Pharmacogenetic guided versus standard warfarin dosing for routine clinical care with its pharmacoeconomic impact: a randomized controlled clinical trial.

BACKGROUND: Empirical use of pharmacogenetic test(PGT) is advocated for many drugs, and resource-rich setting hospitals are using the same commonly. The clinical translation of pharmacogenetic tests in terms of cost and clinical utility is yet to be examined in hospitals of low middle income countries (LMICs). AIM: The present study assessed the clinical utility of PGT by comparing the pharmacogenetically(PGT) guided- versus standard of care(SOC)- warfarin therapy, including the health economics of the two warfarin therapies. METHODS: An open-label, randomized, controlled clinical trial recruited warfarin-receiving patients in pharmacogenetically(PGT) guided- versus standard of care(SOC)- study arms. Pharmacogenetic analysis of CYP2C9*2(rs1799853), CYP2C9*3(rs1057910) and VKORC1(rs9923231) was performed for patients recruited to the PGT-guided arm. PT(Prothrombin Time)-INR(international normalized ratio) testing and dose titrations were allowed as per routine clinical practice. The primary endpoint was the percent time spent in the therapeutic INR range(TTR) during the 90-day observation period. Secondary endpoints were time to reach therapeutic INR(TRT), the proportion of adverse events, and economic comparison between two modes of therapy in a Markov model built for the commonest warfarin indication- atrial fibrillation. RESULTS: The study enrolled 168 patients, 84 in each arm. Per-protocol analysis showed a significantly high median time spent in therapeutic INR in the genotype-guided arm(42.85%; CI 21.4-66.75) as compared to the SOC arm(8.8%; CI 0-27.2)(p < 0.00001). The TRT was less in the PG-guided warfarin dosing group than the standard-of-care dosing warfarin group (17.85 vs. 33.92 days) (p = 0.002). Bleeding and thromboembolic events were similar in the two study groups. Lifetime expenditure was ₹1,26,830 in the PGT arm compared to ₹1,17,907 in the SOC arm. The QALY gain did not differ in the two groups(3.9 vs. 3.65). Compared to SOC, the incremental cost-utility ratio was ₹35,962 per QALY gain with PGT test opting. In deterministic and probabilistic sensitivity analysis, the base case results were found to be insensitive to the variation in model parameters. In the cost-effectiveness-acceptability curve analysis, a 90% probability of cost-effectiveness was reached at a willingness-to-pay(WTP) of ₹ 71,630 well below one time GDP threshold of WTP used. CONCLUSION: Clinical efficacy and the cost-effectiveness of the warfarin pharmacogenetic test suggest its routine use as a point of care investigation for patient care in LMICs.

Design, development and bio-evaluation of a novel radio-ligand 99mTc-THQ-DTPA as a sigma 2 receptor specific breast tumor imaging agent.

Over-expression of sigma-2 receptor in cancer cells provides an opportunity to develop molecular probes for diagnosis, even for non-receptor specific malignancies like triple negative breast cancers. In this work, a novel sigma-2 receptor ligand [THQ-DTPA] has been synthesized and characterized using 6,7-dimethoxy-1,2,3,4-tetrahydroisoquinoline (THQ) and diethylenetriaminepentaacetic acid (DTPA). The ligand is further chelated with 99mTc for application as metal based radiotracer [99mTc-THQ-DTPA]. Radiolabelling with 99mTc was achieved in an excellent yield of 98.0 ± 0.5% using stannous chloride as a reducing agent. The radioligand was found to be stable in human serum up-to 24 h, bio-compatible with less than 4% hemolysis, and exhibited high binding with sigma receptors isolated from rat liver membrane (Kd of 16.32 ± 4.93 nM and Bmax of 0.5232 ± 0.06 pmol/mg). Bio-distribution studies in triple-negative breast tumor bearing nude mice showed high tumor uptake after 30 min of injection with tumor/muscle (T/M) ratio of 3.58 ± 0.09. At 240 min, the T/M ratio (2.84 ± 0.20) decreased by 35% when administered in sigma blocked tumor bearing mice (1.81 ± 0.16) suggesting the selectivity of the ligand. Tumor imaging in gamma camera indicated a contrast of 3.56 at 30 min p.i. The above findings indicate that the ligand 99mTc-THQ-DTPA binds to sigma-2 receptors with high affinity and has potential for triple-negative breast tumor imaging.

