Search

Abstract Background Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and at present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI). A key reason for poor outcomes is non-adherence to medication. Methods The intervention is a 2 × 2 factorial design trial applying two interventions individually and in combination with 1:1 allocation ratio: (i) ASHA-led medication adherence initiative comprising of home visits and (ii) m-health intervention using reminders and self-reporting of medication use. This design will lead to four potential experimental conditions: (i) ASHA-led intervention, (ii) m-health intervention, (iii) ASHA and m-health intervention combination, (iv) standard of care. The cluster randomized trial has been chosen as it randomizes communities instead of individuals, avoiding contamination between participants. Subcenters are a natural subset of the health system, and they will be considered as the cluster/unit. The factorial cluster randomized controlled trial (cRCT) will also incorporate a nested health economic evaluation to assess the cost-effectiveness and return on investment (ROI) of the interventions on medication adherence among patients with CVDs. The sample size has been calculated to be 393 individuals per arm with 4–5 subcenters in each arm. A process evaluation to understand the effect of the intervention in terms of acceptability, adoption (uptake), appropriateness, costs, feasibility, fidelity, penetration (integration of a practice within a specific setting), and sustainability will be done. Discussion The effect of different types of intervention alone and in combination will be assessed using a cluster randomized design involving 18 subcenter areas. The trial will explore local knowledge and perceptions and empower people by shifting the onus onto themselves for their medication adherence. The proposal is aligned to the WHO-NCD aims of improving the availability of the affordable basic technologies and essential medicines, training the health workforce and strengthening the capacity of at the primary care level, to address the control of NCDs. The proposal also helps expand the use of digital technologies to increase health service access and efficacy for NCD treatment and may help reduce cost of treatment. Trial registration The trial has been registered with the Clinical Trial Registry of India (CTRI), reference number CTRI/2023/10/059095.

Introduction Temporomandibular joint disorders (TMD) present with a multitude of symptoms that can range from headaches to shoulder pain. Patients frequently present with pain in the ear, dizziness, and vertigo. It is noted that some patients who report TMDs also have a history of sleep disturbances, which is noted in cone beam computed tomography (CBCT) as a reduction in the oropharyngeal airway volume.

Background: Hyoid bone plays an important role in craniomandibular functions through its unique interaction with other structures. The effects of temporomandibular disorder (TMD) on the craniocervical posture and position of hyoid bone were considered, although the results endure inconclusive. Objective: The objective is the comparison of the position of the hyoid bone in patients with the temporomandibular joint disorder of pre- and post-neuromuscular orthotics utilizing cone-beam computed tomography (CBCT). Treatment using ultra-low-frequency transcutaneous electric nerve stimulation was administered, and a myocentric bite was registered, with which an orthotic was fabricated and delivered to the patient for full-time wear. Materials and Methods: The hyoid bone position of 14 TMD patients of pre- and post-treatment was observed using CBCT, and symptom severity score, joint pain, joint sounds, and limited mouth opening were studied pre- and post-treatment clinically. Results: All patients had relief of symptom severity score post treatment and no significant improvement in the anteroposterior direction of hyoid bone with no statistical significance with P value < 0.001. The majority of the patients had an inferiorly positioned hyoid bone post intervention with a P value less than 0.001. Conclusion: Neuromuscular orthotics resulted in a decrease in the symptom severity score of the patients along with an anteriorly and inferiorly positioned hyoid bone.

Summary: Interaction with microenvironmental factors is crucial for the regulation of hematopoietic stem cell (HSC) function. Stroma derived factor (SDF)-1α supports HSCs in the quiescent state and is central to the homing of transplanted HSCs. Here, we show that integrin signaling regulates Sdf-1α expression transcriptionally. Systemic deletion of Periostin, an Integrin-αv ligand, showed increased expression of Sdf-1α in bone marrow (BM) niche. Pharmacological inhibition or CRISPR-Cas9-mediated deletion of SRC, resulted in a similar increase in the chemokine expression in vitro. Importantly, systemic SRC-inhibition led to increase in SDF-1α levels in BM plasma. This resulted in a robust increase (14.05 ± 1.22% to 29.11 ± 0.69%) in the homing efficiency of transplanted HSCs. In addition, we observed enhancement in the recovery of blood cell counts following radiation injury, indicating an enhanced hematopoietic function. These results establish a role of SRC-mediated integrin signaling in the transcriptional regulation of Sdf-1α. This mechanism could be harnessed further to improve the hematopoietic function.

Oral healthcare providers work near the face of the patients and are at an increased risk of being infected or transmitting the infection to the patients. Standard practice guidelines have to be modified to reorganize Oral Medicine care in the new normality of the COVID-19 pandemic to minimize the negative impacts of the infection on oral and systemic health. This scoping review aims to assess the guidelines for the safe practice of Oral Medicine during the COVID-19 pandemic. The literature search was done using Medline and Pubmed as the database and 23 articles were identified related to 8 domains. Utilization of teledentistry, efficient triaging of the patients with strict adherence to the infection control protocols, knowledge of the possible oral manifestations, and management of patients based on their presenting symptoms can help for the safe practice of Oral Medicine during the COVID-19 pandemic.

