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Purpose: The most effective approach to treat individuals with rotator cuff tears (RCTs) remains uncertain, but operative treatment, especially arthroscopic surgery with various suture anchors, is becoming more popular. The purpose of this study was to assess the functional outcomes in patients who underwent arthroscopic RCTs restoration using Sironix suture anchors. Materials and Methods: Eighty patients (36 males and 44 females) who had arthroscopic rotator cuff restoration using Sironix suture anchors were included. Postoperatively, patients were followed up and functional outcomes were evaluated using the American Shoulder and Elbow Surgeons Standardization Shoulder Assessment (ASES), level of activity using the Simple Shoulder Test (SST) questionnaire, Quality of life using the Shoulder Pain and Disability Index (SPADI) scale, and Single Assessment Numerical Evaluation (SANE) score on a scale of 0–100. Adverse events were recorded post-RCTs restoration. Results: The functional outcomes were presented as the mean (standard deviation [SD]) values of total ASES, SPADI, and SST scores, which were observed to be 92.6 (05.28), 01.6 (02.46), and 90.3 (14.22), respectively. The SANE mean (SD) values of the operated shoulder and the opposite shoulder were 91.8 (10.22) and 97.3 (5.68), respectively, with a P = 0.0001. No serious adverse events were reported and none of the subjects discontinued the study. Conclusions: The current study demonstrated that the functional outcomes were quite satisfactory, with good results. Therefore, Sironix shoulder implants (CEPTRE® Knotted UHMWPE Suture PEEK Anchor and CEPTRE® Knotted UHMWPE Suture Titanium Anchor) were considered safe and effective in rotator cuff restoration.

Abstract Background Occurrences of weight stigma have been documented in prenatal clinical settings from the perspective of pregnant patients, however little is known from the viewpoint of healthcare providers themselves. Reported experiences of weight stigma caused by maternal healthcare providers may be due to negative attitudes towards obesity in pregnancy and a lack of obesity specific education. The objective of this study was to assess weight-related attitudes and assumptions towards obesity in pregnancy among maternal healthcare providers in order to inform future interventions to mitigate weight stigma in prenatal clinical settings. Methods A cross-sectional survey was administered online for maternal healthcare providers in Canada that assessed weight-related attitudes and assumptions towards lifestyle behaviours in pregnancy for patients who have obesity. Participants indicated their level of agreement on a 5-point likert scale, and mean scores were calculated with higher scores indicating poorer attitudes. Participants reported whether they had observed weight stigma occur in clinical settings. Finally, participants were asked whether or not they had received obesity-specific training, and attitude scores were compared between the two groups. Results Seventy-two maternal healthcare providers (midwives, OBGYNs, residents, perinatal nurses, and family physicians) completed the survey, and 79.2% indicated that they had observed pregnant patients with obesity experience weight stigma in a clinical setting. Those who had obesity training perceived that their peers had poorer attitudes (3.7 ± 0.9) than those without training (3.1 ± 0.7; t(70) = 2.23, p = 0.029, Cohen’s d = 0.86). Conclusions Weight stigma occurs in prenatal clinical environments, and this was confirmed by maternal healthcare providers themselves. These findings support advocacy efforts to integrate weight stigma related content and mitigation strategies in medical education for health professionals, including maternal healthcare providers. Future work should include prospective examination of weight related attitudes among maternal healthcare providers and implications of obesity specific education, including strategies on mitigating weight stigma in the delivery of prenatal care.

Background: Orthodontics is a specialized field of dentistry that focuses on correcting maligned teeth and jaws. Friction in orthodontics occurs at multiple contact points along the archwire. We discuss the factors that affect friction in fixed appliances, including biological considerations, the ligation mechanism, the bracket, and the archwire. This bibliometric study’s objective is to review the literature on the subject of friction in orthodontics. This abstract provides an overview of the key concepts, methods, and applications of friction in orthodontics using bibliometric analysis. Methods: Bibliometrics can reveal significant shifts in research and publication trends. The Bibliometrix package with the VOS viewer program (Centre for Science and Technology Studies, Leiden University, The Netherlands), and RStudio 2021.09.0 + 351 for Windows (RStudio, Boston, Massachusetts) was used in the bibliometric research. The literary data for this study came from Elsevier’s Scopus database (www.scopus.com), and they were exported in BibTex format. The following criteria were used to independently classify the articles: (a) annual scholarly output; (b) top nations or regions; (c) top journals; (d) productive authors; (e) citations; (f) study design; (g) topic distribution; (h) keywords used; and (i) trending topics over time. Results: Brazil and Germany have the most single-country publications, according to a statistical analysis. Conclusions: The research done on the aspect of finding the role of friction in orthodontics provided data and knowledge about using friction as a tool to control tooth movement in fixed appliance therapy. Further studies are necessary to obtain more reliable results.

