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Ralstonia solanacearum species complex (RSSC) strains are bacteria that colonize plant xylem tissue and cause vascular wilt diseases. However, individual strains vary in host range, optimal disease temperatures and physiological traits. To increase our understanding of the evolution, diversity and biology of the RSSC, we performed a meta-analysis of 100 representative RSSC genomes. These 100 RSSC genomes contain 4940 genes on average, and a pangenome analysis found that there are 3262 genes in the core genome (~60 % of the mean RSSC genome) with 13 128 genes in the extensive flexible genome. A core genome phylogenetic tree and a whole-genome similarity matrix aligned with the previously named species ( R. solanacearum , R. pseudosolanacearum , R. syzygii ) and phylotypes (I–IV). These analyses also highlighted a third unrecognized sub-clade of phylotype II. Additionally, we identified differences between phylotypes with respect to gene content and recombination rate, and we delineated population clusters based on the extent of horizontal gene transfer. Multiple analyses indicate that phylotype II is the most diverse phylotype, and it may thus represent the ancestral group of the RSSC. We also used our genome-based framework to test whether the RSSC sequence variant (sequevar) taxonomy is a robust method to define within-species relationships of strains. The sequevar taxonomy is based on alignments of a single conserved gene (egl). Although sequevars in phylotype II describe monophyletic groups, the sequevar system breaks down in the highly recombinogenic phylotype I, which highlights the need for an improved, cost-effective method for genotyping strains in phylotype I. Finally, we enabled quick and precise genome-based identification of newly sequenced RSSC strains by assigning Life Identification Numbers (LINs) to the 100 strains and by circumscribing the RSSC and its sub-groups in the LINbase Web service.

BackgroundAdolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10-19 years) compared to older mothers in low and middle-income countries.MethodsThis study was conducted between March 16, 2018 and May 25, 2021. Data were obtained from 20 randomised controlled trials of micronutrient supplementation in pregnancy. Stratified analyses were conducted by age (10-14 years, 15-17 years, 18-19 years, 20-29 years, 30-39 years, 40+ years) and geographical region (Africa, Asia). Crude and confounder-adjusted means, prevalence and relative risks of pregnancy, nutrition and birth outcomes were estimated using multivariable linear and log-binomial regression models with 95% confidence intervals.FindingsAdolescent mothers comprised 31.6% of our data. Preterm birth, small-for-gestational age (SGA), low birthweight (LBW) and newborn mortality followed a U-shaped trend in which prevalence was highest among the youngest mothers (10-14 years) and then reduced gradually, but increased again for older mothers (40+ years). When compared to mothers aged 20-29 years, there was a 23% increased risk of preterm birth, a 60% increased risk of perinatal mortality, a 63% increased risk of neonatal mortality, a 28% increased risk of LBW, and a 22% increased risk of SGA among mothers 10-14 years. Mothers 40+ years experienced a 22% increased risk of preterm birth and a 103% increased risk of stillbirth when compared to the 20-29 year group.InterpretationThe youngest and oldest mothers suffer most from adverse pregnancy and birth outcomes. Policy and programming agendas should consider both biological and socioeconomic/environmental factors when targeting these populations.FundingBill and Melinda Gates Foundation (Grant No: OP1137750).

