Acute splenic hematoma: A rare complication of snake bite.

Splenic hematoma secondary to snake bite is a potential complication due to snake envenomation and poses a significant risk to the health of the patients. Although relatively rare, this complication once diagnosed, should be initiated with timely anti-venom administration and supportive care. Clinicians must be aware of any signs of hematological abnormalities in snakebite patients, as the development of splenic hematoma can have serious implications for patient outcomes. Awareness of this potential complication and multidisciplinary collaboration among medical teams are crucial to ensuring effective management and optimal patient care in these clinical scenarios. Understanding this concern can improve patient prognosis and advance the overall approach to snakebite management in healthcare settings.

An uncommon cause of sub-acute intestinal obstruction in young adult: Wilkie's syndrome.

Abstract: Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare disease presenting as an acute abdomen. It has a clinical presentation similar to intestinal obstruction and is often missed during diagnosis. Reduced weight leading to loss of fat pad between SMA and aorta is the main pathophysiology. Diagnosis is made through barium meal and CT scan. Conservative management remains the treatment of choice; however, surgery is opted for in refractory cases. Key Clinical Message: Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare disease presenting as an acute abdomen with clinical features similar to intestinal obstruction. This is a case of SMA syndrome in an adult male with a decrease in aortomesenteric angle, with no predisposing condition.

Amphotericin B induced pancytopenia.

Amphotericin B (AMB) has been the irreplaceable drug of choice for countless fungal and protozoal infections. One of the lesser-known adverse effects of AMB is Pancytopenia - very rare with very few cases reported - most commonly observed following prolonged administration. We report the case of a patient suffering from visceral leishmaniasis, who developed worsening pancytopenia four to five days after being administered a single bolus dose of Liposomal Amphotericin B (L-AMB). The diagnosis was clinical and management involved supportive care, and granulocyte-macrophage colony-stimulating factor (GM-CSF). AMB is an effective drug, but is also associated with numerous side effects. Physicians are well-versed with the more frequently seen adverse drug reactions and their management. However, pancytopenia, being a rare adverse reaction to AMB, is less known and can be easily overlooked. This case report aims to ensure that the physicians must be aware of such possibilities in the first place to make swift diagnoses and management. The condition itself is seemingly self-limiting, although GM-CSF may be needed in refractory cases. It's true that few previous case reports have indicated pancytopenia in association with prolonged AMB exposure, but we believe certain conditions may predispose a patient to a more acute presentation - as seen in our case.

Development of genome-specific SSR markers for the identification of introgressed segments of Sinapis alba in the Brassica juncea background.

Sinapis alba L. (white mustard) is recognized for carrying host resistance against several biotic stresses including, Alternaria brassicae, which is responsible for blight disease in cultivated Brassica. However, another cultivated Brassica has a dearth for genetic resistance for these stresses due to its narrow genetic base. Therefore, we performed introgression of the genomic regions of S. alba into backcross progenies of B. juncea + S. alba somatic hybrids. These advanced generations with S. alba chromosomal segments are named B. juncea-S. alba introgression lines (ILs). In the present study, we developed the S. alba genome-specific microsatellites from the draft genome to track the S. alba genome introgressions and responsible regions for resistance to A. brassicae. For developing these SSR markers, the unique contigs of S. alba draft genome were identified through BLASTN with B. juncea, B. rapa, B. nigra, and B. oleracea reference genome assemblies, including mitochondrial and chloroplast genomes, and further used for marker development. Out of 403,423 contigs, we have identified 65,343 non-hit contigs of S. alba that yielded a total of 1231 genome-specific microsatellites, out of which 1107 were expected to produce a single allele upon amplification. Out of the total SSRs, 234 primer pairs were randomly picked from whole-genome and validated between B. juncea and S. alba genomes for their specificity. In the validation experiment, these markers gave a single amplicon into S. alba, while they did not amplify in B. juncea genome. Of these, 59 microsatellites were used to track S. alba introgressions in 80 BC2F3 lines. To the best of our knowledge, this is the first time that these two genetic resources are developed in the form of B. juncea-S. alba ILs and S. alba-specific markers. Therefore, both the resources unlock a new avenue of Brassica breeding for biotic and abiotic stresses along with quality traits. Supplementary Information: The online version contains supplementary material available at 10.1007/s13205-022-03402-0.

