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Purpose: To compare the accuracy of unaided visual inspection (UVI) to Software App measurement (SAM) of penile curvature (PC) during hypospadias surgery. Methods: Seven clinical pictures of PC (15°–60°) taken during hypospadias repair were shared with 300 members of the Society of Pediatric Urology (India). The respondents were asked to assess the angles by UVI and indicate their preferred correction method of that PC. For each picture, the angles of curvature estimated by UVI were compared with the objective angle measured using an app (SAM), which was considered an accurate estimation. Statistical analysis was done using software; P30°, the error in UVI estimation was >10°, with no correlation between the accuracy of UVI estimate and surgeon experience. A significant proportion of surgeons chose the incorrect option for PC correction, which was the lowest (69%) for PC 35.8°. Conclusions: Most surgeons preferred UVI to assess PC; UVI is an erroneous technique to measure PC angle, especially in the PC range 30°–60°, where the error was >10°. Most errors were an underestimation of the PC, irrespective of surgeon experience. There was a significant error in the choice of technique for PC correction for a PC of 35°. These results strongly support the objective assessment of PC using SAM during hypospadias repair.

BackgroundCOVID-19 forced healthcare systems to make unprecedented changes in clinical care processes. The authors hypothesized that the COVID-19 pandemic adversely impacted timely access to care, perioperative processes, and clinical outcomes for pediatric patients undergoing primary appendectomy.MethodsA retrospective, international, multicenter study was conducted using matched cohorts within participating centers of the international PEdiatric Anesthesia COVID-19 Collaborative (PEACOC). Patients younger than 18 yr old were matched using age, American Society of Anesthesiologists Physical Status, and sex. The primary outcome was the difference in hospital length of stay of patients undergoing primary appendectomy during a 2-month period early in the COVID-19 pandemic (April to May 2020) compared with prepandemic (April to May 2019). Secondary outcomes included time to appendectomy and the incidence of complicated appendicitis.ResultsA total of 3,351 cases from 28 institutions were available with 1,684 cases in the prepandemic cohort matched to 1,618 in the pandemic cohort. Hospital length of stay was statistically significantly different between the two groups: 29 h (interquartile range: 18 to 79) in the pandemic cohort versus 28 h (interquartile range: 18 to 67) in the prepandemic cohort (adjusted coefficient, 1 [95% CI, 0.39 to 1.61]; P < 0.001), but this difference was small. Eight centers demonstrated a statistically significantly longer hospital length of stay in the pandemic period than in the prepandemic period, while 13 were shorter and 7 did not observe a statistically significant difference. During the pandemic period, there was a greater occurrence of complicated appendicitis, prepandemic 313 (18.6%) versus pandemic 389 (24.1%), an absolute difference of 5.5% (adjusted odds ratio, 1.32 [95% CI, 1.1 to 1.59]; P = 0.003). Preoperative SARS-CoV-2 testing was associated with significantly longer time-to-appendectomy, 720 min (interquartile range: 430 to 1,112) with testing versus 414 min (interquartile range: 231 to 770) without testing, adjusted coefficient, 306 min (95% CI, 241 to 371; P < 0.001), and longer hospital length of stay, 31 h (interquartile range: 20 to 83) with testing versus 24 h (interquartile range: 14 to 68) without testing, adjusted coefficient, 7.0 (95% CI, 2.7 to 11.3; P = 0.002).ConclusionsFor children undergoing appendectomy, the COVID-19 pandemic did not significantly impact hospital length of stay.Editor’s perspective

BackgroundDifficult facemask ventilation is perilous in children whose tracheas are difficult to intubate. We hypothesised that certain physical characteristics and anaesthetic factors are associated with difficult mask ventilation in paediatric patients who also had difficult tracheal intubation.MethodsWe queried a multicentre registry for children who experienced "difficult" or "impossible" facemask ventilation. Patient and case factors known before mask ventilation attempt were included for consideration in this regularised multivariable regression analysis. Incidence of complications, and frequency and efficacy of rescue placement of a supraglottic airway device were also tabulated. Changes in quality of mask ventilation after injection of a neuromuscular blocking agent were assessed.ResultsThe incidence of difficult mask ventilation was 9% (483 of 5453 patients). Infants and patients having increased weight, being less than 5th percentile in weight for age, or having Treacher-Collins syndrome, glossoptosis, or limited mouth opening were more likely to have difficult mask ventilation. Anaesthetic induction using facemask and opioids was associated with decreased risk of difficult mask ventilation. The incidence of complications was significantly higher in patients with "difficult" mask ventilation than in patients without. Rescue placement of a supraglottic airway improved ventilation in 71% (96 of 135) of cases. Administration of neuromuscular blocking agents was more frequently associated with improvement or no change in quality of ventilation than with worsening.ConclusionsCertain abnormalities on physical examination should increase suspicion of possible difficult facemask ventilation. Rescue use of a supraglottic airway device in children with difficult or impossible mask ventilation should be strongly considered.

