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Abstract Background The COVID-19 pandemic has significantly impacted public health, with emerging evidence suggesting substantial effects on maternal and neonatal health. This systematic review and meta-analysis aimed to quantify the prevalence and risk of respiratory distress syndrome (RDS) in newborns born to mothers infected with SARS-CoV-2, the virus responsible for COVID-19. Methods We conducted a literature search in Embase, PubMed, and Web of Science up to April 20, without language or date restrictions. Observational studies reporting on the prevalence or risk of RDS among newborns from mothers with confirmed SARS-CoV-2 infection were included. Quality assessment was performed using the JBI tool. Statistical analysis was performed by using R software version 4.3. Results Twenty-two studies met the inclusion criteria. The pooled prevalence of RDS among newborns born to COVID-19-infected mothers was 11.5% (95% CI: 7.4–17.3%), with significant heterogeneity (I² = 93%). Newborns from infected mothers had a significantly higher risk of developing RDS, with a pooled risk ratio (RR) of 2.69 (95% CI: 1.77 to 4.17). Conclusion Newborns born to mothers with COVID-19 have a substantially increased risk of developing RDS. These findings emphasize the need for vigilant monitoring and appropriate management of pregnant women with COVID-19 to mitigate adverse neonatal outcomes.

Abstract Background The global COVID-19 vaccination campaign, with 13.53 billion doses administered by early 2024, has significantly reduced severe illness and mortality. However, potential adverse effects, such as Postural Orthostatic Tachycardia Syndrome (POTS), have raised concerns. This systematic review evaluates the incidence, mechanisms, and clinical implications of POTS following COVID-19 vaccination. Methods A systematic search of PubMed, EMBASE, and Web of Science was conducted up to June 7, 2024, following PRISMA guidelines to identify studies related to COVID-19 vaccines and POTS. Eligible studies included randomized controlled trials, cohort studies, cross-sectional studies, case-control studies, case series, and case reports. Screening, data extraction, and quality assessment were independently performed by two reviewers using the Joanna Briggs Institute Checklists and the Newcastle-Ottawa Scale. Results Of the 1,531 articles identified, 10 met the inclusion criteria, encompassing a total of 284,678 participants. These studies included five case reports, two case series, one cross-sectional study, one prospective observational study, and one cohort study. The cohort study reported that the odds of new POTS diagnoses post-vaccination were 1.33 (95% CI: 1.25–1.41) compared to the 90 days prior. In contrast, the post-infection odds were 2.11 (95% CI: 1.70–2.63), and the risk of POTS was 5.35 times higher (95% CI: 5.05–5.68) post-infection compared to post-vaccination. Diagnostic findings across studies included elevated norepinephrine levels and reduced heart rate variability. Reported management strategies involved ivabradine, intravenous therapies, and lifestyle modifications. Conclusion The risk of POTS following COVID-19 vaccination is lower than that observed post-SARS-CoV-2 infection; however, existing studies are limited by small sample sizes and methodological variability. Further research is needed to clarify the incidence, mechanisms, and long-term outcomes of vaccine-related POTS to inform effective clinical management strategies.

Introduction: Mishaps such as the accidental ingestion of endodontic instruments and crowns may occur during dental treatment in children. Although such accidents are rare, they can be potentially harmful to patients. The use of a rubber dam is not always possible in paediatric dentistry; thus, the attachment of floss to endodontic files is commonly done during the pulpectomy procedure. However, there are some challenges associated with using Flossed Endodontic Files (FEFs). To overcome these difficulties, a system called i-Grip was introduced. Aim: To evaluate the perception and compare the ease, convenience and safety of i-Grip versus FEFs as perceived by Paediatric Dentists during pulpectomy procedures in children. Materials and Methods: A post-test quasi-experimental study was conducted in the Department of Paediatric and Preventive Dentistry, D.Y. Patil University, School of Dentistry, Navi Mumbai, Maharashtra, India, among 40 Paediatric Dentists over a period of three months. The Paediatric Dentists were asked to use the i-Grip for four weeks, after which they completed validated questionnaires. Statistical Package for the Social Sciences (SPSS) software version 23.0 was used for data analysis. The answers to the questions were statistically analysed using the Z-test of proportion. Results: The mean age of males were 35±0.743 years and females were 25.37±0.543 years. A total of 27 (67.5%) participants found placing the file in the i-Grip to be very easy. 22 (55%) found the i-Grip to be very convenient to use. 31 (77.5%) Paediatric Dentists found the i-Grip to be extremely safe, 6 (15%) considered it to be moderately safe and none found it to be extremely unsafe. There was a statistically significant difference between the ease, comfort and safety of i-Grip compared to FEF (p

Abstract Background Continuous glucose monitoring (CGM) is increasingly popular for managing Type 2 Diabetes Mellitus (T2DM). Many systematic reviews have reported on CGM's effectiveness, but with heterogeneous methodologies and objectives. We aim to conduct an umbrella review (UR) to consolidate a most contemporaneous and comprehensive evidence base comparing CGM with self-monitoring of blood glucose or usual care (SMBG/UC). Methods Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, CINAHL, Epistemonikos, SCOPUS, Web of Science and PubMed were searched from their dates of inception to 28th June 2024. Systematic reviews (SR) with or without meta-analyses comparing the use of CGM with SMBG or usual care (UC) for T2DM management in patients treated with or without insulin were included. Narrative synthesis of HbA1c, glycemic variability metrics and other physical measurements were done. Corrected covered area (CCA) was calculated to assess suitability of meta-meta-analysis. Results 31 SRs were included in this UR. There was high overlap within meta-analyses of HbA1c, time-in-range (TIR), time-above-range (TAR) and time-below-range (TBR). A primary study-level meta-analysis demonstrated that compared to SMBG/UC, CGM was associated with significantly greater HbA1c decrease (n = 11,494, MD = -0.40% [95% CI: -0.54 to -0.25]), TIR increase (n = 1452, MD = 6.00% [95%CI: 3.13 to 8.88]) and TAR decrease (n = 1113, MD = -4.33% [95%CI: -8.37 to -0.28]).These findings were invariant with CGM modality, study funding, pre-existing insulin treatment and risk-of-bias. Meta-analysis of patient reported outcome measures (PROMs) demonstrated insignificant differences in PROMs with CGM use compared to SMBG/UC. Conclusion CGM could lead to better clinical outcomes than SMBG/UC and was of moderate evidence certainty (GRADE), while its effect on PROMs remains inconclusive. We recommend the introduction of CGM into standard care alongside SMBG for T2DM and further research exploring patient experience and acceptability of CGM use.

Abstract This work introduces a novel approach for enhancing mobile audio performance by incorporating graphene-infused terracotta as an acoustic amplifier. Leveraging the high thermal conductivity and mechanical strength of graphene, this study demonstrates the design, fabrication, and acoustic characterization of terracotta amplifiers. We demonstrate the significant impact of graphene-infused terracotta amplifiers on improving sound amplification in addition to mechanical strength. A graphene-based dispersion is prepared for incorporation in clay to make the amplifier. Testing is carried out on normal and graphene-dispersion-incorporated terracotta amplifiers. The experimental results illustrate a substantial improvement in audio quality with increased volume compared to conventional terracotta-based mobile speakers. The frequency-dependent variation of the output signal, SNR, and the influence of submerging in water have also been studied. This work contributes to the field of acoustic materials and offers new possibilities for augmenting the auditory experience of mobile device users while also presenting sustainable and aesthetically appealing acoustic accessories.

Highlights 1. Temperature and precipitation time series data from 1950 to 2020 were analyzed for the states of Haryana and Punjab. 2. SARIMA models provided the most accurate temperature predictions for both states, though precipitation predictions in July were sometimes overestimated. 3. SARIMA provided better results than machine learning-based models, with lower RMSE, AIC, and BIC values. 4. Model forecasts can improve flood prediction, urban planning, and water resource management, benefiting scientists and decision-makers.

