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Abstract Due to the excessive growth of PM 2.5 in aerosol, the cases of lung cancer are increasing rapidly and are most severe among other types as the highest mortality rate. In most of the cases, lung cancer is detected with least symptoms at its later stage. Hence, clinical records may play a vital role to diagnose this disease at the correct stage for suitable medication to cure it. To detect lung cancer an accurate prediction method is needed which is significantly reliable. In the digital clinical record era with advancement in computing algorithms including machine learning techniques opens an opportunity to ease the process. Various machine learning algorithms may be applied over realistic clinical data but the predictive power is yet to be comprehended for accurate results. This paper envisages to compare twelve potential machine learning algorithms over clinical data with eleven symptoms of lung cancer along with two major habits of patients to predict a positive case accurately. The result has been found based on classification and heat map correlation. K-Nearest Neighbor Model and Bernoulli Naive Bayes Model are found most significant methods for early lung cancer prediction.

Abstract It is well-established that women are disproportionately affected by Alzheimer’s disease. The mechanisms underlying this sex-specific disparity are not fully understood, but several factors that are often associated-including interactions of sex hormones, genetic factors, and the gut microbiome-likely contribute to the disease's etiology. Here, we have examined the role of sex hormones and the gut microbiome in mediating Aβ amyloidosis and neuroinflammation in APPPS1-21 mice. We report that postnatal gut microbiome perturbation in female APPPS1-21 mice leads to an elevation in levels of circulating estradiol. Early stage ovariectomy (OVX) leads to a reduction of plasma estradiol that is correlated with a significant alteration of gut microbiome composition and reduction in Aβ pathology. On the other hand, supplementation of OVX-treated animals with estradiol restores Aβ burden and influences gut microbiome composition. The reduction of Aβ pathology with OVX is paralleled by diminished levels of plaque-associated microglia that acquire a neurodegenerative phenotype (MGnD-type) while estradiol supplementation of OVX-treated animals leads to a restoration of activated microglia around plaques. In summary, our investigation elucidates the complex interplay between sex-specific hormonal modulations, gut microbiome dynamics, metabolic perturbations, and microglial functionality in the pathogenesis of Alzheimer's disease.

Introduction: Transsphenoidal resection of pituitary tumours presents challenges for an anaesthesiologist due to haemodynamic fluctuations caused by intense nociceptive stimuli during different surgical stages. This relatively short procedure requires a smooth and rapid emergence for spontaneous airway control and assessment of surgical outcomes. Therefore, the chosen anaesthetic agent should provide effective haemodynamic control and facilitate rapid recovery. Alpha-2 agonists such as dexmedetomidine and clonidine are known to centrally decrease noradrenaline release, thus reducing sympathetic outflow. This could be particularly beneficial in minimising haemodynamic fluctuations during such surgeries. Aim: To compare the effects of preoperative clonidine and perioperative dexmedetomidine in attenuating haemodynamic responses and blood loss in patients undergoing elective Transnasal Transsphenoidal resection (TNTS) of pituitary tumours. Materials and Methods: A randomised, double-blinded study was conducted in the Department of Neuroanesthesiology at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, over a period of one year, from February 2022 to January 2023. Sixty patients of either sex, aged 18-65 years with ASA I or II, scheduled for elective TNTS pituitary surgery, were enrolled and divided into group A and group B. Group A received clonidine tablets (3 mcg/kg) 180 minutes prior to surgery, while group B received intravenous (i.v.) infusion of dexmedetomidine (1 mcg/kg/min) over 10 minutes before induction, followed by 0.5-0.7 mcg/kg/hr. Group A received a placebo of 0.9% Normal Saline (NS) (50 mL). Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP) were recorded at baseline, intubation, nasal pack insertion, endoscope insertion, and at various time intervals. Data obtained were analysed using unpaired sample t-test for independent groups, and Chi-square test was used for categorical data. A probability value of 0.05 was considered significant for both statistical tests. Results: The mean age of participants was 42±11 years for group A and 43±12 years for group B, with a male: female ratio of 66.6% to 33.3% in group A and 70% to 30% in group B, respectively. The mean Body Mass Index (BMI) was 26.4±3.2 in group A and 25.2±1.7 in group B. HR, SBP, and MAP decreased at various stages in group B compared to group A, and these differences were statistically significant (p-value

