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Introduction: With the rising use of medications, Adverse Drug Reactions (ADRs) have emerged as a significant public health issue. Therefore, establishing a robust pharmacovigilance system across the nation has become imperative. The present study focussed to analyse the trends and frequency of ADRs to enhance the safety of drug prescriptions and ensure public health protection. Aim: To assess the pattern of adverse effects, drugs implicated, causality, severity, and outcomes of ADRs reported to the ADR monitoring centre in the Department of Pharmacology, Government TD Medical College, Alappuzha, Kerala, India. Materials and Methods: This was a cross-sectional study in which 262 ADRs reported to the Department of Pharmacology, Government TD Medical College, Alappuzha, Kerala, India from May 2022 to April 2023 were analysed for patient demographics, drug and ADR characteristics, and the outcomes of the ADR. Causality and severity assessments of these ADRs were performed using the World Health Organisation (WHO)-Uppsala Monitoring Centre (UMC) scale and the modified Hartwig and Siegel’s scale, respectively. Data were tabulated using Microsoft Excel and expressed as mean, standard deviation, frequency, and percentage as appropriate, with the help of descriptive statistics using Epi Info 7 software. Results: A total of 262 ADRs were analysed. The mean age of the patients was 47.4±20.1 years. The majority were females 160 (61.1%). The intravenous route was the most common route involved in ADRs 158 (59.8%), followed by the oral route 91 (34.5%). Skin reactions accounted for more than half of the ADRs 151 (53.2%), followed by blood dyscrasias 48 (16.9%). Antibiotics were the most common group of implicated drugs 124 (44.9%), followed by anticancer drugs 43 (15.6%) and antitubercular drugs 34 (12.3%). Among antibiotics, cephalosporins (36.3%) were the most frequently encountered, followed by penicillins (30.6%). A total of 148 patients (56.5%) had recovered by the day of reporting, 146 (55.7%) ADRs were found to be ‘possible’ using the WHO-UMC causality scale, and 144 (54.9%) ADRs were classified as moderate severity. Conclusion: The study identified a widespread occurrence of ADRs, some of which increased healthcare costs due to prolonged hospital stays. The high incidence of ADRs from antimicrobials is concerning, as it contributes to antimicrobial resistance. This underscores the urgent need for prudent antimicrobial usage. The present study emphasises the importance of ADR reporting among healthcare workers and the necessity for hospitals to establish ADR reporting strategies for optimal patient care.

Background: Odontogenic keratocyst (OKC) poses diagnostic challenges due to its aggressive nature and varied clinical as well as radiographic presentations, often resembling other cysts and tumors. The buccolingual to mesiodistal width ratio has been proposed as a potential radiographic parameter for diagnosing OKC. Aim: This study aimed to characterize OKC radiographically using cone beam computed tomography (CBCT) as well as panoramic radiographs, exploring the utility of the buccolingual to mesiodistal width ratio for diagnosis. Materials and Methods: An OKC retrospective radiography investigation was conducted with CBCT and panoramic radiographs from an archival database of patients in our institution, reported from 2019 to 2022. A total of 28 cases that were histopathologically confirmed OKC were analyzed. Results: Analyzing 28 histopathologically confirmed OKC cases, the mean age was 29.3 years, with a 3:4 female-to-male ratio. Predominantly located in the posterior mandible (60%), only one case occurred in the maxilla. The buccolingual to mesiodistal width ratio was

Management of choledocho-cholelithiasis requires a multi-disciplinary approach. It involves clearance of common bile duct stones (CBDS) on the one hand and addressing gallstone disease (GSD) on the other hand. With technological advancements and growing expertise in the fields of endoscopy and laparoscopy, endoscopic retrograde (or radiological) cholangiopancreatography (ERCP) and laparoscopy cholecystectomy (LC) have become modalities of choice for CBDS and GSD, respectively. Conventionally, in patients with choledocho-cholelithiasis, ERCP is performed first followed by LC after an interval of 4–6 weeks. This approach requires two separate admissions involving anesthesia twice, thus increasing the risk related to multiple general anesthesia, higher cost of care, and greater loss of man hours. These issues can be mitigated by the novel approach of single anesthesia ERCP and laparoscopic cholecystectomy (SERLAC). At our center, we follow both approaches, depending on the availability of resources and patient characteristics. Aim: This study aims to evaluate the safety of SERLAC. Materials and Methods: In this retrospective, descriptive study, we analyzed data of patients undergoing SERLAC for outcome, complications, benefits, and constraints. Results: Of the 36 patients who underwent ERCP before LC for choledocho-cholelithiasis, 10 opted for SERLAC. Despite relatively prolonged anesthesia time (mean 85.3 min), owing to both ERCP and LC being performed in the same sitting, no anesthesia-related adverse event was noted. SERLAC was preferred in two cases to avoid exposure to second general anesthesia due to comorbidities such as old age with polytrauma and use of oral anticoagulant related to a prosthetic cardiac valve. Hospital stay was significantly lower (mean 4.3 days) in patients opting for SERLAC and it provided a definite cure for 8 out of 10 patients. The major constraint noted was logistical, in terms of ensuring the availability of the operating room (OR) and teams for both procedures besides setting up the ERCP and laparoscopy workstations in the same OR in quick succession. Our study shows that SERLAC is a safe approach and further studies are required to build consensus. Conclusion: This study has proven that SERLAC is safe and comparable to interval ERCP and LC. It offers a definite cure with a single admission, single anaesthesia, and significantly shorter hospital stay and thus results in much greater patient satisfaction in expert hands.

Renovascular hypertension is important cause of resistant hypertension in young. Fibromuscular dysplasia (FMD) is a rare cause of clinically significant renal artery stenosis. It is commoner in women, usually truncal or distal and typically multifocal, giving characteristic “string of beads” appearance on conventional angiography. Percutaneous transluminal angioplasty alleviates hypertension in up to 80% of such cases. We present a rare case of ostial, unifocal FMD in a 34-year-old male who presented with resistant hypertension. The patient was on nine antihypertensive drugs including diuretics. He became normotensive following nephrectomy and has maintained normal renal function and normotension off drugs on follow-up.

