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Abstract Introduction Advanced technologies in radiation treatment deliveries require high accuracy and precision in setup before treatment to get accurate dose delivery for planned target volumes. During imaging procedures, patients are getting extra doses from kilovoltage computed tomography (KVCT) and megavoltage computed tomography (MVCT). Computed tomography dose index is an important dosimetric parameter to know the degree of radiation-induced side effects. Aim The main aim of this study is to quantify the dose received by patients during MVCT imaging procedures, weighted computed tomography dose index (CTDIw), volume computed tomography dose index (CTDIvol) and dose length product (DLP). Methods and materials This study has been performed on Radixact X9 LINAC machine with 6MV flattening filter-free (FFF) photon beam for treatment and imaging with 3.5 MeV average photon energy. CTDIw and dose length product (DLP) have been calculated for different scanning lengths 18 cm, 10 cm and 0.7 cm with fine, normal and coarse modes with standard imaging A1SL1 ion chamber, cheese phantom and tomoelectrometer. Results CTDIw, CTDIvol, and DLP have been calculated with cheese phantom using A1SL1 ion chamber. CTDIw for 0.7 cm is 2.16 cGy, 1.14 cGy and 0.77 cGy for fine normal and coarse modes, respectively. Conclusion CTDIw is a dosimetric index to know the dose levels at center and periphery of patient according to scan length. It gives an idea about how much additional dose is received by the patient during the imaging procedures. High pitch gives the lesser absorbed dose. DLP gives the knowledge about stochastic effects from radiation to patients after MVCT.

Background Despite beneficial progress in policies, awareness and advocacy, accessibility gaps exist in public buildings in India. Challenges achieving full inclusivity still exist, due to a lack of clear guidance for implementing accessible solutions. Retrofitting older buildings, particularly in developing tier II cities is a major challenge. The authors of this paper aimed to address this issue using a four-round Delphi method to generate a Justice-Centered Best Practices (JCBPs) for accessibility provisions for individuals with mobility disabilities. Methods Conducted in Udupi, the study involved experts including administrators, policy implementers, auditors, advocates, healthcare professionals, individuals with disabilities and their caregivers. In the first round, a 117-item list was generated through triangulation of three methods. In subsequent rounds, experts rated each item using a 5-point Likert scale on feasibility, affordability and priority. Responses were considered valid if the agreement reached ≥80% on the total score. The prioritised list of JCBPs was finalised at a consensus meeting. Results Out of forty-eight experts who began the study, 16 participated in the final meeting. The Wilcoxon signed rank test (p value>0.05) of expert ranking indicated that the scoring of items remained consistent between the two rounds. A machine learning decision tree analysis identified items securing ≥ 80% agreement as the most reliable decision with an accuracy=71.43%. The McNemar’s Test p value=0.79 confirmed consistency of expert scoring on the items with high agreement rates. Conclusion Finally, 33 built and non-built environment items scored highest rank. Stakeholder engagement, use of low-cost technology solutions, coordination between public administrations, funding, good governance practice, awareness, and advocacy were few of the solutions that can help ensure accessibility is in place for individuals with mobility disabilities. The study methodology and findings create a robust foundation for evidence-based JCBPs for accessibility provisions for individuals with mobility disabilities.

Purpose To explore how principles of social justice and equity are integrated into research concerning accessibility to public buildings for individuals with mobility disabilities. Methods Utilising a scoping review methodology to assess literature based on the criteria set by the Joanna Briggs Institute, seven databases were screened. Studies were selected using the framework: “persons with mobility disabilities” AND “accessibility” AND “public buildings”. A theoretical framework helped to extract codes and develop themes through an inductive-deductive analysis method. The results are presented descriptively. Results The examination of 84 studies uncovered a complex interplay between agencies, systemic challenges, discriminatory practices, and societal attitudes perpetuating marginalisation of individuals with mobility disabilities in their access to public buildings. The recommendations emphasize importance of practical measures, research imperatives, and policy developments to promote inclusivity. We present a ‘Ten-step approach’ to integrate social justice and equity into research on accessibility in public buildings for people with mobility disabilities. Conclusion Integrating diversity, active participation, and inclusive methodologies are essential to address systemic issues, discriminatory practices, and societal attitudes that hinder accessibility and inclusion. Collaborations with diverse stakeholders are crucial for policy changes, resource allocation, and advancing social justice and equity in accessibility research and practice.

