Massive Ovarian Mucinous Cystadenoma Complicating Term Birth.

Usually, symptomatic ovarian cysts in pregnancy require surgical removal in the second trimester. However, occasionally, large ovarian cysts may be encountered in the third trimester, which might hinder normal vaginal delivery. Herein, we present one such case to highlight the challenges of managing a large ovarian cyst in a full-term pregnancy.

Impact of crop rotation and tillage operations on mitigating greenhouse gas emissions and evaluation of sustainability index in rice- wheat-green gram cropping system of north Bihar.

In North Bihar (NB), the conventional rice-wheat cropping system has led to soil, water, and environmental degradation, alongside low profitability, threatening sustainability. To address these concerns, a thorough field research was conducted over the course of three years to assess different methods of tillage and crop establishment in a rice, wheat, and greengram cycle. The experiment involved five scenarios with different combinations of crop rotation, tillage techniques, seeding procedures, fertilizer use, and irrigation strategies. Uncertainty analysis showed no significant change in mean and variance estimation among seven scenario replications at 5% significance level. Compared to traditional farming (SN-1), managing DSR-rice (SN-5) increased profitability by 17.56%, improved energy use efficiency (EUE) by 32.16%, and reduced irrigation by 24.76% and global warming potential (GWP) by 23.46%. Similarly, substituting zero tillage wheat (ZTW) SN-5 resulted in comparable profitability gains (18.25%) and significant improvements in irrigation (10 %), EUE (+48.65%), and GWP (-20 %) compared to SN-1. Green gram ZT also showed increased profitability (17.35%), with notable improvements in EUE (+38.31%) and GWP (-12.92%) compared to SN-1. Principal component and correlation analyses revealed relationships between total energy inputs, yields, economic returns, and sustainability indices, highlighting the benefits of crop rotation and tillage practices in optimizing resource use. The study suggests that compared to conventional systems, significant improvements in productivity, profitability, energy-use efficiency, and environmental mitigation can be achieved with Crop Rotation and Tillage Operations techniques.

HRV changes in young adults with depression.

Background and Aims: Depression is a common and debilitant mental health disorder that is very common among young adults of the age group of 18-25 years. There is evidence that autonomic nervous system dysfunction associated with depression may play an important role in cardiovascular disease among patients with depression. HRV that is used to assess ANS function is found to be altered in depression. Since the HRV findings associated with depression remain inconsistent, this study is aimed to find HRV changes associated with depression so that the use of HRV as a diagnostic tool for depression can be validated. Methods: A total of 42 newly diagnosed patients of depression of the age group (18-26) years and 89 non-depressed volunteers matched for age, BMI and sex proportions were included in the study. Heart rate variability was recorded using five-minute stationary RR interval of Lead II by 4-channel Power Lab System (AD Instrument Ltd). HRV findings are summarized into Time-Domain parameters, Frequency-Domain parameters and Non-Linear parameters. Result: All HRV parameters are significantly reduced and the LF/HF ratio is significantly raised (P < 0.05) in the group of depressive patients when compared to the group of healthy controls. The reduction of HRV parameters (SDRR, RMSSD, Total Power, SD1 and SD2) in the group of patients with depression is found to be highly significant (P < 0.0001). Conclusion: The findings of our study suggest that depression may be associated with alterations in ANS activities, which contribute to an increased risk of cardiovascular disease. Thus, HRV can serve as a potential bio-marker for depression.

Surgical Dilemma in Approaching Parapharyngeal Space Pleomorphic adenoma- Transcervical or Transoral Route - A Case Report.

A case of pleomorphic adenoma of deep lobe of parotid in parapharyngeal space presented as intra oral swelling. FNAC showed features of pleomorphic adenoma. Surgery done through transcervical route. HPE of excised mass confirmed pleomorphic adenoma.

Allele Frequencies of Genetic Variants Associated with Varroa Drone Brood Resistance (DBR) in Apis mellifera Subspecies across the European Continent.