ABSTRACT Tuberculosis (TB) caused by Mycobacterium tuberculosis (M. tb) is one of the most devastating infectious diseases afflicting a large number of human lives. In spite of the availability of several drugs for treating TB, emergence of drug-resistant strains of the pathogen has made treatment and eradication of TB a challenging task. Hence, there is an imperative need for new intervention strategies to target M. tb. The enzymes of the diaminopimelate pathway, involved in lysine biosynthesis as well as in cell wall biosynthesis, have been considered as important anti-TB drug targets. One such enzyme is dihydrodipicolinate reductase (DapB), catalyzing the reduction of 2,3-dihydrodipicolinic acid to 2,3,4,5-tetrahydro-dipicolinic acid by utilizing NADH/NADPH as its cofactor. Here, we have generated an antisense knockdown mutant strain of dapB and demonstrated a crucial role of dapB in the in vitro and intracellular growth of M. tb. Further, in silico virtual screening was performed by employing a library of ~95,000 compounds for the identification of inhibitory molecules against DapB. The molecules with high docking scores were screened against the enzymatic activity of DapB to determine their IC50 values. Further, hit molecules that inhibited DapB were screened against the M. tb growth in broth culture and inside macrophages. The molecules exhibiting M. tb inhibition were also evaluated for their cytotoxicity against various mammalian cell lines. In summary, we have identified a lead molecule, B59, with an IC50 value of 11 µg/mL and MIC99 value of 20 µg/mL, which can be further optimized to develop potent inhibitory compounds against M. tb DapB. IMPORTANCE Non-compliance to lengthy antituberculosis (TB) treatment regimen, associated side effects, and emergence of drug-resistant strains of Mycobacterium tuberculosis (M. tb) emphasize the need to develop more effective anti-TB drugs. Here, we have evaluated the role of M. tb dihydrodipicolinate reductase (DapB), a component of the diaminopimelate pathway, which is involved in the biosynthesis of both lysine and mycobacterial cell wall. We showed that DapB is essential for the in vitro as well as intracellular growth of M. tb. We further utilized M. tb DapB, as a target for identification of inhibitors by employing in silico virtual screening, and conducted various in vitro screening assays to identify inhibitors with potential to inhibit DapB activity and in vitro and intracellular growth of M. tb with no significant cytotoxicity against various mammalian cell lines. Altogether, M. tb DapB serves as an important drug target and a hit molecule, namely, 4-(3-Phenylazoquinoxalin-2-yl) butanoic acid methyl ester has been identified as an antimycobacterial molecule in our study.

The transcriptome of a cell governs the overall cellular expression of proteins, hence, targeting mRNA holds promise as a therapeutic strategy in the field of drug discovery. RNA therapeutics especially, antisense oligonucleotide (ASO) technology, have gained tremendous pace in the last few decades with many of the ASOs being evaluated in various clinical phases and several ASO-based drugs are currently marketed after FDA approval. Several chemical modifications in the nucleic acid backbone of ASOs have led to improved properties of ASOs, such as oligonucleotide stability, enhanced affinity, and better pharmacokinetics contributing to their therapeutic success. ASOs interfere with the translation process either by RNase H-mediated mRNA cleavage or by posing steric hindrance in the translation machinery. Further, the cellular delivery of ASOs has always remained questionable, however, with the advancements in the delivery approaches, it is now feasible to achieve better target specific cellular delivery. In this review, we provide comprehensive insights into antisense oligonucleotide therapeutics, their various modifications, the mechanisms involved, different strategies for their delivery, and the utility of ASOs against several bacterial diseases.

