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Abstract Aim The current study emphasizes the impact of adverse drug reactions (ADRs) and Drug-Related Problems (DRPs) caused by supportive care medications administered with chemotherapy. Method This is a longitudinal observational study carried out at the Ramaiah Medical College Hospital in Bengaluru, Karnataka, India, at the Department of Oncology. The data was recorded using a specifically created data collecting form. Based on the PCNE (Pharmaceutical Care Network Europe), DRPs are identified. The WHO probability scale, Modified Hartwig and Siegel for ADR severity assessment, Naranjo's algorithm for causality assessment, Rawlins and Thompson for predictability assessment, and Modified Shumock and Thornton for preventability assessment were all utilized. The OncPal guideline was considered in terms of the precision of supportive care medications regarding the reduction of ADRs in cancer patients. Result We enrolled 302 patients,166 (55%) female and 136 (45%) male (SD 14.378) (mean 49.97), patients with one comorbidity 59(19.6%) and multimorbidity (two or more) 45(14.9%), the DRPs identified were found to be 153 (50.6%); only P2 (safeties of drug therapy PCNE) were considered in this study. ADRs which are identified 175(57.9%) contributed/caused by the supportive care medications. WHO probability scale: 97 (32.1%) possible and 60 (19.9%) unlikely; Naranjo’s algorithm: 97 (32.1%) unlikely and 69 (22.8%) possible; ADR severity assessment scale (Modified Hartwig and Siegel): 95 (31.5%) mild and 63 (20.9%) moderates; Rawlins and Thompson for determining predictability of an ADR: 33 (10.9%) predictable and 137 (45.5%) non-predictable; and Modified Shumock and Thornton for determining preventability of an ADR: 81 (26.8%) probably preventable and 90 (29.8%) non-preventable. The statistical comparison through preforming t-test and measuring Chi-Square between group with ADRs and without ADRs shows in some variables, significantly (Alcohol consumption status, P = .019) and Easter Cooperative Oncology Group (ECOG) performance status P

With the increased emphasis on charting ocean sustainability narratives, marine spatial planning (MSP) is envisioned as a key tenet. MSPs emphasize the systematic and collaborative planning and management of ocean space (resources and activities) for the benefit of all users. Regions that have implemented MSP based on collaborative stakeholder engagement are progressively realizing better ocean sustainability outcomes. Unfortunately, in developing coastal states, progress toward MSP is largely pedestrian and has attracted less interest. This is partly due to archaic coastal/marine resource models that are dominated by few powerful stakeholders. This is worsened by increasing human-environmental shocks, which are creating bleak futures. Our study systematically sourced 12,316 documents from Scopus that were analyzed using bibliometrics to (i) conduct a performance analysis, (ii) conduct a scientific mapping analysis and (iii) identify game-changing developments that can drive ocean sustainability. A performance analysis revealed that even though scholarship and publications on MSP have increased globally, scholarship among or led by researchers from the global south are limited. Scientific mapping analysis revealed emerging positive trends in multi-country collaborations as well as the recognition of threats to the marine environment. Reversing this requires increased stakeholder engagement. However, how to achieve this goal in most developing coastal states has been less studied. Building on this, we developed a novel Collaborative Stakeholder Engagement Pathway (CoSEP) involving eight (8) interrelated steps that can help build collaborative engagements for MSP development and ocean sustainability. A notable takeaway from the CoSEP is that; since research on MSP development is limited or in its infancy, knowledge of how and when to engage which stakeholders is key in creating collaborative mechanisms for positive ocean sustainability, including ocean justice. This can help localize sustainable ocean development pillars and build avenues for integrated coastal resource management. Using participatory approaches that bring forward microlevel stakeholder perspectives could be a future driver in designing effective interventions and cultures to create MSPs that meet ocean sustainability targets.

