Traumatic Abdominal wall hernia with ileal perforation following blunt trauma abdomen: A rare case report and review of literature

Blunt trauma abdomen with abdominal wall herniation with bowel perforation is an acute emergency condition. Road traffic accidents causing blunt trauma are common in a youngster like in our case. Once the patient is resuscitated, ultrasonography and Computed tomography must be done. Early surgical exploration with mesh or primary repair of the defect is the mainstay of management. We have a case of a 25-year-old male with blunt trauma abdomen and anterior wall hernia following a road traffic accident who was managed with emergency exploratory laparotomy as computed tomography suggested anterior abdominal wall herniation of bowel content.

Recurrent Giant Cell Tumor of Sphenoid Bone: A Rare Finding

Giant Cell Tumors of the skull are rare and mostly occur in the middle cranial fossa. Radiological investigations serve as adjunct modalities; however, histopathological confirmation is mandatory. Ten to forty% of GCTs may be recurrent. Complete surgical resection is the treatment of choice, however, partial resection with adjuvant radiotherapy can serve as a secondary alternative. Recurrent cases require post-op radiotherapy. Here, we describe a case of recurrent giant cell tumor of sphenoid bone in a young male, who underwent surgical resection twice, after which he was advised adjuvant radiotherapy and denosumab. The patient did not take radiotherapy.

Malignant rectal GIST managed with chemotherapy (Imatinib Mesylate): A case report and a comprehensive review

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors involving the gastrointestinal tract, arising from the interstitial cells of Cajal. GIST comprises about 1% of all GI tumors. Rectal GISTs are rare and comprise of approximately 5% of all GISTs and only 0.1% of rectal tumors are found to be GISTs. Rectal GISTs may be diagnosed incidentally or present with symptoms, including defecation problems, bleeding, and/or pain. We report a case of a 46-year-old male with rectal GIST metastasized to the liver and bilateral lung parenchyma managed by Imatinib Mesylate (IM) regimen. Rectal GIST although being rare, must be considered as a differential diagnosis in a patient presenting with defecatory problems with bleeding.

Acute intestinal obstruction secondary to ingested foreign body in an adult with autism spectrum disorder: A rare case report and review of literature

Key Clinical Message

Foreign body ingestion is common in pediatric age group however can be found in any age group with intellectual disability and neurodevelopmental delay. There is usually a delay in presentation and interventions following foreign body ingestion in patients with neurodevelopmental delay, leading to increased morbidity, mortality, and complications owing to inability of such patients giving relevant history. Most ingested foreign bodies naturally pass through the digestive tract without untoward effects. Only a few patients may require surgical interventions. Principle of management should be to reduce anxiety among patients and their visitors. Speedy recovery is enhanced so that they can return to their familiar environment soon.

Abstract

Foreign body ingestion is common in pediatric populations and may be found in any age group with intellectual disability and neurodevelopmental delay. As the patient cannot give a clear and relevant history, there is usually a delay in presentation and interventions following foreign body ingestion in patients with neurodevelopmental delay, leading to increased morbidity, mortality, and complications. Most foreign bodies pass through the digestive system without any complications, and very few require surgical intervention. The goal should be to reduce anxiety among patients and their visitors and to enhance speedy recovery so that they can return to their familiar environment soon. Here we report a case of Acute intestinal obstruction secondary to ingestion of the head portion of a doll which was managed with emergency laparotomy with enterotomy and removal of foreign body in a 16 years female with Autism Spectrum Disorder.

Spinal astroblastoma, MN1 altered in 3-year-old child: An uncommon tumor at an unusual site

Astroblastoma is an uncommon circumscribed glial tumor mostly involving the cerebral hemisphere. The characteristic molecular alteration is meningioma (disrupted in balanced translocation) 1 (MN1) rearrangement. No definite World Health Organization grade has been assigned as both low- and high-grade tumors are known to occur. Tumors in the spine are extremely rare; to date only three cases have been reported in the literature. A vigilant microscopy and ancillary testing aid in diagnosis when the tumors present in unusual locations, as in our case. The prompt differentiation of this tumor from its mimickers is a mandate as modalities of management are different and not clearly established.

Gonadotropin upregulates intraovarian calpains-1 and -2 during ovarian follicular recruitment in the SD rat model

Calpain role has been shown in the cumulus cell-oocyte complexes and, corpus luteum. We investigated the association of calpains-1 and -2 in ovarian folliculogenesis using the Sprague-Dawley (SD) rat model and steroidogenesis in the human granulosa cells (hGCs). We induced PCOS in 42-day-old SD rats by letrozole oral gavage for 21 days. Premature ovarian failure (POF) was induced in 21-day-old SD rats by 4-vinylcyclohexene diepoxide (VCD). Ovulation and ovarian hyperstimulatory (OHS) syndrome were induced by pregnant mare gonadotropin (PMSG) + human chorionic gonadotropin (hCG) treatments in 21 days SD rats, respectively. Steroidogenesis is stimulated in human granulosa cells (hGCs) by forskolin and the response of 17-beta-estradiol (E2) on calpains expression was checked in hGCs. The protein expression by immunoblotting and activity by biochemical assay of calpains-1 and -2 showed an oscillating pattern in the ovarian cycle. PMSG-induced follicular recruitment showed upregulation of calpains-1 and -2, but with no change during ovarian function cessation (POF). Upregulated calpain-2 expression and calpain activity was found in the hCG +PMSG-induced ovulation. Letrozole-induced PCOS showed downregulation of calpain-1, but upregulation of calpain-2. PMSG+hCG-induced OHS led to the upregulation of calpain-1. Letrozole and metformin separately increased the expression level of calpains-1 and -2 in the hGCs during luteinization. In conclusion, the expression levels of calpains -1 and -2 are increased with ovarian follicular recruitment by PMSG and calpain-1 is decreased in the PCOS condition, and letrozole and metformin upregulate the expression of calpains-1 and -2 during luteinization in the hGCs possibly via E2 action.

Thiacalix[4]arene-Protected Silver Nanoclusters Encapsulating Different Two-Electron Superatom Oligomers

The subvalent silver kernel represents the nascent state of silver cluster formation, yet the growth mechanism has long been elusive. Herein, two silver nanoclusters (Ag30 and Ag34) coprotected by TC4A4- (H4TC4A = p-tert-butylthiacalix[4]arene) and TBPMT- (TBPMTH = 4-tert-butylbenzenemethanethiol) containing 6e and 4e silver kernels are synthesized and characterized. The trimer of the 2e superatom Ag14 kernel in Ag30 is built from a central Ag6 octahedron sandwiched by two orthogonally oriented Ag5 trigonal bipyramids through sharing vertexes, whereas a double-octahedral Ag10 kernel in Ag34 is a dimer of 2e superatoms. They manifest disparate polyhedron fusion growth patterns at the beginning of the silver cluster formation. Their excellent solution stabilities are contributed by the multisite and multidentate coordination fashion of TC4A4- and the special valence electron structures. This work demonstrates the precise control of silver kernel growth by the solvent strategy and lays a foundation for silver nanocluster application in photothermal conversion.

