Factors Influencing the Outcome of Spontaneous Healing of Traumatic Tympanic Membrane Perforation: A Clinical Prospective Observational Study.

Trauma to the ear is typically attributed to its location in the craniofacial skeleton. TM is prone to rupture, tear, or perforation when traumatized. Etiological factors may be classified according to the pathogenetic mechanisms (air-pressure change, heat, solids, water pressure). MATERIALS & METHOD: This is a prospective study of 70 patients with traumatic tympanic membrane perforation between January 2019 and December 2022. Inclusion and exclusion criteria applied and results interpreted. RESULTS: Traumatic TM affects all age groups with a mean age of 27.94 ± 4.76 years. Traumatic TM affects all age groups with a mean age of 27.94 ± 4.76 years, with the highest incidence among the middle-aged groups 61.4%. The male-to-female ratio was found to be 1.9:1, with high predominance among male patients (65.7%) with a frequency of 57.1% for slap injury group in our study contrary to others. Spontaneous healing was observed in 88.6% over a follow-up period of 12 weeks in this study. Our study has not shown that associated comorbidities influence healing (P = 0.550). About 45.5% Marginal perforations have not healed in 12 weeks follow-up period as compared to central perforations 5.1%. CONCLUSION: There is a high predominance of TM perforation among male patients in our study may be attributed to activity. Spontaneous healing is more common. Duration of healing was significantly affected by the size of the perforation with longer duration for large perforations and vice versa. It is observed in this study that the duration of spontaneous healing is longer in blast injuries when compared to other kinds of injuries. A significant proportion of marginal perforations that have not healed in our study may be attributed to annular ligament involvement.

Common Tumor in an uncommon location: Pleomorphic Adenoma of nasal cavity - a case Report.

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor of which parotid gland involvement is the most common. PA may arise from minor salivary glands as well, however, PA is very rare in the sinonasal and nasopharyngeal areas. It usually affects middle aged females. They are frequently misdiagnosed due to high cellularity and myxoid stroma, leading to delay in diagnosis & further appropriate management. Here we present a case report of a female who presented with gradually progressive nasal obstruction, on examination found to have a nasal mass in right nasal cavity. Imaging was done and the nasal mass was excised. Histopathological report revealed a PA. Common tumor in an uncommon location: Pleomorphic adenoma of the nasal cavity - a case report.

Process development for the total synthesis of the novel drug metabolite Carboxy toremifene as a standard reference material along with characterization and purity assessment for the Antidoping quality Control Purposes.

Tamoxifen and toremifene are two selective estrogen receptor modulators (SERMs) commonly used to treat breast cancer in women. Toremifene is well-known as a triphenylethylene derivative. Carboxy toremifene is a common metabolite of toremifene and tamoxifen. Since 2005, the World Anti-Doping Agency (WADA) has banned the SERMs category during in and out of competition. These substances are in the S4 category in the WADA prohibited list as "agents with anti-oestrogenic activity." However, there is no commercially accessible carboxy toremifene reference material in the market. This research highlights the novel synthetic procedure, the development of a carboxy toremifene HPLC method, and validation, along with detailed characterization using advanced analytical techniques using 1 H NMR, HRMS, FT-IR-ATR and UV-visible spectroscopy. RP-HPLC-DAD method was developed and validated to assess the purity of carboxy toremifene. Developed reference material has shown 100% purity. Therefore, we recommend that this synthesized carboxy toremifene may be used as reference material to strengthen the WADA-accredited lab to maintain a clean sports mission during sports competitions.

Architectural analysis of root system and phytohormone biosynthetic genes expression in wheat (Triticum aestivum L.) inoculated with Penicillium oxalicum.