Seeking ways to encourage broad compliance with health guidelines during the pandemic, especially among youth, we test two hypotheses pertaining to the optimal design of instructional interventions for improving COVID-19-related knowledge, attitudes, and behaviors. We randomly assigned 8376 lower-middle income youth in urban India to three treatments: a concentrated and targeted fact-based, instructional intervention; a longer instructional intervention that provided the same facts along with underlying scientific concepts; and a control. Relative to existing efforts, we find that both instructional interventions increased COVID-19-related knowledge immediately after intervention. Relative to the shorter fact-based intervention, the longer intervention resulted in sustained improvements in knowledge, attitudes, and self-reported behavior. Instead of reducing attention and comprehension by youth, the longer scientific based treatment appears to have increased understanding and retention of the material. The findings are instrumental to understanding the design of instruction and communication in affecting compliance during this and future pandemics.

In orthodontics, the surface roughness and corrosion behavior due to metal ion releases in orthodontic brackets and archwires affect the effectiveness of tooth movement. Atomic force microscopy (AFM) can provide three-dimensional information measurements which are used to evaluate the quantitative analysis of the surface changes of orthodontic brackets. Stainless steel orthodontic brackets and wires can release metal ions which lead to corrosion when exposed to various types of mouthwash. Aim: The main aim of this study is to compare and evaluate the surface changes from conventional metal brackets and self-ligating metal brackets after immersion in three different mouthwashes. Materials and Methods: Sixteen conventional metal brackets and sixteen metal self-ligating brackets were evenly grouped and immersed in deionized water, chlorhexidine mouthwash, herbal mouthwash, and betadine mouthwash for seven days and the surface changes were evaluated using nondestructive AFM. Results: The surface roughness was evaluated at 30 μm and the results showed that more surface roughness was observed P < 0.05 in betadine mouthwash groups and followed by herbal mouthwash and least in chlorhexidine mouthwash. Conclusion: Based on the AFM results, the surface changes were more pronounced in both groups which were immersed in betadine and herbal mouthwash than others and the choice of mouthwash should be considered before prescribing to the patients.

Accomplishing complete dental rehabilitation in a young child requires extra efforts, primarily because of the need to make use of behavior modification techniques, especially in the children requiring extensive dental procedures. Pharmacological means are sought when nonpharmacological techniques fail. General anesthesia (GA) comes to rescue in such cases. The applicability of GA in pediatric dentistry has been researched a lot and found to be effective. The case reports describe the challenges faced in managing the mutilated dentition in two children with Frankel's behavior rating as 1 (definitely negative behavior), in the midst of a pandemic where the pediatric dentist had to take care of the parental anxiety related to the child's oral conditions along with the concern of safety protocols followed in light of the ongoing COVID-19 pandemic. Complete oral rehabilitation was accomplished for both the children under GA.

Systematic evidence maps (SEMs) are increasingly used to inform decision-making and risk management priority-setting and to serve as problem formulation tools to refine the focus of questions that get addressed in full systematic reviews. Within the U.S. Environmental Protection Agency (EPA) Office of Research and Development (ORD) Integrated Risk Information System (IRIS), SEMs have been used to inform data gaps, determine the need for updated assessments, inform assessment priorities, and inform development of study evaluation considerations, among other uses. Increased utilization of SEMs across the environmental health field has the potential to increase transparency and efficiency for data gathering, problem formulation, read-across, and evidence surveillance. Use of the SEM templates published in the companion text (Thayer et al.) can promote harmonization in the environmental health community and create more opportunities for sharing extracted content.

