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Pharmacogenomics has transformed the way we approach the treatment of the most common diseases worldwide, especially cardiovascular. In this article, we highlight the main categories of drugs involved in major cardiovascular diseases (CVD), related genetic variability and their effects on metabolism in each case of contrastive operability. This not only explains disparities in treatment outcomes but also unfolds customised management based on genomic studies to improve efficiency and limit side effects. Genetic variations have been identified that impact the efficacy, safety, and adverse effects of drugs commonly used in the treatment of CVDs, such as Angiotensin converting Enzyme Inhibitor (ACEI), Angiotensin Receptor Blocker (ARBs), calcium channel blockers, antiplatelet agents, diuretics, statins, beta-blockers, and anticoagulants. It discusses the impact of genetic polymorphisms on drug metabolism, efficacy, and adverse reactions, highlighting the importance of genetic testing in optimizing treatment outcomes. Pharmacogenomics holds immense potential for revolutionizing the management of CVDs by enabling personalized medicine approaches tailored to individual genetic profiles. However, challenges such as clinical implementation, cost-effectiveness, and ethical considerations need to be addressed to completely incorporate pharmacogenomic testing into standard clinical practice. Continued research and clinical diligence are required for the utilization of pharmacogenomics to improve therapeutic outcomes and reduce the burden of CVD globally., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: The contrast-enhanced T2-FLAIR (CE-T2-FLAIR) sequence on MRI, through the suppression of CSF and vascular signals, can detect subtle meningeal enhancement in meningitis that may not be appreciable on the routinely used contrast-enhanced T1W (CE-T1W) sequence., Objectives: To assess CE-T2-FLAIR compared to CE-T1W in the diagnosis of meningitis, using CSF analysis as the gold standard, using both qualitative and quantitative approaches for assessment., Method: A retrospective study was conducted on 53 patients with clinically suspected meningitis referred for brain MRI. Twenty-seven patients, positive for meningitis on CSF analysis, were classified as the case group; the remaining patients were designated as controls. The pre-contrast, CE-T1W and CE-T2-FLAIR images were assessed and analysed, qualitatively for the detection of abnormal meningeal enhancement, and quantitatively by measuring single pixel signal intensities (SPSI) over the meninges and vessels., Results: Contrast-enhanced T2-FLAIR demonstrated significantly higher sensitivity (92.59% vs. 57.69%), negative predictive value (92.59% vs. 70.27%) and diagnostic accuracy (94.34% vs. 78.85%) compared to CE-T1W. Additionally, CE-T2-FLAIR showed significantly greater meningeal SPSI and enhancement than CE-T1W., Conclusion: Contrast-enhanced T2-FLAIR is better at detecting abnormal meningeal enhancement in meningitis than CE-T1W, because of significantly greater signal intensity and enhancement of the meninges compared to vessels., Contribution: This study reiterates the usefulness of CE-T2-FLAIR as an additional sequence for the detection of abnormal meningeal enhancement in cases of meningitis as confirmed both qualitatively and quantitatively., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2025. The Authors.)

The present study evaluated the effects of 5-methyltetrahydrofolate (5-MTHF) and Spirulina aqueous extract on diabetes. An in silico docking study with select Spirulina bioactive compounds showed strong binding affinities of folates with glucose metabolism-related proteins. In vitro assay showed 5-MTHF's superior inhibitory activity on alpha-amylase compared to folic acid. The protective effect of Spirulina aqueous extract and 5-MTHF were validated in vivo using an STZ-induced diabetic Wistar rat model. Supplementation with Spirulina extract through diet, and a higher dose of 5-MTHF through gavage effectively lowered fasting blood glucose levels and improved oral glucose tolerance and amylase content. Supplementation also countered hyperlipidemia, improved the levels of antioxidant enzymes, and reduced the inflammatory markers. Weight loss prevention, mitigation of kidney enlargement, and normalisation of the histology of the pancreas, kidney, and liver were also observed. The ameliorative effect of a higher dose of 5-MTHF was comparatively superior to Spirulina aqueous extract and a corresponding higher dose of folic acid. An increase in serum folate levels on supplementation with Spirulina aqueous extract suggests Spirulina to be a source of bioavailable folate. The positive effect of Spirulina aqueous extract suggests a potential synergistic role for folate along with its other bioactive phytochemicals. The study highlights the potential ameliorative effects of Spirulina aqueous extract and 5-MTHF as a dietary supplement on diabetes and associated complications., Supplementary Information: The online version contains supplementary material available at 10.1007/s13205-024-04170-9., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest in the publication., (© King Abdulaziz City for Science and Technology 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Dr P A Mahesh reports financial support was provided by JSS Academy of Higher Education and Research. Dr P A Mahesh reports a relationship with JSS Academy of Higher Education and Research that includes: employment. I am serving as a editor in peer journals If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Aim and Background: There are various theories regarding the ideal hand to be in contact with chest during chest compressions when healthcare professionals and medical students perform cardiopulmonary resuscitation (CPR). Our study aimed to compare the impact of preferred versus non-preferred hand placement on chest on the CPR quality., Methodology: The volunteers were randomised to place their preferred (P)/non-preferred (NP) hand over sternum for the first session and switch hands for the second. Participants performed 2 min of uninterrupted chest compressions, followed by a 2-minute break and another 2 min of chest compressions on Laerdel QCPR Little Anne® mannequin with auditory feedback. The CPR parameters were analysed using QCPR mobile application. Comfort was assessed using 5-point Likert scale., Results: Among the 82 volunteers, 51 participants (62.2%) preferred their dominant hand to be in contact with the chest. Comparable results were seen with mean QCPR score, rate of compression, mean depth and good recoil percentage. The NP set had higher adequate depth percentage (94.8 +/- 13.7) than the P set (92.3 +/- 19.9) (p = 0.042), but participants were more comfortable using their preferred hand over chest (p = 0.0001)., Conclusion: Rescuer performance during chest compressions may not be impacted by whether the preferred hand or non-preferred hand of the provider is in contact with sternum., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Introduction: The evolving curricula in medical education have significantly reduced the time allocated for learning and clinically correlating anatomical facts. This has led to noticeable gaps in the anatomical knowledge observed by specialists while training junior residents and is being extensively documented in the literature., Materials and Methods: The descriptive, cross-sectional, questionnaire-based study was conducted online by sharing the questionnaire via e-mail, WhatsApp, and Telegram to institutes across all Indian states and union territories where postgraduate radiodiagnosis courses are offered., Results: The survey had a predominant response from radiodiagnosis residents belonging to the female gender (53.8%), pursuing MD (83.2%), from final year (43.4%), and from private (58%) institutes. 98% of the residents encountered challenges interpreting radiological images, 89% had no formal training in anatomy during residency, and 59% felt a lack of confidence regarding the human anatomy knowledge required for radiodiagnosis. 91.5% of the residents believe that a short human anatomy posting would significantly improve their radiological reporting skills, and 94% expressed interest in attending workshops or seminars to enhance their knowledge of human anatomy for radiological practice. A standardized curriculum for human anatomy training during the radiodiagnosis residency program is needed for the current period, as 90% of the respondents agreed., Conclusion: To bolster future radiologists' diagnostic acumen, an enhanced anatomical education within radiodiagnosis residency programs in India is indeed necessary. Implementing structured training programs, incorporating interactive workshops, and leveraging advanced technological tools can significantly bridge knowledge gaps among residents., Competing Interests: Declarations. Conflict of interests: The authors declare no competing interests. Ethical approval: Waived for the questionnaire-based anonymised study. Data availability: Data can be shared with a reasonable request to the corresponding author., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background Polycystic ovary syndrome (PCOS) poses a significant health concern among reproductive-aged women and is characterized by ovarian dysfunction, hyperandrogenism, and insulin resistance. This study aims to assess the efficacy and safety of metformin and myo-inositol combination therapy compared to metformin monotherapy in patients with PCOS. Materials and methods This was a phase III, double-blind, randomized controlled clinical trial. A total of 196 patients with PCOS were randomized in a 1:1 ratio to receive either a fixed-dose combination of metformin hydrochloride 500 mg and myo-inositol 600 mg (Met-Myo) or metformin 500 mg alone (Met) twice daily for 24 weeks. The primary study endpoints were improvement in insulin resistance (homeostatic model assessment of insulin resistance, HOMA-IR) at week 24 and improvement in menstrual cycle disturbances at 12 and 24 weeks. Results The Met-Myo combination demonstrated a significantly superior response with 63 (75%) patients showing improvement in HOMA-IR compared to 54 (60.67%) in the Met group (p = 0.049) at week 24. The improvement in the number of patients with heavy menstrual blood flow (>80 mL) was significantly greater in the Met-Myo group (four patients, 4.76%) compared to the Met group (six patients, 6.74%) at week 24 (p = 0.029). Improvement in the percentage of patients with normal menstrual frequency and infrequent menstruation from baseline to week 24 was significantly greater in the Met-Myo group compared to the Met group (p = 0.049). Safety assessments revealed a low and comparable incidence of mild adverse events. Conclusion Metformin-myo-inositol combination therapy is superior to metformin monotherapy in addressing menstrual irregularities and improving insulin resistance in PCOS patients, thereby providing a promising avenue for optimizing the management of PCOS., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Clinisyd Research Global Solutions Private Limited Independent Ethics Committee issued approval CRGSIEC-AP-02/2021-22; dated: 2/06/2021. IEC Charak Hospital and Research Center (IEC/02/2021[01]; dated: 7/04/2021); Institutional Ethics Committee College of Medicine and Sagore Dutta Hospital (CMSDH/IEC/236/03-2021; dated: 3/04/2021); Institutional Ethics Committee King Georges Hospital (CT/KGH/OBG/FEB/2021/8; dated: 8/04/2021); Pushpanjali Hospital Ethics Committee (IEC/PHRC/21/A3; dated: 9/04/2021); Institutional Ethics Committee, Smt. NHL Municipal Medical College (NHLIEC/2021/09/07/no.1; dated: 7/09/2021); Institutional Ethics Committee, Indira Gandhi Institute of Medical Sciences (319/IEC/IGIMS/2021; dated: 13/12/2021); Institutional Ethics Committee, Cheluvamba Hospital Mysore Medical College and Research (MMC/EC/89/2021; dated: 15/03/2021); Institutional Ethics Committee, Om Surgical Center and Maternity Home (EC/OMS/TA/2022-058; dated: 2/05/2022); and Vatsalya Ethics Committee (ECR/1611/Inst/UP/2021; dated: 1/12/2021). The trial adhered to the principles of the 1964 Helsinki Declaration and its later amendments and CONSORT guidelines. Approval was obtained from various institutional ethics committees. The study was registered in the Clinical Trials Registry - India (CTRI) (CTRI Registration: CTRI/2021/04/032522; dated: 05/04/2021). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kriplani et al.)

