Management of ruptured renal angiomyolipoma with bilateral staghorn calculi

Dear Editor,We present a case of ruptured renal angiomyolipoma(AML)and bilateral renal staghorn calculi.We discuss about the management of this patient by angioembolization,partial nephrectomy,and pyelolithotomy,followed by contralateral interval percutaneous nephrolithotomy(PCNL).Our case is a 40-year-old male who presented with history of dull aching and dragging sensation in bilateral flanks of 6-month duration.He was admitted and evaluated at other hospital for dizziness,sweating,and loss of consciousness.He was found to have bilateral staghorn calculi and left AML and was referred to our institute for further management after initial stabilization.The proper written and informed consent was taken from the patient for management as well as publication of the report and images,maintaining the patient’s anonymity.

Enhanced Clustering Based OSN Privacy Preservation to Ensure k-Anonymity, t-Closeness, l-Diversity, and Balanced Privacy Utility

Online Social Networks (OSN) sites allow end-users to share agreat deal of information, which may also contain sensitive information,that may be subject to commercial or non-commercial privacy attacks. Asa result, guaranteeing various levels of privacy is critical while publishingdata by OSNs. The clustering-based solutions proved an effective mechanismto achieve the privacy notions in OSNs. But fixed clustering limits theperformance and scalability. Data utility degrades with increased privacy,so balancing the privacy utility trade-off is an open research issue. Theresearch has proposed a novel privacy preservation model using the enhancedclustering mechanism to overcome this issue. The proposed model includesphases like pre-processing, enhanced clustering, and ensuring privacy preservation.The enhanced clustering algorithm is the second phase where authorsmodified the existing fixed k-means clustering using the threshold approach.The threshold value is determined based on the supplied OSN data of edges,nodes, and user attributes. Clusters are k-anonymized with multiple graphproperties by a novel one-pass algorithm. After achieving the k-anonymityof clusters, optimization was performed to achieve all privacy models, suchas k-anonymity, t-closeness, and l-diversity. The proposed privacy frameworkachieves privacy of all three network components, i.e., link, node, and userattributes, with improved utility. The authors compare the proposed techniqueto underlying methods using OSN Yelp and Facebook datasets. The proposedapproach outperformed the underlying state of art methods for Degree ofAnonymization, computational efficiency, and information loss.

Impact of vericiguat on heart failure with reduced ejection fraction:a review

Introduction:Heart failure is a major public health issue with a prevalence of about 26 million people worldwide.Reduced nitric oxide availability,lower soluble guanylate cyclase(sGC)activity,and decreased cyclic guanosine monophosphate(cGMP)production are the causes of HF's development.Vericiguat prescribed under the brand name Verquvo was approved by U.S.Food and Drug Administration(FDA)in January 2021.It is a novel agent and the first sGC stimulator which helps to treat patients suffering from heart failure with reduced ejection fraction(HFrEF).Objective:The mechanism of action(cGMP pathway)of vericiguat,its clinical trials,its use in the treatment of heart failure,and its possible future aspects in therapeutic recommendations are all covered in this review.It will also raise awareness amongst healthcare professionals about the pharmacokinetic and pharmacodynamic parameters,dosing,administration,and drug-related problems of this new drug.Methods:Various databases for drug review were used in this review like PubMed,Medline,Google scholar,Drug bank,U.s.FDA,Medscape,and European society of cardiology guidelines.A total of 58 articles were screened out of which 39 articles were included in this review.Results:This review discusses vericiguat's mechanism of action(cGMP pathway),clinical studies,application in the treatment of heart failure,and potential future considerations in therapeutic recommendations.It will also educate healthcare professionals about the new drug's pharmacokinetics and pharmacodynamics,dose,administration,and drug-related problems.Conclusion:After hospitalization for HFrEF,the 5-year survival rate is just 25%,and disease morbidity and death are stil significant.As adjunctive therapy for individuals with heart failure and a low ejection fraction,vericiguat has a moderate level of effectiveness.Vericiguat's efficacy as an adjunct therapy to different drugs used to cure HF has to be further investigated.Vericiguat's safety and dosage in patients who have severe renal or hepatic illness need to be studied further.

