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ABSTRACTIntroduction The escalating prevalence of infectious diseases is an important cause of concern in society. Particularly in several developing countries, infectious diarrhea poses a major problem, with a high fatality rate, especially among young children. The condition is divided into four classes, namely, acute diarrhea, invasive diarrhea, acute bloody diarrhea, and chronic diarrhea. Various pathogenic agents, such as bacteria, viruses, protozoans, and helminths, contribute to the onset of this condition.Areas covered The review discusses the scenario of infectious diarrhea, the prevalent types, as well as approaches to management including preventive, therapeutic, and vaccination strategies. The vaccination techniques are extensively discussed including the available vaccines, their advantages as well as limitations.Expert opinion There are several approaches available to develop new-improved vaccines. In addition, route of immunization is important and aerosols/nasal sprays, oral route, skin patches, powders, and liquid jets to minimize needles can be used. Plant-based vaccines, such as rice, might save packing and refrigeration costs by being long-lasting, non-refrigerable, and immunogenic. Future research should utilize predetermined PCR testing intervals and symptom monitoring to identify persistent pathogens after therapy and symptom remission.

Purpose: To compare the deviation in cases of horizontal strabismus as assessed from photographs with the measurements as obtained in the strabismus clinic. Methods: After obtaining informed consent, we recruited subjects with manifest horizontal strabismus. We took a frontal flash photograph from a distance of 50 cm using smart-phone-based cameras with the flash light vertically aligned with the lens. After projecting the photograph on a laptop and using a vernier caliper, we measured the horizontal corneal diameter of the non-strabismic eye and the decentration of reflex in the strabismic eye taking limbus as the reference point. We converted these values to degrees by using a conversion factor of 7.5°/mm and further to prism diopters (PD) by the standard mathematical formula 100*tanθ. Results: We included 74 subjects aged between 5 and 40 years with manifest horizontal deviation from 20 to 85 PD. We found a statistically significant correlation of 82.6% (P value < 0.001) between the clinic and photographic measurements. Agreement analysis suggested that the photographic measurements measured on average 7 PD less (95% confidence interval: 4.6 to 9.2) than clinical measurements along all values of misalignment, although the difference between the two methods decreased as the quantum of deviation increased. Linear regression revealed an r2 of 68% and provided a predictive equation to derive clinic equivalent measurements from photographic estimates. Conclusion: We believe our simple method provides robust evidence that a photographic estimation can provide the basic information of the size of the deviation to plan possible surgeries, especially in situations of a tele-consultation. This is an easy approach to both understand and master and should form the armamentarium of most orthopticians and strabismologists.

Abstract Background Young adult caregivers (YACs, aged 18–25) who take care of a loved one may juggle between caregiving responsibilities and other life areas such as education and social life, leading to an imbalance in their lives. The web-based tool ‘MantelzorgBalans’ aims to support informal caregivers (ICGs) in balancing caregiving tasks and activities in other life areas. However, this tool was designed to support ICGs of loved ones receiving palliative care and is not yet tailored to the needs of YACs. In order to do so, in this study we aim to explore (i) challenges and support needs of YACs in caregiving, (ii) their needs towards the content of the ‘MantelzorgBalans’ tool, and (iii) issues they encountered in using the tool and their preferences for adaptation of the tool. Method We conducted semi-structured interviews and usability testing with 13 student YACs in the Netherlands. Within usability testing, we used three approaches: (i) a thinking-aloud approach (verbalizing thoughts while using the tool), (ii) a task-based performance approach (scoring task completion rate), and (iii) questionnaires. We used thematic analysis to synthesize the qualitative data. For the quantitative data, we calculated frequencies and mean scores. Results Our findings suggest that the majority of YACs faced challenges in balancing caregiving with life areas such as education and social life. They needed support from healthcare professionals who could listen to them without judging them. With respect to the MantelzorgBalans tool, YACs needed more information on how to provide emotional support to their loved one and the emotional support that is available for them. In regards to the aesthetics, they preferred bright colours and more visuals in the tool. Overall, they were satisfied with the information presented in the tool, but they were neutral in their willingness to use it in the future. Conclusion From this study, we learn that YACs may experience specific challenges and needs in general, and towards a web-based tool in specific. In the near future, it will be important to develop digital tools to support YACs that match their specific needs. This may enable healthcare professionals to offer targeted and personalized digital support to YACs in future.

BackgroundUnobtrusive sensing technologies developed for monitoring deviant behaviors in older adult care require integration with an interaction platform to facilitate the flow of information between older adults and their caregivers. However, the continuous monitoring capabilities generate a considerable amount of data that must be interpreted, filtered, and personalized before being communicated to the informal caregivers based on their specific care needs and requirements. ObjectiveFor the effective implementation of unobtrusive sensing solutions (USSs) in the care of older adults with cognitive impairment, we aimed to explore the expectations and preconditions regarding the implementation of USSs from the perspective of informal caregivers. Subsequently, we designed and evaluated a low-fidelity prototype of an interaction platform for its conceptual workflow and usability, incorporating persuasive system design features based on the needs and requirements of informal caregivers. MethodsOverall, 6 informal caregivers of older adults with cognitive impairment living alone participated in this qualitative interview study. We explored the expectation and preconditions regarding implementation through open-ended questions and conducted a formative evaluation (usability study with a think-aloud approach) to evaluate the conceptual workflow and used persuasive system design features in the interaction platform. Overall, a combination of inductive and thematic analyses was used to analyze the interviews. ResultsThe results of this study present both positive and negative outcome expectations regarding the implementation of USSs, highlighting benefits such as objective decision-making and peace of mind and concerns about information overload and the potential substitution of human contact. Strategic information communication agreements between informal and formal caregivers were deemed crucial for the successful implementation of USSs in care. Overall, informal caregivers had a positive experience with the low-fidelity prototype of the interaction platform, particularly valuing the personalization feature. ConclusionsIn conclusion, to achieve successful implementation, a holistic design approach is necessary, and equal consideration should be given to the personalization-privacy paradox to balance users’ needs and privacy.