Effect of high voltage dielectric barrier discharge (DBD) atmospheric cold plasma treatment on physicochemical and functional properties of taro (Colocasia esculenta) starch

The goal of the proposed study is to investigate the effects of three different power levels (30, 32 and 34 kV) and exposure time (2, 4 and 8 min) of dielectric barrier discharge (DBD) atmospheric cold plasma treatment on the functional and physicochemical characteristics of taro starch. Investigations were done into how different treatments impact the multi-structural, functional and physicochemical attributes of taro starch. The findings showed that cold plasma treatments substantially impacted starch granule shapes (3.60-2.54 μm), such as reduced aggregations and developed fissures on granule surface due to the generation of an etching by plasma species and enhancement in the surface topography and roughness of treated starch as compared with native by SEM and AFM analysis. Besides this, no variations were detected in the functional groups of taro starch using FT-IR analysis after cold plasma treatments. However, the A-type pattern in the XRD did not affect it, while a reduction in relative crystallinity (14.20-11.50 %) was seen as a function of the active plasma species depolymerization. Furthermore, depending on the cold plasma voltage and treatment time, amylose content (20.12-15.98 %), paste clarity (24.48-31.27 %), solubility (0.41-65.53 %), freezing thaw stability (% syneresis) (32.10-42.58 %), color properties (L*, 94.79-97.52), whiteness index (79.37-84.66), molecular weight distribution (Peak 1, 12.79-5.35 × 108 g/mol; Peak 2, 4.20-1.56 × 107 g/mol) and in vitro digestibility (RDS, 64.10-64.08 %) significantly changed. So, based on these excellent properties, this study suggested that cold plasm-treated taro starch can be used in the field of food packaging material, functional food and pharmaceutical products. Therefore, a potential approach for physically altering starch is plasma treatment.

Direct Detection of Fluoroquinolone Resistance in Sputum Samples from Tuberculosis Patients by High Resolution Melt Curve Analysis

Multidrug-resistant tuberculosis (MDR-TB) requires treatment with fluoroquinolone (FLQ) drugs, however, the excessive use of FLQ has led to the rise of extensively drug-resistant TB. In 2019, ~ 20% of total MDR-TB cases were estimated to be resistant to FLQ drugs. In the present study, we developed and evaluated the utility of high-resolution melt curve analysis (HRM) for the rapid detection of FLQ-resistant Mycobacterium tuberculosis for the first time directly from sputum samples. A reference plasmid library was generated for the most frequently observed mutations of gyrA gene and was used to discriminate between mutant and wild-type samples in the FLQ-HRM assay. The developed assay was evaluated on n = 25 MDR M. tuberculosis clinical isolates followed by validation on archived sputum DNA (n = 88) using DNA sequencing as a gold standard. The FLQ-HRM assay showed a 100% sensitivity [95% Confidence Interval (CI): 71.5 to 100] and specificity (95% CI: 39.7 to 100) in smear-positive category, and a sensitivity of 88.9% (95% CI: 77.3 to 95.8) with 84.2% (95% CI: 60.4 to 96.6) specificity in smear-negative category. The assay showed a high level of concordance of ~ 90% (κ = 0.74) with DNA sequencing, however, we were limited by the absence of phenotypic drug susceptibility testing data. In conclusion, HRM is a rapid, cost-effective (INR 150/USD 1.83) and closed-tube method for direct detection of FLQ resistance in sputum samples including direct smear-negative samples.

Dicarboxylic Acids Induced Tandem Transformation of Silver Nanocluster

Structural transformation of metal nanoclusters (NCs) is of great ongoing interest regarding their synthesis, stability, and reactivity. Although sporadic examples of cluster transformations have been reported, neither the underlying transformation mechanism nor the intermediates are unambiguous. Herein, we have synthesized a flexible 54-nuclei silver cluster (Ag54) by combining soft (tBuC≡C-) and hard (nPrCOO-) ligands. The existence of weakly coordinated nPrCOO- enhances the reactivity of Ag54, thus facilitating the dicarboxylic acid to induce structural transformation. X-ray structural analyses reveal that Ag54 transforms to Ag28 cluster-based 2D networks (Ag28a and Ag28b) induced by H2suc (succinic acid) and H2glu (glutaric acid), whereas with H2pda (2,2'-(1,2-phenylene)diacetic acid), a discrete Ag28 cluster (Ag28c) is isolated. The key intermediate Ag17 that emerges during the self-dissociation of Ag54 was isolated by using cryogenic recrystallization and characterized by X-ray crystallography. The "tandem transformation" mechanism for the structure evolution from Ag54 to Ag28a is established by time-dependent electrospray ionization mass spectrometry (ESI-MS) and UV-vis spectroscopy. In addition, the catalytic activity in the 4-nitrophenol reduction follows the sequence Ag28c > Ag28b > Ag28a > Ag54 due to more bare silver sites on the surface of the Ag28 cluster unit. Our findings not only open new avenues to the synthesis of silver NCs but also shed light on a better understanding of the structural transformation mechanism from one cluster to another or cluster-based metal-organic networks induced by dicarboxylates.

Evaluation of Mycobacterium tuberculosis derived cell-free DNA using pleural fluid and paired plasma samples for the diagnosis of pleural tuberculosis

Pleural tuberculosis (pTB) is a grave clinical challenge. A novel cell-free M. tuberculosis DNA (cfM.tb-DNA) probe-based-qPCR assay was developed for the diagnosis of pTB. Total cell-free DNA was extracted from pleural fluid (PF) and paired plasma samples and cfM.tb-DNA was quantified by probe-based qPCR targeting devR (109-bp) gene of M. tuberculosis in patients with pleural effusion. Patient categorization was done using 'Composite-Reference-Standard' formulated for the study. Assay cut-offs were determined from samples in the 'Development set' (n = 17; 'Definite & Probable' pTB; n = 9 and 'Non-TB'; n = 8) by ROC-curve analysis and applied to 'Validation set' (n = 112; 'Definite' pTB; n = 8, 'Probable' pTB; n = 34, 'Possible' pTB; n = 28 and 'Non-TB'; n = 42). cfM.tb-DNA qPCR had a sensitivity of 62.5% (95%CI; 24.4,91.4) in 'Definite' pTB category and 59.5% (95%CI; 43.2,74.3) in 'Definite & Probable' pTB category with 95.2% (95%CI; 83.8,99.4) specificity using PF. In plasma (n = 85), the assay had a sub-optimal sensitivity of 7.6% (95%CI; 0.95,25.1) with 88.2% (95%CI; 72.5,96.7) specificity in 'Definite & Probable' pTB group. Xpert MTB/RIF assay detected only six-samples in the 'Validation set'. Logistic regression analysis indicated that PF-cfM.tb-DNA qPCR provided incremental advantage over existing pTB diagnostic algorithms. To the best of our knowledge, this is the first report describing the utility of cfM.tb-DNA for pTB diagnosis in India.

