Role of miRNAs in T-cell activation and Th17/Treg-cell imbalance in acquired aplastic anemia

BACKGROUND

Altered T-cell repertoire with an aberrant T-cell activation and imbalance of the Th17/Treg cells has been reported in acquired aplastic anemia (aAA). miRNAs are well known to orchestrate T-cell activation and differentiation, however, their role in aAA is poorly characterized. The study aimed at identifying the profile of miRNAs likely to be involved in T-cell activation and the Th17/Treg-cell imbalance in aAA, to explore newer therapeutic targets.

METHODS

Five milliliters peripheral blood samples from 30 patients of aAA and 15 healthy controls were subjected to flow cytometry for evaluating Th17- and Treg-cell subsets. The differential expression of 7 selected miRNAs viz; hsa-miR-126-3p, miR-146b-5p, miR-155-5p, miR-16, miR-17, miR-326, and miR-181c was evaluated in the PB-MNCs. Expression analysis of the miRNAs was performed using qRT-PCR and fold change was calculated by 2-ΔΔCt method. The alterations in the target genes of deregulated miRNAs were assessed by qRT-PCR. The targets studied included various transcription factors, cytokines, and downstream proteins.

RESULTS

The absolute CD3+ lymphocytes were significantly elevated in the PB of aAA patients when compared with healthy controls (p < 0.0035), however, the CD4:CD8 ratio was unperturbed. Th17: Treg-cell ratio was altered in aAA patients (9.1 vs. 3.7%, p value <0.05), which correlated positively with disease severity and the PNH positive aAA. Across all severities of aAA, altered expression of the 07 miRNAs was noted in comparison to controls; upregulation of miR-155 (FC-2.174, p-value-0.0001), miR-146 (FC-2.006, p-value-0.0001), and miR-17 (FC-3.1, p-value-0.0001), and downregulation of miR-126 (FC-0.329, p-value-0.0001), miR-181c (FC-0.317, p-value-0.0001), miR-16 (FC-0.348, p-value-0.0001), and miR-326 (FC-0.334, p-value-0.0001). Target study for these miRNAs revealed an increased expression of transcription factors responsible for Th1 and Th17 differentiation (T-bet, RORϒt, IL-17, IL-6, and IFN-ϒ), T-cell activation (NFκB, MYC, and PIK3R2), downregulation of FOX-P3, and other regulatory downstream molecules like SHIP-1, ETS-1, IRAK-1, TRAF-6, and PTEN.

CONCLUSION

The study for the first time highlights the plausible role of different miRNAs in deregulating the Th17/Treg-cell imbalance in aAA, and comprehensively suggest the role of altered NF-kB and mTOR pathways in aAA. The axis may be actively explored for development of newer therapeutic targets in aAA.

Low thermal conductivity in a new mixed metal telluride Mn1.8(1)In0.8(1)Si2Te6

The design of new complex mixed metal tellurides (containing low toxicity cations) with intrinsic ultralow thermal conductivity is of paramount importance in the field of thermoelectrics. Herein, we report the synthesis and characterization of polycrystalline and single crystals of a new mixed-metal quaternary telluride Mn1.8(1)In0.8(1)Si2Te6. The structural aspects and chemical formula of this phase at room temperature have been established using single crystal X-ray diffraction and EDX studies. The trigonal centrosymmetric (space group: P3̄1m) structure of the title phase has cell constants of a = b = 7.0483(7) Å and c = 7.1277(8) Å. The structure has three independent cationic sites, one mixed (In1/Mn1), one partially filled Mn2, and one Si1, which are bonded with Te1 atoms. Each metal atom (In and Mn) in the structure is octahedrally coordinated with six neighboring Te1 atoms. The structure also features dimers of Si atoms, and each Si atom is bonded to three Te1 atoms to form ethane-like Si2Te6 units. The optical absorption study of a polycrystalline Mn1.8In0.8Si2Te6 sample shows a narrow optical bandgap of 0.6(2) eV. Temperature-dependent resistivity and Seebeck coefficient studies confirmed the p-type semiconducting nature of the sample with high values of S (301 μV K-1 to 444 μV K-1). The total thermal conductivity (ktot) study of the polycrystalline sample shows a decreasing trend on heating with an extremely low value of 0.28 W m-1 K-1 at 773 K. Magnetic measurements indicate a glassy magnetic behavior for the sample below 8 K.

Air Embolism-Induced Ischemic Stroke Following Orthognathic Surgery in a Patient With Goldenhar Syndrome

Goldenhar syndrome, a rare congenital anomaly, manifests as craniofacial malformations often necessitating intricate surgical interventions. These procedures, though crucial, can expose patients to diverse postoperative complications, including hemorrhage or infection. A noteworthy complication is stroke, potentially linked to air embolism or local surgical trauma. We highlight a case of a male patient, aged 20 years, who experienced a significant postoperative complication of an ischemic stroke, theorized to be due to an air embolism, after undergoing orthognathic procedures for Goldenhar syndrome. The patient was subjected to LeFort I maxillary osteotomy, bilateral sagittal split ramus osteotomy of the mandible, and anterior iliac crest bone grafting to the right maxilla. He suffered an acute ischemic stroke in the left thalamus post-surgery, theorized to stem from an air embolism. Advanced imaging demonstrated air pockets within the cavernous sinus, a rare and concerning finding suggestive of potential air embolism. This case underscores the intricate challenges in treating Goldenhar syndrome patients and the rare but significant risk of stroke due to air embolism or surgical trauma. Limited literature on managing air embolism complications specific to Goldenhar syndrome surgeries exists. Generally, management includes immediate recognition, positional adjustments, air aspiration via central venous catheters, hyperbaric oxygen therapy, hemodynamic support, and high-flow oxygen administration to expedite air resorption. Our patient was conservatively managed post-surgery, and at a 3-month neurology follow-up, he showed significant improvement with only residual right arm weakness. It emphasizes the imperative of a comprehensive, multidisciplinary approach.

Ozone: An Adjunct in Dental Treatment

Ozone is utilized in dentistry as ozonated oils, ozonated water, and gaseous ozone. The application of ozone in all specialties of dentistry has been demonstrated to be biocompatible. It has been demonstrated to encourage the remineralization of recently carious teeth, and it is utilized in dental caries and intracanal irrigants in endodontic treatment. Herpes virus infection, avascular osteonecrosis of the jaw, and alveolitis have all been treated with it. It can be applied as a supplement in the surgical and ongoing stages of periodontal disease and also hinders plaque formation. The purpose of the present review article is to discuss the numerous application of ozone in dentistry.

