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The primary objective of this article is to explore effects of latest development in the area of three dimensional (3D) printing & to assess its abilities, and further undertake helpful reporting. Here the focus is to assess advantages of 3D printing in orthopedics and analyze how 3D printed models help solve complex 3D orthopedics distortions. This study identified that 3D models manufactured by 3D printing models reduce medical parts development cost and surgical planning time. Integrating 3D printing with orthopaedics helps in understanding the conditions of problems and achieving the operation successfully. This technology can enable doctors/surgeons to design, produce, recreate and plan operations more accurately, carefully, and economically. 3D models can assist specialists with a visual comprehension of the patient-particular pathology and life structures. Innovation in 3D printing initiated a scaffold for the virtual outline and execution of medical procedures. This research proposes the utilisation of 3D printers as an elective procedure for the fabrication of parts. It empowers surgeons/patients for better training, education and research. In the future, there is a foreseeable expansion of additive manufacturing in orthopedics.

Background: One fifth of patients with epithelial ovarian cancers (EOC) present at an early stage (FIGO stage I & II). However, there is scarcity of literature on the outcomes and its predictors. The aim of the study was to assess relapse free survival (RFS), overall survival (OS) and its predictors in early stage EOC. Patients and Methods: In this retrospectively study, we included all patients with early-stage EOC diagnosed between January 2010 and December 2018. Patients with synchronous malignancies were excluded. Clinical profile, clinico-pathological characteristics and treatment details were recorded. Patient underwent initial surgery followed by adjuvant chemotherapy in high-risk disease. Patients with stage IC, or stage II or clear cell histology or high-grade histology irrespective of stage/histological subtype were defined as high-risk disease. Fertility sparing surgery (FSS) [unilateral salpingo-oopherectomy with complete surgical staging] was performed in patient willing to preserve fertility. Primary objective was to assess RFS and OS in all patients with early stage EOC. Secondary objectives were to assess RFS and OS in early stage EOC with high-risk disease, predictors of RFS and OS, and outcomes of FSS. Survival probabilities were estimated according to Kaplan-Meier and compared by the log rank test. Cox's regression model was used to analyze the significance of various factors affecting relapse free survival (RFS) and overall survival (OS). Results: 195 patients with early stage EOC were recruited with median age of 47 years (range, 16–80 years). FIGO stage I and stage II were seen in 72 % and 18 % patients respectively. Serous subtype was reported in 58 % and high-grade histology in 66 %. 184 patients (94.0%) underwent optimal staging surgery, including 27 (14%) with fertility sparing surgery (FSS). 133 (91.7 %) of 145 patients with high-risk disease received adjuvant chemotherapy (paclitaxel and carboplatin), while 12 (8.3 %) patients opted to remain on observation. At median follow up of 56 months (95 % CI, 46–64 months), 49 (25 %) patients relapsed [including 3 of 27 (11.1 %) who underwent FSS], 18 patients died of progressive disease, while 31 patients were alive and disease free. Estimated OS at 5 years is 87.6 % (95 % CI 79.9–92.5) and RFS is 73.2 % (95 % CI 64.7–80.0). On multivariate analysis tumor grade was predictive of RFS (HR 2.9, p

Instrumentation and Control systems (I&C) play a significant role in nuclear power plants (NPP) and other safety critical systems (SCS). We have conducted a rigorous study and discussions with experienced practitioners worldwide the strategy for the development of I&C systems to investigate the several aspects related to their dependability. We discussed with experienced practitioners that work on nuclear domain with the intention of knowing their approach, they use day-to-day for the development of such systems. The aim of this research is to obtain to provide guidance to those building I&C systems of NPP and have implications on state engineering licensure boards, in the determination of legal liability, and in risk assessment for policymakers, corporate governors, and insurance executives.

Abstract Exploring the gut microbiome is an emerging tool for monitoring wildlife health and physiological conditions which often sustained under the variety of stresses and challenges. We analyzed gut microbiome of Arunachal macaque (Macaca munzala) of two disjunct populations from Arunachal Pradesh, India, to validate whether the geography or the feeding habits plays a principal role in shaping the gut microbiome in natural populations. We observed geography has a mere effect but feeding habits (i.e. feeding upon the leftover food and crop-raiding) significantly influenced the gut microbiome composition. The phylum Proteobacteria found to be enriched in leftover feeding group while phylum Bacteroidetes was differentially abundant in crop-raiding group. We observed predominant phyla Firmicutes followed by Proteobacteria and Bacteroidetes with the dominant classes represented by the Clostridia. Interestingly, one individual with known diarrheal/metabolic disorder exhibited complete dominance of the order Bacillales and showed 100% sequence similarity with genus Solibacillus. We raise concern that shift in diet of macaques may compel them to expose for various human diseases as two macaques feeding upon the leftover food exhibited dysbiotic gut microbiome. The present study provides the pragmatic evidences of how the alteration of food resources can harm the physiological condition of the macaques in wild and raises alarm to the forest officials/managers in strategise planting of natural food resources and monitor anthropogenic activities in the distribution of Arunachal macaques.

Abstract The Siwalik Group, ranging from the Early Miocene to Pleistocene, is believed to be deposited in the fluvial environment and controlled by contemporary Himalayan tectonics and climate. In this study, we established the fluvial environment and its controlling factors responsible for the deposition of the Siwalik succession along the Muksar Khola section in the eastern Nepal Himalaya. Five sedimentary facies associations are identified; these are interpreted as the deposits of flood plain-dominated fine-grained meandering river (FA1), flood-dominated overbank environment (FA2), sandy meandering river (FA3), anastomosing river (FA4), and debris flow-dominated gravelly braided river (FA5). These changes in the fluvial system occurred around 10.5 Ma, 10.0 Ma, 5.9 Ma and 3.5 Ma, defined by existing magnetostratigraphy constraints, due to the effects of hinterland tectonics, climate and sea-level change and continuous drifting of the foreland basin towards the hinterland concerning depositional age. The thick succession of an intraformational conglomerate reveals intensification of the monsoon started around 10.5 Ma in the eastern Nepal Himalaya. The present study also shows asynchronous exhumation of the Himalaya from east to west brought a significant difference in the fluvial environment of the Neogene foreland basin.

Abstract Background Losing a child tragically impacts the well-being and functioning of parents. With these effects extending beyond emotional, physical morbidity and compromising self-perceptions, appropriate, longitudinal, timely and personalised support is key to effective care of bereaved parents. However, in the absence of a comprehensive understanding of parental bereavement, effective support of bereaved parents remains suboptimal. To address this gap, we scrutinise prevailing data on the effects of a child’s death, aged 0–12 years, through the lens of the Ring Theory of Personhood (RToP). Methods To study prevailing accounts of bereaved parents following the death of a child, we adopt Krishna’s Systematic Evidence Based Approach (SEBA) to structure our Systematic Scoping Review (SSR in SEBA). Results Three thousand seventy-four abstracts were reviewed, 160 full text articles were evaluated, and 111 articles were included and analysed using thematic and content analysis. Four themes/categories were identified relating to the four rings of the RToP. Findings reveal that static concepts of protective and risk factors for grief are misplaced and that the support of healthcare professionals is key to assisting bereaved parents. Conclusion In the absence of consistent support of bereaved parents, this study highlights the need for effective training of healthcare professionals, beginning with an appreciation that every aspect of an individual parent’s personhood is impacted by the loss of their child. Acknowledging grief as a complex, evolving and personalised process subjected to parental characteristics, settings, context and available support, this SSR in SEBA calls attention to effective nurturing of the relationship between parents and healthcare professionals, and suggests use of the RToP to assess and direct personalised, timely, specific support of parents in evolving conditions. We believe the findings of this review also call for further studies to support healthcare professionals as they journey with bereaved parents.

