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Heart disease or Cardiovascular illness is the most prevalent cause of mortality globally. The challenge of predicting heart illness using clinical data analytics is considerable. Machine learning (ML) has been extensively used in the medical domain for disease prediction. This work performs a comparative analysis of various oversampling methods like the Synthetic Minority Oversampling technique (SMOTE), Synthetic Minority Oversampling Technique with Edited Nearest Neighbor (SMOTE-ENN), and Adaptive Synthetic Sampling Approach (ADASYN) Algorithm used with ML classifiers on imbalanced heart failure prediction dataset. Six ML classifiers are analyzed in the study Logistic Regression (LR), Support Vector Machine (SVM), K Nearest Neighbor (KNN), Decision Tree (DT), Random Forest (RF), and Gradient Boosting (GB). The accuracy metric is used to measure the model’s performance The result depicts that the ADASYN technique performs better for the given dataset and increases the accuracy of the classifier in heart failure prediction.

Introduction: Breast pathology encompasses a wide spectrum, ranging from benign conditions to invasive cancers, posing significant diagnostic challenges. Most breast lesions are usually divided into benign and malignant disorders, and their prognosis can often be reasonably predicted. However, certain tumours exhibit borderline characteristics and occupy a grey area between benign and malignant, making it difficult to forecast their course with any degree of accuracy. Aim: To assess the histopathological spectrum of benign and borderline breast lesions. Materials and Methods: This cross-sectional study, conducted over a period of five years (January 2019 to December 2023) at Shyam Shah Medical College, Rewa, Madhya Pradesh, India analysed 831 cases of breast lesions to determine their clinicopathological features, such as laterality of the breast and gross features. Grossing of the specimens was performed, and details were noted. Tissue pieces were processed, and sections were stained using conventional Haematoxylin and Eosin (H&E) staining. Results: Out of 831 breast lesions, 640 (77.0%) cases were benign, 15 (1.8%) were borderline, and 176 (21.2%) were malignant. Fibroadenoma was the most frequent lesion in females with 419 cases (50.4%), with a mean age of 21.4 years. In males, gynaecomastia was the most common finding in 21 (2.5%), with a mean age of 17 years. The second most common lesion overall was fibrocystic disease 148 (17.8%), with a mean age of 33.5 years. Other benign lesions included inflammatory breast diseases 21 (2.5%), lactational adenoma 2 (0.24%), sclerosing adenosis 7 (0.84%), microglandular adenosis 8 (0.96%), tubular adenoma 7 (0.84%), benign phyllodes 4 (0.48%), and lipoma and hamartoma 3 (0.36% combined). Borderline lesions included atypical ductal hyperplasia 9 (1.08%), ductal carcinoma in-situ 3 (0.36%), and borderline phyllodes tumours 2 (0.12%). Conclusion: In the study population, the range of benign breast diseases appears consistent with findings from other studies, with fibroadenoma emerging as the predominant benign lesion, followed by fibrocystic changes. While premalignant lesions were less prevalent in present study, a thorough evaluation of all cases of breast lesions is recommended to rule out the potential for breast cancer.

The widely advertised category of unhealthy food and beverages (F&B) is calorie-dense, nutrient-poor, and associated with long-term harm, particularly for children. Business literature has been largely silent regarding the ethicality of its advertising targeting children and lacks clarity on questions future research needs to address. Based on a bibliometric analysis of 1,851 articles published between 1973 and 2021 containing 70,379 citations, we uncovered five intellectual clusters underlying research on the ethics of unhealthy F&B advertising to children (ATC). Importantly, we propose a concrete roadmap featuring actionable and pertinent unanswered questions to stimulate research in this crucial domain.

Abstract A highly efficient approach for synthesizing a supramolecular metallogel of Co(II) ions, denoted as CoA-TA, has been established under room temperature and atmospheric pressure conditions. This method employs the metal-coordinating organic ligand benzene-1,3,5-tricarboxylic acid as a low molecular weight gelator (LMWG) in DMF solvent. A comprehensive analysis of the mechanical properties of the resulting supramolecular Co(II)-metallogel was conducted through rheological investigation, considering angular frequency and thixotropic study. The hierarchical rocky network structure of the supramolecular Co(II)-metallogel was unveiled using field emission scanning electron microscopy (FESEM). Transmission electron microscopic (TEM) analysis showed rod-shaped structures via low-magnification high angle annular dark field (HAADF) bright field scanning transmission electron microscopic (STEM) imaging, while energy dispersive X-ray (EDX) elemental mapping confirmed its primary chemical constituents. The formation mechanism of the metallogel was examined via fourier transform infrared spectroscopy (FTIR) spectroscopy. The nature of the synthesized CoA-TA metallogel was affirmed through powder X-ray diffraction (PXRD) analysis. Furthermore, this study involved fabrication of Schottky diode structures in a metal-semiconductor-metal geometry based on cobalt(II) metallogel (CoA-TA), enabling observation of charge transport behavior. Remarkably, a resistive random access memory (RRAM) device utilizing cobalt(II) metallohydrogel (CoA-TA) demonstrated bipolar resistive switching at room temperature and under ambient conditions. The switching mechanism was investigated, revealing the formation and rupture of conductive filaments between metal electrodes that govern the resistive switching behavior. This RRAM device exhibited an impressive ON/OFF ratio (~ 414) and exceptional endurance over 5000 switching cycles. These structures offer great potential for diverse applications such as non-volatile memory design, neuromorphic computing, flexible electronics and optoelectronics. Their advantages lie in their fabrication process, reliable resistive switching behavior and overall performance stability.

Background Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) coinfection has emerged as a leading cause of morbidity throughout the world in the last two decades. The coronavirus disease 2019 (COVID-19) pandemic has escalated the disease burden further by increasing the number of intravenous (IV) drug abusers and unemployment. Aim The present study was done to analyse the impact of COVID-19 on seroprevalence as well as trends during pre, post and pandemic years of coinfection and mono-infections in the Malwa region of Punjab. Setting and Design This descriptive cross-sectional study was done in the department of immunohematology and blood transfusion at a tertiary care hospital. Materials and Methods The data on transfusion-transmitted infections (TTIs) was collected for a period of four years from 2019 to 2022, that is, pre, post and during the pandemic period. All the blood samples were screened for viral markers, HIV I and II, HCV, and hepatitis B surface antigen (HBsAg) using the enzyme-linked immunosorbent assay (ELISA) technique. Malarial antigen and syphilis infection testing was done using a rapid diagnostic card test. The total number of sero-reactive cases and their distribution were noted. Results A total of 58,953 donors were screened and included during the study period. Each blood donor was identified by a donor registration number. The overall TTI seroprevalence in blood donors was 2.83% (n = 1670). The seroprevalence of TTIs in blood donors showed an increasing trend for HIV, HCV, and HBsAg in 2019–2021, whereas there was a decrease in reactivity status in the 2022 (back to pre-pandemic year). There was a significant increase in the coinfection rate from 0.1% to 0.25%. Conclusion The COVID-19 pandemic impact on the coinfection rate of TTI was significant. To curb these TTIs and coinfections, education and public awareness are the key factors. India is a developing country, so transfusion medicine specialists need to work day and night to practice safe blood services.

