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Abstract An adequate bedload prediction is a challenging task in hydraulic engineering because of the complex sediment transport processes and corresponding environmental factors. The current study introduces a novel comparative ensemble approach using metaheuristic machine learning (ML) models to enhance the accuracy of bedload prediction using data from laboratory flume experiments. To uncover key insights in bedload transport prediction, several models are employed, such as K-Nearest Neighbours (KNN), Extra Trees Regressor (ETR), Linear Regression (LR), Random Forest (RF), Bagging Regressor (BR), and XGBoost (XGB). The coefficient of determination (R 2) and root mean square error (RMSE) values vary between various models; however, XGB showed R 2 = 0.99 and RMSE = 0.11. The sensitivity analysis emphasizes the crucial role of the Shields parameter in bedload prediction, while the SHAP analysis highlights the substantial influence of the XGB model in enhancing predictive accuracy. The REC curves show that BR, XGB, and RF, outperformed KNN and LR models. Furthermore, a graphical user interface has also been developed to facilitate user interaction with the predictive models, allowing for easier visualization, analysis, and interpretation of bedload transport predictions. Additionally, k-fold cross-validation was performed to assess the performance, consistency and robustness of the ML models. Thus, it can be concluded from the current study that the utilization of ML algorithms can improve accuracy, providing valuable insights for hydraulic engineers and highlighting the importance of ML models in civil engineering practices, particularly in bedload transport prediction.

Abstract In light of the ongoing battle against COVID-19, while the pandemic may eventually subside, sporadic cases may still emerge, underscoring the need for accurate detection from radiological images. However, the limited explainability of current deep learning models restricts clinician acceptance. To address this issue, our research integrates multiple CNN models with explainable AI techniques, ensuring model interpretability before ensemble construction. Our approach enhances both accuracy and interpretability by evaluating advanced CNN models on the largest publicly available X-ray dataset, COVIDx CXR-3, which includes 29,986 images, and the CT scan dataset for SARS-CoV-2 from Kaggle, which includes a total of 2,482 images. We also employed additional public datasets for cross-dataset evaluation, ensuring a thorough assessment of model performance across various imaging conditions. By leveraging methods including LIME, SHAP, Grad-CAM, and Grad-CAM++, we provide transparent insights into model decisions. Our ensemble model, which includes DenseNet169, ResNet50, and VGG16, demonstrates strong performance. For the X-ray image dataset, sensitivity, specificity, accuracy, F1-score, and AUC are recorded at 99.00%, 99.00%, 99.00%, 0.99, and 0.99, respectively. For the CT image dataset, these metrics are 96.18%, 96.18%, 96.18%, 0.9618, and 0.96, respectively. Our methodology bridges the gap between precision and interpretability in clinical settings by combining model diversity with explainability, promising enhanced disease diagnosis and greater clinician acceptance.

Abstract The current study explores the effects of microwave treatment at varying wattage and durations on the phytoconstituents, antioxidant status, anti-nutritional factors (ANFs), and metabolite profiles of de-oiled rice bran. The total phenolics and flavonoids showed both increases and decreases depending on specific microwave parameters, while flavonol content consistently increased across all treated groups compared to the control. The DPPH and ABTS free radical scavenging activity, total antioxidant capacity, FRAP, CUPRAC, metal chelating activity, and ascorbic acid content were enhanced in most of the microwaved samples; however, longer microwave exposure at higher wattage led to their reduction. A treatment-specific decrease in ANFs, including condensed tannins, oxalates, and phytates, was observed. HRMS-based untargeted metabolomics identified a diverse range of primary and secondary metabolites, which clustered in a group-specific manner, indicating notable group-wise metabolite variations. Analysis of discriminating metabolites revealed no significant differences in the overall levels of phenolics, flavonoids, vitamins and cofactors, sugars, amino acids, terpenoids, fatty acids, and their derivatives among the treated groups compared to the control; however, several individual metabolites within these metabolite classes differed significantly. These findings suggest that optimized microwaving of de-oiled rice bran can enhance phytochemicals and antioxidants while improving the metabolite profile.

Abstract Background Dengue is a vector-borne debilitating disease that is manifested as mild dengue fever, dengue with warning signs, and severe dengue. Dengue infection provokes a collective immune response; in particular, the innate immune response plays a key role in primary infection and adaptive immunity during secondary infection. In this review, we comprehensively walk through the various markers of immune response against dengue pathogenesis and outcome. Main body Innate immune response against dengue involves a collective response through the expression of proinflammatory cytokines, such as tumor necrosis factors (TNFs), interferons (IFNs), and interleukins (ILs), in addition to anti-inflammatory cytokines and toll-like receptors (TLRs) in modulating viral pathogenesis. Monocytes, dendritic cells (DCs), and mast cells are the primary innate immune cells initially infected by DENV. Such immune cells modulate the expression of various markers, which can influence disease severity by aiding virus entry and proinflammatory responses. Adaptive immune response is mainly aided by B and T lymphocytes, which stimulate the formation of germinal centers for plasmablast development and antibody production. Such antibodies are serotype-dependent and can aid in virus entry during secondary infection, mediated through a different serotype, such as in antibody-dependent enhancement (ADE), leading to DENV severity. The entire immunological repertoire is exhibited differently depending on the immune status of the individual. Short conclusion Dengue fever through severe dengue proceeds along with the modulated expression of several immune markers. In particular, TLR2, TNF-α, IFN-I, IL-6, IL-8, IL-17 and IL-10, in addition to intermediate monocytes (CD14+CD16+) and Th17 (CD4+IL-17+) cells are highly expressed during severe dengue. Such markers could assist greatly in severity assessment, prompt diagnosis, and treatment.

Background: Iron deficiency (ID) is a common nutritional concern worldwide. Hypothyroidism during pregnancy also has harmful effects on both mother and child, such as post-partum hemorrhage, pre-eclampsia, low-birth weight, pre-term labour and abruptio placenta. Few articles have shown an association between ID and hypothyroidism. Aims: To evaluate the association between hypothyroidism, hypotriiodothyroninemia and ID in pregnant women. Materials and Methods: This cross-sectional study was conducted between January 2017 and June 2019 at JSS Hospital, a Tertiary Care Teaching and Research Hospital attached to JSS Medical College in Mysuru City, South India. Five hundred consecutive pregnant women aged 18–45 years in the first trimester of pregnancy were recruited. A venous blood sample of approximately 5 mL was drawn and sent for analysis of haemoglobin, thyroid-stimulating hormone (TSH), T3, T4, anti-thyroid peroxidase (TPO) antibodies and serum ferritin. T3, T4, TSH, anti-TPO antibody and serum ferritin levels were measured by chemiluminescence for all pregnant women. Correlation and linear regression analyses were performed to determine the association between ID and T3, T4 and TSH levels. Results: Out of 500 women, nine were excluded because of pre-analytical errors; hence, there were 491 pregnant women in the first trimester. Mean values of T3, T4, TSH and ferritin in the study were 1.45 ± 0.72, 9.29 ± 2.53, 2.37 ± 3.17 and 31.54 ± 30.28. There was a positive correlation between serum ferritin and T4 levels, with a correlation coefficient of 0.135. The scatter plot also showed a linear relationship between serum ferritin and T4 levels. There was no significant correlation between serum ferritin, T3 and TSH levels. Linear regression analysis also showed an association between ferritin and T4 levels, with a significance of 0.003. Linear regression analysis was insignificant for TSH, T3 and serum ferritin levels. Conclusion: ID anaemia (IDA) is associated with hypothyroxinemia in pregnant women. Further extensive studies are needed to evaluate the causal association between hypothyroidism and IDA. Iron therapy might improve thyroid parameters in patients with subclinical hypothyroidism and ID without thyroxine, which requires further research.

