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Abstract Oral squamous cell carcinoma (OSCC) is a serious public health problem in various Asian countries, including Sri Lanka, and a combination of cultural practices, lifestyle factors, and genetic predispositions influences the incidence of these cancers. The examination of the connection between exposure to heavy metals and the probability of developing oral potentially malignant disorders (OPMD) and OSCC has been limited in its scope, and the overall consequences of such exposure remain largely unknown. This study aims to clarify the link between serum levels of heavy metals and the risk of OSCC and OPMD. The concentrations of seven heavy metals—namely, arsenic (As), cadmium (Cd), chromium (Cr), cobalt (Co), copper (Cu), lead (Pb), and zinc (Zn)—were analyzed in serum samples from 60 cases and 15 controls in the Sri Lankan cohort. The Inductively Coupled Plasma-Optical Emission Spectrometry (ICP-OES) was used for the analysis. Subsequently, the data underwent statistical evaluation via the Kruskal–Wallis H test, using the Statistical Package for Social Sciences (SPSS) version 28 software, with a confidence interval set at 95%. A p-value less than 0.05 was considered statistically significant. The cohort consisted of 48 men and 27 women, with 15 patients each diagnosed with OSCC, OSF, OLK, and OLP, and 15 healthy controls. The study used the Kruskal–Wallis Test to compare metal concentrations across groups, finding significant differences for all metals except As and Pb. Significant associations were observed between age, past medical history, drug history, gender, smoking, alcohol consumption, and betel chewing. The Spearman Correlation test showed significant correlations between the concentrations of Cr, Co, Cu, As, and Zn and the presence of cancer/precancer conditions. The study’s findings suggest that heavy metal contamination may be linked to the development of OSCC and precancerous conditions. When comparing OSCC and OPMD cases with controls, the serum concentrations of As and Pb did not differ significantly. However, Cd, Cr, Co, Cu, and Zn exhibited significantly higher concentrations among cases compared to controls (p

Introduction: Caregiving encompasses various challenges and adversities, with resilience playing a crucial role in navigating these hurdles. However, resilience is influenced by individual characteristics, prompting an examination of how demographic variables impact resilience and caregiver burden among caregivers of cancer patients in India. Aim: To investigate the relationship between demographic variables and resilience, as well as caregiver burden, among caregivers of cancer patients in India. Materials and Methods: In this cross-sectional study, a clinical sample of 125 caregivers {males (46.4%) and females (53.6%)} from Indraprastha Apollo Hospital, New Delhi, India was assessed. Resilience was measured using the Connor-Davidson Resilience Scale (CD-RISC), while caregiver burden was evaluated using The Burden Assessment Schedule (BAS). Various demographic factors, including gender, age, qualification, socio-economic status, loss of work, number of children, travel for treatment, duration of treatment, type of illness, and employment status, were examined. T-tests and Analysis of Variance (ANOVA) were utilised for data analysis. Results: The predominance was of female caregivers, comprising 67 (53.6%) individuals, primarily falling within the age bracket of 30-40 years demographic variables significantly influenced resilience levels among caregivers (p-value ranged from 0.001 to 0.86). However, caregiver burden was not significantly impacted by demographics overall (p-value ranged from 0.24 to 0.98), although certain sub-domains were affected. Notably, male caregivers demonstrated higher levels of resilience compared to females (T=9.88, p=0.001), with postgraduate qualifications correlating with increased resilience (mean: 17.02) and lower caregiver burden (mean: 81.53). Additionally, age did not significantly affect the results (effect size ranged from 0.10 to 0.86). Conclusion: The study underscores the importance of tailored support strategies for caregivers, particularly focusing on enhancing resilience among female caregivers and addressing specific burden dimensions affected by demographic factors of socio-economic status and qualification. Overall, resilience was affected by gender, socio-economic status, number of children, travel, duration of treatment, and employment significantly, but caregiver burden was not significantly affected by any demographic variable.

Background: Hypothyroidism is a condition that develops due to the deficiency of circulating thyroid hormones. The correlation between psychiatric disorders and thyroid status is a major concern. Aim and Objective: The present study was conducted to assess the prevalence of depression and anxiety in such patients and to determine the associated risk factors. Materials and Methods: It was an observational and cross-sectional study conducted among 256 patients diagnosed with hypothyroidism attending the department of general medicine and endocrinology in a tertiary care hospital for 2 months. The study participants were selected based on inclusion and exclusion criteria. The permission from the institutional ethics committee was obtained and informed written consent was taken from all the study participants. The questionnaire was a standardized tool. Data were entered in Microsoft Excel worksheet 2013 and analysis was done using the SPSS software trial version 21. Results: Out of 256 study participants, the majority 204 (79.7%) were female. In the present study, 27.3% of study participants had mild depression, 19.10% had moderate depression, 10.5% had severe depression, and 10.5% of study participants had very severe depression. In the present study, 17.6% of study participants had a mild form of anxiety, 23% had moderate anxiety, and 7.7% had severe anxiety. Conclusion: Any patient on treatment for hypothyroidism for longer clinical periods must be screened for depression and anxiety symptoms and treated accordingly.