Research Note: Effect of dietary xylo-oligosaccharide on growth performance, intestinal histomorphology, and specific cecal bacteria in broiler chickens

This study was conducted to evaluate the prebiotic effect of xylo-oligosaccharide (XOS) supplemented in a corn-soybean meal (SBM) based conventional diet on growth performance, intestinal histomorphology, and quantification of specific bacteria in the ceca of broilers. A total of 240 d of hatch Cobb 500 male broiler chicks were randomly assigned to 4 dietary treatments (corn-SBM-based control diet) containing 0, 0.05, 0.1, and 0.2% XOS. The broilers were raised for 21 d in 6 replicate cages, each containing 10 birds. Growth performance parameters were obtained weekly. Additionally, small intestinal tissues were collected to evaluate histomorphometry and whole ceca were collected to quantify bacterial populations on D21. The results showed that inclusion of XOS has similar body weight (BW), body weight gain (BWG), feed intake (FI), and feed conversion ratio (FCR) as the control group during the 21-day study. The results further indicate a tendency for the jejunum villus to crypt ratio (VH:CD) to increase in birds given 0.05 and 0.2% XOS (P = 0.08). Cecal bacteria quantification showed a linear increase in Bifidobacterium with increasing XOS levels (P < 0.0001) and a decrease Clostridium perfringens levels compared to birds fed the control diet (P < 0.0001). However, there were no differences in the total counts of Lactobacillus and E. coli. Together these results showed that while there were no differences in growth parameters up to 21 d, the histomorphology findings and the increase in Bifidobacterium, along with the reduction in C. perfringens observed in the XOS groups, suggest a beneficial impact of XOS inclusion on gut health. Further research with longer feeding periods and higher XOS levels should be conducted to explore potential positive effects on both growth and gut health parameters.

Utilization of Point-of-Care Ultrasound as an Imaging Modality in the Emergency Department: A Systematic Review and Meta-Analysis

Point-of-care ultrasound (POCUS) is an imaging modality that has become a fundamental part of clinical care provided in the emergency department (ED). The applications of this tool in the ED have ranged from resuscitation, diagnosis, and therapeutic to procedure guidance. This review aims to summarize the evidence on the use of POCUS for diagnosis and procedure guidance. To achieve this, CrossRef, PubMed, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched for studies published between January 2000 and November 2023. Additionally, the risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 (for studies on the diagnostic role of POCUS) and Cochrane Risk of Bias tool (for studies on the use of POCUS for procedure guidance). Furthermore, diagnostic accuracy outcomes were pooled using STATA 16 software (StatCorp., College Station, TX, USA), while outcomes related to procedure guidance were pooled using the Review Manager software. The study included 81 articles (74 evaluating the diagnostic application of POCUS and seven evaluating the use of POCUS in guiding clinical procedures). In our findings sensitivities and specificities for various conditions were as follows: appendicitis, 65% and 89%; hydronephrosis, 82% and 74%; small bowel obstruction, 93% and 82%; cholecystitis, 75% and 96%; retinal detachment, 94% and 91%; abscess, 95% and 85%; foreign bodies, 67% and 97%; clavicle fractures, 93% and 94%; distal forearm fractures, 97% and 94%; metacarpal fractures, 94% and 92%; skull fractures, 91% and 97%; and pleural effusion, 91% and 97%. A subgroup analysis of data from 11 studies also showed that the two-point POCUS has a sensitivity and specificity of 89% and 96%, while the three-point POCUS is 87% sensitive and 92% specific in the diagnosis of deep vein thrombosis. In addition, the analyses showed that ultrasound guidance significantly increases the overall success rate of peripheral venous access (p = 0.02) and significantly reduces the number of skin punctures (p = 0.01) compared to conventional methods. In conclusion, POCUS can be used in the ED to diagnose a wide range of clinical conditions accurately. Furthermore, it can be used to guide peripheral venous access and central venous catheter insertion.

Synthesis and crystal structure of Ba2Y0.87(1)Mn1.71(1)Te5

We report the structural characterization of a new quaternary telluride, Ba2Y0.87(1)Mn1.71(1)Te5, which was synthesized by the direct reaction of the elements inside a vacuum-sealed fused-silica tube. The quaternary phase is the first member of the Ba-M-Mn-Te system (M = Sc and Y). The composition and structure of the phase were elucidated using SEM-EDX (scanning electron microscopy-energy dispersive X-ray spectrometry) and single-crystal X-ray diffraction (SCXRD) studies. The title phase is nonstoichiometric and crystallizes in the monoclinic system (space group C2/m) having the refined unit-cell parameters a = 15.1466 (8), b = 4.5782 (3), c = 10.6060 (7) Å and β = 116.956 (2)°, with two formula units (Z = 2). The pseudo-two-dimensional crystal structure of Ba2Y0.87(1)Mn1.71(1)Te5 consists of distorted YTe6 octahedra and MnTe4 tetrahedra as the building blocks of the structure. The YTe6 octahedra are arranged to form infinite one-dimensional chains by sharing edges along the [010] direction. These chains are further connected to the MnTe4 tetrahedra along the c axis to create layered two-dimensional polyanionic [Y0.87(1)Mn1.71(1)Te5]4- units. The stuffing of Ba2+ cations in between the layers of [Y0.87(1)Mn1.71(1)Te5]4- anions brings the charge neutrality of the structure. Each Ba atom in the structure sits at the centre of a distorted monocapped trigonal prism-like polyhedron of seven Te atoms.

Efficacy and Safety of Different Dosing Regimens of Rivaroxaban in Patients With Atrial Fibrillation for Stroke Prevention: A Systematic Review and Meta-Analysis

Atrial fibrillation (AF) poses a substantial risk of stroke, necessitating effective anticoagulation therapy. This systematic review and meta-analysis (SRMA) evaluates the efficacy and safety of different dosing regimens of rivaroxaban in patients with AF. A comprehensive search of relevant databases, focusing on studies published from 2017 onward, was conducted. Inclusion criteria comprised randomized controlled trials (RCTs) and observational studies comparing standard and reduced dosing of rivaroxaban in AF. Data extraction and risk of bias (ROB) assessment were performed, and a meta-analysis was conducted for relevant outcomes. A total of 21 studies fulfilled the inclusion criteria. Standard dosing demonstrates a slightly lower risk of composite effectiveness outcomes and safety outcomes (HR: 0.79, 95% CI: 0.66-0.94, P=0.01) compared to reduced dosing (HR: 0.83, 95% CI: 0.71-0.97, P=0.02). Notable differences in major bleeding, gastrointestinal bleeding (GIB), and intracranial bleeding favored standard dosing. Hemorrhagic stroke and all-cause stroke rates differed significantly, with standard dosing showing a more favorable profile for ischemic stroke prevention. This study highlights the pivotal role of personalized anticoagulation therapy in AF. Standard dosing of rivaroxaban emerges as a preferred strategy for stroke prevention, balancing efficacy and safety. Clinical decision-making should consider individual patient characteristics and future research should delve into specific subpopulations and long-term outcomes to further refine treatment guidelines. The study bridges evidence from clinical trials to real-world practice, offering insights into the evolving landscape of AF management.

Artificial Intelligence in the Early Prediction of Cardiogenic Shock in Acute Heart Failure or Myocardial Infarction Patients: A Systematic Review and Meta-Analysis

Cardiogenic shock (CS) may have a negative impact on mortality in patients with heart failure (HF) or acute myocardial infarction (AMI). Early prediction of CS can result in improved survival. Artificial intelligence (AI) through machine learning (ML) models have shown promise in predictive medicine. Here, we conduct a systematic review and meta-analysis to assess the effectiveness of these models in the early prediction of CS. A thorough search of the PubMed, Web of Science, Cochrane, and Scopus databases was conducted from the time of inception until November 2, 2023, to find relevant studies. Our outcomes were area under the curve (AUC), the sensitivity and specificity of the ML model, the accuracy of the ML model, and the predictor variables that had the most impact in predicting CS. Comprehensive Meta-Analysis (CMA) Version 3.0 was used to conduct the meta-analysis. Six studies were considered in our study. The pooled mean AUC was 0.808 (95% confidence interval: 0.727, 0.890). The AUC in the included studies ranged from 0.77 to 0.91. ML models performed well, with accuracy ranging from 0.88 to 0.93 and sensitivity and specificity of 58%-78% and 88%-93%, respectively. Age, blood pressure, heart rate, oxygen saturation, and blood glucose were the most significant variables required by ML models to acquire their outputs. In conclusion, AI has the potential for early prediction of CS, which may lead to a decrease in the high mortality rate associated with it. Future studies are needed to confirm the results.

