Search

Introduction: Diabetes is a chronic metabolic disorder marked by elevated blood glucose levels, with type 2 diabetes being the most prevalent form. As a non-communicable disease, diabetes poses a major public health challenge, and its prevalence is rising worldwide, reaching epidemic levels that may soon surpass those of communicable diseases in both developing and developed countries. Objective: To evaluate the risk of diabetes among doctors and nurses at a tertiary care hospital. Methodology: A hospital-based cross-sectional study was carried out among doctors and nurses at a tertiary care hospital in Puducherry from February to April 2022. Participants for the survey were selected using a simple random sampling method. Results: Most participants in the study were aged between 36 and 49 years, comprising 60.5% of the sample. Among them, 63.0% were male, and 65.5% resided in urban areas. The largest proportion had a normal BMI (51.5%), followed by overweight individuals (36.5%) and those classified as obese (7.5%). Additionally, 59.5% of participants exhibited abdominal obesity, 63.5% reported no physical activity, and 77.5% did not have a family history of diabetes. Conclusion: This study evaluates the effectiveness of a simplified Indian Diabetes Risk Score (IDRS) in identifying high-risk individuals within the working population. There is an immediate need to encourage for healthy lifestyle practices among doctors and nurses. Physicians should actively strive to implement the knowledge they possess daily.

Introduction: Skin is the largest organ in the body consists of three layers, epidermis, dermis and hypodermis. Skin along with its accessories like nails, hair follicles, sweat glands and sebaceous glands forms the integumentary system. Skin acts as a barrier between the external factors and internal environment and gives protection to deeper tissues in the body. Skin cancer is the fifth most common type of cancer. Materials and Methods: Samples for this study were taken from human cadavers. Histochemical study was done with Van Gieson’s method for collagen fibers, Weigert’s resorcin fuchsin for elastic fibers and Mallory’s trichrome stain for connective tissue were used to study the connective tissue. Collagen, elastic fibers and cells in the interstitium of skin were analyzed. Results: Thick and thin collagen fibers were found to be arranged in vertical and horizontal direction in the dermis. Mast cells and macrophages were more in number in the interstitium near the vessels. Fibers surrounding the vessels transfer the mechanical pressure to the lymphatic vessels. Initial and collecting lymphatic vessels were identified. Conclusion: The arrangement of fibers and distribution of cells in the skin helps in understanding fields like regenerative medicine and tissue engineering.

Context: Smartphones have revolutionized, and become an integral part of a child’s life. The child’s interaction with these modern devices needs to be assessed because it could have an enormous effect on their behavior, sleep habits, and psychological addiction. Aims: The aim of this study is to determine the pattern of exposure to smartphone, and the association between the exposure and behavioral, functional changes among under-five children in rural Puducherry. Settings and Design: This community-based cross-sectional study was done in the field practice area of a private medical college in Puducherry. A multistage sampling technique was used to select 340 eligible participants. Subjects and Methods: A semi-structured questionnaire was used to assess the pattern of exposure and physical, social, and behavioral changes among study participants. Statistical Analysis Used: The data were analyzed using SPSS software, and P < 0.05 was considered statistically significant. Results: Among 340 children, more than half of participants 180 (52.9%) were female. Interestingly, around half of the study participants’ parents 181 (53.2%) accepted that their children were exposed to smartphone for entertainment purposes, and around one-tenth 35 (10.3%) of the participants viewed screen for more than the recommended screen time for age. Increased smartphone exposure was statistically associated with behavioral and functional changes. Conclusions: Measures must be undertaken to prevent deleterious behavioral and functional changes in under-five children due to excessive smartphone usage. Health education sessions and social behavioral change communication should be planned for the parents to protect the budding generation from the negative effects of smartphone usage.

Introduction: Rabies, a deadly viral disease transmitted through animal bites, poses a significant public health challenge in many regions, including Puducherry. Effective prevention and control rely heavily on community awareness and perception. Understanding how the general population perceives rabies risk and prevention strategies is crucial for developing targeted public health interventions. Objectives: To describe the sociodemographic profile and to assess community perceptions of rabies prevention and control among the general population in Puducherry. Methods: A community-based cross-sectional study, conducted in the rural and urban Puducherry region from October 2023 to December 2023. A total of 200 individuals were chosen from rural and urban Puducherry regions using a systematic random sampling technique. Individuals over 18 years of age residing in both rural and urban areas of Puducherry were included in the study. Semi-structured questionnaire was used to collect the data and entered in MS Excel 2019. Chi-square test was applied to test the difference in knowledge between urban and rural. Results: The majority of the study participants belonged to the age group of 18-29 years (55%), 152 were males and 48 were females. Most of the participants (99%) heard about Rabies and their source of knowledge about Rabies was from Doctors (40.5%), Newspapers & Media (39.5%), and Friends (19.0%). Approximately 82.5% of participants were aware of how rabies is transmitted, while 78.5% understood the signs of the disease. Conclusion: Education plays a significant role in the awareness of rabies as most participants were educated at least up to the primary level in the current study. According to our findings, clear gaps exist in rural people's understanding and attitudes toward rabies prevention and control.

Abstract A core component of every blood program is the supply of safe blood and blood products. The elevated risk of transmission through these products is due to parvovirus B19 (B19V) resistance to the virus inactivation procedures. Our study aimed to screen asymptomatic blood donors for B19V at a tertiary care hospital in Chennai, Tamil Nadu, between September 2020 and June 2021. Sera from 106 healthy blood donors who tested negative for Human immunodeficiency virus (HIV), Hepatitis B surface antigen (HBsAg), Hepatitis C virus (HCV), syphilis, and malaria were tested for anti-B19V IgM and IgG using a qualitative indirect enzyme-linked immunosorbent assay (ELISA). In the study population, 23.5% (n = 25) of donors tested IgM positive, 38.6% (n = 41) tested IgG positive, and 7.5% (n = 8) tested positive for both IgM and IgG. A proportion of 61.3% (n = 65) of the blood donors tested IgG negative, suggesting they had no past B19V infection. B19V DNA was not detected in any of the subjects. The high seroprevalence of IgM indicates that blood donors may have been recently exposed to B19V, potentially posing a risk to immunocompromised individuals and those with hematological stress. Further longitudinal studies with a larger sample size are recommended to better understand the risk of B19V transfusion transmission.

ABSTRACT A severe case of bilateral superior semicircular dehiscence was presented in Instituto de Neurorrehabilitación y Balance, Chile. The patient reports hearing and vestibular problems in certain situations; a complete analysis is carried out from the clinical history to neurological laboratory studies and imaging to diagnose bilateral semicircular canal dehiscence finally. Health condition management is under the ICF model, which will allow for determining and classifying the problems and possible interventions for this interesting clinical case.

A 10-year-old girl underwent successful device closure of a 15-mm atrial septal defect with a short and thick retroaortic rim using a 16-mm atrial septal occluder from the conventional approach under transesophageal echocardiographic guidance. There were no periprocedural complications. The aortic valve was noted to be trileaflet and competent. Transthoracic echocardiography at a routine 2-year follow-up visit demonstrated new-onset moderate aortic regurgitation. There was no pericardial effusion.

Abstract Historically, the analysis of stimulus-dependent time–frequency patterns has been the cornerstone of most electroencephalography (EEG) studies. The abnormal oscillations in high-frequency waves associated with psychotic disorders during sensory and cognitive tasks have been studied many times. However, any significant dissimilarity in the resting-state low-frequency bands is yet to be established. Spectral analysis of the alpha and delta band waves shows the effectiveness of stimulus-independent EEG in identifying the abnormal activity patterns of pathological brains. A generalized model incorporating multiple frequency bands should be more efficient in associating potential EEG biomarkers with first-episode psychosis (FEP), leading to an accurate diagnosis. We explore multiple machine-learning methods, including random-forest, support vector machine, and Gaussian process classifier (GPC), to demonstrate the practicality of resting-state power spectral density (PSD) to distinguish patients of FEP from healthy controls. A comprehensive discussion of our preprocessing methods for PSD analysis and a detailed comparison of different models are included in this paper. The GPC model outperforms the other models with a specificity of 95.78% to show that PSD can be used as an effective feature extraction technique for analyzing and classifying resting-state EEG signals of psychiatric disorders.

