MRD at the End of Induction and EFS in T-cell Lymphoblastic Lymphoma: Children's Oncology Group Trial AALL1231.

Defining prognostic variables in T-lymphoblastic lymphoma (T-LL) remains a challenge. AALL1231 was a COG phase 3 clinical trial for newly diagnosed with T Acute Lymphoblastic leukemia or T-LL patients randomizing children and young adults to a modified augmented BFM backbone to receive standard therapy (Arm A) or with addition of bortezomib (Arm B). Optional bone marrow (BM) samples to assess minimal residual disease (MRD) at the end of induction (EOI) were collected in T-LL analyzed to assess the correlation of MRD at the EOI to event-free survival (EFS). Eighty-six (41%) of the 209 T-LL patients accrued to this trial submitted samples for MRD assessment. Patients with MRD <0.1% (n= 75) at EOI had a superior 4-year EFS versus those with MRD >0.1% (n= 11), (89.0±4.4% versus 63.6±17.2%, p= 0.025). Overall survival did not significantly differ between the two groups. Cox regression for EFS using Arm A as a reference demonstrated that MRD EOI ≥0.1% was associated with a greater risk of inferior outcome (Hazard Ratio, HR= 3.73 (1.12-12.40, p= 0.032), which was independent of treatment arm assignment. Consideration to incorporate MRD at EOI into future trials will help establish its value in defining risk groups. CT# NCT02112916.

Influence of upper lip inclination on facial profile attractiveness: A perceptive analysis.

BACKGROUND: One of the major objectives of orthodontic treatment is to improve facial attractiveness. To orthodontists, this means that the nose, lips, and chin form an attractive outline when the faces are viewed from one side. The aim of the study is to evaluate the influence of lip inclination on perceived attractiveness using North Indian observer ratings on profile silhouettes. MATERIALS AND METHODS: A profile photograph of an Indian male and female were converted to silhouettes for the study using computer software. The lip inclination of the idealized profile image was altered in two-degree increments to create a series of profiles with different upper lip inclination angles and rated by laypersons on a Likert scale. RESULTS: An angle of 79° was deemed to be neither attractive nor unattractive. Therefore, within the range of 65°-75°, the pictures were deemed acceptable. Angles above or below this range, up to 91° were perceived as slightly unattractive, and anything outside the range of 93°-105° was deemed very unattractive. LIMITATIONS: The study is not generalizable to ethnic groups other than the North Indian population. Another limitation is the inability to visualize the entire face for a complete facial analysis. CONCLUSION: An upper lip inclination of 75°-85° in the male profile was associated with perceived attractiveness in all three groups whereas it was in the range of 65°-75° for a female profile. An upper lip inclination angle ranging from 95° to 105° was associated with unattractiveness in all three groups of observers and requires correctional intervention.

Nanophytosomal Gel of Heydotis corymbosa (L.) Extract against Psoriasis: Characterisation, In Vitro and In Vivo Biological Activity.

The current study was conducted to examine the possible advantages of Heydotis corymbosa (L.) Lam. extract nanogel as a perspective for enhanced permeation and extended skin deposition in psoriasis-like dermatitis. Optimised nanophytosomes (NPs) were embedded in a pluronic gel base to obtain nanogel and tested ex vivo (skin penetration and dermatokinetics) and in vivo. The optimised NPs had a spherical form and entrapment efficiency of 73.05 ± 1.45% with a nanosized and zeta potential of 86.11 nm and -10.40 mV, respectively. Structural evaluations confirmed encapsulation of the drug in the NPs. Topical administration of prepared nanogel to a rat model of psoriasis-like dermatitis revealed its specific in vivo anti-psoriatic efficacy in terms of drug activity compared to the control and other formulations. Nanogel had improved skin integrity and downregulation of inflammatory cytokines. These findings suggest that developed phytoconstituent-based nanogel has the potential to alleviate psoriasis-like dermatitis with better skin retention and effectiveness.

Rubia cordifolia L. Attenuates Diabetic Neuropathy by Inhibiting Apoptosis and Oxidative Stress in Rats.

