Impact of Shutdown due to COVID-19 Pandemic on Aerosol Characteristics in Kanpur, India.

BACKGROUND: Since March 2020, the number of confirmed COVID-19 positive cases have steadily risen in India. Various preventive measures have been taken to contain the spread of COVID-19. With restrictions on human activities, anthropogenic emissions driving air pollution levels have seen a reduction since March 23, 2020, when the government imposed the first nationwide shutdown. The landlocked Indo-Gangetic Plain (IGP) has many densely-populated cities, witnessing high levels of particulate matter due to both nature-driven and anthropogenic elements. Kanpur is an urban metropolis in the IGP with high aerosol loading, and this paper explores the impact of restricted anthropogenic activities on aerosol characteristics in Kanpur. OBJECTIVES: This study aims to investigate the change in aerosol optical depth level and its related parameters during the shutdown phases in Kanpur city compared to the same time periods in 2017-2019. METHODS: Aerosol optical properties such as aerosol optical depth (AOD) at 500 nm, Angstrom exponent (AE), fine mode fraction (FMF) of AOD at 500 nm and single scattering albedo (SSA) at 440 nm were obtained from the Aerosol Robotic Network (AERONET) station operating in Kanpur from the 1st March to the 30th April for 2017-2020. RESULTS: A significant decrease in aerosol loading was observed during the shutdown period compared to the pre-and partial shutdown periods in 2020 as well as during the same time periods of 2017-2019. Mean AOD, FMF and SSA were 0.37, 0.43 and 0.89, respectively, during the shutdown period in 2020. A 20-35% reduction in mean AOD levels was observed during the shutdown period in 2020 as compared to the same period in 2017-2019. CONCLUSIONS: The shutdown led to an improvement in air quality due to decreases in anthropogenic emissions. As fine particles, typically from urban and industrial emissions, dominate episodic air pollution events, this study can be further utilized by the scientific community and regulators to strengthen the emergency response action plan to check high pollution episodes in Kanpur city until cleaner technologies are in place. COMPETING INTERESTS: The authors declare no completing financial interests.

Air quality forecasting using artificial neural networks with real time dynamic error correction in highly polluted regions.

Air pollution is an important issue, especially in megacities across the world. There are emission sources within and also in the regions around these cities, which cause fluctuations in air quality based on prevailing meteorological conditions. Short term air quality forecasting is used not to just possibly mitigate forthcoming high air pollution episodes, but also to plan for reduced exposures of residents. In this study, a model using Artificial Neural Networks (ANN) has been developed to forecast pollutant concentration of PM10, PM2.5, NO2, and O3 for the current day and subsequent 4 days in a highly polluted region (32 different locations in Delhi). The model has been trained using meteorological parameters and hourly pollution concentration data for the year 2018 and then used for generating air quality forecasts in real-time. It has also been equipped with Real Time Correction (RTC), to improve the quality of the forecasts by dynamically adjusting the forecasts based on the model performance during the past few days. The model without RTC performs decently, but with RTC the errors are further reduced in forecasted values. The utility of the model has been demonstrated in real-time and model validations were performed for the whole year of 2018 and also independently for 2019. The model shows very good performance for all the pollutants on several evaluation metrics. Coefficient of correlations for various pollutants varies from 0.79-0.88 to 0.49-0.68 between the Day0 to Day4 forecasts. Lowest deterioration of performance was observed for ozone over the four days of forecasts. Use of RTC further improves the model performance for all pollutants.

Long-term fertilization and manuring with different organics alter stability of carbon in colloidal organo-mineral fraction in soils of varying clay mineralogy.

