N-Butyl cyanoacrylate embolization of an extremely rare variant of sequestration complex - a high-flow left-to-left shunt between systemic artery and pulmonary vein.

A 19-year-old female presented with hemoptysis. Computed tomography (CT) pulmonary angiography revealed aberrant vessels from descending thoracic aorta, draining into pulmonary veins (left-to-left shunt). She was managed by transcatheter embolization of the aberrant vessels using N-butyl cyanoacrylate (NBCA) with balloon occlusion. A systemic artery to pulmonary vein fistula is one of the least common congenital anomalies. Most of the reported cases have been managed by surgery. Only a few patients have been treated by transcatheter embolization, using coils or vascular plugs as the embolizing agents. To our knowledge, this is the first case of its kind that was managed by glue embolization. Favorable post-procedure results have led us to believe that glue embolization can be considered a suitable alternative to thoracotomy in such patients. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-023-01659-5.

Evaluation of in-feed supplementation of formic acid and thymol as non-antibiotic growth promoters and assessing their effect on antimicrobial resistant E.coli isolated in Turkey.

With the rampant usage of antibiotics as growth promoters (AGPs) in poultry sector, there has been alarming concerns of antimicrobial resistant microbes such as Escherichia coli. Diversification of poultry farming due to consumer demand for safer products with higher protein content, turkey production is gaining popularity. Feed additives such as formic acid (FA) and thymol (TH) are effectively replacing AGPs due to their antimicrobial action. This directed the researchers to find alternatives to antibiotics such as thymol and formic acid because of their strong antimicrobial, anti-oxidative, digestive-stimulating properties. To assess the efficacy of FA and TH as growth promoters and their effect on the antimicrobial resistance (AMR) load, the current study (0-12 weeks) was conducted in CARI VIRAT turkey poults (n = 256; unsexed) those were randomly distributed into eight treatment groups: control(T1), AGP (T2), graded levels of FA (T3 to T5) @ 2.5, 5 and 7.5 ml/kg and TH (T6 to T8) @ 120, 240 and 350 mg/kg. Cloacal swab samples were collected at 0, 4th, 8th and 12th week interval and processed further for isolation, identification and assessment of resistance profile of E. coli. The final body weight, cumulative gain and FCR were significantly (p < 0.05) better for birds under supplementation. The Total plate count (TPC) and coliforms showcased a significant (p < 0.001) reduction in the FA and TH supplement groups as compared to control and AGP group. The resistance profile indicated E. coli isolates from AGP group with significantly (p < 0.001) highest resistivity against antibiotics (viz. chloramphenicol, tetracycline, nalidixic acid, chlortetracycline) while isolates from FA (T5) and TH (T8) groups were the least resistant. blaAmpC gene was significantly (p < 0.001) harbored in T2 isolates whereas least detected in T5 and T8. It was inferred that formic acid (7.5 ml/kg) and thymol (360 mg/kg) can effectively replace AGPs and lower AMR burden in poultry.

Development of superoxide dismutase based visual and spectrophotometric method for rapid differentiation of fresh and frozen-thawed buffalo meat.

Study aimed to develop biomarker-based assay for rapid detection of fresh and frozen-thawed buffalo meat in the supply chain. The method is based on development of a solvent system and identification of suitable substrate and developer for screening of biomarkers. For the confirmation column chromatography, gel electrophoresis and Western Blotting were carried out. Validation was done by intra- and inter-day validation, storability study, and determination of thermal history. Best results were shown with pH 8.0 Tris-HCl; extraction buffer, 205 µM nicotinamide adenine dinucleotide hydrogen; substrate, 184 µM Nitroblue tetrazolium, and 1.9 µM phenazine methosulfate; developer. The thermal history ranged from 0.14 to 0.17 during storage at -20 °C. The intra- and inter-day assay precision (CV %) ranged from 5.3 to 6.5 %; in chilled and 14.1 - 9.2 % in frozen-thawed samples. The study confirmed SOD as a viable biomarker. Developed method using SOD has significant potential for rapidly differentiating chilled or frozen-thawed meat.

Identifying Selectivity Filters in Protein Biosensor for Ligand Screening.

