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Class III malocclusion is always a challenging treatment and has been the subject of interest in many investigations due to the challenges it poses. It can be caused by maxillary retrognathism, mandibular prognathism, or a combination of the two. In around 40% of Class III patients, the cause is maxillary retrognathia. The condition can be treated either by camouflage or by surgery to correct the skeletal disharmony. However, camouflage treatment doesn’t result in a drastic change to the facial profile when it involves skeletal disharmony and may recur after treatment is completed. To increase the stability of this treatment, the patient’s growth and age phase are decisive factors. In young children, the circumaxillary sutures are patent, and protraction of the maxilla can be aided by opening these sutures with orthopaedic force. Protraction appliances like face masks are used to support the growth of a deficient maxilla in cases of maxillary retrognathism. The current case report of a 13-year-six-month-old male presented the correction of class III skeletal malocclusion with an anterior crossbite in a growing patient using the “Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol” and face-mask treatment with the Hyrax appliance. Skeletal class III can be due to mandibular excess, maxillary deficiency, or a combination of both. The treatment time was 18 months, and a notable improvement was observed in the soft tissue profile when assessed through cephalometric measurements and photographs.

Perforation of the colon is frequently encountered in surgical emergencies and requires urgent intervention. Free colonic perforations are diagnosed early due to the development of signs of peritoneal irritation. However, perforation of the posterior wall of the colon into the retro-peritoneal space poses a diagnostic challenge because of the absence of signs of peritoneal irritation and its atypical clinical presentation. The authors reported an unusual case of 42 years old female patient with idiopathic perforation of the posterior wall of the ascending colon that presented as a large retroperitoneal abscess. The abscess was diagnosed based on clinical and Computed Tomography (CT) findings, and the patient underwent incision and drainage of the abscess through a flank incision. There was initial improvement in the patient’s general condition, but on the fourth day, there was faecal discharge through the wound, indicating colonic perforation. The patient was immediately taken for an emergency laparotomy. Intraoperatively, the peritoneal cavity was found to be clean; however, upon mobilisation of the ascending colon, two large perforations on its posterior wall were found with faecal soiling of the retroperitoneal tissues. Right hemicolectomy with end ileostomy and closure of the transverse colonic end were performed. Histopathology revealed the absence of any definite pathology, and a diagnosis of spontaneous perforation was made. This unusual case highlights that this rare possibility should be considered as a differential diagnosis of a retroperitoneal abscess to enable early intervention, which is likely to save the patient.

Cathelicidins are human peptides involved in innate immunity, and are believed to be mediators of vitamin D-related immune benefits. We aimed to evaluate the correlation between serum levels of 25 hydroxy vitamin D (25(OH)D) and serum cathelicidin antimicrobial peptide (CAMP) in children hospitalized with severe pneumonia. This was a secondary analysis from a larger randomized double-blind placebo-controlled trial on vitamin D supplementation in severe pneumonia. Children aged 6 months to 5 years with the World Health Organization (WHO) defined severe pneumonia were included. Any child with rickets, immunodeficiency, or chronic illness was excluded. Baseline serum CAMP, serum 25(OH)D, and immunoglobulins were measured and analyzed. A total of 163 under-five children were recruited with mean (standard deviation) age 16.4 (13.0) months. The median (interquartile range [IQR]) serum CAMP was 12.5(8.0–20.0) ng/mL and serum 25(OH)D was 14.4 (8.4–24.2) ng/mL. There was no significant correlation between serum cathelicidin and serum 25(OH)D (r = −0.064, p = 0.415). Serum 25(OH)D was low (

Cognitive rehabilitation, STEM (science, technology, engineering, and math) skill acquisition, and coaching games such as chess often require tutoring decision-making strategies. The advancement of AI-driven tutoring systems for facilitating human learning requires an understanding of the impact of evaluative feedback on human decision-making and skill development. To this end, we conduct human experiments using Amazon Mechanical Turk to study the influence of evaluative feedback on human decision-making in sequential tasks. In these experiments, participants solve the Tower of Hanoi puzzle and receive AI-generated feedback while solving it. We examine how this feedback affects their learning and skill transfer to related tasks. Additionally, treating humans as noisy optimal agents, we employ maximum entropy inverse reinforcement learning to analyze the effect of feedback on the implicit human reward structure that guides their decision making. Lastly, we explore various computational models to understand how people incorporate evaluative feedback into their decision-making processes. Our findings underscore that humans perceive evaluative feedback as indicative of their long-term strategic success, thus aiding in skill acquisition and transfer in sequential decision-making tasks. Moreover, we demonstrate that evaluative feedback fosters a more structured and organized learning experience compared to learning without feedback. Furthermore, our results indicate that providing intermediate goals alone does not significantly enhance human learning outcomes.

