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• Macropropagation is a low cost farmer friendly technique for large scale production of quality planting material in banana. • Macropropagation technique is likely to bridge the gap in supply of healthy planting material at a reasonable cost to the small and marginal farmers. • Musa cvs. Rasthali and Neypoovan, are the two most important choice varieties in the southern parts of India. • Sucker pre-treatment and age had a significant influence on the propagation rate. • Macropropagated plants of both cultivars performed at par with conventional suckers under field conditions and the survival rate was 100 %. Macropropagation is a low cost farmer friendly alternative to tissue culture propagation to cater to the farmers' need for quality planting material at an affordable cost. Attempts were made to study the effect of age and hot water treatment on macropropagation of cvs. Rasthali (AAB, Silk) and Neypoovan (AB, Neypoovan) in pot and bed methods. Age of the sucker, hot water treatment and propagation method played a vital role on shoot bud production in both the test cultivars. In cv. Rasthali, bed method produced maximum number of plants (50.5) in five months old suckers subjected to hot water treatment in 42.2 days but the same treatment produced only 24.7 plants under pot method. In cv. Neypoovan, five months old suckers subjected to hot water treatment resulted in 23.3 and 16.7 plants in bed and pot methods respectively. Therefore, five months old suckers with hot water treatment under bed method are more appropriate for macropropagation purpose in banana. Results of field evaluation indicated that macropropagated bananas were at par with control in respect of all plant parameters like plant height, bunch weight and fruit parameters like total soluble sugar (TSS) and acidity. [ABSTRACT FROM AUTHOR]

This article reviews the long-term results and complications of bronchial artery embolization (BAE) in patients with hemoptysis at a quaternary hospital in India over a period of 7 years. The study included 70 patients, with a higher incidence in males aged 60-70 years. The most common underlying disease was tuberculosis, followed by fungal infections and bacterial infections. Lung parenchymal changes and bronchial/nonbronchial systemic artery anatomy were assessed using CT scan imaging. The procedure was generally successful, with only a few minor complications reported. [Extracted from the article]

Geographic access to medical care varies for nearly every specialty in India. Given the special nature of its treatments, which sometimes necessitate numerous visits over a lengthy period, and the substantial-high fixed cost infrastructure requirements for radiation facilities, radiation oncology is particularly prone to regional inequities in access to care. Brachytherapy (BT) is emblematic of several of these access difficulties since it necessitates specialized equipment, the capacity to maintain a radioactive source, and particular skill sets. The study was conducted to report the availability of BT treatment units in relation to state-level population, overall cancer incidence, and gynecologic cancer incidence. The availability of BT resources at the state level in India was and the population of each state was estimated using data from the Government of India's Census. The number of cancer cases was approximated for each state and union territory. The total number of gynecological cancers that required BT was determined. The BT infrastructure was also compared to those of other nations in terms of the number of BT units available per million people and for various malignancies. A heterogeneous geographic distribution of BT units was noted across India. India has one BT unit for every 42,93,031 population. The maximum deficit was seen in Uttar Pradesh, Bihar, Rajasthan, and Odisha. Among the states having BT units, the maximum units per 10,000 cancer patients was noted in Delhi (7), Maharashtra (5) and Tamil Nadu (4) and the least was noted in the Northeastern states (<1), Jharkhand, Odisha, and Uttar Pradesh. In BT of gynecological malignancies alone an infrastructural deficit ranging from 1 to 75 units were noted across the states. It was noted that only 104 out of the 613 medical colleges in India had BT facilities. On comparing the BT infrastructure status with other countries India had one BT machine for every 4,181 cancer patients when compared to United States (1 every 2,956 patients), Germany (2,754 patients), Japan (4,303 patients), Africa (10,564) and Brazil (4,555 patients). The study identified the deficits of BT facilities in terms of geographic and demographic aspects. This research provides a roadmap for the development of BT infrastructure in India. [ABSTRACT FROM AUTHOR]

Kneading is a form of massage that involves a gradual circular compression of the soft tissues under the bones. Great pressure is applied as the hands move closer, although the contact continues. Stirring stimulates the flow of tissue fluids and causes reflex vasodilatation. This reduces inflammation and helps resolve inflammation. Exercising vigorously reduces muscle cramps and can stretch the muscles shortened by injury and stimulates the nervous system which can produce calm and reduce feelings of stress and anxiety. Objectives of the study: To assess the level of joint pain among the elderly prior to the initiation of the mixing procedure in the study group. To evaluate the effectiveness of the mixing procedures at the level of joint pain among the elderly in the study group. Comparison of post-test pain scores reported between older adults between the study group and the control group. Finding a link between the level of joint pain between older people and their chosen variables. The scientist has developed a method of multidisciplinary research research and experimental style for sixty seniors living in the Panipat valley in a way that is easily accessible. The Modified Extremities Functional Scale is designed to measure a patient's joint pain. Results: In the evaluation group the pain assessment rate showed that (56.67%) the subject had minimal pain, (43.33%) the subject had moderate joint pain and none of the subjects (0%) had significant pain, severe pain and no pain. respectively while the control group (43.33%) the subject had severe pain, (39%) the subject had severe pain, (26.67%) the subject had moderate pain and none of the subjects had minor or no pain. the mixing method is effective in relieving the level of joint pain. [ABSTRACT FROM AUTHOR]

Introduction: Frailty describes a state or syndrome of reduced physical, physiologic, and cognitive reserve that increases vulnerability to acute illness. To study the prevalence of frailty in critically ill patients and find its association with resource utilization and short-term intensive care unit (ICU) outcomes. Material and methods: This was a prospective observational study. All adult patients ≥50 years admitted to the ICU were included and frailty was assessed by the clinical frailty score (CFS). Data were collected on demography, coexisting illness, CFS, Acute Physiology and Chronic Health Evaluation II (APACHE-II), and Sequential Organ Failure Assessment Score (SOFA) scores. Patients were followed for 30 days. Outcome data were collected on organ supports provided, duration of ICU and hospital length of stay (LOS), and ICU and 30-day mortality. Results: 137 patients were enrolled in the study. The prevalence of frailty was 38.6%. Frail patients were older and had a more comorbid illness. APACHE-II and SOFA scores were 22.1 ± 7.0 and 7.2 ± 3.29, significantly higher in frail patients, respectively. There was a trend towards higher requirement for organ supports in frail patients. Median ICU and hospital LOS were 8 vs 6 and 20 vs 12 (frail vs nonfrail) days, respectively (p < 0.05). Intensive care unit mortality in frail and nonfrail patients was 28.3% and 23.8%, respectively (p = 0.56). Thirty-day mortality in frail patients was 49%, significantly higher compared with nonfrail patients (28.5%). Conclusion: The prevalence of frailty in ICU patients was high. Frail patients were quite ill on ICU admission, and they had a prolonged ICU and hospital LOS. Increasing frailty score was associated with higher mortality at 30 days. [ABSTRACT FROM AUTHOR]