Background and Aim: Evidence suggests a beneficial effect of sun exposure on type 2 diabetes mellitus (DM). However, little is known about the characteristics of sun exposure among DM patients or individuals at risk of developing DM. The aim of this study was to analyze the sun exposure behaviors of individuals diagnosed with DM and those susceptible to developing DM within a semi-urban community in North India. Materials and Methods: A population-based cross-sectional study was conducted in northern India with 494 participants aged 25–60, with or without DM. The participants’ sun exposure characteristics were assessed through a sunlight exposure questionnaire, and total sun exposure in a day was computed using the veritable sun exposure (VSE) index. Fasting blood sugar, anthropometric measurements, and demographic details were also collected. Results: The study had 56.5% female participants, and 9.1% of the participants had DM. The VSE of the study participants ranged from 0.01 to 0.81, with a mean of 0.15 (±0.14) and a median of 0.10, indicating that more than half of the study samples had less than 10% h/day of sunlight exposure. The use of sunscreen, gender, and disease status all influenced VSE. Our data suggest that the characteristics of sun exposure among Indians significantly deviate from standard recommendations. Conclusion: Our results propose a need for evidence-based guidelines and policies that promote awareness about sun exposure among DM patients as well as those at risk of developing DM. Nevertheless, these findings need to be validated through large-scale observational studies.

Abstract The receptor-binding site of influenza A virus hemagglutinin partially overlaps with major antigenic sites and constantly evolves. In this study, we observe that mutations G186D and D190N in the hemagglutinin receptor-binding site have coevolved in two recent human H3N2 clades. X-ray crystallography results show that these mutations coordinately drive the evolution of the hemagglutinin receptor binding mode. Epistasis between G186D and D190N is further demonstrated by glycan binding and thermostability analyses. Immunization and neutralization experiments using mouse and human samples indicate that the evolution of receptor binding mode is accompanied by a change in antigenicity. Besides, combinatorial mutagenesis reveals that G186D and D190N, along with other natural mutations in recent H3N2 strains, alter the compatibility with a common egg-adaptive mutation in seasonal influenza vaccines. Overall, our findings elucidate the role of epistasis in shaping the recent evolution of human H3N2 hemagglutinin and substantiate the high evolvability of its receptor-binding mode.

Predicting the thermal conductivity of two-dimensional (2D) heterostructures is challenging and cannot be adequately resolved using conventional computational approaches. To address this challenge, we propose a new and efficient approach that combines first-principles density functional theory (DFT) calculations with a machine-learning interatomic potential (MLIP) methodology to determine the thermal conductivity of a novel 2D van der Waals TiS2/MoS2 heterostructure. We leverage the proposed approach to estimate the thermal conductivities of TiS2/MoS2 heterostructures as well as bilayer-TiS2 and bilayer-MoS2. A unique aspect of this approach is the combined implementation of the moment tensor potential for short-range (intralayer) interactions and the D3-dispersion correction scheme for long-range (interlayer) van der Waals interactions. This approach employs relatively inexpensive computational DFT-based datasets generated from ab initio molecular dynamics simulations to accurately describe the interatomic interactions in the bilayers. The thermal conductivities of the bilayers exhibit the following trend: bilayer-TiS2 > bilayer-MoS2 > the TiS2/MoS2 heterostructure. In addition, this work makes the case that the 2D bilayers exhibit considerably higher thermal conductivities than bulk graphite, a common battery anode material, indicating the potential to utilize 2D heterostructures in thermal management applications and energy storage devices. Furthermore, the MLIP-based methodology provides a reliable approach for estimating the thermal conductivity of bilayers and heterostructures.

Abstract Phosphorene is a unique semiconducting two-dimensional platform for enabling spintronic devices integrated with phosphorene nanoelectronics. Here, we have designed an all phosphorene lattice lateral spin valve device, conceived via patterned magnetic substituted atoms of 3d-block elements at both ends of a phosphorene nanoribbon acting as ferromagnetic electrodes in the spin valve. Through First-principles based calculations, we have extensively studied the spin-dependent transport characteristics of the new spin valve structures. Systematic exploration of the magnetoresistance (MR) of the spin valve for various substitutional atoms and bias voltage resulted in a phase diagram offering a colossal MR for V and Cr-substitutional atoms. Such MR can be directly attributed to their specific electronic structure, which can be further tuned by a gate voltage, for electric field controlled spin valves. The spin-dependent transport characteristics here reveal new features such as negative conductance oscillation and switching of the sign of MR due to change in the majority spin carrier type. Our study creates possibilities for the design of nanometric spin valves, which could enable integration of memory and logic elements for all phosphorene 2D processors.

Background: Although there is a growing body of literature on cognitive and language processing in bilingual children with developmental language disorder (DLD), there is a major gap in the evidence for language intervention. Critically, speech-language therapists are often required to make clinical decisions for language intervention on specific domains, such as phonology, vocabulary, morphosyntax and literacy. Aims: To examine evidence for language intervention and cross-language transfer effects in bilingual children with DLD. Specifically, the study aimed to review intervention evidence targeting non-linguistic cognitive skills and six areas of language: phonology, vocabulary, morphosyntax, pragmatics, narrative skills and literacy. Methods & Procedures: We carried out searches in five electronic databases--CINAHL, Scopus, Psychinfo, Proquest and Sciencedirect. Data from selected papers were extracted and organized into the three following categories: study information, participant information and intervention information. Critical appraisal for selected papers was conducted using a quality assessment tool (QAT). Outcomes & Results: We included 14 papers in the review. The majority indicated evidence for vocabulary intervention. There was limited evidence for intervention targeting phonology or morphosyntax. Cross-language generalization effects were evident for vocabulary, but in some instances also reported for morphosyntax and literacy. Conclusions & Implications: The present review indicates that there is a significant gap in the literature regarding language intervention for several key language areas such as morphosyntax, narrative skills and literacy. There are only limited data for the effects of cross-language generalization indicating that more research is needed in this area specifically for skills beyond vocabulary.

