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Background: During the first wave of the pandemic, health-care workers (HCWs) experienced high levels of stress, depression, and anxiety. These frontline workers remained a vulnerable group with the second wave of the pandemic being more severe than the first wave across the globe. There is a need to assess the psychological impact of the second wave of COVID-19 on HCWs and identify risk factors associated with higher morbidity. This will be beneficial in planning appropriate prevention and remedial measures. Materials and Methods: Consecutive 1275 HCWs (between the age group of 18 and 60 years) responded to the online survey. After the collection of sociodemographic data, participants were administered the Impact of Event Scale-Revised, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 Scale. Results: Moderate-to-severe stress, depression, and anxiety were reported by 40%, 31.7%, and 24.3% of participants, respectively. Regression analysis revealed that female gender, nurses, high COVID-19 exposure, history of COVID-19, chronic medical illness, and work experience between 10 and 20 years were risk factors for increased psychological morbidity. Conclusions: This study demonstrates that stress, anxiety, and depressive symptoms remained high among HCWs during the second wave of COVID-19. Certain risk factors predicted higher mental health morbidity. There is a need to develop appropriate interventions targeting these groups.

Abstract Doped ceria has been extensively explored as an efficient electrolyte material for intermediate to low temperature solid oxide fuel cell. Among other ceria electrolytes, gadolinia doped ceria (GDC) is one of the most extensively studied electrolyte materials for low temperature SOFC applications. Here, co-precipitation method is employed to synthesize GDC nanoparticles with stoichiometric ratio of GdxCe1−xO2−δ (with 0 $$\le$$ ≤ x $$\le$$ ≤ 0.20). In this process, the molecular water of the precursors has been utilized during the co-precipitation to avoid possible agglomeration caused by hydrogen bonding. The cubic phase formation was examined using X-ray diffraction (XRD) and Raman profile ascribing absence of other phases. XRD along with Reitveld refinement confirm the presence of cubic phase of ceria and Raman profile confirms the oxygen vacancies due to the non-stoichiometry created in CeO2 lattice. The granularity of the sample was observed using field emission scanning electron microscopy (FESEM) with elemental mapping by EDS. It is observed from FESEM that the grains are compact in nature and the density observed was around 98% of the theoretical density. The electrochemical behavior was investigated using electrochemical impedance spectroscopy (EIS), which was taken between the temperature ranges of 350–700 °C. It is observed from the EIS study that ceria doped with 15 mol % Gd3+ (Gd0.15Ce0.85O2−δ) is having highest grain boundary ionic conductivity of about 0.104 S cm−1 at 700 °C with an activation energy of 0.81 eV. This work demonstrates the correlation between oxygen vacancy generation and the enhancement of ionic conductivity with Gd3+ doping in ceria.

Abstract Multistate memory systems have the ability to store and process more data in the same physical space as binary memory systems, making them a potential alternative to existing binary memory systems. In the past, it has been demonstrated that voltage-controlled magnetic anisotropy (VCMA) based writing is highly energy-efficient compared to other writing methods used in non-volatile nano-magnetic binary memory systems. In this study, we introduce a new, VCMA-based and skyrmion-mediated non-volatile ternary memory system using a perpendicular magnetic tunnel junction (p-MTJ) in the presence of room temperature thermal perturbation. We have also shown that ternary states {− 1, 0, + 1} can be implemented with three magnetoresistance values obtained from a p-MTJ corresponding to ferromagnetic up, down, and skyrmion state, with 99% switching probability in the presence of room temperature thermal noise in an energy-efficient way, requiring ~ 2 fJ energy on an average for each switching operation. Additionally, we show that our proposed ternary memory demonstrates an improvement in area and energy by at least 2X and ~ 104X respectively, compared to state-of-the-art spin-transfer torque (STT)-based non-volatile magnetic multistate memories. Furthermore, these three states can be potentially utilized for energy-efficient, high-density in-memory quantized deep neural network implementation.

Abstract Nanogels offer hope for precise drug delivery, while addressing drug delivery hurdles is vital for effective prostate cancer (PCa) management. We developed an injectable elastin nanogels (ENG) for efficient drug delivery system to overcome castration-resistant prostate cancer (CRPC) by delivering Decursin, a small molecule inhibitor that blocks Wnt/βcatenin pathways for PCa. The ENG exhibited favourable characteristics such as biocompatibility, flexibility, and low toxicity. In this study, size, shape, surface charge, chemical composition, thermal stability, and other properties of ENG were used to confirm the successful synthesis and incorporation of Decursin (DEC) into elastin nanogels (ENG) for prostate cancer therapy. In vitro studies demonstrated sustained release of DEC from the ENG over 120 h, with a pH-dependent release pattern. DU145 cell line induces moderate cytotoxicity of DEC-ENG indicates that nanomedicine has an impact on cell viability and helps strike a balance between therapeutics efficacy and safety while the EPR effect enables targeted drug delivery to prostate tumor sites compared to free DEC. Morphological analysis further supported the effectiveness of DEC-ENG in inducing cell death. Overall, these findings highlight the promising role of ENG-encapsulated decursin as a targeted drug delivery system for CRPC.

Leishmaniasis is a chronic inflammatory disease caused by a flagellate protozoan from the genus Leishmania, transmitted by an insect vector belonging to either the genus Phlebotomus spp. or Lutzomyia spp. This disease is considered one of the most prevalent infectious diseases worldwide due to its high detection rate and the morbidity it causes. A 70-year-old woman from a low-income background, with no significant medical or drug history and no other general constitutional symptoms, presented with an asymptomatic, exophytic, granulomatous growth that has a reddish hue. The growth is located on the lingual aspect of the mandibular anterior teeth region and has been progressing over the past six months. Radiographic features suggested associated chronic periodontitis along with hyperdense calcified deposits. On excisional biopsy and histopathology, the excised specimen revealed characteristic Leishmania amastigotes and pseudoepitheliomatous hyperplasia. An abdominal ultrasound was advised to rule out any visceral involvement, but no significant findings were observed. The present case is particularly intriguing due to oral mucosal involvement by Leishmania sp. without associated primary visceral or cutaneous lesions, especially given the male predilection (M:F=7:5) and the most common site involved being the posterior palatal region for Leishmaniasis. The present case represents a rare instance. Considering the difficult socio-economic circumstances, the involvement of the World Health Organization (WHO) demonstrates an understanding of the need for collaboration in supporting underprivileged communities.

Introduction: Concomitant chemoradiation with cisplatin is standard treatment for non-metastatic head and neck cancers, but often limited by toxicities, especially deranged renal function and hearing complications. This leads to limited cycles of cisplatin due to challenges in administration and is not suitable for patients with poor renal function and hearing issues. Need of the study: Not enough data is available for patients who are not suitable for cisplatin administration along with radiation either due to sensitivity to cisplatin or the adverse effects mentioned earlier. Docetaxel has been recently observed to benefit such patients in overall response outcome including Disease Free Survival (DFS) and Overall Survival (OS) when administered concurrently with radiation. Improved clinical response with minimal toxicity to normal tissue is seen with docetaxel, as it is a phase-specific agent. Therefore, this would be a good alternative to Cisplatin in patients with deranged kidney function and sensorineural hearing loss. Aim: To estimate the adverse event profile and compliance of docetaxel with radiation. Methodology: This prospective observational study will be conducted in the department of Medical Oncology and Radiation Oncology at Sidharth Gupta Memorial Cancer Hospital, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha, Maharashtra, India, starting from May 2024 to May 2025. Patients with pathologically confirmed non-metastatic Head and Neck Squamous Cell Carcinoma (HNSCC), who are planned for Concurrent Chemoradiation (CCRT) but not suitable for cisplatin, will receive concurrent weekly docetaxel at a dose of 15 mg/sqm. Radiotherapy (RT) will be delivered according to the institutional protocol, daily dose of 200 cGy for five days a week will be given. Continuous monitoring during treatment will include weekly clinical evaluations, regular blood tests (haemoglobin, blood counts, renal functions), and grading of adverse events (CTCAE v5 criteria). Treatment response will be assessed via clinical evaluation and CECT scans (RECIST v1.1). Statistical analysis will be performed using Statistical Package for Social Sciences (SPSS) version 26.0 and will involve analysis of categorical variables with Chi-square and Fisher-exact tests, and continuous variables with unpaired t-tests and Analysis of Variance (ANOVA). Time to event analysis will be done using the Kaplan-Meier method with p-value

