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Under complex financial circumstances, individuals are empowered to improve financial decision-making by trusting financial advice and utilizing digital technology and resources. Though the extant research has explored numerous factors impacting financial well-being, the specific influence of financial advice and digital financial literacy remains underexamined in the Indian context. Thus, grounded on Social Cognitive theory, this study aimed to examine how insights gained from financial advice and digital financial literacy integrate into individual’s decision-making and, subsequently, influence their financial well-being. The data were collected using purposive sampling from Southern India, with 508 respondents recruited using social media platforms. The research hypotheses were empirically validated through hierarchical regression and mediation analysis using the Hayes Process Macro. The study’s findings reveal that financial advice positively predicted financial decision-making (β = 0.667; p < .000). Similarly, digital financial literacy has a positive impact on financial decision-making (β = 0.369; p < .000). Additionally, financial decision-making (β = 0.105; p < .065) positively predicted financial wellbeing. Thus, both factors emerged as transformative predictors of an individual’s financial well-being. Moreover, the findings reveal the mediating role of financial decision-making between financial advice, digital financial literacy, and financial well-being. Therefore, the study underscores that by leveraging the cumulative effect of professional financial advice and digital technologies, policymakers and government regulatory bodies can augment the critical ability of informed decision-making. Thus, these factors could navigate overcoming individual financial challenges and benefit the overall well-being of a diverse population.

Background and Aims: Preoperative anxiety can complicate patient outcomes. Music is a noninvasive method to allay anxiety, as revealed in studies. Self-selected (SS) versus prefixed (PF) music had not been studied much. This study was performed to compare SS and PF music in anxiety reduction in patients undergoing elective laparoscopic surgery. Methods: In this prospective study, 90 adults of the American Society of Anesthesiologists grade 1–2, either sex, aged 18–65 years were randomized into three groups, SS, PF music, and control (C), and offered music using headphones 20 min before surgery. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were noted preoperatively (T1), preinduction (T2), 10 min post-induction (T3), 5 min (T4), 1 (T5), and 2 h (T6) postsurgery. The Visual Analog Scale for anxiety (VAS-A) at T1 and T2, VAS-pain and postoperative nausea and vomiting at T5 and T6, and serum cortisol at T1 and T5 were recorded. Results: Group C showed higher VAS-A, HR, SBP, DBP, VAS-pain, and nausea than group-SS and PF (P < 0.05), and higher MAP than group-SS (P < 0.05). The PF group showed higher VAS-A, SBP, DBP, MAP, and VAS-pain than the SS group (P < 0.05). The change in serum cortisol was statistically insignificant. Conclusion: Music (SS > PF) reduces preoperative anxiety, postoperative pain, and nausea–vomiting with better hemodynamic stability.

Interventional endoscopy procedures are challenging for anaesthesiologists due to the various patient, procedural, logistic, and position-related issues. Complex endoscopic procedures like biliary interventions and endoscopic myotomy necessitate longer procedural duration. The mode of anaesthesia is usually deep sedation without any definitive airway device and is frequently associated with hypoxemia events which can be catastrophic. An endotracheal tube, though the gold standard for securing the airway, would prolong the anaesthesia time and delay the recovery. The laryngeal mask airway Gastro™ is a novel supraglottic airway device specifically meant for these procedures as it provides access to the gastrointestinal tract simultaneously with a patent airway. Though its purported advantages are undoubted, its clinical usage has various pitfalls that can hinder its wider acceptance and practical utility, especially when newly introduced. The literature is limited on the feasibility of this device in both the ease of endoscopy and the prevention of hypoxemia. In this review, we have discussed the device’s properties, its varied use cases, the supporting evidence for the same, the caveats, and the future perspectives.

Abstract Introduction Primary health care has regained its importance in global policy making. In 2018, the Government of India initiated the Ayushman Bharat - Comprehensive Primary Health Care (AB-CPHC) programme. It was based on upgrading the existing primary health facilities into Health and Wellness Centers (HWCs). The current study aimed to assess the readiness and performance of HWCs in providing comprehensive primary health care services in India’s Chhattisgarh state. Methods We conducted a cross-sectional health facility assessment with a state-representative sample of 404 HWCs. A standardized health facility survey tool was used to collect information on essential inputs and service outputs of HWCs. The expected population healthcare needs were estimated using secondary sources. The performance of HWCs was assessed by comparing the volume of services provided against the expected population need for outpatient care. Results On an average, 358 outpatients including 128 non-communicable disease (NCD) patients were treated monthly at an HWC. HWCs were able to cover 31% of the total population’s health need for outpatient care, 26% for hypertension, and 21% for diabetes care. In addition to services for reproductive and child health, HWCs provided services for common acute ailments (cold, cough, fever, aches and pains); infections of skin, eye, ear, and reproductive tract, and minor injuries. HWCs were also contributing significantly to national disease control programmes. Acute ailments followed by NCDs and communicable diseases had the largest share among services provided. The key gaps were in coverage of mental illnesses and chronic respiratory diseases. Most of the HWCs showed adequate readiness for the availability of required human resources, supplies, and infrastructure. Conclusion HWCs were able to provide a comprehensive range of primary care services and able to cater to a sizable portion of the rural population’s acute and chronic health care needs. The performance was made possible by the adequate availability of medicines, staff, training programmes and tele-consultation linkages. If HWCs in other states are able to reach a similar level of performance, the initiative will prove to be a game changer for equitable primary care in India.

