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Background: The uncinate process is very relevant with respect to the ventilation and drainage of the frontal, maxillary and anterior ethmoid sinuses in the osteomeatal complex. Aims and Objectives: The study was conducted with the aim to examine and assess various patterns of upper attachment of the ethmoidal uncinate process. The secondary objective of the study was to study the incidence of pneumatization of the uncinate process. Materials and Methods: With the objective to study the various patterns of upper attachment of the uncinate process, the study was conducted at the Department of Ear, Nose, and Throat (ENT) Head and Neck Surgery, at Government Medical College, Doda, J and K, India. The period of study was from November 2020 up to November 2021. The study involved 100 patients who had presented to the ENT outpatient with nasal and or sinus-related complaints. Results: The study included 58 males and 42 females. Among the various patterns, it was the type-2 pattern of the uncinate attachment that was the most prevalent (42%). This was followed by a type-1 pattern (attached to the lamina papyracea) (16%) and then a type-6 pattern (14%). Type-3 in 4%, type-4 in 3%, and type-5 in 7%. In 14% of the cases, there was no upper attachment of the uncinate process. The pneumatization of the uncinate process was noted among 42 of the uncinate processes that we studied. The pneumatization was unilateral in 41% and bilateral in 59% of the uncinate process. The patients with a pneumatized uncinate process had more severe clinical presentation. Conclusions: A thorough computerized tomography scan assessment of the attachments of the uncinate process and its variations aids in minimizing damage to the related landmarks during the surgery and helps minimizing the chances of iatrogenic trauma to the nasolacrimal duct, medial orbital wall, and other surrounding structures. It can also assist in figuring out the likely cause of refractory sinusitis.

Background Echocardiography, cardiac magnetic resonance and cardiac 18fluorodeoxyglucose positron emission tomography (FDG-PET) imaging play key roles in the diagnosis and management of cardiac sarcoidosis (CS), but the relative value of each modality in predicting outcomes has yet to be determined. This study sought to determine the prognostic importance of multimodality imaging data over and above demographic characteristics and left ventricular ejection fraction (LVEF).Methods Consecutive patients newly diagnosed with CS were included. Parameters evaluated included echocardiographic regional wall motion abnormality (RWMA), myocardial strain, LVEF, right ventricular ejection fraction (RVEF), late gadolinium enhancement (LGE) extent, SUVmax and RV FDG uptake. The primary endpoint was a composite of all-cause mortality and serious ventricular arrhythmia.Results The study population consisted of 208 patients with mean age of 55±13 years and LVEF of 55±12%. During a median follow-up period of 46 (IQR: 18–55) months, 14 patients died and 28 suffered serious ventricular arrhythmias. On multivariable analysis, RWMA (HR for RWMA presence 2.55, 95% CI 1.27 to 5.28, p=0.008), LGE extent (HR per 1% increase 1.02, 95% CI 1.00 to 1.04, p=0.018), RVEF (HR per 1% decrease 0.97, 95% CI 0.94 to 0.99, p=0.008) and RV FDG uptake (HR for RV FDG presence 2.48, 95% CI 1.15 to 5.33, p=0.020) were independent predictors of the primary endpoint, while LVEF was not predictive. The risk of adverse events was significantly greater in those with LGE extent ≥15% (HR for ≥15% presence 3.96, 95% CI 2.17 to 7.23, p

Ocular prostheses play a crucial role in restoring the form, function, and esthetics of individuals who have undergone trauma or have congenital defects. This case report presents the fabrication and successful application of a ocular prosthesis for a patient who had suffered loss of eye due to trauma in his childhood days. The prosthesis provided the patient with improved facial symmetry, and psychological well-being. The fabrication process, materials used, and clinical outcomes are discussed in detail, along with a review of relevant literature on ocular prostheses.

This report discusses bilateral complete cleft lip and palate (BCLP) and the efficacy of presurgical infant orthopaedics, particularly nasoalveolar molding (NAM). NAM involves custom appliances to reduce cleft severity before primary surgery. A case report illustrates successful NAM treatment in a 2-day-old female with Veau type IV cleft lip and palate. The method aligns alveoli, lip, and nose, improving surgical outcomes and minimizing scar tissue. NAM has shown unique benefits, making it a preferred treatment in BCLP cases for better patient care. The technique aims to reduce the severity of the cleft deformity, leading to improved nasal appearance.