Implementation of marker-assisted selection (MAS) in modern beekeeping would improve sustainability, especially in breeding programs aiming for resilience against the parasitic mite Varroa destructor. Selecting honey bee colonies for natural resistance traits, such as brood-intrinsic suppression of varroa mite reproduction, reduces the use of chemical acaricides while respecting local adaptation. In 2019, eight genomic variants associated with varroa non-reproduction in drone brood were discovered in a single colony from the Amsterdam Water Dune population in the Netherlands. Recently, a new study tested the applicability of these eight genetic variants for the same phenotype on a population-wide scale in Flanders, Belgium. As the properties of some variants varied between the two studies, one hypothesized that the difference in genetic ancestry of the sampled colonies may underly these contribution shifts. In order to frame this, we determined the allele frequencies of the eight genetic variants in more than 360 Apis mellifera colonies across the European continent and found that variant type allele frequencies of these variants are primarily related to the A. mellifera subspecies or phylogenetic honey bee lineage. Our results confirm that population-specific genetic markers should always be evaluated in a new population prior to using them in MAS programs.

Primary Amelanotic Malignant Melanoma of the Tongue.

Background: Primary malignant melanoma rarely occurs in the oral cavity. The tongue is a particularly unusual primary site; lesions may be pigmented or amelanotic. Primary malignant melanoma is frequently mistaken for squamous cell carcinoma. Case Report: A 27-year-old male presented with a large, painless, ulceroproliferative mass on the dorsal surface of the tongue for 6 months. Squamous cell carcinoma was suspected, and the lesion was biopsied. Histopathology was compatible with primary amelanotic malignant melanoma. The patient had no cutaneous lesions consistent with malignant melanoma, and no definitive metastatic lesions were found. Ultrasound and computed tomography did not reveal any evidence of regional draining lymph node metastasis or suspicious lesions anywhere else in the body. The patient underwent composite resection of the tongue tumor and bilateral neck lymph node dissection, had an uneventful postoperative recovery, but was lost to follow-up. Conclusion: Primary oral amelanotic malignant melanoma is a highly aggressive, potentially fatal tumor and because of its rarity, presents a diagnostic challenge. The ideal treatment modality for primary malignant melanoma of the tongue is poorly defined, but surgery is regarded as the most effective course of therapy.

Peutz-Jeghers syndrome: management for recurrent intussusceptions.

BACKGROUND: Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by hamartomatous gastrointestinal polyps along with the characteristic mucocutaneous freckling. Multiple surgeries for recurrent intussusception in these children may lead to short bowel syndrome. Here we present our experience of management in such patients. METHODS: From January 2015 to December 2023, we reviewed children of PJS, presented with recurrent intussusceptions. Data were collected regarding presentation, management, and follow-up with attention on management dilemma. Diagnosis of PJS was based on criteria laid by World Health Organization (WHO). RESULTS: A total of nine patients were presented with age ranging from 4 to 17 years (median 9 years). A total of eighteen laparotomies were performed (7 outside, 11 at our centre). Among 11 laparotomies done at our centre, resection and anastomosis of bowel was done 3 times while 8 times enterotomy and polypectomy was done after reduction of intussusception. Upper and lower gastrointestinal endoscopy (UGIE & LGIE) was done in all cases while intraoperative enteroscopy (IOE) performed when required. Follow-up ranged from 2 months to 7 years. CONCLUSION: Children with PJS have a high risk of multiple laparotomies due to polyps' complications. Considering the diffuse involvement of the gut, early decision of surgery and extensive bowel resection should not be done. Conservative treatment must be tried under close observation whenever there is surgical dilemma. The treatment should be directed in the form of limited resection or polypectomy after reduction of intussusception.

Safety and Efficacy of Enhanced Recovery after Surgery Protocol in Pediatric Patients Undergoing Hepato-Pancreatico-Biliary Surgery: A Prospective Randomized Control Study.