Background: Systematic evidence maps (SEMs) are gaining visibility in environmental health for their utility to serve as problem formulation tools and assist in decision-making, especially for priority setting. SEMs are now routinely prepared as part of the assessment development process for the US Environmental Protection Agency (EPA) Integrated Risk Information System (IRIS) and Provisional Peer Reviewed Toxicity Value (PPRTV) assessments. SEMs can also be prepared to explore the available literature for an individual chemical or groups of chemicals of emerging interest. Objectives: This document describes the typical methods used to produce SEMs for the IRIS and PPRTV Programs, as well as “fit for purpose” applications using a variety of examples drawn from existing analyses. It is intended to serve as an example base template that can be adapted as needed for the specific SEM. The presented methods include workflows intended to facilitate rapid production. The Populations, Exposures, Comparators and Outcomes (PECO) criteria are typically kept broad to identify mammalian animal bioassay and epidemiological studies that could be informative for human hazard identification. In addition, a variety of supplemental content is tracked, e.g., studies presenting information on in vitro model systems, non-mammalian model systems, exposure-level-only studies in humans, pharmacokinetic models, and absorption, distribution, metabolism, and excretion (ADME). The availability of New Approach Methods (NAMs) evidence is also tracked (e.g., high throughput, transcriptomic, in silico, etc.). Genotoxicity studies may be considered as PECO relevant or supplemental material, depending on the topic and context of the review. Standard systematic review practices (e.g., two independent reviewers per record) and specialized software applications are used to search and screen the literature and may include the use of machine learning software. Mammalian bioassay and epidemiological studies that meet the PECO criteria after full-text review are briefly summarized using structured web-based extraction forms with respect to study design and health system(s) assessed. Extracted data is available in interactive visual formats and can be downloaded in open access formats. Methods for conducting study evaluation are also presented which is conducted on a case-by-case basis, depending on the usage of the SEM.

Immune Checkpoint Inhibitors (ICIs) have improved survival in many patients with advanced cancers, however, many patients develop serious and often permanent immune-related adverse events (irAEs). Recent studies have shown that alterations in commensal gut bacteria, also known as gut dysbiosis, may lead to an increased risk of irAEs. This systematic review includes studies published between January 1, 2015, to April 10, 2021, written in the English language, which described an association between antibiotics/other concomitant medications, or fecal microbiota transplant (FMT), or both, on ICI efficacy and/or incidence of irAEs. In total, 1204 studies were identified that were published between January 1, 2015–April 10, 2021, and 28 met the inclusion criteria. Of these 28 articles, 22 examined the effect of antibiotics and other gut-microbiome altering drugs on ICI efficacy, whereas 6 studies examined the effect of FMT on ICI efficacy and irAE reduction. 21 of the 22 articles that examined the effect of antibiotics showed a negative impact on overall survival (OS) and/or progression free survival (PFS). All the studies (6) that examined FMT showed a beneficiary effect in terms of restoring ICI efficacy and/or decreasing incidence or severity of irAEs. Overall, the use of antibiotics had a significant negative impact on patients’ response to ICI treatment. Therefore, the use of antibiotics in this patient population should be carefully considered, taking into account potential risks and benefits. Restoration of a healthy gut microbiota through FMT is a potentially beneficial prospective approach that could be used to enhance therapeutic efficacy of ICIs and ameliorate irAEs.

Gorlin–Goltz syndrome (GGS), due to its sparse occurrence in various populations along with the variety of associated signs and symptoms, very often becomes a missed diagnosis. The most commonly associated triad with GGS is that of multiple odontogenic keratocysts in the jaws, skeletal abnormalities, and multiple basal cell nevus carcinomas. In many cases, each of these conditions is treated separately and the recognition of underlying syndrome is rare or happenstance. The case reported here is rare of its kind as it has been diagnosed in the first decade of life, thus avoiding the possibility of morbidity in later life in the form of neoplasia and hostile basal cell carcinomas. As per our knowledge, no case had yet been reported at this early age and it emphasizes the importance of pedodontist in early recognition of the syndrome.