The impact of economic performance on human development has become a topic of debate in the recent times. For the past few years the member nations of SAARC region reported to have an unprecedented economic growth. But the human development in this region seems to be abysmal. This paper is aiming to assess the impact of economic performance of SAARC nations on its human development. The study extensively covers the macro economic data and the human development index (HDI) of the SAARC nations from 1990 to 2015. The Random effects (RE) model of panel regression analysis confirmed that GDP and GDP per capita can influence human development of these nations whereas the economic growth do not have any significant impact on human development at 1% and 5% levels of significance. The study is also intended to suggest numerous policy measures for enhancing the human development of this region.

Pediatric TB poses challenge in diagnosis due to the paucibacillary nature of the disease. We conducted a prospective diagnostic study to identify immune biomarkers of pediatric TB and controls (discovery cohort) and obtained a separate “validation” cohort of confirmed cases of pediatric TB and controls. Multiplex ELISA was performed to examine the plasma levels of cytokines. Discovery and validation cohorts revealed that baseline plasma levels of IFNγ, TNFα, IL-2, and IL-17A were significantly higher in active TB (confirmed TB and unconfirmed TB) in comparison to unlikely TB children. Receiver operating characteristics (ROC) curve analysis revealed that IFNγ, IL-2, TNFα, and IL-17A (in the discovery cohort) and TNFα and IL-17A (in the validation cohort) could act as biomarkers distinguishing confirmed or unconfirmed TB from unlikely TB with the sensitivity and specificity of more than 90%. In the discovery cohort, cytokines levels were significantly diminished following anti-tuberculosis treatment. In both the cohorts, combiROC models offered 100% sensitivity and 98% to 100% specificity for a three-cytokine signature of TNFα, IL-2, and IL-17A, which can distinguish confirmed or unconfirmed TB children from unlikely TB. Thus, a baseline cytokine signature of TNFα, IL-2, and IL-17A could serve as an accurate biomarker for the diagnosis of pediatric tuberculosis.

Abstract Urinary tract infections (UTI) by antibiotic resistant and virulent K. pneumoniae are a growing concern. Understanding the genome and validating the genomic profile along with pangenome analysis will facilitate surveillance of high-risk clones of K. pneumoniae to underpin management strategies toward early detection. The present study aims to correlate resistome with phenotypic antimicrobial resistance and virulome with pathogenicity in Klebsiella spp. The present study aimed to perform complete genome sequences of Klebsiella spp. and to analyse the correlation of resistome with phenotypic antimicrobial resistance and virulome with pathogenicity. To understand the resistome, pangenome and virulome in the Klebsiella spp, the ResFinder, CARD, IS Finder, PlasmidFinder, PHASTER, Roary, VFDB were used. The phenotypic susceptibility profiling identified the uropathogenic kp3 to exhibit multi drug resistance. The resistome and in vitro antimicrobial profiling showed concordance with all the tested antibiotics against the study strains. Hypermucoviscosity was not observed for any of the test isolates; this phenotypic character matches perfectly with the absence of rmpA and magA genes. To the best of our knowledge, this is the first report on the presence of ste, stf, stc and sti major fimbrial operons of Salmonella enterica serotype Typhimurium in K. pneumoniae genome. The study identifies the discordance of virulome and virulence in Klebsiella spp. The complete genome analysis and phenotypic correlation identify uropathogenic K. pneumoniae kp3 as a carbapenem-resistant and virulent pathogen. The Pangenome of K. pneumoniae was open suggesting high genetic diversity. Diverse K serotypes were observed. Sequence typing reveals the prevalence of K. pneumoniae high-risk clones in UTI catheterised patients. The study also highlights the concordance of resistome and in vitro susceptibility tests. Importantly, the study identifies the necessity of virulome and phenotypic virulence markers for timely diagnosis and immediate treatment for the management of high-risk K. pneumoniae clones.

The present study investigates the influence of hybrid interleaving technique using Glass and Carbon veils to improve the mode-I fracture toughness in Glass epoxy laminates. Commercially available non-woven Carbon and Glass veils with different areal densities were used to develop hybrid interleaved composites. Two approaches of interleaving, namely inter-ply and inter-weaved veils, were followed to manufacture the interleaved composite laminates using the hand layup technique. Double Cantilever Beam (DCB) samples were tested to estimate the interlaminar fracture toughness (IFT). Test results indicate that the inter-ply interleaved composite (I-C30G30) exhibited an improved initial and propagation fracture toughness of about 16.98% and 3.08%, respectively. A decreased IFT during initiation and propagation was observed for I-C15G30 and I-C20G30 when compared to plain samples. In case of inter-weaved veil interleaving approach, an improved fracture toughness (GIC and GIP) of about 7.96% and 12.94%, respectively, was observed for W-C15G30 sample, nevertheless W-C20G30 and W-C30G30 showed a drop in fracture toughness (GIC) of an about 12.15% and 9.22%, respectively, and an improvement in fracture toughness (GIP) of about 12.37% and 13.82%, respectively, when compared to plain sample. Scanning electron photo images (SEPI) of cracked laminates witnessed the fracture mechanisms involved in hybrid ply interleaved and non-interleaved composite laminates

