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Abstract Background Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological condition which is commonly associated with chronic kidney disease (CKD), hypertensive encephalopathy, eclampsia, and the use of cytotoxic drugs. It can cause vasogenic edema of the brain and is characterized by nausea, vomiting, headache, seizures, visual changes, and other focal neurological deficits. Acute hypertension is a predisposing factor for PRES which can occur in CKD patients due to fluid overload. Uremia in CKD patients is also one of the factors for developing PRES. Neuroimaging findings involve posterior white matter edema commonly affecting the parietal and occipital lobes. However, involvement of a non-posterior distribution, mainly in watershed areas, including within the frontal, inferior temporal, cerebellar, and brainstem regions, has been reported. Case presentation This case report discusses a case of a 27-year-old male with underlying IgA nephropathy, who presented with generalized throbbing headache, along with 1-day history of nausea and vomiting. This was followed by blurring of vision and 2 episodes of abnormal jerky movements of the body on the first day of admission. On examination, he was found to be hypertensive with no focal neurological deficits. Magnetic resonance imaging (MRI) T2/fluid-attenuated inversion recovery (FLAIR) findings showed hyperintense areas on the right frontal periventricular and right parietal and bilateral occipitotemporal lobes which was suggestive of PRES. The patient was treated with antiepileptics and antihypertensives and was started on dialysis following which his condition improved, and he was discharged in stable condition. Conclusion Symptoms of PRES are usually reversible unless cerebral hemorrhage or ischemia has occurred which can result in irreversible neurological deficit or death. Hence, it is crucial to identify and manage PRES promptly. Clinical suspicion and radiological findings aid in early diagnosis. It is also important to be aware of uncommon radiological findings (involvement of the right frontal periventricular area) as in our case.

Abstract: Chimeric antigen receptor (CAR) T-cell therapy has transformed the care of lymphoma, yet many patients relapse. Several prognostic markers have been associated with CAR T-cell outcomes, such as tumor burden, response to bridging chemotherapy, and laboratory parameters at the time of lymphodepletion or infusion. The effect of cancer cachexia and weight loss before CAR T cells on toxicity and outcomes is not well understood. Here, we present a retrospective single-institution cohort study of 259 patients with lymphoma treated with CAR T cells between 2017 and 2023. We observed that patients with >5% decrease in their body mass index in the 3 months preceding CAR T-cell treatment (weight loss group; all meeting one of the commonly accepted definitions of cancer cachexia) had higher disease burden and inflammatory parameters (C-reactive protein, ferritin, interleukin-6, and tumor necrosis factor α) at the time of lymphodepletion and CAR T-cell infusion. Patients with weight loss experienced higher rates of grade 3+ neurotoxicity and early hematotoxicity, but those effects were not seen upon multivariable adjustment. However, in both univariate and multivariable analysis, patients with weight loss had worse response rates, overall survival, and event-free survival, indicating that weight loss is an independent poor prognostic factor. Our data suggest that weight loss in the 3 months preceding CAR T-cell therapy represents a worrisome “alarm signal” and a potentially modifiable factor, alongside tumor burden and inflammation, and warrants further investigation in patients treated with CAR T-cell therapy.

Biting midges (Culicoides spp.) are important vectors of several insect borne arboviruses but are underrepresented in terms of availability of high-resolution genomic resources. We assembled and annotated complete mitochondrial genomes for two Culicoides species, namely C. brevitarsis and C. imicola which are proven vectors for Bluetongue Virus (BTV). We used both long read and short read sequencing technologies to assemble the circular genomes. The genome sizes are 17,100 bp and 17,031 bp, respectively, all comprising 37 genes, including 13 protein, 22 tRNA, two rRNA coding genes, and one non-coding AT rich control region. The gene organizations and orientations are comparable to other available Culicoides mitogenomes, except for a translocation of ND2 and six tRNA genes in both C. brevitarsis and C. imicola. Eleven protein-coding genes encode a full TAA stop codon, while two (ND5, COX3) are completed by mRNA polyadenylation. Phylogenetic analysis of the mitogenomes showed C. brevitarsis and C. imicola form a monophyletic group. The sequences of these mitogenomes contribute to a baseline of molecular tools for diagnostics and surveillance for use by World Organisation for Animal Health (WOAH) reference laboratories for monitoring vectors of emerging diseases.

Abstract The motivation for this article stems from the fact that medical image security is crucial for maintaining patient confidentiality and protecting against unauthorized access or manipulation. This paper presents a novel encryption technique that integrates the Deep Convolutional Generative Adversarial Networks (DCGAN) and Virtual Planet Domain (VPD) approach to enhance the protection of medical images. The method uses a Deep Learning (DL) framework to generate a decoy image, which forms the basis for generating encryption keys using a timestamp, nonce, and 1-D Exponential Chebyshev map (1-DEC). Experimental results validate the efficacy of the approach in safeguarding medical images from various security threats, including unauthorized access, tampering, and adversarial attacks. The randomness of the keys and encrypted images are demonstrated through the National Institute of Standards and Technology (NIST) SP 800-22 Statistical test suite provided in Tables 4 and 14, respectively. The robustness against key sensitivity, noise, cropping attacks, and adversarial attacks are shown in Figs. 15–18, 22–23, and 24. The data presented in Tables 5, 6, and 7 shows the proposed algorithm is robust and efficient in terms of time and key space complexity. Security analysis results are shown (such as histogram plots in Figs. 11–14 and correlation plots in Figs. 19–21). Information Entropy ( $$7.9993 \pm 0.0001$$ ), correlation coefficient ( $$\pm 0.09$$ ), Mean Square Error (MSE) ( $$4166.3107 \pm 1645.2980$$ ), Peak Signal to Noise Ratio (PSNR) ( $$12.2643 \pm 1.7032$$ ), Number of Pixel Change Rate (NPCR) ( $$99.60\% \pm 0.2\%$$ ), and Unified Average Changing Intensity (UACI) ( $$33.47\% \pm 0.1\%$$ ) underscore the high security and reliability of the encrypted images, are shown in Tables 8–11. Further, statistical NPCR and UACI are calculated in Tables 12 and 13, respectively. The proposed algorithm is also compared with existing algorithms, and compared values are provided in Table 15. The data presented in Tables 3–15 suggest that the proposed algorithm can opt for practical use.

Abstract AIM- The objective of the systematic review is to evaluate the incidence of postoperative pain after single-visit and multiple-visit root canal therapy. METHODS- Published research indexed in PubMed or Scopus or Cochrane or DOAJ or Web of Science evaluating the frequency percentage of postoperative aching after one and several root canal therapy appointments through randomized controlled trials or prospectively were included. RESULT- Most surveys utilized VAS (Visual Analogue Scale) to estimate the degree of pain among the participants. The majority of the studies (n-8) showed no difference between postoperative pain during single-sitting endodontic treatment or multiple-sitting endodontic treatment. On the contrary, several studies (n-6) also revealed that post-obturation pain in a single-appointment root canal therapy is less compared to multi-visit root canal therapy. The current research results give insight into the incidence of postoperative endodontic pain among the study participants undergoing root canal treatment through single or multiple visit appointments. CONCLUSION- The lack of consistency between studies is due to the different ways in which pain intensity is measured and differences in treatment methods, patient selection and treatment outcomes.