BackgroundIn utero or early-life exposure to aflatoxin, which contaminates staple crops in disadvantaged settings, may compromise pregnancy and infant outcomes, but investigations into the extent, persistence, and determinants of aflatoxin exposure at these life stages have lacked longitudinal data collection and broad geographic representation.ObjectivesAflatoxin exposure and selected determinants thereof were characterized in mother-child dyads with serial plasma/serum samples in prenatal, perinatal, and early life in Malawi and Bangladesh.MethodsCirculating aflatoxin B1 (AFB1)-lysine albumin adducts were measured in dyads from Bangladesh (n = 573; maternal first and third trimester, 3 mo postpartum, cord blood, infant 24 mo) and Malawi (n = 255; maternal second and third trimester, 6 mo postpartum, infant 6 and 18 mo) with isotope dilution mass spectrometry. We examined AFB1-lysine adduct magnitude, persistence, seasonality, and associations with infant feeding, and estimated daily AFB1 intake.ResultsMaternal AFB1-lysine was higher in Malawi (98% detectable; median: 0.469, IQR: 0.225-1.027 pg/µL) than in Bangladesh (59%; 0.030, nondetectable [nd]-0.077 pg/µL). Although estimated dietary exposure in Malawi was temporally stable (648 ng AFB1/day), estimated intake in Bangladesh was reduced by 94% between rainy and winter seasons (98 to 6 ng/day). AFB1-lysine was low in cord blood from Bangladesh (15% detectable; 0.045, 0.031-0.088 pg/µL among detectable) and in Malawian infants at 6 mo of age (0.072, nd-0.236 pg/µL), but reached maternal concentrations by 18 or 24 mo (Bangladesh: 0.034, nd-0.063 pg/µL; Malawi: 0.370, 0.195-0.964 pg/µL). In Malawian infants, exclusive breastfeeding at 3 mo was associated with 58% lower AFB1-lysine concentrations at 6 mo compared with other feeding modes (P = 0.010).ConclusionsAmong pregnant women, aflatoxin exposure was persistently high in Malawi, while lower and seasonal in Bangladesh. Infants were partially protected from exposure in utero and with exclusive breastfeeding, but exposures reached adult levels by 18-24 mo of age. The Bangladesh and Malawi trials are registered at clinicaltrials.gov as NCT00860470 and NCT01239693.

ContextApproximately 7.3 million births occur annually among adolescents in low- and middle-income countries. Pregnant adolescents constitute a nutritionally vulnerable group that could benefit from intervention to mitigate the mortality and adverse birth outcomes associated with adolescent pregnancy.ObjectiveThe aim of this systematic review and meta-analysis was to assess the following: (1) the effect of multiple-micronutrient (MMN) supplementation vs iron and folic acid (IFA) supplementation among adolescents on maternal morbidity, birth outcomes, and mortality outcomes, (2) the effects of MMN supplementation in adolescents compared with the effects in adult women, and (3) the effect modification, if any, of MMN supplementation by baseline and geographic characteristics of adolescents.Data sourcesMEDLINE and Cochrane databases were searched, along with the reference lists of relevant reviews.Study selectionMultiple-micronutrient supplementation trials in pregnancy that were conducted in a low- or middle-income country and had included at least 100 adolescents (10-19 years of age) were eligible for inclusion. Two independent reviewers assessed study eligibility.Data extractionThirteen randomized controlled trials conducted in Africa and Asia were identified from 1792 reviews and 1578 original trials. Individual-level data was shared by study collaborators and was checked for completeness and extreme values. One- and two-stage individual participant data meta-analyses were conducted using data from randomized controlled trials of MMN supplementation.ResultsA total of 15 283 adolescents and 44 499 adult women with singleton births were included in the individual participant data meta-analyses of MMN supplementation vs IFA supplementation. In adolescents, MMN supplementation reduced low birth weight (1-stage OR = 0.87, 95%CI 0.77-0.97; 2-stage OR = 0.81; 95%CI 0.74-0.88), preterm birth (1-stage OR = 0.88, 95%CI 0.80-0.98; 2-stage OR = 0.86, 95%CI 0.79-0.95), and small-for-gestational-age births (1-stage OR = 0.90, 95%CI 0.81-1.00; 2-stage OR = 0.86, 95%CI 0.79-0.95) when compared with IFA supplementation. The effects of MMN supplementation did not differ between adolescents and older women, although a potentially greater reduction in small-for-gestational-age births was observed among adolescents. Effect modification by baseline characteristics and geographic region was inconclusive.ConclusionsMultiple-micronutrient supplementation can improve birth outcomes among pregnant adolescents in low- and middle-income countries. Policy related to antenatal care in these settings should prioritize MMN supplementation over the currently recommended IFA supplementation for all pregnant women, especially adolescents.

BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) surveillance rates are suboptimal in clinical practice. We aimed to elicit providers opinions on the following aspects of HCC surveillance: preferred strategies, barriers and facilitators, and the impact of a patients HCC risk on the choice of surveillance modality. METHODS: We conducted a web-based survey among gastroenterology and hepatology providers (40% faculty physicians, 21% advanced practice providers, 39% fellow-trainees) from 26 US medical centers in 17 states. RESULTS: Of 654 eligible providers, 305 (47%) completed the survey. Nearly all (98.4%) of the providers endorsed semi-annual HCC surveillance in patients with cirrhosis, with 84.2% recommending ultrasound ± alpha fetoprotein (AFP) and 15.4% recommending computed tomography (CT) or magnetic resonance imaging (MRI). Barriers to surveillance included limited HCC treatment options, screening test effectiveness to reduce mortality, access to transportation, and high out-of-pocket costs. Facilitators of surveillance included professional society guidelines. Most providers (72.1%) would perform surveillance even if HCC risk was low (≤0.5% per year), while 98.7% would perform surveillance if HCC risk was ≥1% per year. As a patients HCC risk increased from 1% to 3% to 5% per year, providers reported they would be less likely to order ultrasound ± AFP (83.6% to 68.9% to 57.4%; P < .001) and more likely to order CT or MRI ± AFP (3.9% to 26.2% to 36.1%; P < .001). CONCLUSIONS: Providers recommend HCC surveillance even when HCC risk is much lower than the threshold suggested by professional societies. Many appear receptive to risk-based HCC surveillance strategies that depend on patients estimated HCC risk, instead of our current one-size-fits all strategy.

PurposePediatric readiness scores may be a useful measure of a hospital's preparedness to care for children. However, there is limited evidence linking these scores with patient outcomes or other metrics, including the need for interfacility transfer. This study aims to determine the association of pediatric readiness scores with the odds of interfacility transfer among a cohort of noninjured children (< 18 years old) presenting to emergency departments (EDs) in small rural hospitals in the state of California.MethodsData from the National Pediatric Readiness Project assessment were linked with the California Office of Statewide Health Planning and Development's ED and inpatient databases to conduct a cross-sectional study of pediatric interfacility transfers. Hospitals were manually matched between these data sets. Logistic regression was performed with random intercepts for hospital and adjustment for patient-level confounders.FindingsA total of 54 hospitals and 135,388 encounters met the inclusion criteria. EDs with a high pediatric readiness score (>70) had lower adjusted odds of transfer (aOR: 0.55, 95% CI: 0.33-0.93) than EDs with a low pediatric readiness score (≤ 70). The pediatric readiness section with strongest association with transfer was the "policies, procedures, and protocols" section; EDs in the highest quartile had lower odds of transfer than EDs in the lowest quartile (aOR: 0.54, 95% CI: 0.31-0.91).ConclusionsPediatric patients presenting to EDs at small rural hospitals with high pediatric readiness scores may be less likely to be transferred. Additional studies are recommended to investigate other pediatric outcomes in relation to hospital ED pediatric readiness.

We review recent advances in using mathematical models of the relationship between the brain structure and function that capture features of brain dynamics. We argue the need for models that can jointly capture temporal, spatial, and spectral features of brain functional activity. We present recent work on spectral graph theory based models that can accurately capture spectral as well as spatial patterns across multiple frequencies in MEG reconstructions.