High myopia is often associated with local ectasia and scleral thinning. The progression of myopia depends upon scleral biochemical and biomechanical properties. Scleral thinning is associated with decreased collagen fiber diameter, defective collagen fibrillogenesis, and collagen cross-linking. Reversing these abnormalities may make the sclera tougher and might serve as a treatment option for myopic progression. Collagen cross-linking is a natural process in the cornea and sclera, which makes the structure stiff. Exogenous collagen cross-linkage is artificially induced with the help of external mediators by using light and dark methods. In this systematic review, we discussed existing literature available on the internet on current evidence-based applications of scleral collagen cross-linking (SXL) by using different interventions. In addition, we compared them in tabular form in terms of their technique, mechanisms, cytotoxicity, and the stage of transition from preclinical to clinical development. Furthermore, we discussed the in-vivo technique to evaluate the post-SXL scleral biomechanical property and outcome in the human eye.

Abstract Background The beginning of chemometrics within pattern recognition of the 1960s and 1970s is defined. This article shows a comprehensive deliberation on application of the chemometric techniques to chemical data analysis. Main body of the abstract Many review papers along with the usage of chemometrics in forensic chemistry have been available. The present article has been distributed into several parts which comprise chemometrics, its history, its function and chemometrics methods. Conclusion It is advised that these new chemometrics methods should be applied in forensic chemistry to get accurate and fast results.

Abstract Background Higher EuroSCORE II values are usually associated with increased postoperative morbidity and longer durations of Cardiac intensive care unit (CICU) stay following cardiac surgery. Aim/Purpose The aim is to investigate the predictive performance of EuroSCORE II for the Indian population and its relationship with ICU length of stay. Methods Prospective, observational study in 250 adult cardiac patients undergoing CABG under general Anaesthesia. Preoperatively values of EuroSCORE II was calculated by an online calculator available on www.euroscore.org . These patients were followed up after surgery for 30 days to note mortality and length of CICU stay. Results Of 250 cases studied, 39 (15.6%) had EuroSCORE II less than 1, 163 (65.2%) had EuroSCORE II between 1 and 3, 36 (14.4%) had EuroSCORE II between 3.1 and 5.0 and 12 (4.8%) had EuroSCORE II more than 5 in the study group. Mean EuroSCORE II and length of stay in CICU after surgery was 2.2 ± 1.4 and 4.2 ± 2.5 days respectively. The area under the curve (AUC) for EuroSCORE II as a sole predictor of mortality in the study group based on receiver operating characteristic curve (ROC) analysis was 0.919 (95% CI 0.86–0.97). Based on ROC analysis, AUC is significantly higher for predicting mortality (p

Background: Coronavirus disease 2019 (COVID-19) pandemic raised an immediate demand for skilled workforce in hospitals. There is limited literature related to perspectives of trainers in this unprecedented situation. This study aimed to examine lived experience of trainers while delivering training to a large number of participants in a challenging situation with the fear of contracting the infection themselves. Methods: A qualitative, phenomenological research was conducted in a tertiary care training centre among 21 trainers who trained 8417 healthcare personnel. Data was collected through Google Forms, which consisted of open-ended questions. Thematic analysis was done using MAXQDA software. Three themes and nine subthemes related to the teaching–learning method, administrative support, and challenges faced by the trainers were extracted. Results: Participants included nurses, nursing tutors, resident doctors, and faculty from nursing and medical specialities. Classroom teaching strategies with demonstration, simulation & hands-on training, and even virtual demonstrations were favoured as the effective teaching methods and modes. Well-planned modules, availability of infrastructure and advanced supporting software facilitated training sessions. Hands-on skill assessment was favoured as the best evaluation method. Trainers also expressed various challenges faced in planning and executing the training. Conclusion: A meticulous planning of preparedness training based on the understanding level of participants and their scope of work led to feasible and fast large-scale capacity building of healthcare professionals during COVID-19 pandemic. Diverse educational methods, as per demand of situations, online training, and in-person hands-on techniques via simulation lead to more responsive delivery of training and learning than a single method.

Background and Purpose: In recent years, the inclusion of Candida albicans on the list of infections that pose a threat due to drug resistance has urged researchers to look into cutting-edge and effective antifungal medications. In this regard, the current study investigated the probable mode of action of allyl isothiocyanate (AITC) against Candida albicans.Materials and Methods: In this study, planktonic assay, germ tube inhibition assay, adhesion, and biofilm formation assay were performed to check the growth and virulence factors. Furthermore, ergosterol assay, reactive oxygen production analysis, cell cycle analysis, and quantitative real-time polymerase chain reaction analysis were performed with the aim of finding the mode of action. A biomedical model organism, like a silkworm, was used in an in vivo study to demonstrate AITC anti-infective ability against C. albicansinfection.Results: Allyl isothiocyanate completely inhibited ergosterol biosynthesis in C. albicans at 0.125 mg/ml. Allyl isothiocyanate produces reactive oxygen species in both planktonic and biofilm cells of C. albicans. At 0.125 mg/ml concentration, AITC arrested cells at the G2/M phase of the cell cycle, which may induce apoptosis in C. albicans. In quantitative real-time polymerase chain reaction analysis, it was found that AITC inhibited virulence factors, like germ tube formation, at 0.125 mg/ml concentration by downregulation of PDE2, CEK1, TEC1 by 2.54-, 1.91-, and 1.04-fold change, respectively, and upregulation of MIG1, NRG1, and TUP1 by 9.22-, 3.35-, and 7.80-fold change, respectively. The in vivo study showed that AITC treatment successfully protected silkworms against C. albicans infections and increased their survival rate by preventing internal colonization by C. albicans.Conclusion: In vitro and in vivo studies revealed that AITC can be an alternative therapeutic option for the treatment of C. albicans infection.