Introduction: Although diarrheal diseases are highly preventable, they remain one of the leading causes of mortality and morbidity in the pediatric population in developing countries. Knowledge of etiological agents is essential to implement public health programs. Viral infections are the most common cause of acute infectious diarrhea among children. There is a paucity of information regarding viral enteropathogens responsible for diarrhea in India, as many hospitals do not routinely carry out diagnostic tests for viral detection. Aim and Objectives: To estimate the prevalence of viral enteropathogens in children under five years of age presenting with acute diarrhea using real-time multiplex polymerase chain reaction (PCR) and its correlation with clinico-demographic features. Methodology: A cross-sectional study was carried out in a tertiary care center in Maharashtra from January 2016 to June 2019. Our study included 300 children who were under five years old with acute diarrhea. Standard protocols were advocated for the collection and transportation of stool samples. All samples were subjected to real-time multiplex PCR (Light cycler 480 Roche) using Fast Track Diagnostic kits for viral gastroenteritis. Data analysis was done using descriptive and analytical methods. Results: In our study, 57% of samples were positive for viral enteropathogens. Rotavirus (32%) was the most common isolate, followed by Norovirus Genogroup II (GII) (17%). The majority of pathogens were isolated from children less than 2 years of age. Conclusion: There is a need to test stool specimens of clinically confirmed diarrheal patients for enteric virus. This will avoid blind antibiotic treatment.

Abstract Background Antenatal steroid therapy for fetal lung maturation is routinely administered to women at risk of preterm delivery. There is strong evidence to demonstrate benefit from antenatal steroids in terms of survival and respiratory disease, notably in infants delivered at or below 32 weeks’ gestation. However, dosing remains unoptimized and lung benefits are highly variable. Current treatment regimens generate high-concentration, pulsatile fetal steroid exposures now associated with increased risk of childhood neurodevelopmental diseases. We hypothesized that damage-associated changes in the fetal hippocampal transcriptome would be independent of preterm lung function. Methods Date-mated ewes carrying a single fetus at 122 ± 2dGA (term = 150dGA) were randomized into 4 groups: (i) Saline Control Group, 4×2ml maternal saline intramuscular(IM) injections at 12hr intervals (n = 11); or (ii) Dex High Group, 2×12mg maternal IM dexamethasone phosphate injections at 12hr intervals followed by 2×2ml IM saline injections at 12hr intervals (n = 12; representing a clinical regimen used in Singapore); or (iii) Dex Low Group, 4×1.5mg maternal IM dexamethasone phosphate injections 12hr intervals (n = 12); or (iv) Beta-Acetate Group, 1×0.125mg/kg maternal IM betamethasone acetate injection followed by 3×2ml IM sterile normal saline injections 12hr intervals (n = 8). Lambs were surgically delivered 48hr after first maternal injection at 122–125dGA, ventilated for 30min to establish lung function, and euthanised for necropsy and tissue collection. Results Preterm lambs from the Dex Low and Beta-Acetate Groups had statistically and biologically significant lung function improvements (measured by gas exchange, lung compliance). Compared to the Saline Control Group, hippocampal transcriptomic data identified 879 differentially significant expressed genes (at least 1.5-fold change and FDR

Abstract Background Rare disorders comprise of ~ 7500 different conditions affecting multiple systems. Diagnosis of rare diseases is complex due to dearth of specialized medical professionals, testing labs and limited therapeutic options. There is scarcity of data on the prevalence of rare diseases in different populations. India being home to a large population comprising of 4600 population groups, of which several thousand are endogamous, is likely to have a high burden of rare diseases. The present study provides a retrospective overview of a cohort of patients with rare genetic diseases identified at a tertiary genetic test centre in India. Results Overall, 3294 patients with 305 rare diseases were identified in the present study cohort. These were categorized into 14 disease groups based on the major organ/ organ system affected. Highest number of rare diseases (D = 149/305, 48.9%) were identified in the neuromuscular and neurodevelopmental (NMND) group followed by inborn errors of metabolism (IEM) (D = 47/305; 15.4%). Majority patients in the present cohort (N = 1992, 61%) were diagnosed under IEM group, of which Gaucher disease constituted maximum cases (N = 224, 11.2%). Under the NMND group, Duchenne muscular dystrophy (N = 291/885, 32.9%), trinucleotide repeat expansion disorders (N = 242/885; 27.3%) and spinal muscular atrophy (N = 141/885, 15.9%) were the most common. Majority cases of β-thalassemia (N = 120/149, 80.5%) and cystic fibrosis (N = 74/75, 98.7%) under the haematological and pulmonary groups were observed, respectively. Founder variants were identified for Tay-Sachs disease and mucopolysaccharidosis IVA diseases. Recurrent variants for Gaucher disease (GBA:c.1448T > C), β-thalassemia (HBB:c.92.+5G > C), non-syndromic hearing loss (GJB2:c.71G > A), albinism (TYR:c.832 C > T), congenital adrenal hyperplasia (CYP21A2:c.29–13 C > G) and progressive pseudo rheumatoid dysplasia (CCN6:c.298T > A) were observed in the present study. Conclusion The present retrospective study of rare disease patients diagnosed at a tertiary genetic test centre provides first insight into the distribution of rare genetic diseases across the country. This information will likely aid in drafting future health policies, including newborn screening programs, development of target specific panel for affordable diagnosis of rare diseases and eventually build a platform for devising novel treatment strategies for rare diseases.

Background: Bortezomib and dexamethasone (BD) regimen offers a promising therapeutic approach in multiple myeloma (MM) by inhibiting the proteolytic pathway of tumor cells. Aims and Objectives: This study aims to assess the safety profile and treatment outcomes of MM patients undergoing the BD regimen. Materials and Methods: This prospective observational study included MM patients who received BD regimen. Patients received bortezomib (1.3 mg/m2 intravenous) weekly for 4 weeks along with dexamethasone (40 mg orally) weekly for 4 weeks. Clinical assessments were performed after each cycle, and adverse drug reactions were graded according to National Cancer Institute criteria. Treatment outcomes were evaluated after the 4th cycle based on specific parameters. Results: Thirty-seven patients, with a mean age of 56.2 years, predominantly male (56.8%), were included. Common symptoms included bone pain, fatigue, weight loss, and appetite loss. Toxicities were mainly grade 1 and 2, with peripheral neuropathy (PN) being the most prevalent. The BD regimen exhibited a response rate of 65%, accompanied by significant improvements in bone marrow plasma cells, β2 microglobulin, immunoglobulin assay, and erythrocyte sedimentation rate. In addition, treatment improved performance status, in 51.4% of patients achieving scores above 90 on the Karnofsky scale. Conclusion: The BD regimen demonstrated notable efficacy and tolerability in MM treatment. However, it is associated with a higher risk of PN.