Majority of organic matter is bound to clay minerals to form stable colloidal organo-mineral fraction (COMF) in soil. Stability of carbon (C) in COMF is crucial for long-term C sequestration in soil. However, information on the effect of long-term fertilization and manuring with various organic sources on C stability in such fraction in soils with varying clay mineralogy is scarce. The present study was, therefore, carried out to assess the effect of thirty-one years of continuous fertilization and manuring with different organics on C-stability in COMF extracted from an Inceptisol, a Vertisol, a Mollisol, and an Alfisol. The treatments comprised of control (no fertilization), 100% NPK (100% of recommended N, P and K through fertilizer), 50% NPK+ 50% of recommended N supplied through either farm yard manure (FYM) or cereal residue (CR) or green manure (GM). The stability of C (1/k) in COMF was determined from desorption rate constant (k) of humus-C by sequential extraction and correlated with extractable amorphous Fe-Al-Si-oxides, and crystallite size of illite minerals. Long-term fertilization and manuring with the above sources of organic altered the contents of amorphous Fe-Al-Si-oxides, and decreased the crystallite size of illite in all the soil orders. Fifty percent substitution of fertilizer N by various organics significantly increased C-stability in COMF by 27-221% (mean 111%) over full dose of NPK (100% NPK). Smectite dominating Vertisol exhibited highest stability of C followed by the Mollisol, the Inceptisol and the Alfisol. Stability of such C in soil was correlated positively with the amount of amorphous Fe and Al oxides but negatively with crystallite size of illite (r = -0.46, P < 0.01). Application of NPK + GM or NPK + FYM in Inceptisol, Vertisol and Mollisol and NPK + GM or NPK + CR in Alfisol emerged as the best management practices for higher stabilization of C in COMF for long-term C sequestration.

Expression Analysis of Survivin and XIAP in Gallbladder Cancer: a Case-control Study in Indo-Gangetic Plain.

PURPOSE: Gallbladder cancer is a highly mortal disease with poor prognosis because of late presentation of disease. Survivin and X-linked inhibitor of apoptosis (XIAP) are one of the two important members of inhibitors of apoptosis. Thus, this study aimed to look at the expression of Survivin and XIAP in gallbladder cancer patients. METHODS: Survivin and XIAP expression were investigated in tissues of gallbladder cancer patients (40 cases) and compared with cholelithiasis as control (40 cases) by using immunohistochemistry. Their expression was correlated with clinicopathological parameters. RESULTS: Significantly higher (p < 0.05), Survivin protein was expressed in gallbladder cancer (n = 67.5%) than control (n = 35%). But it did not show any significant association with any of the clinicopathological parameter while XIAP was not expressed in the GBC patients (p > 0.05). CONCLUSION: Overexpression of Survivin in gallbladder cancer suggests its possible role and association with poor prognosis. But XIAP has not been found to be associated with gallbladder carcinogenesis.

Congenital thyroid hemiagenesis with thyroid nodules-Role of TI-RADS to prevent long term thyroid replacement therapy.

BACKGROUND: Hemi-agenesis of thyroid is a rare congenital condition with the clinical significance lying only in cases where the remnant tissue is affected by a pathology mandating removal of the gland. Henceforth, the hemi-thyroidectomy technically becomes a total thyroidectomy with a need for long term thyroid replacement therapy. CASE SUMMARY: We present a series of three cases noted over a period of two years where preoperative imaging evaluation confirmed the developmental abnormality. Further presence of a thyroid nodule in each of these cases posed a specific clinical situation whereby characterization of nodule appeared mandatory for a rational management involving life-long thyroid replacement therapy due to an 'apparent total thyroidectomy', if the remnant gland is removed. Ultrasound TI-RADS is a new system for evidence based sub-classification of thyroid nodules enabling both the surgeon and patient to take a streamlined decision about the overall approach for management. CONCLUSION: Prospective nodule characterization based on the thyroid image reporting and data system (TI-RADS), enables the surgeon to decide the treatment strategy sparing the patient of the cost and morbidity associated with long term thyroid replacement therapy.

The longest tumor diameter in one dimension as a predictor for skeletal metastasis in renal cell carcinoma.

INTRODUCTION: Renal cell carcinoma (RCC) comprises a diverse group of malignant neoplasms that have multifarious histopathological features and biological behavior. One-third of RCC patients develops skeletal metastasis with a poor 5-year survival rate. Data explaining how some of these tumors show sooner bony metastasis than expected is sparse. The objective of this study was to identify whether tumor size can act as a predictor of bony metastases among patients of RCC. MATERIALS AND METHODS: We retrospectively reviewed contrast enhanced computed tomography (CECT) scan and clinical records of 66 patients with RCC, who fulfilled specified inclusion criteria. Patients who had bony metastasis at the time of presentation were selected as case and those without skeletal metastasis were referred to as controls. Receiver operating characteristic (ROC) curve analysis was used to determine the appropriate cut-off value for tumor size, which was measured as the longest tumor diameter (LTD) in one-dimensional (1D). RESULTS: Of the 66 patients selected, 30% developed bone metastasis. The tumor size of RCCs significantly correlated with the presence of skeletal metastasis in our study. None of the patients with 1D LTD <4.8 cm on CECT were found to have skeletal metastasis. ROC analysis revealed that the accuracy of the LTD in predicting bone metastasis was high with an area under ROC curve of 0.823. A cut-off value of 7.5 cm had a sensitivity of 78.9% and specificity of 80.9%. CONCLUSION: The 1D LTD with a cut-off value of 7.5 cm, at the time of presentation is an important predictor of skeletal metastasis. The result of this study may have role in triage of patients into a subgroup which mandates more aggressive treatment and monitoring.

