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Purpose: It has been suggested that follow-up visits for pediatric patients after full-mouth dental rehabilitation (FMDR) under general anesthesia (GA) are important to evaluate healing and restorative treatment, review oral hygiene instruction, provide nutritional counseling and address guardians' concerns. The purpose of this study was to evaluate pediatric dentists' current utilization of follow-up visits after GA and to evaluate pediatric dentists' and guardians' perceptions of their purpose and value. Methods: Three separate surveys were administered: (1) pediatric dentist survey, (2) guardian pre-appointment survey and (3) guardian post-appointment survey. The guardian surveys examined their perceptions of a follow-up visit before and after FMDR under GA. The pediatric dentist survey examined current utilization and perception of follow-up appointments. Results: Most clinicians (72 percent) reported scheduling a follow-up visit. Providers generally agreed that the post-operative appointments were important (69 percent). Of the guardians who attended the follow-up visit, 96.3 percent agreed that the post- operative visit was useful. Conclusion: Both pediatric dentists and guardians of patients undergoing FMDR under GA agreed that a follow-up visit after GA was valuable despite low complication rates.

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

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

Purpose: To estimate the pattern of ocular manifestations, as observed clinically and radiologically, and associated risk factors in cases of coronavirus disease 2019 (COVID-19)-related rhino-orbital cerebral mucormycosis (ROCM) during the second wave at presentation to the hospital in northern India. Materials and Methods: A total of 35 patients of ROCM associated with active cases of COVID-19 or recovered cases of COVID-19 presenting to the Ophthalmology outpatient department or admitted in the COVID ward of the hospital with clinical features suggestive of ROCM. They were confirmed as mucormycosis on KOH and fungal cultures of nasal scrapings and histopathology of debrided tissue. This is an ambispective study with retrospective medical records review for COVID-19 analysis and prospective assessment of ROCM-associated COVID-19 during the second outbreak of the COVID-19 pandemic. Results: The total patients included were 35, which ranged in the age group of 52.91+/- 11.93 years, and the male-to-female ratio was 24:11. The duration between the first positive COVID report and onset of COVID-19-associated ROCM was 9.46+/-11.63 days. The majority (82.9%; n-29) either were diabetics or had high blood glucose levels during the recent COVID-19 infection. 45.7% of patients gave a history of steroid therapy. The most common ocular clinical features were ptosis (80%) and loss of vision 48.7%, respectively. There was diffuse involvement of sinuses in 18 cases (51.4%). Staging based on magnetic resonance imaging scans showed that 7 (20%) had stage II, 20 (57.1%) had stage III, and 28.7% had stage IV disease. Ten patients had varied intracranial extension ranging from meningitis and cavernous sinus thrombophlebitis/thrombosis to brain abscess. Conclusions: COVID-associated ROCM was very rapidly spreading and more destructive. Ptosis and loss of vision related to third nerve involvement and CRAO, respectively, were alarming signs and bad prognostic indicators to the patient. Intracranial involvement and CRAO were poor prognostic features in this type of mucormycosis.

Introduction: Osteoarthritis (OA) of the knee is a degenerative joint disease that leads to changes not only in the articular cavity but also in the ligaments, tendons and muscles. These structures play an important role in human balance, which is important for daily activities. Due to the degeneration of ligaments, tendons and muscles, OA of the knee results in balance impairment. Aim: To evaluate the test-retest reliability of the Balance Error Scoring System (BESS) in patients with OA of the knee. Materials and Methods: This cross-sectional study was conducted at Department of Physiotherapy, MMIPR, MMDU, Ambala, Haryana, India, from March 2023 to April 2024. A total of 20 participants were recruited for the study and balance was evaluated using BESS on a firm surface, first in double limb stance, then in single limb stance and finally in tandem stance, both with eyes open and closed. A single rater conducted the same process twice on a foam surface. Descriptive statistics were used to represent the demographic characteristics of the participants. Reliability was examined using both Intraclass Correlation Coefficients (ICCs) and Cronbach’s alpha was executed to check internal consistency. Results: The mean age of the participants in the present study was 49.4±10.6 years and the Body Mass Index (BMI) was 26.2±4.2. Both males 9 (45%) and females 11 (55%) were recruited for the present study. When comparing the demographic characteristics between males and females using an independent t-test, it revealed that no significant difference exists between them. The reliability analysis demonstrated excellent reliability for all parameters of BESS (ICC: 0.9). Cronbach’s alpha for all parameters was also 0.9. The limits of agreement plotted with the Bland-Altman plot indicated an excellent level of agreement, as the maximum scores fell within the 95% Confidence Interval (CI). Conclusion: Based on the findings of the present study, the authors can conclude that BESS is a reliable tool for balance assessment in patients with OA of the knee.

Background: Forensic nursing is a nursing specialty and sub-specialties that focus on nursing practice who care for victims and offenders, living and deceased at the clinical legal interface. Aims: The aim of the article is to assess the effectiveness of health education on knowledge regarding forensic nursing among B.Sc. (Hons.) Nursing third- and fourth-year students of the College of Nursing, AIIMS Raipur. Settings and Design: The study was conducted at the College of Nursing, AIIMS Raipur. Methods and Material: Pre-experimental one-group pretest and posttest design without the control group was adopted. The sample size was 100 and selected using nonprobability convenience sampling technique. The data were collected by self-structured questionnaire through offline mode to assess the knowledge about forensic nursing. At the end of pretest, structured health education program was given, after seven days posttest was conducted. Statistical Analysis Used: Data were collected and analyzed by using both descriptive and inferential statistics. Results: In pretest, 72% students had poor knowledge and 28% had good knowledge. In posttest, there was a significant increase, only 21% had good knowledge and 79% had excellent knowledge regarding forensic nursing. The mean score of pretests was 10.18 and the mean score of posttests was 23.15 and the mean improvement was 12.97, the paired t value obtained for knowledge was 31.85 which was found significant at 0.05 level (P < 0.05). Conclusions: Result of the study demonstrated that health education program was effective in improving the knowledge among students regarding forensic nursing. The results concluded that the importance of specific training in forensic nursing and support the need of development of a curricular unit in this area for inclusion in nursing curricula.

Abstract Urinary tract infections are a common condition affecting people globally, with multidrug-resistant (MDR) Escherichia coli (E. coli) being a major causative agent. Antimicrobial susceptibility profiling was performed using the VITEK 2 automated system for 1254 E. coli isolates, revealing that 831(66.2%) isolates were determined as MDR E. coli. A significant resistance pattern was observed for nalidixic acid (86.04%), ampicillin (74.16%), ticarcillin (70.73%), cefalotin (65.23%), cefixime (62.68%), ciprofloxacin (55.18%), ceftriaxone (53.75%), amoxicillin-clavulanic acid (22.81%), ertapenem (7.18%), and fosfomycin (2.23%). Whole Genome Sequencing of Carbapenem-resistant E. coli (CREC)—CREC 3 (ST405), CREC 4 (ST448), and CREC 5 (ST167) was performed to determine genomic characteristics. CREC 3, CREC 4, and CREC 5 belong to the phylogroup D, B1, and A, respectively. The NDM-5 gene was common in all three isolates, with CTX-M-15 being present in CREC 3 and CREC 4. Virulence factors of CREC 3 (fliC, shuA), CREC 4 (spaS), CREC 5 (iucA, papH, papG, iucB, yigF), and plasmids (IncFIA, IncFIB) were identified to be significant. The use of pangenome analysis enhances our understanding of resistance traits of isolates ST167, ST405, and ST448, offering valuable insights into comparative genomics of uropathogenic MDR E. coli.

