The Management of a Urinary Bladder Leak in a Patient with Radiation Cystitis.

Urinary dysfunction following treatment for rectal adenocarcinoma is a common and complex complication. We present a case of a 69-year-old male who underwent laparoscopic-assisted left hemicolectomy and loop ileostomy after receiving chemotherapy and radiation therapy for rectal adenocarcinoma. Postoperatively, it was incidentally discovered the patient had urinary frequency and urgency. Cystoscopy revealed radiation changes to the bladder walls and a bladder leak was confirmed by cystogram. The patient underwent successful repair of the urinary bladder leak, with challenges posed by prior radiation therapy. Effective prevention and management strategies for urinary dysfunction require a comprehensive preoperative risk assessment, consideration of nerve-preserving surgical techniques, and prompt identification and repair of postoperative complications.

Exploring the awareness, attitude, and inclination of healthcare students towards interprofessional education: A cross-sectional study in Saudi Arabia.

Background: Interprofessional education (IPE) is acknowledged to enhance understanding between professionals and to facilitate learning. Healthcare professionals may be better equipped to accept and esteem other healthcare professionals, if interprofessional education is incorporated into undergraduate curricula. The management of challenging patient issues may also significantly benefit from this. As a result, the current study examined interprofessional education in their institutions and students' knowledge of and attitudes toward it. Methodology: We conducted a cross-sectional questionnaire-based study among students from a university in the southwest of Saudi Arabia, who were enrolled in courses in medical, pharmacy, nursing, dentistry, allied health, and public health. Following validation, the questionnaire included six questions to probe their knowledge, ten questions to gauge their attitude, and eleven questions to inquire about the growth and use of IPE in their institutions. Multiple regression and the Kruskal-Wallis test were used to examine the data. Results: The survey involved 600 students, and 66.8% of the respondents were male. Less than one-third of students studying medicine replied to the survey, while students in the public health department had the lowest response rate. Compared to students in other programs, pharmacy students achieved a higher mean attitude score toward IPE (P < 0.001). Additionally, nursing and pharmacy students' mean IPE awareness scores were higher than those of medical students (P < 0.001). However, all program participants firmly agreed that integrating IPE into the curriculum was a good idea. Conclusions: The study found that students of a few programs had awareness and a positive attitude toward interprofessional education. Nonetheless, all of them favored its inclusion in their curriculum. They also stressed the need to educate teaching faculty on interprofessional education, to develop skilled facilitators within their institutions.

Primary results of the SAVAL randomized trial of a paclitaxel-eluting nitinol stent versus percutaneous transluminal angioplasty in infrapopliteal arteries.

BACKGROUND: Effective and durable options for infrapopliteal artery revascularization for patients with chronic limb-threatening ischemia (CLTI) are limited. METHODS: The SAVAL trial is a prospective, multicenter, randomized trial of patients with CLTI and infrapopliteal artery lesions with total lesion length ⩽ 140 mm, stenosis ⩾ 70%, and Rutherford category 4-5 assigned 2:1 to treatment with the SAVAL self-expandable paclitaxel drug-eluting stent (DES) or percutaneous transluminal angioplasty (PTA) with an uncoated balloon. The primary effectiveness endpoint was primary vessel patency (i.e., core lab-adjudicated duplex ultrasound-based flow at 12 months in the absence of clinically driven target lesion revascularization or surgical bypass of the target lesion). The primary safety endpoint was the 12-month major adverse event (MAE)-free rate; MAEs were defined as a composite of above-ankle index limb amputation, major reintervention, and 30-day mortality. The endpoints were prespecified for superiority (effectiveness) and noninferiority (safety) at a one-sided significance level of 2.5%. RESULTS: A total of 201 patients were enrolled and randomly assigned to treatment (N = 130 DES, N = 71 PTA). Target lesion length was 68.1 ± 35.2 mm for the DES group and 68.7 ± 49.2 mm for the PTA group, and 31.0% and 27.6% of patients, respectively, had occlusions. The 12-month primary patency rates were 68.0% for the DES group and 76.0% for the PTA group (Psuperiority = 0.8552). The MAE-free rates were 91.6% and 95.3%, respectively (Pnoninferiority = 0.0433). CONCLUSION: The SAVAL trial did not show benefit related to effectiveness and safety with the nitinol DES compared with PTA in infrapopliteal artery lesions up to 140 mm in length. Continued innovation to provide optimal treatments for CLTI is needed. (ClinicalTrials.gov Identifier: NCT03551496).