Background Conventional fascial plane block approaches for upper abdominal surgeries spare the lateral cutaneous nerve. An external oblique intercostal block (EOIB) may be suitable for upper abdominal incisions as it blocks the lateral and anterior branches of the intercostal nerves T6–T10. However, there is a paucity of studies evaluating this block in clinical settings. The study aimed to compare the analgesic efficacy of combined EOIB and rectus sheath block with local infiltration analgesia (LIA) in laparoscopic cholecystectomy (LC). Methods After obtaining written informed consent, 70 patients were randomly allocated to undergo right-sided EOIB with 20 ml and left-sided RSB with 10 ml of 0.25% bupivacaine at the end of surgery (group ER, n = 35). Patients in the LIA group (n = 35) underwent local infiltration at the port site using 20 ml of the same solution (group LIA, n=35). Results The visual analog scale scores with combined EOI and RSB were significantly lower than those with LIA at 1, 2, 4, 8, and 12 h (P < 0.001). Rescue analgesics were required by 65.7% and 14.3% of the patients in the LIA and block groups, respectively (P < 0.001). The time to first rescue analgesic was significantly greater in the ER group than that in the LIA group (2.8 ± 1.10 vs. 1.6 ± 0.50 h; P = 0.012). The number of times rescue analgesia was required was significantly lower in the ER group than that in the LIA group (1.00 ± 0.00 vs. 1.83 ± 0.72; P = 0.015). Nausea and vomiting scores were higher in the LIA group than those in the ER group (P < 0.001). Patient satisfaction scores were higher in the ER group than those in the LIA group. Conclusions EOIB combined with RSB provides superior analgesia compared with LIA and should be considered for LC.

AbstractExploring the financial behavior traits amidst the unexpected financial challenges and the unparalleled rise in fintech, this study provides insight into the interplay of entrepreneur digital financial literacy (EDFL), entrepreneur financial competency (EFC), and entrepreneur financial skill (EFS) impacting entrepreneur financial decision-making (EFDM). Toward this goal, data were gathered from 223 active women entrepreneurs from India who have accounts in the social media platform. The three-step hierarchical regression analysis disclosed that an entrepreneur with sound EDFL, EFS, and EFC can significantly enhance strategic decision-making (EFDM). The research outcome reveals that EFDM is a consistent predictor of the financial performance of women-owned enterprises. In addition, the entrepreneur’s financial decision-making does not mediate the relationship between financial experience, financial competency, financial skill budgeting, and financial skill_acumen with financial performance. In contrast, partial mediation is observed between digital financial awareness, digital financial knowledge, and financial skill_analytics. The novel insight accounted for a significantly low level of experience in entrepreneurs’ utilization of digital platforms for payment, financing loans, and asset management. The outcome carries academic, regulatory, and managerial significance, recognizing the unique interaction; the cumulative efforts strengthen the capacity to address socio-economic challenges and translate them into gender-specific policy interventions and practices.

Over the span of 40 years, a substantial number of conceptual and empirical studies have been conducted on financial vulnerability (henceforth FV). These studies primarily covered socioeconomics, finance, management, and medicine. However, there is a paucity of comprehensive reviews and scientific mapping of the extant literature in the FV domain. Bibliometric analysis attempts to provide quantitative and qualitative knowledge in this area. This study was based on a review of 475 articles published in Scopus-indexed journals from 1990 to 2023. The present study employed the Biblioshiny R studio Bibliometrix package for data extraction and analysis. Our analysis provides information on recent publication trends; prominent authors, institutes, and countries; citations; thematic groups; keyword analysis; and social network analysis to identify influential work in this research domain and future gaps. The present analysis contributes to consolidating the existing fragmented literature on FV and highlights its significance during the current pandemic. Additionally, the study would be useful for researchers, practitioners, and academicians to proceed to further explore the area and outline the trends and their empirical investigation.

KBG syndrome is a rare genetic disorder manifested by craniofacial dysmorphism, skeletal abnormalities, short stature, and developmental delay. The anesthetic management may be challenging due to associated craniofacial and other skeletal abnormalities and possible cardiac defects. We report a case of a 2-year-old child with KBG syndrome presenting with a chylothorax and an abscess on the lower back over the coccygeal region. The child was posted for fistula tract excision and coccygectomy and received sacral erector spinae block as analgesic modality.