Development of de-novo transcriptome assembly and SSRs in allohexaploid Brassica with functional annotations and identification of heat-shock proteins for thermotolerance.

Crop Brassicas contain monogenomic and digenomic species, with no evidence of a trigenomic Brassica in nature. Through somatic fusion (Sinapis alba + B. juncea), a novel allohexaploid trigenomic Brassica (H1 = AABBSS; 2n = 60) was produced and used for transcriptome analysis to uncover genes for thermotolerance, annotations, and microsatellite markers for future molecular breeding. Illumina Novaseq 6000 generated a total of 76,055,546 paired-end raw reads, which were used for de-novo assembly, resulting in the development of 486,066 transcripts. A total of 133,167 coding sequences (CDSs) were predicted from transcripts with a mean length of 507.12 bp and 46.15% GC content. The BLASTX search of CDSs against public protein databases showed a maximum of 126,131 (94.72%) and a minimum of 29,810 (22.39%) positive hits. Furthermore, 953,773 gene ontology (GO) terms were found in 77,613 (58.28%) CDSs, which were divided into biological processes (49.06%), cellular components (31.67%), and molecular functions (19.27%). CDSs were assigned to 144 pathways by a pathway study using the KEGG database and 1,551 pathways by a similar analysis using the Reactome database. Further investigation led to the discovery of genes encoding over 2,000 heat shock proteins (HSPs). The discovery of a large number of HSPs in allohexaploid Brassica validated our earlier findings for heat tolerance at seed maturity. A total of 15,736 SSRs have been found in 13,595 CDSs, with an average of one SSR per 4.29 kb length and an SSR frequency of 11.82%. The first transcriptome assembly of a meiotically stable allohexaploid Brassica has been given in this article, along with functional annotations and the presence of SSRs, which could aid future genetic and genomic studies.

SARS-CoV-2 Vaccination in India: Considerations of Hesitancy and Bioethics in Global Health.

Introduction: Worldwide mass vaccination against SARS-CoV-2, while having been the most critical action in combating further waves of COVID-19, was initially fraught with multiple infrastructural and socio-cultural challenges. Vaccine hesitancy, a phenomenon of doubt over the vaccines' claimed efficacy and/or safety amidst access to vaccination, emerged as a major challenge for global health, despite approval and regular post-marketing surveillance by major regulatory bodies. Methods: We reviewed the literature related to vaccine hesitancy in India published until November 14, 2021 using relevant keywords in various databases and examined it from a bioethical perspective. Results: Factors driving hesitancy either intensified skepticism towards vaccination in general or exacerbated reluctance towards specific vaccines. In India, hesitancy towards indigenously developed vaccines was aggravated by the lack of peer-reviewed phase III trial data before the start of vaccination, lack of public transparency of regulatory bodies, and presence of public perception of inappropriately expedited processes. This perspective piece discusses the state of mass immunization in India as a case of how vaccination and its hesitancy thereof gave rise to unique bioethical challenges in global health. In early 2021, vaccination in India was subject to difficulties in adhering to the principles of equity and justice, while a compromise of the principles of informed consent, beneficence, and non-maleficence also perhaps did occur. Conclusions: Post-pandemic debriefing on the subversion of bioethical principles will be needed, and an appropriate response may be required to rebuild and enhance the public faith in future mass vaccination movements.

Introgression and QTL mapping conferring resistance for Alternaria brassicae in the backcross progeny of Sinapis alba + Brassica juncea somatic hybrids.

