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This study examines the application of Laser Directed Energy Deposition (L-DED) to reduce the use of bronze in the manufacturing of worm gears. Addressing the gap in research regarding the L-DED of bronze on steel substrates, the study refines process parameters to improve deposition quality significantly. The approach involves depositing single bronze tracks using various combinations of process parameters, followed by the analysis of cross-sections to evaluate porosity and track cross-section geometry. Building on the optimized parameters identified during single-track experiments, we achieve multi-layer depositions of 3 mm thickness. These layers are then transformed into cylindrical specimens that are subjected to rigorous wear testing in a pin-on-disc setup against a 42CrMo4V counterpart under dry sliding conditions, aimed at investigating debonding and friction characteristics. Additionally, disc-shaped specimens created with the optimized parameters are evaluated under lubricated conditions via a disc-on-disc test, accurately replicating motor gear loading scenarios. Comprehensive assessments of porosity, microstructure, and microhardness are conducted on these specimens. Finally, our findings reveal the potential of DED bronze as a groundbreaking alternative to traditional wrought bronze in gear applications, highlighting its promise for reducing bronze usage in worm gears with an enhanced wear performance.

Integrons are the special group of mobile genetic elements which can acquire, shuffle and spread antimicrobial resistance genes. They mediate drug resistance among Enterobacteriaceae and Non-fermenters. The present study investigation was undertaken to envisage the presence of Class I integrase gene among multidrug resistant Gram-negative bacteria. In this prospective study, 60 bacterial isolates from various clinical specimens were subjected to routine identification and susceptibility testing by conventional methods. Later the isolates were subjected for detection of intI1 gene by conventional PCR. The overall prevalence of intI1 gene among the clinical isolates was 60% (36/60) in our study. Class I integrase gene distribution among multidrug resistant bacteria was 80% (24/30) in comparison to non-multidrug resistant bacteria 43.34% (13/30). Antibiotics that were linked to Class I Integrons and shown to be statistically significant (p = 0.05) included ampicillin, aztreonam, ciprofloxacin, cefazolin, cefepime and tobramycin all showed high levels of resistance. Prevalence of intI1 gene was high among Enterobacteriaceae than Non-fermenters. There is a significant association between intI1 gene and multidrug resistance among these pathogens. Klebsiella species are highly multidrug resistant in comparison to other isolates and all of them harboured intI1 gene. Integrons can be a platform for the discovery of certain new metabolic pathways which can bring revolution in the field of antibiotic drug resistance. The information on the Integrons will aid us in prompt utilization of antimicrobial agents for the treatment.

Bacterial biofilms, structured communities of microorganisms enmeshed in an extracellular matrix, have emerged as significant players in various pathological processes. Renal calculi, commonly known as kidney stones, pose a prevalent medical concern, and recent research has highlighted the potential influence of bacterial biofilms in their formation and persistence. This review explores the development of biofilms on the surface of urinary tract stones and how they create a favorable environment for the colonization of bacteria. This colonization, in turn, can lead to chronic infections, stone enlargement, and recurrent stone formation. This review offers a comprehensive exploration of the dynamic interplay between bacterial biofilms and renal calculi. It emphasizes the role of biofilm-related mechanisms in chronic infections, inflammation, and mineral deposition, underscoring the potential for innovative therapeutic strategies aimed at managing and preventing biofilm-associated renal calculi.

Background: Microalbuminuria (MAB) in chronic obstructive pulmonary disease (COPD) reflects generalised endothelial dysfunction as well as systemic inflammation. It is considered a vital marker of early cardiovascular involvement and other systemic involvement in COPD. MAB can serve as a surrogate marker to predict the severity of the disease and other systemic co-morbidities amongst COPD patients. This study was carried out to study the association between MAB with COPD severity and to compare the presence of MAB in COPD patients with and without co-morbidities. Methods: The study included 106 COPD patients diagnosed as per the Global Initiative for Obstructive Lung Disease (GOLD) criteria. Severity was assessed with the help of GOLD staging and modified Medical Research Council Dyspnoea Scale. MAB was assessed by urine albumin–creatinine ratio (UACR) of the spot urinary sample. The presence of comorbidities assessed by history, physical examination, laboratory investigations. Results: MAB was evident in n/N (70.8%) patients. MAB was found in 80.6%, 79.1%, 38.1% and 0% of the patients with GOLD Stage 4, Stage 3, Stage 2 and Stage 1 COPD patients, respectively (P = 0.0001). The mean UACR was significantly higher in severe stages of COPD. A significant association of MAB with co-morbidities such as hypertension, ishaemic heart disease, dyslipidaemia and diabetes mellitus (P < 0.05) was evident. Conclusions: MAB could be a promising biomarker to identify COPD patients with severe disease and who are at risk of developing cardiovascular and other systemic co-morbidities.

Background/Aims Cold snare polypectomy (CSP) is routinely performed for small colorectal polyps (≤10 mm). However, challenges include insufficient resection depth and immediate bleeding, hindering precise pathological evaluation. We aimed to compare the outcomes of cold endoscopic mucosal resection (CEMR) with that of CSP for colorectal polyps ≤10 mm, using data from randomized controlled trials (RCTs). Methods Multiple databases were searched in December 2023 for RCTs reporting outcomes of CSP versus CEMR for colorectal polyps ≤10 mm in size. Our primary outcomes were rates of complete and en-bloc resections, while our secondary outcomes were total resection time (seconds) and adverse events, including immediate bleeding, delayed bleeding, and perforation. Results The complete resection rates did not significantly differ (CSP, 91.8% vs. CEMR 94.6%), nor did the rates of en-bloc resection (CSP, 98.9% vs. CEMR, 98.3%) or incomplete resection (CSP, 6.7% vs. CEMR, 4.8%). Adverse event rates were similarly insignificant in variance. However, CEMR had a notably longer mean resection time (133.51 vs. 91.30 seconds). Conclusions Our meta-analysis of seven RCTs showed that while both CSP and CEMR are equally safe and effective for resecting small (≤10 mm) colorectal polyps, the latter is associated with a longer resection time.