Almost 50 years ago, objective structured clinical examination (OSCE) was introduced as a comprehensive and objective tool to assess clinical competencies in a standardized manner. OSCE has not only been used as an assessment tool but also an effective teaching modality. Over the years, the validity, feasibility, reliability and objectivity of OSCE have been questioned. Also, given the need for a large number of stations and examiners, high costs, elaborate checklists, training of examiners and standardization of patients, the acceptance of OSCE has been reluctant. The COVID 19 pandemic saw OSCE in its new avatar and virtual OSCE was used extensively to ensure undisrupted teaching and assessment of medical students worldwide. The recent Competency Based Medical Education (CBME) Guidelines for medical education in India have internalized OSCE as an assessment modality for medical undergraduates. This article focuses on the issues of validity, objectivity, reliability, and standard setting of OSCE and describes the challenges and way ahead for implementation of OSCE in India.

Background The rapid development and deployment of effective COVID-19 vaccines have been critical to halt the spread of the pandemic. India started vaccinating children in early 2022, however, vaccine uptake has been suboptimal.Methods Between September and November 2022, we conducted an online survey that was disseminated to eligible participants via email, text messages and social media platforms across India. The survey aimed to gather the perspectives of Indian healthcare providers regarding key factors related to the rollout of paediatric COVID-19 vaccines. Descriptive statistics were used to analyse participant demographics and responses on knowledge about paediatric COVID-19 vaccines, perceived risks and benefits, and vaccine rollout strategies.Results The survey yielded 805 respondents from 23 Indian states; 63.5% were men, 97.3% were paediatricians, median age was 44 years (IQR 25–81). Eighty-one per cent and 65.2% respondents had heard about the most common paediatric COVID-19 vaccines in India, Covaxin and Corbevax, but only 52.9%, 53.7% and 62.1% felt adequately informed about their safety, efficacy and vaccination schedules, respectively. Thirty per cent of respondents were unaware of vaccination guidelines. Eighty-five per cent of respondents felt that vaccines would reduce the incidence of severe disease, hospitalisation and deaths, and 60.6% felt children with comorbidities should be prioritised for vaccination. Perceived supply side barriers included lack of enforcement of guidelines (45.2%) and adverse effects following immunisation monitoring systems (37.6%), and on the demand side, parental vaccine hesitancy (64.4%). Eighty-one per cent believed that school-based vaccination strategies would be highly effective in increasing uptake.Conclusions Most respondents were in support of the COVID-19 paediatric vaccination, although just over half did not feel adequately informed. Concerns about vaccine hesitancy among caregivers were the leading reported barrier. Targeted interventions are needed to provide adequate knowledge support to healthcare providers and evidence-based public health messaging to reduce vaccine hesitancy among caregivers.

Background: Rheumatoid arthritis (RA) is an inflammation of joints with increased cellularity of synovial tissue. Allopathic drugs possess several adverse effects, which have led to increase in the utilization of herbal medicines. Polyherbal emulgel resolves the bioavailability issue associated with hydrophobic drugs and can be used effectively in the treatment of RA. Objectives: The present study aimed at the formulation of polyherbal emulgel, and evaluation of in vitro anti-inflammatory activity and in vivo antiarthritic activity. Methods: Seven emulgels F-1 to F-7 were optimally formulated. In vitro anti-inflammatory activity was determined using protein denaturation method employing Diclofenac sodium as the standard. In antiarthritic study Complete Freund's Adjuvant (CFA) model was used. The various parameters were assessed, like paw volume, body weight, hematological parameters, antioxidant parameters, Rheumatic factor (RF), and histopathological study of ankle joint. Results: F-4 and F-7 were found to be optimized formulations as compared to other formulations. The in vitro anti-inflammatory activity was found to be highest in F-4 with IC50 7.74 and F-7 with IC50 8.87 in comparison with Diclofenac sodium having IC50 57.0. Both formulations F-7 and F-4 showed a significant reduction in paw volume and normalization of body weights. The formulation F-7 even showed more potent antiarthritic activity than F-4 by decreasing white blood cells (WBC), lymphocytes, increasing packed cell volume (PCV), neutrophils, superoxide dismutase (SOD), catalase and decreasing malondialdehyde (MDA) levels in serum. This was further confirmed by histopathological study. Conclusion: As an anti-inflammatory agent, this newly developed emulgel was found to possess more therapeutic efficacy than commercially available diclofenac sodium.