EARLY IMPLANT OUTCOMES IN ADULTS WITH DENTAL DECAY TREATED WITH PHOTODYNAMIC TREATMENT

A fast implant is a kind of implant to place in the cavity right away after dental extraction. These implants are shown to maintain cervical marrow and reduce the number of surgery operations required for patients. The Photodynamic treatment (PDT) uses antimicrobial processes to supplement nonsurgical periodontal therapy. Combined through the scaling and root planning (SRP), and PDT is more effective. This study aims to assess the effects of PDT on initial findings with dental implants (DI) placed in patients having gum disease with SRP against patients who do not at the 12-month follow-up point. An aggregate of 25 implants were inserted in 16 patients, 12 of whom were in the test group (TG) and 13 of whom were in the control group (CG). SRP is conducted toward rapid implant assignment in the control site, while PDT as an adjunct to SRP (SRP + PDT) is executed prior to instant implant insertion in test sites. At the beginning, 4 months, 8 months, and 12 months, gingival index, radiovisiographs, inquiring pocket intensity, clinical attachment level, and plaque index were obtained. Basic durability was assessed after implant insertion, and the recovery index was measured a week later. In this analysis, Analysis of Variance (ANOVA) technique is used to predict tooth decay earlier. The CG experienced 1.10 mm of mean marginal bone loss after the 12-month research period, compared to 0.97 mm for the (SRP + PDT) group. After reaching the CG and TG, the differences in plaque score and probe depth were noteworthy. Clinical indicators compared to the basis in a year revealed unquestionable improvement, including the probing depth gingival index, plaque index and clinical attachment level. Twelve months were spent monitoring the implants in both groups. The little bone loss improved, although it isn't clinically important. The endurance rate for rapid implants in the PDT grouping is the same as that of the group that underwent SRP. The impact of PTD is utilized as a supplement to SRP. Yet, the consequence is marginal. Because of the improved results with PDT, it is used successfully as an addition to SRP.

Ba14Si4Sb8Te32(Te3): hypervalent Te in a new structure type with low thermal conductivity

Heavier pnictogen (Sb, Bi) containing chalcogenides are well known for their complex structures and semiconducting properties for numerous applications, particularly thermoelectric materials. Here, we report the syntheses of single crystals and polycrystalline phases of a new complex quaternary polytelluride, Ba14Si4Sb8Te32(Te3), via a high-temperature reaction of elements. A single-crystal X-ray diffraction study showed that it crystallizes in an unprecedented structure type with monoclinic symmetry (space group: P21/c). The crystal structure of Ba14Si4Sb8Te32(Te3) consists of one-dimensional ∞1[Si4Sb8Te32(Te3)]28- stripes, which are separated by the Ba2+ cations. Its complex structure features linear polytelluride units of Te34- having intermediate Te⋯Te interactions. A polycrystalline Ba14Si4Sb8Te32(Te3) sample shows a direct narrow bandgap of 0.8(2) eV, which indicates its semiconducting nature. The electrical resistivity of a sintered pellet of the polycrystalline sample exponentially decreases from ∼39.3 Ωcm to ∼0.57 Ωcm on heating it from 323 K to 773 K, confirming the sample's semiconducting nature. The sign of Seebeck coefficient values is positive in the 323 K to 773 K range confirming the p-type nature of the sintered sample. Interestingly, the sample attains an extremely low thermal conductivity of ∼0.32 Wm-1K-1 at 773 K, which could be attributed to the lattice anharmonicity caused by the lone pair effect of Sb3+ species in its complex pseudo-one-dimensional crystal structure. The electronic band structure of the title phase and the strength of chemical bonding of pertinent atomic pairs have been evaluated theoretically using the DFT method.

Psychological health of postmenopausal women: a bibliometric analysis in the recent decade

The aim of this study is to analyze the publication trends on the psychological health of postmenopausal women by performing a bibliometric and visualization analysis that can be used as a foundation for understanding current and future research plans. Publications were retrieved from Dimensions database from 2012 to June 2022. VOSviewer software was used for data mining and visualization. A total of 1718 papers were selected by keyword search and delimiting criteria. To evaluate the productive nations, authors, journals, articles and frequent joint citations, citation analysis, author keyword co-occurrence analysis, co-authorship analysis and co-citation analysis were performed. Results depict that the USA contributed the most papers (n = 457). Maximum articles (n = 192) were published in 2021. The highest number of articles are published in Menopause: The Journal of the North American Menopause Society and Climacteric: The Journal of the International Menopause Society. Out of the top 10 contributing organizations in the field, six organizations were from the USA. R. Nappi of Italy is the most productive author with 20 articles and 1138 citations. From the point of average citations per article, H. Joffe has the highest score (71.5). The data reported in this analysis contribute to discussions about the development, growth and current state of psychological health of postmenopausal women as well as its impact. These findings offer helpful guidance for researchers in choosing their potential fields of study and integrating different approaches to solve complicated issues, finding potential co-authors and choosing the right institutions for supporting academic studies or collaborative research.

Effectiveness of Diode Lasers in the Reduction of Bacteremia Associated with Ultrasonic Scaling: A Clinical and Microbiological Study

Introduction

As is known, periodontal pathogens and their products as well as inflammatory mediators produced in periodontal tissues might enter the bloodstream, causing systemic effects and/or contributing to systemic diseases.

Aim

To evaluate the effect of diode lasers on the incidence of bacteremia associated with ultrasonic scaling and its clinical efficacy as an adjunct to scaling in the treatment of moderate periodontitis.

Result

The use of diode laser is more effective in killing or detoxifying periodontopathic bacteria such as P. gingivalis associated with chronic periodontitis as compared to ultrasonic alone with ablate bacteria only when it comes in contact with plaque biofilm directly.

Conclusion

The results of study confirm the previously reported findings that bacteremia is caused by ultrasonic scaling and adjunct use of diode laser with scaling has the potential to reduce the bacteremia associated with ultrasonic scaling alone.