Naringenin improves ovarian health by reducing the serum androgen and eliminating follicular cysts in letrozole-induced polycystic ovary syndrome in the Sprague Dawley rats

Polycystic ovary syndrome (PCOS) is most common in women of reproductive age, giving rise to androgen excess and anovulation, leading to infertility and non-reproductive complications. We explored the ameliorating effect of naringenin in PCOS using the Sprague Dawley (SD) rat model and human granulosa cells. Letrozole-induced PCOS rats were given either naringenin (50 mg/kg/day) alone or in combination with metformin (300 mg/kg/day), followed by the estrous cycle, hormonal analysis, and glucose sensitivity test. To evaluate the effect of naringenin on granulosa cell (hGC) steroidogenesis, we treated cells with naringenin (2.5 μM) alone or in combination with metformin (1 mM) in the presence of forskolin (10 μM). To determine the steroidogenesis of CYP-17A1, -19A1, and 3βHSD2, the protein expression levels were examined. Treatment with naringenin in the PCOS animal groups increased ovulation potential and decreased cystic follicles and levels of androgens. The expression levels of CYP-17A1, -19A1, and 3βHSD2, were seen restored in the ovary of PCOS SD rats' model and in the human ovarian cells in response to the naringenin. We found an increased expression level of phosphorylated-AKT in the ovary and hGCs by naringenin. Naringenin improves ovulation and suppress androgens and cystic follicles, involving AKT activation.

Edible insects as emerging food products-processing and product development perspective

Edible insects (EI) are also becoming as a part of the diet due to their nutritional value and health benefits in many regions of the world. These EI are inexhaustible sources accessible by garnering from the wild with high feed conversion efficiency. Appreciating the budding of EI in justifiable food production, enlightening food security and biodiversity conversion, is promising a sufficient supply of the insect resource for future food to the world. These insects are processed to develop new products, improve organoleptic and nutritional parameters as well as the extension of shelf life. In this review, we discuss the edible insect characteristics, the potential application of EI in food industry, processing, pretreatments, drying, extraction of edible compounds like protein, lipid and chitin various food products formulation, safety regulation. Availability of broad nutritional spectrum of EI includes protein, mono and poly unsaturaturated fatty acids, amino acids, vitamins, amino aids and minerals has been used as an ingredient in development of various forms of food products such as flours in the form of whole insect powder, protein isolate, canned products, extruded products, hard candies, spreads, liquor infusion, cookies and other products.

Evaluating Alterations of the Oral Microbiome and Its Link to Oral Cancer among Betel Quid Chewers: Prospecting Reversal through Probiotic Intervention

Areca nut and slaked lime, with or without tobacco wrapped in Piper betle leaf, prepared as betel quid, is extensively consumed as a masticatory product in many countries across the world. Betel Quid can promote the malignant transformation of oral lesions as well as trigger benign cellular and molecular changes. In the oral cavity, it causes changes at the compositional level in oral microbiota called dysbiosis. This dysbiosis may play an important role in Oral Cancer in betel quid chewers. The abnormal presence and increase of bacteria Fusobacterium nucleatum, Capnocytophaga gingivalis, Prevotella melaninogenica, Peptostreptococcus sp., Porphyromonas gingivalis, and Streptococcus mitis in saliva and/or other oral sites of the cancer patients has attracted frequent attention for its association with oral cancer development. In the present review, the authors have analysed the literature reports to revisit the oncogenic potential of betel quid and oral microbiome alterations, evaluating the potential of oral microbiota both as a driver and biomarker of oral cancer. The authors have also shared a perspective that the restoration of local microbiota can become a potentially therapeutic or prophylactic strategy for the delay or reversal of lip and oral cavity cancers, especially in high-risk population groups.

Pangenome-driven insights into nitrogen metabolic characteristics of Citrobacter portucalensis strain AAK_AS5 associated with wastewater nitrogen removal

Nitrogen metabolism in the genus Citrobacter is very poorly studied despite its several implications in wastewater treatment. In the current study, Citrobacter portucalensis strain AAK_AS5 was assessed for remediation of simulated wastewater supplemented with different inorganic nitrogen sources. Combination of (NH₄)₂SO₄ with KNO₃ was the most preferred for achieving high growth density followed by (NH₄)₂SO₄ and KNO₃ alone. This was in agreement with highest ammonical nitrogen removal of 92.9% in the presence of combined nitrogen sources and the corresponding nitrate nitrogen removal of 93% in the presence of KNO₃. Furthermore, these removal capacities were validated by investigating the uniqueness and the spread of metabolic features through pan-genomic approach that revealed the largest number of unique genes (2097) and accessory genes (705) in strain AAK_AS5. Of the total 44 different types of nitrogen metabolism-related genes, 39 genes were associated with the core genome, while 5 genes such as gltI, nasA, nasR, nrtA, and ntrC uniquely belonged to the accessory genome. Strain AAK_AS5 possessed three major nitrate removal pathways viz., assimilatory and dissimilatory nitrate reduction to ammonia (ANRA & DNRA), and denitrification; however, the absence of nitrification was compensated by ammonia assimilation catalyzed by gene products of the GDH and GS-GOGAT pathways. narGHIJ encoding the respiratory nitrate reductase was commonly identified in all the studied genomes, while genes such as nirK, norB, and nosZ were uniquely present in the strain AAK_AS5 only. A markedly different genetic content and metabolic diversity between the strains reflected their adaptive evolution in the environment thus highlighting the significance of C. portucalensis AAK_AS5 for potential application in nitrogen removal from wastewater.

PKC-βII is downregulated in the premature ovarian failure SD rat model

We investigated the role of protein kinase c (PKC) -α and -β during the ovarian follicular dynamics using estrous cycle, gonadotropin-induced ovulation, and antral follicle culture, 4-vinylcyclohexene diepoxide (VCD)-induced premature ovarian failure (POF) in the SD rat models. We found the higher activity of PKC during the proestrus stage along with expression of PKC-α during the estrus and metestrus stages of the estrous cycle while PKC-β expression was increased during the diestrus, proestrus, and estrus stages. In response to pregnant mare gonadotropin (PMSG)-induced follicular recruitment and ovulation, the phosphorylated (Thr-642) PKC-β was increased. PKC activity inhibition by hispidin during the proestrus stage resulted in decreased antral follicles and corpus luteum. Treatment with hispidin resulted in the downregulation of granulosa cell (GC) biomarker, follicle stimulating hormone receptor (FSHR) expression in the cultured pre-antral follicle. During the forskolin-induced luteinization of human granulosa cells, the expression level of PKC-α and β (I and II) was decreased. In the POF condition, the activity of total PKC and the expression levels of PKC-α and β (I and II) were increased. Immunostaining depicted ubiquitous expression of PKC-α in the ovary during the estrous cycle and POF conditions. Taken together, we conclude the association of PKC-α and -β (I and II) during ovarian follicular dynamics where the expression level of PKC-α is increased, but the expression level of PKC-β (I and II) is suppressed in the POF condition in the SD rat model.