Sustainable consideration for traditional textile handloom cluster/village in pollution abatement - A case study.

Decentralized handlooms are being traditionally practised throughout India. Siripuram village known for traditional Pochampally/Ikat work was considered as a case study for detailed investigation towards providing a sustainable solution. Nearly 65% of village population solely depend on weaving and dyeing works as primary occupation based on the household survey and generated wash water of 127 KLD on an average from the dyeing operations. Initially, a topographical survey (Aerial drone; PHANTOM 4 RTK UAV) was carried out to understand the drainage pattern, elevations, contours and interlinked with domestic and dyeing functions. The characteristics of combined wastewater and dye wash water were studied at lab scale using sequential batch (SBR) operation under aerobic (SBRAe) and aerobic-anoxic (SBRAex) microenvironments. SBRAex microenvironment showed effective organic and nutrients removal due to infused anoxic microenvironment. Treatment studies depicted 76.2% of organic fraction, 73.3% of phosphate, and 81.6% of nitrate removal. Based on the lab scale studies a closed-loop decentralized effluent treatment system was designed to ensure zero-liquid discharge (ZLD).

Dataset of De Novo hybrid berry transcriptome profiling and characterization of Piper species (Piper nigrum and Piper longum) using Illumina and Nanopore sequencing.

Piper nigrum and Piper longum are the most popular and economically essential spice crops globally valued for their aromatic alkaloids, especially Piperine. However, Piperine synthesis pathway mechanisms are not yet well known. This work was aimed to generate the full-length comparative berry transcriptome analysis dataset of P. nigrum and P. longum by Illumina and Nanopore sequencing platforms. While short-read sequencing technology is widely using to capture transcriptome profiles, there are still some limitations due to the read length. We used Oxford Nanopore technology for long reads and the Illumina sequencing platform for short reads to generate a hybrid transcriptome assembly from half matured and fully matured berries of P. nigrum and P. longum. From P. nigrum and P. longum 37.3 million and 38.1 million raw reads were generated respectively. A total of 308369 contigs from P. nigrum and 267715 contigs from P. longum were obtained and successfully annotated. The transcriptome data revealed gene families involved in piperine and other secondary metabolite biosynthetic pathways. The raw data were uploaded to NCBI database. This dataset shed light on the further exploration of the piperine biosynthetic pathway, its transcriptomic changes, and evolution. Data generated has been submitted to SRA of NCBI with Bio samples accession: (SAMN13981803, SAMN22826456).

Sympatric occurrence of sibling Phytophthora species associated with foot rot disease of black pepper in India.

Foot rot disease caused by Phytophthora capsici is a serious threat to black pepper cultivation in India and globally. High diversity exists among the Phytophthora isolates of black pepper and hence detailed investigations of their morphology and phylogenetic taxonomy were carried out in the present study. In order to resolve the diversity, 182 isolates of Phytophthora, collected from different black pepper-growing tracts of South India during 1998-2013 and maintained in the National Repository of Phytophthora at ICAR-Indian Institute of Spices Research, Kozhikode, were subjected to morphological, molecular and phylogenetic characterization. Morphologically all the isolates were long pedicellate with umbellate/simple sympodial sporangiophores and papillate sporangia with l/b ranging from 1.63 to 2.55 µm. Maximum temperature for the growth was ~ 34 °C. Chlamydospores were observed in "tropicalis" group, whereas they were absent in "capsici" group. Initial molecular studies using internal transcribed spacer (ITS) marker gene showed two clear cut lineages-"capsici-like" and "tropicalis-like" groups among them. Representative isolates from each group were subjected to host differential test, multilocus sequence typing (MLST) and phylogeny studies. MLST analysis of seven nuclear genes (60S ribosomal protein L10, beta-tubulin, elongation factor 1 alpha, enolase, heat shock protein 90, 28S ribosomal DNA and TigA gene fusion protein) clearly delineated black pepper Phytophthora isolates into two distinct species-P. capsici and P. tropicalis. On comparing with type strains from ATCC, it was found that the type strains of P. capsici and P. tropicalis differed from black pepper isolates in their infectivity on black pepper. The high degree of genetic polymorphism observed in black pepper Phytophthora isolates is an indication of the selection pressure they are subjected to in the complex habitat which ultimately may lead to speciation. So based on the extensive analysis, it is unambiguously proved that the foot rot disease of black pepper in India is predominantly caused by two species of Phytophthora, viz. P. capsici and P. tropicalis. Presence of multiple species of Phytophthora in the black pepper agro-ecosystem warrants a revisit to the control strategy being adopted for managing this serious disease. The silent molecular evolution taking place in such an ecological niche needs to be critically studied for the sustainable management of foot rot disease.

