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This paper analyses the networks, experiences and aspirations of Nepalese workers in Southern Portugal's farms and greenhouses. The main research objective is to analyse how recruitment networks, which supported the move of Nepalese to Portugal, were established and have rapidly consolidated. These networks impacted not only the increase of irregular migration flows but also the migration experience and vulnerability in the country of destination, including the passive acceptance of a certain degree of exploitation. By highlighting the perspective of the migrants themselves, we examine the impact on their lives, both of the migration experience and of paying large sums to smugglers, usually obtained through indebtment, to enter Portugal. We relate this impact to a context of immigration where the existence of a large informal labour market facilitates these workers being hired as irregular migrants. The study employed secondary data, in-depth interviews and participant observation. As well as migrants, greenhouse owners and recruiters were also interviewed for the study. The main finding is that the disposition of Nepalese to migrate, in which the pressure of the family plays a key role, tends to be reinforced by the action of the networks of recruiting agents. Secondly, the costs of migration and labour exploitation tend to be accepted by the migrants as a way to fulfil their social aspirations and economic necessities. info:eu-repo/semantics/acceptedVersion

Objectives Childhood osteoporosis is an uncommon condition that usually develops secondary to underlying disease states. Idiopathic juvenile osteoporosis or early onset osteoporosis is a rare cause of primary osteoporosis in childhood associated with mutations in “bone fragility” genes. Case presentation The index case presented with upper back pain and was detected to have multiple vertebral fractures. Further workup for the cause revealed a homozygous benign mutation in low-density lipoprotein receptor-related protein 5, which was also detected in the mother who remained asymptomatic till presentation. The child was successfully treated with intravenous zoledronate. Conclusions The case report describes the management approach and four-year follow-up of the child.

To evaluate the efficacy of daily supplementation of 200 mL milk fortified with 240 IU of vitamin D2 (ergocalciferol). Double-blind randomized controlled trial. School-based study in Delhi between October and December, 2019. 235 healthy children aged 10–14 years. Daily supplementation of 200 mL milk fortified with 240 IU of ergocalciferol in intervention group (n=119) and 200 mL of plain milk in control group (n =116) for 3 months. Change in serum 25 hydroxy vitamin D (25(OH)D), parathyroid hormone (PTH), bone formation and resorption markers, and urinary calcium creatinine ratio (U-Ca/CrR). The mean (SD) baseline serum 25(OH) D level in control and fortification groups was 11.9 (3.8) and 11.4 (3.6) ng/mL (P=0.23), respectively. The serum 25(OH)D levels did not increase post-intervention with the dose used for fortification, but were significantly higher in intervention group as compared to control group [10.8 (3.4) vs 6.7 (3.5) ng/mL; P

Objective: Goodpasture's syndrome (GPS) is the association of pulmonary haemorrhage with acute kidney injury (AKI) resulting from injury by auto-antibodies. Its de novo occurrence in pregnancy is extremely rare with only few cases reported. High risk of mortality and lack of consensus in treatment warrants its reporting. Case report: A 24 year old primigravida, with no history suggestive of renal disease, presented to us in her third trimester with anuria. She was initially managed as sepsis or preeclampsia related AKI. However, even after delivery there was no improvement in kidney function with hemodialysis and she developed hemoptysis. Renal biopsy made a diagnosis of Anti-Glomerular Basement Membrane disease. With careful multi-disciplinary treatment, she delivered a live born baby and was discharged under stable condition on hemodialysis, currently awaiting a kidney transplant. Conclusion: This case highlights that the current management for GPS should be revised to improve the outcome of AKI. Also, it determines how important it is for obstetricians to consider whether a pregnancy should be terminated to improve the outcome of AKI in pregnant patients with GPS

Objectives: Obesity has been mentioned as a high risk factor for Vitamin D deficiency (VDD) requiring supplementation in Indian children. Material and Methods: Forty obese and age-matched non-obese subjects (age 5–18 years) were assessed for lifestyle parameters, metabolic profile, and serum 25-hydroxyvitamin D (25OHD). VDD was defined as serum 25OHD < 12 ng/mL. Results: Mean 25OHD was comparable among obese and controls (15.0 ± 9.95 and 15.1 ± 4.79 ng/mL; P = 0.97) with VDD seen in 82% of cases and 85% of controls. Pubertal cases had lower 25OHD values than prepubertal obese cases (10.78 ± 4.69 and 17.2 ± 11 ng/mL; P = 0.06). Mean duration of physical activity (2 h/day) was similar across prepubertal and pubertal groups and between obese and controls. Obesity was not associated with risk for VDD among cases and controls (odds ratio 0.83, 95% C.I. 0.25–2.7, P = 0.76). Conclusion: Obese pubertal subjects were more at risk for VDD than prepubertal subjects. Routine Vitamin D supplementation to obese Indian children may be considered during adolescence.

