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Background: The COVID-19 pandemic exerts a considerable impact on the healthcare setting and healthcare provider's personal and social life. Adjusting to an entirely new working environment may have added challenges for the nurses without having infectious disease expertise. The study aimed to understand and describe the experiences of nurses taking care of COVID-19 patients in a tertiary care Hospital., Materials and Methods: The study was conducted in a tertiary care multispecialty hospital of Udupi District, Karnataka, India. A qualitative research approach with thematic analysis was used in this study. The inclusion criteria were staff nurses caring for COVID-19 patients for a minimum of 1 week. Samples were selected by purposive sampling technique, and the data saturation was achieved with 12 participants. Data were collected through in-depth, face-to-face interviews directed by a semi-structured interview guide. The interviews were audio-recorded and then transcribed verbatim. Thematic analysis derived from participant's responses. Data collection and data analysis were performed simultaneously. The data were analyzed using Kiger and Vapiro's six-step process of thematic analysis of qualitative data., Results: Ten subthemes were grouped from the three major themes under "working in COVID-19 facility: A "challenging experience", "adaptive coping strategies", and "support during a pandemic" emerged based on the experiences of staff nurses working with the COVID-19 patients., Conclusion: Staff nurses in this study had challenging experiences attributed to several factors at the outbreak of the COVID-19 pandemic. Meanwhile, strategies to confront the difficulties were adopted by them to improve their well-being., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Introduction: This study addresses the imperative in contemporary nursing education to prepare students for diverse healthcare settings by exploring nursing students' expectations and perceptions of preceptorship programs, emphasizing the role of evidence-based educational strategies. The research aims to bridge the existing literature gap and contribute valuable insights into strategically designing preceptorship programs aligned with nursing students' needs, preferences, and aspirations, ultimately enhancing precepting practices and relationships within nursing education., Methods: Employing a sequential explanatory mixed method, 140 nursing students, from various colleges in the United Arab Emirates (UAE) participated in the study. A structured questionnaire, encompassing demographic information, a need assessment survey, and a survey on expectations on preceptors was administered. A focus group discussion was conducted to identify perceived barriers to the utilization of preceptorship practices in nursing colleges. Data analysis involved descriptive statistics, the chi-square test, exploratory factor analysis, and content analysis of the focus group discussion., Results: The majority of participants expressed a high need for a preceptorship program, providing empirical evidence to support the development of a nurse educator preceptorship program in colleges and institutes. Preceptorship was identified as a significant contributor to career growth and achievement for nursing students, serving as a valuable tool to establish professional competency throughout their careers., Conclusion: There is a complex demand and high expectations for the core role of nurse educators as preceptors in the field of nursing education. This pioneering study sheds light on the need and perception of nursing students for a preceptorship program in the nursing curriculum., Competing Interests: The authors declared no conflict of interest., (©2024 The Author(s).)

Aim and Background: Optimal feeding strategy for critically ill patients of intensive care unit (ICU) is often a matter of debate as patients admitted to ICU are highly catabolic and reduction in muscle mass is very common. We aimed at early achievement of nutritional goals in preventing skeletal muscle breakdown and improving clinical outcomes among critically ill patients with high risk of malnutrition., Materials and Methods: Nutrition risk in the critically ill (mNUTRIC) Score was used to identify the risk of malnutrition within 24 hours of admission. Quadriceps muscle mass index was measured within 24 hours of admission to ICU and repeated on 7th day. Enteral feeding was monitored by the nutrition expert as part of routine patient care and clinical outcomes were monitored., Results: A total of 287 patients admitted in ICU were screened for malnutrition and 60 (20.9%) of them had high score (>5). There was no statistically significant reduction in the quadriceps muscle mass index ( p < 0.05) ( t = 0.601) measured within 24 hours of admission and on the 7th day of ICU stay, signifying that the nutritional prescription and monitoring may be useful in preserving the muscle mass. This study did not find statistically significant association between the high mNUTRIC score on admission and the clinical outcomes, such as 28 days mortality, incidence of pressure ulcers, length of ICU stay, and hospital-acquired infection ( p > 0.05)., Conclusion: Early initiation and maintenance of enteral nutrition is essential for meeting target calories and protein requirements. It may help to preserve muscle mass in critically ill patients who are otherwise at high risk of malnutrition., How to Cite This Article: Sharon T, Nayak SG, Shanbhag V, Hebbar S. An Observational Study of Nutritional Assessment, Prescription, Practices, and Its Outcome among Critically Ill Patients Admitted to an Intensive Care Unit. Indian J Crit Care Med 2024;28(4):364-368., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2024; The Author(s).)

Purpose: The study aimed at evaluating the Effectiveness of Comprehensive Intervention Programme (CIP) on Quality of life (QOL), fatigue, self-efficacy, and psychosocial distress among Head and Neck Cancer (HNC) patients receiving radiotherapy treatment., Methods: Single-centre non-RCT time series study was conducted among 134 HNC patients (67 observed, followed by 67 subjected to CIP). FACT- H&N, FACT-F, Cancer Behavior Inventory and psychosocial distress scales were used to assess QOL, fatigue, self-efficacy, and psychosocial distress respectively. CIP was provided to the intervention arm twice a week during the course of radiation therapy along with the standard care; the control arm received only standard care. Data were collected before commencing radiotherapy, and post-test assessments were carried out at the end of radiotherapy treatment, and at 3 and 6 months after completion of radiotherapy., Results: Repeated measures ANOVA revealed a statistically significant improvement with CIP in QOL (F (1.917) = 454.103, p = 0.001), fatigue (F (2.106) = 183.775, p = 0.001), self-efficacy (F (2.429) = 190.861, p = 0.001), and psychosocial distress (F (2.288) = 290.105, p = 0.001) in the intervention arm., Conclusion: The CIP implemented to address multitude of issues in HNC patients receiving radiotherapy, proved to be effective in reducing the impact of treatment on QOL, fatigue, self-efficacy and psychosocial distress in HNC patients receiving radiotherapy., (© 2024. The Author(s).)

