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Serum albumin, often referred to simply as albumin, is a globular protein that in humans is encoded by the ALB gene. Albumin is a multifaceted, highly soluble, stable, nontoxic, non-poisonous, biocompatible and biodegradable plasma protein. Albumin has been widely studied as a protein carrier for drug delivery. Because of its versatile nature, it can also be used for the delivery of the hormones, metals and fatty acids by binding to its specific binding sites. Various studies revealed that albumin can be used to increase the circulating half-life and bioavailability of drug molecules which are smaller than the renal filtration threshold and are rapidly lost from the circulation leading to limiting therapeutic potential. This review article presents advantages, disadvantages, functions, importance, different nanoparticles that can be crowned with an albumin and the special features of albumin as a drug carrier, and how the understanding of these features is currently being employed to optimize the circulatory half-life albumin.

Central nervous system (CNS) disorder is the world’s leading cause of disability and account of more hospitalizations. Central nervous system disorders are a group of neurological disorder that affect the structure or function of the brain or spinal cord. Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. The aim of treatment is release of neurotrophic proteins in the brain that can help to rebuild the hippocampus that has been reduced due to depression and to optimize patients’ physical, psychological and social functioning. This review presents a brief summary on psychological implications of living with depression, pathogenesis, diagnosis, causes, sign and symptoms and treatments associated with depression.

Aims and Objectives: There is lack of understanding of distinct molecular pathways and associated gene mediators of the Potentially malignant disorders of the oral cavity (OPMD), such as Leukoplakia and Oral sub mucous fibrosis. This microarray data analysis aims to highlight common and distinct gene signatures by identifying the differentially expressed genes and the pathways in which they participate to help researchers & clinicians to distinctly characterize the Oral Leukoplakia and Oral Submucous Fibrosis disease conditions for developing appropriate treatment strategies Methods: Gene Expression Omnibus datasets of Oral leukoplakia GSE85195 (OL) and Oral submucous fibrosis (OSMF) GSE64216 were analyzed using GEO2R package (using Log 2 fold change; false discovery rate < 0.05). The lists of differentially expressed genes of both datasets were analyzed for common and distinct members. These were then submitted to Database for Annotation, Visualization and Integrated Discovery (DAVID) for gene set enrichment analysis and functional annotation, to identify enriched Gene Ontology terms and KEGG pathways (Fisher's Exact Test for P-value < 0.05). Results: In total 1107 in OL, 607 in OSMF and 143 common differentially expressed genes in both OL and OSMF were identified. The gene set enrichment analysis by DAVID revealed 26% integral component of membrane, 20% extracellular region and 14% nucleus as cellular components and molecular functions. The distinct gene signatures and altered biological pathways reported here clearly distinguish molecular profiles of both OL and OSMF, which may help to identify potential drug targets for developing and designing new treatment strategies in future.

We describe a case of Linezolid-induced severe toxic optic neuropathy in a patient with drug-resistant tuberculosis. Linezolid produced severe toxic optic neuropathy in some who used it for a long time. To the best of our knowledge, the optic neuropathy was completely reversed after omitting Linezolid which is one of the effective drug regimens in his prescription, with significant improvements in eye vision.

Currently, the entire globe is under the deadliest pandemic of Covid-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). At present, no specific treatment is available to combat COVID-19 infection. Euphorbia hirta (Euphorbiaceae) have been reported for a variety of biological activities, including antiviral. The present investigation aimed to identify potential phytoconstituents of the plant E. hirta from the category flavonoids and coumarins against the SARS-CoV-2 using in silico approach. The molecular docking studies were performed using two different targets of SARS-CoV-2, namely Main protease (Mpro;PDB ID: 6M2N) and RNA-dependent RNA polymerase (RdRp;PDB ID: 7BW4). Based on the molecular docking study in comparison with standard drug, four compounds, namely Euphrobianin, Quercetin, 3-o-alpha-rhamnoside, Isoquercitrin, and rutin, were screened against the target Mpro . Three phytoconstituents, euphorbianin, myricetin, and rutin, were screened against the target RdRp. In the in silico toxicity studies of screened phytoconstituents, except myrectin all were predicted safe. Results of euphorbianin and rutin were found more interesting as both compounds had high binding affinity against both targets. Finally, we want to conclude that euphrobianin, quercetin 3-o-alpha-rhamnoside, isoquercitrin, and rutin could be further explored rapidly as they may have the potential to fight against COVID-19. © 2021 by the authors.