Abstract Thermus thermophilus bacteriophage P23-45 encodes a giant 5,002-residue tail tape measure protein (TMP) that defines the length of its extraordinarily long tail. Here, we show that the N-terminal portion of P23-45 TMP is an unusual RNA polymerase (RNAP) homologous to cellular RNAPs. The TMP-fused virion RNAP transcribes pre-early phage genes, including a gene that encodes another, non-virion RNAP, that transcribes early and some middle phage genes. We report the crystal structures of both P23-45 RNAPs. The non-virion RNAP has a crab-claw-like architecture. By contrast, the virion RNAP adopts a unique flat structure without a clamp. Structure and sequence comparisons of the P23-45 RNAPs with other RNAPs suggest that, despite the extensive functional differences, the two P23-45 RNAPs originate from an ancient gene duplication in an ancestral phage. Our findings demonstrate striking adaptability of RNAPs that can be attained within a single virus species.

Context: Evidence shows that knowledge is important in tackling pandemics. By assessing awareness and knowledge about the coronavirus, more profound insights can be gained into existing public reception and practices, thereby helping to identify attributes that influence the adoption of healthy practices and responsive behavior. Assessing knowledge is important in identifying gaps and strengthening ongoing prevention efforts. Aims: The study aimed to investigate the geriatric population's knowledge, attitudes, and practices (KAP) toward coronavirus disease-2019 (COVID-19) during the pandemic spike. Settings and Design: The study was designed as a cross-sectional study; a questionnaire was developed regarding the World Health Organization training material for the detection, prevention, response, and control of COVID-19 and was validated by experts in geriatrics and public health. Materials and Methods: A prevalidated questionnaire consisting of four sections will be used. The first section consists of demographic data such as age and gender. The second, third, and fourth section will include prevalidated questions to gather information about the patient's KAP regarding general awareness of COVID-19 among geriatric patients in a tertiary care center in central Kerala. The inclusion criteria included patients of age 60 years and above, patients who are willing to participate in the study, and patients who are willing to give informed consent. The questionnaire was answered by over 199 participants anonymously from November 01, 2021, to February 08, 2022. Results: In our study, 199 participants were involved the mean knowledge score was 10.3 ± 1.224. The average attitude score regarding COVID-19 among the participants was 1.9 ± 1.1. The majority of the participants (67.8%) had a poor attitude toward COVID-19. There was a significant difference in average attitude scores according to socioeconomic status. According to the present study, the average correct answer score of the ten questions regarding COVID-19 practice was 6.3 ± 1.4. The majority of participants (75.4%) had moderate practice toward COVID-19. The average practice scores were significant difference among the socioeconomic status. Conclusions: The third wave of the pandemic demonstrated good knowledge, positive attitudes, and reasonable practice regarding COVID-19 during the outbreak. The results indicated the need for the health system to attempt to increase the public knowledge of the older people to improve their attitude and practice to deal with the crisis.

Background: Radiotherapy is the use of high energy ionizing radiation to treat diseases. With newer technological advancements, the application of radiotherapy in cancer treatment is increasing. Administration of radiation therapy requires great precision and competency, hence tools should be available to implement uniformity of care in the procedure of radiotherapy and to reduce medical errors. This necessitates the need of a checklist to serve as a standard guide for the procedure of radiotherapy. The objective of present study was to develop radiotherapy administration checklist for patients undergoing radiotherapy. Materials and methods: Radiotherapy administration checklist was developed by using methodological research design. The checklist was developed in five phases: i) the preliminary phase (including literature review, focused group discussion, assessment of current practices, generation of item pool and preparation of preliminary draft), ii) the validation phase (content validity by modified Delphi technique and construct validation by factor analysis), iii) pilot testing, iv) final try out followed by establishment of reliability (internal consistency and inter-rater reliability), v) evaluation phase. Results: The final draft of Radiotherapy administration Checklist consisting of 29 items was developed and the validity and reliability of the developed tool were established. In content validity, S-CVI/Avg. and S-CVI/UA were 0.97 and 0.79 respectively. Cronbach’s coefficient alpha, and interrater reliability were 0.64 and 0.76 respectively. All 29 items in final checklist were loaded under 8 factors. The checklist developed was found to be a valid and reliable tool for the procedure of Radiotherapy administration. Conclusion: Radiotherapy administration Checklist is a valid and reliable tool with psychometric properties within expected range. The Radiotherapy administration Checklist can be used as a standard tool to ensure safe, uniform and optimal delivery of radiotherapy.

Abstract The ribosomally synthesized and post-translationally modified peptide (RiPPs) class of natural products has undergone significant expansion due to the rapid growth in genome sequencing data. Using a bioinformatics approach, we identify the dehydrazoles, a novel class of hypermodified RiPPs that contain both side chain dehydration of Ser residues, and backbone heterocyclization at Ser, Thr, and Cys residues to the corresponding azol(in)es. Structure elucidation of the hypermodified peptide carnazolamide, a representative class member, shows that 18 post-translational modifications are installed by just five enzymes. Complete biosynthetic reconstitution demonstrates that dehydration is carried out by an unusual DUF4135 dehydration domain fused to a zinc-independent cyclase domain (CcaM). We demonstrate that CcaM only modifies Ser residues that precede an azole in the core peptide. As heterocyclization removes the carbonyl following the Ser residue, CcaM likely catalyzes dehydration without generating an enolate intermediate. Additionally, CcaM does not require the leader peptide, and this core-dependence effectively sets the order for the biosynthetic reactions. Biophysical studies demonstrate direct binding of azoles to CcaM consistent with this azole moiety-dependent dehydration. Bioinformatic analysis reveals more than 50 related biosynthetic gene clusters that contain additional catalysts that may produce structurally diverse scaffolds.

