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Background: India is home to 14 million survivors of human trafficking, with most being trafficked for sexual exploitation. Trafficking constitutes crimes that violate the rights of survivors, and despite its psychological consequences, there is little evidence-based guidance to meet the needs of these individuals. Aim: The current study aimed to examine the outcome of narrative exposure therapy (KIDNET) among adolescent survivors of sex trafficking in improving trauma-related symptoms, along with psychological distress, dissociation, depression, and anxiety. Methods: A pre-post study design was used with 20 adolescent female survivors of trafficking aged 13 to 17 years, with ten participants in the KIDNET group and ten participants in a waitlist control group. Trafficking Victim Identification Tool and Standard Progressive Matrices were administered as screening measures. The Clinician-Administered PTSD Scale for Children and Adolescents, Kessler’s Psychological Distress Scale, Shutdown Dissociation Scale, Patient Health Questionnaire, and Beck Anxiety Inventory were administered as outcome measures. Fourteen sessions of KIDNET were conducted for the clinical group, while sessions were conducted for the control group post delivery of intervention for the clinical group. Results: Findings suggest an overall improvement in the severity of trauma-related symptoms in the KIDNET group, with significant improvement in psychological distress, depression, and anxiety. Conclusion: Results indicate that KIDNET may be a promising and acceptable treatment for adolescent survivors of sex trafficking, and this intervention module may be safely delivered in further randomised controlled trials to ensure that the holistic needs of this vulnerable group are appropriately addressed.

Abstract Background Four out of five people living with osteoarthritis (OA) also suffer with at least one other long-term health condition. The complex interaction between OA and multiple long-term conditions (MLTCs) can result in difficulties with self-care, restricted mobility, pain, anxiety, depression and reduced quality of life. The aim of the MulTI-domain Self-management in Older People wiTh OstEoarthritis and Multi-Morbidities (TIPTOE) trial is to evaluate the clinical and cost-effectiveness of the Living Well self-management support intervention, co-designed with people living with OA, integrated into usual care, in comparison to usual care alone. Methods TIPTOE is a multi-centre, two-arm, individually randomised controlled trial where 824 individuals over 65 years old with knee and/or hip joint pain from their OA affected joint and at least one other long-term health condition will be randomised to receive either the Living Well Self-Management support intervention or usual care. Eligible participants can self-refer onto the trial via a website or be referred via NHS services across Wales and England. Those randomised to receive the Living Well support intervention will be offered up to six one-to-one coaching sessions with a TIPTOE-trained healthcare practitioner and a co-designed book. Participants will be encouraged to nominate a support person to assist them throughout the study. All participants will complete a series of self-reported outcome measures at baseline and 6- and 12-month follow-up. The primary outcome is symptoms and quality of life as assessed by the Musculoskeletal Health Questionnaire (MSK-HQ). Routine data will be used to evaluate health resource use. A mixed methods process evaluation will be conducted alongside the trial to inform future implementation should the TIPTOE intervention be found both clinically and cost-effective. An embedded ‘Study Within A Project’ (SWAP) will explore and address barriers to the inclusion of under-served patient groups (e.g. oldest old, low socioeconomic groups, ethnic groups). Discussion TIPTOE will evaluate the clinical and cost-effectiveness of a co-designed, living well personalised self-management support intervention for older individuals with knee and/or hip OA and MLTCs. The trial has been designed to maximise inclusivity and access. Trial registration ISRCTN 16024745 . Registered on October 16, 2023.

Abstract Background We aim to determine the multiethnic patterns of the prevalence and associated factors of poor muscle health and its associated components in older Chinese, Malays, and Indian Asian adults. Methods We included 2199 participants (mean age ± SD: 72.9 ± 8.3 years; 54.3% female) from the baseline assessment of the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER; 2017–2022) cohort study. Poor muscle health was defined as the presence of either low muscle mass (DEXA), or low muscle strength (handgrip strength), or low physical performance (gait speed). Its components include poor muscle function (low muscle strength and/or low physical performance without low muscle mass), pre‐sarcopenia (low muscle mass only), and any sarcopenia (low muscle mass with low muscle strength and/or low physical performance). Sociodemographic, clinical, and lifestyle factors were assessed using biochemistry, clinical tests, and validated questionnaires. Regression models were utilized to evaluate the independent risk factors of poor muscle health and its components. Results The national census‐adjusted prevalence of poor muscle health (88%) was similar across the three ethnic groups. However, Chinese individuals had higher prevalence of pre‐sarcopenia and any sarcopenia, and a lower prevalence of poor muscle function compared with Indians or Malays. We observed ethnic differences in modifiable risk factors (low physical activity, diabetes, osteoporosis, and obesity) of poor muscle health and its components. Although obesity was protective of pre‐sarcopenia (RRR = 0.19, 95% CI: 0.11, 0.36) and any sarcopenia (RRR = 0.29, 95% CI: 0.18, 0.47) in the overall population and across ethnic groups, it was associated with 1.7 times (95% CI: 1.07, 2.67) the likelihood of poor muscle function in the entire population. Conclusions Almost 90% of community dwelling Singaporean aged ≥60 years have poor muscle health across the three ethnic groups with ethnic disparities in modifiable risk factors, highlighting an urgent need for community‐wide targeted interventions to promote muscle health.

Abstract Background Substance misuse poses a significant public health challenge, characterized by premature morbidity and mortality, and heightened healthcare utilization. While studies have demonstrated that previous hospitalizations and emergency department visits are associated with increased mortality in patients with substance misuse, it is unknown whether prior utilization of emergency medical service (EMS) is similarly associated with poor outcomes among this population. The objective of this study is to determine the association between EMS utilization in the 30 days before a hospitalization or emergency department visit and in-hospital outcomes among patients with substance misuse. Methods We conducted a retrospective analysis of adult emergency department visits and hospitalizations (referred to as a hospital encounter) between 2017 and 2021 within the Substance Misuse Data Commons, which maintains electronic health records from substance misuse patients seen at two University of Wisconsin hospitals, linked with state agency, claims, and socioeconomic datasets. Using regression models, we examined the association between EMS use and the outcomes of in-hospital death, hospital length of stay, intensive care unit (ICU) admission, and critical illness events, defined by invasive mechanical ventilation or vasoactive drug administration. Models were adjusted for age, comorbidities, initial severity of illness, substance misuse type, and socioeconomic status. Results Among 19,402 encounters, individuals with substance misuse who had at least one EMS incident within 30 days of a hospital encounter experienced a higher likelihood of in-hospital mortality (OR 1.52, 95% CI [1.05 – 2.14]) compared to those without prior EMS use, after adjusting for confounders. Using EMS in the 30 days prior to an encounter was associated with a small increase in hospital length of stay but was not associated with ICU admission or critical illness events. Conclusions Individuals with substance misuse who have used EMS in the month preceding a hospital encounter are at an increased risk of in-hospital mortality. Enhanced monitoring of EMS users in this population could improve overall patient outcomes.