Background: Delusional infestation (DI) is a well-recognized delusional disorder presenting as the persisting belief of being infested. Combined clinics have been run by dermatology and psychiatry in a small number of centres. In this article we focus on our Liverpool University Hospitals NHS Foundation Trust clinic hosted at the Liverpool School of Tropical Medicine, UK, where we run a specialist clinic for DI., Methods: We describe the specific set-up and approach of our clinic as a guide for clinicians working in specialties likely to see patients with DI (including tropical medicine, infectious diseases and dermatology) who may either want to set up similar clinics or be better equipped to manage DI patients promptly within existing practice., Results: We describe the details of the clinic's approach. Between 2018 and 2023, the service saw 208 patients, of which 82.7% could be assessed and 55.7% had DI. The female:male ratio was 2:1., Conclusion: Interdisciplinary combined clinics with medical and psychiatry consultants working together offer an approach to managing this rare, challenging and high-consequence condition., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background/purpose of the Study: Globally, gynaecological cancer is an important malignancy and chemotherapy is an essential component of the standard treatment modality. The purpose of the study was to determine the cost minimization analysis by comparing the price of the most expensive and least expensive branded drugs used in the treatment of gynaecological cancer in India, considering body surface area relevant to the Indian context., Methods: This was a conventional pharmacoeconomic study designed to determine the lowest possible cost. We compared the prices of the most and least expensive branded drugs from the Current Index of Medical Stores. Also cost of anticancer drugs available in Jan Aushadi stores was also considered for the study. The cost difference, cost ratio and percentage of change in costs were all calculated in accordance with the standard formula. All drugs and the therapeutic regimens (chemo-radiation regimens and chemotherapy) used in the treatment of gynaecological cancer were analysed to understand the cost difference for the treatment regimens., Results: The results indicate that while all anticancer drugs used in the treatment of gynecalogical cancers were available in both costliest and cheapest brand category, bevacizumab and liposomal doxorubicin were unavailable in the Jan Aushadhi stores. The paclitaxel carboplatin regimen had the biggest cost variation between the costliest brand and Jan Aushadhi (Rs. 81,273). The paclitaxel carboplatin bevacizumab regimen had the greatest cost difference (Rs 14,61,646), while weekly cisplatin (Rs 4017) showed less variance. When replacing the most expensive branded pharmaceuticals with cheaper brands or Jan Aushadhi drugs, the cisplatin paclitaxel regimen cost 4.8 to 9.5 times less (Rs 107,655 vs Rs 54,414.4 vs Rs 13,464). For single-agent chemotherapy, substituting the most expensive branded medications with cheaper or Jan Aushadhi products saved money as follows: paclitaxel 37,266 to 55,149; carboplatin Rs 5,556 to Rs 26,124; and liposomal doxorubicin 22,804., Conclusion: The results indicate a huge difference between the costly and the cheapest branded and Jan Aushadhi anticancer drugs and based regimens in treating gynaecological cancer., (© Federation of Obstetric & Gynecological Societies of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Magnetic resonance imaging (MRI) is used for the evaluation of degenerative spinal disease. However, its utility is restricted in routine practice because of contraindications and a lack of widespread availability. Dual-energy computed tomography (DECT) is a newer technique for the evaluation of degenerative spinal disease., Objectives: This study aimed to evaluate the diagnostic performance of DECT with electron-density (ED) image reconstruction compared to standard CT for the detection of lumbar disc herniation, with MRI as the gold standard., Method: The retrospective study included 84 patients between 01 July 2023 to 31 December 2023 who underwent DECT and 1.5-T MRI within 1 week. Four radiologists, blinded to the clinical and MRI information, independently evaluated the standard CT series and DECT series with ED reconstructions for lumbar disc herniation and spinal nerve root impingement. The gold standard for comparison was lumbar spine MRI, and diagnostic accuracy was measured with sensitivity and specificity., Results: MRI revealed 417 lumbar disc herniations. Dual-energy computed tomography with ED reconstruction showed higher sensitivity (86.36% [532/616] vs. 57.79% [356/616]) and specificity (96.86% [1019/1052] vs. 95.82% [1008/1052]) for the detection of lumbar disc herniation compared to standard CT., Conclusion: Dual-energy computed tomography with ED reconstruction shows better diagnostic performance for the detection of lumbar disc herniation compared to standard CT and can be a useful alternative imaging modality when MRI is contraindicated or unavailable., Contribution: This study shows the usefulness of DECT as an alternative imaging technique for screening of degenerative spinal disease whenever MRI is contraindicated or unavailable., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Background: Cryosurgery remains an important treatment modality in dermatology practice. HYDROZID ® , a new portable cryosurgery medical device using norflurane as a cryogen, was recently introduced in the Indian market. This paper reports the findings of the phase IV study conducted in India., Aims: This is a prospective phase IV study to evaluate its safety and efficacy in the treatment of superficial epidermal and dermal lesions., Methods: The study was conducted across 4 centres in India. The cryosurgery cycles were decided based on the skin lesion considered for the treatment. Safety and efficacy parameters were assessed at day 1, day 7, day 14, day 30 (±2) (end of treatment), and day 60 (±2) after the initial cryosurgery treatment. The local skin reactions scale, pain VAS scale, and Vancouver scale for assessment of pigmentation and scarring were used for the assessment of cutaneous reactions. Assessment of efficacy was done by evaluating the total disappearance of skin lesions at the end of the study visit., Results: Ninety-seven patients completed the study. The reported post-procedural pain was mild to moderate and subsided over the period of 24 hours. There was no pain observed in 84.76% of patients at the end of 24 hours. Complete disappearance of the lesion was seen in 47.4% of patients at the end of the study, while the reduction in the diameter of skin lesions by more than 50% was observed in 79.38% of patients., Conclusion: The data from this study support good clinical tolerability and safety of the Hydrozid ® portable cryo device., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Dermatology.)

Purpose: Squamous cell carcinoma of the head and neck (SCCHN) is the sixth most common cancer, with approximately 225,419 new cases with over 125,000 deaths annually in India. This trial compared the efficacy and safety of biosimilar cetuximab versus innovator cetuximab (IC) in combination with platinum-based chemotherapy in patients with recurrent locoregional or metastatic SCCHN., Methods: This phase III trial is a multicenter, randomized, double-blind and parallel group study performed in Indian patients with recurrent locoregional or metastatic SCCHN. Patients were randomly assigned in 2:1 ratio to receive biosimilar cetuximab and IC in combination with cisplatin and fluorouracil via intravenous infusions. The primary end points were disease control rate (DCR) and overall response rate (ORR) as per response evaluation criteria in solid tumors version 1.1. The secondary end points included pharmacokinetics (PK), immunogenicity, safety, and tolerability., Results: Of 180 patients enrolled, 120 patients received biosimilar cetuximab and 60 patients received IC treatment. No significant statistical difference was observed in the primary outcomes between two groups. Treatment difference in DCR and ORR response was found to be -5.21 (90% CI, -8.94 to -1.48) and -4.79 (90% CI, -19.42 to 9.84), respectively, indicating noninferiority to reference product. The incidence of treatment-emergent adverse events (AEs; biosimilar cetuximab: 89.2% v IC: 91.7%; P = .8364) and serious AEs (biosimilar cetuximab: 23.3% v IC: 13.3%; P = .0603) and PK parameters were comparable between treatment groups. The immunogenicity findings showed higher incidence of anticetuximab antibodies in the biosimilar cetuximab group compared with the IC group at the end of Study., Conclusion: The findings of this study demonstrated noninferiority along with comparable PK, safety, and immunogenicity of biosimilar cetuximab and IC in patients with recurrent or metastatic SCCHN.

