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Background: Being a doctor is physically and mentally challenging but immensely satisfying, as it is one of the most sought-after professions in India. Every year, about 20 lakh candidates appear for the National Eligibility and Entrance Test, commonly known as the NEET examination, of whom only 80,000 (4%) can secure a seat in a medical college (about 43,000 in government colleges and 37,000 in private institutions). Through a mailed questionnaire, we compared why our students became doctors in India and how they differed from their compatriots in Western countries. Aims: Was the motivation to become a doctor not altruistic but more influenced by financial rewards and social status, and did it change over the years? Was there a difference in the ambitions of those who regretted taking medicine as a career? Materials and Methods: We prepared a questionnaire using Google Forms and sent it through WhatsApp and email to 1000 doctors who had completed their final MBBS examination, including a 1-year compulsory internship, and were working in India as residents, medical officers, consultants in public or private hospitals or running their establishments. The results we received automatically over the Google Forms were analysed. Results: Out of 1000 questionnaires sent to doctors all over India, we received 265 responses. ‘Self-interest/passion for the profession, to relieve suffering’, ‘financial security’ and ‘prestige associated with the profession’ were the most common motivating factors. Seventy-one respondents (26.8%) regretted taking medicine as a career, and they were especially those candidates who joined medicine due to their ‘parent’s wishes’ (P = 0.009), ‘as a means to go abroad’ (P = 0.03) and ‘not sure’ (P < 0.001). Out of those who regretted choosing medicine as a career, only eight wanted to change to a non-medical job. Conclusions: India, a developing country with the world’s largest population, grapples with healthcare challenges. Medical students, often burdened by family expectations, struggle with intrinsic motivation. To address this, we can implement strategies such as lifestyle adjustments, mentorship improvements and granting more autonomy. In addition, compulsory internships can guide students towards their desired career paths.

Background and Objective: In India, there is a huge gap between blood demand and supply of blood. Young people form blood donors for the future as they are full of idealism and enthusiasm. Targeting medical students at the entry level itself is beneficial as they can be included in the donor pool early. Hence, we planned this survey to understand knowledge, attitude, and practice of blood donation among them. Methods: Data were collected using a self-administered questionnaire. A briefing about the study was given to students, followed by 15 min to complete the questionnaire. A short awareness session was also conducted. A pre- and post-session willingness for blood donation was also taken. Results: The median age range was 19.36 ± 1.15 years with more males than females. There was a significant difference between knowledge among 1st and 2nd year students; however, attitude and practice showed no difference. Females showed significantly higher knowledge and better attitudes but significantly low practice than males. Significant reasons for blood donation among donors were to help others, even the unknown at the time of need and health benefits for blood donors. The most common reason for nondonation cited by nondonors was fear of weakness/anemia; however, it was not statistically significant. Willingness for donation improved from 83.4% to 93% after the awareness session. Conclusion: The participants had a good amount of knowledge and favorable attitude toward blood donation, but the practice of blood donation was less, especially among females. Improved willingness to donate blood following awareness sessions suggests that conducting regular educational and motivational activities will be helpful.

The present research work investigates the impact of natural and anthropogenic inputs on the chemistry and quality of the groundwater in the Beenaganj-Chachura block of Madhya Pradesh, India. A total of 50 groundwater samples were examined for nitrates, fluoride, chlorides, total dissolved solids, calcium, magnesium, pH, total hardness, and conductivity, and their impact on entropy-weighted water quality index and pollution index of groundwater (PIG) was investigated via the response surface methodology (RSM) using the central composite design. According to analytical findings, Ca, Mg, Cl−, SO42−, and NO3− exceed the desired limit and permitted limit set by the Bureau of Indian Standards (BIS) and the World Health Organization (WHO). According to PIG findings, 76, 16, and 8% of groundwater samples, respectively, fell into the insignificant, low, and moderate pollution categories. The regression coefficients of the quadratic RSM models for the experimental data provided excellent results. Thus, RSM provides an excellent means to obtain the optimized values of input parameters to minimize the PIG values. HIGHLIGHTS Entropy-weighted water quality index (EWQI) and pollution index of groundwater (PIG) of Beenaganj-Chachura India were studied for the first time.; Ca, Mg, Cl−, SO42−, and NO3− exceed the desired limit and permitted limit set by the Bureau of Indian Standards and World Health Organization (WHO).; Distribution maps of EWQI and PIG are obtained for the area.; The quadratic response surface methodology model was found appropriate for the prediction of the groundwater pollution index of this region.; There were major implications for water resource management of the area.;

The Indian bidi industry is largely unorganised with poorly implemented regulations along with laxed taxations. The unaccounted production of bidi sticks might potentiate its illicit circulation and therefore, unchecked availability to the minors. Specific production estimates may lead to stricter compliance with the existing regulatory norms. Due to the paucity of evidence and wide variability in production numbers, this estimation of the exact number of bidi sticks produced annually within the country was conducted. The annual number of produced sticks were estimated using the available literature till May 2023, on: a) the quantity of auctioned tendu leaves, b) number of bidi rollers, and c) bidi tobacco cultivated. Around 10 % attritions were considered during each stage of the manufacturing process to arrive at the production estimates. Annual bidi stick production was estimated as a) 319.83 billion, b) 600 billion to 1 trillion, and c) 974 billion to 1.19 trillion. This research provides a crucial estimate of the alarming number of bidi sticks produced and address the significant gap in reliable data of production figures. These insights underscore the urgency for stringent policy measures and regulation of bidi industry to safeguard health and curtail illicit practices.

Squirrel Cage Induction Generators are the most common machine to operate wind-based power plants. Microgrids are small-scale electrical systems that provide power to a local area, and optimization methods for microgrids aim to ensure that these systems operate in a way that is both efficient and cost-effective. In such applications, STATCOM is used as reactive power provider and It is necessary to use advanced controllers like the Genetic Algorithm (GA), Firefly Algorithm (FA), and Adaptive Neuro Fuzzy Inference System (ANFIS) as the usual approaches for setting gain factors of STATCOM controller which does not perform well in the case of sudden voltage level changes due to disturbances. The firefly algorithm is primarily required to estimate the gain factors of the STATCOM controller which is used in hybrid micro grid with SG and SCIG for controlling the output voltage in the occurrence of large probabilistic ambiguity. The effectiveness of firefly controlled STATCOM controller for voltage-reactive power control in hybrid microgrid is further examined and validated by comparing the results with other GA, ANN and ANFIS tuning techniques. The need for reactive power is accomplished by STATCOM to minimize the time required to control voltage transient response. The main contribution of this paper includes: an assessment of STATCOM performance with step variations in the input wind energy and reactive power load requirement under conditions of severe probabilistic uncertainty, system analyses conducted under dynamic conditions rather than using a composite load model. Additionally, a comparison of reactive power and voltage control by STATCOM is presented, and employing FA techniques to improve, a comparative of STATCOM reactive power and voltage control. Results comparing all tuning techniques shows that utilizing the Integral of Square of Errors (ISE) criterion, sophisticated tuning techniques can maintain excellent performances under a variety of disruptions.

The shift of conventional vehicles to electric vehicles (EVs) is on pace nowadays. Increment in EVs adoption eventually results as increment of load on the existing power distribution system. This increment can adversely affect the performance of the distribution system. Location of electric vehicles charging station (EVCS) in the distribution system requires more technical finding before moving on into it. Implementation needs attention for several aspects like electric profile, economics, and traffic management and so, this work considers all of them. The impact of charging stations (EVCS) on operating parameters of the distribution network such as voltage stability, reliability and power losses are investigated by the proposed formulation of a Voltage Stability-Reliability-Power Loss (VRP) indices in this work. This index has the capabilities of considering voltage stability, reliability, and power loss under a single frame. The capabilities of the system with random load changes are compared with the base system without increments in load. This presented work gives assurance about the EV based load increment capabilities in the existing system without compromising with distribution system constraints. The main contribution of the proposed work is to examine the impact of voltage sensitivity, system stability, power losses, reliability measures, and a complex VRP index on choosing locations for EV charging stations and its effects on the existing system. Also, to ensure accurate results, these factors are assessed across seven distinct load scenarios, contributing significantly to the ongoing research in this field.