In this paper, two types of lightweight fly ash (FA) aggregates: cold bonded fly ash (CFA) and sintered fly ash (SFA) aggregates were prepared through the cold bonding and sintering method. During the pelletization process, different ratios of binders to fly ash were used, i.e., 10:90, 15:85, 17:83, and 20:80 with a set amount of water. Cement, metakaolin, sodium silicate, urea-formaldehyde resin, bentonite powder, and phenol-formaldehyde resin were employed as binders. A comparative study on physicochemical, mechanical, phase identification, microstructure, and optical analysis of CFA and SFA was performed. The results showed that CFA (an alkali binder) had a higher water absorption (WA) value of 9,50 % with a crushing strength (CS) value of 6,30 MPa than SFA (sodium silicate binder) with a CS value of 5,80 MPa and a WA value of 10,28 %. Experimental observations also demonstrated that the leaching ability of SFA was considerably lower than that of CFA. Most notably, SFA can be used as a substitute for construction material and structural applications along with solving FA waste disposal and related problems to a considerable extent.

Today's modern computing environment provides a smart healthcare monitoring system for early prediction of fall detection. The Internet of Things-based health model plays a significant role in the health care service area and helps to improve the processing of data and its prediction. Transferring reports or data from one place to another takes too much time and energy, and it will cause high latency and energy issues. To handle these kinds of hazards, edge computing provides solutions. In this paper w presents smart healthcare system issues, services, and applications. Furthermore, propose a CNN-based prediction model with the use of edge computing and IoT paradigms. Edge computing is a distributed environment framework that enables rapid resource availability and response time through local edge servers computed at the end of IoT devices. The CNN model is used to analyse the health data collected by IoT devices. Furthermore, the role of edge devices is to provide doctors and patients with timely health-prediction reports via edge servers. The proposed mechanism can be analysed using accuracy and error rate performance parameters. In the proposed mechanism, the accuracy is 99.23% in comparison with other techniques.

Abstract Background The water supplies are hindered because aquatic resources have constrained with natural and man-made pollution activities in terms of releasing huge amounts of contaminants from different point and non-point sources across the globe. The industries like metal plating, batteries, paint, fertilizers, tanneries, textile industries, dyeing industries, mining operations, and paper industries discharge their effluents into the environment directly or indirectly, and hence, they are considered as the key sources of heavy metals contamination in water resources. Heavy metals are inorganic, non-biodegradable, persistent, and having a tendency to get accumulated in biotic and abiotic components of environment as compared to organic pollutants. Some heavy metal cations, for example, mercury, arsenic, cadmium, zinc, lead, nickel, copper, and chromium, are carcinogenic in nature and so, lethal. There are growing health concerns due to toxic impacts of heavy metals on every genre of ecosystem. To deal with the bottleneck situation, it is highly imperative to search a feasible solution for heavy metal remediation in water in context of preventing amalgamation of noxious contaminants in food web. Different methods are exercised for the remediation of such impurities from its solutions. One method, i.e. adsorption is found to be the simplest, economical, efficient, and eco-friendly in this context. Main body Geopolymers exhibit heterogeneous amorphous microstructure and wide surface area. The compatibility for depollution and the performance of these materials mainly depend upon their preparation methods, composition, and microstructure. Fly ash-based geopolymer may serve as a better alternate to various cost-effective adsorbents and it will be a proven environmentally viable, waste to money solution by consuming heaps of fly ash waste for the adsorbent modified by using fly ash. The possible utilization of wastes from several industries is a matter of concerned sustainability benefits. This study shows that fly ash-based geopolymers have the potential to cope up with the problems and risk factors associated with the fly ash waste management and it would be the utmost scientific panacea in the field of removing toxins from aqueous medium and maintain environmental health in the future. Short conclusions The literature available in different databases is very limited pertaining to heavy metal remediation using fly ash-based geopolymers. Keeping all the factors in mind, this article is an attempt to summarize relevant informations related to work done on fly ash-based geopolymers for treating aqueous solutions comprising heavy metals.

Abstract Background The purpose of the study was to evaluate survival outcomes in post-operative oral tongue cancer patients undergoing adjuvant radiotherapy (RT) at a tertiary cancer care center and to critically review the impact of various clinical-pathological factors on recurrence and survival. Demographic factors, stage of all the histology proven oral tongue cancer, and treatment details were documented. Overall survival (OS) and recurrence-free survival (RFS) were analyzed along with the potential prognostic factors affecting outcome. Results One hundred forty-four post-operative oral tongue cancer patients referred to our department for adjuvant treatment were evaluated. Median age at presentation was 45 years. Forty-seven patients had pathological early stage disease (stages I and II) and 95 had locally advanced (stages III and IV) disease while post-op details were not present in 2 patients. At a median follow-up of 87 months (60–124) of alive patients, the median RFS for entire cohort was 62 months while median OS was 74 months respectively. Age, perineural invasion (PNI), and grade of the tumor emerged as independent prognostic factors for OS and RFS. Among patients with early stage disease, depth of invasion (DOI), age, and PNI were found as independent prognostic factors for RFS and OS. In locally advanced disease, higher grade, age, and PNI independently impacted the respective survival end points. Conclusions Age (> 45 years), higher grade, and presence of PNI showed inferior survival outcomes across the sub-groups (early versus locally advanced disease). This may warrant adjuvant treatment intensification. DOI > 10 mm was particularly found to worsen survival in early node negative SCC oral tongue patients.

