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Insurance fraud has been a constant presence in the realm of insurance. However, as strategies and methods for committing insurance fraud have evolved, the frequency and volume of such fraudulent activities have also increased. An example of this is vehicle insurance fraud, which involves collaborating to fabricate false or exaggerated claims related to property damage or personal injuries resulting from an accident. Machine learning techniques seems to be more beneficial and great way to address the fraud in the insurance industry. This paper comprehensively examines existing research through a systematic literature review. This review aims to identify previously attempted approaches and evaluate which machine learning algorithm is best suited for this specific problem. This paper proposes a methodology for identifying fraudulent insurance claims. This approach can significantly improve efficiency and cost savings for insurance companies in handling such cases. The most popular traditional machine learning algorithms used to identify insurance fraud in the auto industry were found to be support vector machine, logistic regression, and random forest.

Abstract Background Pregnancy acts as a cardiovascular stress test. Although many complications resolve following birth, women with hypertensive disorder of pregnancy have an increased risk of developing cardiovascular disease (CVD) long-term. Monitoring postnatal health can reduce this risk but requires better methods to identity high-risk women for timely interventions. Methods Employing a qualitative descriptive study design, focus groups and/or interviews were conducted, separately engaging public contributors and clinical professionals. Diverse participants were recruited through social media convenience sampling. Semi-structured, facilitator-led discussions explored perspectives of current postnatal assessment and attitudes towards linking patient electronic healthcare data to develop digital tools for identifying postpartum women at risk of CVD. Participant perspectives were gathered using post-it notes or a facilitator scribe and analysed thematically. Results From 27 public and seven clinical contributors, five themes regarding postnatal check expectations versus reality were developed, including ‘limited resources’, ‘low maternal health priority’, ‘lack of knowledge’, ‘ineffective systems’ and ‘new mum syndrome’. Despite some concerns, all supported data linkage to identify women postnatally, targeting intervention to those at greater risk of CVD. Participants outlined potential benefits of digitalisation and risk prediction, highlighting design and communication needs for diverse communities. Conclusions Current health system constraints in England contribute to suboptimal postnatal care. Integrating data linkage and improving education on data and digital tools for maternal healthcare shows promise for enhanced monitoring and improved future health. Recognised for streamlining processes and risk prediction, digital tools may enable more person-centred care plans, addressing the gaps in current postnatal care practice.

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

Exposure to pesticides changes the microbial community structure in contaminated agricultural fields. To analyze the changes in the native microbial composition qRT-PCR, a metagenomic study was conducted. The qRT-PCR results exhibited that the uncontaminated soil has a higher copy number of 16S rDNA relative to the soil contaminated with pesticide. Metagenome analysis interprets that uncontaminated soil is enriched with proteobacteria in comparison with pesticide-contaminated soil. However, the presence of Actinobacteria, Firmicutes, and Bacteroides was found to be dominant in the pesticide-spiked soil. Additionally, the presence of new phyla such as Chloroflexi, Planctomycetes, and Verrucomicrobia was noted in the pesticide-spiked soil, while Acidobacteria and Crenarchaeota were observed to be extinct. These findings highlight that exposure to pesticides on soil significantly impacts the biological composition of the soil. The abundance of microbial composition under pesticide stress could be of better use for the treatment of biodegradation and bioremediation of pesticides in contaminated environments.

Introduction: Cancer is an abnormal uncontrolled growth of cells that can lead to death. Despite conventional therapies such as surgery, chemotherapy, radiotherapy, hormonal therapy and immunotherapy, cervical, breast, and colorectal cancer has been increased day by day. Hence, the Hydro-Ethanolic Solution of Urginea indica (Vanapalandu) bulb has taken for in vitro anticancer activity on cancer cell lines. Methods: The human cervical cancer cell HeLa, colon cancer cell HT-29, and breast cancer cell MCF-7 were grown and drugs were tested by the sulforhodamine B method. Results: The average value of the study drug was found 19.1, 22.5, 24.7, and 24.4, while the average value of adriamycin was found − 8.1, −34.4, −37.2, 6.6 in drug concentration of 10 μg/ml, 20 μg/ml, 40 μg/ml, 80 μg/ml, respectively, on cell line HeLa. The average value of the study drug has found were found 1.0, −27.3, −45.5, −52.3 while of adriamycin were found − 12.0, 2.7, 0.5,−3.8,−10.4 in concentrations 10 μg/ml, 20 μg/ml, 40 μg/ml, and 80 μg/ml, respectively, on cell Line HT-29. On cell line, MCF-7 the average value in the study drug was found 7.5, 4.5, 2.9,−8.2 while of adriamycin was found − 1.2, −21.4, −56.9, −53.1 in concentrations of 10 μg/ml, 20 μg/ml, 40 μg/ml, and 80 μg/ml, respectively. Conclusion: The anticancer activity of U. indica bulb extract was found more potential than adriamycin on the human colon cancer cell line.

Background: Across the globe, people are seeking integrative and holistic measures to prevent coronavirus (COVID-19) infection in the form of complementary and alternative medicines (CAM) with or without conventional medicines. This study was done to know the extent of CAM use for COVID-19 prophylaxis and to know beliefs and attitudes of people related to CAM use in India. Methodology: A pretested and prevalidated questionnaire was circulated on social media. Participants, who completed the online form and gave voluntary consent, were included. The questionnaire included demographic details and questions related to CAM use, preferences with reasons, preparations used, perceived role of CAM in prevention, immunity boosting and side effects, sources of information, etc. Results: Out of 514 responses, 495 were analyzed. 47.07% of respondents were males and 52.93% were females. 66.9% were using CAM for COVID-19 prophylaxis. The association between age, gender, and profession with CAM use was statistically significant (P < 0.05). 41.1% reported CAM use in the past. 36.6% of CAM users were taking “Kadha” and 33% were using ayurvedic medicines. Other frequently used CAM preparations were chyavanprash, giloy, tulsi, ginger, pepper, cloves, honey, sudarshanghanvati, arsenic-30, lemon juice, cinnamon, steam inhalation, ashwagandha, swasarivati, coronil, and warm saline water gargles. 46.9% of the CAM users were on self-medication and 52.3% preferred CAM over allopathy. Conclusion: Complementary and alternative medicine utilization for COVID-19 prophylaxis is widespread and self-medication is prevalent. As no specific cure is available in conventional systems, people believe in traditional medicines more than conventional, yet confusion exists. There is a need of increasing awareness regarding side effects, drug–drug interactions, and self-medication.

