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Alarming concern over the persistence and toxicity of per- and polyfluoroalkyl substances (PFAS) in the environment has created an imperative need for designing and redesigning strategies for their detection and remediation. Conventional PFAS removal technologies that uses physical, chemical, or biological methods. Increase in the diversity and quantity of PFAS entering the environment has necessitated the need for developing more advanced and integrated strategies for their removal. Despite of the advances reported in this domain, there exist a huge research gap that need to be mentored to tackle the problems associated with mitigation of combined toxicity of wide variety of PFAS in the environment. The possibility of PFAS to combine with other emerging contaminants poses an additional threat to the existing treatment methods thereby stressing the need for a continuous monitoring and updating the treatment processes. This review work aims at understanding the structure, entry, and fate of different types of PFAS in to the environment. Further an in-depth discussion regarding the different levels of toxicity associated with PFAS is elaborated in the review. The process description of recent PFAS remediation techniques along with their significance, limitations and possibility of integration is discussed in detail. Further a detailed outlook on the advantages and limitations of PFAS removal methods and an insight into the recently developed PFAS removal methods is outlined in this review.

Bladder cancer ranks as the 9th most common malignancy worldwide within the urinary system. Urothelial carcinoma stands as the predominant histologic type in the United States and Western Europe, constituting approximately 90% of bladder cancer cases. While common sites of metastasis for urothelial carcinoma typically involve regional and distinct lymph nodes, the liver, lungs, and bones, instances of metastasis to the pericardium are rare. Roughly 10% of urothelial carcinoma cases exhibit cardiac metastasis, often remaining clinically asymptomatic. Hereby, the authors present a rare case of symptomatic pericardial infiltration originating from urothelial carcinoma in a 32-year-old male. The patient initially presented with a two-week history of progressive dyspnoea on exertion and had been previously diagnosed with high-grade transitional cell carcinoma with squamous differentiation upon histopathological examination and urothelial carcinoma on a Positron Emission Tomography (PET) scan 12 months earlier. Following neoadjuvant chemotherapy and radiotherapy, the patient exhibited a partial response to the treatment. However, despite the effectiveness of the therapies, he developed dyspnoea and pericardial effusion. Although pericardial involvement in advanced malignancies is not uncommon, symptomatic cardiac metastasis from urothelial carcinoma remains rare. Radiographic studies revealed right-sided pleural effusion, while a Computed Tomography (CT) scan of the thorax and upper abdomen (plain and contrast) displayed severe bilateral pleural effusion, pericardial effusion, and metastatic deposits in the mediastinal lymph nodes. Electrocardiography indicated sinus tachycardia, inverted T-waves in leads V1 to V5, and flattening of the T-wave in V6. The patient underwent pericardial tapping, yielding approximately 50 cc of pericardial fluid. A 10 cc of the pericardial fluid was subsequently sent for examination in the Pathology Department, with fluid cytology results indicating the presence of malignant cells.

Juvenile Dermatomyositis (JDM) is a rare autoimmune disorder which mainly affects the skin and skeletal muscles. Characteristic features of this rare disorder include Gottron papules, heliotrope rashes and proximal muscle weakness. MDA5 positive JDM is usually associated with interstitial lung disease in later part of life. The authors report a case of an 11-year-old male child who presented to the Paediatric Department with complaints of rashes over extensor surfaces, Gottron papules and pain and weakness in all limbs. The child was on treatment from the Dermatology Department as a case of psoriasis for last six months. During hospital stay after detailed work-up, the child was diagnosed to have JDM. Anti-melanoma Differentiation-Associated gene 5 (Anti-MDA5) antibodies were positive in the present case. The child was treated with immunosuppressive drugs with supportive care and is currently on treatment for the last one and a half years and is largely asymptomatic. JDM requires meticulous clinical examination and specific investigations so that timely diagnosis can be made to ensure appropriate treatment. In the present index case, the authors describe the typical clinical presentation, newer investigative modalities like myositis specific antibody and treatment outcomes of this rare condition.

Accessory scrotum is defined as extra scrotal tissue in the vicinity of the anatomically located normal scrotum. We report a case of 4-day full-term male neonate with a unilateral accessory scrotum. We have discussed clinical presentations and associated anomalies of an accessory scrotum thus guiding its evaluation and treatment.

Introduction:Breast cancer has been a leading malignancy in women across the globe. In breast conserving treatment, radiation therapy plays an important role. This is clinically approved that breast conserving surgery followed by adjuvant radiation therapy produces as the same survival rate as radical breast RT. The aim of this study was to find out suitable number of IMRT fields to treat left-sided breast cancer and analyze the effects of increasing the number of fields in IMRT plans.Material and Methods:We selected 105 patients retrospectively for this study diagnosed with left-sided breast cancer of age ranging from 33 to 74 years. There were 52 cases of chest wall (CW) irradiation including SCF, 20 cases of BCS and 33 cases were of CW including supra-clavicular fossa (SCF) and internal mammary lymph nodes (IMLN).Results:Our main objective was to analyze dose-distribution of left lung. Monitor Units (MUs) were also recorded and found almost same in these three modalities ranging from 1200 to 2000. The mean value of V20Gy(cc) in 11-bIMRT technique was found less by 8-17cc as compared to 7-and 9-bIMRT technique. It was observed that 11-bIMRT technique yielded slightly better outcomes in terms of V20Gy(cc).Conclusion: The technique 7-bIMRT gives slightly better result in controlling low-dose volume of underlying lung and heart. As the number of IMRT beams increases, it translates into better outcomes in terms of reducing high-dose volume as well as mean-dose of left lung. So, it is prudent to use ‘N’ number of IMRT fields such as 7≤ N ≤11 in left breast RT.

Introduction: The objective of this work is to design a new kind of AHFP phantom to determine if this phantom is a realistic representation of actual cervical cancer patients. This can serve as a stand-in for the dosimetry quality assurance of a real patient. Material and Methods: An anthropomorphic heterogeneous female pelvic phantom was designed which was made of paraffin wax, a female pelvic bone, water, gauze, polyvinyl chloride (PVC) and polymerized siloxanes. The AHFP phantom was scanned using a CT scanner (Toshiba Alexion 16 multi–Slice CT scanner) at 120kVp and 250mAs with a slice thickness of 2mm to assess how accurately the resulting phantom product simulates a real patient. The CT images were transferred to the Eclipse treatment planning system for dosimetry analysis. Results: The AHFP phantom's CT numbers and relative electron densities of the uterus, bladder, rectum, muscles, fat, bones, and cavities were found close to real patients. The mean percentage variations between planned and measured doses of all RapidArc QA plans were of 2.14 % and standard deviation of 0.543 (t=0.135, p= 0.447; p>0.05) for homogeneous phantom¸ and 7.57% & standard deviation 2.358 (t=4.674, p=0.00094; p< .05) for AHFP phantom. Conclusion: It is concluded that the existing algorithms in TPS for dosimetry are working fine for homogeneous phantoms, but it does not work good for heterogeneous (AHFP) phantom. Therefore, patient-specific absolute dosimetry should be performed using a heterogeneous phantom that closely resembles the actual human body in terms of both density and design.

With an extensive range of distinctive features at nano meter-scale thicknesses, two-dimensional (2D) materials drawn the attention of the scientific community. Despite tremendous advancements in exploratory research on 2D materials, knowledge of 2D electrical transport and carrier dynamics still in its infancy. Thus, here we highlighted the electrical characteristics of 2D materials with electronic band structure, electronic transport, dielectric constant, carriers mobility. The atomic thinness of 2D materials makes substantially scaled field-effect transistors (FETs) with reduced short-channel effects conceivable, even though strong carrier mobility required for high performance, low-voltage device operations. We also discussed here about factors affecting 2D materials which easily enhanced the activity of those materials for various applications. Presently, Those 2D materials used in state-of-the-art electrical and optoelectronic devices because of the extensive nature of their electronic band structure. 2D materials offer unprecedented freedom for the design of novel p-n junction device topologies in contrast to conventional bulk semiconductors. We also, describe the numerous 2D p-n junctions, such as homo junction and hetero junction including mixed dimensional junctions. Finally, we talked about the problems and potential for the future.