Background: There are several variations in the complex anatomy of intrahepatic bile ducts. Magnetic resonance cholangiopancreatographyis a safer imaging modality that effectively shows these variations, aiding in surgical planning and preventing iatrogenic injuries. This study aims to evaluate these anatomical variations using magnetic resonance cholangiopancreatography. Materials and Methods: This cross-sectional prospective study was performed in the Radiology Department of Nobel Medical College for one year using a convenient sampling technique. A total of 165 cases meeting the inclusion criteriawere selected and magnetic resonance cholangiopancreatography was performed to evaluate the anatomical variations. Results: The mean age of patients was 34.32±10.22 years out of which 51.5%were male and 48.5%were female. The branching pattern of right hepatic duct was typical in 66.7% of cases. The right posterior sectoral duct joining left hepatic duct was the most common variation seen in 15.2%. Right posterior sectoral duct joining the common bile duct was present in 6.7%. 6.1% of cases had unclassified variation whereas a trifurcation pattern was found in 5.5%. Left hepatic duct showed the typical branching pattern in 70.9% of cases. Segment II duct draining into the common trunk of segments III and IV was seen in 20%. Triconfluence among segments II, III, and IV was seen in 8.5% and 0.6% of cases had unclassified variation. Conclusion: This study revealed wide variation in branching patterns of intrahepatic biliary ducts. The typical branching pattern of right and left hepatic ducts were seen in majority of cases.

Background: Urological operations frequently involve the use of spinal anesthesia. In the present scenario, adding different adjuvants to local anesthetic improve its quality and duration has become common. Aims and Objectives: In patients undergoing elective urological procedures, the purpose of this study was to assess the effects of intrathecal fentanyl or tramadol with 0.5% bupivacaine heavy. Materials and Methods: Patients were divided into two groups of 30 patients each, a total of 60 patients aged 20–60 years undergoing elective urological surgeries participated in this prospective, randomized study in which 25 μg fentanyl and 2.5 mL of 0.5% bupivacaine heavy were given to Group F, while 25 mg tramadol and 2.5 mL of 0.5% bupivacaine heavy were given to Group M. The onset and duration of sensory and motor blockage, the duration of analgesia, post-operative Visual Analog Scale score, hemodynamic changes, and adverse effects were evaluated. Results: Fentanyl had a lower mean time of onset for sensory (2:33±0:22 min vs. 4:50±0:33 min) and motor block (3:36±0:28 min vs. 5:52±0:38 min) (P

Background: Platelet-rich plasma (PRP) helps in the treatment of various insertion tendinitis, and the recurrence rate will be low. In this study, we used intralesional injections of autologous PRP for the treatment of insertion tendinitis. Aims and Objectives: Assessment of pain relief following PRP treatment for insertion tendinitis and ascertaining the efficacy of PRP as a treatment option for insertion tendinitis. Materials and Methods: The study was done at Maharani Laxmi Bai Medical College, Jhansi, between January 2021 and June 2022, including 100 patients were applied for the treatment of PRP. We assessed patients before treatment and at three follow-up time points: 2, 4, and 6 months after the end of treatment. During each evaluation, three parameters were noted: Victorian Institute of Sports Assessment- Achilles (VISA-A) score, the Visual Analog Scale, and patient satisfaction according to the roles and Maudsley score. Results: This was a prospective trial by study design conducted on 100 patients, which included 44 patients with plantar fasciitis and 56 patients with tennis elbow. The response to PRP injection in patients with plantar fasciitis was assessed by the VISA-A score. The pre-injection VISA-A score of patients with plantar fasciitis was 56.82 (mean with SD of 18.015), which improved to 65.45 in the 2nd month (mean with SD −18.857), 4th month with 69.77 (mean with SD–19.823), and at 6 months 71.82 (mean with SD–20.829). Statistical analysis with an analysis of variance test gave a P=0.001. In our study, the patients had gradual sequential improvement in VISA-A score throughout the follow-up, with maximum improvement from the pre-injection score were observed in 2 months (65.45 with SD 18.85). Conclusion: Autologous PRP injection is a safe and useful modality of treatment in the treatment of insertion tendinitis.

Context: Worldwide malnutrition is identified as a major health and nutrition problem. Undernutrition contributes to an estimated 45% of child deaths globally. The prevalence of underweight among children in India is among the highest in the world. Our children also bear a tremendous double burden of malnutrition. Aims: To find out the prevalence and determinants of malnutrition among six months to three-year-old children in the rural community of Northern India. Settings and Design: A community-based cross-sectional study conducted among children aged six months to three years in a rural area of Ludhiana district, Methods and Material: A total of 662 children in the age group of six months to three years from a population of 30,000 were identified and included in the study. All the relevant information regarding these children was collected from family folders. Socioeconomic status was assessed using the modified Udai Pareek scale (MUP). Statistical analysis used: The data collected was entered in MS Excel and was analyzed using SPSS version 26 and WHO Anthro Survey Analyzer. Results: Out of 662 children, 16% were underweight. Almost 50% of the children in the two—three years category were underweight. The prevalence of stunting in the study population was 20.7% and that of overweight was 4.8%. The prevalence of underweight was higher in children of low socioeconomic status than in children from upper socioeconomic status (P = 0.000). There was a significant association between birth order and increasing cases of underweight (P = 0.000). Conclusions: The causes of malnutrition in children are complex and involve multiple factors. There is a need for vigorous monitoring for early detection of malnutrition for children aged two—three years. The improvement of maternal education will improve the nutritional status of the child.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder involving the joints along with various other extra-articular manifestations. Mortality due to coronary artery disease is higher in patients with RA when compared to the general population. Hence, this study is undertaken to assess the predictors of sub-clinical atherosclerosis in patients with RA, so that early prompt management can prevent cardiovascular complications. Methods: A case–control study with 42 patients of RA and 42 healthy age- and sex-matched controls was undertaken. Relevant investigations were done. Disease Activity Score (DAS)-28 was calculated. Carotid artery doppler was performed on both sides to examine the common carotid artery. Results: The mean carotid intima–media thickness (CIMT) (mm) was significantly higher in RA patients compared to controls on the right side (0.57 ± 0.11 Vs 0.40 ± 0.03; P < 0.001) as well as left side (0.56 ± 0.11 Vs 0.39 ± 0.06; P < 0.001). Only age (P = 0.006) and DAS-28 (P = 0.002) showed a positive correlation with CIMT. Conclusions: CIMT can be used as a marker for the detection of subclinical atherosclerosis and the risk of atherosclerosis increases with the increasing age and increasing disease severity.

Abstract Grasslands are crucial ecosystems that provide numerous ecological services and support biodiversity conservation. Grasslands undergo significant threats from both anthropogenic and natural sources, compromising their ability to maintain biodiversity, ecosystem services, and human well-being. However, grasslands are frequently ignored in sustainable development objectives. Adequate knowledge of how grassland degradation affects ecosystem services is essential for sustainable management and grassland ecological restoration. The Kachchh region in western India harbours a unique grassland ecosystem known as the Banni grassland, which once became the finest grassland in Asia. However, undesirable anthropogenic interventions have accelerated its degradation. This research paper aims to assess the suitability of different land areas in Banni for sustainable grassland restoration, considering ecological value as a primary criterion. In the present research, land suitability for grassland management was assessed using a geographical information system (GIS)-based multi criteria evolution (MCE) method with satellite data and the analytic hierarchy process (AHP). The ground truthing of the soil samples was carried out alongside. Slope, rainfall, infiltration rate, LULC, geomorphology, soil texture, soil organic carbon, water holding capacity, SAR, CEC, pH, EC, and soil nutrients were among the criteria used. The weights for each criterion were calculated using a pairwise comparison matrix, and the scores were allocated to sub criteria based on field work, expert opinions, and a literature review. The proposed method can be very useful for evaluating the state of the land and can help with the best possible planning for grassland development and conservation. Banni grassland has the potential to be developed into a critical zone observatory (CZO) in the future, and the present study, with further inputs, holds promise for furthering the cause of its sustainable management. Overall, this study underscores the importance of assessing land suitability for sustainable grassland management and highlights the potential for maximising the ecological value of grasslands in western India and beyond.