Background: Quality of life (QOL) is impaired in patients with head and neck cancers (HNC) due to illness and treatment-associated morbidity. Although there is evidence from the studies on interventions' role in improving QOL receiving radiation therapy, these are not systematically synthesised. In this scoping review, we searched and synthesised the evidence on interventions to improve the QOL and its impact among patients with HNCs., Methods: This scoping review was conducted using the framework proposed by Arksey and O'Malley, and the extensions suggested by Levac et al. were incorporated. Two reviewers independently searched four electronic databases using key thesaurus and free-text terms, and the data was extracted, tabulated, synthesised and reported as categories., Results: Seventy-nine papers reported various interventions of diverse nature such as pharmacological, physical, nutritional, complementary and alternative therapies, psychosocial, oral care related, laser and photobiomodulation therapies, rehabilitative, educational, technology-based, surgical, device-related and nurse lead interventions. Most studies reported clinically meaningful impact of interventions on QOL, although the outcome differences were often statistically insignificant. Few studies reported a combination of interventions to address the multidimensional concerns faced by patients with HNCs. None of the studies examined the impact of interventions on QOL among long-term survivors of HNCs., Conclusion: As QOL concerns in patients with HNCs are multifaceted, more extensive studies with complex multi-component interventions and robust research designs are warranted., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Exposure of nursing students to constant work pressure, stress, and emotional turmoil during both clinical and theoretical sessions of nursing training often leads to academic burnout among them. The aim of the study was to determine the presence of academic burnout among undergraduate nursing students and the association of academic burnout with age, gender, year of nursing program, residence location, and relaxation technique practice., Materials and Methods: A descriptive survey design was used, and data were collected from 266 undergraduate nursing students from Udupi Taluka, South India. Baseline information was collected through a demographic proforma, and Oldenburg Burnout Inventory for Students was used for assessing academic burnout. A stratified proportionate sampling technique was used to select the study sample. The data were collected from April 2021 to May 2021. Descriptive and inferential statistics were used for the analysis by using Statistical Package for the Social Sciences (SPSS) version 16., Results: The study revealed that most of the participants had high levels of academic burnout (163, 61.7%), emotional exhaustion (165, 62%), and disengagement (173, 65%). Moreover, academic burnout was significantly associated with age (χ 2 = 8.669, P = 0.012) and relaxation technique practice (χ 2 = 9.263, P = 0.002). Additionally, disengagement was significantly associated with gender (χ 2 = 9.956, P = 0.002), residence location (χ 2 = 7.032, P = 0.027), and relaxation technique practice (χ 2 = 8.729, P = 0.003)., Conclusions: Based on the findings of the study, we recommend that the faculty and administrators of nursing institutes must incorporate strategies for the prevention or reduction of academic burnout in the nursing curriculum., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Education and Health Promotion.)

Objectives: Patients diagnosed with head-and-neck cancer (HNC) face unique challenges in comparison to other types of cancers. Sources of psychosocial distress (PSD) are multifactorial and recognising the key attributes would facilitate better understanding of the experienced distress, potentially enabling directed intervention strategies. The present research was conducted to explore the key attributes of PSD from HNC patients' perspective to develop a tool., Material and Methods: The study adopted a qualitative approach. The data were collected from nine HNC patients receiving radiotherapy through focus group discussion. Data were transcribed, read and reread through for searching the meanings and patterns, to familiarise with the data and obtain ideas on experiences related to PSD. Similar experiences identified across the dataset were sorted and then collated into themes. Detailed analysis of themes and related quotes of the participants are reported with each theme., Results: The codes generated from the study are grouped under four major themes; 'Irksome symptoms are distressing,' 'Distressing physical disability inflicted by the situation,' 'Social Curiosity - a distressing element' and 'Distressing uncertainty of future'. The attributes of PSD and the magnitude of psychosocial problems were reflected in the findings., Conclusion: Psychosocial health of HNC patients is greatly impacted due to disease and/or treatment. Dynamic patterns of attributes identified from the study contributed to developing a tool on PSD. The findings of this study also necessitate the need for constructing an intervention for reducing PSD based on the attributes from the HNC patient's perspective., Competing Interests: There are no conflicts of interest., (© 2023 Published by Scientific Scholar on behalf of Indian Journal of Palliative Care.)

Background: Prolonged labour intensifies labour pain, and failure to address labour pain may lead to abnormal labour and augments the usage of operative interventions. Prolonged labour is common among women, resulting in maternal morbidity, increased caesarean section (CS) rates, and postpartum complications. It may bring forth negative birth experiences that may increase the preference for CS. There is a dearth of evidence concerning the effectiveness of breathing exercises on the duration of labor. As per our knowledge, this is the first systematic review and meta-analysis on the effect of breathing exercises on the duration of labor. This systematic review and meta-analysis aimed to appraise the evidence concerning the effectiveness of breathing exercises on the duration of labour., Methods: Electronic databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Web of Science, SCOPUS, and ClinicalKey were searched for randomized controlled trials, quasi-experimental studies published in the English language between January 2005 to March 2022 that reported on the effectiveness of breathing exercises on the duration of labour. Duration of labour was the primary analysed outcome. The secondary outcomes assessed were anxiety, duration of pain, APGAR scores, episiotomy, and mode of delivery. Meta-analysis was done using RevMan v5.3., Results: The reviewed trials involved 1418 participants, and the study participants ranged from 70 to 320. The mean gestational weeks of the participants among the reported trials was 38.9 weeks. Breathing exercise shortened the duration of the intervention group's second stage of labour compared with the control group., Conclusions: Breathing exercise is a beneficial preventive intervention in shortening the duration of second stage of labour., Registration: The review protocol was registered with PROSPERO (CRD42021247126)., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2023 by the Journal of Global Health. All rights reserved.)

Introduction: Deinstitutionalization and rising psychiatric care in society have led to an increase in the role of caregivers of persons diagnosed with schizophrenia., Objective: The objective of this systematic review was to identify and synthesize qualitative research findings that explored the needs, challenges, and coping strategies among the primary caregivers of a schizophrenia patient., Methodology: The electronic databases namely PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Scopus, Web of Science, ProQuest, and ClinicalKey were searched to identify relevant articles published from 2005 to October 2021. The quality of the included articles was independently appraised by two reviewers using Walsh and Downe criteria and was analysed thematically. The meta-synthesis was modelled on Lucas framework., Results: The richness of information across 38 papers involving 543 participants was noteworthy. The needs of the primary caregivers were rehabilitation and vocational centre, information and education, self-help groups, augmented healthcare services, and communication and collaboration. The challenges reported were treatment expenses, bizarre beliefs, self and other directed harm and violence, therapeutic noncompliance, onerous caregiving task, crumbling family relations, misconception and discrimination, and self-stigmatization. The coping strategies adopted were problem-focused coping, emotional coping, behavioural coping, coping through social support, religious coping and cognitive reappraisal., Conclusion: The primary caregivers provide unparalleled service to the health system and for the patient. The healthcare providers need to give undue attention to the unmet needs and challenges of the caregivers, which would benefit the health system by enabling the caregivers in providing long-term care for the schizophrenic., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: This mixed-methods study was undertaken to ascertain undergraduate medical students' perceptions of remote learning following the COVID-19 restrictions. 545 students participated in this study., Methods: Data was collected using a validated questionnaire and four focus group discussions., Results: Regarding recorded lectures, the quantitative findings indicated that they were important during online learning and the qualitative findings explained that the recorded lectures enabled individual students to pace and customize their learning. The majority of the students agreed that recorded lectures were relevant to their learning, though they watched less than 50% of recorded lectures. Qualitative findings described procrastination as the rationale for not watching the videos. The online live lectures had a relatively higher percentage of contribution towards learning in comparison with instructor recorded video lectures. Students were more engaged with live lectures, and 63.3% of respondents agreed. Qualitative findings confirmed the opportunities for interacting with peers and better clarification of doubts by teachers during live lectures., Conclusions: Online learning with recorded and live lectures provided continuity in medical education during the COVID-19 pandemic. When compared to recorded video lectures, synchronous live lectures were regarded as superior by students largely due to the opportunity to directly communicate with the instructor and receive quick feedback., Competing Interests: No competing interests were disclosed., (Copyright: © 2022 Barche A et al.)