Introduction: Virtual clinic is a new concept in India. This summary describes that how a virtual clinic is transforming the healthcare scenario in rural India. Virtual clinic is based on a social business model, which may involve diverse stakeholders to promote primary care. Aim: This virtual e-clinic aims to expand health outreach in rural and hard-to-reach areas of India and provide primary health care services by connecting local practitioners and health workers visiting patients with qualified allopathic doctors in city through video conferencing technologies. Methodology: This was a cross-sectional study evaluating the feasibility and acceptance of virtual primary care. A convenient sampling method was used. Data on demographic profiles, morbidity patterns, and referrals were collected with proper consent. This virtual clinic comprises of smartphones, monitors, and assistive devices so that patient can interact with the doctors through video-conferencing and can have authenticated prescriptions with standardized protocols. The private organization who initiated the virtual care program had two centers at the beginning and gradually expanded them to 20 in Uttar Pradesh. Consultations charges were kept minimum to no-profit, no-loss. Data were collected from January 2019 to June 2010. Results: Total number of consultations made was 800. Out of 800 patients, 157 patients belonged to age group of ≥60 years. Mean age the patient was 56 ± 1.56 years, among them 421 (52.62%) were male. The participants actively engaged in clinical interactions and completed full sessions of consultations, which highlight the acceptability of the virtual care system and feasibility of effective patient-provider communication and service delivery using digital technologies. Conclusion: The concept of virtual primary care is becoming very popular in rural region where no qualified doctors are available. The initial results of this technological startup appears to be promising; however, it is necessary to evaluate the quality of care, health outcomes, potentials to integrate such innovations in existing primary care, and the legal as well as ethical issues in the future research.

AIM: The aim of this in-vitro study was to observe and analyze the various enamel surface changes that occur due to laser debonding of metal and ceramic brackets, done by means of Er, Cr:YSGG laser. MATERIALS AND METHODS: 90 extracted premolars were randomly allocated into one of six groups with 15 teeth each. The groups represent metal brackets (Groups A1, A2, A3) and ceramic brackets (Groups B1, B2, B3). Each sub-group represents the mode of debonding used in the study. Debonded teeth were analyzed under scanning electron microscopy (SEM) at 80X and at 1000X magnification at three sites. The adhesive remnant index (ARI) scores were analyzed and the presence of enamel damage was observed. RESULT: ARI showed high score in Groups A1 and B1. SEM images of large composite remnants at the site of bracket in Groups A1 and B1 at the site of bracket and multiple enamel microcracks and fractures at interface and enamel adjacent to bracket in Groups A1 and B1. SEM images of minimal composite remnants at the site of bracket in Groups A2, A3, B2, and B3 and little to no presence of enamel microcracks or fractures at interface and enamel adjacent to bracket in Groups A2, A3, B2, and B3. CONCLUSION: The use of Er, Cr:YSGG laser in orthodontic practice, especially in the debonding procedures of orthodontic brackets provide quality care to patient with minimal post-treatment damages.

Whenever any pandemic accelerates, e.g., the corona virus disease 2019 (COVID-19), it is commonly observed that health care systems face tremendous workload in terms of infectious patients seeking testing and care. During such public health emergencies, besides logistics, there is shortage of trained personnel. In this COVID-19 pandemic Government of India is doing its level best for minimizing the impact of COVID-19. Multiple stringent measures are already taken like nationwide lockdown, social distancing, in hospitals-closing of out-patient services, postponement of elective surgeries, creating dedicated COVID-19 treatment hospital, one third of health staff is working on rotation basis and many more, for prevention of COVID-19 and minimizing the impact. Despite of this, the looming communication gap between people living in remote areas and the specialist doctors has always been in the picture. Due to COVID-19, as most of the routine OPDs are closed it is it has become very tough for people specially who have chronic diseases to consult their doctor. In this scenario artificial intelligence enabled Virtual OPD (VOPD) can be boon to the Indian population. The existing problems related to lack of access to OPD care for a major proportion of population can be solved by some extent by virtual OPD care services, in which patients consult with doctors in a virtual platform via mobile phone, computer and other e-devices. It is supposed to offer a number of advantages over traditional medical consultations in terms of convenience and cost. First and foremost, leverage of video consultation is “Therapeutic presence” that it is reassuring for the patients when they see doctor on video. The second advantage is that it helps in diagnostic assessment of the patients. Not only virtual OPDs solve the issues of delays and self-medication. This not only give benefit of availing the service as per the convenience but also provides the utmost medical consultation directly from the expertise. Alongside, the waiting period of minimum 3-4 hours can be reduced by simply audio-video consultations. It becomes easy to generate electronic prescription and can be emailed. However, evidence of clinical outcomes of VOPD is limited in Indian context. Furthermore, if integrated smartly into existing health care systems, VOPD care have the potential to manage the problem caused by the COVID-19 pandemic.