Introduction This project applies a Learning Healthcare System (LHS) approach to antibiotic prescribing for common infections in primary care. The approach involves iterations of data analysis, feedback to clinicians and implementation of quality improvement activities by the clinicians. The main research question is, can a knowledge support system (KSS) intervention within an LHS implementation improve antibiotic prescribing without increasing the risk of complications?Methods and analysis A pragmatic cluster randomised controlled trial will be conducted, with randomisation of at least 112 general practices in North-West England. General practices participating in the trial will be randomised to the following interventions: periodic practice-level and individual prescriber feedback using dashboards; or the same dashboards plus a KSS. Data from large databases of healthcare records are used to characterise heterogeneity in antibiotic uses, and to calculate risk scores for clinical outcomes and for the effectiveness of different treatment strategies. The results provide the baseline content for the dashboards and KSS. The KSS comprises a display within the electronic health record used during the consultation; the prescriber (general practitioner or allied health professional) will answer standard questions about the patient’s presentation and will then be presented with information (eg, patient’s risk of complications from the infection) to guide decision making. The KSS can generate information sheets for patients, conveyed by the clinicians during consultations. The primary outcome is the practice-level rate of antibiotic prescribing (per 1000 patients) with secondary safety outcomes. The data from practices participating in the trial and the dashboard infrastructure will be held within regional shared care record systems of the National Health Service in the UK.Ethics and dissemination Approved by National Health Service Ethics Committee IRAS 290050. The research results will be published in peer-reviewed journals and also disseminated to participating clinical staff and policy and guideline developers.Trial registration number ISRCTN16230629.

Abstract Background Foot complications occur in conjunction with poorly controlled diabetes. Plantar forefoot ulceration contributes to partial amputation in unstable diabetics, and the risk increases with concomitant neuropathy. Reducing peak plantar forefoot pressure reduces ulcer occurrence and recurrence. Footwear and insoles are used to offload the neuropathic foot, but the success of offloading is dependent on patient adherence. This study aims to determine which design and modification features of footwear and insoles improve forefoot plantar pressure offloading and adherence in people with diabetes and neuropathy. Methods This study, involving a series of N-of-1 trials, included 21 participants who had a history of neuropathic plantar forefoot ulcers. Participants were recruited from two public hospitals and one private podiatry clinic in Sydney, New South Wales, Australia. This trial is non-randomised and unblinded. Participants will be recruited from three sites, including two high-risk foot services and a private podiatry clinic in Sydney, Australia. Mobilemat™ and F-Scan® plantar pressure mapping systems by TekScan® (Boston, USA) will be used to measure barefoot and in-shoe plantar pressures. Participants’ self-reports will be used to quantify the wearing period over a certain period of between 2 and 4 weeks during the trial. Participant preference toward footwear, insole design and quality-of-life-related information will be collected and analysed. The descriptive and inferential statistical analyses will be performed using IBM SPSS Statistics (version 27). And the software NVivo (version 12) will be utilised for the qualitative data analysis. Discussion This is the first trial assessing footwear and insole interventions in people with diabetes by using a series of N-of-1 trials. Reporting self-declared wearing periods and participants’ preferences on footwear style and aesthetics are the important approaches for this trial. Patient-centric device designs are the key to therapeutic outcomes, and this study is designed with that strategy in mind. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000699965p. Registered on June 23, 2020

Introduction: Pleural effusion is a typical extrapulmonary cause of Tuberculosis (TB). The routine culture experiences an absence of affectability. Numerous markers in pleural fluid are assessed to analyze tubercular pleural fluid, yet no one is perfect. We have contemplated Adenosine deaminase (ADA), protein (CRP C - responsive) and Lymphocyte/Neutrophil (L/N) ratio in amalgamation for the determination of pleural effusion of tubercular origin.Material & Methods: All patients presented with pleural effusion were put through thoracentesis and differentiated into transudative and exudative using Light's criteria. Patients with exudative pleural effusion aetiology were further bisected into two groups with a sample size of 30 patients. Group I consisted of patients with tubercular cause, and Group II comprised other than tubercular. ADA, CRP and L/N ratio of these subjects were estimated in pleural fluid. The sensitivity, specificity and predictive values were calculated.Results: The ADA, CRP, and L/N ratio's sensitivity, specificity, positive predictive value, and negative predictive value were, respectively, 83.3%, 90.0%, 89.29%, 84.37%, 76.67%, 90.0%, 88.46%, 79.41%, 96.67%, 43.33%, 63.04%, and 92.86%. The conjunction of ADA and CRP exhibited the highest specificity for pleural effusion caused by Tuberculosis; however, both ADA and CRP showed comparable specificity on their own.Conclusions: Diagnosing tubercular from non-tubercular individuals was made easier with the help of Pleural fluid ADA and CRP. Combining ADA, CRP, and L/N ratio does not offer any significant advantages beyond just combining ADA and CRP.

Background: Vaccination against COVID-19 is necessary to reach herd immunity and essential for mitigating the spread. To establish herd immunity, the immunity generated by natural infection or vaccination must prevent onward transmission, not just clinical disease. However, several studies have shown that achieving herd immunity through natural infection might be difficult. Aims and Objectives: The aim of the study is to enquire about parental acceptability for COVID-19 vaccination for their children, factors affecting acceptability, perceptions for pediatric COVID-19 vaccines. Materials and Methods: We conducted an online questionnaire survey in mode of Google form which was distributed through social media platforms to parents/guardians of children below 17 years of age in months of November and December 2021. The questionnaire had various sections: Socio demographic characteristics, family members and medical history, COVID-19-related history, attitudes toward COVID-19, attitudes toward COVID-19 vaccines, and acceptance of COVID-19 vaccination for their children. Results: The most of the parents (71.77%) were ready to vaccinate their child. Graduated parents were showing maximum acceptance. Variables related to maximum vaccine acceptance include English medium of education, higher income, COVID-19-positive member in family, vaccinated parents/guardians, and vigilant parents/guardians about child COVID vaccination. In case of side effects, 68.05% of responders agreed to follow the professional advice of personal doctor/vaccinator. About 35% of respondents want government to roll out vaccination in a phased manner. About 69% responders are in favor of making hospitals and schools as COVID-19 vaccination center for children. Conclusion: The study found high multifactorial acceptability for pediatric COVID-19 vaccination which should be rolled out in phased manner.

