Abdominal wall reconstruction (AWR) for post-trauma laparotomy ventral hernia and follow-up assessment of functional quality of life (QOL): experience of a level-1 trauma centre in India

PURPOSE

The aim of this study was to examine the postoperative outcomes and follow-up QOL of patients after AWR at a level-1 trauma centre in India.

METHODS

The study cohort included AWR patients treated between January 2011 and July 2022. The Activities Assessment Scale (AAS) was used to measure QOL, and the Ventral Hernia Recurrence Inventory (VHRI) was used to determine the occurrence of recurrence. In patients suspected of having recurrence, thorough clinical examination and relevant imaging were performed to confirm or rule out recurrence.

RESULTS

Out of 89 patients, 35 patients whose complete perioperative and follow-up data were available were enrolled. The mean age of the patients was 28 (SD, 9) years. The mean defect size was 14. 9 (SD, 7) cm. The mean time from laparotomy to AWR surgery was 21 months. During the postoperative course, 37% of patients developed complications, such as SSI and seroma. The mean follow-up time was 53 (SD, 43) months. Upon comparing procedures involving the mesh placed in the sublay position with procedures involving the mesh placed in other positions, no statistically significant difference in the recurrence rate (one in each group, p = 0.99), surgical complication rate (33% v/s 66%, p = 0.6), or mean AAS QOL score (94.7 v/s 98, p = 0.4) was observed. The specificity of the VHRI for diagnosing recurrence was 79%.

CONCLUSION

Overall, the recurrence rate was low in these patients despite the presence of large hernia defects. Long-term QOL was not affected by the specific procedure used. Timely planning and execution are more important than the specific repair approach for post-trauma laparotomy ventral hernia.

Radiological presentation of transient perivascular inflammation of carotid artery syndrome in a patient with myelodysplasia

Transient Perivascular Inflammation of Carotid artery syndrome (TIPIC syndrome) is a non-specific inflammatory thickening of the carotid artery. The exact etiology of this syndrome is poorly understood. We will describe the radiological findings of a rare case of TIPIC syndrome in a patient with myelodysplastic syndrome and discuss the potential pathophysiological mechanisms.

Network pharmacology on mechanistic role of Thymus linearis Benth. against gastrointestinal and neurological diseases

BACKGROUND

Thymus linearis Benth. (TL) is native to the Himalayas and has been used traditionally to cure various diseases. Thymus is a well-known aromatic perennial herb commonly known as Van ajwain or Himalayan Thyme. The main components of the TL essential oil are thymol, terpinene, and p-cymene. There are many biological properties that TL has been reported to exhibit, including antioxidant, analgesic, anti-inflammatory, antipyretic, antibacterial, anticancerogenic, and neuroprotective effects.

PURPOSE

In this study, the network pharmacology and molecular docking were used to explore the potential compounds of TL and their interaction mechanism toward gastrointestinal complications and neurological diseases.

METHODS

Network pharmacology was used to analyze the active compounds and protein targets of TL on gastrointestinal and neurological related diseases. Protein-protein interaction and Kyoto Encyclopaedia of Genes and Genomes analysis were used to enrich and evaluate key pathways of target proteins. To ensure the reliability of the network pharmacology prediction estimates, molecular docking was used to confirm the relationships between the core components and targets of TL.

RESULT

77 physiologically active compounds and their 717 predicted protein targets with high association to the neuroactive ligand-receptor interaction pathway were derived from TL. Beta-citronellol, piperitol, p-cymen-8-ol, and alpha-humulene were found to have a role in gastrointestinal diseases associated with neurological diseases. These compounds showed significant levels of multitargeting cluster regulatory activity. The molecular docking results showed regulatory activity of highlighted multi-targeting compounds and the highest docking energy was reported in piperitol.

CONCLUSION

The study shows that Thymus linearis Benth., a medicinal plant with traditional use, possesses valuable biologically active compounds. It emphasizes the potential of Thymus in treating gastrointestinal and neurological diseases by regulating oxidative stress pathways. This research opens up possibilities for discovering antioxidant molecules for future drug development. It is an interesting study with promising implications for further research.

Anastrozole-mediated modulation of mitochondrial activity by inhibition of mitochondrial permeability transition pore opening: an initial perspective

The mitochondrial permeability transition pore (mtPTP) plays a vital role in altering the structure and function of mitochondria. Cyclophilin D (CypD) is a mitochondrial protein that regulates mtPTP function and a known drug target for therapeutic studies involving mitochondria. While the effect of aromatase inhibition on the mtPTP has been studied previously, the effect of anastrozole on the mtPTP has not been completely elucidated. The role of anastrozole in modulating the mtPTP was evaluated by docking, molecular dynamics and network-guided studies using human CypD data. The peripheral blood mononuclear cells (PBMCs) of patients with mitochondrial disorders and healthy controls were treated with anastrozole and evaluated for mitochondrial permeability transition pore (mtPTP) function and apoptosis using a flow cytometer. Spectrophotometry was employed for estimating total ATP levels. The anastrozole-CypD complex is more stable than cyclosporin A (CsA)-CypD. Anastrozole performed better than cyclosporine in inhibiting mtPTP. Additional effects included inducing mitochondrial membrane depolarization and a reduction in mitochondrial swelling and superoxide generation, intrinsic caspase-3 activity and cellular apoptosis, along with an increase in ATP levels. Anastrozole may serve as a potential therapeutic agent for mitochondrial disorders and ameliorate the clinical phenotype by regulating the activity of mtPTP. However, further studies are required to substantiate our preliminary findings.Communicated by Ramaswamy H. Sarma.

