Median nerve schwannoma with a diagnostic delay of 8 years: a case report.

Introduction: Schwannomas are benign tumors of the peripheral nerve sheath, and the median nerve is the most commonly involved nerve. These benign tumors of the peripheral nerve sheath are very rare; they are clinically and radiologically similar to most other benign swellings of the hand; thus, they are often misdiagnosed. Case Presentation: A 41-year-old lady presented with an 8-year-long history of swelling over the distal forearm. The tumor measured 3.5×3.5×3.5 mm and was located over the flexor aspect of the distal part of her right forearm. Schwannoma was suspected from the clinical presentation and imaging, but the final diagnosis was established only after the surgery and histopathological analysis. At the follow-up after 1 year, the patient is doing well and her symptoms have not recurred. Conclusion: Imaging characteristics of schwannoma can be misinterpreted as some other condition, making the preoperative diagnosis very difficult and important. Thus, clinicians should be aware of such swellings, especially those that have been unnoticed or misdiagnosed, and provide optimal diagnoses to confer good outcomes.

Chronic lymphedema reversal following arteriovenous fistula takedown: A case report.

INTRODUCTION AND IMPORTANCE: Lymphedema is a very rare complication of Arteriovenous Fistula. The commonly encountered complications following the arteriovenous fistula are thrombosis, stenosis, congestive heart failure, ischemic neuropathy, steal syndrome, aneurysm and infection. Hence, presence of Lymphedema is a rarity that must be managed vigilantly. The incidence of lymphedema following AV fistula is very rare. Presently there is lack of studies evaluating the outcome of fistula take down. The standard care for lymphedema is complex decongestive physiotherapy in most of other causes bur Fistula Take down also helps in reducing the swelling in our case. CASE PRESENTATION: Our case is of 53 years female presented to the surgical OPD with left upper limb swelling 5 months back which was non-pitting in nature. She was a known case of Acute kidney injury with no history of other comorbidities. The swelling started about 1 year ago involving the upper parts of the left arm which was intermittent and relieved spontaneously. She has a history of brachiocephalic fistula insertion for hemodialysis access 4 years ago with diagnosis of Acute Kidney Injury. However, the fistula was never used because of patient recovering from medical management. Investigations performed were doppler and other routine tests. CLINICAL DISCUSSION: The fistula was patent on examination confirmed by venous hum on auscultation. Fistula takedown surgery was planned after ruling out thrombosis and stenosis using doppler. Other alternatives were not considered because of lack of use of fistula. The swelling started to improve postoperatively and the patient was discharged. CONCLUSION: Our Case report highlights the fact that the rare complication like lymphedema could occur after the arteriovenous fistula which could be managed by fistula take down surgery if the fistula is no longer in use. Though very rare lymphedema should be kept in differential for complication which can be diagnosed by examination and ruling out other causes.

Resectability and prognosis of gallbladder cancer: a cross-sectional study of 100 cases from a tertiary care centre of Eastern Nepal.

Gallbladder cancer (GBC) is the fifth most common neoplasm of the digestive tract and has an overall incidence of 3 per 100 000 people. Only 15-47% of the preoperatively known GBC are suitable for resection. The objective of the study was to investigate the resectability and prognosis of GBC patients. Materials and methods: It is a prospective observational study including all cases of primary cancers of the gallbladder in the Department of Surgical Gastroenterology at a tertiary care center over the period from January 2014 to December 2019. The primary endpoint was resectability and overall survival. Results: During the study period, 100 patients with GBC were reported. The mean age at the time of diagnosis was 52.5 years, with a female predominance (67%). The curative intent resection (radical cholecystectomy) was possible in 30 (30%) patients; while 18 (18%) required palliative surgical treatment. The overall survival of the entire group was 9 months; while those patients who underwent surgery with curative intent had a median overall survival of 28 months after a median follow-up of 42 months. Conclusion: This study found that only one-third of patients achieve radical surgery with curative intent. Overall, the prognosis of patients is poor with a median survival of less than a year due to the advanced stage disease. Multimodality treatment, screening ultrasound, and neo-/adjuvant therapy may improve survival.

