diesel, through palm oil deoxygenation using glycerol as a hydrogen source. Glycerol, a low-value byproduct, was used as a hydrogen donor, whereas nickel-molybdenum-supported catalysts were chosen for their high efficiency in deoxygenation and cost-effectiveness. The study investigated the impact of reaction time, temperature, and catalyst activation method on palm oil deoxygenation. Catalyst characterization methods, including XRD, SEM, TEM, XPS, FTIR, TGA, and nitrogen-sorption, were employed to understand the role of catalysts’ activity during palm oil upgrading. Findings indicated that alkane hydrocarbons are the major components in liquid products. The presence of excess hydrogen in post reaction gaseous phase proves the hydrogen donation capability of glycerol. Increased reaction time and temperature facilitated the removal of oxygen from palm oil. Nickel-molybdenum on zirconia activated by sulfidation demonstrated higher stability than by reduction activation.

Abstract VEXAS (Vacuoles, E1 enzyme, X‐linked, Autoinflammatory, Somatic) syndrome is a rare and recently identified disease resulting from a somatic mutation in the X‐linked UBA1 gene in cells of myeloid lineage. It can present in a myriad of ways with the potential to affect various organ systems, including the lungs. VEXAS is usually steroid responsive, but no strong data exists for the use of a steroid‐sparing agent. There is limited emerging evidence for haematopoietic stem cell transplantation in a select number of cases. Regardless, prognosis for this condition is poor and a treatment algorithm remains a priority. Herein, we present a case of VEXAS that came to attention with discovery of a relatively asymptomatic interstitial lung disease and led to recurrent febrile episodes with evolving multi‐organ involvement.

In 3D-printing, sodium silicate (SS) can be used as an inorganic binder for wood-based composites due to its better rheological properties, high strength, and affordability. Investigating the recyclability of 3D-printed composites is necessary to understand the reusability of demolished additively manufactured construction waste. In this work, the bio-oil through pyrolysis was produced using pine and SS composites and further characterized to observe the effects of the pyrolysis temperatures and the proportion of SS in composites. Pine and SS composites with 0, 33.33, 50, and 66.67 % of the SS on a mass basis were prepared and cured to mimic the 3D-printed composites. Then, pyrolysis of cured composites was performed in a bench-scale fixed bed pyrolysis reactor at four temperatures (450–600 °C). From the pyrolysis of composites with 66 % SS at 600 ℃, a maximum condensed liquid yield of 68 % (wt.%, dry basis) was obtained. Further, it was observed that the selectivity towards hydrocarbons and alkyl phenols increased by increasing the proportion of SS in the composite, but methoxy phenols decreased, which enhanced bio-fuel production. A maximum hydroxyl concentration of 6.54 mmol g−1 was observed for the bio-oil from pyrolysis of SS-based composite at 600 ℃. This study shows the feasibility of upcycling the 3D-printed wood composites through pyrolysis to generate bio-oil that can be used for bio-based resin synthesis and bio-fuel applications.

Background Rilonacept, a once‐weekly interleukin‐1 alpha and beta cytokine trap, reduced pericarditis recurrence in the phase 3 study, RHAPSODY (Rilonacept Inhibition of Interleukin‐1 Alpha and Beta for Recurrent Pericarditis: A Pivotal Symptomatology and Outcomes Study). The RHAPSODY long‐term extension further explored recurrent pericarditis natural history and treatment duration decision‐making during 24 additional months of open‐label rilonacept treatment. Methods and Results Seventy‐four patients commenced the long‐term extension, with a median (maximum) total rilonacept duration of 22 (35) months. Individually, 18 months after the most proximal pericarditis recurrence, investigators decided to continue rilonacept on study, suspend rilonacept for off‐treatment observation (rescue allowed), or discontinue the study. The annualized incidence of pericarditis recurrence on rilonacept up to the 18‐month decision milestone was 0.04 events/patient‐year versus 4.4 events/patient‐year prestudy while on oral therapies. At the 18‐month decision milestone, 64% (33/52) continued rilonacept, 15% (8/52) suspended rilonacept for observation, and 21% (11/52) discontinued the study. Among the 33 patients (1/33; 3.0%) continuing rilonacept (median time to recurrence could not be estimated due to too few events), a single recurrence occurred 4 weeks after a treatment interruption. Among patients suspending rilonacept, 75% (6/8) experienced recurrence (median time to recurrence, 11.8 weeks [95% CI, 3.7 weeks to not estimable]). There was a 98% reduction in risk of pericarditis recurrence among patients continuing rilonacept treatment after the 18‐month decision milestone versus those suspending treatment for observation (hazard ratio, 0.02; P

