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Background: Fitusiran, a subcutaneous, investigational siRNA therapeutic lowers antithrombin to rebalance hemostasis and enhance thrombin generation in People with Hemophilia (PwH) A or B, regardless of inhibitor status. For the management of perioperative hemostasis, Bleed Management Guidelines (BMG) with reduced dose and/or frequency of Clotting Factor Concentrates (CFC), or Bypassing Agents (BPA) were implemented. Aims: To describe hemostatic outcomes of major surgeries conducted while on fitusiran prophylaxis in PwHA/B aged ≥12-years, regardless of inhibitor status. Methods: All major surgeries in the fitusiran clinical development program until June 2023 were evaluated, including participants on the 80 mg QM and revised antithrombin-based dose regimen. Informed consent and ethics committee approval were obtained for all studies. Procedures conducted during fitusiran prophylaxis and AT activity < 60% were included. Major surgeries included: opening into a major body cavity, operation on a joint, removal of an organ, operative alteration of normal anatomy, crossing of a mesenchymal barrier, dental extraction of molar teeth or ≥3 nonmolar teeth, or tooth implantation. Investigators/surgeon assessed peri-operative hemostatic control based on the ISTH 4-point response scale (excellent/good/moderate/poor). Results and discussion: Sixty major surgeries (24 in inhibitor patients) were performed. In 47 (78.3%) major surgeries, BMG were followed, and reduced doses were used as perioperative prophylaxis. Four major surgeries were conducted without additional CFC/BPA. Hemostatic control on the day of the surgery was rated excellent/good in 30/31 (97%) cases following BMG and 9/10 (90%) cases not following BMG. ATIII concentrate was used to reverse the pharmacodynamic effect of fitusiran in 7 surgeries with an excellent/good hemostatic outcome. No major treatmentrelated safety concerns were identified perioperatively. Postoperative thrombosis occurred only when dosing exceeded BMG recommendations in 2 participants. Conclusions: Major surgeries can be safely and effectively conducted during fitusiran prophylaxis when BMG are followed, irrespective of inhibitor status. Reversal of lowered AT is not necessary.

This article investigates the flow dynamics of electrically conducting dusty hyperbolic tangent fluid over a stretching sheet with thermal radiation and heat source effects. Moreover, the suspension of Aluminium oxide (Al2O3) and Tantalum nanoparticles in engine oil as base fluid at 300 K is considered. The flow and thermal dynamics are analysed using Xue and Hamilton Crosser's thermal conductivity models. Moreover, using various ranges, the effect of the Richardson number on forced, mixed and natural convection is examined. The governing partial differential equations of the flow model are converted into ordinary differential equations and then solved numerically using the boundary value problem solver BVP4C along with the shooting technique in MATLAB. The Xue model enhances the heat transfer rate by 3.55% compared to the Hamilton Crosser model ϕ1 = 0.03, ϕ2 = 0.01, R = 0.1, Q = 0.6, βt = 0.2, βv = 0.07. A moderate adjustment to the Richardson number can reduce skin friction by 0.889% in the case of forced convection. The absence of dust particles enhances the thermal and momentum boundary layer thickness. Tantalum nanoparticles outperform Al2O3 in terms of temperature and velocity. It is possible to regulate the temperature and velocity of the backflow by changing the heat source parameter and the nanoparticle volume percentage. The maximum achievable heat transfer rate in the fourth experimental run is 0.2609 when R = 2.5 and Q = 1.5 as determined by the quadratic regression analysis.

Stroke is the second leading cause of death and a major cause of disability worldwide. Stroke severity scales serve as reliable means to track a patient's neurological deficit, predict outcome, and guide treatment decisions in clinical practice. The National Institute of Health Stroke Scale (NIHSS) was introduced over 30 years ago, marking a significant milestone in the field of stroke. Over the years, there have been notable advancements in acute stroke care. Despite several modifications made to NIHSS, none has yet succeeded in effectively capturing all the complex effects of a stroke. This review focuses on the pitfalls of NIHSS and emphasizes the need for a quick and comprehensive clinical and upgraded version of the stroke severity rating scale.

Background and Aims: Dexmedetomidine has been used as an anti-shivering agent in the perioperative period in pregnant patients undergoing caesarean section (CS), but its effectiveness remains inconclusive. This systematic review and meta-analysis aimed to assess the efficacy of intravenous Dexmedetomidine in the management of shivering. Methods: PubMed, MEDLINE, Embase, Scopus, Web of Science, CENTRAL, and Google Scholar were explored for the randomised controlled trials (RCTs), which compared intravenous administration of Dexmedetomidine with normal saline (placebo) or other anti-shivering agents for the prevention or treatment of shivering in pregnant patients undergoing CS under central neuraxial blockade. The primary outcome was either incidence and/or severity (for prevention) and duration and/or success rate (for treatment) of shivering between the two groups. The secondary outcome measures were adverse effects (bradycardia, hypotension, sedation, nausea and vomiting, and effect on the APGAR scores of the baby) if observed. Data were synthesised using a random effect model. We calculated the odds ratio (95% CI) for presenting the categorical outcome and standardized mean difference (95% CI) for continuous outcomes. Heterogeneity was assessed using I2 statistics and was investigated using sensitivity analysis. Results: A total of 15 RCTs were included in the present systematic review and data from 10 RCTs comparing Dexmedetomidine with normal saline were pooled into the meta-analysis for primary outcome measure. The incidence and severity of shivering at 30 and 60 minutes weresignificantly less in the Dexmedetomidine group compared to the normal saline group [OR = 0.30, 95% CI: 0.19 to 0.47, P < 0.0001; MD = -0.54, 95% CI: -0.81 to -0.26, Z = 3.78, P = 0.0002 and MD = -1.06, 95% CI: -1.46 to -0.66, Z = 5.23, P < 0.0001 respectively]. Similarly, the time to reduce shivering was significantly lower and the success rate of treatment was higher in the Dexmedetomidine group compared to the normal saline group [MD = -13.55, 95% CI: −17.78 to -9.12, Z = 6.0, P < 0.0001 and OR = 0.03, 95% CI: 0.02 to 0.07, P < 0.0001 respectively]. There was no heterogeneity among the studies for incidence, severity at 60 minutes, and success rate of treatment outcome, while the severity of shivering at 30 minutes and time to reduce shivering demonstrated moderate heterogeneity. The side effect profile was comparable between the Dexmedetomidine and control (active and passive) group. Conclusion: This meta-analysis shows that intravenous administration of Dexmedetomidine for both prophylaxis and treatment is superior to normal saline in the management of perioperative shivering during CS, but is comparable to other most commonly used anti-shivering agents. There is no statistically significant difference in the incidence of side effects between the two groups.

In the domain of medical research, the importance of developing precise and informative elements such as the title, abstract, keywords, and authorship criteria cannot be overstated. This article provides salient points on drafting these essential components for effective communication, dissemination, and ethical behavior in the medical research field.

