Intraoperative Aortic Dissection in a Case of Aneurysmal Dilatation of the Ascending Aorta Posted for Surgery.

ABSTRACT: Intraoperative aortic dissection is a life-threatening emergency. The prognosis of patients with aortic dissection has markedly improved in recent years due to prompt diagnosis and the institution of effective medical and surgical therapy. Transesophageal echocardiography (TEE) is helpful in the evaluation of this life-threatening disorder.

Unlocking the enigma: Combined percutaneous-transhepatic and endoscopic strategies for retrieval of severed Dormia basket in choledocholithiasis. A case report and literature review.

Choledocholithiasis, characterized by the presence of stones in the common bile duct, poses significant challenges in clinical management, particularly when the stones are massive. While endoscopic methods are often effective in stone removal, complications such as the impaction of foreign bodies like Dormia baskets can occur. These complications may necessitate alternative approaches, including surgical intervention, highlighting the importance of exploring innovative interventional techniques. We report on an 89-year-old patient presenting with massive choledocholithiasis, involving complete filling of the intra- and extrahepatic bile duct system with large stones up to a maximum of 2 cm. The patient underwent interventional removal of a Dormia basket (3.5Fr. Boston Scientific, USA) impacted in the common bile duct. This procedure proved challenging due to the metallic end marker of the basket perforating through the wall of the distal common bile duct, rendering it fixed. Given the complexity of the case, a parallel approach combining percutaneous transhepatic cholangiography and drainage with simultaneous endoscopy was employed to successfully extract the fixed Dormia basket. In cases of severe choledocholithiasis complicated by the impaction of foreign bodies such as Dormia baskets, innovative interventional strategies are crucial for successful management. Our case highlights the effectiveness of a parallel approach involving percutaneous transhepatic cholangiography and drainage alongside simultaneous endoscopy in safely removing the fixed foreign body from the common bile duct. This multidisciplinary approach not only offers a viable alternative to surgical intervention but also underscores the importance of collaboration between interventional radiologists and endoscopists in optimizing patient outcomes in complex biliary interventions.

Photochemical oxidation of VOCs and their source impact assessment on ozone under de-weather conditions in Western Taiwan.

The application of statistical models has excellent potential to provide crucial information for mitigating the challenging issue of ozone (O3) pollution by capturing its associations with explanatory variables, including reactive precursors (VOCs and NOX) and meteorology. Considering the large contribution of O3 in degrading the air quality of western Taiwan, three-year (2019-2021) hourly concentration data of VOC, NOX and O3 from 4 monitoring stations of western Taiwan: Tucheng (TC), Zhongming (ZM), Taixi (TX) and Xiaogang (XG), was evaluated to identify the effect of anthropogenic emissions on O3 formation. Owing to the high-ambient reactivity of VOCs on the underestimation of sources, photochemical oxidation was assessed to calculate the consumed VOC (VOCcons) which was followed by the source identification of their initial concentrations. VOCcons was observed to be highest in the summer season (16.7 and 22.7 ppbC) at north (TC and ZM) and in the autumn season (17.8 and 11.4 ppbC) in southward-located stations (TX and XG, respectively). Results showed that VOCs from solvents (25-27%) were the major source at northward stations whereas VOCs-industrial emissions (30%) dominated in south. Furthermore, machine learning (ML): eXtreme Gradient Boost (XGBoost) model based de-weather analysis identified that meteorological factors favor to reduce ambient O3 levels at TC, ZM and XG stations (-67%, -47% and -21%, respectively) but they have a major role in accumulating the O3 (+38%) at the TX station which is primarily transported from the upwind region of south-central Taiwan. Crucial insights using ML outputs showed that the finding of the study can be utilized for region-specific data-driven control of emission from VOCs-sources and prioritized to limit the O3-pollution at the study location-ns as well as their accumulation in distant regions.

Comparing Accuracy of Helicobacter pylori Identification Using Traditional Hematoxylin and Eosin-Stained Glass Slides With Digital Whole Slide Imaging.

