Uttar Pradesh Association of Physicians of India Position Statement: Betel Quid (Paan) and Diabetes

Betel quid (paan) chewing is common in India, especially in Uttar Pradesh. Betel quid has multifaceted relationship with health, including metabolic and psychosocial health. The current recommendations have been released keeping in view the public health and clinical importance of this addictive behavior. The objective of this document is to offer clinical guidance for screening, diagnosis and management of co-occurring betel quid chewing among persons with Diabetes Mellitus (DM). The document aims to provide education and guidance to clinicians engaged in care and management of persons with DM, and improve access to treatment for co-occurring betel quid chewing among persons with DM. The current recommendation grades are based on published evidence, and categorized as strong, intermediate, weak and no evidence. The strength of these recommendations is based on the level of evidence.

Long-term impact of conservation agriculture and diversified maize rotations on carbon pools and stocks, mineral nitrogen fractions and nitrous oxide fluxes in inceptisol of India

Given the increasing scarcity of production resources such as water, energy and labour coupled with growing climatic risks, maize-based production systems could be potential alternatives to intensive rice-wheat (RW) rotation in western Indo-Gangetic Plains (IGP). Conservation agriculture (CA) in maize systems has been widely promoted for minimizing soil degradation and ensuring sustainability under emerging climate change scenario. Such practices are also believed to provide mitigation co-benefits through reduced GHG emission and increased soil carbon sequestration. However, the combined effects of diversified crop rotations and CA-based management on GHG mitigation potential and other co-benefits are generally over looked and hence warrant greater attention. A field trial was conducted for 5-years to assess the changes in soil organic carbon fractions, mineral-N, N₂O emission and global warming potential (GWP) of maize-based production systems under different tillage & crop establishment methods. Four diversified cropping systems i.e. maize-wheat-mungbean (MWMb), maize-chickpea-Sesbania (MCS), maize-mustard-mungbean (MMuMb) and maize-maize-Sesbania (MMS) were factorially combined with three tillage & crop establishment methods i.e. zero tilled permanent beds (PB), zero-tillage flat (ZT) and conventional tillage (CT) in a split-plot design. After 5-years of continued experimentation, we recorded that across the soil depths, SOC content, its pools and mineral-N fractions were greatly affected by tillage & crop establishment methods and cropping systems. ZT and PB increased SOC stock (0-30 cm depth) by 7.22-7.23 Mg C ha^-1 whereas CT system increased it only by 0.88 Mg C ha^-1as compared to initial value. Several researchers reported that SOC & mineral-N fraction contents in the top 30 cm soil depth are correlated with N₂O-N emission. In our study, global warming potential (GWP) under CT system was higher by 18.1 and 17.4%, compared to CA-based ZT and PB, respectively. Among various maize systems, GWP of MMS were higher by 11.2, 6.7 and 6.6%, compared that of MWMb (1212 kg CO₂-eq. ha^-1), MCS (1274 kg CO₂-eq. ha^-1) and MMuMb (1275 kg CO₂-eq. ha^-1), respectively. The results of our study suggest that CA and diversified crop rotations should be promoted in north-western IGP and other similar agro-ecologies across the globe for ensuring food security, restoration of soil health and climate change mitigation, the key sustainable development goals (SDGs).

Role of computed tomography morphodensitometry in predicting the outcome of shock wave lithotripsy

Objectives:

The objective of this study was to predict the outcome of shock wave lithotripsy (SWL) on the basis of computed tomography (CT) morphodensitometry for ureteral and renal stones. We also assessed the possibility that Hounsfield unit (HU) values and the location of the stones could be used to predict the outcome of SWL.

Material and methods:

A prospective study was performed to measure stone size, location, composition, surface area, surface volume, stone burden, the skin-to-stone distance and the HU for solitary renal and ureteral stones by non-contrast CT studies (NCCT) from August 2013 to September 2015. Success of SWL was defined as: (1) being stone-free or (2) residual stone fragments < 4 mm by radiography/NCCT.