Background: COVID-19 pandemic has remarkable effect not just on physical health, but also on psychological state and overall quality of life (QoL). It affected all the section of community including vulnerable section of pregnant females and children. Aims and Objective: The aim of the study was to assess health-related QoL in recovered COVID-19 positive pregnant females in their extended postpartum period along with insight into prevailing post-COVID symptoms in this population. This was a cross-sectional and questionnaire-based study conducted in Kota, Rajasthan, India. Materials and Methods: This study was conducted on 173 admitted females between March 1, 2021 and June 30, 2021 who were pregnant and contacted COVID-19 infection at any point of their antenatal/intrapartum period. The questionnaire included details related to demographics, symptomatology, hospitalization, oxygen requirement, and ventilator use during the acute disease as well as any symptoms after recovery from acute COVID-19 disease. Patients were contacted during their extended postpartum period and systematically asked about a list of post-COVID-19 symptoms (dyspnea, myalgia, fatigue, anosmia, ageusia, chest pain, cough, mood disturbances, etc.), but they were also free to report any other symptoms that they considered relevant. The health-related QoL was evaluated using the EuroQoL five-dimension five-level questionnaire telephone interview version. In-person interview and telephonic interview methods were arranged for collection of data. Descriptive statistical analysis was done. Results: Among the 173 consented participants, the mean age was 26.3 (±6.6) years, most of them were primiparous (45.66%), admitted with gestational age between 37 and 40 weeks (68.21%), asymptomatic (85.54%) or mildly symptomatic. For symptomatic cases, the most common clinical presentations included fever, cough, and dyspnea. Only 1.16% of symptomatic subjects required ventilator support. For 58.96% patients, hospital stay was less than a week. Mean duration of stay was 5.86 days. However, 87.28% patients required antiviral medications. About 23.70% have various comorbidities among which anemia 7.51% and preeclampsia 6.35% predominated. About 85.55% did not experienced any persistent symptoms after discharge but some of the subjects shown persistent symptoms such as cough, fever, and breathlessness among which persistent cough predominates (7.51%). In relation to post-COVID effects, 82.56% were found asymptomatic while rest 17.44% showed effects such as body ache, insomnia, cough, and loss of taste and smell and depression. Conclusion: COVID-19 pandemic left its sequels both in the form of physical as well as psychological symptoms in extended postpartum period although health-related QoL does not significantly affected by COVID-19 disease during this period.

BackgroundPolypharmacy can be a consequence of overprescribing that is prevalent in older adults with multimorbidity. Polypharmacy can cause adverse reactions and result in hospital admission. This study predicted risks of adverse drug reaction (ADR)-related and emergency hospital admissions by medicine classes.MethodsWe used electronic health record data from general practices of Clinical Practice Research Datalink (CPRD GOLD) and Aurum. Older patients who received at least five medicines were included. Medicines were classified using the British National Formulary sections. Hospital admission cases were propensity-matched to controls by age, sex, and propensity for specific diseases. The matched data were used to develop and validate random forest (RF) models to predict the risk of ADR-related and emergency hospital admissions. Shapley Additive eXplanation (SHAP) values were calculated to explain the predictions.ResultsIn total, 89,235 cases with polypharmacy and hospitalised with an ADR-related admission were matched to 443,497 controls. There were over 112,000 different combinations of the 50 medicine classes most implicated in ADR-related hospital admission in the RF models, with the most important medicine classes being loop diuretics, domperidone and/or metoclopramide, medicines for iron-deficiency anaemias and for hypoplastic/haemolytic/renal anaemias, and sulfonamides and/or trimethoprim. The RF models strongly predicted risks of ADR-related and emergency hospital admission. The observed Odds Ratio in the highest RF decile was 7.16 (95% CI 6.65-7.72) in the validation dataset. The C-statistics for ADR-related hospital admissions were 0.58 for age and sex and 0.66 for RF probabilities.ConclusionsPolypharmacy involves a very large number of different combinations of medicines, with substantial differences in risks of ADR-related and emergency hospital admissions. Although the medicines may not be causally related to increased risks, RF model predictions may be useful in prioritising medication reviews. Simple tools based on few medicine classes may not be effective in identifying high risk patients.

Introduction: Our main aim is to adopt the holistic approach of Ayurveda in the prevention of disease before to treat the cause. Because of changing lifestyle and environmental conditions skin diseases are markedly increased in number. Aims and Objectives: To assess the effect of Ahara (diet) and Vihara (life style) on Kushtha (skin disease) through conceptual study and survey study is applied on clinical grounds. Methods: In the present study, etiological-based survey of 90 patients who visited in the outpatient department and inpatient department of the Department of Agad Tantra (Ayurveda Toxicology) National Institute of Ayurveda was carried out to assess the dietary and habitual lifestyles of people suffering from Kushtha (skin disease). The study was interview-based survey on simple randomized selection of patients. In the present study, an etiology-based survey questionnaire was prepared based on classics to assess dietary and habitual lifestyles of people suffering from skin disease. Results: In the present clinical study, maximum number of patients having mandagni. Aam rasa is produced due to mandagni, which is stated as the prime cause for almost all diseases. Viruddahara, Mithyahara-vihara are perceived as major causative factors in observation during the study. Conclusion: Avoidance of these aetiologies is concluded to be the first step in the direction of control and management of Kushtha (skin disease). As Ahara and its related codes and conducts have been long forgotten by the human being; therefore, this study was undertaken to evaluate and rediscover this ancient science of dietetics in Ayurveda both conceptually and clinically.