Abstract Lymphatic filariasis (LF) is a crippling and disfiguring parasitic condition. India accounts for 55% of the world’s LF burden. The filarial parasite Wuchereria bancrofti is known to cause 99.4% of the cases while, Brugia malayi accounts for 0.6% of the issue occurring mainly in some pockets of Odisha and Kerala states. The Balasore (Baleswar) district of Odisha has been a known focus of B. malayi transmission. We employed molecular xenomonitoring to detect filarial parasite DNA in vectors. In six selected villages, Gravid traps were used to collect Culex mosquitoes and hand catch method using aspirators was followed for collection of mansonioides. A total of 2903 mosquitoes comprising of Cx. quinquefasciatus (n = 2611; 89.94%), Cx. tritaeniorhynchus (n = 100; 3.44%), Mansonia annuliferea (n = 139; 4.78%) and Mansonia uniformis (n = 53; 1.82%) were collected from six endemic villages. The species wise mosquitoes were made into 118 pools, each with a maximum of 25 mosquitoes, dried and transported to the laboratory at VCRC, Puducherry. The mosquito pools were subjected to parasite DNA extraction, followed by Real-time PCR using LDR and HhaI probes to detect W. bancrofti and B. malayi infections, respectively. Seven pools (6.66%) of Cx. quinquefasciatus, showed infection with only W. bancrofti while none of the pools of other mosquito species showed infection with either W. bancrofti or B. malayi. Although the study area is endemic to B. malayi, none of the vectors of B. malayi was found with parasite infection. This study highlights the ongoing transmission of bancroftian filariasis in the study villages of Balasore district of Odisha and its implications for evaluating LF elimination programme.

Introduction: Permanent pacemaker implantation (PPI) in neonates is challenging with respect to indications, device selection, implantation technique, and long-term outcomes. Complex anatomy, the need for long-term pacing with high rates, and a problematic postoperative period are the major problems. Methods: We prospectively followed up 22 newborns who underwent PPI below 28 days of life at our institute. Results: The median age at implantation was 2 days (interquartile range 1–9 days), and 9% were born preterm. The average heart rate before implantation was 46.4 ± 7.2 bpm. Maternal lupus antibodies were positive in 8 (36.4%) neonates, whereas 11 (50.0%) had associated congenital heart disease. Nineteen neonates underwent single chamber (VVI) and three underwent dual chamber (DDD) pacemaker implantation. Over a median follow-up of 46 months (range 2–123 months), the average ventricular pacing percentage was 87.5 ± 24.9%, with a stable pacing threshold. Seven children underwent pulse generator replacement due to battery depletion at a median age of 47 months. Pacing-induced ventricular dysfunction was seen in five children at a median age of 23.6 months, and two underwent upgradation to cardiac resynchronization therapy. Overall mortality was 13.6%, all due to tissue hypoperfusion and lactic acidosis in the postimplantation period. Conclusions: PPI in neonates has a favorable outcome with excellent lead survival. Overall mortality is 13.6%, which is predominantly in the postimplantation period and related to myocardial dysfunction.

Context: Dengue is one of the most dreadful viral diseases of humans, with over half of the world’s population living in the areas of risk. Aims: The aim of this study was to determine the level of knowledge, awareness, and practice of preventive measures regarding dengue fever among people living in Puducherry. Settings and Design: A community-based cross-sectional study was carried out among the individuals residing in Puducherry in the field practice areas of our tertiary care hospital. Subjects and Methods: The study was conducted for a period of 3 months from August to October 2023. The study population included residents of Puducherry in the field practice area of our tertiary care hospital based on the inclusion and exclusion criteria. A simple random sampling method was used with an estimated sample size of 285. Statistical Analysis Used: Continuous variables were presented in the form of frequency and proportion. Chi-square test was used for determining the association. Results: Out of 285 participants, 252 had good knowledge, and 33 had poor knowledge. 94.4% had good attitude and 5.6% had poor attitude. 62.1% (177) had good perception and 108 (37.9) had poor perception. The study showed a significant association between age and knowledge (P = 0.003) regarding dengue awareness. Socioeconomic status of the participants had a significant association with the attitude (P < 0.001). Conclusions: Appropriate use of information education and communication by involving mass media and social network and inclusion of environmental sanitation to the primary school curriculum can go a long way in creating awareness and decreasing the dengue burden in the community.

In 2022, concurrent outbreaks of hepatitis A, invasive meningococcal disease (IMD), and mpox were identified in Florida, USA, primarily among men who have sex with men. The hepatitis A outbreak (153 cases) was associated with hepatitis A virus genotype IA. The IMD outbreak (44 cases) was associated with Neisseria meningitidis serogroup C, sequence type 11, clonal complex 11. The mpox outbreak in Florida (2,845 cases) was part of a global epidemic. The hepatitis A and IMD outbreaks were concentrated in Central Florida and peaked during March–­June, whereas mpox cases were more heavily concentrated in South Florida and had peak incidence in August. HIV infection was more common (52%) among mpox cases than among hepatitis A (21%) or IMD (34%) cases. Where feasible, vaccination against hepatitis A, meningococcal disease, and mpox should be encouraged among at-risk groups and offered along with program services that target those groups.

Abstract Background Genome sequencing of large biobanks from under-represented ancestries provides a valuable resource for the interrogation of Mendelian disease burden at world population level, complementing small-scale familial studies. Methods Here, we interrogate 6045 whole genomes from Qatar—a Middle Eastern population with high consanguinity and understudied mutational burden—enrolled at the national Biobank and phenotyped for 58 clinically-relevant quantitative traits. We examine a curated set of 2648 Mendelian genes from 20 panels, annotating known and novel pathogenic variants and assessing their penetrance and impact on the measured traits. Results We find that 62.5% of participants are carriers of at least 1 known pathogenic variant relating to recessive conditions, with homozygosity observed in 1 in 150 subjects (0.6%) for which Peninsular Arabs are particularly enriched versus other ancestries (5.8-fold). On average, 52.3 loss-of-function variants were found per genome, 6.5 of which affect a known Mendelian gene. Several variants annotated in ClinVar/HGMD as pathogenic appeared at intermediate frequencies in this cohort (1–3%), highlighting Arab founder effect, while others have exceedingly high frequencies (> 5%) prompting reconsideration as benign. Furthermore, cumulative gene burden analysis revealed 56 genes having gene carrier frequency > 1/50, including 5 ACMG Tier 3 panel genes which would be candidates for adding to newborn screening in the country. Additionally, leveraging 58 biobank traits, we systematically assess the impact of novel/rare variants on phenotypes and discover 39 candidate large-effect variants associating with extreme quantitative traits. Furthermore, through rare variant burden testing, we discover 13 genes with high mutational load, including 5 with impact on traits relevant to disease conditions, including metabolic disorder and type 2 diabetes, consistent with the high prevalence of these conditions in the region. Conclusions This study on the first phase of the growing Qatar Genome Program cohort provides a comprehensive resource from a Middle Eastern population to understand the global mutational burden in Mendelian genes and their impact on traits in seemingly healthy individuals in high consanguinity settings.

Abstract Regular monitoring of blood glucose levels is essential for the management of diabetes and the development of appropriate treatment protocols. The conventional blood glucose (BG) testing have an intrusive technique to prick the finger and it can be uncomfortable when it is a regular practice. Intrusive procedures, such as fingerstick testing has negatively influencing patient adherence. Diabetic patients now have an exceptional improvement in their quality of life with the development of cutting-edge sensors and healthcare technologies. intensive care unit (ICU) and pregnant women also have facing challenges including hyperglycemia and hypoglycemia. The worldwide diabetic rate has incited to develop a wearable and accurate non-invasive blood glucose monitoring system. This research developed an Internet of Things (IoT) - enabled wearable blood glucose monitoring (iGM) system to transform diabetes care and enhance the quality of life. The TTGOT-ESP32 IoT platform with a red and near-infrared (R-NIR) spectral range for blood glucose measurement has integrated into this wearable device. The primary objective of this gadget is to provide optimal comfort for the patients while delivering a smooth monitoring experience. The iGM gadget is 98.82 % accuracy when used after 10 hours of fasting and 98.04 % accuracy after 2 hours of breakfast. The primary objective points of the research were continuous monitoring, decreased risk of infection, and improved quality of life. This research contributes to the evolving field of IoT-based healthcare solutions by streaming real-time glucose values on AWS IoT Core to empower individuals with diabetes to manage their conditions effectively. The iGM Framework has a promising future with the potential to transform diabetes management and healthcare delivery.