The MukB-topoisomerase IV interaction mutually suppresses their catalytic activities.

The bacterial condensin MukB and the cellular chromosomal decatenase, topoisomerase IV interact and this interaction is required for proper condensation and topological ordering of the chromosome. Here, we show that Topo IV stimulates MukB DNA condensation by stabilizing loops in DNA: MukB alone can condense nicked plasmid DNA into a protein-DNA complex that has greater electrophoretic mobility than that of the DNA alone, but both MukB and Topo IV are required for a similar condensation of a linear DNA representing long stretches of the chromosome. Remarkably, we show that rather than MukB stimulating the decatenase activity of Topo IV, as has been argued previously, in stoichiometric complexes of the two enzymes each inhibits the activity of the other: the ParC subunit of Topo IV inhibits the MukF-stimulated ATPase activity of MukB and MukB inhibits both DNA crossover trapping and DNA cleavage by Topo IV. These observations suggest that when in complex on the DNA, Topo IV inhibits the motor function of MukB and the two proteins provide a stable scaffold for chromosomal DNA condensation.

Early and mid-term outcomes of double-chambered right ventricle repair: An 8-year experience.

BACKGROUND/AIM: Double-chambered right ventricle is a rare and progressive condition that is characterised by obstruction of the right ventricular tract. Double-chambered right ventricle is usually associated with ventricular septal defect. Early surgical intervention is recommended in patients with these defects. Based on this background, the present study aimed to review early and midterm outcomes of primary repair after double-chambered right ventricle. METHODS: Between January 2014 and June 2021, 64 patients with a mean age of 13.42 ± 12.31 years underwent surgical repair for double-chambered right ventricle. The clinical outcomes of these patients were reviewed and assessed retrospectively. RESULTS: An associated ventricular septal defect was present in all the recruited patients; 48 (75%) patients of sub-arterial type, 15 (23.4%) of perimembranous, and 1 (1.6%) patient of muscular type. The patients were followed up for a mean period of 46.73 ± 27.37 months. During their follow-up, a significant decrease in the mean pressure gradient from 62.33 ± 5.52 mmHg preoperatively to 15.73 ± 2.94 mmHg postoperatively was observed (p < 0.001). Notably, there were no hospital deaths. CONCLUSIONS: The development of double-chambered right ventricle in association with ventricular septal defect results in an increased pressure gradient within the right ventricle. The defect needs correction in a timely manner. In our experience, the surgical correction of double-chambered right ventricle is safe and shows excellent early and mid-term results.

Ensuring carbon neutrality via algae-based wastewater treatment systems: Progress and future perspectives.

The emergence of algal biorefineries has garnered considerable attention to researchers owing to their potential to ensure carbon neutrality via mitigation of atmospheric greenhouse gases. Algae-derived biofuels, characterized by their carbon-neutral nature, stand poised to play a pivotal role in advancing sustainable development initiatives aimed at enhancing environmental and societal well-being. In this context, algae-based wastewater treatment systems are greatly appreciated for their efficacy in nutrient removal and simultaneous bioenergy generation. These systems leverage the growth of algae species on wastewater nutrients-including carbon, nitrogen, and phosphorus-alongside carbon dioxide, thus facilitating a multifaceted approach to pollution remediation. This review seeks to delve into the realization of carbon neutrality through algae-mediated wastewater treatment approaches. Through a comprehensive analysis, this review scrutinizes the trajectory of algae-based wastewater treatment via bibliometric analysis. It subsequently examines the case studies and empirical insights pertaining to algae cultivation, treatment performance analysis, cost and life cycle analyses, and the implementation of optimization methodologies rooted in artificial intelligence and machine learning algorithms for algae-based wastewater treatment systems. By synthesizing these diverse perspectives, this study aims to offer valuable insights for the development of future engineering applications predicated on an in-depth understanding of carbon neutrality within the framework of circular economy paradigms.

Land cover changes and carbon dynamics in Central India's dry tropical forests: A 25-year assessment and nature-based eco-restoration approaches.

