Efficacy of Infraclavicular Brachial Plexus Block Alone Versus Combination With Suprascapular Nerve Block in Patients Undergoing Shoulder Surgeries: A Single-Blind, Randomized Trial.

Background and aim The regional anesthesia technique is commonly used for upper extremity surgery as an alternative to general anesthesia. The study aimed to compare the efficacy of infraclavicular brachial plexus block (BPB) and a combination of infraclavicular brachial plexus block with suprascapular nerve block for postoperative analgesia in patients undergoing shoulder surgeries. Method A total of 62 patients of both sexes with the American Society of Anaesthesiologists (ASA) physical status I/II/III, aged between 18 and 65 years, and undergoing shoulder surgery, were included in this prospective, single-blinded, randomized controlled trial. Patients were equally allocated into two groups: 31 in group A and 31 in group B. After pre-anesthetic evaluation, the purpose and protocol of the study were explained to patients, and informed consent was obtained. Thirty-one patients in group A were given infraclavicular brachial plexus block using 30 ml 0.375% bupivacaine while 31 patients in group B were given a combination of infraclavicular brachial plexus block using 30 ml 0.375% bupivacaine and suprascapular nerve block using 5 ml 0.375% bupivacaine. Blocks were given using ultrasound guidance and a peripheral nerve stimulator; the suprascapular block was given in the sitting position while the infraclavicular block was provided in the supine position. General anesthesia was administered in the operation theatre in the supine position after the administration of blocks. The pain was assessed using the visual analog scale (VAS) and the satisfaction score was assessed by the numeric rating scale (NRS). The Mann-Whitney U test was applied for comparison of pain between the two groups. The chi-square test was utilized for comparing the categorical variables. Result The postoperative pain was significantly lower (p<0.001) in group B as compared to group A at all the periods of observation, i.e., 0h (2.77±0.72 vs. 5.42±0.77), 6h (3.89±0.70 vs. 5.94±0.73), 12h (5.66±0.93 vs. 6.58±0.88), and 24h (6.16±0.80 vs. 6.74±0.90). These findings illustrate that group B patients who received a combination of infraclavicular brachial plexus block and suprascapular nerve block for shoulder surgeries had better pain relief than group A patients who received only the infraclavicular approach. The mean NRS score of patient satisfaction in group B (7.26±0.58) was significantly higher (p<0.001) in comparison to group A (6.16±0.64). Diaphragmatic palsy was observed in only one case in group A and none in group B. No other complication was observed in any of the patients during the study period. Conclusion The combination of infraclavicular brachial plexus block and suprascapular nerve block displays a positive postoperative analgesic profile with less usage of rescue analgesic doses and better patient satisfaction after shoulder surgery.

Redefining bio medical waste management during COVID- 19 in india: A way forward.

India is ranked 120 among 165 nations with respect to sustainable development and critically suffers from insufficient waste treatment provisions and amenities. And the abrupt occurrence of the COVID-19 virus has aggravated the issue of managing of medical waste in India, manifolds. As a result, the safe disposal of a huge volume of hazardous medical waste has become a top priority. This conceptual study evaluates India's management of medical waste during the COVID-19 pandemic. Additionally, this article aims to highlight the inadequacies in India's implementation of the BMW 2016 standards by a synthesis of multiple agency reports (government and non-government) and data obtained directly from the Central Pollution Control Board (CPCB). The findings indicate that India is well behind in terms of COVID-19 waste management and requires comprehensive monitoring and implementation systems to enable the achievement of SDGs related to environmental health.

Identification and the potential involvement of miRNAs in the regulation of artemisinin biosynthesis in A. annua.