Introduction: Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to optimize patient care. The goal of this approach is to reduce the body's reaction to surgical stress by optimizing the perioperative nutritional status, promoting analgesia without opioids, and early postoperative feeding. In pediatric patients, very limited literature is available for the application of ERAS protocol. This study was done to evaluate the application of ERAS protocol in pediatric hepatobiliary and pancreatic patients. Materials and Methods: This is a randomized prospective study conducted over a period of 2 years at a tertiary center in North India. A total of 40 hepatobiliary and pancreatic patients who were willing to participate in the study were included in the study. Patients were randomized by computer-generated method and data were collected regarding demography, clinical diagnosis, preoperative and postoperative workup, and peri-operative care including analgesia, pain scores, postoperative recovery, hospital stay, and complications. These patients were followed for 6 months postoperatively and the results were evaluated using SPSS software. Results: The study included 20 patients each in both the conventional and ERAS group with median ages of 11.5 years and 7.1 years, respectively. The data analysis showed that the ERAS group of patients had better outcomes in terms of hospital stay and drain removal time with significant statistical differences. Pain scores and complications are almost the same in both groups. Conclusion: Principles of ERAS can be safely applied in pediatric patients undergoing major surgery in the present era of emerging infections and also increasing patient burden without morbidity.

Dendritic Cells and the Establishment of Fetomaternal Tolerance for Successful Human Pregnancy.

Pregnancy is a remarkable event where the semi-allogeneic fetus develops in the mother's uterus, despite genetic and immunological differences. The antigen handling and processing at the maternal-fetal interface during pregnancy appear to be crucial for the adaptation of the maternal immune system and for tolerance to the developing fetus and placenta. Maternal antigen-presenting cells (APCs), such as macrophages (Mφs) and dendritic cells (DCs), are present at the maternal-fetal interface throughout pregnancy and are believed to play a crucial role in this process. Despite numerous studies focusing on the significance of Mφs, there is limited knowledge regarding the contribution of DCs in fetomaternal tolerance during pregnancy, making it a relatively new and growing field of research. This review focuses on how the behavior of DCs at the maternal-fetal interface adapts to pregnancy's unique demands. Moreover, it discusses how DCs interact with other cells in the decidual leukocyte network to regulate uterine and placental homeostasis and the local maternal immune responses to the fetus. The review particularly examines the different cell lineages of DCs with specific surface markers, which have not been critically reviewed in previous publications. Additionally, it emphasizes the impact that even minor disruptions in DC functions can have on pregnancy-related complications and proposes further research into the potential therapeutic benefits of targeting DCs to manage these complications.

Nano-nutraceuticals to Combat Oxidative Stress: Unlocking Newer Paradigms in Adjuvant Therapy.

Nutraceuticals are products that provide both nutritional and therapeutic benefits. These compounds can slow the aging process and provide physiological effects shielding individuals from acute and chronic diseases. People's interests have shifted from allopathic to Ayurvedic to nutraceuticals in recent years. These are often common dietary supplements that have drawn customers worldwide because of their high nutritional safety and lack of adverse effects when used for a long time. Although conventional dosage forms, including pills, tablets, and semi-solids, are still available, they nevertheless have poorer bioavailability, less stability, and less effectiveness for targeted delivery of bioactives. The use of effective nanocomplex systems as nano-antioxidants using nanotechnology has become a promising field. Among its many uses, nanotechnology is mostly used to create foods and nutraceuticals that are more bioavailable, less toxic, and more sustainable. Additionally, it has been emphasized how precisely nano-pharmaceuticals for oxidative stress produce the desired effects. These improvements show improved antioxidant delivery to the target region, reduced leakage, and increased targeting precision. The outcomes demonstrated that oxidative stress-related illnesses can be effectively treated by lowering ROS levels with the use of nanonutraceuticals. The major ideas and uses of nano-nutraceuticals for health are outlined in this review, with an emphasis on reducing oxidative stress.

Open Apex and its Management: Review Article.

During root development, the teeth are subjected to a variety of assaults. Due to this, the root stops forming and the closure of the apex does not take place. Root canal treatment becomes a major challenge in these cases because of the width of the canal and wide-open apices. Management of open apices includes apexogenesis in vital young permanent teeth and apexification, which is a method to induce a calcified barrier in the root. Newer concepts include regeneration and revascularization procedures, which still need to be experimented with further.

A Comparative Evaluation of Fracture Resistance of Endodontically Treated Teeth Using Different Post-Obturation Restorative Materials: An In Vitro Study.