Delayed collapse of flow diverter due to acute severe vasospasm: another concern for flow diversion in ruptured aneurysms

In vivo morphological change of flow diverter stents (FDS) is a known phenomenon and can be seen secondary to various device- and vasculature-related factors such as improper sizing of the device, twisting of the device in tortuous anatomy, insufficient proximal landing zone, and insufficient chronic resistive force of the stent, etc. However, we have encountered a case where severe vasospasm due to aneurysmal subarachnoid hemorrhage led to the collapse of the proximal end of the FDS. Development of vasospasm and consequent possible failure of the device should be taken into consideration when planning flow diversion in ruptured aneurysms.

Quantitative assessment of antioxidant potential of selected homeopathic preparations in clinical practice

OBJECTIVES

Antioxidant property like radical scavenging is a primary target to elucidate the efficacy mechanism of a drug against diseases linked to oxidative stress such as cancer, metabolic disorders, rheumatoid arthritis, etc. In alternative therapies, homeopathy is one of the preferred choices by patients and clinicians due to its potential to cure chronic and complex illnesses. However, the efficacy of homeopathic preparations at high diluted potencies attracts rational criticism due to insufficient scientific knowledge supporting the mechanism of action. Therefore, an attempt was made to estimate the total phenolic content (TPC) and radical scavenging activity of clinically prescribed homeopathic drugs.

METHODS

With gallic acid as a reference control, mother tinctures (MTs) and different potencies of Eucalyptus globulus (EG), Syzygium jambolanum (SJ), Ruta graveolens (RG), and Thuja occidentalis (TO) were used to perform Folin-Ciocalteu test, 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS), and 2,2-diphenyl-1-picrylhydrazyl (DPPH) assays.

RESULTS

The results showed TPC of MTs equivalent to µg/mL of gallic acid viz; EG (4,872.5 ± 133.2), SJ (8,840.5 ± 14.8), RG (985.6 ± 39.1), and TO (341.5 ± 19.5) with significant ABTS and DPPH radical scavenging potential. Whereas 30C and 200C potencies of each homeopathic drug showed undetectable phenolic content and insignificant radical scavenging potential compared to vehicle control, i.e., alcohol 90% (2.0 ± 1.5).

CONCLUSIONS

The reported efficacy of 30C and 200C potencies of homeopathic medicines against oxidative stress-related illnesses might be due to mechanisms other than radical scavenging. Furthermore, the assays studied can be helpful in drug standardization and quality control of MTs that are used as starting material in homeopathic preparations.

Deciphering the impact and mechanism of Trikatu, a spices-based formulation on alcoholic liver disease employing network pharmacology analysis and in vivo validation

Trikatu Churna (TC) comprising Zingiber officinale rhizome, Piper longum, and Piper nigrum fruit, is effective in treating liver diseases and has high nutraceutical values. However, the efficacy of TC in treating alcoholic liver disease (ALD) and its mechanism remain largely unknown. This study evaluated the hepatoprotective effects of different doses of TC as well as to identify the bioactive components and determine their mechanism of action against ethanol-induced ALD. A compound-target network analysis model of TC was established to identify its potential bioactive compounds and pathways that might regulate its hepatoprotective effects. Further, in-vivo studies were performed to validate the potential of TC (200 mg/kg and 400 mg/kg b.w.) in the treatment and management of ALD. The study revealed that both the dosages of TC demonstrate significant (p > 0.0001) hepatoprotective effects by improving body weight, total bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), serum alkaline phosphate (ALP), total cholesterol, total protein, globulin, albumin, and liver morphology. The High-performance thin-layer chromatography (HPTLC) fingerprinting of TC showed the presence of piperine. Network pharmacology identifies the role of TC in regulating various signaling processes including Advanced glycation end products-receptor for advanced glycation end products (AGE-RAGE), Hypoxia-inducible factors (HIF-1), Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-Kappa B), and Phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling to exert its anti-inflammatory, antioxidant and anti-apoptotic role in managing ALD. Based on the bioinformatics analysis, some of the key targets of TC were found to be Prostaglandin-Endoperoxide Synthase 2 (PTGS2) or Cyclooxygenase-2 (COX-2), Sirtuin 1 (SRT1), and caspase-3. These effects may serve as a novel therapeutic option for the treatment of ALD. These preclinical validation studies for the ethnopharmacological potential of TC in ALD treatment further paved the way for researchers to perform next-level translational and clinical studies. Further, in-depth experimental studies for the validation of these bioinformatics-based results will give a clearer picture of mechanisms.

Unusual case of coexisting large intramyometrial anterior uterine wall leiomyoma with term pregnancy

Leiomyomas are the most common benign smooth muscle tumors of the uterus. The incidence during pregnancy ranges between 1.6 to 10%. The management of fibroids encountered during caesarean section poses a therapeutic dilemma. We present a case of giant anterior wall leiomyoma complicating term pregnancy which posed a great surgical challenge. We didn't go for myomectomy in the same setting because the patient was primigravida and leiomyoma occupied complete anterior wall of the uterus, an attempt of myomectomy could result in profuse uncontrollable bleeding.

Assessment of indicators on drinking water, sanitation, and hygiene (WASH) practices from rural schools of Kathua

Introduction:

Safe and adequate water supply and sanitation in schools are prerequisites for right to basic education for school children. The provision of water, sanitation, and hygiene (WASH) facilities has been linked to the achievement of Sustainable Development Goals.

Objective:

The objective of this study is to assess the indicators of WASH in schools falling under the Rural Health and Training Centre (RHTC), Budhi, GMC Kathua.

