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Introduction: Tuberculosis (TB) continues to pose a significant public health problem worldwide. Tuberculous meningitis (TBM) is the most devastating form of extrapulmonary TB however other forms of central nervous system (CNS) disease include tuberculoma and spinal arachnoiditis. TBM carries high mortality even for a patient who is already receiving treatment. The difficulty in diagnosis often leads to a delay in treatment and subsequent mortality. The emergence of Xpert ultra has improved the rapid detection of MTB and rifampicin resistance in CSF and is the preferred diagnostic tool in TBM.Case: In this case report we present a 33 years patient of concern who presented with progressive lower limb weakness associated with pain and paresthesia for 4 months, admitted via the Orthopedic unit with a diagnosis of spinal mass (meningioma, neurofibroma, or nerve sheath tumor) for which biopsy was done and revealed a chronic inflammatory process, necrotic bone lesions with no granulomas and no malignancy, he was later diagnosed with tuberculous meningitis and promptly started anti-tuberculous therapy with a dramatic recovery and improvement in neurological function.Conclusion: Tuberculous meningitis conditions have high morbidity and mortality yet diagnosis and start of treatment continue to experience an important delay. Clinicians should keep in mind the limitations of clinical presentation due to pleiotropy and current diagnostics and should employ a combination of diagnostic modalities in addition to a high index of suspicion to prevent morbidity in patients with TBM.

In the year 2020, COVID-19 spread globally. The increase in cases and deaths has created problems such as stress, anxiety, and depression in health workers.The health care workers (inclusive of students in professional practices are vulnerable to psychiatric pathology due to their exposure to the virus, their increased risk of contagion and even death, overload of functions, pressure for decision-making, the close experience of patients, relatives, and colleagues’ pain, and the requirement to function at the top of capacity.The objective of this research is to analyse the personal and academic factors of stress development in nursing students, during clinical practices in the COVID-19 context.It is a cases and controls study, with 154 students who attended clinical practices during the period of May-August 2020. High levels of stress were found in 61% of students, 34 of these had difficulties concentrating (OR: 3.08), 64 participants reported fear of contact with COVID-19 patients, (OR: 1.9) and 68 participants were identified with inadequate knowledge of COVID-19 transmission (OR: 1.5).The study found that the transition to virtual classes as a strategy to reduce contagion increases three times the possibilities of developing stress, another variable that doubles the risk of stress is the fear of caring for a patient with COVID-19 who has not been diagnosed.

Background and objectives: YKL-40, a C-reactive protein belongs to the positive acute-phase protein. It is also known as Human chitinase-3-like protein 1(HCI3L1) and is closely related to both acute and chronic inflammation. The present study aimed to detect and estimate the levels of YKL-40 in gingival crevicular fluid (GCF) in patients with healthy periodontium, chronic periodontitis, and rheumatoid arthritis with chronic periodontitis. Materials and methods: Forty-five patients in the age range of 25-55years were included in the study. Patients were divided into three groups: Group I-15 Periodontal healthy patients, Group II-15 Chronic Periodontitis patients, and Group III-15 Rheumatoid arthritis with chronic periodontitis patients. Clinical parameters recorded were Plaque index, Gingival index, Gingival bleeding index, probing depth, and Relative attachment level. GCF samples were analyzed using ELISA. p - value < 0.05 was considered statistically significant. Results: The highest mean YKL-40 concentration in GCF was observed in rheumatoid arthritis with Chronic periodontitis. The mean concentration of YKL-40 in GCF showed a three to four folds increase in its levels when compared to healthy controls (p < 0.001). Contrary, GCF YKL-40 levels between Group II and Group III were not significant.Conclusion: With the increase in severity of periodontal destruction from healthy periodontium to chronic periodontitis, there was a substantial increase in the concentration of YKL-40 in GCF. Correlation of GCF YKL-40 with clinical parameters demonstrated increased severity of the diseases increased its levels