Plastics i.e. polymers are long chains or networks of monomer molecules which can be fabricated in desired shape, colour and specifications. The multi-functionality of this macromolecule has made it an integral part of society. Due to being given immense importance in various industrial sectors, like information technology, electrical, as well as electronics industries, intelligent, smart and advanced packaging systems, agriculture, automobiles, biomedical applications, etc., they are quite indispensable for the modern generation. The huge demand and high frequency usage have alarmed a number of countries littered with plastic wastes which need to be attended immediately. The effects of plastic solid waste on environmental living and non-living components are noticeable in the ever-increasing level of plastic pollution both on land and in the oceans globally. This paper compiles the various aspects and prospects of disposal methods like landfilling, recycling, progress in recovery and management of plastic waste (i.e. primary, secondary, tertiary and quaternary) in order to minimize its huge volumes. The depolymerisation process is the key technology behind its success which provides a high yield of product and a minimal amount of waste. Few innovative methods other than recycling published by different researchers are also discussed in this paper.

Animals respond to hypoxic stress by adjusting metabolic processes to balance survival and reproduction. Here the authors identify the transcription factor PQM-1 as a metabolic regulator that balances hypoxic lipid and carbohydrate metabolism in C. elegans to limit somatic integrity and promote progeny survival.

The COVID-19 pandemic has been an enigma to all. Contrary to the initial perception that the novel coronavirus spares most kids, evidence has been emerging that children including neonates and infants are also infected. The clinical presentation in the pediatric age group has been reported as often atypical. Given the fact that children could be carriers of this deadly virus and hence act as spreaders, the need to recognize pediatric COVID-19 seems imminent.

Introduction: Faculty development to implement competency-based medical education (CBME) is urgently needed as the Medical Council of India has implemented the competency-based curriculum this year onwards. Objectives: To evaluate a 2-day faculty development workshop in terms of: (a) increase in knowledge about CBME terminology and concepts, (b) self-reported capacity to develop and implement a competency-based module in their respective disciplines, and (c) satisfaction of the participants. Methodology: A single arm interventional study using mixed methods was carried out in which faculty members were purposively identified and requested to volunteer for a two-day faculty development workshop on the development and implementation of CBME. The workshop was evaluated (open-ended and Likert scored items) by the participants for self-reported gain in knowledge, gain in their confidence to develop and implement CBME, and level of satisfaction with respect to the components of the workshop. Quantitative data was analyzed by Wilcoxon signed rank test and Kruskal–Wallis test. Qualitative data was analyzed by doing content analysis and emerging themes have been presented. Results: Eleven faculty members attended a capacity building workshop for developing and implementing a competency-based curriculum for medical undergraduates. There was a significant improvement in their self-reported knowledge and attitude regarding the competency-based curriculum. New concepts learned fell into four domains: modification of the existing curriculum toward competency-based curriculum, knowledge of CBME, teaching-learning and assessment methods, and beneficial to the students. The participants were highly satisfied with the workshop in its current form. Conclusion: A two-day faculty development workshop can increase the knowledge and understanding of competency-based medical education and can be an important first step in the journey to more specialized training.

The COVID-19 pandemic has led to disruptions in essential health services globally. We surveyed Indian paediatric providers on their perceptions of the impact of the pandemic on routine vaccination. Among 424 (survey 1) and 141 (survey 2) respondents representing 26 of 36 Indian states and union territories, complete suspension of vaccination services was reported by 33.4% and 7.8%, respectively. In April–June 2020, 83.1% perceived that vaccination services dropped by half, followed by 32.6% in September 2020, indicating slow resumption of services. Concerns that vaccine coverage gaps can lead to mortality were expressed by 76.6%. Concerted multipronged efforts are needed to sustain gains in vaccination coverage.

Introduction: Both conservative and liberal transfusion thresholds, in regard to hematocrit and hemoglobin levels, have been widely studied with varying outcomes. The aim of this study was to evaluate if transfusion administered peri- (anytime during the admission), pre-, intra-, or postoperatively an its association with morbidity and mortality in the geriatric population undergoing hip surgery. Methods: This study was an institutional review board approved retrospective analysis of data collected from 841 patients at a single urban institution who underwent surgical repairs for hip fractures from 2008 to 2010. Results: Our analysis included data from 841 surgical patients. Mean patient age was 83, 74% were female, 48% received spinal anesthesia while 52% underwent general anesthesia. Out of 841 patients, 425 were transfused during the perioperative period. Most transfusions occurred postoperatively. Perioperative, intraoperative and postoperative transfusion was associated with an increase in post-operative AKI. Intraoperative blood transfusion was associated with an increase in morbidity (11.6% increased to 22.2%) by 1.9 fold, AKI (3.9% increased to 11.1%) by 2.8 fold, as well as an increase in mortality (5.2 increased to 15.6%) within 60 days by 3 fold. Conclusions: This may suggest that patients transfused prior to surgery, despite having met a specific trigger hemoglobin level earlier, may have been treated before deteriorating to a point that would cause future systemic implications.