The Ramayana, the ancient Hindu epic, has been retold and rewritten in various narrative forms by numerous writers from different countries. It has a global appeal that has inspired authors worldwide to create unique Ramayanas. Among these recreations, Bhyrappa's Uttarakaanda stands out with its multiple story views. This research paper, titled “Subverting Patriarchal Narratives: Exploring Bhyrappa’s Depiction of Sita Through Historiographic Metafiction,” delves into the author's methods of retelling the age-old narrative. The present study utilizes the conceptual frameworks of postmodernism, with a particular emphasis on historiographic metafiction. By delving into the deconstruction of grand narratives and questioning traditional elements that impede women's rights, the article aims to shed light on important thematic concerns. Specifically, the primary focus of this research lies in the analysis of the author's work titled 'Sitayana,' where the narrative spotlight is shifted from Rama to Sita. Through a meticulous examination of the author's adept incorporation of alternative perspectives, the paper explores how this approach resonates with both Indian literature and its readership. Moreover, the article critically engages with the power dynamics that influenced Rama's actions and shaped his understanding of dharma.

Background and Aims: Cancer pain guidelines remain confined due to implementation barriers, preventing them from attaining a global perspective. The guidelines must be robust in development and inculcate high-quality content to achieve practical utility. Quality indicators related to safe opioid practice empower effective guideline implementation. Methods: The protocol was registered prospectively in PROSPERO (CRD42021244823). Guidelines published over the last decade providing insights into cancer pain management and incorporating safe opioid practice were evaluated. The review's primary outcome was to evaluate the quality of cancer pain guidelines. Appraisal of guidelines for research and evaluation II (AGREE II) instrument was used to assess a guideline's quality. The ADAPTE collaboration-guideline adaptation resource tool kit (ADAPTE) provided insights into its adaptation based on specific questions within the guideline. Results: Fourteen cancer pain guidelines met the eligibility criteria and were included for quality evaluation. Eight guidelines were evaluated with combined AGREE II and ADAPTE process, attaining >66.7% in the rigour of development domain score, summated scaled domain score, and specific ADAPTE tools to evaluate the quality of each guideline. The intra-class correlation coefficient was utilised for resolving inter-rater agreement. 'Safe opioid practice' within a guideline was assessed for quality content implementation. Conclusion: Combined AGREE II and ADAPTE identified four cancer pain guidelines, namely Ministry of Health Malaysia, National Comprehensive Cancer Network, NCEC-National Clinical Guideline, and World Health Organization, which were of the highest quality and incorporated safe opioid practice effectively.

This research underscores the profound impact of data cleansing, ensuring dataset integrity and providing a structured foundation for unraveling convoluted connections between diverse physical properties and cytotoxicity. As the scientific community delves deeper into this interplay, it becomes clear that precise data purification is a fundamental aspect of investigating parameters within datasets. The study presents the need for data filtration in the background of machine learning (ML) that has widened its horizon into the field of biological application through the amalgamation of predictive systems and algorithms that delve into the intricate characteristics of cytotoxicity of nanoparticles. The reliability and accuracy of models in the ML landscape hinge on the quality of input data, making data cleansing a critical component of the pre-processing pipeline. The main encounter faced here is the lengthy, broad and complex datasets that have to be toned down for further studies. Through a thorough data cleansing process, this study addresses the complexities arising from diverse sources, resulting in a refined dataset. The filtration process employs K-means clustering to derive centroids, revealing the correlation between the physical properties of nanoparticles, viz, concentration, zeta potential, hydrodynamic diameter, morphology, and absorbance wavelength, and cytotoxicity outcomes measured in terms of cell viability. The cell lines considered for determining the centroid values that predicts the cytotoxicity of silver nanoparticles are human and animal cell lines which were categorized as normal and carcinoma type. The objective of the study is to simplify the high-dimensional data for accurate analysis of the parameters that affect the cytotoxicity of silver NPs through centroids.

Context: Various universities have set in a wave of adapting to the newer concepts of teaching–learning to keep pace with the millennial learners. Blended learning is a new teaching–learning method that combines online activity along with face-to-face activity. Flipped classroom approach is the use of Web-enabled strategies that free up class time to allow teachers to spend more time guiding their students. Aim: To assess the impact of flipped classroom approach on the teaching–learning outcomes of dental undergraduates. Settings and Design: A prospective comparative educational intervention was conducted in the Oral Medicine and Radiology department of a private dental college in Belagavi. Methods and Materials: Forty third-year undergraduates were equally allocated into the traditional learning group (20) and flipped classroom learning group (20). A pretest/posttest format was employed with mandatory feedback. For flipped classroom approach, an audio/video lecture of 10 minutes duration was shared through learning management software. The assessment was MCQs and case-based. Statistical Analysis: Mann–Whitney U and Wilcoxon matched-pairs tests were used for intergroup and intragroup comparisons, respectively. Results: The mean posttest score was significantly higher in flipped classroom method than in the traditional method (P = 0.0001). Performance on case-based questions was highly statistically significant in the flipped classroom group with a mean rank of 29.8 (P < 0.001). Intragroup comparison between the mean pretest and posttest scores in the flipped classroom showed a high statistical significance (P = 0.0001). Conclusions: Flipped classroom teaching should be recommended as it has the advantages of providing students with a pace of learning, peer learning, instant feedback, and using classroom time effectively. Faculty have to invest time, but nothing is greater than a meaningful teaching–learning experience.