Key Clinical Message Cerebral Venous Sinus Thrombosis (CVST) is a subtype of venous thromboembolism, which occurs in the dural venous sinuses. Blockage of the venous drainage of the brain leads to the development of hemorrhages. Strokes can hence develop in any individual, irrespective of age or sex. CVST is a very serious condition requiring immediate thrombolysis to prevent residual neurological deficits. We report the case of a lady aged 25 years, who presented to the emergency department with a severe diffuse headache for 4 days, associated with vomiting. This was followed by multiple episodes of seizures and altered sensorium the previous day. She had been taking desogestrel for the past 2 months. On examination, the patient was unconscious and febrile (102.8 F). On admission, Glasgow Coma Scale score of E2V2M3 and bilateral extensor plantar response were noted. Signs of meningeal irritation were absent. Her pupils were mid‐dilated, sluggishly reactive to light, and papilledema was present bilaterally. Based on imaging studies, she was diagnosed with a case of CVST. Her homocysteine levels were elevated. She recovered on appropriate treatment and was discharged on Ryle's feeding tube after 26 days of hospital stay with a Glasgow Coma Scale score of E4V5M6 and a flexor plantar response. The case emphasizes the need to rule out CVST in young adult females on oral contraceptive pills (OCP) presenting with severe neurological dysfunction. Vigilant screening, clinical suspicion and timely management can help cut down the associated mortality and morbidity in such cases.

Background In India first wave of COVID-19 pandemic was followed by a massive surge of COVID-19 cases. Present study was conducted to compare demographic characteristics, clinical and mortality profile of admitted patients during first and second waves of coronavirus outbreak. Methods: This was a cross-sectional analytical study of medical records of admitted patients in a tertiary care centre. Medical records of 500 patients in each of the two waves were chosen randomly for study. Each record included demographic details and clinical records of patients. Statistical analysis: Data was entered on Microsoft Excel 2013, and analysed using STATA version 17. 0. Chi-square test was used for comparison of qualitative data and for quantitative data unpaired t-test was used.

Abstract Blood–brain barrier (BBB) dysfunction is emerging as a key pathogenic factor in the progression of Alzheimer’s disease (AD), where increased microvascular endothelial permeability has been proposed to play an important role. However, the molecular mechanisms leading to increased brain microvascular permeability in AD are not fully understood. We studied brain endothelial permeability in female APPswe/PS1∆E9 (APP/PS1) mice which constitute a transgenic mouse model of amyloid-beta (Aβ) amyloidosis and found that permeability increases with aging in the areas showing the greatest amyloid plaque deposition. We performed an unbiased bulk RNA-sequencing analysis of brain endothelial cells (BECs) in female APP/PS1 transgenic mice. We observed that upregulation of interferon signaling gene expression pathways in BECs was among the most prominent transcriptomic signatures in the brain endothelium. Immunofluorescence analysis of isolated BECs from female APP/PS1 mice demonstrated higher levels of the Type I interferon-stimulated gene IFIT2. Immunoblotting of APP/PS1 BECs showed downregulation of the adherens junction protein VE-cadherin. Stimulation of human brain endothelial cells with interferon-β decreased the levels of the adherens junction protein VE-cadherin as well as tight junction proteins Occludin and Claudin-5 and increased barrier leakiness. Depletion of the Type I interferon receptor in human brain endothelial cells prevented interferon-β-induced VE-cadherin downregulation and restored endothelial barrier integrity. Our study suggests that Type I interferon signaling contributes to brain endothelial dysfunction in AD.

