Impact of COVID-19 pandemic on obstetrics and gynecology residency training program in India: A national online survey

Objective

The goal of this study was to analyze how the COVID‐19 pandemic affected the Obstetrics and Gynecology (OBG) residency program in India.

Study Design

This was a cross‐sectional questionnaire‐based online survey aimed to assess the impact of the pandemic on the residency training program in Obstetrics and Gynecology. The questionnaire consisted of five sections: demographic details, information regarding COVID‐19 status, clinical work load, teaching and research, and psychological impact.

Results

The questionnaire was completed by 280 OBG trainees from different medical colleges from India. Training activity in general was reduced considerably during the pandemic, according to 79.6% (n = 223) respondents. According to 13.21% (n = 37) and 5% (n = 14) respondents, reduction in training activity were due to cancelation of elective operations and reduced patient foot fall respectively. In 74.3% (n = 208) of cases, trainees reported worry about meeting the goals of their specialty training. Logistic regression showed that the extent of training reduction was not significantly associated with residents' age (p = 0.806), gender (p = 0.982), marital status (p = 0.363), and status of their duty in COVID‐19 dedicated hospitals (p = 0.110). However, year of residency was a significant predictor of the perception about degree of training reduction.

Conclusion

The pandemic imposed a significant impact on OBG residency training in India. During the pandemic, exposure to learning opportunities, surgeries, and teaching were reduced, which may result in a decline in the quality of care offered to women in the future if training deficit is not overcome. At the same time, pandemic also gave birth to newer insights of learning and interaction by online mode.

Challenges in implementation of mother milk banks in Rajasthan: A situational analysis

BACKGROUND

Breastmilk is the baby's "first vaccine". Donated human milk (DHM) is the next best alternative when a mother's milk is not available, as recommended by WHO- UNICEF. DHM as a nutritional source provides similar immune protection and may prove revolutionary in reducing neonatal morbidity and mortality. The study aimed to explore the challenges in the implementation of selected Mother Milk Banks (MMBs) of Rajasthan.

MATERIAL AND METHODS

A qualitative in-depth interview of key stakeholders was conducted to know the various facets of the challenges in milk banking practices using the Root Cause Analysis framework.

RESULTS

The system challenges identified in the functioning of AMMBs were lack of recurring funds, dedicated lactational counselors, and trained technicians. Databases for demand-supply estimates were also lacking. The community challenges were low acceptance of DHM due to safety concerns, risk of disease transmission, and quality of donated milk. Moreover, the religious stigma and cultural beliefs regarding the transfer of heredity traits and decrease in mother-child affection act as barriers in donating milk.

CONCLUSION

For acceptance and availability of DHM, Social Behavior Communication Change (SBCC) interventions must be incorporated early during the antenatal check-up period. Our study highlighted the role of education; motivation by healthcare providers has a major influence on infant feeding choices. In a developing country such as India, where the frameworks concerning the development of mother milk banks are still maturing, our study findings provide baseline information to address the barriers in the implementation of mother milk banks in India.

An hybrid deep learning approach for depression prediction from user tweets using feature-rich CNN and bi-directional LSTM

Depression has become one of the most widespread mental health disorders across the globe. Depression is a state of mind which affects how we think, feel, and act. The number of suicides caused by depression has been on the rise for the last several years. This issue needs to be addressed. Considering the rapid growth of various social media platforms and their effect on society and the psychological context of a being, it's becoming a platform for depressed people to convey feelings and emotions, and to study their behavior by mining their social activity through social media posts. The key objective of our study is to explore the possibility of predicting a user's mental condition by classifying the depressive from non-depressive ones using Twitter data. Using textual content of the user's tweet, semantic context in the textual narratives is analyzed by utilizing deep learning models. The proposed model, however, is a hybrid of two deep learning architectures, Convolutional Neural Network (CNN) and bi-directional Long Short-Term Memory (biLSTM) that after optimization obtains an accuracy of 94.28% on benchmark depression dataset containing tweets. CNN-biLSTM model is compared with Recurrent Neural Network (RNN) and CNN model and also with the baseline approaches. Experimental results based on various performance metrics indicate that our model helps to improve predictive performance. To examine the problem more deeply, statistical techniques and visualization approaches were used to show the profound difference between the linguistic representation of depressive and non-depressive content.

