Synchronous pancreatic and scrotal tuberculosis: Double jeopardy.

We describe a patient who presented with scrotal swelling followed by non-healing and discharging scrotal sinuses, following local trauma and was initially suspected to have an infected scrotal hematoma. An evaluation revealed it to be scrotal tuberculosis. He also complained of upper abdominal pain and on transabdominal ultrasonography was detected to have a mass in the head of the pancreas. Evaluation of the pancreatic mass revealed it to be pancreatic tuberculosis. Both lesions responded well to anti-tubercular therapy. This is an unusual case of two rare sites of extrapulmonary tuberculosis presenting simultaneously in the same individual. Care needs to be exercised while evaluating any non-healing ulcers or sinuses and mass lesions in countries endemic for tuberculosis as this disease can be a great masquerader.

Influence of processing conditions on quality of Indian small grey donkey milk powder by spray drying.

The study was carried out to know the quality of small grey donkey milk powder by spray dryer. Donkey milk powder moisture, fat, protein, carbohydrate and ash were 4.12 (d.b), 5.97, 22.84, 4.64 and 62.43 (%). Donkey milk powder was produced at milk total solids of 20, 25 and 30% concentration at 160, 170 and 180 °C inlet air temperature using two fluid flow nozzle type atomizer of 0.84 mm diameter, pressure of 1.75 kg.cm-2, flow rate of 0.5 L.h-1, blower speed of 2100 rpm. L * , a * , b * and aw values decreased with increasing concentrated milk feed as well as inlet air temperature. Density decreased as increase of inlet air temperature and increased as increase milk concentration. Flowability was fair according to Hausner ratio (1.25) and Carr's index (20%) values. The heat utilization efficiency increased as increase of concentration and decreased as increase of inlet air temperature. Solubility decreased as increase of concentration and inlet air temperature. Dispersibility decreased as increase of inlet air temperature and increased as increase of concentration. Wetting time increased as increase of concentration and inlet air temperature. Structure of the donkey milk powder was spherical and minerals were abundant.

Observation of a prethermal discrete time crystal.

Extending the framework of statistical physics to the nonequilibrium setting has led to the discovery of previously unidentified phases of matter, often catalyzed by periodic driving. However, preventing the runaway heating that is associated with driving a strongly interacting quantum system remains a challenge in the investigation of these newly discovered phases. In this work, we utilize a trapped-ion quantum simulator to observe the signatures of a nonequilibrium driven phase without disorder-the prethermal discrete time crystal. Here, the heating problem is circumvented not by disorder-induced many-body localization, but rather by high-frequency driving, which leads to an expansive time window where nonequilibrium phases can emerge. Floquet prethermalization is thus presented as a general strategy for creating, stabilizing, and studying intrinsically out-of-equilibrium phases of matter.

E-pharmacophore based screening to identify potential HIV-1 gp120 and CD4 interaction blockers for wild and mutant types.

HIV-1 gp120 provides a multistage viral entry process through the conserved CD4 binding site. Hunting of potential blockers can diminish the interaction of gp120 with the CD4 host receptor leading to the suppression of HIV-1 infection. Structure-based pharmacophore virtual screening followed by binding free energy calculation, molecular dynamics (MD) simulation and density functional theory (DFT) calculation is applied to discriminate the potential blockers from six small molecule databases. Five compounds from six databases exhibited vital interactions with key residues ASP368, GLU370, ASN425, MET426, TRP427 and GLY473 of gp120, involved in the binding with CD4, host receptor. Most importantly, compound NCI-254200 displayed strong communication with key residues of wild type and drug resistance single mutant gp120 (M426L and W427V) even in the dynamic condition, evidenced from MD simulation. This investigation provided a potential compound NCI-254200 which may show inhibitory activity against HIV-1 gp120 variant interactions with CD4 host cell receptors.

Insight into the charging-discharging of magnetite electrodes: in situ XAS and DFT study.

The structural changes of Fe3O4 nanoparticle electrodes in Li ion batteries during charging-discharging cycles have been investigated using in situ X-ray absorption spectroscopy (XAS). Chemometric methods viz., Principal Component Analysis (PCA) and Multivariate Curve Resolution-Alternate Least Square (MCR-ALS) have been used for analysis of the in situ XANES data during the charge-discharge cycle, which help to identify the various species formed during the lithiation-delithiation of Fe3O4. The concentration variation of the different species has also been determined and the detailed intercalation-conversion mechanism of the Fe3O4 electrodes during the first discharge has been established. Subsequently, the first charge and second discharge cycles were also studied to apprehend the difference in redox reaction between the first discharge and subsequent cycles. The above studies clearly identify the four species involved in the whole intercalation-conversion process of Fe3O4 electrode of a Li ion battery and also indicate the irreversibility of the conversion reaction in subsequent cycles which may be one of the reasons for capacity fading of these electrodes. The above results have also been corroborated with density functional theory (DFT)based ab inito calculations.

