Image-Guided Percutaneous Sclerotherapy for Orbital Low-Flow Malformation: Our Experience.

For a safe sclerotherapy session to be completed in the orbital low-flow malformation (namely lymphovenous malformation or venolymphatic malformation), accurate identification of the target lesion for the drug injection is crucial. Regarding the dependability and viability of the injection approach, the authors have discussed their experiences with image-guided percutaneous sclerotherapy on a few patients.

Lysine and citric acid based pegylated polymeric dendritic nano drug delivery carrier and their bioactivity evaluation.

The main objective of this work is to synthesize multifunctional nanodendritic structural molecules that can effectively encapsulate hydrophilic as well as hydrophobic therapeutic agents. Four different types of fourth-generation lysine-citric acid based dendrimer have been synthesized in this work: PE-MC-Lys-CA-PEG, TMP-MC-Lys-CA-PEG, PE-MS-Lys-CA-PEG, and TMP-MS-Lys-CA-PEG. The antibacterial drug cefotaxime (CFTX) was further conjugated to these dendrimers. The dendrimer and drug-dendrimer conjugate structures were characterized with the help of FTIR,1H-NMR, and 13C-NMR spectroscopy. Zeta sizer, AFM, and HR-TEM techniques were used to investigate the particle size, surface topography, and structural characteristics of drug-dendrimer conjugates. In vitro drug release was then investigated using dialysis method. Various kinetic drug release models were examined to evaluate the type of kinetic drug release mechanism of the formulations. Cytotoxicity study revealed that the dendrimers encapsulated with CFTX exhibited 2-3% toxicity against healthy epithelial cells, indicating their safe use. Plain dendrimers show 10-15% hemolytic toxicity against red blood cells (RBC), and the toxicity was reduced to 2-3% when CFTX was conjugated to the same dendrimers. The 3rd and 4th generation synthesized drug-dendrimer conjugates exhibit a significantly effective zone of inhibition (ZOI) against both Gram-positive and Gram-negative bacteria. For Gram-positive bacteria, the lower concentration of 0.1 mg/mL showed more than 98% inhibition of drug-dendrimer conjugate samples against B. subtilis and more than 50% inhibition against S. aureus using 0.2 mg/mL, respectively. Moreover, samples with concentrations of 0.5 and 1.0 mg/mL exhibited more than 50% inhibition against S. typhimurium and E. coli, respectively.

Hot carrier relaxation dynamics of an aza-covalent organic framework during photoexcitation: An insight from ab initio quantum dynamics.

In order to develop an efficient metal-free solar energy harvester, we herein performed the electronic structure calculation, followed by the hot carrier relaxation dynamics of two dimensional (2D) aza-covalent organic framework by time domain density functional calculations in conjunction with non-adiabatic molecular dynamics (NAMD) simulation. The electronic structure calculation shows that the aza-covalent organic framework (COF) is a direct bandgap semiconductor with acute charge separation and effective optical absorption in the UV-visible region. Our study of non-adiabatic molecular dynamics simulation predicts the sufficiently prolonged electron-hole recombination process (6.8 nanoseconds) and the comparatively faster electron (22.48 ps) and hole relaxation (0.51 ps) dynamics in this two-dimensional aza-COF. According to our theoretical analysis, strong electron-phonon coupling is responsible for the rapid charge relaxation, whereas the electron-hole recombination process is slowed down by relatively weak electron-phonon coupling, relatively lower non-adiabatic coupling, and quick decoherence time. We do hope that our results of NAMD simulation on exciton relaxation dynamics will be helpful for designing photovoltaic devices based on this two dimensional aza-COF.

Point defect-mediated hot carrier relaxation dynamics of lead-free FASnI3 perovskites.

In search of a promising optoelectronic performance, we herein investigated the hot carrier relaxation dynamics of a lead-free cubic phased bulk formamidinium tin triiodide (FASnI3) perovskite. To gain detailed theoretical insights, we should estimate the carrier relaxation dynamics of this pristine perovskite. To control the dynamics, point defects like central tin (Sn), iodine(I) anions, and formamidinium (FA) cations were introduced. With the iodine vacancy in the FASnI3 perovskite, the system seems to be unstable at room temperature, whereas the other three types of FASnI3 perovskites (pristine, Sn vacancy, and FA vacancy) are significantly stable at 300 K having semiconducting nature and excellent optical absorption in the UV-visible range. The computed electron-hole recombination time for the pristine system is 3.9 nanoseconds, which is in good agreement with the experimental investigation. The exciton relaxation processes in Sn and FA vacancy perovskites require 2.8 and 4.8 nanoseconds, respectively. These variations in the hot carrier relaxation dynamics processes are caused by the generation of significant changes in non-adiabatic coupling between energy levels, electron-phonon coupling, and quantum decoherence in different point defect analogous systems. The results presented here offer deeper insight into the temperature-dependent carrier relaxation dynamics of FASnI3 perovskites and thus open up opportunities for future exploration of their optoelectronic properties.