This study aimed to determine understanding the role of serum copper, zinc and copper/zinc ratio with tumor staging in people newly diagnosed to be affected with Head and Neck cancer and by comparing with age matched health individuals devoid of any orodental maladies. The study included patients confirmed to be affected with HN cancer with histological diagnosis of Head and Neck cancer (60) and age matched healthy volunteers (N = 23). The demographic details like age, domicile, menopausal status and pathological details (like tumor stage, number of lymph node involvement, tumor size) were collected from the patient's hospital data file. The serum levels of zinc and copper assayed as per standard procedures and the zinc/copper was calculated for the cancer patients and controls. The data were subjected to unpaired “t” test and ANOVA with Bonferroni’s multiple comparisons. The association between zinc and copper levels with pathological details between the variables was ascertained using the Pearson correlation coefficient(r). A statistical value of p

Background Respectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns. Methods At one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017–July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health – ethnicity, age, sex, mode of birth – as possible predictors for reporting poor care. Results Among 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (β = 0.23, p-value p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (β = − 0.42; p-value Conclusions Measurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women’s age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.

Acute epiglottitis is an airway emergency presenting with edema and inflammation of the epiglottis and aryepiglottic folds [1]. Infectious and other non-infectious etiologies may cause significant airway injury presenting with similar clinical symptoms and radiographic findings [1]. While many causes of thermal epiglottitis have been described in the pediatric and young adult population, we describe an unusual case of an adolescent patient with cannabis induced thermal epiglottitis. A 17-year-old previously healthy, vaccinated adolescent male presented to the pediatric emergency department with dysphagia, odynophagia, drooling, and muffled voice with fever, tachypnea, and leukocytosis. Lateral plain film imaging and computed tomography (CT) scan showed significant edema of the epiglottitis. Urinary drug screen in the emergency department was positive for benzodiazepine, opiates, and cannabinoids. Transnasal flexible laryngoscopy and direct laryngoscopy demonstrated significant erythema, edema, and copious secretions. Culture of the epiglottis culture showed normal oropharyngeal flora. The patient was diagnosed with thermal induced epiglottitis secondary to cannabinoid use based on positive substance use history, urinary drug screen, and negative bacterial cultures. Clinicians must consider thermal injury of the epiglottitis due to substance use, specifically marijuana in vaccinated adolescent patients presenting with positive substance use history, progressive dysphagia, odynophagia, and drooling with a muffled voice. It is essential to obtain a thorough history and physical examination and urinary drug screen in the pediatric emergency department since the clinical and radiographic findings are similar in epiglottitis due to infectious and non-infectious etiologies. Prompt management with intubation should occur to protect and maintain airway integrity.

Introduction: Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood. Several medicinal plants possess curative and protective effect against thrombocytopenia associated with diseases or drugs. Aim: In the present study, we have investigated the platelet augmentation activity of polyherbal formulation (VITA PLAT Capsule) in cyclophosphamide-induced thrombocytopenic rat model. Materials and methods: Twenty-four albino Wistar rats were divided into four groups. Thrombocytopenia was induced in the rats by administering cyclophosphamide (25 mg/kg, i.p.) for three days to all the groups except normal controls. The test groups were given orally a polyherbal formulation suspended in normal saline for 14 days. Blood was withdrawn from the retro-orbital plexus of the rats on days 1, 7, and 14 of study to determine platelet counts in all groups. Clotting time and bleeding time were determined on the last day of study. Data were collected and analyzed using GraphPad Prism 8. Results: The results showed that the polyherbal formulation treatment could significantly ameliorate platelet count in thrombocyto-penic rats in the initial as well as in the later phase. The total WBC count was also improved during later phase in test groups. However, there is no significant difference between clotting time and bleeding time in all groups. Conclusions: Our study suggests a potential role of this formulation in the augmentation of platelet counts in various thrombocyto-penic disorders including a role in ameliorating the haemorrhagic complications of dengue fever.