This in vitro study was conducted to evaluate and compare the fracture resistance of endodontically treated teeth using different post-obturation restorative materials. Seventy-five non-carious extracted human teeth were collected. Access opening, chemicomechanical preparation, and obturation were done. Teeth were randomly divided into various groups depending on the type of post-endodontic restoration: group I-control group, group II-Tetric-N-Flow Bulk Fill, group III-Tetric-N-Flow Bulk Fill + everX Posterior, group IV-P60, and group V-P60 + everX Posterior. The fracture resistance of each sample was measured using the universal testing machine. Results: The results obtained were subjected to statistical analysis. This demonstrated that group III (Tetric-N-Flow Bulk Fill + everX Posterior) was shown to be the most effective group followed by group V (Filtek P60 + everX Posterior) out of all of the other restorative experimental groups. Conclusion: Tetric-N-Flow Bulk Fill + everX Posterior showed maximum fracture resistance among the experimental groups.

Unicentric Portocaval Castleman Disease in an Adolescent: Challenges in Diagnosis and Management.

Castleman disease is an unusual, benign disorder of unknown etiology, characterized by the proliferation of the lymphoid tissue. It can have a unicentric or multicentric presentation, depending on the number of lymph nodes involved. On clinical examination and imaging, it can imitate a malignancy and the diagnosis can only be confirmed on histopathological examination. Retroperitoneal location and presentation in the pediatric age group are extremely rare. We report a case of an adolescent girl with a unicentric lymph nodal mass in the portocaval space which was completely excised.

Evaluation of comorbidities in the SARS-CoV-2-related mortalities: A retrospective observation from a dedicated COVID-19 care hospital.

Since its discovery in Wuhan, China, in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world with being declared a pandemic in March 2020 by the World Health Organization (WHO). Comorbidities are one of the most concerning clinical considerations for mortality. Materials and Methods: This was a retrospective observational study conducted at the All India Institute of Medical Sciences in Patna, Bihar, from June 2020 to December 2020. It included adult patients who succumbed to coronavirus disease 2019 (COVID-19) during this period, and their relevant information, such as demographic information hospital stay duration, haematological parameters and comorbidities, was gathered. Results: The mean age of the study group was 63.5 (11.8) years. Of 150 cases, 126 men (about 84 per cent) and 24 women were involved (16 per cent). In our study, hypertension (HTN) was shown to be the most frequent comorbidity at 68.7% (103/150), followed by diabetes mellitus (DM) at 61.3% (92/150). The most prevalent haematological disorder identified in our investigation was anaemia and leucocytosis. Conclusion: The categorisation of patients who would need extra measures including early hospitalisation, heightened monitoring and intense therapy would be made easier by identifying patient traits and conditions.

Nutrient remobilization and C:N:P stoichiometry in response to elevated CO2 and low phosphorus availability in rice cultivars introgressed with and without Pup1.

The continuously rising atmospheric CO2 concentration potentially increase plant growth through stimulating C metabolism; however, plant C:N:P stoichiometry in response to elevated CO2 (eCO2) under low P stress remains largely unknown. We investigated the combined effect of eCO2 and low phosphorus on growth, yield, C:N:P stoichiometry, and remobilization in rice cv. Kasalath (aus type), IR64 (a mega rice variety), and IR64-Pup1 (Pup1 QTL introgressed IR64). In response to eCO2 and low P, the C accumulation increased significantly (particularly at anthesis stage) while N and P concentration decreased leading to higher C:N and C:P ratios in all plant components (leaf, sheath, stem, and grain) than ambient CO2. The remobilization efficiencies of N and P were also reduced under low P with eCO2 as compared to control conditions. Among cultivars, the combined effect of eCO2 and low P was greater in IR64-Pup1 and produced higher biomass and grain yield as compared to IR64. However, IR64-Pup1 exhibited a lower N but higher P concentration than IR64, indicating that the Pup1 QTL improved P uptake but did not influence N uptake. Our study suggests that the P availability along with eCO2 would alter the C:N:P ratios due to their differential partitioning, thereby affecting growth and yield.

Giant Pleomorphic Adenoma of Submandibular Gland.

Pleomorphic adenoma is a benign tumor of salivary glands which is relatively rare among head & neck neoplasms. Parotid gland is the most common site of occurrence whereas submandibular gland is rarely affected. We present a case of a giant pleomorphic adenoma of submandibular gland.