Biochemical characterization of glutaminase-free L-asparaginases from Himalayan Pseudomonas and Rahnella spp. for acrylamide mitigation.

L-asparaginase having low glutaminase activity is important in clinical and food applications. Herein, glutaminase-free L-asparaginase (type I) coding genes from Pseudomonas sp. PCH182 (Ps-ASNase I) and Rahnella sp. PCH162 (Rs-ASNase I) was amplified using gene-specific primers, cloned into a pET-47b(+) vector, and plasmids were transformed into Escherichia coli (E. coli). Further, affinity chromatography purified recombinant proteins to homogeneity with monomer sizes of ~37.0 kDa. Purified Ps-ASNase I and Rs-ASNase I were active at wide pHs and temperatures with optimum activity at 50 °C (492 ± 5 U/mg) and 37 °C (308 ± 4 U/mg), respectively. Kinetic constant Km and Vmax for L-asparagine (Asn) were 2.7 ± 0.06 mM and 526.31 ± 4.0 U/mg for Ps-ASNase I, and 4.43 ± 1.06 mM and 434.78 ± 4.0 U/mg for Rs-ASNase I. Circular dichroism study revealed 29.3 % and 24.12 % α-helix structures in Ps-ASNase I and Rs-ASNase I, respectively. Upon their evaluation to mitigate acrylamide formation, 43 % and 34 % acrylamide (AA) reduction were achieved after pre-treatment of raw potato slices, consistent with 65 % and 59 % Asn reduction for Ps-ASNase I and Rs-ASNase I, respectively. Current findings suggested the potential of less explored intracellular L-asparaginase in AA mitigation for food safety.

Survival benefit of exenteration in COVID-19-associated rhino-orbital mucormycosis.

PURPOSE: There has been a sudden increase in the number of rhino-orbital mucormycosis cases, primarily affecting patients recovering from COVID-19 infection. The local health authorities have declared the current situation an epidemic. In this study, we assess the role of exenteration in preventing disease progression and improving survival in patients with rhino-orbital mucormycosis. METHODS: The patients undergoing exenteration were grouped into the exenteration arm and those denying exenteration were grouped into the nonexenteration arm. The patients were followed at 1 month and 3 months. The 6-month survival data were collected telephonically. Continuous data were presented as Mean ± SD/Median (IQR) depending on the normality distribution of data, whereas the frequency with percentages was used to present the categorical variables. Kaplan-Meier survival curves were created to estimate the difference in survival of patients with exenteration in rhino-orbital mucormycosis versus those without exenteration. RESULTS: A total of 14 patients were recruited for our study based on the inclusion and exclusion criteria. All the patients were qualified for exenteration; however, only eight patients underwent exenteration and six patients did not consent to exenteration. At the end of 3 months in the exenteration group, four (50%) patients died. Two patients died within a week of exenteration, whereas two patients died after 2 weeks of exenteration. The deaths in the first week were attributed to septic shock and the deaths happening beyond 2 weeks were attributed to severe meningitis. The Kaplan-Meier survival analysis showed the cumulative probability of being alive at 1 month in the exenteration arm to be 85%, and it decreased to 67% by 53 days and subsequently remained stable until the end of 3 months. CONCLUSION: The Kaplan-Meier survival analysis did not show a survival benefit of exenteration at 3 months and 6 months in COVID-associated rhino-orbital mucormycosis.

In vitro Evaluation of Shear Bond Strength of Orthodontic Brackets Bonded with Different Adhesives.

Background: To endure the orthodontic forces used throughout treatment, the bond strength of bonded orthodontic brackets must be enough with assessment of shear bond strength when bonding orthodontic brackets with various adhesives. Materials and Methods: Overall, forty extracted premolars due to orthodontic treatment were included. They were split into four equal cohorts with various primers. With both adhesives, shear bond strength had been assessed with and without salivary contamination. SPSS software was used to assess the outcomes. Consideration was given to statistical significance of P value of less than 0.05. Results: Several groups' average bond strengths in MPa were assessed in both dry and contaminated saliva conditions. When it was dry, Transbond Plus demonstrated greater shear bond strength. Conclusion: Hydrophilic Transbond Plus resin outperformed hydrophobic Transbond XT resin in terms of shear bond strength under both situations.