Background: Mechanical thrombectomy has been established as a safe, standard and effective treatment option for occlusions of the proximal segment of the middle cerebral artery (MCA), as demonstrated in numerous studies. However, performing thrombectomy in the M2 divisions of MCA presents inherent challenges. In this institutional experience, we aim to delineate the recanalisation rates achieved through mechanical thrombectomy in cases involving the M2 segment of the MCA.Methods: We conducted a retrospective analysis of patients who underwent thrombectomy due to M2 MCA occlusions in the period from January 2018 to December 2021. Various factors affecting recanalisation rates were assessed.Results: A total of 15 patients with M2 segment occlusions of the middle cerebral artery were included in the study, comprising 11 in the superior division and 4 in the inferior division. The successful recanalisation rate was 72.33%, with notably higher success observed in cases of inferior division occlusion. The primary outcome of our study was the mTICI recanalisation status, categorised as successful recanalisation (mTICI = 2b or mTICI = 3) and unsuccessful recanalisation (mTICI = 1 or mTICI = 2a) and mRS at 6 months. None of the predictors assessed reached statistical significance.Conclusions: Mechanical thrombectomy demonstrates favourable efficacy and recanalisation rates in cases of M2 MCA division occlusion. Notably, inferior division occlusions exhibit a higher likelihood of successful recanalisation.

Background: Minimum clinically important difference (MCID) is the smallest change in an outcome measure that is considered clinically meaningful. Using validated MCID thresholds for outcomes powers trials adequately to detect meaningful treatment effects, aids in their interpretation and guides development of new outcome measures. Objectives: To provide a comprehensive summary of MCID thresholds of various symptom severity scales reported in movement disorder. Methods: We conducted systematic review of the literature and included studies of one or more movement disorders, and reporting MCID scales. Results: 2763 reports were screened. Final review included 32 studies. Risk of bias (RoB) assessment showed most studies were of good quality. Most commonly evaluated scale was Unified Parkinson's Disease Rating Scale (UPDRS) (11 out of 32). Four studies assessing MDS-UPDRS had assessed its different sub-parts, reporting a change of 2.64,3.05,3.25 and 0.9 points to detect clinically meaningful improvement and 2.45,2.51,4.63 and 0.8 points to detect clinically meaningful worsening, for the Part I, II, III and IV, respectively. For Parts II + III, I + II + III and I + II + III + IV, MCID thresholds reported for clinically meaningful improvement were 5.73, 4.9, 6.7 and 7.1 points respectively; while those for clinically meaningful worsening were 4.7, 4.2, 5.2 and 6.3 points, respectively. MCID thresholds reported for other scales included Abnormal Involuntary Movement Scale (AIMS), Toronto Western Spasmodic Torticollis Rating Scale (TWSRS), and Burke-Fahn-Marsden Dystonia Scale (BFMD). Conclusion: This review summarizes all the MCID thresholds currently reported in Movement disorders research and provides a comprehensive resource for future trials, highlighting the need for standardized and validated MCID scales in movement disorder research.

Writing a manuscript requires a lot of time and skill. The manuscript structure and reporting checklists play an important role for authors to complete the manuscript in a timely manner. This article presents the most salent points, highlights the usual mistakes to be avoided and suggests useful tips for writing a good manuscript.

Background: Simultaneous occurrence of duodenal atresia, annular pancreas, and situs inversus totalis is an exceedingly rare clinical condition. This may pose management-related challenges to the treating surgeon. Case Presentation: We report a case with a preoperative diagnosis of duodenal atresia and situs inversus. Intraoperatively, an annular pancreas encircling the duodenum was found. Instead of duodenoduodenostomy, a duodenojejunal anastomosis was performed. The postoperative course remained uneventful. The patient is doing fine on a 6-month follow-up. Conclusion: The simultaneous presence of multiple anomalies in this patient prompted us to utilize an alternative approach to relieve the duodenal obstruction. This report highlights the importance of tailoring surgical decisions based on the individualized needs of the patient.

Background: Melioidosis, caused by Burkholderia pseudomallei, is becoming a disease of public health importance. Despite appropriate treatment, the disease is associated with a high mortality due to the non-availability of diagnostic modalities at primary care and due to delayed presentation to the tertiary care hospital. Methods: This is a retrospective observational study of 12 cases of culture-proven melioidosis diagnosed at a tertiary care hospital in Hyderabad in South India over a period of 15 months. This study presents the epidemiology, risk factors, clinical and radiological manifestations and outcomes of patients with culture-proven melioidosis. Results: The study included 12 participants, out of which 11 were male, with a mean age of 39 years. Diabetes mellitus was the most common comorbidity in our series. The most common organs involved were lung (n = 5) and bone (n = 4). The other organs involved were prostate, liver, skin and soft tissue, spleen, aorta, brain, kidney and bone marrow. B. pseudomallei was isolated from pus culture in eight patients, blood cultures in seven patients and bone marrow culture in one patient. Eleven out of 12 patients were treated with meropenem. In our series, 7 out of 12 patients died; thus, a mortality of 58.3% was noted. Conclusions: Melioidosis is an emerging disease in India but remains under-recognised. This study showed that young males with diabetes, working in agricultural fields, are susceptible. Although the clinical manifestations are diverse, melioidosis should be suspected when patients with diabetes present with pneumonia and abscesses.

Gestational diabetes mellitus (GDM) is a serious and most frequent health complication during pregnancy which is associated with a significant increase in the risk of maternal and neonatal outcomes. GDM is usually the result of β-cell dysfunction along with chronic insulin resistance during pregnancy. Seshiah et al. pioneer work led to the adoption of Diabetes in Pregnancy Study Group in India criteria as the norm to diagnose GDM, especially in the community setting. In 2014, the Maternal Health Division of the Ministry of Health and Family Welfare, Government of India, updated guidelines and stressed upon the proper use of guidelines such as using a glucometer for self-monitoring and the use of oral hypoglycaemic agents. The 2018 Government of India guidelines stress the importance of counselling about lifestyle modifications, weight control, exercise, and family planning.

Objective: To determine the feasibility, reliability, and acceptability of video teleconference (VTC)-based neuropsychological assessment using Addenbrooke's cognitive examination-III (ACE-III). Methods: This study was performed from January 2022 to April 2022, during the third wave of the COVID-19 pandemic in India. We administered ACE-III using video-teleconferencing and compared the scores to face-to-face (FTF) testing for the eligible participants. We also conducted a participant's satisfaction survey of VTC-administered ACE-III compared to FTF-administered ACE-III, using a 7-point Likert scale. Results: We screened 37 participants and 24 (64.9%) successfully underwent ACE-III testing through VTC. We included 20 patients (mean age: 62.7 ± 10 years, mean education: 12.0 ± 4.6 years, 85% men) for final analysis, (who completed both VTC and FTF-administered ACE-III). Nine patients had major neurocognitive disorder (dementia), eight had mild neurocognitive disorder (MCI), and three had subjective cognitive decline (SCD). The two tests were administered at a median gap of 36 (18,74.5) days. The Intraclass correlation coefficients (ICC) of ACE-3 total scores (0.97) and the subdomain scores was high (>0.8). There was “very low” to “no” bias on the Bland–Altman plots, across all domains. The mean overall satisfaction score was 4.1, indicating that VTC is “as good as” FTF. Conclusions: Results support the feasibility and acceptability of remote administration of ACE-III via VTC. There is a good agreement between the ACE-III scores across VTC and in-person conditions.

