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In comparison to the worldwide burden of asthma, although India contributes to 13% of the total asthma prevalence, it has a threefold higher mortality rate and more than twofold higher DALYs, indicating a substantial gap in asthma diagnosis and treatment. Asthma causes significant suffering, affecting people’s quality of life and draining the country’s resources; therefore, we must devise ways and means to fill these gaps. The most successful and cost-efficient strategy to battle asthma is to form strong partnerships between patients, the general public, the government, the pharmaceutical industry and non-governmental organisations. This necessitates a comprehensive approach that involves raising awareness, developing universally applicable recommendations, increasing access to high-quality asthma care, and other measures. The purpose of this article was to review the existing scenario of asthma management in India and the factors that contribute to it and devise unique and all-encompassing strategies to fill these gaps.

Background and aimsAccumulation of visceral adipose tissue is associated with hepatic inflammation and fibrosis, suggestive of its metabolic and inflammatory properties. We aimed to examine the histologic findings of visceral and subcutaneous adipose tissue and to associate these findings with clinical and radiologic characteristics in patients with cirrhosis.MethodsIncluded were 55 adults with cirrhosis who underwent liver transplantation from 3/2017-12/2018 and had an abdominal computed tomography (CT) scan within 6 months prior to transplant. Visceral-to-subcutaneous adipose tissue ratio (VSR) was calculated using visceral (VATI) and subcutaneous adipose tissue index (SATI) quantified by CT at the L3-vertebral level and normalized for height (cm2/m2). VAT (greater omentum), SAT (abdominal wall), and skeletal muscle (rectus abdominis) biopsies were collected at transplant.ResultsMajority of patients had VAT inflammation (71%); only one patient (2%) had SAT inflammation. Patients with VAT inflammation had similar median VATI (42 vs 41 cm2/m2), lower median SATI (64 vs 97 cm2/m2), and higher median VSR (0.63 vs 0.37, p = 0.002) than patients without inflammation. In univariable logistic regression, VSR was associated with VAT inflammation (OR 1.47, 95%CI 1.11-1.96); this association remained significant even after adjusting for age, sex, BMI, HCC, or MELD-Na on bivariable analyses.ConclusionIn patients with cirrhosis undergoing liver transplantation, histologic VAT inflammation was common, but SAT inflammation was not. Increased VSR was independently associated with VAT inflammation. Given the emerging data demonstrating the prognostic value of VSR, our findings support the value of CT-quantified VSR as a prognostic marker for adverse outcomes in the liver transplant setting.

Objectives To assess the efficacy of exercises in early-stage Parkinson’s disease (PD).Design Single-blind, randomised controlled trial.Setting Tertiary rehabilitation care centre.Participants Forty individuals (≥18 years, either gender) with newly diagnosed PD (Hoehn and Yahr stage ≤2) on a stable dose of PD medications were randomised (1:1) to the intervention group (IG) and control group (CG).Interventions The IG received strengthening (30 min/day, 2 days/week), aerobic (30 min/day, 3 days/week) and agility (30 min/day, 2 days/week) exercises in a structured format for 12 weeks. CG received stretching exercises for 12 weeks.Main outcome measures Unified PD Rating Scale (UPDRS) III (motor) at week 12 (primary), UPDRS I (mentation, behaviour and mood), UPDRS II and VI (Schwab and England Activities of daily living Scale) and Parkinson’s Disease Quality of Life (PDQL) at week 12 (secondary).Results 36 participants completed 12-week study period. UPDRS III (lesser scores reflect improvement) at 12 weeks showed a significant between-group difference (−5.05 points (95% CI: −9.38 to −0.71), p=0.02). At 4 and 8 weeks, UPDRS III did not show a statistically significant between-group difference (−2.15 points (95% CI: −6.77 to 2.47) and −4.1 points (95% CI: −8.54 to 0.34), respectively). From baseline to 12 weeks, UPDRS III in the IG showed a 6.5-point (95% CI (4.85 to 8.14)) reduction, and the CG showed a 0.8-point increase (95% CI (−3.06 to 1.46)), PDQL (higher scores reflect improvement) in the IG showed a 8.45-point (95% CI (–12.78 to –4.11)) increase and CG showed a 2.75-point (95% CI (0.16 to 5.33)) reduction.Conclusions Structured exercises improve motor symptoms and quality of life in early-stage PD. Consistent adherence for at least 12 weeks is crucial for clinical improvement. Early initiation of exercises as neurorehabilitation is recommended. Further research on specific types, dosing and intensity of exercises with a larger sample size is warranted in early-stage PD.Trial registration number CTRI/2018/05/014241.