Background The Government of India undertook several measures for COVID-19 pandemic, of which school closure was one. This led to sudden shift of teaching methods from classroom-based to online mode. This study aimed to understand the effects of school closure on children during lockdown period. Methods This was a community-based qualitative study conducted in Faridabad District, Haryana, India, from January 2022 to February 2022. Two focus group discussions (FGDs) with school students of 8th standard and above and two FGDs with parents of school students below 8th standard were conducted. In-depth interviews were conducted with two school headmasters, two teachers, a Senior Medical Officer (SMO), District Education Officer (DEO), and District Elementary Education Officer (DEEO). Responses were recorded, transcribed, and reviewed to identify themes, and thematic analysis was done. Four major themes were framed—academic, physical, behavioral, and psychosocial. Results Decreased academic performance, teacher-student interaction, and distraction from the study were found in academic domain. There was reluctance to go back to school reopening. Low physical exercise, irregular sleep cycles meal skipping, and increased screen time were noticed. Limited mid-day meal nutrition was available. Increased fear, anxiety, and loneliness were faced along with an increase in household quarrels and violence. An increase in the number of child marriages was also reported. Few students had positive impacts like improvement in hygiene practices, learning new hobbies, and skills. Conclusion School closure had impact on the physical, mental, socio-behavioral, and academic aspects of school-going children. In case of similar events in the future, these impacts must be kept in mind by policymakers to achieve a balance between effective pandemic control and fruitful childhoods.

Objective: To identify the clinical, laboratory, and radiological markers that could predict a positive GeneXpert result in patients suspected of tuberculous meningitis. Methods: In this prospective, observational study, patients with tuberculous meningitis were systematically evaluated. Various clinical, laboratory [including cerebrospinal fluid (CSF) microscopy, culture, and GeneXpert], and neuroimaging factors were examined. All participants were administered anti-tuberculous treatment and corticosteroids. A six-month follow-up was done to evaluate the outcome. Results: Of the 116 patients studied, 54 (46.6%) tested positive for GeneXpert, while 62 (53.4%) were negative. Third cranial nerve involvement (OR 3.71, 95% CI 1.052-13.09, P=0.04) and the presence of basal exudates on neuroimaging (OR 5.22, 95% CI 2.03-13.42, P=0.001) emerged as independent predictive factors for a positive GeneXpert result. A positive CSF GeneXpert result (P=0.002) and drug resistance (P=0.004) were significantly linked to adverse outcomes. Additionally, a high score on the Medical Research Council stage III (OR 5.64, 95% CI 1.18-26.87, P=0.03) and elevated CSF cell counts (OR 1.002, 95% CI 1.00-1.001, P=0.03) were identified as independent predictors of poor prognosis. Conclusions: Third cranial nerve involvement and the presence of basal exudates were significant indicators of a positive GeneXpert result. MRC stage III disability and elevated CSF cell counts predicted poor outcomes.

Background: Public health action (PHA) in tuberculosis (TB) includes six components: doing screening for HIV/diabetes, carrying out drug susceptibility testing, counseling on tobacco, counseling on nutrition, benefits of Nikshay Poshan Yojana, and contact tracing. All the patients notified by the private practitioners (PPs) and missing any of the above components are intervened by the government staff to cover all the above components. Objectives: The aim of the article is (1) to assess the timeliness and completeness of PHA and (2) to assess the impact of PHA on the quality of care for TB patients in the private sector. Methods: A sequential mixed-method (cross-sectional study followed by qualitative study) study was carried out in the Patan district, North Gujarat for a period of one year. Quantitative data were collected through home visits to patients residing in three randomly selected talukas out of nine talukas in the Patan district. Qualitative data were collected purposively from selected clinics of PPs (including a mix of PP notifying and not notifying TB till saturation is achieved) from the above talukas. Results: Out of a total of 176 patients from the private sector, 48 patients took all six components of PHA. Out of them, 98% were cured compared to 82% who did not receive PHA. None of the PP had heard about PHA or its components. Conclusion: The Public–private model for TB management needs strengthening. Regular and mandatory training of PPs on the latest TB management guidelines including importance of timely and complete PHA should be carried out.

Purpose: Assessment of central and peripheral contrast sensitivity (CS) in thyroid eye disease (TED) with and without dysthyroid optic neuropathy (DON). Methods: This cross-sectional study enrolled 33 eyes of 18 treatment-naïve TED patients and 18 age- and sex-matched healthy controls for comparative analysis. A detailed ophthalmic examination included visual acuity (VA), intraocular pressure measurement, slit-lamp biomicroscopy, and CS testing (central and four peripheral regions) using Spaeth–Richman Contrast Sensitivity test was done. Results: The average age of TED patients was 47.17 ± 13.99 years and a female preponderance was noted (66.66%, n = 12). Twenty-five eyes (75.8%) were diagnosed as TED without DON, while eight eyes (24.2%) had DON. Nine eyes (27.2%) were in the active stage of disease and 29 eyes (87.8%) had proptosis. The difference in mean logMAR visual acuities between TED patients and controls was statistically insignificant (P = 0.189), but a significant difference was noted in central and total CS score (P < 0.001, Wilcoxon–Mann–Whitney test). On CS comparison between DON and non-DON eyes, a significant difference in average scores was noted in central and all peripheral areas (P < 0.05, Wilcoxon–Mann–Whitney test). With increasing clinical activity score, a statistically significant reduction was noted in CS in three out of four peripheral regions (Spearman correlation, P < 0.05). Conclusion: Visual function compromise can be detected in TED in the presence of intact VA, by testing CS. Peripheral CS deteriorates with increasing inflammation and in DON. Serial monitoring of both central and peripheral CS may help in diagnosing DON early.

This study aimed to comprehensively explore the intricacies of corneal neurotization (CN) and the nuanced factors that set it apart from routine clinical practice, exerting a substantial influence on its success. A symbiotic relationship is evident between corneal innervation and ocular surface health. The loss of corneal innervation results in a potentially challenging corneal condition known as neurotrophic keratopathy (NK). The majority of treatments are primarily focused on preventing epithelial breakdown rather than addressing the underlying pathogenesis. Consequently, to address the impaired corneal sensation (underlying etiology), a novel surgical approach has emerged, namely CN, which involves transferring healthy sensory nerve axons to the affected cornea. This review offers valuable insights into the existing body of supporting evidence for CN, meticulously examining clinical studies, case reports, and experimental findings. The aim is to enhance our understanding of the effectiveness and potential outcomes associated with this innovative surgical technique. The exploration of innovative therapeutic avenues holds promise for revolutionizing the management of NK, offering a potentially permanent solution to a condition once deemed incurable and severely debilitating.

