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Introduction: Breast pathology encompasses a wide spectrum, ranging from benign conditions to invasive cancers, posing significant diagnostic challenges. Most breast lesions are usually divided into benign and malignant disorders, and their prognosis can often be reasonably predicted. However, certain tumours exhibit borderline characteristics and occupy a grey area between benign and malignant, making it difficult to forecast their course with any degree of accuracy. Aim: To assess the histopathological spectrum of benign and borderline breast lesions. Materials and Methods: This cross-sectional study, conducted over a period of five years (January 2019 to December 2023) at Shyam Shah Medical College, Rewa, Madhya Pradesh, India analysed 831 cases of breast lesions to determine their clinicopathological features, such as laterality of the breast and gross features. Grossing of the specimens was performed, and details were noted. Tissue pieces were processed, and sections were stained using conventional Haematoxylin and Eosin (H&E) staining. Results: Out of 831 breast lesions, 640 (77.0%) cases were benign, 15 (1.8%) were borderline, and 176 (21.2%) were malignant. Fibroadenoma was the most frequent lesion in females with 419 cases (50.4%), with a mean age of 21.4 years. In males, gynaecomastia was the most common finding in 21 (2.5%), with a mean age of 17 years. The second most common lesion overall was fibrocystic disease 148 (17.8%), with a mean age of 33.5 years. Other benign lesions included inflammatory breast diseases 21 (2.5%), lactational adenoma 2 (0.24%), sclerosing adenosis 7 (0.84%), microglandular adenosis 8 (0.96%), tubular adenoma 7 (0.84%), benign phyllodes 4 (0.48%), and lipoma and hamartoma 3 (0.36% combined). Borderline lesions included atypical ductal hyperplasia 9 (1.08%), ductal carcinoma in-situ 3 (0.36%), and borderline phyllodes tumours 2 (0.12%). Conclusion: In the study population, the range of benign breast diseases appears consistent with findings from other studies, with fibroadenoma emerging as the predominant benign lesion, followed by fibrocystic changes. While premalignant lesions were less prevalent in present study, a thorough evaluation of all cases of breast lesions is recommended to rule out the potential for breast cancer.

Abstract A highly efficient approach for synthesizing a supramolecular metallogel of Co(II) ions, denoted as CoA-TA, has been established under room temperature and atmospheric pressure conditions. This method employs the metal-coordinating organic ligand benzene-1,3,5-tricarboxylic acid as a low molecular weight gelator (LMWG) in DMF solvent. A comprehensive analysis of the mechanical properties of the resulting supramolecular Co(II)-metallogel was conducted through rheological investigation, considering angular frequency and thixotropic study. The hierarchical rocky network structure of the supramolecular Co(II)-metallogel was unveiled using field emission scanning electron microscopy (FESEM). Transmission electron microscopic (TEM) analysis showed rod-shaped structures via low-magnification high angle annular dark field (HAADF) bright field scanning transmission electron microscopic (STEM) imaging, while energy dispersive X-ray (EDX) elemental mapping confirmed its primary chemical constituents. The formation mechanism of the metallogel was examined via fourier transform infrared spectroscopy (FTIR) spectroscopy. The nature of the synthesized CoA-TA metallogel was affirmed through powder X-ray diffraction (PXRD) analysis. Furthermore, this study involved fabrication of Schottky diode structures in a metal-semiconductor-metal geometry based on cobalt(II) metallogel (CoA-TA), enabling observation of charge transport behavior. Remarkably, a resistive random access memory (RRAM) device utilizing cobalt(II) metallohydrogel (CoA-TA) demonstrated bipolar resistive switching at room temperature and under ambient conditions. The switching mechanism was investigated, revealing the formation and rupture of conductive filaments between metal electrodes that govern the resistive switching behavior. This RRAM device exhibited an impressive ON/OFF ratio (~ 414) and exceptional endurance over 5000 switching cycles. These structures offer great potential for diverse applications such as non-volatile memory design, neuromorphic computing, flexible electronics and optoelectronics. Their advantages lie in their fabrication process, reliable resistive switching behavior and overall performance stability.

Background Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) coinfection has emerged as a leading cause of morbidity throughout the world in the last two decades. The coronavirus disease 2019 (COVID-19) pandemic has escalated the disease burden further by increasing the number of intravenous (IV) drug abusers and unemployment. Aim The present study was done to analyse the impact of COVID-19 on seroprevalence as well as trends during pre, post and pandemic years of coinfection and mono-infections in the Malwa region of Punjab. Setting and Design This descriptive cross-sectional study was done in the department of immunohematology and blood transfusion at a tertiary care hospital. Materials and Methods The data on transfusion-transmitted infections (TTIs) was collected for a period of four years from 2019 to 2022, that is, pre, post and during the pandemic period. All the blood samples were screened for viral markers, HIV I and II, HCV, and hepatitis B surface antigen (HBsAg) using the enzyme-linked immunosorbent assay (ELISA) technique. Malarial antigen and syphilis infection testing was done using a rapid diagnostic card test. The total number of sero-reactive cases and their distribution were noted. Results A total of 58,953 donors were screened and included during the study period. Each blood donor was identified by a donor registration number. The overall TTI seroprevalence in blood donors was 2.83% (n = 1670). The seroprevalence of TTIs in blood donors showed an increasing trend for HIV, HCV, and HBsAg in 2019–2021, whereas there was a decrease in reactivity status in the 2022 (back to pre-pandemic year). There was a significant increase in the coinfection rate from 0.1% to 0.25%. Conclusion The COVID-19 pandemic impact on the coinfection rate of TTI was significant. To curb these TTIs and coinfections, education and public awareness are the key factors. India is a developing country, so transfusion medicine specialists need to work day and night to practice safe blood services.

Background The Government of India undertook several measures for COVID-19 pandemic, of which school closure was one. This led to sudden shift of teaching methods from classroom-based to online mode. This study aimed to understand the effects of school closure on children during lockdown period. Methods This was a community-based qualitative study conducted in Faridabad District, Haryana, India, from January 2022 to February 2022. Two focus group discussions (FGDs) with school students of 8th standard and above and two FGDs with parents of school students below 8th standard were conducted. In-depth interviews were conducted with two school headmasters, two teachers, a Senior Medical Officer (SMO), District Education Officer (DEO), and District Elementary Education Officer (DEEO). Responses were recorded, transcribed, and reviewed to identify themes, and thematic analysis was done. Four major themes were framed—academic, physical, behavioral, and psychosocial. Results Decreased academic performance, teacher-student interaction, and distraction from the study were found in academic domain. There was reluctance to go back to school reopening. Low physical exercise, irregular sleep cycles meal skipping, and increased screen time were noticed. Limited mid-day meal nutrition was available. Increased fear, anxiety, and loneliness were faced along with an increase in household quarrels and violence. An increase in the number of child marriages was also reported. Few students had positive impacts like improvement in hygiene practices, learning new hobbies, and skills. Conclusion School closure had impact on the physical, mental, socio-behavioral, and academic aspects of school-going children. In case of similar events in the future, these impacts must be kept in mind by policymakers to achieve a balance between effective pandemic control and fruitful childhoods.

Background: Over the last decade, the rate of cesarean sections has steadily increased owing to various reasons, and along with it the incidence of wound sepsis. Different risk factors identified are maternal age, socioeconomic status, educational status, antenatal visits, pregestational diabetes, obesity, recurrent pregnancy losses, duration of surgery, preterm rupture of membranes, etc. Hence, assessing infections and their management is an integral part of health care, as it helps develop strategies for prevention, better management of infection, reducing the hospital stay, and cost of healthcare. Aims and Objectives: The aim of the study was to assess and note the variability of social and demographic profiles of patients undergoing cesarean sections and developing wound infection, along with its various presentations and categories. Materials and Methods: A prospective observational study was conducted on patients who developed wound sepsis after undergoing cesarean section at a tertiary center in India. Results: Among the patients enrolled, 35.83% were illiterate and 45.83% were educated up to the tenth standard. About 74% of patients were not registered during the antenatal period. Furthermore, the majority of patients were overweight and obese (74%) and were from lower socioeconomic strata. About 85% of the patients who developed wound infection had their surgery lasting for more than 60 minutes. About 87.50% developed a superficial category of infection, and 68.33% presented within the first 5 days of surgery. Patients with deep infected wounds had significantly bigger wounds and longer hospitalization. Conclusion: Illiteracy and lower socioeconomic conditions predispose women to wound sepsis. A longer duration of surgery was associated with a higher risk of infection. Superficial wounds are the most common type of infection encountered. Deep and organ space categories of wound infection are associated with increased morbidity and longer hospitalization warranting aggressive management. Reducing the incidence of wound sepsis can help to reduce morbidity by identifying risk factors before pregnancy and supporting the implementation of preconception counseling centers and prenatal programs to educate and raise awareness among patients.