A unique case of anaplastic thyroid carcinoma comprising of two distinct patterns osteoclastic variant and squamous cell carcinoma in separate lobe imitating collision tumor: A case report

Anaplastic thyroid carcinoma with two distinct morphologies in two lobes with no intermixing is very rare and not reported earlier. Furthermore, osteoclastic variant of anaplastic thyroid carcinoma as well as primary squamous cell carcinoma without any differentiated components are also very rare with only few reported cases describing their cytological features. Herein, we are reporting a unique and first case of anaplastic thyroid carcinoma comprising of two distinct patterns osteoclastic variant and squamous cell carcinoma in different lobes in a 55-years-old lady with review of literature.

Regulating the assembly and expansion of the silver cluster from the Ag37 to Ag46 nanowheel driven by heteroanions

Precise control over the shape and size of metal nanoclusters through anion template-driven self-assembly is one of the key scientific goals in the nanocluster community, however, it is still not understood comprehensively. In this work, we report the controllable synthesis and atomically precise structures of silver nanowheels Ag37 and Ag46, using homo (Cl^- ions) and heteroanion (Cl^- and CrO₄ ^2- ions) template strategies, along with macrocyclic p-phenyl-thiacalix[4]arene and small ⁱPrS^- ligands. Structural analyses revealed that in Ag37, Cl^- ions serve as both local and global templates, whereas CrO₄ ^2- ions function as local and Cl^- ions as global templates in Ag46, resulting in a pentagonal nanowheel (Ag37) and a hexagonal (Ag46) nanowheel. The larger ionic size and more negative charges of CrO₄ ^2- ions than Cl^- ions offer more coordination sites for the silver atoms and are believed to be the key factors that drive the nanowheel core to expand significantly. Also, by taking advantage of the deep cavity of thiacalix[4]arene with an extended phenyl group, Ag46 has been used as a host material for dye adsorption depending on the charge and size of organic dyes. The successful use of heteroanions to control the expansion of well-defined silver nanowheels fills the knowledge gap in understanding the directing role of heteroanions in dictating the shape and size of nanoclusters at the atomic level.

Recent trends in the biotechnology of functional non-digestible oligosaccharides with prebiotic potential

Prebiotics as a part of dietary nutrition can play a crucial role in structuring the composition and metabolic function of intestinal microbiota and can thus help in managing a clinical scenario by preventing diseases and/or improving health. Among the different prebiotics, non-digestible carbohydrates are molecules that selectively enrich a typical class of bacteria with probiotic potential. This review summarizes the current knowledge about the different aspects of prebiotics, such as its production, characterization and purification by various techniques, and its link to novel product development at an industrial scale for wide-scale use in diverse range of health management applications. Furthermore, the path to effective valorization of agricultural residues in prebiotic production has been elucidated. This review also discusses the recent developments in application of genomic tools in the area of prebiotics for providing new insights into the taxonomic characterization of gut microorganisms, and exploring their functional metabolic pathways for enzyme synthesis. However, the information regarding the cumulative effect of prebiotics with beneficial bacteria, their colonization and its direct influence through altered metabolic profile is still getting established. The future of this area lies in the designing of clinical condition specific functional foods taking into consideration the host genotypes, thus facilitating the creation of balanced and required metabolome and enabling to maintain the healthy status of the host.

Unique granulated leucocytes in peripheral blood in yellow phosphorous poisoning: An interesting tool for monitoring therapeutic response

Yellow phosphorus is one of the most commonly used rodenticides in India for household pest control. It is available as pastes containing 2% to 5% of yellow phosphorus. Yellow phosphorous-containing rodenticides are easily available and account for one of the most common causes of suicidal poisoning in India. We describe a case of yellow phosphorus poisoning in a 17-years-old child who recovered from hepatic encephalopathy and showed unique peripheral smear findings in the form of spurious monocytosis and hypergranulosis of these granulocytes.

In Silico Genomic Characterization of Bacillus velezensis Strain AAK_S6 for Secondary Metabolite and Biocontrol Potential

This study reports the draft genome sequence of Bacillus velezensis strain AAK_S6 as a valuable biocontrol agent with high genetic potential to harbor broad-spectrum secondary metabolite producing capacity. A genome data of 4,430,946 bp were generated with a GC content of 46.4% that comprised a total of 4861 genes including a total of 4757 coding sequences (CDS), 104 rRNAs, 85 tRNAs and 80 pseudo-genes. Based on the overall genome-based relatedness indices (OGRI), the strain AAK_S6 has been reassigned to its correct taxonomic position. The strain shared > 99% OrthoANI, > 98% ANIb, > 99% ANIm, > 0.9900 TETRA, > 93% dDDH and 0.08% GC content difference with model strains B. velezensis FZB42^T and B. velezensis NRRL B-41580^T thus delineating them as closely related species. The genome was mined for strain-specific secondary metabolites that revealed 20 gene clusters for the biosynthesis of several cyclic lipopeptides, saccharides, polyketides along with bacilysin. Thus, the comparative genome analysis of strain AAK_S6 with members of the genus Bacillus by phylogenomic approach revealed that the genomes were almost similar genetically and contained the core genome for B. velezensis. Genomic data strongly supported that the strain AAK_S6 represented an excellent potential candidate for the production of secondary metabolites that could serve as a basis for developing new biocontrol agents, plant growth promoters, and microbial fertilizers.

Penetrating Chest trauma with right atrium rupture - A case report

Background

Penetrating chest trauma can have lethal consequences. Anterior chest wall penetrating injury can cause fatal lacerations over the chest wall, lungs, pericardium, and the heart. There are few reports on these kinds of injuries and operative management.

Purpose

To describe a case of penetrating chest trauma with right atrium ruptured, after a fall from height. The patient was successfully managed with prompt resuscitation and definitive surgical intervention.

Case presentation

A 48-years-old gentleman presented with history of fall from height and right sided penetrating chest injury. The patient had a penetrating injury to the right-fourth intercostal space in parasternal region. Chest X-ray showed massive right-sided hemothorax and chest tube drained more than 1700 ml upon insertion. Emergency right thoracotomy was performed, after initial resuscitation with fluids and blood transfusion in the emergency department. He had injury to the intercostal arteries, lacerations of the pericardium and the right atrium ruptured, which was managed successfully with definitive repair.

Conclusion

Survival is rare after penetrating chest trauma with right atrium ruptured if not intervened on time. Prompt diagnosis and resuscitation, along with the definitive surgical repair were the key elements for successful management of the patients.