Green Hydrogen-Compressed natural gas (bio-H-CNG) production from food waste: Organic load influence on hydrogen and methane fusion.

Biogenic hydrogen (bioH2) enriched compressed natural gas (bio-H-CNG or biohythane) is emerging interest due to its feasibility to use in the existing transportation infrastructure with induced environmental benefits. This study evaluated the production of bioH2and biomethane (bioCH4) towards bio-H-CNG formation at a varying organic load (OL: 30,40,50 g COD/L) of food waste (FW). Acidogenic reactor operated with FW at 40 g COD/L showed the highest cumulative bioH2production while elevated OL (50 g COD/L)showedhigher cumulative bioCH4production (CMP: 11.92 L) from the methanogenic reactor. BioH2 and bioCH4 produced at different time intervals were combined to assess bio-H-CNG. The nature of biocatalyst and OLsignificantly regulated the composition of bio-H-CNG varying between 0.1 and 0.3 of H2/(H2+CH4) ratio accounting for5-12.6 kJ/g COD. Chain elongation, converting short (C2-C4) to medium-chain fatty acids(Caproic acid,1.16 g/L) was specifically observed during the acidogenic process.

An unusual case of neutrocytic, culture-negative meningitis in an immunocompetent adult.

Patient presenting with fever, acute onset seizure and neck stiffness on examination; deteriorating despite initiation of early treatment for meningitis.

Elucidation of antibacterial effect of calcium chloride against Ralstonia pseudosolanacearum race 4 biovar 3 infecting ginger (Zingiber officinale Rosc.).

Bacterial wilt incited by Ralstonia pseudosolanacearum (Rps) race 4 biovar 3 is a serious threat to ginger (Zingiber officinale Rosc.) cultivation throughout the ginger growing tracts and warrants effective remedial measures since most of the strategies failed at field level implementation. After a series of experiments, calcium chloride was found to be effective against Rps both in vitro and in planta and its prophylactic effect has been successfully demonstrated under field conditions. CaCl2 at a concentration of > 2% significantly inhibited Rps under in vitro conditions. Calcium is an important nutritional element imparts a major role in plant disease resistance, and numerous studies have demonstrated the mitigating effect of calcium for disease management. CaCl2 being inhibitory to Rps, the mechanism of inhibition by CaCl2 against Rps was elucidated by a series of in vitro assays including swarming motility and biofilm formation. Direct inhibition was also studied using Scanning Electron Microscopy (SEM). The minimum bactericidal concentration and minimum inhibitory concentration were found to be around 3% while the EC 90 value was found to be 2.25%. The SEM analysis revealed the destruction of cell structure by making perforations on the cell surface. CaCl2 at the targeted concentrations inhibited biofilm formation as well as swarming motility of Rps. These findings suggest that CaCl2 exhibits strong antibacterial activity against Rps and has the potential to be used as an effective bactericide for Rps in managing bacterial wilt in ginger.

Cryptogenic Stroke: To Close a Patent Foramen Ovale or Not to Close?

