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Objective: A Randomized, open-label comparative clinical study was conducted to evaluate the comparative efficacy and safety of Metformin 500mg twice daily versus Metformin 500mg twice daily Plus Dapagliflozin (10mg) once daily in achieving glycemic control among new onset T2DM in forty plus obese women. Method: A total of 100 subjects were enrolled in the study and after inclusion exclusion criteria 60 subjects were randomized into two groups. Group A received Metformin 500mg twice daily and Group B received Metformin twice daily and Dapagliflozin 10 mg once daily. FBS and PPBS were done at Day 0, 4th week, 8th week, 12th week, HbA1c was done on 0 days and 12 weeks. Results: Metformin plus Dapagliflozin was found to be significantly superior at the 4th-week p value < 0.001 and remained comparable at the 8th and 12th weeks to Metformin alone on FBS and PPBS. The percentage reduction was clinically significant (>10%) reduction for the Metformin plus Dapagliflozin group when compared to the Metformin group (4.46%). Conclusion: Dapagliflozin in combination with Metformin had superior efficacy to Metformin alone in achieving tight glycemic control.

Fingerprint codes are required to protect digital rights. These codes were embedded in digital media before distribution. Each of these digital media codes is unique. These codes identify pirated digital media copies. This method is used to identify the creator of an illegal copy. But such principles tend to be collectively attacked. In the Collusion Attack, criminal users conspired to integrate the attacks into these codes.Criminal users devise and switch digital fingerprint media with different codes to print the same content. The code is modified to accuse the innocent user. Thus, this attack is a threat to the protection of digital rights.The minority collusion assault being conducted against the Boneh-Shaw and Tardos codes to assess how serious this threat is can be used to demonstrate the significance of the research. Understanding these ideas is essential for improving the protection of digital rights in the face of changing security issues in the digital sphere. This study launches a minority collusion attack against both the Tardos code and the Boneh-Shaw fingerprint code to analyze the impact. The development of more resilient, adaptable codes to prevent changing collusion strategy is part of the prospective focus for Boneh-Shaw Fingerprint Code and Tardos Code Analysis and Optimization in Minority Collusion Attacks.

Being a pulse crop, green gram has huge scope in crop improvement in terms of productivity and other yield related parameters. Genetic variability is a preferable option for breeders in breeding programme for varietal development programme and others crop improvement aspect. The present investigation was framed to create the variability in mung bean var. GAM 8 during the seedling period through gamma (γ) irradiation. The significant variation was observed in germination percentage and it was found that dose dependent relationship between the germination rate and dose. Significantly minimum germination percentage (22.38 %) was observed in 700 Gy but optimal lethal dose (LD50) calculated through Probit analysis based on germination percentage was revealed at 540.26 Gy. Data revealed that γ irradiation had significantly reduced the seedling growth parameters such as shoot length (10.05 cm), shoot dry weight (19.68 mg), seedling length (13.90 cm), vigour index I (311.01) and II (509.01) was registered in 700 Gy while minimum root length (3.83 cm) was occurred in 600 Gy γ irradiation. Growth reduction (GR) 50 and 30 with respect to the seedling length was occurred respectively at 1093.79 and 1469.74 Gy. Therefore, this finding as the source of genetic variability would be used in future breeding and crop improvement programme like enhancement of yield potentiality and stress management in mung bean var. GAM 8.

Abstract Cicer arietinum, Cajanus cajan, Vigna radiata, and Phaseolus vulgaris are economically important legume crops with high nutritional value. They are negatively impacted globally by different biotic and abiotic stresses. Hyperosmolality-gated calcium-permeable channels (OSCA) have been characterized as osmosensors in Arabidopsis thaliana but have not previously reported in legumes. This study provides a genome-wide identification, characterization, and comparative analysis of OSCA genes in legumes. Our study identified and characterized 13 OSCA genes in C. cajan, V. radiata, P. vulgaris, and 12 in C. arietinum, classified into four distinct clades. We found evidence to suggest that the OSCAs might be involved in the interaction between hormone signalling pathways and stress signalling pathways. Furthermore, they play a major role in plant growth and development. The expression levels of the OSCAs vary under different stress conditions in a tissue-specific manner. Our study can be used to develop a detailed understanding of stress regulatory mechanisms of the OSCA gene family in legumes.

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

Abstract Calcineurin B-like proteins (CBL)-interacting protein kinases (CIPKs) regulate the developmental processes, hormone signal transduction and stress responses in plants. Although the genome sequence of chickpea is available, information related to the CIPK gene family is missing in this important crop plant. Here, a total of 22 CIPK genes were identified and characterized in chickpea. We found a high degree of structural and evolutionary conservation in the chickpea CIPK family. Our analysis showed that chickpea CIPKs have evolved with dicots such as Arabidopsis and soybean, and extensive gene duplication events have played an important role in the evolution and expansion of the CIPK gene family in chickpea. The three-dimensional structure of chickpea CIPKs was described by protein homology modelling. Most CIPK proteins are localized in the cytoplasm and nucleus, as predicted by subcellular localization analysis. Promoter analysis revealed various cis-regulatory elements related to plant development, hormone signaling, and abiotic stresses. RNA-seq expression analysis indicated that CIPKs are significantly expressed through a spectrum of developmental stages, tissue/organs that hinted at their important role in plant development. The qRT-PCR analysis revealed that several CaCIPK genes had specific and overlapping expressions in different abiotic stresses like drought, salt, and ABA, suggesting the important role of this gene family in abiotic stress signaling in chickpea. Thus, this study provides an avenue for detailed functional characterization of the CIPK gene family in chickpea and other legume crops.