Competency-based medical curriculum: Exploring the preclinical medical teachers' pedagogical and technical readiness levels

Background The medical curriculum for undergraduates was revised by the Medical Council of India in 2019, after 21 years. We did this study to determine teachers' pedagogical and technical readiness to implement the competency-based curriculum in medical colleges and determine factors that affect readiness, from their perspective. Methods We conducted a cross-sectional survey in the form of an online questionnaire. The qualitative data were coded numerically and were analysed using frequencies and proportions. Pearson Chi-square test was used to study the association among variables. Results The majority (85%) of respondents had attended a curriculum implementation training programme; 62.2% with experience <5 years, 56.1% with experience 5-10 years and a minority of 13.3% with >10 years' experience were ready to a 'great extent' to implement the new curriculum; 54.1% agreed to re-frame lectures and 64.9% possessed technological skills to suit the needs of a competency-based curriculum. About 77% agreed that it will provide a rich learning environment, inspire self-directed learning while 52% believed it will promote scientific thinking and provide better learning outcomes in the long run. Conclusion Medical teachers had a positive attitude towards implementation of the new curriculum. However, numerous factors such as low teacher-student ratio, textbooks designed according to the traditional curriculum, limited teachers' training and cumbersome paperwork may hinder its successful implementation. Updation of teachers' knowledge and skills through seminars/workshops is recommended to facilitate delivery of the new curriculum. Like any other ongoing reforms in medical education, competency-based curriculum is a work in process.

Identifying oral microbiome alterations in adult betel quid chewing population of Delhi, India

The study targets to establish a factorial association of oral microbiome alterations (oral dysbiosis) with betel quid chewing habits through a comparison of the oral microbiome of Betel quid chewers and non-chewing individuals. Oral microbiome analysis of 22 adult individuals in the Delhi region of India through the 16S sequencing approach was carried out to observe the differences in taxonomic abundance and diversity. A significant difference in diversity and richness among Betel Quid Chewers (BQC) and Betel Quid Non-Chewers (BQNC) groups was observed. There were significant differences in alpha diversity among the BQC in comparison to BQNC. However, in the age group of 21-30 years old young BQC and BQNC there was no significant difference in alpha diversity. Similar result was obtained while comparing BQC and Smoker-alcoholic BQC. BQ smoker-chewers expressed significant variance in comparison to BQC, based on cluster pattern analysis. The OTU-based Venn Diagram Analysis revealed an altered microbiota, for BQ chewing group with 0-10 years exposure in comparison to those with 10 years and above. The change in the microbial niche in early chewers may be due to abrupt chemical component exposure affecting the oral cavity, and thereafter establishing a unique microenvironment in the long-term BQC. Linear discriminant analysis revealed, 55 significant features among BQC and Alcoholic-Smoker BQC; and 20 significant features among BQC and Smoker BQC respectively. The study shows the abundance of novel bacterial genera in the BQC oral cavity in addition to the commonly found ones. Since the oral microbiome plays a significant role in maintaining local homeostasis, investigating the link between its imbalance in such conditions that are known to have an association with oral diseases including cancers may lead to the identification of specific microbiome-based signatures for its early diagnosis.

Mining the landfill soil metagenome for denitrifying methanotrophic taxa and validation of methane oxidation in microcosm

In the present study, the microbial community residing at different depths of the landfill was characterized to assess their roles in serving as a methane sink. Physico-chemical characterization revealed the characteristic signatures of anaerobic degradation of organic matter in the bottom soil (50-60 cm) and, active process of aerobic denitrification in the top soil (0-10 cm). This was also reflected from the higher abundance of bacterial domain in the top soil metagenome represented by dominant phyla Proteobacteria and Actinobacteria which are prime decomposers of organic matter in landfill soils. The multiple fold higher relative abundances of the two most abundant genera; Streptomyces and Intrasporangium in the top soil depicted greater denitrifying taxa in top soil than the bottom soil. Amongst the aerobic methanotrophs, the genera Methylomonas, Methylococcus, Methylocella, and Methylacidiphilum were abundantly found in the top soil metagenome that were essential for oxidizing methane generated in the landfill. On the other hand, the dominance of archaeal domain represented by Methanosarcina and Methanoculleus in the bottom soil highlighted the complete anaerobic digestion of organic components via acetoclasty, carboxydotrophy, hydrogenotrophy, methylotrophy. Functional characterization revealed a higher abundance of methane monooxygenase gene in the top soil and methyl coenzyme M reductase gene in the bottom soil that correlated with the higher relative abundance of aerobic methanotrophs in the top soil while methane generation being the active process in the highly anaerobic bottom soil in the landfill. The activity dependent abundance of endogenous microbial communities in the different zones of the landfill was further validated by microcosm studies in serum bottles which established the ability of the methanotrophic community for methane metabolism in the top soil and their potential to serve as sink for methane. The study provides a better understanding about the methanotrophs in correlation with their endogenous environment, so that these bacteria can be used in resolving the environmental issues related to methane and nitrogen management at landfill site.

Spectrophotometric analysis of color stability of esthetic restorative material in chlorhexidine mouthwash: An in vitro study

Background

Commendable aesthetic properties of composites make it a pioneer filling material. However, discoloration of composite resin materials emerges as a major clinical problem in a long term.

Aims and Objectives

Aim of the study is to evaluate the color stability of nano filled and micro hybrid dental composite resin in chlorhexidine mouthwash.

Materials and Methods

20 specimens of dimension 10*2mm were prepared of A2 shade. All the prepared samples were immersed in 20 ml of distilled water in separate containers according to the group. Further incubation at 37°C for 24 h was done. After 24 h, baseline color values of each sample were recorded using a spectrophotometer. After recording the baseline color measurements, 10 specimens (random selection) from each group were placed in 20 ml of 0.2% chlorhexidine mouthwash for 24 h duration. The L*a*b* system of the Commission Internationale de l'Eclairage (CIE L*a*b* Color Scale) was used for the determination of colorimetric values of the specimens.

Results

The color change was displayed by both the samples after immersion in the mouthwash but the change was not statistically significant (0.763). ΔE value for nano filled composites is 3.25 while for the micro-hybrid composites the value is 3.56.

Conclusion

The colorimetric values of nano filled composite resins are more stable than the micro hybrid composite due to exposure to chlorhexidine mouthwash.

Outcomes of laparoscopic repair in complicated groin hernia: A single institutional based cohort study in Nepal

Introduction

Laparoscopic hernia repairs have comparable recurrence rate with less persisting pain and numbness and quicker return to usual activities as compared to open mesh repair. The excellent outcomes of minimally invasive surgery encourage us to extend the laparoscopic technique to complicated groin hernia.

Method

A total of 22 patients with complicated groin hernia who presented to our institute from September 2017 to September 2018 were included in this prospective cohort study. Inclusion criteria were patients with age greater than 18 years and clinically diagnosed as complicated groin hernia. Patients with peritonitis, those with previous abdominal surgery and unfit for general anesthesia were excluded from our study.

