Monodigital Double Cross-Finger Flaps-A Novel Approach for Coverage of Large Volar Defects.

INTRODUCTION: A single cross-finger flap can only address digital defects of a limited size, and larger defects often require distant flaps such as abdominal or groin flaps that are cumbersome to perform and sometimes bulky. Two cross-finger flaps harvested from the same donor digit could offer a simple and effective solution for many such defects. In this study, we describe the technique of monodigital double cross-finger flaps and its clinical applicability, with evaluation of donor and recipient site morbidity. METHODS AND MATERIALS: A total of 10 subjects with large volar defects were included in the study. The demographic data, etiology, defect size, flap donor, and recipient sites were tabulated prior to surgery. Each subject was assessed for postoperative complications at the donor and recipient site and followed up for 6-12 months to document any flap or donor site morbidities. RESULTS: The subjects included 9 males and 1 female subjects, with an average age of 35.6 years (21-67 years). Most patients had posttraumatic defects, with 3 cases of full thickness burns and one with postsurgical tissue necrosis. All defects were volar, with 4 on the little finger, 3, 2, and 1 in the ring, index and middle fingers, respectively. No major postoperative complications were noted in any case. All flaps survived well with good contour, and donor fingers achieved near-normal range of flexion with only minimal restriction (10-15°) at the distal interphalangeal joint that did not result in any overall functional disability. CONCLUSIONS: Monodigital double cross-finger flap technique offers a simple and effective solution for reconstruction of large digital defects that are not amenable for closure by a classical cross-finger flap, and is a good alternative for other procedures, providing supple soft tissue coverage and no significant morbidity at the donor digit provided that there is preservation of a small skin bridge across the proximal interphalangeal joint.

Edema India: Executive Summary of Screening, Diagnosis, and Management of Edema.

The management of edema requires a systematic approach to screening, diagnosis, and treatment, with an essential initial assessment to differentiate between generalized and localized edema. The Association of Physicians of India (API) aimed to develop the first Indian Edema Consensus (Edema India), offering tailored recommendations for screening, diagnosing, and managing edema based on the insights from the expert panel. The panel suggested when evaluating edema symptoms, important factors to consider include the patient's current illness, medical history, risk factors, family history, and medications. Key diagnostic investigations for edema include complete blood count, cardiovascular imaging and markers, deep vein thrombosis (DVT) assessment, along with renal, hepatic, and thyroid function tests. Edema management involves a combination of pharmacologic and nonpharmacologic interventions, including limb elevation, physiotherapy, compression therapy, fluid removal, diuretics (loop diuretics: first-line therapy), and a sodium-restricted diet. The panel believed that educating patients could foster a preventive mindset, helping to prevent the worsening of edema.

The impact of household energy poverty on the mental health of parents of young children.

BACKGROUND: Energy poverty, typified by cold homes and/or an inability to afford energy bills, presents risks to the mental health of occupants. Parents of young children may be especially susceptible to a mental health toll from energy poverty since they have a significant care obligation and spend much of their day at home. METHODS: Data from the Growing Up in Ireland study inform this longitudinal analysis. RESULTS: A 1.64 greater odds of maternal depression were estimated for households containing young children characterized by energy poverty [P = 0.000; 95% confidence interval (CI): 1.31-2.05]. For energy poor households with older children (9 years and above), the odds of maternal depression were also higher [odds ratio (OR) 1.74, P = 0.001; 95% CI: 1.27-2.39]. Fathers of young children had greater odds of depression in energy poor households (OR 1.59, P = 0.002; 95% CI: 1.19-2.12), though the deleterious effect on mental health was not statistically significant for fathers of older children. CONCLUSIONS: Energy poverty increases the likelihood of depression in parents. These findings merit policy attention since a mental health burden is in itself important, and more widely, parental well-being can influence child development and outcomes.

Neonatal testing leading to the identification of Bh (para-Bombay) phenotype in the mother: case report with review of the literature.