Introduction: Measles, a highly transmissible disease marked by fever and a maculopapular rash, posed a substantial threat to life in the 1960s. Nevertheless, the advent of the measles vaccine had a profound impact, significantly diminishing its toll on mortality. Similarly, through effective influenza surveillance and early epidemic warning systems, public health officials can timely identify influenza trends and provide crucial scientific support for prevention and control measures. This proactive approach holds great public health significance. Aim: To analyse the long-term trend of measles cases in Rajasthan, India, and the impact of Coronavirus Disease-2019 (COVID-19) on it, with future predictions using Auto-Regressive Integrated Moving Average (ARIMA) modelling. Materials and Methods: The present study was a retrospective, descriptive observational study in which monthly diagnosed measles cases were collected from the Measles Rubella Laboratory, Department of Microbiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India, for the period of April 2010 to April 2023. An ARIMA model was developed using data from 2010 to 2020 to predict the monthly number of measles cases in 2021. The predicted values were then compared to the actual cases in 2021 to assess the model’s accuracy. Results: Out of the total positive cases, males were slightly more prone to acquire infection than females (1734 males, 54%; 1477 females, 46%). The monthly index for new measles cases ranged from 0.11 to 2.6. It reached its lowest point in July (0.106) and August (0.25) and peaked in March (2.594) and April (1.84). The overall trend was fluctuating; however, the incidence of measles cases clearly increased after the year 2021. The difference between observed cases and predicted cases for the period of April 2020 to December 2021 was not statistically significant (t-value=0.261 and p-value=0.797). Conclusion: The fluctuating trend of measles was observed during the last decade; however, the observed cases of measles showed an upward trajectory during and after the COVID-19 outbreak. This study also highlighted the monthly index of the measles cases, which peaked in March to April and was lowest in July to August.

Infections due to Non Typhoidal Salmonella (NTS) are emerging as a major health problem for both humans and animals worldwide including in India. In humans, NTS infections routinely remain restricted to the intestinal tract and may or may not manifest as a clinical illness but in immunocompromised patients systemic involvement may result in frank bacteraemia or focal involvement depending on the site of localisation. A 70-year-old, male presented to the Emergency Department with complaints of pain for about five days, on the right side of the scrotum. A drained pus sample was received at the Department of Microbiology for culture and sensitivity. Salmonella kentucky was identified by standard microbiological techniques. Here the authors present a case of scrotal abscess caused by Salmonella kentucky in an old immunocompromised patient and this possibly appears to be the first case report of scrotal involvement from India. No single diagnostic approach may be able to identify the NTS up to the species level. To determine the identity of organisms in cases where individual labs may not have the necessary capacity to produce the results, it would be extremely sensible from a scientific standpoint to create a network of cooperating labs with varying diagnostic capacities.

Compound heterozygous Sickle Haemoglobin (HbS) beta (β) thalassaemia arises from the mutations associated with sickle cell and β thalassaemia and significantly affects populations in low income countries like India. Elevated levels of Haemoglobin A2 (HbA2) represent the primary indicator for identifying carriers of β thalassaemia. However, it’s worth noting that sometimes, High Performance Liquid Chromatography (HPLC) encounters challenges in confirming a final diagnosis when levels of HbA2 and HbS fall outside the diagnostic range. A nine-year-old male and his sister 11-year-old female patient presented with high-grade fever and jaundice since two weeks. Following admission, Complete Blood Count (CBC) and HPLC of both children were done. Hb of male and female child revealed 1.8 g/dL and 1.5 g/dL, respectively. HPLC of male child revealed Haemoglobin F (HbF) 27.4%, HbS 56.3%, HbA2 3.8% and of female child revealed HbF 39.2%, HbS 43.5%, HbA2 3%. HPLC reports of both children were suggestive of differential of compound heterozygous HbS β thalassaemia and HbS homozygous. Later, HPLC of their parents was also done. HPLC of father was suggestive of thalassaemia trait and of mother suggestive of sickle cell trait, following which final diagnosis of both children was given as compound heterozygous HbS β thalassaemia. Diagnosing these compound heterozygous haemoglobinopathies can be challenging. As their is resemblance in clinicopathological features of sickle cell anaemia and β thalassaemia disorders, it is important to carefully differentiate between them although prognosis is better than thalassaemia major or sickle cell anaemia.

Background: Blood transfusions play a pivotal role in medical care, saving millions of lives annually. The timely provision of safe blood is critical in various clinical scenarios, necessitating a careful balance between supply and demand. Despite advanced blood banking facilities globally, challenges persist in ensuring appropriate blood component utilization, prompting a need for clinical audits and optimization strategies. Aims and Objectives: This study aims to analyze the patterns of blood product utilization in a tertiary care hospital in Madhya Pradesh over 1 year, focusing on transfusion requests, cross-match-to-transfusion (C/T) ratios, transfusion indices (TIs), and indications for transfusions. Materials and Methods: A retrospective study was conducted at Shyam Shah Medical College from January 01, 2023, to December 31, 2023. Data from transfusion and cross-match requests in various departments were collected. C/T ratios, TI, and non-usage probability were computed to assess blood utilization efficiency. Results: Out of 16,682 cross-matched units, 71.93% were transfused. The overall C/T ratio was 1.39. The department of medicine demonstrated the most efficient blood usage with a C/T ratio of 1.16. Obstetrics and gynecology had the highest TI (1.06), while surgery had the lowest (0.71). Indications for transfusion included anemia (29.9%), pre-operative (17.2%), intraoperative (21.8%), and post-operative (31.1%). Conclusion: This study provides valuable insights into blood utilization patterns, offering a foundation for refining transfusion practices and enhancing the efficiency of blood management in the studied tertiary care hospital.

Background: Salivary gland tumors (SGTs) globally account for

Background: SARS-COV virus operates as a significant risk factor for invasive fungal aspergillosis and mucormycosis. Successful management of this fulminant infection requires early recognition of the disease and aggressive medical or surgical interventions to prevent the high morbidity and mortality associated with the disease process. Aims and Objective of the Study: 1. To isolate and identify different species of fungi among acute rhinosinusitis patients. 2. To assess the association of risk factors causing fungal rhinosinusitis. 3. To assess the changing trend in fungal rhinosinusitis during the COVID era. Material and Methods: This is a retrospective observational study conducted from May 2020 to October 2022, attending the ENT department and relevant data were collected from the medical records department of ABVIMS and Dr RML Hospital, New Delhi, a Tertiary Care Referral Centre in India. The major risk factors studied were age, gender, COVID-19 infection and underlying diseases (such as diabetes mellitus, ischaemic heart disease, hypertension, malignancies, chronic kidney DISEASES, etc.); details of corticosteroid use of all patients were recorded in the datasheet. The pandemic data was divided into three distinct time periods/waves/eras, i.e., first, second, and third waves, each of which included ten months, to examine the changing trend in fungal rhinosinusitis in the pandemic era of COVID-19. Results: A total of 412 patients out of which 236 patients were clinically diagnosed with fungal sinusitis based on revised EORTC criteria. The most common site involved was the orbit with paranasal sinus and eye 86/236 (36.4%), followed by involvement of nasal and paranasal sinus alone 68/236 (28.8%). The most prevalent age range affected was 40 to 50 years. The most commonly associated comorbidity was diabetes mellitus (DM) in 176 (74.5%), followed by head and neck malignancies in 22 (9.32%) patients. Thirty-eight (50.6%) Rhizopus species and 18 (24%) Aspergillus flavus were the most common isolated fungal species on culture, followed by Mucor spp. 14 (18.6%) and Aspergillus fumigatus 5 (6.6%) in the period. In the second wave of COVID, there was a surge in Zygomycetes cases 36 (45%) and after the second wave, the Aspergillus cases increased by 14 (19%) during Jan-Oct 2022. Conclusion: With the continuing coronavirus pandemic, there is an unprecedented and discernible rise in the prevalence of acute invasive fungal sinusitis certainly a spike in cases of Aspergillus infection was observed, probably due to unprecedented usage of Amphotericin B for the treatment of mucormycosis during the third wave This underlines the importance of the need to tailor our treatment protocol as per the etiological agents hence the right antifungal drugs combined with urgent surgical procedures on a case-to-case basis may certainly increase the chances of survival.