Differentiation of malignant from benign pleural effusions is challenging in clinical practice due to limitations in the cytologic analysis. The combination of pleural fluid biomarkers has previously been used to predict malignant pleural effusion (MPE). We have conducted a prospective observational study to assess the diagnostic potential of cancer ratio [(CR) serum lactate dehydrogenase (sLDH): pleural fluid adenosine deaminase (pADA)], CR plus (CR: pleural lymphocyte count), sLDH: pleural lymphocyte count, and age: pADA in differentiating malignant effusions from benign ones. Prospective data from patients evaluated for exudative pleural effusions in the pulmonary medicine department at our institute over 12 months were collected. All subjects underwent thoracentesis, and if the results were inconclusive, they underwent invasive diagnostic testing for confirmation. They were divided into MPE and non-MPE groups for analysis. Pleural fluid biomarker ratios were calculated and compared between both groups, and receiver operating characteristic curves were generated. We included 120 subjects: 59 were diagnosed with MPE, and 61 had benign effusion (46 tubercular and 15 parapneumonic). The mean (standard deviation) age of the study population [64 (53.3%) males] was 52.4 (14.5) years. CR, CR plus, and age: pADA were significantly higher in the MPE group compared to the benign group. The sLDH: lymphocyte count was similar between both groups. Age: pADA ratio and CR performed best, with areas under the curve of 0.99 [95% confidence interval (CI), 0.97-1.0] and 0.97 (95% CI, 0.94-1.0) respectively. A higher age: pADA level was associated with a malignant etiology of effusion (adjusted odds ratio 12.27, 95% CI 2.37-63.54) on multivariate analysis. At a cut-off of 2, age: pADA ratio provided 96.6% sensitivity, 93.4% specificity, with a positive likelihood ratio of 14.7. Age: pADA and CR are promising diagnostic indices for differentiating MPE and non-MPE with high sensitivity and specificity. The diagnostic accuracy of CR plus and sLDH: lymphocyte ratio is inferior to that of CR and age: pADA.

Drug-eluting embolic transarterial chemoembolization (DEE-TACE) improves the overall survival of hepatocellular carcinoma (HCC), but the agents used are not tailored to HCC. Our patented liposomal formulation enables the loading and elution of targeted therapies onto DEEs. This study aimed to establish the safety, feasibility, and pharmacokinetics of sorafenib or regorafenib DEE-TACE in a VX2 model. DEE-TACE was performed in VX2 hepatic tumors in a selective manner until stasis using liposomal sorafenib- or regorafenib-loaded DEEs. The animals were euthanized at 1, 24, and 72 h timepoints post embolization. Blood samples were taken for pharmacokinetics at 5 and 20 min and at 1, 24, and 72 h. Measurements of sorafenib or regorafenib were performed in all tissue samples on explanted hepatic tissue using the same mass spectrometry method. Histopathological examinations were carried out on tumor tissues and non-embolized hepatic specimens. DEE-TACE was performed on 23 rabbits. The plasma concentrations of sorafenib and regorafenib were statistically significantly several folds lower than the embolized liver at all examined timepoints. This study demonstrates the feasibility of loading sorafenib or regorafenib onto commercially available DEEs for use in TACE. The drugs eluted locally without release into systemic circulation.

Abstract Farmers from South Asian countries spray insecticides without protective gear, which leads to insecticide exposure through dermal and nasal routes. Acetylcholinesterase plays a crucial role in controlling neuromuscular function. Organophosphate and carbamate insecticides inhibit acetylcholinesterase, which leads to severe neuronal/cognitive dysfunction, breathing disorders, loss of endurance, and death. To address this issue, an Oxime-fabric is developed by covalently attaching silyl-pralidoxime to the cellulose of the fabric. The Oxime-fabric, when stitched as a bodysuit and facemask, efficiently deactivates insecticides (organophosphates and carbamates) upon contact, preventing exposure. The Oxime-fabric prevents insecticide-induced neuronal damage, neuro-muscular dysfunction, and loss of endurance. Furthermore, we observe a 100% survival rate in rats when repeatedly exposed to organophosphate-insecticide through the Oxime-fabric, while no survival is seen when organophosphate-insecticide applied directly or through normal fabric. The Oxime-fabric is washable and reusable for at least 50 cycles, providing an affordable solution to prevent insecticide-induced toxicity and lethality among farmers.