The conversion of biomass into bio-oil through the pyrolysis process offers numerous benefits, such as bio-fuel and bio-resin synthesis. However, for bio-oil usage for any application, understanding its composition is vital. Therefore, this study investigated the effects of different commonly available woody biomass (Douglas fir, eucalyptus, and poplar) on bio-oil composition. The bio-oil was produced through fast pyrolysis at 500 °C in a fluidized bed reactor and collected using an electrostatic precipitator. The chemical composition was analyzed using gas chromatography–mass spectroscopy, and the hydroxyl groups were quantified using phosphorous-31 nuclear magnetic resonance. The poplar bio-oil had the most significant proportion (67 area%) of lignin-derived compounds and the highest OH concentration (6 mmol g−1). However, the proportion of carbohydrate-derived compounds was the largest (44 area %) in bio-oil produced from Douglas fir. Based on the OH concentration, poplar would be the most suitable feedstock for resin synthesis among the three feedstocks tested.

Modern functional foods are designed to provide health benefits beyond basic nutrition. They are enriched with bioactive ingredients like probiotics, vitamins, minerals, and antioxidants. These foods support overall health, enhance immune function, and help prevent chronic diseases. Milk proteins and tea are known to influence satiety and regulate body weight. Studies have shown that green tea polyphenols, namely, (−)-epigallocatechin gallate (EGCG), and whey proteins, predominantly lactoferrin (LF) from milk, play a role in regulating satiety. This study aims to investigate the effect of conjugating EGCG with apo-lactoferrin (Apo-LF) and assessing these effects on satiety through monitoring glucagon-like peptide-1 (GLP-1) regulation in a human colon (NCI-H716) cell line. Apo-LF-EGCG conjugates were synthesized and characterized in terms of structural and functional properties. The effect on GLP-1 regulation was assessed by real-time quantitative reverse-transcription polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA) to monitor gene and protein expressions, respectively. The results revealed that the protein–polyphenol interaction occurs through the complex formation of hydrogen bonds at the O-H and carbonyl groups of EGCG. The conjugates also showed a significant up-regulation of gene and protein expression levels of GLP-1 while also preventing EGCG from degradation, thereby preserving its antioxidant properties. The Apo-LF-EGCG conjugates increase satiety via increasing GLP-1 secretion in human colon cells while simultaneously retaining the antioxidant properties of EGCG. Therefore, these conjugates show potential for use as dietary supplements to enhance satiety.

Objectives:Axial length (AL) is an important contributor to refraction, and growth curves are gaining importance in the prediction of myopia. This study aimed to profile the distribution of ocular biometry parameters and to identify correlates of spherical equivalent refraction (SE) among school children in South India.Materials and Methods:The School Children Ocular Biometry and Refractive Error study was conducted as part of a school screening program in southern India. The enrolled children underwent tests that included vison check, refraction, binocular vision assessment, and biometry measurements.Results:The study included 1382 children whose mean (standard deviation [SD]) age was 10.18 (2.88) years (range: 5-16 years). The sample was divided into 4 groups (grades 1-2, grades 3-5, grades 6-9, and grade 10) based on significant differences in right AL (p

Efficient treatment of nutrient-rich wastewater is of paramount importance for protecting the ecosystem. In this work, an efficient, abundant, and eco-friendly adsorbent was derived from biochar and employed for phosphorus (P) adsorption. The key factors influencing the P removal efficiency of the activated biochar, including P concentration, pH, dosage, temperature, adsorption time, and influence of co-existing ion type, were investigated. Maximum P adsorption percentage (100%) was obtained with 10 mg/L and zinc chloride activated biochar (BC–Zn) compared to the other activated biochars. Results show that by increasing the P concentration from 5 to 200 mg/L, the phosphorus adsorption capacity increases from 0.13 to 10.4 mg/g biochar. Isotherms and kinetic studies further show that the P adsorption follows the Langmuir and quasi-second-order kinetic models. The mechanistic investigation demonstrated that P adsorption occurred by precipitation reaction. Furthermore, P desorption has been studied at different time intervals to understand the P release rate after adsorption.

