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Background: Gestational diabetes mellitus (GDM), a common medical condition affecting a high number of pregnant women worldwide, is characterized by high blood glucose levels that develop during pregnancy, usually in the second or third trimester, in women with no prior history of diabetes. While GDM usually resolves after delivery, it can have significant short-term and long-term adverse effects on both the mother and the fetus. Though insulin therapy is the recommended primary treatment, there exists limited evidence comparing the safety and effectiveness of different long-acting insulin analogues, including glargine U-100 and detemir insulin. Objective: The study aimed to compare the effectiveness and safety of long-acting insulin analogs, glargine U-100 and detemir insulin, in hyperglycemic pregnancy. Methods: This record-based observational study involved 64 subjects, with data collected from medical records. The study assessed demographic data, glycaemic parameters, incidence of hypoglycemia, and neonatal outcomes. Results: The results showed that both insulins were effective in reducing glycaemic levels, but glargine U-100 was associated with better glycemic control, fewer hypoglycemic episodes and less need for dose intensification. The results showed that both insulins were safe when considering infants' health assessed at 6 months. Conclusion: The study concluded that glargine U-100 may be a preferred treatment option for hyperglycemic pregnancy. Further studies are needed for optimizing treatment strategies in hyperglycemic pregnancies. [ABSTRACT FROM AUTHOR]

Among the various post-COVID sequelae, thyroid function impairment stands as a significant concern. COVID-19-related primary hypothyroidism has been documented in the literature. This study aimed to determine the number of cases with subclinical hypothyroidism and a history of moderate COVID-19 pneumonia who progressed to clinically overt hypothyroidism at six months. A prospective casecontrol study enrolled adult patients with known subclinical hypothyroidism and a history of moderate COVID-19 pneumonia as cases. Detailed medical history and physical examinations were conducted for all participants. Thyroid profiles, including free T4 and TSH, were measured at baseline and again at six months for all cases. The results revealed that 20% of cases with a history of moderate COVID-19 exhibited low free T4 levels at six months following infection, indicating progression from subclinical to clinical hypothyroidism. The mean TSH level at baseline was 7.29 mU/L, which increased to 8.76 mU/L at six months. New-onset symptoms were more prevalent in these cases compared to the controls. Furthermore, the mean baseline TSH level for cases progressing to clinical hypothyroidism was significantly higher (9.17 ± 0.63 mU/L) compared to those who did not progress (6.82 ± 1.16 mU/L; p<0.001). These findings suggest that patients with subclinical hypothyroidism and a history of moderate to severe COVID-19 pneumonia should undergo periodic monitoring to ensure timely treatment initiation if overt hypothyroidism develops. [ABSTRACT FROM AUTHOR]

Monocytes are associated with human cardiovascular disease progression. Monocytes are segregated into three major subsets: classical (cMo), intermediate (iMo), and nonclassical (nMo). Recent studies have identified heterogeneity within each of these main monocyte classes, yet the extent to which these subsets contribute to heart disease progression is not known. Peripheral blood mononuclear cells (PBMC) were obtained from 61 human subjects within the Coronary Assessment of Virginia (CAVA) Cohort. Coronary atherosclerosis severity was quantified using the Gensini Score (GS). We employed high-dimensional single-cell transcriptome and protein methods to define how human monocytes differ in subjects with low to severe coronary artery disease. We analyzed 487 immune-related genes and 49 surface proteins at the single-cell level using Antibody-Seq (Ab-Seq). We identified six subsets of myeloid cells (cMo, iMo, nMo, plasmacytoid DC, classical DC, and DC3) at the single-cell level based on surface proteins, and we associated these subsets with coronary artery disease (CAD) incidence based on Gensini score (GS) in each subject. Only frequencies of iMo were associated with high CAD (GS > 32), adj.p = 0.024. Spearman correlation analysis with GS from each subject revealed a positive correlation with iMo frequencies (r = 0.314, p = 0.014) and further showed a robust sex-dependent positive correlation in female subjects (r = 0.663, p = 0.004). cMo frequencies did not correlate with CAD severity. Key gene pathways differed in iMo among low and high CAD subjects and between males and females. Further single-cell analysis of iMo revealed three iMo subsets in human PBMC, distinguished by the expression of HLA-DR, CXCR3, and CD206. We found that the frequency of immunoregulatory iMo_HLA-DR+CXCR3+CD206+ was associated with CAD severity (adj.p = 0.006). The immunoregulatory iMo subset positively correlated with GS in both females (r = 0.660, p = 0.004) and males (r = 0.315, p = 0.037). Cell interaction analyses identified strong interactions of iMo with CD4+ effector/memory T cells and Tregs from the same subjects. This study shows the importance of iMo in CAD progression and suggests that iMo may have important functional roles in modulating CAD risk, particularly among females. [ABSTRACT FROM AUTHOR]