Summary: Hypertension is an important modifiable risk factor for cardiovascular disease (CVD). Among normotensives, excessive dietary salt elevates the blood pressure and thereby increases the risk of CVD events. Despite such solid evidence, there is no effective approach to address excessive salt intake in India. Instead of just encouraging patients to lower their salt intake, we must provide an alternative technique by fostering an environment that facilitates this behaviour change. In this Viewpoint, we propose ‘Taste Modification’ strategy, i.e., a salt-reduction technique in which individuals are informed that adding spices/herbs to meals will reduce their salt intake. We hypothesise that a gradual reduction in salt intake can aid in the treatment of hypertension over time. The goal is to progressively substitute salt with spices for effective salt reduction. However, the ‘Taste Modification’ strategy must be first validated using multicentric clinical trials.

In the realm of agriculture, a pressing concern remains the abiotic stresses, such as temperature fluctuation, drought, soil salinity, and heavy metal contamination. These adverse growth conditions hamper crop yields and global food security. In this review, we present a comprehensive examination of the recent advancements in utilizing genomics and transcriptomics, tools to enhance crop resilience against these stress factors. Genomics aids in the identification of genes responsive to stress, unravels regulatory networks, and pinpoints genetic variations linked to stress tolerance. Concurrently, transcriptomics sheds light on the intricate dynamics of gene expression during stress conditions, unearthing novel stress-responsive genes and signaling pathways. This wealth of knowledge shapes the development of stress-tolerant crop varieties, achieved through conventional breeding programs and state-of-the-art genetic engineering and gene editing techniques like CRISPR-Cas9. Moreover, the integration of diverse omics data and functional genomics tools empowers precise manipulation of crop genomes to fortify their stress resilience. In summary, the integration of genomics and transcriptomics holds substantial promise in elucidating the molecular mechanisms behind crop stress tolerance, offering a path towards sustainable agriculture and safeguarding food security amidst shifting environmental challenges.

We hereby report a first case of substance abuse, where regular insulin by intravenous route has been misused to augment the cocaine abuse to derive sedation, euphoria, and a state of semi-consciousness leading to medication error in the form of extensive thrombophlebitis/cellulitis necrotising fasciitis. The said case report is important to create awareness among the drug regulatory authorities regarding this new face of substance abuse, which can prove potentially fatal among abusers warranting necessary regulatory action.

BackgroundDuchenne muscular dystrophy (DMD) is a rare progressive muscular disease that primarily affects boys. A lack of comprehensive care for patients living with DMD is directly associated with a compromised quality of life (QoL) for those affected and their caregivers. This disease also has a huge economic impact on families as its treatment requires substantial direct, indirect, and informal care costs. ObjectiveThis study presents a protocol developed to evaluate the feasibility and efficacy of a patient-centered care (PCC) model for children with DMD. The care model was designed with the aim to empower families, improve QoL, and reduce economic burden on their families. MethodsThis study is planned as a quasi-experimental study that will enroll 70 consecutive families with boys (aged 5-15 years) with DMD visiting a tertiary care center. The study is being conducted in 2 phases (preintervention and postintervention phases, referred to as phase 1 and phase 2, respectively). During phase 1, the patients received routine care. The study is now in phase 2, with the intervention currently being administered. The intervention is based on the PCC model individualized by the intervention team. The model has a comprehensive DMD telecare component that includes teleconsultation as one of its key components to reduce in-person physician visits at the health facility. Teleconsultation is especially beneficial for late-ambulatory and nonambulatory patients. Data on economic burden are being collected for out-of-pocket expenses for both phases during in-person visits via telephone or messaging apps on a monthly basis. QoL data for patients and their primary caregivers are being collected at 3 time points (ie, time of enrollment, end of phase 1, and end of phase 2). Outcome measures are being assessed as changes in economic burden on families and changes in QoL scores. ResultsParticipant recruitment began in July 2021. The study is ongoing and expected to be completed by March 2023. The findings based on baseline data are expected to be submitted for publication in 2023. ConclusionsThis paper outlines a research proposal developed to study the impact of a PCC model for patients with DMD in low- and middle-income countries (LMICs). This study is expected to provide evidence of whether a multicomponent, patient-centric intervention could reduce economic burdens on families and improve their QoL. The results of this study could guide policy makers and health professionals in India and other LMICs to facilitate a comprehensive care program for patients living with DMD. The economic impact of a rare disease is an important consideration to formulate or evaluate any health policy or intervention related to new treatments and financial support schemes. Trial RegistrationClinical Trials Registry India (ICMR-NIMS) CTRI/2021/06/034274; https://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=56650 International Registered Report Identifier (IRRID)PRR1-10.2196/42491

BackgroundDue to the COVID-19 pandemic, physical meetings and continuing medical education (CMEs) are being conducted in virtual mode. Digital sobriety has been advocated as a strategy for controlling the environmental emission from online events. The present study was undertaken to assess the impact of virtual CMEs on the environment and the participants' perception, knowledge, attitude, and practices of digital sobriety during the CMEs.MethodsA retrospective cross-sectional Google form-based online study was conducted among the 1,311 registrants of 23 virtual CMEs hosted in India. A pre-tested English questionnaire was used to collect the data. The potential carbon footprint of the significant physical CME activities and the carbon emission (CE) of the virtual CMEs were estimated. Among the registrants contacted, 251 consented and participated in the study.ResultsThe CE of the virtual CMEs was 0.787 metric tons of carbon dioxide equivalent (MT CO2 Eq). If the CMEs were conducted physically, the potential CE was estimated to be 290.094 MT CO2 Eq. The awareness rate of digital sobriety was 35%. Most of the participants (58.7%) from the current study preferred the hybrid mode of CMEs.ConclusionsVirtual, digitally sober CMEs have reduced the potential CE by 99.7% compared to physical CMEs in India. The awareness and knowledge about digital sobriety is low in India. Knowledge, networking, social interactions, and overall satisfaction were relatively lower in the virtual mode of CMEs than in the physical mode.