BackgroundIndia's recent increase in urbanization alongside with feminization of rural agriculture could increase the existing gender disparities in dietary diversity. With many rural men migrating to urban areas, women have increased domestic burdens as well as productive burdens such as making informed crop production decisions so household members consume a diverse diet. Given the rapid and recent onset of this phenomenon, there is a need to explore gender differentials in diet diversity across urban and rural areas to assess if certain populations are being disproportionately impacted by this trend. There are limited established quantitative studies discussing this gender disparity with respect to urbanization. Therefore, this paper compares dietary diversity among adult men, adult women, adolescent males, and adolescent females in urban and peri-urban locations. The authors also assess if various sociodemographic factors correlate with dietary diversity.MethodsAnalyses were conducted on dietary diversity data collected by the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) from selected urban (1108 individuals) and peri-urban (808 individuals) locations of Hyderabad, India. The total sample size of the population is n = 1816: 660 adult males, 662 adult females, 205 adolescent males, and 289 adolescent females.ResultsAdult women and adolescent females have a higher diet disparity between peri-urban and urban areas when compared to adult males and adolescent males. Multivariate analyses followed by post hoc multiple comparisons testing further support that peri-urban adult women consume a less diverse diet compared to their urban counterparts and less than other peri-urban adult men and adolescent women. It was also found that marital status, type of household card owned, and the highest degree of education are statistically significant correlators of an individual's dietary diversity.ConclusionsGiven that urbanization could negatively impact already vulnerable populations such as peri-urban adult women, who play a key role in children's nutrition, it is important to provide support to these populations. This paper suggests it is possible to do so through government subsidization of peri-urban farmers to grow more diverse crops, fortifying easily accessible foods with commonly lacking micronutrients, including Vitamin A, folic acid, and iron, market access, and affordable prices.

Background: Pediatric dentistry necessitates efficient behavior management methods to ensure successful treatment outcomes and positive experiences for young patients. This research aims to evaluate the comparative effectiveness of “Tell-Show-Do (TSD)”, positive reinforcement, nitrous oxide sedation, and pharmacological sedation in pediatric dental practice. Methods: A retrospective analysis was conducted on pediatric patients aged 3-12 years who underwent dental treatment at a designated dental center over a 1-year period. Patients were categorized based on the behavior management method utilized: TSD, positive reinforcement, nitrous oxide sedation, or pharmacological sedation. Treatment success rates and patient cooperation levels were evaluated for each method. Results: Positive reinforcement and TSD demonstrated the highest treatment success rates (85% and 80%, respectively) and patient cooperation levels (90% and 85%, respectively). Nitrous oxide sedation exhibited moderate effectiveness with a treatment success rate of 70% and a patient cooperation level of 75%. Pharmacological sedation had the lowest treatment success rate (60%) and patient cooperation level (65%). Statistical analysis revealed significant differences in treatment success rates (P < 0.05) and patient cooperation levels (P < 0.05) among the behavior management methods. Conclusion: Positive reinforcement and TSD emerge as highly efficient behavior management methods in pediatric dentistry, promoting high treatment success rates and patient cooperation levels. Nitrous oxide sedation offers a valuable adjunct for managing anxiety and enhancing patient comfort. Pharmacological sedation, while efficient in certain cases, should be used judiciously due to associated risks.

Background: “Early childhood caries (ECC)” is a prevalent and serious oral health issue affecting preschool-aged children globally, with adverse effects on their overall health and well-being. Objective: This center-based research designed to investigate the prevalence and management of ECC among preschoolers within a specific setting and evaluate associated factors. Methods: A cross-sectional research design was employed, involving 300 preschoolers aged 3 to 5 years. Clinical examinations were conducted, and data on demographic characteristics, oral hygiene practices, dietary habits, and dental visits were collected through structured interviews. Statistical analysis was performed to assess ECC prevalence and examine associations between demographic/behavioral factors and ECC severity. Results: The prevalence of ECC among preschoolers was 65%, with a mean dmfs score of 4.2. Factors such as age, gender, socioeconomic status, and oral hygiene practices were associated with ECC severity. Management strategies included topical fluoride application, oral health education, and restorative treatments. Conclusion: ECC remains a significant public health concern among preschoolers. Comprehensive oral health programs targeting this population are essential to mitigate ECC burden and improve oral health outcomes. Further research is needed to address systemic barriers and disparities in ECC prevention and management.