Cerebral collateral circulation refers to the auxiliary vascular structures which compensate cerebral blood flow when it has been compromised due to stenosis or occlusion of the principal supplying arteries. They play a vital role in sustaining blood flow to the ischemic areas in acute, subacute or chronic phases of ischemic stroke or TIA. Good collateral circulation has shown protective effects towards a favorable functional outcome and a lower risk of recurrence of stroke. The benchmark mechanical thrombectomy trials utilized these collateral scoring methods to guide patient selection and prognosticate favorable outcome models. This shows a promising future of the collateral circulation for extending the time frame of the reperfusion therapies by optimally guiding patient selection and moving from a “time window” to a “tissue window.”

Background and Purpose: There is an unmet need for a more effective thrombolytic agent in acute ischemic stroke (AIS) management. Various studies and meta-analysis suggest tenecteplase (TNK) as non-inferior over alteplase (rTPA). The present single-center study compares biosimilar TNK and rTPA in a tertiary care setting. Methods: Data of patients who presented with AIS and underwent intravenous thrombolysis (IVT) were recruited retrospectively from January 2018 to July 2021. Primary efficacy outcome was a modified Rankin score (mRS) at 90 days dichotomized at < = 2. Qualitative and quantitative variables were assessed using Chi-square test and Student's t-test, respectively. Results: A total of 160 patients, 103 in the rTPA and 57 in TNK group, were analyzed. The baseline characteristics were well matched apart from hypertension. Large artery atherosclerosis was the most frequent subtype of stroke among the two groups. Good functional outcome was seen in 47.92% of patients TNK and 64.77% of patients in rTPA group (p = 0.069). No difference was seen in the rates of any ICH (p = 0.29) and mortality at 3 months (p = 0.32) among the two groups. Conclusion: This present study observed no difference in the efficacy and safety between biosimilar TNK and rTPA. Our findings are in concordance with published trials showing equivalence between the two molecules.

Background: Teledentistry which is similar to telemedicine has emerged as a new tool for various dental disciplines. Teleperiodontics is a branch of telehealth which focuses on the application of digital communication technology into the field of periodontics without demanding a specialist presence. An early detection and diagnosis of periodontal conditions can not only treat the disease in its early stage but also prolong the health of the periodontium, thereby improving the overall quality of life of an individual. However, teledentistry has not penetrated into the field of periodontics to a level it has to in providing periodontal care. Hence, the aim of this questionnaire study was to assess the knowledge, attitude, and application of teleperiodontics into everyday practice among the dental surgeons at various levels. Materials and Methods: An electronic questionnaire consisting of 29 close-ended questions including sections assessing the knowledge, attitude, and practice of teledentistry and teleperiodontics was sent to dental colleges present in East and West Godavari districts of Andhra Pradesh. Results: A total of 350 responses were received and 80.57% dental surgeons were aware about teledentistry, and a total of 74% dental surgeons were likely to prescribe oral hygiene aids and medication for temporary management of periodontal conditions. Conclusion: Teleperiodontics is an emerging science whose knowledge, attitude, and application are yet to be explored.

Background: Stroke is a leading cause of death and disability globally. Over the last decade, digital health and related technology has emerged as a useful adjunct in the management of persons with stroke, particularly with the development of a large number of mobile phone applications dedicated to various aspects of stroke. However, whether social media can provide similar key support in stroke is an intriguing question. In this systematic review, we aimed to the scope and limits of social media platforms in care and research pertinent to persons with stroke. Methods: PubMed database was searched using Medical Subject Headings terms and exploded keywords. The search retrieved 556 abstracts, which were screened by two reviewers. Of these, 14 studies met the review inclusion criteria. Given the small number of studies and heterogeneity of outcomes, quantitative analysis was not possible. The review was registered on PROSPERO (CRD42022324384). Results: The social media platforms employed by the included studies comprised YouTube (n = 5), Twitter (n = 5), Facebook (n = 2), both Twitter and Facebook (n = 1), and WhatsApp (n = 1). Four assessed quality and accuracy of videos on YouTube available for stoke patients and caregivers. Three used social media to research link between role of gender and stroke descriptors on social media platforms, and one studied Twitter-derived racial/ethnic perceptual construction on the occurrence of cardiovascular disease. Three studies described use of social media by stroke survivors, in post-stroke care and engagement. 11 studies were assessed to be of “fair” quality and three were assessed to be of “poor” quality. Conclusions: Limited preliminary data of low quality indicates that social media is used by persons with stroke and their caregivers, and may be harnessed as a tool of education and research. Future studies must address the current lack of high-quality evidence for the use of social media in stroke care.

Context: Gingivitis is among the most prevalent periodontal disease occurring in the oral cavity, which is plaque induced and if untreated, can progress to periodontitis. Various adjunct chemotherapeutic agents are available for plaque control with their own pros and cons. Hence, a plaque-controlling therapeutic agent which is readily available at low cost and without any side effects is the need of the hour. According to the ancient texts, Ayurveda and the traditional culture of India, Curcuma longa is used externally for inflammation of skin and mucosa. Aims: To evaluate the therapeutic effect of curcuma gel on gingival health and its possible usage in the treatment of gingivitis. Settings and Design: This study comprises hundred participants with gingivitis which were divided randomly in two groups. Subjects and Methods: Experimental group – Scaling and topical application of curcuma gel and control group – Scaling alone without the topical application of curcuma gel. Clinical parameters (Gingival Index, Gingival Bleeding Index, and Plaque Index) were assessed at different time intervals (0, 7, 14, and 21 days) in both experimental and control groups. Statistical Analysis Used: Within groups, a repeated measures ANOVA model was used for repeated observations over a period which is followed by the Dunnett test for multiple comparisons. Experimental and control groups were compared for normally distributed data by Student's t-test. Whereas for skewed data, the Wilcoxon test or Mann–Whitney U-test was employed. Results: Statistically significant improvement of gingival health parameters was seen in the group which received topical curcuma oral gel application after scaling compared with the control group. Conclusions: Significant improvement in clinical parameters of gingivitis on the application of Curcuma oral gel after scaling with no obvious adverse effects suggesting its possible use as a topical adjunct treatment in clinical or community level prevention as well as treatment programs in the future.