Retrosternal goitres, often due to longstanding thyroid enlargement, can compress critical structures like the trachea and oesophagus, necessitating thyroidectomy. Managing the airway while ensuring patient safety presents a significant challenge for anaesthesiologists. This case series explores the complex airway management in three patients with large retrosternal goitres undergoing total thyroidectomy. The patients, aged 50, 60, and 73, presented with long-standing neck swelling, tracheal deviation and symptoms including breathlessness, dysphagia and hoarseness of voice. The goitres had progressively enlarged over many years, leading to significant tracheal compression and deviation, which posed a high-risk for airway obstruction during surgery. Given these challenges, Awake Fiberoptic Intubation (AFOI) was chosen to secure the airway while minimising the risk of airway loss. AFOI was performed under conscious sedation with dexmedetomidine and local anaesthesia, providing effective intubation with minimal discomfort and stable haemodynamics. This approach was critical in managing the anticipated difficult airway due to the retrosternal extension of the goitres and their impact on surrounding structures. Postoperatively, the patients were kept intubated to prevent tracheomalacia, a potential complication arising from prolonged tracheal compression. Tracheomalacia, characterised by the weakening of tracheal walls, can lead to airway collapse after extubation. To ensure airway stability, extubation was delayed until a satisfactory cuff-leak test was performed 24-36 hours after surgery. This case series emphasises the importance of careful preoperative planning and the use of AFOI in managing patients with large retrosternal goitres to avoid a ‘can’t intubate, can’t ventilate’ situation. The successful management of these cases highlights the effectiveness of AFOI in reducing perioperative risks and ensuring patient safety, particularly in scenarios where difficult airway management is anticipated. By implementing appropriate postoperative protocols, the risk of complications such as tracheomalacia can be significantly reduced, leading to improved surgical outcomes.

Abstract Neuroeconomics theories propose that the value associated with diverse rewards or reward-predicting stimuli is encoded along a common reference scale, irrespective of their sensory properties. However, in a dynamic environment with changing stimulus-reward pairings, the brain must also represent the sensory features of rewarding stimuli. The mechanism by which the brain balances these needs—deriving a common reference scale for valuation while maintaining sensitivity to sensory contexts—remains unclear. To investigate this, we conducted an fMRI study with human participants engaged in a dynamic foraging task, which required integrating the reward history of auditory or visual choice options and updating the subjective value for each sensory modality. Univariate fMRI analysis revealed modality-specific value representations in the orbitofrontal cortex (OFC) and modality-general value representations in the ventromedial prefrontal cortex (vmPFC), confirmed by an exploratory multivariate pattern classification approach. Crucially, modality-specific value representations were absent when the task involved instruction-based rather than value-based choices. Effective connectivity analysis showed that modality-specific value representations emerged from selective bidirectional interactions across the auditory and visual sensory cortices, the corresponding OFC clusters, and the vmPFC. These results illustrate how the brain enables a valuation process that is sensitive to the sensory context of rewarding stimuli.

Abstract Background A new species of smut fungus, Urocystis heteropogonis, was discovered infecting Heteropogon contortus in Shawar Valley, Swat district, Khyber Pakhtunkhwa, Pakistan. The study aimed to characterize this fungus based on its morpho-anatomical and molecular features and clarify its phylogenetic position within the genus Urocystis. Results Urocystis heteropogonis was identified as a novel species, distinct from other Urocystis species. Morphologically, it is characterized by larger spore balls (14–69 × 11–45 μm) and central spores that are 14–28 × 11–20 μm in size, with each spore containing1–8 central spores. The spore walls measure 0.9–2.5 μm in thickness and the species differs in infection patterns compared to other Urocystis species. Phylogenetic analysis based on the ITS and LSU regions of nuclear ribosomal DNA (nrDNA) further confirmed the novelty of the species, placing it within a distinct clade alongside U. agropyri, U. occulta, U. piptatheri, and U. tritici. Conclusions The discovery of Urocystis heteropogonis adds to the diversity of smut fungi infecting grasses and highlights the need for further research into its ecological and agricultural implications. Future studies should focus on the disease’s spread, management, and potential impact on host populations.

Abstract Background An importance of tillage, inorganic and organic nutrient sources in the mustard - soybean cropping system lies in their ability to enhance soil fertility, improve nutrient availability, optimize crop growth and yield, and promote sustainable agricultural practices. Any cropping system’s sustainability could be increased by implementing better management techniques like zero and reduced tillage with residue retention and better nutrient sources. Results A field experiment was conducted for four consecutive seasons (Winter 2019 to Rainy 2021) to compare the two enhanced management practices, zero and reduced tillage to conventional tillage across four levels of nutrient sources: 75 and 100% recommended dose of nitrogen through FYM and 75 and 100% recommended dose of fertilizers through urea, single super phosphate and muriate of potash in a two years experiment. Experiment results were evaluated in terms of nutrient status, profitability and productivity of Mustard-Soybean cropping system. The results show a substantial improvement in yield, nutrient status, and overall yield performance of mustard and soybean when using the full recommended dose of fertilizers combined with reduced tillage and mulching, compared to other treatment methods. The implementation of reduced tillage practices recorded significantly higher yield of mustard and soybean over conventional and zero tillage. Conclusion System productivity and profitability i.e. mustard equivalent yield, productivity, gross returns, net returns, profitability and B: C (benefit: cost) was found to be improved with reduced tillage and 100% recommended dose of fertilizer under reduced tillage practices. To enhance cropping system productivity in various sub-humid regions worldwide, farmers can adopt reduced tillage techniques combined with the full recommended dose of fertilizers (100% RDF).

Abstract Background Gut microbiome dysbiosis and related immune dysfunction have been associated with the pathogenesis of Human Cytomegalovirus (HCMV) infection in infants with neonatal cholestasis (NC) as previously reported by us. However, the interaction of a perturbed microbiome, HCMV infection, and dysregulated immunity leading to exacerbation of disease severity has not been investigated so far. In this study, we examined the association of gut microbiome, host inflammatory and homeostatic markers that are likely to govern increased pathogenesis of NC in HCMV infected IgM positive infants (N = 15) compared to IgM negative (N = 15) individuals. Stool samples of HCMV infected infants and age-matched healthy controls (N = 10) were assessed for gut bacteria-derived metabolites like short-chain fatty acids (SCFAs), Lipopolysaccharide (LPS), cytokines and markers of gut barrier integrity. Data were correlated with previously determined gut microbiome composition and frequency of immune cell subsets. Finally, validation of clinical potential was undertaken by principal component analysis (PCA) of integrated data to delineate the spectrum of clinical pathology. Results Significantly lower levels of SCFAs and elevated fecal levels of soluble inflammatory mediators were observed in IgM positive HCMV infected infants. Further, increased plasma LPS levels and markers of gut permeability, suggestive of microbial translocation due to a ‘leaky gut’ were observed in HCMV infected IgM positive group. PCA of integrated data revealed clearly disparate profiles representative of IgM positive, IgM negative, and uninfected healthy states. Conclusion Our results suggest the utility of an integrated approach involving dysregulated microbiome-immune axis for gaining a better understanding of pathogenesis associated with HCMV infection in NC. Graphical Abstract

Abstract Background Collection and use of sociodemographic data (SDD), including race, ethnicity and income, are foundational to understanding health inequities. Ontario’s public health units collected SDD as part of COVID-19 case management and vaccination activities. This research aimed to identify enablers and barriers to collecting SDD during COVID-19 case management and vaccination. Methods As part of a larger mixed-method research study [1], qualitative methods were used to identify enablers and barriers to SDD collection during the COVID-19 pandemic. Purposive sampling was used to recruit participants from Ontario’s 34 public health units. Sixteen focus groups and eight interviews were conducted virtually using Zoom. Interview data were transcribed and analyzed using inductive and deductive qualitative description. Results SDD collection enablers included: legally mandating SDD collection and having dedicated data systems, technological and legal supports, senior management championing SDD collection, establishing rapport and trust between staff and clients, and gaining insight from the experiences from local communities and other jurisdictions. Identified barriers to SDD collection included: provincial data systems being perceived as lacking user-friendliness, SDD collection “was not a priority,” time and other constraints on building staff and client rapport, and perceived discomfort with asking and answering personal SDD questions. Conclusion A combination of provincial and local organizational strategies including supportive data systems, training, and frameworks for data collection and use, are needed to normalize and scale up SDD collection by local health units beyond the context of the COVID-19 pandemic.