Purpose: To compare the safety and efficacy of Active Sentry handpiece with Ozil handpiece for Centurion phacoemulsification system. Setting: Tertiary eye center, South India. Design: Prospective observational study. Methods: 204 eyes of 204 patients with uncomplicated cataract who underwent phacoemulsification cataract surgery with Centurion Vision System were randomized into 2 groups: Ozil handpiece (n = 101) and Active Sentry handpiece (n = 103). Intraoperative factors such as patient pain perception, surgeon comfort level, amount of phacoemulsification energy and aspiration fluid used, and frequency of activation of active surge mitigation (ASM) were analyzed, and postoperatively, corrected distance visual acuity (CDVA) and corneal edema on day 1 were compared. Results: A total of 204 eyes of 204 patients were included among which 101 underwent surgery with ozil hand piece and 103 with Active Sentry handpiece. Patient pain perception was comparable between the groups with no statistically significant differences in patients who had pain-free surgery (66% vs 61.3%) and those who experienced moderate pain (24.3% vs 28.7%). Surgeons were more comfortable using Ozil handpiece during entry into anterior chamber and emulsification of hard nuclei (48.5% vs 28.6%). The mean cumulative dissipated energy for soft and hard cataracts was 5.6 and 4.8 and 9.3 and 9.4 for Ozil and Active Sentry groups, respectively. ASM was activated for 53 eyes (51.5%), of which 42 eyes (79.2%) had soft cataract and 11 eyes (20.7%) hard cataract. Postoperative CDVA and incidence of corneal edema were comparable between the groups. Conclusions: For Centurion Vision System, Active Sentry handpiece was as safe and efficacious as the Ozil handpiece with added benefit of operating at lower intraocular pressure levels. [ABSTRACT FROM AUTHOR]

Purpose: To compare real-time intraocular pressure (IOP) response to occlusion break event in 2 phacoemulsification systems. Setting: Iladevi Cataract and IOL Research Center, India. Design: Randomized, experimental study. Methods: Rabbits were randomized to:Group I (n = 10 eyes), Centurion Vision system with active fluidics, or, Group II (n = 10 eyes), Centurion with Active Sentry. Within each group, parameter set 1 (IOP 30 mm Hg, aspiration flow rate [AFR] 20 mL/min, and vacuum 600 mm Hg) and parameter set 2 (IOP 50 mm Hg, AFR 25 mL/min, and vacuum 600 mm Hg) were tested. Real-time rate of drop and rise of IOP after occlusion break event (mm Hg per second) and percentage reduction of IOP from maximum during nuclear fragment removal were compared. Results: 10 rabbits (20 eyes) were included. Rate of drop of IOP after occlusion break was not significantly different between groups. Rate of rise of IOP was statistically significantly higher in Group II with both parameter sets (199.09 +/- 69.28 vs 94.33 +/- 45.66 in parameter set 1, P =.006; and 256 +/- 45.05 vs 165.25 +/- 51.80 in parameter set 2, P =.005), suggesting faster recovery to baseline IOP after occlusion break. The mean percentage reduction of IOP from maximum was significantly higher in Group I (P =.003). Conclusions: Rise of IOP to baseline after occlusion break event was faster and mean percentage reduction of IOP from maximum during nuclear fragment removal was lower when using the Centurion Vision system with the Active Sentry upgrade compared with the traditional handpiece. The ability to sense IOP at the level of the handpiece with the Active Sentry upgrade allows faster mitigation of surge response. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate outcomes of manual small-incision cataract surgery (MSICS) and phacoemulsification in eyes with chorioretinal coloboma. Setting: Tertiary eye center, South India. Design: Retrospective study. Methods: Electronic medical records of 71 patients with chorioretinal coloboma undergoing cataract surgery from January 2017 to December 2019 were evaluated. Demographics, corrected distance visual acuity (CDVA), slitlamp biomicroscopy findings, grade of cataract, type of coloboma and associated posterior segment pathology, outcomes of different surgical techniques and risk factors for poor visual outcomes, and intraoperative complications were analyzed. Results: Among the 78 eyes studied, 53.9% eyes achieved visual outcome of 20/40 or greater and 20.5% eyes achieved CDVA less than 20/200. For the MSICS group, the median preoperative CDVA was 1.78 (interquartile range [IQR] 1.08 to 2.60) logMAR), which improved to 0.60 (IQR 0.30-1.08) logMAR postoperatively. In phacoemulsification group, the CDVA improved from 0.78 (IQR 0.60-1.00) logMAR to 0.18 (IQR 0.18-0.30) logMAR. Statistically significant visual improvement was noticed in both groups (P <.001 in both). However, eyes that underwent phacoemulsification showed better visual recovery (P <.001). The mean age at presentation was 49.7 +/- 10.8 years. MSICS was the most commonly performed surgery (61.54%), and 62 eyes had uneventful cataract surgery. Twelve eyes in MSICS group and 4 eyes in phacoemulsification group had intraoperative complications. Poor visual outcome was associated with male sex, microcornea, hard cataracts, and macular involvement of coloboma. Conclusions:. MSICS is an alternative to phacoemulsification in colobomatous eyes with advanced cataract. Hard cataract and microcornea were risk factors for intraoperative complications. Significant postoperative improvement in CDVA was noticed in both macula involved and macula not involved groups. [ABSTRACT FROM AUTHOR]

Purpose: To report the incidence, risk factors, and visual outcomes of acute postoperative endophthalmitis in patients undergoing resurgery after cataract surgery. Setting: Tertiary eye hospital in southern India. Design: Retrospective, clinical registry. Methods: Medical records of patients were retrospectively reviewed from January 2010 to December 2018. Incidence, risk factors, causative organisms, management, and outcomes were studied. Patients who underwent resurgery within 6 weeks of primary cataract surgery and developed endophthalmitis within 6 weeks of resurgery were included. Results: A total of 5705 patients (0.64%) underwent resurgery. Of 5705 resurgeries, 11 patients (0.19%) developed postoperative endophthalmitis. The incidence of endophthalmitis was higher in the eyes having a breach in the posterior capsule than the eyes with no breach in the posterior capsule (10/1277 [0.78%] vs 1/4428 [0.02%]). Among the 11 patients, secondary intraocular lens (IOL) implantation was the most common indication for resurgery (9/11 [82%]) after which endophthalmitis occurred. Three (27.3%) of the 11 patients were culture-positive. Nine (82%) of 11 patients were managed with a vitreous tap along with intravitreal antibiotics and steroid injections. After treatment, 80% of the patients achieved a visual acuity of 6/18 or greater (logMAR 0.5, P value <.05). None of the eyes developed phthisis bulbi. Conclusions: Eyes having a breach in the posterior capsule requiring vitrectomy and taken for resurgery as secondary IOL implantation were having an increased risk for endophthalmitis. The posttreatment visual outcomes were favorable. [ABSTRACT FROM AUTHOR]

The article describes the case of an 11-year old boy diagnosed with acute disseminated encephalomyelitis (ADEM) with coexisting neurocysticercosis (ADEM). The patient was treated with albendazole, levetiracetam, phenytoin, valproate, hypertonic saline, mannitol, dexamethasone, methylprednisolone and intravenous immunoglobulin. The infections triggering ADEM, criteria for ADEM diagnosis, and underlying pathophysiological mechanisms involved in the development of ADEM are identified.

Purpose: To determine the efficacy of the femtosecond laser with integrated anterior segment optical coherence tomography (AS-OCT) for the detection of posterior capsular dehiscence in posterior polar cataracts (PPCs). To evaluate the safety of phacoemulsification in these eyes undergoing femtosecond laser-assisted cataract surgery (FLACS). Setting: Centre For Sight Group of Eye Hospitals, a chain of tertiary eyecare hospitals in India. Design: Prospective interventional case series. Methods: The study included eyes with PPCs undergoing FLACS using the CATALYS femtosecond platform. Real-time OCT guidance was used to image the posterior capsule (PC), which was then classified as intact or dehiscent. The femtosecond laser was used for the creation of capsulotomy, nuclear fragmentation, and corneal incisions. In all eyes, the posterior offset (distance between the posterior extent of nucleotomy and the PC) was increased to enable a thick epinuclear cushion. Intraoperative status of the PC was noted, and the specificity and the sensitivity of AS-OCT to detect a preexisting posterior capsular defect was determined. Results: The cohort included 50 eyes (40 patients), in which a posterior capsular discontinuity on AS-OCT was observed in 7 eyes (14%). Five (10%) of these 7 eyes developed an intraoperative posterior capsular rent (PCR) A sensitivity and negative predictive value of 100% was noted. No case of nucleus drop was noted. Conclusions: Femtosecond laser with integrated AS-OCT is a relevant and helpful tool to detect and increase the safety in preexisting posterior capsular dehiscence, alerting the surgeon ahead of phacoemulsification. [ABSTRACT FROM AUTHOR]