Burkholderia cepacia complex (BCC) represent a group of opportunistic organisms that cause a wide variety of infections including the nosocomial. The organism is found to cause sepsis and is also reported to cause blood stream infections in malignancy. Here, we present a case series of five patients with sepsis in which an unsual violet pigment producing BCC was isolated. Keywords: Violet pigment, Burkholderia, Sepsis, Malignancy

Introduction: Hearing impairment is caused by damage in the inner ear (can be even birth defect), ear infection, ruptured eardrum and so on. It can be prevented using early detection thus, helps in avoiding severe psychosocial, educational, and linguistic repercussions. Infants, who are not diagnosed of hearing impairment before six months of age, will have delays in speech and language development. Aim: To determine the prevalence of hearing impairment in high-risk neonates and to establish the fact that, these neonates have higher prevalence of hearing impairment as compared to normal population. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at Jawaharlal Nehru Medical College and Hospital, Ajmer, Rajasthan, India. The duration of the study was six months, from December 2012 to May 2013. A total of 500 babies including 297 normal and 203 high-risk babies were enrolled into the study. All the neonates were screened using Behavioural Observation Audiometry (BOA) and Distortion Product Oto-acoustic Emission (DPOAE) preferably within three days of life. Those, who failed under this test, underwent for Brain stem Evoked Response Audiometry (BERA). Data was collected in the Microsoft Excel and analysis done by Statistical Package for Social Sciences (SPSS) version 23.0. Results: The mean age of the newborns on admission, was 3.86±4.25 days and the mean weight was 2560±510 g. Out of 500 newborns screened, 58 babies had abnormal results with the first screening test. When these 58 babies subjected to BERA, eight babies showed Hearing Loss (HL). Sepsis, Neonatal Intensive Care Unit (NICU) stay >5 days and use of aminoglycosides >7 days were the important risk factors associated with hearing impairment. Prevalence of hearing impairment in the present study was came out to be 16/1000. This finding was statistically significant with p-value5 days and use of aminoglycosides >7 days should have mandatory audiologic evaluation at discharge.

Introduction: Breast cancer is the most common cancer of women worldwide. Early diagnosis of it has a very important role in its management. Breast self-examination (BSE) is a key to the early diagnosis of breast cancer. Materials and Methods: A community-based cross-sectional study was conducted on 300 females of Jaipur city. This study was conducted by a house-to-house survey through a systematic random sampling technique in the field practice area of the Urban Health Training Centre (UHTC) of SMS medical college, Jaipur (Rajasthan), India. A predesigned semi-structured questionnaire containing predesigned questions regarding knowledge and practice of BSE was used to collect data. A Chi-square test was used to find out associations. Results: Only 18% of females were aware of BSE and 5.7% of the females were practicing BSE. Health professionals (31.03%) were the main source of knowledge. Only 50% of females who have heard the name of BSE, knew that it is performed by self. Awareness and practice of BSE both were found to be associated with religion, education, socioeconomic status, and occupation and there was no association with age and marital status. Females with higher education and socioeconomic status were more aware of BSE. The most common (94.69%) reason for not practicing BSE was the lack of awareness of steps followed by ‘find it unnecessary’. Conclusion: As knowledge and practice of BSE were observed very poor and considering the important role that can be played by BSE in the early diagnosis and management of breast cancer, there is an urgent need to implement and reinforce BSE in the existing cancer awareness and screening programs. IEC activities regarding BSE also motivated proper knowledge of BSE.

Objectives Though hospital leaders across the USA have invested significant resources in collection of patient-reported outcome measures (PROMs), there are very limited data on the impetus for hospital leadership to establish PROM programmes. In this qualitative study, we identify the drivers and motivators of PROM collection among hospital leaders in the USA.Design Exploratory qualitative study.Setting Thirty-seven hospital leaders representing seven different institutions with successful PROMs programs across twenty US states.Methods Semistructured interviews conducted with hospital leaders. Transcripts were analysed using thematic analysis.Results Leaders strongly believe that collecting PROMs is the ‘right thing to do’ and that the culture of the institution plays an important role in enabling PROMs. The study participants often believe that their institutions deliver superior care and that PROMs can be used to demonstrate the value of their services to payors and patients. Direct financial incentives are relatively weak motivators for collection of PROMs. Most hospital leaders have reservations about using PROMs in their current state as a meaningful performance metric.Conclusion These findings suggest that hospital leaders feel a strong moral imperative to collect PROMs, which is also supported by the culture of their institution. Although PROMs are used in negotiations with payors, direct financial return on investment is not a strong driver for the collection of PROMs. Understanding why leaders of major healthcare institutions invest in PROMs is critical to understanding the role that PROMs play in the US healthcare system.