The Pass/Fail Effect: A Longitudinal Study of United States Medical Licensing Examination (USMLE) Step 1 Performance Over a Decade

Objectives This study aimed to analyze the impact of the United States Medical Licensing Examination (USMLE) Step 1 transition to a pass/fail scoring system in 2022 on the performance of first-time test takers in three distinct groups: Doctor of Osteopathy (DO) and Doctor of Medicine (MD) examinees from US/Canadian schools and examinees from non-US/Canadian schools. The analysis spans a decade-long period from 2012 to 2022, offering insights into the implications of this pivotal change in medical education. Methods We analyzed the performance of first-time USMLE Step 1 examinees from US/Canadian MD and DO programs and non-US/Canadian schools from 2012 to 2022, including the transition year to a pass/fail scoring system. Data were obtained from USMLE performance data reports and organized into annual contingency tables. Descriptive statistics and comparative analysis were used to identify trends and differences in performance across the groups. Data visualization techniques were employed to illustrate these findings, and the results were contextualized within the broader changes in medical education. Results In 2021, first-time takers from US/Canadian MD and DO Degree programs had pass rates of 96% and 94%, respectively, while non-US/Canadian schools had a pass rate of 82%. However, in 2022, these rates dropped to 93%, 89%, and 74%, respectively. The most significant relative decline was observed among non-US/Canadian Schools' first-time takers, with an 8% decrease. Repeaters consistently had lower pass rates across all groups. Conclusion The study reveals a notable decline in pass rates following the transition to pass/fail scoring, although this is based on just one year of data. This underscores the importance of students not rushing into the exam and dedicating sufficient time for preparation. The potential impact of this research could be transformative for medical education, but more years of data post-transition will be needed to confirm these initial findings. These findings serve as a reminder that the change in scoring does not diminish the rigor of the exam, prompting students to approach their studies with diligence and patience and potentially paving the way for systemic improvements in medical education and healthcare delivery worldwide.

Evaluation of a dacitic (rhyolitic) tuff breccia use on performance, inflammatory, and antioxidant responses in broilers mildly challenged with Eimeria spp

The objective of the study was to investigate the effects of a dacitic tuff breccia (DTB) on Eimeria-infected broilers. A total of 600 one-day-old Cobb 500 male chickens were randomly assigned to 5 treatments with 10 replicates of 12 birds. Treatments were: an unchallenged control (UC), a challenged (CC) control (0% DTB), and 3 challenged groups with 0.125, 0.25, or 0.5% DTB. At d 14, birds in the CC and DTB groups were orally gavaged with mixed Eimeria spp., while the UC received water. Growth performance was evaluated during prechallenge, challenge, and postchallenge periods (0-14 d; 14-20 d; and 20-26 d, respectively). Gastrointestinal permeability was measured at 5 days postinfection (dpi). Intestinal histology and nutrient digestibility of dry matter (DM), crude protein (CP), and ileal digestible energy (IDE) were measured at 6 dpi. Liver activity of glutathione peroxidase (GSH-Px) was determined at 6 dpi, and concentrations of reduced (GSH) and oxidized glutathione (GSSG) were analyzed at 6 and 12 dpi. Data were analyzed using a linear mixed model analysis and Tukey's test (P ≤ 0.05). From 0 to 14 d, similar average daily gain (ADG) and average daily feed intake (ADFI, P > 0.05) were observed. Gain:feed ratio (GF) was higher in 0.125, 0.25, and 0.5% of DTB than the CC and UC (P < 0.001). From 14 to 20 d, the UC had the highest ADG, ADFI, and GF (P < 0.001). At 5 dpi, intestinal permeability was higher in the challenged groups than the UC. Additionally, the UC showed the highest apparent ileal digestibility of CP, whereas 0.125% DTB had higher CP digestibility than the CC and 0.5% DTB (P < 0.001). At 6 dpi, 0.125% DTB increased GSH-Px activity compared to the CC, 0.5% DTB, and UC (P < 0.001). At 12 dpi, 0.125% DTB showed increased GSH concentration compared to the CC, 0.25% DTB, and 0.5% DTB (P < 0.01). The mild coccidia infection negatively impacted growth performance, apparent ileal nutrient digestibility, intestinal histology, and gastrointestinal integrity in broilers. The use of 0.125% DTB exhibited potential in improving antioxidant responses, apparent ileal digestibility of CP, and growth performance.

Ba4FeAgS6: a new antiferromagnetic and semiconducting quaternary sulfide

The single crystals of a quaternary sulfide, Ba₄FeAgS₆, have been synthesized by reacting elements at 873 K inside a sealed fused silica tube. The title phase is the first ordered quaternary compound of the Ba-Ag-Fe-S system. The crystal structure of Ba₄FeAgS₆ is characterized by a single-crystal X-ray diffraction study at 298(2) K. It crystallizes in the space group C52h - P2₁/n of the monoclinic crystal system with unit cell dimensions of a = 8.6367(5) Å, b = 12.0291(7) Å, c = 13.2510(7) Å, and β = 109.015(2)°. This compound is stoichiometric, and its structure contains twelve unique crystallographic sites: four Ba, one Fe, one Ag, and six S sites. All atoms of the structure occupy the general positions. The Ba₄FeAgS₆ structure consists of one-dimensional chains of 1∞[FeAgS₆]^8- that are extended in the [100] direction. The negative charges on these chains are counterbalanced by the filling of Ba²⁺ cations in between the 1∞[FeAgS₆]^8- chains. The Fe atoms are bonded to four S atoms that form a distorted tetrahedral geometry around the central Fe atom. Each Ag atom in this structure is coordinated with four S atoms in a distorted tetrahedral fashion. These FeS₄ and AgS₄ motifs are the main building blocks of the Ba₄FeAgS₆ structure. The corner-sharing of FeS₄ and AgS₄ tetrahedra creates one-dimensional chains of 1∞[FeAgS₆]^8-. This structure does not contain any homoatomic or metallic bonds and can be charge-balanced as (Ba²⁺)₄(Fe³⁺)₁(Ag¹⁺)₁(S^2-)₆. The optical absorption study performed on a polycrystalline Ba₄FeAgS₆ sample reveals a direct bandgap of 1.2(1) eV. The magnetic studies reveal the antiferromagnetic behavior of Ba₄FeAgS₆ below 50 K. The thermal conductivity and theoretical electronic structure of Ba₄FeAgS₆ are also studied in detail.

Synthesis, crystal structure, DFT, and photovoltaic studies of BaCeCuS3

We report the synthesis of single crystals of the quaternary sulfide, BaCeCuS3, for the first time by heating a polycrystalline sample of BaCeCuS3 with an excess of KCl flux inside...

Feasibility and impact of a one-stop thyroid clinic in a low- and middle-income country

BACKGROUND

The study was done to evaluate the feasibility, safety and outcomes of a one-stop thyroid clinic (OSTC) in a low- and middle-income country (LMIC) setting.

METHODS

This was a prospective non-randomised case control study consisting of patients with thyroid nodules evaluated and managed at a tertiary referral centre in an LMIC between February 2019 and January 2020. Patients were divided into two groups based on the kind of preoperative evaluation protocol: OSTC group (n = 118) - OSTC protocol, and control group (CG, n = 108) - routine protocol.

RESULTS

Baseline clinical characteristics of the two groups including median age (p = 0.13) and gender distribution (p = 0.76) were comparable. The majority of patients in both groups belonged to a low-income group (46.6% vs 47.3%; p = 0.91), followed by a middle-income group (35.6% vs 30.5%; p = 0.41). The median number of outpatient department visits (1 vs 3 days; p = < 0.001), waiting time for neck ultrasonography (1 vs 3 days; p = < 0.0001), fine needle aspiration cytology (1 vs 2 days; p = < 0.0001), and out of pocket expenditure (INR 3 965 vs 6 624; p = < 0.001) was significantly less in the OSTC group compared to the CG. Patients in the OSTC group reported better satisfaction levels (p = < 0.0001). Accuracy of diagnosis did not differ between the two groups (p = 0.14).

