Transformative weight loss with Dulaglutide: A case report of success in a challenging patient profile of an ex-sumo wrestler.

Key Clinical Message: Dulaglutide is a relatively unpopular GLP-1 receptor agonist used for weight loss. This case demonstrates that dulaglutide may be beneficial for weight loss in morbidly obese patients with multiple comorbidities after thoroughly evaluating its efficacy, benefits, and long-term adverse effects through clinical trials. Abstract: We present a case of a 27-year-old ex-sumo wrestler with bipolar II disorder, morbid obesity, hypertension, Type 2 Diabetes Mellitus (DM), and a Body Mass Index (BMI) of 49.66 kg/m2. He was non-compliant with lifestyle modifications and resistant to conventional treatments, including metformin, and was also using multiple antipsychotic drugs. After introducing dulaglutide, he achieved a 40 kg (-21%) weight loss and a BMI reduction of 10.3 kg/m2 over 6 months, with no side effects and improved glycemic control, demonstrating dulaglutide's efficacy for weight loss in such challenging presentations.

Spatiotemporal distribution of cyanobacteria in relation to water chemistry of Sutlej River, Punjab (India).

In this investigation, the spatiotemporal distribution of cyanobacteria and their relationships with variations in water chemistry (physico-chemical parameters and heavy metal) of Sutlej River, Punjab (India) has been analyzed by employing multivariate statistical methods. Sutlej River exhibits a rich array of cyanobacterial diversity, comprising 28 species across 15 genera, distributed among 11 families and spanning 5 orders within the class Cyanophyceae. In terms of relative abundance, Microcystis aeruginosa (17.47%) was documented as the most abundant taxa followed by Microcystis robusta (16.55%), Merismopedia punctata (11.03%), Arthrospira fusiformis (6.67%) and Pseudanabaena galeata (3.68%). Significant variations were observed among sampling sites in most of the physico-chemical parameters. Principal Component Analysis delineated sampling sites into two discernible groups according to variations in water chemistry. River Pollution Index (RPI) showed that river water is under the unpolluted (RPI 1.5) to negligibly polluted category in the upstream sites, while moderately polluted (RPI 5.5) in the downstream sites. Heavy metal Pollution Index (HPI) revealed consistent heavy metal contamination at sites RWS7 and RWS8 across all seasons. Conversely, site RWS1 consistently exhibited lower HPI values throughout the three studied seasons. Further, Canonical Correspondence Analysis identified that pH, TDS, TA, NO3, Na, and NH4 are the key physicochemical parameters which affect the spatiotemporal distribution of cyanobacteria in the studied river system. Overall, this study will offer significant information for hydrologists, ecologists, and taxonomists to develop future holistic strategies for further monitoring of the Sutlej River and other similar habitats.

Demographic and clinical profile of patients undergoing colonoscopy at a tertiary care center in Nepal: a retrospective cross-sectional study.

Background: Colonoscopy is widely used as a tool for diagnosis, screening and treatment of various pathologies in the rectum, colon, and terminal ileum. The aim of this study is to evaluate the demographic, clinical, and histological parameters of the records of patients undergoing colonoscopy at a tertiary care hospital in Nepal. Materials and methods: This retrospective cross-sectional study included the hospital records of all patients who underwent colonoscopy from 2015 to 2019 in a tertiary care centre in Nepal. Results: A total of 1255 records were included in the study. The mean and standard deviation of age were 43.8 and 19 years, respectively. Among the total study population, 61.9% were males and 38.1% were females. Common indications for colonoscopy included lower gastrointestinal bleeding (27.7%), altered bowel habit (26.9%) and persistent or recurrent abdominal pain (17.3%). Only 3% of the patients who underwent colonoscopy had inadequate bowel preparation. The overall diagnostic yield of colonoscopy was 57.5%. Findings during colonoscopy included colorectal polyp (19.4%), internal haemorrhoids (8.2%) and colitis (6.5%). Having an age of 50 or more years was significantly associated with the presence of colorectal adenocarcinoma (P=0.017, χ2 test) with an odds ratio of 2.35 (95% CI: 1.14, 4.89). Furthermore, having a female sex was found to be significantly associated with the presence of colorectal adenocarcinoma (P=0.012, χ2 test) with an odds ratio of 2.43 (95% CI: 1.19, 4.97). Conclusion: In the authors' study, a smaller proportion of the colonoscopies was aimed at screening for colorectal carcinoma (CRC), when compared to studies in developed countries. The sex predisposition of CRC in the authors' study is in contrast to the global trend. The authors recommend conducting studies to determine the risk factors and need for CRC screening in the Nepalese population.