Comparison of efficacy of metformin and D-chiro-inositol on clinical biomarkers in patients with polycystic ovarian syndrome:an open label study

Objective:Polycystic ovary syndrome(Pcos)is a pathophysiological disorder affecting reproductive and metabolic indices in females.The present study was designed to compare the efficacy of metformin and D-chiroinositol in PcoS patients.Methods:In a tertiary care hospital in North India,prospective observational research was undertaken on 1o0 patients with PCOS,which was diagnosed based on European Society of Human Reproduction and Embryology Guidelines and ultrasound of lower abdomen.The study involves various clinical characteristics into consideration for the determination of statistical significance(P<0.05)in PCOS patients.Student's t-test along with the association between PCOS and patients taking metformin and D-chiro-inositol,as well as their impact on various biochemical parameters,were investigated finally using Pearson Correlation Analysis.Results:This study comprises 50 patients taking metformin and 50 patients taking D-chiro-inositol in women suffering from PCOS.Body mass index(BMI)and waist-to-hip ratio(WHR)were statistically significant(P<0.05)within the groups of both metformin and D-chiro-inositol.Biochemical parameters such as luteinizing hormone(LH),follicle stimulating hormone(FSH),anti-mullerian hormone(AMH)and glycated hemoglobin(HbA1c)were found to be statistically significant(P<0.05)in both groups.LH,FSH and AMH(14.40±0.52;14.28±0.53;1.99±0.10)were comparatively lower in patients taking D-chiro-inositol as compared to metformin group(14.17±0.42;19.88±1.01;2.61±0.04).HbA1c(3.71±0.08)with P<0.05 was found to be decreased more in metformin group as compared to patients taking D-chiro-inositol(4.90±0.09).A positive correlation was found between HbAlc and LH in metformin,&HbAlc and FSH in D-chiro-inositol groups,respectively.Conclusion:The results indicate that D-chiro-inositol shows better results in reducing clinical variables involved in causing PCOS as compared to metformin whereas metformin has better glycemic control in PCOS patients.

Right versus left fully robotic live donor nephrectomy and open kidney transplantation:Does the laterality of the donor kidney really matter?

Objective Robotic-assisted live donor nephrectomy(LDN)is being gradually adopted across transplant centers.The left donor kidney is preferred over right due to anatomical factors and ease of procurement.We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys.Methods All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed.Results Out of 196 robotic LDN(49[right]vs.147[left]),10(5.1%)donors had intra-operative events(6.1%[right]vs.4.8%[left],p=0.71).None of the LDN required conversion to open surgery.The operative times were comparable for the two groups.Nausea(13.3%)was the most common post-operative complication.There was no mortality in either LDN group.Herein,we report our outcomes on 156 recipients(39 right and 117 left allografts)excluding robotic implants,exports,and pediatric recipients.There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival(100.0%vs.98.1%,p=0.45)or graft survival(93.9%vs.97.1%,p=0.11),or delayed graft function(7.7%vs.5.1%,p=0.55).Conclusion Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes.Right LDN was not associated with higher incidence of complications compared to left LDN.Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.

The role of drug utilization evaluation in medical sciences

Background:Drug utilization evaluation(DUE)is defined by the World Health Organization(WHO)and focuses on the medical,social,and economic consequences of pharmaceutical marketing,distribution,prescribing,and usage in society.The WHO recommends a physician to every 1000 people.According to the recent data from the Health Ministry in 2019,in which 1.16 million doctors are of active population with just 80%,or 0.9 million,practicing.As a result,a ratio of 0.68 doctors for every 1000 people,which is much below as per the WHO reports.This article describes history,types,WHO guidelines,need and purpose of DUE.Objective:The main aim of this paper is to provide information about the rational use of medication in outpa­tient and inpatient department with special emphasis of DUEs.It also provides awareness directly to healthcare professionals,researchers,academicians,pharmacist and nurses to reduce the irrationality of medicines.Methods:The method used to compile this review information gathered from websites,Google scholar,PubMed,Research gate,and studies published on DUE from July 20 to Oct 22 were included as source of information.Results:We studied more than 35 published study on DUE,that reveals most of the physicians prescribed branded drugs not generic drugs,but WHO prescribing indicator allows to prescribe generic drugs in the hospital pharmacy to maintain better inventory control.It may also help to prevent pharmacist misunderstanding during dispensing.Conclusion:The use of generic prescription names avoids the possibility of medication product duplication and lowers patient costs.It is important to remember that incorrect medication prescriptions have impact on both patients and their family members.WHO indicators identify irrational prescribing behaviours to make therapy more rational and cost-effective.