Anthropogenic land use and land cover changes are major drivers of environmental degradation and declining soil health across heterogeneous landscapes in Central India. To examines the land cover changes and spatio-temporal variations in forest carbon stock and soil organic carbon (SOC) over the past 25 years in central India. Geospatial techniques, coupled with ground measurements were employed to detect changes in land cover, carbon stocks in vegetation, and soil carbon in various vegetation types. The results indicate that forested areas have decreased, while agriculture and habitation have expanded between 1997 and 2022. Vegetation C stocks varied significantly (P < 0.05) from 39.42 to 139.95 Mg ha-1 and the SOC varied from 7.02 to 17.98 Mg ha-1 under different soil profiles across vegetation types, which decreased with soil depth, while the pH and bulk density increased. The maximum bulk density in the soil was found at a depth of 40-60 cm (lower profile) in Bamboo Brake, while the minimum was observed under Dense Mixed Forest at a depth of 0-20 cm (top profile). The topsoil profile contributed 33.6%-39%, the middle profile (20-40 cm) was 33.6%-34.4%, and the lower profile was 26.5%-30.8% of soil organic carbon. The study site has experienced rapid carbon losses due to changes in land cover, such as illegal expansion of agriculture, encroachments into forest fringes, and activities like selective logging and overgrazing, which have degraded dense forests. The ecological engineering of degraded ecosystems poses a great challenge and application of complex biological, mechanical and engineering measures is highly cumbersome, expensive, uneconomical and practically not feasible for upscaling. Nevertheless, proposed nature-based solutions mimic natural reparation and processes provide sustainable interventions for the reclamation of ruined landscapes besides improving ecological integrity and rendering many co-benefits to ecosystems and human societies.

Intersubunit and intrasubunit interactions driving the MukBEF ATPase.

MukBEF, a structural maintenance of chromosome-like protein complex consisting of an ATPase, MukB, and two interacting subunits, MukE and MukF, functions as the bacterial condensin. It is likely that MukBEF compacts DNA via an ATP hydrolysis-dependent DNA loop-extrusion reaction similar to that demonstrated for the yeast structural maintenance of chromosome proteins condensin and cohesin. MukB also interacts with the ParC subunit of the cellular chromosomal decatenase topoisomerase IV, an interaction that is required for proper chromosome condensation and segregation in Escherichia coli, although it suppresses the MukB ATPase activity. Other structural determinants and interactions that regulate the ATPase activity of MukBEF are not clear. Here, we have investigated the MukBEF ATPase activity, identifying intersubunit and intrasubunit interactions by protein-protein crosslinking and site-specific mutagenesis. We show that interactions between the hinge of MukB and its neck region are essential for the ATPase activity, that the ParC subunit of topoisomerase IV inhibits the MukB ATPase by preventing this interaction, that MukE interaction with DNA is likely essential for viability, and that interactions between MukF and the MukB neck region are necessary for ATPase activity and viability.

Combinatorial Network of Transcriptional and miRNA Regulation in Colorectal Cancer.

Colorectal cancer is one of the leading causes of cancer-associated mortality across the worldwide. One of the major challenges in colorectal cancer is the understanding of the regulatory mechanisms of biological molecules. In this study, we aimed to identify novel key molecules in colorectal cancer by using a computational systems biology approach. We constructed the colorectal protein-protein interaction network which followed hierarchical scale-free nature. We identified TP53, CTNBB1, AKT1, EGFR, HRAS, JUN, RHOA, and EGF as bottleneck-hubs. The HRAS showed the largest interacting strength with functional subnetworks, having strong correlation with protein phosphorylation, kinase activity, signal transduction, and apoptotic processes. Furthermore, we constructed the bottleneck-hubs' regulatory networks with their transcriptional (transcription factor) and post-transcriptional (miRNAs) regulators, which exhibited the important key regulators. We observed miR-429, miR-622, and miR-133b and transcription factors (EZH2, HDAC1, HDAC4, AR, NFKB1, and KLF4) regulates four bottleneck-hubs (TP53, JUN, AKT1 and EGFR) at the motif level. In future, biochemical investigation of the observed key regulators could provide further understanding about their role in the pathophysiology of colorectal cancer.

Quantum Communications Feasibility Tests over a UK-Ireland 224 km Undersea Link.

