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Byline: Richa. Kumar, Manas. Chatterjee, R. Ranjan Sir, A 42-year-old male, resident of Ajmer district, Rajasthan, and armed forces personnel by occupation presented with complaints of swelling and pain over [...]

Byline: Richa. Kumar, Manas. Chatterjee Sir, Toxic epidermal necrolysis (TEN) is a severe life-threatening mucocutaneous adverse reaction, most commonly triggered by medications.[1] Lupus erythematosus (LE) is a multisystem, autoimmune disorder [...]

We hereby present a case of a 41-year-old female with hypertension and right mastectomy, who presented with bilateral visual loss, weakness of all four limbs, and livedo reticularis of acute onset and was found to have multifocal areas of infarct in bilateral occipital lobes and left external capsule due to antiphospholipid syndrome. Various differentials in the form of sepsis-induced posterior reversible encephalopathy syndrome, posterior circulation stroke, and purpura fulminans confused the final diagnosis of an orphan disease – Sneddon syndrome. This case is reported for the rarity of the disease and the diagnostic dilemmas faced by the nondermatologist in diagnosing this condition even in the presence of striking skin changes. [ABSTRACT FROM AUTHOR]

Baptisia tinctoria (Wild indigo; Fabaceae) has long tradition of use in Indian systems of medicine for the treatment of depression. This investigation deals with the evaluation of the antidepressant activity of various extracts and fractions of B. tinctoria roots and estimation of the content of bioactive principle using thin-layer chromatography densitometry. Roots of B. tinctoria were successively extracted to obtain n-hexane, chloroform, methanol and water extracts. The chloroform, methanol and water extracts were screened for antidepressant activity at doses of 200 or 400 mg/kg, p.o., in mice subjected to forced swim test. Methanol extract showed significant activity at a dose of 400 mg/kg. The methanol extract was further fractionated successively to obtain ethyl acetate and 1-butanol fractions. Antidepressant activity of these fractions was assessed using forced swim test at the doses of 90 and 80 mg/kg, p.o., respectively. The ethyl acetate fraction showed significant antidepressant activity at the dose of 90 mg/kg in mice. Further, specific antidepressant activity without psychostimulant effects of bioactive methanol extract and ethyl acetate fraction was confirmed through evaluation of locomotor behaviour in mice using open field test. Phytochemical screening showed the presence of flavonoids as major class of phytoconstituents in the methanol extract. Comparative thin-layer chromatography fingerprint studies confirmed the presence of hesperitin in methanol extract. Hesperitin was used as a chemical marker to standardize B. tinctoria roots using validated thin-layer chromatography densitometric method and the content of hesperitin was found to be 0.0085% w/w. [ABSTRACT FROM AUTHOR]

Both diabetes mellitus (DM) and hypertension (HTN) have been on the rise in recent decades all over the world more remarkably in developing countries like India. We intend to measure the prevalence of DM and HTN in the Indian population and to compare the trends and various correlates of these diseases in NFHS (National Family Health Survey)-4 and 5. Data of NFHS-4 and 5 were accessed from dhs program website. All statistical analyses were done in SAS (version 9.4). Mixed effects survey logistic regression models were used for estimating odds ratio (OR).p-values <0.05 were considered significant.1,637,762 individual case entries were evaluated. Both the diseases showed an increasing trend as per the advancing age in both sexes. The highest prevalence of DM is seen in the age group of 45–49 years (7.8%) in females and > 50 years (11.9%) in males as per NFHS-5. Similarly, the highest prevalence of HTN was seen in the age group of45–49 years (31.2%) in females and > 50 years (41.4%) in males as per NFHS-5. The OR (95% CI) of prevalence of DM, HTN and both the diseases in age group >50 years was 14.46 (13.14–15.7), 16.65 (15.78–17.6), 79.5 (64.76–97.73) respectively when compared to reference age group15-19 years. Highest odds for having both DM, HTN concurrently was in age >50 years with aOR(95% CI) 65.32 (52.26–72.63) in NFHS 4 and 35.57 (97.47–45.53) in NFHS 5.Rise in prevalence of DM, HTN and concurrent presence is noted with an apparent increase in cases. [ABSTRACT FROM AUTHOR]

Background: Adolescence is an important developmental phase of life associated with various ideas and emotions filled with energy, many times spent in the form of aggressive behavior. Mental Health, as an important part of healthy well-being, cannot be ignored, and hence it becomes imperative to study aggression and associated factors among adolescents. Objective: To determine the prevalence of aggression among school-going adolescents and to study factors associated with aggression amongst study participants. Materials and Methods: A cross-sectional study was conducted using a self-administered semi-structured questionnaire having questions regarding socio-demographic data, details of friends, history of substance use etc. and the Buss and Perry Aggression Questionnaire (BPAQ). Data were analyzed using appropriate statistical tests. Ethical clearance was obtained from the Institutional Ethics Committee of Safdarjung Hospital, and informed written consent was taken from participants. Results: The study involved a total of 463 school-going adolescents with a mean age of 13.78 ± 2.06 years. More than half (50.5%) of the participants were found to be aggressive. Male gender, history of family member ever jailed, parent's argument in front of them, ever tried cigarette/smoking, being involved in some fight and provocation by friends for aggression were the factors found to be significantly associated with aggression. Conclusion: The prevalence of aggression among school-going adolescents of Delhi was quite high. There is a need to make the students aware about aggression and how to deal with it. A holistic approach may be adopted in which all authorities and stakeholders must work together to provide safer and nurturing environment to all students. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Kidney Disease (CKD) is a debilitating illness that impairs an individual's physical and social functioning and ultimately affects the quality of life (QOL). Aim: To determine the impact of psychiatric comorbidity on QOL and activities of daily living in individuals suffering from CKD undergoing hemodialysis. Materials and Methods: Fifty subjects suffering from CKD undergoing hemodialysis were consequently enrolled in the department of medicine. Institutional ethics committee permission was obtained before the start of the study. The interview was conducted only after the hemodialysis procedure. Consent was obtained and socio-demographic details were noted in the socio-demographic proforma. Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used to assess psychiatric comorbidity. QOL was assessed on Short Form-36 (SF-36). Katz Index of Independence of Activities of Daily Living scale (KADL) was used to assess the activities of living of such individuals. Results: 46% (n = 23) of subjects suffering from CKD had psychiatric co-morbidity. The most common psychiatric disorder observed was moderate depressive disorder (14%, n = 7) followed by adjustment disorder (12%, n = 6). QOL on SF-36 in all eight domains was low compared to the general population. There was a high statistically significant negative impact of psychiatric comorbidity on QOL on eight domains of SF-36 and activities of daily living. (P = 0.001). Conclusion: Psychiatric co-morbidity is common in CKD patients on hemodialysis. Quality of life is lower compared to the general population. There is a negative impact of psychiatric co-morbidity on quality of life and activities of daily living. [ABSTRACT FROM AUTHOR]