KEY MESSAGE: A total of three QTLs, responsible for A. brassicae resistance were introgressed into S. alba - B. juncea introgression lines from S. alba and mapped through donor genome-specific SSR markers. Alternaria brassicae is a key pathogen of the Brassicaceae family causing severe blight disease to oilseed crops that leads to heavy yield losses due to lack of resistance source within cultivated Brassicas. However, the host resistance present in the Sinapis alba, an allied member of the Brassicaceae family is still unexplored precisely due to the unavailability of segregating population for Alternaria blight resistance and scarcity of donor genome-specific genetic markers. The present study was undertaken to identify quantitative trait loci governing resistance to Alternaria blight which was introgressed from S. alba to the backcross population of stable S. alba + B. juncea somatic hybrids (2n = 60; AABBSS). The second backcross population showed significant phenotypic variations for Alternaria blight ranging from immune to highly susceptible phenotype, thus suggesting quantitative nature of resistance for the disease. A subset of 154 BC2F3-4 lines was used for disease screening and genotyping with 234 S. alba genome-specific microsatellite markers. As a result of the study, twelve linkage groups were developed corresponding to 12 chromosomes of S. alba (n = 12) covering a length of 1694.02 cM. The chromosomes 5 and 11 harbored a total of 1 (Abr-01), and 2 (Abr-02, and Abr-03) QTLs detected by ICIM-ADD mapping method at LOD score values 3.7, 5.12, and 6.74, respectively. The QTLs identified during the study have a range of 5.51-10.87 percent phenotypic variations for disease resistance. To the best of our knowledge, this is the first report of QTLs introgression for A. brassicae resistance in cultivated Brassica from an allied member of Brassicaceae.

Perception towards Online Teaching-learning in Medical Education among Medical Students during COVID-19 Outbreak in Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: The outbreak of coronavirus disease in Nepal led medical colleges to suspend in person teaching-learning activities and ultimately online platform was introduced to deliver the contents of medical education. The objective of this study was to describe the perception of medical students towards online teaching-learning introduced during the COVID-19 outbreak in Nepal. METHODS: An online survey using a descriptive cross-sectional study design was carried out among 515 undergraduate medical students currently enrolled in medical colleges in Nepal. Ethical approval was sought from Nepal Health Research Council to conduct this study, and digital informed consent was taken from study respondents. A semi-structured questionnaire in Google form was utilized to collect data. The link of the Google form was sent to the potential respondents through email and social media. Descriptive statistics, including frequency, percentage, mean, and standard deviation were used to analyze data in Stastical Package for the Social Sciences version 20. Ethical approval was sought from Nepal Health Research Council to conduct this study, and digital informed consent was taken from study respondants. RESULTS: The overall score of perception of online teaching-learning was 17.61±7.19, which indicated many problems in this method of teaching-learning. The mean score of perception of online teaching-learning was found to be different across sex, location of enrolled medical colleges, having a personal electronic device, having an internet connection at residence, having separate room/space for attending online classes, and self-rated computer skills. Moreover, only 28 (5.4%) of respondents had perceived online teaching-learning as a better method of delivering content of medical curricula. CONCLUSIONS: Surveyed medical students in Nepal were found to perceive many problems in online teaching-learning. Moreover, management and faculty members need to take the necessary measures for enhancing the online teaching-learning quality.

Current Status of the Disease-Resistant Gene(s)/QTLs, and Strategies for Improvement in Brassica juncea.