Introduction Brace treatment is common to address radiological dysplasia in infants with developmental dysplasia of the hip (DDH); however, it is unclear whether bracing provides significant benefit above careful observation by ultrasound. If observation alone is non-inferior to bracing for radiological dysplasia, unnecessary treatment may be avoided. Therefore, the purpose of this study is to determine whether observation is non-inferior to bracing for infants with radiological dysplasia.Methods and analysis This will be a multicentre, global, randomised, non-inferiority trial performed under the auspices of a global prospective registry for infants and children diagnosed with DDH. Patients will be included if they present with radiological dysplasia (centred hip, alpha angle 43–60°, percent femoral head coverage greater than 35% measured on ultrasound) of a clinically stable hip under 3 months old. Patients will be excluded if they present with clinical hip instability, have received prior treatment or have known/suspected neuromuscular, collagen, chromosomal or lower-extremity congenital abnormalities or syndromic-associated hip abnormalities. Patients will be enrolled and randomised to undergo observation alone or brace treatment with a Pavlik harness for a minimum of 6 weeks. Follow-up visits will occur at 6 weeks, 1 year and 2 years post-enrolment. The primary outcome will be the norm-referenced acetabular index measured on the 2-year radiograph with a 3° non-inferiority margin. A total of 514 patients will be included.The study is anticipated to start in April 2024 and end in September 2028.The primary outcome will be compared between arms with a mixed-effects model with a random intercept for study centre, and a single covariate for the treatment group. If the lower bound of the 95% CI lies within 3° of the mean, we will treat this as evidence for non-inferiority.Ethics and dissemination Ethics approval has been obtained from the lead site’s ethics board (University of British Columbia, Children’s and Women’s Research Ethics Board). Ethics approval will be obtained from the local ethics committees or institutional review boards at each institution prior to patient enrolment. It is intended that the results of this study shall be published in peer-reviewed journals and presented at suitable conferences.Trial registration number NCT05869851.

Abstract We report a continuous-wave, O-band quantum-dot semiconductor comb laser for WDM optical interconnects exhibiting a 2.2 THz optical bandwidth with up to 89 comb wavelengths spaced at 25 GHz, over 30% peak ex-facet electrical-to-optical power conversion efficiency, up to 270 mW of usable laser power, relative intensity noise below − 135 dB/Hz per individual mode, individual laser mode linewidth of 140 kHz, mode beating linewidths of 50 kHz across all modes, and stable far-field output with 75% coupling efficiency to PM fiber in a butterfly package.

Background/Aim: Strict glycaemic control delays the onset as well the progression of diabetes related microvascular complications. The major roadblock in achieving the target glycated haemoglobin (HbA 1 c) and blood glucose levels is hypoglycaemia. The aim of this study was to assess the clinical characteristics and outcomes of hypoglycaemia in the type 2 diabetes mellitus (T2DM) hospitalised patients. Methods: This was an observational study done for nine months in T2DM patients who had documented hypoglycaemia (blood glucose < 70 mg/ dL) during the hospital stay. T2DM patients with hypoglycaemia on admission , hypoglycaemia due to anti-diabetic drug overdose, intensive care unit (ICU) patients with hypoglycaemia were excluded from the study. Eligible patients were categorised into two groups as symptomatic and as-ymptomatic hypoglycaemia. Clinical features, risk factors, hospitalisation outcome were compared between the symptomatic and asymptomatic hypoglycaemia group. Results: Two hundred patients were enrolled in this study (n = 89, symptomatic group and n = 111, asymptomatic hypoglycaemia). Hypoglycaemic episode in past was significantly associated with symptomatic hypoglycaemic events during hospitalisation [34 (38.2 %) vs 27 (24.3 %)], p = 0.01. Admission blood glucose levels (mg/dL), HbA 1 c (%) were significantly higher in symptomatic hypoglycaemia group [(225.93 vs 178.72, p = 0.008), (8.55 ± 2.49 vs 7.72 ± 1.82, p = 0.007)], respectively. The blood glucose level during the hypoglycaemia episode was significantly higher in patients with asymptomatic hypoglycaemia group (56.38 ± 9.51 vs 44.22 ± 11.21 mg/dL, p < 0.001). Patients with HbA 1 c ≤ 6 % were significantly higher in asymptomatic hypoglycaemia (n = 12, 10.8 % vs n = 2, 2.24 %, p = 0.02). Majority recovered fully without complications and got discharged (n = 155, 77.5 %). Conclusion: In presented study, symptomatic hypoglycaemic patients had significantly higher admission blood glucose levels and HbA 1 c %. Patients with HbA 1 c < 6 % were significantly higher in asymptomatic group. Past history of hypoglycaemia was significantly associated with symptomatic hypoglycaemia during hospitalisation.

Abstract The ability to distinguish between the abdominal conditions of adult female mosquitoes has important utility for the surveillance and control of mosquito-borne diseases. However, doing so requires entomological training and time-consuming manual effort. Here, we design computer vision techniques to determine stages in the gonotrophic cycle of female mosquitoes from images. Our dataset was collected from 139 adult female mosquitoes across three medically important species—Aedes aegypti, Anopheles stephensi, and Culex quinquefasciatus—and all four gonotrophic stages of the cycle (unfed, fully fed, semi-gravid, and gravid). From these mosquitoes and stages, a total of 1959 images were captured on a plain background via multiple smartphones. Subsequently, we trained four distinct AI model architectures (ResNet50, MobileNetV2, EfficientNet-B0, and ConvNeXtTiny), validated them using unseen data, and compared their overall classification accuracies. Additionally, we analyzed t-SNE plots to visualize the formation of decision boundaries in a lower-dimensional space. Notably, ResNet50 and EfficientNet-B0 demonstrated outstanding performance with an overall accuracy of 97.44% and 93.59%, respectively. EfficientNet-B0 demonstrated the best overall performance considering computational efficiency, model size, training speed, and t-SNE decision boundaries. We also assessed the explainability of this EfficientNet-B0 model, by implementing Grad-CAMs—a technique that highlights pixels in an image that were prioritized for classification. We observed that the highest weight was for those pixels representing the mosquito abdomen, demonstrating that our AI model has indeed learned correctly. Our work has significant practical impact. First, image datasets for gonotrophic stages of mosquitoes are not yet available. Second, our algorithms can be integrated with existing citizen science platforms that enable the public to record and upload biological observations. With such integration, our algorithms will enable the public to contribute to mosquito surveillance and gonotrophic stage identification. Finally, we are aware of work today that uses computer vision techniques for automated mosquito species identification, and our algorithms in this paper can augment these efforts by enabling the automated detection of gonotrophic stages of mosquitoes as well.

Background: The impact of macromastia is unfortunately underestimated among developing South Asian countries. However, it remains a common cause of physical and emotional suffering among women. Aims and Objectives: We aimed to evaluate the efficacy of reduction mammoplasty in alleviating symptoms of macromastia and its impact on quality of life (QOL) among Sri Lanka females. Materials and Methods: A prospective study was conducted among 48 patients who underwent reduction mammoplasty in a surgical unit in Sri Lanka. SF-36 questionnaire and a Visual Analog Scale were used to assess QOL and pain. The outcomes were assessed 1 week prior and at 2 weeks and 6 months after surgery. Results: Median age was 43 years and the median body mass index was 26.8 kg/m2. The average duration of symptoms was 2 years. All patients initially were reluctant to seek medical advice. Only 10.4% of patients were aware of the availability of treatment. Wise-pattern reduction mammoplasty was performed in 79.2%. There was a significant reduction in pain following surgery. There was also an improvement in all domains of the QOL following surgery, especially in general health, pain, and physical functions. Conclusion: Reduction of mammoplasty caused a significant improvement in the overall QOL with the reduction in pain for patients suffering from macromastia. Creating more awareness among the public to encourage women to discuss breast-related symptoms and to overcome sociocultural taboos is a timely necessity.