BACKGROUND: Diabetic neuropathy is a debilitating manifestation of long-term diabetes mellitus. The present study explored the effects of the roots of Rubia cordifolia L. (R. cordifolia L.) in the Wistar rat model for diabetic neuropathy and possible neuroprotective, antidiabetic, and analgesic mechanisms underlying this effect. MATERIALS AND METHODS: Rats were divided into five experimental groups. An amount of 0.25% carboxy methyl cellulose (CMC) in saline and streptozotocin (STZ) (60 mg/kg) was given to group 1 and group 2, respectively. Group 3 was treated with STZ and glibenclamide simultaneously while groups 4 and 5 were simultaneously treated with STZ and hydroalcoholic extract of the root of R. cordifolia, respectively. Hot plate and cold allodynias were used to evaluate the pain threshold. The antioxidant effects of R. cordifolia were assessed by measuring Thiobarbituric acid reactive substances (TBARS), reduced glutathione (GSH), catalase (CAT), and superoxide dismutase (SOD). At the end of the study, sciatic nerve and brain tissues were collected for histopathological study. Bcl-2 proteins, cleaved caspase-3, and Bax were assessed through the Western blot method. RESULTS: R. cordifolia significantly attenuated paw withdrawal and tail flick latency in diabetic neuropathic rats. R. cordifolia significantly (p < 0.01) improved the levels of oxidative stress. It was found to decrease blood glucose levels and to increase animal weight in R. cordifolia-treated groups. Treatment with R. cordifolia suppressed the cleaved caspase-3 and reduced the Bax:Bcl2 ratio in sciatic nerve and brain tissue compared to the diabetic group. Histopathological analysis also revealed a marked improvement in architecture and loss of axons in brain and sciatic nerve tissues at a higher dose of R. cordifolia (400 mg/kg). CONCLUSION: R. cordifolia attenuated diabetic neuropathy through its antidiabetic and analgesic properties by ameliorating apoptosis and oxidative stress.

Restorations of Class II Cavities Evaluated for Marginal Leakage When Restored with Composites or a Giomer Using Different Bonding Agents.

PURPOSE: To evaluate the marginal leakage of three different types of bonding agents used with two posterior composites and a giomer, available commercially. MATERIAL AND METHODS: Class II box-only cavities were prepared on 90 mandibular first molars with margins extending 1 mm beyond the cementoenamel junction. The samples were divided into nine groups based on three different bonding agents, two different composites, and a giomer. Cavities were restored per the manufacturer's description. Teeth were subjected to a thermocycling procedure (500×, 5°C to 55°C) and dye penetration by immersing in a 2% methylene blue solution (Merck Specialties) for 24 hours. The marginal adaptation was evaluated as a continuous margin at the gingival level under a stereomicroscope. The results were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The results of the groups with the total-etch technique showed no statistical difference between the nanohybrid Filtek Z250 XT (3M ESPE) and fine hybrid SwissTEC composite (Coltène\Whaledent AG). The groups with the self-etch technique showed no statistical difference when used with either of the two composites. The acid-etch technique showed better marginal adaptation than the self-etch technique. When the giomer (Beautifil II, Shofu) was used with the total-etch technique, it showed better adaptation than when used with the self-etch technique but overall showed more marginal leakage than the composites. CONCLUSION: The total-etch technique provided better marginal adaptation for the composites and giomer compared to the self-etch technique. CLINICAL SIGNIFICANCE: The demand for esthetic restorations continues to increase, and composite restorations are now considered the material of choice for Class II cavities. There are various concerns with composite restorations, one of them being good marginal adaptation to increase the life of the restoration. This study evaluated marginal leakage with the nanohybrid composite Filtek Z250 XT, fine hybrid composite SwissTEC, and a giomer when used with the total-etch technique and self-etch technique and reported satisfactory adaptation with the total-etch technique.

Nanoencapsulation and characterisation of Hypericum perforatum for the treatment of neuropathic pain.

AIM: This work aimed to encapsulate Hypericum perforatum extract (HPE) into nanophytosomes (NPs) and assess the therapeutic efficacy of this nanocarrier in neuropathic pain induced by partial sciatic nerve ligation (PSNL). METHODS: Hydroalcoholic extract of Hypericum perforatum was prepared and encapsulated into NPs by thin layer hydration method. Particle size, zeta potential, TEM, differential scanning calorimetry (DSC), entrapment efficiency (%EE), and loading capacity (LC) of NPs were reported. The biochemical and histopathological examinations were measured in the sciatic nerve. RESULTS: Particle size, zeta potential, %EE, and LC were 104.7 ± 1.529 nm, -8.93 ± 1.71 mV, 87.23 ± 1.3%, and 53.12 ± 1.7%, respectively. TEM revealed well-formed and distinct vesicles. NPHPE (NPs of HPE) was significantly more effective than HPE in reducing PSNL-inducing pain. Antioxidant levels and sciatic nerve histology were reversed to normal with NPHPE. CONCLUSIONS: This study demonstrates that encapsulating HPE with phytosomes is an effective therapeutic approach for neuropathic pain.