Para-Bombay is a rare phenotype with a homozygous nonfunctional FUT1 gene and a normal FUT2 gene leading to H-deficient red blood cells (RBCs) with or without ABH substances, depending on inheritance of the ABO gene. This case is about a 5-day-old male baby suffering from sepsis who required a 45-mL packed RBC transfusion. The baby's sample tested as A1B, D+ and mother's sample tested as group O, D+ with group 4 discrepancy due to ABO isoagglutinins. Further workup of the mother's sample with anti-H lectin was negative, which suggested the mother to be group Oh, D+. Antibody screening was panreactive with negative autocontrol, suggestive of anti-H. The titer of immunoglobulin (Ig)M anti-H was 64, IgG titer using dithiothreitol was 8, and anti-IH was absent. A negative adsorption and elution test suggested that RBCs were devoid of A and B antigens. The father's sample tested clearly as group A1, D+; hence, the cis-AB blood group was ruled out in the baby. The secretor study of the mother's saliva revealed the presence of B and H substances that neutralized polyclonal B and H antisera. Therefore, we concluded that the mother was of the para-Bombay (Bh) phenotype. This case highlights the importance of reverse grouping and resolving blood grouping discrepancies between mother and child-in this case because of an incongruous ABO blood type of the baby and the mother who was previously tested as group O, D+.Para-Bombay is a rare phenotype with a homozygous nonfunctional FUT1 gene and a normal FUT2 gene leading to H-deficient red blood cells (RBCs) with or without ABH substances, depending on inheritance of the ABO gene. This case is about a 5-day-old male baby suffering from sepsis who required a 45-mL packed RBC transfusion. The baby's sample tested as A1B, D+ and mother's sample tested as group O, D+ with group 4 discrepancy due to ABO isoagglutinins. Further workup of the mother's sample with anti-H lectin was negative, which suggested the mother to be group Oh, D+. Antibody screening was panreactive with negative autocontrol, suggestive of anti-H. The titer of immunoglobulin (Ig)M anti-H was 64, IgG titer using dithiothreitol was 8, and anti-IH was absent. A negative adsorption and elution test suggested that RBCs were devoid of A and B antigens. The father's sample tested clearly as group A1, D+; hence, the cis-AB blood group was ruled out in the baby. The secretor study of the mother's saliva revealed the presence of B and H substances that neutralized polyclonal B and H antisera. Therefore, we concluded that the mother was of the para-Bombay (Bh) phenotype. This case highlights the importance of reverse grouping and resolving blood grouping discrepancies between mother and child­in this case because of an incongruous ABO blood type of the baby and the mother who was previously tested as group O, D+.

Constructed wetland, an eco-technology for wastewater treatment: A review on types of wastewater treated and components of the technology (macrophyte, biolfilm and substrate).

Constructed wetland (CW) represents an efficient eco-technological conglomerate interweaving water security, energy possibility and environmental protection. In the context of wastewater treatment technologies requiring substantial efficiency at reduced cost, chemical input and low environmental impact, applications of CW is being demonstrated at laboratory and field level with reasonably high contaminant removal efficiency and ecological benefits. However, along with the scope of applications, role of individual wetland component has to be re-emphasized through related research interventions. Hence, this review distinctively explores the concerns for extracting maximum benefit of macrophyte (focusing on interface of pollutant removal, root radial oxygen loss, root iron plaque, endophyte-macrophyte assisted treatment in CW, and prospects of energy harvesting from macrophyte) and role of biofilm (effect on treatment efficiency, composition and factors affecting) in a CW. Another focus of the review is on recent advances and developments in alternative low-cost substrate materials (including conventional type, industrial by-products, organic waste, mineral based and hybrid type) and their effect on target pollutants. The remainder of this review is organized to discuss the concerns of CW with respect to wastewater type (municipal, industrial, agricultural and farm wastewater). Attempt is made to analyze the practical relevance and significance of these aspects incorporating all recent developments in the areas to help making informed decisions about future directions for research and development related to CW.

Concerns and strategies for wastewater treatment during COVID-19 pandemic to stop plausible transmission.

