Search

Abstract Background Inhaled medications have been the cornerstone of treatment for the exacerbations as well as stable chronic obstructive pulmonary disease (COPD) which is one of the leading cause of deaths in the recent times. Inadequate knowledge on handling of inhalers leads to noncompliance which in turn results in increased hospital visits limelighting the negative impact on the morbidity status. The aim of our study was to assess the compliance of inhalers and to correlate the level of compliance to the morbidity of COPD as assessed by number of hospital visits. Methods In our cross-sectional observational study conducted in the rural medical college hospital in Dakshina Kannada of Karnataka, 69 subjects with COPD were evaluated for the compliance of inhaler usage, and the morbidity related to the disease was assessed with number of hospital visits in the past 6 months. Appropriate statistical analysis was used in evaluation. Results Out of 69 patients, 24 patients visited the health care facility at least 3 times or more. Of these 24 patients, 20 (83.33%) of them were not compliant with inhalers. Among the 45 patients who visited the health care facility less than 2 times, 28 (62.22%) patients were compliant with inhalers. This relationship was found to be statistically significant proving that the higher the number of visits, the lesser the compliance and vice versa. Conclusions Our study highlights the importance of patient education about compliance to inhalers which is an economical and effective modality which has significant impact on reduction of exacerbations and morbidity.

This study investigates the integration of spaceborne Global Ecosystem Dynamics Investigation (GEDI) LiDAR data with optical imagery from Linear Imaging Self Scanning Sensor (LISS IV), Sentinel-1 Synthetic Aperture Radar (SAR) and PALSAR data for continuous forest canopy height mapping in Kaziranga National Park (KNP), Assam for the years 2018 and 2022. Four machine learning models were trained and evaluated to assess the predictive ability of LISS IV data in conjunction with SAR variables. The mean canopy height was measured at approximately 8.58 m in 2018, which increased to about 9.07m in 2022. Results reveal Extreme Gradient Boosting (XGB) as the top-performing model, achieving an RMSE of 5.47m and an R2 of 0.55. In comparison, Random Forest (RF), Support Vector Machine (SVM), and k-Nearest Neighbors (kNN) achieved RMSE values of 5.49, 5.51, and 5.73, respectively. Analysis shows a prevalent occurrence of canopy heights below 5 meters in KNP (more than 35% of the area), while taller canopies beyond 20m can be found in less than 5% of the area. This finding underscores the importance of integrating satellite data and machine learning and highlights the novel application of LISS IV data in enhancing canopy height mapping. Furthermore, it represents the first comprehensive attempt to map canopy height in KNP, laying the groundwork for further research on biomass assessment and carbon sequestration in this vital biodiversity hotspot. Overall, the study highlights the potential of leveraging advanced remote sensing technologies and machine learning approaches for improved understanding and management of forest ecosystems.

Abstract Systematic under-representation of pregnant women and gender diverse pregnant people in clinical research has prevented them from benefitting fairly from biomedical advances. The resulting lack of pharmacological safety and efficacy data leads to medicine discontinuation, sub-optimal dosing, and reliance on repurposed therapies. We identify four roadblocks to fair inclusion. First, investment and research are inhibited by protectionist attitudes among research gatekeepers who view pregnancy as a vulnerable state. Second, exclusion ignores human-specific biological variations affecting medication absorption and impacts on the pregnant body. Third, pregnant populations in low-and middle-income countries face a double disadvantage due to gender and location, despite bearing a disproportionate maternal mortality burden. Fourth, perspectives and experiences of pregnant populations are undervalued in clinical intervention design. We propose five actions to optimize fair inclusion: fostering reciprocal partnerships, prioritizing multi-disciplinary research, awareness-raising of the need for pharmaceutical innovation, conducting regulatory analyses, and promoting responsible inclusion over presumptive exclusion.