Ceftriaxone is having many uses and useful “third-generation” cephalosporin that necessitates being given every day. Ceftriaxone acts as binds to one or many of the penicillin-binding proteins which inhibit the final transpeptidoglycan step of peptidoglycan synthesis in the bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.Ceftriaxone-associated biliary adverse events in children less than eighteen years cause biliary pseudolithiasis and scarcely nephrolithiasis often happen in children less than eighteen years after receiving overdoses of ceftriaxone. Ceftriaxone perhaps binds with calcium and figure insoluble chelation leading to biliary pseudolithiasis. Cholelithiasis, increased biliary thickness, and pseudolithiasis rarely happen in a period of being a child, but there are two modes of distribu¬tion described by two peaks, the first being at an early stage of development and the second is a period of life when a child develops into an adult. Hyperbilirubinemia is significantly contraindicated for neonates administrated ceftriaxone, particularly premature neonates, because of the displacement of bilirubin from albumin-binding sites and increase in blood concentrations of free bilirubin. A child than one month old and a child less than twelve-month old in special are at great risk of poor results because of bilirubin encephalopathy. Coincident administrations of ceftriaxone with aminoglycosides such as gentamycin and loop diuretics (furosemide) perhaps increase the risk of nephrotoxicity (rapid degeneration in the kidney function to the toxic outcome of double or triple medications). Coincident administrations of ceftriaxone with anticoagulant medications such as warfarin are associated with bleeding due to increased prothrombin times, which is reversible with vitamin K.

Background: The prevalence of cyanotic congenital heart diseases (CCHD) varies world wide. It accounts for a third of all congenital heart diseases. The common CCHD includes Tetralogy of Fallot(TOF), transposition of the great arteries (TGA), total anomalous pulmonary venous return (TAPVR), truncus arteriosus, and tricuspid atresia (TA). Less common variants include Ebstein’s anomaly, Hypoplastic left heart syndrome, pulmonary atresia, and single ventricle. Children of all ages can be are affected. The commonest presentation is cyanosis. Bradycardia and/or congenital heart block are rare presentations and mostly occur in the presence of an associated congenital atrioventricular block.Case report: We report a case of a 3-month-old female presenting with congenital heart block and bradycardia at 3 months of age and found to have complex cyanotic congenital heart disease on echocardiography.Conclusion: An infant presenting with bradycardia clinically should be screened for congenital heart defect as bradycardia may be an ominous sign of serious underlying cardiac defect.

Background: Arterial stiffness has been considered an independent predictor of cardiovascular disease in addition to the traditionally known cardiovascular risk factors. Objectives: This study aimed to investigate the associations between arterial stiffness with left ventricular mass index and carotid intima-media thickness in the hypertensives. Methods: A descriptive cross-sectional study compared a control group in 210 study subjects (105 hypertensives and 105 normotensives). Measuring left ventricular mass index by echocardiography and carotid intima-media thickness by carotid doppler ultrasonography. Pulse wave velocity was measured using the Agedio B900 device and the Agedio K520 application. The manual method was measured by the ankle-brachial index.Results: There was a statistically significant positive correlation between pulse wave velocity and age (r = 0.922, p < 0.001). The ankle-brachial index had a statistically significant positive correlation at a weak level with left ventricular mass index and carotid intima-media thickness, in which the coefficient r was equal to 0.219 (p < 0.05) and 0.250 (p < 0,001), respectively. Pulse wave velocity also had a statistically significant positive correlation at a weak level with left ventricular mass index and carotid intima-media thickness, in which the coefficient r was equal to 0.188 (p < 0.05) and 0.289 (p < 0,001), respectively. Pulse wave velocity had a multivariable linear correlation with gender, pulse, mean blood pressure, and ankle-brachial index with statistical significance; and they were written in the form of the following equation: Pulse wave velocity (R2: 41.3%) = 0.641*(Gender) – 0.027*(Pulse) + 0.043*(Mean blood pressure) + 8.378*(Ankle-brachial index) – 3.254.Conclusion: Arterial stiffness was statistically correlated with left ventricular mass index and carotid intima-media thickness in the hypertensives. Through the above research results, we suggest that the hypertensives should be combined with the evaluation of hemodynamic parameters and arterial stiffness for contributing to the diagnosis and detection of cardiovascular complications, thereby improving the quality of monitoring and treatment in hypertensive patients.

Helminthiasis is also known as worm infection, is any macroparastic disease of humans and other animals in which a part of the body is infected with parasitic worms known as helminths. Anthelmintic agents are medicines that used for treatment and inhibition of parasitic infections caused by helminths; which involve both flat worms, such as, flukes and tapeworms and round worms, such as, nematodes. Anthelmintics are categorized into groups depending on the basis of their identical chemical structure and mode of action. Thiabendazole, mebendazole, and albendazole belong to benzimidazoles group of antihelmenthic medicines. From benzimidazoles group of antihelmenthic, thiabendazole was first discovered in 1961 and already a mentioned number of more benzamidazoles were interpolated as wide spectrum anthelmintics. Praziquantel has a particular effect on the enveloping layer of trematodes and increases permeability of calcium ion influx leading to uncontrolled muscle contraction and paralysis. Praziquantel has a particular toxic effect on schistosome parasites, where its mode of action has been resulted more extensively than in cestodes. Coadministration of mebendazole with CYP450 inhibitors medications such as cimetidine, ketoconazole and etc may be increases plasma levels of mebendazole, by extending the half-life and decreasing plasma clearance.