Background The rural–urban healthcare disparity in India was exacerbated during the COVID-19 pandemic, with the second wave hitting rural areas particularly hard due to weak infrastructure. A study in Chhattisgarh aims to explore the experiences of severely ill COVID-19 survivors and caregivers to inform patient-centric care delivery in primary settings. Methods In this qualitative study, we conducted in-depth interviews with seven patients and seven caregivers during home visits or telephonically to understand lived experiences of receiving care for COVID-19 in an ICU in the public health system. Socioecological model was used to guide the qualitative inquiry. Results COVID-19 patients faced stigma due to their diagnosis. The survivors felt lonely due to isolation, uncertainty about their illness, and fear of death. Poor mental health during ICU stay affected their physical health. Patients with caregivers felt supported despite visitor restrictions. Transparent communication with health providers reduced distress. Conclusion The study in Chhattisgarh, India, highlights ICU survivors’ and caregivers’ experiences, revealing fear and loneliness among patients. Effective communication and caregiver presence improve outcomes, emphasizing holistic support. There’s an urgent need for palliative care integration, caregiver inclusion, and comprehensive post-discharge follow-up by primary-level practitioners in rural settings. Lack of state-level palliative care policy emphasizes the need for comprehensive initiatives to enhance healthcare outcomes.

Scurvy is often considered a disease of the past and well described in children with neurodevelopment and autistic spectrum disease. Clinicians overlook the diagnosis of scurvy, leading to unwarranted laboratory investigations and, unfortunately, significant delays in diagnosis. This study aims to describe 10 cases of scurvy in a tertiary hospital setup with their clinical profile, comorbidities, radiological, and subsequent disease course in children presenting to the pediatric rheumatology department at Amrita Hospital, Kochi, from 2017 to 2022. Demographic, imaging, and associated comorbid conditions including neuropsychiatric abnormalities were documented. They were all reviewed in 2 weeks for improvement of symptoms. A total of 10 children (3 females) were included in this study. The disease manifested predominantly in early childhood (median age: 5.5 years). All patients had unexplained bone pain and inability to bear weight. The referral diagnosis of 8/10 patients was juvenile idiopathic arthritis. Two patients had autism as a comorbidity. Selective eating habits and food faddism were present in 2/10 children. All patients have made a full functional recovery at review. All patients had imaging findings suggestive of scurvy. Pediatricians and rheumatologists alike must consider scurvy in a child with unexplained bone pain and symptoms masquerading as primary rheumatological diseases. Selective eating habits need to be treated with timely and appropriate psychological rehabilitation and dietary education. Resolution of symptoms and radiographic features with vitamin C supplementation is the strongest evidence for scurvy.

Background The presence of dental caries may have a negative impact on well-being of children and their parents, causing pain and discomfort, leading to poor oral health-related quality of life (OHRQoL) in them. The objective of this study was to evaluate the impact of different levels of caries experience on the OHRQoL of pre-school children and their families in Odisha, assessed using Odia version of Early Childhood Oral Health Impact Scale (Od-ECOHIS). Methodology A cross-sectional survey was carried out on a sample of 369 pre-school children using Od-ECOHIS. Dental caries was recorded using International Caries Detection and Assessment System (ICDAS) index. Result The total score of ECOHIS ranged from 0 to 42 with a mean of 2.4 (±5.3) and a median score of 0. The items bearing high mean scores in the child impact section were related to “pain”, “difficulty in drinking hot or cold beverages”, “difficulty in eating some food”, and “irritable or frustrated”. Though half of children (50.4%) had cavitated carious lesions, the prevalence of negative impact was 30.6%. Compared to the child being caries-free, the expected count of total Od-ECOHIS score increased by 1.54 times if the child had white spot lesion and 1.94 times if the child had a cavitated lesion. Conclusion Presence of dental carious lesions has a significant impact on OHRQoL of pre-school children and their families measured by using Od-ECOHIS even after adjusting for SES and caregivers’ perception of their children’s oral health.

Aim: This study aimed to evaluate the effectiveness of a tailored progressive dietary intervention against the standard care instructions on the nutritional status and nutrient intake in geriatric patients receiving new complete dentures. Settings and Design: Randomized controlled trial. Materials and Methods: A randomized controlled trial was conducted on completely edentulous patients seeking complete dentures. The participants were randomly allocated into two groups, and each group received a separate set of advice. The cognitive function was assessed using the mini–mental state examination (MMSE) form. The outcome measures were assessed at the baseline and 3 months after denture insertion. The Mini Nutritional Assessment (MNA) form was used to evaluate the nutritional status and the nutrient intake was calculated by a 3-day 24-h dietary recall and fed into the DietCal software. Statistical Analysis Used: The analysis was done using the independent sample t-test, paired sample t-test, and analysis of co-variance. The significance level was set at 0.05 for all tests. Results: In total, 68 participants completed the trial. There were no significant differences in food intake between the two groups at baseline. However, at 3-month follow-up, the intervention group displayed a statistically significant improvement in body mass index (BMI) compared to the control group. Although the nutrient intake such as protein, dietary fiber, total fat, calcium, carbohydrate, energy, iron, and Vitamin B12 was higher in the intervention group than in the control group, it was not statistically significant. Conclusion: Simple, tailored dietary intervention with prosthetic restoration of the edentulous patients significantly improved BMI and MNA scores.

Abstract The effects of classical music on psychophysiological parameters are not well understood. This study aimed to investigate the impact of listening to raga Bhairavi, an Indian Classical Music for six days on anxiety, stress, depression, and heart rate variability (HRV) parameters. Forty-four individuals were randomly assigned to either the intervention group (VR-raga), where they listened to raga Bhairavi via 360° video in a virtual reality environment, or the control group, where there was no exposure to raga Bhairavi for six days. Before allocation, the HRV baselines (relax-baseline and stress-baseline) were recorded on the first day. On the first and sixth days of the intervention, HRV was monitored, and the Depression, Anxiety, and Stress Scale (DASS-21) questionnaire was administered before and after the intervention. After six days, all DASS-21 subscales were significantly reduced in the VR-raga group. A similar trend was observed in the seven HRV parameters evaluated in this study, which demonstrated reduced physiological stress and enhanced autonomic balance following the six-day intervention. The findings collectively indicated the efficacy of the VR-based raga Bhairavi intervention in reducing psychological stress markers and highlighted the potential applications of utilizing the VR-based raga intervention for improving mental well-being in the real-world context.