Abstract Background Cervical cancer is a significant health issue, especially in low- and middle-income countries like India, where it ranks fourth among women. The Human papillomavirus (HPV) vaccination, a vital preventive measure, has suboptimal uptake among nursing students. We aimed to assess the level of knowledge, attitudes, willingness, and reasons for non-uptake of HPV vaccination among nursing students. Methods A descriptive cross-sectional study was conducted from April to June 2023, using a total enumeration method. Data were collected from 313 nursing students using a validated questionnaire covering sociodemographic information, knowledge, attitudes, and reasons for non-uptake of HPV vaccination. Statistical analysis was performed using SPSS version 26.0. Descriptive statistics summarized the data, while binary and multivariable logistic regression analyses identified factors associated with knowledge, attitude, and willingness for HPV vaccination. Results The mean age of the students was 20.98 ± 2.38 years, with the majority being females (81.2%) and unmarried (93.0%). About half of the participants demonstrated moderate knowledge (52.4%) and negative attitudes (50.1%) towards HPV vaccination, with none having received the vaccine. Female students had 4.24 times the odds of having good knowledge (AOR = 4.24, 95% CI = 1.66–10.80), while those pursuing a bachelor’s degree exhibited 2.70 times the odds of good knowledge (AOR = 2.70, 95% CI = 1.40–5.21). In contrast, first-year students had 0.30 times the odds of having good knowledge (AOR = 0.30, 95% CI = 0.11–0.79) but displayed 4.69 times the odds of having a positive attitude (AOR = 4.69, 95% CI = 1.92–11.41). Additionally, Hindu students had 2.44 times the odds of being willing to receive the vaccine (AOR = 2.44, 95% CI = 1.15–5.20). Most participants expressed willingness to receive the vaccine (62.0%), citing reasons such as not being sexually active (35.8%) and needing more information (18.2%) for non-uptake of the vaccine. Conclusions The study highlights gaps in knowledge and negative attitudes towards HPV vaccination among nursing students. Targeted educational interventions and policy initiatives are essential to improve awareness, promote positive attitudes, and increase HPV vaccination uptake among nursing students.

Gingival hyperpigmentation can be defined as a darker gingival colour beyond what is normally expected. The colour of the gingiva is vital for facial beauty and contributes in a great manner to the appearance of an aesthetic and confident smile. A dark colour of gingiva can have a negative psychological impact, particularly when combined with a higher lip line or a smile with visible gingiva. The gold standard for managing gingival pigmentation is by scalpel surgical technique, despite its disadvantage of resulting in an open wound that requires special care and dressing. Hereby, the authors present a case report of 21-year-old-male patient with concern about dark colour of gums and used scalpel surgical technique for gingival depigmentation and aimed to assess and evaluate the efficacy of reactive oxygen available in gel form (Blue®m gel™) and long-accepted Coe-Pak™ dressing on healing of the gingiva, pain perception, and re-epithelisation following surgical depigmentation. On follow-up, it was inferred that gingival healing, pain tolerance, and re-epithelisation was better with Blue®m gel™.

Abstract We hypothesized that daily exercise promotes joint health by upregulating anti-inflammatory mediators via adaptive molecular and metabolic changes in the infrapatellar fat pad (IFP). We tested this hypothesis by conducting time-resolved analyses between 1 and 14 days of voluntary wheel running exercise in C57BL/6J mice. IFP structure and cellularity were evaluated by histomorphology, picrosirius red collagen staining, and flow cytometry analysis of stromal vascular fraction cells. Joint inflammation and metabolism were evaluated by multiplex gene expression analysis of synovium-IFP tissue and synovial fluid metabolomics, respectively. Exercise transiently increased cytokine and chemokine gene expression in synovium-IFP tissue, resolving within the first 5 days of exercise. The acute inflammatory response was associated with decreased adipocyte size and elevated CD45+Gr1+ myeloid cells, increased collagen content, and oxidized phospholipids. Exercise acutely altered synovial fluid metabolites, characterized by increased amino acids, peptides, bile acids, sphingolipids, dicarboxylic acids, and straight medium chain fatty acids and decreased hydroxy fatty acids and diacylglycerols. Between 5 and 14 days of exercise, inflammation, collagen, and adipocyte size returned to pre-exercise levels, and CD206+ immuno-regulatory macrophages increased. Thus, although the onset of new daily exercise transiently induced synovium-IFP inflammation and altered tissue structure, sustained daily exercise promoted IFP homeostasis.

Introduction: Burn wound infections remain a significant cause of morbidity and mortality in patients admitted to burn units. Burn wounds serve as a susceptible site for opportunistic colonisation by endogenous and exogenous organisms due to local and systemic immunosuppression. The bacterial infection profile changes over time in hospitalised patients which increases the risk of systemic invasion. Aim: To determine the temporal changes in the bacterial profile of burn wound infections and identify the risk factors associated with invasive infections. Materials and Methods: A prospective cohort study of patients with burn injuries was conducted over 15 months in the burns unit of a tertiary care hospital in Mumbai, Maharashtra, India. Since, it was a time bound prospective cohort study, samples from all patients admitted with burn wounds between June, 2018 and September, 2019 were considered as study participants (n=131). Wound swabs were obtained from patients upon admission and subsequently at regular intervals. Bacterial isolates were identified and their antibiotic susceptibility patterns were determined. Data were analysed to identify temporal changes in the bacterial profile to determine the risk factors associated with invasive infections. Results: A total, of 131 patients with burn injuries were included. A total of 503 swabs were collected, of which 373 (74.2%) showed bacterial growth; five (1.34%) were contaminants and were excluded from analysis. Gram-negative bacteria were the predominant isolates in the first week, whereas gram-positive organisms predominated from the second week onwards. The most common organism isolated was Pseudomonas aeruginosa (n= 100, 27.17%) followed by Staphylococcus aureus (n=84, 22.83%), Acinetobacter baumannii (n=74, 20.11%), and Klebsiella pneumoniae (n=65, 17.66%). A total of 74 blood culture specimens were collected from 47 patients suspected of having invasive infections based on clinical signs and symptoms of systemic infection clinically. Of these, 37 patients (78.7%) were culture positive. Mortality was noted in 28 patients (28/31, 90.32%) in the group with invasive infections. Upon calculating the Odds Ratio (OR), risk factors found to be associated with invasive infections included a higher degree and depth of burns and a longer hospital stay. Conclusion: The shift from gram-negative to gram-positive bacteria and the increasing resistance over time highlight the importance of ongoing surveillance and appropriate antimicrobial stewardship measures in the management of burn wound infections.

