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A cross-sectional, web-based survey was conducted to assess the health-care professionals (HCPs)’ perception toward existing medical device postmarket surveillance (PMS) practices in India. A total of 1756 responses (medical practitioners [19.8%], nurses [22.5%], pharmacists [21.4%], and biomedical engineers [13.8%]) were recorded and analyzed. About 71.2% of participants were aware about the ongoing PMS program, 87.5% were aware that medical devices are under regulation in India, and 83.3% were aware about who can report medical device adverse event (MDAE). About 56.3% of participants agreed that they take regular feedback from patients after using high-risk medical device. Majority of participants (69.4%) were aware about tools for reporting MDAE and the online reporting form is the most preferable tool among users. About 76.2% of participants were agreeing that reporting of MDAE is their professional/ethical responsibility. This study reveals that Indian HCPs show a good understanding of PMS practices and a positive perception toward MDAE reporting. However, underreporting still remains a challenge in India.

Introduction: Colposcopy is important for triaging any abnormal cervical screening test. Scarcity of trained colposcopists and colposcopy centers is a big hurdle to screening programs in low- and middle-income countries. Objectives of the Study: The objective was to assess the performance of the artificial intelligence incorporated into the mobile optical device technologies (ODT) Enhanced Visual Assessment (EVA visual check) against physician colposcopic diagnosis and the gold standard of histopathology. Materials and Methods: It was a cross-sectional observational study conducted on women referred to a colposcopy clinic following an abnormal screening test. Colposcopic examination was performed by colposcopists using the MobileODT EVA system. Physician’s impression and Visual Check analysis were compared with the final histopathological analysis or cytology. Cases with normal cytology and normal colposcopy did not undergo biopsy, and these were considered normal. Results: A total of 2050 women were screened, and 147 screen-positive women were recruited in the study. EVA Visual Check had a sensitivity of 86.8% (75–95), specificity of 28.7% (20–39), positive predictive value (PPV) of 40.7% (32–50), negative predictive value (NPV) of 79.4% (62–91), and diagnostic accuracy of 49.7% (41–58) for diagnosing cervical intraepithelial neoplasia (CIN) 1+ lesions. EVA Visual Check has a sensitivity of 89.3% (72–98), specificity of 26.1% (18–35), PPV of 22.1% (15–31), NPV of 91.2% (76–98), and diagnostic accuracy of 38.1% (30–46) for CIN 2+ lesions. Conclusion: MobileODT EVA colposcope with AI has sensitivity comparable to physician’s diagnosis, whereas specificity, PPV, and NPV were less than that of physician’s diagnosis. It could prove valuable for triage of screen-positive women for further management.

Background and Aim: Pharmacotherapeutic options for attention-deficit hyperactivity disorder (ADHD) are limited due to adverse effects and inadequate efficacy of existing drugs. Clinical trials were conducted on dasotraline in search of a safer and more efficacious alternatives to stimulant agents. This meta-analysis was conducted to evaluate the efficacy and safety of dasotraline in ADHD compared to placebo. Methods: The reviewers extracted data from five relevant clinical trials after a literature search on Medline/PubMed, Embase, Scopus, Google Scholar, and Cochrane databases and Clinical Trial Registries. Quality assessment was done using the risk of bias assessment tool, and the random-effects model was used to estimate the effect size. Sub-group analysis, meta-regression, and sensitivity analysis were done as applicable. PRISMA guidelines were followed in the selection, analysis, and reporting of findings. Results: Dasotraline significantly reduced the ADHD total symptom score (SMD: -0.35; 95% CI: -0.55 to -0.15; P < 0.001), hyperactivity/impulsivity subscale score (SMD: -0.27; 95% CI: -0.44 to -0.11; P = 0.001), inattentiveness sub-scale score (SMD: -0.33; 95% CI: -0.53 to -0.14; P < 0.001), and CGI-S (SMD: -0.25; 95% CI: -0.42 to -0.08; P = 0.003). Sub-group analysis showed a significant reduction of ADHD symptoms in both pediatric and adult age groups. Meta-regression showed a significant association between SMD of ADHD symptom score reduction and the duration of dasotraline therapy. The incidence of decreased appetite showed dose dependence but not the incidence of insomnia. Conclusions: Dasotraline 4 mg (in children) and 6 mg (in adults) can improve the clinical outcome in patients with ADHD by improving symptoms and global functioning with acceptable tolerability. PROSPERO Registration number: CRD42022321979

We propose controlling the hybridization between Majorana zero modes at the ends of magnetic adatom chains on superconductors by an additional magnetic adatom deposited close by. By tuning the additional adatom's magnetization, position, and coupling to the superconductor, we can couple and decouple the Majorana modes, as well as control the ground-state parity. The scheme is independent of microscopic details in ferromagnetic and helical magnetic chains on superconductors, with and without spin-orbit coupling, which we show by studying their full microscopic models and their common low-energy description. Our results show that scanning tunneling microscopy and electron-spin-resonance techniques are promising tools for controlling the Majorana hybridization in magnetic adatoms-superconductor setups, providing a basis for Majorana parity measurements, fusion, and braiding techniques.