In this study, a fungal plant growth promoter Penicillium oxalicum T4 isolated from non-rhizosphere soil of Arunachal Pradesh, India, was screened for different plant growth promoting traits in a gnotobiotic study. Though inoculation improved the overall growth of the plants, critical differences were observed in root architecture. Confocal Laser Scanning Microscope, Scanning electron microscope and the stereo microscopic study showed that inoculated wheat plants could develop profuse root hairs as compared to control. Root scanning indicated improvement in cumulative root length, root area, root volume, number of forks, links, crossings, and other parameters. A confocal scanning laser microscope indicated signs of endophytic colonization in wheat roots. Gene expression studies revealed that inoculation of T4 modulated the genes affecting root hair development. Significant differences were marked in the expression levels of TaRSL4, TaEXPB1, TaEXPB23, PIN-FORMED protein, kaurene oxidase, lipoxygenase, ACC synthase, ACC oxidase, 9-cis-epoxycarotenoid dioxygenase, and ABA 8'-hydroxylase genes. These genes contribute to early plant development and ultimately to biomass accumulation and yield. The results suggested that P. oxalicum T4 has potential for growth promotion in wheat and perhaps also in other cereals.

A Study of Otological Manifestations of Temporal Bone Fractures.

The aim of study was to evaluate various otological manifestations of temporal bone fractures and to suggest their management. This prospective observational study was conducted in a tertiary care hospital of Armed Forces over 2.5 years in 57 cases of temporal bone fracture in patients of age group of 12-59 yrs comprising 49 males and 8 females. Radioimaging was done for diagnosing the fracture, mapping its extent and for clinical correlation. Hearing was assessed by tuning forks, free field hearing and pure tone audiogram as per the fitness of patient. Majority of patients were in the age group 20-40 years who had met with road accidents. Important otological features included Battle sign (24.6%), ear canal laceration (53%), tympanic membrane perforation (7%), haemotymanum (40%), ear discharge (66.7%), hearing loss (63%), vertigo (16%), tinnitus (21%), facial paralysis (68%) and cerebrospinal fluid otorrhea (3.5%). Otic capsule sparing fracture was three times more common than violating ones. Facial palsies were treated with oral steroid with complete recovery in 56.41% cases but three required decompression surgery. 4 patients underwent tympanoplasty. Both the cerebrospinal fluid leaks stopped in 2 weeks time. Facial palsy is as common as hearing loss. TM perforation is as rare as CSF leak. Otic capsule violating fracture line is less common. Hearing loss shows recovery in most of the cases. Delayed onset positional vertigo is more common than acute vertigo. Large numbers of immediate onset complete facial palsy do recover from injury without surgery.

Non-destructive insights into photosynthetic and photoprotective mechanisms in Arabidopsis thaliana grown under two light regimes.

Probing insights into understanding photosynthetic processes via non-invasive means has an added advantage when used in phenotyping or precision agriculture. We employed Raman spectroscopy and fluorescence-based methods to investigate both the changes in the photosynthetic processes and the underlying protective mechanisms on Arabidopsis thaliana wild-type (WT), and ros1, which is a mutant of a repressor of transcriptional gene silencing, both grown under low light (LL: 100 µmol m-2s-1) and high light (HL: 400 µmol m-2s-1) regimes. Raman imaging detected a lower carotenoid intensity after two weeks in those plants grown under HL, compared to those grown under the LL regime; we interpret this as the result of oxidative damage of ß-carotene molecules. Further, the data revealed a significant depletion in carotenoids with enhanced phenolics around the midrib and tip of the WT leaves, but not in the ros1. On the contrary, small necrotic zones appeared after two weeks of HL in the ros1 mutant, pointing to the starting oxidative damage. The lower maximum quantum yield of the photochemistry (Fv/Fm) in the WT as well as in the ros1 mutant grown in HL (compared to those in the LL two weeks post-exposure), indicates the HL partially inactivated photosystems. Chlorophyll a fluorescence imaging further showed high non-photochemical quenching (NPQ) in the plants grown under the HL regime for both the WT and the ros1 mutant, but the spatial heterogeneity of NPQ images was much higher in the HL-grown ros1 mutant. Fluorescence screening methods revealed significantly high values of chlorophyll proxies in the WT as well as in the ros1 mutant two weeks after in the HL compared to those under LL. The data generally revealed an increased accumulation of phenolics under HL in both the WT and ros1 mutant plants, but the proxies of anthocyanin and flavonols were significantly lower in the ros1 mutant than in the WT. The comparatively low accumulation of anthocyanin in the ros1 mutant compared to the WT supports the Raman data. We conclude that integrated use of these techniques can be efficiently applied for a better understanding of insights into photosynthetic mechanisms.