Introduction: The brachial plexus is a variable nerve plexus in its formation and branching pattern. Variations in the brachial plexus are not uncommon, and its area of supply and associations with other adjacent anatomical structures require clinical and surgical attention. Aim: To find out any anatomical variations in the formation and branching pattern of the brachial plexus in human foetuses. Materials and Methods: A morphometric prospective observational study was conducted from January 2020 to July 2022, on 30 stillborn or Intrauterine Dead (IUD) human foetuses were taken in the study. Gestation age from 28 to 40 weeks of gestation were included in the study, while those with gross anomalies or morphological anomalies of the cranium and vertebral column were excluded. The dissection includes vertical midline incision of the skin from the external occipital protuberance to the lower limit of the thoracic vertebra (T12). The skin was cut in the midline and reflected laterally. All superficial and deep muscles of the neck were dissect out to clear the cervical and thoracic parts of the vertebral column. The vertebral column was cut and opened to visualise the spinal cord and spinal nerves. Based on gestational age, the foetuses were divided into three groups: four in the first group (28-31 weeks), twelve in the second group (32-35 weeks), and fourteen in the third group (36-40 weeks) were divided for descriptive purposes. The gender of foetuses was determined based on the external genitalia. Results: A total of 60 brachial plexuses were dissected, of which 49 (81.66%) had the usual anatomical formation of the trunks: the upper trunk formed by C5 and C6 roots, the middle trunk by the C7 root, and the lower trunk by the C8 and T1 roots. Eleven (18.34%) plexuses presented variations in trunk formation. Specifically, 8 (13.3%) brachial plexuses were of the prefix type, where the upper trunk was formed by the C5 and C6 roots with an additional contribution from the C4 root; there was inter-branch communication between C6 and C7 in one (1.7%) case; the middle and lower trunks united by C7, C8, and T1 roots formed the lower trunk in another (1.7%) case, and finally, one (1.7%) case exhibited the post-fix type. Conclusion: In this study, out of the 30 foetuses examined, 11 showed variations, which is not uncommon. The prefix type of brachial plexus is quite common among the possible variations, although anatomists and neurosurgeons cannot ignore the possibility of other variations, like post-fix type or communication between the roots of the brachial plexuses.

This article provides a cross-case study of three studies that utilized anti-adultist approaches to collaborating with youth as co-researchers. Drawing on reflections from both adults and youth, we present an analysis of three case studies of adult and youth experiences in planning, implementing, and conducting research studies aimed at centering youth perspectives. Findings include what adults and youth learned about the co-researching process and highlight the need for careful consideration of how both adults and youth can disrupt adultist power dynamics. We argue that amplifying youth co-researcher perspectives in research can create a mutually meaningful and empowering research process for both adults and youth by promoting more equitable relationships and participatory practices.

Abstract Background To determine the prevalence, risk factors; and impact on patient health and economic outcomes across the laterality spectrum of multiple sensory impairment (MSI) in a multi-ethnic older Asian population. Methods In this population-based study of Singaporeans aged ≥ 60 years, MSI was defined as concomitant vision (visual acuity > 0.3 logMAR), hearing (pure-tone air conduction average > 25 dB), and olfactory (score

We focus on the use of flourishing as a new measure in studies of pathways in STEM (science, technology, engineering, and mathematical) fields. While the concept of flourishing is promising, the concept may need careful interrogation to ensure it takes structural and personal (cultural, religious, socioeconomic, and racial) differences into account. Our longitudinal study explores emerging adult’s educational and career pathways with careful attention to structural inequities, enabling us to productively explore the concept of flourishing in a larger systemic context. Drawing from a set of qualitative interviews with our participants, we explore the ways that our sample of emerging adults (N = 30), predominantly people of color, define and discuss flourishing. The concept resonated with our diverse participants, and a substantial number did report flourishing. But despite the regularity with which the participants described experiencing racism and microaggressions, they did not often mention those harmful experiences when discussing flourishing. We caution that flourishing data on its own may provide an overly rosy image of the pathways and development, especially of young people of color. Our data suggest that it may be especially important to examine flourishing in context with other measures that can flesh out a fuller picture of well-being, especially in relation to race, racism, sexism, or any other experiences related to personal identities. In particular, instruments should be carefully designed to ensure–especially for emerging adults–that all aspects of their lives and identities can be fully understood.

Abstract Background We explored the relationships between sarcopenia (SP), osteoporosis (OP), obesity (OB), (alone and in combination) with physical frailty (PF) in a multi-ethnic, population-based study of Asians aged ≥ 60 years. Methods Participants were enrolled from the PopulatION HEalth and Eye Disease PRofile in Elderly Singaporeans Study (PIONEER) study. PF was defined using the modified Fried phenotype; SP using the Asian Working Group for Sarcopenia 2019; OP using bone mineral density scores; and OB using the fat mass index. Modified Poisson regression models investigated the associations between exposures and PF, and the relative excess rates of PF due to interactions (RERI) to determine synergistic or antagonistic interactions. Results Of the 2643 participants, 54.8% was female; and 49.8%, 25.1%, 25.0% were Chinese, Indians, and Malays, respectively. 25%, 19.0% and 6.7% participants had OB only, SP only, and OP only, respectively. A total of 356 (17.5%), 151 (7.4%) and 97 (4.8%) had osteosarcopenia (OSP), sarcopenic obesity (SOB) and osteo-obesity (OOB), respectively; while 70 (3.5%) had all 3 morbid conditions (osteosarcopenic obesity, OSO). Both SP only and OB only were strongly associated with increased rates of PF (RR: 2.53, 95% CI: 1.95, 3.29; RR: 2.05, 95% CI: 1.58, 2.66 respectively); but not OP. Those with OSP, OOB and SOB were also associated with high risks of PF (RR: 2.82, 95% CI: 2.16, 3.68; RR: 2.34, 95% CI: 1.69, 3.23; and RR: 2.58, 95% CI: 1.95, 3.41, respectively) compared to robust individuals. Critically, individuals with OSO had the highest relative risk of having PF (RR: 3.06, CI: 2.28, 4.11). Only the sarcopenia-obesity interaction was significant, demonstrating negative synergism (antagonism). The concurrent presence of SP and OB was associated with a 100% lower rate of PF compared to the sum of the relatively rates of SP only and OB only. Conclusion The prevalence of SP, OB and OP, alone and combined, is substantial in older Asians and their early identification is needed to mitigate the risk of frailty. OB may interact with SP in an antagonistic manner to moderate rates of frailty. Further longitudinal studies are needed to address causality and mechanistic underpinnings our findings.