Tobacco, being an established risk factor for significant mortality and morbidity, causes over 7 million annual deaths globally. India is a country with over 270 million active tobacco users. On the one hand, although the willingness to quit amongst tobacco users is as high as 55.4%, the actual quit rates translate to less than 20%. Taking a cue from the economic principle of commitment and consistency, paying a nominal fee can serve as a form of public commitment and motivation to decrease the dropout rate amongst those committed to quitting. This study uses contingent valuation assessment to determine the willingness to pay (WTP) values for an effective tobacco cessation service across individuals with different socio-demographic characteristics. A cross-sectional observational study with multistage cluster sampling in Rajasthan was conducted to recruit 360 active tobacco users from 8 districts. Q-Q plots were used to determine the non-parametric distribution, and statistical differences between median WTP values were compared using Mann-Whitney U and Kruskal-Wallis H tests, considering a p-value less than 0.05 to be statistically significant. The majority of participants were males (57.78%) between the ages of 26 and 35 (40.28%), married (82.50%), and with children (65.83%), with an annual income between USD 7500-10,000 (23.61%) and graduate-level education (40.56%). Exclusive smokers formed the majority of the cohort (48.06%), and 50.83% were willing to quit as well as willing to pay for cessation. Median WTP values were maximum for males (USD 54.05; p

Chronic low back disorders are the leading cause of direct and indirect healthcare burden globally. Exercise training improves pain intensity, mental health and physical function. However, the optimal prescription variables are unknown. We aim to compare the efficacy of various exercise dosages for chronic low back disorders to identify the optimal prescription variables. Six databases (Medline, SPORTDiscus, CINAHL, PsycINFO, EMBASE and CENTRAL), trial registries (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) and reference lists of prior systematic reviews will be searched, and we will conduct forward and backward citation tracking. We will include peer-reviewed randomised controlled trials (individual, cluster or cross-over trials) published in English or German language comparing exercise training to other exercise training or non-exercise training interventions (conservative, non-surgical, non-pharmacological, non-invasive treatments, placebo, sham, usual/standard care, no-treatment control, waitlist control) in adults with chronic low back disorders. Outcomes will include pain intensity, disability, mental health, adverse events, adherence rate, dropout rate and work capacity. Version 2 of the Cochrane risk-of-bias tool will be employed. The dose will be categorised as cumulative dose (total and weekly minutes of exercise training) and individual dose prescription variables (intervention duration, session duration, frequency and intensity). Dose-response model-based network meta-analysis will be used to assess the comparative efficacy of different exercise doses to determine a dose–response relationship. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation. Information about optimal exercise training dosage will help in enhancing treatment outcomes.

Abstract Atomic-scale spin entity in a two-dimensional topological insulator lays the foundation to manufacture magnetic topological materials with single atomic thickness. Here, we have successfully fabricated Fe monomer, dimer and trimer doped in the monolayer stanene/Cu(111) through a low-temperature growth and systematically investigated Kondo effect by combining scanning tunneling microscopy/spectroscopy (STM/STS) with density functional theory (DFT) and numerical renormalization group (NRG) method. Given high spatial and energy resolution, tunneling conductance (dI/dU) spectra have resolved zero-bias Kondo resonance and resultant magnetic-field-dependent Zeeman splitting, yielding an effective spin S eff = 3/2 with an easy-plane magnetic anisotropy on the self-assembled Fe atomic dopants. Reduced Kondo temperature along with attenuated Kondo intensity from Fe monomer to trimer have been further identified as a manifestation of Ruderman-Kittel-Kasuya-Yosida (RKKY) interaction between Sn-separated Fe atoms. Such magnetic Fe atom assembly in turn constitutes important cornerstones for tailoring topological band structures and developing magnetic phase transition in the single-atom-layer stanene.

Abstract Background The International Space Station (ISS) stands as a testament to human achievement in space exploration. Despite its highly controlled environment, characterised by microgravity, increased CO $$_{2}$$ 2 levels, and elevated solar radiation, microorganisms occupy a unique niche. These microbial inhabitants play a significant role in influencing the health and well-being of astronauts on board. One microorganism of particular interest in our study is Enterobacter bugandensis, primarily found in clinical specimens including the human gastrointestinal tract, and also reported to possess pathogenic traits, leading to a plethora of infections. Results Distinct from their Earth counterparts, ISS E. bugandensis strains have exhibited resistance mechanisms that categorise them within the ESKAPE pathogen group, a collection of pathogens recognised for their formidable resistance to antimicrobial treatments. During the 2-year Microbial Tracking 1 mission, 13 strains of multidrug-resistant E. bugandensis were isolated from various locations within the ISS. We have carried out a comprehensive study to understand the genomic intricacies of ISS-derived E. bugandensis in comparison to terrestrial strains, with a keen focus on those associated with clinical infections. We unravel the evolutionary trajectories of pivotal genes, especially those contributing to functional adaptations and potential antimicrobial resistance. A hypothesis central to our study was that the singular nature of the stresses of the space environment, distinct from any on Earth, could be driving these genomic adaptations. Extending our investigation, we meticulously mapped the prevalence and distribution of E. bugandensis across the ISS over time. This temporal analysis provided insights into the persistence, succession, and potential patterns of colonisation of E. bugandensis in space. Furthermore, by leveraging advanced analytical techniques, including metabolic modelling, we delved into the coexisting microbial communities alongside E. bugandensis in the ISS across multiple missions and spatial locations. This exploration revealed intricate microbial interactions, offering a window into the microbial ecosystem dynamics within the ISS. Conclusions Our comprehensive analysis illuminated not only the ways these interactions sculpt microbial diversity but also the factors that might contribute to the potential dominance and succession of E. bugandensis within the ISS environment. The implications of these findings are twofold. Firstly, they shed light on microbial behaviour, adaptation, and evolution in extreme, isolated environments. Secondly, they underscore the need for robust preventive measures, ensuring the health and safety of astronauts by mitigating risks associated with potential pathogenic threats. Video Abstract

Abstract Background Scleral buckling is typically implemented to repair rhegmatogenous retinal detachments (RRD) in young patients. Therefore, there is limited data on post-pars plana vitrectomy (PPV) cataract formation in this cohort. We report the rates and risk factors of cataract progression after PPV for RRD repair in young eyes. Methods Retrospective single-center cohort study. Medical records of patients between the ages of 15 to 45 undergoing PPV for uncomplicated RRD between 2014 and 2020 were reviewed. Results Twenty-eight eyes from 26 patients met inclusion criteria. Cataracts developed in 20/28 (71%) eyes after PPV. After PPV, nuclear sclerotic cataract (NSC) rates were higher in patients above 35 (65%) compared to below 35 years (18%) (p = 0.024). Cataracts developed more frequently after macula-off RRDs (88%) compared to macula-on RRDs (50%) (p = 0.044) with NSC more common in macula-off detachments (p = 0.020). At postoperative month 2, all eyes with C3F8 gas developed cataracts compared to 59% of eyes with no gas (p = 0.040). Conclusions Cataract formation was common and frequent after PPV. After PPV, young eyes and macula-on detachments developed cataracts less frequently than older eyes and macula-off detachments. If appropriate, a shorter acting gas tamponade should be considered in young eyes to minimize cataract formation.