Deletion of STAT3 from Foxd1 cell population protects mice from kidney fibrosis by inhibiting pericytes trans-differentiation and migration

Signal transduction and activator of transcription 3 (STAT3) is a key transcription factor implicated in the pathogenesis of kidney fibrosis. Although Stat3 deletion in tubular epithelial cells is known to protect mice from fibrosis, vFoxd1 cells remains unclear. Using Foxd1-mediated Stat3 knockout mice, CRISPR, and inhibitors of STAT3, we investigate its function. STAT3 is phosphorylated in tubular epithelial cells in acute kidney injury, whereas it is expanded to interstitial cells in fibrosis in mice and humans. Foxd1-mediated deletion of Stat3 protects mice from folic-acid- and aristolochic-acid-induced kidney fibrosis. Mechanistically, STAT3 upregulates the inflammation and differentiates pericytes into myofibroblasts. STAT3 activation increases migration and profibrotic signaling in genome-edited, pericyte-like cells. Conversely, blocking Stat3 inhibits detachment, migration, and profibrotic signaling. Furthermore, STAT3 binds to the Collagen1a1 promoter in mouse kidneys and cells. Together, our study identifies a previously unknown function of STAT3 that promotes kidney fibrosis and has therapeutic value in fibrosis.

Abnormal exocrine-endocrine cell cross-talk promotes β-cell dysfunction and loss in MODY8

MODY8 (maturity-onset diabetes of the young, type 8) is a dominantly inherited monogenic form of diabetes associated with mutations in the carboxyl ester lipase (CEL) gene expressed by pancreatic acinar cells. MODY8 patients develop childhood-onset exocrine pancreas dysfunction followed by diabetes during adulthood. However, it is unclear how CEL mutations cause diabetes. In the present study, we report the transfer of CEL proteins from acinar cells to β-cells as a form of cross-talk between exocrine and endocrine cells. Human β-cells show a relatively higher propensity for internalizing the mutant versus the wild-type CEL protein. After internalization, the mutant protein forms stable intracellular aggregates leading to β-cell secretory dysfunction. Analysis of pancreas sections from a MODY8 patient reveals the presence of CEL protein in the few extant β-cells. The present study provides compelling evidence for the mechanism by which a mutant gene expressed specifically in acinar cells promotes dysfunction and loss of β-cells to cause diabetes.

Awareness, Attitude, and Acceptability of Healthcare Workers About COVID-19 Vaccination in Western India

Introduction In the coronavirus disease 2019 (COVID-19) pandemic, healthcare workers (HCWs) are at the frontline around the world and categorized as a priority group for COVID-19 vaccines. Our study aimed to find out the COVID-19 vaccine awareness, attitude, and acceptance in HCWs in western India. Methods A cross-sectional study was carried out between January 14 and January 28, 2021, at a tertiary care hospital located in western India. Data were collected anonymously using Google Forms. Descriptive statistics were used to determine the sociodemographic variables. The knowledge and attitude of HCWs were analyzed using mean and SD. Multivariate analysis was done to find out the association between participants' attitudes with demographic characteristics. Results Of the total health care workers, 498 answered the survey. The mean age of participants was 29.8 years (SD 6.4), and 354 (71.1%) were male. Among the respondents, 445 (89.4%) would accept a COVID-19 vaccine when available. Four-hundred seventy-six (476) HCWs (95.6%) had excellent knowledge regarding COVID-19 and COVID-19-appropriate behavior. The majority of the subjects (399) had a neutral attitude toward COVID-19 vaccination. Health care professionals (doctors and nurses) had higher acceptance for vaccination against COVID-19 than non-professionals. Conclusions The higher rates of COVID-19 vaccine acceptability and the excellent knowledge among HCWs will directly enhance the level and acceptability of vaccine among the general population and will definitely help in reducing the mortality and morbidity related to COVID-19.