Abstract: Isolated vaginal metastasis from colorectal cancer is a rare entity with very few reports in the literature. Here we report a patient who presented with bleeding per vagina from a vaginal mucosal lesion. Biopsy of the vaginal lesion indicated a metastatic adenocarcinoma from a colorectal primary. Further workup of the patient with colonoscopy and Positron emission tomography (PET CT) indicated a primary in the sigmoid colon. As the patient had a single site of metastasis, she was planned for definitive management. The colonic primary, as well as the vaginal deposit were managed surgically. Further, the patient received adjuvant chemotherapy as well as adjuvant external beam radiation to the site of the vaginal lesion. Vaginal metastases from colorectal primary are usually part of systemic dissemination with multiple metastatic sites and hence has poor prognosis. When the patient presents with an isolated metastasis in the vagina., the survival appears reasonable as per the few reports available in the literature. Due to the rarity of the presentation, there are no standard treatment guidelines available. Surgical management, radiation and adjuvant chemotherapy have been used in varying combinations in the reports available in the literature. To conclude, vaginal metastasis should be included in the differential diagnosis of patients presenting with vaginal bleeding, especially with a history of colorectal carcinoma. Available limited evidence suggests that isolated vaginal metastasis from colorectal cancer that is amenable to local surgical resection has a reasonable outcome. Hence, isolated vaginal metastasis should be treated with curative intent in a multidisciplinary context like other sites of oligometastatic disease., (Copyright © 2024 Copyright: © 2024 Indian Journal of Cancer.)

Introduction: Snakebite envenoming (SBE) results in over 500 000 deaths or disabling injuries annually. Varespladib methyl, an oral inhibitor of secretory phospholipase A2, is a nearly ubiquitous component of snake venoms. We conducted a phase II clinical trial to assess efficacy and safety of oral varespladib methyl in patients bitten by venomous snakes., Methods: This double-blind, randomised, placebo-controlled trial enrolled patients in emergency departments in India and the USA. Patients with SBE were randomly assigned (1:1) to receive varespladib methyl or placebo two times per day for 1 week. All patients received standard of care, including antivenom. The primary outcome was change in the composite Snakebite Severity Score (SSS) measuring the severity of envenoming, from baseline to the average composite SSS at 6 and 9 hours., Results: Among 95 patients randomised August 2021 through November 2022, the most common snakebites were from Russell's vipers (n=29), copperheads (n=18) and rattlesnakes (n=14). The SSS improved from baseline to the average at 6 and 9 hours by 1.1 (95% CI, 0.7 to 1.6) in the varespladib group versus 1.5 (95% CI, 1.0 to 2.0) in the placebo group (difference -0.4, 95% CI, -0.8 to 0.1, p=0.13). While key secondary outcomes were not statistically different by treatment group, benefit was seen in the prespecified subgroup initiating study drug within 5 hours of bite (n=37). For this early treatment group, clinically important differences were observed for illness severity over the first week, patient-reported function on days 3 and 7 and complete recovery. No death or treatment emergent serious adverse event occurred., Conclusion: For emergency department treatment of snakebites, the addition of varespladib to antivenom did not find evidence of difference for the primary outcome based on the SSS. A potentially promising signal of benefit was observed in patients initiating treatment within 5 hours of snakebite., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background The relation of diabetes mellitus with cardiovascular diseases is well-known, even acute coronary syndrome (ACS). High levels of glycated haemoglobin (HbA1c) are used is a sign of long-term glycemic control and may be associated with severity in coronary artery disease (CAD). In this particular setting, the aim of this investigation was to examine the relationship between the HbA1c values and the angiographic patterns of patients who were admitted with an ACS diagnosis. Methodology A cross-sectional study included 120 patients diagnosed with ACS. The criteria for eligibility included patients with ST-elevation myocardial infarction, unstable angina, and non-ST elevation myocardial infarction with history of documented diabetes mellitus. Every patient had a suitable clinical examination, had their HbA1c checked, and had coronary angiography to determine the severity of their CAD. Descriptive statistics and ANOVA were performed for statistical analyses to determine the connection between angiographic patterns and HbA1c. Results Patients with elevated HbA1c levels demonstrated a strong association with severe coronary artery disease. Notably, those with HbA1c exceeding 10.5% exhibited significant triple vessel disease and Type C lesions, indicative of advanced coronary artery disease. Statistical analyses revealed a marked difference in angiographic patterns across various HbA1c categories (p < 0.05). Conclusion The findings of this study suggest that maintaining optimal HbA1c levels is essential for mitigating the severity of coronary artery disease in patients with ACS. Moreover, effective glycemic control may be protective against advanced coronary atherosclerosis and subsequent cardiovascular complications in both diabetic and non-diabetic individuals., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Madha Medical College and Research Institute issued approval MMCRI/IEC/2022/027. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Garg et al.)

Multiple myeloma, a complex hematologic malignancy, has devastating consequences for patients, including dramatic bone loss, severe bone pain, and pathological fractures that markedly decrease the quality of life and impact the survival of affected patients. This necessitates a refined understanding of biomarkers for accurate diagnosis and prognosis of such severe malignancy. Therefore, this article comprehensively covers current research, elucidating the diverse spectrum of biomarkers employed in clinical settings. From traditional serum markers to advanced molecular profiling techniques, the review provides a thorough examination of their utility and limitations. Through this scoping review, emphasis is placed on the evolving landscape of personalized medicine, where biomarkers play a pivotal role in tailoring therapeutic strategies. The integration of genomic, proteomic, next generation sequencing and flow cytometric data further enriches the discussion, unravelling the molecular intricacies underlying disease progression. The updated criteria allow for the treatment of people who clearly would benefit from therapy and might live longer if treated before significant organ damage occurs. Navigating through the evolving diagnostic and prognostic paradigms in multiple myeloma, this article equips clinicians and researchers with crucial insights for optimizing patient care and advancing future therapeutic approaches., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: Burn registers are an important source of surveillance data on injury intent. These data are considered essential to inform prevention activities. In South Asia, intentional burn injuries are thought to disproportionately affect women. Assessment of injury intent is difficult because it is influenced by personal, family, social, and legal sensitivities. This can introduce misclassification into data, and bias analyses. We conducted a descriptive, hypothesis generating study to explore misclassification of injury intent using data from a newly digitised single centre burn register in south India., Methods: Data from 1st February 2016 to 28th February 2022 were analysed. All patients in the data set were included in the study (n = 1930). Demographic and clinical characteristics for patients are described for each classification of injury intent. All data cleaning and analyses were completed using RStudio., Results: Injury intent data were missing for 12.6% of cases. It was the most commonly missing variable in the data set. "Accidental" injuries had a similar distribution over time, age, and total body surface area (TBSA) for males and females. "Homicidal" injuries were more common in females. Injuries reported as "Suicidal" affected men and women equally. A decrease in reporting of "Suicidal" injuries in females corresponded to an increase in high TBSA injuries classified as 'Other' or with missing data. Overwriting of injury intent was present in 1.5% of cases. The overwritten group had a greater proportion of females (62.1% vs. 48.5%) and higher median TBSA (77.5% vs. 27.5%) compared to the group where intent was not overwritten., Conclusion: Our findings indicate that some subgroups, such as females with high TBSA burns, appear to be more likely to be misclassified and should be the focus of future research. They also highlight that quality of surveillance data could be improved by recording of clinical impression, change in patient reported intent, and use of a common data element for intent to standardise data collection. We also recommend that injury intent is recorded as a unique variable and should not be mixed with other elements of injury causation (e.g. mechanism). Although this is a single centre study, the methods will be of interest to those who utilise routinely collected data and wish to reduce misclassification of this important variable., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Salivary Hemoglobin (SH) has emerged as the mainstay non-invasive and a practicable screening method for Chronic Periodontitis. Current research aims to comprehensively assess the diagnostic value of Salivary Hb (SH) in comparison with Salivary IL-6 (SIL-6) and levels of Salivary lactate dehydrogenase enzyme (SLDH) amongst Type II Diabetes subjects having Chronic Periodontitis (CP) and associated tooth loss., Materials and Methods: In this cross-sectional comparative investigation, 240 individuals with at least 15 remaining teeth, ranging in age from 30 to 70, were chosen and Group I controls were defined as follows: healthy (HbA1c levels ≤6.4 %) with no CP; Group II included chronic periodontitis and non-T2DM (HbA1c ≤ 6.4 %); Group III included T2DM (HbA1c ≥ 6.5 %) and CP; and Group IV included T2DM (HbA1c ≥ 6.5 %) with periodontitis-related tooth loss. ELISA colorimetric assay was used to quantify the results using the unstimulated whole saliva of fasting participants. Tukey's post hoc test was used for statistical analysis following Analysis of Variance (ANOVA), and Sensitivity and Specificity were computed following the determination of the correlation coefficient., Results: One-way ANOVA comparing Biomarker levels across the four groups revealed a statistically significant difference (F = 68.013) (p = 0.0001). Tukey's multiple post hoc yielded a significant difference between groups with least mean average biomarker levels observed among the controls (Group1) and maximum with group IV. Diagnostic Accuracy to discriminate between CP in T2DM & Controls with SH surpassed that of SIL-6 & SLDH, Receiver operating characteristic (ROC) curve depicted an overall sensitivity of 67.62 %, specificity of 80 % and accuracy of 74 % in T2DM subjects with tooth loss for the identification and assessment of CP., Conclusion: Estimates of Salivary Hemoglobin can assume an important role in comparison to SIL-6 & SLDH in determining the degree of periodontitis, including tooth loss, and identifying elevated glycemic levels. Advanced detection and monitoring can be ensured by routine use in dental offices and general practice., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier B.V. on behalf of Craniofacial Research Foundation.)

