Long-term survival following medical management of Aspergillus endocarditis with dissemination as a consequence of steroid therapy in severe COVID-19 pneumonia.

A male in his 40's with no known comorbidities developed severe COVID-19 pneumonia and received a four-week course of methylprednisolone. The patient subsequently developed disseminated Aspergillus endocarditis, manifesting as multiple organ involvement including the heart, eyes, and brain. Despite the poor prognosis generally associated with fungal endocarditis, the patient survived following aggressive medical management with a combination of liposomal amphotericin b and voriconazole therapy and is now doing well for over two years and is off antifungal therapy for a year.

Harmony in nature: understanding the cultural and ecological aspects of plant use in Ladakh.

BACKGROUND: Traditional knowledge (TK) in Ladakh encapsulates a repository of experimental wisdom cultivated over millennia. Despite this cultural wealth, dwindling interest among the younger generations in the region's age-old practices underscores the urgency to document TK. The current study investigates the diverse usage of plants in Surru, Wakha and Lower Indus valleys of Western Ladakh exploring the influence of socioeconomic and ecological factors. METHODS: A stratified random sample approach was adopted to select 540 respondents for gathering information of useful plants through interviews and questionnaires. Participant observation, questionnaires, open-ended and semi-structured interviews were conducted for data collection. Free listing was done to create an extensive list of plants and their uses. Ethnobotanical metrics such as relative frequency of citation (RFC), relative importance index (RI), cultural value (CV) index and cultural importance (CI) index were computed to assess species applicability. Additionally, one-way analysis of variance (ANOVA) was utilized to discern significant differences in knowledge levels based on valleys, gender, education and religion using TK as a response variable. RESULTS: Altogether, we recorded 246 plant species under various ethnobotanical uses from Western Ladakh. These include medicinal (126), fodder (124), wild ornamentals (86), food (81), fuel wood (54), dye (20), religious (31) and others (34). Novel plant reports include Berberis brandisiana Ahrendt and Dactylorhiza kafiriana Renz. The dominant plant family is Asteraceae with 35 species. Suru valley exhibits the highest number of cited plants followed by Wakha-chu and Lower Indus valleys (192, 168 and 152 species, respectively). CONCLUSION: Disparities in plant use understanding are evident among different groups, prompting further investigation through intercultural comparisons. Plants such as Arnebia euchroma, Juniperus semiglobosa, and Artemisia species emerge with cultural importance. Gender, valley affiliation, religious background and the remoteness of a village all influence local plant knowledge. These variations are linked to socioeconomic disparities among communities.

Ocular surface changes in patients who have undergone head and neck radiation therapy.

PURPOSE: Dry eye syndrome (DES) is a familiar sequelae of radiation therapy (RT) for head and neck cancers (HNC). Ocular surface changes such as DES occur due to injury to the conjunctival epithelium, goblet cells, corneal surface, lacrimal glands, and meibomian glands. This study aimed at the evaluation and early detection of changes in ocular surface parameters in patients receiving RT for extraocular HNC. METHODS: Forty-two eyes of 21 patients undergoing HNC RT were evaluated. Radiation technique and dose of radiation to the lens and eye were recorded. Subjects were evaluated for meibomian gland changes by meiboscore grading, ocular surface disease index (OSDI) questionnaire, Schirmer's test, tear film break-up time (TBUT), and slit-lamp examination before RT, immediately post RT, and 6 weeks post RT. A comparison of the ipsilateral eye on the irradiated side to the contralateral eye was done. RESULTS: A significant reduction in TBUT was seen immediately post RT and 6 weeks post RT ( P < 0.001 and 0.008, respectively), with an increase in meiboscore at both visits ( P < 0.001). An OSDI score of >13 was seen in 23.80% of patients post RT, with a significant difference from baseline ( P < 0.001). On comparing ipsilateral and contralateral eye groups, a significant difference from baseline was seen in TBUT ( P < 0.001 and 0.033, respectively) and meiboscore ( P < 0.001 for both eyes). A significant change of >1 second in TBUT and >1.7 in meiboscore was seen with a mean dose of around 8 Gy to the lens. CONCLUSION: All patients undergoing HNC RT should be followed up for ocular surface and meibomian gland changes. The contralateral eye should also be evaluated. Patients receiving lower doses to the ocular structures should also be kept under follow-up.

Constructing a database of alien plants in the Himalaya to test patterns structuring diversity.

