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Abstract Road traffic is an important source of urban air pollutants. Due to increasingly strict controls of exhaust emissions from road traffic, their contribution to the total emissions has strongly decreased over time in high-income countries. In contrast, non-exhaust emissions from road vehicles are not yet legislated and now make up the major proportion of road traffic emissions in many countries. Brake wear, which occurs due to friction between brake linings and their rotating counterpart, is one of the main non-exhaust sources contributing to particle emissions. Since the focus of brake wear emission has largely been on particulate pollutants, little is currently known about gaseous emissions such as volatile organic compounds from braking and their fate in the atmosphere. This study investigates the oxidative ageing of gaseous brake wear emissions generated with a pin-on-disc tribometer, using an oxidation flow reactor. The results demonstrate, for the first time, that the photooxidation of gaseous brake wear emissions can lead to formation of secondary particulate matter, which could amplify the environmental impact of brake wear emissions.

Background Heart failure affects almost 64 million people, with more than half of it constituting heart failure with reduced ejection fraction (HFrEF). Angiotensin receptor-neprilysin inhibitors (ARNI) and sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) are in the first line for HFrEF, but no head-to-head trials are available. Moreover, growth differentiation factor-15 (GDF-15) has been demonstrated as a promising prognostic marker, specifically for HFrEF, but has not been explored much.Methods This pragmatic randomised controlled trial recruits 100 patients with HFrEF (ejection fraction

BACKGROUND: Mycetoma is introduced as a rare neglected disease in tropical areas. It is a chronic, localized, slowly progressive infectious granulomatous disease of soft tissue. It may be caused by true fungi such as eumycetoma or filamentous bacteria such as actinomycetoma. In India, there is variation in the species causing mycetoma according to geographical location. The purpose of this study was to review all currently available information to identify knowledge gaps and/or research priorities. METHODS: The study was conducted retrospectively in the Department of Histopathology for biopsy-confirmed cases of mycetoma. Eight histopathologically confirmed cases were found in the two-year study period from 2018 to 2019, and a clinicopathological analysis of de-identified patient data was done. RESULTS: Five cases were reported as mycotic mycetoma, and the rest were reported as actinomycosis. All patients were men, and the mean age of presentation was 41.37 years old. The foot, ankle, head, and neck were the sites that were the most infected regions. CONCLUSION: Mycetoma is a rare disease but should be considered a differential diagnosis of any foot and ankle lump in a patient from the subtropics. An accurate and timely histopathological diagnosis is essential in mycetoma for its treatment and prognosis, as when left untreated, the disease progresses and leads to increased morbidity. Appropriate preventive and control measures can be utilized by health workers/community leaders to educate people at risk to reduce their exposure risk and report the cases as early as possible.

Implantation and placentation at the normal site are critical for a successful pregnancy. Many complications associated with pregnancy, which manifest late in pregnancy, such as preeclampsia and preterm labour, have been reported to have origins early during pregnancy with abnormalities in implantation and placental development. Placental abnormalities result from impaired embedding of the placenta in the endometrium, encompassing a wide range of placental pathologies associated with high maternal morbidity and mortality. Pregnancy-related complications such as Postpartum Haemorrhage (PPH) and hysterectomy have been closely linked to the Placenta Accreta Spectrum (PAS). PAS refers to the aberrant and invasive implantation of the placenta into the myometrium. Invasiveness in placenta accreta is marginal, followed by placenta increta (partial), placenta percreta (total), and placenta previa (covering the cervix). Here, the authors present a unique case report of an antenatal woman with antepartum haemorrhage, placenta previa, and placenta accreta at the previous Lower Segment Caesarean Section (LSCS) scar site, with massive PPH at 35 weeks, who benefited from an emergency LSCS with bilateral uterine and internal iliac artery ligation procedure, resulting in a life-saving outcome. The most common risk factors for PAS include prior caesarean section and curettage. The adhered placenta can lead to pelvic bleeding and necessitate an emergency hysterectomy. Therefore, it poses unique diagnostic and treatment issues, with the majority of cases requiring preterm termination of pregnancy.

Abstract Background The rapid development of coronavirus disease 2019 vaccines during the pandemic has left their long-term effects largely unknown. Instances of autoimmune and subacute thyroiditis showing features of autoimmune/inflammatory syndrome induced by adjuvants have been reported post-vaccination. This case report aims to highlight the autoimmune/inflammatory syndrome induced by adjuvants syndrome after coronavirus disease 2019 vaccination, drawing attention to a possible connection with thyroid dysfunction and urging for further thorough research. Case presentation We present a case of thyroiditis induced by the COVISHIELD vaccine in a 37-year-old Indian woman. An apparently normal and healthy adult woman developed neck pain and easy fatigability 2 weeks after the second dose of COVISHIELD, which gradually increased and was associated with irritability, decreased sleep, excessive sweating, tremor, palpitation, and weight loss. She presented to the outpatient department after 1 week of symptoms and was evaluated with laboratory tests and imaging. She was diagnosed with thyroiditis due to the coronavirus disease 2019 vaccine and was treated with propranolol. Conclusion This case report adds to the growing evidence of coronavirus disease 2019 vaccine-related thyroid issues. The development of thyroiditis is rare and underreported post-coronavirus disease 2019 vaccination; hence, research to evaluate the association of coronavirus disease 2019 vaccines with thyroid dysfunction needs to be done in the future.