Background: Medical students are expected to have good dietary habits and to maintain a healthy lifestyle considering their increased knowledge regarding healthy and balanced diets. Although medical students possess high knowledge about healthy dietary habits, they do not practice these habits. Objectives: This study aimed to assess the dietary habits and risk factors associated with poor dietary habits among medical students. Methods: A cross-sectional study using the complete enumeration sampling method was conducted on medical students of North Delhi Municipal Corporation Medical College and Hindu Rao Hospital. A pre-designed pre-tested semi-structured questionnaire was used to collect student data. To assess dietary habits, the World Health Organization-STEPwise approach to the noncommunicable disease risk factor surveillance questionnaire was modified and used. Data were analyzed using Statistical Package for the Social Sciences (version 21). Results: Among the study participants, 31.3% of male students and 31.6% of female students had good dietary habits. Furthermore, 42.7% of the students consumed two main meals a day, whereas only 4.7% consumed one main meal a day. Of the study participants, 47% did not eat meals at regular intervals. Moreover, 41% consumed snacks between the main meals. Most medical students (90.2%) consumed fast food. It was found that 58.2% of the students consumed fruits and vegetables at least once daily. Residence and alcohol consumption were strong predictors of dietary habits. The findings of this study revealed that poor dietary habits were significantly associated with poor-quality sleep. Conclusion: Although medical students possess high knowledge about healthy dietary habits, they do not practice these habits.

Kimura disease (KD) is a rare chronic inflammatory disorder characterized by multiple painless solitary head and neck lymphadenopathy often accompanied by peripheral eosinophilia and elevated serum IgE levels. Initially, the lesion was described in 1937 as a neoplasm (Kimm and Szeto) and first coined by Kimura, a Japanese scientist. Now it is well documented that it is a benign condition with unknown etiology. An allergic reaction and an alteration of the immune system remains one of the pathophysiological bases. Persistent antigenic stimulation following arthropod bites and parasitic or candida infection are also suspected. KD is a quite rare condition, affected Caucasians are very rare. It is found almost exclusively in Asian males in their 2nd to 4th decade of life (70–80%). There are only few cases of KD reported from Indian subcontinent. We present a case series of three patients of Kimura disease, presenting with painless cervical and parotid lymphadenopathy. All three patients underwent lymph node fine needle aspiration cytology (FNAC) showing no evidence of malignancy. This case series highlights the very rare yet important cause of cervical lymphadenopathy in young patients. Cervical lymphadenopathy can be misleading if not evaluated by histopathology and serum IgE levels.

This study engages with the experiences of Dalit-Bahujan (oppressed social castes) students at a higher education institution in India. Drawing from interview-based data, it explores the students’ narratives to map their educational experiences, taking the medium of instruction as a case in point. The study aims to deepen understanding of the intersection of caste and curricular-pedagogic context of higher education and its relation to knowledge production in institutional contexts. The findings highlight a significant gap between the socio-economic backgrounds of Dalit-Bahujan students and the institutional and pedagogical structures, processes, and discourses they encounter. Based on these findings, the study further examines the framing of marginality at the intersection of caste, language and background of Dalit-Bahujan students. The lack of institutional support often relegates Dalit-Bahujan students to the margins within higher education institutions, not only excluding the disadvantaged social groups but also impinging upon the democratisation of knowledge production. We conclude that the question of medium of knowledge production necessitates a critical examination of which lives and voices are included in curricular and pedagogic processes.

Abstract Single-molecule tracking provides direct real-time measurements of protein dynamics in live cells with high spatiotemporal resolution. In the last decade, this method has been adopted by several labs to understand the dynamics of DNA replication, transcription, telomerase, chromatin remodeling, etc. in a variety of model systems (bacteria, yeast S. cerevisiae, cell lines, embryo). However, it has not been employed for the yeast Schizosaccharomyces pombe, despite being a valuable model system. Here, we present single-molecule tracking datasets for chromatin-bound histone H3 (Hht1) in live and fixed cells and freely diffusing GFP in S. pombe nuclei to benchmark the diffusion parameters (diffusion coefficient, mean squared displacement, fraction of bound molecules, residence time). These parameters will be used to differentiate chromatin-bound molecules from unbound (free) molecules of any protein. It will be a valuable resource for any lab that starts employing this method for studying protein dynamics. This dataset can also be used to validate the performance of various tracking software and as a training dataset for machine learning-based automated tracking.

Abstract The antibiotic 2-nitroimidazole (2NI) or azomycin, used for treating drug-resistant tuberculosis and imaging tumor hypoxia, requires activation by bacterial nitroreductases for its antibiotic and cytotoxic effect. Mycobacterium sp. JS330 produces 2-nitroimidazole nitrohydrolase (NnhA) that circumvents 2NI activation, conferring 2NI resistance by hydrolysing it to nitrite and imidazol-2-one (IM2O) instead. This study elucidates NnhA’s structure, catalytic mechanism, and evolutionary background within the guanidino-group modifying enzyme (GME) superfamily, aided by a more soluble protein variant engineered through directed evolution. Despite low sequence similarity and limited occurrence in a few soil-dwelling mycobacteria and Actinomycetota, NnhA maintains the α/β propeller fold characteristic of GME superfamily enzymes and forms an unusual hexameric ring structure formed by a trimer of domain-swapped dimers. The similarity of its active site to arginine deiminases (ADIs) and human dimethylarginine dimethylaminohydrolases (DDAHs), along with molecular dynamics simulations, suggests NnhA’s catalytic mechanism resembles the hydrolysis reactions of these related enzymes.

Abstract Background Designing effective immunization programs requires a strong understanding of how the factors affecting vaccine uptake interplay. In this review, we analyze the relationships between the Behavioral and Social Drivers (BeSD) of routine immunization using qualitative systems mapping (QSM). Methods In this review, we analyzed 92 experimental and quasi-experimental impact evaluations (IEs) from 11 LMICs that were published between 2010 and 2020. Secondary literature on the study context or the intervention was also included. The WHO’s behavioral and social determinants (BeSD) framework was used to code the determinants identified in these IEs, and their relationships were mapped using qualitative systems mapping. We computed the in-degree (influenced by other determinants) and out-degree scores (influencing other determinants) to assess the extent of the influence of the BeSD determinants on one another. Results The results identified that knowledge regarding immunization, trust in the health system and quality of immunization services, and community engagement by the health workers was influenced by several other determinants and had a high in-degree score. Caregivers perceptions of quality of immunization services, health provider availability, religious leaders, community engagement by health workers, and physical accessibility had a high out-degree score. We also identified two feedback loops between health provider availability and physical accessibility, and trust and perceptions of immunization quality. Conclusions QSM analysis shows that the determinants of immunization uptake were interlinked with each other in complex ways. Our research identified BeSD drivers that affected multiple factors and can be viewed as key leverage points. Programs for improving vaccination uptake need to account for the strong role that caregivers’ experience of immunization services and their trust in the health system play in indirectly affecting immunization uptake. There is also a need to acknowledge that fear of vaccination is fear of the opportunity and monetary costs associated with vaccine side-effects. The results from this review can inform discussion and form the basis for context specific research on the factors affecting immunization.

Background: Chenopodium quinoa is a nutrient-dense pseudocereal packed with proteins, vital amino acids, and bioactive substances that may have medicinal uses. These include antioxidant, anti-inflammatory, anti-cancer, and antibacterial properties. Notably, quinoa proteins and peptides show multifunctional bioactivities such as immunological regulation, cancer cell death, and microbial suppression. This study aimed to separate, purify, and describe the bioactive proteins found in quinoa seeds, emphasizing their potential applications as medicines. Methodology: Quinoa seeds underwent protein extraction, defatting, and de-saponification. Ion exchange chromatography, dialysis, and ammonium sulfate precipitation were used to purify the seeds. The Lowry technique was used to quantify the proteins. Functional tests assessed the seeds' antibacterial, antifungal, protease, and anticancer properties, and peptide identification was carried out using LC-MS/MS. Results: The protein content decreased during purification steps, indicating effective removal of impurities. Protein fractions exhibited significant antibacterial and antifungal activities. Protease activity varied among fractions, with the pH 2 fraction showing the highest activity. Crude extract and pH 2-treated fractions demonstrated significant anticancer activity against A549 and Hela cell lines. pH 2 fraction exhibits the highest protease activity of 2.451 units/ml, indicating enhanced enzymatic capability under acidic conditions. Peptides identified from the pH 2 fraction showed potential therapeutic properties. Conclusion: The antibacterial, antifungal, proteolytic, and anticancer properties of quinoa-derived peptides and proteins demonstrate their potential for use in medicine. Clinical validation and the creation of functional foods or nutraceuticals based on quinoa should be the main objectives of future research.