Academic and industry researchers are becoming more interested in pharmaceutical cocrystals as they emerge as a new class of solid pharmaceuticals with enhanced physico-chemical features. Pharmaceutical co-crystal formation is a simple method for significantly altering a therapeutic substance's solid-state characteristics namely its solubility and consequently bioavailability. A drug's physico-chemical properties can be adjusted by a cocrystal between an active pharmaceutical ingredient (API) and co-former without altering the drug's molecular structure. Numerous types of co-crystals, nano co-crystals and co-crystal-loaded nanocarriers have shown significant promise in the fight against cancer through enhanced pharmacokinetic capabilities, decreased toxicities and improved physico-chemical properties. In this review the physico-chemical properties of co-crystals along with its impact in management of cancer have been demonstrated. Keywords Co-Crystals, Physicochemical, Co-Former, Bioavailability, Nanocarriers

A major change in postgraduate medical education in India will occur in 2023 with the launch of the District Residency Programme (DRP) by the National Medical Commission (NMC). This required three-month curriculum immerses resident physicians in the reality of district-level healthcare with the goal of bridging the knowledge gap between theory and practice. Postgraduates in community medicine have a priceless chance to close the knowledge gap between theory and practice using DRP. They become well-prepared public health professionals ready to have a big impact on community health by actively engaging in public health programs and obtaining clinical experience within the district system. Its successful implementation will however depend on addressing the issues of what work community medicine postgraduates should be assigned and custom duties for them.

Introduction: Breast lesions commonly present as a breast lump. The most accepted protocol followed for the diagnosis of a breast lump is a triple assessment which includes clinical assessment, radiological imaging, and pathological diagnosis. Fine needle aspiration cytology (FNAC) and histopathological biopsy are techniques for pathological diagnosis. FNAC is an invasive technique with minimum trauma to patients while histopathology requires surgical excision of lesions. Methodology: A total of 100 female patients attending the surgical outpatient department with clinically palpable breast lump and age less than 18 years were enrolled in the study. Details of case history and clinical examination were recorded. Fine needle aspiration with 22-23 gauze needle was carried out. Cytomorphological observations were recorded and cyto-diagnosis was given. After surgical excision of lump, histo-pathological diagnosis were given after routine tissue processing. Cytopathological findings were then correlated with histopathological findings. Results: In the study, the sensitivity, specificity, positive predictive value, and negative predictive value of cytology as compared with histopathology were 92.30%, 97.18%, 92.30%, and 97.18%, respectively. Conclusion: FNAC can be relied upon for early diagnosis, its diagnostic efficacy is further enhanced when combined with clinical features and radiology.

Summary: Background: Emerging research indicates growing concern over long COVID globally, although there have been limited studies that estimate population burden. We aimed to estimate the burden of long COVID in three districts of Haryana, India, using an opportunity to link a seroprevalence study to follow-up survey of symptoms associated with long COVID. Methods: We used a population-based seroprevalence survey for COVID-19 conducted in September 2021 across Haryana, India. Adults from three purposively selected districts (Rohtak, Gurugram, and Jhajjar) were eligible to participate; 2205 of 3213 consented to participate in a survey on health status. Trained investigators administered a structured questionnaire that included demographic characteristics, self-reported symptoms of illness in the last six months before the survey, mental health, and history of COVID-19. Findings: Unadjusted regression estimates indicated positive correlations between symptomatic complaints and COVID-19 exposure, suggesting lingering effects of COVID-19 in this population. The overall physical morbidity index was higher among those who tested positive for COVID-19, as was the incidence of new cases. However, both morbidity and incidence became statistically insignificant after adjustment for multiple comparisons. Cough emerged as the only statistically significant individual persistent symptom. Sex-stratified analyses indicated significant estimates only for physical morbidity in women. Interpretation: This study is one of the first from India that uses a large population-based sample to examine longer term repercussions of COVID infections. The burden of long COVID should primarily be addressed in clinical settings, where specialised treatment for individual cases continues to evolve. Our analyses also provide insight into the size and nature of studies required to assess the population-level burden of long COVID. Funding: This paper was produced under the auspices of the Lancet COVID 19 Commission India Task Force, which was supported financially by the Reliance Foundation. The Lancet COVID 19 Commission was set up in July 2020 and submitted its final report by October 2022. This report by the India Task Force was prepared during the same period.

