Synthesis of thiazolidine-2,4-dione tethered 1,2,3-triazoles as α-amylase inhibitors: In vitro approach coupled with QSAR, molecular docking, molecular dynamics and ADMET studies.

A new series of thiazolidine-2,4-dione tethered 1,2,3-triazole derivatives were designed, synthesized and screened for their α-amylase inhibitory potential employing in vitro and in silico approaches. The target compounds were synthesized with the help of Cu (I) catalyzed [3 + 2] cycloaddition of terminal alkyne with numerous azides, followed by unambiguously characterizing the structure by employing various spectroscopic approaches. The synthesized derivatives were assessed for their in vitro α-amylase inhibition and it was found that thiazolidine-2,4-dione derivatives 6e, 6j, 6o, 6u and 6x exhibited comparable inhibition with the standard drug acarbose. The compound 6e with a 7-chloroquinolinyl substituent on the triazole ring exhibited significant inhibition potential with IC50 value of 0.040 µmol mL-1 whereas compound 6c (IC50 = 0.099 µmol mL-1) and 6h (IC50 = 0.098 µmol mL-1) were poor inhibitors. QSAR studies revealed the positively correlating descriptors that aid in the design of novel compounds. Molecular docking was performed to investigate the binding interactions with the active site of the biological receptor and the stability of the complex over a period of 100 ns was examined using molecular dynamics studies. The physiochemical properties and drug-likeliness behavior of the potent derivatives were investigated by carrying out the ADMET studies.

The antecedents, drivers and outcomes of employee family incivility in the workplace: A systematic review and future research avenues.

Family Incivility has emerged as an important construct that may impact the employee's mental wellbeing and thus affect various organizational outcomes including financial and market related outcomes. The construct however is nascent stage of scholarly research. Thus through a systematic literature review we organise the scholarship till date on the theories, contexts and methods used to explore the construct We also propose a unique framework for employee family incivility and its impact on workplace that identifies and maps the antecedents, drivers and outcomes of family incivility. These two contributions would help both scholars and practitioners in further development of theory and practice. The study follows the PRISMA method for literature review which is an established and rigorous protocol to minimise the errors and biases. That identified 34 articles for the review that were analysed and synthesised for the findings. The third unique and novel contribution of the study is the identification of specific future research questions with reference to employee family incivility and workplace, based on the analysis done in the review.

Unveiling the In Vitro Anti-Biofilm Potential of Lactobacillus rhamnosus Against Saliva-Based Pathogens: A Gender-Age-Area Specific Study.

Probiotics, like lactobacilli and bifidobacteria, benefit health by populating the digestive system, which houses numerous microbial species. Studies demonstrate their ability to inhibit biofilm formation, crucial in preventing oral conditions like dental caries. Our research evaluated a probiotic strain's anti-biofilm efficacy against oral pathogens in 45 individuals' saliva, alongside its biofilm-forming potential. Analysis revealed significant biofilm inhibition in 36 samples. Comparisons based on age, gender, and geography further supported these findings. We propose further exploration of probiotics tailored to specific demographics to enhance oral health outcomes, suggesting a promising avenue for preventing oral microbial diseases.

Expression of CD44 and SALL4 in Leukoplakia and Oral Squamous Cell Carcinoma.

CD44 and SALL4 are markers of stemness and expressed in cancer stem cells (CSCs). Their deregulated expression was seen in various tumors and has been correlated with clinical severity. We evaluated immunohistochemical expression of CD44 and SALL4 in leukoplakia and oral squamous cell carcinoma (OSCC). CD44 was expressed in all the cases of leukoplakia and Its expression correlated with severity of the dysplasia in leukoplakia but varied with differentiation in OSCC. SALL4 did not express in leukoplakia. Its expression was varied in OSCC cases. We opine that CD44 expression is consistent with the progression of dysplasia in leukoplakia and differentiation in OSCC.

Realization of a green-emitting pyrosilicate-structured Er3+-activated Y2Si2O7 phosphor: a systematic study of opto-electronic characteristics and thermal stability for lighting applications.