Results:

Of the 100 assessed patients, 68 patients (68%) were stone-free, 12 (12%) had residual stone fragments < 4 mm (clinically insignificant residual fragments) and 20 (20%) had residual stone fragments ≥ 4 mm/ancillary procedures. Multivariate analysis revealed that stone location and mean HU were significant predictors of SWL success. Receiver operating characteristic curves defined cut-off values for predicting treatment outcome. Treatment success rates were significantly higher for stones < 800 HU than with stones > 800 HU ( p = 0.160).

Conclusion:

Evaluation of stone HU values and stone location prior to SWL can predict treatment outcome and aid in the development of treatment strategies.

Level of evidence

2 & 4

Effect of in ovo injection of raffinose on growth performance and gut health parameters of broiler chicken

The effects of in ovo injection of raffinose (RFO) as a prebiotic on growth performance, relative weight of proventriculus, gizzard, drumstick and breast muscles, and ileum mucosa morphology were examined in Cobb 500 broilers. A total of 240 fertilized eggs were divided into 4 groups: a non-injected with intact shell and 3 levels of RFO solution (1.5, 3.0, and 4.5 mg in 0.2 mL of an aqueous diluents). The RFO solution was injected into the air sac on d 12 of incubation. In total 144 birds were fed a standard diet and management and sacrificed at d 21 post hatch for collection of samples. Total RNA was extracted from the small intestine, and RT-qPCR was performed to quantify mRNA levels of marker genes of immune cells. Injection of RFO had no significant effect (P > 0.05) on d one body weight of chicks. On d 21, the relative weight of the proventriculus, drumstick, breast, and gizzard was not affected (P > 0.05) by RFO. On hatch d, the villus height increased linearly (P < 0.01) with an increasing dose of RFO. Also, an increasing dose of RFO increased the villus height and villus height:crypt depth ratio (P < 0.05) but did not affect the crypt depth on d 21. The expression levels of CD3 and chB6, which are T cell and B cell marker genes, respectively, were significantly enhanced by high dose RFO (4.5 mg). In conclusion, although an increasing dose of RFO in ovo injection did not significantly influence growth performance or slaughter yield of broilers, RFO has the potential of enhancing ileum mucosa morphology and improving immunity in the small intestine, which are indicators of improved gut health.

Recent development in antihyperalgesic effect of phytochemicals: anti-inflammatory and neuro-modulatory actions

INTRODUCTION

Pain is an unpleasant sensation triggered by noxious stimulation. It is one of the most prevalent conditions, limiting productivity and diminishing quality of life. Non steroidal anti inflammatory drugs (NSAIDs) are widely used as pain relievers in present day practice as pain is mostly initiated due to inflammation. However, due to potentially serious side effects, long term use of these antihyperalgesic drugs raises concern. Therefore there is a demand to search novel medicines with least side effects. Herbal products have been used for centuries to reduce pain and inflammation, and phytochemicals are known to cause fewer side effects. However, identification of active phytochemicals of herbal medicines and clear understanding of the molecular mechanism of their action is needed for clinical acceptance.

MATERIALS AND METHODS

In this review, we have briefly discussed the cellular and molecular changes during hyperalgesia via inflammatory mediators and neuro-modulatory action involved therein. The review includes 54 recently reported phytochemicals with antihyperalgesic action, as per the literature available with PubMed, Google Scholar and Scopus.

CONCLUSION

Compounds of high interest as potential antihyperalgesic agents are: curcumin, resveratrol, capsaicin, quercetin, eugenol, naringenin and epigallocatechin gallate (EGCG). Current knowledge about molecular targets of pain and their regulation by these phytochemicals is elaborated and the scope of further research is discussed.

