This view point focuses on increasing and retaining Indian MRO market within India by improving the maintenance standard through EASA approved maintenance organizations and by change in existing investment approach. An overview on MRO market demand and the market retention with respect to outsourced services during pre covid-19 is detailed. The existing standard of maintenance with respect to global standards was compared to identify the well-focused training need. Need of EASA framework implementation for maintenance training to improve existing training standard are detailed. Focus to improve leasing and investment approaches in MRO are discussed to retain and increase the MRO market. Effective business retention and focused growth to become a global MRO hub can be achieved by adopting EASA regulatory framework for maintenance training and MRO, supported by the developments in aircraft leasing sector. Addressing the EASA training need and leasing opportunities can be helpful in convincing authorities and market leaders to realize the potential of India to be a global MRO hub. This view point can be thought provoking in retaining the Indian MRO market by addressing the need of EASA standardization in maintenance training with respect to improve the maintenance quality and to attract investment and leasing. Ways of increasing the MRO business through change in existing aircraft leasing approach and need of EASA framework in maintenance training and standardization are provided to convince authorities and market leaders to realize that India can become future global MRO hub.

Variations in the newborns’ oral cavity have been an enduring interest to the pediatric dentist. The occurrence of natal and neonatal teeth is a rare anomaly, which for centuries has been associated with diverse superstitions among many different ethnic groups. Natal teeth are more frequent than neonatal teeth, the ratio being approximately 3:1. The purpose of this case report is to review the literature related to the natal teeth folklore and misconceptions and discuss their possible etiology and treatment.

HighlightsFaciobrachial dystonic seizures (FBDS) are caused by autoantibodies to leucine-rich glioma-inactivated1 proteins, a component of the voltage-gated potassium channel complex (VGKC-complex) and precede the clinical presentation of limbic encephalitis.The exact pathophysiology of FBDS is not known and whether they are seizures or movement disorder is still debated.We suggest the fronto-temporo-basal ganglia network involving the medial frontal and temporal regions along with the corpus striatum and substantia nigra being responsible for the clinical phenomenon of FBDS.The varied clinical, electrical and imaging features of FBDS in our cases and in the literature are best explained by involvement of this network.Entrainment from any part of this network will result in similar clinical expression of FBDS, whereas other electro-clinical associations and duration depends on the extent of involvement of the network.

AbstractKlebsiella pneumoniae is one of the leading causes of nosocomial infections. Carbapenem-resistant (CR) K. pneumoniae are on the rise in India. The biofilm forming ability of K. pneumoniae further complicates patient management. There is still a knowledge gap on the association of biofilm formation with patient outcome and carbapenem susceptibility, which is investigated in the present study.K. pneumoniae isolates from patients admitted in critical care units with catheters and ventilators were included. K. pneumoniae (n = 72) were tested for antimicrobial susceptibility as recommended by CLSI 2019 and subjected to 96-well microtitre plate biofilm formation assay. Based on optical density at 570 nm isolates were graded as strong, moderate and weak biofilm formers. Subset of strong biofilm formers were subjected to whole genome sequencing and a core genome phylogenetic analysis in comparison with global isolates were performed. Biofilm formation was compared for an association with the carbapenem susceptibility and with patient outcome. Statistical significance, correlations and graphical representation were performed using SPSS v23.0.Phenotypic analyses showed a positive correlation between biofilm formation and carbapenem resistance. Planktonic cells observed to be susceptible in vitro exhibited higher MICs in biofilm structure. The biofilm forming ability had a significant association with the morbidity/mortality. Infections by stronger biofilm forming pathogens significantly (P<0.05) resulted in fewer ‘average days alive’ for the patient (3.33) in comparison to those negative for biofilms (11.33). Phylogenetic analysis including global isolates revealed the clear association of sequence types with genes for biofilm mechanism and carbapenem resistance. Carbapenemase genes were found specific to each clade. The known hypervirulent clone-ST23 with wcaG, magA, rmpA, rmpA2 and wzc with a lack of mutation for hyper-capsulation might be poor biofilm formers. Interestingly, ST15, ST16, ST307 and ST258 – reported global high-risk clones were wcaJ negative indicating the high potential of biofilm forming capacity. Genes wabG and treC for CPS, bcsA and pgaC for adhesins, luxS for quorum sensing were common in all clades in addition to genes for aerobactin (iutA), allantoin (allS), type I and III fimbriae (fimA, fimH, mrkD) and pili (pilQ, ecpA).This study is the first of its kind to compare genetic features of antimicrobial resistance with a spectrum covering most of the genetic factors for K. pneumoniae biofilm. These results highlight the importance of biofilm screening to effectively manage nosocomial infections by K. pneumoniae. Further, data obtained on epidemiology and associations of biofilm and antimicrobial resistance genetic factors will serve to enhance our understanding on biofilm mechanisms in K. pneumoniae.

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