Background: The Perfusion Measures and Outcomes (PERForm) registry was established in 2010 to advance cardiopulmonary bypass (CPB) practices and outcomes. The registry is maintained through the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and is the official registry of the American Society of Extracorporeal Technology. Methods: This first annual PERForm registry report summarizes patient characteristics as well as CPB-related practice patterns in adult (≥18 years of age) patients between 2019 and 2022 from 42 participating hospitals. Data from PERForm are probabilistically matched to institutional surgical registry data. Trends in myocardial protection, glucose, anticoagulation, temperature, anemia (hematocrit), and fluid management are summarized. Additionally, trends in equipment (hardware/disposables) utilization and employed patient safety practices are reported. Results: A total of 40,777 adult patients undergoing CPB were matched to institutional surgical registry data from 42 hospitals. Among these patients, 54.9% underwent a CABG procedure, 71.6% were male, and the median (IQR) age was 66.0 [58.0, 73.0] years. Overall, 33.1% of the CPB procedures utilized a roller pump for the arterial pump device, and a perfusion checklist was employed 99.6% of the time. The use of conventional ultrafiltration decreased over the study period (2019 vs. 2022; 27.1% vs. 24.9%) while the median (IQR) last hematocrit on CPB has remained stable [27.0 (24.0, 30.0) vs. 27.0 (24.0, 30.0)]. Pump sucker termination before protamine administration increased over the study period: (54.8% vs. 75.9%). Conclusion: Few robust clinical registries exist to collect data regarding the practice of CPB. Although data submitted to the PERForm registry demonstrate overall compliance with published perfusion evidence-based guidelines, noted opportunities to advance patient safety and outcomes remain.

Abstract The continuous search for natural product-based biopesticides from fungi isolated from untapped sources is an effective tool. In this study, we studied a pre-selected fungal endophyte, isolate Aa22, from the medicinal plant Artemisia absinthium, along with the antifungal, insect antifeedant and nematicidal compounds present in the extract. The endophyte Aa22 was identified as Stemphylium solani by molecular analysis. The antifungal activity was tested by broth microdilution against Fusarium solani, F. oxysporum, F. moniliforme and Botrytis cinerea, the insect antifeedant by choice bioassays against Spodoptera littoralis, Myzus persicae and Rhopalosiphum padi and the in vitro mortality against the root-knot nematode Meloiydogyne javanica. The structures of bioactive compounds were determined on the basis of 1D and 2D NMR spectroscopy and mass spectrometry. The ethyl acetate extract obtained from the solid rice fermentation showed mycelial growth inhibition of fungal pathogens (EC50 0.08–0.31 mg/mL), was antifeedant to M. persicae (99%) and nematicidal (68% mortality). A bioguided fractionation led to the isolation of the new compound stempholone A (1), and the known stempholone B (2) and stemphol (3). These compounds exhibited antifeedant (EC50 0.50 mg/mL), antifungal (EC50 0.02–0.43 mg/L) and nematicidal (MLD 0.5 mg/mL) activities. The extract activities can be explained by 3 (antifungal), 1–3 (antifeedant) and 1 (nematicidal). Phytotoxicity tests on Lolium perenne and Lactuca sativa showed that the extract and 1 increased L. sativa root growth (121–130%) and 1 reduced L. perenne growth (48–49%). These results highlight the potential of the endophytic fungi Aa22 as biotechnological source of natural product-based biopesticides.

Mesodiverticular band associated with Meckel’s diverticulum can lead to surgical emergencies like intestinal obstruction or volvulus and may prove fatal as this pathology is quite rare, it may escape the clinical diagnosis. This band needs to be excised during emergent laparotomy along with Meckel’s diverticulectomy. A high level of clinical suspicion and surgical acumen is required to manage this rare condition and have an uneventful recovery of the patient.

Ainhum is an extremely rare and challenging case where there is development of a constricting ring along the digits leading to autoamputation. As rare case .it is being reported from India as not many literatures on this case from this part of the continent.

Phytobezoar causing acute intestinal obstruction is a rare event. A case of accidental ingestion of mango seed causing intestinal obstruction is being reported requiring surgical intervention to extract the mango seed from the ileum. This condition must be kept in mind during the mango season while dealing with a case of intestinal obstruction in an emergency.

Abstract Breast Cancer is the most common cancer among women globally. Despite significant improvements in overall survival, many tumours are refractory to therapy and so novel approaches are required to improve patient outcomes. We have evaluated patient-derived explants (PDEs) as a novel preclinical platform for breast cancer (BC) and implemented cutting-edge digital pathology and multi-immunofluorescent approaches for investigating biomarker changes in both tumour and stromal areas at endpoint. Short-term culture of intact fragments of BCs as PDEs retained an intact immune microenvironment, and tumour architecture was augmented by the inclusion of autologous serum in the culture media. Cell death/proliferation responses to FET chemotherapy in BC-PDEs correlated significantly with BC patient progression-free survival (p = 0.012 and p = 0.0041, respectively) and cell death responses to the HER2 antibody therapy trastuzumab correlated significantly with HER2 status (p = 0.018). These studies show that the PDE platform combined with digital pathology is a robust preclinical approach for informing clinical responses to chemotherapy and antibody-directed therapies in breast cancer. Furthermore, since BC-PDEs retain an intact tumour architecture over the short-term, they facilitate the preclinical testing of anti-cancer agents targeting the tumour microenvironment.

Abstract The aim of this study was to evaluate the antimicrobial efficacy of an air gas soft jet CAP for its potential use in removing oral biofilms, given that plasma-based technologies have emerged as promising methods in periodontology. Two types of biofilms were developed, one by Streptococcus mutans UA 159 bacterial strain and the other by a complex mixture of saliva microorganisms isolated from a patient with periodontitis. This latter biofilm was characterized via Next Generation Sequencing to determine the main bacterial phyla. The CAP source was applied at a distance of 6 mm for different time points. A statistically significant reduction of both CFU count and XTT was already detected after 60 s of CAP treatment. CLSM analysis supported CAP effectiveness in killing the microorganisms inside the biofilm and in reducing the thickness of the biofilm matrix. Cytotoxicity tests demonstrated the possible use of CAP without important side effects towards human gingival fibroblasts cell line. The current study showed that CAP treatment was able to significantly reduce preformed biofilms developed by both S. mutans and microorganisms isolated by a saliva sample. Further studies should be conducted on biofilms developed by additional saliva donors to support the potential of this innovative strategy to counteract oral pathogens responsible for periodontal diseases.

Scrolling smartphones while sitting on the toilet is believed to be one of the reasons predisposing to haemorrhoidal disease. Not much is written about the problem of the use of smartphones and the development of haemorrhoidal disease in the literature, but the rising incidence of haemorrhoids globally does require guidelines to be set for toilet hygiene, especially in the young generation to prevent this issue from becoming an epidemic in future. It may be time to designate the washroom as a smartphone-free zone.

Pilonidal sinus disease (PSD) is a chronic inflammatory disease affecting the soft tissue of the sacrococcygeal region and remains a challenging disease for surgeons to treat. With controversies in management to prevent recurrence leading to economic burden to the patient, these cases require special care by expert surgeons. From Jan 2023 to Nov 2023, 10 patients with pilonidal sinus were treated with complete excision of the tract and reconstruction using a rhomboid flap. The factors evaluated included the duration of surgery, postoperative pain, length of hospital stay, and postoperative complications. The patients were followed up on an outpatient basis, monthly for the first three months. The majority of the patients were young males with a mean age of 28 years. The surgery time was 40 to 75 minutes, and the mean operation time was 55 minutes. The stitches were removed after 2 weeks. Among complications, two patients developed mild discharge with infection. In one patient, necrosis at the tip of the flap was noted. We recommend the Rhomboid flap as a method of choice for surgical management of Pilonidal sinus in a postgraduate medical college as it is easy to teach, learn, and perform and gives complete recovery of the patient with negligible recurrence rate.