Polar skyrmions are predicted to emerge from the interplay of elastic, electrostatic and gradient energies, in contrast to the key role of the anti-symmetric Dzyalozhinskii-Moriya interaction in magnetic skyrmions. Here, we explore the reversible transition from a skyrmion state (topological charge of -1) to a two-dimensional, tetratic lattice of merons (with topological charge of -1/2) upon varying the temperature and elastic boundary conditions in [(PbTiO3)16/(SrTiO3)16]8 membranes. This topological phase transition is accompanied by a change in chirality, from zero-net chirality (in meronic phase) to net-handedness (in skyrmionic phase). We show how scanning electron diffraction provides a robust measure of the local polarization simultaneously with the strain state at sub-nm resolution, while also directly mapping the chirality of each skyrmion. Using this, we demonstrate strain as a crucial order parameter to drive isotropic-to-anisotropic structural transitions of chiral polar skyrmions to non-chiral merons, validated with X-ray reciprocal space mapping and phase-field simulations.

Abstract This study synthesized a highly efficient KOH-treated sunflower stem activated carbon (KOH-SSAC) using a two-step pyrolysis process and chemical activation using KOH. The resulting material exhibited exceptional properties, such as a high specific surface area (452 m2/g) and excellent adsorption capacities for phenol (333.03 mg/g) and bisphenol A (BPA) (365.81 mg/g). The adsorption process was spontaneous and exothermic, benefiting from the synergistic effects of hydrogen bonding, electrostatic attraction, and stacking interactions. Comparative analysis also showed that KOH-SSAC performed approximately twice as well as sunflower stem biochar (SSB), indicating its potential for water treatment and pollutant removal applications. The study suggests the exploration of optimization strategies to further enhance the efficiency of KOH-SSAC in large-scale scenarios. These findings contribute to the development of improved materials for efficient water treatment and pollution control.

Abstract Background For patients on dialysis with poor quality of life and prognosis, dialysis withdrawal and subsequent transition to palliative care is recommended. This study aims to understand multi-stakeholder perspectives regarding dialysis withdrawal and identify their information needs and support for decision-making regarding withdrawing from dialysis and end-of-life care. Methods Participants were recruited through purposive sampling from eight dialysis centers and two public hospitals in Singapore. Semi-structured in-depth interviews were conducted with 10 patients on dialysis, 8 family caregivers, and 16 renal healthcare providers. They were held in-person at dialysis clinics with patients and caregivers, and virtually via video-conferencing with healthcare providers. Interviews were audio-recorded, transcribed, and thematically analyzed. The Ottawa Decision Support Framework’s decisional-needs manual was used as a guide for data collection and analysis, with two independent team members coding the data. Results Four themes reflecting perceptions and support for decision-making were identified: a) poor knowledge and fatalistic perceptions; b) inadequate resources and support for decision-making; c) complexity of decision-making, unclear timing, and unpreparedness; and d) internal emotions of decisional conflict and regret. Participants displayed limited awareness of dialysis withdrawal and palliative care, often perceiving dialysis withdrawal as medical abandonment. Patient preferences regarding decision-making ranged from autonomous control to physician or family-delegated choices. Cultural factors contributed to hesitancy and reluctance to discuss end-of-life matters, resulting in a lack of conversations between patients and providers, as well as between patients and their caregivers. Conclusions Decision-making for dialysis withdrawal is complicated, exacerbated by a lack of awareness and conversations on end-of-life care among patients, caregivers, and providers. These findings emphasize the need for a culturally-sensitive tool that informs and prepares patients and their caregivers to navigate decisions about dialysis withdrawal and the transition to palliative care. Such a tool could bridge information gaps and stimulate meaningful conversations, fostering informed and culturally aligned decisions during this critical juncture of care.