Green and decent work in the Global South is inextricably linked to sustaining rural livelihoods especially in agriculture that has undergone significant deskilling under the top-down, technocentric assemblages of the Green Revolution. Additionally, agrarian communities are also seeing youth quitting farming occupations in search of better livelihood options. Scholarly attention to green transitions though has been largely limited to the ecological dimensions. Enacting futures with a focus on ecologically responsible livelihoods need to go beyond existing narratives of technocentric and economic change and foreground the diverse micro institutional innovations that offer newer framings of reskilling. The growing evidence of agroecological initiatives across India indicates less discussed stories of transformation and innovations. Recognising the processes and linkages that allow for, and hinder, transformations at multiple scales and organisational levels is crucial for designing transformative initiatives and policies. Using two illustrative case studies, this paper explores opportunities for green work and the newer skills that might be required to enable sustainable agri-food systems. The case of Natural Farming Fellows (NFFs), a unique programme to encourage young agri-graduates to pursue Natural Farming is presented to understand enabling processes at the grassroots level. The second study explores institutional initiatives to engage rural youth through discussing the pedagogy and curricular approach of a Gandhian university along with opportunities to intern with field organisations. Together, these cases illustrate possible pathways and complexities underlying the process of nurturing sustainable livelihoods, the conception of which needs a broader idea of skilling based on personal aspirations and institutional support. [ABSTRACT FROM AUTHOR]

The phenomenon of protein aggregation is associated with a wide range of human diseases. Our knowledge of the aggregation behaviour of viral proteins, however, is still rather limited. Here, we investigated this behaviour in the SARS-CoV and SARS-CoV-2 proteomes. An initial analysis using a panel of sequence-based predictors suggested the presence of multiple aggregation-prone regions (APRs) in these proteomes and revealed a strong aggregation propensity in some SARS-CoV-2 proteins. We then studied the in vitro aggregation of predicted aggregation-prone SARS-CoV and SARS-CoV-2 proteins and protein regions, including the signal sequence peptide and fusion peptides 1 and 2 of the spike protein, a peptide from the NSP6 protein, and the ORF10 and NSP11 proteins. Our results show that these peptides and proteins can form amyloid aggregates. We used circular dichroism spectroscopy to reveal the presence of β-sheet rich cores in aggregates and X-ray diffraction and Raman spectroscopy to confirm the formation of amyloid structures. Furthermore, we demonstrated that SARS-CoV-2 NSP11 aggregates are toxic to mammalian cell cultures. These results motivate further studies about the possible role of aggregation of SARS proteins in protein misfolding diseases and other human conditions. Bhardwaj et al., have explored the proteomes of SARS-CoV and SARS-CoV-2, and have demonstrated the amyloid formation of viral proteins, in vitro, through diverse biophysical techniques. [ABSTRACT FROM AUTHOR]

Modern medicine does not have reliable liver protection drugs that prevent and treat liver injury caused by drugs. The leaves of sacred / holy basil (Ocimum sanctum) belong to the family of lamiaceae, which is traditionally used for its liver protection. We aimed to determine if Ocimum sanctum has hepatoprotective properties and, if so, whether or not they work synergistically with silymarin. Albino rats (150-200 g) were divided into five groups. Groups A and B are normal control groups and experimental control groups, respectively. Groups C, D and E received the alcoholic extract of Ocimum sanctum leaves (OSE) 200 mg / kg BW / day, silymarin 100 mg/kg BW/day and OSE 100 mg/kg BW/day + silymarin 50 mg/kg BW/day p.o., respectively, for 10 days. Hepatotoxicity was induced in Groups B, C, D and E on the eighth day with paracetamol 2 g/kg BW/day. The effect of hepatoprotection was evaluated through a study of serum proteins, albuminglobulin ratios, alkaline phosphatase, transaminase, and liver histology. The results of the study were presented as averages and standard deviations for each group (SEM). The study group was compared with the control group with a single-way ANOVA and Bonferoni test followed. A P-value of <0.01 was considered significant. In groups C, D and E, liver enzymes and albumin globulin ratio were significantly (P < 0.01) closer to normal than in group B. On histological inspection, groups C, D and E revealed reduced sinusoidal congestion, cloudy edoema, fatty abnormalities, and regenerating regions of the liver, but group B showed only liver necrosis. The extract of the alcoholic leaves of Ocimum sanctum has significant liver protection and synergy with Silimarin. [ABSTRACT FROM AUTHOR]