Background: Multiple myeloma is characterized by the uncontrolled proliferation of monoclonal plasma cells in the bone marrow, leading to the production of non-functional intact immunoglobulin chains. This retrospective study aimed to investigate the correlation between plasma cell percentage (below 60% and above 60%) in different types of monoclonal gammapathies (IgA, IgG) and various biochemical parameters. Methods: This analysis was conducted at the Division of Biochemistry in the Malabar Cancer Centre, a tertiary care cancer center in Kerala, India. A total of 89 patient case reports were reviewed, and complete treatment data were available for 60 patients. The study aimed to evaluate the relationship between plasma cell percentage (below 60% and above 60%) in different types of monoclonal gammapathies (IgA, IgG) and various biochemical parameters. Results: The majority of the patients enrolled in the study were above 60 years of age, and more men were included than women. Among the parameters studied, a significant increase in plasma protein level was observed in the group with a plasma cell percentage below 60% and IgG type monoclonal gammapathy (P value = 0.014, p < 0.05). Additionally, there was a significant elevation in WBC count in patients with plasma cell percentage below 60% and IgG type MM when compared to IgA type MM patients (p = 0.023, p < 0.05). However, no significant changes were observed in plasma protein level, liver enzyme activity, renal function, serum electrolytes, CBC, and calcium level between patients with plasma cell percentages above and below 60% in multiple myeloma. Conclusion: This study found that only a few biochemical and hematological parameters showed significant deviations between plasma cell percentages above and below 60% in different types of monoclonal gammapathies in multiple myeloma patients.

Abstract Catalytic asymmetric α-alkylation of carbonyl compounds represents a long-standing challenge in synthetic organic chemistry. Herein, we advance a dual biocatalytic platform for the efficient asymmetric alkylation of α-keto acids. First, guided by our recently obtained crystal structures, we develop SgvMVAV as a general biocatalyst for the enantioselective methylation, ethylation, allylation and propargylation of a range of α-keto acids with total turnover numbers (TTNs) up to 4,600. Second, we mine a family of bacterial HMTs from Pseudomonas species sharing less than 50% sequence identities with known HMTs and evaluated their activities in SAM regeneration. Our best performing HMT from P. aeruginosa, PaHMT, displays the highest SAM regeneration efficiencies (TTN up to 7,700) among HMTs characterized to date. Together, the synergistic use of SgvMVAV and PaHMT affords a fully biocatalytic protocol for asymmetric methylation featuring a record turnover efficiency, providing a solution to the notorious problem of asymmetric alkylation.

Climate change-induced heat stress combines two challenges: high day- and nighttime temperatures, and physiological water deficit due to demand-side drought caused by increase in vapor-pressure deficit. It is one of the major factors in low productivity of maize in rainfed stress-prone environments in South Asia, affecting a large population of smallholder farmers who depend on maize for their sustenance and livelihoods. The International Maize and Wheat Improvement Center (CIMMYT) maize program in Asia, in partnership with public-sector maize research institutes and private-sector seed companies in South Asian countries, is implementing an intensive initiative for developing and deploying heat-tolerant maize that combines high yield potential with resilience to heat and drought stresses. With the integration of novel breeding tools and methods, including genomics-assisted breeding, doubled haploidy, field-based precision phenotyping, and trait-based selection, new maize germplasm with increased tolerance to heat stress is being developed for the South Asian tropics. Over a decade of concerted effort has resulted in the successful development and release of 20 high-yielding heat-tolerant maize hybrids in CIMMYT genetic backgrounds. Via public–private partnerships, eight hybrids are presently being deployed on over 50,000 ha in South Asian countries, including Bangladesh, Bhutan, India, Nepal, and Pakistan.

The purpose of this research is to plug the research gap in the literature that lies in the association of quality of work life (QWL) and employee performance (EMP) in general, and hospitality industry. So, the research tries to develop and test a theoretical model to address the direct and indirect impact of QWL on EMP with job satisfaction (JSF) and life satisfaction (LSF) as the mediating variables. The research gap identified through the literature review was that there was no empirical study that explored this nexus. The research methodology uses interpretivist paradigm using structural equation modeling (SEM) to test the 10 hypotheses with a sample size of 206 middle-level managers chosen from 22 five-star hotels. Results indicated that QWL had positive significant relationship on JSF, LSF and EMP. LSF had a positive and significant relationship with EMP ([Formula: see text]; [Formula: see text]; [Formula: see text]), the QWL also had a significant and positive relationship with the LFS in the hospitality industry ([Formula: see text]; [Formula: see text]; [Formula: see text]), JFS and LSF had positive and significant relationship in hospitality industry ([Formula: see text]; [Formula: see text]; [Formula: see text]), QWL had a positive and significant relationship with EMP ([Formula: see text]; [Formula: see text]; [Formula: see text]), but JSF had no significant relationship with EMP. The indirect relationship has revealed that JSF mediates a significant positive relationship between QWL and life satisfaction.

Perianal fistula is a common disease affecting the general population but development of mucinous adenocarcinoma (MA) in a chronic perianal fistula is a rare entity. Due to the rare nature of the disease, there are no established guidelines regarding the diagnosis and management of the condition. The aim of this article is to report a case of MA perianal region that we managed surgically with an extra levator abdominoperineal resection and flap reconstruction.

Introduction: The World Health Organization (WHO)'s Research and Development (R&D) Blueprint for Action to Prevent Epidemics, a plan of action, highlighted several infectious diseases as crucial targets for prevention. These infections were selected based on a thorough assessment of factors such as transmissibility, infectivity, severity, and evolutionary potential. In line with this blueprint, the VACCELERATE Site Network approached infectious disease experts to rank the diseases listed in the WHO R&D Blueprint according to their perceived risk of triggering a pandemic. VACCELERATE is an EU-funded collaborative European network of clinical trial sites, established to respond to emerging pandemics and enhance vaccine development capabilities. Methods: Between February and June 2023, a survey was conducted using an online form to collect data from members of the VACCELERATE Site Network and infectious disease experts worldwide. Participants were asked to rank various pathogens based on their perceived risk of causing a pandemic, including those listed in the WHO R&D Blueprint and additional pathogens. Results: A total of 187 responses were obtained from infectious disease experts representing 57 countries, with Germany, Spain, and Italy providing the highest number of replies. Influenza viruses received the highest rankings among the pathogens, with 79 % of participants including them in their top rankings. Disease X, SARS-CoV-2, SARS-CoV, and Ebola virus were also ranked highly. Hantavirus, Lassa virus, Nipah virus, and henipavirus were among the bottom-ranked pathogens in terms of pandemic potential. Conclusion: Influenza, SARS-CoV, SARS-CoV-2, and Ebola virus were found to be the most concerning pathogens with pandemic potential, characterised by transmissibility through respiratory droplets and a reported history of epidemic or pandemic outbreaks.