BackgroundEvery year an estimated 7.9 million babies are born with birth defect. Of these babies, more than 3 million die and 3.2 million have disability. Improving nationwide information on prevalence of birth defect, risk factor and consequence is required for better resource allocation for prevention, management and rehabilitation. In this study, we assess the prevalence of birth defect, associated risk factors and consequences in Nepal.MethodThis is a prospective cohort study conducted in 12 hospitals of Nepal for 18 months. All the women who delivered in the hospitals during the study period was enrolled. Independent researchers collected data on the social and demographic information using semi-structured questionnaire at the time of discharge and clinical events and birth outcome information from the clinical case note. Data were analyzed on the prevalence and type of birth defect. Logistic regression was done to assess the risk factor and consequences for birth defect.ResultsAmong the total 87,242 livebirths, the prevalence of birth defects was found to be 5.8 per 1000 live births. The commonly occurring birth defects were anencephaly (3.95%), cleft lip (2.77%), cleft lip and palate (6.13%), clubfeet (3.95%), eye abnormalities (3.95%) and meningomyelocele (3.36%). The odds of birth defect was higher among mothers with age ConclusionMaternal age younger than 20 years and advantaged ethnicity were risk factors of birth defects. Babies with birth defect have high risk for birth asphyxia, neonatal infection and pre-discharge mortality at birth. Further evaluation on the care provided to babies who have birth defect is warranted.FundingSwedish Research Council (VR).

Introduction The vast Indian population represents a potential case load of rotator cuff (RC) tears in the millions and repair options include both open and arthroscopic techniques. Indian shoulders are different from Western shoulders both in terms of morphology and functional demand. Despite this, the uptake of shoulder surgery in India has been extremely slow, due to various factors. Aims/objective The purpose of this review is to better understand functional outcomes of rotator cuff repair (RCR) in the Indian population. This will help Indian surgeons to discuss outcomes with their patients in an evidence based manner and provide for cross study comparisons of new data. Methods A search of online databases (Cochrane, Embase, Medline and Google Scholar) was performed for the period of January 2001–March 2020. Specific inclusion and exclusion criteria were adopted for the purposes of systematic review according to PRISMA guidelines. The primary outcome was assessment of functional outcome using validated instruments (such as UCLA score, ASES score etc.). Results A total of fourteen studies representing a pooled patient population set of 785 patients were included in this review. Of the fourteen studies included in this review, a total of three studies evaluated functional outcomes after mini-open repair whereas eleven studies evaluated outcomes after arthroscopic rotator cuff repair (ARCR). The pooled mean outcome measured showed significant improvement (pre-operative vs post-operative; average follow-up); CM 12 months), UCLA (11 (+/- 5) vs 31 (+/- 1); 26 months), ASES (25 (+/- 5) vs 84 (+/- 4); 12 months), and VAS (8 (+/- 1) vs 1.0; 22 months). Conclusion Overall the studies included in this systematic review show a significant improvement in functional outcomes. Both mini-open and arthroscopic repair offer favourable outcomes for RCR in the Indian population, and there appears to be no difference in outcome measures between single and double row repairs. Most of the studies included in this systematic review offer weak evidence and are underpowered, hence further studies with more patients and better design are needed to validate these findings. Level of Evidence Systematic review Level III.