The study has been undertaken to investigate the determination of digital financial fraud (cyber fraud) in Jamtara district of Jharkhand (the hub of cyber fraudsters) the basic tools & techniques which are used by the offenders and to find out the socio-economic condition of their social life & find the new challenging in cybercrime investigation and to find out the more secure way of digital financial flow, by using survey research method and work on secondary as well primary data which was related to this study, cybercrime especially financial fraud becomes the new challenging task for law enforcement agencies.Digital financial frauds are being within an undefined jurisdiction so it becomes more difficult to investigate the cases and due to other different public as well private sectors of service providers like the telecom companies and the banks are unable to make the defensive system for their customer also. This is the main reason for delays in cyber-related case investigation and a very low conviction rate in cyber-related cases.

Introduction: Studies have shown a high prevalence of sexual dysfunction in Medical residents. Psychological, interpersonal, and sociocultural factors play an important role in sexual vulnerability. In addition, distraction or interference in the cognitive process of the erotic stimulus plays an important role in the development of sexual dysfunction. The aim of our study was to determine the prevalence of sexual dysfunctions among a sample of married female medical resident doctors and to explore its relation with cognitive distraction during sex.Subjects and methods: This was a cross-sectional study, which was carried out in October 2017 with 70 married female medical resident doctors. We used the Female Sexual Function Index (FSFI) for sexual functioning assessment and the cognitive distraction during sex scale. Results: The mean age of women was 30.52 years. They had been married for 6.04 years on the mean. The majority (74%) had children. According to the FSFI, 40% of resident doctors had sexual dysfunction. The mean cognitive distraction during sex score was 4.37.In our study, women with female sexual dysfunction reported significantly lower sexual desire score = 3.2 vs. 4.1 and p = 0.03) and arousal (score = 3.è vs. 4.7 and p = 10-3), decreased lubrication (score = 3.8 vs. 5.1; p = 10-3), less sexual satisfaction (score = 3.9 vs. 5.8; p = 10-3)and higher orgasm difficulties (score = 3.4 vs. 5.1; p = 10-3). Yet, our results highlighted that women with female sexual dysfunction presented significantly more cognitive distraction during sex (score = 3.9 vs. 4.6; p = 0.03). Conclusion: According to our study, it appears that the prevalence of FSD in medical resident doctors is considerable. Besides, intrusive thoughts and cognitive distraction during sexual intercourse are importantly associated with sexual functioning. Therefore, several measures should be implemented in this population to prevent or act on these factors.

Cutaneous metastases of urothelial tumors are extremely rare. Iatrogenic tumor implantations are the main cause of this type of metastasis. We report the case of a 75-year-old patient who underwent nephroureterectomy with the removal of a bladder collarette for a tumor of the upper excretory tract; 3 years later the patient developed parietal swelling at the level of the lumbotomy scar. A histological study of the mass after surgical excision confirmed that it was a secondary location. Through a study of the literature, we will detail the clinical and paraclinical particularities of such a location as well as its impact on the prognosis.

Soft-bodied is the intermediate host of helminthiases, in the body of which several development stages of larval forms of helminths occur. There is the highest population density of mollusks in the areas of ruminant grazing, which leads to mass infection of animals with trematodes. To destroy the intermediate host of helminths in agricultural production, molluscicidal remedies of synthetic and plant origin are used. The work aimed to determine the molluscicidal effectiveness of a plant remedy based on Silene Latifolia in conditions of natural pastures. The material for work was the green mass of the plant S. Latifolia obtained in the warm season from roots, leaves, stems, flowers, and seeds. By grinding this plant, a powder with a particle size of 1-3 mm was obtained. Then, the powder was extracted with ethyl alcohol. The obtained product (concentrate) was an amorphous gel-like mass of dark green color with a specific smell and well soluble in water. Fieldwork in natural pastures was carried out on 5 biotopes with an area of 4-25 m2. Three species of gastropods were recorded from freshwater mollusks in the biotopes: Planorbis planorbis, Planorbarius corneus, Physa fontinalis, Lymnaea truncatula, and L. palustris. The results of experiments conducted in the conditions of pastures indicate a high molluscicidal activity of the studied plant agent on pond fish, intermediate hosts of trematodes pathogens. The effectiveness of the developed molluscicide on gastropods, when treated with a working solution (10.0 g/l) is from 98.1 to 100%.

