Dodecanoic acid & palmitic acid disarms rifampicin resistance by putatively targeting mycobacterial efflux pump Rv1218c

Background & objectives: Drug-resistant tuberculosis (TB) jeopardizes the treatment process with poor outcomes. Efflux pumps (EPs) belonging to the ABC transporter family in Mycobacterium tuberculosis confer resistance to rifampicin (RMP) besides genetic mutations thus serving as a target for a potential adjunct therapeutic inhibitory molecule. Rv1218c is one such pump that was previously reported to be active in multidrug-resistant TB clinical isolates. Methods: In this study, the inhibition potential of Rv1218c-EP was tested on 8 molecules that were shortlisted by in silico methods. These molecules were subjected to the minimum inhibitory concentration (MIC) determination, checkerboard drug combination assay, ethidium bromide-DNA binding assay, and in vitro and ex vivo cytotoxicity assay. Results: Based on the outcome of the study, two molecules dodecanoic acid (DA) and palmitic acid (PA) were found to be potential enough to decrease the MIC of RMP by 8 to 1000 folds against multidrug-resistant clinical isolates and Rv1218c expressing recombinant Mycobacterium smegmatis. Interpretation & conclusions: These molecules were also found to reduce the time taken by RMP to kill these drug-resistant Mycobacteria to 48 h, unlike control isolates that survived more than 240 h of RMP exposure. The functional concentration of both molecules was non-toxic to the epithelial and blood mononuclear cells. With further comprehensive scientific validation, PA and DA could be recommended as adjunct therapeutic molecules with first-line anti-TB drugs to treat drug-resistant TB.

Effect of Aging and Thermocycling on Flexural Strength of PEEK as a Provisional Restoration for Full Mouth Rehabilitation – An In vitro Study

Introduction: To compare the flexural strength of autopolymerizing poly methyl methacrylate resins (PMMA) resin, CAD/CAM milled PMMA and CAD/CAM milled poly ether ether ketone (PEEK) when used as provisional restorative materials for long span situations in full mouth rehabilitation after aging and thermocycling. Materials and Methods: Sixty samples (25 mm × 2 mm × 2 mm) were fabricated using autopolymerizing PMMA resin (GROUP I), CAD/CAM milled PMMA (GROUP II) and PEEK (GROUP III). The groups were subdivided into A and B and subjected to 7 days of aging and 500 cycles of thermocycling (subgroup A) and 14 days of aging and 1000 cycles of thermocycling (subgroup B), respectively, and flexural strength was evaluated using a three?point bend test. The data were analyzed with student t test and pair?wise comparison of mean values was done by ANOVA. Results: The flexural strength of PEEK subjected to 7 days of aging and 500 cycles of thermocycling (III (A) ? 6628.70 MPa) was the highest among all groups followed by PEEK subjected to 14 days of aging and 1000 cycles of thermocycling (III (B) ? 3760.50 MPa). Conclusion: The mean flexural strength of PEEK was statistically significant than the other two materials tested and hence can be recommended for use as a provisional restorative material for long span situations in full mouth rehabilitation. However, the mean flexural strength of PEEK reduced approximately by 44% when subjected to further aging

Clinical features and visual outcomes of pediatric optic neuritis in the Indian population: A prospective study

Purpose: Optic neuritis, defined as inflammation of the optic nerve, is the most common optic neuropathy affecting adults. Various studies in Southeast Asia have shown that the clinical profile of optic neuritis might differ in these regions from that reported in the western literature. Through this study, we evaluate the clinical profile of pediatric optic neuritis (PON) in the Indian population. Methods: This was a hospital?based prospective observational study. Patients with optic neuritis younger than 16 years who attended the neuro?ophthalmology clinic from May 2016 to April 2017 were included in the study. Results: This study included 54 eyes of 38 patients. The mean age of presentation was 10.6 years. Unilateral disease (58%) was found to be more common, and a slight female preponderance (58%) was noted. The most common feature was visual loss (96.3%). Pupillary light reflex abnormality was seen in most patients. Fundus examination revealed disk edema (77.7%) to be the most common feature. Neuroimaging was performed in 34 patients, and multiple sclerosis was diagnosed in four patients. At 3 months follow?up after treatment, 89% of eyes had best correct visual acuity of 6/9 or better (P < 0.001). Conclusion: In our study, we found the clinical profile of PON to be similar to that seen in western studies as well as those done previously in the Indian population, although with a few differences