Comprehensive Search for Novel Circulating miRNAs and Axon Guidance Pathway Proteins Associated with Risk of ESKD in Diabetes

BACKGROUND

Mechanisms underlying the pro gression of diabetic kidney disease to ESKD are not fully understood.

METHODS

We performed global microRNA (miRNA) analysis on plasma from two cohorts consisting of 375 individuals with type 1 and type 2 diabetes with late diabetic kidney disease, and targeted proteomics analysis on plasma from four cohorts consisting of 746 individuals with late and early diabetic kidney disease. We examined structural lesions in kidney biopsy specimens from the 105 individuals with early diabetic kidney disease. Human umbilical vein endothelial cells were used to assess the effects of miRNA mimics or inhibitors on regulation of candidate proteins.

RESULTS

In the late diabetic kidney disease cohorts, we identified 17 circulating miRNAs, represented by four exemplars (miR-1287-5p, miR-197-5p, miR-339-5p, and miR-328-3p), that were strongly associated with 10-year risk of ESKD. These miRNAs targeted proteins in the axon guidance pathway. Circulating levels of six of these proteins-most notably, EFNA4 and EPHA2-were strongly associated with 10-year risk of ESKD in all cohorts. Furthermore, circulating levels of these proteins correlated with severity of structural lesions in kidney biopsy specimens. In contrast, expression levels of genes encoding these proteins had no apparent effects on the lesions. In in vitro experiments, mimics of miR-1287-5p and miR-197-5p and inhibitors of miR-339-5p and miR-328-3p upregulated concentrations of EPHA2 in either cell lysate, supernatant, or both.

CONCLUSIONS

This study reveals novel mechanisms involved in progression to ESKD and points to the importance of systemic factors in the development of diabetic kidney disease. Some circulating miRNAs and axon guidance pathway proteins represent potential targets for new therapies to prevent and treat this condition.

Distribution and molecular characterisation of Lactobacilli in the oral cavity of children

Background

Dental caries is a chronic and multifactorial disease mainly caused by microorganisms that are accumulated on soft and hard tissues of oral cavity. Lactobacillus is one of that kind, produces acid after metabolic breakdown of dietary sugar and reduces the pH of oral environment, resulting in teeth demineralisation or dental caries.

Aim

The present study focuses on the distribution and characterisation of lactobacilli in the oral cavity of children which are associated with dental caries formation.

Methods

Total 116 swab samples were collected from different age groups of children by swabbing the caries surface of teeth. Physiological, morphological and biochemical characteristics of Lactobacillus were analysed. Whole cell protein profiling using SDS-PAGE was also performed for their characterisation. Molecular characterisation of selected isolates was done using 16S-rRNA sequencing for identification.

Results

Total 269 isolates were successfully isolated and identified by physiological and biochemical tests according to Bergey's Manual Systematic Bacteriology, which belongs to the seven species of Lactobacillus i.e., L. acidophilus, L. casei, L. delbrueckii, L. helveticus, L. plantarum, L. rhamnosus, L. salivarius. All the isolates were further differentiated by whole cell proteins profiling and species level identification was done by 16S-rRNA gene sequencing method.

Conclusions

The present study, suggested that the occurrence of the species of Lactobacillus changes with the age of the individual, but L. rhamnosus (20.54%) and L. acidophilus (18.21%) were abundantly found in age group of 3-12 yr which could be the possible causative agent of dental caries formation in the children of Central India.

Sex Determination in Western Indian Population by Limb Measurements

For individual identification, the principal biological element is sex determination from disfigured and amputated limbs or body fragments in forensic investigation. Diverse dimensions and proportions affect the anthropometric assessment of sex in different populations. A cross-sectional study was conducted during July 2014 to June 2016 on five hundred and four healthy individuals of age-group 22-40 years of Western India to see the degree of sexual dimorphism in limb measurements. The forearm length, whole upper limb length, tibial length and whole lower limb length of both sides were measured by the universal anthropometric criteria. Demarking points, sexual dimorphism indices and discriminant functions were developed for each measurement. The sexual dimorphism was observed in all variables and males have a higher value than females (p<0.001). The tibial length showed the highest accuracy in sex determination and the highest sexual dimorphism, followed by whole lower limb length. The range of Cross-validated sex classification precision was between 58-90% for the individual variables, 91.7% for the stepwise method and 95.4% for all measurements taken together. The established prototypes delivered effective and consistent sex estimates with high precision rates and low prediction errors.

