A survey of practice patterns and adherence to national and international guidelines on the management of Helicobacter pylori infection among gastroenterologists and gastroenterology fellows in India.

BACKGROUND: Patients and primary care providers alike benefit greatly from the expertise of gastroenterologists when it comes to managing Helicobacter pylori (H. pylori) infection. However, information on gastroenterologists' practices in the management of H. pylori infection is scarce in this part of the world. This study aimed at evaluating the practice patterns of gastroenterologists and gastroenterology fellows in India. METHOD: This was a cross-sectional questionnaire-based survey of gastroenterologists and gastroenterology fellows working in India. RESULTS: Total 207 gastroenterologists and 53 fellows filled out the questionnaire. Responses were received from all around India. Approximately 70% of respondents perceive H. pylori to be a gastric pathogen, while 20% regard it as a commensal bacterium. While the proportion of respondents who chose a test and treat method (34.6%) for uninvestigated dyspepsia without alarm symptoms was comparable to empirical proton pump inhibitor (PPI) therapy (38.8%), about one-fifth chose a scope and treat strategy in this setting. Even in the absence of alarm signs, more than half of respondents (61.5%) preferred endoscopic biopsy to detect H. pylori. While rapid urease testing (RUT) was the preferred modality (80%) for detecting H. pylori, about one-third preferred single-site RUT (from the antrum). Only 40% followed the Updated Sydney protocol, while performing biopsies and a majority (78.8%) are unable to discontinue PPIs before testing for H. pylori. PPI-clarithromycin-based triple treatment was the preferred regimen (67%) for first-line eradication, while nearly a quarter of respondents did not utilize bismuth due to concerns about adverse effects. CONCLUSION: The survey reveals a lack of adherence to the current H. pylori guidelines for diagnosis, testing and treatment among gastroenterologists and gastroenterology fellows in India. It is vital that scientific societies simplify guidelines, investigate challenges to their effective implementation and execute targeted interventions to increase adherence.

Histological scores are poor predictors of short term outcomes in acute severe ulcerative colitis: An observational study.

BACKGROUND: The role of various histologic scores in predicting outcomes in acute severe ulcerative colitis (ASUC) is unexplored. METHODS: Consecutive patients of ASUC undergoing sigmoidoscopy and histological assessment by two independent pathologists for Simplified Geboes score (SGS), Robarts Histopathology Index (RHI) and Nancy histological index (NHI)] were included. Primary outcome was the role of histology in predicting need for second-line therapy or colectomy. RESULTS: Of 82 patients with ASUC (mean age: 36 years, males 47.5 %), non-response to steroids was observed in 27 (32.9 %) of cases. Sixteen patients required second-line drug therapy and 8 required colectomy. There was no significant association between the need for second-line therapy or colectomy and the baseline histological scores [NHI (p = 0.61), SGS (p = 0.116) and RHI (p = 0.109)]. All three scores performed poorly to predict the need for second-line treatment or colectomy within 28 days. There was no significant association between histological scores and steroid response (NHI (p = 0.796), SGS (p = 0.57) and RHI (p = 0.941)]. All three scores had a strong positive correlation observed between each other but not with endoscopic Mayo score. CONCLUSION: The three histologic scores (SGS, RHI and NHI) performed poorly in prediction of need for second-line treatment or colectomy in ASUC. Future studies should study the impact of histologic assessment on long term outcomes in ASUC.

Forensic age estimation from ossification centres: a comparative investigation of imaging and physical methods.

Age estimation is a crucial component of human identification in forensic science. It has a vital role in forensic anthropology, including examinations of skeletal remains, disaster victim identification, and locating missing individuals. Present communication focuses on the age estimation through the examination of ossification centers of bones and its significance in identifying the age of 18 years old, a recognized age of majority in many countries. The process of ossification is integral to biological development and serves as critical standard for age estimation in forensic identification. This study reviews relevant literature from well-known databases such as PubMed, Scopus, Web of Science, and ScienceDirect. Additionally, the present review elaborates various classification methods used by authors to classify the stages of ossification centers of bones. The objective of this communication is to assess the effectiveness of both imaging and physical methods for age estimation and to provide a critical comparison to determine the superior approach. The findings suggest that imaging methods are more reliable for the estimation of age from ossification centers. Staging methods introduced by Schmeling et al, Kellinghaus et al, Dedouit et al, Vieth et al, and Kvist et al. are found to be the best methods for age estimation.

Animal family discrimination from hair using ATR-FTIR and machine learning methods for applications in illegal wildlife trafficking.

