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Abstract Background There is limited understanding of how universal health coverage (UHC) schemes such as publicly-funded health insurance (PFHI) benefit women as compared to men. Many of these schemes are gender-neutral in design but given the existing gender inequalities in many societies, their benefits may not be similar for women and men. We contribute to the evidence by conducting a gender analysis of the enrolment of individuals and households in India’s national PFHI scheme, Rashtriya Swasthya Bima Yojana (RSBY). Methods We used data from a cross-sectional household survey on RSBY eligible families across eight Indian states and studied different outcome variables at both the individual and household levels to compare enrolment among women and men. We applied multivariate logistic regressions and controlled for several demographic and socio-economic characteristics. Results At the individual level, the analysis revealed no substantial differences in enrolment between men and women. Only in one state were women more likely to be enrolled in RSBY than men (AOR: 2.66, 95% CI: 1.32-5.38), and this pattern was linked to their status in the household. At the household level, analyses revealed that female-headed households had a higher likelihood to be enrolled (AOR: 1.36, 95% CI: 1.14-1.62), but not necessarily to have all household members enrolled. Conclusion Findings are surprising in light of India’s well-documented gender bias, permeating different aspects of society, and are most likely an indication of success in designing a policy that did not favour participation by men above women, by mandating spouse enrolment and securing enrolment of up to five family members. Higher enrolment rates among female-headed households are also an indication of women’s preferences for investments in health, in the context of a conducive policy environment. Further analyses are needed to examine if once enrolled, women also make use of the scheme benefits to the same extent as men do. India is called upon to capitalise on the achievements of RSBY and apply them to newer schemes such as PM-JAY.

الملخص: أهداف البحث: للتحقيق في انتشار ظاهرة المحتال بين طلاب طب الأسنان الجامعيين واستكشاف علاقتها بالجنس والسنة الأكاديمية. طرق البحث: تم إجراء البحث المقطعي الملاحظ على طلاب طب الأسنان الجامعيين من السنة الأولى إلى الخامسة في كلية طب الأسنان بجامعة القصيم ، بين فبراير وأبريل 2021. تم استخدام مقياس كلانس لظاهرة المحتال المدار إلكترونيا والمحقق مسبقا من 20 عنصرا كأداة لجمع البيانات. النتائج: بلغ معدل الاستجابة 80.59٪ (162 مستجيبا). أشارت النتائج إلى أن 8.8٪ من المشاركين كان لديهم حالات خفيفة، و 84.1٪ حالات متوسطة إلى شديدة، في حين أن 7.05٪ تعرضوا لتجارب مكثفة في ظاهرة المحتال. كان متوسط درجة ظاهرة المحتال أعلى بالنسبة للسنة الثالثة ولوحظ الحد الأدنى للقيمة لطلاب السنة الرابعة في طب الأسنان. تم العثور على علاقة ذات دلالة إحصائية بين درجات ظاهرة المحتال على مدار العام، بينما لم يلاحظ أي فرق كبير على أساس الجنس. الاستنتاجات: تنتشر ظاهرة المحتال بصور وأعداد كبيرة بين طلاب طب الأسنان. قد يكون لذلك آثار جسدية وعقلية ضارة مع عواقب سلبية وبالتالي تؤثر على تطوراتهم الفكرية والمهنية. تنفيذ المناهج المعدلة وخطط التطوير الذاتي هي بعض الحلول الموصى بها. Abstract: Objective: To investigate the prevalence of impostor phenomenon (IP) among undergraduate dental students and explore its relationship with gender and academic year. Methods: This study involved observational cross-sectional research involving undergraduate dental students (first to fifth year) at Qassim University Dental School, between February and April 2021. An electronically administered, 20-item pre-validated Clance Impostor Phenomenon Scale (CIPS) was used for data collection. Data analysis was performed using SPSS version 23. Mean IP scores of both genders were compared using t-tests, one-way ANOVA and Post-Hoc tests to establish the relationship between year-wise IP scores. Results: The response rate was 80.59% (162 respondents). The results indicated that 8.8% of the participants had mild IP experiences, 84.1% had moderate to severe IP experiences, and 7.05% exhibited intense IP experiences. The mean IP score was highest and lowest in the third and fourth-year dental students, respectively. A statistically significant relationship was identified between year wise IP scores, while no significant difference was observed based on gender. Conclusions: Impostor phenomenon is prevalent in substantial frequencies amongst dental students. This may have damaging physical and mental effects with negative consequences and could subsequently affect their intellectual and professional developments. The implementation of a modified curriculum and self-development plans are some of the recommended solutions.