Objective(s): The present study evaluated the protein-based analysis to unravel the role and mechanism behind the Dendropthae falcata plant extract treatment in breast cancer cells. Materials and Methods: The protein sample was extracted from the cancer cells after treatment with the plant extract and subjected to two-dimensional electrophoresis for protein separation. Further, the proteins that were differentially regulated among the samples which were treated and non-treated were selected and processed further for protein identification using a tandem mass spectrometry approach.Results: Using these strategies, we identified 16 potential candidates which were showing remarkable changes in treated samples. All the candidates were analyzed further for gene ontology analysis, and it was observed that all proteins were involved in multiple pathways pertaining to the carcinogenesis process. Specifically, apoptotic pathway proteins including BAD, BIK, BID, CASP8, MCL1, BCL2, and BAK1 were highly impacted by treatment with D. falcata plant extract. All these protein hits were further taken for validation experiments using RT PCR analysis. Conclusion: Initiation of these apoptotic proteins by D. falcata plant extract treatment in breast cancer cells shows a positive direction toward nature-based alternative medicine.

Vitamin D possesses immunomodulatory functions and vitamin D deficiency has been associated with the rise in chronic inflammatory diseases, including asthma (Litonjua and Weiss, 2007). Vitamin D supplementation studies do not provide insight into the molecular genetic mechanisms of vitamin D-mediated immunoregulation. Here, we provide evidence for vitamin D regulation of two human chromosomal loci, Chr17q12-21.1 and Chr17q21.2, reliably associated with autoimmune and chronic inflammatory diseases. We demonstrate increased vitamin D receptor (Vdr) expression in mouse lung CD4+ Th2 cells, differential expression of Chr17q12-21.1 and Chr17q21.2 genes in Th2 cells based on vitamin D status and identify the IL-2/Stat5 pathway as a target of vitamin D signaling. Vitamin D deficiency caused severe lung inflammation after allergen challenge in mice that was prevented by long-term prenatal vitamin D supplementation. Mechanistically, vitamin D induced the expression of the Ikzf3-encoded protein Aiolos to suppress IL-2 signaling and ameliorate cytokine production in Th2 cells. These translational findings demonstrate mechanisms for the immune protective effect of vitamin D in allergic lung inflammation with a strong molecular genetic link to the regulation of both Chr17q12-21.1 and Chr17q21.2 genes and suggest further functional studies and interventional strategies for long-term prevention of asthma and other autoimmune disorders.

Introduction: Supraglottic Airway Devices (SAD) can be used instead of endotracheal intubation in both regular and complicated airway situations. Auragain, ProSeal and Protector Laryngeal Mask Airways (LMA) are second generation LMAs. They have a separate provision for gastric drainage. Auragain LMA is a recent second-generation Supra Glottic Airway device (SGA) with a pre-formed curved shaft and a double lumen having wider airway path to aid endotracheal intubation. ProSeal LMA also has a double cuff for better sealing to prevent gastric insufflation and aspiration. Protector LMA has two large-volume gastric drainage channels and an integrated cuff pressure indicator called the cuff pilot which enables application of higher respiratory pressure. Aim: To compare the adequacy of placement of Auragain, ProSeal and protector LMAs by vocal cord visualisation using fiberoptic bronchoscopy. Materials and Methods: A randomised clinical study was conducted in the Department of Anaesthesiology, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from October 2021 to October 2022 among 120 patients. They were allocated by computer-generated random numbers into three groups namely Auragain, ProSeal and Protector LMA Group. The adequacy of placement of LMA through Fiberoptic Bronchoscopy (FOB) using Brimacombe and berry scoring, Oropharyngeal Leak Pressure (OLP), time of insertion of LMA, number of attempts for insertion, ease of insertion of LMA, Ryle’s tube insertion success rate and postoperative complications were recorded immediately, after an hour and 24 hour, respectively. Statistical analysis was performed using International Business Machines-Statistical Package for the Social Sciences (IBM-SPSS) software version 21.0. Results: The mean±Standard Deviation (SD) age in Auragain groups, ProSeal and Protector LMA groups was 41.35±12.96 years, 36.58±12.62 years and 36.65±12.50 years, respectively. The demographic data, procedures and duration of anaesthesia were comparable between the three groups. The mean insertion time (in seconds) was lower in the Auragain LMA group (16.80±3.66) when compared to protector LMA (20.20±6.93) and ProSeal LMA (21.68±4.44) with statistically significant difference (p-value

In our report, silver nanoparticles (AgNPs) were prepared from the leaf extract of Datura metel L. via the green synthesis method. Datura metel L. is a herbal medicinal plant from the Solanaceae family. The as‐prepared AgNPs were characterized using UV‐Vis spectrometer, X‐ray Diffraction (XRD), Fourier Transform Infrared (FTIR) spectroscopy and Scanning Electron Microscopy (SEM) with Energy Dispersive X‐ray (EDAX) analysis. The peak appearance of a Surface Plasmon Resonance (SPR) at 415 nm suggested the creation of AgNPs in the UV‐Vis spectrum. The XRD pattern showed the face‐centered cubic crystal structure of AgNPs with organometallic complex phase. Based on the FTIR spectrum, the peaks revealed the existence of biomolecules. SEM images showed the shape of the clastic rocks and the EDAX profile authenticated the presence of Ag and plant trace element. The cyclic voltammetry, Chronopotentiometry, and electrochemical impedance spectroscopy analysis were performed on an as‐prepared Ag electrode. A specific capacitance of 267.59 F/g at 0.5 A/g and a cyclic retention of 83.7% after 5000 charge‐discharge cycles were obtained. Hence, this material could be utilized in supercapacitor energy storage devices.

Key Clinical Message Spontaneous intracerebral hemorrhage commonly affects the brainstem. This report describes a 31‐year‐old male with hypertension who developed a pontine hemorrhage. The neurological deficits included left‐third nerve palsy, right‐sided weakness, and disabling tinnitus. Tinnitus is linked to central auditory pathway disruption. Magnetic resonance imaging revealed the hemorrhagic lesion and additional micro‐hemorrhages. The International Classification of Functioning, Disability, and Health (ICF) enhances rehabilitation by characterizing multifaceted stroke disability. The ICF profile revealed impairments in body structures/functions, limitations in activities/participation, and positive/negative environmental factors. ICF‐based goal‐setting informed interventions, including tinnitus retraining and physical/occupational therapy. Comprehensive ICF assessment is crucial for optimized, patient‐centered post‐stroke rehabilitation as it determines the extent of impact on functional level of the patient irrespective of disease severity.

Cytomegalovirus (CMV) infection is often asymptomatic. However, in certain individuals, it can cause non-specific signs and symptoms that maybe hard to recognise. The condition may therefore be overlooked or misdiagnosed, leading to prolonged illness and serious sequelae. In this case report, we present a rare instance of CMV infection in an HIV-negative patient who had a remote history of splenectomy and was experiencing prolonged fever and markedly elevated white blood cell (WBC) count.

Abstract Background and Aims The connection between marital status and suicidal behavior has been poorly assessed in South Asia. We aimed to see the proportion of marital status in individuals with suicidal behavior in South Asian countries. Methods We followed PRISMA guidelines and registered the protocol in advance (PROSPERO 2023 CRD42023399906). A systematic search was conducted in Medline, Embase, and PsycINFO. Meta‐analyses were performed to pool the proportion of married individuals with suicidal behavior (total [suicide + suicide attempts], suicide, and suicide attempt) in South Asian countries. We considered suicidal behavior consist of suicide and suicide attempts (nonfatal). Results Our search identified 47 studies for this review from 6 countries published from 1999 to 2022 with a sample size ranging from 27 to 89,178. The proportion of married individuals was 55.4% (95% CI: 50.1–60.5) for suicidal behavior, 52.7% (95% CI: 44.5–60.7) for suicides, and 43.1 (95% CI: 32.9–53.9) for suicide attempts. The proportion of married persons among suicide attempts varied significantly across countries (p = 0.016) which was highest (61.8%; 95% CI: 57.2–66.2) in India, followed by Bangladesh (52.5%; 95% CI: 41.8%–62.9%) and Pakistan (45.1%; 95% CI: 30.9–59.9). The pooled proportions did not differ significantly in relation to the quality of the studies (p = 0.633). Conclusion This review identified married persons died more than others by suicide in South Asian countries while single persons attempted suicide than married. As the current study did not assess any cause‐and‐effect association, a cautious interpretation is warranted while considering married marital status as a risk factor.