A series of green-emitting Y2-x Si2O7:xEr3+ phosphors (x = 1-7 mol%) have been successfully synthesized using a straightforward gel-combustion method facilitated by urea. X-ray diffraction analysis provided specific patterns for samples, confirming a consistent triclinic phase across erbium-doped structures compared to undoped structures. Studies using TEM and EDX were conducted to identify the surface-related characteristics and chemical composition of the synthesized nanophosphor, respectively. The band gap was determined to be 5.55 eV and 5.80 eV for the host material and optimal sample, respectively. The primary peak of excitation, observed at 379 nm, represents the highly sensitive electric dipole transition from the 4I15/2 state to the 4G11/2 level, suggesting that the prepared phosphors could effectively absorb NUV light for activation. The PL profiles of Y2-x Si2O7:xEr3+ (x = 1-7 mol%) phosphors demonstrate characteristic emissions at 409 nm (2H9/2 → 4I15/2), 522 nm (2H11/2 → 4I15/2), 553 nm (4S3/2 → 4I15/2) and 662 nm (4F9/2 → 4I15/2). In accordance with Dexter's theory, luminescence quenching observed at a concentration of 4 mol% Er3+ is attributed to dipole-quadrupole interactions. The optimal sample demonstrates excellent thermal stability, indicated by its luminescence at different temperatures and activation energy of 0.2641 eV. Additionally, the CIE, color purity and CCT values of the fabricated nanomaterials make it ideal for use in lighting applications.

Comparative study of reproductive and estrus characteristics of sexed and conventional semen in crossbred cows under field conditions.

Background and Aim: Sexed semen (SS), a reproductive biotechnology tool, can alter the sex ratio of offspring in bovines. This study elucidates a comparative analysis of estrus-related parameters influencing conception rate and pregnancy losses under field conditions between conventional and SS. Materials and Methods: In the present study, artificial insemination with (SS; n = 143) and conventional semen (CS; n = 143) was performed at spontaneous estrus, i.e., 16-18 h after the onset of estrus signs, to analyze their comparative evaluation in terms of conception rates in crossbred cows under field conditions. Different parameters such as age, parity, body condition score (BCS), estrus duration, inter-estrus interval (IEI), diameter of pre-ovulatory follicle (DPOF) at estrus, and cervical mucus properties (pH and spinnbarkeit [SBK]) were recorded for each cow. Results: The first insemination conception rates for sexed and conventional semen were 55.24% and 63.63% whereas the overall conception rates were 49.14% and 57.37% on days 35 and 75 post-insemination, respectively, with no significant difference (p > 0.05). Conception rates between sexed and CS inseminations were statistically significant (p < 0.01), whereas factors such as age, parity, BCS, DPOF, IEI), and SBK value exhibited no substantial variance (p > 0.05) for both types of semen straw. Conclusion: SS straws yielded a conception rate equivalent to CS straws, with estrus duration being the key factor affecting conception under field conditions.

Cool green-emissive Y2Si2O7:Tb3+ nanophosphor: auto-combustion synthesis and structural and photoluminescence characteristics with good thermal stability for lighting applications.

A cheap, versatile, sustainable and energy-efficient gel-combustion method was applied to develop a series of green-emitting down-converted Y2Si2O7:Tb3+ (YPS:Tb3+) nanophosphors. Employing XRD-based Rietveld refinement approach, the phase purity and crystallographic evaluation of the produced phosphor were conducted, revealing a triclinic crystal with P1̄ space group. EDX and TEM analyses were performed on the synthesized samples to determine their elemental composition and morphological properties. Diffuse reflectance spectra yielded 5.61 eV and 5.79 eV optical energy band gaps for the host and the optimized (0.04 mole of Tb3+) sample, respectively. UV light has the ability to excite the nanocrystalline phosphor in an efficient manner, leading to significant luminosity qualities attributed to the radiative relaxation of 5D4 → 7FJ (J = 6, 5, 4, 3). The bi-exponential decay function was derived by the PL decay curves. With an activation energy of 0.2206 eV, the Y1.96Si2O7:0.04Tb3+ phosphor exhibits good thermal quenching capabilities. Improved photometric attributes including CIE coordinates, CCT and color purity confirmed the green glow, indicating a strong competitor for cool-green emission in lighting applications.

