Novel pathogenic adenovirus in Timneh grey parrot (Psittacus timneh) unveils distinct lineage within Aviadenovirus.

Wild birds harbour a vast diversity of adenoviruses that remain uncharacterised with respect to their genome organisation and evolutionary relatedness within complex host ecosystems. Here, we characterise a novel adenovirus type within Aviadenovirus genus associated with severe necrotising hepatitis in a captive Timneh grey parrot, tentatively named as Timneh grey parrot adenovirus 1 (TpAdV-1). The TpAdV-1 genome is 39,867 bp and encodes 46 putative genes with seven hitherto not described ones. Comparative genomics and phylogenetic analyses revealed highest nucleotide identity with psittacine adenovirus 1 and psittacine adenovirus 4 that formed a discrete monophyletic clade within Aviadenovirus lineage suggesting a deep host co-divergent lineage within Psittaciformes hosts. Several recombination breakpoints were identified within the TpAdV-1 genome, which highlighted an ancient evolutionary relationship across the genera Aviadenovirus, Mastadenovirus and Atadenovirus. This study hints towards a host-adapted sub-lineage of avian adenovirus capable of having significant host virulence in Psittaciformes birds augmented with ecological opportunity.

Study on Universal Health Coverage Scheme in India - The Stumper to Private Hospitals.

BACKGROUND: Many governments have introduced health insurance schemes for the poor sections of society to save them from catastrophic health expenditure. Private hospitals play a key role in India, as they are in significant number in secondary and tertiary care services. Private hospitals have to fund their infrastructure, staff salaries from the revenue of previous year. In this study, we compared money received by a private medical college hospital bed through government insurance scheme patient and private paying patient. METHODS: Observational study, comparing money reimbursed for top ten procedures treated in private medical college hospitals by Ayushman Bharat (AB) fund and the price offered by a paying patient in similar bed. RESULTS: On average 600 patients received medical care through the AB scheme per month at our tertiary care super-specialty hospital. Highest numbers were seen in specialties like cardiovascular, and cancer treatments and infectious diseases under general medicine specialty. The costs considered were surgeon's cost, medicines, devices, and hospitalization costs. The laparoscopic procedures were incurring a loss of 130%, knee replacements about 50%, coronary bypass grafting thankfully due to controlling of prices by central government is incurring a loss of 10%. The package amount offered accounts to 26-52% only of the costs incurred by the private hospitals. CONCLUSION: The private academic hospitals need 25% to 50% more than current prices offered, across various procedures.

Unraveling the cation dependent carrier cooling and transient mobility in lead-free A3Sb2I9 perovskites.

Lead halide perovskites (LHPs) have gained prominence for their exceptional photophysical properties, holding promise for applications in high-end optoelectronic devices. However, the presence of lead is one of the major obstacles to the commercialization of LHPs in the field of photovoltaics. To address this, researchers have explored environment friendly lead-free perovskite solar cells by investigating non-toxic perovskite materials. This study explores the enhancement of photophysical properties through chemical engineering, specifically cation exchange, focusing on the crucial photophysical process of hot carrier cooling. Employing femtosecond transient absorption spectroscopy and optical pump terahertz probe spectroscopy, we have probed the carrier relaxation dynamics in A3Sb2I9 with cesium and rubidium cations. This study unravels that the carrier relaxation is found to be slower in Rb3Sb2I9; along with this, the transient mobility decay is found to be retarded. Overall, this study suggests that an antimony-based Rb3Sb2I9 perovskite could be a substantial lead-free perovskite in photovoltaics. These findings provide valuable insights into cation engineering strategies, aiming to improve the overall performance of lead-free-based photovoltaic devices.

Bioactive constituents from Tinospora cordifolia (willd.): Isolation, synthesis and their immunomodulatory activity.

Traditional medicinal plants have been used for centuries for their immunomodulatory properties and therapeutic potentials. The present study aims to investigate the immunomodulatory constituents from traditional medicinal plant, Tinospora cordifolia (willd.). Our study resulted in the isolation of new compound, 27-hydroxy octacosyl ferulate (1) along with eleven known compounds (2-12). The structures of the isolated compounds were characterized by combination of NMR (1D and 2D) and Mass spectroscopic methods. The hemisynthesis of compound 12 (ferulic acid) yielded (12a-12d and 12e-12 m) derivatives. Further, the isolated compounds and synthesized derivatives were assessed for their immunomodulatory potentials by evaluating their cytotoxicity and pro-inflammatory effects against macrophage cells (IL-6) and DC activation markers (CD 11c and 86). The biological results indicated that crude extract displayed potent immunomodulatory activity while isolated compounds and synthetic analogues showed moderate activity. Among the tested compounds, new compound (1), quercetin (10) and derivatives 12b, 12c found to be non-cytotoxic and displayed immunomodulatory potentials. Therefore, these compounds can be studied for autoimmunity and other immune suppressing conditions.

