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Abstract An examination of the dynamics of seed markets in Bihar, India, reveals a paradox—despite an influx of wheat varieties bred by public and private sectors and the proliferation of seed market networks in rural villages, older wheat varieties remain prevalent—necessitating a thorough investigation of the seed distribution system. Unlike most empirical studies that examine the adoption of new and improved crop varieties from a farmer's perspective, our study shifts the focus to the seed supply side. We analyse data collected from 200 private seed dealers who cater to the needs of over 163,000 farmers spread across 10 districts in Bihar. We use descriptive statistics alongside dealer-level and varietal-level regression models to examine the relationship between seed sales and varietal age. Findings indicate that the number of varieties available with a dealer (varietal richness) is positively associated with the number of seed buyers (dealer’s reach) and the total quantity of seeds sold. Private varieties are in demand despite their higher prices. Dealer-level models showed that varietal age affects neither the reach nor the sales, allowing older public-sector varieties to coexist with more recent private-sector ones. However, the varietal-level regression models show that dealers rank the new varieties higher as the ones being sold more. To explore the potential of private seed markets to reduce the proliferation of old wheat varieties that are more susceptible to evolving biotic and abiotic stress factors, we recommend strengthening the varietal registration and seed certification processes, implementing better seed traceability systems, and fostering public–private partnerships in variety development and seed dissemination. Investing in market experiments to incentivize seed dealers to engage in quality assurance can help refine strategies and ensure efficient and inclusive dissemination of promising wheat varieties.

Background: Tuberculosis (TB) has significant health, social, psychological, and economic impacts on patients. This study aimed to assess and compare quality of life (QOL) among multidrug-resistant (MDR) TB patients and drug-sensitive TB patients. MATERIALS AND METHODS: A comparative study was conducted among 40 MDR-TB patients and 80 age- and gender-matched drug-sensitive TB patients in Chitradurga district, South India. Sociodemographic data were collected and QOL was assessed using the WHO BREF scale. Data were analyzed using SPSS v20. Results: The study population was predominantly male (65%) and aged 27–35 years. Education level and socioeconomic status differed significantly between MDR and sensitive TB groups (P < 0.05). MDR-TB patients had significantly lower self-rated QOL and health satisfaction compared to sensitive TB patients (P < 0.001). MDR-TB patients scored lower on all four QOL domains (physical, psychological, social relationships, and environmental), with the psychological domain most affected. The majority of both MDR and sensitive TB patients had “fair” QOL across domains. Conclusion: QOL was impaired in both MDR and sensitive TB patients, but more severely in MDR-TB. The psychological domain was most affected. Factors such as poor accessibility to health services, low socioeconomic status, and poor mental health may contribute to reduce QOL in TB patients.

Background & objectives: Mosquito-bome diseases are increasing problems in various parts of the world, causing high mortality and morbidity for humans. This study was done to assess the vector protection measures taken by rural below poverty line (BPL) families, and to assess the awareness about vector-borne diseases along with Total Sanitation Campaign (TSC) in rural BPL families. Methods: A cross-sectional study was conducted in a rural area which won “Nirmal Gram Puraskar” Award i.e., “clean village” among 96 below BPL families for a period of three months. These families (every 5th) were selected by systematic random sampling until we reached a sample size. Basic socio-demographic details, status of vector protection measures, solid waste management, vector-borne diseases and total sanitation campaign details were collected from the study participants. Pretested, semi-structured questionnaire was applied to the head of the families which included sanitation status at home by house-to-house visit. Data collected was analysed using SPSS version 20 and presented as frequency, percentages, mean and standard deviation. Results: Among 96 families studied (454 adults and children), 84 (87.5%) were males and 12 (12.5%) were females. Among these, 291 (64.1%) were using one or the other mosquito protection measures, 52 (54.2%) were using bednets and 23 (23.9%) used coils. 12 families (12.5%) were not using any mosquito protection measures. In our study, 66 (68.8%) families had individual household latrine (IHHL) and 50 (52.1%) had open drainage. Even though 314 participants had an access to individual household latrine, 20 (6.36%) had practice of open air defecation compared to 127 (90.7%) who practiced open air defecation without an access to individual household latrine. When asked about the awareness regarding vector-borne diseases, 56 (58.3%) were aware about chikungunya, 47 (48.9%) about dengue, 46 (47.9%) about malaria, 14 (14.6%) and only 5 (5.2%) families were aware about Japanese encephalitis. In this study, 37 (38.5%) were aware about the total sanitation campaign and 40 (41.6%) about the government support for sanitation. Interpretation & conclusion: While there is a general awareness of vector-borne diseases, the implementation of vector protection measures is not uniform across the village. There is a need for targeted interventions to improve the effectiveness of vector protection measures and increase awareness among the community.

Abstract Major research interests on quantum key distribution (QKD) are primarily focused on increasing 1. Point-to-point transmission distance (1000 km). 2. Secure key rate (Mbps). 3. Security of quantum layer (device-independence). It is great to push the boundaries in these fronts but these isolated approaches are neither scalable nor cost-effective due to requirements of specialised hardware and different infrastructure. Current and future QKD network requires addressing different set of challenges apart from distance, key rate and quantum security. In this regard, we present ChaQra—a sub quantum network with core features as 1. Crypto agility (integration in the already deployed telecommunication fibres). 2. Software defined networking (SDN paradigm for routing different nodes). 3. reliability (addressing denial-of-service with hybrid quantum safe cryptography). 4. upgradability (modules upgradation based on scientific and technological advancements). 5. Beyond QKD (using QKD network for distributed computing, multi-party computation etc). Our results demonstrate a clear path to create and accelerate quantum secure Indian subcontinent under national quantum mission.