Along with outbreak of the pandemic COVID-19 caused by SARS-CoV-2, the problem of biomedical wastewater disposal has caused widespread public concern, as reportedly the presence is confirmed in wastewater. Keeping in mind (i) available evidence indicating need to better understand potential of wastewater mediated transmission and (ii) knowledge gaps in its occurrence, viability, persistence, and inactivation in wastewater, in this present work, we wanted to re-emphasize some strategies for management of SARS-CoV-2 contaminated wastewater to minimise any possible secondary transmission to human and environment. The immediate challenges to consider while considering wastewater management are uncertainty about this new biothreat, relying on prediction based treatments options, significant population being the latent asymptomatic carrier increased risk of passing out of the virus to sewage network, inadequacy of wastewater treatment facility particularly in populated developing countries and increased generation of wastewater due to increased cleanliness concern. In absence of regulated central treatment facility, installation of decentralized wastewater treatment units with single or multiple disinfection barriers in medical units, quarantine centre, isolation wards, testing facilities seems to be urgent for minimizing any potential risk of wastewater transmission. Employing some emerging disinfectants (peracetic acid, performic acid, sodium dichloro isocyanurate, chloramines, chlorine dioxide, benzalconium chloride) shows prospects in terms of virucidal properties. However, there is need of additional research on coronaviruses specific disinfection data generation, regular monitoring of performance considering all factors influencing virus survival, performance evaluation in actual water treatment, need of augmenting disinfection dosages, environmental considerations to select the most appropriate disinfection technology.

Risk of persistent or recurrent cervical neoplasia in patients with 'pure' adenocarcinoma-in-situ (AIS) or mixed AIS and high-grade cervical squamous neoplasia (cervical intra-epithelial neoplasia grades 2 and 3 (CIN 2/3)): a population-based study.

OBJECTIVE: To compare outcomes of patients with pure adenocarcinoma-in-situ (AIS) and mixed AIS/CIN 2/3 lesions including the incidence of AIS persistence, recurrence and progression to adenocarcinoma. DESIGN: Retrospective cohort study. SETTING: Statewide population in Western Australia. POPULATION: Women diagnosed with AIS between 2001 and 2012. METHODS: We conducted a retrospective, population-based cohort study. MAIN OUTCOME MEASURES: De-identified linked data were utilised to ascertain the association between patient age at excisional treatment, margin status, lesion type, lesion size, and risk of persistent AIS (defined as the presence of AIS <12 months from treatment), recurrent AIS (≥12 months post-treatment), and adenocarcinoma. RESULTS: 636 patients were eligible for analysis. The mean age was 32.3 years and median follow-up interval was 2.5 years. Within the study cohort, 266 patients (41.8%) had pure AIS and 370 (58.2%) had mixed AIS/CIN 2/3. Overall, 47 patients (7.4%) had AIS persistence/recurrence and 12 (1.9%) had adenocarcinoma. Factors associated with persistence/recurrence were pure AIS (hazard ratio (HR) 2.3; 95%CI 1.28-3.94; P = 0.005), age >30 years (HR 2.1; 95%CI 1.16-3.81; P = 0.015), positive endocervical margins (HR 5.8; 95%CI 3.05-10.92; P = <0.001) and AIS lesions >8 mm (HR 2.5; 95%CI 1.00-6.20; P = 0.049). A histologically positive AIS ectocervical margin was not associated with persistence/recurrence. CONCLUSION: In this study, pure AIS was associated with greater risk of persistence/recurrence than was mixed AIS/CIN 2/3. AIS lesions >8 mm and positive endocervical margins were significant predictors for persistent or recurrent disease. TWEETABLE ABSTRACT: Pure cervical adenocarcinoma-in-situ (AIS) may have greater risk of recurrence than AIS co-existing with CIN 2/3.

Removal of lead and fluoride from contaminated water using exhausted coffee grounds based bio-sorbent.

