Guidelines for endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA): Joint Indian Chest Society (ICS)/Indian Association for Bronchology (IAB) recommendations.

Over the past decade, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become an indispensable tool in the diagnostic armamentarium of the pulmonologist. As the expertise with EBUS-TBNA has evolved and several innovations have occurred, the indications for its use have expanded. However, several aspects of EBUS-TBNA are still not standardized. Hence, evidence-based guidelines are needed to optimize the diagnostic yield and safety of EBUS-TBNA. For this purpose, a working group of experts from India was constituted. A detailed and systematic search was performed to extract relevant literature pertaining to various aspects of EBUS-TBNA. The modified GRADE system was used for evaluating the level of evidence and assigning the strength of recommendations. The final recommendations were framed with the consensus of the working group after several rounds of online discussions and a two-day in-person meeting. These guidelines provide evidence-based recommendations encompassing indications of EBUS-TBNA, pre-procedure evaluation, sedation and anesthesia, technical and procedural aspects, sample processing, EBUS-TBNA in special situations, and training for EBUS-TBNA.

Ultrasonic investigation of materials-An avenue for project-based learning.

Project-based learning (PBL) provides an effective practical application to the learners. Further, PBL develops problem-solving, critical thinking, etc., in the learner. This paper describes a type of project offered to the students at the collegiate level to enhance the students' ability to work in a team, manage a project, and present their results. These projects use acoustic waves in the ultrasound frequency range that can be used as a powerful nondestructive tool for the characterization of the materials. In situ measurement of the ultrasonic longitudinal velocity and evaluation of the elastic constants carried out on the materials in solid pellet form over a wide range of temperatures at a fundamental frequency of 5 MHz enables the study of various phase transitions, such as metal to insulator, ferromagnetic to paramagnetic, and even structural phase transitions that occur in the materials. Here, the investigation is elaborated on using ultrasonic waves on some materials in pellet form and the results obtained are presented.

Musculoskeletal problems of hand-sewn crafted footwear manufacturing artisans in Kolhapur, India.

BACKGROUND: Kolhapuri hand-sewn crafted footwear is one of the well-designed and traditional footwear in India. Many of the processes in these industries are manual. The study was carried out to establish the occurrence of musculoskeletal disorders (MSD) in different body parts of artisans engaged in crafted footwear manufacturing activity. Due to the difficult physical activities carried out by artisans, there was a possibility of evolving different kinds of MSDs. OBJECTIVE: To evaluate the prevalence of MSD symptoms in various body regions of crafted footwear manufacturing artisans. This work further aims to assess different working postures. METHODS: The existing working environment and the occurrences of MSD indications of 105 artisans of Kolhapuri crafted footwear manufacturing were evaluated in this study. The data collection was done through an interview and using Nordic musculoskeletal questionnaire. The work uses the Rapid Upper Limb Assessment (RULA) method for posture analysis. Multiple regression investigation was used to evaluate different risk factors linked with MSDs symptoms. RESULTS: It has been cleared that there are high occurrences of MSD pain between crafted footwear manufacturing artisans. The most frequently affected body areas were low back, neck, hips/thighs/buttocks, shoulder, elbows, hand and wrist, knees and upper back. The final RULA grand total of 6.1 specifies that artisans' posture needs to be change. CONCLUSION: The artisans who were associated with the manufacturing of Kolhapuri footwear had a high prevalence of musculoskeletal symptoms. Analysis of data suggests that the necessity of operational implementation program for handcrafted footwear manufacturing artisans.

The cricothyroid versus the spray-as-you-go method for topical anesthesia during flexible bronchoscopy: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Lignocaine can be administered during bronchoscopy using either a direct injection through the cricothyroid membrane (the cricothyroid method) or a spray of lignocaine solution through the bronchoscope working channel (the spray-as-you-go method). In this meta-analysis of randomized controlled trials (RCTs), we compared the efficacy of these two methods for topical anesthesia during flexible bronchoscopy. METHODS: We performed a systematic search to extract the relevant RCTs comparing the two techniques. RESULTS: Five RCTs meeting the inclusion criteria (747 subjects) were identified. The cricothyroid method was associated with significantly less cough (standardized mean difference [SMD] = -1.18, 95% confidence interval [CI] [-1.75, -0.62], P < 0.001, significant heterogeneity I2 = 86%, P < 0.001). On analysis of secondary outcomes, the cricothyroid method was associated with a greater operator-rated procedure satisfaction (SMD = 1.00, 95% CI [0.74, 1.25], P < 0.001), less time for upper airway negotiation (mean difference, MD = -0.99, 95% CI [-1.37, -0.6], P < 0.001), and a significantly less cumulative dose of lignocaine administered (MD = -68.12, 95% CI [-130.18, -6.06], P = 0.03). The overall procedure duration (MD = 0.08, 95% CI [-0.09, 0.24], P = 0.36) and patient discomfort (MD = -0.08, 95% CI [-0.38, 0.22], P = 0.59) were not different between the two methods. There was no significant publication bias (P = 0.94). CONCLUSIONS: The cricothyroid method is associated with less cough during flexible bronchoscopy. Other advantages are a greater operator-rated procedure satisfaction at a less cumulative lignocaine dose. These findings highlight the superior performance characteristics of the cricothyroid method for lignocaine administration for flexible bronchoscopy.