Abstract Hyperglycemia is a major risk factor in the development of diabetic complications and promotes vascular complications through dysregulation of endothelial cell function. Various mechanisms have been proposed for endothelial cell dysregulation but the early transcriptomic alterations of endothelial cells under hyperglycemic conditions are not well documented. Here we use deep time-series RNA-seq profiling of human aortic endothelial cells (HAECs) following exposure to normal (NG) and high glucose (HG) conditions over a time course from baseline to 24 h to identify the early and transient transcriptomic changes, alteration of molecular networks, and their temporal dynamics. The analysis revealed that the most significant pathway activation/inhibition events take place in the 1- to 4-h transition and identified distinct clusters of genes that underlie a cascade of coordinated transcriptional events unique to HG conditions. Temporal co-expression and causal network analysis implicate the activation of type 2 diabetes (T2D) and growth factor signalling pathways including STAT3 and NF-κB. These results document HAEC transcriptional changes induced by hyperglycemic conditions and provide basic insight into the rapid molecular alterations that promote endothelial cell dysfunction.

Wild and ancient wheat are considered to be a rich source of nutrients and better stress tolerant, hence being re-considered for mainstreaming its cultivation by the farmers and bringing it back to the food basket. In the present study, thirty-four diverse accessions of Indian dwarf wheat, Triticum sphaerococcum conserved in the Indian National Genebank were evaluated for thirteen-grain quality parameters namely thousand-grain weight (TGW), hectolitre weight (HW), sedimentation value (Sed), grain hardness index (HI), protein (Pro), albumin (Alb), globulin (Glo), gliadin (Gli), glutenin (Glu), gluten, lysine (Lys), Fe2+ and Zn2+ content, and four antioxidant enzymes activities. Substantial variations were recorded for studied traits. TGW, HW, Sed, HI, Pro, Alb, Glo, Gli, Glu, Gluten, Lys, Fe2+, and Zn2+ varied from 26.50–45.55 g, 70.50–86.00 kg/hl, 24.00–38.00 ml, 40.49–104.90, 15.34–19.35%, 17.60–40.31 mg/g, 10.75–16.56 mg/g, 26.35–44.94 mg/g, 24.47–39.56 mg/g, 55.33–75.06 mg/g, 0.04–0.29%, 42.72–90.72 ppm, and 11.45–25.70 ppm, respectively. Among antioxidants, peroxidase (POX), catalase (CAT), glutathione reductase (GR), and superoxide dismutase (SOD) activity ranged from 0.06–0.60 unit/ml, 0.02–0.61 unit/ml, 0.11–2.26 unit/ml, and 0.14–0.97 unit/ml, respectively. Hardness Index was positively associated with Pro and Zn2+ content whereas Lys was negatively associated with gluten content. Likewise, gluten and Fe2+ content had a positive association with the major protein fraction i.e., Gli and Glu. Hierarchical cluster analysis grouped 34 accessions into four clusters and the major group had nine indigenous and eight exotic accessions. We also validated high GPC accessions and EC182958 (17.16%), EC187176 and EC182945 (16.16%), EC613057 (15.79%), IC634028 (15.72%) and IC533826 (15.01%) were confirmed with more than 15% GPC. Also, superior trait-specific accessions namely, EC187167, IC534021, EC613055, EC180066, and EC182959 for low gluten content and IC384530, EC313761, EC180063, IC397363, EC10494 for high iron content (>76.51) were identified that may be used in wheat quality improvement for nutritional security of mankind.

Elucidating the role of one of the proteins produced by Lactiplantibacillus plantarum reveals a new molecule that allows this gut bacterium to support the development of fruit fly larvae.