OBJECTIVE: Nearly 1.5 billion people of an Asian country are living their lives without a country-specific over-the-counter (OTC) drug list. A study was planned to assess the understanding and practice of OTC medication consumption in the pregnant population. METHODS: A questionnaire-based cross-sectional study evaluating different perspectives on OTC drug consumption was planned in around 500 pregnant women attending tertiary care outpatient antenatal clinics. The association of knowledge, attitude and practice versus indications, knowledge regarding harmful effects possible, reasons for choosing OTC medication, the practice of consulting nonmedical persons and drug interactions with the disease or prescription medications was determined. Regression analysis was performed in statistical software R. RESULTS: Seven percent (36/516) of pregnant women were found to consume oral antimicrobials without prescription. Local chemist consultation was the most common channel (72.48%) to procure the OTC medicines. Participants with good knowledge score showed an odds ratio (OR) of 1.87 (95% C.I.; 1.28–2.73), 1.6 (95% C.I.; 0.99–2.63), 1.66 (95% C.I.; 1.14–2.42) and 2.66 (95% C.I.; 1.49–4.89) for self-medication encouragement tendency possible, restricting sale of OTC medications, the habit of reading drug leaflets and understanding the potentially harmful effects, with OTC drugs, respectively. Right-attitude participants showed an OR of 1.89 (95% C.I.; 1.29–2.80) and 1.8 (95% C.I.; 1.19–2.76) for identifying knowledge of acetaminophen overdose and liver damage link as well as the disease symptom masking possibility with OTC, respectively. Participants with insufficient knowledge and attitude scores showed an association with more OTC antacid-antiemetics and analgesic use, respectively. CONCLUSION: Antenatal pregnant women need to be guided on avoiding OTC antimicrobial usage. Both obstetricians and regulators have to play an active role in educating pregnant women and contributing to developing country-specific OTC drug lists with the guidelines. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13224-021-01481-2.

There is scarce literature on managing superior mediastinal syndrome during pregnancy. We report a case of 26-year-old primigravida who presented with life-threatening superior mediastinal syndrome at 32 weeks of gestation. The diagnosis was significantly delayed and, as a result, she reached the emergency with stridor and impending respiratory failure. She was diagnosed with primary mediastinal B cell lymphoma Lugano Stage II with a bulky mediastinal mass. She was treated with chemoimmunotherapy and underwent a preterm vaginal delivery after a week. She delivered a 1.6 kg healthy child with no malformations. Later, she completed three cycles of rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone and five cycles of dose-adjusted etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin, rituximab, followed by radiotherapy. She continues to be in remission at 18 months of follow-up. Delaying diagnostic imaging that involves ionizing radiation exposure and chemotherapy to avoid teratogenic and obstetric complications during pregnancy can adversely affect the prognosis in certain patients with high-grade malignancies. On the contrary, prompt multidisciplinary management can lead to a gratifying outcome.

Guillain Barre Syndrome (GBS) is usually a post-infectious autoimmune disease that manifests as acute ascending flaccid paralysis. The disease is usually uncommon. However, recently it was reported in a few COVID-19 cases before complete resolution of COVID symptoms. An association between olfactory-gustatory disturbances and sensory abnormalities is frequently observed in GBS with COVID-19. The electrophysiological studies usually reveal a demyelinating pattern. Respiratory involvement, as part of respiratory muscle paralysis or COVID-19 pneumonia, is associated with poor recovery in affected patients. Here, we present a case of a young man, pre-morbid healthy, who presented with GBS with mild COVID-19 infection. He successfully recovered after treatment with Intravenous immunoglobulin IVIg. How to cite this article:Dabas A, Kumar N. Guillain Barre Syndrome in a Young Man with SARSCoV-2: A Rare Association. J Adv Res Med 2021;8(1): 22-25. DOI: https://doi.org/10.24321/2349.7181.202104

Nanotechnology has been accepted as a successful general-purpose technology and engine for growth in the 21st century. Research in the last two decades has highlighted the numerous potential applications of nanomanufacturing and commercialization. Nanotechnology has revolutionized various aspects of different areas, like cosmetics, medicines, medical devices, pharmaceuticals, cement, agriculture, electronics, etc. Effective commercialization is of prodigious importance to inventive firms, and the latest literature has progressively recognized that industry has involvement not only in research and development but also in commercialization. Research into nanotechnology is extremely broad and involves different products, such as in the fields of cosmetics, medicines, medical devices, electronics, cement, etc.; many examples have already been commercialized and others are in development. The present review article explores recent developments relating to industrial nanotechnology and nanotechnology commercialization, which involves the development of products and techniques with a view toward their commercialization.

Objective: The aim of this study was to evaluate thyroid dysfunction in COVID-19 and study its association with disease severity in COVID-19. Methods: Patients with confirmed COVID-19 infection who were admitted to dedicated COVID hospital were recruited over 3 months period. Those with pre-existing thyroid disease were excluded. The thyroid function tests were performed and correlated with interleukin-6 levels. Results: A total of 164 patients (14 children) with mean(SD) age 53.85 (19.54) years were recruited. The proportion of patients with mild, moderate and severe disease were 22 (13.4%), 78 (47.6%) and 64 (39.0%), respectively, among which 12 (54.5%), 56 (71.8%) and 43 (67.2%) patients had thyroid dysfunction, respectively; P = 0.309. Eighty eight (53.7%) had sick euthyroid (84 had low fT3 only), 14 had overt hypothyroidism and 9 had thyroiditis. Median (IQR) levels of serum fT3 showed significant decline from mild category [4.54 (3.81, 5.27)], to moderate [3.95 (3.67, 4.24)] and severe category [3.56 (3.22, 3.89)]; P = 0.011. Low fT3 had significant risk [odds ratio (95% CI)] of death [2.634 (1.01, 6.87); P = 0.031] and elevated IL-6 [2.575 (1.084, 6.118); P = 0.021]. Conclusion: Sick euthyroid was seen in the majority of patients hospitalized with COVID. Low fT3 was associated with death and increased inflammation, suggesting poor prognosis.