Wildlife forensics plays a pivotal role in the combating illegal trafficking, supporting biodiversity conservation, and aiding in the identification of animals in wildlife. Animal hair, often found in trafficking crimes, serves as vital biological evidence that can provide significant information for animal identification. This study proposes a novel method integrating machine learning classifiers with Fourier transform infrared (FTIR) spectroscopy in attenuated total reflectance (ATR) mode to enhance the effectiveness of animal identification in wildlife forensic casework. Additionally, compound microscopy has also been utilized as a preliminary tool to perform morphological analysis of hair samples from four animal families, including Bovidae, Cervidae, Elephantidae, and Felidae. Further, chemical profiling through spectral data revealed significant overlapping peaks between family Bovidae and Cervidae. The classification experiment provides the random forest (RF) classifier as the most effective for family discrimination model. This research offers valuable insights for wildlife forensics by improving the identification accuracy of unknown hair samples, thus enhancing the overall effectiveness in forensic investigations.

Aflatoxin exposure is associated with an increased risk of gallbladder cancer.

Gall bladder cancer (GBC) is common among the socioeconomically deprived populations of certain geographical regions. Aflatoxin is a genotoxic hepatocarcinogen, which is recognized to have a role in the pathogenesis of hepatocellular carcinoma. However, the role of aflatoxin in the pathogenesis of GBC is largely unknown. We determined serum AFB1-Lys albumin adduct (AAA) levels as a marker of aflatoxin exposure in the patients with GBC and compared to those without GBC. The relationship of AAA levels to cytogenetic (TP53mutation&HER2/neu amplification) and radiological characteristics of the tumor was assessed. We included GBC cases (n = 51) and non-GBC controls (n = 100). Mean serum AAA levels were higher in the GBC group (n = 51) than those without GBC (n = 100) (26.1 ± 12.2 vs. 13.1 ± 11.9 ng/mL; p < .001). HER2/neu expression was associated with higher AAA levels compared to those with equivocal or negative expression (43.9 ± 3 vs. 28.6 ± 10 vs. 19.3 ± 7 ng/mL; p < .001). Older age (age >50 years) (odds ratio [OR] = 3.2 [CI: 1.3-8.2]; p = .013), positive Helicobacter pylori serology (OR = 5.1 [CI: 1.4-17.8]; p = .012), presence of GS (OR = 5 [CI: 1.5-16.9]; p = .009) and detectable AAA levels (OR = 6.8 [CI: 1.3-35.7]; p = .024) were independent risk factors for the presence of the GBC among all study subjects. Among patients harboring GS, older age (age >50 years) (OR = 4.5 [CI: 1.3-14.9]; p = .015), female gender (OR = 3.8 [CI: 1.2-12.5]; p = .027), presence of multiple GS (OR = 21.9 [CI: 4.8-100.4]; p < .001) and high serum AAA levels (OR = 5.3 [CI: 1.6-17.3]; p = .006) were independent risk factors for the presence of the GBC. Elderly age >50 years (OR = 2.6 [CI: 1.3-5.2]; p = .010) and frequent peanut consumption (OR = 2.3 [CI: 1.1-4.9]; p = .030) were independent risk factors for high serum AAA levels. The current study has implications for the prevention of GBC through the reduction of dietary aflatoxin exposure.

Tracking Wall Characteristics of Necrotic Pancreatic Fluid Collections in Acute Pancreatitis on Serial Contrast-Enhanced Computed Tomography.

Background Encapsulated pancreatic fluid collection (PFC) is a requisite for endoscopic drainage procedures. The 4-week threshold for defining walled-off necrosis does not capture the dynamic process of encapsulation. We aim to investigate the changes in the wall characteristics of PFC in acute necrotizing pancreatitis (ANP) by comparing baseline contrast-enhanced computed tomography (CECT) with follow-up CT scans. Methods This retrospective study comprised consecutive patients with ANP who underwent a baseline CECT within first 2 weeks and follow-up CECT in the third to fifth weeks of illness. Presence, extent, and encapsulation thickness (defined as enhancing wall around the collection) on baseline CECT were compared with follow-up CT (done in the third-fifth weeks of illness). Results Thirty patients (19 males and 11 females; mean age 41.5 ± 13.5 years) were included in the study. The mean time to first CECT was 10 ± 3.6 days. There were 58 collections. The most common site was the lesser sac ( n = 29), followed by the left pararenal space ( n = 15). At baseline CT, 52 (89.7%) collections had varying degree of encapsulation (15.3%, complete encapsulation). Complete encapsulation was seen in 52 and 82.6% collections in third and fourth week, respectively. All collections in fifth week and beyond were encapsulated. The wall was thicker on follow-up CECT scans ( p < 0.01). The mean wall thickness was not significantly associated with the degree of encapsulation ( p = 0.417). There was no significant association between the site and degree of encapsulation ( p = 0.546). Conclusion Encapsulation is dynamic and collections may get "walled off" before 4 weeks. Walled-off collections should be defined based on imaging rather than a fixed 4-week revised Atlanta classification threshold.

