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Abstract Background Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and at present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI). A key reason for poor outcomes is non-adherence to medication. Methods The intervention is a 2 × 2 factorial design trial applying two interventions individually and in combination with 1:1 allocation ratio: (i) ASHA-led medication adherence initiative comprising of home visits and (ii) m-health intervention using reminders and self-reporting of medication use. This design will lead to four potential experimental conditions: (i) ASHA-led intervention, (ii) m-health intervention, (iii) ASHA and m-health intervention combination, (iv) standard of care. The cluster randomized trial has been chosen as it randomizes communities instead of individuals, avoiding contamination between participants. Subcenters are a natural subset of the health system, and they will be considered as the cluster/unit. The factorial cluster randomized controlled trial (cRCT) will also incorporate a nested health economic evaluation to assess the cost-effectiveness and return on investment (ROI) of the interventions on medication adherence among patients with CVDs. The sample size has been calculated to be 393 individuals per arm with 4–5 subcenters in each arm. A process evaluation to understand the effect of the intervention in terms of acceptability, adoption (uptake), appropriateness, costs, feasibility, fidelity, penetration (integration of a practice within a specific setting), and sustainability will be done. Discussion The effect of different types of intervention alone and in combination will be assessed using a cluster randomized design involving 18 subcenter areas. The trial will explore local knowledge and perceptions and empower people by shifting the onus onto themselves for their medication adherence. The proposal is aligned to the WHO-NCD aims of improving the availability of the affordable basic technologies and essential medicines, training the health workforce and strengthening the capacity of at the primary care level, to address the control of NCDs. The proposal also helps expand the use of digital technologies to increase health service access and efficacy for NCD treatment and may help reduce cost of treatment. Trial registration The trial has been registered with the Clinical Trial Registry of India (CTRI), reference number CTRI/2023/10/059095.

Introduction Temporomandibular joint disorders (TMD) present with a multitude of symptoms that can range from headaches to shoulder pain. Patients frequently present with pain in the ear, dizziness, and vertigo. It is noted that some patients who report TMDs also have a history of sleep disturbances, which is noted in cone beam computed tomography (CBCT) as a reduction in the oropharyngeal airway volume.

Background: Hyoid bone plays an important role in craniomandibular functions through its unique interaction with other structures. The effects of temporomandibular disorder (TMD) on the craniocervical posture and position of hyoid bone were considered, although the results endure inconclusive. Objective: The objective is the comparison of the position of the hyoid bone in patients with the temporomandibular joint disorder of pre- and post-neuromuscular orthotics utilizing cone-beam computed tomography (CBCT). Treatment using ultra-low-frequency transcutaneous electric nerve stimulation was administered, and a myocentric bite was registered, with which an orthotic was fabricated and delivered to the patient for full-time wear. Materials and Methods: The hyoid bone position of 14 TMD patients of pre- and post-treatment was observed using CBCT, and symptom severity score, joint pain, joint sounds, and limited mouth opening were studied pre- and post-treatment clinically. Results: All patients had relief of symptom severity score post treatment and no significant improvement in the anteroposterior direction of hyoid bone with no statistical significance with P value < 0.001. The majority of the patients had an inferiorly positioned hyoid bone post intervention with a P value less than 0.001. Conclusion: Neuromuscular orthotics resulted in a decrease in the symptom severity score of the patients along with an anteriorly and inferiorly positioned hyoid bone.

Summary: Interaction with microenvironmental factors is crucial for the regulation of hematopoietic stem cell (HSC) function. Stroma derived factor (SDF)-1α supports HSCs in the quiescent state and is central to the homing of transplanted HSCs. Here, we show that integrin signaling regulates Sdf-1α expression transcriptionally. Systemic deletion of Periostin, an Integrin-αv ligand, showed increased expression of Sdf-1α in bone marrow (BM) niche. Pharmacological inhibition or CRISPR-Cas9-mediated deletion of SRC, resulted in a similar increase in the chemokine expression in vitro. Importantly, systemic SRC-inhibition led to increase in SDF-1α levels in BM plasma. This resulted in a robust increase (14.05 ± 1.22% to 29.11 ± 0.69%) in the homing efficiency of transplanted HSCs. In addition, we observed enhancement in the recovery of blood cell counts following radiation injury, indicating an enhanced hematopoietic function. These results establish a role of SRC-mediated integrin signaling in the transcriptional regulation of Sdf-1α. This mechanism could be harnessed further to improve the hematopoietic function.