Background: Considering enterococci as an emerging important cause of nosocomial infections, and antibiotic resistance by Enterococcus as a major obstacle for treatment, determination of the prevalence of various Enterococcus species and their antibiotic resistance pattern among urinary isolates is very crucial and need of the hour. The present study tried to identify the burden of urinary tract infections (UTIs) caused by Enterococcus species and analyze the current antibiotic susceptibility patterns of the uropathogenic isolates and evaluate the risk factors. Methods: A cross-sectional study included all clinico-microbiologically diagnosed cases of admitted UTI cases. Hospital records were analyzed for the clinical background of the UTI cases, and urine sample was collected and processed for antibiotic susceptibility testing. Data were statistically analyzed. Results: Out of the 372 urine samples, Enterococcus spp. was identified in 13.44% of isolates as the causal uropathogen. Enterococcus faecalis was the predominant species identified, followed by Enterococcus faecium. Cases were mostly observed in clinical settings of sepsis followed by pyelonephritis and cystitis. Antimicrobial susceptibility profile showed that resistance was most frequently observed with norfloxacin followed by levofloxacin, ciprofloxacin, ampicillin, and high-level gentamicin. Linezolid showed maximum sensitivity, followed by vancomycin, nitrofurantoin, and others. Conclusion: The rise of multidrug-resistant (MDR) Enterococcus species is of particular concern in terms of antibiotic therapy. Speciation along with routine culture and sensitivity is essential to gather knowledge about the available antibiotics in MDR uropathogenic Enterococcus species, particularly oral choices. [ABSTRACT FROM AUTHOR]

Purpose: Due to their abundance in the blood, low RNA content, and short lifespan, neutrophils have been classically considered to be one homogenous pool. However, recent work has found that mature neutrophils and neutrophil progenitors are composed of unique subsets exhibiting context-dependent functions. In this study, we ask if neutrophil heterogeneity is associated with melanoma incidence and/or disease stage. Experimental design: Using mass cytometry, we profiled melanoma patient blood for unique cell surface markers among neutrophils. Markers were tested for their predictiveness using flow cytometry data and random forest machine learning. Results: We identified CD79b+ neutrophils (CD3- CD56- CD19- Siglec8- CD203c-CD86LoCD66b+CD79b+) that are normally restricted to the bone marrow in healthy humans but appear in the blood of subjects with early-stage melanoma. Further, we found CD79b+ neutrophils present in tumors of subjects with head and neck cancer. AI-mediated machine learning analysis of neutrophils from subjects with melanoma confirmed that CD79b expression among peripheral blood neutrophils is highly important in identifying melanoma incidence. We noted that CD79b+ neutrophils possessed a neutrophilic appearance but have transcriptional and surface-marker phenotypes reminiscent of B cells. Compared to remaining blood neutrophils, CD79b+ neutrophils are primed for NETosis, express higher levels of antigen presentation-related proteins, and have an increased capacity for phagocytosis. Conclusion: Our work suggests that CD79b+ neutrophils are associated with early-stage melanoma. [ABSTRACT FROM AUTHOR]