A rare case of meningothelial meningioma in middle ear and mastoid.

A case of chronic suppurative otitis media, active squamosal variety on Examination under microscopy revealed grade 3 attic retraction. CT scan revealed soft tissue thickening and opacification in left middle ear cavity and mastoid. Surgery performed. Excised soft tissue on HPE revealed meningothelial meningioma.

Exploring the pharmacological and chemical aspects of pyrrolo-quinazoline derivatives in Adhatoda vasica.

Adhatoda or Justicia is one of the biggest and complex genera of the Acanthaceae family. Adhatoda vasica is commonly known as 'Adosa'. It is an ayurvedic medicine with a medicinal history of more than a thousand years in India. Traditionally, it is used to treat cough, asthma, phlegm, bleeding hemorrhoids, for both adults and youth. This plant possesses antiarthritis, antiseptic, antimicrobial, anti-tuberculosis, anti-inflammatory and abortifacient properties. Alkaloids are the major phytoconstituents present in the plant in the form of pyrrolo-quinazoline derivatives viz vasicine, vasicinone, vasicinol, adhatodine, adhatodinine, adhavasinone and anisotine etc. The asserted objectives are to conduct a systematic review on the phytochemistry, pharmacology and traditional uses of A. vasica, as well as highlighting the challenges found in the research. This will promote the utilization of A. vasica at extract level and further development of new drug leads based on the compounds isolated and used for treatment of various ailments. The present review covers the literature survey from 1888 to 2023. The relevant data has been collected from various peer-reviwed journals, and books via Sci-Finder, PubMed, Science Direct, Google Scholar, EBSCO, online electronic journals, SpringerLink and Wiley. This paper aims to present a systematic review of known traditional applications, pharmacological and chemical aspects in Adhatoda vasica.

Comparative analysis of tuberculin and defined antigen skin tests for detection of bovine tuberculosis in buffaloes (Bubalus bubalis) in Haryana state, India.

BACKGROUND: Bovine tuberculosis (bTB) is a chronic disease that results from infection with any member of the Mycobacterium tuberculosis complex. Infected animals are typically diagnosed with tuberculin-based intradermal skin tests according to World Organization of Animal Health which are presently in use. However, tuberculin is not suitable for use in BCG-vaccinated animals due to a high rate of false-positive reactions. Peptide-based defined skin test (DST) antigens have been identified using antigens (ESAT-6, CFP-10 and Rv3615c) which are absent from BCG, but their performance in buffaloes remains unknown. To assess the comparative performance of DST with the tuberculin-based single intradermal test (SIT) and the single intradermal comparative cervical test (SICCT), we screened 543 female buffaloes from 49 organized dairy farms in two districts of Haryana state in India. RESULTS: We found that 37 (7%), 4 (1%) and 18 (3%) buffaloes were reactors with the SIT, SICCT and DST tests, respectively. Of the 37 SIT reactors, four were positive with SICCT and 12 were positive with the DST. The results show that none of the animals tested positive with all three tests, and 6 DST positive animals were SIT negative. Together, a total of 43 animals were reactors with SIT, DST, or both, and the two assays showed moderate agreement (Cohen's Kappa 0.41; 95% Confidence Interval (CI): 0.23, 0.59). In contrast, only slight agreement (Cohen's Kappa 0.18; 95% CI: 0.02, 0.34) was observed between SIT and SICCT. Using a Bayesian latent class model, we estimated test specificities of 96.5% (95% CI, 92-99%), 99.7% (95% CI: 98-100%) and 99.0% (95% CI: 97-100%) for SIT, SICCT and DST, respectively, but considerably lower sensitivities of 58% (95% CI: 35-87%), 9% (95% CI: 3-21%), and 34% (95% CI: 18-55%) albeit with broad and overlapping credible intervals. CONCLUSION: Taken together, our investigation suggests that DST has a test specificity comparable with SICCT, and sensitivity intermediate between SIT and SICCT for the identification of buffaloes suspected of tuberculosis. Our study highlights an urgent need for future well-powered trials with detailed necropsy, with immunological and microbiological profiling of reactor and non-reactor animals to better define the underlying factors for the large observed discrepancies in assay performance, particularly between SIT and SICCT.