Efficacy and safety comparison of combination of 0.04% tretinoin microspheres plus 1% clindamycin versus their monotherapy in patients with acne vulgaris: a phase 3, randomized, double-blind study.

BACKGROUND AND OBJECTIVES: There is an unmet need for topical treatments with good tolerability in management of acne vulgaris. The present study aimed to evaluate efficacy and safety of a novel tretinoin (microsphere, 0.04%) formulation in combination with clindamycin (1%) gel for treatment of acne vulgaris. MATERIALS AND METHODS: This phase 3 randomized, double-blind study included patients with moderate-to-severe acne. Patients were treated with tretinoin (microsphere, 0.04%) + clindamycin (1%) or one of the monotherapies (tretinoin, 0.025%; clindamycin, 1%). Key endpoints included percent change in lesion counts, and improvement in Investigator's Static Global Assessment (ISGA) score. RESULTS: 750 patients were randomized (combination, n = 300; tretinoin and clindamycin, each n = 150). At week 12, reductions in inflammatory (77%), non-inflammatory (71%) and total lesions (73%) were significantly greater with combination treatment versus either monotherapy (p < .03). Proportion of patients rated 'clear' or 'almost clear' with ≥2-grade ISGA improvement was higher with combination (46%) versus monotherapies (p < .02). Adverse events occurred in 20 patients, most were mild-moderate; no deaths or serious adverse events were reported. The discontinuation rates due to adverse events with combination therapy were low (≤1%). CONCLUSION: The once-daily, microsphere-based formulation was generally tolerable with a positive impact on therapeutic outcomes and patients' compliance. CLINICALTRIAL REGISTRATION NO.: CTRI/2014/08/004830.

Physico-chemical composition, minerals, vitamins, amino acids, fatty acid profile and sensory evaluation of donkey milk from Indian small grey breed.

Composition, nutritional value and sensory characteristics of donkey milk of Indian small grey breed was analysed using AOAC and other standard methods. Fresh donkey milk had 90.63% (w.b.) moisture content, 0.76% fat, 1.96% protein, 6.30% lactose, 0.40% ash. Particle size of donkey milk was 355.00 d.nm. The UHPLC analysis ascertained that lysozyme content was more in donkey milk sample. The ICPMS confirmed that Ca, K, Mg, Na, vitamin C and E, glutamic acid, leucine, proline were the most abundant in donkey milk, but Fe, Zn, Vitamin A and B1, methionine shown lower amount. The GC analysis determined that butyric acid, lauric acid was more and lower amount of unsaturated fatty acids were observed in donkey milk sample. Finally, the TPC, yeast and mould count were acceptable and confirmed that donkey milk is microbiologically safe and sensory evaluation studies of donkey milk confirmed that the desired sensory attributes.

Flux-induced topological superconductivity in full-shell nanowires.

Hybrid semiconductor-superconductor nanowires have emerged as a promising platform for realizing topological superconductivity (TSC). Here, we present a route to TSC using magnetic flux applied to a full superconducting shell surrounding a semiconducting nanowire core. Tunneling into the core reveals a hard induced gap near zero applied flux, corresponding to zero phase winding, and a gapped region with a discrete zero-energy state around one applied flux quantum, corresponding to 2π phase winding. Theoretical analysis indicates that the winding of the superconducting phase can induce a transition to a topological phase supporting Majorana zero modes. Measured Coulomb blockade peak spacing around one flux quantum shows a length dependence that is consistent with the existence of Majorana modes at the ends of the nanowire.

Automated diagnosis of Coronary Artery Disease using pattern recognition approach.

Coronary Artery Disease (CAD) is the most leading Cardiovascular Disease (CVD), which results due to buildup of plaque inside the coronary arteries. The CAD and Normal Sinus Rhythm (NSR) heartbeats can be discriminated and diagnosed noninvasively using the standard tool Electrocardiogram (ECG). However, manual diagnosis of ECG is tiresome and time consuming task, due to complex nature and unseen nonlinearities of ECG. Hence an automated system plays a substantial role. In this study, CAD and NSR heartbeats are discriminated and diagnosed using Higher-Order Statistics (HOS) cumulants features. Further, the cumulants coefficients dimensionality reduced using Principal Components Analysis (PCA) and the medically significant features (p-value<;0.05) Principal Components (PCs) are subjected for classification using Random Forest (RAF) and Rotation Forest (ROF) ensemble classifiers. Proposed system is robust which helps in screening CAD risk factors and telemonitoring applications.

