The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection technique.

Background: Laparoscopic Heller myotomy (LHM) can be performed by blunt dissection technique (BDT). Only a few studies have assessed long-term outcomes and relief of dysphagia following LHM. The study reviews our long-term experience following LHM by BDT. Methods: This retrospective study was analysed from a prospectively maintained database (from 2013 to 2021) of a single unit of the Department of Gastrointestinal Surgery at G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi. The myotomy was performed by BDT in all patients. A fundoplication was added in selected patients. Post-operative Eckardt score >3 was considered treatment failure. Results: A total of 100 patients underwent surgery during the study period. Of them, 66 patients underwent LHM, 27 underwent LHM with Dor fundoplication and 7 underwent LHM with Toupet fundoplication. The median length of myotomy was 7 cm. The mean operative time was 77 ± 29.27 min and the mean blood loss of 28.05 ± 16.06 ml. Five patients had intraoperative oesophageal perforation. The median length of hospital stay was 2 days. There was no hospital mortality. The post-operative integrated relaxation pressure (IRP) was significantly lower than the mean pre-operative IRP (9.78 vs. 24.77). Eleven patients developed treatment failure, of which ten patients presented with recurrence of dysphagia. There was no difference in symptom-free survival amongst various types of achalasia cardia (P = 0.816). Conclusion: LHM performed by BDT has a 90% success rate. Complication using this technique is rare, and recurrence post-surgery can be managed with endoscopic dilatation.

Lipopeptide(s) associated with human microbiome as potent cancer drug.

Human microbiota comprises of trillions of microbes which have evolved with and continued to live on/ within their human hosts. Different environmental factors and diet have a large impact upon human microbiota population. These microorganisms live in synergy with their hosts and are beneficial to the host in many different ways. Many microorganisms help to fight against human diseases. Cancer is one such diseases which effects a large human population often leading to death. Cancer is also one of the most fatal human diseases killing millions of people world-wide every year. Though many treatment procedures are available but none is 100 % effective in curing cancer. In this review, we seek to understand the role of human microbiota in cancer treatment. Lipopeptide(s) (LPs) produced by different microorganisms can act as efficient drug(s) against cancer. LPs are low molecular weight lipo-proteins that are also known for their anti-cancer activities. As human microbiota belongs to an environment within the host body, a drug prepared using these microorganisms will be easily accepted by the body. This novel approach of using LPs produced by human microbiota can be considered for the much needed change in cancer treatment. Therefore, it is proposed that research should focus on the host-microbe interaction which could pave the way in understanding role played by these microorganisms in cancer treatment.

Synthesis and Characterization of Isoindigo-Based Push-Pull Chromophores.

Symmetrical and unsymmetrical chromophores of isoindigo 3-7 were designed and synthesized, in which isoindigo was used as the central unit (electron acceptor unit A), triphenylamine as the end capping unit (electron donor group D), 1,1,4,4-tetracyanobutadiene (TCBD, A') and cyclohexa-2,5-diene-1,4-diylidene-expanded TCBD (A″) as the acceptor unit. The effects of multiacceptor units on photophysical, electrochemical, and computational studies were investigated. The photophysical properties of isoindigo 6 and 7 exhibit a strong intramolecular charge transfer (ICT) absorption band in the near IR region. The isoindigo 4-7 shows multi-redox waves with a low electrochemical band gap, which signifies the tuning of highest occupied molecular orbital-lowest unoccupied molecular orbital energy levels and enhance the π-conjugation. The computational studies demonstrate that there is a good agreement with experimental data. The molecular design and synthesis of isoindigo 4-7 gives a new avenue for the development of building blocks in organic electronics.

Ocular manifestations in patients attending antiretroviral therapy centre at a tertiary care hospital in Himachal Pradesh, India.