Recurrent Atrial Flutter Requiring Multiple Cardioversions in a Preterm Infant

We describe the first case of atrial flutter requiring multiple cardioversions in a preterm infant. Direct current cardioversion is one of the best-understood treatment options, with a first-time success rate higher than 96%. The electrocardiograms provided reveal a second run of atrial flutter occurring after successful cardioversion. (Level of Difficulty: Intermediate.).

Recent approaches towards one-carbon homologation-functionalization of aldehydes

One-carbon homologation-functionalization in organic synthesis is a quite challenging and difficult task in terms of atom economy, ease of reaction, selectivity and number of steps involved. Due to the reactivity associated with most classes of carbonyls, these groups have always attracted a great deal of attention from synthetic chemists to transform them into various functionalities. In this context various researchers developed new methods for one-carbon extension-functionalization of carbonyls that serve as effective synthetic methodologies and are widely used in target-oriented and natural product synthesis. On account of the vast applicability associated with these transformations, herein we seek to summarize and highlight the important synthetic achievements in this advancing arena for various one-carbon homologation cum functionalization reactions of aldehydes and deep dive into some modern approaches adopted by organic chemists.

Insulin receptor substrate 1, but not IRS2, plays a dominant role in regulating pancreatic alpha cell function in mice

Dysregulated glucagon secretion deteriorates glycemic control in type 1 and type 2 diabetes. Although insulin is known to regulate glucagon secretion via its cognate receptor (insulin receptor, INSR) in pancreatic alpha cells, the role of downstream proteins and signaling pathways underlying insulin's activities are not fully defined. Using in vivo (knockout) and in vitro (knockdown) studies targeting insulin receptor substrate (IRS) proteins, we compared the relative roles of IRS1 and IRS2 in regulating alpha cell function. Alpha cell-specific IRS1-knockout mice exhibited glucose intolerance and inappropriate glucagon suppression during glucose tolerance tests. In contrast, alpha cell-specific IRS2-knockout animals manifested normal glucose tolerance and suppression of glucagon secretion after glucose administration. Alpha cell lines with stable IRS1 knockdown could not repress glucagon mRNA expression and exhibited a reduction in phosphorylation of AKT Ser/Thr kinase (AKT, at Ser-473 and Thr-308). AlphaIRS1KD cells also displayed suppressed global protein translation, including reduced glucagon expression, impaired cytoplasmic Ca2+ response, and mitochondrial dysfunction. This was supported by the identification of novel IRS1-specific downstream target genes, Trpc3 and Cartpt, that are associated with glucagon regulation in alpha cells. These results provide evidence that IRS1, rather than IRS2, is a dominant regulator of pancreatic alpha cell function.

Defective insulin receptor signaling in hPSCs skews pluripotency and negatively perturbs neural differentiation

Human embryonic stem cells are a type of pluripotent stem cells (hPSCs) that are used to investigate their differentiation into diverse mature cell types for molecular studies. The mechanisms underlying insulin receptor (IR)-mediated signaling in the maintenance of human pluripotent stem cell (hPSC) identity and cell fate specification are not fully understood. Here, we used two independent shRNAs to stably knock down IRs in two hPSC lines that represent pluripotent stem cells and explored the consequences on expression of key proteins in pathways linked to proliferation and differentiation. We consistently observed lowered pAKT in contrast to increased pERK1/2 and a concordant elevation in pluripotency gene expression. ERK2 chromatin immunoprecipitation, luciferase assays, and ERK1/2 inhibitors established direct causality between ERK1/2 and OCT4 expression. Of importance, RNA sequencing analyses indicated a dysregulation of genes involved in cell differentiation and organismal development. Mass spectrometry–based proteomic analyses further confirmed a global downregulation of extracellular matrix proteins. Subsequent differentiation toward the neural lineage reflected alterations in SOX1⁺PAX6⁺ neuroectoderm and FOXG1⁺ cortical neuron marker expression and protein localization. Collectively, our data underscore the role of IR-mediated signaling in maintaining pluripotency, the extracellular matrix necessary for the stem cell niche, and regulating cell fate specification including the neural lineage.