Abstract Dinanath grass (Pennisetum pedicellatum Trin.) is an extensively grown forage grass known for its significant drought resilience. In order to comprehensively grasp the adaptive mechanism of Dinanath grass in response to water deficient conditions, transcriptomic and metabolomics were applied in the leaves of Dinanath grass exposed to two distinct drought intensities (48-hour and 96-hour). Transcriptomic analysis of Dinanath grass leaves revealed that a total of 218 and 704 genes were differentially expressed under 48- and 96-hour drought conditions, respectively. The genes that were expressed differently (DEGs) and the metabolites that accumulated in response to 48-hour drought stress mainly showed enrichment in the biosynthesis of secondary metabolites, particularly phenolics and flavonoids. Conversely, under 96-hour drought conditions, the enriched pathways predominantly involved lipid metabolism, specifically sterol lipids. In particular, phenylpropanoid pathway and brassinosteroid signaling played a crucial role in drought response to 48- and 96-hour water deficit conditions, respectively. This variation in drought response indicates that the adaptation mechanism in Dinanath grass is highly dependent on the intensity of drought stress. In addition, different genes associated with phenylpropanoid and fatty acid biosynthesis, as well as signal transduction pathways namely phenylalanine ammonia-lyase, putrescine hydroxycinnamoyl transferase, abscisic acid 8’-hydroxylase 2, syntaxin-61, lipoxygenase 5, calcium-dependent protein kinase and phospholipase D alpha one, positively regulated with drought tolerance. Combined transcriptomic and metabolomic analyses highlights the outstanding involvement of regulatory pathways related to secondary cell wall thickening and lignin biosynthesis in imparting drought tolerance to Dinanath grass leaves. These findings collectively contribute to an enhanced understanding of candidate genes and key metabolites relevant to drought response in Dinanath grass. Furthermore, they establish a groundwork for the creation of a transcriptome database aimed at developing abiotic stress-tolerant grasses and major crop varieties through both transgenic and genome editing approaches.

Abstract Micropollutants, such as heavy metals and pesticides, inhibit microbial growth, threatening ecosystems. Yet, the mechanism behind mycoremediation of the pesticide lindane and multiple metals (Cd, Total Cr, Cu, Ni, Pb, Zn) remains poorly understood. In our study, we investigated cellular responses in Aspergillus fumigatus PD-18 using LC-MS/MS, identifying 2190 proteins, 1147 of which were consistently present under both stress conditions. Specifically, Cu-Zn superoxide dismutase and heat shock proteins were up-regulated to counter oxidative stress and protein misfolding. Proteins involved in intracellular trafficking, secretion, and vesicular transport; RNA processing and modification showed enhanced abundance and regulating stress response pathways. Additionally, haloalkane dehalogenase and homogentisate 1,2-dioxygenase played pivotal roles in lindane mineralization. Bioinformatics analysis highlighted enriched pathways such as Glyoxylate and dicarboxylate metabolism and Purine metabolism, that are crucial for combating adverse environments. We identified the hub protein 26 S proteasome regulatory subunit complex as potential biomarker and remedial targets for mycoremediation of wastewater, suggesting practical applications for environmental remediation.

Abstract Background Enteric infections are hypothesized to be associated with intussusception in children. A small increase in intussusception following rotavirus vaccination has been seen in some settings. We conducted post-marketing surveillance for intussusception following rotavirus vaccine, Rotavac introduction in India and evaluated association of intussusception with enteric pathogens. Methods In a case-control study nested within a large sentinel hospital-based surveillance program in India, stool samples from 272 children aged less than 2 years admitted for intussusception and 272 age-, gender- and location-matched controls were evaluated with Taqman array card based molecular assays to detect enteric viruses, bacterial enteropathogens and parasites. Matched case-control analysis with conditional logistic regression evaluated association of enteropathogens with intussusception. Population attributable fractions (PAF) were calculated for enteropathogens significantly associated with intussusception. Results The most prevalent enteropathogens in cases and controls were enteroaggregative Escherichia coli, adenovirus 40/41, adenovirus C serotypes and enteroviruses. Children with intussusception were more likely to harbor adenovirus C serotypes (adjusted odds-ratio (aOR) = 1.74; 95% confidence interval (CI) 1.06–2.87) and enteroviruses (aOR = 1.77; 95% CI 1.05–2.97) than controls. Rotavirus was not associated with increased intussusception risk. Adenovirus C (PAF = 16.9%; 95% CI 4.7% − 27.6%) and enteroviruses (PAF = 14.7%; 95% CI 4.2% − 24.1%) had the highest population attributable fraction for intussusception. Conclusion Adenovirus C serotypes and enteroviruses were significantly associated with intussusception in Indian children. Rotavirus was not associated with risk of intussusception.

Background. This case report aims to present an occurrence of Rhabdomyolysis following locally brewed alcohol consumption. We describe the clinical features, diagnostic evaluation, treatment, and outcomes of a patient diagnosed with rhabdomyolysis and secondary to locally made alcohol consumption. Case report. The patient, a 31-year-old male, known alcoholic since 13 years, presented with sudden-onset bilateral lower limb weakness for 4 days, h/o inability to walk, h/o leg pain for 4 days, non-progressive, no aggravating and relieving factors following alcohol consumption. Investigations revealed critically high levels of CPK, deranged renal parameters and liver parameters. Prompt intervention and mechanical hemodialysis were initiated along with administration of supportive care. The patient demonstrated gradual improvement of symptoms and renal parameters. Conclusions. This case highlights the importance of recognizing the potential muscle injury with acute kidney and liver injury following locally brewed alcohol consumption. In many villages in India locally brewed alcohol is still being consumed. Early diagnosis and prompt management are crucial for good prognostic outcome.

Background. Paraneoplastic neurological syndromes (PNS) are a rare and diverse group of disorders caused by immune-mediated effects of malignancies. Affecting less than 1% of all cancer patients, these syndromes often present diagnostic and therapeutic challenges. Motor Neuron Disease as a paraneoplastic condition is particularly uncommon, especially in association with gastrointestinal malignancies like sigmoid colon adenocarcinoma. Case report. A 62-year-old male with Type 2 Diabetes Mellitus (T2DM) presented with chronic diarrhea and a three-year history of progressive bilateral limb weakness. Initial symptoms were attributed to diabetic neuropathy, but the rapid progression and severity warranted further investigation. Neurological examination revealed hypotonia, muscle wasting, and absent reflexes in all four limbs. Diagnostic tests, including electromyography (EMG) and nerve conduction studies, confirmed motor sensory axonal neuropathy. Colonoscopy revealed a mass in the sigmoid colon, and biopsy confirmed adenocarcinoma. The patient was managed with surgical resection of the tumor, adjuvant chemotherapy, and immunomodulatory treatments, resulting in stabilization of neurological symptoms. Conclusions. This case highlights the importance of considering paraneoplastic syndromes in patients with unexplained neurological symptoms, particularly when a malignancy is suspected or known. Early recognition and a multidisciplinary approach are crucial for improving patient outcomes. Further research is needed to understand the pathophysiological mechanisms and develop sensitive biomarkers for early detection.