Integration of palaeobotanical (spores, pollen, phytoliths and non-pollen palynomorphs) and organic geochemical proxies, such as stable isotopes of organic carbon (δ13C) and n- alkanes, for studying the evolution and palaeoenvironmental conditions of an archaeological site are rare in India. The evolution of a protohistoric-historic site at Erenda, situated in the eastern coastal region of India, has been studied by using multiple palaeobotanical and organic geochemical proxies assisted with AMS radiocarbon dates. The excavated site lies above Late Pleistocene–Early Holocene Sijua Formation. The absence of anthropogenic evidence in the Sijua Formation likely indicates inhabitable conditions in nearshore/estuarine marshy conditions. The earliest human settlements at the excavation site begin during the first millennium BCE after the initiation of habitable conditions along the coast. The presence of fungal spores and the dominance of C4 phytolith morphotypes indicate prevailing warm and humid climatic conditions and proximity to a freshwater body. The δ13C signature and n- alkane composition indicate the use of C4 grass for the construction of the mud and clay-built huts. The settlers most likely used to consume wild or domestic variety of rice, as evidenced by the presence of bilobate scooped morphotypes. The site was partly abandoned, covered with C3 and C4 vegetation and used as a dumping ground after 663 ± 92 BCE. This implies that people continued to live in the area but possibly moved to a nearby site while using the excavated site as refuse. [ABSTRACT FROM AUTHOR]

Background: Frailty is vulnerability to adverse outcomes resulting from an interaction of physical, socioeconomic and co-morbidity factors. The study aims to find out the prevalence of Frailty and its association with risk factors and adverse outcomes associated with frailty in elderly Diabetes mellitus study subjects. Methodology: This descriptive, cross-sectional study was done at a tertiary care centre in Karnataka, India. 224 Elderly diabetics were recruited for the study using systematic random sampling from diabetic Registry. Frailty was assessed by using Multi-dimensional prognostic index by using questionnaire. Results: Proportion of Frailty and Pre-Frailty in elderly diabetics the were 9.3% and 55.8% respectively. Age, Duration of Diabetes Mellitus, number of Drugs were important determinants of frailty. Frailty associated with adverse health outcomes like hypoglycemic episodes, need for hospitalisation and duration of hospital stay. Conclusion: Recognizing and understanding frailty is important as it predicts long term outcomes and frailty may be reversible in early stage. Frailty also opens up a new conundrum and challenge for public health, incites research. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of bromfenac ophthalmic solution 0.09% in comparison with topical steroids after phacoemulsification cataract surgery, while specifically looking at differences in visual acuities, anterior chamber reaction, and central retinal thickness changes. Setting: Mission Nethralaya, India. Design: Prospective, randomized, investigator-masked, comparative clinical trial. Methods: Patients were randomly assigned to 3 treatment groups: In group I, bromfenac was prescribed 3 times a day for 1 month; in group II, prednisolone acetate 1% eye suspension was prescribed 4 times a day for 1 month; and in group III, prednisolone acetate 1% was prescribed 4 times a day for 2 weeks and bromfenac 2 times a day for 1 month. All patients received anti-infective preoperative and postoperative standards of care. Study visit assessments included corrected distance visual acuity, biomicroscopy, intraocular pressure, adverse events, and concomitant medication review. Optical coherence tomography was performed on postoperative days 7, 21, and 60. Results: Each group included 150 eyes. All treatment groups had similar baseline measurements. There was a significant difference in anterior chamber reaction observed between group I and group II (P <.001) and group I and group III (P <.001) on postoperative days 1 and 7. On postoperative day 21, thickening of the central fovea was observed in group II as compared with group I and group III. This difference was statistically significant (P <.001). Conclusions: The combination of topical nonsteroidal anti-inflammatory drugs and topical steroids resulted in positive clinical outcomes after cataract surgery. [ABSTRACT FROM AUTHOR]

Background: In India at least 13.7 per cent of general population has various mental disorders, 10.6 per cent of them require immediate interventions. While nearly 10 per cent of the population has common mental disorders, 1.9 per cent of the population suffers from severe mental disorders. Objective: To evaluate the effectiveness of recreational therapy on level of wellbeing and hope among psychiatric inpatients Method: The present study adopted a Quantitative research approach. The sample comprised of 33 psychiatric in patients with psychotic and neurotic disorder admitted in psychiatry ward of MMIMSR hospital, Haryana on the basis of purposive sampling technique. The data were collected before and after the administration of recreational therapy, and only two components of recreational therapy (Physical exercise and Mandala Art therapy) were administered to the patients for 8 consecutive days with 16 sessions. The level of wellbeing and hope were assess by using Wardwick Edenburg Mental Wellbeing scale and Herth Hope Index. Conclusion: The results of the study show a significant mean difference in the level of hope and level of wellbeing. The value of p=0.00 was also statically significant at 0.05 level of significance. From the study, it can be concluded that recreational therapy was effective in increasing the level of wellbeing and hope among the psychiatric inpatients. [ABSTRACT FROM AUTHOR]

Quasi experimental research study was conducted during the month of August 2018 with the aim of establishing the effectiveness of ginger tea in reducing the morning sickness. Total of 60 antenatal mothers were selected and grouped into 30 in each for experimental and control respectively. The subjects were selected by using Non probability purposive sampling technique. The level of morning sickness was evaluated by using modified Rhodes index scale among antenatal mothers. The intervention was exercised i.e. Ginger tea 200ml once in a day for 5 days was administered to the subjects of experimental group. The reliability of the tool was determined by using split half method. The reliability coefficient “r” was more than 0.7, hence the tool was found to be reliable. Also, 30 eminent experts from all over India had validated the tool for its content. Data was analyzed using descriptive ie. Frequency and percentage distribution, inferential statistics ie. ‘t’ test, z test. Study results showed that, the ginger tea is effective on morning sickness and statistically there is significant difference in the experimental and control group. Hence study concludes that there is significant effect of ginger tea on morning sickness among antenatal mothers [ABSTRACT FROM AUTHOR]

Objective: The treatment of bipolar disorder is challenging because of its clinical complexity and availability of multiple treatment options, none of which are ideal mood stabilizers. This survey studies prescription practices of psychiatrists in India and their adherence to guidelines. Method: In total, 500 psychiatrists randomly selected from the Indian Psychiatric Society membership directory were administered a face-to-face 22-item questionnaire pertaining to the management of bipolar disorder. Results: For acute mania, most practitioners preferred a combination of a mood stabilizer and an atypical antipsychotic to monotherapy. For acute depression, there was a preference for a combination of an antidepressant and a mood stabilizer over other alternatives. Electroconvulsive therapy was preferred in the treatment of severe episodes and to hasten the process of recovery. Approximately, 50% of psychiatrists prescribe maintenance treatment after the first bipolar episode, but maintenance therapy was rarely offered lifelong. While the majority (85%) of psychiatrists acknowledged referring to various clinical guidelines, their ultimate choice of treatment was also significantly determined by personal experience and reference to textbooks. Limitations: The study did not study actual prescriptions. Hence, the responses to queries in the survey are indirect measures from which we have tried to understand the actual practices, and of course, these are susceptible to self-report and social-desirability biases. This was a cross-sectional study; therefore, temporal changes in responses could not be considered. Conclusion: Overall, Indian psychiatrists seemed to broadly adhere to recommendations of clinical practice guidelines, but with some notable exceptions. The preference for antidepressants in treating depression is contrary to general restraint recommended by most guidelines. Therefore, the efficacy of antidepressants in treating bipolar depression in the context of Indian psychiatrists' practice needs to be studied systematically. Not initiating maintenance treatment early in the course of illness may have serious implications on the long-term outcome of bipolar disorder. [ABSTRACT FROM AUTHOR]