Evaluation of Hepatoprotective Efficacy of a Polyherbal Unani Formulation Majoon-Najah against Cadmium Chloride-induced Liver Damage.

BACKGROUND: Majoon-Najah is a composite Unani formulation that consists of multiple medicinal plants and is advised for neurological illnesses. Several studies were carried out on Majoon-Najah (MN) and its ingredients to evaluate the protective effect against seizure and antidepressant activity in animals using a classical form as well as extract. Terminalia bellerica and Emblica officinalis are the major constituents of MN. Scientifically documented literature summarises the hepatoprotective potential of these constituents. AIM: The current study aimed to evaluate the possible hepatoprotective, antioxidant and antiinflammatory perspective of traditional Indian Unani formulation MN and Majoon-Najah hydroalcoholic extract (MNHE) in a Guinea pig model. METHODS: Thirty adult male albino guinea pigs were randomly assigned into five groups for this study. MN and MNHE were given intragastrically for 15 days, followed by intraperitoneal Cadmium chloride (CdCl2, 3 mg/kg/day) from days 8 to 15, as per the schedule. Blood samples were taken from the heart on the 16th day, and the liver was operated on for biochemical analysis and histopathology under complete anesthesia. RESULTS: CdCl2 changed the levels of liver function markers, serum biochemical indicators like albumin, total protein, glucose, and cholesterol in the blood; lipid peroxidation (MDA), glutathione reductase (GSH), superoxide dismutase (SOD), and glutathione peroxidase (GPX) in hepatic tissue homogenate, pro-inflammatory cytokines level and liver cytoarchitecture. MN and MNHE were found to protect guinea pigs' liver from CdCl2-induced injury by lowering raised parameters and increasing enzymatic antioxidants. MN and MNHE did not significantly heal injured liver tissues caused by CdCl2 in histopathological examinations. CONCLUSION: CdCl2 induces hepatotoxicity that is likely to worsen with increasing dosage and duration of exposure. MN and MNHE exert their hepatoprotective action by scavenging free radicals, decreasing malondialdehyde levels, activating antioxidant enzymes, and down-regulating proinflammatory indicators.

Healing Potential of Propolis Extract-Passiflora edulis Seed Oil Emulgel Against Excisional Wound: Biochemical, Histopathological, and Cytokines Level Evidence.

Propolis is rich in natural bioactive compounds, and considering its importance for many skin therapies, emulgel was prepared. This study examines how a propolis extract (PE) and Passiflora edulis seed (PS) oil emulgel affect rat deep skin wound healing. Based on preset criteria of maximum drug content and optimum drug permeation through the stratum corneum along with drug retention in the skin layers, an optimized emulgel formula based on Box-Behnken factorial design was prepared and used for subsequent in vitro and in vivo evaluations. In vivo wound-healing activities of emulgel and control treatments were investigated in a rat model. The optimized emulgel formula exhibited superior healing activity compared with plain PE suspension-treated rats on day 14 of wounding. Histopathological investigations of hematoxylin and eosin and Masson's Trichrome-stained skin sections supported this effect. Emulgel promotes cutaneous wound healing through a variety of mechanisms, including anti-inflammatory through modulation of cytokines tumor necrosis factor-α, interleukin (IL)-1ß, and IL-6 production, and promotion of collagen fiber formation, all of which contribute to tissue remodeling. Furthermore, when compared with propolis suspension, emulgel showed significant antioxidant and anti-inflammatory effects. Emulgel significantly increased the skin's hydroxyproline level, antioxidant potential, wound contraction, increased penetration, and localized propolis deposition across the skin. Incorporation of PS oil into the emulgel accelerates the tissue regeneration process. The findings suggest that 5% propolis emulgel could be used as an alternative to treat wounds.

Combining cysteine scanning with chemical labeling to map protein-protein interactions and infer bound structure in an intrinsically disordered region.