CONCLUSION

OSTC practice is feasible, provides comparative clinical outcomes and seems cost effective in an LMIC. This protocol can be adopted as a routine practice in any health system.

Effect of nurse-led lifestyle modification follow up program on health outcomes and quality of life among post myocardial infarction patients: a randomized controlled trial

Funding Acknowledgements

Type of funding sources: None.

Background

India has among the world's highest burden of cardiovascular disease, potentially contributed by myocardial infarction. Despite growing trouble, there are no known post-discharge programs & randomized trials reporting health status outcomes & quality of life among post-myocardial infarction patients. Cardiac rehabilitation programs reduce mortality, therefore, it is crucial to understand the local burden of the disease, common challenges, public perceptions, develop timely & effective interventional programs.

Purpose

This study aimed to evaluate the effect of a nurse-led lifestyle modification follow-up program on health outcomes & quality of life among post-myocardial infarction patients.

Methods

A two-arm randomized controlled trial was adopted & 104 post-myocardial infarction patients were recruited from August to December 2021. An equal number of participants were randomly assigned to intervention & control group by random number table generator. The control group patients received routine care, while the intervention group was provided routine care along with a nurse-led lifestyle modification follow-up program(health education, educational booklet, & telephone follow- up). A low-cost intervention based on information-motivation-behavioural skill model was developed. It was designed according to the needs of patients to know their risk factors, help patients establish a knowledge base, & adapt to the post-illness lifestyle changes. Data were assessed & compared by using the demographic datasheet, health outcomes datasheet, & MacNew heart disease quality of life questionnaire. All evaluations were conducted at baseline after 12 weeks post-discharge, by face-to-face interview & biophysiological measurements.

Results

The nurse-led lifestyle modification follow-up program was convenient for clinical application. The intervention group showed a appreciable improvement in low density lipoprotein(p=0.045), systolic blood pressure(p=0.009), diastolic blood pressure(p=0.044), body mass index(p=0.043), and NT ProBNP(p=0.007). The program effectively improved the lifestyle behaviours thereby considerably improving the quality of life in all the subscales-physical, emotional & social (p&lt;0.001) after 12 weeks of discharge.

Conclusion

In the Indian context, it is a novel & extensive approach to improve access to health care and emphasizes post-discharge self-management. The greatest benefit of this program was allowing the intervention group participants to consult with us immediately. Since lifestyles vary among different individuals, we considered individuality when providing education & involving them in implementation of an intervention to enhance their confidence & ultimately achieve optimal health outcomes & quality of life. The findings of this study are important for health care professionals caring for post-myocardial infarction patients & direct incorporation of such programs into routine practice to reduce morbidity & mortality.

Hypercalcemia with methotrexate pneumonitis: A rare, important and intriguing adverse event

Methotrexate leading to hypercalcaemia is a rarely reported adverse event. We present three elderly patients with inflammatory arthritis who developed hypercalcemia probably due to methotrexate-induced granulomatous pneumonitis. All patients presented with worsening non-productive cough with dyspnea, nausea, loss of appetite, and confusion. Their clinical and radiologic features were consistent with methotrexate-induced pneumonitis. On evaluation, all patients concurrently had hypercalcemia with normal 25OH D3, and low PTH with markedly elevated levels of 1,25OH D3 seen in two patients. In all three patients, hypercalcemia and pneumonia responded to hydration, corticosteroids, and methotrexate withdrawal. There was no relapse of symptoms on long term follow-up. In these three patients with inflammatory arthritis, methotrexate-induced pneumonitis led to symptomatic hypercalcemia. Unless hypercalcemia is looked for and treated in this setting, the morbidity can be high.

AB1108 IMPACT OF THE FIRST WAVE OF THE COVID 19 PANDEMIC ON HEALTHCARE ACCESSIBILITY, DISEASE BEHAVIOUR, ANXIETY, AND PHYSICAL ACTIVITY IN RHEUMATIC DISEASE PATIENTS: AN ONLINE SURVEY AND POTENTIAL SOLUTIONS

Background

Coronavirus Disease (covid 19) negatively impacted psychosocial health, health care accessibility and exercise regimen but problem’s scope and potential solutions remain elusive. We conducted a patient based online survey to understand these impacts and discussed potential solutions.

Objectives

Assess impact of Covid 19 on rheumatological disease status, accessibility to health care, patient anxiety and behavior and continuation of physical activity during pandemic.

Methods

Google form (18-question) based questionnaire was sent via SMS/WhatsApp in Aug 2020, at height of first pandemic and responses were collected over next month.

Results

Only 339 /2700 patients (12.5 %) responded to the survey. Other authors (1)(2) have observed a similar low response rate to online surveys. We recognise questionnaires with fewer questions tend to generate more responses, which should be considered critical in constructing future health-related surveys. Patients’ global assessment of their disease score was 7/10, with 0 representing the worst disease status and10 representing best disease status, also 1/3 patients not felt need for rheumatological consultation during six months (March 2020- Aug 2020) of lockdown. These may imply adequate rheumatic disease control over long periods and during subsequent waves of pandemic, rheumatology patients can be shielded by avoiding non-urgent hospital follow up visits. Significant number of patients (20%) were unable to contact their rheumatologist, implying a significant impact of covid 19 and lockdown on rheumatology care, as suggested by other authors (1). As expected, there was switch to tele consultancy mode of communication, with 22 per cent of patients already using it within 3 months of its introduction, which appears to be a good indicator of future adaptability and feasibility of teleconsultation. Identifying specific profile of patients during physical consultation who can be easily managed via teleconsultation, may reduce unnecessary hospital visits while also improving healthcare delivery. 1/3 of our patients had anxiety about disease flare, and 41 %were concerned about increased risk of covid 19 infection as they were on immunosuppressive medications as noted by other authors (3). Improving access to health care and increasing public awareness could help alleviate this anxiety. Reaching out to isolated rheumatology patients through SMS / educational video may improve the sense of health security. Contrary to our expectations, overall medication adherence was reasonable, likely due to be management of supply chains by local authorities .15% completely stopped exercising and 25% reduced their exercise regimen by 50%. Shifting to home-based exercise, educational videos on physical therapy and online teleconsultation with physiotherapists could overall have positive impact.

Conclusion

Covid 19 has significantly impacted rheumatological patients in terms of increased anxiety, decreased healthcare accessibility and decreased exercise and physical activities. Modifications in teleconsultation methodology are needed in the future. Patients’ anxiety can be alleviated by educating them through digital and social media platforms and enrolling them in online patient support groups.