Background: Nymphaea nouchali is a widely distributed aquatic plant prevalent in tropical and subtropical areas, flourishing in freshwater habitats. It is widely recognized as the water lily. Historically, it has been utilized in several medical systems to address conditions such as diabetes, liver diseases, and urinary tract issues. The plant comprises several bioactive substances, including flavonoids, phenolic acids, and alkaloids, which enhance its therapeutic qualities. This review examines the botanical, phytochemical, and pharmacological characteristics of Nymphaea nouchali to evaluate its medicinal potential. Methodology: This review combines data from previous botanical, phytochemical, and pharmacological research on Nymphaea nouchali. The bioactive components extracted from the plant were examined for their therapeutic capabilities. The pharmacological effects, encompassing antibacterial, antioxidant, anti-inflammatory, antinociceptive, and anticancer properties, were assessed by several in vitro and in vivo experimental methods. Results: A phytochemical study identified the presence of substances, including nymphal, gallic acid, and quercetin. These chemicals are associated with notable biological functions. Alkaloids and tannins had antibacterial activities, but phenolic compounds and flavonoids showed potent antioxidant capabilities. The herb demonstrated antinociceptive properties. Initial investigations suggested possible anticancer effects on some cell lines; nevertheless, further study is required. Conclusion: Nymphaea nouchali shows significant pharmacological potential due to its many bioactive components. Although traditional medicinal usage supports its therapeutic benefits, further preclinical and clinical investigations are necessary to validate its efficacy and safety for pharmaceutical uses.

Abstract Major underlying health issues can be indicated by even minor nail infections. Subungual Melanoma is one of the most severe kinds since it is identified at a much later stage than other conditions. The purpose of this research is to offer novel deep-learning algorithms that target the autonomous categorization of six forms of nail disorders by employing images: Blue Finger, Clubbing, Pitting, Onychogryphosis, Acral Lentiginous Melanoma, and Normal Nail or Healthy Nail Appearance. Based on this, we build an initial baseline CNN model, which is then further advanced by the introduction of the Hybrid Capsule CNN model by the reduction of space hierarchy deficiencies of the classic CNN model. All these models were trained and tested using the Nail Disease Detection dataset with intensive uses of techniques of data augmentation. The Hybrid Capsule CNN model, thus, provided superior classification accuracy compared to the others; the training accuracy was 99.40%, while the validation accuracy was 99.25%, whereas the hybrid model outperformed the Base CNN model with astounding precision, recall of 97.35% and 96.79%. The hybrid model additionally leverages the capsule network and dynamic routing, offering improved robustness against transformations as well as improving spatial properties. The current study consequently provides a very viable, economical, and accessible diagnostic tool, especially for places with a paucity of medical services. The proposed methodology provides tremendous capacity for early diagnosis and better outcomes for the patient in a healthcare scenario. Clinical trial number Not applicable.

Clinical trials are essential for evaluating the safety and efficacy of new medical interventions, ensuring evidence-based advancements in healthcare. They play a critical role in improving patient outcomes and guiding regulatory approvals for new treatments. India has emerged as a key player in clinical trials, owing to its skilled manpower, state-of-art infrastructure and robust regulatory framework. The manuscript has been written with the objectives of summarising the key imperatives of clinical trial administration including strategic planning, focusing on the development of protocol, appropriate study designs and the establishment of SMART objectives. It further emphasises regulatory compliance, ethics and the selection of study sites based on epidemiological and infrastructural factors. The role of data management, especially electronic data capture, and the necessity of robust monitoring, including risk-based approaches, are then highlighted. The document also addresses common challenges such as patient recruitment, retention, budgeting and site coordination, and proposes solutions, such as leveraging technology and ensuring ethical standards. Finally, it examines the complexities of multi-centric clinical trials, offering strategies for overcoming these hurdles.

Machine Learning centers on applications that gain for a fact and further develop their dynamic or prescient exactness over the long run. Behavioral Modification is the use of basic learning techniques such as conditioning, biofeedback, assertiveness training, positive or negative reinforcement, aversion therapy to change unwanted individual or group behavior. Behavior change is vital to addressing both the challenges facing human health and wellbeing and to promoting the uptake of research findings in health policy and practice. This paper provides a solution about the utilization of machine learning in behavioral modification by giving some real-time examples. The device based on machine learning is used to develop and evaluate a ‘Knowledge System’ that automatically extracts, synthesizes, and interprets findings from Brain Computer Interface (BCI) evaluation reports to generate new insights to conduct change and further develop forecast of intervention viability and permits clients to effectively and productively examine the framework to find solutions. Organizations engaged in healthcare are charged with the complex task of keeping expenses down without compromising healthcare quality. The key prerequisite is to focus instead of fix, with the greatest test being the need to follow up on enormous volumes of totaled medical care driven Big Data.

Since ancient times, zinc oxide has been a crucial industrial substance, and there is a lot of new interest in it these days. Its use in an incredibly wide range of industries has been ensured by a combination of physical properties like relatively high electrical and thermal conductivity, optical absorption, and very high-temperature stability, chemical properties such as stability at neutral pHs and mildly antimicrobial action, and techno-economic attributes such as easy availability and affordable price. The processes used to produce ZnO have continuously changed. In the present study, Nanoparticles of zinc oxide (Zn Nps) have been synthesized by a green chemistry approach using zinc acetate, sodium hydroxide, and water extract of Chenopodium ambriosoides and Angelica glauca. In this study, we report here a simple green technology to synthesize ZnO nanoparticles. Biologically synthesized Zn Nps characterized by UV-Vis spectral analysis, FT-IR, XRD, Scanning Electron Microscope (SEM), and Energy Dispersive X-ray Analysis (EDAX). The Zn Nps size obtained from water extract of Chenopodium ambriosoides and Angelica glauca have also been compared. Our result suggests that the water extract of Chenopodium ambriosoides is more suitable than the water extract of Angelica glauca for synthesizing ZnO Nps.

Background and Aims: Bispectral index (BIS) and minimum alveolar concentration (MAC) are commonly used to monitor the depth of anesthesia. The objective was to study the correlation between BIS and age-adjusted minimum alveolar concentration (aaMAC) during the maintenance phase of anesthesia. The influence of variables affecting BIS and or aaMAC was studied to determine an equation between BIS and aaMAC. Material and Methods: This prospective observational study was carried out after institutional ethical approval in adult patients 18–60 years of either sex, ASA I and II posted for elective surgery under general anesthesia. Five minutes after airway management, BIS values and aaMAC equivalents were noted during the maintenance phase of anesthesia. aaMAC and corresponding BIS values were recorded every minute for periods, where the anesthetic agent concentration had remained the same during preceding 5 minutes till the switching off of the anesthetic agent. Age, sex, ASA status, use of nitrous oxide, inhalational agent, dose of midazolam, and opioid used were also recorded. Results: BIS/aaMAC showed an inverse correlation. Increasing age, ASA II status, morphine equivalent >5, and use of nitrous oxide, sevoflurane, or isoflurane were associated with a higher BIS at equivalent aaMAC. Using the exchangeable correlation structure, a generalized estimation equation was obtained as the best predictor. Conclusion: Factors affecting both aaMAC and BIS affect the relationship between the two, and although there are wide variations, BIS and aaMAC can be equated and values of either can be calculated if one is known using a generalized estimates equation.