Relationship of depth of invasion to survival outcomes and patterns of recurrence for T3 oral tongue squamous cell carcinoma

INTRODUCTION

Current research is elucidating how the addition of depth of invasion (DOI) to the 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging for oral cavity squamous cell carcinoma influences its prognostic accuracy. However, there is limited research on survival in pT3N0M0 oral tongue SCC (OTSCC) patients when stratifying by DOI.

OBJECTIVES

Determine 5-year overall survival (OS), and cancer-specific survival (CSS) for patients with pT3N0M0 oral OTSCC based on shallow DOI (<10 mm) and deep DOI (10-20 mm).

METHODS

Retrospective review involving three tertiary care cancer centers in North America. cT3N0M0 OTSCC patients receiving primary surgical treatment from 2004 to 2018 were identified. Inclusion: age > 18 years old and confirmation of pT3N0M0 OTSCC on surgical pathology. Exclusion: patients undergoing palliative treatment or previous head and neck surgery/radiotherapy. Analysis comprised two groups: shallow pT3 (tumor diameter > 4 cm, DOI < 10 mm) and deep pT3 (DOI 10 mm-20 mm).

RESULTS

One hundred and four patients with pT3N0M0 OTSCC were included. Mean age was 59.1 years (range: 18-80.74). Age, gender, and Charlson Comorbidity Index were similar between the two groups (p > 0.05). Recurrence, LVI, PNI, and positive margins were more common in deep T3 tumors (P < 0.05). 5-year OS (50% vs 26%, p = 0.006) and CSS (72% vs 24%, p = 0.005) were worse in deep pT3 tumors. Deep pT3 disease was an independent predictor of OS (p = 0.004) and CSS (p = 0.01) on Cox-Regression analysis.

CONCLUSION

DOI is an independent predictor of poor survival in pT3N0M0 OTSCC patients. Consideration should be given to escalating adjuvant therapy for deep pT3N0M0 OTSCC patients.

Essential roles of insulin and IGF-1 receptors during embryonic lineage development

The insulin and insulin-like growth factor-1 (IGF-1) receptors are important for the growth and development of embryonic tissues. To directly define their roles in the maintenance of pluripotency and differentiation of stem cells, we knocked out both receptors in induced pluripotent stem cells (iPSCs). iPSCs lacking both insulin and IGF-1 receptors (double knockout, DKO) exhibited preserved pluripotency potential despite decreased expression of transcription factors Lin28a and Tbx3 compared to control iPSCs. While embryoid body and teratoma assays revealed an intact ability of DKO iPSCs to form all three germ layers, the latter were composed of primitive neuroectodermal tumor-like cells in the DKO group. RNA-seq analyses of control vs DKO iPSCs revealed differential regulation of pluripotency, developmental, E2F1, and apoptosis pathways. Signaling analyses pointed to downregulation of the AKT/mTOR pathway and upregulation of the STAT3 pathway in DKO iPSCs in the basal state and following stimulation with insulin/IGF-1. Directed differentiation toward the three lineages was dysregulated in DKO iPSCs, with significant downregulation of key markers (Cebpα, Fas, Pparγ, and Fsp27) in adipocytes and transcription factors (Ngn3, Isl1, Pax6, and Neurod1) in pancreatic endocrine progenitors. Furthermore, differentiated pancreatic endocrine progenitor cells from DKO iPSCs showed increased apoptosis. We conclude that insulin and insulin-like growth factor-1 receptors are indispensable for normal lineage development and perturbations in the function and signaling of these receptors leads to upregulation of alternative compensatory pathways to maintain pluripotency.

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Insulin and IGF-1 receptor signaling regulate the expression of pluripotency genes Lin28 and Tbx3.

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The STAT3 pathway is upregulated in DKO iPSCs.