Objective: To determine whether oral clindamycin reduces the risk of preterm birth (PTB) in women with abnormal vaginal microflora as evidenced by a vaginal pH ≥5.0.Design: Randomised double-blind placebo-controlled trial.Setting: Rural southern India.Population: Pregnant women with a singleton fetus between 13+0/7 weeks and 20+6/7 weeks.Methods: Pregnant women were recruited during prenatal visits in Karnataka, India, from October 2013 to July 2015. Women were required to have a singleton fetus between 13+0/7 weeks and 20+6/7 weeks and an elevated vaginal pH (≥5.0) by colorimetric assessment. Participants were randomised to either oral clindamycin 300 mg twice daily for 5 days or an identical-appearing placebo.Main Outcome Measures: The primary outcome was the incidence of PTB, defined as delivery before 37+0/7 weeks.Results: Of the 6476 screened women, 1727 women were randomised (block randomised in groups of six; clindamycin n = 866, placebo n = 861). The demographic, reproductive, and anthropomorphometric characteristics of the study groups were similar. Compliance was high, with over 94% of capsules being taken. The rate of PTB before 37 weeks was comparable between the two groups [clindamycin 115/826 (13.9%) versus placebo 111/806 (13.8%), between-group difference 0.2% (95% CI -3.2 to 3.5%, P = 0.93)], as was PTB at less than 34 weeks [clindamycin 40/826 (4.8%) versus placebo group 37/806 (4.6%), between-group difference 0.3% (95% CI -1.8 to 2.3%, P = 0.81)]. No differences were detected in the incidence of birthweight of<2500 g, <1500 g, miscarriage, stillbirth or neonatal death.Conclusion: In this setting, oral clindamycin did not decrease PTB among women with vaginal pH ≥5.0.Tweetable Abstract: Oral clindamycin between 13+0/7 and 20+6/7 weeks does not prevent preterm birth in women with a vaginal pH ≥5.0. [ABSTRACT FROM AUTHOR]

Recent studies have documented Pfhrp2/3 gene deletion globally as one of the biological threats in the fight against malaria. For malaria diagnosis, PfHRP2 based RDTs are most widely used in India, and performance of these RDTs are affected by deleted Pfhrp2/3 gene in Plasmodium falciparum. This study was planned to confirm Pfhrp2/3 gene deletion incidences and genetic variation in PfHRP2-based RDT positive with P.falciparum malaria cases from India. Confirmed positive samples by PfHRP2-based RDTs as P. falciparum (n = 240) from six different endemic regions of India were validated by PCR to assure the actual infection. Two hundred forty samples qualified for DNA intactness by single-copy genes were subjected to amplification for the Pfhrp2/3 gene and its neighbouring gene (downstream and upstream) by PCR genotyping. Genetic variation in samples was analysed post-sequencing using Mega X software. Statistical analysis was performed to validate the genetic variation using Mann-Whitney Test. RDT target region of Pfhrp2 gene (exon2) was found deleted in a single sample with presence of the Pfhrp3 exon2. Complete gene deletion of 4.2% was observed in the Pfhrp3 gene. Partial gene deletion was recorded for both pfhrp2 gene (exon2–0.4%, upstream 25.8% and downstream −9.1%) and Pfhrp3 gene (exon2–18.75%, upstream - 22.08% and downstream 13.3%). Eleven new unique types of amino acid repeat sequence and earlier reported amino acid repeat type was found in the Pfhrp2 gene, prompting high genetic variation. This study suggests that parasites lacking Pfhrp2/3 gene and its neighbouring gene (downstream and upstream) are present in malaria endemic areas of India, resulting in false positive results by RDT. Systematic countrywide monitoring for malaria control and elimination of malaria is warranted in this regard. [Display omitted] • WHO suggests measuring the prevalence of suspected false-negative HRP2 RDT of symptomatic patients with P.falciparum. • RDT target region of Pfhrp2 gene (exon2) was found deleted in single sample with presence of Pfhrp3 exon2. • Complete gene deletion of 4.1% was observed in Pfhrp3 gene. Partial gene deletion was recorded for both Pfhrp2 gene (- and Pfhrp3 gene (• Eleven new- types of amino acid repeat sequence along with earlier reported repeat type were found in Pfhrp2 gene prompting high genetic variation. [ABSTRACT FROM AUTHOR]

The article discusses the teaching of English vocabulary in Tamilnadu and other states across India. It explains that English language acquisition and learning is advocated in the Indian constitution especially in the educated circles for personal and business communication. It adds that the English language is dominantly used in the private sector in the fields of mass communication, industry and commerce, administration, engineering, medicine, travel and tourism.

Please cite this paper as: Bellad M, Tara D, Ganachari M, Mallapur M, Goudar S, Kodkany B, Sloan N, Derman R. Prevention of postpartum haemorrhage with sublingual misoprostol or oxytocin: a double-blind randomised controlled trial. BJOG 2012;119:975-986. Objective Sublingual misoprostol produces a rapid peak concentration, and is more effective than oral administration. We compared the postpartum measured blood loss with 400 μg powdered sublingual misoprostol and after standard care using 10 iu intramuscular (IM) oxytocin. Design Double-blind randomised controlled trial. Setting A teaching hospital: J N Medical College, Belgaum, India. Sample A cohort of 652 consenting eligible pregnant women admitted to the labour room. Methods Subjects were assigned to receive the study medications and placebos within 1 minute of clamping and cutting the cord by computer-generated randomisation. Chi-square and bootstrapped Student's t-tests were used to test categorical and continuous outcomes, respectively. Main outcome measures Measured mean postpartum blood loss and haemorrhage (PPH, loss ≥500 ml), >10% pre- to post-partum decline in haemoglobin, and reported side effects. Results The mean blood loss with sublingual misoprostol was 192 ± 124 ml ( n = 321) and 366 ± 136 ml with oxytocin IM ( n = 331, P ≤ 0.001). The incidence of PPH was 3.1% with misoprostol and 9.1% with oxytocin ( P = 0.002). No woman lost ≥1000 ml of blood. We observed that 9.7% and 45.6% of women experienced a haemoglobin decline of >10% after receiving misoprostol and oxytocin, respectively ( P ≤ 0.001). Side effects were significantly greater in the misoprostol group than in the oxytocin group. Conclusion Unlike other studies, this trial found sublingual misoprostol more effective than intramuscular oxytocin in reducing PPH, with only transient side effects being greater in the misoprostol group. The sublingual mode and/or powdered formulation may increase the effectiveness of misoprostol, and render it superior to injectable oxytocin for the prevention of PPH. Further research is needed to confirm these results. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of diabetes mellitus (DM) and its associated diabetic complications in rural Goa, India. Materials and Methods: A community-based study was carried out in a rural setting in Goa, India. About 1,266 participants were selected by systematic random sampling. The participants were interviewed using a semi-structured questionnaire and were subjected to anthropometric, clinical evaluation and biochemical investigations. American Diabetes Association criteria were used to determine the prevalence of diabetes and standard operational definitions were used to define the diabetic complications. Data was analyzed using SPSS version 14.0 while chi-square and chi-square for trend were the tests used. Results: Among the total 1,266 study participants about 130 (10.3%) were diabetics. The prevalence of the associated diabetic complications were as follows viz. neuropathy (60%), CHD (32.3%) and cataract (20%), retinopathy (15.4%), peripheral vascular disease (11.5%) and cerebrovascular accidents (CVAs) (6.9%). A significant rising trend in the prevalence of all diabetic complications was observed with advancing duration of diabetes. Conclusion: The prevalence of DM and its associated complications was higher among the diabetic individuals in the rural setting of Goa, India. All the associated diabetic complications observed need to be addressed with appropriate prevention and control strategies. [ABSTRACT FROM AUTHOR]

The article explores how the English translation of the novel "Koolla Madari" by Perumal Murugan reflect the relationship between the upper class and the untouchables in India. The novel's translation by writer V. Geetha is said to illustrate the problem of maltreating the poor community in India. A discussion on the role of translation in a multilingual country such as India is presented. Also given is an explanation on how the novel adds important dimension to the concept of Dalit literature.