The study of Sufism, the mystical aspect of Islam, known as I ta awwuf i to those closer to the sources and practices, has come a long way since Richard Eaton complained in 1978 that it was mainly studied as doctrine.[1] Eaton noted that scholars tended to study the ideas of individual Sufis, with no attention to the societies and polities in which the Sufi saints lived. The simple answer is that the relationship was close, in particular with Sufi saints of the Chishti order who supported the Mughal policy of religious toleration. As the following chapters show, subsequent generations of the Mughal dynasty approached other Sufi orders, such as the Qadiris, as with the "liberal" Prince Dara Shukoh, and also went back to the Naqshbandis, as with the "conservative" Prince, later Emperor, Awrangzeb. [Extracted from the article]

Anthropologists and historians have recently underscored the ways in which European colonialism created novel regimes of legality and record-keeping, associated with ambitious and exclusive state-centered claims to both truth and rights, while being inevitably and constantly sucked into eddies of forgery and corruption. However, attention so far has been focused on English/European-language records and the colonial institutions that produced, stored, and deployed them. This has communicated a monolithic sense of power and normativity that unwittingly replicates the aspirations of colonial states. Drawing on eight case studies from in and around South Asia from the eighteenth to the twentieth centuries, we propose instead that the law of empires was rooted in the highly localized, often multilingual, and fragmented bureaucracies that produced its records. Here, historians of pre-colonial Indian regimes join hands with historians of British, Dutch, and French colonialism in order to unearth the genealogies of records written in Bengali, Marathi, Persian, Sinhala, and Tamil, as well as in French, Dutch, and English. This special issue collectively excavates the many layers, regimes, and languages in which legally effective records were produced by imperial regimes in South Asia and its much larger watery penumbra, the Indian Ocean. [ABSTRACT FROM AUTHOR]

This article examines Persian-language orders—parwanas—issued by regimes that succeeded the Mughal Empire in South Asia, to European trading companies. Focussing in particular on the mid-eighteenth-century exchanges between the Nizam of Hyderabad; the Nawab of Arcot; and the French Compagnie des Indes , we see how Mughal-style parwanas, or sub-imperial orders, previously used to give instructions or to make or withdraw grants, were transformed into a form of political currency. They were now used to exchange military and fiscal resources between South Asian state-builders and militarised European corporations, and to secure political legitimacy for all within a putative Mughal imperium. Moreover, the legal fiction of Mughal sovereignty led to a grants race, such that rivals—European and South Asian—sought more and more parwanas, while also querying the legitimacy of authorities that issued them. The very fragility of the Mughal empire and the lability of the political landscape in eighteenth-century South Asia was thus generative of prolific Persian legal documentation, as well as its rewiring to novel uses. European empire-builders negotiated this legal landscape with only partial literacy, consequently fetishizing the material aspects and ceremonial accompaniments of Persian legal documents, and according them power beyond their immediate substance. [ABSTRACT FROM AUTHOR]

Prescribing cascades entail misinterpreting drug-related adverse events as new medical problems, resulting in unnecessary prescriptions and potential harm, especially in the elderly, leading to adverse outcomes like falls, cognitive defects, and increased health-care costs. For geriatric patients with complex medical histories, the intricacies of symptom differentiation and polypharmacy poses further challenges. This report focuses on managing a geriatric patient with multiple conditions, highlighting the risks and complexities of prescribing cascades. [ABSTRACT FROM AUTHOR]

An increasing body of research implies that emergency department (ED) physicians fail to identify drug-related ED visits due to the department's hectic workflow. In cases of poisoning or drug intoxications, the offending agent(s) may not be identified during the acute and possibly critical period of the exposure. For cases of suicidal incidents, laboratory assistances in identifying the offending chemical are not promptly available. The diagnosis of "toxidromes" is, therefore, an acceptable clinical diagnostic method that has been pioneered by clinical toxicologists. The present case has emphasized the need for applying clinical pharmacology principles in the early detection of drug-induced ED visits. [ABSTRACT FROM AUTHOR]

The article describes clinical pharmacological interventions in routine care that improved prescribing and patient outcomes. These are medical reconciliation, de-prescribing, potential adverse drug reaction detection, improving medication adherence, potential drug-drug interaction detection, prevention of medication error during the transition of care, choice of optimal medications, use of therapeutic drug monitoring tool, reducing healthcare cost and dealing with drug hypersensitivity.