Background: Hypertension is one of the main factors contributing to the global burden of non-communicable diseases. Previous research has revealed that stress, bad lifestyle choices and a lack of knowledge about the disease are the main causes of hypertension that can be controlled. The key cause behind the prevalence of the condition is the lack of medication adherence by patients. This study aims to evaluate medication adherence in patients with hypertension through the Morisky Medication Adherence Scale (MMAS) and to observe any adverse drug reaction leading to non-adherence of medications. Methods: A descriptive, cross-sectional study was conducted on 124 patients who attended the outpatient department of medicine. The descriptive tools were MMAS and causality scales for adverse drug reactions. Result: The mean MMAS score was 5.20±1.29. Amongst the demographic profile, age, sex, comorbidities and duration of disease were significantly associated with decreased mean MMAS scores. Forty-two patients experienced drug reactions and only four patients were adherent to their medications. Conclusion: Our study suggests that patients were poorly adherent to their medications. Effective interventions should be considered to improve adherence in patients. Monitoring for adverse drug reactions can lead to improved patient outcomes, whilst interventions to improve adherence can lead to better blood pressure control and reduced risk of cardiovascular events.

Abstract The study reports on the magnetization, magnetoresistance, and transport properties of superparamagnetic 10% Co-doped Ni/NiO (C10-NN), Graphene Oxide (GO) incorporated 10% Co-doped Ni/NiO (C10-NNG), and 15% Co-doped Ni/NiO (C15-NN) nanoparticles synthesized via a microwave-assisted sol-gel auto-combustion method. All samples show hysteresis in negative Magnetoresistance (M-R) at different temperatures. Resistivity ρ(T) versus temperature plots of samples C10-NN and C15-NN show metallic behavior with applied fields of 0, 1, 5, 8 T, and at 0 T, 1 T respectively. However, the plot of R-T of the C15-NN sample shows a significant difference at 0 T and 1 T. At 0 T for this sample, the metallic behavior is observed for temperature T > TM, with the resistivity falling abruptly at and above TM = 246 K. The resistivity decreases with increasing temperature, exhibiting metallic behavior again above TMM

Abstract Background Cancer poses a significant public health challenge in India, making it crucial to predict its future impact for effective healthcare planning. This study forecast cancer incidence, mortality, and disability-adjusted life years (DALYs) in India from 2022 to 2031. Methods We extracted age-standardized data on incidence, prevalence, DALYs, and mortality from 1990 to 2021 from the Global Burden of Disease (GBD) study. We used Decadal Average Percentage Change techniques to identify trends in cancer burden over decades and the Autoregressive Integrated Moving Average (ARIMA) method were used for forecasting. The ARIMA (2,2,2) model was identified as the best for predicting cancer incidence, ARIMA (0,3,3) for DALYs, and ARIMA (0,2,2) for mortality. Results The cancer incidence rate is expected to rise from 529.40 (95% CI: 525.41-533.38) in 2022 to 549.17 (95% CI: 487.43-610.92) per 100,000 population in 2031. The DALYs rate is projected to decrease from 2001.53 (95% CI: 1964.24-2038.82) in 2022 to 1842.08 (95% CI: 1273.57-2410.60) per 100,000 population in 2031, indicating improvements in cancer burden management. Mortality rates are forecasted to increase slightly, from 71.52 (95% CI: 69.91–73.12) in 2022 to 73.00 (95% CI: 60.88–85.11) per 100,000 population in 2031. Overall, while incidence and mortality rates show a slight upward trend, the DALYs rate is projected to decrease, reflecting potential advancements in cancer management and treatment over the forecast period. Conclusions Over the next decade, cancer incidence and mortality are expected to increase in India, highlighting the need for enhanced prevention, early detection, and proper treatment strategies. Despite these increases, the anticipated decrease in DALYs suggests potential advancements in cancer management, warranting further investigation into the drivers of this positive trend and measures to sustain it.

Introduction: Due to bony changes and narrow lumbar interspinous spaces, performing a neuraxial block becomes difficult in older patients undergoing lower limb arthroplasties. Aim: To formulate a difficulty predictor score (MUSG score) for anticipating difficult Central Neuraxial Blocks (CNB) and to compare lumbar spine radiological findings with clinical findings. Materials and Methods: A cross-sectional study was conducted on 166 patients admitted for knee or hip arthroplasties from March 2023 to March 2024 in the main operation theatre complex of a tertiary care hospital. All patients were advised to get X-rays of the lumbosacral spine in both anteroposterior and lateral views before surgery. The total difficulty predictor score was calculated from the X-rays based on the presence or absence of scoliosis, bony osteophytes, angulation of spinous processes, calcification of the ligamentum flavum, and the ratio of inner and outer visible interspinous space. The minimum score was 5 and the maximum was 12. The individual score at each interspinous level was calculated and selected the space with the minimum score for the CNB. A comparison was also made with the clinically selected best space, which was identified using the traditional palpation technique. A block was labeled difficult if there were more than two attempts for spinal and epidural block, respectively. All collected data were entered into a Microsoft Excel sheet and analysed using Microsoft Excel software. Results: The study patients had a mean age of 59.83 years. The total difficulty predictor score (MUSG Score) of the lumbar spine was 5 in 3 patients (1.8%), 6-9 in 140 patients (84.3%), and ≥10 in 23 patients (13.9%). However, the minimum score at the best interspinous space was 5 in 15 patients (9%), 6-9 in 151 patients (91%), and none had a score of 10 or more. From radiological imaging, the spaces with minimal scores were in the order of L2-L3 (76), L3-L4 (62), and L1-L2 (28); while on clinical examination, they were – L2-L3 (96), L3-L4 (43), L1-L2 (23). The difference between the two was statistically significant (p-value

Abstract Background Understanding the level of exposure to Lassa virus (LASV) in at-risk communities allows for the administration of effective preventive interventions to mitigate epidemics of Lassa fever. We assessed the seroprevalence of LASV antibodies in rural and semiurban communities of two cosmopolitan cities in Nigeria with poorly understood Lassa epidemiology. Methods A cross-sectional study was conducted in ten communities located in the Abuja Municipal Area Council (AMAC), Abuja, and Ikorodu Local Government Area (LGA), Lagos, from February 2nd to July 5th, 2022. Serum samples collected from participants were analyzed for IgG and IgM antibodies using a ReLASV® Pan-Lassa NP IgG/IgM enzyme-linked immunosorbent assay (ELISA) kit. A questionnaire administered to participants collected self-reported sociodemographic and LASV exposure information. Seroprevalence of LASV IgG/IgM was estimated overall, and by study site. Univariate and multivariate log-binomial models estimated unadjusted and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CI) for site-specific risk factors for LASV seropositivity. Grouped Least Absolute Shrinkage and Selection Operator (LASSO) was used for variable selection for multivariate analysis. Results A total of 628 participants with serum samples were included in the study. Most participants were female (434, 69%), married (459, 73%), and had a median age of 38 years (interquartile range 28–50). The overall seroprevalence was 27% (171/628), with a prevalence of 33% (126/376) in Abuja and 18% (45/252) in Lagos. Based on site-specific grouped LASSO selection, enrollment in the dry season (vs. wet; aPR, 95% CI: 1.73, 1.33–2.24), reported inconsistent washing of fruits and vegetables (aPR, 95% CI: 1.45, 1.10–1.92), and a positive malaria rapid test (aPR, 95% CI: 1.48, 1.09-2.00) were independently associated with LASV seropositivity in Abuja, whereas, only a self-reported history of rhinorrhea (PR, 95% CI: 2.21, 1.31–3.72) was independently associated with Lassa seropositivity in Lagos. Conclusions The LASV seroprevalence was comparable to that in other areas in Nigeria. Our findings corroborate those from other studies on the importance of limiting human exposure to rodents and focusing on behavioral factors such as poor hygiene practices to reduce exposure to LASV.

