The antagonistic transcription factors, EspM and EspN, regulate the ESX-1 secretion system in M. marinum.

Bacterial pathogens use protein secretion systems to transport virulence factors and regulate gene expression. Among pathogenic mycobacteria, including Mycobacterium tuberculosis and Mycobacterium marinum, the ESAT-6 system 1 (ESX-1) secretion is crucial for host interaction. Secretion of protein substrates by the ESX-1 secretion system disrupts phagosomes, allowing mycobacteria cytoplasmic access during macrophage infections. Deletion or mutation of the ESX-1 system attenuates mycobacterial pathogens. Pathogenic mycobacteria respond to the presence or absence of the ESX-1 system in the cytoplasmic membrane by altering transcription. Under laboratory conditions, the EspM repressor and WhiB6 activator control transcription of specific ESX-1-responsive genes, including the ESX-1 substrate genes. However, deleting the espM or whiB6 gene does not phenocopy the deletion of the ESX-1 substrate genes during macrophage infection by M. marinum. In this study, we identified EspN, a critical transcription factor whose activity is masked by the EspM repressor under laboratory conditions. In the absence of EspM, EspN activates transcription of whiB6 and ESX-1 genes during both laboratory growth and macrophage infection. EspN is also independently required for M. marinum growth within and cytolysis of macrophages, similar to the ESX-1 genes, and for disease burden in a zebrafish larval model of infection. These findings suggest that EspN and EspM coordinate to counterbalance the regulation of the ESX-1 system and support mycobacterial pathogenesis.IMPORTANCEPathogenic mycobacteria, which are responsible for tuberculosis and other long-term diseases, use the ESX-1 system to transport proteins that control the host response to infection and promote bacterial survival. In this study, we identify an undescribed transcription factor that controls the expression of ESX-1 genes and is required for both macrophage and animal infection. However, this transcription factor is not the primary regulator of ESX-1 genes under standard laboratory conditions. These findings identify a critical transcription factor that likely controls expression of a major virulence pathway during infection, but whose effect is not detectable with standard laboratory strains and growth conditions.

Association of Hand Grip Strength with Ultrasound-derived Forearm Muscle Thickness and Echo Intensity in Young Indian Adults.

Background: Muscle thickness (MT) quantification, which reflects the muscle function, can be measured using ultrasonography. Echo intensity (EI) quantified from the ultrasonography-derived skeletal muscle images reflects muscle quality. This study aimed to analyze the associations between handgrip strength, ultrasound-measured forearm MT, and EI in healthy young adults. Methods: Sixty healthy volunteers between the ages of 18 and 25 years participated in the study. Brightness mode ultrasonography (USG) was done to measure forearm radial and ulna MT. The EI was measured from an ultrasound image as a mean pixel value using a histogram in Adobe Photoshop. Individuals were tested for forearm handgrip strength using hand dynamometry. Results: Males had higher forearm MT and handgrip strength compared to females. Handgrip strength had a significant positive correlation with forearm radius, ulna MT (r = 0.726, 0.757 and P < 0.01), and forearm circumference (r = 0.529 and P < 0.01) and a negatively correlation with subcutaneous fat thickness (r = -0.496 and P < 0.01) and EI (r = -0.618 and P < 0.01). Linear regression showed a significant correlation between MT, circumference, and EI with handgrip strength (r = 0.825 and P < 0.001). After adjustment for the other two parameters, the forearm MT correlated positively and EI negatively with handgrip strength. Conclusion: USG can be more easily used than other imaging methods in research and clinical setting as it is nonhazardous, less expensive, versatile, and provides results faster. Thus, USG measurements in skeletal muscle are useful for measuring MT and subcutaneous fat thickness. EI measurement can be a convenient and noninvasive method for assessing muscle quality.

Perception on Anxiety among Adolescents and Mental Health Professionals and Development of Comic Strip.

Background: Adolescence is a phase of many physical and psychological developments. This stage is also vulnerable to the development of mental illness. Anxiety is one of the most prevalent disorders among adolescents, which mostly onsets before puberty. This study aimed to understand the perception on anxiety among adolescents and mental health professionals and develop a comic strip on anxiety. Methods: This qualitative study involved focus group discussions (FGDs) among mental health professionals and pre-university college students. The FGD data were analyzed through direct content analysis according to the predetermined broad themes. Results: Awareness regarding anxiety was poor among adolescents, and in certain situations they were found to be reluctant to seek professional help. The comic strip on anxiety was developed based on the findings of FGD based on the themes, general awareness, factors responsible, symptoms and coping, management, and barriers to seeking professional help. Conclusions: Adolescents perceived mental health as very important for their overall health. The adolescents did not know that they were going through anxiety, but they noticed that they had some mental health issues and wanted to get out of it. The development of comic strip on anxiety for adolescents was an attempt to overcome these barriers.

