Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia.

South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions-initiatives and innovations-toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).

Oral Rehabilitation of a Patient with Papillon Lefèvre Syndrome Using Fixed Full-Arch Hybrid Prostheses Supported by Four Axially Loaded Implants: A Case Report with Four-Year Follow-up.

This report details the successful prosthetic rehabilitation of a 25-year-old male patient with Papillon Lefèvre Syndrome (PLS) using an implant-supported hybrid prosthesis. Six implants were placed in the maxilla, and four were placed in the mandibular arch. All implants were inserted axially (non-tilted) and were planned to be loaded after a healing period of 6 months. One implant failed due to graft loss during the healing phase, which was removed and the remaining implants were restored with a hybrid prosthesis after 6 months, using the delayed loading protocol. The patient was followed-up for four years and all the remaining implants successfully integrated and remained fully functional during this period. The prosthesis significantly improved the functional, aesthetic, and psychological well-being of the patient. This case report is the first of its kind to use only four axially placed implants for rehabilitation of a PLS patient with a successful four-year follow-up.

Answer ALS, a large-scale resource for sporadic and familial ALS combining clinical and multi-omics data from induced pluripotent cell lines.

Answer ALS is a biological and clinical resource of patient-derived, induced pluripotent stem (iPS) cell lines, multi-omic data derived from iPS neurons and longitudinal clinical and smartphone data from over 1,000 patients with ALS. This resource provides population-level biological and clinical data that may be employed to identify clinical-molecular-biochemical subtypes of amyotrophic lateral sclerosis (ALS). A unique smartphone-based system was employed to collect deep clinical data, including fine motor activity, speech, breathing and linguistics/cognition. The iPS spinal neurons were blood derived from each patient and these cells underwent multi-omic analytics including whole-genome sequencing, RNA transcriptomics, ATAC-sequencing and proteomics. The intent of these data is for the generation of integrated clinical and biological signatures using bioinformatics, statistics and computational biology to establish patterns that may lead to a better understanding of the underlying mechanisms of disease, including subgroup identification. A web portal for open-source sharing of all data was developed for widespread community-based data analytics.

Challenges in microalgal biofuel production: A perspective on techno economic feasibility under biorefinery stratagem.

Rapidly exhausting fossil fuels combined with the ever-increasing demand for energy led to an ongoing search for alternative energy sources to meet the transportation, manufacturing, domestic and other energy demands of the grown population. Microalgae are at the forefront of alternative energy research due to their significant potential as a renewable feedstock for biofuels. However, microalgae platforms have not found a way into industrial-scale bioenergy production due to various technical and economic constraints. The present review provides a detailed overview of the challenges in microalgae production processes for bioenergy purposes with supporting techno-economic assessments related to microalgae cultivation, harvesting and downstream processes required for crude oil or biofuel production. In addition, biorefinery approaches that can valorize the by-products or co-products in microalgae production and enhance the techno-economics of the production process are discussed.

An overview on mechanism, cause, prevention and multi-nation policy level interventions of dietary iron deficiency.

Iron deficiency anemia (IDA) is probably the most ignored situation in the world of malnutrition-largely due to its slow progression. Multiple reasons can be attributed as the cause of IDA, which is not limited to any specific region or population; therefore, making it a matter of global concern. Despite the human body's ability to absorb and conserve iron stores, the gradual loss due to various physiological conditions leads to net deficiency of iron. Countless commercial iron supplements are available, but at given physiological conditions, almost all of these "Bio-not-available" iron forms quite often become ineffective. World Health Organization and other government bodies have jointly developed health advisories and tried to developed nutrition supplements several times in the last two decades. IDA, when combined with other disease conditions, becomes a life-threatening situation. At the same time, an overdose of iron could also be very harmful to the body. Therefore, it is important to deal with this situation with caution. This article covers iron metabolism, available options for iron supplementation, regulatory aspects and strategies to prevent IDA.

A comparative study on the electrochemical capacitor performance of 1T/2H hybridized phase and 2H pure phase of MoS2nanoflowers.

The 1T/2H hybridized and 2H pure phases of MoS2nanoflowers were synthesized in a one-step hydrothermal process with the molybdenum source as sodium molybdate dihydrate and the sulfur source as thiourea. The as-prepared 1T/2H hybridized and 2H pure phases of MoS2were investigated using a thermogravimetry\differential thermal analysis, powder x-ray diffraction, field emission scanning electron microscopy, and energy-dispersive x-ray spectroscopy. The obtained 1T/2H hybridized phases of MoS2were confirmed by the Raman spectroscopy. The electrochemical characteristics of MoS2electrodes were examined using cycle voltammetry, galvanostatic charge-discharge and electrochemical impedance spectroscopy. The electrodes are based on the 1T/2H hybridized phases MoS2with specific capacitance (Cp) of 555.4 F g-1at current densities (Cd) of 0.5 A g-1, capacity retention ratio of 85% after 10 000 cycles were observed that could be a strong potential electrode material for supercapacitors application.