A field experiment was conducted to study the effect of fertigation on chilli F1 Hybrid Arka Meghana during kharif of 2017 and 2018, with ten treatments, including different doses, sources of fertilizers and its frequency of application, in randomized block design with three replications. The pooled analysis revealed that application of fertilizer dose (125:100:125 kg N: P2O5: K2O ha-1) through fertigation on bi-weekly basis resulted in higher plant height (76.3 cm) at 80 days after transplanting, which was on par with the same dose and source applied at weekly interval (74.0 cm). These two treatments recorded higher fruit length (12.63 and 12.27 cm), number of fruits per plant (153.33 and 169.67) and dry weight of 10 fruits (9.00 and 8.63 g), respectively. All the fertigation treatments recorded higher yields over the conventional soil application of fertilizers to the tune of 14.84 to 61.55%. Among the fertigation treatments, application of 100% of fertilizer dose using water soluble fertilizers at bi-weekly interval resulted in significantly higher yield (32.44 t ha-1) compared to all treatments except the treatment where the weekly application of same dose of fertilizer through the same sources (31.81 t ha-1) and 75% of 125:100:125 kg N: P2O5: K2O ha-1 was applied weekly or bi-weekly intervals (29.23 and 30.01 t ha-1). Biweekly and weekly application of 100% fertilizer dose of 125:100:125 kg N: P2O5: K2O ha-1 through fertigation could yield maximum net income (Rs. 400151 and Rs. 387551 ha-1) with B: C (1.61 and 1.56). However, fertilizer applied to soil resulted in minimum net income of Rs.183054 ha-1 and B: C (0.84).

Abstract Maize is gaining impetus in non-traditional and non-conventional seasons such as off-season, primarily due to higher demand and economic returns. Maize varieties directed for growing in the winter season of South Asia must have cold resilience as an important trait due to the low prevailing temperatures and frequent cold snaps observed during this season in most parts of the lowland tropics of Asia. The current study involved screening of a panel of advanced tropically adapted maize lines to cold stress during vegetative and flowering stage under field conditions. A suite of significant genomic loci (28) associated with grain yield along and agronomic traits such as flowering (15) and plant height (6) under cold stress environments. The haplotype regression revealed 6 significant haplotype blocks for grain yield under cold stress across the test environments. Haplotype blocks particularly on chromosomes 5 (bin5.07), 6 (bin6.02), and 9 (9.03) co-located to regions/bins that have been identified to contain candidate genes involved in membrane transport system that would provide essential tolerance to the plant. The regions on chromosome 1 (bin1.04), 2 (bin 2.07), 3 (bin 3.05–3.06), 5 (bin5.03), 8 (bin8.05–8.06) also harboured significant SNPs for the other agronomic traits. In addition, the study also looked at the plausibility of identifying tropically adapted maize lines from the working germplasm with cold resilience across growth stages and identified four lines that could be used as breeding starts in the tropical maize breeding pipelines.

Introduction: Health-care workers (HCWs) across the country were administered Covishield (COVID vaccination) in a phased manner. This study aimed to explore the trends in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection postvaccination among HCWs, with a view of the demographic and clinical features among a subset of those affected. Materials and Methods: A cross-sectional study was performed at a tertiary care center among HCWs who were affected following vaccination during the period April 2021–October 2022. A Google Form was sent out to assess the disease profile and transmission dynamics of which a subset was returned. Results: A total of 1657 HCWs tested positive for coronavirus disease-2019 (COVID-19) during the period April 2021–October 2022. Of these, 77.42% were females and 92.67% were completely vaccinated. Nurses were the majority (46.30%) and the least-doctors (6.63%). The most common symptom presentation was cough (76.90%) and fever (73.50%), whereas anosmia, ageusia, and breathing difficulty were minimal. The mean duration between second dose and turning positive was between 165.54 ± 121.98 days. Among HCWs who turned positive, only 7.10% required hospital admission and only one person needed intensive care unit admission. Among those who reported positive, 54.60% mentioned that their close contacts subsequently turned positive. Of these, workplace and household contacts were 49.2% and 46.2%, respectively. Conclusion: The predominant symptoms in COVID-19 infection postvaccination are fever, cough, and myalgia. However, the severity of the infection was decreased, requiring mostly home isolation. Transmission of infection was mainly to household and workplace close contacts.

Aneurysmal subarachnoid hemorrhage is a life-threatening, neurological emergency characterized by accumulation of blood in the subarachnoid space due to a ruptured aneurysm. Over the past several decades, improvements in the clinical management of aneurysmal subarachnoid hemorrhage have led to better patient outcomes. However, aneurysmal subarachnoid hemorrhage is still associated with high morbidity and mortality. During the acute phase of aneurysmal subarachnoid hemorrhage and prior to the definitive management of the aneurysm, numerous medical emergencies, such as elevated intracranial pressure and cerebral vasospasm, must be effectively managed to ensure the best possible neurological outcome. Early and rapid open communication between the clinical specialties caring for the aneurysmal subarachnoid hemorrhage patient is vital for rapid data collection, decision-making, and definitive treatment. In this narrative review, we aim to present the current guidelines for the multidisciplinary acute management of aneurysmal subarachnoid hemorrhage.