The EspN transcription factor is an infection-dependent regulator of the ESX-1 system in M. marinum.

Bacterial pathogens use protein secretion systems to translocate virulence factors into the host and to control bacterial gene expression. The ESX-1 (ESAT-6 system 1) secretion system facilitates disruption of the macrophage phagosome during infection, enabling access to the cytoplasm, and regulates widespread gene expression in the mycobacterial cell. The transcription factors contributing to the ESX-1 transcriptional network during mycobacterial infection are not known. We showed that the EspM and WhiB6 transcription factors regulate the ESX-1 transcriptional network in vitro but are dispensable for macrophage infection by Mycobacterium marinum . In this study, we used our understanding of the ESX-1 system to identify EspN, a critical transcription factor that controls expression of the ESX-1 genes during infection, but whose effect is not detectable under standard laboratory growth conditions. Under laboratory conditions, EspN activity is masked by the EspM repressor. In the absence of EspM, we found that EspN is required for ESX-1 function because it activates expression of the whiB6 transcription factor gene, and specific ESX-1 substrate and secretory component genes. Unlike the other transcription factors that regulate ESX-1, EspN is required for M. marinum growth within and cytolysis of macrophages, and for disease burden in a zebrafish larval model of infection. These findings demonstrate that EspN is an infection-dependent regulator of the ESX-1 transcriptional network, which is essential for mycobacterial pathogenesis. Moreover, our findings suggest that ESX-1 expression is controlled by a genetic switch that responds to host specific signals. Importance: Pathogenic mycobacteria cause acute and long-term diseases, including human tuberculosis. The ESX-1 system transports proteins that control the host response to infection and promotes bacterial survival. Although ESX-1 transports proteins, it also controls gene expression in the bacteria. In this study, we identify an undescribed transcription factor that controls the expression of ESX-1 genes, and is required for both macrophage and animal infection. However, this transcription factor is not the primary regulator of ESX-1 genes under standard laboratory conditions. These findings identify a critical transcription factor that controls expression of a major virulence pathway during infection, but whose effect is not detectable with standard laboratory strains and growth conditions.

Imaging and Intervention in Internal Carotid Artery Pseudoaneurysm Secondary to Retropharyngeal Abscess.

Vascular complications secondary to retropharyngeal abscess are rarely encountered in the post antibiotic era and include compression of internal carotid artery (ICA), infective arteritis and pseudoaneurysm formation. Post infectious ICA pseudoaneurysm formation is reported predominantly in the paediatric age group and rare in adults. We report a case of retropharyngeal abscess complicated by ICA pseudoaneurysm in an adult successfully managed by endovascular approach.

Insights from Magnetic Evoked Field Analysis in Patients with Wilson's Disease.

Aims: To study the latency, amplitude, and source localization of magnetic evoked field (MEF) responses to visual, auditory, and somatosensory stimuli in Wilson's disease (WD) using magnetoencephalography (MEG) and compare it with "healthy" controls, and correlate the observations with disease severity and brain MRI. Methods: MEF of 28 patients with neurological WD (age: 22.82 ± 5.8 years; M:F = 12:16) and 21 matched controls (age: 25.0 ± 4.6 years; M:F = 10:11) were recorded using MEG. Source localization was performed using standard models on the components of M100, M20, and M100 for visual, somatosensory, and auditory evoked fields, respectively and its latency/amplitude was correlated with disease severity. Results: There were significant differences in source location between control and WD during visual evoked field (VEF) and auditory evoked field (AEF) studies. Latencies of M20 (right-p = 0.02; left-p = 0.04) and M32 (right-p = 0.01) components of SSEF were significantly prolonged. The amplitude of M20 was significantly reduced in patients bilaterally (P = 0.001). There was a trend for the prolonged latency of M100 of VEF in patients (P = 0.09). Five patients had reduced right M145 compared to 8 controls. The left somatosensory evoked fields (SSEF) latency correlated with disease severity (P = 0.04). There was no significant correlation between major components of other MEF with disease severity or MRI score. Conclusions: This study, first of its kind to use MEF analysis in a large cohort of patients with WD, detected subclinical but a variable degree of abnormalities, most consistently of SSEF. It provides valuable insights of functioning and localization of various pathways in a disease known to have protean clinical manifestations and widespread MRI changes.