Adrenal tumors: An experience of 10 years in a single surgical unit.

INTRODUCTION: Most of the adrenal masses are discovered incidentally by imaging techniques for reasons unrelated to adrenal diseases. Treatment is based on various factors such as, nature of adrenal mass, age of presentation, size of tumor, and the functional status of tumor. We report a series of 14 consecutive cases of adrenal tumors treated in a single surgical unit in our hospital. AIM: The aim of this study was to evaluate the clinical profile and outcome of treatment of adrenal tumors treated in a surgical unit. MATERIALS AND METHODS: It is a retrospective study data of 14 cases of adrenal tumors treated in a single surgical unit in University Hospital over 10 years have been analyzed. Various parameters such as gender, age, size of tumor, functional status, histopathology, type of management, and outcome have been reviewed. RESULTS: A total of 14 patients with adrenal masses were seen over a 10 year period (1997-2006). All were referred cases, either from endocrinology or medicine wards. There were seven female and seven male patients. Mean age of patients was 48.6 years (range 14-60 years). Mean size of tumor was 8.0 cm (5.9 cm for benign tumors and 9.7 cm for malignant tumors). There were six cases of adrenal carcinoma, four cases of adrenal myelolipoma, two cases of pheochromocytoma, and one each case of adrenal hyperplasia and histoplasmosis. There were only two functional tumors. All, except two malignant cases were treated operatively. A total of 5 year survival was 100% in benign cases and 27% in malignant tumors. CONCLUSION: Adrenal tumors need to be assessed for their functional status and malignant potential prior to treatment. Surgical excision is usually curative for benign lesion. Among malignant tumors the benefits of surgery depend on local extent and metastatic status of tumors.

Sphincter of Oddi disorder (SOD): Is it necessary to investigate and treat?

Sphincter of Oddi disorder (SOD) is a part of functional gastrointestinal disorder which is a non-calculous obstructive disorder. This disease is more common in middle-aged women with a prevalence of around 1.5% but in patients with post-cholecystectomy syndrome (PCS) the prevalence rate is markedly higher (9-55%). This high variability maybe attributed to lack of uniformity in patient selection criteria, definition of SOD, and the diagnostic method used. Abdominal pain is the most common symptom occurring due to obstruction at the SO leading to ductal hypertension, ischemia from spastic contraction and hypersensitivity of papilla. Clinical diagnosis of SOD can be achieved by Rome III criteria. Various classifications are used (Milwaukee billiary and modified Milwaukee group classification) for billiary and pancreatic SOD. Not a single non-invasive method is diagnostic. Sphincter of Oddimanometry (SOM) is the gold standard method for evaluating and deciding the management of an SOD patient. The symptomatic relief rate varies from 55% to 95%, so risk-benefit ratio should be evaluated with each patient.

FT-IR, FT-Raman and UV spectroscopic investigation, electronic properties, electric moments, and NBO analysis of anethole using quantum chemical calculations.

FT-IR and FT-Raman spectra of anethole (1-Methoxy-4-(1-propenyl)benzene), a flavoring agent of commercial value, have been recorded in the regions 4000-400 and 4000-100cm(-1) respectively. The structure of the title molecule has been optimized and the structural parameters have been calculated by DFT/B3LYP method with 6-311++G(d,p) basis set. The fundamental vibrational wavenumbers as well as their intensities were calculated and a good agreement between observed and scaled calculated wavenumbers has been achieved. UV-Vis spectrum of the title compound was recorded in the region 200-500nm and the electronic properties such as HOMO and LUMO energies and associated energy gap were calculated by Time dependent-density functional theory (TD-DFT) approach. Nonlinear optical (NLO) study divulges the nonlinear properties of the molecule. Stability of the title molecule arising from hyper-conjugative interactions and charge delocalization has been investigated using natural bond orbital (NBO) analysis. The theoretical results were found to be in coherence with the measured experimental data.

Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study.