Abstract Background Since the World’s population is increasing, it’s critical to boost agricultural productivity to meet the rising demand for food and reduce poverty. Fertilizers are widely used in traditional agricultural methods to improve crop yield, but they have a number of negative environmental consequences such as nutrient losses, decrease fertility and polluted water and air. Researchers have been focusing on alternative crop fertilizers mechanisms to address these issues in recent years and nanobiofertilizers have frequently been suggested. “Nanophos” is a biofertilizer and contains phosphate-solubilising bacteria that solubilises insoluble phosphate and makes it available to the plants for improved growth and productivity as well as maintain soil health. This study evaluated the impact of nanophos on the growth and development of maize plants and its rhizospheric microbial community such as NPK solubilising microbes, soil enzyme activities and soil protein under field condition after 20, 40 and 60 days in randomized block design. Results Maize seeds treated with nanophos showed improvement in germination of seeds, plant height, number of leaves, photosynthetic pigments, total sugar and protein level over control. A higher activity of phenol, flavonoid, antioxidant activities and yield were noticed in nanophos treated plants over control. Positive shift in total bacterial count, nitrogen fixing bacteria, phosphate and potassium solubilizers were observed in the presence of nanophos as compared to control. Soil enzyme activities were significantly (P

With the increase in world population, the demography of humans is estimated to be exceeded and it has become a major challenge to provide an adequate amount of food, feed, and agricultural products majorly in developing countries. The use of chemical fertilizers causes the plant to grow efficiently and rapidly to meet the food demand. The drawbacks of using a higher quantity of chemical or synthetic fertilizers are environmental pollution, persistent changes in the soil ecology, physiochemical composition, decreasing agricultural productivity and cause several health hazards. Climatic factors are responsible for enhancing abiotic stress on crops, resulting in reduced agricultural productivity. There are various types of abiotic and biotic stress factors like soil salinity, drought, wind, improper temperature, heavy metals, waterlogging, and different weeds and phytopathogens like bacteria, viruses, fungi, and nematodes which attack plants, reducing crop productivity and quality. There is a shift toward the use of biofertilizers due to all these facts, which provide nutrition through natural processes like zinc, potassium and phosphorus solubilization, nitrogen fixation, production of hormones, siderophore, various hydrolytic enzymes and protect the plant from different plant pathogens and stress conditions. They provide the nutrition in adequate amount that is sufficient for healthy crop development to fulfill the demand of the increasing population worldwide, eco-friendly and economically convenient. This review will focus on biofertilizers and their mechanisms of action, role in crop productivity and in biotic/abiotic stress tolerance.

Vitamin D signaling via the Vitamin D Receptor (VDR) has been shown to protect against intestinal inflammation. Previous studies have also reported the mutual interactions of intestinal VDR and the microbiome, indicating a potential role of probiotics in modulating VDR expression. In preterm infants, although probiotics have been shown to reduce the incidence of necrotizing enterocolitis (NEC), they are not currently recommended by the FDA due to potential risks in this population. No previous studies have delved into the effect of maternally administered probiotics on intestinal VDR expression in early life. Using an infancy mouse model, we found that young mice exposed to maternally administered probiotics (SPF/LB) maintained higher colonic VDR expression than our unexposed mice (SPF) in the face of a systemic inflammatory stimulus. These findings indicate a potential role for microbiome-modulating therapies in preventing diseases such as NEC through the enhancement of VDR signaling.

Emotional support for patients is critical for achieving person-centered care. However, the literature evidences an ongoing challenge in embedding emotional support within current health services. This study aimed to investigate the strategies to embed emotional support from the perspectives of patients and clinicians. This is an exploratory qualitative study that collected data through focus group discussions (FGDs) and interviews from 11 patients, 2 carers, and 7 clinicians in the multi-disciplinary care teams in an outpatient complex and chronic care setting in New South Wales, Australia. The FGDs and interviews were recorded, transcribed, and thematically analyzed. Three main themes emerged from the experience of both the patients and clinicians: (1) warmth and kindness, (2) deep listening, and (3) social connection in the process of treatment. Clinicians’ and patients’ shared experience of these themes was key to embed emotional support in care. Practical strategies including promoting shared understanding of emotional support, enhancing provider's capability to deliver emotional support, and building patient's networking opportunities in treatment processes were discussed to facilitate emotional support in patient care and health services.

Introduction: Needlestick, Sharp, and Splash Injuries (NSSSIs) are the major occupational hazards for the Healthcare Workers (HCWs) risking them for Blood Borne Viruses (BBVs) such as Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) and are contributed by factors like work stress, inadequate experience and training. Aim: To analyse the baseline data and risk factors for developing NSSSI’s and to establish the recommendations to prevent them in future. Materials and Methods: A retrospective cohort analysis was carried out in a Tertiary Care Centre from January 2016 to December 2019. The data of all the HCWs who voluntarily reported NSSSIs like needlestick injury, sharp injuries from cannulas, broken vials and splash injuries on intact skin and mucous membranes by potentially infectious materials such as blood and other body fluids during the study period was analysed. Data was collected and entered into Microsoft Excel 2007 and percentages were calculated. Results: A total of 202 NSSSI’s were reported (85.14% needlestick injuries, 10.80% sharp injuries and 4% splash injuries). Most injuries of NSSSIs occurred in wards (30.70%), followed by emergency department (14.9%). Females (63.4%) were more affected than males. Doctors (30.2%) and nurses (26.7%) reported the maximum episodes of injuries. Fingers (72.1%) accounted for maximum affected body part during the needlestick and sharp injuries followed by palm (15.9%), while splash injury involved most commonly non intact skin (75%). Hollow needles accounted for maximum (84.3%) of episodes of needlestick injuries whereas most of the other sharp injuries were due to surgical blades (63.63%). Most injuries occurred during the use of device (38.12%) like blood withdrawal, suturing, giving injections, etc. Conclusion: There was significant incidence of NSSSIs among HCWs. However, with continuous efforts of educating the staff; the problem of underreporting has slightly improved especially among the doctors, but there is significant work to do in case of the paramedics and nurses. Thus continuous education, timely reporting, prevention strategies and emphasis on appropriate Biomedical Waste (BMW) disposal are needed to increase occupational safety for HCWs.