Purpose: Reports suggest that females experience more adverse events post-coronavirus disease 2019 (COVID-19) vaccination compared to males. However, no gender-specific data on the impact of vaccines on the Indian population are available. The present study was intended to understand the impact of COVID-19 vaccines on the health status of young Indian female adults and to identify the factors associated with experiencing adverse events post-vaccination. Methods: A web-based survey was conducted among 433 young female adults who have taken at least one dose of the COVID-19 vaccine. The prevalence and duration of systemic and generalized symptoms were analyzed using descriptive statistics. The factors associated with symptoms post-vaccination were analyzed using binary logistic regression. Adjusted odds ratios and 95% confidence intervals were computed. A P value of ≤ 0.05 was considered to be statistically significant. Results: Of the 404 surveys returned (93.3%), 371 respondents have received both vaccine doses. COVISHIELD™ was the vaccine of choice among 73% of respondents and nearly 91% of the respondents reported a re-infection post-vaccination. At least one form of the symptom as a side effect of vaccination was experienced by 88.4% (n = 357) of the participants. This included generalized symptoms (77.5%) followed by musculoskeletal (53.2%), localized (38.9%), psychological (35.1%), gastrointestinal (25.5%), gynecological (24%), and endocrine symptoms (22.5%). Presence of chronic ailments was significantly associated with experiencing localized symptoms (OR 2.21, 95% CI 1.25-3.91), psychological symptoms (OR 2.41, 95% CI 1.34-4.34), neurological symptoms (OR 2.98, 95% CI 1.38-6.46), gastrointestinal symptoms (OR 4.76, 95% CI 2.59-8.75), respiratory symptoms (OR 2.45, 95% CI 1.29-4.67), endocrine symptoms (OR 2.92, 95% CI 1.58-5.38), and gynecological symptoms (OR 4.05, 95% CI 2.21-7.44). Older than 21 years was significantly associated with the experience of gynecologic symptoms (OR 2.12, 95% CI 1.24-3.64). Not being re-infected post-vaccination has lower odds of experiencing psychological, gastrointestinal, and respiratory symptoms. Conclusion: Our result suggests serious planning and counseling are warranted while disseminating COVID-19 vaccination among young female adults especially those with comorbidities to foster trust and coverage.

Background: Hyoid bone plays an important role in craniomandibular functions through its unique interaction with other structures. The effects of temporomandibular disorder (TMD) on the craniocervical posture and position of hyoid bone were considered, although the results endure inconclusive. Objective: The objective is the comparison of the position of the hyoid bone in patients with the temporomandibular joint disorder of pre- and post-neuromuscular orthotics utilizing cone-beam computed tomography (CBCT). Treatment using ultra-low-frequency transcutaneous electric nerve stimulation was administered, and a myocentric bite was registered, with which an orthotic was fabricated and delivered to the patient for full-time wear. Materials and Methods: The hyoid bone position of 14 TMD patients of pre- and post-treatment was observed using CBCT, and symptom severity score, joint pain, joint sounds, and limited mouth opening were studied pre- and post-treatment clinically. Results: All patients had relief of symptom severity score post treatment and no significant improvement in the anteroposterior direction of hyoid bone with no statistical significance with P value < 0.001. The majority of the patients had an inferiorly positioned hyoid bone post intervention with a P value less than 0.001. Conclusion: Neuromuscular orthotics resulted in a decrease in the symptom severity score of the patients along with an anteriorly and inferiorly positioned hyoid bone.

Objectives: To compare the need for mechanical cervical dilatation following vaginal misoprostol or synthetic osmotic dilator (Dilapan-S) usage for cervical preparation before operative hysteroscopy. Materials and Methods: Fifty-five premenopausal women scheduled for operative hysteroscopic procedures with a 26 Fr resectoscope were included in this randomized, controlled clinical trial. After randomization, either 400 μg of vaginal misoprostol or intracervical synthetic osmotic dilator (Dilapan-S) was inserted 12 h before operative hysteroscopy. The need for additional mechanical cervical dilatation before insertion of the resectoscope was compared between the two groups. Initial cervical diameter before mechanical dilatation, intraoperative complications (cervical tears, creation of a false passage), and ease of dilatation were also compared between the two groups. Results: In the misoprostol group, 92% of women required additional mechanical cervical dilatation, whereas only 36% of women in the Dilapan-S group required additional dilatation (P < 0.05). The median initial cervical diameter achieved with Dilapan was 9 mm (Q1: 7 mm; Q3: 10 mm), and with misoprostol, it was 6 mm (Q1: 4.5 mm; Q3: 8 mm) (P < 0.05). There was no significant difference in other outcome parameters between the two groups. Conclusion: Synthetic osmotic dilator (Dilapan-S) is more efficacious than vaginal misoprostol at ripening the cervix before operative hysteroscopy.

Problem Considered: Vitamin D deficiency is a global concern that needs significant attention. This observational study reports the impact of Vitamin D supplementation on general body aches, frequency of infection, and energy levels among Indian adults. Methods: This study included 508 adults aged 19–89 years old from low socioeconomic backgrounds who were given Vitamin D supplements for 4 months. The severity of musculoskeletal symptoms, frequency of infection or its symptoms, and perceived energy levels of the participants before and after the exposure were measured using a structured questionnaire. Data were analyzed descriptively for the frequencies, and a Chi-square and Wilcoxon signed-rank test was used to analyze the impact of Vitamin D on the variables studied. Results: The majority of the participants were female (82.3%) and were never exposed to Vitamin D supplementation earlier (84%). Nearly 65% of the participants were either homemakers, students, unemployed, or retired. Vitamin D supplementation was significantly associated with the reduction in back pain (P < 0.001), fatigue and body pain (P < 0.001), knee pain (P < 0.001), and pain in the hands and legs (P < 0.001). Vitamin D also significantly reduced the frequency of infection and/or its symptoms (P < 0.001) and improved physical work capacity (P < 0.001). Conclusion: Vitamin D supplementation for urban low socioeconomic groups may be beneficial as it can reduce the pain, frequency of infection and improve general well-being. The limitations of this study, such as the lack of a nonexposed group and data on the Vitamin D status of the participants, warrant consideration in future studies.

Background: Due to the close proximity to the oral cavity, shade guides are prone to contamination with saliva. Hence, disinfection of shade guides is important to prevent cross infection in clinics. This study has compared and evaluated the color change in VITA shade guide and the WALDENT shade guide after disinfecting with 70% isopropyl alcohol. Objectives: The objective of this study was to compare and evaluate the amount of color change in the VITA shade guide and WALDENT shade guide after disinfecting them with 70% isopropyl alcohol for the simulated time of 6 months and 1 year. Materials and Methods: Four commonly used shade tabs, namely A2, A3.5, B2, and C1 of two shade guides – VITA Classical Shade Guide and Waldent shade guides – were chosen for this study. VITA Easyshade spectrophotometer measured the shade, and the values were recorded in the International Commission on Illumination L*a*b* Scale. Baseline values of 8 shade tabs were obtained followed by surface disinfection using 70% isopropyl alcohol using gauze. The testing process was done to simulate a 6-month period and 1-year period. Results: Unpaired t-test was used for statistical analysis. It was found that shade tabs underwent significant changes in short period of time. Conclusion: Within the limitations of this study, it was found that shade guides undergo significant changes in color when disinfected with 70% isopropyl alcohol during a simulated period of 6 months. Clinical Significance: If shade guides are not periodically evaluated using a control (preferably unused) shade guide, they may have a profound impact on resulting restoration.