A patent foramen ovale (PFO) has been shown to be highly prevalent in patients diagnosed with strokes of unknown cause, which are also called cryptogenic strokes (CSs). It has been a long-running controversy as to whether a PFO should be closed or not to prevent recurrent strokes in patients diagnosed with CS. A paradoxical embolism that is produced through a PFO is hypothesized to be a leading cause of CS, especially in younger patients with low risk factors for stroke. It remains controversial as to which anticoagulation therapy, defined as antithrombin or antiplatelet therapy, is better for patients with CS and a PFO. In addition, surgical and transcutaneous closure of a PFO has been proposed for the secondary prevention of stroke in patients with CS with PFO. Several randomized controlled trials have been conducted in recent years to test whether a PFO closure gives a significant benefit in the management of CS. Three earlier randomized controlled trials failed to show a statistically significant benefit for a PFO closure; thus, many investigators believed that a PFO was an incidental bystander in patients with CS. However, meta-analyses and more recent specific trials have eliminated several confounding factors and possible biases and have also emphasized the use of a shunt closure over medical therapy in patients with CS. Therefore, these latest studies (the CLOSE and REDUCE trials) can possibly change the treatment paradigm in the near future.

The Utility of Anti-Inflammatory Agents in Cardiovascular Disease: A Novel Perspective on the Treatment of Atherosclerosis.

Approximately 40% of heart attack survivors remain at increased risk of recurrent cardiovascular events, despite the current treatment options showing that atherothrombosis is not exclusively a disorder of lipoprotein aggregation in the arterial wall. Clinical and experimental data suggest that inflammation plays an important role in atherothrombosis independent of the cholesterol level. Acute-phase reactants, such as C-reactive protein, increase in patients with coronary artery disease and are known to predict adverse outcomes in such patients. The recent CANTOS trial published in The New England Journal of Medicine provides evidence that interleukin-1ß along with other cytokines play central roles in the inflammatory reaction that drives the interleukin-6 signaling pathway and have profound effects on cardiovascular outcomes. Several other ongoing studies are focused on multiple immune mediators involved in this process to support the inflammatory hypothesis of cardiovascular diseases. These new classes of drugs could represent the biggest breakthrough in cardiovascular medicine, which could have the greatest impact on cardiovascular mortality since the advent of statins. The drug canakinumab has shown promise in lowering atherosclerosis, and other drugs, such as colchicine and methotrexate, are gaining interest and are being investigated in multiple ongoing trials. A major concern is the affordability of these drugs, as most cardiovascular diseases are noted among people of lower socioeconomic statuses. The LoDoCo trial showed some benefits of colchicine, and whether this old drug can be marketed with a new label for cardiovascular disease remains in question. Therefore, a clear understanding of the different inflammatory pathways involved in atherosclerosis is needed to help develop more effective treatment modalities that will benefit humankind.

Draft Genome Sequence of Highly Virulent Race 4/Biovar 3 of Ralstonia solanacearum CaRs_Mep Causing Bacterial Wilt in Zingiberaceae Plants in India.

The genome of Ralstonia solanacearum CaRs_Mep, a race 4/biovar 3/phylotype I bacterium causing wilt in small cardamom and other Zingiberaceae plants, was sequenced. Analysis of the 5.7-Mb genome sequence will aid in better understanding of the genetic determinants of host range, host jump, survival, pathogenicity, and virulence of race 4 of R. solanacearum.

Genetic analysis of plant endophytic Pseudomonas putida BP25 and chemo-profiling of its antimicrobial volatile organic compounds.