Abstract Background Hydroxyurea is an affordable drug that reduces vaso-occlusive crises and transfusion requirements in sickle cell disease. However, its effectiveness in preventing chronic organ damage is still unclear. This systematic review and meta-analysis aimed to evaluate the role of hydroxyurea in preventing organ morbidity. Method We included original articles published in English from 1st January 1990 to 31st January 2023, reporting hydroxyurea therapy and organ damage from PubMed, Google Scholar, Scopus, and CrossRef databases. A total of 45 studies with 4681 sickle cell disease patients were evaluated for organ damage. Results Our analysis showed that hydroxyurea intervention significantly lowered transcranial Doppler and tricuspid regurgitant velocity, with a standardized mean difference of − 1.03 (− 1.49; − 0.58); I 2 = 96% and − 1.37 (CI − 2.31, − 0.42); I 2 = 94%, respectively. Moreover, the pooled estimate for albuminuria showed a beneficial effect post-hydroxyurea therapy by reducing the risk of albuminuria by 58% (risk ratio of 0.42 (0.28; 0.63); I 2 = 28%). Conclusion Our study found that a hydroxyurea dose above 20 mg/kg/day with a mean rise in HbF by 18.46% post-hydroxyurea therapy had a beneficial role in reducing transcranial doppler velocity, tricuspid regurgitant velocity, albuminuria, and splenic abnormality. Systematic review registration PROSPERO CRD42023401187.

Abstract Background There is growing evidence that extracellular vesicles (EVs) play a crucial role in the paracrine mechanisms of transplanted human mesenchymal stem cells (hMSCs). Little is known, however, about the influence of microenvironmental stimuli on the osteogenic effects of EVs. This study aimed to investigate the properties and functions of EVs derived from undifferentiated hMSC (Naïve-EVs) and hMSC during the early stage of osteogenesis (Osteo-EVs). A further aim was to assess the osteoinductive potential of Osteo-EVs for bone regeneration in rat calvarial defects. Methods EVs from both groups were isolated using size-exclusion chromatography and characterized by size distribution, morphology, flow cytometry analysis and proteome profiling. The effects of EVs (10 µg/ml) on the proliferation, migration, and osteogenic differentiation of cultured hMSC were evaluated. Osteo-EVs (50 µg) or serum-free medium (SFM, control) were combined with collagen membrane scaffold (MEM) to repair critical-sized calvarial bone defects in male Lewis rats and the efficacy was assessed using µCT, histology and histomorphometry. Results Although Osteo- and Naïve-EVs have similar characteristics, proteomic analysis revealed an enrichment of bone-related proteins in Osteo-EVs. Both groups enhance cultured hMSC proliferation and migration, but Osteo-EVs demonstrate greater efficacy in promoting in vitro osteogenic differentiation, as evidenced by increased expression of osteogenesis-related genes, and higher calcium deposition. In rat calvarial defects, MEM with Osteo-EVs led to greater and more consistent bone regeneration than MEM loaded with SFM. Conclusions This study discloses differences in the protein profile and functional effects of EVs obtained from naïve hMSC and hMSC during the early stage of osteogenesis, using different methods. The significant protein profile and cellular function of EVs derived from hMSC during the early stage of osteogenesis were further verified by a calvarial bone defect model, emphasizing the importance of using differentiated MSC to produce EVs for bone therapeutics.

Abstract Poor bone quality is a major factor in skeletal fragility in elderly individuals. The molecular mechanisms that establish and maintain bone quality, independent of bone mass, are unknown but are thought to be primarily determined by osteocytes. We hypothesize that the age-related decline in bone quality results from the suppression of osteocyte perilacunar/canalicular remodeling (PLR), which maintains bone material properties. We examined bones from young and aged mice with osteocyte-intrinsic repression of TGFβ signaling (TβRII ocy−/− ) that suppresses PLR. The control aged bone displayed decreased TGFβ signaling and PLR, but aging did not worsen the existing PLR suppression in male TβRII ocy−/− bone. This relationship impacted the behavior of collagen material at the nanoscale and tissue scale in macromechanical tests. The effects of age on bone mass, density, and mineral material behavior were independent of osteocytic TGFβ. We determined that the decline in bone quality with age arises from the loss of osteocyte function and the loss of TGFβ-dependent maintenance of collagen integrity.

Abstract Background Phyllodes tumours (PT) of the breast are rare primary breast neoplasms, mostly seen in fourth to fifth decades of life. These tumours are exceptionally rare in children and young females. The clinico-radiological features often overlap with fibroadenoma. Though imaging plays a pivotal role in providing an initial diagnostic approach, the final confirmation is dispensed on histopathology, which further classifies PT into either benign, low-grade malignant (borderline), or high-grade malignant. On reviewing the literature, only 20 cases have been reported so far in young females, with majority of them being benign and very few numbers of malignant PT. Case presentation Herein, we report the clinical and imaging features of PT in four young females, of benign, borderline and high-grade malignant categories as confirmed on histopathology, thereby adding few more numbers to the already existing cases. Additionally, our fourth case depicts rare presentation of high-grade malignant recurrent PT in adolescent female with nodal and unilateral ovarian metastases. Conclusions In conclusion, a possibility of PT should be considered in differential diagnosis in a large rapidly enlarging breast mass even in young females with characteristic imaging features, as it alters the plan of management.

Abstract Simulation studies, such as finite element (FE) modeling, provide insight into knee joint mechanics without patient involvement. Generic FE models mimic the biomechanical behavior of the tissue, but overlook variations in geometry, loading, and material properties of a population. Conversely, subject-specific models include these factors, resulting in enhanced predictive precision, but are laborious and time intensive. The present study aimed to enhance subject-specific knee joint FE modeling by incorporating a semi-automated segmentation algorithm using a 3D Swin UNETR for an initial segmentation of the femur and tibia, followed by a statistical shape model (SSM) adjustment to improve surface roughness and continuity. For comparison, a manual FE model was developed through manual segmentation (i.e., the de-facto standard approach). Both FE models were subjected to gait loading and the predicted mechanical response was compared. The semi-automated segmentation achieved a Dice similarity coefficient (DSC) of over 98% for both the femur and tibia. Hausdorff distance (mm) between the semi-automated and manual segmentation was 1.4 mm. The mechanical results (max principal stress and strain, fluid pressure, fibril strain, and contact area) showed no significant differences between the manual and semi-automated FE models, indicating the effectiveness of the proposed semi-automated segmentation in creating accurate knee joint FE models. We have made our semi-automated models publicly accessible to support and facilitate biomechanical modeling and medical image segmentation efforts ( https://data.mendeley.com/datasets/k5hdc9cz7w/1 ).

Abstract Reproductive success requires the development of viable oocytes and the accurate segregation of chromosomes during meiosis. Failure to segregate chromosomes properly can lead to infertility, miscarriages, or developmental disorders. A variety of factors contribute to accurate chromosome segregation and oocyte development, such as spindle assembly and sister chromatid cohesion. However, many proteins required for meiosis remain unknown. In this study, we aimed to develop a screening pipeline for identifying novel meiotic and fertility genes using the genome of Drosophila melanogaster. To accomplish this goal, genes upregulated within meiotically active tissues were identified. More than 240 genes with no known function were silenced using RNA interference (RNAi) and the effects on meiosis and fertility were assessed. We identified 94 genes that when silenced caused infertility and/or high levels of chromosomal nondisjunction. The vast majority of these genes have human and mouse homologs that are also poorly studied. Through this screening process, we identified novel genes that are crucial for meiosis and oocyte development but have not been extensively studied in human or model organisms. Understanding the function of these genes will be an important step towards the understanding of their biological significance during reproduction.

Abstract Heparan sulfate (HS) polysaccharides are major constituents of the extracellular matrix, which are involved in myriad structural and signaling processes. Mature HS polysaccharides contain complex, non-templated patterns of sulfation and epimerization, which mediate interactions with diverse protein partners. Complex HS modifications form around initial clusters of glucosamine-N-sulfate (GlcNS) on nascent polysaccharide chains, but the mechanistic basis underpinning incorporation of GlcNS itself into HS remains unclear. Here, we determine cryo-electron microscopy structures of human N-deacetylase-N-sulfotransferase (NDST)1, the bifunctional enzyme primarily responsible for initial GlcNS modification of HS. Our structures reveal the architecture of both NDST1 deacetylase and sulfotransferase catalytic domains, alongside a non-catalytic N-terminal domain. The two catalytic domains of NDST1 adopt a distinct back-to-back topology that limits direct cooperativity. Binding analyses, aided by activity-modulating nanobodies, suggest that anchoring of the substrate at the sulfotransferase domain initiates the NDST1 catalytic cycle, providing a plausible mechanism for cooperativity despite spatial domain separation. Our data shed light on key determinants of NDST1 activity, and describe tools to probe NDST1 function in vitro and in vivo.