Abstract We numerically investigate the ultrafast nucleation of antiferromagnetic (AFM) skyrmion using in-plane spin-polarized current and present its key advantages over out-of-plane spin-polarized current. We show that the threshold current density required for the creation of AFM skyrmion is almost an order of magnitude lower for the in-plane spin-polarized current. The nucleation time for the AFM skyrmion is found to be $$12-7$$ 12 - 7 ps for the corresponding current density of 1– $$3\times 10^{13}~\text{A/m}^{2}$$ 3 × 10 13 A/m 2 . We also demonstrate ultrafast nucleation of multiple AFM skyrmions that is possible only with in-plane spin polarized current and discuss how the current pulse width can be used to control the number of AFM skyrmions. The results show more than one order of magnitude improvement in energy consumption for ultrafast nucleation of AFM skyrmions using in-plane spin-polarized current, which is promising for applications such as logic gates, racetrack memory, and neuromorphic computing.

Abstract In preceding efforts, we demonstrated that antibiotic (ABX) cocktail-mediated perturbations of the gut microbiome in two independent transgenic lines, termed APP SWE /PS1 ΔE9 and APPPS1-21, leads to a reduction in Aβ deposition in male mice. To determine whether these observed reductions of cerebral Aβ amyloidosis are specific to any individual antibiotic or require the synergistic effects of several antibiotics, we treated male APPPS1-21 transgenic mice with either individual ABX or an ABX cocktail and assessed amyloid deposition. Specifically, mice were subject to oral gavage with high dose kanamycin, gentamicin, colistin, metronidazole, vancomycin, individually or in a combination (ABX cocktail) from postnatal days (PND) 14 to 21, followed by ad libitum, low-dose individual ABX or ABX cocktail in the drinking water until the time of sacrifice. A control group was subject to gavage with water from PND 14 to 21 and received drinking water till the time of sacrifice. At the time of sacrifice, all groups showed distinct cecal microbiota profiles with the highest differences between control and ABX cocktail-treated animals. Surprisingly, only the ABX cocktail significantly reduced brain Aβ amyloidosis compared to vehicle-treated animals. In parallel studies, and to assess the potential exposure of ABX to the brain, we quantified the levels of each ABX in the brain by liquid chromatography-mass spectrometry (LC-MS) at PND 22 or at 7 weeks of age. With the exception of metronidazole (which was observed at less than 3% relative to the spiked control brains), we were unable to detect the other individual ABX in brain homogenates. Our findings suggest that synergistic alterations of gut microbial consortia, rather than individual antimicrobial agents, underlie the observed reductions in brain amyloidosis.

Introduction: Glaucoma has been established as the second most leading cause of blindness after cataract, which is usually irreversible and accounts for 10.1% of total blindness worldwide. Glaucoma has affected 79.6 million people worldwide by 2020. The estimated prevalence of glaucoma in India is 12 million. The Government of India aims to reduce the prevalence of blindness to 0.25/1000 by 2025 and disease burden by one third from current levels. In a developing country, like India, ‘physician of first contact’ may be a general practitioner, resident doctor or intern. Aim: To assess knowledge of glaucoma in general practitioners, resident doctors and interns in Anand district, Gujarat and to identify the level of difference of knowledge in each group and to suggest remedial measures for the same. Materials and Methods: A descriptive semi-structured questionnaire based cross-sectional study was conducted in Pramukhswami Medical College, Karamsad, Gujarat, India, after obtaining ethical clearance from the Institutional Ethics Committee between July 2017 to September 2017. Informed written consent was taken from 240 medical doctors comprising of interns (undergoing compulsory rotatory internship), 1st to 3rd year resident doctors (postgraduate students) working in different wards of all the clinical department and general practitioners practising in radius of 15 kilometers from the main hospital located in Anand district of Gujarat state (80 in each category) and a questionnaire was administered. Participants were inquired about the knowledge of glaucoma, the sneak thief of sight. Residents of Ophthalmology were excluded to avoid bias. Cramer’s V association, Chi-square test and Fisher's-Exact tests were applied for data analysis. Results: Respondents included general practitioners, residents and interns (80:80:80). Glaucoma knowledge was to be higher in residents as compared to interns and general practitioners. About 78.75% residents scored 7 and above out of 10 whereas 61.25% interns and 50% general practitioners obtained the same score. Conclusion: The authors found that knowledge about glaucoma in multi-scale medical practitioners was not uniform and reasonably less than it should be. Resident doctors (fresh graduates and completed compulsory rotatory internship) have better knowledge about various aspects of glaucoma as compared to general practitioners and interns which demands the need for frequent reorientation programme and internship in Ophthalmology guiding about various aspects of disease entities responsible for blindness.