Though permanent vocal cord palsy consequent to recurrent laryngeal nerve (RLN) injury is rare following thyroidectomies, its consequences are grave enough for it to be the most feared complication postoperatively. Anesthesiologists and surgeons take various precautions to prevent its occurrence and employ various methods for its early detection. They include direct visualization of the nerve intraoperatively, use of intraoperative nerve monitoring, and post-extubation visualization of vocal cord mobility by use of direct or indirect methods. In the present narrative review, we aim to discuss the clinical evidence pertaining to the various methods adopted for the prevention and early detection of RLN palsy during thyroidectomy.

Background: Ultrasound (US)-guided costoclavicular block (CCB) is a promising new approach to brachial plexus (BP) block which is increasingly being utilized. Conventionally, the costoclavicular space (CCS) has been described to contain three cords. However, there may be variations in the neural pattern of the BP which is important to know to prevent inadvertent injury. We intend to describe the variations in neural patterns from retrospective scans of patients receiving costoclavicular BP block. Methods: The stored US images of patients who had received BP block using the CCB for surgery at the level of the elbow or below in the last year (from March 2021 to March 2022) were analyzed by two investigators independently. The clinical data were retrieved from the records of the same patients for the study outcomes. We collated the variations of the neural pattern, the number of neural structures seen, and the echogenicity of the structures in the costoclavicular BP space. Results: In the CCS, the median number of neural structures was 4.5 (minimum of 3 to maximum of 8). With the BP lateral to the axillary artery and sandwiched between the subclavius-pectoralis minor superiorly and the serratus anteriorly inferiorly, numerous variations in the neural structures were noted. The most common arrangement was caterpillar-like (28.6%) and pecker-like (20.3%). The neural structures were found to be hypoechoic in the majority (66%). Conclusion: The CCS hosts several mostly hypoechoic neural structures which may be the variations of the cords or the extension of BP divisions. These new findings have been unreported in the recent past.

The study investigates whether adverse conditions associated with disability stimulate entrepreneurial pursuits, emphasizing perceived discrimination in entrepreneurship. It investigates the direct effect of Entrepreneurial Competency (EC) on Entrepreneurial Intention (EI) and Entrepreneurial Behavior (EB) among Persons with Spinal Cord Injuries (PSCI) in South Karnataka. Additionally, it assesses the moderating effect of Perceived Discrimination (PD) on the EC and EB relationship. A structured questionnaire based on validated scales to measure EC, EI, EB, and PD was administered to 49 participants. Data were analyzed using Partial Least Square Structural Equation Modeling (PLS-SEM) to test the hypotheses. Results demonstrate that EC significantly enhances EI and EB, with path coefficients of 0.608 and 0.334, respectively. EI significantly influences EB with a path coefficient of 0.55. The interaction between PD and EC showed a positive relationship with EI at the 90% confidence interval (p = 0.096). The R-squared values indicated moderate predictive validity for the model. This research highlights the importance of EC in fostering EI and EB among PSCI. PD may strengthen these relationships, showing a nuanced impact that aligns with literature that suggests PD can catalyze activism and collective action among PWDs. The findings highlight the necessity of acknowledging PD’s dual role as an impediment and a potential motivator for entrepreneurial endeavors, emphasizing the imperative for tailored interventions that mitigate the negative impacts of PD and harness its potential to drive entrepreneurial innovation and resilience among PSCI.

Envenomation from snakebites is a significant public health concern in the Southeast Asian region resulting in considerable mortality and morbidity. Anti-snake venom (ASV) despite being the only rescue can bring forth several acute and delayed adverse effects. Among them, serum sickness is a late manifestation after treatment with ASV that presents after 5–14 days of treatment. However, there is no specific definition to diagnose serum sickness or proven treatment. Here, we present a case of serum sickness to provide an insight into this unventured zone, briefing the presentation, treatment and probable reason for serum sickness and its prevention after common krait envenomation and treatment with polyvalent ASV in India.

Background Patients who undergo spine surgery often experience severe pain postoperatively. Multimodal analgesia inclusive of a regional block provides optimal pain relief. Thoracolumbar interfascial plane (TLIP) block may provide promising analgesia in these patients.

Abstract In tissue engineering, the pivotal role of scaffolds is underscored, serving as key elements to emulate the native extracellular matrix. These scaffolds must provide structural integrity and support and supply electrical, mechanical, and chemical cues for cell and tissue growth. Notably, electrical conductivity plays a crucial role when dealing with tissues like bone, spinal, neural, and cardiac tissues. However, the typical materials used as tissue engineering scaffolds are predominantly polymers, which generally characteristically feature poor electrical conductivity. Therefore, it is often necessary to incorporate conductive materials into the polymeric matrix to yield electrically conductive scaffolds and further enable electrical stimulation. Among different conductive materials, carbon nanomaterials have attracted significant attention in developing conductive tissue engineering scaffolds, demonstrating excellent biocompatibility and bioactivity in both in vitro and in vivo settings. This article aims to comprehensively review the current landscape of carbon‐based conductive scaffolds, with a specific focus on their role in advancing tissue engineering for the regeneration and maturation of functional tissues, emphasizing the application of electrical stimulation. This review highlights the versatility of carbon‐based conductive scaffolds and addresses existing challenges and prospects, shedding light on the trajectory of innovative conductive scaffold development in tissue engineering.

