Hydrogen sulphide-mediated alleviation and its interplay with other signalling molecules during temperature stress

The sessile habit of plants does not provide choices to escape the environmental constraints, leading to negative impacts on their growth and development. This causes significant losses in the agriculture sector and raises serious issues on global food security. Extreme temperatures (high or low) influence several aspects of plant life and can cause reproduction malfunction. Therefore, a strategy for temperature amelioration is necessary for the management of agricultural productivity. Supplementation with various chemicals (e.g. phytohormones, gasotransmitters, osmolytes) is considered a good choice to manage plant stress. Gasotransmitters are well-recognized for stress mitigation in plants, among which hydrogen sulphide (H₂ S) has proved promising to alleviate stress. Temperature (heat/cold) stress can stimulate the endogenous production of H₂ S in plants, and many studies have reported the significance of H₂ S for temperature stress amelioration. Here, H₂ S led to positive changes in plant physiological, biochemical and molecular responses, which are usually compromised during stress. Further, H₂ S also coordinate with other signalling components that act either upstream or downstream during stress mitigation. This review focuses on the significance of H₂ S for mitigation of temperature stress, with a comprehensive discussion on cross-talk with other signalling components or supplements (e.g. NO, H₂ O₂ , salicylic acid, trehalose, proline). Finally, the review provides a rational assessment and holistic understanding of H₂ S-mediated mitigation of extreme temperature stress and addresses the prospects for development of an effective strategy to manage temperature stress.

Labour absorption in livestock activities in arid Western and Northern region ofRajasthan

In the arid western and northern regions of Rajasthan livestock activity is a complementary activity to farming and it provides much needed risk cover in case of crop failure. The present investigation was undertaken to study the labour absorption in different livestock activities in Arid western and northern regions of Rajasthan. The study was conducted based on primary data. The primary data were collected from the 200 households of 10 villages during year of the 2018-2019. The average utilization of human labour in livestock activities was found 54.48 man-days/animal/year in arid western and northern region. The participation of woman labour in all livestock activities was found more than man labour in all herd size group in arid western and northern region. The annual average human labour absorption was maximum in site preparation activity i.e., 28.76 hours/animal/year for male and 101.63 hours/animal/year for female, then other activities in all size of farms.

COVID-19 vaccination and breakthrough infections in patients with cancer

BACKGROUND

Vaccination is an important preventive health measure to protect against symptomatic and severe COVID-19. Impaired immunity secondary to an underlying malignancy or recent receipt of antineoplastic systemic therapies can result in less robust antibody titers following vaccination and possible risk of breakthrough infection. As clinical trials evaluating COVID-19 vaccines largely excluded patients with a history of cancer and those on active immunosuppression (including chemotherapy), limited evidence is available to inform the clinical efficacy of COVID-19 vaccination across the spectrum of patients with cancer.

PATIENTS AND METHODS

We describe the clinical features of patients with cancer who developed symptomatic COVID-19 following vaccination and compare weighted outcomes with those of contemporary unvaccinated patients, after adjustment for confounders, using data from the multi-institutional COVID-19 and Cancer Consortium (CCC19).

RESULTS

Patients with cancer who develop COVID-19 following vaccination have substantial comorbidities and can present with severe and even lethal infection. Patients harboring hematologic malignancies are over-represented among vaccinated patients with cancer who develop symptomatic COVID-19.

CONCLUSIONS

Vaccination against COVID-19 remains an essential strategy in protecting vulnerable populations, including patients with cancer. Patients with cancer who develop breakthrough infection despite full vaccination, however, remain at risk of severe outcomes. A multilayered public health mitigation approach that includes vaccination of close contacts, boosters, social distancing, and mask-wearing should be continued for the foreseeable future.

22 Lessons Learned During COVID-19 Pandemic, a Worldwide Survey: Part 1 -Evolution of Global Neurosurgical Practice

Aim

During the COVID-19 pandemic, many surveys have analysed the impact of the virus spreading on everyday medical practice, including neurosurgery. However, no one has examined the perceptions of neurosurgeons towards the pandemic, their life changes, and the strategies they implemented to deal with their patients in such a difficult time.

Method

From April 2021 to May 2021, a modified Delphi method was used to construct, pilot, and refine the questionnaire. The first part focused on the evolution of global neurosurgical practice during the pandemic. This survey was distributed worldwide among 1000 neurosurgeons. The responses were then collected and critically analysed.