Aims and Background: Various types of parenteral nutritional products exist, each with specific formulations designed to meet the diverse nutritional needs of patient's post-abdominal surgery. Here, two different parenteral nutrition (PN) solutions BFLUID and NUTRIFLEX PERI are compared in terms of therapeutic efficacy and safety profile., Materials and Methods: A prospective, multi-center, randomized, parallel-group, non-inferiority Phase III clinical trial compared two PN solutions namely BFLUID ( N = 78) and NUTRIFLEX PERI ( N = 72) in 150 patients undergoing gastrectomy or colectomy. Primary endpoints included length of hospital stay while secondary endpoints included assessment and comparison of length of ICU/HDU stay, assessment of incidents of infections and mortality, change in blood levels of vitamin B1, change in nutritional parameters, thrombophlebitis, pain at the injection site, and recording of adverse events (AEs)., Results: There was no significant difference in terms of length of hospital stay, length of ICU/HDU stay as well as changes in nutritional parameters from baseline and change in blood levels of vitamin B1 from baseline. Both study groups exhibited comparability in terms of AEs, pain at the injection site, and the incidence of phlebitis. There was no significant difference in the number and severity of adverse events reported in both groups. Additionally, no signs of infection were observed in patients from either group., Conclusion: The trial successfully demonstrated the non-inferiority of BFLUID to NUTRIFLEX PERI. Moreover, the results indicated that PN enriched with high levels of branched-chain amino acids (BCAAs), essential amino acids (EAAs), and thiamine is both safe and efficacious for adult patients undergoing gastrectomy or colectomy., How to Cite This Article: Goyal A, Pathak A, BS Madhu, Soni H, Bhatt K, Raju KVVN, et al . Role of Peripheral Parenteral Nutrition Composition on Clinical Outcomes in Patients Undergoing Gastrectomy or Colectomy: A Phase III Indian Clinical Trial. Indian J Crit Care Med 2024;28(9):871-878., Competing Interests: Source of support: The clinical trial was sponsored by Otsuka Pharmaceutical India Pvt. Ltd., which also provided the study drug. All investigators received research funding, although Otsuka Pharmaceutical India Pvt. Ltd. was not directly involved in the disbursement process. Conflict of interest: Chetna Shah and Dignesh Patel are currently an employee of Otsuka Pharmaceutical India Pvt. Ltd.Conflict of interest: Chetna Shah and Dignesh Patel are currently an employee of Otsuka Pharmaceutical India Pvt. Ltd., (Copyright © 2024; The Author(s).)

Background: Benign Prostatic Hyperplasia (BPH) commonly affects older men, leading to lower urinary tract symptoms (LUTS) that affect sleep and quality of life. This study evaluates the effect of Pranic Healing (PH) as a complementary therapy for bothersome LUTS by normalising biofield energy centres called Chakras., Methodology: A single blind trial involving 76 men with LUTS was conducted, randomised into Medication-only (MED) and Medication-plus-Pranic Healing (MEDPH) groups. The MEDPH received PH sessions twice weekly for 5 weeks., Results: The study compared MED (n = 30) and MEDPH (n = 36) participants, finding significant improvements in IPSS scores (p ≤ .001) in both groups. The MEDPH group showed a greater reduction in incomplete bladder emptying and intermittency. The post void residual volume increased significantly in the MED group (Wilcoxon Z = -2.335, p = .02), while the MEDPH group reduced non-significantly. Sleep quality index improved significantly (McNemar=.013) in the MEDPH group, while the MED group showed no significant change. Subjective sleep quality, duration, and latency improved significantly in the MEDPH group. Healers reported improved energy balance in chakras of MEDPH group. Perceived energy by healers in lower chakra relates to urinary parameters., Conclusion: PH could alleviate LUTS, enhancing quality of life due to urination, and improved sleep, among moderate BPH patients., Trial Registration: This study has been registered under the Clinical Trial Registry of India. (CTRI No: CTRI/2023/01/049004)., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Srikanth N Jois reports financial support and article publishing charges were provided by World Pranic Healing Foundation India. Srikanth N Jois, Vinu V, Nagendra Prasad K, Roopa reports a relationship with World Pranic Healing Foundation India that includes: employment. Srikanth N Jois has patent Nil pending to Nil. Nil If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aims: There is minimal research on the duration of biofield experiences. This preliminary study used the experiential learning practice of Master Choa Kok Sui's hands sensitisation to determine the duration to experience biofield sensations in between hands and to find the relationship between learning style preferences and biofield sensations., Methods: This randomized placebo controlled, single blinded trial included 88 male and female pre-service teachers, aged 22.8±1.2 years. Participants completed a ruler drop test for reaction time, and Six Letter Cancellation test for measuring attention, learning style questionnaire for preferred method of learning, before randomization. The experimental (hands facing each other as introduced by Master Choa Kok Sui) and sham (hands facing opposite) groups practiced hands sensitisation. A semi-structured questionnaire was provided to gather information about biofield sensations and the time it took to experience these sensations between the hands., Results: All (N=44) the participants in the experimental group and 13 participants in the sham group reported experiencing biofield sensations. A significant difference was noticed in experiencing magnetic (X 2 = 38.247, p ≤ .001), physical sensations of energy (X 2 = 12.02, p ≤ .001) and pain (X 2 = 62.259, p ≤ .001) among the experimental and sham group . In the experimental group, the average time taken to first experience magnetic sensation, other biofield sensations and temperature variation was 34.84±12.97seconds, 40.28±20.96 seconds and 42.50±19.79 seconds, respectively. Minimum time taken to first experience biofield sensation was 5 seconds and lasted up to study duration of 120 seconds. There was no correlation found between reaction time, sustained attention, and the time needed to experience biofield sensations., Conclusions: This study highlights importance of Master Choa Kok Sui hand sensitization in controlled setting revealing differences in experiences of various biofield sensations, showing valuable time-related insights and variability of sensation based on preferred learning., Competing Interests: Competing interests: Authors and funding are from the World Pranic Healing Foundation, India., (Copyright: © 2024 Vijayakumar V et al.)

Background  The integration of large language models (LLMs) into medical education has received increasing attention as a potential tool to enhance learning experiences. However, there remains a need to explore radiology postgraduate students' engagement with LLMs and their perceptions of their utility in medical education. Hence, we conducted this study to investigate radiology postgraduate students' knowledge, attitudes, and practices regarding LLMs in medical education. Materials and Methods  A cross-sectional quantitative survey was conducted online on Google Forms. Participants from all over India were recruited via social media platforms and snowball sampling techniques. A previously validated questionnaire was used to assess knowledge, attitude, and practices regarding LLMs. Descriptive statistical analysis was employed to summarize participants' responses. Results  A total of 252 (139 [55.16%] males and 113 [44.84%] females) radiology postgraduate students with a mean age of 28.33 ± 3.32 years participated in the study. The majority of the participants (47.62%) were familiar with LLMs with their potential incorporation with traditional teaching-learning tools (71.82%). They are open to including LLMs as a learning tool (71.03%) and think that it would provide comprehensive medical information (62.7%). Residents take the help of LLMs when they do not get the desired information from books (46.43%) or Internet search engines (59.13%). The overall score of knowledge (3.52 ± 0.58), attitude (3.75 ± 0.51), and practice (3.15 ± 0.57) were statistically significantly different (analysis of variance [ANOVA], p  < 0.0001), with the highest score in attitude and lowest in practice. However, no significant differences were found in the scores for knowledge ( p  = 0.64), attitude ( p  = 0.99), and practice ( p  = 0.25) depending on the year of training. Conclusion  Radiology postgraduate students are familiar with LLM and recognize the potential benefits of LLMs in postgraduate radiology education. Although they have a positive attitude toward the use of LLMs, they are concerned about its limitations and use it only in limited situations for educational purposes., Competing Interests: Conflict of Interest None declared., (Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background: Boswellin ® Super is a standardized extract of Boswellia serrata Roxb gum resin, standardized to contain 30% 3-acetyl-11-keto-β-boswellic acid along with other β-boswellic acids (BSE). A randomized, double-blind, placebo-controlled clinical trial was conducted at two doses of BSE to understand its safety and efficacy in supporting joint health and improving mobility and symptoms of osteoarthritis (OA) of the knee., Methods: Based on the inclusion/exclusion criteria, 105 newly diagnosed participants with degenerative hypertrophy OA were recruited and randomized into Placebo, BSE-150 mg or BSE-300 mg (n = 35 in each group) to receive either 150 mg or 300 mg BSE or a placebo tablet twice a day for 90 days. All the participants were evaluated for pain and physical function using the standard tools including the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne Functional Index (LFI), EuroQol- 5 Dimension (EQ-5D) quality of life, 6-min walk test at day 0, days 5, 30, 60 and 90 of treatment. Additionally, the circulating levels of inflammatory biomarkers, tumor necrosis factor-α (TNFα), high-sensitive C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were evaluated. Safety was evaluated by blood biochemical, hematological analysis, urinary analyses and by monitoring adverse events throughout the study., Results: Ninety-eight subjects completed the study. Improvements in pain scores were observed as early as 5 days after the start of the supplement in the BSE-150 and BSE-300 groups. By 90 days, the VAS pain score reduced by 45.3% and 61.9%, WOMAC- total score improved by 68.5% and 73.6% in the BSE-150 and BSE-300 groups respectively. WOMAC pain (70.2%, 73.9%, WOMAC stiffness (65.6%,68.9%), WOMAC function (68.8%,74.2%), LFI severity (50%,53.3%), decreased and EQ5D (56.9%, 62.9%) and distance walked in 6 minutes (21.2%, 21.9%) improved in the BSE-150 and BSE-300 groups in 90 days. Further, the levels of TNFα, hs-CRP, and IL-6 were found to decrease in the serum in BSE-supplemented participants. No significant adverse events were recorded during the study., Conclusion: The study confirms that Boswellin® Super can be used as a safe and effective supplement to support joint health and mobility in the management of osteoarthritis., Clinical Trial Registration: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NzU2Nzc=&Enc=&userName=CTRI, identifier CTRI/2022/11/047397., Competing Interests: Authors AM, GS, RM, and LM were employed by Sami-Sabinsa Group Limited. Author SM was employed by Sabinsa Corporation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Majeed, Majeed, Satish, Manjunatha, Rabbani, Patil and Mundkur.)