Glaucoma is a chronic and progressive eye disease, commonly associated with elevated intraocular pressure (IOP) and characterized by optic nerve degeneration, cupping of the optic disc, and loss of retinal ganglion cells (RGCs). The pathological changes in glaucoma are triggered by multiple mechanisms and both mechanical effects and vascular factors are thought to contribute to the etiology of glaucoma. Various studies have shown that endothelin-1 (ET-1), a vasoactive peptide, acting through its G protein coupled receptors, ETA and ETB, plays a pathophysiologic role in glaucoma. However, the mechanisms by which ET-1 contribute to neurodegeneration remain to be completely understood. Our laboratory and others demonstrated that macitentan (MAC), a pan endothelin receptor antagonist, has neuroprotective effects in rodent models of IOP elevation. The current study aimed to determine if oral administration of a dual endothelin antagonist, macitentan, could promote neuroprotection in an acute model of intravitreal administration of ET-1. We demonstrate that vasoconstriction following the intravitreal administration of ET-1 was attenuated by dietary administration of the ETA/ETB dual receptor antagonist, macitentan (5 mg/kg body weight) in retired breeder Brown Norway rats. ET-1 intravitreal injection produced a 40% loss of RGCs, which was significantly lower in macitentan-treated rats. We also evaluated the expression levels of glial fibrillary acidic protein (GFAP) at 24 h and 7 days post intravitreal administration of ET-1 in Brown Norway rats as well as following ET-1 treatment in cultured human optic nerve head astrocytes. We observed that at the 24 h time point the expression levels of GFAP was upregulated (indicative of glial activation) following intravitreal ET-1 administration in both retina and optic nerve head regions. However, following macitentan administration for 7 days after intravitreal ET-1 administration, we observed an upregulation of GFAP expression, compared to untreated rats injected intravitreally with ET-1 alone. Macitentan treatment in ET-1 administered rats showed protection of RGC somas but was not able to preserve axonal integrity and functionality. The endothelin receptor antagonist, macitentan, has neuroprotective effects in the retinas of Brown Norway rats acting through different mechanisms, including enhancement of RGC survival and reduction of ET-1 mediated vasoconstriction.

Lymphangitis carcinomatosis (LC) is the infiltration and inflammation of lymphatic vessel secondary to the spread of malignancy from a primary site. Most cases result from dissemination of adenocarcinomas. Its presentation may be unilateral or bilateral, it is asymmetrical and is limited to one lobe of the lung especially lower lobes, focal unilateral presentation is observed in 50% of patients, while only 6%–8% of lung metastases present as diffusely infiltrating pattern. In this case report, we present a case of adenocarcinoma with LC presenting as diffuse parenchymal lung disease which is a rare presentation. A 45-year-old female matchbox industry worker by occupation with no comorbid illness presented with 8-month history of cough with scanty mucoid expectoration and Grade II dyspnea according to the modified Medical Research Council along with history of loss of appetite and weight. CT chest shows parenchymal nodule with spiculated margin in the anterior segment of the upper lobe, nodular thickening of the Broncho vascular interstitium and pleura, diffuse interstitial septal thickening and randomly distributed nodules in all lobes. PET scan showed low grade metabolically active nodule in the anterior segment of the left upper lobe, metabolically active mediastinal, supraclavicular and retrocrural lymph nodes, mild pleural effusion and Low-grade diffuse metabolism was noted in the uterine endometrium. Low-grade diffuse metabolism was noted in the uterine endometrium. Abdominal ultrasound revealed an endometrial thickness of 8 mm. Visual inspection with acetic acid (VIA), visual inspection with lugol's iodine (VILI) and Papanicolaou smear was done which was suggestive of inflammatory smear, and Papanicolaou smear was done and was suggestive of inflammatory smear. Fiber-optic bronchoscopy was done, it was normal, and transbronchial lung biopsy revealed adenocarcinoma lung. The patient was referred to medical oncology, and the first cycle of chemotherapy was started with cisplatin and pemetrexed. Physicians should be aware of pulmonary lymphangitic carcinomatosis from lung adenocarcinoma and consider it in patients with pulmonary symptoms who are unresponsive to antibiotics. Despite establishment of diagnosis with cellular etiology even primary source, the condition is fatal. This rare condition needs to be considered in appropriate clinical settings.

Introduction and Aims : Dilated cardiomyopathy (DCM) is an important cause of heart failure (HF) among children. Research on pediatric DCM remains surprisingly scarce. The primary objective of the study was to evaluate the clinical profile and outcomes of pediatric DCM and the secondary objective was to study the predictors of outcome. Methods and Results : We enrolled all patients with cardiomyopathy who presented to us between 1990 and 2020 and were younger than 18 years. During the 30-year study period, we identified 233 cases of pediatric cardiomyopathy. One hundred and nineteen (51%) cases had DCM. This retrospective cohort was analyzed to study their outcome and the possible predictors of outcome. Nearly, 8% presented in the neonatal period, and 37% in infancy. The most common mode of presentation was dyspnea on exertion (71%). Ninety-three patients presented in heart failure (78%). The median left ventricular dimension z-score in diastole was 4.3 (range 2.5–9.06). The median left ventricle (LV) ejection fraction was 31%. Seventy-two percent of this cohort were on angiotensin-converting-enzyme inhibitors, 40% on aldosterone antagonists, and 47% on beta-blockers. One-third had syndromic, metabolic, genetic, or any secondary cause identified. Twenty-seven patients satisfied the three-tiered clinical classification for the diagnosis of probable acute myocarditis. Over a mean follow-up of 3.29 years, 27% were lost to follow-up. Among the remaining patients who were on follow-up (n = 86), 39 (45%) died, 31 (36%) recovered, and 16 (18%) had persistent LV dysfunction. Heart Failure was the most common cause of death. Eight patients in this cohort (4.2%) had thromboembolic phenomena. Nine had sustained ventricular arrhythmias and six had atrial/junctional arrhythmias. Among the various risk factors studied, only infantile onset had a significant relationship with death or ventricular arrhythmias (P value– 0.05). The 5-year survival rate of DCM patients was 59%. Conclusion : A reasonably good percentage of our population showed recovery of the left ventricular function (36%). Only infantile onset had a significant relationship with death or ventricular arrhythmias. The outcome in our DCM cohort is similar to other population cohorts.

Context: Chronic kidney disease (CKD) has emerged as one of the most prominent causes of death and suffering in the 21st century. Aims: This study aims to assess the knowledge, attitude, and perception regarding CKD among caregivers of patients with kidney disease. Settings and Design: A cross-sectional study was conducted at our institute with a well-equipped dialysis center. Subjects and Methods: The study was conducted for 3 months from August to October 2023. This study population mainly consists of caregivers of CKD patients based on inclusion and exclusion criteria. A simple random sampling method has been used with an estimated sample size of 375. Statistical Analysis Used: Continuous variables were presented in the form of frequency and proportion. The Chi-square test was used for determining association. Results: Out of the 375 participants, 59.2% had good knowledge about CKD and 40.8% had poor knowledge. 57.1% had good attitude and 161 had poor attitude. 52.3% had good perception and 179 had poor perception. The study showed a significant association between age and knowledge (P < 0.001). A significant association between occupation and knowledge (P = 0.000) toward the risk of CKD was observed. The socioeconomic status of the caregivers had good association with knowledge and attitude (P < 0.001). Conclusions: Through this research, the knowledge of kidney disease can be improved among the general population in the view of reducing morbidity and mortality.

Pseudoepitheliomatous hyperplasia (PEH) is a benign condition marked by reactive epithelial proliferation seen in response to various insults like trauma, infection, persistent inflammation and neoplasia. In this report, we discuss a case of a 35-year-old man who presented with a perineal swelling, later turned into a non-healing ulcer, first diagnosed as PEH. Still, after clinical suspicion, a deeper biopsy was conducted, confirming the diagnosis of squamous cell carcinoma and directing treatment appropriately. Non-healing perineal lesions are not uncommon. Most of the lesions turn out to be Squamous Cell Carcinoma. But, if the histopathological picture suggests Pseudoepitheliomatous Hyperplasia, it is vital to consider the limitations of the biopsy, and a solid clinicopathological correlation is required to look aggressively for underlying Squamous Cell Carcinoma. Due to the benign nature of PEH, most cases are treated via excision biopsy, while grafts or flaps are occasionally required to restore severe tissue defects. It is therefore crucial to rule out and distinguish this condition from other benign and malignant conditions, as the treatment and prognosis differ widely. It is of utmost importance to sample the base of the lesion, analyze multiple sections, and consider clinical data to ensure an accurate diagnosis.