The Current Study elaborates the classification of Lung Cancer by traversing the potential consumption of a Hybrid Model in which ROI (Region of interest) is recognised through different segmentation techniques by extracting key points through different features extraction and optimization techniques are implemented to the dataset of CT scan images of 800 pictures. A total of 800 patients were included in this retrospective study and divided into the training set and test set with a ratio of 8:2 randomly. The research work developed a Hybrid Model by using distinct Optimization techniques i.e. Particle Swarm Optimization (PSO). Artificial BEE colony (ABC) and features extraction method namely SIFT (Scale Invariant Feature Transform, Speed Up Robust Feature (SURF), in context of the least execution time with least mean square error rate with support vector machine (SVM) classifier. Additionally, working of the Hybrid Model has been gauged in respect of parameter Accuracy, Error rate, Precision, Recall, and Execution Time. The overall Accuracy of the hybrid model is 99.56% while recall value is 89%, F-measure 93.44% have been obtained for the Hybrid Model. [ABSTRACT FROM AUTHOR]

The development of the bacterial and fungal resistance towards the antibiotics is considerably problem now days as the number of diseases increase frequently worldwide and the recent studies and advancement on mettaloantibioticcs found more effective in term of biological activity and efficacy. The current research work is on metal-drug complex compounds have become more popular nowadays in recent years as a result of their various biological actions, such as antibacterial, antifungal, antiviral, and anticancer. The synthesis of novel imines or Schiff base metal ion complexes or ligand are differentiated during various molecular analysis like FTIR and mass spectroscopy etc. Antimicrobial studies will also be done. The purpose of the synthesis of new Schiff base metal ion derivative is to contribute important role in the synthesis of new drugs with better antimicrobial resistance1 .The various studies have shown that these novel metal complex derivatives have a lot of biological activity and could be a good way to come up with new antibacterial agents. [ABSTRACT FROM AUTHOR]

In the present paper, the nonlinear features of a high-intensity q-Gaussian laser beam propagating in collisional plasma have been investigated. The collisional plasma dynamics is basically dominated by local collisional forces rather than collective actions in it. Naturally, the nonlinearity in the dielectric function of plasma due to nonuniform heating of carriers along the wavefront of the laser beam becomes important. Here in q-Gaussian beam intensity profile q can explored right from extremely low to extremely high value such as infinity. As a consequence of it studies in propagation dynamics becomes quite interesting. By following Akhmanov parabolic equation approach under Wentzel-Kramers-Brillouin (WKB) and paraxial approximations, the differential equation is set up for the beam width parameter f and is solved numerically. The significant effect of wide range of q on critical beam radius as well as on propagation a dynamic of q-gaussian laser beam have been found interesting and is presented graphically. [ABSTRACT FROM AUTHOR]