Material and Methodology:

A cross-sectional study was conducted during a period of two months in the month of September 2019 to October 2019. It was done in the rural area under CHC Nagri Parole Kathua. The total number of schools under CHC is 981. Interview of the head of the school was done using world health organization (WHO) and united nations international children’s emergency fund (UNICEF) Standardized Questionnaire for WASH Practices. The Questionnaire includes core and expanded questions on drinking water, sanitation, and hygiene practices. Data were entered in Microsoft Excel and descriptive statistics was analyzed in the form of number and percentages.

Results:

Out of total 139 schools, 57.72% schools had basic drinking water facilities. Only 29.11% schools have basic hand-washing facilities with soap and water; 81.29% of the schools have improved toilets.

Conclusion:

Political will and financing and effective delivery of interventions will be required to ensure universal access to WASH in schools.

Knowledge, Attitude and Perception about Neurodevelopmental Disorder among Pregnant Women: A Cross-sectional Study

Introductuion: Neurological Developmental Disorders (NDD) reflects disruptions of neuroanatomic structure or psychophysiological function and place a child at-risk for developmental, cognitive, emotional, behavioural, psychosocial and adaptive challenges. The common NDD are Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), Tics disorder, Intellectual disabilities, Specific Learning Disorders (SLD), Motor disorders and communication disorders. The purpose of the study was in agreement with the literature overviewed, which suggests, the prevalence of NDD is high in children. Complications that happen during the antenatal or perinatal period, and the awareness of the same in pregnant women is significantly low. Aim: To know about the knowledge, attitude and perception of NDD among pregnant women. Materials and Methods: This cross-sectional study was conducted at Dr DY Patil College of Physiotherapy, Pimpri, Pune from September 2020 to February 2021 on pregnant women with informed and voluntary consent. A total of 200 primigravida women were included and women with complicated pregnancy were excluded. A self-constructed questionnaire was prepared and administered. It had three domains of total 21 items- the knowledge domain with 8 questions, the attitude domain with 7 questions and the perception domain with 6 questions. Descriptive statistics were used to analyse the results. Results: Total 200 women were included, mean age was 25.6±2 years. A 24% of the women had heard about the term NDD and only 13% of them knew its meaning. Attitude of pregnant women where 79.5% were aware about infections, use of drugs and alcohol and smoking during pregnancy can lead to harmful effects on the foetus. Perception of NDD, where 84% women believed that good health of the mother during pregnancy can prevent NDD, 91.5% believed that a proper diet and nutrition during pregnancy plays a role in prevention. Conclusion: The study concluded that, only 24% have ever heard of the term NDD and only 13% were aware of the meaning of it. While 79% of the pregnant women knew about the importance of antenatal care, significantly less pregnant women had knowledge about NDD and only few of them were aware about the possible signs of NDD.

Mechanical clot dissolution technique for surgical clip-related occlusions: An emergent triple-step approach

Cerebral ischemia following clipping of cerebral aneurysms constitutes major cause of morbidity and mortality. Clip-related injury to vessel, postoperative clip rotation, prolonged temporary occlusion, intraoperative rupture, and vasospasm are some etiological factors compromising forward flow in parent or branch vessel. On suspicion of compromised forward flow, immediate intraoperative evaluation is done to detect the cause of vascular compromise and further management is done by microsurgical or endovascular means. We describe a case of ruptured distal anterior cerebral artery (ACA) aneurysm complicated by occlusion of ACA after surgical clipping. The patient was managed by endovascular means by combined technique of intra-arterial nimodipine, antiplatelet infusion, and mechanical clot disruption using J-tip microwire.

Getting a lead on Pb2+-amide chelators for 203/212Pb radiopharmaceuticals

Amide-based chelators DTPAm, EGTAm and ampam were synthesized to investigate which chelator most ideally coordinates [^nat/203Pb]Pb²⁺ ions for potential radiopharmaceutical applications. ¹H NMR spectroscopy was used to study each metal-ligand complex in the solution state. The ¹H NMR spectrum of [Pb(DTPAm)]²⁺ revealed minimal isomerization and fluxional behaviour compared to [Pb(EGTAm)]²⁺ and [Pb(ampam)]²⁺, both of which showed fewer spectral changes indicative of less static behaviour. The solid-state coordination properties of each complex were also examined from single crystal structures that were studied by X-ray diffraction (XRD). In the solid-state, octadentate DTPAm coordinated Pb²⁺ to form an eight-coordinate hemidirected complex; octadentate EGTAm coordinated Pb²⁺ forming a ten-coordinate holodirected complex with a bidentate NO₃^- ion also coordinated to the metal centre; decadentate ampam completely encapsulated the Pb²⁺ ion to form a ten-coordinate holodirected complex with a C₂ axis of symmetry. Potentiometric titrations were carried out to assess the thermodynamic stability of each metal-ligand complex. The pM values obtained for [Pb(DTPAm)]²⁺, [Pb(EGTAm)]²⁺ and [Pb(ampam)]²⁺ were 9.7, 7.2 and 10.2, respectively. The affinity of each chelator for Pb²⁺ ions was tested by [²⁰³Pb]Pb²⁺ radiolabeling studies to evaluate their prospects as chelators for [^203/212Pb]Pb²⁺-based radiopharmaceuticals. DTPAm radiolabeled [²⁰³Pb]Pb²⁺ ions achieving molar activities as high as 3.5 MBq μmol^-1 within 15 minutes, at 25 °C, whereas EGTAm and ampam produced lower molar activities of 0.25 MBq μmol^-1 within 30 minutes, at 37 °C. EGTAm and ampam were therefore deemed unsuitable for [^203/212Pb]Pb²⁺-based radiopharmaceutical applications, while DTPAm warrants further studies.