Human brucellosis is a zoonosis with a global distribution that can affect several organs and tissues. The most frequent brucellosis consequence, osteoarticular arthritis, has been reported in 10-85% of patients. Arthritis (most common), bursitis, tenosynovitis, sacroiliitis, spondylitis, and osteomyelitis are among the range of bone and joint disorders. The age of the patient and the Brucella species involved both have an impact on the type of skeletal involvement. The most common and significant clinical type of osteoarticular involvement in adults with Brucella species infection is spondylitis. The diagnosis of spondylitis may be challenging, and it may be made more difficult by potentially fatal neurological or vascular problems. In most cases, spinal arthritis is the most common presentation which emerges a few weeks following the initial Brucella infection and can impact any segment of the spine (especially lumbar region). Unlike in this case, a 54-year-old male with a history of remittent fever presented with complications where uncommon complication of sacroiliac joints are involved. Managing the infection involves a combination of antibiotics and stabilising the affected joints. Nonetheless, the therapeutic process could extend over several months, and there's a possibility of infection recurrence if not treated appropriately.

Abstract Background The genetic architecture underlying Familial Hypercholesterolemia (FH) in Middle Eastern Arabs is yet to be fully described, and approaches to assess this from population-wide biobanks are important for public health planning and personalized medicine. Methods We evaluate the pilot phase cohort (n = 6,140 adults) of the Qatar Biobank (QBB) for FH using the Dutch Lipid Clinic Network (DLCN) criteria, followed by an in-depth characterization of all genetic alleles in known dominant (LDLR, APOB, and PCSK9) and recessive (LDLRAP1, ABCG5, ABCG8, and LIPA) FH-causing genes derived from whole-genome sequencing (WGS). We also investigate the utility of a globally established 12-SNP polygenic risk score to predict FH individuals in this cohort with Arab ancestry. Results Using DLCN criteria, we identify eight (0.1%) ‘definite’, 41 (0.7%) ‘probable’ and 334 (5.4%) ‘possible’ FH individuals, estimating a prevalence of ‘definite or probable’ FH in the Qatari cohort of ~ 1:125. We identify ten previously known pathogenic single-nucleotide variants (SNVs) and 14 putatively novel SNVs, as well as one novel copy number variant in PCSK9. Further, despite the modest sample size, we identify one homozygote for a known pathogenic variant (ABCG8, p. Gly574Arg, global MAF = 4.49E-05) associated with Sitosterolemia 2. Finally, calculation of polygenic risk scores found that individuals with ‘definite or probable’ FH have a significantly higher LDL-C SNP score than ‘unlikely’ individuals (p = 0.0003), demonstrating its utility in Arab populations. Conclusion We design and implement a standardized approach to phenotyping a population biobank for FH risk followed by systematically identifying known variants and assessing putative novel variants contributing to FH burden in Qatar. Our results motivate similar studies in population-level biobanks – especially those with globally under-represented ancestries – and highlight the importance of genetic screening programs for early detection and management of individuals with high FH risk in health systems.

Abstract Patients with SARS-CoV-2 infection are at an increased risk of cardiovascular and thrombotic complications conferring an extremely poor prognosis. COVID-19 infection is known to be an independent risk factor for acute ischemic stroke and myocardial infarction (MI). We developed a risk assessment model (RAM) to stratify hospitalized COVID-19 patients for arterial thromboembolism (ATE). This multicenter, retrospective study included adult COVID-19 patients admitted between 3/1/2020 and 9/5/2021. Among 3531 patients from the training cohort, 15.5% developed acute in-hospital ATE, including stroke, MI, and other ATE, compared to 13.4% in the validation cohort. The 16-item final score was named SARS-COV-ATE (Sex: male = 1, Age [40–59 = 2, > 60 = 4], Race: non-African American = 1, Smoking = 1 and Systolic blood pressure elevation = 1, Creatinine elevation = 1; Over the range: leukocytes/lactate dehydrogenase/interleukin-6, B-type natriuretic peptide = 1, Vascular disease (cardiovascular/cerebrovascular = 1), Aspartate aminotransferase = 1, Troponin-I [> 0.04 ng/mL = 1, troponin-I > 0.09 ng/mL = 3], Electrolytes derangement [magnesium/potassium = 1]). RAM had a good discrimination (training AUC 0.777, 0.756–0.797; validation AUC 0.766, 0.741–0.790). The validation cohort was stratified as low-risk (score 0–8), intermediate-risk (score 9–13), and high-risk groups (score ≥ 14), with the incidence of ATE 2.4%, 12.8%, and 33.8%, respectively. Our novel prediction model based on 16 standardized, commonly available parameters showed good performance in identifying COVID-19 patients at risk for ATE on admission.

The present study was aimed to green synthesize of α-Fe2O3 nanoparticles (NPs) using flower extract of Musa acuminata and examination of their antibacterial and photocatalytic activities. The synthesized NPs were investigated using UV-visible spectroscopy, which exhibited a colour change pattern, and the maximum absorption peak at 265 nm confirmed the formation of α-Fe2O3 NPs. The FTIR analysis showed the presence of various functional groups coated over the synthesized α-Fe2O3 NPs. The XRD pattern showed that the formation of rhombohedral structure with an average crystallite size was 21.86 nm. FESEM micrographs revealed that α-Fe2O3 NPs were roughly spherical in shape. EDX spectrum confirmed the presence of Fe and O elements. By TEM analysis, the average particle size was calculated to be 32 nm. Using the well diffusion method, the antibacterial activity of α-Fe2O3 NPs was tested against both gram positive and negative bacterial strains of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). The NPs exhibited good antibacterial activity against the tested bacteria. Finally, the synthesized α-Fe2O3 NPs demonstrated the photocatalytic degradation of Crystal Violet (CV) dye under sunlight. The efficiency of degradation within 150 min was determined to be 90.27% for CV. This effective removal method under sunlight may support a cost-effective method for degradation of CV dyes from wastewater.

Abstract Developing sustainable materials for recovering and recycling nutrients from wastewater is critically needed for nutrients such as phosphorus that have a diminishing supply. Struvite crystallization is emerging as a promising strategy for phosphorus recovery which can be enhanced with seeding through microalgal biochar. The main bottleneck of using microalgae is its high harvesting cost. In this study, an integrated electrocoagulation-flotation (ECF) process is used to recover and at the same time modify the algal surface with magnesium anode and inert carbon cathode. Harvesting efficiency of 98% was achieved with 40.78 mA cm−2, 0.5 cm inter-electrode distance and energy consumption of 4.03 kWh kg−1 in 15 min. The harvested microalgae were pyrolyzed to obtain a yield of 52.90% Mg-laden microalgal biochar. Simultaneously, surface impregnation of 28% magnesium was attained as confirmed by Scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS). Phosphorus recovery and struvite yield of 93.70% and 2.66 g L−1, respectively, were obtained from dosing 1.50 g L−1 Mg-laden microalgal biochar. Comparison of physicochemical characteristics of residual supernatant after microalgal harvesting and struvite recovery showed that the combined use of both the residuals can serve as a sustainable growth medium for microalgae. The overall operating cost of the integrated process was found to be 2.48 USD kg−1 with a total energy consumption of 10.76 kWh kg−1, which was found to be lower than conventional harvesting unit processes such as centrifugation and filtration. This novel approach can help attaining a circular bioeconomy by encompassing nutrient recovery and waste management in an integrated process.

Abstract Egg production is an important economic trait and a key indicator of reproductive performance in ducks. Egg production is regulated by several factors including genes. However the genes involved in egg production in duck remain unclear. In this study, we compared the ovarian transcriptome of high egg laying (HEL) and low egg laying (LEL) ducks using RNA-Seq to identify the genes involved in egg production. The HEL ducks laid on average 433 eggs while the LEL ducks laid 221 eggs over 93 weeks. A total of 489 genes were found to be significantly differentially expressed out of which 310 and 179 genes were up and downregulated, respectively, in the HEL group. Thirty-eight differentially expressed genes (DEGs), including LHX9, GRIA1, DBH, SYCP2L, HSD17B2, PAR6, CAPRIN2, STC2, and RAB27B were found to be potentially related to egg production and folliculogenesis. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis suggested that DEGs were enriched for functions related to glutamate receptor activity, serine-type endopeptidase activity, immune function, progesterone mediated oocyte maturation and MAPK signaling. Protein–protein interaction network analysis (PPI) showed strong interaction between 32 DEGs in two distinct clusters. Together, these findings suggest a mix of genetic and immunological factors affect egg production, and highlights candidate genes and pathways, that provides an understanding of the molecular mechanisms regulating egg production in ducks and in birds more broadly.