Mesenchymal stem/stromal cells (MSCs) have emerged as a promising therapeutic approach for a variety of diseases due to their immunomodulatory and tissue regeneration capabilities. Despite their potential, the clinical application of MSC therapies is hindered by limited cell retention and engraftment at the target sites. Electrospun scaffolds, with their high surface area-to-volume ratio and tunable physicochemical properties, can be used as platforms for MSC delivery. However, synthetic polymers often lack the bioactive cues necessary for optimal cell-scaffold interactions. Integrating electrospun scaffolds and biological polymers, such as polysaccharides, proteins, and composites, combines the mechanical integrity of synthetic materials with the bioactivity of natural polymers and represents a strategic approach to enhance cell-scaffold interactions. The molecular interactions between MSCs and blended or functionalized scaffolds have been examined in recent studies, and it has been shown that integration can enhance MSC adhesion, proliferation, and paracrine secretion through the activation of multiple signaling pathways, such as FAK/Src, MAPK, PI3K/Akt, Wnt/β-catenin, and YAP/TAZ. Preclinical studies on small animals also reveal that the integration of electrospun scaffolds and natural polymers represents a promising approach to enhancing the delivery and efficacy of MSCs in the context of regenerating bone, cartilage, muscle, cardiac, vascular, and nervous tissues. Future research should concentrate on identifying the distinct characteristics of the MSC niche, investigating the processes involved in MSC-scaffold interactions, and applying new technologies in stem cell treatment and biofabrication to enhance scaffold design. Research on large animal models and collaboration among materials scientists, engineers, and physicians are crucial to translating these advancements into clinical use.

With the increasing burden of professional burnout in physicians, attention is being paid to optimizing sleep health, starting in training. The multiple dimensions of physicians' sleep are not well described due to obstacles to easily and reliably measuring sleep. This pilot study tested the feasibility of using commercial wearable devices and completing manual sleep logs to describe sleep patterns of medical students and residents. Prospective pilot study of 50 resident physicians and medical students during a single year of training. Participants completed a manual sleep log while concurrently wearing the Fitbit Inspire device for 14-consecutive days over three clinical rotations of varying work schedules: light, medium, and heavy clinical rotations. Study completion was achieved in 24/50 (48%) participants. Overall correlation coefficients between the sleep log and Fitbit were statistically low; however, the discrepancies were acceptable, i.e., Fitbit underestimated time in bed and total sleep time by 4.3 and 2.7 minutes, respectively. Sleep onset time and waketime were within 8 minutes, with good agreement. Treatment of sleep episodes during the day led to variance in the data. Average missingness of collected data did not vary between medical students or residents or by rotation type. When comparing the light to heavy rotations, hours slept went from 7.7 (±0.64) to 6.7 (±0.88), quality-of-life and sleep health decreased and stress, burnout, and medical errors increased. Burnout was significantly associated with worse sleep health, hours worked, and quality-of-life. Prospective data collection of sleep patterns using both sleep logs and commercial wearable devices is burdensome for physicians-in-training. Using commercial wearable devices may increase study success as long as attention is paid to daytime sleep. In future studies investigating the sleep of physicians, the timing of data collection should account for rotation type.

Objectives To explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks’ gestation in England and Wales.Design Population based cohort study.Setting England and Wales, comprising routine data for births and hospital records.Participants Babies alive at the onset of care in labour at 22 weeks+0 days to 22 weeks+6 days and at 23 weeks+0 days to 24 weeks+6 days for comparison purposes between 1 January 2018 and 31 December 2021.Main outcome measures Percentage of babies given survival focused care (active respiratory support after birth), admitted to neonatal care, and surviving to discharge in 2018-19 and 2020-21.Results For the 1001 babies alive at the onset of labour at 22 weeks' gestation, a threefold increase was noted in: survival focused care provision from 11.3% to 38.4% (risk ratio 3.41 (95% confidence interval 2.61 to 4.45)); admissions to neonatal units from 7.4% to 28.1% (3.77 (2.70 to 5.27)), and survival to discharge from neonatal care from 2.5% to 8.2% (3.29 (1.78 to 6.09)). More babies of lower birth weight and early gestational age received survival focused care in 2020-21 than 2018-19 (46% to 64% at

Background To evaluate the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of common shoulder diseases. Methods The PubMed, Medline, and Central databases and trial registries were searched from their inception to October 2020 for randomized controlled trials of autologous PRP injections for shoulder diseases versus placebo or any control intervention. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed in the selection, analysis, and reporting of findings. The primary outcome was pain intensity (visual analog scale), and secondary outcomes were changes in function and quality of life (QoL). Results A total of 17 randomized controlled trials of PRP versus control were analyzed. From 8–12 weeks to ≥1 year, PRP injections were associated with better pain relief and functional outcomes than control interventions. PRP injections were also associated with greater QoL, with an effect size of 2.61 (95% confidence interval, 2.01–14.17) at medium-term follow-up. Compared with placebo and corticosteroid injections, PRP injections provided better pain relief and functional improvement. In subgroup analyses, trials in which PRP was prepared by the double centrifugation technique, the platelet concentration in the PRP was enriched ≥5 times, leucocyte-rich PRP was used, or an activating agent was used before application reported the most effective pain relief at 6–7 months. Conclusions PRP injections could provide better pain relief and functional outcomes than other treatments for persons presenting with common shoulder diseases. PRP injections have a greater capacity to improve shoulder-related QoL than other interventions.