Lack of heart rate variability during sleep-related apnea in patients with temporal lobe epilepsy (TLE)-an indirect marker of SUDEP?

PURPOSE: Apneas occurring during sleep may precipitate autonomic instability in epilepsy patients making them susceptible to sudden death (SUDEP). Literature on heart rate variability (HRV) during apnea among patients with temporal lobe epilepsy (TLE) is sparse. The aim of this study was to characterize the HRV during the peri-apneic period in patients with TLE and compare with HRV of matched healthy individuals during the overnight polysomnographic (PSG) recording. Further, the role of carbamazepine (CBZ) in modulating peri-apneic HRV in the above cohort was also assessed. METHODS: Twenty patients diagnosed to have TLE (drug naive (n = 10) or on CBZ monotherapy (n = 10)) were compared with ten healthy controls. In both patients and controls, the time domain, frequency domain, and non-linear HRV indices were analyzed for 2 min before and after apnea/hypopnea termination and compared using paired t test (p ≤ 0.05). Additionally, the changes in HRV parameters in the peri-apnea/hypopnea period were compared between the three groups using one-way ANOVA followed by post hoc comparison (p ≤ 0.05). RESULTS: The three study groups were age (p = 0.21) and gender (p = 0.27) matched. In controls (M/F = 5:5; mean age 24.3 ± 5.0 years), there were significant changes in standard deviation of RR interval (SDNN), low frequency (LF) component and long-term HRV (SD2) parameters in the peri-apnea/hypopneic period. Conversely, in drug-naive TLE (M/F = 6:4; mean age: 22.8 ± 4.1 years), all the HRV parameters, including non-linear measures were comparable in the pre- and post-apneic period. On the other hand, patients on CBZ (M/F = 6:4; mean age 20.5 ± 4.8 years) showed significant changes in low-frequency nu (LFnu) and high-frequency nu (HFnu) components in the peri-apnea/hypopneic period. Comparison of the changes in HRV parameters in the peri-apnea/hypopnea period in patients with TLE and controls showed significantly lower changes in drug-naive TLE patients in SDNN, LF, and SD2 as compared to controls. CONCLUSIONS: This study showed that there was a lack of apnea-mediated HRV changes in patients with drug-naive TLE. This might suggest a possible alteration in reflex baroreceptor activation in patients with TLE, predisposing them to SUDEP, and this may be worsened with CBZ.

Extended x-ray absorption fine structure measurements on radio frequency magnetron sputtered HfO2 thin films deposited with different oxygen partial pressures.

Two sets of HfO2 thin film have been deposited by the radio frequency magnetron sputtering technique at various oxygen partial pressures, one set without any substrate bias and another set with a 50 W pulsed dc substrate bias. The films have been characterized by extended x-ray absorption fine structure (EXAFS) measurements at the Hf L3 edge, and the structural information obtained from analysis of the EXAFS data has been used to explain the macroscopic behavior of the refractive index obtained from spectroscopic ellipsometry measurements. It has been observed that the variation of refractive index with oxygen partial pressure depends on the Hf-Hf bond length for the set of films deposited without substrate bias, while for the other set of films deposited with pulsed dc substrate bias, it depends on the oxygen coordination of the nearest neighbor shell surrounding Hf sites.

Growth of block copolymer stabilized metal nanoparticles probed simultaneously by in situ XAS and UV-Vis spectroscopy.

The growth of Au and Pt nanoparticles from their respective chloride precursors using block copolymer-based reducers has been studied by simultaneous in situ measurement of XAS and UV-Vis spectroscopy at the energy-dispersive EXAFS beamline (BL-08) at INDUS-2 SRS at RRCAT, Indore, India. While the XANES spectra of the precursor give real-time information on the reduction process, the EXAFS spectra reveal the structure of the clusters formed at the intermediate stages of growth. The growth kinetics of both types of nanoparticles are found to be almost similar and are found to follow three stages, though the first stage of nucleation takes place earlier in the case of Au than in the case of Pt nanoparticles due to the difference in the reduction potential of the respective precursors. The first two stages of the growth of Au and Pt nanoparticles as obtained by in situ XAS measurements could be corroborated by simultaneous in situ measurement of UV-Vis spectroscopy also.