Precise irrigation water and nitrogen management improve water and nitrogen use efficiencies under conservation agriculture in the maize-wheat systems.

A 3-year field experiment was setup to address the threat of underground water depletion and sustainability of agrifood systems. Subsurface drip irrigation (SDI) system combined with nitrogen management under conservation agriculture-based (CA) maize-wheat system (MWS) effects on crop yields, irrigation water productivity (WPi), nitrogen use efficiency (NUE) and profitability. Grain yields of maize, wheat, and MWS in the SDI with 100% recommended N were significantly higher by 15.8%, 5.2% and 11.2%, respectively, than conventional furrow/flood irrigation (CT-FI) system. System irrigation water savings (~ 55%) and the mean WPi were higher in maize, wheat, and MWS under the SDI than CT-FI system. There was saving of 25% of fertilizer N in maize and MWS whereas no saving of N was observed in wheat. Net returns from MWS were significantly higher (USD 265) under SDI with 100% N (with no subsidy) than CT-FI system despite with higher cost of production. The net returns were increased by 47% when considering a subsidy of 80% on laying SDI system. Our results showed a great potential of complementing CA with SDI and N management to maximize productivity, NUE, and WPi, which may be economically beneficial and environmentally sound in MWS in Trans-IGP of South Asia.

A Fire Incident Case at a Radiodiagnostic Center of a Tertiary Care Hospital: Methods for Reduction in Fatality by Smoke Evacuation.

For the general public, healthcare facilities are always a safe and secure place for treatment. Generally, healthcare institutions are equipped to deal with exterior interruptions, but circumstances brought on by internal risks are more serious and frequently require an emergency evacuation of the facility. An incident happened at the radiodiagnostic setup of a tertiary care institute in North India. This fire incident created panic among staff and patients. At the place of casualty, there were around 150 persons, including staff, patients, and their attendants. Immediately after the confirmation of the fire incident, the fire department and security department took action in the form of fire control and smoke evacuation. Though six fire handling staff required minor emergency services for asphyxia due to smoke inhalation and were cured by oxygen support only, none of the patients was affected due to timely smoke evacuation. Most often, smoke management techniques implemented are compartmentation, pressurization, dilution, ventilation, buoyancy, and airflow. So, we concluded that the step of timely smoke evacuation and preventing the spread of smoke by various methods help to reduce fatality due to smoke. The training programs and mock drills give stakeholders the needed knowledge, skills, and practice they need to safeguard patients and employees.

Anticoagulation failure in pulmonary thromboembolism in COVID-19 pneumonia despite prolonged anticoagulation: A case series.