Knowledge, Attitudes, and Practices (KAP) studies offer valuable insights into the socio-cultural, psychological, and behavioral determinants of nutrition. This study aims to assess nutrition KAP during pregnancy and lactation in selected areas of Adilabad and Kumaram Bheem Asifabad districts, Telangana, India. A cross-sectional KAP survey was conducted on 536 individuals from February to March 2020, employing tablet-based data collection for pregnant women, lactating mothers, young mothers, and frontline staff. Departing from the standard equal-weight approach, we assigned different weights to responses based on existing literature and stakeholder consultation, acknowledging the varying significance of each response. This novel approach aims to mitigate the risk of overestimating or underestimating factors, thereby designing more effective policy interventions tailored to societal complexities. The results reveal that regarding the three micronutrients (Iron, vitamin A, and Iodine), the knowledge levels of pregnant women, lactating mothers, and young mothers were low, that is, less than 50% when compared with the functionaries/frontline staff. Pregnant women scored low on attitudes regarding micronutrients compared to lactating mothers, young mothers, and functionaries/frontline staff. Attitudes translate into practices; however, the data revealed that pregnant women, lactating mothers, and young mothers were not adopting appropriate dietary and nutrition practices except for the micronutrient iodine. The inadequate knowledge of all categories of respondents indicates a gap in nutrition literacy and education. The results point to the urgent need for policy action for nutrition education interventions among the vulnerable population.

Background: Bronchiectasis is a chronic disorder of the lung caused due to permanent structural changes in the bronchial tree which consequently leads to high morbidity. Many clinical factors lead to severe morbidity in patients and affect the respiratory quality of life. Aim: The present study aimed to determine the various clinical and radiological factors affecting the respiratory quality of life of patients with bronchiectasis. Materials and Methods: We recruited forty diagnosed patients with bronchiectasis and collected their social, clinical, and radiological data, and correlated various obtained parameters with their respiratory quality of life, based on the St. George Respiratory Questionnaire scoring. Observation: We observed low body mass index, higher bronchial obstruction, and worse structural damage to the lungs correlated with worse respiratory quality of life in the patients. Conclusion: Parameters worsening the quality of life can be considered prognostic factors for the disease. Treating clinicians can design protocols for patient management and the institutional pulmonary rehabilitation program based on these prognostic factors.

Background Acute facial trauma in motor vehicle accident defects may be associated with skeletal, neuromuscular, or mucosal losses. Simultaneous repair of the critical structures in these defects mandates the use of flap cover; paucity of local tissues necessitates the use of free skin flaps.

The diagnosis of congenital diaphragmatic hernia (CDH) is associated with significant morbidity and mortality. Survival of neonates with CDH has improved recently, although the clinical course is complicated by sequelae of hypoplastic pulmonary parenchyma and vasculature, pulmonary hypertension, ventilation/perfusion (V/Q) mismatch, reduced pulmonary function and poor somatic growth. In this case report, we describe an infant with an antenatal diagnosis of CDH with a poor prognosis who underwent initial surgery followed by a tracheostomy but had a worsening clinical course due to a large area of ventilated but poorly perfused lung based on a V/Q nuclear scintigraphy scan. The emphysematous left lung was causing mediastinal shift and compression of the right lung, further compromising gas exchange. The infant had clinical improvement following bronchial blockade of the under-perfused left lung. This paved the way for further management with resection of the under-perfused lung lobe and continued clinical improvement. We present the novel use of selective bronchial blockade in a challenging case of CDH to determine if surgical lung resection may benefit the infant. We also review the physiology of gas exchange during the use of a bronchial occluder and the relevant literature.