Objectives This paper describes a Population Health Research Network project establishing the NMLK as a national linkage system utilising an enduring linkage between national and jurisdictional linkage spines. It used keys from existing enduring linkages within each participating jurisdictional Data Linkage Unit (DLU). The process is demonstrated with reference to an enduring map between AIHW Health Linkage Spine (HLS) and Centre for Health Record Linkage (CHeReL) MLK. Approach The NMLK has jurisdictional sections. The NSW section was established in four steps. • CHeReL provided data from its regularly updated MLK for the NMLK project authorised by existing project ethics approval. • AIHW linked NSW MLK subset to HLS and the de-identified linkage map and report were sent to CHeReL for review. • CHeReL reviewed the results, particularly the additional duplicates identified through the linkage process. The agreed links form the AIHW-NSW section of NMLK quarantined for a year. • The annual update, scheduled for later in 2024, will focus only on linking the new and unlinked individuals in both datasets. Results The NSW cohort was supplied with almost 50 million records, comprising over 14 million unique person ids. Of these, 12 million were matched with reasonable confidence to HLS, or 84.4% of the total (or around 97% if we exclude NSW records with missing personal information and around 140,000 individuals out of scope of HLS.) Conclusion Establishment of the NMLK enabled effective production of high-quality enduring linkage maps used across multiple cross-jurisdictional projects while minimising the privacy risks.

Advanced triple-negative breast cancer (TNBC) has poorer outcomes due to its aggressive behavior and restricted therapeutic options. While therapies like checkpoint inhibitors and PARP inhibitors offer some benefits, chemotherapy remains ineffective beyond the first line of treatment. Antibody–drug conjugates (ADCs) like sacituzumab govitecan-hziy (SG) represent a significant advancement. SG combines SN-38, an irinotecan derivative, with a Trop-2-targeting antibody via a pH-sensitive linking moiety, achieving a good drug:antibody ratio. In a phase I-II study involving metastatic TNBC (mTNBC) individuals, SG achieved an overall response rate of 33.3% and a median response period of 7.7 months. The phase III ASCENT trial demonstrated SG’s efficacy in relapsed or refractory TNBC, improving median progression-free survival and median overall survival compared to chemotherapy. Common side effects include neutropenia, nausea, and fatigue. This article highlights the clinical potential, pharmacokinetics, safety profile, and resistance mechanisms of SG along with key ongoing clinical trials, emphasizing its role in managing refractory mTNBC, especially in third-line therapy. The review also discusses current strategies for managing adverse reactions and sequencing ADC treatments in clinical practice, along with the predicted basis of resistance. The optimal sequencing of SG relative to other ADCs, such as trastuzumab deruxtecan or T-DXd, remains an evolving question, especially as newer agents with distinct mechanisms of action and safety profiles enter the field. Further research is essential to establish evidence-based strategies for sequencing SG and addressing disease progression post-ADC therapy.

The proliferation of malicious webpages presents a growing threat to online security, necessitating advanced detection methods to mitigate risks. This paper proposes a novel approach that integrates Natural Language Processing (NLP) techniques with an ensemble of machine learning models for the proactive detection of malicious web content. By leveraging semantic analysis, lexical patterns, and metadata extraction, the proposed framework enhances the identification of suspicious patterns in web page content. The ensemble model combines decision trees, random forests, and gradient boosting methods, optimizing classification accuracy and reducing false positives. A comprehensive evaluation using a large dataset of web pages, including both benign and malicious examples, demonstrates the superiority of the proposed method over traditional single-model approaches. With accuracy rates exceeding 98%, this framework achieves a robust, scalable solution for real-time web content analysis, providing a critical tool for cybersecurity professionals to detect and block malicious webpages before they can cause harm. Future directions include the integration of deep learning architectures and adaptive filtering techniques to further refine detection capabilities.

This article investigates the staff outcomes that are influenced by physical environment features in a healthcare facility. Over the past few decades, research on the physical environment and its effects on hospital staff has advanced steadily. Focusing on the physical environment has become a research area with great potential because it is crucial to provide a favorable work environment for health professionals, which directly impacts the quality of care. A systematic literature review was conducted to identify research articles from two scientific databases and a healthcare journal. Articles that fulfilled the inclusion and exclusion criteria for relevant articles were included in this review. Relevant data were derived from the final shortlisted articles. The features identified in the articles were divided into three dimensions of the physical environment. The results demonstrate different outcomes for staff. This review shows the need to develop a comprehensive study involving the most important features of the three dimensions of the physical setting and its effects on staff. This study contributes invaluable insights for hospital administrators, architects, and designers by informing them about the critical factors shaping the healthcare workplace environment.