Water pollution by industrial and anthropogenic actives has become a serious threat to the environment. World Health Organization (WHO) has identified that lead and fluoride amid the environmental pollutants are most poisonous water contaminants with devastating impact on the human race. The present work proposes a study on economical bio-adsorbent based technique using exhausted coffee grounds in the removal of lead and fluoride contaminants from water. The exhausted coffee grounds gathered from industrial wastes have been acid-activated and examined for their adsorption capacity. The surface morphology and elemental characterization of pre-and-post adsorption operations by FESEM, EDX and FTIR spectral analysis confirmed the potential of the exhausted coffee ground as successful bio-sorbent. However, thermodynamic analysis confirmed the adsorption to be spontaneous physisorption with Langmuir mode of homogenous monolayer deposition. The kinetics of adsorption is well defined by pseudo second order model for both lead and fluoride. A significant quantity of lead and fluoride is removed from the synthetic contaminated water by the proposed bio-sorbent with the respective sorption capabilities of 61.6 mg/g and 9.05 mg/g. However, the developed bio-sorbent is also recyclable and is capable of removing the lead and fluoride from the domestic and industrial waste-water sources with an overall removal efficiency of about 90%.

Inhibition of SGLT1 abrogates preconditioning-induced cardioprotection against ischemia-reperfusion injury.

BACKGROUND: Recently, we reported Na+/glucose co-transporter (SGLT1) expression in mouse and human heart. We speculated that SGLT1 might play an important role in ischemic preconditioning-induced cardioprotection. Therefore, the present study was designed to find the role of SGLT1 in ischemic preconditioning-induced cardioprotection. METHODS: Hearts isolated from SD male rats were subjected to either ischemia-reperfusion injury (I/R) (15 min global ischemia followed by 20 min reperfusion) or ischemic preconditioning (IPC) (3 cycles of 2 min global ischemia separated by 3 min reperfusion) followed by I/R in presence and absence of phlorizin, an SGLT1 inhibitor. RESULTS: IPC increased membrane SGLT1 expression in rat heart as observed by immunoblotting and immunohistochemistry. Hearts from I/R group showed significant increase in oxidative stress levels and marked myocardial injury as compared to control. We also observed significant increase in apoptotic parameters in I/R heart, as measured by caspase-3 activity, TUNEL positive nuclei and gene expression analysis. Significant improvement in oxidative stress, apoptosis parameters and cardiac injury was observed in I/R hearts when subjected to IPC. However, all beneficial effects of preconditioning were lost when hearts were pre-treated with phlorizin. CONCLUSION: Present study indicated that inhibition of SGLT1 by phlorizin abrogated the beneficial effect of ischemic-preconditioning and for the first time, provides evidence that SGLT1 plays a crucial role in ischemic preconditioning-induced cardioprotection.

Antibodies to group A streptococcal virulence factors, SIC and DRS, increase predilection to GAS pyoderma.

BACKGROUND: Streptococcus pyogenes (group A streptococcus; GAS) is an etiological agent for pharyngitis, pyoderma, and invasive infections in humans. Pharyngitis and pyoderma may lead to serious immune sequelae such as rheumatic heart disease and post-streptococcal glomerulonephritis (PSGN). Streptococcal Inhibitor of Complement (SIC) and its orthologue, distantly related to SIC (DRS), are virulence factors expressed by only four of more than 100 M types of GAS. These four types (M1, M57, M12 and M55) are among the M types, which are associated with PSGN. In several populations PSGN has been shown to be a risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). Previous studies showed SIC or DRS antibody-prevalence was associated with PSGN, and seroprevalence of SIC antibodies is significantly high among CKD and ESRD patients in Mumbai. METHODS: Streptococcal isolates recovered from GAS pyoderma cases were typed. Seropositivity for SIC and DRS antibodies in subjects with pyoderma, PSGN pediatric cases, age matched healthy controls and non-GAS pyoderma cases were determined. RESULTS: We confirm in this study an association between seroprevalence to SIC and DRS antibodies, and PSGN in Mumbai population despite low point prevalence of M1, M12, M55 and M57. In addition we extended the study to GAS-pyoderma and non-GAS pyoderma cases. To our surprise, we found a positive association between the seroprevalence to SIC and DRS antibodies, and GAS-pyoderma owing to infection with diverse M types. The mechanism of increased predisposition to pyoderma owing to infection by diverse GAS among SIC or DRS antibody-positive population is not clear. Nonetheless, our findings could be explained by a phenomenon akin to antibody-dependent enhancement (ADE). CONCLUSIONS: This is the first report showing a small number of GAS M types conferring predisposition to pyoderma by diverse types. Implications of this ADE-like phenomenon are discussed in the light of evolutionary advantage to GAS, vaccine design and control of renal diseases.