Abstract The study aimed to determine the level of self‐reported adherence to antihypertensive drug(s) and its associated factors among patient with hypertension at a tertiary care center. The authors performed hospital based observational cross‐sectional study using semi‐structured questionnaires, WHO STEP tool and Hill and Bone high blood pressure compliance scale from December 1, 2021 to February 28, 2022. Descriptive statistics, Chi‐square/Fisher's exact test and non‐parametric tests were used for statistical analysis. Among 150 cases included in the study, majority (94, 62.67%) had good adherence based on Hill and Bone high blood pressure compliance scale with adherence level labelled as “good adherence” (score 3) and “not good adherence” (score

Background and Purpose: Rhinosinusitis (RS) is a clinical and radiological diagnosis that rarely reaches a proper infective etiological diagnosis. The most dreaded fact about invasive fungal rhinosinusitis is its poor prognosis in immunocompromised patients with a 60-80% mortality rate. The present study highlights and compares the various diagnostic techniques to establish a fungal etiological diagnosis in clinically suspected cases of RS from nasal biopsy specimens, with the emphasis on the molecular diagnostic approach.Materials and Methods: This prospective study included a total of 34 clinically suspected cases of RS who had recently undergone functional endoscopic sinus surgery (FESS)/biopsy from nasal polyps. Various laboratory methods (microbiological and histopathological) were utilized, including direct microscopic examination of clinical samples and fungal culture isolation. The molecular detection method of polymerase chain reaction (PCR) from clinical samples was also explored simultaneously. Serum immunoglobulin-E (IgE) testing of patients was also performed.Results: Out of 34 clinically suspected RS cases, fungal etiology was established in a total of 18 cases, 17 of whom were culture-proven. A total of 15 and 14 culture-proven cases were also detected on direct microscopic examination by potassium hydroxide (KOH) mount and histopathological staining, respectively. One case was additionally identified by molecular method. Aspergillus flavus complex was the most common pathogen isolated in culture. Allergic fungal RS was the most common type, followed by acute and chronic invasive types among all fungal RS cases.Conclusion: Accurate and prompt etiological diagnosis of fungal RS is still lagging with fewer options for quick results. Although microscopy and culture isolation can’t be replaced, PCR is a sensitive and specific method that should be incorporated as a supplementary tool for the early diagnosis and management, considering the delayed growth of fungi.

Aortic stenosis is one of the most common cardiac valve pathologies in the world and its prevalence increases with age. Although previously associated with increased perioperative mortality, more recent studies suggest that mortality rates may be decreasing. Recent guidelines suggest that major non-cardiac surgery can be performed safely in asymptomatic severe aortic stenosis patients with close hemodynamic monitoring. Among symptomatic patients, the guidelines recommend aortic valve intervention prior to major non-cardiac surgery because of a reduction in the incidence of postoperative heart failure and improved rates of long-term overall survival. This review provides a comprehensive and contemporary review of the perioperative management of patients with severe aortic valve stenosis.

Background: Limitations of echocardiography have long been known for the assessment of right ventricular (RV) systolic function in postoperative tetralogy of Fallot (TOF) patients. In this study, we evaluated the role of RV-global longitudinal strain (GLS) for the assessment of RV systolic function. Materials and Methods: It was a single institution prospective observational study of ninety postoperative TOF patients. Detailed 2-dimensional echocardiography along with RV-GLS using speckle tracing imaging was done at baseline and after 1 year. The children were divided into three groups based on duration since total correction, i.e., group A (6 months to 5 years), group B (6–10 years), and group C (>10 years) to assess the differences in RV systolic function. Furthermore, correlation of RV-GLS with RV-fractional area change (FAC), tricuspid annular plane systolic excursion, and tricuspid valve tissue Doppler imaging s' velocity was done. Results: In group A patients, a statistically significant increase in RV systolic function was seen over a period of 1 year. However, in group B and C patients, no significant change was seen. There was a strong positive correlation of RV-GLS only with RV-FAC during the first follow-up (r = 0.41, P < 0.01) and second follow-up periods (r = 0.67, P < 0.01). Conclusion: RV-GLS has a strong positive correlation with RV-FAC, and it detects preclinical regional myocardial dysfunction even when the RV-FAC is normal and thus must be included in the evaluation of postoperative TOF children.