For identification (ID) of irregular antibodies, a standard antibody identification (AI) panel consisting of 18 mandatory antigens expressed on reagent red blood cells is used. The phenotype for each antigen is listed on a red cell antigram provided with each lot of the ID panel. In addition, special type of low-incidence antigens that are clinically significant are separately mentioned on the left- or right-hand column or on the reverse of the antigram. These cases highlight the importance of diligent AI to ensure safe transfusions and prevent adverse transfusion reactions in patients. The ID of rare and low-incidence red cell alloantibodies is important in ensuring safe transfusions and preventing hemolytic disease of fetus and newborn. In routine practice, these types of antibodies are often categorized as having an undetermined specificity due to their rarity and low prevalence in the population. We describe two cases of successful ID of rare and low-incidence red cell alloantibodies, Anti-Colton-b (Co(b)) and Anti-Kpa. Type and screen and irregular AI were performed on Immucor NEO Iris® (SPRCA), for both the female patients. Autocontrol and direct agglutination test were performed by column agglutination technique method (BIO-RAD, Coombs Anti-Ig G cards) and were negative for both the patients. Analysis of respective antigrams was done to rule out or rule in irregular antibodies. Initially, the reaction pattern indicated the presence of anti-Co(b) and anti-Kpa. However, the reaction only occurred in one cell out of the 14 cells tested for both patients. To ensure accuracy, the samples were rerun using different lots using the SPRCA methodology. To confirm the presence of anti-Co(b) antibodies, a selected panel cell was treated with an enzyme to enhance the expression of the Co(b+) antigen. Anti-Co(b) and anti-Kpa alloantibodies were successfully identified and AHG crossmatched; compatible and phenotype-matched blood units were reserved for the patients. Low prevalence antibodies are often missed during antibody screening due to lack of corresponding antigen-positive cells in cell panels or due to their weak reaction pattern and considering it for nonspecific reaction.

Abstract Cervical cancer is one of the biggest challenges in global health, thus it forms a critical need for early detection technologies that could improve patient prognosis and inform treatment decisions. This development in the form of an early detection mechanism increases the chances of successful treatment and survival, as early diagnosis promptly offers interventions that can dramatically reduce the rate of deaths attributed to this disease. Here, a customized Convolutional Neural Network (CNN) model is proposed for cervical cancerous cell detection. It includes three convolutional layers with increasing filter sizes and max-pooling layers, followed by dropout and dense layers for improved feature extraction and robust learning. By using ResNet models as inspiration, the model further innovates by incorporating skip connections into the CNN design. By enabling direct feature transmission from earlier to later layers, skip links enhance gradient flow and help preserve important spatial information. By boosting feature propagation, this integration increases the model’s ability to recognize minute patterns in cervical cell images, hence increasing classification accuracy. In our methodology, the SIPaKMeD dataset has been employed which contains 4049 cervical cell images that are arranged into five different categories. To address class imbalance, Generative Adversarial Networks (GANs) have been applied for data augmentation; that is, synthetic images have been created, that improve the diversity of the dataset and further enhance the robustness of the same. The present model is astonishingly accurate in classifying five cervical cell types: koilocytes, superficial-intermediate, parabasal, dyskeratotic, and metaplastic, thus significantly enhancing early detection and diagnosis of cervical cancer. The model gives an excellent performance because it has a validation accuracy of 99.11% and a training accuracy of 99.82%. It is a reliable model in the diagnosis of cervical cancerous cells because it ensures advancement in the computer-assisted cervical cancer detection system.

Abstract Background Swellings of the neck are a common presentation encountered by surgeons in outpatient settings, often prompting early medical attention due to their visibility and potential cosmetic concerns. Neck masses can range from reactive lymphadenitis to malignant lesions. Aim of the study This observational study aimed to investigate the clinical profile and etiopathology of neck masses within the Indian population. Methods Over a six-month period, patients presenting with neck swellings at the Department of ENT in a multi-speciality government hospital, Delhi, were included. 100 patients were included in the study. Detailed demographic data and presenting symptoms were recorded, along with local examination findings and cytological analysis using fine needle aspiration cytology (FNAC). Results The study population predominantly consisted of individuals aged 21 to 30 (30%) and 11 to 20 (22%), with females comprising 68% of the total, male to female ratio being 0.6:1. The most common etiologies observed were infective or inflammatory (42%), followed by thyroid-related conditions (35%). Tubercular lymphadenitis was the most common among infective etiology, accounting for 36% of these cases. Notable variations were observed across age groups, with younger demographics showing higher prevalence of benign and inflammatory conditions, while older individuals presented with diverse etiologies including thyroid nodules and salivary gland tumors. Conclusion The age distribution data of patients presenting with neck masses provides valuable insights into the epidemiology and etiology of such conditions across different age groups. FNAC remains a valuable and cost-effective diagnostic tool for evaluating superficial and deep-seated lesions in the head and neck region. It offers reliable categorization of lesions due to its high sensitivity and specificity.

Lumbar spine surgeries are complex procedures often associated with challenges in maintaining hemodynamic stability and controlling intraoperative bleeding, which are crucial for optimizing patient outcomes. Clonidine and dexmedetomidine both are α2-adrenergic agonists with sedative and analgesic properties, known for their potential to attenuate sympathetic responses and stabilize hemodynamics. However, their comparative efficacy in lumbar spine surgeries remains underexplored. METHODOLOGY This study was carried out in 40 patients, ASA grade1 and 2, undergoing lumbar spinal instrumentation requiring laminectomy. The patients were randomly allocated into two groups (20 each) using the computer generated random number table. Group C received 2 µg/kg of clonidine diluted in 10 ml of normal saline, given slowly intravenous infusion over 10 min before induction of general anaesthesia. Group D received 1 µg/kg of dexmedetomidine diluted in 10 ml normal saline, given slow intravenous infusion over 10 minutes before induction of general anaesthesia. Heart rate, systolic, diastolic, and mean arterial pressure were monitored before intubation as the baseline and after intubation, 15, 30, and 60 minutes after starting the surgery, and after extubation. The amount of intraoperative blood loss was estimated based on the volume of blood in the suction bottle and the number of the blood-soaked gauze pads (20 mL for a completely blood-soaked gauze and 50 mL for a completely blood-soaked long gauze). OBSERVATION No statistically significant difference was found on comparing the two drugs in terms of Baseline characteristics, Mean Arterial Pressure and the amount of blood loss. However Dexmedetomidine group had a higher reduction in Heart Rate as compared to the Clonidine Group. CONCLUSION In conclusion, both the alpha2 agonist drugs; intravenous clonidine and dexmedetomidine represent valuable options for achieving stable hemodynamics as well as decreases the intraoperative surgical bleeding in lumbar spine surgeries. Total opioid requirements for intraoperative and rescue analgesia in postoperative period were decreased in both the groups.

Abstract Mechanically rechargeable zinc-air batteries are considered promising for powering electric vehicles due to their high theoretical energy density, but a few practical hurdles impede their implementation. Understanding the key technical blockades that restrict their implementation will enable quick deployment of these batteries in electric vehicles. This Review analyzes the performance of various on-road electric vehicle segments powered by lithium-ion batteries and compares this with the current rechargeable zinc-air battery development. We discuss the theoretical limits and vehicle-specific blockades involved in achieving the performance of mechanically rechargeable zinc-air battery-powered electric vehicles, equivalent to those powered by lithium-ion batteries. Based on the identified blockades, we present ideas on future research direction on positive and negative electrodes, and battery operation and architecture. Finally, we discuss the conditions under which these batteries can be implemented in various electric vehicle segments.