A discrete-velocity Boltzmann equation (DVBE) with Bhatnagar-Gross-Krook (BGK) approximation is discretized in time and space using a third-order Runge-Kutta (RK3) and fifth-order weighted essentially nonoscillatory (WENO) finite-difference scheme to simulate benchmark inviscid compressible flows. The implementation of the WENO ensures that solutions behave with minimal or no oscillations, narrowing the gap between the exact and the numerical results. Discrete-velocity sets given by Kataoka and Tsutahara [Phys. Rev. E 69, 056702 (2004)10.1103/PhysRevE.69.056702] are used. The additional dissipation terms as well as artificial viscosity are incorporated in the formulation to solve the compressible flows at high Mach number. Further, the flows which are subjected initially to a high density ratio are effectively simulated. In this article, one-dimensional benchmarks are simulated at initial Mach number up to 30 and density ratio up to 1000, whereas, the benchmarks in two dimensions are simulated with a Mach number up to 10. The algorithm is assessed by simulating numerous benchmarks, namely, (i) one-dimensional Riemann problem for various shock waves combinations [namely (a) shock-shock waves in the case of different Mach numbers, (b) rarefaction-shock waves for various density ratios, (c) sudden contact shock discontinuity, and (d) shock-rarefaction waves for density ratio 5], (ii) isentropic vortex convection test, (iii) regular shock reflection (RR) for Mach numbers 2.9 and 10, (iv) double Mach reflection (DMR) for inflow Mach numbers as 6 and 10, and (v) forward-facing step for inflow Mach numbers 2 to 5. Further, the effect of change in Mach numbers and wedge angles on the flow structures in the case of DMR are detailed. In the case of a forward-facing step, the variations of flow structure (e.g., the Mach stem height, triple points location, and shock standoff distance) are detailed with respect to Mach number, step height, and specific-heat ratios. Finally, the numerical stability of the proposed formulation is carried out to assess the behavior of the free parameters.

Telemedicine has great potential in urology as a strong medium for providing patients with continuous high-quality urological care despite the hurdles involved in its implementation. Both clinicians and patients are crucial factors in determining the success of tele-consults in terms of simplicity of use and overall satisfaction. For it to be successfully incorporated into routine urological practice, rigorous training and evidence-based recommendations are lacking. If these issues are addressed, they can provide a significant impetus for future tele-consults in urology and their successful deployment, even beyond the pandemic, to assure safer and more environment-friendly patient management., Competing Interests: The 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 © 2022 Naik, Nandyal, Nayak, Shah, Ibrahim, Hameed, Patil, Suresh, Shetty, Rai, TP, Rice, Reddy, Bhat, Garg, Chłosta and Somani.)

Background: Head and Neck Cancer (HNC) patients are at increased risk of psychosocial distress compared with patients with other forms of cancer. Various symptoms of the disease and side effects of treatment are attributing factors for distress. This systematic review aimed to identify the prevalence of psychosocial distress among HNC patients receiving radiotherapy., Methods: The following search engines from 2000-2021 were searched: PubMed, CINAHL, Cochrane, Web of Science, ProQuest, Scopus, and Embase. Citation checking and extensive reference checking were also conducted. Cross-sectional, longitudinal, cohort, exploratory and prospective, repeated measure studies published in English were included. Newcastle Ottawa Scale assessed the quality, and the data were extracted on a validated data extraction form., Results: Out of 782 articles, eleven records met the eligibility criteria, including 776 HNC patients receiving radiotherapy. Data were synthesized and summarized descriptively as measurements were not homogenous. Prevalence estimates of depression or depressive symptoms were calculated. Outcomes were measured with various measuring tools and reported in frequency, percentage, mean, and standard deviation in various studies. All studies reported depression ranging from 9.8% to 83.8%, and pooled estimated prevalence of depression among HNC patients receiving radiotherapy is 63% (95% CI 42-83) with significant heterogeneity (I2= 97.66%; p<0.001). An increase in the trend is observed along with treatment progression. Another three studies reported anxiety along with depression. Physical symptoms, body image, low social support, fatigue specific radiotherapy regimens were the predictive factors of depression., Conclusion: HNC patients are psychosocially distressed during radiotherapy, and the distress is steadily increased during the therapy. The predictive factors could serve as potential areas of intervention and supportive therapy during radiotherapy.

Sudden closure of schools due to coronavirus disease 2019 (COVID-19) pandemic introduced extensive use of digital technology in education across the globe. The gadgets connected to the internet have become an essential part of the lives of children in the contemporary world. Children and adolescents are more exposed to smart devices for academic learning and entertainment. The concern of smartphone addiction among children and adolescents in recent decades has been heightened by the spread of COVID-19. Excessive use of smartphones has physical, psychological, and social unfavorable outcomes signifying the need for developing strategies to reduce the usage., (© 2022 Wiley Periodicals LLC.)

Telemedicine is the delivery of healthcare to patients who are not in the same location as the physician. The practice of telemedicine has a large number of advantages, including cost savings, low chances of nosocomial infection, and fewer hospital visits. Teleclinics have been reported to be successful in the post-surgery and post-cancer therapy follow-up, and in offering consulting services for urolithiasis patients. This review focuses on identifying the outcomes of the recent studies related to the usage of video consulting in urology centers for hematuria referrals and follow-up appointments for a variety of illnesses, including benign prostatic hyperplasia (BPH), kidney stone disease (KSD), and urinary tract infections (UTIs) and found that they are highly acceptable and satisfied. Certain medical disorders can cause embarrassment, social exclusion, and also poor self-esteem, all of which can negatively impair health-related quality-of-life. Telemedicine has proven beneficial in such patients and is a reliable, cost-effective patient-care tool, and it has been successfully implemented in various healthcare settings and specialties., Competing Interests: The 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 © 2022 Naik, Hameed, Nayak, Gera, Nandyal, Shetty, Shah, Ibrahim, Naik, Kamath, Mahdaviamiri, D'costa, Rai, Chlosta and Somani.)