Background India has a high typhoid fever burden. In 2022, the National Technical Advisory Group on Immunisation recommended introducing typhoid conjugate vaccine (TCV) into the Universal Immunisation Programme. Our study aims to identify research priorities to support ongoing TCV decision-making in India.Methods We identified 45 evidence factors for TCV decision-making in India by adapting WHO’s Evidence-to-Recommendation framework. We assigned an evidence gap score for each evidence factor from 0 (low) to 4 (high) based on the availability and sufficiency, quality, breadth and applicability of evidence identified in a literature review (end date 30 November 2023). We assigned each evidence factor an importance score based on the results of an online survey conducted among national immunisation stakeholders (n=22, 1 July 2023–31 October 2023), where they ranked the importance of seven WHO’s Evidence-to-Recommendation criteria and several evidence factors within them. We rescaled mean stakeholder rankings into importance scores from 0 (low) to 4 (high). Finally, we added the evidence gap score to the importance score and used the overall scores to identify research priorities to support ongoing TCV decision-making in India.Results We estimated the highest evidence priority scores for public perception of typhoid fever, vaccination budget impact, vaccine availability, socioeconomic impact, fiscal space, antimicrobial resistance tracking, typhoid fever mortality, public perception of TCV, immunisation managers’ acceptance and vaccine schedule preferences among caregivers.Conclusion By adapting WHO’s Evidence-to-Recommendation framework to the Indian context, we systematically identified several research priorities to support ongoing decision-making on TCV in India. These priorities will evolve as new research studies and questions emerge about the optimal scheduling, roll-out and implementation of TCV in India.

Tenosynovial Giant Cell Tumor (TSGCT) is a solitary, firm, and extra-articular localized benign soft tissue tumor that may present with painless swelling for many years. It usually involves the tiny joints of the extremities in the hands and feet. Here, we present the case of a male in his 20s who presented with a painful, stiff, slow-growing mass over the distal interphalangeal joint of the right-hand ring finger. Fine Needle Aspiration Cytology (FNAC) was performed and based on the microscopic features, it was reported as a case of Tenosynovial Giant Cell Tumor. Surgical excision of the swelling was performed and histopathological examination confirmed the diagnosis. The rarity of this case arises from the fact that the diagnosis of TSGCT was established on cytology, as TSGCT is very rarely reported on cytology.

Introduction : Micro discectomy is the surgical procedure of choice for treating lumbar disc herniations. A laminectomy can cause instability, significant epidural fibrosis, continued radiated pain, and surgical site infection, although there is still concern about the dangers of muscle damage, such as to the multifidus, and excessive articular facet resection. Unilateral biportal endoscopic discectomy has been suggested as a less invasive therapeutic approach.Objective: To compare the clinical effects in terms of pain, impairment, and complications associated with percutaneous endoscopic lumbar discectomy with standard micro discectomy for the treatment of disc herniations. Materials and methods: A study of 60 people with disc herniations who were treated with either microdiscectomy or unilateral biportal endoscopic lumbar discectomy. The Oswestry Disability Index and visual analogue score for back and leg pain was evaluated after three, six, and twelve months. Results: In comparison to Group E, Group M's mean operating time was substantially lower (p

The objective of this study is to investigate short-run performance and whether the IPOs are over-priced or under-priced in various window periods. This study applies one-sample t-tests, capital asset pricing models, and market-adjusted excess return to quantify the short-term pricing performance as well as the risk and return of initial public offerings and market indices. The study investigates the claim that post-listing initial public offerings (IPOs) guarantee short-term gains. The twelve months following the listing, in particular, have seen the biggest gains. According to reports, investors who buy shares in IPOs get strong returns in this period. The market-adjusted initial returns for the IPOs registered on the National Stock Exchange between January 2019 and December 2020 have been found to be roughly 44%, per this analysis.

This review delves into using e-learning technology and personalized recommendation systems in education. It examines 60 articles from prominent databases and identifies the different methods used in recommendation systems, such as collaborative and content-based approaches with a recent shift towards machine learning. However, the current personalized recommendation system faces challenges such as a lack of understanding of the content, student discontinuity, language barriers, confusion in selecting study materials, and inadequate infrastructure and funding. The review proposes using new digital technologies to address these issues, including Fluxy AI, Twin technology, AI-powered virtual proctoring, and Alter Ego. These technologies can create a dynamic and interactive learning environment, providing tailored learning experiences for students and insights for educators to provide targeted support and guidance. The integration of these technologies can improve individualized learning, increase understanding capacity and enhance the learning experience for students with speech disorders.

Autism, also known as Autism Spectrum Disorder (ASD) or Asperger’s syndrome, has an impact on cognition, social relationships, and behavior. Based on these characteristics and their learning interests, e-learning (Electronic Learning) recommendation systems attempt to provide personalized recommendations. This may enhance the learning ability of individuals with ASD. However, some technological challenges limit the ability of the population to use support scenarios and prevent efficient learning. This study tries to review e-learning recommender systems for individuals with ASD. The main identified aspects are 1) lack of design principles while building customized e-learning platforms for those with ASD; 2) technological limitations to developing recommender systems for e-learning, and 3) suggestions that reduce field limitations. The studies additionally discovered that social communication and psychological abilities had the greatest focus of study. A small number of studies mentioned the participant’s ASD level, the majority of the articles highlighted the beneficial effects of designing a content-based recommender system specifically for those with ASD.

Due to the variability of Photovoltaic (PV) output, a forecasting framework is essential for grid connected PV plants to ensure a stable and uninterrupted power supply. Among existing prediction and forecasting algorithms, only some have attempted to provide a holistic framework for short and long-term forecasting of PV yield together using automated input feature selections and data cleaning features. Furthermore, it has been identified that many existing algorithms only predicted PV output instead of forecasting in future times; therefore, their reported accuracy needs to be upheld in forecasting scenarios. This paper has proposed a framework to streamline solar yield forecasting for both the short and long term to ensure effective integration of PV plant output with the main grid. The proposed framework has used a novel combination of XGBoost (eXtreme Gradient Boosting), time series seasonal decomposition and rolling LSTM (Long- and Short-Term Memory) model to address the need for a comprehensive forecasting framework in hourly, daily and yearly periods. Based on our experiment result, the developed framework has performed in 98% − 95% prediction accuracy with less than 0.15% normalized Root Mean Squire error (nRMSE). The framework has performed in 89%- 87% forecasting accuracy with less than 0.45% nRMSE. Both the prediction and forecasting performance of the proposed model have outperformed many benchmarks forecasting frameworks, including Long short-term memory (LSTM) based recurrent neural network (RNN), Full RNN (FRNN), Neural Network Ensemble (NNE), Neural Network with AdaBoost, and many more as detailed in our comparative study section.