Anterior shoulder dislocation (ASD) is the most common type of dislocation presented to the emergency department (ED) with severe pain and limitation of range of movement. Procedural sedation and analgesia are commonly used for ASD, but regional techniques are gaining popularity. Interscalene brachial plexus block is effective but has several limitations. Suprascapular nerve block (SSNB) has been explored for this indication. The SSNB is commonly performed using the posterior approach in a sitting position and can be technically difficult in dislocated patients. Recently, anterior subomohyoid approach performed in the lower neck has been described but has not yet been reported in the ED. We, hereby, report our experience of using low-volume ultrasound-guided anterior SSNB for procedural analgesia in 10 patients with ASD.

Background and Aims: Videolaryngoscopes have an undisputed role in difficult airway management, but their role in routine intubation scenarios remains underappreciated. McGrath MAC is a lightweight laryngoscope with a disposable blade. It remains to be proven if it performs as efficiently as the reusable videolaryngoscopes like C-MAC and whether it has an advantage over standard Macintosh laryngoscope in predicted normal airways. Material and Methods: We recruited 180 adult patients and randomly divided them into three groups for intubation with either Macintosh laryngoscope (Group-A), C-MAC (Group-B), and McGrath (Group-C). The primary objective was to compare the first attempt success rate. Secondary objectives included Cormack-Lehane (CL) grades, laryngoscopy time, intubation time, ease of intubation, need for optimization manoeuver, and the number of passes to place the endotracheal tube. Results: The two videolaryngoscopes provided a superior first attempt success rate as compared to Macintosh laryngoscope (P = 0.027). The CL grade-I was 100% in group B, 41.7% in group-A and 90% in group-C (B vs C; P = 0.037). Laryngoscopy time was 9.9 ± 2.5 s, 12.6 ± 0.8 s, and 13.1 ± 0.8 s for groups A, B, and C, respectively (B vs C; P = 0.001). Intubation time was 24.4 ± 12 s, 28.3 ± 1.9 s, and 37.3 ± 5.8 s for groups A, B, and C, respectively (P < 0.0001). The number of tube passes was highest in group C. Conclusion: Videolaryngoscopes provided a superior glottic view and resulted in a superior first attempt success rate as compared to Macintosh laryngoscope. When comparing the two videolaryngoscopes, C-MAC resulted in better intubation characteristics (shorter intubation time, better glottic views, and higher first-attempt success rates) and should be preferred over McGrath for intubation in adult patients with normal airways.

Caffeine has a multitude of uses in anaesthesia, and numerous studies have evaluated its efficacy and usefulness in various aspects of anaesthesia and medical practice. Its various applications in anaesthesia include its role in awakening from anaesthesia, managing post-dural puncture headache, managing post-sedation paradoxical hyper-activity in children, post-operative bowel paralysis, and apnoea in paediatric populations, that is, apnoea in infancy, paediatric obstructive apnoea, and post-anaesthetic apnoea in pre-mature infants. Though the effects of caffeine on bronchial smooth muscle, neurological, and cardio-vascular systems are well known, the relatively little-known effects on the endocrine and gastro-intestinal (GI) system have been recently taking primacy for eliciting its therapeutic benefits. The literature shows encouraging evidence in favour of caffeine, but unambiguous evidence of caffeine benefits for patients is lacking and needs further investigation. In this narrative review of literature, we summarise the available literature to provide insights into the pharmacokinetics, pharmacodynamics, clinical application of caffeine in modern anaesthetic practice, and evidence available in this field to date. An awareness of the various physiological effects, adverse effects, reported applications, and their evidence will widen the horizon for anaesthesiologists to increase its rational use and advance research in this field. Well-designed randomised controlled trials regarding the various outcomes related to caffeine use in anaesthesia should be planned to generate sound evidence and formulate recommendations to guide clinicians.