Differences in the number of alien plant species in different locations may reflect climatic and other controls that similarly affect native species and/or propagule pressure accompanied with delayed spread from the point of introduction. We set out to examine these alternatives for Himalayan plants, in a phylogenetic framework. We build a database of alien plant distributions for the Himalaya. Focusing on the well-documented regions of Jammu & Kashmir (west) and Bhutan (east) we compare alien and native species for (1) richness patterns, (2) degree of phylogenetic clustering, (3) the extent to which species-poor regions are subsets of species-rich regions and (4) continental and climatic affinities/source. We document 1470 alien species (at least 600 naturalised), which comprise ~14% of the vascular plants known from the Himalaya. Alien plant species with tropical affinities decline in richness with elevation and species at high elevations form a subset of those at lower elevations, supporting location of introduction as an important driver of alien plant richness patterns. Separately, elevations which are especially rich in native plant species are also rich in alien plant species, suggesting an important role for climate (high productivity) in determining both native and alien richness. We find no support for the proposition that variance in human disturbance or numbers of native species correlate with alien distributions. Results imply an ongoing expansion of alien species from low elevation sources, some of which are highly invasive.

Aminoacylase efficiently hydrolyses fatty acid amino acid conjugates of Helicoverpa armigera potentially to increase the pool of glutamine.

One of the most prevalent bioactive molecules present in the oral secretion (OS) of lepidopteran insects is fatty acid amino acid conjugates (FACs). Insect dietary components have influence on the synthesis and retaining the pool of FACs in the OS. We noted differential and diet-specific accumulation of FACs in the OS of Helicoverpa armigera by using Liquid Chromatography-Quadrupole Time of Flight Mass Spectrometry. Interestingly, we identified FACs hydrolyzing enzyme aminoacylase (HaACY) in the OS of H. armigera through proteomic analysis. Next, we have cloned, expressed, and purified active recombinant HaACY in the bacterial system. Recombinant HaACY hydrolyzes all the six identified FACs in the OS of H. armigera larvae fed on host and non-host plants and releases respective fatty acid and glutamine. In these six FACs, fatty acid moieties vary while amino acid glutamine was common. Glutamine obtained upon hydrolysis of FACs by HaACY might serve as an amino acid pool for insect growth and development. To understand the substrate choices of HaACY, we chemically synthesized, purified, and characterized all the six FACs. Interestingly, rHaACY also shows hydrolysis of synthetic FACs into respective fatty acid and glutamine. Our results underline the importance of diet on accumulation of FACs and role of aminoacylase(s) in regulating the level of FACs and glutamine.

Knowledge and awareness of clinical trials among trial participants in India: A multicentric questionnaire-based cross-sectional study.

PURPOSE: The knowledge and attitude of participants toward clinical trials (CTs) are a key determinant in successful recruitment and retention. This study aimed to evaluate knowledge and awareness-attitude among the recruited CT participants about CTs. METHODS: This was a cross-sectional face-to-face survey comprising CT participants involved in the past or currently a part of a CT during this study within the Indian Ophthalmology Clinical Trial Network (IOCTN). A previously validated questionnaire was used, and data regarding demographics, knowledge, and awareness-attitude about CTs were collected. The total awareness-attitude score was used to determine the knowledge and awareness of the participants. RESULTS: A total of 121 subjects had participated in the study who were part of ongoing trials, of which only five participants had prior experience of CTs. The majority (90%) had knowledge about CTs, whereas only 7% had confirmed signing consent forms. The total awareness-attitude score significantly varied across locations (27% for the southern zone, 53% for the central zone, and 52% for the western zone), and this was negatively associated with education. The most negative attitude (38.6%) was observed regarding adequate information sharing among participants, whereas non-disruption of their routine family life (60.7%) and financial stability (67.6%) were the top most positive attitudes revealed during their participation. The participants' pre- and post-participation attitude toward CTs revealed a positive attitude. CONCLUSION: The factors influencing a participant's knowledge and attitudes toward CTs were revealed in the study. Furthermore, the need for awareness regarding benefits of CTs to the public, participant's rights, and their voluntary power were the major highlights.

Biofilm's Impact on Inflammatory Bowel Diseases.