Abstract Microbial communities at the airway mucosal barrier are conserved and highly ordered, in likelihood reflecting co-evolution with human host factors. Freed of selection to digest nutrients, the airway microbiome underpins cognate management of mucosal immunity and pathogen resistance. We show here the initial results of systematic culture and whole-genome sequencing of the thoracic airway bacteria, identifying 52 novel species amongst 126 organisms that constitute 75% of commensals typically present in heathy individuals. Clinically relevant genes encode antimicrobial synthesis, adhesion and biofilm formation, immune modulation, iron utilisation, nitrous oxide (NO) metabolism and sphingolipid signalling. Using whole-genome content we identify dysbiotic features that may influence asthma and chronic obstructive pulmonary disease. We match isolate gene content to transcripts and metabolites expressed late in airway epithelial differentiation, identifying pathways to sustain host interactions with microbiota. Our results provide a systematic basis for decrypting interactions between commensals, pathogens, and mucosa in lung diseases of global significance.

In recent years, combining hydrogels with nanozymes has shown promise as a platform for sensing applications. Nanozymes are simple, affordable, and stable alternatives that use enzyme-like capabilities. Conversely, hydrogels provide hydrated, biocompatible environments, which enhance the stability and activity of nanozymes. The most recent advancements in nanozyme-hydrogel hybrid sensing systems are examined in this study, with a focus on their enzymatic activities—peroxidase and oxidase mimetics—and how they can be used to detect a variety of analytes, such as glucose, pesticide, and many more.In addition to simulating the biological environment, the synergistic combination of hydrogels and nanozyme improves the biosensor's sensitivity, specificity, and fast reaction times. These hybrid systems also provide an extensible framework for integrating multiple sensory modalities into a single functional device. This review highlights the groundbreaking potential and uses of hydrogel sensors based on nanozymes in environmental and medical diagnostics and potential future developments.

A library of chlorophenyl, thiophenyl, and biphenyl clubbed 3′,4,4′,5-tetrahydro-2′H-[1,3′-bipyrazole]-2′-carbaldehydes was produced via aldolic condensation followed by hetero-cyclization. Synthesized moieties were characterized by IR, 1H, and 13CNMR spectral analysis. The molecular docking was conducted utilizing microbial target proteins, 1JX9, and 5C1P to explore the binding interactions of scaffolds. Analogues 4f, 4l, 4r, and 4x exhibited the best docking score of -10.3 kcal/mol with 1JX9 whereas scaffolds 4l and 4o showed maximum docking of -10.4 and -10.2 kcal/mol with target protein 5C1P. Further, scaffolds 4f, 4I, 4l, 4o, 4 u, and 4v showed excellent (pMIC: 1.92 µM/mL) antibacterial activity against S. aureus, B. subtilis, E. coli, P. aeruginosa whereas; analogues 4c, 4l, 4o, 4r, and 4v exhibited admirable (pMIC: 1.92 µM/mL) antifungal activity against R. oryzae fungal strain. Also, analogues were tested for their radical scavenging ability and 4a, 4 g, 4i, 4p, and 4x exhibited good antioxidant activity with 4i standing out as a propitious scaffold with 93.25 % radical scavenging activity. SAR study revealed that biphenyl, 4‑hydroxy-3‑methoxy phenyl, and thiophenyl moieties on the bipyrazole-carbaldehyde scaffold are accountable for virtuous antibacterial, antifungal, and antioxidant activity, respectively. Further in-silico ADME, pharmacokinetic, and toxicity properties were studied, forecasting less-toxic analogues (300 < LD50 ≤ 5000). These findings collectively underscore the potential of the synthesized compounds, with 4l, 4o, 4v and 4x standing out as particularly promising candidates for further exploration.

Forró is a stream cipher proposed by Coutinho et al. in the Journal of Cryptology 2023 as a refinement of ChaCha design by providing better diffusion. The authors showed that existing attacks against ChaCha, which can attack ChaCha until seven rounds, can attack Forró till 5 rounds only. In this study, we provide the first cryptanalysis of Forró after the proposal of the cipher. We provide an attack against 5.5 rounds of Forró with a complexity (2225.04) significantly lower than the brute force search (2256), thus showing that the bound of 5 rounds can be breached. We also improve the attack against 5-round Forró proposed by the designers themselves by a margin of 213.86. These revelations raise concerns regarding Forró’s resilience against cryptographic attacks and underscore the necessity for ongoing scrutiny and refinement in cipher development.

The study investigates the intricate influence of gender and age variability in individuals diagnosed with diabetes, aiming to gain a comprehensive understanding of the diverse impact and implications of this prevalent metabolic disorder. A real-world dataset, obtained from a renowned diabetologist and meticulously maintained by Dr. Reddys’ Lab, serves as the foundation for rigorous analysis. Leveraging the capabilities of ensemble learning, an advanced technique that combines multiple models, the predictive model’s efficiency is substantially enhanced, resulting in precise and reliable predictions of individuals’ diabetic status. Addressing the challenge of diabetes prediction, a novel ensemble learning model was proposed. The model combines the strengths of three distinct algorithms: Random Forest, Extra Trees, and Multilayer Perceptron (MLP). The model’s output comprises a ternary label categorizing individuals as “diabetic, non-diabetic, or pre-diabetic”, while the accompanying prediction score quantifies the likelihood of individuals belonging to each respective category. The findings of this research expand the existing body of knowledge on diabetes prediction, underscoring the untapped potential of ensemble learning methodologies in augmenting accuracy and predictive performance for diabetic patients.

The stream cipher ChaCha has been subjected to differential linear cryptanalysis since 2008. Aumasson et al. (2008) laid the groundwork for this attack, employing the concept of probabilistically neutral bits for key recovery. Subsequently, various enhancements have been made to this attack over the last few decades. These improvements are essentially refinements to the probabilistically neutral bit-based attack approach. Despite the proposed modifications in these improvements, which increase attack complexity, the consequential changes in the associated probability of key recovery have not been thoroughly examined. A comprehensive analysis of the probability of key recovery is lacking in all attacks within this domain. No systematic process is available in the existing works for analyzing the probability of key recovery. This paper addresses this gap by proposing a method for estimating the probability of key recovery in these attacks. Employing this method, we calculate an estimated interval for the probability of key recovery for both the original idea presented by Aumasson et al. (2008) and the subsequent modifications to this idea. This analysis allows us to understand the variations in probability associated with these modifications.

Background: The transportation system plays a crucial role in the context of socioeconomic development, whereas the highway infrastructure acts as a base for the transportation system. In recent years, a rich impetus has been given to the development of road infrastructure by Indian governance. There is a need to introspect how well the prevailing highway infrastructure is equipped with emergency rescue management during road accidents. Lack of ambulance service and trauma facilities along the highways results in a steady loss of lives and injuries and increases people's exposure to risks. Objective: This study aims to determine the response time of ambulance reachability to the accident spot on Indian national highways associated with heavy commercial transportation. Also, determining the time to transport the injured to the nearest trauma facility is another factor included as an objective in this investigation. Methods: The study adopted survey-based research, whereby the variables in the questionnaire were designed to record and assess the time for an ambulance to reach the accident spot and, from there, to transport the injured to the trauma management facility on Indian highways. Two hundred twenty-five participants who were either victims/relatives of victims or those involved in the rescue of the injured have participated in the survey. The dates of the accident events were 2017 and 2022. Results: The survey resulted in the identification of two categories of highway accidents. The first category of accidents happened on the highways near city limits/dense settlements, and the second category occurred on the core highways. The percentage of accidents caused on the highways either adjacent to or passing through the city limits/dense settlements was reported to be higher than the accidents on the core highways. Ninety percent of the participants reported successful contact with the ambulance call/service centre, but only ~75% success rate exists for ambulances to reach the accident scene. On the core highways, the time taken for the ambulance to arrive at the accident scene is 25–35 minutes. The results from the survey ascertained that the patients were prioritised for treatment in the nearest hospitals (irrespective of having a trauma facility) at a distance of ~12–20 km, for which the time taken is ~15–25 minutes. Importantly, from the interviews, it is understood that in many cases, these hospitals have further referred to specialty hospitals located in nearby cities or trauma centres with greater facilities. Occasions exist where the injured were taken directly to hospitals 30–40 km from the accident spot, for which the time was more than 40 minutes. Conclusions: The results provide evidence that in either of the accident cases on the highways that are adjacent to/passing through the city limits or on the core highways, the total time for emergency care accessibility is nearly 60 minutes or greater; this implies that in the majority of cases, there is very meagre time left to provide emergency medical care to the needy and injured on the Indian highways to abide by the concept of golden hour. Plausible reforms backed by technology for enabling highways into 'emergency rescuable highways' are highly needed to guarantee a safer and more sustainable transportation system in India.