Abstract Microorganisms known as psychrophiles/psychrotrophs, which survive in cold climates, constitute majority of the biosphere on Earth. Their capability to produce cold‐active enzymes along with other distinguishing characteristics allows them to survive in the cold environments. Due to the relative ease of large‐scale production compared to enzymes from plants and animals, commercial uses of microbial enzyme are alluring. The ocean depths, polar, and alpine regions, which make up over 85% of the planet, are inhabited to cold ecosystems. Microbes living in these regions are important for their metabolic contribution to the ecosphere as well as for their enzymes, which may have potential industrial applications. Cold‐adapted microorganisms are a possible source of cold‐active enzymes that have high catalytic efficacy at low and moderate temperatures at which homologous mesophilic enzymes are not active. Cold‐active enzymes can be used in a variety of biotechnological processes, including food processing, additives in the detergent and food industries, textile industry, waste‐water treatment, biopulping, environmental bioremediation in cold climates, biotransformation, and molecular biology applications with great potential for energy savings. Genetically manipulated strains that are suitable for producing a particular cold‐active enzyme would be crucial in a variety of industrial and biotechnological applications. The potential advantage of cold‐adapted enzymes will probably lead to a greater annual market than for thermo‐stable enzymes in the near future. This review includes latest updates on various microbial source of cold‐active enzymes and their biotechnological applications.

BackgroundIt has been reported that differential diagnosis of bacterial or viral pneumonia and tuberculosis (TB) in infants and young children is complex. This could be due to the difficulty in microbiological confirmation in this age group. In this study, we aimed to assess the utility of a real-time multiplex PCR for diagnosis of respiratory pathogens in children with pulmonary TB.MethodsA total of 185 respiratory samples [bronchoalveolar lavage (15), gastric aspirates (98), induced sputum (21), and sputum (51)] from children aged 3–12 years, attending tertiary care hospitals, Chennai, India, were included in the study. The samples were processed by N acetyl L cysteine (NALC) NAOH treatment and subjected to microbiological investigations for Mycobacterium tuberculosis (MTB) diagnosis that involved smear microscopy, Xpert® MTB/RIF testing, and liquid culture. In addition, DNA extraction from the processed sputum was carried out and was subjected to a multiplex real-time PCR comprising a panel of bacterial and fungal pathogens.ResultsOut of the 185 samples tested, a total of 20 samples were positive for MTB by either one or more identification methods (smear, culture, and GeneXpert). Out of these 20 MTB-positive samples, 15 were positive for one or more bacterial or fungal pathogens, with different cycle threshold values. Among patients with negative MTB test results (n = 165), 145 (87%) tested positive for one or more than one bacterial or fungal pathogens.ConclusionThe results suggest that tuberculosis could coexist with other respiratory pathogens causing pneumonia. However, a large-scale prospective study from different geographical settings that uses such simultaneous detection methods for diagnosis of childhood tuberculosis and pneumonia will help in assessing the utility of these tests in rapid diagnosis of respiratory infections.

Background: In spite of the various advances in the Tuberculosis (TB) management system in our country, we are still struggling to achieve the End TB strategy. Addressing the health provider difficulties in TB care will definitely be potential tool to control TB. Objective: To assess the competency, challenges and solutions of Indian medical graduates to provide effective Tuberculosis care. Method: It is a mixed methodological study conducted among the Bachelor of Medicine and Bachelor of Surgery (MBBS) graduates practising in various parts of Chennai, Tamil Nadu, India. The competency of the Indian medical graduates in delivering TB care was assessed using a content validated e-survey questionnaire disseminated through social media affinity groups andfree listing;pile sorting and in-depth interview was done in the qualitative part. Results:The proportion of participants having good, fair and poor competency in providing effective TB care was 35%,19% and 46%, respectively. Various challenges in attaining good competency were enlisted by the participants through free listing, a smaller number of TB patients in private medical college has attained the highest Smith S value followed by other eleven challenges. Based on the pile sorting and in-depth interview various solutions have been suggested, with most of them emphasizing on compulsory TB chest clinic posting followed by others measures. Conclusion:The major reason identified in difficulties in delivering TB care was inadequate exposure in managing TB patients, incomplete knowledge on notification,referral and followup system. These lacunae can be overturned by compulsory posting in TB clinics during internship period, provision of required personal protective equipment (PPE) for doctors and patients in TB wards and outpatient department, mandatoryteaching on updates of TB management.