Ergonomics and efficient workplace design for hand-sewn footwear artisans in Kolhapur, India.

BACKGROUND: The footwear manufacturing industry is one of the significant sectors of leather businesses in India. In the Indian footwear production industry, there is an enormous potential for employment, export, and development. Kolhapuri footwear is a popular handmade craft in India. It is a well-designed craft used by Indian people for many years. Artisans using traditional tools manufacture this footwear manually. Workers of this craft use traditional methods and work in cottage-based enterprises where organized laws and legislations are not applicable. Therefore, any occupational hazard-related documentation is not available. Due to the nature of the job, workers occupy various apparent non-optimal postures that may cause multiple work-related disorders such as musculoskeletal disorders (MSDs). OBJECTIVE: The main objective was to study and assess different footwear manufacturing workstations and working postures. The work further aimed to improve the design of current workstations and evaluate the proposed design using virtual ergonomic assessment techniques. METHODS: An anthropometric database for the Kolhapuri footwear making population was developed. This work measured 35 different body dimensions of the footwear manufacturing artisans. Rapid Upper Limb Assessment (RULA) was used for postural analysis of the artisans. RESULTS: It was observed that the entire footwear making activity was carried out in awkward postures. RULA scores suggested that 'a change in posture' to improve the efficiency of artisans was required for most of the workstations. This work proposed a novel workstation design to reduce the high risk of MSDs. The design was evaluated for thigh clearance, vision analysis and RULA analysis with the help of Digital Human Modelling (DHM). The virtual ergonomics assessment of this design revealed that the vision, thigh clearances, and RULA scores were satisfactory in the new design. CONCLUSION: The anthropometric database proposed in this study is likely to be useful in designing Kolhapuri footwear manufacturing tools. The proposed workstation and work layout are helpful to improve the accessibility of required tools and materials to footwear workers. It also helps to reduce occupational risks by easing uncomfortable work positions.

A Study on Drug-Induced Tardive Dyskinesia: Orofacial Musculature Involvement and Patient's Awareness.

OBJECTIVE: Schizophrenia is a psychiatric disorder that requires long-term treatment. Long-term antipsychotic treatment is often associated with the emergence of tardive dyskinesia (TD), the severity of which is measured by Abnormal Involuntary Movement Scale (AIMS). This study examined the relationship among TD, orofacial musculature activity, and patient's awareness of AIM. The knowledge would help dentists to deliver oral care for schizophrenics with TD. MATERIALS AND METHODS: We identified 317 patients from a standard, data sharing initiative, of whom 38.3% exhibited AIM score of 2 to 15. The patient demographics, drug history, details of AIMS were subjected to descriptive and inferential statistical analysis using SPSS with P≤0.05 as significance. RESULTS: The mean of only orofacial features (n = 56) was 3.43 ± 2.68. Muscles of facial expression was involved in nine (7.9% of all TD), lip/perioral area in 27 (23.68%), jaw in 52 (45.61%), and tongue in 77 (67.54%). The patient's perception of AIM precipitated stress when involving jaw, tongue, limbs, and trunk was statistically significant (P≤0.05). The multiple regression model statistically significantly predicted TD for factors considered. CONCLUSION: Around 1% of global population is being diagnosed with schizophrenia, carry an inherent risk of developing TD. They might have orodental care requirements, including prosthodontic and restorative services. Primary physicians and dentists need to be aware of TD and its mechanism for appropriate patient management.

The Quasi-Coarse-Grained Dynamics Method to Unravel the Mesoscale Evolution of Defects/Damage during Shock Loading and Spall Failure of Polycrystalline Al Microstructures.