Abstract Catalytic asymmetric synthesis of polysubstituted chiral cyclopropane presents a significant challenge in organic synthesis due to the difficulty in enantioselective control. Here we report a rhodium-catalyzed highly chemo-, regio- and enantioselective hydroformylation of trisubstituted cyclopropenes affording chiral quaternary cyclopropanes. Importantly, the easy made sterically bulky ligand L1 can effectively suppress hydrogenation and decomposition reactions and give quaternary cyclopropanes with high regio- and enantioselectivities for both aryl and alkyl functionalized substrates. Control experiments and computational studies reveal the sterically hindered well-defined chiral pocket instead of the substrates bearing electron-withdrawing diester groups is important for controlling the enantioselectivity and regioselectivity. Scale-up reaction and follow-up diverse transformations are also presented. Density Functional theory (DFT) computations suggest that the regio- and enantio-selectivities originate from the cyclopropene insertion to the Rh-H bond. The high regioselectivity is found to benefit from the presence of more efficient noncovalent interactions (NCIs) manifesting in the form of C–H···Cl, C–H···N, and l.p(Cl)···π contacts.

Celiac disease is a unique enteropathic immune disorder and is now considered a distinct disease entity with protein manifestation and worldwide distribution. The deposition of immune complexes in the small intestine could be a possible reason for the extraintestinal autoimmune manifestations of Celiac disease. Pericardial effusion, though rare in adults, is likely a result of these autoimmune disorders related to Celiac disease. In present study case report, the authors present the case of a 67-year-old female patient with generalised oedema, anasarca, and pitting oedema in the lower extremities. Due to multiple episodes of vomiting, upper gastrointestinal endoscopy was performed, which revealed atrophic duodenal mucosa, and duodenal biopsies were taken from the second part of the duodenum (D2 biopsies). The possibility of Celiac disease was considered, and anti-deamidated gliadin peptide, Immunoglobulin A (IgA), and Immunoglobulin G (IgG) antibodies were sent. Celiac disease was diagnosed based on elevated serum levels of anti-deamidated gliadin peptide, IgA, and IgG antibodies, as well as histologic findings in the small bowel (duodenal biopsies D2). During the thorough evaluation, pericardial effusion was incidentally detected. Celiac disease is an autoimmune disorder in which exposure to gluten triggers inflammation in genetically predisposed individuals. The illness is estimated to have a prevalence of 2%, and most affected people remain undiagnosed. Pericardial effusion is a possible manifestation of Celiac disease, but there is currently no evidence that the disease directly causes the effusion.

Eosinophilia can be due to both infectious and non-infectious causes, many of which may be clinically indistinguishable. Filariasis, a tropical and subtropical infection, is caused by Wuchereria bancrofti, Brugia timori (B. timori), and Brugia malayi. Filariasis is conventionally diagnosed by demonstration of microfilaria in the peripheral blood smear. The disease may be missed if one is not aware of the possibility. We report two cases in two individuals with eosinophilia due to filaria resulting in tropical pulmonary eosinophilia and deep vein thrombosis (DVT). They had complete symptomatic improvement after a 3-week course of diethylcarbamazine (DEC) +/- ivermectin.

BackgroundNeurological disorders are a major global health concern, especially in BRICS nations (Brazil, Russia, India, China, South Africa), where demographic and socio-economic changes have amplified their impact. This study evaluates trends in incidence, prevalence, mortality, and Disability-Adjusted Life Years (DALYs) associated with neurological diseases in these countries from 1990 to 2021, focusing on sex disparities and key risk factors.MethodsData were obtained from the Global Burden of Disease (GBD) 2021 database. Join point regression and Estimated Annual Percentage Change (EAPC) analyses were used to assess trends in neurological disease burden. Age-standardized rates for incidence, prevalence, and mortality were calculated, along with DALYs, and key risk factors were analyzed.ResultsChina showed the largest increase in incidence (7541.89 to 8031.37 per 100,000) and prevalence (26494.85 to 28534.79 per 100,000). Mortality increased in India (21.01 to 24.27 per 100,000) and South Africa (27.66 to 30.65 per 100,000), while China showed a decline (39.59 to 37.30 per 100,000). Brazil experienced a substantial rise in DALYs (1610.65 to 42024.59). Sex disparities showed higher DALY rates for females across all nations.ConclusionThe research highlights the rising burden of neurological disorders in BRICS nations, especially in China and Brazil due to aging populations and metabolic risks. It emphasizes the need for targeted interventions in India and South Africa, where increasing mortality rates and DALYs are concerning. Effective health policies should focus on early detection, managing metabolic risks, and implementing sex-specific strategies to address these issues.

Background: Psoriasis is a chronic, non-communicable condition of the skin with an immune-mediated etiology. Periodontitis is a chronic inflammatory disease of the tooth-supporting tissues and is now recognized as an established risk factor for various systemic diseases. The present observational study aims to assess the prevalence of periodontitis and its related indices in individuals with psoriasis and to compare them with individuals without psoriasis. A cross-sectional case-control study was performed in a hospital setting, including 200 diagnosed cases of psoriasis and 200 age- and sex-matched healthy controls. Methods: The case group included patients diagnosed with psoriasis (defined as ICD-10 L40.0-L40.9) by a trained dermatologist. Controls included age- and sex-matched healthy individuals. After history-taking, a detailed dermatological and periodontal examination was done for all the enrolled subjects. The results were statistically analyzed using SPSS software. Results: The study group had a significantly higher mean GI, PI, PPD and CAL in comparison to the controls. Psoriasis patients had significantly greater scores for GI and PI (1.68 ± 0.61 and 1.57 ± 0.54, respectively) as compared to controls (1.48 ± 0.56 and 1.39 ± 0.60, respectively). Periodontitis was also found to be more prevalent among the cases. Stage II and Stage III periodontitis were found in 41.0 % of cases and 30.5 % of controls, while 12.5 % of cases and 6.0 % of controls had stage IV periodontitis. This difference was statistically significant. Conclusion: An association between psoriasis and periodontitis was found in the present study, as the individuals with psoriasis had a higher severity and prevalence of periodontitis.

Background: The coronary arteries, being the major vascular channels, are known to affect the complete circulatory system and hemodynamics of the body. However, as a matter of fact, the coronary arteries are known to have many anatomical and developmental variations along all the morphological aspects, which include location of orifices, various routes that the artery and its tributaries follow, and of course, the pattern of branching of the main artery. The developmental anomalies in the arterial structures result in abnormalities of arterial blood flow, hypoxia, and other conditions which may lead to atherosclerosis of the coronary artery. To the best of our knowledge, the current systematic review and meta-analysis aim to assess the association between variations in the branching pattern of the coronary artery. Moreover, we propose future studies to assess the association and preventive strategies for clinicians and various health-care workers. Methodology: We performed an electronic search of PubMed, MEDLINE, Cochrane Central Register, EMBASE, Science Citation Index, Web of Science, and Database of Abstracts of Reviews of Effects, and various clinical tribulation registries till 2022. Two independent reviewers extracted the data, and the present meta-analysis was performed with the help of RevMan version 5.4. For the present meta-analysis, we used 10-year database from 2012 to 2022. Results: Appropriate data were fetched from studies that were included for the meta-analysis, and the data were presented in tables for evaluation and drawing of accurate results. A total of 904 articles were found after searching all of the major medical databases. Thirteen more sources of reference were included in the search. After primary screening, full text articles of around 148 were analyzed, and among them, 114 were excluded because those articles were in the category of #case series, reports, or #letters to the editors, #animal studies or #irrelevant documents, reporting duplicate documents, or broadcasting a certain variant as opposed to occurrence. After the complete screening and analysis of the data were done, the final number of articles that were included in the meta-analysis was 29 (n = 29). Conclusion: The present meta-analysis is an attempt to review and analyze the recent literature published on the variation in anatomy and developmental abnormalities of the coronary arteries in the differing population across the geography of the globe. The structural aspects of the coronary arteries, and not just the lifestyle issues, are the ones which are associated with coronary artery disease (CAD), a major cause of mortality in the population. However, the anatomical factors are not attending limelight as other obesity- or age-related issues for the same. Hence, the present review aimed to deliver a thorough understanding of the most predominant branching pattern of the coronary artery seen among Asian population. This study will be beneficial to cardiologists and radiologists when performing various treatments such as coronary angiograms, coronary angioplasty, bypass grafting, and other medical procedures and can also lead to prevention of the CAD.

