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Abstract Background Road traffic injuries (RTI) are an increasing public health problem in India where out-of-pocket (OOP) expenditures on health are among the highest in the world. We estimated the OOP expenses for RTI in a large city in India. Methods Information on medical and non-medical expenditure was documented for RTI cases of all ages that reported alive or dead to the emergency departments of two public hospitals and a large private hospital in Hyderabad. Differential risk of catastrophic OOP total expenditure (COPE-T) and medical expenditure (COPE-M), and distress financing was assessed for 723 RTI cases that arrived alive at the study hospitals with multiple logistic regression. Catastrophic expenditure was defined as expenditure > 25% of the RTI patient’s annual household income. Variation in intensity of COPE-M in RTI was assessed using multiple classification analysis (MCA). Results The median OOP medical and non-medical expenditure was USD 169 and USD 163, respectively. The prevalence of COPE-M and COPE-T was 21.9% (95% CI 18.8-24.9) and 46% (95% CI 42–49.3), respectively. Only 22% had access to medical insurance. Being admitted to a private hospital (OR 5.2, 95% CI 2.7–9.9) and not having access to insurance (OR 3.8, 95% CI 1.9–7.6) were significantly associated with risk of having COPE – M. Similar results were seen for COPE - T. MCA analysis showed that the burden of OOP medical expenditure was mainly associated with in-patient days in hospital (Eta =0.191). Prevalence of distress financing was 69% (95% CI 65.5-72.3) with it being significantly higher for those reporting to the public hospitals (OR 2.8, 95% CI 1.7-4.6), those belonging to the lowest per capita annual household income quartile (OR 7.0, 95% CI 3.7-13.3), and for those without insurance access (OR 3.4, 95% CI 2.0-5.7). Conclusions This paper has outlined the high burden of out-of-pocket medical and total expenditure associated with RTI in India. These data reinforce the need for implementing more effective financial protection mechanisms in India against the high out-of-pocket expenditure incurred on RTI.

Breast cancer (BC) is the most common malignancy among women globally, with high mortality rates in India. Early detection of BC significantly increases survival rates and reduces mortality. Raising awareness about BC is crucial for educating the public about screening, symptoms, and treatment to help recognize early signs and seek prompt treatment. This article aims to describe a case of breast primary lymphedema and emphasizes the importance of public awareness regarding risk factors, clinical manifestations, and self-examination for early detection and mortality reduction.

Ulcerative Colitis (UC) is a chronic Inflammatory Bowel Disease (IBD) that affects the inner lining of the colon, imposing a significant burden on healthcare systems worldwide. Symptoms include bloody stools and abdominal pain. The prevalence of UC is increasing, particularly among young adults. The pathogenesis involves immune responses, genetics and environmental factors. Diagnostic delays are common, leading to complications and increased costs. Early diagnosis is crucial for preventing complications. Endoscopy is the primary diagnostic tool. Treatment aims to reduce inflammation and achieve remission. Delayed diagnosis can lead to long-term complications such as Colorectal Cancer (CRC) and bowel stenosis. Prompt recognition and management are essential for minimising the disease burden and optimising care. The present study delves into the complex nature of UC, a chronic IBD, revealing its epidemiology, pathogenesis, diagnostic challenges, treatment strategies, prognosis, complications and the impact of delayed diagnosis on patients’ quality of life. The study highlights the evolving understanding of UC pathogenesis, incorporating immune responses, genetics, environmental factors and biomarkers. It also discusses diagnostic delays due to symptom similarities and the need for increased awareness among healthcare providers and the public. The study also discusses advanced diagnostic methods and therapeutic approaches, including novel drug targets and surgical interventions. It also highlights the negative consequences of delayed diagnosis, including increased morbidity, psychological distress and socioeconomic burden. The study emphasises the need for collaborative efforts to ensure timely and appropriate care for UC patients.