Introduction: Rheumatic Heart Disease (RHD) remains the primary cause of acquired Valvular Heart Disease (VHD) in developing countries. The role of Tissue Doppler Indices (TDI) in RHD is understudied. This study aims to fill evidence gaps identified by the American College of Cardiology/American Heart Association in the management of Valvular Heart Disease (VHD) by analysing newer echocardiographic techniques {Tissue Doppler Imaging (TDI)} and biochemical markers (NT-proBNP) against clinical parameters {New York Heart Association (NYHA)} in an understudied patient group. Aim: To evaluate the role of TDI and its association with the functional class of dyspnoea and serum NT-proBNP levels in RHD. Materials and Methods: This cross-sectional study was conducted in the Cardiology and Medicine departments, Central Gujarat, Western India, from January 2021 to June 2022. Fifty-seven consenting adult patients with RHD who underwent echocardiography with Standard Echocardiographic Techniques (SET) to stratify VHD severity were included. Patients were divided into three sub-groups: a) Isolated MR and MR with mild/moderate MS (n=23); b) Isolated MS and MS with mild MR (n=29); and c) Isolated MS and MS with mild or moderate MR (n=48). TDI parameters (e’, a’, e’/a’, and E/e’) at medial mitral, lateral mitral, and tricuspid annuli, NYHA classification, and serum NT-proBNP levels were analysed. The Analysis of Variance (ANOVA) was used to assess the association between NYHA class and clinical and NT-proBNP parameters. The Pearson correlation coefficient was employed to determine linear relationships between NT-proBNP and TDI parameters. Results: The mean age was 45.4±16 years, with the age groups 20-40 years (n=20) and 40-60 years (n=22) having a nearly equal distribution. The female-to-male ratio was 1.48 (34/23). In subgroup C, the a’ velocity decreased from 13.74±3.92 cm/s in NYHA I to 5.17±1.98 cm/s in NYHA IV (p=0.0312), and the e’/a’ ratio increased from 0.96±0.40 in NYHA I to 2.41±1.00 in NYHA IV (p=0.0210). These changes paralleled trends in a’ value (p=0.0306) and e’/a’ ratio (p=0.0157) with increasing NT-proBNP levels. Conclusion: At the tricuspid annulus, the e’/a’ ratio and a’ velocity can complement NT-proBNP in cases where there is a discrepancy between the clinical status of the patient and the severity of the valve lesion as determined by SET. Larger-scale studies are needed to further evaluate the association between TDI parameters and long-term clinical outcomes, as well as to identify the optimal timing for surgical intervention in RHD patients.

Abstract This study presents a novel biosorbent developed by immobilizing dead Sp2b bacterial biomass into calcium alginate (CASp2b) to efficiently remove arsenic (AsIII) from contaminated water. The bacterium Sp2b was isolated from arsenic-contaminated industrial soil of Punjab, a state in India. The strain was designated Acinetobacter sp. strain Sp2b as per the 16S rDNA sequencing, GenBank accession number -OP010048.The CASp2b was used for the biosorption studies after an initial screening for the biosorption capacity of Sp2b biomass with immobilized biomass in both live and dead states. The optimum biosorption conditions were examined in batch experimentations with contact time, pH, biomass, temperature, and AsIII concentration variables. The maximum biosorption capacity (qmax = 20.1 ± 0.76 mg/g of CA Sp2b) was obtained at pH9, 35 ̊ C, 20 min contact time, and 120 rpm agitation speed. The isotherm, kinetic and thermodynamic modeling of the experimental data favored Freundlich isotherm (R2 = 0.941) and pseudo-2nd-order kinetics (R2 = 0.968) with endothermic nature (ΔH° = 27.42) and high randomness (ΔS° = 58.1).The scanning electron microscopy with energy dispersive X-ray (SEM–EDX) analysis indicated the As surface binding. The reusability study revealed the reasonable usage of beads up to 5 cycles. In conclusion, CASp2b is a promising, efficient, eco-friendly biosorbent for AsIII removal from contaminated water.

Abstract This study discusses the feasibility of Ferroelectric Capacitors (FeCaps) and Ferroelectric Field-Effect Transistors (FeFETs) as In-Memory Computing (IMC) elements to accelerate machine learning (ML) workloads. We conducted an exploration of device fabrication and proposed system-algorithm co-design to boost performance. A novel FeCap device, incorporating an interfacial layer (IL) and $$\text {Hf}_{0.5}\text {Zr}_{0.5}\text {O}_2$$ Hf 0.5 Zr 0.5 O 2 (HZO), ensures a reduction in operating voltage and enhances HZO scaling while being compatible with CMOS circuits. The IL also enriches ferroelectricity and retention properties. When integrated into crossbar arrays, FeCaps and FeFETs demonstrate their effectiveness as IMC components, eliminating sneak paths and enabling selector-less operation, leading to notable improvements in energy efficiency and area utilization. However, it is worth noting that limited capacitance ratios in FeCaps introduced errors in multiply-and-accumulate (MAC) computations. The proposed co-design approach helps in mitigating these errors and achieves high accuracy in classifying the CIFAR-10 dataset, elevating it from a baseline of 10% to 81.7%. FeFETs in crossbars, with a higher on-off ratio, outperform FeCaps, and our proposed charge-based sensing scheme achieved at least an order of magnitude reduction in power consumption, compared to prevalent current-based methods.

Primary breast stromal sarcomas are rare entities arising from connective tissue within the breast, accounting for