Background. Our study was taken up to explore the possible factors influencing poor performance of undergraduate students in clinical skill demonstration. Aims. Identification of factors leading to poor clinical skill development in undergraduate medical students. Settings and Design. This is an observational study. Methods and Material. The study population comprised the undergraduate students and teachers of the Department of Medicine. All were provided with structured questionnaires who responded anonymously which were then interpreted with the help of software statistical calculator. Results. Of the 145 students, only 57 (39.3%) actually attended medicine ward. The major factors that the students reported were large groups of students around a patient (94.74% ± 4.67), inadequacy of information in books of clinical medicine (78.9% ± 8.53), overcrowded unclean wards (73.7% ± 9.2), lack of practice of clinical methods at home (50.8% ± 10.4), and timing of classes (42.1% ± 10.3). Teachers cited poor attendance of students to wards (76.2% ± 17.1), poor condition of wards and lack of separate enclosures to teach (100%), and large groups around a single patient (66.67% ± 17.9). Conclusions. Absenteeism of students, overcrowding of wards, and lack of uniformity of study materials were prime factors.

Tetralogy of Fallot (TOF) presenting with superior vena cava (SVC) syndrome is an exceedingly rare scenario. The diagnosis of this condition is still a difficult task due to its unspecific clinical features and unclear recommendations for the best diagnostic tools. We report an interesting case of a 23‑year‑old male who was found to have TOF with the presentation of SVC syndrome after a sequential diagnosis. The timely diagnosis helped in the successful management of the patient. Through this case, we want to make clinicians aware of such a rare association and its diagnosis. [ABSTRACT FROM AUTHOR]

The collection of essays in this volume examines forms of business documentation in the late Persianate world and the Indian Ocean, between the seventeenth and twentieth centuries. Looking upon business in its broadest sense, the themes range from property disputes within families to inter-polity and inter-imperial deals, all of which is captured within the notion of the bazaar. Presenting documents and documentary forms written in Persian, but also the associated languages of Arabic, Bengali, Gujarati, Hindi, Marathi and Rajasthani, the articles collectively enrich the idea of the Persianate, delineating its specific dispensations within regional contexts, and also its boundaries and limitations. This is also a contribution to the study of Persographia, in this case Persianate rather than just Persian writing. The articles study specific language combinations, lexical elements and usages that came to be deployed in different areas and the legal cultures they provide evidence for. [ABSTRACT FROM AUTHOR]

A necessarily widespread feature of language practice in the Persianate world was the need for translation of speech and text, with a range of lexical and semantic challenges involved in taking meaning from one language to another. This article focusses on legal translation, with its highly functional aims, by following the career of a pair of Indo-Persian legal forms known as tamassuk and fārigh-khaṭṭī , used for recording obligation and requital respectively. Tracing their reincarnations from Persian into Marathi, Hindi and Bengali, this article reveals several forms of boundary-crossing: doctrinal, jurisdictional, political and linguistic. In doing so, it explores the legal mindscapes in the early modern Indo-Persian world, spilling from the late Mughal into the colonial, and shows how multilingualism functioned within specific parts of the Persianate cosmopolis. [ABSTRACT FROM AUTHOR]

Scottish Orientalists and India: The Muir Brothers, Religion, Education and Empire, by Avril A. Powell. Worlds of the East India Company series. Rochester, New York, Boydell Press, 2010. xviii, 318 [...]