Long COVID, or post-acute sequelae of SARS-CoV-2 infection, leads to vascular dysfunction, which contributes to the chronic multi-organ damage often seen in affected patients. Long COVID, a global health concern is associated with increased thrombotic risk, also known as COVID-19-associated coagulopathy (CAC). Here, we derived an induced pluripotent stem cell (iPSC) line from peripheral blood mononuclear cells (PBMCs) of a long COVID patient. This iPSC line showed normal morphology, maintained pluripotency, had a stable karyotype, and demonstrated the ability to differentiate into the three germ layers (ectoderm, endoderm, and mesoderm). This line provides a valuable tool for modeling long COVID and exploring mechanisms underlying multi-organ dysfunction.

Background: Procedural sedation and analgesia (PSA) in the emergency department (ED) is mainly used for wound irrigation, reduction of fractures, and wound closure. Ketamine is one of the most commonly used drugs for PSA in the ED. The study was conducted in the ED of a large tertiary care hospital in southern India to evaluate the adverse effects of Ketamine on PSA. Materials and Methods: This is a prospective observational study performed in the ED for 6 months (October 2019-March 2020) in 151 patients who required Ketamine for PSA. Titrated doses of Ketamine was administered in all patients; hemodynamic variables and adverse events were recorded at timed intervals. Results: During the study period, a total of 151 patients in the ED required PSA. The mean age of the study Cohort was 37 ± 15 years, and males accounted for 83%. All individuals obtained adequate sedation and pain relief. It was found that the incidence of adverse reactions to Ketamine was higher in young people (18- to 40-year-old), which was 63%. The most common adverse reaction in the study population was 39 cases of hypertension (44.8%), followed by vomiting in 25 cases (28.7%) and delusion in 6 cases (4%). There was no significant adverse effect in any patients which necessitated admission. Conclusion: Ketamine is a drug with good analgesic, sedative properties and has been shown to have a good safety profile with minimal adverse events for use as PSA in ED. Side effects were most common in the younger adult age group and hypertension was the most common side effect. [ABSTRACT FROM AUTHOR]

IntroductionFrench bean (Phaseolus vulgaris L.) holds global significance as one of the most consumed legumes, with commercial value surpassing that of all other legume crops combined. In India, the consumption of French beans has grown steadily, especially in the North Eastern region, driven by heightened consumer interest in its nutritional benefits. Considering these factors, we initiated an induced mutagenesis program to enhance the genetic diversity of locally grown French bean genotypes, traditionally cultivated for their superior adaptability.MethodsTo achieve this, we initiated an induced mutagenesis program. Seeds from the village seed stock were subjected to treatments with varying doses of ethyl methane sulfonate (EMS) ranging from 0.1% to 0.4% and sodium azide (SA) from 0.1% to 0.4%. The objective was to increase yield potential and enhance genetic diversity.ResultsThe treatment with EMS and SA led to a non-specific, dosage-independent reduction in biophysiological characteristics in French bean mutants. Notably, the 0.4% SA treatment significantly inhibited germination and fertility, causing a decrease in chlorophyll (10.02 mg. g-1 FW) and carotenoid (1.57 mg. g-1 FW) levels. This suggests a disruption in genes associated with chlorophyll and carotenoid synthesis. However, in the M2 generation, the mutagenic treatments substantially improved yield and associated traits. The highest pod yield per plant was recorded at 79.50 gm for the 0.2% EMS treatment. A character association study revealed strong correlations (0.217 to 0.995) between pod yield and other agronomic traits.DiscussionThe results indicate that selecting mutants based on these traits in populations treated with EMS and SA can significantly increase crop yield. The 0.2% SA and 0.2% EMS M2 mutant populations exhibited the highest induced variability, making them ideal for selecting higher-yielding mutant lines for further breeding generations. The increased yields in these mutant lines, derived from a local cultivar, show promise for meeting the growing demand for French bean production through their widespread cultivation.