Characterization of nanocellulose production by strains of Komagataeibacter sp. isolated from organic waste and Kombucha.

Bacterial nanocellulose production is gaining popularity owing to its applications in food, cosmetics and medical industry. Three Acetobacter strains isolated from organic waste and fermented tea were identified using 16S rDNA sequencing and their ability to produce nanocellulose was studied. Strain isolated from Kombucha has 99% homology with Komagataeibacter rhaeticus DSM 16663 T. This is the first report where nanocellulose productivity of this strain with different carbon sources such as glucose, glycerol, fructose and sucrose has been studied. 1% glycerol was found to be optimal concentration, with up to 69% of the utilized carbon converted to nanocellulose. Maximum productivity of 4.5 g/L of bacterial nanocellulose was obtained. Average nitrogen and phosphorus consumption rate was 45 mg/L/day each. Physical properties such as crystallinity, fibril dimensions, and glass transition temperature were studied. Bacterial cellulose was 80% crystalline when glycerol and glucose were used as carbon source and 73% for fructose and sucrose. Renewable materials such as bacterial cellulose with their unique properties are the future for applications in the field of cosmetics, composite and wound care.

Empowering blue economy: From underrated ecosystem to sustainable industry.

With increasing demand for resources to achieve global food-water-energy nexus and rapid decline in land-based sources, oceans represent both solution and boost to sustainable environment and economy. In addition to fundamental part of earth's ecosystem for uncatalogued diversity of life, oceans are undervalued economy powerhouse with gross marine product value. With sustainable management of existing assets including shipping, transportation, manufacturing, fisheries, tourism and exploration of new business like marine biotechnology and renewable energy, the ocean or blue economy has potential to fulfill sustainable development goals (SDG). In spite of recognition of blue economy as a new economic frontier, investments by existing industries and emergence of new ones are limited and less known, hence require more in depth attention and scientific understanding. In the present study, authors present a systematic comparative assessment of blue economy sectors with distinct challenges and strategies to be further explored and implemented for industrial deployment. The conceptualization of integrated routes of bio(economy) by the current study can act as gateway for key stakeholders, i.e. governance, bluepreneurs (scientists and industries) to prioritize technologies for sustainable applications of marine resources.

The Use of a Novel CAD-CAM Splint to Simplify Open Reduction and Internal Fixation of Mandibular Angle Fracture: A Technical Note.

Mandibular angle fractures are frequently encountered as they constitute an area of weakness. Complications after open reduction and internal fixation (ORIF) of angle fractures commonly arise due to improper reduction and fixation methods that fail to counteract the dynamic muscle forces present in this region. Conventional reduction methods such as digital manipulation, intermaxillary fixation, towel clip traction, and wiring are associated with various limitations. This technical note highlights the fabrication and use of a computer-aided designing/computer-aided manufacturing-generated splint for ORIF of a superiorly displaced mandibular angle fracture. The splint consisted of 2 components: (1) a distal tooth-borne component to guide the teeth into maximum intercuspation and (2) a proximal bone-borne component to reduce the angle fracture. This composite splint facilitates simultaneous restoration of occlusion as well as reduction of mandibular angle fractures. The advantages of this technique include the following: (1) easy fabrication of splint, (2) easy and precise anatomical reduction of angle fracture, and (3) less operative time.

Synchronous correction in secondary cleft deformities: a prospective cohort study.