A phase II randomized, double-blind, placebo-controlled study of Nuvastatic (C50SEW505OESA), a standardized rosmarinic acid-rich polymolecular botanical extract formulation to reduce cancer-related fatigue in patients with solid tumors.

AIM: We evaluated the efficacy and safety of Nuvastatic™ (C5OSEW5050ESA) in improving cancer-related fatigue (CRF) among cancer patients. METHODS: This multicenter randomized double-blind placebo-controlled phase 2 trial included 110 solid malignant tumor patients (stage II-IV) undergoing chemotherapy. They were randomly selected and provided oral Nuvastatic™ 1000 mg (N = 56) or placebo (N = 54) thrice daily for 9 weeks. The primary outcomes were fatigue (Brief Fatigue Inventory (BFI)) and Visual Analog Scale for Fatigue (VAS-F)) scores measured before and after intervention at baseline and weeks 3, 6, and 9. The secondary outcomes were mean group difference in the vitality subscale of the Medical Outcome Scale Short Form-36 (SF-36) and urinary F2-isoprostane concentration (an oxidative stress biomarker), Eastern Cooperative Oncology Group scores, adverse events, and biochemical and hematologic parameters. Analysis was performed by intention-to-treat (ITT). Primary and secondary outcomes were assessed by two-way repeated-measures analysis of variance (mixed ANOVA). RESULTS: The Nuvastatic™ group exhibited an overall decreased fatigue score compared with the placebo group. Compared with the placebo group, the Nuvastatic™ group significantly reduced BFI-fatigue (BFI fatigue score, F (1.4, 147) = 16.554, p < 0.001, partial η2 = 0.333). The Nuvastatic™ group significantly reduced VAS-F fatigue (F (2, 210) = 9.534, p < 0.001, partial η2 = 0.083), improved quality of life (QoL) (F (1.2, 127.48) = 34.07, p < 0.001, partial η2 = 0.243), and lowered urinary F2-IsoP concentrations (mean difference (95% CI) = 55.57 (24.84, 86.30)), t (55) = 3.624, p < 0.001, Cohen's d (95% CI) = 0.48 (0.20, 0.75)). Reported adverse events were vomiting (0.9%), fever (5.4%), and headache (2.7%). CONCLUSION: Nuvastatic™ is potentially an effective adjuvant for CRF management in solid tumor patients and worthy of further investigation in larger trials. TRIAL REGISTRATION: ClinicalTrial.gov ID: NCT04546607. Study registration date (first submitted): 11-05-2020.

Serotype-Specific Regulation of Dengue Virus NS5 Protein Subcellular Localization.

Dengue virus (DENV) nonstructural protein 5 (NS5), consisting of methyltransferase and RNA-dependent RNA polymerase (RdRp) domains, is critical for viral RNA synthesis within endoplasmic reticulum-derived replication complexes in the cytoplasm. However, a significant proportion of NS5 is localized to the nucleus of infected cells for DENV2, 3, and 4, whereas DENV1 NS5 is localized diffusely in the cytoplasm. We still have an incomplete understanding of how the DENV NS5 subcellular localization is regulated. Within NS5, two putative nuclear localization signal (NLS) sequences have been identified: NLSCentral residing in the palm of the RdRp domain as well as the recently discovered NLSC-term residing in the flexible region at the C-terminal of the RdRp domain. We have previously shown that DENV2 NS5 nuclear localization can be significantly reduced by single-point mutations to the NLSC-term. Here, we present biochemical, virological, and structural data demonstrating that the relative importance of either NLS in NS5 nuclear localization is unique to each of the four DENV serotypes. DENV1 NS5's cytoplasmic localization appears to be due to a functionally weak interaction between its NLSCentral and importin-α (IMPα), while DENV2 NS5 is almost exclusively nuclear through its NLSC-term's strong interaction with IMPα. Both NLSs of DENV3 NS5 appear to contribute to directing its nuclear localization. Lastly, in the case of DENV4, the regulation of its NS5 nuclear localization remains an enigma but appears to be associated with its NLSC-term.