Abstract Background Poor communication skills can potentially compromise patient care. However, as communication skills training (CST) programs are not seen as a priority to many clinical departments, there is a discernible absence of a standardised, recommended framework for these programs to be built upon. This systematic scoping review (SSR) aims to gather prevailing data on existing CSTs to identify key factors in teaching and assessing communication skills in the postgraduate medical setting. Methods Independent searches across seven bibliographic databases (PubMed, PsycINFO, EMBASE, ERIC, CINAHL, Scopus and Google Scholar) were carried out. Krishna’s Systematic Evidence-Based Approach (SEBA) was used to guide concurrent thematic and content analysis of the data. The themes and categories identified were compared and combined where possible in keeping with this approach and then compared with the tabulated summaries of the included articles. Results Twenty-five thousand eight hundred ninety-four abstracts were identified, and 151 articles were included and analysed. The Split Approach revealed similar categories and themes: curriculum design, teaching methods, curriculum content, assessment methods, integration into curriculum, and facilitators and barriers to CST. Amidst a wide variety of curricula designs, efforts to develop the requisite knowledge, skills and attitudes set out by the ACGME current teaching and assessment methods in CST maybe categorised into didactic and interactive methods and assessed along Kirkpatrick’s Four Levels of Learning Evaluation. Conclusions A major flaw in existing CSTs is a lack of curriculum structure, focus and standardisation. Based upon the findings and current design principles identified in this SSR in SEBA, we forward a stepwise approach to designing CST programs. These involve 1) defining goals and learning objectives, 2) identifying target population and ideal characteristics, 3) determining curriculum structure, 4) ensuring adequate resources and mitigating barriers, 5) determining curriculum content, and 6) assessing learners and adopting quality improvement processes.

The experiment was done on finger millet during the zaid season of 2021-22 at crop research farm, Department of Agronomy, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Prayagraj (Uttar Pradesh). The treatments consisted of three planting geometry viz., 20 cm × 20 cm, 25 cm × 25 cm and 30 cm × 30 cm and three NPK levels viz., 75%, 100% and 125%. The experiment was conducted in randomized block design with nine numbers of treatments and replicated thrice. The results showed that treatment with 30 cm × 30 cm spacing at 125 % NPK /ha growth parameters viz., maximum plant height (69.73 cm), number of tillers per plant (17.36 g/plant), dry weight per plant (7.36 g) while yield were recorded highest with treatment 20 cm × 20 cm spacing at 125 % NPK /ha. viz., Grain yield (45.76 t/ha), Straw yield (4.33 t/ha) and harvest index (44.91) of finger millet at harvest. This may due to the highest plant population with close spacing treatment and higher number of heads/ m2 as compare with wide spacing.

Introduction: The skin is the largest organ system in humans. Different skin diseases consist of non specific, non infectious and infectious diseases to various neoplastic lesions. Dermatological lesions are commonly encountered in all countries and it encompasses a wide spectrum, varies from country to country and various regions within a country and influenced by sex, age and associated systemic disorders, economy, literacy, racial and social customs. The clinical presentation is restricted to only a few changes such as hyperpigmentation, hypopigmentation, macules, papules, nodules and few others. However, the spectrum of histopathology of skin disorders is varied. Accurate diagnosis of skin disorders is of utmost importance as treatment is varied for different skin disorders presenting with the similar clinical lesions. Aim: To study histomorphological spectrum and distribution of skin lesions. Materials and Methods: This hospital-based cross-sectional study was conducted in Department of Pathology in collaboration with Department of Skin and Venereal Diseases, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, over a period of two years from September 2019 to August 2021. The biopsy sample taken from clinically diagnosed skin lesions sent to histology laboratory in 10% formalin. Sample was fixed in 10% neutral buffered formalin over a period of 12 to 24 hours. Paraffin wax blocks were made and 3-4 micrometer sections were taken and stained with Haematoxylin and Eosin (H&E) stain and histology was studied under microscope. Special stains such as Ziehl-Neelsen (Z-N) stain and Fite stain was done, whenever required. Data was entered in Microsoft Excel excel and descriptive data was obtained. Results: Out of total 105 cases, the maximum patients were of 21-30 years of age group 30 (28.57%) cases followed by 11-20 years of age group 25 (23.81%) cases with male and female ratio M:F=1.5:1. Out of total 105 cases, the most common site involved was trunk in 42 (40%) cases followed by upper limb in 25 (23.81%) cases. The most common skin lesions were non infectious 70 (66.67%) cases, followed by infectious disease 22 (20.95) cases. In non infectious papulosquamous diseases group found 25 (23.81%) cases followed by vesiculobullous and vesiculopustular diseases group 24 (22.86%) cases. Infectious diseases were seen in 22 (20.95%) cases, out of which bacterial diseases being most common in 19 (18.10%) cases followed by parasitic infection 2 (1.90%) cases. Conclusion: According to the findings of the present study the majority of skin lesions cases requiring biopsy in developing countries is still psoriasis in non infectious papulosquamous diseases group. Tuberculosis and leprosy in infectious diseases category were being the leading cause of morbidity.

Introduction: The need for longitudinal and comprehensive evidenced development of surgical knowledge, skills and attitudes, and the attainment of appropriate competencies have spotlighted portfolio use. Yet variations in structure, content and roles as well as its resource-heavy reputation have limited its impact. The purpose of this study is to map prevailing data on the use of portfolios in postgraduate surgical education to address a lack of e-portfolio use and guide its design and structuring in surgery. Material and methods: A Systematic Evidenced Based Approach (SEBA) guided systematic scoping review (SSR) (SSR in SEBA) was conducted to map prevailing data. The constructivist ontological approach used allowed for enhanced reflexivity in the analysis and discussion. Results: 13,092 articles were reviewed, 839 full-text articles were evaluated, and 37 articles were included. Concurrent thematic and content analysis revealed similar themes and categories which were the role of portfolios, evaluation of portfolio use, and implementation of e-portfolios. Discussion: Lessons from traditional surgical portfolios can be employed to enhance the design, support and utility of e-portfolios and yet maintain as a balanced trainee-led perspective of their progress. Focused on documenting the trainee's competencies, achievements, experiences, feedback, and reflections, a variety of methods are presently used to assess the reliability, validity, educational impact, acceptability and feasibility of surgical portfolios. The use of e-portfolios, in particular, has been adopted due to its accessibility, portability and convenience. Beyond its flexibility in access, repository and content, e-portfolios offer increased user accessibility, better quality interactions and smoother facilitation, clarification, and feedback. Conclusions: The data in this SSR in SEBA underscores the need for systematic assessment tools to evaluate e-portfolio as well as evaluate the programs as a whole. Further research into training mentors to support e-portfolio use, assess progress and ensure effective oversight of e-portfolios are required.

Background Concepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians.Methods A systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows.Results A total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions.Conclusions Initial reviews suggest that MD involves conflicts within a physician’s personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician’s personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician’s MD and preventing burn-out.