References

[1]Ganapati A, Padiyar S, Nair A, et al. Impact of COVID-19 Pandemic and Resultant Lockdown in India on Patients with Chronic Rheumatic Diseases: An Online Survey. Indian J Rheumatol. 2021;16(1):30. doi:10.4103/injr.injr_231_20

[2]McKee P, Irvine A, Riddell C, Ball E. IMPACT OF THE COVID PANDEMIC ON RHEUMATOLOGY PATIENTS IN NORTHERN IRELAND - A WEB BASED CROSS-SECTIONAL SURVEY OF PATIENT REPORTED OUTCOMES. Ulster Med J. 2021;90(3):197

[3]Hammad MAH, Eissa M, Dawa GA. Impact of coronavirus disease 2019 (COVID-19) pandemic on attitude, behavior, and mental health of patients with rheumatic diseases. Egypt Rheumatol Rehabil. 2020;47(1). doi:10.1186/s43166-020-00045-y

Disclosure of Interests

None declared

Axin2+ PDL Cells Directly Contribute to New Alveolar Bone Formation in Response to Orthodontic Tension Force

Wnt-β-catenin signaling plays a key role in orthodontic tooth movement (OTM), a common clinical practice for malocclusion correction. However, its targeted periodontal ligament (PDL) progenitor cells remain largely unclear. In this study, we first showed a synchronized increase in Wnt-β-catenin levels and Axin2+ PDL progenitor cell numbers during OTM using immunostaining of β-catenin in wild-type mice and X-gal staining in the Axin2-LacZ knock-in line. Next, we demonstrated time-dependent increases in Axin2+ PDL progenitors and their progeny cell numbers within PDL and alveolar bones during OTM using a one-time tamoxifen-induced Axin2 tracing line (Axin2CreERT2/+; R26RtdTomato/+). Coimmunostaining images displayed both early and late bone markers (such as RUNX2 and DMP1) in the Axin2Lin PDL cells. Conversely, ablation of Axin2+ PDL cells via one-time tamoxifen-induced diphtheria toxin subunit A (DTA) led to a drastic decrease in osteogenic activity (as reflected by alkaline phosphatase) in PDL and alveolar bone. There was also a decrease in new bone mass and a significant reduction in the mineral apposition rate on both the control side (to a moderate degree) and the OTM side (to a severe degree). Thus, we conclude that the Axin2+ PDL cells (the Wnt-targeted key cells) are highly sensitive to orthodontic tension force and play a critical role in OTM-induced PDL expansion and alveolar bone formation. Future drug development targeting the Axin2+ PDL progenitor cells may accelerate alveolar bone formation during orthodontic treatment.

199 The Influence of Pre-Operative Factors on Patient Length of Stay After Total Knee Replacement

Aim

This study aims to assess the impact of pre-operative factors on the length of stay in patients following total knee replacement at our institution.

Method

A total of 478 patients following total knee replacement between January 2017-Decemeber 2019 are included in this study. All patients underwent total knee replacement with a medial rotating total knee prosthesis (MRK; Matt Ortho UK).

Data for each patient was collated retrospectively and included the following: Patient demographics (age and sex), American Society of Anaesthesiology (ASA) score, pre-operative range of movement (ROM), Body Mass Index (BMI), and pre-operative haemoglobin. Each factor was then compared with the length of stay for all 478 patients. Statistical significance was sort for each pre-operative factor for both men and women.

Results

Our cohort of patients includes 291 females and 187 males. Patients ranged from 39 to 90 years with an average age of 68. The average BMI of the cohort was 31.3(18.6–56.56) and the average ASA grade was 2.

Preoperative hemoglobin and the Age of the patient at the time of surgery were the only two factors which had a statistically significant impact on the length of hospital stay (p&lt;0.05). BMI, Pre- operative range of motion and ASA scores had no statistically significant effect on the length of hospital stay in our cohort.

Conclusions

Low pre-operative hemoglobin and increasing age have significant effects on length of stay after total knee replacement. The BMI, pre-operative range of movement and ASA scores do not influence the length of hospital stay.

Influence of Brassica spp. rapeseed and canola meal, and supplementation of bioactive compound (AITC) on growth performance, intestinal-permeability, oocyst shedding, lesion score, histomorphology, and gene expression of broilers challenged with E. maxima

This study was performed to investigate the effect of feeding Brassica spp. including full-fat rapeseed, canola meal, and allyl isothiocyanate (AITC) to broiler chicken challenged with E. maxima. A total of 576 one-day old male broiler chicks were completely randomized to 8 treatments with 6 replicated cages and 12 birds per cage. The treatment diets consisted of nonchallenge control (NC, corn-SBM based diet), challenge control (CC), 10% rapeseed (10RS), 30% rapeseed (30RS), 20% canola (20CLM), 40% canola (40CLM), 500 ppm AITC (500AITC), and 1,000 ppm AITC (1000AITC). At d 14, all birds were challenged, except NC group, with a subclinical dose of E. maxima. Intestinal permeability was conducted on 5 d post-infection (dpi) and for oocyst shedding 5 to 6 dpi feces were pooled and collected. On 6 dpi, growth performance, lesion score, histomorphology, and gene expression were measured. The growth performance result showed that 10RS and 30RS groups had lower BW, BWG, FI, and higher FCR (P < 0.0001). During the challenge and overall periods, NC group had highest BW, BWG, and FI, and lowest FCR. The inclusion of canola meal showed lower performance during prechallenge period but was able to catch up BWG during challenge period. The AITC levels showed similar growth performance to CC group. Intestinal permeability for 20CLM, 40CLM, 500AITC and 1000AITC was similar to NC group, whereas CC, 10RS, and 30RS had higher permeability compared to NC (P < 0.0001). Oocyst shedding was significantly lower for 40CLM and NC, whereas all other treatments had higher oocyst shedding (P < 0.0001). All the challenged treatment groups had higher lesion score and microscore than NC (P < 0.0001). Histomorphology data showed that jejunum villus height (VH) for 1000AITC was similar to NC group, whereas CC group had the lowest VH (P = 0.01). The 30RS group had lower VH: crypt depth (CD) ratio in the jejunum and ileum. The gene expression at 6 dpi for claudin1, occludin, IL2, IL6, GLUT5, EAAT, BoAT, and LAT1 was significantly changed among the treatments. The results suggest that 30RS retards growth performance and deteriorate gut health during coccidiosis and should not be fed to chicken during the starter phase. Canola meal showed decline in growth prechallenge but maintained growth and intestinal health during the challenge period at 40% inclusion. AITC at 1,000 ppm showed similar growth as control group, but with improved gut health during the challenge period. Canola meal could be a good alternative to SBM especially during coccidiosis, whereas AITC needs to be tested vigorously in animal feeding regime.

Syntheses and characterization of two new layered ternary chalcogenides NaScQ2 (Q = Se and Te)

Two new metal ternary chalcogenides, NaScSe2 and NaScTe2, have been synthesized via high-temperature reaction.

Five coordinated Mn in Ba4Mn2Si2Te9: synthesis, crystal structure, physical properties, and electronic structure

A new structure type Ba4Mn2Si2Te9 containing unique MnTe5 units is synthesized. The structure comprises two independent Mn atoms, each with 50% occupancy. It is a narrow bandgap semiconductor (Eg = 0.6(1) eV) consistent with the DFT studies.

Ba3Zr2Cu4S9: the first quaternary phase of the Ba–Zr–Cu–S system

We report the synthesis of red-colored crystals of Ba3Zr2Cu4S9 via a high-temperature reaction of elements at 1223 K. The title compound is the first quaternary phase of the Ba–Zr–Cu–S system....

