Zinc oxide and ferric oxide nanoparticles combination increase plant growth, yield, and quality of soybean under semiarid region

Zinc (Zn) and iron (Fe) malnutrition are global health challenges that need immediate attention. Hence, to address these issues, a two-pronged approach involving the development and application of novel Zn and Fe products for crop fertilization may be a potential solution. Therefore, zinc oxide (ZnO) (∼13.2 nm) and ferric oxide (Fe2O3) (∼15 nm) nanoparticles (NPs) were synthesized and characterized. Seven nutrients treatments viz, control, ZnO- NPs (25 mg kg-1), Fe2O3-NPs (25 mg kg-1), ZnO + Fe2O3-NPs (25 mg kg-1each), ZnSO4 (55.8 mg kg-1), FeSO4 (60.4 mg kg-1) and ZnSO4+ FeSO4 (55.8 and 60.4 mg kg-1) were arranged in five-time replicated Completely Randomized Design model to test the effectiveness of ZnO and Fe2O3 NPs in two soybean cultivars over conventional zinc sulfate (ZnSO4) and ferrous sulfate (FeSO4) fertilizers. The results indicated that the photosynthetic rate (Pn) and chlorophyll content increased (33.9-86.2%) significantly at the flowering stage with ZnO and Fe2O3 NPs applications, compared to their conventional counterparts. Likewise, the combined application of ZnO and Fe2O3 NPs reduced H2O2 production by 17-19% and increased the superoxide dismutase (SOD) and catalase (CAT) activities by 15-17% and 9.6-11.4% over the combined use of ZnSO4 and FeSO4, respectively. The normalized difference vegetation index (NDVI) showed an increase of 6.9-44.2% under ZnO and Fe2O3 NPs, as well as ZnSO4 and FeSO4. Furthermore, the combined application of NPs enhanced soybean seed yield by 4.6-18.3% compared to conventional Zn and Fe fertilizers. Concerning seed Zn and Fe density, conjoint application of ZnO and Fe2O3 NPs increases Zn by 1.8-2.2-fold and Fe by 19.22-22.58% over the combined application of Zn SO4 and FeSO4, respectively. While the application of NPs significantly decreased seed phytic acid concentrations by 7.3-59.9% compared to the control. These findings suggest that the combined application of ZnO and Fe2O3 NPs effectively enhances soybean productivity, seed nutrient density, and overall produce quality. Therefore, the combined application of ZnO and Fe2O3 -NPs in soybean can be a potential approach for sustainable soybean production and to reduce/arrest Zn and Fe malnutrition in a growing population.

Expert panel recommendations for topical hemostatic agent use in varied bleeding sites and situations during neuro-spine surgeries

Intraoperative bleeding poses a substantial challenge, particularly in neuro-spine surgeries leading to complications such as hematomas, infections, and hemodynamic instability. Despite their proven efficacy, use of topical hemostatic agents (THAs) lacks comprehensive published literature and guidelines particularly in the Indian setting. The present study provides the first-ever Indian expert panel recommendations for effective adjunct THA use in different intraoperative bleeding sites and situations in neuro-spine surgeries. A comprehensive approach, encompassing a literature review, followed by experience sharing in a meeting using a survey helped integrate expert opinions in the form of practical algorithms to guide THA selection. Our survey results revealed a strong inclination towards specific THAs, flowable gelatin + thrombin being choice of THA for difficult to access and problematic bleeding situations during tumor removal/resection, transsphenoidal hypophysectomy and skull-based procedures. Both oxidized regenerated cellulose (ORC)/Fibrillar and flowable gelatin + thrombin were recommended for continuous oozing. ORC/Fibrillar was preferred for arteriovenous and cavernous malformations. This expert-panel guidance on THA use aims to optimize hemostat use practices and improve surgical outcomes in neuro-spine surgery.

Combining biophysical parameters with thermal and RGB indices using machine learning models for predicting yield in yellow rust affected wheat crop

Evaluating crop health and forecasting yields in the early stages are crucial for effective crop and market management during periods of biotic stress for both farmers and policymakers. Field experiments were conducted during 2017-18 and 2018-19 with objective to evaluate the effect of yellow rust on various biophysical parameters of 24 wheat cultivars, with varying levels of resistance to yellow rust and to develop machine learning (ML) models with improved accuracy for predicting yield by integrating thermal and RGB indices with crucial plant biophysical parameters. Results revealed that as the level of rust increased, so did the canopy temperature and there was a significant decrease in crop photosynthesis, transpiration, stomatal conductance, leaf area index, membrane stability index, relative leaf water content, and normalized difference vegetation index due to rust, and the reductions were directly correlated with levels of rust severity. The yield reduction in moderate resistant, low resistant and susceptible cultivars as compared to resistant cultivars, varied from 15.9-16.9%, 28.6-34.4% and 59-61.1%, respectively. The ML models were able to provide relatively accurate early yield estimates, with the accuracy increasing as the harvest approached. The yield prediction performance of the different ML models varied with the stage of the crop growth. Based on the validation output of different ML models, Cubist, PLS, and SpikeSlab models were found to be effective in predicting the wheat yield at an early stage (55-60 days after sowing) of crop growth. The KNN, Cubist, SLR, RF, SpikeSlab, XGB, GPR and PLS models were proved to be more useful in predicting the crop yield at the middle stage (70 days after sowing) of the crop, while RF, SpikeSlab, KNN, Cubist, ELNET, GPR, SLR, XGB and MARS models were found good to predict the crop yield at late stage (80 days after sowing). The study quantified the impact of different levels of rust severity on crop biophysical parameters and demonstrated the usefulness of remote sensing and biophysical parameters data integration using machine-learning models for early yield prediction under biotically stressed conditions.