Introduction: With respect to care setting, there are mixed results in the literature with respect to the role of trauma centers in management of isolated geriatric hip fractures. During a transition from a Level 3 to a Level 1 trauma center, significant protocol changes were implemented that sought to standardize and improve the care of hip fracture patients. The objective of this study was to determine the effects of this transition on the management, efficiency, morbidity, mortality, and discharge of geriatric hip fracture patients. Methods: A retrospective chart review of geriatric hip fractures treated operatively was conducted. Two cohorts were compared: hip fractures in the year prior to (2015) and year following (2017) Level 1 Trauma designation. Primary outcome measures were length of stay (LOS), transfusion rate, complication rate, and mortality rate. Secondary outcome measures were time from emergency department (ED) arrival to medical optimization, time from medical optimization to surgery, time from ED arrival to surgery, and discharge destination. Results: There were no differences in LOS, transfusion rate, or complication rate between the two cohorts. There was a nonsignificant trend toward lower in-hospital mortality after the transition (2.24% vs 0.83%). There were no differences in time from ED arrival to medical optimization, time from medical optimization to surgery, time from ED arrival to surgery, and percentage of patients discharged home between the cohorts. Discussion: Management of operative geriatric hip fractures at our institution has remained consistent following transition to a Level 1 trauma center. There was a trend toward lower mortality after transition, but this difference was not statistically significant. We attribute the variety of findings in the literature with respect to trauma center management of hip fractures to individualized institutional trauma protocols as well as the diverse patient populations these centers serve.

Abstract Background Age is one of the most important risk factors for developing breast cancer. However, age-related changes in normal breast tissue that potentially lead to breast cancer are incompletely understood. Quantifying tissue-level DNA methylation can contribute to understanding these processes. We hypothesized that occurrence of breast cancer should be associated with an acceleration of epigenetic aging in normal breast tissue. Results Ninety-six normal breast tissue samples were obtained from 88 subjects (breast cancer = 35 subjects/40 samples, unaffected = 53 subjects/53 samples). Normal tissue samples from breast cancer patients were obtained from distant non-tumor sites of primary mastectomy specimens, while samples from unaffected women were obtained from the Komen Tissue Bank (n = 25) and from non-cancer-related breast surgery specimens (n = 28). Patients were further stratified into four cohorts: age

Introduction: There are variations in surgical procedures included in urology residency curricula across various programs. We conducted a survey of practicing urologists to determine which procedures are considered essential to a core urology residency curriculum. Materials and Methods: A web-based survey was conducted between October 2016 and February 2017 using SurveyMonkey. The questionnaire, comprising a set of 5-questions, was sent to the members of the Urological Society of India. Respondents were requested to grade 37 of the most common urological procedures (competencies) into three groups. Group A, were those that the respondent believed were vital for the trainee to learn (must know). Group B, were those that the respondent thought were essential to acquire (good to know). Group C procedures were labeled as desirable to know by respondents. Results: A total of 485 (15.75%) responses were received out of 3018 members contacted. 67% respondents were working in the private-sector. Out of the 37 listed procedures, 20 procedures received a median weightage of 1 indicating vital clinical competency for urology curriculum, 15 were identified as “essential to know” while two procedures were identified as “desirable to know.” Conclusions: Twenty surgical procedures were identified as 'must-know' for a urology trainee. The choice of procedures was not affected by the region of the responder or his practice type, suggesting a wide consensus.

Gene therapy is being considered as a promising modality for more than two decades now. It has been used for a number of difficult-to-treat conditions and has shown good results in some of the conditions, but not that effective in some others. Overcoming the initially faced hindrances, the research in the field of gene therapy resurged. India is one the major Asian countries where gene therapy-related research and centers have shown remarkable growth, despite certain constraints faced by the researchers. Current article discusses the different types of gene therapy along with its clinical implications and its current status in Indian context.

Navratri is one of the most common religious fasts observed among Hindus. A large number of people with diabetes follow Navratris fast irrespective of its health implications, often without proper education and medical advice. The quest for the scientific research on dietary advices for Hindu fasts including Navratris shows paucity of literature comparative to the dietary advices advocated during Ramadan. The eating and physical activity patterns during different fasts vary a lot depending up on social and cultural factors. Even eating pattern is not uniform among all persons following Navratris and is modified as per their region, local culture, and religious beliefs. Dietary advice during Navratris depends upon pattern of fasting, religious beliefs, and local sociocultural factors. In this review, efforts are made to provide pragmatic dietary advice for people with diabetes, modifications in the menus and cooking practices, and timings of the meals for successful blood glucose management during Navratris. This review will also help plan diet and physical activity advice for persons observing other fasts as well.