Photo by Naveed Ahmed on Unsplash ABSTRACT India has had a solid standard for medical ethics since the birth of Ayurvedic holistic science over 5000 years ago. The country’s views on healthcare policy, counsel on how to deal with patients, and what constitutes good behavior within the profession stem from ancient outlines for medical practice. These “codes of conduct” were heavily influenced by religious and spiritual practices, emphasizing the sanctity of life and transcending the needs of the body. With time, however, medical care evolved through shifting priorities in education and governmental pressures. These once-cherished “codes of conduct” were referred to less often, while malpractice issues have steadily increased. There is a need for an open discussion of why this spike in medical malpractice is happening in a country that used to condemn it and how improving ethics, limiting the role of profits, and returning traditional philosophies to the medical ethics curricula could help. INTRODUCTION Currently, India has the largest number of bioethics units of any country, reflecting the importance of ethical behavior in Indian society. These centers do not affiliate with schools, yet they serve as spaces for bioethical discourse. The Indian Psychiatric Society (IPS) was the first to address escalating malpractice cases. Other major medical organizations (e.g., the Indian Medical Association and the Medical Council of India) followed, stressing the importance of standardized ethics. Some have formed symposiums and organized conferences to address these concerns.[1] There have been several calls to revisit the classic “codes of conduct” and their focus on the spiritual concept of life-death-rebirth. Toward this end, modern Indian doctors were reminded that physicians existed not for fortune or status but for the welfare of their patients. These altruistic teachings came from the seminal Ayurvedic texts, the cornerstone of India’s modern medicine. Happiness for the “healer” was to come out of showing compassion for all living beings and prolonging the precious gift of life.[2] In contrast, Indian novelist, Shashi Tharoor, speaking on the current state of medical practice, recently remarked: “India is not an underdeveloped country, but a highly developed one in an advanced state of decay.”[3] Taking a closer look at what caused the core values of an ancient healthcare system to change so drastically involves evaluating how the Indian medical education system evolved. This paper examines the development of medical principles, their influence across the subcontinent, commercialization, and the government’s role in India’s healthcare instability. This paper then lists some of the measures taken by bioethical units to counteract some of the issues brought on by corruption. l. Western Influence Western influence on medical practices came when the French, Portuguese, and British arrived in India. They almost completely reinvented India’s healthcare system. Medical ethics based on the values of spirituality were almost completely stripped away and replaced by Western concepts.[4] Established traditional ethical standards were no longer taught, resulting in less deference to traditional moral beliefs. Coupled with an increase in medical misconduct, the general population lost trust in their healthcare leaders.[5] Before the influence of Western medicine, the Carakha Sumhita, a millennia-old Sanskrit text detailing Ayurveda, helped establish healthcare guidelines. A passage from the text sums up the ethics of that time: “He who practices medicine out of compassion for all creatures, rather than for gain or for gratification of the senses, surpasses all.”[6] The Carakha Sumhita’s focus on medical ethics was ahead of its time, centuries before bioethics became a subject in its own right. Healthcare was predicated on aphorisms that all medical students internalized rather than on business models, as in many developed nations. India’s caste system, established generations ago, permeated every aspect of South Asian society except for when it came to medicine. Healers tended to ignore the conventions of adhering to an individual’s caste. Instead, they treated patients as if they were family and incorporated elements of spirituality when dealing with patients, making ethical misconduct a rare phenomenon. This was the case for almost two centuries.[7] To become practicing physicians, doctors committed to a consecration ceremony to prove their good moral standing to the people they were to serve.[8] Their schooling prepared them for a profession designed to “give back,” not for monetary gain. The core values taught in medical school affect the mentality doctors carry with them. The lack of ethics training may have been at fault for the underlying corruption levels that now plague the healthcare space in India. There is a 110 percent increase in the rise of medical negligence cases in India every year.[9] To pinpoint why this occurred, we must look at current medical training practices and how they influence doctors of our time period. After colonization, many established core values were stripped from the medical curriculum.[10] In fact, by 1998, only one medical college in India, St. John’s in Bangalore, even addressed medical ethics in its curriculum.[11] Graduates across the country were left ill-equipped to deal with the ethical issues that cropped up once they made it into the field. As a result, they were not prepared to think through consequences pertaining to patients and their families. Some suggest that the curriculum changes were linked to rising malpractice cases. “When society at large is corrupt and unethical, how can you expect doctors to be honest?”[12] This topic arises regularly in bioethics discussions and the answer lies in education. Reverting to a system of medicine that encourages students to recognize ethical consequences can solve many of the ethical problems in contemporary society. ll. Privatization and Tuition Some argue that the global increase in capitalism caused the subcontinent’s ethical problems, that the Indian medical education system began its descent into corruption and nepotism, and its loss in prestige, with the privatization of their colleges.[13] In India, just over 50 percent of medical schools are public, and just under 50 percent are private.[14] Through changing policies, private medical schools became increasingly for-profit like other businesses.[15] Despite having more medical schools than any other country, India has a shortage of doctors, primarily due to low enrollment rates and high university fees. While there are 202 medical schools in India, its large population means there are 5 million people per medical school.[16] Christian Medical College, a top-ranked university in Vellore, once had an acceptance rate of 0.25 percent, with only 100 seats for medical students.[17] Now its acceptance rate hovers around 5 percent. There has been minimal progress in making it easier to get a medical school acceptance; there is still a long way to go in equalizing access to education. India’s system for training doctors is now rife with corruption, with bribes accepted under the guise of “donations” and new curricula completely devoid of traditional Indian training methods.[18] Nepotism in the industry has made qualifications even less significant. In 2010, 69 hospitals and medical colleges were reported for selling exam papers to students, and most employed staff lied about their clinical experience.[19] In a cheating scandal in 2013 involving several Indian universities, students purchased falsified entrance exam results. Not only are these students unqualified for the placements they secured, but legal action by the government did not materialize.[20] Dr. Anand Rai, a physician who had to go into protective hiding following death threats for being a whistleblower in the 2013 scandal subsequently remarked: “...the next generation of doctors is being taught to cheat and deceive before they even enter the classroom.”[21] The effects of this scandal can be felt far beyond its borders - India also happens to be the world’s largest exporter of doctors, with about 47,000 currently practicing in the United States.[22] lll. Hospital Privatization With the privatization of major hospitals and the shift to a “United States” business focus, another serious problem emerged. In the recent past, patients hailing from rural villages and often living in poverty could access quality health care from public hospitals. They had access to highly trained doctors, and all costs were usually fully subsidized.[23] This was in keeping with the old tradition that believed in aid no matter the circumstance. As the focus shifted towards maximizing profitability, these opportunities for poor patients vanished. Chains of private hospitals are rapidly replacing public ones. Their purchasing model is to consolidate through a centralized subsidiary.[24] This usually results in significant savings. Instead of passing on some savings to patients through reduced pricing, any savings are used to fulfill a key objective of privatized businesses: maximize profitability. The poor now contend with inflated prices and are being turned away from facilities that once treated them at no cost, all while levels of trust in the healthcare system have plummeted. This distrust can discourage people who cannot afford care from seeking medical aid when they need it. The healthcare system has devolved to the point whereby remaining public hospitals are overrun by huge numbers of patients unable to afford the hugely inflated prices at private institutions. This, coupled with healthcare workers that often have substandard training, has created deplorable public health conditions. lV. Corruption This deplorable public health condition reflects a failing healthcare system. To make matters worse, hospitals hire unqualified graduates untrained in medical ethics to meet India's urgent need for large numbers of qualified doctors. Many hospitals have even resorted to employing corrupt doctors to counteract the physician shortage. According to the Indian Medical Association (IMA), about 45 percent of those who practice medicine in India have no formal training.[25] IMA also reported that close to 700,000 doctors employed at some of the biggest hospitals, who are currently diagnosing, treating, and operating, have neither the training nor experience to do so. A large-scale forgery ring, broken up in 2011, revealed that buyers could pay as little as 100 US dollars for a medical degree from a non-existent college. This “cleared” them for practice.[26] It has been estimated that over 50,000 fraudulent medical degrees have been purchased in the past decade. Government level corruption is widespread, as one can gain placement into medical school, “graduate” with fake degrees, and sell fake practicing licenses. V. Solutions These topics, raised by bioethics centers, are now being taken more seriously by healthcare professionals taking steps to address medical misconduct. As many as five million people in India die each year due to medical negligence.[27] By requiring each physician to complete a new comprehensive Acute Critical Care Course (ACCC), specialists estimate that physicians can reduce the rate of malpractice deaths by as much as 50 percent in rural areas.[28] This intensive two-year course contains detailed training methods built off of current knowledge and walks healthcare professionals through crucial steps designed to reduce errors. Even small errors, such as a poorly inserted IV for fluid or a minor surgery mishap, can be life threatening. The course thoroughly covers these as mandated.[29] The ACCC is unfortunately not a widely spread concept in a lot of rural areas. For now, while many major hospitals continue to ignore the high rates of avoidable deaths, implementation of the ACCC program seems slow. The current Medical Council of India needs to be more effective at addressing malpractice cases, as there are so many of them.[30] One possible solution to the growth of unethical business practices in medicine is to offer physicians incentives to make ethically sound decisions. This can start by increasing the number of slots available for medical students at government-run medical schools. Less student debt would lead more doctors away from overbilling their patients. This is a strategy currently being employed in the state of Tamil Nadu, where a centrally sponsored scheme has approved the induction of an additional 3,496 MBBS seats in government colleges.[31] More students studying at subsidized costs with less competition lowers the inclination toward deceit and profiteering. Another incentive for ethical practice can come from accountability and transparency. The background of every doctor operating should be public information, including the rate of successful surgeries versus unsuccessful ones resulting from personal negligence. This would encourage doctors to keep a clean record and, in turn, encourage hospitals to hire and train those who will preserve or improve their reputation. This information is kept in a medical record monitored in most parts of India through a traditional paper method.[32] While eliminating paper in medical recording and reverting to digital use is the ultimate aim, it will take time to implement a system that takes into account e-signatures and verifiable witnesses. CONCLUSION India’s history of leadership in medical ethics has undergone some major changes. A relatively recent privatization of the education system has caused a shift in values and decimated the medical industry on many levels. The moral principles of doctors have come into question. While industry and government leaders are trying to solve the multi-faceted issues facing the medical industry, it is obvious that this is an undertaking requiring inventive solutions. Prioritizing ethics in medical education, de-privatizing medical schools and hospitals, offering affordable options, and limiting corruption would improve India’s ability to offer high-quality medical care. Adding traditional Indian medical ethics back into the curricula would foster a workforce dedicated to serving patients over profiteering. - [1] Deshpande, SmitaN. 2016. “The UNESCO Movement for Bioethics in Medical Education and the Indian Scenario.” Indian Journal of Psychiatry 58 (4): 359. https://doi.org/10.4103/0019-5545.196722. [2] Mukherjee, Ambarish, Mousumi Banerjee, Vivekananda Mandal, Amritesh C. Shukla, and Subhash C. Mandal. 2014. “Modernization of Ayurveda: A Brief Overview of Indian Initiatives.” Natural Product Communications 9 (2): 1934578X1400900. https://doi.org/10.1177/1934578x1400900239. [3] 2020. Eubios.info. 2020. https://www.eubios.info/EJ102/EJ102E.htm. [4] Arnold, David, ed. 2000. “Western Medicine in an Indian Environment.” Cambridge University Press. Cambridge: Cambridge University Press. 2000. https://www.cambridge.org/core/books/abs/science-technology-and-medicine-in-colonial-india/western-medicine-in-an-indian-environment/28BAB761BE205B06D32BC3DC972E9384. [5] Kulkarni, Vani, Veena Kulkarni, and Raghav Gaiha. 2019. “Trust in Hospitals-Evidence from India.” https://repository.upenn.edu/cgi/viewcontent.cgi?article=1026&context=psc_publications. [6] Bhasin, Dr Sanjay K. 2005 “What Ails Medical Profession.” Www.academia.edu. Accessed September 17, 2022. https://www.academia.edu/7631547/What_Ails_Medical_Profession. [7] Shapiro, Natasha, and Urmila Patel. (2006) “Asian Indian Culture: Influences and Implications for Health Care.” https://www.molinahealthcare.com/~/media/Molina/PublicWebsite/PDF/providers/fl/medicaid/resource_fl_asianindianculture_influencesandimplicationsforhealthcare.pdf. [8] Swihart, Diana L, and Romaine L Martin. 2021. “Cultural Religious Competence in Clinical Practice.” Nih.gov. StatPearls Publishing. 2021. https://www.ncbi.nlm.nih.gov/books/NBK493216/. [9] “India’s Mighty Medical Education Mess.” 2022. Education World. July 11, 2022. https://www.educationworld.in/indias-mighty-medical-education-mess/. [10] Pandya, Sunil. 2020. “Medical Education in India: Past, Present, and Future Perspectives. in Sun Kim, ed. Medical Schools Nova Science Publishers, Inc. (= [11] Ravindran, G. D., T. Kalam, S. Lewin, and P. Pais. 1997. “Teaching Medical Ethics in a Medical College in India.” The National Medical Journal of India 10 (6): 288–89. https://pubmed.ncbi.nlm.nih.gov/9481103/. [12] “Chapter 9: Opinions on Professional Self-Regulation”(2016) https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-9.pdf. [13]Sanjiv Das. 2020. “The Pill for India’s Ailing Medical Education System.” Express Healthcare. February 3, 2020. https://www.expresshealthcare.in/education/the-pill-for-indias-ailing-medical-education-system/416711/. [14] https://www.marketresearch.com/Netscribes-India-Pvt-Ltd-v3676/Private-Medical-Colleges-India-30399614/."There are ~50.89% government medical colleges and ~49.11% private medical colleges in the country.”; NPR.org. (2021) “When Students in India Can’t Earn College Admission on Merit, They Buy Their Way In.” Accessed September 19, 2022. https://www.npr.org/2019/08/04/745182272/when-students-in-india-cant-earn-college-admission-on-merit-they-buy-their-way-i. [15] https://timesofindia.indiatimes.com/india/how-medical-colleges-in-india-became-a-business-one-policy-change-at-a-time/articleshow/69707594.cms [16] Muula A. S. (2006). Every country or state needs two medical schools. Croatian medical journal, 47(4), 669–672. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080437/ [17] Miglani, Andrew MacAskill, Steve Stecklow, Sanjeev. 2015. “Why India’s Medical Schools Are Plagued with Fraud.” Mint. June 17, 2015. https://www.livemint.com/Politics/BDGOx3SApU3QbsRMjZUK9M/Why-Indias-medical-schools-are-plagued-with-fraud.html. [18] Clark, J. 2015. “Indian Medical Education System Is Broken, Reuters Investigation Finds.” BMJ 350 (jun18 3): h3324–24. https://doi.org/10.1136/bmj.h3324. [19] Reuters. 2015. “Special Report - Why India’s Medical Schools Are Plagued with Fraud,” June 16, 2015, sec. Special Reports. https://www.reuters.com/article/uk-india-medicine-education-specialrepor/special-report-why-indias-medical-schools-are-plagued-with-fraud-idINKBN0OW1N520150616. [20] Andrew Emett. (2015) “Over Two Dozen Witnesses and Suspects Mysteriously Die in Indian Cheating Scandal | NationofChange.” Accessed September 19, 2022. https://www.nationofchange.org/2015/07/08/over-two-dozen-witnesses-and-suspects-mysteriously-die-in-indian-cheating-scandal/. [21] (Reuters 2015) [22] Clark, J. 2015. “Indian Medical Education System Is Broken, Reuters Investigation Finds.” BMJ 350 (jun18 3): h3324–24. https://doi.org/10.1136/bmj.h3324. [23] Barik, Debasis, and Amit Thorat. 2015. “Issues of Unequal Access to Public Health in India.” Frontiers in Public Health 3 (October). https://doi.org/10.3389/fpubh.2015.00245. [24] “Investment Opportunities in India’s Healthcare Sector.” (2021) https://www.niti.gov.in/sites/default/files/2021-03/InvestmentOpportunities_HealthcareSector_0.pdf. [25] Clark, J. 2015. “Indian Medical Education System Is Broken, Reuters Investigation Finds.” BMJ 350 (jun18 3): h3324–24. https://doi.org/10.1136/bmj.h3324. [26] “Are We Importing Fake Doctors?” (2015) Www.workerscompensation.com. Accessed September 19, 2022. https://www.workerscompensation.com/news_read.php?id=21672&forgot=yes. [27] Boston, 677 Huntington Avenue, and Ma 02115 +1495‑1000. 2013. “Millions Harmed Each Year from Unsafe Medical Care.” News. September 19, 2013. https://www.hsph.harvard.edu/news/press-releases/millions-harmed-each-year-from-unsafe-medical-care/. [28] “Specialised Course for Doctors Can Help Cut the Deaths due to Medical Errors; Experts.” 2018. DailyRounds. October 29, 2018. https://www.dailyrounds.org/blog/specialised-course-for-doctors-can-help-cut-the-deaths-due-to-medical-errors-experts/. 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AIM: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an ongoing global health emergency. To control the spread, a mass vaccination program is initiated. Antibody titer after vaccination can be a better marker to monitor immunological response. MATERIALS AND METHODS: The study was carried out at the Department of Microbiology, Narayan Medical College and Hospital, Jamuhar Sasaram, southwest Bihar, considering the sample size, type, and collection. First, antibody was tested before vaccination and second antibody value after 28 days of the first dose of COVID vaccine among the health-care workers and housekeeping staff. RESULTS: A total of 251 subjects were administered with vaccination (Covishield) to check the immunoglobulin g (IgG) responses. The concentration of the SARS-CoV-2 IgG antibody in female patients tended to be higher than in male patients. CONCLUSION: There is a difference in antibody positivity among males and females. Most of the participants had IgG positivity, because of their profession, vaccination boosted percentage positivity in both males and females. Females have more IgG levels compared to males. Hence, recommend that separate guidelines can be made between males and females for vaccination dosages. [ABSTRACT FROM AUTHOR]