Aggressive Angiomyxoma (AA) is a rare, benign, and slow-growing mesenchymal tumor that affects the female pelvis and perineum. It appears as an infiltrative tumor with a high likelihood of local recurrence (up to 71%), which is why it is called aggressive. In this case, a 35-year-old female presented with heavy menstrual bleeding for four months and abdominal pain for one month. Clinical examination revealed the presence of a palpable, uniform, non-mobile mass over the uterus. Ultrasonography revealed fibroid with cystic change. Surgical excision of the mass was performed and its histopathological examination established the diagnosis as aggressive angiomyxoma. The diagnosis of AA is difficult due to its nonspecific clinical and radiological findings. This case report reveals the importance of histopathology in the diagnosis of aggressive angiomyxoma.

Background: Dexmedetomidine and Fentanyl both possess hypnotic, sedative, analgesic properties and have been utilised as an additive in epidural anaesthesia. The purpose of this study is to compare the sedative and analgesic effects of Dexmedetomidine and Fentanyl when added epidurally with Ropivacaine (0.75%) during lower limb orthopaedic surgery. Methods: The study comprised of 60 patients, both male and female, aged 18 to 60, who had ASA classification I or II for tibia fibula surgery. Two groups of patients were split up at random: Group RD contains– Ropivacaine (0.75%) 15ml + Dexmedetomidine (1microgm/kg) 0.5ml + 0.5ml sterile water (Total volume-16ml) and Group RF - Ropivacaine 15ml (0.75%) + 1ml Fentanyl (1microgm/kg) (Total volume-16 ml). The epidural space was maintained 4 cm within and situated between L3 and L4 space. Investigations were conducted on parameters such as sensory and motor block features, sedation score, hemodynamic factors and pain assessment. Using the student `t` test, statistical analysis was performed using STATAIC13 software. Results: Onset of sensory analgesia at L1 and Complete sensory and motor blockage occurred much earlier in the RD group. Higher sedation scores and significantly prolonged postoperative analgesia was observed in RD group. Conclusion: Dexmedetomidine is a safer and more effective epidural adjuvant than fentanyl because it provides stable hemodynamics, extended post-operative analgesia, early onset and development of sensory and motor effects and sedation.

AbstractThe progressive deformations of a shear band formation were studied to understand the fracture mechanism of AA6082(T6) sheets. The fracture characteristics of the alloys can be dictated by the intermetallic particles. Damage evolution of the alloy is quantitatively characterized as a function of strain. Larger, elongated, and favorably oriented particles fracture first (with initial deformation), and with progressive deformation (blanking), smaller and rounded particles start breaking. These broken particles become a crack nucleus for matrix cracking and coalescences. In the initial deformation stages, fragmentation of particles takes place without significant void growth. However, with subsequent deformation stages, the fragmentation process has been enhanced with multi-fragmentation and re-fracturing of previously broken particles. Larger particles nucleate voids at much lower strains with void growth. Crack has initiated in the shear band, preferably from the punch side (the punch side is sharper than the die side), and cracks are found almost parallel to the loading axis.

Deliberate self-harm is an act or self-inflicted injury without suicidal intent and nonfatal outcome. In recent years, the rates of self-harm are increasing in women of childbearing age and are recognized as a global health problem. Various risk factors such as adverse life events, lack of social and emotional support, and personality traits have been identified in women presenting with self-harm. Such acts not only affect the physical and psychological well-being of the women but also have deleterious effects on overall children’s development of all domains. Women presenting with self-harm during perinatal period should be evaluated carefully for underlying causative factors and adequately treated so as to decrease the morbidity.

Background: The mobile uses have been increased drastically, creating increased health concern about radiation effects emitted from mobile phone. Hence, this study aimed to evaluate the micronuclei (MN) frequency in exfoliated oral mucosal cells in high and low mobile users. Materials and Methods: The total of 50 subjects was divided into two major groups: low mobile phone users and high mobile phone users. Further, subjects who use mobile phone for more than 10 h a week were considered high talk time users and

Background: Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), spread rapidly leading to a pandemic in March 2020. To combat this, the COVID-19 vaccination drive was conducted in India and had its first recipients as the health-care workers who represent a high-risk population for the same. It included both Covishield and Covaxin. This study draws attention to the COVID-19 attack rate among health-care workers in a teaching Medical hospital, Basaveshwara Medical College and Hospital, in Chitradurga, Karnataka, India. Objective: The objective of the study was to assess breakthrough COVID-19 infection after vaccination among health-care workers. Methodology: A cross-sectional study was carried out in Basaveshwara Medical College and Hospital in October 2021 and December 2021. The study participants were more than 18 years old. The participants include BMCH staff including doctors, nurses, watchman, and ward boys. A sample size of 200 was obtained. Results: Most of the sample lies in the age group of 18–30 years, consisting of more females than males. 191/200, i.e., 95.5% of the population have been vaccinated against COVID-19, of which 69.5% have taken Covishield vaccine and 26% have Covaxin vaccine. Only 9/200 tested positive for COVID-19, postvaccination, whereas 2/200 were hospitalized for complications of COVID-19, postvaccination. Conclusion: Breakthrough COVID-19 among BMCH staff members shows that the vaccination has reduced COVID-19 infection.