Mesodiverticular band associated with Meckel’s diverticulum can lead to surgical emergencies like intestinal obstruction or volvulus and may prove fatal as this pathology is quite rare, it may escape the clinical diagnosis. This band needs to be excised during emergent laparotomy along with Meckel’s diverticulectomy. A high level of clinical suspicion and surgical acumen is required to manage this rare condition and have an uneventful recovery of the patient.

Ainhum is an extremely rare and challenging case where there is development of a constricting ring along the digits leading to autoamputation. As rare case .it is being reported from India as not many literatures on this case from this part of the continent.

Phytobezoar causing acute intestinal obstruction is a rare event. A case of accidental ingestion of mango seed causing intestinal obstruction is being reported requiring surgical intervention to extract the mango seed from the ileum. This condition must be kept in mind during the mango season while dealing with a case of intestinal obstruction in an emergency.

Abstract Evapotranspiration (ETo) is an important component of the hydrological cycle and reliable estimates of ETo are essential for assessing crop water requirements and irrigation management. Direct measurement of evapotranspiration is both costly and involves complex and intricate procedures. Hence, empirical models are commonly utilized to estimate ETo using accessible meteorological data. Given that empirical methods operate on various assumptions, it is essential to assess their performance to pinpoint the most suitable methods for ETo calculation based on the availability of input data and the specific climatic conditions of a region. This study aims to evaluate different empirical methods of ETo in the tropical highland Udhagamandalam region of Tamil Nadu, India, utilizing sixty years of meteorological data from 1960–2020. In this study, 8 temperature-based and 10 radiation-based empirical models are evaluated against ETo estimates derived from pan evaporation observation and the FAO Penman–Monteith method (FAO-PM), respectively. Statistical error metrics indicate that both temperature and radiation-based models perform better for the Udhagamandalam region. However, radiation-based models performed better than the temperature based models. This is possibly due to the high humidity of the study region throughout the year. The results suggest that simple temperature and radiation-based models using minimum meteorological information are adequate to estimate ETo and thus find potential application in agricultural water practices, hydrological processes, and irrigation management.

Abstract Background Current clinical diagnosis pathway for lysosomal storage disorders (LSDs) involves sequential biochemical enzymatic tests followed by DNA sequencing, which is iterative, has low diagnostic yield and is costly due to overlapping clinical presentations. Here, we describe a novel low-cost and high-throughput sequencing assay using single-molecule molecular inversion probes (smMIPs) to screen for causative single nucleotide variants (SNVs) and copy number variants (CNVs) in genes associated with 29 common LSDs in India. Results 903 smMIPs were designed to target exon and exon–intron boundaries of targeted genes (n = 23; 53.7 kb of the human genome) and were equimolarly pooled to create a sequencing library. After extensive validation in a cohort of 50 patients, we screened 300 patients with either biochemical diagnosis (n = 187) or clinical suspicion (n = 113) of LSDs. A diagnostic yield of 83.4% was observed in patients with prior biochemical diagnosis of LSD. Furthermore, diagnostic yield of 73.9% (n = 54/73) was observed in patients with high clinical suspicion of LSD in contrast with 2.4% (n = 1/40) in patients with low clinical suspicion of LSD. In addition to detecting SNVs, the assay could detect single and multi-exon copy number variants with high confidence. Critically, Niemann-Pick disease type C and neuronal ceroid lipofuscinosis-6 diseases for which biochemical testing is unavailable, could be diagnosed using our assay. Lastly, we observed a non-inferior performance of the assay in DNA extracted from dried blood spots in comparison with whole blood. Conclusion We developed a flexible and scalable assay to reliably detect genetic causes of 29 common LSDs in India. The assay consolidates the detection of multiple variant types in multiple sample types while having improved diagnostic yield at same or lower cost compared to current clinical paradigm.

Pilonidal sinus disease (PSD) is a chronic inflammatory disease affecting the soft tissue of the sacrococcygeal region and remains a challenging disease for surgeons to treat. With controversies in management to prevent recurrence leading to economic burden to the patient, these cases require special care by expert surgeons. From Jan 2023 to Nov 2023, 10 patients with pilonidal sinus were treated with complete excision of the tract and reconstruction using a rhomboid flap. The factors evaluated included the duration of surgery, postoperative pain, length of hospital stay, and postoperative complications. The patients were followed up on an outpatient basis, monthly for the first three months. The majority of the patients were young males with a mean age of 28 years. The surgery time was 40 to 75 minutes, and the mean operation time was 55 minutes. The stitches were removed after 2 weeks. Among complications, two patients developed mild discharge with infection. In one patient, necrosis at the tip of the flap was noted. We recommend the Rhomboid flap as a method of choice for surgical management of Pilonidal sinus in a postgraduate medical college as it is easy to teach, learn, and perform and gives complete recovery of the patient with negligible recurrence rate.

Abstract The NOD-like receptor pyrin domain-containing protein 3 (NLRP3) inflammasome has been associated with worse outcomes from severe traumatic brain injury (TBI). The NLRP3 inflammasome is also strongly associated with other pro-inflammatory conditions, such as obesity. Little is known about the potential effect of mild TBI (mTBI) on the NLRP3 inflammasome and the extent to which modifying factors, such as obesity, may augment the inflammatory response to mTBI. The purpose of this study was to evaluate the association of NLRP3 inflammasome proteins with obese body mass index (BMI ≥ 30) within 24 h of mTBI after presenting to a level 1 trauma center emergency department. This is a secondary analysis of prospectively enrolled patients with mTBI who presented to the emergency department of one U.S. Level 1 trauma center from 2013 to 2018 (n = 243). A series of regression models were built to evaluate the association of NLRP3 proteins obtained from blood plasma within 24 h of injury and BMI as well as the potential interaction effect of higher BMI with NLRP3 proteins (n = 243). A logistic regression model revealed a significant association between IL-18 (p

Introduction: Evidence regarding throat packing for head and neck surgeries is limited. A video laryngoscope, an airway adjunct used for various diagnostic and therapeutic purposes, can also effectively pack the throat. Aim: To compare the Time Taken for Throat Packing (TTTP) using a non-channeled video laryngoscope BPL™ versus the conventional Macintosh larynogoscope direct laryngoscope. Materials and Methods: In this non-inferiority, randomised controlled, single-blind study, 72 patients undergoing head and neck surgeries requiring throat packing were recruited. The non-inferiority margin was set at 10 seconds between the two groups (n=36 each). Throat packing in Group-M and Group-V was performed using the Macintosh and video laryngoscopes with the assistance of Magill’s forceps. The TTTP was recorded from the blade insertion to complete blade removal. A one-sided two-sample unpaired t-test was used to test non-inferiority hypothesis considered in this study. Results: The mean age of patients in Group-M was 37.39 years and in Group-V was 33.65 years, with mean weights of 60.89 kg and 56.32 kg, respectively. The mean TTTP difference between Group-M and Group-V was found to be -12.6 seconds with a lower limit of the one-sided 95% Confidence Interval (CI) of −20.6s. The null hypothesis was accepted, concluding that video laryngoscope-guided throat packing took a longer duration. The ease of throat packing, haemodynamic stress response, and Postoperative Sore Throat (POST) were comparable between both groups. Conclusion: Video laryngoscope-guided throat packing is inferior to conventional Macintosh throat packing in terms of TTTP. However, it is equivocal regarding the ease of throat packing and the stress response induced. POST was the same whether throat packing was performed using a video laryngoscope or a Macintosh laryngoscope.