Pleistocene glaciations had profound impact on the spatial distribution and genetic makeup of species in temperate ecosystems. While the glacial period trapped several species into glacial refugia and caused abrupt decline in large populations, the interglacial period facilitated population growth and range expansion leading to allopatric speciation. Here, we analyzed 40 genomes of four species of ibex and found that Himalayan ibex in the Pamir Mountains evolved independently after splitting from its main range about 0.1 mya following the Pleistocene species pump concept. Demographic trajectories showed Himalayan ibex experienced two historic bottlenecks, one each c. 0.8–0.5 mya and c. 50–30 kya, with an intermediate large population expansion c. 0.2–0.16 mya coinciding with Mid-Pleistocene Transitions. We substantiate with multi-dimensional evidence that Himalayan ibex is an evolutionary distinct phylogenetic species of Siberian ibex which need to be prioritized as Capra himalayensis for taxonomic revision and conservation planning at a regional and global scale.

Abstract Background Transdermal delivery of drugs is a quite challenging task for pharmaceutical scientists. The transdermal route is preferred over the oral route due to various advantages like avoidance of the first-pass effect, non-invasiveness, and high patient compliance. Therefore, it is necessary to develop an effective carrier system that enables the effective passage of the drug through the dermal barrier. Main body of abstract Various novel drug delivery systems are used to enhance the permeation of a variety of drugs through the skin barrier. Researchers around the globe have explored nanofibers for the transdermal delivery of various therapeutic agents. Nanofibers are designed to have a high concentration of therapeutic agents in them promoting their flux through various skin layers. Polymeric nanofibers can be explored for the loading of both hydrophilic and lipophilic drugs. Biopolymer-based nanofibers have been also explored for transdermal delivery. They are capable of controlling the release of therapeutic agents for a prolonged time. Short conclusion The literature presented in this review paper provides significant proof that nanofibers will have an intense impact on the transdermal delivery of different bioactive molecules in the future. Graphic abstract

Introduction: The granulomatous reaction is defined as a distinctive inflammatory pattern characterised by the granuloma. The term Granuloma was first coined by Virchow in 1864. The granuloma is characterised by collection of activated histiocytes, epithelioid cells and multinucleate giant cells that may or may not be rimed by lymphocytes and/or show central necrosis. The pattern of skin disease varies from one country to another and across different parts within same country. The granulomatous lesions of skin are a common and intriguing problem in developing countries. Aim: To study the histomorphological spectrum of granulomatous lesions of skin. Materials and Methods: This cross-sectional study was conducted in Department of Pathology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, over a period of two years (from September 2018 to September 2020). All skin biopsies coming to the Department of Pathology were fixed in 10% neutral buffered formalin for duration of 12 to 24 hours. Paraffin wax blocks were made and 3-4 micrometer section were taken and stained with Haematoxylin and Eosin (H&E), showing granulomas on histology were included in the study. On H&E, stained slide, granulomas were studied for type, morphology and site. Special stains were used for further evaluations and analysis. Results: Out of total 124 cases studied, the maximum patients 34 (27.41%) were of 11-20 years age group. The epithelioid granuloma was the most common type in 76 (61.29%) cases followed by histiocytic granuloma in 24 (19.35%). The infectious granulomatous dermatoses were the most common histological type in which tuberculosis was most common followed by leprosy. Most commonly the lesions were found to involve the whole dermis in 74 (59.68%) cases, followed by upper and mid dermis in 35 (28.22%) cases. Out of 40 cases of leprosy, 17 (42.50%) cases were found Wade-Fite Stain positive. Out of total 57 cases of tuberculosis, 31 (54.38%) cases were found Acid-Fast Bacillus (AFB) positive. Conclusion: Authors concluded that major cause of granulomatous dermatoses in developing countries is still infectious, tuberculosis and leprosy being the leading causes. Histopathology is gold standard for diagnosis and categorisation of granulomatous dermatoses. Special stains are useful in cases of any dilemma

Abstract Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has recently emerged as a viable management option for peritoneal surface malignancy (PSM). CRS and HIPEC is a complex, multidisciplinary and resource-intensive surgical procedure. It has a steep learning curve and is associated with significant morbidity and mortality. The expertise is mostly limited to few dedicated high-volume centers located in developed countries. We present a single institutional experience of 232 cases of CRS and HIPEC performed at a tertiary care cancer center in a low- and middle-income country (LMIC). Methods A multidisciplinary PSM program was initiated in 2015 at a high-volume public-sector tertiary care cancer center in North India catering largely to patients belonging to low- and middle-income groups. Perioperative protocols were developed, and a prospective structured database was created to capture data. All patients undergoing CRS and HIPEC between January 2015 and December 2020 were identified, and the data was retrospectively analyzed for clinical spectrum, surgical details, and perioperative morbidity and mortality. Results Two hundred and thirty-two patients underwent CRS and HIPEC during the study period. Epithelial ovarian carcinoma (56.5%) was the most common malignancy treated, followed by pseudomyxoma peritonei (18.5%), colorectal carcinoma (13.4%), and malignant mesothelioma (5.6%). Optimal CRS could be achieved in 94.4% of patients. Cisplatin and mitomycin were the most common drugs used for HIPEC. A total of 28.0% of patients had morbidity including deep vein thrombosis, subacute intestinal obstruction, sepsis, burst abdomen, lymphocele, urinoma, acute renal failure, and enterocutaneous fistula. The overall treatment-related mortality was 3.5%. Conclusions Results of the current study indicate that it is feasible to establish a successful CRS and HIPEC program for PSM in government-funded hospitals in LMIC facing resource constraints. The most common indication for CRS and HIPEC were carcinoma of the ovary followed by pseudomyxoma peritonei and colorectal carcinoma. Overall morbidity and mortality in the current series are comparable to global standards, reported from high-income countries. A protocol-based multidisciplinary team approach, optimal patient selection, and surgical expertise can help achieve optimal outcomes in government-funded hospitals in LMIC.

Abstract Background Molding competent clinicians capable of applying ethics principles in their practice is a challenging task, compounded by wide variations in the teaching and assessment of ethics in the postgraduate setting. Despite these differences, ethics training programs should recognise that the transition from medical students to healthcare professionals entails a longitudinal process where ethics knowledge, skills and identity continue to build and deepen over time with clinical exposure. A systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature to guide the development of a local physician training curriculum. Methods With a constructivist perspective and relativist lens, this systematic scoping review on postgraduate medical ethics training and assessment will adopt the Systematic Evidence Based Approach (SEBA) to create a transparent and reproducible review. Results The first search involving the teaching of ethics yielded 7669 abstracts with 573 full text articles evaluated and 66 articles included. The second search involving the assessment of ethics identified 9919 abstracts with 333 full text articles reviewed and 29 articles included. The themes identified from the two searches were the goals and objectives, content, pedagogy, enabling and limiting factors of teaching ethics and assessment modalities used. Despite inherent disparities in ethics training programs, they provide a platform for learners to apply knowledge, translating it to skill and eventually becoming part of the identity of the learner. Illustrating the longitudinal nature of ethics training, the spiral curriculum seamlessly integrates and fortifies prevailing ethical knowledge acquired in medical school with the layering of new specialty, clinical and research specific content in professional practice. Various assessment methods are employed with special mention of portfolios as a longitudinal assessment modality that showcase the impact of ethics training on the development of professional identity formation (PIF). Conclusions Our systematic scoping review has elicited key learning points in the teaching and assessment of ethics in the postgraduate setting. However, more research needs to be done on establishing Entrustable Professional Activities (EPA)s in ethics, with further exploration of the use of portfolios and key factors influencing its design, implementation and assessment of PIF and micro-credentialling in ethics practice.