Central venous catheter-related blood stream infection (CRBSI) is a major cause of morbidity and mortality in patients on maintenance hemodialysis. The objective of the study was to assess the microbiology and clinical outcomes of CRBSI in patients on maintenance hemodialysis. This was a retrospective observational study of all the patients with Stage 5 chronic kidney disease on maintenance hemodialysis at Pushpagiri Medical College Hospital who developed CRBSI between 1st January 2019 and 31st December 2020. Out of the 105 CRBSI patients included in the study, 75% had diabetes mellitus while 95% had hypertension. The median time gap between central venous catheter (CVC) placement and CRBSI was found to be 22 days with a range of 3 days to 150 days. Fever was the most common clinical presentation of CRBSI while a few patients presented with encephalopathy and septic shock. The most commonly used empirical antibiotic was intravenous Cephalosporins. The most common micro-organism grown in culture was non-fermenting gram-negative rods (22.84%) followed by Staphylococcus aureus and Bacillus species. The success rate which was defined as resolution of symptoms without the need of modifying the antibiotic or change of CVC was 34.28%. 31% of patients required modification of antibiotic while 56.18% required change of CVC. Complications developed in 10.47% of patients, the most common being encephalopathy followed by septic shock. 5(4.7%) patients succumbed to complications while all others recovered completely. While treatment of CRBSI with empirical intravenous antibiotics alone was successful in only about one-third of the patients, culture-guided modification of antibiotic regimen with or without change of CVC, led to clinical improvement in the majority of cases. [J Med Allied Sci. 2022; 12(2):70-75]

The case report evaluates shoulder injury related to COVID-19 vaccine administration. A 26-year-old female patient presented with shoulder pain, which increased on extension and overhead abduction in routine work. Magnetic resonance imaging (MRI) was done based on which, a diagnosis of shoulder injury related to vaccine administration (SIRVA) was reported. Significant improvement was seen after Non-steroidal anti-inflammatory drugs (NSAIDs), topical diclofenac ointment, and serratiopeptidase tablets. Physical muscle strengthening exercises were advised. Based on Naranjo and World Health Organization (WHO) casualty assessments, the adverse drug reaction (ADR) was categorized under probable. Preventability, Hartwig's scales for severity was assessed, which showed preventability and moderate grade in severity. The total cost (direct and indirect) for management was found to be rupees 7021 and 41,781 in government and private hospital respectively. Thus ADRs not only add to patient suffering but also increase the economic burden. Health care professionals (HCPs) need to be made aware of potentially fatal ADRs associated with the administration of vaccines and should be keen to report such ADRs to drug safety authorities.

Background: COVID-19 pandemic led to increased self-medication of antimicrobials, vitamins, and immune boosters among the common people and consuming without prescription can lead to adverse consequences including antimicrobial resistance. Methods: A cross-sectional study was conducted on community pharmacies in Jodhpur, India. They were inquired regarding the prescription and increased sales (75% increase in vitamin C sales. Conclusion: There was an increase in the demand for COVID-19 medications without prescription. This study was unable to detect a significant increase in sales of antimicrobials, which is encouraging.

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) rarely cause euglycemic diabetic ketoacidosis (euDKA) in diabetic patients. The aim was to identify demographic, clinical, and predisposing factors for euDKA from published case reports. Methods: A systematic review of published case reports of euDKA in patients receiving SGLT2 inhibitors and meta-analysis of clinical trials to quantify the risk ratio (RR) of DKA in patients receiving SGLT2 inhibitors. PubMed and EMBASE databases were searched for the case reports of and clinical trials from January 2010 to August 2020. Studies published in English language were included and other languages were excluded. Data related to patients' demography, clinical presentation, drug and dose of SGLT2 inhibitors, and concomitant medication were extracted. Incidence of diabetic ketoacidosis (DKA) extracted from clinical trials. Data related to demographic, clinical, and other parameters presented as ratios and proportions and incidence of DKA in RR using Review Manager 5.3. Results: Forty-seven of 160 reports with an aggregate of 77 patients were included in the analysis. The majority of the patients were females (67.53%), with T2DM and with gastrointestinal symptoms (58%). Surgery was the most common precipitating factor (n/N = 15/77). Canagliflozin (n/N = 34/77) was the commonest SGLT2 inhibitor reported along with metformin as the concomitant medication (63.6%). The pooled RR of DKA was 3.70 (95%CI 2.58, 5.29) and I2 = 0%. Conclusion: euDKA is commonly seen in middle-aged female, T2DM patients taking SGLT2 inhibitors along with metformin. The risk of DKA in patients receiving SGLT2 inhibitors increases by 3.7 times than the other medication.

Introduction: Inflammation is body’s immune response to harmful stimulus. Commonly used conventional anti-inflammatory agents are Non-Steroidal Anti-inflammatory Drugs (NSAIDs). But on prolonged long-term use, it causes serious adverse events. So, the search towards natural agents which have anti-inflammatory property are increasing nowadays. Sinapis arvensis is an annual flowering plant which has proven multipurpose medicinal phytoconstituents. Aim: To evaluate in-vitro anti-inflammatory effects of flower extracts of Sinapis arvensis with diclofenac as standard. Materials and Methods: This in-vitro study assessed the laboratory based anti-inflammatory activity, performed using Bovine Serum Albumin (BSA) assay in December 2021 at Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India. BSA at pH of 6.8 generated denatured proteins. The anti-inflammatory activity of the sample (flower extracts of Sinapis arvensis) and standard (Diclofenac) was assessed by adding to BSA and percentage of inhibition of denaturation were calculated using the formula based on the absorbance measured. Descriptive statistics was used for analysis of collected data. Results: The concentration-dependent inhibition of protein denaturation was observed for both Sinapis arvensis and Diclofenac. At 100 μg concentration, percentage of inhibition reached up to 81.8% and 100% for Sinapis arvensis and Diclofenac, respectively. Conclusion: The present study showed that flower extracts of Sinapis arvensis exhibited concentration dependent anti-inflammatory property invitro which proves to be nearly equivalent with that of the standard Diclofenac.