Decaprenylphosphoryl-β-D-ribose-oxidase (DprE1), a subunit of the essential decaprenylphosphoribose-2′-epimerase, plays a crucial role in the synthesis of cell wall arabinan components in mycobacteria, including the pathogen responsible for tuberculosis, Mycobacterium tuberculosis. In this study, we designed, synthesised, and evaluated 15 (BOK-1–BOK-10 and BOP-1–BOP-5) potential inhibitors of DprE1 from a series of 1,2,3-triazole ligands using a validated DprE1 inhibition assay. Two compounds, BOK-2 and BOK-3, demonstrated significant inhibition with IC50 values of 2.2 ± 0.1 and 3.0 ± 0.6 μM, respectively, whereas the standard drug (TCA-1) showed inhibition at 3.0 ± 0.2 μM. Through molecular modelling and dynamic simulations, we explored the structural relationships between selected 1,2,3-triazole compounds and DprE1, revealing key features for effective drug–target interactions. This study introduces a novel approach for designing ligands against DprE1, offering a potential therapeutic strategy for tuberculosis treatment.

Introduction: The technique for harvesting Split-thickness Skin Grafts (STSG) varies among surgeons. To control bleeding from split-thickness skin graft donor sites, the use of several haemostatic agents has been reported. The tumescent technique involves injecting tumescent fluid into the subcutaneous fat, obtaining swelling and firmness (tumescence) of the surgical area. This creates regional anaesthesia of the skin and subcutaneous tissue, allowing painless cutaneous surgery, with adrenaline acts as a haemostatic agent. Aim: To compare the surgical outcomes in terms of blood loss during the harvesting of STSG, postoperative pain experienced by the patient, healing of the donor site, and graft take rate with tumescent versus non tumescent techniques of STSG. Materials and Methods: The present prospective cohort study was conducted in the Department of General Surgery, M S Ramaiah Medical College, Bengaluru, Karnataka, India, from November 2017 to March 2019. A total of 56 patients were enrolled after applying inclusion and exclusion criteria. Patients were alternately assigned into the groups of tumescent or non tumescent technique groups. Intraoperative bleeding was assessed, postoperative pain was assessed using the Visual Analogue Score (VAS), and healing of the donor and recipient sites were assessed. Student’s t-test (two-tailed, independent) was used to find the significance of study parameters on a continuous scale between the two groups. The Chi-square/Fisher’s-exact test was used to assess the significance of study parameters on a categorical scale between two or more groups. Results: The mean±Standard Deviation (SD) age of patients in the tumescent group was 48.25±12.79 years and in the non tumescent group was 52.79±12.91 years. Intraoperative bleeding ranged from 0-25% in all 28 patients in the tumescent group, while it ranged from 76-100% in all 28 patients in the control group (p-value

Melatonin and magnesium nanoparticles exhibit diverse pharmacological properties. Trimethyltin and trimethyltin derived compounds both are toxic to neurons. The proposed research work is focus on synthesis on novel magnesium oxide nanoparticles conjugated with melatonin and evaluate its neuroprotective efficacy against trimethyltin induced neurotoxicity. Sol-gel method was used to fabricate Melatonin-MgO nanoparticles. Synthesized Melatonin-MgO particle were spectrally characterized. UV spectral analysis showed lambda max of Melatonin-MgO at 342 nm. Particle size analysis indicated that M − MgO nanoparticles have Z-average of 160.6 nm. Zeta potential estimation revealed that M − MgO exhibited Zeta potential of −0.1 mV. XRD analysis of M − MgO nanoparticles indicated that it has amorphous nature. SEM images revealed the agglomerated state of the particles. The cytotoxicity studies revealed that the IC50 value of M − MgO against L929 mouse fibroblast cell line for 24 h treatment was found to be 77.02 μg/ml. The results of this investigation indicate that the Neuroprotective studies revealed that melatonin conjugated magnesium oxide was exhibited maximum neuroprotection rendering cell viability of 88.59 % at 30 μg/ml against trimethyltin induced neurointoxication in SK-N-SH cells. By utilizing the distinct neuroprotective properties of both substances, melatonin-functionalized magnesium oxide nanoparticles may provide a more efficient and focused method of treating oxidative stress and neuronal dysfunction in a range of neurological conditions.