Hindi translation and validation of the English version of the gastrointestinal symptom rating scale questionnaire: An observational study.

BACKGROUND: The gastrointestinal symptom rating scale (GSRS) is a questionnaire in English language which is designed to assess the clinical symptoms in patients with irritable bowel syndrome (IBS) and peptic ulcer disease. This validated scale has questions on around 15 items and has been validated in patients with dyspepsia and IBS. AIM: To translate and validate the English version of the GSRS questionnaire to the Hindi version. METHODS: The purpose of the present work was to create a Hindi version of this questionnaire for use in the Indian population. The process involved various steps as per the World Health Organization methodology including initial forward translation, backward translation, and assessment by an expert committee. Initial pilot testing was followed by testing in healthy and diseased individuals. RESULTS: The Hindi translation was pilot tested in 20 individuals and further validated in healthy controls (n = 30, 15 females) and diseased individuals (n = 72, 27 females). The diseased group included patients with functional dyspepsia and IBS. Cronbach's alpha for internal consistency on the final translated GSRS questionnaire was 0.715 which is considered adequate. Twelve questions significantly differentiated the diseased population from the healthy population (P value < 0.05) in the translated Hindi version of the GSRS. CONCLUSION: The translated Hindi GSRS can be used to evaluate gastrointestinal function in clinical trials and community surveys in Hindi speaking populations.

Does enamel deproteinisation with 10% papain affect shear bond strength of orthodontic adhesives: a randomised controlled trial.

OBJECTIVE: To evaluate the effect of 10% papain as an enamel deproteinising agent on the shear bond strength (SBS) of three orthodontic adhesives: Transbond XT, resin-modified glass ionomer cement (RMGIC) and Biofix. DESIGN: Single-centre, double-blinded, split-mouth randomised controlled trial. SETTING: Department of Orthodontics and Dentofacial Orthopaedics, Nair Hospital Dental College, Mumbai, India. PARTICIPANTS: A total of 20 participants requiring bilateral premolar extraction for fixed orthodontic treatment in both the maxillary and mandibular arches were included in this study. METHODS: In total, 80 premolars from the above-mentioned participants were divided into four groups as follows: group A: Transbond XT deproteinised with 10% papain gel; group B: Biofix deproteinised with 10% papain gel; group C: RMGIC deproteinised with 10% papain gel; and group D: Transbond XT without enamel deproteinisation as a control group-bonded as instructed by the manufacturer. After deproteinisation, brackets were bonded and after a follow-up period of 28 days, the teeth were extracted. The SBS was then measured using the Universal Testing Machine. The force needed to shear the bracket was documented, and bond strengths were subsequently calculated in megapascals (MPa). The obtained results were subjected to statistical analysis and one-way ANOVA was performed to compare the mean SBS between the groups. Subsequently, pairwise comparisons were conducted using Tukey's post hoc test. RESULTS: There was a statistically significant difference in SBS among all groups (P = 0.002). The SBS of TransXT with deproteinisation increased significantly compared with TransXT without deproteinisation (P = 0.03). There was no statistically significant difference between the SBS of TransXT without deproteinisation and RMGIC (P = 0.47) and Biofix (P = 0.39), both with deproteinisation. CONCLUSION: The use of 10% papain for deproteinising enamel improved the SBS of all materials. Deproteinising improved the SBS of RMGIC and Biofix to the level of TransXT without deproteinisation.

Dietary behaviour, attitude and food perceptions of patients with ulcerative colitis - An observational study.