Results

Outpatient department practices changed with a rapid rise in teleservices. 63.9% of respondents reported that they had changed their OT practices to emergency cases with occasional elective cases. 40.0% of respondents and 47.9% of their family members reported having suffered from COVID-19 at some time. 56.2% of the respondents reported having felt depressed in the last 1 year. 80.6% of the respondents found online webinars to be a good source of learning. 47.8% of respondents tried to improve their neurosurgical knowledge, while 31.6% spent extra time in research activities during the COVID-19 pandemic.

Conclusions

Progressive increase in operative waiting lists, preferential use of telemedicine, reduction in the tendency to complete stoppage of physical clinic services and reduction in the administration and application of PPE kits were evident across the world. Respondents’ age impacted how the clinical services and impacted mental health across the global neurosurgical fraternity.

Morphometric Analysis of Anatomy of Anterior Cruciate Ligament of Knee and its Attachments - a Cadaveric Study in Indian Population

Introduction:

The Anterior Cruciate Ligament tends to stabilise the knee in various range of extension and flexion. Precise study of anatomy, attachments and position of bundles is important for successful ACL reconstruction. In our study, we attempt to assess general anatomy of ACL, determine and compare its morphometric data pertaining to length and width and its tibio-femoral foot prints in different gender and secondarily determine changes in the same during ACL dynamics witnessed during knee flexion changes.

Materials and methods:

A total of 19 knees from 10 cadavers were used in the research with mean age of 61±7 years. After dissecting the skin, muscles, patellar and articular capsule were removed and bundle attachments were studied. Thereafter the relative length, width and stiffness of ACL bundles at 0, 90, 140 (maximum) angles of knee flexion were measured along with maximum horizontal and vertical bundle footprints at tibio-femoral attachments were recorded.

Results:

Mean length and width of insertion of anteromedial (AM) bundle on the tibial surface was 8.8mm and 9.0mm in males and 8.1mm and 8.8mm in females. Furthermore, that of PL bundle was 9.1mm and 7.8mm in males and 8.9mm and 7.1mm in females.

Conclusion:

The anteromedial (AM) bundle and posterolateral (PL) bundle of ACL were found to be most relaxed at full extension and were most taut at maximum flexion of 140°. AM bundle underwent greater stretching and change of length in comparison to the PL bundle, indicating that it is comparatively a more dominant bundle.

Consecutive Hits of COVID-19 in India: The Mystery of Plummeting Cases and Current Scenario

The novel coronavirus disease 2019 (COVID-19)-related pandemic has been in existence for almost 2 years now after its possible emergence from a wet market in the city of Wuhan of the Chinese mainland. Evidence of the emergence and transmission of this virus was attributed to bats and pangolins. The causative virus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has rapidly spread globally, affecting humans considerably with its current death toll to be over 4.7 million out of more than 233 confirmed cases as of September 2021. The virus is constantly mutating and continuously trying to establish itself in humans by increasing its transmissibility and virulence through its numerous emerging variants. Several countries have been facing multiple waves of COVID-19 outbreaks one after the other, putting the medical and healthcare establishments under tremendous stress. Although very few drugs and vaccines have been approved for emergency use, their production capabilities need to meet the needs of a huge global population. Currently, not even a quarter of the world population is vaccinated. The situation in India has worsened during the ongoing second wave with the involvement of virus variants with a rapid and huge surge in COVID-19 cases, where the scarcity of hospital infrastructure, antiviral agents, and oxygen has led to increased deaths. Recently, increased surveillance and monitoring, strengthening of medical facilities, campaigns of awareness programs, progressive vaccination drive, and high collaborative efforts have led to limiting the surge of COVID-19 cases in India to a low level. This review outlines the global status of the pandemic with special reference to the Indian scenario.

1454 The Challenges of Consent and COVID-19: Analysis of Documentation of Risk of Hospital Acquired COVID-19 Infection in a District General Hospital

Background

The COVID-19 pandemic has been a challenging time for society and raised further challenges for medical practice. It poses a new material risk to any hospital admission or procedure, and consenting practice must modify to accommodate this.

Aim

To assess the documentation of the risk of COVID-19 infection and associated morbidity in consenting practice, using the existing consent form as benchmark, for patient’s undergoing general surgical procedures under general anaesthesia.

Method

Retrospective case-note analysis of 41 general surgical inpatient consent forms and operation notes during April 2020. Data were gathered on multiple points mentioned in Royal College of Surgeons (RCS) guidance. This includes documentation of risk of COVID-19 infection, the patient’s diagnosis, other risk documentation, peri-operative lifestyle advice and likelihood of success.

