Nanotechnology based technological development in biofuel production: Current status and future prospects.

Depleting fossil fuels and net carbon emissions associated with their burning have driven the need to find alternative energy sources. Biofuels are near-perfect candidates for alternative energy sources as they are renewable and account for no net CO2 emissions. However, biofuel production must overcome various challenges to compete with conventional fuels. Conventional methods for bioconversion of biomass to biofuel include chemical, thermochemical, and biological processes. Substrate selection and processing, low yield, and total cost of production are some of the main issues associated with biofuel generation. Recently, the uses of nanotechnology and nanoparticles have been explored to improve the biofuel production processes because of their high adsorption, high reactivity, and catalytic properties. The role of these nanoscale particles and nanocatalysts in biomass conversion and their effect on biofuel production processes and yield are discussed in the present article. The applicability of nanotechnology in production processes of biobutanol, bioethanol, biodiesel, biohydrogen, and biogas under biorefinery approach are presented. Different types of nanoparticles, and their function in the bioprocess, such as electron transfer, pretreatment, hydrolysis, microalgae cultivation, lipid extraction, dark and photo fermentation, immobilization, and suppression of inhibitory compounds, are also highlighted. Finally, the current and potential applications of nanotechnology in biorefineries are also discussed.

A panoramic view of technological landscape for bioethanol production from various generations of feedstocks.

Bioethanol is an appropriate alternate energy option due to its renewable, nontoxic, environmentally friendly, and carbon-neutral nature. Depending upon various feedstocks, bioethanol is classified in different various generations. First-generation ethanol created a food vs fuel problem, which was overcome by second-generation, third-generation and fourth-generation ethanol. The considerable availability of lignocellulosic biomass makes it a suitable feedstock, however, its recalcitrant nature is the main hurdle in converting it to bioethanol. The present study gives a comprehensive assessment of global biofuel policies and the current status of ethanol production. Feedstocks for first-generation (sugar and starch-based), second-generation (lignocellulosic biomass and energy crops), third-generation (algal-based) and fourth-generation (genetically modified algal biomass or crops) are discussed in detail. The study also assessed the process for ethanol production from various feedstocks, besides giving a holestic background knowledge on the bioconversion process, factors affecting bioethanol production, and various microorganisms involved in the fermentation process. Biotechnological tools also play a pivotal role in enhancing process efficiency and product yield. In adddition, most significant development in the field of genetic engineering and adaptive evolution are also highlighted.

Global biofuels policies on bioethanol production were presentedTechnological integrations of 1G, 2G, 3G and 4G bioethanol were discussedVarious factors affecting bioethanol production were mentionedTechno-economic analysis and LCA of bioethanol production are discussed.

Preoperative Predictors for the Presence of Motile Spermatozoa in the Epididymis and Patency of Anastomosis during Microsurgical Vasoepididymal Anastomosis in Patients with Obstructive Azoospermia.

Background: Following microsurgical vaso-epididymal anastomosis (VEA), anastomotic patency with sperm returning to the ejaculate is not always present and may even be delayed. The presence of motile spermatozoa is highly suggestive of future patency following surgery. Aims: We prospectively analyse the factors that could predict motile spermatozoa at the epididymis intraoperatively and predictors of patency in patients with obstructive azoospermia (OA) undergoing microsurgical VEA. Settings and Design: Department of Urology of a tertiary care centre in Northern India. It is a prospective observational study. Materials and Methods: Over a 2-year period (July 2019 to June 2021), 26 patients with idiopathic OA were enrolled in the study. Twenty patients underwent microsurgical VEA. Patients were divided into two groups based on the presence/absence of intraoperative motile spermatozoa. Statistical Analysis Used: Analysis of preoperative and intraoperative factors was done using the Mann-Whitney U-test, Chi-squared test and Fischer exact test. Results: Out of 20 patients, 5 (group 2) had intraoperative motile spermatozoa in the epididymal fluid and 15 (group 1) had nonmotile spermatozoa. Low luteinising hormone (LH) levels (P = 0.01) and high testosterone levels (P = 0.05) were the predictive of presence of motile spermatozoa in epididymal fluid. Mean follow-up was 9 months (6-18 months). Predictors of higher patency were grade 2 epididymis (firm, turgid and tense) (P = 0.003), low LH levels (P = 0.03), low sertoli cell index (P = 0.006), high sperm-Sertoli index (P = 0.002) and better surgeon satisfaction (P = 0.01). Conclusion: Low LH levels and high testosterone levels may be predictive of the presence of motile spermatozoa in epididymal fluid. Firm, turgid and tense epididymis, low Sertoli cell index, high sperm-Sertoli index and surgeon satisfaction suggest a greater chance of success after VEA for idiopathic azoospermia.