Micro RNAs (miRNAs) play crucial regulatory roles in multiple biological processes. Recently they have garnered the attention for their strong influence on the secondary metabolite production in plants. Their role in the regulation of artemisinin (ART) biosynthesis is, however, not fully elucidated. ART is a potent anti-malarial compound recommended by WHO for the treatment of drug-resistant malaria. It is produced by Artemisia annua (A. annua). The lower in planta content of ART necessitates a deep understanding of regulatory mechanisms involved in the biosynthesis of this metabolite. In this study, using modern high throughput small RNA-sequencing by Illumina Nextseq 500 platform for identification and stem-loop RT PCR for validation, miRNAs were identified in the leaf sample of A. annua plant. Here, we report a total of 121 miRNAs from A. annua that target several important genes and transcription factors involved in the biosynthesis of ART. This study revealed the presence of some important conserved miRNA families, miR396, miR319, miR399, miR858, miR5083 and miR6111 not identified so far in A. annua. The expression patterns and correlation between miRNAs and their corresponding targets at different developmental stages of the plant using real-time PCR indicate that they may influence ART accumulation. These findings thus, open new possibilities for the rational engineering of the secondary metabolite pathways in general and ART biosynthesis in particular.

Happiness among second year MBBS students and its correlates using Oxford Happiness Questionnaire.

OBJECTIVES: Inner happiness and the ability to fully receive joy is the utmost necessity to be healthy, to mature in professional life and eventually serving the mankind. Medical students are less ecstatic compared to other students in university because of concrete inculcation and work conditions. The aim of the present study was to evaluate happiness among medical students& its correlates. MATERIALS AND METHODOLOGY: The study was conducted among 115 medical students of MBBS (2nd year) of Subharti Medical College, Meerut. The information was gathered by using the Oxford Happiness Questionnaire which was distributed among the MBBS second year students present during the study at Subharti Medical College, Meerut. Descriptive statistics and chi-square test were used for the analysis. RESULTS: The happiness distribution in regards to baseline characteristic showed that 60.8% of the selected medical students were in happy group. It was found that male students (51.4%) were happier than females (48.6%). It was seen that 85.7% of medical students who were happy, had never consumed drugs and this association was found to be statistically significant. It was observed that comparatively younger siblings were happier. Those who believed in higher power or universal consciousness were found to be more contented and happier. CONCLUSION: Overall the medical students were found to be happy. To make a conducive environment for internal happiness, a belief in superpower was very helpful. All kind of drugs (alcohol and tobacco) should be discouraged as these may cause a temporary feeling of elation but not internal happiness.

MINDY1 Is a Downstream Target of the Polyamines and Promotes Embryonic Stem Cell Self-Renewal.

Embryonic stem cells have the ability to self-renew or differentiate and these processes are under tight control. We previously reported that the polyamine regulator AMD1 is critical for embryonic stem cell self-renewal. The polyamines putrescine, spermidine, and spermine are essential organic cations that play a role in a wide array of cellular processes. Here, we explore the essential role of the polyamines in the promotion of self-renewal and identify a new stem cell regulator that acts downstream of the polyamines: MINDY1. MINDY1 protein levels are high in embryonic stem cells (ESCs) and are dependent on high polyamine levels. Overexpression of MINDY1 can promote ESC self-renewal in the absence of the usually essential cytokine Leukemia Inhibitory Factor (LIF). MINDY1 protein is prenylated and this modification is required for its ability to promote self-renewal. We go on to show that Mindy1 RNA is targeted for repression by mir-710 during Neural Precursor cell differentiation. Taken together, these data demonstrate that high polyamine levels are required for ESC self-renewal and that they function, in part, through promotion of high MINDY1 levels. Stem Cells 2018;36:1170-1178.

Comparative study of withanolide production and the related transcriptional responses of biosynthetic genes in fungi elicited cell suspension culture of Withania somnifera in shake flask and bioreactor.