Abstract Aim To compare and evaluate the sealing ability of four different commercially available sealers to provide seal against the dye penetration test using a stereomicroscope-an in-vitro study. Material/Method 80 extracted single rooted mandibular premolar with single canal were used in this study. The samples were divided in 4 groups (20 in each) based on sealer. Group I (Diaproseal), Group II (apexit Plus), Group III (MTA Fillapex) and Group IV (Bio-C). The samples were analyzed using a stereomicroscope and data analysis was done with one-way Anova And post hoc Tukey’s test. Result The mean dye penetration score was 1.2400 ± 0.778 mm for Group I. 2.6000 ± 0.897 mm for Group II, 4.2000 ± 0.923 mm for Group III and 4.225 ± 2.055 mm for Group IV. One-way Anova analysis shows that intergroup comparison was statistically significant between the four groups. The post hoc Tukey’s test reveals that the difference was statistically non-significant between group III and group IV. Conclusion It was concluded that between the four groups the Group I (Diaproseal) showed the least dye penetration followed by Group II (Apexit Pus), Group III (MTA Fillapex) and then Group IV (Bio-C), where there was no significant difference between the Group III (MTA Fillapex) and Group IV (Bio-C).

Abstract Background Gestational diabetes mellitus (GDM) is frequently misdiagnosed during pregnancy. There is an abundance of evidence, but little is known regarding the regional prevalence estimates of GDM in India. This systematic review and meta-analysis aims to provide valuable insights into the national and regional prevalence of GDM among pregnant women in India. Methods We conducted an initial article search on PubMed, Scopus, Google Scholar, and ShodhGanga searches to identify quantitative research papers (database inception till 15th June,2022). This review included prevalence studies that estimated the occurrence of GDM across different states in India. Results Two independent reviewers completed the screening of 2393 articles, resulting in the identification of 110 articles that met the inclusion criteria, which collectively provided 117 prevalence estimates. Using a pooled estimate calculation (with an Inverse square heterogeneity model), the pooled prevalence of GDM in pregnant women was estimated to be 13%, with a 95% confidence interval (CI) ranging from 9 to 16%.. In India, Diabetes in Pregnancy Study of India (DIPSI) was the most common diagnostic criteria used, followed by International Association of Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO) 1999. It was observed that the rural population has slightly less prevalence of GDM at 10.0% [6.0–13.0%, I2 =96%] when compared to the urban population where the prevalence of GDM was 12.0% [9.0–16.0%, I2 = 99%]. Conclusions This review emphasizes the lack of consensus in screening and diagnosing gestational diabetes mellitus (GDM), leading to varied prevalence rates across Indian states. It thoroughly examines the controversies regarding GDM screening by analyzing population characteristics, geographic variations, diagnostic criteria agreement, screening timing, fasting vs. non-fasting approaches, cost-effectiveness, and feasibility, offering valuable recommendations for policy makers. By fostering the implementation of state-wise screening programs, it can contribute to improving maternal and neonatal outcomes and promoting healthier pregnancies across the country.

Giant Congenital Melanocytic Naevi (GCMN) is a very rare condition that mostly occurs due to an oncogenic mutation involving the NRAS (neuroblastoma RAS viral oncogene homologue) gene. GCMNs can be clinically diagnosed due to their typical features, but histopathology confirms the diagnosis. GCMN has a high propensity for transforming into malignant melanoma and leptomeningeal melanocytosis, leading to neurological deficits such as epilepsy and neurofibromatosis. As it is associated with Central Nervous System (CNS) melanosis, Magnetic Resonance Imaging (MRI) of the brain and spine is crucial. Here, three cases are reported of the babies born with GCMN from August 2022 to July 2023 in a tertiary care hospital among a total of 11,915 live births, where the incidence is much higher than found in the literature. Present series describes three cases with GCMN, including clinical features, MRI findings, short-term outcomes, risk factors, and modalities of the management. All three cases showed extensive blackish pigmented patches involving most of the body surface and MRI evidence of Neurocutaneous Melanosis (NCM). The third baby succumbed to death due to fulminant sepsis on day 2 of life. Management of GCMN requires a multimodal approach, including medical, surgical, chemotherapeutic, palliative, and psychological support for patients as well as parents, and follow-up is necessary for the early detection of malignant transformation. Detailed knowledge of this very rare condition may enable us to develop newer treatment modalities to achieve better outcomes in the near future.

Background: Candida species are members of the normal flora of the skin, mucous membranes, and gastrointestinal tract. They are endogenous opportunists which cause secondary infection in individuals with some underlying immunocompromised conditions. Candidiasis is a common fungal disease found in humans affecting mucosa, skin, nails, and internal organs of the body. Candida albicans is generally considered the major pathogen among the Candida species. An increase in the prevalence of non-albicans species has been noted during the last decades. Aims and Objectives:The study was done to evaluate the performance of the conventional identification method and commercially available chromogenic Candida speciation media (CHROMagar) for the identification of medically important yeast and yeast-like organisms in a routine clinical microbiology laboratory. Materials and Methods: This study was conducted in the Department of Microbiology, Gandhi Medical College, Hamidia, and Associated Hospitals, Bhopal (M.P.), from January 2020 to October 2021. A total of 180 samples were collected from patients suspected of superficial mycoses which were then subjected to direct KOH examination and culture on plain Sabouraud’s dextrose agar (SDA), on SDA with antibiotics slants (cycloheximide and chloramphenicol). The growths were examined macroscopically as well as microscopically. Germ tube tests and inoculations on CHROMagar Candida medium were performed on all growths identified as yeasts and confirmed by morphology on CMA. Results: In our study, the majority of patients, belonged to the age group of 21–30 years (25%) with a male-to-female ratio of 2:1. Candida tropicalis (44.68%) was the most common Candida species, followed by C. albicans (38.30%), Candida krusei (12.77%), and Candida glabrata (4.25%). Conclusion: Along with C. albicans, non-albicans Candida spp such as C. tropicalis, C. krusei, and C. glabrata are increasingly being isolated from clinical specimens. Identification of Candida species by colony color on Hicrome correlated with the morphology on CMA. Thus, the incorporation of CMA in routine yeast identification is more judicious than Hicrome as it increases the accuracy in the identification of Candida species within the same time as that of Hicrome.

Abstract Background Mice lacking vitamin D receptor (VDR) exhibit a glycogen storage disorder, disrupting carbohydrate utilization in muscle. Here, we asked if the defective carbohydrate metabolism alters the fat utilization by the skeletal muscles of vdr−/− mice. Methods To check the effect of high‐fat‐containing diets on muscle mass and metabolism of vdr−/− mice, we subjected them to two different milk fat‐based diets (milk fat diet with 60% of energy from milk fat and milk‐based diet [MBD] with 37% of energy from milk fat) and lard‐based high‐fat diet (HFD) containing 60% of energy from lard fat. Skeletal muscles and pancreas from these mice were analysed using RNA sequencing, quantitative reverse transcription polymerase chain reaction and western blot to understand the changes in signalling and metabolic pathways. Microscopic analyses of cryosections stained with haematoxylin and eosin, BODIPY, succinate dehydrogenase and periodic acid–Schiff reagent were performed to understand changes in morphology and metabolism of muscle fibres and pancreatic islets. Results Transcriptomic analyses showed that the skeletal muscles of vdr−/− mice exhibit upregulation of the fatty acid oxidation pathways, suggesting a shift towards increased lipid utilization even in a carbohydrate‐enriched regular chow diet (chow). Two different milk fat‐enriched diets restored body weight (12.01 ± 0.33 g in chow vs. 17.99 ± 0.62 g in MBD) and muscle weights (38.58 ± 3.84 mg in chow vs. 110.72 ± 1.96 mg in MBD for gastrocnemius [GAS]) of vdr−/− mice. Muscle ATP levels (0.56 ± 0.18 μmol in chow vs. 1.48 ± 0.08 μmol in MBD) and protein synthesis (0.25 ± 0.04 A.U. in chow vs. 2.02 ± 0.06 A.U. in MBD) were upregulated by MBD. However, despite increasing muscle energy levels, HFD failed to restore the muscle mass and cross‐sectional area to that of wild‐type (WT) mice (104.95 ± 2.6 mg for WT mice on chow vs. 77.26 ± 1.7 mg for vdr−/− mice on HFD for GAS). Moreover, HFD disrupted glucose homeostasis in vdr−/− mice, while MBD restored it. We further analysed insulin response and pancreatic insulin levels of these mice to show that HFD led to reduced insulin levels in pancreatic beta cells of vdr−/− mice (mean intensity of 1.5 × 10−8 for WT mice on chow vs. 4.3 × 10−9 for vdr−/− mice on HFD). At the same time, MBD restored glucose‐stimulated pancreatic insulin response (mean intensity of 9.2 × 10−9). Conclusions Skeletal muscles of vdr−/− mice are predisposed to utilize fatty acids as their primary energy source to circumvent their defective carbohydrate utilization. Thus, HFDs could restore energy levels in the skeletal muscles of vdr−/− mice. This study reveals that when mice are subjected to a lard‐based HFD, VDR signalling is essential for maintaining insulin levels in pancreatic islets. Our data show a critical role of VDR in muscle metabolic flexibility and pancreatic insulin response.