The Mycobacterium tuberculosis genome harbours nine toxin-antitoxin (TA) systems of the mazEF family. These consist of two proteins, a toxin and an antitoxin, encoded in an operon. While the toxin has a conserved fold, the antitoxins are structurally diverse and the toxin binding region is typically intrinsically disordered before binding. We describe high throughput methodology for accurate mapping of interfacial residues and apply it to three MazEF complexes. The method involves screening one partner protein against a panel of chemically masked single cysteine mutants of its interacting partner, displayed on the surface of yeast cells. Such libraries have much lower diversity than those generated by saturation mutagenesis, simplifying library generation and data analysis. Further, because of the steric bulk of the masking reagent, labeling of virtually all exposed epitope residues should result in loss of binding, and buried residues are inaccessible to the labeling reagent. The binding residues are deciphered by probing the loss of binding to the labeled cognate partner by flow cytometry. Using this methodology, we have identified the interfacial residues for MazEF3, MazEF6 and MazEF9 TA systems of M. tuberculosis. In the case of MazEF9, where a crystal structure was available, there was excellent agreement between our predictions and the crystal structure, superior to those with AlphaFold2. We also report detailed biophysical characterization of the MazEF3 and MazEF9 TA systems and measured the relative affinities between cognate and non-cognate toxin-antitoxin partners in order to probe possible cross-talk between these systems.

Effect of various malocclusion on maximal bite force- a systematic review.

Objective: This systematic review evaluates the variation in molar bite force (MBF) with the type and severity of dental malocclusion in young adults with permanent dentition. Methods: We searched seven electronic databases until December 31, 2021, and identified 1898 articles, of which 22 full-texts were reviewed. Eight clinical studies with subjects having permanent dentition with various dental malocclusions and quantifying maximal bite force were included for the review. Newcastle Ottawa scale was used to assess the risk of bias and GRADE to study the certainty of evidence. Articles were evaluated for the primary outcome (variation of MBF in different malocclusion groups) and confounding factors affecting MBF. Results: All studies measured MBF in individuals with normal and malocclusion, with 2329 subjects having permanent dentition. A positive correlation of Class I normal occlusion with the bite force was seen compared to Class II and III malocclusion. Unilateral crossbite patients had lesser bite force. Six studies with 1023 males and 1175 females showed MBF more in males than females. In 3 studies (332 subjects), no significant difference for MBF between the right and left sides of the jaws was measured. Conclusion: MBF decreases significantly with vertical and transverse craniofacial and dental discrepancy. Normal sagittal occlusion has more molar bite force than patients with different malocclusions. Also, MBF is more in males than females, and it increases with age. Registration: PROSPERO CRD42021249328.

Children's Oncology Group Trial AALL1231: A Phase III Clinical Trial Testing Bortezomib in Newly Diagnosed T-Cell Acute Lymphoblastic Leukemia and Lymphoma.

PURPOSE: To improve the outcomes of patients with T-cell acute lymphoblastic leukemia (T-ALL) and lymphoblastic lymphoma (T-LL), the proteasome inhibitor bortezomib was examined in the Children's Oncology Group phase III clinical trial AALL1231, which also attempted to reduce the use of prophylactic cranial radiation (CRT) in newly diagnosed T-ALL. PATIENTS AND METHODS: Children and young adults with T-ALL/T-LL were randomly assigned to a modified augmented Berlin-Frankfurt-Münster chemotherapy regimen with/without bortezomib during induction and delayed intensification. Multiple modifications were made to the augmented Berlin-Frankfurt-Münster backbone used in the predecessor trial, AALL0434, including using dexamethasone instead of prednisone and adding two extra doses of pegaspargase in an attempt to eliminate CRT in most patients. RESULTS: AALL1231 accrued 824 eligible and evaluable patients from 2014 to 2017. The 4-year event-free survival (EFS) and overall survival (OS) for arm A (no bortezomib) versus arm B (bortezomib) were 80.1% ± 2.3% versus 83.8% ± 2.1% (EFS, P = .131) and 85.7% ± 2.0% versus 88.3% ± 1.8% (OS, P = .085). Patients with T-LL had improved EFS and OS with bortezomib: 4-year EFS (76.5% ± 5.1% v 86.4% ± 4.0%; P = .041); and 4-year OS (78.3% ± 4.9% v 89.5% ± 3.6%; P = .009). No excess toxicity was seen with bortezomib. In AALL0434, 90.8% of patients with T-ALL received CRT. In AALL1231, 9.5% of patients were scheduled to receive CRT. Evaluation of comparable AALL0434 patients who received CRT and AALL1231 patients who did not receive CRT demonstrated no statistical differences in EFS (P = .412) and OS (P = .600). CONCLUSION: Patients with T-LL had significantly improved EFS and OS with bortezomib on the AALL1231 backbone. Systemic therapy intensification allowed elimination of CRT in more than 90% of patients with T-ALL without excess relapse.