Background: Preoperative anxiety (PA) in children is a common phenomenon associated with various negative patient outcomes. Allaying PA is accepted as a standard of care, but its use is not universal and often overlooked. This survey is designed to evaluate the nationwide current practice patterns and attitudes of anesthesiologists toward the practice of allaying PA in children. Materials and Methods: A questionnaire of 25 questions, including information on methods of relieving PA in children, reasons for noncompliance, and associated complications, was framed. It was circulated among members of the Indian Society of Anaesthesiologists through an online survey of Google Forms and manually. Results: Four hundred and fifty anesthesiologists were surveyed. Responses were predominantly from anesthesiologists practicing in medical colleges across the country. Although 97% of the surveyed respondents practiced anxiety-relieving strategies, only 37% used it consistently. Seventy-three percent of anesthesiologists practiced both pharmacological and nonpharmacological techniques. The most common reason for avoiding premedication was an anticipated difficult airway (88%). Inadequate sedation was a commonly reported problem. Ninety-five percent of participants felt that PA-relieving strategies should be integral to pediatric anesthesia practice. The most common reason for not following these practices was an inadequate hospital infrastructure (67%). Ninety-seven percent of the participants believed that more awareness is required on this crucial perioperative issue. Conclusion: Only 37% of the surveyed anesthesiologists consistently used some form of PA-relieving strategy and the practice varied widely. Further improvement and team approach involving anesthesiologists, surgeons, and nurses is required to ensure the quality of pediatric PA-relieving services and establish it as a standard of care.

The proposed paper deals with the hardware validation of Hybrid Maximum power point tracking (MPPT) technique via Novel ML (Monotonous Learning) Controller & Perturb & Observe (P&O) Method. MPPT methods find its inability in handling periodic variation against tiny change in irradiance and temperature. Further, it also shows its inability in enhancing its dynamic responsiveness when irradiance varies quickly. To overcome these problems, this paper proposed a Novel ML controller incorporated with P&O method along with its hardware validation to confirm the suitability of this Novel controller in practical environment. Novel ML Controller can manage periodic fluctuations whenever there is a little irradiance to eliminate mistakes and steady state oscillations. To improve dynamic responsiveness when irradiance fluctuates fast, we are using P&O approach without dead time. The presented paper also discusses the design, stability analysis, hardware validation of proposed Novel ML Controller along with MATLAB simulation.

Abstract Background Quadratus lumborum block has been claimed to provide effective analgesia in abdominal surgeries by covering both somatic as well as visceral pain. However, its utility in morbidly obese patients has not been reported or evaluated. Case presentation In this case report, of laparoscopic hernia repair in a morbidly obese patient (weight 110 kg, height 1.53 m, BMI 46.9 kg/m2), there was excellent perioperative analgesia with no rescue opioid consumption in intraoperative period and average VAS score of 3 in 24 h postoperatively. The first recue analgesic was administered in the form of intravenous (IV) diclofenac 75 mg (diluted in 100 ml normal saline) 12 h after surgery when the patient reported a VAS of 5. Conclusions QL block is an effective, feasible, and safe option for providing analgesia for laparoscopic hernia repair in morbidly obese patients.

The proposed paper presents the novelty of new type of controller for three phase grid tied SPPS. This new controller is credited with a name of “PRESH” helpful in mitigating the harmonic of three phase GTSPPS (Grid Tied Solar Photovoltaic Power System) even during abnormal grid condition. Presented Novel PRESH controller is formed by combining the characteristic of PRES and RESH Controller but is totally different from the already proposed controller of present days. Further, investigation of Novel PRESH controller is done in term of its harmonic mitigation technique with the help of both Bode-Plot and MATLAB Simulink. Presently, for eliminating the harmonic from three phase GTSPPS, various filters and controllers have already been proposed but it either resulted in increase of computational load or make the system bulky. Earlier technique develops in eliminating the harmonic face difficulty in eliminating the harmonic when the reference waveform gets distorted from its original position. The proposed Novel “PRESH” controller can also be incorporated when grid suffers from any abnormal condition. The proposed paper has also discussed the performance analysis of Novel PRESH controller along with its design procedure that are helpful in mitigating the THD of three phase SPPS near to 1% and thus satisfying the IEEE standard 519 and 1547.

Introduction: Stillbirths account for a major proportion of perinatal deaths. In many cases of stillbirth, the cause remains unexplained. The ReCoDe system (classification of stillbirths by relevant condition at death) is a frequently used classification system that has helped us to improve the understanding of the causes of stillbirths. Aim: To identify factors associated with stillbirths and to classify the causes of stillbirths using the ReCoDe system. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, Punjab, India, from February 2020 to January 2021. All the mothers with a history of antepartum and intrapartum foetal mortality with the diagnosis of intrauterine foetal death after 20 weeks of gestation were included in the study. A detailed history of the mother was taken and an examination of the mother, stillborn babies, placenta, and umbilical cord was done. ReCoDe system was used to classify the causes of stillbirth. For statistical analysis mean and percentages were used. Results: There were 287 women with intrauterine foetal death admitted during the study period. Maternal age ranged from 18-40 years, majority (n=157, 54.7%) women belonged to the age group of 24-29 years. The stillbirth rate was 78.95 per 1000 live births. The cause of stillbirth could be explained in 235 (81.89%) cases by using the ReCoDe system. Hypertensive disorders in 91 (31.71%) were the most common cause followed by foetal growth restriction in 46 (16.02%). Conclusion: ReCoDe system was useful in classifying the causes of stillbirths in the resource-limited settings.