Results

The most common age group was 51–60 (31.8%) years.17 cases were repaired with totally laparoscopic approach (12 TEP, 5 TAPP). Laparoscopic repair with additional procedure was needed in 3 cases and 2 cases were converted to open for completion of the procedure. The mean operating time was 154.8 ± 51.6 (range: 90 to 230) minutes. The average length of hospital stay was 3.8 ± 3 (range: 1 to 12) days. Bleeding from the inferior epigastric and testicular vessels were the major intra-operative complication (11.8%). Seroma and surgical site infection were seen in 2 (11.8%) patients.

Conclusion

Laparoscopic approach in cases of complicated groin hernia can achieve desirable patient outcomes without major complications, provided good patient selection and expertise. The evidence for laparoscopic repair as the choice of procedure in complicated groin hernia can be established from further comparative studies.

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Laparoscopic repair in complicated hernia has been attempted more frequently due to availability of expertise and detailed knowledge of anatomy.

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Successful reduction of hernia contents in laparoscopic repair is possible with minimal complications.

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Complications in laparoscopic repair in complicated hernia (intraoperative/postoperative) are comparable to that of laparoscopic repair of uncomplicated hernia or open repair of complicated hernia.

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Mesh can be used in laparoscopic repair of uncomplicated hernia.

Susceptibility-weighted imaging: an emerging technique for evaluation of the spine and spinal cord

We present the application of three-dimensional susceptibility-weighted imaging technique for evaluation of pathologies of the spine and spinal cord. This work focuses on the advantage of this imaging technique as an adjunct to the conventional imaging to evaluate various disorders of the spine and spinal cord like trauma, degenerative diseases, vascular malformations, and tumours, where susceptibility-weighted imaging may offer valuable harmonising evidence that may be helpful in the diagnosis and management of the patients with these pathologies.

Clinico-pathological characteristics of obstructing colorectal cancer and its management outcomes at a tertiary referral center of Eastern Nepal

Background

The aim of this study is to explore the treatment strategies being followed for patients with obstructing colorectal cancer (OCRC) at our institute and to know the management outcomes.

Methods

This study included 28 patients who were diagnosed with obstructing colorectal cancer (OCRC) either preoperatively or intraoperatively over a period of 5 years.

Results

Most were in the younger age group with mean age of 49.78 ± 15.96 years with 1/4th of the patients being younger than 40. There was no difference in incidence of OCRC among genders. It was found to be common in rural areas of the eastern Nepal, 16(57%) patients from such areas. 21.4% patients had complete bowel obstruction at presentation. The investigating modalities used were abdominal X-ray, ultrasonoghraphy of abdomen/pelvis, abdominal CT-scan, colonoscopy, serum CEA, punch biopsy and Faecal occult blood test. The anatomical shift to the right was observed with 54% lesions in the proximal colon. Majority were in advanced stage (stage 3:53.6%, stage 4:32.1%) with histologically adenocarcinoma (100%) and a higher incidence of synchronous lesion (28.6%). Patients averaged 13.82 days in the hospital with post-operative mortality rate of 3.6%. The 1-year and 2-years disease free survivals were 89.3% and 82.1% while overall survivals were 92.8% and 82.1% respectively.

Conclusion

In developing countries like ours, relatively younger patients present to health center with obstructive colorectal cancer with anatomical shift to the right sided lesions. The treatments provided at our center and their outcomes are not inferior to that of the developed world.

Genomic characterization of denitrifying methylotrophic Pseudomonas aeruginosa strain AAK/M5 isolated from municipal solid waste landfill soil

Municipal landfills are known for methane production and a source of nitrate pollution leading to various environmental issues. Therefore, this niche was selected for the isolation of one-carbon (C1) utilizing bacteria with denitrifying capacities using anaerobic enrichment on nitrate mineral salt medium supplemented with methanol as carbon source. Eight axenic cultures were isolated of which, isolate AAK/M5 demonstrated the highest methanol removal (73.28%) in terms of soluble chemical oxygen demand and methane removal (41.27%) at the expense of total nitrate removal of 100% and 33% respectively. The whole genome characterization with phylogenomic approach suggested that the strain AAK/M5 could be assigned to Pseudomonas aeruginosa with close neighbours as type strains DVT779, AES1M, W60856, and LES400. The circular genome annotation showed the presence of complete set of genes essential for methanol utilization and complete denitrification process. The study demonstrates the potential of P. aeruginosa strain AAK/M5 in catalysing methane oxidation thus serving as a methane sink vis-à-vis utilization of nitrate. Considering the existence of such bacteria at landfill site, the study highlights the need to develop strategies for their enrichment and designing of efficient catabolic activity for such environments.

Impact of Natural Farming Cropping System on Rural Households—Evidence From Solan District of Himachal Pradesh, India

Natural farming, popularly known as zero budget natural farming, is an innovative farming approach. It is low input based, climate resilient, and low cost farming system because all the inputs (insect repellents, fungicides, and pesticides) are made up of natural herbs and locally available inputs, thereby reducing the use of artificial fertilizers and industrial pesticides. It is becoming increasingly popular among the smallholder farmers of Himachal Pradesh. Under the natural farming system, 3 to 12 crops are cultivated together on the same area, along with leguminous crops as intercrop in order to ensure that no piece of land is wasted and utilized properly. This article focuses mainly on the different cropping systems of natural farming and comparing the economics of natural farming (NF) with conventional farming (CF) systems. Study shows that farmers adopted five major crop combinations under natural farming system, i.e., vegetables-based cropping system (e.g., tomato + beans + cucumber and cauliflower + pea + radish), vegetables-cereals-based cropping system, and other three more cropping systems discussed in this article. The results indicated that a vegetable-based cropping system has 19.68% more net return in Kharif season and 24.64% more net return in Rabi season as compared to conventional farming vegetable-based monocropping system. NF maximizes land use and reduces the chance of crop yield loss. NF has resulted in increased returns especially in the vegetable cropping system where reduction in cost was 30.73 per cent (kharif) and 11.88 per cent (rabi) across all crop combinations in comparison to CF. It is found in study that NF was cost savings from not using chemical fertilizers and pesticides, as well as higher benefit from intercrops.