Role of the Mosaic Cisternal Maturation Machinery in Glycan Synthesis and Oncogenesis.

Tumorigenesis is associated with the deregulation of multiple processes, among which the glycosylation of lipids and proteins is one of the most extensively affected. However, in most cases, it remains unclear whether aberrant glycosylation is a cause, a link in the pathogenetic chain, or a mere consequence of tumorigenesis. In other cases, instead, studies have shown that aberrant glycans can promote oncogenesis. To comprehend how aberrant glycans are generated it is necessary to clarify the underlying mechanisms of glycan synthesis at the Golgi apparatus, which are still poorly understood. Important factors that determine the glycosylation potential of the Golgi apparatus are the levels and intra-Golgi localization of the glycosylation enzymes. These factors are regulated by the process of cisternal maturation which transports the cargoes through the Golgi apparatus while retaining the glycosylation enzymes in the organelle. This mechanism has till now been considered a single, house-keeping and constitutive function. Instead, we here propose that it is a mosaic of pathways, each controlling specific set of functionally related glycosylation enzymes. This changes the conception of cisternal maturation from a constitutive to a highly regulated function. In this new light, we discuss potential new groups oncogenes among the cisternal maturation machinery that can contribute to aberrant glycosylation observed in cancer cells. Further, we also discuss the prospects of novel anticancer treatments targeting the intra-Golgi trafficking process, particularly the cisternal maturation mechanism, to control/inhibit the production of pro-tumorigenic glycans.

Analytical developments of p-hydroxy prenylamine reference material for dope control research: Characterization and purity assessment.

Prenylamine was initially used for the treatment of angina pectoris and later on withdrawn from the market in 1988 due to cardiac arrhythmias concern. The major phase I metabolite of prenylamine is p-hydroxy prenylamine that has a chiral center in the structure. Even though p-hydroxy prenylamine was synthesized earlier, it lacked complete analytical developments for chiral high-performance liquid chromatography (HPLC) separation. However, p-hydroxy prenylamine reference material is not commercially available. The innovation of this manuscript is the development and validation of a chiral HPLC separation method and more extensive characterization of the reference material than previously reported method. Therefore, it was hypothesized to develop and validate normal phase HPLC method for p-hydroxy prenylamine reference material. p-Hydroxy prenylamine was synthesized in two batches and characterized successfully using 13 C NMR, 1 H NMR, high-resolution mass spectrometry (HRMS), Fourier transform infrared spectroscopy (FT-IR), and thermogravimetric analysis (TGA). A normal phase chiral HPLC method was developed to analyze the p-hydroxy prenylamine purity. Separation of the p-hydroxy prenylamine enantiomers were achieved using ultra-high-performance liquid chromatography (UHPLC) on a ChiralCel ODH column at wavelength of 220 nm. The developed method was validated in terms of its linearity, accuracy, precision, and robustness for purification, purity assessment, and stability studies. Proton and carbon peaks were confirmed by nuclear magnetic resonance (NMR) analysis. Functional groups were confirmed by FT-IR. Loss on drying was 0.3% and 0.6% for Batches 1 and 2, respectively. The purity of the developed reference material for Batches 1 and 2 was found to be 99.59% and 100%, respectively. Therefore, the synthesized batches of p-hydroxy prenylamine can be used in dope testing as reference material.