Hardware trojan classification/detection systems (HTDs) based on machine or deep learning have recently been proven to be effective. However, the existence of irrelevant features as well as class imbalance reduces the effectiveness of these models. To address these issues, this work describes a hardware trojan detection method based on gate-level net-list structural features. To begin with, SMOTE-Tomek is used for data augmentation. The best features are then selected using a hybrid feature selection technique that combines the filter and wrapper. The results show that using the optimal features and tuned parameters, KNORA-U and KNORA-E, dynamic ensemble classifiers, outperform existing techniques with area under the receiver operating characteristic curve (AUC-ROC) values of 0.988 and 0.982, respectively. The circuit and systems (CAS) lab dataset is used to analyze these evaluations. Furthermore, knowing the details of the prediction is extremely crucial for the model’s transparency and generalizability. As a result, when using a model agonistic framework such as SHapley Additive exPlanations (SHAP), it is proved that, in addition to other features, the number of references is consistent across models and has a significant impact on prediction. Due to consistent interpretations, this methodology strengthens the hardware security professionals’ trust in HTDs.

Introduction: The caroticoclinoid ligament extends from the Anterior Clinoid Process (ACP) to the Middle Clinoid Process (MCP). Occasionally, it gets ossified and forms the caroticoclinoid foramen. Anterior clinoidectomy is a common surgical procedure to treat internal carotid artery aneurysms or pituitary tumours. Abnormal ossification of the caroticoclinoid ligament may lead to intraoperative or postoperative complications as it is not normally present. Aim: To find out the incidence of ossification of the caroticoclinoid ligament in adult human skulls. Materials and Methods: This was an observational cross-sectional study that included 100 dry adult human skulls collected from the Department of Anatomy, Gandhi Medical College, Secunderabad; Osmania Medical College, Hyderabad; Bhaskar Medical College, Moinabad, Telangana, India, from January 2021 to February 2023. Adult human skulls with open vault were included. All the skulls were observed and skulls damaged in the clinoid regions were excluded from the study. The skulls were observed for the presence of any ossifications of the caroticoclinoid ligaments and the observations were noted. The qualitative data was presented as number and percentage was calculated. The data was recorded in MS excel version 2021. Results: The incidence of ossification of caroticoclinoid ligament was 8 (8%). The incidence was higher on right-side when compared to the left-side. Bilateral complete ossification of the caroticoclinoid ligament was observed in 2 (2%) skulls; bilateral incomplete ossification was observed in 3 (3%) skulls, unilateral complete ossification was observed in 2 (2%) skulls on the right-side. In one skull 1 (1%), complete ossification was observed on the right-side and incomplete ossification was observed on the left-side. Conclusion: Knowledge of the ossification of the caroticoclinoid ligament is important for neurosurgeons while performing anterior clinoidectomies or skull base surgeries. Radiological confirmation of the ossification of the caroticoclinoid ligament is essential to avoid complications.

Analyzing how AI will change HRM strategies is the focus of this research. We may achieve our goals by concentrating on the following: precision, automation, processing capacity and power, real-time experience, customization, and saving time and money. The possible advantages of AI adoption are the target of the study. A well-structured online survey is utilized to gather data from 300 IT employees in the city of Coimbatore. The study presents a new research framework that makes use of AMOS version 21 and IBM SPSS version 21 for analysis. The outcomes show that factors like Personalization, Computing Power and Capacity, and Accuracy have a substantial impact on Time-Saving and Cost Reduction, however factors like Real-Time Experience and Automation do not. This unique addition of the study’s is to investigate the concrete results of implementing artificial intelligence technologies into human resource management procedures. The study delves deeply into the expected results and interrelationships of artificial intelligence implementation in human resource management by concentrating on critical variables including Computing Power & Capacity, Precision, Real-time experience, Time-Saving and Cost Saving, Automation, and Personalization.

Introduction: The trigeminal nerve is principally responsible for controlling the sensory modalities of the face. The Foramen Ovale (FO) is one of the apertures present in the skull base, through which the mandibular nerve, a branch of the trigeminal nerve passes. Aim: To deliver a thorough understanding of the anatomical variations of the trigeminal ganglion and FO that would be beneficial to neurologists and neurosurgeons when performing various treatments involving these structures. Materials and Methods: The present systematic review was formulated according to Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Major electronic databases were screened and all types of studies including descriptive studies, surveys, full-text literature providing information about the variations in trigeminal ganglion and FO, were incorporated in the current review. Studies from 2001 to 2022 were included in this review. The risk of bias evaluation in the present study was conducted by using the review manager software (Rev Man version 5.4) and risk assessment domains were classified as high, indeterminate, or low risk. The recommended approach to check biases such as selection, performance, attrition, reporting, and other biases was done. Results: A total of 12 studies were examined. The studies measured the proper location and the size (diameter) of the trigeminal ganglion and FO using the MRI-based findings in 1,341 subjects in total. It was observed that the length of the trigeminal nerve was found to be about 9.66 mm in the cistern (range 6.04-20.74 mm) in 50% of studies, whereas in 16.67% of the studies trigeminal nerve was longer in the older patients as compared to the normal anatomy. Additionally, the distinctive form of the FO was noted in the current investigation. In total, (n=4) 66.66% of the studies demonstrated the oval shape of the FO, and (n=3) 50% of studies noticed an almond shape, 50% identified a round shape; (n=2) (33%; n=2) displayed a slit form. Only one investigation demonstrated a bony bridged of FO whereas 33% showed tubercle and triangular shapes. Conclusion: Majority of the studies showed that the length of the trigeminal nerve was found to be about 9.66 mm. Whereas, only one author reported that the trigeminal nerve is longer in the older patients as compared to the normal anatomy. The majority of studies demonstrated that the variations were observed in the shape of the FO, i.e., oval, round, almond, slit, spine.