The area of study of motion control to Wireless Sensor Networks (WSN) was difficult. This study examines the problem of vehicular networks in the previously implemented IETF pathing algorithm standard to reduce power electricity WSN, the Routing Algorithm of Low power and Lossy Networks (RAL). RAL lacks motion capabilities because it was developed at the origin of static networks.In this study, we discuss the issue and suggest CoRAL as a RAL change that supports portability and should be based on the Corona mechanism.The researchers carried out an in-depth simulation analysis using the Contiki/Cooja emulator and compared the results with those of the traditional RAL emulator to demonstrate the efficacy of Co-RAL.We investigated the number of roots of Directed Acyclic Graphs (DAG), packet transmission rate, or network speed affecting system performance. According to the simulation results, Co-RAL reduces final time to 2.5 s, median power usage 50%, but alsothe packet delivery rate by 45% correlated with normal RAL.

Background: The renowned biological role of cobalt is it is main component of vitamin B12, however other cobalt compounds have been listed as toxic for the environment as well as to human. Methods: Various samples from different sources are analyzed for their cobalt(II) content by extraction followed by UV–visible spectrophotometry and compared with atomic absorption spectrophotometry. Results: In this article, the chromogenic reagent 2-chlorobenzaldehyde thiocarbohydrazone is introduced for extractive spectrophotometric determination of cobalt(II) from various samples. This reagent forms yellow colored 1:2:2 [Co(II)–2CBTCH–iodide] complex in dichloromethane which was extracted from an acetate buffer having pH of 4.2 in presence of potassium iodide solution which was stable up to 48 h. The absorbance of the complex exhibit peak absorbance at 400 nm. The present technique was optimized for numerous influences and the interference of other ion has also been cautiously studied. The calculated values of molar absorptivity and Sandell's sensitivity of the complex are found to be 0.3006 × 104 mol−1 cm−1 and 0.0196 µg cm−2 respectively. The technique conforms Beer's law up to 13 μg mL−1 with 0.999 correlation coefficient of the [Co(II)–2CBTCH–iodide] complex, which specifies linearity between the two variables. For five replicate determinations (n = 5), the relative standard deviation was 1.18 with the regression equations as y = 0.0672 x + 0.01 with R2 = 0.999 as the correlation coefficient. The recovery percentages were warranted the accuracy and found around 99.0%. Conclusion: The technique was successfully used to the determination of cobalt(II) in water, alloy and nano powders with acceptable results and was evaluated its performance in terms of Student ‘t’ test and Variance ‘f’ test, which indicates the significance of the present method as an inter comparison of the experimental values using AAS. The technique was also useful for analysis of alloys and synthetic mixtures.

Background: Vaccination is the most important prophylactic measure taken to curb COVID-19 pandemics. This study was undertaken to throw light on the safety of Covishield vaccine among health care workers (HCWs) and to assess the co-variates associated with incidence of adverse events. Methods: This prospective observational study was conducted in a tertiary care center in South India as part of the HCW vaccination drive. All consenting HCWs who received the first dose of Covishield vaccine and developed ADRs were included in this study. After vaccination, all beneficiaries were monitored for AEFI for a period of half an hour and later followed up through telephone and google survey forms on day 2 and day 7 of vaccination. The data was subsequently collated into spreadsheet format and analyzed. Results: The study included 1264 consenting healthcare workers who were predominantly youth, aged 15–24 years (n = 583, 46 %) and with a female preponderance of 76 % (n = 960). Past history of COVID-19 infections was reported among 4.6 % (58) of the study population. Postvaccination symptoms were majorly reported during the first (40 %) and second day (44 %) after vaccination with a high prevalence of both local (n = 1083, 85 %) and systemic symptoms (n = 1065, 84 %). The mean duration of symptoms was observed to be 1.4 ± 0.81 days post vaccination. Symptoms were observed significantly high among females (76.7 %, p = 0.013). The prevalence of systemic (88 % vs 80 %) (p