Brassica juncea is a major oilseed crop in tropical and subtropical countries, especially in south-east Asia like India, China, Bangladesh, and Pakistan. The widespread cultivation of genetically similar varieties tends to attract fungal pathogens which cause heavy yield losses in the absence of resistant sources. The conventional disease management techniques are often expensive, have limited efficacy, and cause additional harm to the environment. A substantial approach is to identify and use of resistance sources within the Brassica hosts and other non-hosts to ensure sustainable oilseed crop production. In the present review, we discuss six major fungal pathogens of B. juncea: Sclerotinia stem rot (Sclerotinia sclerotiorum), Alternaria blight (Alternaria brassicae), White rust (Albugo candida), Downy mildew (Hyaloperonospora parasitica), Powdery mildew (Erysiphe cruciferarum), and Blackleg (Leptoshaeria maculans). From discussing studies on pathogen prevalence in B. juncea, the review then focuses on highlighting the resistance sources and quantitative trait loci/gene identified so far from Brassicaceae and non-filial sources against these fungal pathogens. The problems in the identification of resistance sources for B. juncea concerning genome complexity in host subpopulation and pathotypes were addressed. Emphasis has been laid on more elaborate and coordinated research to identify and deploy R genes, robust techniques, and research materials. Examples of fully characterized genes conferring resistance have been discussed that can be transformed into B. juncea using advanced genomics tools. Lastly, effective strategies for B. juncea improvement through introgression of novel R genes, development of pre-breeding resistant lines, characterization of pathotypes, and defense-related secondary metabolites have been provided suggesting the plan for the development of resistant B. juncea.

Delivering High-Quality, Equitable Care in India: An Ethically-Resilient Framework for Healthcare Innovation After COVID-19.

Developing countries struggle to provide high-quality, equitable care to all. Challenges of resource allocation frequently lead to ethical concerns of healthcare inequity. To tackle this, such developing nations continually need to implement healthcare innovation, coupled with capacity building to ensure new strategies continue to be developed and executed. The COVID-19 pandemic has made significant demands of healthcare systems across the world-to provide equitable healthcare to all, to ensure public health principles are followed, to find novel solutions for previously unencountered healthcare challenges, and to rapidly develop new therapeutics and vaccines for COVID-19. Countries worldwide have struggled to accomplish these demands, especially the latter two, considering that few nations had long-standing systems in place to ensure processes for innovation were on-going before the pandemic struck. The crisis represents a critical juncture to plan for a future. This future needs to incorporate a vision for the implementation of healthcare innovation, coupled with capacity building to ensure new strategies continue to be developed and executed. In this paper, the case of the massive Indian healthcare system is utilized to describe how it could implement this vision. An inclusive, ethically-resilient framework has been broadly laid out for healthcare innovation in the future, thereby ensuring success in both the short- and the long-term.

Psychological and clinical-epidemiological profile of poisoning in Nepal: an institutional experience.

Background  Poisoning has become a major public health problem, with the intent in most cases being self-harm and commit suicide. This study highlights the psychological and clinical-epidemiological profile of patients visiting Scheer Memorial Adventist Hospital after poisoning.  Methods  This retrospective record-based study was done among poisoning patients of a hospital in Nepal from 1st January 2018 to 31st December 2020. Data were analyzed using STATA version-15.  Results  Out of 134 total poisoning cases, 71 had consumed organophosphate compounds. The majority of the cases were female (59.2% in organophosphate groups, 69.8% in non-organophosphate groups). The circumstances of poisoning were mostly suicidal (95.8% in organophosphate groups, 90.5% in non-organophosphate groups) and the reasons for this being mostly family disputes. Organophosphate groups had 8.41 times higher odds of having complications when compared to non-organophosphorus compounds.   Conclusions  The majority of the poisoning cases were suicidal in nature and family disputes being the major reason for the intake of a poisonous substance. This demands that more attention be given to psychological and family counseling to resolve any disputes, as well as psychological management of poisoning cases after medical management. Also, a strong regulatory mechanism should be imposed to control the easy access to poisonous substances.

Development of a Yellow-Seeded Stable Allohexaploid Brassica Through Inter-Generic Somatic Hybridization With a High Degree of Fertility and Resistance to Sclerotinia sclerotiorum.