Background: Over the last decade, the rate of cesarean sections has steadily increased owing to various reasons, and along with it the incidence of wound sepsis. Different risk factors identified are maternal age, socioeconomic status, educational status, antenatal visits, pregestational diabetes, obesity, recurrent pregnancy losses, duration of surgery, preterm rupture of membranes, etc. Hence, assessing infections and their management is an integral part of health care, as it helps develop strategies for prevention, better management of infection, reducing the hospital stay, and cost of healthcare. Aims and Objectives: The aim of the study was to assess and note the variability of social and demographic profiles of patients undergoing cesarean sections and developing wound infection, along with its various presentations and categories. Materials and Methods: A prospective observational study was conducted on patients who developed wound sepsis after undergoing cesarean section at a tertiary center in India. Results: Among the patients enrolled, 35.83% were illiterate and 45.83% were educated up to the tenth standard. About 74% of patients were not registered during the antenatal period. Furthermore, the majority of patients were overweight and obese (74%) and were from lower socioeconomic strata. About 85% of the patients who developed wound infection had their surgery lasting for more than 60 minutes. About 87.50% developed a superficial category of infection, and 68.33% presented within the first 5 days of surgery. Patients with deep infected wounds had significantly bigger wounds and longer hospitalization. Conclusion: Illiteracy and lower socioeconomic conditions predispose women to wound sepsis. A longer duration of surgery was associated with a higher risk of infection. Superficial wounds are the most common type of infection encountered. Deep and organ space categories of wound infection are associated with increased morbidity and longer hospitalization warranting aggressive management. Reducing the incidence of wound sepsis can help to reduce morbidity by identifying risk factors before pregnancy and supporting the implementation of preconception counseling centers and prenatal programs to educate and raise awareness among patients.

Abstract Background The ongoing global crisis of Higher Education (HE) institutions during the post-COVID-19 pandemic period has increased the likelihood of enduring psychological stressors for staff. This study aimed to identify factors associated with job insecurity, burnout, psychological distress and coping amongst staff working at HE institutions globally. Methods An anonymous cross-sectional study was conducted in 2023 with staff at HE institutions across 16 countries. Job insecurity was measured using the Job Insecurity Scale (JIS), burnout using the Perceived Burnout measure question, psychological distress using the Kessler Psychological Distress Scale (K10), and coping using the Brief Resilient Coping Scale. Multivariable logistic regression with a stepwise variable selection method was used to identify associations. Results A total of 2,353 staff participated; the mean age (± SD) was 43(± 10) years and 61% were females. Most staff (85%) did not feel job insecurity, one-third (29%) perceived burnout in their jobs, more than two-thirds (73%) experienced moderate to very high levels of psychological distress, and more than half (58%) exhibited medium to high resilient coping. Perceived job insecurity was associated with staff working part-time [Adjusted Odds Ratio 1.53 (95% Confidence Intervals 1.15–2.02)], having an academic appointment [2.45 (1.78–3.27)], having multiple co-morbidities [1.86 (1.41–2.48)], perceived burnout [1.99 (1.54–2.56)] and moderate to very high level of psychological distress [1.68 (1.18–2.39)]. Perceived burnout was associated with being female [1.35 (1.12–1.63)], having multiple co-morbidities [1.53 (1.20–1.97)], perceived job insecurity [1.99 (1.55–2.57)], and moderate to very high levels of psychological distress [3.23 (2.42–4.30)]. Staff with multiple co-morbidities [1.46 (1.11–1.92)], mental health issues [2.73 (1.79–4.15)], perceived job insecurity [1.61 (1.13–2.30)], and perceived burnout [3.22 (2.41–4.31)] were associated with moderate to very high levels of psychological distress. Staff who perceived their mental health as good to excellent [3.36 (2.69–4.19)] were more likely to have medium to high resilient coping. Conclusions Factors identified in this study should be considered in reviewing and updating current support strategies for staff at HE institutions across all countries to reduce stress and burnout and improve wellbeing.

Background: Phenotypic drug susceptibility testing (DST) is considered the gold standard for detecting linezolid (LZD) resistance in Mycobacterium tuberculosis (MTB), but it is time-consuming. Nanopore sequencing offers a potentially faster alternative approach. This study evaluated the agreement between phenotypically detected LZD resistance and mutations in the rrl and rplC genes of MTB isolates using nanopore sequencing. Methods: Consecutive drug-resistant MTB isolates from pulmonary samples collected in 2021 underwent liquid culture (LC) DST for LZD. All resistant isolates and an equal number of susceptible isolates were subjected to targeted sequencing of the rrl and rplC genes using nanopore technology. Results: Sequencing identified a C154R mutation in the rplC gene in only one LZD-resistant isolate. No mutations were detected in the rrl gene. The agreement between sequencing and LC-DST for detecting LZD resistance was poor (Cohen’s kappa: 0.03571, 95% confidence interval [CI]: −0.034–0.105). Additionally, no significant association was found between LZD resistance and clinical or microbiological outcomes at 6-month follow-up. Conclusion: This study revealed a considerable discrepancy between phenotypic and genotypic detection of LZD resistance in MTB. Further research is needed to better understand the genetic mechanisms underlying LZD resistance and to develop reliable molecular diagnostics for rapid resistance detection.

Abstract Sustainable farming practices aim to produce agricultural products at a low environmental cost, ensuring food availability for future generations. These approaches combine the production of agricultural crops and livestock for site-specific uses, with an emphasis on long-term objectives including satisfying the food supply worldwide, improving the environment, making the most efficient use of resources and boosting the welfare of farmers and society as a whole. Sustainability in farming is mostly dependent on soil health, which is the soil’s capacity to function within ecological and land-use boundaries. It enhances general wellness, maintains the purity of the air and water, and supports biological productivity. The depletion of soil functions brought about by modern agricultural intensification has an impact on ecosystem services and long-term productivity. The goal of sustainable farming is to raise fertility and organic matter in the soil. Key practices include carbon farming, conservation agriculture, integrated pest management (IPM), and precision farming. In order to support sustainable crop production, these techniques improve soil fertility, structure, and biodiversity. Going forward, research should concentrate on developing novel approaches to tackle the issues of climate change and global food security.

Abstract Skin conditions are becoming increasingly prevalent across the world in current times. With the rise in dermatological disorders, there is a need for computerized techniques that are completely noninvasive to patients’ skin. As a result, deep learning models have become standard for the computerized detection of skin diseases. The performance efficiency of these models improves with access to more data with their primary aim being image classification. In this paper, we present a skin disease detection methodology using image processing techniques, non-local means denoising and convolutional neural network (CNN) backed by sparse dictionary learning. Here, the major benefit of using NLM denoising followed by sparse dictionary learning with CNNs in image classification lies in leveraging a multi-stage approach that enhances the quality of input data, extracts meaningful and discriminative features, and improves the overall performance of the classification model. This combined approach addresses challenges such as noise robustness, feature extraction, and classification accuracy, making it particularly effective in complex image analysis tasks. For denoising, the average Peak Signal to Noise Ratio (PSNR) obtained for images from HAM-10000 dataset is 33.59 dB. For the ISIC-2019 dataset, the average PSNR for the train folder is 34.37 dB, and for the test folder it is 34.39 dB. The deep learning network is trained for the analysis of skin cancer images using a CNN model and is achieving acceptable results in classifying skin cancer types. The datasets used contain high-resolution images. After all the tests, the accuracy obtained is 85.61% for the HAM-10000 dataset and 81.23% for the ISIC-2019 dataset, which is on par with existing approaches validated by benchmarking results.