Abstract Germline ATM gene variations result in phenotypic heterogeneity characterized by a variable degree of disease severity. We retrospectively collected clinical, genetic, and immunological data of 26 cases with A-T. Clinical manifestations included oculocutaneous telangiectasia (100%), ataxia (100%), fever, loose stools or infection (67%), cerebellar atrophy (50%), nystagmus (8%), dysarthria (15.38%), and visual impairment (8%). Genetic analysis confirmed ATM gene variations in 16 unrelated cases. The most common type of variation was stopgain variants (56%). Immunoglobulin profile indicated reduced IgA, IgG, and IgM in 94%, 50%, and 20% cases, respectively. T cell lymphopenia was observed in 80% of cases among those investigated. Unusual presentations included an EBV-associated smooth muscle tumour located in the liver in one case and Hyper IgM syndrome-like presentation in two cases. Increased immunosenescence was observed in T-cell subsets (CD4+CD57+ and CD8+CD57+). T-cell receptor excision circles (TRECs) were reduced in 3/8 (37.50%) cases.

Rainfall, along with temperature, is the major component of the hydrological cycle, and its spatiotemporal variability is essential from both scientific and practical perspectives. Due to the recent rise in temperatures all over the world, there are quite a number of conflicting trends in inter-annual variability in monsoon rainfall and temperature over the Western Ghats. The Western Ghats, next to the Himalayas, are the major watershed for the major south Indian rivers. In this study, an attempt has been made to understand the monthly, inter-seasonal, and inter-annual trends of rainfall and temperature over the two meteorological sub-divisions, namely Konkan Goa, and Coastal Karnataka. Monthly rainfall data for the period of 1977 to 2016 and temperature data from 1980 to 2016 are used. According to the analysis, maximum rainfall occurs during the summer, whereas the least rainfall occurs during the winter. The parametric, linear regression analysis and student t-test have been used to identify the existence of trends and to determine the changes in rainfall over the time period. An effort has been made to understand the relationship between ISMR (Indian Summer Monsoon Rainfall) and the ENSO phenomenon and to investigate whether the rainfall over WG is influenced by the ENSO phenomenon or not. Results reveal that although there is increased rainfall over Konkan and Goa, while declining over coastal Karnataka, the changes over both the sub-divisions were statistically significant. Considering rainfall in different seasons, there is a significant change during the monsoon season only. The study further reveals that there is increasing rainfall over Konkan and Goa and decreasing rainfall over Coastal Karnataka. Furthermore, no statistically significant trend (positive or negative) was evident in any of the seasons. All temperature trends were positive. The results of this study may prove useful in the preparation of climate change mitigation and adaptation strategies by understanding the patterns of rainfall over WG. Doi: 10.28991/HIJ-SP2022-03-03 Full Text: PDF

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome after the use of first-line antitubercular drugs (ATDs) is rare and literature regarding DRESS syndrome due to ATDs is scarce in children. We report a young boy with tuberculosis who developed DRESS syndrome after exposure to isoniazid. A 9-year-old boy, diagnosed clinically as pulmonary tuberculosis, presented with fever, fast breathing, maculopapular rash, and one episode of gross hematuria. He had been on 4-drug ATD therapy (isoniazid, rifampicin, ethambutol, and pyrazinamide) for the past 4 weeks. In view of multiorgan involvement and absence of a microbiological diagnosis of tuberculosis, vasculitis was considered and he was treated with steroids. As the child recovered, both corticosteroids and ATD therapy were stopped. At 6 months of follow-up, he was presented with pneumonia. Microbiological diagnosis of tuberculosis was made and 4-drug ATD therapy was reinitiated. After 15 days, he again developed a high-grade fever and rash. On evaluation, isoniazid-induced DRESS syndrome was diagnosed. Subsequently, he received a modified regimen of ethambutol, pyrazinamide, levofloxacin, and linezolid. DRESS syndrome did not recur on these ATDs and the child became asymptomatic. Linezolid was stopped after 3 months of therapy and ethambutol, pyrazinamide, and levofloxacin are being continued. Currently, he has completed 15 months of modified ATD therapy. As a high index of suspicion is required for early diagnosis and management that are crucial to reducing morbidity and mortality, DRESS syndrome should be among the differentials in children with unexplained febrile illnesses.

Monkeypox is a contagious disease that manifests as a smallpox-like skin rash. The disease has shown a sudden surge worldwide across several countries. These patients may present for emergency surgery. Anesthetic management of these cases in an emergency setting is challenging. There is not much literature on the anesthetic management of monkeypox patients. We aimed to discuss the anesthetic management of monkeypox in this review.