Abstract Background Extracorporeal shock wave lithotripsy (ESWL) is a well-established non-surgical treatment of urolithiasis. ESWL as a monotherapy to treat vesical calculi is still unfamiliar among many urologists, despite its early introduction in the 1990’s. ESWL monotherapy for vesical calculi was performed in our study in a unique fashion in supine position with full bladder unlike any other previous reported studies. Methods We aimed this study to report our experience with ESWL as a monotherapy in treating urinary bladder stones with a unique technique. A total of 29 patients with vesical calculi were treated with ESWL monotherapy from May 2021 to January 2023 using Dornier delta lithotripter in the supine position with the full bladder without per urethral catheterisation. Patients with stone size > 2.5cm or Hounsfield units > 1200 were excluded. Stone clearance was assessed with the help of fluoroscopy and ultrasonography on a second visit on day 7 after the procedure. Patients were followed up for 3 months. Results The mean size of vesical calculus was 1.6 cm (SD 0.32), and the mean Hounsfield unit was 940 HU (SD 86.61). None of the study subjects required surgical intervention. The stone clearance was obtained in 93.1% after a single session. The remaining two patients (6.9%) required one more session of ESWL following which stone clearance was obtained. One patient had acute urinary retention, and five (17.2%) patients had mild haematuria. Conclusion ESWL monotherapy is a safe and effective treatment option for vesical calculi, with minimal or no patient discomfort, when done in supine position without routine per urethral catheterisation as described in the study. It should be considered more often by practicing urologists for vesical calculi.

Aim: We estimated the relationship between routine biochemical laboratory parameters with static bone histomorphometric parameters and their high and low bone turnover capacity predictability in hemodialysis patients. Method: It was a single-center cross-sectional study, included 28 hemodialysis patients. The routine biochemical parameters measured including calcium, phosphorous, alkaline phosphatase, intact PTH, and 25-hydroxycholecalciferol. The histomorphometric parameters assessed were osteoblasts perimeter, osteoclast perimeter, eroded perimeter, osteoid perimeter, bone fibrosis and bone volume. Result: Total 28 hemodialysis patients underwent bone biopsy. Seventy percent were male, with a mean age was 33.07 ± 10.42 yrs; serum alkaline phosphatase was 219.10 ± 311.3 IU/ml; vitamin D was 18.18 ± 9.56 ng/ml, and intact PTH was 650.7 ± 466.0 pg/ml. Intact PTH had a significant positive association with osteoblast, osteoclast, eroded surface, and osteoid perimeter. Serum alkaline phosphatase had a significant relationship with bone fibrosis (r = 0.525, p-value = 0.004). Intact PTH was significantly higher in females than males (1078.75 ± 533.04 vs. 479.6 ± 309.83; p-value = 0.004). The osteoid surface was significantly high in females compared to males (p = 0.038). Age had a significant impact on osteoblast and eroded surface (p = 0.008 and p = 0.031, respectively). Intact PTH is a reliable biomarkers for bone turnover compare to ALP (p

Abstract With evolving lifestyle preferences, consumer interest has shifted toward diets rich in antioxidants, notably anthocyanins. This study evaluates the engineering, milling, and nutritional properties of three colored wheat types (Amber, Purple P1, and Purple P2) as well as their bran fractions. Moisture levels (12%, 14%, and 16%) were investigated for their effects on engineering and debranning characteristics. The bran and flour samples of the selected wheat samples were examined for their nutritional and antioxidant characteristics. Purple P1 wheat demonstrated the highest protein, fiber, ash, and phytic acid content. Purple P2 had elevated crude fat content, while Amber exhibited increased starch content in both whole wheat flour and pearled bran. Bran consistently contained nearly double the anthocyanin content compared to flour, with Purple P1 wheat exhibiting the highest levels. Purple P1 also displayed superior polyphenol content, total flavonoids, and total antioxidant activity, while Amber samples showed minimum antioxidant activity. Considering the high nutritional and antioxidant qualities of wheat bran, their utilization as functional food seems promising. Also, there is good scope to incorporate wheat bran into different food products (like cookies, bread, noodles, etc.). The application of different modification treatments especially biological modification can further enhance their health‐promoting and functional properties.

In recent years, three dimensional concrete printing (3DCP) has gained traction as a promising technology to mitigate the carbon footprint associated with construction industry. However, despite its environmental benefits, studies frequently overlook its impact on social sustainability and its overall influence on project success. This research investigates how strategic decisions by firms shape the tradeoffs between economic, environmental, and social sustainability in the context of 3DCP adoption. Through interviews with 20 Indian industry leaders, it was found that companies primarily invest in 3DCP for automation and skilled workforce development, rather than solely for environmental reasons. The lack of incentives for sustainable practices in government procurement regulations emerges as a significant barrier to the widespread adoption of 3DCP. Our study identifies five key strategies firms employ to promote sustainability through 3DCP and proposes actionable measures for government intervention to stimulate its advancement. Addressing these issues is crucial for realizing the full societal and environmental benefits of 3DCP technology.

The rapidly growing global energy demand, environmental concerns, and the urgent need to reduce carbon footprints have made sustainable household energy consumption a critical priority. This study aims to analyze household energy data to predict the electricity self-sufficiency rate of households and extract meaningful insights that can enhance it. For this purpose, we use LightGBM (Light Gradient Boosting Machine)-, SHAP (SHapley Additive exPlanations)-, and correlation-heatmap-based approaches to analyze 12 months of energy and questionnaire survey data collected from over 200 smart houses in Kitakyushu, Japan. First, we use LightGBM to predict the ESSR of households and identify the key features that impact the prediction model. By using LightGBM, we demonstrated that the key features are the housing type, average monthly electricity bill, presence of floor heating system, average monthly gas bill, electricity tariff plan, electrical capacity, number of TVs, cooking equipment used, number of washing and drying machines, and the frequency of viewing home energy management systems (HEMSs). Furthermore, we adopted the LightGBM classifier with ℓ1 regularization to extract the most significant features and established a statistical correlation between these features and the electricity self-sufficiency rate. This LightGBM-based model can also predict the electricity self-sufficiency rate of households that did not participate in the questionnaire survey. The LightGBM-based model offers a global view of feature importance but lacks detailed explanations for individual predictions. For this purpose, we used SHAP analysis to identify the impact-wise order of key features that influence the electricity self-sufficiency rate (ESSR) and evaluated the contribution of each feature to the model’s predictions. A heatmap is also used to analyze the correlation among household variables and the ESSR. To evaluate the performance of the classification model, we used a confusion matrix showing a good F1 score (Weighted Avg) of 0.90. The findings discussed in this article offer valuable insights for energy policymakers to achieve the objective of developing energy-self-sufficient houses.

Accurate measurement of various lipids- total cholesterol, cholesterol lipoproteins and triglycerides- is important for coronary artery disease (CAD) prevention and management. Over the years many technologies have developed for their accurate measurements and in recent years the assays have been internationally standardised. Most of the guidelines recommend measurement of non fasting levels of total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL cholesterol (non-HDL-C) and triglycerides (TG) for risk estimation and guiding treatment. Measurement of lipid profile in clinics and emergency departments can lead to earlier estimation of CAD risk and rapid initiation of lipid lowering therapy. CAD risk and baseline levels of LDL-C guide intensity of lipid lowering therapies. The LDL-C targets according to CAD risk are detailed in this review. There is an urgent need for standardization of lipid estimation in medical laboratories across the country so that every eligible individual can receive evidence-based lipid lowering interventions.