Background & objectives: Ocular manifestations in HIV/AIDS patients range from adnexal disorders to the posterior segment disease. This study was aimed to evaluate the ocular manifestations, including vision-threatening manifestations in HIV-positive patients attending an antiretroviral therapy centre (ART) of a tertiary care hospital in north India and its association with the CD4+ cell count. Methods: This cross-sectional study was conducted in the department of Ophthalmology in collaboration with the ART centre. An equal number of patients were selected from each year. i.e: ., 30 patients each from those registered in the year 2010 till 2015. These patients were selected randomly from the register using systematic randomization. Hence, a total of 150 patients were examined for ocular manifestations. All the patients included in this study were on highly active ART. Results: Of the 150 patients examined, 53 per cent were females and 47 per cent were males. Heterosexual transmission was the most common mode of transmission in 126 (84%) patients. Maximum number of patients was in the age group of 31-40 yr. Ocular manifestations were present in 53 [35.3%; 95% confidence interval (CI): 28-43%] patients. Twelve (8%; 95% CI: 4-12%) patients had lid and adnexal manifestations. Anterior-segment manifestations were present in 20 (13.3%; 95% CI: 8-19%) patients. Posterior-segment manifestations were present in 21 (14%; 95% CI: 8-20%) and vision-threatening posterior-segment ocular lesions were present in 14 per cent of the patients. Univariate logistic regression showed a significant (P<0.001) inverse association of CD4+T-cell count with the vision-threatening posterior-segment ocular lesions. Interpretation & conclusions: Routine ocular examination may be done in all the HIV/AIDS patients to detect and treat vision-threatening ocular lesions at the earliest.

Emphysematous pyelonephritis (class IIIa) managed with antibiotics alone.

A 54-year-old male with long-standing diabetes presented with vague left flank pain for 5 days with uncontrolled blood glucose. The patient was commenced on insulin and injectable ceftriaxone empirically, for possibly acute pyelonephritis. Ultrasound examination revealed extensive emphysematous pyelonephritis of upper half of left kidney with involvement of perinephric space. Computed tomography of abdomen confirmed the diagnosis of emphysematous pyelonephritis which was categorised as class IIIa. The recommended treatment for class IIIa emphysematous pyelonephritis is nephrectomy but the patient refused to give consent for surgery or even percutaneous drainage. Thus, the patient was continued on medical management alone and surprisingly showed marked recovery over the next few days. There were no new complications, and the patient was discharged after 2 weeks of antibiotics with 2 more weeks of oral antibiotics. After 4 months, the ultrasound showed normal kidneys. We present this case because it adds to the little existing evidence that conservative management can successfully cure patients with class IIIa emphysematous pyelonephritis, although supplementation with percutaneous drainage would have been better in this case.

Naphthalene poisoning manifesting as hemoglobinuria.

Reddish black discoloration of urine in absence of red blood cells (RBCs) can be a manifestation of hemoglobinuria or myoglobinuria. We report a patient who was admitted for persistent vomiting. On 2(nd) day of admission, his urine turned reddish black. The patient then revealed that he had ingested mothballs 1 day back to commit suicide. The patient was managed conservatively with intravenous (IV) fluids and antiemetics. Mothballs are rarely reported as a suicidal agent and most cases are related to accidental exposure of children while playing. IV hemolysis is also reported with mothball ingestion. Our patient quickly became normal within 24 h and there was no residual organ damage.

Leveraging Zero-Effort Technology for Quantification of Sleep Quality Metrics.

Sleep quality is a critical factor in human health and well-being, with implications for various physiological and psychological processes. Traditional methods of sleep data collection are often limited by the quality and reliability of the data due to issues such as recall bias and subjective interpretation. This research aims to propose a novel framework that objectively measures and evaluates sleep quality using smart thermostats equipped with motion sensors, providing noninvasive and effortless sleep monitoring. The study conducts a comprehensive analysis of sleep patterns, exploring the relationship between activity sensors and sleep quality. By analyzing behavioral characteristics, the study identifies periods or clusters of days that require attention in terms of health and stress levels. The approach ensures privacy, ease of access, and integrates environmental factors, enabling a comprehensive understanding of an individual's sleep health. The findings suggest that this zero-effort technology can significantly enhance sleep monitoring at both individual and population levels, with implications for health monitoring, stress management, and personalized healthcare interventions. Future work will focus on expanding the data set, incorporating more variables, and integrating contextual data to further improve sleep quality analysis and support real-time health interventions.