BACKGROUND: COVID-19 pandemic has forced medical colleges around the world to shift to online teaching. There is hardly any evidence regarding such rapid transitions to online teaching, especially from resource-poor settings. We share our experience of developing an online teaching program based on teachers' and students' feedback. MATERIALS AND METHODS: A mixed methods study was conducted during the COVID-19 lockdown period in a public-funded medical institute of India. Online feedback was obtained 3 weeks after the beginning of emergency remote teaching. The responses by the students and teachers shaped the final online teaching program which reinforced the perceived strengths and addressed the weaknesses. Observations were made for the proportion of scheduled lectures delivered through digital platform and students' attendance in the 1st week and last week of the study period. RESULTS: Feedback was obtained from 367 students and 56 teachers. Around three-fourths of the students (76.7%) and teachers (73.2%) were satisfied with online teaching. The themes generated for benefits of online teaching were similar for both students and teachers, but the perceived challenges differed. Students found online teaching more stressful, and teachers were apprehensive of the new technology and lack of a controlled environment. CONCLUSIONS: A rapid transition to development and implementation of an online teaching program was found to be feasible and acceptable to the primary stakeholders. Not only the content but student engagement and supportive environment for both students and teachers are essential requirements in the context of an online undergraduate teaching program.

Context: Overt hypothyroidism accelerates the cardiovascular disease. Subclinical hypothyroidism (SCH), being considered as a preclinical state, impacts on cardiovascular status is not clear. Aims: This study was aimed at assessing cardiac risk stratification by Framingham risk scoring (FRS) and coronary coronary artery calcium score (CACS) by noncontrast cardiac computed tomography in SCH. Study Design: Observational study. Subjects and Methods: We enrolled thirty treatment-naive SCH patients (aged 30–60 years with no serious concurrent medical conditions), thirty euthyroid (age, sex, and body mass index-matched) controls, and ten healthy controls. All cases were evaluated for coronary artery calcium scoring and Framingham risk score. Statistical Analysis: Qualitative data were analyzed using the Chi-square test. In addition, demographics and CACS are summarized graphically or in a table. Results: SCH cases had higher thyroglobulin, while there was a trend toward an increase in total cholesterol, low-density lipoprotein (LDL), very LDL, and decrease in HDL levels. All participants had low-risk FRS (10-year FRS < 10%). The mean CACS in SCH was significantly higher than simple obese and healthy controls (47.17 vs. 2.67 vs. 0.00). Conclusion: This study suggests that SCH is an independent risk factor for coronary artery disease in apparently healthy controls. The risk of occult coronary artery disease is increased in SCH cases.

Background: Food related advertisements on television may have a major influence on the dietary habits and obesity among young adolescents. Objective: To evaluate the frequency and typology of food advertisements on most popular television channels, watched by school-going young adolescents in Delhi. Methodology: Biphasic study to (a) identify the three television channels most frequently watched by administering a questionnaire to 400 school going young adolescents; and (b) view each of these channels for 2 hours per day for 6 days each, and observe the content of advertisements related to foods, beverages, and food outlets. Results: Four hundred and three food related advertisements were viewed over 36 hour on Discovery, MTV and Disney Channels. Among 235 food related advertisements 163 (69.3%) pertained to candies, chocolates and confectionary and 35 (14.8%) to salty snacks. Sugar sweetened soft drinks contributed 90 of 106 (85%) of beverage advertisements. Of 62 advertisements related to food outlets, 59 were of fast food joints. Conclusion: Majority of food advertising content on television most commonly watched by young adolescents is related to unhealthy foods and beverages, igh in energy and low in micronutrient content.

A Correction to this paper has been published: https://doi.org/10.1038/s41467-020-19868-6

Introduction: Hip fractures are common in elderly patients. However, this population frequently presents with significant medical comorbidities requiring extensive medical optimization. Methods: This study sought to elucidate optimal time to surgery and evaluate its effect on postoperative morbidity, mortality, and length of stay (LOS). We performed a retrospective analysis of data collected from 2008 to 2010 on 841 patients who underwent hip fracture surgery. Patients were classified based on time to surgery and were also classified and analyzed according to the American Society of Anesthesiologists (ASA) physical classification system. Results: Patients with a delay of greater than 48 hours had a significant increase in overall LOS, postoperative days, and overall postoperative complications. Patients classified as ASA 4 had an odds ratio for postoperative morbidity of 3.32 compared to the ASA 1 and 2 group ( P = .0002) and 2.26 compared to the ASA 3 group ( P = .0005). Delaying surgery >48 hours was also associated with increased in-hospital mortality compared to 24 to 48 hours ( P = .0197). Increasing ASA classification was also associated with significantly increased mortality. Patients classified as ASA 4 had 5.52 times the odds of ASA 1 and 2 ( P = .0281) of in-hospital mortality. Those classified ASA 4 had 2.97 times the odds of ASA 3 ( P = .0198) of an in-house mortality. Anesthetic technique (spinal vs general) and age were not confounding variables with respect to mortality or morbidity. Discussion: Surgical timing and ASA classification were evaluated with regard to LOS, number postoperative days, morbidity, and mortality. Conclusions: Delaying surgery >48 hours, especially in those with increased ASA classification, is associated with an increase in overall LOS, postoperative days, morbidity, and mortality. However, rushing patients to surgery may not be beneficial and 24 to 48 hours of preoperative optimization may be advantageous.