Seizure-Induced Cardiomyopathy: A Case of Takotsubo Cardiomyopathy Following an Epileptic Event

We present a case, written with the assistance of the Chat Generative Pre-training Transformer (ChatGPT) Artificial Intelligence (AI), of a 75-year-old female with a history of hypertension, epilepsy, coronary artery disease, and alcohol use disorder. She presented with a tonic-clonic seizure, tachycardia, and a cyanotic right hand. Diagnostic tests revealed stress-induced cardiomyopathy, patent bilateral subclavian and axillary arteries with heavy calcification of bilateral upper extremity arteries, and a small filling defect in the segmental branch of the left lower lobe. The patient was started on antiepileptic medication, thiamine/folate, and heparin drip for limb ischemia. Despite treatment with multiple anti-arrhythmic agents, the patient developed cardiogenic shock and underwent left heart catheterization with Impella placement. The Impella was removed 72 hours after placement, and the patient was started on low-dose Milrinone and Levophed for hemodynamic support. The patient eventually recovered and was discharged to long-term acute care.

Therapeutic Plasma Exchange in Severe Rhabdomyolysis: A Case-Control Study

INTRODUCTION

 Rhabdomyolysis is a serious condition that can cause acute kidney injury (AKI), compartment syndrome, severe metabolic and electrolyte derangement leading to arrhythmias, and even death. Total plasma exchange (TPE) has been used as a treatment modality to clear myoglobin, but the evidence is limited. In this study, we aim to investigate the use of TPE in critically ill rhabdomyolysis patients.

METHODS

 We retrospectively chart reviewed adult patients admitted to the intensive care unit (ICU) with a diagnosis of rhabdomyolysis between 2012 and 2021. We dichotomized patients into two groups based on whether TPE was used or not in addition to standard care. PRISMA machines with TPE2000 filters and either 5% albumin or fresh frozen plasma were used in the TPE group.

RESULTS

 The patients' age ranged from 23 years to 87 years (mean 49.4, SD 18.1), and 51% were male. Initial creatinine ranged from 0.6 to 16mg/dL (mean 3.4, SD 2.7), creatinine phosphokinase (CPK) from 403-93,232 U/L, and myoglobin from 934 to >20,000. The Sequential Organ Failure Assessment (SOFA)scores on admission ranged from 6 to 17 (mean 7.23, SD 3.40). Overall, 28.78% (N=19) of the patients received therapeutic plasma exchange. The overall mortality in our study was 31.9%, with the length of ICU stay ranging from 1-25 days (mean 7.10, SD 5.91) among survivors. Older age and the presence of shock were predictive of mortality in univariate and multivariate analyses. There was no statistically significant association in mortality between the TPE and non-TPE groups (36.84% in TPE vs. 36.17% in the non-TPE group, OR 0.7209, p=0.959). Only two patients in the non-TPE group developed CKD/ESRD on long-term follow-up.

CONCLUSION

Our study showed that TPE administration in critically ill patients with rhabdomyolysis did not improve mortality or length of ICU stay. Further studies are required to elucidate its indication and effect on long-term renal outcomes.

Glucocorticoid Therapy in COVID-19-Induced Organizing Pneumonia: A Rare Occurrence

Background Although the incidence of post-COVID-19 organizing pneumonia (OP) is low, the mortality and morbidity in select patients appear to be high. Anticipating specific populations who may be at higher risk and initiating treatment earlier could reduce mortality. Research question Does treatment with high dose, standard dose, or no glucocorticoids for COVID-19 infection impact the incidence and clinical outcome in COVID-19-induced OP? Study design and methods This was a single-center, retrospective, observational cohort study conducted from 03/01/2020 to 06/30/2021 in hospitalized patients over the age of 18 with confirmed COVID-19 infection and computed tomography (CT) scan evidence of OP. Institutional review board (IRB) approval was obtained from the institution (STUDY00002241). Patients' demographics and oxygen requirements at the time of diagnosis, at the time of discharge, and at one, three, six, 10, and 12 months post-discharge were obtained. The dose, duration, and choice of glucocorticoid therapy were recorded for each subject, as well as oxygen requirements during hospitalization. Despite radiological evidence of OP, patients on minimal supplemental oxygen requirements did not receive high-dose or long-duration glucocorticoid therapy. Results A total of 881 patients were admitted with COVID-19, of which 42 met the study criteria. Three patients underwent a lung biopsy to confirm the diagnosis of organizing pneumonia. All other patients were diagnosed based on CT imaging and clinical presentation. Of the patients, 17% did not receive any steroid treatment, while 36% received dexamethasone and 43% received prednisone. The most common oxygen requirement at the time of discharge for steroid-treated patients was nasal cannula (55%) and room air (29%). The incidence of OP in this patient population was 0.05 with a mortality rate of 14%. Interpretation and relevance The incidence of post-COVID-19 OP appears to be lower than anticipated. Steroids for patients on lower supplemental oxygen requirements were discontinued although they had radiological evidence of OP. Patients who were on higher supplemental oxygen requirements at 10 days were continued on steroids regardless of imaging. The decision to continue steroids should be based on individual patient characteristics such as oxygen requirements. In the future, larger multicenter cohort studies would help understand further treatment of post-COVID-19-associated OP. Anticipating specific populations who may be at higher risk and starting treatment earlier could help reduce mortality.