Introduction: Cervical cancer is the second most common gynaecological malignancy worldwide. Persistent Human Papillomavirus (HPV) infection is the principal risk factor leading to cervical carcinogenesis and causes a large number of casualties. Aim: To estimate the risk factors and symptoms related to cervical carcinoma and to check for mono-infection or co-infections of low-risk and high-risk HPVs in Northern Indian females. Materials and Methods: This cross-sectional study was conducted from January 2019 to January 2021 on 110 confirmed cervical cancer tissue samples collected from the Department of Obstetrics and Gynaecology at Pandit BD Sharma University of Health Sciences, Rohtak, Haryana, India. Information about risk factors and symptoms was collected using a semistructured proforma. Detection of HPV infection and HPV genotyping (16, 18, 33, 58, 6, and 11) was done by using type-specific Polymerase Chain Reaction (PCR). Fisher’s exact test was applied to determine the association of high-risk HPV infection with other risk factors using GraphPad Prism Version 6 (La Jolla, California, USA). A p-value of ≤0.05 was considered significant. Results: Of all the studied cases, 68 (62%) were above 55 years old, 67 (61%) were in a postmenopausal state, and 86 (78%) were from a rural background. Irregular menstruation was observed in 99 (90%) cases, bleeding after menopause in 59 (54%) cases, and early age at first intercourse in 57 (52%) cases were the most common symptoms. HPV infection was found in all cases of cervical carcinoma. The incidence of high-risk-HPV16 (84%) and HPV18 (73%) was the most prominent, while the incidence of low-risk-HPV6 (7.2%) and HPV11 (6%) was the lowest. Co-infection of HPV16/18 was the Highest in 60 (54.5%) cases, followed by HPV16/33 in 13 (11.8%) cases. Multi-infection of HPV types 16/18/33 was found in 10 (9.1%) cases, and multi-infection of HPV types 16/18/33/6/11, except HPV58, was found in one patient. Conclusion: Higher age, postmenopausal status, early age at intercourse, and poor menstrual hygiene were significantly associated with high-risk HPV co-infection. Educating women about the risk factors and symptoms of cervical cancer and screening for high-risk HPVs in rural women are required to reduce the prevalence of cervical cancer in Northern India.

Introduction Tuberculosis (TB) continues to be one of the deadliest infectious diseases over the centuries, killing more people worldwide than any other single infectious disease. There is an urgent need for additional strategies which can expedite efforts to combat TB including a preventive vaccine. In this endeavour, we have developed a protocol for a multisite, double-blind, placebo-controlled clinical trial in India that aims to evaluate the efficacy and safety of two TB vaccines; namely, VPM1002 and Immuvac (M.w) (Mycobacterium Indicus Pranii) (MIP) among healthy household contacts (HHCs) of sputum smear-positive pulmonary TB (PTB) patients.Methods and analysis In the three-arm randomised double-blind placebo-controlled trial study protocol, a total of 12 000 HHCs (aged 6−99 years) of sputum smear-positive PTB patients will be randomised to receive either of the two vaccine candidates VPM1002 and MIP or placebo. The primary efficacy endpoint is the prevention of microbiologically confirmed TB. Secondary endpoints will include (1) prevention against Latent TB infection, (2) incidence of adverse events and serious adverse events in study participants, (3) efficacy of vaccine in prevention of PTB/extra PTB in different age groups (6–18 years, 19–35 years, 36–60 years and above 60 years) and (4) immunogenicity of VPM1002 and MIP at month 2 and month 6 after first vaccination in terms of flow cytometric analysis of M.Tb specific CD4+ and CD8+ T cells secreting cytokines and Luminex assays for the presence of different cytokines in the sera and supernatants of peripheral blood mononuclear cells cultures stimulated with whole cell lysates of M.Tb and subsequently similar analysis for the cases who develop TB postvaccination during the follow-up period.Ethics and dissemination Ethics committees’ approvals have been granted by the Institutional Human Ethics Committees of all participating centres in this study and the names of the ethics committees and approvals are as follows: (1) National Institute for Research in Tuberculosis (NIRT)-Chennai (including subsites): ECR/135/Inst/TN/2013/RR-19, Approval No. 390/NIRT-Institutional Ethics Committee (IEC)/2018 dated 5 December 2018 (NIRT-Madurai-ECR/1365/Inst/TN/2020; approval dated 8 June 2020; NIRT, Vellore: ECR/1215/Inst/TN/2019; approval dated 26 September 2020); (2) All India Institute of Medical Sciences (AIIMS), Delhi (including subsites)-Institute Ethics Committee, ECR/547/Inst/DL/2014/RR-17 ECR/538/Inst/DL/2014/RR-20; approval No.IEC-385/06-07-2018, approval OP-28/05.04.2019 and SFH- ECR/593/Inst/DL/2014/RR-20 IEC/VMMC/SJH/project/2019-05/25 ; 23 May 2019; (3) National Institute of Tuberculosis and Respiratory Diseases (NITRD), Delhi: ECR/315/Inst/DL/2013/RR-19; approval IEC-No-NITRD/EC/2019/9004; 8 January 2019; (4) Pune-National AIDS Research Institute (NARI) and subsite-ECR/23/Inst/MH/2013/RR-19; IEC-NARI/EC/approval/2018/196; 29 May 2018; (5) Regional Medical Research Centre-Bhubaneshwar-ECR/911/Inst/OR-2017/RR-21; approval, dated 25 April 2018; Subsites- AIIMS, Bhubaneshwar ECR/534/Inst/OD/2014/RR-17 and 20 approval No. T/EMF/Pulm. Med/19/01 dated 13 May 2019; SCB, Cuttack No. No.ECR/84/Inst/OR/2013/RR-20; approval no.186 dated 7 February 2020; (6) NTI-Bengaluru: Ethics Committee-No-ECR/1819/Inst/KA/2019; approval No NTI-IEC/1.2019/principal investigator, dated 31 January 2019; (7) BMMRC, Hyderabad- ECR/450/Inst/AP/2013/RR-16 approval No. 779/BMMRC/2018/IEC, dated 11 June 2018 (Subsite Share India- Mediciti Ethics Committee-ECR/283/Inst/AP/2013/RR-20; Approval no. EC/11/VII/2K20(1) dated 11 July 2020) and (8) SJMC-Bengaluru: ECR/238/Inst/KA/2013/RR-19; approval IEC/1/491/2020; 7 August 2020.The trial findings will be published in accordance with the Consolidated Standards of Reporting Trials guidance. The results of this clinical trial will be presented at scientific conferences and disseminated through publications in peer-reviewed journals, conference presentations and shared with Ministry of Health and Family Welfare, policy-makers and other stakeholders.Trial registration number CTRI/2019/01/017026.

Introduction: Telomere length (TL), the marker of cellular aging, is regulated by a reverse transcriptase complex that contains reverse transcriptase (hTERT). Oxidative stress (OS) generated by environmental and genetic reasons can alter the TL in the blood. Metallothionein (MT) is a metal-binding protein with a low molecular weight and a high cysteine content found in all eukaryotes. Studies using animal models have provided evidence supporting the antioxidant function of MT. Since TL and MT both can be altered by oxidative stress, the present study was conducted to find association between them. Methodology: A total of 40 healthy volunteers in the age group of 18-45 years were enrolled in the study. mRNA expression of hTERT and Metallothionein (MT1A) and estimation of telomere length (TL) was done by qPCR and compared. Result: Comparison of groups based on quartiles of TL (groups A-D) revealed an increased expression of hTERT in groups with shorter TL. Expression of MT1A was similar in these groups. Comparison of groups based on quartiles of ∆Ct of MT1A (Groups 1-4) revealed lower TLin groups with low expression of MT1A. Correlation analysis revealed a significant negative correlation between mRNA expression of hTERT with TL (r = - 0.84, p =0.04) and a positive non-significant association between mRNAexpression of MT1Aand TL(r = 0.76, p = 0.2). Conclusion: Our study has documented an increase in expression of hTERT in groups with shorter TL in healthy individuals, reinforcing the role of hTERT in maintenance of telomeres. Caution needs to be maintained when comparing TL/hTERT expression in normal versus diseased individuals. Though our study has documented a possible link between MT1A and TL, the exact role of MT1A with regard to telomere biology needs to be elucidated further.