Accuracy of Femoral Tunnel Placement between Anteromedial and Anterolateral Visualisation Portals in Anterior Cruciate Ligament Reconstruction - Outcomes of a CT based Cross-Sectional Study

@#Introduction: Anatomical femoral tunnel placement is critical for anterior cruciate ligament reconstruction (ACLR). Tunnel placement may vary with different surgical techniques. The aim of this study was to compare the accuracy of femoral tunnel placement between the Anteromedial (AM) and Anterolateral (AL) visualisation portals on post-operative CT scans among a cohort of ACLR patients. Materials and methods: This cross-sectional study was conducted from January 2018 to March 2020 after obtaining ethics clearance. Patients who went for arthroscopic ACLR in our institute were divided into an AM (group 1) and an AL (group 2) based on the visualisation portal for creating the femoral tunnel and a 3D CT scan was done. The femoral tunnel position was calculated in deep to shallow and high to low direction using the Bernard Hertel grid. Femoral tunnel angle was measured in the 2D coronal image. Statistical analysis was done with the data collected. Results: Fifty patients with an average age of 26.36 (18-55) years ±7.216 SD were enrolled in the study. In this study, the AM technique was significantly more accurate (p<0.01) than the AL technique in terms of femoral tunnel angle. Furthermore, the deep to the shallow position was significantly (p= 0.018) closer to normative values, as determined by the chi-square test. The chances of error in tunnel angle in femoral condyle are 2.6 times greater in the AL technique (minimal clinical difference). Conclusion: To conclude, in ACLR the anteromedial visualisation portal can facilitate accurate femoral tunnel placement compared to the anterolateral visualisation portal.

A Retrospective Analysis of the Incidence, Outcome and Factors Associated with the Occurrence of Euglycemic Ketoacidosis in Diabetic Patients on Sodium Glucose Co?Transporter – 2 Inhibitors Undergoing Cardiac Surgery

Introduction:SGLT2i is a new class of drugs used for type 2 diabetes. SGLT2i are known to cause EuKA in the perioperative period. Euglycemic ketoacidosis (EuKA) can cause life?threatening metabolic acidosis in the perioperative setting. Though the event rate of SGLT2i associated diabetic ketoacidosis in nonoperative setting is low, incidence among peri?operative patients can be very high and remains unknown. Aim: The aim of this study was to find the incidence, analyze outcome, and establish correlation between risk factors and EuKA in cardiac surgical patients on SGLT2i. Materials and Methods: This is a retrospective study analyzing 24 cardiac surgical patients who were on SGLT2i for type 2 diabetes mellitus. Data collection included age, sex, BMI, preoperative HbA1C, albumin, creatinine, type of SGLT2i and timing of stopping before surgery, insulin administration in the immediate pre?operative period; use of CPB, GI infusion and inotropes in the intraoperative period; blood ketone, duration of ventilation, hydration status and length of postoperative stay in postoperative period. Patients were diagnosed to have EuKA if any one of the serially measured postoperative ketone values was more than 0.6 mmol/L(ketone positive). The collected data were used to find an association between the risk factors and the occurrence of EuKA. Results: Of the 24 patients, 17 patients developed EuKA. (70.8.%). 10 of the 17 EuKA in our study required preoperative Insulin for diabetic control whereas none in the ketone negative patients required insulin. This was statistically significant (P = 0.019). Association of other factors to EuKA were not statistically significant. Conclusion: Though the event rate of SGLT2i associated Diabetic ketoacidosis in nonoperative setting is low, (17), the occurrence of EUKA in cardiac surgical patients on SGLT2i in our study was 70.8% (17 out of 24 patients). Patients who require insulin in addition to other oral hypoglycemic drugs for immediate preoperative glycemic control are at risk for the development of SGLT2 inhibitor?induced EuKA postoperatively. Missing the diagnosis of EuKA is fatal in these patients. We couldn’t make a diagnosis in our first patient whom we lost. Since it was diagnosed in all our study patients by measuring serial ketone values, there was no mortality and insignificant morbidity. Cessation of SGLT2i before surgery, expectant watch for blood ketones, and treatment with GI infusion reduce morbidity and mortality in cardiac surgical patients.