Dentists' Perception of Mysmartalign Clear Aligner Treatment.

Aim and Objective: To assess the dentist perception of efficiency, treatment outcome, and stability of the tooth movement treated with mysmartalign clear aligner therapy (MSA CAT). Materials and Method: A cross-sectional web-based questionnaire survey was carried out to evaluate the dentist perception of MYSMARTALIGN (MSA). To determine the sample size, a pilot study has been carried out and the final sample arrived was 4990 subjects. The current study's inclusion criteria took into account those who had finished their BDS and MDS as well as dentists and orthodontists who had been using the MSA CAT system on their patients for the previous 7 years. Results: The result of the study showed that most research participants (3650) used MSA to treat mild to moderate malocclusion, and 3996 participants said that initial digital treatment plans have been authorised with no revisions. In view of efficiency, 3894 doctors were satisfied with the final outcome. Conclusions: Finally concluded that recent survey showed that dentists were very satisfied with the effectiveness and treatment results of the MSA clear aligner procedure.

Spatial transcriptomics reveals discrete tumour microenvironments and autocrine loops within ovarian cancer subclones.

High-grade serous ovarian carcinoma (HGSOC) is genetically unstable and characterised by the presence of subclones with distinct genotypes. Intratumoural heterogeneity is linked to recurrence, chemotherapy resistance, and poor prognosis. Here, we use spatial transcriptomics to identify HGSOC subclones and study their association with infiltrating cell populations. Visium spatial transcriptomics reveals multiple tumour subclones with different copy number alterations present within individual tumour sections. These subclones differentially express various ligands and receptors and are predicted to differentially associate with different stromal and immune cell populations. In one sample, CosMx single molecule imaging reveals subclones differentially associating with immune cell populations, fibroblasts, and endothelial cells. Cell-to-cell communication analysis identifies subclone-specific signalling to stromal and immune cells and multiple subclone-specific autocrine loops. Our study highlights the high degree of subclonal heterogeneity in HGSOC and suggests that subclone-specific ligand and receptor expression patterns likely modulate how HGSOC cells interact with their local microenvironment.

Volatile Oil Containing Plants as Phytopharmaceuticals to Treat Psoriasis: A Review.

INTRODUCTION: Psoriasis is a chronic skin condition caused by an autoimmune response that accelerates the life cycle of skin cells, resulting in the characteristic symptoms of scaling, inflammation, and itching. METHODS: Palliative treatment options for psoriasis often prioritize the use of volatile oils. These oils contain monoterpenes, sesquiterpenes, and phenylpropanoids that are intricately linked to the molecular cascades involved in the pathogenesis and symptoms of psoriasis. To evaluate the antipsoriatic efficacy of volatile oils and their components, we conducted a systematic review of scientific studies. Our literature search encompassed various online databases, including PubMed, BIREME, SCIELO, Open Grey, Scopus, and ScienceDirect. The selected studies included experimental in vitro/in vivo assessments as well as clinical studies that examined the potential of volatile oils and their extracts as antipsoriatic agents. We excluded conference proceedings, case reports, editorials, and abstracts. Ultimately, we identified and evaluated a total of 12 studies for inclusion in our analysis. RESULTS: The data collected, compiled, and analyzed strongly support the interaction between volatile oils and their constituents with the key molecular pathways involved in the pathogenesis of psoriasis and the development of its symptoms. Volatile oils play a significant role in the palliative treatment of psoriasis, while their chemical constituents have the potential to reduce the symptoms and recurrence of this condition. CONCLUSION: The current review highlights that the constituents found in volatile oils offer distinct chemical frameworks that can be regarded as promising starting points for the exploration and development of innovative antipsoriatic agents.

Chemical composition and biological activities of Lonicera caprifolium L. (Caprifoliaceae) essential oil.