Background and Objectives: The ongoing coronavirus pandemic was first identified in Wuhan, Hubei, China on December 2019. India reported its first case on January 30, 2020 in Kerala. As COVID-19 is mostly a droplet infection, it necessitates the use of masks, gloves, and sanitizers for containing its spread. This study aims to understand the potential adverse effects of constant use of masks, gloves, and sanitizers among healthcare workers (HCWs). Materials and Methods: This is a cross-sectional study conducted among 165 HCWs from a single tertiary healthcare center in Kerala using a validated questionnaire. Data were analyzed using Microsoft Excel and SPSS version 20. Results: Among 165 participants, the most common adverse effects due to mask usage were dermatological in nature (57%). With regard to sanitizers, majority experienced dryness of hands (53.3%). Gloves were well tolerated with 62% of the participants reporting no adverse effects. Conclusion: Prolonged use of mask, sanitizer, and gloves has caused adverse effects in majority of HCWs surveyed. As the pandemic still stands as a crisis, it is necessary to identify solutions to manage these adverse effects for the betterment of the health of our HCWs.

Silver nanoparticles (AgNPs) display unique plasmonic and antimicrobial properties, enabling them to be helpful in various industrial and consumer products. However, previous studies showed that the commercially acquired silver nanoparticles exhibit toxicity even in small doses. Hence, it was imperative to determine suitable synthesis techniques that are the most economical and least toxic to the environment and biological entities. Silver nanoparticles were synthesized using plant extracts and their physico-chemical properties were studied. A time-dependent in vitro study using HEK-293 cells and a dose-dependent in vivo study using a Drosophila model helped us to determine the correct synthesis routes. Through biological analyses, we found that silver nanoparticles’ cytotoxicity and wound-healing capacity depended on size, shape, and colloidal stability. Interestingly, we observed that out of all the synthesized AgNPs, the ones derived from the turmeric extract displayed excellent wound-healing capacity in the in vitro study. Furthermore, the same NPs exhibited the least toxic effects in an in vivo study of ingestion of these NPs enriched food in Drosophila, which showed no climbing disability in flies, even at a very high dose (250 mg/L) for 10 days. We propose that stabilizing agents played a superior role in establishing the bio-interaction of nanoparticles. Our study reported here verified that turmeric-extract-derived AgNPs displayed biocompatibility while exhibiting the least cytotoxicity.

Background and Aims: Research is an integral component of medical education and practice. However, the art of medical writing remains neglected. Case report writing marks foray into the world of publications and presentations. We assessed and compared the impact of basic medical writing workshop about case report writing and their perception levels of confidence in these skills, among post-graduate anaesthesia students. Methods: A needs assessment for medical writing skills was performed among all anaesthesia residents. A total of 20 students were enrolled in this study. The pre-workshop assignment consisted of writing one case report per participant within 30 days, followed by students' confidence assessment in these skills. A workshop on basic medical writing including analytical writing, scientific writing and plagiarism were conducted. Post-workshop a similar assignment was provided, followed by students' confidence assessment. Results: Moderate-to-high need for help was felt by 92.63% for analytical skills, 100% for scientific skills and writing without plagiarism, 95.78% for overall writing skills. For case report writing, the analytical and scientific writing significantly improved after the workshop (P = 0.01 and P = 0.016, respectively). There was a significant improvement in the students' confidence levels post-workshop in their analytical writing skills, avoiding plagiarism and overall writing capabilities (P = 0.02, P = 0.016 and P = 0.002, respectively). Conclusion: Writing skills of participants and their confidence in these skills improved post-workshop.