Structural insights into DarT toxin neutralization by cognate DarG antitoxin: ssDNA mimicry by DarG C-terminal domain keeps the DarT toxin inhibited.

In the DarTG toxin-antitoxin system, the DarT toxin ADP-ribosylates single-stranded DNA (ssDNA), which stalls DNA replication and plays a crucial role in controlling bacterial growth and bacteriophage infection. This toxic activity is reversed by the N-terminal macrodomain of the cognate antitoxin DarG. DarG also binds DarT, but the role of these interactions in DarT neutralization is unknown. Here, we report that the C-terminal domain of DarG (DarG toxin-binding domain [DarGTBD]) interacts with DarT to form a 1:1 stoichiometric heterodimeric complex. We determined the 2.2 Å resolution crystal structure of the Mycobacterium tuberculosis DarT-DarGTBD complex. The comparative structural analysis reveals that DarGTBD interacts with DarT at the DarT/ssDNA interaction interface, thus sterically occluding substrate ssDNA binding and consequently inactivating toxin by direct protein-protein interactions. Our data support a unique two-layered DarT toxin neutralization mechanism of DarG, which is important in keeping the toxin molecules in check under normal growth conditions.

Differential loss of fat in polycystic ovary syndrome: A welcome or warning sign?

Lipodystrophy syndrome is a rare disorder characterized by selective deficiency of adipose tissue and severe insulin resistance resulting in metabolic complications. Its presentation as polycystic ovary disease (PCOD) is even rarer. We present a 23-year-old woman who came with complaints of oligomenorrhoea and hirsutism. When specifically asked, she accepted noticing loss of fat from some areas of her body. Examination showed loss of fat from the face, buttocks and thighs. Her investigations revealed deranged blood sugars, transaminitis, dyslipidaemia and elevated serum testosterone; ultrasonography showed fatty liver and polycystic ovary. Fat composition measurement revealed loss of fat from lower limbs and increased ratio of trunk-to-leg fat. Based on these findings, a diagnosis of lipodystrophy was made. She was started on metformin, statins and ursodeoxycholic acid. Blood sugars, lipid profile and dyslipidaemia improved over a period of 6 months. We suggest that in lean patients with PCOD, lipodystrophy becomes a differential diagnosis, so attention should be paid to body fat distribution in them. Despite normal body mass index (BMI), these patients tend to develop metabolic complications as in our patient (BMI 21.5). This diagnosis has long-term implications in view of its association with metabolic complications.

How trainee doctors and nurses react to simulated scenarios of violence against healthcare workers: A cross-sectional study.

Medical and nursing students may have to face healthcare-related violence, especially now as they may be doing clinical duty during the Covid-19 pandemic. This study was conducted to analyse the perceptions and attitudes of medical and nursing students towards violence against healthcare workers (HCWs), when presented with audio-visual depiction of simulated scenarios. This cross-sectional study was conducted over a period of six months (April to September 2019) among the undergraduate medical and nursing students of first, second, pre-final and final years making it a total of 800 students. Video clips were shown to the students pertaining to HCWs' interactions with patients and relatives, and their responses were noted. Among 615 participants who completed the proforma, 248 (40%) students reported having observed or experienced violence in their clinical postings. Overall, 70.7% of medical and 68.5% of nursing students said that they would report incidents of violence to the authority. The questionnaire based on video-based simulated scenarios brought forth the perception that in triggering an act of violence, both the healthcare worker and the attendant could be at fault and full disclosure of complications was a necessary step in preventing such an act of violence. Sensitisation about the same should be incorporated into the teaching curriculum by using simulated scenarios to prepare them to manage such incidents.

Anthropometric and Pubertal Outcomes in Girls With Classical Congenital Adrenal Hyperplasia.