Introduction: Leukaemic ophthalmopathy can be either symptomatic or asymptomatic. Several factors can cause leukaemic ophthalmopathy, including opportunistic infections, direct ocular infiltration by leukaemic cells, indirect ocular involvement from subsequent haematologic alterations, and consequences from different treatment modalities. Patients with leukaemia who develop leukaemic infiltrates must undergo urgent systemic and neurological re-evaluation. Aim: To evaluate the prevalence and spectrum of leukaemic ophthalmopathy among leukaemic patients and to identify and analyse the common ocular manifestations of leukaemia in different age and gender groups. Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital in South Gujarat, India. A total of 48 patients diagnosed with leukaemia were included in the study. Detailed histories regarding their systemic illness, present systemic complaints, ocular complaints, and history of treatment were noted. Detailed ophthalmoscopic examinations like slit lamp examinations, fundoscopic examinations, visual acuity, and intraocular pressure were performed on each participant. Statistical analysis was conducted using descriptive data analysis methods in Microsoft Excel sheets. Results: Out of the total 48 leukaemia patients recruited, 16 (33.33%) had ocular manifestations. Among the 25 acute leukaemia patients and 23 chronic leukaemia patients, 8 (32%) and 8 (34.78%) had ocular manifestations, respectively. Among all ocular manifestations, venous tortuosity was the most common, followed by deep and superficial retinal haemorrhage, dry eye, and Roth’s spot. Conclusion: The prevalence of ocular manifestations in leukaemia was reported to be 33.33%. Although an ophthalmologist's involvement in leukaemia treatment is secondary, it is nonetheless crucial to promptly recognise any ocular signs due to the worse prognosis associated with ocular involvement and to rule out extramedullary disease.

Abstract In wireless networking, the security of flying ad hoc networks (FANETs) is a major issue, and the use of drones is growing every day. A distributed network is created by a drone network in which nodes can enter and exit the network at any time. Because malicious nodes generate bogus identifiers, FANET is unstable. In this research study, we proposed a threat detection method for detecting malicious nodes in the network. The proposed method is found to be most effective compared to other methods. Malicious nodes fill the network with false information, thereby reducing network performance. The secure ad hoc on-demand distance vector (AODV) that has been suggested algorithm is used for detecting and isolating a malicious node in FANET. In addition, because temporary flying nodes are vulnerable to attacks, trust models based on direct or indirect reliability similar to trusted neighbors have been incorporated to overcome the vulnerability of malicious/selfish harassment. A node belonging to the malicious node class is disconnected from the network and is not used to forward or forward another message. The FANET security performance is measured by throughput, packet loss and routing overhead with the conventional algorithms of AODV (TAODV) and reliable AODV secure AODV power consumption decreased by 16.5%, efficiency increased by 7.4%, and packet delivery rate decreased by 9.1% when compared to the second ranking method. Reduced packet losses and routing expenses by 9.4%. In general, the results demonstrate that, in terms of energy consumption, throughput, delivered packet rate, the number of lost packets, and routing overhead, the proposed secure AODV algorithm performs better than the most recent, cutting-edge algorithms.

Introduction: Anatomy courses in health science disciplines, including allied health programs, face criticism for being extensive and lacking focus on career-relevant competencies. Objectives: To evaluate allied health students' perceptions of the anatomy syllabus using feedback analysis to identify areas for improvement and align the curriculum with their needs. Methods: A qualitative study gathered feedback from 100 second, third, and fourth-year allied health students through an anonymous questionnaire comprising of eight items, six of which were rated using a five-point Likert scale, while two comprised open-ended questions. By recording the number and percentage of students responding to each item and calculating mean ratings. Results: Over 75% of students find the anatomy syllabus extensive, requiring memorization. About 70% believe it addresses essential competencies, but 60% feel practical aspects receive inadequate emphasis. Half note a lack of clear distinction between anatomy and physiology in textbooks. Conclusion: Tailoring the anatomy syllabus to specific allied health courses is crucial, focusing on appropriateness, conciseness, and well-defined learning outcomes. Students' perceptions highlight the need for a more targeted and simplified approach, aligning the curriculum with practical demands for professional success. Collaborative efforts between educators and students are vital for ongoing refinement and optimization.

Background and objectives. Forward head posture is associated with weakness in deep cervical short flexor & shortening of the opposing cervical extensor & Pectoralis muscles. Deep cervical flexor (DCF) has a major postural function in supporting and straightening the cervical lordosis. There were few studies on the correlation between craniovertebral angle & vertical mandibular opening. So there was a need to evaluate the effect of deep cervical muscle strengthening on forward head posture and vertical mandibular opening and find out the correlation between vertical mandibular opening (VMO) and craniovertebral angle(CVA). Materials and methods. A total of 84 subjects were included in an experimental study. Subjects were screened according to the inclusion and exclusion criteria. Selected CVA were assessed using MB ruler software (ICC= 0.88). Selected VMO was measured using a ruler (ICC= 0.95-0.96). Subjects received DCF strengthening using pressure biofeedback, 2 sets of 10 repetitions, 5 days per week for 4 weeks. “Paired t test” was used within the group to test the change in quantitative data, pre-intervention and post-intervention. For the correlation between VMO & CVA, Pearson’s correlation coefficient test was used. Results. Strengthening of DCF using pressure biofeedback was effective in improving CVA & VMO (p value

Background: This review aimed to comprehensively investigate the impact of Hormone Replacement Therapy (HRT) on implant osseointegration and bone loss. The study considered factors such as HRT type, osteoporosis, smoking, and diabetes mellitus, and analysed the available literature to provide insights into the association between HRT and implant outcomes. Methods: Multiple databases were utilized, and studies with diverse designs and methodologies were included that examined the relationship between HRT and implant osseointegration. The selected studies were analyzed and relevant data on implant success rates, bone loss, and other correlations was extracted. Results: The review findings indicate that HRT has a detrimental impact on implant osseointegration, as evidenced by lower implant success rates and increased bone loss in HRT-treated individuals. The odds ratio analysis further strengthens this association, with significant values of 0.59 (95% CI: 0.50–0.70) and 0.64 (95% CI: 0.54–0.76), indicating a higher likelihood of implant failure in HRT-treated patients., highlighting the need for caution when considering HRT as a treatment option in patients undergoing implant procedures. Smoking and diabetes mellitus were also found to significantly affect implant outcomes, emphasizing the importance of addressing these factors in patient management. Conclusion: The assessments demonstrate that HRT adversely affects implant osseointegration and increases bone loss. The results suggest the importance of considering the potential negative impact of HRT on implant outcomes and the need for thorough patient evaluation and management. Further research is warranted to explore the underlying mechanisms, assess the impact of specific HRT types and dosages, and evaluate preventive strategies to mitigate the detrimental effects of HRT on implant success.

Background: Gastric adenocarcinoma in Indian patients’ is on the rise. A high level of plasma von Willebrand factor (vWF) is associated not only with the development of cancerassociated thrombosis but also with the degree of malignancy, the rate of metastasis, and cancer prognosis. Aims and Objectives: The aim of this study was to study the association of vWF with tumor location, TNM staging, and grades of tumor differentiation in gastric adenocarcinoma and to assess the usefulness of circulating vWF levels as a potential biomarker for gastric adenocarcinoma. Materials and Methods: This study is a prospective observational study done in the Department of Surgical Gastroenterology, Madurai Medical College, Madurai, over a period of 2 years between September 2020 and August 2022. Fifty cases of gastric cancer and 50 controls were recruited and vWF levels were analyzed. Results: Among the 50 gastric cancer patients, 8% belonged to Stage II, 62% belonged to Stage III, and 30% belonged to Stage IV. vWF was elevated in Gastric Cancer patients compared to control group. Mean value of vWF in Cases and Control population was 3.68 ng/ml and 0.58 ng/ml respectively (p value 0.0005). Pertaining to Stage, the vWF value was, Stage II – 4.7, Stage III – 3.3, and Stage IV – 4.1 ng/mL. With respect to tumor differentiation, the vWF values were, poorly differentiated – 4.7, moderately differentiated – 3.0, and well differentiated – 3.9 ng/mL. Conclusion: vWF values were significantly elevated in gastric cancer patients. Based on the results, vWF can be used as a surrogate marker to predict the tumor differentiation in patients, thereby prognosticating the disease. Stage-wise, there was no significant difference in the vWF values.