With advancements in the field of digital pathology, there has been a growing need to compare the diagnostic abilities of pathologists using digitized whole slide images against those when using traditional hematoxylin and eosin (H&E)-stained glass slides for primary diagnosis. One of the most common specimens received in pathology practices is an endoscopic gastric biopsy with a request to rule out Helicobacter pylori (H. pylori) infection. The current standard of care is the identification of the organisms on H&E-stained slides. Immunohistochemical or histochemical stains are used selectively. However, due to their small size (2-4 µm in length by 0.5-1 µm in width), visualization of the organisms can present a diagnostic challenge. The goal of the study was to compare the ability of pathologists to identify H. pylori on H&E slides using a digital platform against the gold standard of H&E glass slides using routine light microscopy. Diagnostic accuracy rates using glass slides vs digital slides were 81% vs 72% (P = .0142) based on H&E slides alone. When H. pylori immunohistochemical slides were provided, the diagnostic accuracy was significantly improved to comparable rates (96% glass vs 99% digital, P = 0.2199). Furthermore, differences in practice settings (academic/subspecialized vs community/general) and the duration of sign-out experience did not significantly impact the accuracy of detecting H. pylori on digital slides. We concluded that digital whole slide images, although amenable in different practice settings and teaching environments, does present some shortcomings in accuracy and precision, especially in certain circumstances and thus is not yet fully capable of completely replacing glass slide review for identification of H. pylori. We specifically recommend reviewing glass slides and/or performing ancillary stains, especially when there is a discrepancy between the degree of inflammation and the presence of microorganisms on digital images.

Utilization of modern temporary contraceptive methods and its predictors among reproductive-aged women in India: insights from NFHS-5 (2019-21).

Evidence from various studies on modern contraceptive methods shows that the utilization varies greatly. The present study aimed to estimate the magnitude and determinants for temporary modern contraceptive utilization among reproductive-aged (15-49 years) women in India. We analysed National Family Health Survey-5 data using the "svyset" command in STATA software. Modern contraception utilization was estimated using the weighted prevalence, and its correlates were assessed by multivariable regression by reporting an adjusted prevalence ratio (aPR) with 95% confidence interval (CI). QGIS 3.2.1 software was used for spatial analysis of different temporary modern contraceptives. The mean (SD) age of 359,825 respondents was 31.6 (8.5) years with 75.1% (n = 270,311) and 49.2% (n = 177,165) of them being from rural area and having completed education up to secondary school, respectively. The overall utilization of modern temporary contraception was 66.1% [95%CI: 65.90-66.35, n = 237,953]. Multigravida (vs. nulligravida) [aPR = 2.13 (1.98-2.30)], higher education of husband (vs. not educated) [aPR = 1.20 (1.14-1.27)], urban (vs. rural) [aPR = 1.06 (1.03-1.10)], watching television less than once a week (vs. not at all) [aPR = 1.04 (1.01-1.08)], divorced (vs. married) [aPR = 0.65 (0.45-0.94)], and Scheduled Tribe (ST) (vs. unreserved) [aPR = 0.92 (0.88-0.96)] were significant independent determinants. The highest utilization of male condoms, IUCDs, pills and injections were in Himachal Pradesh (86%), Nagaland (64%), Tripura (85%), and Ladakh (20%), respectively. Out of every ten reproductive-aged (15-49 years) women in India, six are using temporary modern contraceptive methods. More intervention strategies should be planned, considering factors like gravida, education, residence, health promotion and caste to attain replacement fertility level.

Effectiveness of mHealth Interventions for Monitoring Antenatal Care among Pregnant Women in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

Antenatal care (ANC) is essential in maternal and child health since it provides care to pregnant women from conception through to labour in order to ensure a safe pregnancy and childbirth. In recent years, mobile health (mHealth) interventions have emerged as a promising solution to improve maternal and child health outcomes in low- and middle-income countries (LMICs). The present study aimed to conduct a systematic review and meta-analysis of trials to evaluate the effectiveness of mHealth interventions to monitor prenatal care among pregnant women in LMICs. A systematic literature review was conducted using the databases CINHAL, Embase, MEDLINE, and PsycINFO on the effectiveness of mHealth interventions in monitoring the antenatal care of pregnant women. The study selection, data extraction of the included articles, and quality appraisal were assessed. Our study included six studies considering 7886 participants. All articles were from low- and middle-income countries (LMICs). Antenatal mothers who used a mobile health intervention were more likely (RR = 1.66, 95%CI = 1.07-2.58, I2 = 98%) to attend ANC check-ups when compared with the women who did not use any mobile health applications or did not receive any short message services. mHealth technologies are being utilised more and more to increase care accessibility and improve maternal and fetal health. Policymakers should prioritise the integration of mHealth interventions into maternal healthcare services in LMICs, ensuring that they are cost-effective, accessible, and sustainable and that healthcare workers are trained to deliver these interventions effectively.