Revolutionizing patient care:the latest advancements in clinical pharmacy practice

The world of healthcare is constantly evolving,and one area that has seen significant advancements in recent years is clinical pharmacy practice.1 In the past,pharmacists were mainly responsible for dispensing medications and ensuring that patients understood how to use them safely.However,the role of clinical pharmacists has expanded significantly in recent years,and they now play a critical role in optimizing medication regimens,providing personalized patient counselling,and collaborating with other healthcare professionals to improve patient outcomes.2-3 In the extension of the role of the clinical pharmacist,nowadays health economics is also added,which includes cost-benefit analysis,cost-effectiveness analysis,cost-utilization analysis and costminimization analysis,which will ultimately help the policy and decision makers to make the cost of the drugs affordable,so that all the patient population can avail the benefits.

Public health progression and related challenges

Public health has experienced a significant improvement over the last decades.Two factors are responsible for this:increased scientific knowledge through research and acceptance of health as a public responsibility.Conducting more health surveys and publishing the results has been proven to substantially improve public health particularly in developing nations.Public health research remains of utmost importance to society.1-3 Both non-communicable and communicable diseases are on the rise and they are of great concern regardless of age,sex or any other individualistic categorization.

Review of the potential of mesenchymal stem cells for the treatment of infectious diseases

The therapeutic value of mesenchymal stem cells (MSCs) for the treatment of infectious diseases and the repair of disease-induced tissue damage has been explored extensively. MSCs inhibit inflammation, reduce pathogen load and tissue damage encountered during infectious diseases through the secretion of antimicrobial factors for pathogen clearance and they phagocytose certain bacteria themselves. MSCs dampen tissue damage during infection by downregulating thelevels of pro-inflammatory cytokines, and inhibiting the excessive recruitment ofneutrophils and proliferation of T cells at the site of injury. MSCs aid in theregeneration of damaged tissue by differentiating into the damaged cell types orby releasing paracrine factors that direct tissue regeneration, differentiation, andwound healing. In this review, we discuss in detail the various mechanisms bywhich MSCs help combat pathogens, tissue damage associated with infectiousdiseases, and challenges in utilizing MSCs for therapy.

Molecular identification of sex in Hippophae rhamnoides L. using isozyme and RAPD markers

In many dioecious plants, gender affects economic value, breeding schemes and opportunities for commercial harvests. Hippophae rhamnoides L. is a dioecious plant species in which female genotypes are commercially preferred over male genotypes. Its berries have rich medicinal, nutritional and pharmaceutical properties because of their large amounts of vitamins, essential oils, proteins, fatty acids, free amino acids and flavanoids. Primary limitation for breeding H. rhamnoides L. is its dioecious nature, since gender cannot be identified by traditional methods. Therefore, some reliable and quick methods need to be developed. This commu- nication deals with the development of isozyme and RAPD markers for early sex identification in this dioecious tree. The isozyme analysis was conducted with four enzyme systems, viz. peroxidase, esterase, malate dehydrogenase and catalase. The peroxidase enzyme system produced a female specific sex marker, which successfully differentiated between the staminate and pistillate geno- types ofH. rhamnoides L. Thirty five random decamer primers were used in our study and one male sex linked marker was identified. OPD-20 （5＇-ACTTCGCCAC-3＇） displayed a band at 911 bp that expressed polymorphism between male and female genotypes. The staminate and pistillate genotypes could be distinguished using RAPD marker OPD-209n. These results revealed the immense poten- tial of peroxidase isozyme patterns and RAPD as genetic markers for sex identification in H. rhamnoides L.