Background: Sebaceous carcinoma is a rare cancer, and little is known about its current epidemiology and treatment. This is particularly true for sebaceous carcinomas of the trunk and extremities. Objective: We present a database analysis of sebaceous carcinoma cases to further delineate demographics, location, tumor characteristics, and treatment modalities among patients diagnosed with these tumors. Methods: The National Cancer Database was queried for cases of sebaceous carcinoma between 2004 and 2016. 3211 cases were analyzed for descriptive and comparative statistics. Results: Twenty-six percent of sebaceous carcinomas were found on the trunk and extremities. Tumors on the trunk and extremities were more likely to be larger than tumors on the head and neck, with 8% being greater than 50 mm (P

Background and Aims: Ultrasonography (USG)-guided arterial cannulation is a frequently performed procedure in the operating room and intensive care unit. Conventionally, longitudinal/in-plane and transverse/out-of-plane approaches are used for cannulation. Recently, a longitudinal oblique approach has been described with the advantage of wide visualization area. Hence, the present study was designed to compare the success of USG-guided radial artery cannulation in longitudinal oblique axis (LOA) and longitudinal axis (LA). Material and Methods: Seventy patients requiring radial artery cannulation were randomly allocated into two groups: group L (USG-guided radial artery cannulation in LA) and group O (USG-guided radial artery cannulation in LOA). Primary outcome was to assess cannulation success in the first attempt, while the secondary outcomes were to assess the number of attempts, failure rate, total cannulation time, and associated complications. Results: First-attempt success was higher in group O (80%) compared to group L (54.3%), with a P value of 0.022. In group L, 31.4% required two attempts and 5.7% had three attempts, while in group O, 14.3% had two attempts and 2.9% required three attempts. Group L failure rate was 8.6%, while it was 2.9% in group O. The mean total cannulation time (sec) for group L was 146.83 ± 89.37 and group O was 63.89 ± 26.277. No complication was observed with group O, while in group L, 9% had hematoma formation. Conclusion: The LOA approach for USG-guided radial artery cannulation has higher first-pass success rate, total success rate, and requires less cannulation time compared to the LA approach.

Background: Patients with posterior uveitis can develop vision-threatening complications. Optical coherence tomography (OCT) plays an important role in the diagnosis and management of these complications. Aims: The objectives of this study were to describe different retinal morphological characteristics presenting on OCT in patients with posterior uveitis, with an aim to facilitate early diagnosis to initiate specific treatment and also to observe the response to treatment. Materials and Methods: A cross-sectional prospective non-randomized study was undertaken at a tertiary eye care hospital. The study included 30 eyes of 30 patients with posterior uveitis between the period of May 2016 and May 2018. All subjects underwent a set of systemic investigations for etiological diagnosis and complete ophthalmic examination, including OCT (Zeiss Cirrus machine (model number 5000)] imaging). Data were collected and analyzed. A P value of

The extreme conditions linked with abiotic stresses have greatly affected soil and plant health. The diverse biochemical activities occurring in the soil environment have been attributed to shaping the dynamics of plant–soil microbiomes by contributing to microbial lifestyles and enhancing microbial functional properties to boost plant tolerance to abiotic-induced stresses. Soil microbiomes play crucial roles in enhancing plant nutrition and abiotic stress management through diverse mechanisms. With the current insights into the use of engineered soil microbes as single or combined inoculants, their use has contributed to plant fitness and stability under different environmental stress conditions by activating plant defense mechanisms, enzyme production (lowering free radicals resulting in plant oxidative stress), protein regulation, and the production of growth factors. The detection of certain genes involved in the growth factors can underline microbial functions in mitigating plant stress. Hence, the projections for sustainable eco-friendly agriculture with the possible exploration of beneficial rhizosphere microbes to manage the effect of abiotic stress on plant nutrition remain critical points of discussion recently, with prospects for ensuring food security. Therefore, this review focuses on the impacts of soil microbiomes in abiotic stress mitigation for enhancing plant nutrition.

Abstract Background Does preschool height predict adult stature in undernourished settings? The extent to which preschool length or height forecasts young adult stature is unclear in chronically undernourished populations. Methods In 2006-8, we assessed height in a cohort of 2074 young adults, aged 16–23 years, in rural Nepal who, as preschoolers (≤ 4 year), were measured at baseline and again 16 months later during a vitamin A supplementation trial in 1989-91. We assessed by linear regression the ability of preschool length (L, measured -1) increased from 38–40% mid-infancy to ∼ 69–74% by 6 years of age. By 3–6 years of age heights of stunted children (L/HAZ

Abstract The spectral content of macroscopic neural activity evolves throughout development, yet how this maturation relates to underlying brain network formation and dynamics remains unknown. Here, we assess the developmental maturation of electroencephalogram spectra via Bayesian model inversion of the spectral graph model, a parsimonious whole-brain model of spatiospectral neural activity derived from linearized neural field models coupled by the structural connectome. Simulation-based inference was used to estimate age-varying spectral graph model parameter posterior distributions from electroencephalogram spectra spanning the developmental period. This model-fitting approach accurately captures observed developmental electroencephalogram spectral maturation via a neurobiologically consistent progression of key neural parameters: long-range coupling, axonal conduction speed, and excitatory:inhibitory balance. These results suggest that the spectral maturation of macroscopic neural activity observed during typical development is supported by age-dependent functional adaptations in localized neural dynamics and their long-range coupling across the macroscopic structural network.

Introduction: Measles, a highly transmissible disease marked by fever and a maculopapular rash, posed a substantial threat to life in the 1960s. Nevertheless, the advent of the measles vaccine had a profound impact, significantly diminishing its toll on mortality. Similarly, through effective influenza surveillance and early epidemic warning systems, public health officials can timely identify influenza trends and provide crucial scientific support for prevention and control measures. This proactive approach holds great public health significance. Aim: To analyse the long-term trend of measles cases in Rajasthan, India, and the impact of Coronavirus Disease-2019 (COVID-19) on it, with future predictions using Auto-Regressive Integrated Moving Average (ARIMA) modelling. Materials and Methods: The present study was a retrospective, descriptive observational study in which monthly diagnosed measles cases were collected from the Measles Rubella Laboratory, Department of Microbiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India, for the period of April 2010 to April 2023. An ARIMA model was developed using data from 2010 to 2020 to predict the monthly number of measles cases in 2021. The predicted values were then compared to the actual cases in 2021 to assess the model’s accuracy. Results: Out of the total positive cases, males were slightly more prone to acquire infection than females (1734 males, 54%; 1477 females, 46%). The monthly index for new measles cases ranged from 0.11 to 2.6. It reached its lowest point in July (0.106) and August (0.25) and peaked in March (2.594) and April (1.84). The overall trend was fluctuating; however, the incidence of measles cases clearly increased after the year 2021. The difference between observed cases and predicted cases for the period of April 2020 to December 2021 was not statistically significant (t-value=0.261 and p-value=0.797). Conclusion: The fluctuating trend of measles was observed during the last decade; however, the observed cases of measles showed an upward trajectory during and after the COVID-19 outbreak. This study also highlighted the monthly index of the measles cases, which peaked in March to April and was lowest in July to August.

III‐V semiconductors are favoured photo absorber materials for solar energy conversion due to their ideal bandgap, yet their high‐cost hinders widespread adoption. Utilizing thin films of these semiconductors presents a viable way to address the cost‐related challenges. Here, a novel mechanical exfoliation technique is demonstrated, also known as controlled spalling, as a cost‐effective and facile way to obtain thin films of III‐V semiconductors. As a proof of concept, 15 μm thick InP films are successfully exfoliated from their original wafers. Thorough characterization using cathodoluminescence and photoluminescence spectroscopy confirms that the opto‐electronic properties of the exfoliated InP films remain unaffected. Utilizing these InP thin films, InP thin‐film heterojunction solar cells with efficiencies exceeding 13% are demonstrated. Additionally, InP photoanodes are fabricated by integrating NiFeOOH catalyst onto these InP thin‐film solar cells, achieving an impressive photocurrent density of 19.3 mA cm−2 at 1.23 V versus reversible hydrogen electrode, along with an applied bias photon‐to‐current efficiency of ≈4%. Overall, this study showcases the efficacy of controlled spalling in advancing economically viable and efficient III‐V semiconductor‐based solar energy conversion devices.