Introduction: Ocular trauma is a significant cause of unilateral vision loss, especially in developing countries. Proper assessment of ocular damage and prompt treatment initiation after the injury have a crucial impact on the final outcome. B-scan Ultrasonography (USG) plays an important role in detecting findings that may not be evident during clinical examination. Aim: To assess the role of B-scan in blunt ocular trauma and to determine if B-scan provides any additional advantages over clinical examination. Materials and Methods: A cross-sectional study was conducted from May 1, 2021 to April 30, 2022, at Hind Institute of Medical Sciences, Sitapur, Uttar Pradesh, India. Fifty consecutive patients with blunt ocular trauma, presenting with hazy or opaque ocular media or unexplained visual loss during clinical examination, were evaluated in the casualty and ophthalmology Out Patient Department (OPD). The frequency of lesions such as traumatic cataract, vitreous degeneration, and retinal detachment was assessed clinically and using B-scan USG. Anterior and posterior segment manifestations of blunt trauma, including traumatic cataract, vitreous haemorrhage, and retinal detachment, were evaluated clinically and with B-scan imaging. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0, including frequency counts, percentage calculations, and Kappa’s statistical analysis to correlate B-scan USG and clinical findings. Results: Majority of patients (28%) were in the age group of 21-30 years. Workplace-related injuries, particularly agricultural injuries, were the most common cause of blunt ocular trauma (30%). Traumatic cataract (44%), vitreous degeneration (8%), vitreous haemorrhage (6%), and retinal detachment (4%) were the common clinical posterior segment findings. On B-scan USG, the most frequent findings were retinal detachment (30%) and vitreous haemorrhage (28%). Choroidal detachment was noted in 2% of cases. B-scan USG was more helpful in accurately diagnosing vitreous lesions and retinal lesions (52%, 30%) compared to clinical examination (16%, 6%). Conclusion: B-scan USG emerged as a superior diagnostic tool for identifying posterior segment lesions, including vitreous, retinal, and choroidal lesions. Lesions such as retinal detachment and vitreous haemorrhage were more easily identified using USG, especially in the presence of hazy or opaque media. Therefore, B-scan USG should be considered an integral part of all ophthalmic set-ups dealing with trauma to avoid missing significant posterior segment pathologies.

BACKGROUND: The maintenance of oral hygiene and subsequent health related issues in visually handicapped children is a challenging task. Hence, tools must be used to ensure good oral health in these children. The study aimed to analyze the effectiveness of preventive programs on oral health using specialized audio and tactile aids in visually impaired school children. MATERIALS AND METHODS: 100 visually handicapped children were selected for the study. They were divided into two groups: Group A (Training using Braille) and Group B (training by means of audio aids). Children were trained using appropriate tools and oral health was assessed using Plaque and Gingival bleeding indices. STATISTICAL ANALYSIS: Independent ‘T-test’ was used for comparing mean ± SD values. RESULTS: Statistically significant improvements in both plaque and gingival bleeding indices were obtained on follow-up observations at 3rd and 6th months. CONCLUSION: The use of specialized tactile and audio tools significantly improved the oral health status of visually impaired school children.

Leucism is a genetic trait caused by a lack of melanin pigment in an animal’s skin, feathers, or fur. Unlike albinism, which is defined by a total lack of melanin synthesis, leucism is characterised by a partial loss of pigmentation. The definitions of leucism and various aspects of albinism are exceedingly vague. This very first documented report of a leucistic Jungle Babbler (Turdoides striata) in Northern India was made in Lucknow, Uttar Pradesh. More study is needed to look at the additional places of occurrence of these leucistic individuals, as well as the genetic basis of leucism in Jungle Babblers.

Objectives Current cognitive screening and diagnostic instruments rely on visually dependent tasks and are, therefore, not suitable to assess cognitive impairment (CI) in visually impaired older adults. We describe the content development of the VISually Independent test battery Of NeuroCOGnition (VISION-Cog)–a new diagnostic tool to evaluate CI in visually impaired older Singaporean adults.Design The content development phase consisted of two iterative stages: a neuropsychological consultation and literature review (stage 1) and an expert-panel discussion (stage 2). In stage 1, we investigated currently available neuropsychological test batteries for CI to inform constructions of our preliminary test battery. We then deliberated this battery during a consensus meeting using the Modified Nominal Group technique (stage 2) to decide, via agreement of five experts, the content of a pilot neuropsychological battery for the visually impaired.Setting Singapore Eye Research Institute.Participants Stakeholders included researchers, psychologists, neurologists, neuro-ophthalmologists, geriatricians and psychiatrists.Outcome measure pilot VISION-Cog.Results The two-stage process resulted in a pilot VISION-Cog consisting of nine vision-independent neuropsychological tests, including the modified spatial memory test, list learning, list recall and list recognition, adapted token test, semantic fluency, modified spatial analysis, verbal subtests of the frontal battery assessment, digit symbol, digit span forwards, and digit span backwards. These tests encompassed five cognitive domains–memory and learning, language, executive function, complex attention, and perceptual-motor abilities. The expert panel suggested improvements to the clarity of test instructions and culturally relevant test content. These suggestions were incorporated and iteratively pilot-tested by the study team until no further issues emerged.Conclusions We have developed a five-domain and nine-test VISION-Cog pilot instrument capable of replacing vision-dependent diagnostic batteries in aiding the clinician-based diagnosis of CI in visually impaired older adults. Subsequent phases will examine the VISION-Cog’s feasibility, comprehensibility and acceptability; and evaluate its diagnostic performance.

Objectives We pilot-tested the VISually Independent test battery Of NeuroCOGnition (VISION-Cog) to determine its feasibility, comprehensibility and acceptability in evaluating cognitive impairment (CI) in visually impaired older Asian adults.Design The VISION-Cog was iteratively fine-tuned through pilot studies and expert-panel discussion. In the first pilot study (Stage 1), we recruited 15 visually impaired and cognitively normal participants aged ≥60 years to examine the pilot VISION-Cog’s feasibility (length of time to administer), comprehensibility (clarity of instructions) and acceptability (participant burden). We then presented the pilot results to the expert panel (Stage 2) who decided via agreement on a revised version of the VISION-Cog. Subsequently, we conducted a second pilot study (Stage 3) on another four participants to ascertain improvement in feasibility, comprehensibility and acceptability of the revised version.Setting Singapore Eye Research Institute.Participants Nineteen Asian adults aged ≥60 years with visual impairment (defined as near visual acuity worse than N8) were recruited.Outcome measure Revised VISION-Cog.Result The VISION-Cog was deemed feasible, taking approximately 60 min to complete on average. All participants agreed that the test instructions were clear, and the battery did not cause undue discomfort or frustration. The data collector rated all tests as very user-friendly (score of 5/5). Minor modifications to the pilot VISION-Cog were suggested by the panel to improve its safety, clarity of instructions and content validity, which were incorporated and iteratively tested in the second pilot study until no further issues emerged.Conclusions Using an iterative mixed-methods process, we have developed a feasible, comprehensible and acceptable 5-domain and 9-item visually independent VISION-Cog test battery suitable to assist CI diagnosis in older adults with visual impairment. We will assess its diagnostic potential against clinician-based assessment of CI in subsequent phases.