The rising global demand for sustainable and eco-friendly practices has led to a burgeoning interest in circular bioeconomy, wherein waste materials are repurposed into valuable resources. Lignocellulosic waste, abundant in agricultural residues and forestry by-products, represents a significant untapped resource. This article explores the potential of fungal-mediated processes for the valorisation of lignocellulosic waste, highlighting their role in transforming these recalcitrant materials into bio-based products. The articles delve into the diverse enzymatic and metabolic capabilities of fungi, which enable them to efficiently degrade and metabolise lignocellulosic materials. The paper further highlights key fungal species and their mechanisms involved in the breakdown of complex biomass, emphasising the importance of understanding their intricate biochemical pathways for optimising waste conversion processes. The key insights of the article will significantly contribute to advancing the understanding of fungal biotechnology for circular bioeconomy applications, fostering a paradigm shift towards a more resource-efficient and environmentally friendly approach to waste management and bio-based product manufacturing.

This study investigated the accuracy of mortality attributions assigned by the US News and World Report (USNWR) to the diabetes and endocrinology specialty. We reviewed medical records of all consecutive Medicare fee-for-service inpatients at Mayo Clinic, Florida (Jacksonville, Florida) with a Medicare Severity Diagnosis Related Group included in the USNWR Diabetes & Endocrinology specialty cohort admitted from November 2018 to April 2022, with documented mortality in our institution’s electronic health record within 30 days of the index admission. A clinician adjudicated the primary cause of death, categorizing it as diabetes or endocrine, cancer, failure to thrive, or other. Among 49 deceased patients, only 7 (14.3%) had diabetes or an endocrine-related cause of death. Cancer (49.0%) and failure to thrive (30.6%) were the leading causes. This substantial discrepancy (86% misattribution) suggests USNWR’s methodology might not precisely reflect the quality of care, potentially misleading patients and impacting hospital rankings.

Abstract Orbital tuberculosis is a rare form of extra pulmonary TB and may arise either by hematogenous route or spread directly from the paranasal sinus. We herein report two cases of orbital TB with a vision threatening complication. Case-1 is a 31-year-old female with a headache, a diminution of vision in the right eye, and pain in ocular movement. On examination, there was no proptosis with RAPD present in right eye and tenderness on palpation. CEMRI revealed a diffuse infiltrating lesion at the orbital apex, suggesting of inflammatory pathology. Case-2 is a 40-year-old male with similar complaints in the left eye, CECT showed edema and swelling in the optic nerve and extraocular muscle of the left eye. A detailed investigation was done, and a diagnosis of orbital tuberculosis was made in both patients. They were started on ATT and oral steroids but lost follow-up initially and due to delayed treatment, it led to irreversible vision loss. A long-term follow-up showed resolution of ocular symptoms with occasional headaches.

Abstract Background Rapid utilization of natural resources and other anthropogenic activities intruded heavy metals into the food chain and raised alarming concern for all life forms. The available methods proved insufficient in handling waste and pollutants due to the high cost and generation of toxic residues. Bioremediation strategies have offered sustainable solutions for toxic pollutants. In the current study, cadmium and lead (Cd and Pb respectively) tolerant strains have been isolated from industrial effluent and characterized for tolerance towards target pollutants. The strain was identified by 16s rRNA gene and further used for metal removal from the industrial effluents. Results Bacterial isolates were obtained from industrial discharge and evaluated for their tolerance towards Cd and Pb. AS-1 bacterial isolate exhibited maximum tolerance towards both the metals and hence was selected for further study. The isolate was identified as Staphylococcus epidermidis. ICP-MS and energy dispersive X-ray (EDX) analysis of biomass revealed that a significant proportion of cadmium (90.89%) and lead (94.87%) available in effluent were sequestered within bacterial biomass. Characteristic peaks at 2Ɵ (31.8637 and 45.6247 for cadmium) and (21.0397, 27.0127, 46.0537, 54.2707 and 75.6547 for lead) confirmed the crystalline nature of the sequestered metals. The selected strain was characterized on biochemical and molecular basis and was found to be Staphylococcus epidermidis. Based on 16 S rDNA sequence analysis, a phylogenetic dendrogram was created for the maximum likelihood of the bacterial strain. The sequence was deposited in the NCBI repository (accession number PP587422). Conclusion The work has shown the possible way out of heavy metal pollution sustainably. To the best of the author’s knowledge, this is the first report on the sequestration and reduction of cadmium and lead by a nonpathogenic strain of Staphylococcus epidermidis AS-1 that may be useful for alleviating heavy metal contamination.

Abstract Background POT is a relatively newly described benign odontogenic tumor with very few cases registered to date. We present the 1st case of Primordial odontogenic tumor (POT) from Sub-Saharan Africa with unique clinicopathological features; also, this is the first case to report POT’s existence as a Hybrid Odontogenic lesion (HOL), with a pertinent review of the literature. Case presentation This was a 17-year-old patient who presented with slow-growing, painless posterior mandibular swelling. The imaging revealed a well-defined, unilocular, expansile, lytic lesion with internal calcific foci surrounding an impacted #36, indicating a calcifying odontogenic cyst. The incisional biopsy revealed the presence of POT. The tumor was excised along with the involved tooth. Conclusion POT is predominantly a non-aggressive and mostly affects the pediatric population. Hence, clinicians must be updated on all the aspects of this tumor to diagnose it appropriately and avoid any undue over—or under-treatment.

Objective: A comparative study undertaken to measure the the marginal bone loss (MBL), implant survival rate, and prosthetic and biological complications among short implants (8 mm or shorter) and conventional implants (longer than 8 mm) in the posterior atrophic maxilla. Materials and Methods: A search in three databases PubMed (Medline), Scopus, and Cochrane was conducted. The present systematic review was registered with identification number CRD42020212805 at the International Prospective Register of Systematic Reviews. Data extraction included the publication year, patients’ number and number of implants, implant length and width, MBL, implant survival rate, and biological and mechanical complications. The Cochrane Risk of Bias 1.0 tool was used to assess the risk of bias. A meta-analysis was performed to evaluate the outcome variables. Comparisons for dichotomous variables, such as prosthetic and biological complications and implant survival rate, were done by applying the Mantel–Haenszel method. In contrast, a comparison was made by applying the inverse variance method for continuous variables like MBL. Results: Initially, 618 reports were recognized from electronic database searches. Five randomized controlled trials (RCTs) were included in the meta-analyses regarding the MBL, implant survival rate, and prosthetic complications, while three were included for biological complications. In 5 years of follow-up, no evidence of difference could be found between conventional and short implants for survival rate (risk ratio [RR]: 3.54; 95% confidence interval [CI]: 0.99–12.67; P = 0.05; I2 = 0%). We do not find any evidence of difference for MBL between short implants and conventional implants (mean difference: −0.29; 95% CI: −0.49 to −0.08; P = 0.02; I2 = 65%). Furthermore, no evidence of a difference exists between short and conventional implants for prosthetic complications (RR: 1.56; 95% CI: 0.68–3.55; P = 0.29; I2 = 0%). The biological complications were seen less with short implants (RR: 0.47; 95% CI: 0.24–0.93; P = 0.03; I2 = 0%). Conclusion: The results suggest no significant difference among conventional and short implants regarding survival rate in the posterior atrophic maxilla. The results of this systematic review and meta-analysis suggest that, for a 5-year period of follow-up, short implants are related to rarer biological complications and comparable MBL compared to conventional implants. Despite these promising findings, long-term studies with consistent study designs and clinical protocols are required to appraise the performance and durability of short implants.