OBJECTIVES: To evaluate the anthropometric and pubertal outcomes, over a spectrum of treatment regimens and compliance. METHODS: We reviewed records of the patients with classical CAH seen at the endocrinology clinic of a tertiary care center between 1995 and 2016. RESULTS: 25 females were included in the study, the majority (80%) with simple virilizing variant. All patients had genital ambiguity since birth, yet 40% (10/25) presented much later with menstrual complaints. All patients received hydrocortisone, but some switched to dexa-methasone (n=7) or prednisolone (n=4). 7/9 (77.9%) girls who achieved target height, were on hydrocortisone. Menarche occurred with corticosteroid treatment in 60% (15/25) patients at a median (IQR) age of 16 (12-22) years. CONCLUSION: Hydrocortisone seems to have a beneficial effect on linear growth. Once target height is achieved, dexamethasone may be considered as an alternative.

Developing and evaluating mental health lived experience practitioner (LXP) roles in an NHS trust.

BACKGROUND: The value of establishing roles for people with lived experience of mental distress within mental health services is increasingly being recognised. However, there is limited information to guide the introduction of these roles into mental health services. AIMS: This study details the development and evaluation of a new mental health peer worker role, the Lived Experience Practitioner (LXP), within an NHS Trust. METHODS: A three-phase exploratory mixed-methods approach was used. Qualitative data were collected and analysed in the first phase. The qualitative findings were then translated into the formal procedures for introducing LXPs into the Trust, with the approach examined quantitatively in the third phase. RESULTS: The qualitative analysis identified five themes; role design, training, piloting, career pathways and communication. These formed the basis for working groups (workstreams) which developed policies and procedures for introducing the LXP role into the Trust. Twenty-eight applicants commenced a training programme with 10 successful completions. Seven LXPs were employed by the Trust and were still in their posts after 2 years. CONCLUSION: In this study, three areas were viewed as important when introducing LXP roles into mental health services; organisational support, the training programme and employment procedures.

Clinical indicators to define etiology in patients with primary amenorrhea: Lessons from a decade of experience.

CONTEXT: Primary Amenorrhea is worrisome for the adolescent as well as their guardian. It is essential to be able to identify the underlying pathology and initiate appropriate management strategies, well in time. AIMS: To study the clinical features, with an aim to identify discriminatory clinical features to indicate a most probable diagnosis. DESIGN: A prospective, observational study. SETTING: The Gynecologic Endocrinology Clinic of Department of Obstetrics and Gynecology and Endocrinology Outpatient Department of a tertiary centre in North India. METHODOLOGY: In total 328 women with primary amenorrhea, registered during a duration of 10 years (January 2008 to December 2017), were enrolled for the study and a proforma was filled with their medical details. RESULTS: It was observed that patients with normal stature and underdeveloped breasts were likely to be hypogonadotropic hypogonadism, whereas those with short stature and underdeveloped breasts were more likely to be gonadal failure with underlying chromosomal abnormality. The three most common causes of primary amenorrhea in the index population were hypogonadotropic hypogonadism (117/328 = 35.1%), gonadal dysgenesis (99/328 = 30.2%) and mullerian agenesis (53/328 = 16.2%). CONCLUSION: Age, height, and Tanner staging at presentation can provide a clue toward diagnosis, even before confirmatory tests are available. One of the largest studies reported on primary amenorrhea, we found hypogonadotropic hypogonadism to be the commonest cause, in contrast to previous studies.

"Through Thick and Thin:" Morphological Spectrum of Epididymal Tubules in Obstructive Azoospermia.

Morphological appearance of the epididymal tubules encountered at the time of microsurgical vasoepididymal anastomosis (VEA) is quite variable. They are the indicators of underlying etiology as well as guide further course of management. We present three cases of obstructive azoospermia with three different morphologies encountered during the microsurgical VEA. As the etiologies encountered in our setup are different from that of the western world, this report highlights the morphological variation of tubules encountered in our subpopulation. This also helps us in deciding the customization of microsurgical VEA accordingly.

Tracing the Journey of Endometrium, from Womb to Arm: Deltoid Endometriosis.