Influence of rapeseed, canola meal and glucosinolate metabolite (AITC) as potential antimicrobials: effects on growth performance, and gut health in Salmonella Typhimurium challenged broiler chickens

Poultry is the major sources of foodborne salmonellosis. Antibiotic resistance and a surge in zoonotic diseases warrant the use of natural alternatives. Glucosinolates (GLs) are naturally occurring antimicrobial compounds in rapeseed and canola. This study investigated the effect of feeding rapeseed, canola meal, and allyl isothiocyanate (AITC; Brassica secondary metabolites) on growth performance (GP), gut health, and the potential antimicrobial activity against nalidixic acid-resistant Salmonella Typhimurium (STNR) in chickens. A total of 640 one-day-old male Cobb 500 broilers were randomly allocated to 8 treatments with 8 replicated cages and 10 birds per cage. Dietary treatments were nonchallenge control (NC, corn-SBM based), challenge (Salmonella) control (CC), 10% rapeseed (10RS), 30% rapeseed (30RS), 20% canola meal (20CLM), 40% canola meal (40CLM), 500 ppm AITC (500AITC), and 1,500 ppm AITC (1500AITC). On d 1, all the birds except NC were orally challenged with STNR (7 log CFU/bird). The chickens were reared for 21 d, and their FI and BW were recorded weekly. Salmonella cecal colonization and fecal shedding were quantified, whereas organ translocation (OT) of STNR to the spleen, liver, and kidney was tested on 0, 3, 6, 13, and 20-d postchallenge (dpc). Data were subjected to one-way ANOVA, and the means were separated by Duncan's test, except mortality and OT data analyzed after transformation by square root of (n +1) (P < 0.05). Overall, feeding 30RS resulted in reduced BW (P = 0.003), BWG (P = 0.003), and FI (P = 0.001) compared to CC, 500AITC, and 1500AITC. Similarly, feeding 20CLM resulted in lower BW and BWG compared to CC (P < 0.05) and increased FCR compared to 1500AITC (P = 0.03). Feeding CC resulted in higher mortality compared to NC and 30RS (P = 0.03). Cecal colonization of STNR was reduced (P < 0.0001) for 30RS on 6 dpc and 500AITC on 6 and 13 dpc (P < 0.0001). Although no difference in gut permeability was observed 6 dpc (P > 0.05), OT of STNR population was the highest for CC in the spleen (P = 0.05). In the liver, 10RS showed reduced OT compared to 20CLM on 13 dpc (P = 0.03), whereas 30RS showed the lowest OT on 6 dpc in the kidney. Fecal shedding was lowest for 30RS on 6 dpc (P = 0.004). Histomorphology showed 30RS had the highest duodenum (P = 0.01) and jejunum (P = 0.02) villus height (VH) and VH to crypt depth (CD) ratio compared to the other treatments, whereas 1500AITC showed similar results to 30RS. Both 30RS and 1500AITC contained comparatively higher functional GL metabolites and were able to maintain gut health. Including higher levels of rapeseed or AITC in poultry feed can reduce Salmonella colonization in the feces and their translocation to other organs.

Teaching Learning Methodology in Times of COVID-19 Pandemic: A Case Study

The Education system in India underwent a major change due to the sudden lockdown announced by the Government in view of COVID – 19 pandemic. Both teachers and students had to shift to online mode in a very short time period. The present study analysis the positive and negative aspect of this online mode of education and measures adopted by teachers to maintain the flow of education along with attendance. The sur- vey was conducted at JSS Academy of Technical Education, Noida. More than 100 teachers and students participated in the survey conducted. Also experienced faculty came up with sug- gestions and ideas to improve the online mode of education in view of such pandemic situations. Two teachers who were also teaching kids at an NGO school running in the campus prem- ises shared their view on what efforts they took to let education reach the kids at the NGO as digital divide was the main prob- lem there. Such findings will help in designing a future teach- ing model to cope with pandemic situations and not let educa- tion suffer.

Factors influencing local and distant recurrence following resection of periampullary cancer

BACKGROUND

Recurrence of periampullary cancer after pancreatoduodenectomy is common. The aim of this study was to investigate patterns of recurrence, incidence, and factors associated with local and distant recurrences.

METHODS

This retrospective, single-centre study included consecutive patients with periampullary cancer who underwent resection with curative intent from January 2012 to January 2018. Survival, patterns of recurrence, and factors associated with recurrences were analysed.

RESULTS

Median overall survival (OS) and disease-free survival among 398 included patients was 58.4 and 49.5 months respectively. Twenty-three patients (5.8 per cent) developed isolated local recurrences (LR), 50 (12.6 per cent) developed LR along with distant metastasis (DM), and 103 (25.9 per cent) developed isolated DM. Median OS was 40.4 months for patients with isolated LR versus 23 months for those with DM (P < 0.001). Tumour subtype (distal common bile duct (CBD): odds ratio (OR) 6.18, 95 per cent c.i. 2.19 to 17.46) and node-positive status (OR 2.36, 1.26 to 4.43) were independently associated with higher rates of LR. The most common site for isolated LR was along the superior mesenteric artery (12 of 23 patients). Tumour subtype (distal CBD: OR 2.86, 1.09 to 7.52), nodal positivity (OR 2.46, 1.53 to 3.94), and presence of perineural invasion (OR 1.80, 1.02 to 3.18) were independently associated with DM.

CONCLUSION

Isolated LR is associated with better survival than DM and occurs most commonly along the superior mesenteric artery.

A contribution to the earthworm diversity (Clitellata, Moniligastridae) of Kerala, a component of the Western Ghats biodiversity hotspot, India, using integrated taxonomy

Earthworms (Clitellata, Moniligastridae) of Chaliyar River Malappuram, Eravikulam National Park, Neyyar Wildlife Sanctuary, Parambikulam Tiger Reserve, Peppara Wildlife Sanctuary, Periyar National Park, Shendurney Wildlife Sanctuary and Wayanad Forest, Kerala, a component of the hotspot of Western Ghats, India, were studied by the standard method of taxonomy, and their DNA barcode signatures using the mitochondrial gene cytochrome c oxidase I (COI) were generated for the first time. This study represents eleven species of earthworms of the family Moniligastridae: Drawida brunnea Stephenson, Drawida circumpapillata Aiyer, Drawida ghatensis Michaelsen, Drawida impertusa Stephenson, Drawida nilamburensis (Bourne), Drawida robusta (Bourne), Drawida scandens Rao, Drawida travancorense Michaelsen, Moniligaster aiyeri Gates, Moniligaster deshayesi Perrier, and Moniligaster gravelyi (Stephenson). In the phylogenetic analysis all the species were recovered in both neighbour–joining (NJ) and maximum likelihood (ML) trees with high clade support. The average K2P distance within and between species was 1.2 % and 22 %, whereas the clear barcode gap of 2–5 % was suggested by barcode gap analysis (BGA) of studied species, reflecting the accuracy of characterization. The study presents the first step in the molecular characterization of the native earthworm family Moniligastridae of India. Data published through GBIF (Doi: 10.15470/l2nlhz)

Challenges in Sensors Technology for Industry 4.0 for Futuristic Metrological Applications

The current advances and innovations in sensor technologies attributed to Industry 4.0 serve as the backbone for the inclusive growth of industry and ramping up the economy of any country. Industry 4.0 was basically conceptualized by introducing the Internet of Things (IoT) and Information and Communication technologies (ICT) that serve as an interface between digital and physical world through the fusion of smart sensors. The role of smart sensors and IoT-enabled industrial infrastructure is pivotal for adapting to the advanced technologies based on fusion of smart sensors. Digital meteorological traceability and uses of intelligent sensors, instrumentation and machinery in Industry 4.0, Smart Cities, Digital India and AtmaNirbhar Bharat missions of the government of India, are not only highly important but also in huge demand, which is going to increase manifolds in the years to come. The present paper is an attempt to provide a terse review and perspectives related to the advanced technological developments in this field and the challenges therein.