Diabetes mellitus (DM) is a common comorbidity in COVID-19 subjects. Hyperglycemia at hospital admission identified as a major risk factor and is responsible for poor prognosis. Hematological and inflammatory parameters have been recognized as predictive markers of severity in COVID-19. In this clinical study, we aimed to assess the impact of hyperglycemia at hospital admission on hematological and several inflammatory parameters in COVID-19 patients. A total of 550 COVID-19 subjects were primarily categorized into two major groups (normoglycemic and hyperglycemic) based on random blood sugar levels. On the first day of hospitalization, subjects' oxygen saturation, random blood sugar, hematological variables, and inflammatory parameters were recorded. The hyperglycemic group exhibited higher levels of serum ferritin, total leukocyte count (TLC), lactate dehydrogenase (LDH), neutrophil count, and neutrophil-to-lymphocyte ratio (NLR). In contrast, oxygen saturation and lymphocyte count were lower compared to the normoglycemic group. Significantly elevated levels of hematological variables (TLC, neutrophil count, NLR) and inflammatory parameters (serum ferritin) were observed in the hyperglycemic group. Among inflammatory parameters, only serum ferritin levels showed statistical significance. This study supports the clinical association between hyperglycemia and an increased severity of COVID-19. Consequently, the identification of these parameters is a crucial and valuable prognostic indicator for assessing disease severity in hyperglycemic subjects.

Background and Aims: In cervical spine injuries, there is an impairment in positioning of the patient to maintain the airway axis during endotracheal intubation (ETI). Literature shows video laryngoscope (VLS) facilitating the intubation in these patients with cervical immobilization. VL3 VLS (HugeMed Medical Technical Development, Shenzhen, China) is a newer VLS with limited studies. The primary aim of this study is to compare the efficacy of ETI using VL3 VLS with Macintosh and McCoy (MC) blades for simulated difficult airway with rigid cervical collar (RCC). The secondary aim was to compare the oral insertion of laryngoscope and intraoral bleeding., Methods: One hundred and fifty patients were randomly divided into three groups depending on laryngoscope used for ETI. Group M, Group V, and Group MC used Macintosh, VL3, and MC laryngoscopic blades, respectively, for ETI. During ETI, the Intubation Difficulty Scale (IDS), intubation time (IT), ease of laryngoscope insertion, and any bleeding intraorally were noted. The data collected were further analyzed., Results: IDS was statistically significantly least (0.9 ± 1.5) with VL3 VLS compared to direct laryngoscopy with Macintosh and MC blades. There was significantly no difference in IT among the three groups. Insertion of blade of VL3 was significantly more difficult than Macintosh or MC. Intraoral bleeding was present in 8% of patients with VL3., Conclusion: VL3 VLS can be used for ETI during cervical immobilization using RCC. More studies are needed to define its efficacy in different difficult airway situations compared with different VLS., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)

Porokeratosis (PK) is a chronic progressive disorder of keratinization characterized clinically by hyperkeratotic papules or plaques surrounded by a threadlike, elevated border that expands centrifugally. Pathogenesis involves heterozygous mutations in mevalonate kinase enzyme. The most common variants are disseminated superficial actinic porokeratosis (DSAP) and PK of Mibelli. All forms show a thin column of parakeratosis, the cornoid lamella, representing the active border. Dermoscopy reveals central brownish discoloration surrounded by a single hypopigmented band and a peripheral 'white track'. Long-standing cases of PK may undergo malignant transformation. UV-protection and topical agents, such as 5-fluorouracil, imiquimod, calcipotriol, tretinoin and oral retinoids are helpful. To study the clinical and epidemiological pattern of PK and the clinico-dermoscopic and histopathological correlation of PK. A prospective cross-sectional study was conducted on the patients attending the dermatology outpatient department (OPD) over 9 months with suspected features of PK. These patients were evaluated clinically and subjected to dermoscopy and histopathology. Statistical Package for the Social Sciences (SPSS) Of 11 patients, there were four (36.36%) males and seven (63.66%) females. The youngest was 18-year-old boy, and the eldest was 63-year-old man. The clinically most common type was PK of Mibelli with five (45.45%) cases. The most common dermoscopic feature observed was double-marginated, white peripheral border. The most common histopathological feature noted was cornoid lamella. PK is a rare skin disorder with a wide spectrum of clinical variants. Dermoscopy and histopathology aid in diagnosis, whereas dermoscopy plays a pivotal role in early and non-invasive diagnosis. Regular follow-up is mandatory to watch for the development of malignancies in a few variants., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Dermatology.)

Introduction: A single cross-finger flap can only address digital defects of a limited size, and larger defects often require distant flaps such as abdominal or groin flaps that are cumbersome to perform and sometimes bulky. Two cross-finger flaps harvested from the same donor digit could offer a simple and effective solution for many such defects. In this study, we describe the technique of monodigital double cross-finger flaps and its clinical applicability, with evaluation of donor and recipient site morbidity., Methods and Materials: A total of 10 subjects with large volar defects were included in the study. The demographic data, etiology, defect size, flap donor, and recipient sites were tabulated prior to surgery. Each subject was assessed for postoperative complications at the donor and recipient site and followed up for 6-12 months to document any flap or donor site morbidities., Results: The subjects included 9 males and 1 female subjects, with an average age of 35.6 years (21-67 years). Most patients had posttraumatic defects, with 3 cases of full thickness burns and one with postsurgical tissue necrosis. All defects were volar, with 4 on the little finger, 3, 2, and 1 in the ring, index and middle fingers, respectively. No major postoperative complications were noted in any case. All flaps survived well with good contour, and donor fingers achieved near-normal range of flexion with only minimal restriction (10-15°) at the distal interphalangeal joint that did not result in any overall functional disability., Conclusions: Monodigital double cross-finger flap technique offers a simple and effective solution for reconstruction of large digital defects that are not amenable for closure by a classical cross-finger flap, and is a good alternative for other procedures, providing supple soft tissue coverage and no significant morbidity at the donor digit provided that there is preservation of a small skin bridge across the proximal interphalangeal joint., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Chemotherapy in an integral part of cancer treatment, either administered alone or in combination with radiation. However, the cost of these drugs is often prohibitively high for most patients. To address this issue, the Government of India has established Jan Aushadhi (JAS) stores across the country, where affordable generic medicines are available. In the current study, we performed a cost minimization analysis comparing JAS drugs with branded chemotherapeutic drugs used in various cancer treatment regimens., Objectives: This study was to conduct a cost-minimization analysis by comparing the costs of different regimens when using JAS drugs, the most expensive branded drugs, and the least expensive branded drugs in the treatment of cancer in India., Materials and Methods: The study focused on conducting a cost minimization analysis of various chemotherapy drugs used in the treatment of different cancers, considering the availability of anticancer drugs at JAS stores. The costs for different chemotherapy regimens, including both anticancer and supportive drugs, were calculated for single and complete cycles. The costs of the most expensive and least expensive branded drugs were noted from the Current Index of Medical Stores. The cost difference (CD) was calculated by subtracting the cost of the cheaper drug from that of the costliest brand. The cost ratio (CR) and the percentage of cost variation (PCV) were calculated for India-specific conditions., Results: The study analyzed the CD for various regimens using JAS drugs for chemotherapy treatment of breast, esophagus, rectal, colon, stomach, prostate, ovary, endometrial, cervical, head and neck, lung, multiple myeloma, testicular, and lymphoma cancers. It also considered chemoirradiation regimens for brain, head and neck, anorectal, esophageal, and uterine cervical cancers. Significant CDs were observed when both anticancer and supportive drugs were obtained from JAS stores., Conclusion: To the best of the authors' knowledge, this is the first study to consider the CD, CR, and PCV for various regimens using JAS drugs, as well as the costliest and cheapest branded drugs in standard cancer treatment regimens. The results of this study are expected to assist healthcare professionals and pharmacists in understanding the cost-saving benefits of substituting expensive branded drugs with more affordable chemotherapeutic drugs for the treatment of cancer. This substitution can provide financial benefit for socioeconomically marginalized population., (Copyright © 2024 Copyright: © 2024 Journal of Cancer Research and Therapeutics.)