Background: In Low-and Middle-Income Countries, including India, consumers often purchase antibiotics over-the-counter (OTC) from retail pharmacies. This practice leads to the inappropriate use of antibiotics in the community which is an important driver for the development of antimicrobial resistance. A better understanding of consumers’ views towards this grave public health concern is critical to developing evidence-based intervention programs for awareness among the general population. Objective: To explore knowledge, practice and, behavior of consumers towards antibiotics, antibiotic use, antimicrobial resistance, purchasing behavior of consumers for antibiotics, and to gain insight which will help in developing evidence-based policy interventions. Methods: 72 in-depth consumer interviews were conducted in all 11 districts of the National Capital Territory of Delhi. The qualitative data were analyzed using thematic analysis. Results: Our study found that retail pharmacies were the first point of consultation for common ailments for patients/consumers once home remedies failed; they were largely unaware of the threat of antimicrobial resistance. Consumers’ knowledge of antibiotic use and about antimicrobial resistance was low, they used old prescriptions, and bought antibiotics OTC to save time and money. Despite the presence of regulations constituted to regulate the sale of antibiotics by the Government and the implementation of national campaigns, the practice of self-medication and behaviors such as OTC purchase, non-adherence to prescribed antibiotics was prevalent. Consumers perceive that antibiotics provide quick relief and accelerate the curing process and retail pharmacy shops try to protect their retail business interests by honoring old prescriptions and self-medication for antibiotics. Conclusions: The lack of awareness and insufficient knowledge about what antibiotics are and issues such as antimicrobial resistance or antibiotic resistance resulted in misuse of antibiotics by consumers. Limited access to public healthcare and affordability of private healthcare are factors that contribute towards the self-medication/OTC purchase of antibiotics. The regular misuse of antibiotics through irrational use reinforces the need for strong enactment of strategies like continuous community awareness campaigns. Mitigation efforts should focus upon educating consumers continuously and sustainably for the understanding of antibiotic misuse, antimicrobial resistance, and promote better compliance with regulations.

Background and Aims: Neuromuscular blocking agents have been one of the cornerstones of anaesthesia. With the advent of newer surgical, anaesthetic and neurological monitoring techniques, their utility in neuroanaesthesia practice seems dispensable. The aim of this prospective, comparative, randomised study was to determine whether neuromuscular blocking agents are required in patients undergoing supratentorial surgery when balanced anaesthesia with desflurane, dexmedetomidine and scalp block is used. Methods: Sixty patients with the American Society of Anesthesiologists physical status I or II, aged between 18 and 60 years were included in the study. All patients received anaesthesia including desflurane, dexmedetomidine and scalp block. The patients were randomly allocated to receive no neuromuscular blocking agent (Group A) or atracurium infusion to keep train-of-four count 2 (Group B). The two groups were compared with respect to haemodynamic stability, brain relaxation scores and recovery characteristics. Haemodynamic parameters and time taken to achieve Aldrete score >9 and other secondary outcomes were analysed using Student's t-test. Non-parametric data were analysed using the Mann–Whitney test. Results: The mean arterial pressure was comparable between the groups. The intraoperative heart rate was comparable; however, in the post-operative period, it remained higher in Group B for 30 min after extubation (P = 0.02). The brain relaxation scores were comparable among the two groups (P = 0.27). Tracheal extubation time, time taken for orientation and time required to reach Aldrete score ≥9 were comparable among the two groups. Conclusion: The present study suggests that balanced anaesthesia using desflurane, dexmedetomidine and scalp block can preclude the use of neuromuscular blocking agents in patients undergoing supratentorial surgery under intense haemodynamic monitoring.

Introduction: Since, thousands of years we have been using natural medication in Indian system of medicine. Till today lots of work has been done to study their toxicity, but very few studies have been undertaken on genotoxicity. There is urgent requirement for taking initiative in this regard. Hence, interested in evaluating the genotoxicity potential of Tamra Bhasma well known metallic (Copper) preparation widely used in alternative system of medicine. Aim: To evaluate the genotoxicity profile of Tamra Bhasma drug (a copper based metallic formulation in Indian system of Medicine) with main emphasis on comet assay, micronucleus assay and chromosomal aberration assay in Swiss albino mice. Materials and Methods: Animals were randomly grouped into four different groups containing ten mice (five male and five female) in each group. Group I considered as normal control which received only vehicle (0.5% CMC). The Group II considered as positive control and on 28th day which received cyclophosphamide (40 mg/kg/body weight) through intra-peritoneal injection for comparative assessment. The Groups III and IV administered with test drug Tamra Bhasma 2.86 mg/kg and 14.3 mg/kg respectively. These groups were administered the test drug for 28 consecutive days. On 29th day blood was collected into heparinized tubes for comet assay analysis. Half of the animals were injected with colchicine (4 mg/kg IP) in order to arrest the cells into metaphase stage and then sacrificed the animals to collect the bone marrow from the both the femurs for chromosomal aberration analysis. The rest of the animals were also sacrificed and bone marrow was collected for micronuclei analysis. Results: The repeated administration of test drug Tamra Bhasma of both the dose levels didn’t produce remarkable genotoxicity, DNA damage or chromosomal abnormalities both numerically as well as structurally. However, Tamra Bhasma administered at both the dose level groups showed slight increase in comet height, comet tail length, % DNA and Tail movement. But increase was not significant as compare to normal control. Conclusion: The repeated administration of test drug Tamra Bhasma at therapeutic dose level confirms its relative safety and did not produce any marked toxic effect or genetic material abnormalities. This work may inspire more efficacious and safer use in clinical set up and global acceptance of the test formulation.