Abstract In this study, the AlFe2O4@n-Pr@Et-SO3H heterogeneous catalyst was successfully synthesized and utilized to produce biodiesel from oleic acid through an esterification process and to oxidize sulfides. To examine the physicochemical characteristics of the AlFe2O4@n-Pr@Et-SO3H nanomaterial, a variety of advanced techniques were employed, including Fourier Transform infrared spectroscopy (FT-IR), Field emission scanning electron microscopy (FE-SEM), Energy dispersive X-ray spectroscopy (EDX), Vibrating sample magnetometer (VSM), Elemental Mapping, Transmission electron microscopy (TEM), Inductively coupled plasma (ICP), and X-ray diffraction (XRD). The AlFe2O4@n-Pr@Et-SO3H materials demonstrated excellent performance in both the esterification of oleic acid and the oxidation of sulfides. Moreover, the catalyst can be easily recovered and reused multiple times without a significant reduction in its effectiveness.

Introduction: Conventionally, the raw wound after gingival excision is protected with non eugenol periodontal pack, in order to alleviate pain and preserve healing tissue which includes some potential disadvantages such as patient intolerance, pack loosening, speech difficulties and plaque accumulation. Aim: To clinically evaluate wound healing following the use of a resorbable periodontal dressing following gingival excisional procedures and to compare the outcomes with the conventional COE-PAKTM periodontal dressing. Materials and Methods: A randomised controlled trial was conducted in the Department of Periodontology, SRM Dental College, Chennai, Tamil Nadu, India from June 2022 to March 2023. Patients requiring gingival excision for gingival pigmentation, gummy smile correction and crown lengthening were included in this study, 36 patients in control group were treated with Laser assisted surgery followed by conventional COE-PAKTM and 36 patients in test group were treated with Laser assisted surgery protected with resorbable pack (RESO-PAC®). Wound healing scores (Landry’s scale) and patient comfort assessment {Visual Analogue Score (VAS)} was recorded at 7, 14 days following therapy. Data were analysed with IBM Statistical Packages for Social Sciences (SPSS) software 17.0 version using Independent t-test with level of significance 5%. Results: A total of 72 patients (38 males and 34 females) with a mean age range of 32.6 years were randomised into two study groups. Following the intervention, two participants in the test group and one subject in the control group could not report for the seven day follow-up and hence, the data of 69 participants, control (n=35) and test (n= 34) was used for final analysis. Both test and control groups showed satisfactory healing. Results in the test group were significantly better with respect to both wound healing and VAS assessment. Statistically significant difference was noted in the Wound Healing Index (WHI), VAS and Pain Intensity (PI) scores at the 7th and 14th day follow-ups (p

Background: Endotracheal intubation is considered to be the “Gold Standard” for airway management during the administration of general anesthesia and in critical care setting because of its advantages, which allows delivery of anesthetic gases and oxygen through positive pressure ventilation without inflation of stomach, permits access to tracheobronchial tree for pulmonary hence minimizing the risk of gastric content aspiration, and improves surgical access to head and neck. The major determinants of easy tracheal intubation are optimal laryngoscopy and a good visualization of the glottis. Aims and Objectives: The aims and objectives of the study are to seek the optimal pillow height that gives the best direct laryngoscopic view and can be recommended as the starting head position before direct laryngoscopy in adults. Materials and Methods: The present study was conducted in a prospective randomized comparative manner in the Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma University of Health Sciences, Rohtak after obtaining approval from the institutional ethical committee (approval number: No. BREC/Th/20/Anaesth.../034). Patients included were scheduled for elective surgery under general anesthesia requiring endotracheal intubation. The inclusion criteria were patients aged 18–50 years of either sex of ASA I and II. Results: A total of 50 subjects, 25 in each group, were included in the final analysis. Following observations and results were drawn from the present prospective and randomized study using appropriate statistical tests. The various observations were out of 50 patients in the study population, and the mean age in years of patients in Group 1 was 38.48±11.77 years and 39.36±11.64 years in Group 2. Conclusion: To conclude, alignment of external auditory meatus to sternal notch offers better conditions for endotracheal intubation than conventionally used sniffing position when assessed in terms of Cormack–Lehane grading and time taken for laryngoscopy and intubation.

Background: Percutaneous nephrolithotomy (PCNL) is the most common surgical procedure for the removal of renal stone of size >2 cm. It has evolved over the years both in terms of surgical technique and plan of anesthesia. The procedure is performed most commonly in the prone position. This position provides edge in offering greater anatomical feasibility due to the posterior retroperitoneal position of kidneys. Supine position bestows several perks over prone in terms of better access to patient’s airway, lower cardiopulmonary complications, better patient comfort, repositioning issues addressal along with convenient access to the patient by anesthesiologist in case of untoward medical emergency. Aims and Objectives: The primary aim to compare the safety and efficacy of prone versus supine PCNL. The objective Visual Analog Scale Score, patient satisfaction rate, stone-free rate, procedure time (calculated from placement of ureteric catheter to skin closure), overall complication rate. Materials and Methods: This prospective randomized study of 80 patients was conducted at our institute from December 2022 to June 2023. Institutional Ethical Committee clearance was sought and the inclusion criteria were all adult patients aged between 16 and 65 years with single renal, upper ureteric calculus of size 10–25 mm with ASA physical status 1 and 2 having normal renal function and a sterile urine culture. Results: All the patients completed the study and there were no dropouts. Male/female ratio, age, and stone size were comparable in both the groups. The mean time taken in supine PCNL was 48.3 min and in prone PCNL was 68.7 min, which was significant. Conclusion: Supine PCNL is a safe and efficacious procedure for renal stone disease in the selected group of patients with results comparable to prone PCNL, having additional advantages like less time-consuming, better upper calyceal access through lower calyx, less radiation exposure to surgeon’s hand, overcoming positional difficulties of prone position, simultaneous accessibility for performing flexible ureteroscopy and more convenient airway access to anesthesiologist and better pain scores.

Chronic Obstructive Pulmonary Disease (COPD) is a top cause of death. It is a lung disease that gets worse over time and includes emphysema and chronic bronchitis, causing blocked airflow. Hospitalisations, mortality and exacerbations of COPD are all increased by poor air quality. Significant occupational dosages include excessive pesticide exposure and home air pollution from burning coal, wood, animal dung and crop residues. Besides medical treatments, pulmonary rehabilitation is crucial for patient recovery from hospital to home. This study focuses on a 67-year-old man who visited a respiratory clinic with breathing problems for the past 15 days and chest pain for the past week. He also had a yellowish cough and occasional fever in the last week. With a 5-year history of COPD, he used an inhaler twice daily. His symptoms worsened in winter but stayed the same throughout the day. A chest X-ray confirmed a flare-up of COPD. A two-week pulmonary rehab plan with physical therapy was recommended. Before starting treatment, a baseline assessment was done, including measures like Modified Medical Research Council (mMRC) grading for breathlessness, 6-Minute Walk Distance (6MWD) and chest movement. Following the completion of the instructed pulmonary rehabilitation, significant improvements in dyspnoea grading, 6MWD, and thoracic were found. The findings imply that when modified to each patient’s specific requirements and capabilities, an organised pulmonary rehabilitation program can have an important beneficial therapeutic impact on those suffering from Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD).