Abstract Human teeth are mechanically robust through a complex structural composite organisation of materials and morphology. Efforts to replicate mechanical function in artificial teeth (typodont teeth), such as in dental training applications, attempt to replicate the structure and morphology of real teeth but lack tactile similarities during mechanical cutting of the teeth. In this study, biomimetic typodont teeth, with morphology derived from X-ray microtomography scans of extracted teeth, were 3D printed using an approach to develop novel composites. These composites with a range of glass, hydroxyapatite and porcelain reinforcements within a methacrylate-based photopolymer resin were compared to six commercial artificial typodont teeth. Mechanical performance of the extracted human teeth and 3D printed typodont teeth were evaluated using a haptic approach of measuring applied cutting forces. Results indicate 3D printed typodont teeth replicating enamel and dentine can be mechanically comparable to extracted human teeth despite the material compositions differing from the materials found in human teeth. A multiple parameter variable of material elastic modulus and hardness is shown to describe the haptic response when cutting through both human and biomimetic, highlighting a critical dependence between the ratio of material mechanical properties and not absolute material properties in determining tooth mechanical performance under the action of cutting forces.

BackgroundHepatocellular cancer (HCC) is associated with high mortality, and early diagnosis leads to better survival. Patients with cirrhosis, especially due to nonalcoholic fatty liver disease and viral hepatitis, are at higher risk of developing HCC and form the main screening group. The current screening methods for HCC (6-monthly screening with serum alpha fetoprotein and ultrasound liver) have low sensitivity; hence, there is a need for better screening markers for HCC. ObjectiveOur study, TENDENCY, aims to validate the novel screening markers (methylated septin 9, urinary volatile organic compounds, and urinary peptides) for HCC diagnosis and study these noninvasive biomarkers in liver disease. MethodsThis is a multicenter, nested case-control study, which involves comparing the plasma levels of methylated septin 9 between confirmed HCC cases and patients with cirrhosis (control group). It also includes the comparison of urine samples for the detection of HCC-specific volatile organic compounds and peptides. Based on the findings of a pilot study carried out at University Hospital Coventry & Warwickshire, we estimated our sample size to be 308 (n=88, 29% patients with HCC; n=220, 71% patients with cirrhosis). Urine and plasma samples will be collected from all participants and will be frozen at –80 °C until the end of recruitment. Gas chromatography–mass spectrometry will be used for urinary volatile organic compounds detection, and capillary electrophoresis–mass spectrometry will be used for urinary peptide identification. Real-time polymerase chain reaction will be used for the qualitative detection of plasma methylated septin 9. The study will be monitored by the Research and Development department at University Hospital Coventry & Warwickshire. ResultsThe recruitment stage was completed in March 2023. The TENDENCY study is currently in the analysis stage, which is expected to finish by November 2023. ConclusionsThere is lack of effective screening tests for hepatocellular cancer despite higher mortality rates. The application of more sensitive plasma and urinary biomarkers for hepatocellular cancer screening in clinical practice will allow us to detect the disease at earlier stages and hence, overall, improve HCC outcomes. International Registered Report Identifier (IRRID)DERR1-10.2196/44264

Abstract In this work, a systematic photoluminescence (PL) study on three series of gallium oxide/aluminum gallium oxide films and bulk single crystals is performed including comparing doping, epitaxial substrates, and aluminum concentration. It is observed that blue/green emission intensity strongly correlates with extended structural defects rather than the point defects frequently assumed. Bulk crystals or Si-doped films homoepitaxially grown on (010) β-Ga2O3 yield an intense dominant UV emission, while samples with extended structural defects, such as gallium oxide films grown on either (-201) β-Ga2O3 or sapphire, as well as thick aluminum gallium oxide films grown on either (010) β-Ga2O3 or sapphire, all show a very broad PL spectrum with intense dominant blue/green emission. PL differences between samples and the possible causes of these differences are analyzed. This work expands previous reports that have so far attributed blue and green emissions to point defects and shows that in the case of thin films, extended defects might have a prominent role in emission properties.

Objectives: To estimate the prevalence, pattern, and factors associated with functional impairment among elders. Materials and Methods: A community-based cross-sectional analytical study was conducted among older adults (aged ≥60 years) residing in the urban blocks of West Bengal. An interview was conducted using a structured questionnaire, which included Katz index and half-arm span to measure functional impairment and body mass index (BMI), respectively. Results: The mean (SD) age (in years) of 457 participants was 69.0 (7.3) years and 52% were males, 72% were graduates, 52% were obese, and 55% had hypertension. The prevalence of functional impairment was 7.4% (95% confidence interval [CI]: 5.21–10.24). The most common aid or appliance used was spectacles (93%) followed by a denture (20%). The functional impairment was more common among the oldest-old (≥85 years) (adjusted prevalence ratio (aPR) 8.26, 95% CI: 2.50–27.28), middle-old (75–84 years) age group (aPR 3.85, 95% CI: 1.44–10.31), underweight (BMI < 18.50 kg/m2) (aPR 3.60, 95% CI: 1.44–9.00), and among the individuals using walking sticks (aPR 3.47, 95% CI: 1.60–7.51). Conclusion: The burden of functional impairment is low among older adults in the urban area of West Bengal. Policies need to be framed at the household level to reduce the extent of disability among the oldest-old and elders who are underweight and use walking aids.

Introduction: Perceived Stress Scale (PSS), developed in 1983, is one among the widely used global scales to assess the perceived psychological stress status. Hence, our study aimed at developing a Tamil version of THE 10-item PSS (TPSS-10) and assess its construct validity and internal consistency among patients with diabetes in Puducherry, South India. Methods: We translated the TPSS-10 by language experts and pilot-tested the sample with a subsample of diabetes patients. The finalized version of TPSS-10 was administered to 117 Tamil-speaking diabetic patients availing services from the rural health center in Puducherry, South India. Construct validity was assessed using the exploratory factor analysis (EFA) and the principal component analysis (PCA). A confirmatory factor analysis (CFA) was also done to obtain the goodness-of-fit. Reliability of questionnaire was evaluated by Cronbach's alpha. Results: Two factors were obtained with Eigenvalues of 4.61 and 2.16. Both factors explained 67.8% of the total variance. The two-factor model assessed by CFA found a χ2 value of 714.99 (P < 0.001). Goodness-of-fit revealed acceptable comparative fit indices (0.93). The reliability coefficient (Cronbach's alpha) for complete TPSS-10 was 0.86, indicating good internal consistency. Discussion: Our study concludes that the TPSS-10 questionnaire is internally valid and consistent with good reliability coefficient after its administration to Tamil-speaking urban diabetic patients in order to measure perceived stress. However, further research is warranted to content-validate the tool with a standard diagnostic instrument.

Objectives (1) Assess the distribution of skin-to-deltoid-muscle distance (SDMD) at the deltoid intramuscular (IM) injection site; (2) its relationship with demographic and anthropometric variables and (3) Consider the findings in relation to clinical guidance on IM injection, such as COVID-19 vaccines.Design Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sources MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, CINAHL and SCOPUS between June and July 2021 with no publication date limit.Eligibility criteria Studies reporting measurements of the SDMD in living adults aged 16 years and older, at the deltoid IM injection site, published in English were considered.Data extraction and synthesis Two independent reviewers performed each stage of screening, data extraction and quality assessments using the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross sectional studies.Results 16 105 papers were identified, of which 11 studies were suitable for review, representing 1414 participants. Heterogeneity in the definition of the deltoid IM injection site, locations measured and methods of measurement precluded meta-analysis. Evidence from ultrasound SDMD measurements demonstrated some patients in all but ‘underweight’ body mass index (BMI) categories, may require needles longer than 25 mm for successful IM injection. Calliper measurements overestimated SDMD compared with ultrasound. Female sex, higher BMI categories and greater weight in women were associated with greater SDMD.Conclusions The reviewed evidence was insufficient to inform definitive needle length ‘cut points’ for IM injection based on demographic or anthropomorphic variables. Contemporary clinical guidance currently based on this evidence, including the site of injection and choice of needle length, may result in subcutaneous administration in a small proportion of recipients, particularly if obese or of female sex.PROSPERO registration number CRD42021264625.