Specialized sensing mechanisms in bacteria enable the identification of cognate ligands with remarkable selectivity in highly xenobiotic-polluted environments where these ligands are utilized as energy sources. Here, via integrating all-atom computer simulation, biochemical assay, and isothermal titration calorimetry measurements, we determine the molecular basis of MopR, a phenol biosensor's complex selection process of ligand entry. Our results reveal a set of strategically placed selectivity filters along the ligand entry pathway of MopR. These filters act as checkpoints, screening diverse aromatic ligands at the protein surface based on their chemical features and sizes. Ligands meeting specific criteria are allowed to enter the sensing site in an orientation-dependent manner. Sequence and structural analyses demonstrate the conservation of this ligand entry mechanism across the sensor class, with individual amino acids along the selectivity filter path playing a critical role in ligand selection. Together, this investigation highlights the importance of interactions with the ligand entry pathway, in addition to interactions within the binding pocket, in achieving ligand selectivity in biological sensing. The findings enhance our understanding of ligand selectivity in bacterial phenol biosensors and provide insights for rational expansion of the biosensor repertoire, particularly for the biotechnologically relevant class of aromatic pollutants.

The Association Between Self-Managed versus Clinician-Managed Abortion and Self-Reported Abortion Complications: A Cross-Sectional Analysis in India.

Purpose: To examine the association between self-managed abortion and the self-reported experience of abortion complications in India, a country with a high incidence of self-managed abortion. Patients and Methods: The study used a cross-sectional multivariable logistic regression analysis of data from the National Family Health Survey (NFHS-4) of 2015-2016 to compare the odds of self-reported complications experienced during abortion between self-managed and clinician-managed abortions in India. Results: On average, self-managed abortions occurred earlier in gestation than clinician-managed abortions, 7.8 weeks and 11.3 weeks, respectively (p < 0.001). Self-managed abortion was associated with fewer self-reported abortion-related complications than clinician-managed abortions when adjusted for covariates not including gestational age (Adjusted Odds Ratio (aOR) 0.82, 95% confidence interval (CI) 0.69, 0.97). However, once adjusted for gestational age, there was no longer a clinically meaningful or statistically significant difference in the odds of self-reported complications between self-managed and clinician-managed abortions (aOR = 0.98, 95% CI 0.81, 1.18). Conclusion: These findings suggest that people in India are using safe methods to self-manage abortions and support the hypothesis that self-managed abortion can improve access to abortion and reproductive choice without increasing risk.

Reconditioned monocytes are immunomodulatory and regulate inflammatory environment in sepsis.

Sepsis is caused by dysregulated immune response to severe infection and hyper inflammation plays a central role in worsening the disease. The immunomodulatory properties of mesenchymal stem cells (MSCs) have been evaluated as a therapeutic candidate for sepsis. Reconditioned monocytes (RM), generated from healthy human peripheral blood mononuclear cells (PBMCs) exhibit both macrophage and MSCs-like properties. RM were administered at different stages of sepsis in a mouse model. It reduced serum levels of IL6, MCP-1, IL-10, improved hypothermia, increased survival, and recovery from 0 to 66% when combined with antibiotics in the mouse model. The reduced human leucocyte antigen DR molecules expression on RM enables their co-culture with PBMCs of sepsis patients which resulted in reduced ROS production, and up-regulated TGF-ß while down-regulating IL6, IL8, and IL-10 in-vitro. RM are potentially immunomodulatory, enhance survival in sepsis mouse model and modulate inflammatory behaviour of sepsis patient's PBMCs.

Effects of Spirulina (Arthrospira platensis) as a drinking water supplement during cyclical chronic heat stress on broiler chickens: Assessing algal composition, production, stress, health and immune-biochemical indices.