Measurement(s) glaucoma severity grading Technology Type(s) cup-to-disc ratio Factor Type(s) Indian ethnicity fundus image database for glaucoma prescreening Sample Characteristic - Organism Human Sample Characteristic - Environment Ophthalmology Sample Characteristic - Location India

Background: The co-infection of human immunodeficiency virus-tuberculosis (HIV-TB) is a serious public health concern and aptly called the 'deadly duo'. Recognising the determinants of the co-infection will help target the vulnerable population for prevention and reduce mortality. Aims: The objective of this study was to estimate the proportion of HIV-TB co-infection among adults attending the antiretroviral therapy (ART) centre at a tertiary healthcare facility and associated clinico-epidemiological determinants. Patients and Methods: A cross-sectional analytical research that lasted for 6 months was conducted at the ART Centre of Medical College, Gwalior, Madhya Pradesh. According to the inclusion criteria, 251 newly diagnosed HIV patients were enrolled in the study. The pro forma administered by the interviewer was utilised to collect the socio-demographic information at the time of enrolment by face-to-face interviews. To gather the clinical details, records were reviewed. A Chi-square test of significance was used to determine the difference between proportions after descriptive analysis. Variables found significant in bivariate analysis were put in multivariate logistic regression to predict HIV-TB co-infection. The odds ratio was estimated at 95% confidence interval (CI). Results: Among the participants, 27.5% of the 251 people had both TB and HIV. Males who were employed as labourers (X2 = 25.5, df = 4 and P = 0.001) were epidemiologically more likely to get co-infection. In comparison to the other group of HIV-only patients, the CD4+ count of co-infected individuals was considerably lower (X2 = 6.37, df = 3 and P < 0.01). Clinical staging of HIV (adjusted odds ratio [aOR] =4.70, 95% CI 2.34–9.43; P = 0.001), body mass index (aOR = 0.46, 95% CI 0.013; P = 0.25–0.85) and CD4+ count (aOR = 0.22, 95% CI 0.08–0.60; P = 0.003) were found to predict HIV-TB co-infection among people living with HIV (PLHIV). Conclusion: The study concludes, being underweight with an advanced clinical staging (World Health Organisation Clinical Stage III or IV of HIV) and a CD4+ count equal to or below 300 cells/μL increase the vulnerability of HIV-TB co-infection among adult PLHIV.

Background: According to the World Health Organization, substance dependence is persistent or sporadic drug use inconsistent with or unrelated to acceptable medical practice. Substance dependence is showing a rising trend all over the world, and these disorders are rapidly recognized throughout in India. It is considered as a major cause of preventable ill health, social harm, and premature death throughout the population. As compared to the general population, those with substance use disorders are 5.3% more likely to die from suicide. There are several distal or predisposing risk factors associated with suicidal behavior such as personality traits, childhood trauma, and family history of suicide. Therefore, the present study is to compare and examine the distal factors of suicidal ideation (SI) and suicidal attempt (SA) with patients without SI and SA (WS) in patients with substance dependence. Materials and Methods: This was a cross-sectional observational study conducted at the inpatient departments of Central Institute of Psychiatry, Ranchi. Purposive sampling of sixty patients was done to further divide them into Group 1 (SI), Group 2 (SA), and Group 3 (WS). The sample was purposively collected to include sixty patients with substance dependence. They were screened by using the Addiction Severity Index scale, and Beck Scale for Suicidal Ideation (BSSI), Suicide Intent Scale, Childhood Trauma Questionnaire (CTQ), and the NEO five-factor inventory-3 (NEO-FFI-3) were administered to assess SI, SA, childhood trauma and personality traits, respectively. Results: The present study reveals that all the personality domains except conscientiousness on NEO-FFI 3 may have importance in differentiating the substance-dependent patients with SI/SA from WS patients. Only physical and emotional abuse on CTQ may be a significant distal factor for suicidal thoughts and behavior, whereas physical abuse may have more significance for SAs in substance dependence patients. Family history of suicide was not significant in patients with SI/SA. Conclusions: These findings may assist in formulation of therapeutic strategies for suicidal patients of substance dependence.

Abstract To determine the differential impact of the irreversible eye diseases on vision-related quality of life (VRQoL) in a multi-ethnic Asian population. 2652 participants from the Singapore Epidemiology of Eye Disease Study, with any of the following early and late-stage eye conditions including age-related macular degeneration (AMD, n = 158), diabetic retinopathy (DR, n = 105; non vision threatening [non-VTDR]; VTDR), glaucoma (n = 57) and myopic macular degeneration (MMD, n = 106), or none of the above (controls, 2226 [83.9%]) were included. Rasch-scaled scores of the Emotional well-being Mobility and Reading subscales of the Impact of Vision Impairment (IVI) questionnaire, collectively referred to as “VRQoL” were assessed. Multivariable linear regression analyses and pairwise comparisons adjusting for age, gender, ethnicity, socio-economic status, BMI, smoking, alcohol use, presence of systemic diseases and presenting VI were performed to assess and compare the impact of the presence and severity of each eye condition on the three IVI domains. Multivariable adjusted pairwise comparisons of VRQoL between early stages of the four eye diseases showed no significant differences (all P > 0.05). For late stage diseases, individuals with VTDR had significantly larger decrements in Emotional well-being compared to glaucoma (β − 0.81; 95% CI − 1.47 to − 0.16) and MMD (β − 1.17; 95% CI − 2.16 to − 0.18); and Reading decrements compared to glaucoma (β − 0.66; 95% CI − 1.22 to − 0.11). When compared to late glaucoma, individuals with late AMD (β − 0.76; 95% CI − 1.50 to − 0.01) had significantly larger IVI Mobility subscale decrements. VTDR and late AMD, appear to have the greatest impact on VRQoL, compared to late glaucoma and MMD, suggesting a differential impact of late-stage eye disease categorization on VRQoL.

Abstract Sensory impairments and sarcopenia are both highly prevalent age‐related conditions, with the former having been postulated to contribute to the pathogenesis of the latter condition. Confirming this hypothesis may therefore help to better inform strategies for early treatment and intervention of sarcopenia. We performed a systematic review of the current literature examining the relationships between four major sensory impairments [vision (VI), hearing (HI), smell (SI), and taste (TI)] with (i) sarcopenia; and (ii) its associated components (low handgrip strength, slow gait speed, and low muscle mass). PubMed, EMBASE, CINAHL, and Cochrane Library databases were searched for observational studies investigating the relationship of VI, HI, SI, and TI with sarcopenia, low handgrip strength, slow gait speed, and low muscle mass, in adults aged 50 years or older, from inception until 24 May 2021. The risk of bias of the included studies was assessed using the Newcastle‐Ottawa Scale. This study was registered with PROSPERO, reference CRD42021247967. Ten cross‐sectional and three longitudinal population‐based studies of community‐dwelling adults (N = 68 235) were included, with five studies investigating more than one sensory impairment. In total, 8, 6, 3, and 1 studies investigated the relationship between VI, HI, SI, and TI and sarcopenia and its related components, respectively. Follow‐up duration for the longitudinal studies ranged from 4 to 11 years. All studies had a low or moderate risk of bias. We found that the presence of VI and SI, but not TI, independently increased the odds of sarcopenia. In addition, VI and SI were each independently associated with low muscle mass; and VI, HI, and SI were each independently associated with slow gait speed. However, we found inconclusive evidence for the associations between VI, HI and SI, and low handgrip strength. Our systematic review suggests a potential association between the presence of single or multiple sensory impairments and a greater likelihood of sarcopenia and/or deficits in its associated components, especially for VI, HI, and SI. Prospective studies are needed to untangle the relationship between sensory impairment and sarcopenia to better inform clinical guidelines for disease prevention and management.

