Baseline findings of a multicentric ambispective cohort study (2021-2022) among hospitalised mucormycosis patients in India.

In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.

Graphene-Coated Halloysite Nanoclay Membrane for the Enhanced Separation of Hydrogen from a Hydrogen-Helium Mixture.

This study highlights the separation of hydrogen from H2-He mixture gas by a graphene-coated halloysite nanoclay membrane. The graphene-coated clay membrane along with its pure clay counterpart is successfully developed and studied for gas separation using hydrogen (H2)-helium (He) single and mixture gases. Hydrothermal and nonhydrothermal methods were applied for the synthesis of a ″coated″ membrane on a porous alumina substrate from the graphene and halloysite clay. To date, nanoporous zeolites are the potential materials for gas separation based on a molecular sieving mechanism. A similar separation mechanism for hydrogen and helium from mixture gases may not work efficaciously due to the closeness of their kinetic diameter (H2: 2.89 Å and He: 2.6 Å). The presence of defects and torn nanopores between graphene layers along with the different surface charges of the inner and outer layer of halloysite nanotubes facilitates the ″coated″ membrane to show an appreciable H2/He separation factor of ∼4 using H2-He (1:1) mixture gas compared to 2.86 for the pure halloysite membrane. The available charge layer of graphene also has a significant contribution for this increased H2/He selectivity value. The permeate flux of H2 and He through both the graphene-coated clay membrane and pure clay membrane has also been noted. The permeate flux of pure H2 and He was 2 × 10-7 and 1.3 × 10-7 mol m-2 s-1 Pa-1 for the clay membrane, whereas for the ″coated″ clay membrane, the values changed to 0.1 × 10-7 and ∼0.05 × 10-7 mol m-2 s-1 Pa-1 at 100 kPa, respectively.

Sex-Cord Tumor with Annular Tubules with Unusual Morphology in an Infant with Peutz-Jeghers Syndrome.

Background Peutz-Jeghers syndrome (PJS) is characterized by hamartomatous gastrointestinal polyposis, mucocutaneous pigmentation and cancer predisposition. The clinical features of PJS manifest in first two decades of life; however, neonatal presentation is uncommon. Case report: We present a five day old girl with PJS that presented with obstructive hamartomatous polyps in the sigmoid colon. At colostomy closure at six months, an incidental ovarian sex-cord tumor with annular tubules (SCTAT) was detected. It showed predominantly a solid pattern with limited tubule formation and was composed of lipid-rich cells. She had no hormonal symptoms. Conclusion: SCTAT can occur as young as six months of age in PJS, and may show histologic overlap with lipid-rich Sertoli cell tumors.

Communicating climate change findings from IPCC reports: insights from outreach events in India.

In recent years, the Intergovernmental Panel on Climate Change (IPCC) has been collaborating with Indian institutions to organise outreach events. This essay draws on the perspective of participants, speakers and organisers of 17 in-person outreach events conducted across India in 2018 and 2020, to share insights and recommendations for future IPCC events in India and other developing country contexts. The formats analysed in this essay range from panel events with very large public audiences to more focused workshops, meetings and seminars. Target audiences covered both academic and non-academic audiences and included researchers, teachers, students, industry and NGOs. The events, while achieving their main objective of communicating the findings of IPCC reports, also provided a platform for open discussion of localised climate impacts and good practices in adaptation and mitigation. There are, however, notable challenges to public outreach in India, specifically in terms of attracting an adequate number of participants, experts' availability, communicating to a diverse audience and translation into local languages. The biggest challenge faced by speakers was a lack of knowledge about the number of attendees and the composition of the audience prior to an event. It is our recommendation that future outreach events in India are designed to be interactive, tailored to the regional context and complemented by simplified communication materials. Speakers should be provided with audience information and background prior to the event, and greater reach into rural areas, including school children, could be achieved with material in local languages. Additionally, event organisers often require logistical and operational support to host outreach events.

Development of LTA zeolite membrane from clay by sonication assisted method at room temperature for H2-CO2 and CO2-CH4 separation.