Objective: The objective of this study was to assess the test–retest reliability and inter-rater agreement between the traditional Chinese medicine (TCM) pulse diagnosis between two Indian TCM practitioners. Methods: A total of 300 participants were evaluated for their bilateral pulse based on TCM independently by two investigators with similar years of experience but who graduated from different medical schools. The investigators who were blinded diagnosed the participants as per TCM based on the depth, rate, and strength of their pulse. Cronbach α and weighted kappa were used for assessing the reliability and repeatability. Results: The data of all the 300 participants were included in the analysis. The test–retest reliability computed using Cronbach's alpha indicated high reliability between the investigators (α =0.963). There were a total of 37 different types of diagnoses identified by both investigators. The investigators diagnoses matched for 116 participants out of 300 participants; whereas 184 cases were not matched between the investigators. The inter-rater agreement for the TCM diagnosis tested by weighted Kappa did not returned any significant agreement (Kappa = 0.370). Discussion: The present study shows higher reliability between the pulse diagnoses between the investigators. However, the inter-rater agreement for TCM diagnosis based on pulse diagnosis was not significant probably due to the variation in subjective assessments. This calls for the standardization of training in TCM diagnostic methods among practitioners. Future studies should include the differences in training, medical education, and experience among the practitioners while determining the reliability of pulse diagnosis.

Introduction Temporomandibular joint disorders (TMD) present with a multitude of symptoms that can range from headaches to shoulder pain. Patients frequently present with pain in the ear, dizziness, and vertigo. It is noted that some patients who report TMDs also have a history of sleep disturbances, which is noted in cone beam computed tomography (CBCT) as a reduction in the oropharyngeal airway volume.

Introduction: Nursing students are valuable human resources in the health profession. During their student life, they face a great deal of stress, which can negatively affect their mental and physical health, as well as their academic performance. However, there is limited evidence regarding stress, anxiety, and depression among nursing students in Karnataka, India. Aim: To estimate the prevalence of stress, anxiety, and depression among nursing students and determine the factors associated with these conditions amongst them. Materials and Methods: A cross-sectional study was conducted at Department of Community Medicine, Mysore Medical College and Research Institute, Mysuru from March 2022 to August 2022, involving 200 undergraduate nursing students. The study included nursing students from the 1st year to the 4th year. Data was obtained using a predesigned and pretested questionnaire consisting of two parts: the first part collected details on sociodemographic and academic parameters, and the second part assessed psychological parameters using the Depression, Anxiety and Stress scale (DASS) 21 Scale. Data were entered into an excel spreadsheet and presented as frequencies and percentages using Statistical Package for Social Sciences (SPSS) software version 24.0. Factors associated with stress, anxiety, and depression were analysed using the Chi-square test, with a p-value

Gingival diseases are commonly observed in children and young adults. However, Giant Cell Fibroma (GCF) is a rare occurrence in children, accounting for only 2.2-7.3% of oral fibrous tumour cases. Clinically, these lesions often resemble squamous papillomas, and a definitive diagnosis can only be confirmed through histopathological {Haematoxylin and Eosin (H&E)} examination. Hereby, the authors present a rare case of gingival GCF in a three-year-old boy who presented with a pebbly growth on the mandibular gingiva. Initially, the lesion was clinically diagnosed as a papilloma and subsequently excised. The final diagnosis of GCF was established through histological examination. It is crucial for paediatric dentists to consider GCF as a differential diagnosis for lesions, particularly those with a papillary surface. Additionally, submitting all excised specimens for histopathological examination is recommended.

BACKGROUND: Due to the physical demands of work, blue-collar workers (BCW) frequently experience fatigue, musculoskeletal pain, and burnout. The purpose of this study was to determine the feasibility and utility of introducing yoga-based loosening exercises (YLE) at the workplace for improving fatigue, musculoskeletal pain, and burnout among BCW. MATERIALS AND METHODS: One hundred and twenty-eight BCW were randomized into a yoga group that received 40 minutes of supervised YLE daily, 5 days a week, for 1 month, followed by 1 month of unsupervised practice at home or a waitlisted control group. The Chalder Fatigue Scale (CFS), Visual Analog Scale for pain, Oldenburg Burnout Inventory (OLBI), sit-and-reach test (SRT), handgrip strength dynamometer, and the Short Form-8 (SF-8) questionnaire were measured at baseline, at the end of the first month, and at follow-up after the first month. RESULTS: All the participants adhered well to the YLE (≈86% at the workplace, ≈70% at home). Compared to the controls, the yoga group reported significant reductions in fatigue, pain, and burnout and significant improvements in flexibility, strength, and quality of life (P < 0.001) at all the time points. CONCLUSION: Our findings demonstrate that workplace yoga programs for BCW are feasible and can considerably reduce fatigue, pain, and burnout and improve their quality of life.

Lei et al. systematically characterized the epistasis among natural mutations in the neuraminidase of human influenza H3N2 virus, which provide insights into the biophysical constraints that shaped its evolution trajectory over the past half-century.