Abstract Background Cancer is an outcome of various disrupted or dysregulated metabolic processes like apoptosis, growth, and self‐cell transformation. Human anatomy harbors trillions of microbes, and these microbes actively influence all kinds of human metabolic activities, including the human immune response. The immune system which inherently acts as a sentinel against microbes, curiously tolerates and even maintains a distinct normal microflora in our body. This emphasizes the evolutionarily significant role of microbiota in shaping our adaptive immune system and even potentiating its function in chronic ailments like cancers. Microbes interact with the host immune cells and play a part in cancer progression or regression by modulating immune cells, producing immunosuppressants, virulence factors, and genotoxins. Recent Findings An expanding plethora of studies suggest and support the evidence of microbiome impacting cancer etiology. Several studies also indicate that the microbiome can supplement various cancer therapies, increasing their efficacy. The present review discusses the relationship between bacterial and viral microbiota with cancer, discussing different carcinogenic mechanisms influenced by prokaryotes with special emphasis on their immunomodulatory axis. It also elucidates the potential of the microbiome in transforming the efficacy of immunotherapeutic treatments. Conclusion This review offers a thorough overview of the complex interaction between the human immune system and the microbiome and its impact on the development of cancer. The microbiome affects the immune responses as well as progression of tumor transformation, hence microbiome‐based therapies can vastly improve the effectiveness of cancer immunotherapies. Individual variations of the microbiome and its dynamic variability in every individual impacts the immune modulation and cancer progression. Therefore, further research is required to understand these underlying processes in detail, so as to design better microbiome‐immune system axis in the treatment of cancer.

BackgroundWith the increase in the older adult population, sensor-based care solutions that can monitor the deviations in physical, emotional, and physiological activities in real-time from a distance are demanded for prolonging the stay of community-dwelling older adults with cognitive impairment. To effectively develop and implement these care solutions, it is important to understand the current experiences, future expectations, perceived usefulness (PU), and communication needs of the informal caregivers of older adults with cognitive impairment regarding such solutions. ObjectiveThis comprehensive study with informal caregivers of older adults with cognitive impairment aims to (1) highlight current experiences with (if any) and future expectations from general sensor-based care solutions, (2) explore PU specifically toward unobtrusive sensing solutions (USSs), (3) determine the information communication (IC) needs and requirements for communicating the information obtained through USSs in different care scenarios (fall, nocturnal unrest, agitation, and normal daily life), and (4) elicit the design features for designing the interaction platform in accordance with the persuasive system design (PSD) model. MethodsA multimethod research approach encompassing a survey (N=464) and in-depth interviews (10/464, 2.2%) with informal caregivers of older adults with cognitive impairment was used. The insights into past experiences with and future expectations from the sensor-based care solutions were obtained through inductive thematic analysis of the interviews. A convergent mixed methods approach was used to explore PU and gather the IC needs from USSs by using scenario-specific questions in both survey and interviews. Finally, the design features were elicited by using the PSD model on the obtained IC needs and requirements. ResultsInformal caregivers expect care infrastructure to consider centralized and empathetic care approaches. Specifically, sensor-based care solutions should be adaptable to care needs, demonstrate trust and reliability, and ensure privacy and safety. Most informal caregivers found USSs to be useful for emergencies (mean 4.09, SD 0.04) rather than for monitoring normal daily life activities (mean 3.50, SD 0.04). Moreover, they display variations in information needs including mode, content, time, and stakeholders involved based on the care scenario at hand. Finally, PSD features, namely, reduction, tailoring, personalization, reminders, suggestions, trustworthiness, and social learning, were identified for various care scenarios. ConclusionsFrom the obtained results, it can be concluded that the care scenario at hand drives PU and IC design needs and requirements toward USSs. Therefore, future technology developers are recommended to develop technology that can be easily adapted to diverse care scenarios, whereas designers of such sensor-driven platforms are encouraged to go beyond tailoring and strive for strong personalization while maintaining the privacy of the users.

Introduction The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.Methods Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020–October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.Results Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30–60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6–7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).Conclusion Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