A rare presentation of cystic nephroma in a young adult

Cystic nephroma is a rare benign renal lesion with non-specific presenting symptoms.This tumour has a bimodal age distribution presenting in children between 3 months and 2 years and in adults over 30 years of age.There is male preponderance with a 2:1 male to female ratio in the childhood whereas it is commoner in females in adults.It is uncommon in the age-group of 5 yearse30 years.We describe a case of cystic nephroma in a 25-year-old female which was managed by partial nephrectomy.

Pulmonary vein thrombosis in a patient with polycythemia vera

Pulmonary vein thrombosis(PVT) is a rarely encountered disease entity with varied clinical presentations. It is usually associated with lung carcinoma, lung surgeries and as a complication of the radiofrequency catheter ablation procedure for atrial fibrillation. Its clinical manifestations can vary from mild hemoptysis to lung infarction with hemodynamic compromise. A 76-year-old male presented with a 2-d history of pleuritic left sided chest pain. His past medical history included polycythemia vera, atrial fibrillation, coronary artery disease, pulmonary embolism and pulmonary hypertension. Chest radiograph was normal, troponins were normal and the 12-lead electrocardiogram did not show any ischemic changes. A computerized tomography pulmonary angiogram revealed a filling defect in the left lower lobe pulmonary vein. He was treated with subcutaneous enoxaparin and his symptoms improved. This case highlights a rare etiology of chest pain and the first reported case of the association of polycythemia vera and pulmonary vein thrombosis. A high index of suspicion is required for appropriate diagnostic work up. PVT can mimic pulmonary embolism. The diagnostic work up and treatment strategies depend on acuity of presentation.

Cosmology using long gamma-ray bursts: statistical analysis of errors in calibrated data

We investigate direction dependence and non-Gaussian features in high-z cosmological data using ?_(χ~2) and ?_χ statistics and the Kolmogorov-Smirnov test. These techniques are applied on a set of calibrated long gamma-ray bursts(GRBs) and its combination with recent Type Ia supernovae data(Union2). Our statistical analysis shows a weak but consistent direction dependence in both the data sets.The analysis also indicates a non-Gaussian nature of errors in both data sets.

Optimal Policy for EOQ Model with Two Level of Trade Credits in One Replenishment Cycle

In general, a supplier/retailer frequently offer trade credit to stimulate their respective sales. The main purpose of this paper is to investigate the optimal supplier/retailer’s replenishment decisions under two levels of trade credit policy within the economic order quantity (EOQ) framework. This paper deals with the supplier/retailer’s inventory replenishment problem under two levels of trade credit in one replenishment cycle. A different approach of two levels of trade credit is used, which give more freedom to the supplier/retailer in business. In addition, the easy-to-use procedure is developed to efficiently find the optimal cycle time for the retailer under minimizing annual total relevant cost. Finally, a numerical example is given to illustrate these results.

On the non-Gaussian errors in high-z supernovae type Ia data

The nature of random errors in any data set is Gaussian, which is a well established fact according to the Central Limit Theorem. Supernovae type Ia data have played a crucial role in major discoveries in cosmology. Unlike in laboratory experiments, astronomical measurements cannot be performed in controlled situations. Thus, errors in astronomical data can be more severe in terms of systematics and non-Gaussianity compared to those of laboratory experiments. In this paper, we use the Kolmogorov-Smiruov statistic to test non-Gaussianity in high-z supernovae data. We apply this statistic to four data sets, i.e., Gold data （2004）, Gold data （2007）, the Union2 catalog and the Union2.1 data set for our analysis. Our results show that in all four data sets the errors are consistent with a Gaussian distribution.