BackgroundNeuronal- and circuit-level abnormalities of excitation and inhibition are shown to be associated with tau and amyloid-beta (Aβ) in preclinical models of Alzheimer's disease (AD). These relationships remain poorly understood in patients with AD.MethodsUsing empirical spectra from magnetoencephalography and computational modeling (neural mass model), we examined excitatory and inhibitory parameters of neuronal subpopulations and investigated their specific associations to regional tau and Aβ, measured by positron emission tomography, in patients with AD.ResultsPatients with AD showed abnormal excitatory and inhibitory time-constants and neural gains compared to age-matched controls. Increased excitatory time-constants distinctly correlated with higher tau depositions while increased inhibitory time-constants distinctly correlated with higher Aβ depositions.ConclusionsOur results provide critical insights about potential mechanistic links between abnormal neural oscillations and cellular correlates of impaired excitatory and inhibitory synaptic functions associated with tau and Aβ in patients with AD.FundingThis study was supported by the National Institutes of Health grants: K08AG058749 (KGR), F32AG050434-01A1 (KGR), K23 AG038357 (KAV), P50 AG023501, P01 AG19724 (BLM), P50-AG023501 (BLM and GDR), R01 AG045611 (GDR); AG034570, AG062542 (WJ); NS100440 (SSN), DC176960 (SSN), DC017091 (SSN), AG062196 (SSN); a grant from John Douglas French Alzheimer's Foundation (KAV); grants from Larry L. Hillblom Foundation: 2015-A-034-FEL (KGR), 2019-A-013-SUP (KGR); grants from the Alzheimer's Association: AARG-21-849773 (KGR); PCTRB-13-288476 (KAV), and made possible by Part the CloudTM (ETAC-09-133596); a grant from Tau Consortium (GDR and WJJ), and a gift from the S. D. Bechtel Jr. Foundation.

BackgroundMeta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Identification of subgroups who benefit most from SQ-LNSs may facilitate program design.ObjectivesWe aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes.MethodsWe conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 37,066). We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons.ResultsSQ-LNS provision decreased stunting (length-for-age z score < -2) by 12% (relative reduction), wasting [weight-for-length (WLZ) z score < -2] by 14%, low midupper arm circumference (MUAC) (

BackgroundSmall-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development.ObjectivesWe aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects.MethodsWe conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6-24 mo (total n = 30,024).ResultsIn 11-13 intervention against control group comparisons (n = 23,588-24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 mo by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11-0.13 SD; 8-9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11).ConclusionsChild SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1-1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020159971.

BackgroundSmall-quantity lipid-based nutrient supplements (SQ-LNSs) have been shown to reduce the prevalence of child anemia and iron deficiency, but effects on other micronutrients are less well known. Identifying subgroups who benefit most from SQ-LNSs could support improved program design.ObjectivesWe aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes.MethodsWe conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect modifiers.ResultsSQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin 12 mo and provided 9 (as opposed to

Background: Diabetes is a chronic lifestyle disease which can be kept under control by some simple lifestyle modifications like blood sugar monitoring, dietary modification and exercise pattern. Diabetes mellitus (DM) appears to be a global epidemic and an increasingly major non-communicable disease threatening both affluent and non-affluent sections of the society. Methods: A cross-sectional study was conducted in tertiary care hospitals in Mangalore involving 109 participants. The study utilized the Summary Diabetes Self-Care Activities questionnaire to collect data. Practices were categorized as good or poor based on an average score, with scores above 75% indicating good and lower scores indicating poorer practices. Data analysis was performed using SPSS version 16.0. Results: The dietary modifications were good in 7.3% of the subjects, exercise behavior in 14.67%, foot care practices in 12.6% and sugar monitoring in only 1% of the subjects. Being male and married was associated with better self-care behaviors. People belonging to low socio-economic status had better dietary modification habits. Conclusion: Self-care activities with respect to diet and sugar monitoring are poor in the population studied. The self-care activities relating to exercise behavior and foot care are good. Improving self-care behavior among patients with diabetes in India should start with adequate targeted health education.

Background: Planning the waste management of all waste generated in healthcare facilities is a crucial task to reduce the hazards and risks to individuals and the community. Objectives: To assess the knowledge and practices regarding bio-medical waste management among paramedical staff and Group IV workers. Methods: In this cross-sectional study, 210 paramedical staff working at hospitals affiliated with Kasturba Medical College, Mangalore were assessed regarding their knowledge and practices regarding BMW. Institutional Ethics Committee permission was obtained before the commencement of the study. Data was analysed using IBM SPSS for Windows version 25.0, Armonk, New York, 25.0. Results: Among the total participants, there were 127 nurses, 6 lab technicians and 77 Group IV workers. 98.1% of healthcare providers were aware that their hospital has a waste management plan. 87.6% of healthcare providers follow hospital policies every time while disposing of waste. 92% of healthcare providers are aware of diseases transmitted by biomedical waste. The majority of the participants preferred using all five protective measures - gloves, goggles, masks, boots, and gowns while dealing with biomedical waste. Conclusion: The majority of the paramedical staff in our study were aware of the BMW management practices.