Objectives Early initiation of tobacco use can lead to lifelong addiction and increases tobacco-attributable morbidity and mortality. This study assesses trends in tobacco use initiation and factors associated with tobacco use initiation using disaggregated data from two rounds of the Global Adult Tobacco Survey India (GATS; 2009–2010 (GATS 1) and 2016–2017 (GATS 2)).Design Secondary analysis of repeated cross-sectional studies.Settings and participants The study involved data from 69 296 individuals and 76 069 households in GATS 1 and 74 037 individuals and 77 170 households in GATS 2, two rounds of a nationally representative survey in India.Outcome measures Mean age of initiation (as recalled by the participants) of smoked and smokeless tobacco (SLT) use (dependent variable) was compared and analysed across different sociodemographic variables (independent factors). We assessed change in mean age of initiation of tobacco usage on a daily basis between GATS 1 and GATS 2, and investigated the factors associated with early tobacco use initiation in the GATS 2 dataset (reported using adjusted ORs (aORs) with 95% CIs).Results The mean age of initiation of smoked tobacco and SLT in GATS 2 was 20.9±8.5 and 22.3±10.6 years, compared with 18.5±9.7 and 19.7±12.0 years in GATS 1. The mean age of initiation increased with age and among those who were better aware of the adverse effects of tobacco. As per GATS 2, males initiated smoked tobacco and SLT use earlier (20.6±7.4 and 21.7±9.1) than females (23.3±14.2 and 23.2±12.6 years). Younger participants (15–24 years) reported earlier initiation of SLT (15.5±4.2 years) compared with others. Binary logistic regression depicted variables associated with early initiation of tobacco. Awareness about the harms caused by tobacco affected the odds of SLT (aOR 1.4, 95% CI 1.3 to 1.7) and dual usage initiation (1.8, 1.6 to 2.0), but not of initiation of smoked tobacco products (1.1, 0.9 to 1.2).Conclusions More robust health advocacy campaigns that communicate the harmful effects of tobacco on health could be useful to delay tobacco initiation, along with reducing the ease of access and affordability of tobacco products among vulnerable groups.

Purpose: Cycloplegic refraction is mandatory for children to know the eye's refractive status. In this study, we compared cycloplegia induced by cyclopentolate 1% to that induced by atropine 1% by means of retinoscopy. Methods: In this parallel-designed interventional study, we included 67 children aged between 4 and 17 years. After the initial retinoscopy under cyclopentolate 1% (used twice in each eye), we repeated it a week later under atropine ointment 1% (used twice a day for 3 days); both were done by the same trained optometrist masked to the drug. Each eye's refraction was converted to spherical equivalents (SEs), and the values averaged between the two eyes of each child under each drug. We compared SE with paired t-test (JASP 16.4). In addition, we performed correlational analysis, and looked for agreement using the Bland–Altman plot. Significance was set at P < 0.05. Wherever possible, 95% confidence intervals (CIs) are quoted. Results: The mean SE with atropine was +1.93 ± 2.0 D, compared to +1.75 ± 1.95 D under cyclopentolate. On average, atropine induced greater cycloplegia by a mere 0.18 D (95% CI: 0.07 to 0.29 D, P value 0.002). The two cycloplegic refractions correlated significantly (Pearson's r: 0.975, P < 0.001). The Bland–Altman plot revealed the limits of agreement as 1.06 and −0.71 D. Conclusion: Our study suggests that cyclopentolate works for the most part as well as atropine to attain cycloplegia. Atropine may be considered for children less than 15 years of age with greater than 5.0 D of hyperopia. Cycloplentolate, with its advantages of quick action and short duration, should form the first go-to topical cycloplegic in busy outpatient clinics.

Background: Healthcare workers (HCWs) are at the front line of the Coronavirus disease (COVID-19) outbreak response. They have faced great risks to both physical and mental health. We aimed to assess the psychological effect of COVID-19 among ancillary hospital staff. Methods: A cross-sectional study was conducted among 267 on-duty ancillary hospital staff using a semi-structured questionnaire to assess their psychological status and risk perception. In addition, their knowledge, attitude, and practices (KAP) and risk perception were also assessed. The General Health Questionnaire (GHQ-12) was used to screen for psychological distress. Results: Among 267 participants, the mean (±SD) age was 33.5 (7.6) years. The majority knew about the symptoms of COVID-19 (88.4%), droplet spread (99.3%), and the importance of isolation (99.3%). About 35.2% were worried about infecting family members, while 26.2% were worried about colleagues at the frontline. Only 38.9% of them had a good knowledge score. Participants with high school and above education level had significantly good knowledge about COVID-19 (OR = 1.99; 95% CI = 1.17- 3.39) than those with primary school or below. Being female (OR 1.99; 95% CI 1.17-3.39) and working with COVID-19 patients (OR 3.88, 95% CI 1.77-8.47, P = 0.001) was associated with psychological distress. Conclusion: The ancillary hospital staff had insufficient knowledge regarding the risk factors of COVID-19 but possessed positive attitudes and practices. Continued health education and appropriate psychological interventions may improve understanding and reduce psychological distress.

Background: Tobacco is one of the major behavioral risk factors for noncommunicable diseases in India. Tobacco control depends on public awareness regarding prevalent antitobacco measures. Objectives: The present study documents the understanding of young adults (

Agitation is a commonly found behavioral condition in persons with advanced dementia. It requires continuous monitoring to gain insights into agitation levels to assist caregivers in delivering adequate care. The available monitoring techniques use cameras and wearables which are distressful and intrusive and are thus often rejected by older adults. To enable continuous monitoring in older adult care, unobtrusive Wi-Fi channel state information (CSI) can be leveraged to monitor physical activities related to agitation. However, to the best of our knowledge, there are no realistic CSI datasets available for facilitating the classification of physical activities demonstrated during agitation scenarios such as disturbed walking, repetitive sitting–getting up, tapping on a surface, hand wringing, rubbing on a surface, flipping objects, and kicking. Therefore, in this paper, we present a public dataset named Wi-Gitation. For Wi-Gitation, the Wi-Fi CSI data were collected with twenty-three healthy participants depicting the aforementioned agitation-related physical activities at two different locations in a one-bedroom apartment with multiple receivers placed at different distances (0.5–8 m) from the participants. The validation results on the Wi-Gitation dataset indicate higher accuracies (F1-Scores ≥0.95) when employing mixed-data analysis, where the training and testing data share the same distribution. Conversely, in scenarios where the training and testing data differ in distribution (i.e., leave-one-out), the accuracies experienced a notable decline (F1-Scores ≤0.21). This dataset can be used for fundamental research on CSI signals and in the evaluation of advanced algorithms developed for tackling domain invariance in CSI-based human activity recognition.