BACKGROUND: Patients with cleft lip and palate deformities undergo multiple surgical procedures from infancy till adolescence. We hypothesized that combining these surgical procedures might offer a better quality of life without compromising on surgical outcomes. METHODS: A prospective cohort study was conducted at our center including all adult patients who reported to us for the correction of secondary cleft deformities. All patients with secondary deformities associated with cleft lip palate and alveolus were enrolled in the study. Patients with medical issues who are not fit for general anesthesia, Bilateral Cleft deformities, and patients with gross skeletal deformity warranting surgical correction by Le fort I distraction were excluded from the study. All the patients who were included in the study underwent simultaneous lip revision, rhinoplasty and cleft alveolar bone grafting. The outcome lip nose profile was assessed using standardized patient photographs with Ascher Mcdade Scale and Aesthetic outcome index by 2 blinded maxillofacial surgeons and the bone grafting was assessed using Berglands grading system. RESULTS: Twenty-eight patients were enrolled in the study, 10 patients were excluded based on the exclusion criteria. Thus 18 patients planned for synchronous correction of unilateral secondary cleft deformities were included in the study The Ascher Mcdade Score improved from 15 (13-16), to 4 (4-5) in the post op. All the patients were totally satisfied with the surgical outcome. The aesthetic index showed excellent outcomes in all the lip-nose procedures, except for one case which showed a good outcome. The Bergland Scale showed normal bone height in all cases of alveolar bone grafting, except for one case, which showed less than 3/4th fill of bone. No complications were associated with any of the procedures. CONCLUSIONS: Simultaneous correction of multiple secondary cleft lip deformities should be considered when feasible, to improve the psychological benefit and reduce financial burden on these patients. However, careful planning and execution of the techniques is essential to avoid complications associated with vascular compromise.

Is the Vazirani-Akinosi Nerve Block a Better Technique Than the Conventional Inferior Alveolar Nerve Block for Beginners?

PURPOSE: This study was performed to compare the efficacy and comfort of the inferior alveolar nerve (IAN) block and the Vazirani-Akinosi (VA) nerve block when administered by dental trainees. MATERIALS AND METHODS: In this prospective, randomized controlled trial, patients requiring extraction of mandibular teeth received either the conventional IAN block (IAN group) or VA nerve block (VA group). Objective parameters evaluated included ease of locating landmarks, incidence of positive aspiration, and failure rate. Patient comfort during injection was assessed with a visual analog scale. Statistical analysis was performed with the unpaired t test and Fisher exact test. RESULTS: One hundred patients were included in each group. Landmarks were easier to locate in the VA group. The incidence of positive aspiration was higher in the IAN group (0.08%) than in the VA group (0.01%, P < .05). The incidence of failed blocks was higher in the IAN group than in the VA group. Patients appeared to experience less pain with the VA injection than with the IAN injection. CONCLUSIONS: This study showed that the dental trainees found the VA technique more straightforward to perform. It had a higher success rate and lower incidence of positive aspiration and was more comfortable for patients than the conventional IAN block.

Synthesis, Optical and Electrochemical Properties of Y2O3 Nanoparticles Prepared by Co-Precipitation Method.

Y2O3 nanoparticles were synthesized by co-precipitation route using yttrium nitrate hexahydrate and ammonium hydroxide as precursors. The prepared sample was calcined at 500 degrees C and subjected to various characterization studies like thermal analysis (TG/DTA), X-ray diffraction (XRD), transmission electron microscope (TEM), UV-visible (UV-Vis) and photoluminescence (PL) spectroscopy. The XRD pattern showed the cubic fluorite structure of Y2O3 without any impurity peaks, revealing high purity of the prepared sample. TEM images revealed that the calcined Y2O3 nanoparticles consist of spherical-like morphology with an average particle size of 12 nm. The absorption spectrum of calcined samples shows blue-shift compared to the as-prepared sample, which was further confirmed by PL studies. The possible formation mechanism of Y2O3 nanoparticles has been discussed based on the experimental results. Electrochemical behavior of Y2O3 nanoparticles was studied by cyclic voltammetry to assess their suitability for supercapacitor applications.

Molecular insight of putative pathogenicity markers with ESBL genes and lipopolysaccharide in Laribacter hongkongensis.

Laribacter hongkongensis is an emerging bacterial pathogen causing gastroenteritis and traveller's diarrhoea. However, pathogenicity of L. hongkongensis has not yet been properly understood. We therefore, investigated putative pathogenicity markers like elt, est, stx1, stx2, eae, eaf, EAgg, bfpA, Int I, Int II, Int III and cnf respectively in strains received from Queen Mary Hospital, Hong Kong University. Above genes were commonly found among pathogenic member genera of Enterobacteriaceae-causing diarrhoea. Received strains were confirmed microbiologically and by 16S ribosomal RNA (rRNA) sequencing. Cultivability was examined using 23 different commercially available microbial growth media followed by antibiotic susceptibility test, lipopolysaccharide (LPS) extraction and raising antisera in rabbit against heat-killed L. hongkongensis. Moreover, Escherichia coli classification genes chuA, yjaA, TspE4 and extended spectrum beta lactamase (ESBL) genes like TEM, SHV, OXA, CTXM, CTXM1 and CTXM9 were also examined by PCR assay. Results showed the possession of eae, bfpA, Int and CTXM9 respectively for putative virulence. Furthermore, purity of extracted LPS was confirmed by HPLC, and raised serum was found useful in diagnosis of LPS; bacterium thus can be employed for immunodiagnostics.