Background and objective: Nutrition in pregnancy plays an important role for wellbeing of mother and fetus, later it further influences the development of child. Iron is one among the most important micronutrients required in pregnancy. There is no validated Food frequency questionnaire (FFQ) to assess iron intake in pregnant women. This initiated the process to develop and validate a FFQ to assess dietary intake of Iron in Pregnant women. Methodology: Based on the food habits in study region and foods rich in iron, in reference to the standard literature, the FFQ was prepared. FFQ was designed in the following categories-cereal grains and products, pulses & legumes, green leafy vegetables, roots-tuber & other vegetables, nuts & seeds, Fruits, non-veg foods and milk & milk products. Content validity carried out by subject experts. To perform construct validity, 25 Primary health centre and 25 Tertiary care hospital pregnant women were interviewed using this FFQ and 24 h diet recall method. The results of both records were analyzed using Wilcoxon signed rank test. Internal reliability (Cronbach's alpha) and construct validity (Pearson correlation) of the questionnaire were determined. Results: Overall internal reliability of questionnaire is 0.804, indicating good reliability and showing satisfactory construct validity. Median dietary iron intake from FFQ method was 7.67 mg/day and 24 h dietary recall method was 15.70 mg/day. There was a significant difference between both method in assessing dietary iron intake. Conclusion: The FFQ designed in this study is reliable and valid tool to assess dietary iron intake among pregnant women.

Introduction: Chest tube insertion is a common procedure designed to alleviate the accumulation of air, fluid, pus, or blood in the pleural cavity. Despite being a bedside procedure often performed by emergency residents, Intercostal Drain (ICD) tube insertion carries associated risks, if not executed with care. Complications such as misplacement, organ injury, bleeding and pain are noteworthy concerns. Aim: To assess surgical outcome of Trocar versus Blunt dissection technique for ICD insertion. Materials and Methods: The present prospective interventional study was conducted in the Department of General Surgery, M S Ramaiah Hospitals, Bengaluru, India, from September 2018 and August 2020, with a sample size of 64 after obtaining Institutional Ethical Committee approval. Patients requiring ICD insertion were divided into two groups: Blunt (group A) and Trocar (group B) dissection, with 32 participants in each group. Demographic, clinical and diagnostic data were meticulously documented. Statistical analyses, including descriptive statistics, t-tests and Chi-square test, were employed to compare variables such as insertion time, complications and pain scores. Both groups were assessed for the time required for insertion and complications with each method during and after the procedure. Results: The mean age among subjects with the Blunt dissection method and Trocar method was 45.53±14.85 years and 45.06±10.46 years, respectively. In the Blunt dissection technique, 6 (18.8%) were females and 26 (81.3%) were males, while of those who underwent the Trocar method of insertion, 7 (21.9%) were females and 25 (78.1%) were males. The present study findings revealed that the Trocar method demonstrates comparable surgical outcomes to the Blunt dissection method. Trocar insertion proves notably quicker, especially in obese patients. The time taken for insertion was significantly longer (p-value

Background: Congenital myasthenic syndrome is a rare inherited neuromuscular disorder resulting in abnormal weakness and fatigue on exertion with onset at or shortly after birth or in early childhood. Clinical Description: A 2-year-old boy presented to us with respiratory failure, having a history of recurrent respiratory tract infections and underlying isolated motor delay. His 7-year-old elder sister had undiagnosed generalized weakness. Management and Outcome: While the index case was being stabilized with mechanical ventilation, his elder sibling was evaluated. Ptosis was noted in her, which improved with neostigmine. Examination and laboratory investigations ruled out other differentials. Clinical exome sequencing was sent which showed homozygous CHRNE ENST00000649488.2.c.1367_1369del. (p.Asn456del) resulting in acetylcholine receptor deficiency. Both siblings were started on oral pyridostigmine and salbutamol, resulting in improvement in muscle weakness over 3 months and 4 months in younger and older sibling, respectively. Conclusion: Recurrent respiratory insufficiency when associated with motor delay may be suggestive of a neuromuscular disorder. Even siblings with the same mutation may have different levels of severity of clinical manifestation.