This research work presents a hybrid approach combining a type-2 fuzzy inference system with particle swarm optimization (PSO) to develop a type-2 fuzzy optimized inference system, specifically tailored for asthma patient data. Addressing the inherent uncertainty in medical diagnostics, this model enhances traditional type-1 fuzzy logic by incorporating ambiguity into linguistic variables and utilizing type-2 fuzzy if-then rules. The system is trained to minimize diagnostic error in asthma disease identification. Applied to a dataset comprising eight medical entities from asthma patients, the model demonstrates substantial accuracy improvements. Numerical computations validate the system, showing a decrease in error rate from 1.445 to 0.03, indicating a significant enhancement in diagnostic precision. These results underscore the potential of our model in medical diagnostic problems, providing a novel and effective tool for tackling the complexities of asthma diagnosis.

Crystalline silicon PV module dominates PV technology worldwide and are constantly emerging with innovative PV designs. Passivated Emitter and Rear Cell PV technology (PERC) is one such high efficiency crystalline PV design that is dominating almost 60% market share. The present study intends to fill the gap by comparing the experimental behavior of high efficiency Mono and Polycrystalline PERC PV Module under realistic conditions. Outdoor installed PV modules are severely impacted by partial shading that results in decline in energy efficiency and develop multiple power peaks in the I-V characteristics. Innovative MPPT techniques are frequently researched to mitigate this problem. However, these techniques do not consider the increase of temperature developed in the shaded cells which may cause critical degradations in the entire module. In this regard, the experimental work presented aim to investigate the shaded percentage that could build hotspots in shaded cells of temperature of approximately twice the unshaded cells of the modules. In our study single cell shading percentage of 60% in monocrystalline (hotspot temperature of 90.1°C) and single cell shading percentage of 40% (hotspot temperature of 92.3°C) in polycrystalline triggered the hotspot in the modules. This research work concludes that the power losses, efficiency loss are recorded more in Polycrystalline PV module in comparison with Monocrystalline PV module. It may be concluded from results that polycrystalline PV module is vulnerable to develop hotspots at faster rate with lesser shaded area than monocrystalline PV module This study helps to analyse the thermal degradations in commercial new designs of crystalline PV technologies and may be used by researchers to build up better design which could be used to minimize hotspot issues.

We propose and theoretically analyze a novel sensor based on plasmonic mode interference in a one-dimensional degenerate n-doped silicon core waveguide. The waveguide supports both, the symmetric- as well as anti-symmetric surface plasmon polaritons (SPPs), with a large propagation constant difference between them, drastically miniaturizing the probe size to $\sim$100 $\mu$m. Our study reveals that the symmetric plasmonic mode has significant field localization in the sensing region as compared to the anti-symmetric plasmonic mode which has a large field localization in the substrate region. This makes the symmetric SPP considerably more suitable for bio/chemical sensing applications. The core mode projection technique with an optimized transverse offset between the lead-in waveguide and plasmonic waveguide has been used to couple appreciable power into the two SPP modes enhancing the extinction ratio of the transmission spectra. The estimated sensitivity of the sensor is $\sim$ 3400 nm/RIU over biologically relevant refractive indices. Our study demonstrates the effectiveness of plasmonic mode interference in designing highly sensitive bio/chemical sensors with miniaturized probe length through careful design considerations. We also discuss the effect of temperature cross-sensitivity on the performance of the sensor and have presented a sensitivity matrix-based approach for the simultaneous detection of two perturbations using a single sensor probe. We have shown that using this sensitivity-matrix approach, the error associated with the estimated variations in the perturbations is of the order of 10$^{-4}$ to 10$^{-3}$, making it a powerful tool to estimate simultaneously varying perturbation parameters by tracking multiple resonances.

In this paper, we look into the modeling of free space optical channel and design of the HAP-based wireless optical networks. For vertical beam propagation, the pressure and temperature gradients alter with height. Microscale variations in refractivity result in uncertainties that depend on elevation. As a result, irradiance fading variance caused by turbulence keeps on changing throughout the propagation path. Also, the eddies' shape transitions from spherical and symmetrical near the ground to highly asymmetrical and anisotropic at heights far away from the ground. In this paper, taking into account these variations concerning height, we propose to break the vertical FSO (VFSO) channel into parallel layers. We develop a VFSO channel model built upon the cascaded structure of fading coefficients. Correlated phase screen simulation method is used to verify the accuracy of the proposed channel model. Next, a closed-form expression for the probability density function is developed for the concatenated channel incorporating a generalized pointing error model. To demonstrate the significance of this newly developed VFSO channel model in HAP-based optical networks, closed-form expressions for bit error rate performance is also derived. Monte Carlo simulations substantiate that the newly formulated analytical expressions offer accurate assessments of the BER performance for HAP-based VFSO links. For HAP-based optical networks facing weak turbulence, the newly developed expressions provide an accuracy of about 2 dB for a BER of $10^{-4}$ as compared to the existing competitive models. This value increases to 4 dB after incorporating pointing errors in HAP-based optical networks. In optical networks facing strong fluctuation regions, the newly developed expressions provide an accuracy of about 8 dB for a BER of $10^{-4}$ as compared to the existing competitive model. Similar observations are made after incorporating pointing errors in HAP-based optical networks facing strong turbulence regions.

Abstract Background India has rolled out Early Infant Diagnosis (EID) program for HIV infection in all states. EID program consists of testing of Infants exposed to HIV periodically over 18 months of age which is a multi-step complex testing cascade. Caregivers represent the primary beneficiary of EID program i.e., infants exposed to HIV and face multiple challenges to access EID services. As part of national EID program outcome assessment study, this study narrates caregivers’ perspectives on barriers and facilitators to access and utilize EID services. Methods The study was conducted in 31 integrated counselling and testing centres (ICTCs) located in 11 high burden HIV states. A total of 66 in-depth interviews were conducted with caregivers’ of infants enrolled in EID program. Thematic analysis was carried out to help identify themes underlying barriers and facilitators to access EID services and utilization from caregivers’ perspectives. Results The stigma and discrimination prevalent in society about HIV remains a key demand side (caregiver-level) barrier. Non-disclosure or selective disclosure of HIV status led to missed or delayed EID tests and delayed HIV diagnosis and initiation of Anti-Retroviral Therapy (ART) for infants exposed to HIV. On supply side (health system-level), accessibility of healthcare facility with EID services was reported as a key barrier. The distance, time and cost were key concerns. Many caregivers faced difficulties to remember the details of complex EID test schedule and relied on a phone call from ICTC counsellor for next due EID test. Delayed EID test results and lack of communication of test results to caregiver were reported as primary barriers for completing the EID test cascade. Discussion The study reports caregiver-level and health system-level barriers and facilitators for access to EID services from the caregivers’ perspectives. While, decentralisation and single window approaches can improve the access, timely communication of test results to the caregiver also need to be built in with appropriate use of technology. A holistic intervention including PLHIV support networks and the peer-led support mechanisms would be useful to address societal factors. Conclusion The study findings have high significance for developing program implementation strategies to improve access and to build right-based and patient-centred EID services.

Abstract Discrete symmetries play an important role in particle physics with violation of CP connected to the matter-antimatter imbalance in the Universe. We report the most precise test of P, T and CP invariance in decays of ortho-positronium, performed with methodology involving polarization of photons from these decays. Positronium, the simplest bound state of an electron and positron, is of recent interest with discrepancies reported between measured hyperfine energy structure and theory at the level of 10−4 signaling a need for better understanding of the positronium system at this level. We test discrete symmetries using photon polarizations determined via Compton scattering in the dedicated J-PET tomograph on an event-by-event basis and without the need to control the spin of the positronium with an external magnetic field, in contrast to previous experiments. Our result is consistent with QED expectations at the level of 0.0007 and one standard deviation.