Process optimization and oxidative stability of omega-3 ice cream fortified with flaxseed oil microcapsules

Microencapsulated flaxseed oil powder (MFOP) was supplemented for the fortification of α-linolenic acid (ALA, ω-3 fatty acid) in ice cream. Processing parameters were optimized in terms of the stage of homogenization of ice-cream mix, level of fortification (3, 4 and 5%) and flavors (vanilla, butter scotch and strawberry). Data revealed that free fatty acids increased significantly during first 15 days in all the samples and then remained constant. Peroxide value and thiobarbituric acid value first increased up to 30 and 45 days, respectively; and then decreased followed by a gradual increase up to 120 days. Fatty acids profile showed 18.74-21.38% decrease in ALA content in fortified ice creams after 120 days. A serving of 100 g of freshly prepared functional ice cream was able to meet ~ 45% of the RDA (1.4 g ALA/day), which reduced to 35.37-36.56% on the end of storage i.e. 120 days. Overall, it can be concluded that MFOP was oxidative stable in ice-cream throughout the storage, which could be fortified successfully at 4% (w/w) level.

IL-17-driven intestinal fibrosis is inhibited by Itch-mediated ubiquitination of HIC-5

Intestinal fibrosis is a major complication in inflammatory bowel diseases, but the regulatory mechanism that inhibits fibrosis remains unclear. Here we demonstrate that Itch^-/-myofibroblasts express increased amounts of profibrotic collagen type I and α-SMA in response to IL-17. Mechanistically, we demonstrate that Itch directly binds to HIC-5 and targets it for K63-linked ubiquitination to inhibit IL-17-driven intestinal fibrosis. Reconstitution of Itch^-/- myofibroblasts with wild-type Itch but not the Itch-C830A mutant normalized the expression of profibrotic genes. Similarly, shRNA-mediated inhibition of HIC-5 normalized the expression of profibrotic gene expression. Thus, we have uncovered a novel mechanism by which Itch negatively regulates intestinal fibrosis.

First report on characterization and pathogenicity study of emerging Lactococcus garvieae infection in farmed rainbow trout, Oncorhynchus mykiss (Walbaum), from India

"Warm water lactococcosis" in farm-reared rainbow trout, Oncorhynchus mykiss (Walbaum) in the northern Himalayan region of India, caused by bacterium Lactococcus garvieae is described in this study. Nine bacterial isolates were recovered from the organs of haemorrhagic septicaemia rainbow trout and were subjected to biochemical and molecular identification. Cell surface characteristics and virulence of the bacterial isolates are also described. All the nine bacterial isolates had homogenous biochemical characteristics and were Gram-positive, short chains forming (two to eight cells long), α-haemolytic, non-motile ovoid cocci. Partial 16S rDNA nucleotide sequence (~1,400 bp) of current isolates shared 99% identities with the 16S rDNA nucleotide sequence of L. garvieae R421, L. garvieae FMA395 and L. garvieae CAU:1730. The identity of the bacterial isolates was further confirmed by PCR amplification of L. garvieae-specific ~1,100 bp fragment. Transmission electron microscopy (TEM) of one representative isolate, L. garvieae RTCLI04, indicates that the isolated strain lacks thick outer capsule and is of KG+ (non-capsulates) phenotype. An intraperitoneal and intramuscular injection (2.6 × 10⁵ CFU ml^-1 ) and also immersion in bacterial suspension @ of 2.6 × 10⁵ CFU ml^-1 to healthy rainbow trout juveniles (body weight: 27.5 ± 3.7 g) with L. garvieae RTCLI04 caused 80%, 60% and 10% cumulative mortality in challenged fish, respectively, within 15 days post-infection. The haemorrhagic septicaemic disease was reproduced experimentally. Histopathological examination of organs of experimentally infected fish revealed extensive degenerative and inflammatory changes in eye, kidney, gill and liver. PCR amplification of several putative virulence genes such as haemolysins, adhesins, LPxTG-containing surface proteins and adhesins cluster confirms the virulence of our Indian L. garvieae isolates. To the best of our knowledge, we are reporting for the first time that L. garvieae is associated with fatal haemorrhagic septicaemia in farmed rainbow trout in India.