Wilson disease is one of the uncommon, hereditary, slowly progressing, and autosomal recessive diseases that cause motion disorders. The pathogenesis of Wilson disease is attributed to the accumulation of copper in different parts of body mainly the brain, eyes, liver, etc. due to the mutation taking place in the ATP7B gene. This disease thus leads to dysfunction of liver, neurons, brain, eyes and infertility. Thus, there is a need of proper treatment for this disease. There are numerous treatments available, including penicillamine, zinc, ammonium tetrathiomolybdate, trientine, and combination drugs; however, these treatments have a variety of side effects and poor pharmacokinetics, leading to the approval of trientine salts, of which trientine tetrahydrochloride was found to be an efficient, safe, and drug with few side effects. In this review, various aspects related to the disease and trientine salts have been summarized including the pathogenesis of Wilson disease, treatments of Wilson disease, mechanism of trientine as well as comparative pharmacokinetics with the safety and efficacy of both the salts of trientine. We have also tried to explain the preference of usage of trientine tetrahydrochloride over trientine dihydrochloride with some drugs in clinical trials. Here various factors that lead to treatment failure and consideration of alternate therapies have been discussed. Clinical trials and investigations are still going on over gene therapy and stem cells usage in the treatment of Wilson disease which can be used as an effective treatment in future.

(1) Background: Understanding the physicians’ knowledge, attitudes, and antimicrobial prescribing behavior is a crucial step towards designing strategies for the optimal use of these agents. (2) Methods: A cross-sectional online survey was conducted among clinicians across India between May and July 2022 using a self-administered questionnaire in English comprising 35 questions pertaining to demographic characteristics, knowledge, attitude, and practices domains. (3) Results: A total of 544 responses were received from 710 physicians contacted. Sixty percent of participants were males, with mean age of 34.7 years. Mean ± Standard Deviation scores for knowledge, attitude, and practices domains were 8 ± 1.6, 20.2 ± 3.5, and 15.3 ± 2.1, respectively. Higher scores were associated with basic [odds ratio (95% Confidence Interval), p value: 2.95 (1.21, 7.2), 0.02], medical and allied sciences [2.71 (1.09, 6.67), 0.03], and central zone [3.75 (1.39, 10.12), 0.009]. A substantial proportion of dissatisfactory responses were found regarding hospital antibiograms, antibiotics effective against anaerobes, WHO AWaRe (access, watch, and reserve) classification of antibiotics, and the role of infection prevention and control (IPC) measures in the containment of antimicrobial resistance (AMR). (4) Conclusions: There is a need to sensitize and educate clinicians on various issues related to antimicrobial use, such as antibiograms, double anaerobic cover, IPC practices, and guideline-based recommendations, to curb the AMR pandemic.

liver diseases (CLD) are one of the hepatic disorders that lead to scarring of hepatic tissues due to abnormalities like obstruction of bile flow, hepatitis and alcohol abuse. The primary biliary cholangitis (PBC) and primary sclerosis cholangitis (PSC) are slow progressive autoimmune diseases, which are the foremost types of CLD. The pathogenesis for the disease is unclear till date. Only limited therapies are available and liver transplant is the final resort for the same but the number of patients waiting for liver transplantation is quite higher than the number of active donors. Moreover, it is also associated with high risk also like rejection of donated liver and in a study, about 25% of mortality rate within five years of transplantation has been reported. There are some recent advancements in allopathic and natural treatment and some drugs under clinical trials are preferred only to prolong the timeline for liver transplantation but do not treat the disease completely. This review mentions about the pathogenicity, treatments including natural compounds and drugs in use as well as under clinical trials. The future RNA and DNA approaches that can be explored to treat CLD and result in an effective approach for the prevention of this disease have also been discussed here. We are confident that the current review study will assist future medicinal researchers in their quest of rational approaches for the treatment of primary biliary cholangitis and primary sclerosis cholangitis.

BackgroundCOVID-19 vaccination of the healthcare workers (HCWs) is a key priority in the fight against the SARS-CoV-2 pandemic. India launched its COVID-19 vaccination program in January 2021. We aimed to understand the trends in willingness to receive COVID-19 vaccines and its associated factors among HCWs in India.MethodsUsing a repeated cross-sectional survey design, we collected information from HCWs in three critical time points: before (n = 937, October 2020), during (n = 1346, January 2021); and after (n = 812, May 2021) the introduction of COVID-19 vaccines in India. The third survey coincided with the peak of the second wave of COVID-19 pandemic in India.FindingsOf the study participants, 43.7, 60.2, and 73.2% were willing to receive COVID-19 vaccines during the first, second and third rounds of surveys, respectively. In multivariable logistic regression analysis, participants who trusted the health care system were more likely to report willingness to receive a COVID-19 vaccine; medical trust emerged as a significant factor in all the three rounds of surveys (First survey—aOR: 2.24, 95% CI: 1.67–2.99; Second survey—aOR: 3.38, 95% CI: 2.64-4.33; Third survey—aOR: 2.54, 95% CI: 1.65–3.91). Having confidence in domestic vaccines (Second survey—aOR: 2.21, 95% CI: 1.61–3.02; Third survey—aOR: 2.05, 95% CI: 1.24–3.37); and high perceived risk of contracting COVID-19 (Second survey—aOR: 1.48, 95% CI: 1.13–1.93; Third survey—aOR: 2.02, 95% CI: 1.31–3.13) were found to be associated with willingness to receive vaccines. Among socio-demographic characteristics, being married (aOR: 1.71, 95% CI: 1.08–2.71) and having high socio-economic status (aOR: 3.01, 95% CI: 1.65–5.51) emerged as significant factors associated with willingness to receive COVID-19 vaccines in the third round of the surveys.InterpretationWillingness to receive COVID-19 vaccine increased with time, as the severity of the pandemic increased. To increase COVID-19 acceptance and coverage among HCWs, it is important to instill confidence in domestic vaccines and assist in accurate assessment of risk toward contracting COVID-19 infection.