Background: Social distancing, mask, and sanitizers are advised to cut the chain of transmission of the droplet and airborne infection since the first case of COVID-19 was reported from Wuhan. Universal mask usage is advised by the center for disease control. Despite this, it is assumed that there is no adequate mask practice. Aims and Objectives: The objectives of the study are as follows: (1) To assess the knowledge and practice regarding optimal mask usage in a different setting by the general community. (2) To identify the barriers for optimal mask usage as experienced by users. Materials and Methods: We did a cross-sectional study in Kerala using self-made validated questionnaire translated to Malayalam, the regional language distributed by web based Google form. The sample size was calculated as 200 with an assumption of awareness regarding mask usage among the general public to be at least 60% with a confidence interval of 95 and allowable error of 10% Knowledge was considered as high if 80–100%, moderate if 60–79% and low if 0–59%. The practice was considered as good if >75, 74–50 satisfactory and if

IntroductionEnvironmental enteropathy (EE), a chronic small intestine disease characterized by gut inflammation, is widely prevalent in low-income countries and is hypothesized to be caused by continuous exposure to fecal contamination. Targeted nutritional interventions using potential probiotic strains from fermented foods can be an effective strategy to inhibit enteric pathogens and prevent chronic gut inflammation.MethodsWe isolated potential strains from fermented rice water and lemon pickle and investigated their cell surface properties, antagonistic properties, adhesion to HT-29 cells, and inhibition of pathogen adherence to HT-29 cells. Bacteriocin-like inhibitory substances (BLIS) were purified, and in vivo, survival studies in Caenorhabditis elegans infected with Salmonella enterica MW116733 were performed. We further checked the expression pattern of pro and anti-inflammatory cytokines (IL-6, IL8, and IL-10) in HT-29 cells supplemented with strains.ResultsThe strains isolated from rice water (RS) and lemon pickle (T1) were identified as Limosilactobacillus fermentum MN410703 and MN410702, respectively. Strains showed probiotic properties like tolerance to low pH (pH 3.0), bile salts up to 0.5%, simulated gastric juice at low pH, and binding to extracellular matrix molecules. Auto-aggregation of T1 was in the range of 85% and significantly co-aggregated with Klebsiella pneumoniae, S. enterica, and Escherichia coli at 48, 79, and 65%, respectively. Both strains had a higher binding affinity to gelatin and heparin compared to Bacillus clausii. Susceptibility to most aminoglycoside, cephalosporin, and macrolide classes of antibiotics was also observed. RS showed BLIS activity against K. pneumoniae, S. aureus, and S. enterica at 60, 48, and 30%, respectively, and the protective effects of BLIS from RS in the C. elegans infection model demonstrated a 70% survival rate of the worms infected with S. enterica. RS and T1 demonstrated binding efficiency to HT-29 cell lines in the 38–46% range, and both strains inhibited the adhesion of E. coli MDR and S. enterica. Upregulation of IL-6 and IL-10 and the downregulation of IL-8 were observed when HT-29 cells were treated with RS, indicating the immunomodulatory effects of the strain.DiscussionThe potential strains identified could effectively inhibit enteric pathogens and prevent environmental enteropathy.

Purpose: Several studies have shown that platelet size is a reliable indicator of platelet activity and, therefore, a valuable biomarker for cardiovascular events. Many inflammatory and prothrombotic disorders have been linked to it. As a biomarker for inflammation and neoplastic disease, This study aims to examine existing research on changes to mean platelet volume (MPV). Materials and methods: The present study portrays MPV comparison among the female players who participated in three games viz Yoga, Volleyball, and Rugby conducted at the university level throughout India with age groups ranging from 17 to 25 years in the sample. The sample size is 45, with 15 players chosen from each game Yoga, Volleyball, and Rugby. Results: The results mean, standard deviation (SD), standard error of the mean (SEM), and lowest and maximum scores were used to examine the data. SPSS software was used to do the One-Way Analysis of variance. It was observed that there is a significant difference in the MPV of players from three distinct sports. Furthermore, there exists a one-to-one correspondence between the MPV between the players participating in individual games. The present results displayed the values of MPV among players from different games are independent of one another and unaffected by one another. Conclusion: The study's findings indicate a significant difference in the MPV of players from three distinct sports. However, when MPV of Volleyball and rugby players were compared, it was discovered that they were connected. In conclusion, MPV among players from different games are independent of one another and unaffected by one another. Variability in MPV was also observed across all sample sizes in the study.

Introduction: A good understanding of biostatistics can improve clinical thinking, decision-making, evaluations, and medical research. Undoubtedly, medical professionals are becoming aware of the importance of learning and applying biostatistical methods in their research. This study was done to assess the knowledge and attitude among medical graduates regarding the role and application of biostatistics in medical science. Method: The study was a cross-sectional study conducted in a tertiary care teaching hospital among 120 medical students pursuing MBBS third and final year. Systematic random sampling was used to select the study participants. A pretested validated semi-structured questionnaire was used for data collection. Results: Majority of the study participants, strongly agree that the subject helps in interpretation (75.8%), and is important in medical practice (61.7%). However, 85% of the study participants feel that software is difficult to use. 90% of the study participants find the subject hard to understand. The mean score of subject content, understanding, the current impact was significantly higher among the fourth-year students than the third-year students. There was no significant difference between the genders. Conclusion: Introduction of data collection sessions and appraisal of excerpts in published articles can provide practical knowledge and accentuate the role of bio statistics in health care.

