White light emission from helically stacked humin-mimic based H-aggregates in heteroatom free carbon dots.

White light emission (WLE), particularly from heteroatom free carbon dots (CDs), is unusual. Besides, deciphering the origin of WLE from a H-aggregated molecular fluorophore in such kinds of CDs is a challenging task due to their non-fluorescent character resulting from a forbidden transition from a lower-energy excitonic state. Therefore, rigorous investigation on their elusive excited state photophysical properties along with their steady-state optical phenomena has to be carried out to shed light on the nature of distinct emissive states formed in the CDs. Herein, for the first time, we report WLE from imperfect H-aggregates of co-facially π-π stacked humin-like structures comprising furfural monomer units as a unique molecular fluorophore in CDs, as revealed from combined spectroscopic and microscopic studies, synthesized through hydrothermal treatment of the single precursor, dextrose. H-aggregates in CDs show a broad range of excitation-dependent emission spectra with color coordinates close to pure white light, i.e., CIE (0.35, 0.37) and a color temperature of 6000 K. Imperfect orientation between the transition dipole moments of adjacent monomer units in the H-aggregate's molecular arrangement is expected to cause ground state symmetry breaking, as confirmed by Circular Dichroism (CD) studies, which established helically stacked nature in molecular aggregates and produced significant oscillatory strength at lower energy excitonic states to enable fluorescence. TRES and TAS investigations have been performed to minimise the intricacies associated with excited state photophysics, which is regarded as an essential step in gaining a grasp on emissive states. Based on the observation of two isoemissive spots in the time-resolved area normalized emission spectra (TRANES), the existence of three oligomeric species in the excited state equilibrium of the pure/hybrid H-aggregates has been established. The exciton dynamics through electron relaxation from the higher to the lower excitonic states, charge transfer (CT) states, and surface trap mediated emission in excimer states of H-aggregates have also been endorsed as three distinct emissive states from femtosecond transient absorption spectroscopy (TAS) studies corroborating with their steady-state absorption and emission behavior. The results would demonstrate the usage of CDs as a cutting-edge fluorescent material for creating aggregate-induced white light emission.

Optical Asymmetry and Structural Complexity in Hierarchically Organized Chiral CuO Nanostructures: Insight into the Geometric and Crystallographic Effects on Cooperative Chirality.

Optical asymmetry and structural complexity across different length scales were realized in flower-shaped CuO nanostructures, prepared through refluxing an aqueous solution of copper acetate, sodium hydroxide, and D-tartaric acid, as well as in their toroid-like forms obtained on calcination at 600 °C. Atomic scale chirality in the flower morphology could be visualized as putative Boerdijk-Coexter-Bernal like tetrahelical fragments, while that in the toroid form could be identified as screw dislocation-driven helicity. The fraction of asymmetry in the nanostructures has been evaluated from their chiroptical responses based on Kuhn asymmetry factor (g) from circular dichroism (CD) spectroscopy in the entire UV-vis range. The origin of chirality in the two CuO nanostructures has been assigned to the helical arrangement of the Cu-O-Cu network in accordance with their microscopic and spectroscopic observations. Attempts have been made to interpret the crystallographic and geometric chiralities in the two CuO nanostructures based on the redshift and augmented intensity of the CD signal along with an increase in their corresponding anisotropic factor on calcination. Further, the diverse interaction of the toroid-shaped CuO nanostructures with enantiomeric tryptophan moieties has been illustrated from the measurement of their corresponding thermodynamic parameters.

Pyridinic-N-rich carbon dots in IFE-based Turn-off Fluorometric detection of nerve agent Mimic- Diethyl chlorophosphate and multicolor cell imaging.

Fluorometric sensors for the detection of nerve agent mimics have received a lot of interest nowadays due to their high sensitivity and selectivity, ease of operation, and real-time monitoring. Pyridinic-N-rich carbon dots (NCDs) prepared through microwave-assisted pyrolysis of l-Malic acid and urea have been explored first time in this work as a novel turn-off fluorescent probe for the sensitive and selective detection of diethyl chlorophosphate (DCP), a nerve agent mimic. The as-prepared carbon dots contained a large amount of pyridinic nitrogen on their surface, which can modulate the photoluminescence properties of the NCDs. The blue emissive NCDs possessed both excitation wavelength-dependent and independent emission behavior. The detection of DCP was premised on quenching of the fluorescence emission intensity of NCDs in the presence of similar chemical reagents (e.g., trimethyl phosphate, triethyl phosphate, triethyl phosphonoacetate, triphenyl phosphate, diphenyl phosphate, tributyl phosphate). Fluorescence quenching of the NCDs in the presence of DCP has been attributed to the inner filter effect (IFE). From the linear Stern-Volmer plot (R2 = 0.9992), the limit of detection (LOD) was found to be 84 µM for sensing DCP for the concentration ranging between 3 and 15 mM. The biocompatibility of NCDs was assessed through cytotoxicity assay on MDA-MB-231 breast cancer cells. Fluorescence imaging demonstrated that NCDs have low cytotoxicity and can be employed successfully in cell imaging.