Final Results of RIGHT Choice: Ribociclib Plus Endocrine Therapy Versus Combination Chemotherapy in Premenopausal Women With Clinically Aggressive Hormone Receptor-Positive/Human Epidermal Growth Factor Receptor 2-Negative Advanced Breast Cancer.

PURPOSE: A head-to-head comparison of efficacy between a cyclin-dependent kinase 4/6 inhibitor plus endocrine therapy (ET) versus combination chemotherapy (CT) has never been reported in patients with clinically aggressive hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) advanced breast cancer (ABC). METHODS: In this open-label, multicenter, randomized phase II trial, pre/perimenopausal women with clinically aggressive HR+/HER2- ABC were randomly assigned 1:1 to first-line ribociclib (600 mg once daily; 3 weeks on, 1 week off) plus letrozole/anastrozole and goserelin or investigator's choice of combination CT (docetaxel plus capecitabine, paclitaxel plus gemcitabine, or capecitabine plus vinorelbine). The primary end point was progression-free survival (PFS). RESULTS: Among 222 patients randomly assigned to ribociclib plus ET (n = 112) or combination CT (n = 110), 150 (67.6%) had symptomatic visceral metastases, 41 (18.5%) had rapid disease progression per investigator's judgment, and 31 (14.0%) had symptomatic nonvisceral disease. Overall, 106 (47.7%) patients had investigator-assessed visceral crisis. The median follow-up time was 37.0 months. At data cutoff, 31.3% (ribociclib arm) and 15.5% (CT arm) of patients had completed study treatment and transitioned to post-trial access. The median PFS was 21.8 months (ribociclib plus ET; [95% CI, 17.4 to 26.7]) and 12.8 months (combination CT; [95% CI, 10.1 to 18.4); hazard ratio, 0.61 [95% CI, 0.43 to 0.87]; P = .003. The overall response rates and the median time to response in the ribociclib versus CT arms, respectively, were 66.1% and 61.8% and 4.9 months and 3.2 months (hazard ratio, 0.76 [95% CI, 0.55 to 1.06]). Lower rates of symptomatic adverse events were observed in the ribociclib versus CT arm. CONCLUSION: First-line ribociclib plus ET showed a significant PFS benefit, similar response rates, and better tolerability over combination CT in patients with clinically aggressive HR+/HER2- ABC.

Brain tumor segmentation using neuro-technology enabled intelligence-cascaded U-Net model.

According to experts in neurology, brain tumours pose a serious risk to human health. The clinical identification and treatment of brain tumours rely heavily on accurate segmentation. The varied sizes, forms, and locations of brain tumours make accurate automated segmentation a formidable obstacle in the field of neuroscience. U-Net, with its computational intelligence and concise design, has lately been the go-to model for fixing medical picture segmentation issues. Problems with restricted local receptive fields, lost spatial information, and inadequate contextual information are still plaguing artificial intelligence. A convolutional neural network (CNN) and a Mel-spectrogram are the basis of this cough recognition technique. First, we combine the voice in a variety of intricate settings and improve the audio data. After that, we preprocess the data to make sure its length is consistent and create a Mel-spectrogram out of it. A novel model for brain tumor segmentation (BTS), Intelligence Cascade U-Net (ICU-Net), is proposed to address these issues. It is built on dynamic convolution and uses a non-local attention mechanism. In order to reconstruct more detailed spatial information on brain tumours, the principal design is a two-stage cascade of 3DU-Net. The paper's objective is to identify the best learnable parameters that will maximize the likelihood of the data. After the network's ability to gather long-distance dependencies for AI, Expectation-Maximization is applied to the cascade network's lateral connections, enabling it to leverage contextual data more effectively. Lastly, to enhance the network's ability to capture local characteristics, dynamic convolutions with local adaptive capabilities are used in place of the cascade network's standard convolutions. We compared our results to those of other typical methods and ran extensive testing utilising the publicly available BraTS 2019/2020 datasets. The suggested method performs well on tasks involving BTS, according to the experimental data. The Dice scores for tumor core (TC), complete tumor, and enhanced tumor segmentation BraTS 2019/2020 validation sets are 0.897/0.903, 0.826/0.828, and 0.781/0.786, respectively, indicating high performance in BTS.