Abstract Fetal liver hematopoietic stem and progenitor cells (HSPCs) have been considered appropriate for the management of aplastic anemia owing to their proliferative potential. Bone marrow recovery was possible in some cases; the engraftment potential of these cells, however was unsatisfactory, possibly due to the availability of a smaller number of these cells from a single fetus. The present study explores how we can expand fetal liver hematopoietic stem cells under in vitro conditions. We isolated mononuclear cells from fetal liver and hematopoietic stem cells were identified and analyzed by cell surface marker CD34. CD34+ fetal liver HSPCs cells were separated by magnetic cell sorting positive selection method. HSPCs (CD34+) were cultured by using 5 cytokines, stem cell factor (SCF), granulocyte macrophages-colony stimulating factor (GM-CSF), interleukin-6 (IL-6), Fms-related tyrosine kinase 3 (FLT-3) and erythropoietin (EPO), in 4 different combinations along with supplements, in serum-free culture media for 21 days. Cell viability continued to be greater than 90% throughout 21 days of culture. The cells expanded best in a combination of media, supplements and 5 cytokines, namely SCF, FLT-3, IL6, EPO and GM-CSF to yield a large number of total (CD34+ & CD34-) cells. Even though the total number of nucleated cells increased in culture significantly, levels of CD34 antigen expression declined steadily over this period.

The lymphatic system plays a crucial role in mounting immune response against intracellular pathogens, and recent studies have documented its role in facilitating tumor dissemination linked largely with cancer cells. However, in mucocutaneous leishmaniasis (MCL) caused by Leishmania Viannia subgenus showing infectious metastasis and resulting in severe distant secondary lesions, the route of escape of these parasites to secondary sites has not yet been investigated in detail. Our results demonstrated that when infection was associated with inflammation and additionally exacerbated by the presence of dsRNA viral endosymbiont (LRV1), lymphatic vessels could serve as efficient routes for infected cells to egress from the primary site and colonize distant organs. We challenged this hypothesis by using the intracellular Leishmania protozoan parasites Leishmania guyanensis (Lgy) associated with or without a dsRNA viral endosymbiont, exacerbating the infection and responsible for a strong inflammatory response, and favoring metastasis of the infection. We analyzed possible cargo cells and the routes of dissemination through flow cytometry, histological analysis, and in vivo imaging in our metastatic model to show that parasites disseminated not only intracellularly but also as free extracellular parasites using migrating immune cells, lymph nodes (LNs), and lymph vessels, and followed intricate connections of draining and non-draining lymph node to finally end up in the blood and in distant skin, causing new lesions.

Introduction: The term monoclonal gammopathy of renal significance (MGRS) has been described to include patients with renal manifestations associated with circulating monoclonal proteins with or without a clonal lymphoproliferation (B-cell or plasma cell) and not meeting diagnostic criteria for an overt hematological malignancy. A host of MGRS-associated lesions have been described that involve various renal compartments. Our study describes the histomorphological spectrum of MGRS cases at our center in the last 5 years and description as per the classification system of the International Kidney and Monoclonal Gammopathy Research Group (IKMG). Material and Methods: Retrospective analysis was carried out of all the renal biopsies with characteristic monoclonal immunoglobulin lesions for histopathological diagnosis between years 2015 and 2020 and reviewed by two independent pathologists. Results: Most patients in the study belonged to the fifth decade, with a median age of 50 years (mean 50.14 ± 10.43) range (24–68 years) with a male preponderance. Most patients presented with proteinuria as the sole manifestation (66.6%). Many of the patients (48%) had an M spike by serum protein electrophoresis or urinary protein electrophoresis with an abnormal serum free light chain assay (60.8%). AL amyloidosis was the most common diagnosis observed on histopathological evaluation (68.7%), followed by light chain deposition disease (10.4%). Conclusion: MGRS lesions are infrequently encountered in the practice of nephropathology and pose a diagnostic challenge due to the limitation of a congruent clinical or hematological picture. A thorough histological examination with immunofluorescence and electron microscopy often precipitates in the right diagnosis and prompts timely management.

Abstract Brown bear‐mediated conflicts have caused immense economic loss to the local people living across the distribution range. In India, limited knowledge is available on the Himalayan brown bear (HBB), making human–brown bear conflict (HBC) mitigation more challenging. In this study, we studied HBC in the Lahaul valley using a semi‐structured questionnaire survey by interviewing 398 respondents from 37 villages. About 64.8% of respondents reported conflict in two major groups—crop damage (30.6%) and livestock depredations (6.2%), while 28% reported both. Conflict incidences were relatively high in summer and frequently occurred in areas closer to the forest (

HSF-1 is a key regulator of cellular proteotoxic stress response and is required for animal lifespan. In C. elegans, HSF-1 mediated heat shock response (HSR) declines sharply on the first day of adulthood, and HSF-1 was proposed to function primarily during larval stages for lifespan assurance based on studies using RNAi. The tissue requirement for HSF-1 in lifespan, however, is not well understood. Using the auxin-inducible degron (AID) system, we manage to uncouple the roles of HSF-1 in development and longevity. In wild-type animals, we find HSF-1 is required during the whole self-reproductive period for lifespan. This period is extended in long-lived animals that have arrested germline stem cells (GSC) or reduced insulin/IGF-1 signaling (IIS). While depletion of HSF-1 from any major somatic tissues during development results in severe defects, HSF-1 primarily functions in the intestine and likely neural system of adults to support lifespan. Finally, by combining AID and genome-wide transcriptional analyses, we find HSF-1 directly activates the transcription of constitutively-expressed chaperone and co-chaperone genes among others in early adulthood, which underlies its roles in longevity assurance.

PURPOSEPatients with advanced and metastatic cervical cancer have a poor prognosis with a 1-year survival rate of 10%-15%. Recently, an antiangiogenic humanized monoclonal antibody bevacizumab has shown to improve the survival of these patients. This study was designed to assess the cost effectiveness of incorporating bevacizumab with standard chemotherapy for the treatment of patients with advanced and metastatic cervical cancer in India.METHODSUsing a disaggregated societal perspective and lifetime horizon, a Markov model was developed for estimating the costs and health outcomes in a hypothetical cohort of 1,000 patients with advanced and metastatic cervical cancer treated with either standard chemotherapy alone or in combination with bevacizumab. Effectiveness data for each of the treatment regimen were assessed using estimates from Gynecologic Oncology Group 240 trial. Data on disease-specific mortality in metastatic cervical cancer, health system cost, and out-of-pocket expenditure were derived from Indian literature. Multivariable probabilistic sensitivity analysis was undertaken to account for parameter uncertainty.RESULTSOver the lifetime of one patient with advanced and metastatic cervical cancer, bevacizumab along with standard chemotherapy results in a gain of 0.275 (0.052-0.469) life-years (LY) and 0.129 (0.032-0.218) quality-adjusted life-years (QALY), at an additional cost of $3,816 US dollars (USD; 2,513-5,571) compared with standard chemotherapy alone. This resulted in an incremental cost of $19,080 USD (7,230-52,434) per LY gained and $34,744 USD (15,782-94,914) per QALY gained with the use of bevacizumab plus standard chemotherapy.CONCLUSIONAddition of bevacizumab to the standard chemotherapy is not cost effective for the treatment of advanced and metastatic cervical cancer in India at a threshold of 1-time per-capita gross domestic product.