In low-resource settings, a point-of-care test for cervical cancer screening that can give an immediate result to guide management is urgently needed. A transvaginal digital device, “Smart Scope®” (SS), with an artificial intelligence-enabled auto-image-assessment (SS-AI) feature, was developed. In a single-arm observational study, eligible consenting women underwent a Smart Scope®-aided VIA-VILI test. Images of the cervix were captured using SS and categorized by SS-AI in four groups (green, amber, high-risk amber (HRA), red) based on risk assessment. Green and amber were classified as SS-AI negative while HRA and red were classified as SS-AI positive. The SS-AI-positive women were advised colposcopy and guided biopsy. The cervix images of SS-AI-negative cases were evaluated by an expert colposcopist (SS-M); those suspected of being positive were also recommended colposcopy and guided biopsy. Histopathology was considered a gold standard. Data on 877 SS-AI, 485 colposcopy, and 213 histopathology were available for analysis. The SS-AI showed high sensitivity (90.3%), specificity (75.3%), accuracy (84.04%), and correlation coefficient (0.670, p = 0.0) in comparison with histology at the CINI+ cutoff. In conclusion, the AI-enabled Smart Scope® test is a good alternative to the existing screening tests as it gives a real-time accurate assessment of cervical health and an opportunity for immediate triaging with visual evidence.

Despite the global decline, neonatal mortality rates (NMR) remain high in India. Family members are often responsible for the postpartum care of neonates and mothers. Yet, low health literacy and varied beliefs can lead to poor health outcomes. Postpartum education for family caregivers, may improve the adoption of evidence-based neonatal care and health outcomes. The Care Companion Program (CCP) is a hospital-based, pre-discharge health training session where nurses teach key healthy behaviors to mothers and family members, including skills and an opportunity to practice them in the hospital. We conducted a quasi-experimental study to assess the effect of the CCP sessions on mortality outcomes among families seeking care in 28 public tertiary facilities across 4 Indian states. Neonatal mortality outcomes were reported post-discharge, collected via phone surveys at four weeks postpartum, between October 2018 to February 2020. Risk ratios (RR), adjusting for hospital-level clustering, were calculated by comparing mortality rates before and after CCP implementation. A total of 46,428 families participated in the pre-intervention group and 87,305 in the post-intervention group; 76% of families completed the phone survey. Among the 33,599 newborns born before the CCP implementation, there were 1386 deaths (NMR: 41.3 deaths per 1000 live births). After the intervention began, there were 2021 deaths out of 60,078 newborns born (crude NMR: 33.6 deaths per 1000 live births, RR = 0.82, 95% CI: 0.76, 0.87; cluster-adjusted RR = 0.82, 95% CI: 0.71, 0.94). There may be a substantial benefit to family-centered education in the early postnatal period to reduce neonatal mortality.

Abstract Background Recent concerns linked with the application of chemical pesticides and the increasing necessity of low inputs sustainable agriculture have put the use of microbial biocontrol agents and bio-pesticides to the forefront for their application against plant pathogens and insect–pest management. Results This review tended to scrutinize the prospects of microbial biocontrol agents and microbes-based nano-formulations against plant diseases and for pest management with emphasis on bacteria-based nanoparticles, especially derived from Bacillus species. It also tended to discuss the probable mechanism of action and effect on plant growth along with its prospects in a brief manner. Conclusion The use of microbial biocontrol agents offers effective, eco-friendly, and long-lasting management of plant diseases. The employment of nanotechnology in the field of biopesticides has emerged as a promising solution. Nano-biopesticides in the form of biologically derived active pesticides or compounds integrated as nanoparticles and integrated into a suitable polymer have application in insect–pest management.

Objective Describe the population of babies who do and do not receive postnatal corticosteroids for prevention or treatment of bronchopulmonary dysplasia (BPD).Design Retrospective cohort study using data held in the National Neonatal Research Database.Setting National Health Service neonatal units in England and Wales.Patients Babies born less than 32 weeks gestation and admitted to neonatal units from 1 January 2012 to 31 December 2019.Main outcomes Proportion of babies given postnatal corticosteroid; type of corticosteroid; age at initiation and duration, trends over time.Secondary outcomes Survival to discharge, treatment for retinopathy of prematurity, BPD, brain injury, severe necrotising enterocolitis, gastrointestinal perforation.Results 8% (4713/62019) of babies born

In this study, the strain induced modification in Au-Ag bimetallic nanoparticles (BNPs) coated on silica rich activated sand has been investigated. The coating of BNPs on activated sand modifies the interface as well as induces microstrain in the structure of the BNPs. The detailed investigation of the interfacial interaction of BNPs with silica in activated sand is performed by using X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS) and micro-Raman spectroscopy. Phonon confinement model has been employed to find out the insights of the Raman spectrum. The effect of microstrain induced in the nanoparticles is found to be influencing the catalytic efficiency significantly. The effectiveness as well as the kinetics and thermodynamics of the BNPs coated on activated sand has been studied for the catalytic reduction of an aromatic nitro compound usually present in wastewater. Density functional theory has also thrown light on the enhanced photocatalytic activity of the BNPs supported on activated sand and provides finer details of the electronic structure. Also, the supported BNPs can be conveniently recovered and reutilized multiple times without significant reduction in the catalytic efficiency.

Nematode–microbe symbiosis plays a key role in determining pathogenesis against pests. The modulation of symbiotic bacteria may affect the virulence of entomopathogenic nematodes (EPNs) and the biological management of pests. We tested the influence of asafoetida (ASF) extract on the virulence of Steinernema carpocapsae and its symbiotic bacterium, Xenorhabdus nematophila, in Pyrrhocoris apterus. A total of 100 mg of ASF killed 30% of EPNs in 48 h, while P. apterus remained unaffected. The EPNs pre-treated with 100 mg of ASF influenced P. apterus’s mortality by 24–91.4% during a period of 24 to 72 h. The topical application of ASF acted as a deterrent to S. carpocapsae, lowering host invasion to 70% and delaying infectivity with 30% mortality for 168 h. Interestingly, Steinernema’s symbiotic bacterium, Xenorhabdus, remained unaffected by ASF. An in vitro turbidity test containing 100 mg of ASF in a medium increased the growth rate of Xenorhabdus compared to a control. A disc diffusion assay confirmed the non-susceptibility of Xenorhabdus to ASF compared to a positive control, streptomycin. Pro-phenol oxidase (PPO) and phenol oxidase (PO) upregulation showed that ASF influences immunity, while EPN/ASF showed a combined immunomodulatory effect in P. apterus. We report that ASF modulated the virulence of S. carpocapsae but not that of its symbiotic bacterium, X. nematophila, against P. apterus.