Nitroimidazoles comprise a class of broad-spectrum anti-microbial drugs with efficacy against parasites, mycobacteria, and anaerobic Gram-positive and Gram-negative bacteria. Among these drugs, metronidazole (MTZ) is commonly used with other antibiotics to prevent infection in open fractures. However, the effect of MTZ on bone remains understudied. In this paper, we evaluated six nitroimidazole drugs for their impact on osteoblast differentiation and identified MTZ as having the highest osteogenic effect. MTZ enhanced bone regeneration at the femur osteotomy site in osteopenic ovariectomized (OVX) rats at the human equivalent dose. Moreover, in OVX rats, MTZ significantly improved bone mass and strength and improved microarchitecture compared to the vehicle-treated rats, which was likely achieved by an osteogenic mechanism attributed to the stimulation of the Wnt pathway in osteoblasts. To mitigate the reported neurological and genotoxic effects of MTZ, we designed an injectable sustained-release in situ gel formulation of the drug that improved fracture healing efficacy by 3.5-fold compared to oral administration. This enhanced potency was achieved through a significant increase in the circulating half-life and bioavailability of MTZ. We conclude that MTZ exhibits osteogenic effects, further accentuated by our sustained-release delivery system, which holds promise for enhancing bone regeneration in open fractures.

Abstract Background The Pradhan Mantri Jan Arogya Yojana (PM-JAY), a publicly funded health insurance scheme, was launched in India in September 2018 to provide financial access to health services for poor Indians. PM-JAY design enables state-level program adaptations to facilitate implementation in a decentralized health implementation space. This study examines the competency, organizational, and leadership approaches affecting PM-JAY implementation in three contextually different Indian states. Methods We used a framework on implementation drivers (competency, organizational, and leadership) to understand factors facilitating or hampering implementation experiences in three PM-JAY models: third-party administrator in Uttar Pradesh, insurance in Chhattisgarh, and hybrid in Tamil Nadu. We adopted a qualitative exploratory approach and conducted 92 interviews with national, state, district, and hospital stakeholders involved in program design and implementation in Delhi, three state capitals, and two anonymized districts in each state, between February and April 2019. We used a deductive approach to content analysis and interpreted coded material to identify linkages between organizational features, drivers, and contextual elements affecting implementation. Results and conclusion PM-JAY guideline flexibilities enabled implementation in very different states through state-adapted implementation models. These models utilized contextually relevant adaptations for staff and facility competencies and organizational and facilitative administration, which had considerable scope for improvement in terms of recruitment, competency development, programmatic implementation support, and rationalizing the joint needs of the program and implementers. Adaptations also created structural barriers in staff interactions and challenged implicit power asymmetries and organizational culture, indicating a need for aligning staff hierarchies and incentive structures. At the same time, specific adaptations such as decentralizing staff selection and task shifting (all models); sharing of claims processing between the insurer and state agency (insurance and hybrid model); and using stringent empanelment, accreditation, monitoring, and benchmarking criteria for performance assessment, and reserving secondary care benefit packages for public hospitals (both in the hybrid model) contributed to successful implementation. Contextual elements such as institutional memory of previous schemes and underlying state capacities influenced all aspects of implementation, including leadership styles and autonomy. These variations make comparisons across models difficult, yet highlight constraints and opportunities for cross-learning and optimizing implementation to achieve universal health coverage in decentralized contexts.

ABSTRACTIndia launched one of the world’s largest health insurance programs, the Pradhan Mantri Jan Arogya Yojana (PM-JAY), targeting more than 500 million economically and socially disadvantaged Indians. PM-JAY is publicly funded and covers hospitalization costs in public and private facilities. We examine how PM-JAY has affected hospitalizations and out-of-pocket expenditures (OOPE), and given the high use of private health care in India, we compare these outcomes across public and private facilities. We conducted a household survey to collect data on socioeconomic and demographic information, health status and hospitalizations for more than 57,000 PM-JAY eligible individuals in six Indian states. Using multivariate regression models, we estimated whether PM-JAY was associated with any changes in hospitalizations, OOPE and catastrophic health expenditures (CHE) and whether these differed across public and private facilities. We found that PM-JAY was not associated with an increase in hospitalizations, but it increased the probability of visiting a private facility by 4.6% points (p

Background: Dental clinical educational environment plays a critical part in the inculcation of skills and enhancement of knowledge for the dental students. The objective was to assess undergraduate dental students' and interns' perceptions towards the clinical learning environment. Methods: Current cross-sectional study was conducted from December 2020 to February 2021, using the 24-item dental clinical learning environment inventory (DECLEI) on a six point Likert scale. The possible range of cumulative score for DECLEI was from 0 to 100 (interpretation poor to excellent). The inventory was emailed to 111 students and interns at College of Dentistry, Qassim University. The relationship between the independent variables and DECLEI scores was determined by using Pearson correlation test. SPSS version-23 was used for statistical analysis. Results: Overall response rate was 78.37%. The mean DECLEI score was noted as 67.5 ± 17.98. Among the factors, the highest mean score was documented for the systematic self-evaluation and the lowest mean score was observed for the item related to patients' punctuality for appointments. A factor-wise analysis of three subscales of DECLEI demonstrated the respondents had good perception towards all subscales with the highest mean score (72.3 ± 18.06) for Factor III and lowest mean score (61.3 ± 19.81) for Factor II. Overall, the DECELI was found to be reliable with the Cronbach's Alpha value of 0.94. The Pearson's correlation test showed the weak positive insignificant correlation of mean DECLEI score with gender and categories.Conclusions: Present study indicated more positive than negative perceptions of the dental students related to their clinical learning environment. The DECLEI helped in recognizing both strengths and shortcomings of the dental clinical learning environment.