Atrial myxoma: a rare cause of ischemic stroke.

Arial myxoma can present as stroke and should be considered as a differential diagnosis of stroke in young individuals. We present here a 42 years female who presented with sudden loss of conciousness. After extensive work up for young stroke, left atrial myxoma was detected and tumor was removed surgically and histopathological report was consistent with the atrial myxoma.

Geochemistry and mobilization of arsenic in Shuklaganj area of Kanpur-Unnao district, Uttar Pradesh, India.

The level of arsenic (As) contamination and the geochemical composition of groundwater in Shuklaganj area located on the banks of the Ganges Delta of Kanpur-Unnao district were elucidated. Samples (n = 59) were collected from both India Mark II hand pumps (depth, 30-33 m) and domestic hand pump tube wells (10-12 m) located within 5 km from the banks of Ganges. Samples were analyzed for various parameters, including total inorganic As, sulfate, nitrate, alkalinity, ammonia, and iron. Hydrochemistry of the groundwater aquifer was studied through the trilinear plots between monovalent and divalent cations and anions. In Indian mark II hand pumps, arsenic concentration ranged from below detection limit to 448 µg/L. Most of the samples contained both As(III) and As(V). The pH of the samples ranged from 7.1 to 8.2. Except for a few, most of the samples were reducing in nature as evident by their negative oxidation reduction potentials. A positive correlation for arsenic with iron, ammonia, and dissolved organic carbon shows the probability of biodegradation of organic matter and reductive dissolution of Fe oxyhydroxide processes to leach As in aquifers. For confirmation of the suggested arsenic mobilization mechanism, the presence and absence of sulfate-reducing bacteria and iron-reducing bacteria were also tested.

In vitro caries-preventive effect of fluoridated orthodontic resins against cariogenic challenge stimulation.

AIM: The aim of the present study was to evaluate the in vitro caries preventive effect of fluoridated orthodontic resins under pH cycling with two types of acid demineralizing saliva. MATERIALS AND METHODS: Brackets were bonded to 120 extracted human premolars, using Rely-a-bond (n = 40), Tru- Bond (n = 40) and Ortho-one (n = 40) orthodontic bonding agents. Each group of resin was divided into 2 subgroups (n = 20): immersion in remineralizing artificial saliva for 14 days and acid saliva with pH 4.3. After 14 days of pH cycling the caries preventive effect on the development of white spot lesion was evaluated considering the presence of inhibition zones to white spot lesions using two scores: 0 = absence and 1 = presence. Kruskal-Wallis ANOVA and Mann-Whitney U tests were used. RESULTS: Formation of white spot lesions was observed only under pH cycling using acid saliva with pH 4.3; with Rely-a-bond and Tru-Bond being significantly more effective in preventing the appearance of white spot lesions effect than Ortho-one. CONCLUSION: The acidity of the demineralizing solution influenced the formation of white spot lesions around orthodontic brackets under highly cariogenic conditions. Rely-a-bond and Tru-bond presented higher caries-preventive effect than Orthoone. CLINICAL SIGNIFICANCE: The development of fluoride-containing materials cannot be regarded as a permanent means to control dental caries lesions, but a complement along with other preventive methods.

An Insight in Developing Carrier-Free Immobilized Enzymes.

Enzymes play vital roles in all organisms. The enzymatic process is progressively at its peak, mainly for producing biochemical products with a higher value. The immobilization of enzymes can sometimes tremendously improve the outcome of biocatalytic processes, making the product(s) relatively pure and economical. Carrier-free immobilized enzymes can increase the yield of the product and the stability of the enzyme in biocatalysis. Immobilized enzymes are easier to purify. Due to these varied advantages, researchers are tempted to explore carrier-free methods used for the immobilization of enzymes. In this review article, we have discussed various aspects of enzyme immobilization, approaches followed to design a process used for immobilization of an enzyme and the advantages and disadvantages of various common processes used for enzyme immobilization.

Combination of classical and statistical approaches to enhance the fermentation conditions and increase the yield of Lipopeptide(s) by Pseudomonas sp. OXDC12: its partial purification and determining antifungal property.