Design, Synthesis, Structural Investigation and Photo Induced Biological Investigations of Co(II), Ni(II) and Cu(II) Complexes Derived from N,O Donor Schiff Bases.

A series of chelated metal complexes, [Co(LI)2] (1), [Ni(LI)2] (2), [Cu(LI)2] (3) [Co(LII)2] (4), [Ni(LII)2] (5) and [Cu(LII)2] (6) were designed and synthesized from newly synthesized Schiff bases, LI = 2-((E)-(5-(4-fluorophenyl)isoxazol-3-ylimino)methyl)-5-methylphenol and LII = 2-((E)-(5-(4-fluorophenyl)isoxazol-3-ylimino)methyl)-4-chlorophenol. The synthesized compounds were characterized by elemental analysis, nuclear magnetic resonance spectroscopy (NMR), electronic spectroscopy (UV-Vis), infrared spectroscopy (FT-IR), magnetic susceptibility (µeff), electron spin resonance spectroscopy (ESR), Thermogravimetric analysis (TGA), scanning electron microscopy (SEM), energy dispersive X-ray analysis (EDX), and powder X-ray diffraction analysis (P-XRD). The spectral investigations have been clearly suggested 1:2 (metal: ligand) stoichiometric complexes with square planar geometrical arrangement around the metal ion. The thermal gravimmetric analysis (TGA) of these complexes indicates greater thermal stability and various steps involved in thermal decomposition of metal complexes. The binding ability between these metal complexes and calf thymus DNA (CT-DNA) was investigated by UV-Vis, fluorescence spectroscopy and viscometric experiments, which disclosed that, the complexes interacted to CT-DNA via an intercalation binding mode. The cleavage property of metal complexes against pBR322 DNA has been explored by gel electrophoresis technique mediated by UV-illumination and H2O2, showed momentous cleavage activity. Antioxidant activity of all complexes was determined by DPPH free radical scavenging experiment and showed prominent antioxidant activity. Further, the antibacterial and antifungal activities of all compounds were screened against bacterial and fungal strains via in-vitro disc diffusion method. These studies revealed that the complexes showed comparatively more antimicrobial activity than free ligands against tested microbial strains.

Correlation Between Nasal Allergy and the Number of Eosinophils in Adenoid Tissue.

To study adenoid tissue eosinophilia in allergic rhinitis. A single-centre clinical case-control prospective study with 66 subjects enrolled for the study after taking written informed consent from all the participants. All patients underwent adenoidectomy with histopathological evaluation of adenoid tissue samples for eosinophils. 36 patients (cases) with Symptoms for Allergic Rhinitis (SFAR) score indicative of allergic rhinitis. 30 patients (control) with SFAR scores not indicative of allergic rhinitis. All patients were evaluated for serum absolute eosinophil count and total serum immunoglobulin E (Ig-E). There was a significant relationship between allergic rhinitis and serum Ig-E levels using the Kruskal-Wallis rank sum test amongst case and control groups with a p-value of 0.031. Pathologically examined slides of adenoid tissue eosinophil count per 10 random high power fields in these patients showed significant results with a p-value of 0.002432, via the Kruskal-Wallis rank sum test. Statistical analysis, shows that adenoid tissue eosinophil count and serum Ig-E levels can somewhat predict the presence of clinical features of allergic rhinitis. Based on several similar studies with similar results, allergic rhinitis can be gauged with adenoid tissue histopathology and routine evaluation should be considered as a standard of care.

Eicosane: An antifungal compound derived from Streptomyces sp. KF15 exhibits inhibitory potential against major phytopathogenic fungi of crops.

In the present scenario, food security is of major concern due to exponentially increasing population and depleted crop production. The fungal diseases have contributed majorly to the scarcity of staple food products and economic loss worldwide. This problem could be tackled by preventing the crop loss during both pre and post-harvest seasons. During the current investigation, the bioactive compound eicosane was extracted from Streptomyces sp. KF15, subjected to purification and identified based on mass spectrometry and NMR analysis. The evaluation of in-vitro antifungal activity was done by poisoned food method, SEM analysis and growth pattern analysis. The bioactive compound eicosane with molecular weight of 282.5475 g/mol was purified by column chromatography and the straight chain hydrocarbon structure of CH3CH2(18)CH3 was elucidated by NMR analysis. In poisoned food assay, eicosane effectively inhibited the radial growth of all tested fungal pathogens; F. oxysporum was found to be the most sensitive with 24.2%, 33.3%, 42.4%, and 63.6% inhibition at 25-100 µg/ml concentrations. The SEM micrograph established clear differences in the morphology of eicosane treated fungi with damaged hyphae, flaccid mycelium and collapsed spores as compared to the tubular, turgid and entire fungi in control sample. Finally, the growth curve assay depicted the right side shift in the pattern of eicosane treated fungi indicating the delay in adapting to the conditions of growth and multiplication. The findings of this study encourage further research and development towards the novel antifungal drugs that can act against major phytopathogens.