The article reports on library use by visually impaired persons in the libraries located in Delhi, India. At issue is the use of information and the information seeking behavior of those with visual impairments. A number of topics are addressed including the use of information in decision making and for national development, the significant number of visually impaired individuals in India, and the use and availability of software that assists impaired readers. Also discussed is the methodology used in this research survey.

The effective use of radiotherapy in cancer cure and palliation is compromised by the side-effects resulting from radiosensitivity of bordering normal tissues, which are invariably exposed to the cytotoxic effects of ionizing radiation during treatment. In this situation, use of radioprotective compounds that can protect normal tissues against radiation injury are of immense use. In addition to protecting normal tissue these compounds will also permit use of higher radiation doses to obtain better cancer control and possible cure. However, to date, no ideal radioprotectors are available as most synthetic compounds are toxic at their optimal concentrations and have produced little success in clinics. Radiation ill-effects are principally the result of generation of free radicals, and the antioxidant compounds that counter them are supposed to be of immense use in preventing them. In Ayurveda, the traditional Indian system of medicine, several plants have been observed to avert/ameliorate free radical-mediated ailments-an effect that has been documented-and such plants have recently been the focus of attention. Aegle marmelos (L.) Correa (Bael), commonly known as bael, has been used since antiquity for treating various ailments, some of which are now known to be the result of oxidative stress. In studies spanning nearly a decade, it has been observed that bael prevented radiation-induced ill-effects, and the results of these studies indicate that it has the potential to be an effective, nontoxic radioprotective agent. In this current review, for the first time, an attempt is made to summarize these observations and to discuss the plausible reasons responsible for bael's radioprotective effects. [ABSTRACT FROM AUTHOR]

Hypokalaemic periodic paralysis (HPP) is a life-threatening condition. Our aim was to study the clinical profile and laboratory parameters of HPP patients and to develop an algorithm to determine the causes of HPP. 84 patients presented with HPP over a 3 year period. 58 (69.0%) were found to have renal tubular acidosis (RTA). The other causes were idiopathic HPP (8 (9.5%)), acute gastroenteritis (4 (4.8%)), suspected primary hyperaldosteronism and familial HPP (2 each (2.4%)) and suspected Gitelman/Bartter Syndrome and thyrotoxic periodic paralysis (1 each (1.2%)). The number of cases peaks in the hot season. Over a third of the patients (35.7%) had recurrent episodes. 80% had secondary HPP and therefore a biochemical evaluation is mandatory. A simple algorithm was developed. Both health professionals and patients need further education regarding this problem in order to improve diagnosis and treatment and to improve compliance. [ABSTRACT FROM PUBLISHER]

Background: Anaplastic lymphoma kinase (ALK) rearranged metastatic non-small cell lung cancer (NSCLC) comprises 5%-7% of all lung cancer and carries a good prognosis with available ALK-inhibitors. Majority of registration trials in ALK-inhibitors did not include Indian patients. Hence, this study was planned to analyze the outcome of Indian patients treated with ALK-inhibitors and associated challenges. Methods: This is a multi-center study in 5 major tertiary care cancer centers across India treating ALK-rearranged NSCLC patients from April 2013 to April 2019. ALK rearrangement was determined by Ventana immunohistochemistry with D5F3 clone and/or by break-apart FISH. Patients treated with ALK-inhibitors in any lines of treatment were included in this study. Patients were evaluated for clinicopathologic features, patterns of ALK-inhibitors use and outcome. Progression free-survival (PFS) and overall survival (OS) were calculated and data were censored on April 30, 2019. Results: A total of 274 patients were studied, out of which 250 patients received ALK inhibitor and were analyzed further for outcome. The median age was 50 years (range: 24-82) and male to female ratio of 1.17:1. ALK was evaluated by immunohistochemistry in majority of patients (97%), 3 patients by FISH and 3 more patients were evaluated by both methods. Sixty-five percent (n = 162) of the patients received ALK-inhibitor as first line therapy, 51 patients received ALK-inhibitor as switch maintenance therapy after initial chemotherapy. Crizotinib and Ceritinib were used in 88% and 12%, respectively. One patient received Alectinib. Forty-one percent of patients had CNS progression. After median follow up of 27 months (1-72 months), the median OS was 24.7 months with OS rate of 72%, 51%, and 18% at 1, 2, and 4-years respectively. Median OS was 21.2, 26, and 38 months in the first line ALK-inhibitors use (n = 162), switch maintenance group (n = 51) and second line ALK-inhibitors use (postchemotherapy progression) (n = 33), respectively. No baseline variable predicted PFS. Presence of brain metastasis (P = 0.039) and first line ALK-inhibitors use (P = 0.032) emerged as poor prognostic factor for OS on multivariate analysis. PFS rate was 70%, 47%, and 31% at 6, 12, and 18 months respectively. Conclusion: This is one of the largest real-world data on outcome of ALK inhibitors in ALK-rearranged NSCLC from Asia. In absence of second line ALK inhibitor, initial chemotherapy followed by ALK-inhibitors (switch maintenance) had better outcome. This fact may be studied in individual patient data meta-analysis. Poor performance status and brain metastases at presentation are poor prognostic factors for overall survival. Second-line ALK inhibitor use crucial for better outcome and access to clinical trials are much needed in Indian patients. [ABSTRACT FROM AUTHOR]