Background and objectives. Stroke, a leading cause of morbidity and mortality worldwide, encompasses ischemic and hemorrhagic subtypes with distinct pathophysiological mechanisms. Understanding the demographic, clinical, and coagulation profile differences between these subtypes is crucial for optimizing management strategies and improving patient outcomes. Material and methods. This observational study was conducted at Saveetha Medical College, Chennai, involving 60 patients presenting with symptoms of acute stroke. Patients were categorized into ischemic or hemorrhagic stroke groups based on brain imaging confirmation. Demographic, clinical, and coagulation profile data were collected and analyzed using descriptive statistics and comparative analyses. Results. Hemorrhagic stroke patients were younger (mean age: 58.79 years) compared to ischemic stroke patients (mean age: 68.12 years) and exhibited higher stroke severity scores (NIH Stroke Scale mean: 12.22 vs. 8.87). Hypertension and diabetes mellitus were more prevalent among hemorrhagic stroke patients, while atrial fibrillation was more prevalent among ischemic stroke patients. Coagulation profiles differed significantly between groups, with hemorrhagic stroke patients demonstrating prolonged clotting times, elevated INR values, and lower platelet counts compared to ischemic stroke patients. Conclusion. This study provides comprehensive insights into demographic, clinical, and coagulation profile variations between hemorrhagic and ischemic stroke patients. By elucidating these distinctions, clinicians can refine management approaches and researchers can identify targeted therapeutic strategies, ultimately advancing stroke care and patient outcomes.

Background and Objective: Often, the treatment goals for chronic periodontitis in smokers are not achieved only by scaling and root planing (SRP) as non-surgical periodontal therapy. Adjunctive therapy such as local drug delivery (LDD) can be carried out in an attempt to reduce the need for periodontal surgery. The study was carried out to determine the efficacy of subgingivally delivered ketoprofen (K) + doxycycline (D) gel and compare it with that of subgingivally delivered ketoprofen (K) gel alone as an adjunct to SRP in smokers and non-smoker patients having chronic periodontitis. Materials and Methods: Twelve patients in the non-smoker group and nine patients in the smoker group having chronic periodontitis with ≥4-mm pocket depth in at least three adjacent teeth in each quadrant were recruited for the study. The quadrants were randomized into K alone and K + D subgroups. 2.5% ketoprofen gel and 2.5% ketoprofen + 3% doxycycline gel were delivered into designated sites after SRP, and the sites were secured using periodontal dressing. Plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and relative attachment level (RAL) were recorded at baseline and 3 months. Results: At 3 months follow-up, both the groups showed significant improvement in PI, BOP, PPD, and RAL (P < 0.05). K + D showed a significantly greater reduction of PI, BOP, PPD, and RAL in both smokers and non-smokers than K alone (P < 0.05). Non-smokers responded significantly better than smokers for PI, BOP, PPD, and RAL with both treatment modalities (P < 0.05). Conclusion: The results indicate that smokers and non-smokers demonstrate better clinical outcomes by using K + D LDD as an adjunct to SRP. Moreover, non-smokers responded better to both modalities than smokers.

Abstract Multivesicular bodies (MVBs) are vesicles of endosomal origin containing intraluminal vesicles, which upon fusion with plasma membrane, secrete exosomes. They play a significant role in the physiology and pathology of type‐2 diabetes (T2D) due to disrupted intercellular communication. The role of MVBs and their influence on insulin secretory granules (ISGs) of β‐cells or their characterization is yet to be uncovered. In our study, we compared MVBs to largely well‐characterized ISGs in β‐cells. This study compares the density, localization, and exocytosis of CD63+ compartments (CD63+c) with NPY labelled ISGs (NISGs) in β‐cells. For this, tetraspanin CD63 was exploited to majorly label MVBs in β‐cells. These labels preserve the structural integrity of labelled compartments and mostly do not localize with other endo‐lysosomal compartments. This study showed that the β‐cells have a significantly higher density of NISGs than CD63+c. CD63+c and NISGs are spatially localized apart within β‐cells. The proteins that localize with CD63+c are different from the ones that localize with NISGs. Exocytosis of NISGs occurs at the periphery of the β‐cells and takes significantly less time when compared to the release of CD63+c, which is non‐peripheral and takes a longer duration. Mechanistically, the availability of CD63+c for exocytosis was assessed and found that an equilibrium is maintained between docking and undocking states at the plasma membrane. Although there are a high number of short‐term residing, visiting CD63+c at the plasma membrane, the availability of CD63+c for exocytosis is maintained due to docking and undocking states. Further, a significant reduction in the density of NISGs and CD63+c was observed in β‐cells isolated from T2D donors compared to healthy counterparts. Studying the effect of MVBs on insulin secretion in physiological and T2D conditions has huge potential. This study provides a strong basis to open new avenues for such future studies.

Microplastics (MPs), defined as plastic particles smaller than 5 mm, are increasingly recognized as environmental contaminants with potential health risks. These emerge as breakdown products of larger plastics and are omnipresent in marine, freshwater, and terrestrial ecosystems. They are primarily composed of polymers such as polyethylene, polypropylene, polystyrene, and additives that enhance their performance. MPs also adsorb harmful environmental chemicals like persistent organic pollutants and heavy metals, posing risks to human and environmental health. Human exposure to MPs occurs mainly through ingestion and inhalation, with MPs detected in food products, water, and even the air. MPs have been shown to accumulate in the gastrointestinal tract, disrupting the gut microbiome, and causing dysbiosis-a harmful imbalance between beneficial and harmful bacteria. This disruption has been linked to various health issues, including gastrointestinal disorders, systemic inflammation, and chronic diseases. Furthermore, the gut-brain axis may be affected, with potential neuroinflammatory consequences. As research continues to unravel the health impacts of MP exposure, understanding the mechanisms of accumulation and the broader implications on human health is crucial. This review highlights the effects of MPs on human health, emphasizing their impact on the gut microbiome. We discuss the potential connections between MP exposure and cardiometabolic and inflammatory diseases, and disorders related to the Gut-Brain Axis. By synthesizing the latest research, this work sheds light on the silent yet pervasive threat posed by MPs and underscores the importance of further studies to understand their health impacts fully.