Background There has been increasing emphasis towards adopting strengths-based practice (SBP) within adult social care in England. Whilst there is agreement that SBP is the right approach to discharge adult social care duties, there is limited evidence regarding the implementation of SBP. This paper presents findings from the evaluation of the implementation of SBP in fourteen local authorities in one region in England. Methods We employed a mixed methods research design, drawing on data from a scoping review, 36 interviews with practice leaders and two surveys, one with wider adult social care staff and the other, with external organisations like independent care providers and community and voluntary organisations. Our data collection and analysis were guided by two well established implementation theories: the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT). Interviews were analysed deductively, and surveys were analysed descriptively. Results Local authorities are at different stages in their implementation journey. The Care Act 2014 and support for SBP demonstrated by key professional groups were seen as major drivers for implementing SBP. Whilst SBP resonated with the professional principles of social workers and occupational therapists, staff did not always have the confidence and skills to adapt to SBP. Changing paperwork and recording systems, providing training opportunities to develop staff competencies, establishing new care pathways, genuine co-production, and senior management buy-in were key enablers supporting implementation. Conclusions To successfully implement SBP, a whole system approach that meaningfully collaborates with key professionals across sectors is essential. When implemented well, SBP has the potential to empower individuals by focusing on what matters to them.

Background: A stroke is described as a sudden neurological deficit with a focused vascular origin. Atrial fibrillation, carotid stenosis, myocardial infarction, hypertension, diabetes, hyperlipidaemia, obesity, smoking and atrial myxomas are all risk factors for stroke. Stroke mortality in urban India accounts for 1% of all hospital admissions, 4% of all medical cases, and around 20% of all central nervous system illnesses. Diabetes, hypertension, smoking, and hyperlipidaemia are risk factors for stroke and have been linked to alterations in haematology and coagulation, including elevated fibrinogen levels. Methodology: The present case-control study was conducted among 50 cases of acute stroke and 50 controls without stroke history. Plasma fibrinogen of 50 consecutive patients with acute stroke presenting to the OPD/Casualty or getting admitted to Shri Ram Murti Smark Institute of Medical Sciences was compared with 50 controls who is not suffering from stroke. An unpaired t-test was applied to compare the mean fibrinogen level of the two groups. For statistical significance p value less than 0.05 was taken with 95% confidence interval. Result: fibrinogen level among the control group (267.0±98) was low compared to patients with overall stroke (428.8±97.8), either ischemic (470±80.5) or haemorrhagic stroke (387.6±97.6). Conclusion: Patients with Ischemic Stroke having a mean Fibrinogen level of (508.8 mg/dL ± 74.6) and haemorrhagic stroke with 487.5±66 mean fibrinogen level had the worst outcome. There was a significant difference in mean fibrinogen levels among survival and non-survival groups of patients in ischemic and haemorrhagic stroke.

Adenoid cystic carcinoma (AdCC) is a malignant salivary gland neoplasm that presents as an indolent but aggressive neoplasm. AdCC histogenesis is linked to the intercalated ducts of the salivary glands, equally affecting the major and minor glands. AdCC is associated with distant metastasis, most commonly to the lungs, and a high recurrence rate. AdCC accounts for 4.2% of all tumors. About 55% of all reported cases affect the submandibular gland, and around 50% of AdCC cases occur in the minor salivary glands. The present review describes a case of AdCC which presented a single nodular swelling on the right side involving the floor of the mouth. It also consolidates the histopathological profile of a case of AdCC with all the relevant histopathological features.

In most healthy individuals, intermittent fasting during Ramadan, which occurs just once a year, could have positive effects on metabolic consequences. That even though there are several exceptions to fasting, many Muslims who have medical issues choose to fast. This may have a significant influence on their health if not addressed properly. The health consequences of Ramadan fasting have recently sparked renewed study. This study is designed to evaluate the effect of fasting in Ramadan on the level of some metals and minerals compare these levels with a control group that is not fasting during Ramadan and show the effect of Ramadan on the health of fasting people. It was a study consisting of two categories. The first group was composed of 50 people (males and females) who fasted during Ramadan, while the second group was composed of 50 people who ate and drank during Ramadan. From both groups tacked 5 ml of venous blood to estimate the concentration of metals which include: cadmium (Cd), lead (Pb), copper (Cu), zinc (Zn), calcium (Ca), chromium (Cr), magnesium (Mg), potassium(K) and sodium (Na) during Ramadan month. The present study found that the concentration of cadmium, lead, copper and magnesium increase significantly in fasting group as compared to control group (with p- value =0.001 for Cd and p= 0.000 for other). whereas no significant difference in concentration of calcium, sodium and potassium between the fasting and control group. The results showed that fasting in Ramadan not affect the level of calcium, sodium and potassium, whereas the levels of cadmium, lead, copper, magnesium and chromium were affected, since they increased during fasting except chromium decreased. However, observing healthy food guidelines while fasting throughout Ramadan can lessen these alterations.

Key Clinical Message Patients of Bullous Pemphigoid with predominant lymphocytic inflammatory infiltrate on histopathology have a severe form of the disease requiring high doses of steroids along with an adjuvant immunosuppressant. Thus, the histopathological evaluation would predict the severity of Bullous Pemphigoid, especially in countries where ELISA and immunofluorescence are not readily available.

This case report explores a rare manifestation of Becker’s nevus, where the patient exhibited an unusual dermatomal distribution featuring a hyperpigmented, irregular patch with associated hypertrichosis on the T4 segment. While Becker’s nevus is a well-known dermatological condition typically observed in the upper back region, instances of dermatomal distribution are exceptionally uncommon. This case presents a unique occurrence of segmental Becker’s nevus, highlighting the atypical presentation of this condition.

Introduction: The hazard of smoking is not only limited to the general health risks but also makes the smokers more vulnerable to various perioperative complications ranging from pulmonary complications to delayed wound healing to cardiovascular events. Methodology: This is an observational study in the department of general surgery of a tertiary care teaching hospital over a period of 24 months (May 2019–April 2021). Patients between 18- and 60-year age undergoing noncardiac elective surgical procedures were included in the study. Results: A total of 240 patients, meeting the inclusion criteria, posted for elective, noncardiac surgery were enrolled in this prospective observational study. In smoker patients’ group (n = 138) undergoing surgery, 42 (30.4%) patients developed postoperative complications as compared to 12 (11.8%) patients in nonsmoker group (n = 102). The risk of postoperative complications among smokers was 3.2 times (odds ratio [OR], 95% confidence interval [CI]: 1.62–6.63) (P ≤ 0.0009). Smokers with pack-years > 11 had 3.8 times increased risk of postoperative complications as compared to nonsmokers (OR, 95% CI: 1.85–8.098) (P ≤ 0.0003). Conclusion: Our study aims to add to existing evidence and improve our understanding of delayed wound healing and major complications in smoker patients as surgical cases. Nonsmokers are at a lesser risk than smokers in postoperative complications. Awareness regarding the harmful effects of smoking and its influence on postoperative wound healing, motivation for quitting, and abstinence from smoking will help in reducing postoperative complications and better treatment outcomes.