Abstract Background Interstitial lung abnormalities (ILA) are radiologic findings that may progress to idiopathic pulmonary fibrosis (IPF). Blood gene expression profiles can predict IPF mortality, but whether these same genes associate with ILA and ILA outcomes is unknown. This study evaluated if a previously described blood gene expression profile associated with IPF mortality is associated with ILA and all-cause mortality. Methods In COPDGene and ECLIPSE study participants with visual scoring of ILA and gene expression data, we evaluated the association of a previously described IPF mortality score with ILA and mortality. We also trained a new ILA score, derived using genes from the IPF score, in a subset of COPDGene. We tested the association with ILA and mortality on the remainder of COPDGene and ECLIPSE. Results In 1469 COPDGene (training n = 734; testing n = 735) and 571 ECLIPSE participants, the IPF score was not associated with ILA or mortality. However, an ILA score derived from IPF score genes was associated with ILA (meta-analysis of test datasets OR 1.4 [95% CI: 1.2–1.6]) and mortality (HR 1.25 [95% CI: 1.12–1.41]). Six of the 11 genes in the ILA score had discordant directions of effects compared to the IPF score. The ILA score partially mediated the effects of age on mortality (11.8% proportion mediated). Conclusions An ILA gene expression score, derived from IPF mortality-associated genes, identified genes with concordant and discordant effects on IPF mortality and ILA. These results suggest shared, and unique biologic processes, amongst those with ILA, IPF, aging, and death.

A once often neglected virus from common practice has been demanding the attention of all researchers for the past decade ever since it started to infect humans from its usual wild habitats. The severe acute respiratory syndrome coronavirus 2 infection in humans is now found to have frequent manifestations of thromboembolic events as a result of a hyper-coagulable state. Anti-coagulants (ACs) have been suggested to overcome such a state, and studies have been conducted to assess its role. The objective of this meta-analysis is to determine the existence of such a role and its nature, either beneficial or not, and to assess the strength of this role if it exists. We have conducted an online search in the databases such as PubMed, Google scholar, Lancet, Elsevier, JAMA, Medline, and so on and concluded ten studies among 2562 that had results which were more precise and of better quality. The results of six studies favored the use of ACs, whereas one study showed no beneficial response and four studies discussed the effects of therapeutic versus prophylactic anti-coagulation. The result of our statistical analysis was that the odds ratio for mortality reduction of ACs in coronavirus disease 2019 (COVID-19) patients is 0.6757 (95% CI; 0.5148 to 0.961) and that for benefits of therapeutic ACs versus prophylactic ACs in COVID-19 patients is 0.809 (95% CI; 0.6137 to 1.1917). AC was associated with lower mortality and intubation among hospitalised COVID-19 patients. Compared with therapeutic AC, prophylactic AC was associated with lower mortality, although not statistically significant, and lower bleeding risks.

Attaining sufficient flow uniformity in catalytic aftertreatment systems is a major challenge for the automotive industry. Computational fluid dynamics (CFD) simulations offer means of analyzing and quantifying this flow uniformity in silico. In this work, predictions from numerical simulations of flow uniformity obtained using a conventional steady-state Reynolds-Averaged Navier-Stokes (RANS) approach are contrasted against comprehensive Detached Eddy Simulations (DES) where the large-scale turbulence is resolved in space and time. It is shown that the DES approach provides access to data on flow uniformity fluctuations that could be significant for the catalyst light-off behavior. However, the computational cost of the DES is approximately three orders of magnitude larger than that of the corresponding RANS simulation.

Abstract The manufacture of recombinant therapeutics is a fastest-developing section of therapeutic pharmaceuticals and presently plays a significant role in disease management. Yeasts are established eukaryotic host for heterologous protein production and offer distinctive benefits in synthesising pharmaceutical recombinants. Yeasts are proficient of vigorous growth on inexpensive media, easy for gene manipulations, and are capable of adding post translational changes of eukaryotes. Saccharomyces cerevisiae is model yeast that has been applied as a main host for the manufacture of pharmaceuticals and is the major tool box for genetic studies; nevertheless, numerous other yeasts comprising Pichia pastoris, Kluyveromyces lactis, Hansenula polymorpha, and Yarrowia lipolytica have attained huge attention as non-conventional partners intended for the industrial manufacture of heterologous proteins. Here we review the advances in yeast gene manipulation tools and techniques for heterologous pharmaceutical protein synthesis. Application of secretory pathway engineering, glycosylation engineering strategies and fermentation scale-up strategies in customizing yeast cells for the synthesis of therapeutic proteins has been meticulously described.

Background: Essential health services including immunization were significantly impacted due to COVID-19 with devastating outcomes in low- and middle-income countries (LMIC). The disruption in immunization services due to global pandemic and measures undertaken at regional levels to overcome need to be studied as pandemic preparedness strategy. Objective: To document the contextual narratives related to immunization services during the Covid-19 disease outbreak by interviewing qualified pediatricians in the field practice area of private tertiary care teaching medical college Methodology: In-depth phone-based interviews were conducted with pediatricians in diverse settings during November 2020 to March 2021. Reflexive thematic analysis was performed, major themes identified, and case studies documented. Results: Pediatricians shared rich experiences related to immunization services impacted due to COVID-19 especially during the earlier months due to imposition of lockdowns leading to discontinuation, disruption of services, decrease in volume of immunizations, modest transition to telehealth service delivery, facility-level changes brought in to ensure immunization services, capacity building measures for upskilling. Conclusions: Contextual narratives revealed in this study provide rich narrative about the disruption of immunization services due to COVID-19. These findings need to be understood and leveraged to be future ready and prevent further disruptions by identifying and scaling up key solutions piloted in this study.

