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Abstract Gestational Diabetes Mellitus (GDM) has been on the rise for the last two decades along with the growing incidence of obesity. The ubiquitous use of Endocrine-Disrupting Chemicals (EDCs) worldwide has been associated with this increase in GDM incidence. Epigenetic modifications such as DNA methylation, histone acetylation, and methylation have been associated with prenatal exposure to EDCs. EDC exposure can also drive a sustained disruption of the hypothalamus-pituitary-thyroid axis and various other signaling pathways such as thyroid signaling, PPARγ signaling, PI3K-AKT signaling. This disruption leads to impaired glucose metabolism, insulin resistance as well as β-cell dysfunction, which culminate into GDM. Persistent EDC exposure in pregnant women also increases adipogenesis, which results in gestational weight gain. Importantly, pregnant mothers transfer these EDCs to the fetus via the placenta, thus leading to other pregnancy-associated complications such as intrauterine growth restriction (IUGR), and large for gestational age neonates. Furthermore, this early EDC exposure of the fetus increases the susceptibility of the infant to metabolic diseases in early life. The transgenerational impact of EDCs is also associated with higher vascular tone, cognitive aberrations, and enhanced susceptibility to lifestyle disorders including reproductive health anomalies. The review focuses on the impact of environmental toxins in inducing epigenetic alterations and increasing the susceptibility to metabolic diseases during pregnancy needs to be extensively studied such that interventions can be developed to break this vicious cycle. Furthermore, the use of EDC-associated ExomiRs from the serum of patients can help in the early diagnosis of GDM, thereby leading to triaging of patients based on increasing risk factor of the clinicopathological condition.

Background: Evidence suggests that hypothyroidism may be associated with an increased risk of acute coronary syndrome (ACS).The data regarding the influence of hypothyroidism on cardiovascular disease in the Asian population is conflicting. Therefore, we undertook this study to assess the overall prevalence of hypothyroidism in Acute Coronary Syndrome (ACS) patients and determine if there is a relationship between hypothyroidism, both sub-clinical and overt and other significant risk factors of ACS in an Indian population. Methods: We studied 487 hospitalized patients between March 2018 and February 2021 with a diagnosis of ACS to determine the prevalence of hypothyroidism, both clinical and sub-clinical and their relationship with other known coronary risk factors. Thyroid function Tests - free T3, free T4 and TSH were collected from all the patients within 24 h of their admission to the coronary care unit (CCU) of 2 major hospitals in New Delhi and Imphal (Manipur). Results: Subclinical hypothyroidism was prevalent in 44 (9 %), followed by overt hypothyroidism in 25 (5.2 %).Subclinical hypothyroidism was more common in females, whereas overt hypothyroidism was more common in males. ST Elevation Myocardial Infarction (STEMI) (52 %), followed by Non-ST-Elevation Myocardial Infarction (NSTEMI) (25 %), was the commonest diagnosis at presentation. Patients with overt hypothyroidism showed a higher proportion of increased triglyceride levels.Patients with hypothyroidism had no differences in the prevalence of concomitant diabetes hypertension and other coronary risk factors. Conclusions: Patients with ACS without known thyroid disorders should be screened for hypothyroidism since it is found frequently. There might be a case to treat their thyroid dysfunction appropriately.