Background Fluoride is a noxious element known to destroy gastrointestinal mucosa, leading to erythrocytes’ destruction and causing anaemia. The birth weight of newborn babies is a significant indicator of a child’s vulnerability to the risk of childhood diseases and chances of existence. Methods This prospective cohort study was planned to find linkages between fluorosis and the low-birth weight of newborn babies with anaemic mothers. Antenatal mothers until the 20th week of gestation were followed up till delivery in the Antenatal Clinic of a District Hospital in one of the known fluoride-endemic districts (Nagaur) and the other not-so-endemic district (Jodhpur) of Western Rajasthan. Results Around 19% of the newborn in Jodhpur and around 22% in Nagaur had low birth weight. Mean fluoride values in water samples were measured to be 0.57 (range from 0.0 to 2.7 PPM) in Jodhpur and 0.7 (range from 0.0 to 3.4 PPM) in Nagaur. Conclusions Thus, in fluoride endemic areas, other factors should be included besides iron and folic acid supplementation for improving anaemia in pregnant women. This calls for assessing the effectiveness of de-fluoridation activities along with the area’s most common indigenous food practices.

High soil salinity has an unfavorable consequence on the growth and productivity of rice crop. However, some salt-tolerant plant growth-promoting bacteria (ST-PGPB) regulate specific physiological, biochemical, and molecular properties to promote crop growth while minimizing the detrimental effects of salt stress. In this regard, we isolated ST-PGPB from rhizospheric soil and examined it to mitigate the salinity stress in rice seedlings. The growth of the bacterium at 3 M NaCl demonstrated its halotolerance, and 16S rRNA sequencing identified it as Bacillus siamensis, and the isolated strain was named BW. Further study indicated that biopriming with BW strain helps plant growth promotion-related phenotype and significantly mitigates salinity stress in rice seedlings. Treatment of rice seeds with BW resulted in significantly improved germination of seedlings at 75 mM to 150 mM NaCl, along with better physiology and biochemical parameters than the untreated ones. Furthermore, Bacillus sp. BW efficiently colonizes rice roots and produces auxin and siderophore, via forming biofilm under different salt concentrations. Under 100–200 mM NaCl treatment conditions, the extracellular metabolite profile from BW showed a substantial abundance in specific metabolites, such as osmoprotective chemicals, suggesting the likely protective mechanism against salinity stress damage. This study demonstrates the role and potential of a halotolerant- BW strain in supporting the growth of rice plants under salinity conditions.

Microbial diversity estimation involves extracting nucleic acids from intricate sample matrices. Preparing nucleic acid samples is time-consuming, necessitating effective cell lysis and obtaining pure, inhibitor-free nucleic acid purifications before further use. An automated system offers advantages for field deployment due to its ease of use and quick autonomous results. This is especially beneficial for rapid measurement of in situ microbial diversity in remote areas. Our study aimed to assess microbial diversity of Yellowstone hot springs using a field-deployable lab in a resource-limited remote setting and demonstrate on-site nucleic acid sample processing and sequencing. We collected microbial mat and sediment samples from several Yellowstone National Park hot springs, focusing on the Five Sister Springs (FSS), spring LNN010, and Octopus Spring (OS). The samples were processed for DNA extraction on-site and further sequenced in the lab for microbial diversity. In addition, DNA extracted from one sample was sequenced and analyzed on-site as proof-of-concept. Using either Illumina or Oxford Nanopore Technology sequencing, we found similar microbial diversities. Bacteria (over 90%) were predominant at the FSS and OS sites, with archaea accounting for less than 10%. Metagenomic results were taxonomically categorized based on the closest known organism with a sequenced genome. The dominant archaeal community member was Candidatus Caldiarchaeum subterraneum, and among bacteria, Roseiflexus sp. RS-1 was abundant in mat samples. Interestingly, Bacterium HR17 was also frequently found, suggesting the need for more research on this newly recognized bacterial community member. The presence of Bacterium HR17 in these hot springs suggests its potential role in nitrogen cycling, informing both ecological understanding and industrial potential. This pioneering study assessed the microbiome of Yellowstone hot springs in about 8-9 hours using an automated system for nucleic acid extraction. By its deployment, the system’s value in elucidating the microbial diversity of extreme environments without the need to bring samples to the lab for processing had been highlighted. Sample processing and sequencing had been included in the benefits of the field-deployable lab, and the Nanopore platform had been utilized.

A 48-year-old male with oculocutaneous albinism (OCA) presented with bilateral diminution of vision. Ocular examination revealed bilateral central corneal thinning, scarring with ectasia, depigmented irides, transillumination defects, and pseudophakia. Examination of the right eye also revealed a hyperoleon, emulsified silicon oil in the vitreous cavity, and an attached retina, while the left eye had a total rhegmatogenous retinal detachment (RRD). This case describes a unique set of challenges (the presence of an ectatic scarred cornea and a hypopigmented fundus) and sodium fluorescein dye as an adjunct in the surgical management of a complex RRD. A review of literature highlighting the association of keratoconus and RRD in OCA is also presented in this report.

Solar energy is playing a crucial role in easing the burden of environmental protection and depletion of conventional energy resources. The use of solar energy in urban settings is essential to meet the growing energy demand and achieve sustainable development goals. This research assesses the solar potential of buildings considering shading events and analyzes the impact of urban built forms (UBFs) on incoming solar potential. The primary data for constructing a virtual 3D city model are derived from a UAV survey, utilizing drone deployment software for flight planning and image acquisition. Geospatial modelling was conducted using the MATLAB Mapping Toolbox to simulate solar irradiation on all the building envelopes in the study area in Jamshedpur, India. The empirical investigation quantified annual solar potential for more than 30,000 buildings in the region by considering time-varying shadowing events based on the sun’s path. The region’s annual solar energy of 310.149 TWh/year is estimated. Integrating UAV-derived datasets with MATLAB introduces a cost-effective and accurate approach, offering to develop 3D city models, assess solar potential, and correlate the impact of urban building forms (UBFs) to incoming solar potential.

Abstract Background Bone tissue engineering, based on three-dimensional (3D) printing technology, has emerged as a promising approach to treat bone defects using scaffolds. The objective of this study was to investigate the influence of porosity and internal structure on the mechanical properties of scaffolds. Methods We fabricated composite scaffolds (which aimed to replicate trabecular bone) from polycaprolactone (PCL) reinforced with 30% (wt.) nano-hydroxyapatite (nHAp) by extrusion printing. Scaffolds with various porosities were designed and fabricated with and without an interlayer offset, termed as staggered and lattice structure, respectively. Mechanical compressive testing was performed to determine scaffold elastic modulus and yield strength. Linear regression was used to evaluate mechanical properties as a function of scaffold porosity. Results Different relationships between mechanical properties and porosities were noted for the staggered and lattice structures. For elastic moduli, the two relationships intersected (porosity = 55%) such that the lattice structure exhibited higher moduli with porosity values greater than the intersection point; vice versa for the staggered structure. The lattice structure exhibited higher yield strength at all porosities. Mechanical testing results also indicated elastic moduli and yield strength properties comparable to trabecular bone (elastic moduli: 14–165 MPa; yield strength: 0.9–10 MPa). Conclusions Taken together, this study demonstrates that scaffolds printed from PCL/30% (wt.) nHAp with lattice and staggered structure offer promise for treating trabecular bone defects. This study identified the effect of porosity and internal structure on scaffold mechanical properties and provided suggestions for developing scaffolds with mechanical properties for substituting trabecular bone.