Chest wall tuberculosis (TB) is often associated with primary pulmonary TB. Primary chest wall TB without any pulmonary involvement is a rare form of musculoskeletal TB and is relatively difficult to diagnose due to nonspecific symptoms. Without significant clinical indications, accepting the possibility of a tubercular origin in chest wall tuberculosis can be challenging, which can mimic a pyogenic abscess or tumor. To rule out potential mycobacterial causes, all abscesses in tuberculosis-endemic areas like India that are resistant to standard therapy must be investigated. Herein, we present a case of primary tuberculosis of the chest wall, which was treated successfully.

Abstract Lymphatic filariasis (LF) is a crippling and disfiguring parasitic condition. India accounts for 55% of the world’s LF burden. The filarial parasite Wuchereria bancrofti is known to cause 99.4% of the cases while, Brugia malayi accounts for 0.6% of the issue occurring mainly in some pockets of Odisha and Kerala states. The Balasore (Baleswar) district of Odisha has been a known focus of B. malayi transmission. We employed molecular xenomonitoring to detect filarial parasite DNA in vectors. In six selected villages, Gravid traps were used to collect Culex mosquitoes and hand catch method using aspirators was followed for collection of mansonioides. A total of 2903 mosquitoes comprising of Cx. quinquefasciatus (n = 2611; 89.94%), Cx. tritaeniorhynchus (n = 100; 3.44%), Mansonia annuliferea (n = 139; 4.78%) and Mansonia uniformis (n = 53; 1.82%) were collected from six endemic villages. The species wise mosquitoes were made into 118 pools, each with a maximum of 25 mosquitoes, dried and transported to the laboratory at VCRC, Puducherry. The mosquito pools were subjected to parasite DNA extraction, followed by Real-time PCR using LDR and HhaI probes to detect W. bancrofti and B. malayi infections, respectively. Seven pools (6.66%) of Cx. quinquefasciatus, showed infection with only W. bancrofti while none of the pools of other mosquito species showed infection with either W. bancrofti or B. malayi. Although the study area is endemic to B. malayi, none of the vectors of B. malayi was found with parasite infection. This study highlights the ongoing transmission of bancroftian filariasis in the study villages of Balasore district of Odisha and its implications for evaluating LF elimination programme.

As one of the most common diseases in ophthalmology today, dry eye disease (DED) poses a great challenge for public health systems globally. This is a multifactorial condition involving the production/evaporation of tears and consequential damage to the ocular surface. Symptoms of DED like discomfort and visual disturbance alter a person’s quality of life and pose a significant economic burden to healthcare systems. Today’s lifestyle favors DED development, especially long-term exposure to screens, poor sleep quality, and a diet abundant in saturated fats and omega-6 fatty acids, and we can expect that its prevalence will extend far beyond the currently estimated 10%. The underlying inflammation and symptoms of DED, are treated with various anti-inflammatory agents and autologous and/or allogeneic serum drops. Considering the role of lifestyle in DED pathophysiology, lifestyle modifications, including diet, sleep, and physical activity are getting more attention. Among them, supplementation with omega-3 fatty acids shows the most promising results in alleviating subjective and objective measures of DED through a direct effect on the stability and production of the tear film, inflammation markers, and corneal nerve regeneration. We aimed to provide insights into currently available research findings supporting omega-3 fatty acids as a valuable adjuvant therapy in treating DED.

Abstract We investigate tensionless (or null) bosonic string theory with a Kalb-Ramond background turned on. In analogy with the tensile case, we find that the Kalb-Ramond field has a non-trivial effect on the spectrum only when the theory is compactified on an (S 1)⊗d background with d ≥ 2. We discuss the effect of this background field on the tensionless spectrum constructed on three known consistent null string vacua. We elucidate further on the intriguing fate of duality symmetries in these classes of string theories when the background field is turned on.

Background: Recently researches in the field of dental implantology have increased, in spite of that very limited knowledge is available to the patients about dental implants as an option for replacement of missing teeth. Goal of replacement of missing teeth is not only functional rehabilitation but overall improvement in quality of life of the patient. Aim: To assess the awareness of dental implants and to compare oral health related quality of life (OHRQoL) in patients treated with implant supported fixed prosthesis (ISPs) and teeth supported fixed prosthesis (FPDs). Methods: & Material: General implant awareness questionnaire was used to assess the awareness of dental implants in 500 participants. Oral health impact profile (OHIP) questionnaire was used to compare OHRQoL between 300 patients treated with ISPs and 300 patients treated with FPDs. Statistical analysis: Sample size was taken to estimate difference between groups at 30 % & 80% power and 5% risk. IBM SPSS 20 (SPSS Inc., Chicago, IL) was used for statistical analysis. Chi square test and independent t- test was used to find statistical difference between variables. Results: 27.2% participants were aware about dental implants. 74.4% participants agreed that missing teeth should be replaced with prosthetic options. Dentists were primary source of knowledge (66%) of dental implants for patients. Parameters like functional limitations, psychological discomfort and pain during mastication were significantly (p

Abstract Transesophageal echocardiography (TEE) has been the preferred imaging modality to help guide left atrial appendage closure. Newer technologies such as the Nuvision 4D Intracardiac echocardiography (ICE) catheter allow for real-time 3D imaging of cardiac anatomy. There are no direct comparison studies for procedural imaging between TEE and 4D ICE. To evaluate the performance and safety of left atrial appendage (LAA) closure procedures with the Watchman FLX and Amulet, guided by the Nuvision 4D ICE Catheter. This retrospective observational analysis was conducted on institutional LAAO National Cardiovascular Data Registry from January 2022 to March 2023. Patients had undergone LAA closure procedures with the Watchman FLX or Amulet device guided by TEE or a 4D ICE Catheter. The primary outcome evaluated was successful LAAO device placement. A total of 121 patients underwent LAAO device placement with 46 (38.0%) patients guided by 4D ICE during LAAO implantation. The 4D ICE group had a shorter procedural time compared with TEE guidance. Post procedural 45-day TEE post implant was also comparable for both groups with no patients in either group having incomplete closure of the left atrial appendage and peri-device leak > 5 mm. No device related complications (device related access, stroke, or pericardial effusion) occurred in either group at follow-up. There was no significant difference in device implant success or post procedural outcomes at 45 days in either the TEE or 4D ICE group. However, there was a noticeable improvement in procedural time with the 4D ICE catheter.