Results

Of 41 cases, 16 (39%) had risk of chest infection documented. Of these 16, 10 (63%) specified COVID-19 in the risk documentation. Further, morbidity related to COVID-19 was documented in 4 out of 41 (10%) cases identified.

Conclusions

A material risk is classified as anything that poses substantial risk to a patient, and it is vital that they are made aware of this prior to undertaking any form of medical intervention. This study demonstrates deviation from RCS guidance, and the results have been discussed and distributed within the general surgical department. Advice has been communicated regarding improvements required in consenting practice from the clinical lead. We aim to re-audit practice in the coming months.

898 Awareness Regarding the Use of Topical Vancomycin in Cranial and Spinal Surgeries in Developing Countries

Introduction

Surgical site infections (SSI’s) remain a worrisome complication of any procedure requiring invasive intervention, consequences varying from suture abscesses to sepsis. Topical vancomycin administration has become popular in developed countries for SSI prevention, subsequent publications, and clinical experience supporting the practice as an effective strategy against SSI development. Yet, little information is available regarding the current practices and awareness of surgeons working in developing countries topically applying vancomycin for SSI prevention.

Method

An online anonymous validated survey comprising a structured questionnaire targeted at gaining an insight into current surgical practice and awareness in developing countries regarding topical administration of vancomycin for SSI prevention was conducted.

Results

243 responses were recorded, with respondents from publicly and privately funded institutions evenly distributed. Increased awareness concerning topical administration of vancomycin was apparent amongst orthopaedic surgeons compared to neurosurgeons (p-value = 0.59) and South American respondents compared to Asia and Africa (p-value = 0.04). No difference in topical vancomycin usage awareness was found as per annual number of surgeries performed or respondents’ experience. Neurosurgeons administered topical vancomycin less frequently than orthopaedic respondents (p-value = 0.014), most frequent usage found in South America compared to Africa, which had the least (p-value = 0.051). Neurosurgeon respondents obtained information regarding topical vancomycin administration during residency, while orthopaedic respondents from journal articles.

Conclusions

75% of respondents were aware topical vancomycin administration led to postoperative SSI risk reduction. Neurosurgeons were less familiar than orthopaedic surgeons, with South American respondents more likely to administer topical vancomycin than respondents practicing in other continents.

1470 Consenting for a Bedside Procedure: A Prospective Observational Analysis of Consenting Practice in the Surgical Emergency Admissions Unit of a District General Hospital

Aim

Consent is necessary to enable patient autonomy, and it is vital that it is voluntary, informed and, where possible, the patient has valid mental capacity to give consent. Recent case law has grown around consent and practice guidance has evolved.

This was a prospective observational study investigating the quality of consenting practice for incision and drainage procedures performed within the surgical emergency admissions unit (SEAU) at a district general hospital.

Method

A prospective study was conducted on consent documentation for a study period from August to September 2020, for patients undergoing bedside incision and drainage (I&D) procedures within the SEAU. Documentation was reviewed and data collected for quality of consent. Further data into the quality of this documentation was also collected; including legibility, risk and benefit discussions, local anaesthetic used, operation note documentation and discussion of the procedure. This was compared against GMC standards.

Results

Of 20 cases (n = 20), 1 case had written consent and 15 cases had verbal consent documented. 4 cases had no documentation of consent. No cases had benefit documentation, and 4 out of the 20 cases had risks documented. 4 cases had documentation of procedure discussion. 13 cases had an operation note included.

Conclusions

This study highlights a deviation from recommended practice, and results have been communicated at a departmental level. Recommendations have been offered in an attempt to improve compliance, including the display of posters in the SEAU. We shall re-audit practice within the coming months after these changes have been implemented.

1487 The Pied-Piper, How Gastroenteritis Led Us Astray. Fibromuscular Dysplasia: A Surgical Perspective of a Rare Vascular Disorder

Background

FMD is a rare idiopathic condition of abnormal cellular growth in medium/large arterial vessel walls. It has a frequency of approximately 0.02%, predominantly affecting middle-aged Caucasian women. It manifests mostly in renal and cerebrovascular arteries and can present as hypertension or stroke. Complications include aneurysms, stenosis and dissections. Characteristic angiographical finding is a “beads on a string” appearance. There is no current cure, but surgical or interventional involvement by angioplasty and stenting may play a role treatment.