Ladakh is a hilly Himalayan dry desert, situated at an altitude of >11000 feet. Studies have demonstrated that the spirometric values of high-altitude residents are significantly higher than those of low-landers. This is a retrospective observational study that analyzes the spirometry pattern in chronic lung diseases among people from Ladakh. Enrolled subjects were clinic-radiologically diagnosed and had at least one spirometry report. The spirometric parameters were analyzed for normal and abnormal patterns of lung function. The abnormal patterns were further classified into types of ventilator defects and their severity. A total of 122 cases were included, with 67 (55%) men. The mean age was 52.2±15.4 years. The most common diseases were chronic obstructive pulmonary disease (COPD) in 51 cases (41%), and asthma in 41 (33%). The median predicted percentage of forced vital capacity (FVC) was 116% (63-179%) with >100% in 105 (85%) patients. The median predicted percentage of the forced expiratory volume in the 1st second (FEV1) was 113% (99-175%) with >100% in 90 (74%) patients. FVC was reduced in 9 (7%) cases, normal in 62 (51%), and more than normal in 49 (42%), with 11 (9%) cases having >150% of the predicted percentage. FEV1 was reduced in 9 (8%) cases, normal in 67 (55%), and more than normal in 46 (37%) cases, with >150% predicted seen in 10 (8%) cases. Similarly, overall, the predicted percentages of both FVC and FEV1 were >100% in all obstructive airway diseases as well as in the separate COPD and asthma subgroups. FVC and FEV1 amongst chronic lung disease patients from Ladakh were more than normal in the majority. These higher values of spirometry led to incorrect disease severity classifications and disease patterns. We propose that studies should be done to devise local reference equations for spirometry for Himalayan high-altitude residents of India.

OBJECTIVE: Hypersensitivity pneumonitis (HP) is an inflammatory and/or fibrotic lung disease. The restrictive lung function with low diffusing capacity of carbon monoxide (DLCO) is common in interstitial lung diseases (ILD). There are limited data on pulmonary function test (PFT) in HP and its role for diagnosis is questionable. We analyzed the data of 152 HP patients for type of defect, lung volume, and DLCO. MATERIAL AND METHODS: The present study is a retrospective analysis of 152 patients at one of the tertiary chest institutes in India. All diagnosed cases with at least spirometry were included. PFT findings were classified and graded as obstructive, restrictive, and mixed patterns. The correlation of PFT was calculated with disease duration and 6MWT distance. RESULTS: The majority were female [106 (70%)], with a mean age of 47.8 ± 12.3 years. Spirometry with lung volume data were available for 97% patients. PFT was abnormal in 118 (80%) cases. Among the patterns of abnormality, the most common type was restrictive (74%) followed by mixed (15%) and obstructive (11%) with the majority in the severe to very severe grade. The mean total lung capacity (TLC) and residual volume (RV) were reduced, with the grade more severe when the pattern of abnormality was restrictive while the RV/ TLC was higher suggestive of air tapping. DLCO data were available for 132 (87%) cases, with levels decreased in 67%. The severity of DLCO was highest when the pattern of abnormality was restrictive. One of the PFT parameters was abnormal in 137 (90%) cases, with isolated decreased DLCO levels seen in 16 (10%) cases. Forced vital capacity (FVC), TLC, and DLCO showed positive correlation with 6MWT distance (FVC r = .22, P = .02; TLC r = .28, P = .003; DLCO r = .30, P = .002). CONCLUSION: The PFT abnormality is seen in >80% of HP patients. All types of abnormality were seen, with the restrictive pattern being the most common. Isolated decreased DLCO levels were seen in 10% of cases. We advised to do full PFT for diagnosis and followup of HP

Introduction: Alloimmunisation to red blood cell antigens, resulting from genetic disparities between donors and recipients, is one of the risks associated with blood transfusions. Antibody screening cells are used to detect unexpected antibodies. The risk of alloimmunisation is higher in patients who have undergone multiple blood transfusions. Aim: To estimate the frequency of various Red Blood Cell (RBC) alloantibodies and to determine the types of antibodies present in repeatedly transfused patients. Materials and Methods: This cross-sectional study was conducted on 200 patients with a history of multiple blood transfusions from October 1, 2019, to April 30, 2021, at the blood centre of Sri Guru Ram Das Institute of Medical Sciences and Research (SGRDIMSR), Amritsar, Punjab, India. Antibody detection and identification were performed, and the results were recorded. The data was statistically analysed using the Statistical Package for Social Sciences (SPSS) version 26.0 to draw relevant conclusions. The observations were tabulated in the form of numbers and percentages. Categorical data was analysed using the Chi-square test. The level of significance was determined as p≤0.05. Results: The study included 200 patients who were on multiple transfusions. The most common blood group among the patients was B positive (39%), followed by O positive (26%). The majority of patients (73.50%) had solid malignancies, followed by 28 (14%) thalassemia patients and 25 (12.50%) patients with chronic kidney disease. Solid malignancies included patients with breast cancer, cervical cancer, ovarian cancer, prostate cancer, and liver cancer. Alloantibodies were found in 15 patients (7.50%), of which 11 had solid malignancies and 4 had thalassemia. The most frequent antibody detected was the anti-K antibody (40%). Alloantibody formation was observed in both males and females. However, no statistical significance was found between gender and alloimmunisation (p=0.940). Conclusion: The effect of alloimmunisation can be avoided by routine RBC antibody screening before blood transfusion, especially in patients with a history of multiple blood transfusions. These measures decrease the incidence of red blood cell alloimmunisation and delayed hemolytic transfusion reactions in multi-transfused patients.

Background: Psoriasis is a chronic skin disease. Nailfold capillaroscopy (NFC) is a method to analyze nail changes in autoimmune disorders and is gaining popularity as a bedside tool for studying the capillaroscopic changes of psoriasis. Aim: The aim was to assess the nail fold capillaroscopic parameters in controls versus psoriasis patients and to assess the nail fold capillaroscopic parameters in various morphological types of psoriasis patients. Materials and Methods: A cross-sectional observational study of NFC was conducted on 100 patients and 100 controls who attended the outpatient department of dermatology of a tertiary care hospital in Central India from June 2022 to October 2022. Nail fold of little fingers of both hands was studied by the Universal Serial Bus (USB) Digital Microscope and photographed. Results: This study was conducted on 100 patients of psoriasis and 100 controls. The mean age of patients was 50.77 ± 11.33 years with a male-to-female ratio of 1.27. The most common type of psoriasis was chronic plaque psoriasis, and erythrodermic psoriasis was the least common. Majority of 51 patients were having a Psoriasis Area and Severity Index score of >3–15 suggestive of moderate psoriasis. Capillary morphology in 89% of psoriasis cases was inverse U-shape, while remaining 11% had bizarre morphology. There was a significant difference (P < 0.011) in capillary density between psoriasis patients and controls. Only 6% of patients had irregular and haphazard capillary distribution, compared to 94% of patients who had regular and parallel capillary distribution. Other parameters of NFC such as subpapillary plexus, ramified/bushy capillaries, and hemorrhage were also studied. Conclusion: Psoriasis is characterized by microvascular abnormalities which can be studied by a novel technique of nailfold capillaroscopy.

Objective: Sightly low serum free T4 levels are associated with longer life expectancy. However, hypothyroidism is associated with increased risk of inflammation and vascular complications. Therefore, relation of thyroid hormones (THs) with life expectancy seems to be complex. This study was carried out in an effort to understand the contribution of THs in inflammation and aging. Methodology: 15 cases of treatment naïve primary hypothyroidism and 15 age and sex matched euthyroid controls were recruited. mRNA expression of Telomerase (hTERT), leucocyte telomere length (LTL) and Lipoprotein associated phospholipase A2 (Lp-PLA2), a marker of vascular inflammation and risk predictor of cardiovascular events were measured by qPCR in whole blood. Result: Expression of hTERT was found to be 6.95 times higher in the cases as compared to the controls. mRNA expression of Lp-PLA(2) was also 3.3 times higher in cases. LTL in euthyroid was approximately 81% of the length in hypothyroid patients. Conclusion: A higher expression of hTERT indicates that hypothyroidism confers better cell survival in peripheral leucocytes inspite of the presence of vascular inflammation. However causal relationship cannot be ascertained with these results.