H4HBEDpa: Octadentate Chelate after A. E. Martell

H₄HBEDpa, a new octadentate chelator inspired by the 1960s ligand HBED of Arthur E. Martell, has been investigated for a selection of trivalent metal ions useful in diagnostic and therapeutic applications (Sc³⁺, Fe³⁺, Ga³⁺, In³⁺, and Lu³⁺). Complex formation equilibria were thoroughly investigated using combined potentiometric and UV-vis spectrophotometric titrations which revealed effective chelation and high metal-sequestering capacity, in particular for Fe³⁺, log K_FeL = 36.62, [Fe(HBEDpa)]^-. X-ray diffraction study of single crystals revealed that the ligand is preorganized and forms hexa-coordinated complexes with Fe³⁺ and Ga³⁺ at acidic pH. Density functional theory (DFT) calculations were applied to probe the geometries and energies of all the possible conformers of [M(HBEDpa)]^- (M = Sc³⁺, Fe³⁺, Ga³⁺, In³⁺, and Lu³⁺). DFT calculations confirmed the experimental findings, indicating that [Fe(HBEDpa)]^- is bound tightly in an asymmetric pattern as compared to the symmetrically bound and more open [Ga(HBEDpa)]^-, prone to hydrolysis at higher pH. DFT calculations also showed that a large metal ion such as Lu³⁺ fully coordinates with HBEDpa^4-, forming a binary octadentate complex in its lowest-energy form. Smaller metal ions form six or seven coordinate complexes with HBEDpa^4-.

MR vessel wall imaging in cerebral bacterial and fungal infections

Purpose

Central nervous system (CNS) bacterial and fungal infections can cause secondary vasculitis which worsens the prognosis due to development of complications like infarctions or hemorrhages. In this prospective study, we aim to study intracranial vessel wall imaging findings in bacterial and fungal infections.

Methods

We included 12 cases of nontubercular bacterial and fungal CNS infections each, in whom definitive microbiological diagnosis could be made. High-resolution vessel wall imaging (VWI) and time of flight MR angiography (TOF MRA) were incorporated in the routine imaging protocol. All cases were evaluated for the presence of vascular enhancement, pattern of enhancement, and stenosis on VWI. Statistical analysis was done to evaluate association between findings of vessel wall imaging and infarctions.

Results

We found infarctions in 5 out of 12 cases (41.7%) of the bacterial group and 7 out of 12 cases (58.3%) of the fungal group. Vessel wall enhancement was seen in 5 cases (41.7%) of the bacterial group and 9 cases (75%) of the fungal group. There was a significant association between infarctions and vessel wall enhancement in the fungal group. However, pattern of enhancement or stenosis on VWI was not significantly associated with presence of infarction. VWI detected more cases of vascular involvement than TOF MRA.

Conclusion

Secondary infectious vasculitis in bacterial and fungal infections can be detected by VWI, which can play an important role in better patient management as detection of vascular involvement can prompt early treatment to prevent complications like infarctions or hemorrhages.

H2pyhox - Octadentate Bis(pyridyloxine)

A new versatile chelating ligand for intermediate size and softness radiometals [⁶⁴Cu]Cu²⁺ and [¹¹¹In]In³⁺, H₂pyhox, was synthesized by introducing pyridine as a new donor moiety to complement 8-hydroxyquinoline on an ethylenediamine backbone. The combination of pyridine and oxine as donor sets was explored through structural analysis, and crystals of the three metal complexes with Cu²⁺, La³⁺, and In³⁺ demonstrate how the ligand adapts to accommodate metal ions of different sizes and charge. Exhaustive in-batch UV solution studies characterized the protonation constants of the free ligand as well as the formation constants of the metal complexes with Cu²⁺, In³⁺, and La³⁺. Preliminary concentration-dependent radiolabeling studies with [¹¹¹In]In³⁺ and [⁶⁴Cu]Cu²⁺ show the robustness of H₂pyhox to successfully coordinate both radiometals under mild conditions (<15 min, room temperature, pH 6). H₂pyhox is the first oxinate ligand to successfully radiolabel [²²⁵Ac]Ac³⁺, albeit only at high concentrations (0.1-1 mM) with gentle heating to 37 °C. Whole serum, protein, and ligand challenge assays further demonstrate the kinetic inertness of the [¹¹¹In]In³⁺ and [⁶⁴Cu]Cu²⁺ radiometal-ligand complexes, confirming H₂pyhox to be a promising versatile radiopharmaceutical chelator.

Early presentation of traumatic pseudoaneurysm of deep lingual artery as a massive oral bleed

Tongue trauma with active bleed is most commonly due to the ruptured lingual artery and its branches, whereas delayed haemorrhage is usually secondary to pseudoaneurysm formation. This case is a unique presentation of traumatic tongue bleeds with early formation of pseudoaneurysm of a lingual artery branch. We present our experience in its management. A contrast-enhanced CT (CECT) with angiography detected right deep lingual artery pseudoaneurysm, which was managed by endovascular gelfoam embolisation followed by tongue laceration repair. Tongue bleed stopped immediately post embolisation; tongue viability and functions restored on postoperative day 1 of repair. No complications like secondary haemorrhage or tongue necrosis were noted at 1-month follow-up. High index of suspicion for lingual artery and/or its branch pseudoaneurysm is crucial in acute and uncontrollable traumatic tongue bleed. A CECT is a minimum norm in early diagnosis. Choice of management is the cornerstone of a successful outcome.