The present paper expounds development of a two stage solvent extraction scheme for separation of rare earths (REE) from a sulfuric acid leachate obtained from an Indian coal flyash sample containing 2160 ppm REE. The leachate has low concentration of REE (305 mg/L) and high content of impurities (32.6 g/L). The problem of gel formation due to presence of Si in the leachate was prevented by gelatin strike which lowered dissolved Si content. About 94% of HREE and 86% of Light Rare Earths (LREE) values could be recovered in first and second stages of solvent extraction stages using D2EHPA solvent of optimized concentrations 12% (v/v) and 40% (v/v) saponified up to 40%, respectively. The two organic streams, former rich in HREE and the later rich in LREE, were subjected to multi stage cross current stripping at low A/O ratio using 6 mol/L HCl solution to obtain strip solutions concentrated in HREE and LREE respectively. The two strip liquors were neutralized with NaOH from which REE were precipitated using oxalic acid dihydrate to produce mixed REE concentrates, assaying 13% HREE and 17.5% LREE. The present study was a maiden attempt to recover REE from the actual leachate, of complex chemistry, obtained from an India flyash sample. Further, the flowsheet was up scaled to bench scale which includes easily scalable processes like leaching at ambient temperature (25 °C) and high solids concentration (20% w/v) followed by solvent extraction and precipitation stages. This study establishes a high potential for the recovery of REE from an Indian coal flyash at industrial scale. Scope exists for future studies on separation of individual rare earths oxides from the mixed REE oxalates that can be produced according to the present study.

Background: Multidrug-resistant tuberculosis (MDR-TB) has become a global threat concerning to a risk of high mortality with the potential to cause adverse drug reactions (ADRs) which if not managed properly may affect patient compliance, resulting in below par treatment outcome. Aim: The aim of the study was to study, assess, and report the ADRs of patients diagnosed with MDR-TB. Subjects and Methods: An ambispective, observational study was conducted among confirmed cases of MDR-TB patients without any comorbidities during the period of January 2015–December 2018 in patients of age 15 years and above. Statistical Analysis: Data were analyzed descriptively using MS-Excel sheet 2013 and Chi-square test in GraphPad Prism 8.2.1. Results were expressed as either frequency, percentage, or mean ± standard deviation. ADRs were evaluated for causality, severity, and preventability attributes. Results: In the sample size of 400 patients, 236 (ADRs) were reported among 136 patients. The proportion of ADRs was higher in males (P = 0.0001) and in the age group of 36–75 years (P = 0.0211). Most commonly encountered ADRs include nausea and vomiting (35.31%) and arthralgia (14.04%), followed by peripheral neuropathy (8.93%) and giddiness (8.93%). Overall, 53% were of possible category and 60% of moderate level severity and 85% were unpreventable ADRs. Conclusion: Our study included 13 types of ADRs, of which most commonly reported were nausea and vomiting, arthralgia, and peripheral neuropathy and least common were psychosis, nephrotoxicity, and gynecomastia with a higher incidence in males. Majority of ADRs were moderate, unpreventable ADRs and had a possible relationship with the suspected drugs.

A series of 6-aryl substituted pyrimidine azodyes were synthesized by coupling of phenyl pyrimidine 2-amine with different aromatic amines. The synthetic compounds were screened for their in-vitro antioxidant and anti-inflammatory activities. The characterization of the synthesized compounds was carried out by IR, 1H NMR, 13C NMR and Mass spectrophotometry. Computational study of designed compounds was done by OCHEM, Molinspiration cheminformatics, Datawarrior, and Swiss ADME. DPPH assay was used to determine the antioxidant activity and heat hemolysis method for anti-inflammatory activity.