Micronutrient iron (Fe) deficiency poses a widespread agricultural challenge with global implications. Fe deficiency affects plant growth and immune function, leading to reduced yields and contributing to the global “hidden hunger.” While conventional Fe-based fertilizers are available, their efficacy is limited under certain conditions. Most recently, nanofertilizers have been shown as promising alternatives to conventional fertilizers. In this study, three nanohematite/nanoferrihydrite preparations (NHs) with different coatings were applied through the roots and shoots to Fe-deficient cucumber plants. To enhance Fe mobilization to leaves during foliar treatment, the plants were pre-treated with various acids (citric acid, ascorbic acid, and glycine) at a concentration of 0.5 mM. Multiple physiological parameters were examined, revealing that both root and foliar treatments resulted in improved chlorophyll content, biomass, photosynthetic parameters, and reduced ferric chelate reductase activity. The plants also significantly accumulated Fe in their developing leaves and its distribution after NHs treatment, detected by X-ray fluorescence mapping, implied long-distance mobilization in their veins. These findings suggest that the applied NHs effectively mitigated Fe deficiency in cucumber plants through both modes of application, highlighting their potential as nanofertilizers on a larger scale.

Background: Nurse led noncommunicable diseases (NCD) clinic may address the significant shortage of human resource for health for managing common NCDs. The objective of this study is to assess the feasibility and effectiveness of nurse-led NCD clinic for identification, prevention, and management of common NCDs. Materials and Methods: A quasi experimental study was conducted at a Public Health Dispensary in periurban community of Northern India. Situational analysis and stakeholders' interview were done based on which the clinic was setup and run over a period of 2 months by registered nurses and nursing students to offer screening, health education and appropriate referral. The primary outcome of study was proportion of population screened, prevalence of common NCDs, risk factors modification, medication adherence, and patient satisfaction. Results: It was feasible to run a nurse led clinic in terms of availability of space, equipment to run the clinic and human resource. A total of 455 individuals aged ≥30 years were enrolled using the total enumeration sampling technique. There was a significant increase in screening rates from 0.29% to 3.7% in nurse-led NCD clinic. There was significant mean change in systolic blood pressure (18.75 ± 6.92 mm Hg), diastolic blood pressure (4.4 ± 3.71 mm Hg), random blood sugar (33.36 ± 38.49 mg/dl) Body Mass Index, and waist circumference (P < 0.01) among the population screened. Medication adherence significantly increased from 7.8% to 76.4% (P < 0.01) after 2 months of nurse-led NCD clinic. Conclusion: Task sharing for managing common NCDs in nurse-led NCD clinic was feasible and effective in increasing screening rates, medication adherence, and risk factors modification among studied population.

Background: Food Safety and Standards Authority of India, established under the Food Safety and Standards Act, 2006, is mandated with disseminating evidence-based standards, regulating the manufacture, storage, distribution, sale, and import of street food, for ensuring the availability of safe and wholesome food for human consumption and matters connected in addition to that or incidental to that. Hence, this study was conducted to ascertain the conformance of the design of street food vendor's carts to the prescribed standards. Methods: We conducted a cross-sectional study in Chandigarh between July 2017 and March 2018 among 400 street food vendors. The primary dependent variable of the study was conformance. The carts were evaluated for their conformance to the standard recommended design based upon a checklist designed using the guidelines of Food Safety and Standards Regulations, 2011. Results: Almost half of the respondents had an experience of 6–15 years (48.5%) and were earning between Rs. 500 and 1000/day (56.3%). The majority of them (95%) were migrants from other states. Only 26.3% were using mobile vending sites. On regression analysis, better cart score was predicted by age, education, increasing experience, higher income, when food was prepared at home only, and with assistance in the form of helpers. Conclusions: This study indicates that although the policy was formulated 8 years back, the standards of street food carts were still below par in Chandigarh. The government should give technical specifications and ensure uniformity at the national level.

Potassium (K+) is an essential macronutrient for plant growth and development. K+ deficiency hampers important plant processes, such as enzyme activation, protein synthesis, photosynthesis and stomata movement. Molecular mechanism of K+ deficiency tolerance has been partly understood in model plants Arabidopsis, but its knowledge in legume crop chickpea is missing. Here, morphophysiological analysis revealed that among five high yielding desi chickpea cultivars, PUSA362 shows stunted plant growth, reduced primary root growth and low K+ content under K+ deficiency. In contrast, PUSA372 had negligible effect on these parameters suggesting that PUSA362 is K+ deficiency sensitive and PUSA372 is a K+ deficiency tolerant chickpea cultivar. RNA-seq based transcriptome analysis under K+ deficiency revealed a total of 820 differential expressed genes (DEG’s) in PUSA362 and 682 DEGs in PUSA372. These DEGs belongs to different functional categories, such as plant metabolism, signal transduction components, transcription factors, ion/nutrient transporters, phytohormone biosynthesis and signalling, and root growth and development. RNA-seq expression of randomly selected 16 DEGs was validated by RT-qPCR. Out of 16 genes, 13 showed expression pattern similar to RNA-seq expression, that verified the RNA-seq expression data. Total 258 and 159 genes were exclusively up-regulated, and 386 and 347 genes were down-regulated, respectively in PUSA362 and PUSA372. 14 DEGs showed contrasting expression pattern as they were up-regulated in PUSA362 and down-regulated in PUSA372. These include somatic embryogenesis receptor-like kinase 1, thaumatin-like protein, ferric reduction oxidase 2 and transcription factor bHLH93. Nine genes which were down-regulated in PUSA362 found to be up-regulated in PUSA372, including glutathione S-transferase like, putative calmodulin-like 19, high affinity nitrate transporter 2.4 and ERF17-like protein. Some important carbohydrate metabolism related genes, like fructose-1,6-bisphosphatase and sucrose synthase, and root growth related Expansin gene were exclusively down-regulated, while an ethylene biosynthesis gene 1-aminocyclopropane-1-carboxylate oxidase 1 (ACO1) was up-regulated in PUSA362. Interplay of these and several other genes related to hormones (auxin, cytokinin, GA etc.), signal transduction components (like CBLs and CIPKs), ion transporters and transcription factors might underlie the contrasting response of two chickpea cultivars to K+ deficiency. In future, some of these key genes will be utilized in genetic engineering and breeding programs for developing chickpea cultivars with improved K+ use efficiency (KUE) and K+ deficiency tolerance traits.