An unusual case of tenosynovitis in Hansen's disease.

Tenosynovitis is an infrequent presentation of Hansen's disease. It may occur during the natural course of disease or treatment as part of type 1 reaction or rarely may be the presenting complaint. We report a case of tenosynovitis of bilateral wrist joints who after being ineffectively treated by an orthopedician as well as rheumatologist for several months and was finally diagnosed as a case of Hansen's disease (borderline lepromatous) in type 1 reaction with excellent response to multidrug therapy and tapering doses of systemic steroids.

Human papillomavirus (HPV) vaccine introduction in Sikkim state: Best practices from the first statewide multiple-age cohort HPV vaccine introduction in India-2018-2019.

BACKGROUND: Cervical cancer is a leading cause of cancer-associated mortality among women in India, with 96,922 new cases and 60,078 deaths each year, almost one-fifth of the global burden. In 2018, Sikkim state in India introduced human papillomavirus (HPV) vaccine for 9-13-year-old girls, primarily through school-based vaccination, targeting approximately 25,000 girls. We documented the program's decision-making and implementation processes. METHODS: We conducted a post-introduction evaluation in 2019, concurrent with the second dose campaign, by interviewing key stakeholders (state, district, and local level), reviewing planning documents, and observing cold chain sites in two purposefully-sampled community areas in each of the four districts of Sikkim. Using standard questionnaires, we interviewed health and education officials, school personnel, health workers, community leaders, and age-eligible girls on program decision-making, planning, training, vaccine delivery, logistics, and communication. RESULTS: We conducted 279 interviews and 29 observations in eight community areas across four districts of Sikkim. Based on reported administrative data, Sikkim achieved >95% HPV vaccination coverage among targeted girls for both doses via two campaigns; no severe adverse events were reported. HPV vaccination was well accepted by all stakeholders; minimal refusal was reported. Factors identified for successful vaccine introduction included strong political commitment, statewide mandatory school enrollment, collaboration between health and education departments at all levels, and robust social mobilization strategies. CONCLUSIONS: Sikkim successfully introduced the HPV vaccine to multiple-age cohorts of girls via school-based vaccination, demonstrating a model that could be replicated in other regions in India or similar low- and middle-income country settings.

Successful Ayurvedic Management of Dermatophytosis-A case report.

Fungal infections are quite common in day-to-day practice. The available conventional treatments include various topical and systemic anti-pruritic and anti-fungal agents which are associated with high rates of treatment failure and adverse effects. Fungal infections manifest a great challenge to clinicians due to higher rate of recurrences and if not treated early, can lead to the development of more extensive diseases. In Ayurveda, this condition has resemblance with Dadru kustha. The characteristics of Dadrukustha are circumscribed erythematous, scaly plaques due to dematophytes infection. It is a type of Kshudra kushta, tridosaja vyadhi with dominance of pitta and kaphadosha, having characteristic features such as presence of utsannamandal (elevated circular skin lesion), kandu (itching), raga (erythyma), and pidaka (eruptions). In this case report, a 62-year old male patient suffering from tinea corporis on and off for one year was treated effectively with Ayurvedic medicines. Significant changes were observed in the skin lesion and in the patient symptoms after 42 days of regular treatment. Post-treatment follow-up after 1 month did not reveal any signs of recurrences of lesions. Ayurvedic medicines offer an effective approach to manage tinea corporis.

Early Welsh cervical screening programme learning as a consequence of the coronavirus pandemic.