Background: Human exposure to per- and polyfluoroalkyl substances (PFAS) has been primarily attributed to contaminated food and drinking water. However, additional PFAS exposure pathways have been raised by a limited number of studies reporting correlations between commercial and industrial products and PFAS levels in human media and biomonitoring. Systematic review (SR) methodologies have been widely used to evaluate similar questions using an unbiased approach in the fields of clinical medicine, epidemiology, and toxicology, but the deployment in exposure science is ongoing. Here we present a systematic review protocol that adapts existing systematic review methodologies and study evaluation tools to exposure science studies in order to investigate evidence for important PFAS exposure pathways from indoor media including consumer products, household articles, cleaning products, personal care products, plus indoor air and dust. Objectives: We will systematically review exposure science studies that present both PFAS concentrations from indoor exposure media and PFAS concentrations in blood serum or plasma. Exposure estimates will be synthesized from the evidence to answer the question, “For the general population, what effect does exposure from PFAS chemicals via indoor media have on blood, serum or plasma concentrations of PFAS?” We adapt existing systematic review methodologies and study evaluation tools from the U.S. EPA’s Systematic Review Protocol for the PFBA, PFHxA, PFHxS, PFNA, and PFDA IRIS Assessments and the Navigation Guide for exposure science studies, as well as present innovative developments of exposure pathway-specific search strings for use in artificial intelligence screening software. Data Sources: We will search electronic databases for potentially relevant literature, including Web of Science, PubMed, and ProQuest. Literature search results will be stored in EPA’s Health and Environmental Research Online (HERO) database. Study eligibility and criteria: Included studies will present exposure measures from indoor media including consumer products, household articles, cleaning products, personal care products, plus indoor air and dust, paired with PFAS concentrations in blood, serum or plasma from adults and/or children in the general population. We focus on a subset of PFAS chemicals including perfluorooctanoic acid (PFOA), perfluorooctanesulfonate (PFOS), perfluorobutanoic acid (PFBA), perfluorobutane sulfonate (PFBS), perfluorodecanoic acid (PFDA), perfluorohexanoic acid (PFHxA), perfluorohexanesulfonate (PFHxS), and perfluorononanoic acid (PFNA). Study appraisal and synthesis methods: Studies will be prefiltered at the title and abstract level using computationally intelligent search strings to expedite the screening process for reviewers. Two independent reviewers will screen the prefiltered studies against inclusion criteria at the title/abstract level and then full-text level, after which the reviewers will assess the studies’ risk of bias using an approach modified from established systematic review tools for exposure studies. Exposure estimates will be calculated to investigate the proportion of blood, serum or plasma) PFAS concentrations that can be explained by exposure to PFAS in indoor media.

Lactate threshold (LT) estimation in endurance sports continues to be a widely controversial field amongst sports scientists and students despite beyond 50 years of research. With the advent of technology and superior sensors, LT research has ventured into newer fields involving wearables and artificial intelligence. Still, there is a felt need to understand the focused areas of LT research and to guide the students, sports scientists and coaches. The main aim of this mini-review is to identify research categories in a descriptive manner and to synthesize broad themes for future research from latest literature. A comprehensive electronic search in three databases was performed including only original free full text research articles conducted in athletes and heathy subjects, published in English between 2016 and 2020 following PRISMA guidelines. Out of screened 466 articles, 14 articles were finally shortlisted as per inclusion criteria and the findings were summarized. Five research categories were identified and reviewed. To conclude, there is a need for consensus in Graded Exercise test protocols used, LT concepts validity for specific sports and the application of valid, reliable noninvasive LT estimation methods in endurance sports. Synthesized broad themes would help guide sports scientists, students and researchers for future research.