Introduction: Isolated pulmonary valve stenosis with intact ventricular septum constitutes the third most common congenital heart disease apart from Ventricular Septal Defect (VSD) and Atrial Septal Defect (ASD). Percutaneous balloon pulmonary valvuloplasty is an effective therapeutic alternative procedure of choice in severe valvular PS. Conventionally, the Mansfield balloon is being used worldwide for pulmonary valvuloplasty. Joseph Mitral Valvuloplasty (JOMIVA) balloon offers advantages of longer size, lower cost and its familiarity to use this balloon for mitral valvuloplasty in this institution since long. Aim: To assess the immediate and long term results of Joseph Mitral Valvuloplasty (JOMIVA) balloon for Pulmonary valvuloplasty in isolated severe Pulmonary Stenosis (PS). Materials and Methods: This was a long term retrospective study conducted at the Cardiology Department of SCB Medical College and Hospital, Cuttack, Odisha, India, where pulmonary valvuloplasty was performed using single JOMIVA balloon in 21 adults and adolescent patients. Clinical and Echocardiography (Echo) Doppler evaluation for restenosis and Pulmonary Regurgitation (PR) were assessed. All the cases were followed-up serially in Outpatient Department (OPD) for 12 years in retrospect manner. Results: Data of total 21 participants (15 males and six females; mean age was 18.3±6.8 years) were analysed in the study. After pulmonary valvuloplasty, the median transvalvular gradient significantly decreased from 115 mmHg (interquartile range (IQR) 101-128 mmHg) to 46 mmHg (IQR 37-51 mmHg) (p-value

Abstract Background Computerized clinical decision support (CDSS) –digital information systems designed to improve clinical decision making by providers – is a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes. Methods We have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August –October 2017 (baseline) and the data collected between December 2019 – March 2020 (latest) was analysed. The data sources included: digitized labour room registers, case sheets, referral and discharge summary forms, observation checklist and complication format. Descriptive, univariate and multivariate and interrupted time series regression analyses were conducted. Results The completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased. Conclusions Our study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care.

The complete mitochondrial genome of the near threatened mahseer fish, Neolissochilus hexastichus, was characterized for the first-time using Ion Torrent NGS platform. The total length of the mitogenome was 16,538 bp including a standard set of 22 transfer RNAs (tRNAs), 2 ribosomal RNAs (rRNAs), 13 protein-coding genes and a non-coding control region. Twenty-eight of the 37 genes are located on the light strand and, the remaining nine genes are situated on the heavy strand. Phylogenetic analysis showed the sister relationship between N. hexastichus and N. hexagonolepis. The mitogenome could be useful for phylogenetics, population genetics, and conservation of the mahseers.

Introduction: Coronary Artery Disease (CAD) is a major cause of mortality and morbidity. Among Acute Coronary Syndrome (ACS), Non ST Elevated Acute Coronary Syndrome (NSTE-ACS) continues to increase. Unlike ST Elevated Myocardial Infarction (STEMI), association of ischaemic changes in Electrocardiogram (ECG) with culprit lesion localisation in NSTE-ACS has not been well reported. Aim: To investigate the association between ECG abnormalities and angiographic localisation of culprit vessel in patients of NSTE-ACS. Materials and Methods: This observational, prospective study was conducted in SCB Medical college and Hospital, Cuttack, Odisha, India, from December 2019 to November 2020. A total of 200 eligible patients of newly diagnosed NSTE-ACS were included. Demographic and risk factor assessment, clinical examination and routine blood investigations were done. All patients had an admission Electrocardiogram (ECG), Echocardiography (Echo) and Coronary Angiography (CAG) done within 72 hours of admission. Admission ECG was associated with CAG to assess predictive value in localisation of culprit vessel. Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Likelihood Ratio (LR), pre and post-test odds of individual ECG findings were assessed. Statistical Package for the Social Sciences (SPSS) version 24.0 was used for statistical analysis. Results: Sensitivity, specificity, PPV, NPV, LR+, pretest odds and post-test odds of anterior wall, inferior wall, lateral wall and augmented Vector Right (aVR) group ECG changes in predicting Left Anterior Descending (LAD), Right Coronary Artery (RCA), Left Circumflex Artery (LCX) and Left main or Triple Vessel Disease (LM/TVD) as culprit artery were 75.9%, 90.5%, 91.7%, 73.1%, 7.96, 1.38 and 10.98; 69.1%, 91.5%, 87.8%, 76.9%, 8.14, 0.89 and 7.21; 64%, 93%, 87.3%, 77.4%, 9.10, 0.75 and 6.86 and 69.2%, 96.3%, 90%, 86.7%, 18.66, 0.48 and 8.98, respectively. Sensitivity, specificity, PPV and NPV of anterior and lateral, inferior and lateral and anterior and inferior wall ECG changes in predicting LAD and LCX, RCA and LCX and LAD and RCA as culprit vessels were 75.0%, 82.6%, 27.27% and 97.43%; 47.0%, 88.5%, 27.5% and 94.73% and 53.3%, 83.2%, 20.51% and 95.65%, respectively. The ECG was normal in 31% of which Myocardial Infarction with Non Obstructive Coronary Artery (MINOCA) (34%) and Single Vessel Disease (SVD) (30.6%) were prevalent. The MINOCA were mostly seen in normal ECG pattern. Conclusion: An ECG is a moderately sensitive but highly specific parameter in predicting LAD, LCX, RCA and LM/TVD as culprit vessels in Non ST Segment Elevation Myocardial Infarction- Acute Coronary Syndromes (NSTE-ACS). Double territory ECG changes have a poor association in predicting culprit vessel. However, a good association was noted for (anterior and lateral) wall ECG changes in predicting LAD and LCX as culprit arteries.