Introduction: In April 2005, under the umbrella of National Rural Health Mission (NRM) in response to the slow and varied progress in improvement of maternal and neonatal health, the Government of India launched a scheme known as Janani Suraksha Yojana (ISY) Objectives: With the help of this study, we intend to understand the knowledge, source of information, awareness, and barriers to acceptance of JSY among women in Western Uttar Pradesh and conduct a SWOT analysis for the same. Material and Methods: The sample size was 300 and calculated using the prevalence of institutional delivery taken from National Family Health 2015-16 Survey (NFHS-4) in Uttar Pradesh, India, which was 67.8%. Data were analysed using appropriate statistical tests by Statistical Package for Social Sciences (SPSS) software and Microsoft excel. Results: Grassroot-level workers, namely, ASHA, ANM, AWW, and Dai, were an important source of information regarding JSY in the rural area with 68% beneficiaries saying that they got their information about JSY from them compared to only 22% in the urban area. Out of the 105 beneficiaries who delivered at home, the two most common reasons for noninstitutional delivery were the cost of the institutional delivery (51.4%) and home is convenient (47.696). Conclusion: Cash incentives help in the use of health services such as antenatal care, postnatal care, and counselling services. Less focus and ASHA coverage in urban areas as compared to rural areas.

Background: Many public health topics in the subject of Community Medicine have a psycho sociocultural aspect to them, and these are taught by traditional methods like didactic lectures with little or no interaction of faculty and students. This limits the comprehensive understanding of the students regarding sensitive issues. There is a felt need to improve the knowledge and understanding of many of these competencies among students through available cinema movies addressing these concepts. Objectives: 1. To assess effectiveness of “Cinemeducation” as a tool to teach identified competencies in Community Medicine subject. 2. To assess perception of students for “Cinemeducation” to enhance learning and communication skills. Methodology: Study Design: Nonrandomized intervention study. Setting: Department of Community Medicine, Government Medical College, Pali, Rajasthan. Participants: Year 2 from 2020 Batch. Sample Size: 159 students. Sampling: Complete enumeration. Intervention: All 159 students were divided into two groups and alternately shown movies, Toilet–Ek Prem Katha, Padman, Outbreak, and Steel Magnolias, or exposed to didactic lecture and were assessed using pre- and post-tests and student satisfaction and self-confidence in learning scale. Results: The post-test scores of cinemeducation showed an improvement by a mean of 1.88 ± 0.7 points. The self-confidence and learning scale showed that 86% of students agreed that cinemeducation was better than didactic lectures. The mean satisfaction index of cinemeducation as a teaching–learning method was 97.6. Three out of the four movies addressed the competency well, and the difference between the pre- and post-test scores was statistically significant following cinemeducation as compared to lectures. Conclusions: As the student correlates real-life situations in movies like Toilet–Ek Prem Katha, Outbreak, and Padman, they definitely understood the topic better with cognitive scores showing an increase.

Introduction: Breast pathology encompasses a wide spectrum, ranging from benign conditions to invasive cancers, posing significant diagnostic challenges. Most breast lesions are usually divided into benign and malignant disorders, and their prognosis can often be reasonably predicted. However, certain tumours exhibit borderline characteristics and occupy a grey area between benign and malignant, making it difficult to forecast their course with any degree of accuracy. Aim: To assess the histopathological spectrum of benign and borderline breast lesions. Materials and Methods: This cross-sectional study, conducted over a period of five years (January 2019 to December 2023) at Shyam Shah Medical College, Rewa, Madhya Pradesh, India analysed 831 cases of breast lesions to determine their clinicopathological features, such as laterality of the breast and gross features. Grossing of the specimens was performed, and details were noted. Tissue pieces were processed, and sections were stained using conventional Haematoxylin and Eosin (H&E) staining. Results: Out of 831 breast lesions, 640 (77.0%) cases were benign, 15 (1.8%) were borderline, and 176 (21.2%) were malignant. Fibroadenoma was the most frequent lesion in females with 419 cases (50.4%), with a mean age of 21.4 years. In males, gynaecomastia was the most common finding in 21 (2.5%), with a mean age of 17 years. The second most common lesion overall was fibrocystic disease 148 (17.8%), with a mean age of 33.5 years. Other benign lesions included inflammatory breast diseases 21 (2.5%), lactational adenoma 2 (0.24%), sclerosing adenosis 7 (0.84%), microglandular adenosis 8 (0.96%), tubular adenoma 7 (0.84%), benign phyllodes 4 (0.48%), and lipoma and hamartoma 3 (0.36% combined). Borderline lesions included atypical ductal hyperplasia 9 (1.08%), ductal carcinoma in-situ 3 (0.36%), and borderline phyllodes tumours 2 (0.12%). Conclusion: In the study population, the range of benign breast diseases appears consistent with findings from other studies, with fibroadenoma emerging as the predominant benign lesion, followed by fibrocystic changes. While premalignant lesions were less prevalent in present study, a thorough evaluation of all cases of breast lesions is recommended to rule out the potential for breast cancer.

Introduction: Fascin is an actin-binding protein that mediates invasion by modulating metastasis-associated genes. Fascin expression in breast carcinoma is correlated with clinical aggressiveness, metastasis, histological subtype and shorter disease-free survival. Aim: To evaluate fascin expression through Immunohistochemistry (IHC) and its association with clinicopathological parameters in breast cancer. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology and Surgery at Pandit B. D. Sharma PGIMS, Rohtak, Haryana, India, from May 1, 2021, to April 30, 2022. A total of 80 cases of breast carcinoma were included in the study. The IHC detection of fascin expression was evaluated in relation to the molecular subtypes of breast carcinoma {luminal A, luminal B, human epidermal growth factor receptor 2 (HER2), and Triple-Negative (TN)} and other clinicopathological factors, including age, grade, tumour size, stage, regional lymph node status and survival. The collected data were categorised, compiled, tabulated, and analysed using Statistical Package for Social Sciences (SPSS) version 24.0. Associations were tested using Pearson’s Chi-square and Fisher’s exact tests. A p-value

Highlights The inaugural Clinical and Scientific Conference on Adenylosuccinate Synthetase 1 (ADSS1) myopathy was held on June 3, 2024, at the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS) in Rockville, Maryland, USA. ADSS1 myopathy is an ultra-rare, inherited neuromuscular disease. Features of geographical patient clusters in South Korea, Japan, India and the United States of America were characterised and discussed. Pre-clinical animal and cell-based models were discussed, providing unique insight into disease pathogenesis. The biochemical pathogenesis was discussed, and potential therapeutic targets identified. Potential clinical and pre-clinical biomarkers were discussed. An ADSS1 myopathy consortium was established and a roadmap for therapeutic development created.

Background Cervical spondylosis is the common degenerative disease of the vertebrae in adults which can lead to change in sagittal alignment of cervical spine. Radiograph and Magnetic resonance imaging (MRI) are widely used imaging modalities for measuring the sagittal parameters. However sagittal parameters measured using radiograph and MRI can be influence by patient positioning and imaging technique. The study aims to compare sagittal parameters measured using MRI (Magnetic Resonance Imaging) and radiograph in cervical spondylosis patients. Methods The study was done retrospectively. 77 patients who underwent both MRI and radiograph were included in the study. The sagittal parameters such as Neck Tilt (NT), T1 slope (T1S), thoracic inlet angle (TIA), C2-C7 angle (C2-C7A) and C2-C7 sagittal vertical axis (C2-C7 SVA) were measured on sagittal MRI and lateral cervical spine radiograph. Paired t-test was used to compare cervical sagittal measurements between MRI and radiography. Results The cervical sagittal parameters such as NT, T1S, TIA and C2-7 SVA showed significant difference between MRI and radiograph (p < 0.05). But C2-C7A did not show significant difference (p > 0.05) Conclusion The study concludes that MRI cannot be used as an alternative to cervical spine radiograph in spondylosis patient for measuring the sagittal balance as there was significant difference between sagittal parameters except C2-C7 A.