Spin-polarized density-functional theory (DFT) has been employed to study the effects of atmospheric gases on the electronic and magnetic properties of a defective transition-metal dichalcogenide (TMD) monolayer, MoX2 with X = S or Se. This study focuses on three single vacancies: (i) molybdenum “VMo”; (ii) chalcogenide “VX”; and (iii) di-chalcogenide “VX2”. Five different samples of sizes ranging from 4 × 4 to 8 × 8 primitive cells (PCs) were considered in order to assess the effect of vacancy–vacancy interaction. The results showed that all defected samples were paramagnetic semiconductors, except in the case of VMo in MoSe2, which yielded a magnetic moment of 3.99 μB that was independent of the sample size. Moreover, the samples of MoSe2 with VMo and sizes of 4 × 4 and 5 × 5 PCs exhibited half-metallicity, where the spin-up state becomes conductive and is predominantly composed of dxy and dz2 orbital mixing attributed to Mo atoms located in the neighborhood of VMo. The requirement for the establishment of half-metallicity is confirmed to be the provision of ferromagnetic-coupling (FMC) interactions between localized magnetic moments (such as VMo). The critical distance for the existence of FMC is estimated to be dc≅ 16 Å, which allows small sample sizes in MoSe2 to exhibit half-metallicity while the FMC represents the ground state. The adsorption of atmospheric gases (H2O, O2, O3) can drastically change the electronic and magnetic properties, for instance, it can demolish the half-metallicity characteristics. Hence, the maintenance of half-metallicity requires keeping the samples isolated from the atmosphere. We benchmarked our theoretical results with the available data in the literature throughout our study. The conditions that govern the appearance/disappearance of half-metallicity are of great relevance for spintronic device applications.

Illicit drug use and gambling are global problem, and multiple stakeholders are involved in it. This often leads to devastating physical, mental, and socioeconomic consequences for the family. In this case study, we describe our experience with an urban poor family from north India that was disintegrated by illicit drug and gambling use by one of its members. In this case, the family and school failed to recognize and act on the early warning signs of drug addiction and gambling. Health system failed to retain and follow him up. Law enforcement was also inadequate. It was a multisystem failure. For managing an illicit drug use case, we have also to address the cultural and social complexities that are part of the poverty subculture. Adequate involvement of multiple sectors and optimal follow-up can not only help the patient but also it prevents the collateral damage to a large extent in the affected families.

Recent advancements in artificial intelligence (AI) technologies have shown promising success in optimizing health-care processes and improvising health services research and practice leading to better health outcomes. However, the role of public health ethics in the era of AI is not widely evaluated. This article aims to describe the responsible approach to AI design, development, and use from a public health perspective. This responsible approach should focus on the collective well-being of humankind and incorporate ethical principles and societal values. Such approaches are important because AI concerns and impacts the health and well-being of all of us collectively. Rather than limiting such discourses at the individual level, ethical considerations regarding AI systems should be analyzed enlarge, considering the complex socio-technological reality around the world.

Introduction: Pregnancy brings about many changes in mothers' body which continue even after the baby is born. After a vaginal delivery, taking good care of the mother is an essential part of postpartum care and to maintain overall fitness. Objective: The purpose of this research was to evaluate the effect of a physiotherapeutic intervention to improve the maternity fitness of Indian women. Methodology: It was a three-group RCT (randomized controlled trial). The target population consisted of women in ante and postnatal stage, 50 participants (58 were included in the end) in each group, randomly selected from Obstetrics and Gynecology OPD of a tertiary care hospital in North India. The study was carried out in the department of PRM (Physiotherapy). A total of 174 participants was included in the study and was divided into three groups, two intervention groups, and one control group. The target population consisted of women in ante and postnatal stage, randomly selected from ANC (Antenatal clinic) and PNC (Post-natal clinic). The study was conducted over a period of 4 years (2014–2018). They were advised to do exercise, postural correction, regular walking, and electrotherapy modalities and six follow-ups throughout their pregnancy. Outcome measures like (Visual Analogue Scale = VAS): Low and upper back pain relief (n = 158), Leg cramps (n = 41), Coccyx pain (n = 36), Sacro-iliac joint pain (n = 26) was considered. Results: The impact of the intervention package on both ante-natal and post-natal women with fitness-related health problems showed significant improvement. Conclusion: Pain, leg cramp and heaviness in the lower limb, coccyx pain, etc., during pregnancy are common complaints that start early in pregnancy and may persist throughout life if treatment does not start early in the pregnancy.