Abstract Stem-cell derived in vitro cardiac models have provided profound insights into mechanisms in cardiac development and disease. Efficient differentiation of specific cardiac cell types from human pluripotent stem cells using a three-step Wnt signaling modulation has been one of the major discoveries that has enabled personalized cardiovascular disease modeling approaches. Generation of cardiac cell types follow key development stages during embryogenesis, they intuitively are excellent models to study cardiac tissue patterning in primitive cardiac structures. Here, we provide a brief overview of protocols that have laid the foundation for derivation of stem-cell derived three-dimensional cardiac models. Further this article highlights features and utility of the models to distinguish the advantages and trade-offs in modeling embryonic development and disease processes. Finally, we discuss the challenges in improving robustness in the current models and utilizing developmental principles to bring higher physiological relevance. In vitro human cardiac models are complimentary tools that allow mechanistic interrogation in a reductionist way. The unique advantage of utilizing patient specific stem cells and continued improvements in generating reliable organoid mimics of the heart will boost predictive power of these tools in basic and translational research.

Hispanics are the fastest-growing minority group in the United States. There has been a burgeoning interest in understanding the reasons underlying health disparities among this population. To facilitate the modeling and investigation of diseases that differentially impact Hispanics, we generated three induced pluripotent stem cell (iPSC) lines from the peripheral blood mononuclear cells (PBMCs) of healthy Hispanic subjects. All three lines exhibited normal morphology and karyotypes, robust expression of pluripotency markers, and the capacity for trilineage differentiation. The derivatives of these lines will serve as valuable ethnic-appropriate cell sources for further mechanistic studies on diseases impacting Hispanics.

Background: Thyroid hormones act on many organs including central and peripheral nervous system for maintaining metabolic homeostasis. Entrapment neuropathies are most common in hypothyroidism. Nerve conduction parameters are impaired even in newly diagnosed cases of hypothyroid. Aims and Objectives: This study aims to study the correlation between thyroid hormone and nerve conduction study (NCS) parameters in newly diagnosed hypothyroid patients. Materials and Methods: This cross-sectional, descriptive study included newly diagnosed hypothyroid patients (n=30; age: 31.96±9.12). In all subjects, NCS was performed in median, ulnar, tibial motor nerve and median, ulnar, sural sensory nerve using Nihon Kohden machine in Neurophysiology lab 2, B. P. Koirala Institute of Health Science. Thyroid function test (TFT) was analyzed by ELISA. The association between thyroid hormone and NCS parameters was done using Pearson’s correlation. Results: In NCS sensory parameters; SNAP amplitude of the left sural nerve showed significant positive correlation with t3 (lt; r=0.451, P=0.012). Among motor parameters, distal latency of left median nerve showed significant negative correlation with t3 whereas nerve conduction velocity of the left median nerve showed positive correlation with t3. In rest of the nerve, the association between NCS parameters and TFT (t3, t4, and TSH) parameters did not show any significant changes. Conclusion: Our study reveals that in newly diagnosed cases of hypothyroidism, nerve impairment occurs in which the left side is affected much earlier than right side and further its severity can be correlated with level of T3 rather than TSH.

Introduction: Acute exacerbation of chronic obstructive pulmonary disease is a life-threatening condition triggered by infections or non-infectious agents. Antibiotics use in such cases prevents severe deterioration and treatment failure. Past studies have shown inappropriate use of antibiotics in different health care settings. The objective of this study was to find out the prevalence of antibiotics use in patients with acute exacerbation of chronic obstructive pulmonary disease in the Department of Internal Medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among 108 patients with acute exacerbation of Chronic Obstructive Pulmonary Disease admitted to Department of Internal Medicine of a tertiary care centre from 12th February, 2022 to 15th April, 2022 after taking ethical clearance from Institutional Review Committee (Reference number: 417). Convenience sampling was done. Data analysis was done using the Statistical Package for the Social Sciences version 23.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data along with median and interquartile range for continuous data. Results: The prevalence of antibiotics use among study participants was 106 (98.15%) (95.61-100.69 at a 95% Confidence Interval). Penicillin 82 (75.93%) was the most commonly used antibiotics group. Conclusions: The use of antibiotics in acute exacerbation of chronic obstructive pulmonary disease was higher as compared to other similar studies.