The First Differentiated TB Care Model From India: Delays and Predictors of Losses in the Care Cascade.

To reduce TB deaths in resource-limited settings, a differentiated care strategy can be used to triage patients with high risk of severe illness (i.e., those with very severe undernutrition, respiratory insufficiency, or inability to stand without support) at diagnosis and refer them for comprehensive assessment and inpatient care. Globally, there are few examples of implementing this type of strategy in routine program settings. Beginning in April 2022, the Indian state of Tamil Nadu implemented a differentiated care strategy called Tamil Nadu-Kasanoi Erappila Thittam (TN-KET) for all adults aged 15 years and older with drug-susceptible TB notified by public facilities. Before evaluating the impact on TB deaths, we sought to understand the retention and delays in the care cascade as well as predictors of losses. During April-June 2022, 14,961 TB patients were notified and 11,599 (78%) were triaged. Of those triaged, 1,509 (13%) were at high risk of severe illness; of these, 1,128 (75%) were comprehensively assessed at a nodal inpatient care facility. Of 993 confirmed as severely ill, 909 (92%) were admitted, with 8% unfavorable admission outcomes (4% deaths). Median admission duration was 4 days. From diagnosis, the median delay in triaging and admission of severely ill patients was 1 day each. Likelihood of triaging decreased for people with extrapulmonary TB, those diagnosed in high-notification districts or teaching hospitals, and those transferred out of district. Predictors of not being comprehensively assessed included: aged 25-34 years, able to stand without support, and diagnosis at a primary or secondary-level facility. Inability to stand without support was a predictor of unfavorable admission outcomes. To conclude, the first quarter of implementation suggests that TN-KET was feasible to implement but could be improved by addressing predictors of losses in the care cascade and increasing admission duration.

--Eleven tips for operational researchers working with health programmes: our experience based on implementing differentiated tuberculosis care in south India.

Due to the workload and lack of a critical mass of trained operational researchers within their ranks, health systems and programmes may not be able to dedicate sufficient time to conducting operational research (OR). Hence, they may need the technical support of operational researchers from research/academic organisations. Additionally, there is a knowledge gap regarding implementing differentiated tuberculosis (TB) care in programme settings. In this 'how we did it' paper, we share our experience of implementing a differentiated TB care model along with an inbuilt OR component in Tamil Nadu, a southern state in India. This was a health system initiative through a collaboration of the State TB cell with the Indian Council of Medical Research institutes and the World Health Organisation country office in India. The learnings are in the form of eleven tips: four broad principles (OR on priority areas and make it a health system initiative, implement simple and holistic ideas, embed OR within routine programme settings, aim for long-term engagement), four related to strategic planning (big team of investigators, joint leadership, decentralised decision-making, working in advance) and three about implementation planning (conducting pilots, smart use of e-tools and operational research publications at frequent intervals). These may act as a guide for other Indian states, high TB burden countries that want to implement differentiated care, and for operational researchers in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes). Following these tips may increase the chances of i) an enriching engagement, ii) policy/practice change, and iii) sustainable implementation.

Retraction Note: The prediction of the lifetime of the new coronavirus in the USA using mathematical models.

[This retracts the article DOI: 10.1007/s00500-021-05643-2.].

Actinomycotic osteomyelitis of the maxilla in a female patient: A rare case report with the review of the literature.

Actinomycotic osteomyelitis is a rare chronic suppurative, granulomatous, fibrosing saprophytic infection. It is an endogenous infection caused by the Actinomyces species, which are part of the normal oral microflora. There is a male predilection for this type of infection, with the male to female ratio of 4:1. Though the etiopathogenesis of the infection is unclear, it is mostly attributed to the disruption of the normal oral microflora and the invasion of the microorganism into deeper tissues through a break in the mucosal barrier due to damage from trauma, extraction or previous injury. The portal of entry can be through the pulpal, periodontal or mucosal route, causing the purulent and necrotic infection of soft tissue, bone, or both. The diagnosis is usually considered when there is a persistent infection without the presence of regional lymphadenopathy and is usually confirmed through the histopathological depiction of the bacterial colonies - 'ray fungus' - as obtaining the positive culture of the causative microorganisms is difficult and is reported to be effective in less than 50%. Patients with such infections are managed with surgical debridement, followed by antibiotic therapy for a longer time period. Recent advances have been emphasized for an early diagnosis and a better prognosis of the therapy. Therefore, this paper aimed to present a rare case of actinomycotic osteomyelitis of the maxilla in a 45-year-old female patient, and also to review the literature on this rare infection.