A rare case of undifferentiated pleomorphic sarcoma affecting the mandible - A case report.

Undifferentiated pleomorphic sarcoma (UPS) is a rare entity found in the oral cavity which involves the mandible in only 3% of all UPS bone lesions. The correlation of the clinical presentation of the neoplasm with the histopathological and immunohistochemistry findings is very important for appropriate diagnosis. Its incidence in membranous bone like mandible is rare. According to our literature search in the PubMed database, there are only four reported cases from India some of which does not have any immunohistochemistry findings to confirm the diagnosis. We present a rare case of UPS of mandible which was clinically mimicking squamous cell carcinoma. Upon immunohistochemical analysis, we found vimentin, KI67, CD68 positive and desmin, Melan A, LCA, S100 and myogenin negative, which lead us to the diagnosis of UPS.

Effect of Neck Rotation With Flexion on Ultrasonographic Optic Nerve Sheath Diameter in Patients Undergoing Elective Craniotomy.

Background Extreme neck positioning to facilitate craniotomy can result in impaired venous drainage from the brain and a subsequent rise in increased intracranial pressure (ICP). The effects of varied neck positioning intraoperatively on ultrasonographic optic nerve sheath diameter (USG-ONSD) are still unexplored. This study aims to quantify the angle of neck rotation and flexion that can cause a significant increase in USG-ONSD in patients undergoing elective craniotomy. Methods A total of 100 patients were recruited in this non-randomized study and equally divided into two groups. In one group, patients with neck rotation ≤30 degrees and in another group, patients with neck rotation >30 degrees with varying degrees of neck flexion were included. The average of three USG-ONSD measurements in both eyes was obtained and compared in both groups at baseline, after positioning, and at the end of the surgery after making the neck neutral. Results The results of 100 recruited patients were analyzed. All the patients had neck flexion in the range of 40° to 45°, whereas the neck rotation ranged from 10° to 45°. The USG-ONSD of both eyes changed significantly from baseline to post-positioning time point in patients with neck rotation >30° (right eye p=0.038, left eye p=0.04) when compared to neck rotation ≤30°. There was no significant change in USG-ONSD from baseline to the postoperative time point after making the neck neutral (right eye p=0.245, left eye p=0.850) in both groups. Conclusions This study demonstrates that USG-ONSD, a surrogate measure of ICP, increased significantly after neck flexion with rotation >30° in neurosurgical patients. However, USG-ONSD becomes comparable to baseline after putting the patient's neck in a neutral position after surgery.

Developments in conducting polymer-, metal oxide-, and carbon nanotube-based composite electrode materials for supercapacitors: a review.

Supercapacitors are the latest development in the field of energy storage devices (ESDs). A lot of research has been done in the last few decades to increase the performance of supercapacitors. The electrodes of supercapacitors are modified by composite materials based on conducting polymers, metal oxide nanoparticles, metal-organic frameworks, covalent organic frameworks, MXenes, chalcogenides, carbon nanotubes (CNTs), etc. In comparison to rechargeable batteries, supercapacitors have advantages such as quick charging and high power density. This review is focused on the progress in the development of electrode materials for supercapacitors using composite materials based on conducting polymers, graphene, metal oxide nanoparticles/nanofibres, and CNTs. Moreover, we investigated different types of ESDs as well as their electrochemical energy storage mechanisms and kinetic aspects. We have also discussed the classification of different types of SCs; advantages and drawbacks of SCs and other ESDs; and the use of nanofibres, carbon, CNTs, graphene, metal oxide-nanofibres, and conducting polymers as electrode materials for SCs. Furthermore, modifications in the development of different types of SCs such as pseudo-capacitors, hybrid capacitors, and electrical double-layer capacitors are discussed in detail; both electrolyte-based and electrolyte-free supercapacitors are taken into consideration. This review will help in designing and fabricating high-performance supercapacitors with high energy density and power output, which will act as an alternative to Li-ion batteries in the future.