Aim: To assess distress, insomnia, and psychosocial impact of SARS-CoV-2 outbreak on children with SLE and their caregivers. Methods: Patients with pSLE undergoing treatment in the Department of Pediatrics, PGIMER, Chandigarh, and their caregivers were enrolled. Questionnaires were sent to eligible patients and their parents through email or WhatsApp and telephonic interviews were conducted. Self-designed SLE-COVID-19 stress questionnaire; Peritraumatic Distress Inventory; Insomnia Severity Index, Positive and Negative Affect Schedule were used. Ethical approval was sought from Institutes Ethics Committee (IEC/2020/000583). Results: Telephonic connection was possible with 80 families (160 participants). Telephonic contact was possible with 80 families (160 participants); off these 61 children with pSLE (78.2%) and 55 caregivers (70.5%) responded to the questionnaire. Among participants, 23% patients, and 21.8% caregivers were severely stressed about SARS-CoV-2 infection; 78.7% patients and 80% caregivers had heard about hydroxychloroquine (HCQ) being used for the treatment of COVID-19; 52.7% caregivers exhibited moderate concern about shortage of HCQ; and 52.5% patients, and 43.6% caregivers were worried about side effects of HCQ. We found that 20 (32.8%) patients and 18 (32.7%) caregivers experienced significant distress. Majority of participants reported sleep disturbances. High positive affect scores were seen in 40 (65.5%) patients and 43 (78.2%) caregivers, low positive affect scores were noted in 21 (34.5%) patients and 12 (21.8%) caregivers. Conclusion: Patients with pSLE and their caregivers are at risk of psychosocial problems during the COVID-19 pandemic. Psychological interventions can be very helpful.

Background Nasotracheal intubation (NTI) is commonly performed in oromaxillofacial surgeries. We did this meta-analysis to ascertain whether use of video laryngoscopy (VL) provided better NTI characteristics as compared to direct laryngoscopy (DL) in patients undergoing oromaxillofacial surgeries. Methods We performed a systematic search to identify randomized controlled trials comparing VL with DL for NTI in adults undergoing elective oromaxillofacial surgery. The primary outcome was time to intubation. Secondary outcomes included the first attempt success, overall success, incidence of nasal bleeding, Cormack and Lehane grade, and maneuvers required. Results Of the 456 studies identified following a systematic search, 10 were included. Meta-analysis showed a significantly lower time to tracheal intubation favoring VL (mean difference: –9.04, 95% CI [–12.71, –5.36], P < 0.001; I2 = 59%). VL was also associated with a greater first attempt success (relative risk [RR]: 1.10, 95% CI [1.04, 1.16], P = 0.001). Maneuvers to facilitate intubation were less with VL (RR: 0.22, 95% CI [0.10, 0.51], P < 0.001). There was no difference in overall intubation success (RR: 1.04, 95% CI [0.98, 1.10], P = 0.17). The incidence of bleeding did not differ between the DL and VL groups (RR: 0.59, 95% CI [0.32, 1.08], P = 0.09). Conclusions Evidence as per this meta-analysis suggests VL leads to a shorter time to NTI, a greater first attempt success rate, and reduced need for maneuvers when compared to DL. The present study supports use of VL as a first line device for NTI in oral-maxillofacial surgeries in experienced hands.

ObjectivesBlau syndrome (BS) is a rare autoinflammatory disease characterized by arthritis, dermatitis, and granulomatous uveitis in early childhood. The study presents the clinical experience of patients with BS at a tertiary care centre in Chandigarh, North India.MethodsAnalysis of the clinical profile of patients of BS with NOD2 gene mutations under follow-up was carried out.ResultsDiagnosis of BS was genetically confirmed in 11 patients (10 children and one adult; six male and five female patients) from 10 families. The median age of onset of symptoms was 12 months (range, 4 months–4 years), while the age at diagnosis ranged from 2.3 to 26 years. The classic triad of arthritis, dermatitis, and uveitis was present in 6/11 (54.5%) patients. The frequency of arthritis, dermatitis, and uveitis was 100%, 81.8%, and 72.7%, respectively. The median age at diagnosis of ocular symptoms was 4 years (range, 2–26 years). Family history was noted in six families. Renal involvement was observed in two children. All patients in our cohort had the R334W variant in NOD2 gene. An asymptomatic carrier sibling with R334W mutation was identified in one family. Methotrexate was used as a first-line agent in all children. Adalimumab, which was commenced in five patients with uveitis, resulted in significant improvement in four patients. The total follow-up duration of the present cohort is 1,063.8 patient-months.ConclusionsThe possibility of BS should always be considered in patients with arthritis and early ocular involvement. Uveitis is often progressive and refractory to currently available therapies. Systemic involvement appears to remain a significant cause of morbidity and mortality.