Type 1 diabetes mellitus (T1DM) is a major problem worldwide that affects the quality of life, well-being of patients and their families. This study aimed to determine the relationship between the cost of illness and quality of life among patients with T1DM. A concurrent, parallel, mixed-method study of 113 adolescents with T1DM registered in public and private hospitals in the Mysore district was conducted by obtaining data related to the cost of illness and quality of life using a validated Diabetes-Specific Quality of Life (DSQoL) questionnaire. Thematic analysis was used to identify the themes. There was a significant association amonghealth insurance status, treatment facility type, catastrophic health expenditure (CHE), and cost of illness. The CHE proportion was32.7%. Financial sources for treatment were met primarily by borrowing money with interest (58 patients, 51.3%), followed by individualincome (40 patients, 35.3%), contributions from friends and relatives (10 patients, 8.8%), and selling of assets (5 patients, 4.4%). The monthly health expenditures of approximately 22 (19.46%) households were greater than their monthly incomes. There was a positive correlation (rvalue of 0.979) between the cost of treatment and the DSQoL score, and this correlation was statistically significant, with a p value < 0.001. The higher theDSQoL score was, the worse the quality of life and the worse the well-being of T1DM patients. Three themes were identified: the impact of financial cost on family coping, the impact of financial cost on seeking care and the emotional burden of financial cost. There was a statistically significant positive correlation between the cost of treatment and the DSQoLscore. Adolescents with T1DM who had greatertreatment costs had worseDSQoL, and significantly lower health expenses were observed among adolescentswho had health insurance. Cost of illness acts as a barrier to treatment and placesa burden on patients and their families., (© 2024. The Author(s).)

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. However, there is a lack of comprehensive data from low- and middle-income countries (LMICs) regarding factors influencing COPD outcomes, particularly in regions where biomass exposure is prevalent., Objective: The Factors Affecting Survival in Severe and Very Severe COPD Patients Admitted to Tertiary Centers of India (FAST) study aims to address this gap by evaluating factors impacting survival and exacerbation rates among COPD patients in LMICs like India, with a specific focus on biomass exposure, clinical phenotypes, and nutritional status in patients admitted to the Intensive Care Unit (ICU)., Methods: The FAST study is an observational cohort study conducted in university teaching hospitals across India. The study aims to enroll 1000 COPD patients admitted to the ICU meeting specific inclusion criteria, with follow-up assessments conducted every 6 months over a 2-year period. Data collection includes demographic information, clinical manifestations, laboratory investigations, pulmonary function tests, medications, nutritional status, mental health, and health-related quality of life. Adjudication of exacerbations and mortality will also be undertaken. The FAST study seeks to provide crucial insights into COPD outcomes in LMICs, informing more precise management strategies and mitigating the burden of COPD in these settings. By evaluating factors such as biomass exposure, clinical phenotypes, and nutritional status, the study aims to address key knowledge gaps in COPD research., How to Cite This Article: Arunachala S, Devapal S, Swamy DSN, Greeshma MV, Ul Hussain I, Siddaiah JB, et al . Factors Affecting Survival in Severe and Very Severe COPD after Admission in ICUs of Tertiary Care Centers of India (FAST COPD): Study Protocol for a Multicentric Cohort Study. Indian J Crit Care Med 2024;28(6):552-560., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2024; The Author(s).)

Intestinal obstruction is a common surgical emergency that can be caused by mechanical causes or by different pathological processes. The most common cause of small bowel intestinal obstruction is post-operative adhesion, and the most common cause of large bowel obstruction is malignancy. These are classified into dynamic and adynamic types. The patient was selected based on the presentation management plan. Some cases require immediate operative intervention; however, some cases, as mentioned in this case series, require further investigation and a different approach. In this study, we report the rare causes of intestinal obstruction presented to Safdarjung Hospital, Department of General Surgery, New Delhi: one case of foreign body impaction, one case of spontaneous migration of feeding jejunostomy, one case of extrauterine IUCD causing intestinal obstruction, one case of mesentery band causing obstruction, and one case of abdominopelvic mass causing small bowel obstruction. These cases presented to the surgical emergency department with challenges in their diagnosis, intraoperative findings, and their outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Singh et al.)

While NCDs are in rise globally, tribal and rural populations residing near to reserve forests with limited exposure to modern lifestyles may bear a unique burden. This study investigates the prevalence and risk factors of hypertension, diabetes, and dyslipidemia among these communities. We conducted a cross-sectional study between 2018 and 2020 in the forest-dwelling population of Chamarajanagar, India. Using multistage stratified sampling based on caste and remoteness, we enrolled 608 participants aged over 18 years, including 259 non-tribal and 349 tribal individuals. Data collection includes the administration of STEPS questionnaire and measurement of fasting blood sugar, lipid levels, and blood pressure. The prevalence of diabetes, hypertension, and dyslipidemia were 4.6%, 28.8%, and 85.7%, respectively, among the study population. We also found abnormal levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), Triglycerides (TGA), Total cholesterol (TC), and very low-density lipoprotein (VLDL)in 4.9%, 82.4%, 22.7%, 5.8%, and 7.4% of participants, respectively. Significant differences were observed in diabetes, LDL abnormality, TGA abnormality, VLDL abnormality, and TC abnormality, but not in hypertension, dyslipidemia, or HDL abnormality, across the Socio Geographic Discrimination Index. We found a significant difference in diabetes and HDL abnormality, but not in hypertension, dyslipidemia, LDL abnormality, TGA abnormality, TC abnormality, or VLDL abnormality, between tribal and non-tribal populations living in the forest-dwelling area. Waist circumference was a significant independent predictor of diabetes among tribal participants, while wealth index, age, and waist circumference were significant predictors of hypertension. There were no significant predictors for dyslipidemia among tribal participants. Our study suggests that tribal population living in a remote area are at a lower risk of developing diabetes compared to non-tribal populations living in the same geographic area. However, the prevalence of hypertension and dyslipidemia among tribal populations remains high and comparable to that of the general population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mallikarjuna Majgi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction  Seroma formation is a common complication following axillary dissection. The pathogenesis of seroma is poorly understood. Various chemical and mechanical methods have been tried to reduce seroma with varying results. In this study, we look at a novel method of axillary dissection to reduce seroma and its attendant morbidity. The objective of the study is to compare endofascial axillary lymphadenectomy with routine axillary lymphadenectomy regarding axillary drain output following breast conservation surgery. Methods  We did a prospective interventional study of endofascial axillary dissection in patients undergoing breast conservation surgery. Comparison was done with historical controls who underwent breast conservation surgery with routine axillary lymphadenectomy before the study period. All patients were operated by the same surgeon. Results  Breast conservation surgery with endofascial axillary dissection was performed in 36 patients and compared with 36 patients who underwent routine axillary dissection before the study period. The mean total axillary drain output in the endofascial and routine groups were 796.8 and 1,259.3 mL, respectively ( p  = 0.001). The average day of drain removal in the endofascial and routine groups were 10.8 and 14.9 days, respectively ( p  = 0.001). The nodal yield of the endofascial and routine groups were 15.3 and 16.4 nodes, respectively ( p  = 0.449). The duration of surgery of the endofascial and routine groups were 89.3 and 85.1 minutes, respectively ( p  = 0.366). Conclusion  Endofascial axillary dissection significantly reduced the mean total axillary drain output and resulted in early drain removal compared with routine axillary dissection. There were no significant differences in the nodal yield, operative time, seroma aspirations, and wound complications between the endofascial and routine axillary dissection groups., Competing Interests: Conflict of Interest None declared., (MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background: Data remain scarce for the first-line antipsychotic choice in treating delusional infestation (DI)., Objectives: We evaluated the treatment responses associated with different antipsychotics in DI patients., Methods: We undertook a multicentre, retrospective observational study using anonymised electronic patient records from two hospitals in the United Kingdom from 1 January 2011 to 1 January 2023. Eligible participants were adults (≥18 years) diagnosed with DI treated with an antipsychotic, and had both an assigned baseline and follow-up Clinical Global Impression Scale (CGI-S) score. The CGI-S is a validated psychiatric research tool. Participants were excluded if they had known limited or non-adherence to an antipsychotic, or if no CGI-S scores were present at follow-up. First clinic visits before the initiation of an antipsychotic were assigned as the baseline CGI-S score. The last available CGI-S score before the patient either changed antipsychotic or left the clinic for any reason was used to assign follow-up CGI-S scores. The primary outcome was the response to each individual antipsychotic treatment, measured by the difference in the baseline and last available follow-up CGI-S scores. Differences in CGI-S changes between antipsychotic episodes were tested by analysis of variance (ANOVA)., Results: In total, 414 patient records were analysed, and data were extracted. The mean age was 61.8 years (SD 14.1). One hundred seventy (41%) of 414 patients were men and 244 (59%) were women. In total, 156 (38%) of 414 patients were eligible, yielding a total of 315 antipsychotic prescribing episodes. The ANOVA, ranking in order of treatment response, showed that the highest mean score (expressing highest treatment response) was observed in amisulpride (31 [67%] of 46) and risperidone (95 [57%] of 167), followed by some distance by quetiapine (9 [36%] of 25), aripiprazole (13 [28%] of 46) and olanzapine (7 [25%] of 28)., Conclusions: Amisulpride and risperidone were associated with a higher treatment response than quetiapine, aripiprazole and olanzapine. Amisulpride and risperidone should therefore be considered the first-line treatment options in DI patients., (© 2024 European Academy of Dermatology and Venereology.)