Introduction: Moderate to severely ill patients diagnosed with Coronavirus disease 2019 (COVID-19) pneumonia develop a series of complications and less frequently, we might witness cases of Pulmonary Thromboembolism (PE)-refractory to the standard treatment with Low Molecular Weight Heparin (LMWH). The aim of this case series is to report the presentation and management of pulmonary thromboembolism secondary to COVID-19 pneumonia. Method: We report a case series of seven cases aged 40-70 who were presented in Dhulikhel Hospital with COVID-19 symptoms in different stages. The case details were extracted from their medical reports of the hospital. The written informed ethical consents were obtained from all the cases and their voluntary participation was assured. Outcome: The cases in the case series admitted with COVID-19 pneumonia, after diagnostic investigation (Chest x-ray, HRCT, CTPA) were suggestive of COVID-19 Pneumonia with ARDS and pulmonary thromboembolism. The cases received rivaroxaban, a newer anticoagulant-15 mg twice daily for 21 days and after discharge, they were asked to continue once daily doses for 9 weeks. Significant improvement was witnessed, with the presence of additional intervention including rehabilitative chest exercises. Conclusion: Pulmonary thromboembolism secondary to COVID-19 pneumonia is a life-threatening condition. Rivaroxaban is seen to be very effective in the management of this condition when an anticoagulation failure occurs even after the therapeutic dose of low molecular weight heparin. Future studies may require more scientific investigations to prevent complications even in the early stages of COVID-19.

Implementation of Taguchi and Genetic Algorithm Techniques for Prediction of Optimal Part Dimensions for Polymeric Biocomposites in Fused Deposition Modeling.

Additive manufacturing has gained popularity among material scientists, researchers, industries, and end users due to the flexible, low cost, and simple manufacturing process. Among number of techniques, fused deposition modeling (FDM) is the most recognized technology due to easy operation, lower environmental degradation, and portable apparatus. Despite numerous advantages, the limitations of this technique are poor surface finish, dimensional accuracy, and mechanical strength, which must be improved. The present study focuses on the implementation of the genetic algorithm and Taguchi techniques to achieve minimum dimensional variability of FDM parts especially for polymeric biocomposites. The output has been measured using standard testing techniques followed by Taguchi and genetic algorithm analyses. Four response variables were measured and were converted into single variable with combination of different weightages of each response. Maximum weightage was given to width of FDM polymeric biocomposite parts which may play critical role in biomedical and aerospace applications. The advanced optimization and production techniques have yielded promising results which have been validated by advanced algorithms. It was found that layer thickness and orientation angle were significant parameters which influenced the dimensional accuracy whereas best fitness value was 0.377.

A Diagnostic Dilemma in Fine-Needle Aspiration Cytology: Spindle Cell/Pleomorphic Lipoma.

Pleomorphic lipoma is an uncommon, pseudosarcomatous lesion. It is characterized by the pleomorphic appearance on cytology and histology, follows a benign course, with a low rate of recurrence after complete excision, and has no risk of metastasis. Here, we describe a case of pleomorphic lipoma/spindle cell lipoma in a 41-year-old man who presented with a slow-growing mass on the inner aspect of the left thigh. On fine-needle aspiration cytology, it was reported as a cellular nerve sheath tumour followed by a wide excision sample sent for histopathological examination, which revealed spindle cells exhibiting pleomorphism with mature adipocytic cells and multinucleated floret cells in a myxoid background. It was reported as pleomorphic lipoma on histological examination.

Evaluation of growth and carotenoid production by a green microalga Scenedesmus quadricauda PUMCC 4.1.40. under optimized culture conditions.

Microalgae are a potential source of a wide range of food and novel value-added products. The versatility of microalgae to produce different kind of pigments is gaining interest as a sustainable source of natural carotenoids. Currently, commercial production of carotenoids from selected microalgae requires special culture conditions which are difficult to maintain. The present study has been undertaken to optimize culture conditions for growth and carotenoid production by a new isolate Scenedesmus quadricauda PUMCC 4.1.40. The results revealed that test organism produced 1.54 mg dry biomass/ml with a content of 40 µg carotenoids/mg dry biomass during stationary phase. The growth and carotenoid production was increased by 2.4-fold under combined optimized culture conditions. The optimized conditions were growth medium, Chu-10; pH 8.5; temperature, 30°C; nitrogen, 20 mM nitrate; phosphate, 0.22 mM; NaCl, 0.42 mM and blue light. Separation and identification of four important carotenoids through high-performance thin-layer chromatography (HPTLC) followed by purification using flash chromatography and quantification by HPLC revealed 23.8, 19.0, 6.5, and 4.0 µg astaxanthin, ß-carotene, lutein, and canthaxanthin /mg dry biomass, respectively. The amount of total carotenoids (98 µg/mg dry biomass) containing 40% valuable astaxanthin and ß-carotene produced under optimized conditions was significantly higher than control cultures. This justifies that S. quadricauda is a promising candidate for scale-up production of carotenoid.