To the Editor: Cholangiocarcinoma (CCA) is a rare malignancy of the biliary tract, comprising 3% of all gastrointestinal cancers.1 Typically diagnosed in the seventh decade of life, it seldom occurs in the pediatric age group, making cases in pediatric patients notable.2 CCA in children and adolescents is frequently associated with underlying risk factors. In contrast, only 30% of adults exhibit them.3 We report the youngest presentation of a sporadic case of CCA in a 5-year-old boy with an unremarkable medical history. A 5-year-old boy presented with a 15-day history of progressive abdominal distension and vomiting. Notably, there was no weight loss, fever, or jaundice. Clinical examination revealed a distended abdomen with dilated veins and marked hepatosplenomegaly. Laboratory findings included a hemoglobin of 12.5 g/dL (13-18 g/dl), a white blood cell count of 14,810/μL (4000-11500/uL), and a platelet count of 341,000/μL (331000/uL). The biochemical profile revealed a total serum bilirubin level of 0.6 mg/dL (0.2-1.2 mg/dL), serum aspartate aminotransferase of 37 U/L (up to 35 U/L), serum alanine transaminase of 11 U/L (up to 55 U/L), albumin of 3 g/dl (3.5-5.2 g/dL), and an INR of 1.1. Tests for human immunodeficiency virus, hepatitis B surface antigen, and hepatitis C virus were negative. The abdominal and pelvic contrast-enhanced computed tomography revealed an enlarged liver with multiple scattered, well-defined hypodense lesions, the largest in segment VI of 3.3x3.0cm. The spleen was enlarged, without focal lesions. Multiple paraaortic and mesenteric lymph nodes were enlarged, and the abdomen had moderate free fluid. Serum carbohydrate antigen 19-9 (CA 19-9) was l136 U/mL (RR: 0-37 IU/mL), and alpha-fetoprotein was 2.19 IU/mL (RR: 0-8 IU/mL). An ultrasound-guided liver biopsy revealed a neoplasm characterized by tumor cells with eosinophilic cytoplasm, vesicular nuclear chromatin, and prominent nucleoli arranged in a glandular pattern, cords, and nests. Immunohistochemistry (IHC) results were strongly positive for CK7 and CK19 and negative for CK20, SALL4, AFP, Glypican 3, HepPar1, Arginase1, and β-catenin, suggesting CCA (Figure 1). Figure 1Photomicrographs of the liver biopsy. A – Microscopy displaying a neoplasm composed of tumor cells arranged in a glandular pattern, cords, and nests (H&E, 10X); B – positive, diffuse, and strong cytoplasmic reaction for CK19 (10X); C – negative reaction for CK 20 (10X); D – negative reaction for HepPar1(10X).: Fluorodeoxyglucose positron emission tomography (FDG-PET) indicated liver enlargement with FDG avid multiple hypodense lesions but no distant metastasis. Pediatric surgery consultation was sought, but due to the poor general condition of the patient and multifocal lesions in the liver, it was deemed inoperable. The child underwent systemic chemotherapy with gemcitabine and cisplatin. After two cycles, the patient developed massive pleural effusion, ascites, and respiratory failure. Repeat FDG PET indicated progressive disease, and the patient continued on supportive measures but ultimately succumbed to the illness. Parents were counselled to an autopsy to search for any underlying hepatic disease but were not willing to do the same. CCA is an extremely rare malignancy in children, with an incidence of 0.0036/100,000, compared to that of 1.67/100,000 in the adult population.4 It is a bile duct malignancy and is divided into three subtypes depending on their anatomical site of origin: intrahepatic (iCCA), perihilar (pCCA), and distal CCA (dCCA). The most characteristic and common presentation of extrahepatic cholangiocarcinoma (eCCA) is jaundice and is seen only in 10-15% of cases of iCCA. iCCA is located in the liver parenchyma proximal to the second-degree bile ducts and generally presents with nonspecific symptoms like abdominal pain, nausea, weight loss, malaise, and night sweats. Diagnosis is often delayed in such cases. It also has a propensity for liver metastasis. Surgical resection with negative tumor margins is achieved only in 45% of the patients.5 Several risk factors have been linked to CCA like congenital biliary dilatation, choledochal cyst, choledocholithiasis, Caroli disease, primary sclerosing cholangitis (PSC), progressive familial intrahepatic cholestasis (PFIC), viral infections (Hepatitis B virus and hepatitis C virus), Inflammatory bowel disease, and Opisthorchis viverrine and Clonorchis sinensis infection.6-8 Most pediatric and adolescent cases have underlying risk factors for CCA, while only 30% have an underlying risk factor in adults. An extensive search revealed only three cases reported in English literature of pediatric cholangiocarcinoma presenting in the first decade of life. All cases had underlying risk factors; PFIC in 2 and 1 had congenital biliary dilatation. The presenting complaints were fever, pruritis, abdominal pain, and vomiting, and none of them had features of biliary obstruction. Two of them were diagnosed with iCCA and succumbed to their illness within 5 months of diagnosis. One had eCCA who underwent surgical resection and is alive post-year after surgery.6,8 To the best of our knowledge, our case represents the youngest presentation of sporadic CCA (Table 1). Table 1 Summary of patients with pediatric cholangiocarcinoma presenting in the first decade of life described in the literature: Ref. Age (years)/ Sex Comorbidities Presenting symptoms Tumor markers Site Treatment Status/ Follow up Scheimann et al.8 4/F PFIC Fever CA 19-9 132 IU/mL ICCA Chemo Death within 5 months from diagnosis Giant cell hepatitis Biliary cirrhosis AFP-61.5 IU/mL Scheimann et al.8 7/F PFIC Pruritis Not available ICCA None Death within 4 months from diagnosis Giant cell hepatitis Biliary cirrhosis Saikusa et al.6 3/M Congenital biliary dilatation with pancreaticobiliary maljunction Abdominal pain Not available ECCA Resection Alive/ 1 year Index case 5/M No comorbidities Abdominal distension CA 19-9- 136 IU/mL ICCA Chemo Death within 2 months from diagnosis AFP (–) 2.19IU/mL AFP: Alpha-fetoprotein. CA: Carbohydrate antigen; Chemo: chemotherapy; ECCA: Extrahepatic cholangiocarcinoma; ICCA: Intrahepatic cholangiocarcinoma; PFIC: Progressive familial intrahepatic cholestasis. Morphologically, CCA can be tubular/acinar adenocarcinoma with well, moderate, or poor differentiation and show immunopositivity for CK7, CK19, and EMA. Metastatic colorectal adenocarcinoma, upper gastrointestinal tract cancers, and metastatic pancreaticobiliary adenocarcinoma are close differentials and can be differentiated based on CK20 and a comprehensive IHC panel including MUC2, MUC5AC, CA19-9, mCEA, CA125, SMAD4, respectively.9 The prognosis for children and adolescents with CCA is unfavorable. Surgery is a potentially curative option; however, most patients have metastatic or locally advanced disease at presentation, and only 25% are eligible for resection. Robust data supports the use of first-line cisplatin and gemcitabine chemotherapy in adults with advanced disease.10 Survival is related to the extent of disease spread; thus, early diagnosis of CCA is essential for positive outcomes.

Endobronchial ultrasound (EBUS)-guided mediastinal cryobiopsy is a new modality for sampling mediastinal lymph nodes. The data regarding the diagnostic yield and utility of mediastinal cryobiopsy is still limited. Consecutive patients who were undergoing EBUS-guided transbronchial needle aspiration (EBUS-TBNA) were recruited in this study. We subjected the enrolled patients to EBUS-guided mediastinal cryobiopsy after obtaining their informed consent. The final diagnosis was made with a clinical-pathological-radiological assessment and clinical-radiological follow-up. A total of 101 patients were enrolled in the study. Adequacy in sampling achieved in EBUS-TBNA was 92.07%, compared to 98.01% achieved in EBUS-TBNA with mediastinal cryobiopsy. Diagnostic yields achieved in EBUS-TBNA and EBUS-TBNA with mediastinal cryobiopsy were 67.32% and 86.13%, respectively (p=0.001). EBUS patterns failed to predict the utility of mediastinal crobiopsy. No significant complications were observed. To conclude, EBUS-guided mediastinal cryobiopsy improves yield in patients undergoing EBUS-TBNA.

Background Recent innovations are making radiology more advanced for patient and patient services. Under the immense burden of radiology practice, Artificial Intelligence (AI) assists in obtaining Computed Tomography (CT) images with less scan time, proper patient placement, low radiation dose (RD), and improved image quality (IQ). Hence, the aim of this study was to evaluate and compare the positioning accuracy, RD, and IQ of AI-based automatic and manual positioning techniques for CT kidney ureters and bladder (CT KUB). Methods This prospective study included 143 patients in each group who were referred for computed tomography (CT) KUB examination. Group 1 patients underwent manual positioning (MP), and group 2 patients underwent AI-based automatic positioning (AP) for CT KUB examination. The scanning protocol was kept constant for both the groups. The off-center distance, RD, and quantitative and qualitative IQ of each group were evaluated and compared. Results The AP group (9.66±6.361 mm) had significantly less patient off-center distance than the MP group (15.12±9.55 mm). There was a significant reduction in RD in the AP group compared with that in the MP group. The quantitative image noise (IN) was lower, with a higher signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the AP group than in the MP group (p

Giant subpectoral lipoma is an extremely rare case that can occasionally turn malignant. We highlight this case for the first time from India.

In 1971, Arrigoni MG et al., used the term “hamartoma” for breast lesions in 10 patients who presented with encapsulated breast tumours clinically and grossly resembling fibroadenomas. Hamartomas in breast lesions are very uncommon and include adenolipoma and chondrolipoma. Despite the availability of imaging modalities, it is often difficult to distinguish fibroadenoma from breast carcinoma. Chondrolipoma of the breast is a rare benign mesenchymal tumour composed of adipose and mature cartilaginous tissue, which is often mistaken for malignant lesions in preoperative studies, leading to overdiagnosis and overtreatment. Hence, a proper histopathological examination is required for a correct diagnosis. Only eight cases have been reported in the literature. This report presents one such rare case of lump in a 67-year-old female, which was suspected to be a fibroadenoma clinically and radiologically, but was diagnosed as chondrolipoma on histopathological examination. All routine investigations were within normal limits, and a clinical diagnosis of fibroadenoma was made. Mammography was done, comprising fat, soft tissue, and calcific strandings along with coarse calcific specks suggestive of BI-RADS (Breast Imaging-Reporting and Data System) Category 3: high probability of being benign.