Objectives: This research was done to assess the periodontal ligament cells viability using propolis, coconut water, aloe vera, and soy milk storage media. Materials and Methods: Periodontal ligament cells were taken from freshly extracted teeth and stored into four groups of storage media: Group A-propolis, Group B-coconut water, Group C-aloe vera, and Group D-soy milk. Later, the cell viability was assessed at 1, 12, and 24 hours. Results: The periodontal ligament cell viability was significantly greater in propolis, followed by coconut water, aloe vera, and soy milk. Conclusion: We found that propolis, coconut water, aloe vera, and soy milk can be used as an effective storage media. These are naturally occurring and easily available storage medium.

Background and Objectives: An understanding of the anatomical complexity of teeth is a significant factor for a successful endodontic treatment outcome. The aim of this study was to explore the frequency and pattern of distribution of radix entomolaris (RE) in mandibular first molars (MFMs) of a Saudi Arabian subpopulation using CBCT scans. Materials and Methods: This study was conducted at dental clinics of Qassim University from February to May 2023 by evaluating CBCT scans that were previously obtained for diagnostic purposes. Scans of Saudi national patients with bilaterally present MFMs and fully formed root apices were included. Conversely, scans with one/or two missing MFMs, MFMs with incomplete root apices, full- or partial-coverage prosthesis, endodontic treatment, and associated radicular resorption were excluded from study. A total of 303 CBCT scans with 606 bilateral MFMs were analyzed by two calibrated evaluators for the presence of, and type according to Song’s typolgy of RE. The data were analyzed using SPPS-24. The descriptive variables were documented as frequencies and percentages. The chi-square test was used to determine the association between the prevalence of RE with the gender, jaw side and age group. Both inter-rater and intra-rater agreements were estimated for detecting and classifying RE using Cohen’s kappa test. Results: The sample had 63.7% males and 36.3% females. The prevalence of RE was 6.6%, with Song’s type III (57.5%) as the most common variant. Absolute agreement was noted between the raters about the presence of RE and very strong agreement was noted for the classification of the RE. Conclusions: RE is an uncommon finding among the mandibular first molars of the Saudi population without any gender and quadrant predilection. The clinicians’ knowledge of the presence and Song’s type of RE may contribute towards the enhancement of endodontic treatment outcomes.

Outbreak of COVID-19 pandemic in December 2019 affected millions of people globally. After substantial research, several biomarkers for COVID-19 have been validated however no specific and reliable biomarker for the prognosis of patients with COVID-19 infection exists. Present study was designed to identify specific biomarkers to predict COVID-19 severity and tool for formulating treatment. A small cohort of subjects (n = 43) were enrolled and categorized in four study groups; Dead (n = 16), Severe (n = 10) and Moderate (n = 7) patients and healthy controls (n = 10). Small RNA sequencing was done on Illumina platform after isolation of microRNA from peripheral blood. Differential expression (DE) of miRNA (patients groups compared to control) revealed 118 down-regulated and 103 up-regulated known miRNAs with fold change (FC) expression ≥2 folds and p ≤ 0.05. DE miRNAs were then subjected to functional enrichment and network analysis. Bioinformatic analysis resulted in 31 miRNAs (24 Down-regulated; 7 up-regulated) significantly associated with COVID-19 having AUC>0.8 obtained from ROC curve. Seventeen out of 31 DE miRNAs have been linked to COVID-19 in previous studies. Three miRNAs, hsa-miR-147b-5p and hsa-miR-107 (down-regulated) and hsa-miR-1299 (up-regulated) showed significant unique DE in Dead patients. Another set of 4 miRNAs, hsa-miR-224-5p (down-regulated) and hsa-miR-4659b-3p, hsa-miR-495-3p and hsa-miR-335-3p were differentially up-regulated uniquely in Severe patients. Members of three miRNA families, hsa-miR-20, hsa-miR-32 and hsa-miR-548 were significantly down-regulated in all patients group in comparison to healthy controls. Thus a distinct miRNA expression profile was observed in Dead, Severe and Moderate COVID-19 patients. Present study suggests a panel of miRNAs which identified in COVID-19 patients and could be utilized as potential diagnostic biomarkers for predicting COVID-19 severity.