Introduction: In children uncorrected refractive errors have a profound effect on educational and psychosocial development hence it is necessary to estimate the prevalence both at the community and at the school level to aid planning and implementation of refractive error services in children. Objective: To determine the refractive status of 5 to 15 years old children attending government schools of rural areas of district Agra, Uttar Pradesh (UP), India. Method: Study conducted on 902 students of age group 5-15 years of randomly selected government schools of Bichpuri Block of district Agra. Children underwent visual acuity assessment and torch light examination, height and weight measurement. Children with VA ≤6/9 were further examined and cycloplegic retinoscopy, fundus examination, slit lamp examination and post mydriatic refraction was done. On the basis of values of cycloplegic refraction and post mydriatic refraction, refractive error was classified as myopia, hypermetropia and astigmatism. Statistical Analysis was done by applying Chi square test. Result: Out of 902 children, 125 children (13.86 %) were having refractive error of which 76 were myopic (8.43%), 39 were astigmatic (4.32%) and 10 were hypermetropic (1.11%). There was an increase in the overall prevalence of refractive error with advancing age. There was no significant association of refractive error with gender and nutritional status. Conclusion: Vision screening of school children is very useful for early detection and correction of refractive errors. Screening of the refractive errors in school should be carried out periodically and regularly.

Background In India, adolescents constitute 21.4% that is one-fifth of the total population and world adolescents' (10–19 years) population is more than 1.2 billion. The trend of consumption of fast food increases worldwide, and in India, fast food production and consumption is very high. The popularity of these food is because of easy preparation and more convenient to finish the meal in less time. Great taste, attractive packaging, and advertisement play a very important role in promotion of such food adolescents. Adolescents also develop the various problems related to health because of less nutritious diet, such as Chinese food, junk food, and beverages. Methodology The present study was a cross-sectional study and conducted for a duration of three months from January 2017 to March 2017. A total of 437 adolescents enrolled with their consent from five randomly selected schools of a city in Madhya Pradesh, India. All adolescents who were present in school on the day of visit and willing to participate were included in the study. Result In our study, a total of 437 students were registered, out of which 97.02% were boys. About 41.82% were of early adolescence and the rest of them were of late-adolescence group. Majority of the adolescents consumed regular meals such as chapati (84%), rice (79%), and dal (74%), they consumed relatively less, green leafy vegetables (60%) than the other vegetables (67%). Most of the participants consumed milk most of the days in a week, but more than 20% students consumed fried food/pizza/burger/fast food more frequently (more than 4 days a week) in a week, and only very few students were not consuming these foods or consuming less frequently. Conclusion Most of the adolescents consume regular meals, but adolescents consumed irregular or skipping of meal and breakfast is still high. And more than 50% adolescents consumed chocolate/pastries/sweet/cake/cookies/bread/toast/cookies/biscuits/cold drinks/soft drinks/potato chips/namkeens/deep-fried snacks/pizza/burger/Frankie, or any other fast food (including Chinese food), these foods are highly energy dense and have less nutritious value.

Purpose: An unprecedented surge has been noted in rhino-orbital-Cerebral mucormycosis (ROCM) in times of current COVID-19 pandemic. The present prospective study aims to evaluate clinico-epidemiological profile, risk factors, management, and outcome of the cases of ROCM that presented to our tertiary care center during the study period from April to June 2021. Methods: All patients were subjected to complete history taking, ophthalmological examination, and imaging studies. The patients were staged and were treated with intravenous liposomal amphotericin B (AMB) and sino-nasal debridement of local necrotic tissue. Transcutaneous retrobulbar AMB (TRAMB), orbital decompression, and exenteration were instituted as indicated. All patients were followed up for a minimum of 6 months before arriving at the final outcome. Statistical analysis was performed. Results: A total of 49 patients presented during the study period, with a mean age of 42.2 years. The major risk factors included uncontrolled diabetes (89.8%), COVID-19 positivity (51.02%), and concurrent steroid use (38.77%). The most common presenting symptom was facial pain/swelling (43.65%), while the most common presenting sign was deterioration in vision (75.51%). Intravenous liposomal AMB was given to all patients along with sino-nasal debridement (85.71%), TRAMB (57.14%), orbital decompression (14.28%), and exenteration (12.24%). Overall, mortality at 6 months was 22.45% (11 patients). Age more than 60 years, intracranial extension, and HbA1c of more than 8.0% were observed to be statistically significant indicators of mortality. Conclusion: Early suspicion and timely diagnosis of mucormycosis at rhino-orbital stage is warranted in order to salvage life as well as visual function. TRAMB may prove as potentially favorable treatment modality in cases with limited orbital involvement.

Background: It is evident from the research in recent years that short sleep has been found as a risk factor for obesity. However, we still need enough evidence in this field. Therefore, we explored the directionality of the association between sleep duration and sleep quality with body mass index (BMI). Aims: The aim of this study is to evaluate the association of sleep duration and sleep quality with BMI among young adults. Objectives: (a) To assess the association of sleep duration with BMI. (b) To assess the quality of sleep with BMI. Methods: In this cross-sectional study, 88 individuals selected from King George's Medical University were taken as participants. Majority of patients were males (67%). There were 29 (33.0%) females. Sex ratio of study was 2.03, and we used Pittsburgh sleep quality index (PSQI) questionnaire to assess time spent in bed and sleep quality. BMI was divided into 3 categories. Underweight (BMI

Background & Aims: An oral examination is an essential tool of assessment of depth of knowledge and the communication skill of medical students. There are many shortcomings like examiner bias, improper time distribution, gender bias, and many more. Therefore, in the present study we structured oral examination as an assessment tool for Phase -I Bachelor of Medicine, Bachelor of Surgery (MBBS) students in Biochemistry, along with the examiner’s feedback to abate biases. Materials & Methods: Structural viva voce (SVV) was implemented during 2nd formative assessment, in the Department of Biochemistry. 150 participants (146 students & 4 faculties/ examiners) were contributed. Participants were sensitized and trained about SVV. All the participants were simultaneously assessed with traditional and structured oral examination without intermixing. Feedback form (based on 4-point Likert scale) via a Google form was collected for both types of the viva, from the participants.. Apposite statistical analysis was done. Results: Analysis of the study depicted the optimistic response of the participant towards the SVV. Statistically significant differences (p < 0.00001) were observed in the marks obtained, stress, time allotment, etc. Examiners also acknowledged that SVV was a better way of taking the oral examination as it reduced the bias and brings uniformity of questions. Conclusion: Although before implementing any new tool in assessment, it is necessary to develop the infrastructure accordingly, sensitization and training of the participants and and preparation of the module prior to the examination, but the results of the current study indicated that SVV should be tried in other subjects of medical education and with the majority of medical colleges of other states.