Objective: To develop an automated algorithm to detect, quantify, and differentiate between tremor using pen-on-paper spirals. Methods: Patients with essential tremor (n = 25), dystonic tremor (n = 25), Parkinson’s disease (n = 25), and healthy volunteers (HV, n = 25) drew free-hand spirals. The algorithm derived the mean deviation (MD) and tremor variability from scanned images. MD and tremor variability were compared with 1) the Bain and Findley scale, 2) the Fahn–Tolosa–Marin tremor rating scale (FTM–TRS), and 3) the peak power and total power of the accelerometer spectra. Inter and intra loop widths were computed to differentiate between the tremor. Results: MD was higher in the tremor group (48.9 ± 26.3) than in HV (26.4 ± 5.3; p < 0.001). The cut-off value of 30.3 had 80.9% sensitivity and 76.0% specificity for the detection of the tremor [area under the curve: 0.83; 95% confidence index (CI): 0.75, 0.91, p < 0.001]. MD correlated with the Bain and Findley ratings (rho = 0.491, p = 0 < 0.001), FTM–TRS part B (rho = 0.260, p = 0.032) and accelerometric measures of postural tremor (total power, rho = 0.366, p < 0.001; peak power, rho = 0.402, p < 0.001). Minimum Detectable Change was 19.9%. Inter loop width distinguished Parkinson’s disease spirals from dystonic tremor (p < 0.001, 95% CI: 54.6, 211.1), essential tremor (p = 0.003, 95% CI: 28.5, 184.9), or HV (p = 0.036, 95% CI: -160.4, -3.9). Conclusion: The automated analysis of pen-on-paper spirals generated robust variables to quantify the tremor and putative variables to distinguish them from each other. Significance: This technique maybe useful for epidemiological surveys and follow-up studies on tremor.

Background: Numerous tests are available for determining the cause of exudate, but all these tests lack sensitivity and specificity, and they are not generally available. Adenosine deaminase (ADA) activity in pleural or peritoneal fluid is simple and useful investigation in diagnosis of exudate effusion, particularly in differentiating tuberculous from nontuberculous exudative effusion. Objectives: To estimate the diagnostic utility of pleural and peritoneal fluid ADA/serum ADA ratio, in the diagnosis of tubercular pleural effusion. Materials and Methods: A hospital-based cross-sectional diagnostic evaluation study was carried out among 50 patients with pleural effusions selected to assay ADA activity in pleural fluid and serum along with pleural fluid analysis. Effusions were classified into transudative and exudative after careful evaluation of all biochemical parameters of pleural fluid. Cutoff value for pleural ADA was taken as 60 U/L and for pleural/serum ADA was taken as 2.5. Results: Forty-three patients had exudative effusions among which 38 were tubercular and five were nontubercular, seven cases were transudative. Mean pleural ADA levels in tuberculous group (80.31 ± 24.84 U/L) were higher (P < 0.01) than nontubercular group (23.00 ± 5.22 U/L). Serum ADA levels in tubercular group (27.23 ± 7.32 U/L) were significantly higher (P < 0.0l) as compared to nontubercular group (14.95 ± 7.04 U/L). Serum ADA levels in tubercular group (27.23 ± 7.32 U/L) were also significantly higher as compared to the control group of healthy individuals (13.00 ± 2.75 U/L). Pleural ADA cutoff at 60 U/L gave a sensitivity and specificity of 81% and 100%, respectively, whereas pleural serum ADA ratio at a cutoff of 2.5 gave a sensitivity and specificity of 71% and 81%, respectively. Conclusion: The measurement of ADA in tubercular pleural effusion is not only relevant, but also of a high diagnostic value when other clinical and laboratory tests are either negative or inconclusive.

Recent demand of eco-friendly advanced materials for automotive components motivated to develop natural fiber-reinforced composites due to their extraordinary properties with minimum weight at low cost. The reinforcement of microcellulosic extracted from lignocellulosic materials can enhance the mechanical properties with astonishing the biodegradability quality in the polymer-based composites. Bahunia racemosa (BR) fibers were chosen to extract cellulose microfibers through chemo-mechanical method and the chemical compositions at different stages are determined by using ASTM standards. The average diameter of the extracted cellulose micro Bahunia racemosa fibers (CMBRF) found as 10 μm. The microfiber composites are fabricated at different weight fractions such as 20, 30, 40 and 50 by compression molding method. Surface properties of the produced fibers and fabricated composite structures are analyzed through microscopic techniques. The influence of reinforcement effect on the mechanical properties of fabricated composite structures is analyzed through standard testing methods. The composites reinforced with 40 wt% of cellulose microfibers exhibited highest enhancement about the tensile strength and young modulus of 80.25 and 40%, respectively. The proposed composites can be used to make various low cost, light weight composite materials for industrial and construction industries.

Introduction Indian Council of Medical Research (ICMR), New Delhi has established a nationwide registry ‘Indian Registry for Venous Thromoembolism Disorder (i-RegVeD)’ for real-time analytics of sociodemographic profile of patients, disease patterns, management strategies, treatment choices and outcomes of patients with venous thromboemobolism (VTE). The purpose is to generate evidence on VTE in order to fill the gaps in the knowledge of the disease across various demographic regions.Methods and analysis This prospective hospital-based registry will be a continuous data collection process on the occurrence and characteristics of VTE from the 16 hospital sites pan India. This process would include obtaining clinical profiles, risk factors, diagnostic tests, treatment and outcome information of patients collected from medical records through an active method of data abstraction and data capture mechanism guided by an online web-based tool.Ethics and dissemination At centralised programme management unit, the study protocol was approved by the Institutional Ethics Committees (IEC) named ICMR-Central Ethics Committee on Human Research and similarly each of the participating site has obtained the ethical approval by their respective IECs. The results from this study will be disseminated publicly on the study website (https://iregved.icmr.org.in) as well as through scientific meetings and publications.

A comprehensive study was conducted to optimise cage space allowance (CSA) for White Leghorn (WL) layers (65-80 weeks of age). For the purpose, a total of 900 layers were housed in California colony cages in an open sided poultry house at three different CSA (422, 563, 844 cm2/bird). Each of the CSA was studied with 20 replicates. The daily egg production (EP), feed intake (FI), feed efficiency (FE, FI/egg mass) and egg quality traits were recorded at the end of each 28d interval. Anti-oxidant responses like lipid peroxidation (LP) and glutathione peroxidase, glutathione reductase and superoxide dismutase in blood were measured at 80 weeks of age. Similarly, the antibody titres against ND vaccine and cell mediated immune response (CMI) against PHA- P were measured at 80 weeks of age. The variation in CSA did not influence EP, egg mass, weight gain and egg shell thickness. The FI reduced and FE improved with reduction in CSA. However, the egg density and egg shell percentage increased with increase in CSA. The LP was higher and the activities of anti-oxidant enzymes were lower at 422 cm2/bird as compared to the higher space allowances. No effect of CSA on ND titre was observed, while the CMI response was higher at 844 cm2/ bird than the other two CSA. It could be concluded that, though the FE was better at 422 cm2/b, the trends of shell quality traits and antioxidant variables indicated 546 cm2/bird as requirement for WL layers in open sided poultry house under tropical regions.