Metal ion size profoundly affects H3glyox chelate chemistry

The bisoxine hexadentate chelating ligand, H₃glyox was investigated for its affinity for Mn²⁺, Cu²⁺ and Lu³⁺ ions; all three metal ions are relevant with applications in nuclear medicine and medicinal inorganic chemistry. The aqueous coordination chemistry and thermodynamic stability of all three metal complexes were thoroughly investigated by detailed DFT structure calculations and stability constant determination, by employing UV in-batch spectrophotometric titrations, giving pM values (pM = −log[Mⁿ⁺]_free when [Mⁿ⁺] = 1 μM, [L] = 10 μM at pH 7.4 and 25 °C) – pCu (25.2) > pLu (18.1) > pMn (12.0). DFT calculated structures revealed different geometries and coordination preferences of the three metal ions; notable was an inner sphere water molecule in the Mn²⁺ complex. H₃glyox labels [^52gMn]Mn²⁺, [⁶⁴Cu]Cu²⁺ and [¹⁷⁷Lu]Lu³⁺ at ambient conditions with apparent molar activities of 40 MBq μmol⁻¹, 500 MBq μmol⁻¹ and 25 GBq μmol⁻¹, respectively. Collectively, these initial investigations provide insight into the effects of metal ion size and charge on the chelation with the hexadentate H₃glyox and indicate that further investigations of the Mn²⁺–H₃glyox complex in ^52g/55Mn-based bimodal imaging might be worthwhile.

The bisoxine hexadentate chelating ligand, H₃glyox was investigated for its affinity for Mn²⁺, Cu²⁺ and Lu³⁺ ions; all three metal ions are relevant with applications in nuclear medicine and medicinal inorganic chemistry.

Pattern of Tobacco consumption among urban slum population in Jammu region: A cross-sectional study

Introduction:

Consumption of tobacco leads to a myriad of ill effects among the smokers as well as those in their proximity. The study related to tobacco consumption was conducted among individuals over 15 years of age, residing in urban slums.

Objective:

To assess the pattern of tobacco consumption in urban slum population, using WHO standardized questionnaire which is Global Tobacco Surveillance System (GTSS); questions related to tobacco from the surveys, which are the subset of GATS 2^nd Edition key questions.

Materials and Methods:

The present study was observational cross-sectional in nature which was conducted over a period of 6 months i.e., from September 2019 to February 2020 in urban slums of Trikuta Nagar, urban health training centre which is a field practice area of Postgraduate Department of Community Medicine, GMC Jammu. The information about the tobacco consumption was gathered by interview sessions after taking consent from all the participants. Totally, 718 individuals were met, out of which, 539 were over 15 years of age and 510 agreed to participate in the study.

Results:

36% (maximum) belonged to 36-45 year age group and lowest (3%) among individuals >66 years. 48% prevalence of active smoking; maximum indulgence (53%) observed in 36-55 year group. Highest exposure to passive smoking seen in 56-65 year group (75%). 45% prevalence of smokeless tobacco consumption, highest in 56-65 year group (72%), lowest in 15-25 year age group (17%).

Conclusion:

Regular conducting of IEC activities for generating awareness with the strict implementation of tobacco control measures by the government needs to be carried out as urban slum population is a vulnerable group and most susceptible to the vicious cycle of disease and poverty.

Phosphonate Chelators for Medicinal Metal Ions

A family of phosphonate-bearing chelators was synthesized to study their potential in metal-based (radio)pharmaceuticals. Three ligands (H₆phospa, H₆dipedpa, H₆eppy; structures illustrated in manuscript) were fully characterized, including X-ray crystallographic structures of H₆phospa and H₆dipedpa. NMR spectroscopy techniques were used to confirm the complexation of each ligand with selected trivalent metal ions. These methods were particularly useful in discerning structural information for Sc³⁺ and La³⁺ complexes. Solution studies were conducted to evaluate the complex stability of 15 metal complexes. As a general trend, H₆phospa was noted to form the most stable complexes, and H₆eppy associated with the least stable complexes. Moreover, In³⁺ complexes were determined to be the most stable, and complexes with La³⁺ were the least stable, across all metals. Density functional theory (DFT) was employed to calculate structures of H₆phospa and H₆dipedpa complexes with La³⁺ and Sc³⁺. A comparison of experimental ¹H NMR spectra with calculated ¹H NMR spectra using DFT-optimized structures was used as a method of structure validation. It was noted that theoretical NMR spectra were very sensitive to a number of variables, such as ligand configuration, protonation state, and the number/orientation of explicit water molecules. In general, the inclusion of an explicit second shell of water molecules qualitatively improved the agreement between theoretical and experimental NMR spectra versus a polarizable continuum solvent model alone. Formation constants were also calculated from DFT results using potential-energy optimized structures. Strong dependence of molecular free energies on explicit water molecule number, water molecule configuration, and protonation state was observed, highlighting the need for dynamic data in accurate first-principles calculations of metal-ligand stability constants.

Barriers in adoption of additive manufacturing in medical sector supply chain

Purpose

Additive manufacturing (AM) is expected to significantly transform the operations in manufacturing sector. It is also proposed to have optimistic applications in the medical supply chains (SC). However, its adoption in medical sector is faced with a range of barriers. Motivated by the need to establish an AM-based medical SC in a developing economy, the present paper analyses the potential barriers that would hinder the adoption of AM in medical SC.