The colon has a large surface area covered with a thick mucus coating. Colon's biomass consists of about 1,012 colony-forming units per gram of feces and 500-1,000 distinct bacterial species. The term inflammatory bowel disease (IBD) indicates the collection of intestinal illnesses in which the digestive system (esophagus, large intestine, mouth, stomach, and small intestine) experiences persistent inflammation. IBD development is influenced by environmental (infections, stress, and nutrition) and genetic factors. The microbes present in gut microbiota help maintain intestinal homeostasis and support immune and epithelial cell growth, differentiation, as well as proliferation. It has been discovered that a variety of variables and microorganisms are crucial for the development of biofilms and mucosal colonization during IBD. An extracellular matrix formed by bacteria supports biofilm production in our digestive system and harms the host's immunological response. Irritable bowel syndrome (IBS) and IBD considerably affect human socioeconomic well-being and the standard of living. IBD is a serious public health issue, affecting millions of people across the globe. The gut microbiome may significantly influence IBS pathogenesis, even though few diagnostic and treatment options are available. As a result, current research focuses more on disrupting biofilm in IBD patients and stresses primarily on drugs that help improve the quality of life for human well-being. We evaluate studies on IBD and bacterial biofilm to add fresh insights into the existing state of knowledge of biofilm formation in IBD, incidence of IBD patients, molecular level of investigations, bacteria that are involved in the formation of biofilm, and present and down the line regimens and probiotics. Planning advanced ways to control and eradicate bacteria in biofilms should be the primary goal to add fresh insights into generating innovative diagnostic and alternative therapy options for IBD.

Attitude and perception toward clinical trials in India among patients and patient bystanders visiting the Indian Ophthalmology Clinical Trial Network: A multi-centric, cross-sectional survey.

Purpose: Advances in patient treatment depend heavily on clinical trials (CTs). Patient volunteers for CT are tougher to recruit and retain. In order to administer CTs effectively, it is necessary to comprehend how the public views and perceives participating in them. The study assessed the perception and attitudes of patients and bystanders toward CTs in India. Methods: This was a multi-centric, cross-sectional study among patients and bystanders using a questionnaire that consisted of socio-demographic characteristics and questions on knowledge and attitude toward participation in CTs. The minimum sample size estimated for the survey was 750. Results: A total of 1260 respondents (patients and bystanders) had participated in the survey. 42% of total respondents were aware about CTs. Unawareness regarding (i) voluntary power of an individual to participate in a CT (only 47%), (ii) entitled benefits of free treatment and medical insurance during enrolment in a CT (only 47%), and (iii) only 16% of the respondents knew involvement of human subjects in CT were the major highlights among those who had prior knowledge about CTs. Education was the most pervasive factor in shaping positive perception among the respondents. Occupation was another ubiquitous factor in shaping their perception regarding CTs. Conclusion: The majority of respondents were not aware of CTs. The major concerns observed were time consumption and harmful nature of CTs that influenced their unwillingness to participate in CTs. Initiatives such as awareness campaigns and survey assessments that would result in scientifically effective health service policies would be strategic methods to enhance CT participation.

Association between resistivity index of central retinal artery and severity of diabetic retinopathy.

Purpose: Diabetic retinopathy (DR) is a leading cause of ocular morbidity. Its progression depends mainly on retinal vasculature and ocular blood flow. Color Doppler imaging (CDI) is a noninvasive imaging technique that measures blood flow velocity. The resistivity index (RI), calculated by the CDI, reflects the vascular resistance distal to the measuring location. RI is independent of the doppler angle and position of the patient, making it a reliable and reproducible parameter. To the best of our knowledge, there is only one study in literature studying the association between resistivity index (RI) of the central retinal artery (CRA) and severity of DR. Aim: To determine the association between RI of CRA and severity of DR. To determine the association between RI of CRA and spectral-domain optical coherence tomography (SD-OCT) biomarkers for DR. Methods: Type II diabetics visiting our OPD underwent DR screening and were graded into three categories according to ETDRS classification which include Group A-No diabetic retinopathy (No DR), Group B-Nonproliferative diabetic retinopathy (Moderate-Severe-Very Severe NPDR), and Group C-Proliferative diabetic retinopathy (PDR). SD-OCT was performed. Ultrasonic color doppler imaging was done. RI of the CRA was noted. It was compared between the three groups and its association with severity of DR and OCT biomarkers (central subfield thickness, cube average thickness and ellipsoid zone disruption) was studied. Results: 56 eyes of 28 patients were included in our study with 20 in Group A,14 in Group B, and 22 in Group C. RI of CRA compared within groups showed statistically significant association with severity of DR (P < 0.001). The presenting BCVA (LogMar) showed positive correlation with RI in all groups. OCT biomarker central subfield thickness showed a positive correlation with RI in Groups A (P < 0.001) and B. Ellipsoid zone (EZ) disruption showed a statistically significant association with RI in Group C (P < 0.001). Conclusion: The RI of CRA is a reliable biomarker for the assessment of the severity of DR. Patients with high RI of CRA had higher chances of EZ disruption and presented with poor visual acuity.