Around 200 different lipopeptides (LPs) have been identified to date, most of which are produced via Bacillus and Pseudomonas species. The clinical nature of the lipopeptide (LP) has led to a big surge in its research. They show antimicrobial and antitumor activities due to which mass-scale production and purification of LPs are beneficial. Response surface methodology (RSM) approach has emerged as an alternative in the field of computational biology for optimizing the reaction parameters using statistical models. In the present study, Pseudomonas sp. strain OXDC12 was used for production and partial purification of LPs using Thin Layer Chromatography (TLC). The main goal of the study was to increase the overall yield of LPs by optimizing the different variables in the fermentation broth. This was achieved using a combination of one factor at a time (OFAT) and response surface methodology (RSM) approaches. OFAT technique was used to optimize the necessary parameters and was followed by the creation of statistical models (RSM) to optimize the remaining variables. Maximum mycelial growth inhibition (%) against the fungus Mucor sp. was 61.3% for LP. Overall, the combination of both OFAT and RSM helped in increasing the LPs yield by 3 folds from 367mg/L to 1169mg/L.

Adolescent Females are More Susceptible than Males for Tuberculosis.

BACKGROUND AND OBJECTIVES: Published literature is silent about the gender gap in tuberculosis (TB) among adolescent (10-19 years) population despite extensive information on increased susceptibility of the male gender after 20 years. We analyzed the data from 1113 adolescent microbiologically confirmed TB cases using cartridge-based nucleic acid amplification test (CBNAAT) in 2019 in the State of Himachal Pradesh (HP), India. MATERIALS AND METHODS: The data generated by 39 CBNAAT sites in HP were analyzed with an objective to describe the gender gap in TB among adolescents. RESULTS: Among 983 patients with pulmonary TB (PTB), the male: female ratio was 1:1.5 (P = 0.0001), whereas in 130 patients with extra PTB (EPTB), the male: female ratio was 1:1.8 (P = 0.0001). This male: female ratio was seen to reverse after 20 years for PTB, and but it persisted till 40 years for EPTB. Two main forms of TB that were significantly high in females during adolescence were PTB and lymph node TB (P = 0.0001). INTERPRETATION AND CONCLUSIONS: Significant gender difference with female susceptibility was seen for TB among adolescents, a fact that needs more research. Adolescent TB is a neglected area with little published data driven mainly by the fact that most countries report their TB population above and below 15 years, dividing the adolescent population into two halves. The world needs to acknowledge adolescents (10-19 years) as a separate important group for reporting TB statistics.

The World Health Organization Collaborating Center for Emergency and Trauma (WHO-CCET) in South East Asia, The World Academic Council of Emergency Medicine (WACEM), and The American College of Academic International Medicine (ACAIM) 2021 Framework for using Telemedicine Technology at Healthcare Institutions.

The coronavirus disease 2019 crisis has forced the world to integrate telemedicine into health delivery systems in an unprecedented way. To deliver essential care, lawmakers, physicians, patients, payers, and health systems have all adopted telemedicine and redesigned delivery processes with accelerated speed and coordination in a fragmented way without a long-term vision or uniformed standards. There is an opportunity to learn from the experiences gained by this pandemic to help shape a better health-care system that standardizes telemedicine to optimize the overall efficiency of remote health-care delivery. This collaboration focuses on four pillars of telemedicine that will serve as a framework to enable a uniformed, standardized process that allows for remote data capture and quality, aiming to improve ongoing management outside the hospital. In this collaboration, we recommend learning from this experience by proposing a telemedicine framework built on the following four pillars-patient safety and confidentiality; metrics, analytics, and reform; recording of audio-visual data as a health record; and reimbursement and accountability.

Intrarectal application of formalin for chronic radiation proctitis: a simple, cheap and effective treatment.