Purpose: Solid organic waste is a major environmental issue in various parts of the world. Proper management techniques for disposing of such wastes can reduce health issues as well as contamination of the environment. Modern scientific techniques in conjugation with traditional practices can manage biowaste in an efficient, economical, and sustainable manner. This present review highlights the possibilities of utilizing biowastes from various sources for the enhancement of soil fertility, residue management, crop growth and higher yields. Methodology: The article is prepared from secondary materials i.e. research and review articles published in different journals. The review of literature from these articles in terms of soil quality, salinity, impact of salinity on crop production and possibilities to reclamate saline soil to improve productivity of soil were systematically carried out. A summary of the present work was developed using the following approach. Result: Various management practices, in-situ and ex-situ techniques help reduce biowastes and transform them into useful nutrients that could be applied to soil for alleviating the nutritional deficiency in saline/sodic soil. Composting using microbes and earthworms has been traditionally practiced for reducing/converting waste into compost and applying them to agricultural fields to improve soil fertility and crop productivity. Conclusion: Using waste management techniques and converting biowaste into manure for enhancing agricultural productivity provides sustainable agriculture practices in addition to pollution reduction. Research highlights · Using solid organic waste management techniques to address major environmental issues is crucial. · By combining scientific techniques with traditional practices, biowaste can be managed in an efficient and sustainable way, minimizing health risks and environmental contamination. · In-situ and ex-situ management practices, as well as composting, improve soil fertility and crop productivity by transforming waste into nutrients. · A variety of biowastes can contribute to increased soil fertility, greater crop yields, and reduced residues.

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

Inflammatory bowel disease (IBD) frequently affects women of childbearing age and often coincides with pregnancy. With an increased incidence of IBD, gastroenterologists and obstetricians are more frequently involved in caring for women of reproductive age. While the development of novel therapies has allowed for successful conception and pregnancy outcomes, many patients may hesitate to conceive due to concerns for presumed adverse IBD effects on maternal and fetal health. As such, a noticeable percentage of patients may choose voluntary childlessness. Indeed, active IBD carries a greater risk of adverse pregnancy outcomes, including a loss of pregnancy, preterm delivery, and emergent C-sections. However, those with a quiescent disease tend to have fewer pregnancy complications. Therefore, it is essential to achieve remission prior to conception to optimize pregnancy outcomes. Dedicated IBD and pregnancy clinics can greatly assist in improving patient knowledge and attitudes towards pregnancy; through individualized pre-conception counseling, education, and medication adherence, the risks of poor pregnancy outcomes can be minimized. Furthermore, it is important for healthcare providers to have a sufficient understanding of the medication safety and tools to measure the disease activity, while counseling patients during gestation and breastfeeding periods. This review article aims to provide the most recent evidence-based management methods for IBD during pregnancy.

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

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

Abstract Background Acne vulgaris is caused due to several different biological, environmental and specific pathological factors, resulting in secretion of unregulated amount of sebum by the sebaceous glands. Acne is thought to be a minor, self-restraint, puberty leading and hormone-induced cosmetic disorder. It significantly affects the quality of life leading to social disengagement, anxiety, depression, necessitating its therapeutic management in due course of time. Thus, despite not being fatal it has social and mental impact on individual’s life. Pathogenesis of acne is complex and multifactorial involving diverse physiological, environmental factors and significant role of propionibacterium acne. Retinoids have been used as preferred first-line therapy for treatment of acne, but they have many limitations. Adapalene has found to be acting synergistically with other drugs like benzoyl peroxide, salicylic acid, clindamycin, etc., and various other topical antioxidants. Results The study investigates the formulation and characterization of novel nanostructured lipid vesicles (NLVs) co-loaded with adapalene and lycopene, through topical gel. The high-pressure homogenization method was used to prepare nanostructured lipid vesicles followed by incorporation into hydrophilic gel vehicle. This novel system was scientifically tested for various evaluation parameters like size and vesicle size distribution, polydispersity index, drug entrapment efficiency and in vitro drug release characteristics, along with rheological behavior of formulation gel. Skin permeation and biodistribution characteristics through skin were also evaluated, and better localization of drug in dermis and reduced systemic penetration were the key observation in prepared formulation. Conclusion The simultaneous co-administration of lycopene resulted in an additive effect in therapeutic management of acne. It can be predicted that this novel NLVs-based gel along with synergistic effect of lycopene will definitely result in better therapeutic efficacy and reduced systemic adverse effects of adapalene. This combination can be explored as future alternative for acne therapy.