Investigations were carried out to identify the source of resistance in 67 bottle gourd genotypes for gummy stem blight, powdery mildew and cucumber green mottle mosaic virus (CGMMV) diseases, under natural field epiphytotic conditions. The genotypes BG-95 (105.13), BG-114-1 (131.04), BG-114-3 (208.81) and BG-77-6-1 (221.80) were resistant for gummy stem blight with low AUDPC values, while, BG-125-5 (232.22), BG-6-3 found (250.00), BG-125-4 (307.78), BG-8-1 (308.89), BG-125-2 (311.11) and BG-124-2 (423.33) resistant with low AUDPC values for powdery mildew. Further, the two genotypes such as IIHR-19 and BG- 131 showed field level resistance against CGMMV. The selected genotypes based on field evaluation were subjected for artificial screening under glass house conditions. The genotypes, recorded consistent resistant reactions were BG-114-3, BG-77-6-1 and BG-95 for gummy stem blight disease and BG-6-3, BG-8-1, BG-125-4 and BG-125-2 for powdery mildew. The stable and durable source of resistance identified for gummy stem blight and powdery mildew in bottle gourd genotypes will hasten the process of developing resistance varieties in bottle gourd.

China aster [Callistephus chinensis (L.) Nees] is a flowering annual mainly cultivated for loose flower and cut flower, bedding and pot culture. To assess the genetic diversity, 42 genotypes were evaluated for fourteen quantitative traits. The genotypes were found to be highly variable for the traits such as plant height, plant spread, flower stalk length, 100 flower weight, number of flowers per plant, weight of flowers per plant and flower yield per hectare. However, low variability was recorded for vase life and shelf life. The genotypes were broadly grouped into two clusters, which were further divided into cluster 1a, 1b and cluster 2a, 2b, respectively. All the genotypes in cluster 1a were vigorous and medium flowering, whereas, genotypes in cluster 1b were tall, erect, vigorous and late flowering. The cluster 2a comprises of the genotypes with short stature, small flower and early flowering, however, cluster 2b contains only two genotypes. In principal component analysis (PCA) PC1 was highly correlated to flower yield, weight of flowers/plant, flower stalk length and plant height and PC2 was highly positively correlated to shelf life and vase life and negatively correlated to 100 flower weight. The results suggested that the existing variation in China aster genotypes could be used for the development of trait-specific novel genotypes.

Annealing of color centers was studied in lithium fluoride crystals, irradiated with 23-MeV nitrogen and 28-MeV oxygen ions. Basing on the optical absorption spectroscopy and reaction-rate modelling, a new interpretation of the annealing kinetics at the practically important temperatures below 500 K is suggested. Proposed model explains simultaneous decrease of the F and F _2 /F _3 ^+ peaks as a result of migration of the F centers and formation of larger aggregates, and does not include additional assumptions about impurities and cation vacancies. It specifies the migration energy of the F centers in the ground state to be about 1.3 eV, that corresponds to earlier studies.

In the field of sustainable energy storage systems, zinc-ion batteries (ZIB) employing aqueous electrolytes have emerged as viable successors to the widely used lithium-ion batteries, attributed to their cost-effectiveness, environmental friendliness, and intrinsic safety features. Despite these advantages, the performance of ZIBs is significantly hindered by the scarcity of suitable cathode materials, positioning manganese zinc oxide (ZnMn _2 O _4 ) as a potential solution. In this study, we describe the ZnMn _2 O _4 (ZMO) compound focusing on its properties variations during Zn extraction and potential battery applications. For the sake of comparison, we also analyze the same properties of the LiMn _2 O _4 in its tetragonal phase (TLMO), for the first time, motivated by a recent discovery that the substitution of Zn ions by Li in ZMO forms isostructural TLMO compound at room temperature. The study was conducted within the density functional theory (DFT) framework, where the structural, electronic, magnetic, electrochemical, and spectroscopic properties of ZMO and TLMO are investigated under various conditions. Although both systems crystallize in tetragonal structures, they demonstrate distinct electronic and magnetic properties due to different oxidation states of the Mn. Computationally optimized lattice parameters align closely with experimental values. The TLMO exhibits a narrower band gap compared to ZMO, indicating enhanced electrical conductivity. In addition, TLMO presented a lower diffusion energy barrier than ZMO, indicating better ionic conductivity. To evaluate the potential application of these materials in battery technologies, we further explored their volume changes during charging/discharging cycles, simulating Zn or Li ions extraction. TLMO underwent a significant volume contraction of 5.8% upon complete Li removal, while ZMO experienced a more pronounced contraction of 12.5% with full Zn removal. By adjusting ion extraction levels, it is possible to reduce these contractions, thereby approaching more viable battery applications. Voltage profiles, constructed from DFT-based simulation results, unveiled an average voltage of 4.05 V for TLMO, closely matching experimental values. Furthermore, spectroscopy results provide insights into the electronic transitions and validate the computational findings, consolidating our understanding of the intrinsic properties of ZMO and TLMO.

Ifosfamide, an analog of cyclophosphamide, is commonly used as a chemotherapeutic agent to treat sarcomas and solid tumors. However, neurotoxicity is a rare side effect of this drug. When present, the symptoms range from confusion, agitation, and delirium in mild cases to mutism, visual blurring, hallucinations, seizures, stupor, and even coma in extreme cases. Within this spectrum, extrapyramidal symptoms are extremely rare, and when present, may not revert with drug discontinuation. Sequelae may occasionally persist even after discontinuation of the drug. Our case illustrates a rare occurrence of ifosfamide-induced extrapyramidal neurotoxicity in a patient with metastatic phyllodes tumor of the breast and concomitant COVID-19 illness. Ifosfamide-induced extrapyramidal neurotoxicity is a clinical diagnosis of exclusion and requires ruling out of other possible causes. The diagnosis is supported by a temporal correlation with drug administration, presence of risk factors, and improvement after infusion cessation, along with normal brain imaging.

The aim of present study is to determine the mechanical properties of hollow concrete block masonry externally bonded with coir and glass textile reinforced mortar composites. The properties of textile composites were determined by testing TRM Coupons. A total number of 39 prisms were cast. The block masonry prisms were externally bonded with coir and glass textile fibre mesh with mortar. The elastic properties of block masonry, shear and flexural strength were determined for both unreinforced and strengthened specimens. The results showed that increasing the number of layers of textile fibers, enhanced the flexural capacity of TRM coupons. The provision of connectors also enhanced flexural strength. The stiffness of unreinforced masonry prisms was found to increase by strengthening with textile reinforcements even though the increase in compressive strength is marginal. There is a significant enhancement in flexural strength and shear bond strength when compared to unreinforced masonry.