Abiotic stress, which includes salinity, drought, heat, and cold, as well as their many combinations, severely reduces crop productivity across the globe each year. Considering the intensified worldwide climatic changes, the effects of these conditions on plant productivity become increasingly more concerning. Sulfur is essential for several metabolic processes, including the organization and control of electron transport. Reductive assimilation and integration into cysteine and methionine, sulfate absorption, and reductive assimilation and integration are the key methods that oxidized and reduced forms of organically bound sulfur get to their different roles. Protective compounds with sulfur, such as glutathione, phytochelatins, S-rich proteins, and several secondary metabolites, are essential for plants to survive abiotic stress, such as dihydroasparagusic acid, hydrogen sulfide, etc. This thorough review covered the regulation of sulfur at the protein and gene transcription levels in response to abiotic stress.

Advancing understanding of the diverse properties of essential oils has spurred a significant increase in both their production and application. The current research aimed to study the chemical, physical, and antifungal characteristics of Vinca rosea leaves’ essential oil compared to its extract. The leaf’s essential oil and extract composition were examined using GC-MS and further tested for antifungal activity against Fusarium graminearum and Bipolaris sorokiniana by poisoned food technique. 34 compounds were identified in leaves essential oil predominantly composed of butylated hydroxytoluene (32.74%). The methanolic extract showed the presence of alkaloids, mainly vindoline, and the non-polar extract showed the presence of cholesterol as the primary compound. The methanolic extract demonstrated stronger antifungal activity against F. graminearum, with ED50 and ED90 of 80 and 240 µg/mL, compared to the essential oil, which had higher ED50 and ED90 of 98 and 865 µg/mL, respectively. In the case of B. sorokiniana, ED50 values of methanol extract, essential oil, and hexane extract were 76, 100, and >1000 µg/ml, respectively, and ED90 were observed to be 290, 875, and >1000 µg/ml. Vinca rosea essential oil can potentially be used to develop natural antifungal agents. For the first time, the chemical composition of the essential oil of V. rosea cultivated in the Northern Indian region is being reported.

Objective: We developed and evaluated a training program for Accredited Social Health Activists (ASHAs), female community health workers (CHWs) in India, on non-communicable diseases (NCDs). Methods: A 5-day training program, developed using government-approved manuals, was tested in a randomised controlled trial in the Tehri-Garhwal district. Quantitative comparisons were undertaken using Student's t-test and two-way ANOVA. ASHAs in the intervention group were asked questions about new skills learnt. Results: Thirty-six ASHAs (20 intervention, 16 controls) participated (response rate 75.0%). Mean pre-test knowledge score was 43.3/100 points (95% CI 36.7–49.9) for the intervention group and 44.4 (38.9–49.9) for controls. The mean post-test knowledge score increased more in the intervention group (48.5-point increase; P

ABSTRACT Whole-cell pertussis (wP) vaccines introduced in the 1940s led to a dramatic reduction of pertussis incidence and are still widely used in low- and middle-income countries (LMICs) worldwide. The reactogenicity of wP vaccines resulted in reduced public acceptance, which drove the development and introduction of acellular pertussis (aP) vaccines in high-income countries in the 1990s. Increased incidence of pertussis disease has been observed in high-income countries following the introduction of aP vaccines despite near universal rates of pediatric vaccination. These increases are attributed to the reduced protection against colonization, carriage, and transmission as well as reduced duration of immunity conferred by aP vaccines relative to the wP vaccines they replaced. A reduced reactogenicity whole-cell pertussis (RRwP) vaccine was recently developed with the goal of achieving the same protection as conferred by wP vaccination but with an improved safety profile, which may benefit countries in which wP vaccines are still in routine use. In this study, we tested the RRwP vaccine in a baboon model of pertussis infection. We found that the RRwP vaccine induced comparable cellular and humoral immune responses and comparable protection following challenge relative to the wP vaccine, while significantly reducing injection-site reactogenicity.IMPORTANCEThe World Health Organization (WHO) recommended in 2015 that countries administering wP vaccines in their national vaccine programs should continue to do so, and that switching to aP vaccines for primary infant immunization should only be considered if periodic booster vaccinations and/or maternal immunization could be assured and sustained in their national immunization schedules (WHO, Vaccine 34:1423–1425, 2016, https://doi.org/10.1016/j.vaccine.2015.10.136). Due to the considerably higher cost of aP vaccines and the larger number of doses required, most LMICs continue to use wP vaccines. The development and introduction of a wP vaccine that induces fewer adverse events without sacrificing protection would significantly benefit countries in which wP vaccines are still in routine use. The results of this study indicate this desirable goal may be achievable.

Transplant Renal Artery Stenosis (TRAS) is the leading vascular complication following kidney transplantation (KT), causing premature allograft loss and increased post-KT mortality. While risk factors for TRAS, such as prolonged cold ischemia time and delayed graft function, are well-documented in deceased donor-KT, the risk factors remain less clearly defined in living donor-KT. This matched case-control study, conducted at a leading national transplant center predominantly performing living donor-KT, evaluated risk factors and long-term outcomes of clinical TRAS (cTRAS). cTRAS cases diagnosed from January 2009 to December 2022 were matched with four control kidney transplant recipients (KTRs) in a study powered to assess whether ex-vivo arterial vascular reconstruction of multiple renal arteries (VR-MRA) increases the risk of cTRAS. Among 2,454 KTs, 28 KTRs (1.14%) were diagnosed with cTRAS around 3.62 ± 1.04 months post-KT, with renal allograft dysfunction (92.86%) as the most common presenting feature. Notably, 27 cTRAS cases were successfully treated with endovascular intervention, yielding favorable outcomes over a 6–180 months follow-up period. The study identified ex-vivo VR-MRA as an independent risk factor for cTRAS (P < 0.001). cTRAS cases receiving timely treatment exhibited long-term outcomes in graft and patient survival similar to control KTRs. Early screening and timely intervention for cTRAS post-KT may improve graft and patient outcomes.

The rapid integration of generative AI (GenAI) into industries and society has prompted a re-evaluation of copyright and intellectual property rights (IPR) frameworks. GenAI's ability to produce original content using data from human-created sources raises critical ethical and legal concerns. Current copyright and IPR frameworks, designed around human authorship, are insufficient to address these challenges. This study, using a multi-perspective approach, explores GenAI's disruptive potential in replicating or transforming copyrighted materials, challenging established IPR norms. Findings highlight gaps in legislation and the opacity of GenAI platforms. To address these issues, this study presents a Dynamic Ethical Framework linked to a future global fair use policy, aiming to guide responsible GenAI development and use. By incorporating insights from domain experts, this study contextualizes emerging challenges and potential solutions within broader societal and technological trends. That said, this study calls for international collaboration and further research to reform IPR related laws and frameworks, ensuring they remain relevant and equitable in a GenAI-driven era.