Orthodontic alignment of a horizontally impacted canine placed high and deep in the maxilla represents a challenging clinical scenario. This article describes a case report of a 16-year-old postpubertal male patient who was concerned about an unesthetic smile. The clinical and radiographic investigations revealed that the patient had retained deciduous canines and bilaterally impacted maxillary canines. The right impacted canine had a good prognosis. The left canine was horizontally impacted in the labial side with a Kau-Pan-Gallerano index score of 19, which indicates a “difficult” degree of treatment. The initial treatment plan was application of distal traction to the impacted left canine from reinforced anchorage unit to change its inclination from horizontal to vertical before erupting it toward occlusion. In this case report, we demonstrated the use of a mini-implant and a modified Nance button–assisted forced eruption of an impacted canine. The 12-month follow-up review showed that the results were maintained during the time, and the previously impacted teeth showed intact gingival attachments. A conservative surgical exposure of the impacted canine and well-planned biomechanics helped us achieve a desirable, esthetic outcome.

Background:Tobacco harm reduction when advocated by care providers as continuum of care towards the goal of tobacco cessation might result in long-term abstinence than it is currently seen. This study aimed to qualitatively explore the healthcare professionals approach and self-reported practices related to tobacco harm reduction and smoking cessation. Methods: A purposive sample (N=36) of multi-specialty healthcare professionals providing tobacco related cessation services at six private medical teaching institutes were engaged in semi-structured qualitative interviews between July 2020 and October 2020 in Chennai. Results: The results indicated that majority of the healthcare professional’s lack conceptual understanding about tobacco harm reduction. Harm reduction was practised and nicotine replacement therapy was prescribed by psychiatrists in this study. Majority of the healthcare professionals were found to have misconceptions that promoting harm reducing practices instead of cessation might result in continued addiction to nicotine products among the clientele. Conclusions: The findings reveal that tobacco harm reduction remains an under-utilized clinical practise in Indian setting due to knowledge and awareness gaps among multi-specialty healthcare professionals. Improved sensitization through continuous medical education updates is needed to inform effective clinician-affirmative tobacco harm reduction practices.

Urbanization and industrialization are two of the most important features of modern civilization. This leads to traffic congestion at the major roads of urbanized areas. At intersections, particularly those where four roads converge, signalization is also regarded as a more challenging issue. It takes longer for cars to cross that intersection and move from one side of the roads to the other, especially during rush hour. This may lead to heavy traffic congestion at the junction and may cause accidents. This paper presents the proposed alternatives for signalized intersection at Laxmi mill junction, Coimbatore. To control the flow of heavy traffic and also make sure the vehicles are moving continuously without waiting at the intersection, following two alternatives have been proposed. a) To design the medians instead of the signals with pedestrian crossing bridge in junction b) To design the roundabout at the intersection with pedestrian bridge. By providing these alternatives, Junction traffic flow rates can be managed and accident rate also will get reduced in that junction

Financial derivatives are widely recommended by financial advisors and brokers to hedge the investment position of their clients. But due to the heterogeneity existed between retail investor groups they are not in a position to offer more customized service to their clients. The present study is developed on the basis of a survey conducted among 200 experts working in various broking firms. The opinions, so collected from experts were evaluated using different statistical measures in order to select some suitable strategies. Statistical tools like MANOVA, Chi-square, paired sample ‘t’ test, etc. were used to analyze the viability of the expert recommendations. Based on this empirical analysis some strategies were identified for derivative trading and a theoretical model was formulated for dealing with diversified group of retail investors.

Aims: To assess the salivary flow rate levels and total antioxidant levels in ectodermal dysplasia (ED) patients and to compare with normal individuals. Materials and Methods: Unstimulated saliva sample of control and case were collected from the mouth to a pre-weighed Eppendorf tube using a Pasteur pipette for 4 min. Stimulated saliva of case and control was also collected after chewing paraffin wax for 30 s. Both the Eppendorf tubes were weighed again after collection of both the saliva samples. The flow rate was calculated as difference of weight of the tube divided by time (4 min). Both unstimulated and stimulated saliva was also separately collected for estimation for total antioxidant levels. Statistical analysis: For intergroup comparison, Mann–Whitney test was used, and for intragroup comparison, Wilcoxon signed-rank test was used. Results: In the intergroup comparison of both the salivary flow rate and total antioxidant levels, there was no statistically significant difference; however, there was statistically significant difference in the intragroup comparison of salivary flow rate and total antioxidant levels in case group. Conclusions: There was a diminished unstimulated salivary flow rate in ED group, but stimulated salivary flow rate was significantly high and the total antioxidant levels in unstimulated saliva of the case group were significantly higher than the stimulated antioxidant levels.