Port Site Morbidities Following the Extraction of the Gallbladder from the Umbilical Port in Comparison to the Epigastric Port in Laparoscopic Cholecystectomy: A Double-Blinded, Randomized Controlled Trial.

Background Port site morbidities after laparoscopic cholecystectomy may be related to the port used for the extraction of the gallbladder. Prior randomized trials that tried to address the suitable port for gallbladder extraction showed mixed results favouring epigastric, whereas others favoured umbilical. Thus, the present study was conducted with the aim of finding a suitable port for gallbladder extraction after laparoscopic cholecystectomy. Methodology A total of 104 patients undergoing laparoscopic cholecystectomy were randomized to either the epigastric (Group 1) or umbilical (Group 2) port group for gallbladder extraction. Post-operative pain (by visual analogue scale (VAS)), the frequency of surgical site infection (SSI), and port site herniation were compared. Results Post-operative pain was lower in the umbilical port group in the initial 24 hours. The SSIs and port site herniation rates were lower in the umbilical port group; however, they were statistically not significant. Conclusion Less post-operative pain at the umbilical port may help with the early discharge of patients. In contrast to other studies, our trial had fewer infections and hernias in the umbilical port group.

The Prevalence of Anemia in Hospitalized Patients With Diabetic Foot Ulcer (DFU) and the Relationship Between the Severity of Anemia and the Severity of DFU.

BACKGROUND AND AIMS: We aim to determine the prevalence of anemia in hospitalized patients with diabetic foot ulcers (DFUs) and estimate the relationship between the severity of anemia and diabetic foot ulcer. MATERIALS AND METHODS: We retrospectively collected and evaluated the data of 323 patients hospitalized with diabetic foot ulcer (DFU). We included 299 type 2 diabetic patients with foot ulcers of neuropathic or neuroischemic nature with infection. Anemia was defined based on World Health Organization (WHO) criteria, and the severity of DFU was classified in University of Texas (UT) grades. RESULTS: Anemia was detected in 94.3% of DFU, and the prevalence of mild, moderate, and severe anemia was 16.7%, 55.7%, and 27.6%, respectively. There was a significant difference in the mean hemoglobin (Hb) levels among the patients with varying grades of severity of DFU (1B: Hb=10.17±2.08 gm/dL, 2B: Hb=9.27±2.04 gm/dL, 3B: Hb=8.03±1.829 gm/dL; p value=<0.0001). The iron study was available in 141 (47.15%) patients and was suggestive of anemia of chronic disorder (mean serum iron=40.22±23.81 mcg/dL, mean total iron-binding capacity (TIBC)=239.34±67.24 mcg/dL, mean ferritin=378.05±141.337 ng/mL). TIBC significantly decreased (1B=262.13±61.05, 2B=233.65±71.26, 3B=222.43±74.18; p=0.04), and ferritin significantly increased (1B=309.9±70.76, 2B=351.73±94.22, 3B=488.58±170.4; p<0.0001) with increasing DFU severity. Hemoglobin was significantly decreased at the time of discharge in comparison to that at admission (9.3±2.1 gm/dL versus 8.8±1.5 gm/dL; p value=0.01). Red blood cell (RBC) counts, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), lymphocyte counts, albumin, calcium, and high-density lipoprotein (HDL) significantly decreased with the increase of DFU severity. The duration of hospitalization, total leucocyte counts, neutrophil counts, and neutrophil-to-lymphocyte ratio (NLR) increased with the severity of DFU. CONCLUSIONS: The prevalence of anemia was very high in DFU and more than three-fourths of the patients had moderate to severe anemia. The severity of anemia was associated with the severity of DFU. The most common cause of anemia was anemia of chronic disorder secondary to diabetic foot infection. During the period of hospitalization, hemoglobin decreased despite improvement in DFU infection.

Ensemble learning-based early detection of influenza disease.

Across the world, the seasonal disease influenza is a respiratory illness that impacts all age groups in many ways. Its symptoms are fever, chills, aches, pains, headaches, fatigue, cough, and weakness. Seasonal influenza can cause mild to severe illness and lead to death at times. The task of early detection of influenza is an important research area these days. Various studies show that machine learning techniques have attracted many researchers' attention to the early detection of influenza disease. In this paper, early detection of Influenza disease among all age groups is done using various machine learning techniques. Influenza Research Database and the Human Surveillance Records data sets are used. Data analysis is undertaken, and ensemble-based stacked algorithms are implemented on the whole data set. The performance of different models has been evaluated using different performance metrics. Overall, the study proposes efficient machine learning models that can be implemented to provide a cheaper and quicker diagnostic tool for detecting influenza.