The future quantum internet will leverage existing communication infrastructures, including deployed optical fibre networks, to enable novel applications that outperform current information technology. In this scenario, we perform a feasibility study of quantum communications over an industrial 224 km submarine optical fibre link deployed between Southport in the United Kingdom (UK) and Portrane in the Republic of Ireland (IE). With a characterisation of phase drift, polarisation stability and the arrival time of entangled photons, we demonstrate the suitability of the link to enable international UK-IE quantum communications for the first time.

Effect of organic food production and consumption on the affective and cognitive well-being of farmers: analysis using prism of NVivo, etic and emic approach.

Extant research studies support has stressed the significance of nourishment on the physical health of humans. Some of the past academic literature has also hinted at an interconnect between food, thoughts, and action that becomes especially significant in the current era of Anthropocene. Organic farming production and consumption can not only enhance economic well-being but also promote social well-being along with subject well-being. Beyond the individual level, a community level facilitates fostering physical emotional physical and emotional ecosystems. However, several studies have inferred seemingly dubious claims about the impact of natural food intake on the mental well-being of an individual. In light of this impinging need, this first-of-its-kind study focused to search the impact of organic food consumption on the cognitive behaviour of individuals. Interview-based qualitative field research with 30 peasants' families was conducted in two phases in the model organic village of Manj Gaon of Uttarakhand. Results indicate that organic farming has positively impacted the mental well-being of the farmers, and apart from it, physical health, food security, and financial security are the fringe benefits for native organic farmers. However, there are many bottlenecks from the policy perspective such as non-availability of organic seeds, lack of marketplaces, lack of transportation infrastructure, and almost no facility of cold storage and warehouse, especially during the time of summer season. All these significantly hamper the adoption and sustenance of organic food production and consumption. Although many farmers exhibit the attributes of subjective well-being, as an outcome, it is rooted in the consumption of organic food, because better intake leads to a better thought process and eventually the results get reflected in the form of a better human being. To conclude, better thoughts, emotions, mind, and health of a human individual and society are strongly rooted in the adoption of chemical and pesticide-free food, i.e. organic.

Experimental study on underwater continuous-variable quantum key distribution with discrete modulation.

We experimentally demonstrated the feasibility of an underwater continuous-variable quantum key distribution (CV-QKD) system based on four-state protocol, which is promising to guarantee the unconditionally secure underwater wireless optical communication. CV-QKD parameter estimation is performed after transmitting quantum coherent signal from Alice to Bob through a water tank. The secure key rate under collective attack of the demonstrated CV-QKD system is estimated as 22.9 kbits/s at a channel loss of 12.4 dB. In addition, the performance is also investigated with various water types and the maximum underwater transmission distance of the demonstrated CV-QKD system is estimated as 148.7 m in the pure sea water.

Hotel building design, occupants' health and performance in response to COVID 19.

In the COVID-19 pandemic, the employee realized the importance of a healthy workplace. A healthy workplace provides natural protection against respiratory disease and reduces exposure to viruses. Therefore, the current COVID-19 pandemic should be a wake-up call to understand the importance of building design and a dress rehearsal for future challenges because building-based prevention and control measures have become one of the most significant ways of fighting against the epidemic. This study investigates the role of hotel building design in employee health and performance during the COVID-19 pandemic. The study covered the LEED-certified hotel building in India. The formulated Hypothesis was tested empirically by the structural equation modeling (SEM) for determining the potential of the hotel building design. It was obtained from the study that during the COVID-19 pandemic, the hotel building design of the hospitality industry had a more significant influence on employee performance, followed by employee health.

Towards underwater coherent optical wireless communications using a simplified detection scheme.

In this paper, an effective method of underwater coherent optical wireless communication (UCOWC) with a simplified detection scheme is proposed. The proof-of-concept experiments with M-ary PSK have been conducted with a common laser used for the signal source and local oscillator (LO). The BER performance has been evaluated at different underwater channel attenuations and the maximum achievable attenuation length (AL) with a BER below the forward error correction (FEC) limit of 3.8×10-3 is investigated. The tested system offers data rates of 500 Mbps, 1 Gbps, and 1.5 Gbps with the BPSK, QPSK and 8PSK modulated signals, respectively. The corresponding maximum achievable attenuation lengths are measured as 13.4 AL 12.5 AL, and 10.7 AL. In addition, the performance degradation of the practical system with separate free running lasers for the signal and LO is also estimated. To the best of our knowledge, the UCOWC system is proposed and experimentally studied for the first time. This work provides a simple and effective approach to take advantages of coherent detection in underwater wireless optical communication, opening a promising path toward the development of practical UCOWC with next-generation underwater data transmission requirements on the capacity and transmission distance.