A systematic review of literature, in order to investigate an association between Major depressive disorder (MDD) and Oral health was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered on PROSPERO (registration number: CRD42023470383). The search and screening according to previously established protocol were conducted by two authors. Electronic databases such as PubMed, Scopus, and DOAJ were searched from January 2000 until October 2022 for studies reporting data on oral health status and MDD. Quality assessment of included studies was evaluated using NIH tool developed by NHLBI for retrospective and prospective studies and Cochrane risk of bias 2 (RoB 2) tool for interventional studies through its domains. The RoB summary graph and RoB summary applicability concern were plotted using RevMan software version 5.3. All the studies tried to understand the association and impact of major depressive impact on oral health and hygiene. The collective result demonstrates a mixed relationship of depression and oral health. Recognizing the oral health status of individuals with depressive symptoms can serve as valuable information for both dental and mental health professionals. This awareness enables the development of customized treatment plans to assist patients in achieving comprehensive wellness. There is an opportunity for further research of similar nature in developing countries such as India, Indonesia, and China, which have substantial population sizes.

As per the World Health Organization, governments should aim to accomplish two significant global milestones by 2030: reducing health disparities and granting universal accessibility to healthcare. The aim of this article was to systematically review the inequalities and understand the multifactorial causation of oral health inequalities among the older adults. Methods Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) standards were used to carry out the review and is documented in PROSPERO CRD42026695761. Two authors did the search and screening in accordance with the protocol. Electronic databases such as PubMed, Google Scholar, and EBSCOhost articles of the last 10 years were searched for research presenting data on oral health status and oral health related quality of life in the elderly population. Quality assessment was performed using the Newcastle Ottawa Scale (NOS) for retrospective and prospective research. Results Only 24 studies fulfilled the eligibility criteria and were incorporated into the qualitative synthesis. Multiple aspects of oral health and the related variables influencing disparities in oral health in the elderly population living in institutions have a positive link. Conclusion The findings support the notion that this demographic consists of weak, dependent individuals who have poor oral health. The vulnerable elderly institutionalized population was recognized and validated, thus helps in providing measures that will eventually focus the risk factors to improve their OHRQoL.

Background There is little information available regarding knowledge and attitudes towards the human papillomavirus (HPV) and its vaccines among the students in mainland India. Furthermore, there has not been much information accessible on how to increase their understanding of and readiness to receive HPV and associated vaccines, which could be crucial for the future success of vaccination campaigns. This study aims to assess the knowledge and attitude of middle- and high-school students towards HPV infection, HPV vaccine and cervical cancer prevention. Method The present study was an observational study conducted from July 2023 to December 2023 in the Gwalior District of Northern India among the 490 students aged 11–16 years. A self-administered questionnaire was used to collect information from the students. The collected data was entered into an Microsoft Excel spreadsheet for easy calculation. Frequency and percentage were calculated and significance in proportion was tested using the chi-square test. P value was judged at a 5% level of significance. Results The average age of the student was 13.67 ± 1.95 years range between 11 years and 16 years with a 0.52:1 sex ratio. Out of the 490 enrolled participants, 41.0% of subjects had previously heard about cervical cancer. About 64.7% of students heard it from the mass media. A total of 181 (36.9%) knew that cervical cancer was caused by HPV infection. Only 168 (34.3%) participants knew the fact that men were also infected by HPV infection. Only 12.4% knew that a healthy-looking person could have an HPV infection. Only 11.6% had shown their willingness for the HPV vaccination. There was a significant difference observed among the males and females regarding knowledge questions. Males (54.76%) heard more about cervical cancer than females (33.85%). Males had more knowledge (60.1%) regarding cervical cancer caused by HPV infection as compared with females (24.8%). Conclusion Students’ awareness of HPV and the HPV vaccine was low. Training that focusses on HPV information in addition to sex education is needed to promote HPV vaccine coverage.

Background Published data demonstrate promising results for rehabilitation in patients with multiple sclerosis (MS), including telerehabilitation technologies. Given the travel limitations during the coronavirus disease 2019 (COVID-19), telerehabilitation may provide a viable alternative to in-person physiotherapy. Objective To determine the efficacy of telerehabilitation in MS patients during COVID-19. Design/Methods A total of 42 patients participated in the study of which 24 were followed up till the end of 6 weeks. The investigated group consisted of 15 females and 09 males; the mean age was 42 ± 10 years. The telerehabilitation was provided for a duration of 6 weeks at a frequency of three classes per week. The patients used either laptops or mobile phones for attending these sessions. The inclusion criteria were a 6-minute walk test (with or without assistance). Motor function was evaluated using the Timed Up and Go (TUG) test and the 30-Second Sit-to-Stand (30STS) test. Patients were required to fill out two questionnaires also: 12-item MS Walking Scale (MSWS) and Modified Fatigue Impact Scale (MFIS). All the patient assessments were made by an independent physiotherapist before and after the intervention. Results There was a statistically significant improvement in motor performance and MFIS and 12-item MSWS. The following results were observed: statistically improved parameters of TUG, 30STS, 12-item MSWS and MFIS. Conclusions Based on the findings, it is reasonable to infer that the use of telemedicine in the rehabilitation of MS patients is very promising.

Abstract Background Equitable access to healthcare for rural, tribal, and underprivileged people has been an emerging area of interest for researchers, academicians, and policymakers worldwide. Improving equitable access to healthcare requires innovative interventions. This calls for clarifying which operational model of a service innovation needs to be strengthened to achieve transformative change and bring sustainability to public health interventions. The current study aimed to identify the components of an operational model of mobile medical units (MMUs) as an innovative intervention to provide equitable access to healthcare. Methods The study empirically examined the impact of scalability, affordability, replicability (SAR), and immunization performance on the sustainability of MMUs to develop a framework for primary healthcare in the future. Data were collected via a survey answered by 207 healthcare professionals from six states in India. Partial least squares structural equation modeling (PLS-SEM) was conducted to empirically determine the interrelationships among various constructs. Results The standardized path coefficients revealed that three factors (SAR) significantly influenced immunization performance as independent variables. Comparing the three hypothesized relationships demonstrates that replicability has the most substantial impact, followed by scalability and affordability. Immunization performance was found to have a significant direct effect on sustainability. For evaluating sustainability, MMUs constitute an essential component and an enabler of a sustainable healthcare system and universal health coverage. Conclusion This study equips policymakers and public health professionals with the critical components of the MMU operational model leading toward sustainability. The research framework provides reliable grounds for examining the impact of scalability, affordability, and replicability on immunization coverage as the primary public healthcare outcome.

Abstract Breast cancer (BC) remains a leading cause of morbidity and mortality among women worldwide, with triple-negative breast cancer (TNBC) posing significant treatment challenges due to its aggressive phenotype and resistance to conventional therapies. Recent advancements in nanocarrier technology offer promising solutions for enhancing drug delivery, improving bioavailability, and increasing drug accumulation at tumor sites through targeted approaches. This review delves into the latest innovations in BC detection and treatment, highlighting the role of nanocarriers like polymeric micelles, liposomes, and magnetic nanoparticles in overcoming the limitations of traditional therapies. Additionally, the manuscript discusses the integration of cutting-edge diagnostic tools, such as multiplex PCR-Nested Next-Generation Sequencing (mPCR-NGS) and blood-based biomarkers, which are revolutionizing early detection and molecular profiling of BC. The convergence of these technologies not only enhances therapeutic outcomes but also paves the way for personalized medicine in BC management. This comprehensive review underscores the potential of nanocarriers in transforming BC treatment and emphasizes the critical importance of early detection in improving patient prognosis.