Abstract Background CT- coronary calcium score, is one of the most studied and widely available modalities in cardiovascular medicine. Coronary artery calcium score (CACS) is an established predictor of coronary artery disease. The ‘standard of care’ diagnostic modality to measure CACS is ECG-gated Cardiac Multi-Detector Computed Tomography. There is convincing evidence of a strong association between CACS and major cardiovascular (CV) events in asymptomatic individuals. Cancer patients (C) may have a higher risk for CV disease than non-cancer patients (NC) related not only to cancer treatments but also to shared biological factors and pathways. Thus, identifying tools for early detection of CV disease in this population is of utmost importance. Methods A retrospective cohort analysis was performed with patients from Cleveland Clinic Florida and Ohio who had CACS from 2017 to 2021. Patients who had cancer diagnosis prior to CACS were matched to NC for age and sex. CV events after their index CACS events were compared between C and NC, and matched control and propensity analysis were conducted. Results Ten thousand seven hundred forty-two patients had CACS; 703 cancer patients had CACS and were eligible. Extensive CACS (> 400) were significantly higher in cancer, 94 (13.37%) vs non-cancer patients, 76 (10.83%), P = 0.011. Furthermore, after propensity matched analysis, CACS > 400 was 14.8% in C vs 9.6% in NC, P = 400) CACS, the prevalence of stroke and peripheral arterial disease, a marker of systemic atherosclerosis, was significantly higher in patients with cancer (P

Abstract Background Indian adolescents exhibit unhealthy food behaviours and inactive lifestyles which increase their risk of developing obesity and associated negative health consequences. The family food environment represents a vital setting to nurture healthy lifestyle behaviours in adolescents, with parents influencing their adolescents’ dietary and physical activity behaviours. Yet, much of the existing evidence exploring parental influences predominantly focuses on mothers while fathers’ engagement in instilling healthy dietary and physical activity behaviours is understudied, more so in the context of developing economies like India. Therefore, this qualitative study was designed to understand Indian fathers’ views on instilling healthy behaviours in their children. Methods Convenience sampling along with snowball sampling techniques were employed to recruit fathers of adolescents aged 10–19 years from Kolkata city, India. Informed by the research aim and review of literature, an interview guide was developed and pre-tested. Interviews were carried out either in person or virtually (Zoom/telephone) in English/Hindi/Bengali as per the preference of the participants. All interactions were audio recorded, transcribed verbatim, and translated to English for the purpose of data analysis. The transcripts were analysed thematically using NVivo software program. Themes were identified using both inductive and deductive approaches. Results A total 36 fathers participated in the interviews. Seven main themes were identified: (i) Involvement of fathers in adolescent upbringing (i.e. engagement in meal preparation, food shopping, educational activities, physical activity); (ii) Family food environment (i.e. setting food rules, having meals with children, making food available); (iii) Challenges to instilling healthy behaviours in adolescents (i.e. adolescents’ sedentary lifestyle and liking for unhealthy foods); (iv) Barriers to routine involvement in adolescent upbringing (i.e. time constraints due to paid employment, poor socio-economic status); (v) Adolescent nutrition education: (vi) Dual burden of malnutrition (i.e. awareness of malnutrition, no knowledge about government-led health programs for adolescents); (vii) Paternal knowledge. Conclusions The emerging themes reveal that Indian fathers played a crucial role in instilling healthy dietary and physical activity behaviour in their adolescents through various parenting practices such as purchasing nutritious food, enforcing food rules, disseminating nutrition-related knowledge, and encouraging adolescents to participate in moderate-to-vigorous intensity outdoor sports. This provides strong support for the inclusion of fathers in sustainable family-focused lifestyle interventions to maximise the nurturing care required by adolescents as well as assist in normalising the representation of fathers in health and welfare policies designed for adolescents.

Background: Cleft lip chelioplasty can be approached with a wide array of different techniques.The ultimate goal of all techniques is to restore sphincter competence and aesthetically favorable outcome. Dr.C. Balakrishnan of Government medical college,Nagpur devised an original triple wedge technique,a form of three triangular flap,that was evolved independently of the triangular flap technique.Unfortunately he did not publish his technique,even today many of his 4th and 5th generation trainees perform triple wedge technique for cleft lip repair.[1],[2,],[3] The history of cleft lip repair in Nagpur and it's growth can not be dissociated from modern plastic surgery in India by the father of modern plastic surgery in India Dr. C.Balakrishnan himself,who established the first department of plastic surgery in India at GMC Nagpur,credited it with a new classification of cleft lip and palate, a new technique of cleft lip repair and propagated the principles of comprehensive cleft care. In our institute triple wedge repair for cleft lip is the repair of choice since 1950, although many modifications have been done in original technique since then. I was trained in KEM hospital,Mumbai and learned Millard's repair there. After coming to Nagpur,I joined the department as lecturer under respected Dr S.M. Kale sir and I got the opportunity to learn triple wedge technique from him. Over the last 20 years I have added few modifications like changing the orientation of triangles,using the mucosal element for anterior palate repair which used to be discarded in original triple wedge technique and primary rhinoplasty. Aims and Objectives: In this original article we are describing the original triple wedge technique invented by father of modern plastic surgery in India Dr.C. Balakrishnan 2 and its evolution since then in the first department of plastic surgery in India. Materials and Methods: Patients operated in last 50 years at Government Medical college,Nagpur and data available in department. Results: Early and late postoperative pictures showing result of the technique. Conclusion: The purpose of this article is illuminating unpublished work of legend of plastic surgery in India Dr. C. Balakrishnan.

Introduction: Access to oral healthcare is limited in rural areas, resulting in disparities in oral health services. Primary health centers (PHCs) are essential for providing integrated oral healthcare to rural populations. This study examines the patterns, barriers, and utilization of oral healthcare at PHCs in Rohtak district, Haryana. Materials and Methods: In this 6-month household cross-sectional study, data were collected from a sample of 600 participants residing in rural areas under the jurisdiction of three randomly selected PHCs in Rohtak district. The study employed multistage cluster systematic random sampling procedures. Data collection included structured questionnaires and clinical oral examinations following the type-III ADA classification. Participants' oral health status was evaluated using the WHO oral health assessment form for adults (2013). Descriptive and analytical statistics were used for data analysis. Results and Discussion: Dental caries and periodontal diseases were more common in older age groups. Barriers to oral healthcare among the elderly include fear of dental procedures and low dental literacy. Proximity to PHCs influenced dental service utilization, with higher rates among participants living near a PHC, that is, within 5 km of a PHC. Conclusion: Age, gender, proximity to PHCs, household size, and socioeconomic status play crucial roles in the utilization of oral health services among the rural population. Addressing these factors is essential for improving oral healthcare and overcoming barriers. It is crucial to enhance the accessibility, affordability, and availability of oral health services at PHCs to promote better oral health and overall well-being in rural areas.

Background: Adequate management of hypertension is crucial for decreasing the likelihood of cardiovascular ailments and associated complications. Nonetheless, in the Indian context, maintaining compliance with prescribed hypertensive therapies presents a notable hurdle, impeding the attainment of favorable health outcomes. Thus, this study was conducted with the aim to evaluate the prevalence of treatment adherence and explore the diverse factors that impact adherence patterns among individuals diagnosed with hypertension. Material and Methods: A community-based cross-sectional questionnaire-based study was carried out among the diagnosed hypertensive patients from 12 purposefully selected villages of Khagaul block, Patna. A total of 262 participants were recruited in the study by using non-probability sampling. The 8-item Morisky Medication Adherence Scale (MMAS-8) was used for measuring adherence. The Statistical Package for the Social Sciences (SPSS) for Windows version 21.0 (SPSS Inc; Chicago, IL, USA) was used for statistical analysis of data. Result: As per MMAS scores, 10 (3.8%) had high, 133 (50.8%) moderate, and 119 (45.4%) poor adherence. However, good adherence was reported among geriatric patients [1.65 (1.01–2.7)], those with a history of absence of comorbidities [2.15 (1.21–3.85)], more than 5 years' duration of hypertension [3.2 (1.89–5.41)], once-a-day drug intake [2.8 (1.61–4.87)], and having controlled blood pressure [5.2 (3.08–8.96)]. Controlled blood pressure (AOR = 0.048, 0.023-0.098), perception of high benefit of treatment [0.497 (0.255–0.97)], and absence of comorbidity [0.016 (0.168–0.832)] were identified as predictors of good treatment adherence. Conclusion: Overall medication adherence in the current study was 54.6%. Achieving treatment adherence frequently demands proactive patient engagement, highlighting their active role in disease management. Also, involving the patient's caregivers can offer an additional tactic to tackle non-adherence stemming from forgetfulness of the patient.