Accumulating Impact of Smoking and Co-morbidities on Severity and Mortality of COVID-19 Infection: A Systematic Review and Meta-analysis.

Background: High prevalence, severity, and formidable morbidity have marked the recent emergence of the novel coronavirus disease (COVID-19) pandemic. The significant association with the pre-existing co-morbid conditions has increased the disease burden of this global health emergency, pushing the patients, healthcare workers and facilities to the verge of complete disruption. Methods: Meta-analysis of pooled data was undertaken to assess the cumulative risk assessment of multiple co-morbid conditions associated with severe COVID-19. PubMed, Scopus, and Google Scholar were searched from January 1st to June 27th 2020 to generate a well-ordered, analytical, and critical review. The exercise began with keying in requisite keywords, followed by inclusion and exclusion criteria, data extraction, and quality evaluation. The final statistical meta-analysis of the risk factors of critical/severe and non-critical COVID-19 infection was carried out on Microsoft Excel (Ver. 2013), MedCalc (Ver.19.3), and RevMan software (Ver.5.3). Results: We investigated 19 eligible studies, comprising 12037 COVID-19 disease patients, representing the People's Republic of China (PRC), USA, and Europe. 18.2% (n = 2200) of total patients had critical/severe COVID-19 disease. The pooled analysis showed a significant association of COVID-19 disease severity risk with cardiovascular disease (RR: 3.11, p < 0.001), followed by diabetes (RR: 2.06, p < 0.001), hypertension (RR: 1.54, p < 0.001), and smoking (RR: 1.52, p < 006). Conclusion: The review involved a sample size of 12037 COVID-19 patients across a wide geographical distribution. The reviewed reports have focussed on the association of individual risk assessment of co-morbid conditions with the heightened risk of COVID-19 disease. The present meta-analysis of cumulative risk assessment of co-morbidity from cardiovascular disease, diabetes, hypertension, and smoking signals a novel interpretation of inherent risk factors exacerbating COVID-19 disease severity. Consequently, there exists a definite window of opportunity for increasing survival of COVID-19 patients (with high risk and co-morbid conditions) by timely identification and implementation of appropriately suitable treatment modalities.

Rare branching pattern of the aortic arch in a neonate.

Here, we describe the case of a neonate who was found to have a complex pattern of branching on radiological imaging. The right common carotid artery, left common carotid artery and left subclavian artery were arising as a common single trunk from the arch of aorta with the additional presence of an aberrant right subclavian artery from the distal aortic arch on the left side and having a retroesophageal course to reach the right arm.

Implications of left atrial enlargement and patent foramen ovale creation on early surgical outcomes in patients with total anomalous pulmonary venous connection.

INTRODUCTION: In patients with total anomalous pulmonary venous connection (TAPVC), left atrium (LA) is small and suprasystemic pulmonary artery (PA) pressures may be present in some patients. In our study, we studied the relationship between surgical LA enlargement and patent foramen ovale (PFO) creation separately on the outcomes of patients with TAPVC. MATERIALS AND METHODS: Out of the 130 patients operated in our institute between January 2014 and December 2020, LA was enlarged in 60 patients. LA enlargement was done using a larger patch for atrial septal defect (ASD) closure. Thus, the LA volume was increased by shifting the patch towards the right atrium (RA). Suprasystemic or high PA pressures were present in 60 patients. In 33 patients, PFO was created. Early surgical outcomes were determined on the basis of vasoactive inotropic score (VIS), hours of ventilation, hours of inotropic support, intensive care unit (ICU) stay, and hospital stay. RESULT: Between the LA enlarged and nonenlarged group there was statistically significant less VIS score (18 [13-27.5] vs. 24 [18-30], p value .019), hours of ventilation (23 [16-46.5] vs. 26 [18-60], p value .039), hours of inotropic support (45.5 [30-72] vs. 55 [38-84], p value .038), and ICU stay (7 [5-9] vs. 8 [7-10] p value .0352) and statistically nonsignificant less hospital stay (11.5 [9-13] vs. 12 [9-14], p value .424). In patients with preoperative suprasystemic or high PA pressures, there was a statistically significant less VIS score (16 [11-23.5] vs. 18 [13-25], p value .044), hours of ventilation (20 [14-37] vs. 22 [18-39], p value .038), hours of inotropic support (34 [29.5-71] vs. 38 [30-78], p value .042), and hospital stay (9 [5-12] vs. 11 [9-14], p value .038) and statistically nonsignificant less ICU stay (7 [5.5-9] vs. 7 [6-9], p value .886) in the group with a PFO with respect to the other group in which no PFO was created. CONCLUSION: In patients with TAPVC, LA can be enlarged by using a large ASD patch and thus shifting the septum towards RA. Early surgical outcomes were improved with LA enlargement. In patients with suprasystemic or high PA pressures, leaving a PFO improved the postoperative outcomes.