Spirulina, the blue green algae is considered to exhibit multifaceted benefits on both human health and animal production. Three hundred sixty day old unsexed broiler chicks of CARIBROVISHAL strain were assigned to five treatment groups each comprising nine replicates of 8 chicks. The experiment was carried out during the hot humid summer season (Mid-April to May) under deep litter rearing system with uniform managemental conditions. Birds were administered orally with Spirulina through drinking water in the morning (06:00-12:00 PM) on daily basis throughout the experimental period at 5, 10, 15 and 20 gL-1 concentration. Spirulina supplementation neither improved nor compromised production performance of broilers reared during hot climatic condition. Results based on one way analysis of variance indicated a significant effect on haemoglobin and total red blood cell count. Serum lipid content and transaminases were reduced, while serum protein concentration was higher (P < 0.01) in the groups administered with 15 and 20 gL-1 of Spirulina. The extent of imparting shank pigmentation was improved in all the supplemented groups. Cell mediated and humoral immunity against Phytoheamagglutunin-P and Newcastle disease vaccination respectively were maximized (P < 0.05) at 20 gL-1. These findings provide direct evidence of dose-related modulation of production, physiological and immunological attributes by Spirulina engendering its further investigation as a potential source of drinking water supplement for stress alleviation in broilers. From the results, it may concluded that Spirulina can be incorporated at 15 or 20 gL-1 for achieving optimal improvement of health and welfare attributes in broilers reared during hot summer without compromising production.

Retrograde transvenous selective lymphatic duct embolization in post donor nephrectomy chylous ascites.

Chylous ascites is a rare, potentially sinister complication in post donor nephrectomy patients which may cause significant morbidity in form of severe malnutrition and an immuno-compromised state. We present two patients with post donor nephrectomy-related chylous leaks who failed conservative treatment. In both cases, lymphangiography was done first to detect the chylous leak site in the left renal fossa, and thereafter transvenous retrograde approach via left subclavian vein with selective lymphatic duct embolization of chylous leak was done with coils and glue successfully. Chylous ascites resolved in both patients after the embolization. Hence retrograde transvenous embolization technique appears to be an effective management option for refractory chylous leaks.

Subnational mortality estimates for India in 2019: a baseline for evaluating excess deaths due to the COVID-19 pandemic.

BACKGROUND: Estimates of excess mortality are required to assess and compare the impact of the COVID-19 pandemic across populations. For India, reliable baseline prepandemic mortality patterns at national and subnational level are necessary for such assessments. However, available data from the Civil Registration System (CRS) is affected by incompleteness of death recording that varies by sex, age and location. METHODS: Under-reporting of CRS 2019 deaths was assessed for three age groups (< 5 years, 15-59 years and ≥60 years) at subnational level, through comparison with age-specific death rates from alternate sources. Age-specific corrections for under-reporting were applied to derive adjusted death counts by sex for each location. These were used to compute life expectancy (LE) at birth by sex in 2019, which were compared with subnational LEs from the Global Burden of Disease (GBD) 2019 Study. RESULTS: A total of 9.92 million deaths (95% UI 9.70 to 10.02) were estimated across India in 2019, about 2.28 million more than CRS reports. Adjustments to under-five and elderly mortality accounted for 30% and 56% of additional deaths, respectively. Adjustments in Bihar, Jharkhand, Madhya Pradesh, Maharashtra, Rajasthan and Uttar Pradesh accounted for 75% of all additional deaths. Adjusted LEs were below corresponding GBD estimates by ≥2 years for males at national level and in 20 states, and by ≥1 year for females in 12 states. CONCLUSIONS: These results represent the first-ever subnational mortality estimates for India derived from CRS reported deaths, and serve as a baseline for assessing excess mortality from the COVID-19 pandemic. Adjusted life expectancies indicate higher mortality patterns in India than previously perceived. Under-reporting of infant deaths and those among women and the elderly is evident in many locations. Further CRS strengthening is required to improve the empirical basis for local mortality measurement across the country.

Premature adult mortality in India: what is the size of the matter?