Vitreoretinal disease: a critical review on current technological perspectives and innovative drug-delivery strategies.

Aim: To review the state of the art aspects and contemporary innovative drug delivery strategies, for the treatment of vitreoretinal diseases, their mechanism of action through ocular routes and their future perspectives. Materials & methods: Scientific databases such as PubMed, Science Direct, Google scholar were used to obtain 156 papers for review. The keywords searched were vitreoretinal diseases; ocular barriers; intravitreal injections; nanotechnology; biopharmaceuticals. Results & conclusion: The review explored the various routes which can be used to facilitate drug delivery adopting novel strategies, the pharmacokinetic aspects of novel drug-delivery strategies in treating posterior segment eye diseases and current research. Therefore, this review drives focus into the same and underlines their implications to the healthcare sector in making necessary interventions.

Eye diseases that affect the major part of the eye can create eyesight loss in patients. Even though medicines are now available, there is a need to drive the existing techniques further. These can be done by the use of small sized particles in the treatment, which are easy to reach the site wherever healing is required. Natural medicines and treatment can also benefit people. In this paper, we discuss treatment approaches on these factors and their importance in curing people with eye diseases.

Knowledge and perception of health-care professionals on clinical trials in India: A pan-Indian cross-sectional survey.

Purpose: The purpose of the study was to evaluate the knowledge and perception of health-care professionals (HCPs), such as doctors/surgeons, pharmacists, nurses, optometrists, and lab technicians, on clinical trials (CTs) in India. Methods: The study was a pan-Indian cross-sectional survey initiated by the Indian Ophthalmology Clinical Trial Network (IOCTN) by using a previously validated questionnaire for three months of data collection. An online survey was used to record information regarding demographics, CT knowledge, and CT perception among HCPs. Results: A total of 630 responses were recorded from HCPs: 207 doctors and surgeons, 159 pharmacists, and 264 laboratory technicians, nurses, and optometrists across India. Over 90% of HCPs had a clear knowledge on the purpose of CTs, the informed consent (IC) process, ethical approval by the Drugs Controller General of India (DCGI). About 80% and 90% were aware of confidentiality of patients, voluntariness of participation, and good clinical practice. Surprisingly, less than 50% had lesser knowledge regarding monetary incentives of CT participants (CTPs). A slightly positive perception was observed regarding the potential benefits of CTPs, compensation related to injury, and importance of obtaining IC. Less than 50% had a negative perception that monetary compensation to CTPs led to bias and deprivation of standard treatments. However, no significant difference was observed between other aspects of demographics and perception regarding CTs. Conclusion: We observed doctors and surgeons to be having the highest regarding CTs, followed by pharmacists. The survey highlighted the necessity of scheduling awareness programs among the HCPs, which would improve their misconceptions and perception of CTs while interacting with patients for CT enrollment.

A hybrid piezoelectric and triboelectric nanogenerator with lead-free BZT-BCT/PDMS composite and PVA film for scavenging mechanical energy.

A hybrid piezo/triboelectric nanogenerator (H/P-TENG) is designed for mechanical energy harvesting using polymer ceramic composite films; polydimethylsiloxane/Ba(Zr0.2Ti0.8)O3-0.5(Ba0.7Ca0.3)TiO3 (PDMS/BZT-BCT) and polyvinyl alcohol (PVA). A lead-free BZT-BCT piezoelectric ceramic was prepared via solid-state method and blended into PDMS to form a series of polymer-ceramic composite films, ranging from 5% to 30% by weight. The films were forward/reverse poled with corona poling and their electrical properties were compared to non-poled samples. The H/P-TENG constructed with forward-poled 15 wt% BZT-BCT in PDMS achieved the highest open-circuit voltage, V oc of 127 V, short-circuit current density, J sc of 67 mA m-2, short-circuit charge density, Q sc of 118 µC m-2, and peak power density of 7.5 W m-2, an increase of 190% over pristine PDMS-based TENG. It was discovered that incorporating BZT-BCT into the PDMS matrix improved the triboelectric properties of PDMS. The overlapping electron cloud (OEC) model was used to explain the enhancement and the effect of poling direction of the PDMS/BZT-BCT composite used in H/P-TENG, providing fundamental knowledge of the influence of piezoelectric polarisation on contact electrification.