Objective: Acute undifferentiated febrile illness (AUFI) is a neglected topic in health care. It has considerable morbidity and mortality worldwide. Slum dwellers are at high risk due to poor living conditions. This longitudinal cohort study estimated the incidence of AUFI in urban slum dwellers in Delhi. Methods: This study was conducted on urban slum dwellers in Delhi. Data were collected using a structured interviewer-administered questionnaire over a period of 18 months. Adjusted incidence rates (IR) and incidence rate ratios (IRR) were calculated using Poisson regression models. Kaplan-Meier survival curves were used to estimate survival from fever. Results: A total of 1497 population were studied. Incidence rate of AUFI was 47.43 per 1000 person-months (95% CI: 44.88; 50.08). The incidence was highest among the 50–59 year age group (54.18 per 1000 person months; 95% CI: 43.19; 67.17). Significant seasonal variation was observed with IR high in winter (IR: 32.80 per 1000 person month; adjusted IRR: 1.44 (95% CI: 1.26; 1.66) and monsoon (IR:19.89 per 1000 person month; adjusted IRR: 0.44 (95% CI: 0.36; 0.53). Conclusion: This study has shown a high incidence rate of AUFI amongst the slum dwellers in Delhi. This calls for awareness about clinical investigation and management among patients and healthcare providers. The findings from this study may sensitize policymakers and healthcare stakeholders to draw a road map with insightful consideration of the environmental factors that bring health burdens to the slum population. Further, comparative studies between slum and non-slum dwellers may be undertaken to evaluate the incidence of AUFI.

Abstract Introduction India has a multifaceted healthcare system and recognizes complementary and alternative systems of medicine (AYUSH) that cater to the healthcare needs of people. Multimorbidity requires frequent visits to physicians and long-term use of medications, due to which people tend to prefer AYUSH systems as they provide holistic patient-centered treatment. Hence, we aimed to estimate the prevalence of multimorbidity and assess its correlates among patients attending AYUSH primary care clinics in Delhi. Methods A cross-sectional study was conducted among 943 patients aged ≥ 18 years attending various AYUSH primary care clinics in Delhi from September 2021 to February 2022, employing a stratified random sampling technique. Descriptive statistics such as frequency and proportion were used to report the prevalence of multimorbidity (two or more chronic conditions in an individual out of the 33 conditions listed as per the Multimorbidity Assessment Questionnaire for Primary Care). A multivariable logistic regression assessed the association between various socio-demographic characteristics and multimorbidity, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI). Results The prevalence of diabetes (14.7%) was found to be the highest (out of all included chronic conditions) among the patients attending various AYUSH primary care settings. The overall prevalence of multimorbidity was observed to be around 39.4%. We observed a higher likelihood of having multimorbidity among participants aged ≥ 70 years [AOR: 9.19 (95% CI: 3.75–22.54)], females [AOR: 1.57 (95% CI: 1.04–2.37)], and middle class [AOR: 2.23 (95% CI: 1.45–3.43)]. Conclusion Multimorbidity was evidently prevalent across AYUSH primary care settings, which cannot be overlooked. The results suggest behavioral change communication may be aimed at older individuals, females, and the middle class.

Breast cancer is one of the top two reproductive cancers responsible for high rates of morbidity and mortality among women globally. Despite the advancements in the treatment of breast cancer, its early diagnosis remains a challenge. Recent evidence indicates that despite the adroit use of numerous strategies to facilitate rapid and precision-oriented screening of breast cancer at the community level through the use of mammograms, Fine-needle aspiration cytology (FNAC) and biomarker tracking, no strategy has been unequivocally accepted as a gold standard for facilitating rapid screening for disease. This necessitates the need to identify novel strategies for the detection and triage of breast cancer lesions at higher rates of specificity, and sensitivity, whilst taking into account the epidemiologic and social-demographic features of the patients. Recent shreds of evidence indicate that exosomes could be a robust source of biomaterial for the rapid screening of breast cancer due to their high stability and their presence in body fluids. Increasing evidence indicates that the Exosomal microRNAs- play a significant role in modifying the tumour microenvironment of breast cancers, thereby potentially aiding in the proliferation, invasion and metastasis of breast cancer. In this review, we summarize the role of ExomiRs in the tumour microenvironment in breast cancer. These ExomiRs can also be used as candidate biomarkers for facilitating rapid screening and triaging of breast cancer patients for clinical intervention.