With the widespread adoption of high yielding rice (Oryza sativa L.) varieties and accompanying changes in the cultural practices, rice leaf folder [Cnaphalocrocis medinalis (Guenee)] and yellow stem borer [Scirpophaga incertulas (Walker)] has attained the status of major pests and influence the yield if proper timely management practices are not adopted. For effective management of these pests, identification of new molecules with novel mode of action, low toxicity to non-target insects and environmental safety is required for sustainable IPM. Chlorantraniliprole 0.4% gr (Ferterra 0.4% gr) is an anthranillic diamide insecticide in granular form for the control of lepidopterous pests in rice. A field experiment was conducted to evaluate the efficacy of chlorantraniliprole 0.4% gr (Ferterra 0.4% gr) against rice leaf folder and yellow stem borer during rainy (kharif) seasons 2017–19. The study revealed that broadcast application of chlorantraniliprole 0.4% gr @40 g a.i./ha at tillering stage was found effective and best insecticidal treatment in reducing rice leaf folder and yellow stem borer infestation with no phytotoxicity symptoms and increased grain yield. Chlorantraniliprole 0.4% gr @40 g a.i./ha was also safer to the natural enemies of the rice ecosystem. Post-harvest residual analysis of chlorantraniliprole 0.4% gr was found below the limit of quantification, i.e. 0.01 ppm in rice grains, soil, paddy straw and husk at recommended and double of the recommended dose indicating its safety to human, animals and environment.

Bi2Te3-based thermoelectric (TE) materials have been demonstrated to be a potential candidate for mainly thermoelectric cooling/refrigeration applications. However, minority charge carriers excitation at high temperature reduces thermopower which restricts these materials for the use in power generation. In present work, substitution of Ni on Sb site in Bi0.5Sb1.5-xNixTe3 (x = 0, 0.01, 0.04 and 0.08) actuates the system to supress the intrinsic excitation leading to shift in highest ZT to higher temperature regime. The Density functional theory (DFT) calculations and experimental results reveal that Ni in Bi0.5Sb1.5Te3 provides the extra holes and slightly reduces the band gap Eg which enhances the σ of Ni-doped Bi0.5Sb1.5-xNixTe3 samples and α at elevated temperature. Moreover, Ni-doping in Bi0.5Sb1.5Te3 also reduces κL which is attributed to the phonon scattering due to mass fluctuations and microstructural features such as grain boundary and strain field domain observed from HRTEM investigation. These favourable condition leads to maximum ZT∼1.38 at 433K for Bi0.5Sb1.46Ni0.04Te3 and ZTavg ∼1.1 between 300K and 503K. Interestingly the calculated theoretical TE conversion device efficiency η of Bi0.5Sb1.46Ni0.04Te3 (η∼5.5%) was achieved to be nearly twice than the efficiency of matrix Bi0.5Sb1.5Te3 (η∼3%). Experimental electronic transport is well corroborated with theoretically estimated DFT results.

Background Hypocalcemia is a rare reversible cause of dilated cardiomyopathy in pediatric population. Myocarditis is another more frequent cause of cardiomyopathy with overlapping presenting features. Cardiac magnetic resonance imaging (CMRI) is a vital modality capable of tissue characterization for the evaluation of cardiomyopathy. The present study is the first attempt to determine if any specific characteristics on CMR exist in patients with hypocalcemic dilated cardiomyopathy.