Introduction Gender-based discrimination (GBD) is generally defined as unequal or disadvantageous treatment based on one’s gender. Emerging evidence suggests that exposure to GBD in its various forms can yield negative consequences for women’s health, including delaying access to healthcare services and lowering the quality of nutrition. Although consensus exists around the theoretical definitions of GBD, current studies are limited on how to measure GBD empirically in order to assess its true impact on women’s health. Our mixed-methods scoping review aims at synthesising existing evidence by answering the question How is gender-based discrimination defined and measured in the health literature, with specific reference to Low and Middle-Income Countries (LMICs)?. Our ambition is to identify commonalities across definitions and measures to generate a dialogue towards reaching consensus around the development of a single standardised tool to be applied in health studies.Methods and analysis Our mixed-method scoping review includes quantitative, qualitative and mixed-methods studies and unfolds according to the six stages proposed by Levac et al. Eligibility criteria for studies were defined in order to reflect the three core elements of the search, namely (1) the discrimination based on the gender, (2) the link to health outcomes and (3) the developing countries context. Four databases (PubMed, Web of Science, Cinahl and Econlit) were searched. We will extract and synthesise information from quantitative and qualitative studies following the framework proposed by Hong and use the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review tool as a guide.Ethics and dissemination Since our scoping review relies exclusively on information extracted from published articles, its conduct is not subjected to ethical clearance. Results will be described and discussed in a peer-reviewed article and presented at relevant workshops and conferences.

Background: Present study aimed to identify DNA polymorphisms (variants) which can modulate the risk of COVID-19 infection progression to severe condition. TaqMan based SNP genotyping assay was performed for 11 single nucleotide polymorphisms (SNPs) in pro-coagulant and anti-coagulant genes. Methodology: A total of 33 COVID-19 patients, including dead, severe and moderately infected individuals were compared to 35 healthy controls. Both alleles in the SNP were labelled with two different fluorescent dyes (FAM and VIC) during assay formulation. DNA of study subjects were mixed with SNP assay and TaqMan master mix on 96 well PCR plate according to manufacturer’s protocol and RT-PCR was performed. Allelic discrimination assay gave clear results for presence of specific allele in each sample. Three SNPs were located in the pro-coagulant genes, another three involved in blood clot dissolution while rest five were in the genes encoding natural anti-coagulants. COVID-19 infected patients were further sub-divided into three groups, deceased (n = 16), severe (n = 10) and moderately infected (n = 7). Results: SNP genotyping showed significant differences between COVID-19 patients and controls in two SNPs, rs6133 in Selectin-P (SELP) and rs5361 in Selectin-E (SELE) gene. Also, rs2020921 and rs8176592, in clot dissolution genes, tissue Plasminogen activator (tPA) and tissue factor pathway inhibitor (TFPI) respectively showed significant genotypic and allelic difference in patients of COVID-19 compared to healthy controls. Further three SNPs rs2227589, rs757583846, and rs121918476 in natural anti-coagulant genes anti-thrombin III (ATIII), protein C (PROC), and protein S (PROS) respectively showed statistically significant difference between the study groups. Conclusion: Our findings indicate that gene variants, those involved in coagulation and anti-coagulation may play a major role in determining individual susceptibility to COVID-19.

The elimination of necrotic and inflamed pulp tissue, dentin debris, and microorganisms is essential for the success of endodontic treatment. However, the root canal’s complexity has led to incomplete cleaning and disinfection. This study aims to compare the efficacy of the penetrability of three different irrigation activating techniques to the apical third of the root canal. Sixty sound single-rooted human mandibular premolars are prepared with rotary instrumentation under continuous sodium hypochlorite irrigation. Three irrigation activation techniques are utilized: group 1 (n = 20), conventional needle irrigation (CN); group 2 (n = 20), side-vented endodontic needle irrigation (EN); and group 3 (n = 20), manual activation irrigation with gutta-percha cone (MA). The penetrability is assessed with the aid of a radiopaque irrigation solution using digital radiography in conjunction with cone-beam computed tomographic (CBCT) measurements. Data are analyzed using a statistical package for social sciences (SPSS), using multiple comparisons to compare the baseline and test values. One-way analysis of variance with post hoc analysis (Tukey honestly significant difference) is performed to detect the statistically significant differences between groups. Manual activation (MA) shows effective delivery of the irrigant into full WL, followed by endodontic needle (EN) and conventional (CN) methods of activation (p < 0.001). The results of the present study show that maximum penetrability of the irrigant is observed with manual activation (MA) using a gutta cone in comparison with the conventional needle (CN).