Toward Measuring the Mechanical Stresses Exerted by Branching Embryonic Airway Epithelial Explants in 3D Matrices of Matrigel.

Numerous organs in the bodies of animals, including the lung, kidney, and mammary gland, contain ramified networks of epithelial tubes. These structures arise during development via a process known as branching morphogenesis. Previous studies have shown that mechanical forces directly impact this process, but the patterns of mechanical stress exerted by branching embryonic epithelia are not well understood. This is, in part, owing to a lack of experimental tools. Traditional traction force microscopy assays rely on the use of compliant hydrogels with well-defined mechanical properties. Isolated embryonic epithelial explants, however, have only been shown to branch in three-dimensional matrices of reconstituted basement membrane protein, or Matrigel, a biomaterial with poorly characterized mechanical behavior, especially in the regime of large deformations. Here, to compute the traction stresses generated by branching epithelial explants, we quantified the finite-deformation constitutive behavior of gels of reconstituted basement membrane protein subjected to multi-axial mechanical loads. We then modified the mesenchyme-free assay for the ex vivo culture of isolated embryonic airway epithelial explants by suspending fluorescent microspheres within the surrounding gel and tracking their motion during culture. Surprisingly, the tracked bead motion was non-zero in regions of the gel far away from the explants, suggestive of passive swelling deformations within the matrix. To compute accurate traction stresses, these swelling deformations must be decomposed from those generated by the branching explants. We thus tracked the motion of beads suspended within cell-free matrices and quantified spatiotemporal patterns of gel swelling. Taken together, these passive swelling data can be combined with the measured mechanical properties of the gel to compute the traction forces exerted by intact embryonic epithelial explants.

Green chemistry principles for the synthesis of anti fungal active gum acacia-gold nanocomposite - natamycin (GA-AuNC-NT) against food spoilage fungal strain Aspergillus ochraceopealiformis and its marked Congo red dye adsorption efficacy.

In this present study, a highly stable gum acacia -gold nanocomposite fabricated with food preservative agent natamycin (GA-AuNC-NT) was prepared via green science principles under in vitro conditions. Various characterisation techniques reveal highly stable structural, functional properties of the synthesised nanocomposite with marked antifungal activity and adsorption efficacy against congo red dye. The antifungal activity was investigated against the fungal strain Aspergillus ochraceopealiformis isolated from spoiled, expired bread. The well diffusion assay, fungal hyphae fragmentation assay and spore germination inhibition assay were used to determine the antifungal activity of the synthesised nanocomposite. Potential antifungal activity of the synthesised nanocomposite was confirmed by recording zone of inhibition, high rate of hyphae fragmentation and marked spore germination inhibition against the tested fungal strain. The molecular mechanism of antifungal activity was studied by measuring oxidative stress marker genes like catalase (CAT), superoxide dismutase (SOD), peroxidase (POD) induction adopting quantitative real-time polymerase chain reaction (q RT-PCR). Among the various treatment, a notable reduction in all the tested marker genes expression was recorded in the nanocomposite treated fungal strain. Release profile studies using different solvents reveals sustained or controlled release of natamycin at the increasing periods. The synthesised nanocomposite's high safety or biocompatibility was evaluated with the Wistar animal model by determining notable changes in behavioural, biochemical, haematological and histopathological parameters. The synthesised nanocomposite did not exhibit any undesirable changes in all the tested parameters confirming the marked biosafety or biocompatibility. The nanocomposite was coated on the bread packaging material. The effect of packaging on the proximate composition, antioxidative enzymes status, and fungal growth of bread samples incubated under the incubation period were studied. Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM) studies reveal that the nanocomposite was effectively coated on the packaging material without changing size, shape, and functional groups. No changes in the proximate composition and antioxidative enzymes of the packaged bread samples incubated under different incubation periods reveal the nanocomposite's marked safety. The complete absence of the fungal growth also indicates the uniqueness of the nanocomposite. Further, the sorption studies revealed the utilisation of Langmuir mechanism and pseudo II order model successfully The present finding implies that the synthesised nanocomposite can be used as an effective, safe food preservative agent and adsorbent of toxic chemicals.