A study of [2 + 2] cycloaddition-retroelectrocyclization in water: observation of substrate-driven transient-nanoreactor-induced new reactivity.

Organic solvents limit [2 + 2] cycloaddition-retroelectrocyclization (CA-RE) in biological fields. We examined the formation of 1,1,4,4-tetracyanobuta-1,3-dienes (TCBDs) through CA-RE reactions and their unusual reactivity to produce N-heterocyclic compounds when the nature of the surfactant and the concentrations were varied in the aqueous phase. An environment in which transient self-assemblies (vesicles) were induced by the substrate and surfactant molecules initiated new reactivity through H2O addition on the TCBD, generating the enol form of the intermediate, which results in the formation of the 6,6-dicyano-heteropentafulvene (amidofulvene) compound, while lamellar sheets at higher concentrations favored TCBD generation. Interestingly, the amidofulvene underwent a clean transformation to 6-membered heterocycles that resemble cardiotonic drugs (milrinone, amrinone) via keto-enol tautomerism mediated by a polar aprotic solvent, opening up a new avenue for drug discovery. Unlike organic-solvent-mediated CA-RE reactions, the present nanoreactor-mediated approach enabled the selective production of TCBDs as well as new heterocycles using H2O as a green solvent. In addition to the widely explored organic electronics/materials, we believe that this study will help to overcome the long-standing limitation of CA-RE reaction applicability in biological fields.

Effect of dexamethasone implant on intraocular cytokines in diabetic macular edema.

Purpose: Our primary aim was to evaluate intraocular cytokines (IC) before and after dexamethasone in diabetic macular edema (DME). Our secondary aim was to study the early and late effects of single dexamethasone implant in DME. Methods: This before and after comparative study was conducted at the Department of Ophthalmology and Centre for Nanosciences at a quaternary referral center in Kerala, India, from September 2016 to September 2018. Patients underwent complete ophthalmological examination and cytokine analysis before and after dexamethasone implant. Levels of cytokines at baseline and repeat sample were studied. Results: Twenty-seven eyes (21 patients) were divided into two groups depending on time from baseline to second injection. Group 1 included patients with <3 months between the two samples - 12 (44.4%). Group 2 included patients with >3 months between the two samples -15 (55.6%). Best corrected visual acuity (BCVA) and central macular thickness (CMT) improved significantly post-dexamethasone in group 1, but not in group 2. Interleukin (IL)-4, IL-6, IL-10, vascular endothelial growth factor (VEGF), IL-1ß, interferon-gamma inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), and IL-2 decreased post-injection in group 1. But cytokines increased post-dexamethasone in group 2, except IL-10. When compared to baseline, IL-6 reduced to half in group 1 (P-value 0.814) and it tripled in group 2 ( P-value 0.009). The level of VEGF in the first and second samples was not different in either group. Conclusion: Our study suggests that dexamethasone acts more on IC than VEGF in DME. This is significant in the first 3 months with a rebound effect on IL-6 after 3 months. Our study also suggests that repeat injection of DEX in DME should be done at 3 months to prevent deterioration of visual acuity (VA) and worsening of CMT.

Risk factors for secondary ocular hypertension in silicone oil-filled eyes following transconjunctival sutureless vitrectomy - A prospective cohort study.

Purpose: Our aim was to determine the various risk factors for secondary ocular hypertension (OHT) following pars plana vitrectomy (PPV) with silicone oil (SO) injection. Methods: A prospective cohort study was performed on 46 eyes of 42 patients who underwent PPV with SO injection under a single surgeon between January 2020 and July 2021. Complete ophthalmological examination including gonioscopy and Goldmann applanation tonometry was performed preoperatively and on three postoperative visits, that is, day 7, day 30, and day 90. Axial length and lens thickness were measured at baseline using immersion A-scan. Anterior segment optical coherence tomography (OCT) was used for measuring anterior chamber depth (ACD) at baseline and at 3 months. Results: There was a statistically significant increase in intraocular pressure (IOP) (>21 mmHg) on day 7 (4.70 ± 7.754 mmHg), day 30 (5.24 ± 7.481 mmHg), and day 90 (2.39 ± 5.659 mmHg) (P<0.01 for all). Age <50 years, rhegmatogenous retinal detachment (RRD), and pseudophakia had a strong association with short-term OHT on day 7. Preexisting glaucoma was the only independent risk factor for long-term OHT (day 90). Higher baseline IOP and SO emulsification also contributed to long-term OHT. Conclusion: There was a statistically significant elevation in IOP at all postoperative visits. Short-term OHT was associated with younger age (<50 years), RRD, and pseudophakia. Patients with emulsified SO in the anterior chamber, higher baseline IOP, and preexisting glaucoma were at higher risk for long-term OHT.