Background: Fetal growth restriction (FGR), a condition occurring due to various reasons, is an important cause of fetal and neonatal morbidity and mortality. It has been defined as a rate of fetal growth less than normal in light of the growth potential of that specific infant. These infants have many acute neonatal problems that include perinatal asphyxia, hypothermia, hypoglycemia, and polycythemia. The likely long-term complications are growth retardation and major and subtle neurodevelopmental handicaps. Adequate surveillance of fetal growth is a crucial factor. Objective: To correlate clinical and ultrasound diagnosis of fetal growth restriction .Methodology: This prospective study was conducted in the Department of Obstetrics and Gynaecology at NSCB medical college, Jabalpur during the period of March 2018 to August 2019. Total 288 cases were included in the study. Results: The prevalence of FGR was found to be 33.7%. 60.81% of cases were in the age group 20-25 years. 89% of women belonged to rural areas. 67.30% of women belonged to the upper-lower class. The sensitivity and specificity of clinical methods were found to be 70.7% and 74.2% respectively. The sensitivity of ultrasonography and Doppler was 80.5% and 90.2%, and specificity was found to be 87.7% and 95.1% respectively. Out of 126 clinically suspected IUGR cases, overall 82 cases (65.1%) were confirmed as IUGR at birth. 43(20.63%) were lost to follow-up. Conclusion: The Doppler study is the best available modality for diagnosing FGR due to its high specificity, however clinical assessment, being a cost-effective screening tool, is equally good in diagnosing FGR.

Abstract Introduction Infant and neonatal mortality estimates are typically derived from retrospective birth histories collected through surveys in countries with unreliable civil registration and vital statistics systems. Yet such data are subject to biases, including under-reporting of deaths and age misreporting, which impact mortality estimates. Prospective population-based cohort studies are an underutilized data source for mortality estimation that may offer strengths that avoid biases. Methods We conducted a secondary analysis of data from the Child Health Epidemiology Reference Group, including 11 population-based pregnancy or birth cohort studies, to evaluate the appropriateness of vital event data for mortality estimation. Analyses were descriptive, summarizing study designs, populations, protocols, and internal checks to assess their impact on data quality. We calculated infant and neonatal morality rates and compared patterns with Demographic and Health Survey (DHS) data. Results Studies yielded 71,760 pregnant women and 85,095 live births. Specific field protocols, especially pregnancy enrollment, limited exclusion criteria, and frequent follow-up visits after delivery, led to higher birth outcome ascertainment and fewer missing deaths. Most studies had low follow-up loss in pregnancy and the first month with little evidence of date heaping. Among studies in Asia and Latin America, neonatal mortality rates (NMR) were similar to DHS, while several studies in Sub-Saharan Africa had lower NMRs than DHS. Infant mortality varied by study and region between sources. Conclusions Prospective, population-based cohort studies following rigorous protocols can yield high-quality vital event data to improve characterization of detailed mortality patterns of infants in low- and middle-income countries, especially in the early neonatal period where mortality risk is highest and changes rapidly.

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

The fundamental human resource that influences financial well-being is financial literacy. People are more likely to save and invest if they understand the time value of money, credit, insurance, and investments. Having a sound financial understanding lessens stress and increases financial well-being. This study used a structured survey questionnaire and back-translated it into Bangla to ease readability for the respondents. Four hundred thirty-five invitations were sent mainly to the Dhaka city dwellers’ and only 253 complete responses were retained for analysis. Partial least squares structural equation modeling (PLS-SEM) is used to assess the intercorrelations and validate the measurement model among the constructs (financial attitude, behavior, knowledge, self-efficacy, technological self-efficacy, and financial well-being) using SmartPLS version 4. The result found a full mediation effect among financial behavior, financial self-efficacy, and financial well-being. Partial mediation effects are found among financial attitudes toward financial self-efficacy, technological self-efficacy, and financial well-being.