Persistent organic pollutants in water resources: Fate, occurrence, characterization and risk analysis.

Persistent organic pollutants (POPs) are organic chemicals that can persist in the environment for a longer period due to their non-biodegradability. The pervasive and bio-accumulative behavior of POPs makes them highly toxic to the environmental species including plants, animals, and humans. The present review specifies the POP along with their fate, persistence, occurrence, and risk analysis towards humans. The different biological POPs degradation methods, especially the microbial degradation using bacteria, fungi, algae, and actinomycetes, and their mechanisms were described. Moreover, the source, transport of POPs to the environmental sources, and the toxic nature of POPs were discussed in detail. Agricultural and industrial activities are distinguished as the primary source of these toxic compounds, which are delivered to air, soil, and water, affecting on the social and economic advancement of society at a worldwide scale. This review also demonstrated the microbial degradation of POPs and outlines the potential for an eco-accommodating and cost-effective approach for the biological remediation of POPs using microbes. The direction for future research in eliminating POPs from the environmental sources through various microbial processes was emphasized.

A Giant Nondural-Based Lumbosacral Clear Cell Meningioma Mimicking Schwannoma: A Case Report and Review of the Literature.

Spinal clear cell meningiomas (CCMs) are rare and dural-based lesion usually affecting the younger population. We report the rare case of giant nondural-based spinal CCM mimicking schwannoma and review the literature. A literature search was performed at PubMed and Embase until January 1, 2020. A total of 19 cases of nondural-based spinal CCM was reported. The following relevant data were extracted: authors, publication year, patient and tumor characteristics, treatment, and outcome. The mean age of the presentation was 20.58 years. Twelve (63.16%) were female and seven patients (36.84%) were male. The most common location was lumbosacral region 15 (79%). Fifteen (79%) tumors had cranio-caudal dimension ≤2 vertebral level, and only four (21%) tumors had dimension ≥2 vertebral level. Gross total resection (GTR) was performed in 18 (95%) patients and subtotal resection (STR) in 1 patient. Recurrences were reported in five (26.14%) patients. Four of them showed recurrences within 6 months; earliest at 2.3 months in the patient had undergone STR. Our patient is 19-year-old male diagnosed with a lumbosacral intradural lesion. Craniocaudal dimension is ≥2 vertebral level shows the foraminal extension and vertebral scalloping. GTR is performed. Intraoperatively, the tumor has foraminal extension and shows attachment with right S1S2 nerve root. No dural attachment is found. Six-month follow-up magnetic resonance image shows no evidence of disease. Nondural-based spinal CCMs are extremely rare and should be kept as a differential diagnosis in young patients with giant intradural tumor, and whose radiological features suggesting of schwannoma. It affects young patients and usually involves more than one vertebral level. The chances of recurrences and metastasis are always high even after GTR; hence, close follow-up of the entire neuraxis is warranted.

The prediction of the lifetime of the new coronavirus in the USA using mathematical models.