Design/methodology/approach

Based on an extensive literature review and expert discussions, 12 significant barriers have been identified, which are analysed using an integrated interpretive structural modelling–analytical network process (ISM–ANP) methodology. An interrelationship between these barriers using ISM has been analysed to determine the driving-dependence power of these barriers using MICMAC (Matrice d' Impacts Croises-Multiplication Applique' e a' Classement) analysis. The barriers are then ranked using the ANP approach.

Findings

It has been focussed that the non-availability of a variety of materials, lack of education and training to designers and workers and production technology limitation are the most critical barriers. The results suggest that the managers should give greater significance to the technological and organizational barriers.

Originality/value

An approach to overcome these barriers can help the managers and organizations to develop successful AM-based SCs. The study is the first to identify and analyse the barriers for successful adoption of AM in medical SC context.

Deciphering the multi-scale mechanisms of Tephrosia purpurea against polycystic ovarian syndrome (PCOS) and its major psychiatric comorbidities: Studies from network pharmacological perspective

Tephrosia purpurea (T. purpurea), a plant belonging to Fabaceae (pea) family, is a well-known Ayurvedic herb and commonly known as Sarapunkha in traditional Indian medicinal system. Described as "Sarwa wranvishapaka", i.e. having a capability to heal all types of wounds, it is particularly recognized for its usage in splenomegaly. Towards exploring the comprehensive effects of T. purpurea against polycystic ovarian syndrome (PCOS) and three comorbid neuropsychiatric diseases (anxiety, depression, and bipolar disorder), its constituent phytochemicals (PCs) were extensively reviewed and their network pharmacology evaluation was carried out in this study. The complex regulatory potential of its 76 PCs against PCOS is enquired by developing and analyzing high confidence tripartite networks of protein targets of each phytochemical at both pathway and disease association scales. We also developed a high-confidence human Protein-Protein Interaction (PPI) sub-network specific to PCOS, explored its modular architecture, and probed 30 drug-like phytochemicals (DPCs) having multi-module regulatory potential. The phytochemicals showing good binding affinity towards their protein targets were also evaluated for similarity against currently available approved drugs present in DrugBank. Multi-targeting and synergistic capacities of 12 DPCs against 10 protein targets were identified and evaluated using molecular docking and interaction analyses. Eight DPCs as a potential source of PCOS and its comorbidity regulators are reported in T. purpurea. The results of network-pharmacology study highlight the therapeutic relevance of T. purpurea as PCOS-regulator and demonstrate the effectiveness of the approach in revealing action-mechanism of Ayurvedic herbs from holistic perspective.

Secretory carcinoma of the breast, commonly exhibits the features of low grade, triple negative breast carcinoma- A Case report with updated review of literature

Secretory carcinoma of the breast (SBC) is a rare breast neoplasm. Most of the patients present at an early stage with a relatively indolent clinical course. Lymph node and distant metastasis are also very infrequent. The histomorphological features of the secretory breast carcinoma are quite characteristic. Predominantly three histological patterns, solid, microcystic, and tubular, have been noted with copious amounts of intra and extracellular secretory material. Most commonly, no positivity for estrogen receptor (ER), progesterone receptor (PR) and ERBB2(HER2/neu) is observed in SBCs. As SBC can occasionally be hormone receptor-positive, they should not be categorized in the triple-negative breast carcinoma (TNBC) group in general. A very characteristic genetic translocation t (12;15) has been noted in this rare tumor, resulting in a fusion between ETV6 and NTRK3 proteins. We present a case of a 60-year-old lady who presented with right breast lump of 1-month duration and was managed by lumpectomy and sentinel lymph node dissection. Axillary dissection was not performed because the sentinel lymph node biopsy was negative. Postoperative radiotherapy was given to the right breast with a boost to the tumor bed. No adjuvant chemotherapy was given No recurrence has been noted even after a year of the completion of treatment

Reporting of the core indicators on drinking water and sanitation from urban slums of Jammu: A cross-sectional study

Introduction:

Water, sanitation, and hygiene (WASH) play an important role in decreasing the morbidity and mortality associated with poor WASH practices. Poor knowledge and awareness lead to an increase in communicable diseases.

Objective:

To assess and report the core indicators on sanitation and drinking water from urban slums using standardized WHO and UNICEF questionnaires.

Materials and Methodology:

The present observational cross-sectional study was conducted for 2 months i.e., from September 2019 to October 2019 in urban slums of Trikuta Nagar, a field practice area of Department of Community Medicine, GMC Jammu. Information was gathered from the head of the household as well as from other household members. About 50% of the population were selected randomly by lottery method i.e., 450 and consist of 112 households. However, at the time of the study, only 100 households were assessed because of the nonavailability of household members and some houses were locked at the time of the interview.

Results:

The study revealed that nearly 62% of families were of a joint type and most of the families were headed by male members. Around 82.5% of the slum members used water for drinking from improved source but only 21.5% of the household members used adequate water treatment method i.e., boiling. Besides, about 49.5% of the household members used improved sanitation facilities.

Conclusion:

Local administration needs to accelerate the process of supplying piped water connections to the underserved to improve their drinking water sources and also increase access to basic sanitation services at the household level.