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RNA-seq analyses revealed key developmental and apoptosis pathways regulated by insulin and IGF-1 receptors.

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Lineage development was dysregulated in DKO iPSCs with downregulation of key mesoderm and endodermal markers.

DAP derived fatty acid amide organogelators as novel carrier for drug incorporation and pH-responsive release

Low-molecular mass fatty acid amide gelators were synthesized using 2,6-diaminopyridine as a linker and alkyl chains of varying lengths. The prepared organogel-elusions are able to trap and release ibuprofen molecule without changing its structure and activity.

Two-point versus three-point fixation in the management of zygomaticomaxillary complex fractures: A comparative study

Introduction:

The zygoma plays an important role in the facial contour for both cosmetic and functional reasons; therefore, zygomatic bone injuries should be properly diagnosed and adequately treated. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements that require a protocol for management and long-term follow-up. The objectives of this study were to compare the efficacy of zygomatic bone after treatment with open reduction internal fixation (ORIF) using two-point fixation and ORIF using three-point fixation and compare the outcome of two procedures.

Materials and Methods:

Twenty patients were randomly divided equally into two groups. In Group A, ten patients were treated by ORIF using two-point fixation by miniplates and in Group B, ten patients were treated by ORIF using three-point fixation by miniplates. They were evaluated with their advantages and disadvantages and the difference between the two groups was observed.

Results:

We found that postoperative facial and neurological complications are minimum in two-point fixation group. Based on this study, open reduction and internal fixation using two-point fixation by miniplates is sufficient and the best available treatment of choice for the management of zygomaticomaxillary complex fractures.

Discussion:

Alignment of the fracture at three points and fixation at two stable points provide the most accurate and satisfactory postoperative results. Two-point interosseous fixation at the “buttress” fracture and the frontozygomatic (FZ) fracture is suitable for routine surgery. The results of these studies confirm with the present study that two-point fixation provided better stability in patients with clinical and radiological evidence of fracture in FZ and zygomaticomaxillary buttress area.

Breast cancer risk factor evaluation in a Western Himalayan state: A case-control study and comparison with the Western World

Context:

Breast cancer incidence is increasing rapidly in India. The lifestyle, built, genetic makeup, reproductive and breastfeeding patterns are quite different in Indian females when compared to the Western population. Generalizing the Western data to the population residing in the Himalayan region would breed inaccuracies.

Aim:

The aim of our study was to identify risk factors in our own population in a Western Himalayan state of Himachal Pradesh, India.

Subjects and Methods:

A case–control study with 377 cases of invasive breast cancer and 346 hospital-based controls was conducted for 1 year. The data were collected by interviewing the individuals during their visit to hospital using a questionnaire. The data were analyzed using standard statistical techniques using SPSS version 17 software.

Results:

Factors found to have strong association with invasive breast cancer on multivariate analysis are late age at first childbirth >30 years, which is the strongest risk factor associated, late age of menopause > 50 years, high socioeconomic class, and age of female above 50 years.

Conclusion:

In our females, age >50 years, late age of menopause (>50 years), late age at first childbirth (>30 years), and high socioeconomic status were found to be major risk factors associated with breast cancer. Several factors implicated in the Western data were not found to be significant in our study. We need to identify such aspects in reproductive and breastfeeding patterns of women and spread awareness regarding the same.

A Prospective Observational Study Comparing Long-Course Conventional Neoadjuvant Chemoradiotherapy with Short-Course Radiotherapy Followed by Consolidation Chemotherapy with Delayed Surgery in Locally Advanced Rectal Cancer