Applications of Sentinel-2 satellite data for spatio-temporal mapping of deep pools for monitoring the riverine connectivity and assessment of ecological dynamics: a case from Godavari, a tropical river in India (2016-2021)

Rivers are dynamic ecosystems with diverse habitats that require ample connectivity to ensure the flow of ecosystem services, thus empowering the sustainable development of an entire basin. Geo-spatial tools offer powerful prospects for monitoring of aquatic ecosystems. The usefulness of Sentinel-2 datasets to assess river connectivity has been explored for an un-gauged seasonal river system. The present study was undertaken in five ecologically unique river reaches viz. Wainganga, Wardha, Pranhita, Godavari-mid and Manair in Godavari Basin in the Indian Deccan Plateau to map water spread dynamics at various time scales, i.e., fortnightly, monthly, seasonal, annual and demi-decadal during 2016-2021. The maximum value of perennial water spread per square kilometre of total floodplain area (2016-2021), determined using Sentinel-2 imageries, was observed in river Wardha (0.18) followed by Pranhita (0.12) and Wainganga (0.11). The water spread showed a decreasing trend, while the number of patches in the river corridor increased over time from post-monsoon to pre-monsoon season. The copious perennial habitat with relatively larger patches, incessant flow in river Pranhita and obstructed flow, large-sized patches reported in river Wardha during summer months, hold importance in terms of providing refuge to aquatic biota. This study provides evidence for the impact of water projects on spatio-temporal water spread dynamics in Godavari Basin. The demonstrated utility of Sentinel-2 imagery coupled with gauge station measurements for river continuity assessment and deep pool mapping would aid in enhancing our understanding on environmental flow at a spatial scale, which in turn would aid in effective river management to achieve the Sustainable Development Goals. The implications of this study for sustainable environmental management and limitations are also discussed.

A Case of Antineutrophil Cytoplasmic Antibodies (ANCA)-Associated Vasculitis Post COVID-19 Vaccination

In this report, we examine the case of a patient who developed antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis after receiving the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine. This is a case of a 62-year-old female who received the first dose of COVID-19 vaccine in July 2021 before presenting a few weeks later with migrating polyarthralgia and hemoptysis. Autoimmune workup was positive for ANCA against proteinase 3 (PR3).

ACTA2-Related Dysgyria: An Under-Recognized Malformation of Cortical Development

BACKGROUND AND PURPOSE

Pathogenic variants in the ACTA2 gene cause a distinctive arterial phenotype that has recently been described to be associated with brain malformation. Our objective was to further characterize gyral abnormalities in patients with ACTA2 pathogenic variants as per the 2020 consensus recommendations for the definition and classification of malformations of cortical development.

MATERIALS AND METHODS

We performed a retrospective, multicentric review of patients with proved ACTA2 pathogenic variants, searching for the presence of malformations of cortical development. A consensus read was performed for all patients, and the type and location of cortical malformation were noted in each. The presence of the typical ACTA2 arterial phenotype as well as demographic and relevant clinical data was obtained.

RESULTS

We included 13 patients with ACTA2 pathogenic variants (Arg179His mutation, n = 11, and Arg179Cys mutation, n = 2). Ninety-two percent (12/13) of patients had peri-Sylvian dysgyria, 77% (10/13) had frontal dysgyria, and 15% (2/13) had generalized dysgyria. The peri-Sylvian location was involved in all patients with dysgyria (12/12). All patients with dysgyria had a characteristic arterial phenotype described in ACTA2 pathogenic variants. One patient did not have dysgyria or the characteristic arterial phenotype.

CONCLUSIONS

Dysgyria is common in patients with ACTA2 pathogenic variants, with a peri-Sylvian and frontal predominance, and was seen in all our patients who also had the typical ACTA2 arterial phenotype.

Interactive effect of elevated tropospheric ozone and carbon dioxide on radiation utilisation, growth and yield of chickpea (Cicer arietinum L.)