Ketone Hydrogenation by Using ZnO-Cu(OH)Cl/MCM-41 with a Splash of Water: An Environmentally Benign Approach

MCM-41-supported ZnO-Cu(OH)Cl nanoparticles were synthesized via an incipient wetness impregnation technique using zinc chloride and copper chloride salts as well as water at room temperature. The catalyst was characterized by powder X-ray diffraction (PXRD), infrared spectroscopy (IR), and TGA, whereas surface and morphological studies were performed by using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The above studies revealed the incorporation of metal species into the pores of MCM-41, leading to a decrease in surface area of the nanoparticles that was found to be 239.079 m² /g. The substituents attached to the ketone determine the rate of the reaction, and the utilization of the green solvent 'water' astonishingly completes the hydrogenation reaction in 45 minutes at 40 °C with 100% conversion and 100% selectivity as analyzed by gas chromatography-mass spectrometry. Hence, ZnO-Cu(OH)Cl/MCM-41 nanoparticles with 2.46 wt% zinc and 6.39 wt% copper were demonstrated as an active catalyst for the reduction of ketones without using any gaseous hydrogen source making it highly efficient as well as environmentally and economically benign.

PATIENTS DOSE ESTIMATION IN CT EXAMINATIONS USING SIZE SPECIFIC DOSE ESTIMATES

The present work reports data of radiation exposure to the patients during head, chest, pelvis and abdomen CT examinations performed on a third-generation 16-slice CT machine. Radiation exposure was estimated using size specific dose estimates (SSDE) method, which takes into account patient's physical dimensions in phantom measured computed tomography dose index (CTDI) value. The reported median CT dose volume index CTDIvol values in head, chest, pelvis and abdomen examinations were 26.76, 16.27, 29.81 and 14.74 mGy, respectively. The median doses evaluated using SSDE methodology for the above mentioned procedure were 54.1, 23.1, 42.8 and 20.1 mGy, respectively. Our results showed variation in dose values estimated using CTDI and SSDE methods in all examinations. The evaluated SSDE values were also compared to the values derived from data reported by the American Association of Physicist in Medicine (AAPM). SSDE values in present measurements are 4-8% lower than AAPM values. The present results show that CTDI parameters recorded on CT console should not be used to specify patient dose during CT procedures.

Insights about multi-targeting and synergistic neuromodulators in Ayurvedic herbs against epilepsy: integrated computational studies on drug-target and protein-protein interaction networks

Epilepsy, that comprises a wide spectrum of neuronal disorders and accounts for about one percent of global disease burden affecting people of all age groups, is recognised as apasmara in the traditional medicinal system of Indian antiquity commonly known as Ayurveda. Towards exploring the molecular level complex regulatory mechanisms of 63 anti-epileptic Ayurvedic herbs and thoroughly examining the multi-targeting and synergistic potential of 349 drug-like phytochemicals (DPCs) found therein, in this study, we develop an integrated computational framework comprising of network pharmacology and molecular docking studies. Neuromodulatory prospects of anti-epileptic herbs are probed and, as a special case study, DPCs that can regulate metabotropic glutamate receptors (mGluRs) are inspected. A novel methodology to screen and systematically analyse the DPCs having similar neuromodulatory potential vis-à-vis DrugBank compounds (NeuMoDs) is developed and 11 NeuMoDs are reported. A repertoire of 74 DPCs having poly-pharmacological similarity with anti-epileptic DrugBank compounds and those under clinical trials is also reported. Further, high-confidence PPI-network specific to epileptic protein-targets is developed and the potential of DPCs to regulate its functional modules is investigated. We believe that the presented schema can open-up exhaustive explorations of indigenous herbs towards meticulous identification of clinically relevant DPCs against various diseases and disorders.

Functionally Versatile and Highly Stable Chelator for 111In and 177Lu: Proof-of-Principle Prostate-Specific Membrane Antigen Targeting

Here, we present the synthesis and characterization of a new potentially nonadentate chelator H₄pypa and its bifunctional analogue ^tBu₄pypa-C7-NHS conjugated to prostate-specific membrane antigen (PSMA)-targeting peptidomimetic (Glu-urea-Lys). H₄pypa is very functionally versatile and biologically stable. Compared to the conventional chelators (e.g., DOTA, DTPA), H₄pypa has outstanding affinities for both ¹¹¹In (EC, t_1/2 ≈ 2.8 days) and ¹⁷⁷Lu (β^-,γ, t_1/2 ≈ 6.64 days). Its radiolabeled complexes were achieved at >98% radiochemical yield, RT within 10 min, at a ligand concentration as low as 10^-6 M, with excellent stability in human serum over at least 5-7 days (<1% transchelation). The thermodynamic stabilities of the [M(pypa)]^- complexes (M³⁺ = In³⁺, Lu³⁺, La³⁺) were dependent on the ionic radii, where the smaller In³⁺ has the highest pM value (30.5), followed by Lu³⁺ (22.6) and La³⁺ (19.9). All pM values are remarkably higher than those with DOTA, DTPA, H₄octapa, H₄octox, and H₄neunpa. Moreover, the facile and versatile bifunctionalization enabled by the p-OH group in the central pyridyl bridge of the pypa scaffold (compound 14) allows incorporation of a variety of linkers for bioconjugation through easy nucleophilic substitution. In this work, an alkyl linker was selected to couple H₄pypa to a PSMA-targeting pharmacophore, proving that the bioconjugation sacrifices neither the tumor-targeting nor the chelation properties. The biodistribution profiles of ¹¹¹In- and ¹⁷⁷Lu-labeled tracers are different, but promising, with the ¹⁷⁷Lu analogue particularly outstanding.

A comparative study of perception and practices regarding menstrual hygiene among adolescent girls in urban and rural areas of Jodhpur district, Rajasthan

Context:

There are vast disparities of information gap between urban and rural adolescent girls in India, which do have an impact on the practices during menstruation.

Aim:

To assess and compare the knowledge, perceptions, and practices of adolescent girls regarding menstrual hygiene in rural and urban areas of Jodhpur.

Settings and Design:

It was a cross-sectional study, which was conducted on school going adolescent girls in urban and rural schools of Jodhpur.