In this work, sodium aluminosilicate zeolite powder and membranes were synthesized by ultrasonic irradiation at room temperature using montmorillonite clay as precursor material. For comparison, same zeolite powder and membranes were synthesized at 100 °C also. The synthesized zeolites were characterized by X-ray diffraction (XRD), infrared (IR) spectral analysis, and field-emission scanning electron microscopy (FESEM). XRD and IR results showed that phase pure mainly LTA phase was formed after 15 days of aging at room temperature. By using the zeolite powders as seeds, membranes were synthesized on clay alumina support tubes at room temperature and also at 100 °C. In both the cases membranes were formed on support surface. The membrane thickness was found to be 15 µm. The performances of the membranes were evaluated by single gas as well as mixture gas permeation measurement for H2-CO2 and CO2-CH4 respectively. The H2-CO2 and CO2-CH4 separation selectivity for the mixture gas of the membrane was found to 16.2 and 20.9 at room temperature respectively. To the best of our knowledge, there is no report of synthesis of zeolite membrane at room temperature using clay as raw materials. For the first time we have reported the synthesis of alumino-silicate zeolite membrane on clay alumina support surface using clay as starting material by sonochemical method at room temperature.

Ultrasonic assisted synthesis of Bikitaite zeolite: A potential material for hydrogen storage application.

Li containing Bikitaite zeolite has been synthesized by an ultrasound-assisted method and used as a potential material for hydrogen storage application. The Sonication energy was varied from 150W to 250W and irradiation time from 3h to 6h. The Bikitaite nanoparticles were characterized by X-ray diffraction (XRD), infrared (IR) spectral analysis, and field-emission scanning electron microscopy (FESEM) thermo-gravimetrical analysis and differential thermal analysis (TGA, DTA). XRD and IR results showed that phase pure, nano crystalline Bikitaite zeolites were started forming after 3h irradiation and 72h of aging with a sonication energy of 150W and nano crystalline Bikitaite zeolite with prominent peaks were obtained after 6h irradiation of 250W sonic energy. The Brunauer-Emmett-Teller (BET) surface area of the powder by N2 adsorption-desorption measurements was found to be 209m2/g. The TEM micrograph and elemental analysis showed that desired atomic ratio of the zeolite was obtained after 6h irradiation. For comparison, sonochemical method, followed by the hydrothermal method, with same initial sol composition was studied. The effect of ultrasonic energy and irradiation time showed that with increasing sonication energy, and sonication time phase formation was almost completed. The FESEM images revealed that 50nm zeolite crystals were formed at room temperature. However, agglomerated particles having woollen ball like structure was obtained by sonochemical method followed by hydrothermal treatment at 100°C for 24h. The hydrogen adsorption capacity of Bikitaite zeolite with different Li content, has been investigated. Experimental results indicated that the hydrogen adsorption capacities were dominantly related to their surface areas as well as total pore volume of the zeolite. The hydrogen adsorption capacity of 143.2c.c/g was obtained at 77K and ambient pressure of (0.11MPa) for the Bikitaite zeolite with 100% Li, which was higher than the reported values for other zeolites. To the best of our knowledge, there is no report on the synthesis of a Bikitaite zeolite by sonochemical method for H2 storage.

Delayed migration of a bullet from loin to scrotum.

Here, we report a rare case of migration of a foreign body has occurred from loin to scrotum. A 35-year-old male patient presented with right sided scrotal mass, on exploration it was found to be a metallic bullet. The patient had a history of gunshot injury in his loin 8 years back and was treated conservatively that time. The probable explanation to this mysterious incident may be that, the bullet might have entered the peritoneal cavity through the loin, but did not cause any extensive damage, so the patient well responded to the initial conservative management. With time, due to changes in abdominal pressure or may be due to gravitational force, it had migrated to the dependent scrotum through the patent processus vaginalis. So, this case signifies that a foreign body can migrate through the body planes and get settled far from the primary place.

Comparing Ksharasutra (Ayurvedic Seton) and open fistulotomy in the management of fistula-in-ano.