This work aimed to investigate the chemical composition, antioxidant activity, antinociceptive effect, and wound healing activity of the Lonicera caprifolium L. flower essential oil (LCEO). Linalool (16.42%), d-limonene (9.99%), and α-cadinol (10.65%) were the most prevalent components of the LCEO. The LCEO revealed moderate DPPH and ABTS radical-scavenging activity. LCEO exhibited potent antinociceptive activity in acetic acid-induced writhing and hot plate-induced pain model; LCEO reduced 73.88 ± 2.78% of writhing and significantly increased pain withdrawal latency in the mice, respectively. The LCEO also presented a potent wound healing effect, with 98.08 ± 1.37% wound closure on the 12th day of treatment. The results of the study demonstrate antioxidant and wound healing potential with antinociceptive effect. To the best of our knowledge, this is the first report on the bioactivities of L. caprifolium L. essential oil.

Pre-emptive, early, and delayed alendronate treatment in a rat model of knee osteoarthritis: effect on subchondral trabecular bone microarchitecture and cartilage degradation of the tibia, bone/cartilage turnover, and joint discomfort.

OBJECTIVE: Bisphosphonates are considered potential disease modifying osteoarthritis (OA) agents. The present study investigated the efficacy of pre-emptive, early, and delayed alendronate (ALN) treatment initiation on subchondral trabecular bone and cartilage in low-dose monosodium iodoacetate (MIA)-induced knee OA in rats. METHODS: Male rats received pre-emptive (n = 12, day 0-end of week 2), early (n = 12, end of week 2-end of week 6), or delayed (n = 12, end of week 6-end of week 10) ALN treatment (30 µg/kg/week). Pre-emptive ALN-treated rats were scanned using in vivo micro-computed tomography (micro-CT) after 2 weeks and then sacrificed, early ALN-treated rats were scanned after 2 and 6 weeks and sacrificed, and the delayed ALN-treated rats were scanned after 2, 6, and 10 weeks of OA induction and sacrificed. After sacrifice, bone histomorphometry and histology of the tibia and biomarker analyses were undertaken. Changes in hind limb weight-bearing were assessed from day -1 until day 14. RESULTS: MIA-induced pathological features similar to progressive human OA in the cartilage and subchondral bone. Pre-emptive ALN treatment preserved subchondral trabecular bone microarchitecture, prevented bone loss, decreased bone turnover and joint discomfort. Pre-emptive ALN treatment had moderate effects on cartilage degradation. Early and delayed ALN treatments prevented loss of trabeculae and decreased bone turnover, but had no significant effect on cartilage degradation. CONCLUSION: ALN prevented increased bone turnover and preserved the structural integrity of subchondral bone in experimental OA. The time point of treatment initiation is crucial for treating OA. Treating both the subchondral bone and cartilage in OA would be clinically more beneficial.

Nutritional Composition, Mineral Profiling, In Vitro Antioxidant, Antibacterial and Enzyme Inhibitory Properties of Selected Indian Guava Cultivars Leaf Extract.

Psidium guajava L. is a small evergreen tree known for its magnificent medicinal and nutritional value. This study aimed to evaluate the nutritional profile and in vitro pharmacological potentialities of the different leaf extracts of four cultivars of Psidium guajava namely Surka chitti, Allahabad safeda, Karela, and Lucknow-49. The standard procedures of the Association of Official Analytical Chemists (AOAC) were followed to carry out the nutritional analysis and all of the cultivars recorded the presence of elements at a nominal range. The highest presence of phenols (125.77 mg GAE/g) and flavonoids (92.38 mg QE/g) in the methanolic leaf extract of the Karela cultivar was recorded. A wide range of minerals such as sodium, phosphorus, magnesium, zinc, and boron were recorded with a higher percentage in the Karela cultivar of Psidium guajava. In the enzyme inhibitory assays, Allahabad safeda showed potential inhibition with an IC50 of 113.31 ± 1.07, 98.2 ± 0.66 and 95.73 ± 0.39 µg/mL in α-amylase, α-glucosidase, and tyrosinase inhibition assays, respectively. The strong antioxidant effect was established by Lucknow-49 (IC50 of 74.43 ± 1.86 µg/mL) and Allahabad safeda (IC50 of 78.93 ± 0.46 µg/mL) for ABTS and DPPH assays, respectively. The ethyl acetate and methanolic leaf extracts of the Allahabad safeda cultivar showed better inhibition against Pseudomonas aeruginosa with an MIC of 14.84 and 28.69 µg/mL, respectively. A decent mean zone of inhibition was recorded in methanolic leaf extract that ranged from 21-25 mm in diameter against the tested bacterial strains (Proteus vulgaris, Bacillus subtilis, and P. aeruginosa). This is the first scientific report on the comparative and comprehensive analysis of indigenous guava cultivars to evidently shortlist the elite cultivars with enriched dietary nutrition and biological activities.