Nanotheranostics, especially those employing biomimetic approaches, are of substantial interest for molecular imaging and cancer therapy. The incorporation of diagnostics and therapeutics, known as cancer theranostics, represents a promising strategy in modern oncology. Biomimetics, inspired by nature, offers a multidisciplinary avenue with potential in advancing cancer theranostics. This review comprehensively analyses recent progress in biomimetics-based cancer theranostics, emphasizing its role in overcoming current treatment challenges, with a focus on breast, prostate, and skin cancers. Biomimetic approaches have been explored to address multidrug resistance (MDR), emphasizing their role in immunotherapy and photothermal therapy. The specific areas covered include biomimetic drug delivery systems bypassing MDR mechanisms, biomimetic platforms for immune checkpoint blockade, immune cell modulation, and photothermal tumor ablation. Pretargeting techniques enhancing radiotherapeutic agent uptake are discussed, along with a comprehensive review of clinical trials of global nanotheranostics. This review delves into biomimetic materials, nanotechnology, and bioinspired strategies for cancer imaging, diagnosis, and targeted drug delivery. These include imaging probes, contrast agents, and biosensors for enhanced specificity and sensitivity. Biomimetic strategies for targeted drug delivery involve the design of nanoparticles, liposomes, and hydrogels for site-specific delivery and improved therapeutic efficacy. Overall, this current review provides valuable information for investigators, clinicians, and biomedical engineers, offering insights into the latest biomimetics applications in cancer theranostics. Leveraging biomimetics aims to revolutionize cancer diagnosis, treatment, and patient outcomes.

Summary: Background: The Paediatric Difficult Intubation Collaborative identified multiple attempts and persistence with direct laryngoscopy as risk factors for complications in children with difficult tracheal intubations and subsequently engaged in initiatives to reduce repeated attempts and persistence with direct laryngoscopy in children. We hypothesised these efforts would lead to fewer attempts, fewer direct laryngoscopy attempts and decrease complications. Methods: Paediatric patients less than 18 years of age with difficult direct laryngoscopy were enrolled in the Paediatric Difficult Intubation Registry. We define patients with difficult direct laryngoscopy as those in whom (1) an attending or consultant obtained a Cormack Lehane Grade 3 or 4 view on direct laryngoscopy, (2) limited mouth opening makes direct laryngoscopy impossible, (3) direct laryngoscopy failed in the preceding 6 months, and (4) direct laryngoscopy was deferred due to perceived risk of harm or poor chance of success. We used a 5:1 propensity score match to compare an early cohort from the initial Paediatric Difficult Intubation Registry analysis (August 6, 2012–January 31, 2015, 785 patients, 13 centres) and a current cohort from the Registry (March 4, 2017–March 31, 2023, 3925 patients, 43 centres). The primary outcome was first attempt success rate between cohorts. Success was defined as confirmed endotracheal intubation and assessed by the treating clinician. Secondary outcomes were eventual success rate, number of attempts at intubation, number of attempts with direct laryngoscopy, the incidence of persistence with direct laryngoscopy, use of supplemental oxygen, all complications, and severe complications. Findings: First-attempt success rate was higher in the current cohort (42% vs 32%, OR 1.5 95% CI 1.3–1.8, p

BackgroundPediatric anesthesiology has been greatly impacted by COVID-19 in the delivery of care to patients and to the individual providers. With this study, we sought to survey pediatric centers and highlight the variations in care related to perioperative medicine during the COVID-19 pandemic, including the availability of protective equipment, the practice of pediatric anesthesia, and economic impact.AimThe aim of the survey was to determine how COVID-19 directly impacted pediatric anesthesia practices during the study period.MethodsA survey concerning four major domains (testing, safety, clinical management/policy, economics) was developed. It was pilot tested for clarity and content by members of the Pediatric Anesthesia COVID-19 Collaborative. The survey was administered by email to all Pediatric Anesthesia COVID-19 Collaborative members on September 1, 2020. Respondents had six weeks to complete the survey and were instructed to answer the questions based on their institution's practice during September 1 - October 13, 2020.ResultsSixty-three institutions (100% response rate) participated in the COVID-19 Pediatric Anesthesia Survey. Forty-one hospitals (65%) were from the United States, and 35% included other countries. N95 masks were available to anesthesia teams at 91% of institutions (n = 57) (95% CI: 80%-96%). COVID-19 testing criteria of anesthesia staff and guidelines to return to work varied by institution. Structured simulation training aimed at improving COVID-19 safety and patient care occurred at 62% of institutions (n = 39). Pediatric anesthesiologists were economically affected by a reduction in their employer benefits and restriction of travel due to employer imposed quarantine regulations.ConclusionOur data indicate that the COVID-19 pandemic has impacted the testing, safety, clinical management, and economics of pediatric anesthesia practice. Further investigation into the long-term consequences for the specialty is indicated.