Introduction Comprehensive oral care is a service centered around the patient, and individuals who need it the most often face limited access. Patient perception acts as a guide for enhancing quality, ensuring patients’ future intent to utilize the services and facilitating recommendations to others. The present study aimed to assess the patients’ perception of comprehensive dental services availed at a Primary Health Center (PHC). Methods This qualitative study was based on a phenomenological interpretive approach, and judgment sampling method was employed. A validated interview guide, developed from relevant literature was employed in the local language to conduct interviews among adults visiting the PHC, gathering their views regarding the services provided. The interviews were audio recorded on a digital voice recorder, and files were password protected. Content saturation guided the determination of the final number of participants interviewed. After translating and transcribing the interviews, thematic analysis and coding were performed using ATLAS. ti 23 for Windows. Results A total of 12 participants were included in the study, following data saturation. Among them, there were 8(66.7%) female and 4(33.3%) male participants. Ten overarching main themes were discerned through the assigned codes, including positive views, neutral views, negative views, previous dental clinics visited, previous experience with dental treatment, treatments sought at the center, referrals, source of information about the dental center, subsequent visits and suggestions for improvement. Conclusions The findings of this study revealed a positive patient perception of the comprehensive dental services offered at the PHC. Through insightful interviews, various strengths, and areas for improvement regarding the center and care provision were identified. These insights provide valuable suggestions that can be applied to elevate the utilization of dental services, ensuring continuous improvement in patient care.

This review presents a comprehensive examination of the contemporary landscape pertaining to latent tuberculosis infection (LTBI) diagnostics, with a particular emphasis on the global ramifications and the intricacies surrounding LTBI diagnosis and treatment. It accentuates the imperative of bolstering diagnostic, preventive, and treatment modalities for tuberculosis (TB) to fulfill the ambitious targets set forth by the World Health Organization aimed at reducing TB-related mortalities and the incidence of new TB cases. The document underscores the significance of addressing LTBI as a means of averting the progression to active TB, particularly in regions burdened with high TB prevalence, such as India. An in-depth analysis of the spectrum delineating latent and active TB disease is provided, elucidating the risk factors predisposing individuals with LTBI to progress towards active TB, including compromised immune functionality, concurrent HIV infection, and other immunosuppressive states. Furthermore, the challenges associated with LTBI diagnosis are elucidated, encompassing the absence of a definitive diagnostic assay, and the merits and demerits of tuberculin skin testing (TST) and interferon-γ release assays (IGRAs) are expounded upon. The document underscores the necessity of confronting these challenges and furnishes a meticulous examination of the advantages and limitations of TST and IGRAs, along with the intricacies involved in interpreting their outcomes across diverse demographics and settings. Additionally, attention is drawn towards the heritability of the interferon-γ response to mycobacterial antigens and the potential utility of antibodies in LTBI diagnosis.

Background Understanding the pivotal interplay between systemic and oral health is paramount to ensuring holistic care, particularly among the aging demographic. Therefore, this review article aims to explore the emerging concept of Rapid Oral Health Deterioration (ROHD) by reviewing the current knowledge base among older adults and identifying knowledge gaps in this area of research. Methods This scoping review was conducted in line with Arksey and O’Malley’s framework between December 2023 and March 2024 and reported while adhering to the PRISMA-ScR guidelines. A systematic database search was performed across three databases i.e. PubMed, Scopus, and EMBASE to collate the existing literature published in English between January 2013 and February 2024 addressing ROHD among older adults. After data charting, a critical appraisal of the selected studies was followed by qualitative thematic analysis. Results Among the 12 papers in this scoping review, 10 were cross-sectional studies, with one each of retrospective cohort and case-control studies. The qualitative thematic analysis of the selected articles resulted in the emergence of four main themes: risk factors for ROHD, attributes related to ROHD, challenges encountered in the management of ROHD, and management approaches for ROHD among older adults. Conclusions This scoping review provides an overview of the rapid deterioration of oral health among older adults. Age-related dental disease harms the quality of life and overall health. To avoid dental disorders and to maintain and improve oral health in older adults, an integrated and multidisciplinary approach is essential. If ROHD is not treated, it may lead to poor health, a lower quality of life, and in severe cases, systemic infections that increase hospitalizations and possibly cause death.

Primary polydipsia (PP) is a disorder that is clinically characterised by excessive thirst accompanied by increased fluid intake and subsequent excessive excretion of urine without an obvious cause. PP in childhood due to psychogenic causes is a rare condition and may be more prevalent than thought. The differential diagnosis of polydipsia and polyuria is broad due to extensive associated disease spectrum, including renal, endocrine, and neurological diseases. Furthermore, differentiating PP from diabetes insipidus (DI) is essential because the treatment of the latter could be deleterious in patients with PP. We present the case of a 3-year-old boy who presented with psychogenic polydipsia. In the present case, the child was started on desmopressin, considering it a case of DI, in view of the history of increased water intake and urinary output. However, a detailed psychological assessment of the child revealed the case to be an autism spectrum disorder. Subsequently, desmopressin was discontinued, and there was a rapid normalisation of fluid intake along with significant reduction in the urine output after starting psychological intervention and implementing strict water restriction. This confirmed the diagnosis as a case of psychogenic polydipsia, which is a common occurrence in children with developmental disorders.

Abstract Background Breast milk (BM) provides complete nutrition for infants for the first six months of life and is essential for the development of the newborn’s immature immune and digestive systems. While BM was conventionally believed to be sterile, recent advanced high throughput technologies have unveiled the presence of diverse microbial communities in BM. These insights into the BM microbiota have mainly originated from uncomplicated pregnancies, possibly not reflecting the circumstances of mothers with pregnancy complications like preterm birth (PTB). Methods In this article, we investigated the BM microbial communities in mothers with preterm deliveries (before 37 weeks of gestation). We compared these samples with BM samples from healthy term pregnancies across different lactation stages (colostrum, transitional and mature milk) using 16S rRNA gene sequencing. Results Our analysis revealed that the microbial communities became increasingly diverse and compositionally distinct as the BM matured. Specifically, mature BM samples were significantly enriched in Veillonella and lactobacillus (Kruskal Wallis; p

Background: Diabetes is a major burden globally, more commonly so in developing countries, as its complications are detected relatively late due to underdeveloped healthcare systems. These complications, when detected, are more or less irreversible, thereby leading to increased morbidity and mortality. Among these, complications related to bones (mainly osteoporosis) start fairly early (even in the prediabetes stage) but are less emphasized, nonetheless are major contributors to morbidity in diabetics due to increased fracture risk. One of the novel bone markers recently discovered is sclerostin, which helps in the assessment of the effect of hyperglycemia on bone homeostasis. Bone mineral density (BMD) by DXA scan is a good tool to assess the status of bone health but requires modern expensive radiological equipment. In this study, we wanted to see the correlation of serum levels of sclerostin to BMD so that by a simple serum investigation, early detection of poor bone quality in treatment-naive prediabetics can be done. Objective: The aim of the study was to measure serum levels of sclerostin in prediabetics, compare them with normoglycemic controls, and find the correlation of serum levels of sclerostin with BMD. Methods: 50 prediabetic patients and 50 age, sex, blood pressure, and BMI-matched controls were recruited in the study. In both the groups, serum levels of fasting blood glucose and postprandial glucose, glycated hemoglobin (HbA1c), Vitamin D, fasting insulin, and serum sclerostin levels were measured in both groups using ELISA. The obtained values were compared between the two groups. Bone mineral density is measured by DXA scan in cases and a correlation between BMD and serum levels of sclerostin was observed. Results: Serum sclerostin was significantly higher in the cases [18.22 (19.42) ng/ml] compared to the control group [11.08 (4.73) ng/ml] with a P value of 0.013. The mean of BMD in prediabetes is 1.06 g/cm2, T score is − 1.02, and Z score is − 0.59. There was a significant negative correlation between serum sclerostin levels and BMD in prediabetes (r = −0.404, P < 0.001). Conclusion: Serum levels of sclerostin are increased in prediabetes and correlate well with low BMD in prediabetes, and can therefore be used for early recognition of osteoporosis and fractures in diabetes.