The teaching profession in higher education demands strong research skills, and with rapid technological advancements, university teaching professionals must familiarize themselves with digital research skills. Thus, university teachers and PhD research scholars across the globe are eager to develop their digital research skills to enhance their work efficiency. Acquiring digital research skills on the job or during the PhD program has proven to be challenging. These skills assist higher education professionals in various ways, such as supervising doctoral students, conducting research, working on research projects, and publishing research articles. Thus, the present study attempted to provide ICT-integrated modular training (MT) to facilitate the higher education teaching faculty and PhD scholars with digital research skills. The study employed a repeated cross-sectional research design and measured the effectiveness of the MT through a single group pre and post-test design. Researchers conducted three modular training sessions annually on digital research skills over five consecutive years. In total, 300 scholars attended the training and participated in the pre-test, post-test, and satisfaction survey. Findings from paired sample t-tests (t-value varied between 4.117 to 7.525, p < 0.05) revealed that modular training has been significantly effective with a large effect size (d > 0.8). Furthermore, the satisfaction survey revealed a high degree of satisfaction among participants. Future research may explore ways to strengthen the technological and pedagogical content knowledge of modular training programs in developing digital research skills.

IntroductionRecent immigrants from racialized minority backgrounds and those who are not proficient in the local language are some of the most vulnerable members of society. Despite having postsecondary educational qualifications and permanent residency status, many are engaged in precarious employment. There is a scarcity of research that has explicitly focused on the work experiences and mental health challenges faced by these immigrants.MethodsUsing a grounded theory approach and semi-structured face-to-face interviews, this study examined the work experiences and mental health challenges of 42 recent immigrant employees from two cities in Canada who were working in various industries and engaged in precarious employment.FindingsEighty-one percent of the employee participants were overqualified for their jobs. Findings highlighted several ongoing mental problems that participants experienced, stemming from challenging physical and psychological workplace conditions, negative mindsets associated with their recent immigrant status, and other contextual factors and barriers. However, various coping strategies, both constructive and unconstructive, were used to address this mental distress.DiscussionThe study proposes a multidimensional approach to address workplace conditions to promote good mental health for these employees. This includes preventative programs for raising awareness among employers about the importance of recent immigrant employees’ mental health and well-being and policy and legislation changes to ensure the employer’s commitment to creating a safe and culturally friendly workplace. The approach also recommends that recent immigrant employees receive occupational health and safety training, learn about Canadian workplace norms and culture, and have access to professional healthcare services.

Hepatic factors secreted by the liver promote homeostasis and are pivotal for maintaining the liver-gut axis. Bile acid metabolism is one such example wherein, bile acid synthesis occurs in the liver and its biotransformation happens in the intestine. Dysfunctional interactions between the liver and the intestine stimulate varied pathological outcomes through its bidirectional portal communication. Indeed, aberrant bile acid metabolism has been reported in inflammatory bowel disease (IBD). However, the molecular mechanisms underlying these crosstalks that perpetuate intestinal permeability and inflammation remain obscure. Here, we identify a novel hepatic gene program regulated by Rela and Stat3 that accentuates the inflammation in an acute experimental colitis model. Hepatocyte-specific ablation of Rela and Stat3 reduces the levels of primary bile acids in both the liver and the gut and shows a restricted colitogenic phenotype. On supplementation of chenodeoxycholic acid (CDCA), knock-out mice exhibit enhanced colitis-induced alterations. This study provides persuasive evidence for the development of multi-organ strategies for treating IBD and identifies a hepatocyte-specific Rela-Stat3 network as a promising therapeutic target.

key Clinical Message Constrictive Pericarditis is a rare fibrotic conversion of the pericardium that results in non‐specific clinical symptoms such as hepatomegaly, ascites, pleural effusions, and lower extremity edema. A multi‐modal diagnostic approach with cardiac imaging tools, cardiac hemodynamic measurements, and tissue biopsy can be used to diagnose Constrictive Pericarditis. Abstract Constrictive Pericarditis is a rare complication resulting in the fibrotic conversion of the pericardium secondary to idiopathic, infective, post‐surgical, or post‐radiation etiologies. The rigid and restrictive nature of the pericardium can result in non‐specific symptoms of volume overload that can mimic liver cirrhosis or congestive heart failure. We present the case of a 73‐year‐old female with constrictive pericarditis who presented with vague symptoms of abdominal pain, abdominal bloating, and bilateral lower extremity edema. This case report highlights the clinical manifestation, invasive, and non‐invasive diagnostic work‐up, and management of constrictive pericarditis.

Millions of people worldwide suffer from diabetes, a medical condition that is spreading at an accelerating pace. Numerous studies show that risk factors that may arise from diabetes can be avoided if the disease is detected early. The health-care monitoring system has benefited greatly from early diabetes prediction made possible by the integration of Deep Learning (DL) and Machine Learning (ML) algorithms. The objective of many early studies was to increase the prediction model accuracy. However, DL algorithms often cannot fully exploit the potential of the available datasets because they are too small. This study includes a very accurate DL model as well as a novel system that integrates cloud services and allows users to directly enhance an existing data set, which can increase the accuracy of DL techniques. Therefore, the Long Short-Term Memory (LSTM) model with controller is chosen for efficient type-1 diabetes prediction. Experimental validation of the proposed Nonlinear Model Predictive Control (NMPC)_LSTM algorithm method is compared with other conventional DL algorithms. The proposed controller method achieves excellent blood glucose set point tracking and the proposed algorithms achieves 98.95% accuracy for the obtained data. It outperforms other existing methods with an increase in percentage accuracy compared to the Benchmark Pima Indian Diabetes Datasets (PIDD).