Background Recurrent pericarditis is characterized by painful flares and inflammation, which negatively impact health‐related quality of life. RHAPSODY (rilonacept inhibition of interleukin‐1 alpha and beta for recurrent pericarditis: a pivotal symptomatology and outcomes study) evaluated the efficacy and safety of rilonacept (IL‐1α and ‐β cytokine trap) in recurrent pericarditis. A secondary analysis of these data evaluated the patient‐reported outcome questionnaire score change during the trial. Methods and Results Participants completed 5 patient‐reported outcome (PRO) questionnaires assessing pericarditis pain, health‐related quality of life, general health status, sleep impact, and overall symptom severity. PRO score changes during the treatment run‐in period (12 weeks) and the blinded randomized withdrawal period (up to 24 weeks) were evaluated using descriptive statistics and mixed model repeated measures analyses. Participants with PRO data from the run‐in period (n=84) and the randomized withdrawal period (n=61; 30 rilonacept, 31 placebo) were included in analyses. Run‐in baseline PRO scores indicated that pericarditis symptoms during pericarditis recurrence impacted health‐related quality of life. All PRO scores significantly improved (P

Background: In traumatic brain injury patients, coagulation disorder causes secondary brain injury, thereby increasing mortality and morbidity. Aim: This study aims to know the impact of coagulation profile derangements and their effect on the outcome of head injury patients. Materials and methods: A total of 100 patients admitted with traumatic brain injury were included in the study. Samples of complete haemogram (CBC), prothrombin time (PT), partial thromboplastin time (PTTK), D-Dimers and fibrinogen were obtained. Coagulopathy was defined as platelet counts < 100,000 cells/mm2 and PTI >15 seconds or a DIC(Disseminated intravascular coagulation) score of more than 4. The outcome in each group was measured according to the Glasgow outcome score. The data were analysed with the Chi-square test and independent t-test. Results: In patients with severe and moderate traumatic brain injury, there was no significant difference in the Haemoglobin, Fibrinogen and D-Dimer between the patients with and without coagulopathy. But, the platelet count was significantly lower in the patients with coagulopathy and the PT and PTTK were significantly higher in the patients with coagulopathy in comparison to the patients without coagulopathy (p

We often face situations when the exact etiological diagnosis of meningitis is difficult. The reason behind this is that many pathogens have similar clinical, radiological, and laboratory pictures. The low yield of the pathogen in cerebrospinal fluid (CSF), non-availability of detail tests in all corners of the world, delay in availability of reliable results (like cultures), and difficulty in performing confirmatory tests like brain biopsy (in inconclusive cases) make the job of a clinician challenging. We report here a case where a late diagnosis of a disease owing to inconclusive results leads to dissemination. The complications following the introduction of the treatment based on presumption lead to further difficulty. We remained inclined to our diagnosis based on clinical judgement, acknowledged and managed the inflammatory changes secondary to the infection, and finally won the long battle. So, sometimes we need to make decisions based on clinical grounds. We need to depend on the fact that uncommon presentations of common diseases are commoner than a common presentation of uncommon diseases.

Abstract Background Impact of recurrent pericarditis (RP) on patient health-related quality of life (HRQoL) was evaluated through qualitative patient interviews and as an exploratory endpoint in a Phase 2 trial evaluating the efficacy and safety of rilonacept (IL-1α/IL-1β cytokine trap) to treat RP. Methods Qualitative interviews were conducted with ten adults with RP to understand symptoms and HRQoL impacts, and the 10-item Patient-Reported Outcomes Measurement Information System Global Health (PROMIS GH) v1.2 was evaluated to determine questionnaire coverage of patient experience. The Phase 2 trial enrolled participants with active symptomatic RP (A-RP, n = 16) and corticosteroid-dependent participants with no active recurrence at baseline (CSD-RP, n = 9). All participants received rilonacept weekly during a 6-week base treatment period (TP) plus an optional 18-week extension period (EP). Tapering of concomitant medications, including corticosteroids (CS), was permitted during EP. HRQoL was assessed using the PROMIS GH, and patient-reported pain and blood levels of c-reactive protein (CRP) were collected at Baseline and follow-up periods. A secondary, descriptive analysis of the Phase 2 trial efficacy results was completed using HRQoL measures to characterize both the impact of RP and the treatment effect of rilonacept. Results Information from qualitative interviews demonstrated that PROMIS GH concepts are relevant to adults with RP. From the Phase 2 trial, both participant groups showed impacted HRQoL at Baseline (mean PROMIS Global Physical Health [GPH] and Global Mental Health [GMH], were lower than population norm average). In A-RP, GPH/MPH improved by end of base TP and were sustained through EP (similar trends were observed for pain and CRP). Similarly, in CSD-RP, GPH/MPH improved by end of TP and further improved during EP, during CS tapering or discontinuation, without disease recurrence (low pain scores and CRP levels continued during the TP and EP). Conclusion This is the first study demonstrating impaired HRQoL in RP. Rilonacept treatment was associated with HRQoL improvements using PROMIS GH scores. Maintained/improved HRQoL during tapering/withdrawal of CS without recurrence suggests that rilonacept may provide an alternative to CS. Trial registration: ClinicalTrials.Gov; NCT03980522; 5 June 2019, retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT03980522 .