Following infection with M. tuberculosisIL-12B

The use of enzymes or microorganisms in food preparations is an age-old process. With the advancement of technology, novel enzymes with wide range of applications and specificity have been developed and new application areas are still being explored. Microorganisms such as bacteria, yeast and fungi and their enzymes are widely used in several food preparations for improving the taste and texture and they offer huge economic benefits to industries. Microbial enzymes are the preferred source to plants or animals due to several advantages such as easy, cost-effective and consistent production. The present review discusses the recent advancement in enzyme technology for food industries. A comprehensive list of enzymes used in food processing, the microbial source of these enzymes and the wide range of their application are discussed.

Characteristics of microjet hydrogen diffusion flames stabilized near extinction are investigated numerically. Two-dimensional simulations are carried out using a detailed reaction mechanism. The effect of burner wall material, thickness, and thermal radiation on flame characteristics such as flame height and maximum flame temperature are studied. Results show that the flame stabilizes at lower fuel jet velocities for quartz burner than steel or aluminum. Higher flame temperatures are observed for low conductive burners, whereas the flame length increases with an increase in thermal conductivity of the burner. Even though thermal radiation has a minor effect on flame characteristics like flame temperature and flame height, it significantly influences the flame structure for low conductive burner materials. The burner tip and its vicinity are substantially heated for low conductive burners. The effect of burner wall thickness on flame height is significant, whereas it has a more negligible effect on maximum flame temperature. Variation in wall thickness also affects the distribution of H and HO2 radicals in the flame region. Although the variation in wall thickness has the least effect on the overall flame shape and temperature distribution, the structure near the burner port differs.

In this study, the prebiotic potential of soluble dietary fibre extracted from plantain inflorescence (PIF) was investigated. PIF demonstrated prebiotic potential by enhancing the growth of the probiotics under study and thereby hindered colon cancer development. The soluble dietary fibre from Musa paradisiaca inflorescence (PIF) was fermented using Lactobacillus casei and Bifidobacterium bifidum. The fermentation supernatants (LS and BS) were enriched with short chain fatty acids (SCFA) and were able to initiate apoptotic signalling in HT29 colon cancer cells leading to cell death. Both BS and LS exhibited cytotoxic effect; induced DNA damage and enhanced generation of reactive oxygen species in HT29 cells leading to apoptosis. The induction of apoptosis was facilitated by the reduction of membrane potential of mitochondria and ATP synthesis; enhanced delivery of cytochrome c and interference with the expression of pro/antiapoptotic proteins. BS, which exhibited better activity, was further analysed for the identification of differentially regulated proteins by performing two dimensional electrophoresis and MALDI-TOF mass spectrometry. Results emphasized on the fact that, the exposure to BSalteredthe HT29 proteins expression, particularly the upregulation of apoptosis- inducing factor-AIFM1 leading to apoptosis of HT29 cells.

Interferon‐beta (IFNβ) is a cytokine involved in the antiviral, anti‐proliferative and immunomodulatory responses of cells, and a potent drug for multiple sclerosis. Human interferon beta (HuIFNβ) gene fused with the glucoamylase signal sequence in the N‐terminus and 6 His Tag in the C‐terminus was cloned into pKlac1 vector and introduced in Kluyveromyces lactis to allow secreted expression and one‐step purification of the protein. Recombinant yeast transformant with the highest level of HuIFNβ production was identified, and this secreted up to 1 mg/L of the cytokine after 72 h of incubation. Glycosylated and non‐glycosylated forms of the cytokine were elaborated by the yeast, the latter in higher quantities. His tag of the protein allowed easy one‐step purification by nickel‐nitriloacetic acid affinity chromatography, yielding close to 100% purity. SDS‐PAGE, western blot and MALDI‐TOF‐TOF confirmed the identity of the protein. The biological activity of the recombinant HuIFNβ was confirmed by its anti cell proliferative activity on HeLa cells. Expression of HuIFNβ in K. lactis is advantageous since it is a very safe organism to produce proteins for therapeutic applications, allows glycosylation and offers a cost effective method for large scale production as it can be grown in cheap carbon sources.

Introduction: Mupirocin competitively inhibits bacterial isoleucyl transfer-RNA synthetase and inhibit bacterial protein synthesis. Widespread usage and over the counter availability of the drug has resulted in resistance among Staphylococcus species. Objectives: This study aimed to determine the overall prevalence of mupirocin resistance among staphylococci. Correlate clinical significance of mupirocin resistance and its relationship to clinical use. Methods: Consecutive, nonrepetitive, clinical isolates of Staphylococcus aureus (n = 98), and coagulase-negative staphylococci (CoNS) (n = 45) from skin and soft-tissue infections between January 2014 and June 2014 were studied. Antibiotic susceptibility testing was done according to Clinical and Laboratory Standards Institute guidelines. Low- and high-level mupirocin resistance was screened by using 5 μg and 200 μg discs respectively and confirmed by agar dilution. Annual consumption of mupirocin was studied and correlated with resistance. Results: High-level mupirocin resistance was found in 8.2% S. aureus and 15.6% of CoNS, while low-level mupirocin resistance was found in 17% S. aureus and 8.9% CoNS. High-level mupirocin resistance was more common in methicillin-sensitive S. aureus isolates when compared with methicillin-resistant S. aureus isolates (P < 0.05). Mupirocin resistant S. epidermidis were associated with methicillin resistance and constitutive clindamycin resistance. Conclusion: High prevalence of mupirocin resistance was found in the present study. Increased prevalence of mupirocin resistance among community-acquired staphylococci demands the judicious use of the drug in the community.