An experiment was conducted in the Free Air Ozone and Carbon dioxide Enrichment (FAOCE) facility to study the impact of elevated O₃, CO₂ and their interaction on chickpea crop (cv. Pusa-5023) in terms of phenology, biophysical parameters, yield components, radiation interception and use efficiency. The crop was exposed to elevated O₃ (EO:60ppb), CO₂ (EC:550 ppm) and their combined interactive treatment (ECO: EC+EO) during the entire growing season. Results revealed that the crop's total growth period was shortened by 10, 14 and 17 days under elevated CO₂, elevated O₃ and the combined treatment, respectively. Compared to ambient condition, the leaf area index (LAI) under elevated CO₂ was higher by 4 to 28%, whilst it is reduced by 7.3 to 23.8% under elevated O₃. The yield based radiation use efficiency (RUE_y) was highest under elevated CO₂ (0.48 g MJ^-1), followed by combined (0.41 g MJ^-1), ambient (0.38 g MJ^-1) and elevated O₃ (0.32 g MJ^-1) treatments. Elevated O₃ decreased RUE_y by 15.78% over ambient, and the interaction results in a 7.8% higher RUE_y. The yield was 31.7% more under elevated CO₂ and 21.9% lower in elevated O₃ treatment as compared to the ambient. The combined interactive treatment recorded a higher yield as compared to ambient by 9.7%. Harvest index (HI) was lowest under elevated O₃ (36.10%), followed by ambient (39.18%), combined (40.81%), and highest was under elevated CO₂ (44.18%). Chickpea showed a positive response to elevated CO₂ resulting a 5% increase in HI as compared to ambient condition. Our findings quantified the positive and negative impacts of elevated O₃, CO₂ and their interaction on chickpea and revealed that the negative impacts of elevated O₃ can be compensated by elevated CO₂ in chickpea. This work promotes the understanding of crop behaviour under elevated O₃, CO₂ and their interaction, which can be used as valuable inputs for radiation-based crop simulation models to simulate climate change impact on chickpea crop.

Sensitivity analysis of cultivar parameters to simulate wheat crop growth and yield under moisture and temperature stress conditions

Sensitivity of cultivar input parameters were characterised on the outputs of yield and growth variables using a web based crop simulation model Web InfoCrop Wheat. The crop model was assessed for each combination of seventeen input cultivar parameters tested under moisture and temperatures stress conditions in four different ecological regions. Three model outputs, total dry matter at harvest, grain yield at harvest and duration of the crop were chosen for subsequent evaluation. The most dominant cultivar parameters were identified to be TPOPT (Optimum Temp), TTVG (Thermal time for germination to 50% Flowering), KDFMAX (Extinction coefficient of leaves at flowering), GNOCF (Slope of storage organ number/m² to dry matter during storage organ formation), POTGWT (Potential storage organ weight) and PHOTOSENS (Photoperiod sensitivity) which were associated with growth, thermal time accumulation, leaf area index, grain number and photosensitivity. Comparison of crop simulations with all the cultivar parameters incorporated from the experimental observations and those with only the most sensitive cultivar parameters incorporated was performed. Outputs of the crop simulation were significantly correlated with results from the field experiments. The present study could save time and effort in generating all the cultivar parameters required to perform the crop simulation under moisture and temperature stress conditions. The most significant cultivar parameters (TPOPT, TTVG, KDFMAX, GNOCF, POTGWT and PHOTOSENS) identified through the sensitivity analysis conducted in this study could significantly simulate the crop growth and yield of wheat.

Assessment of soil health parameters and application of the sustainability index to fields under conservation agriculture for 3, 6, and 9 years in India

The effect of duration of conservation agriculture adoption on soil carbon dynamics and system sustainability was evaluated on farms of 30 villages in the Nilokheri block of Karnal district, Haryana, India. Sustainability was evaluated, in which a number of soil physical, chemical, and biological parameters were measured and a Sustainability Index (SI) was applied. Soil samples were collected from existing conservation agriculture (CA) and conventional tillage (CT) farms. Villages under CA practices were subdivided as CA3, CA6, and CA9 based on the number of years of CA practice adoption. Results showed that bulk density (BD) of 0-15 cm soil depth was 7% greater in CA3 plots, whereas in CA6 and CA9 plots BD values were only 2% and 3% higher than CT. Soil organic carbon (SOC) in 0-15 cm soil depth was found to be greater by 16.32% in CA3 than CT plots, whereas SOC was higher by 38.77% and 61.22% in CA6 and CA9. In CA, for the 0-15 and 15-30 cm soil depths, labile pools were 36% and 22% greater than CT, respectively. For both the soil depths in CA, the recalcitrant pool was 12% and 9% more than CT, respectively. Microbial biomass carbon (MBC) values of the 0-15 cm soil depth were increased over CT by 18.57%, 47.08%, and 71.5% for CA3, CA6, and CA9 respectively. In CA plots, the SI of 0-15 cm soil depth ranged between cumulative ratings (CR) of 18-21, which indicates that CA practice is "sustainable" for both soil depths. For CT, CR ranged from 25 to 30 for both soil depths resulting in a SI of "sustainability with high input". Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) scores showed that SOC had the maximum weight (0.96) towards sustainability, giving it a rank of 1. Effective rooting depth (ERD), BD, texture, and wilting point (WP) ranked 2, 3, 4 and 5, respectively, indicating their corresponding weight of contribution towards the SI. Farmers in the Karnal district should be encouraged to adopt CA practices as they can increase SOC and move the systems from "sustainable with high input" to "sustainable".