BackgroundReports of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome from developing countries are sparse. Recognizing PFAPA is often challenging in these regions due to a higher incidence of infectious illnesses and significant resource constraints. Herein, we present our experience from North India regarding the diagnosis and management of PFAPA syndrome.MethodsWe reviewed cases of non-monogenic periodic fever syndrome diagnosed at our center from January 2011 to December 2021. A total of 17 children who fulfilled the Marshall criteria for PFAPA syndrome were included. Data regarding basic clinical features, treatment/outcome, and performance of the recently proposed Eurofever/PRINTO and Takeuchi criteria were analyzed.ResultsBesides recurrent fever, the triad of oral aphthae, pharyngitis, and adenitis was noted in only 18% of patients. Episodes of exudative pharyngitis/tonsillitis were documented in 24%. These figures were lower than the values reported from developed countries. The Takeuchi and Eurofever/PRINTO criteria were fulfilled in 76% and 71% cases, respectively. In addition to antipyretics and supportive care, intermittent steroid therapy was the main treatment modality used. Additional treatment with colchicine (n = 3) and thalidomide (n = 1) was used successfully in a few patients. Before the diagnosis of PFAPA, all patients had received multiple courses of antimicrobials (without microbiological confirmation). These included multiple courses of antibacterials for fever, pharyngotonsillitis, and/or cervical adenitis in all patients and antivirals for fever and aphthous stomatitis in a patient. Empiric antitubercular therapy had also been administered in two patients.ConclusionsA significant proportion of patients with PFAPA seem to remain undiagnosed in the Indian subcontinent. Increased awareness and improvement in basic healthcare facilities are crucial in enhancing the recognition of PFAPA, which would eliminate the unprecedented scale of undesirable antimicrobial use in such children.

To address inborn errors of immunity (IEI) which were underdiagnosed in resource-limited regions, our centre developed and offered free genetic testing for the most common IEI by Sanger sequencing (SS) since 2001. With the establishment of The Asian Primary Immunodeficiency (APID) Network in 2009, the awareness and definitive diagnosis of IEI were further improved with collaboration among centres caring for IEI patients from East and Southeast Asia. We also started to use whole exome sequencing (WES) for undiagnosed cases and further extended our collaboration with centres from South Asia and Africa. With the increased use of Next Generation Sequencing (NGS), we have shifted our diagnostic practice from SS to WES. However, SS was still one of the key diagnostic tools for IEI for the past two decades. Our centre has performed 2,024 IEI SS genetic tests, with in-house protocol designed specifically for 84 genes, in 1,376 patients with 744 identified to have disease-causing mutations (54.1%). The high diagnostic rate after just one round of targeted gene SS for each of the 5 common IEI (X-linked agammaglobulinemia (XLA) 77.4%, Wiskott–Aldrich syndrome (WAS) 69.2%, X-linked chronic granulomatous disease (XCGD) 59.5%, X-linked severe combined immunodeficiency (XSCID) 51.1%, and X-linked hyper-IgM syndrome (HIGM1) 58.1%) demonstrated targeted gene SS should remain the first-tier genetic test for the 5 common X-linked IEI.

In the past, management of pain in neonates was regarded as unnecessary, with the belief that neonates have an immature nervous system and do not perceive pain. Later studies confirmed that neonates certainly do feel pain, though they lack the inhibitory mechanisms that modulate excruciating stimuli, unlike in older children. Repeated painful encounters experienced in the newborn period are associated with poor cognitive and motor development by 1 year of age. Pain in preverbal infants and children is also poorly recognized and often undertreated. Neonates and preverbal children cannot verbally communicate their pain and discomfort but express them through specific behavioral, physiological, and biochemical responses. Several pain measurement tools have been developed for young children as surrogate measures of pain. To achieve optimum postoperative or procedural pain relief, easily understandable tools and a multimodal treatment module should be tailor-made for each health-care facility that cares for neonates and young infants. The aim of this advisory is to outline key concepts of pain assessment in neonates and preverbal children and suggest a rational approach to its management by all anesthesiologists, pediatricians, nursing staff, and other medical personnel caring for these children. The Indian Association of Paediatric Anaesthesia (IAPA) convened an online meeting in April 2020 to formulate the advisory on pain management in neonates and preverbal children under the chairmanship of Dr. Elsa Varghese, President IAPA, and members of the guideline committee. After several such meetings and revisions using feedback from IAPA members, the final guidelines were released in October 2020 on the IAPA website. Recommendations: Pain relief should generally be accomplished with a combination of nonpharmacologic approaches and pharmacologic techniques in a stepwise tiered manner by escalating type and dose of analgesia with anticipated increases in procedural pain. Nonpharmacological distraction measures may be sufficient for minor needle procedures like vaccination and venipuncture and may be offered as a first step and to complement other pain management remedies. An interdisciplinary approach involving pharmacologic, cognitive-behavioral, psychologic, and physical treatments should be employed whenever feasible.

Introduction: the use of cuffed endotracheal tubes (ETTs) in children is debatable. Despite recent literature on the use of cuffed ETT in children, its use is relatively low even in developed world. We conducted this survey to explore the perceptions and patterns of cuffed/uncuffed ETT usage in children,