Study of sleep microstructure in patients of migraine without aura.

PURPOSE: Although the relationship between sleep and migraine has been widely reported, studies on sleep microstructure are few. The aim was to study and compare microstructural polysomnographic characteristics in patients of "migraine without aura" (MOA) with controls. METHODS: Twenty-five patients of MOA and 25 age- and gender-matched healthy controls were subjected to overnight polysomnography. Microstructural sleep analysis, including arousal and cyclic alternating pattern (CAP) analysis was performed. Arousals and CAP parameters were compared between the two groups using the Mann-Whitney U test (p ≤ 0.05). RESULTS: The overall arousal index (p = 0.528) and that during non-rapid eye movement (NREM) sleep (p = 0.503) were comparable between the two groups. However, the arousal index was lower in migraineurs during rapid eye movement (REM) sleep (p = 0.001). The overall CAP rate (p = 0.020) as well as the number of CAP cycles and sequences (p = 0.032) was lower among migraineurs. The total phase A duration (p < 0.0001) was increased, and conversely, phase B duration (p = 0.001) was decreased in migraineurs. The phase A1 duration (p = 0.036) was higher in migraineurs. Finally, phase A1 (p = 0.357) index was comparable, and conversely, A2 (p < 0.0001) and A3 (p = 0.020) indices were decreased in migraineurs. CONCLUSIONS: This study showed a decreased REM arousability as well as a decreased overall CAP rate and CAP cycling in patients with migraine as compared to controls. This indicates that there is probably an alteration of the arousal mechanisms in patients with migraine that may facilitate the occurrence of headache paroxysms during sleep.

Complexation of Eu(III) with cucurbit[n]uril, n = 5 and 7: a thermodynamic and structural study.

Cucurbit[n]urils (CBn) are a new class of macrocyclic cage compounds capable of binding organic and inorganic species, owing to their unique pumpkin like structure comprising of both a hydrophobic cavity and a hydrophilic portal. The thermodynamics of the complexation of Eu(III) with CBn of a different cavity size viz. cucurbit[5]uril (CB5) and cucurbit[7]uril (CB7) has been studied by UV-Vis spectroscopy and calorimetry at 25 °C whereas the structure of the complexes was investigated using time resolved fluorescence spectroscopy (TRFS) and extended X-ray absorption fine structure spectroscopy (EXAFS) in a formic acid-water mixture (50 wt%). This is the first report on the structural investigation of Eu-CBn complexes in solution. The thermodynamic data (ΔG, ΔH and ΔS) for Eu(III) complexation with CBn reveal the formation of a 1 : 1 complex with CB5, while both 1 : 1 and 1 : 2 complexes are observed with CB7. The signatures of these species are observed in ESI-MS measurements, which corroborates with the species postulated in thermodynamic studies. The complexation reactions are found to be driven by ΔS as ΔH is either small negative or positive indicating the formation of inner sphere complexes, which is in line with TRFS and EXAFS results. These studies show that Eu(III) caps one of the CB5 portals by binding with all the carbonyl groups in the 1 : 1 Eu-CB5 complex, whereas in the 1 : 1 Eu-CB7 complex, Eu(III) interacts with only a few of the carbonyl groups of CB7. The computational studies (DFT calculations) on Eu-CB5 and Eu-CB7 complexes further support the experimental data.

Magnetic-field-tuned Aharonov-Bohm oscillations and evidence for non-Abelian anyons at ν = 5/2.

We show that the resistance of the ν = 5/2 quantum Hall state, confined to an interferometer, oscillates with the magnetic field consistent with an Ising-type non-Abelian state. In three quantum Hall interferometers of different sizes, resistance oscillations at ν = 7/3 and integer filling factors have the magnetic field period expected if the number of quasiparticles contained within the interferometer changes so as to keep the area and the total charge within the interferometer constant. Under these conditions, an Abelian state such as the (3, 3, 1) state would show oscillations with the same period as at an integer quantum Hall state. However, in an Ising-type non-Abelian state there would be a rapid oscillation associated with the "even-odd effect" and a slower one associated with the accumulated Abelian phase due to both the Aharonov-Bohm effect and the Abelian part of the quasiparticle braiding statistics. Our measurements at ν = 5/2 are consistent with the latter.

Randomized controlled pilot study to compare Homeopathy and Conventional therapy in Acute Otitis Media.