Background: Chronic low back pain is a common public health problem all over the world. Conservative therapy is prescribed as the initial treatment strategy in chronic low back pain. The cornerstone of conservatism in back care is core muscle strengthening. However, exercises prescribed for the purpose are manifold and some are not easily done by patients in Asian countries. We developed an easy to adhere exercise protocol for core stabilization and tested its effectiveness in south Indian population. Methods: Prospective study of 73 patients with chronic low back pain (CLBP) who were subjected to Trivandrum Community-based Core Stabilisation protocol of treatment. The enrolled patients underwent initial Oswestry Disability Index (ODI) evaluation and Keele Start Back (KSB) questionnaire before starting the protocol. Back education was given, and the patient started on stratified exercise protocol. ODI assessment was done weekly. The trend in ODI changes and the factors determining them were assessed using ANOVA. The correlation of quantitative variables like age, initial ODI score, and KSB score with the rate of reduction of ODI was assessed using Pearson's correlation. Cross-tabulations were done using the chi-square test. Parametric tests were used throughout the analysis as the quantitative study variables found to be linear. Multiple linear regression (for the quantitative outcome) and binary logistic regression (for the dichotomous outcome) were performed. Results: Mean (SD) of ODI score has reduced significantly from 43.4 (16.6) to 24.6 (17.1) over the period of 6 weeks (p value < 0.001). The trend in reduction of ODI scores was significantly more in KSB score less than or equal to 3 compared to KSB more than 3 even after adjusting for the general trend of decreasing ODI score over time. The reduction in ODI scores appeared to be low for advancing age (p = 0.468) and higher KSB scores (p = 0.001). Conclusion: The TRICCS protocol is effective in a community-based approach in achieving satisfactory outcomes in CLBP in a period of 6 weeks. Patients with high KSB scores may require cognitive intervention also. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of cancer in a child places considerable economic burden on families. The health expenditures are more catastrophic in resource limited countries like India where GDP spend on health is just over 1% and financing of treatment is usually out-of-pocket (OOP). Consequently parents may abandon their child's cancer treatment to ensure financial sustainability of the family. Research in this area is mostly from resource rich countries and OOP expenditure burden remains unknown in India. Aim: The objective of this study is to describe the OOP expenditure incurred by families of children (< 18 years age) with cancer being treated in India prior to and during cancer directed treatment. Methods: A prospective cost of illness study from a family household perspective was conducted in 14 centers (5 public, 5 private and 4 charitable trust sector) in 4 cities in India from 2016-2018. Baseline family demographic and socioeconomic data were collected followed by OOP expenditure incurred prior to start of treatment. For the duration of the child's treatment, a social worker contacted parents at regular intervals to record their expenditure on cancer directed treatment. Data collection was stopped when one of these happened - completion of treatment or death or progression/relapse or abandonment or transfer. Data were described descriptively and a univariate/multivariate analysis using logistic regression was done to detect factors associated with OOP expenditure. Results: 394 children (63% male, median age 5 years) with cancer (64% leukemia/lymphoma, 33% solid tumors, 3% CNS tumors) were enrolled from public (45%), charitable trust (28%) and private (27%) sector hospitals. They were symptomatic for a median duration of 6 weeks (range 0 to 104 weeks). 88% had no insurance and 73% were from families with monthly income of ≤ 10,000 rupees (≤ 159 US$). Mean OOP expenditure was Rs 209,500 (3325 US$) which is 195% of per capita income (1706 US$) of India. OOP expenditure from onset of symptoms to start of treatment was Rs 53,104 (843 US$) of which 77% was medical (15% laboratory tests, 11% medicines, 9% hospital bed costs) and 23% nonmedical (12% travel, 6% food, 3% lodging). OOP expenditure on cancer directed treatment was Rs 156,396 (2482 US$) of which 64% was medical (9% hospital bed costs, 9% supportive care drugs, 8% laboratory tests) and 36% nonmedical (19% food, 9% travel, 6% lodging). On univariate analysis age, gender, city, type of treatment facility, insurance, type of cancer, driving time and distance were significantly associated with OOP expenditure but only insurance and type of treatment facility were found significant on multivariate analysis. Conclusion: Families of children with cancer incur significant OOP expenditure prior to and during cancer directed treatment, which includes a significant portion on nonmedical expenses. Expenditure varied significantly by insurance and type of treatment facility. [ABSTRACT FROM AUTHOR]

The yak (Bos grunniens), renowned for its adaptability to extreme cold and hypoxic conditions, stands as a remarkable domestic animal crucial for sustaining livelihoods in harsh climates. We conducted a comprehensive analysis of the whole genome sequence data from three distinct Indian yak populations: Arunachali yak (n = 10), Himachali yak (n = 10), and Ladakhi yak (n = 10). The genomic data for Indian yaks were meticulously generated by our laboratory and compared with their Chinese counterpart, the Jinchuan yak (n = 8), for a more nuanced understanding. Our investigation revealed a total of 37,437 runs of homozygosity (ROH) segments in 34 animals representing four distinct yak populations. The Jinchuan yak population exhibited the highest proportion, constituting 80.8 % of total ROHs, predominantly as small segments (<0.1 Mb), accounting for 63 % of the overall ROHs. Further analysis uncovered a significantly higher degree of inbreeding in Chinese yaks compared to their Indian counterparts. The Indian yak populations, in contrast, demonstrated relatively lower and consistent levels of inbreeding. Moreover, we identified ROH hotspots that covered at least 60 % of individuals in our study, indicating their pivotal role in environmental adaptation. A total of five hotspot regions were detected, housing genes such as ENSBGRG00000015023 (WNT2), YIPF4, SPAST, TLN2, and DSG4. These genes are associated with traits including hair follicle initiation, nutrient stress response, microtubule assembly, development of cardiac muscle, hair follicle, and coat color. This observation strongly suggests that there is substantial selection acting on these genes, emphasizing their important role in environmental adaptation among yak populations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The environment is the most important stratum in the epidemiological triad of a parasitic disease and any variations in the environmental factors may decide the dynamic occurrence and existence of different lifecycle stages of these parasites. The present study investigated the correlations between key biometeorological and demographical parameters with the incidence of different gastrointestinal parasites and hemoparasites among goats. Four hundred and thirty-two goats were screened for parasitic infection in a yearlong survey conducted from July 2022 to June 2023 in the Teaching Veterinary Clinical Complex, Mannuthy, Kerala, India. The weather parameters (T max , T min , RH, THI, and bright sunshine hours), air quality parameters [AQI, PM 2.5 , and PM 10 ], and demographic parameters (gender and age) were recorded along with the test positivity of different categories of gastrointestinal parasites and hemoparasites in goats by routine fecal sample examination and blood smear examination, respectively. The infection level was ranked based on the severity of the infection. The mean and daily variations in biometeorological parameters were calculated and the data were statistically analyzed to figure out the pertinent correlations in host-parasite-environment interaction patterns. High levels of parasitic infections with significant month-wise variations and climate-correlated peak infection patterns were noticed. The incidence of parasites was negatively correlated to all parameters except humidity, indicating more severe parasitism during monsoon months. The significant variations in the host-parasite interaction dynamics point towards the need for detailed explorations concerning the lifecycle of each specific parasite with a focus on the possible environment-favourable and resistant lifecycle stages. Future studies may be designed from a biometeorological perspective to develop a crucial understanding of host-parasite-environment interactions in goats ensuring sustainable goat farming., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Dypsis lutescens, commonly known as areca palm, is a highly valued ornamental species due to its aesthetic value. However, the foliage is vulnerable to various pathogens, particularly those responsible for fungal leaf spot diseases. In October 2023, a severe incidence (93 %) of destructive leaf spots was recorded on Dypsis lutescens at the University of Agricultural Sciences, GKVK, Bangalore, and surrounding areas. The leaf spot symptoms manifested as frog-eye-like lesions, leading to complete leaf desiccation and significantly reducing the palms ornamental value. The pathogen exhibited the highest radial growth (90.00 mm) and prominent sporulation on oat meal agar, whereas Richard's synthetic agar resulted in the lowest radial growth (38.00 mm) with no sporulation. Morphological and multilocus phylogenetic analyses confirmed the pathogen as Bipolaris heliconiae. Pathogenicity tests fulfilled Koch's postulates, confirming that Bipolaris heliconiae is the causative agent of leaf spot disease in Dypsis lutescens in India. This novel finding underscores the emergence of a new disease and highlights the urgent need for effective management strategies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this research paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Major psychiatric illnesses often cluster in families, and their impact on affected and unaffected members within families may reflect the consequence of both genetic and social liability., Methods: Data was derived from 202 families with multiple affected individuals. Affected individuals (N = 259) had a diagnosis of schizophrenia, bipolar disorder, obsessive-compulsive disorder or substance use disorder. For comparison, we used the unaffected siblings from the same families (N = 229) and a matched random subset of healthy control (HC) data (N = 229) from India's National Mental Health Survey, 2016 (NMHS). We compared the three groups' educational attainment, functional marital status, and occupational status., Results: The highest educational attainment was significantly different between the groups. The affected and unaffected siblings had poorer educational attainment compared to HC. Similarly, the affected and unaffected siblings more often remained single, in contrast to HC. Moreover, employment rates were significantly higher in the unaffected siblings, especially female siblings. Overall, females had spent fewer years at school, were primarily married, and were majority homemakers across the three groups compared to males., Discussion: Affected and unaffected siblings had lower education and marriage rates than HC. The unaffected siblings were more likely to be employed than HC. Whether the poor educational attainment and lower marriage rates in unaffected siblings is a biological marker of shared endophenotype or the effect of the social burden of having an affected family member requires further systematic evaluation., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflicts of interests to declare with respect to the current study., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Lifestyle diseases significantly contribute to the global health burden, with lifestyle factors playing a crucial role in the development of depression. The COVID-19 pandemic has intensified many determinants of depression. This study aimed to identify lifestyle and demographic factors associated with depression symptoms among Indians during the pandemic, focusing on a sample from Kolkata, India. An online public survey was conducted, gathering data from 1,834 participants (with 1,767 retained post-cleaning) over three months via social media and email. The survey consisted of 44 questions and was distributed anonymously to ensure privacy. Data were analyzed using statistical methods and machine learning, with principal component analysis (PCA) and analysis of variance (ANOVA) employed for feature selection. K-means clustering divided the pre-processed dataset into five clusters, and a support vector machine (SVM) with a linear kernel achieved 96% accuracy in a multi-class classification problem. The Local Interpretable Model-agnostic Explanations (LIME) algorithm provided local explanations for the SVM model predictions. Additionally, an OWL (web ontology language) ontology facilitated the semantic representation and reasoning of the survey data. The study highlighted a pipeline for collecting, analyzing, and representing data from online public surveys during the pandemic. The identified factors were correlated with depressive symptoms, illustrating the significant influence of lifestyle and demographic variables on mental health. The online survey method proved advantageous for data collection, visualization, and cost-effectiveness while maintaining anonymity and reducing bias. Challenges included reaching the target population, addressing language barriers, ensuring digital literacy, and mitigating dishonest responses and sampling errors. In conclusion, lifestyle and demographic factors significantly impact depression during the COVID-19 pandemic. The study's methodology offers valuable insights into addressing mental health challenges through scalable online surveys, aiding in the understanding and mitigation of depression risk factors., (© 2024. The Author(s).)