Objectives This study aimed to increase the understanding of healthcare stakeholders’ viewpoints on the challenges and potential solutions regarding healthcare financing for the Rohingya refugees in Cox’s Bazar.Design A mixed-method approach, containing semi-structured interviews with healthcare stakeholders and review of financial documents, was employed. Thematic analysis was performed to analyse the transcripts. Financial documents (available online) and reports from respective coordinating agencies were also reviewed.Setting Online key informant interviews (KIIs) were conducted from Stockholm with participants residing in Bangladesh between June 2022 and September 2022.Participants Eight KIIs were conducted with professional health programme managers, executives and personnel involved in policy coordination and implementation in refugee camps in Cox’s Bazar district of Bangladesh.Results We identified four themes and three subthemes outlining key challenges in healthcare funding, including decreasing funds (supported by a quantitative assessment) due to macroglobal issues, conflicting short-term and long-term priorities between implementing partners, insufficient efficacy due to challenges with collaborative priority-setting and implementing common processes, and a lack of consensus regarding equity between host and refugee communities.Conclusions The study identified unique challenges beyond the commonly discussed health financing issues in a resource-deficient setting: stakeholders’ conflicting priorities regarding funding and undecided equity issues among the host and refugee communities are worth scholarly and policy focus. A needs-based, equitable and effective action plan might ensure the proper utilisation of resources.

BackgroundPatient recruitment and data management are laborious, resource-intensive aspects of clinical research that often dictate whether the successful completion of studies is possible. Technological advances present opportunities for streamlining these processes, thus improving completion rates for clinical research studies. ObjectiveThis paper aims to demonstrate how technological adjuncts can enhance clinical research processes via automation and digital integration. MethodsUsing one clinical research study as an example, we highlighted the use of technological adjuncts to automate and streamline research processes across various digital platforms, including a centralized database of electronic medical records (enterprise data warehouse [EDW]); a clinical research data management tool (REDCap [Research Electronic Data Capture]); and a locally managed, Health Insurance Portability and Accountability Act–compliant server. Eligible participants were identified through automated queries in the EDW, after which they received personalized email invitations with digital consent forms. After digital consent, patient data were transferred to a single Health Insurance Portability and Accountability Act–compliant server where each participant was assigned a unique QR code to facilitate data collection and integration. After the research study visit, data obtained were associated with existing electronic medical record data for each participant via a QR code system that collated participant consent, imaging data, and associated clinical data according to a unique examination ID. ResultsOver a 19-month period, automated EDW queries identified 20,988 eligible patients, and 10,582 patients received personalized email invitations. In total, 1000 (9.45%) patients signed consents to participate in the study. Of the consented patients, 549 unique patients completed 779 study visits; some patients consented to the study at more than 1 time period during their pregnancy. ConclusionsTechnological adjuncts in clinical research decrease human labor while increasing participant reach and minimizing disruptions to clinic operations. Automating portions of the clinical research process benefits clinical research efforts by expanding and optimizing participant reach while reducing the limitations of labor and time in completing research studies.

Introduction Magnetic resonance imaging (MRI) is essential for brain imaging, but conventional methods rely on qualitative contrast, are time-intensive, and prone to variability. Magnetic resonance finger printing (MRF) addresses these limitations by enabling fast, simultaneous mapping of multiple tissue properties like T1, T2. Using dynamic acquisition parameters and a precomputed signal dictionary, MRF provides robust, qualitative maps, improving diagnostic precision and expanding clinical and research applications in brain imaging. Methods Database searches were performed through PubMed, Embase, Scopus, Web of science to identify relevant articles focusing on the application of MR finger printing in the adult brain. We utilized the preferred reporting items for systematic reviews and meta-analysis guidelines to extract data from the selected studies. Results Nine articles were included in the final review, with a total sample size of 332 participants. In healthy brains, notable regional, sex, age, and hemispheric variations were identified, particularly in the corpus callosum and thalamus. MRF effectively differentiated meningioma subtypes, glioma grades, and IDH mutation status, with T2 values providing particularly predictive for glioma classification. In brain metastases, significant relaxometry differences were noted between normal and lesional tissues. For multiple sclerosis, MRF values correlated with clinical and disability measures, distinguishing relapsing-remitting secondary progressive forms. In traumatic brain injury, longitudinal T1 changes strongly correlated with clinical recovery, surpassing T2 values. Conclusions The systematic review highlighted MRD as a groundbreaking technique that enhances neurological diagnosis by simultaneously quantifying T1 and T2 relaxation times. With reduced acquisition times, MRF outperforms conventional MRI in detecting subtle pathologies, distinguishing properties, and providing reliable biomarkers.

Abstract Introduction: The respiratory syndrome coronavirus (SARS-CoV-2) has undergone genetic evolution and led to variants of concern that vary in transmissibility and clinical severity. Methods: This retrospective cohort analysis studied 232,364 hospitalized COVID-19-positive patients in the National COVID Cohort Collaborative [April 27, 2020 and June 25, 2022]. The primary outcomes were to compare demographics and need for mechanical ventilation and 30-day mortality across variants including Alpha (B.1.1.7), Delta (B.1.617.2), and Omicron (B.1.1.529). Results: The severity of SARS-CoV-2 decreased in the omicron-subsequent wave with decreased utilization of mechanical ventilation and decreased 30-day mortality among patients with comorbidities like diabetes mellitus, obesity, and liver disease. Although with each subsequent wave, the sex distribution remained equal and constant, there was an increase in rates of diabetes, liver disease, and respiratory disease amongst patients hospitalized with COVID-19 over the COVID waves despite the decreasing 30-day mortality and mechanical ventilation. Conclusions: Despite changes in demographics over time, more recent COVID waves were associated with decreasing severity and mortality. These observations will help guide specific and effective resource allocation and patient care.