The current study reports an integrated approach of machine learning and tryptophan fluorescence and photoacoustic spectral properties to assess the mitochondrial status under oral pathological conditions. The mitochondria in the study were isolated from oral cancer tissues and adjacent normal counterparts, and the corresponding fluorescence and photoacoustic spectra of tryptophan were recorded at 281 nm pulsed laser excitations. A set of features were selected from the pre-processed spectra and were used to classify the data using support vector machine (SVM) learning in the MATLAB platform. SVM analysis demonstrated clear differentiation between mitochondria isolated from normal and cancer tissues for fluorescence (sensitivity, 86.6%; specificity, 90%) and photoacoustic (sensitivity, 86.6%; specificity, 96.6%) measurements. Further investigation into the influence of change in protein conformation on the nature of tryptophan spectral properties was evaluated by 8-anilino-1-naphthalene sulfonic acid (ANS) fluorescence assay. The impact of protein structural changes on the mitochondrial functions was also estimated by mitochondrial membrane potential (MMP), reactive oxygen species (ROS), and cytochrome c oxidase (COX) assays, suggesting an altered mitochondrial function. The findings indicate that tryptophan fluorescence and photoacoustic spectral properties together with machine learning algorithms may delineate the mitochondrial functional status in vitro , indicating its translational potential.

Mycobacterium tuberculosis, one of the major threats to mankind, requires micronutrients like metal ions for their survival and pathogenicity inside the host system. Intracellular pathogens such as M. tuberculosis have co-evolved to combat the nutritional immunity developed by the host. It has developed eminent mechanisms to sequester essential metal ions from the host system. One such prominent mechanism to scavenge metal ions to thrive in the host cell involves ATP-binding cassette (ABC) transporters, which transport metal ions (in free and/or complex forms) across the cell membrane. This study employs a high-throughput data mining analysis to identify open reading frames (ORFs) encoding metal uptake ABC transporters in M. tuberculosis H37Rv. In total, 19 ORFs resulting in seven ABC transport systems and two P-type ATPases were identified, which are potentially involved in the uptake of different metal ions. The results also suggest the existence of a subunit sharing mechanism in M. tuberculosis where the transmembrane and nucleotide binding domains are shared among different ABC transport systems indicating the import of multiple substrates via a single ABC transporter. Thus, this study reflects an overview of the repertoire of metal-specific ABC transport systems in M. tuberculosis H37Rv, providing potential therapeutic targets for the future., (Copyright © 2021 Elsevier B.V. All rights reserved.)

In the current study, a breast tumor xenograft was established in athymic nude mice by subcutaneous injection of the MCF-7 cell line and assessed the tumor progression by photoacoustic spectroscopy combined with machine learning tools. The advancement of breast tumors in nude mice was validated by tumor volume kinetics and histopathology and corresponding image analysis by TissueQuant software compared to controls. The ex vivo tumors in progressive conditions belonging to time points, day 5 th , 10 th , 15 th & 20 th , were excited with 281 nm pulsed laser light and recorded the corresponding photoacoustic spectra in time domain. The spectra were then pre-processed, augmented for a 10-fold increase in the data strength, and subjected to wavelet packet transformation for feature extraction and selection using MATLAB software. In the present study, the top 10 features from all the time point groups under study were selected based on their prediction ranking values using the mRMR algorithm. The chosen features of all the time-point groups were then subjected to multi-class Support Vector Machine (SVM) algorithms for learning and classifying into respective time point groups under study. The analysis demonstrated accuracy values of 95.2%, 99.5%, and 80.3% with SVM- Radial Basis Function (SVM-RBF), SVM-Polynomial & SVM-Linear, respectively. The serum metabolomic levels during tumor progression complemented photoacoustic patterns of tumor progression, depicting breast cancer pathophysiology.

Aim: The overall aim of the study is to develop a module for the structure, staffing, job responsibilities, training and workflow for the hospital Infection Control Department., Design: An exploratory research design in two phases. Phase 1: Hospital based exploratory survey design. Phase 2: Delphi technique with Focus Group Discussion., Method: Data will be collected through interviewing Infection Control Nurses (ICNs) or infection control in-charge using Infection Prevention and Control Assessment Framework (IPCAF) released by World Health Organization (WHO) in the first phase and Delphi technique in the second phase to determine the problems and solutions for the concerns pertaining to the ICNs. The study is funded by Indian Council of Medical Research from 15 October 2019 for 3 years duration., Discussion: Healthcare Associated Infection (HAI) affects the care quality of millions of people around the globe. Many researchers have explored the evidence for causes and measures to contain infection. However, there are hardly few researches from the perspective to structure, staffing pattern and factors affecting ICNs. As staffing is considered as a vital component in infection prevention, there is a necessity for optimization to reduce the global burden related to HAI., Impact: This protocol on Structure, staffing, and factors affecting ICN will provide insight into developing strategy, policy or educational module for the ICNs across the country., Trial Registration: The trial is registered with Central Trial Registry of India (CTRI) with reference ID: CTRI/2020/07/026286., (© 2020 John Wiley & Sons Ltd.)

The aim of this study was to synthesize newer potent Schiff bases by condensing 2-amino-5-(2,4-dichlorophenyl)thiophene-3-carbonitrile and 1,3-disubstituted-1H-pyrazole-4-carbaldehydes, and to investigate their biological activity. The compounds were synthesized via Gewald synthesis and characterized by spectral data and elemental analyses. They were screened for their in vitro antibacterial and anti-inflammatory activities. The synthesized compounds were also evaluated for in vitro antitubercular activity against Mycobacterium tuberculosis H37Rv using the microplate Alamar Blue assay. Compounds 8b, 8c, 8f, 8g, 8k, 8n, and 8o showed promising antibacterial activity. The interactions between the substituted pyrazoles and bovine protein showed promising anti-inflammatory activity. The experimental results revealed compound 8a as a promising antitubercular agent. Hemolytic assays confirmed that the compounds are nontoxic, with percentage hemolysis ranging from 3.6 to 20.1, at a concentration of 1 mg/ml. The results suggest that the pyrazole ring and the substitution pattern on the heterocyclic moiety have an effect on the bioactivity., (© 2020 Deutsche Pharmazeutische Gesellschaft.)