The new CBME curriculum differs from the older one by being more learner and patient centric, outcome based, aligned & integrated, and emphasis on skill development, attitudes, ethics & communication. The affective domain which was implicit in the curriculum, is now to be taught explicitly. Newer additions like foundation course, early clinical exposure and self-directed learning are introduced. The curriculum implementation support programme is making tremendous efforts in inculcating the new curriculum into day-to-day teaching. The curriculum committee has a huge task to train the faculty in their respective colleges for a smooth transition. Hence, a thorough understanding of the new curriculum by these members is very essential. Keywords: Harden’s ladder, Integration

China aster [Callistephus chinensis (L.) Nees] is commercially grown as annual flower crop for cut flower and loose flower. It is used for flower decoration, preparation of bouquets and garlands. It belongs to the family Asteraceae and is native of China. Morphological characterization of China aster genotypes was carried out in the division of Floriculture and Medicinal Crops, ICAR-IIHR, Bengaluru during 2015-16 and 2016-17 by adopting DUS guidelines developed by Protection of Plant Varieties and Farmers Rights Authority, New Delhi. A total of 42 genotypes were characterized for 21 traits belonging to vegetative and floral traits. Among these 21 traits, two were monomorphic, four dimorphic and 15 were polymorphic indicating their potential for varietal characterization. This characterization clearly established distinctness among the different genotypes for various traits. This study will be useful for breeders/farmers to identify and differentiate China aster genotypes and to pursue protection under PPV and FR Authority, New Delhi. The characterizations of genotypes will also results trait specific information which can be used in the development of superior genotypes in China aster.

A line × tester set of 8 parents involving five females (Arka Kamini, Arka Poornima, Arka Aadya, Arka Archana, Arka Violet Cushion) and three pollen parents (Arka Shashank, Local Violet, Local Pink) were analyzed for heterosis with respect to growth, flower quality and yield traits in China aster [Callistephus chinensis (L.) Nees]. The experiments were conducted at Division of Floriculture and Medicinal Crops, ICAR-Indian Institute of Horticultural Research, Bengaluru during 2015-17. Results revealed that the cross L2 × T1 exhibited highest positive significant heterosis for plant height over mid parent, better parent as well as commercial check cv. Arka Kamini. For days to first flowering, cross L3 × T1 exhibited maximum negative heterosis over commercial check. The cross L2 × T1 exhibited highest positive significant heterosis for duration of flowering over mid parent, better parent as well as commercial check. For flower stalk length, the highest positive significant heterosis over mid parent, better parent as well as commercial check was observed in cross L4 × T3. The cross L3 × T2 recorded highest heterosis for flower yield over better, mid and commercial check.

Background: Global climate change has a major impact on occupational health. Construction workers are the most vulnerable group to work under a warmer planet. Potential health consequences to them include occupational skin diseases, musculoskeletal diseases, respiratory problems, cancers, mental health disorders, and infectious diseases. The incidence of occupational dermatitis and work-related musculoskeletal diseases is at its peak. This study aimed to bring out the burden of the above-mentioned occupational diseases among construction workers at Kottayam and also to calculate their heat strain score index as they are the most vulnerable group to work under a warmer planet. Objectives: To assess the prevalence of work related occupational dermatitis and musculoskeletal disorders among construction workers and also to calculate their heat strain score index. Materials and Methods: A cross-sectional study was conducted among 82 (n = 82) construction workers in Kottayam, Kerala. Purposive sampling was done. Validated, standard questionnaires were used to collect data by interview method, followed by clinical examination. Data were entered and analyzed in SPSS version 23. Results: Eighty-two construction workers participated in the present study. A total of 62% were migrants, and 38% were Keralites. Among 82 workers, nine (11%) of them reported having hand eczema and eight of them (9.8%) reported having wrist eczema. Neck pain (18.3%) and low back ache (18.3%) were the most common musculoskeletal symptoms. Heat strain score index of the workers was calculated. A total of 69.5% were in the green zone, 28% were in the yellow zone, and 2.5% were in the red zone. Conclusion: Construction workers are highly exposed to the risk of getting work-related occupational dermatitis and musculoskeletal disorders. The most common occupational skin complaint among these construction workers was itchy rash (12.2%). The overall prevalence of musculoskeletal symptoms was 51.2%. Neck pain and low backache were the most common musculoskeletal symptoms. On the calculation of heat strain score index, these workers were found to have a higher heat strain score index. A total of 28% in the yellow/alarm zone and 2.5% in the red/danger zone. Statistically significant association was established between the intensity of physical work (P = 0.0001) and the intensity of thirst (P = 0.001) with the total heat strain score.

Mental health and mental well-being of the population are the most important prerequisites for a good quality of life. A special position in the healthcare of the Russian Federation is occupied by the protection of the health of the younger generation, therefore, in the implementation of national projects, much attention is paid to the development of infrastructure for providing multiprofessional medical care to children and the prevention of mental and somatic diseases.Purpose. Description of the model of saving the mental health of the adolescent population, implemented in the city of Kirov (model). The presented materials reflect the advantages and novelty of the model organized with the involvement of the resources of related departments for the implementation of psychological education and continuous prevention with a risk group in schools, routing of persons with prenosological have shown the effectiveness of diagnostics using psycho-diagnostic screening to identify RISK GROUPS and PHENOMENOLOGICAL MENTAL STATES for further preventive work and medical and psychological assistance aimed at preventing the development of clinically pronounced MENTAL DISORDERS with impaired social adaptation.A detailed description of the stages of the model is presented, in which emphasis is placed on preventive work with the risk group in general education schools and medical, psychological and social care for persons with prenosological conditions in pediatric medical institutions, which reduces stigmatizing aspects and increases accessibility.Step-by-step implementation of measures involving administrative and human resources of departments providing preventive care and medical and psychosocial assistance to adolescents allows you to model and adapt the structure without attracting additional economic costs, which shows the versatility and functionality of the model.

Patients who face a stressful situation related to cancer and loss of a limb have not been thoroughly studied form a psychological perspective, what limits the possibilities of targeted psychological assistance and social rehabilitation. In this regard, the aim of the research was to study the clinical and psychological status, strategies and personal resources for coping with the stress of the disease, as well as the main parameters of the quality of life (QoL) of patients who underwent lower limb amputation due to cancer (group 1, n = 24, men — 62.5%, average age 47.25 ± 3.17), in comparison with patients amputated due to other somatic diseases not accompanied by an actual vital threat (group 2, n = 15, men — 93.3%, average age 59.67 ± 2.27), as well as with normative psychodiagnostic data. Methods of clinical and psychological diagnostics were used, including “Ways of Coping Questionnaire”, “Big V Questionnaire”, “Purpose in Life Test”, EORTC “Quality of Life of Cancer Patients Questionnaire” (QLQ-C30). It was found that functional capability (p