Clinicohistological correlation of etiological spectrum of chronic liver disease diagnosed during noncirrhotic stages in children: Can need of liver biopsy be obviated?

BACKGROUND AND AIM: Limited data exist regarding the etiological spectrum of the subset of chronic liver diseases (CLDs) diagnosed in noncirrhotic states in children. Our primary objective was to study the clinicoetiological profile of CLDs detected in noncirrhotic stages in children younger than 12 years of age. The secondary objective was to find the hepatic histological correlation of provisional diagnosis by different ranks of doctors. METHODS: This was an observational epidemiological study, cross-sectional in design, conducted in a tertiary-care setting over a 2-year period. RESULTS: Thirty-seven cases were enrolled, with a mean ± SD age of 8 ± 4.1 years and a male:female ratio of 1.8:1. Etiologies noted were Wilson disease (n = 8), autoimmune hepatitis (n = 4), secondary hemochromatosis (n = 4), chronic hepatitis B (n = 3), chronic hepatitis C (n = 2), non-alcoholic steatohepatitis (n = 2), progressive familial intrahepatic cholestasis (n = 2), extrahepatic biliary atresia (n = 2), Alagille syndrome (n = 1), galactosemia (n = 1), Gaucher disease (n = 1), Niemann-Pick disease (n = 1), and Budd-Chiari syndrome (n = 1), with an inconclusive diagnosis in five children. Relevant investigations were ordered more frequently by the specialist consultant (SC) and super specialist (SS) combined in comparison with the senior resident (SR) and junior resident (JR) together. (P = 0.0013). Irrelevance of the tests ordered was significantly higher in the junior tier (JR and SR; SR > JR) in contrast to the senior tier of doctors (SC and SS) (P < 0.01). The clinicohistological correlation of an etiological diagnosis significantly differed between the junior and senior ranks of physicians. We noted that an ideal clinical acumen could help to avoid liver biopsy for etiological diagnosis in 78.3% (29/37) of the study population. CONCLUSION: Interpretation of clinical presentation by the senior set of doctors is preferable, which could obviate the need for liver biopsy regarding diagnosis in a proportion of pediatric CLD patients.

Validation of Revised Baveno VI Criteria for Screening of Varices Needing Treatment in Children with Cirrhosis.

BACKGROUND: Baveno VI criteria for screening varices needing treatment (VNT) have not yet been validated in an exclusive pediatric and adolescent set of the population, in whom baseline parameters differ in relation to adults. Therefore, our primary objective was to validate Baveno VI and its expanded form in children below 18 years of age. The secondary aim was to elicit whether any revision of the above criteria with a target of not missing more than 5% VNT could be more accurate for this age group. MATERIALS AND METHODS: The work was carried out in two medical institutes, over a span of 3 years. Consecutively enrolled patients below 18 years of age, with compensated cirrhosis confirmed by liver biopsy, were evaluated for related blood parameters, transient elastography (TE) and esophagogastroduodenoscopy. RESULTS: Out of the 33 recruited patients, five (15.15%) met the criteria for VNT. The sensitivity, specificity, PPV and NPV of Baveno VI and Expanded Baveno VI were observed as 60%, 92.3%, 60% and 92.3%, and 20%, 100%, 100% and 88%, respectively. We found that the Revised Baveno VI criteria with TE <19 kPa and platelet count of >175×109 cells/L, with sensitivity 100%, specificity 79%, PPV 45%, NPV 100% and accuracy of 82%, are more appropriate for this age group. CONCLUSION: We propose that further multicentrer studies with a larger sample size should be conducted before incorporating Revised Baveno VI criteria for high-risk varices in patients below 18 years in future guidelines.

A rare case of solitary pulmonary cavernous haemangioma with non-resolving recurrent haemoptysis.

A 24-year-old male presented with history of recurrent unresolving haemoptysis since 1.5 years. He underwent repeated hospitalisation. Initial computed tomography (CT) scan was suggestive of pneumonitis of the left lower lobe and was treated conservatively with broad-spectrum antibiotics. He had no past history of pulmonary tuberculosis. On presentation at our hospital, a repeat CT pulmonary angiogram was done which showed a low attenuating mass lesion in the left lower lobe with eccentric calcification supplied by branches from the left pulmonary artery. Few dot-like enhancing pulmonary veins are noted within the lesion. He underwent left lower lobectomy. Post-operative period was uneventful and patient was discharged on the ninth post-operative day. On histopathology, the diagnosis was primary haemangioma arising from the lung parenchyma which is a rare benign lung tumour reported worldwide and probably for the first time from India.

Single-centre experience in treatment of multiple-site hydatid disease in a tertiary care centre of Eastern India.