Introduction: Spending a few hours to cool down in a cooling center reduces the impact of heat on health. But limited or lack of accessibility of these facilities is often a barrier to their utilization. The objective of this study was to assess accessibility of the cooling centers to heat-vulnerable populations in New York State (NYS) by various modes of transportation., Methods: We estimate the proximity of 377 cooling centers to general and heat-vulnerable populations in NYS (excluding New York City (NYC)) and determine their accessibility via walking, public transportation and driving. Distances between tract populations and nearest cooling center, and between cooling centers and public transportation stops were estimated. Accessibility in four metropolitan regions was determined via public transportation while accessibility in heat-vulnerable rural areas was estimated via driving., Results: Distances to nearest cooling center ranged from 0 to 53.2 miles with only a third of NYS population within walking distance (0.5 miles) of a cooling center. About 51% of heat-vulnerable tracts were within 0.5 miles, with an average distance of 2.4 miles to the nearest cooling center. Within the four metro politan regions 80% of cooling centers within 0.5 miles of a public transportation stop. All cooling centers in heat-vulnerable tracts were accessible via public transportation. In rural heat-vulnerable tracts, driving distances averaged at about 18 miles., Conclusions: In urban areas many residents were not within walking distance of a cooling center, but most, and nearly all in the most heat-vulnerable areas, were within walking distance of public transportation to a cooling center. In rural locations distances were longer, and accessibility is a greater issue. Cooling centers can be a valuable resource for general and heat-vulnerable populations during an extreme heat event. When planning and implementing cooling centers, it is therefore important to improve accessibility and address other barriers that can hamper their utilization., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest.

2-Amino-5-(3-fluoro-4-methoxyphenyl)thiophene-3-carbonitrile have been synthesized from 1-(3-fluoro-4-methoxyphenyl)ethanone, malononitrile, a mild base and sulfur powder using Gewald synthesis technique and the intermediate was treated with 1,3-disubstituted pyrazole-4-carboxaldehyde to obtain the novel Schiff bases. 1,3-disubstituted pyrazole-4-carboxaldehyde derivatives have been synthesized by Vilsmeier-Haack reaction in the course of a multi-step reaction. The structure of novel compounds were established on the basis of their elemental analyses IR, 1 H NMR, 13 C NMR, and mass spectral data and then screened for their in vitro antimicrobial activity. Among them 5a, 5c, 5f and 5h showed excellent activity when compared to other derivatives. Remaining derivatives showed moderate activity.

Pursuing our recent interest regarding the antimicrobial activity of Schiff bases derivatives, we have synthesized a series of 6-(substitutedphenyl)- N' -(( E )-(substitutedphenyl)methylidene)-2-methylpyridine-3-carbohydrazides ( 5a-n ) and evaluated their antibacterial activity. Structures of these compounds were confirmed by standard studies of FTIR, 1 H NMR, 13 C NMR, MS and elemental analysis. Antibacterial activity of synthesized molecules was tested against Gram-positive ( S. aureus and E. faecalis ) and Gram-negative ( E. coli and P. aeruginosa ) bacterial strains. Synthesized compounds showed good antibacterial activity at a lower concentration than standard. Most of the compounds ( 5a , 5c , 5i , 5j and 5n ) are potent against all the tested bacterial strains with MIC values ranging from 1.56-12.5 μg/mL.

Aim of the Study: The current research was conducted with the aim of determining the quality of life of head and neck cancer (HNC) patients using mixed method approach., Methods: A mixed method triangulation design (QUAN + QUAL) was adopted in the study. Quantitative data were collected among 54 and qualitative data were collected till data saturation using nested sampling technique. Data were collected from seven oncological wards of two tertiary care hospitals during the 4 th week of radiation therapy. Quantitative data were collected through functional assessment of cancer therapy: head and neck, and a semi-structured interview schedule was adopted to elicit their experiences. Quantitative and qualitative data were compared during the analysis phase. Both qualitative and quantitative data were depicted in meta-matrices., Results: Results showed that the most affected domains were functional well-being followed by HNC subscale. Similar findings were observed in narrative description of participants. Most focused experience was pain, and difficulty in eating and swallowing was experienced due to pain. Their verbal communication was inefficacious due to loss of voice and tone. Moreover, communication was difficult owing to changes in the oral mucous membrane and pathology., Conclusion: Patients with HNC suffer from varying degrees of psychosocial problems, and it is important to identify the psychosocial adjustment of the patients since the symptoms are sufficient to lay heavy burden., Competing Interests: None

Background: Regional National Weather Service (NWS) heat advisory criteria in New York State (NYS) were based on frequency of heat events estimated by sparse monitoring data. These may not accurately reflect temperatures at which specific health risks occur in large geographic regions. The objectives of the study were to use spatially resolved temperature data to characterize health risks related to summertime heat exposure and estimate the temperatures at which excessive risk of heat-related adverse health occurs in NYS. We also evaluated the need to adjust current heat advisory threshold and messaging based on threshold temperatures of multiple health outcomes., Methods: We assessed the effect of multi-day lag exposure for maximum near-surface air temperature (T max) and maximum Heat Index derived from the gridded National Land Data Assimilation System (NLDAS) reanalysis dataset on emergency department (ED) visits/ hospitalizations for heat stress, dehydration, acute kidney failure (AKF) and cardiovascular diseases (CVD) using a case-crossover analysis during summers of 2008-2012. We assessed effect modification using interaction terms and stratified analysis. Thresholds were estimated using piecewise spline regression., Results: We observed an increased risk of heat stress (Risk ratio (RR) = 1.366, 95% confidence interval (CI): 1.347, 1.386) and dehydration (RR = 1.024, 95% CI: 1.021, 1.028) for every 1 °C increase in T max on the day of exposure. The highest risk for AKF (RR = 1.017, 95% CI: 1.014, 1.021) and CVD (RR = 1.001, 95% CI: 1.000, 1.002) were at lag 1 and 4 respectively. The increased risk of heat-health effects persists up to 6 days. Rural areas of NYS are at as high a risk of heat-health effects as urban areas. Heat-health risks start increasing at temperatures much lower than the current NWS criteria., Conclusion: Reanalysis data provide refined exposure-response functions for health research, in areas with sparse monitor observations. Based on this research, rural areas in NYS had similar risk for health effects of heat. Heat advisories in New York City (NYC) had been reviewed and lowered previously. As such, the current NWS heat advisory threshold was lowered for the upstate region of New York and surrounding areas. Enhanced outreach materials were also developed and disseminated to local health departments and the public.