Abstract The debate surrounding the roles of thermal and non-thermal pathways in plasmonic catalysis has captured the attention of researchers and sparked vibrant discussions within the scientific community. In this review, we embark on a thorough exploration of this intriguing discourse, starting from fundamental principles and culminating in a detailed understanding of the divergent viewpoints. We probe into the core of the debate by elucidating the behavior of excited charge carriers in illuminated plasmonic nanostructures, which serves as the foundation for the two opposing schools of thought. We present the key arguments and evidence put forth by proponents of both the non-thermal and thermal pathways, providing a perspective on their respective positions. Beyond the theoretical divide, we discussed the evolving methodologies used to unravel these mechanisms. We discuss the use of Arrhenius equations and their variations, shedding light on the ensuing debates about their applicability. Our review emphasizes the significance of localized surface plasmon resonance (LSPR), investigating its role in collective charge oscillations and the decay dynamics that influence catalytic processes. We also talked about the nuances of activation energy, exploring its relationship with the nonlinearity of temperature and light intensity dependence on reaction rates. Additionally, we address the intricacies of catalyst surface temperature measurements and their implications in understanding light-triggered reaction dynamics. The review further discusses wavelength-dependent reaction rates, kinetic isotope effects, and competitive electron transfer reactions, offering an all-inclusive view of the field. This review not only maps the current landscape of plasmonic photocatalysis but also facilitates future explorations and innovations to unlock the full potential of plasmon-mediated catalysis, where synergistic approaches could lead to different vistas in chemical transformations.

Abstract Several parameters affect our brain's neuronal system and can be identified by analyzing electroencephalogram (EEG) signals. One of the parameters is alcoholism, which affects the pattern of our EEG signals. By analyzing these EEG signals, one can derive information regarding the alcoholic or normal stage of an individual. Many road accident cases around the world, including drinking and driving scenarios, which result in loss of life, have been reported. Another reason for such incidents is that riders avoid wearing helmets while driving two-wheelers. Many road accident cases involving two-wheelers, including drinking, driving, overspeeding, and nonwearing helmets, have been reported. Therefore, to solve such issues, the present work highlights the features of an intelligent model that can predict the alcoholism level of the subject, wearing of a helmet, vehicle speed, location, etc. The system is designed with the latest technologies and is smart enough to make decisions. The system is based on multilayer perceptron, histogram of oriented gradients (HoG) feature extraction, and random forest to make decisions in real time. The accuracy of the proposed method is approximately 95%, which will reduce the fatality rate due to road accidents. The system is tested under different working environments, i.e., indoor and outdoor, and satisfactory outcomes are observed.

Introduction: Upholding good dental health has wider effects on productivity and performance at work in addition to being crucial for individual well-being. Because it can affect both their personal well-being and productivity at work, post office workers’ oral health is therefore a critical issue of concern. Hence, evaluating Bhubaneswar city post office workers’ dental health is the study’s aim. Materials and Methodology: With the aid of the WHO 2013 oral health assessment form, a cross-sectional study involving 171 regular post office workers was undertaken. Using the Chi-square test and an ANOVA for pertinent variables, the data were analysed using SPSS statistical software version 27.0. Potential confounding variables were adjusted using multiple logistic regression analysis. Results: The survey included a total of 171 post office personnel, of which 76.6% were men and 23.4% were women. The participants’ periodontal health revealed that 67.7% had deep periodontal pockets, 18.7% had shallow ones, and 95.3% had bleeding gums. The mean DMFT of the study participants was 4.10 ± 3.149. Conclusion: Among post office workers, tobacco use and oral health conditions represent a crucial junction of variables that call for caution and preventative action.

Background and Aim: Management of pain and anxiety associated with dental procedures in pediatric age group is a big challenge. In this part of the world, counselling has been the main modality for managing such patients. It is associated with mixed outcome. We share our experience of managing 23 patients using a combination of inhalational nitrous oxide- oxygen and intravenous midazolam with satisfactory outcomes. Material and Methods: Patients aged more than six years, American society of anaesthesiologists classification (ASA) I or II, procedure that could be finished within one hour like pulpectomies, root canal treatments, extraction and multiple restorations were accepted for conscious sedation. Complete blood count was done and pre-anaesthetic checkup (PAC) with written informed consent from the parent was taken for the dental procedure under conscious sedation. We placed the nasal mask of the Conscious sedation anesthesia machine and made the child inhale Oxygen/Nitrous oxide mixture. After inhaling variable concentration of nitrous oxide/ oxygen mixture in proportion increasing from 30:70 to 70:30, procedure was done. After completion of the procedure, the patient was administered hundred percent oxygen for five minutes. Results: We have done a total of twenty-three cases till now with ages between five to seventeen years. The duration of procedures ranged from 30 min to one and half hour. Two patients less than six years were found to be uncooperative for the procedure. Conclusion: Minimum age group that was suitable for conscious sedation was six years and above. Frequent meetings and counselling by the same team should be facilitated prior to taking up for the procedure.

Background: Gender differences in acute coronary syndrome (ACS) outcomes have been noted in global data, which however did not analyse Indian data. No prior systematic review and meta-analysis (SRM) has addressed this important aspect of gender bias in Indian women with ACS. Hence this SRM aimed to address this knowledge gap. Methods: Electronic databases were searched for studies in ACS comparing cardiovascular disease presentation, treatment received and outcomes in women and men from India. Primary outcomes were to evaluate gender-differences in 30-day death and major adverse cardiovascular events (MACE). Secondary outcomes were to evaluate gender-differences in presentation, management and mortality. The SRM is registered with PROSPERO (CRD42023477286). Results: From initially screened 3753 articles, data from 9 studies (61,185 patients) were analysed. Women with ACS had higher prevalence of diabetes [Odds ratio (OR) 1.65(95%CI:1.33–2.04); p

Background: Critically ill patients on Non- invasive Ventilation (NIV) or Continuous Positive Airway Pressure (CPAP) tend to desaturate off ventilatory support. Hence, they are unable to meet their nutritional needs, leading to increase in hospital stay. It was evident during the COVID 19 pandemic. The failure rates of NIV were unusually high, from 30-45%. Despite the overall success of the treatment modality, NIV failure rates still range between 18% and 40% in the acute setting. It was seen that the patients on NIV get only 650 Kcal/ day which is far lower than the required energy requirement. There is a need to have an affordable and sustainable solution to deliver adequate nutrition to critically ill patients on NIV and CPAP, which is able to maintain a NG/ OG tube without frequent disconnections from the ventilator. With this fact in mind a NIV mask with inbuilt feeding port (NIV-IFP) was designed. Aims and Objectives: The aim of this case series was to compare the modified NIV-IFP mask with the conventional mask in terms of both effectiveness of ventilation as well as caloric replacement in critically ill patients. For the purpose of this study, we enlisted three patients who were critically ill and required NIV. Results: With the use of NIV-IFP mask we were able to substitute adequate amount of nutrition (2000Kcal to 2500 Kcal) without any discontinuation of NIV application and with minimal leak in the mask. Conclusion: When compared to other available technologies in this field, the NIV mask with the inbuilt feeding port is very economical and can be a boon in third world countries. The placement of this unique mechanism in the mask was instrumental in weaning off patients from NIV and avoided Invasive ventilation. It was proved beyond doubt that addition of this gland nut assembly was extremely effective in delivering adequate nutrition to our patients without compromising on the ventilation.

Uterocutaneous fistula is a rare pathology that commonly occurs following uterine surgeries, endometriosis, chronic infection, malignancy, and foreign bodies. Many diagnostic and management strategies have been practiced. In this case series, we describe three cases of uterocutaneous fistula following cesarean and myomectomy, which was diagnosed clinically, confirmed by magnetic resonance imaging, and managed successfully by surgery with fertility preservation.