Abstract Background and Aim The literature is lacking on associations of endoscopic retrograde cholangiopancreatography (ERCP) related outcomes in rheumatoid arthritis (RA) patients. The aim of this study is to evaluate the effects of RA on clinical outcomes and hospital resource utilization in patients undergoing ERCP. Methods The National Inpatient Sample database was used to identify hospitalized patients who had underwent an ERCP study from 2012 to 2014 using International Classification of Diseases‐Ninth Edition (ICD‐9) codes. Primary outcomes were mortality, hospital charges, and length of stay. Secondary outcomes were ERCP‐related complications. Chi‐squared tests for categorical data and independent t‐test for continuous data were utilized. Multivariate analysis was performed to assess the primary outcomes. Results There was 83 890 ERCP procedures performed, of which 970 patients had RA. In patients with RA, 74.2% were female, and the average age was 65.7 years. RA primary outcomes of mortality rate and hospital cost were lower and statistically significant. There was no statistically significant difference in secondary outcomes except for lower cholecystectomy rates in RA patients. Conclusion With a high inflammatory state, it was hypothesized that RA would be associated with worse outcomes after ERCP. Yet, the primary outcomes of mortality and hospital cost were found to be lower than controls, with no difference in secondary outcomes. We posit that immunosuppressants used to treat RA provides a protective effect to overall complications with ERCP.

Boerhaave syndrome (BS) is a full thickness oesophageal tear. Most cases require surgical correction. In rare cases, conservative management can be attempted. This case describes a 30-year-old patient with a history of BS 9 months prior, managed conservatively at that time, presenting with 2 days of vomiting. Their vitals and physical examination were within normal limits. Imaging revealed extensive air tracking along the mediastinum, oesophagus, and bilateral neck and chest wall consistent with BS. Gastrographin and barium oesophagrams showed no contrast extravasation. The patient was successfully treated with conservative measures including pantoprazole, piperacillin-tazobactam, cessation of oral intake, and parenteral nutrition. This case represents one of only two documented cases of recurrent BS in an adult patient in which both cases were managed conservatively. Of these two cases, this is the first report with the second episode of BS occurring more than 4 weeks after the first episode. Additionally, unlike the other recurrent BS case that was conservatively managed, this patient lacked any known comorbid risk factors for development of BS. While the management of this case resembles the care provided in some prior case reports, the significant variation and lack of standardisation in the approach of conservative BS treatment posed a significant challenge in developing a therapeutic plan. Given the absence of high-quality studies about conservatively managed BS, an increased sample size of case reports detailing their non-procedural management approaches and their subsequent outcomes would hopefully eventually clarify an optimal treatment regimen, and allow for standardisation of conservative BS treatment.

PurposeWe examined the effectiveness of proprietary and open large language models (LLMs) in detecting disease presence, location, and treatment response in pancreatic cancer from radiology reports.MethodsWe analyzed 203 deidentified radiology reports, manually annotated for disease status, location, and indeterminate nodules needing follow-up. Using generative pre-trained transformer (GPT)-4, GPT-3.5-turbo, and open models such as Gemma-7B and Llama3-8B, we employed strategies such as ablation and prompt engineering to boost accuracy. Discrepancies between human and model interpretations were reviewed by a secondary oncologist.ResultsAmong 164 patients with pancreatic tumor, GPT-4 showed the highest accuracy in inferring disease status, achieving a 75.5% correctness (F1-micro). Open models Mistral-7B and Llama3-8B performed comparably, with accuracies of 68.6% and 61.4%, respectively. Mistral-7B excelled in deriving correct inferences from objective findings directly. Most tested models demonstrated proficiency in identifying disease containing anatomic locations from a list of choices, with GPT-4 and Llama3-8B showing near-parity in precision and recall for disease site identification. However, open models struggled with differentiating benign from malignant postsurgical changes, affecting their precision in identifying findings indeterminate for cancer. A secondary review occasionally favored GPT-3.5's interpretations, indicating the variability in human judgment.ConclusionLLMs, especially GPT-4, are proficient in deriving oncologic insights from radiology reports. Their performance is enhanced by effective summarization strategies, demonstrating their potential in clinical support and health care analytics. This study also underscores the possibility of zero-shot open model utility in environments where proprietary models are restricted. Finally, by providing a set of annotated radiology reports, this paper presents a valuable data set for further LLM research in oncology.