BackgroundRespiratory syncytial virus (RSV) commonly causes lower respiratory tract infections and hospitalization in children. In 2019-2020, the Europe-wide RSV ComNet standardized study protocol was developed to measure the clinical and socioeconomic disease burden of RSV infections among children aged

Background: Heart failure (HF) is a multi-morbid chronic condition, which adversely affects the quality of life of the affected individual. Engaging the patient and their caregivers in self-care is known to reduce mortality, rehospitalisation and improve quality of life among HF patients. The PACT-HF trial will answer whether clinical benefits in terms of mortality and hospitalisation outcomes can be demonstrated by using a pragmatic design to explore the specific effects of physical activity, and cognitive behavioural therapy in HF patients in India. Methods: We will conduct a 2 × 2 factorial, randomized, open-label trial, which aims to see if rehabilitation strategies of structured physical activity training and cognitive behavioural therapy for depression and self-management reduce the risk of repeat hospitalisation and deaths in HF patients in India. Patients will be randomised to (1) physical activity + usual care (2) cognitive behaviour therapy + usual care, (3) physical activity + cognitive behaviour therapy + usual care, and (4) usual care at 1:1:1:1 ratio. Time to mortality will be the primary outcome. A composite of mortality and hospitalisation for HF will be the main secondary outcome. Additional secondary outcomes will include ‘days alive and out of hospital’, cumulative hospitalisation, quality of life, Minnesota Living with Heart Failure questionnaire score, depression score, six minutes walking distance, handgrip strength, and adherence to medicines and lifestyle. The effects of intervention on the primary outcome will be estimated from Cox proportional hazard models. For the continuous secondary outcome variables, differences between randomised groups will be estimated from linear mixed models or generalised estimating equations (GEE) as appropriate. Discussion: PACT-HF is designed to provide reliable evidence about the balance of benefits and risks conferred by physical activity and cognitive behavioural therapy-based cardiac rehabilitation for those with HF, irrespective of their initial disease severity.

The major targets of coronavirus disease 2019 (COVID-19) are the respiratory and immune systems. However, a significant proportion of hospitalized patients had kidney dysfunction. The histopathological surveys have principally focused on respiratory, hematopoietic, and immune systems, whereas histopathologic data of kidney injury are lacking. Our study aimed to summarize the renal histopathological findings in COVID-19 from the published case report and case series. We conducted a systematic searching of databases such as MEDLINE, EMBASE, and Cochrane Library for published reports of COVID-19 patients with renal histopathological changes from autopsy studies and from “for cause” indication biopsies. Included in our study are case reports and case series with extractable quantitative data on patient demographics such as age, sex, ethnicity, as well as data on renal function tests, their comorbidities, and biopsy to study the histopathological changes. Data were analyzed with Microsoft Excel. To evaluate the methodological quality, we chose the framework for appraisal, synthesis, and application of evidence suggested by Murad et al. Systematic searches of literature found 31 studies that fulfilled the eligibility criteria. These studies included a total of 139 cases, where individual case details including clinical and histopathological findings were available. The median age of the cases was 62 years with a male:female ratio of 2.5:1. Associated comorbidities were noted in 78.4% of cases. The majority of the cases had renal dysfunction with proteinuria which was documented in more than two-thirds of the cases. The histopathological findings observed the frequent tubular involvement manifested by acute tubular injury. Regarding glomerular pathology, collapsing glomerulopathy emerged as a distinct lesion in these patients and was noted among 46.8% of cases with glomerular lesions. A small subset of cases (4.3%) had thrombotic microangiopathy. Collapsing glomerulopathy emerged as a hallmark of glomerular changes among COVID-19 patients. Tubular damage is common and is linked to multiple factors including ischemia, sepsis among others. In the form of thrombotic microangiopathy seen in a subset of patients, vascular damage hints toward the hyper-coagulable state associated with the infection. The demonstration of viral particles in renal tissue remains debatable and requires further study.