Assessment is an integral part of the curriculum. However, the assessment tools, devised more than a century ago, have not kept up with changing scenario of health care and demand of the consumers. In the present scenario, what is tested is a one-time assessment at the exit examination as a surrogate marker for real and observable competence. Most Indian medical schools employ the traditional assessment tools that hardly permit testing of most competencies desirable of a physician; i.e., skills in communication, management, collaboration, professionalism, medical knowledge, health promotion, and counseling. Also, the competencies are not assessed in real time situations. A few medical schools have tried to bridge the gap by introducing the second generation tools, yet the overall approach and methodology is fraught with major drawback of fragmentation and non-contextualization. The physician is supposed to satisfy the patient in a holistic manner or in other words, win the trust. It is this trust primarily what needs to be assessed. The present article stresses on the need of a global assessment conducted on an ongoing/periodic basis, with adequate weightage given to the opinion/assessment of the consumer. Utility of some newer tools including mini clinical evaluation exercise (mini-CEX), direct observation of procedural skills (DOPS), multisource (360º), and portfolio based assessment is discussed. Finally, we introduce the reader to the concept of assessment of entrustable professional activities (EPAs). The concept of EPA helps integrate the theoretical concepts of individual competencies into a measurable parameter of Trust.

Adolescents and youth, together addressed as "young people", form the future building blocks of any society. They being most energetic and dynamic, tend to get involved in high-risk behaviors making themselves susceptible to criminal offences, accidents, physical injuries, emotional trauma, and medical problems - some of them extremely serious like transmission of human immunodeficiency virus (HIV). The concept of vulnerability is applicable to all the people who are more exposed to risks than their peers like the young people. In order to deal with social evils like criminal offences, domestic violence, sexual abuse, HIV, etc. we need to define vulnerability and understand the factors that influence it. This review also attempts to summarize the indicators of vulnerability and the data currently available to estimate its burden in India. Measuring the magnitude of vulnerability by means of certain indicators/variables might help us in devising tools to assess this poorly defined entity. This may also evolve a conceptual framework on which targeted remedial interventions can be devised and implemented.

Background: Molecular methods which allow for rapid and reliable detection of drug resistance have yet not been sufficiently evaluated for timely management of patients with tuberculous meningitis. Aims: We aimed to evaluate Geno Type MTBDRplus line probe assay for early detection of drug resistance in Mycobacterium tuberculosis isolates and CSF samples of confirmed tuberculous meningitis patients. Settings and Design: This was a multicentric prospective study carried out from July 2011 to December 2013 in tertiary care hospitals of Delhi. Materials and Methods: The assay was performed on 89 M. tuberculosis isolates and 31 direct CSF samples from microbiologically confirmed tuberculous meningitis patients. The sensitivity and specificity of this assay was calculated in comparison to drug susceptibility testing by BACTEC MGIT 960 system. Results: The sensitivity, specificity for detection of resistance to Isoniazid was 93%, 97% and to Rifampicin was 80%, 98.8%, respectively by this assay in comparison with the phenotypic drug susceptibility testing. The line probe assay could detect M. tuberculosis in 55% of CSF samples from patients with microbiologically confirmed tuberculous meningitis. Only 5/89 isolates (5.6%) were resistant to both Isoniazid and Rifampicin while 9/89 (10%) isolates were additionally resistant to Isoniazid. Resistance to any of the drugs, namely Isoniazid, Rifampicin, Streptomycin or Ethambutol, was seen in 24.7% of strains. Conclusion: The line probe assay has a good sensitivity and specificity for detection of drug resistance to Isoniazid and Rifampicin in M. tuberculosis culture isolates. However, this assay has limited role in detection of M. tuberculosis and drug resistance from direct samples with confirmed diagnosis of tuberculous meningitis.