Among different climatic zones in India, the tropical monsoon region comprises a diverse ecosystem characterized by the endemic nature of several parasites including certain emerging and re-emerging vector-borne pathogens of humans, whereas a systematic investigation of the occurrence of different parasites among domestic goats in this area is not yet explored. The goal of the present study is to explore the parasite diversity focusing on molecular identification of vector-borne hemoparasites and its health impacts on domestic goats reared in the tropical monsoon climate zone of Kerala, India. Among 227 goats presented to the Teaching Veterinary Clinical Complex (TVCC) in the monsoon months of 2023, thirty animals were recruited for the study. The animals were screened for the presence of different hemoparasites (Anaplasma spp., Theileria spp., and Babesia spp.), ectoparasites (ticks, lice, and fleas), and gastrointestinal (GI) parasites (hookworms, threadworms, tapeworms, whipworms, and coccidia). The isolated hemoparasites were further characterized by sequencing and phylogenetic analysis. The correlation studies to elucidate the association between the occurrence of different parasites and clinical manifestations (hyperthermia, pallor of mucous membrane, circulatory failure, respiratory signs, neurological instability, and GI signs), blood picture (anemia, leukopenia, thrombocytopenia), demographics (sex and age), and treatment history (hemoparasitic therapy, ectoparasiticidal application, and prophylactic deworming) were conducted. The co-infection status of these parasites was also evaluated. A substantial portion of the goats in the study group was found to be affected by vector-borne hemoparasitic diseases and their arthropod vectors or GI parasites or both. This can be attributed to the constantly warm and humid climate of the region, which is favorable for the survival and growth of different life cycle stages of these parasites and vectors. A strategic parasitic disease surveillance-cum-control program is the need of the hour for ensuring climate resilience and profitable goat farming in the region., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Deep cerebral venous thrombosis (DCVT) is an uncommon cause of stroke with diverse predisposing factors, clinical presentations, imaging findings, and functional outcomes, which makes the diagnosis of DCVT even more challenging., Materials and Methods: Retrospective observational study (December 2018 to January 2023). Cases with imaging data suggestive of DCVT were included. The neuroradiological assessment was performed using multimodality imaging to determine the location of parenchymal changes and the number of deep veins involved in isolation or with the superficial dural venous system. Clinical variables were tabulated., Results: Of the 206 cases with CVT in the study period, 27 had DCVT (13.1%), of which four (14.8%) had isolated DCVT (male-to-female ratio 13:14; mean age = 33.4 years). Hyperhomocysteinemia ( n = 11) is the most common risk factor associated with it. The most common presentations were headaches ( n = 27) and focal motor deficits ( n = 13). Raised intracranial tension (ICT) was present in almost half of the study population ( n = 14). Mean and median modified Rankins score (mRS) at the time of discharge were 2.0 and 1, respectively. The most common deep vein involved was the straight sinus (SS) ( n = 25), followed by the internal cerebral vein ( n = 23). The mean and median mRS after 3 months from discharge were 0.3 and 0, respectively., Conclusion: A knowledge of diverse clinical presentations in DCVT, its neurovascular anatomy, and imaging characteristics with prompt diagnosis and timely interventions can assist in attenuating the risk of acute complications and long-term sequelae. Extensive deep grey matter involvement in DCVT is associated with neurological manifestations like altered sensorium and motor deficits, with increased severity of illness as measured by the mRS score., (© Journal of the Association of Physicians of India 2024.)

Tooth bleaching has become increasingly popular in recent times. It is the preferred conservative approach for lightening discolored teeth. The primary objective of tooth bleaching is to whiten teeth using oxidizing chemicals that work on both enamel and dentin. The noninvasive nature of modern bleaching systems allow for effective treatment options that meet the high expectations of patients. The objective of this study was to investigate the knowledge, attitude, and practices of dental practitioners in South India for managing discolored upper front teeth. We created and distributed a structured, validated questionnaire about bleaching discolored anterior teeth to South Indian dental practitioners and analyzed the data. We found a statistically significant relationship between endodontists and general dentists in their preferences for isolation techniques, choice of materials for vital bleaching, management of intact nonvital teeth, and management of postbleaching sensitivity. Women exhibit a greater preference for teeth-whitening procedures than men, with 74% opting for whitening treatments. The predominant method for addressing tooth discoloration is bleaching, which makes up approximately 63.8% of the whitening procedures. In-office bleaching is the preferred method for both vital and nonvital bleaching procedures, demonstrating its widespread acceptance and preference among practitioners., Competing Interests: All authors declare that they have no conflict of interest., (Copyright © 2024 International Society of Plastic and Aesthetic Nurses. All rights reserved.)

Purpose: The coronavirus disease 2019 (COVID-19) pandemic led to overall interrupted medical care, resulting in disease progression and morbidity. The study aimed to evaluate clinicopathological presentations and severity of eyelid malignancy during the COVID era, comparing the results with patients presented during pre-COVID era and evaluating the reasons for delayed presentation in patients with advanced eyelid malignancy in the COVID-era., Methods: This was a comparative, ambispective observational study. Data regarding demographic, clinical, histopathology, and treatment modalities of confirmed cases of eyelid malignancy admitted during the period from March 2020 to September 2022 (defined as COVID era group) were collected and compared with retrospectively collected data from March 2017 to March 2020 (defined as pre-COVID era group). COVID era patients were further categorized as localized and advanced disease. Patients with advanced eyelid malignancy during COVID era were further subjected to a questionnaire to evaluate the reasons for delayed presentation., Results: In total, 115 patients of eyelid malignancy were studied [COVID era group 40 (35%) and pre-COVID era group 75 (65%)]. A statistically significant increase in the duration of disease (P = 0.0001) and advanced tumor T-stage (P = 0.03) was noticed in the COVID era group. Demographic, histopathology, and ocular morbidity details were similar in both groups. The common reasons that led to delay in presentation and treatment in advanced T-stage patients during the COVID era were fear of acquiring COVID, lockdown, and lack of medical facilities., Conclusion: During the COVID-19 pandemic, both hospital- and patient-related factors contributed to delay in presentation, leading to advanced-stage disease indicating need of triaging of eyelid malignancy in the event of such pandemics in future., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