Objectives: High prevalence of vitamin D deficiency mandates prescribing an appropriate form of vitamin D that allows attainment of sufficiency in a cost-effective manner. We aimed to compare vitamin D products in Indian market in terms of composition and cost in 2020 with 2013 to understand price dispersion over 7 years. Methods: Constituents, formulations, and prices of 'branded' and generic vitamin D products were sourced from various drug information compendia and online sources. Price per defined daily dose (DDD), percentage cost variation, and change in prices over 7 years (2020 vs. 2013) was determined. Results: There has been a disproportionate increase in the number of brands and cost variation of cholecalciferol and calcitriol in the last 7 years. The percentage cost variation increased almost 10 times for calcitriol and 4.4 times for alfacalcidiol tablets and cholecalciferol granules. An analysis of >1,100 products in 2020 showed that the predominant form was calcitriol which was combined with calcium in >90% of the products with huge cost variation (>3000%). Ergocalciferol and cholecalciferol were available in 22 and 15 different strengths respectively. Median price/unit of cholecalciferol (60,000IU) was lower for tablets/capsules compared to other formulations; but with >1000% cost variation. Conclusion: A wide cost variation exists with the use of different vitamin D brands and preparations with conventional cholecalciferol tablets and capsules being a low-priced alternative. Quality control measures and strict enforcements of existing regulations are essential to ensure that competitive prices of branded generics are translated into availability and affordability for the population.

BACKGROUND There is an increasing incidence of caesarean section around the world. As caesarean section is associated with infectious complications, frequent and inappropriate use of all newly discovered antimicrobial drugs has led to the development of altered mechanisms and treatment failure or ineffective management of such patients which increase the rate of morbidity and mortality in mothers. Many guidelines and studies recommend single dose antibiotic prophylaxis for women undergoing elective or non-elective caesarean section. The aim of this study was to assess the effectiveness of ceftriaxone as prophylactic antibiotic in elective caesarean section patients. METHODS This study was carried out in Indira Gandhi Government Medical College and Hospital, Nagpur from 2017 to 2019. Approval from Institutional Ethics committee was taken prior to commencement of the study. Two hundred patients were included in the study from wards who fulfilled the inclusion criteria. They were divided into two groups, group 1 had hundred patients who received inj. Ceftriaxone as single dose prophylaxis after cord clamping. Group 2 of hundred patients received combination of inj. cefotaxime, metronidazole and gentamicin, which was administered for 2 days IV followed by oral Augmentin for 5 days Postoperatively. The efficacy was measured in terms of febrile morbidity, wound infection, duration of hospital stay, and cost of antibiotic. RESULTS Febrile morbidity was significantly less in group 1 compared to group 2. 3% from group 1 and 16% from group 2 had wound discharge and therefore, the difference was statistically significant (p=0.003). 2% from group 1 and 9% from group 2 presented with wound dehiscence (p=0.027). 74% from group 1 had a shorter hospital stay of 7 days (p=

BACKGROUND Foetal growth restriction is the second most common cause of low birth weight after prematurity. Hypertensive disorders are some of the most common medical complications and are associated with a substantial increase in maternal perinatal morbidity and mortality. Evidence suggests that these conditions generally manifest later in pregnancy, but their underlying pathophysiology is established early in pregnancy. This finding has sparked great interest in the search for tests to predict them early in pregnancy before these complications occur. METHODS The study was carried out on 200 pregnant women of 20 - 24 weeks gestation in the Department of Obstetrics and Gynaecology, Indira Gandhi Government Medical College, Nagpur, from September 2017 to October 2019. All three doppler indices were studied and these patients were followed up till delivery, and details of pregnancy events, labour and delivery, and neonatal outcome were noted. The abnormal pregnancy outcomes considered were preeclampsia and foetal growth restriction. RESULTS Uterine diastolic notch shows high sensitivity (77.76%), specificity (94.52%), positive predictive value (84%), and negative predictive value (92%) in the prediction of pre-eclampsia and it also has high sensitivity (73.68%), specificity (86.42%), positive predictive value (56.9%), and negative predictive value (93.33%) in the prediction of foetal growth restriction as compared to abnormal PI and RI. Hence, uterine diastolic notch is associated with maternal morbidity and increased adverse perinatal outcome. CONCLUSIONS Women with abnormal uterine artery Doppler (at 20-24 weeks of gestation), are recommended intensive antenatal surveillance, adequate rest, nutritional supplements and institutional delivery as they may require intensive care at the time of delivery and baby may also require neonatal intensive care.

As the emaciated healthcare system is attempting to break the tide of the novel coronavirus pandemic across the globe, the highest cost of this fight is being borne by the third world countries. India is currently experiencing the peak incidence of COVID-19 cases. For the last 9 months, non-emergency services including OPDs have been suspended in majority of the hospitals to divert resources for combatting emergency medical care during this deadly pandemic. This temporary pause and containment could be detrimental to even patients suffering from malignancy. During this critical hour, commencement of infertility treatments including assisted reproductive technologies (ART) will add to additional burden upon the crippled medical fraternity. Fate of thousands of patients seems to hang by a fine thread now. In the resource-poor countries, it is our duty to divert maximum medical power to curtail this contagious pandemic rather than focusing on non-urgent treatment services.