BACKGROUND: The coronavirus pandemic has had a profound impact on the cervical screening programme in Wales for the eligible women, sample takers, and laboratory and colposcopy services. AIMS: To explore what changes due to the pandemic have adversely affected screening outcomes in Wales and what lessons can be learned to improve cervical screening in Wales and elsewhere. METHODS: A review of the screening performance in 2020 and the first quarter of 2021 in Wales as well as a comparison with other cervical screening programme responses to the pandemic. RESULTS: A 3 month pause of screening together with a change in a variety of working practices, including social distancing, use of personal protective equipment, use of virtual meetings, and home working have been implemented. The combination of a pause to the issuing of invitations, plus reduced services in primary and secondary care, together with population lockdown, have contributed to longer waiting times for colposcopy and potentially delayed cancer diagnoses. Some programme changes which were being evaluated prior to the pandemic could be developed now to mitigate the impact of the pandemic such as improved information, increased screening intervals for human papillomavirus-based screening programmes, and home working for call and recall staff. CONCLUSIONS: Despite a considerable short-term interruption to the cervical screening programme, some changes introduced as a result of the coronavirus pandemic could provide key lessons learnt for improvement for cervical cancer prevention services.

L-cysteine functionalized graphene quantum dots for sub-ppb detection of As (III).

Here, we report functionalized graphene quantum dots (GQDs) for the optical detection of arsenic at room temperature. GQDs with the fluorescence of three fundamental colors (red, green, and blue) were synthesized and functionally capped with L-cysteine (L-cys) to impart selectively towards As (III) by exploiting the affinity of L-cys towards arsenite. The optical characterization of GQDs was carried out using UV-vis absorption spectroscopy, Fourier transform infrared spectroscopy, and fluorescence spectrometry, and the structural characterizations were performed using transmission electron microscopy. The fluorescence results showed instantaneous quenching in intensity when the GQDs came in contact with As (III) for all test concentrations over a range from 0.025 to 25 ppb, which covers the permissible limit of arsenic in drinking water. The experimental results suggested excellent sensitivity and selectivity towards As (III).

Effect of COVID-19 Pandemic on Oncology Residency Training in India and a Novel Online Academic Solution: Results of an Online Survey.

PURPOSE: Coronavirus disease 2019 (COVID-19) has had a global effect on the training of residents of medicine because of what has been required in the pandemic. The field of oncology has not been spared, as prepandemic training schedules have not been available for residents. We conducted an online survey to understand the effect of the pandemic and the effect of online teaching schedules as a measure to help residents of oncology in their training. METHODS AND MATERIALS: An online survey consisting of 31 questions was sent through various social media platforms based on the training pattern before the onset of COVID-19, effect of the pandemic on educational activities, and the effect of online academic activities on residency training and learning. The survey addressed the need for online academics as an alternate mode of teaching. The survey was left open for a period of 4 weeks with participation requests from the various branches of oncology, including radiation, surgical and medical oncology, onco-anesthesia, palliative oncology, neuro-oncology, and so forth. The frequencies obtained in the survey were analyzed using descriptive statistical analyses. RESULTS: After a 4-week period, there were 255 responses received from students of oncology from various specialties. Around 69.8.1% of respondents (n = 178) were junior residents, followed by senior residents (n = 72; 28.2%). The majority of the respondents were radiation oncologists (n = 204; 80%). Around 70.9% had an ongoing structured teaching program related to oncology training, with the majority (40.3%) of them having more than 3 hours every week of oncology-based training. Another 31.3% reported having 1 to 2 hours of such training every week, and 60.8% of participants agreed their training was affected by pandemic and related safety regulations. Most students (90.9%) found the online teaching sessions helped maintain training qualities as they were in the pre-COVID times. About 69.1% of the students felt that the quality of these online sessions was better compared with the institute-based onsite classroom teaching. However, as is expected, 77.6% of them agreed that their hands-on training was affected in the pandemic. When asked if online teaching can replace every aspect of classroom teaching, 66.7% of respondents did not agree. The majority (83.9%) felt that students should be given the opportunity to present a given topic under the supervision of a senior faculty member experienced and expert in that topic. The students pointed out the lack of practical exposure as the most common deficiency, followed by the lack of direct interaction with the teaching faculty. CONCLUSIONS: The pandemic has limited the access to essential training in the branches of oncology, and though online sessions cannot replace the hands-on training and clinical exposure needed for the students, online academics and webinars have proven to be an effective tool to minimize that effect and can lead to a positive outcome, as shown by the survey. A combination of online and onsite training modules may be the future of teaching and training in our country.

Efficacy of transcutaneous bilirubinometry as compared to serum bilirubin in preterm newborn during phototherapy.