BACKGROUND: Dietary knowledge, perception and practices may have a role in determining the nutritional status of patients with inflammatory bowel disease (IBD). However, the assessment of these patterns has infrequently been done in developing countries. We aimed to evaluate patients with ulcerative colitis (UC) about their dietary beliefs, practices and changes after the diagnosis. METHODS: We conducted a cross-sectional survey among patients with UC at a tertiary care centre in North India. Apart from clinical details, we collected information about dietary beliefs, sources of information, dietary practices and changes after the diagnosis of UC. The information was collected using a designed and pretested survey questionnaire. RESULTS: We included 93 patients with a mean age of 40.6 ± 13.3 years and 49 (52.7%) were men. A majority of patients felt that diet had an important role in the causation of IBD (86%, n = 80) and triggering relapses (86%, n = 80). A total of 94.6% of patients (n = 88) felt that certain foods (especially spicy and fatty food and milk) items increased the symptoms of IBD. Patients felt that some food items (yogurt and buttermilk) improved the symptoms. A total of 96.8% of patients (n = 90) changed their diet in some form (commonly, restriction of milk products and outside food), 64% of patients (n = 60) deprived themselves of their favourite food after diagnosis, 80.6% of patients (n = 75) felt a need for additional dietary advice. Regular milk intake was seen more often by patients in remission than those with active disease in IBD (36/47 (76.6%) vs 7/15(46.6%), p = 0.03). CONCLUSION: Most patients believe that diet has an important role in the causation, relapses and treatment of UC. Patients also felt the need for more information regarding diet in IBD.

Novel quinolone substituted 1,3,4-oxadiazole derivatives: design, synthesis, antimicrobial and anti-inflammatory potential.

A novel series of quinolone-substituted 1,3,4-oxadiazole derivatives 4(a-l) have been designed and synthesized. The target compounds were investigated for their antibacterial activity against gram positive (Staphylococcus aureus, ATCC 25923, Enterococcus faecalis, ATCC 29212) and gram negative bacterium (Escherichia coli, ATCC 25922, Pseudomonas aeruginosa, ATCC 27853) for antifungal activity using (Candida albicans, ATCC 10231) and anti-inflammatory activity as COX-II inhibitors, respectively. The 1,3,4-oxadiazole functionality was introduced at C-6 position of pipemidic acid derivatives. IR, 1H NMR and Mass spectrometry techniques confirmed the structure of synthesized derivatives. The quinolone (pipemidic acid)-oxadiazole hybrid derivatives were effective against bacterial strains. When compared to ciprofloxacin (MIC 16 µg/mL), the compounds under consideration (4f, 4h, and 4k) showed significant antibacterial activity against all bacterial strains except Enterococcus faecalis, with MICs of 8 µg/mL. On the other hand, synthesized target compounds 4(a-l) did not respond well against Candida albicans fungal strain. The compound (4k) represents high % inhibition against COX-II. The compounds (4f, 4h and 4k) exhibited highest hydrogen bonding interaction with ARG57, ARG72, ARG78, LEU54 and MET16 target residues with a binding energy of - 8.4, - 8.6 and - 8.5 kcal/mol into the active pocket of DNA gyrase enzyme respectively even better in comparison to reference ligands. Based on the docking study, quinolone (pipemidic acid) oxadiazole hybrid structural ligands exhibited strong interaction at binding pockets of DNA gyrase enzyme.

Pursuing multifaceted-disciplinarity to enrich the future of justice in sustainability science.

Although sustainability issues disproportionately affect disenfranchised populations, justice considerations are often left to social scientists in sustainability research. As early-career researchers pursuing doctoral degrees in diverse disciplines focusing on sustainability, we reflect on the unintentional exclusion of justice in sustainability research. Building on our individual and collective research experiences, we propose a critical multifaceted-disciplinary perspective, advocating for the holistic creation of interdisciplinary academic teams involving scholars from diverse racial, social, cultural, and economic contexts. By embracing multifaceted-disciplinarity, we can step toward establishing and nurturing spaces that enrich justice considerations in sustainability science, forming a more comprehensive understanding of sustainability predicaments and building sustainable and humane futures for all.

Severe pulmonary arterial hypertension in congenital sideroblastic anemia from PUS1 mutation - a case report.

BACKGROUND: Myopathy, lactic acidosis and inherited sideroblastic anemia (MLASA) are a group of rare intriguing disorders with wider pathophysiological implications. One of the causes of MLASA is the mutation in PUS1 gene that encodes for pseudouridine synthase. This PUS1 mutation results in MLASA in which anemia and myopathy predominate. Severe pulmonary arterial hypertension has not been previously reported in patients with PUS1 gene mutation. CASE REPORT: A 17 year old girl with congenital sideroblastic anemia presented with worsening of breathlessness. Severe pulmonary artery hypertension was documented on investigations. A homozygous variant in exon 3 of gene PUS1,( chromosome 12:g.131932301 C > T c.430 C > T) was found on sanger sequencing. CONCLUSION: We document severe pulmonary arterial hypertension in a patient of congenital sideroblastic anemia from PUS1 gene. We hypothesis that cross talk with TGFb pathways might occur in PUS1 mutation, and that might cause severe PAH. This observation might have therapeutic implications.