Biological derivatives and their effective influence on psychological parameters are increasingly being deciphered to better understand body-mind perspectives in health. Recent evidence suggests that the gut-brain immune axis is an attractive theragnostic target due to its innate capacity to excite the immune system by activating monocyte exosomes. These exosomes induce spontaneous alterations in the microRNAs within the brain endothelial cells, resulting in an acute inflammatory response with physiological and psychological sequelae, evidenced by anxiety and depression. Exploring the role of the stress models that influence anxiety and depression may reflect on the effect and role of exosomes, shedding light on various physiological responses that explain the contributing factors of cardiovascular disorders. The pathophysiological effects of gut-microbiome dysbiosis are further accentuated by alterations in the glucose metabolism, leading to type 2 diabetes, which is known to be a risk factor for cardiovascular disorders. Understanding the role of exosomes and their implications for cell-to-cell communication, inflammatory responses, and neuronal stress reactions can easily provide insight into the gut-brain immune axis and downstream cardiovascular sequelae.

IntroductionMesenchymal stem cells (MSCs) are pluripotent progenitor cells that can be differentiated into a variety of specialized cell types. Menstrual blood, such as umbilical cord blood and bone marrow stem cells, is a rich source of MSCs with proliferative properties. This research was conducted to understand the knowledge, attitude, and practice of menstrual blood donation regarding menstrual blood-derived mesenchymal stem cells (MenSCs) among female healthcare workers in India.MethodologyA cross-sectional online and offline survey was conducted at the national level between 20 November 2021 and 10 March 2022. A self-constructed semi-structured questionnaire was distributed through Google Forms on various social media platforms. The questionnaire was self-administered, and data were collected using the purposive sampling technique.ResultsA total of 499 respondents completed the questionnaire. Nearly 49% of the respondents had adequate knowledge, 54% showed a positive attitude, and 45% reported adequate practices regarding menstrual blood donation and the usage of related products. The educational background, occupational status, and monthly income of the participants were found to be significantly associated with their attitude toward MenSCs.ConclusionThere is a need to promote interactive sessions on MenSCs among healthcare professionals in order to bridge the gap between general populations and the healthcare setting. Enhancing knowledge and awareness regarding the potential benefits of MenSCs would help in dissipating the age-old myths associated with menstruation and will benefit society as a whole.

Objectives: To assess the awareness, practice, and utilization pattern of Unani medicine among the general population of Trilokpuri, East Delhi. Materials and Methods: A cross-sectional, observational descriptive survey was conducted in New Delhi using pretested, predesigned, and structured questionnaire to assess the awareness and utilization pattern of Unani medicine on a sample size of 100 subjects. Result: Out of 100 subjects, 60% were males and 40% were females with mean age 38.96 ± 9.12 years, ranged between 18 and 65 years. The awareness about Unani medicine was found in 67% of adopted population, while 57% population among them preferred Unani system of medicine as a mode of treatment. Unani is preferred because of minimal side effects associated as reported by 47% users. On the other hand, among nonuser (n = 29), 48% population do not prefer Unani medicine because of its slow action. Very few (2.6%) users adopted Unani medicine exclusively, while most of them preferred Unani as an adjuvant with allopathic. Unani medicine is preferred mainly for the management of musculoskeletal disorders (35%), followed by GIT disorders (19%) and their related disorders. Conclusion: The awareness level regarding Unani medicine is good rather utilization of is relatively lower as compared to modern system of medicine. There is a need and scope for promotion of health education as well as improvement in the people's attitude towards Unani system of medicine.