Over the course of four years, our small team of informal marine science educators at the University of Texas-Austin Marine Science Institute and the Mission-Aransas National Estuarine Research Reserve established a professional learning community (PLC) to strengthen and advance our own professional practice and improve the education programs we designed and facilitated. During this period of growth and community-building, we experienced the devastation of a category 4 hurricane and the COVID-19 pandemic. Despite the turmoil of these events, our team was able to rely upon the PLC’s established routines to maintain a sense of normalcy, as well as a trusted, safe, and supportive environment to work through the impacts to our professional practice. The upfront investment of time and staff energy yielded unexpected value and power by getting our team through two highly disruptive events and created a team that showed up, stayed committed, collaborated, and continued to work toward our shared goals. While all of our informal marine science education colleagues around the nation shared the impacts of the pandemic, our team had already weathered the devastation of a hurricane and reaped the benefits of our PLC, setting us up to be even more responsive and resilient to the pandemic. This article seeks to reflect on what contributed to our resilience, how we might use that information to (re)build our programs going forward, and how others can use our story to examine their own investment in their teams and programs through a PLC lens.

Abstract Background Two critical challenges in science education are how to engage students in the practices of science and how to develop and sustain interest. The goal of this study was to examine the extent to which high school youth, the majority of whom are members of racial and ethnic groups historically underrepresented in STEM, learn the skills and practices of science and in turn develop interest in conducting scientific research as part of their career pursuits. To accomplish this goal, we applied Hidi and Renninger’s well-tested theoretical framework for studying interest development in the context of a museum-based, informal science education (ISE) program. We used a mixed methods approach, incorporating both survey and interview data, to address three research questions: (1) As youth engage in authentic science research, do they develop perceived competence in mastering the skills and practices of science? (2) Do participants increase, maintain, or decrease interest in science research as a result of this experience? (3) How does participation in scientific practices manifest in non-program contexts? Results Our study yielded three main results. First, we found that participants developed competence in mastering several of the skills and practices of science. Strikingly, there was significant improvement in self-reported level of competency for 15 specific research skills. Second, we found that participants maintained their interest in scientific research over time. Our post-survey results revealed that one hundred percent of students were either excited about or expressed deep interest in scientific research. Based on a Phases of Interest Development Rubric developed for this study, most participants exhibited emerging individual interest. Finally, participants exhibited significant increases in the frequency in which they engaged in scientific practices outside of the program. Conclusions Our findings suggest that participation in authentic research in an ISE context affords youth critical opportunities for gaining mastery of several of the skills and practices of science, which in turn reinforces, and in some cases increases participants’ interest in scientific research beyond the span of the program.

Introduction: The covering of spinal cord is same as that of brain. The pia mater, arachnoid and dura mater covers the spinal cord from inside out. The pia mater extends from cephalic end of spinal cord upto terminal portion i.e., conus medullaris. Beyond the conus, the pia mater extends in the form of filum terminale. The filum terminale extends beyond the conus medullaris and attaches upto dorsal aspects of coccyx to stabilise the spinal cord in its position. Aim: To study the length of filum terminale in the foetuses of third trimester gestational age. Materials and Methods: The present cross-sectional observational study was carried out in 30 foetuses collected from museum of Department of Anatomy and Department of Obstetrics and Gynaecology. The permission and approval from University Ethical Committee was taken before starting the study. The foetuses were divided into three groups taking into consideration their gestational age (four foetuses in 1st group 28-31 weeks, 12 foetuses in 2nd group 32-35 weeks and 14 foetuses were in 3rd group 36-40 weeks gestational age). Also, the gender-wise variation (11 male and 19 female foetuses) was taken into account. All the data were recorded in Microsoft excel sheet and Statistical Package for the Social Sciences (SPSS) 23.0 software was used for statistical analysis. Numerical values were reported as the mean±standard deviation. Results: In this study, the mean length of filum terminale was 4.35±1.04 cm with range minimum 2.31 cm to maximum 5.90 cm. The length of spinal cord and length of filum terminale measurements significantly increased with increasing gestational age (p

Abstract Background Omentum and bowel loops are commonly seen in inguinal hernia. An unusual case of extraperitoneal herniation of ureter was detected in hernial sac with other contents, on computed tomography (CT) urography. Case presentation A 54-year-old male presented with inguinal hernia, with no previous history of surgery or trauma. Pre-operative screening showed a unilateral hydroureteronephrosis involving the pelvicalyceal system and entire ureter. No calculus was visualized in the ureter on ultrasound. On non-contrast CT (NCCT) followed by CT urography, the ureter was seen descending into the hernia sac causing hydroureteronephrosis. The patient subsequently underwent mesh repair surgery of the inguinal hernia with meticulous reduction of the herniated contents including the ureter, resulting in complete resolution of the hydroureteronephrosis. Conclusion An isolated extraperitoneal inguinal herniation of the ureter without concomitant urinary bladder involvement is extremely rare, especially with no prior history of trauma or surgery, as seen in our case. The case also exemplifies the role of pre-operative imaging as a protocol in cases of inguinal hernia to prevent per-operative complications.

Introduction: Coronavirus Disease-2019 (COVID-19) has been a major cause of apprehension, morbidity, and mortality in 2020. It had been postulated that associated co-morbid conditions in COVID-19 patients increase the severity of COVID-19 which leads to six times more chances of hospitalisation than patients without co-morbid condition. Mortality is also 12 times higher in such patients. Aim: To find out the association between co-morbidities and mortalities due to COVID-19 pneumonia. Materials and Methods: A prospective, observational study was conducted in a tertiary teaching institute of North India which was designated Level 3 (L-3) facility for treatment of COVID-19 patients. All 109 COVID-19 patients confirmed by Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR), admitted in Intensive Care Unit (ICU) from 1st July 2020 to 30th November 2020 formed the sample of the study. Data was taken regarding past history, clinical histories and examinations and ICU care and treatments. Based on their final outcome at the end of ICU care, patients were divided into two groups-group 1 (Non-survivor or Expired) and group 2 (Survived) and intergroup differences were studied. Results: COVID-19 infection was about three times more common in males. Severe category of COVID-19 patients had higher mortality (59.2 % of severe category expired during hospital course, 1.7% patients expired in moderate category group). Most common co-morbidities were hypertension (n=51, 46.8%) and diabetes (n=48, 44%). Multivariate analysis showed that co-morbidities in the form of chronic liver disease (OR -0.127(0.024-0.681, p-value 0.016)) and post tubercular sequel (OR 0.036(0.003-0.442, p-value 0.009)) were less likely to occur in COVID-19 patients who survived, thus making these co-morbidities significant contributor to the adverse outcomes in COVID-19 patients. More number of co-morbidities in a patient were associated with higher chance of mortality and this trend was significant statistically (p-value

Swyer-James-MacLeod Syndrome (SJMS) is a rare cause of a hyperlucent unilateral hemithorax. It is usually found in childhood and is a long-term sequalae of postinfectious bronchiolitis obliterans. It can be an incidental finding in adults. Most patients are asymptomatic. However, some patients can present with recurrent pulmonary infections, haemoptysis or dyspnoea. The diagnosis of SJMS is made radiographically by chest x-ray and CT scan. Majority of symptomatic patients will require conservative management. It is also important to rule out other diseases which have similar radiological picture as inaccurate diagnoses can lead to inappropriate therapy. Here we report a case of 63-year-old woman who presented with haemoptysis and progressive dyspnoea and was subsequently diagnosed as a case of SJMS.