Introduction: Breast cancer is the most frequent cancer among women. The CD34 immunohistochemical antigen serves as a tool in differentiating between benign and malignant breast lesions. It has been suggested that CD34 may be related to invasive potential. Aim: To evaluate the expression of the CD34 antigen in the stroma of benign and malignant breast lesions using the Immunohistochemistry (IHC) method. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology in collaboration with the Department of Surgery at Sarojini Naidu Medical College, Agra, Uttar Pradesh, India over a period of 18 months (from January 2021 to June 2022), involving a total of 50 histopathologically confirmed cases of benign and malignant breast lesions. Postsurgical specimens, including biopsies and mastectomies, were fixed in 10% neutral buffered formalin. The initial diagnosis was made by Haematoxylin and Eosin (H&E)- stained tissue sections. Sections from the same block were subjected to IHC staining using a monoclonal antibody to the CD34 antigen, and the intensity of expression in stromal cells was graded from 0 to 3+ based on nuclear positivity: up to 5% stromal cells immunoreactive (grade-0), >5% and up to 25% (grade-1), >25% and up to 50% (grade-2), and > 50% (grade-3). The data was entered into Microsoft Excel 2007 and analysed using Statistical Package for Social Sciences (SPSS) statistical software version 19.0. The inferential statistics included the use of the Chi-square test. Results: Out of the total 50 cases evaluated, 25 (50%) were categorised as benign, and rest 25 (50%) were categorised as malignant lesions. Among the benign lesions, the most common lesion was fibroadenoma, accounting for 9 (36%) cases, followed by benign phyllode tumour, with 6 (24%) cases. Among malignant lesions, the most common lesion was Invasive Ductal Carcinoma (IDC), accounting for 23 (92%) cases. The intensity of CD34 expression was found to be significantly higher in benign as compared to malignant breast lesions. Out of the 25 benign breast cases, the maximum number of cases (19) showed Grade-3+ positivity, 5 cases showed Grade-2+, and 1 case showed Grade-0 positivity. However, among malignant lesions, maximum cases (23, 92%) showed Grade-0 on CD34 immunostaining. Conclusion: This study was undertaken to evaluate the CD34 expression in benign and malignant breast lesions which might be able to distinguish between the benign and malignant breast lesions. The most benign breast lesions express CD34 in the stroma, while it is almost totally lost in all malignant neoplasms. Loss of CD34 is associated with the tumour’s capacity for invasion. However, to determine its function as a therapeutic target in cases of breast cancer, additional research can also be done.

Abstract Individual cancers are composed of heterogeneous tumor cells with distinct phenotypes and genotypes, with triple negative breast cancers (TNBC) demonstrating the most heterogeneity among breast cancer types. Variability in transcriptional phenotypes could meaningfully limit the efficacy of monotherapies and fuel drug resistance, although to an unknown extent. To determine if transcriptional differences between tumor cells lead to differential drug responses we performed single cell RNA-seq on cell line and PDX models of breast cancer revealing cell subpopulations in states associated with resistance to standard-of-care therapies. We found that TNBC models contained a subpopulation in an inflamed cellular state, often also present in human breast cancer samples. Inflamed cells display evidence of heightened cGAS/STING signaling which we demonstrate is sufficient to cause tumor cell resistance to chemotherapy. Accordingly, inflamed cells were enriched in human tumors taken after neoadjuvant chemotherapy and associated with early recurrence, highlighting the potential for diverse tumor cell states to promote drug resistance.

Introduction: Despite the presence of multiple Government Health Insurance (GHI) schemes in West Bengal, the National Family Health Survey report (NFHS-5) has indicated that only 29.3% of households are covered by a health scheme. Awareness of health insurance schemes increases their utilisation. The absence of health insurance coverage results in increased out-of-pocket health expenditures, pushing families into debt. Therefore, there is a need to determine whether this lack of awareness among patients contributes to the issue. Aim: To estimate the awareness level, enrollment in GHI schemes, experiences of their utilisation, and to determine the contributory factors of awareness and enrollment among patients attending the Outdoor Patient Departments (OPDs) at a tertiary care hospital in Kolkata. Materials and Methods: An observational cross-sectional study was conducted from April 2023 to June 2023 at Medical College, Kolkata, West Bengal, India. A total of 390 respondents were chosen using a systematic random sampling technique and were interviewed using a predesigned, pretested, and semistructured questionnaire. Data were analysed using R Studio version 4.3.0. A p-value

Umbilicus is a rare site of endometrioma. Spontaneous or primary umbilical endometrioma are still rarer. A 41years old primipara presented with 1.5 years history of nodular umbilical swelling with cyclical pain and increase in size occurring more pronounced during menses with no prior history of any abdominal surgery or procedure or abdominal trauma. Clinical history gave a likely possibility of umbilical endometrioma. Surgical excision was done as she had not responded to prior hormonal treatment and histopathology confirmed the diagnosis.

Abstract Macrophages are associated with innate immune response and M1-polarized macrophages exhibit pro-inflammatory functions. Nanoparticles of natural or synthetic compounds are potential triggers of innate immunity. As2O3 is the major component of the homeopathic drug, Arsenic album 30C.This has been claimed to have immune-boosting activities, however, has not been validated experimentally. Here we elucidated the underlying mechanism of Ars. alb 30C-mediated immune priming in murine macrophage cell line. Transmission Electron Microscopy (TEM) and X-ray diffraction (XRD) used for the structural analysis of the drug reveals the presence of crystalline As2O3 nanoparticles of cubic structure. Similarly, signatures of M1-macrophage polarization were observed by surface enhanced Raman scattering (SERS) in RAW 264.7 cells with concomitant over expression of M1 cell surface marker, CD80 and transcription factor, NF-κB, respectively. We also observed a significant increase in pro-inflammatory cytokines like iNOS, TNF-α, IL-6, and COX-2 expression with unaltered ROS and apoptosis in drug-treated cells. Enhanced expression of Toll-like receptors 3 and 7 were observed both in transcriptional and translational levels after the drug treatment. In sum, our findings for the first time indicated the presence of crystalline As2O3 cubic nanostructure in Ars. alb 30C which facilitates modulation of innate immunity by activating macrophage polarization.

Introduction: Neurobiological understanding of schizophrenia and bipolar disorder has revealed presence of structural brain changes in areas of brain controlling cognition. These cognitive deficits have been hypothesized to have been present as endophenotype which further deteriorate and precipitate mood episode and psychotic episode. The presence of these deficits early in the course of illness only supports the hypothesis. The study was conducted with the aim to describe the cognitive pattern in patients with treatment naiive schizophrenia and first episode bipolar affective disorder and to study the correlation between the deficits and severity of disorder. Methodology: The study was conducted in a zonal service hospital wherein successive patients of BPAD and schizophrenia, between the age group of 20-45 years, studied at least up to class 5, with no evidence of past psychiatric or neurological illness or other physical comorbidity were included in the study. Age and sex matched unrelated controls were selected from the general population. The groups where administered PGI memory scale, Bhatia's short battery of performance test for adults and Verbal assessment of intelligence scale for adults (VAIS) by the clinical psychologist. Symptom severity was scored on PANSS, YMRS and HAM-D respectively. SPSS program for windows, version 17.0 was used. Continuous variables were compared using ANOVA. Categorical variables were analysed using the chi square test. Results: There was significant deficit in cognitive functioning in treatment naive schizophrenia and first episode BPAD compared to matched controls. The cognitive domain of visual retention was comparatively more impaired in patients with BPAD. Other cognitive domains did not show any difference between the two groups. The cognitive deficits in patients with bipolar disorder did not show any correlation with symptom severity (YMRS, HAM-D) whereas negative symptoms in schizophrenia showed positive correlation with dysfunction in memory scale and performance tests. Conclusion: The findings of our study was in line with the existing literature. The presence of cognitive deficits in treatment naiive schizophrenia and first episode bipolar disorder confirms the neuropathological hypothesis of the disorders and challenges the dichotomy of the two disorders.