Introduction: Rasamanikya is a most acquainted Rasaushadhi containing Haratala. Ayurveda vaidya often uses in Vata-Kaphaja Vikaras such as Shwasa (asthma), Kasa (cough), and Kusta (skin disorders). As it has good clinical results, so currently it has high demand in pharma market. Various methods of preparation are mentioned in Rasa classics; hence, three different pharmaceutical procedures were selected to accord technological evidence and analytical study that includes the physicochemical analysis of the ingredients and the finished products, so the present study was entitled as “Analytical Screening on Rasamanikya Prepared by Different Pharmaceutical Methods.” Methods: Kushmanda swarasa and Amla dadhi Shodhita Patra Haratala. Methods: (1) Preparation of Rasamanikya by Abhraka Patra method; (2) preparation of Rasamanikya by Valuka Yantra; and (3) preparation of Rasamanikya by glass bulb method. Later, all the samples of Rasamanikya were subjected to analytical studies. Results: All the samples of Rasamanikya were in the amorphous form due to loss of crystallinity. Sudden cooling of molten solids converts it into amorphous solids. The detailed analytical study and observation were documented. Conclusion: All three pharmaceutical procedures produce the good ruby-colored Rasamanikya. The first two products having arsenic percentage within pharmacopoeial standards, but the third one is below the limit. However, all other tests are within the standards. All the samples of Rasamanikya were in the amorphous form due to loss of crystallinity.

OBJECTIVES: The present study intended to identify community elderly at risk for Motor dysfunction by developing a new programme. METHODOLOGY: Twenty-one Individuals aged ≥60 years were assessed using Five minutes sit to stand test (FTSTST) for lower limb strength, mobility; The Functional Gait Index (FGI) assessed Balance, Gait; Older people's Quality of Life Scale-Brief (OPQL-Brief) assessed Quality of Life. RESULTS: One way ANOVA (P < 0.05) was used for Comparison of gender specific scores of FTSTST, FGI, OPQL-Brief the first two had no significant change but the third one showed significantly higher difference in males (P = 0.0004). Correlation analysis between age and all three outcome measures was significantly positive for FTSTST, significantly negative for FGI; OPQL-Brief scale showed non-significant negative correlation. CONCLUSION: This study provides evidence that the new programme developed is effective in assessing motor dysfunction in community elderly.

Background: If oral mucosal lesions are detected early by the oral health practitioners, there will be a better prognosis for the lesions diagnosed. This cross-sectional study was designed to assess the perceptions and awareness of dental students of the Government Dental College and Hospital, Mumbai, toward oral tissues. Materials and Methods: A questionnaire was created to assess the perceptions and awareness of dental students towards oral tissues. This questionnaire had 25 questions with multiple choices. Options of these questions were based on 3-point and 5-point Likert scale. This questionnaire was converted into a Google Form and distributed among all the undergraduate students of the Government Dental College and Hospital, Mumbai, along with a declaration form via electronic methods such as Gmail and WhatsApp, after explaining to them the aim and objectives of the study. Results: A total of n = 334 dental students responded, yielding a response rate of 66.8%. Most dental students agreed that it is important to focus on oral soft tissues apart from oral hard tissues. Most participants believed that it is the role of the dentist to perform the complete oral examination. Lack of training, confidence, time, etc., were seen as barriers to at least some degree by participants. Conclusion: This study highlights the awareness of oral soft tissues among dental students and the importance of its academic reinforcement. This would definitely help budding dentists to work more on oral cancer prevention and detection, which ultimately may lead to a decrease in the incidence of oral cancers.

Background: Menopause is a normal physiological change and an important transition in women’s life. Onset of menopause has important implications on women’s fertility and health. Menopausal symptoms vary in severity and may decrease quality of life Thise is, because the majority of women still do not take treatment for these symptoms as most Indian women have a history of self-denial and neglect. This study is conducted to find the prevalence of postmenopausal symptoms among women resisting in urban slums Methods: This was a community based, cross-sectional study conducted among 334 postmenopausal women (45-60) residing in urban slums by systematic random sampling. Menopause Rating Scale (MRS) was used to assess postmenopausal symptoms Pre-designed, pre-tested proforma was used for collecting data to identify the factors affecting it. General physical examination was carried out and anthropometric measurements were recorded. Data were analysed using SPSS software version 20. Results were expressed as descriptive statistics (Mean (SD), Frequency (%)) and Chi-square test was used to find the association between two attributes. Results: 69.76% of participants had mild symptoms, 23.95% moderate symptoms and only 2.1% suffered from severe symptoms. Prevalence of somatic symptoms was 93.11%, psychological symptoms 85.33% and urogenital symptoms was 33.53%. 44.31% of women from class 4 of SES suffered from mild to severe symptoms, followed by class 3 with 20.06% (p= 0.00005). 73.86% from nuclear families and 66.67% for three generations in their families suffered from mild symptoms (p=0.0001) Conclusion: The prevalence of somatic postmenopausal symptoms was high compared to psychological and urogenital using MRS. Factors like age, poor socio-economic status, marital and educational status played a role in postmenopausal symptoms. Measures should be taken for early recognition of symptoms and treatment. To achieve this, the government, private, and voluntary organizations can establish postmenopausal clinics as soon as possible at the earliest at all levels of healthcare.