OBJECTIVES: One major contributor to avoidable ocular morbidity is ocular trauma (OT). The study aimed to document the epidemiological factors, pattern of injury, and outcome among patients with OT presenting to the emergency department (ED). METHODS: This was a prospective observational study conducted in the ED of a tertiary care teaching hospital in Eastern India after due approval from the institutional ethics committee. The data were collected during the period from March 2021 to February 2022. Data pertaining to age, sex, type of injury, mechanism of injury, time and place of injury, details of tissue involvement, visual acuity, any prior history of injury, initial diagnosis, and management were noted. To estimate the severity of the injury and the probable visual outcome, we calculated through OT score (OTS), including one raw score and OTS. Statistical analysis was performed using the R, version 4.6.1. RESULTS: A total of 180 patient’s data were included for final analysis. The median (interquartile range) age of the patients was 32 (24–45) years. The majority were males (n = 147 [81.6%]) with a male–female ratio of 4.5:1. Road traffic accidents (RTA) were the common cause of injury (n = 122 [67.7%]). Unilateral eye involvement was the most common (n = 147 [81.6%]). In the pattern of injury, most of the patients sustained closed globe injuries (CGIs) (n = 158 [87.7%]). Among the CGIs, injury to the ocular adnexa and conjunctiva (n = 141 and 127, respectively) was the most common. Injury to the retina and choroids occurred in 20 (11%) patients. The vision was not affected in most of the cases (n = 125 [69.4%]) with a visual acuity of > 6/18. The majority (n = 120 [67%]) of the patients had an OTS of grade-4, followed by grade-2 (n = 22 [12%]). Most of the patients required only medical management (n = 100 [56%]), whereas 77 (43%) patients required surgical interventions. CONCLUSION: OT was a common presentation in the ED. Male patients with monocular injuries involved in RTAs were mostly affected. The vision was preserved in most of the cases.

Objective: Women report higher incidence of musculoskeletal discomfort due to computer use. This study examines the gender differences in the association of musculoskeletal discomfort and computing characteristics among university students. Methods: A cross-sectional survey design was used with a sample size of 338 students from a public university. Multivariable logistic regression models were used to assess associations of musculoskeletal discomfort and participant characteristics. Results: 61% of students reported having MSD. Male students between the age group of 26-35 years (AOR=5.086 [CI=1.05-24.48]) and those who only sometimes took breaks (AOR=3.835 [CI=1.25-11.71]) were more likely to report MSDs. Female students who used computer for more than 8 hours a day (AOR=6.199 [CI=2.38-16.11]), those who spent between 5-8 hours (AOR=2.174 [CI=1.04-4.51]), and those who assumed awkward postures (AOR =5.588 [CI= 1.24-25.1]) were more likely to report MSDs after adjustment. Conclusion: It is important to emphasize the benefits of ergonomics for males in the adult age group. Regardless of age, for female students' adequate breaks from using the computer, and avoiding awkward postures are necessary to prevent and mitigate the risk factors of musculoskeletal discomfort. The different risks factors for male and female students have important implications for prevention of musculoskeletal disorders.

Abstract Background Immune-checkpoint inhibitors (ICIs) have showed unprecedent efficacy in the treatment of patients with advanced non-small cell lung cancer (NSCLC). However, not all patients manifest clinical benefit due to the lack of reliable predictive biomarkers. We showed preliminary data on the predictive role of the combination of radiomics and plasma extracellular vesicle (EV) PD-L1 to predict durable response to ICIs. Main body Here, we validated this model in a prospective cohort of patients receiving ICIs plus chemotherapy and compared it with patients undergoing chemotherapy alone. This multiparametric model showed high sensitivity and specificity at identifying non-responders to ICIs and outperformed tissue PD-L1, being directly correlated with tumor change. Short conclusion These findings indicate that the combination of radiomics and EV PD-L1 dynamics is a minimally invasive and promising biomarker for the stratification of patients to receive ICIs.

Magnetic fraction isolated from steel furnace slag was tested as a component of Cu-free friction composites. The friction–wear performance and production of wear particles during their testing using a pin-on-disc tester against a cast iron disc were evaluated. To compare the effect of the magnetic fraction on the parameters studied, the composite with alumina and the composite with original steel furnace slag were also prepared and tested. All composites showed a comparable friction coefficient. The composite with original steel furnace slag, and the composite with a magnetic fraction showed higher wear resistance compared to the composite containing alumina. The positive effect of the magnetic fraction on the extent of the emission of wear particles was observed and explained by the decreased aggressiveness of this composite to the cast iron disc. The influence of the phase composition of the steel furnace slag and the magnetic fraction on the friction film formation was also indicated, and its effect on the production of wear particles was proposed.

Cannabis, derived from Cannabis sativa plants, is a prevalent illicit substance in the United States, containing over 400 chemicals, including 100 cannabinoids, each affecting the body’s organs differently upon ingestion. Cannabis hyperemesis syndrome (CHS) is a gut–brain axis disorder characterized by recurring nausea and vomiting intensified by excessive cannabis consumption. CHS often goes undiagnosed due to inconsistent criteria, subjective symptoms, and similarity to cyclical vomiting syndrome (CVS). Understanding the endocannabinoid system (ECS) and its dual response (pro-emetic at higher doses and anti-emetic at lower doses) is crucial in the pathophysiology of CHS. Recent research noted that type 1 cannabinoid receptors in the intestinal nerve plexus exhibit an inhibitory effect on gastrointestinal motility. At the same time, the thermoregulatory function of endocannabinoids might explain compulsive hot bathing in CHS patients. The prevalence of cannabis CHS is expected to rise as legal restrictions on its recreational use decrease in several states. Education and awareness are vital in diagnosing and treating CHS as its prevalence increases. This comprehensive review explores the ECS’s involvement, CHS management approaches, and knowledge gaps to enhance understanding of this syndrome.

Abstract Background Single parenthood is becoming increasingly common in today's society for various reasons such as divorce, the death of a spouse, or the choice of parenthood. Regrettably, there seems to be no significant concern among world leaders regarding depression arising from single parenting. Aim This article aimed to explore the prevalence of depression in single parents, the factors contributing to it, and its effects on their physical and emotional well‐being. Additionally, it aims to investigate the long‐lasting effects of depression in single parents, effective therapeutic approaches to tackle these issues and offer proactive suggestions for relevant global stakeholders. Methodology A selection of studies was identified through electronic databases such as PubMed, Embase, and PsycINFO databases. The search strategy encompassed terms related to single parenthood, depression, mental health, prevalence, risk factors, and treatment modalities. Included studies comprised of peer‐reviewed research articles, systematic reviews, meta‐analyses, and observational studies published in English. Result Today, there is a growing prevalence of single parenthood due to a range of factors, including divorce, the loss of a partner, and intentional decisions regarding single parenthood. However, this transition comes with challenges, including the risk of developing depression. Depression is a serious mental health condition affecting many individuals worldwide. Raising a child alone increases the likelihood of developing depression for the parent due to the increased burden and responsibilities. Such parents tend to have low self‐esteem, suicide/suicide attempts, and so forth and children born by those parents are vulnerable to depression, physical abuse, infections, etc. Conclusion Future research should focus on identifying effective interventions for treating depression among single parents and improving the availability of mental health facilities for this vulnerable population, especially in places with a high prevalence of depression. Mental health physicians in collaboration with obstetricians and gynecologists across the globe should offer counseling and mediation services during pre‐conception care visits for both single and partnered parents.