The accumulation of body fat due to an imbalance between calorie intake and energy expenditure is called obesity. Metabolic syndrome increases the risk of heart disease, type 2 diabetes, and stroke. The purpose of this study was to determine the effect of Jatropha tanjorensis (J.T.) and Fraxinus micrantha (F.M.) leaf extracts on high-fat diet-induced obesity in rats. Normal control, high-fat diet (HFD) control, orlistat standard, and test groups were created using male Albino Wistar rats (n = 6 per group) weighing 190 ± 15 g. Except for the control group, all regimens were administered orally and continued for 6 weeks while on HFD. Evaluation criteria included body weight, food intake, blood glucose, lipid profile, oxidative stress, and liver histology. High-Performance Thin Layer Chromatography (HPTLC) analysis was performed using a solvent system (7:3 hexane: ethyl acetate for sitosterol solution and Jatropha tanjorensis extracts and 6:4 hexane: ethyl acetate: 1 drop of acetic acid for esculetin and Fraxinus micrantha extracts). There were no deaths during the 14 days before the acute toxicity test, indicating that aqueous and ethanolic extracts of both J.T. and F.M. did not produce acute toxicity at any dose (5, 50, 300, and 2000 mg/kg). The ethanolic and aqueous extracts of J.T. and F.M. leaves at 200 and 400 mg/kg/orally showed a reduction in weight gain, feed intake, and significant decreases in serum glucose and lipid profile. As compared to inducer HFD animals, co-treatment of aqueous and ethanolic extract of both J.T. and F.M. and orlistat increased the levels of antioxidant enzymes and decreased lipid peroxidation. The liver’s histological findings showed that the sample had some degree of protection. These results indicate that ethanolic samples of J.T. have antidiabetic potential in diabetic rats fed an HFD. The strong antioxidant potential and restoration of serum lipid levels may be related to this. Co-treatment of samples JTE, JTAQ, FME, FMAQ and orlistat resulted in an increase in antioxidant enzymes and reduction in lipid peroxidation as compared to inducer HFD animals. We report, for the first time, on using these leaves to combat obesity.

Background: The philosophy of minimum interventional dentistry (MID) is to integrate prevention, remineralization, and minimal intervention for the placement and replacement of restorations. All branches of dentistry play an important role in practicing MID, and their primary goal is to realize that any restoration is of less biological significance than the healthy original tissue Objectives: The objective of this study was to assess the perception of MID among dental undergraduate students and interns in terms of knowledge, attitude, and practice at the College of Dentistry. Materials and Methods: This cross-sectional study was conducted among undergraduate students and interns at the College of Dentistry, Qassim University, Saudi Arabia. A self-administered questionnaire was distributed, which included basic demographic profiles and questions about the knowledge, attitude, and practices toward MID. The data were tabulated in MS Excel, and all statistical analyses were performed using SPSS version 21. Results: A total of 163 dental students were recruited, with senior students comprising 73% and interns comprising 27%. Male students were slightly more prevalent (50.9%) than female students (49.1%). About 37.6% of participants received training about MID during educational courses, while 10.3% received it during their internship. A statistical test revealed that the prevalence of interns who were trained in performing MID was significantly higher (p < 0.001). Conclusions: The majority of the participants demonstrated proper knowledge, attitude, and practice in different aspects of MID. Interns reported a higher rate of knowledge, attitude, and practice in MID compared to undergraduate students. However, more education and hands-on training about MID concepts during the college curriculum are necessary to attain better knowledge, attitude, and practices that could be useful for more conservative clinical practice.

Introduction: COVID-19 pandemic has threatened the safety of both donors and recipients thus negatively impacting the blood donation process. Home confinement limits the ability of donors to attend blood services and the staff to take part in collection teams as well. The restrictions and limitations of large gatherings also reduce the number of large blood drives and campaigns. Aim: The current survey was undertaken soon after the official announcement of nationwide lockdown to assess the COVID-19-related knowledge and expressed practices about precautions among blood donors visiting blood bank. Materials and Methods: This was a cross-sectional survey conducted on 109 blood donors visiting blood bank in the month of March–April 2020. Data were collected using structured knowledge questionnaire and expressed practice checklist. After collecting data, the donors were provided with information related to COVID-19, and its precautions as per the guidelines from the Ministry of Health and Family Welfare, India. The obtained data were analyzed using the SPSS software version 22. Results: In terms of knowledge, it was found that 51.3% donors had very good knowledge, 42.3% had good knowledge, whereas 6.4% donors had poor knowledge about COVID-19. With regard to practices related to COVID precautions, it was noticed that most (90.82%) of the donors followed best practices, 9.18% donors followed good practices, whereas none of the donor followed poor practices. A significant positive correlation (P ≤ 0.01) was found between knowledge and practice score of blood donors. Significant association was seen in knowledge with educational status (P = 0.003) and practice with place of residence (P = 0.010). Conclusion: Based on the findings, it was concluded that 51.3% donors had very good knowledge, whereas 6.4% donors had poor knowledge about COVID-19. With regard to the practices related to COVID precautions, most (90.82%) of the donors followed best practices, 9.18% donors followed good practices, whereas none of the donor followed poor practices. Hence, the health-care professionals must take active steps to disseminate correct and updated information to blood donors regarding COVID-19 and related precautions.