Summary: Notch-Delta-Jagged (NDJ) signaling among neighboring cells contributes crucially to spatiotemporal pattern formation and developmental decision-making. Despite numerous detailed mathematical models, their high-dimensionality parametric space limits analytical treatment, especially regarding local microenvironmental fluctuations. Using the low-dimensional dynamics of the recently postulated least microenvironmental uncertainty principle (LEUP) framework, we showcase how the LEUP formalism recapitulates a noisy NDJ spatial patterning. Our LEUP simulations show that local phenotypic entropy increases for lateral inhibition but decreases for lateral induction. This distinction allows us to identify a critical parameter that captures the transition from a Notch-Delta-driven lateral inhibition to a Notch-Jagged-driven lateral induction phenomenon and suggests random phenotypic patterning in the case of lack of dominance of either Notch-Delta or Notch-Jagged signaling. Our results enable an analytical treatment to map the high-dimensional dynamics of NDJ signaling on tissue-level patterning and can possibly be generalized to decode operating principles of collective cellular decision-making.

IntroductionNew onset refractory status epilepticus (NORSE) is a rare and devastating condition characterised by the sudden onset of refractory status epilepticus (RSE) without an identifiable acute or active structural, toxic, or metabolic cause in an individual without a pre-existing diagnosis of epilepsy. Febrile infection-related epilepsy syndrome (FIRES) is considered a subcategory of NORSE and presents following a febrile illness prior to seizure onset. NORSE/FIRES is associated with high morbidity and mortality in children and adults.Methods and resultsIn this review we first briefly summarise the reported clinical, paraclinical, treatment and outcome data in the literature. We then report on existing knowledge of the underlying pathophysiology in relation to in vitro and in vivo pre-clinical seizure and epilepsy models of potential relevance to NORSE/FIRES.DiscussionWe highlight how pre-clinical models can enhance our understanding of FIRES/NORSE and propose future directions for research.

Small bowel obstruction is a common surgical emergency due to mechanical blockage of the bowel. Though it can be caused by varied pathology, the leading cause in the developed world is intra-abdominal adhesions. We present a rare case of small bowel obstruction at 5 months of pregnancy who presented with acute pain in abdomen and vomiting, and responded to laparoscopic adhesiolysis.

Introduction: Emergency laparotomies carry significant morbidity and mortality. Preoperative risk assessment is the key part for all emergency laparotomies. Therefore, the use of Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) and National Emergency Laparotomy Audit (NELA) scores helps stratify the risk and highlight the importance of high-risk patients, aiding in the provision of appropriate treatment plans and care. Aim: To determine and compare the Portsmouth-POSSUM (P-POSSUM) score and NELA score in predicting mortality at 30 days and 60 days in patients undergoing emergency laparotomies. Materials and Methods: This retrospective cohort study included all patients who underwent emergency laparotomy at a tertiary care centre from January 2021 to March 2023. A total of 116 patients were included, and demographic variables, laboratory values, and operative details were recorded. Mortality on postoperative day 30 and 60 was observed. All data were recorded in an MS excel spreadsheet, and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 19.0. An independent sample t-test was used. Results: Among the total study sample of 116 patients, the 30-day mortality rate was 8.6% (10 out of 116), and the 60-day mortality rate was 13.8% (16 out of 116). The area under the ROC curve (AUC) for mortality prediction was 0.533 (0.361-0.726) for the P-Possum score and 0.873 (0.799-0.948) for the NELA score, which was significantly higher. Conclusion: The NELA Score demonstrated greater accuracy in predicting early and late mortality compared to the P-POSSUM score in this study. Therefore, the authors highly recommend the use of the NELA score for risk assessment in all emergency laparotomies.