Comparison of Opioid-Based Versus Opioid-Sparing Anesthesia in Patients Undergoing Glioma Surgery.

Background In the neurosurgical population, opioids may cause respiratory depression, leading to hypercapnia, increased cerebral blood flow (CBF), and ultimately increased intracranial pressure (ICP), which can mask early signs of intracranial complications and delayed emergence. This study was designed to compare perioperative hemodynamic stability, analgesia, and recovery parameters in opioid-based (fentanyl) general anesthesia versus opioid-sparing (dexmedetomidine) general anesthesia in patients undergoing glioma surgeries. Methodology This prospective observational comparative study compared 52 patients in two groups. Twenty-six (50%) patients in group F received Inj. fentanyl IV (intravenous; bolus 2 mcg/kg 10 minutes before induction and then infusion 1 mcg/kg/hour till 30 minutes before skin closure), whereas 26 (50%) patients in group D received Inj. dexmedetomidine IV (0.5 mcg/kg infusion 10 minutes before induction and then maintenance with a 0.5 mcg/kg/hour infusion till 30 minutes before skin closure). Perioperative heart rate (HR), mean arterial pressure (MAP), Numerical Rating Scale for Pain (NRS) assessment and postoperative emergence time, modified Aldrete score, patient satisfaction, and surgeon satisfaction score were estimated and compared in both groups. Results The mean HR was less in group D compared to group F at following time points - 10 minutes after infusion (P = 0.006), laryngoscopy and intubation (P = 0.003), pinning of the skull (P < 0.001), one hour after dura opening (P = 0.007), two hours after dura opening (P = 0.006), five minutes after extubation (P < 0.001), and 30 minutes after extubation (P = 0.011). MAP was lower in group D compared to group F at the following time intervals: 10 minutes after infusion (P = 0.008), five minutes after extubation (P = 0.007), 30 minutes after extubation (P < 0.001), and one hour after extubation (P = 0.023). A significant decrease in emergence time in group D compared to group F (P < 0.001) was noted. NRS was lower in group D at eight hours (P = 0.005) and 12 hours (P < 0.001) post-extubation. Conclusions Dexmedetomidine can be used as an alternative to fentanyl in terms of perioperative hemodynamic stability, perioperative analgesia, smooth early recovery from anesthesia, patient satisfaction, and surgeon satisfaction.

Pharmacological potential of (L.) P. Royen (Sapodilla): a narrative review.

Herbal medicine is safe and effective in treating various diseases. Traditional herbal medicine plays a tremendous role in treatment of various diseases and accompanying complications, hence herbal medicine requires remarkable attention in further research for the development of numerous active formulations for treatment of health troubles. The plant needs special consideration for development and research of unidentified compound and characterization of novel active molecules that overcome multiple pathological abnormalities. The genus Manilkara contains 135 plants around the world. This overview discusses all the virtues of most important and commonly used plant Manilkara zapota (L.) P. Royen (M. zapota), also known as Sapodilla. M. zapota has various traditional beneficial effects in treatment of various diseases and disorders dating back to prehistoric times and used in ancient traditional system of herbal medicine.

A methodical exploration of imaging modalities from dataset to detection through machine learning paradigms in prominent lung disease diagnosis: a review.

BACKGROUND: Lung diseases, both infectious and non-infectious, are the most prevalent cause of mortality overall in the world. Medical research has identified pneumonia, lung cancer, and Corona Virus Disease 2019 (COVID-19) as prominent lung diseases prioritized over others. Imaging modalities, including X-rays, computer tomography (CT) scans, magnetic resonance imaging (MRIs), positron emission tomography (PET) scans, and others, are primarily employed in medical assessments because they provide computed data that can be utilized as input datasets for computer-assisted diagnostic systems. Imaging datasets are used to develop and evaluate machine learning (ML) methods to analyze and predict prominent lung diseases. OBJECTIVE: This review analyzes ML paradigms, imaging modalities' utilization, and recent developments for prominent lung diseases. Furthermore, the research also explores various datasets available publically that are being used for prominent lung diseases. METHODS: The well-known databases of academic studies that have been subjected to peer review, namely ScienceDirect, arXiv, IEEE Xplore, MDPI, and many more, were used for the search of relevant articles. Applied keywords and combinations used to search procedures with primary considerations for review, such as pneumonia, lung cancer, COVID-19, various imaging modalities, ML, convolutional neural networks (CNNs), transfer learning, and ensemble learning. RESULTS: This research finding indicates that X-ray datasets are preferred for detecting pneumonia, while CT scan datasets are predominantly favored for detecting lung cancer. Furthermore, in COVID-19 detection, X-ray datasets are prioritized over CT scan datasets. The analysis reveals that X-rays and CT scans have surpassed all other imaging techniques. It has been observed that using CNNs yields a high degree of accuracy and practicability in identifying prominent lung diseases. Transfer learning and ensemble learning are complementary techniques to CNNs to facilitate analysis. Furthermore, accuracy is the most favored metric for assessment.