IntroductionUnmet oral health needs remain a significant issue among immigrant adolescents, often exacerbated by experiences of racial discrimination. This study aimed to examine the associations between perceived discrimination and oral health behaviours in adolescents with immigrant backgrounds and explore the potential moderating role of resilience on this association.MethodsEthical approval for this cross-sectional study was obtained from the University of Alberta Research Ethics Board. Participants were 12 to 18-year-old adolescents from immigrant backgrounds. Participants were recruited through nine community organizations using a snowball sampling technique. After obtaining active parental consent and assent from the adolescent, the participants completed a questionnaire covering demographics, oral health behaviours, and perceived racial discrimination and resilience. Perceived racial discrimination and resilience were measured using validated scales. Descriptive statistics summarized variables. Logistic regression assessed associations, controlling for confounding factors. Resilience's moderating impact was analyzed via the interaction model of regression analysis.ResultsIn this cross-sectional study of 316 participants, average age of 15.3 (SD = 1.9) years, and a median age of 15 years (Inter Quartile Range-12-18), 76% reported discrimination experiences. Adjusted analysis showed that an increase of one unit in the total discrimination distress score was associated with 51% less likelihood of categorizing self-rated oral health as good (OR = 0.49, 95% CI: 0.29-0.81). The odds of brushing teeth more than twice a day, as opposed to once a day, decreased by 58% with one unit increase in the total discrimination distress score (OR = 0.42, 95% CI: 0.25-0.71). The odds of visiting the dentist for an urgent procedure instead of a regular check-up were 2.3 times higher with a unit increase in the total discrimination distress score (OR = 2.3: 95% CI:1.3-4.0) Resilience did not moderate the observed association.ConclusionPerceived racial discrimination was associated with the pattern for dental attendance, tooth brushing frequency, and self-rated oral health. Resilience did not moderate the observed association.

Background Rational prescription writing is an important skill to master during internship. This Quality Improvement (QI) project aimed to understand the state of prescription writing among interns posted in the Department of Psychiatry, analyze the causes responsible for errors in prescription writing and bring about a change in the current practice. Methods The MBBS interns are posted in the Department of Psychiatry for 15 days. During day 1 to day 5 of their posting, a pre intervention phase was conducted wherein prescriptions written by interns in the Department of Psychiatry were collected. The prescriptions were scored based on 14 criteria which were selected based on World Health Organization (WHO) guidelines and Medical Council of India (MCI) ideal prescription format. During PDSA (Plan Do Study Act) Cycle 1, an educational handout was distributed to the interns containing the MCI ideal prescription format and WHO guidelines regarding prescription writing. The brochure was also verbally explained to the interns. From day 7 to day 15 of their posting, prescriptions written by the interns were collected. The prescriptions were scored using the same criteria. Results During the pre intervention phase the mean total score of prescriptions was 9.54 ± 1.003. There was a significant improvement in the mean total score to 10.26 ± 0.746. There was a 7.54% improvement. There was also a significant improvement in several individual criteria. Conclusions The first PDSA cycle was successful in improving the quality of prescription writing among interns posted in the Department of Psychiatry. There is a need to implement more PDSA cycles to improve the quality still further.

Wolf–Hirschhorn syndrome (WHS) is a malformation syndrome that is characterised by a partial deletion of the short arm of chromosome 4 and is known to occur in about one per 50,000 births. Ophthalmic manifestations are common in patients with WHS, who often require corrective surgery under general anaesthesia. Managing the airway, titration of the anaesthetic medications while vigilant monitoring and controlling the haemodynamics during the surgery can be difficult. Further, presence of various anomalies, concurrent seizures, predisposition to cardiac failure and post-operative occurrence of malignant hyperthermia pose anaesthetic challenges in patients with WHS. We present the case of an 11-month-old child with WHS posted for multiple ophthalmological procedures and the challenges faced while administering anaesthesia for the same.

Primary and secondary neurulation – processes that form the spinal cord – are incompletely understood in humans, largely due to the challenge of accessing neurulation-stage embryos (3–7 weeks post-conception). Here, we describe findings from 108 human embryos, spanning Carnegie stages (CS) 10–18. Primary neurulation is completed at the posterior neuropore with neural plate bending that is similar, but not identical, to the mouse. Secondary neurulation proceeds from CS13 with formation of a single lumen as in mouse, not coalescence of multiple lumens as in chick. There is no evidence of a ‘transition zone’ from primary to secondary neurulation. Secondary neural tube ‘splitting’ occurs in 60% of proximal human tail regions. A somite is formed every 7 hr in human, compared with 2 hr in mice and a 5 hr ‘segmentation clock’ in human organoids. Termination of axial elongation occurs after down-regulation of WNT3A and FGF8 in the CS15 embryonic tailbud, with a ‘burst’ of apoptosis that may remove neuro-mesodermal progenitors. Hence, the main differences between human and mouse/rat spinal neurulation relate to timing. Investigators are now attempting to recapitulate neurulation events in stem cell-derived organoids, and our results provide ‘normative data’ for interpretation of such research findings.

BackgroundIn high-income countries, only 50% of patients treated for chronic diseases adhere to the prescribed treatment. This issue is even more pronounced in resource-limited countries. Medication adherence scales are simple, low-cost approaches to identify nonadherence in clinical practice. In India, nonadherence to medication varies from 18.7% to 74%, assessed using scales validated in the Western population, as there is no validated medication adherence tool contextualized to the Indian setting. The phrasing of questions in scales validated elsewhere and its interpretations may vary when applied in Indian patients unless accounting for the unique cultural, social, and economic factors influencing medication adherence in India. This could result in inaccurate reports of adherence behavior. ObjectiveThis study aims to develop and validate a novel medication adherence tool for select noncommunicable diseases (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, bronchial asthma, and coronary artery disease) in the Indian population. MethodsAn exploratory sequential mixed methods design will be used, beginning with a qualitative phase where the construct of the scale is defined and preliminary items are generated through a scoping review, focus group discussions, and in-depth interviews. This will be followed by the tool’s development phase, including an expert panel review and item revision. Finally, a quantitative phase in 4 zones in India (North, South, East, and West) will be conducted to confirm and validate the newly developed scale. ResultsIn the first phase, we will frame the construct definition and develop an inventory of potential items for the proposed medication adherence tool. In the second phase, item-level and scale-level content validity indices, along with content validity ratio, will be estimated. In the third phase, we will conduct an item reduction analysis and determine the scoring matrix and item weightage after expert review. We will assess the tool's psychometric properties, plot the receiver operating characteristic (ROC) curve to set an adherence cut-off score, and compute the construct validity and test-retest reliability from the quantitative survey. ConclusionsA medication adherence tool for noncommunicable diseases, developed after ensuring it is ethnically, culturally, and linguistically appropriate incorporating stakeholder perspectives and validated in community settings, would offer a real-world perspective of adherence. The tool will have 2 versions for clinical practice and research, aiding policy makers in adopting tailored adherence policies. International Registered Report Identifier (IRRID)PRR1-10.2196/60805

INTRODUCTION This study is conducted to assess the Olfactory dysfunction (OD) of CoVid-19 recovered patients using ODOFIN Sniffin’ Sticks and to analyze the demographic features, duration of recovery, co-morbidities/metabolic disorders associated with persistence of OD in Post CoVid-19 patients. MATERIALS AND METHODS This Prospective observational study was conducted at our tertiary care hospital on 40 CoVid-19 recovered patients with persistent OD. The olfaction was assessed qualitatively using ODOFIN Sniffin’ sticks at 6th, 10th, 12th weeks Post CoVid and the results documented and analysed. RESULTS Total 40 eligible patients were selected. 50% of study participants were males and 60% aged 18-38 years. 3 patients were Diabetic and 3 were Hypertensive. 37 had OD of which 26 had Hyposmia and 11 had Anosmia 6 weeks Post CoVid. 22 had OD of which 14 had Hyposmia and 8 had Anosmia 10 weeks Post CoVid. 10 had persistent OD 12 weeks Post CoVid. There was no association found between age, co-morbidities and OD at 6, 10 and 12 weeks Post CoVid (p>0.05). Hyposmia was common among females at 10 weeks Post CoVid which was found to be statistically significant (p