BACKGROUND: Endometriosis is an enigma. Extrapelvic endometriosis is even more challenging, as theories of origin are difficult to explain. Very few cases of skeletal endometriosis have been reported in the literature. METHOD: We managed a case of 39-year-old nulliparous woman, who presented to the department of plastic surgery with complaints of a painful nodule measuring about 2 cm, in left upper arm since past 8 years. She had history of myomectomy 8 years back, while she was undergoing treatment for primary infertility. Differential diagnosis of extrapelvic endometriosis was made based on clinical history of cyclical pain and swelling, and she was referred to gynecology for hormonal treatment. MRI and FNAC were inconclusive. She underwent excision biopsy of the lesion. RESULT: Histopathology confirmed intramuscular endometriosis of left deltoid with positive margins. Postoperatively, she was started on dienogest 2 mg once daily and LNG IUS was inserted. Both were withdrawn a year later, due to side effects. It has been more than 6 months since removal of LNG IUS, and currently she is asymptomatic. CONCLUSION: To the best of our knowledge, this is the third case of deltoid endometriosis reported till date.

Prospective randomized trial comparing efficacy of letrozole step-up protocol with letrozole plus gonadotropins for controlled ovarian stimulation and intrauterine insemination in patients with unexplained infertility.

PURPOSE: Empirical treatment options for unexplained infertility treatment include controlled ovarian stimulation (COS) with clomiphene citrate, letrozole or gonadotropins followed by intrauterine insemination (IUI). Achieving consistent multifollicular development with letrozole generally requires addition of gonadotropins. However, the cost and discomfort of injections remains a drawback of this regimen. Therefore, there is a need for evolving newer cost-effective regimens for COS/IUI using orally administered drugs like letrozole. METHODS: Sixty couples with unexplained infertility (on standard infertility investigations) visiting the infertility clinic at a tertiary centre in North India were randomized into two groups. Group A COS was done by step-up protocol of letrozole from day 2 or 3 of menstrual cycle, starting with 2.5 mg and increased by 2.5 mg per day for next 3 days (2.5 mg, 5 mg, 7.5 mg, 10 mg). Group B COS was done with combination of letrozole and hMG (human menopausal gonadotropin). Starting from day 2 or 3 of menses, tablet letrozole 2.5 mg twice a day was given for 5 days. Intramuscular injection of hMG 150 IU was given every alternate day starting from day 7 and titrated according to the response. HCG was given when leading follicle was 17 mm and IUI done 36 h after HCG. RESULTS: Twenty-eight couples in letrozole step-up group (group A) and 30 couples in letrozole plus hMG group (group B), completed follow up for 44 and 55 cycles, respectively. Mean numbers of follicle ≥ 16 mm in both groups were comparable: 1.74 (± 0.83) in group A and 1.94 (± 0.68) in group B (p = 0.178). Ovulation rate of 90.9% (40/44) was achieved in group A, whereas it was 100% (55/55) in group B (p = 0.022), although there was no significant difference in clinical pregnancy rate per patient, which was 3/28 (10.7%) in group A versus 5/30 (16.67%) in group B (p = 0.707). The mean (SD) cost of medicines was significantly lower in group A Rs. 345.00 (00) compared to group B Rs. 2148.64 (515.67) [p < 0.0001]. There was one case each of hyperstimulation and multiple pregnancies in group B, while none in group A. CONCLUSION: It is possible to achieve multifollicular development with use of novel letrozole step-up protocol, even without addition of gonadotropins, at significantly lower cost.

Adult Granulosa Cell Tumor: A Sinister Differential for Clomiphene-resistant Infertility.

Granulosa cell tumors (GCTs) are rare sex cord-stromal tumors of the ovary. They may present with features of hyperestrogenism. We present a case of a 29-year-old nulliparous female, with infertility and oligomenorrhoea, initially managed with a provisional diagnosis of polycystic ovarian syndrome. She did not respond to multiple cycles of ovulation induction with clomiphene citrate. Later, an ovarian mass was detected, and she was initially planned for laparoscopy. Magnetic resonance imaging pelvis revealed a solid-looking mass in the ovary, with increased vascularity. Fine-needle aspiration cytology from the mass suggested GCT. She underwent staging laparotomy with fertility-preserving surgery. Thereafter, she conceived on first cycle of clomiphene citrate. She delivered twins and is presently 8 months postpartum. Thus, a high index of suspicion for underlying androgen- or estrogen-secreting tumor in cases of clomiphene-resistant infertility with ovarian cysts is advisable.