BACKGROUND: Most commonly practiced surgical "lay open" technique to treat fistula-in-ano (a common anorectal pathology) has high rate of recurrence and anal incontinence. Alternatively, a nonsurgical cost efficient treatment with Ksharasutra (cotton Seton coated with Ayurvedic medicines) has minimal complications. In our study, we have tried to compare these two techniques. MATERIALS AND METHODS: A prospective randomized control study was designed involving patients referred to the Department of General Surgery in RG Kar Medical College, Kolkata, India, from January 2010 to September 2011. RESULTS: Among 50 patients, 26 were in Ksharasutra and 24 were in fistulotomy group. 86% patients were male and 54% of the patients were in the fourth decade. About 74% fistulas are inter-sphincteric and 26% were of trans-sphincteric variety. Severe postoperative pain was more (7.7% vs. 25%) in fistulotomy group, while wound discharge was more associated with Ksharasutra group (15.3% vs. 8.3%). Wound scarring, bleeding, and infection rate were similar in both groups. Ksharasutra group took more time to heal (mean: 53 vs. 35.7 days, P = 0.002) despite reduced disruption to their routine work (2.7 vs. 15.5 days work off, P <0.001). Interestingly, pain experienced was less in Ksharasutra group, there was no open wound in contrast to fistulotomy and it was significantly cost effective (Rupees 166 vs. 464). CONCLUSION: Treatment of fistula-in-ano with Ksharasutra is a simple with low complications and minimal cost.

Mercaptoundecanoic acid capped palladium nanoparticles in a SAPO 34 membrane: a solution for enhancement of H2/CO2 separation efficiency.

In this work, the high quality Pd/SAPO 34 membranes were grown on the support using a secondary (seeded) growth hydrothermal technique followed by insertion of 11-mercaptoundecanoic acid capped palladium (MUA-Pd) nanoparticles (NPs) to the membrane surface. For this, first, the indigenous low cost clay-alumina support was treated with poly diallyldimethylammonium chloride (PolyDADMAC) polymer, and subsequently, a seed layer of SAPO 34 crystals was deposited homogeneously in a regular orientation. Since PolyDADMAC is a high charge density cationic polymer, it assisted in reversing the charge of the support surface and produced an attractive electrostatic interaction between the support and zeolite crystals. This may facilitate the zeolite grain orientation in the synthesized membrane layer. Here, the Pd NPs were deposited in the membrane matrix by a simple dip-coating method. After thermal treatment of the Pd/SAPO 34 membrane, the defects were formed because of the removal of the structure-directing agent (SDA) from the zeolite pores but the presence of Pd NPs, which were entrapped inside the nonzeolitic pores and clogged the defects of the membrane. Field emission scanning electron microscopy (FESEM) and elemental mapping of the membrane cross-section confirmed that most of the Pd NPs were deposited at the interface of the membrane and the support layer which may increase the membrane efficiency, i.e., separation factor, as well as permeability of H2 through the membrane. As the membrane structure was associated with the oriented crystal, the pores were more aligned and permeation adequacy of H2 through the membrane enhanced. These membranes have a relative hydrogen permeance of 14.8 × 10(-7) mol·m(-2)·s(-1)·Pa(-1). The selectivity of H2/CO2 based on single gas permeation was 10.6, but for the mixture gas (H2/CO2 55:45), the H2/CO2 mixture separation factor increased up to 20.8 at room temperature. It is anticipated that this technique may be useful for making a defect free membrane and also a hydrogen selective Pd loaded membrane with lower cost (as the quantity of Pd is low) which can be utilized for a "clean energy" related application.

Synthesis of NaP zeolite at room temperature and short crystallization time by sonochemical method.

NaP zeolite nano crystals were synthesized by sonochemical method at room temperature with crystallization time of 3h. For comparison, to insure the effect of sonochemical method, the hydrothermal method at conventional synthesis condition, with same initial sol composition was studied. NaP zeolites are directly formed by ultrasonic treatment without the application of autogenous pressure and also hydrothermal treatment. The effect of ultrasonic energy and irradiation time showed that with increasing sonication energy, the crystallinity of the powders decreased but phase purity remain unchanged. The synthesized powders were characterized by XRD, IR, DTA TGA, FESEM, and TEM analysis. FESEM images revealed that 50 nm zeolite crystals were formed at room temperature by using sonochemical method. However, agglomerated particles having cactus/cabbage like structure was obtained by sonochemical method followed by hydrothermal treatment. In sonochemical process, formation of cavitation and the collapsing of bubbles produced huge energy which is sufficient for crystallization of zeolite compared to that supplied by hydrothermal process for conventional synthesis. With increasing irradiation energy and time, the crystallinity of the synthesized zeolite samples increased slightly.

Evaluation of customer satisfaction level of different projects.

Customer satisfaction as the key element for success in business is a major concern for any industry. In this paper we propose a customer satisfaction index using principal component analysis for a software solution company. This index was used as an input to the marketing division to identify their potential customers from their past experience. Since this is a very common problem for any industry, the same approach can be used in similar situations.