Antimicrobial resistance (AMR) is a major public health problem in India. We surveyed medical students to assess their knowledge, attitudes, and factors associated with confidence in antibiotic prescribing intent. In this cross-sectional study, a convenience sample of 356 students were surveyed in July–August 2017 on AMR-related knowledge, attitudes, information sources and antimicrobial training. Antimicrobial resistance knowledge and attitude scores were calculated. Bivariate analysis using the chi-square test of independence and multivariate binary logistic regression analysis were used to investigate factors associated with confidence in antibiotic prescribing intent. A total of 347 students completed the survey; 64% agreed that strong knowledge of antibiotics is important in their medical careers; 61% stated that they would like more education regarding appropriate use of antibiotics. The mean total knowledge score was 11.5 out of 31 (SD = 3.4), and the mean attitude score was 6.0 out of 16 (SD = 4.2). Although 13% of students were “very familiar”/“familiar” with the term “antimicrobial stewardship,” only 35% of students felt “very confident” or “confident” in antimicrobial prescribing to patients in the future. On multivariate analysis, female gender, clinical vignette antimicrobial knowledge scores, positive attitude scores, awareness of Infection Control Policy, and > 3 years of antimicrobial prescribing clinical training were predictors of confidence in antimicrobial prescribing. A higher attitude score was independently associated with decreased confidence in antimicrobial prescribing intent. There is a need to improve education regarding AMR in the curriculum, and increase awareness of infection control policies and antimicrobial stewardship program in clinical settings.

Zika virus (ZIKV) infection is a public health problem in the Americas. We assessed ZIKV knowledge, attitudes, and future ZIKV vaccine intent among medical students. In this cross-sectional study, a convenience sample of medical students in San José, Costa Rica, were surveyed to assess knowledge, attitudes, vaccine intent, and sources of information about ZIKV. Knowledge and attitude scores were calculated. Factors associated with vaccine intent were determined by bivariate analysis using a chi-square test. Of 468 participants surveyed, majority were females (299, 63.8%) and lived in urban areas (411, 87%). The participant mean knowledge score was 12.2 (SD: 3.65) out of a possible 20. Students residing in suburban or rural areas (odds ratio [OR]: 0.432; CI: 0.24–0.78), first- or second-year students (OR: 0.423; CI: 0.27–0.67), and aged < 20 years (OR: 0.586; CI: 0.36–0.97) had significantly lower knowledge scores. The participant mean attitude score was 30.2 (SD: 4.76) on a scale of 13–65, with lower numbers indicating a concern for ZIKV severity. A majority of the participants indicated they would be likely or extremely likely to receive a ZIKV vaccine (420, 89.7%) and recommend the vaccine to their patients (439, 93.8%). Vaccine intent was not influenced by demographics, total knowledge, and attitude scores. Students (388, 83%) identified the Internet as their primary source of ZIKV information. A majority of students demonstrated a positive attitude toward ZIKV and willingness to accept and recommend a vaccine. Low knowledge scores underscore the need for ZIKV education, especially in the early years of medical school. Use of the Internet should be considered in dissemination of ZIKV education.

Background There were 142,101 new cases of non-melanomatous skin cancers reported by the UK National Cancer Statistics in 2015. The UK statistics published that the incidence is highest in the 90+ population and that this represented an overall 61% increase in skin cancer incidence in the UK in the last decade. This article aims to first provide an understanding of the change in service requirement over the last 25 years for skin cancer management in nonagenarians, and second, understand the subtypes of skin cancer and possible differences in the management for this cohort. Methods All skin cancer biopsies received by a UK university teaching hospital dermato-histopathology department were analysed over a five-year period spanning 2013–2017. This was compared with snap shot data at five-year intervals dating back to 1993. The patient demographics including age, sex and anatomical region were seen along with the types of skin cancers and histological subtypes. Results A total of 1050 skin cancers were managed with surgical input between January 2013 and December 2017 in 733 patients. The number of biopsies/year has increased 7-fold from 1993 (33) to 2017 (231). The annual cost of the surgical element to this service has dramatically increased, and in 2017, it was £220k compared to £33k in 1993. Conclusion Partly because of the ageing UK population, there has been a dramatic increase in the demand on the surgical service regarding managing skin cancers in those over the age of 90. There is a higher rate of incomplete excision in this population than that reported in the national British Association of Dermatologists (BAD) guidelines. Despite higher incomplete excision rates, there is a low re-operation rate in this population probably due to patient comorbidities affecting reconstructive options, patient preference and clinical decisions on surgical morbidity versus benefit.