Background: The incidence of difficult intubation in patients undergoing general anaesthesia is estimated to be approximately 1-18% whereas that of failure to intubate is 0.05-0.35%.1,2,3 Various methods have been used for prediction of difficult laryngoscopy. Although, upper lip bite has been shown to be a promising test in its introductory article, repeated validation in various populations is required for any test to be accepted as a routine test. We have compared upper lip bite test (ULBT), modified Mallampati test (MMC) and thyromental distance (TMD) individually and in various combinations to verify which of these predictor tests are significantly associated with difficult glottic exposure. Methods: After obtaining institutional ethics committee approval, 402 ASA I and II adult patients undergoing elective surgical procedures requiring endotracheal intubation were included. All the three test were performed in all the patients preoperatively and their glottic exposure was recorded by Cormack-Lehane classification during intubation. Sensitivity, specificity, positive predictive value and negative predictive value were used for comparison. Results: In our study, the incidence of difficult laryngoscopy was 11.4% and failure to intubate 0.49%. None of the three are a suitable predictive test when used alone. Combination of tests added incremental diagnostic value. Conclusion: We conclude that all three screening tests for difficult intubation have only poor to moderate discriminative power when used alone. Combinations of individual tests add some incremental diagnostic value.

Ameloblastoma of jaws are common and locally destructive tumors originating from odontogenic apparatus. They constitute approximately 1% of all jaw tumors with 80% occurring in the mandible. Ameloblastoma exhibiting a frank malignancy is a rare entity and occurs in less than 1% of all ameloblastomas. Among the two jaws, ameloblastic carcinoma involving maxilla is extremely rare with only few cases reported so far in the literature. Here we report two cases of ameloblastic carcinoma one involving the maxilla and the other involving mandible, with an aggressive clinical course leading to extensive local destruction of the affected jaws.

Chronic pain conditions involving the maxillofacial region represent a major health problem and patients with persistent pain are difficult to manage successfully. Most of these conditions are often comorbid with additional health issues. Capsaicin has been studied in various models of pain and neuropathy. Currently, its best known use is as a topical analgesic and anti-inflammatory. Its use as a noxious stimulus offers several benefits and has been used with considerable success in conditions like postherpetic neuralgia, atypical facial pain, musculoskeletal pain etc. Adverse events from capsaicin are mainly at the application site (burning, stinging, erythema), and systemic events are rare. This review highlights the emerging evidence on the use of capsaicin in the commonly encountered orofacial pain conditions.

The art of medicine consist in amusing the patient, while nature cures the disease". Consuming a diet rich in plant food will provide a milieu of phytochemicals (non-nutritive plant chemicals that have protective or disease preventive properties). The additive and synergistic effects of phytochemicals in fruit and vegetables are responsible for their potent antioxidant and anticancer activities, and that the benefit of a diet rich in fruit and vegetables is attributed to the complex mixture of phytochemicals present in whole foods. The aim of this paper is to highlight and discuss the importance of natural chemical substances available in fruits, vegetables and herbs as they interfere with multiple important cellular pathways and this property is utilized for the prevention and treatment of oral diseases.