Background: Availability and advertising of caffeinated drinks is on the rise in Indian market. Excess caffeine intake may have deleterious effects on health. Objective: To estimate the daily consumption of caffeine among urban school-going adolescents from Delhi. Materials and Methods: A school-based survey was conducted to determine the amount and pattern of caffeine consumption among students of classes 9-12, using a self-administered questionnaire. Results: Of 300 participants (median age 15 year, 174 boys), 291 (97%) were consuming caffeine [mean (SD): 121.0 (98.2) mg/day]. Nineteen (6%) students were consuming more than 300 mg of caffeine per day. Tea/coffee contributed to more than 50% of the caffeine intake. The rest was derived from cola beverages, chocolates, and energy drinks. Conclusion: Average caffeine consumption among school-going adolescents from Delhi is high. The findings of this preliminary survey need to be confirmed in larger data sets.

Background: Micronutrient deficiencies are common among women in low-income and middle-income countries. Data from randomised trials suggest that maternal multiple micronutrient supplementation decreases the risk of low birthweight and potentially improves other infant health outcomes. However, heterogeneity across studies suggests influence from effect modifiers. We aimed to identify individual-level modifiers of the effect of multiple micronutrient supplements on stillbirth, birth outcomes, and infant mortality in low-income and middle-income countries. Methods: This two-stage meta-analysis of individual patient included data from 17 randomised controlled trials done in 14 low-income and middle-income countries, which compared multiple micronutrient supplements containing iron-folic acid versus iron-folic acid alone in 112 953 pregnant women. We generated study-specific estimates and pooled subgroup estimates using fixed-effects models and assessed heterogeneity between subgroups with the χ2 test for heterogeneity. We did sensitivity analyses using random-effects models, stratifying by iron-folic acid dose, and exploring individual study effect. Findings: Multiple micronutrient supplements containing iron-folic acid provided significantly greater reductions in neonatal mortality for female neonates compared with male neonates than did iron-folic acid supplementation alone (RR 0·85, 95% CI 0·75–0·96 vs 1·06, 0·95–1·17; p value for interaction 0·007). Multiple micronutrient supplements resulted in greater reductions in low birthweight (RR 0·81, 95% CI 0·74–0·89; p value for interaction 0·049), small-for-gestational-age births (0·92, 0·87–0·97; p=0·03), and 6-month mortality (0·71, 0·60–0·86; p=0·04) in anaemic pregnant women (haemoglobin

Introduction: Bronchiolitis is the leading acute viral infection in infants. Early diagnosis and determination of severity of bronchiolitis in children is crucial for rapid initiation of treatment. This may be diffi cult to achieve in a resource-poor setting, where laboratory support and facilities for hospitalization are limited. Objectives: To determine the clinical predictors for severe bronchiolitis in children below 24 months of age in a resource-poor setting. Place and duration of study: Paediatric emergency department of a tertiary hospital over a period of one year. Patients and Methods: Children below 24 months age presenting with bronchiolitis. Children were classifi ed as having severe or moderate bronchiolitis, depending upon the improvement seen in respiratory rate 48-72 hours after admission. Nasopharyngeal aspirates and serum samples obtained from the cases were used to detect the viral etiology. The clinical characteristics in the two groups were compared using Chi square/ student’s t-test where applicable, and were correlated with the disease severity. The sensitivity, specifi city, and relative risk for the various clinical parameters in detecting severity of bronchiolitis were obtained by statistical analysis. Results: Bronchiolitis accounted for 1.7% of the pediatric admissions. Respiratory rate ≥ 68/m, and the use of accessory muscles of respiration were found to be major clinical determinants for severe bronchiolitis. Infl uenza virus (H3N2) followed by respiratory syncytial virus were the dominant viral pathogens. Conclusion: Respiratory rate and the use of accessory muscles of respiration can predict the severity of bronchiolitis in the absence of advanced diagnostic facilities in developing countries.

Aberrant beta-catenin signaling plays a key role in several cancer types, notably colon, liver and breast cancer. However approaches to modulate beta-catenin activity for therapeutic purposes have proven elusive to date.To uncover genetic dependencies in breast cancer cells that harbor active beta-catenin signaling, we performed RNAi-based loss-of-function screens in breast cancer cell lines in which we had characterized beta-catenin activity. Here we identify CSNK1E, the gene encoding casein kinase 1 epsilon (CK1epsilon) as required specifically for the proliferation of breast cancer cells with activated beta-catenin and confirm its role as a positive regulator of beta-catenin-driven transcription. Furthermore, we demonstrate that breast cancer cells that harbor activated beta-catenin activity exhibit enhanced sensitivity to pharmacological blockade of Wnt/beta-catenin signaling. We also find that expression of CK1epsilon is able to promote oncogenic transformation of human cells in a beta-catenin-dependent manner.These studies identify CK1epsilon as a critical contributor to activated beta-catenin signaling in cancer and suggest it may provide a potential therapeutic target for cancers that harbor active beta-catenin. More generally, these observations delineate an approach that can be used to identify druggable synthetic lethal interactions with signaling pathways that are frequently activated in cancer but are difficult to target with the currently available small molecule inhibitors.