Background: Phyllodes tumours of the breast are benign, borderline or malignant fibroepithelial lesions. They are uncommon and usually treated with surgical or radiological excision. The association with local recurrence has led to much debate over the extent of excision margins. It has traditionally followed that clinical surveillance for local recurrence is necessary following surgery. Follow-up is without any nationally agreed protocol and is therefore variable. Methods: After exclusions, 116 cases of benign (n=81), borderline (n=30) and malignant (n=5) phyllodes tumours were identified in a single centre, between 2005 and 2018. These were analysed using a database, electronic patient records and notes-based review. Results: Benign recurrence occurred in six patients with complete excision of benign PTs (7.4%) and one with borderline PT (3.3%). No malignant Phyllodes tumours developed following excision of benign or borderline lesions. Conclusions: This study of 13 years experience with 111 non-malignant Phyllodes tumours provides support for no routine clinical surveillance, but patient education and open access to breast clinic.

Agricultural yield of major crops is low due to the injudicious use of chemical fertilizers that affects soil fertility and biodiversity severely and thereby affecting plant growth. Soil health is regulated by various factors such as physicochemical properties of the soil, availability of micro/macronutrients, soil health indicator enzymes and microbial diversity which are essential for agriculture productivity. Thus, it is required to draw attention towards an eco-friendly approach that protects the beneficial microbial population of soil. Application of different bioinoculants and agriusable nanocompounds has been reported to enhance soil quality with increased nutrient status and beneficial bacterial population, but additive effects of combined treatments on soil microbial population are largely unknown. The present study investigated the impact of nanozeolite and nanochitosan along with two Bacillus spp. on rhizospheric microbial flora and indicator enzymes to signify soil health under field conditions on maize. Soil health was ascertained by evaluating physicochemical analysis; total bacterial counts including N, P, and K solubilizing bacteria; and soil health indicator enzymes like fluorescein diacetate hydrolysis, alkaline phosphatase, β-glucosidase, dehydrogenase, amylase, and arylesterase. Change in copy number of 16S rRNA as a marker gene was used to quantify the bacterial population using quantitative PCR (qPCR) in different treatments. Our study revealed that nanocompounds with Bacillus spp. significantly (p < 0.05) enhanced total microbial count (16.89%), NPK solubilizing bacteria (46%, 41.37%, and 57.14%), and the level of soil health indicator enzymes up to twofold over control after 20, 40, and 60 days of the experiment. qPCR analysis showed a higher copy number of the 16S rRNA gene in treated samples, which also indicates a positive impact on soil bacterial population. This study presents a valuable approach to improve soil quality in combined treatments of nanocompounds and bioinoculants which can be used as a good alternative to chemical fertilizers for sustainable agriculture.

Background and Aims: To evaluate existing knowledge, attitude and perception and compliance of hand hygiene activity among various healthcare workers in a tertiary care centre in Uttarakhand. Methods: A cross sectional study was done for a period of two months. WHO hand hygiene and compliance form with slight modification were used to study knowledge, attitude, perception and compliance (overt and covert) by direct observational technique. Statistical analysis was done using Microsoft Excel 2010 and IBM SPSS 23.0 version software. Results: A total of 220 participants were given questionnaire out of which 172 participated in study. 159 (92.4%) had already received training in HH in the past 3 years and were using alcohol based hand rub routinely. The overall correct knowledge score of various professional categories of HCW was good i.e. 71.6% Most of the healthcare workers knew the importance of adhering to this simple practice in prevention of healthcare associated infections. Most of them were aware of the conditions before or after when HH activity has to be performed. Poor compliance of hand hygiene was noted among healthcare workers on covert observation. For given hand hygiene opportunities the HH was started in 53.2% and 15.7% of overt and covert observations, respectively. However, HH compliance decreased drastically among HCW, which was 15.7% and 1.6% of overt and covert observations, respectively. Interpretation and Conclusions: The acceptance of the fact by most of the HCW that direct vigilance over this activity helped them performed better, suggested the demand of regular surveillance and several other promotional activities in the centre.

Abstract Pulmonary hypertension (PH) is a global health issue with a prevalence of 10% in ages >65 years. Right heart failure (RHF) is the main cause of death in PH. We have previously shown that monocrotaline (MCT)‐induced PH and RHF are due to an increase in oxidative stress. In this study, probucol (PROB), a strong antioxidant with a lipid‐lowering property, versus lovastatin (LOV), a strong lipid‐lowering drug with some antioxidant effects, were evaluated for their effects on the MCT‐induced RHF. Rats were treated (I.P.) with PROB (10 mg/kg ×12) or LOV (4 mg/kg ×12), daily 6 days before and 6 days after a single MCT injection (60 mg/kg). Serial echocardiography was performed and at 4‐week post‐MCT, lung wet‐to‐dry weight, hemodynamics, RV glutathione peroxidase (GSHPx), superoxide dismutase (SOD), catalase, lipid peroxidation, and myocardial as well as plasma lipids were examined. MCT increased RV systolic and diastolic pressures, wall thickness, RV end diastolic diameter, mortality, and decreased ejection fraction as well as pulmonary artery acceleration time. These changes were mitigated by PROB while LOV had no effect. Furthermore, PROB prevented lipid peroxidation, lowered lipids, and increased GSHPx and SOD in RV myocardium. LOV did decrease the lipids but had no effect on antioxidants and lipid peroxidation. A reduction in oxidative stress and not the lipid‐lowering effect of PROB may explain the prevention of MCT‐induced PH, RHF, and mortality. Thus targeting of oxidative stress as an adjuvant therapy is suggested.