Conclusions

This case elegantly highlights the ambiguity in diagnosis of abdominal pain in a general surgical setting; with a wide variety of differentials spanning multiple specialties, it emphasises the importance to consider rare presentations of equally rare pathologies. It is a celebration of the merits of a multi-disciplinary approach to solve complex clinical questions.

P–084 Microfluidic Sperm Sorting (MFSS) technique versus Physiological Intracytoplasmic Sperm Injection (PICSI) technique in high DNA fragmentation index sperm samples

Study question

To evaluate the effectiveness of using Microfluidic Sperm Sorting (MFSS) technique and Physiological Intracytoplasmic Sperm Injection (PICSI) technique in patient with high DNA fragmentation index (DFI) sperm samples.

Summary answer

Sperm selected by microfluidic sorting are associated with significant increase in day 3 grade A embryo development rate, clinical pregnancy rate over PICSI.

What is known already

DNA damage is unrecognisable in living sperm prior to insemination and an increased sperm DNA fragmentation index has been associated with lower fertilization rates, impaired embryo development and reduced pregnancy rates. Standard semen processing techniques are associated with centrifugation, which may induce reactive oxygen species and DNA damage. In strategies to minimize sperm DNA fragmentation, Physiological ICSI can relatively reduce sperm DNA fragmentation by 67.9% (Parmegiani et al., 2010) while new technique Microfluidic sperm sorter technique also demonstrate sperm selection with significantly reduced DNA damage.

Study design, size, duration

A prospective randomised study was conducted from 1st August 2019 to 31st December 2020. Two hundred patients were randomised by computer generated list and divided into 2 groups. Group A (n = 100) , in which sperm were processed by microfluidic sperm sorter (MFSS) while in group B (n = 100), sperm were selected by Physiological Intracytoplasmic Sperm Injection (PICSI) technique and morphologically normal motile sperm were injected by Intracytoplasmic sperm injection (ICSI) technique in all mature oocytes.

Participants/materials, setting, methods

The study period included all normozoospermic patients with high DNA fragmentation index (>25% ) while oligospermic, asthenozoospermic samples, patients with poor ovarian reserve and advanced age were excluded from the study. All A grade embryos were vitrified and transferred in frozen embryo replacement cycle. Both groups were compared on the basis of fertilisation rate, day 3 grade A embryo development rate , clinical pregnancy rate and miscarriage rate.

Main results and the role of chance

Cycle characteristics (female age, length of stimulation, gonadotrophin dose, number of oocytes and number of transferred embryos) were similar in both groups. Between the 2 groups, There was a significant increase observed in day 3 grade A embryo development rate (60% vs. 42%, p–0.016) and clinical pregnancy rate (62% vs. 46%, p–0.049), while no statistical significant difference observed in fertilisation rate (82% vs. 78%, p–0.80) and miscarriage rate ( 12% vs. 11%, p- 1). Limitations, reasons for caution: Larger randomised control studies are needed to strengthen these results.

Wider implications of the findings: We have demonstrated that sperm sorted by microfluidic helps in selection of sperm with better DNA integrity over Physiological ICSI. Using it in routine practice can help in reducing the negative effect of reactive oxygen species and thus improve pregnancy rate and live birth rate.

Trial registration number

MCDH/2019/31

Role of probiotics in adjunct to non-surgical periodontal therapy in patients with chronic periodontitis: a systematic review and meta-analysis

The objective of this study was to establish the significance of probiotic usage, both as a preventive as well as a therapeutic strategy for the management of periodontal disease. It also substantiates the existing studies of single/combined bacterial strain for exhibiting variable ecological impact on oral bacteria. Data sources included literature searches of PubMed (MEDLINE), Scopus, Embase, CENTRAL and Web of science databases for placebo controlled randomized clinical trials of SRP with orally administered probiotics in any form as an adjunct. Data extraction was conducted and information from the included studies was tabulated according to the study designs, form of drug delivery, main outcomes, and clinical parameters. Data collected were based on the focused question outlined for the present systematic review. The reviewers cross-checked all extracted data. CAL and PD were assessed as the primary outcome to compare the effectiveness of adjunctive probiotic therapy in addition to SRP. Fourteen clinical studies were included and demonstrated efficacy in reducing periodontal probing depth (PPD) and gaining clinical attachment level (CAL), between probiotics and SRP/placebo. Adjunctive probiotic therapy in addition to SRP leads to decrease in probing depth and clinical attachment gain in chronic periodontitis patients. However, further high-quality randomized clinical trials with microbiological outcomes are required to fortify the conclusion.