Introduction: Moschcowitz syndrome or Thrombotic Thrombocytopenic Purpura (TTP) is a thrombogenic condition due to deficiency or dysfunction of A disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13 (ADAMTS13), which causes a myriad of clinical presentations. The association between acute pancreatitis and TTP is a conundrum as both can be etiology and effect of one another. We describe a clinical case and review the available literature to understand this conundrum better. Case: A 52-year-old male was admitted to our setting with acute pancreatitis and on further evaluation was found to have deranged renal function with anemia and thrombocytopenia. He had multiple seizures during his stay requiring mechanical ventilation. Based on clinical findings a diagnosis of TTP was suspected which was confirmed on relevant investigations. His course and management were a challenge for the team. Discussion: A thorough literature search was conducted to identify all published reports/case series on acute pancreatitis and TTP. Of 38 identified publications, 20 case reports were reviewed as a cohort of acute pancreatitis and TTP. All cases had acute pancreatitis before TTP, alcohol being the most common cause. Early diagnosis and initiation of plasma exchange improves prognosis. Conclusion: Acute pancreatitis is a sinister trigger for TTP. Vigilance, suspicion, and early diagnosis are crucial to manage these cases. Early plasma exchange reduces mortality and hospital stay.

Aggregation of mutant forms of Huntingtin is the underlying feature of neurodegeneration observed in Huntington’s disorder. In addition to neurons, cellular processes in non-neuronal cell types are also shown to be affected. Cells expressing neurodegeneration–associated mutant proteins show altered uptake of ligands, suggestive of impaired endocytosis, in a manner as yet unknown. Using live cell imaging, we show that clathrin-mediated endocytosis (CME) is affected in Drosophila hemocytes and mammalian cells containing Huntingtin aggregates. This is also accompanied by alterations in the organization of the actin cytoskeleton resulting in increased cellular stiffness. Further, we find that Huntingtin aggregates sequester actin and actin-modifying proteins. Overexpression of Hip1 or Arp3 (actin-interacting proteins) could restore CME and cellular stiffness in cells containing Huntingtin aggregates. Neurodegeneration driven by pathogenic Huntingtin was also rescued upon overexpression of either Hip1 or Arp3 in Drosophila. Examination of other pathogenic aggregates revealed that TDP-43 also displayed defective CME, altered actin organization and increased stiffness, similar to pathogenic Huntingtin. Together, our results point to an intimate connection between dysfunctional CME, actin misorganization and increased cellular stiffness caused by alteration in the local intracellular environment by pathogenic aggregates.

The excessive cosolute densities in the intracellular fluid create a physicochemical condition called macromolecular crowding (MMC). Intracellular MMC entropically maintains the biochemical thermodynamic equilibria by favoring associative reactions while hindering transport processes. Rapid cell volume shrinkage during extracellular hypertonicity elevates the MMC and disrupts the equilibria, potentially ushering cell death. Consequently, cells actively counter the hypertonic stress through regulatory volume increase (RVI) and restore the MMC homeostasis. Here, we establish fluorescence anisotropy of EGFP as a reliable tool for studying cellular MMC and explore the spatiotemporal dynamics of MMC during cell volume instabilities under multiple conditions. Our studies reveal that the actin cytoskeleton enforces spatially varying MMC levels inside adhered cells. Within cell populations, MMC is uncorrelated with nuclear DNA content but anti-correlated with the cell spread area. Although different cell lines have statistically similar MMC distributions, their responses to extracellular hypertonicity vary. The intensity of the extracellular hypertonicity determines a cell’s ability for RVI, which correlates with nuclear factor kappa beta (NFkB) activation. Pharmacological inhibition and knockdown experiments reveal that tumor necrosis factor receptor 1 (TNFR1) initiates the hypertonicity-induced NFkB signaling and RVI. At severe hypertonicities, the elevated MMC amplifies cytoplasmic microviscosity and hinders receptor interacting protein kinase 1 (RIPK1) recruitment at the TNFR1 complex, incapacitating the TNFR1-NFkB signaling and consequently, RVI. Together, our studies unveil the involvement of TNFR1-NFkB signaling in modulating RVI and demonstrate the pivotal role of MMC in determining cellular osmoadaptability.

Community engagement has emerged as a critical component in the effective control and elimination of neglected tropical diseases (NTDs), particularly in regions with persistent stigma and limited healthcare access. Drawing on case studies from Brazil, India, and Nigeria, this opinion piece explores how community-driven initiatives have successfully improved leprosy awareness, reduced stigma, and fostered early case detection and treatment adherence. The importance of culturally sensitive, inclusive approaches in health education and stigma reduction campaigns is highlighted, emphasizing the potential for community engagement to enhance national leprosy programs and contribute to the World Health Organization’s Zero Leprosy Strategy. By examining these examples, this article illustrates how integrating community participation into leprosy control and elimination programs can drive sustainable outcomes for achieving Zero Leprosy, even in resource-limited settings.

Atrial myxomas are rare cardiac tumors. It has to be surgically resected early when diagnosed, due to possible complications such as intracardiac obstruction, embolus, and metastasis. It becomes more challenging when found as an incidental finding in routine evaluation for a case of a ruptured aneurysm. Atrial myxoma is a common cause of ischemic and hemorrhagic strokes, but in 10%–15% of cases, it is associated with the development of metastatic intracranial aneurysms which is a rare complication of myxomatous emboli. We report the case of a 42-year-old female patient presented with subarachnoid hemorrhage, posted for the repair of left paraclinoid internal carotid artery aneurysm under general anesthesia with left interatrial septum myxoma.

Background and Aim: Metallo-beta-lactamases (MBLs) which open β-lactam ring with help of metal cofactor degrade all the classes of β-lactams except monobactams and are notable for their constant and efficient carbapenemase activity. New Delhi Metallo-beta-lactamase (NDM) is type of carbapenemase which is able to inactivate all β-lactams except aztreonam. Combined disk synergy test (CDST) and polymerase chain reaction (PCR) analysis are used for the detection of MBL production. Materials and Methods: All clinical specimens received in the microbiology department for culture and sensitivity from indoor patients were included in study. Brief history and related data of the patients was being recorded. The direct Gram staining and samples were inoculated on culture media and incubated at 37°C for 18–24 h. Biochemical reactions were performed and the antibiotic susceptibility test was performed by Kirby–Bauer Disk-Diffusion method and VITEK 2. All the multidrug-resistant (MDR) Gram-negative bacteria (GNB) which were carbapenem resistant subjected to CDST and Genotypic detection of NDM-1 by PCR was done. The association between categorical variables was explored using the Pearson’s Chi-square test. Results: The present study was conducted on 260 GNB isolated from 5307 specimens, 164 were MDR, 68 were carbapenem resistant, and 48 were found to be MBLs (19 were fermenters; 29 were nonfermenters). Thirty-six blaNDM-1 gene was isolated from both MDR fermenters and nonfermenters. The positivity of CDST in detecting blaNDM-1 positive MBLs taking PCR as the gold standard was 75%. Conclusion: NDM-1 carrying isolates disseminate quickly even among the organisms of different genera, their presence in high proportion could further threaten the public health and put an end to our current pharmacopoeia.