Introduction: Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) is a state governments’ health insurance scheme of free quality critical care for low income families. Aim: The aim of this study was to assess the patients’ awareness about the MJPJAY scheme and to study patients’ perception about the scheme through Service Quality (SERVQUAL) at tertiary care hospital. Materials and Methods: A total of 100 exit interviews of MJPJAY beneficiaries (patients) were conducted through structured questionnaire over 6 months’ study period, who availed the services of MJPJAY. Results were analyzed by descriptive statistics and displayed in the form of percentage. Service quality has been measured with “SERVQUAL” a scale to assess the perception of MJPJAY beneficiaries. Results: A total of 100, 71% males and 29% females benefitted by the scheme. The mean age of MJPJAY beneficiaries was 20 years. The SERVQUAL score of MJPJAY services provided at tertiary care hospital was found to be satisfactory at 4 rating on Likert scale for all five dimensions. Conclusion: In this study, their perception has been measured by service quality (SERVQUAL) tool, consisting a set of questions that mainly focuses on soft skills used by service provider, which allows patients to express their opinion regarding services rendered to them by the hospital.

Context: There is a need for a simple screening method for the detection of anemia that can be used by public health workers in the field. Aims: The aim of this study was to compare two methods for hemoglobin estimation, i.e., automated hematology analyzer and Digital Hemoglobinometer, and to find out the sensitivity and specificity of Digital Hemoglobinometer for the estimation of hemoglobin. Subjects and Methods: A hospital-based cross-sectional study was carried out for 6 months from April to September 2017 in a District Hospital of five High Priority Districts of Madhya Pradesh. Two hundred and sixty antenatal females per district were selected for the study. Results: The mean hemoglobin by autoanalyzer is 10.19, and that by Digital Hemoglobinometer device is 9.89. Overall, sensitivity of Digital Hemoglobinometer for hemoglobin estimation was calculated to be 89.4% and specificity was calculated to be 63.6%. Positive predictive value was found to be 82.6% and negative predictive value was 75.8% compared against AutoAnalyser (gold standard). Conclusions: As the Digital Hemoglobinometer device has high sensitivity and specificity and good diagnostic accuracy, it must be used at the community level in resource-poor setting for hemoglobin estimation. In primary health-care conditions, Digital Hemoglobinometer can significantly reduce misdiagnosis of anemia compared with clinical assessment alone.

Worldwide, many newborns die in the first month of life, with most deaths happening in low/middle-income countries (LMICs). Families’ use of evidence-based newborn care practices in the home and timely care-seeking for illness can save newborn lives. Postnatal education is an important investment to improve families’ use of evidence-based newborn care practices, yet there are gaps in the literature on postnatal education programmes that have been evaluated to date. Recent findings from a 13 000+ person survey in 3 states in India show opportunities for improvement in postnatal education for mothers and families and their use of newborn care practices in the home. Our survey data and the literature suggest the need to incorporate the following strategies into future postnatal education programming: implement structured predischarge education with postdischarge reinforcement, using a multipronged teaching approach to reach whole families with education on multiple newborn care practices. Researchers need to conduct robust evaluation on postnatal education models incorporating these programee elements in the LMIC context, as well as explore whether this type of education model can work for other health areas that are critical for families to survive and thrive.

Zinc is essential for the functioning of numerous proteins in plants. To investigate how Zn homeostasis interacts with virus infection, Zn-tolerant Noccaea ochroleucum plants exposed to deficient (Zn’0’), optimal (Zn10), and excess Zn (Zn100) concentrations, as well as Cd amendment, were infected with Turnip yellow mosaic virus (TYMV). Imaging analysis of fluorescence kinetics from the μs (OJIP) to the minutes (Kautsky effect, quenching analysis) time domain revealed strong patchiness of systemic virus-induced photosystem II (PSII) inhibition. That was more pronounced in Zn-deficient plants, while Zn excess acted synergistically with TYMV, in both cases resulting in reduced PSII reaction centers. Infected Cd-treated plants, already severely stressed, showed inhibited non-photochemical quenching and PSII activity. Quantitative in situ hybridization at the cellular level showed increased gene expression of ZNT5 and downregulation of HMA4 in infected Zn-deficient leaves. In Zn10 and Zn100 infected leaves, vacuolar sequestration of Zn increased by activation of HMA3 (mesophyll) and MTP1 (epidermis). This correlated with Zn accumulation in the mesophyll and formation of biomineralization dots in the cell wall (Zn100) visible by micro X-ray fluorescence tomography. The study reveals the importance of adequate Zn supply and distribution in the maintenance of photosynthesis under TYMV infection, achieved by tissue-targeted activation of metal transporter gene expression.