Allogeneic hematopoietic cell transplantation often represents the only solution for several poor-prognosis hematologic malignancies. The curative strategy for patients with synchronous hematologic disorders is always difficult and, in most cases, ineffective. Herein, we report an unusual case of synchronous hematologic disorders successfully treated with an “ad-hoc” conditioning regimen followed by allogeneic hematopoietic cell transplantation.

Plant-parasitic nematodes are ubiquitous in nature and cause large losses in agriculture. The current concerns regarding the use of chemical pesticides have increased the interest in new control alternatives. One of these is the one based on Bacillus thuringiensis (Bt). These Gram-positive bacteria have the ability to synthesize pesticide proteins during sporulation. Some of these proteins have nematicidal properties. Studies have shown that preparations of certain strains of Bt can prevent or slow down the infestation of phytonematodes. The expression of some Bt nematicidal genes in transgenic plants has also demonstrated their effectiveness. Bt is nowadays an effective ecological alternative for controlling plant-parasitic nematodes.

Introduction: The world is currently facing the SARS-CoV-2 pandemic with evolving 2nd wave. The COVID-19 patients present most commonly with Severe Acute Respiratory Illness (SARI) in an emergency room with acute onset fever, cough, and breathlessness. However, not all SARI cases as per definition are due to COVID-19 infection, which is well proven in this case series of 113 cases of SARI. This is just the opposite of the other SARI series done in the pre-COVID-19 era. Also, no previous SARI case series data has shown significant association with Diabetes Mellitus, including new-onset diabetes thus figuring out the major Pathophysiological association of COVID-19 with glucose metabolism and has a bearing on the pathogenesis, treatment, and outcome of COVID-19 infection and perpetuity of pandemic of this magnitude. Here we raise concern for the first time about the growing association of an infectious pandemic with the lifestyle disorders which are non-communicable diseases but carry with them the potential of fertile soil for rapidly spreading epidemics.Aim and objective: To find out the etiology, clinical profile, treatment outcome, and mortality rate in different sub-groups of SARI cases in a tertiary care hospital and the incidence of new-onset Diabetes Mellitus in them and to investigate theoretically the hypothesis that maintaining normal glucose metabolism could prevent progression of a mild Flu-like illness (FLI) to a severe form of Severe Acute Respiratory Illness (SARI) and consequent complications such as Cytokine Storm Syndrome and Multi-Organ failure.Design: Retrospective, single-center case series of 113 SARI patients at a tertiary care hospital in Agra India between 1 March- 30 October 2020.Main outcome: The demographics, clinical, pathological, imaging, and treatment outcome data were collected. The SARI cases analyzed were defined as “Severe acute respiratory infections (SARIs) an acute respiratory illness of recent onset (within seven days) manifested by fever (≥38°C), cough and shortness of breath or difficulty in breathing requiring hospitalization and were sub-classified according to the primary etiology producing SARI in them. The findings were compiled and compared. Conclusion: Of the 113 patients of SARI – 32.7 %were associated with Diabetes, with 9.74% new-onset Diabetes and 26 % previously known Diabetes. This was mainly due to SARS-CoV-2 (24 Diabetics out of 52 COVID-19 cases- 46.1 %).The Average hospitalization stay of SARI cases was 10 days with a maximum in SARS-CoV-2 and a minimum stay of 5.22 days in Bacterial Pneumonia and 5.66 days in Koch’s Lungs.The death rate was maximum (4 out of 26) 15.3%. Hospitalized TB/Koch’s Lung patients who presented as SARI and 3.8% in Bacterial Pneumonia, 2.43% in SARS-CoV-2, and <1% in Sepsis.Those SARI cases who were euglycemic at the time of initial presentation recovered early and carried a good prognosis with less mortality as compared to those who were hyperglycemic on presentation. Also, those FLI cases who maintained euglycemia or did not have any other risk factor which predisposes them to stress (Diabetes, Prolonged fasting, Obesity, major organ disorder, Psychological disorder, and Cancer) did not progress to SARI as the endogenous steroid secretion and sympathetic activation did not occur, the intracellular pH levels remained in the alkaline range.10.18% of cases developed new-onset diabetes (a total of 11 cases) out of which 10 were in COVID-19. Thus 19.2% incidence of new-onset diabetes in SARS-CoV-2 and a prevalence of 26.9% in SARS-CoV-2, making total diabetes 46.1% in SARS-CoV-2, and out of all SARI cases, 26 % of patients developed pulmonary fibrosis with consequent long-term complications. In COVID-19 patients, it was seen only in diabetics SARS CoV-2 male patients, thus no death in non-diabetic females in COVID-19 in this case series.