An Enhancement on Convolutional Artificial Intelligent Based Diagnosis for Skin Disease Using Nanotechnology Sensors.

Skin disease is the major health problem around the world. The diagnosis of skin disease remains a challenge to dermatologist profession particularly in the detection, evaluation, and management. Health data are very large and complex due to this processing of data using traditional data processing techniques is very difficult. In this paper, to ease the complexity while processing the inputs, we use multilayered perceptron with backpropagation neural networks (MLP-BPNN). The image is collected from the devices that contain nanotechnology sensors, which is the state-of-art in the proposed model. The nanotechnology sensors sense the skin for its chemical, physical, and biological conditions with better detection specificity, sensitivity, and multiplexing ability to acquire the image for optimal classification. The MLP-BPNN technique is used to envisage the future result of disease type effectively. By using the above MLP-BPNN technique, it is easy to predict the skin diseases such as melanoma, nevus, psoriasis, and seborrheic keratosis.

The relationship between physical performance and quality of life and the level of physical activity among the elderly.

BACKGROUND: Loss of physical function during the process of aging might affect the quality of life. Physical function assessment tests predicts outcomes such as falls, institutionalization, and death. Studies assessing the association of physical function with quality of life and physical activity level of elderly population in India is scarce. Hence we aimed to assess the physical function of community dwelling older adults and to determine its association with physical activity levels and quality of life. MATERIALS AND METHODS: This was a cross-sectional analytical study. 89 community dwelling older adults between 60 and 80 years of age were recruited. Physical function was assessed by standing balance, walking speed, and grip strength. Quality of life was assessed by WHO QOL BREF questionnaire and physical activity level was assessed by International Physical activity Questionnaire. RESULTS: Standing balance was reduced in 24% and walking speed was decreased in 33% of the participants. Males had higher walking speed, and grip strength. Quality of life was better among males. Standing balance, walking speed and grip strength was significantly higher in moderate - heavy activity levels. There was positive correlation between physical function and quality of life. There was also positive correlation between physical activity level and quality of life. CONCLUSION: Physical function, quality of life and physical activity level were decreased. Males had better physical function and quality of life. Physically active individuals had better physical function and quality of life. Early detection of decreased physical function and increase in physical activity level could result in better quality of life among elderly.

Radiological and cadaveric study of anatomical safe zone for transoral base of tongue surgery.

The aim of this study is to identify a surgical safe zone in base of tongue surgery. Fifteen Fresh frozen cadavers (30 head and neck regions) were included in the anatomical study. Twenty-two CT-angiogram (CTA) scans of neck were included in the radiological study. Surgical safe zone for base of tongue surgery was studied in cadavers and correlated the same in CTA. Depth of the lingual artery (LA) from the tongue surface and distance of origin of lingual artery from tip of greater cornu of hyoid bone was significantly different when comparing anatomical to radiological study (p < 0.005). On protruded position of tongue, lingual artery appeared more close to the tongue surface and was never encountered posterior to foramen caecum. Preoperative CTA evaluation would over-estimate the depth of LA putting the lingual artery at risk during resection. A surgical safe zone exists posterior to foramen caecum and towards the midline.

Tungstate Control of Microbial Sulfidogenesis and Souring of the Engineered Environment.

Sulfide accumulation in oil reservoir fluids (souring) from the activity of sulfate-reducing microorganisms (SRM) is of grave concern because of the associated health and facility failure risks. Here, we present an assessment of tungstate as a selective and potent inhibitor of SRM. Dose-response inhibitor experiments were conducted with a number of SRM isolates and enrichments at 30-80 °C and an increase in the effectiveness of tungstate treatment at higher temperatures was observed. To explore mixed inhibitor treatment modes, we tested synergy or antagonism between several inhibitors with tungstate, and found synergism between WO42- and NO2-, while additive effects were observed with ClO4- and NO3-. We also evaluated SRM inhibition by tungstate in advective upflow oil-sand-packed columns. Although 2 mM tungstate was initially sufficient to inhibit sulfidogenesis, subsequent temporal CaWO4 precipitation resulted in loss of the bioavailable inhibitor from solution and a concurrent increase in effluent sulfide. Mixing 4 mM sodium carbonate with the 2 mM tungstate was enough to promote tungstate solubility to reach inhibitory concentrations, without precipitation, and completely inhibit SRM activity. Overall, we demonstrate the effectiveness of tungstate as a potent SRM inhibitor, particularly at higher temperatures, and propose a novel carbonate-tungstate formulation for application to soured oil reservoirs.