Exosomal microRNA (ExomiRs) serves as potential cargo molecules responsible for post-translation of gene expression and intracellular communication playing a vital role in acting as clinically relevant prognostic biomarkers for identifying pregnancy-associated complications in patients. ExomiRs are associated with Gestational Diabetes Mellitus (GDM) as potential targets for understanding the pathophysiology of beta-cell dysfunction. ExomiRs (ExomiR 122, ExomiR 16-5p, ExomiR 215-5p, ExomiR 450b-3p, ExomiR 122-5p) aid to act as biomarkers and regulate the progression of diabetes and its related complication. These ExomiRshave been reported to interfere with the regulation of various genes such as ZEB2, IRS1, IRS2, GLUT1, GLUT4, etc. and inhibition of several pathways like PI3K/AKT, Wnt, and mTOR signaling pathways leading to the modulation in the development of GDM affecting the clinical and pathological features of women. These ExomiRs have also been associated with other pregnancy-associated complications, including preeclampsia, hypothyroidism, pregnancy loss, and ectopic pregnancies. On the other hand, overexpression of certain ExomiRs such as Exomir-515-5p, ExomiR-221, and ExomiR-96 serve a regulatory role in overcoming insulin resistance. Taken together, the current review focuses on the prospective capabilities of ExomiRs for diagnosis and clinical prognosis of GDM women with respect to pregnancy outcomes.

Unani medicine is one of the traditional medical systems in India that is practiced and taught in an organized manner. While going through the literature, it has been observed that in the past, not many efforts have been made to understand the awareness level and utilization pattern among the population. This systematic review was conducted to better understand the awareness and utilization pattern of Unani medicine in India. Using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guideline, the results of survey-based studies conducted about the awareness and utilization pattern of Unani medicine in India were systematically reviewed. Thirteen studies conducted on awareness or utilization patterns, which exclusively represented data on Unani medicine and not Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy (AYUSH) in general, were included in the present systematic review. A wide variation regarding awareness of Unani medicine is observed, ranging from 28.9% to 100% in different populations. Only five studies reported utilization patterns, which also varied considerably (13.8% to 74%). Unani Medicine is generally used in musculoskeletal disorders (20%-60.2%) and skin disorders (21.1%-64.9%). On the other hand, fifty-seven papers on surveys of CAM and AYUSH were found regarding utilization and consumption patterns. The findings demonstrate that thirteen papers entirely focused on the Unani System of Medicine. Henceforth, the awareness of the Unani system of Medicine has not been reported among the masses, and to provide its maximum benefits, certain strategies need to be formulated.

Shigellosis is one of the driving factors for extrahepatic manifestations of sexually transmitted Hepatitis-C infection, which was previously thought to affect only men who have sex with men (MSM) who were human immunodeficiency virus (HIV)-positive. Highly infectious diseases like shigellosis which has been termed as the potent factor for creating “perfect storm” of disease transmission with the conjunction of specific sexual activities between men, and HIV status is something which needs attention. Strategies such as health communication and social marketing could be utilized to enhance MSM awareness of shigellosis, and these efforts should focus on giving answers to the sorts of queries respondents pose regarding shigellosis.

Exosomes are extracellular vesicles produced by various cell types and extensively distributed in physiological fluids. Because of their significant role in cancer progression, they have been a focal point for the novel cancer therapy approach. Exosomes are highly efficient at transporting proteins, RNAs, and small drugs into cancer cells for therapeutic purposes. In addition to their prominent role as potential biomarkers for transporting targeted information from their progenitor cells, exosomes have also emerged as a new avenue for developing more effective clinical diagnostics and therapeutic techniques, also known as exosome theranostics. Lipids, proteins, and nucleic acids transported by exosomes were investigated as potential biomarkers for cancer diagnosis, prognosis, and future cancer treatment targets. The unique mechanism of exosomes and their therapeutic as well as diagnostic uses, also known as theranostic applications of exosomes in malignancies, are discussed in this review.

There is considerable association of thyroid function and the cardiovascular system during various acute systemic illnesses. It is well established that the normal thyroid homeostasis is known to alter in disease states including the acute coronary syndromes (ACS). Abnormal thyroid hormonal status has been shown to be related to worse outcomes and prognosis. This review focuses on the relationship of alterations in thyroid function and its influence on the pathophysiological mechanisms and cardiovascular hemodynamics in ACS and based upon the literature, summarises all the existing evidence to this date on this subject. The data largely points out that low levels of triiodothyronine (T3) levels seen in ACS might be useful in prognosticating the outcomes of ACS.