Assessment of water quality condition and spatiotemporal patterns in selected wetlands of Punjab, India.

Wetlands are one of the most productive aquatic ecosystems on earth, and their water quality is an indicative of their suitability for maintaining various ecosystem services. In this study, different statistical techniques and water quality index (WQI) were employed to access the status and spatiotemporal patterns in water quality of seven selected (two natural and five manmade) wetlands of Punjab. The results revealed that the status of water quality in the selected wetlands was between good and poor during studied seasons (summer, monsoon, and winter) of year 2019. The principal component analysis identified three groups of wetlands with distinct water quality characteristics with spatial patterns: Kahnuwan Chhamb and Keshopur Miani having nearly similar values of pH, total dissolve salts, electrical conductivity, chemical oxygen demand, total alkalinity, bicarbonate and ammonium content; Ropar, Kanjli, and Harike having higher value of nutrients than the other wetlands; and Ranjit Sagar and Nangal with low value of measured water quality characteristics. Further, analysis of variance revealed that all analyzed water quality parameters showed temporal patterns in water quality except water pH, electrical conductivity, dissolved oxygen, biological oxygen demand, and phosphate content. This comparative study enhanced our knowledge about the spatiotemporal patterns in water quality and in the future will be helpful to the policymakers and concerned authorities for developing better water quality management strategies for these wetlands.

Rice straw biochar application to soil irrigated with saline water in a cotton-wheat system improves crop performance and soil functionality in north-west India.

Applications of biochar to degraded soils have attracted considerable interest because of its capacity to enhance nutrients availability to the plants, sequester C and immobilize organic and inorganic pollutants. A five-year field experiment was conducted in a cotton-wheat system to investigate the effect of different levels of irrigation water salinity (0.3, 5, 10, and 15 dS m-1) and rice straw biochar (0, 2, 4, and 8 t ha-1) on the crop yield and soil functions. Rice straw-derived biochar was applied every year to cotton and its residual effect was observed on wheat. Results of the study indicated that regular irrigation with saline water (5-15 dS m-1) reduced both seed cotton (12-44%) and wheat grain (7-27%) yield. However, application of biochar (2-8 t ha-1) to plots irrigated with saline water showed 6-23% and 13-27% greater seed cotton and wheat grain yield compared with unamended plots, respectively. Likewise, biochar application to soil irrigated with canal or saline water showed significant beneficial effects on soil pH, EC, nutrient metabolism and availability, bulk density, infiltration rate and microbial biomass carbon. Our results indicated that biochar amendment especially at the optimum rate of 4 t ha-1 effectively promoted crop performance by ameliorating soil physical, chemical, and biological properties. In the absence of any chemical amendment for alleviating salinity stress, the results of the present study established that the biochar holds promising potential as a soil amendment in ameliorating soil functions and promoting plant productivity under saline water irrigated conditions.

Bacterial Communities Associated with the Biofilms Formed in High-Altitude Brackish Water Pangong Tso Located in the Himalayan Plateau.