Introduction: Growing pressures upon Emergency Departments [ED] call for new ways of working with frequent presenters who, although small in number, place extensive demands on services, to say nothing of the costs and consequences for the patients themselves. EDs are often poorly equipped to address the multi-dimensional nature of patient need and the complex circumstances surrounding repeated presentation. Employing a model of intensive short-term community-based case management, the Checkpoint program sought to improve care coordination for this patient group, thereby reducing their reliance on ED. Method: This study employed a single group interrupted time series design, evaluating patient engagement with the program and year-on-year individual differences in the number of ED visits pre and post enrolment. Associated savings were also estimated. Results: Prior to intervention, there were two dominant modes in the ED presentation trends of patients. One group had a steady pattern with ≥7 presentations in each of the last four years. The other group had an increasing trend in presentations, peaking in the 12 months immediately preceding enrolment. Following the intervention, both groups demonstrated two consecutive year-on-year reductions. By the second year, and from an overall peak of 22.5 presentations per patient per annum, there was a 53% reduction in presentations. This yielded approximate savings of $7100 per patient. Discussion: Efforts to improve care coordination, when combined with proactive case management in the community, can impact positively on ED re-presentation rates, provided they are concerted, sufficiently intensive and embed the principles of integration. Conclusion: The Checkpoint program demonstrated sufficient promise to warrant further exploration of its sustainability. However, health services have yet to determine the ideal organisational structures and funding arrangements to support such initiatives.

Introduction: Patients with Type 2 Diabetes Mellitus (T2DM) are at higher risk to develop depression. Depression in turn adversely affects glycaemic control and increases the risk of diabetes-related complications and mortality. There is a large variation among Indian studies on prevalence of depression in T2DM and associated risk factors. Aim: To assess the prevalence, severity, and determinants of depression among patients with T2DM. Materials and Methods: The study was conducted at a Tertiary Care Hospital during February 2018-February 2019, in North-Indian state of Uttarakhand. Study subjects were patients with T2DM, age >18 years. Based on exclusion and inclusion criterias, a total sample of 290 patients were studied. Presence of depression was assessed using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Hamilton Depression Rating Scale (HAM-D) was used to estimate the severity of depression. Unpaired t-test and Mann-Whitney U test were used to compare continuous variables between subjects with and without depression. Chi-Square test was used to analyse categorical data. Binary logistic regression analysis was used to study the association between likelihood of depression and predictor variables. Results: Among 290 (155 males and 135 females, mean age of all subjects 58.2±11.08 years) study subjects with T2DM, 64 (22.1%) were found to have depression using DSM-5 criteria. Out of these 64 patients with depression, 46 were detected to have mild depression, 14 moderate depression and 4 severe depression using HAM-D scale. Subjects with T2DM and depression had: higher proportion of females (62.5% vs. 42.0%; p-value 0.004); lower literacy level (53.1% vs. 67.3%; p-value 0.037); higher frequency of diabetic retinopathy (85.9% vs. 62.8%; p-value

In the present study we examined the effect of nanogypsum and Pseudomonas taiwanensis strain BCRC 17751on plant and soil health using conventional and metagenomics approaches. Soil physicochemical properties and agronomical parameters of maize plants were reported to be better when applied with nanogypsum and bacterial inoculum together. When compared to control a significant increase in total bacterial counts, nitrogen, phosphorus, potassium (NPK) solubilizing bacterial population and soil enzyme activities (fluorescein diacetate, alkaline phosphatase, dehydrogenase, β-glucosidase, arylesterase and amylase) was reported in treatments. The metagenomics studies revealed dominance of beneficial bacteria such as Proteobacteria, Bacteriodetes, Planctomycetes, Acidobacteria and Nitrospirae in treated soil. On the other hand some novel bacterial diversity was also reported in treated soil which was evident from presence of taxonomically unclassified sequences. Hence, it can be concluded that combined application of nanogypsum and Pseudomonas taiwanensis in maize help in improving the structure and function of soil which affects the plant health without causing any toxic effect. However, in situ validation of the prescribed treatment is required under field conditions on different crops in order to give maximum benefits to the farmers and the environment.

A potential pesticide degrading bacterial isolate (2D), showing maximum tolerance (450 mg∙L-1) for cypermethrin, fipronil, imidacloprid and sulfosulfuron was recovered from a pesticide contaminated agricultural field. The isolate degraded cypermethrin, imidacloprid, fipronil and sulfosulfuron in minimal salt medium with 94, 91, 89 and 86% respectively as revealed by high performance liquid chromatography (HPLC) and gas chromatography (GC) analysis after 15 days of incubation. Presence of cyclobutane, pyrrolidine, chloroacetic acid, formic acid and decyl ester as major intermediate metabolites of cypermethrin biodegradation was observed in gas chromatography mass spectrometry (GC-MS) analysis. Results based on 16S rDNA sequencing, and phylogenetic analysis showed maximum similarity of 2D with Bacillus cereus (Accession ID: MH341691). Stress responsive and catabolic/pesticide degrading proteins were over expressed in the presence of cypermethrin in bacteria. Enzymatic kinetics of laccase was deduced in the test isolate under normal and pesticide stress conditions which suggested that the production of enzyme was induced significantly in pesticide stress (163 μg.μL-1) as compare to normal conditions(29 μg.μL-1) while the Km value was decreased in pesticides stress condition (Km = 10.57 mM) and increases in normal condition (Km = 14.33 mM).Amplification of laccase gene showed a major band of 1200bp. The present study highlights on the potential of 2D bacterial strain i.e., high tolerance level of pesticide, effective biodegradation rate, and presence of laccase gene in bacterial strain 2D, could become a potential biological agent for large-scale treatment of mixture of pesticide (cypermethrin, fipronil, imidacloprid and sulfosulfuron) in natural environment (soil and water).