Scrub typhus is a mite borne zoonosis, caused by Orientia tsutsugamushi , a gram-negative intracellular organism. This infection usually presents in high prevalence in the rural areas of East Asia and Western pacific islands. It usually presents with fever, chill, myalgia, headache, skin rashes, having pathognomonic and skin lesion i.e. eschar in ~10% cases in Indian subcontinent. It can present with life-threatening complications on occasional. The simultaneous presentation of more than two complications is uncommon, rarely reported in literature. Here we report a case of 37-year-old woman with acute febrile illness, complicated with myocarditis, acute liver failure and leukemoid reaction. She was diagnosed promptly and successfully treated with doxycycline with full recovery of the complications. [ABSTRACT FROM AUTHOR]

Despite the welcome reflexivity produced by the «archival turn» in history writing, the predominant image of the archive remains that of the serialized, indexed colonial repository, offering systematic information retrieval, creating a dominant form of knowledge aimed at social control. This article questions that impression, and reveals the ephemeral and derivative nature of colonial archives, especially those of law courts. It uses the voluminous records associated with a single important case decided by the Judicial Committee of the Privy Council (JCPC), the final court of appeal of the British Empire. The case of Abul Fata Mahomed Ishak and Ors. v. Russomoy Dhur Chowdhry (JCPC, 1894) was of great importance to the history of Islamic law in colonial India, especially with regards to waqfs or religious endowments. This article explores how parties to the case, mainly members of a land-owning Muslim family in nineteenth-century Bengal, raided their household store of records in order to create a temporary and purpose-built collection aimed at supporting their respective claims. In doing so, this article also uses colonial court archives as a window into the documentation practices of landed lineages in colonial Bengal, tracing patterns of change as well as continuity from earlier periods of time. [ABSTRACT FROM AUTHOR]

Abstract Background An improved understanding in transmission variation of kala-azar is fundamental to conduct surveillance and implementing disease prevention strategies. This study investigated the spatio-temporal patterns and hotspot detection for reporting kala-azar cases in Vaishali district based on spatial statistical analysis. Methods Epidemiological data from the study area during 2007–2011 was used to examine the dynamic space-time pattern of kala-azar outbreaks, and all cases were geocoded at a village level. Spatial smoothing was applied to reduce random noise in the data. Inverse distance weighting (IDW) is used to interpolate and predict the pattern of VL cases distribution across the district. Moran’s I Index (Moran’s I) statistics was used to evaluate autocorrelation in kala-azar spatial distribution and test how villages were clustered or dispersed in space. Getis-Ord Gi*(d) was used to identify the hotspot and cold spot areas within the study site. Results Mapping kala-azar cases or incidences reflects the spatial heterogeneity in the incidence rate of kala-azar affected villages in Vaishali district. Kala-azar incidence rate map showed most of the highest endemic villages were located in southern, eastern and northwestern part of the district; in the middle part of the district generally show the medium occurrence of VL. There was a significant positive spatial autocorrelation of kala-azar incidences for five consecutive years, with Moran’s I statistic ranging from 0.04-0.17 (P P < 0.01). Conclusions The results pointed to the usefulness of spatial statistical approach to improve our understanding the spatio-temporal dynamics and control of kala-azar. The study also showed the north-western and southern part of Vaishali district is most likely endemic cluster region. To employ exact and geographically suitable risk-reduction programmes, apply of such spatial analysis tools should suit a vital constituent in epidemiology research and risk evaluation of kala-azar.

Byline: Mainak. Mukhopadhyay, Nandini. Chatterjee, Pranab. Maity, Kartik. Patar Spontaneous rupture of the spleen with hemoperitoneum is a very rare, but serious manifestation of dengue fever (DF). We report a [...]