Phytochemical profile, antioxidant, cytotoxic and anti-inflammatory activities of stem bark extract and fractions of Ailanthus excelsa Roxb.: In vitro, in vivo and in silico approaches.

This study aimed to assess the phytochemical composition, in vitro antioxidant, cytotoxicity, and in vivo anti-inflammatory activities of the methanolic extract of Ailanthus excelsa (Simaroubaceae) stem bark and its fractions. Quantitative phytochemical analysis revealed that methanolic extract and all fractions contained a high level of flavonoids (20.40-22.91 mg/g QE), phenolics (1.72-7.41 mg/g GAE), saponins (33.28-51.87 mg/g DE), and alkaloids (0.21-0.33 mg/g AE). The antioxidant potential was evaluated in vitro using a range of assays, i.e., DPPH•, ABTS radical scavenging ability, and total antioxidant capacity. The chloroform and ethyl acetate fractions showed stronger antioxidant activity than the methanol extract. In vitro cytotoxic activity was investigated in three human tumor cell lines (A-549, MCF7 and HepG2) using the SRB assay. In addition, the in vivo anti-inflammatory effect was assessed by carrageenan-induced paw edema in rats. The chloroform fraction showed a more pronounced effect by effectively controlling the growth with the lowest GI50 and TGI concentrations. The human lung cancer cell line (A-549) was found to be more sensitive to the chloroform fraction. Furthermore, the chloroform fraction exhibited significant anti-inflammatory activity at a dose of 200 mg/kg in the latter phase of inflammation. Besides, methanol extract and ethyl acetate fraction revealed a significant cytotoxic and anti-inflammatory effects. The chloroform fraction of stem bark showed a strong anti-inflammatory effect in experimental animals and significant COX-2 inhibitory potential in the in vitro experiments. GC-MS analysis of chloroform fraction identified the phytochemicals like caftaric acid, 3,4-dihydroxy phenylacetic acid, arachidonic acid, cinnamic acid, 3-hydroxyphenylvaleric acid, caffeic acid, hexadeconoic acid, and oleanolic acid. The in-silico results suggest that identified compounds have better affinity towards the selected targets, viz. the BAX protein (PDB ID: 1F16), p53-binding protein Mdm-2 (PDB ID: 1YCR), and topoisomerase II (PDB ID: 1QZR). Amongst all, caftaric acid exhibited the best binding affinity for all three targets. Thus, it can be concluded that caftaric acid in combination with other phenolic compounds, might be responsible for the studied activity. Additional in vivo and in vitro studies are required to establish their exact molecular mechanisms and consider them as lead molecules in developing of valuable drugs for treating oxidative stress-induced disorders, cancers, and inflammations.

Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis.