A Randomized, Double-Blind, Parallel-Group Phase III Trial Investigating the Glycemic Efficacy and Safety Profile of Fixed-Dose Combination Dapagliflozin and Linagliptin Over Linagliptin Monotherapy in Patients with Inadequately Controlled Type 2 Diabetes with Metformin.

INTRODUCTION: The aim of the study was to evaluate the efficacy and safety of fixed-dose combination (FDC) of dapagliflozin (10 mg) and linagliptin (5 mg) in comparison to linagliptin 5 mg (Trajenta) in patients with insufficiently controlled type 2 diabetes mellitus (T2DM) on metformin monotherapy. METHODS: The double-blind, randomized, multicentric, parallel-group phase III trial screened 287 adult patients with T2DM (age 18-65 years) from 16 sites across India. The recruited subjects were undergoing metformin monotherapy ≥ 1000 mg/day for at least 28 days. Patients with HbA1c of 7.5-10.5% (58-91 mmol/l) (n = 232) after 2 weeks of run-in period with linagliptin monotherapy and placebo dapagliflozin/linagliptin on metformin monotherapy were randomized (1:1) in parallel to once daily dapagliflozin/linagliptin 10/5 mg or linagliptin 5 mg for 16 weeks. Patients were stratified on the basis of HbA1c (≤ 9.0% and > 9.0%; ≤ 75 mmol/l and > 75 mmol/l)). A total of 225 subjects completed 16 weeks of treatment, 115 patients in the test group and 110 patients in the reference group. RESULTS: Dapagliflozin/linagliptin (p = 0.0003) exhibited a greater change in HbA1c from baseline than linagliptin (p < 0.0001) in 16 weeks (mean reduction, - 1.28% vs - 0.83%). Test group showed a significant decrease in fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and body weight compared to the reference group. The FDC was well tolerated with adverse events being more frequent in the reference group. No serious adverse events (SAEs) were reported in the study. CONCLUSION: Dapagliflozin/linagliptin combination is a novel dipeptidyl peptidase 4 (DPP4)/sodium-glucose co-transporter 2 (SGLT2) inhibitor FDC approved in India for patients with T2DM. Potential limitations of this study are a small dose of dapagliflozin (10 mg) in the FDC, a short study duration (30 weeks) and a high minimum threshold for HbA1c (≤ 7.5%; ≤ 53 mmol/l). Results indicate the FDC to be a superior therapeutic option over linagliptin for patients with T2DM on metformin monotherapy. TRIAL REGISTRATION: CTRI/2022/08/044563; 01/08/2022.

Intra-operative Safety of an Autonomous Robotic System for Total Knee Replacement: A Review of 500 Cases in India.

Background: Manual total knee arthroplasty (TKA) has been documented several times for their safety and complications data. In contrast, there is a limited evidence-based analysis for safety and complications of autonomous robotic-assisted (RA)-TKA. This study aimed to evaluate the safety features and intra-operative surgical complications associated with the use of Cuvis Joint™ autonomous robotic system for TKA. Methods: The study included 500 consecutive patients who underwent TKA using the Cuvis Joint™ autonomous robotic system from November 2020 to November 2021. All surgeries were performed by a senior surgeon. Patients in whom the surgery was abandoned midway due to technical errors, were excluded from the analysis. In case of unilateral abandonment of the robotic arm during a bilateral RA-TKA, data of the side on which the surgery was completed with robotic assistance was recorded. Results: There was no incidence of neurological injury, vascular injury, extensor mechanism disruption, or medial collateral ligament injury. There was one case of superficial abrasion of the patellar tendon; however, it did not require any intervention. There were no cases of midway abandonment due to threatened soft tissue injury. There was no intra-operative pin loosening or stress-related fractures at the pin sites. There was one case of Steinmann pin breakage and another case of drill bit breakage, which were removed without any damage to the bone. Conclusion: The Cuvis Joint™ autonomous robotic system for TKA is safe with no significant intra-operative complications.