Long-term postnatal outcome of fetuses with prenatally suspected septo-optic dysplasia

OBJECTIVES

Septo-optic dysplasia (SOD) is a clinical syndrome characterized by varying combinations of optic nerve hypoplasia, pituitary gland hypoplasia and abnormal cavum septi pellucidi. It is suspected on prenatal imaging when there is non-visualization or hypoplasia of the septal leaflets. Long-term postnatal outcomes of fetuses with prenatally suspected SOD have been documented poorly. The aims of this study were to describe the natural history of deficient septal leaflets, to quantify the incidence of postnatally confirmed SOD and to document the visual, endocrine and long-term neurodevelopmental outcomes of these infants.

METHODS

This was an observational retrospective study of all fetuses with prenatal imaging showing isolated septal agenesis, assessed at a single tertiary center over an 11-year period. Pregnancy, delivery and neonatal outcomes and pre- and postnatal imaging findings were reviewed. Neonatal evaluations or fetal autopsy reports were assessed for confirmation of SOD. Ophthalmologic, endocrine, genetic and long-term developmental evaluations were assessed. Imaging findings and outcome were compared between infants with and those without postnatally confirmed SOD.

RESULTS

Of 214 fetuses presenting with septal absence on prenatal ultrasound and magnetic resonance imaging (MRI), 18 (8.4%) were classified as having suspected isolated septal agenesis suspicious for SOD. Uniform prenatal MRI findings in cases with suspected SOD included remnants of the leaflets of the cavum septi pellucidi, fused forniceal columns, normal olfactory bulbs and tracts and a normal optic chiasm. Twelve fetuses were liveborn and five (27.8%) had postnatally confirmed SOD. Only two of these five fetuses had additional prenatal imaging features (pituitary cyst, microphthalmia and optic nerve hypoplasia) supporting a diagnosis of SOD. The other three confirmed SOD cases had no predictive prenatal or postnatal imaging findings that reliably differentiated them from cases without confirmed SOD. Visual and endocrine impairments were present in two (40%) and four (80%) cases with confirmed SOD, respectively. In those with visual and/or endocrine impairment, developmental delay (median age at follow-up, 2.5 (interquartile range, 2.5-7.0) years) was common (80%) and mostly severe. Neonates with isolated septal agenesis and a lack of visual or endocrine abnormalities to confirm SOD had normal development.

CONCLUSIONS

Only a quarter of fetuses with isolated septal agenesis suggestive of SOD will have postnatal confirmation of the diagnosis. Clinical manifestations of SOD are variable, but neurodevelopmental delay may be more prevalent than thought formerly. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Expanding the Neuroimaging Phenotype of Neuronal Ceroid Lipofuscinoses

BACKGROUND AND PURPOSE

Neuronal ceroid lipofuscinoses are a group of neurodegenerative disorders characterized by the accumulation of autofluorescent lipopigments in neuronal cells. As a result of storage material in the brain and retina, clinical manifestations include speech delay, cognitive dysfunction, motor regression, epilepsy, vision loss, and early death. At present, 14 different ceroid lipofuscinosis (CLN) genes are known. Recently, the FDA approved the use of recombinant human proenzyme of tripeptidyl-peptidase 1 for CLN2 disease, while phase I/IIa clinical trials for gene therapy in CLN3 and CLN6 are ongoing. Early diagnosis is, therefore, key to initiating treatment and arresting disease progression. Neuroimaging features of CLN1, CLN2, CLN3, and CLN5 diseases are well-described, with sparse literature on other subtypes. We aimed to investigate and expand the MR imaging features of genetically proved neuronal ceroid lipofuscinoses subtypes at our institution and also to report the time interval between the age of disease onset and the diagnosis of neuronal ceroid lipofuscinoses.

MATERIALS AND METHODS

We investigated and analyzed the age of disease onset and neuroimaging findings (signal intensity in periventricular, deep, and subcortical white matter, thalami, basal ganglia, posterior limb of the internal capsule, insular/subinsular regions, and ventral pons; and the presence or absence of supratentorial and/or infratentorial atrophy) of patients with genetically proved neuronal ceroid lipofuscinoses at our institution. This group consisted of 24 patients who underwent 40 brain MR imaging investigations between 1993 and 2019, with a male preponderance (male/female ratio = 15:9).

RESULTS

The mean ages of disease onset, first brain MR imaging, and diagnosis of neuronal ceroid lipofuscinoses were 4.70 ± 3.48 years, 6.76 ± 4.49 years, and 7.27 ± 4.78 years, respectively. Findings on initial brain MR imaging included T2/FLAIR hypointensity in the thalami (n = 22); T2/FLAIR hyperintensity in the periventricular and deep white matter (n = 22), posterior limb of the internal capsule (n = 22), ventral pons (n = 19), and insular/subinsular region (n = 18); supratentorial (n = 21) and infratentorial atrophy (n = 20). Eight of 9 patients who had follow-up neuroimaging showed progressive changes.