Background: Introduction of pneumococcal conjugate vaccines (PCVs) reduced the number of cases of pneumococcal disease (PD). However, there is an increase in clinical and economic burden of PD from serotypes that are not part of the existing pneumococcal vaccines, particularly impacting pediatric and elder population. In addition, the regions where the PCV is not available, the disease burden remains high. In this study, immunogenicity and safety of the BE's 14-valent PCV (PNEUBEVAX 14™; BE-PCV-14) containing two additional epidemiologically important serotypes (22F and 33F) was evaluated in infants in comparison to licensed vaccine, Prevenar-13 (PCV-13)., Methods: This is a pivotal phase-3 single blind randomized active-controlled study conducted at 12 sites across India in 6-8 weeks old healthy infants at 6-10-14 weeks dosing schedule to assess immunogenic non-inferiority and safety of a candidate BE-PCV-14. In total, 1290 infants were equally randomized to receive either BE-PCV-14 or PCV-13. Solicited local reactions and systemic events, adverse events (AEs), serious AEs (SAEs), and medically attended AEs (MAAEs) were recorded. Immunogenicity was assessed by measuring anti-PnCPS (anti-pneumococcal capsular polysaccharide) IgG concentration and functional antibody titers through opsonophagocytic activity (OPA), one month after completing three dose schedule. Cross protection to serotype 6A offered by serotype 6B was also assessed in this study., Findings: The safety profile of BE-PCV-14 was comparable to PCV-13 vaccine. Majority of reported AEs were mild in nature. No severe or serious AEs were reported in both the treatment groups. For the twelve common serotypes and for the additional serotypes (22F and 33F) in BE-PCV-14, NI criteria was demonstrated as defined by WHO TRS-977. Primary immunogenicity endpoint was met in terms of IgG immune responses for all 14 serotypesof BE-PCV-14. Moreover, a significant proportion of subjects (69%) seroconverted against serotype 6A, even though this antigen was not present in BE-PCV-14. This indicates that serotype 6B of BE-PCV-14 cross protects serotype 6A. BE-PCV-14 also elicited comparable serotype specific functional OPA immune responses to all the serotypes common to PCV-13., Interpretations: BE-PCV-14 was found to be safe and induced robust and functional serotype specific immune responses to all 14 serotypes. It also elicited cross protective immune response against serotype 6B.These findings suggest that BE-PCV-14 can be safely administered to infants and achieve protection against pneumococcal disease caused by serotypes covered in the vaccine. The study was prospectively registered with clinical trial registry of India - CTRI/2020/02/023129., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘RVM, ST, SG, VY, RM, KT and PP are employees of Biological E Limited and they do not have any stock options or incentives. All the other participating authors declare no conflicts of interest.’., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Non-invasive methods for haemoglobin estimation hold enormous potential for early detection and treatment of anaemia, especially in limited resource settings. We sought to validate the diagnostic accuracy of ToucHb, a non-invasive haemoglobin estimation device available in the Indian market. We prospectively evaluated the diagnostic performance of the ToucHb device using the Automated complete blood count (CBC) method as the gold standard. Persons referred for haemoglobin estimation to the central laboratory of the government medical college hospital in Mysore, southern India were included in the study. Out Of 140 people approached, 127 gave consent; 65% (n = 82) were female with median age of 37 (IQR 28-45). ToucHB reported median haemoglobin value of 14 g/dL compared to 13.3 g/dL for CBC. Within 1 g/dL and 2 g/dL of CBC, 55.2% (70/127) and 74% (94/127) of ToucHb haemoglobin observations fell, respectively. The Bland-Altman plot showed a mean difference of 3 g/dL in haemoglobin between ToucHb and CBC among those with anaemia. The ToucHb device showed 22.2% sensitivity and 94.5% specificity for anaemia detection. In rural resource-limited settings, point of care non-invasive devices such as ToucHb can improve access and acceptance for anaemia screening. However, ToucHb has showed low sensitivity for anaemia detection and low accuracy at lower haemoglobin values. The utility of the instrument is especially limited in detecting anaemia, while it can estimate haemoglobin accurately among those with haemoglobin is in the normal range. Based on these findings, ToucHb and devices that work on the core technology deployed in ToucHb may be better suited to monitor known haemoglobin level rather than in anaemia screening or detection in primary/ secondary care and community settings., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Channa Basappa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Alzheimer disease (AD) is the most common cause of dementia worldwide. Its clinical manifestations include a progressive loss of memory and other cognitive domains, as well as brain atrophy. An elevated homocysteine level (&gt;15 µmol/L), known as hyperhomocysteinemia, is also an attributing risk factor for AD, vascular pathologies, and brain atrophy. Neuroimaging studies including T2-weighted magnetic resonance imaging scans revealed white matter hyperintensities in the periventricular and deep white matter, enlarged ventricles, widened sulci, and decreased white matter mass, which are features of aging, as well as cerebrovascular changes. This case series investigated changes in biochemical marker levels including serum homocysteine, folate, and vitamin B12, and the degree of atrophic variations in cortical-subcortical white matter in AD. The present study hypothesized that serum homocysteine levels might be used as a surrogate marker to screen for AD at an earlier stage.

Introduction: Burn registers provide important data that can track injury trends and evaluate services. Burn registers are concentrated in high-income countries, but most burn injuries occur in low- and middle-income countries where surveillance data are limited. Injury surveillance guidance recommends utilisation of existing routinely collected data where data quality is adequate, but there is a lack of guidance on how to achieve this. Our aim was to develop a rigorous and reproducible method to establish an electronic burn register from existing routinely collected data that can be implemented in low resource settings., Methods: Data quality of handwritten routinely collected records (register books) from a tertiary government hospital burn unit in Mysore, India was assessed prior to digitisation. Process mapping was conducted for burn patient presentations. Register and casualty records were compared to assess the case ascertainment rate. Register books from February 2016 to February 2022 were scanned and anonymised. Scans were quality checked and stored securely. An online data entry form was developed. All data underwent double verification., Results: Process mapping suggested data were reliable, and case ascertainment was 95%. 1930 presentations were recorded in the registers, representing 0.84% of hospital all-cause admissions. 388 pages were scanned with 4.4% requiring rescanning due to quality problems. Two-step verification estimated there to be errors remaining in 0.06% of fields following data entry., Conclusion: We have described, using the example of a newly established electronic register in India, methods to assess the suitability and reliability of existing routinely collected data for surveillance purposes, to digitise handwritten data, and to quantify error during the digitisation process. The methods are likely to be of particular interest to burn units in countries with no active national burns register. We strongly recommend mobilisation of resources for digitisation of existing high quality routinely collected data as an important step towards developing burn surveillance systems in low resource settings., Competing Interests: Declaration of Competing Interest none., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: A key component in the classification of all injury types is to differentiate whether the injury was deliberately inflicted and by whom, commonly known as "intent" in the surveillance literature. These data guide patient care and inform surveillance strategies. South Asia is believed to have the greatest number of intentional burn injuries, but national surveillance data is not disaggregated by injury intent. Scientific literature can be used for injury surveillance where national data collection does not exist. In order to synthesise research findings, it is essential to assess the potential impact of misclassification bias. We therefore conducted a systematic scoping review to understand terminology and methods used to differentiate injury intent of hospital burn patients in South Asia., Methods: We followed the methods in our registered protocol (https://doi.org/10.17605/OSF.IO/DCYNQ). Studies met defined population, concept, context, and study design criteria. The databases Embase, MEDLINE, CINAHL, PsycInfo, and PakMediNet were searched. Two reviewers independently screened results. Data were extracted in a standardised manner and verified. The rigour of the method used to differentiate injury intent was appraised., Results: 1435 articles were screened. Of these, 89 met our inclusion criteria. Most articles were from India and Pakistan, and used an observational study design. There were 14 stem terms used in the articles. The most common was "cause". There were 40 classifier terms. The most common were "accident", "suicide", and "homicide". Few articles defined these terms. The method used to differentiate injury intent was only described explicitly in 17% of articles and the rigour of the methods used were low. Where methods of differentiation were described, they appear to be based on patient or family report rather than multidisciplinary assessment., Conclusion: The heterogeneity in terms, lack of definitions, and limited investigation of injury intent means this variable is likely to be prone to misclassification bias. We strongly recommend that the global burn community unites to develop a common data element, including definitions and methods of assessment, for the concept of burn injury intent to enable more reliable data collection practices and interstudy comparisons., Competing Interests: Declarations of interest None., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Schizencephaly is a rare congenital anomaly characterized by the formation of abnormal clefts in the brain. Despite the association of psychotic symptoms with various brain abnormalities or insults, their occurrence in individuals with schizencephaly is relatively infrequent. The association of bipolar disorder, with or without psychosis, with schizencephaly is rarer. A systematic search on PubMed using "Schizencephaly AND Bipolar Disorder" yielded only four case studies specifically addressing the connection between these two conditions. Here, we present a case of a 22-year-old male patient with a history of childhood seizures who developed first episode psychosis along with manic symptoms and was found to have closed-lip schizencephaly., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Rama Rao et al.)