Immunomodulatory effect of a proprietary polyherbal formulation on healthy participants: A single- blind, randomized, placebo- controlled, exploratory clinical study.

Context: Clinical study for immunity. Aims: The present study aimed to assess the effect of proprietary polyherbal formulation (PPHF), labelled as Kofol immunity tablets (KIT) on innate and adaptive immune responses in healthy individuals, on the backdrop of COVID-19 pandemic. Settings and Design: Single-blind, randomized, placebo-controlled, exploratory study in institutional setting. Materials and Methods: Post Ethics Committee permission, screened healthy individuals of either sex aged 18-35 years were randomized to PPHF/Placebo for 2 months. Major assessment variables included peak expiratory flow rate (PEFR), questionnaire-based immune status, perceived stress, and quality of life (QOL) with immune-specific cell counts (CD4+, CD8+), cytokines (interferon gamma [IFN-γ], tumor necrosis factor-alpha [TNF-α], interleukin 10 [IL-10]), and oxidative stress in red blood cells (RBCs) (malondialdehyde (MDA), glutathione peroxidase [GPx]), done at day 60. Statistical Analysis Used: Mean ± standard deviation and paired/unpaired t-test for parametric data analysis while median (range) and Wilcoxon Rank sum test/Mann-Whitney test for nonparametric data analysis, were done. Categorical data was analyzed using Chi-square test. GraphPad InStat software, version 9 was used with p < 0.05, as the level of statistical significance. Results: Of 52 recruited, 28 individuals completed the study. PPHF significantly increased PEFR, improved immune status along with QOL compared to baseline. It also decreased perceived stress from moderate and severe grade to mild. Serum IFN-γ levels remained almost constant post-PPHF treatment. PPHF significantly decreased MDA and increased GPx in RBCs. Significant decrease and increase in TNF-α and IL-10, respectively, were seen in PPHF group. The safety parameters post-PPHF treatment remained within normal reference ranges. Conclusions: PPHF is an efficacious and safe formulation with immunomodulatory potential.

Source-apportionment and spatial distribution analysis of VOCs and their role in ozone formation using machine learning in central-west Taiwan.

This study assessed the machine learning based sensitivity analysis coupled with source-apportionment of volatile organic carbons (VOCs) to look into new insights of O3 pollution in Yunlin County located in central-west region of Taiwan. One-year (Jan 1 to Dec 31, 2021) hourly mass concentrations data of 54 VOCs, NOX, and O3 from 10 photochemical assessment monitoring stations (PAMs) in and around the Yunlin County were analyzed. The novelty of the study lies in the utilization of artificial neural network (ANN) to evaluate the contribution of VOCs sources in O3 pollution in the region. Firstly, the station specific source-apportionment of VOCs were carried out using positive matrix factorization (PMF)-resolving six sources viz. AAM: aged air mass, CM: chemical manufacturing, IC: Industrial combustion, PP: petrochemical plants, SU: solvent use and VE: vehicular emissions. AAM, SU, and VE constituted cumulatively more than 65% of the total emission of VOCs across all 10 PAMs. Diurnal and spatial variability of source-segregated VOCs showed large variations across 10 PAMs, suggesting for distinctly different impact of contributing sources, photo-chemical reactivity, and/or dispersion due to land-sea breezes at the monitoring stations. Secondly, to understand the contribution of controllable factors governing the O3 pollution, the output of VOCs source-contributions from PMF model along with mass concentrations of NOX were standardized and first time used as input variables to ANN, a supervised machine learning algorithm. ANN analysis revealed following order of sensitivity in factors governing the O3 pollution: VOCs from IC > AAM > VE ≈ CM ≈ SU > PP ≈ NOX. The results indicated that VOCs associated with IC (VOCs-IC) being the most sensitive factor which need to be regulated more efficiently to quickly mitigate the O3 pollution across the Yunlin County.

Kocuria kristinae - An unusual opportunistic pathogen in head and neck malignancy: Case series from central India's regional cancer care centre.