Let us take a walk to the sustainable tourism practices: a qualitative study through the lens of tourism experts.

The rising opportunities of sustainable tourism have brought many policies to control the exploitation of the environment and increase the reach of luxurious, safe, and authentic experiences to the different segments of tourists. This study seeks to prioritize the variables influencing the development of sustainable tourism and pinpoint key success factors that align with the Sustainable Development Goals (SDGs). It adopts a tri-dimensional framework encompassing economic, social, and environmental aspects, further delineated into eleven sub-dimensions, to provide a quantitative evaluation of sustainable tourism. We conducted interviews with 26 tourism industry experts hailing from eight countries, analyzing their responses using interval type-2 fuzzy sets. The results underscore the critical role of specific components in advancing sustainable tourism. In the economic dimension, "financial resources and tourism costs" emerge as vital factors. In the social dimension, "health and safety" takes center stage, while "green infrastructure" plays a pivotal role in the environmental dimension. These findings underscore the significance of these aspects in promoting sustainable tourism. Furthermore, this study explores the strategic importance of sustainable tourism equity in shaping tourism planning and development for emerging markets.

A green light emissive LaSr2AlO5:Er3+ nanocrystalline material for solid state lighting: crystal phase refinement and down-conversion photoluminescence with high thermal stability.

The present study reveals the structural and optoelectronic characteristics of a down-converted (DC) green luminous Er3+ doped LaSr2AlO5 phosphor that was produced by employing an efficient and reliable gel-combustion process assisted with urea as a fuel. Using Rietveld refinement of diffraction data, the crystal structure and phase formation were examined. The surface morphology and elemental configuration of the phosphor were analyzed via TEM and EDX spectroscopy, respectively. The band gap of LaSr2AlO5 (5.97 eV) and optimized La0.96Sr2AlO5:4 mol% Er3+ (5.51 eV) classify the optimized sample as a direct band-gap material. The PL peaks located in the visible range corresponding to transitions 2H9/2 → 4I15/2 (406 nm), 2H11/2 → 4I15/2 (520 nm), 4S3/2 → 4I15/2 (550 nm), and 4F9/ 2 → 4I15/2 (665 nm) were revealed by photoluminescence spectroscopy under 377 nm excitation. Above 4 mol% Er3+ doping, concentration quenching was observed, which was controlled by the quadrupole-quadrupole interaction. Based on the findings of the double exponential fitting of lifetime curves acquired from the emission spectra at λex = 377 nm and λem = 550 nm, the average lifetime of the excited levels of considered nanomaterials was estimated. The temperature-dependent emission spectra of the La0.96Sr2AlO5:4 mol% Er3+ sample were collected in the range 298-498 K. The considered phosphor was found to have a high thermal stability as evidenced by the luminous intensity being sustained at 74.29% at 498 K compared to the intensity at ambient temperature (298 K) with an activation energy of 0.1453 eV. The calculated color purity and superb chromaticity coordinates indicates that the phosphors have a high degree of color purity, which further supports its applicability as a green component in solid-state lighting.

A computer vision-based system for real-time component identification from waste printed circuit boards.