Synthesis, characterization, method development, and validation of nor-ethylmorphine hydrochloride reference material using established analytical techniques for dope control analysis.

Ethylmorphine is permitted internationally for therapeutic purposes where morphine is not indicated across the globe. Nor-ethylmorphine a major metabolite of ethylmorphine. To differentiate the intake of morphine from ethylmorphine, nor-ethylmorphine stable reference material is desirable. There is no available commercial source and no data for reference material context for this substance. Therefore, nor-ethylmorphine HCl was synthesized and characterized, and purity and potency were assessed using nuclear magnetic resonance (NMR), high-resolution mass spectrometry (HRMS), Fourier transform infrared spectroscopy (FT-IR), thermogravimetry (TGA), and high-performance liquid chromatography (HPLC). Purity and potency were found to be 98.29% and 96.40%, respectively, providing a fit for purpose reference material for doping control analysis in sports.

Self-perceived stress among medical students in relation to their perceptions on virtual learning during the COVID-19 pandemic

Medical education has shifted from the traditional face-toface method to virtual learning due to the COVID-19 pandemic, bringing with it many challenges. Medical students already experience high levels of stress due to may stressors such as excessive workload. This together with the new challenges encountered during virtual learning, such as technological barriers, can cause physiological distress which can affect the mental health of medical students.

Endophyte roles in nutrient acquisition, root system architecture development and oxidative stress tolerance.

Plants associate with communities of microbes (bacteria and fungi) that play critical roles in plant development, nutrient acquisition and oxidative stress tolerance. The major share of plant microbiota is endophytes which inhabit plant tissues and help them in various capacities. In this article, we have reviewed what is presently known with regard to how endophytic microbes interact with plants to modulate root development, branching, root hair formation and their implications in overall plant development. Endophytic microbes link the interactions of plants, rhizospheric microbes and soil to promote nutrient solubilization and further vectoring these nutrients to the plant roots making the soil-plant-microbe continuum. Further, plant roots internalize microbes and oxidatively extract nutrients from microbes in the rhizophagy cycle. The oxidative interactions between endophytes and plants result in the acquisition of nutrients by plants and are also instrumental in oxidative stress tolerance of plants. It is evident that plants actively cultivate microbes internally, on surfaces and in soils to acquire nutrients, modulate development and improve health. Understanding this continuum could be of greater significance in connecting endophytes with the hidden half of the plant that can also be harnessed in applied terms to enhance nutrient acquisition through the development of favourable root system architecture for sustainable production under stress conditions.

DFT and MD simulation supplemented experiments for isotopic fractionation of zinc compounds using a macrocyclic crown ether appended polymeric resin.

Isotope effect is a quantum mechanical phenomenon and thus poses a challenge for the separation of isotopes of an element of interest, especially for heavy elements. Isotopic fractionation of zinc is also quite difficult and challenging but is necessitated due to various applications of its isotopes ranging from nuclear medicine to nuclear power reactors. Here, we developed the dibenzo-18-crown-6 (DB18C6) ether-functionalized poly(methacrylic acid) (PMA) resin by exploiting the ion and isotope recognition ability of the crown ether using DFT/MD simulations followed by experiments for isotopic fractionation of zinc. The PMADB18C6 adsorbent was prepared and suitably characterized. Both computational and experimental findings demonstrate that the adsorption and isotope separation of zinc with PMADB18C6 are due to the molecular recognition effect of the "O" dipole of the crown ether. Furthermore, both MD simulations and experiments suggest Langmuir type adsorption isotherms. The adsorption of Zn2+ ions on the PMA resin is predicted to be endothermic, whereas it is exothermic on the PMADB18C6 resin, as revealed from the experimentally observed enthalpy change. A small scale fixed bed column study was demonstrated to test the scale-up application. The values of the experimental separation factors: 1.0013 for 66/64 and 1.0027 for 68/64 confirm the computationally predicted results of 1.00088 and 1.0010, respectively, thus establishing the combined strength of the theory and experiments for the identification of efficient fractionating agents for a complex quantum isotope effect which eventually helps in planning further experiments in view of medicinal and technological applications of zinc isotopes.