Background: Patients with large perimembranous ventricular septal defects (pm-VSDs) undergo surgical repair with prosthetic material during infancy. However, the effect of the presence of akinetic patch in the ventricular septum on the left ventricular (LV) mechanical synchrony and ventricular function has not been studied. In our study, we assessed LV function in postoperative pm-VSD closure patients on two-dimensional (2D) echocardiography (echo) after 1 year of surgery using biplane Simspon's method, fractional shortening (FS), and global longitudinal strain (GLS) to assess the regional strain pattern. Methods: This was a a single-institution observational study. Patients following up 1 year after surgical ventricular septal defect closure at our institute were enrolled. On follow-up, detailed 2D echo was done with special emphasis on left atrial size, LV size (by M-mode), and presence of any residual shunt. LV function was assessed using biplane Simpson's method and longitudinal strain on 2D echo. GLS was measured in three standard apical views. Results: Of the 121 patients enrolled, 101 patients fulfilling the inclusion and exclusion criteria were analyzed. Of these 101 patients, 75.2% were males. The median age at follow-up after surgery was 3.67 ± 2.7 years. About 92.1% of patients did not have residual VSD lesion. No patient had pulmonary arterial hypertension. All except one patient had normal ventricular function. Patients with ventricular dysfunction had LV ejection fraction (LVEF) of 47%, GLS –17.4%, and FS −20.5%. The mean values of FS, LVEF, and GLS were 32.0 ± 5.28%, 62.2% ± 4.2%, and −26.53 ± 2.93%, respectively, in pm-VSD closure patients. Regional strain pattern analysis showed significantly lower strain values in basal anteroseptal segment with a mean of −21.4 ± 2.7%. FS and GLS were noted to have significant correlation with each other (P = 0.01) and LVEF by biplane Simpson's method and GLS had significant correlation with each other (P = 0.0001). Conclusions: GLS has strong correlation with LVEF by Simson's method and FS. Basal anteroseptal segment in pm-VSD patients had significantly lower strain values compared to other segments. There is no significant correlation between age at surgery and GLS in pm-VSD closure patients who were operated within 1 year of age. The type of VSD closure does not have significant influence on GLS.

Background: Transcatheter paravalvular leak (PVL) closure in recent times has emerged as a safe and effective alternate to redo-surgical repair. We sought to examine the clinical efficacy and safety of percutaneous PVL closure at our center. Methods and Results: A retrospective study from August 2012 to December 2019 of 19 patients who underwent 21 procedures for PVL closure. The mean age was 49.25 ± 14.72 years. The target valve was mitral in 11 (57%) and aortic in 7 (36%) cases. One (5%) patient had prosthetic valve in left atrioventricular valve with congenitally corrected transposition of great arteries. Majority of the cohort presented with heart failure without hemolysis (89%), with most of them being in NYHA functional class III (57%) or class IV (21%). A procedural success of 85% was achieved. Post procedure severity of regurgitation reduced from severe in thirteen patients and moderate in six patients to moderate in two patients and mild in fourteen patients. Symptomatic improvement was observed in all cases who had successful closure with NYHA function class improving from 3 ± 0.64 to 1.6 ± 0.94. The mean follow-up duration was 21 ± 13 months (median 24 months). There was one (4.7%) mortality with cumulative survival from all-cause mortality of 95%. Conclusion: The results of percutaneous PVL closure appear encouraging in our series with modest number of patients and offers a promising alternative to redo-surgery in this high-risk cohort.