Caesarean scar ectopic pregnancy is a rare form of ectopic pregnancy where gestational sac is implanted in the myometrium at the site of previous caesarean scar. Incidence of scar pregnancy is increasing due to the rise in caesarean section (CS) rate. A 26-year-old female [G1P1L0 with 3MA, prev. lower segment CS (LSCS)] came with acute abdomen and hypovolemic shock. Caesarean scar pregnancy was diagnosed. The patient was resuscitated and emergency laparotomy and resection of ectopic mass was done. In women with a history of caesarean scar pregnancy, early ultrasound should be performed in subsequent pregnancies in order to establish the location of implantation, and make early diagnosis so that conservative management is initiated to avoid severe maternal morbidity and spare fertility in patients with cesarean scar pregnancy.

Abstract Background Multi drug-resistant and mycobacterial infections are a major public health challenge, leading to high mortality and socioeconomic burdens through worldwide. Novel therapeutics are necessary to treat the drug resistant strains, since no new chemical entities are emerged in the last four decades for the treatment of TB. Findings A series of novel 2-heterostyrylbenzimidazole derivatives were synthesised by cyclisation of (3,4-diaminophenyl)(phenyl)methanone, cinnamic acid using glycerol in high yield. The molecular structures of target compounds (5a–5n) were confirmed by 1H and 13C NMR spectroscopy and mass spectrometry. Newly synthesized compounds were screened for anti-tubercular activity and the MIC was determined against Mycobacterium tuberculosis H37Rv by broth microdilution method using Lowenstein Jensen medium (LJ). These compounds docked into the active site of “Crystal structure of pantothenate synthetase in complex with 2-(2-(benzofuran-2-ylsulfonylcarbamoyl)-5-methoxy-1H-indol-1-yl)acetic acid” (PDB code, 3IVX). Auto dock 4.2 software was used for docking studies. Results 5d, 5e, 5f, 5g, 5i, and 5l show better activity and the most active inhibitor of tuberculosis 5f showed a promising inhibition of M. tuberculosis with MIC value of 16 μg/mL. The molecules functionalized with electron-donating groups (Cl, O, S, etc.) on different aromatic aldehydes (5a–5n) were found to be more active in inhibiting M. tuberculosis. Conclusions On the basis of docking studies, 5f has shown good affinity for the enzyme. Comparison was made with the binding energies of the standard drugs amoxicillin (−34.28 kcal/mol) and ciprofloxacin (−28.20 kcal/mol). Among all the designed compounds, the compound 5f shows highest binding energy with two amino acid interactions Lys160, Val187 (−9.80 kcal/mol).

The present investigation deals with the fabrication of a novel flexible and highly conductive PPy electrode. This was made by festooning PPy nanoparticles on carbon cloth (CC) by using chemical liquid process. The developed porous PPy@CC composite have good flexibility with low weight (1.1 mg) and high electrical conductivity (89 Ω−1cm−1). Fourier-transform infrared spectroscopy (FTIR) and X-ray diffraction spectroscopy (XRD) confirmed the formation of PPy on carbon cloth. Scanning electron micrographs (SEM) reveals that the PPy nanoparticles are encapsulated in carbon cloth. The fabricated carbon cloth has been used for solid-state symmetrical supercapacitors (SC) and low-cost material for electrode in potential energy storage devices. These film electrodes showed much superior electrochemical performance i.e. high stability under different current density, encouraging energy density, lower internal resistivity and higher specific capacitance. Synthesized flexible PPy@CC composite electrodes have brilliant applications in various kinds of electrochemical energy storage devices.

Introduction: Allergic diseases are common and affect a large population worldwide. Not many studies are available regarding the same and almost none in Solan district. Aim: To assess the prevalence of allergies in this region, the major symptoms involved, the major allergens causing them and their association with vitamin D insufficiency. Materials and Methods: This prospective case-control study was conducted in Maharishi Markandeshwar Medical College and Hospital, Himachal Pradesh, India (March 2017 to October 2017). A total of 159 patients in allergic group were evaluated for age and sex distribution, common symptoms involved, spirometry, nasal endoscopy findings and the common allergens responsible. They were compared with 148 patients in the control group for utility of Skin Prick Tests (SPT), Total IgE levels and to study the impact of vitamin D insufficiency on the disease. Results: Allergies were common in younger age group of 21 to 40 years of age (61%) and in females the most common complaints were nasal (63%) and the most common allergens involved were dust mite mix, cockroach and pine mix in this region. Majority of the patients had obstructive disease with reversibility suggestive of asthma and most common nasal finding is bilateral inferior turbinate hypertrophy (65%). SPT are more sensitive and specific as compared to total IgE levels. There is good association between allergic diseases and vitamin D insufficiency (odds ratio 3.4). Conclusion: Present study focussed on the nature of allergens among allergic patients in the Solan district and found SPT to be the most reliable and vitamin D insufficiency to be one of the factors for allergies.