Hydroxychloroquine (HCQ) is a relatively safe drug, and has been emerged as one of the treatment options for the management of COVID-19. This review is from the viewpoint of cardiologists, and it covers the pharmacokinetics, pharmacodynamics, and mechanism of drug interaction of HCQ with the commonly used cardioactive drugs.

The innovative way of telling stories by using visuals with a motive of imparting a message to an audience has influenced several writings. The use of visual narratives turns out to be a profound technique of illustrating stories that has existed and continues to exist event today. From oral narratives to visual ones the art of storytelling has always been efficacious and more absorbing. Impressing upon what, how, where, and in what manner the event took place through graphics is fascinating. There is substantial writing that primarily deals with research on visual stories. One such is Marjane Sartapis Persepolis told through the eyes of a young girl, and this unique perspective of graphic narration offers distinctive insight into the perseverance to retain one's identity in tumultuous times. Nations and homelands play an important part in ones identity formation. Associating oneself to national sentiments and signs, individuals feel themselves part of the nation. However, identity becomes problematic for those in diaspora. This research paper intends to look at Majane Sartapis Persepolis as an attempt of the author to surface through many of her inner-outer conflicts. The paper shall trace her journey of self-approval from Iran to Vienna and finally to France. The trauma and the identity crisis she faces during her childhood in Iran and later in Vienna is an experience which she decides to narrate using animated comic images. The use of visual narrative form has helped her convey the trauma and pain she long carried. Finding a homeland and an identity became challenging.

Here, the authors report a multi-ethnic genome wide association meta-analysis of 12 studies from the International Cataract Genetics Consortium. They find six new loci associated with age-related nuclear cataract, in addition to replicating the association at CRYAA, and suggest a strong genetic link between age-related nuclear and congenital cataracts.

Background A knowledge gap exists in understanding the beneficial use and duration of domiciliary supplemental oxygen (DSO) therapy among survivors of coronavirus disease 2019 (COVID-19) hospitalisations with persistent hypoxaemia upon discharge. The purpose of this single centre study was to begin to address this issue. Methods In this retrospective study we report features of US military veterans residing in metropolitan Chicago with no prior DSO therapy who survived COVID-19 hospitalisation, were discharged on DSO and were followed for 6 months. Results We found that the majority of the 65 elderly patients (median age, 70 years), predominantly obese Black males, who survived COVID-19 hospitalisations at the Jesse Brown VA Medical Center and were discharged on DSO did not undergo a formal 6-min walk test (6MWT) to re-assess ongoing ambulatory supplemental oxygen requirements (46 patients or 71%). Nonetheless, DSO therapy was discontinued in most patients predominantly within 8 weeks of hospital discharge (34 patients, 52%). In addition, a large proportion of patients, obese Black people in particular, who survived COVID-19 hospitalisations and were treated with DSO for at least 8 weeks thereafter developed post-acute sequelae of COVID-19 infection (PASC) (30 patients, 46%). Conclusions Given these findings, we recommend that healthcare providers be appraised about proper monitoring and evaluation, including timely performance of 6MWT, of patients who survived COVID-19 hospitalisations and were treated with DSO for persistent hypoxaemia upon discharge. Whether obese Black males who survived COVID-19 hospitalisations and are treated with DSO thereafter have an elevated risk in developing PASC remains to be determined in larger, prospective studies.

Background: First case of COVID-19 was reported in December 2019 and within a timespan of few months, it has become a pandemic. It has created havoc globally and India is no exception. Globally, it is emphasized that preventive measures play an important role in controlling the rapid spread of COVID-19. In India, 68% of population is rural and this population is going to play a crucial role in the containment of the pandemic. Realizing the key position of rural population in COVID control, this study was conducted to assess the knowledge, attitude, and practices of rural population about the disease. Method and Material: A cross-sectional questionnaire-based study was conducted on patients and their relatives from 1st April, 2020 to 31st May, 2020. A total of 372 participants hailing from rural areas were enrolled. Results: Most common source of information for the participants was through television (54.8%) and radio (49.2%). Only 77% claimed that they were using face mask and 72% claimed to be following social distancing. A large (60%) proportion of the participants did not know that COVID-19 could spread from asymptomatic patients. Education of participants was a key determinant for use of social distancing and face mask as a preventive tool. With increasing age, the practice of social distancing and the use of face mask were decreasing in our study. Conclusion: Television/Radio channels form an important source of information and need to be used more effectively to educate the people about the disease and create awareness about effective preventive measures. People need to be educated about the role of asymptomatic carriers in spreading the disease.

Calcifying odontogenic cyst (COC), also known as “Gorlin cyst,” is a rare developmental odontogenic lesion, introduced by Gorlin in 1962. COC exists either as a cystic or a solid variant. This lesion has been known by different names and classified into various subtypes. The World Health Organization classified (2005) COC as a neoplasm and used the term calcifying cystic odontogenic tumor for benign cystic type, the dentinogenic ghost cell tumor for the benign solid type lesions which occur centrally or peripherally, and the malignant one as ghost cell odontogenic carcinoma. COC mimics other odontogenic cysts clinically as well as radiologically, and a definitive diagnosis can be made only by histological means. The present article discusses the various terminologies, classification, histopathology, and immunohistochemistry of COC.

Abstract Background To explore the prevalence and determinants of unawareness of diabetes, hypertension and hypercholesterolemia and its association with poor disease control in a multi-ethnic Asian population without cardiovascular disease (CVD). Methods We included 6904 Chinese, Malay and Indian individuals (mean age [SD] 58.2 [10.2] years; 52.6% female) with diabetes, hypertension and/or hypercholesterolemia from the cross-sectional population-based Singapore Epidemiology of Eye Diseases study (2004–2011). Diabetes was defined as random blood glucose ≥ 11.1 mmol/L or HbA1c > 6.5% or self-reported use of diabetes medication; hypertension as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or self-reported use of anti-hypertensive treatment; and hypercholesterolemia as total cholesterol ≥ 6.2 mmol/L or self-reported use of lipid-lowering medications. Unawareness was based on participants’ answers to the questions: “Did your medical practitioner ever tell you that you have diabetes/hypertension/high cholesterol?” The determinants of unawareness, and its association with poor disease control, were assessed using multivariable binary logistic regression models adjusted for known potential confounders. Results Of the 2380 (34.5%), 5386 (78.0%) and 3607 (52.2%) with diabetes, hypertension and hypercholesterolemia, respectively, unawareness rates were 30.7%, 43.1% and 40.9%, respectively. Having a higher BMI, particularly if obese, and Malay ethnicity were associated with greater unawareness of diabetes; Malay and Indian ethnicities and current smoking with greater unawareness of hypertension; and education ≤6 years, current smoking, and blue collar jobs or unemployment with greater unawareness of hypercholesterolemia (all P < 0.05). Lack of awareness of each condition was independently associated with poorer disease control in the case of hypertension and hypercholesterolemia, while the converse was true for diabetes (all P < 0.05). Conclusions Unawareness of diabetes, hypertension, or hypercholesterolemia is high in Singapore, with risk factors varying across all three diseases, although Malay ethnicity is a consistent one. Unawareness was also associated with poor management for hypertension and hypercholesterolemia. Public health education and screening programs should target at-risk individuals, especially Malays, to reduce the likelihood of incident CVD.