CONCLUSIONS

We identified reported classic neuroimaging features in all except 1 patient with neuronal ceroid lipofuscinoses in our study. CLN2, CLN5, and CLN7 diseases showed predominant cerebellar-over-cerebral atrophy. We demonstrate that abnormal signal intensity in the deep white matter, posterior limb of the internal capsule, and ventral pons is more common than previously reported in the literature. We report abnormal signal intensity in the insular/subinsular region for the first time. The difference in the median time from disease onset and diagnosis was 1.5 years.

Radiographic evaluation of bone density in dentulous and edentulous patients in Riyadh, KSA

Background

The Cone Beam Computed Tomography (CBCT) is currently being used as the most common diagnostic method to evaluate the bone density of the maxilla and the mandible for planning dental implant. Aim: The aim of the study is to check the quantitative alveolar bone density in complete or partial edentulous and dentulous male and female patients among Riyadh sample population in Saudi Arabia.

Materials and Methods

The study involved a cross-sectional analysis of 231 consecutive CBCT images of 231 different patients (115 males and 116 females). The scans were of Saudi National patients who were partially or completely edentulous without any bone infections in the maxilla and the mandible. The findings are presented as descriptive statistics and inferential statistics: student -t-test for two group means, ANOVA for three groups, Post-hoc LSD test for multiple comparisons, Levene statistics for testing the homogeneity of variances and a statistical significance at 5% level.

Results

Comparison of mean alveolar bone density in maxillae of dentulous male smokers showed a statistically significant difference for bucco-cortical plate and cancellous bone among different regions. In dentulous male nonsmokers, no significant difference was observed for maxillary regions, while in mandibular areas, a statistically significant difference was seen for buccal cortex, palatal cortex, and cancellous bone among different regions. While studying the scans of female dentulous patients, a statistically significant difference was observed in alveolar bone density for all the areas.

Conclusion

Evaluation of bone density is an important step in treatment planning and this study was aimed to provide insight into bone density patterns of population in Riyadh, Saudi Arabia. Further similar studies in different populations can help in planning for more efficient treatment outcomes.

Role of contrast-enhanced ultrasound in the evaluation of post-liver transplant vasculature

Liver transplantation is a frequently used treatment for patients with end-stage liver disease and ultrasound is often the first-line imaging technique for detection of vascular complications after liver transplant. Although colour Doppler ultrasound is a good screening method for evaluation of post-liver transplant vasculature, it has limitations in evaluating small-calibre vessels and vessels in close proximity. Contrast-enhanced ultrasound (CEUS) has been proposed to overcome these limitations by improving visualisation of post-liver transplant vasculature and reducing the number of false-positive cases, which necessitate unnecessary additional investigations such as computed tomography or angiography. Liver transplant anatomy and the wide array of post-transplant imaging findings on colour Doppler have already been well described but literature on the use of CEUS and its image interpretation remain scarce. This review aims to discuss the indications for CEUS after liver transplant, to demonstrate CEUS technique and familiarise readers with the imaging appearances of post-transplant vascular complications on CEUS.

Acute Cortical Lesions in MELAS Syndrome: Anatomic Distribution, Symmetry, and Evolution

BACKGROUND AND PURPOSE

Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome is a rare mitochondrial disorder affecting children and young adults. Stroke-like episodes are often associated with acute cortical lesions in the posterior cerebral cortex and are classically described as asymmetric and transient. In this study we assessed the anatomic distribution of acute cortical lesions, the incidence of symmetry, and the temporal evolution of lesions.

MATERIALS AND METHODS

This was a retrospective cohort study of patients who had a confirmed genetic diagnosis of a pathogenic variant associated with MELAS and MR imaging performed at our center (2006-2018). Each MR imaging study was assessed for new lesions using T1, T2, FLAIR, DWI, ADC, and SWI. The anatomic location, symmetry, and temporal evolution of lesions were analyzed.

RESULTS

Eight patients with the same pathogenic variant of MELAS (MT-TL1 m.3243A>G) with 31 MR imaging studies were included. Forty-one new lesions were identified in 17 of the studies (5 deep, 36 cortical). Cortical lesions most commonly affected the primary visual cortex, the middle-third of the primary somatosensory cortex, and the primary auditory cortex. Thirty of 36 cortical lesions had acute cortical diffusion restriction, of which 21 developed cortical laminar necrosis on subacute imaging. Six of 11 studies with multiple lesions showed symmetric cortical involvement.

CONCLUSIONS

Acute cortical lesions in MELAS most commonly affect the primary visual, somatosensory, and auditory cortices, all regions of high neuronal density and metabolic demand. The most common pattern of temporal evolution is acute cortical diffusion restriction with subacute cortical laminar necrosis and chronic volume loss. Symmetric involvement is more common than previously described.