A Study on the Clinical and Hormonal Profile of Polycystic Ovarian Syndrome Patients Attending a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction:

Polycystic ovarian syndrome is the most common endocrinological disorder in women of reproductive age and has a considerable metabolic, reproductive, and cardiovascular consequences. This study was designed to provide an overview of the clinical profile and hormonal presentation of the patients with polycystic ovarian syndrome attending a tertiary care hospital.

Methods:

A descriptive cross-sectional study was conducted between September 14, 2019 to October 16, 2019 on patients presenting to a tertiary care hospital, after obtaining ethical clearance from Institutional Review Committee (Dated 03/09/2019) and informed consent from the patient or patient relatives. Data entry and analysis were done in Microsoft Excel 10. The data was statistically analysed using Statistical Package for the Social Sciences version 20.0.

Results:

Out of 100 patients, the mean age of the patients was 24.9 ± 4.52 years, and the most common group was 26-34 years. The most common presenting symptom was menstrual irregularity which was seen in 86 (86%) of the patients, followed by weight gain in 55 (55%) of the patients. Thirty (30%) patients were overweight, while 11 (11%) of the patients had grade I obesity. LH/FSH ratio was more than or equal to 2 in eighty-three percent 83 (83%) of the patients.

Conclusions:

Polycystic ovarian syndrome has varying clinical manifestations, most commonly affecting the young women of reproductive age group. The commonest presenting complaint in our study was menstrual abnormality. Majority of the patients had a deranged hormonal profile which can increase the risk of cardiovascular diseases and type two diabetes. Thus, awareness regarding the disease is important for early diagnosis prevention of complications.

Spontaneous Pneumothorax: Follow up Treatment Outcome in a Tertiary Care Center of Eastern Nepal

Background Spontaneous pneumothorax is not an uncommon medical emergency in pulmonary practice. Related data are not available in our setting. In emergency departments, clinical presentation is often confused with other cardiopulmonary problems. Follow up outcome is important for better patient care. Objective To study clinical profile and outcome after non surgical intervention in a tertiary care center. Method This was a prospective observational study carried out in Nobel Medical College, Biratnagar over last 3 years. We enrolled consecutive spontaneous pneumothorax patients over 15 years of age. Each data related to individual patients were collected in predefined proforma. To study follow up outcome of management, we used OPD attendance or if not possible took, at least two telephone numbers from the patients. All patients were followed for recurrences. Data was statistically analyzed using SPSS software. Result Over the last 3 years, we enrolled 65 spontaneous pneumothorax patients. Secondary spontaneous pneumothorax was more common (92.3%). Commonest presentations were acute pleuritic chest pain (92.3%), dyspnea (84.62%) and cough (92.3%). COPD (46.14%), PTB sequelae (15.38%), bronchiectasis (23.07%) and bullous lung disease (23.07%) were common risk factors. Tube thoracostomy (95.38%) with pleurodesis with iodopovidone (84.61%) led to lung expansion in 92.3% cases. During follow up, only 4.61% had recurrences of pneumothorax. There was one mortality. Conclusion Spontaneous pneumothorax is a common pulmonary emergency. Meticulous and careful assessment of the patients may help reach the diagnosis even in primary care setting. Tube thoracostomy followed by pleurodesis with iodo-povidone suffices in most circumstances leading lower future recurrences.

1107 Arousal And Sleepiness In Opioid Use Disorder Compared To Insomnia Disorder With And Without Comorbid Psychiatric Conditions

Introduction

Insomnia is frequent in opioid use disorder patients on buprenorphine (OUDB) and increases risk of relapse. There is lack of data evaluating specific differences in hyperarousal and daytime sequelae between OUDBs as compared to individuals with insomnia disorder without (ID) or with comorbid psychiatric conditions (CID).

Methods

We studied 112 patients with ID (47.8±16.3y, 55% female, 13% minority) and 148 with CID (44.7±15.6y, 69% female, 16% minority) evaluated at the Behavioral Sleep Medicine program of Penn State Hershey Sleep Research & Treatment Center and 71 OUDB (37.8±11.2y, 51% female, 16% minority) evaluated at the Recovery, Advocacy, Empowerment and Service program and WellSpan Internal Medicine clinics (York, PA). Subjects completed the Insomnia Severity Index (ISI), Ford Insomnia Response to Stress (FIRST), Arousal Predisposition Scale (APS), Pre-sleep Arousal cognitive (PSAS-C) and somatic (PSAS-S) Scale, Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) and Epworth Sleepiness Scale (ESS). Excessive daytime sleepiness (EDS) was defined as an ESS score ≥ 10. MANCOVA included age, sex, race/ethnicity and depression as covariates, while logistic regression further included ISI, APS and PSAS-S.

Results

No differences across groups were observed in PSAS-C or DBAS scores. Subjects with CID and OUDB had significantly higher PSAS-S (15.7±0.5 and 16.4±0.7, respectively) and APS (35.6±0.6 and 36±1, respectively) scores as compared to the ID group (14.2±0.6 and 33.2±0.7, respectively). Subjects with OUDB had significantly higher ESS score (9.8±0.6) as compared to the ID or CID groups (6.2±0.5 and 6.4±0.4, respectively). The odds of EDS were 2.7 times (95%CI=1.2-6.1) higher in the OUDB group as compared to the ID group.

Conclusion

OUDB may present with similar phenotypic insomnia symptoms as patients with ID or CID but report more sleep-disturbing somatic symptoms and EDS. These data have important implications for tailoring behavioral and pharmacological treatments of insomnia to this specific patient population.

Support

Junior Faculty Development Program, Penn State College of Medicine

Drops That Change Their Mind: Spontaneous Reversal from Spreading to Retraction

A liquid drop may spread faster on surfaces when surfactants are added. Here we show that after some time the spreading in such systems can, under certain conditions, spontaneously reverse to retraction and the droplet pulls itself back, receding from areas it has just recently wetted, elevating its center of mass in a jerklike motion. The duration from drop placement to the onset of retraction ranges from hours to less than a second primarily as a function of surfactant concentration. When the retraction is asymmetric, it results in drop motion, and when it is symmetric, the mass of the drop collects itself on its spot. This phenomenon, which was predicted theoretically in 2014, is apparently a general one for drops with surfactants; however, other factors, such as evaporation and contamination, prevented its observance so far.

Mechanical and Fracture Peculiarities of Polypropylene-Based Functionally Graded Materials Manufactured via Injection Molding

This research presents the investigation of mechanical and thermal characteristics as well as fracture toughness of Polypropylene (PP) based functionally graded materials (FGMs) and compares them vis-a-vis PP based homogeneous composites and neat PP. FGMs and homogeneous composites are fabricated with 15 wt.% and 30 wt.% glass fiber-reinforced PP. The gradient of fiber distribution in functionally graded materials is verified by scanning electron microscope analysis and ignition loss test. Findings of this work reveal that FGMs outperform neat PP and homogeneous composites. Tensile, flexural and compression strength of FGMs are found to be better as compared to neat PP and homogeneous composites. Fracture toughness and thermal conductivity are also found higher for FGMs. The performance of fabricated composites is optimized by using the VlseKriterijuska Optimizacija I Komoromisno Resenje (VIKOR) method.