Aim: The aim of this study was to evaluate the effect of different glide path establishing systems when used along with WaveOne Gold (WOG) single-file reciprocating system and ProTaper Gold (PTG) rotary multifile system on apically extruded debris in curved root canals. Methods: Eighty extracted mandibular molar teeth with curved mesial roots were selected for this study. Specimens were randomly divided into eight experimental groups according to the root canal preparation (n = 10): Group 1 (WOG + H and K-file), Group 2 (WOG+ G-Files),Group 3 (WOG+ One G), Group 4 (WOG + ProGlider), Group 5 (PTG + Hand K-file), Group 6 (PTG+ G-Files), Group7 (PTG+ One G), and Group 8 (PTG + ProGlider). Roots were attached to preweighed Eppendorf tubes. All instruments were used according to the manufacturers' instructions. During root canal preparation, 8 mL of distilled water was used for each specimen. Apically extruded debris was collected in Eppendorf tubes. After the completion of root canal preparation, Eppendorf tubes were removed from the specimens and stored in an incubator at 70°C for 5 days. Eppendorf tubes were weighed after evaporation to calculate the amount of extruded debris. The data were subjected to statistical analysis using one-way analysis of variance and post hoc Tukey's test at a significance level of P < 0.05. Results: A statistically significant difference was observed between the ProGlider and K-file groups. The ProGlider group was associated with significantly less debris extrusion than the K-file group for both the shaping systems used: WOG (P = 0.048) and PTG (P = 0.044). There was no statistically significant difference between NiTi rotary glide path files: ProGlider, G-Files, and One G files. All experimental groups caused apical debris extrusion. Conclusion: Among all mechanical glide path files tested, ProGlider showed the least debris extrusion which was significantly less than K-file. Glide path preparation using NiTi rotary files in combination with rotary shaping files (PTG) was associated with less apical debris extrusion than the rotary glide path files used along with reciprocating file (WOG).

Over the past decade, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become an indispensable tool in the diagnostic armamentarium of the pulmonologist. As the expertise with EBUS-TBNA has evolved and several innovations have occurred, the indications for its use have expanded. However, several aspects of EBUS-TBNA are still not standardized. Hence, evidence-based guidelines are needed to optimize the diagnostic yield and safety of EBUS-TBNA. For this purpose, a working group of experts from India was constituted. A detailed and systematic search was performed to extract relevant literature pertaining to various aspects of EBUS-TBNA. The modified GRADE system was used for evaluating the level of evidence and assigning the strength of recommendations. The final recommendations were framed with the consensus of the working group after several rounds of online discussions and a two-day in-person meeting. These guidelines provide evidence-based recommendations encompassing indications of EBUS-TBNA, pre-procedure evaluation, sedation and anesthesia, technical and procedural aspects, sample processing, EBUS-TBNA in special situations, and training for EBUS-TBNA.

Combinational circuits that utilize solely optical means are crucial elements for processing optical information and are used in a wide variety of applications. Optical devices are the fundamental components of integrated circuits. In this paper, the fundamental structure of a full-subtractor circuit is generated utilizing Y-shaped plasmonic power splitter concept that employs the linear interference principle to produce the required output. This work is encapsulated within a 20 µm × 18 µm frame, and the extinction ratio (ER) of this model is 13.01 for both difference and borrow which is higher compared to other full-subtractor structures. This work introduces the first Y-shaped plasmonic all-optical full-subtractor structure. Various structure parameters such as transmission rate, response time, and bit rate are also calculated and analyzed. The transverse electric (TE) polarization of the intended device, that has an operational wavelength of 1.55 µm, is tailored toward optical communication.

The expansion of the digital market is accelerating, and for faster communication, optical technologies have been developed. The binary subtractor is a combinational circuit that can compute the subtraction operations in arithmetic logic unit (ALU). The desired design is depicted as a 2-D structure with two T-shaped waveguides, and it is operates at a wavelength of 1550nm. The design is verified and analyzed using finite-difference-time-domain (FDTD) method. It is also verified using MATLAB software. The identical design has been computed and simulated numerous times in this work, but with different lattice constants, refractive indices, and silicon rod radii. In this study, photonic crystals are used to construct a binary subtractor that is both compact and capable of producing a high contrast ratio (5.185dB for difference and 17.78dB for borrow). Moreover, the transmission efficiency is achieved 89.3%, insertion loss is 0.49dB, and the response time and bit rate are achieved by 0.0204Ps and 49.01Tbps respectively.

The optimized representation of an effective all-optical 3-input XOR/XNOR gate is designed with T-shaped 2-D photonic crystals (PhC) composed of silicon (Si) material embedded in an air background. Both XOR/XNOR logic gates are implemented in a single layout, with a phase change between the input signals applied. The beam interference concept is used to design the layout and simulation results are evaluated using finite-difference-time-domain (FDTD) method. This layout has a contrast ratio (CR) of 13.37 dB and 11.81 dB for XOR and XNOR gates respectively. Several other parameters such as response time, transmission efficiency, insertion loss etc., are calculated resulting in good outputs by optimizing the radius and refractive index that can be employed in photonic integrated circuits.