Posttreatment Persistence of Monoclonal Protein on Immunofixation Electrophoresis but Absence on Serum Protein Electrophoresis in a Case of Solitary Bone Plasmacytoma.

Laboratory investigations for any suspected case of solitary plasmacytoma of bone include routine biochemical and hematological investigations along with ß2-microglobulin, electrophoresis of serum protein and/or 24-hour urine protein, serum protein immunofixation (IFE), and nephelometric quantification of total immunoglobulin isotype and serum free light chain levels. Bone marrow aspirate and trephine biopsy are mandatory to confirm the absence of clonal plasma cells (for solitary plasmacytoma) or the presence of less than 10% clonal cells (solitary plasmacytoma with minimal bone marrow involvement). Imaging studies such as X-ray, computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT should be used to complement laboratory tests in diagnosis, staging, and defining the local extent of the plasmacytoma. However, guidelines regarding choice of technique for the detection of M band when monitoring a follow-up case of operated plasmacytoma are still not clear. Through this case study, we try to highlight the role of IFE in a follow-up case of operated solitary plasmacytoma of the bone.

Quantitative sonoelastography of the uterine cervix in predicting successful outcome of induction of labour.

Objectives: The aim of the study was to evaluate the stiffness of cervix and determine its significance in predicting successful outcome of induction of labour. The primary objective was to determine the differences in elastography indices of different areas of cervix between the outcome groups of successful and failed induction of labour. A secondary objective was to find out the correlation of these elastography indices with Bishop's score and cervical length. Methods: This was a prospective, observational study conducted over a period of 6 months on pregnant women admitted in the labour room for induction of labour. Establishment of adequate regular uterine contractions - at least three contractions lasting 40-45 s in a 10-min period - was taken as end point for successful outcome of induction of labour. Even after 24 h of initiation of induction of labour, regular, adequate and painful uterine contractions were not established, then induction of labour was described as having failed. Prior to induction, cervical length measurement, Bishop's scoring and elastographic evaluation of the cervix were done by stress-strain elastography. A colour map was produced from purple to red and a five-step scale - the elastography index - was used to describe the various parts of the cervix. The differences between elastography indices of different parts of cervix were estimated using Mann-Whitney U test. Correlation of the indices with cervical length and Bishop's score was determined by Spearman's correlation coefficient. Results: A total of 64 women were included in the study. A significant difference (p < 0.001) was found in the elastography index of internal os between the two outcome groups of success (1.76 ± 0.64) and failure (0.54 ± 0.18). However, the elastography index of central cervical canal, external os, anterior lip and posterior lips did not differ significantly across the outcome groups. A significant positive correlation was found between elastography index of internal os and cervical length (Spearman's correlation coefficient, r = 0.441, p < 0.001) and between elastography index of external os and cervical length (r = 0.347, p = 0.005), whereas a negative correlation was seen between elastography index of external os and Bishop's score (r = -0.270, p = 0.031). Conclusion: Elastography index of internal os can be used to predict outcome of induction of labour. Cervical elastography is a promising new technique for cervical consistency assessment. Further larger studies are required to determine some cut-off point for elastography index of internal os in prediction of outcome of induction of labour and to strongly establish the usefulness of cervical elastography for pregnancy management, preventing preterm delivery and establishment of cut-off points to determine successful induction.

Biochemical characterization of extremozyme L-asparaginase from Pseudomonas sp. PCH199 for therapeutics.

L-asparaginase (L-ASNase) from microbial sources is a commercially vital enzyme to treat acute lymphoblastic leukemia. However, the side effects associated with the commercial formulations of L-ASNases intrigued to explore for efficient and desired pharmacological enzymatic features. Here, we report the biochemical and cytotoxic evaluation of periplasmic L-ASNase of Pseudomonas sp. PCH199 isolated from the soil of Betula utilis, the Himalayan birch. L-ASNase production from wild-type PCH199 was enhanced by 2.2-fold using the Response Surface Methodology (RSM). Increased production of periplasmic L-ASNase was obtained using an optimized osmotic shock method followed by its purification. The purified L-ASNase was a monomer of 37.0 kDa with optimum activity at pH 8.5 and 60 ℃. It also showed thermostability retaining 100.0% (200 min) and 90.0% (70 min) of the activity at 37 and 50 ℃, respectively. The Km and Vmax values of the purified enzyme were 0.164 ± 0.009 mM and 54.78 ± 0.4 U/mg, respectively. L-ASNase was cytotoxic to the K562 blood cancer cell line (IC50 value 0.309 U/mL) within 24 h resulting in apoptotic nuclear morphological changes as examined by DAPI staining. Therefore, the dynamic functionality in a wide range of pH and temperature and stability of PCH199 L-ASNase at 37 ℃ with cytotoxic potential proves to be pharmaceutically important for therapeutic application.