Virtual conferences are environment-friendly alternatives to physical conferences. COVID-19 pandemic has increased the use of virtual conferences. However, they are not without their share of impact on the environment. We assessed the carbon emissions (CE) of a three day national public health conference with 1474 attendees held in virtual mode and the potential CE saved compared to the physical mode. The CE of the virtual conference were estimated to be 6.44 Metric Tonne (MT) carbon dioxide (CO 2 ) Equivalent (Eq). Potential CE that would have resulted from the physical mode of the conference were 355.85 MT CO 2 Eq which is 55 times higher than the virtual mode. The live video streaming of the proceedings was the highest contributor to the virtual conference’s overall CE (81.5%). A digitally sober conference would have emitted 1.27 MT CO 2 Eq, translating to a CE reduction of 80.3% from the estimated virtual conference emission. Academic conferences should strive to become carbon neutral by adopting the virtual mode of conferencing, and within that, digital sobriety should be the policy of action. Policies to motivate the adoption of virtual conferencing and digital sobriety need to be undertaken at the organizational and individual levels.

Calcium-dependent protein kinases (CDPKs) are a major group of calcium (Ca2+) sensors in plants. CDPKs play a dual function of “Ca2+ sensor and responder.” These sensors decode the “Ca2+ signatures” generated in response to adverse growth conditions such as drought, salinity, and cold and developmental processes. However, knowledge of the CDPK family in the legume crop chickpea is missing. Here, we have identified a total of 22 CDPK genes in the chickpea genome. The phylogenetic analysis of the chickpea CDPK family with other plants revealed their evolutionary conservation. Protein homology modeling described the three-dimensional structure of chickpea CDPKs. Defined arrangements of α-helix, β-strands, and transmembrane-helix represent important structures like kinase domain, inhibitory junction domain, N and C-lobes of EF-hand motifs. Subcellular localization analysis revealed that CaCDPK proteins are localized mainly at the cytoplasm and in the nucleus. Most of the CaCDPK promoters had abiotic stress and development-related cis-regulatory elements, suggesting the functional role of CaCDPKs in abiotic stress and development-related signaling. RNA sequencing (RNA-seq) expression analysis indicated the role of the CaCDPK family in various developmental stages, including vegetative, reproductive development, senescence stages, and during seed stages of early embryogenesis, late embryogenesis, mid and late seed maturity. The real-time quantitative PCR (qRT-PCR) analysis revealed that several CaCDPK genes are specifically as well as commonly induced by drought, salt, and Abscisic acid (ABA). Overall, these findings indicate that the CDPK family is probably involved in abiotic stress responses and development in chickpeas. This study provides crucial information on the CDPK family that will be utilized in generating abiotic stress-tolerant and high-yielding chickpea varieties.

Varietal development plays a crucial role in improving the overall yield of a crop and the impact assessment of a particular variety is essential to support this statement. Present study was carried out in North-Western Indo-Gangetic Plains (Punjab, Haryana and Western Uttar Pradesh) in India during 2017–18 to observe the response on the yield with the adoption of newly developed yellow rust resistant wheat variety HD 3086. The Structural Equation Model (SEM) was used to establish a relationship between the rate of adoption and factors affecting the same. Households (1000) were surveyed through random sampling for the study. Punjab was found to have the highest adoption rate amongst the 3 states followed by Haryana. This study has observed an increasing trend in coverage of farm area under HD 3086 in Punjab and Haryana. However, in Uttar Pradesh creating awareness among the seed companies and Krishi Vigyan Kendra (KVK) centres was found imperative for the multiplication of HD 3086.

Health systems in low- and middle-income countries like India continue to struggle with the overwhelming burden of noncommunicable diseases (NCDs) alongside the coexistence of multiple medical conditions. Such cases are challenging to diagnose and treat, especially in places where electronic health records are not readily available. In such contexts, using colour coding system for recording health conditions may ensure optimal documentation, effective patient-provider communication, adherence to treatment and follow up, quality of health services, and an overall improvement in health systems performance for NCDs. Colour coding is a common tool used in several service industries including public health programmes locally and globally. Despite such promising aspects, colour coding is not widely used for NCDs in health services organizations, which necessitates a translation of evidence from other sectors and the adoption of innovative and evidence-based approaches to promote the use of colour coding for better addressing NCD epidemic.

Introduction: Virtual clinic is a new concept in India. This summary describes that how a virtual clinic is transforming the healthcare scenario in rural India. Virtual clinic is based on a social business model, which may involve diverse stakeholders to promote primary care. Aim: This virtual e-clinic aims to expand health outreach in rural and hard-to-reach areas of India and provide primary health care services by connecting local practitioners and health workers visiting patients with qualified allopathic doctors in city through video conferencing technologies. Methodology: This was a cross-sectional study evaluating the feasibility and acceptance of virtual primary care. A convenient sampling method was used. Data on demographic profiles, morbidity patterns, and referrals were collected with proper consent. This virtual clinic comprises of smartphones, monitors, and assistive devices so that patient can interact with the doctors through video-conferencing and can have authenticated prescriptions with standardized protocols. The private organization who initiated the virtual care program had two centers at the beginning and gradually expanded them to 20 in Uttar Pradesh. Consultations charges were kept minimum to no-profit, no-loss. Data were collected from January 2019 to June 2010. Results: Total number of consultations made was 800. Out of 800 patients, 157 patients belonged to age group of ≥60 years. Mean age the patient was 56 ± 1.56 years, among them 421 (52.62%) were male. The participants actively engaged in clinical interactions and completed full sessions of consultations, which highlight the acceptability of the virtual care system and feasibility of effective patient-provider communication and service delivery using digital technologies. Conclusion: The concept of virtual primary care is becoming very popular in rural region where no qualified doctors are available. The initial results of this technological startup appears to be promising; however, it is necessary to evaluate the quality of care, health outcomes, potentials to integrate such innovations in existing primary care, and the legal as well as ethical issues in the future research.