Abstract Background Empathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. To inform future design of programs aimed at nurturing empathy in medical students and doctors, a review is proposed. Methods This systematic scoping review (SSR) employs a novel approach called the Systematic Evidence Based Approach (SEBA) to enhance the reproducibility and transparency of the process. This 6-stage SSR in SEBA involved three teams of independent researchers who reviewed eight bibliographic and grey literature databases and performed concurrent thematic and content analysis to evaluate the data. Results In total, 24429 abstracts were identified, 1188 reviewed, and 136 included for analysis. Thematic and content analysis revealed five similar themes/categories. These comprised the 1) definition of empathy, 2) approaches to nurturing empathy, 3) methods to assessing empathy, 4) outcome measures, and 5) enablers/barriers to a successful curriculum. Conclusions Nurturing empathy in medicine occurs in stages, thus underlining the need for it to be integrated into a formal program built around a spiralled curriculum. We forward a framework built upon these stages and focus attention on effective assessments at each stage of the program. Tellingly, there is also a clear need to consider the link between nurturing empathy and one’s professional identity formation. This foregrounds the need for more effective tools to assess empathy and to better understand their role in longitudinal and portfolio based learning programs.

Abstract Objectives Human identification systems based on STRs are widely used in human population genetics and forensic analysis. This study aimed to validate the cross-reactivity of three widely known human-specific STR identification systems i.e. GlobalFiler™ PCR Amplification Kit, Investigator 24plex QS Kit, and PowerPlex® Fusion 6C in chimpanzee. Results The present study revealed the successful amplification of 18 loci using GlobalFiler™ PCR Amplification Kit, 18 loci using Investigator 24plex QS Kit, and 20 loci using PowerPlex® Fusion 6C system. The marker Amelogenin (AMEL) showed differential allele size between male and female revealing the gender identity of chimpanzees and thus validates their application concerning forensic examination, population estimation, and genetic analysis.

Abstract Multiple myeloma (MM) is a plasma cell malignancy with diverse clinical phenotypes and molecular heterogeneity not completely understood. Differentially expressed genes (DEGs) and miRNAs (DEMs) in MM may influence disease pathogenesis, clinical presentation / drug sensitivities. But these signatures overlap meagrely plausibly due to complexity of myeloma genome, diversity in primary cells studied, molecular technologies/ analytical tools utilized. This warrants further investigations since DEGs/DEMs can impact clinical outcomes and guide personalized therapy. We have conducted genome-wide meta-analysis of DEGs/DEMs in MM versus Normal Plasma Cells (NPCs) and derived unified putative signatures for MM. 100 DEMs and 1,362 DEGs were found deranged between MM and NPCs. Signatures of 37 DEMs (‘Union 37’) and 154 DEGs (‘Union 154’) were deduced that shared 17 DEMs and 22 DEGs with published prognostic signatures, respectively. Two miRs (miR-16–2-3p, 30d-2-3p) correlated with survival outcomes. PPI analysis identified 5 topmost functionally connected hub genes (UBC, ITGA4, HSP90AB1, VCAM1, VCP). Transcription factor regulatory networks were determined for five seed DEGs with ≥ 4 biomarker applications (CDKN1A, CDKN2A, MMP9, IGF1, MKI67) and three topmost up/ down regulated DEMs (miR-23b, 195, let7b/ miR-20a, 155, 92a). Further studies are warranted to establish and translate prognostic potential of these signatures for MM.

Insufficient research has been conducted on musk deer species across their distribution range, primarily because of their elusive behaviour and the fact they occupy remote high-altitude habitats in the Himalayas above 2500 m. The available distribution records, primarily derived from ecological studies with limited photographic and indirect evidence, fail to provide comprehensive information on the species distribution. Consequently, uncertainties arise when attempting to determine the presence of specific taxonomic units of musk deer in the Western Himalayas. This lack of knowledge hampers species-oriented conservation efforts, as there need to be more species-specific initiatives focused on monitoring, protecting, and combatting the illegal poaching of musk deer for their valuable musk pods. We used transect surveys (220 trails), camera traps (255 cameras), non-invasive DNA sampling (40 samples), and geospatial modelling (279 occurrence records) to resolve the taxonomic ambiguity, and identify the suitable habitat of musk deer (Moschus spp.) in Uttarkashi District of Uttarakhand and the Lahaul–Pangi landscape of Himachal Pradesh. All the captured images and DNA-based identification results confirmed the presence of only Kashmir musk deer (KDM) (Moschus cupreus) in Uttarakhand and Himachal Pradesh. The results suggest that KMD inhabit a narrow range of suitable habitats (6.9%) of the entire Western Himalayas. Since all evidence indicates that only KMD are present in the Western Himalayas, we suggest that the presence of other species of musk deer (Alpine musk deer and Himalayan musk deer) was wrongly reported. Therefore, future conservation plans and management strategies must focus only on KMD in the Western Himalayas.

BCS class II molecules suffer from low oral bioavailability because of their poor permeability and sub-optimal aqueous solubility. One of the approaches to enhance their bioavailability is using cyclodextrin-based nanosponges. This study aimed to optimise and evaluate the feasibility of a microwave-assisted approach to synthesise nanosponges and improve domperidone’s solubility and drug delivery potential. In the production process, microwave power level, response speed, and stirring speed were optimised using the Box-Behnken approach. Ultimately, the batch with the smallest particle size and highest yield was chosen. The optimised method of synthesis of the nanosponges resulted in a product yield of 77.4% and a particle size of 195.68 ± 2.16 nm. The nanocarriers had a drug entrapment capacity of 84 ± 4.2% and a zeta potential of −9.17± 0.43 mV. The similarity and the difference factors demonstrated proof-of-concept, showing that the drug release from the loaded nanosponges is significantly greater than the plain drug. Additionally, spectral and thermal characterisations, such as FTIR, DSC, and XRD, confirmed the entrapment of the drug within the nanocarrier. SEM scans revealed the porous nature of the nanocarriers. Microwave-assisted synthesis could be used as a better and greener approach to synthesise these nanocarriers. It could then be utilised to load drugs and improve their solubility, as seen in the case of domperidone.

Abstract Background The number of people with implanted hip prosthesis has grown worldwide. For radiotherapy planning of patients with hip implants, few main challenges are encountered. The aim of the present study was to evaluate the feasibility of different planning algorithms in the presence of high-density metallic implant in the treatment of patients with carcinoma cervix. Results It was found that D 98% were 44.49 ± 0.11, 44.51 ± 0.13, 44.39 ± 0.22, and 44.45 ± 0.16 Gy for 4FMC6MV (4-field technique calculated with Monte-Carlo algorithm and 6 MV photon energy), 4FMC6MV_WP (4-field technique calculated with Monte-Carlo algorithm and 6 MV photon energy without prosthesis), 4FCC6MV (4-field technique calculated with collapse-cone-convolution algorithm and 6 MV photon energy), and 4FCC6MV_WP (4-field technique calculated with collapse-cone-convolution algorithm and 6 MV photon energy without prosthesis) respectively. Similarly, D 2% were 49.40 ± 0.84, 49.05 ± 0.76, 48.97 ± 0.91, and 48.57 ± 0.85 Gray (Gy) for 4FMC6MV, 4FMC6MV_WP, 4FCC6MV, and 4FCC6MV_WP respectively. The present study has not suggested any major difference between the Monte-Carlo (MC) and collapse-cone-convolution (CCC) calculation algorithm in the presence of high-Z metallic implants. Volume of bowel receiving 15 Gy dose has shown a significant difference with prosthesis cases. This study investigates that hip prosthesis creates considerable changes in the treatment planning of cervical malignancies. Conclusion CCC algorithm is in good agreement with MC calculation algorithm in the presence of high-density metallic implants in terms of target coverage and avoidance organ sparing except few parameters.