Background: Information about antimicrobial use is scarce and poorly understood among neonatal intensive care units (NICUs) in India. In this study, we describe antimicrobial use in eight NICUs using four point prevalence surveys (PPSs). Methods: As part of the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children (GARPEC) study, one-day, cross-sectional, hospital-based PPSs were conducted four times between 1 February 2016 and 28 February 2017 in eight NICUs. Using a standardized web-based electronic data entry form, detailed data were collected for babies on antimicrobials. Results: A total of 403 babies were admitted to NICUs across all survey days, and 208 (51.6%) were prescribed one or more antimicrobials. Among 208 babies, 155 (74.5%) were prescribed antimicrobials for treatment of an active infection. Among 155 babies with an active infection, treatment was empiric in 109 (70.3%). Sepsis (108, 49.1%) was the most common reason for prescribing antimicrobials. Amikacin (17%) followed by meropenem (12%) were the two most commonly prescribed antimicrobials. For community-acquired sepsis, piperacillin-tazobactam (17.5%) was the most commonly prescribed drug. A combination of ampicillin and gentamicin was prescribed in only two babies (5%). Conclusions: The recommended first-line antimicrobial agents, ampicillin and gentamicin, were rarely prescribed in Indian NICUs for community acquired neonatal sepsis.

Endocarditis caused by Mycobacterium abscessus is rare and often missed without appropriate blood cultures. It does not respond to standard antitubercular treatment and is also resistant to many other antibiotics. The course of the disease may be indolent and often results in a fatal outcome. Accurate identification and sensitivity, combination therapy, and prolonged duration of antibiotics are, therefore, important for a successful outcome.

Contamination of soil / water resources by petroleum products poses severe threats to underground water and soil quality. In the present study biosurfactant producing bacterial cultures were used to degrade petrol engine oil under in situ conditions in the plant rhizosphere system. Two bacterial isolates used in this study were recovered from Haldia oil refinery site & petrol station of Pantnagar and identified as Pseudomonas aeruginosa (JX100389) and P. plecoglossicida (JX149549). Application of consortium C2, (Pseudomonas aeruginosa and P. plecoglossicida) degraded 56.14 % petrol engine oil @ 2% in the soil planted with wheat (Triticum aestivum var. 2565) crop after 120 days. GC-MS of biodegraded fuel showed the presence of new product like octanoic acid-2-ethylhexyl ester and 1, 2-benzenedicarboxylic acid.

Lyme disease is a multisystem infectious disease caused by the spirochete “Borrelia burgdorferi,” which is transmitted by “Ixodes” tick, with skin being the most common and earliest organ to be affected. Diagnosis of erythema chronicum migrans (ECM), which is the characteristic lesion of early disease, may help in early treatment and prevention of complications. Here, we are reporting a case of Lyme disease in a 10-year-old young boy from a non-endemic zone of Himachal Pradesh, who presented with typical as well as atypical ECM lesions. The clinical diagnosis was confirmed serologically, and the child was treated successfully with doxycycline.

Cypermethrin is popularly used as an insecticide in households and agricultural fields, resulting in serious environmental contamination. Rapid and effective techniques that minimize or remove insecticidal residues from the environment are urgently required. However, the currently available cypermethrin-degrading bacterial strains are suboptimal. We aimed to characterize the kinetics and metabolic pathway of highly efficient cypermethrin-degrading Bacillus thuringiensis strain SG4. Strain SG4 effectively degraded cypermethrin under different conditions. The maximum degradation was observed at 32 °C, pH 7.0, and a shaking speed of 110 rpm, and about 80% of the initial dose of cypermethrin (50 mg·L−1) was degraded in minimal salt medium within 15 days. SG4 cells immobilized with sodium alginate provided a higher degradation rate (85.0%) and lower half-life (t1/2) of 5.3 days compared to the 52.9 days of the control. Bioaugmentation of cypermethrin-contaminated soil slurry with strain SG4 significantly enhanced its biodegradation (83.3%). Analysis of the degradation products led to identification of nine metabolites of cypermethrin, which revealed that cypermethrin could be degraded first by cleavage of its ester bond, followed by degradation of the benzene ring, and subsequent metabolism. A new degradation pathway for cypermethrin was proposed based on analysis of the metabolites. We investigated the active role of B. thuringiensis strain SG4 in cypermethrin degradation under various conditions that could be applied in large-scale pollutant treatment.

BACKGROUND:The prevalence of maternal obesity is rising. Pre-pregnancy obesity is associated with later cardiovascular disease in the child and the underlying pathogenesis begins in early life. Therefore, pregnancy and infancy are key periods for potential intervention. The aim of this study was to study the cardiac function in newborns of obese women compared to newborns of normal-weight women, and to determine if exercise intervention during pregnancy could have an effect on cardiac function of newborns to obese women. MATERIAL AND METHODS:Fifty-five pregnant women, 51 obese (BMI ≥ 30 kg/m2) and four overweight (BMI 28-30 kg/m2), were randomized to an exercise training group (n = 27) or a control group (standard maternity care, n = 28). From gestational week 14 until delivery participants in the intervention group were offered supervised training sessions three times weekly. In addition, they were told to exercise at home once weekly. All newborns had an echocardiogram performed 1-3 days and 6-8 weeks after delivery. The results were compared with newborns of normal weight women (n = 20, standard maternity care). RESULTS:Newborns of obese women had an impaired systolic and diastolic cardiac function with reduced global strain, strain rate, tissue Doppler velocities and a thicker intraventricular septum at birth and after 6-8 weeks after delivery compared to newborns of normal weight women. Exercise had no statistically significant effect on either of the cardiac function parameters. The mean (± standard deviation) adherence to the exercise protocol was 1.3 ± 0.8 sessions per week for supervised training and 0.8 ± 0.7 sessions per week for home-based exercise training. CONCLUSIONS:Newborns of obese women had reduced cardiac function and thicker intraventricular septum compared to newborns of normal weight women. Exercise training during pregnancy had no significant effect, potentially due to a low number of subjects and low adherence to the exercise protocol. TRIAL REGISTRATION:ClinicalTrials.gov NCT01243554.