The increased burden of cancer disease globally arouses the urgent need for the development of novel chemical agent with improved efficacy and potency which can provide selective therapeutic outcome to an individual cancer patient. In this connection the in-silico designing of novel scaffolds are greatly helpful evading the need for synthesizing and evaluating the series of large number compounds. We have constructed novel pyrazolopyrimidines with reference to existing fused pyrimidine standards like central aromatic heterocycles, spacers, hydrophobic heads and tails. We examined for the nature and biochemical targets, ADMET evaluations using various online tools and molecular docking analysis through Schrodinger suite studied binding affinities with reference to standards as well as co-crystals. We designed pyrazolopyrimidines 7a-j and 12a-j along with molecular docking studies revealed that few were potential candidates compared to standard scores against various target kinases. The hydroxyl moiety in 7b & 7d, hydroxyl in 7e with 4-bromo showed more bonding affinity towards targets and remaining compounds produced mild to moderate affinities against various targets. GLU339, GLU51, LEU83, SER345, ASP404, ASN391, and ASP348 are major residues for H-bonding interactions, PHE80, LEU83, GLN275 influenced hydrophobic bonding and ASP404 for nitro group, GLU339 for hydroxyl group, LYS89 for methoxy groups are key residues in binding affinity. We also identified the key residues of target proteins involved in the interaction with ligands at the active pocket. We believe that these results could benefit the future development of anticancer scaffold containing pyrazolopyrimidine motifs in the core structure.

Children undergoing microdirect laryngoscopy and bronchoscopy (MDLB) pose anesthetic challenges while providing a motionless surgical field without an endotracheal tube.

Introduction: Even after decades of the development of lowcost and effective antibiotics, puerperal infections remain an important cause of preventable maternal morbidity and mortality. Aim: The aim of the present study was to determine the risk factors, morbidity, and mortality associated with puerperal infections. Materials and Methods: A retrospective study was conducted from March 2021 to October 2021, at the Obstetrics and Gynaecology Department of Gandhi Hospital in Telangana, India. The study included all women who delivered in this hospital and were referred within 42 days after delivery with fever and any of the following symptoms: pain abdomen, malodorous lochia, abdominal distention, subinvolution of the uterus, pelvic abscess, peritonitis, any system/organ failure, or shock. Various risk factors such as age, parity, socioeconomic status (according to the modified Kuppuswamy scale), BMI, rupture of membranes, mode of delivery, and comorbidities associated with puerperal infection were assessed. Complications following puerperal infection were also studied. Data analysis was performed using SPSS version 23.0, and the results were presented in frequency and percentages of categorical variables. Results: During the study period, there were 161 cases of puerperal infection. The majority of cases were between the age group of 26-30 years, constituting 72 (44.7%) cases. Among them, 86 (53.4%) cases were multiparous, 50 (31%) cases were primiparous, 10 (6.2%) cases were second gravida, and 15 (9.3%) cases were third gravida. Lower middle-class women accounted for 67 (41.6%) cases, and 85 (52.7%) cases were in the overweight range. Prolonged premature rupture of membranes for more than 24 hours was observed in 78 (48.4%) cases. Caesarean section was the mode of delivery for 90 (56%) cases of puerperal infection cases. The most commonly associated comorbidities were anaemia in 63 (39.1%) cases, severe preeclampsia in 47 (29.1%) cases, abruption in 31 (19.2%) cases, and diabetes in 20 (12.4%) cases. Prolonged hospital stay was observed in 144 (89.4%) cases, wound gaping in 26 (16.1%) cases, and disseminated intravascular coagulation in 24 (14.9%) cases. A total of 31 (19.2%) cases of women succumbed, mostly due to multi-organ failure. Conclusion: Early diagnosis, proper ICU facilities at all levels of healthcare, timely referral to tertiary facilities, health education, and strict aseptic measures would be crucial in tackling this menace.