For real-time patient heart rate management, most widely used biomedical implantable devices in the cardiovascular system is the cardiac pacemaker (CP). A key factor in keeping the patient alive is the development of novel heart pacing techniques which can reduce the risk of cardiac arrhythmia. The present work is inspired to achieve this goal. To achieve an accurate, controlled, and regulated heart rate, a pacemaker with an intelligent proportional integral derivative (PID) controller is considered. The proposed PID controller is an integration of the traditional PID controller with appropriate tuning, that uses a swarm intelligence-based artificial bee colony (ABC) algorithm for handling the bio-electrical signals. To ensure the efficacy of the proposed controller experiments are conducted. MATLAB/Simulink software is used to test and simulate the suggested model and to adjust the controller gains. The simulation is performed in the time and frequency domain. The resulting pulse rate from the ABC-PID controller has a rise time (0.0985 s), settling time (0.3293 s), maximum overshoot (0.111367%), and MSE (0.0040565). External disturbances of various duty cycles are also introduced in the proposed CP control system. The proposed ABC-PID controller for implanted pacemakers reduces the risk of heart rate over-run. [ABSTRACT FROM AUTHOR]

Aim: The current study emphasizes the impact of adverse drug reactions (ADRs) and Drug-Related Problems (DRPs) caused by supportive care medications administered with chemotherapy. Method: This is a longitudinal observational study carried out at the Ramaiah Medical College Hospital in Bengaluru, Karnataka, India, at the Department of Oncology. The data was recorded using a specifically created data collecting form. Based on the PCNE (Pharmaceutical Care Network Europe), DRPs are identified. The WHO probability scale, Modified Hartwig and Siegel for ADR severity assessment, Naranjo's algorithm for causality assessment, Rawlins and Thompson for predictability assessment, and Modified Shumock and Thornton for preventability assessment were all utilized. The OncPal guideline was considered in terms of the precision of supportive care medications regarding the reduction of ADRs in cancer patients. Result: We enrolled 302 patients,166 (55%) female and 136 (45%) male (SD 14.378) (mean 49.97), patients with one comorbidity 59(19.6%) and multimorbidity (two or more) 45(14.9%), the DRPs identified were found to be 153 (50.6%); only P2 (safeties of drug therapy PCNE) were considered in this study. ADRs which are identified 175(57.9%) contributed/caused by the supportive care medications. WHO probability scale: 97 (32.1%) possible and 60 (19.9%) unlikely; Naranjo's algorithm: 97 (32.1%) unlikely and 69 (22.8%) possible; ADR severity assessment scale (Modified Hartwig and Siegel): 95 (31.5%) mild and 63 (20.9%) moderates; Rawlins and Thompson for determining predictability of an ADR: 33 (10.9%) predictable and 137 (45.5%) non-predictable; and Modified Shumock and Thornton for determining preventability of an ADR: 81 (26.8%) probably preventable and 90 (29.8%) non-preventable. The statistical comparison through preforming t-test and measuring Chi-Square between group with ADRs and without ADRs shows in some variables, significantly (Alcohol consumption status, P =.019) and Easter Cooperative Oncology Group (ECOG) performance status P < 0.001. Conclusion: Comprehensive assessment of supportive medications in cancer patients would enhance the patient management and therapeutic outcome. The potential adverse drug reactions (ADRs) caused by supportive care medications can contribute to longer hospital stays and interact with the systemic anti-cancer treatment. The health care professionals should be informed to monitor the patients clinically administered with supportive medications. [ABSTRACT FROM AUTHOR]

Network dynamical systems with higher-order interactions are a current trending topic, pervasive in many applied fields. However, our focus in this work is neurodynamics. We numerically study the dynamics of the smallest higher-order network of neurons arranged in a ring-star topology. The dynamics of each node in this network is governed by the Chialvo neuron map, and they interact via linear diffusive couplings. This model is perceived to imitate the nonlinear dynamical properties exhibited by a realistic nervous system where the neurons transfer information through multi-body interactions. We deploy the higher-order coupling strength as the primary bifurcation parameter. We start by analyzing our model using standard tools from dynamical systems theory: fixed point analysis, Jacobian matrix, and bifurcation patterns. We observe the coexistence of disparate chaotic attractors. We also observe an interesting route to chaos from a fixed point via period-doubling and the appearance of cyclic quasiperiodic closed invariant curves. Furthermore, we numerically observe the existence of codimension-1 bifurcation points: saddle-node, period-doubling, and Neimark–Sacker. We also qualitatively study the typical phase portraits of the system, and numerically quantify chaos and complexity using the 0–1 test and sample entropy measure, respectively. Finally, we study the synchronization behavior among the neurons using the cross correlation coefficient and the Kuramoto order parameter. We conjecture that unfolding these patterns and behaviors of the network model will help us identify different states of the nervous system, further aiding us in dealing with various neural diseases and nervous disorders. [ABSTRACT FROM AUTHOR]