Magnetic impurities in s-wave superconductors lead to spin-polarized Yu-Shiba-Rusinov (YSR) in-gap states. Chains of magnetic impurities offer one of the most viable routes for the realization of Majorana bound states, which hold promise for topological quantum computing. However, this ambitious goal looks distant, since no quantum coherent degrees of freedom have yet been identified in these systems. To fill this gap, we propose an effective two-level system, a YSR qubit, stemming from two nearby impurities. Using a time-dependent wave-function approach, we derive an effective Hamiltonian describing the YSR-qubit evolution as a function of the distance between the impurity spins, their relative orientations, and their dynamics. We show that the YSR qubit can be controlled and read out using state-of-the-art experimental techniques for manipulation of the spins. Finally, we address the effect of spin noise on the coherence properties of the YSR qubit and show robust behavior for a wide range of experimentally relevant parameters. Looking forward, the YSR qubit could facilitate the implementation of a universal set of quantum gates in hybrid systems where they are coupled to topological Majorana qubits.

Plants consistently synthesize and accumulate medically valuable secondary metabolites which can be isolated and clinically tested under in vitro conditions. An advancement with such important phytochemical production has been recognized and utilized as herbal drugs. Bioactive andrographolide (AGL; C20H30O5) isolated from Andrographis paniculate (AP) (Kalmegh) is a diterpenoid lactones having multifunctional medicinal properties including anti-manic, anti-inflammatory, liver, and lung protective. AGL is known for its immunostimulant activity against a variety of microbial infections thereby, regulating classical and alternative macrophage activation, Ag-specific antibody production during immune disorder therapy. In vitro studies with AGL found it to be effective against multiple tumors, neuronal disorders, diabetes, pneumonia, fibrosis, and other diverse therapeutic misadventures. Generally, virus-based diseases like ZIKA, influenza A virus subtype (H1NI), Ebola (EBOV), Dengue (DENV), and coronavirus (COVID-19) epidemics have greatly increased scientific interest and demands to develop more effective and economical immunomodulating drugs with minimal side effects. Trials and in vitro pharmacological studies with AGL and medicinally beneficial herbs might contribute to benefit the human population without using chemical-based synthetic drugs. In this review, we have discussed the possible role of AGL as a promising herbal-chemo remedy during human diseases, viral infections and as an immunity booster.

We previously developed a mass spectrometry-based method, dynamic organellar maps, for the determination of protein subcellular localization and identification of translocation events in comparative experiments. The use of metabolic labeling for quantification (stable isotope labeling by amino acids in cell culture [SILAC]) renders the method best suited to cells grown in culture. Here, we have adapted the workflow to both label-free quantification (LFQ) and chemical labeling/multiplexing strategies (tandem mass tagging [TMT]). Both methods are highly effective for the generation of organellar maps and capture of protein translocations. Furthermore, application of label-free organellar mapping to acutely isolated mouse primary neurons provided subcellular localization and copy-number information for over 8,000 proteins, allowing a detailed analysis of organellar organization. Our study extends the scope of dynamic organellar maps to any cell type or tissue and also to high-throughput screening.

Galleria mellonella larvae spin protective tubes, which they use until they finish feeding, when they spin cocoons. A feeding choice experiment showed that some of the silk produced by feeding larvae was consumed in addition to the standard diet (STD). To determine the effect of feeding on silk, last instar larvae were fed for 24 h on foods based on STD but modified by replacing the dry milk component (10% of the diet) with equal amounts of different kinds of silk. While each control larva consumed 21 ± 0.5 mg of the STD and produced 4.5 ± 0.1 mg of silk, larvae that ate the food that contained larval silk consumed 10 ± 0.4 mg of food and produced 6.1 ± 0.1 mg silk; the percentage ratio of silk produced to diet consumed was 21% and 61%, respectively. A more pronounced reduction in food consumption occurred when larvae were supplied with Galleria "cocoon" silk or the sericin fraction of such silk, and only 3.8 mg/larva was ingested of the diet containing Bombyx mori cocoon silk or its sericin fraction. Silk production expressed in terms of percentage of diet consumed was always higher than that recorded for larvae fed STD. We conclude that G. mellonella larvae recycle part of the silk that they produce during feeding. Presence of silk in the diet reduces food intake but increases the ratio of silk production to diet consumption. Sericin fraction of the cocoon silk seems to deter feeding.

Presence of high amount of polysaccharide and polyphenolic compounds in barnacles restricts the isolation of high molecular weight good quality DNA. CTAB, which is a detergent used to isolate DNA from high polysaccharide containing plants, is used in this study to extract quality DNA from ship barnacle. This modified CTAB method is simple, efficient and quick enough to be carried out within 2 h. Taking DNAzol ® isolated DNA as a reference, restriction digestion and PCR was performed to prove the absence of any enzyme inhibitory substances in the isolate. Traditional phenol-chloroform and salting out method failed to even isolate the DNA from barnacle sample. The molecular weight of the modified CTAB extracted DNA was higher than that of DNAzol ® extracted DNA which makes it better candidate for analyses like whole genome sequencing.