A Comparative Study on the Efficiency of Commercial Reverse Transcriptase–Polymerase Chain Reaction Kits for the Detection of Severe Acute Respiratory Syndrome Coronavirus 2 Infections

Background: Real?time reverse transcriptase–polymerase chain reaction (RT?PCR) kits have been reliably employed for the diagnosis of coronavirus disease 2019 (COVID?19) by the detection of the severe acute respiratory syndrome coronavirus 2 (SARS?CoV?2) RNA since the beginning of the disease outbreak. In consideration of reliable diagnosis, apart from RT?PCR, the isothermal nucleic acid amplification?based point-of-care automated kits have also been tagged as a simpler and rapid alternative to the conventional techniques. Currently, the availability of a better diagnostic method for COVID?19 when compared to RT?PCR is nil. The most important step in the detection of SARS?CoV?2 in a RT?PCR diagnostic laboratory is to identify and employ RT?PCR kits with higher sensitivity as well as specificity. Objectives: This study aimed to study commercially available RT?PCR kits for the detection of SARS?CoV?2 infections. Methods: The performance of seven different RT-PCR kits from different manufacturers used for diagnosis of COVID-19 in Govt Theni Medical College and Hospital, Theni, Tamil Nadu were analysed. Nasopharyngeal and oropharyngeal swabs were collected from patients and subjected to RT-PCR using these kits. Results and Conclusion: The sensitivities and batch effects of the assessed kits were slightly different for different targets, for SARS?CoV?2 detection in nasopharyngeal swab specimens. Examination of COVID-19 kits should be done using currently employed kits in routine diagnosis for better efficiency

COLORECTAL CANCER IN YOUNG ADULTS: A CASE SERIES

Introduction & Background: Colorectal cancer (CRC) is a frequent tumor in adults, it rarely occurs before the age of 25 years, with an annual incidence of only 1-2 cases per 10,00,000 people, accounting for only about 80 cases per year worldwide. Overall incidence of CRC involving hepatic ?exure is 2%, ascending colon is 5%, sigmoid colon is 21% which is very rare in young age group. Herein we report a 3 rare cases of CRC in young adults less than 25 years of age involving hepatic ?exure, ascending colon and sigmoid colon respectively. Case Description: Case 1: A 20 year-old male presented with complaints of abdominal distension and constipation for 1 week and loss of weight for 1 month. Patient had no comorbities and no family history of malignancy. CECT done showed an asymmetric wall thickening involving proximal transverse colon with signi?cant luminal narrowing. He underwent emergency laparotomy and intra operatively patient had a growth at hepatic ?exure of colon with dilated ascending colon, caecum and distal ileum and multiple enlarged mesenteric lymph nodes. He was proceeded with right hemicolectomy with ileo transverse anastomosis. Post operative histopathology revealed mucinous adenocarcinoma involving hepatic ?exure. Case 2: A 25 year-old female was hospitalized due to com plaint s of abdominal pain for 3 months, lower abdomen mass for 1 month and melena for the past 15 days and loss of weight and appetite. Patient had no comorbities and no family history of malignancy. CECT done showed a suspicious wall thickening involving ascending colon. The patient was taken up for laparotomy and per operative ?ndings showed a ulceroproliferative growth involving ascending colon. Patient was proceeded with right hemicolectomy with ileo transverse anastomosis. Post operative histopathology revealed mucinous adenocarcinoma involving ascending colon.Case 3: A 22 year-old male was admitted for comp laint s of lower abdominal pain for 4 months, bleeding per rectum on and off for 1 month and abdomen distension and constipation for 5 days and loss of weight and appetite. Patient had no comorbities and no family history of malignancy. CECT done showed a circumferential wall thickening involving sigmoid colon. Hence the patient was proceeded for emergency laparotomy and per operative ?ndings showed a stenosing growth involving sigmoid colon. Patient was proceeded with Hartmann's procedure. Post operative histopathology revealed adenocarcinoma involving sigmoid colon. Conclusion: Within a young group, CRC is usually diagnosed later andpotentially associated with worst prognosis. Detecting CRC at an early, more treatable stage is important for cure and survival. This report suggest a greater suspicion rate and early screening that necessary when evaluating young patients with common symptoms

Non-Alcoholic Fatty Liver Disease and other Non-Communicable Diseases: Time for an Integrated Approach