Chronic hepatitis B virus (HBV) infection is a major public health problem in China. We evaluated the impact of psychosocial factors (stigma, disclosure, depression, and anxiety) on health-related quality of life (HRQoL) among people living with chronic HBV infection (CHB) in the city of Dalian, Liaoning Province, China. In this hospital-based cross-sectional study, 401 patients living with chronic HBV infection were enrolled as study participants. Study measures included the Beck depression and anxiety inventory, the WHO Quality of Life (WHOQOL-BREF) assessment, the Toronto Chinese HBV Stigma Scale, and disclosure of HBV status to sexual partners. The primary outcome was HRQoL score as measured by the WHOQOL-BREF. A linear regression model was used to examine the association between HRQoL and the potential risk factors including stigma, disclosure, depression, anxiety, and sociodemographic variables. Stigma, disclosure, depression, and anxiety were the covariates of interest. A majority of the participants were females (n = 251, 65.6%), married (81.6%), and had a college or higher degree (32.4%). Depression, anxiety, stigma, and disclosure of HBV infection were associated with low HRQoL in all four domains of the WHOQOL-BREF (physical, psychological, social, and environmental domains) (P < 0.05), when all psychological factors were included in the model separately. Depression was found to be independently associated with low HRQoL in people living with HBV, when all psychological factors were included in the model simultaneously (P < 0.0001). Our data indicate the urgent need for healthcare providers (HCPs) and policy-makers to implement psychological interventions to improve HRQoL among people living with CHB.

Renal tubular epithelial cells (RTECs) perform the essential function of maintaining the constancy of body fluid composition and volume. Toxic, inflammatory, or hypoxic-insults to RTECs can cause systemic fluid imbalance, electrolyte abnormalities and metabolic waste accumulation- manifesting as acute kidney injury (AKI), a common disorder associated with adverse long-term sequelae and high mortality. Here we report the results of a kinome-wide RNAi screen for cellular pathways involved in AKI-associated RTEC-dysfunction and cell death. Our screen and validation studies reveal an essential role of Cdkl5-kinase in RTEC cell death. In mouse models, genetic or pharmacological Cdkl5 inhibition mitigates nephrotoxic and ischemia-associated AKI. We propose that Cdkl5 is a stress-responsive kinase that promotes renal injury in part through phosphorylation-dependent suppression of pro-survival transcription regulator Sox9. These findings reveal a surprising non-neuronal function of Cdkl5, identify a pathogenic Cdkl5-Sox9 axis in epithelial cell-death, and support CDKL5 antagonism as a therapeutic approach for AKI.

New Delhi metallo-β-lactamase-1 (NDM-1) is a novel type of metallo-β-lactamase (MBL) associated with Enterobacteriaceae constitutes an important growing public health threat. The present study aims to characterize the NDM-1 producing Gram-negative bacteria (GNB) from the effluents of two tertiary care hospitals in Mangalore, South India and to profile their antibiotic resistance pattern. A total of 134 GNB were isolated from 30 hospital wastewater samples (treated and untreated) and analyzed. High-level resistance among untreated effluent sample was found toward nalidixic acid (74.52%), followed by cefotaxime (72.64%) and ampicillin (66.03%). Among the treated effluent isolates, the high resistance was found toward ampicillin (85.71%) followed by cefotaxime (85.71%) and piperacillin-tazobactam (53.57%). From untreated effluent isolates, 9 were NDM-1 positive by PCR; no isolates from treated effluent samples harbored blaNDM-1 . Untreated hospital wastewater is found to be important reservoirs of antibiotic-resistant bacteria carrying blaNDM-1 , and the presence of such bacteria in the effluents is a matter of great concern because they can contribute the antibiotic resistance to the natural environment. However, the absence of NDM in treated effluents emphasizes the importance of effluent treatment in reducing the dissemination of antibiotic-resistant bacteria. PRACTITIONER POINTS: Hospital wastewater is the important reservoir of antibiotic-resistant bacteria especially metallo-β-lactamase producers (NDM-1). Wastewater treatment procedures in hospitals reduce the NDM isolates in the treated effluent. Thereby reduces the risk of resistance spread in the environment.