The World Health Organization (WHO) on December 31, 2019, was informed of several cases of respiratory diseases of unknown origin in the city of Wuhan in the Chinese Province of Hubei, the clinical manifestations of which were similar to those of viral pneumonia and manifested as fever, cough, and shortness of breath. And, the disease caused by the virus is named the new coronavirus disease 2019 and it will be abbreviated as 2019-nCoV and COVID-19. As of January 30, 2020, the WHO classified this epidemic as a global health emergency (Chung et al. in Radiology 295(1):202-207, 2020). It is an international real-life problem. Due to deaths, globally everyone is under fear. Now, it is the responsibility of researchers to give hope to the people. In this article, we aim to better protect people and general pandemic preparedness by predicting the lifetime of the disease-causing virus using three mathematical models. This article deals with a complex real-life problem people face all over the world, an international real-life problem. The main focus is on the USA due to large infection and death due to coronavirus and thereby the life of every individual is uncertain. The death counts of the USA from February 29 to April 22, 2020, are used in this article as a data set. The death counts of the USA are fitted by the solutions of three mathematical models and a solution to an international problem is achieved. Based on the death rate, the lifetime of the coronavirus COVID-19 is predicted as 1464.76 days from February 29, 2020. That is, after March 2024 there will be no death in the USA due to COVID-19 if everyone follows the guidelines of WHO and the advice of healthcare workers. People and government can get prepared for this situation and many lives can be saved. It is the contribution of soft computing. Finally, this article suggests several steps to control the spread and severity of the disease. The research work, the lifetime prediction presented in this article is entirely new and differs from all other articles in the literature.

Infected congenital lumbosacral dermal sinus tract with conus epidermoid abscess: a rare entity.

PURPOSE: Dermal sinus is more commonly associated with intradural dermoid than an epidermoid cyst. Conus epidermoid cyst with dermal sinus is a rare entity. We are presenting a rare case of infected conus epidermoid cyst along with the dermal sinus in an 18-month-old girl presented with flaccid paraparesis with sphincter dysfunction and timely intervention leads to complete recovery. We had searched PubMed for previously reported similar cases and did a case-based review of the literature. CASE REPORT: This 18-month-old girl with discharging lumbosacral sinus with fever since 3 days presented with flaccid paraparesis with sphincter dysfunction. Preoperative magnetic resonance imaging (MRI) showed a large enhancing lesion from L1-S1 along with the dermal sinus tract. Complete excision of the cyst along with the sinus tract, followed by long-term antibiotic therapy. The excision of the infected cyst was done through myelotomy under neuromonitoring, while some part of the capsule densely adherent to the neural tissue was left behind. The patient gradually improved following surgery and motor power of the lower limbs were [Formula: see text] while going home. Histopathology revealed epidermoid cyst with secondary inflammatory tissue. Follow-up MRI of the spine showed excision of the dermal sinus tract and cyst with postoperative changes. At 1-year follow-up, the patient was asymptomatic without any focal deficits. CONCLUSION: Early surgical intervention followed by long-term antibiotic therapy is a must for good functional recovery in patients of an infected dermal sinus tract with associated cyst. While excising cyst through myelotomy, some part of the capsule densely adherent to neural tissue may be left behind. Regular follow-up in the first year of surgery is essential to look for the recurrence of the lesion.

Foreign body-related oesophageal perforation: a case series at a community-based hospital in Nepal.

Oesophageal perforation is rare, associated with diagnostic dilemma, delayed presentation and high mortality rate (36%). Early diagnosis and treatment are crucial for a good outcome. Treatment is by non-operative methods (antibiotics, drainage of collections, oesophageal stenting and nutritional support) or by surgery, depending on the condition of the patient, timing of presentation and expertise. During a five-year period (2015-2019), we managed seven cases of oesophageal perforation due to a foreign body. Of them, 4 (57%) received operative intervention, while 3 (43%) were managed non-operatively. One postoperative mortality ensued; there was a mean hospital stay of 20 days.

Open pleural decortication for the late stage empyema thoracis in children: a retrospective observational study from a tertiary hospital of eastern Nepal.