Black pepper associated bacterium BP25 was isolated from root endosphere of apparently healthy cultivar Panniyur-5 that protected black pepper against Phytophthora capsici and Radopholus similis - the major production constraints. The bacterium was characterized and mechanisms of its antagonistic action against major pathogens are elucidated. The polyphasic phenotypic analysis revealed its identity as Pseudomonas putida. Multi locus sequence typing revealed that the bacterium shared gene sequences with several other isolates representing diverse habitats. Tissue localization assays exploiting green fluorescence protein expression clearly indicated that PpBP25 endophytically colonized not only its host plant - black pepper, but also other distantly related plants such as ginger and arabidopsis. PpBP25 colonies could be enumerated from internal tissues of plants four weeks post inoculation indicated its stable establishment and persistence in the plant system. The bacterium inhibited broad range of pathogens such as Phytophthora capsici, Pythium myriotylum, Giberella moniliformis, Rhizoctonia solani, Athelia rolfsii, Colletotrichum gloeosporioides and plant parasitic nematode, Radopholus similis by its volatile substances. GC/MS based chemical profiling revealed presence of Heneicosane; Tetratetracontane; Pyrrolo [1,2-a] pyrazine-1,4-dione, hexahydro-3-(2-methylpropyl); Tetracosyl heptafluorobutyrate; 1-3-Eicosene, (E)-; 1-Heneicosanol; Octadecyl trifluoroacetate and 1-Pentadecene in PpBP25 metabolite. Dynamic head space GC/MS analysis of airborne volatiles indicated the presence of aromatic compounds such as 1-Undecene;Disulfide dimethyl; Pyrazine, methyl-Pyrazine, 2,5-dimethyl-; Isoamyl alcohol; Pyrazine, methyl-; Dimethyl trisulfide, etc. The work paved way for profiling of broad spectrum antimicrobial VOCs in endophytic PpBP25 for crop protection.

"Krokodil"-a menace slowly spreading across the Atlantic.

Krokodil (also known as crocodile, croc, krok, and poor man's heroin) is a suspension of desomorphine as the core substance with contaminants like iodide, phosphorous, and heavy metals, which are the byproducts of the manufacturing process. The name krokodil emerged due to the appearance of the skin lesions around the injection site, where it turns green and scaly like a crocodile skin due to desquamation. It is also known as the "drug that eats junkies" and "Russia's Designer drug." It is not available as a prescription anywhere in the world. It is a modern day man-made Frankenstein-like drug, which was manufactured due to the pursuit of drug addicts to make a cheap yet effective narcotic but ended up in creating havoc on its users. It has devastating effects on its users, including damage to skin, blood vessels, muscles, bones, and sometimes even multiorgan failure and eventually death. A systemic review was conducted to obtain any available data for the term krokodil to collect information for this article.

Virtual screening and in vitro assay of potential drug like inhibitors from spices against Glutathione-S-Transferase of Meloidogyne incognita.

Glutathione S-transferases (GSTs) enzymes are critical antioxidant and detoxification system responsible for long-term existence of nematodes in host species. Hence, 16 phytochemicals predicted and reported to have potential nematicidal activity have been docked to GST enzyme of Meloidogyne incognita to assess their binding affinity and inhibitory activity. In vitro effects of these phytochemicals from in silico results have been done for validation of docking studies and efficacy in GST inhibition of following compounds such as alpha- pinene, alpha- terpineol, beta- caryophyllene, capsaicin, cinnamic acid, citronellol, curcumin, eugenol, geraniol, isoeugenol, linalool, myristicin, neral, NVA (N-vanillylnonanamide), piperine, vanillin have been revealed. Nematode inhibition in vitro bioassay for selected compounds could conclude that maximum mortality was observed with highest concentrations of beta- caryophyllene (78%) followed by eugenol (61.6%), cinnamic acid (55%) and N-vanillylnonanamide (49%). These findings thus suggest that the above phytochemicals could be potentially developed as nematicidal molecules against M. incognita infections.

A modified provisional stenting approach to coronary bifurcation lesions: clinical application of the "jailed-balloon technique".

OBJECTIVES: To demonstrate the application of a novel provisional side branch (SB) stenting strategy for coronary bifurcation lesions using a "jailed-balloon" technique (JBT). BACKGROUND: Adverse cardiac events are higher for percutaneous coronary intervention (PCI) of bifurcation lesions. Recent studies support the use of provisional SB stenting, but a risk of SB closure and a higher rate of target lesion revascularization (TLR) remain important limitations. METHODS: From December 2007 to August 2010, 100 patients with 102 bifurcation lesions underwent PCI using the JBT. Baseline and postprocedural quantitative coronary angiography (QCA) analysis were performed. Procedural and immediate clinical outcomes were reviewed. RESULTS: The majority of patients presented with acute coronary syndrome (68%) and had Medina class 1,1,1 bifurcation lesions (91%). TIMI 3 flow was established in 100% of main branch and 99% of SB lesions. QCA revealed preservation of the bifurcation angle after PCI (pre-PCI: 59.6 ± 30.0; post-PCI: 63.3 ± 26.8, P = 0.41). Nine patients (9%) had lesions that required rewiring and two patients (2%) required provisional stenting of the SB. SB loss occurred in one patient (1%). The jailed-balloon or wire was not entrapped during any PCI. One patient (1%) suffered a periprocedural myocardial infarction (MI). CONCLUSIONS: Provisional stenting of complex coronary bifurcation lesions using a JBT is associated with a high procedural success rate, improved SB patency, and a low rate of immediate cardiac events. Further study is warranted to evaluate the role of JBT in improving long-term clinical outcomes in PCI of complex bifurcation lesions.