Background:. The No Surprises Act (NSA) went into effect on January 1, 2022. This federal law is designed to minimize surprise bills for emergency care, out of network (OON) care, and care for uninsured or self-pay individuals. To achieve these goals, the NSA relies heavily on physicians providing cost estimates to patients prior to administering care. Because healthcare is often price-opaque, this study was conducted to assess physician and patient attitudes toward price transparency in plastic surgery and aesthetic/self-pay medicine. Methods:. Two cohorts of providers received a survey asking whether and how their practice offers pricing information prior to a consultation and their views regarding the NSA. Patients who had previously used an online price estimator tool also received a survey regarding their experience and accuracy of estimates received online. Results:. Most surveyed providers do not share the costs of their services online, whereas patients had a positive experience when receiving estimates of medical services before consultation. Although many providers cited the inaccuracy of price estimator tools as a reason not to incorporate them into their website, most patients reported that their final cost of service was close to (or even less than) the estimate received online prior to the consultation. Conclusions:. This study suggests that price transparency is a patient satisfier. Therefore, plastic surgeons should exercise price transparency to be compliant with federal law and to gain a competitive advantage in the market, as the decision to implement price transparency can be mutually beneficial to patients and providers.

Neurological complications, including encephalopathy and stroke, occur in a significant proportion of COVID-19 cases but viral protein is seldom detected in the brain parenchyma. To model this situation, we developed a novel low-inoculum K18-hACE2 mouse model of SARS-CoV-2 infection during which active viral replication was consistently seen in mouse lungs but not in the brain. We found that several mediators previously associated with encephalopathy in clinical samples were upregulated in the lung, including CCL2, and IL-6. In addition, several inflammatory mediations, including CCL4, IFNγ, IL-17A, were upregulated in the brain, associated with microglial reactivity. Parallel in vitro experiments demonstrated that the filtered supernatant from SARS-CoV-2 virion exposed brain endothelial cells induced activation of uninfected microglia. This model successfully recreates SARS-CoV-2 virus-associated para-infectious brain inflammation which can be used to study the pathophysiology of the neurological complications and the identification of potential immune targets for treatment.

BackgroundRheumatoid arthritis (RA) is a common condition treated with biological disease-modifying anti-rheumatic medicines (bDMARDs). However, many patients exhibit resistance, necessitating the use of machine learning models to predict remissions in patients treated with bDMARDs, thereby reducing healthcare costs and minimizing negative effects.ObjectiveThe study aims to develop machine learning models using data from the Kuwait Registry for Rheumatic Diseases (KRRD) to identify clinical characteristics predictive of remission in RA patients treated with biologics.MethodsThe study collected follow-up data from 1,968 patients treated with bDMARDs from four public hospitals in Kuwait from 2013 to 2022. Machine learning techniques like lasso, ridge, support vector machine, random forest, XGBoost, and Shapley additive explanation were used to predict remission at a 1-year follow-up.ResultsThe study used the Shapley plot in explainable Artificial Intelligence (XAI) to analyze the effects of predictors on remission prognosis across different types of bDMARDs. Top clinical features were identified for patients treated with bDMARDs, each associated with specific mean SHAP values. The findings highlight the importance of clinical assessments and specific treatments in shaping treatment outcomes.ConclusionThe proposed machine learning model system effectively identifies clinical features predicting remission in bDMARDs, potentially improving treatment efficacy in rheumatoid arthritis patients.

Abstract Balanced energy protein (BEP) supplementation in pregnancy is recommended in the context of undernutrition for the reduction of small‐for‐gestational age neonates and stillbirths. To inform an effectiveness trial, we evaluated the acceptability of a packaged, ready‐to‐eat fortified BEP product among women of reproductive age and their health care providers (HCPs) in rural Bangladesh and explored the feasibility of adhering to daily supplementation. We implemented a formative study using focus groups discussions with women (n = 29) and HCPs (n = 17) to introduce the product and investigate components of acceptability. A “trials of improved practice” activity was conducted in subset of women (n = 16) to evaluate adherence to BEP over a 2‐week period, followed by focus group discussions to identify challenges with adherence and strategies employed. Contributors to BEP acceptability included the product's sensory attributes, such as taste, smell and texture; the attractive packaging and informative labelling; and the perceived benefits of use. Participants also identified household and community level factors influencing the adoption of BEP, such as trust in the provider, cultural beliefs on supplement use in pregnancy, and family member tasting and approval. Over the 2‐week period, women consumed over 80% of the supplements provided to them and identified strategies for adherence, including visual aids and reminders from family members or providers. HCPs recommended targeted communication messages for mothers‐in‐law to foster a supportive home environment. Findings informed changes to the BEP product to improve acceptability and shaped the content of communication messages to optimise adherence in a forthcoming effectiveness trial.

Abstract Balanced energy protein (BEP) supplementation is an efficacious intervention in pregnancy for improving birthweight and is recommended by World Health Organization (WHO) in countries with high maternal undernutrition. Few countries have implemented BEP programmes due in part to high cost, lack of data on acceptability and feasibility, and complexity of delivery. We sought to address implementation gaps in BEP interventions through a formative study designed to understand implementation outcomes. We conducted 52 in‐depth interviews and 8 focus‐group discussions with married women of reproductive age, family members, health care providers and pharmacists in three unions of the Gaibandha district in rural Bangladesh. Interviews were translated and transcribed in English and analysed using an analytic framework for implementation science in nutrition. BEP was viewed as an acceptable and appropriate intervention to combat undernutrition in this setting. There was a lack of clarity on who should or could be responsible for providing/distributing BEP in a way convenient to mothers. Many participants preferred door‐to‐door delivery and thought this approach could address social and gender inequities, but providers mentioned already being overworked and worried about adding new tasks. Participants were concerned about the affordability of BEP and opportunity costs associated with travel to proposed distribution sites such as ANC or pharmacies. Women in these communities do not always have the agency to travel without supervision or make purchasing decisions. BEP supplementation is a complex intervention; future trials seek to assess ways to overcome these implementation challenges and inform a long‐term systems‐owned BEP intervention.

Abstract Balanced energy protein supplementation (BEP) is recommended for contexts of high maternal undernutrition by the World Health Organization. Despite recent improvements in undernutrition, Bangladesh remains a context where BEP could help accelerate progress towards nutrition goals. In preparation for an effective trial testing a fortified BEP, a qualitative study was undertaken to better understand sociocultural factors influencing dietary behaviours in pregnancy. Married women of reproductive age (n = 23), their husbands (n = 6) and mothers‐in‐law (n = 6) were interviewed, and focus group discussions were conducted with women (n = 4). Women had a clear understanding of which nutritious foods are important to consume during pregnancy, including green leafy vegetables, dairy and other animal‐source foods. Many explained affordability as a barrier to consuming those foods with the desired frequency. Women acquired information about diet and nutrition in pregnancy from community health workers as well as other women in the community. Most preferred to seek information from their own networks before formal health care providers. Women and husbands generally had positive views about micronutrient supplements, although some mothers‐in‐law were more hesitant. Some food taboos relating to the consumption of certain foods like duck and pigeon meat persist, mainly stemming from concerns for the unborn child. Opportunities exist to build on existing perceptions of healthy diets, potentially framing food or nutrient supplements as a beneficial ‘add‐on’ to promote a healthy pregnancy. There is a scope to strengthen nutrition counselling, especially for the family members, to dispel myths and misconceptions and promote dietary and other support for pregnant women.