The present research evaluates how E-learning environment, E-learning adoption, Digital readiness, and Students attitudes towards E-learning, affect Academic achievement. The study focuses on a much-neglected cultural context, Gulf Cooperation Council countries (GCC), since Student's readiness as well as institutions and professors' endowments greatly varied within countries and among universities. The study further incorporates Instructors attitudes and evaluates the mediation effect of Academic engagement on Academic achievement. The methodology relies on Partial Least Squares structural equation modelling (PLS-SEM). The research findings emphasize the role of E-learning environment, Digital readiness, Academic engagement, students as well as instructors E-learning attitude as the decisive factors that determine students' Academic achievement. This implies that institutions who adapt to a changing environment by aligning students and instructors' goals to develop a positive and supportive E-learning environment, will foment Academic engagement and promote students' Academic achievement.

Aim: The present study was conducted to determine the podoplanin expression in odontogenic tumors and cysts. Materials and Methods: It consisted of 12 cases of the keratocystic odontogenic tumor (KCOT), 10 cases of ameloblastoma, 8 cases of dentigerous cysts (DC), 8 cases of radicular cysts (RC) and 8 dental follicles (DF) as controls which were immunohistochemically evaluated using an antibody against podoplanin. Results: Immunostaining intensity, % of PPC and total score of ameloblastoma was higher than DC and DF but less than KCOT (t- 1.48). When DC was compared with KCOT and RC, the podoplanin expression was significantly higher with DC (P < 0.05). The podoplanin expression was comparatively higher with KCOT as compared to RC and DC. OT (t-4.40) revealed higher podoplanin expression as compared to OC and DF (t-5.54). Conclusion: There was significantly higher expression of podoplanin in cases of ameloblastoma and KCOT as compared to the RC, DC and DF. Podoplanin may be considered as a useful marker to delineate the aggressiveness of ameloblastoma and KCOT.

Among all the various existing skills needed in palliative end-of-life care, none is more important the ability to communicate effectively. Terminal ill experience is the time when patients were overwhelmed with several emotional and psychological symptoms, which need the maximum amount of care, through effective communication in the most appropriate way. Effective communication is the fundamental component to physician and patient quality relationship, which make clinician to be trusted by the patient, resulting in quality decision making for patient treatment and future diagnosis plan in the clinical practices. However, looking at the present scenario of Indian health care system, the absence of good communication is visible in most of the clinical practices, which becomes the underlying reason for terminal patient receiving unwanted life sustaining medical treatment, along with inappropriate care that goes against the patient's choices. Moreover, effective communication also plays an important role in breaking the bad news to patient and family. Thus, seeing at the urgent needs of effective communication in the clinical practices, the present study is forms through fieldwork that is follow up by an analytical study. The aim of this particular research is to inquire, how important the effective communication is in terminal care, and what are the strategies for breaking bad news effectively without hurting the feelings of the dying individual's.

Root fracture has been defined as a fracture involving dentin, cementum, pulp and periodontal ligament. Depending on the level of the fracture line various treatment modalities may be employed by the clinician to promote healing. The following case reports highlight how changes in technique allow for conservative management of horizontal root fractures at different levels. This approach allows the patient to retain their natural dentition at an affordable cost and provide a viable alternative to the use of more invasive and expensive alternatives. These patients presented with complaints of pain and mobility in upper front tooth region following trauma. Diagnosis was confirmed on the basis of intra-oral periapical radiographs following which non-surgical root canal treatment was performed.