Pharmaceutical excipients are compounds or substances other than API which are added to a dosage form, these excipients basically act as carriers, binders, bulk forming agents, colorants, and flavouring agents, and few excipients are even used to enhance the activity of active pharmaceutical ingredient (API) and various more properties. However, despite of these properties, there are problems with the synthetic excipients such as the possibility of causing toxicity, inflammation, autoimmune responses, lack of intrinsic bioactivity and biocompatibility, expensive procedures for synthesis, and water solubility. However, starch as an excipient can overcome all these problems in one go. It is inexpensive, there is no toxicity or immune response, and it is biocompatible in nature. It is very less used as an excipient because of its high digestibility and swelling index, high glycemic index, paste clarity, film-forming property, crystalline properties, etc. All these properties of starch can be altered by a few modification processes such as physical modification, genetic modification, and chemical modification, which can be used to reduce its digestibility and glycemic index of starch, improve its film-forming properties, and increase its paste clarity. Changes in some of the molecular bonds which improve its properties such as binding, crystalline structure, and retrogradation make starch perfect to be used as a pharmaceutical excipient. This research work provides the structural modifications of native starch which can be applicable in advanced drug delivery. The major contributions of the paper are advances in the modification of native starch molecules such as physically, chemically, enzymatically, and genetically traditional crop modification to yield a novel molecule with significant potential for use in the pharmaceutical industry for targeted drug delivery systems. [ABSTRACT FROM AUTHOR]