Non-Alcoholic fatty liver disease (NAFLD) is a broad term covering a spectrum of conditions ranging from hepatic steatosis, steatohepatitis and cirrhosis. NAFLD is highly prevalent across all regions of the world with its global prevalence of 25.2%(95%CI:22.1-28.7). It is commonly referred as the ‘hepatic manifestation’ of metabolic syndrome (MetS). Moreover, it is strongly associated with the individual components as well as MetS as a whole. NAFLD has been independently associated with other non-communicable diseases (NCDs) like chronic kidney disease (CKD), Polycystic ovary Syndrome (PCOS), Stroke and Cancers. This strong association of NCDs with NAFLD not only affects the prevalence but also the progression and management of the disease. Thus, this review aims at highlighting the association of NAFLD with other NCDs. A literature search was undertaken in the MEDLINE database using the necessary MeSH terms. The review concludes NAFLD is a systemic disease, not just confined to liver-specific morbidity and mortality, but also associated with numerous extra-hepatic manifestations, such as metabolic syndrome, cardiovascular diseases, chronic renal diseases, and malignancy. With coexistence of NAFLD with various NCDs it is expected to become the most overwhelming liver disease in the world in coming years. Hence, to reduce medical and economic impact associated with these comorbidities, it is recommended that all countries should estimate and predict the burden on comorbidities associated with NAFLD and galvanize its health resources in providing integrated therapeutic approaches for management of NAFLD and related comorbidities at an early stage.

Genetic variability of early flowering and yield contributing traits in Barnyard Millet [Echinochloa frumentacea (Roxb). Link] grown at different altitudes

Barnyard millet is an important up surging minor millet in Asia countries for food and nutritional security. Being a minorcrop, the genetics and inheritance of the traits need to understand, for effective utilization in the crop improvementprogrammes. Here, we investigated the genetic background and inheritance of different traits in barnyard millet genotypes.Forty germplasm accessions were evaluated in different ecological environments of southern India for 17 quantitative traits.Genetic variability analysis using GENSTAT and the pooled REML mean data results revealed that Phenotypic Co-efficientof Variation (PCV) was greater than the Genotypic Co-efficient of Variation (GCV) over the diverged ecological locationsindicating the existence of environmental influence on all the biometric traits studied. In the Western Ghats region (E1),high heritability coupled with high genetic advance was exhibited for traits like days to flowering, plant height, days tomaturity, number of nodes, length of nodes, number of basal tillers, stem diameter, flag leaf length, flag leaf width,inflorescence length, inflorescence width, length of peduncle, number of racemes, single ear head weight and grain yield perplant. Traits like thousand grain weight expressed moderate genetic advance with high heritability while, length of lowerracemes expressed moderate heritability with high genetic advance. Similarly, high heritability coupled with high geneticadvance was recorded for all the characters in valley region (E2) except thousand grain weight that showed high heritabilitybut moderate genetic advance. In contrast, in the area of plains (E3), all the traits exhibited high heritability coupled withhigh genetic advance. Since, majority of the traits have shown high heritability with high genetic advance, selection mightbe effective in these traits irrespective of the environment.

Study the co-relation between SpO2 and radiological and biochemical markers with the severity and outcome in geriatric Covid-19 patients

Background: Pandemics are natural calamities, which humans have been encountering since time im-memorial. The world has witnessed and endured several pandemics like from Justinian Plague to Spanish Flu. The 21st century has already witnessed three major pandemics like Severe Acute Respiratory Syndrome in 2002, Middle East Respiratory syndrome in 2012 and at present COVID?19. The first case of COVID?19 was reported in Wuhan, Hubein Province in Dec 2019. The first case of COVID?19 was reported in Kerala on 30th January 2020. COVID?19 virus is a single stranded RNA Virus and resembles SARS -2 virus and hence the name SARS -COV 2. There has been a report of around 34 million cases with 1 million deaths. Majority of the deaths occur in the elderly population as they have immunosenescence and multiple comorbidities. Hence a study aiming at analysis of correlation between SpO2, radiological and biochemical markers is essential in management of COVID 19 in elderly. Aims & Objectives: To study the correlation between SpO2 and radiological features in X ray and CT Chest and biochemical markers with the severity and outcome in geriatric patients. Study Period: April 2020 to September 2020, Duration: 6 months. Study Centre: Chengalpattu Medical College, Tamilnadu. Inclusion Criteria: RT PCR positive Covid 19 patients more than 60 years of age. Exclusion Criteria: Covid 19 patients less than 60 years, RT PCR Negative patients. Materials and Methods: Retrospective analysis of records of 300 Covid 19 patients, aged more than 60 years hospitalized in Chengalpattu Medical College during April to September 2020 was done and biochemical parameters mentioned below were corelated with features in CXR and CT Chest RTPCR positive spo2 and analysis with severity of disease and outcome was done. Results and Discussion: On retrospective analysis of records of elderly Covid 19 patients, it was observed that the elderly could be graded as mild, moderate and severe based on clinical criteria. Radiological parameters co-relating in the same group classified as mild, moderate and severe could be derived and could be used for assessment of patients. Similarly, it was observed that the biochemical parameters of D? Dimer, C reactive protein, Neutrophil Lymphocyte Ratio correlated most significantly in that order with the clinical severity of disease and hence could be used as useful tools for assessment of severity of patients and the ranges corelating withseverity could be derived. Conclusion: Analyzing SpO2, radiological features, biochemical parameters individually and in combination with clinical severity and outcome in elderly patients helps in deriving biochemical and radiological parameters to predict severity which in turn helps in a holistic approach and right management at the right time preventing or reducing mortality due to Covid 19 in the elderly.