Materials and Methods:

The sample size for the study was 450, which was divided into rural and urban adolescent girls. A self-administered questionnaire was used for data collection.

Statistical Analysis Used:

Data were analyzed using SPSS v. 16. Inferences were drawn using Chi-square test and t test.

Results:

The mean age of menarche was 13.41 ± 1.07 years. A significantly more number of girls from an urban area (56.2%) were using sanitary napkins during menstruation. Only around one-fourth of the girls in study area had ever been counseled for menstrual hygiene. Awareness about adolescent health clinic was significantly more among urban girls.

Conclusion:

Significant differences were observed among urban and rural adolescent girls in terms of knowledge, perception, and practices related to menstrual hygiene.

Psychological health and its associates - A comparative study among migrants and non migrants in a rural area of Northern India

Background: Migration, whether voluntary or forced, entails major adaptations. An elaborate insight into the circumstances helps to induce various interventions in migrants. Aims and Objectives: To elicit the psychological health, lifestyle variables, religiosity, spirituality and coping among migrants and compare it with non migrants in a rural locality. Material and Methods: A community based cross-sectional study was undertaken among 404 adults aged 20 years and above. The General Health Questionnaire–12, Religiosity scale by Wilkes, The Daily Spiritual Experience Scale and COPE scale were used as psychometric tools for data collection. Data was analysed using SPSS (ver. 20.0). Results: A sample of 137 migrants and 267 non migrants were analysed. There was a statistically significant difference between the two groups for occupation and education (p=0.002 & 0.000 resp). The mean scores of the psychological health of migrants (10.58± 6.32) were slightly better than that of non migrants (11.49 ±5.69, p= 0.142). Spirituality scores showed migrants being more inclined towards spiritualism (p=0.016). Young age, religious and spiritual propensity showed a statistically significant correlation with better Psychological health (p=0.036, 0.000&0.013resp). Conclusion: Providing psychosocial assistance to migrant populations focussing on educational, occupational & religious-spiritual issues can reduce vulnerabilities especially for psychological health.

A Risk-benefit Assessment Approach to Selection of Adjuvant Chemotherapy in Elderly Patients with Early Breast Cancer: A Mini Review

Decision-making regarding the use and selection of adjuvant chemotherapy for breast cancer in elderly patients is challenging due to the presence of age-related comorbidities, frailty, and competing causes of mortality. One area, relatively neglected in most guidelines, is the effect of competing causes of mortality on presumed benefit of adjuvant chemotherapy for breast cancer in these patients. This article utilizes a clinical case to illustrate the principles of risk-benefit assessment of adjuvant chemotherapy in elderly patients. We suggest an approach that incorporates validated tools for estimating survival benefits of adjuvant chemotherapy, geriatric assessment, predicting toxicity, and estimating remaining life expectancy without cancer. Integration of all these variables provides a better picture of the possible benefits and harms of adjuvant chemotherapy in this population compared to conventional approaches that incorporate tumor-related variables and nonstandard measures of geriatric assessment.

H4octapa: synthesis, solution equilibria and complexes with useful radiopharmaceutical metal ions

H₄octapa is synthesized and complexed to nine metals of medicinal interest. Crystal structures of the ligand and its La complex were obtained. Solution equilibria for the ligand and several lanthanide complexes were investigated.

Persistent Trophoblastic Disease at Cesarean Scar

Pregnancy over the cesarean scar is the rarest cause of ectopic pregnancy and development of persistent trophoblastic disease at the scar site is extremely rare. A high index of suspicion is needed for early diagnosis and management of cesarean scar molar pregnancy. This condition is difficult to diagnose and must be considered in the patient with a history of cesarean section who has persistent vaginal bleeding or symptoms of pregnancy after suction evacuation. Diagnosis can be confirmedby measuring ß Human Chorionic Gonadotropin levels, transvaginal ultrasound with doppler flow evaluation. As this is an uncommon condition, this case report with conservative non surgical approach will add up to its clinical spectrum.

Use of ABO-incompatible grafts in living donor liver transplantation--first report from India

ABO incompatibility is the commonest reason for rejection of donors in living donor liver transplantation (LDLT). The donor pool could be expanded by 25 % to 35 % if the ABO barrier is overcome. In the absence of pre-conditioning, transplantation across the blood groups is fraught with the almost universal risk of antibody-mediated rejection (AMR) that rapidly leads to graft loss. However, AMR can be prevented by removal of preformed antibodies and reducing their production by B cells. We describe our initial experience of three cases of ABO-incompatible (ABO-i) LDLT: a 42-year-old male, an 8-month-old male and a 28-month-old female, all of blood group O+ who received blood group B + right lobe, B + left lateral segment, and A + left lateral segment liver grafts, respectively. Pre-LDLT conditioning included administration of anti-CD20 antibody (Rituximab(®)) to the adult 4 weeks prior, and four to seven sessions of double-filtration plasmapheresis to all, to remove preformed antibodies and achieve anti-donor blood group antibody (ADA) titers of ≤ 1:16 IgG and ≤ 1:8 IgM, respectively. In addition, cases 1 and 3 received mycophenolate mofetil for 7 days prior to LDLT. After LDLT, all three patients achieved normal graft function over 8-17 days with no evidence of AMR and without the need for further plasmapheresis. Postoperative complications included portal vein thrombosis (one successfully re-explored), CMV (one), Pseudomonas and Klebsiella sepsis (one each), and abdominal collection (one treated with percutaneous drainage). All are currently well with normal graft function and low ADA titers at 8, 16, and 19 months after ABO-i LDLT.