Background: Migraine is a disabling primary headache disorder characterized by recurrent episodes of headache. Migraine not only imposes a burden on the sufferer but also imposes a burden on their family members too. A holistic approach is more essential in the management of migraine and family members should also be included in the management of migraine. There are no published studies done in India so far to look for the impact of migraine on partners and adolescent children (IMPAC). This pilot study was done to assess the IMPAC. Objective: The objective of the study was to study the IMPAC. Materials and Methods: In this descriptive study, 130 chronic migraine patients were observed in a row during 9 months. The impact of migraine on family members as well as migraine disability and Migraine-specific Quality of Life (MSQoL) was evaluated using validated questionnaires. Results: One hundred and thirty chronic migraine patients were studied as part of this study. The mean age of the study population was 34.43 ± 9.002 years, and two-third of the participants were female. The majority of the participants had a moderate-to-severe disability due to migraine and had negatively impacted their MSQoL. The impact of migraine on family members was moderate-to-severe grade in most of the participants and affected their family life negatively both with children and spouses. The males were more significantly affected than females in terms of MSQoL, anxiety, depression, and also on migraine's impact on family members. Conclusion: Migraine not only affects the sufferers, it also significantly affects their family members. [ABSTRACT FROM AUTHOR]

Green nanotechnology is an emerging field of research in recent decades with rapidly growing interest. This integrates green chemistry with green engineering to avoid using toxic chemicals in the synthesis of organic nanomaterials. Green nanotechnology would create a huge potential for the use of nanoparticles for more sustainable utilization in improving animal health. Nanoparticles can be synthesised by physical, chemical and biological processes. Traditional methods for physical and chemical synthesis of nanoparticles are toxic to humans, animals and environmental health, which limits their usefulness. Green synthesis of nanoparticles via biological processes and their application in animal health could maximize the benefits of nanotechnology in terms of enhancing food animal health and production as well as minimize the undesirable impacts on Planetary Health. Recent advances in nanotechnology have meant different nanomaterials, especially those from metal sources, are now available for use in nanomedicine. Metal nanoparticles are one of the most widely researched in green nanotechnology, and the number of articles on this subject in food animal production is growing. Therefore, research on metal nanoparticles using green technologies have utmost importance. In this review, we report the recent advancement of green synthesized metal nanoparticles in terms of their utilization in monogastric animal health, elucidate the research gap in this field and provide recommendations for future prospects.

Background and Aims: Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a valuable adjunct during apnoea. Conventional techniques of apnoeic anaesthesia have limitations. THRIVE helps to maintain oxygenation during the apnoeic periods in tubeless airway surgeries. We aimed to evaluate tubeless apnoeic anaesthesia in shared airways using THRIVE to determine safe apnoea time. Methods: Two years of retrospective data were collected at a tertiary care centre, which included 60 patients in whom THRIVE was used for apnoeic anaesthesia. We appraised tubeless apnoeic anaesthesia in shared airways using THRIVE to determine safe apnoea time. Data on oxygenation, haemodynamic parameters, ventilation and the perioperative course were also collected. The data were analysed using GNU PSPP 1.0.1 software. Results: The patients’ mean age was 48.53 [standard deviation (SD):16.62] years. Microlaryngoscopy [24 (40%)], rigid bronchoscopy [12 (20%)], tracheal dilatation [12 (20%)] and foreign body removal [8 (13.3%)] were the common procedures. The mean apnoea time was 14.5 (SD: 2.05) min. Patients maintained normal haemodynamic parameters, with a mean oxygen saturation of 98% during apnoea. The highest mean end-tidal carbon dioxide at the end of apnoea was 55 mmHg, which normalised after 1–2 min of ventilation. Intermittent ventilation was done in eight patients as the apnoea time exceeded 20 min. Emergence and recovery were smooth, and none of the patients developed any complications throughout the procedure. Conclusion: THRIVE can be effectively and safely used for tubeless apnoeic anaesthesia, with an uninterrupted apnoea time of approximately 15 min without complications.