Purpose: To develop an indigenous "Do it yourself" (DIY) three-dimensional (3D) ophthalmic surgery recording system and validate the perception of stereopsis using it. Methods: A cross-sectional survey of practicing ophthalmologists with post-postgraduation experience of at least 5 years for perception of stereopsis for three different surgeries was performed; cataract, retinal detachment, and intravitreal drug injection were recorded on DIY assembly, viewed on VRBOX and using laptop videos and pseudo 3 d videos as control. Results: The laptop videos and 3D VR Box videos received higher ratings for stereopsis than the pseudo 3D videos. The parameters that received significantly higher ratings on the 3D VR Box viewing were instrument's position relative to the ocular surface in cataract surgery, anterior chamber depth during capsular staining, ophthalmic visco-surgical device injection, capsulorhexis, phaco tunnel depth, movement of nuclear fragments in the anterior chamber, and intra-ocular lens tilt in the capsular bag during cataract surgery (P < 0.05). In scleral buckling surgery, the parameters that were significantly rated higher on VR Box were globe contour, separation of the scleral plane from muscle, and explant plane (P < 0.05). Furthermore, the depth of the needle in the vitreous cavity while administering intravitreal drug injection was also rated significantly higher on VR Box (P < 0.05). However, the ratings for the depth of corneal incision, depth of scleral incision, overall color, and overall quality were not different statistically when compared between laptop and VR Box viewing. Conclusion: DIY 3D recording assembly offers a superior means of appreciating depth at various stages of cataract surgery, scleral buckling, and intravitreal drug injection when compared to laptop viewing and can serve as an effective tool for skill transfer. [ABSTRACT FROM AUTHOR]

Oral healthcare providers work near the face of the patients and are at an increased risk of being infected or transmitting the infection to the patients. Standard practice guidelines have to be modified to reorganize Oral Medicine care in the new normality of the COVID-19 pandemic to minimize the negative impacts of the infection on oral and systemic health. This scoping review aims to assess the guidelines for the safe practice of Oral Medicine during the COVID-19 pandemic. The literature search was done using Medline and Pubmed as the database and 23 articles were identified related to 8 domains. Utilization of teledentistry, efficient triaging of the patients with strict adherence to the infection control protocols, knowledge of the possible oral manifestations, and management of patients based on their presenting symptoms can help for the safe practice of Oral Medicine during the COVID-19 pandemic.

The impact of economic performance on human development has become a topic of debate in the recent times. For the past few years the member nations of SAARC region reported to have an unprecedented economic growth. But the human development in this region seems to be abysmal. This paper is aiming to assess the impact of economic performance of SAARC nations on its human development. The study extensively covers the macro economic data and the human development index (HDI) of the SAARC nations from 1990 to 2015. The Random effects (RE) model of panel regression analysis confirmed that GDP and GDP per capita can influence human development of these nations whereas the economic growth do not have any significant impact on human development at 1% and 5% levels of significance. The study is also intended to suggest numerous policy measures for enhancing the human development of this region.

Pediatric TB poses challenge in diagnosis due to the paucibacillary nature of the disease. We conducted a prospective diagnostic study to identify immune biomarkers of pediatric TB and controls (discovery cohort) and obtained a separate “validation” cohort of confirmed cases of pediatric TB and controls. Multiplex ELISA was performed to examine the plasma levels of cytokines. Discovery and validation cohorts revealed that baseline plasma levels of IFNγ, TNFα, IL-2, and IL-17A were significantly higher in active TB (confirmed TB and unconfirmed TB) in comparison to unlikely TB children. Receiver operating characteristics (ROC) curve analysis revealed that IFNγ, IL-2, TNFα, and IL-17A (in the discovery cohort) and TNFα and IL-17A (in the validation cohort) could act as biomarkers distinguishing confirmed or unconfirmed TB from unlikely TB with the sensitivity and specificity of more than 90%. In the discovery cohort, cytokines levels were significantly diminished following anti-tuberculosis treatment. In both the cohorts, combiROC models offered 100% sensitivity and 98% to 100% specificity for a three-cytokine signature of TNFα, IL-2, and IL-17A, which can distinguish confirmed or unconfirmed TB children from unlikely TB. Thus, a baseline cytokine signature of TNFα, IL-2, and IL-17A could serve as an accurate biomarker for the diagnosis of pediatric tuberculosis.