Context: Adolescents constitutes 21% of total Indian population. Iron deficiency anaemia has remained as a major nutritional problem amongst adolescents. To overcome this problem, Government of India started weekly iron-folic acid supplementation (WIFS) in 2012. Aims: Amongst adolescents in selected schools of urban Puducherry, to determine the prevalence of anaemia, proportion of those compliant to WIFS and to assess the sociodemographic and clinical factors associated with anaemia and compliance to WIFS. Subjects and Methods: A cross-sectional analytical study was conducted amongst school-going adolescents (10–18 years) in selected schools of Urban Puducherry. Data were collected using semi-structured, self-administered and pretested questionnaire. Haemoglobin estimation was done using a digital haemoglobinometer. Details regarding intake of iron and albendazole tablets were recorded. The anaemia status was evaluated as per World Health Organization guidelines. Results: The prevalence of anaemia was found to be 62.7% (95% confidence interval [CI]: 58.2–67.0). Proportion having mild, moderate and severe anaemia were 27.3%, 32.5% and 2.8% respectively. The proportion of adolescents compliant to WIFS was 67.7%. Late adolescents were significantly more associated with anaemia (adjusted prevalence ratio [aPR]: 1.7 95% CI: 1.0–3.0) as compared to early adolescents. Males were more compliant to iron-folic acid (IFA) tablets (aPR 1.4 95% CI: 1.0–1.8). Conclusions: More than half of adolescents were anaemic. This study emphasises on the fact that stricter supervision by teachers will result in better compliance to WIFS program. Strategies to improve WIFS compliance, imparting knowledge regarding IFA intake and involvement of school teachers will help to tackle anaemia amongst adolescents.

Background: In India, adolescents constitute 21% of the total population. Majority of boys and girls in developing countries enter adolescence as undernourished, making them more vulnerable to several diseases. Objective: Among adolescents in selected schools of urban Puducherry, we determined the prevalence of malnutrition and also assessed the sociodemographic and clinical factors associated with undernutrition. Materials and Methods: A cross-sectional analytical study was conducted among adolescents (10–18 years) in selected public schools of Urban Puducherry. Data were collected using semi-structured and pre-tested questionnaires. The data collection period was between September and October 2019. Malnutrition was assessed by the World Health Organisation recommended Height-for-age and body mass index-for-age cut-offs using AnthroPlus software. Results: A total of 144 (28.9%) boys and 355 (71.1%) girls were included in the study (N = 499). The prevalence of malnutrition was 46.8% (95% confidence interval [CI]: 42.5–51.3). The prevalence of undernutrition was 33.3% (Stunting [21.6%] and Thinness [15%]). The prevalence of overweight and obesity were 10.2% and 5.8%, respectively. Male gender was found to be an independent risk factor of undernutrition (annual percentage rate = 1.4; 95% CI: 1.0–1.9); and known risk factors such as socio-economic status, parental education were not significantly associated with undernutrition. Conclusions: One in every two school-going adolescents was malnourished. Despite the high prevalence of undernourishment, over nourishment was also commonly observed. Educating parents and students about growth monitoring and dietary habits might help in bringing down the burden of malnutrition.

Hundreds of genetic variants in KCNQ2 encoding the voltage-gated potassium channel KV7.2 are associated with early onset epilepsy and/or developmental disability, but the functional consequences of most variants are unknown. Absent functional annotation for KCNQ2 variants hinders identification of individuals who may benefit from emerging precision therapies. We employed automated patch clamp recordings to assess at, to our knowledge, an unprecedented scale the functional and pharmacological properties of 79 missense and 2 inframe deletion KCNQ2 variants. Among the variants we studied were 18 known pathogenic variants, 24 mostly rare population variants, and 39 disease-associated variants with unclear functional effects. We analyzed electrophysiological data recorded from 9,480 cells. The functional properties of 18 known pathogenic variants largely matched previously published results and validated automated patch clamp for this purpose. Unlike rare population variants, most disease-associated KCNQ2 variants exhibited prominent loss-of-function with dominant-negative effects, providing strong evidence in support of pathogenicity. All variants responded to retigabine, although there were substantial differences in maximal responses. Our study demonstrated that dominant-negative loss-of-function is a common mechanism associated with missense KCNQ2 variants. Importantly, we observed genotype-dependent differences in the response of KCNQ2 variants to retigabine, a proposed precision therapy for KCNQ2 developmental and epileptic encephalopathy.

Background: Vitamin D is an important vitamin required to maintain an important physiological function of the body. The body should maintain an optimal level of vitamin D to maintain skeletal and metabolic functions. It was observed that inverse relationship is maintained by vitamin D level in the body with musculoskeletal symptoms and metabolic disorders. Objective: The study is conducted to associate between serum levels of vitamin D with self-reported symptoms (musculoskeletal) and blood pressure. Material and Methods: Venous blood sample was collected from 126 adults with musculoskeletal symptoms. The subjects were stratified based on their vitamin D levels. Groups were tested for the frequency of symptoms and the relationship of different parameters with vitamin D. Results: The frequency of subjects in the study was more in the deficient category (