Abstract Background Childhood vaccinations are a vital preventive measure to reduce disease incidence and deaths among children. As a result, immunisation coverage against measles was a key indicator for monitoring the fourth Millennium Development Goal (MDG), aimed at reducing child mortality. India was among the list of countries that missed the target of this MDG. Immunisation targets continue to be included in the post-2015 Sustainable Development Goals (SDG), and are a monitoring tool for the Indian health care system. The SDGs also strongly emphasise reducing inequalities; even where immunisation coverage improves, there is a further imperative to safeguard against inequalities in immunisation outcomes. This study aims to document whether socioeconomic inequalities in immunisation coverage exist among children aged 12–59 months in India. Methods Data for this observational study came from the fourth round of the National Family Health Survey (2015–16). We used the concentration index to assess inequalities in whether children were fully, partially or never immunised. Where children were partially immunised, we also examined immunisation intensity. Decomposition analysis was applied to examine the underlying factors associated with inequality across these categories of childhood immunisation. Results We found that in India, only 37% of children are fully immunised, 56% are partially immunised, and 7% have never been immunised. There is a disproportionate concentration of immunised children in higher wealth quintiles, demonstrating a socioeconomic gradient in immunisation. The data also confirm this pattern of socioeconomic inequality across regions. Factors such as mother’s literacy, institutional delivery, place of residence, geographical location, and socioeconomic status explain the disparities in immunisation coverage. Conclusions In India, there are considerable inequalities in immunisation coverage among children. It is essential to ensure an improvement in immunisation coverage and to understand underlying factors that affect poor uptake and disparities in immunisation coverage in India in order to improve child health and survival and meet the SDGs.

Abstract Background Despite a fast-growing economy and the largest anti-malnutrition programme, India has the world’s worst level of child malnutrition. Despite India’s 50% increase in GDP since 1991, more than one third of the world’s malnourished children live in India. Among these, half of the children under age 3 years are underweight and a third of wealthiest children are over-nutrient. One of the major causes for malnutrition in India is economic inequality. Therefore, using the data from the fourth round of National Family Health Survey (2015–16), present study aims to examine the socio-economic inequality in childhood malnutrition across 640 districts of India. Method Concentration curve and generalized concentration index were used to examine the socioeconomic inequalities in malnutrition. However, regression-based decomposition methodology was used to decomposes the causes of inequality in childhood malnutrition. Result Result shows that about 38% children in India were stunted and 35% were underweight during 2015–16. Prevalence of stunting and underweight children varies considerably across Indian districts (13 to 65% and 7 to 67% respectively). Districts having the higher share of undernourished children is coming from the particular regions like central, east and west part of the country. On an average about 35% of household in a district having the access of safe drinking water and 42% of household in a district exposed to open defecation. The study found the inverse relationship between district’s economic development with childhood stunting and underweight. The concentration of stunted as well as underweight children were found in least developed districts of India. Decomposition approach found that practice of open defecation is positively influenced the inequality in stunting and underweight. Further, inequality in undernutrition is accelerated by the height and education of the mother, and availability of safe drinking water in a district. Conclusions The districts that lied out in a spectrum of developmental diversity are required some specific set of information’s that covering socio-economic, demographic and health-related quality of life of people in those backward districts. More generally, policies to avail improved water and sanitation facility to public and female literacy should be continued. It is also important to see that the benefits of both infrastructure and more general economic development are spread more evenly across districts.

The four rounds of National Family Health Survey (NFHS) conducted during 1992–93, 1998–99, 2005-06 and 2015-16 is main source to track the health and development related indicators including nutritional status of children at national and state level in India. Except NFHS-4, first three rounds of NFHS were unable to provides district-level estimates of childhood stunting due to the insufficient sample sizes. The small area estimation (SAE) techniques offer a viable solution to overcome the problem of small sample size. Therefore, this study uses SAE techniques to derive district level prevalence of childhood stunting corresponding to NFHS-2 (1998–99). Study further estimated GIS maps, univariate Local indicator of spatial autocorrelation (LISA) and Moran's I to understand the trend in district level childhood stunting between NFHS-2 and NFHS-4. Estimates obtained by SAE techniques suggest that prevalence of childhood stunting ranges from 20.7% (95% CI: 18.8–22.7) in South Goa district of Goa to 64.4% (95%CI: 63.1–65.7) in Dhaulpur district of Rajasthan during 1998–99. The diagnostic measures used to validate the reliability of estimates obtained by SAE techniques indicate that the model-based estimates are reliable and representative at district level. Results of geospatial analysis indicates substantial reduction in childhood stunting between 1998 and 2016. Out of 640 district,about 81 district experience reduction of more than 50%. At the same time 60 district experience less than 10% of reduction between 1998 and 2016. Spatial clustering of childhood stunting remains same over the study period except few additional cluster in Maharashtra, Andhra and Meghalaya in 2016. The district level estimates obtained from this study might be helpful in framing decentralized policies and implementation of vertical programs to enhance the efficacy of various nutrition interventions in priority districts of the country.