Background Almost all preventable neonatal deaths take place in low- and middle-income countries and affect the poorest who have the least access to high quality health services. Cost of health care is one of the factors preventing access to quality health services and universal health coverage. In Nepal, the majority of expenses related to newborn care are borne by the caregiver, regardless of socioeconomic status. We conducted a study to assess the out of pocket expenditure (OOPE) for sick newborn care in hospitals in Nepal. Methods This cross-sectional study of hospital care for newborns was conducted in 11 hospitals in Nepal and explored OOPE incurred by caregivers for sick newborn care. Data were collected from the caregivers of the sick newborn on the topics of cost of travel, accommodation, treatment (drugs, diagnosis) and documented on a sick newborn case record form. Results Data were collected from 814 caregivers. Cost of caregivers’ stay accounted for more than 40% of the OOPE for sick newborn care, followed by cost of travel, and the baby’s stay and treatment. The overall OOPE ranged from 13.6 to 226.1 US dollars (USD). The median OOPE was highest for preterm complications ($33.2 USD; CI 14.0–226.1), followed by hyperbilirubinemia ($31.9 USD; CI 14.0–60.7), respiratory distress syndrome ($26.9 USD; 15.3–121.5), neonatal sepsis ($ 25.8 USD; CI 13.6–139.8) and hypoxic ischemic encephalopathy ($23.4 USD; CI 13.6–97.7). Discussion for practice In Nepal, OOPE for sick newborn care in hospitals varied by neonatal morbidity and duration of stay. The largest proportion of OOPE were for accommodation and travel. Affordable and accessible health care will substantially reduce the OOPE for sick newborn care in hospitals.

Aim The aim of this study was to identify the incidence, risk factors and outcome associated with meconium aspiration syndrome (MAS). Methods An observational study was conducted in 12 public hospitals in Nepal from 1 July 2017 to 29 August 2018. All babies born within the study period were included in the study. Babies who were diagnosed as MAS were designated as outcome. Data were analysed with bivariate analysis followed by multiple regression analysis. Results The overall incidence of MAS was 2.0 per 1000 livebirths. Babies born at post-term gestation (adjusted odds ratio (AOR) = 2.41; 95% confidence interval (CI): 1.05-5.55), nulliparity (AOR = 2.26; 95% CI: 1.20-4.28), instrumental delivery (AOR = 4.79; 95% CI: 2.52-9.10) and caesarean delivery (AOR = 3.67; 95% CI: 2.29-5.89) were significantly associated with MAS. Babies with MAS had a 10-fold risk for pre-discharge mortality (odds ratio = 9.87; 95% CI: 5.81-16.76). Conclusions The findings in this study are consistent with that reported in other studies. MAS has a high risk of neonatal mortality. Thus, monitoring during pregnancy and labour is necessary for early identification of high-risk conditions associated with MAS. Strengthening of newborn care services is essential to curtail mortality.

Goal: COSMIC Medical, a Vancouver-based open-source volunteer initiative, has designed an accessible, affordable, and aerosol-confining non-invasive positive-pressure ventilator (NIPPV) device, known as the COSMIC Bubble Helmet (CBH). This device is intended for COVID-19 patients with mild-to-moderate acute respiratory distress syndrome. System Design : CBH is composed of thermoplastic polyurethane, which creates a flexible neck seal and transparent hood. This device can be connected to wall oxygen, NIPPVs including Continuous Positive Airway Pressure and Bi-level Positive Airway Pressure, and mechanical ventilators. Discussion : Justification of CBH design components relied on several factors, predominantly the safety and comfort of patients and healthcare providers. Conclusion: CBH has implications within and outside of the pandemic, as an alternative to invasive mechanical ventilation methods. We have experimentally verified that CBH is effective in minimizing aerosolization risks and performs at specified clinical requirements.