In the digital era, we are greatly dependent on the popular applications of the Location Based Services (LBS) in our day-to-day activities. The smart phone comes with a variety of applications which acquire the user location and build up user profile like the user activities, hobbies, places of visit, food orders etc. Such sensitive information in the LBS server can pose privacy risk for the user. To safe guard the user from such threat we propose a smart privacy protection technique in this paper that can conceal the user location when using the location based services. We adopt the generation of dummy locations to obfuscate the user original location from the LBS server. The server generates the result set for the dummy user locations. In this work we try to optimize the things at server as well as user ends with two objectives. The first goal is to work towards identifying the overlap in result sets and generate unique and reduced result set with which the communication load on the network can be reduced. The second goal is to prioritize the result set by Queuing model for the result set through which waiting time of the customer can be minimized. We have also illustrated that this model show good performance in terms of the reduced communication load through experimental results.

This paper examines the predicament of the Dalit youth in their pursuit of higher education through a qualitative study in a low-income locality of Delhi. In absence of control over material resources historically, education offered promise in liberating socially excluded groups for its instrumental link with modern occupational structure. The policy of universal public education backed up with affirmative action in India has formally aided its access across sections. Even as the participation of the hitherto marginalized groups has been increasing manifold, privatization and marketisation in the education sector under the neo-liberal regime have transformed the educational landscape. Dalit youth is largely segregated into low-quality distance and social sciences education. The paper discusses various constraining and motivating factors embedded within and outside the neighbourhood and educational institutions which shape their educational interests, choices, and decisions. It elaborates on how cumulative socio-cultural, spatial, and historical disadvantages continue to shape the process of educational exclusion, even when these groups live in a metropolitan city amidst educational institutions. However, we also stress that the state policies, informed mentors, shared aspirations, and diversity in socio-cultural interactions hold the potential to alter and widen educational aspirations, access, and outcomes.

Introduction: Free to total prostate specific antigen ratio (f/t PSA) has been used to help improving specificity of PSA in the range of 4-10 ng/ml based on the data on population based screening. There is no data on test characteristics of f/t PSA in men presenting with clinical symptoms of benign prostatic hyperplasia (BPH). This study is aimed to determine the usefulness of f/t PSA in symptomatic men. Methodology: From January 2006 to June 2012, men of 50-75 years with lower urinary tract symptoms (LUTS), normal rectal examination and PSA between 4-20 ng/ml had free and total PSA assessment. Men with clinical evidence of prostatitis, retention, history of 5α blocker reductase inhibitors and those who had surgery or biopsy on the prostate in last 3 months were excluded. Receiver operating characteristic curves were derived for f/t PSA and total PSA. The effect of age, prostate volume and Gleason score on the f/t PSA was also analyzed. All statistical analyses were performed on SPSS 16 (Chicago, USA). Results: Out of 170 men with the mean age of 67.4 ΁ 6.6 years, 43 (25.3%) had cancer on biopsy. Area under the curve for predicting the presence or absence of prostate cancer in all the men with f/t ratio was 0.63 (confidence interval [CI]: 0.54-0.71). The median value of f/t PSA for men with cancer was 5.5% (1-25%) and 9.2% (1-63%) for those with no cancer. Cut-offs derived at 95% specificity at PSA between 4-10 ng/ml and 4-20 ng/ml were 0.5% and 1% respectively. The specificity of f/t PSA ratio at cut-off levels 7%, 10% and 15% was 73%, 60%, 45% for PSA range of 4-10 ng/ml and 63%, 47% and 35% for PSA range of 4-20 ng/ml PSA. Age, prostate volume and Gleason grade did not show any effect on f/t PSA. Conclusion: In men with LUTS the specificity of various f/t PSA ratio cut-offs; described for population based screening, is too low to be used as an aid to defer the decision of biopsy in PSA ranges of 4-20 ng/ml.