Abstract Background The present study was conducted to estimate the prevalence and distribution of MSDs in different anatomical regions among Doctors and NO and to determine their ergonomic risk factors and predictors. Methods This cross-sectional study was conducted in an apex institution in Western India. The socio-demographic information, medical and occupational history, and other personal and work-related attributes were captured using a semi-structured questionnaire, which was developed and finalized by piloting on 32 participants (who were not part of the study). Nordic Musculoskeletal and International Physical Activity Questionnaires were used to assess MSDs and Physical activity. Data were analyzed using SPSS v.23. Prevalence of Musculoskeletal Symptoms (M.S.), Multisite Musculoskeletal Symptoms (MMS), and Widespread Musculoskeletal Symptoms (WMS) were calculated. A comparison was made to estimate the burden and distribution of MSD among Doctors and Nursing officers. Logistic regression was applied to identify the predictors of MSDs and pinpoint the risk factors associated with MSDs. Results A total of 310 participants, of which 38.7% were doctors, and 61.3% were Nursing Officers (NOs) were included in the study. The mean age of the respondents was 31.63 ± 4.9 years. Almost 73% (95%CI: 67.9–78.1) of participants had MSD in the last 12 months, with approximately 41.6% (95%CI: 36.1–47.3) suffering from MSDs in the previous seven days of the survey. The lower back (49.7%) and the neck (36.5%) were the most affected sites. Working in the same position for a long time (43.5%) and not taking adequate breaks (31.3%) were the highest self-reported risk factors. Females had significantly higher odds of having pain in the upper back [aOR:2.49(1.27–4.85)], neck [aOR:2.15(1.22–3.77)], shoulder [aOR:2.8 (1.54–5.11)], hips [aOR:9.46 (3.95–22.68)] and knee [aOR:3.8(1.99–7.26)]. Conclusions Females, who are NOs, work for > 48 h per week, and fall in the obese category were significantly at more risk of developing MSDs. Working in an awkward position, treating an excessive number of patients in a day, working in the same position for a long period, performing repeated tasks, and not having enough rest breaks were significant risk factors for MSDs.

The purpose of immunization is the effective cellular and humoral immune response against antigens. Several studies on novel vaccine delivery approaches such as micro-particles, liposomes & nanoparticles, etc. against infectious diseases have been investigated so far. In contrast to the conventional approaches in vaccine development, a virosomes-based vaccine represents the next generation in the field of immunization because of its balance between efficacy and tolerability by virtue of its mechanism of immune instigation. The versatility of virosomes as a vaccine adjuvant, and delivery vehicle of molecules of different nature, such as peptides, nucleic acids, and proteins, as well as provide an insight into the prospect of drug targeting using virosomes. This article focuses on the basics of virosomes, structure, composition formulation and development, advantages, interplay with the immune system, current clinical status, different patents highlighting the applications of virosomes and their status, recent advances, and research associated with virosomes, the efficacy, safety, and tolerability of virosomes based vaccines and the future prospective.

ABSTRACT Klebsiella species, such as Klebsiella pneumoniae, Klebsiella aerogenes, and Klebsiella quasipneumoniae, are opportunistic pathogens that commonly cause infections in humans. Hypervirulent Klebsiella pneumoniae (hvKP) is a subgroup of K. pneumoniae, which has gained attention due to its global dissemination, its capacity to cause invasive infections in community settings among immunocompetent individuals, and its escalating antibiotic resistance levels. Our study presents the first comprehensive phenotypic and genotypic analysis including mobile genetic elements (MGEs) of Klebsiella isolates from the International Space Station (ISS). The genomes of K. pneumoniae, K. aerogenes, and K. quasipneumoniae offered insights into their antimicrobial resistance, virulence, thermotolerance, disinfectant resistance, and MGEs. All isolates were part of emerging pathogenic lineages with K. quasipneumoniae ST138 presenting spatial and temporal persistence aboard the ISS, possibly due to its genotypic profile encoding for numerous resistance genes to disinfectants and heavy metals. We also report on the isolation of a yersiniabactin-encoding K. pneumoniae, belonging to the emerging high-risk ST101 clone, aboard the ISS. A potential dissemination of hvKp strains on ISS might pose a risk to the immunocompromised crew members. Moreover, MGEs containing virulent loci could enable horizontal gene transfer to other benign microorganisms on the ISS, possibly enhancing their virulence potential. Additionally, some Klebsiella genomes exhibited genetic divergence from their respective lineages, which we hypothesize results from the unique spaceflight associated environmental pressures. These findings underscore the need to monitor microbial communities in space to comprehend their survival mechanisms and implications for human health. IMPORTANCE The International Space Station (ISS) is a unique, hermetically sealed environment, subject to environmental pressures not encountered on Earth, including microgravity and radiation (cosmic ionising/UV). While bacteria's adaptability during spaceflight remains elusive, recent research suggests that it may be species and even clone-specific. Considering the documented spaceflight-induced suppression of the human immune system, a deper understanding of the genomics of potential human pathogens in space could shed light on species and lineages of medical astromicrobiological significance. In this study, we used hybrid assembly methods and comparative genomics to deliver a comprehensive genomic characterization of 10 Klebsiella isolates retrieved from the ISS. Our analysis unveiled that Klebsiella quasipneumoniae ST138 demonstrates both spatial and temporal persistence aboard the ISS, showing evidence of genomic divergence from its Earth-based ST138 lineage. Moreover, we characterized plasmids from Klebsiella species of ISS origin, which harbored genes for disinfectant resistance and enhanced thermotolerance, suggestin possible adaptive advantages. Furthermore, we identified a mobile genetic element containing a hypervirulence-associated locus belonging to a Klebsiella pneumoniae isolate of the “high-risk” ST101 clone. Our work provides insights into the adaptability and persistence of Klebsiella species during spaceflight, highlighting the importance of understanding the dynamics of potential pathogenic bacteria in such environments.

The present study aimed at the numerical optimization of process variables to analyze the effect of hypochlorous acid (HOCl) treatment on postharvest quality characteristics of tomatoes. Box Behnken design was used to optimize the process variables, including concentration (40, 60, and 80 ppm), pH (4, 5, and 6), and dipping time (2, 4, and 6 min), and their effect on responses, i.e., weight loss (%), redness (a*), and microbial load (log cfu/ml). The optimized values of HOCl treatment process variables were found to be concentration (80 ppm), pH (4), and dipping time (6 min), and the corresponding responses were 11.69% (weight loss), 21.09 (redness), and 4.79 log cfu/ml (microbial load). The effects of different treatments, i.e., HOCl treatment (optimum values), ClO2 treatment (concentration 60 ppm, dipping time 15 min), and control (tap water), on weight loss (%), firmness (N), TSS (%), redness (a*), and microbial load (log cfu/ml) were compared for 10 days of storage (ambient conditions). Results revealed that decay rates for HOCl-treated tomatoes were significantly lower (54.86%) in comparison to ClO2 treatment (79.16%) and control samples (97.22%) at the end of the storage period, indicating the effectiveness of HOCl treatment. However, the microbial load in the HOCl-treated samples was significantly lower (7.61 ± 0.01 log cfu/ml), followed by ClO2 (8.39 ± 0.04 log cfu/ml) in comparison to control samples (10.14 ± 0.02 log cfu/ml) during the storage period. It could be concluded that HOCl could be used as a disinfectant for enhancing the shelf life of tomatoes and ensuring microbial safety.