Background: Aspartic protease found in plasmodium parasites such as plasmepsin I, II and IV plays an important role in the degradation of hemoglobin. The studies have shown that effective drug must be able to inhibit more than one type of plasmepsin to avoid further growth of parasites and to prevent resistance of drug. Therefore, plasmepsins are believed to be excellent drug target for malarial disease. Extract of the plant Euphorbia hirta has been proved to exert antimalarial activity. However, molecular mechanism of this activity was not described. Aim: The aim of present investigation is to identify antimalarial phytochemicals of Euphorbia hirta as plasmepsin protease inhibitors using an in silico approach. Materials and methods: Docking studies were performed on three different protein targets plasmepsin I, II, and IV using iGEMDOCK. ADME and bioactivity predictions were done using molinspiration online tool. Toxicity studies were performed using ProTox-II online tool. Results: In the docking studies seven compounds showed significant inhibitory activity with low docking score as compared to standard drug artemisinin. Six compounds showed no violations as per Lipinski rule. Bioactivity prediction states that all the compounds may act through enzyme inhibition. The results of in silico studies suggest that out of the eleven selected phytochemicals isorhamnetin and pinocembrin have more drug likeliness properties and lesser in silico toxicity with more binding affinity than artemisinin on all receptors. Conclusion: These findings indicate that isorhamnetin and pinocembrin have promising potential for development of antimalarial drug as plasmepsin inhibitors.

Chemobrain or chemofog is one of the important but less investigated side effects, where the cancer survivors treated with chemotherapy develop long-term cognitive impairments, affecting their quality of life. The biological mechanisms triggering the development of chemobrain are largely unknown. However, a literature study suggests the generation of free radicals, oxidative stress, inflammatory cytokines, epigenetic chromatin remodeling, decreased neurogenesis, secretion of brain-derived neurotropic factor (BDNF), dendritic branching, and neurotransmitter release to be the cumulative contributions to the ailment. Unfortunately, there is no means to prevent/mitigate the development and intensity of chemobrain. Given the lack of effective prevention strategies or treatments, preclinical studies have been underway to ascertain the usefulness of natural products in mitigating chemobrain in the recent past. Natural products used in diets have been shown to provide beneficial effects by inhibition of free radicals, oxidative stress, inflammatory processes, and/or concomitant upregulation of various cell survival proteins. For the first time, this review focuses on the published effects of astaxanthin, omega-3 fatty acids, ginsenoside, cotinine, resveratrol, polydatin, catechin, rutin, naringin, curcumin, dehydrozingerone, berberine, C-phycocyanin, the higher fungi Cordyceps militaris, thyme (Thymus vulgaris) and polyherbal formulation Mulmina™ in mitigating cognitive impairments in preclinical models of study, and also addresses their potential neuro-therapeutic mechanisms and applications in preventing/ameliorating chemobrain.

Human Papillomavirus (HPV) has been identified as an important risk factor that predisposes to cervical cancer. Traditionally the Papanicolaou (Pap) smear test has been routinely used for the detection of premalignant lesions in the uterine cervix. However, due to the rise in false positive and negative results, advanced molecular techniques like PCR are more sensitive and reliable. This study aimed to assess the burden of HPV infection in women with normal and abnormal Pap testing attending a tertiary care hospital. Methods A total of 126 sexually active women were recruited for cervical examination in this cross sectional study. Cervical exfoliated cells were collected for cytology and HPV analysis. DNA was extracted and HPV detection was performed using nested PCR technique. Results HPV prevalence was higher in women with abnormal cytology infection (12.5%) compared with those who had normal Pap smear(3.8%); HPV 16 was found to be the most common subtype. Younger age at marriage, multiple sexual partners, and multiparity were found to be the most important confounding factors in the acquisition of HPV. Conclusion The current study demonstrated the presence of high-risk HPV in cervical smear specimens irrespective of normal and abnormal cytology, and hence emphasizes the need for implementation of effective national cervical cancer screening programs that could decrease the burden of cervical cancer in India.