The assigned work was aimed to examine the capability of phytoconstituents of an aqueous seed extract of Acacia senegal (L.) Willd to inhibit HMG-CoA reductase and regression of the atherosclerotic plaque. The chemical fingerprinting of the test extract was assessed by LC-MS/MS. Consequently, the analyses of in-vitro, in-vivo, and in-silico were executed by using the standard protocols. The in-vitro assessment of the test extract revealed 74.1% inhibition of HMG-CoA reductase. In-vivo assessments of the test extract indicated that treated hypercholesterolemic rabbits exhibited a significant (P≤0.001) amelioration in the biomarker indices of the dyslipidaemia i.e., atherogenic index, Castelli risk index(I&II), atherogenic coefficient along with lipid profile. Subsequently, significant reductions were observed in the atherosclerotic plaque and antioxidant levels. The in-silico study of molecular docking shown interactions capabilities of the leading phytoconstituents of the test extract i.e., eicosanoic acid, linoleic acid, and flavan-3-ol with target protein of HMG-CoA reductase. The values of RSMF and potential energy of top docked complexes were show significant interactions. Accordingly, the free energy of solvation, interaction angle, radius of gyration and SASA were shown significant stabilities of top docked complex. The cumulative data of results indicate phytoconstituents of an aqueous seed extract of Acacia senegal have capabilities to inhibit the HMG-CoA reductase and improve the levels of antioxidants.

Background: Vitamin D is an important vitamin required to maintain normal skeletal as well as nonskeletal functions. The daily supplementation of vitamin D not only have poor adherence to the regimen but also of doubtful efficacy in deficient patients. Objectives: The aim of this study was to compare the effect of oral high-dose vitamin D regimens (60,000 IU weekly) and daily low-dose vitamin D regimen of 1000 IU in mitigating symptoms and increase in serum levels of vitamin D in patients with hypovitaminosis D. Materials and Methods: A total of 90 patients aged 18–60 years with vitamin D deficiency (serum levels < 30 ng/mL) were enrolled. A total of 38 subjects received 60,000 IU of vitamin D weekly with 500 mg/day calcium and 40 subjects received a dose of 1000 IU of vitamin D daily with 500 mg/day calcium for 10 weeks. Baseline and follow-up total serum vitamin D levels and improvement in symptoms were measured within and between groups. Results: For high-dose vitamin D (60,000 IU weekly), the increase in mean serum vitamin D levels from baseline was 28.33 ng/mL over 10 weeks' treatment period; whereas for the low-dose group (1000 IU daily) the mean increment in serum vitamin D was 6.79 ng/mL for the same period. The mean difference in increase in serum vitamin D between two groups was highly significant (P < 0.001). In both the groups, decrease in myalgia as evaluated on visual analog scale was observed after 10 weeks. Conclusions: High-dose vitamin D (60,000 IU weekly) regimen rapidly normalized 25(OH) D levels and ensure symptomatic relief earlier than daily dosing of 1000 IU vitamin D for same duration.

The function of the voltage-gated KCNQ1 potassium channel is regulated by co-assembly with KCNE auxiliary subunits. KCNQ1-KCNE1 channels generate the slow delayed rectifier current, IKs, which contributes to the repolarization phase of the cardiac action potential. A three amino acid motif (F57-T58-L59, FTL) in KCNE1 is essential for slow activation of KCNQ1-KCNE1 channels. However, how this motif interacts with KCNQ1 to control its function is unknown. Combining computational modeling with electrophysiological studies, we developed structural models of the KCNQ1-KCNE1 complex that suggest how KCNE1 controls KCNQ1 activation. The FTL motif binds at a cleft between the voltage-sensing and pore domains and appears to affect the channel gate by an allosteric mechanism. Comparison with the KCNQ1-KCNE3 channel structure suggests a common transmembrane-binding mode for different KCNEs and illuminates how specific differences in the interaction of their triplet motifs determine the profound differences in KCNQ1 functional modulation by KCNE1 versus KCNE3.

Diabetic foot ulceration is the most distressing complication of diabetes having no standard therapy. Nanofibers are an emerging and versatile nanotechnology-based drug-delivery system with unique wound-healing properties. This study aimed to prepare and evaluate silk-sericin based hybrid nanofibrous mats for diabetic foot ulcer. The nanofibrous mats were prepared by electrospinning using silk sericin mixed with different proportions of polycaprolactone (PCL) and cellulose acetate (CA) loaded with ferulic acid (FA). The in vitro characterizations, such as surface morphology, mechanical properties, swelling behavior, biodegradability, scanning electron microscopy, and drug release were carried out. The SEM images indicated that nanofibers formed with varied diameters, ranging from 100 to 250 nm, and their tensile strength was found to range from 7 to 15 MPa. In vitro release demonstrated that the nanofibers sustained FA release over an extended time of period. In vitro cytotoxicity showed that the nanofibers possessed a lower cytotoxicity in HaCaT cells. The in vivo wound-healing studies demonstrated an excellent wound-healing efficiency of the nanofibers in diabetic rats. Furthermore, the histopathological studies showed the nanofibers’ ability to restore the skin’s normal structure. Therefore, it was concluded that the prepared silk-sericin-based hybrid nanofibers loaded with FA could be a promising drug-delivery platform for the effective treatment of diabetic foot ulcers.