Electrical discharge machining (EDM) is mainly utilized for the die manufacturing and also used to machine the hard materials. Pure Copper, Copper based alloys, brass, graphite, steel are the conventional electrode materials for EDM process. While machining with the conventional electrode materials, tool wear becomes the main bottleneck which led to increased machining cost. In the present work, the composite tool tip comprises 80% Copper and 20% silicon carbide was used for the machining of hardened D2 steel. The powder metallurgy route was used to fabricate the composite tool tip. Electrode wear rate and surface roughness were assessed with respect to the different process parameters like input current, gap voltage, pulse on time, pulse off time and dielectric flushing pressure. During the analysis it was found that Input current (I p ), Pulse on time (T on ) and Pulse off time (T off ) were the significant parameters which were affecting the tool wear rate (TWR) while the I p , T on and flushing pressure affected more the surface roughness (SR). SEM micrograph reveals that increase in I p leads to increase in the wear rate of the tool. The data obtained from experiments were used to develop machine learning based surrogate models. Three machine learning (ML) models are random forest, polynomial regression and gradient boosted tree. The predictive capability of ML based surrogate models was assessed by contrasting the R 2 and mean square error (MSE) of prediction of responses. The best surrogate model was used to develop a complex objective function for use in firefly algorithm-based optimization of input machining parameters for minimization of the output responses.

This prospective observational study sought to correlate segmental late gadolinium enhancement (LGE) seen in cardiac magnetic resonance imaging with occurrence of ventricular arrhythmias (VAs) in patients with hypertrophic cardiomyopathy. LGE was assessed in a 17-segmental model of heart. Of 57 patients, VAs were present in 26.3% of patients and 10.5% had sustained ventricular tachycardia. LGE was present in 43.9% of patients. Presence of LGE in 4 or more segments was associated with VAs with a sensitivity of 73% and specificity of 76% with area under curve of 0.733 in C-statistics.

Purpose – Block chain technology (BCT) has apparent capability of handling information in digital format, which has dragged attention of the practitioners for its utility in industrial and manufacturing practices. Conversely, the managerial adoption of BCT is relatively limited, which motivated the authors to identify crucial dimensions that can persuade the acceptance of BCT from an executive perspective. Thus, the present study is aimed to conduct to understand crucial barriers under BCT for managerial implementation in supply chain management (SCM) of small and medium enterprises (SMEs). Design/methodology/approach – The present study investigated evident barriers to understand implementation of BCT. A questionnaire based survey is performed to collect primary data from service and manufacturing based companies in India. Survey responses are received online and the data is analyzed in a scorecard. The scorecard embedded the scribed entries of Likert scale to determine the relative score. Findings – In present study, sixteen barriers from three categories named as technological, organizational and environmental are evaluated, where, five sub-barriers from technological domain, seven sub-barriers from organizational domain and four sub-barriers from environmental domain are evaluated. The findings of the study determined that the three factors, i.e. “complexity in setup/use”, “Security and privacy concern” and “Technological awareness” mostly affect the adaptation of BCT in SCM. Conversely, “Market dynamics”, “Scalability” and “Cost” do not influence the intention to adopt the technology. Originality/value – Only few studies have endeavored to ascertain the BCT adoption in SCM of SMEs in developing country like India. Thus, the study is filling a momentous gap of mapping BCT dimensions in the scholastic literature. The findings are expected to enable SMEs to understand important factors to be considered for adopting BCT in their curriculum. Furthermore, the study may benefit the BCT developers and suppliers to endure customized solutions based on the findings.

Diabetic nephropathy (DN) is characterized by an increase in urinary albumin excretion, diabetic glomerular lesions, and a decline in glomerular filtration rate (GFR). We assessed the expression of phosphatase and tensin homolog (PTEN), nuclear factor kappa-β (NF-κB), matrix metalloproteinase-2 (MMP2), and microRNA-181 in healthy controls (HC), individuals with type 2 diabetes mellitus (T2DM) without nephropathy, and those with DN. Our study investigated the association between these genes, insulin resistance (IR), and eGFR to gain insight into their roles in the pathogenesis and progression of DN. Anthropometric measurements and biochemical tests were conducted on HC (N = 36), T2DM (N = 38) patients, and DN (N = 35) patients. We used real-time polymerase chain reaction (RT-PCR) for whole blood gene expression analysis and performed bioinformatics analyses, including protein–protein interaction, gene ontology, and co-expression networks. We compared our expression data with other GEO-Microarray datasets. Our study highlights the role of IR in the progression of nephropathy in T2DM via the PTEN-Akt-mTOR signalling pathway. We also observed a decreasing trend in the expression of MMP2 and PTEN and an increasing trend in the expression of NF-κB and miR-181b-5p with the progression of nephropathy to the severe stage. The dysregulated expression of MMP2, PTEN, NF-κB, and miR-181b-5p in patients with T2DM contributes to the progression of T2DM to DN by aggravating IR, inflammation, accelerating basement membrane thickening, mesangial matrix expansion, and renal fibrosis.

ABSTRACT: Objectives: Kalamiella piersonii is a newly identified bacterial species, first isolated from surfaces of the International Space Station (ISS). It also appears as a novel human pathogen reported to be implicated in bacteremia and kidney stone disease. Here, we report the first complete genome of a multidrug-resistant strain of K. piersonii (GABEKP28), isolated from the saliva of a patient with treatment-resistant schizophrenia (TRS), to determine the mobile genetic elements (MGEs), antibiotic resistance genes (ARGs), and virulence factors (VFs) harboured by such a strain of this novel species. Methods: Whole-genome sequencing was performed using DNABSEQ (PE150) and Nanopore MinION platforms. Hybrid assembly was conducted using Unicycler v0.5.0. Genome assembly quality was verified using QUAST v5.0.2. The assembly was annotated using PROKKA v1.14.5. ARGs and VFs were identified using Abricate v1.0.0. Results: K. piersonii strain GABEKP28 was classified as multidrug-resistant while also carrying plasmidic genetic determinants associated with a hypervirulent phenotype. The complete genome size is 3 881 479 bp and has a guanine-cytosine content of 57.76% while it encodes for 3 525 chromosome coding sequences. The strain was also identified to carry three plasmids of 513 647 bp, 261 771 bp, and 106 029 bp, respectively. Conclusions: K.piersonii GABEKP28 is the first complete genome of this species to be submitted to GenBank and only the second to be sequenced from a human host. The whole-genome sequencing data with multiple plasmids, ARGs, and VFs will aid in understanding the pathogenicity, evolution, and phylogeny of this novel opportunistic pathogen.

Abstract Background Scleral buckling has been the standard for rhegmatogenous retinal detachment repair in young patients given the typical lack of posterior vitreous detachment, phakic status, and lower risk of proliferative vitreoretinopathy. In older patients, pars plana vitrectomy alone is typically used for rhegmatogenous retinal detachment repair. We report the outcomes and complications of pars plana vitrectomy for rhegmatogenous retinal detachment in young eyes. Methods Retrospective, single-center cohort study. Medical records of patients between 15 to 45 years of age undergoing primary pars plana vitrectomy for rhegmatogenous retinal detachment repair between 2010 and 2020 were carefully reviewed. All analyses were performed using the Kruskal–Wallis tests for numeric covariates between age groups. Results Eyes were stratified by age: 15–24 (group 1, n = 10), 25–34 (group 2, n = 14), and 35–45 (group 3, n = 38). The average number of surgeries were 1.9, 1.4, and 1.1 in groups 1, 2, and 3, respectively (p = 0.004). Single surgery success rates were 50%, 64%, and 92% in groups 1, 2 and 3, respectively (p = 0.005). Final reattachment rates were 80%, 93%, 100% in groups 1, 2, and 3, respectively (p = 0.568). Proliferative vitreoretinopathy developed in 50%, 7%, and 8% of eyes in groups 1, 2, and 3, respectively (p