Bipaddle Pectoralis Major Myocutaneous Flap for Single Stage Reconstruction of Oromandibular Defects.

Reconstruction of full thickness defects after resection of oral cancer is a challenge. Although microvascular free flaps are considered the first choice, their use is limited in the developing regions by availability of resources and the expertise. In this study, we have presented our experience with the use of bipaddle pectoralis major myocutaneous (PMMC) flap as a single stage reconstruction option for defects of the oral cavity. After undergoing resection of oral cancer, 12 patients with full thickness defects of the oral cavity were reconstructed using bipaddle/bilobed/double-island/folded PMMC flap in a single stage procedure. The results of PMMC flaps were studied. All the patients had through and through defects of oral cavity, which were reconstructed in a single stage surgery using bipaddle PMMC flap. The overall complication rate was 33.33%, however, there were no cases of total flap necrosis. The mean time of reconstruction was 141.25 min with average hospital stay of 18.5 days. PMMC flap is a versatile flap with dedicated blood supply, good bulk and great reach. With limited availability of resources, it can be used as a single stage reconstruction technique in oral cavity defects with good results.

Epidemiological Aspects of Oral Cancer in North Indian Population.

INTRODUCTION: Head and neck cancers are common in the developing nations, especially in the south-east Asia. They account for the commonest malignancy type in India and pose a major public health concern. Oral cancer is the commonest of all head and neck malignancies. MATERIAL AND METHODS: It is a prospective study done from January 2017 to July 2018 at a tertiary care centre with patient population ranging from 22 to 87 years of age. All the 128 patients, irrespective of their gender, with a proven malignancy of the oral cavity were observed for various epidemiological and disease characteristics. RESULTS: Oral cavity cancers were more common in males than females. It is prevalent in the age group of 60-70 years. The most common site of involvement is the buccal mucosa followed by the tongue. Tobacco chewing and smoking is the most significant risk factor associated. The most commonly involved neck nodes are level I and II lymph nodes. CONCLUSION: Oral cancers are common in Indian population. It presents at advanced stage due to poor socioeconomic status of the patients. However, it has also been seen in younger population owing to increasing use of tobacco products. Preventive strategy, based on the epidemiological characteristics, is the need of the hour to reduce the disease burden.

Electro-Physiology of Coupling Model and Its Impact on Naja Kaouthia Venom Treated Sciatic Nerves of Toad.

Demyelination in peripheral nerves causes dysfunction of slowing down and stoppage of nerve impulses causing many neurological diseases, such as chronic inflammatory demyelinating polyneuropathy, Guillain-Barre syndrome, etc. This paper aims to develop a recovery model having interaction of a demyelinated nerve with a normal myelinated nerve. We validated the model by coupling between peripheral nerve of toad (demyelinated with Naja kaouthia venom) and a normal nerve of toad. An increase in both nerve conduction velocity as well as compound action potential amplitude is observed in the repetition of the experiments indicating gradual recovery of the patients. The significance behind this work is to suppress the malfunctioning of the demyelinated nerve by the normal electro-physiological activity of the normal nerve for speedy recovery using coupling model. The recovery model will be used in the treatment of neurological disorders with the influence of normal neuro physiological properties of a normal adjacent nerve.

P and T wave detection and delineation of ECG signal using differential evolution (DE) optimization strategy.