In India, the number of people with disabilities is continuously growing over the past few decades. The figure is expected to increase due to population aging, with a resultant increase in chronic health conditions. The health of people with disabilities is a relatively neglected and ignored area. Further, the disabled face poor access to healthcare and frequently encounter discrimination or stigmatization. These situations make them more vulnerable to many comorbidities in their health, making severe compromises in their quality of life. Therefore, people with disabilities need special healthcare than people without disabilities. There is a need for sensitization of all health-care providers to ensure quality, affordable, and accessible health-care services for people with disabilities. To address the health-care needs of people with disabilities to the maximum, Ministry of Health, Government of India should incorporate appropriate guidelines in various national health programs and work together with a relevant ministry.

In the changing global socio-economic and epidemiological landscapes, non communicable diseases (NCDs) are affecting the health and wellbeing of populations. The burden is worse among people in low- and middle-income countries with more than 32 million deaths attributable to NCDs each year. This scenario can be explained through the concept of collateral damage, where intentional actions often lead to adverse consequences alongside the primary outcomes. Thus, NCDs can be viewed as collateral damage of unplanned urbanization, rapid globalization, fast pace of life etc., In addition, a lack of appropriate public health approaches has aggravated the situation. It is essential to build a collaborative approach engaging public health agencies to ensure that the developmental initiatives are without the threat of collateral damages and are people-friendly. This will help in reducing the burden of NCDs in primary care settings.

Preserving health requires a holistic approach involving the component of physical, mental, social, and spiritual well-being as stated by World Health Organisation. Salutogenesis concept focuses on the factors responsible for well-being rather than the disease pathogenesis in contrary to pathogenesis concept. This evidence-based summary tries to shed a light on existing concept called salutogenesis which is much required in the current scenario.

Diffusion of Innovation expedites the health promotion through enhancement in behaviour changes. If the natural course is uninterrupted the DOI theory follows the normal curve but if dissemination component is supplemented with this, it can bring about change in the normal curve with faster adoption rate by the society. This new way of adoption will not only benefit the adopters but guide public health experts, policy makers and implementers amidst pandemic crises like COVID-19. Thus, the theory of dissemination should be clubbed with DOI theory for formulating any health policy for any country.

BACKGROUND: Knee osteoarthritis (KOA) patients seek improvement in their quality of life by attaining independence in activities of daily living. Literature recommends nonpharmacological intervention as first-line treatment for KOA. The study aims to ascertain the effectiveness of online supervised nonpharmacological intervention sessions of virtual knee school (eKS) training among mild and moderate KOA patients in comparison to routine care during COVID-19 pandemic and assessment of cost-effectiveness of eKS against the routine care for KOA patients during COVID-19 pandemic.MATERIALS AND METHODS: A quasi-experimental pre-post with control group, enrolling 50 participants each in two groups: usual/routine KOA care or usual care plus KS interventions via virtual mode. Our primary outcome measures are pain, quality of life, and incremental cost-effectiveness ratio. Secondary outcomes include performance-based tests (30-second chair test, timed up and go test, 6-minute walk test) and patient satisfaction. Intervention fidelity will be assessed with a priori checklist tailored to eKS assessing adherence, dose, quality, and user engagement in the key components. Quantitative data collection will be conducted at baseline and 6 months. Descriptive data analysis will be carried for quantitative data. For qualitative data, the thematic analysis will be performed; we propose to undertake a deterministic and probabilistic sensitivity analysis to address the issue of uncertainty in the present cost-effectiveness analysis model.CONCLUSION: The management of KOA through virtual mode emphasizes the concepts of patient-as-person, family-centered, with socially interactive approach. The study will provide information on the effectiveness of nonpharmacological interventions for improving the quality of life of patients suffering from KOA through virtual knee school. Nevertheless, pitfalls in running eKS will be noted, which will help improve all aspects of online medical communications in the future.

BACKGROUND: Polycystic ovarian syndrome (PCOS) has now become a common problem among adolescent girls and young women in India. However, little is known about the treatment and satisfaction incurred from it. Our study aimed to assess the treatment-seeking behaviour among patients with PCOS. MATERIALS AND METHODS: The cross-sectional study was carried out in gynecology OPD of PGIMER, Chandigarh. Women with PCOS, 275, visiting the gynecology OPD were included. The treatment-seeking behavior for PCOS was elucidated among cases using a questionnaire. This included parameters like healthcare consulted, preferred system of medicine, referral pattern, treatment efficacy, and expenses incurred. Univariate descriptive analysis was used to present the results. RESULTS: The majority (68%) of the study participants were less than 25 years of age. The average weight was 66.78 (±13.0) Kg. Half of the participants were students. More than 70% belonged to the upper or upper-middle class. The study participants were diagnosed with PCOS at an average age of 21.4 (±4.7) years. The minimum age reported at diagnosis was 11 years, and the maximum age of diagnosis was 36 years. Most respondents preferred Allopathic treatment followed by homeopathy and Ayurveda. Few also opted for other treatment choices like diet therapy, yoga & meditation, weight loss supplements, and home remedies. Treatment efficacy ranged between 17.3%-34.2%. The majority of respondents reported the treatment to be moderately expensive. Most respondents (58.91%) were hardly influenced, while 16% were quite influenced by PCOS medicine or treatment advertisements. CONCLUSION: PCOS patients opt for different treatment options but generally find the treatment less effective and expensive.