Introduction: Surgery and anaesthesia provoke anxiety in almost all the patients, causing increased sympathetic activity, leading to increase in heart rate and blood pressure. Non pharmacological means are now being evaluated for relieving anxiety and stress during perioperative period due to their safe and non interfering profile among the multitude pharmacological interventions and music is one of the most practical and easy to use application. Aim: This study was conducted to evaluate the effects of a preoperative music intervention on changes in anxiety levels and its indirect haemodynamic parameters which are mean arterial pressures, heart rate and serum catecholamine levels in patients undergoing surgery. Materials and Methods: A total of 100 patients were included of which 50 each were assigned to the music intervention group and the control group. Serum catecholamine levels were assessed in 10 patients from each group randomly. Patients in the intervention group listened to music during the preoperative period for a minimum period of 20 minutes which was continued till the patient was rolled into the operation theatre. Patients in the control group received standard care without any intervention. Data was collected preoperatively at time 1 (T1) in the pre-surgical area and at time 2 (T2) before induction in the operation theatre and analysed with professional statistical software. Results: There was statistically significant decrease in the HR, MAP and anxiety score (2-tailed significance

Evans syndrome, a complex uncommon disease, poses a great diagnostic dilemma due to its variable presentation. The present case of 26-year-old Indian female faced similar difficulty as it was not diagnosed initially when it presented with thrombocytopenia and was treated by platelet concentrate transfusion and steroids. However, the patient showed repeated episodes of remissions and exacerbations without any substantial improvement and later at a tertiary care center it was diagnosed as Evans′ Syndrome after direct antiglobulin test and relevant investigations to rule out other causes. This case stresses on the importance of direct antiglobulin test in every patient presenting with autoimmune thrombocytopenia to rule out autoimmune hemolytic anemia and thus excluding this syndrome.

Background: Investigation of the potential association of single nucleotide polymorphisms (SNPs) at –308 G/A and –238 G/A of Tumor necrosis factor α (TNFα) with susceptibility to HPV-16 associated cervical cancer in Indian women. Methods: The study included 165 histologically confirmed cases with 45 precancer and 120 cancer patients and an equal number (165) of healthy controls with normal cervical cytology. PCR-RFLP was employed to analyze TNFα promoter polymorphisms, which were confirmed by direct sequencing. Both patients and controls were screened for Human Papillomavirus (HPV) infection. Results: The frequency of –308 A allele in TNFα was significantly higher in cases compared with control subjects (21% in cases vs. 9% in controls; p < 0.01), with an odds ratio of 2.7 (95% CI = 1.41–5.15). Also, women carrying A allele for this locus presented 3 times increased susceptibility to HPV 16 infection as evident from carrier genotype distribution between HPV positive cases and control subjects (24% in HPV positive cases vs. 9% in controls; p < 0.01; OR = 3.1; 95% CI = 1.60–6.03). No such association was found for TNFα–238 (G/A) polymorphism with the risk of development of cervical cancer. Conclusion: It suggests that SNP at –308 (G/A) of TNFα promoter may represent an increased risk for HPV infection and development of cervical cancer in Indian women.

The prevalence of antimicrobial resistance in India is among the highest in the world. Antimicrobial use in inpatient settings is an important driver of resistance, but is poorly characterized, particularly in hospitalized children. In this study, conducted as part of the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children (GARPEC) project, we examined the prevalence of and indications of antimicrobial use, as well as antimicrobial agents used among hospitalized children by conducting four point prevalence surveys in six hospitals between February 2016 and February 2017. A total of 681 children were hospitalized in six hospitals across all survey days, and 419 (61.5%) were prescribed one or more antimicrobials (antibacterials, antivirals, antifungals). Antibacterial agents accounted for 90.8% (547/602) of the total antimicrobial prescriptions, of which third-generation cephalosporins (3GCs) accounted for 38.9% (213/547) and penicillin plus enzyme inhibitor combinations accounted for 14.4% (79/547). Lower respiratory tract infection (LRTI) was the most common indication for prescribing antimicrobials (149 prescriptions; 24.8%). Although national guidelines recommend the use of penicillin and combinations as first-line agents for LRTI, 3GCs were the most commonly prescribed antibacterial agents (55/149 LRTI prescriptions; 36.9%). In conclusion, 61.5% of hospitalized children were on at least one antimicrobial agent, with excessive use of 3GCs. Hence there is an opportunity to limit their inappropriate use.

Diwali-the festival of lights, is celebrated in India, every year during October or November with great fireworks display which contributes to pollution of air. In order to assess the impacts of fireworks on ambient air quality during Diwali festival in Katra town, Jammu , (J&K); monitoring of RSPM, NRSPM, SO2 and NO2 during day and night times for Pre-Diwali (day before Diwali); Diwali and Post-Diwali (day after Diwali) for two successive years i.e. 2011 and 2012 has been carried out in a residential area. The air quality levels observed on Diwali has been compared with the air quality levels observed before and after Diwali which has revealed considerable increase in RSPM, NRSPM, SO2 and NO2 concentration due to Diwali fireworks. On Diwali day, the concentration of RSPM, NRSPM, TSPM, SO2 and NO2 was found to be 118.27µg/m³, 153.2µg/m³, 271.47µg/m3, 6.61µg/m3 and 10.51µg/m3 respectively in 2011 and 141.2µg/m³, 199.14µg/m³, 340.34µg/m³, 7.06µg/m³ and 10.53µg/m³ respectively in 2012.These concentrations were found to be 1.75, 1.57, 1.65, 1.73 and 1.52 times higher in 2011 and 1.86, 2, 2, 1.47 and 1.39 times higher in 2012, when compared with the respective concentrations of normal day. The higher level of these pollutants due to fireworks during Diwali festival poses serious health hazards to the inhabitants of the area.

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The monitoring of ambient air quality of Katra (one of the important town of Jammu from economic as well as religious point of view), at selected locations of residential areas, commercial areas and traffic crossings with respect to particulate matter (both respirable and non-respirable) has been conducted for a period of two years i.e. July 2010 – June 2012. Large variations in ambient particulate matter concentrations have been observed throughout the study period. Seasonally, the particulate matter exhibited low values during monsoon period and high values during post-monsoon period. The concentration of particulates (both respirable and non-respirable) in post monsoon season exceeded the concentrations than that of other seasons at most of the sites, thereby signifying the impact of local factors on pollutant concentrations, besides the impact of meteorological factors. Higher concentrations have been recorded in the year 2011-2012 as compared to 2010-2011 at all the sites except traffic crossings.