Background: Insomnia is a common feature of schizophrenia. Patients with schizophrenia also encounter the problem of insomnia, which impairs their cognitive functioning, quality of life, mental well-being, and functional recovery. Studies support pharmacological treatment of insomnia with certain drugs; however, these hypnotic medications also have adverse effects. There are no grounded recommendations about insomnia treatment in this clinical setting and research in nonpharmacological areas is sparse. To the best of our knowledge, this is the first study to see the effect of cognitive behavioural therapy for insomnia (CBT-I) in schizophrenia patients in an Indian population. Aims: To evaluate the effects of CBT-I in schizophrenia patients. Materials and Methods: It is a randomized controlled study. Forty schizophrenic patients were recruited and were randomly allocated into two groups. The CBT-I group (n = 20) received four sessions of CBT-I in addition to treatment as usual, whereas the control group (n = 20) received. no additional intervention. The Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) were administered at baseline, week 4, and week 8. Results: Both the groups showed significant time–group interactions on the ISI and PSQI. Post hoc testing showed that, compared to the control group, the CBT-I group showed significant reductions in ISI at both week 4 and week 8. Conclusion: CBT-I was effective for reducing insomnia symptoms in patients with schizophrenia and the effect lasted for 4 weeks after the intervention.

Background: Mallampati grading (MPG) classification in a sitting position is the most commonly used method for airway assessment. The study aimed to compare the predictive value of MPG in the sitting and supine positions to predict difficult tracheal intubation (DTI). Patients and Methods: The present study was a prospective, blinded, and observational study. Three hundred nine patients aged 18–60 years, scheduled for surgery requiring orotracheal intubation, were included. Airway assessment was performed preoperatively, including sitting MPG with and without phonation. Supine MPG with and without phonation was noted in the operation theater. The ease of bag-mask ventilation (BMV) and laryngoscopy view were graded according to the Han scale and the Cormack and Lehane scores, respectively. A receiver operating characteristic curve was used to assess the cutoff point, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of MPG, and body mass index for predicting DTI. Results: Difficult BMV, DTI, and both (difficult BMV and DTI) were observed in 22.7%, 12.9%, and 5.2% of patients, respectively. MPG in the sitting position without phonation yielded the highest diagnostic accuracy (76.38%), specificity (79.55%), and PPV (28.6%), with good sensitivity (55%) and NPV (92.2%). Supine MPG without phonation showed comparable results. Conclusion: Sitting position MPG without phonation is the best predictor of DTI, followed by supine MPG without phonation. Therefore, supine MPG without phonation is equivalent to sitting without phonation MPG and can be used for predicting DTI whenever the patient cannot be made upright.

Background and Aims: Peri-capsular nerve group (PENG) block is a novel ultrasound (US)-guided technique to achieve regional analgesia in hip fractures. We compared the effectiveness of two doses of 0.25% bupivacaine (20 mL and 15 mL) in the US-guided PENG block for positioning patients for sub-arachnoid block (SAB) during hip fracture surgery. Methods: The randomised trial included 60 patients aged 40–90 years undergoing hip fracture surgery under SAB. PENG block was given by a US-guided approach with the patient in a supine position 20 minutes before SAB, and a total of 20 mL and 15 mL of bupivacaine (0.25%) were given in groups A and B, respectively. The primary outcome was to measure and compare the ease of positioning (EOP) of patients for the conduct of SAB. The secondary outcome was the pain assessment at rest and 15° leg raise position at baseline and 10 and 20 minutes post block using the verbal analogue scale (VAS). Continuous variables were compared using the t-test, and categorical variables were analysed using Pearson's Chi-square test or Fisher's exact test. Results: The mean (standard deviation) grade of EOP for SAB was significantly better in group A (2.47 (0.73) (95% confidence interval [CI]: 2.19–2.69)) than in group B (1.86 (0.62) (95% CI: 1.65–2.1)) (P = 0.001). The decrease in VAS scores was significantly higher in group A compared to group B at resting and 15° leg raise position at all-time points (P < 0.05). Conclusion: A dose of 20 mL of 0.25% bupivacaine shows better outcomes than 15 mL regarding the patient's positioning during the SAB.

Keratoprosthesis (Kpro) evolution over the years has been remarkable from initially rejected due to devastating complication to the present with development of multiple biocompatible materials and acceptable designs. Its indications have expanded beyond recurrent immunologic rejection to include other conditions such as chemical injury and other causes of bilateral limbal stem cell deficiency, extensive corneal neovascularization, neurotrophic corneas, and hypotony. Since then, it is accepted worldwide by many cornea specialists and now has become a standard procedure. Improvement in pre-operative, intra-operative, and post-operative management has resulted in favorable outcomes with reduction in complications. However, sight-threatening complications are even now reported in auto-immune and cicatrizing conditions, which requires prompt management and frequent follow-ups. Researchers in the field have been recently working on improving the design of the currently available devices by introducing the use of new materials that are more biocompatible with the eye. This review article gives an update on recent research in the field, indications, types, and comprehensive detail on outcomes with Kpro.

Research backgroundThere is considerable diversity in newly developed pummelo × sweet orange citrus hybrids. Most hybrids showed lower peel thickness and high juice yield but there is a lack of information on fruit quality parameters and molecular characterization. Therefore, the aim of the current study is to determine the content of antioxidants and properties of the fresh juice of 24 new pummelo × sweet orange citrus hybrids (Citrus maxima [Burm. f.] Osbeck × Citrus sinensis [L.] Osbeck) and the parental genotypes along with molecular characteristics determined using acidity specific markers. Experimental approach. The correlation and estimate of inheritance of the fruit juice properties: ascorbic acid, total phenol, total flavonoid, total antioxidant, total soluble solid and sugar contents, pH, titratable acidity, along with sensory evaluation was performed. Molecular characterization of these hybrids was carried out using de novo generated acidity specific simple sequence repeat (SSR) markers. Results and conclusions. The main constituents of the fruit juice of pummelo × sweet orange hybrids were observed in the range of w(ascorbic acid)=40.00–58.13 mg/100 g, total phenols expressed as gallic acid equivalents w(GAE)=40.67–107.33 mg/100 g, total antioxidants expressed as Trolox equivalents b(Trolox)=2.03–5.49 µmol/g, total flavonoids expressed as quercetin equivalents w(QE)=23.67–59.33 mg/100 g, along with other properties: total soluble solids=7.33–11.33 %, w(total sugar)=2.10–5.76 %, w(reducing sugar)=1.69–2.78 %, w(non-reducing sugar)=0.39–3.17 % and titratable acidity 1.00–2.11 %. The above parameters differed significantly in the fruit juice of the evaluated pummelo × sweet orange hybrids. Considering these parameters, the hybrids SCSH 17-9, SCSH 13-13, SCSH 11-15 and SCSH 3-15 had superior antioxidant properties in terms of these parameters. A higher heritability (≥80 %) was also observed for all juice properties. Molecular characterization of pummelo × sweet orange hybrids showed that >50 % of the hybrids were grouped with medium acidity parents. Both molecular and biochemical parameter-based clustering showed that interspecific hybrids exhibit transgressive segregation with increased antioxidants that help alleviate the health problems. Novelty and scientific contribution. These newly developed pummelo × sweet orange citrus hybrids are a valuable source of high-quality antioxidants for a healthy diet. The identification of trait markers that enable selection at the seedling stage is of great benefit to citrus breeders, as the characteristic features of a mature tree are not yet visible at the juvenile stage.