Portable cost-effective EEG data acquisition system.

Neuro-cognitive dysfunctions are common clinical abnormalities found in society. They require objective analysis by various instruments; an important technique involves monitoring electroencephalogram (EEG) signals. To date, EEG machines have been robust, costly and require patients to come to a hospital for test. Therefore, we have constructed a simple, cheap and portable EEG instrument for wider patient use. It consists of two active digital EEG probes with two channels each, making it a four-channel portable acquisition system. It is further connected through a two-wire serial bus to the acquisition unit, which comprises an analogue to digital converter (ADC) and an ARM board processor with 2 GB memory and USB interface. The whole system is placed in a small box making it highly portable for wider use in clinical settings.

Use of mechanical assist during high-risk PCI and STEMI with cardiogenic shock.

Infarct size may be reduced by left ventricular unloading after ST-segment elevation MI (STEMI) in addition to reperfusion therapy. Likewise, high-risk percutaneous coronary intervention (PCI) may benefit from periprocedural support especially in patients with low cardiac output at baseline or when periprocedural hemodynamic deterioration is anticipated. Traditionally, intraaortic balloon-pumps have been used in acute MI with cardiogenic shock. As this modality has limited hemodynamic benefits, new developments have focused on active hemodynamic assist devices. These devices actively unload the left ventricle increasing cardiac output by 2.5-5 L/min and are increasingly easier to implant and monitor. Thus, interventional cardiologists will be able to offer a safer more effective alternative to an increasing patient population with complex cardiac conditions and high-risk PCI.

Influence of respiratory rate on the variability of blood volume pulse characteristics.

Photoplethysmogram (PPG) measures have been proven useful for the quantification of sympathetic reactivity and continuous monitoring of vascular reactivity. This study was designed to delineate the influence of respiratory rate on the variability of various PPG characteristics in time and frequency domains. PPG, electrocardiogram (ECG) and respiration were simultaneously recorded for 2 min from eight healthy volunteers during paced respiration of 6, 12 and 18 cycles min(-1). The PPG characteristics such as peak-to-peak interval (PPI), systolic peak amplitude, slope, T(crest), T(decay) and pulse transit time (PTT) were computed for every pulse. In time domain, the mean of amplitude, slope and T(crest) were not significantly different amongst three different respiratory rates. However, the mean of T(decay), PPI and PTT were significantly increased (p < 0.05, p < 0.05 and p < 0.01, respectively) during respiration of 6 cycles min(-1) compared to 12 cycles min(-1). The maximal spectral powers of the variability of all PPG measures were centred on the respiratory frequency in frequency domain. In conclusion, the results that the amplitude and slope in time domain are not altered by the respiratory frequency suggest their application in faithful assessment of cardiovascular reactivity. As the variability of PPI, T(decay) and PTT are altered by the slow respiration, the influence of respiration on these time derivatives should not be ignored during interpretation of vascular reactivity.

Diagnosis of Intracranial Epidermoid Rupture by MR Imaging. A Case Report.

Intracranial epidermoids are benign tumours arising from retained ectodermal implants. Spontaneous rupture is an important though rare complication of intracranial epidermoid. To our knowledge, MR findings in spontaneous epidermoid rupture have not been well described to date. We report the case of a 60-year-old man who presented with a two day history of headache, altered sensorium and left hemiplegia. A diagnosis of ruptured epidermoid was made based on MR imaging findings which were subsequently proven by histopathology.