Ashwagandha (Withania somnifera) is one of the most reputed medicinal plants in the traditional medicinal system. In this study, cell suspension culture of W. somnifera was elicited with cell homogenates of fungi (A. alternata, F. solani, V. dahliae and P. indica) in shake flask and the major withanolides like withanolide A, withaferin A and withanone were analysed. Simultaneously expression levels of key pathway genes from withanolides biosynthetic pathways were also checked via quantitative PCR in shake flask as well as in bioreactor. The results show that highest gene expression of 10.8, 5.8, 4.9, and 3.3 folds were observed with HMGR among all the expressed genes in cell suspension cultures with cell homogenates of 3% P. indica, 5% V. dahliae, 3% A. alternata and 3% F. solani, respectively, in comparison to the control in shake flask. Optimized concentration of cell homogenate of P. indica (3% v/v) was added to the growing culture in 5.0-l bioreactor under optimized up-scaling conditions and harvested after 22 days. The genes of MVA, MEP and withanolides biosynthetic pathways like HMGR, SS, SE, CAS, FPPS, DXR and DXS were up-regulated by 12.5, 4.9, 2.18, 4.65, 2.34, 1.89 and 1.4 folds, respectively in bioreactor. The enhancement of biomass (1.13 fold) and withanolides [withanolide A (1.7), withaferin A (1.5), and withanone (1.5) folds] in bioreactor in comparison to shake flask was also found to be in line with the up-regulation of genes of withanolide biosynthetic pathways.

Dual symbiosis between Piriformospora indica and Azotobacter chroococcum enhances the artemisinin content in Artemisia annua L.

At present, Artemisia annua L. is the major source of artemisinin production. To control the outbreaks of malaria, artemisinin combination therapies (ACTs) are recommended, and hence an ample amount of artemisinin is required for ACTs manufacture to save millions of lives. The low yield of this antimalarial drug in A. annua L. plants (0.01-1.1%) ensues its short supply and high cost, thus making it a topic of scrutiny worldwide. In this study, the effects of root endophyte, Piriformospora indica strain DSM 11827 and nitrogen fixing bacterium, Azotobacter chroococcum strain W-5, either singly and/or in combination for artemisinin production in A. annua L. plants have been studied under poly house conditions. The plant growth was monitored by measuring parameters like height of plant, total dry weight and leaf yield with an increase of 63.51, 52.61 and 79.70% respectively, for treatment with dual biological consortium, as compared to that of control plants. This significant improvement in biomass was associated with higher total chlorophyll content (59.29%) and enhanced nutrition (especially nitrogen and phosphorus, 55.75 and 86.21% respectively). The concentration of artemisinin along with expression patterns of artemisinin biosynthesis genes were appreciably higher in dual treatment, which showed positive correlation. The study suggested the potential use of the consortium P. indica strain DSM 11827 and A. chroococcum strain W-5 in A. annua L. plants for increased overall productivity and sustainable agriculture.

Oral health status and awareness among tuberculosis patients in an Indian population.

BACKGROUND: Knowledge and awareness regarding oral health problems of tuberculosis patients are lacking among patients, physicians, as well as dental practitioners. AIM: This study aimed to assess the oral health status and awareness among the tuberculosis patients in an Indian population. METHODS: Study sample comprised of 210 tuberculosis patients and 210 nontuberculosis subjects. The tuberculosis patients were categorized into new patients (group A), previously treated (group B), and drug-resistant tuberculosis patients (group C). History of present problem and awareness about oral health was noted. Periodontal health status was ascertained using Community Periodontal Index (CPI). Other oral findings were also recorded. RESULTS: The results were analyzed statistically. 62.9% of total tuberculosis patients had one or more oral problems. Most common problem was tooth pain (34%). CPI score was significantly higher (p<0.05) for tuberculosis patients (2.94) than in control group (1.34). Mean CPI score for groups A, B, and C patients was 2.83, 2.91, and 3.09, respectively. CONCLUSION: This study suggests awareness of oral health status and oral manifestations of tuberculosis among physicians and dental professionals.

Expression of P-glycoprotein in human retinoblastoma and its clinical significance.