Abstract Insufficient progress in the development of national highways and state highways, coupled with a lack of public awareness regarding road safety, has resulted in prevalent traffic congestion and a high rate of accidents. Understanding the dominant and contributing factors that may influence road traffic accident severity is essential. This study identified the primary causes and the most significant target‐specific causative factors for road accident severity. A modified partitioning around medoids model determined the dominant road accident features. These clustering algorithms will extract hidden information from the road accident data and generate new features for our implementation. Then, the proposed method is compared with the other state‐of‐the‐art clustering techniques with three performance metrics: the silhouette coefficient, the Davies–Bouldin index, and the Calinski–Harabasz index. This article's main contribution is analyzing six different scenarios (different angles of the problem) concerning grievous and non‐injury accidents. This analysis provides deeper insights into the problem and can assist transport authorities in Tamil Nadu, India, in deriving new rules for road traffic. The output of different scenarios is compared with hierarchical clustering, and the overall clustering of the proposed method is compared with other clustering algorithms. Finally, it is proven that the proposed method outperforms other recently developed techniques.

Thorium is considered as a promising resource for the production of nuclear power, with its abundance in the Earth's crust offering potential for sustainable energy generation to fulfill upcoming energy needs. As a fertile material, thorium has the capability to be converted into fissile uranium-233, which is essential for sustaining nuclear chain reactions. Therefore, the extraction of thorium from the Earth's crust is imperative for its utilization as fuel in nuclear reactors. This study presents the synthesis of titanium dioxide with a mesoporous structure using the solvothermal method for extracting Th(IV) from aqueous solutions. Batch adsorption experiments were carried out to evaluate the impact of solution pH, adsorption kinetics, adsorbent dosage, initial Th(IV) concentration, and temperature. The adsorption process is influenced by the pH, showing a maximum adsorption capacity of 101.4 mg per gram of mesoporous TiO2 adsorbent (MTA) at an initial Th(IV) concentration of 400 mg L − 1 at pH 4.0. Results indicate a significant correlation with the pseudo-second-order and Freundlich adsorption isotherm models. Temperature-dependent investigations revealed that the adsorption of Th(IV) is spontaneous at room temperature and increases with higher temperatures (endothermic process). Moreover, the study highlights the rapid kinetics of Th(IV) adsorption by MTA, making it a favorable choice for upscaling the extraction process of Th(IV). In conclusion, the results suggest MTA as a promising adsorbent for the removal of Th(IV) from aqueous solutions.

Abstract Normal fetal development is critically dependent on optimal nutrient supply by the placenta, and placental amino acid transport has been demonstrated to be positively associated with fetal growth. Mechanistic target of rapamycin (mTOR) is a positive regulator of placental amino acid transporters, such as System A. Oleic acid (OA) has been previously shown to have a stimulatory role on placental mTOR signaling and System A amino acid uptake in primary human trophoblast (PHT) cells. We investigated the mechanistic link between OA and System A activity in PHT. We found that inhibition of mTOR complex 1 or 2, using small interfering RNA to knock down raptor or rictor, prevented OA‐stimulated System A amino acid transport indicating the interaction of OA with mTOR. Phosphatidic acid (PA) is a key intermediary for phospholipid biosynthesis and a known regulator of the mTOR pathway; however, phospholipid biosynthetic pathways have not been extensively studied in placenta. We identified placental isoforms of acyl transferase enzymes involved in de novo phospholipid synthesis. Silencing of 1‐acylglycerol‐3‐phosphate‐O‐acyltransferase‐4, an enzyme in this pathway, prevented OA mediated stimulation of mTOR and System A amino acid transport. These data indicate that OA stimulates mTOR and amino acid transport in PHT cells mediated through de novo synthesis of PA. We speculate that fatty acids in the maternal circulation, such as OA, regulate placental functions critical for fetal growth by interaction with mTOR and that late pregnancy hyperlipidemia may be critical for increasing nutrient transfer to the fetus.

Background: Evidence suggests that hypothyroidism may be associated with an increased risk of acute coronary syndrome (ACS).The data regarding the influence of hypothyroidism on cardiovascular disease in the Asian population is conflicting. Therefore, we undertook this study to assess the overall prevalence of hypothyroidism in Acute Coronary Syndrome (ACS) patients and determine if there is a relationship between hypothyroidism, both sub-clinical and overt and other significant risk factors of ACS in an Indian population. Methods: We studied 487 hospitalized patients between March 2018 and February 2021 with a diagnosis of ACS to determine the prevalence of hypothyroidism, both clinical and sub-clinical and their relationship with other known coronary risk factors. Thyroid function Tests - free T3, free T4 and TSH were collected from all the patients within 24 h of their admission to the coronary care unit (CCU) of 2 major hospitals in New Delhi and Imphal (Manipur). Results: Subclinical hypothyroidism was prevalent in 44 (9 %), followed by overt hypothyroidism in 25 (5.2 %).Subclinical hypothyroidism was more common in females, whereas overt hypothyroidism was more common in males. ST Elevation Myocardial Infarction (STEMI) (52 %), followed by Non-ST-Elevation Myocardial Infarction (NSTEMI) (25 %), was the commonest diagnosis at presentation. Patients with overt hypothyroidism showed a higher proportion of increased triglyceride levels.Patients with hypothyroidism had no differences in the prevalence of concomitant diabetes hypertension and other coronary risk factors. Conclusions: Patients with ACS without known thyroid disorders should be screened for hypothyroidism since it is found frequently. There might be a case to treat their thyroid dysfunction appropriately.

Rearranged during transfection (RET) alteration promotes oncogenesis in a few cancers. RET mutation positivity is seen in approximately 70% of medullary thyroid cancers, around 30% of differentiated papillary thyroid cancers, and 1-2% of non-small-cell lung cancers (NSCLC). To write this narrative drug review, we searched various websites like the United States Food and Drug Administration, PubMed, Google Scholar, UpToDate, and recently published papers in various international conferences using the search terms “RET,” “RET alteration,” “Retevmo,” “RET inhibitors,” and “selpercatinib.” We shortlisted 31 articles published between January 1980 and January 2024. We discuss the history, mechanism of action, resistance, pharmacodynamics, pharmacokinetics, dosing, toxicity, pivotal trials, and indications of selpercatinib. Selective RET inhibitors like selpercatinib are indicated in the treatment of RET-altered NSCLC and thyroid cancer.