The research, focusing on the analysis of nine trace elements, namely As, Cd, Cr, Cu, Fe, Mn, Ni, Pb, and Zn, completely analyzed their quantities in both water and sediment inside the Rabnabad Channel. Samples were collected during the post-monsoon and analyzed by ICP-OES following acid digestion. The mean concentrations of elements in water and sediments are as follows: Fe > Mn > Pb > Cu > Ni > Zn > Cr > As>Cd, and Zn > Fe > Pb > Mn > As>Cu > Cr > Ni > Cd. To understand the state of ecological and human health risk, several indices were incorporated. Health risk assessment revealed that children posed higher risk than adults. PERI, TRI, and I geo indices for water sediment indicate a significant ecological risk. Moreover, Mn and Pb exhibit elevated HPI values and contribute substantially to contamination factors. Correlation and PCA implicate both anthropogenic and geogenic sources, such as agricultural practices, coal-based power plants, and the Payra seaport, in the elevated concentrations of Cd, Cr, Mn, and Fe in both water and sediment samples., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Timely diagnosis and management of pediatric acute liver failure (PALF) is of paramount importance to improve survival. The Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition invited national and international experts to identify and review important management and research questions. These covered the definition, age appropriate stepwise workup for the etiology, non-invasive diagnosis and management of cerebral edema, prognostic scores, criteria for listing for liver transplantation (LT) and bridging therapies in PALF. Statements and recommendations based on evidences assessed using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were developed, deliberated and critically reappraised by circulation. The final consensus recommendations along with relevant published background information are presented here. We expect that these recommendations would be followed by the pediatric and adult medical fraternity to improve the outcomes of PALF patients., (© 2024. Asian Pacific Association for the Study of the Liver.)

Purpose: Leptospirosis is an endemic disease in India and uveitis is its late complication. Several Indian reports showed diversity of serovars, changing patterns and existence of new serovars. Failure to add new serovars in testing panel result in increased false-negativity in serology., Aim: To analyse seroprevalence, changing patterns and to discuss the resulting challenges in diagnosis., Methods: In this retrospective study covering the period from 1994 to 2020, we analysed data from laboratory records of patients diagnosed with leptospiral uveitis in South India. Microscopic agglutination Test (MAT) and/or Enzyme-Linked Immunosorbent Assay (ELISA) were performed on clinically diagnosed leptospiral uveitis cases from our hospital, as well as on systemic leptospirosis patients from government and private hospitals., Results: Out of a total of 87 216 new uveitis cases with varying causes over 27 years, 3,658 (4.1%) were clinically diagnosed as leptospiral uveitis. Among them, 1,268 (34.7%) patients were seropositive. In 1994, 92% of clinically diagnosed leptospirosis patients were seropositive in the MAT performed at the Centers for Disease Control and Prevention in Atlanta. However, the positivity rate gradually declined to 35% over the years. The predominant serovars identified were L. autumnalis , L. icterohaemorrhagiae , and L. australis . There were notable variations in the distribution of serovars over the years., Conclusions: The data suggest a declining sensitivity of MAT and ELISA, possibly due to the emergence of new serovars. Customizing the panel based on local isolates could enhance the performance of MAT. Critical need is the addition of advanced molecular techniques to improve the diagnosis.

Aim: To assess the prevalence of non-communicable disease risk factors among the nursing staff and educate them on prevention., Background: Nursing staff is integral to the Indian community healthcare systems. Recent studies report a high prevalence of non-communicable diseases in Indian nursing staff. Therefore, data on the prevalence of non-communicable disease risk factors among nursing staff are crucial for education on prevention., Design: A cross-sectional digital survey-based study., Method: We invited 4435 nursing staff to attend our online survey. We used a customized questionnaire for data collection, including a digitized version of the Community-Based Assessment Checklist form. A score of >4 was considered high risk and warranted screening., Result: Among 682 nursing staff who attended, 70% had never undergone screening for non-communicable diseases. The prevalence of non-communicable disease risk factors was significantly higher in male nursing staff. In addition, logistic regression analysis showed that age, tobacco and alcohol use, increased waist circumference, physical inactivity and family history of non-communicable diseases were significant risk factors among nursing staff., Conclusion: The study findings suggest that the nursing staff have suboptimal self-health concerns on non-communicable diseases. This situation warrants continued medical education, awareness campaigns on adopting a healthy lifestyle and health promotion., (© 2024 John Wiley & Sons Australia, Ltd.)

Purpose: While research on inguinal hernias is well-documented, ventral/incisional hernias still require investigation. In India, opinions on laparoscopic ventral hernia repair (LVHR) techniques are contested. The current consensus aims to standardize LVHR practice and identify gaps and unfulfilled demands that compromise patient safety and therapeutic outcomes., Methods: Using the modified Delphi technique, panel of 14 experts (general surgeons) came to a consensus. Two rounds of consensus were conducted online. An advisory board meeting was held for the third round, wherein survey results were discussed and the final statements were decided with supporting clinical evidence., Results: Experts recommended intraperitoneal onlay mesh (IPOM) plus/trans-abdominal retromuscular/extended totally extraperitoneal/mini- or less-open sublay operation/transabdominal preperitoneal/trans-abdominal partial extra-peritoneal/subcutaneous onlay laparoscopic approach/laparoscopic intracorporeal rectus aponeuroplasty as valid minimal access surgery (MAS) options for ventral hernia (VH). Intraperitoneal repair technique is the preferred MAS procedure for primary umbilical hernia < 4 cm without diastasis; incisional hernia in the presence of a vertical single midline incision; symptomatic hernia, BMI > 40 kg/m 2 , and defect up to 4 cm; and for MAS VH surgery with grade 3/4 American Society of Anaesthesiologists. IPOM plus is the preferred MAS procedure for midline incisional hernia of width < 4 cm in patients with a previous laparotomy. Extraperitoneal repair technique is the preferred MAS procedure for L3 hernia < 4 cm; midline hernias < 4 cm with diastasis; and M5 hernia., Conclusion: The consensus statements will help standardize LVHR practices, improve decision-making, and provide guidance on MAS in VHR in the Indian scenario., (© 2024. The Author(s).)

Background: The most frequent head and neck cancer is oral squamous cell carcinoma (OSCC), the common histological cancer of the oral cavity and is one of the most prevalent forms of cancer globally. It has been known that there are several biomarkers and therapeutic targets that have been discovered for OSCC, but none of them were effective against the progression of OSCC. Interestingly, small non-coding RNAs termed microRNAs (miRNAs) regulate cellular activity by targeting numerous signaling pathways or genes that either promote or repress the progression of diseases. Surprisingly, among the differentially expressed miRNAs, miR-34a was identified to be highly sensitive and specific to OSCC and widely studied for its role in various cancers, including OSCC., Methods: The secondary structure of miR-34a-3p was analyzed using bioinformatic analysis and its targets were screened using the TargetScan database. Specimens of 25 OSCC cancer tissues and adjacent normal tissues were collected from the Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals. The tissues were processed for H&E staining and gene expression analysis of miR-34a-3p and tumor necrosis factor alpha (TNF-α)., Results: The minimum free energy for miR-34a-3p was found to be -47.20 kCal which proved the stability of the miRNA. The histopathological examination confirmed the OSCC cases and the gene expression analysis revealed that miR-34a-3p was significantly downregulated in OSCC tissues, whereas TNF-α showed vice versa expression., Conclusions: miR-34a-3p could be postulated as a potential therapeutic target for OSCC.