Background and Aim: Pectoral nerve blocks have emerged as a promising technique for postoperative pain management following breast surgery. The addition of dexamethasone to local anesthetics has been shown to prolong the duration of nerve blocks, enhancing analgesic efficacy. This study investigates the efficacy of PECS-1 and PECS-2 blocks with dexamethasone for postoperative pain management and preventing chronic postmastectomy pain (CPM) syndrome. We evaluated time to first rescue analgesia, pain intensity (Numerical Rating Scale), analgesic consumption, and adverse effects. The findings may provide valuable insights into optimizing pain management strategies for breast surgery patients. Materials and Methods: This prospective, double-blind, randomized trial included 60 patients undergoing elective modified radical mastectomy (MRM). The participants were randomly allocated to one of two groups: Group B – patients in this group received an ultrasound-guided PECS block with 0.25% bupivacaine (28 mL) combined with 2 mL of saline. Group BD: Patients in this group received an ultrasound-guided PECS block with 0.25% bupivacaine (28 mL) combined with dexamethasone 8 mg (2 mL). Results: Group BD exhibited a statistically significant reduction in 24-h analgesic consumption compared to Group B (P < 0.001). The duration to first rescue analgesia was notably longer in Group BD (462.33 ± 22.23 min) versus Group B (378.67 ± 50.36 min), with P < 0.001. Group BD demonstrated significantly lower Numeric Rating Scale compared to Group B (P < 0.001). Adverse effects were comparable across the study groups. Conclusion: This study concludes that PECS blocks with bupivacaine and dexamethasone provide effective postoperative pain relief, reduce opioid use, and prolong pain relief duration in breast cancer surgery patients. By minimizing intense pain, this approach may reduce the risk of CPM syndrome, improving patient outcomes. Integrating PECS blocks with dexamethasone into perioperative care may enhance patient care and reduce long-term pain risks.

Stripe rust caused by Puccinia striiformis f. sp. tritici (Pst) remains a major constraint to wheat productivity, necessitating rapid and accurate detection tools for effective disease management. In the present study, an effector-mediated diagnostic approach was developed targeting the Puccinia NPR1 interactor (PNPi) gene for precise detection of stripe rust infection in wheat. Specific primers were designed to amplify a 146 bp fragment of the single-copy PNPi effector gene. The assay demonstrated high specificity, successfully amplifying all tested Indian stripe rust pathotypes while showing no cross-reactivity with other rust pathogens or 42 non-target fungal species. The developed PCR assay reliably detected the pathogen in wheat leaf samples as early as 5 days post-inoculation, confirming its utility for early diagnosis. A SYBR Green-based quantitative PCR (qPCR) assay was further optimized, exhibiting a strong linear relationship (R2 > 0.989) between cycle threshold (Cq) values and pathogen DNA concentration, with a detection limit as low as 0.007 ng μL−1. Field validation revealed a strong correlation between pathogen load and disease severity, with Cq values inversely related to infection levels. Overall, the effector-based qPCR assay provides a rapid, sensitive, and highly specific tool for early detection and quantification of stripe rust, enabling improved disease surveillance and management strategies.

BACKGROUND:The management of Mirizzi syndrome has been primarily surgical, but there are no comparisons between surgical and digital single-operator cholangioscopy (dSOC)-guided treatment. The objective of this study was to compare the safety and other outcomes of the two approaches. METHODS:A large multicenter international retrospective analysis was conducted comparing dSOC and surgery in patients with type II-IV Mirizzi syndrome between January 2005 and June 2023. Patients with postsurgical anatomy, Mirizzi type I or V, or previous cholecystectomy were excluded. RESULTS:290 patients were included (dSOC, n = 176; surgery, n = 114). At baseline, patients undergoing dSOC were older P = 0.006) and exhibited more co-morbidities. While technical success was lower with dSOC (89.8 % vs. 96.5 %; P = 0.04), the need for reintervention was comparable after a median follow-up duration of 741.5 days (interquartile range [IQR] 320-1781) vs. 346 days (IQR 67-1220; P = 0.009). Overall adverse events (10.2 % vs. 41.2 %; P < 0.001) and severe adverse events (1.7 % vs. 15.8 %; P < 0.001) occurred less frequently with dSOC, findings that were confirmed with propensity score-matching. A lower need for hepaticojejunostomy (8.2 % vs. 25.4 %; P = 0.006) and lower rate of conversion to open surgery (6.0 % vs. 22.8 %; P = 0.009) were observed in patients undergoing elective cholecystectomy following dSOC compared with the primary surgery group. CONCLUSIONS:Our study demonstrates that the use of dSOC for Mirizzi syndrome is effective, showing superior safety despite being used to treat patients with more underlying co-morbidities. dSOC seems valuable in downgrading the extent of subsequent surgery, by potentially reducing the need for hepaticojejunostomy and conversion to open surgery.