Comparison of in vitro and in vivo fertilizing potential of buffalo bull semen frozen in egg yolk-, soya bean lecithin- and liposome-based extenders

The objective of this study was to compare different extenders for post-thaw in vitro sperm function and in vivo fertility of buffalo semen. Accordingly, sperm of 30 ejaculates extended in egg yolk (TRIS with 20% egg yolk; EY), two soya lecithin-based (SL-1; AndroMed® and SL-2; Bioxcell® ) and a liposome-based extender (LS; OptiXcell® ) were tested. The post-thaw semen was evaluated for computer-assisted sperm analysis (CASA), sperm viability, membrane and acrosome integrity, DNA integrity and acrosome reaction and first service pregnancy rate (FSPR) in a fixed-time artificial insemination programme. Total motility and VCL were the only CASA-based parameters that exhibited significantly higher (p < .05) percentage in LS among these extenders. Post-thaw percentage of acrosome integrity (55.9 ± 1.4, 58.1 ± 2.0, 55.8 ± 2.0, 56.6 ± 2.3) and DNA integrity (68.8 ± 2.0, 69.2 ± 2.3, 71.3 ± 2.1, 69.1 ± 2.1) did not differ (p > .05) in EY, SL-1, SL-2 and LS extender, respectively. However, a variable response in terms of efficacy of different extenders for sperm viability and plasma membrane integrity was observed. Assessment of inducibility of acrosome reaction showed significant differences between extenders (51.9 ± 2.1, 44.3 ± 2.4, 46.1 ± 2.3 and 58.1 ± 3.1%, respectively, for EY, SL-1, SL-2 and LS). Furthermore, field trials revealed significantly higher (p < .05) FSPR of LS-extended semen as compared to that for EY, SL-1 and SL-2 extender (46.3%, 41.2%, 31.2% and 29.7%, respectively). It is concluded that the liposome-based extender is more effective than egg yolk- and soya lecithin-based extenders and may be used for cryopreservation of buffalo semen in the future.

Determining the Effectiveness of Three-Gene Pyramids Against Aphis glycines (Hemiptera: Aphididae) Biotypes

Since the discovery of Aphis glycines Matsumura (Hemiptera: Aphididae) in the United States, the primary management tactic has been foliar insecticides. Alternative management options such as host plant resistance to A. glycines have been developed and their effectiveness proved. However, the use of host plant resistance was complicated by the discovery of multiple, virulent biotypes of A. glycines in the United States that are capable of overcoming single Rag genes, Rag1 and Rag2, as well as a two-gene pyramid of Rag1+Rag2. However, current models predict that the virulent allele frequency of A. glycines decreases in response to the use of pyramided Rag genes, suggesting that pyramids represent a more sustainable use of these traits. Previous research has demonstrated that virulent biotypes can be effectively managed using a three-gene pyramid of Rag1+Rag2+Rag3. Additional Rag-genes have been discovered (Rag4 and Rag5), but whether the incorporation of these genes into novel three-gene pyramids will improve efficacy is not known. We tested single-gene (Rag1 and Rag2) and pyramid cultivars (Rag1+Rag2, Rag1+Rag2+Rag3, Rag1+Rag2+Rag4) to multiple biotypes in laboratory assays. Our results confirm that the Rag1+Rag2+Rag3 pyramid effectively manages all known A. glycines biotypes when compared with cultivars that are overcome by the associated biotype. Our results indicate that Rag1+Rag2+Rag4 would be an effective management option for biotype-1, biotype-2, and biotype-3 A. glycines, but had a negligible impact on biotype-4.