Objective: Safe and effective human papillomavirus vaccines are available against cervical cancer and other human papillomavirus–associated diseases. Vaccine uptake is low in India given lack of universal vaccination programme. This exploratory study describes the medical, dental and nursing undergraduate student perspectives about human papillomavirus and intentions to receive the vaccine. Methods: Using a cross-sectional, explorative study design, we conducted two focus group discussions among a convenience sample of male (n = 11) and female (n = 9) student group aged ⩾18 years, respectively, at a medical college in South India. The focus group discussion sessions were recorded, transcribed and analysed using thematic content analysis. Results: Over half of the students showed adequate knowledge of cervical cancer and human papillomavirus. Medical students had much in-depth knowledge of cervical cancer, vaccine cost and its side effects compared to dental and nursing students. Human papillomavirus vaccine knowledge was relatively less among males compared to females; most male participants were unaware of the availability of the human papillomavirus vaccine. Intention to receive the vaccine was higher among females than males. All the participants had positive attitude in creating awareness in the community and making the vaccine cost-effective. Cultural concerns and high vaccine cost were cited major barriers for vaccine uptake. Suggestion of physician recommendation in promotion of human papillomavirus vaccine uptake was an emerging theme. Conclusion: Educating male students and those enrolled in dental and nursing courses about human papillomavirus vaccine, addressing cultural concerns and advocating provider recommendation for promoting vaccine uptake are potential strategies to improve future human papillomavirus vaccine intent among students and recommendations to patients in their role as future healthcare provider.

The study aimed to screen for the presence of multidrug-resistant Klebsiella pneumoniae from diarrheal stool and environmental water samples and to check the epidemiological link between the two categories. Isolates obtained after culturing on different media were tested for antibiotic resistance and extended-spectrum beta-lactamase (ESBL) production. Polymerase chain reaction (PCR) analysis was done for important β-lactamase encoding genes. Random amplified polymorphic DNA (RAPD) typing was done using two primers. Results showed a high prevalence of K. pneumoniae from fish market effluents compared with stool and well water. Stool isolates showed high resistance to ceftazidime (80.0%) and cefepime (80.0%), fish market effluent isolates to cefoperazone-sulbactam (92.1%), and erythromycin (78.9%), while well water isolates to erythromycin (72.7%) and cefuroxime (54.4%). The ESBL genes blaCTX , blaSHV , and blaTEM were detected in 22.85%, 14.28%, and 42.85% of K. pneumoniae isolates, respectively. The results of RAPD-PCR showed high genetic similarities between the isolates from different sources. PRACTITIONER POINTS: Detection of multi-drug resistant Klebsiella strains in hospital wastewater and drinking water sources has progressively increased since its emerging resistance to third-generation cephalosporins and carbapenems. Detection of beta-lactamase encoding genes by molecular techniques and typing by random amplified polymorphic DNA (RAPD) can be useful in identifying the genetic fingerprints for epidemiological study. Implementation of effective antimicrobial stewardship program and infection control policy thereby helps assess the risk factors associated with infections.

Although the evidence is inconclusive, epidemiological studies strongly suggest that increased exposure to electromagnetic radiation (EMR) increases the risk of brain tumors, parotid gland tumors, and seminoma. The International Agency for Research on Cancer (IARC) has classified mobile phone radiofrequency radiation as possibly carcinogenic to humans (Group 2B). Humans being are inadvertently being exposed to EMR as its prevalence increases, mainly through mobile phones. Radiation exposure is unavoidable in the current context, with mobile phones being an inevitable necessity. Prudent usage of medicinal plants with a long history of mention in traditional and folklore medicine and, more importantly, are safe, inexpensive, and easily acceptable for long-term human use would be an appealing and viable option for mitigating the deleterious effects of EMR. Plants with free radical scavenging, anti-oxidant and immunomodulatory properties are beneficial in maintaining salubrious health. Green tea polyphenols, Ginkgo biloba, lotus seedpod procyanidins, garlic extract, Loranthus longiflorus, Curcuma amada, and Rosmarinus officinalis have all been shown to confer neuroprotective effects in validated experimental models of study. The purpose of this review is to compile for the first time the protective effects of these plants against mobile phone-induced neuronal damage, as well as to highlight the various mechanisms of action that are elicited to invoke the beneficial effects.