OBJECTIVE OF STUDY:To determine the clinical, radiological and histopathological changes in maxillary antrum compared to ethmoid sinuses in patients with chronic sinusitis with nasal polyposis. STUDY DESIGN:This is a prospective observational study conducted in a tertiary care hospital. MATERIALS AND METHODS:A total number of 30 primary cases of inflammatory nasal polypi, not responding to conservative measures, were evaluated clinically and radiologically. They underwent endoscopic sinus surgery, and all sinuses were cleared of diseases. Histopathological evaluation of both maxillary sinus and ethmoid sinuses was done and compared. RESULTS:Among 30 patients with 60 nasal cavities studied, nearly all showed partial or complete opacity of their maxillary antrum and blocked osteomeatal complexes on radiology. But, only a few patients (16.67%) showed frank polypi in their antrum intra-operatively. On histopathology, antral mucosa showed rare involvement, and the submucosa showed variable grades of inflammation, but it was significantly less compared to ethmoids. CONCLUSION:Although maxillary antrum gets involved clinically in nearly all polyposis cases, pathological involvement is unlikely compared to ethmoid sinuses. Thus, it indicates a secondary inflammatory change in maxillary sinuses rather than primary involvement.

A rapid, sensitive, and specific visual detection assay for Mycobacterium avium subsp. paratuberculosis (MAP) was developed and optimized using a polymerase spiral reaction (PSR) method. A pair of primers was designed targeting MAP specific sequence of IS900 putative transposes (p43) gene, and PSR results were assessed using agarose gel electrophoresis and colour change with SYBR Green-I dye. The assay was optimized using water bath and the optimum reaction time and temperature for MAP-PSR were 60 min and 64 °C, respectively. The sign of target amplification can be visualized by naked eyes as SYBR Green-I change its colour due to intercalation with amplified products. The developed assay demonstrated that the primers specifically detected MAP and showed no cross-reaction with other common Mycobacterium. The sensitivity of the PSR assay for MAP detection was 122 fg or ~ 23 copy number of the template. The MAP-PSR assay was also evaluated using 100 clinical samples, and a total 59 samples were found positive. When same samples were tested by conventional PCR, 50 samples were found positive, and all PCR positive clinical samples were found positive by MAP-PSR too. In conclusion the developed MAP-PSR assay is simple, rapid, specific, and sensitive, and thereby very suitable for application and promotion in the field and resource limited laboratories.

ABSTRACT Background: Pancreaticoduodenectomy (PD) is a complex procedure with significant postoperative morbidity. Associated sarcopenia could be a potential risk for increased post-operative complications. Methods: Patients who had undergone pancreaticoduodenectomy between July 2019 to December 2020 were included in the study. Preoperative comprehensive sarcopenia assessment was done by hand grip strength test, Dual energy X-ray absorptiometry (DEXA) scan and gait speed test. Only myopenia was also assessed by DEXA scan in all the patients. Post-operative outcomes were recorded and the association of preoperative sarcopenia with postoperative complications were analyzed. Results: Of 47 patients assessed, 36 patients were finally included (Median age -58 years (IQR-51,68) years, 26 male). The five (13.8%) had sarcopenia confirmed on comprehensive assessment. Thirteen (36.5%) patients had myopenia on DEXA assessment. The major Clavien-Dindo complications were significantly higher in sarcopenia (40% vs 6.6%, P=0.04) and similarly, grade C DGE (40% vs 0, P=0.04) was also more frequent in patients with sarcopenia. The patients with myopenia only did not have a significant correlation with post-operative complications. (15.4% vs 8.7% P=0.66). Conclusion: Comprehensive assessment using muscle strength and muscle quantity is essential for sarcopenia diagnosis. Preoperative sarcopenia is a significant risk factor for post-operative complications.

Objective This article studies the role of dual-energy computed tomography (DECT) enterography with iodine material decomposition images in activity assessment of tuberculosis of the bowel. Materials and Methods Twenty-four patients with suspected tuberculous bowel involvement were enrolled in this prospective study. All patients underwent DECT enterography as well as endoscopy and biopsy. Quantitative assessment of iodine overlay images was done to map the absolute and relative iodine uptake in involved segments of the bowel and lymph nodes. Comparison of the iodine uptake was made with histopathological activity grading using Spearman's correlation. The temporal change in the iodine uptake on posttreatment versus pretreatment group was recorded and tested for significance using Student's t -test and Wilcoxon signed rank test. Results Excellent correlation was found between grading of inflammatory activity on histopathology and relative bowel enhancement measured on iodine maps (Spearman's rho 0.895, p < 0.001). Attenuation values and absolute iodine uptake in the bowel showed no significant difference in the pre- and posttreatment groups ( p > 0.05), while relative bowel as well as lymph nodal enhancement were significantly different ( p = 0.001 and 0.008, respectively). Conclusion Uptake on the iodine maps in DECT data set showed correlation with histopathology as well as posttreatment resolution, suggesting the role of DECT in disease activity assessment.