Introduction: Kocuria kristinae is a commensal organism, sometimes considered as a lab contaminant, but its repeated isolation from clinical samples in immunocompromised patients should raise red flags. Materials and Methods: We confirmed the infection with re-isolation of the organism from the same site before starting treatment. For the identification of Kocuria kristinae we used IDGP cards on VITEK 2 compact system. Antibiotic susceptibility test was done manually following CLSI guidelines 2018 for Coagulase-negative staphylococci. Results: A total of 510 major head neck oncosurgeries were performed during the period of two years. Out of which 120 patients had skin and soft tissue infections. Out of these infected patients, 90 were culture positive and of these Kocuria kristinae were isolated in 12 patients. Resistance to penicillin and oxacillin is seen in all isolates. Conclusion: Kocuria kristinae should not be ignored as a commensal flora or lab contaminant in immunocompromised hosts. Its Increase in resistance pattern is a matter of concern. It is an ignored opportunistic pathogen whose detailed sensitivity test should be developed to treat patients timely and effectively.

Successful heparin-perfusion therapy for complete thrombosis of the intra- and extrahepatic portal and mesenteric vein. A case report and literature review.

The initial treatment of acute and subacute portal vein thrombosis, which is the most common cause of portal vein occlusion, consists of intravenous anticoagulation with heparin, but there is still a huge uncertainty among physicians regarding the role of more invasive therapies. We report a 61-year-old male patient, who presented in our emergency room with a subacute complete thrombosis of the intra- and extrahepatic portal vein, mesenteric vein, with associated venous congestion of 20-30 cm length of the small intestine with a quick and complete remission of the portal vein thrombosis under sole i.v. heparin-perfusor therapy without any complications. Molecular genetic analysis found combined genetic mutations of the gene factor 2 (c.20210G>A, heterozygotic), SERPINE1 (-675 5G>4G, heterozygotic), and the MTHFR gene. Along with this interesting case, we also present the recent status of portal vein thrombosis and portal vein occlusion in the literature.

Tubercular Osteomyelitis of the Orbit Presenting as Periorbital Cellulitis.

PURPOSE: Osteomyelitis of the orbital bones presenting as an orbital cellulitis is a rare form of extrapulmonary tuberculosis (TB). We report a rare case of tubercular osteomyelitis of the orbital bones presenting as a periorbital cellulitis. CASE REPORT: A seven-year-old female child presented to our tertiary eye care center with swelling involving the right eyelids and the right cheek for two months. She had been provisionally diagnosed elsewhere as pre-septal cellulitis and had been given oral antibiotics. We clinically diagnosed her as orbital cellulitis, but her non-responsiveness to intravenous antibiotics prompted us to get a contrast enhanced computed tomography (CECT) of the orbit and paranasal sinuses, which was suggestive of tubercular etiology. However, the patient had no foci for TB elsewhere. We used a relatively new, but rapid test, called Cartridge-based Nucleic Acid Amplification Test (CBNAAT) on the pus aspirate which was positive for TB. Thereafter, the patient was started on anti-tubercular treatment to which she responded wonderfully. CONCLUSION: A high index of suspicion should be kept for TB infection in cases of orbital cellulitis with unusual clinical behavior in an endemic region such as India.

Wet deposition of total dissolved nitrogen in Indo-Gangetic Plain (India).

Very limited information on the magnitude and environmental impacts of both inorganic and organic forms of nitrogen (N) wet deposition is available in India. Molar concentrations of inorganic (NH4+ and NO3-) and organic N in rainwater were monitored at three different land use sites in Indo-Gangetic Plain (IGP) during the monsoon period (June-September) of 2017. It has been observed that dissolved organic N (DON) contributed significantly to the total dissolved N (TDN) ranging from 5 to 60%. Dissolved inorganic N (DIN = NH4+ + NO3-) concentration was recorded as high as 221.0 µmol L-1 at urban site to as low as 65.9 µmol L-1 at the rural site. A similar pattern was also observed for DON. NH4+ contribution to TDN had the order urban megacity (65%) > urban (70%) > rural (75%). Agriculture and animal husbandry are the primary sources of NH4+ emissions in the rural site. However, NO3- has shown a contrasting trend at these sites (25%, 15%, and 8%, respectively). Wet deposition fluxes of atmospheric TDN were observed to be higher at urban sites. This can be attributed to a variety of local sources such as vehicular emission, microbial emissions, biomass burning, human excreta due to higher population density, and transportation from surrounding areas, as observed from concentration weighted trajectories (CWT) model and cluster analysis. Upwind region of IGP has experienced major influence of air mass transported from agriculturally rich northwest part of India. However, both the downwind sites have experienced by-and-large the influence of south-westerly air masses originated over the Arabian Sea. This study has found that the DON contributes significantly to TDN, and therefore, its inclusion for nitrogen budget assessment in South Asia is emphasized.