Acute kidney injury (AKI) is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI) in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years) of either gender who developed AKI based on RIFLE criteria (using serum creatinine), 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively (P < 0.0001). There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward (P = 0.001). RIFLE-R was the most common AKI in medical (39.2%) and ICU (50%) wards but in the surgical ward, it was RIFLE-F that was most common (52.6%). Acute tubular necrosis was more common in ICU (P = 0.043). Most common etiology of HAAKI in medical unit was drug induced (39.2%), whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively). Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively (P = 0.003). Length of hospital stay in surgical, ICU and medical units were different (P = 0.007). This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.

Biological behavior and disease pattern of carcinoma gallbladder shown on 64-slice CT scanner: a hospital-based retrospective observational study and our experience.

PURPOSE: The aim of this diagnostic observational study was to assess the spread and biological behavior of gallbladder cancer using 64-slice computerized tomography (CT) scanner in this particular geographic belt (eastern Uttar Pradesh, western Bihar, and northern Madhya Pradesh provinces of North India). Indians are ethnically and culturally different from their Western counterparts among whom the incidence of this disease is comparatively low. SUBJECTS AND METHODS: After systemic examination, all patients (87) were subjected to ultrasonographic examination. All cases were histopathologically proven. Confirmed cases were subjected to volumetric CT examination of abdomen and pelvis, plain, post contrast and delayed phase. RESULTS: Majority of the cases were adenocarcinoma. There was female preponderance with majority belonging to fifth and sixth decades. Commonest presentation was diffuse, irregular, enhancing wall thickening in 49.4%. Majority had invasion of liver parenchyma (74.7%). Cholelithiasis was seen in 48.3% cases. Invasion of biliary radicals was high (13.8-18.4%). Eleven cases had invasion of portal vein and tumor thrombus, with hepatic artery invasion in one case. In two cases, both hepatic artery and portal vein invasion was seen. Portal and peripancreatic nodal metastasis was seen in 58.5%. Distant metastasis was reported. CONCLUSION: Few studies involving the Indian population have attempted to use multi-row detector CT to define the biological behavior of carcinoma gallbladder. The opinion whether the pathology is operable or non-operable can reasonably be given. This large-scale, single-center study gives insight about the epidemiology and biological behavior of carcinoma gallbladder.

Chromosomal structural analysis in carcinoma of the gallbladder.

BACKGROUND: The etiopathogenesis of gallbladder cancer is still unknown. Both environmental and patient factors have been incriminated in its cause. That it is found in pockets of epidemiological distribution raises an issue of genetic changes associated with it. The aim of this study was to find out the chromosomal changes in gallbladder cancer. METHODS: Lymphocyte cell culture was carried out on blood of gallbladder cancer patients to determine chromosomal banding abnormalities. Native PAGE was also evaluated to analyze lactate dehydrogenase (LDH), superoxide dismutase (SOD) and catalase enzyme activity from the same blood of gallbladder cancer patients. RESULTS: Out of 30 gallbladder cancer patients, 4 male showed breakage on the long arm of chromosome 1 while only one male patient showed the translocation from the long arm of chromosome 4 to the long arm of chromosome 6 in a male patient. CONCLUSION: The aberrations found in our study may suggest underlying genetic predisposition for the development of gallbladder cancer. They can act as a marker for gallbladder cancer, which needs further study.

Study of AP endonuclease (APEX1/REF1), a DNA repair enzyme, in gallbladder carcinoma.

AIM: This study investigated the levels of Apurinic/Apyrimidinic Endonuclease (APEX1) in gallbladder carcinoma (CaGB) tissue and co-related these levels with various clinicopathological parameters. PATIENTS AND METHODS: Twenty cases of CaGB and cholelithiasis were included in the study. Western blot analysis of APEX1 protein was performed using actin as the reference point. Densitometric analysis and the integrated density value (IDV) of APEX1 protein samples were determined. The ratio of IDV of APEX1/actin was determined. RESULTS: The mean IDV ratio of APEX1 in CaGB was 0.63±0.33 and 0.45±0.19 in cholelithiasis. The mean IDV ratio of a variant of APEX1 (ΔAPEX1) in CaGB was 0.50±0.09, whereas it was 0.40±0.16 in cholelithiasis. Calculating the mean IDV ratio of total APEX (APEX1+ΔAPEX1) in CaGB was 1.13±0.31 whereas in cholelithiasis, 0.85±0.23. The differences were statistically significant (p<0.05). CONCLUSION: A significant correlation was found between the relative expressions of APEX1 in cancer as compared to that in cholelithiasis patients. There was significant association between APEX1 expression and perineural invasion. A variant of APEX1 correlated with tumor infiltration. Hence APEX1 may be of use as a prognostic marker in patients with CaGB.