With an exponential increase in consumers' need for electronic products, the world is facing an ever-increasing economic and environmental threat of electronic waste (e-waste). To minimize their adverse effects, e-waste recycling is one of the pivotal factors that can help in minimizing the environmental pollution andto increase recovery of valuable materials. For instance, Printed Circuit Boards (PCBs), while they have several valuable elements, they are hazardous too; and therefore, they form a large chunk of e-waste being generated today. Thus, in recycling PCBs, Electronic Components (ECs) are segregated at first, and separately processed for recovering key elements that could be re-used. However, in the current recycling process, especially in developing nations, humans manually screen ECs, which goes on to affect their health. It also causes losses of valuable materials. Therefore, automated solutions need to be adopted for both to classify and to segregate ECs from waste PCBs. The study proposes a robust EC identification system based on computer vision and deep learning algorithms (YOLOv3) to automate sorting process which would help in further processing. The study uses a publicly available dataset, and a PCB dataset which reflect challenging recycling environments like lighting conditions, cast shadows, orientations, viewpoints, and different cameras/resolutions. The outcome of YOLOv3 detection model based on training of both datasets presents satisfactory classification accuracy and capability of real-time competent identification, which in turn, could help in automatically segregating ECs, while leading towards effective e-waste recycling.

Biomarkers for Early Detection of Charcot Arthropathy: A Prospective Study on Type 2 Diabetes Patients with Severe Neuropathy.

BACKGROUND: Charcot arthropathy (CA) is a progressive noninfectious inflammatory disease that causes irreversible destruction to pedal architecture in diabetic neuropathy (DN) patients. The debilitating prognosis demands early detection to prevent the development and progression of this disorder. Dysregulated and persistent production of inflammatory cytokines is reported as the key element in initiating osteoclastogenesis in CA. The study analyzed the potential association of markers of inflammation and bone turnover of prediagnostic serum samples on CA. METHODS: Seventy-one type 2 severe DN patients were selected based on inclusion-exclusion criteria. Serum samples of interleukin 6 (IL-6), osteoprotegerin (OPG), bone alkaline phosphatase (BALP), and C-reactive protein (CRP) were analyzed. These patients were followed for the development of symptoms of CA for 12 months. In the year of monitoring, 7 patients developed CA (group 1), whereas the remaining 64 patients did not develop CA (group 2). RESULTS: The rate of development of CA in patients with severe DN was 9.8%. In this group, significantly increased median values of HbA1c (group 2: 8.00 [7.00-9.00], group 1: 10.00 [9.25-11.50], P = .013); IL-6 (group 2: 1.21 [0.72-2.16], group 1: 11.08 [6.65-63.64], P = .008); and CRP (group 2: 1.25 [0.78-3.20], group 1: 3.31 [1.18-41.33], P = .041) were found. The receiver operating characteristic analysis showed that IL-6 was more strongly associated with the onset of CA (IL-6: area under the curve = 0.808; P = .008) than CRP. Cut-off values of ≥6.6 for IL-6 show potential to rule out CA in high-risk patients, with a positive predictive value of 26.1%, a negative predictive value of 97.9%, a sensitivity of 85.7%, and a specificity of 73.4%. CONCLUSION: In our study population, we found that an exacerbated inflammatory state, reflected by IL-6 values, generally occurred in DN patients before the clinical detection of CA. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Local auxin biosynthesis promotes shoot patterning and stem cell differentiation in Arabidopsis shoot apex.

The shoot apical meristem (SAM) of higher plants comprises distinct functional zones. The central zone (CZ) is located at the meristem summit and harbors pluripotent stem cells. Stem cells undergo cell division within the CZ and give rise to descendants, which enter the peripheral zone (PZ) and become recruited into lateral organs. Stem cell daughters that are pushed underneath the CZ form rib meristem (RM). To unravel the mechanism of meristem development, it is essential to know how stem cells adopt distinct cell fates in the SAM. Here, we show that meristem patterning and floral organ primordia formation, besides auxin transport, are regulated by auxin biosynthesis mediated by two closely related genes of the TRYPTOPHAN AMINOTRANSFERASE family. In Arabidopsis SAM, TAA1 and TAR2 played a role in maintaining auxin responses and the identity of PZ cell types. In the absence of auxin biosynthesis and transport, the expression pattern of the marker genes linked to the patterning of the SAM is perturbed. Our results prove that local auxin biosynthesis, in concert with transport, controls the patterning of the SAM into the CZ, PZ and RM.