Serum Vitamin B12 Level and Dietary intake in Adult Atopic Dermatitis: A Case Control Study

Background@#Vitamin B12 is a contributing factor in pruritus and peripheral nerve regeneration. Its role in atopic dermatitis (AD) is still unclear. This study aimed to compare vitamin B12 level between AD patients and healthy controls, determine its correlation with pruritus and AD severity, and evaluate dietary pattern with energy, macro and micronutrient intakes.@*Methods@#This was a case control study involving adult AD patients and age-, gender-, ethnicity- and body mass index-matched healthy controls. All adult patients who fulfilled UK Working Party AD diagnostic criteria were included. Exclusion criteria include patients on systemic agents, diseases known to affect B12 level and vegan diet. AD severity was determined using SCORing Atopic Dermatitis (SCORAD) index. Serum vitamin B12 level were measured. A three-day 24-hour dietary recall was collected and analyzed.@*Results@#A total of 42 AD patients and 42 controls were recruited. Mean SCORAD index was 39.2±16.6, and AD duration was 12.7 ± 8.1 years. Vitamin B12 was lower among AD (215.6 ± 110.2 pmol/L) versus control (295.1± 119.9 pmol/L), p<0.01 despite similar dietary B12 intake in both groups. There were no significant correlations between AD duration and severity with vitamin B12 level. Energy intake (kcal/ day) was significantly lower in AD (p=0.04). There were no significant differences in proportion of main food groups consumed and other macronutrient and micronutrient intakes.@*Conclusion@#Serum vitamin B12 level was significantly lower in AD patients despite similar dietary pattern and nutrient intake with healthy controls. There were no correlations with AD severity or disease duration. Dietary pattern of AD patients should be routinely assessed to ensure adequate nutrition.

Bringing the Treatment of Atopic Eczema Into a New Era with Janus Kinase Inhibitors: A Position Statement By the Persatuan Dermatologi Malaysia

Abstract@#Atopic eczema (AE) is a complex, chronic and recurrent inflammatory pruritic skin condition that impacts the quality of life and exerts an economic toll on patients and their families. One of the factors contributing to AE is the immune dysregulation of the Janus kinase-signal transducers and activators of transcription (JAK-STAT) inflammatory pathway. This has prompted the conduct of various large clinical trial programs to evaluate the efficacy and safety of Janus kinase inhibitors (JAK-i) for AE. The overall and significant benefit of these drugs from clinical studies resulted in regulatory approvals for JAK-i to treat moderate-to-severe atopic eczema. The objective of this position paper was to evaluate the safety, efficacy and role of upadacitinib, baricitinib and abrocitinib in managing AE and update the current recommended treatment algorithm within the 2018 Malaysian Clinical Practice Guidelines for the Management of Atopic Eczema. The Persatuan Dermatologi Malaysia recommends that these JAK-i can be considered as an option for systemic therapy in severe AE.