Abstract Detecting potholes and traffic signs is crucial for driver assistance systems and autonomous vehicles, emphasizing real-time and accurate recognition. In India, approximately 2500 fatalities occur annually due to accidents linked to hidden potholes and overlooked traffic signs. Existing methods often overlook water-filled and illuminated potholes, as well as those shaded by trees. Additionally, they neglect the perspective and illuminated (nighttime) traffic signs. To address these challenges, this study introduces a novel approach employing a cascade classifier along with a vision transformer. A cascade classifier identifies patterns associated with these elements, and Vision Transformers conducts detailed analysis and classification. The proposed approach undergoes training and evaluation on ICTS, GTSRDB, KAGGLE, and CCSAD datasets. Model performance is assessed using precision, recall, and mean Average Precision (mAP) metrics. Compared to state-of-the-art techniques like YOLOv3, YOLOv4, Faster RCNN, and SSD, the method achieves impressive recognition with a mAP of 97.14% for traffic sign detection and 98.27% for pothole detection.

Abstract The present study was conducted to evaluate the genetic variability for morphological and qualitative traits of Coccinia for development of trait specific lines at ICAR-Central Horticultural Experiment Station (CIAH-RS), Panchmahals (Godhra), Gujarat during 2020–2022. In this study, we evaluated 26 gynoecious accessions to assess the genetic divergence through principal component and cluster analysis. The experiment was carried out in a randomized complete block design with three replications under rainfed semi-arid conditions. High values of PCV and GCV were observed for variables such as NFFP (25.13 and 22.20), PL (23.14 and 20.69), FD (24.01 and 21.46), AFW (22.98 and 20.13), NFPY (26.38 and 24.40), FYP (37.57 and 31.29), FY (35.55 and 33.20), AsC (28.65 and 27.73), Ac (24.32 and 21.06), TSS (37.23 and 35.94), DPPHL (20.71 and 20.38), FRAPL (21.08 and 20.92), TPF(20.81 and 20.45) respectively. High heritability coupled with high genetic advance as per cent of mean was observed for vine length (VL), internodal length (IL), number of female flowers per plant (NFFP), fruit length (FL), peduncle length (PL), fruit diameter (FD), average fruit weight (AFW), number of fruit per plant per year (NFPY), fruit yield per plant (FYP), fruit yield (FY), ascorbic acid (AsC), acidity (Ac), total soluble solids (TSS), total phenols in leaves TPL), total flavonoids in leaves TFL, CUPRAC in leaves (CUPRACL), DPPH in leaves (DPPHL), FRAP in leaves (FRAPL), Total phenols in fruits (TPF), Total flavonoids in fruits (TFF), CUPRAC in fruits (CUPRACF) and DPPH in fruits (DPPHF). The FYP exhibited a significant positive correlation with variables like VL (0.6833), IL (0.2991), NFFP (0.8107), FD (0.5245), AFW (0.6766), NFPY (0.7659), ASC (0.4611), TSS (0.5004) and TPF (0.4281). The estimates of genetic parameters revealed scope for further improvement of fruit yield by selection. Of the eight principal components, PC-I through PC-VIII had eigen values greater than 1 and it accounts 85.02% of the total variation for 26 gynoecious accessions of Ivy gourd. The eigen values of PC-I comprised 5.775% of total variation followed by PC-II (4.250%), PC-III (3.175%), PC-IV (2.588%), PC-V (1.828%), PC-VI (1.447%), PC-VII (1.179%) and PC-VIII (1.013%).The cluster VI and cluster I having highest mean values for most of traits under study. Thus, genotypes from the distinct cluster like cluster VI and I for should be used for selection of parents and varietal improvement for further breeding programme in ivy gourd.

Trends and factors associated with cervical cancer screening (CCS) among women of reproductive age are essential for designing cancer prevention strategies to reduce mortality. The present study investigates the factors contributing to CCS in India through multilevel modeling on data from women files of the fifth round of the National Family Health Survey (NFHS- 5). Districts, villages, and individuals were considered as the levels under investigation. Age, contraception use, and wealth index impacted the CCS significantly. The percentage of CCS is 1.2, and it varies across socioeconomic factors. The prevalence of cervical cancer screening is high among women in the 30–49 age group, in the rich wealth index, and not utilizing condoms as contraception. The screening percentage was found to be highest in southern states. A pressing need was felt for organizing awareness camps and all-inclusive dissemination of information, especially in the Northern part of India.

Background Recent innovations are making radiology more advanced for patient and patient services. Under the immense burden of radiology practice, Artificial Intelligence (AI) assists in obtaining Computed Tomography (CT) images with less scan time, proper patient placement, low radiation dose (RD), and improved image quality (IQ). Hence, the aim of this study was to evaluate and compare the positioning accuracy, RD, and IQ of AI-based automatic and manual positioning techniques for CT kidney ureters and bladder (CT KUB). Methods This prospective study included 143 patients in each group who were referred for computed tomography (CT) KUB examination. Group 1 patients underwent manual positioning (MP), and group 2 patients underwent AI-based automatic positioning (AP) for CT KUB examination. The scanning protocol was kept constant for both the groups. The off-center distance, RD, and quantitative and qualitative IQ of each group were evaluated and compared. Results The AP group (9.66±6.361 mm) had significantly less patient off-center distance than the MP group (15.12±9.55 mm). There was a significant reduction in RD in the AP group compared with that in the MP group. The quantitative image noise (IN) was lower, with a higher signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the AP group than in the MP group (p

Objectives Diabetes care remains unavailable and unaffordable for many people. Adapting models of care to low-income and middle-income country contexts is a priority. Digital technology offers substantial potential yet must surmount health system, technological and acceptability issues. This formative research aimed to identify the potential for a digital technology solution (Diabetes Compass) to address diabetes care gaps in primary healthcare.Design Qualitative research was conducted in selected districts of Sri Lanka and Tanzania with practitioners, patients and family members. In-depth interviews assessed how digital solutions may improve diabetes care, acceptability and usability; contextual and clinical observations identified practitioner clinical competencies, strengths and weaknesses, and the influence of the care environment on service delivery; and workshop discussions explored strategies to encourage digital solution uptake and sustain use.Setting The research was undertaken in 2022 at nine health facilities in Sri Lanka’s Southern Province (Galle), and 16 health facilities in Tanzania’s Lindi and Pwani Regions.Participants Participants included primary and secondary care practitioners, facility managers, patients and family members.Results There was striking concordance in the diabetes care gaps and potential for digital solutions in the two countries, and between practitioners, patients and family members. Five main gaps were practitioner training; health information systems and data; service delivery; infrastructure, equipment and medication; and community awareness and knowledge. Practitioners, patients and family members saw strong potential for digital solutions to improve early detection, diagnosis, secondary prevention of complications and improve patients’ and families’ experience of living with diabetes. They identified specific design and implementation considerations to enable the Diabetes Compass to realistically meet these needs and overcome challenges.Conclusion There was a strong appetite among practitioners, patients and family members for a digital solution to strengthen diabetes care. Their experience of challenges and practical recommendations informed the Diabetes Compass design.

Obstructive sleep apnea (OSA) encompasses a diverse population, manifesting with or without symptoms of excessive daytime sleepiness. There is contention surrounding the significance of non-sleepy OSA within clinical contexts and whether routine treatment is warranted. This study aims to evaluate epidemiological and clinical distinctions between sleepy and non-sleepy OSA patients. A retrospective analysis was conducted on consecutive patients undergoing polysomnography for OSA assessment at tertiary care hospitals between 2018 and 2023. For 176 of 250 patients, complete polysomnography records with OSA diagnoses were available. Non-sleepy OSA was defined when a patient had an Epworth sleepiness scale score

Persistent air leaks in patients with pneumothorax can lead to significant morbidity. If a patient with persistent air leak is medically unfit for thoracic surgery, medical pleurodesis via chest tube or thoracoscopy is either an option. Thoracoscopy offers the advantage of visualizing the site of the air leak and enabling direct instillation of the pleurodesis agent or glue at that location. Autologous blood patch instillation via chest tube has been reported to be a cheap and very effective technique for the management of persistent air leaks. However, thoracoscopic blood patch instillation has not been reported in the literature. We report two cases of secondary spontaneous pneumothorax in which patients had persistent air leaks for more than seven days and were subjected to thoracoscopy to locate the site of the leak. In the same sitting, 50 mL of autologous blood patch was instilled directly at the leak site. Post-procedure, the air leak subsided in both patients, and the chest tube was removed with complete lung expansion. We also conducted a systematic review of the use of medical thoracoscopic interventions for treating persistent air leaks.