Part One of this two-article series reviews assessment tools to measure burnout and other negative states. Physician well-being goes beyond merely the absence of burnout. Transient episodes of burnout are to be expected. Measuring burnout alone is shortsighted. Well-being includes being challenged, thriving, and achieving success in various aspects of personal and professional life. In this second part of the series, we identify and describe assessment tools related to wellness, quality of life, resilience, coping skills, and other positive states.

Background: HIV infection is characterized by replication by aberrant immune activation and persistent inflammation. HIV infection is associated with loss of CD4 T cells, resulting in dysfunction of immune system. Adenosine Deaminase (ADA) has a cytokine-like costimulatory role in T cell proliferation. Materials and Methods: The study included 150 HIV-positive patients between age group of 20-50 years from ICTC (Integrated Counseling and Testing Centre) and ART centre of Belagavi Institute of Medical Sciences, Hospital, Belagavi, Karnataka, India. ADAactivity and CD4 cell count were estimated before starting any treatment and after 3 months interval of ART up to 9 months. Serum ADA activity was estimated by using colorimetric method of Giusti and Galanti. Results and Discussion: The study showed increased ADA activity before ART, which was gradually decreasing after 3, 6 and 9 months of ART (p

When working in a chaotic Emergency Department (ED) with competing priorities, clinical teaching may be sacrificed for the sake of patient flow and throughput. An organized, efficient approach to clinical teaching helps focus teaching on what the learner needs at that moment, incorporates regular feedback, keeps the department on track, and prevents over-teaching. Effective clinical teaching in a busy environment is an important skill for senior residents and faculty to develop. This review will provide a critique and comparison of seven structured teaching models to better prepare readers to seize the teachable moment.

Leishmania are unicellular eukaryotes responsible for leishmaniasis in humans. Like other trypanosomatids, leishmania regulate protein coding gene expression almost exclusively at the post-transcriptional level with the help of RNA binding proteins (RBPs). Due to the presence of polycystronic transcription units, leishmania do not regulate RNA polymerase II-dependent transcription initiation. Recent evidence suggests that the main control points in gene expression are mRNA degradation and translation. Protein-RNA interactions are involved in every aspect of RNA biology, such as mRNA splicing, polyadenylation, localization, degradation, and translation. A detailed picture of these interactions would likely prove to be highly informative in understanding leishmania biology and virulence. We developed a strategy involving covalent UV cross-linking of RBPs to mRNA in vivo, followed by interactome capture using oligo(dT) magnetic beads to define comprehensively the mRNA interactome of growing L. donovani amastigotes. The protein mass spectrometry analysis of captured proteins identified 79 mRNA interacting proteins which withstood very stringent washing conditions. Strikingly, we found that 49 of these mRNA interacting proteins had no orthologs or homologs in the human genome. Consequently, these may represent high quality candidates for selective drug targeting leading to novel therapeutics. These results show that this unbiased, systematic strategy has the promise to be applicable to study the mRNA interactome during various biological settings such as metabolic changes, stress (low pH environment, oxidative stress and nutrient deprivation) or drug treatment.

Acute hypocalcaemia is a medical emergency that can have catastrophic implications like tetany, seizures, cardiac arrythmias or laryngospasm if left untreated. We are presenting a case of a 30-year-old female patient undergoing total abdominal hysterectomy with bilateral salpingoopherectomy under spinal anaesthesia. She developed unexpected bilateral carpal spasm intraoperatively which was promptly diagnosed and successfully managed with intravenous calcium administration. We conclude that the anaesthetist should be aware of the clinical presentation of acute hypocalcaemia, its causes and emergency management in the perioperative period to prevent any adverse outcomes.

Objectives: To evaluate the knowledge of nurses about the analgesics they administer in our hospital. Methodology: A total of 102 nurses completed the questionnaire which included 20 multiple choice questions based on the dosage forms, mechanism of action, route of administration, adverse effects of the commonly administered analgesics, the nurses’ educational qualifications and their working experience. Frequency, percentage, mean, Kruskal Wallis test and Mann Whitneys test were used to analyse data. Answers were given a score out of 20(100%). Results: The sample comprised of 17(16.6%) senior staff nurses, 38(37%) junior staff nurses and 47(46%) student nurses. Of the staff, 10.8 % were BSc and MSc nurses, 43.1 were GNM staff. The mean knowledge score of BSc & MSc staff was 12.18, GNM staff was 11.7 and of student nurses was 13.38. None of the groups scored more than 15, suggesting their knowledge was inadequate. There was a correlation between knowledge and experience in the staff nurses. Conclusion: The result of this study suggests that the knowledge of pharmacology of analgesics among nurses is inadequate, and thus supports the need for supplementary pharmacology education for nurses in clinical settings, focusing on common drugs they administer and help prevent medical errors.