Transcutaneous measurement of bilirubin is being used for neonatal jaundice. Its utility during phototherapy in preterm babies is not established. The objective of our study was to assess the efficacy of transcutaneous bilirubin (TcB) measurement in comparison to total serum bilirubin in preterm newborns at admission and during phototherapy at the covered skin area (glabella). It was a prospective observational study and conducted at the neonatal intensive care unit of a tertiary care hospital from January 2017 to January 2019. One hundred eligible preterm neonates were enrolled. Babies who were very sick, with poor peripheral circulation, edematous, having conjugated hyperbilirubinemia, with major congenital malformations, already received phototherapy or exchange transfusion were excluded. Paired total serum bilirubin and transcutaneous bilirubin were measured at admission and 6 h and 24 h during phototherapy. TcB was measured from the area (glabella) covered by an eye protector during phototherapy. The sample for TsB was taken within 10 min of TcB measurement. The mean differences between TsB and TcB values at admission and 6 h and 24 h of phototherapy were - 0.005 (0.353) mg/dl, - 0.350 (0.611) mg/dl, and - 0.592 (0.353) mg/dl, respectively. At admission or before starting of phototherapy, the difference (TsB-TcB) was statistically not significant (p = .125), while the difference in these values was statistically significant at 6 h and 24 h of phototherapy.Conclusion: TcB measurements from the covered skin area in jaundiced preterm infants during phototherapy were not correlated with TsB and cannot be used as an alternate of serum bilirubin testing. What is known • HPLC bilirubin measurement is a gold standard test for bilirubin measurement but impractical for day to day use. Serum total bilirubin is used for clinical testing.. • There is evidence for use of transcutaneous bilirubinometry for assessment of bilirubin in term newborn. What is new • TcB measurements from a covered skin area in jaundiced preterm newborns under phototherapy were not correlated significantly at 6 h and 24 h of phototherapy, but correlated before phototherapy. • TcB cannot be used as an alternate of serum bilirubin testing in preterm infants during phototherapy.

Unique photoluminescence response of MoS2quantum dots over a wide range of As (III) in aqueous media.

We report the solvothermal synthesis of MoS2based quantum dots (QDs) and the performance evaluation of bare QDs for the detection of aqueous As (III) oxidative state at room temperature and neutral pH over a vast range (0.1-1000 ppb). Concentration-dependent photoluminescence (PL) of the QDs enhances up to 50 ppb and then suppresses till 1000 ppb. It shows two distinctive slopes for enhancement and suppression. The enhancement is possibly due to the passivation of trap states or defects. The formation of tiny glassy As2S3particles on the QD surface may be the possible reason for suppression. The pattern of optical absorption of QDs follows the similar patterns of PL. Still, it shows an enhanced absorbance in the near UV range below ≤300 nm, which increases with As (III) concentration up to 50 ppb and then decreases following the PL pattern. The MoS2QDs were characterized by using transmission electron microscopy, x-ray diffraction, UV-Vis, and PL spectroscopy. The enhancement and suppression results were excellently fitted with the modified Stern-Volmer equation. The detection of arsenic is possible using these linear fit equations as calibration curves.

Incapacity in childbirth - Rare or common?

OBJECTIVE: Impaired decision making ability is common on general medical wards. Audit evidence suggests that the prevalence of incapacity may be higher than previously assumed in Obstetric Emergency Procedures (OEP) during childbirth. We investigated the prevalence of incapacity in OEP and factors associated with this. DESIGN: Capacity to consent to treatment was assessed retrospectively in 93 women undergoing OEP. All women were interviewed using a semi-structured questionnaire aided interview within 24 h of the emergency. Five assessors (3 obstetricians and 2 psychiatrists) were asked to determine capacity to consent from audio recordings of the interviews. RESULTS: All 5 assessors determined 59 % of women to have capacity to consent to treatment and 2 % of women to lack capacity. In 39 % of women there was some disagreement between assessors. Using a majority decision (3 assessors in agreement), 14 % of women lacked capacity. High pain scores, young age and no previous history of theatre deliveries were associated with more incapacity judgments, whilst parity and history of mental illness were not. Using a 7point Likert scale only marginally improved agreement between assessors, compared to their binary decision. CONCLUSION: It is often assumed that it is rare to lack capacity in an obstetric emergency procedure during childbirth, but these data suggest that incapacity may be relatively common. In particular, severe pain is a demonstrable risk factor for impaired capacity. Wide variation between assessors questions the validity of current commonly employed (informal) methods used in clinical practice to assess capacity to consent during OEP.