Unveiling a novel terpolymer-metal complex: A detailed exploration of synthesis, characterization, and its potential as an antimicrobial and antioxidant agent.

In an innovative approach to push the boundaries of antimicrobial and antioxidant strategies, we present the synthesis and characterization of a novel terpolymer derived from N-Phenyl-p-phenylenediamine and 2-aminopyrimidine with formaldehyde in the presence of dimethylformamide as a reaction medium through polycondensation technique. Leveraging this terpolymer as a ligand, we introduce an intriguing terpolymer-metal complex, created with Ni (II) metal ion. In our pursuit to validate the structure and properties of these substances, we performed meticulous characterizations using important spectral studies such as FTIR, electronic, and 1H NMR spectroscopy. This provided us with a unique fingerprint for the (N-Phenyl-p-phenylenediamine-2-aminopyrimidine-formaldehyde) terpolymeric ligand (PAF) and its metal complex. In addition, the molecular weights of PAF terpolymer were established using gel permeation chromatography. Upon investigation, PAF terpolymer and PAF-Ni complex exhibited impressive antimicrobial activity, tested by the disc-diffusion technique. Both demonstrated potency against a range of harmful bacterial and fungal strains, including Staphylococcus aureus, Escherichia coli, Candida albicans, and Aspergillus niger. In an extension to their biological applications, we evaluated the free radical scavenging activity of PAF terpolymer and PAF-Ni complex using the DPPH assay. The complex PAF-Ni showcased an enhanced scavenging activity 73.94% (IC50 = 17.58) compared to the ligand PAF 63.06% (IC50 = 27.61) at 100 µg/ml indicating its potential role in oxidative stress management.

Thermal, dielectric, mechanical and structural behavior of 2-amino 4-methylpyridinium 4-nitrophenolate 4-nitrophenol bulk single crystal.

Applications in both science and industry have received increased attention as a result of bulk single crystals with particular orientations. However, due to the instability of organic crystals at high temperatures and stress, there is an interest in growing good-quality bulk single crystals with stable thermal and mechanical properties. Here, the 2-amino 4-methylpyridinium 4-nitrophenolate 4-nitrophenol (2A4MPPP) crystal was prepared employing a single-wall ampoule and the vertical Bridgman technique. Structure and functional groups were determined by XRD, NMR, and FTIR studies. More importantly, detailed thermal and kinetic properties such as activation energy, frequency factor, rate constant, and Avrami exponent are discussed. The mechanical stability and dielectric studies are also demonstrated for the title compound. According to the single crystal XRD investigation, 2A4MPPP is a member of the orthorhombic crystal system with the Pna21 space group. Through the TGA and DTA analyses, it was confirmed that the compound starts to melt at 98 °C and complete melting occurs at 103.3 °C. The dielectric experiments reveal the crystal's poor dielectric constant and high-frequency dielectric loss. Vickers microhardness investigations show that grown 2A4MPPP belongs to the soft materials group. As a result of these findings, the 2A4MPPP crystal should be well suited for usage in thermomechanical, microelectronic, optical communications, and nonlinear optical applications.

Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with metastatic colorectal cancer.

The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with metastatic colorectal cancer (mCRC), published in late 2022, were adapted in December 2022, according to previously established standard methodology, to produce the Pan-Asian adapted (PAGA) ESMO consensus guidelines for the management of Asian patients with mCRC. The adapted guidelines presented in this manuscript represent the consensus opinions reached by a panel of Asian experts in the treatment of patients with mCRC representing the oncological societies of China (CSCO), Indonesia (ISHMO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO), co-ordinated by ESMO and the Japanese Society of Medical Oncology (JSMO). The voting was based on scientific evidence and was independent of the current treatment practices, drug access restrictions and reimbursement decisions in the different Asian countries. The latter are discussed separately in the manuscript. The aim is to provide guidance for the optimisation and harmonisation of the management of patients with mCRC across the different countries of Asia, drawing on the evidence provided by both Western and Asian trials, whilst respecting the differences in screening practices, molecular profiling and age and stage at presentation, coupled with a disparity in the drug approvals and reimbursement strategies, between the different countries.