Evaluation of Knowledge, Disease Severity and Quality of Life of Patients with Psoriasis

Background@#Psoriasis vulgaris is a chronic immune-mediated inflammatory multi-system disease characterised by keratinocyte hyperproliferation. Data regarding patients’ disease severity, knowledge and quality of life (QOL) is important to optimize treatment strategies for psoriasis. This study aims to evaluate and investigate the relationship between disease severity, knowledge and QOL of patients with psoriasis. @*Methods@#A cross-sectional multicentre study utilizing a socio-demographic data collection form, Psoriasis Knowledge Assessment Questionnaire (PKAQ), Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI was conducted. Correlations between PKAQ, DLQI and PASI were analysed using Spearman’s test. @*Results@#A total of 114 subjects participated in this study. Majority of them had mild psoriasis (n=73, 64%) based on PASI. The mean score of PKAQ was fourteen out of a total possible score of twenty-five, whereas the DLQI had a non-parametric distribution with a median (interquartile range) of 7 (10). Most subjects (32.5%) stated that psoriasis had a ‘moderate effect’ on their QOL, while only 3.5% said that it had an ‘extremely large effect’ on their QOL. There was a statistically significant correlation between PASI and DLQI (rs = 0.264, p = 0.004), with higher PASI scores corresponding to higher DLQI scores. No statistically significant correlation was found between DLQI and PKAQ (rs = -0.048, p= 0.612), and between PASI and PKAQ (rs = 0.058, p= 0.542).@*Conclusion@#Impairment of QOL was positively associated with severity of psoriasis. However, there was no significant relationship between knowledge and quality of life, as well as between knowledge and psoriasis severity.

Preditores de videogames para dispositivos móveis na dor do músculo esquelético entre estudantes universitários em Selangor, Malásia / Predictors of Mobile Video Gaming on Musculoskeletal Pain among University Students in Selangor, Malaysia

OBJETIVOS: Jogar videogames em dispositivos móveis tem aumentado rapidamente entre estudantes universitários, mais do que antes da pandemia do COVID-19. Isso é muito preocupante, pois pode desencadear vários problemas, como dores musculoesqueléticas e distúrbios de jogo. Vários estudos semelhantes foram realizados em vários países, mas limitados na Malásia. O presente estudo tem como objetivo investigar o efeito dos videogames móveis na dor musculoesquelética entre estudantes universitários em Selangor, Malásia. PARTICIPANTES E MÉTODOS: Este estudo foi conduzido online usando um questionário online auto-relatado por meio do Formulário Google e enviado a estudantes universitários em Selangor, Malásia. O vício em jogos dos participantes foi medido por meio do questionário Ten Item Internet Gaming Disorder test (IGDT-10) e a prevalência de dor musculoesquelética foi avaliada pelo Modified Nordic Musculoskeletal Questionnaire (MNMQ). RESULTADOS: A prevalência de Transtorno de Jogos na Internet entre estudantes universitários em Selangor, Malásia, é de 1,8% (n = 3). A região do pescoço (74,2%) foi a região do corpo mais comumente relatada com dor musculoesquelética, seguida pela região dos ombros (60,7%), região lombar (55,8%) e região superior das costas (50,9%). Houve associação significativa entre a posição corporal durante o videogame móvel (p = 0,002) e a dor musculoesquelética na região lombar. CONCLUSÃO: De acordo com os resultados deste estudo, a prevalência de Transtorno de Jogos na Internet entre estudantes universitários era baixa e não viciados em jogos no bloqueio Covid-19. Também descobrimos que os participantes que se sentaram enquanto jogavam videogames para celular tinham maior probabilidade de desenvolver dor lombar.

INTRODUCTION: Mobile video gaming among university students has increased rapidly, more than before the COVID-19 pandemic. This is very concerning as this could spark various problems, such as musculoskeletal pain and gaming disorders. OBJECTIVES: The present study is to identify the predictors of mobile video gaming on musculoskeletal pain among university students in Selangor, Malaysia. PARTICIPANTS AND METHODS: This study was conducted online using a self-reported online questionnaire via Google Form and sent to university students in Selangor, Malaysia. Participants' gaming addiction was measured using the Ten Item Internet Gaming Disorder Test (IGDT-10) questionnaire, and the prevalence of musculoskeletal pain was assessed by the Modified Nordic Musculoskeletal Questionnaire (MNMQ). The data was analyzed using SPSS version 25. A descriptive and binomial linear regression test was used to predict the variables. The statistical significance was set at p < 0.05, and odds ratios were calculated with confidence intervals of 95%. RESULTS: The prevalence of Internet Gaming Disorder among university students in Selangor, Malaysia is 1.8% (n=3). The neck region (74.2%) was the most commonly reported body region with musculoskeletal pain, followed by the shoulder region (60.7 %), lower back region (55.8 %), and upper back region (50.9 %). The body position was the only predictor of mobile video gaming with musculoskeletal pain (p = 0.002) in the lower back region. CONCLUSION: According to the findings of this study, the prevalence of Internet Gaming Disorder (IGD) among university students was low and not addicted to gaming in the Covid-19 lockdown. We also found that participants who sat while playing mobile video games were more likely to develop low back pain. However, one of the limiting factors could be prolonged sitting in virtual classes during the lockdown, which causes low back pain.