The management of late-stage empyema thoracis requires surgical intervention. We performed a retrospective descriptive analysis of open pleural decortication for late stage empyema thoracis in 55 children (age ≤ 15 years; median age = 6 years; age range = 1-15 years; 40 [72.7%] boys) over 42 months. The median time to thoracotomy from the onset of symptoms was 24 days, and the median duration of hospital stay before and after surgery was 15 and 4 days, respectively. Three (5.5%) patients had necrotising pneumonia, requiring debridement; 4 (7.3%) patients had superficial surgical site infection; 12 (21.8%) patients had perioperative pus culture positive for bacteria; and 3 (5.5%) patients had tubercular aetiology. There was no operative mortality. At median follow-up of 18 months, all patients are in good general health. Open pleural decortication leads to rapid resolution of symptoms and reduces hospital stay in paediatric late-stage empyema thoracis.

Green and low-cost synthesis of zinc oxide nanoparticles and their application in transistor-based carbon monoxide sensing.

There has been steady progress in developing reliable and cost-effective strategies for the clean production of zinc oxide (ZnO) nanoparticles (NPs) owing to their unique structural and wide functional characteristics. While the green synthesis of such NPs from plant extracts has emerged as a sustainable and eco-friendly protocol, it is greatly restricted owing to the scarcity of potential natural precursors necessitating comprehensive investigations in this direction. Herein, we report a facile, low-cost green synthesis and characterization of ZnO NPs along with the demonstration of their usage as an active media in organic field-effect transistor (OFET) devices for sensing carbon monoxide (CO) gas. The ZnO NPs obtained from Nelumbo nucifera (lotus) leaf extract-mediated solution combustion synthesis at a much lower initiation temperature, the first of its kind, were characterized by various techniques such as UV-vis spectroscopy, XRD, EDX analysis, TEM and FESEM. The data derived from these experiments clearly evidence the formation of very pure and crystalline ZnO NPs possessing nearly spherical-shape with a size of 3-4 nm. The p-type organic field-effect transistor (OFET) device, fabricated using poly(3-hexylthiophene-2,5-diyl) (P3HT) and ZnO NPs, showed a field-effect mobility of 10-2 cm2 V-1 sec-1 with a slightly enhanced response of detecting CO gas at room temperature (RT). The phenomenon was further confirmed by the variation in electrical parameters of the OFET such as field-effect mobility (µ), on-current (I on), and off-current (I off). The selectivity and sensitivity of the fabricated device in CO gas detection was found to be more prominent than the other reducing gases (hydrogen sulphide, H2S and ammonia, NH3) and methanol vapours tested.

Atypical presentation of extraspinal neurofibroma presenting with acute-onset monoparesis and Horner's syndrome: Case report and review of literature.

The clinical presentation of spinal or extraspinal neurofibroma is radiculopathy or myelopathy, pain, and motor weakness. Extraspinal neurofibroma presenting with acute-onset monoparesis and Horner's syndrome is very rare. We report the case of a 55-year-old female who presented with acute-onset monoparesis of the left upper limb along with left-side drooping of the eyelid. Imaging revealed C6-D2 extraspinal solitary mass lesion lateral to spinous process with bleed without intraspinal component. The patient underwent an anterior cervical approach and excision of the tumor. Final biopsy report was a neurofibroma. At 3-year follow-up, she recovered from motor weakness, and Horner's syndrome subsided. Extraspinal neurofibroma can present with acute bleed, and surgical outcome is superior in early intervention.

Oxidative stress response in the pathogenesis of dengue virus virulence, disease prognosis and therapeutics: an update.

Dengue virus (DENV) is a mosquito-borne arbovirus that causes febrile illness and can lead to a potentially lethal disease. The mechanism of disease pathogenesis is not completely understood, and there are currently no vaccines or therapeutic drugs available to protect against all four serotypes of DENV. Although many reasons have been suggested for the development of the disease, dengue studies have shown that, during DENV infection, there is an imbalance between oxidants and antioxidants that disrupts homeostasis. An increase in reactive oxygen species (ROS) levels triggers the sudden release of cytokines, which can lead to plasma leakage and other severe symptoms. In the present review, we give an overview of the oxidative stress response and its effect on the progression of dengue disease. We also discuss the role of oxidative-stress-associated molecules in disease prognostic and therapeutics.