The increasing fossil fuel scarcity has led to an urgent need to develop alternative fuels. Currently microorganisms have been extensively used for the production of first-generation biofuels from lignocellulosic biomass. Yeast is the efficient producer of bioethanol among all existing biofuels option. Tools of synthetic biology have revolutionized the field of microbial cell factories especially in the case of ethanol and fatty acid production. Most of the synthetic biology tools have been developed for the industrial workhorse Saccharomyces cerevisiae. The non-conventional yeast systems have several beneficial traits like ethanol tolerance, thermotolerance, inhibitor tolerance, genetic diversity, etc., and synthetic biology have the power to expand these traits. Currently, synthetic biology is slowly widening to the non-conventional yeasts like Hansenula polymorpha, Kluyveromyces lactis, Pichia pastoris, and Yarrowia lipolytica. Herein, we review the basic synthetic biology tools that can apply to non-conventional yeasts. Furthermore, we discuss the recent advances employed to develop efficient biofuel-producing non-conventional yeast strains by metabolic engineering and synthetic biology with recent examples. Looking forward, future synthetic engineering tools’ development and application should focus on unexplored non-conventional yeast species.

The umbilicus contributes significantly to the cosmetic appearance of the abdomen especially in women. Loss of umbilicus may result not only in cosmetic disfigurement but also in significant psychological effects. Omphalectomy may accompany certain surgical procedures like ventral hernia repairs and abdominoplasty. For such patients, many techniques have been described by various authors in literature for creation of a neoumbilicus for good cosmetic appearance. In this report, we describe how a laparoscopic port site was utilized to create a neoumbilicus in a patient who required omphalectomy as a part of large umbilical hernia repair. Satisfactory postoperative result promted us to report this novel technique of neoumbilicus creation. This can be utilized in patients who have been previously subjected to laparoscopic procedures. This is the first case description in literature where a laparoscopic port scar was utilized for neoumbilicoplasty.

BACKGROUND: Knowledge of medical students about research has been little explored. Although there has been a practice of medical research among undergraduate level, the practice is not universal and there have been potential barriers and difficulties in carrying out the research. The present study was done to find the perception and attitude toward medical research and to assess the practices and potential barriers in carrying out medical research. METHODOLOGY: This cross-sectional study was conducted among 344 medical school students of a medical college in Chennai, Tamil Nadu, in 2018. Systematic random sampling was used. The study tool was self-administered questionnaire including questions on knowledge, barrier, and 5-point Likert scale for assessing attitude. Adequate knowledge (>70% correct answers) and positive attitude (>25 score) were considered. RESULTS: Among the 344 study participants, only 127 (36.9%) of students had adequate knowledge and 68 (19.8%) had positive attitude toward medical research. Regarding practice of research, only 34.3% had conducted a research and only 17.4% had published in journals. Difficulty in choosing topic, difficulty in collecting data, and allocation of time amidst academic activities were considered as a barrier by 41.6%, 40.7%, and 45.9%, respectively. Association of adequate knowledge and practice was statistically significant for age (P = 0.000), gender (P = 0.000), and academic year (P = 0.000). CONCLUSION: Adequate knowledge and positive attitude were lacking in majority of students. Barriers could be addressed by support programs and sensitization toward research.

BACKGROUND: Although rabies is highly fatal, with timely and correct postexposure prophylaxis (PEP) of animal bite victims, it could be prevented. Medical school students should be trained about the appropriate rabies management during their formative years so that they put the right practice later on. The study was conducted to assess the knowledge about rabies epidemiology and prophylaxis among medical students and to find the effect of an educational intervention. MATERIALS AND METHODS: This was a quasi-experimental study conducted with 156 third academic year medical school students at a tertiary care teaching hospital. The study participants were given health education intervention. A study tool assessed the knowledge of study participants on domains such as epidemiology of rabies, pre-exposure prophylaxis (PrEP) and PEP, and national program guidelines of rabies prevention. The study tool was administered before and after the intervention. The impact of educational intervention was measured with scores. Wilcoxon signed-rank test was applied to test the difference. RESULTS: The overall total mean pretest total score was 14.9 (±3.7) and posttest score was 22.7 (±3.23) for a maximum score of 29. The mean pretest scores for epidemiology, PrEP and PEP and national program components were 6.09, 7.95, and 0.85 respectively. Likewise, the mean posttest scores were 8.09, 13.26, and 1.35 respectively. There were a statistically significant improvement in the scores after health education intervention. CONCLUSIONS: After educational intervention, there were statistically significant improvement in the scores of all the three domains. PrEP and PEP and national program domain of rabies need to be emphasized during formative years.