Uttar Pradesh Association of Physicians of India Position Statement: Tobacco Use and Metabolic Syndrome

Tobacco use is one of the main preventable causes of mortality and morbidity worldwide. The global disease burden due to tobacco use is huge with projected mortality of eight million lives per year by 2030. Metabolic syndrome (MS) is defined as a constellation of cardiovascular and endocrine risk factors such as insulin resistance, obesity, raised blood pressure, and abnormal lipid profile. The relationship between tobacco use and MS has been well established. Also, the causal association between tobacco use and development of individual components of MS is well established. The Uttar Pradesh Association of Physicians of India (UP API) has drafted this position statement on managing tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). This position statement presents evidence-based recommendations as described below. Scope and purpose The objective of this position statement is to offer clinical recommendations for screening, diagnosis and management of tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). The purpose of this document is to aid in identification and treatment of maladaptive patterns of tobacco use i.e. tobacco use disorder (tobacco dependence, harmful use, abuse) in person with or at risk of developing MS. Intended Audience The position statement is targeted at the clinicians engaged in care and management of person with or at risk of developing Metabolic Syndrome (MS). This might also be of relevance to the policy makers considering the public health burden of both MS and tobacco use disorders.

Computational methods for 2D materials: discovery, property characterization, and application design

The discovery of two-dimensional (2D) materials comes at a time when computational methods are mature and can predict novel 2D materials, characterize their properties, and guide the design of 2D materials for applications. This article reviews the recent progress in computational approaches for 2D materials research. We discuss the computational techniques and provide an overview of the ongoing research in the field. We begin with an overview of known 2D materials, common computational methods, and available cyber infrastructures. We then move onto the discovery of novel 2D materials, discussing the stability criteria for 2D materials, computational methods for structure prediction, and interactions of monolayers with electrochemical and gaseous environments. Next, we describe the computational characterization of the 2D materials' electronic, optical, magnetic, and superconducting properties and the response of the properties under applied mechanical strain and electrical fields. From there, we move on to discuss the structure and properties of defects in 2D materials, and describe methods for 2D materials device simulations. We conclude by providing an outlook on the needs and challenges for future developments in the field of computational research for 2D materials.

The Department of Neurosurgery, G. B. Pant Hospital, New Delhi

The history of the prestigious Department of Neurosurgery, Gobind Ballabh Pant Institute of Medical Education Institute and Research, New Delhi, a leading tertiary care centre, is presented. Its eminent faculty and outstanding patient care attracts patients and students from all over the country.The patients opt for this institution to get a standard of care that may be comparable with the highest standards prevalent; and, the students achieve their goal of getting excellent education in Neurosurgery at par with the best institutes of the world. The department has, therefore, over the years, established its place in the country as a premier training facility and an epitome of medical excellence.

Observation of self-polarization in BSA protected Au20 clusters

Bovine serum albumin (BSA)-protected gold clusters (atomicity ∼ 20), prepared using a wet chemical route, show strong dipolar radiative transition with a gap energy of 1.93 eV due to the high oscillator strength, as confirmed by the emission studies. Self-arrangement of the clusters with fixed atomicity yields a low dispersive dielectric and electric self-polarization nature. The electrical hysteresis loop measurements returned a remanent polarization of 0.05 μC cm^-2, which can be correlated with the dipolar orientation (activation energy ∼ 45.32 meV), originating from the structure-dependent deformation of the charge density.

Basion-Cartilaginous Dens Interval: An Imaging Parameter for Craniovertebral Junction Assessment in Children

BACKGROUND AND PURPOSE

Widening of the basion-dens interval is an important sign of cranioverterbral junction injury. The current literature on basion-dens interval in children is sparse and based on bony measurements with variable values. Our goal was to establish the normal values of a recently described new imaging parameter, the basion-cartilaginous dens interval in children.

MATERIALS AND METHODS

Three hundred healthy pediatric patients (0-10 years of age) were selected retrospectively. These patients were divided into 3 different groups: A (0-3 years), B (3-6 years), and C (6-10 years). The basion-cartilaginous dens interval was calculated on the sagittal MPR image of cervical spine CT in a soft-tissue window. The mean, SD, and the upper limit of normal (mean +2 SDs) of the 3 groups were calculated, and statistical tests were used to check for significant differences of the basion-cartilaginous dens interval among these 3 groups.