Bariatric Surgery Causing Hyperammonemia

Bariatric surgery is recognized as a highly effective therapy for obesity but it does carry a risk of short term and long term complications since it results in a permanent alteration of the patient's anatomy. We present a case of 45-year-old female presented with a macular rash on extremities and facial rash from a rehabilitation center after having been discharged a month earlier from a revision surgery on her gastric bypass for anastomotic bleeding. She progressively became lethargic with Magnetic Resonance Imaging (MRI) of the brain showed symmetrically restricted diffusion concerning for hypoxic injury. Her ammonia levels were at 142 micromoles per liter (mmol/L) at the initial check which worsened to 432 mmol/L over a few days, despite treatment. Laboratory investigation later revealed her to be deficient in zinc along with many essential and nonessential amino acids. Supplemental nutrition was initiated, specifically fortifying her parenteral feeds with the essential amino acid combinations that were found deficient on testing. This lead to a slow but progressive improvement in encephalopathy. This case highlights the importance of understanding the short and long term complications of bariatric surgery. Although neurological complications are rare with peripheral neuropathy being the most common one, hyperammonemic encephalopathy is a very severe complication, with incompletely understood mechanisms and predispositions, frequently resulting in failure of recognition and subsequent delays in intervention.

Receptor status conversion between primary and recurrent/metastatic breast cancer: A single institutional study

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Background: Hormone receptor and HER2 status have both predictive and prognostic implications in breast cancer (BC). Studies report differences of 3% to 54% for Estrogen receptor (ER), 5% to 78% for Progesterone receptor (PR), and 0% to 34% for HER2 between primary (P) and recurrent/metastatic breast cancer (RMBC). To evaluate this difference, we conducted an observational single institution study in adult patients (pts) ≥ 18 years with RMBC. Methods: After IRB approval, we conducted a retrospective chart review of pts diagnosed with RMBC between January 1st, 2010 and October 31st, 2018, with history of PBC. We recorded age at PBC diagnosis, stage, tumor type, receptor status, initial treatment, age at RMBC diagnosis, if biopsy performed, receptor status and survival. We studied the differences in ER, PR and HER2 receptors between P and RMBC. Descriptive statistics was used for analysis. Results: We found a total of 179 pts in the time interval. Median age was 54 ± 13.2 years at PBC diagnosis, 98.9% females, 1.1% males. 187 events were recorded. At PBC diagnosis, 27.4% had Stage I, 37.4% had Stage II and 31.8% had Stage III disease. Tumor type was ductal in 83.8% and lobular in 12.2%. 78.8% was ER+, 68.7% was PR+ and 14% was HER2+. 70.9% received chemotherapy, 12.8% received HER2 therapy and 67% received hormonal therapy. Age at RMBC was median of 61 ± 13.1 years. Biopsy was done in 93.3%. Time between PBC and RMBC ranged from 7 and 324 months. 31.3% had local recurrence and 68.7% had distant disease. In RMBC, 59.2% was ER+, 41.9% was PR + and 13.4% was HER2 +. 58.7% are alive and 38% deceased. With RMBC, 19.2% who were ER+ became ER-, 4.9% who were ER- became ER+, 37.5% who were PR+ became PR-, 8.6% who were PR- became PR+, 23.1% who were HER2+ became HER2-, 4.5% who were HER2 - became HER2+. In pts who became ER-/PR-, 88.5% received hormonal therapy and 61.5% received chemotherapy at the time of PBC. In pts who became HER2-, 83.3% received HER2 therapy at the time of PBC. Conclusions: In our study, we found a difference of 24.1% in ER, 46.1% in PR and 27.6% in HER2 between PBC and RMBC. It is recommended that patients with RMBC should have a biopsy to evaluate the receptor status as it would impact treatment and survival.

Effect of elevated carbon dioxide on soil hydrothermal regimes and growth of maize crop (Zea mays L.) in semi-arid tropics of Indo-Gangetic Plains

To see the effect of climate change on the variation of soil hydrothermal regimes and growth of maize crop, an experiment was conducted in free-air carbon dioxide enrichment (FACE) facility during the kharif season of 2015 at Climate Change Facility of Indian Agricultural Research Institute, New Delhi, India. Under elevated CO₂ and ambient condition, surface bulk density (BD) were 1.38 Mgm^-3 and 1.44 Mgm^-3, respectively but BD were not significantly different. During different days after sowing (DAS), in 0 to 10-cm soil depth, soil water content (SWC) in FACE varied between 14.58-20.70%, whereas in ambient condition, SWC variations were in between 19.33-22.94%. In 10 to 20-cm soil depth, SWC ranged in between 20.47-27.14% in FACE and 23.57-25.42% in ambient condition for different DAS. It is also observed that the arrival of peak surface ST was 1 h early in elevated CO₂ condition. Photosynthetic rate increased by 5.7% on 44 DAS and 18.1% on 70 DAS under elevated carbon dioxide condition. Elevated carbon dioxide had reduced the stomatal conductance but the reduction was not significant. Like variation in air temperature for climate change, more intensive study is required to see the effect of climate change on soil temperature and its effect on crop growth.