Background: Although emergency contraceptive pills are available over the counter, the quality of consultation, including key areas of contraceptive counseling and prevention of sexually transmitted infections (STI), has not been well documented. Objective: To evaluate actual pharmacist services while dispensing emergency contraception through a mystery shopper technique. Material and Methods: This cross-sectional study was conducted in 81 pharmacies situated in Delhi by 4 trained mystery shoppers posed as customers over a period of 6 months. Results: None of the pharmacists asked about the time lapsed since last unprotected sexual intercourse or last menstrual period before deciding the eligibility of the customer. The majority were unclear about side effects associated with emergency contraception (78.57%) or with anticipated changes in menstrual flow (78.57%); 85.71% did not know whether subsequent unprotected intercourse would be protected. Only 15.71% counseled shoppers regarding risk of STI on asking leading questions and 88.5% did not provide any contraceptive advice. Conclusion: There is a huge gap in the technical knowledge and mindset of the pharmacists when it comes to checking for the eligibility of the client and providing advice regarding use of regular contraception and barrier for protection from STI, which needs to be addressed in order to realize the full benefit of making emergency contraceptive pills available over the counter.

Topological superconductivity in multiband systems has received much attention due to a variety of possible exotic superconducting order parameters as well as nontrivial bulk and surface states. While the impact of coexisting magnetic order on superconductivity, such as ferromagnetic superconductors, has been studied for many years, the implication of coexisting multipolar order has not been explored much despite the possibility of multipolar hidden order in a number of f-electron materials. In this work, we investigate topological properties of multipolar superconductors that may arise when quadrupolar local moments are coupled to conduction electrons in the multiband Luttinger semimetal. We show that the multipolar ordering of local moments leads to various multipolar superconductors with distinct topological properties. We apply these results to the quadrupolar Kondo semimetal system, PrBi, by deriving the microscopic multipolar Kondo model and examining the possible superconducting order parameters.

Chronic lymphocytic leukemia is a disease with up-regulated expression of the transmembrane tyrosine-protein kinase ROR1, a member of the Wnt/planar cell polarity pathway. In this study, we identified COBLL1 as a novel interaction partner of ROR1. COBLL1 shows clear bimodal expression with high levels in chronic lymphocytic leukemia patients with mutated IGHV and approximately 30% of chronic lymphocytic leukemia patients with unmutated IGHV. In the remaining 70% of chronic lymphocytic leukemia patients with unmutated IGHV, COBLL1 expression is low. Importantly, chronic lymphocytic leukemia patients with unmutated IGHV and high COBLL1 have an unfavorable disease course with short overall survival and time to second treatment. COBLL1 serves as an independent molecular marker for overall survival in chronic lymphocytic leukemia patients with unmutated IGHV. In addition, chronic lymphocytic leukemia patients with unmutated IGHV and high COBLL1 show impaired motility and chemotaxis towards CCL19 and CXCL12 as well as enhanced B-cell receptor signaling pathway activation demonstrated by increased PLCγ2 and SYK phosphorylation after IgM stimulation. COBLL1 expression also changes during B-cell maturation in non-malignant secondary lymphoid tissue with a higher expression in germinal center B cells than naïve and memory B cells. Our data thus suggest COBLL1 involvement not only in chronic lymphocytic leukemia but also in B-cell development. In summary, we show that expression of COBLL1, encoding novel ROR1-binding partner, defines chronic lymphocytic leukemia subgroups with a distinct response to microenvironmental stimuli, and independently predicts survival of chronic lymphocytic leukemia with unmutated IGHV.

Introduction: Pregnancy and postpartum confers four to five fold increased risk for complications and mortality if affected by Swine flu. Swine flu in pregnancy contributes to almost 18- 25% of total ICU admissions and high perinatal morbidity and mortality. Aim: The present study was an analysis of the pattern of critical illness and mortality due to Swine flu virus in pregnant and postpartum women. Materials and Methods: It was a retrospective study of all clinically suspected, probable as well as confirmed cases of Swine flu, in pregnancy and postpartum period up to two weeks; who were admitted to Swine flu Intensive Care Unit (ICU) from February 2009 to December 2015. We analyzed the presenting complaints, condition on admission, criteria for admission in ICU, abnormalities in laboratory reports, course of illness and perinatal outcome. Results: In the span of seven years 30 pregnant and 10 postpartum women were admitted in Swine flu ICU. Mortality was 40% (16 out of 40) in pregnant and postpartum women. There were 17 (42.5%) cases which were positive for H1N1 confirmed by Real time-PCR (RT-PCR) and culture. Mean interval of onset of symptoms to start of oseltamivir was four and a half days. Perinatal outcome was poor and only 18% babies were alive after one week of birth. Conclusion: We emphasize that high index of suspicion, early diagnosis, early antiviral therapy and immunization to pregnant women are the key factors which can reduce the complications, ICU admissions and mortality in this group.

P1B-ATPases are decisive for metal accumulation phenotypes, but mechanisms of their regulation are only partially understood. Here, we studied the Cd/Zn transporting ATPases NcHMA3 and NcHMA4 from Noccaea caerulescens as well as AhHMA3 and AhHMA4 from Arabidopsis halleri. Protein biochemistry was analyzed on HMA4 purified from roots of N. caerulescens in active state. Metal titration of NcHMA4 protein with an electrochromic dye as charge indicator suggested that HMA4 reaches maximal ATPase activity when all internal high-affinity Cd2+ binding sites are occupied. Although HMA4 was reported to be mainly responsible for xylem loading of heavy metals for root to shoot transport, the current study revealed high expression of NcHMA4 in shoots as well. Further, there were additional 20 and 40 kD fragments at replete Zn2+ and toxic Cd2+, but not at deficient Zn2+ concentrations. Altogether, the protein level expression analysis suggested a more multifunctional role of NcHMA4 than previously assumed. Organ-level transcription analysis through quantitative PCR of mRNA in N. caerulescens and A. halleri confirmed the strong shoot expression of both NcHMA4 and AhHMA4. Further, in shoots NcHMA4 was more abundant in 10 μM Zn2+ and AhHMA4 in Zn2+ deficiency. In roots, NcHMA4 was up-regulated in response to deficient Zn2+ when compared to replete Zn2+ and toxic Cd2+ treatment. In both species, HMA3 was much more expressed in shoots than in roots, and HMA3 transcript levels remained rather constant regardless of Zn2+ supply, but were up-regulated by 10 μM Cd2+. Analysis of cellular expression by quantitative mRNA in situ hybridisation showed that in A. halleri, both HMA3 and HMA4 mRNA levels were highest in the mesophyll, while in N. caerulescens they were highest in the bundle sheath of the vein. This is likely related to the different final storage sites for hyperaccumulated metals in both species: epidermis in N. caerulescens, mesophyll in A. halleri.