In the present study, we have designed a laser-induced fluorescence (LIF) based instrumentation and developed a sensitive methodology for the effective separation, visualization, identification and analysis of proteins on a single platform. In this method, intrinsic fluorescence spectra of proteins were detected after separation on 1 or 2 dimensional Sodium Dodecyl Sulfate-Tris(2-carboxyethyl)phosphine (SDS-TCEP) polyacrylamide gel electrophoresis (PAGE) and the data were analyzed. The MATLAB assisted software was designed for the development of PAGE fingerprint for the visualization of protein after 1- and 2-dimensional protein separation. These provided objective parameters of intrinsic fluorescence intensity, emission peak, molecular weight and isoelectric point using a single platform. Further, the current architecture could differentiate the overlapping proteins in the PAGE gels which otherwise were not identifiable by conventional staining, imaging and tagging methods. Categorization of the proteins based on the presence or absence of tyrosine or tryptophan residues and assigning the corresponding emission peaks (309-356 nm) with pseudo colors allowed the detection of proportion of proteins within the given spectrum. The present methodology doesn't use stains or tags, hence amenable to couple with mass spectroscopic measurements. This technique may have relevance in the field of proteomics that is used for innumerable applications., (© 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Objectives: The frequency and intensity of extreme heat events are increasing in New York State (NYS) and have been linked with increased heat-related morbidity and mortality. But these effects are not uniform across the state and can vary across large regions due to regional sociodemographic and environmental factors which impact an individual's response or adaptive capacity to heat and in turn contribute to vulnerability among certain populations. We developed a heat vulnerability index (HVI) to identify heat-vulnerable populations and regions in NYS., Study Design: Census tract level environmental and sociodemographic heat-vulnerability variables were used to develop the HVI to identify heat-vulnerable populations and areas., Methods: Variables were identified from a comprehensive literature review and climate-health research in NYS. We obtained data from 2010 US Census Bureau and 2011 National Land Cover Database. We used principal component analysis to reduce correlated variables to fewer uncorrelated components, and then calculated the cumulative HVI for each census tract by summing up the scores across the components. The HVI was then mapped across NYS (excluding New York City) to display spatial vulnerability. The prevalence rates of heat stress were compared across HVI score categories., Results: Thirteen variables were reduced to four meaningful components representing 1) social/language vulnerability; 2) socioeconomic vulnerability; 3) environmental/urban vulnerability; and 4) elderly/ social isolation. Vulnerability to heat varied spatially in NYS with the HVI showing that metropolitan areas were most vulnerable, with language barriers and socioeconomic disadvantage contributing to the most vulnerability. Reliability of the HVI was supported by preliminary results where higher rates of heat stress were collocated in the regions with the highest HVI., Conclusions: The NYS HVI showed spatial variability in heat vulnerability across the state. Mapping the HVI allows quick identification of regions in NYS that could benefit from targeted interventions. The HVI will be used as a planning tool to help allocate appropriate adaptation measures like cooling centers and issue heat alerts to mitigate effects of heat in vulnerable areas., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Conceptual models developed through qualitative research are based on the unique experiences of suffering and individuals' adoptions of each participant. A wide array of problems are faced by head-and-neck cancer (HNC) patients due to disease pathology and treatment modalities which are sufficient to influence the quality of life (QOL). Men possess greater self-acceptance and are better equipped with intrapersonal strength to cope with stress and adequacy compared to women., Methodology: A qualitative phenomenology study was conducted among seven women suffering from HNC, with the objective to understand their experiences of suffering and to describe the phenomenon. Data were collected by face-to-face, in-depth, open-ended interviews. Data were analyzed using Open Code software (OPC 4.0) by following the steps of Colaizzi process., Results: The phenomenon that emerged out of the lived experiences of HNC women was "Personified as paragon of suffering.optimistic being of achieving normalcy," with five major themes and 13 subthemes., Conclusion: The conceptual model developed with the phenomenological approach is very specific to the women suffering from HNC, which will be contributing to develop strategies to improve the QOL of women., Competing Interests: There are no conflicts of interest.

The contribution of the tumor microenvironment to the development of pancreatic adenocarcinoma (PDAC) is unclear. The LSL-KrasG12D/+;LSL-p53R172H/+;Pdx-1-Cre (KPC) tumor model, which is widely utilized to faithfully recapitulate human pancreatic cancer, depends on Cre-mediated recombination in the epithelial lineage to drive tumorigenesis. Therefore, specific Cre-loxP recombination in stromal cells cannot be applied in this model, limiting the in vivo investigation of stromal genetics in tumor initiation and progression. To address this issue, we generated a new Pdx1FlpO knock-in mouse line, which represents the first mouse model to physiologically express FlpO recombinase in pancreatic epithelial cells. This mouse specifically recombines Frt loci in pancreatic epithelial cells, including acinar, ductal, and islet cells. When combined with the Frt-STOP-Frt KrasG12D and p53Frt mouse lines, simultaneous Pdx1FlpO activation of mutant Kras and deletion of p53 results in the spectrum of pathologic changes seen in PDAC, including PanIN lesions and ductal carcinoma. Combination of this KPF mouse model with any stroma-specific Cre can be used to conditionally modify target genes of interest. This will provide an excellent in vivo tool to study the roles of genes in different cell types and multiple cell compartments within the pancreatic tumor microenvironment.

Local agencies in New York State (NYS) set up cooling centers to provide relief from summer-time heat especially for people with limited access to air-conditioning. We aimed to determine cooling center locations in NYS, and explore county agencies' involvement in organizing and promoting utilization of cooling centers. We conducted a survey among county health and emergency preparedness offices in NYS (excluding NYC) and explored official county websites. We identified 377 cooling centers, mostly in metropolitan areas of NYS. Although 47 % of counties listed locations online, only 29 % reported locations via survey. Radio (90 %) and internet (84 %) were popular for information dissemination. Air-conditioning was available at all indoor cooling center facilities. Cooling centers in 13 % of the counties were accessible by either public transportation or shuttles arranged by the facility. About 38 % counties do not consider cooling centers important in their region or promote informal cooling centers. More than a third of New York counties had neither cooling centers nor plans to establish a cooling center as extreme heat was not perceived as a threat in their region.

The contribution of the microenvironment to pancreatic acinar-to-ductal metaplasia (ADM), a preneoplastic transition in oncogenic Kras-driven pancreatic cancer progression, is currently unclear. Here we show that disruption of paracrine Hedgehog signaling via genetic ablation of Smoothened (Smo) in stromal fibroblasts in a Kras(G12D) mouse model increased ADM. Smo-deleted fibroblasts had higher expression of transforming growth factor-α (Tgfa) mRNA and secreted higher levels of TGFα, leading to activation of EGFR signaling in acinar cells and increased ADM. The mechanism involved activation of AKT and noncanonical activation of the GLI family transcription factor GLI2. GLI2 was phosphorylated at Ser230 in an AKT-dependent fashion and directly regulated Tgfa expression in fibroblasts lacking Smo Additionally, Smo-deleted fibroblasts stimulated the growth of Kras(G12D)/Tp53(R172H) pancreatic tumor cells in vivo and in vitro. These results define a non-cell-autonomous mechanism modulating Kras(G12D)-driven ADM that is balanced by cross-talk between Hedgehog/SMO and AKT/GLI2 pathways in stromal fibroblasts., (© 2016 Liu et al.; Published by Cold Spring Harbor Laboratory Press.)