Adenomatoid Odontogenic Tumour (AOT) is a rare odontogenic neoplasm that primarily affects adolescents and young adults. The present case report discusses the presentation, diagnosis, and successful surgical management of AOT in a 14-year-old patient with a six-month history of upper left jaw swelling. Radiological investigations confirmed the lesion’s characteristics, leading to a provisional diagnosis of AOT. Subsequently, surgical enucleation and histopathological examination {Haematoxylin and Eosin (H&E)} confirmed the diagnosis. The patient showed no recurrence during follow-up at three weeks and six months postsurgery, with excellent functional and aesthetic outcomes. Postoperative follow-up is essential for optimal patient care and long-term outcomes. The present case report contributes to the existing literature on AOT, providing real-world clinical insights and data, which aids in a better understanding and management of this rare condition.

Introduction: Epilepsy is one of the most prevalent noncommunicable neurologic conditions, accounting for significant disability and mortality. The effects of Antiepileptic Drugs (AEDs) on total cholesterol, triglycerides, High-Density Lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, and apolipoprotein levels have been demonstrated in many studies, mainly conducted with adults. However, there have been very few studies in children. Derangement of lipid profile and other metabolic abnormalities could lead to the development of metabolic syndrome in children. The adverse metabolic effects of anti-epileptics are underestimated, as only a few studies have been done in this area, which is a legitimate concern. Aim: To assess the impact of AEDs on metabolic parameters in children with epilepsy. Materials and Methods: This was a descriptive, crosssectional study conducted in the Department of Paediatrics and Pharmacology at Pt. BD Sharma PGIMS, Rohtak, Haryana, India. The study included 100 children with epilepsy from May 2022 to October 2022. A predefined case record form, including demographic and clinical characteristics, was filled for each participant. The parameters recorded were age, gender, outpatient number, type of epilepsy, history of duration of epilepsy, current AED history, and seizure frequency over the preceding six months, as per the case record form. Guidelines from the International Diabetes Federation were used for diagnosing metabolic syndrome in children. The data was entered into Microsoft excel and presented using descriptive statistics. The chi-square test was used to differentiate between categorical variables. Results: The mean age of the study participants was 10.2±2.97 years. There were more males (62%) than females (38%). A 48% of the patients received monotherapy, while 52% received polytherapy. A total of 24% of the patients had derangement in lipid profile (increased triglycerides and decreased HDL), with 14% of patients on monotherapy and 10% on polytherapy. The difference in metabolic derangements between monotherapy and polytherapy was not statistically significant (p=0.25). Out of 100 participants, 3% fulfilled the criteria for metabolic syndrome, with a predominance in males. Conclusion: Metabolic derangements are known with 1st generation AEDs, but 2nd generation AEDs can also lead to significant metabolic abnormalities.

Introduction: Breakfast has long been considered the most important meal of the day, yet the frequency of breakfast consumption has declined in recent decades. Adequate breakfast habits are related to optimal physiological, psychological, and social health. Aim: To assess the breakfast eating habits of medical students and find the association between breakfast habits and academic performance. Materials and Methods: A cross-sectional, observational study was carried out in the Department of Physiology at Shaheed Hasan Khan Mewati (SHKM) Government Medical College, Nuh, Haryana, India. The duration of the study was three months from July 2022 to September 2022. A total of 350 apparently healthy medical undergraduates from the second year to final year participated in the study. Breakfast eating patterns and other characteristics of the morning meal consumed by participants were assessed using a structured proforma. Participants were divided into three groups (regular, irregular, and skippers) based on the frequency of breakfast consumption. Academic performance was assessed based on the aggregate marks (%) obtained in the university examination. Data were compiled and analysed using Statistical Package for Social Sciences (SPSS) software version 20.0 (SPSS Inc., Chicago, IL, USA). One-way Analysis of Variance (ANOVA) was used to compare academic performance (% marks) among the breakfast groups, and the relationship between the aforementioned variables was determined using Pearson’s Chi-square test. A p-value of

Aims and objective: The main aim of this study was to employ non-invasive methodologies, such as evaluating the portal vein diameter (PVD) and the size of the spleen, as well as the ratio of platelet count to splenic length, in order to identify individuals with cirrhosis who are at a heightened risk of developing esophageal varices. Materials and Methods: The present study utilized a descriptive analysis methodology to investigate a cohort of 50 individuals who received a diagnosis of liver cirrhosis. The individuals, ranging in age from 35 to 70 years, were subjected to both ultrasonography and upper gastrointestinal endoscopy. The statistical analysis was performed utilizing the one-way analysis of variance (ANOVA) and chi-square tests within the Stata 14 software. Results: In the sample of 50 patients, it was shown that 23 individuals (46%) demonstrated a PVD greater than 12mm. Additionally, a statistically significant correlation was observed between an increase in PVD and a rise in variceal grading. Additionally, it was noted that a total of 31 individuals, including 62% of the sample, displayed a splenic size above 13 cm. Nevertheless, no statistically significant positive connection was observed between the increase in splenic size and the grading of varices. The positive predictive value of a platelet count/spleen length ratio less than 909 is 100%. Conclusion: The application of ultrasound-guided measurement of PVD exceeding 12.0 mm and splenic size exceeding 13.0 cm can be considered a dependable and independent approach for predicting the presence of varices in persons with a diagnosis of cirrhosis. The reliability of predicting esophageal varices is higher when using the platelet count/spleen length ratio of less than 909, as opposed to relying solely on spleen size. However, in cases where there has been no previous instance of gastrointestinal bleeding, it is recommended to consider the use of surveillance endoscopy if any of these predictors are identified in individuals with cirrhosis.

Retroperitoneal cystic tumours often cause a diagnostic dilemma and present several clinical challenges because of their rarity, relative late presentation, anatomical location, close relationship with several vital structures in the retroperitoneal space and the surgical expertise required for the management. We present three challenging retroperitoneal cystic space occupying lesions – hydatid cyst, dermoid cyst, and cystic lymphangioma. All 3 cases underwent surgery after initial diagnostic difficulty and had smooth postoperative recovery. Retroperitoneal cyst needs surgical expertise for complete excision which is often difficult due to neighbouring important vital anatomical structures.

Aims and Objectives: The study aimed to assess the efficacy of incisional negative pressure wound therapy (iNPWT) in reducing the risk of suture site infections (SSI) in patients undergoing post-operative emergency non-traumatic laparotomy. Materials and Methods: A cross-sectional observational prospective study was conducted in a tertiary care setup in a rural area between March 2018 and July 2018. Fifty emergency exploratory laparoto-mies performed for non-traumatic reasons were included. Patients were randomized into two groups: one receiving conventional povidone-iodine dressing and the other receiving iNPWT over the main wound. After 7 days, SSI was assessed using the center for disease control and prevention's criteria. Results: iNPWT demonstrated a significant reduction in the risk of SSI development when compared to conventional povidone-iodine dressing (p

Background: The aim of the study was to analyze the prevalence of Kell antigen and its correlation to major blood groups, ABO & Rh system in Eastern India. There was simultaneous retrospective analysis of Kell alloimmunization to find out the implication and recommendation of transfusion protocols in multi-transfused thalassemia and sickle cell patients. Methods: The study was a prospective observational conducted on 3000 donors for KELL and ABO grouping. Retrospective analysis was made to identify common alloantibodies in multi-transfused patients. Results: The overall prevalence of Kell antigen was 2.6% (80) in 3000 donors. Among male, it was highly prevalent i.e. 2.77% and in females 0.65%. Kell antigen was highly prevalent among AB donors, i.e. 5.1%. It was 2.5% in A, 2.9% in B, 1.9% in Blood Donors. Kell prevalence was high in Rh D positive donors, i.e. 2.72% and was 1.72% among Rh D negative donors. Anti-K was the 3rd most common alloantibody detected in 638 cases of multi-transfused thalassemia and sickle cell (SCD) patients (9.25%). Anti-E (42.6%)was most common entity followed by anti-c (24.0%). Conclusion: The higher incidence of Kell prevalence in AB & Rh D Positive Blood groups and also in male persons indicate that there should be a donor database and knowledge of red cell antigen prevalence in a population. This will help blood centers in providing antigen negative compatible blood units to patients with corresponding alloantibodies. Hemolytic transfusion reactions due to Kell alloimmunization are of a significant severity. Prevalence of Kell alloantibody is high among multi-transfused patients and is next to anti E & anti c. Kell sensitized mothers may also cause serious consequences like hemolytic disease of fetus and newborn. Therefore, it is suggested that extended phenotyping including Kell blood group antigen should be implemented in cases of multi-transfused patients. Keywords: Blood donors, Extended phenotyping, Kell, Multitransfused thalassemia patients, Multitransfused sickle cell disease patients