BACKGROUND: Polycystic ovarian syndrome (PCOS) is a complex and heterogeneous disorder affecting various body organs. Menstrual irregularity, anovulation, and many cosmetic issues faced by PCOS patients endanger the essence of being a woman and may have a deleterious impact on their health-related quality of life (HRQOL). This study aimed to assess HRQOL in patients with PCOS and to identify the clinical and socio-demographic factors that might predict poor HRQOL. MATERIALS AND METHODS: This cross-sectional study was carried out in the tertiary care hospital in India. A total of 275 women visiting the same setting and diagnosed with PCOS were included. The participants' quality of life was studied using a disease-specific HRQOL questionnaire. Information regarding clinical and socio-demographics was collected using the interviewer schedule. For evaluating the predictors of HRQOL in PCOS subjects, analysis of variance and independent t-test was applied. For subgroup analysis, the post hoc (Gabriel) test was applied. RESULTS: The average total score of HRQOL of the study participants was 125.41 ± 29.1. The lowest weighted mean score was for menstrual problems. Among the socio-demographic variables, age and educational level influenced the HRQOL scores. Highly educated women reported the poorest HRQOL. The analysis of variance also indicated a significant variation in HRQOL scores among body mass index categories [F (4,270) = 5.09, P =

Background: In the era of new normal life (after Coronavirus Disease 2019 (COVID-19)), our children are experiencing the double threat of COVID-19 and Childhood Obesity (CO-BESITY). The rate of childhood obesity has been rapidly increasing in developed as well as low middle-income countries during the pandemic. Design and Methods: The current paper aims to identify the probable reasons of increase in childhood obesity during this pandemic and offers suggestions to reduce the burden of it. Literature search was done using PubMed, Google Scholar, and Scopus databases for the key terms “childhood obesity,” “obesity,” “pandemic,” and/or childhood obesity. All the relevant articles were included to support the argument for this viewpoint. Results: Childhood obesity is a complicated disorder having diverse outcomes. The incidence of childhood obesity is clearly analysed from Bronfenbrenner's model of child development. The model examines an overabundance of bio-psycho-social backgrounds, risks, and probable outcomes on the development of a child. COVID-19 pandemic has disrupted the ecosystem of this dynamic model and has created an economic and social-cultural crisis that has ignited a chain reaction of stressors upon children and their families. In this paper, we have described how this Bronfenbrenner's model of child development also known as the Bioecological Model can be effective for the estimation and prevention of childhood obesity. Conclusion: We propose that this Bioecological Model will help the children and their families further to understand and manage the problem of childhood obesity during this pandemic on their own.

Background and Aims: Diabetic retinopathy is the most common diabetes-associated microvascular complication and is among the leading causes of vision loss or blindness in the adult population. The present study is a retrospective study that reported the natural history of diabetic retinopathy.Methods: Retrospective medical records of 170 patients aged > 20 years with a confirmed complication of diabetic retinopathy were recruited into the present study. A questionnaire was also sent to each subject for gathering their experiences, and verification was done by the attending medical physicians. The questionnaire was answered by all recruited patients.Results: The results showed that 23 (13.5%) subjects have a family history of diabetic retinopathy with 10 (5.9%) having mild NPDR, 63 (37.1%) with moderate NPDR, 60 (25.3%) have severe NPDR while 37 (21.8%) have PDR complications. The presence of co-morbidities was found in 139 (81.8%) subjects. Patients with PDR reported a significantly longer duration of diabetes mellitus with worse glycemic control.Conclusions: The study revealed and concluded that adherence to the prescribed management regimen is important, for which patient education was the key which was lacking.

Understanding the demographic and clinical characteristics cases and deaths is essential for better clinical and public health management of coronavirus disease-2019 (COVID-19) in resource-limited settings. We analyzed the COVID-19 deaths reported from India, to describe the demographic and clinical characteristics and identify the factors associated with early hospital deaths (within one day of hospitalization) and survival duration. We conducted a record review of the publicly available data on COVID-19 deaths reported between January 30th and November 30th, 2020. After imputation for missing data, we calculated unadjusted and adjusted prevalence ratio, and regression coefficient for factors associated with early hospital death and survival duration. Of the 20,641 COVID-19 deaths analyzed, a) 14,684 (71.1%) were males; b) 10,134 (50.9%) were aged < 65 years; c) 9,722 (47.1%) treated at public hospitals and d) 5405 (27.1%) were early hospital deaths. Breathlessness was the most common presenting complaint. Diabetes (11,075,53.7%), hypertension (95,77,46.5%) and coronary artery disease (2,821,13.7%) were the common comorbidities. After adjustment, early hospital death was significantly higher among patients aged 10% of India's COVID-19 deaths, providing essential information regarding the COVID-19 epidemiology. The characteristics associated with early hospital death and survival duration among the COVID-19 fatalities may be deliberated as markers for prognosis and compared with survivors.

Hepatitis B virus (HBV) infection is a global health concern, and it is considered one of the deadliest infections in the world, having nearly 1.2 million deaths annually. Around 75% of all global HBV carriers live in the Asia-Pacific region. In this regard, India has a prevalence ranging between 2% and 7% with exposure rates of 10%–60%. Hepatitis B is a vaccine-preventable disease. In India, the World Health Organization protocol for hepatitis B vaccination has been followed, and it is given free of cost in public health facilities under the National Immunization Schedule. Despite the free hepatitis vaccination program in India, coverage and awareness are low. Low awareness, followed by low coverage of hepatitis vaccination, can prove dangerous for the Indian population in the long run. A majority of chronic hepatitis cases progress silently to end-stage liver disease without having many signs and symptoms. Once occurred, a complete cure is not possible with currently available drugs. The studies from neighboring countries such as China and Taiwan documented that the impact of single-dose booster for children of 10 years has made a significant difference from the cost-effectiveness perspective. They have also included the booster dose in their national vaccination program. Considering the low level of vaccination awareness, small coverage, high disease burden, and high treatment cost, now, it is high time for India to introduce hepatitis B booster vaccine.