Posterior fossa giant adenoid cystic carcinoma with skull base invasion mimicking glomus jugulare: A case report and review of literature.

The author describes a rare case of giant adenoid cystic carcinoma (ACC) mimicking large paraganglioma with lower cranial nerve palsy. A 60-year-old female presented with a progressive increase in postauricular swelling with unilateral hearing loss, facial deviation, difficulty in swallowing, and hoarseness of voice. MRI brain showed highly vascular infiltrating and osteolytic mass suggestive of large glomus jugulare versus sarcoma. It was completely engulfing the jugular foramen and lower cranial nerves with bony erosion of the jugular foramen and occipital condyle. The whole mastoid was filled with the tumor. On digital subtraction angiography the majority of blood supply was from the occipital branch of the external carotid artery and vertebral artery. The patient underwent percutaneous embolization followed by external carotid ligation and resection of the mass. The postoperative course was uneventful. Histopathology was suggestive of mixed ACCs. The patient received radiotherapy. After 1 year of follow up no recurrence or distant metastasis was noted.

Management and outcome of unusual pediatric brain tumors: challenges experienced at a tertiary care center of a developing country.

PURPOSE: Primary brain tumors are the most frequent solid pediatric tumors, accounting for 40-50% of all cancers in children. Eighty to ninety percent of the 250,000 new cases of pediatric cancer each year are discovered in low and middle-income nations, where nearly 88 percent of the world's children reside. This article aims to emphasize the unusual presentation, management, and surgical outcome of complex pediatric brain tumors. METHODS: We performed a retrospective study of patients who were admitted to the neurosurgery department with unusual pediatric brain tumors between March 1, 2019, and March 1, 2022. The study included pediatric patients up to age 18 years. We included those pediatric brain tumors whose (i) location was uncommon, or (ii) presented with unusual clinical presentation, or (iii) histopathology suggested to be a rare tumor, or (iv) radiological features were atypical. RESULTS: We included 9 cases of rare unusual pediatric brain tumors. Three out of 9 cases required preoperative embolization due to its hypervascular nature on digital subtraction angiography (DSA). All patients underwent surgical excision within 24-48 h of tumor devascularization. One out of 9 cases died in follow-up period due to pleural effusion and distant metastasis to lungs. CONCLUSION: Treatment considerations for unusual pediatric brain tumors include a comprehensive multidisciplinary approach, including community-based screening and proper referral system for early treatment, a variety of treatment modalities, and sophisticated follow-up strategy. Government shall work in coherence with tertiary centers to spread social awareness and provide various financial scheme to prevent treatment dropouts.

Ultrasound-guided aspiration of an orbital abscess.

A 10-year-old boy presented with severe proptosis due to a retrobulbar abscess. Ultrasound-guided needle aspiration was performed under intravenous sedation with complete abscess core decompression and resolution of proptosis.

Neurocysticercosis With Internal Carotid Artery and Middle Cerebral Artery Vasculitis and Stenosis.

A seven-year-old female child presented with sub-acute onset headache, vomiting, and aphasia with right-sided upper motor neuron (UMN) type hemiparesis and ipsilateral UMN type facial nerve weakness. Her coagulation profile and thrombotic profile were normal. MRI brain with magnetic resonance angiography (MRA) detected neurocysticercosis causing secondary vasculitis and narrowing of supraclinoid left internal carotid artery (ICA) and middle cerebral artery (MCA). The patient was given aspirin along with steroids and albendazole. She improved gradually, and her hemiparesis and facial nerve palsy improved completely by three months and aphasia by four months.

Scrub Typhus Presenting as Acute Flaccid Paralysis in a Child: A Differential to Be Included in a Common Presentation.

Neurological manifestations are common in scrub typhus in children. A 12-year-old girl presented with acute onset fever, bilateral lower limb weakness, and urinary retention. On initial investigations, scrub typhus immunoglobulin M (IgM) ELISA (enzyme-linked immunosorbent assay) was reactive. She was given an injection of doxycycline along with other supportive therapies. Her symptoms improved gradually and bilateral lower limb power came back gradually without residual weakness by the 13th day of admission.