BACKGROUND: Single-stage surgery for multiple-site hydatid cysts especially for the lung and liver is a less performed approach. OBJECTIVE: The aim of the study is to assess the feasibility of this approach in terms of outcome. METHODS: We studied 42 patients with multiple-site hydatid cysts over a period of 36 months admitted or referred to the department of CTVS of a tertiary-level hospital of Eastern India. RESULTS: Maximum numbers of cases were found in the age group of 11-20 years comprising 35.71% of the patient population with a female preponderance (18 versus 24). Chest pain was the commonest presenting feature (66.66%) followed by cough (52.38%), haemoptysis and dyspnoea 33.33% respectively. Eosinophilia was observed in four patients (9.52%). Twenty-two patients had simultaneous occurrence of pulmonary and hepatic hydatid disease (52.38%). Fourteen patients had only pulmonary involvement (33.33%). Chest wall (including the parietal pleura) was involved in six patients (14.28%). 23.03% patients presented with complicated cysts in the form of rupture into the pleura (19.35%) or the peritoneum (9.68%). Eighteen patients (42.86%) were operated via posterolateral thoracotomy and 18 (42.86%) were operated via thoracotomy with phrenotomy. Twenty-four patients (57.14%) underwent cyst excision by Barrett's technique. 59.09% patients underwent cystostomy for hepatic hydatids and five underwent omental packing (22.72%). Prolonged air leak was the commonest complication (35.71%). The mean operative time for thoracotomy was 136.87 min (~ 140 min) and 145 min for thoracotomy with phrenotomy. Only five patients (11.9%) required a prolonged intensive -treatment unit (ITU) stay of > 2 days and four had prolonged hospital stay > 15 days (1 of bronchopleural fistula, 1 of anaphylactic shock and 1 of bilateral lung cyst excision with postoperative lobar collapse). CONCLUSION: Single-stage surgery is a viable option for multiple- and multi-site hydatids.

Congenital Cystic Adenomatoid Malformation, Type II: A Rare Cause of Haemoptysis.

Congenital cystic adenomatoid malformation (CCAM) occurs secondary to the cystic adenomatous over-growth of terminal bronchioles, which results in the secondary inhibition of alveolar growth. In most of the cases, respiratory distress is the presenting feature during the neonatal period. In about 90% of patients, recurrent respiratory infections necessitating chest imaging reveal CCAM before the age of two years. We describe here the occurrence of congenital cystic adenomatoid malformation of right lung in a 12-year-old girl presenting with haemoptysis and hypovolaemic shock. She underwent right middle lobectomy; and histopathological examination confirmed the diagnosis. She has been doing well on follow-up.

Lugol's iodine identifies dysplastic tissue in precancerous lesions: A clinical trial.

INTRODUCTION: Intraepithelial dysplasia, or "invisible" precancerous lesions, provides a challenge for visualization to the surgical team. The prognostic relevance of dysplasia and carcinoma in situ at surgical margins is well documented. MATERIALS AND METHODS: We evaluated the use of Lugol's iodine in visualizing the surgical margins of dysplastic tissue by an observational study of 100 patients having oral precancerous lesions between June 2013 and March 2016. CONCLUSION: Lugol's iodine is a simple, inexpensive, and apparently effective means of diagnosing and visualizing the surgical margins of the dysplastic tissue in oral precancerous lesions.

Association of Joubert syndrome and Hirschsprung disease.

BACKGROUND: Association between Joubert Syndrome and Hirschsprung disease is rare. CASE CHARACTERISTICS: A 9-month-old girl having developmental delay and chronic constipation. OBSERVATION: Molar tooth sign on MRI brain and absence of ganglion cells in rectal biopsy specimen. OUTCOME: Child underwent surgical repair for Hirschsprung disease. MESSAGE: Association of these two rare entities could be explained by ciliopathy.

Status epilepticus as the only presentation of the neonatal Bartter syndrome.

Bartter syndrome is a rare hereditary (autosomal recessive) salt-losing tubulopathy characterized by hypokalemia, hypochloremia, metabolic alkalosis, and normal blood pressure with hyperreninemia, The underlying renal abnormality results in excessive urinary losses of sodium, chloride, and potassium. We report a case of a four-month-old infant with neonatal Bartter syndrome, who presented only with status epilepticus. To the best of our present knowledge, there is no reported case of Bartter syndrome who presented with status epilepticus.

Umbilical Myiasis Associated with Staphylococcus Aureus Sepsis in a neonate.

Myiasis is an infection of live mammalian tissue by the larvae of dipteran flies and commonly found in the tropics and subtropics. It usually infects domestic and wild animals, but sometimes also affects human. Umbilical cord myiasis in the neonatal period associated with sepsis is a rare occurrence with few reported cases in the literature. In this article, authors report a 7-day-old neonate from a rural area presented with neonatal sepsis due to umbilical myiasis caused by fly larval form of blow fly (Chrysomya megacephala).

Sternal bands for closure of midline sternotomy leads to better wound healing.

Midline sternotomy is the most common incision for cardiac surgery, but problems of wound healing and sternal instability are still matters of concern. The use of stainless steel wires only was compared with the use of wires plus sternal bands for closure of midline sternotomy wounds in a 2-year period. Of 370 patients in whom only stainless steel wires were used, 14 (3.78%) required re-operation for dehiscence. Only 3 (0.76%) of 395 patients in whom sternal bands were also used, required re-operation for dehiscence. The difference was highly significant. It was concluded that use of sternal bands leads to a more stable union.