Background  Polish and Australian randomized studies compared short-course radiotherapy (RT) with immediate surgery and long-course chemoradiotherapy (CRT) with delayed surgery. In these studies, similar long-term survival and local control have been reported for both these approaches, but pathological complete response (pCR) is not better with short-course RT. Moreover, studies have shown better tumor downstaging with delayed surgery. In this context, the use of short-course RT with delayed surgery may have some advantages and needs to be tested in clinical trials. Patients and Methods  This was a two-arm, prospective, observational study, in which preoperative short-course RT followed by two cycles of chemotherapy was compared with the conventional neoadjuvant CRT in locally advanced rectal cancer. The primary end points were the rate of complete response and toxicity profile. The secondary end points were the rate of R0 resection, overall survival, and progression-free survival. The data obtained from the two arms were analyzed using Pearson's chi-square test to determine the statistical significance between the two treatment arms. Results  The pCR rate was 6.7% in the study arm and 0 in the control arm ( p = 0.343). The RO resection rates were 92.8 and 92.3% in the study and control arms, respectively. The rates of grade 3and 4 acute toxicity in the study and control arms were 14.2 and 61.5%, respectively ( p = 0.011). The rates of grade 3 and 4 late toxicity in the study and control arms were 21.4 and 15.3%, respectively ( p = 0.686). Conclusions  The pCR rates and the late toxicities in both arms are comparable. The major advantages of the 5 × 5 Gy regimen with chemotherapy in a neoadjuvant setting are a significant reduction in acute toxicities and better patient compliance along with similar efficacy as that of the standard regimen.

Potential of graphene-based materials to combat COVID-19: properties, perspectives, and prospects

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new virus in the coronavirus family that causes coronavirus disease (COVID-19), emerges as a big threat to the human race. To date, there is no medicine and vaccine available for COVID-19 treatment. While the development of medicines and vaccines are essentially and urgently required, what is also extremely important is the repurposing of smart materials to design effective systems for combating COVID-19. Graphene and graphene-related materials (GRMs) exhibit extraordinary physicochemical, electrical, optical, antiviral, antimicrobial, and other fascinating properties that warrant them as potential candidates for designing and development of high-performance components and devices required for COVID-19 pandemic and other futuristic calamities. In this article, we discuss the potential of graphene and GRMs for healthcare applications and how they may contribute to fighting against COVID-19.

Leptin Receptor Signaling Regulates Protein Synthesis Pathways and Neuronal Differentiation in Pluripotent Stem Cells

The role of leptin receptor (OB-R) signaling in linking pluripotency with growth and development and the consequences of dysfunctional leptin signaling on progression of metabolic disease is poorly understood. Using a global unbiased proteomics approach we report that embryonic fibroblasts (MEFs) carrying the db/db mutation exhibit metabolic abnormalities, while their reprogrammed induced pluripotent stem cells (iPSCs) show altered expression of proteins involved in embryonic development. An upregulation in expression of eukaryotic translation initiation factor 4e (Eif4e) and Stat3 binding to the Eif4e promoter was supported by enhanced protein synthesis in mutant iPSCs. Directed differentiation of db/db iPSCs toward the neuronal lineage showed defects. Gene editing to correct the point mutation in db/db iPSCs using CRISPR-Cas9, restored expression of neuronal markers and protein synthesis while reversing the metabolic defects. These data imply a direct role for OB-R in regulating metabolism in embryonic fibroblasts and key developmental pathways in iPSCs.

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Pluripotency markers are decreased in db/db iPSCs (lacking functional OB-R)

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Mouse db/db iPSCs exhibit higher protein synthesis mediated by the Stat3/Eif4e axis

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OB-R signaling regulates neuronal development markers—NOGGIN, NESTIN, GFAP

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CRISPR correction reverses defects in db/db iPSCs

Tissue-Specific Fructose Metabolism in Obesity and Diabetes

PURPOSE OF REVIEW

The objective of this review is to provide up-to-date and comprehensive discussion of tissue-specific fructose metabolism in the context of diabetes, dyslipidemia, and nonalcoholic fatty liver disease (NAFLD).