Background: Neuregulin-4 is a recently recognized adipokine acting as ligands to tyrosine kinases receptor of the Erb B family. This adipose tissue augmented endocrine factor participates in the modulation of lipid and glucose metabolism and energy homeostasis. This novel adipokine is associated with insulin resistance, dyslipidemia, obesity, oxidative stress, and inflammation. Objective: The study aimed to compare plasma levels of neuregulin-4 in newly diagnosed type 2 diabetes mellitus as compared to matched controls and to correlate with glycemic and lipid parameters. Materials and Methods: 100 newly diagnosed T2DM patients and 100 age, sex, and BMI-matched controls after fulfilling all exclusion and inclusion criteria were included in the study. Fasting and postprandial blood glucose levels, glycated hemoglobin (HbA1c), and fasting plasma insulin levels were measured in both cases and controls. HOMA-IR values in both groups were calculated using fasting glucose and insulin levels. Results: Mean levels of plasma neuregulin-4(pg/mL) in newly diagnosed T2DM were 7949.76 ± 949.76) pg/ml, which was significantly lower as compared to 9143 ±949.76) pg/ml in the control group (P-value

Abstract Thermal Power Plant generates FGD gypsum as by-product during coal combustion. This study evaluates the characterization (spectroscopic and elemental), potentially toxic elements (PTEs) distribution, and environmental risk assessment of FGD gypsum for safe and sustainable use in agriculture. The XRD and SEM analysis confirmed the dominance of crystalline CaSO4·2H2O in FGD gypsum. The order of concentrations of PTEs in FGD gypsum was Fe > Al > Mn > Zn > Ni > Co. The residual fraction was the dominant pool, sharing 80–90% of the total PTEs. The heavy metals (HMs) were below the toxic range in the leachates. The Co, Ni, Al, Fe Mn, Zn had low (

Aims: 1. To compare the outcome of tympanoplasty alone with tympanoplasty combined with cortical mastoidectomy in patients with quiescent Chronic otitis media (COM). 2. To assess gain in hearing in dB. Materials and Methods: Patients diagnosed with mucosal type of chronic otitis media in the quiescent stage were selected. Two groups were formed. Patients were selected randomly and alternately they were included in groups A and B. The patients underwent otomicroscopy. Pure tone audiometry would depict pure conductive hearing of hearing loss. Group A (50% patients) were subjected to tympanoplasty alone and group B (other 50% patients) were subjected to tympanoplasty combined with cortical mastoidectomy. Prior to surgery, all patients underwent routine blood and urine examination, pure tone audiometry, and B/L mastoid X-ray Schuller’s view. Results: In our study, hearing gain in decibels in the tympanoplasty group was 17.1% and in tympanoplasty combined with cortical mastoidectomy was 21.1%. Graft uptake was 94% in the tympanoplasty group and 96% in tympanoplasty combined with cortical mastoidectomy. Recurrence of discharge was seen in three cases of tympanoplasty. Though tympanoplasty combined with cortical mastoidectomy is better in hearing improvement, graft uptake but the difference in two groups is statistically insignificant. Conclusion: Hearing improvement and graft uptake were statistically insignificant in two groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain and graft uptake in patients with quiescent mucosal chronic otitis. Media: Clinical significance: Hearing improvement and graft uptake were statistically insignificant in two groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain and graft uptake in patients with quiescent mucosal chronic otitis media.

Abstract Phyllanthus emblica (Aonla, Indian Gooseberry) is known to have various medicinal properties, but studies to understand its genetic structure are limited. Among the various secondary metabolites, ascorbic acid, flavonoids, terpenoids, phenols and tannins possess great potential for its pharmacological applications. Keeping this consideration, we assembled the transcriptome using the Illumina RNASeq500 platform, generating 39,933,248 high-quality paired-end reads assembled into 1,26,606 transcripts. A total of 87,771 unigenes were recovered after isoforms and unambiguous sequences deletion. Functional annotation of 43,377 coding sequences against the NCBI non-redundant (Nr) database search using BlastX yielded 38,692 sequences containing blast hits and found 4685 coding sequences to be unique. The transcript showed maximum similarity to Hevea brasilensis (16%), followed by to Jatropha curcas (12%). Considering key genes involved in the biosynthesis of flavonoids and various classes of terpenoid compounds, thirty EST-SSR primer sequences were designed based on transcriptomic data. Of which, 12 were found to be highly polymorphic with an average of 86.38%. The average value for marker index (MI), effective multiplicity ratio (EMR), resolution power (Rp) and polymorphic information content (PIC) was 7.20, 8.34, 8.64 and 0.80, respectively. Thus, from this study, we developed newly EST-SSRs linked to important genes involved in the secondary metabolites biosynthesis that will be serving as an invaluable genetic resource for crop improvement including the selection of elite genotypes in P. emblica and its closely related Phyllanthaceae species.

Abstract In pregnant animals, communication between the mother and conceptus occurs via extracellular vesicles (EVs) that carry several biomolecules such as nucleic acids (miRNAs, mRNAs), proteins, and lipids. At the time of implantation, the endometrium undergoes several morphological and physiological changes, such as angiogenesis, apoptosis, and cell proliferation regulation at the implantation site, to attain a receptive state. This study was conducted to detect pregnancy-specific miRNAs derived from extracellular vesicles in the systemic circulation of Bubalus bubalis (water buffalo) and to assess their functional significance in the modulation of endometrial primary cells. The extracellular vesicles were isolated from the blood plasma using a precipitation-based method and further characterized by various methods such as Differential light scattering, Nanoparticle tracking assay, Western blot, and transmission electron microscopy. The relative expression of the selected extracellular vesicles associated miRNAs (EV-miRNA) at different intervals (days 15, 19, 25, and 30) post artificial insemination (AI) was analyzed using RT-qPCR, and expression of miR-195-5p was found to be significantly higher (P

Background: The microbiological diagnosis of extrapulmonary tuberculosis (TB) is quite difficult because of paucibacillary load and required radiological, cytohistopathological tests for confirmation along with clinical suspicion in case of cervical TB lymph node, body fluid examination such as pleural fluid, cerebrospinal fluid, ascitic fluid in cases of TB pleurisy, TB meningitis, and abdominal Koch’s and was quiet challenging before inclusion of CBNAAT. Aims and Objectives: The aim of the study was to study epidemiological, clinical profile and pathological diagnosis and management of TB cervical lymph node patients coming to a tertiary care center where, 60 patients were enrolled during a 2.5-month period and were followed up for 8 months. Data were entered in Microsoft Excel and analysis was done by in EP Info (version 7.0). Descriptive statistics was applied in the form of percentage, proportion, and measures of central tendency. Test of significance was applied. Materials and Methods: To study epidemiological, clinical profile and pathological diagnosis and management of TB cervical lymph node patients coming to a tertiary care center where, 60 patients were enrolled during a 2.5-month period and were followed up for 8 months. Data were entered in Microsoft Excel, and analysis was done by in EP Info (version 7.0). Descriptive statistics was applied in the form of percentage, proportion, and measures of central tendency. Test of significance was applied. Results: In this study, 23 cases (38.3%) were male and 37 cases (61.7%) were females, with a female preponderance. The mean age was 27.33 years, with a SD of 93. In this study, maximum number of cases, i.e., 44 cases (73.3%) were seen in the age group of 19–28 years. Neck swelling was the chief presenting complaint among them followed by fever, 36 patients (60%), weight loss 31 (51.7%), anorexia in 28 (46.7%), and cough in 7 patients (11.7%). 75% patients improved after taking antitubercular therapy for 6 months and 5% patients not responded to the treatment till 8 months. Conclusion: There is high incidence of TB cervical lymphadenopathy in developing countries like India.