Arsenic (As) is a widespread environmental and food chain contaminant and class I, non-threshold carcinogen. Plants accumulate As due to ionic mimicry that is of importance as a measure of phytoremediation but of concern due to the use of plants in alternative medicine. The present study investigated As accumulation in native plants including some medicinal plants, from three districts [Chinsurah (Hoogly), Porbosthali (Bardhman), and Birnagar (Nadia)] of West Bengal, India, having a history of As pollution. A site-specific response was observed for Specific Arsenic Uptake (SAU; mg kg dw) in total number of 13 (8 aquatic and 5 terrestrial) collected plants. SAU was higher in aquatic plants (5-60 mg kg dw) than in terrestrial species (4-19 mg kg dw). The level of As was lower in medicinal plants (MPs) than in non-medicinal plants, however it was still beyond the WHO permissible limit (1 mg kg dw). The concentration of other elements (Cu, Zn, Se, and Pb) was found to be within prescribed limits in medicinal plants (MP). Among the aquatic plants, Marsilea showed the highest SAU (avg. 45 mg kg dw), however, transfer factor (TF) of As was the maximum in Centella asiatica (MP, avg. 1). Among the terrestrial plants, the maximum SAU and TF were demonstrated by Alternanthera ficoidea (avg. 15) and Phyllanthus amarus (MP, avg. 1.27), respectively. In conclusion, the direct use of MP or their by products for humans should not be practiced without proper regulation. In other way, one fern species ( Marsilea) and some aquatic plants ( Eichhornia crassipes and Cyperus difformis) might be suitable candidates for As phytoremediation of paddy fields. [ABSTRACT FROM AUTHOR]