Characterization of breast tumors using machine learning based upon multiparametric magnetic resonance imaging features

Magnetic resonance imaging (MRI) is playing an important role in the classification of breast tumors. MRI can be used to obtain multiparametric (mp) information, such as structural, hemodynamic, and physiological information. Quantitative analysis of mp-MRI data has shown potential in improving the accuracy of breast tumor classification. In general, a large set of quantitative and texture features can be generated depending upon the type of methodology used. A suitable combination of selected quantitative and texture features can further improve the accuracy of tumor classification. Machine learning (ML) classifiers based upon features derived from MRI data have shown potential in tumor classification. There is a need for further research studies on selecting an appropriate combination of features and evaluating the performance of different ML classifiers for accurate classification of breast tumors. The objective of the current study was to develop and optimize an ML framework based upon mp-MRI features for the characterization of breast tumors (malignant vs. benign and low- vs. high-grade). This study included the breast mp-MRI data of 60 female patients with histopathology results. A total of 128 features were extracted from the mp-MRI tumor data followed by features selection. Five ML classifiers were evaluated for tumor classification using 10-fold crossvalidation with 10 repetitions. The support vector machine (SVM) classifier based on optimum features selected using a wrapper method with an adaptive boosting (AdaBoost) technique provided the highest sensitivity (0.96 ± 0.03), specificity (0.92 ± 0.09), and accuracy (94% ± 2.91%) in the classification of malignant versus benign tumors. This method also provided the highest sensitivity (0.94 ± 0.07), specificity (0.80 ± 0.05), and accuracy (90% ± 5.48%) in the classification of low- versus high-grade tumors. These findings suggest that the SVM classifier outperformed other ML methods in the binary classification of breast tumors.

Direct Molecular Detection of Drug-Resistant Tuberculosis from Transported Bio-Safe Dried Sputum on Filter-Paper

In 2019, amongst half a million new rifampicin-resistant tuberculosis (TB) cases, 78% were multi drug-resistant TB (MDR-TB). Access to rapid and Universal-Drug susceptibility testing (DST) to patients in remote areas is a major challenge to combat drug-resistant TB. To overcome this challenge, we had recently reported the development of 'TB Concentration & Transport kit' for bio-safe ambient temperature transport of dried sputum on filter-paper (Trans-Filter). The present study was conducted to evaluate the utility of DNA extracted from sputum on Trans-Filter in a Multiplex PCR-based sequencing assay (Mol-DSTseq) for diagnosing drug-resistant TB. The developed Mol-DSTseq assays were standardized on Mycobacterium tuberculosis clinical isolates (n = 98) and further validated on DNA extracted from sputum on Trans-Filter (n = 100). Using phenotypic DST as gold standard, the Mol-DSTseq assay showed 100% (95% Confidence Interval [CI] 79.4-100%) and 73.3% (95% CI 54.1-87.7%) sensitivity for detecting rifampicin and isoniazid resistance with a specificity of 85.1% (95% CI 66.2-95.8%) and 100% (95% CI:82.3-100%), respectively. For fluoroquinolones and aminoglycosides, the Mol-DSTseq assay showed a sensitivity of 78.5% (95% CI 49.2-95.3%) and 66.6% (95% CI 9.4-99.1%) with a specificity of 88.2% (95% CI 72.5-96.7%) and 100% (95% CI 93.1-100%), respectively. The Mol-DSTseq assays exhibited a high concordance of ~ 83-96% (κ value: 0.65-0.81) with phenotypic DST for all drugs. In conclusion, the 'TB Concentration and Transport kit' was compatible with Mol-DSTseq assays and has the potential to provide 'Universal-DST' to patients residing in distant areas in high burden countries, like India for early initiation of anti-tubercular treatment.

Repurposing Novel Antagonists to p7 Viroporin of HCV Using in silico Approach

Abstract:

Background: P7 viroporin in HCV is a cation-selective ion channel-forming protein, functional in the oligomeric form. It is considered to be a potential target for anti-HCV compounds due to its crucial role in viral entry, assembly and release.

Method:

Conserved crucial residues present in HCV p7 protein were delineated with a specific focus on the genotypes 3a &1b prevalent in India from the available literature. Using the Flex-X docking tool, a library of FDA-approved drugs was docked on the receptor sites prepared around crucial residues. In the present study, we propose drug repurposing to target viroporin p7, which may help in the rapid development of effective anti-HCV therapies.

Results:

With our approach of poly-pharmacology, a variety of drugs currently identified classified as antibiotics, anti-parasitic, antiemetic, anti-retroviral, and anti-neoplastic were found to dock successfully with the p7 viroporin. Noteworthy among these are general-purpose cephalosporin antibiotics, leucal, phthalylsulfathiazole, and granisetron, which may be useful in acute HCV infection and anti-neoplastic sorafenib and nilotinib, which may be valuable in advanced HCV-HCC cases.

Conclusion:

This study could pave the way for quick repurposing of these compounds as anti-HCV therapeutics.

Ileosigmoid knotting: A case report of unique cause of acute abdomen in a Nepalese patient

Introduction and importance

Ileosigmoid knotting is a surgical emergency. Common in Asian males, it is presented with signs and symptoms of diffuse peritonitis. Aggressive resuscitation with intravenous fluids and antibiotics followed by workup enable the patient hemodynamically stable. Explorative laparotomy followed by colo-colic anastomosis and double barrel ileostomy is curative.

Case presentation

A 32-year-old-male from Nepal with a chief complain of diffuse abdominal pain for a day and signs of peritonitis presented to Emergency room. After assessing and stabilizing the patient, explorative laparotomy was performed. Ileal and sigmoid resection followed by colo-colic anastomosis and double barrel ileostomy was done. On regular follow-up, he is in his usual state of health.

Discussion

The incidence of ileosigmoid knotting is reported to be about 1.6 cases per year. It is often misdiagnosed as non-specific intestinal obstruction which confers poor prognostic value to the patient. It should be identified promptly and intervened timely.

Conclusion

Ileosigmoid knotting is a rare but dangerous differential of acute abdomen not to be missed. Early assessment and quick decision making is the key to provide excellent prognosis to the patient in need, provided adequate surgical skills are demonstrated.

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Ileosigmoid knotting is a surgical emergency.

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It is common in Asian males.

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Patient presents with signs and symptoms of diffuse peritonitis.

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Explorative laparotomy should be done.

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Ileal and sigmoid resection followed by colo-colic anastomosis with double barrel ileostomy was performed.

18F-Labeled Fluoro-2-Deoxyglucose Positron Emission Tomography and Computed Tomography in a Large Pulmonary Sclerosing Pneumocytoma with Contralateral Lung Metastasis

Pulmonary sclerosing pneumocytoma is an exceedingly rare neoplasm of the lung. These tumors are usually slow growing with a benign disease course but can easily be mistaken for carcinoid tumors or adenocarcinoma in cytology or histopathology specimens. Rare occurrences of metastases have been reported in the literature making ¹⁸F-labeled fluoro-2-deoxyglucose positron emission tomography and computed tomography useful for the evaluation of these tumors.