Pangong Tso is a long and narrow lake situated at an altitude of ~ 4266 m amsl in the Himalayan Plateau on the side of the India/China border. Biofilm has been observed in a small area near the shore of Pangong Tso. Bacterial communities of the lake sediment, water and biofilms were studied using amplicon sequencing of V3-V4 region of the 16S rRNA gene. The standard QIIME pipeline was used for analysis. The metabolic potential of the community was predicted using functional prediction tool Tax4Fun. Bacterial phyla Proteobacteria, followed by Bacteroidetes, Acidobacteria, Planctomycetes, Actinobacteria, and Firmicutes, were found to be dominant across these samples. Shannon's and Simpson's alpha diversity analysis revealed that sediment communities are the most diverse, and water communities are the least diverse. Principal Coordinates based beta diversity analysis showed significant variation in the bacterial communities of the water, sediment and biofilm samples. Bacterial phyla Verrucomicrobia, Deinococcus-Thermus and Cyanobacteria were explicitly enriched in the biofilm samples. Predictive functional profiling of these bacterial communities showed a higher abundance of genes involved in photosynthesis, biosynthesis of secondary metabolites, carbon fixation in photosynthetic organisms and glyoxylate and dicarboxylate metabolism in the biofilm sample. In conclusion, the Pangong Tso bacterial communities are quite similar to other saline and low-temperature lakes in the Tibetan Plateau. Bacterial community structure of the biofilm samples was significantly different from that of the water and sediment samples and enrichment of saprophytic communities was observed in the biofilm samples, indicating an important succession event in this high-altitude lake.

Conservation Agriculture-based Sustainable Intensification of Cereal Systems Leads to Energy Conservation, Higher Productivity and Farm Profitability.

In the Indo-Gangetic Plains of South Asia, the quadruple challenges of deteriorating soil quality, declining groundwater, energy shortages, and diminishing farm profitability threaten sustainability of conventional till (CT)-based cereal production systems. A 5-year study was conducted to evaluate the effect of conservation agriculture (CA)-based management (tillage, crop establishment, residue management, and system intensification through mungbean integration) on energy budget, water productivity, and economic profitability in cereal (rice-wheat, RW/maize-wheat, MW)-based systems compared with CT-based management. In CA systems, crop residues contributed the maximum (~76%) in total energy input (167,995 MJ ha-1); however, fertilizer application (nonrenewable energy source) contributed the maximum (43%) in total energy input (47,760 MJ ha-1) in CT-based systems. CA-based cereal (rice/maize) systems recorded higher net energy and energy-intensiveness (EI) levels of 251% and 300%, respectively, compared with those of the CT-based rice-wheat system (RW/CT) (295,217 MJ ha-1 and 46.05 MJ USD-1), irrespective of mungbean integration. MWMb/ZT+R utilized 204% more input energy, which resulted in 14% higher net energy and 229% higher EI compared with RW/CT. CA-based RW and MW systems enhanced the crop productivity by 10 and 16%, water productivity by 56 and 33%, and profitability by 34 and 36%, while saving in irrigation water by 38 and 32%, compared with their respective CT-based systems, respectively. CA-based system improved net energy, crop productivity, and profitability; therefore, it should be outscaled to improve the soil and environmental quality in north-west India.

Biogenic synthesis of silver nanoparticles using cyanobacterium Leptolyngbya sp. WUC 59 cell-free extract and their effects on bacterial growth and seed germination.

The biogenic synthesis of metal nanoparticles (NPs) is of great significance, as it renders clean, biocompatible, innocuous and worthwhile production. Here, we present a clean and sustainable route for the synthesis of silver nanoparticles (Ag NPs) using the cell-free aqueous extract of the cyanobacterium Leptolyngbya sp. WUC 59, isolated from polluted water and identified using a polyphasic approach. The conformation and characterisation of the as-synthesized biogenic Ag NPs was carried out using various sophisticated techniques like UV-visible (UV-Vis), X-ray diffraction (XRD), Fourier transform infrared (FTIR), energy dispersive X-ray spectroscopy (EDS) and high-resolution transmission electron microscopy (HRTEM). The sharp colour change and emergence of a characteristic peak at 430 nm in the UV-Vis spectrum confirm the formation of the Ag NPs. The morphological and physical appearance indicated that the synthesized Ag NPs are crystalline with a typical size of 20-35 nm. Furthermore, the bio-reduced nanoparticles were explored for their antibacterial activity against Bacillus subtilis and Escherichia coli bacteria, seed germination effects and early seedling growth of wheat (Triticum aestivum L.). The Ag NPs significantly suppressed the growth of both Bacillus subtilis and Escherichia coli bacteria with the treatment of 10 mg L-1 concentration within the initial 3 hours. The lower concentration (25 mg L-1) of the synthesized Ag NPs significantly enhanced the seed germination and early seedling growth of wheat in comparison to the control on the 4th and 8th day. The present investigations show that the use of the cyanobacterium Leptolyngbya sp. WUC 59 provides a simple, cost-effective and eco-friendly tool for the synthesis of Ag NPs. Moreover, it could have great potential for use as an alternative to chemical-based bactericides not only in pharmaceutical industries, but also to control bacterial diseases in agricultural crops.