The demand for smart solutions to support people with dementia (PwD) is increasing. These solutions are expected to assist PwD with their emotional, physical, and social well-being. At the moment, state-of-the-art works allow for the monitoring of physical well-being; however, not much attention is delineated for monitoring the emotional and social well-being of PwD. Research on emotion monitoring can be combined with research on the effects of music on PwD given its promising effects. More specifically, knowledge of the emotional state allows for music intervention to alleviate negative emotions by eliciting positive emotions in PwD. In this direction, the paper conducts a state-of-the-art review on two aspects: (i) the effect of music on PwD and (ii) both wearable and non-wearable sensing systems for emotional state monitoring. After outlining the application of musical interventions for PwD, including emotion monitoring sensors and algorithms, multiple challenges are identified. The main findings include a need for rigorous research approaches for the development of adaptable solutions that can tackle dynamic changes caused by the diminishing cognitive abilities of PwD with a focus on privacy and adoption aspects. By addressing these requirements, advancements can be made in harnessing music and emotion monitoring for PwD, thereby facilitating the creation of more resilient and scalable solutions to aid caregivers and PwD.

In recent years, solid waste management has developed from early approaches of burning or dumping to reuse, recycle, regain, and retain various alternative technologies. The present study aims at developing an effective community waste management model with a solution to multiple issues. It aims to provide an alternative to widespread stubble burning, burning dry leaf litter and promoting plastic reuse. The present novel technology involved the cultivation of Oyster Mushroom (Pleurotus ostreatus) in used plastic bottles to convert agricultural and urban waste into a highly nutritional end product. In this direction, the effect of different wheat straw and dry leaves’ ratios was assessed on the spawn run time, primordial formation, final harvesting time, mean yield per plastic bottle, and the % biological efficiency per gram of the substrate. Both the combinations of L30:WS70 and L50:WS50 represented ideal options for using the two waste substrates to cultivate the mushroom species. This model will help recycle agro-waste and serve as an effective method of generating nutritious food for fighting food security while decreasing the plastic load and trash thrown for disposal.

Toenails provide stability to the foot. A stubbed toe may result in nail injury or fracture. Toe injuries are often ignored, leading to inappropriate or delayed management. The COVID-19 pandemic has badly affected the health services leading to further delay in treatment. We present a case report of an adult male who presented with an injured toe at a primary care clinic in India. Due to the apprehension of contracting severe acute respiratory syndrome coronavirus 2 infection and lockdown restrictions, the patient neither wanted to go to a higher center or get investigations done. The case report discusses the management and ways to handle such cases for primary care doctors in a resource-constrained setting.

Abstract The present study aims at developing PGMD (poly-glycerol-malic acid-dodecanedioic acid)/curcumin nanoparticles based formulation for anticancer activity against breast cancer cells. The nanoparticles were prepared using both the variants of PGMD polymer (PGMD 7:3 and PGMD 6:4) with curcumin (i.e. CUR NP 7:3 and CUR NP 6:4). The size of CUR NP 7:3 and CUR NP 6:4 were found to be ~ 110 and 218 nm with a polydispersity index of 0.174 and 0.36, respectively. Further, the zeta potential of the particles was − 18.9 and − 17.5 mV for CUR NP 7:3 and CUR NP 6:4, respectively. The entrapment efficiency of both the nanoparticles was in the range of 75–81%. In vitro anticancer activity and the scratch assay were conducted on breast cancer cell lines, MCF-7 and MDA-MB-231. The IC50 of the nanoformulations was observed to be 40.2 and 33.6 μM at 48 h for CUR NP 7:3 and CUR NP 6:4, respectively, in MCF-7 cell line; for MDA-MB-231 it was 43.4 and 30.5 μM. Acridine orange/EtBr and DAPI staining assays showed apoptotic features and nuclear anomalies in the treated cells. This was further confirmed by western blot analysis that showed overexpression of caspase 9 indicating curcumin role in apoptosis.

Introduction: District Jaipur of Rajasthan has a high prevalence of Human Immunodeficiency Virus (HIV) and it comes under category B of HIV transmission. The geographical and sociocultural environments of different states of India are different; hence, the profile of HIV cases also differs from place to place. Area-specific data regarding the profile of HIV cases attending the biggest government hospital of Jaipur could be utilized by higher authorities for the implementation of control measures. Objective: The objective was to describe the sociodemographic profile of HIV cases and to find out the comorbidity of TB-HIV cases. Materials and Methods: The hospital-based, observational, and descriptive study was undertaken at a tertiary care teaching hospital of Jaipur from 1 January to 28 February 2019. Primary data were collected from 220 HIV-positive cases through an interview, and secondary data were collected from case records. Results: The maximum cases (40%) were in the age group of 31 to 40 years. Around 30% of cases were unmarried, widows, or divorced. Half of them were from the below poverty line (BPL) families. Only 9% of patients had a college education. Every third case reported was a housewife. Around 13% of cases were not aware of their spouse’s HIV status. HIV-TB coinfection was present in 20% of cases. Conclusion: The majority of cases were from the sexually active age groups and were poor, unmarried, widows, or divorced, and housewives. The spouse of every eighth case was unaware of the HIV status of their partner. Tuberculosis (TB) was the most common coinfection. This basic information would help policymakers formulate better information, education and communication and control measures that are area and population specific.