The present study was carried out during winter (rabi) season 2021–22 at ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana to ascertain genetic basis of stripe rust (YR) resistance with bread wheat (Triticum aestivum L.) resistant stock, IC0640204 and considering seven susceptible genotypes, namely IC261932, IC532880, IC536321, EC609338, Restorer5, Restorer37 and Restorer38 for YR, summer nursery 2022 and 2022–23. IC0640204 conferred YR resistance against 10 pathotypes at the seedling stage, including the prevalent YR races, 110S119 and 238S119. Seven highly susceptible bread wheat genotypes were crossed with IC0640204 during winter (rabi), 2021–22 at Karnal and the developed materials were advanced at Dalang Maidan, Himachal Pradesh. During rabi 2022–23, the monogenic dominant inheritance (3R:1S) was observed in the F2 generation at both Karnal and Durgapura locations, indicating presence of a major gene in the genotype IC0640204. Furthermore, agronomically promising genotypes were screened at eight locations each against stripe, leaf and stem rusts under artificial epiphytotic conditions to identify multiple rust resistant genotypes. The genotypes WAP2206, WAP2207 and WAP2208 conferred seedling resistance (0) against the most virulent YR pathotypes, 110S119 and 238S119. The genotype WAP2206 showed resistance against stem (ACI:0.7) and brown rusts (ACI:0.3), while WAP2207 conferred resistance against stripe (ACI:0.6) and leaf rusts (ACI:0.3). The widely grown wheat cultivars such as HD2967, HD3086 and DBW187 have been compromised against these newly evolved YR races. Therefore, IC0640204 has great significance for delivering resistance into the breeding programs. Several deployed genes for leaf and stem rust namely, Lr9, Lr19, Lr26, Lr28 and Sr24 and Sr25 have been overcome by the virulent pathotypes. The genotypes, WAP2206, WAP2207, WAP2211 and WAP2212 can be deployed for pre-emptive breeding and enriching allelic diversity.

The Indian Society of Gastroenterology has developed an evidence-based practice guideline for the management of caustic ingestion–related gastrointestinal (GI) injuries. A modified Delphi process was used to arrive at this consensus containing 41 statements. These statements were generated after two rounds of electronic voting, one round of physical meeting, and extensive review of the available literature. The exact prevalence of caustic injury and ingestion in developing countries is not known, though it appears to be of significant magnitude to pose a public health problem. The extent and severity of this preventable injury to the GI tract determine the short and long-term outcomes. Esophagogastroduodenoscopy is the preferred initial approach for the evaluation of injury and contrast-enhanced computed tomography is reserved only for specific situations. Low-grade injuries (Zargar grade ≤ 2a) have shown better outcomes with early oral feeding and discharge from hospital. However, patients with high-grade injury (Zargar grade ≥ 2b) require hospitalization as they are at a higher risk for both short and long-term complications, including luminal narrowing. These strictures can be managed endoscopically or surgically depending on the anatomy and extent of stricture, expertise available and patients’ preferences. Nutritional support all along is crucial for all these patients until nutritional autonomy is established.

Rickets is a common metabolic bone disease in children, primarily caused by vitamin D deficiency. This study aimed to compare the efficacy of oral weekly vitamin D supplementation and injectable stoss therapy in treating nutritional rickets in Indian children. This prospective, randomized, controlled trial was conducted over 18 months at a tertiary care center. Forty children aged 6 months to 16 years with clinical, biochemical, and radiological evidence of nutritional rickets were enrolled and randomly assigned to receive either oral vitamin D3 (60,000 IU weekly for 10 weeks) or a single intramuscular injection of vitamin D3 (600,000 IU). Clinical, biochemical, and radiological assessments were conducted at baseline and at 3 weeks, 6 weeks, 3 months, and 6 months post-treatment. Both treatment regimens significantly improved vitamin D, calcium, phosphorus, alkaline phosphatase, and parathyroid hormone (PTH) levels, with no significant differences between the groups. Radiological healing, assessed by Thacher’s score, was achieved in both groups by 6 months. While both treatments were effective, injectable stoss therapy resulted in a more sustained increase in vitamin D levels and may offer better compliance due to its single-dose administration. No cases of local skin complications or vitamin D toxicity or symptomatic hypercalcemia were observed. Oral weekly and injectable stoss therapies are both effective and safe for treating nutritional rickets. Injectable stoss therapy may be more suitable for the Indian population due to its cost-effectiveness and lower compliance demands. Serum parathyroid hormone (PTH) levels emerged as a useful early marker of rickets severity as well as treatment response. Early diagnosis and treatment are crucial to prevent long-term skeletal deformities.