Objective: The objective was to evaluate the prevalence of psychological distress, functional impairment, and social attitude toward the COVID-19 pandemic and induced lockdown among the Indian population. Methodology: A cross-sectional study was conducted among 155 people residing in India. Data were collected on sociodemographic variables, psychological distress, functional impairment, and social attitude toward COVID-19 and the induced lockdown via an online survey. Kessler's K10 scale was used to measure psychological distress and Work and Social Adjustment Scale (WSAS) was used to evaluate functional impairment due to the COVID-19 pandemic. Descriptive statistic and Chi-square test were applied, where P < 0.05 was considered statistically significant. Pearson's analysis was used to measure the correlation between psychological distress and functional impairment. Results: Overall, the mean age of the study participants was 29.24 (standard deviation = 7.869) years. Majority of the study participants were female (63.9%). On applying K10 scale, it was found that 20% of the participants suffered from mild psychological distress and 16.1% were moderate-to-severely distressed. On applying WSAS scale, it was found that 23.9% of the study participants suffered from significant functional impairment and 7.9% from severe functional impairment. On assessing the social attitude, 63.9% of the participants purchased groceries from local market and 56.8% said that they would visit mall after the lockdown gets over. Eating out in a restaurant (P = 0.028) and visiting shopping mall (P = 0.032) after the lockdown gets over were significantly associated with psychological distress. Conclusion: Our findings identified the level of psychological distress, functional impairment, and social attitude toward the COVID-19 pandemic and the induced lockdown. Such evidences can be used to formulate interventions to improve the mental health and well-being of people during such emergencies.

Introduction: A key feature of the 'One Health' concept pertains to the design of novel point of care systems for largescale screening of health of the population residing in resource-limited areas of low- and middle-income countries with a view to obtaining data at a community level as a rationale to achieve better public health outcomes. The physical properties of blood are different for different samples. Our study involved the development of an innovative system architecture based upon the physical properties of blood using automated classifiers to enable large-scale screening of the health of the population living in resource-limited settings. Methods: The proposed system consisted of a simple, robust and low-cost sensor with capabilities to sense and measure even the minute changes in the physical properties of blood samples. In this system, the viscosity of blood was derived from a power-law model coupled with the Rabinowitsch-Mooney correction for non-Newtonian shear rates developed in a steady laminar Poiseuille flow. Surface tension was measured by solving the Young-Laplace equation for pendant drop shape hanging on a vertical needle. An anticipated outcome of this study would be the development of a novel automated classifier based upon the rheological attributes of blood. This automated classifier would have potential application in evaluating the health status of a population at regional and global levels. Results: The proposed system was used to measure the physical properties of various samples like normal, tuberculous and anemic blood samples. The results showed that the physical properties of these samples were different as compared to normal blood samples. The major advantage of this system was low-cost, as well as its simplicity and portability. Conclusion: In this work, we proposed making a case for the validation of a low-cost version of a microfluidic system capable of scanning large populations for a variety of diseases as per the WHO mandate of "One Health".

Background: Globally, 570,000 cases of cervical cancer and 311,000 deaths from the disease occurred in 2018. Cervical cancer is the fourth most common cancer in women. About 96,922 new cervical cancer cases are diagnosed annually in India. Objective: To summarize the knowledge, attitude, and practice toward screening of cervical cancer among health professionals in India. Materials and methods: Health sciences electronic databases PubMed and Google Scholar were searched for studies published between 2012 and March 2020. Keywords used for the search were (“CERVICAL CANCER”), (“SCREENING”), (“KNOWLEDGE”), (“ATTITUDE”), (“PRACTICE”), (“HEALTH PROFESSIONALS”), AND (“INDIA”). A total of 22 articles were included in the review based on the eligibility criteria. Statistical software SPSS-V.23 was used for the statistical application. Results: A total of 22 studies met the inclusion criteria with total of 6811 health professionals. The age of the study participants ranged from 18 to 60 years. The overall knowledge of cervical cancer among health professionals was 75.15%. The knowledge toward signs and symptoms and risk factors was adequate among health professionals. The knowledge, attitude, and practice toward screening was 86.20%, 85.47%, and 12.70%, respectively. Conclusion: The health professionals have optimum level of knowledge of cervical cancer and knowledge of screening of cervical cancer with appropriate attitude toward screening with low uptake of practice toward screening.