Histone deacetylase inhibitors (HDACi) sensitize homologous recombination (HR)-proficient human ovarian cancer cells to PARP inhibitors (PARPi). To investigate mechanisms of anti-tumor effects of combined HDACi/PARPi treatment we performed transcriptome analysis in HR- proficient human ovarian cancer cells and tested drug effects in established immunocompetent mouse ovarian cancer models. Human SKOV-3 cells were treated with vehicle (Con), olaparib (Ola), panobinostat (Pano) or Pano+Ola and RNA-seq analysis performed. DESeq2 identified differentially expressed HR repair and immune transcripts. Luciferised syngeneic mouse ovarian cancer cells (ID8-luc) were treated with the HDACi panobinostat alone or combined with olaparib and effects on cell viability, apoptosis, DNA damage and HR efficiency determined. C57BL/6 mice with intraperitoneally injected ID8-luc cells were treated with panobinostat and/or olaparib followed by assessment of tumor burden, markers of cell proliferation, apoptosis and DNA damage, tumor-infiltrating T cells and macrophages, and other immune cell populations in ascites fluid. There was a significant reduction in expression of 20/37 HR pathway genes by Pano+Ola, with immune and inflammatory-related pathways also significantly enriched by the combination. In ID8 cells, Pano+Ola decreased cell viability, HR repair, and enhanced DNA damage. Pano+Ola also co-operatively reduced tumor burden and proliferation, increased tumor apoptosis and DNA damage, enhanced infiltration of CD8+ T cells into tumors, and decreased expression of M2-like macrophage markers. In conclusion, panobinostat in combination with olaparib targets ovarian tumors through both direct cytotoxic and indirect immune-modulating effects.

Background: Knee osteoarthritis (KOA) is a frequent degenerative disease of joints. The prevalence is approximately 28% among the Indian elderly. Recently complementary and alternative medicine therapies have been used in managing pain and disability. Dynamic cupping therapy is one of the forms used nowadays. Foam rolling and vibration therapy is also a popular intervention in musculoskeletal conditions such as osteoarthritis, osteoporosis, sarcopenia, and low back pain. Nowadays, these two have been combined for the development of vibrating foam rollers. Objectives: This research aimed to compare the result of dynamic cupping therapy to that of a vibrating foam roller on pain, range of motion, function, and quality of life in elderly with sub-acute and chronic KOA. Materials and Methods: The research was carried out on 45 subjects with subacute to chronic KOA who were given thrice a week sessions for 4 weeks’ intervention. Through the randomized method, subjects were divided into a conventional group, dynamic cupping group and vibrating foam roller group outcome measures Numeric Pain Rating Scale, knee range of motion, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and brief Older People′s Quality of Life Questionnaire (OPQOL-brief) were used. Results: Wilcoxon rank test revealed a pre-post difference in all three groups with significant P-values which were

Background: The high level of out-of-pocket expenditures (OOPEs) increases the risk for catastrophic expenditure and may further increase the risk of impoverishment. Objective: To know the economic impact of hypertension (HTN) in urban Chitradurga. Materials and Methods: A cross-sectional study was conducted among 196 hypertensives aged more than 18 years taking treatment for more than 1 year. Newly diagnosed hypertensives and with other debilitating illness were excluded. This study was done in urban field practice area of Chitradurga, for a period of 3 months. Subjects were selected by simple random sampling by line listing all cases. Sociodemographic data and cost of treatment were collected. Along with this cost of consultation, medicine, travel, diagnostic cost, patient's wage lost for treatment and other expenditure details was collected. Results: It was found that most of the subjects were above the age of 60 years and unemployed. Only 29.6% of the participants chose to seek care from government hospitals. Around 67.9% of participants had associated comorbidities. Median monthly OOPE toward HTN was found to be Rs. 600 (400–750). When this was analyzed separately for hospitalized and nonhospitalized cases, total cost of expenditure due to HTN was Rs. 2583 and Rs. 700, respectively. The monthly direct cost of subjects seeking care in private hospitals is Rs. 850 which is Rs. 650 more than what the subjects who seek care in government hospitals pay. Total monthly cost was Rs. 400 and Rs. 1050 for government and private hospitals, respectively. Conclusion: High OOPE makes it a necessity for intervention.

Grading system for prostatic cancer (PC) was first described in1966 by Dr. Donald Gleason. Over the years, histologic, clinical diagnosis and management of PCa have evolved, leading to revisions of the Gleason system first by the International Society of Urological Pathology (ISUP) in 2005 and more recently in 2014. Unlike the original Gleason score (GS) ranging from 2 to 10, the current system no longer assign Scores 2–5, the lowest score being 6. The new grading system of 2014 proposed Five Grade Groups based on revised GS which produces a smaller number of grades with the most significant prognostic differences and may contribute to a decrease in the overtreatment of low-grade PC detected by prostate-specific antigen screening. This review provides an update on the evolution and revision of the Gleason grading system, with a discussion on the deficiencies, benefits, and limitations of the revised and new grading system of ISUP 2005, 2014, and 2019.

Adenocarcinoma of prostate with pleomorphic giant cells is very rarely encountered entity. It is necessary to identify this variant due to its highly aggressive clinical course and bad prognosis. Though this variant has been described in other sites, very few cases has been reported in the prostate till date. We report one such case with typical features with discussion on the differential diagnosis that must be considered when such case is encountered.

AIM: To evaluate the astigmatic changes before and after pterygium surgery and to study the effect of autologous fibrin glue over sutures in terms of efficacy in reducing corneal astigmatism. SETTINGS AND DESIGN: Randomized controlled trial. SUBJECTS AND METHODS: Forty-four patients with primary pterygia were taken up and divided as follows: Conjunctival autograft with autologous fibrin glue as Group 1 (n = 22) and autograft with 8-0 vicryl sutures as Group 2 (n = 22). All patients were preoperatively assessed for visual acuity, anterior, posterior segments, and Keratometric values using Bausch-Lomb keratometer on postoperative day 1, 7, 1 month, and 3 months. STATISTICAL ANALYSIS: Mann–Whitney test was performed to compare the median keratometric astigmatic changes preoperatively and postoperatively between the groups. P < 0.05 was considered statistically significant. RESULTS: 50.5 was the mean age and 14.81 standard deviation (SD) in Group 1 and 48.86 was the mean and 13.23 SD in Group 2. Group 1 had 40.9% males and 59.1% females, Group 2 had 54.5% males and 45.5% females. The preoperative keratometric values significantly decreased postoperatively in both groups and the median postoperative keratometric value was significantly reduced in Group 1 (0.5) as compared to Group 2 (1.25). Pterygium excision using autologous blood was more effective in reducing corneal astigmatism. CONCLUSION: Pterygium excision surgery reduces corneal astigmatism and thus improves visual acuity. Autologous blood is better option to attach the conjunctival autograft than sutures in reducing astigmatism.