Introduction: Use of internet has increased exponentially worldwide with prevalence of internet addiction ranging from 1.6% to 18 % or even higher. Depression and insomnia has been linked with internet addiction and overuse in several studies. Aims and Objectives: Present study has looked in to pattern and prevalence of internet addiction in university students. This study has also explored the association of internet addiction with depression and insomnia. Material and Methods: In this cross sectional study 954 subjects were enrolled who had been using internet for past 6 months. Information regarding pattern of use and socio demographic characteristics were recorded. Internet addiction Test (IAT), PHQ-9,and insomnia Severity Index (ISI) were applied to measure internet addiction, depression and insomnia respectively. Results: Among 954 subjects, 518 (60.59%) were male and 376 (39.41%) were female with mean age of 23.81 (SD ± 3.72). 15.51% study subjects were internet addicts and 49.19% were over users. Several parameters including graduation level, time spent per day on line, place of internet use, smoking and alcohol had significant association with internet addiction. Internet addiction was predominantly associated with depression and insomnia. Conclusion: Internet addiction is a rising concern among youth. Several parameters including gender, time spent on line, alcohol, smoking predicts higher risk of internet addiction. Depression and insomnia are more common in internet addicts and overusers.

The growing energy demands and rapid industrialization drove the attention towards a sustainable living. The methods to a adopt renewable source of energy has made the field of heterogeneous photocatalysis so famous. The photocatalytic hydrogen production seems to be an answer for our future energy crisis. In this regard, alkaline earth metal titanates with a perovskite structure are one of the in demand materials these days. Among these, strontium titanates (SrTiO3) play an important role and have shown a potential, especially in the field of hydrogen production. This review summarizes the significance of (SrTiO3) in photocatalytic water splitting, to produce hydrogen and the photocatalytic degradation of the pollutants from the waste water. Different synthesis methods used for preparing SrTiO3 are also discussed.

BackgroundThe continuous growth of the older adult population will have implications for the organization of health and social care. Potentially, in-home monitoring unobtrusive sensing systems (USSs) can be used to support formal or informal caregivers of older adults, as they can monitor deviant physical and physiological behavior changes. Most existing USSs are not specific to older adult care. Hence, to facilitate the implementation of existing USSs in older adult care, it is important to know which USSs would be more suitable for older adults. ObjectiveThis scoping review aims to examine the literature to identify current USSs for monitoring human activities and behaviors and assess their implementation readiness for older adult care. MethodsWe conducted a structured search in the Scopus, Web of Science, and ACM Digital Library databases. Predefined inclusion criteria included studies on unobtrusive sensor-based technology; experimental in nature; aimed at monitoring human social, emotional, physical, and physiological behavior; having the potential to be scalable in in-home care; and having at least 5 adults as participants. Using these criteria, we screened studies by title, abstract, and full text. A deductive thematic analysis based on the Proctor implementation framework along with an additional outcome of external validity was applied to the included studies to identify the factors contributing to successful implementation. Finally, the identified factors were used to report the implementation readiness of the included studies for older adult care. ResultsIn this review, 52 studies were included. Deductive analysis using the implementation framework by Proctor resulted in six factors that can contribute to the successful implementation of USSs in older adult care: study settings, age of participants, activities monitored, sensor setup, sensing technology used, and usefulness of USSs. These factors were associated with the implementation outcomes as follows: study settings and age of participants contributed to external validity, sensor setup contributed to acceptability, usefulness of USSs contributed to adoption, activities monitored contributed to appropriateness, and sensing technology used contributed to implementation cost. Furthermore, the implementation assessment of the included 52 studies showed that none of the studies addressed all the identified factors. This assessment was useful in highlighting studies that have addressed multiple factors; thus, these studies represent a step ahead in the implementation process. ConclusionsThis review is the first to scope state-of-the-art USSs suitable for older adult care. Although the included 52 USS studies fulfilled the basic criteria to be suitable for older adult care, systems leveraging radio frequency technology in a no-contact sensor setup for monitoring life risk or health wellness activities are more suitable for older adult care. Finally, this review has extended the discussion about unobtrusiveness as a property of systems that cannot be measured in binary because it varies greatly with user perception and context.

Novel hybrid structures have attracted attention in several instances of scientific research and different technological applications in this decade due to their novel characteristics and wide range of applicability. Hybrid membranes with multiple components (three or more) are also increasingly used in water purification applications, and their ease of handling and reusability make them a promising candidate for the degradation of organic pollutants by photocatalysis. In this study, the preparation and characterization of tungsten trioxide nanowire (WO3 NW)-based hybrid membrane structures are reported. Furthermore, the adsorption properties and photocatalytic efficiency of the as-prepared membranes against methylene blue (MB) organic dye under UV irradiation is also presented. Characterization techniques, such as scanning electron microscopy (SEM), high-resolution transmission electron microscopy (HRTEM), energy-dispersive X-ray spectroscopy (EDS), and X-ray powder diffraction (XRD) are performed to study the morphology and surface of the as-prepared hybrid membranes. The removal efficiency of the hybrid membranes against MB is 77% in a 120 min decomposition reaction. The enhanced value can be attributed to the hybrid structure of the membrane that enhances not only the adsorption capability, but also the photocatalytic performance. Based on the results obtained, it is hoped that hybrid membrane technology could be a promising candidate for future photocatalysis-based water treatment applications.