Role of Ensemble Deep Learning for Brain Tumor Classification in Multiple Magnetic Resonance Imaging Sequence Data.

The biopsy is a gold standard method for tumor grading. However, due to its invasive nature, it has sometimes proved fatal for brain tumor patients. As a result, a non-invasive computer-aided diagnosis (CAD) tool is required. Recently, many magnetic resonance imaging (MRI)-based CAD tools have been proposed for brain tumor grading. The MRI has several sequences, which can express tumor structure in different ways. However, a suitable MRI sequence for brain tumor classification is not yet known. The most common brain tumor is 'glioma', which is the most fatal form. Therefore, in the proposed study, to maximize the classification ability between low-grade versus high-grade glioma, three datasets were designed comprising three MRI sequences: T1-Weighted (T1W), T2-weighted (T2W), and fluid-attenuated inversion recovery (FLAIR). Further, five well-established convolutional neural networks, AlexNet, VGG16, ResNet18, GoogleNet, and ResNet50 were adopted for tumor classification. An ensemble algorithm was proposed using the majority vote of above five deep learning (DL) models to produce more consistent and improved results than any individual model. Five-fold cross validation (K5-CV) protocol was adopted for training and testing. For the proposed ensembled classifier with K5-CV, the highest test accuracies of 98.88 ± 0.63%, 97.98 ± 0.86%, and 94.75 ± 0.61% were achieved for FLAIR, T2W, and T1W-MRI data, respectively. FLAIR-MRI data was found to be most significant for brain tumor classification, where it showed a 4.17% and 0.91% improvement in accuracy against the T1W-MRI and T2W-MRI sequence data, respectively. The proposed ensembled algorithm (MajVot) showed significant improvements in the average accuracy of three datasets of 3.60%, 2.84%, 1.64%, 4.27%, and 1.14%, respectively, against AlexNet, VGG16, ResNet18, GoogleNet, and ResNet50.

Incidence of post vitrectomy endophthalmitis in India - A multicentric study by VRSI study Group.

INTRODUCTION: The incidence of post vitrectomy endophthalmitis (PVE) is reported to be between 0.02 and 0.84%. Resterilization of single use instruments is a common practice amidst developing countries to make it more affordable to the patients by reducing the cost of the surgery and also reduce the environmental hazard. The aim of our study is to evaluate the incidence of PVE amidst existing sterilization practices of reused instruments in multiple vitreoretinal centres in India. METHODOLOGY: Centres with an endophthalmitis tracking system were invited to participate in a survey. Twenty-five centres were sent a questionnaire via email. The questionnaire included details about the institution, number of vitrectomies performed in a year, sterilization practices followed pre-operatively, intraoperatively and postoperatively, incidence of endophthalmitis and instrument reuse policies. RESULTS: A total of 29 cases of endophthalmitis were reported out of the 47,612 vitrectomies performed across various centres. The mean incidence of endophthalmitis was 0.06%. There was no difference in the rates of endophthalmitis based on various pre-operative, intraoperative or postoperative prophylactic measures. Nearly 80% of the centres change most of the instruments after every case, while the rest reused. The mean number of times a cutter was being reused until discarded was 4.7. Nearly 76% followed a performance-based protocol, and the remaining 24% had a fixed protocol for the number of times an instrument can be reused before discarding it. CONCLUSION: PVE rates are not significantly different in India despite the multiuse of single use instruments. The purpose of this paper is not to suggest an alternate protocol but to creating one in the future with these results in mind, to rationalise the use of single use instruments, make VR surgery more affordable and also have a positive impact on the carbon footprint of consumables in surgery.

Modern cemented Furlong hemiarthroplasty: Are dislocations rates better?