Refractive index of graphene AA and AB stacked bilayers under the influence of relative planar twisting

The optical properties of graphene in monolayer and bilayer structure is essential for the development of optical devices viz surface plasmon resonance (SPR) based bio-sensors. The band structure of the twisted bilayer graphene (BLG) is remarkably different than the normal AA or AB stacking. This provides an opportunity to control the optical and electrical properties of BLG by applying an in-plane twist to one of the layer relative to other in a BLG system. Here, we calculated the refractive index (RI) of AA and AB stacking of BLG system using density functional theory. Though the spectrum for AA stacking shows some similarity with that of monolayer graphene, the spectrum for AB stacking was found to be remarkably different. The spectrum of AB stacked layer is red-shifted and the absorption peaks in low energy regime increases nearly by three-folds. A large dependency of the twist angle on RI of twisted BLG were found. Based on the calculation, a schematic of phase diagram showing material behavior of such twisted BLG systems as a function of twist angle and photon energy was constructed. The twisted AA stacked BLG shows largely dielectric behavior whereas the twisted AB stacked BLG shows predominately semimetallic and semiconducting behavior. This study presents a RI landscape of twisted BLG dependent on important parameters viz photon energy and inplane relative twist angle. Our studies will be very useful for the design and development of optical devices employing BLG systems particularly SPR based bio-sensors which essentially measures change in RI due to adsorption of analytes.

Bilateral giant inguinoscrotal hernia: A case report

Introduction

Bilateral giant inguinoscrotal hernia (GIH) is rare and creates significant challenge in surgical management. The main concern of hernia reduction to abdominal cavity is development of abdominal compartment syndrome (ACS). Different approaches for prevention of ACS after surgery have been suggested.

Case presentation

We report a case of 68-year-old male with bilateral inguinoscrotal hernia for 20 years reaching just below midpoint of thigh. He presented with difficulty in micturition and mobility. Preoperative investigations were normal. He underwent bilateral mesh repair without any preoperative or intraoperative adjunct measures. No significant complication occurred in postoperative period.

Case discussion

Bilateral GIH is rare and the patients usually present late. GIH has been classified into three types on the basis of extension. Type I GIH can be managed with simple hernioplasty, in both unilateral and bilateral cases. Measures like resection of hernia contents and measures to enlarge intraabdominal space are warranted in type II and III GIH. Abdominal volume can be increased by utilising techniques like Pre-operative Progressive Pneumoperitoneum (PPP), injection of Botulinum toxin A (BTA) in the anterior abdominal wall, and rotation of viable tissue. The measures can be used either alone or in combination.

Conclusion

Type I GIH can be treated with simple hernioplasty with safety with monitoring for features of ACS and respiratory complications postoperatively. However, additional measures like resection of hernia contents or procedures to enlarge intra-abdominal space are warranted for type II and III GIH.

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Surgical management of bilateral giant inguinoscrotal hernia is challenging as reduction of hernia contents to abdominal cavity may lead to development of abdominal compartment syndrome (ACS) and cardiorespiratory complications.

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We report a case of bilateral GIH managed with bilateral mesh repair with postoperative monitoring for features of ACS and cardiorespiratory complications.

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There was no significant complication in the postoperative period and no recurrence in six month follow-up period.

Pancreaticoduodenectomy: Impact of Volume on Outcomes at a Tertiary Care Center-Our Experience in Single Institute of Nepal

BACKGROUND

Pancreaticoduodenectomy is a complex high-risk surgical procedure usually done for malignant disease carrying significant postoperative morbidity and mortality. An audit and analysis of rate of postoperative morbidity and mortality and the impact of case volume can provide information about the lacunas in patient care and methods to improve it for safe and early discharge of patients. This study was conducted to find out demographic profile, the rate of perioperative morbidities, mortality, and impact of case volume on patients undergoing pancreaticoduodenectomy for malignant disease which may serve as a guide to uplift the patient care in our center.

METHODS

Retrospective analysis of prospectively collected data of patients undergoing pancreaticoduodenectomy from 2015 to 2019 was performed. A total of 62 patients were included in the study. Patient's clinic-demographic details and intraoperative and postoperative events were recorded. The rate of various postoperative morbidities and mortality and year-wise trend of these factors were analyzed.

RESULTS

Most of the patients were in the sixth decade of life (38.7%) with male preponderance (61.3%). Pancreatic cancer was most commonly seen followed by cholangiocarcinoma (46.8%). SSI (32.3%), intraabdominal collection (25.8%), anastomotic leak (14.5%), pancreatic fistula (22.6%), and postpancreatectomy hemorrhage (8.1%) were the major postoperative events. Mortality was found in 12.9% patients.

CONCLUSION

There has been a decrease in rate of all these postoperative adverse events and improvement in the intraoperative blood loss and surgical duration with advancing years and increasing number of cases.

Impact of COVID-19 induced lockdown and unlock down phases on the ambient air quality of Delhi, capital city of India

The present study deals with the impact of the pandemic outbreak of COVID-19 on the ambient air quality in the capital city of India. Real-time data were collected from eight continuous ambient air quality monitoring stations measuring important air quality parameters (NO₂, PM₁₀ and PM_2.5). Results revealed that the city's air quality had improved significantly during the lockdown period due to COVID-19 outbreak. The concentration of gaseous and particulate matter during the lockdown period (March-May 2020) declined significantly compared with the preceding years' data from the same timeframe. However, the ambient air quality deteriorates with the onset of unlocking phases and post-monsoon season (October 2020). Higher concentration of NO₂, PM₁₀ and PM_2.5 were recorded at industrial (S1 and S2) and hotspot (S4 and S5) sites. The lowest concentrations of studied pollutants were observed during the first phase of lockdown (March 24 - May 14, 2020). The present study, once again, establishes the direct effect of anthropogenic activities and deteriorating ambient air quality of Delhi.

Comparison of Bone-Patellar Tendon-Bone Graft, Semitendinosus-Gracilis Graft and Semitendinosus-Gracilis with Preserved Tibial Insertion Graft in Anterior Cruciate Ligament Reconstruction in Sports Persons

Introduction

Bone-patellar tendon-bone (BPTB) and semitendinosus-gracilis (STG) are the commonest grafts used for ACL reconstruction. However even after having been debated for years, there is no consensus about the ideal graft. Moreover, the literature is deficient about STG graft with preserved tibial insertion (STGPI) which preserves the proprioception. Our aim is to compare the outcome of BPTB, free STG and STGPI grafts after ACL reconstruction in professional sports persons. We compared the outcome in terms of mechanical stability, functional outcome, return to sports activity and degenerative changes.

Material and Methods

Professional sports persons aged between 16-50 years operated for ACL tear using BPTB, free STG and STGPI grafts with minimum follow-up of two years were identified from hospital records. Patients with associated knee injuries were excluded. Patients, divided in three groups according to graft used, were compared in terms of mechanical stability (arthrometric examination KT-1000 score), functional outcome (Lysholm Score), return to sports activity (Tegner score and difference in thigh circumference) and degenerative changes (KL grading).

Results

BPTB graft group was found to be better than free STG and STGPI graft groups in terms of KT-1000 score. There was no statistically significant difference among the groups in terms of Lysholm score, Tegner score, difference in thigh circumference and KL grading.

Conclusion

BPTB graft is better than free STG and STGPI grafts in terms of knee stability. When compared for patient reported outcome, return to sports activity, osteoarthritic changes and graft failure there is no significant difference among the three types of grafts.