Aim: To investigate the relationship between vitamin D levels and cardiac structure and functions in pre-dialysis diabetic and non-diabetic chronic kidney disease(CKD) patients. Methodology: All the patients under study were selected randomly from medicine and nephrology OPD or admitted in indoor of medicine dept, who have not yet started dialysis and not on vit D supplementation. All were subjected to thorough clinical examination, followed by relevant laboratory investigations. Patients were considered diabetic if they are in insulin, oral hypoglycaemic agents, diagnosed as diet controlled diabetes or had a fasting blood sugar of =126 mg/dL. - Chronic Kidney Disease were diagnosed according to KDOQI guideline and staging were done using eGFR. -Estimation of Vitamin D level done. -Echocardiography of the selected patient were performed(using M mode). Results: The present study showed correlation between different stages of vitamin D deficiency and different group of abnormal LVMI in CKD patients. It shows among the CKD patients who are severely vitamin D deficient (stage III) 17 (35.4%) have severely abnormal (group III) LVMI and 5(10.4%) have moderately abnormal LVMI and among moderate vitamin D deficient (stage II) have 112(25%) group II LVMI & 7 (14.58%) have group III LVMI. these relation are statistically significant (p=0.0163).From multiple regression analysis it can be conclude that haemoglobin level, eGFR, ejection fraction all can affect LVMI but vitamin D has a statistically significant role. Conclusion: Chronic kidney disease is associated vitamin D deficiency and abnormal LVMI. Diabetic CKD are more vitamin D deficient and maximum are within age group of 41 to 60 years. Vitamin D deficiency may be associated with widespread risk for CVD in CKD patients. [ABSTRACT FROM AUTHOR]

A study was conducted to delineate the groundwater potential zones of Nawada district of Southern Bihar using satellite-derived information layers, namely, elevation, slope, drainage density, land use, fractional impervious surface (FIS) and also using existing thematic maps (lithology, soil, pre- and post-monsoon water level) based on the weighted linear combination method. On the basis of the relative contribution of each datum towards groundwater potential, the weight of each thematic map has been computed. The normalized weights of the individual themes and their different features were obtained through Saaty's analytical hierarchy process. Results showed that zones of 'very high' and 'high' groundwater potential are present in the central and northeastern part of the study area. 'Very low' and 'low' groundwater potential zones are found in the southeastern and very small pockets of the eastern corner of the district. Thus surface investigation of groundwater has proved that an integrated approach involving remote sensing and geographic information system (GIS) technique can be successfully used in identifying potential groundwater zones in a short time and at low cost, while the yield could be ascertained with some sample ground truth 'test drillings'. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus and its impact on the human body have been extensively dissected over the years. However, skin which is the largest organ in the body, has received minimum attention. Therefore, this study was designed to analyze the prevalence and pattern of skin disorders among diabetic patients from Eastern region of India. Materials and Methods: This is an observational study, conducted in the General Medicine and Endocrinology departments of a Medical College and Hospital in Eastern India. The data were collected prospectively and systematically in a pre-established proforma designed by us, where clinical findings along with investigations were recorded. Results: Six hundred and eighty (680) diabetic patients were examined, there were (64.8%) male and (35.1%) were female, of them 95.3% were Type 2 diabetics while 4.7% were Type 1. Five hundred and three patients (503) out of six hundred and eighty. i.e. 73.9% were found to have skin lesions. Thirteen (13) (41%) Type1 diabetics demonstrated skin lesions commonest being diabetic xerosis, infections and diabetic hand. Among Type2 diabetics 490(75.61%) showed skin lesions. Here infections, xerosis, hair loss beneath the knees, diabetic dermopathy were the most frequent. Majority of patients (67%) had combination of more than one type of skin lesion. There was statistically significant correlation of skin lesions with duration of diabetes, however similar correlation could not be demonstrated regarding metabolic control. Conclusion: Involvement of skin is inevitable and multifarious in diabetes mellitus. Higher prevalence is seen in Type 2 diabetic population. The duration of diabetes is positively correlated with lesions and infective dermatologic manifestations were associated with higher HbA1C values. [ABSTRACT FROM AUTHOR]