Intraoperative echocardiography is an integral component of the peri-operative management of pediatric heart disease. It confirms the adequacy of surgery, identifies residual lesions, and can provide useful hemodynamic data. It, therefore, helps to decide on the need for revision of repair and guides the postoperative management strategy. Intraoperative echocardiography is done with the use of either an epicardial probe or a transesophageal probe. Epicardial echocardiography is a simple, useful modality and has the ability to perform imaging in cases where transesophageal echocardiography cannot be easily performed, for example, in low birth weight babies. We attempt to describe in detail the technique of epicardial echocardiography and the various views that we have found useful for a complete postsurgical evaluation. The limitations of the technique are also discussed in detail.

Background : Transcatheter valves provide a safe and effective alternative to surgery for treating dysfunctional right ventricular outflow tracts (RVOTs). We present our early multicenter experience of percutaneous pulmonary valve implantation (PPVI) using Melody valve (Medtronic Inc., Minneapolis, MN). Methods : Patients with stenosed conduits or degenerated bioprosthetic valves in RVOT with combined stenosis and regurgitation were evaluated for suitability of Melody valve implantation. After undergoing an initial structured training, PPVI using Melody transcatheter pulmonary valve (TPV) was guided by an approved proctor. Conduits were serially dilated and prestented with careful coronary interrogation, and bioprosthetic valves were dilated with high-pressure balloons. Clinical and echocardiographic follow-up was performed at 6 monthly intervals. Results : Fifteen patients (three females) aged 23.1 ± 9.5 years in NYHA Class II-III underwent Melody TPV implantation in four Indian centers. The underlying anatomy comprised surgically implanted bioprosthetic valves for pulmonary regurgitation (n= 5), conduit repair for pulmonary atresia (n = 4), Rastelli repair (n = 3), truncus (n = 1), and Ross procedure (n = 2). Twelve patients had more than one previous surgery. Doppler gradient decreased from 74.2 ± 21.5 mmHg to 10.2 ± 4.5 mmHg after the PPVI. At a median follow-up of 14 months (1–39 months), all the patients were in NYHA Class I with echocardiographic gradients of 8 ± 5.7 mmHg with no evidence of pulmonary regurgitation. There were no major procedural adverse events or deaths. Conclusions : Our early experience shows encouraging results of the PPVI program in India with proctored case selection and meticulous planning. It also confirms the safety and efficacy of Melody TPV for treating dysfunctional RVOT in postoperative patients.

Background : COVID-19 pandemic has disrupted pediatric cardiac services across the globe. Limited data are available on the impact of COVID.19 on pediatric cardiac care in India. Aims : The aims are to study the impact of COVID-19 pandemic on the care of children with heart disease in India in terms of number of outpatient visits, hospitalizations, catheter-based interventions, and cardiac surgeries. Settings and Design : This is a retrospective, multicentric, observational study. Methods : We collected monthly data on the number and characteristics of outpatient visits, hospitalizations, catheter-based interventions, and cardiac surgeries and major hospital statistics, over a period of 5 months (April to August 2020), which coincided with the first wave of COVID-19 pandemic in India and compared it with data from the corresponding months in 2019. Results : The outpatient visits across the 24 participating pediatric cardiac centers decreased by 74.5% in 2020 (n = 13,878) as compared to the corresponding period in 2019 (n = 54,213). The reduction in the number of hospitalizations, cardiac surgeries, and catheterization procedures was 66.8%, 73.0%, and 74.3%, respectively. The reduction in hospitalization was relatively less pronounced among neonates as compared to infants/children (47.6% vs. 70.1% reduction) and for emergency surgeries as compared to elective indications (27.8% vs. 79.2%). The overall in-hospital mortality was higher in 2020 (8.1%) as compared to 2019 (4.8%), with a higher postoperative mortality (9.1% vs. 4.3%). Conclusions : The current COVID-19 pandemic significantly impacted the delivery of pediatric cardiac care across India with two-third reduction in hospitalizations and cardiac surgeries. In an already resource-constrained environment, the impact of such a massive reduction in the number of surgeries could be significant over the coming years. These findings may prove useful in formulating strategy to manage subsequent waves of ongoing COVID-19 pandemic.