A long-standing problem in modeling of shock response of metals is the ability to model defect nucleation and evolution mechanisms during plastic deformation and failure at the mesoscales. This paper demonstrates the capability of the "quasi-coarse-grained dynamics" (QCGD) simulation method to unravel microstructural evolution of polycrystalline Al microstructures at the mesoscales. The various QCGD simulations discussed here investigate the shock response of Al microstructures comprising of grain sizes ranging from 50 nm to 3.20 µm and correspond to system sizes ranging from 150 nm to 9.6 µm, respectively. The QCGD simulations are validated by demonstrating the capability to retain atomistic characteristics of the wave propagation behavior, plastic deformation mechanisms (dislocation nucleation, dissociation/recombination behavior, dislocation interactions/reactions), evolution of damage (voids), and evolution of temperature during shock loading. The capability to unravel the mesoscale evolution of microstructure is demonstrated by investigating the effect of grain size, shock pulse and system size on the shock response and spall failure of the metal. The computed values of spall strengths predicted using the QCGD simulations agree very well with the trend predicted by MD simulations and a strain rate dependence of the spall strength is proposed that fits the experimentally available values in the literature.

Molluscum contagiosum in a 12-year-old child - report of a case and review of literature.

Molluscum contagiosum (MC) is an infection of the skin and mucous membrane caused by a DNA virus from the poxvirus family. It usually affects any part of the body and presents as pearly, flesh colored dome shaped nodule with a central umbilication. Clinical diagnosis can be supplemented with histopathology for the confirmed diagnosis of MC. This article presents a case of 12-year-old male child afflicted with MC along with a review of the literature on MC.

Phylogeny and polyploidy: resolving the classification of cyprinine fishes (Teleostei: Cypriniformes).

Cyprininae is the largest subfamily (>1300 species) of the family Cyprinidae and contains more polyploid species (∼400) than any other group of fishes. We examined the phylogenetic relationships of the Cyprininae based on extensive taxon, geographical, and genomic sampling of the taxa, using both mitochondrial and nuclear genes to address the phylogenetic challenges posed by polyploidy. Four datasets were analyzed in this study: two mitochondrial gene datasets (465 and 791 taxa, 5604bp), a mitogenome dataset (85 taxa, 14,771bp), and a cloned nuclear RAG1 dataset (97 taxa, 1497bp). Based on resulting trees, the subfamily Cyprininae was subdivided into 11 tribes: Probarbini (new; Probarbus+Catlocarpio), Labeonini Bleeker, 1859 (Labeo & allies), Torini Karaman, 1971 (Tor, Labeobarbus & allies), Smiliogastrini Bleeker, 1863 (Puntius, Enteromius & allies), Poropuntiini (Poropuntius & allies), Cyprinini Rafinesque, 1815 (Cyprinus & allies), Acrossocheilini (new; Acrossocheilus & allies), Spinibarbini (new; Spinibarbus), Schizothoracini McClelland, 1842 (Schizothorax & allies), Schizopygopsini Mirza, 1991 (Schizopygopsis & allies), and Barbini Bleeker, 1859 (Barbus & allies). Phylogenetic relationships within each tribe were discussed. Two or three distinct RAG1 lineages were identified for each of the following tribes Torini, Cyprinini, Spinibarbini, and Barbini, indicating their hybrid origin. The hexaploid African Labeobarbus & allies and Western Asian Capoeta are likely derived from two independent hybridization events between their respective maternal tetraploid ancestors and Cyprinion.

High prevalence of circulating autoantibodies against thyroid hormones in vitiligo and correlation with clinical and historical parameters of patients.

BACKGROUND: Autoantibodies against thyroid hormones (THAbs) directed towards triiodothyronine (T3-Ab) and/or thyroxine (T4-Ab) are very rare in the general population. They are increased in some nonthyroidal autoimmune diseases, where they seem to predict autoimmune thyroid disorders (ATDs). So far, their presence in patients with vitiligo has not been evaluated, but it might have a possible predictive role. OBJECTIVES: To assess the prevalence of THAbs in a group of vitiligo patients and to correlate their presence with clinical and historical parameters. METHODS: In total 79 patients with nonsegmental vitiligo and 100 controls were examined. Clinical characteristics of vitiligo and family and personal medical history were evaluated. Antinuclear autoantibodies, thyroid hormones and thyroid autoantibodies were measured. IgM T3-Ab, IgG T3-Ab, IgM T4-Ab and IgG T4-Ab were assayed by a radioimmunoprecipitation technique. Fisher's test, Student's t-test and χ(2)-test were used for statistical analysis. RESULTS: Overall 77 of 79 patients (97%) had at least one type of THAb (11 T3-Ab, 10 T4-Ab, 56 both). In the control group, only one person (1%) had THAbs. In patients with vitiligo, T3-Abs were significantly associated with leucotrichia (IgM+IgG, P = 0.033; IgG, P = 0.039; IgM, P = 0.005) and thyroglobulin autoantibodies (IgM+IgG, P = 0.031; IgG, P = 0.058), while the absence of T3-Ab was related to personal history of cancer (IgM+IgG, P = 0.021; IgG, P = 0.039). T4-Abs were significantly associated with vitiligo activity (IgM+IgG, P < 0.001; IgM, P = 0.037) and duration (IgG, P = 0.013). CONCLUSIONS: The surprisingly high prevalence of THAb in patients with vitiligo and their associations suggest a possible pathogenetic role in the disease and stress the tight link between vitiligo and ATDs. Further evaluation in a larger group of patients and an adequate follow-up are needed to define their potential predictive role.