Objective : To determine the proportion of polycystic ovarian syndrome (PCOS) patients who have normal body mass index (BMI) and to compare the clinical, hormonal, and metabolic profile between lean and overweight patients of PCOS. Materials and Methods: One hundred consecutive infertile women with PCOS were studied and divided into lean (BMI between 18.5 and 23) and overweight (BMI ≥ 23). Metabolic and hormonal profile (serum FSH, LH, testosterone, prolactin, TSH on days 2-3 of menstrual cycle; serum progesterone premenstrually; serum insulin-fasting and 2 hours postglucose, glucose tolerance test, and fasting serum lipid profile) was performed along with pelvic sonogropahy; and clinical features, viz. waist hip ratio, hirsutism, acne, acanthosis nigricans, and clitoromegaly were recorded. Results: 42% of the PCOS subjects had normal BMI. Average age, hirsutism (80.9% vs. 89.7%), irregular cycles (92.8% vs. 96.6%), acne (9.5% vs. 15.5%), clitoromegaly (2.3% vs. 3.4%), endometrial thickness >4 mm (9.5% vs. 15.5%), and hormonal profile were similar in the lean and overweight PCOS groups. Family history of diabetes (9.5% vs. 24.1%), abnormal glucose tolerance test (GTT) (4.7% vs. 10.3%), deranged lipid profile (14.2% vs. 31%), and 2-hour postprandial insulin levels were higher in the overweight PCOS (P < 0.05). Insulin resistance was observed in 83.3% of lean PCOS but was still lower than 93.1% seen in overweight PCOS (P < 0.05). Conclusion: 42% of the PCOS had normal BMI, but clinical and hormonal profile was similar to PCOS patients with elevated BMI (overweight/obese). However, insulin resistance is observed in 83.3% of lean PCOS. Family history of diabetes, impaired GTT, deranged lipid profile, and insulin resistance were more prevalent in overweight PCOS.

Surrogacy refers to a contract in which a woman carries a pregnancy "for"another couple. Number of infertile couples from all over the World approach India where commercial surrogacy is legal. Although this arrangement appears to be beneficial for all parties concerned,there are certain delicate issues which need to be addressed through carefully framed laws in order to protect the rights of the surrogate mother and the intended parents.

Aruna Nigam, Ratna Biswas, Archana MishraDepartment of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, IndiaAbstract: Intrauterine contraceptive device (IUCD) migration subsequent to uterine wall perforation is an uncommon but serious complication. Three cases of misplaced IUCD at three different sites, ie, posterior fornix, rectal wall, and mesoappendix, are reported. An IUCD thread coming through the posterior fornix is reported in the literature for the first time.Keywords: intrauterine device, contraception, migration, laparoscopy

In most terrestrial ecosystems, nitrogen (N) is the most limiting nutrient for plant growth. Honey bees may help alleviate this limitation because their feces (frass) have high concentration of organic nitrogen that may decompose in soil and provide inorganic N to plants. However, information on soil N processes associated with bee frass is not available. The objectives of this work were to 1) estimate the amount of bee frass produced by a honey bee colony and 2) evaluate nitrogen mineralization and ammonia volatilization from bee frass when surface applied or incorporated into soil. Two cage studies were conducted to estimate the amount of frass produced by a 5000-bee colony, and three laboratory studies were carried out in which bee frass, surface-applied or incorporated into soil, was incubated at 25(o)C for 15 to 45 days. The average rate of bee frass production by a 5,000-bee colony was estimated at 2.27 to 2.69 g N month(-1). Nitrogen mineralization from bee frass during 30 days released 20% of the organic N when bee frass was surface applied and 34% when frass was incorporated into the soil. Volatilized NH3 corresponded to 1% or less of total N. The potential amount of inorganic N released to the soil by a typical colony of 20,000 bees foraging in an area similar to that of the experimental cages (3.24 m(2)) was estimated at 0.62 to 0.74 g N m(-2) month(-1) which may be significant at a community scale in terms of soil microbial activity and plant growth. Thus, the deposition of available N by foraging bees could have adaptive benefits for the plants they visit, a collateral benefit deriving from the primary activity of pollination.

In India, freshwater ecosystems are most threatened by the man made reservoirs, loss of seasonally flooded forests, polluted wetlands and deforestation of surrounding watersheds. Specific actions are needed for conservation of the water valuable insects through detailed scientific studies. A study has been carried out in the Sapna Dam of Betul District, Madhya Pradesh. Field surveys have been carried out to prepare geographical coordinates. Water depth, water quality and biotic characteristics at different locations were measured with the help of limnological equipments. Results of these studies are presented in this paper.