Characterization of demographics and NS5A genetic diversity for hepatitis C virus genotype 4-infected patients with or without cirrhosis treated with ombitasvir/paritaprevir/ritonavir

Hepatitis C virus (HCV) genotype 4 (GT4) is genetically diverse with 17 confirmed and 4 provisional subtypes. In this report, HCV GT4-infected patient samples from Phase 2/3 clinical studies were analysed to characterize global demographics and genetic diversity of GT4 infection among patients treated with ombitasvir (OBV, NS5A inhibitor) plus paritaprevir/r (NS3/4A inhibitor codosed with ritonavir). Among 17 subtypes isolated from GT4-infected patients in the PEARL-I and AGATE-I studies, subtype prevalence by country of enrolment and country of origin suggested that subtypes 4a and 4d were likely circulating in Europe, while heterogeneous GT4 subtypes and a portion of GT4a detected in European and North American countries were likely due to immigration of HCV-infected patients from Africa. The distributions of birth cohort and race were also significantly different across GT4 subtypes 4a, 4d, and non-4a/4d. In addition, phylogenetic analyses of NS5A sequences revealed clustering within subtype 4a which segregated by the patient-reported country of origin and the presence of the L30R/S polymorphism. HCV NS5A sequences derived from GT4a-infected patients who originated from Europe and the United States clustered separately from sequences derived from patients who originated from Egypt, suggesting that genetically distinct strains of subtype 4a may be circulating globally. Finally, NS5A baseline polymorphisms were frequently detected at amino acid positions of interest for the inhibitor-class and OBV retained activity against 37 of 39 NS5A GT4 clinical isolates, with no impact on treatment outcome in the PEARL-I and AGATE-I studies.

Endemic Indian clones of Klebsiella pneumoniae-harbouring New Delhi metallo-beta-lactamase-1 on a hybrid plasmid replicon type: A case of changing New Delhi metallo-beta-lactamase plasmid landscapes in India?

PURPOSE

blaNDM genes are MBL genes that confer resistance to carbapenems. Globally, they are associated with diverse clones and plasmids. In this study, we characterised three isolates of Klebsiella pneumoniae-harbouring blaNDM1 from patients undergoing chronic haemodialysis and renal transplantation.

MATERIALS AND METHODS

3 blaNDM1 -producing K. pneumoniae were isolated from end-stage renal disease patients undergoing haemodialysis and renal transplantation from a nephrology unit. All the three isolates were screened for clinically relevant resistant genes. Plasmid replicon content was analysed by polymerase chain reaction based replicon typing. Conjugation assays were done using azide-resistant Escherichia coli J53 as the recipient strain. Multilocus sequence typing and variable number tandem repeat typing were done to find the clonality. Replicon sequence based typing was attempted to find the diversity of replicon-associated sequences in IncHI3 plasmids.

RESULTS

All the 3 blaNDM positive isolates possessed the New Delhi metallo-beta-lactamase-1 (NDM-1) allele with an IncHI3 plasmid which was not transferable in one isolate. The isolates were found to be sequence type 14 (ST14; 2 nos) and ST38 both of which were previously reported to be the NDM-producing K. pneumoniae STs prevalent in India. Replicon sequence analysis revealed limited sequence diversity within the repHI3 and repFIB locus.

CONCLUSION

To the best of our knowledge, this is the first report of IncHI3, a newly assigned enterobacterial plasmid incompatibility group from India. This could either be a case of importation or a widely circulating NDM plasmid type in India.

Plausible Role of Acute HIV Infection Mediated Immune Activation in Causing Renal Allograft Rejection: A Case Report

Current research states that AIDS pathogenesis has its roots in a chronic activation of immune system secondary to human immunodeficiency virus (HIV)-induced proliferation of T cells, B cells, NK cells, and macrophages. Immune activation due to acute HIV infection can be highly detrimental to allograft survival in a renal transplant recipient. In this report, we describe a 32-year-old African-American male patient who underwent a second live donor renal transplant, following which he developed acute allograft rejection coincident with newly acquired HIV seropositivity.

Erratum: Endemic Indian clones of Klebsiella pneumoniae harbouring New Delhi metallo beta lactamase 1 on a hybrid plasmid replicon type: A case of changing New Delhi metallo beta lactamase plasmid landscapes in India?

[This corrects the article DOI: 10.4103/0255-0857.188314.].

Dangers of flying high and diving low! An unusual case of dyspnea

Giant bullae are bullae that occupy at least 30 percent of a hemi thorax. This condition can rarely be idiopathic and not usually suspected in young patients with no risk factors. We describe a case of a giant solitary pulmonary bulla in a healthy young female with no known risk factors. 23-year-old female presented to the Emergency department with dyspnea and pleuritic right sided chest pain. She started experiencing these symptoms when she was on a 7-h flight and later experienced similar symptoms when she went scuba diving. Lung exam revealed decreased breath sounds on the right and she was saturating well on room air. Chest X-ray done showed a large bleb at the right lung apex. CT angiogram done was negative for pulmonary embolism, but confirmed a large bulla involving the right upper lobe. She had no history of lung diseases, marfanoid features, cigarette smoking, drug use or family history of similar condition. She underwent VAT assisted mini thoracotomy with resection of the right apical bulla and tube thoracostomy. Surgical pathology showed a pulmonary bleb with pleural fibrosis and prominent adhesions with parietal pleura and no evidence of malignancy. She was advised to avoid air travel and diving for 3 months and is doing well. Idiopathic giant pulmonary bullae have rarely been reported. It is a rare cause of dyspnea and chest pain in young adults. This may be suspected when patients develop symptoms with air travel and deep sea diving.