In vehicular networks, diverse safety information can be shared among vehicles through internet connections. In vehicle-to-internet communications, vehicles on the road are wirelessly connected to different cloud networks, thereby accelerating safety information exchange. Onboard sensors acquire traffic-related information, and reliable intermediate nodes and network services, such as navigational facilities, allow to transmit safety information to distant target vehicles and stations. Using vehicle-to-network communications, we minimize delays and achieve high accuracy through consistent connectivity links. Our proposed approach uses intermediate nodes with two-hop separation to forward information. Target vehicle detection and routing of safety information are performed using machine learning algorithms. Compared with existing vehicle-to-internet solutions, our approach provides substantial improvements by reducing latency, packet drop, and overhead.

Abstract Recent advances in anticounterfeiting technology highlight the importance of functional materials with innovative processing methods for achieving robust anticounterfeiting tags. Here, we report a fabrication approach that enables the formation of randomly oriented MoSx or MoOx clusters of unpredictable shapes for use as anticounterfeiting tags. We exploit the combined effects of capillary and Marangoni flows to drive solute in a pre-deposited wet film that produces random clusters, creating tags. The reading of these tags is achieved using high-speed confocal laser microscopy, which allows for the extraction of complex topographies in seconds. The digitization of the tags involves converting height profiles into grayscale images, followed by the application of mathematical tools and the von Neumann debiasing technique. The extracted keys are subjected to the NIST statistical test, which consists of six tests to confirm the randomness of the generated keys. The recent advancements in anticounterfeiting technology highlight the importance of functional materials with innovative processing methods to achieve robust anticounterfeiting tags.

Aims There are a shortage of specialist services available for Functional Neurological Disorders, especially within the paediatric population. Patients and families often find themselves falling within the borderland between medical and psychiatric services. Functional symptoms can cause significant morbidity and disruption to the lives of children and young people, impacting their access to education and social lives. Early diagnosis and explanation of FND is a mainstay of treatment, and is associated with positive outcomes. A Functional Neurological Disorder pilot MDT clinic was set up within Great Ormond Street Hospital, with the aim to provide a one-off therapeutic assessment and psychoeducation. We surveyed families who attended the clinic to assess their experiences and outcomes. Methods A pilot clinic was set up for patients referred within GOSH with a confirmed diagnosis of FND. The Multidisciplinary team consisted of a CAMHS psychiatrist, paediatric neurologist, physiotherapist and occupational therapist. Patients received a one-off outpatient consultation to discuss FND symptoms and background history. Clinicians provided psychoeducation for patients and families about the diagnosis and devised treatment plans including follow-up assessments, onward referral to local services and a consultation with teams where appropriate. A follow-up survey was conducted using semi-structured telephone interviews and patient satisfaction questionnaires. Questionnaires were scored using a Likert rating scale (1: very dissatisfied – 5: very satisfied). Parents were asked about their understanding of the FND diagnosis and about their experiences of support from local teams. Results 25 patients diagnosed with FND were referred to the clinic. Of those, 20 patients took up the consultation. Patients presented with range of functional syndromes. 15 families consented to follow-up interviews. Parents rated their experience at the FND clinic highly (median score 5 – very satisfied). They were very dissatisfied with follow up care (median score 1). Only one patient remained under CAMHS at the time of follow up. 3 families had sought support privately. Parents subjectively rated their children's symptoms at follow up as: much worse (3); a bit worse (1); the same (7); a bit better (2) and much better (2). Conclusion Patients and parents demonstrated high levels of satisfaction with the one-off therapeutic assessment. The majority of parents reported that the GOSH consultation helped them to understand the diagnosis of FND. All families felt they had received inadequate support from primary care, local CAMHS services and schools. Patients who struggled to access support from CAMHS/ school were less likely to experience any improvement in FND symptoms and had poorer levels of functioning.