Abstract Background Cervical cancer is the fourth most common cancer in the world, affecting mainly women residing in low- and middle-income countries. Progression from a pre-invasive phase to that of an invasive phase generally takes years and provides a window of opportunity to screen for and treat precancerous lesions. Methods This study is being conducted at four sites in north Karnataka, India. Community sensitization activities have been organized in the study areas to create awareness among stakeholders, including elected representatives, physicians, health care workers, and potential participants. Organized community based as well as hospital-based screening is being conducted using visual inspection with acetic acid (VIA). Screen positive women are referred to respective study hospitals for colposcopy and directed biopsy. Participants with confirmed high-grade cervical dysplasia (high-grade squamous intraepithelial lesions or HSIL) who fit all other eligibility criteria will be recruited to the study and will receive cryotherapy using CryoPop®, an innovative new cryotherapy device. Discussion There is a need to develop an inexpensive, simple, and effective cryotherapy device for use by frontline health care providers at locations where screening and timely treatment can be given, accelerating access to cervical cancer prevention services and minimizing loss to follow-up of women with precancerous lesions who need treatment. Trial registration Clinical Trial Registry - India CTRI/2019/01/017289 ClinicalTrials.Gov number NCT04154644 . Registered on November 6, 2019.

Introduction: Excessive menstruation outside the normal parameters is one of the most common manifestations of hypothyroidism affecting the females. Thyroid disorders, such as hypothyroidism and hyperthyroidism are associated with late onset puberty, anovulatory cycles and abnormally high incidence of foetal morbidity and mortality. Aim: To study the association of bleeding pattern with thyroid dysfunction among patients with Abnormal Uterine Bleeding (AUB). Materials and Methods: This was a prospective cross-sectional study carried out in the Department of Obstetrics and Gynaecology at Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India, from October 2012 to June 2014, among 140 females with a provisional diagnosis of abnormal uterine bleeding were subjected to testing for serum Triiodothyronine (T3), Thyroxine (T4), Thyroid Stimulating Hormone (TSH) and Thyroid Peroxidase (TPO) antibodies estimation in their serum. Data was analysed using Chi-square test and the p-value

Background Anthropogenic sources can lead to the accumulation of heavy metals in marine organisms through ingestion, absorption, or inhalation. For sea turtle embryos, heavy metals can be absorbed into the egg from the incubation environment or be maternally transferred to the offspring causing neurological, reproductive, and developmental problems. Here, we report heavy metal concentrations in green turtle hatchlings from the largest rookery on the Red Sea, Ras Baridi. Methods Deceased hatchlings were collected from two beaches near a cement factory at Ras Baridi, from which heavy metal concentrations (chromium (Cr), manganese (Mn), iron (Fe), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), cadmium (Cd), and lead (Pb)) were measured from the liver, muscle, and residual yolk of the hatchlings. Results Although based on a small sample of hatchlings, the data presented here provides the first measurements of heavy metals from sea turtles in the Red Sea and highlights the link between human activity and its impact on the ecology of sea turtles. In general, the heavy metal concentrations of heavy metals were not significantly different between the beach next to the cement factory and the beach downwind from the factory. However, the concentrations of heavy metals were significantly different between sampled tissues (liver, muscle, and residual yolk). Discussion This study provides insight into current heavy metal levels in green turtle hatchlings, which can be used as bio-indicators for environmental contaminants as coastal development increases in the Red Sea. Moreover, we found a lack of standardized methodology to evaluate heavy metals in hatchling sea turtles. Future efforts should work toward creating comparable techniques for long-term heavy metal monitoring, as this is a useful determinant of anthropogenic pollution.

Introduction: Diabetes Mellitus (DM) is a metabolic disorder characterised by persistence hyperglycaemia resulting from the defects in insulin secretion, action or both. Diabetes prevalence is rapidly increasing, especially in urban India. The changing lifestyle has majorly contributed to the increasing prevalence of diabetes. Aim: To determine the incidence of microalbuminuria and its correlation with age, sex, duration, Fasting Blood Sugar (FBS), Postprandial Blood Sugar (PPBS) and Body Mass Index (BMI). Also to detect the presence of vascular complications using Ankle Brachial Index (ABI), Pulse Wave Velocity (PWV), Augmentation Index (AI) and microalbuminuria. Materials and Methods: The present cross-sectional study was conducted in Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India, from March to June 2018. The study included assessment of blood glucose level both FBS and PPBS, microalbumin levels in 100 known diabetic patients and also ABI, PWV and AI were measured using periscope instrument. Analytical test to measure the differences between two means of the two groups independent t-test was applied and multiple regressoon analysis was done. Results: Out of total 100 subjects, 59% were males and 41% were females. The correlation of microalbuminuria with factors like, duration of diabetes, FBS, PPBS, PWV and AI was statistically significant with a p-value of

Abstract Background An easy, defined, rapid, and accurate reverse phase high-performance liquid chromatography method was developed and subsequently validated for the concurrent estimation of lamivudine, efavirenz, and tenofovir disoproxil fumarate in their pure blend and combined tablet formulation. An efficient and appropriate separation of the three analytes was attained with Zorbax eclipse XDB-Phenyl column, with a mobile phase of methanol: buffer (0.1% v/v formic acid in water) (73:27 v/v) at a flow rate of 1mL/min and isocratic elution by using 260nm as detection wavelength. Equal ratio of acetonitrile and water was used as diluent. Results The retention times of lamivudine, tenofovir disoproxil fumarate, and efavirenz were found at 2.6, 4.4, and 5.9 min respectively. The linear response for lamivudine, tenofovir disoproxil fumarate, and efavirenz was in the range of 15.0–45.0μg/mL, 15.0–45.0μg/mL, and 20.0–60.0 μg/mL respectively. The method validation was done in accordance to ICH guidelines and all validation parameters in compliance with ICH standards. The degradants produced by stress testing were well resolved from the peaks of active analytes, which stipulates the stability-indicating property of the method. Conclusion The method has the ability to separate lamivudine, efavirenz, and tenofovir disoproxil fumarate concurrently in blended powder and their combined tablet. All degradants produced by application of stress conditions were separated with high resolution and determined with good sensitivity that ensures the stability-indicating property of the method. Thus, the projected method has high probability to adopt in the pharmaceutical industrial sector.