Immune checkpoint inhibitors (ICIs) targeting the programmed cell death protein-1 (PD-1) and programmed cell death ligand-1 (PD-L1) have improved survival in many advanced cancers including advanced melanoma, renal cell, urothelial, and non-small-cell lung cancers. However, not all patients respond, and immune-related adverse events (irAEs) are common. Commensal gut bacteria may serve as an immunoregulatory link-mediating ICI response and toxicity. Recent studies have shown that a lack of bacterial diversity, known as gut dysbiosis, can have an adverse impact on patients’ response to ICIs and predispose to the development of irAEs. Data were collected from 167 patients with metastatic melanoma who received antibiotics within 30 days prior to and/or after initiation of ICI and patients who received NSAIDs, statins, steroids, or proton-pump inhibitors (PPI) within 30 days prior to ICI initiation. The primary outcome was time-to-discontinuation (TTD) of ICI therapy, measured from the date of ICI initiation to the last treatment date. The secondary outcome of interest was toxicity, with incidence of irAEs graded as per the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Here, we demonstrate that individuals who received antibiotics had a significantly shorter time-to-discontinuation (TTD) of the ICI therapy as opposed those who were not administered antibiotics. Consistent with results from previous research, we propose that antibiotics have a negative effect on a patient’s response to ICI therapy, most likely due to the result of gut dysbiosis, and should be critically assessed in terms of their use in patients undergoing ICI treatment.

With development of specialized pediatric critical care units, referral from community, district or other peripheral hospitals has gained greater momentum. Referral is a process in continuum; starting from the referring and ending at the referred hospital. Establishing a one on one communication with peripheral hospitals and healthcare providers over a wide geographical area is not an easy task. This gap can be reduced effectively using technology. An ‘electronic’ referral system can improve the two way communication and ensure completeness of requisite information about every referral. Therefore we studied the feasibility of an e-referral system to streamline the referrals coming to our Pediatric Emergency Unit. An online e-referral system may be a good initiative to connect hospitals and enable 24X7 communications over the patients being referred between them.

Introduction: Traumatic dental injuries are one of the commonly encountered dental emergencies. Missing anterior tooth in children due to any injury can be a source of considerable physical and psychological discomfort for the child. The prognosis of some dental injuries depends to a great extent on parents’ knowledge of correct and prompt emergency measures. Aim: The purpose of this cross-sectional study was to assess the knowledge, attitude and awareness level of parents regarding the emergency management of dental trauma and to find out the relation of the responses to social variables. Materials and Methods: A total of 2000 parents were surveyed over a period of three months using a pretested close ended questionnaire prepared in English, Hindi as well as in the regional language which was divided into three parts: Part 1 contained questions on personal information, Part 2 on an imaginary case of trauma to assess their knowledge regarding trauma management and Part 3 related to their attitude towards dental trauma management education. The data was statistically analysed using descriptive and chi-square statistics. Results: The overall knowledge of parents regarding emergency management of trauma was not satisfactory. Although most of the people were in favour of taking professional consultation for emergency management of trauma but most of them were unaware of the steps that need to be taken on their part so as to minimize complications and improve prognosis. Conclusion: Educational campaigns are the need of the day to increase the knowledge of parents regarding emergency management of dental trauma.

Fitspiration is a social media trend that utilizes images and quotes to promote and inspire physical health and fitness. However, research has shown Fitspiration reinforces the rigidly defined appearance ideal, particularly in women, which can lead to negative body image. There remains limited understanding of the characteristics and impact of men's Fitspiration. The purpose of this content analysis was to investigate the nature, presentation, and text-based messages of male-focused Fitspiration on Instagram. Hashtags (#) were used to collect 1,000 random images from Instagram. Content codes for images included body type, objectification, activities, and messages conveyed. Results showed most images consisted of men accentuating their highly muscular upper bodies with low body fat, consistent with the male appearance ideal. Also, men were often shown engaging in activities irrelevant to health or fitness (i.e., passive modeling) that emphasized their physical appearance. Consistent with research examining female-focused Fitspiration, male-focused Fitspiration reinforces a glamorized appearance ideal with low focus on health and fitness. • First study to explore the presentation of male-focused fitspiration on Instagram. • Most posts included men with a noticeable muscular upper body and little body fat. • The majority of the men did not objectify themselves. • Men posted content not related to fitness and exercise. • Male fitspiration on Instagram reinforces the male appearance ideal. [ABSTRACT FROM AUTHOR]