Abstract We present an innovative approach to achieve all-optical modulation within an ITO-based vertically coupled ring resonator. This method leverages the material's enhanced nonlinear response in the near-infrared wavelengths, particularly within the epsilon-near-zero (ENZ) state. To enhance the interaction between light and the material while minimizing scattering losses, our approach employs an ITO-based vertically connected ring resonator. The vertical arrangement eliminates the need for etching fine gaps to separate the ring and bus waveguide. The novel waveguide design addresses the necessity of high sensitivity, non-linear effects and compact size opening the possibilities for all-optical signal processing. This unique resonator structure effectively facilitates the coupling of a high-intensity pump wavelength into the ITO-based micro-ring resonator. Consequently, this optical pumping induces electron heating within the ITO material, leading to a significant increase in its nonlinear optical properties. This, in turn, results in a noteworthy alteration of ITO's refractive index, specifically in the unity order, thereby modifying the complex effective index of the optical beam propagating at 1550 nm. Our experimental findings demonstrate an impressive extinction ratio of 18 dB for a 30 µm long device, which highlights the efficiency of our approach in achieving all-optical modulation through the optical pumping of an ITO-based vertically coupled ring resonator. The proposed all-optical modulator has outperformed as compared to conventional waveguide-based modulators in terms of extinction ratio and footprint. This novel technique holds immense potential for advancing high-speed data communication systems in the future. As the demand for advanced processing capabilities, such as artificial intelligence, continues to grow, all-optical modulation emerges as a groundbreaking technology poised to revolutionize the next generation of computing and communication systems.

Abstract The certification of wine quality is essential to the wine industry. The main goal of this work is to develop a machine learning model to forecast wine quality using the dataset. We utilised samples from the red wine dataset (RWD) with eleven distinct physiochemical properties. With the initial RWD, five machine learning (ML) models were trained and put to the test. The most accurate algorithms are Random Forest (RF) and Extreme Gradient Boosting (XGBoost). Using these two ML approaches, the top three features from a total of eleven features are chosen, and ML analysis is performed on the remaining features. Several graphs are employed to demonstrate the feature importance based on the XGBoost model and RF. Wine quality was predicted using relevant characteristics, often referred to as fundamental elements, that were shown to be essential during the feature selection procedure. When trained and tested without feature selection, with feature selection (RF), and with key attributes, the XGBoost classifier displayed 100% accuracy. In the presence of essential variables, the RF classifier performed better. Finally, to assess the precision of their predictions, the authors trained an RF classifier, validated it, and changed its hyperparameters. To address collinearity and decrease the quantity of predictors without sacrificing model accuracy, we have also used cluster analysis.

This study investigated how Rhus toxicodendron (RT) (6C, 30C, and 200C) can boost the immune system of BALB/c mice that were given cyclophosphamide (CPM), which is an anticancer drug that weakens the immune system. RT, known for its historical use in traditional homeopathic remedies, has demonstrated immunomodulatory and anti-inflammatory effects in various experimental models. To test the immune-boosting effects of RT, CPM (80 mg/kg) was given intraperitoneally to mice on days 4, 8, and 12 of the study but not to the normal control group. CPM-induced immunosuppression led to significant decreases in red blood cell (RBC), white blood cell (WBC), and hemoglobin (Hb) levels, and reduced spleen and thymus indices. Phagocytic activity, cytokine concentrations, and spleen architecture were also adversely affected. RT treatment, particularly at 200C, significantly ameliorated these effects, improving RBC, WBC, and Hb levels. Furthermore, RT partially prevented CPM-induced atrophy of immune organs. Treatment positively influenced cytokine production at both the protein and mRNA levels, restoring immune balance. Histopathological results confirmed that RT stimulated the immune system. The cells were more stable, and the white pulp in the spleen was arranged in a regular pattern. These findings suggest that RT may serve as an adjunctive immunostimulant therapy for conditions characterized by immunosuppression. However, further investigations in other immunocompromised states must validate these results before considering human clinical trials.

Abstract Background Multimorbidity among older adults is a growing concern in India. Multimorbidity is defined as the coexistence of two or more chronic health conditions in an individual. Primary studies have been conducted on risk factors of multimorbidity in India, but no systematic review has been conducted on this topic. This systematic review aimed to synthesize the existing evidence on risk factors of multimorbidity among older adults in India. Methods The JBI and Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines were followed. Several databases were searched for published and unpublished studies until August 03, 2022. The screening of titles and abstracts and full texts, data extraction, and quality assessment were conducted by two independent reviewers. Any disagreements were resolved through discussion or by involving a third reviewer. Data synthesis was conducted using narrative synthesis and random effects meta‐analysis, where appropriate. Results Out of 8781 records identified from the literature search, 16 and 15 studies were included in the systematic review and meta‐analysis, respectively. All included studies were cross‐sectional, and 10 met a critical appraisal score of more than 70%. Broadly, sociodemographic, lifestyle, and health conditions‐related factors were explored in these studies. The pooled odds of multimorbidity were higher in people aged ≥70 years compared to 60‐69 years (odds ratio (OR) 1.51; 95% confidence interval (CI) 1.20–1.91), females compared to males (1.38; 1.09–1.75), single, divorced, separated, and widowed compared to married (1.29; 1.11–1.49), economically dependent compared to economically independent (1.54; 1.21–1.97), and smokers compared to non‐smokers (1.33; 1.16–1.52) and were lower in working compared to not working (0.51; 0.36–0.72). Conclusion This systematic review and meta‐analysis provided a comprehensive picture of the problem by synthesizing the existing evidence on risk factors of multimorbidity among older adults in India. These synthesized sociodemographic and lifestyle factors should be taken into consideration when developing health interventions for addressing multimorbidity among older adults in India.

Aims Development of non-invasive and minimally invasive glucose monitoring devices (NI-MI-GMDs) generally takes place in high-income countries (HICs), with HIC’s attributes guiding product characteristics. However, people living with diabetes (PLWD) in low-income and middle-income countries (LMICs) encounter different challenges to those in HICs. This study aimed to define requirements for NI-MI-GMDs in LMICs to inform a target product profile to guide development and selection of suitable devices.Methods This was a multiple-methods, exploratory, qualitative study conducted in Kyrgyzstan, Mali, Peru and Tanzania. Interviews and group discussions/activities were conducted with healthcare workers (HCWs), adults living with type 1 (PLWD1) or type 2 diabetes (PLWD2), adolescents living with diabetes and caregivers.Results Among 383 informants (90 HCW, 100 PLWD1, 92 PLWD2, 24 adolescents, 77 caregivers), a range of differing user requirements were reported, including preferences for area of glucose measurement, device attachment, data display, alert type and temperature sensitivity. Willingness to pay varied across countries; common requirements included ease of use, a range of guiding functions, the possibility to attach to a body part of choice and a cost lower than or equal to current glucose self-monitoring.Conclusions Ease-of-use and affordability were consistently prioritised, with broad functionality required for alarms, measurements and attachment possibilities. Perspectives of PLWD are crucial in developing a target product profile to inform characteristics of NI-MI-GMDs in LMICs. Stakeholders must consider these requirements to guide development and selection of NI-MI-GMDs at country level, so that devices are fit for purpose and encourage frequent glucose monitoring among PLWD in these settings.