Given a large clinical database of longitudinal patient information including many covariates, it is computationally prohibitive to consider all types of interdependence between patient variables of interest. This challenge motivates the use of mutual information (MI), a statistical summary of data interdependence with appealing properties that make it a suitable alternative or addition to correlation for identifying relationships in data. MI: (i) captures all types of dependence, both linear and nonlinear, (ii) is zero only when random variables are independent, (iii) serves as a measure of relationship strength (similar to but more general than R2), and (iv) is interpreted the same way for numerical and categorical data. Unfortunately, MI typically receives little to no attention in introductory statistics courses and is more difficult than correlation to estimate from data. In this article, we motivate the use of MI in the analyses of epidemiologic data, while providing a general introduction to estimation and interpretation. We illustrate its utility through a retrospective study relating intraoperative heart rate (HR) and mean arterial pressure (MAP). We: (i) show postoperative mortality is associated with decreased MI between HR and MAP and (ii) improve existing postoperative mortality risk assessment by including MI and additional hemodynamic statistics.

Background While effective lay-health worker models for mental health care have been demonstrated through efficacy trials, there is limited evidence of the effectiveness of these models implemented in rural LMIC settings. Aim To evaluate the impact of a volunteer community-led intervention on reduction in depression and anxiety symptoms and improvement in functioning, and social participation among people living in rural Gujarat, India. Methods Stepped-wedge cluster randomized controlled trial was used to assess the effectiveness of delivery of psychosocial intervention across 645 villages in Mehsana district of Gujarat, India between April 2017 and August 2019. The primary outcome was an improvement in depression and/or anxiety symptoms assessed using GHQ-12 at 3-month follow-up. Secondary outcomes were improvement in (a) depression and anxiety (Patient Health Questionnaire, (PHQ-9), Generalized Anxiety Disorder (GAD-7) & Self-Reporting Questionnaire-20 (SRQ-20); b) quality of life (EQ- 5D); c) functioning (WHO-DAS-12), and social participation (Social Participation Scale SPS). Generalized linear mixed-effects models were used to assess the independent effect of the intervention. Results Out of a total of 1191 trial participants (608- intervention & 583-control), 1014 (85%) completed 3-month follow-up. In an adjusted analysis, participants in the intervention condition showed significant recovery from symptoms of depression or anxiety (OR 2.2; 95% CI 1.2 to 4.6; pConclusion Findings suggest that Atmiyata had a significant effect on recovery from symptoms of depression and anxiety with sustained effects at 8-month follow-up. Trial registration Trial registration details. The trial was registered prospectively with the “Clinical Trial Registry in India” (registry number: CTRI/2017/03/008139).

India has targeted elimination of lymphatic filariasis (LF) through mass drug administration (MDA) by 2027. Mapping of LF endemic areas is a priority for implementation of MDA. Current national LF remapping tool for unsurveyed/uncertain districts, have many limitations. The WHO has recommended a sensitive and rapid remapping protocol (Mini-TAS), that needs validation in Indian setting. Hence, in the present study a comparative assessment of these two protocols (national protocol vs Mini-TAS) was undertaken in two non-MDA districts of Odisha, with unknown filarial endemicity but reporting chronic cases. Purposive sampling was done in five top sites based on filarial case count as per the national protocol. Random 30 cluster survey was done by conducting school based Mini-TAS, Microfilariae (Mf) survey among adults (>10 years) in villages/wards with schools and Molecular Xenomonitoring (MX) of infection in vectors. Costing by activity and items of the surveys was acomplished using itemized cost menu. In Kalahandi, one of the five purposive sampling sites showed Mf prevalence above threshold (> 1%). But except Mini-TAS neither MX nor house-hold Mf survey among adults could detect the infection above the threshold. While in Balangir, Mf prevalence in all purposive sampling sites,Mini-TAS, Mf prevalence among adult and MX were above the respective thresholds confirming endemicity of LF in the district. The per sample cost of purposive sampling for Mf was the lowest INR 41, followed by adult Mf sampling INR 93. Mini-TAS and MX were expensive with INR 659 and 812 respectively. The study demonstrates that though all the sampling methods could detect filarial infection above the threshold in high-risk areas, Mini-TAS could only detect infection in low-risk areas. Therefore, in the national programme Mini-TAS can be used as a decision-making tool to determine whether to exclude/ include a district having uncertain endemicity for MDA.

Tuberculous epididymal mass is a condition that presents as a painless scrotal swelling. It resembles a testicular mass and is more often diagnosed after orchidectomy. About 22% of all genitourinary tuberculosis show epididymal involvement and 22% of epididymal tuberculosis are bilateral. This report reiterates the need for an increased awareness amongst the treating urologists that would enable an earlier diagnosis, appropriate treatment and may avert the need for orchidectomy in most cases. A 35-year-old diabetic male presented with rapidly enlarging right testicle associated with recent onset of pain over the testis. He also had fever and chills. At the age of 18, he was treated for pulmonary tuberculosis. The right testicle was enlarged, irregular and mildly tender. The right epididymis was also irregular and nodular, blended with the right testicle and indistinguishable from it. A clinical diagnosis of testicular tumour was made. Tumour markers were normal and he underwent high orchidectomy. Histopathological diagnosis confirmed right epididymal tuberculosis. This case report mainly highlights the need for a high index of suspicion amongst the treating physicians. A previous history of treatment for pulmonary tuberculosis should alert the physician to think in lines of tuberculous pathology in epididymis too. A prompt diagnosis and early, appropriate treatment would largely prevent removal of testicles in most cases.

Abstract To study the association and possible predictive role of visfatin, resistin, fetuin-A and chemerin with incident type 2 diabetes (T2DM) among Asian Indians with prediabetes. Their association with insulin resistance, β-cell function, glycaemia and anthropometry were also studied. This is a nested case–control study of a large 2-year prospective prevention trial in persons at high risk of developing T2DM. Baseline HbA1c values between 6.0% (42 mmol/mol) and 6.2% (44 mmol/mol) were chosen for this analysis (n = 144). At follow-up, persons with incident T2DM (HbA1c ≥ 6.5%, 48 mmol/mol) were grouped as cases (n = 72) and those reverted to normoglycaemia, (HbA1c

Introduction: Adolescence is an important period of growth and development. Sleep patterns undergo changes as the child transitions from adolescence to adulthood. A proper sleep hygiene for adolescents is important for their proper health, academic performance and prevention of adult-onset diseases. Aim: To assess sleep pattern and factors influencing sleep among adolescent school-going children. Materials and Methods: This cross-sectional questionnaire-based study was conducted at Saveetha Medical College Hospital, Chennai, Tamil Nadu, India (tertiary care centre), from June 2021 to December 2021. School children aged 12-19 years, studying in class 8-12 were included in the study. Adolescent Sleep Hygiene Scale (ASHS) questionnaire, was used to collect information about the sleep practices. In addition, socio-economic class, start to school time, after school activities, sharing of bed room and access to personal devices like mobile phone were also noted. Sleep was assessed with regards to different parameters like physiological factors, cognitive and emotional factor, sleep environment factor, sleep stability factor, daytime sleep factor, bedtime routine factors. In addition, disturbance of sleep based on sharing of bed with others; use of social media, school routine preventing adequate sleep and presence or absence of outdoor activities was also assessed. The primary data was tabulated using Microsoft excel sheet. Analysis of the independent variables with dependant variables was done using a three-way Analysis of Variance (ANOVA) was done using Sigma Plot 13 (Systat Software, USA). Results: A total of 826 students were enrolled in the study. Majority of the study population was females (n=500). Mean age was 15.1±1.6 years. The mean sleep score was 118.7±14.3, out of a possible 150. Sleep stability and bedtime routine factors were the areas the children had lesser scores of 12.6 and 4.2 respectively, compared to other domains. Majority of the children (76.8%, 635) did not have a bedroom of their own and shared it with their parents, siblings or grandparents. Total 602 children did not have television inside their bedroom, likewise, access to computer was also limited (129,15.6%). Socio-economic status was found to be significantly impacting behavioural arousal factors (p-value=0.006), sleep environmental factors (p-value=0.009), sleep stability factors (p-value=0.001) and bedtime routine factors (p-value=0.004) as assessed using ASHS questionnaire. Conclusion: The overall sleep quality was good in the study population. In the Indian setting, the socio-economic class and the type of family play an important role in the sleep hygiene practices of an adolescent. School based and family-based interventions will do a lot of good to adolescent sleep hygiene thereby increasing their overall health, productivity and academic performance.