BACKGROUND: Chronic radiation proctitis is known to be a difficult to treat condition. Argon Plasma Coagulation (APC) though being effective requires prolonged sessions and has limited availability. Formalin, by virtue of its chemical cauterizing effects, has been found to be effective in patients with bleeding radiation cystitis and hemorrhagic proctitis. Our goal was to study the effectiveness of 4% formalin instillation in resistant patients of chronic hemorrhagic radiation proctitis. METHODS: 13 patients with chronic radiation proctitis were treated with instillation of 50 mi 4% formalin into the rectum (3 minutes for 3 times). The total mucosal contact time was approximately 10 minutes. Their clinical response, tolerance to treatment and complications were assessed. Patients who did not have complete response were given another session(s) a week later. RESULTS: The mean (SD) age of patients was 48.62 +/- 11.66 years. Twelve patients (92%) were female who received radiotherapy for carcinoma cervix and 1(08%) was male with carcinoma prostate. The overall clinical response rate was 100%; eight patients (61.5%) had complete cessation of bleeding while 5 patients (38.5%) had significant cessation of bleeding. Eight patients needed only one session, four needed 2 sessions and one patient needed 3 sessions for the clinical response. Serious complications were not observed. No recurrence of symptoms was seen during follow-up. CONCLUSION: The treatment of hemorrhagic radiation proctitis with local formalin instillation is effective, well tolerated, inexpensive, technically simple and safe procedure.

Colchicine, Aspirin, and Montelukast - A Case of Successful Combined Pharmacotherapy for Adult Multisystem Inflammatory Syndrome in COVID-19.

Since the beginning of the COVID-19 pandemic, many therapeutic strategies have been tried, with mixed results, to prevent and treat adult multisystem inflammatory syndrome in COVID-19 (AMIS-COVID-19). The reason behind this may the complex web of highly intertwined pathophysiologic mechanisms involved in the SARS-CoV-2 infection and the corresponding human systemic response, leading to end-organ damage, disability, and death. Colchicine, high-dose aspirin, and montelukast are being investigated currently as potential modulators of AMIS-COVID-19 in patients who fail to improve with traditional therapeutic approaches. Here, we present a patient who presented with high fevers, extreme fatigue and dyspnea, and ongoing deterioration. As part of our clinical approach, we used the simultaneous combination of the three agents listed above, capitalizing on their different respective mechanisms of action against AMIS-COVID-19. Following the initiation of therapy, the patient showed symptomatic improvement within 24 h, with the ability to return to daily activities after 72 h of continued triple-agent approach. Based on this experience, we have reviewed the immunomodulatory basis of this regimen, including potential avenues in which it may prevent the development of cytokine release syndrome (CRS) and its clinical manifestation, AMIS-COVID-19. By blocking the early stages of an inflammatory response, via diverse mechanistic pathways, the regimen in question may prove effective in halting the escalation of CRS and AMIS-COVID-19 in acutely symptomatic, nonimproving COVID-19 patients.

COVID-19 Blind Spots: A Consensus Statement on the Importance of Competent Political Leadership and the Need for Public Health Cognizance.

As the COVID-19 pandemic continues, important discoveries and considerations emerge regarding the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pathogen; its biological and epidemiological characteristics; and the corresponding psychological, societal, and public health (PH) impacts. During the past year, the global community underwent a massive transformation, including the implementation of numerous nonpharmacological interventions; critical diversions or modifications across various spheres of our economic and public domains; and a transition from consumption-driven to conservation-based behaviors. Providing essential necessities such as food, water, health care, financial, and other services has become a formidable challenge, with significant threats to the existing supply chains and the shortage or reduction of workforce across many sectors of the global economy. Food and pharmaceutical supply chains constitute uniquely vulnerable and critically important areas that require high levels of safety and compliance. Many regional health-care systems faced at least one wave of overwhelming COVID-19 case surges, and still face the possibility of a new wave of infections on the horizon, potentially in combination with other endemic diseases such as influenza, dengue, tuberculosis, and malaria. In this context, the need for an effective and scientifically informed leadership to sustain and improve global capacity to ensure international health security is starkly apparent. Public health "blind spotting," promulgation of pseudoscience, and academic dishonesty emerged as significant threats to population health and stability during the pandemic. The goal of this consensus statement is to provide a focused summary of such "blind spots" identified during an expert group intense analysis of "missed opportunities" during the initial wave of the pandemic.