Horizontal Transfer of Bacterial Cytolethal Distending Toxin B Genes to Insects.

Horizontal gene transfer events have played a major role in the evolution of microbial species, but their importance in animals is less clear. Here, we report horizontal gene transfer of cytolethal distending toxin B (cdtB), prokaryotic genes encoding eukaryote-targeting DNase I toxins, into the genomes of vinegar flies (Diptera: Drosophilidae) and aphids (Hemiptera: Aphididae). We found insect-encoded cdtB genes are most closely related to orthologs from bacteriophage that infect Candidatus Hamiltonella defensa, a bacterial mutualistic symbiont of aphids that confers resistance to parasitoid wasps. In drosophilids, cdtB orthologs are highly expressed during the parasitoid-prone larval stage and encode a protein with ancestral DNase activity. We show that cdtB has been domesticated by diverse insects and hypothesize that it functions in defense against their natural enemies.

Mind the gap: imaging spectrum of abdominal ventral hernia repair complications.

Ventral hernia repair with or without mesh placement is a commonly done procedure. Laparoscopic approach is more preferred than open in recent surgical practice. Complications occur as like any other abdominal surgeries and are dependent on multiple factors. Complications such as collections, adhesions, and related changes are non-specific. Specific complications related to hernia repair include recurrent hernia, mesh infection, mesh migration, and fistula formation. Post inguinal hernia repair chronic inguinal pain is gaining more attention with increasing use of image-guided nerve interventions for symptomatic management. Imaging plays a vital role in defining and delineating the type and extent of complications. Prior knowledge of the surgical indication and technique helps in better imaging interpretation of complications. This article describes the role of imaging in diagnosis of complications in general ventral hernia surgery setting.

Complete genome sequence of sacbrood virus isolated from Asiatic honey bee Apis cerana indica in India.

We determined the complete genome sequence of a sacbrood virus (SBV) infecting Indian honey bee (Apis cerana indica) from Tamil Nadu, India named as AcSBV-IndTN1. The genome of AcSBV-IndTN1 comprised of 8740 nucleotides, encoding a single large ORF containing 2849 amino acids flanked by 5' and 3' untranslated regions. Results of phylogenetic tree analysis based on complete genomes of SBV isolates indicated that the virus isolates from India isolated from the Asiatic honey bee A. cerana (AcSBVs) formed a separate group along with six Vietnam isolates and three Chinese isolates. The AcSBV-IndTN1 isolate showed closer genetic relationship with other isolates from India. The second major group had both AcSBVs and AmSBVs (virus isolated from European honey bee, Apis mellifera SBV) of Korea, China and Vietnam. The third and a distantly related group had AmSBVs of Australia, UK, USA and Korea. The results obtained from phylogenetic analysis were further supported with evolutionary distance analysis. AcSBV-IndTN1 isolate open reading frame had 95-99% amino acid sequence similarity with other Indian isolates and 92-96% with AcSBVs and AmSBVs of other geographical locations. In addition, sequence difference count matrix ranged from 154 to 907 nt among all the SBV isolates. This suggests that the virus isolates have evolved significantly in different geographical locations but isolates on different hosts in a given location/country are closely related. The high similarity in the genome among the AcSBV and AmSBV isolates indicate possible cross-infections and recombination of SBV isolates in Asian continent where both the honey bee species are reared in close proximity. Gene flow between SBV population indicating that an infrequent gene flow occur between them. The pattern of molecular diversity in SBV population revealed that the occurrence of recent population expansion of SBV. To the best of our knowledge this is the first report of the complete nucleotide sequence of AcSBV from Tamil Nadu, India. This study provided an opportunity to establish the molecular evolution of SBV isolates and shall be useful in the development of diagnostics and effective disease control strategies.

Hydropic degeneration of leiomyoma in nongravid uterus: The "split fiber" sign on magnetic resonance imaging.

Extensive hydropic degeneration in uterine leiomyoma is a rare occurrence and is commonly reported in association with pregnancy. It is a close mimicker of malignancy due to rapid growth and atypical imaging appearances. Awareness of the imaging features helps in diagnosis, avoids unnecessary patient anxiety, and hence reassurance especially when encountered in pregnancy. We report two cases of extensive hydropic degeneration of leiomyoma in nonpregnant females with imaging and histopathology correlation. We also propose the "split fiber" sign as a useful magnetic resonance imaging feature for diagnosing this condition.