“Texting neck” or “iNeck pain” syndrome is emerging as a public health threat globally because of our adjustment to a NEW NORMAL existence (work-from-home culture) because of the COVID-19 pandemic. This term coined by Dr. Dean L. Fishman, “text neck,” refers to overuse syndrome or a repetitive stress injury, in which we have our head hung forward and down looking at our cellular electronic device for prolonged durations. In our normal anatomical position, neck muscle groups are designed to endure the load of our head, which is about 10–12 pounds and when we bend our head ahead for an inch, we double the weight on these neck muscle groups. The signs and symptoms vary from continual nagging ache to muscle fatigue and limited variety of neck movements. For handling “Texting neck” or “iNeck ache” syndrome, nonpharmacological and pharmacological treatment alternatives are available. The burden of neck pain is already high in countries such as Norway, Finland, and Denmark. It is emerging as a public health problem in other countries also, thanks to work-from-home culture in the COVID-19 era. Few studies have revealed that the awareness for texting neck is poor among poor countries, and increasing population awareness about the risk factors and preventive measures for neck pain is the only way to tackle this emerging threat.

Introduction: A complete Anterior Cruciate Ligament (ACL) injury can result in a progressively increasing symptomatic knee instability, which can cause recurrent intra articular damage and eventually results in osteoarthritis if not treated on time. Aim: To analyse the effects of delaying ACL reconstruction beyond a period of 12 weeks and compared the results with cases managed before that time period. Materials and Methods: A prospective cohort study was conducted between July 2017 to October 2019 in Government Medical College, Jammu on two groups of patients divided into early (12 weeks) on the basis of interval between the injury and definitive surgery. ACL reconstruction was done using a quadrupled semitendinosusgracilis graft. A standard rehabilitation protocol was followed and the results were compared. Patients were followed-up till one year postsurgery. Software used for statistical analysis was EpiInfo Version 3.0 and SPSS. Results: A total of 72 patients were included in the study. Forty patients were in the early group and 32 in delayed. Male patients outnumbered the females in both the groups and the incidence of injury was more on the right side. Sports injuries were the most common mode of injury, followed by falls and road traffic accidents in both the groups. The incidence of grade 3/4 medial and Lateral Meniscal (LM) tears was more in the delayed group and the association was statistically significant (p

Whenever any pandemic accelerates, e.g., the corona virus disease 2019 (COVID-19), it is commonly observed that health care systems face tremendous workload in terms of infectious patients seeking testing and care. During such public health emergencies, besides logistics, there is shortage of trained personnel. In this COVID-19 pandemic Government of India is doing its level best for minimizing the impact of COVID-19. Multiple stringent measures are already taken like nationwide lockdown, social distancing, in hospitals-closing of out-patient services, postponement of elective surgeries, creating dedicated COVID-19 treatment hospital, one third of health staff is working on rotation basis and many more, for prevention of COVID-19 and minimizing the impact. Despite of this, the looming communication gap between people living in remote areas and the specialist doctors has always been in the picture. Due to COVID-19, as most of the routine OPDs are closed it is it has become very tough for people specially who have chronic diseases to consult their doctor. In this scenario artificial intelligence enabled Virtual OPD (VOPD) can be boon to the Indian population. The existing problems related to lack of access to OPD care for a major proportion of population can be solved by some extent by virtual OPD care services, in which patients consult with doctors in a virtual platform via mobile phone, computer and other e-devices. It is supposed to offer a number of advantages over traditional medical consultations in terms of convenience and cost. First and foremost, leverage of video consultation is “Therapeutic presence” that it is reassuring for the patients when they see doctor on video. The second advantage is that it helps in diagnostic assessment of the patients. Not only virtual OPDs solve the issues of delays and self-medication. This not only give benefit of availing the service as per the convenience but also provides the utmost medical consultation directly from the expertise. Alongside, the waiting period of minimum 3-4 hours can be reduced by simply audio-video consultations. It becomes easy to generate electronic prescription and can be emailed. However, evidence of clinical outcomes of VOPD is limited in Indian context. Furthermore, if integrated smartly into existing health care systems, VOPD care have the potential to manage the problem caused by the COVID-19 pandemic.

Blockchain technology is a decentralized system of recording data and performing transactions which is increasingly being used across many industries, including healthcare. It has several unique features like the validation of transaction processes, prevention of systems failure from any single point of transaction, and approval of data sharing with optimal security, to name a few. At the hospital level, blockchain technologies are used in the electronic medical records systems, insurance claims, billing management, and so on. Moreover, this technology is helpful to manage logistic and human resources to achieve the quality of care in learning health systems. In many countries, blockchain is being used to promote patient-centered care by sharing patient data for remote monitoring and management. Furthermore, blockchain technology has the potential to strengthen disease surveillance systems in cases of disease outbreaks resulting in local and global health emergencies. In such conditions, blockchain can be used to identify health security concerns, analyze preventive measures, and facilitate decision-making processes to act rapidly and effectively. Despite its limitations, research, and practice based on blockchain technology have shown promises to strengthen health systems around the world with a potential to reduce the global burden of diseases, mortality, morbidity, and economic costs.