PURPOSE:Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in the world. Early detection would be greatly enhanced if accurate and cost-effective diagnostic biomarkers for CRC were accessible. The development of blood tests would evidently lower the screening cost of CRC detection. The aim of the present study was to examine the prospective of plasma miRNAs as non-invasive biomarkers for CRC screening. METHODS:The expressions of miR-21 and miR-145 in the plasma of colorectal adenocarcinomas and normal healthy controls were quantified by using TaqMan miRNA assays. MiRNA expression levels were also correlated with commonly used clinicopathological features of CRC. RESULTS:Out of 30 CRC patients, 19 were male and 11 were female. The Mean age of patients was 51.3 ±14.6 years. A statistically significant increase in expression of miR-21 was observed in CRC patients' as compared to healthy controls (p<0.001). A significant association between miR-21 expression and age group (p=0.002) was noticed. Also, a statistically significant difference (p=0.015) between miR-21 expression and tumor location in the proximal and distal sites of the colon was observed in CRC patients. Further, a statistically significant downregulation of miR-145 expression was observed in the plasma of CRC patients as compared to healthy controls (p<0.05). This is the first study to report a significant association between miR-21 expression, age group, and tumor location in CRC patients. CONCLUSION:The present study thus emphasises that the appraisal of miR-21 and miR-145 plasma levels may serve as a promising non-invasive screening tool for the early detection of colorectal cancer.

Background Gallbladder cancer (GBC) is highly aggressive. Diagnosis of GBC is challenging as benign gallbladder lesions can have similar imaging features. We aim to develop and validate a deep learning (DL) model for the automatic detection of GBC at abdominal ultrasound (US) and compare its diagnostic performance with that of radiologists. Methods In this prospective study, a multiscale, second-order pooling-based DL classifier model was trained (training and validation cohorts) using the US data of patients with gallbladder lesions acquired between August 2019 and June 2021 at the Postgraduate Institute of Medical Education and research, a tertiary care hospital in North India. The performance of the DL model to detect GBC was evaluated in a temporally independent test cohort (July 2021-September 2022) and was compared with that of two radiologists. Findings The study included 233 patients in the training set (mean age, 48 +/- (2SD) 23 years; 142 women), 59 patients in the validation set (mean age, 51.4 +/- 19.2 years; 38 women), and 273 patients in the test set (mean age, 50.4 +/- 22.1 years; 177 women). In the test set, the DL model had sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of 92.3% (95% CI, 88.1-95.6), 74.4% (95% CI, 65.3-79.9), and 0.887 (95% CI, 0.844-0.930), respectively for detecting GBC which was comparable to both the radiologists. The DL-based approach showed high sensitivity (89.8-93%) and AUC (0.810-0.890) for detecting GBC in the presence of stones, contracted gallbladders, lesion size <10 mm, and neck lesions, which was comparable to both the radiologists (p = 0.052-0.738 for sensitivity and p = 0.061-0.745 for AUC). The sensitivity for DL-based detection of mural thickening type of GBC was significantly greater than one of the radiologists (87.8% vs. 72.8%, p = 0.012), despite a reduced specificity. Interpretation The DL-based approach demonstrated diagnostic performance comparable to experienced radiologists in detecting GBC using US. However, multicentre studies are warranted to explore the potential of DL-based diagnosis of GBC fully.

BACKGROUND:Caustic ingestion is associated with long-term sequelae like esophageal stricture, gastric cicatrization, and long-term risk of dysplasia or even carcinoma. However, only a few small studies have explored histopathological aspects of caustic-induced esophageal/gastric injury. MATERIALS AND METHODS:We retrospectively evaluated specimens of patients undergoing surgery due to caustic ingestion-related complications from 2008 to 2020. Pathological examination was conducted by two independent gastro-pathologists to evaluate the extent and depth of the caustic injury, presence or absence of tissue necrosis, type and degree of inflammation, or presence of any dysplastic cells. RESULTS:A total of 54 patients underwent surgical exploration during the inclusion period and complete details of 39 specimens could be retrieved. The mean age of the included patients was 28.66 ± 9.31 years and 25 (64.1%) were male. The majority of patients (30; 76.9%) had a history of caustic ingestion more than three months before the surgery and the presence of long or refractory stricture was the most common indication for the surgery (20; 51.28%). In the resected specimen, a majority of patients had superficial esophageal or gastric ulcer (90.6%; 60.0%), transmural inflammation (68.8%; 65.6%), transmural fibrosis (62.5%; 34.4%), and hypertrophied muscularis mucosa (78.13%; 53.3%). However, none of the patients had dysplasia in the resected esophageal or gastric specimens. CONCLUSION:Caustic ingestion leads to mucosal ulceration, transmural inflammation, and transmural fibrosis which might be the reason for refractory stricture in such patients.