Encapsulation of [X2(H2O)4]2- (X = F/Cl) clusters by pyridyl terminated tripodal amide receptor in aqueous medium: single crystal X-ray structural evidence.

A new tris-amide receptor L based on 1,3,5-methyl substituted benzene platform and pyridyl as an attached unit is synthesized and explored towards anion recognition in aqueous environment. The presence of pyridyl terminal in L facilitates its aqueous solubility. The binding of halides and oxyanions towards L are examined by (1)H-NMR technique in solution and by single crystal X-ray crystallography in solid state studies. Crystallization of fluoride and chloride with L is carried out in acetone-water (1 : 1, v/v) binary solvent mixture that yields crystals for respective host-guest complexes, [L]2·[F2(H2O)4]·[TBA]2 (1) and [L]2·[Cl2(H2O)4]·[TBA]2 (2) suitable for single crystal X-ray diffraction studies. On the other hand, complexation of L with fluoride in dioxane-acetone (1 : 1, v/v) solvent mixture, results the formation of SiF6(2-) encapsulated complex, [L]2·[SiF6(H2O)2]·[TBA]2 (3). Crystallographic result shows the formation of [F2(H2O)4](2-) and [Cl2(H2O)4](2-) zipped 1D-polymeric tweezer-like assemblies of L in acetone-water (1 : 1, v/v) binary solvent mixture in complexes 1 and 2 respectively. Solution state (1)H-NMR studies in D2O-acetone-d6 (1 : 19, v/v) support 1 : 4 (host-guest) binding stoichiometry of F(-), Cl(-), Br(-), NO3(-), HSO4(-) and H2PO4(-) with L. Binding constants of these investigated anions with L by 1 : 1 binding model are calculated which show the following binding order: NO3(-) ≈ HSO4(-) > F(-) ≈ Cl(-) ≈ Br(-) > H2PO4(-). Further, solution state (19)F-NMR studies are also carried out to establish the F(-) binding with L in DMSO-d6.

Non-segmental vitiligo and psoriasis comorbidity - a case-control study in Italian patients.

BACKGROUND: A recent systematic evaluation of vitiligo and psoriasis comorbidity has not yet been reported in a large series of patients with vitiligo. OBJECTIVE: To investigate the practical/clinical implications in subjects with both vitiligo and psoriasis compared to those with vitiligo alone. METHODS: This was a case-control study on 463 vitiligo patients in our clinic from March 2008 to April 2011. Medical assessment was performed by dermatologists using the modified Vitiligo European Task Force form. RESULTS: In an univariate analysis, inflammation/pruritus [odds ratio (OR) 2.42, P = 0.03], use of drugs that can induce psoriasis (OR 2.74, P = 0.01), a family history (FH) of psoriasis (OR 2.87, P = 0.02), cardiovascular disease (OR 5.70, P = 0.001), hypertension (OR 4.7, P = 0.006) and type 2 diabetes mellitus (OR 3.87, P = 0.004), were significantly correlated with patients exhibiting vitiligo and psoriasis comorbidity. A trend was found in personal history of cardiovascular disease in patients with both diseases (OR 2.99, P = 0.07). FH of vitiligo was significantly associated with patients having only vitiligo (OR 0.35, P = 0.05). Multivariate analysis demonstrated that inflammation/pruritus in vitiligo macules (OR 2.56, P = 0.047) and a FH of cardiovascular disease (OR 4.07, P = 0.02) were the most significant predictors of patients having both psoriasis and vitiligo, while the presence of organ-specific autoantibodies (OR 0.24, P = 0.007) was significantly associated with patients having only vitiligo. CONCLUSION: The presence of vitiligo and even mild psoriasis is significantly correlated with a family history of cardiovascular disease, a factor that requires greater attention and follow-up with respect to that necessary for vitiligo patients.