Abstract Background The alphabaculoviruses are lethal pathogens of lepidopteran caterpillars including a polyphagous and globally recognized pest, Helicoverpa armigera (Hubner) infesting economically important agriculture crops worldwide. The biological and molecular characterizations of indigenous nucleopolyhedrovirus of the genus Alphabaculovirus isolated from H. armigera in chickpea fields are described. Results The virulence of virus isolate was tested in 3rd instar H. armigera larvae, and LC50 (median lethal concentration) was estimated to be 2.69 × 104 OBs ml−1. The ST50 (median survival time) was 4 days post-inoculation, when the 3rd instar H. armigera larvae were inoculated by OB (occlusion body) concentration equivalent to LC90. An average incubation period of the virus isolate in 3rd instar ranged between 4 and 6 days post-inoculation. The OBs of a virus isolate appeared irregular in shape and variable in size with diameter ranging from 0.57 to 1.46 μm on the longest edge and average of 1.071 ± 0.068 μm (mean ± SE). On the basis of phylogenetic analysis of polh, pif-1, and lef-8 genes, the isolate was found to be a member of the genus Alphabaculovirus. The isolate showed a genetic affinity with species of group II Alphabaculoviruses and appeared to be a group II NPV. Conclusions On the basis of molecular phylogeny and associated host insect, this indigenous isolate was designated as HearNPV-IIPR05 isolate, which could be a potential candidate for the biological control of H. armigera infesting legumes and other commercial crops.

Background: Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous drug reactions with a high morbidity and mortality that require immediate medical care. Several immunomodulatory drugs are used for the treatment but evidence of their efficacy is limited. Cyclosporine has recently been found to have a promising role in SJS/TEN owing to its potent antiapoptotic activity. Aims: This open label prospective study was conducted to determine the efficacy, safety, and tolerability of cyclosporine in patients with SJS/TEN. Methods: This study was conducted at a tertiary care teaching hospital of South Rajasthan during a period of 4 years (August 2015 to July 2019). Data regarding clinical profile, causative drug(s), disease severity, associated comorbidities, treatment received, and outcome were recorded in a predesigned proforma. SCORTEN prognostic score was calculated for each patient at the time of admission. Cyclosporine was administered in a dose of 5 mg/kg body weight in two divided dosage until reepithelization. Results: Out of 16 patients 10 were males and 6 were females. Mean age of patients was 30.62 ± 16.98 years (range: 7–63). Most of the patients, i.e., 8 out of 16 had TEN, 5 patients had SJS, and 3 patients had SJS/TEN overlap. Mean ± SD delay between onset and admission was 3.812 ± 1.377 days (range: 2–7). Among the suspected drugs, antiepileptics (43.7%) formed the major group. Mean duration of reepithelization was 10.5 ± 3.46 days (range: 7–15). Based on the SCORTEN, the expected mortality was 2.55 with mean predicted mortality rate of 16.43% with SD of 19.3. Limitations: 1) Sample size was small. 2) Placebo control trial could not be done due to the severity of the disease. Conclusion: We recommend cyclosporine (5 mg/kg/day) as the first line-specific immunomodulatory agent in SJS/TEN on account of its efficacy, safety, rapid reepithelization, decrease hospital stay, and reduced morbidity and mortality.

Introduction: To compare the dosimetric outcomes of 6 and 10 MV flattening filter free beam (FFFB) energies in gynaecological malignancies RapidArc (RA) planning. Material and Methods: The RA plans were generated for a cohort of 20 patients using 6 and 10 MV FFFBs. The plans aimed to deliver a dose of 50.4Gy in 28 fractions to planning target volume (PTV); moreover, planning objectives were kept as low as reasonably achievable for organs at risk (OARs). Dosimetric analysis was performed in terms of PTV coverage, conformity index (CI), homogeneity index (HI), dose to OAR’s, integral dose to normal tissue (NTID), and total number of monitor units (MU’s). Results: According to the results, volumes of PTV receiving prescription dose and CI values were 95.03±0.10% and 95.02±0.18%, as well as 1.018±0.028 and 1.024±0.027, respectively. Moreover, HI values were estimated at 1.063±0.008 and 1.068±0.010. Additionally, the corresponding values of mean NTID and MUs were 280.3±42.5 and 267.9±39.1 (liter-Gy), as well as 610.3±30.3 and 630.6±39.7 for FFFB using 6 and 10 MV, respectively. The 6 and 10 MV FFFBs were statistically similar in terms of mean dose to bladder, rectum and both femoral heads, while comparison yielded significant difference (p

Abstract Pleistocene glaciations facilitated climatic oscillations that caused for enormous heterogeneity in landscapes, and consequently affected demography and distribution patterns of the mountain endemic species. In this context, we investigated demographic history and population genetic structure of red panda, distributed along the geographical proximity in the southern edge of the Qinghai-Tibetan Plateau. Bayesian based phylogeny demonstrated that red panda diverged about 0.30 million years ago (CI 0.23–0.39) into two phylogenetic (sub) species, that correspond to the middle-late Pleistocene transition. The observed intraspecific clades with respect to Himalayan and Chinese red panda indicated restricted gene flow resulting from the Pleistocene glaciations in the eastern and southern Tibetan Plateau. We found Himalayan red panda population at least in KL-India declined abruptly in last 5–10 thousand years after being under demographic equilibrium. We suggest revisiting the ongoing conservation activities through cross border collaboration by developing multi-nationals, and multi-lateral species-oriented conservation action plans to support the red panda populations in transboundary landscapes.

Abstract The complete mitogenome of Himalayan black bear (Ursus thibetanus laniger) from Indian Himalayan region was assembled following the modified approach of mitochondrial baiting and mapping using the next-generation sequencing reads. The complete mitogenome was of 16,556 bp long, consisted of 37 genes that contained 13 protein-coding genes, 22 tRNAs, 2 rRNAs and 1 control region. The complete base composition was 31.33% A, 15.24% G, 25.45%C, and 27.98%T and gene arrangement was similar to the other sub-species of Asiatic black bear. The relative synonymous codon usage analysis revealed the maximum abundance of Isoleucine, Tyrosine, Leucine and Threonine. The assembled mitogenome of U. t. laniger exhibited 99% similarity with the mitogenomes of Himalayan black bear available from Nepal and Tibetan Plateau-Himalaya region. The findings of the present study has proven low depth sequencing data, adequate and highly efficient in rapid recovering the mitochondrial genome by overcoming the conventional strategies of obtaining long-range PCR and subsequently drawing phylogenetic inferences.