Preclinical studies have suggested that the pancreatic tumor microenvironment both inhibits and promotes tumor development and growth. Here we establish the role of stromal fibroblasts during acinar-to-ductal metaplasia (ADM), an initiating event in pancreatic cancer formation. The transcription factor V-Ets avian erythroblastosis virus E26 oncogene homolog 2 (ETS2) was elevated in smooth muscle actin-positive fibroblasts in the stroma of pancreatic ductal adenocarcinoma (PDAC) patient tissue samples relative to normal pancreatic controls. LSL-Kras(G12D/+); LSL-Trp53(R172H/+); Pdx-1-Cre (KPC) mice showed that ETS2 expression initially increased in fibroblasts during ADM and remained elevated through progression to PDAC. Conditional ablation of Ets-2 in pancreatic fibroblasts in a Kras(G12D)-driven mouse ADM model decreased the amount of ADM events. ADMs from fibroblast Ets-2-deleted animals had reduced epithelial cell proliferation and increased apoptosis. Surprisingly, fibroblast Ets-2 deletion significantly altered immune cell infiltration into the stroma, with an increased CD8+ T-cell population, and decreased presence of regulatory T cells (Tregs), myeloid-derived suppressor cells, and mature macrophages. The mechanism involved ETS2-dependent chemokine ligand production in fibroblasts. ETS2 directly bound to regulatory sequences for Ccl3, Ccl4, Cxcl4, Cxcl5, and Cxcl10, a group of chemokines that act as potent mediators of immune cell recruitment. These results suggest an unappreciated role for ETS2 in fibroblasts in establishing an immune-suppressive microenvironment in response to oncogenic Kras(G12D) signaling during the initial stages of tumor development., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: The aim of the study was to assess the self-image of the patients with head and neck cancers (HNCs) by using a mixed method research., Subjects and Methods: A mixed method approach and triangulation design was used with the aim of assessing the self-image of the patients with HNCs. Data was gathered by using self-administered self-image scale and structured interview. Nested sampling technique was adopted. Sample size for quantitative approach was 54 and data saturation was achieved with seven subjects for qualitative approach. Institutional Ethical Committee clearance was obtained., Results: The results of the study showed that 30 (56%) subjects had positive self-image and 24 (44%) had negative self-image. There was a moderate positive correlation between body image and integrity (r = 0.430, P = 0.001), weak positive correlation between body image and self-esteem (r = 0.270, P = 0.049), and no correlation between self-esteem and integrity (r = 0.203, P = 0.141). The participants also scored maximum (24/24) in the areas of body image and self-esteem. Similar findings were also observed in the phenomenological approach. The themes evolved were immaterial of outer appearance and desire of good health to all., Conclusion: The illness is long-term and impacts the individual 24 h a day. Understanding patients' self-concept and living experiences of patients with HNC is important for the health care professionals to improve the care.

The current study reports the photoacoustic spectroscopy-based assessment of breast tumor progression in a nude mice xenograft model. The tumor was induced through subcutaneous injection of MCF-7 cells in female nude mice and was monitored for 20 days until the tumor volume reached 1000  mm3. The tumor tissues were extracted at three different time points (days 10, 15, and 20) after tumor inoculation and subjected to photoacoustic spectral recordings in time domain ex vivo at 281 nm pulsed laser excitations. The spectra were converted into the frequency domain using the fast Fourier transformed tools of MATLAB® algorithms and further utilized to extract seven statistical features (mean, median, area under the curve, variance and standard deviation, skewness and kurtosis) from each time point sample to assess the tumor growth with wavelet principal component analysis based logistic regression analysis performed on the data. The prediction accuracies of the analysis for day 10 versus day 15, day 15 versus day 20, and day 10 versus day 20 were found to be 92.31, 87.5, and 95.2%, respectively. Also, receiver operator characteristics area under the curve analysis for day 10 versus day 15, day 15 versus day 20, and day 10 versus day 20 were found to be 0.95, 0.85, and 0.93, respectively. The ability of photoacoustic measurements in the objective assessment of tumor progression has been clearly demonstrated, indicating its clinical potential.

Epidemiological analyses of air quality often estimate human exposure from ambient monitoring data, potentially leading to exposure misclassification and subsequent bias in estimated health risks. To investigate this, we conducted a case-crossover study of summertime ambient ozone and fine particulate matter (PM(2.5)) levels and daily respiratory hospitalizations in New York City during 2001-2005. Comparisons were made between associations estimated using two pollutant exposure metrics: observed concentrations and predicted exposures from the EPA's Stochastic Human Exposure and Dose Simulation (SHEDS) model. Small, positive associations between interquartile range mean ozone concentrations and hospitalizations were observed and were strongest for 0-day lags (hazard ratio (HR)=1.013, 95% confidence interval (CI): 0.998, 1.029) and 3-day lags (HR=1.006, 95% CI: 0.991, 1.021); applying mean predicted ozone exposures yielded similar results. PM(2.5) was also associated with admissions, strongest at 2- and 4-day lags, with few differences between exposure metrics. Subgroup analyses support recognized sociodemographic differences in concentration-related hospitalization risk, whereas few inter-stratum variations were observed in relation to SHEDS exposures. Predicted exposures for these spatially homogenous pollutants were similar across sociodemographic strata, therefore SHEDS predictions coupled with the case-crossover design may have masked observable heterogeneity in risks. However, significant effect modification was found for subjects in the top exposure-to-concentration ratio tertiles, suggesting risks may increase as a consequence of infiltration or greater exposure to outdoor air.

This nested case-control study examined the association between prevalent asthma and indoor allergen sensitization and/or exposure among children (aged 5-17 years) in Buffalo, New York. The study included a self-administered questionnaire, clinical interviews, skin allergen sensitivity tests and home dust sampling for house dust mites, cat, dog, cockroach and mouse allergens. After adjusting for multiple confounders, asthma cases had higher odds of being sensitized to Der p dust mites (odds ratio [OR]=1.94, 95% confidence interval (CI): 1.13-3.35), cat (OR=1.96, 95% CI: 1.13-3.39), or dog allergens (OR=1.89, 95% CI: 1.10-3.22) than the controls. A significantly positive association between asthma status presence of cat allergen in the child's mattress (ORs: 2.61, 95% CI: 1.09-6.28) was also found. Children with both sensitization and environmental exposure to cat allergens had higher odds of asthma (OR=7.08, 95% CI: 2.12-23.62) than those who were only sensitized to cat allergen (OR=2.31, 95% CI: 1.01-5.32) or had only home exposures (OR=1.47, 95% CI: 0.47-4.65). The association between allergen sensitization and asthma was more consistent than for home exposures. The findings help to confirm the role of allergen sensitization and home exposure in regard to asthma, and suggest that both, individually and jointly, are associated with asthma., (Copyright © 2011 Elsevier GmbH. All rights reserved.)