The novel photoactive membranes have grabbed the attention in the field of environmental protection by employing wastewater treatments and the removal of microorganisms or organic pollutants from wastewater. Here we present a promising self-supported photoactive hybrid membrane for future antimicrobial and water treatment applications. In this study, the efficiency of bacterial cellulose (BC) - zinc oxide (ZnO) - multi walled carbon nanotube (MWCNT) hybrid membranes in the adsorption and photocatalytic degradation of methylene blue (MB) under UV radiation and the removal of Escherichia coli (E. coli) was investigated. It was found that the photocatalytic efficiency is strongly dependent on both the preparation method and the amount of ZnO-MWCNT additives loaded into the hybrid membranes. The characterization of BC-ZnO-MWCNT membranes was done using scanning electron microscopy (SEM), mercury intrusion porosimetry (MIP), and X-ray micro computed tomography (μCT) to study the morphological and porosity aspect of the prepared-membranes. The promising results of this study could provide a new pathway in the field of photocatalysed-based water treatment technology by the application of hybrid membranes.

Nowadays, the use of hybrid structures and multi-component materials is gaining ground in the fields of environmental protection, water treatment and removal of organic pollutants. This study describes promising, cheap and photoactive self-supported hybrid membranes as a possible solution for wastewater treatment applications. In the course of this research work, the photocatalytic performance of titania nanowire (TiO2 NW)-based hybrid membranes in the adsorption and degradation of methylene blue (MB) under UV irradiation was investigated. Characterization techniques such as scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDS), X-ray powder diffractometry (XRD) were used to study the morphology and surface of the as-prepared hybrid membranes. We tested the photocatalytic efficiency of the as-prepared membranes in decomposing methylene blue (MB) under UV light irradiation. The hybrid membranes achieved the removal of MB with a degradation efficiency of 90% in 60 min. The high efficiency can be attributed to the presence of binary components in the membrane that enhanced both the adsorption capability and the photocatalytic ability of the membranes. The results obtained suggest that multicomponent hybrid membranes could be promising candidates for future photocatalysis-based water treatment technologies that also take into account the principles of circular economy.

BACKGROUND:Malnutrition is a major public health problem in India, especially among urban poor children. The objective of the study was to determine the effectiveness of a culturally appropriate nutrition educational intervention that can be delivered through health services and digitized child undernutrition tracking module for health workers to improve complementary feeding of infants of age six months to 12 months in Chandigarh, North India, to prevent malnutrition in infants. METHODS:A quasi-experimental study was conducted in a non-randomized intervention (Burail) and control area (Maloya) among a vulnerable population in Chandigarh, North India. The mother-infant dyads (MIDs) in the intervention group(n = 202) received culturally appropriate nutrition educational intervention, were supported individually by trained health workers in infant feeding and followed up for six months. Health workers were monitored through a digitized tracking module. The MIDs in the control group (n = 202) received routine care under the national health program. The mean (±S.D.) age of infants in the intervention and control group was 5.4 (±0.8) months and 5.5 (±0.7) months, respectively. The data was collected using a pre-tested semi-structured questionnaire and anthropometry of infants at baseline and end line. The primary outcome was a mean change in weight. The effectiveness of the intervention was measured by conducting the difference in difference (DID) analysis in mean change in weight between intervention and control group. RESULT:At baseline, the mean (±S.D.) weight of infants was 6.6(±0.64) kg and 6.6 (±0.52) kg in the intervention and control group. The mean (±S.D.) length of infants was 64.3 (±2.0) cm in the intervention group and 65.1 (±1.7) cm in the control group. Out of 404, 190 and 191 MIDs in the intervention and control group completed the study, respectively. A significantly higher number of infants in the intervention group were started on complementary feeding at six months of age (72.6% versus45.5%, p

Vaccines are essential to ensure that the population is immune to certain diseases, and immunization is one of the most cost-effective interventions to prevent the occurrence of the diseases. Recently, new vaccines such as rotavirus, measles-rubella vaccine, and pneumococcal vaccines are introduced in the universal immunization program of some of the states in India. Human papillomavirus (HPV) vaccine is also introduced in Punjab through its own initiative. This paper documents the experience in terms of implementation plans, issues, and challenges in introducing these vaccines in North Indian states, including Haryana (rotavirus vaccine), Punjab (HPV vaccine), Himachal Pradesh (pneumococcal vaccine), and Chandigarh (measles and rubella vaccination campaign).

Abstract Pancreatic tumors are renowned for their extremely hypoxic centers, resulting in upregulation of a number of hypoxia mediated signaling pathways including cell proliferation, metabolism and cell survival. Previous studies from our laboratory have shown that Minnelide, a water-soluble pro-drug of triptolide (anti-cancer compound), decreases viability of cancer cells in vitro as well as in vivo. However, its mechanism of action remain elusive. In the current study we evaluated the effect of Minnelide, on hypoxia mediated oncogenic signaling as well as stemness in pancreatic cancer. Minnelide has just completed Phase 1 trial against GI cancers and is currently awaiting Phase 2 trials. Our results showed that upon treatment with triptolide, HIF-1α protein accumulated in pancreatic cancer cells even though hypoxic response was decreased in them. Our studies showed even though HIF-1α is accumulated in the treated cells, there was no decrease in HIF-1 binding to hypoxia response elements. However, the HIF-1 transcriptional activity was significantly reduced owing to depletion of co-activator p300 upon treatment with triptolide. Further, treatment with triptolide resulted in a decreased activity of Sp1 and NF-kB the two major oncogenic signaling pathway in pancreatic cancer along with a decreased tumor initiating cell (TIC) population in pancreatic tumor.