RESULTS

The upper limits of the basion-cartilaginous dens interval for the 3 groups were 5.34 mm in group A, 5.64 mm in group B, and 7.24 mm in group C. There were statistically significant differences in the basion-cartilaginous dens interval values among the 3 groups. There was no statistically significant difference in basion-cartilaginous dens interval values between groups A and B; however, values in group C were significantly different from those in both A and B. There was no statistically significant difference in the basion-cartilaginous dens interval values between males and females.

CONCLUSIONS

The basion-cartilaginous dens interval is a novel imaging parameter to assess cranioverterbral junction integrity in children, which includes the nonossified cartilage in the measurement.

Hydrogen peroxide test for intraoperative bile leak detection

BACKGROUND

Bile leakage (BL) is a common complication following liver surgery, ranging from 3 to 27% in different series. To reduce the incidence of post-operative BL various BL tests have been applied since ages, but no method is foolproof and every method has their own limitations. In this study we used a relatively simpler technique to detect the BL intra-operatively. Topical application of 1.5% diluted hydrogen peroxide (H₂O₂) was used to detect the BL from cut surface of liver and we compared this with conventional saline method to know the efficacy.

METHODS

A total of 31 patients included all patients who underwent liver resection and donor hepatectomies as part of Living Donor Liver Transplantation. After complete liver resection, the conventional saline test followed by topical diluted 1.5% H₂O₂ test was performed on all.

RESULTS

A BL was demonstrated in 11 patients (35.48%) by the conventional saline method and in 19 patients (61.29%) by H₂O₂ method. Statistically compared by Wilcoxon signed-rank test showed significant difference (P = 0.014) for minor liver resections group and (P = 0.002) for major liver resections group.

CONCLUSION

The topical application of H₂O₂ is a simple and effective method of detection of BL from cut surface of liver. It is an easy, non-invasive, cheap, less time consuming, reproducible, and sensitive technique with no obvious disadvantages.

Clinical Profile of Pediatric Oncology Patients Treated by External Beam Radiotherapy: An Institutional Experience

Introduction:

Pediatric tumors are a heterogeneous group of malignant conditions requiring multimodal treatment, and management of such cases is at time challenging. We present the clinical profile of pediatric cancer patients who received radiation, either alone or as adjuvant to surgery and chemotherapy; in prophylactic, radical or palliative clinical setting.

Aim:

This study was envisaged to review our experience of pediatric oncology cases, their clinical and morphological profile, dosage schedule of radiotherapy, and the therapy induced complications.

Settings and Design:

This was a retrospective, observational study carried out in an apex tertiary care cancer institute of government set-up in a developing country.

Materials and Methods:

The treatment charts and clinical summary of patients who had received radiation over the last 5 years period were retrieved and perused. Various clinical and pathological parameters were studied and inferences drawn.

Results:

A total of 50 patients got radiation over 5 year study-period, including 37 male and 13 female patients. The commonest age group of presentation was 8-12 years followed by 13-16 years. The mean age of presentation was 9.3 years. The most common diagnosis was hematological malignancies followed by CNS tumors with 21 and 13 patients respectively. Overall the most common indication of RT was in adjuvant setting after surgery as the definitive management, where 24 patients were irradiated; and the next common indication was prophylactic cranial irradiation in 14 patients of childhood leukemias. 10 patients tolerated treatment with Grade 1 site-specific or systemic toxicities while 7 patients developed Grade 2 and more systemic toxicities. 9 patients received craniospinal irradiation, common indications being medulloblastoma and Atypical teratoma rhabdoid tumor (ATRT). 3 patients received concurrent chemotherapy with weekly Inj Vincristine. 17 patients required sedation or short general anaesthesia for radiation planning and execution.

Conclusion:

External beam Radiotherapy constitutes an important component of management of pediatric cancers. One should be judicious in Radiotherapy planning, execution and monitoring acute and delayed toxicities.