Abstract The World Health Organization (WHO) has articulated a priority pathogens list (PPL) to provide strategic direction to research and develop new antimicrobials. Antimicrobial resistance (AMR) patterns of WHO PPL in a tertiary health care facility in Southern India were explored to understand the local priority pathogens. Culture reports of laboratory specimens collected between 1st January 2014 and 31st October 2019 from paediatric patients were extracted. The antimicrobial susceptibility patterns for selected antimicrobials on the WHO PPL were analysed and reported. Of 12,256 culture specimens screened, 2335 (19%) showed culture positivity, of which 1556 (66.6%) were organisms from the WHO-PPL. E. coli was the most common organism isolated (37%), followed by Staphylococcus aureus (16%). Total of 72% of E. coli were extended-spectrum beta-lactamases (ESBL) producers, 55% of Enterobacteriaceae were resistant to 3rd generation cephalosporins due to ESBL, and 53% of Staph. aureus were Methicillin-resistant. The analysis showed AMR trends and prevalence patterns in the study setting and the WHO-PPL document are not fully comparable. This kind of local priority difference needs to be recognised in local policies and practices.

This study aims to propose building envelope retrofit packages for existing naturally ventilated school buildings in the hot–humid climatic region of Chennai, India. Indoor thermal parameters were collected through field studies from nine sample classrooms of a selected school building in May 2019, between 9.00 am and 4.00 pm. The thermal performance assessment of the existing building was performed by examining the discomfort hours using the CBE thermal comfort tool. Envelope retrofit strategies gathered from the literature and building standards were applied and studied through simulation. The findings reveal the enormous potential to increase the thermal comfort of existing school buildings through envelope retrofit measures. The results demonstrate that the whole-building temperature can be reduced up to 3.2 °C in summer and up to 3.4 °C in winter. Implementing retrofit measures to the building envelopes of existing buildings will help school owners to increase the comfortable hours of whole buildings by up to 17%. In comparison, annual energy savings of up to 13% for the whole building can be made by enhancing the thermal performance of the building envelope. The findings will also help architects to optimise thermal performance and energy usage with minimal interventions.

Purpose: In India, school eye screening is an important component of the National Programme for the Control of Blindness providing spectacles free of cost to children from primary section. The primary aim of this study was to know the compliance of wearing spectacles provided during school screening program and to find out reasons for noncompliance. The secondary aim of this study was to get information regarding the types of modifications required in the school eye screening program to improve the compliance level. Methods: It was a cross-sectional follow-up study involving school children of age group 10–16 years, class 5–9 from different parts of the country. Public or private schools were randomly selected based on their distance from the base hospitals/partner organizations. Data were collected by standard format directly from the students after informed written consent from school principal or class teacher. Results: The utilization of spectacles was found to be only 29.8% (n = 289) within 2 years of receiving the spectacles. Thirty-five percent (n = 108) students were using spectacles with less than 0.75 D. Appearance of the frame was a deciding factor. It was observed that the frames provided by the DBCS were especially not liked by the children. Twenty-five percent (n = 79) children were found to be wearing adult frames.Conclusion: Less than a third of the students were compliant with their spectacle prescription in this study. To improve the compliance, children should not be prescribed spectacles for nonsignificant refractive errors, should be given choices for frames and quality of work being conducted under school screening program needs a review.

Purpose: Diabetic retinopathy (DR) remains a leading cause of vision loss in the adult population. The purpose of our study was to analyze and co-relate diabetic retinopathy-related micro-vascular changes using Optical Coherence Tomography Angiography (OCTA) in various stages of diabetic retinopathy. Methods: One hundred and twenty eyes of diabetic patients were categorized into three groups of forty each. Group-A included eyes without retinopathy, Group-B included eyes with Non-Proliferative Diabetic Retinopathy and Group-C included eyes with proliferative DR. Apart from complete ocular examination, foveal avascular zone parameters were analyzed using OCTA. Results: Statistically significant differences were found concerning vascular density and perfusion density between eyes with DR when compared to eyes without DR (P>0.001). 9 Vascular density (VD) significantly decreases in eyes with the progressive stage of DR. Foveal avascular zone showed a significant increase in area, perimeter, and circularity in the eyes with PDR compared to other groups. Conclusion: FAZ metrics showed significant changes proportional to diabetic retinopathy stages. Vascular density and perfusion density parameter analysis by OCTA could be used as early biomarkers in predicting the risk of diabetic retinopathy progression.