Case 248: Cystic Duodenal Dystrophy with Groove Pancreatitis.

History A 59-year-old man presented to the gastroenterology outpatient department with acute abdominal pain centered in the epigastrium. He had experienced similar episodes of abdominal pain in the past that had been treated with surgery. He reported multiple failed attempts at upper gastrointestinal endoscopy. Laboratory tests were performed at the time of admission and revealed a serum glutamic-oxaloacetic transaminase level of 9 U/L [0.15 µkat/L] (normal range, 5-40 U/L [0.08-0.67 µkat/L]), a serum glutamic-pyruvic transaminase level of 34 U/L [0.57 µkat/L] (normal range, 5-45 U/L [0.08-0.75 µkat/L]), a serum γ-glutamyltransferase level of 210 U/L (3.50 µkat/L) (normal range, 10-50 U/L [0.17-0.83 µkat/L]), a serum alkaline phosphatase level of 157 U/L (2.62 µkat/L) (normal range, 30-120 U/L [0.50-2.0 µkat/L]), a serum amylase level of 210 U/L (3.50 µkat/L) (normal range, 30-100 U/L [0.50-1.66 µkat/L]), a serum lipase level of 391 U/L (6.52 µkat/L) (normal range, 13-60 U/L [0.21-1.0 µkat/L]), an α-fetoprotein level of 3.81 ng/ mL (normal range, 0-9 ng/mL), a total protein level of 4.6 g/dL (normal range, 6.0-8.5 g/dL), and an albumin level of 2.6 g/dL (normal range, 3.5-5.2 g/dL). The rest of the laboratory data were unremarkable. The patient underwent erect abdominal radiography, contrast material-enhanced multidetector row computed tomography (CT) of the abdomen with 100 mL of iohexol (300 mg iodine per milliliter, Omnipaque; GE Healthcare, Shanghai, China) followed by combined positron emission tomography (PET) and CT (hereafter, PET/CT) with 6.9 mCi of fluorodeoxyglucose (FDG) and magnetic resonance (MR) imaging of the upper abdomen.

A rare case of adult ovarian hernia in MRKH syndrome.

Inguinal hernias containing ovary have a documented incidence of 3%. Most of the cases are associated with congenital anomalies of genital tract such as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. A 20-year-old female presented with primary amenorrhoea, normal secondary sexual characteristics and genetic karyotyping showing 46XX chromosome. On USG abdomen and pelvis examination complete absence of uterus, cervix and vagina was found. Both the ovaries were seen away from normal anatomical location in bilateral inguinal canal without significant complication. MRI study confirmed agenesis of uterus, cervix and vagina; bilateral inguinal hernia with ovaries as contents. Type 1 MRKH syndrome with bilateral ovarian hernias was diagnosed.

Bilateral nasolabial cysts - case report and review of literature.

Nasolabial cyst is a non-odontogenic, extraosseous, soft tissue cyst, commonly unilateral, located in the nasolabial fold. Bilateral nasolabial cysts are of rare occurrence. This case report describes the multimodality imaging appearance of bilateral nasolabial cysts with a review of literature.

Oesophageal perforation as a complication of ingested partial denture.

We report herein the case of a 53-year-old female who came to the emergency room with the chief complaints of severe dysphagia and chest pain following accidental swallowing of her denture. The patient had swelling of the face, neck and eyelids with difficulty in breathing. A skull radiograph was taken, which revealed a missing partial denture from the right lower jaw. Anteroposterior radiograph of the chest showed two metallic objects in the mid-thorax, adjacent to the descending aorta. CT scan of the neck and chest revealed two metallic objects (measuring approximately 17mm each) in the middle one-third of the oesophagus (right posterolateral aspect), causing perforation of the oesophagus and leading to pneumomediastinum, and left pneumothorax with subcutaneous emphysema of the neck and chest. An emergency thoracoscopic removal of the foreign body (partial denture) was performed with subsequent repair of the oesophageal tear in the same sitting. Post surgery, the patient was shifted to intensive care unit and she recovered well over a course of time. In summary, accidental ingestion of a partial denture can lead to grave complications such as oesophageal perforation, which should be managed on an emergency basis with thoracoscopic removal of the foreign body.