Background: Kidney transplantation is a superior treatment for end-stage renal disease (ESRD), compared with hemodialysis, offering better quality of life and birth outcomes in women with ESRD and lower fertility rates., Objectives: To investigate the pregnancy, maternal, fetal, and graft outcomes following kidney transplantation in women with ESRD and evaluate the improvements in quality of life and associated risks., Design: A systematic review and meta-analysis performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-analysis of Observational Studies in Epidemiology guidelines., Data Sources and Methods: A thorough search of multiple databases, including PubMed, Embase, Scopus, ATC abstracts, and Cochrane Central Register of Controlled Trials, was conducted to identify studies that analyzed pregnancy outcomes in kidney transplant patients. The search was conducted from the inception of each database to January 2023., Results: The study reviewed 109 studies that evaluated 7708 pregnancies in 5107 women who had undergone renal transplantation. Of these, 78.48% resulted in live births, 9.68% had induced abortion, and 68.67% had a cesarean section. Miscarriage occurred in 12.54%, preeclampsia in 20.87%, pregnancy-induced hypertension in 24.30%, gestational diabetes in 5.08%, and preterm delivery in 45.30% of cases. Of the 853 recipients, 123 had graft loss after pregnancy and 8.06% suffered acute rejection., Conclusion: Pregnancy after kidney transplantation is associated with risks for mother and fetus; however, live births are still possible. In addition, there are reduced overall risks of stillbirths, miscarriages, neonatal deaths, and gestational diabetes., Registration: PROSPERO (CRD42024541659).

Background: Antibody persistence of a whole-cell pertussis-containing hexavalent vaccine (DTwP-IPV-HB-PRP~T) and its co- or sequential administration with measles, mumps, rubella (MMR) vaccine were evaluated., Methods: Phase III, open-label, randomized, multicenter study in India. Healthy toddlers 12-24 months of age who had received DTwP-IPV-HB-PRP~T or separate DTwP-HB-PRP~T+IPV primary vaccination at 6-8, 10-12 and 14-16 weeks of age received a DTwP-IPV-HB-PRP~T booster concomitantly with MMR (N = 336) or 28 days before MMR (N = 340). Participants had received a first dose of measles vaccine. Immunogenicity assessment used validated assays and safety was by parental reports. All analyses were descriptive., Results: All participants had prebooster anti-T ≥0.01 IU/mL and anti-polio 1 and 3 ≥8 1/dil, and ≥96.5% had anti-D ≥0.01 IU/mL, anti-HBs ≥10 mIU/mL, anti-polio 2 ≥8 1/dil and anti-PRP ≥0.15 µg/mL; for pertussis, antibody persistence was similar in each group. Postbooster immunogenicity for DTwP-IPV-HB-PRP~T was similar for each antigen in each group: ≥99.5% of participants had anti-D ≥0.01 IU/mL, anti-T ≥0.01 IU/mL, anti-polio 1, 2 and 3 >8 1/dil, anti-HBs ≥10 mIU/mL and anti-PRP ≥1 µg/mL; for pertussis, vaccine response was similar in each group [72.0%-75.9% (anti-PT), 80.8%-81.4% (anti-FIM), 77.6%-79.5% (anti-PRN), 78.2%-80.8% (anti-FHA)]. There was no difference in MMR immunogenicity between groups, and no difference in DTwP-IPV-HB-PRP~T booster immunogenicity based on the primary series. There were no safety concerns., Conclusions: DTwP-IPV-HB-PRP~T antibody persistence was similar to licensed comparators. Booster immunogenicity was robust after DTwP-IPV-HB-PRP~T with or without MMR, and MMR immunogenicity was not affected by coadministration with DTwP-IPV-HB-PRP~T., Clinical Trials Registry India Number: CTRI/2020/04/024843., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Oxidative stress is an imbalance between free reactive oxygen species and antioxidant defences leading to neurological and other chronic disorders. The interaction between food and gut microbiota and their metabolites significantly reduces oxidative stress and influences host physiology and metabolism. This process mainly involves enzymes that hydrolyse complex polysaccharides and produce metabolites. Ferulic acid esterases (FAE) one of the most important enzymes of the gut microbiome, release ferulic acid from feruloylated sugar ester conjugates, that occur naturally in grains, fruits, and vegetables. FA is crucial in combating oxidative stress resulted from free radical formation. This study investigated the effect of two plant-based nutraceutical formulations, cereal-millet-based (PC1) and fruit-vegetable-based (PC2), on gut microbiota and the production of FAE, short chain fatty acids (SCFA) and other small metabolites in in vitro fermentation using human faecal samples. After in vitro fermentation, both nutraceutical formulations increased the abundance of Bifidobacterium, Lactobacillus, Prevotella, Feacalibacteria, and Clostridium leptum. Furthermore, they induced the production of FAE, xylanase and pectinase enzymes, SCFA and other small metabolites, resulting in increased antioxidation activity of the fermentate. PC1 stimulated FAE and xylanase production more effectively. These results demonstrated a positive correlation between the feruloylated nutraceutical formulation and the production of FAE and other accessory enzymes, suggesting that PC1 and PC2 stimulate the proliferation of the FAE-producing microbial consortium of the gut microbiome and therefore, increase FA and SCFA concentration. From this study it is evident that FA-rich plant-based formulation can be used as a prophylactic nutraceutical supplement to alleviate oxidative stress by modulating the gut microbiota., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The goal of 'Measles and Rubella Strategic Framework 2021-2030' is to make "A world free from measles and rubella". To be a part of this journey, Human Biologicals Institute has developed Mebella™ vaccine, which is a lyophilized Measles and Rubella (Live) vaccine. A randomized, single blind, comparative, multicenter Phase II/III trial was conducted to compare the immunogenicity and safety of Mebella™ vaccine with MR-VAC® vaccine in healthy subjects., Methods: A total of 888 subjects were enrolled in four age groups (222 subjects in each group) of 18 years to 49 years; 2 years to below 18 years; 12 months to below 24 months; and 9 months to below 12 months of age. The subjects were randomized in 2:1 ratio to receive single dose of either Mebella™ vaccine of Human Biologicals Institute or MR-VAC® vaccine. Immunogenicity was assessed at 42 days after the vaccination and was compared between the vaccine arms in each group. Safety was also assessed and compared between the vaccine arms during the study period., Results: A total of 875 subjects completed the study out of 888 enrolled subjects. The seroprotection rates, seroconversion rates, and geometric mean titres for both Measles and Rubella components of Mebella™ vaccine were found to be comparable and non-inferior to the MR-VAC® vaccine after 42 days of vaccination. Injection site pain was the most common local adverse event reported whereas fever was the only systemic adverse event reported in both the vaccine arms. No serious adverse event was reported., Conclusion: It was concluded from the study results that the test vaccine, Mebella™, was immunogenic and well tolerated and was non-inferior to the comparator vaccine, MR-VAC®, when administered to healthy subjects of 9 months to 49 years of age. Clinical Trial Registry of India Identifier: CTRI/2020/07/026930., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Gluten, as a term, causes unease among a vast majority of the population. The reason is the body's inability to process gluten, causing various pathological manifestations. While celiac disease is predominantly a gastrointestinal disease, it also has various extra-intestinal manifestations. Many children receive diagnoses of idiopathic neuropsychiatric symptoms such as epilepsy, attention-deficit hyperactivity disorder (ADHD), restless leg syndrome (RLS), and peripheral neuropathy without ever finding the root cause. A majority of these cases may be associated with celiac disease if only their antibody titers and other appropriate investigations were conducted. The treatment of these manifestations may be eliminated or at least controllable with dietary modification to a gluten-free diet (GFD). In this paper, we will discuss the pathology of celiac disease and the impact of GFD on the neuropsychiatric aspects of this disease, which is of higher prevalence in the pediatric population. A comprehensive literature search was conducted in prominent databases, namely PubMed and Google Scholar, to include studies that provided individual-level data on the neuropathological manifestations and the impact of a GFD on extra-intestinal manifestations of celiac disease. The research protocol was registered in the PROSPERO database (International Prospective Register of Systematic Reviews) with the registration ID: CRD42023415100. Based on the inclusion and exclusion criteria, we included prospective studies, observational studies, and case reports on pediatric patients with biopsy-proven celiac disease, serologically positive celiac disease, celiac disease with neuropsychiatric manifestations, and studies reporting the impact of GFD. After a rigorous quality assessment to remove the risk of bias, we finally included 20 studies to be discussed.  In 6 (30%) studies, patients with neuropsychiatric manifestations had positive serology findings and a relatively higher grade of biopsy results. Seven studies discussed the positive impact of GFD. Five of these seven studies reported statistically significant results (p ≤ 0.001). Our study suggests that gluten plays a role in the severity of neuropsychiatric manifestations of celiac disease. Considering the results of our study, we can see that GFD does impact the prognosis of the disease. Neuropsychiatric findings without gastrointestinal manifestations are more common in the pediatric age group. We have clear evidence that several neurological conditions (neuropathy, ADHD, epilepsy, and RLS) have not only a significant association with gluten but can also potentially benefit from GFD. Thus, screening, with a combination of serological, biopsy, and imaging techniques, must be adapted into the guidelines for early detection and induction of GFD. Furthermore, studies should aim at introducing GFD in the pediatric population as a mode of primary prevention. In conclusion, our review underscores the importance of gluten while dealing with idiopathic neurological conditions in children and hopes to shed light on this commonly misdiagnosed and easily manageable disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Nagarajappa et al.)