Four-dimensional joint visualization of electrode degradation and liquid water distribution inside operating polymer electrolyte fuel cells.

Understanding of degradation mechanisms present in polymer electrolyte fuel cells (PEFCs) is important to continue the integration of this clean energy technology into everyday life. Further comprehension of the interaction between various components during fuel cell operation is also critical in this context. In this work, a four-dimensional operando X-ray computed tomography method is developed for combined visualization of all PEFC components as well as transient water distribution residing in the cell, which results as a by-product of the electrochemical reaction. Time resolved, identical-location visualization through degradation stages is uniquely enabled by the non-invasive and non-destructive qualities of this method. By applying an accelerated stress test that targets cathode catalyst layer (CCL) corrosion, novel observations resulting from morphological changes of the CCL such as reduction in the water volume in the adjacent gas diffusion layer, CCL crack formation and propagation, membrane swelling, as well as quantification of local carbon loss is achieved. Additionally, insight into features that contribute to reduced fuel cell performance is enabled by the use of this specialized imaging technique, such as increased membrane undulation causing delamination and separation of the CCL from the microporous layer, which greatly affects liquid water pathways and overall device performance.

Incidence, predictors, and long term clinical outcome of angiographic definite stent thrombosis in real world scenario - A prospective cohort study.

BACKGROUND: The occurrence of stent thrombosis (ST) in real world scenario is far different from that mentioned in the literature. Our study identifies the various parameters of ST. METHODS: This is a prospective observational-cohort study where-in consecutive patients who received successful percutaneous transluminal angioplasty (PTCA) over the study period of 1-year was included and were followed for 1-year from the primary procedure. RESULTS: The overall incidence of definite ST was 1.4% and 1.7% at 30 days and 1 year respectively. The most common mode of presentation of ST was ST-elevation myocardial infarction (82.6%). The history of prior PTCA, multi-vessel disease, emergent PTCA, acute coronary syndrome and type B2/C lesions were found to be the independent predictors for definite ST. The incidence of late ST was significantly higher with bare metal stent (BMS) than drug-eluting stent (DES) (OR-2.4, 95% CI:1.3-4.5). At mean follow-up of 13.9 months after ST, the overall mortality was 36.9%. The independent predictors of mortality after ST were post-PTCA thrombolysis in myocardial infarction (TIMI) flow grade < 3, and cardiogenic shock at the time of presentation. CONCLUSION: The overall incidence of definite ST is high in the real world scenario and the DES fared better than BMS. ST carries a bad prognosis especially so if the patients present in cardiogenic shock, or unable to achieve TIMI-3 flow after PTCA.

Percutaneous coronary intervention in a rare variety of single coronary artery.

We present a case of 50-year-old male having unstable angina. A rare type of single coronary artery was identified during the Coronary angiogram. The left anterior descending (LAD) and left circumflex artery (LCX) had originated from the proximal segment of right coronary artery along with significant lesion in LCX. Computed tomographic (CT) coronary angiogram confirmed the origin and course following which successful percutaneous coronary intervention (PCI) was done to LCX. The incidence of this type of coronary anomaly is 0.004%. We emphasize the importance of having a CT coronary angiogram to identify the course before the intervention. The procedural risk during PCI in patients with single coronary ostium is high. Moreover, the angulation and course of the culprit artery also pose a challenge. Good coaxial guide support by using an appropriate guiding catheter is the key to success.