Infections due to Non Typhoidal Salmonella (NTS) are emerging as a major health problem for both humans and animals worldwide including in India. In humans, NTS infections routinely remain restricted to the intestinal tract and may or may not manifest as a clinical illness but in immunocompromised patients systemic involvement may result in frank bacteraemia or focal involvement depending on the site of localisation. A 70-year-old, male presented to the Emergency Department with complaints of pain for about five days, on the right side of the scrotum. A drained pus sample was received at the Department of Microbiology for culture and sensitivity. Salmonella kentucky was identified by standard microbiological techniques. Here the authors present a case of scrotal abscess caused by Salmonella kentucky in an old immunocompromised patient and this possibly appears to be the first case report of scrotal involvement from India. No single diagnostic approach may be able to identify the NTS up to the species level. To determine the identity of organisms in cases where individual labs may not have the necessary capacity to produce the results, it would be extremely sensible from a scientific standpoint to create a network of cooperating labs with varying diagnostic capacities.

Purpose The objective of the present study was to provide an update on the 16 sports with the highest incidence of brain injuries. Thereafter, its diagnosis, treatment, and management strategies are discussed. Methods The manuscript addresses the brain-related injuries individually in each of the 16 sports with the highest incidence. To simplify the reading, the mentioned 16 sports are sorted alphabetically. A subpart mentioning the management of brainrelated sports injuries, including pharmacological management, is also included in the manuscript. Results The incidence of sports-mediated brain injuries within hospital-based studies ranged between 3.5 and 31.5 per 100,000. One community-based study using multiple case ascertainment sources identified a higher incidence of 170 per 100,000. Brain injuries due to sports total 1.2–30.3% of all TBIs (traumatic brain injuries). Men have a higher prevalence than women (75.6% vs. 66.1%), and adolescents and young adults had the highest incidence of sports-mediated brain injuries. Almost 50% of head injuries reported during the practice of sports or recreational activities occur in bicycling, skateboarding, or skating incidents. More than 775,000 children, aged 14 and younger, are treated yearly in hospital emergency rooms for sports-related injuries. Conclusions Brain injuries are common in sports and difficult to manage, but athlete health and injury prevention should be the priority. Preventive measures should be stricter in sports with a higher incidence of brain injury. As for treatment, a comprehensive approach should be adopted.

Abstract Background Subtotal petrosectomy (STP) has attracted massive interest over last two decades. The aim is to present our experience of this uncommon surgery. The indications, outcomes, and our variation in surgical technique would be presented and literature reviewed. Methods A retrospective observational study of all patients who underwent STP at a tertiary care center in India was analyzed. Results A total of 9 ears (in 8 patients) underwent STP over last 5 years at our center. The pathological conditions for which STP was done included chronic otitis media squamous (four ears), middle ear tumors (three ears), petrous apicitis (one ear), and traumatic cerebrospinal fluid (CSF) otorhinorrhea (one ear). The indication of STP included disease clearance (eight ears), unserviceable hearing (seven ears), hearing rehabilitation with otological implants (six ears), and intraoperative CSF gusher (one ear). Intraoperative indications included CSF gusher, large tegmen defect with erosion of apical turn of cochlea, and erosion of anterior bony wall of external auditory canal. The mean follow-up period was 36 months (range of 6 months to 60 months). None of the patients had any dehiscence of blind sac closure or secondary acquired cholesteatoma on imaging. Conclusions STP facilitates disease clearance by providing unmatchable exposure in difficult otological scenarios and additionally isolates middle ear cleft from external environment, thereby eliminating problems of mastoid cavity. Furthermore, it also prepares ear for second stage otological implants. It is a safe surgery with minimal complications.

Purpose: To study the demographic profile of keratoconus (KC) patients visiting a tertiary eye care hospital in Western India. Materials and Methods: This cross-sectional, observational study included newly diagnosed KC patients visiting our hospital between January 2018 and October 2022. Patient’s demographic details (self-reported age at first presentation, age at diagnosis, and sex) and mean maximum curvature (K Max) were collected. The patients were divided into age band of 5-year groups. A subanalysis of gender and severity was performed among groups. Spearman’s correlation coefficient was used to evaluate the relationship between KC severity and age. Results: A total of 536 patients with clinical KC were included. A self-reported age at first presentation was 19.4 ± 6.2 years. The mean age of diagnosis was 20.5 ± 6.0 years (range: 4–43 years). There were 61.6% (330) of males and 38.4% (206) of females (P < 0.01). The mean K Max value was 59.2 ± 13.3 diopter (D). The mean K Max was not significantly different between the sexes, with the exception of the age range of 24–28 years, where females had more severe KC than males (P = 0.02). Among the included patients, 38.6% (207) of patients were pediatrics (≤18 years), while 61.4% (329) were adults (>18 years). The mean K Max in pediatric KC (62.3 ± 15.1 D) was significantly higher than adult KC (57.3 ± 11.5), P < 0.01. Severity of KC did not correlate with the age of the patients (r = −0.20, P = 0.04). Conclusion: KC presented at a younger age with moderate-to-severe stage of the disease, indicating the need for early KC detection in our population.

Background: Defining lipid goals solely on low-density lipoprotein-cholesterol (LDL-C) levels in Indian population may cause misclassification due to high prevalence of hypertriglyceridemia and small dense LDL-C particles. International guidelines now recommend Apoliporotein-B (Apo-B) and non-high-density lipoprotein-cholesterol (non-HDL-C) levels as alternative targets. In this study, we used a cross-sectional representative population database to determine Apo-B and non-HDL-C cut-offs corresponding to identified LDL-C targets and compared them to international guidelines. Methods: A community-based survey carried out in urban Delhi and adjacent rural Ballabhgarh provided lipid values for 3047 individuals. The Spearman correlation coefficient was used to evaluate the degree of relationship between Apo-B and LDL-C and non-HDL-C. Cut-off values for Apo-B and non-HDL-C were established using receiver operator curve analysis correlating with guideline-recommended LDL-C targets. Results: Spearman's rank correlations between Apo-B and LDL-C (0.82) and non-HDL-C and LDL-C (0.93) were significant (p 150 mg/dl the corresponding Apo-B and non-HDL-C values were 85.1, 92.7, 103.5, 117.5 and 135 mg/dL and 124.5, 126.5, 147.5, 167.5 and 190.5 mg/L respectively. Conclusion: Based on this study we provide Apo-B and non-HDL cut-offs corresponding to target LDL-C values in Indian patients with and without high triglycerides. It is noted that in individuals with triglycerides ≥ 150 mg/dl, the Apo-B levels are much higher than the values recommended by guidelines.