RECENT FINDINGS

Increased intake of dietary fructose is a risk factor for a myriad of metabolic complications. Tissue-specific fructose metabolism has not been well delineated in terms of its contribution to detrimental health effects associated with fructose intake. Since inhibitors targeting fructose metabolism are being developed for the management of NAFLD and diabetes, it is essential to recognize how inability of one tissue to metabolize fructose may affect metabolism in the other tissues. The primary sites of fructose metabolism are the liver, intestine, and kidney. Skeletal muscle and adipose tissue can also metabolize a large portion of fructose load, especially in the setting of ketohexokinase deficiency, the rate-limiting enzyme of fructose metabolism. Fructose can also be sensed by the pancreas and the brain, where it can influence essential functions involved in energy homeostasis. Lastly, fructose is metabolized by the testes, red blood cells, and lens of the eye where it may contribute to infertility, advanced glycation end products, and cataracts, respectively. An increase in sugar intake, particularly fructose, has been associated with the development of obesity and its complications. Inhibition of fructose utilization in tissues primary responsible for its metabolism alters consumption in other tissues, which have not been traditionally regarded as important depots of fructose metabolism.

Systems approach for assessment of maternal deaths in Rajasthan: A feasibility study

Background

High maternal mortality in the state like Rajasthan, which is at second rank in terms of high Maternal Mortality Ratio (MMR) in India, require concentrated efforts in this direction The objectives of this study were to assess the magnitude and trend of maternal death and underlying factors contributing to maternal deaths in Rajasthan and to identify barriers and challenges in reporting maternal deaths in Rajasthan.

Methods

Data related to maternal deaths, cause of deaths and live births were retrieved from official Government sources and MMR was calculated. To find out the underlying factors contributing to maternal deaths, Verbal Autopsies were conducted through household surveys. In-depth interviews of health care staff were conducted to carry out the 'SWOT' analysis in order to identify the barriers in reporting maternal deaths. Data was analysed using SPSS version 23.

Results

A total of 7185 maternal deaths were reported from Rajasthan in last five years. The mean age of mothers was 25.18±4.98 years. Haemorrhage were reported as most common cause of maternal death (17%) followed by Severe hypertension or fits (8%) and obstructed labour (2%). The median duration of hospital stay was 23 hours (IQR=7.5-70). Maximum deaths were reported during post-partum period (61%), while around one fourth of the deaths happened during delivery.

Conclusions

The discrepancies were observed in the reporting of number and causes of maternal deaths. The trend and forecasted figures were quite different from the published National and State level reports in this regard.

Key messages

need to streamline and strengthen the Maternal Deaths Surveillance and Response to track the number of deaths and get the exact information about the underlying factors contributing to them. Effective strategies can be developed to reduce the Maternal Deaths in the State.

Prolonged persistence of SARS-CoV-2 in the upper respiratory tract of asymptomatic infected individuals

BACKGROUND

Duration of persistence of SARS-CoV-2 in the upper respiratory tract of infected individuals has important clinical and epidemiological implications.

AIM

We aimed to establish the duration and risk factors for persistence of SARS-CoV-2 in the upper respiratory tract of asymptomatic infected individuals.

METHODS

Data of repeat rRT-PCR (real-time reverse transcription-polymerase chain reaction) test done for SARS-CoV-2 infected individuals at our institute at Jodhpur, India were analysed from 19 March to 21 May 2020. Duration of virus persistence was estimated with parametric regression models based on weibull, log-normal, log-logistic, gamma and generalized gamma distributions. Factors associated with prolonged viral persistence were analysed with the best-fitting model.

RESULTS

Fifty-one SARS-CoV-2 infected individuals with repeat rRT-PCR test were identified with 44 asymptomatics. The asymptomatic individuals had median virus persistence duration of 8.87 days (95% CI: 7.65-10.27) and 95 percentile duration of 20.70 days (95% CI: 16.08-28.20). The overall median virus persistence including both symptomatic and asymptomatic individuals was found to be 9.18 days (95% CI: 8.04-10.48). Around one-fourth asymptomatics (10/44) demonstrated SARS-CoV-2 persistence beyond 2 weeks. Age <60 years and local transmission were found to be significantly associated with longer virus persistence among asymptomatic individuals on univariate regression but not in multivariate analysis.

CONCLUSION

Recommended home isolation duration for SARS-CoV-2 infected individuals in India should be extended from 17 days to at least 3 weeks. Prolonged persistence of SARS-CoV-2 in a considerable proportion of asymptomatic individuals merits attention with regard to ensuring universal infection prevention precautions irrespective of symptomatic status.