Recurrent cardiac myxoma: A case report.

Cardiac myxomas are the most common benign tumors of the heart. They are most commonly found in the left atrium, followed by a right atrium and rarely in the left ventricle. Herein, we report a rare case of left ventricular myxoma in a patient who had twice undergone removal of left atrial myxoma. Complete removal of the tumor through aortotomy, without causing fragmentation led to the uneventful recovery of the patient.

A rare case of double orifice mitral valve: A case report.

Double-orifice mitral valve is a rare congenital anomaly being associated with other cardiac defects and rarely presented in isolation. Valve function can be preserved for long and it is usually an incidental finding. We present an unusual case of double-orifice mitral valve with mitral regurgitation in a middle-aged man associated with the atrial septal defect, highlighting the role of three-dimensional transesophageal echocardiography.

Left ventricle pseudoaneurysm-recurrence following surgical repair.

Left ventricular (LV) pseudoaneurysm is a rare complication following free wall rupture post transmural myocardial infarction or left ventricular surgery. A lot of imaging modalities like echocardiography, computerised tomography and cardiac magnetic resonance imaging are available to diagnose it. Echocardiography plays a significant role in delineating the cavity, orifice and impact on the surrounding structures. We present a case of LV pseudoaneurysm recurrence following surgical repair.

Tiny Flies: A Mighty Pest That Threatens Agricultural Productivity-A Case for Next-Generation Control Strategies of Whiteflies.

Whiteflies are a group of universally occurring insects that are considered to be a serious pest in their own way for causing both direct and indirect damages to crops. A few of them serve as vectors of plant viruses that are detrimental to the crop in question and cause an actual loss in productivity. A lot of attention is focused on pest control measures under the umbrella of IPM. In this review, we attempt to summarize the existing literature on how and why whiteflies are a serious concern for agriculture and society. We reviewed why there could be a need for fresh insight into the ways and means with which the pest can be combated. Here, we have emphasized next-generation strategies based on macromolecules, i.e., RNA interference and genetic engineering (for the expression of anti-whitefly proteins), as these strategies possess the greatest scope for research and improvement in the future. Recent scientific efforts based on nanotechnology and genome editing, which seem to offer great potential for whitefly/crop pest control, have been discussed. Comprehensive apprehensions related to obstacles in the path of taking lab-ready technologies into the farmers' field have also been highlighted. Although the use of RNAi, GM crops, nanotechnologies, for the control of whiteflies needs to be evaluated in the field, there is an emerging range of possible applications with promising prospects for the control of these tiny flies that are mighty pests.

Waste candle soot derived carbon nanoparticles: A competent alternative for the management of Helicoverpaarmigera.

Helicoverpaarmigera (Lepidoptera: Noctuidae) is considered as one of the foremost pests of global agriculture. This pest is contemplated for substantial economic loss apart from the socio-economic and environmental costs associated with its control. Farmers adopt several strategies for the control of this pest but the cost associated with these strategies is always a big question. This is the first time when waste-candle soot (CS) derived carbon nanoparticles (CNPs) are explored for the putative toxicity to H. armigera. In the present study, the entomotoxic effects of CNPs on H. armigera were investigated and compared with that of commercially available multi-walled carbon nanotubes (MWCNTs). Larvae fed on both the nanomaterials exhibited significant weight reduction and enhanced levels of antioxidant enzymes. Moths developed from the treated larvae exhibit very poor egg-laying capacity and poor egg hatchability. However, these entomotoxic effects were found more noticeable in larvae and moths fed on CNPs that eventually led to the complete cessation of the population build-up of H. armigera. These findings advocate the candidature of CNPs as a cost-effective alternative for efficient control of H. armigera in pest management programs.

[18-C-6H3O+]: an in-situ generated macrocyclic complex and an efficient, novel catalyst for synthesis of pyrano[2,3-c]pyrazole derivatives.

Synthesis of small aromatic heterocycles is of greater importance in the organic chemistry due to their vibrant applications in pharmaceuticals, agrochemicals and veterinary products. Pyranopyrazoles are one such class of heterocycles associated with numerous applications. Hence herein we report a multicomponent crown ether catalyzed, ultrasound irradiated methodology to make different functionalized pyranopyrazoles in a single step. This technique involves the in-situ generation of [18-C-6H3O+][OH-] complex, which in turn activates the aromatic aldehyde and aids in the facile nucleophilic addition.