The ongoing farmer's agitations foremost demand is ?the written assurance from the Indian government that it will not scrap the minimum support price (MSP) regime and will continue to procure rice and wheat from them. The farmers biggest worry is that the law would lead to inadequate demand for their produce in the local markets. This is largely because they have survived on the selling of wheat and paddy on MSP procured by the union government for the central pool". Paddy is being sown in the season when pulses and other high value crops can also be sown. The problem currently is that farmers need the assurance of an MSP. They feel they would be left in the lurch if they agreed to grow for alternate crops a would loose the security of the already prevalent crop cycle of wheat and paddy even through it was providing to be a loos making proposition. It is lamentable that the ?state lacks a successful procurement model for crops other than wheat and paddy for instance, the Maize crop. Farmers sowing maize in February and March had to sell their produce between Rs. 800 and 900 per quintal, which was reportedly far below the declared Minimum Support Price (MSP) of Rs 1,850 per quintal. In Rajpura Mandi of Patiala maize was sold at a price as low as Rs 600 per quintal. The Sunflower crop also met with the same fate as farmers in Patiala and nearby districts got Rs 3,500-4,000 per quintal for their crop, which was far below the promised MSP of Rs 5,885 promised MSP". [ABSTRACT FROM AUTHOR]

Background. All medical graduates must know how to stabilize and manage critically ill patients. A 2-day intensive course, called the acute critical care course (ACCC), was conducted to train interns in technical and non-technical skills for managing a patient whose condition is deteriorating. This analysis aims to assess the feasibility and effectiveness of ACCC for interns. Methods. We developed and conducted the ACCC to train interns. It included lectures and skill stations. Twentyfour interns participated in the course. Immediate, postcourse, quantitative and qualitative feedback was taken online. Qualitative information was also collected verbally and later by email. These data were analysed both quantitatively and qualitatively. Thematic analysis was used to identify, analyse and report the patterns of responses and behaviour. Results. The average score for the utility of the course was 4.7 and for the skill stations it was 4.6 on a scale of 5. The qualitative analysis of the feedback emphasized the need for the course before the clinical posting and more skill-based modules rather than lectures. The interactive style of teaching and training in communication using role-play was appreciated. Few suggestions to improve the course were provided. Conclusions. Implementing the ACCC needed simulation, interactive discussions, role-play, modified Pendleton's feedback, and reflective exercise that form the basis of a range of educational principles. The blended learning set of objectives of ACCC were the pillars for this successful internship training programme. [ABSTRACT FROM AUTHOR]

Malaria, a vector-borne disease, is a significant public health problem in Keonjhar district of Odisha (the malaria capital of India). Prediction of malaria, in advance, is an urgent need for reporting rolling cases of disease throughout the year. The climate condition do play an essential role in the transmission of malaria. Hence, the current study aims to develop and assess a simple and straightforward statistical model of an association between malaria cases and climate variates. It may help in accurate predictions of malaria cases given future climate conditions. For this purpose, a Bayesian Gaussian time series regression model is adopted to fit a relationship of the square root of malaria cases with climate variables with practical lag effects. The model fitting is assessed using a Bayesian version of R2 (RsqB). Whereas, the predictive ability of the model is measured using a cross-validation technique. As a result, it is found that the square root of malaria cases with lag 1, maximum temperature, and relative humidity with lag 3 and 0 (respectively), are significantly positively associated with the square root of the cases. However, the minimum and average temperatures with lag 2, respectively, are observed as negatively (significantly) related. The considered model accounts for moderate amount of variation in the square root of malaria cases as received through the results for RsqB. We also present Absolute Percentage Errors (APE) for each of the 12 months (January–December) for a better understanding of the seasonal pattern of the predicted (square root of) malaria cases. Most of the APEs obtained corresponding to test data points is reasonably low. Further, the analysis shows that the considered model closely predicted the actual (square root of) malaria cases, except for some peak cases during the particular months. The output of the current research might help the district to develop and strengthen early warning prediction of malaria cases for proper mitigation, eradication, and prevention in similar settings. [ABSTRACT FROM AUTHOR]

Whey protein-maltodextrin conjugate is used as emulsifier and stabilizer to prepare peppermint (Mentha piperita L.) oil (PO) nanoemulsion. The mean particle size, zeta potential and poly dispersity index (PDI) of stable PO nanoemulsion (5% oil+8% conjugate+0.5% Tween 80) was 144.8±5.32 nm, -24.40±0.42 mV and 0.217±0.05 respectively and this formulation was not unstable to food processing conditions like pH 3.0 to pH 7.0, heat treatments and ionic strength 0.1 M to 1.0 M. The emulsion was stable at 25°C for 15 days and its particle size is 332.2±4.66 nm at 15th day of storage. Agar well diffusion method is used to assess the antimicrobial efficacy of PO (5%) dissolved in dimethyl sulphoxide (DMSO) and 5% PO nanoemulsion against microorganisms like E. coli ATCC 25922, B. cereus ATCC 14459, Salmonella typhi NCDC 6017 and E. faecalis NCDC 115. The formulation prepared in the present study will have the application in preservation of various foods against spoilage microorganisms. [ABSTRACT FROM AUTHOR]