Introduction: During general anaesthesia, prevention of reflex sympathetic responses following direct laryngoscopy and intubation remains an important clinical goal during airway management. Aim: To compare efficacy of nebulised lignocaine and intravenous lignocaine to suppress haemodynamic response to laryngoscopy and tracheal intubation. Materials and Methods: This randomised control study was conducted, during January 2018 to June 2019, on 90 American Society of Anesthesiologists (ASA) grade I and II patients in the age group of 18 to 45 years of either sex, undergoing elective surgeries under general anaesthesia. Patients were randomly allocated into three groups with the sample size of 30 each. Group A was nebulised with Normal Saline (NS) 0.075 mL/kg and 10 mL NS intravenous (iv) given and served as control. Group B was nebulised with 3 mg/kg (0.075 mL/kg) of 4% lignocaine and iv normal saline 10 mL given. Group C was nebulised with 0.075 mL/kg of normal saline and iv 2 mg/kg of 2% lignocaine diluted to 10 mL. Descriptive statistical analysis was carried out in the present study. Analysis of variance (ANOVA) has been used to find the significance of parameters between three groups. Chi-square test was used to find the significance of parameters on categorical scale between three groups. Results: Statistical evaluation between the groups showed that the increase in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) observed at 1 minute after intubation in control group was highly significant (p

Objective: The present study was conducted to evaluate the correlation of renal functions with thyroid hormone levels in patients with undialyzed chronic kidney disease (CKD). Literature shows significant alteration in thyroid hormone function tests in CKD patients who are receiving long-standing dialysis treatment. However, not much is described in those receiving conservative management without dialysis. Although CKD is associated with an increased prevalence of primary hypothyroidism, various studies on thyroid hormone status in uremic patients have reported conflicting results. Methodology: Thyroid hormone levels and biochemical markers of renal function were estimated in 30 undialyzed CKD patients and similar number of age- and sex-matched healthy controls, followed by statistical analysis and correlation. Results: Free triiodothyronine (FT3) and free thyroxine (FT4) were found to be significantly reduced (P < 0.001 for each) in undialyzed CKD patients whereas thyroid-stimulating hormone (TSH) levels showed statistically insignificant alteration in both groups. We also observed that urea and creatinine were negatively correlated whereas creatinine clearance was positively correlated with both FT3 and FT4 having high statistical (two tailed) significance with P < 0.001. Nonsignificant correlation was seen between blood urea and TSH (r = 0.236, P = 0.069), creatinine clearance, and TSH (r = 0.206, P = 0.114 Pearson's correlation coefficient). There is just significant positive correlation between the serum creatinine values and TSH (r = 0.248, P = 0.049). Conclusions: Thyroid hormones were significantly decreased in undialyzed CKD patients as compared to healthy controls.

To compare the retreatment efficacy of XP-endo Shaper (XPES) and Reciproc Blue (RB) files in in the removal of a bioceramic-based root canal filling material from oval shaped canals. Forty human mandibular first premolars with oval canals were selected for the study. Initially, access cavity preparation and instrumentation were completed. Obturation of the root canals were carried out using a bioceramic sealer (BCS), followed by micro-computed tomography (MCT) analysis to assess the volume of the filling material. The samples were then randomly divided into two groups: Group 1 (XPES) and Group 2 (RB). Post-retreatment procedures (RTP) MCT imaging analysis was conducted, and the volume of the remaining filling material was calculated. Statistical analysis of the data was performed using SPSS software. The mean volume of filling material in both groups did not show statistical significance (p > 0.05). However, XPES demonstrated a significant reduction in the remaining filling material in the C3 and M3 areas (p < 0.05). In contrast, there was no statistically significant difference in the mean volume between the two groups in the A3 area (p > 0.05). XPES is notably more effective than RB in removing root canal filling material from the C3 and M3 areas. [ABSTRACT FROM AUTHOR]

This study aimed to determine the topographic changes (TC) of gutta-percha cones (GPC) after disinfection with 5.25% sodium hypochlorite (NaOCl), 1% Alexidine (ALX) and MTAD with and without a final rinse with distilled water (DW). 140 GPC were divided into seven groups and treated with three types of disinfection reagent-5.25% NaOCl, 1% ALX and MTAD with or without a final rinse with DW. The TC changes of GPC were examined under scanning electron microscope (SEM). The obtained data was statistically analysed using SPSS software. 90% GPC were found to have deposit formation with 5.25% NaOCl which was statistically significant than as compared to groups treated with 1% ALX and MTAD (p<0.05). Moreover, significant difference in deposit formation were observed in the groups which received a final rinse with DW (p<0.05). ALX and MTAD were identified as the optimal disinfecting solution of GPC with a final rinse of DW. The TC seen in GPC were maximum with 5.25%NaOCl and minimal with 1% ALX and MTAD within a clinically acceptable time of 1 minute. It is crucial to conduct a final rinse of GPC with DW to remove any surface deposits. [ABSTRACT FROM AUTHOR]