The Brassica coenospeceis have treasure troves of genes that could be beneficial if introgressed into cultivated Brassicas to combat the current conditions of climate change. Introducing genetic variability through plant speciation with polyploidization is well documented, where ploidy augmentation of inter-generic allohexaploids using somatic hybridization has significantly contributed to genetic base broadening. Sinapis alba is a member of the Brassicaceae family that possesses valuable genes, including genes conferring resistance to Sclerotinia sclerotiorum, Alternaria brassicae, pod shattering, heat, and drought stress. This work aimed to synthesize stable allohexaploid (AABBSS) Brassica while incorporating the yellow-seed trait and resistance to S. sclerotiorum stem rot. The two fertile and stable allohexaploids were developed by polyethylene glycol mediated protoplast fusions between Brassica juncea (AABB) and S. alba (SS) and named as JS1 and JS2. These symmetric hybrids (2n = 60) were validated using morphological and molecular cytology techniques and were found to be stable over consecutive generations. The complete chromosome constitution of the three genomes was determined through genomic in situ hybridization of mitotic cells probed with S. alba genomic DNA labeled with fluorescein isothiocyanate. These two allohexaploids showed 24 hybridization signals demonstrating the presence of complete diploid chromosomes from S. alba and 36 chromosomes from B. juncea. The meiotic pollen mother cell showed 30 bivalent sets of all the 60 chromosomes and none of univalent or trivalent observed during meiosis. Moreover, the backcross progeny 1 plant revealed 12 hybridization signals out of a total of 48 chromosome counts. Proper pairing and separation were recorded at the meiotic metaphase and anaphase, which proved the stability of the allohexaploid and their backcross progeny. When screening, the allohexaploid (JS2) of B. juncea and S. alba displayed a high degree of resistance to S. sclerotiorum rot along with a half-yellow and half-brown (mosaic) seed coat color, while the B. juncea and S. alba allohexaplopid1 (JS1) displayed a yellow seed coat color with the same degree of resistance to Sclerotinia rot.

Clinicobacteriological evaluation of leprosy patients with 1-5 skin lesions.

Background: Mycobacterium leprae is a noncultivable mycobacteria, and diagnosis of the disease is based on its clinical and histopathological characteristics and finding the bacteria in skin scrapings and in biopsies taken from the patients. The aim of this study was to shed light on the clinical classification (based on the number of skin lesions) used extensively in the field where patients classified as paucibacillary (PB) were positive on skin smears and histopathology leading to treatment failure and drug resistance. Methods: In this study, we enrolled untreated 62 leprosy patients with 1-5 skin lesions and did a detailed bacterio-histopathological analysis by slit-skin smears (SSSs) and histopathology. Results: Of 62 patients analyzed, 15 patients came out to be multibacillary (MB) and 47 were PB by SSS and histopathology. Conclusion: The findings of the present study showed that the WHO classification of leprosy based on the number of lesions seems to be inappropriate as it considers a number of MB lesions as PB only, thus misleading the treatment strategies. Hence, it is essential that a comprehensive clinicobacteriological assessment of leprosy cases should be done to ensure the appropriate bacillary status and guiding the appropriate treatment strategy.

Draft genome of multiple resistance donor plant Sinapis alba: An insight into SSRs, annotations and phylogenetics.

BACKGROUND: Sinapis alba is a wild member of the Brassicaceae family reported to possess genetic resistance against major biotic and abiotic stresses of oilseed brassicas. However, the resistance nature of S. alba was not exploited generously due to the unavailability of usable genome sequences in public databases. Therefore, the present study was conducted to assemble the first draft genome from raw whole genome shotgun sequences with annotation and develop simple sequence repeat markers for molecular genetics and marker-assisted breeding. RESULTS: The raw genome sequences had 96x coverage on the Illumina platform with 170 Gbp data. The developed assembly by SOAPdenovo2 has ~459 Mbp genome size covered in 403,423 contigs with an average size of 1138.04 bp. The assembly was BLASTX with Arabidopsis thaliana which showed 32.9% positive hits between both plants. The top hit species distribution analysis showed the highest similarity with A. thaliana. A total of 809,597 GO level annotations were recorded after BLASTX results, and 34,012 sequences were annotated with different enzyme codes grouped under seven classes. The gene prediction tool AUGUSTUS identified 113,107 probable genes with an average size of 684 bp. The biochemical pathway annotation assigned 16,119 potential genes to 152 KEGG maps and 1751 enzyme codes. The development of potential SSRs from the de-novo assembly yielded 70731 unique primer pairs. Out of 159 randomly selected SSR markers for validation, 149 successfully amplified in S. alba. However, 10 SSR markers did not amplify during the validation experiment. CONCLUSION: The annotated genome assembly with a large number of SSRs was developed in the present study. To the best of our knowledge, this is the first report of S. alba genome assembly development, annotation, and SSRs mining to date. The data presented here will be a very important resource for future crop improvement programs, especially for resistant breeding.