Transition metal-free efficient synthesis of bis(indolyl)propynes (BIPs).

A transition metal-free approach has been devised for the synthesis of a variety of bis(indolyl)propyne (BIP) derivatives. The strategy involves an iodine-catalyzed cascade condensation of α,ß-unsaturated acetylenic aldehydes with diversely substituted indoles. The strategy was applicable to gram scale synthesis and a library of 50 molecules, which were afforded in good to excellent yields (up to 96%), was developed. The salient features of the reaction involve the synthesis of indole based privileged scaffolds in a short reaction time under transition metal-free conditions, with a wide substrate scope and excellent yields under ambient conditions.

Enhanced forest fire evacuation planning using real-time sensor and GPS algorithm.

Forest fires are the source of countless fatalities and extreme economic repercussions. The safe evacuation of residents of an area affected by forest fires is the highest priority of local authorities, and finding the most optimal course of action has been a primary research focus for years. Previous studies over several decades have attempted to find an optimal solution using the applications of bug navigation systems, road network reconfiguration, graph traversals, swarm optimization, etc. The author, with the motivation to prevent human casualties at the time of such calamity, presents a novel study which solves the problem in nearly linear time computation, surpassing the performance standards of previous research, and accommodates the unpredictability of the spread of forest fires. This includes a proposal of an algorithm which builds upon the application of Spielman and Teng's Electrical Circuit Approach to solve for maximum flow in a network and implements this with real-time sensor and Global Positioning System input.

Cigarette paper as evidence: Forensic profiling using ATR-FTIR spectroscopy and machine learning algorithms.

This research highlights the underestimated significance of cigarette paper as evidence at crime scenes. The primary objective is to distinguish cigarette paper from similar-looking alternatives, addressing the first research objective. The second objective involves identifying cigarette paper brands using attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy and machine learning (ML) algorithms. Accurate differentiation of cigarette paper from normal paper is emphasized. ATR-FTIR spectroscopy, coupled with principal component analysis (PCA) for dimensionality reduction, is employed for brand identification. Among fifteen ML algorithms compared, the CatBoost classifier excels for both objectives. This research presents a non-destructive, effective method for studying cigarette paper, contributing valuable insights to crime scene investigations.

Efficient oil spill cleanup from water: Investigating the effectiveness of a sustainable anti-swelling hydrogel for rapid water repellency and oil absorption.

Considering the significant harm caused to aquatic ecosystems and marine life by oil spills and the discharge of oily wastewater, there is a pressing need to address this issue to protect our environment and prevent the wastage of valuable resources. We introduced a two-step approach to create an anti-swelling, water-repellent sorbent using a green polysaccharide called gum gellan, functionalized with Octadecyl trichlorosilane (OTS) through dip coating method. Natural gums like gellan have high absorption capability due to their large surface area. However, they are hydrophilic, which means they can only absorb water. This property makes them unsuitable for oil spill applications. To make gum gellan suitable for oil spill applications, we have modified it in this study. We have introduced a material called octadecyltrichlorosilane, which has low surface energy and hierarchical roughness. This modification changes the wettability of gellan from hydrophilic to hydrophobic/oleophilic, allowing it to absorb oil and repel water. The sorbent is analyzed using several techniques, such as FTIR, XRD, TGA, FE-SEM, BET, Raman, EDX, and H1-NMR. The hydrophobic sorbent obtained demonstrates low density, high surface area, and high porosity. These characteristics give it excellent floatability and immediate and exceptional selectivity for absorbing oil from water. Additionally, it does not absorb any detectable amount of water. The sorbent exhibited a water contact angle (WCA) of 140 ± 3 ° and an oil contact angle (OCA) of 0° for various oils and organic solvents. It has rapid oil absorption capacity of 3.72 g/g for diesel, and can be easily recovered after use. The BET analysis revealed that after the modification with OTS, the sorbent's total surface area increased from 0.579 m2/g to 4.713 m2/g. This indicates that the OTS modification greatly enhances the surface area and pore volume of the, thus improving its ability to absorb oil. This sorbent efficiently separates oil-in-water emulsions, both surfactant-stabilized and surfactant-free, achieving over 90% separation through gravity alone. Moreover, the sorbent can sustain its wettability even under harsh environmental conditions, including exposure to acids, alkalis, and salts. The absorption data predominantly aligned with the pseudo-2nd-order model. Thus, this sorbent provides a cost-effective alternative for efficiently absorbing and separating oil-water emulsions in households and industries.