Hanwoo was originally raised for draft purposes, but the increase in local demand for red meat turned that purpose into full-scale meat-type cattle rearing; it is now considered one of the most economically important species and a vital food source for Koreans. The application of genomic selection in Hanwoo breeding programs in recent years was expected to lead to higher genetic progress. However, better statistical methods that can improve the genomic prediction accuracy are required. Hence, this study aimed to compare the predictive performance of three machine learning methods, namely, random forest (RF), extreme gradient boosting method (XGB), and support vector machine (SVM), when predicting the carcass weight (CWT), marbling score (MS), backfat thickness (BFT) and eye muscle area (EMA). Phenotypic and genotypic data (53,866 SNPs) from 7324 commercial Hanwoo cattle that were slaughtered at the age of around 30 months were used. The results showed that the boosting method XGB showed the highest predictive correlation for CWT and MS, followed by GBLUP, SVM, and RF. Meanwhile, the best predictive correlation for BFT and EMA was delivered by GBLUP, followed by SVM, RF, and XGB. Although XGB presented the highest predictive correlations for some traits, we did not find an advantage of XGB or any machine learning methods over GBLUP according to the mean squared error of prediction. Thus, we still recommend the use of GBLUP in the prediction of genomic breeding values for carcass traits in Hanwoo cattle.

Aging is an unavoidable phenomenon, often afflicting structure and functionality of body, marked with onset of age associated manifestations. Parkinson's disease (PD), the second most common form of dementia is manifested with Lewy body formation and dopaminergic dysfunction. Present study explores silymarin, a known hepatoprotective regimen for its efficacy in Aging and PD using Caenorhabditis elegans. Silymarin positively modulated longevity, reduced oxidative stress, independent of feeding behaviour. Up-regulation of longevity and stress related genes daf-16, sod-3, gst-4 and skn-1 indicate the possible involvement of these genes for regulating longevity. In-addition silymarin alleviated PD symptoms by reducing α-synuclein levels, lipid accumulation and enhanced dopamine function. Silymarin executes its beneficial effects through mitigation of free radicals, while achieving alleviation in Parkinsonism possibly through pdr-1 mediated recruitment of ubiquitin proteasome system as evident from qPCR studies. Altogether, silymarin emerged as a potent molecule for investigation in Aging and age related disorders.

IntroductionAlthough the number of women who deliver with a skilled birth attendant in India has almost doubled between 2006 and 2016, the country still has the second highest number of maternal deaths and the highest number of neonatal deaths globally. This study examines the impact of a nurse mentoring programme intended to improve the quality of intrapartum care at primary healthcare centre (PHC) facilities in Bihar, India.MethodWe conducted an evaluation study in 319 public PHCs in Bihar, where nurses participated in a mentoring programme. Using a quasi-experimental trial design, we compared the intrapartum quality of care between the mentored (n=179) and non-mentored PHCs (n=80). Based on direct observation of 847 women, we examined percent differences in 39 labour, delivery and postpartum care-related recommended tasks on five domains: vital sign and labour progress monitoring after admission, second and third stages of labour management, postpartum counselling, infection prevention and essential newborn care practices.ResultsA significantly higher proportion of women at mentored PHCs received the recommended clinical care, compared with women at non-mentored PHCs. The overall total score of quality of care, expressed in percent of tasks performed, was 30.2% (95% CI: 28.3 to 32.2) in the control PHCs, suggesting that less than one-third of the expected tasks during labour and delivery were performed by nurses in these facilities; the score was 44.2% (95% CI: 42.1 to 46.4) among the facilities where the nurses were trained within last 3 months. The task completion score was slightly attenuated when observed 1 year after mentoring (score 39.1% [37.7–40.5]).ConclusionMentoring improved intrapartum care by nurses at PHCs in Bihar. However, less than half of the recommended normal delivery intrapartum tasks were completed by the nurse providers. This suggests the need for further improvement in the provision of quality of intrapartum care when risks to maternal and perinatal mortality are highest.

Summary: The glucocorticoid receptor (GR) acts as a ubiquitous cortisol-dependent transcription factor (TF). To identify co-factors, we used protein-fragment complementation assays and found that GR recognizes FLI1 and additional ETS family proteins, TFs relaying proliferation and/or migration signals. Following steroid-dependent translocation of FLI1 and GR to the nucleus, the FLI1-specific domain (FLS) binds with GR and strongly enhances GR’s transcriptional activity. This interaction has functional consequences in Ewing sarcoma (ES), childhood and adolescence bone malignancies driven by fusions between EWSR1 and FLI1. In vitro, GR knockdown inhibited the migration and proliferation of ES cells, and in animal models, antagonizing GR (or lowering cortisol) retarded both tumor growth and metastasis from bone to lung. Taken together, our findings offer mechanistic rationale for repurposing GR-targeting drugs for the treatment of patients with ES. : The single oncogene of Ewing sarcoma (ES), a childhood cancer, encodes a FLI1 fusion protein. Srivastava et al. report physical interactions between the fusion protein and the glucocorticoid receptor. Drug-induced inhibition of these interactions retards the progression of ES in mouse models. Keywords: cancer therapy, Ewing sarcoma, glucocorticoid receptor, metastasis, protein-fragment complementation assay