Generally, P and T waves in an electrocardiogram (ECG) signal are lower in amplitude compared to amplitude of QRS complex and contaminated with noises from various sources. Due to these problems and lack of universal delineation rule, the automated detection and delineation of T and P waves (on, off, and peak position of T and P wave) in the ECG signal are challenging task. The effectiveness for detection of on, off, and peak position of T and P wave by using differential evolution (DE) algorithm with the denoising technique has been verified in this manuscript. The denoising operation of the ECG signal has been performed by extended Kalman smoother (EKS) framework. DE algorithm is used for selection of optimized width and phase of five waves of the ECG signal. These parameters are used in EKS for initialization of the process noise covariance matrix and also development of the state equation. The new algorithm (an intelligent process of searching and subtraction) for detection of on, off and peak location of P and T waves without using amplitude threshold is developed by using the optimized parameters computed by the DE algorithm and denoised ECG signal with the help of the EKS framework. The effectiveness of the proposed technique has been validated using real-time QT database. Our proposed method shows better sensitivity, predicitvity and accuracy compared to other well-known methods for detection of on, off, peak location of P and T wave.

Efficacy of generic oral directly acting agents in patients with hepatitis C virus infection.

Novel direct-acting antivirals (DAAs) are now the standard of care for the management of hepatitis C virus (HCV) infection. Branded DAAs are associated with high sustained virological response at 12 weeks post-completion of therapy (SVR12), but are costly. We aimed to assess the efficacy of generic oral DAAs in a real-life clinical scenario. Consecutive patients with known HCV infection who were treated with generic-oral DAA regimens (May 2015 to January 2017) were included. Demographic details, prior therapy and SVR12 were documented. Four hundred and ninety patients (mean age: 38.9 ± 12.7 years) were treated with generic DAAs in the study time period. Their clinical presentations included chronic hepatitis (CHC) in 339 (69.2%) of cases, compensated cirrhosis in 120 (24.48%) cases and decompensated cirrhosis in 31 (6.32%) cases. Genotype 3 was most common (n = 372, 75.9%) followed by genotype 1 (n = 97, 19.8%). Treatment naïve and treatment-experienced (defined as having previous treatment with peginterferon and ribavirin) were 432 (88.2%) and 58 (11.8%), respectively. Generic DAA treatment regimens included sofosbuvir in combination with ribavirin (n = 175), daclatasvir alone (n = 149), ribavirin and peginterferon (n = 80), ledipasvir alone (n = 43), daclatasvir and ribavirin (n = 37), and ledipasvir and ribavirin (n = 6). Overall SVR12 was 95.9% (470/490) for all treatment regimens. SVR12 for treatment naïve and experienced patients was 97.0% (419/432) and 87.9% (51/58), respectively, P = .005. High SVR12 was observed with various regimens, irrespective of genotype and underlying liver disease status. There were no differences in SVR12 with 12 or 24 weeks therapy. No major adverse event occurred requiring treatment stoppage. Generic oral DAAs are associated with high SVR rates in patients with HCV infection in a real-life clinical scenario.

Efficacy of Phacotrabeculectomy Alone versus Phacotrabeculectomy Augmented with Autologous Anterior Capsule Implantation Beneath the Sclera Flap.

PURPOSE: To evaluate the efficacy of autologous anterior lens capsule (ALC) in phacotrabeculectomy. MATERIAL AND METHODS: In this prospective, randomized case control study, after obtaining institutional ethical clearance and informed consent, 88 eyes posted for phacotrabeculectomy were divided into ALC and non-ALC groups. Combined phacoemulsification, with posterior chamber intraocular lens implantation and trabeculectomy, was performed in both groups. Anterior lens capsule transplantation was done in the first group beneath the sclera flap. Follow-up of three months was carried out and the morphology of bleb, intraocular pressure (IOP), requirement for additional medications, and complications were compared between the two groups. RESULT: Statistical difference favoring the ALC group was seen in IOP reduction (p < 0.05) at each follow-up, qualified success rate and failure rate at the three-month follow-up (p = 0.006), but no difference in bleb morphology was seen. CONCLUSION: ALC implantation is beneficial in maintaining filtration in a combined surgery with minimal complications.