BACKGROUND: Reducing adult mortality by 2030 is a key component of the United Nations Sustainable Development Goals (UNSDGs). Monitoring progress towards these goals requires timely and reliable information on deaths by age, sex and cause. To estimate baseline measures for UNSDGs, this study aimed to use several different data sources to estimate subnational measures of premature adult mortality (between 30 and 70 years) for India in 2017. METHODS: Age-specific population and mortality data were accessed for India and its 21 larger states from the Civil Registration System and Sample Registration System for 2017, and the most recent National Family and Health Survey. Similar data on population and deaths were also procured from the Global Burden of Disease Study 2016 and the National Burden of Disease Estimates Study for 2017. Life table methods were used to estimate life expectancy and age-specific mortality at national and state level from each source. An additional set of life tables were estimated using an international two-parameter model life table system. Three indicators of premature adult mortality were derived by sex for each location and from each data source, for comparative analysis RESULTS: Marked variations in mortality estimates from different sources were noted for each state. Assuming the highest mortality level from all sources as the potentially true value, premature adult mortality was estimated to cause a national total of 2.6 million male and 1.8 million female deaths in 2017, with Bihar, Maharashtra, Tamil Nadu, Uttar Pradesh and West Bengal accounting for half of these deaths. There was marked heterogeneity in risk of premature adult mortality, ranging from 351 per 1000 in Kerala to 558 per 1000 in Chhattisgarh among men, and from 198 per 1000 in Himachal Pradesh to 409 per 1000 in Assam among women. CONCLUSIONS: Available data and estimates for mortality measurement in India are riddled with uncertainty. While the findings from this analysis may be useful for initial subnational health policy to address UNSDGs, more reliable empirical data is required for monitoring and evaluation. For this, strengthening death registration, improving methods for cause of death ascertainment and establishment of robust mortality statistics programs are a priority.

Does the prenatal factor or the postnatal factor contribute more to changes in the child sex ratio in India? An investigation in the context of fertility and mortality transition.

There has been a drastic decline in the child sex ratio (number of females per 1000 males between ages 0 and 4) in India and many of its states. This study aimed to examine if prenatal factors, such as change in sex ratio at birth, or postnatal factors, such as change in relative mortality of females and males, contribute to this more by analysing the dynamics of the child sex ratio. Changes in the child sex ratio during 2001-2011 were decomposed into a 'fertility' component attributable to prenatal sex selection and a 'mortality' component attributable to sex differentials in postnatal survival at the country as well as the state level. Between the prenatal factor and the postnatal factor, the contribution of the latter to the declining child sex ratio has been greater than the former in India as a whole and in most of the states. By focusing on both prenatal and postnatal factors, the imbalance in the child sex ratio in the country can be reduced to a large extent.

Chylothorax - Modalities of management and outcomes: A case series.

BACKGROUND: At present, there are no universally accepted protocols for the management of chylothorax. This study aims at reporting the clinical experience and presenting our institutional protocol for managing chylothorax. MATERIALS AND METHODS: This is a retrospective analysis of chylothorax patients managed at a dedicated thoracic surgical unit over 8 years. A detailed analysis of demography and perioperative variables including complications was carried out. Factors influencing failure of conservative and surgical therapy were analyzed. RESULTS: A total of 26 patients were included with a mean age of 42.4 years (range, 2-72 years). Postsurgical chylothorax was the most common variant (53.8%). Majority (46.1%) of the patients had >1000 ml/24 h intercostal tube drainage at presentation. All patients were initially subjected to conservative management, of which 11 (42.4%) patients were managed successfully with conservative therapy alone. Rest 15 (57.6%) patients required video-assisted thoracoscopic thoracic duct ligation, which was successful in 10/15 (66.7%) patients, whereas additional intervention was required in 5/15 (33.3%) patients. Drain output of >1000 ml/day was an independent predictor of failure of conservative therapy. Nontraumatic bilateral chylothorax was associated with high probability of failure of surgical therapy in the first attempt and may require additional treatment modality. CONCLUSIONS: Initial conservative management is recommended for all chylothorax patients, which is unlikely to succeed if daily drainage is >1000 ml/24 h. VATS thoracic duct ligation is recommended in such cases. Nontraumatic bilateral chylothorax has higher surgical failure rates. In such cases, additional procedures in the form of pleurodesis and/or thoracic duct embolization/disruption should be considered.

Factors Influencing the Sex Ratio at Birth in India: A New Analysis based on Births Occurring between 2005 and 2016.