Background Congenital adrenal hyperplasia (CAH) is a chronic disorder requiring lifelong therapy. False perceptions, poor knowledge, and social isolation adversely affect the psychosocial health and quality of life of patients and caregivers. The study was undertaken to ascertain the quality of life of caregivers of children with CAH. Method A hospital-based cross-sectional study enrolled caregivers of children diagnosed with CAH where newborn screening was unavailable. Quality of life (QoL) was measured using the WHO-QoL-BREF questionnaire to compare physical, psychological health, social relationships, and environment. Results Eighteen children with CAH (9 males), 14 salt-wasting, and 4 simple virilizing CAH with median (IQR) age of 4.3 (2.6, 9.8) years and a follow-up period of 3.8 (1.3, 8.4) years were enrolled. Out of 18 caregivers, 6 were fathers and 12 mothers with a mean (SD) age of 38 (8) years. The mean (SD) of the total score was 69.2 (10.6); physical, psychological, environmental, and social domain were 69.8 (15.1), 57 (12.6), 64 (14.5), and 65 (9.9), respectively. Physical, psychological, and environmental domain scores were significantly higher in upper-middle than lower-middle socioeconomic strata (P Conclusion The study reflects the suboptimal quality of life in caregivers of children with CAH. There was no correlation of the duration of disease with the QoL scores. Psychological and social relationship scores were poorest, indicating the need to creating more awareness to remove social taboos associated with this disease.

Background: Sex differences in presentation, management, and outcomes of heart failure (HF) have been observed, but it is uncertain whether these differences exist in South India.Objective: We describe sex differences in presentation, management, and in-hospital outcomes in patients hospitalized with HF in South India and explore sex-based differences in the effect of the quality improvement intervention in a secondary analysis of a prospective, interrupted time series study.Methods: The Heart Failure Quality Improvement in Kerala (HF QUIK) study evaluated the effect of a quality improvement toolkit on process of care measures and clinical outcomes in patients hospitalized with HF in eight hospitals in Kerala using an interrupted time series design from February 2018 to August 2018. The primary outcome was guideline-directed medical therapy (GDMT) at hospital discharge for patients with HF with reduced ejection fraction (HFrEF). We performed sex-stratified analyses using mixed effect logistic regression models.Results: Among 1,400 patients, 536 (38.3%) were female. Female patients were older (69.6 vs. 65 years, p < 0.001), were less likely to have an ischemic etiology of HF (control period: 78.2% vs. 87.5%; intervention period: 83.6% vs. 91.5%; p < 0.05 for both) and were less likely to undergo coronary angiography or percutaneous coronary intervention. The quality improvement intervention had similar effects on the odds of GDMT at discharge in females with HFrEF (adjusted OR 1.79, 95% CI 0.92, 3.47) and males with HFrEF (adjusted OR 1.68, 95% CI 1.07, 2.64, pinteraction = 0.69).Conclusions: We observed sex-specific differences in presentation and procedural management of patients with HF but no differences in the effect of the quality improvement intervention on discharge GDMT rates. Both male and female patients with HFrEF remained undertreated in the study intervention period, demonstrating the need for implementation strategies to close the HFrEF treatment gap in South India.

Blockchain Technology, the fundamental technology behind Bitcoin, has drawn considerable recognition ever since its origin. Its potential has gained significant interest in various applica...

Background: Poor shelf life and nutrient availability is a limiting factor in adoption of pearl millet. It can be addressed by indigenous processing like malting, blanching and roasting. This study delineates outcome of processing on protein, fat, ash, nutrient digestibility and storage stability of biofortified pearl millet varieties. Methods: Unprocessed, malted, blanched and roasted millet grains’ flour was analysed and compared for protein, fat, ash and nutrient digestibility. To assess storage stability, flours were stored at 25 ± 1°C at 40 ± 2% RH and fat acidity and per oxide values analysed at an interval of 10 days. Result: It was found that the protein and fat contents of flours decreased on processing. Blanched and roasted flours possessed more ash compared to malted flour. The amount of fat and ash in HC-20 was significantly more than that of Dhanshakti variety. Digestibilities of protein and starch, of processed flours improved significantly and maximum improvement was exhibited by malted flours followed by roasted and blanched. The fat acidity and peroxide value of stored flours increased and this increase was more in unprocessed compared to processed flours. The findings of this study can be useful for augmenting the nutritional and keeping quality of pearl millet.

COVID-19 has emerged as a dreadful pandemic caused by the virus SARS-CoV-2. Though the number of patients recovering from infection is encouraging, sturdy cure is still being researched upon and the effective vaccines are yet to be rigidly resolute. COVID-19 has so far instigated a massive loss of lives globally and even the countries with the most advanced healthcare systems have come under its grasp. Health experts suggest in such case “Prevention is better than cure” which includes an appropriate daily lifestyle and a rugged immune system that could help mankind surmount this peril. This review highlights the importance of influential herbs and their medicinal significance. Biomedical articles were explored from PubMed, Google Scholar, Web of Science for the period of 2010-2021. Guidelines from the Ministry of Ayush (India) were also considered. The Ayurveda does not mention any cure for the novel coronavirus; however, it emphasizes the means of boosting one’s immunity. Accordingly, this article highlights some of the role of prevalent Ayurvedic herbs in promoting immunity for combating the novel coronavirus. The herbs in combination with drugs could be utilized for the sake of curtailing the side effects as well as the malefic repercussions of strong synthetic drugs used for treating COVID-19 patients, which would be a paramount leap in the field of Ayurveda as well as western-style medicine. However, the beneficial effects of these traditional medicines and their clinical trials remained to be known. We reviewed the latest updates on traditional medicines proposed for promoting immunity towards COVID-19.