Honeycomb in the heart: A rare case of hydatid cyst of the interventricular septum.

The incidence of cardiac hydatid disease, caused by Echinococcus granulosus, is 0.5% to 2% in the sheep grazing areas of developing and under-developed countries. The cyst can be present in the interventricular septum in 5% to 9% of the patients, along with conduction block or arrythmia. Intraoperative transesophageal echocardiography (TEE) can guide the surgeon in cyst localization and excision. This image review highlights the TEE findings in a young patient with multiple hydatid cysts of the interventricular septum, and the cyst membrane adhering to the septal tricuspid leaflet.

Emergency valve preserving ascending aorta replacement following iatrogenic right coronary artery dissection: A life-saving procedure.

Iatrogenic aortocoronary dissection is a rare but potentially fatal complication of coronary catheterizations. Although the incidence is comparatively low, dissection often leads to procedure failure with increased risk of myocardial infarction and death. Iatrogenic aortocoronary dissection is principally caused by disruption of intima at the ostia of the right or left coronary artery during interventional procedures and appears as luminal filling defects, the persistence of contrast or intimal tear outside the coronary lumen. We present a case of right coronary artery dissection leading to type-A aortic dissection suffered during diagnostic coronary catheterization. This required emergency supracoronary replacement of the ascending aorta with an aortic interposition tube graft and venous grafts to coronary arteries.

Pulmonary valve neocuspidisation with glutaraldehyde-treated autologous pericardium-A novel technique in pulmonary valve endocarditis.

Infective endocarditis (IE) is a serious condition leading to heart failure, persistent sepsis. The management of IE involving valve is mainly excision of the infected valve and replacement with a heart valve; which are also at the risk of prosthetic valve endocarditis. Hence repair of the valve with autologous pericardium is much more physiological. We had a 20-year-old male presented with features of heart failure and high-grade fever not responding to optimum medical management. Two-dimensional echocardiogram revealed vegetation on pulmonary valve cusps with the erosion of the left and right cusps. Neo cusps with autologous pericardium offered good hemodynamics with trivial regurgitation. The patient is doing well with normal pulmonary valve function 3 months after surgery. This technique is reliable, economic, and easily reproducible.

The MukB-topoisomerase IV interaction is required for proper chromosome compaction.

The bacterial condensin MukB and the cellular decatenating enzyme topoisomerase IV interact. This interaction stimulates intramolecular reactions catalyzed by topoisomerase IV, supercoiled DNA relaxation, and DNA knotting but not intermolecular reactions such as decatenation of linked DNAs. We have demonstrated previously that MukB condenses DNA by sequestering negative supercoils and stabilizing topologically isolated loops in the DNA. We show here that the MukB-topoisomerase IV interaction stabilizes MukB on DNA, increasing the extent of DNA condensation without increasing the amount of MukB bound to the DNA. This effect does not require the catalytic activity of topoisomerase IV. Cells carrying a mukB mutant allele that encodes a protein that does not interact with topoisomerase IV exhibit severe nucleoid decompaction leading to chromosome segregation defects. These findings suggest that the MukB-topoisomerase IV complex may provide a scaffold for DNA condensation.