Background: Cervical Cancer is the second most common cancer among women in the world leading to 90% deaths in low and middle income countries. About 96,922 new Cervical Cancer cases are diagnosed annually in India. Objective: To study the knowledge, attitude and practice on Cervical Cancer and screening among women in India. Materials and Methods: Health sciences electronic databases PubMed and Google Scholar were searched for studies published between 2012 to March 2020. Keywords used for the search were (“Cervical Cancer screening”), (“knowledge”),(“attitude”), (“practice”) AND (“India”). 19 articles were included in the review based on the eligibility criteria. Statistical software SPSS-V.23 was used for the statistical application. Results: 7688 women were included in the study. Age of study participants ranged from 12-65 years. Overall knowledge on Cervical Cancer among women was 40.22%. Knowledge of risk factors and signs and symptoms was fairly adequate among the women. 32.68% of women knew that early age of marriage was a risk factor for Cervical Cancer followed by 23.01% women who mentioned that early age of initiation of sexual activity was a common risk factor for Cervical Cancer. Inter menstrual bleeding and foul smelling discharge was the most common sign and symptom reported in 30.75% and 28.86% women respectively. Knowledge, attitude and practice regarding Cervical Cancer screening was seen in 20.31%, 43.64% and 13.22% of women respectively. Conclusion: Effective information, education and communication strategies are required to improve the level of awareness of women on Cervical Cancer.

Cervical cancer is a major public health challenge that can be cured with early diagnosis and timely treatment. This challenge formed the rationale behind our design and development of an intelligent and robust image analysis and diagnostic tool/scale, namely “OM—The OncoMeter”, for which we used R (version-3.6.3) and Linux (Ubuntu-20.04) to tag and triage patients in order of their disease severity. The socio-demographic profiles and cervigrams of 398 patients evaluated at OPDs of Batra Hospital & Medical Research Centre, New Delhi, India, and Delhi State Cancer Institute (East), New Delhi, India, were acquired during the course of this study. Tested on 398 India-specific women’s cervigrams, the scale yielded significant achievements, with 80.15% accuracy, a sensitivity of 84.79%, and a specificity of 66.66%. The statistical analysis of sociodemographic profiles showed significant associations of age, education, annual income, occupation, and menstrual health with the health of the cervix, where a p-value less than (

Hemodialysis vascular access can develop venous neointimal hyperplasia (VNH) causing stenosis. Recent clinical and experimental data has demonstrated that there is increased expression of a disintegrin and metalloproteinase thrombospondin motifs-1 (ADAMTS-1) at site of VNH. The experiments outlined in the present paper were designed to test the hypothesis that targeting of the adventitia of the outflow vein of murine arteriovenous fistula (AVF) using a small hairpin RNA that inhibits ADAMTS-1 expression (LV-shRNA-ADAMTS-1) at the time of fistula creation will decrease VNH. At early time points, ADAMTS-1 expression was significantly decreased associated with a reduction in vascular endothelial growth factor-A (VEGF-A) and matrix metalloproteinase-9 (MMP-9) (LV-shRNA-ADAMTS-1 transduced vessels vs. controls). These changes in gene and protein expression resulted in favorable vascular remodeling with a significant increase in mean lumen vessel area, decrease in media/adventitia area, with a significant increase in TUNEL staining accompanied with a decrease in cellular proliferation accompanied with a reduction in CD68 staining. Collectively, these results demonstrate that ADAMTS-1 transduced vessels of the outflow vein of AVF have positive vascular remodeling.