Lund and Browder chart-modified versus original: a comparative study.

BACKGROUND: The Lund and Browder (LB) chart is currently the most accurate and widely used chart to calculate total body surface area affected by a burn injury. However, it is not easy to use charts to calculate burn percentages because of the difficulty in performing mathematical calculations with the percentages attributed to various body regions that are only partially burned. It is also cumbersome to have to perform mental calculations, especially in emergency situations. METHODS: We compared results from the LB chart with a modified Lund and Browder (MLB) chart using 10 assessors on five different burn wounds each drawn on both charts. RESULTS: Variability of results was significantly reduced using the MLB chart compared to the LB chart. CONCLUSIONS: Assessments performed using the MLB chart are less variable than those using the LB chart. Using this chart will help burn care providers rapidly, accurately, and reliably estimate burn extent.

Effect of exercise on type 2 diabetes-associated cognitive impairment in rats.

OBJECTIVES: Type 2 diabetes (T2D)-associated cognitive impairment is highly prevalent especially among the geriatric population. Here, we investigate the role of exercise in T2D-associated cognitive decline in rats. METHODS: T2D was induced using high-fat diet (15 days) followed by low-dose STZ (25mg/kg). The T2D animals were subjected to aerobic exercise on running wheel for 6 weeks. Effect of aerobic exercise on cognitive performance of T2D animals was measured using step-down and transfer latency tests. This was followed by the measurement of reduced glutathione levels in hippocampal homogenates. We also measured hippocampal AchE activity and levels of neuroinflammatory markers such as IL-1 ß, TNF-α and MCP-1. Morphology and density of hippocampal neurons were also determined by histopathological studies. RESULTS: Exercise led to the following changes in T2D animals. It led to decrease in fasting blood glucose level (<250 mg/kg) and HbA1c (8.5 ± 0.23) compared to diabetic (11.73 ± 0.14) animals and improved insulin resistance. There was an increase in step-down latency (p < 0.001) and a decrease in transfer latency (p < 0.01) suggesting improved cognitive function. A significant increase in GSH levels (1.828 ± 0.024) compared to diabetic group (1.52 ± 0.03; p < 0.001) and decrease in AchE activity (1.4 ± 0.05) compared to diabetic group (1.65 ± 0.03; p < 0.05) were also observed. It reduced the levels of neuroinflammatory markers such as IL-1ß, TNF-α and MCP-1 (p < 0.01). Hippocampal sections showed higher CA1 and CA3 neuronal density (p < 0.001) than T2D group. CONCLUSION: We may conclude that aerobic exercise could partially reverse diabetes-associated cognitive decline by reducing oxidative stress and inflammatory milieu in T2D animal brain.

A Humorously Serious Take on Plight of Postgraduate Medical Entrance Examinees in India.

Following is a satire on the plight of postgraduate medical entrance examinees in India. It highlights the questions they have to face during their entrance examination preparations and the annoying explanations they have to read in the entrance preparation books. Though the system of examination is improving in India, few loopholes do exist and need to be rectified. This article, thus, attracts the attention of readers towards one such backdrop regarding controversial/wrong/misprinted questions which has come a long way but still has scope of improvement.