The present study deals with stakeholder-driven implementation of pen culture for raising of fish seed for Culture-based fisheries (CBF) in Chamta, a floodplain wetland, in Gangetic plains through polyculture of Indian Major Carps (IMCs) Labeo catla, Labeo rohita and Cirrhinus mrigala with Small Indigenous Fishes (SIFs) Labeo bata, Systomus sarana and grass carp, Ctenopharyngodon idella in co-management mode. In the first polyculture trial IMCs and minor carps were cultured in 4 High Density Poly Ethylene (HDPE) pens (0.1 ha each) at a stocking density of 25 Nos. m−3 in equal numbers for 90 days. In the second polyculture trial IMCs were cultured with grass carp at a density of 25 Nos. m−3 in 4 HDPE pens in the ratio of 1:1:1:2 for 90 days. The same set of pens was utilized for both trials during different times of the year. Net yield of 682.3 ± 20.6 kg and 413.9 ± 21.7 kg per pen was achieved through polyculture of IMCs and SIFs and polyculture and for IMCs and grass carp, respectively. The survival percentage varied with species and culture period with overall survival of 77 (IMCs + minor carps) to 85% (IMCs + grass carp). Polyculture was economically feasible with a BC ratio of 2.01 for IMC and SIFs and 1.88 for IMC and grass carp. All the seeds produced in the pens were released to the wetland as input for CBF. The study indicated the potential of grass carp fishery in macrophyte-infested wetland. The species could attain 1.5–2 kg in 6 months and up to 3–3.5 kg weight within 1 year, utilizing macrophyte resources of the wetland. SIFs S. sarana and L. bata were observed to attain maturity in pens. The study indicated pen as an economically feasible technology to boost CBF in the wetland. The cultivation of SIFs through pen culture and CBF can enhance their production while alleviating pressure on their natural populations. Integrating pen culture using diversified species will promote sustainable fisheries management in these floodplain wetlands.

Digital innovation and its integration in various parts of lifestyle are inevitable as humans have started to evolve over time. Its integration in our health and various systems is irrefutable. In this position paper, we explore the various aspects of this important component of technology, discuss its evolution over time, discuss the various existing modalities, highlight the regulatory frameworks in India, and elaborate on the different ways it can be integrated in our country’s future health plans. We believe digital health is here to stay and play important role in shaping our lives in terms of our accessibility and other interactions related to health.

Background: Epidemiological data show a high frequency of thyroid nodules in the general population, with rates increasing with age. Aim and Objectives: To analyze thyroid swelling with high-resolution ultrasonographic correlation. Results: 90% of cases were surgically treated. Surgical decision made on basis of age, gender of patient, size of thyroid mass, thyroid profile FNAC, ultrasonographic reports, and other patient related factor. Conclusion: The findings provide a thorough understanding of thyroid pathology, paving the door for more effective diagnostic approaches and personalized therapeutic strategies in clinical practice.

Intimate partner violence has been one of the foremost public health problems and a violation of women's human rights impacting one in three women worldwide (UN Women, 2020). Offering an insight into and questioning the concomitant edifices of violence inherent within the intimate marital relationships, the authors put forth arguments to interrogate the unique factors that impact women’s experiences and understandings of the abuse and demonstrate how gendered discourses function to polarize women’s sexuality. The authors argue that violence both stems from and perpetuates gender differences and disparities and embodies lived experience where one can see the ubiquity and reproduction of male dominated gender relations (Wendt & Zannettino, 2015). Backed by research evidence from the post pandemic global and national intelligences, they unfold the multifarious impact of violence by intimate partners on women and how these pose a greater risk gross vandalism of human rights while magnifying the gendered perils of the public health crisis. The paper also contours domestic violence and its trepidation effect on women’s reproductive and sexual health while reaffirming the impact of gender-based power imbalances within sexual relationships on sexual, reproductive, physical and mental health of women. As feminist social work academic/ researchers, the authors attempt to link their pragmatic reflections through social work practice and the feminist perspective ‘at work’. They focus on valuing the local experiences and understandings of marital violence and the gendered relations and identities that inhere in such experiences while accelerating the vigour to identify, realize and take actions paving pathways to sustainable development. They contend the pertinent role of social workers from a feminist lens in addressing the critical issues surrounding intimate partner violence and delineate holistic social work interventions relevant to the global dynamic environment advocating human rights-based perspective. The paper concludes with few suggestive eclectic mechanisms to address the issue of violence within marriage from a feminist social work perspective.

BackgroundAdults classified as immunosuppressed have been disproportionately affected by the COVID-19 pandemic. Compared to the immunocompetent, certain patients are at increased risk of suboptimal vaccine response and adverse health outcomes if infected. However, there has been insufficient work to pinpoint where these risks concentrate within the immunosuppressed spectrum; surveillance efforts typically treat the immunosuppressed as a single entity, leading to wide confidence intervals. A clinically meaningful and computerised medical record (CMR) compatible method to subdivide immunosuppressed COVID-19 data is urgently needed.MethodsWe conducted a rapid scoping review into COVID-19 mortality across UK immunosuppressed categories to assess if differential mortality risk was a viable means of subdivision. We converted the risk hierarchy that surfaced into a pilot digital phenotype—a valueset and series of ontological rules ready to extract immunosuppressed patients from CMR data and stratify outcomes of interest in COVID-19 surveillance dataflows.ResultsThe rapid scoping review returned COVID-19 mortality data for all immunosuppressed subgroups assessed and revealed significant heterogeneity across the spectrum. There was a clear distinction between heightened COVID-19 mortality in haematological malignancy and transplant patients and mortality that approached the immunocompetent baseline amongst cancer therapy recipients, autoimmune patients, and those with HIV. This process, complemented by expert clinical input, informed the curation of the five-part digital phenotype now ready for testing in real-world data; its ontological rules will enable mutually exclusive, hierarchical extraction with nuanced time and treatment conditions. Unique categorisations have been introduced, including ‘Bone Marrow Compromised’ and those dedicated to differentiating prescriptions related and unrelated to cancer. Codification was supported by existing reference sets of medical codes; absent or redundant codes had to be resolved manually.DiscussionAlthough this work is in its earliest phases, the development process we report has been highly informative. Systematic review, clinical consensus building, and implementation studies will test the validity of our results and address criticisms of the rapid scoping exercise they are predicated on.ConclusionComprehensive testing for COVID-19 has differentiated mortality risks across the immunosuppressed spectrum. This risk hierarchy has been codified into a digital phenotype for differentiated COVID-19 surveillance; this marks a step towards the needs-based management of these patients that is urgently required.

Fingerprints are considered as one of the most important and prominent feature for an individual identification. Due to their consistency and reliability in biometric feature identification, they are most widely used for biometric recognition systems. In these systems, the relevant feature extraction plays important role in achieving required classification accuracy. In recent time, deep learning techniques are being used for fingerprint recognition with more accuracy and efficient results. Major difficulty which has been reported in previous researches, is the limited size of samples. Therefore, we propose two approaches, inversion and multi augmentation to augment the sample size with newly generated images for each feature map. Besides this, multiple networks are used simultaneously for feature extraction from newly generated images in parallel mode. Deep neural network architectures are used with proposed inversion methods and multi augmentation methods to classify the samples of fingerprints for personnel identification and verification. Pre-trained deep convolutional models like VGG16, VGG19, ResNet50 and InceptionV3 are fine-tuned with new processed fingerprint images for feature extraction and classification. The collective samples of fingerprints have been classified into 10 classes. The simulation results have been obtained with different optimizers and it has been observed that VGG 19 model exhibits the accuracies of 88 % and 93 % with inversion and multi augmentation approaches respectively. Whereas, VGG16 model exhibits 93 % with inversion approach and 97 % with multi augmentation approach. Thus, the proposed approach exhibits the accuracy up to 97 % with VGG16 model which is significantly much higher than that of any other model with the same dataset FVC2000_DB4.