Background: The global program to eliminate lymphatic filariasis (GPELF) was started in 2003 with two strategies: the mass drug administration (MDA) to interrupt disease transmission and the morbidity management and disability prevention (MMDP) to provide the basic hygienic care to filariasis lymphedema patients. Among the two strategies, the MDA is well advanced and got the desired results, but the MMDP is lagging due to poor execution. Objectives: To assess the awareness of MMDP and ongoing morbidity management practices by lymphedema patients and to estimate the impacts of the MMDP on the prevalence and severity of lymphedema. Materials and Methods: This study was conducted among 100 lymphedema patients in 7 filariasis endemic villages of Villupuram district, Tamil Nadu, India through interviews using a structured, pretested questionnaire. The grading and adenolymphangitis (ADL) attack determination were done by a clinician. The impact was assessed in terms of changes in the lymphedema grades, frequency of ADL attacks, and changes in the burden. Results: Of the 100 patients, 70% were aware of the program and among them, only 48% were practising MMDP regularly (i.e. two times per day). The majority of them (80%) were taking treatment during ADL attacks. The overall lymphedema grades reversal and progression were observed in 13% and 52% of cases, respectively. Conclusion: This study has revealed that the second arm of the GPELF, “MMDP” has not yielded the desired results as evidenced by the incidence of frequent ADL attacks and advancement of lymphedema grades.

Background & objectives: Infections caused by arboviruses and transmitted by Aedes species mosquitoes are a serious health concern. India is endemic for diseases like Dengue, Chikungunya and recently Zika has been reported from few states. Vector control is the only way to contain these diseases, however, data regarding vectors from central India is lacking; to fulfill the lacuna we conducted this study. Methods: Entomological surveys were conducted from November 2017 to December 2018 for Aedes species in Dengue endemic areas of central India. The mosquitoes were identified, pooled and tested for the presence of Dengue, Chikungunya and Zika viruses by RT-PCR. The PCR products were sequenced to identify serotypes and genotypes of viruses. Results: A total of 2991 adults of Aedes specimens were collected and tested. Ae. aegypti (94.6%) was found to be the most abundant species. Highest mosquito density was recorded in the monsoon periods. Dengue (n=5) and Chikungunya (n=4) virus were detected from pools of female Ae. aegypti. One pool of male Ae. aegypti was positive for Dengue virus-3 and Chikungunya virus. Zika virus was not detected from any pool. Interpretation & conclusion: The findings suggest that Ae. aegypti is the principal vector of Dengue and Chikungunya, which is capable to transmit these viruses vertically. The findings have epidemiological importance and will be helpful to program managers.

Introduction: Whilst the importance of effective communications in facilitating good clinical decision-making and ensuring effective patient and family-centred outcomes in Intensive Care Units (ICU)s has been underscored amidst the global COVID-19 pandemic, training and assessment of communication skills for healthcare professionals (HCPs) in ICUs remain unstructured. Methods: To enhance the transparency and reproducibility, Krishna’s Systematic Evidenced Based Approach (SEBA) guided Systematic Scoping Review (SSR), is employed to scrutinise what is known about teaching and evaluating communication training programmes for HCPs in the ICU setting. SEBA sees use of a structured search strategy involving eight bibliographic databases, the employ of a team of researchers to tabulate and summarise the included articles and two other teams to carry out content and thematic analysis the included articles and comparison of these independent findings and construction of a framework for the discussion that is overseen by the independent expert team. Results: 9532 abstracts were identified, 239 articles were reviewed, and 63 articles were included and analysed. Four similar themes and categories were identified. These were strategies employed to teach communication, factors affecting communication training, strategies employed to evaluate communication and outcomes of communication training. Conclusion: This SEBA guided SSR suggests that ICU communications training must involve a structured, multimodal approach to training. This must be accompanied by robust methods of assessment and personalised timely feedback and support for the trainees. Such an approach will equip HCPs with greater confidence and prepare them for a variety of settings, including that of the evolving COVID-19 pandemic.

Abstract Background The re-introduction of medical students into healthcare systems struggling with the COVID-19 pandemic raises concerns as to whether they will be supported when confronted with death and dying patients in resource-limited settings and with reduced support from senior clinicians. Better understanding of how medical students respond to death and dying will inform educationalists and clinicians on how to best support them. Methods We adopt Krishna’s Systematic Evidence Based Approach to carry out a Systematic Scoping Review (SSR in SEBA) on the impact of death and dying on medical students. This structured search process and concurrent use of thematic and directed content analysis of data from six databases (Split Approach) enhances the transparency and reproducibility of this review. Results Seven thousand six hundred nineteen were identified, 149 articles reviewed and 52 articles included. The Split Approach revealed similar themes and categories that correspond to the Innate, Individual, Relational and Societal domains in the Ring Theory of Personhood. Conclusion Facing death and dying amongst their patients affect how medical students envisage their personhood. This underlines the need for timely, holistic and longitudinal support systems to ensure that problems faced are addressed early. To do so, there must be effective training and a structured support mechanism.

Employee wellbeing as a central aspect of organizational growth has been widely regarded and accepted. Therefore, a considerable growth in the number of researches focusing on employee wellbeing has been comprehended in recent years. Employee wellbeing characterizes the individual’s own cognitive interpretation of his/her life at work. The present study made an attempt to examine how workplace spirituality, empathic concern and organizational politics influences employee wellbeing. It was hypothesized that empathic concern mediates the relationship between workplace spirituality and employee wellbeing while organizational politics act as a moderator in this relationship. A survey was conducted on 253 employees working in Uttar Pradesh Police department (Uttar Pradesh, India). The results obtained revealed that workplace spirituality, empathic concern and employee wellbeing carries a positive association among them whereas these variables were found to be negatively correlated with organizational politics. Results also depicted that empathic concern significantly mediates between workplace spirituality and employee wellbeing. Further, moderated mediation analysis confirmed employee wellbeing as a function of workplace spirituality, empathic concern and organizational politics. The present study has put forward several practical implications for business practitioners and research directions for academicians, emphasizing upon the need to investigate the comprehensive impact of employee wellbeing in organization and the society as a whole.

Introduction: Ovary is the most common site of neoplastic and non neoplastic lesion, can present in childhood to postmenopausal age group and remain the most lethal of all gynaecological malignancies. Tumour Protein (p53) gene mutations or deletions are most common in ovarian carcinoma. However, Wilms’ Tumour gene1 (WT1) and p16 expression are also seen in serous ovarian carcinoma. These Immunohistochemistry (IHC) markers are useful in the differential diagnosis of serous ovarian carcinomas. Aim: To study histomorphology of ovarian neoplasm along with expression of p53 and WT1 in surface epithelial tumours and to assess the prevalence of various ovarian neoplasms in different age groups. Materials and Methods: This cross-sectional study was conducted in Department of Pathology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, over a period of two years (from September 2018-September 2020). A total of 78 ovarian specimen received in histology laboratory was studied for gross and microscopic features. The p53 and WT1 IHC expression pattern was studied in surface epithelial tumours. Statistical significance was calculated in relation to p53 and WT1 expression with histological type and grade of tumour using Chi-square test. Results: A total of 78 cases were studied, out of which benign tumours were the most common 40 (51.3%) cases, followed by malignant tumours 32 (41.0%) cases and borderline malignancy 6 (7.7%) cases. The most common benign lesions were mucinous cystadenoma 20 (50%) cases. Serous carcinomas were most common malignant tumours 19 (59.3%) cases followed by Germ Cell Tumours (GCT) 5 (15.6%) cases. All benign and borderline epithelial ovarian tumours were found p53 and WT1 negative. Out of 22 cases of malignant surface epithelial tumour, 14 (63.6%) and 12 (54.4%) were positive for p53 and WT1 respectively and all were serous carcinomas. Conclusion: Ovarian lesions present with wide spectrum of histomorphological features. The p53 and WT1 show different rates of expression and staining pattern in various epithelial ovarian carcinomas. Hence routine gross, proper histological examination and correct IHC interpretation is required for specific diagnosis.