Contribution of Indian researchers in high impact periodontal journals: a bibliometric analysis of last three years

Bibliometric Analysis researches and analyses the quantitative data derived from scientific publications through the empirical evidence of scientific activity generated by collaborating authors through the final product of their research: the scientific article. In scientific society, the concept of impact factor is probably the most widely used in bibliometric construction. To assess the scientometrics of three high-impact factor periodontal journals and identify the contribution of India in these most productive journals over three years (Jan 2018 - Dec 2020) and to know the most influential topics researched. A retrospective observational study was conducted for the Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research. All issues of 2018, 2019, and 2020 were electronically and hand searched for the following parameters: Number of papers, affiliated organizations, and countries, topics reported, and contribution of Indian authors. The data were organized and analyzed with descriptive statistics using SPSS software (version 21.0). In total 469 articles were published by Journal of Periodontology, followed by 454 articles in Journal of Clinical Periodontology and 287 articles in Journal of Periodontal Research. In all the three journals, China had the maximum contributions, succeeded by USA. India has published maximum number of articles in the Journal of Periodontal Research. When analysed, although less as compared to the western counterparts, an increasing trend in the publications is seen in case of India.

Sorption-desorption coefficients of uranium in contaminated soils collected around Fukushima Daiichi Nuclear Power Station

Various radionuclides including fission products and heavy nuclides were released into the environment during the Fukushima Daiichi Nuclear Power Station (FDNPS) accident. The dissolution followed by migration of deposited radionuclides of Cs, Sr and U on soils could take place to the local environment. Therefore, it is necessary to determine sorption-desorption coefficients of U in soil-water system around the FDNPS from a migration viewpoint. The determination of sorption coefficient K_d(S) as well as desorption coefficient K_d(D) for U has been carried out in the present study using a laboratory batch method. Stable U was used for sorption from simulated ground water onto contaminated soil samples collected from Okuma Town, Fukushima. Different soil parameters were measured to understand their effects on sorption and desorption processes. The obtained K_d(S) and K_d(D) values of U were compared with values of K_d(S) and K_d(D) of Cs and Sr and K_d(S)-U in known Fukushima accident contaminated soils reported in the literature for better understanding. It was observed that K_d(S)-U varied from 160 to 5100 L/kg, whereas K_d(D)-U ranged from 200 to 11000 L/kg. K_d(D) was higher than K_d(S) for U in these soils implying irreversibility of the sorption process. Pearson's correlation of K_d(S) values suggested that U sorption is affected by various soil parameters. However, desorption is decided by the nature of U species formed in sorption process and soil parameters like pH, presence of carbonates, Ca ions, clay minerals etc. to some extent. The comparison between K_d(S) and K_d(D) values for Cs, Sr and U revealed that unsorbed Sr could migrate farther than unsorbed Cs or U under the present experimental conditions. Both sorption and desorption studies are of great importance to understand migration of metal ions from contaminated sites to local uncontaminated areas.

COVID-19 vaccine-induced Stevens-Johnson syndrome

Herein, we are reporting a case of Stevens–Johnson syndrome due to COVID‐19 vaccine, which has been proved by history taking, clinical examination and histopathology. To the best of our knowledge we are reporting the first case of COVID‐19 vaccine‐induced Stevens–Johnson syndrome.

Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium

BACKGROUND

Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies.

PATIENTS AND METHODS

Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients).

RESULTS

A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality.

CONCLUSIONS

Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies.

CLINICAL TRIAL IDENTIFIER

NCT04354701.

A modified two-process Knox test for investigating the relationship between law enforcement opioid seizures and overdoses

Recent research has shown an association between monthly law enforcement drug seizure events and accidental drug overdose deaths using cross-sectional data in a single state, whereby increased seizures correlated with more deaths. In this study, we conduct statistical analysis of street-level data on law enforcement drug seizures, along with street-level data on fatal and non-fatal overdose events, to determine possible micro-level causal associations between opioid-related drug seizures and overdoses. For this purpose, we introduce a novel, modified two-process Knox test that controls for self-excitation to measure clustering of overdoses nearby in space and time following law enforcement seizures. We observe a small, but statistically significant ( p  < 0.001), effect of 17.7 excess non-fatal overdoses per 1000 law enforcement seizures within three weeks and 250 m of a seizure. We discuss the potential causal mechanism for this association along with policy implications.