Introduction: Shoulder pain in subcoracoid impingement syndrome was due to intrusion of rotator cuff tendons in the coracohumeral space. One of the predisposing factors for subcoracoid impingement syndrome was limited subcoracoid space which causes impingement of lesser tubercle of humerus against the coracoid process to produce pain in the anterior region of shoulder. Coracoid process was also used as graft in Latarjet operation done to treat glenohumeral instability. So, understanding the morphometry of coracoid process is very important for orthopaedic surgeons for various surgical procedures. Aim: To analyse the morphometry of coracoid process, coracoglenoid distance and shape of coracoglenoid space among South Indian population. Materials and Methods: This was a cross-sectional study done between March 2018 to September 2018 on 100 dried human scapulae obtained from the bone bank of Department of Anatomy of Private Medical Colleges in South India. Maximum length, breadth, thickness, height of coracoid process, coracoglenoid distance and maximum width of glenoid cavity were measured in millimetres (mm) using digital vernier callipers with the precision of 0.01 mm. Results: Total of 100 dried human scapulae (51 of right side, 49 of left side) were studied and analysed. The average length of coracoid process was 39.47±3.29 mm. The average breadth of coracoid process was 13.91±1.36 mm. The mean thickness of coracoid process was 8.24±1.003 mm. The mean coracoglenoid distance was 27.19±2.42 mm. Breadth of coracoid represents 57.92% of Glenoid width and thickness of coracoid represents 34.27% of Glenoid width. Most common variety of coracoglenoid space found in our study was round bracket shape which was in 51% of scapulae, followed by square bracket shaped in 30% and fish hooked shaped in 19% of scapulae. Conclusion: Morphometry of coracoid process will be taken into account while treating patients with subcoracoid impingement syndrome. Thickness of coracoid process was always smaller than the breadth of coracoid. Hence, the breadth was taken into account when coracoid process was used as a graft to reconstruct glenoid bone loss in recurrent shoulder dislocation.

Adenoid cystic carcinoma is an extremely rare subtype of breast carcinoma. Usually they are triple negative, but have favourable prognosis in contrast to their salivary gland counterparts. They have distinct morphological features, the solid component determining the grade of the tumour. They have low recurrence rate, may rarely metastasize after a long time after diagnosis, hence requiring a long term follow up. There is no consensus on the effective treatment. Breast conserving surgery with adjuvant radiotherapy appears to be effective. It is hence important to identify this distinct subtype of breast carcinoma.

Cholera remains a public health threat among the least privileged populations and regions affected by conflicts and natural disasters. Together with Water, Sanitation and Hygiene practices, use of oral cholera vaccines (OCVs) is a key tool to prevent cholera. Bivalent whole-cell killed OCVs have been extensively used worldwide and found effective in protecting populations against cholera in endemic and outbreak settings. No cholera vaccine had been available for United States (US) travelers at risk for decades until 2016 when CVD 103-HgR (Vaxchora™), an oral live attenuated vaccine, was licensed by the US FDA. A single dose of Vaxchora™ protected US volunteers against experimental challenge 10 days and 3 months after vaccination. However, use of Vaxchora™ poses several challenges in resource poor settings as it requires reconstitution, is age-restricted to 18 to 64 years, has no data in populations endemic for cholera, and faces challenges related to cold chain and cost.

Context: Breast cancer constitutes nearly one third of cancers among women. Immune responses caused by neoplastic cells lead to the accumulation of inflammatory cells like mast cells (MCs), macrophages, lymphocytes, and plasma cells around the tumor tissue forming the tumor microenvironment. Aim: The study aims at quantifying the role of MCs in different grades of invasive carcinoma of breast with respect to estrogen receptor (ER), progesterone receptor (PR), and Human Epidermal growth factor Receptor 2 (HER2/neu). Materials and Methods: This study included 60 cases of invasive carcinoma of breast. Toluidine blue staining was used for quantitative MC analysis and correlated with immunohistochemistry analysis for hormonal markers' positivity—ER, PR and HER2/neu. Results: The mean age was 52 years (range: 25–75 years). The average number of MCs in Grade I, II, and III were 24.05, 18.4, and 7.9, respectively, with a significant P value. ER, PR, and HER2/neu positivity was found in 60%, 55%, and 32% of the cases, respectively. ER positivity with mean MC count of 23.55 was found in 36 cases, and 33 cases were positive for PR with a mean MC count of 24.18 and a significant P value. HER2 positive cases were 28 with a mean MC count of 20.82. Conclusion: The presence of MCs in breast cancer is inversely proportional to the grade of tumor, i.e., a maximum number of MCs were seen in low grade tumors. In addition, there is a positive correlation between ER and PR receptor positivity with the presence of MCs in the stroma of breast cancer.

One major source of controversy related to possible health effects of radiofrequency radiation (RFR) is the large number of reported statistically significant effects of exposure, over the entire RF part of the spectrum and over a wide range of exposure levels, even as health agencies do not find clear evidence for health hazards of exposure at levels within current IEEE and ICNIRP exposure limits. This Perspective considers 31 studies related to genetic damage produced by exposure to RFR at frequencies above 6 GHz, including at millimeter-wave (mm-wave) frequencies. Collectively, the papers report many statistically significant effects related to genetic damage, many at exposure levels below current exposure limits. However, application of five risk of bias (RoB) criteria and other considerations suggest that the studies in many cases are vulnerable to false discovery (nonreplicable results). The authors call for improvements in study design, analysis and reporting in future bioeffects research to provide more reliable information for health agencies and regulatory decision makers. This Perspective is a companion to another Perspective by Mattsson et al. elsewhere in this volume (Mattsson et al., 2021)1.

Introduction: Ewing's sarcoma (ES) is an extremely rare bone malignancy observed in otorhinolaryngeal practice. In otorhinolaryngology, it sometimes involves the facial bones and cervical vertebrae. In children, ES is the second most common primary malignancy of bone after osteosarcoma. Extraskeletal Ewing’s sarcoma (EES) is an extremely rare malignancy of mesenchymal cell origin. The EES is observed in the trunk and lower extremities. The neck is an extremely rare primary site for EES. Case Report: A 3-year-old female child referred with a rapidly enlarging right-sided neck swelling since 2 months ago. Physical examination and preoperative investigations suggested the diagnosis of a carotid body tumor and histopathological findings were similar. However, the results of immunohistochemistry revealed a confirmatory diagnosis of ES. Conclusion: Hereby, we presented a case of EES of the neck in a child, which was completely misdiagnosed preoperatively due to its rare incidence. The incidence of EES in the head and neck region can be successfully managed with radical excision and radiotherapy.