A conjunctival cyst is a slow-growing benign lesion that forms beneath or on the conjunctiva. Inclusion cysts contribute to most cases, more commonly secondary than primary. In an inflamed inclusion cyst, inflammatory features may or may not be seen clinically but can be confirmed on histopathological evaluation after surgical excision of the cyst. Removal of the cyst surgically with complete cyst wall excision is desirable in all conjunctival cysts. We report a giant conjunctival inclusion cyst in a 44-year-old female with no history of trauma or surgery. The patient had a history of a tiny cyst present since childhood and was found to enlarge gradually to the present size in the last 4 months. The cyst was excised entirely without rupturing the wall. Histopathology of the excised tissue showed a thin-walled cystic structure lined by nonkeratinized epithelium stratified at places. The wall was composed of fibrocollagenous tissue infiltrated by sparse inflammatory cells with a predominance of lymphocytes forming lymphoid nodules. The histological diagnosis was consistent with a conjunctival inclusion cyst. Primary inclusion cysts are mostly present since childhood and often remain asymptomatic. The size may later increase and become symptomatic when triggered by some factors like trauma, infection, inflammation, and drugs.

Background: An aging population ultimately has deprived physiological stores making them vulnerable for development of a syndrome called frailty, which presents with a cumulative decrease in tolerance, immunity, vision, balance, organ functions, health, and independent living. All these result in rising prevalence of frailty and its components, along with burden of disease, dependence, and health care cost. Thus, early estimation and assessment and interventions to correct it mark the mile stone in geriatric medicine. The present study was conducted with an aim to compare and correlate FIRE-MADE (Frailty Index in Rural Elderly – Mental status, Activities of daily living, Depression, and Events) FI (frailty index) with LASA (Longitudinal Aging Study Amsterdam) FI in central rural India’s geriatric population. Methodology: A cross-sectional study for assessment of frailty in the geriatric population of central rural India, reporting to the medicine department of a tertiary hospital, situated at Wardha district, by using FIRE-MADE and LASA FI was undertaken. Their scores were compared. The efficiency of FIRE-MADE FI in comparison with LASA FI was calculated. A frailty threshold of ≥ 0.25 is considered for diagnosing frailty. Standard descriptive and inferential statistics were used to evaluate all parametric and non-parametric data. Results: Out of 250 geriatric people, 224 (89.6%) were frail according to LASA FI and 204 (81.6%) were frail according to FIRE-MADE FI. As compared to LASA FI, FIRE-MADE FI was 91.07% sensitive and 73.08% specific, with a positive predictive value of 96.68% and a diagnostic accuracy of 89.20%. Conclusion: The Indian rural population of central India has high prevalence of frailty. FIRE-MADE FI can be used as a potential, effective, and validated tool for early diagnosing and management of frailty. Among the parameters of FIRE-MADE FI, IHD was the most important contributing factor for development of frailty, followed by cognitive impairment, polypharmacy, and remaining factors mentioned in FIRE-MADE FI.

Background: Existing literature does not account for food choice motives associated with the non-communicable disease risk factor of an unhealthy diet, primarily characterised by inadequate fruit and vegetable consumption, among adults residing in Kochi Municipal Corporation. Our study aims to measure the prevalence of inadequate fruit and vegetable consumption in this urban population and to identify priority food choice motives among individuals at risk. Methods: A community-based cross-sectional study was conducted among 300 adults (mean age 46 years, men 50%) selected by cluster sampling. Information on socio-demographic variables, diet, and food choice motives was collected through a pre-tested structured interview schedule. Binary logistic regression analysis was done to identify factors associated with inadequate fruit and vegetable consumption. Results: In our study, 86% (95% CI: 82.07-89.93) of participants reported inadequate fruit and vegetable consumption. The food choice motives of “price” [aOR 2.99, 95% CI: 1.32–6.78], “health” [aOR 2.56, 95% CI: 1.08–6.24], and “sensory appeal” [aOR 2.20, 95% CI: 1.06–4.56] were found to be significantly associated with inadequate fruit and vegetable consumption per day (P < 0.05). Conclusion: The high prevalence of inadequate fruit and vegetable consumption in this urban community necessitates targeted and comprehensive educational campaigns that highlight the health benefits and sensory appeal of fruits and vegetables, as well as the affordability of seasonal produce, to ensure adequate intake of these foods.

Introduction: Sex determination is a critical step in the identification of individuals in forensic medicine. Cone beam computed tomography (CBCT) is an excellent tool for analyzing the volume of paranasal sinuses that can be used for sex determination. Aim: To measure and compare sexual dimorphism in the bizygomatic distance and the volumes of the maxillary and sphenoidal sinuses on CBCT images and evaluate their significance in sex determination. Materials and Methods: A retrospective study was conducted using 102 CBCT scans, which were analyzed using ITK-SNAP software to determine the volumes of the maxillary sinus and sphenoidal sinuses. The bizygomatic width was measured in the axial section. The differences in the volumes of the maxillary and sphenoidal sinuses and bizygomatic width were assessed for their significance in sex determination. The study population was divided into male and female groups (51 males and 51 females). The age range was 20–75 years. Statistical analysis was conducted using independent t-tests and discriminant functional analysis. Results: Statistically significant differences were observed in bizygomatic width, right maxillary sinus volume, left sphenoidal sinus volume, total maxillary sinus volume, and total sphenoidal sinus volume (P < 0.05). Conclusion: Adult paranasal sinus volumes and bizygomatic width analyzed using CBCT may be useful for sex determination in forensic investigations.

Abstract Background Mpox is a severe viral zoonosis that has emerged as a public health concern due to its potential for human-to-human transmission and severe illness. Understanding its clinical manifestations is crucial for effective management and control. Several systematic reviews have assessed various manifestations of Mpox. This umbrella review synthesizes evidence on Mpox’s manifestations across different organ systems. Method We conducted an umbrella review, adhering to Joanna Briggs Institute (JBI) methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, focusing on systematic reviews of Mpox manifestations. We performed a literature search up to 25th September 2023, in databases like PubMed, Embase, and Web of Science. We included systematic reviews of observational studies, case reports, case series, or RCTs reporting any manifestations of Mpox in humans, focusing on a global scope. AMSTAR 2 was used to evaluate the quality of systematic reviews, and data has been synthesized in narrative and tabular manners. Results A total of 25 systematic reviews were included, uncovering diverse manifestations of Mpox, such as cutaneous, cardiovascular, oral, ophthalmic, gastrointestinal, respiratory, and pregnancy-related. Cutaneous manifestations (up to 100%) were the most prevalent, featuring lesions and rashes. Constitutional symptoms of viral illness were reported in ~ 60% to > 85% of the cases. Significant respiratory symptoms were present in ~ 50% of cases overall. Headaches were the leading neurological symptom present in > 30%. Symptoms of gastrointestinal involvement ranged from 39% (oral lesions) with decreasing frequency to low diarrhea at ~ 5%, with proctitis percentages ranging from high teens to mid-twenties. Ophthalmic manifestations (6% but with wide variations among studies). Many primary studies included in the systematic reviews consisted of case reports and case series. A wide range of manifestations across different organ systems was observed. Negative outcomes for pregnancies were reported, but evidence is limited. Adverse cardiovascular and neurological outcomes were identified, though only a few studies provided insights into these findings. Conclusion Mpox exhibits diverse manifestations, impacting multiple organ systems, with substantial variations. The findings highlight the importance of ongoing, nuanced, and region-specific research and management strategies for Mpox. The reliance on case reports and series underscores the need for more high-quality, long-term studies to deepen our understanding and management of this significant public health concern.