Previous research on sex ratio at birth (SRB) in India has largely relied on macro-analysis of census data that do not contain the breadth of factors needed to explain patterns in SRB. Additionally, no previous research has examined the differentiation of factors associated with SRB across birth orders, a key determinant in societies affected by son preference. This study aims to fill these gaps using micro-data related to 553,461 births occurring between 2005 and 2016 collected as part of the 2015-2016 National Family Health Survey. Analyses used multivariable logistic regressions stratified by birth order to examine associations with SRB at the national level. The SRB at birth order 1 was outside the biological normal limit, and generally increased with birth order. First births in households with wealth in the middle and richest quintiles, with mothers who desired a higher ideal number of sons than daughters, and in lower fertility communities had a higher probability of being male. Most SRB correlates were visible at birth orders 3 or higher. Programs and policies designed to address India's male-skewed SRB must consider the diverse factors that influence SRB, particularly for higher order births.

The association between intimate partner violence and recent self-managed abortion in India.

BACKGROUND: Previous studies have shown that women who experience intimate partner violence have higher rates of unintended pregnancy and abortion-but whether there are differences between the types of abortion care accessed is unknown. Understanding the predictors of self-managed abortion is important for providing risk-mitigating information and resources to those at highest risk for unintended pregnancy and intimate partner violence. With access to information and medication abortion drugs, it is possible that self-managed abortion can be performed safely, increasing reproductive autonomy for women. OBJECTIVE: The purpose of this study is to evaluate the association between experiencing intimate partner violence and using self-managed abortion. STUDY DESIGN: This is a cross-sectional analysis of responses of 57,090 married women to the National Family Health Survey-4 conducted across India from 2015 to 2016. The association between the type of intimate partner violence and self-managed abortion was analyzed using multivariable multinomial logistic regression. RESULTS: Women who have ever experienced physical intimate partner violence were more likely to have any abortion (adjusted relative risk=1.5; 95% confidence interval, 1.2-2.0) and use self-managed abortion (adjusted relative risk=1.7; 95% confidence interval, 1.1-2.6) than women who have not experienced physical intimate partner violence. Women who have ever experienced sexual intimate partner violence may have been more likely to use self-managed abortion, though this association was not statistically significant (adjusted relative risk=2.7; 95% confidence interval, 0.7-10.4). CONCLUSION: Women who have experienced physical intimate partner violence disproportionately use abortion care, both facility-based and self-managed. Women who have experienced sexual intimate partner violence may also be more likely to use self-managed abortion. Although abortion is legal, self-managed abortion is commonly occurring in India. Self-managed abortion represents an additional choice and enhances reproductive autonomy in settings where abortion is legal. The implementation of risk-mitigation resources and policies regarding self-managed abortion would provide protection and enhanced autonomy to susceptible groups across India.

Percutaneous Recanalization of Anastomotic Portal Vein in a Pediatric Patient After Liver Transplant Without Any Recognizable Portal Vein Remnant on Imaging.

In patients with complete portal vein thrombosis, the main portal vein is obstructed, resulting in development of hepatopetal collateral vessels. In cases of complete portal vein thrombosis, interventional procedures are challenging, with the greatest difficulty in the form of passing the guide wire across the level of obstruction. A recognizable main portal vein remnant has been deemed as a mandatory criterion in previous reports. Here, we report a case of cavernous trans-formation of the portal vein in a pediatric patient after liver transplant who had no obvious detectable portal vein remnant on radiologic imaging. Using digital subtraction angiography, we were successful in passing a guide wire through the level of obstruction and placing a stent, thus causing successful recanalization of the occluded segment.

Association between the total fertility rate and under-five child sex ratio in India: a panel study among districts of the major states.

This study examined the relationship between the total fertility rate and under-five child sex ratio to understand the role of fertility in the phenomenon of missing girls in India. Using data from the last four decennial censuses for the fifteen major states of India and their districts, covering more than 90% of the population of India, the study showed that there was a major decline in the female to male child sex ratio from 1981 to 2011 in most of the major Indian states and their districts. The panel regression model showed that the total fertility rate was significantly associated with the under-five child sex ratio at the district level for the 30-year period from 1981 to 2011 in India, even after controlling for other factors and any other unobserved heterogeneity. This indicates that areas of India with the highest fertility had the higher female to male child sex ratio, while low-fertility districts had a more male-biased sex ratio.