Intravenous catheter associated complications.

Two cases of intravenous catheter associated complications are reported herewith.

Targeting connexin 43 in diabetic wound healing: future perspectives.

The unknown mechanisms of impaired tissue repair in diabetes mellitus are making this disease a serious clinical problem for the physicians worldwide. The lacuna in the knowledge of the etiology of diabetic wounds necessitates more focused research in order to develop new targeting tools with higher efficacy for their effective management. Gap-junction proteins, connexins, have shown some promising results in the process of diabetic wound healing. Till now the role of connexins has been implicated in peripheral neuropathy, deafness, skin disorders, cataract, germ cell development and treatment of cancer. Recent findings have revealed that gap junctions play a key role in normal as well as diabetic wound healing. The purpose of this review is to provide the information related to etiology, epidemiology, clinical presentation of diabetic wounds and to analyze the role of connexin 43 (Cx43) in the diabetic wound healing process. The current control strategies and the future research challenges have also been discussed briefly in this review.

Primary high-grade testicular leiomyosarcoma.

We herein present an extremely rare occurrence of primary intratesticular leiomyosarcoma. A 65-year-old patient presented with painless enlargement of the right testis. A high inguinal orchiectomy was done. Histopathological examination of the excised mass was consistent with high-grade leiomyosarcoma. Pertinent literature is reviewed and the importance of excluding the germ cell tumor and the paratesticular neoplasm is emphasized.

Lifestyle, reproductive factors and risk of gallbladder cancer.

INTRODUCTION: Lifestyle and dietary habits play an important role in carcinogenesis. Carcinoma of the gallbladder is no different. The present study was carried out to evaluate the roles of lifestyle, menstrual and reproductive factors in gallbladder cancer. METHODS: A prospective case-control study involving 78 newly-diagnosed cases of carcinoma of the gallbladder and 78 age- and gender-matched controls with cholelithiasis were investigated for their lifestyle history, with an emphasis on habits with chewing betel nut and tobacco, alcohol consumption and smoking. Besides this, female patients were investigated for their menstrual and reproductive factors. Odds-ratio and significance were calculated. RESULTS: A Hindu preponderance was seen. About half of the patients with carcinoma of the gallbladder and gallstone were either illiterate or had a very low level of education (primary or below). Religion, education, family income, chewing of tobacco as well as smoking were comparable. But numbers of chewing tobacco and smoking per day differed significantly. Alcohol was consumed by 11.6 percent of carcinoma and 4.1 percent of gallstone patients. Lower age of menarche, higher number of pregnancies and higher age at menopause had a significantly increased risk of gallbladder carcinogenesis. A significant difference in carcinogenesis was seen in the postmenopausal women compared with the menopausal group. CONCLUSION: Carcinoma of the gallbladder was common in tobacco chewers. Females with lower age at menarche, higher number of pregnancies and childbirths and higher age at last childbirth had an increased risk of gallbladder cancer.

Risk assessment for pressure ulcer: a hospital-based study.

AIM: To identify patients at risk for developing pressure ulcer among hospitalized patients and the prevalence of pressure ulcer in this group. PATIENTS AND METHOD: A prospective study included 100 patients from medical and surgical wards. Data were collected on admission, and subjects were followed up at regular intervals. The Waterlow pressure ulcer risk assessment tool was completed and patients were stratified "as not at risk," "at risk", "high risk", and "very high risk". Subjects were then monitored for 2 weeks and the actual incidence of pressure ulcer formation was analyzed in the various risk groups. RESULTS: Of 100 patients studied, 20% were at risk, 10% were assessed at high risk, and 7% were classified as at very high risk for developing a pressure ulcer. Necessary preventive measures were taken (posture change, specialized beds/mattresses, nursing care, nutritional input, etc) for those patients at risk of development of pressure ulcer. Four of 7 patients (57.1%) who were at very high-risk developed pressure ulcer as compared with 2 of 10 patients (20%) categorized in the high-risk category within a period of 2 weeks. No patient who was classified as not at risk on the Waterlow pressure ulcer risk assessment tool developed a pressure ulcer within the observation period. CONCLUSION: Pressure ulcers developed in identified risk groups despite adequate available preventive measure being taken to prevent their development. It is of extreme importance to identify patients at risk for the development of pressure ulcers so that preventive measures can be instituted to reduce the incidence of hospital-acquired pressure ulcers.