Dandy walker syndrome is a rare congenital malformation that involves the cerebellum and fourth ventricle. It is characterized by agenesis or hypoplasia of cerebellar vermis, cystic dilatation of the fourth ventricle and enlargement of the posterior fossa. Dandy Walker Malformation is a condition which can be effectively diagnosed by imaging modalities, especially in antenatal period with a proper antenatal checkup and sonography

Parmeet Kaur Manchanda, Anant Kumar, Raj K Sharma, Himanshu Goel, Rama Devi MittalDepartment of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, Uttar Pradesh, IndiaAbstract: T-helper (Th) type 1/Th2 cytokines are key mediators in induction/effecter phases of all immune and inflammatory responses playing role in acute/chronic renal allograft rejection. Association studies lead to identification of patient risk profiles enabling individualization of level of immunosuppressions. We investigated the association of allograft rejection with interleukin-2 (IL-2), IL-4, IL-6, tumor necrosis factor-α (TNF-α) –308, transforming growth factor-β (TGF-β) (C-del, codon 10 and 25) gene variants in 184 renal transplant recipients and 180 controls. These cytokine genotypes were also evaluated with cyclosporine levels (C2) at one month in 135 stable recipients. High producing genotypes B1B1 of IL-4 and AA of TNF-α −308 showed significant association with rejection of allograft. The dose-adjusted C2 levels were significantly lower in patients with the high producing genotype T/T of IL-2 and heterozygous G/C of TGF-β codon 25 (P = 0.012 and 0.010, respectively). Haplotype frequencies were comparable in subjects for TGF-β codon-10 and 25. Combined inter-gene interaction showed high risk for rejection in recipients with high producing genotype B1B1 of IL-4 and AA of TNF-α and high TNF-α (AA) with low TGF-β (CC or Pro/Pro). In conclusion, association of IL-4 VNTR and TNF-α –308 suggested the involvement of these cytokines contributing to pathogenesis of allograft rejection. Recipients with TT genotype of IL-2 and GC of TGF-β codon 25 having low C2 levels may require higher cyclosporine dosage. Combined analysis of gene-gene interaction demonstrated synergistic effect of cytokines increasing risk for rejection. Thus, this information may help in pre-assessment of allograft outcome and to optimize cyclosporine therapy in post-transplant patients.Keywords: cytokines, renal transplant, polymorphism, ARMS–PCR, PCR–RFLP, cyclosporine

Background Despite beneficial progress in policies, awareness and advocacy, accessibility gaps exist in public buildings in India. Challenges achieving full inclusivity still exist, due to a lack of clear guidance for implementing accessible solutions. Retrofitting older buildings, particularly in developing tier II cities is a major challenge. The authors of this paper aimed to address this issue using a four-round Delphi method to generate a Justice-Centered Best Practices (JCBPs) for accessibility provisions for individuals with mobility disabilities. Methods Conducted in Udupi, the study involved experts including administrators, policy implementers, auditors, advocates, healthcare professionals, individuals with disabilities and their caregivers. In the first round, a 117-item list was generated through triangulation of three methods. In subsequent rounds, experts rated each item using a 5-point Likert scale on feasibility, affordability and priority. Responses were considered valid if the agreement reached ≥80% on the total score. The prioritised list of JCBPs was finalised at a consensus meeting. Results Out of forty-eight experts who began the study, 16 participated in the final meeting. The Wilcoxon signed rank test (p value>0.05) of expert ranking indicated that the scoring of items remained consistent between the two rounds. A machine learning decision tree analysis identified items securing ≥ 80% agreement as the most reliable decision with an accuracy=71.43%. The McNemar’s Test p value=0.79 confirmed consistency of expert scoring on the items with high agreement rates. Conclusion Finally, 33 built and non-built environment items scored highest rank. Stakeholder engagement, use of low-cost technology solutions, coordination between public administrations, funding, good governance practice, awareness, and advocacy were few of the solutions that can help ensure accessibility is in place for individuals with mobility disabilities. The study methodology and findings create a robust foundation for evidence-based JCBPs for accessibility provisions for individuals with mobility disabilities.

Purpose To explore how principles of social justice and equity are integrated into research concerning accessibility to public buildings for individuals with mobility disabilities. Methods Utilising a scoping review methodology to assess literature based on the criteria set by the Joanna Briggs Institute, seven databases were screened. Studies were selected using the framework: “persons with mobility disabilities” AND “accessibility” AND “public buildings”. A theoretical framework helped to extract codes and develop themes through an inductive-deductive analysis method. The results are presented descriptively. Results The examination of 84 studies uncovered a complex interplay between agencies, systemic challenges, discriminatory practices, and societal attitudes perpetuating marginalisation of individuals with mobility disabilities in their access to public buildings. The recommendations emphasize importance of practical measures, research imperatives, and policy developments to promote inclusivity. We present a ‘Ten-step approach’ to integrate social justice and equity into research on accessibility in public buildings for people with mobility disabilities. Conclusion Integrating diversity, active participation, and inclusive methodologies are essential to address systemic issues, discriminatory practices, and societal attitudes that hinder accessibility and inclusion. Collaborations with diverse stakeholders are crucial for policy changes, resource allocation, and advancing social justice and equity in accessibility research and practice.