A transitioning universe with time varying G and decaying Λ

We present a model of a universe that transitions from an early deceleration phase to the current acceleration phase under the framework of general relativity, in the presence of gravitational coupling G（t） and cosmological terms A（t）. Einstein＇s field equations have been solved by considering the time dependent deceleration parameter （DP） which renders the scale factor e = （thekt）1/m where m, n and k are positive con- stants. The cosmological term （A （t）） is found to be positive and a decreasing function of time, which supports the result obtained from observations of type Ia supernovae. The geometrical and kinematical features of the model are examined in detail.

Delivery of Bull Dog Calf from a Hydroallantoic Murrah Buffalo

An 8 years old Murrah buffalo in its 5^(th) party was presented with the history of 9 month of gestation and sudden bilateral abdominal distension since last 25 days.Animal was 7 anorectic with pale mucus membrane and had staggering gait.Per vaginum examination revealed closed cervix with intact cervical seal.By transrectal palpation only the fluid in the uterus could be palpable.Based on history and clinical examination findings,it was diagnosed as hydroallantois.Parturition was induced using cloprostenol and dexamethasone.Beside this an intracervical injection of closprostenol was also given on 6 o’clock and 12 o’clock position(250μg each)of external os to hasten the cervical dilation.A dead bulldog calf was removed with manual traction after 26 hours of initial treatment.It was concluded that the cloprostenol and dexamethasone are effective for the induction of parturition in animals suffering from hydroallantois provided fluid from the allantoic sac is removed slowly.

Lighting up plants with near-infrared fluorescence probes

Fluorescence imaging is a non-invasive and highly sensitive bioimaging technique that has shown remarkable strides in plant science. It enables real-time monitoring and analysis of biological and pathological processes in plants by labeling specific molecular or cellular structures with fluorescent probes. However, tissue scattering and phytochrome interference have been obstacles for conventional fluorescence imaging of plants in the ultraviolet and visible spectrum, resulting in unsatisfactory imaging quality. Fortunately, advances in near-infrared(NIR) fluorescence imaging technology(650-900 nm) offer superior spatial-temporal resolution and reduced tissue scattering, which is sure to improve plant imaging quality. In this review, we summarize recent progress in the development of NIR fluorescence imaging probes and their applications for in vivo plant imaging and the identification of plant-related biomolecules. We hope this review provides a new perspective for plant science research and highlights NIR fluorescence imaging as a powerful tool for analyzing plant physiology, adaptive mechanisms, and coping with environmental stress in the near future.

Tempering of exhausted T cells to comprehend their adaptive response for suitable clinical translation

Although cancer immunotherapy has taken center stage,exhaustion of T cells is undeniably one of the major problems preventing it from being fully successful[1].Certainly,reversal of T-cell exhaustion or dysfunction is of great importance for developing new strategies and restoring immune function.Nevertheless,counterarguments about the adverse effect of reversing T-cell exhaustion(leading to overactivation of T cells and cytotoxicity)and even their irreversible properties have been quite common in scientific debates.With more to be discovered about the reasons for T-cell failure,a better understanding of the molecular factors/determinants[2,3]that shape/remodel“heterogeneous”dysfunctional T cells in cancer makes clear sense.Indeed,two recent publications in Nature immunology have described the intriguing perspective of T-cell exhaustion[4,5].Of interest,Vignali et al.focused on the hypoxia-driven CD39-dependent suppressor function of exhausted T cells,whereas Saadey et al.emphasized restoring the epigenetic balance of TGFβ1/BMP signaling in exhausted T cells to unlock responsiveness to immune checkpoint blockade therapy.

Bifurcation behaviors analysis of a plankton model with multiple delays

A mathematical model describing the dynamics of toxin producing phytoplankton- zooplankton interaction with instantaneous nutrient recycling is proposed. We have explored the dynamics of plankton ecosystem with multiple delays; one due to gestation period in the growth of phytoplankton population and second due to the delay in toxin liberated by TPP. It is established that a sequence of Hopf bifurcations occurs at the interior equilibrium as the delay increases through its critical value. The direction of the Hopf bifurcation and the stability of the bifurcating periodic solutions are determined using the theory of normal form and center manifold. Meanwhile, effect of toxin on the stability of delayed plankton system is also established numerically. Finally, numerical simulations are carried out to support and supplement the analytical findings.