Aim: There is limited data on prognostic value of baseline plasma cell free DNA (cfDNA) in advanced squamous non-small cell lung cancer (sq-NSCLC). This prospective observational study aimed to assess change in plasma cfDNA levels in locally-advanced/metastatic sq-NSCLC with chemotherapy and its correlation with symptom-scores and radiological-responses. Methods: Chemotherapy-naive patients with stages-IIIB/IIIC/IV sq-NSCLC (n = 59), smokers with chronic obstructive pulmonary disease [COPD, COPD-controls (CC); n = 27] and healthy-controls (n = 25) were enrolled. Respiratory symptom burden (RSB) and total symptom burden (TSB) were calculated from mean visual-analog-scores (VAS) of dyspnoea, cough, chest pain, hemoptysis RSB, anorexia and fatigue (all six for TSB). cfDNA was isolated from peripheral blood. All patients received platinum-doublet chemotherapy. RSB/TSB/cfDNA assessment and contrast-enhanced computed tomography (CECT)-thorax scans were done at baseline and post-chemotherapy. Results: At baseline, 13/59 (22%) sq-NSCLC, 3/27 (11%) CC and none (0%) healthy-controls had detectable cfDNA. All three CC were heavy smokers with no evidence of malignancy and undetectable cfDNA levels on repeat testing. In sq-NSCLC group, majority were males (95%), current-smokers (88%), heavy-smokers (70%), had metastatic disease (59%) with median age of 65 years. Eastern Co-operative Oncology Group (ECOG) performance status (PS) was 0–1 (56%) and 2 (42%). Median RSB- and TSB-scores were 9 [interquartile range (IQR) = 5–14] and 16 (IQR = 9–23), respectively. Of the 59 patients, 54 received ≥ 1 cycle while 27 underwent post-C4 evaluation with detectable cfDNA levels in 18/27 (66.7%). No baseline characteristic correlated with cfDNA detectability. Median overall survival (OS) and progression-free survival (PFS) were 262 days and 167 days, respectively. ECOG PS ≥ 2, RSB-score > 9 and TSB-score > 16 were all associated with worse OS and PFS as was cfDNA detectability [median OS = 97 days vs. 298 days and median PFS = 97 days vs. 197 days; P = 0.025; hazard ratio (HR) = 2.17]. Conclusions: Baseline cfDNA detectability is independently associated with poor OS and PFS in patients with advanced sq-NSCLC on chemotherapy.

Abstract Background Greater wax moth (Galleria mellonella L.) (Lepidoptera: Pyralidae) is most commonly used for mass multiplication of entomopathogenic nematodes. An investigation on economical modification and comparative analysis of factitious diets of G. mellonella was carried out under laboratory conditions. Different diets were assessed in comparison with standard diet. Results Modifications based on quantity change of dietary components (wheat flour, maize flour, dry milk, dry yeast, honey and glycerin), addition of vitamin E and vitamin-B complexes, elimination of dry milk and replacement of glycerin with sorbitol showed reduction in the cost of production and increase in food conversion efficiency in G. mellonella. The weight of larva in diet III (303.40 mg) was highest as compared to the larval weight in control diet (280.00mg). The conversion of ingested and digested food into biomass of G. mellonella was the highest for factitious diet III. Also, the highest number of Steinernema abbasi was produced from G. mellonella larvae reared on diet III (25418.43IJs) followed by diet I (21805.31IJs). The economics of the diets also showed that the percent cost reduction in factitious diet III and diet I was 48.86 and 28.85%, respectively. Overall, the results suggested that factitious diet III was superior to diet I followed by diet II. Conclusion Addition of supplements of vitamin E and B-complexes enhances the biological activity of the insect, thereby increasing its food conversion efficiencies. Factitious diet III can be successfully used for mass multiplication of the G. mellonella.

Abstract Background The World Health Organization (WHO) recommends balanced energy and protein (BEP) supplementation be provided to all pregnant women living in undernourished populations, usually defined as having a prevalence > 20% of underweight women, to reduce the risk of stillbirths and small-for-gestational-age neonates. Few geographies meet this threshold, however, and a large proportion of undernourished women and those with inadequate gestational weight gain could miss benefiting from BEP. This study compares the effectiveness of individual targeting approaches for supplementation with micronutrient-fortified BEP vs. multiple micronutrient supplements (MMS) alone as control in pregnancy in improving birth outcomes. Methods The TARGET-BEP study is a four-arm, cluster-randomized controlled trial conducted in rural northwestern Bangladesh. Eligible participants are married women aged 15–35 years old identified early in pregnancy using a community-wide, monthly, urine-test-based pregnancy detection system. Beginning at 12–14 weeks of gestation, women in the study area comprising 240 predefined sectors are randomly assigned to one of four intervention arms, with sector serving as the unit of randomization. The interventions involving daily supplementation through end of pregnancy are as follows: (1) MMS (control); (2) BEP; (3) targeted BEP for those with pre-pregnancy body mass index (BMI)

Compound heterozygous Sickle Haemoglobin (HbS) beta (β) thalassaemia arises from the mutations associated with sickle cell and β thalassaemia and significantly affects populations in low income countries like India. Elevated levels of Haemoglobin A2 (HbA2) represent the primary indicator for identifying carriers of β thalassaemia. However, it’s worth noting that sometimes, High Performance Liquid Chromatography (HPLC) encounters challenges in confirming a final diagnosis when levels of HbA2 and HbS fall outside the diagnostic range. A nine-year-old male and his sister 11-year-old female patient presented with high-grade fever and jaundice since two weeks. Following admission, Complete Blood Count (CBC) and HPLC of both children were done. Hb of male and female child revealed 1.8 g/dL and 1.5 g/dL, respectively. HPLC of male child revealed Haemoglobin F (HbF) 27.4%, HbS 56.3%, HbA2 3.8% and of female child revealed HbF 39.2%, HbS 43.5%, HbA2 3%. HPLC reports of both children were suggestive of differential of compound heterozygous HbS β thalassaemia and HbS homozygous. Later, HPLC of their parents was also done. HPLC of father was suggestive of thalassaemia trait and of mother suggestive of sickle cell trait, following which final diagnosis of both children was given as compound heterozygous HbS β thalassaemia. Diagnosing these compound heterozygous haemoglobinopathies can be challenging. As their is resemblance in clinicopathological features of sickle cell anaemia and β thalassaemia disorders, it is important to carefully differentiate between them although prognosis is better than thalassaemia major or sickle cell anaemia.

Abstract We report the de novo design of small (

Background: Blood transfusions play a pivotal role in medical care, saving millions of lives annually. The timely provision of safe blood is critical in various clinical scenarios, necessitating a careful balance between supply and demand. Despite advanced blood banking facilities globally, challenges persist in ensuring appropriate blood component utilization, prompting a need for clinical audits and optimization strategies. Aims and Objectives: This study aims to analyze the patterns of blood product utilization in a tertiary care hospital in Madhya Pradesh over 1 year, focusing on transfusion requests, cross-match-to-transfusion (C/T) ratios, transfusion indices (TIs), and indications for transfusions. Materials and Methods: A retrospective study was conducted at Shyam Shah Medical College from January 01, 2023, to December 31, 2023. Data from transfusion and cross-match requests in various departments were collected. C/T ratios, TI, and non-usage probability were computed to assess blood utilization efficiency. Results: Out of 16,682 cross-matched units, 71.93% were transfused. The overall C/T ratio was 1.39. The department of medicine demonstrated the most efficient blood usage with a C/T ratio of 1.16. Obstetrics and gynecology had the highest TI (1.06), while surgery had the lowest (0.71). Indications for transfusion included anemia (29.9%), pre-operative (17.2%), intraoperative (21.8%), and post-operative (31.1%). Conclusion: This study provides valuable insights into blood utilization patterns, offering a foundation for refining transfusion practices and enhancing the efficiency of blood management in the studied tertiary care hospital.