Background: Pruritus is a frequent complaint associated with various inflammatory dermatoses. Sleep is often disturbed because of pruritus but the impact of severity and diurnal pattern of pruritus has not been studied so far. Objectives: To estimate the prevalence of nocturnal itch (NI) and its association with itch severity, sleep disturbance and quality of life (QoL) compared with non-NI in chronic plaque psoriasis (CPP) and chronic spontaneous urticaria (CSU). Methods: We performed a cross-sectional study in patients aged ≥18 years with CPP or CSU for at least 6 weeks. A comprehensive in-house questionnaire designed for study formed the basis for categorizing patients into NI and non-NI. Validated instruments like visual analog scale, pruritus grading system, General Sleep Disturbance Scale, and Dermatology life quality index were used to assess itch severity, sleep, and QoL. Results: A total of 255 patients (CPP: 131; CSU: 124) were included in this study. Prevalence of NI was 43.5% (95% confidence interval: 34.9%-52.4%) in CPP and 29% (95% confidence interval: 21.2%-37.9%) in CSU. NI was strongly associated with higher pruritus grading system scores in CSU and CPP (regression coefficient = 1.5, P =0.004 and regression coefficient = 1.3, P =0.004, respectively), with impaired sleep (OR = 2.97, P = 0.025) in CPP and with itch-affected sleep in CSU. Itch severity was associated with impaired sleep; however, the association was modified by the presence of NI in CSU patients. Conclusion: Nocturnal itch is prevalent in chronic dermatoses and significant for sleep deficit and impaired QoL. Early screening and management of sleep disturbance among patients presenting with nocturnal itch should be routinely undertaken.

Introduction: The chronic persistence of diabetes leads to microvascular complications, such as Diabetic Nephropathy (DN) and Diabetic Retinopathy (DR). Both of these are progressive disorders involving pathological changes in capillaries. A few biochemical pathways have been suggested to link hyperglycaemia and microvascular complications. The probability of developing and progressing DN and DR is associated with the duration of diabetes. These complex disorders are strongly influenced by both genetics and environmental factors. Several candidate genes have been reported to be associated with DN and DR in different populations. Aim: To determine the co-existence of DN and DR in relation to gene polymorphisms of Angiotensin-Converting Enzyme (ACE), Angiotensinogen (AGT), Receptor for Advanced Glycation End-products (RAGE), Aldose reductase (ALR2), and Vascular Endothelial Growth Factor (VEGF). Materials and Methods: The present DN and DR cross-sectional study was conducted at the Department of Endocrinology, University College of Medical Sciences, University of Delhi and GTB, New Delhi, India, and the Discipline of Biochemistry, Indira Gandhi National Open University, New Delhi, India. The study was conducted from October 2019 to August 2022. All the participants under uniform diabetes management were divided into two groups (100 in each group): Group 1 included Type-II diabetic patients with DN and DR, and Group 2 comprised Type-II diabetic patients with DN only. Polymorphisms in all genes were determined using Polymerase Chain Reaction (PCR), followed by digestion with restriction enzymes and visualisation through an ultraviolet transilluminator. The analysis of biochemical parameters and association of gene polymorphisms was performed using Statistical Package for Social Sciences (SPSS) version 26.0 software. Results: There were 57 males and 43 females in the DN+DR group, and 51 males and 49 females in the DN-DR group. The mean age of study subjects in the DN+DR group was 52.60±9.08 years, compared to the DN-DR group (47.33±10.68 years). The DN+DR group had a significantly higher mean duration of diabetes (11.78±6.86 vs. 5.13±4.78, p≤0.001) and a significantly lower mean waist circumference (91.30±13.99 vs. 95.11±9.95 cm, p≤0.02). The DN+DR group also had significantly higher urea (34.34±16.32 vs. 26.43±12.34 cm, p≤0.001), creatinine (1.34±0.90 vs. 0.89±0.25 cm, p≤0.03) and significantly lower estimated Glomerular Filtration Rate (eGFR) levels compared to the DN-DR group. The distribution of genotypes of ALR2 (p≤0.04) and VEGF genes (p≤0.001) showed a significant difference between both DN+DR and DN-DR groups. The frequency of the D allele of the VEGF gene (p≤0.02) (OR=1.94, 95% Confidence Interval (CI)=1.10-3.40) was higher in the DN+DR group. The DN+DR group also had a significantly lower frequency of the CT+TT dominant model of the ALR2 gene (p≤0.04) as well as an increased frequency of the ID+DD dominant model of the VEGF gene (p≤0.002). No significant differences were found in genotypic as well as allelic frequencies of ACE, AGT, and RAGE gene polymorphisms between the two groups. Conclusion: The D allele of the VEGF (I/D) gene polymorphism is significantly associated with DR in patients with DN. It can be concluded that the VEGF gene plays an important role in the development of retinopathy in DN patients.

Introduction: Fentanyl bolus during induction often leads to cough. It is usually benign, but in some cases, it can be explosive and life-threatening. The incidence of Fentany-induced Cough (FIC) varies from 18% to 65%. Aim: To compare the effect of acupressure, incentive spirometry, and nebulisation with lignocaine on the incidence and severity of FIC. Materials and Methods: This single blind randomised controlled study was conducted in Department of Anaesthesia, Himalayan Institute of Medical Sciences, HIMS, Dehradun, Uttarakhand, India over a period of nine months from May 2019 to February 2020. Four hundred patients, aged 18-60 years, of either sex, scheduled for elective surgery, were randomly assigned to four groups: acupressure group (A), incentive spirometry group (S), nebulisation with lignocaine group (N), and control group (C). All patients received undiluted fentanyl at a dose of 2 mcg/kg over five seconds. Episodes of cough within 60 seconds of fentanyl administration were classified as FIC, and the severity was graded based on the number of coughs (mild: 1-2, moderate: 3-4, severe: 5 or more). The time of onset of FIC was recorded. Hemodynamic changes and adverse effects due to fentanyl injection and the procedure were noted. The Kruskal-Wallis test, Mann-Whitney U test, and Chi-square test were used for statistical analysis. Results: There were no differences among the four groups in terms of patients’ characteristics and a American Society of Anaesthesiologist (ASA) status. The incidence of FIC was higher in Group C (37%) compared to Group A (8%), S (12%), and N (10%), which was statistically significant (p-value

Background: Automated hematology analyzers have become mainstream of complete blood count (CBC) during the past two decades; they are potential, more accurate to produce results of CBCs. However, often automated analyzers can give false results too, specially, falsely low platelet count due to platelets aggregates, which have to be confirmed on peripheral smears. Aims and Objectives: The aim and objective of the study was to diagnose thrombocytopenia (TCP) cases and differentiate them from pseudothrombocytopenia (PTCP) cases by analyzing platelet histogram and to determine the sensitivity and specificity of platelet histograms for diagnosing TCP and PTCP. Materials and Methods: The present study was conducted in the Department of Pathology at Shyam Shah Medical College, Rewa, M.P., after obtaining ethical clearance from the Institutional Ethics Committee. It was prospective study conducted for a period of 15 months from January 2021 to May 2022 on 1000 samples. Results: The sensitivity and specificity of platelet histogram flags and presence of multiple peaks to diagnose TCP and PTCP cases were calculated as 73.60% and 93.60%, respectively. The present study also interpret that mean platelet volume and platelet distribution width cannot use as indicator to differentiate between TCP and PTCP. Conclusion: The present study concludes that analysis and interpretation of histogram more specifically platelet histogram flagging provide clue for early detection of PTCP cases prior peripheral smear examination and also helpful in differentiating them from true TCP cases. These platelet histogram flagging can be used as a screening parameter for the detection of PTCP and these are helpful in preventing unnecessary stress for clinician, patients, and their relatives. However, the peripheral smear examination will remain the gold standard to differentiate TCP from, PTCP.

Scedosporium aurianticum infection developed in 2 recipients of kidney transplants in India, acquired from the same deceased near-drowning donor. Given the substantial risk for death associated with Scedosporium infection among solid-organ transplant recipients, safety protocols for organ transplantation from nearly drowned donors should be thoroughly revaluated and refined.