Abstract Inadequate conservation of medicinal plants can affect their productivity. Traditional assessments and strategies are often time-consuming and linked with errors. Utilizing herbs has been an integral part of the traditional system of medicine for centuries. However, its sustainability and conservation are critical due to climate change, over-harvesting and habitat loss. The study reveals how machine learning algorithms, geographic information systems (GIS) being a powerful tool for mapping and spatial analysis, and soil information can contribute to a swift decision-making approach for actual forethought and intensify the productivity of vulnerable curative plants of specific regions to promote drug discovery. The data analysis based on machine learning and data mining techniques over the soil, medicinal plants and GIS information can predict quick and effective results on a map to nurture the growth of the herbs. The work incorporates the construction of a novel dataset by using the quantum geographic information system tool and recommends the vulnerable herbs by implementing different supervised algorithms such as extra tree classifier (EXTC), random forest, bagging classifier, extreme gradient boosting and k nearest neighbor. Two unique approaches suggested for the user by using EXTC, firstly, for a given subregion type, its suitable soil classes and secondly, for soil type from the user, its respective subregion labels are revealed, finally, potential medicinal herbs and their conservation status are visualised using the choropleth map for classified soil/subregion. The research concludes on EXTC as it showcases outstanding performance for both soil and subregion classifications compared to other models, with an accuracy rate of 99.01% and 98.76%, respectively. The approach focuses on serving as a comprehensive and swift reference for the general public, bioscience researchers, and conservationists interested in conserving medicinal herbs based on soil availability or specific regions through maps.

Abstract Fall armyworm (FAW), Spodoptera frugiperda (J.E. Smith) has significantly affected maize crop yields, production efficiency, and farmers’ incomes in the Indian Eastern Gangetic Plains region since it was first observed in India in 2018. A lack of awareness by maize growers of the appropriate selection, method, and timing of insecticide application not only creates a barrier to sustainable FAW control but also contributes to increased environmental pollution, reduced human health and increased production costs. We demonstrated that FAW inflicted the most damage in early whorl growth stage of maize, regardless of whether chemical insecticides were applied. FAW egg masses and larvae collected from maize fields in which no insecticides had been sprayed showed high parasitism rates by parasitoid wasps; in contrast fields that had been sprayed had much lower rates of parasitism on FAW. Ten hymenopteran parasitoids were observed in maize fields across the study region, suggesting a diversity of natural methods to suppress FAW in maize at different growth stages. These included two FAW egg parasitoids and eight FAW larval parasitoids. Microplitis manilae Ashmead was the most abundant FAW larval parasitoid species, and Telenomus cf. remus was the dominant FAW egg parasitoid species. Endemic FAW parasitoids such as those observed in this study have great potential as part of a sustainable, cost-effective agroecological management strategy, which can be integrated with other methods to achieve effective control of FAW.

Abstract Optimization algorithms have come a long way in the last several decades, with the goal of reducing energy consumption and minimizing interference with primary users during data transmission over shorter distances. The adaptive ant colony distributed intelligent based clustering algorithm (AACDIC) is a key component of the cognitive radio (CR) system because of its superior performance in spectrum sensing among a group of multi-users in terms of reduced sensing errors, power conservation, and faster convergence times. This study presents the AACDIC method, which improves energy efficiency by determining the ideal cluster count using connectedness and distributed cluster-based sensing. In this study, we take into account the reality of a system with an unpredictable number of both primary users and secondary users. As a result, the proposed AACDIC method outperforms pre-existing optimization algorithms by increasing the rate at which solutions converge via the utilisation of multi-user clustered communication. Experiments show that compared to other algorithms, the AACDIC method significantly reduces node power usage by 9.646 percent. The average power of Secondary Users nodes is reduced by 24.23 percent compared to earlier versions. The AACDIC algorithm is particularly strong at reducing the Signal-to-Noise Ratio to levels as low as 2 dB, which significantly increases the likelihood of detection. When comparing AACDIC to other primary detection optimization strategies, it is clear that it has the lowest false positive rate. The proposed AACDIC algorithm optimizes network capacity performance, as shown by the results of simulations, due to its ability to solve multimodal optimization challenges. Our analysis reveals that variations in SNR significantly affect the probability of successful detection, shedding light on the intricate interplay between signal strength, noise levels, and the overall reliability of sensor data. This insight contributes to a more comprehensive understanding of the proposed scheme's performance in realistic deployment scenarios, where environmental conditions may vary dynamically. The experimental results demonstrate the effectiveness of the proposed algorithm in mitigating the identified drawback and highlight the importance of SNR considerations in optimizing detection reliability in energy-constrained WSNs.

Background: Digital media consumption is prevalent among pre-schoolers, but its impact on language development remains unclear. Aims and Objectives: This study investigates the effects of different types of digital media on pre-school children’s language outcomes. Materials and Methods: A total of 100 pre-school-aged children (mean age 4.2±0.5 years; 51% male) were observed for 12 months. Digital media exposure was categorized into educational interactive, educational passive, and non-educational content, with average screen time being 1.5±0.45 h daily. Language development was assessed using the Preschool Language Scale-5 (PLS-5) at baseline and 12-month follow-up. Results: At the 12-month follow-up, the study participants exhibited an average Total Language Score (TLS) increase from 100±10 to 107±12. Interactive educational app users showed significant language improvements (TLS: 112±10; P

Introduction: Female fecundity decreases significantly after the age of 32, and rapidly so after age 37. There is no treatment to prevent this decline. Furthermore, globally, women are getting married later and the age at which they have their first child is increasing. As of July 2023, elective egg freezing (EEF) or oocyte cryopreservation (OC) for age-related fertility decline, commenced in Singapore. With medical advancements in OC, EEF is no longer considered experimental. The aim of this review is to examine the existing literature around EEF with regard to reproductive outcomes and its safety, to better guide clinicians in counselling young single women. Method: Published studies were examined to increase understanding on optimal age for EEF, ideal number of oocytes for a live birth, recommended OC protocols, cryopreservation techniques affecting thaw survival or fertilisation, oocyte storage and pregnancy risks. Results: Models predict that EEF should be performed at age

Background: An outbreak of fever and cough was notified to public health authorities by the management of school X among their students, Kozhikode district, Kerala, on Jan 1, 2020. We conducted an outbreak investigation to confirm the diagnosis, describe the case patients by time, place, and person, and propose appropriate recommendations. Materials and Methods: We defined a probable case of influenza as any student or staff of school X, Kozhikode district with a fever and cough between Dec 30, 2019, and Jan 14, 2020. We conducted an active case search and contact tracing in the school. We described the cases by date of symptom onset using an Epicurve, plotted cases by their classroom, and calculated the attack rate by age, and gender. Results: We identified 270 cases of influenza; among them, 264 (98%) were students, and 6 (2%) were the staff. The overall attack rate was 36%. The attack rate was higher among the students (39%) than the staff (12%, 6/49, P < 0.0003). The attack rate was higher among students of class 10E (90%, 37/41) and class 10A (80%, 33/41), where the index case had contact with the students during the symptomatic phase. Conclusion: An outbreak of influenza A (H1N1) occurred among students and staff, predominantly affecting the 10th division. School and health authorities implemented several interventions to limit the outbreak, including training students on personal hygiene. We recommended conducting surveillance of influenza, maintaining adequate spacing of benches, self-hygiene practices, and classroom ventilation.