BackgroundPoor representation of pregnant and lactating women and people in clinical trials has marginalised their health concerns and denied the maternal-fetal/infant dyad benefits of innovation in therapeutic research and development. This mixed-methods systematic review synthesised factors affecting the participation of pregnant and lactating women in clinical trials, across all levels of the research ecosystem.Methods and findingsWe searched 8 databases from inception to 14 February 2024 to identify qualitative, quantitative, and mixed-methods studies that described factors affecting participation of pregnant and lactating women in vaccine and therapeutic clinical trials in any setting. We used thematic synthesis to analyse the qualitative literature and assessed confidence in each qualitative review finding using the GRADE-CERQual approach. We compared quantitative data against the thematic synthesis findings to assess areas of convergence or divergence. We mapped review findings to the Theoretical Domains Framework (TDF) and Capability, Opportunity, and Motivation Model of Behaviour (COM-B) to inform future development of behaviour change strategies. We included 60 papers from 27 countries. We grouped 24 review findings under 5 overarching themes: (a) interplay between perceived risks and benefits of participation in women's decision-making; (b) engagement between women and the medical and research ecosystems; (c) gender norms and decision-making autonomy; (d) factors affecting clinical trial recruitment; and (e) upstream factors in the research ecosystem. Women's willingness to participate in trials was affected by: perceived risk of the health condition weighed against an intervention's risks and benefits, therapeutic optimism, intervention acceptability, expectations of receiving higher quality care in a trial, altruistic motivations, intimate relationship dynamics, and power and trust in medicine and research. Health workers supported women's participation in trials when they perceived clinical equipoise, had hope for novel therapeutic applications, and were convinced an intervention was safe. For research staff, developing reciprocal relationships with health workers, having access to resources for trial implementation, ensuring the trial was visible to potential participants and health workers, implementing a woman-centred approach when communicating with potential participants, and emotional orientations towards the trial were factors perceived to affect recruitment. For study investigators and ethics committees, the complexities and subjectivities in risk assessments and trial design, and limited funding of such trials contributed to their reluctance in leading and approving such trials. All included studies focused on factors affecting participation of cisgender pregnant women in clinical trials; future research should consider other pregnancy-capable populations, including transgender and nonbinary people.ConclusionsThis systematic review highlights diverse factors across multiple levels and stakeholders affecting the participation of pregnant and lactating women in clinical trials. By linking identified factors to frameworks of behaviour change, we have developed theoretically informed strategies that can help optimise pregnant and lactating women's engagement, participation, and trust in such trials.

Neuromorphic devices are electronic devices that mimic the information processing methods of neurons and synapses, enabling them to perform multiple tasks simultaneously with low power consumption and exhibit learning ability. However, their large-scale production and efficient operation remain a challenge. Herein, we fabricated an aluminum-doped zinc oxide (AZO) synaptic transistor via solution-based spin-coating. The transistor is characterized by low production costs and high performance. It demonstrates high responsiveness under UV laser illumination. In addition, it exhibits effective synaptic behaviors under blue LED illumination, indicating high-efficiency operation. The paired-pulse facilitation (PPF) index measured from optical stimulus modulation was 179.6%, indicating strong synaptic connectivity and effective neural communication and processing. Furthermore, by modulating the blue LED light pulse frequency, an excitatory postsynaptic current gain of 4.3 was achieved, demonstrating efficient neuromorphic functionality. This study shows that AZO synaptic transistors are promising candidates for artificial synaptic devices.

Industrial high-speed rotating machines entail constant and consistent monitoring to prevent downtime, affecting quantity and quality. Complex machines need advanced intelligent fault diagnosis showing minimal errors. This work offers a MATLAB-based fault diagnosis for sugar industry machines. The preliminary survey for sugar factories is conducted to gain critical vibration problems in sugar industries. The vibration behaviour of physical industrial machines is obtained, and the signals are provided to a MATLAB program to identify the fault. The information helps to suggest remedies to include in the maintenance schedule. The ease and comprehensible nature of the method reduce time and enhance the reliability of condition monitoring for industrial machines.