Body dissatisfaction in pregnancy has been associated with negative psychological maternal outcomes, including increased risk of postpartum depression. This study aimed to explore weight-related factors that influence body dissatisfaction in pregnancy, including gestational weight gain (GWG), weight stigma, obesity, and weight loss attempts before pregnancy. Secondary analysis of a larger cross-sectional study. Online survey administered via Qualtrics. ≥12 weeks pregnant, ≥18 years of age, having a singleton pregnancy and residing in Canada. A battery of questionnaires were completed, including the Body Image in Pregnancy Scale (BIPS) sub-scale. The BIPS scores were compared based on experiences of weight stigma in pregnancy, perception towards their GWG, weight loss attempts before pregnancy, obesity, and GWG category classified as excessive or not referring to Institute of Medicine (2009) guidelines. Significant differences were entered into a linear regression model with BIPS scores as the dependent variable. Significance was accepted as p <0.05. A total of 182 participants completed the survey. There were no differences in BIPS scores based on GWG category (p = 0.160), or obesity (p = 0.230). Poorer BIPS scores were reported by those who felt they had gained 'too much' pregnancy weight than 'appropriate' (p <0.001), and among those who were trying to lose weight before pregnancy compared to those who were not (p = 0.002). Poorer BIPS scores were also reported by individuals who indicated they had experienced weight stigma during pregnancy compared to those who had not (p <0.001). Regression results showed that significant variables were perceptions towards GWG (p = 0.003) and experiencing weight stigma in pregnancy (p = 0.011). Perceptions towards GWG and experiencing weight stigma can influence body dissatisfaction in pregnancy. Given the detrimental physical and psychological consequences of body dissatisfaction, effective strategies to reduce prenatal weight stigma are needed, such as training maternal healthcare providers to offer sensitive preconception and prenatal weight counselling. [ABSTRACT FROM AUTHOR]

Summary Fat and muscle lipolysis involves functional interactions of adipose triglyceride lipase (ATGL), α-β hydrolase domain-containing protein 5 (ABHD5), and tissue-specific perilipins 1 and 5 (PLIN1 and PLIN5). ABHD5 potently activates ATGL, but this lipase-promoting activity is suppressed when ABHD5 is bound to PLIN proteins on lipid droplets. In adipocytes, protein kinase A (PKA) phosphorylation of PLIN1 rapidly releases ABHD5 to activate ATGL, but mechanisms for rapid regulation of PLIN5-ABHD5 interaction in muscle are unknown. Here, we identify synthetic ligands that release ABHD5 from PLIN1 or PLIN5 without PKA activation and rapidly activate adipocyte and muscle lipolysis. Molecular imaging and affinity probe labeling demonstrated that ABHD5 is directly targeted by these synthetic ligands and additionally revealed that ABHD5-PLIN interactions are regulated by endogenous ligands, including long-chain acyl-CoA. Our results reveal a new locus of lipolysis control and suggest ABHD5 ligands might be developed into novel therapeutics that directly promote fat catabolism. [ABSTRACT FROM AUTHOR]

Background: The sudden surge of mucormycosis cases which happened during the second wave of COVID-19 pandemic was a significant public health problem in India., Objectives: The aim of this study was to analyse the clinico-epidemicological characteristics of the mucormycosis cases to determine the changes that had occurred due to COVID-19 pandemic., Methodology: A retrospective cross-sectional study was conducted at the Department of Otolaryngology Head and Neck Surgery, PGIMER, Chandigarh, India. Patients diagnosed with rhino-orbital mucormycosis were categorised into the following groups: Pre-pandemic(May 2019 to April 2020), Pandemic Pre-epidemic (May 2020 to April 2021) and Epidemic (1 May 2021 to 12 July 2021). The epidemiological, clinical and surgical data of all the patients were retrieved from the hospital records and analysed., Results: The epidemic period had 370 cases, compared with 65 during pandemic period and 42 in the pre-pandemic period. Diabetes mellitus was seen in 87% of cases during epidemic period, 92.9% in the pre-pandemic period and 90.8% in the pre-pandemic pre-epidemic period. The proportion of patients suffering from vision loss, restricted extra-ocular movements, palatal ulcer and nasal obstruction was higher in the pre-epidemic groups, and the difference was significant (p, <.01). There was no history of oxygen use in 85.9% of patients and no steroid use in 76.5%. The death rates were the lowest during epidemic (10%)., Conclusion: COVID-19 has caused a statistically significant increase in the number of mucormycosis infections. The mortality and morbidity which showed an increase during the first wave of COVID-19 decreased significantly during the epidemic period., (© 2022 Wiley-VCH GmbH.)