Abstract A genomic database of all Earth’s eukaryotic species could contribute to many scientific discoveries; however, only a tiny fraction of species have genomic information available. In 2018, scientists across the world united under the Earth BioGenome Project (EBP), aiming to produce a database of high-quality reference genomes containing all ~1.5 million recognized eukaryotic species. As the European node of the EBP, the European Reference Genome Atlas (ERGA) sought to implement a new decentralised, equitable and inclusive model for producing reference genomes. For this, ERGA launched a Pilot Project establishing the first distributed reference genome production infrastructure and testing it on 98 eukaryotic species from 33 European countries. Here we outline the infrastructure and explore its effectiveness for scaling high-quality reference genome production, whilst considering equity and inclusion. The outcomes and lessons learned provide a solid foundation for ERGA while offering key learnings to other transnational, national genomic resource projects and the EBP.

Abstract The distinction between separate primary lung carcinomas (SPLCs) and intrapulmonary metastases (IPMs) is crucial to accurate cancer staging. Histopathology‐based classification cannot always determine the relatedness of multiple tumors taken from the lung. Recently, next‐generation sequencing (NGS) has been used for biomarker determination, but it also has the potential to inform clonality determination among multiple tumors. Here we present a patient with three lung tumors, each diagnosed as adenocarcinoma by histopathology with a differential diagnosis of SPLC versus IPM. We pursued molecular profiling by NGS, which revealed three unique mutational patterns ruling out the possibility of clonal relatedness among the cancers. Our case supports the utility of NGS in supplementing histopathological methods to distinguish between SPLCs and IPMs and to guide treatment decisions.

Abstract Building capacity for Health Policy and Systems Research (HPSR) is critical for advancing the field in lower- and middle-income countries (LMICs). The India HPSR fellowship program is a home-grown capacity-building initiative, anchored at the Health Systems Transformation Platform (HSTP), New Delhi, and developed in collaboration with a network of institutes in India and abroad. In this practice-oriented commentary, we provide an overview of the fellowship program and critically reflect upon the learnings from working with three cohorts of fellows between 2020 and 2023. This commentary draws on routine program documentation (guidelines, faculty meeting reports, minutes of meetings of curricula and course development) as well as the perspectives of faculty and program managers associated with the fellowship. We have had several important learnings in the initial years of program implementation. One, it is important to iteratively modify globally available curricula and pedagogies on HPSR to suit country-specific requirements and include a strong component of ‘unlearning’ in such fellowships. Secondly, the goals of such fellowship programs need to be designed with country-specific contextual realities in mind. For instance, should publication of fellows’ work be an intended goal, then contextual deterrents to publication such as article processing fees, language barriers and work-related obligations of faculty and participants need to be addressed. Furthermore, to improve the policy translation of fellows’ work, such programs need to make broader efforts to strengthen research–policy–practice interfaces. Lastly, fellowship programs are cost-intensive, and outputs from them, such as papers or policy translation, are less immediate and less visible to donors. In the absence of these outputs, consistent funding can be a roadblock to sustaining these fellowships in LMICs. The experience of our fellowship program suggests that LMIC-led capacity-building initiatives on HPSR have the potential to influence changes in health systems and build the capacity of researchers to generate evidence for policy-making. The sharing of resources and teaching material through the fellowship can enable learning for all institutions involved. Furthermore, such initiatives can serve as a launchpad for the creation of regional and international HPSR communities of practice, with a focus on LMICs, thereby challenging epistemic injustice in teaching and learning HPSR.

Biogenic synthesis of papain-conjugated copper metallic Nanoparticles and their antibacterial and antifungal activities Papain metallic conjugated nanoparticles (Papain-CuNPs) were synthesised using Papain and CuSO4.5H2O. Papain-CuNPs were characterized using UV-visible spectroscopy, FT-IR, HR-TEM, XRD, FE-SEM, zeta potential, and a zeta sizer. The antibacterial activity of papain-CuNPs against human infectious microorganisms (Citrobacter spp, Pseudomonas aeruginosa and Candida albicans) was investigated. The mechanism of action of papain-CuNPs was evaluated using FE-SEM and HRTM. UV spectroscopy confirmed the plasma resonance (SPR) at 679 nm, which indicated the formation of papain-CuNPs. The FT-IR spectrum absorbance peaks at 3927, 3865, 3842, 3363, 2978, and 2900 cm-1 indicate the presence of O-H and N-H of the secondary amine, and peaks at 1643 and 1572 cm-1 represent C=O functional groups in Papain-CuNPs. EDAX analysis confirmed the presence of copper in the papain-CuNPs. The zeta potential (-42.6 mV) and zeta size (99.66 d. nm) confirmed the stability and size of the nanoparticles. XRD confirmed the crystalline nature of the papain-CuNPs. FE-SEM and HRTM showed an oval structure, and the nano particles' 16.71244–34.84793 nm. The synthesized papain-NPs showed significant antibacterial activity against clinical P. aeruginosa (15 mm). MIC 125 µg/ml) showed bactericidal activity against P. aeruginosa and the mechanism of action of Papain-NPs was confirmed using an electron microscope by observing cell damage and cell shrinking. Papain-CuNPs have significant antibacterial activity and are thus used in the treatment of P. aeruginosa infections

This study explores the influence of infill patterns on machine acceleration prediction in the realm of three-dimensional (3D) printing, particularly focusing on extrusion technology. Our primary objective was to develop a long short-term memory (LSTM) network capable of assessing this impact. We conducted an extensive analysis involving 12 distinct infill patterns, collecting time-series data to examine their effects on the acceleration of the printer’s bed. The LSTM network was trained using acceleration data from the adaptive cubic infill pattern, while the Archimedean chords infill pattern provided data for evaluating the network’s prediction accuracy. This involved utilizing offline time-series acceleration data as the training and testing datasets for the LSTM model. Specifically, the LSTM model was devised to predict the acceleration of a fused deposition modeling (FDM) printer using data from the adaptive cubic infill pattern. Rigorous testing yielded a root mean square error (RMSE) of 0.007144, reflecting the model’s precision. Further refinement and testing of the LSTM model were conducted using acceleration data from the Archimedean chords infill pattern, resulting in an RMSE of 0.007328. Notably, the developed LSTM model demonstrated superior performance compared to an optimized recurrent neural network (RNN) in predicting machine acceleration data. The empirical findings highlight that the adaptive cubic infill pattern considerably influences the dimensional accuracy of parts printed using FDM technology.

A commonly accepted standard protocol for noninvasive techniques for the genetic evaluation of an embryo remains elusive due to inconclusiveness regarding the volume of spent media to be acquired and the possibility of acquiring the same for subsequent analysis. Single embryo culture is imperative for standardizing noninvasive preimplantation testing using cell-free DNA (cf-DNA) released by individual developing embryos. This study aims to compare the development dynamics of single-drop embryonic culture against with group embryonic culture to establish a standardized protocol for noninvasive Preimplantation Genetic Testing (PGT) in bovine. A total of 239 cumulus–oocyte complexes were aspirated and subjected to in vitro maturation and fertilization. Among these, 120 embryos of day 3 were transferred to single-drop culture until the blastocyst stage. The single-drop culture drops were prepared using microdrops of 30 μL. At the blastocyst stage, spent media from all single-drop embryos were utilized for extracting cell-free genomic DNA to standardize the protocol. The blastocyst rate indicates no significant difference between the two culture methods, suggesting that single-drop culture is suitable for the process. Additionally, the extracted spent media yielded sufficient quantities of cf-DNA, supporting its potential use for PGT (p