Highlights • Screening for Lynch syndrome mostly is done by IHC or MSI testing. • They are sensitive, specific and also mostly concordant with each other as well as genetic testing. • Discordance between screening and genetic testing, although rare is not unknown. • In such cases, we must proceed with germline DNA testing by Next Generation Sequencing., Immunohistochemistry for mismatch repair proteins and microsatellite instability testing are recommended screening methods for Lynch syndrome. They have a good sensitivity and specificity, allowing for directed genetic testing and diagnosis. We report a case of Lynch syndrome with retained MMR protein expression who later showed an MLH1 gene variant on genetic testing (Next Generation Sequencing) requested because of the clinical presentation of metachronous colonic and endometrial carcinoma. This report makes the case for strong clinical suspicion and directed genetic testing despite initial screen negative results.

Craniopharyngiomas are benign tumors of neuroepithelial origin, believed to arise from remnants of Rathke’s pouch. Their proximity to vital structures of the visual pathway and hypothalamus leads to both neurological and endocrinological complications. Endocrinal complications are seen in 40%–87% of the affected and can develop at presentation or post-surgery and radiotherapy. Central diabetes insipidus (CDI) is a common endocrinopathy associated with craniopharyngioma, but rarely a presenting symptom before or after surgery. CDI most commonly presents with polyuria and polydipsia. Here, we report a postoperative child with craniopharyngioma where recurrent urinary tract infection and hydronephrosis were initial clues to diagnose CDI.

The study aimed to explore the perception and knowledge-gain of undergraduate medical students during the Medical Council of India-mandated one month foundation course in August, 2019. A total of 129 consenting students who underwent the foundation course were enrolled and their feedback collected using an email-based structured questionnaire. A majority (>60%) had positive attitudes towards various aspects of the course, with good scores obtained in the post-test by the majority of the students. The information reported will assist in the planning of future foundation course programs.

Congenital adrenal hyperplasia (CAH) is an autosomal recessive endocrine disorder which can manifest after birth with ambiguous genitalia and salt-wasting crisis. However, genital ambiguity is not seen in male babies and may be mild in female babies, leading to a missed diagnosis of classical CAH at birth. In this review, we provide a standard operating protocol for routine newborn screening for CAH in Indian settings. A standardization of first tier screening tests with a single consistent set of cut-off values stratified by gestational age is also suggested. The protocol also recommends a two-tier protocol of initial immunoassay/time resolved fluoroimmunoassay followed by liquid chromatography tandem mass spectrometry for confirmation of screen positive babies, wherever feasible. Routine molecular and genetic testing is not essential for establishing the diagnosis in all screen positive babies, but has significant utility in prenatal diagnosis and genetic counseling for future pregnancy.

In the current age of high competition and risk in markets, technological advancements are a must for better growth and sustainability. The same applies to the agriculture industry. Every farmer has high stakes on the crops, their yield and quality. Rising water issues and need for proper methodologies for farm maintenance is a hot issue that needs to be tackled at utmost propriety. An automation of irrigation systems in farms is proposed in this research. The proposed solution is based on the Internet of Things (IoT), which would be a cheaper and more precise solution to the farm needs. A Monitoring system whose main purpose is to solve the over irrigation, soil erosion and crop-specific irrigation problem will be developed to ease and efficiently manage Irrigation problems. Since it is a well-known fact that the water is a scarce resource and over wastage of such an essential resource should be minimized. The proposed solution will be developed by establishing a distributed wireless sensor network (WSN), wherein each region of the farm would be covered by various sensor modules which will be transmitting data on a common server. Machine learning (ML) algorithms will support predictions for irrigation patterns based on crops and weather scenarios. So, a sustainable approach to irrigation is provided in this paper.

To evaluate the seasonal change in serum 25-hydroxyvitamin D (25-OHD) level in healthy infants and to relate it to common childhood morbidities. 72 healthy breastfed infants residing in Delhi were enrolled at the end of summer and followed till the end of winter [mean (SD) duration 200 (10) d]. Serum 25-OHD was estimated at baseline and follow-up. Infants were monitored for common childhood diseases. Mean (SD) serum 25-OHD level was lower at the end of winter (20.7 (8.02) ng/mL) than summer (22.9 (8.70) ng/mL) [mean difference (95% CI) −2.14 ng/mL (−3.36, −1.06), P