Background and Aims: Intubation with cuffed endotracheal tube (ETT) is common in operation rooms, critical care, and emergency rooms. The pressure exerted by the cuff on the tracheal mucosa can lead to a reduction in blood flow to the tracheal wall and result in mucosal ischemia. There are many methods for ETT cuff inflation. Aim of the study was to compare the cuff pressures and volumes between the three methods of ETT cuff inflation. Material and Methods: One hundred and twenty patients were randomized into three groups: Group SG (stethescope guided), group AL (audible leak), and group P (palpation). In group SG, the cuff was inflated by auscultating with the bell of the stethoscope over the thyroid cartilage for leak around cuff. In group AL, the cuff was inflated by listening for an audible leak around the cuff with observer's ear 5 cm away from the mouth of the patient. In group P, the cuff was inflated by palpating for a leak over the cricoid and trachea. The adequacy of the cuff seal was compared between the groups by assessing the volumes of additional air needed to stop the leak around the cuff as confirmed by supraglottic capnometry. Results: The initial volumes needed to inflate the cuff were significantly more in the stethoscope (SG) and hearing (AL) groups than in the palpation (P) group (SG = 5.1 ± 1.4 ml, AL = 4.6 ± 1.6 ml, P = 3.1 ± 0.9 ml; SG and AL vs. P, P < 0.001). Additional cuff volumes required to achieve zero leak around cuff by supraglottic capnometry were 0.85 ± 1 ml in group SG, 1.3 ± 1.1 ml in group AL, and 2.237 ± 0.8 ml in group P (SG vs. P and AL vs. P; P < 0.001). Conclusion: Out of the auscultation-guided, audible leak-guided, and palpation-guided methods of ETT cuff inflation, the auscultation-guided and audible leak-guided methods achieve significantly better tracheal seal than the palpation-guided method.

Context: Matrix metalloproteinases (MMPs) have widely been demonstrated in inflamed periodontal tissues and oral fluids. MMP3 is one of the MMPs which is effective in the degradation of numerous extracellular matrix substrates. It also participates in the proteolytic activation cascades of latent pro-MMP1, -8, and -9 which mediate collagenosis. Aims: This study aimed to estimate the gingival crevicular fluid (GCF) MMP3 levels in chronic periodontitis before and after scaling and root planing (SRP). Settings and Design: A total of 60 subjects aged 25–55 years are randomly selected from the outpatient department of periodontology of our institute and categorized into two groups of 30 each; Group I - periodontally healthy and Group II - generalized chronic periodontitis. Subjects and Methods: Clinical parameters such as plaque index, gingival index, probing depth, and clinical attachment loss were recorded in both groups. GCF was collected only once in Group I but twice in Group II. After the baseline records, Group II received SRP treatment followed by re-recording of clinical parameters and GCF sample collection 6 weeks posttreatment. GCF samples were analyzed for MMP3 molecule by enzyme-linked immunosorbent assay. Statistical Analysis Used: Data were analyzed by Student's t-test and Pearson's correlation coefficient. Results: All the clinical parameters showed improvements after the treatment procedure (P < 0.05). Baseline GCF MMP3 values in the test group were significantly higher than in controls (P < 0.05), and all the parameters decreased significantly after treatment (P < 0.05). Furthermore, the correlation between individual clinical parameters and biochemical parameter was positive but statistically insignificant (P > 0.01). Conclusions: Within the confines of this study, GCF MMP3 was increased in Group II subjects, suggesting its role in chronic periodontitis and the possibility of it being used as an early diagnostic biomarker.

Background and Purpose: We aimed to explore the characteristics, clinical features, predictors of seizure, and associated clinical outcomes in patients with cerebral venous thrombosis (CVT). Methods: We enrolled patients with CVT from January 2014 to July 2020. Prospectively patients were recruited from December 2018. We analyzed predictors of seizures and associated good functional outcomes (modified Rankin Scale, mRS: 0–2) using multivariable logistic regression. Results: We enrolled 153 patients with CVT in which 77 (50%) had presented with a seizure. The median age was 31 years (IQR 16-46), and the majority were men (73.2%). Focal to bilateral tonic-clonic was the most common seizure type (27%), followed by generalized seizures (22%). None of the patients had status epilepticus. Antiseizure medications (ASM) were used in 71% of patients at diagnosis, 42% having received them prophylactically. Supratentorial parenchymal involvement was seen in 72% of seizure patients compared to 38% in those without, and superior sagittal sinus was most commonly involved. Percentage of patients who achieved good clinical outcome (mRS 0-2) at 3 months did not vary significantly between both groups. The only predictor for seizures with CVT was the presence of a parenchymal lesion (OR-3.75, 95% CI 1.79-7.85), whereas seizure occurrence (OR- 12.55, 95% CI- 1.53-102.59) was associated with statistically significant risk for recurrent seizures, by multiple logistic regression analysis. Seizure occurrence was not associated with adverse functional outcomes. Conclusion: Seizures at presentation occurred in 50% of patients with CVT which was associated with a parenchymal lesion in the brain. There was no association between seizure at presentation and clinical outcome.

Introduction/Aims: Studies conducted during the coronavirus disease 2019 (COVID-19) pandemic have reported varied data regarding the incidence of Guillain–Barre syndrome (GBS). The present study investigated demographic and clinical features, management, and outcomes of patients with GBS during a specified period of the COVID-19 pandemic, and compared these features to those of GBS in the previous year. Methods: A multicenter, ambispective cohort study including 26 centers across India was conducted. Data from a pre-COVID-19 period (March 1 to August 31, 2019) were collected retrospectively and collected ambispectively for a specified COVID-19 period (March 1 to August 31, 2020). The study was registered with the Clinical Trial Registry India (CTRI/2020/11/029143). Results: Data from 555 patients were included for analysis: pre-COVID-19 (n = 334) and COVID-19 (n = 221). Males were more commonly affected during both periods (male:female, 2:1). Gastroenteritis was the most frequent antecedent event in 2019 (17.4%), whereas fever was the most common event in 2020 (10.7%). Paraparesis (21.3% versus [vs.] 9.3%, P = 0.001) and sensory involvement (51.1% vs. 41.3%; P = 0.023) were more common during COVID-19 in 2020, whereas back pain (26.3% vs. 18.4%; P = 0.032) and bowel symptoms (20.7% vs. 13.7%; P = 0.024) were more frequent in the pre-COVID period. There was no difference in clinical outcomes between the two groups in terms of GBS disability score at discharge and 3 months after discharge. Independent predictors of disability in the pre-COVID period included areflexia/hyporeflexia, the requirementfor intubation, and time to bulbar weakness; in the COVID-19 period, independent predictors included time from onset to admission, intubation, and intubation requirement. The mortality rate was 2.3% during the entire study period (13/555 cases). Discussion: Results of this study revealed an overall reduction in the frequency of GBS during the pandemic. The lockdown likely reduced the risk for antecedent infections due to social distancing and improved hygiene, which may have resulted in the reduction of the frequency of GBS.