The sternal foramen is a well-known variant of the sternum that carries the risk of life-threatening complications like pneumothorax, injury to vital structures like pericardial and cardiac puncture during acupuncture. A foramen was found in one sternum during the routine bone study of bones of the bank which were secured in Department of Anatomy. It was oval shaped measuring 8.75 mm × 7.35 mm, present in lower one-third of the body of the sternum. Distance from a sternal angle was 68.06 mm and 25.26 mm from the lower end of the sternum. The sternal foramen is usually asymptomatic found incidentally on chest X-ray. Hence this variation should keep in mind while performing invasive procedures like sternal puncture for bone marrow aspiration to prevent life-threatening complications.

BackgroundCell surface biomarker CD44 plays an important role in breast cancer cell growth, differentiation, invasion, angiogenesis and tumour metastasis. Therefore, we aimed to investigate the role of CD44 gene polymorphisms in breast cancer risk and prognosis in North Indian population.Materials & methodsA total of 258 breast cancer patients and 241 healthy controls were included in the case-control study for risk prediction. According to RECIST, 114 patients who received neo-adjuvant chemotherapy were recruited for the evaluation of breast cancer prognosis. We examined the association of tagging SNP (rs353639) of Hapmap Gujrati Indians in Houston (GIH population) in CD44 gene along with a significant reported SNP (rs13347) in Chinese population by genotyping using Taqman allelic discrimination assays. Statistical analysis was done using SPSS software, version 17. In-silico analysis for prediction of functional effects was done using F-SNP and FAST-SNP.ResultsNo significant association of both the genetic variants of the CD44 gene polymorphisms was found with breast cancer risk. On performing univariate analysis with clinicopathological characteristics and treatment response, we found significant association of genotype (CT+TT) of rs13347 polymorphism with earlier age of onset (P = 0.029, OR = 0.037). However, significance was lost in multivariate analysis. For rs353639 polymorphism, significant association was seen with clinical tumour size, both at the genotypic (AC+CC) (P = 0.039, OR = 3.02) as well as the allelic (C) (P = 0.042, OR = 2.87) levels. On performing multivariate analysis, increased significance of variant genotype (P = 0.017, OR = 4.29) and allele (P = 0.025, OR = 3.34) of rs353639 was found with clinical tumour size. In-silico analysis using F-SNP, showed altered transcriptional regulation for rs353639 polymorphism.ConclusionsThese findings suggest that CD44 rs353639 genetic variants may have significant effect in breast cancer prognosis. However, both the polymorphisms- rs13347 and rs353639 had no effect on breast cancer susceptibility.

A case of congenital glaucoma with developmental delay and several dysmorphic features showing 22p+ chromosomal variant is reported.

Objectives: To evaluate the effect of liver diseases in patients, on serum free prostate specific antigen (JPSA) levels, total prostate specific antigen (tPSA) levels and fPSA/tPSA ratios. Methods: Serum concentrations of total and free as well as JPSA/tPSA were determined in 20 men with histologi-cally confirmed liver cirrhosis, 15 men with chronic hepa-titis and 20 healthy men. Results: The serum levels of total PSA in liver cirrhosis as well as in chronic hepatitis were significantly lower than those observed in control. Free PSA remained unchanged. Conclusions: Our study suggests that despite severe liver dysfunction the tPSA, fPSA as well as the ratio of fPSA/ tPSA were not elevated as it was hypothesized that liver impairment might affect the PSA levels, as liver is a site for PSA metabolism.

Purpose To explore how principles of social justice and equity are integrated into research concerning accessibility to public buildings for individuals with mobility disabilities. Methods Utilising a scoping review methodology to assess literature based on the criteria set by the Joanna Briggs Institute, seven databases were screened. Studies were selected using the framework: “persons with mobility disabilities” AND “accessibility” AND “public buildings”. A theoretical framework helped to extract codes and develop themes through an inductive-deductive analysis method. The results are presented descriptively. Results The examination of 84 studies uncovered a complex interplay between agencies, systemic challenges, discriminatory practices, and societal attitudes perpetuating marginalisation of individuals with mobility disabilities in their access to public buildings. The recommendations emphasize importance of practical measures, research imperatives, and policy developments to promote inclusivity. We present a ‘Ten-step approach’ to integrate social justice and equity into research on accessibility in public buildings for people with mobility disabilities. Conclusion Integrating diversity, active participation, and inclusive methodologies are essential to address systemic issues, discriminatory practices, and societal attitudes that hinder accessibility and inclusion. Collaborations with diverse stakeholders are crucial for policy changes, resource allocation, and advancing social justice and equity in accessibility research and practice.