Safe sinus lift: use of acrylic stone trimmer to avoid sinus lining perforation.

Iatrogenic injury to the maxillary sinus membrane is a common complication during direct sinus lift procedures. The most common cause is perforation of the Schneiderian membrane using a tungsten-carbide round bur no.6. We propose a safe technique in which an acrylic stone trimmer is used to create a window in the maxillary antrum thereby minimizing the risk of injury to the delicate sinus membrane.

Generation of an expressed sequence tag (EST) library from salt-stressed roots of Jatropha curcas for identification of abiotic stress-responsive genes.

Improving salinity and drought tolerance of crop plants has been an important aim of modern agricultural development, which depends on understanding the functions of genes expressed during the process of stress adaptation. EST resources are an efficient and cost-effective solution to gene discovery. Jatropha curcas is emerging as the most promising tree oil seed as a source of biodiesel. To identify genes that respond to abiotic stress, in the present study, we report 1240 ESTs generated from root cDNA libraries of J. curcas. ESTs were clustered and assembled into a collection of 865 unigenes, with 107 contigs and 758 singleton sequences. The putative functions of several ESTs could be assigned by similarity to plant gene sequence comparisons. It was found that 23 full-length CDS (34%) and the majority of transcription factors had sequence similarity to genes known to be involved in abiotic and biotic stress tolerance. The expression pattern of nine selected genes revealed that these genes are differentially expressed in various tissues during adaptation to stress. The data could serve as a critical resource to enable plant improvement programmes towards enhancing the adaptability of J. curcas to growth on marginal lands.

Isolation of high-quality RNA from various tissues of Jatropha curcas for downstream applications.

A method for isolating transcriptionally active RNA for downstream applications from diverse tissues of Jatropha curcas, a plant rich in latex, lipids, waxes, polysaccharide, polyphenols, and secondary metabolites, is described. The described method uses alkaline borate buffer during tissue homogenization to negate the formation of viscous gel observed in guanidium-salt-containing methods. By this method, quality RNA was extracted from leaf, immature inflorescence, endosperm, and root tissues with yields ranging from 1.80 to 7.80mg/100mg fresh weight (FW). The total RNA obtained was found to be suitable for poly(A)(+)RNA purification, complementary DNA (cDNA) synthesis, cloning of full-length cDNA, and cDNA library construction.

Yeast functional screen to identify genetic determinants capable of conferring abiotic stress tolerance in Jatropha curcas.

BACKGROUND: Environmentally inflicted stresses such as salinity and drought limit the plant productivity both in natural and agricultural system. Increasing emphasis has been directed to molecular breeding strategies to enhance the intrinsic ability of plant to survive stress conditions. Functional screens in microorganisms with heterologous genes are a rapid, effective and powerful tool to identify stress tolerant genes in plants. Jatropha curcas (Physic nut) has been identified as a potential source of biodiesel plant. In order to improve its productivity under stress conditions to benefit commercial plantations, we initiated prospecting of novel genes expressed during stress in J. curcas that can be utilized to enhance stress tolerance ability of plant. RESULTS: To identify genes expressed during salt tolerance, cDNA expression libraries were constructed from salt-stressed roots of J. curcas, regulated under the control of the yeast GAL1 system. Using a replica based screening, twenty thousand yeast transformants were screened to identify transformants expressing heterologous gene sequences from J. curcas with enhanced ability to tolerate stress. From the screen we obtained 32 full length genes from J. curcas [GenBank accession numbers FJ489601-FJ489611, FJ619041-FJ619057 and FJ623457-FJ623460] that can confer abiotic stress tolerance. As a part of this screen, we optimized conditions for salt stress in J. curcas, defined parameters for salt stress in yeast, as well as isolated three salt hypersensitive yeast strains shs-2, shs-6 and shs-8 generated through a process of random mutagenesis, and exhibited growth retardation beyond 750 mM NaCl. Further, we demonstrated complementation of the salt sensitive phenotypes in the shs mutants, and analyzed the expression patterns for selected J. curcas genes obtained from the screen in both leaf and root tissues after salt stress treatments. CONCLUSIONS: The approach described in this report provides a rapid and universal assay system for large scale screening of genes for varied abiotic stress tolerance within a short span of time. Using this screening strategy we could isolate both genes with previously known function in stress tolerance as well as novel sequences with yet unknown function in salt stress tolerance from J. curcas. The isolated genes could be over-expressed using plant expression system to generate and evaluate transgenic plants for stress tolerance as well as be used as markers for breeding salt stress tolerance in plants.