Immunosenescence, a systematic reduction in the immune system connected with age, profoundly affects the health and well-being of elderly individuals. This review outlines the hallmark features of immunosenescence, including thymic involution, inflammaging, cellular metabolic adaptations, and hematopoietic changes, and their impact on immune cells such as macrophages, neutrophils, T cells, dendritic cells, B cells, and natural killer (NK) cells. Thymic involution impairs the immune system’s capacity to react to novel antigens by reducing thymopoiesis and shifting toward memory T cells. Inflammaging, characterized by chronic systemic inflammation, further impairs immune function. Cellular metabolic adaptations and hematopoietic changes alter immune cell function, contributing to a diminished immune response. Developing ways to reduce immunosenescence and enhance immunological function in the elderly population requires an understanding of these mechanisms.

Background: Deploying mobile health vans (MHVs) to service disadvantaged, underserved mountainous hamlets across six districts of Uttarakhand on a “fixed day-fixed location” strategy was an effective initiative in the state in collaboration with Technology Information Forecasting and Assessment Council (TIFAC) and NRHM. Aims and Objectives: The aim of the study was to provide quality diagnostic and curative care through mobile health clinics at select mountainous outreaches of Uttarakhand state. Materials and Methods: A bimonthly mobile health services with fully equipped MHV sponsored by the directorate of science and TIFAC and assessment council and Government of Uttarakhand on a “fixed day, fixed time and fixed place” schedule were provided along pre-designated service locations. Results: A total of 77,688 beneficiaries received services through 902 camps spanning 13 quarters with an estimated 5976 and 89 beneficiaries per quarter per camp; 573 clients received ultrasound, 639 X-ray, 34 ECG, and 3543 other lab procedures. Quarterly demand for services was highest, 19.5% for gastrointestinal disorders, followed by 18.4% for musculoskeletal disorders, 13.8% for genitourinary system disorders, 11.8% for respiratory system disorders, and 8.5% for ENT and ocular disorders. The prevalent morbidity was predominantly acid peptic disease (15.5%), followed by osteoarthritis (13.3%) and low backache and renal stones (7.2% each). Conclusion: Integrating mobile health service delivery component with existing strategies adopted by public health system in primary health care is an operationally feasible and viable option to address ‘inaccessibility at disadvantaged mountainous outreach.

Background: Thalassemia major is a genetic disorder characterized by severe anemia and the need for lifelong blood transfusions. Aims and Objectives: The aim of this study was to investigate the clinical profile of transfusion-dependent thalassemia major children with reference to serum ferritin levels and liver function. Materials and Methods: A prospective observational study included 100 children aged 1–12 years with beta-thalassemia major, who were receiving blood transfusions. Clinical data, including growth parameters, serum ferritin levels, and liver function tests, were collected. Descriptive and inferential statistical analyses were performed. Results: The study population predominantly consisted of children aged 1–5 years (54%) and males (51%). Hindu children accounted for 85% of the participants. Most children were diagnosed with thalassemia major before the age of 1 year (84%) and were diagnosed through Hb electrophoresis (77%). The majority of children received blood transfusions every 15–30 days (49%). Pre-transfusion hemoglobin levels ranged from

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) are among the greatest public health challenges around the globe. India ranks the third largest HIV epidemic in the world. People Living With HIV (PLWH) are highly susceptible to life threatening conditions as HIV destroys the body’s immune system. Despite anti-retroviral treatments, tackling HIV and AIDS has been an uphill task for decades with all the countries contributing their best to decrease the incidence and mortality rate. But this has been difficult as there are problems in plenty across the globe. Loss of life, economic burden, psychological effects, stigma, discrimination are the perennial problems of HIV and AIDS. Awareness about HIV/AIDS and factors influencing the disease progression is the key to break this cycle. One of the important factors influencing the disease outcome is immune status of an individual. The immune system is highly influenced by nutrition which is an integral part in managing HIV. Nutrition has always contributed to the robust functioning of the immune system of an individual. PLWH almost always have malnutrition which, if not corrected, influences the outcome of HIV infection drastically. With people across the globe showing malnutrition, either under or excess, the immune system functioning is impaired, particularly so in PLWH. Unfortunately, nutrition has been ignored or sidelined in managing HIV/AIDs. This review gives an overview of the interrelation of nutrition and immune system and how these influence the outcomes in PLWH.

Background: Supraglottic airway devices (SGD) are indispensable for airway management. The successful placement of the laryngeal mask airway (LMA) supreme largely depends on the right size selection. Aims and Objectives: The study was undertaken to compare three LMA supreme insertion methods in short elective surgeries under general anesthesia. Materials and Methods: Atotal of 90 American Society of Anesthesiologists I and II patients (either gender, 18–55 years, Mallampati grade I and II) undergoing short surgeries were randomized into three equal groups (n=30 in each). Insertion of LMA was done after an adequate depth of anesthesia for jaw relaxation (Young’s criteria). The efficacy of controlled ventilation through LMA by each method, success rate, ease of insertion, insertion time, additional induction dose (propofol) required during insertion, hemodynamic stability (baseline vitals and 10 min after insertion), and adverse events after LMA removal were evaluated between groups. Results: Better ventilation (tidal volume at 10 cmH2O) was observed in the thyromental group (448±35) than in tongue width (440±46) and weight-based (409±33) groups. Minimum additional propofol requirement during insertion was in thyromental distance group. Thyromental distance group had the most easy LMA insertions (70%) with minimum insertion time (10±4) and minimum additional propofol requirement during insertion (P

Background: Surgical site infections (SSIs) are infections of the tissues, organs, or spaces exposed by surgeons while performing an invasive procedure. SSI is one of the most common healthcare-associated infections, but its importance as a health-care priority is not fully understood, and limited work has been published defining the role of surgeons in SSIs. Aims and Objectives: In the present study, we assess the burden of SSI after gastrointestinal (GI) surgery in a tertiary care hospital in the Central India. Materials and Methods: The present study was conducted on patients admitted to Gandhi Medical College-affiliated Hamidia Hospital, Bhopal, in the General Surgery Department. The study included 207 patients who underwent emergency/routine GI surgeries between September 2020 and April 2022. Patient characteristics and laboratory data were recorded on a pre-designed form, and all patients were evaluated postoperatively for soakage along with culture and antibiotic testing. Results: The overall incidence of SSI was 42.51% and its distributions between emergency and routine surgeries were 22.7% and 19.8%, respectively. SSI was predominant in male patients. White blood cell level was significantly associated between emergency and routine surgeries, while Hb level, serum protein level, and the time required for surgery were insignificant. SSI under contaminated dirty wounds was prevalent in both emergency and routine surgeries. Klebsiella was the most commonly isolated organism, followed by Escherichia coli. The commonly susceptible antibiotics have been found to be meropenem, pipzo, amikacin, and imipenem. Commonly resistant antibiotics were amoxiclav, ceftriaxone, linezolid, and doxycycline. Conclusion: This paper presents the incidence of SSI in the hospital setting of Central India and the factors that may contribute to the high incidence of SSI. Further research needs to be done to better understand how specific risk factors are responsible for post-operative wound infections in open GI surgery.