Empirical treatment options for unexplained infertility treatment include controlled ovarian stimulation (COS) with clomiphene citrate, letrozole or gonadotropins followed by intrauterine insemination (IUI). Achieving consistent multifollicular development with letrozole generally requires addition of gonadotropins. However, the cost and discomfort of injections remains a drawback of this regimen. Therefore, there is a need for evolving newer cost-effective regimens for COS/IUI using orally administered drugs like letrozole. Sixty couples with unexplained infertility (on standard infertility investigations) visiting the infertility clinic at a tertiary centre in North India were randomized into two groups. Group A COS was done by step-up protocol of letrozole from day 2 or 3 of menstrual cycle, starting with 2.5 mg and increased by 2.5 mg per day for next 3 days (2.5 mg, 5 mg, 7.5 mg, 10 mg). Group B COS was done with combination of letrozole and hMG (human menopausal gonadotropin). Starting from day 2 or 3 of menses, tablet letrozole 2.5 mg twice a day was given for 5 days. Intramuscular injection of hMG 150 IU was given every alternate day starting from day 7 and titrated according to the response. HCG was given when leading follicle was 17 mm and IUI done 36 h after HCG. Twenty-eight couples in letrozole step-up group (group A) and 30 couples in letrozole plus hMG group (group B), completed follow up for 44 and 55 cycles, respectively. Mean numbers of follicle ≥ 16 mm in both groups were comparable: 1.74 (± 0.83) in group A and 1.94 (± 0.68) in group B (p = 0.178). Ovulation rate of 90.9% (40/44) was achieved in group A, whereas it was 100% (55/55) in group B (p = 0.022), although there was no significant difference in clinical pregnancy rate per patient, which was 3/28 (10.7%) in group A versus 5/30 (16.67%) in group B (p = 0.707). The mean (SD) cost of medicines was significantly lower in group A Rs. 345.00 (00) compared to group B Rs. 2148.64 (515.67) [p

Background: Endometrial stromal sarcoma (ESS) is a rare tumor. Extension into the inferior vena cava (IVC) and heart has been described infrequently. Case: A 35-year-old female had low-gra...

Goldston syndrome (GS) is a rare association of Dandy-Walker malformation (DWM) and cystic renal dysplasia with or without hepatic fibrosis. It is considered to be a milder variant of Meckel Gruber syndrome (MGS) and shares features with Miranda syndrome. We reported a 22 day old infant with DWM and autosomal recessive polycystic kidney disease (ARPKD) who presented with cholestasis and acholic stools. Ultrasonography and magnetic resonance cholangiopancreatography (MRCP) confirmed the diagnosis of congenital hepatic fibrosis (CHF). The child improved with supportive treatment. CHF is a rare condition which may present as a syndromic association.

To determine the incidence, risk factors and outcome of acute kidney injury (AKI) in hospitalized children with nephrotic syndrome. All consecutive hospitalized children (aged 1–14 years) with diagnosis of nephrotic syndrome between February 2016 and January 2017 were enrolled for the study. Children (aged 1–14 years) with features of nephritis, underlying secondary causes of nephrotic syndrome as well as children admitted for diagnostic renal biopsy and intravenous cyclophosphamide or rituximab infusion were excluded. A total of 73 children (81 admissions) were enrolled; incidence of AKI was 16% (95% CI, 9-23). On multivariate logistic regression analysis, furosemide infusion was observed as an independent risk factor for acute kidney injury (OR 23; 95% CI, 3-141; P

Sign language was originally created to fulfil the gap of communication between the speech impaired. However, with recent advances, we can see the applications of sign language in a variety of different fields such as automated vehicle movements, assistant systems, human robot interaction. In this paper, the main focus is towards creating a system that is highly efficient in detecting the hand sign gestures. To achieve these results, numerous deep learning techniques and advanced models have been used in this paper. The models were trained on ASL (American Sign language) dataset in which the highest validation accuracy was 99.56% achieved with Resnet 50 architecture. Other pre-trained models used also received similar validation accuracies. A combined voting classifier is also implemented to achieve the maximum accuracy. All the models were finally tested on the HGM -4 dataset which is a totally new dataset with a different set of images and our models obtained decent results here also as shown in Table 1.

The sensitivity of single abdominal paracentesis for diagnosis of peritoneal carcinomatosis in patients with malignant ascites is 40-70%. Tumor cells shed from the peritoneum settle preferentially in certain recesses of the peritoneum. We aim to compare the standard technique of abdominal paracentesis versus a rollover technique in a randomized crossover study to assess the cytological yield in patients suspected to have peritoneal carcinomatosis. Each patient will serve as their own control and the outcome assessor (cytopathologist) will be blinded to the method of paracentesis performed. The primary objective will be to compare the tumor cell positivity between the standard paracentesis group and the rollover group among enrolled patients.Lay abstract Existing methods of diagnosing cancer-related ascites are dependent on microscopic evaluation of fluid obtained from the ascites. However, this may not diagnose all such cases because the fluid may not contain many tumor cells. This may be due to the settling of tumor cells in certain inaccessible locations of the peritoneum (the lining of the abdominal cavity). This trial will look at whether rolling the patient from side to side could be helpful in increasing the chances of finding tumor cells in the ascites.

Background Nations have faced significant challenges with the COVID-19 related biomedical waste since its outbreak. Before the pandemic, Indian hospitals typically generated 500g of BMW per bed each day, which has now risen to about 2.5-4 kg per bed per day. Proper BMW aims to reduce waste generation, ensures efficient collection, handling and safe disposal that it controls infection and improves safety for the medical professionals. Hence, the present study was conducted to assess the level of knowledge among medical professionals regarding biomedical waste segregation , transport and treatment and thereafter provide constructive suggestions to reduce mismanagement practices. Methodology An e-survey was done to assess the knowledge and awareness of management of Biomedical Waste generated due to Covid-19 among Medical Professionals (students, residents and consultants) of tertiary care hospital of North India. Result The average knowledge score about BMW waste generated due to Covid-19 was found to be: for segregation - 27.46%, 59.615%, and 49.8%; transport of waste from site of generation to the site of disposal- 63.66%, 89.1% and 95.2% ; disposal of waste generated- 29%, 71.96%, and 68.24% in students, residents, and consultants respectively. Overall, the knowledge score was 41.4%, 67.98%, and 61.34% among the students, residents and consultants respectively. We found that participants with greater years of experience (residents and consultants) had better knowledge compared to that of the students(pDiscussion Our study found that the mean score was 56.9% which is comparably more than the knowledge score of few Low and Middle Income Countries but less than the knowledge score of some European countries. Studies have found that the chances of infection directly correlates with the low level of knowledge. This underlines that training aspects of health-care waste management should be strengthened, not only for the practising medical professionals but also of the students so that the current, existing, and future regulations are practiced diligently and uniformly. Hence, it is important that we strengthen the training aspect of medical professionals. Periodic evaluation and assessment should become routine to enforce adherence to waste management.