Abstract Background India’s recent increase in urbanization alongside with feminization of rural agriculture could increase the existing gender disparities in dietary diversity. With many rural men migrating to urban areas, women have increased domestic burdens as well as productive burdens such as making informed crop production decisions so household members consume a diverse diet. Given the rapid and recent onset of this phenomenon, there is a need to explore gender differentials in diet diversity across urban and rural areas to assess if certain populations are being disproportionately impacted by this trend. There are limited established quantitative studies discussing this gender disparity with respect to urbanization. Therefore, this paper compares dietary diversity among adult men, adult women, adolescent males, and adolescent females in urban and peri-urban locations. The authors also assess if various sociodemographic factors correlate with dietary diversity. Methods Analyses were conducted on dietary diversity data collected by the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) from selected urban (1108 individuals) and peri-urban (808 individuals) locations of Hyderabad, India. The total sample size of the population is n = 1816: 660 adult males, 662 adult females, 205 adolescent males, and 289 adolescent females. Results Adult women and adolescent females have a higher diet disparity between peri-urban and urban areas when compared to adult males and adolescent males. Multivariate analyses followed by post hoc multiple comparisons testing further support that peri-urban adult women consume a less diverse diet compared to their urban counterparts and less than other peri-urban adult men and adolescent women. It was also found that marital status, type of household card owned, and the highest degree of education are statistically significant correlators of an individual’s dietary diversity. Conclusions Given that urbanization could negatively impact already vulnerable populations such as peri-urban adult women, who play a key role in children’s nutrition, it is important to provide support to these populations. This paper suggests it is possible to do so through government subsidization of peri-urban farmers to grow more diverse crops, fortifying easily accessible foods with commonly lacking micronutrients, including Vitamin A, folic acid, and iron, market access, and affordable prices.

Introduction The axial vessels like the anterior and posterior tibial emerge as the first choice of recipient vessels, in free flaps for lower limb trauma. When the defects are located more proximally in the leg, the deeper course of the axial vessels makes the dissection more tedious. Alternative vessels like the descending genicular, medial genicular, and distal end of the descending branch of the lateral circumflex femoral can be used for an end-to-end anastomosis, well away from the zone of trauma. The objective of this study was to define the indications and technique of the use of the sural vessels as the recipient pedicle for proximal and middle third leg defects. Patients and Methods For the period 2006 to 2022, 18 leg defects following road traffic accidents were covered with latissimus dorsi muscle flap using sural vessels as the recipient pedicle. Results Among 18 patients, 8 patients had defect in proximal third, 8 had a combined defect in proximal and middle third leg, and 2 had defect in middle third leg. Two patients developed arterial thrombosis and one patient had venous thrombosis for which re-exploration was performed. Two flaps were lost and sixteen had successful wound coverage. Conclusion The sural vessels as recipient pedicle are easier to access and can be considered as a reliable option for free flaps in limb defects of proximal and middle third leg. Using the submuscular part of the vessel ensures a better distal reach of the flap.

Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide, affecting over 10 million people annually, with an estimated cost of $76.5 billion. Although apocynin freely transverses the blood–brain barrier (BBB), its application is limited due to its rapid elimination, low terminal half-life (t1/2 = 6.7 min), narrow dose–response relationship, and cytotoxicity, thereby requiring repeated dosages. With this study, we aimed to develop transferrin-functionalized nanoparticles encapsulating apocynin to treat neuroinflammation for targeted drug delivery to sites of brain injury. As a preliminary approach, we endeavored to optimize the formulation parameters of apocynin-loaded albumin nanoparticles prepared through the desolvation method. The nanoparticles were characterized for their size, polydispersity, surface charge, drug loading and in vitro drug release. In this study, we also investigated the anti-inflammatory and neuroprotective effects of free apocynin and nanoparticle-loaded apocynin in neuronal cells. We show that the developed formulation displayed monodispersed, nanosized particles with higher entrapment efficiency, loading, stability, and sustained release profiles. The permeability of the nanoparticles across HBMECs reached the maximum at 67%. The in vivo evaluation revealed the enhanced uptake of transferrin-anchored nanoparticles in the brain tissues when compared with unmodified nanoparticles after I.V. administration. In vivo nanoparticle localization studies using a blast TBI (bTBI) model and confocal fluorescence microscopy have shown that tf-apoANPs are successful in delivering relatively high amounts of nanoparticles to the brain parenchyma and glial cells compared to non-targeted nanoparticles. We also establish that targeted nanoparticles accumulate in the brain. In conclusion, tf-apoANPs are efficacious carriers for targeted delivery across the blood–brain barrier to potentially treat neuroinflammation in brain injury and other diseases.