Abstract Background This study aimed to explore the perception of doctors regarding telemedicine consultations and the level of patient satisfaction with the services received through teleconsultations. Methods This cross-sectional study was conducted on clinicians who provided teleconsultations and patients who received teleconsultations in an Apex healthcare institution in Western India. Semi-structured interview schedules were used to record the quantitative and qualitative information. Clinicians’ perceptions and patients’ satisfaction were assessed using two different 5-point Likert scales. Data were analyzed using SPSS v.23 using non-parametric tests (Kruskal Wallis and Mann-Whitney U). Results A total of 52 clinicians who delivered teleconsultations and 134 patients who received teleconsultations from those doctors were interviewed in this study. For 69% of doctors, telemedicine was feasible to implement, and for the rest, it was challenging. Doctors believe telemedicine is convenient for patients (77%) and prevents the transmission of infection (94.2%). Difficulty in clinical evaluation (73%), communication (55.7%), network connectivity (34%), diagnosis and investigations (32%), and patients’ e-illiteracy (32%) were the most common challenges faced by clinicians. Patients’ experiences were positive in terms of ease of registration (82.1%), audio quality (100%), freedom to discuss medicine (94.8%), and comprehension of the diagnoses (88.1%). Patients expressed satisfaction with the length of the teleconsultation (81.4%), the advice and care they received (78.4%), and the manner and communication of the clinicians (78.4%). Conclusions Though there were some challenges in the implementation of telemedicine, the clinicians perceived it quite helpful. The majority of the patients were satisfied with teleconsultation services. Difficulty in registration, lack of communication, and a deep-rooted mindset of physical consultations were the primary concerns from the patient side.

Background: Achalasia cardia is a neuromuscular disorder of unknown etiology characterized by aperistalsis of the body of the esophagus and failure of relaxation of the lower esophageal sphincter. The diagnosis of achalasia cardia is delayed due to the rarity and the ability to mimic other common conditions in children. Hence, a study was conducted to evaluate the clinical presentation and the management of achalasia cardia in children. Materials and Methods: A retrospective observational study was conducted in the department of pediatric surgery at a tertiary center. The children with achalasia cardia who presented between January 2014 and December 2021 were included. Results: A total of 12 patients were treated for achalasia cardia during the study period. All children presented with recurrent episodes of vomiting, whereas dysphagia was seen in six (50%) children. Eighty-three percent of the children presented with a history of weight loss, whereas failure to thrive was seen in nine (75%) children. Five (42%) children were managed as gastroesophageal reflux disease (GERD) for more than a year before presenting to us. Three (25%) children underwent open cardiomyotomy with Thal fundoplication and the rest nine (75%) underwent laparoscopic cardiomyotomy. All are thriving well. Conclusion: Achalasia is an important differential diagnosis in children with suspected GERD. The most common symptom of achalasia cardia is vomiting followed by dysphagia. Weight loss and failure to thrive are important presenting features in children with achalasia which are uncommon in adults. Cardiomyotomy without fundoplication is safe and effective to treat achalasia cardia in children without having any extra complications.

Aim: To find out the normal mean oral temperature in the Indian population as per a longitudinal study. Background: 98.6°F is generally accepted as normal body temperature as defined by Wunderlich (1868) and later challenged by Mackowiak (1992) and Protsiv (2020) who concluded it as 98.2°F based on cross-sectional studies. Hence, the normal body temperature at present needs quantification as per a longitudinal study in Indians. Patients and Methods: A longitudinal study on the healthy population of Northern India was followed-up over 1 year. Participants were advised for self-monitoring of oral temperature with a standard digital thermometer in either left or right sublingual pocket and record it in the thermometry diary. The study was considered complete if the participant had all three phases of the study (i.e., non-febrile, febrile and post-febrile phases) or completed the duration of the study. Results: The mean oral temperature of the participants (n = 144) during the non-febrile and post-febrile phases (temperature readings = 6543) were 98.0°F (standard deviation [SD], 0.61) and 98.01°F (SD, 0.60), respectively (P < 0.001). With the diurnal variability, the morning (am), noon (an) and afternoon (pm) mean temperatures were 97.91°F, 98.08°F and 98.27°F (P < 0.001), respectively, during the non-febrile phase. Similar trends were observed in variability among men and women, seasons and across post-febrile phase. Conclusions: The mean oral temperature was 98.0°F (SD, 0.61). The temperature was as low as 96.9°F and as high as 99.1°F. The temperature during the post-febrile phase was found to be higher than the non-febrile phase temperature such as pm over an and am, women over men, summer over other seasons in the non-febrile phase and spring over others in the post-febrile phase.

Background: Due to the staggering number of tobacco users in India, it is important to determine the exact mortality and morbidity rates due to tobacco use. This study aimed to estimate deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) attributable to cigarettes, bidis, and smokeless tobacco (SLT) in India. Methods: Data pooling and meta-analysis were done using case-control studies available on the three types of tobacco products. Health burden was estimated by applying the population attributable fraction (PAF) value to the total disease burden. Findings: A total of 33 studies were included. PAF was calculated for oral and lung cancer as well as ischemic heart disease (IHD) due to cigarettes, oral and lung cancer, IHD, and chronic obstructive pulmonary disease due to bidi, and oral and stomach cancer and IHD due to SLT. Cigarettes resulted in 8.4 million DALYs, 8.26 million YLLs, and 341 deaths; bidis led to 11.7 million DALYs, 10.7 million YLLs, and 478 thousand deaths, and SLTs accounted for 4.38 million DALYs, 4.3 million YLLs, and 171 thousand deaths annually. Conclusion: Evidence of measurable health burden and methodology for calculation for individual states was provided in the study. The generated evidence could be utilized for policy recommendations and revision of the existing taxation norms.

Background: The National Program for the HealthCare of the Elderly (NPHCE) was adopted by the Ministry of Health and Family Welfare in 2010 to provide promotional, preventive, curative, and rehabilitative health-care services for the fast-growing older population in India. As literature about the assessment of NPHCE is lacking, the present study was conducted to perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the program. Methods: The SWOT of the NPHCE program is analyzed using available literature and relevant documents. Results: Although this program embraces strategies to provide specialized training and services at primary health center, community health center, and district levels, including dedicated bedded wards, equipment, consumables, and pharmaceuticals but home-based care for the elderly, and the role of caregivers is overlooked in this program. NPHCE program can utilize the framework and take support of various ongoing healthy aging initiatives of international agencies to augment the health-care strategies for the elderly in India. Integrating schemes developed by the government for the upliftment of the elderly and the inclusion of traditional medicine systems in the program can serve as an opportunity for meeting unmet needs and improving the quality of life and well-being of the elderly. However, the growing elderly population, rise in nuclear families, and dual disease burden are significant threats to the program's implementation. Conclusion: This program can be more effective in providing comprehensive health care to the elderly if more emphasis is given to community participation, home-based care, and integrating digital health technologies and other existing welfare schemes.

Background: High blood pressure (BP) in adolescents and young adults is a rising concern in today's world. Behavioral factors largely contribute toward the development of hypertension. Once these are established, they often persist throughout life, and if identified timely, might play a significant role in prevalence reduction. This study was conducted to assess the prevalence and association of hypertension and its risk factors in college students of Jodhpur district. Methodology: A cross-sectional study was conducted in ten colleges across five zones of Jodhpur district using modified WHO STEPS questionnaire and by taking physical measurements of BP, height, and weight. Descriptive analysis was done using means and percentages, and statistical significance was established using prevalence odds ratio (POR). Results: Of the 421 study participants, 251 (59.60%) were males and 170 (40.20%) were females, with a mean age of 20.12. The prevalence of risk factors and significant association were observed between gender and educational level with behavioral habits. Further, hypertension prevalence (16.15%) was found to be associated with smoking (POR = 2.72), high salt intake (POR = 3.21), physical activity (POR = 0.30), overweight (POR = 2.34), and obese body mass index (POR = 4.02). Conclusion: The study provided evidence of high prevalence of hypertension and its associated behavioral risk factors such as tobacco, salt, and physical inactivity. Such evidences may be utilized for health promotion programs for the specific age group and region.