Case Series of Akurit-4 Associated DRESS

Summary@#We describe nine cases of anti-tuberculosis DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome, a potentially serious complication of treatment that led to interruption of treatment, systemic corticosteroid usage and the resumption of treatment with different regimens. All patients had skin rash, six out of nine patients with hepatitis, two out of nine patients had acute kidney injury, five out of nine patients died. All-cause mortality is high in our cohort.

Iatrogenic Phaeohyphomycosis: A Rare and Underrecognized Disease

Summary@#Phaeohyphomycosis refers to a heterogenous group of mycotic infections caused by dematiaceous fungi where unintentional traumatic inoculation accounts for majority of the cases. Herein, we are reporting a rare case of iatrogenic subcutaneous phaeohyphomycosis which is secondary to intravenous cannula placement.

Rituximab as First-line Therapy for Severe Pemphigus: A Case Series and Review of Current Literature

Summary@#Pemphigus refers to a group of life-threatening, autoimmune blistering disease that presents as blisters and erosions involving the skin and mucosa. Systemic corticosteroids and rituximab have been recommended as mainstay therapy for pemphigus vulgaris and pemphigus foliaceus. Herein, we report three cases of pemphigus vulgaris and a case of pemphigus foliaceus treated with rituximab as first-line therapy.

Effectiveness of Foot Reflex Therapy in Post-Operative Pain among Patients Subjected to Major Abdominal Surgery

Most patients experience post–operative pain and it is unavoidable. It is the duty of the nurses to ensure that patients' pain is assessed and managed effectively when they are at the hospital. Foot reflex therapy is one effective way nurses can adopt to manage the patient with pain after surgery. We wanted to evaluate the effectiveness of foot reflex therapy on post-operative pain in patients who are subjected to major abdominal surgery. METHODSThis is a descriptive randomized control study that was conducted at Sri Ramachandra Medical College and Hospital, among 360 patients who underwent major abdominal surgery. They were equally divided into two groups as control and study groups and the results were analyzed statistically. RESULTSMajority of the patients in the study group showed a positive effect on pain control during 4th and 5th [ (Mean: 1.27 with SD: 1.12) (Mean: 0.03with SD: 0.32) at p < 0.001] post-operative day following foot reflex therapy. CONCLUSIONSThe existing pain and the post-operative pain can be managed by nurses, patients, their care takers or families together, whenever appropriate, in a multidisciplinary manner. Foot reflex therapy is one such alternative complementary therapy which the nurses can adopt to implement the techniques independently.

Advances in the Xoo-rice pathosystem interaction and its exploitation in disease management

Bacterial blight caused by Xanthomonas oryzae pv. oryzae (Xoo), is one of the devastating diseases of riceworldwide. The pathogen reported to cause 70% crop loss in some of the susceptible genotypes under diseasefavoring environments, viz., temperature ranging between 25 to 34C and relative humidity more than 70%. InXoo, about 245 genes govern the pathogenicity and host specificity. The hypersensitive response andpathogenicity (hrp) genes responsible for disease occurrence were clustered in the pathogenicity island of 31.3Kb. The protein secreted through type three secretory system and type one secretory system mediates infectionand establishment of the pathogen inside the host. However, elicitor molecules from Xoo triggered the resistantresponse in rice against the pathogen. An array of resistant genes (R genes) was known to be invoked by thehost to combat the bacterial infection. To date, of the 45 Xa genes in rice, nine were cloned and characterized.The evolution of new races has made the task of developing resistant rice genotypes more challenging as itdemands a comprehensive breeding strategy involving the best use of R genes from the existing gene pool.Thus, to combat the infection from the existing races and to slow down the emergence of new Xoo races,pyramiding two or more R genes was found to be effective against bacterial blight disease. In India, thesuccessfully commercialized example includes the development of rice genotypes, viz., Improved Pusa Basmati-1, Improved Samba Mahsuri, PR106, Type 3 Basmati, and Mahsuri with selected R genes, viz., xa5, Xa4,xa13 and Xa21 against bacterial blight resistance. This review primarily portray Xoo-rice interactions andprovides opportunities for its effective management through sustainable technologies.