Hydatid disease is an ancient endemic parasitic infestation caused by Echinococcus granulosus, which results in the formation of hydatid cysts in various parts of the body, the liver, and lungs being the most common sites. However, in 15% to 20% of the cases it may occur in unusual sites. We report a 25-year-old male patient who presented with clinical features similar to scrofuloderma in the axillary region but confirmed from histological examination to have hydatid cyst. This case highlights the uncommon site of hydatid cyst and unusual clinical and histopathological features along with the fact that it should be kept in differential diagnosis of nodules and sinuses in the axillary region. The treatment of choice is excision along with combination of albendazole and praziquantel.

Introduction: This in-vitro study aimed to test the accuracy and reproducibility in detection of incipient occlusal caries and treatment decision making using unenhanced visual–tactile technique and low level magnification by the use of loupes and surgical operating microscope (SOM). Methodology: Sixty extracted human posterior teeth were assessed by two examiners using ICDAS- II index and CPI- TN probe, with and without magnification. Histopathology was used as gold standard for diagnosis of caries and treatment decision making. Inter and intra examiner reproducibility was determined using Kappa statistics. Results: Intraobserver reproducibility for caries detection using surgical operating microscope ranged from average to good (0.4-0.63). Inter-examiner reproducibility values for treatment decision making using experimental techniques such as unaided (0.40), Loupes (0.51) & SOM (0.63) were similar.

The amount and quality of nutrients consumed by organisms have a strong impact on stress resistance, life-history traits and reproduction. The balance between energy acquisition and expenditure is crucial to the survival and reproductive success of animals. The ability of organisms to adjust their development, physiology or behavior in response to environmental conditions, called phenotypic plasticity, is a defining property of life. One of the most familiar and important examples of phenotypic plasticity is the response of stress tolerance and reproduction to changes in developmental nutrition. Larval nutrition may affect a range of different life-history traits as well as responses to environmental stress in adult.Here we investigate the effect of larval nutrition on desiccation, starvation, chill-coma recovery, heat resistance as well as egg to adult viability, egg production and ovariole number in Drosophila ananassae. We raised larvae on either protein rich diet or carbohydrate rich diet. We found that flies consuming protein rich diet have higher desiccation and heat shock resistance whereas flies developed on carbohydrate rich diet have higher starvation and cold resistance. Egg production was higher in females developed on protein rich diet and we also found trade-off between egg production and Egg to adult viability of the flies. Viability was higher in carbohydrate rich diet. However, sex specific viability was found in different nutritional regimes. Higher Egg production might be due to higher ovariole number in females of protein rich diet.Thus, Drosophila ananassae adapts different stress tolerance and life-history strategies according to the quality of the available diet, which are correlated with phenotypic adjustment at anatomical and physiological levels.

Increase in the generation and deposition of amyloid-β (Aβ) plays a central role in the development of Alzheimer's Disease (AD). Elevation of the activity of γ-secretase, a key enzyme required for the generation for Aβ, can thus be a potential risk factor in AD. However, it is not known whether γ-secretase can be upregulated in vivo. While in vitro studies showed that expression of all four components of γ-secretase (Nicastrin, Presenilin, Pen-2 and Aph-1) are required for upregulation of γ-secretase, it remains to be established as to whether this is true in vivo. To investigate whether overexpressing a single component of the γ-secretase complex is sufficient to elevate its level and activity in the brain, we analyzed transgenic mice expressing either wild type or familial AD (fAD) associated mutant PS1. In contrast to cell culture studies, overexpression of either wild type or mutant PS1 is sufficient to increase levels of Nicastrin and Pen-2, and elevate the level of active γ-secretase complex, enzymatic activity of γ-secretase and the deposition of Aβ in brains of mice. Importantly, γ-secretase comprised of mutant PS1 is less active than that of wild type PS1-containing γ-secretase; however, γ-secretase comprised of mutant PS1 cleaves at the Aβ42 site of APP-CTFs more efficiently than at the Aβ40 site, resulting in greater accumulation of Aβ deposits in the brain. Our data suggest that whereas fAD-linked PS1 mutants cause early onset disease, upregulation of PS1/γ-secretase activity may be a risk factor for late onset sporadic AD.