Previously, Solitary Fibrous Tumour (SFT) was thought to originate from the pleura, a relatively rare mesenchymal neoplasm with an indolent course. Vulva is a very uncommon site of extrathoracic SFT. This is a report of a very uncommon case of vulval SFT in a 30-year-old female with complaint of a swelling over vulval region. Fine Needle Aspiration Cytology (FNAC) of the growth was attempted twice and only blood was aspirated. The swelling was excised completely. On histological examination, the sections revealed a cellular tumour of ovoid-to-fusiform spindle cells with indistinct cell borders, with haphazard arrangement or patternless pattern along with proliferation of variable sized blood vessels. The diagnosis was finalised to be a benign stromal tumour (most probably SFT), which was confirmed on immunohistochemical examination using Cluster of Differentiation 34 (CD34), CD99 and Signal Transducer and Activator of Transcription 6 (STAT6) markers.

Phenomenon Medical Student Portfolios (MSP)s allow medical students to reflect and better appreciate their clinical, research and academic experiences which promotes their individual personal and professional development. However, differences in adoption rate, content design and practice setting create significant variability in their employ. With MSPs increasingly used to evaluate professional competencies and the student's professional identity formation (PIF), this has become an area of concern. Approach We adopt Krishna’s Systematic Evidence-Based Approach to carry out a Systematic Scoping Review (SSR in SEBA) on MSPs. The structured search process of six databases, concurrent use of thematic and content analysis in the Split Approach and comparisons of the themes and categories with the tabulated summaries of included articles in the Jigsaw Perspective and Funnelling Process offers enhanced transparency and reproducibility to this review. Findings The research team retrieved 14501 abstracts, reviewed 779 full-text articles and included 96 articles. Similarities between the themes, categories and tabulated summaries allowed the identification of the following funnelled domains: Purpose of MSPs, Content and structure of MSPs, Strengths and limitations of MSPs, Methods to improve MSPs, and Use of E-portfolios. Insights Variability in the employ of MSPs arise as a result of a failure to recognise its different roles and uses. Here we propose additional roles of MSPs, in particular, building on a consistent set of content materials and assessments of milestones called micro-competencies. Whislt generalised micro-competencies assess achievement of general milestones expected of all medical students, personalised micro-competencies record attainment of particular skills, knowledge and attitudes balanced against the medical student’s abilities, context and needs. This combination of micro-competencies in a consistent framework promises a holistic, authentic and longitudinal perspective of the medical student’s development and maturing PIF.

Abstract Background Effective Interprofessional Communication (IPC) between healthcare professionals enhances teamwork and improves patient care. Yet IPC training remains poorly structured in medical schools. To address this gap, a scoping review is proposed to study current IPC training approaches in medical schools. Methods Krishna’s Systematic Evidence Based Approach (SEBA) was used to guide a scoping review of IPC training for medical students published between 1 January 2000 to 31 December 2018 in PubMed, ScienceDirect, JSTOR, Google Scholar, ERIC, Embase, Scopus and PsycINFO. The data accrued was independently analysed using thematic and content analysis to enhance the reproducibility and transparency of this SEBA guided review. Results 17,809 titles and abstracts were found, 250 full-text articles were reviewed and 73 full text articles were included. Directed Content analysis revealed 4 categories corresponding to the levels of the Miller’s Pyramid whilst thematic analysis revealed 5 themes including the indications, stages of trainings and evaluations, content, challenges and outcomes of IPC training. Many longitudinal programs were designed around the levels of Miller’s Pyramid. Conclusion IPC training is a stage-wise, competency-based learning process that pivots on a learner-centric spiralled curriculum. Progress from one stage to the next requires attainment of the particular competencies within each stage of the training process. Whilst further studies into the dynamics of IPC interactions, assessment methods and structuring of these programs are required, we forward an evidenced based framework to guide design of future IPC programs.

Abstract Background Amidst expanding roles in education and policy making, questions have been raised about the ability of Clinical Ethics Committees (CEC) s to carry out effective ethics consultations (CECons). However recent reviews of CECs suggest that there is no uniformity to CECons and no effective means of assessing the quality of CECons. To address this gap a systematic scoping review of prevailing tools used to assess CECons was performed to foreground and guide the design of a tool to evaluate the quality of CECons. Methods Guided by Levac et al’s (2010) methodological framework for conducting scoping reviews, the research team performed independent literature reviews of accounts of assessments of CECons published in six databases. The included articles were independently analyzed using content and thematic analysis to enhance the validity of the findings. Results Nine thousand sixty-six abstracts were identified, 617 full-text articles were reviewed, 104 articles were analyzed and four themes were identified – the purpose of the CECons evaluation, the various domains assessed, the methods of assessment used and the long-term impact of these evaluations. Conclusion This review found prevailing assessments of CECons to be piecemeal due to variable goals, contextual factors and practical limitations. The diversity in domains assessed and tools used foregrounds the lack of minimum standards upheld to ensure baseline efficacy. To advance a contextually appropriate, culturally sensitive, program specific assessment tool to assess CECons, clear structural and competency guidelines must be established in the curation of CECons programs, to evaluate their true efficacy and maintain clinical, legal and ethical standards.

Abstract Background Mentoring provides mentees and mentors with holistic support and research opportunities. Yet, the quality of this support has been called into question amidst suggestions that mentoring is prone to bullying and professional lapses. These concerns jeopardise mentoring’s role in medical schools and demand closer scrutiny. Methods To better understand prevailing concerns, a novel approach to systematic scoping reviews (SSR) s is proposed to map prevailing ethical issues in mentoring in an accountable and reproducible manner. Ten members of the research team carried out systematic and independent searches of PubMed, Embase, ERIC, ScienceDirect, Scopus, OpenGrey and Mednar databases. The individual researchers employed ‘negotiated consensual validation’ to determine the final list of articles to be analysed. The reviewers worked in three independent teams. One team summarised the included articles. The other teams employed independent thematic and content analysis respectively. The findings of the three approaches were compared. The themes from non-evidence based and grey literature were also compared with themes from research driven data. Results Four thousand six titles were reviewed and 51 full text articles were included. Findings from thematic and content analyses were similar and reflected the tabulated summaries. The themes/categories identified were ethical concerns, predisposing factors and possible solutions at the mentor and mentee, mentoring relationship and/or host organisation level. Ethical concerns were found to stem from issues such as power differentials and lack of motivation whilst predisposing factors comprised of the mentor’s lack of experience and personality conflicts. Possible solutions include better program oversight and the fostering of an effective mentoring environment. Conclusions This structured SSR found that ethical issues in mentoring occur as a result of inconducive mentoring environments. As such, further studies and systematic reviews of mentoring structures, cultures and remediation must follow so as to guide host organisations in their endeavour to improve mentoring in medical schools.

Through the present manuscript, we are reporting for the first time the presence of Cyclophorus pfeifferi Reeve, 1861 in India. Previously, this species of land snail was reported only from South-East Asian countries Malaysia, Thailand, Cambodia and Vietnam. The specimens were collected during field sur- veys in Dampa Tiger Reserve in Mizoram state, India. The presence of C. pfeifferi in India reveals the range expansion and long-distance dispersal abilities of the species. Here we discuss the taxonomy, ecology and possible routes of dispersal of the species in India.