The aim of the study is to document the long term oncological results of trans-oral laser microsurgery (TLM) for early and moderately advanced glottic cancer in primary and salvage settings. In this prospective cohort study 43 consecutive patients of glottic cancer (T1-30, T2-7, and selected T3 with mobile cords-6) were recruited. TLM was performed in these 35 primary and 8 previously treated cases. In our series, the local disease control rate with TLM was 90% (27/30) for T1 disease, 71.4% (5/7) for T2 cancer and 66.6% (4/6) for T3 lesions. The overall disease control rates after subsequent treatment for locoregional recurrences were 100% (30/30), 85.7% (6/7) and 83.3% (5/6) for T1, T2, and T3 glottic cancers respectively. The 5-years disease free survival rate for primary cases was 100% and 50% for salvage cases. The 5-years local disease control rate was 96.4% and 41.67% in primary and salvage TLM settings respectively. The 5-years laryngectomy free rates were 96.3% and 18.75% for primary and salvage cases respectively. TLM offers a minimally invasive and oncologically robust treatment option for early glottic cancer with an overall disease free survival of 100% at 5 years noted for primary untreated cases in this experience. TLM for post radiation salvage cases has however been disappointing and alternate larynx preserving option of open partial laryngectomy needs to be considered in this setting. [ABSTRACT FROM AUTHOR]

Objective: Urinary fistula is a distressing complication after difficult vaginal deliveries, obstetric, and gynecologic surgeries. The present study describes a single center's experience in the management of urinary fistula at a tertiary care hospital. It was performed to analyze the etiology of genitourinary fistula, to assess the outcome after surgical repair, and to determine the changing trends in the etiology and management of urinary fistula. Material and Methods: This retrospective study was conducted over 5 years in the department of obstetrics and gynecology, All India Institute of Medical Sciences, New Delhi. Twenty patients who underwent surgical repair of urinary fistula were included in the study and analyzed for their etiology, presentation, site, size, previous failed repair, approach of surgical repair, and outcome. The findings of the present study were compared with a previous study at our center to determine the changing trends of urinary fistula. Results: The mean age of the study population was 37.05±8.08 years. The majority (65%) of the fistulae occurred following gynecologic surgeries, whereas 25% were due to obstructed labor, and 10% after cesarean section for other indications. The vaginal approach was used in all except one case of uterovesical fistula, which was repaired abdominally. The outcome was successful in 85% of cases. The success rate was similar in primary versus previous failed repair (p=0.270). Conclusion: The most common cause of urinary fistula in the present study was gynecologic surgery. The vaginal approach can be used even in cases with previous failed repairs with a high success rate. [ABSTRACT FROM AUTHOR]

3,5-Disubstituted isoxazoles have been designed and synthesized to be used as central units for bent-core mesogens. The substituents at position 3 of the isoxazole ring are either hydroxymethyl or carboxyl, while alkenylterminated substituents have been inserted at position 5. A multi-step reaction sequence comprising the O-alkylation of 4-hydroxyacetophenone with the suitable alkenyl halide, the Claisen-type condensation with diethyl oxalate and the cyclization to isoxazole led to the isoxazole esters as key intermediates, which were subsequently reduced and hydrolyzed to the corresponding isoxazol-3-ylmethanols and isoxazole-3-carboxilic acids, respectively. [ABSTRACT FROM AUTHOR]

Patients wearing conventional removable dentures often complain particularly about the instability of the mandibular denture. Due to instability of mandibular dentures, there is an increase in the severity of mandibular atrophy. Furthermore, denture instability leads to a feeling of insecurity, inefficient mastication, and overall dissatisfaction with the prosthesis. Placement of endosseous dental implants to retain and support mandibular overdentures or fixed complete dentures have been developed and studied as a method for solving the problem of instability associated with conventional dentures. Implant-retained dentures have many advantages compared to conventional removable dentures. Occasionally, anatomical or financial limitations may prohibit the patient to use of a fixed implant-retained prosthesis. In these cases, a removable implant-retained denture with a limited number of implants may be the possible choice. The aim of this article is to review the literature to compare implant-retained or supported dentures versus conventional dentures in terms of masticatory efficiency, stability, and patient satisfaction. [ABSTRACT FROM AUTHOR]

Chronic neutrophilic leukemia (CNL) is a rare disease grouped under World health organization classification as chronic myeloproliferative disease. It is a diagnosis of exclusion in patients with sustained mature neutrophilia and splenomegaly with no evidence of other myeloproliferative disease or reactive neutrophilia. V617F JAK 2 mutation has been described in classical myeloproliferative diseases, but its association with CNL has been reported in a few cases. Here in, we describe three cases of CNL with presence of V617F JAK 2 mutation. To distinguish CNL from secondary neutrophilia can be difficult. Detection of the V617F JAK 2 mutation in such scenario can provide a useful diagnostic test to establish the neoplastic nature of the neutrophilia. [ABSTRACT FROM AUTHOR]

Introduction: Gastrointestinal tuberculosis often involves the ileocecal region. Duodenal and gastric tuberculosis found in only 1% of patients suffering from pulmonary tuberculosis with associated HIV infection in non-endemic areas. Duodenal obstruction due to tuberculosis is very rare and needs high index of suspicions for diagnosis. Mostly this entity is suspected on intraoperative findings. In this manuscript we emphasized on ways and means for establishing histopathological diagnosis before starting anti-tubercular treatment in such cases. Method and Material: All patients of suspected gastroduodenal tuberculosis presented with feature of gastric-outlet obstruction managed during Jan 2009 to June 2011 were included in the study. After proper evaluation (routine hematological and biochemical examination, microbiological examination, serological and endoscopic evaluation) exploratory laparotomy was done and if there is no mesenteric lymphadenopathy or it is not safe to take biopsy form the diseased duodenum, multiple FNAC were taken from the diseased portion for histopathological and microbiological diagnosis. Result: A total of five patients were treated during this period. The most common presentation was vomiting followed by failure to thrive and weight loss; two patients had abdominal pain. Biopsy of mesenteric lymph node was possible in two cases. FNAC from diseases portion was taken in all cases. FNAC showed granulomas in four cases. Cases where even FNAC fi nding was non-conclusive on HPE/ Microbiology was not subjected to antitubercular drug. Conclusion: Multiple intra-operative FNAC may be taken from the diseased portion of the duodenum to establish the histopathological diagnosis if diagnosis is not established by any other mean. [ABSTRACT FROM AUTHOR]