BACKGROUND: Dislocation following hip hemiarthroplasty is a major complication with increased mortality and morbidity. Data looking at dislocation following contemporary bipolar stems are lacking in literature. METHODS: Retrospective review of our prospective national hip fracture database over a two-year period. Group 1 comprised of consecutive patients receiving bipolar Furlong prosthesis (N222) while Group 2 was made up of a historical cohort (uncemented; N254). Clinical and radiological records were reviewed to determine dislocation rates, causes and associative factors of dislocations. Data were analysed using SPSS. RESULTS: Following 476 hemiarthroplasties performed during the study period, 12 (2.5%) dislocations were reported (eight in Group 1; four in Group 2). There was no significant difference in dislocation rates (3.6% vs 1.6%) between groups (p = 0.159). Subgroup analysis of Group 1 demonstrated a significant difference in dislocations with Furlong cemented (6%) as compared with Furlong uncemented (0%) hemiarthroplasties (p = 0.024). Following dislocation, death rates increased to 8.3% from 1.7% in both groups. CONCLUSION: There is a statistically significant increase in dislocation rate following use of cemented Furlong prosthesis when compared to similar uncemented prosthesis at the same treatment period. However, when compared to traditional uncemented prosthesis, there is no difference in dislocation rates.

High-resolution structures illuminate key principles underlying voltage and LRRC26 regulation of Slo1 channels.

Multi-modal regulation of Slo1 channels by membrane voltage, intracellular calcium, and auxiliary subunits enables its pleiotropic physiological functions. Our understanding of how voltage impacts Slo1 conformational dynamics and the mechanisms by which auxiliary subunits, particularly of the LRRC (Leucine Rich Repeat containing) family of proteins, modulate its voltage gating remain unresolved. Here, we used single particle cryo-electron microscopy to determine structures of human Slo1 mutants which functionally stabilize the closed pore (F315A) or the activated voltage-sensor (R207A). Our structures, obtained under calcium-free conditions, reveal that a key step in voltage-sensing by Slo1 involves a rotameric flip of the voltage-sensing charges (R210 and R213) moving them by ∼6 Šacross a hydrophobic gasket. Next we obtained reconstructions of a complex of human Slo1 with the human LRRC26 (γ1) subunit in absence of calcium. Together with extensive biochemical tests, we show that the extracellular domains of γ1 form a ring of interlocked dominos that stabilizes the quaternary assembly of the complex and biases Slo1:γ1 assembly towards high stoichiometric complexes. The transmembrane helix of γ1 is kinked and tightly packed against the Slo1 voltage-sensor. We hypothesize that γ1 subunits exert relatively small effects on early steps in voltage-gating but structurally stabilize non-S4 helices of Slo1 voltage-sensor which energetically facilitate conformational rearrangements that occur late in voltage stimulated transitions.

Shifts in Bacterial Community Composition and Functional Traits at Different Time Periods Post-deglaciation of Gangotri Glacier, Himalaya.

Climate change causes an unprecedented increase in glacial retreats. The melting ice exposes land for colonization and diversification of bacterial communities leading to soil development, changes in plant community composition, and ecosystem functioning. Although a few studies have focused on macro-level deglaciation impacts, little is known about such effects on the bacterial community succession. Here, we provide meta-barcoding-based insight into the ecological attributes of bacterial community across different retreating periods of the Gangotri glacier, western Himalaya. We selected three sites along a terminal moraine representing recent (~ 20 yrs), intermediate (~ 100 yrs), and late (~ 300 yrs) deglaciation periods. Results showed that the genus Mycobacterium belonging to phylum Actinobacteria dominated recently deglaciated land. Relative abundance of these pioneer bacterial taxa decreased by 20-50% in the later stages with the emergence of new and rising of the less abundant members of the phyla Proteobacteria, Firmicutes, Planctomycetes, Acidobacteria, Verrucomicrobia, Candidatus TM6, and Chloroflexi. The community in the recent stage was less rich and harbored competitive interactions, while the later stages experienced a surge in bacterial diversity with cooperative interactions. The shift in α-diversity and composition was strongly influenced by soil organic carbon, carbon to nitrogen ratio, and soil moisture content. The functional analyses revealed a progression from a metabolism focused to a functionally progressive community required for bacterial co-existence and succession in plant communities. Overall, the findings indicate that the bacterial communities inhabit, diversify, and develop specialized functions post-deglaciation leading to nutrient inputs to soil and vegetation development, which may provide feedback to climate change.