Background and Aims: Bruns-Garland syndrome (BGS) continues to be a contentious topic even 100 years after its discovery. Its lifelong incidence is 1% amongst diabetic individuals and affects middle aged-elderly individuals with type 2 diabetes mellitus (usually not poorly controlled). Methods: The data presented in this review was collated from studies published on PubMed, MEDLINE and Google Scholar in October 2021. The search words included: “Bruns-Garland syndrome”, “diabetic amyotrophy” and “diabetic lumbosacral radiculoplexus neuropathy” and “proximal diabetic neuropathy”. Results: The exact pathophysiology is debatable but an ischemic pathology (non-systemic microvasculitis) is most plausible. Its cardinal symptoms include acute onset of severe proximal lower extremity pain followed by weakness and wasting, some sensory loss, weight loss and autonomic symptoms. Conclusion: The prognosis is good as most patients improve to near- normal strength with pain cessation within 18 months of onset.

Background and Objectives: An increasing prevalence of sexually transmitted infections especially Syphilis in blood donors may lead to increased donor deferrals and lessen the donor pool. Hence it is the need of the hour to device a structured screening methodology for Syphilis reactive donors. The aim of the study is to estimate the prevalence of syphilis in blood donors and to estimate the response rate of notified blood donors. Patients and Methods: This was a retrospective study, conducted in a Blood Centre (BC) on the blood donors visiting for donation from January 2020 to September 2021. The donors screened positive on chemiluminescence immunoassay were included after informed consent was obtained, and donor demographics and follow-up response rate were analyzed. Frequency and percentages were used to express descriptive statistics and Chi-square was used to test the relationship between categories( p

Despite few inherent issues, ultrasound (US) has emerged as a new frontier in the assessment and management of pediatric airway due to easy availability of US machines in operation theaters, noninvasive and radiation-free properties, and reproducibility. In this narrative review, we discussed the ergonomics and equipment needed to perform the airway scan, types of scans performed and their clinical applications, normal appearance of airway structures, and important clinical applications of US in the management of pediatric airway. The greatest advantage of US lies in accurate location of cricothyroid membrane and tracheal rings, in measuring the narrowest part of the airway (cricoid) to determine the size of the endotracheal tube, to rule out esophageal intubation, and in assessing the movements of the vocal cords, among others. In our view, upper airway US is a convenient, cost-effective, noninvasive, first-line airway assessment tool which is dynamic in nature. It can be used preoperatively, intraoperatively for real-time guidance in performing interventional procedures, and in the postoperative period.

Purpose: The most common cause of mortality in patients undergoing open surgical repair for aortoiliac disease is from cardiac complications. As there is a paucity of literature about the surgical outcomes in patients with compromised cardiac status, this study was undertaken to study the perioperative outcomes of open surgical repair for aortoiliac occlusive disease in patients with poor cardiac status. Methodology: A retrospective study was carried out from January 2017 to December 2020. Patients with aortoiliac occlusive disease based on computed tomography angiographic findings with poor cardiac reserve (ejection fraction ≤40% on echocardiography) were included in the study. The primary endpoints were perioperative complications which included intraoperative hemodynamic complications and early postoperative complications. Results: During 2017–2020, a total of 44 patients with aortoiliac occlusive disease (AIOD) with erectile function ≤40% underwent open surgical repair. Of these, 25 (57%) patients had infrarenal aortoiliac involvement and 19 (43%) had juxtarenal aortoiliac involvement. In our study of open surgical repair for juxtarenal and infrarenal aortoiliac occlusive disease in patients with poor cardiac status, intraoperative hemodynamic complications were noted in 26 (59%) patients, early postoperative complications were noted in 11 (25%), and mortality rate was 4.5%. Conclusion: Even though AIOD patients with poor cardiac status are at high operative risk than patients with normal cardiac status, open surgical repair with in-line bypass can be considered as a suitable option in these patients, especially where facilities for appropriate intraoperative monitoring and management are available.

Background: Strip crowns are the first treatment of choice for restoring anterior teeth affected with early childhood caries. However, shade matching of resin composites is still an issue. The broad color matching ability of a recently introduced single shade composite, Omnichroma eliminates the need for shade-matching procedure, reduces composite inventory, and minimizes chair-side time. Aim: The aim is to evaluate the color match, color stability, and retention of one shade universal composite resin, Omnichroma and nanohybrid resin composite, Tetric-N-Ceram. Settings and Design: The study design involves split-mouth randomized controlled trial. Materials and Methods: The study was conducted on 25 children aged 3–5 years with multi-surface caries lesions in primary maxillary anterior teeth. Teeth were allocated to two groups randomly: Group 1 – One shade universal composite, Omnichroma (n = 25), Group 2 – Nanohybrid composite, Tetric-N-Ceram (n = 25). After caries excavation and tooth preparation, teeth were restored with corresponding materials using strip crowns. Color match at baseline, color stability, and retention after 6- and 12-month follow-up were evaluated using the Modified United States Public Health Services criteria. Statistical Analysis: The Mann–Whitney U test and Wilcoxon signed-rank test were used to analyze the data. Results: On comparison of Omnichroma and Tetric-N-Ceram groups, no statistically significant difference was observed in the color match at baseline (P = 0.716) as well as color stability (P = 0.575 at 6 months and 0.990 at 12 months) and retention (P = 0.153 at 6 months and 0.226 at 12 months) at both 6- and 12-month intervals. On intragroup comparison, the difference in the color stability at 6 and 12-month interval was statistically significant (P = 0.001) for both the groups, indicating that the color stability of restorations was better at 6-month interval compared to 12-month interval. In both Omnichroma and Tetric-N-Ceram groups, retention of restorations was better at 6-month interval compared to 12-month interval and this difference was statistically significant (P = 0.025 and 0.014, respectively). Conclusion: The clinical performance of Omnichroma in terms of color match, color stability, and retention was comparable to nanohybrid composite, Tetric-N-Ceram.

Introduction: In India, a national program for stroke (national programme for the control of cardiovascular diseases, diabetes, cancer, and stroke) and stroke management guidelines exist. Its successful implementation would need an organized system of stroke care in practice. However, many challenges exist including lack of awareness, prehospital notification systems, stroke ready hospitals, infrastructural weaknesses, and rehabilitation. We present here a protocol to investigate the feasibility and fidelity of implementing a uniform stroke care pathway in medical colleges of India. Methods and Analysis: This is a multicentric, prospective, multiphase, mixed-method, quasi-experimental implementation study intended to examine the changes in a select set of stroke care-related indicators over time within the sites exposed to the same implementation strategy. We shall conduct process evaluation of the implementation process as well as evaluate the effect of the implementation strategy using the interrupted time series design. During implementation phase, education and training about standard stroke care pathway will be provided to all stakeholders of implementing sites. Patient-level outcomes in the form of modified Rankin Scale score will be collected for all consecutive patients throughout the study. Process evaluation outcomes will be collected and reported in the form of various stroke care indicators. We will report level and trend changes in various indicators during the three study phases. Discussion: Acute stroke requires timely detection, management, and secondary prevention. Implementation of the uniform stroke care pathway is a unique opportunity to promote the requirements of homogenous stroke care in medical colleges of India.