Introduction: Drug-induced lichen planus is a cutaneous adverse effect that manifests as a systemic eruption of flat-topped, erythematous, or violaceous papules resembling lichen planus on the trunk and extremities. Although antitubercular therapy has been linked to cutaneous hypersensitivity reactions, the literature on such cases is scarce. Here, we present a case to contribute to this field, reporting on its presentation and management, and reviewing previous case studies. Case Report: Our patient, a 63-year-old male, presented with black pigmented patches on the skin, having been diagnosed with pulmonary tuberculosis and on antitubercular therapy for the past two months. A diagnosis of ATT-induced lichen planus was made, and all ATT was stopped. The patient was treated with antihistamines, apremilast, tacrolimus, and corticosteroids, and rechallenge of each drug was performed consecutively. No new lesions appeared after rechallenge with isoniazid and rifampicin. However, ethambutol was not reintroduced due to strong suspicion, by exclusion, that it was the offending agent, whereas on rechallenge with isoniazid and rifampicin, the patient's skin lesions gradually improved with eventual resolution of hyperpigmentation. Discussion and Conclusion: Lichenoid drug eruptions are characterized by type IV hypersensitivity reactions, and rechallenge is required to ensure safer treatment since the risk of disseminated and multi-drug-resistant tuberculosis increases with the cessation of antitubercular therapy.

Abstract In the present work, the Nickel oxide (rGO–NiO), Silver (rGO–Ag), Copper oxide (rGO–CuO) doped Graphene Oxide are reported for catalytic reactions. A comparative study for catalytic activities of these materials are performed with nitroaromatic compound 4-nitroaniline and the results are statistically studied by using univariate analysis of variance and Post Hoc Test through Statistical Package for Social Sciences and it is observed that CuO doped Graphene material is showing better catalytic activity in minimum time. So, further research has been focused on the catalytic acitivity of rGO–CuO only and it is found that it is efficient in reducing other nitro compounds also such as Picric acid and Nitrobenzene. Dye degradation of Methylene blue is also performed using CuO decorated Graphene material and significant changes were observed using UV spectroscopy. The characterization of rGO–CuO is done with Fourier-transform Infrared Spectroscopy, Powder X-ray Diffraction, Thermogravimetric Analysis, Scanning Electron Microscope and Transmission Electron Microscopy.

Abstract Advanced molecular and cellular technologies provide promising tools for wildlife and biodiversity conservation. Induced pluripotent stem cell (iPSC) technology offers an easily accessible and infinite source of pluripotent stem cells, and have been derived from many threatened wildlife species. This paper describes the first successful integration-free reprogramming of adult somatic cells to iPSCs, and their differentiation, from three endangered Southeast Asian primates: the Celebes Crested Macaque (Macaca nigra), the Lar Gibbon (Hylobates lar), and the Siamang (Symphalangus syndactylus). iPSCs were also generated from the Proboscis Monkey (Nasalis larvatus). Differences in mechanisms could elicit new discoveries regarding primate evolution and development. iPSCs from endangered species provides a safety net in conservation efforts and allows for sustainable sampling for research and conservation, all while providing a platform for the development of further in vitro models of disease.

Abstract The study presents the first to characterize novel Erucastrum canarianse Webb and Berthel (or Can) sterile cytoplasm-based CMS lines in Indian cauliflower (Brassica oleracea var. botrytis L.) and investigating their commercial suitability. Eleven Can-based CMS lines were examined for 12 agro-morphological and yield traits,18 floral traits, four seed yield traits together with three each of the Ogura (source: wild Japanese Radish) and Tour (Source: Brassica tournefortii) cytoplasms. All of the recorded floral and seed traits showed significant (P > 0.05) differences between the CMS lines of each group. Agro-morphological and yield traits in CMS lines and their maintainers, however, were non-significantly different. All the Can- and Ogura-based CMS lines showed flowering and appropriate seed formation by natural cross-pollination. Only two Tour cytoplasm-based CMS lines, Tour (DC-41-5) and Tour (DC-67), produced the smallest malformed flowers and stigma. The highest seed yield per plant in CMS lines was in Ogu (DC-98-4) and the lowest in Tour (DC-67). P14 and P15, two polymorphic mtDNA markers, were discovered for the Can CMS system for early detection. Five primers (ITS5a-ITS4, atpF-atpH, P16, rbeL and trnL), along with their maintainers, were sequenced and aligned to detect nucleotide changes including as additions and or deletions at different positions. The newly introduced E. canariense sterile cytoplasm-based CMS system in cauliflower is the subject of the first comprehensive report, which emphasises their potential as a further stable and reliable genetic mechanism for hybrid breeding.

Abstract The genitourinary symptom of menopause (GSM) affects up to 65% of women, resulting in symptoms such as vulvovaginal dryness, discomfort, and dysuria, which significantly impacts quality of life. The current assessment methods rely on subjective questionnaires that can be influenced by individual differences, as well as invasive measurements that are time-consuming and not easily accessible. In this study, we explore the potential of a non-invasive and objective assessment tool called diffuse reflectance spectroscopy and imaging (DRSI) to evaluate tissue chromophores, including water, lipid, oxyhemoglobin, and deoxyhemoglobin. These measurements provide information about moisture content, lipid levels, oxygen saturation, and blood fraction, which can serve as surrogate markers for genital estrogen levels. Our findings reveal distinct differences in these chromophores among pre, peri, and postmenopausal subjects. By using lipid and blood fraction tissue chromophores in a K-Nearest Neighbour classifier model, we achieved a prediction accuracy of 65% compared to vaginal maturation index (VMI) that is clinically used to assess estrogen-related hormonal changes. When age was included as the third feature, the accuracy increased to 78%. We believe that by refining the study protocol and configuring the fiber probe to examine tissue chromophores both in the superficial vulva skin for epidermal water content and the deeper layers, DRSI has the potential to provide objective diagnosis and aid in monitoring the treatment outcome of GSM.

Digital Imaging and Communications in Medicine (DICOM) is a paradigm that enables interoperability between health-related digital applications, imaging devices, and Picture Archiving and Communications Systems (PACS). DICOM has its foundation in the USA, established by the American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA) in 1983 with the objective of establishing a “gold standard” for monitor and print-copy devices. In 1996, the American Dental Association (ADA) became a member of DICOM, followed by the American Academy of Oral and Maxillofacial Radiology and the American Association of Orthodontics. A working committee specifically for dentistry (WG-22) was initiated in 2003, and in 2005, it was finally adopted as an international standard. Currently, it is internationally recognised as the standard configuration for compatibility between dental radiological images and various scanners and digital X-ray devices. DICOM synchronises network communication and facilitates the exchange of patient data through a transmission protocol. The purpose of the present paper is to emphasise the reliance of digital dentistry on DICOM and its relationship with Three-Dimensional (3D) printing.

Plant compounds such as flavonoids, terpenoids, polyphenols, enzymes, and alkaloids are used as reducing agents in eco-friendly titanium dioxide nanoparticle manufacturing. In the current investigation, titanium oxide was converted into titanium dioxide nanoparticles with the application of a lemon extract. Amazingly, the process was also cheap, eco-friendly, and easy to implement. Seeing the white fluid change to a pale yellowish white allowed us to visually confirm that the nanoparticles had been successfully created. Transmission electron microscopy (TEM) and ultraviolet-visible spectroscopy were employed for further characterization. Nanoparticles of titanium dioxide were measured to be between 30 and 45 nm in size. In the DPPH assay, a titanium dioxide nanoparticle concentration of 50 L was shown to be optimal for antioxidant activity. The results of the bovine serum albumin denaturation experiment validated the green produced nanoparticles' dose-dependent anti-inflammatory effect. Consequently, the green synthetic titanium dioxide nanoparticles have great potential as an anti-inflammatory and antioxidant in future medicinal applications.