Background: Prostatic artery embolization (PAE) has recently emerged as an effective minimally invasive procedure for the treatment of patients with symptomatic benign enlargement of prostate (BEP). Aim and Objective: The objective of the study was to evaluate the efficacy of PAE in BEP patients. Materials and Methods: A prospective observational clinical study was conducted at tertiary care hospital over 1-year from April 2022 to March 2023. This study included patients with lower urinary tract symptoms indicative of BEP and a prostate volume of 100 cc or more. The primary endpoints of the study were determining the International Prostate Symptom Score (IPSS), Q-max, prostate volume, intraprostatic resistive index, and prostate-specific antigen (PSA). Results: A total of 21 patients, with a mean age of 72 years were included in the study. After a 6-month follow-up, 15 patients were catheter-free, while 6 patients required adjunctive surgical treatment in the form of transurethral resection of prostate or holmium enucleation of prostate. The mean IPSS significantly decreased from 22 to 8 after PAE (P = 0.0394 Mean Q-max significantly increased from 8 mL/s to 16 mL/s (P = 0.05), while prostate volume decreased significantly at 6 months' follow-up (122.0 cc vs. 58.0 cc, P = 0.0334). Intraprostatic resistive index showed a statistically significant increase after embolization of unilateral/bilateral prostatic arteries. 0.62 versus 1.34, P = 0.0317, and serum PSA values were comparable pre- and post- PAE. Conclusion: PAE effectively treats symptomatic BEP with a prostatic volume of 100cc or more, achieving a success rate of 71.5% with improvements in IPSS, increased Q-max values, and reduced prostate size.

Background: Depression and anxiety are common among patients with diabetes mellitus and it affects the control of diabetes negatively. Depression is the third leading reason for the most disability-adjusted life years. Once depression coexists with diabetes mellitus, it is related to major health consequences and ends up in poor health outcomes. Aim: The study aimed to estimate the prevalence of depression in diabetes mellitus people and to find an association of depressive symptoms with sociodemographic and clinical predictors among patients with diabetes mellitus attending follow-ups at the general public hospital, in western Gujarat. Materials and Methods: It is an institutional-based cross-sectional study conducted among people living with diabetes mellitus at Tertiary Hospitals, Urban Health Training Center, and Rural Health Training Center. The study period was from January 2023 to May 2023. Data were collected using a structured questionnaire. Depression was assessed by the Patient Health Questionnaire 9. The collected data were cleaned, edited, entered into MS Excel (2006), and analyzed using SPSS software (version 26). A P value of

To evaluate the level of understanding (knowledge), beliefs (attitude), and behavior (practice) of staff nurses toward medication errors (MEs).

The occurrence of ovarian cyst in the neonate is rare and antenatally diagnosed by ultrasonography. This study aims to increase awareness about its occurrence and histological features. We performed a retrospective review on 10 cases of neonatal ovarian cyst (NOC) during 4 years (2016–2020) in a tertiary care center in South India. The neonates were diagnosed with abdominal cysts by the antenatal ultrasonogram in the third trimester. They were operated from day 5 to 35 days of age. There was no side predilection, and most of them were unilateral (9 out of 10 cases). Histopathological examination showed simple cysts (50%), serous cystadenomas (20%), cyst with no viable lining (20%), and follicular cyst (10%) and 90% of the cysts had torsion-induced changes. The pathologist and the clinician should be aware of the occurrence of serous histology in NOC cases.

The importance of growth mindset and teachers’ feedback has been widely recognised to improve the English language performance of students; however, the impact of growth mindset as a mediator is least explored. Therefore, the study aimed to empirically analyse the interrelationships between growth mindset and teachers’ feedback levels on secondary school students’ English as a Second Language (ESL) performance and to study the mediation effects of growth mindset in the relationships. The research model examined growth mindset along with four types of feedback. The levels of feedback include task, process, self-regulation and self-based feedback that teachers provide to improve the ESL performance of students. Survey questionnaires were administered to 301 secondary school students in Class 9 from two private schools in India. The data were analysed using PLS-SEM 4.0 software. The results indicated that the direct effect of feedback that emphasised process and self-regulation fosters a growth mindset in ESL students. Feedback levels focused on task, process, self-regulation, and growth mindset significantly impact ESL performance. Moreover, growth mindset mediated the relationships between process and self-regulation-focused feedback and ESL performance. However, no evidence supports the relationship between self-focused feedback, growth mindset, and ESL performance. The study concludes with implications and directions for future research.

Abstract We study circle compactifications of tensionless bosonic string theory, both at the classical and the quantum level. The physical state condition for different representations of BMS3, the worldsheet residual gauge symmetry for tensionless strings, admits three inequivalent quantum vacua. We obtain the compactified mass spectrum in each of these vacua using canonical quantization and explicate their properties.

Objectives: To study the sensitivity and specificity of various biomarkers in cases diagnosed with sepsis in the obstetric critical care unit and to compare the clinical criteria with the biomarkers in these cases. Methods: A total of 52 patients admitted in the obstetric critical care unit of our institution with the diagnosis of sepsis were enrolled in the study and were assessed clinically on the basis of q SOFA and total SOFA scores and the quantitative assessment of biomarkers for sepsis, namely CRP, serum lactate and procalcitonin was done. The sensitivity and specificity of both clinical criteria and biomarkers was determined. Results: Our study confirmed the high sensitivity and specificity of serum lactate, followed by procalcitonin (PCT) among biomarkers in subjects suspected or diagnosed with sepsis. It was also found that q SOFA score had the highest sensitivity (78.9%) but low specificity (57.60%), in contrast to high specificity (84.80%) of total SOFA score, emphasizing the role of q SOFA score as a screening tool and the total SOFA score as a confirmatory tool in cases of sepsis. Conclusion: Serum lactate is the most sensitive and specific predictor of prognosis in cases of maternal sepsis, followed by procalcitonin. CRP (C-reactive protein) is the least specific of the biomarkers. q SOFA may be used for initial screening followed by total SOFA scores.