Calcineurin B-like (CBL)-interacting protein kinases (CIPKs) play a crucial role in the complex molecular systems of plants, acting as coordinators in different plant development processes, manage hormone signaling, and respond to environmental stress. Despite their well-established importance in various physiological process, the CIPK gene family in banana has remained an unexplored, creating a knowledge gap that this research aims to address. Through comprehensive analysis, we identified and characterized 34 CIPK genes in the banana genome. Structural diversity analysis revealed distinct clades characterized by homologs with varying intron-rich and intron-poor members. Particularly, evolutionary conservation was observed in intron-less members. Exploring conserved motifs and physicochemical properties provided insights into the detailed structure of specific homologs. Subcellular localization predictions indicated that most CIPK proteins primarily reside in the cytoplasm and nucleus, indicating their involvement in essential cellular activities. The predicted chromosomal distribution pattern suggests that the CIPK gene family largely expanded through segmental duplications in the banana genome. The phylogenetic analysis has uncovered two monophyletic clades for intron-less and intron-containing homologs, providing insights into two separate evolutionary history and expansion of the CIPK gene family. The clustering pattern in the phylogeny suggest that sequence of CIPKs members in the different genomes are largely conserved during course of evolution after evolution of higher plants. However, a few members having diverse sequences that these homologs are evolving with higher rate of evolution. Diverse physiological roles of banana CIPKs members are further supported by the presence of numerous cis-acting elements associated with growth, development, hormone responsiveness, and stress, with certain MaCIPK promoters exhibiting multiple hormone-sensitive elements. The protein-protein interaction network sheds light on the functional associations between MaCIPKs and MaCBLs, highlighting specific clusters of interactions. 3D protein structure predictions provide additional insights, revealing variations among the MaCIPK proteins. Real-time expression analysis across various tissues and developmental stages emphasizes the significant roles played by CIPKs in plant development. Under stress conditions, 16 in leaves and 22 in root MaCIPK gene transcript levels were up –regulated in response to drought and cold stress. These insights into the dynamic expression and functional roles of CIPK genes provide valuable information for understanding the mechanisms underlying banana's resilience to stress, with direct implications for the development of stress-resistant banana varieties. Overall this research offers promising prospects for enhancing global food security by ensuring the sustainability of banana production in the face of changing environmental conditions.

Purpose: To study the biomarkers present in primary pterygium samples of patients of Indian ethnicity and compare it with the samples obtained from the unaffected conjunctiva of the same eye. Methods: A prospective case-control study of 17 eyes in patients above 10 years of age with primary pterygium who underwent pterygium excision using limbal conjunctival autograft technique. The pterygium samples (cases) and conjunctival samples (controls) were sent for immunohistochemical (IHC) staining for the following biomarkers: p53, Bcl-2, Ki-67, and vascular endothelial growth factor (VEGF). Result: The immunohistochemistry of the samples and the controls revealed p53 positivity in 47.05% of pterygium samples and 29.4% of controls (P < 0.587). Nine cases each in pterygium and control samples were positive for Ki-67 expression. Differences in the staining pattern between the two groups were not statistically significant (P < 1.000). Bcl-2 positivity was seen in 10 pterygium samples (58.8%) and 12 controls (70.5%), with no statistical difference between the two groups (P < 0.455). VEGF expression was seen in both epithelial and endothelial cells of the samples and controls, with no statistical difference between the two groups, with P = 1.000 for the epithelial staining and P = 0.637 for endothelial staining. Conclusion: The expression of biomarkers was comparable in both groups. We conclude that pterygium, against common belief, might not be a localized disease process but a global ocular phenomenon where the apparently healthy tissue also has some ongoing disease process at a molecular level.