OBJECTIVE: To compare the effectiveness of Homeopathy and Conventional therapy in Acute Otitis Media (AOM). METHOD: A randomized placebo-controlled parallel group pilot study of homeopathic vs conventional treatment for AOM was conducted in Jaipur, India. Patients were randomized by a computer generated random number list to receive either individualized homeopathic medicines in fifty millesimal (LM) potencies, or conventional treatment including analgesics, antipyretics and anti-inflammatory drugs. Patients who did not improve were prescribed antibiotics at the 3rd day. Outcomes were assessed by the Acute Otitis Media-Severity of Symptoms (AOM-SOS) Scale and Tympanic Membrane Examination over 21 days. RESULTS: 81 patients were included, 80 completed follow-up: 41 for conventional and 40 for homeopathic treatment. In the Conventional group, all 40 (100%) patients were cured, in the Homeopathy group, 38 (95%) patients were cured while 02 (5%) patients were lost to the last two follow-up. By the 3rd day of treatment, 4 patients were cured in Homeopathy group but in Conventional group only one patient was cured. In the Conventional group antibiotics were prescribed in 39 (97.5%), no antibiotics were required in the Homeopathy group. 85% of patients were prescribed six homeopathic medicines. CONCLUSION: Individualized homeopathy is an effective conventional treatment in AOM, there were no significant differences between groups in the main outcome. Symptomatic improvement was quicker in the Homeopathy group, and there was a large difference in antibiotic requirements, favouring homeopathy. Further work on a larger scale should be conducted.

Telecommunication technology used in home healthcare.

Current telemedicine applications are usually developed for doctors to do consultation and case study between several hospitals. Patients see doctor at home via Internet becomes possible and it might be a part of lifestyle in the future. Telemedicine has been an active area of research for over 30 years. In the past, several telemedicine applications using wired EPABX telecommunications equipment were provided whereas now-a-days the evolution of wireless communication means enabling telemedicine systems to operate everywhere in the world, thus expanding telemedicine benefits, services and applications. How these applications are used in healthcare delivery and what are the technologies used in this system are explained in this paper.

Increased interleukin-4 and decreased interferon-γ levels in serum of children with asthma.

BACKGROUND AND PURPOSE: Immune and inflammatory responses, mediated by cytokines, play important roles in the pathophysiology of asthma. These responses are associated with over expression of T helper (Th)-2 cytokine, particularly interleukin (IL)-4 and IL-5, and decreased expression of Th-1 cytokine, IL-2 and IFN-γ. We hypothesized that there would be an imbalance in the levels of circulating IL-4 and IFN-γ in the asthmatic subjects. METHOD: We investigated serum levels of IL-4 and IFN-γ among eighty children (18 steroid-naïve, 30 steroid-treated children with asthma and 32 healthy controls) using commercially available ELISA kits. RESULTS: Serum level of IL-4 was significantly higher in steroid-naïve group of asthmatic children compared to the healthy control subjects and was lower in steroid-treated group though the level was statistically not significant. In contrast, serum levels of IFN-γ were significantly lower in both steroid-naïve and steroid-treated groups of asthmatic children compared to healthy control subjects. CONCLUSION: The results of our study suggest that serum level of IL-4 may be elevated in concert with decreased level of IFN-γ in asthma. Determination of serum levels of IL-4 and IFN-γ may be a useful tool for understanding the disease processes in asthma.

Verrucous condyloma lata mimicking condyloma acuminata: An unusual presentation.

A 15-year-old boy from a child center presented with a three-month history of a growth in the perianal region. There was a history of repeated peno-anal sexual exposures. On examination there was a fleshy, hyperpigmented, verrucous plaque around the anal verge. The Venereal Disease Research Laboratory Test was reactive in a titer of 1 : 64. Lesional biopsy showed marked epidermal hyperplasia without koilocytes, with a dermal infiltrate composed of lymphocytes, plasma cells and histiocytes. Patient was treated with parenteral penicillin with complete healing of the plaque. This is a rare presentation of secondary syphilis showing condyloma lata resembling condyloma acuminata.

Density matrix renormalization group study of incompressible fractional quantum Hall states.

We develop the density-matrix renormalization group (DMRG) technique for numerically studying incompressible fractional quantum Hall (FQH) states on the sphere. We calculate accurate estimates for ground-state energies and excitation gaps at FQH filling fractions nu=1/3 and nu=5/2 for systems that are considerably larger than the largest ever studied by exact diagonalization. We establish, by carefully comparing with existing numerical results on smaller systems, that DMRG is a highly effective numerical tool for studying incompressible FQH states.