Context: Peripheral nerve blocks are widely accepted as the gold standard for providing perioperative and postoperative analgesia in lower limb surgeries. Aims: This study aimed to determine which block is better in terms of onset of action among ultrasound-guided femoral nerve block (USG FNB) and ultrasound-guided fascia iliaca compartment block (USG FICB) for positioning for spinal anesthesia in patients operated for proximal femur fracture and find the total duration of analgesia, total consumption of rescue analgesics, and complications. Settings and Design: This was a prospective, randomized, comparative, interventional, single-blinded study. Subjects and Methods: Patients in Group A (n = 43) were administered USG FNB with 15 mL of 0.25% bupivacaine and patients in Group B (n = 43) were administered USG FICB with 30 mL of 0.25% bupivacaine. The primary objective was to find out which nerve block was better in reducing pain associated with a sitting position for spinal anesthesia, and the secondary objective was to find the difference in the mean time of first rescue analgesia. Statistical Analysis: Data analysis was done using the Student’s t-test and Chi-square tests. Results: Before block administration, patients in Group A had a Visual Analog Scale (VAS) score of 7.65 ± 0.75, and patients in Group B had a VAS score of 7.79 ± 0.74 (P = 0.389). The primary objective was to achieve VAS < 3. It was 3 min in Group A and 5 min in Group B (P = 001). The secondary objectives were the duration of postoperative analgesia in Group A was 330.58 ± 28.16 min and in Group B was 482.33 ± 19.89 min (P < 0.001). The mean value of tramadol consumption in 24 h in both the study groups was comparable (P = 1.000). The anesthesiologist satisfaction score, patient satisfaction score, and proportion of side effects in both study groups were comparable. Conclusion: USG FICB is more efficacious. Although the onset of action delays by 2 min, it provides longer postoperative analgesia compared to USG FNB.

The objective of nasoalveolar molding is to provide an approximation of lip and palatal segments, to reduce tension in the tissues in a nonsurgical way along with reshaping of gums, lips, and nostrils to give a symmetrical appearance, and help in narrowing the cleft width before surgery. The goal of this case report is to describe the use of a modified MU hook appliance in a case of a bilateral cleft lip and palate. This appliance aids in lengthening the columella and significantly improves the surgical outcome. This report also highlights the benefits, adjustments required, proper training for parents, and clinical management of the appliance.

Background and Introduction: Cleft lip and palate (CL/P) is one of the most common congenital anomalies which require multidisciplinary care. Patients with CL/P require appropriate corrective treatment to improve health, function, and esthetics. Knowledge about the various treatment procedures available and the timing of the procedures among pediatricians is vital for them to refer the patient at the correct stage to the appropriate specialist for the best possible rehabilitation. Aim: The aim of this study was to evaluate the knowledge and awareness of pediatricians about early interventions performed by pediatric dentists in the management of CL/P. Materials and Methods: A closed-ended questionnaire that included questions regarding the knowledge and awareness of obturators, lip taping, and nasoalveolar moldings was formulated. A questionnaire with 20 questions was circulated among the pediatricians through a web-based portal. Their knowledge and awareness about early interventions performed by pediatric dentists in the management of CL/P were assessed. Results: Results showed that out of 323 pediatricians who participated in the survey, 99.4% had heard of obturators. Awareness about lip taping was 78.3% while that of nasoalveolar molding was 55.1%. The benefits of the procedure and appliance were not well known. Conclusion: To improve the health, psychological, and social support of patients with CL/P, more awareness needs to be created among pediatricians regarding the management to provide better and timely oral rehabilitation.

Objective: To analyze the effectiveness of dexmedetomidine and fentanyl pre-medication, followed by infusion in modulating hemodynamic and neuro-endocrine responses to laryngoscopy and pneumoperitoneum during laparoscopic surgery. Methods: Forty adult patients were randomized into two groups. Before induction, group dexmedetomidine (group D) were given dexmedetomidine at 0.5 μgm/kg IV as loading over 10 min and infusion at the rate of 0.2 mcg/kg/hour during the surgical procedure. Group fentanyl (group F) were given 0.5 mcg/kg as loading over 10 min and infusion at the rate of 0.2 mcg/kg/hour during the surgical procedure. Hemodynamic parameters and blood glucose levels were pre-operatively monitored. Results: No significant differences were observed in the demographic profiles. There was a discernible difference in the heart rate compared to the pre-operative values in both groups. The systolic blood pressure was significantly lower in group D than in group F. There were no significant changes in the blood glucose levels during the intra-operative period, and the blood glucose levels remained low after extubation in group D (P = 0.0001). Conclusion: Dexmedetomidine causes greater attrition of the hemodynamic response to intubation and pneumoperitoneum during the peri-operative period and modulates the neuro-endocrine stress response, resulting in better hemodynamic stability.

Background and Aims: Preoperative parental anxiety can have a profound impact on their children undergoing surgery. The present study was done to analyse the correlation between preoperative parental anxiety and their child’s anxiety in paediatric patients undergoing elective surgery. Methods: Paediatric patients aged 2–12 years, scheduled for elective surgeries under general anaesthesia, were included in the study. The child’s behaviour and anxiety were assessed in the preoperative area using the modified Yale Preoperative Anxiety Scale (m-YPAS). The parent filled out the demographic questionnaire and the Spielberger State–Trait Anxiety Inventory (STAI) form in the preoperative area on the day of surgery. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) statistics software version 23.0 (IBM Corp, Armonk, NY, USA). Results: A total of 150 children undergoing elective surgery were analysed. Our results showed a strong positive correlation between a child’s m-YPAS and his/her parents’ anxiety on the day of the surgery (STAI-state) (r = 0.545, P < 0.001). However, the correlation between a child’s m-YPAS and his/her parents’ anxiety levels (STAI-trait) was not found to be significant (r = 0.109, P = 0.188). A positive correlation was observed between a parent’s STAI-state and STAI-trait (r = 0.366, P < 0.001). Factors like area of residence, type of surgery and previous hospitalisation had an influence on the anxiety levels of the child. The birth order of the child, previous hospitalisation and gender of the parent also influenced parental anxiety. Conclusion: Parental anxiety has a significant impact on the child’s anxiety during the preoperative period.

The subspecialty of obstetric anaesthesiology is different from other subspecialties in anaesthesiology in that, at any point of time, two lives are at stake, making drug errors particularly critical. This narrative review explores the incidence, contributing factors, and preventive strategies for medication errors in Obstetric Anaesthesia. Key contributors of medication errors include distractions, fatigue, look-alike/sound-alike drugs, lack of standardized protocols, poor communication strategies, inadequate training and education. Effective strategies for reducing errors include double-check procedures, bar-coded medication administration systems, implementing “Tall Man lettering for look-alike/sound-alike drugs, structured communication tools, continuous education and training. The review also introduces the mnemonic "SAFE-LABEL CHECK" to encapsulate best practices for minimizing drug errors. Future directions suggest integrating advanced technologies and fostering a multidisciplinary approach to enhance patient safety in obstetric anaesthesia.

Abstract Objective To identify variables associated with a patients’ ability to reproducibly hold their breath for deep-inspiration breath-hold (DIBH) radiotherapy (RT) and to develop a predictive model for DIBH eligibility. Methods This prospective, single-institution, IRB-approved observational study included women with left-sided breast cancer treated between January 2023 and March 2024. Patients underwent multiple breath-hold sessions over 2–3 consecutive days. DIBH waveform metrics and clinical factors were recorded and analysed. Logistic mixed modelling was used to predict DIBH eligibility, and a temporal validation cohort was used to assess model performance. Results In total, 253 patients were included, with 206 in the model development cohort and 47 in the temporal validation cohort. The final logistic mixed model identified increasing average breath-hold duration (OR, 95% CI: 0.308, 0.104–0.910. p = 0.033) and lower amplitude (OR, 95% CI: 0.737, 0.641–0.848. p