The incidence of gestational diabetes mellitus (GDM) has increased significantly in the last few decades in the US. Understanding its risk factors is imperative for the prevention of GDM and its sequelae, but the roles of behavioural risk factors such as stressful events and smoking on GDM are generally not well understood. Using data obtained from the New York State (NYS) Pregnancy Risk Assessment Monitoring System survey for 2004-06 and the NYS birth certificates, we examined relationships between GDM, stressful events and smoking among 2690 women who had live singleton births and did not have pre-pregnancy diabetes. After adjustment for risk factors such as maternal age, race/ethnicity, pre-pregnancy body mass index, hypertension, as well as smoking exposure, education, parity, and gestation at first visit for prenatal care, we found that having five or more stressful events 12 months before the baby was born was significantly associated with GDM (OR = 2.49, [95% CI 1.49, 4.16]). In another model, having any stressful event(s) other than 'moved to a new address' 12 months before the baby was born was also moderately associated with GDM (OR = 1.38, [95% CI 1.04, 1.85]). Smoking exposure, assessed by combining maternal smoking and second-hand smoke exposure into six levels, had no significant association with GDM, and did not show a dose-response pattern. The present study suggests that stressful events during pregnancy may be an independent risk factor for GDM. Future studies of GDM should include this common, but potentially modifiable risk factor in analyses., (© 2011 Blackwell Publishing Ltd.)

This study examined agreement (concordance or convergent validity) between self-report and birth certificate for gestational diabetes. Study population was 2,854 women who had live births 2-6 months earlier and responded to a questionnaire from the New York State Pregnancy Risk Assessment Monitoring System (PRAMS) survey, 2004-2006. Agreement between self-report and birth certificate was assessed for the study population overall, and for subgroups defined by race, age, education, marital status, number of previous live births, time of first prenatal care, and birth weight of the newborn. A total of 258 women self-reported gestational diabetes, while birth certificates indicated that 138 women had gestational diabetes. For the study population overall, percent agreement was 93.8% and Kappa was 0.53. Due to the moderate bias index (68.2% overall, ranged from 33.3 to 100% in subgroups) and the high skewed prevalence index (91.8% overall, ranged from 70.7 to 97.5% in subgroups), we determined Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) was a better measure of agreement. PABAK was 0.88 overall, indicating very good agreement. PABAK was uniformly high in all subgroups. The highest PABAK was found among women aged 25 years and younger (0.93), and the lowest PABAK was among Asian women (0.79). Although the absence of a gold standard for gestational diabetes hinders assessment of criterion validity, high PABAK measures suggest that self-reporting by PRAMS respondents is feasible for identifying cases of gestational diabetes for surveillance and population-based epidemiologic research.

An increased risk of venous thromboembolism has been demonstrated following renal transplantation. Commonly reported sites have been deep vein thrombosis, pulmonary thromboembolism and vascular thrombosis involving the graft. Cerebral venous thrombosis (CVT) has not been reported in literature so far. A 36-year-old male patient, transplanted in Jan 2005 with normal graft functions, was admitted with history of headache, blurring of vision and vomiting. Examination revealed papilledema and no neurological deficits. Baseline investigations and analysis of cerebrospinal fluid were normal. Cerebral magnetic resonance venogram revealed extensive CVT involving superior sagittal sinus, bilateral transverse sinuses and the right sigmoid sinus. He was investigated for a thrombophilic disorder; serum homocysteine, protein C and S levels, antiphospholipid antibody and antithrombin-III levels were done despite which no conclusive diagnosis could be arrived at. To our knowledge, this is the first report of extensive CVT described in a transplant recipient. No definite prothrombotic or predisposing factors could be identified in our patient and the cause of CVT remains unclear.

Dialysis and transplantation have prolonged survival and quality of life in patients with chronic kidney disease (CKD). This is an exploratory/descriptive study, looking into the socio-demographic profile and social factors in these patients associated with acceptance of therapy. Association between attitudes and demographics were examined. A total of 670 patients with CKD were prospectively evaluated during the years 2000-2003 and based on the degree of renal failure, were categorized into conservative therapy, dialysis alone, or transplantation. A detailed psycho-social assessment and counseling regarding the treatment options was done. The mean age of the study patients was 49.27 +/- 16.7 years. Of the study patients, 66.7% were males, 70.6% were married, 40% were undergraduates, 34% were employed, 41.6 and 37.3% were respectively from low- and middle-income groups, 60% lived in nuclear families and 64% had an urban background. Patients with CKD Stages II - IV (37.3%) were advised conservative treatment, while CKD Stage V patients were advised dialysis alone in 35.5% and dialysis and transplantation in 64.5%. The major psycho-social factors negatively influencing the acceptance of treatment were finance (69.3%), logistics (66.0%), no willing donors (11.0%), no medically fit donors (13.0%) and/or lack of social support (17.0%). Statistically significant association was noted between attitudes and marital status (p < 0.05, education and domicile (p = 0.05), occupation, income and family type (p < 0.05). Our study suggests that finance is one of the important factors deciding the acceptance of treatment. Social factors negatively affecting were logistics, lack of willing and medically fit donors and lack of social support.

Crescentic transformation of primary membranous nephropathy (MN) associated with the development of anti-GBM antibody is a rare cause of acute renal failure in patients with MN. We report a 54-year-old lady, diagnosed to have MN four years earlier, who presented with acute deterioration of renal functions. Renal biopsy revealed circumferential crescents in all glomeruli. Serum anti-GBM antibodies were positive. Despite therapy with plasmapheresis, steroids and oral cyclophosphamide, she did not improve and continues to be dialysis dependent.

A number of plant drugs are used in topical application meant for medical and cosmetic purposes. Many of such recommended drugs have been reported to cause contact dermatitis which fact is well supported by clinical studies. To find out the role of these plant drugs in the etiology of contact dermatitis, clinical studies of 34 such herbal drugs were carried out.

Experimental evidences are offered in this article for the popular medicinal use of some umbelliferous herbs.

By personal observation and on consultation with large numbers of local folks with some interest and experiences, local popular healers, ayurvedic physicians the folkloric uses of a popular medicinal plant Memcyclon Malabaricum are discussed here.

The histological features of both the bark and leaf of a poisonous plant H.ferruginea March responsible for contact dermatitis has been reported.