Background: Opioid prescribing guidelines have significantly decreased overprescribing and post-discharge use after cardiac surgery; however, limited recommendations exist for general thoracic surgery patients, a similarly high-risk population. We examined opioid prescribing and patient-reported use to develop evidence-based, opioid prescribing guidelines after lung cancer resection. Methods: This prospective, statewide, quality improvement study was conducted between January 2020 to March 2021 and included patients undergoing surgical resection of a primary lung cancer across 11 institutions. Patient-reported outcomes at 1-month follow-up were linked with clinical data and Society of Thoracic Surgery (STS) database records to characterize prescribing patterns and post-discharge use. The primary outcome was quantity of opioid used after discharge; secondary outcomes included quantity of opioid prescribed at discharge and patient-reported pain scores. Opioid quantities are reported in number of 5-mg oxycodone tablets (mean ± standard deviation). Results: Of the 602 patients identified, 429 met inclusion criteria. Questionnaire response rate was 65.0%. At discharge, 83.4% of patients were provided a prescription for opioids of mean size 20.5±13.1 pills, while patients reported using 8.2±13.0 pills after discharge (P<0.001), including 43.7% who used none. Those not taking opioids on the calendar day prior to discharge (32.4%) used fewer pills (4.4±8.1 vs. 11.7±14.9, P<0.001). Refill rate was 21.5% for patients provided a prescription at discharge, while 12.5% of patients not prescribed opioids at discharge required a new prescription before follow-up. Pain scores were 2.4±2.5 for incision site and 3.0±2.8 for overall pain (scale 0-10). Conclusions: Patient-reported post-discharge opioid use, surgical approach, and in-hospital opioid use before discharge should be used to inform prescribing recommendations after lung resection.

An ergonomic evaluation of workers in the winding section of the pump manufacturing industry.

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) are prevalent and have an impact across occupations. However, there are very few studies that document the prevalence of WMSDs in the pump industry. In manufacturing industries, the common issue for WMSDs and physiological stress among the workers is caused by poor working posture. OBJECTIVE: To investigate the occupational risks at the winding station in the pump manufacturing industry. In addition, this study examined the influence of work-study on mitigating occupational risks. METHODS: Workers who were involved in circular coil winding and insulation testing were considered for the study. Awkward postures adopted while performing these tasks cause fatigue, injuries and WMSDs. Tasks were evaluated as per the National Institute for Occupational Safety and Health (NIOSH) standards. A work-study was conducted to better understand the workflow. Virtual ergonomic postural evaluation (Rapid Upper Limb Assessment, RULA) was used to identify the occupational risks. RESULTS: Time taken for making circular windings and insulation testing (7.5 Hp submersible motor) was found to be 4.04 minutes and 0.95 minutes, respectively. A CAD model was used for ergonomic evaluation in the virtual environment. The RULA final score of 2 and 3 is attributed to coil winding and insulation testing. CONCLUSION: For further studies, the whole pump manufacturing process should be taken into account. The ergonomic tools used in this study will considerably reduce the occupation risks at the winding station in the pump manufacturing industry.

Reverse algorithm for screening of syphilis and trends in prevalence among blood donors in Coastal Karnataka.

BACKGROUND: Transfusion transmissible syphilis is caused by Treponema pallidum; blood donors are traditionally screened with non-treponemal antibody tests to ensure transfusion safety. Detection of specific antibodies against T. pallidum is employed in reverse algorithm screening. We aim to analyze the utility of the reverse algorithm screening strategy for T. pallidum and to determine the prevalence trends among blood donors in our centre. MATERIAL AND METHODS: The study was conducted in a Transfusion Centre catering to the 2030 bedded Tertiary Care Centre in coastal Karnataka in two timelines from 2012 to 2014, and 2019 to 2020, respectively. A fully automated Enzyme-Linked Immunosorbent Assay and Enhanced Chemiluminescence Immunoassay, which detect both IgM and IgG antibodies against T.pallidum were used in the study. Blood donor data from 2008 to 2020 were also analyzed to observe the trend in prevalence rate of syphilis among blood donors. RESULTS: Among 26329 and 388 blood donors screened with ELISA and ECI, 134 (0.51%) and 9 (2.3%) were reactive to T. pallidum antibodies respectively. TPHA confirmed that 104 and 9 donors were reactive from each of the ELISA and ECI reactive donor groups. The increase in the prevalence of syphilis was observed with the use of reverse algorithm compared to the traditional strategy. The prevalence of syphilis in the present study ranged from 0.02 to 0.28%. CONCLUSION: The reverse algorithm screening can give a better result with a positive predictive value of 77.61% and 88.9% for ELISA and ECI. respectively Our study found that the use of reverse algorithm might increase the blood discard rate slightly but adds on to safety of blood components.