The process of controlling the flow of products and services from a company by encompassing each stage involved in transforming raw materials and parts into finished items, also delivering them to the final consumer is known as Supply Chain Management (SCM). The development of numerous smart city applications including smart grids, smart homes, smart supply chains, and smart healthcare has drawn attention to the Internet of Things (IoT). Nowadays, researchers are considering the smart healthcare system’s role as a Public Emergency Service (PES) to treat patients promptly. A distributed smart fire brigade system receives little attention like PES to save lives and property from catastrophic fire damage. The conventional PES methods are created using a centralized method that needs a lot of processing power and doesn’t offer timely services. The traditional systems developed for managing the supply chain have drawbacks like single-point failure issues, data integrity, transparency, and lack of trust. To alleviate the existing issues, in this paper, a Blockchain and IoT Enable Secure and Transparent Supply Chain Management framework is utilized for PES in the smart city environment. Further, two edge computing servers, like a service controller and an IoT controller are adapted. The local storage is handled by the service and IoT controller. Thus, it enhances the data processing speed of PES requests and PES fulfillment. The service controller utilizes the Optimal Queue Model to manage the PES requests based on the minimum service queue length. The efficiency of the network is improved by fine-tuning the parameters from the Queue model with the aid of a Revised Fitness-based Political Optimizer (RF-PO). The multi-objective constraints like queue length, utilization, actual arrival time, expected arrival time, and end-to-end delay are utilized for the efficient supply chain system. These stimulated results show the feasibility and effectiveness of the supply chain framework.

Background: Endometrial cancer is one of the most commonly diagnosed cancers in women worldwide. Aim and Objectives: To study the expression of estrogen receptor (ER), progesterone receptor (PR) and p53 immunohistochemistry (IHC) markers in subtyping endometrial carcinoma. Materials and Methods: A total of 100 cases of carcinoma endometrium submitted during January 2016 to October 2018 were included in our study. The ER, PR and p53 expressions were scored as per the adopted scoring system. Agreement between ER, PR and p53 IHC expression and the consensus HE diagnosis, FIGO grading and tumour staging were assessed using Chi square tests. Results: There was a statistical association between ER, PR and p53 status and tumour histologic type with a P value < 0.01. There was no statistical significance observed between ER and PR expressions and different FIGO grades. Statistical significance (P = 0.036) between p53 and different FIGO grades seen. No statistical significance was observed between ER, PR and p53 expressions and different tumour stages and tumour invasiveness. There was a statistical association between ER and PR status and lymph node metastasis. p53 did not show a statistical significance. Conclusion: Combination of ER, PR and p53 IHC markers can be used to distinguish type 1 and type 2 endometrial cancers. PR expression is more specific than ER in endometrioid carcinomas. p53 expression is more specific in serous carcinoma, however, p53 IHC alone cannot be used to distinguish different grades of endometrioid carcinomas as there is variability of staining in endometrioid carcinomas.

Objective: This study sought to determine the relationship between right ventricular (RV) function and clinical variables and prognosis in individuals with acute myocardial infarction (AMI) utilizing strain imaging. Materials and Methods: A prospective observational research involving 150 patients who had been admitted with AMI was carried out. Utilizing two-dimensional speckle-tracking strain imaging, RV function was assessed. Age, sex, risk factors, and comorbidities were recorded as clinical parameters. A 12-month follow-up was conducted to assess major adverse cardiovascular events (MACE). Results: 65% of the study's participants were men, with a mean age of 58.2 years. When compared to a healthy control group, individuals with AMI had significantly lower RV longitudinal strain (RVLS) (P 0.001). RVLS and left ventricular ejection fraction had a statistically significant connection (r = 0.642, P 0.001). Patients with compromised RVLS had a greater rate of MACE over the follow-up period compared to those with maintained RV function (P = 0.014). Conclusion: In conclusion, strain imaging offers useful information for evaluating RV function in patients with AMI. Reduced left ventricular performance and a higher likelihood of unfavorable clinical outcomes are linked to impaired RVLS. Utilizing strain imaging to detect RV dysfunction early can help direct treatment plans and enhance patient outcomes.

Cemento-osseous dysplasia is a subgroup of fibro-osseous dysplasia commonly invading the tooth-bearing regions of the mandible quite often. These bony pathologies are asymptomatic and are seen on radiographs as an incidental finding. Accurate diagnosis of periapical cemento-osseous dysplasia is very crucial as it will help in the proper management of the patient as the incorrect diagnosis can lead to the unnecessary endodontic treatment of the concerned teeth as it may be misdiagnosed as a periapical pathology. We describe a case of periapical cemento-osseous dysplasia in which a 52-year-old woman had been experiencing discomfort in the right mental area of her mandible for the previous 6 months and had finally sought help at the outpatient department. This case study aims to highlight the significance of making an accurate diagnosis of cemento-osseous dysplasias in the tooth-bearing area.

In response to the escalating demand for hardware-efficient Deep Neural Network (DNN) architectures, we present a novel quantize-enabled multiply-accumulate (MAC) unit. Our methodology employs a right shift-and-add computation for MAC operation, enabling runtime truncation without additional hardware. This architecture optimally utilizes hardware resources, enhancing throughput performance while reducing computational complexity through bit-truncation techniques. Our key methodology involves designing a hardware-efficient MAC computational algorithm that supports both iterative and pipeline implementations, catering to diverse hardware efficiency or enhanced throughput requirements in accelerators. Additionally, we introduce a processing element (PE) with a pre-loading bias scheme, reducing one clock delay and eliminating the need for conventional extra resources in PE implementation. The PE facilitates quantization-based MAC calculations through an efficient bit-truncation method, removing the necessity for extra hardware logic. This versatile PE accommodates variable bit-precision with a dynamic fraction part within the sfxpt< N,f $>$ representation, meeting specific model or layer demands. Through software emulation, our proposed approach demonstrates minimal accuracy loss, revealing under 1.6% loss for LeNet-5 using MNIST and around 4% for ResNet-18 and VGG-16 with CIFAR-10 in the sfxpt< 8 ,5 $>$ format compared to conventional float32-based implementations. Hardware performance parameters on the Xilinx-Virtex-7 board unveil a 37% reduction in area utilization and a 45% reduction in power consumption compared to the best state-of-the-art MAC architecture. Extending the proposed MAC to a LeNet DNN model results in a 42% reduction in resource requirements and a significant 27% reduction in delay. This architecture provides notable advantages for resource-efficient, high-throughput edge-AI applications.

Accurate indoor positioning is critical to a variety of use cases including tracking, proximity, mapping, and navigation. Existing positioning methods are either inaccurate (e.g. RSSI-based ranging), impractical (e.g. fingerprinting), or uncommon (e.g. Ultra-Wide Band/UWB). WiFi Round-Trip Time (RTT) marries the ubiquity of WiFi infrastructure with the accuracy of such ranging mechanisms as those used in UWB. We present WhereArtThou, a commercial-grade, plug-and-play indoor positioning solution (IPS) based on WiFi RTT. Our base algorithm uses an extended Kalman filter with a random walk motion model (EKF-RW) which relies solely on RTT distance measurements. We propose two EKF components to enhance positioning accuracy. First, as distance measurements can further be fused with inertial sensor readings, we propose a step-and-heading-based filter (EKF-SH) when such readings are available. We devise a method to fit the non-Gaussian step error with a Gaussian random variable to remain within the computationally-efficient Kalman filtering framework. Second, we define a distance-dependent measurement model to match the true statistics of the measurement noise and approach optimal position estimation. Moreover, we measure the gain from the proposed enhancements not only through the almost-exclusively-used error metric in the indoor positioning literature, the Euclidean distance and its variations, but also through metrics commonly used in satellite and maritime navigation, the cross-track and along-track errors, in addition to a set of metrics of our own definition. Finally, we show that RTT is highly susceptible to the human body holding the device measuring it, and we case-study the impact of human-body blockage on positioning and ranging errors. We test our algorithms on over 18 hours of walking data collected on different devices, in different locations, and with different users, and we observe that the EKF-RW and EKF-SH achieve 90th percentile distance errors of 1.65 m and 1.45 m, and 90th percentile cross-track errors of 0.85 m and 1.55 m, making our solution primed for commercial deployment.

Malaria presents a significant global public health challenge, with severe malarial anaemia being a primary manifestation of the disease. The understanding of anaemia caused by malaria remains incomplete, making the treatment more complex. Iron is a crucial micronutrient essential for haemoglobin synthesis, oxygen delivery, and other vital metabolic functions in the body. It is indispensable for the growth of human beings, as well as bacteria, protozoa, and viruses in vitro and in vivo. Iron deficiency is among the most common nutritional deficiencies and can have detrimental effects during developmental stages of life. Malaria-induced iron deficiency occurs due to the hemolysis of erythrocytes and the suppression of erythropoiesis, leading to anaemia. Meeting iron requirements is particularly critical during pivotal life stages such as pregnancy, infancy, and childhood. Dietary intake alone may not suffice to meet adequate iron requirements, thus highlighting the vital role of iron supplementation. While iron supplementation can alleviate iron deficiency, it can exacerbate malaria infection by providing additional iron for the parasites. However, in the context of pregnancy and childhood, iron supplementation combined with malaria prevention and treatment has been shown to be beneficial in improving birth outcomes and ensuring proper growth and development, respectively. This review aims to identify the role and impact of iron supplementation in malaria infection during the life stages of pregnancy and childhood.