Abstract Synbiotics are employed as feed additives in animal production as an alternate to antibiotics for sustaining the gut microbiota and providing protection against infections. Dairy calves require a healthy diet and management to ensure a better future for the herd of dairy animals. Therefore, the present study was carried out to investigate the effect of synbiotics formulation on growth performance, nutrient digestibility, fecal bacterial count, metabolites, immunoglobulins, blood parameters, antioxidant enzymes and immune response of pre-ruminant Murrah buffalo calves. Twenty-four apparently healthy calves (5 days old) were allotted into four groups of six calves each. Group I (control) calves were fed a basal diet of milk, calf starter and berseem with no supplements. Group II (SYN1) calves were fed with 3 g fructooligosaccharide (FOS) + Lactobacillus plantarum CRD-7 (150 ml). Group III (SYN2) calves were fed with 6 g FOS + L. plantarum CRD-7 (100 ml), whereas calves in group IV (SYN3) received 9 g FOS + L. plantarum CRD-7 (50 ml). The results showed that SYN2 had the highest (P

Introduction: Neonatal sepsis is a leading cause of morbidity & mortality in developing countries especially like India. As per involvement of different organisms, mortality rates differ among neonates. So, early detection of causing organism along with the identification of risk factors helps to prevent mortality among Neonates in India. Objectives: To study the risk factors associated with neonatal septicemia and its bacteriological profile at one of the tertiary care hospital of Gujarat. Method: The study was prospective observational research study in which purposive sampling technique was used to identify the 106 neonates blood culture positive to sepsis admitted in NICU of one of the tertiary care hospital in Gujarat in time period of 1 year from Nov 2021 to Oct 2022. Results: Out of 106 neonates, common factors associated with neonatal septicemia were gender, prematurity, law birth weight, gestational age & onset of septicemia. Meconium stained liquor, Pregnancy induced hypertension and Oligohydramnios were the commonest maternal risk factor associated with neonatal sepsis. Blood culture proven sepsis in neonatal septicemia was predominantly caused by Gram negative organism Klebsiella pneumonia. Conclusion: Neonatal septicemia is more common in preterm and low birth weight neonates. Early onset septicemia is more common which can be curtailed by clean vaginal deliveries. Prematurity and low birth remains the major presentation for admission in NICU followed by respiratory distress syndrome. Maternal risk factors like meconium stained liquor, pregnancy induced hypertension oligohydramnios, & leaking per -vaginal are associated With increase in the incidence of neonatal septicemia

Abstract Gestational diabetes mellitus (GDM) is a common complication of pregnancy that has been associated with an increased risk of obesity and diabetes in the offspring. Pregnancy is accompanied by tightly regulated changes in the endocrine, metabolic, immune, and microbial systems, and deviations from these changes can alter the mother’s metabolism resulting in adverse pregnancy outcomes and a negative impact on the health of her infant. Maternal microbiomes are significant drivers of mother and child health outcomes, and many microbial metabolites are likely to influence the host health. This review discusses the current understanding of how the microbiota and microbial metabolites may contribute to the development of GDM and how GDM-associated changes in the maternal microbiome can affect infant’s health. We also describe microbiota-based interventions that aim to improve metabolic health and outline future directions for precision medicine research in this emerging field.

Background: Renal stone disease is prevalent worldwide. Percutaneous nephrolithotomy (PCNL) has become an important mode of treatment for large size renal stones. Various anesthetic techniques have described for performing PCNL, with each having its own merits and demerits. There is lacuna in evidence for the ideal mode of anesthesia with best results and least associated complications. Aims and Objectives: PCNL is a common procedure for renal stones. It can be performed under various anesthesia techniques. Selection of an appropriate anesthetic technique is essential for successful outcome. In this study, we compared three anesthesia techniques during PCNL and their outcomes. Materials and Methods: Retrospective and observational study involved all cases of PCNL performed from February 2022 to January 2023. Baseline clinical and anesthesia parameters were recorded. Three groups based on anesthesia method were made; Group A for general anesthesia (GA), B for spinal anesthesia (SA), and C for combined spinal epidural anesthesia (CSEA). Intraoperative variables including heart rate (HR), blood pressure, operation time, and analgesia adequacy were noted. Post-operative pain level, hospital stay, stone free rate (SFR), complications, patient, and surgeon satisfaction were recorded. Results: Seventy-two cases (56 Male and 16 Female) with a mean age of 36.2±15.9 years were included in the study. Age and body mass index were lower in Group A, while ASA status and comorbidities were comparable. Intraoperative HR and mean blood pressure were higher in Group A than in B and C (P=0.000, P=0.003). Hypotension was more frequent in Group B (24.1%, P=0.046). Operation time, hospital stay, transfusion rates, SFR, and overall patient satisfaction were similar. Group A patients experienced more post-procedure pain (Visual analogue scale 4.1 vs. 2.2 vs. 2.1; P=0.001). Nausea-vomiting and shivering episodes were also higher in Group A (P=0.033, P=0.021). Anesthetic effect weaned-off in 6 patients of SA. Post-operative headache was higher but non-significant in Group B and C (P=0.621). Conclusion: CSEA appears a superior alternative to both SA and GA, with additional adequate post-operative comfort.

Abstract A home point-of care FCP test (IBDoc) and a self-reported clinical disease activity program (IBD Dashboard) may improve routine monitoring of IBD activity during pregnancy. We aimed to evaluate the feasibility of tight control management using remote monitoring in pregnant patients with IBD. Pregnant patients (

Background: Healthcare workers (HCWs) are at the front line of the Coronavirus disease (COVID-19) outbreak response. They have faced great risks to both physical and mental health. We aimed to assess the psychological effect of COVID-19 among ancillary hospital staff. Methods: A cross-sectional study was conducted among 267 on-duty ancillary hospital staff using a semi-structured questionnaire to assess their psychological status and risk perception. In addition, their knowledge, attitude, and practices (KAP) and risk perception were also assessed. The General Health Questionnaire (GHQ-12) was used to screen for psychological distress. Results: Among 267 participants, the mean (±SD) age was 33.5 (7.6) years. The majority knew about the symptoms of COVID-19 (88.4%), droplet spread (99.3%), and the importance of isolation (99.3%). About 35.2% were worried about infecting family members, while 26.2% were worried about colleagues at the frontline. Only 38.9% of them had a good knowledge score. Participants with high school and above education level had significantly good knowledge about COVID-19 (OR = 1.99; 95% CI = 1.17- 3.39) than those with primary school or below. Being female (OR 1.99; 95% CI 1.17-3.39) and working with COVID-19 patients (OR 3.88, 95% CI 1.77-8.47, P = 0.001) was associated with psychological distress. Conclusion: The ancillary hospital staff had insufficient knowledge regarding the risk factors of COVID-19 but possessed positive attitudes and practices. Continued health education and appropriate psychological interventions may improve understanding and reduce psychological distress.

Abstract A detailed understanding of the different mechanisms being responsible for terahertz (THz) emission in ferromagnetic (FM) materials will aid in designing efficient THz emitters. In this report, we present direct evidence of THz emission from single layer Co $$_{0.4}$$ 0.4 Fe $$_{0.4}$$ 0.4 B $$_{0.2}$$ 0.2 (CoFeB) FM thin films. The dominant mechanism being responsible for the THz emission is the anomalous Hall effect (AHE), which is an effect of a net backflow current in the FM layer created by the spin polarized current reflected at the interfaces of the FM layer. The THz emission from the AHE-based CoFeB emitter is optimized by varying its thickness, orientation, and pump fluence of the laser beam. Results from electrical transport measurements show that skew scattering of charge carriers is responsible for the THz emission in the CoFeB AHE-based THz emitter.

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health.

Background: Cataract is the most common cause of curable blindness worldwide. Aims and Objectives: A comparative analysis of clear corneal phacoemulsification with rigid intra-ocular Lens (IOL) and small incision cataract surgery (SICS) in low socioeconomic group patients in terms of post-operative visual outcome, surgically induced astigmatism (SIA), and intra-and post-operative complications. Materials and Methods: A prospective hospital-based comparative study was conducted for 8 months in 424 eyes of 400 senile cataract patients divided into PHACO and SICS groups. Each group consisted of 212 eyes of 200 patients. Detailed examinations for best corrected visual acuity (BCVA), SIA, and complications were evaluated on the 1st post-operative day, 1st week and 6 weeks postoperatively. Results: BCVA 6\18 or higher was 95.38% in the phacoemulsification group and 94.81% in the SICS group. The study revealed good visual outcome in both SICS and Phaco groups with no significant difference. The mean SIA was more in SICS group (−0.96±0.57) than in phaco group (−0.71±0.47) which was statistically significant. In terms of complications, no significant difference was noted between the groups. Conclusion: The outcome of this study indicated that though SIA is more in SICS group than Phaco group, there is no difference between the groups in terms of visual outcome. The study has proven that SICS has comparable effectiveness as phacoemulsification with rigid IOL, which should be considered in low- and middle-income countries.