Objective: This study examined the glenoid fossa in Class II and Class III malocclusions with mandibular retrusion and protrusion. Materials and Methods: A retrospective investigation examined 60 Class II and 60 Class III cephalometric radiographs. Cephalometric landmarks and glenoid fossa measurements were taken. Statistical analysis contrasted the two malocclusion groups' glenoid fossas. Results: Class II malocclusion had a much lower mean Sella–Nasion–Condylion (SNCd) angle (glenoid fossa sagittal position) than Class III (14.6° ± 1.9). Class II malocclusion had a lower mean Sella–Nasion–Gonion (SNGo) angle (32.5° ± 4.3) than Class III (36.2° ± 3.9). The SNCd angle and SNGo angle in both groups demonstrated a negative correlation, demonstrating a relationship between the glenoid fossa and the mandibular sagittal axis. Conclusion: The glenoid fossa location differs significantly between Class II malocclusion with mandibular retrusion and Class III with protrusion. Class II malocclusion has a posterior glenoid fossa, while Class III has a less posterior one. Understanding these links may help patients receive more personalized treatment.

Traditional plants have huge demand as medicines to treat a wide range of illnesses. Tylophora is an important genus of medicinal plant in India, used to treat asthma and other ailments. The plants of this genus have been studied in vivo and in vitro for various pharmacological properties. In this article, we have given information regarding ethnomedicinal importance, phytochemistry and pharmacological uses of 18 species of Tylophora. Comprehensive information regarding different species of Tylophora were collected using different keywords in various electronic databases such as ACS, Google Scholar, PubMed, Science Direct, SciFinder, Web of Science, Springer Link, library search, J gate, Wiley, Semantic Scholar and ResearchGate since 1960 to 2023. Additionally, data was collected from some textbooks and chapters like Flora of India and Indian medicinal plants. This article highlights the traditional uses, phytochemistry, and pharmacological activities of the few studied taxa of Tylophora that would serve as a reference for pharmaceutical research. More than 100 compounds have been isolated from selected species of the genus Tylophora. Among them, phenanthroindolizidine alkaloids have received the most attention and are the most abundant active constituents of the plant. Other types of active components of genus Tylophora include C21 glycosides, secoiridoids, triterpenes, and furano alkaloids. These compounds have shown a variety of therapeutic activities like antiasthmatic, antitumour, antimicrobial, antidiabetic and antiallergic properties. This review can be an important scientific resource for further research.

For the first time Pb, Ni, and Cu nanocomposites were synthesized by versatile solution combustion synthesis using Aloevera extract as a reducing agent, to study the potential applications in X-ray/gamma, neutron, and Bremsstrahlung shielding. The synthesized Lead–Nickel–Copper (LNC) nanocomposites were characterized by PXRD, SEM, UV–VIS, and FTIR for the confirmation of successful synthesis. PXRD analysis confirmed the formation of multiphase LNC NCs and the Scherrer equation and the W-H plot gave the average crystal sizes of 19 nm and 17 nm. Surface morphology using SEM and EDX confirmed the presence of LNC NCs. Strong absorption peaks were analyzed by UV visible spectroscopy and the direct energy gap is found to be 3.083 eV. Functional groups present in the LNC NCs were analyzed by FTIR spectroscopy. X-ray/gamma radiation shielding properties were measured using NaI(Tl) detector coupled with MCA. It is found to be very close to Pb. Neutron shielding parameters were compared with traditional shielding materials and found LNC NCs are better than lead and concrete. Secondary radiation shielding known as Bremsstrahlung shielding characteristics also studied and found that LNC NCs are best in secondary radiation shielding. Hence LNC NCs find shielding applications in ionizing radiation such as X-ray/gamma and neutron radiation.

Solar UV radiation influence the Earth's climate and upper atmosphere. The UV emission from the Sun modulates with the sunspot cycle with an 11-year periodicity. The variations in UV, EUV, and X-rays emission are significant during the solar cycle evolution compared to the visible part of the spectrum. The h & k lines of the Mg II spectra emitted from the chromosphere represent the solar UV variability. The sunspot's magnetic fields and dynamics are responsible for the UV and EUV emissions from the solar chromosphere and corona. This paper compares the Mg II core-to-wing ratio of the h & k lines observed at 278 nm wavelength (obtained from Solar Backscattered Ultraviolet Spectrograph (SBUV) instrument onboard the NOAA satellite) with the sunspot area parameter obtained from Royal Greenwich Observatory. When the sunspot group area is small, there is a linear relationship between the sunspot group area and the Mg II index. But a non-linear relationship between the two is observed for the large sunspot group area. There is no phase delay between the appearance of sunspot groups on the solar photosphere and the emission from the Mg II doublet. Apart from 11-year periodicity, we observed common 4.7, 3.2, and 2.2-year periodicity in both the data sets, suggesting the Mg II index is related to the sunspot parameters.