OBJECTIVES: To examine the trends and influencing factors of suboptimal complementary feeding (CF) practices among children aged 6–23 months in Niger using national data from 2000 to 2018. METHODS: Using data from the 2000 Multiple Indicator Cluster Survey, 2012 Demographic and Health Surveys (DHS), and 2018 Standardized Monitoring and Assessment of Relief and Transitions survey in Niger, the trends and predictors of WHO-UNICEF CF indicators including timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD) were estimated. Using the most completed data in CF and influencing factors (available from 2012 DHS), multilevel logistic regression models were applied to identify factors at the individual, household and community levels that were associated with meeting INTRO, MMF, MDD, and MAD. RESULTS: The weighted proportion of children aged 6–8 months meeting INTRO increased from 56.0% in 2000 to 84.4% in 2018. The weighted proportion of children meeting MMF (51.3% to 77.9%), MDD (9.8% to 14.2%), and MAD (5.6% to 10.9%) also increased between 2012 - 2018. At the individual level, children with mothers who were employed had higher odds of meeting all four indicators as compared to those whose mothers were unemployed. Older child age and maternal exposure to media were significantly associated with higher odds of meeting MMF, MDD, and MAD. Maternal education and child birth weight greater or smaller than average (reference) were positively associated with the odds of meeting MMF and MAD, and antenatal iron supplementation and currently breastfeeding were positively associated with the odds of achieving MDD and MAD. At the household level, the odds of meeting MMD and MAD were higher among children from wealthier households. At the community level, the odds of meeting INTRO and MMF were higher among children from communities with greater access to health services. CONCLUSIONS: Despite the improvement in CF practices since 2000, only 10% of children from 6–23 months received minimum acceptable diets. Factors associated with CF were distributed across individual, household and community levels, suggesting the need for multi-level strategies to improve child nutrition in Niger. FUNDING SOURCES: UNICEF West and Central Africa Regional Office (Grant # 43279190).

To determine seroprotective titres for diphtheria, pertussis, tetanus and measles in children with nephrotic syndrome who had received essential immunization. Children (2–18 years) with steroid sensitive nephrotic syndrome (SSNS) or steroid-resistant nephrotic syndrome (SRNS) who were in disease remission and had received essential childhood immunization were included. Anti-diphtheria, anti-pertussis, anti-tetanus and anti-measles antibody titres were measured. Seventy-six (40 with SSNS; 36 with SRNS) children with mean (SD) age 7.54 (3.96) years were enrolled. The time elapsed since last vaccination was >5 years in 68.4% patients. The seroprotection rates for diphtheria, tetanus, pertussis, and measles were 86.8%, 93.4%, 31.6% and 77.6% respectively; lower in SRNS subjects compared to SSNS. Robust seroprotection titers (1.0 IU/mL) for diphtheria were seen in 23.8% SSNS and 17.9% SRNS; P=0.04, and for tetanus in 69.3% SSNS and 43.8% of SRNS subjects; P=0.03, respectively. Children with nephrotic syndrome especially those with SRNS have lower seroprotective titers for diphtheria, tetanus, pertussis and measles, necessitating a booster dose of DPT/DT/Td and MR/MMR.

There is a lack of clarity regarding management of COVID-19 infection in children. This review aims to summarize the key clinical presentations and management of Pediatric COVID-19. The Medline database was searched for seminal articles and guidelines on COVID-19 presentation and management in children less than 18 years of age. COVID-19 has a lower incidence (1-5% of reported cases worldwide), causes milder disease with lower need for intensive care admission and lower mortality rate (0-0.7%) in children compared with adults. Multisystem inflammatory syndrome is a rare but severe complication in children. Majority of patients require supportive care including adequate hydration, nutrition and antipyretics. Supplemental oxygen therapy should be given in moderate to severe cases with all precautions to prevent air-borne COVID-19 spread. Steroids may be helpful in severe cases. Anticoagulation is indicated in moderate to severe cases with risk factors. More data on the efficacy and safety of antivirals and immunomodulators in children is needed.