Summary: This presentation explores clinician burnout in the NHS, focusing on junior doctors and the role of F3 career breaks in burnout recovery. It identifies four themes, discussing how F3 contributes to addressing burnout's clinical features, culminating in a novel framework for promoting enduring burnout recovery in early-stage training: a positive mindset shift. The mindset shift enables better career expectation management and improved work-life boundaries. Organisational recommendations are discussed to enhance support for F3 and its relevance to NHS workforce planning.IntroductionMass clinician burnout in the NHS is an increasingly well-evidenced phenomenon, with adverse work-related stress recently reported to affect 77% of junior doctors. Contrastingly, burnout recovery within this demographic is sparsely considered in the literature despite its role in addressing workforce longevity. F3, a career break taken by junior doctors straight after UK Foundation Training (FT), has risen in incidence, becoming a widely-accepted feature of training pathways (1). Although burnout is indicated as the primary driver in clinicians’ decisions to pursue F3, an organisation-level understanding of if and how clinicians are using F3 for burnout recovery is notably absent. Methods: 12 semi-structured interviews with clinicians returning to training post-F3 were conducted, reaching theoretical saturation. Deductive thematic analysis was performed via NVivo and organisational behavioural theory applied to understand data phenomena. Results: Four dimensions comprising 13 subthemes emerged from the data: post-FT burnout (comprising self-awareness of burnout during FT, established coping mechanisms pre-F3 and burnout drivers in FT), opportunities in F3 (F3 utility, wellness, autonomy and professional development), planning F3 (structure, logistics and expectations) and retrospective perceptions of F3 (positives, downsides and attitudes on return to training). F3 collectively led to burnout recovery via addressing all three clinical features of burnout – emotional exhaustion, depersonalisation, and feelings of personal ineffectiveness at work. Discussion: The autonomy of F3 allows clinicians to engage in self-elected recovery activities, forging the ability to craft healthier relationships with their work. Crucially, this endured post-F3. As such, a mindset shift amongst clinicians towards work that persisted following returning to training was identified. This attitude change allowed clinicians to recalibrate their personal career expectations, and more effectively manage work boundaries allowing re-assertion of passion in their careers post-F3. The evidenced advantages of flexible working like F3 pose additional relevance to NHS workforce strategy planning, and thus 3 organisational-level recommendations to improve support for F3 were evaluated.

Introduction: Addressing physician wellbeing is an increasing trend in both literature and policymaking (1). Despite recognition that occupational burnout is widespread within all healthcare systems, neither a collective understanding of burnout in medical training nor an understanding of burnout recovery strategies has been established globally (2). Thus, a narrative literature review aiming to synthesise the current state of burnout in global medical training was employed, focusing uniquely on how drivers of burnout interact with how clinicians recover from the phenomenon. Methods: Three medical databases (EMBASE, MEDLINE, HMIC) were searched using a scoping approach with keywords from 2013 to March 2023. Grey literature was additionally included. Reviewers screened titles and abstracts prior to full text review of selected articles. Broad eligibility criteria were applied, and subsequently articles were critically appraised alongside formal risk-of-bias assessment. Only burnout-focused papers published in English were included. Outcomes: 536 articles were identified, and after full-text screening, 84 articles met the inclusion criteria. The review provided a rich overview of prevalence by personality, speciality, and training stage as well as both intrinsic and extrinsic contributing factors to burnout and the corresponding impact on work. Existing interventions for burnout recovery were categorised into three domains comprising wellness, individual and institutional-level strategies – the latter two comprised resilience and mindfulness training, self-awareness, mentorship, culture, working conditions, discussion facilitation and screening. Importantly, burnout was consistently found to have negative impacts on patients, the institution, and clinicians. Discussion: Despite the well-evidenced negative effects of burnout (three), this review highlighted significant homogeneity in factors facilitating burnout. Contrastingly, burnout recovery strategies were mostly individual-specific with strong basis surrounding giving protected time to clinicians, promoting wellness approaches over respite and personal engagement. The influence of organisation-level changes, such as those made by the NHS, remain poorly considered within burnout and warrants tailored research given the heterogeneity of the evidence base.

Purpose Acinetobacter baumannii is a highly virulent bacteria in modern health care, with a high ability to acquire antimicrobial resistance. Carbapenemases production appears to be the most common mechanism involved in drug resistance to carbapenem. As the prevalence of carbapenem-resistant A. baumannii was high in intensive care unit (ICU) patients, this study was designed to find the frequency of oxacillinases (OXA) genes including OXA-23, OXA-24, OXA-51, and OXA-58.