The overall incidence of meningitis in infants 0-90 days is low; however, it remains a serious cause of morbidity and mortality among affected patients. It is standard of care to perform lumbar punctures as part of the work-up of fever in the first four weeks of life and sick-looking babies up to the age of 90 days. This particular procedure is often refused by parents, and physicians are left to predict the possibility of meningitis based on blood culture results.The aim of this study is to determine whether it would be safe to rule out meningitis based on a negative blood culture in this age group.

Steady-state VEPs, have been used to estimate visual acuity since the 1970s and allow responses to a range of stimulus sizes to be collected rapidly- with particular utility in infants. However, the assessment of children with cortical visual impairment is a bigger challenge that lead to the development of the Step VEP. Its initial evaluation revealed that accuracy and precision were poorer for pediatric patients than for optically degraded normal adults and that it was not necessarily successful in every child. Statistical models generated the equations: VAO = 0.56 VAStep (r2 = 0.75, F = 60.93, p = 0.000) and VAPL = 0.45 VAStep (r2 = 0.82, F = 156.85, p = 0.000), supported by a recent a systematic review of VA comparisons showing that recognition VA (optotypes) agrees more closely than discrimination VA (PL) with VEP VA. In combination, Step VEPS and subjective tests allowed complete assessment in 96% of patients, with incomplete Step VEPS much more likely to be partially successful than not, and more likely to be partially successful than incomplete subjective tests. This supports the rationale that Step VEPs maintain attention by limiting the time spent stimulating away from an individual’s threshold of spatial resolution. For the small number of patients in whom VA cannot be estimated, alternative stimuli and methods of presentation are proposed. 

Durum wheat (Triticum turgidum L. var. durum) is a member of the Poaceae family and tetraploid (genomes of AABB) with 28 chromosomes (2n=4x=28). Narrow genetic variability was a problem to develop genotypes with better adaptation to different agro-ecologies. Therefore, the objective of this study was to investigate the genetic variability, divergence, and path coefficient analysis of durum wheat genotypes by using morphological traits and identifying essential yield-related traits of durum wheat, and to identify promising candidate genotypes to be used in future durum wheat breeding program. The study was carried out on 81 genotypes and the experiment was laid out in a triple lattice design with an arrangement of 9 x 9 x 3 treatment, which made 243 experimental units. Results obtained on genetic variability, path coefficient, and genetic divergent analysis among yield-related traits are presented here under the present study. Generally, the present study revealed the existence of significant genetic variability among the tested genotypes for different traits helpful for direct and indirect selection.This study recommended that the potential durum wheat genotypes 214552, 208150, 238516, 5645, Mekuye, 236984, 7960, 7152, 231599, and 208242 could be used for durum wheat breeding programs for yield and yield component traits improvement under similar agro-ecologies.

Cancer metastasis to the pituitary gland is rare, but in most cases, it originates from a late-stage breast tumor or lung cancer. The most common symptoms of metastasis to the pituitary gland are diabetes insipidus and visual disturbance. The common site of metastasis is the posterior portion of the pituitary gland because it is highly vascularized. Metastases to this site represent 1% of all tumors [1]. Metastasis to the pituitary gland is difficult to diagnose by hormonal analysis and magnetic resonance imaging of the brain and requires biopsy for confirmation [2].

The wheat production (Triticum aestivum L.) in Argentina is the third in importance after soybeans and corn (source: BCR). 

Cerebral brain injuries (CBIs) account for up to 20% of all injuries in boxing. Approximately 97% of sports-related brain injuries are mild, their neurological symptoms are unexpressed, and young, strong, highly motivated athletes tend to dismiss the severity of their injuries. This may lead to an underestimation of the severity and extent of brain injuries. Changes in computed tomography (CT) and magnetic resonance imaging (MRI) in mild traumatic brain injury are absent in the early stages, making diagnosis difficult. Frequent repetitive traumatic brain injuries, including mild brain injuries, can result in functional and structural brain lesions that affect athletes’ performance and, in the long term, significantly impair their quality of life. Also, the consequences of cerebral brain injuries, including mild brain injury, can be affected by the individual condition of the Circle of Willis.