Objective The aim of the study was to identify indicated homeopathic remedies based on the clinical characteristics of coronavirus disease 2019 (COVID-19) patients in India. Methods In this retrospective, cohort study, confirmed COVID-19 patients admitted at a COVID Health Centre in New Delhi between April 29 and June 17, 2020 were given conventional and homeopathic treatment. Patients were grouped into mild, moderate or severe categories of disease. Their symptomatologic profiles were analyzed to identify indicated homeopathic medicines. Results A total of 196 COVID-19 patients were admitted. One hundred and seventy-eight patients had mild symptoms; eighteen patients had moderate symptoms; no patients with severe symptoms were included as they were referred to tertiary care centers with ventilatory support. The mean age of patients with mild symptoms was significantly lower (38.6 years; standard deviation or SD ± 15.8) compared with patients in the moderate category (66.0 years; SD ± 9.09). The most important symptoms identified were fever (43.4%), cough (47.4%), sore throat (29.6%), headache (18.4%), myalgia (17.9%), fatigue (16.8%), chest discomfort (13.8%), chills (12.6%), shortness of breath (11.2%) and loss of taste (10.2%). Twenty-eight homeopathic medicines were prescribed, the most frequently indicated being Bryonia alba (33.3%), Arsenicum album (18.1%), Pulsatilla nigricans (13.8%), Nux vomica (8%), Rhus toxicodendron (7.2%) and Gelsemium sempervirens (5.8%), in 30C potency. Conclusion Data from the current study reveal that Arsenicum album, Bryonia alba, Pulsatilla nigricans, Nux vomica, Rhus toxicodendron and Gelsemium sempervirens are the most frequently indicated homeopathic medicines. A randomized controlled clinical trial based on this finding is the next step.

Background The lockdown imposed due to novel coronavirus disease 2019 (COVID-19) has resulted in adopting electronic learning (e-learning) as the means of education in various institutions all over India. This study aimed to collect the experiences of faculty and students regarding e-learning in medical colleges during COVID-19 and to analyse the likely perceived benefits and problems to choose blended learning activities after the COVID crisis. Methods A survey-based study was conducted among undergraduate students and faculty members in medical colleges of Delhi-NCR. Result Two hundred forty-eight medical students and 23 faculty members participated in the study. Two hundred twelve (85.4%) students considered medical education to be severely affected during the lockdown and 219 (88.3%) students found the online classes to be useful. Poor connectivity followed by lack of human interface and poor sound or acoustics were the major hindering factors, whereas convenience and access were reported as important facilitating factors. In the postlockdown phase, 135 (54.4%) students want online classes to be continued in addition to classroom teaching for the cognitive domain, 42 (16.9%) students want it for both cognitive and psychomotor domain and 60 (24.1%) do not want online classes. The majority of the faculty members (65.2%) were in favour of including online teaching modules in routine curriculum and 69.6% suggested a 70%:30% distribution of traditional and online classes after the COVID lockdown. Conclusion Implementation of e-learning within the existing curriculum is bound to be challenging; however, it remains the only solution during COVID-19 imposed lockdown for maintaining the chain of learning.

There is a current public health issue threatening human health worldwide with the rapid spread of the novel coronavirus (2019-nCoV) or severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The infection was reported to first originate in bats and subsequently spread to humans via yet unknown source animals in Wuhan, Hubei, China in December, 2019. Coronavirus disease 2019 (COVID-19) caused by extreme acute respiratory coronavirus-2 syndrome (SARS-CoV-2) is an unprecedented healthy global emergency. The outbreak of SARS-CoV-2 has once again revealed the vulnerabilities of global healthcare systems, the capacity of these systems to respond to an infectious threat, as well as the rate of infection and transmission across international borders. The present review article aimed to provide an update of the current knowledge regarding COVID-19 epidemiology, patho- genesis and transmission, as well as public health measures. The present review also emphasises the key learning points related to COVID-19 prevention and identifies the need to invest in healthcare systems, community-led defence systems, as well as the need for resilience and global health security. © 2021 World Academy of Sciences Journal. All rights reserved.

Chronic mucocutaneous candidiasis (CMC) is characterized by recurrent fungal infections of the skin, mucosa and nails and is commonly associated with primary immune-deficiency states, autoimmune polyendocrinopathy syndrome and Hyper-IgE syndrome1 . STAT mutations are the commonest mutations associated with CMC2 . We present a young boy who was diagnosed CMC and pancytopenia.

Background Small-quantity lipid-based nutrient supplements (SQ-LNS) are efficacious in controlled settings; data are scarce on the effectiveness utilizing health care delivery platforms. Objective We evaluated the impact of an infant young child feeding (IYCF)–SQ-LNS intervention on anemia and growth in children aged 6–18 mo in the Democratic Republic of Congo following a quasi-experimental effectiveness design. Methods An intervention health zone (HZ) received enhanced IYCF including improved counseling on IYCF during pregnancy until 12 mo after birth and daily use of SQ-LNS for infants 6–12 mo; the control HZ received the standard IYCF package. We analyzed data from 2995 children, collected in repeated cross-sectional surveys. We used adjusted difference-in-difference analyses to calculate changes in anemia, iron and vitamin A deficiencies, stunting, wasting, and underweight. Results Of mothers, 70.5% received SQ-LNS at least once in the intervention HZ, with 99.6% of their children consuming SQ-LNS at least once. The mean number of batches of SQ-LNS (28 sachets per batch, 6 batches total) received was 2.3 ± 0.8 (i.e., 64.4 ± 22.4 d of SQ-LNS). The enhanced program was associated with an 11.0% point (95% CI: −18.1, −3.8; P

We collected information regarding vitamin D supplementation practices of 230 pediatricians through an online survey. Routine supplementation was being practiced during infancy, 1-5 y, 6-10 y, and >10-19 y age by 187 (81.3%), 60 (26.1%), 34 (14.8%) and 41 (17.8%) respondents, respectively. 182 (79%) participants promoted sunlight exposure, and 171 (74.3%) did not measure serum 25-hydroxy vitamin D levels before supplementation. The survey highlights that majority of pediatricians prescribe routine vitamin D supplementation during infancy, but not beyond.