Possible Ambiguity in Interpretation Between Immunoglobulin G4-Related Disease (IgG4-RD) and Sarcoidosis in a Post-COVID-19 Pandemic.

A 36-year-old lady presented with fever, cough, maculopapular rash, painless sialadenitis, episcleritis, and arthralgia of more than 10 months, occurring in episodes since she tested positive for COVID-19 in 2020. Her symptoms were well controlled with corticosteroid and immunosuppressant therapy. Her clinical presentation and findings on bronchoscopy resembled that of sarcoidosis. However, the bronchial biopsy histopathology ruled out sarcoidosis. An increased serum immunoglobulin G4 level and its possible association with COVID-19 raises the question of whether the possibility of immunoglobulin G4-related disease (IgG4-RD) could be entertained.

Molecular characterization of the Indian isolate (Ka-To) of tomato spotted wilt virus (TSWV) infecting tomato (Solanum lycopersicum L.).

Tomato spotted wilt virus (TSWV) infecting tomato has been identified as an emerging constraint for tomato cultivation in the southern Indian states of Karnataka and Tamil Nadu. Infection of TSWV produces circular necrotic ring spots on leaves, stem and floral necrosis and necrotic ringspots on fruits of tomato. In this study, we describe the characterization of TSWV isolate (Ka-To) infecting tomato from India based on biological, serological and molecular assay. Pathogenicity of TSWV (Ka-To) isolate was established by mechanical inoculation of sap from infected leaves on tomato, cowpea and datura which expressed necrotic or chlorotic local lesions. Samples were tested positive in the serological assay performed with TSWV-specific immunostrips. Further, reverse transcription polymerase chain reaction (RT-PCR) amplification of coat protein gene followed by sequencing, unequivocally confirmed the identity of TSWV. The obtained full-length nucleotide sequences of Ka-To isolate [L RNA-MK977648; M RNA-MK977649; and S RNA-MK977650] had greater similarity to the TSWV isolates of Spain and Hungary infecting tomato and pepper. The phylogenetic and recombination analysis showed the evidence for reassortment and recombination in the genome of Ka-To isolate. To the best of our knowledge, this is the first confirmed evidence for the occurrence of TSWV on tomato in India. Information obtained in this study issues a forewarning on the emergence of TSWV on vegetable ecosystem in the Indian subcontinent, requiring urgent management strategies to curtail its pestilence. Supplementary Information: The online version contains supplementary material available at 10.1007/s13205-023-03579-y.

Oral Dextrose gel use in asymptomatic hypoglycemic newborns decreases NICU admissions and parenteral dextrose therapy: A retrospective study.

BACKGROUND: Neonatal hypoglycemia is one of the most common causes of admission to neonatal intensive care unit requiring intravenous dextrose therapy. Administration of IV dextrose and transfer to the NICU may interfere with parent-infant bonding, breastfeeding, and has financial implications. OBJECTIVE: Retrospective study to evaluate the effect of dextrose gel supplementation for asymptomatic hypoglycemia in reducing NICU admissions and intravenous dextrose therapy. METHOD: A retrospective study conducted for eight months each before and after introduction of dextrose gel in the management of asymptomatic neonatal hypoglycemia. Asymptomatic hypoglycemic infants were given only feeds in pre dextrose gel period and dextrose gel along with feeds in the dextrose gel period. Rates of admission to NICU and the need of IV dextrose therapy were evaluated. RESULTS: High risk characteristics (Prematurity, Large for Gestational Age, small for Gestational Age, Infants of diabetic mother etc.) were equally distributed among both the cohorts. Primary outcome results showed significant reduction in NICU admissions from 396/1801(22%) to 329/1783 (18.5%) (odds ratio, 95% CI 1.24(1.05-1.46, p 0.008). There was significant reduction in IV dextrose therapy requirement from 277/1405 (15.4%) to 182/1454 (10.2%) (odds ratio, 95% CI 1.59(1.31- 1.95, p < 0.001).Babies discharged on predominant breast feeding showed significant improvement from 237/396(59.8%) in the pre dextrose gel period to 240/329 (72.9%) (odds ratio, 95% CI 0.82(0.73-0.90, p < 0.001) in dextrose gel period. CONCLUSIONS: Dextrose gel supplementation with feeds reduced NICU admissions, the need for parenteral dextrose therapy, avoided maternal separation and promoted breastfeeding.