Background: Chronic obstructive pulmonary disease (COPD) is presently regarded as a multi-system disorder. A decrease oxygen transport to brain in these patients alters spontaneous brain activity. Yoga plays a vital role in complementary management of the disease. Brainstem auditory evoked potentials (BAEP) reflect neuronal activity along the auditory pathway up to the midbrain. Thus, we aimed to assess the effects of short-term yogic exercises in BAEP in stable COPD patients. Methods: This one group pretest – posttest observational study enrolled 50 stable patients with COPD. Steps of yogic exercises which included bhujangasana (snake pose), nadisodhana pranayama (alternate nostril breathing), swana pranayama (panting dog breathing) and ajapa-japa meditation (constant awareness of breathing) were taught to subjects by yoga instructor and given rest for 15 minutes. Then, BAEP latencies were recorded. After recording subjects performed the 20-25 minutes of yogic exercises as per the instructions, immediately after the completion, BAEP latencies were recorded. Thereafter, subjects were allowed to have rest for 10-15 minutes recording was done again. Results: Latency of BAEP wave I (1.78 ± 0.50 vs 1.99 ± 0.49 ms, p=0.006) and wave II (2.91 ± 0.32 vs 2.99 ± 0.30 ms, p=0.006) significantly decreased immediately after yoga, compared to baseline in right ear. Similarly, latency of wave II (2.77 ± 0.42 vs 2.92 ± 0.46 ms, p=0.005) and wave V (5.72 ± 0.32 vs 5.91 ± 0.37 ms, p=0.017) significantly decreased immediately after yoga, compared to baseline in left ear. However, latency of wave IV (5.51 ± 0.32 vs 5.34 ± 0.40 ms, p=0.042) increased significantly after the rest of 30 minutes, compared to immediately after yoga in right ear. Conclusions: Enhancement of neuronal transmission along the auditory pathway up to the midbrain was seen immediately after yogic exercises, which returned back to the baseline after 30 mins of rest.

Summary: Endothelial cells (ECs) have emerged as key pathogenic players in cardiac disease due to their proximity with cardiomyocytes. Induced pluripotent stem cells (iPSCs) have been employed to generate ECs. However, it may be more clinically relevant to transdifferentiate fibroblasts into ECs directly without introducing pluripotent or virally driven transcription factors. Here, we present a protocol that describes the direct conversion of human cardiac fibroblasts into ECs by leveraging the innate immune system. Our protocol produces bona fide human ECs with 95%–98% purity by first passage.For complete details on the use and execution of this protocol, please refer to Liu et al. (2020) and Sayed et al. (2015).

Human pluripotent stem cells (PSCs), which are composed of embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs), provide an opportunity to advance cardiac cell therapy–based clinical trials. However, an important hurdle that must be overcome is the risk of teratoma formation after cell transplantation due to the proliferative capacity of residual undifferentiated PSCs in differentiation batches. To tackle this problem, we propose the use of a minimal noncardiotoxic doxorubicin dose as a purifying agent to selectively target rapidly proliferating stem cells for cell death, which will provide a purer population of terminally differentiated cardiomyocytes before cell transplantation. In this study, we determined an appropriate in vitro doxorubicin dose that (a) eliminates residual undifferentiated stem cells before cell injection to prevent teratoma formation after cell transplantation and (b) does not cause cardiotoxicity in ESC-derived cardiomyocytes (CMs) as demonstrated through contractility analysis, electrophysiology, topoisomerase activity assay, and quantification of reactive oxygen species generation. This study establishes a potentially novel method for tumorigenic-free cell therapy studies aimed at clinical applications of cardiac cell transplantation.