Dapsone (4,4'-diaminodiphenylsulfone) is a drug commonly used to treat various infectious, immunological, granulomatous, and hypersensitivity disorders. It can cause varied adverse effects, including sulfone syndrome which can have a potentially fatal outcome. We report a case of a female diagnosed as a case of Hansen's disease with Type II lepra reaction, who developed sulfone syndrome and hemolytic anemia as adverse drug effects to dapsone. The case is presented to stress on the importance of timely diagnosis and institution of early treatment in the management of a rare complications of a commonly used drug with a favorable outcome.

Silver nanoparticles have been widely studied to possess antimicrobial as well as anticancer activity, and have found its applications in various fields including pharmaceutical industry, diagnostics, drug delivery, food industry, and others. For this purpose, several cell proliferation assays are widely used for the evaluation of anticancer activity of synthetic compounds as well as natural plant extracts. In general, a compound is said to possess an anticancer activity if it prevents the cancer cells to grow and divide actively, and indirectly activates the generic program of cell death. In this protocol, Alamar blue and MTT assay are described for the analysis of metabolic function and health of the cell. These procedures are generally used for the endpoint analysis. A549 cells are seeded in a 96-well plate, and after the adherence of the cells, they are treated with different concentrations of silver nanoparticles. Followed by 24 h of incubation, colorimetric dyes are added to the wells, and the absorbance is recorded to quantify the percentage cytotoxicity in the sample wells.

Introduction: In developing countries like India, maternal mortali- ty is a big concern. Antenatal care is being the effective approach for safe motherhood but these services are deficient in rural area. So the objective of this study is to evaluate utilization of antenatal care services in rural field area Naila in Jaipur, Rajasthan. Methodology: A community based cross sectional study was con- ducted among 111 women, who delivered between January 2017 - December 2017 by using a predesigned & pre-tested questionnaire. Statistical analysis: Percentages, Proportions and chi-square test. Results: The 97.2% women registered their pregnancy and among them 72.0% were registered during first trimester. 47.7% women had received four or more antenatal visits, 98.19% were immun- ized with adequate dose of tetanus toxoid and 30.6% had con- sumed 100 or more than 100 IFA tablets. Only 17.1% women had utilized full antenatal care during pregnancy. Factors like educa- tional status, type of family and Socio-economic status had a sig- nificant association with full ANC utilization. Conclusion: The lower socioeconomic status, lower literacy, Nu- clear family were related to low utilization of antenatal services. These findings may be useful for improving the maternal health practices and thus improve the health status of the women.

This study aims to determine the anticancer efficacy of diosgenin encapsulated poly-glycerol malate co-dodecanedioate (PGMD) nanoparticles. Diosgenin loaded PGMD nanoparticles (variants 7:3 and 6:4) were synthesized by the nanoprecipitation method. The synthesis of PGMD nanoparticles was systematically optimized employing the Box-Behnken design and taking into account the influence of various independent variables such as concentrations of each PGMD, diosgenin and PF-68 on the responses such as size and PDI of the particles. Mathematical modeling was done using the Quadratic second order modeling method and response surface analysis was undertaken to elucidate the factor-response relationship. The obtained size of PGMD 7:3 and PGMD 6:4 nanoparticles were 133.6 nm and 121.4 nm, respectively, as measured through dynamic light scattering (DLS). The entrapment efficiency was in the range of 77–83%. The in vitro drug release studies showed diffusion and dissolution controlled drug release pattern following Korsmeyer–Peppas kinetic model. Furthermore, in vitro morphological and cytotoxic studies were performed to evaluate the toxicity of synthesized drug loaded nanoparticles in model cell lines. The IC50 after 48 h was observed to be 27.14 µM, 15.15 µM and 13.91 µM for free diosgenin, PGMD 7:3 and PGMD 6:4 nanoparticles, respectively, when administered in A549 lung carcinoma cell lines.

Combination therapy using chemically distinct drugs has appeared as one of the promising strategies to improve anticancer treatment efficiency. In the present investigation, poly-(lactic-co-glycolic) acid (PLGA) nanoparticles electrostatically conjugated with polyethylenimine (PEI)-based co-delivery system for epirubicin and paclitaxel (PLGA-PEI-EPI-PTX NPs) has been developed. The PLGA-PEI-EPI-PTX NPs exhibited a monodispersed size distribution with an average size of 240.93 ± 12.70 nm as measured through DLS and 70.8–145 nm using AFM. The zeta potential of 41.95 ± 0.65 mV from −17.45 ± 2.15 mV further confirmed the colloidal stability and PEI modification on PLGA nanoparticles. Encapsulation and loading efficiency along with in vitro release of drug for nanoparticles were done spectrophotometrically. The FTIR analysis of PLGA-PEI-EPI-PTX NPs revealed the involvement of amide moiety between polymer PLGA and PEI. The effect of nanoparticles on the cell migration was also corroborated through wound healing assay. The MTT assay demonstrated that PLGA-PEI-EPI-PTX NPs exhibited considerable anticancer potential as compared to the naïve drugs. Further, p53 protein expression analysed through western blot showed enhanced expression. This study suggests that combination therapy using PLGA-PEI-EPI-PTX NPs represent a potential approach and could offer clinical benefits in the future for lung cancer patients.