This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient—these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single “best” care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country’s current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient’s geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources.

Bronchopulmonary sequestration (BPS) is a rare congenital disorder of the lung. It consists of a nonfunctioning lung tissue that is not normally connected with the tracheobronchial tree and receives its blood supply from systemic circulation. The presentation of sequestration is variable, ranging from asymptomatic to more severe symptoms such as massive hemoptysis, resulting in increased mortality and morbidity. Although BPS commonly involves left lower airway, here we report the case of a 17-year-old female who presented with recurrent hemoptysis and was eventually diagnosed with pulmonary sequestration in the right lower lobe, an unusual presentation of intralobar sequestration.

Introduction: Severe acute respiratory syndrome coronavirus 2 has caused a worldwide pandemic. This study was aimed to describe the clinico-demographic, hematological, and comorbidity profile in a group of coronavirus disease 2019 (COVID-19) patients at a tertiary care center in north India. Materials and Methods: We conducted a prospective, single-center collection of data regarding clinico-epidemiological, hematological parameters, and comorbidity profile of COVID-19 patients admitted at a tertiary care facility. Results: Data from 200 patients with COVID-19 were collected and analyzed. The median age of the patients was 48 years, with 63% males, and 78% patients were from urban area. Ten patients were smokers while 11 patients were alcoholic. The occupation of 20.6% of patients was related directly or indirectly with medical or allied professions. The most common mode of transmission of COVID-19 was direct close contact with microbiologically confirmed patients. Fever (n = 93; 46.5%) was the most common presenting symptom and the median duration of onset of symptoms before admission were 3.5 days (range 2–6 days). In hematological profile, lymphopenia (n = 48; 24%) had been the most common documented finding. Comorbidities were present in 39 (19.5%) patients, of which diabetes mellitus (n = 25; 12.5%) was the most common. Furthermore, the case fatality rate in our study was 1.5%. Conclusion: Among all patients of COVID-19 at our center, the characteristic findings included high proportion of male patients with younger to middle-age group, diabetes as most common comorbidity and people who were directly or indirectly in contact with the health-care system were more prone for developing the disease.

Introduction: Coronavirus Disease-2019 (COVID-19) is caused by the Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2) which is an enveloped positive-sense single-stranded RNA virus. Initial steps of the infection involve binding of the spike protein(S) of the virus to Angiotensin Converting Enzyme-2 (ACE-2) receptor on the mucosal surfaces of various organs like lungs, kidney, heart, intestine. Pathogenesis of complications are still poorly understood. Aim: This study was designed to find out the baseline biochemical parameters at the time of admission which may predict outcome in COVID-19 patients. Materials and Methods: This observational study was conducted in a dedicated COVID-19 hospital, Dr. Ram Manohar Lohia Institute of Medical Sciences (Dr. RMLIMS), Lucknow, Uttar Pradesh, India, from 1st July, 2020 to 30th November, 2020 . A total of 109 moderate to severe COVID-19 pneumonia patients who required Intensive Care Unit (ICU) admission, were enrolled. Based on their outcome, patients were divided into two groups: “Survived” and “Expired”. Biochemical characteristics of patients were compared among the two groups using univariate and multivariate analysis. Results: On Univariate analysis Coagulation profile, Prothrombin Time (PT), International Normalised Ratio (INR), Activated Partial Thromboplastin Time (APTT) and D-Dimer vales were raised significantly in the expired group. Among other acute phase reactants Lactate Dehydrogenase (LDH), C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Creatinine Phosphokinase-MB (CPKMB) were raised in expired group and this difference was significant statistically too. On Multivariate analysis among all acute phase reactant only IL-6 was increased significantly. All other variables were found to be non-significantly associated with mortality, statistically (p-value

Chronic pulmonary aspergillosis includes several disease manifestations, including aspergilloma, Aspergillus nodules, chronic cavitary pulmonary aspergillosis, and chronic fibrosing pulmonary aspergillosis. Although rarely reported in the literature, Aspergillus nodules can occur in immunocompetent hosts, may be single or multiple, and may or may not have cavitation within them. Because of similar clinical presentation of Aspergillus nodule and lung cancer, the diagnosis of Aspergillus nodule becomes delayed leading to increased mortality and morbidity. Here, we are reporting a case of lung nodule initially suspected for lung carcinoma but turn out to be an Aspergillus nodule after histopathological examination.

A kiosk-based survey at the American Museum of Natural History in New York City in 2016-2018 allowed us to assess public knowledge of antibiotics and public attitudes toward microbes in museum goers. Over 22,000 visitors from 172 countries and territories answered several carefully designed questions about microbes and antibiotics. These visitors also entered age, gender, and country demographic data that allowed for stratification along these demographic and geographic divisions. Because museum goers are likely to be better informed about these and other science-based topics, the results described here can set a potential upper bound for public knowledge on these topics. Surprisingly, the results of our analysis of museum goers' answers about microbes and antibiotics indicate a substantial lack of familiarity with both topics. For example, overall only about 50% of respondents can correctly identify penicillin as an antibiotic and less than 50% of museum visitors view microbes as beneficial. The results described here suggest that we are perhaps off target with our educational efforts in this area and that a major shift in approach toward more basic microbial topics is warranted in our educational efforts.

Background: Proteins have tendency to form inactive aggregates at higher temperatures due to thermal instability. Maintenance of thermal stability is essential to gain the protein in sufficient quantity and biologically active form during their commercial production. Methods: BL21-DE3 Rosetta E. coli cells which contains plasmid pET43.1a vector was used for producing zDHFR protein commercially. The purification of N-terminal Histidine tagged zDHFR was performed by Immobilized Metal Ion chromatography (IMAC). Investigations were performed in existence and non existence of Silver nanoparticles (AgNPs). The inactivation kinetics of zDHFR in existence and non existence of AgNPs were monitored over a range of 40–80 °C as monitored by UV–Visible absorption spectroscopy. Results: The protein completely lost its activity at 55 °C. Kinetics of inactivated zDHFR follows first order model in presence and absence of AgNPs. Decrease in rate constant (k) values at respective temperatures depicts that AgNPs contribute in the thermostability of the protein. AgNPs also assists in regaining the activity of zDHFR protein. Conclusions: AgNPs helps in maintaining thermostability and reducing the aggregation propensity of zDHFR protein. General significance: Result explains that AgNPs are recommended as a valuable system in enhancing the industrial production of biologically active zDHFR protein which is an important component in folate cycle and essential for survival of cells and prevents the protein from being aggregated.