Background: The present study is a retrospective observational analysis of patients diagnosed with DLBCL and T cell lymphoma during the period of January 2011 to December 2015 at Malabar Cancer Centre, Thalassery. Several studies have shown that ALC and LMR can be used as prognostic indicators for diagnosis, treatment and survival in DLBCL. But there were very few studies done on the correlation of these parameters with T cell lymphoma. So we analysed the influence of haematological parameters in both DLBCL and T cell lymphomas. The primary objective of the present study was to correlate haematological parameters and LMR as predictors of DLBCL and T cell lymphomas. Methods: We analysed total cases of 108 with DLBCL and 25 with T cell lymphomas. The study was done to determine the changes in haematological parameters including WBC count, Platelet count, Hb, HCT, lymphocyte count, monocyte count, ALC, AMC and lymphocyte monocyte ratio in diffuse large B cell lymphoma and T cell lymphomas before and after chemotherapy. Results: The results showed a significant decrease (p˂ 0.05) in the blood platelet counts after chemotherapy in DLBCL. AMC in female patients with DLBCL were decreased (0.69 ± 0.36 to 0.53 ± 0.31; p-value = 0.023) and this was highly significant. LMR was also increased (3.47 ± 3.05 to 5.22 ± 4.34; p-value = 0.048) in female patients with DLBCL. Conclusion: Haematological parameters can be used as a prognostic marker in predicting the extent of disease progression and the effectiveness of the treatment adopted.

Although several therapeutics are used to treat coronavirus disease 2019 (COVID-19) patients, there is still no definitive metabolic marker to evaluate disease severity and recovery or a quantitative test to end quarantine. Because severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infects human cells via the angiotensin-converting-enzyme 2 (ACE2) receptor and COVID-19 is associated with renin-angiotensin system dysregulation, we evaluated soluble ACE2 (sACE2) activity in the plasma/saliva of 80 hospitalized COVID-19 patients and 27 non-COVID-19 volunteers, and levels of ACE2/Ang (1–7) in plasma or membrane (mACE2) in lung autopsy samples. sACE2 activity was markedly reduced (p

The development of multiomic profiling tools has rapidly expanded in recent years, along with their use in profiling skin tissues in various contexts, including dermatologic diseases. Among these tools, single-cell RNA-sequencing (scRNA-seq) and spatial transcriptomics (ST) have emerged as widely adopted and powerful assays for elucidating key cellular components and their spatial arrangement within skin disease. In this paper, we review the recent biological insights gained from the use of scRNA-seq and ST and the advantages of combining both for profiling skin diseases, including aberrant wound healing, inflammatory skin diseases, and cancer. We discuss the role of scRNA-seq and ST in improving skin disease treatments and moving toward the goal of achieving precision medicine in dermatology, whereby patients can be optimally matched to treatments that maximize therapeutic response.

BackgroundMonocytes and monocyte-derived tumor infiltrating cells have been implicated in the immunosuppression and immune evasion associated with pancreatic adenocarcinoma (PDAC). Yet, precisely how monocytes in the periphery and tumor microenvironment in patients with intraductal papillary mucinous neoplasm (IPMN), a precursor lesion to PDAC, change during disease progression has not been defined. Here we functionally profiled the peripheral immune system and characterized the tumor microenvironment of patients with both IPMN and PDAC. We also tested if sera from patients with IPMN and PDAC functionally reprogram monocytes relative to that of healthy donors.MethodsPancreatic tissue and peripheral blood were collected at the time of resection from 16 patients with IPMN and 32 patients with PDAC. Peripheral blood and pancreatic tissue/tumor were immunophenotyped using flow cytometry. Whole blood was plated and incubated with R848 (a TLR 7/8 agonist) or LPS (a TLR4 agonist) for 6 hours and TNF expression in monocytes was measured by flow cytometry to measure monocyte activation. To test if TLR sensitivity is determined by factors in patient sera, we preconditioned healthy donor monocytes in serum from PDAC (n=23), IPMN (n=15), or age-matched healthy donors (n=10) followed by in vitro stimulation with R848 or LPS and multiplex cytokine measurements in the supernatant.ResultsTNF expression in R848-stimulated peripheral blood monocytes was higher in patients with low grade vs high grade IPMN (65% vs 32%, p = 0.03) and stage 1 vs stage 2/3 PDAC (58% vs 42%, p = 0.03), this was not observed after LPS stimulation. TLR activation correlated with increasing grade of dysplasia from low grade IPMN to high grade IPMN. Serum from patients with IPMN and PDAC recapitulated suppression of TNF induction after R848 stimulation in naïve, healthy donor monocytes.ConclusionPeripheral blood monocyte TNF secretion inversely correlates with the degree of dysplasia in IPMN and cancer stage in PDAC, suggesting innate immune reprogramming as IPMNs progress to invasive disease. These effects are, at least in part, mediated by soluble mediators in sera.

ObjectivesThe aim of this study is to identify the characteristics of patients who underwent yoga therapy for pain in yoga and naturopathy clinical settings in India.MethodsElectronic medical records of patients who received yoga therapy for pain in three inpatient yoga and naturopathy hospitals were reviewed retrospectively from January 2021 to September 2022. Demographic characteristics and details on pain condition, socioeconomic status, comorbidities, ancillary therapies received, and insurance status were collected. In addition, we prospectively collected data on adherence to yoga practice through a telephonic interview.ResultsA total of 984 patients were identified from a pool of 3,164 patients who received yoga therapy for pain for an average of 9.48 (1.13) days. Patients aged between 8 and 80 underwent therapy for varying pain conditions and diseases that include pain in the extremities, pain due to infection, trauma, degenerative diseases, autoimmune diseases, and spine and neurological diseases. The majority of the patients were females (66.3%), from middle class families (74.8%), and who did not have any insurance coverage (93.8%). Most of the patients were under naturopathy treatment (99.8%), followed by ayurveda (56%), and physiotherapy (49.3%), along with yoga therapy. All patients reported a significant reduction in pain post-integrated yoga therapy (p

Abstract Dehydration of the upper airways increases risks of respiratory diseases from COVID-19 to asthma and COPD. We find in human volunteer studies involving 464 human subjects in Germany, the US, and India that respiratory droplet generation increases by up to 4 orders of magnitude in dehydration-associated states of advanced age (n = 357), elevated BMI-age (n = 148), strenuous exercise (n = 20) and SARS-CoV-2 infection (n = 87), and falls with hydration of the nose, larynx and trachea by calcium-rich hypertonic salts. We also find in a protocol of exercise-induced airway dehydration that hydration of the airways by calcium-rich salts increases oxygenation relative to a non-treatment control (P