Dynamic Molding of Cleft Nasal Cartilage in Unilateral Complete Cleft Lip and Palate Using Simple Segmented NAM.

Objective: Nasal morphology remodeling by nasoalveolar molding (NAM) before primary lip repair gives better post-surgery outcomes. However, traditional NAM has high technical sensitivity, a steep learning curve, frequent need for modifications, and interrupts lifting forces on the nasal cartilage during oral movements, thereby reducing overall efficacy of device. To eliminate interaction and interdependency of the nasal bulb with alveolar molding plate, we propose segmenting NAM (SNAM) into nasolabial complex molding (NCM) and alveolar complex molding (ACM). NCM addresses ala-septum, lip-premaxilla via lambda-nasal hook and lip taping. ACM addresses palate-alveolus via Yen-modified feeding plate. When the hook is suspended by elastic traction, nasal complex undergoes a natural rotation, where cleft-side ala lifts and septum medializes. Lip taping and feeding plate augment positive molding of cleft segments and maintain transverse relation. The current study outlines SNAM treatment strategy and assesses the effect on nasal deformity. Design and setting: Retrospective observational cohort study set in a comprehensive cleft care centre. Patients: Twenty patients with unilateral complete cleft lip and palate who underwent SNAM were selected. Main outcome measures: Retrospectively, standardized basilar views, pre-, and post-SNAM therapy were evaluated for nostril height, and nostril width, as a ratio of cleft to non-cleft side along with columellar deviation angle. Results: SNAM resulted in significantly improved nostril symmetry with no complications observed. Nostril height ratio increased from 0.35 ± 0.10 to 0.78 ± 0.17. Nostril width ratio decreased from 3.14 ± 0.66 to 2.18 ± 0.42. Columellar deviation angle increased from 26.5 ± 6.30 to 58.5 ± 9.88 degrees. Conclusions: Dynamic correction of the nasal deformity in UCLP is possible through SNAM therapy.

Etiological Profile, Targeted Levothyroxine Dosing and Impact of Partial Newborn Screening in Congenital Hypothyroidism-A Single Centre Experience.

Background: Congenital hypothyroidism (CH) is the most common cause of preventable intellectual disability. Newborn screening (NBS) for CH has been in vogue in many parts of the world since 1970, but despite its well-known benefits, many developing countries including India have not been able to establish universal NBS for CH till date. Objective: The aim of this study was to review the clinical aspects of congenital hypothyroidism in a tertiary care university referral teaching hospital, focusing on aetiology of CH, predictors of permanence, optimal targeted dose strategies based on aetiology and the effect of newborn screening on the time to diagnosis. Material and Methods: The electronic medical records of 233 children with CH referred to our centre between January 2009 and December 2019 were analysed. A partial NBS was established in the state in 2012. Results: Dyshormonogenesis (57.5%) was the most common aetiology of CH. The incidence of transient CH in children with a gland in situ (GIS) was 35%. Levothyroxine (LT-4) dose of >2.75 µg/kg/day (sensitivity 76.5, specificity 72), >2.15 µg/kg/day (sensitivity 82.4, specificity 61.9) and >1.85 µg/kg/day (sensitivity 76.5, specificity 61.9) at years 1, 2 and 3, respectively, were predictors of permanent CH. An initial LT-4 dose ≥8 µg/kg was sufficient and very seldom led to undertreatment in children with dyshormonogenesis. On the contrary, even doses ≥13 mcg/kg/day led to frequent undertreatment in children with thyroid dysgenesis. After the introduction of newborn screening, the median age at diagnosis came down from 45 days (IQR 14-180 days) to ten days (IQR 3-12 days). Conclusion: Targeted dosing based on aetiology of CH may be more appropriate to optimise outcomes. The time to diagnosis of CH reduced significantly after the adoption of even a partial NBS program highlighting the urgent need for implementation of the same in resource poor settings.