Retinoblastoma is the most common malignant intraocular tumor of childhood. Drug resistance and relapses are major problems with chemotherapy, which is regarded as the mainstay of globe preserving treatment in retinoblastoma. P-glycoprotein (P-gp) expression has been reported to be associated with chemoresistance and poor prognosis in various malignancies. We analyzed P-gp expression in retinoblastoma specimens, enucleated either primarily or after neoadjuvant chemotherapy by immunohistochemistry and immunoblotting, and correlated with the histopathological findings. Variables were statistically analyzed by Fischer's exact and chi-square tests. Tumor tissues were collected from enucleated eyes of 24 children. Fifteen of these were primarily enucleated (group I), and nine (group II) had received chemotherapy prior to enucleation. P-gp was expressed in 4/15 (26.7 %) eyes in group I and in 5/9 (55.6 %) eyes in group II. P-gp was highly expressed in group II as compared to group I. There was no correlation between P-gp expression and tumor differentiation, invasion, or laterality. In conclusion, there was markedly high expression of P-gp in eyes with retinoblastoma enucleated after chemotherapy. This may possibly play a role in chemoresistance or it may be that chemotherapy might have induced high expression. These findings may have important implications for the treatment of retinoblastoma patients but need further prospective investigations in a larger patient population.

Differential expression of genes in retinoblastoma.

Retinoblastoma is a pediatric eye tumor that serves as a paradigm for understanding the genetic basis of cancer. Mutations and/or epigenetic alterations inactivating both alleles of the retinoblastoma gene (RB) are associated with retinoblastoma. There are many other genes which express differentially in the preneoplastic retinal cells after RB loss, as cells progress to form tumors. These genetic changes and the pathways involved can provide valuable insight into the development and progression of this cancer. Conventional molecular and genetic methods for studying cancer are limited to the analysis of one locus at a time. A cluster of genes that are regulated together can be identified by DNA microarray, and the functional relationships can uncover new aspects of cancer biology. Meta analysis is an important tool for the identification and validation of differentially expressed genes to increase power in clinical and biological studies across different sets of data. Recently, meta analysis approaches have been applied to large collections of microarray datasets to investigate molecular commonalities of multiple cancer types not only to find the common molecular pathways in tumor development but also to compare the individual datasets to other cancer datasets to identify new sets of genes. The outcome of these analyses might accelerate the application of basic research findings into daily clinical practice through translational research and may have an impact on foreseeing the clinical outcome, predicting tumor response to specific therapy, identification of new prognostic biomarkers, discovering targets for the development of novel therapies and providing further insights. These and related research efforts reveal novel data that enhance our understanding of the biology of retinoblastoma. These observations may facilitate new therapeutic approaches to further decrease the morbidity and mortality associated with retinoblastoma and other more common forms of cancer.

WITHDRAWN: Transforming growth factor-ß2 levels in the aqueous humor of patients with primary open angle glaucoma and primary angle closure glaucoma.

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Ocular angiogenesis: mechanisms and recent advances in therapy.

Ocular angiogenesis, the formation of new blood vessels from the existing vascular tree, is an important cause for severe loss of vision. It can occur in a spectrum of ocular disorders such as age-related macular degeneration (AMD), diabetic retinopathy, retinal artery or vein occlusion, and retinopathy of prematurity (ROP). One of the underlying causes of vision loss in proliferative retinal diseases is the increased vascular permeability leading to retinal edema, vascular fragility resulting in hemorrhage, or fibrovascular proliferation with tractional and rhegmatogenous retinal detachment. Pro- and antiangiogenic factors regulate an "angiogenic switch," which when turned on, leads to the pathogenesis of the above ocular diseases. Although neovascularization tends to occur at a relatively late stage in the course of many ocular disorders, it is an attractive target for therapeutic intervention, since it represents a final common pathway in processes that are multifactorial in etiology and is the event that typically leads directly to visual loss. Identification of these angiogenesis regulators has enabled the development of novel therapeutic approaches. In this light, antibodies directed against common markers of neovasculature, expressed in different diseases, may open up a very general and widely applicable approach for diagnostic and therapeutic interventions. Local gene transfer, that is, the intraocular delivery of recombinant viruses carrying genes encoding angiostatic proteins and small interfering RNA (siRNA) against vascular endothelial growth factor (VEGF) and VEGF receptors, offers the possibility of targeted, sustained, and regulatable delivery of angiostatic proteins and other angiogenic regulators to the retina. Recent progress has enabled the planning of clinical trials of gene therapy for ocular neovascularization.