Introduction: Patients with diabetes mellitus monitor their blood glucose at home with monitors that require a drop of blood or use a continuous glucose monitoring device that implants a small needle in the body. However, both cause discomfort to the patients which may inhibit them for regular blood glucose checks. Photoplethysmogram (PPG) sensing technology is an approach for non-invasive blood glucose measurement and PPG sensors can be used to predict hypoglycaemic episodes. InChcek is a PPG-based non-invasive glucose monitor. However, its accuracy has not been checked yet. Hence, this study aimed to evaluate the accuracy of InCheck, a non-invasive glucose monitor for the estimation of blood glucose. Methods: In a tertiary care hospital, patients who came for blood glucose estimation were tested for blood glucose non-invasively on the InCheck device and then by the laboratory method (glucose oxidase-peroxidase). These two readings were compared. We used International Organization for Standardization (ISO) 15197:2013 (95% of values should be within ± 15 mg/dL of reference reading if reference glucose

Introduction: Hearing loss is a global issue of hearing disability and early detection and rehabilitation of hearing loss are important for the development of speech and language skills in hearing-impaired infants. There are multiple risk factors that aid in hearing loss but some are potential factors that contribute toward hearing loss in infants. The aim of this study was to assess the burden of hearing loss and its correlation with risk factors among high-risk infants at a teaching institution in Jaipur, Rajasthan. Method: This study was carried out after approval of institutional ethics committee on a total of 320 high-risk infants at RUHS College of medical sciences and associated hospitals. Hearing loss was assessed by brainstem evoked response audiometry (BERA). Statistical analysis of data was done by cross-tabulation analysis with Pearson correlation and quantile regression. Results: Out of 320 high-risk infants, 59.69% of infants had normal hearing, 9.09% Unilaterally hearing impaired, 20.31% were bilaterally mild-moderate hearing loss, and 10.94% had severe-profound deafness. The prevalence of important risk factors viz. hyperbilirubinemia, low birth weight, appearance, pulse, grimace, activity, and respiration score, meconium aspiration, respiratory distress, and ventilation greater than five days were 86%, 58.9%, 40%, 36%, 29%, and 22%, respectively. Conclusion: In high-risk infants, hearing loss is a common hearing disorder. Because of this, early diagnosis of hearing loss gives them the best chance of developing functional speech. Brainstem evoked response audiometry is a simple, reliable, and effective technique for the assessment of auditory functions in infants.

Introduction: Malnutrition is very common in India and black wheat might be an acceptable solution to this problem. The aim of the study was to assess acceptability of black wheat flour products and factors affecting it among Anganwadi beneficiaries and workers. Materials and Methods: This was a mixed-method prospective observational study. All the family members enrolled for supplementary nutrition and Anganwadi workers/helpers of three randomly selected Anganwadi centers were taken in the study. For qualitative data, in-depth interview was done, and for quantitative data, 9-point hedonic scale was administered. Braun and Clarke's six-phase data analysis framework was used for qualitative data. Results: A total of 16 pregnant females, 14 lactating females, 16 children, 2 Anganwadi workers, and 3 Anganwadi helpers participated in the study. Thematic analysis of the data revealed five significant themes. It included characteristics of black wheat flour, the process of making the product (experience of making the product), family acceptability, availability, and hygiene. Participants expressed that the black color appearance is one of the negative influencers in the acceptability of black wheat flour. Most of the participants liked the taste as well as the texture. However, kneading, rolling, and puffing were more challenging than traditional wheat flour. On the hedonic scale, the mean rank of acceptability is lowest for color (3.03), followed by puffing (3.49) and highest for texture (4.87) and taste (4.60). Conclusion: Our study results revealed that black wheat is acceptable to the Anganwadi beneficiaries and workers.

Background: The healthcare managers need to develop the managerial skills and use it for better healthcare delivery. A manager requires leadership skill to empower employees and motivate them to work in an efficient manner to achieve organizational goal. Motivating employees/subordinates and developing positive attitude toward them is one of the crucial skills that the leader needs to develop. The way health team works as a unit affects the outcome and needs good leader. With this background, the current study tends to explore the managerial skills of middle-level managers. Objectives: 1. To assess the leadership and team management skills of middle-level managers and 2. To find out motivational factors used by managers. Materials and Methods: A cross-sectional study was conducted among district-level healthcare managers and medical officers. Data collection was performed via semistructured and scale-based questionnaire and analyzed using Microsoft office excel. Results: 60% of managers had participative leadership style. Team work skills were fair enough among the managers. 53% of medical officers were freshly appointed with experience of less than one year. The middle-level managers used appreciation of work (41.8%) as major motivator of the team. Conclusions: The middle-level healthcare managers have good leadership quality as well as teamwork skills. Appreciation of work is commonly used motivator.

Introduction: Activation of the focal adhesion kinase (FAK) in podocytes is involved in the pathogenesis of minimal change disease (MCD), but the pathway leading to its activation in this disease is unknown. Here, we tested whether podocyte β1 integrin is the upstream modulator of FAK activation and podocyte injury in experimental models of MCD-like injury. Methods: We used lipopolysaccharide (LPS) and MCD sera to induce MCD-like changes in vivo and in cultured human podocytes, respectively. We performed functional studies using specific β1 integrin inhibitors in vivo and in vitro, and integrated histological analysis, western blotting, and immunofluorescence to assess for morphological and molecular changes in podocytes. By ELISA, we measured serum LPS levels in 35 children with MCD or presumed MCD (idiopathic nephrotic syndrome [INS]) and in 18 healthy controls. Results: LPS-injected mice showed morphological (foot process effacement, and normal appearing glomeruli on light microscopy) and molecular features (synaptopodin loss, nephrin mislocalization, FAK phosphorylation) characteristic of human MCD. Administration of a β1 integrin inhibitor to mice abrogated FAK phosphorylation, and ameliorated proteinuria and podocyte injury following LPS. Children with MCD/INS in relapse had higher serum LPS levels than controls. In cultured human podocytes, β1 integrin blockade prevented cytoskeletal rearrangements following exposure to MCD sera in relapse. Conclusions: Podocyte β1 integrin activation is an upstream mediator of FAK phosphorylation and podocyte injury in models of MCD-like injury. Resumen: Antecedentes: La activación de la quinasa de adhesión focal (FAK) en podocitos juega un papel en la patogénesis de la enfermedad de cambios mínimos (ECM), pero su mecanismo de activación en dicha enfermedad es desconocido. En este estudio investigamos si la integrina β1 de los podocitos modula la activación de FAK y del daño podocitario en modelos experimentales de la ECM. Métodos: Utilizamos lipopolisacárido (LPS) y suero de pacientes con ECM para inducir daño podocitario in vivo e in vitro, respectivamente. Realizamos estudios funcionales usando inhibidores específicos de la integrina β1 in vivo e in vitro, así como estudios histológicos, western blots y técnicas de inmunofluorescencia para evaluar cambios morfológicos y moleculares en podocitos. Usando ELISA medimos los niveles séricos de LPS en 35 niños con ECM o sospecha de ECM (síndrome nefrótico idiopático [SNI]) y en 18 individuos sanos. Resultados: Los ratones inyectados con LPS desarrollaron cambios morfológicos (fusión de pedicelos, con apariencia normal de los glomérulos) y moleculares (pérdida de la expresión de sinaptopodina, cambio en la localización de la nefrina fosforilada y fosforilzación de FAK), que son característicos de la ECM en humanos. La administración de un inhibidor de la integrina β1 en ratones disminuyó la fosforilación de FAK, proteinuria y daño podocitario que ocurre tras la inyección de LPS. En niños con ECM/SNI, los niveles séricos de LPS fueron más elevados que en controles. En cultivos de podocitos humanos, la adicción de un inhibidor de la integrina β1 al suero de niños con ECM en recaída evitó cambios en el citoesqueleto. Conclusiones: La integrina β1 de los podocitos actúa como mediador de la activación de la FAK y del daño podocitario en modelos experimentales de la ECM.