Lung adenocarcinoma (LUAD), the most prevalent form of non-small cell lung cancer (NSCLC), remains a leading cause of cancer-related death globally, including in India, with a 5-year survival rate below 10%. Despite these grim statistics, recent advances in the use of next-generation sequencing (NGS) for identifying genetic alterations and the emergence of targeted therapies have opened new possibilities for personalized treatment based on distinct molecular signatures. To understand the molecular pattern of NSCLC, a retrospective study was conducted with 53 Indian LUAD patient samples, using a targeted NGS panel of 46 cancer-relevant oncogenes to identify clinically relevant variants. Pathogenic or likely pathogenic variants were detected in 94% of the 53 cases. Non-synonymous mutations, rearrangements, copy number alterations, insertions, and deletions of functional relevance were observed in 31 out of 46 genes. The most frequently mutated genes included TP53 (52.8%) and EGFR (50.9%), followed by RET, PIK3CA and ERBB2; some patients had multiple alterations in the same gene. Gender-based enrichment analysis indicated that ALK and IDH2 alterations were more prevalent in females, while TP53 and PTEN were more common in males. No significant correlation was found between mutations and other clinicopathological attributes, such as age, stage, and subtype. A higher prevalence of EGFR, RET, PIK3CA, ERBB2 and ALK mutations were observed compared to previous LUAD genetic studies coupled with a lower frequency of KRAS mutations. Clinically actionable variants were annotated using OncoKB and categorized into the four therapeutic levels based on their clinical evidence. Seventy-nine percent of cases had at least one clinically actionable alteration. Most patients (39.6%) had the highest level of actionability (Level 1) wherein an FDA-approved drug is available specifically for the observed mutation in lung cancer patients. EGFR Exon19 in-frame deletions and EGFR L858R were the most frequent among targetable variants (20.7%). These findings emphasize the importance of a selective NGS panel in enabling personalized medicine approaches by identifying actionable molecular alterations and informing the choice of targeted therapy for more effective treatment options in Indian NSCLC patients.

The gut microbiota can be beneficial and harmful to cardiovascular health depending on the mechanisms. The interaction between gut microbiota-derived flagellin and toll-like receptor 5 in hepatocytes, resulting in apolipoprotein A1 (ApoA1) production, brings forth a cardiovascular benefit to the host. Here, the association between flagellated microbiota and high-density lipoprotein-cholesterol (HDL-C) in humans was explored. Through sex-based gut microbiota analysis of two population-based cohorts, the 500 Functional Genomics Project (500FG) and Chinese cohorts, we found positive correlations between the capacity to produce flagellins in the gut microbiota and HDL-C in females of the 500FG and males of Chinese cohorts. Eubacterium rectale, Lachnospira pectinoschiza, Roseburia intestinalis and Roseburia inulinivorans were crucial species for such correlations. Diverse types of flagellins and TLR5, but not NAIP/NLRC4, flagellin-engaging receptors, were detectable by proteomic analysis of the human liver. However, not all flagellated bacteria yield the same degree of such benefit because of differences in the penetration of flagellins where other factors such as geographics and diets may play important roles.

Rhododendron is a highly perishable and nutritious flower abundant in phytocompounds. However, due to its availability for a short span, it is not much exploited by food researchers. Therefore, the aim of the current study was to optimize the pre-treatments for drying of Rhododendron with maximum phytochemical retention. The effect of different variables was evaluated on the physico-chemical parameters (such as moisture, ash, protein, total sugars and reducing sugars) and phytocompounds (such as ascorbic acid, carotenoids, anthocyanin, total phenols, flavonoids, antioxidant activity and tannins). All the quality attributes were significantly (p ≤ 0.05) affected by blanching treatment and dipping time. Among the chemical pre-treatments, KMS had a significant (p ≤ 0.05) effect on the retention of all phytochemicals, whereas, citric acid could not possess a significant (p ≤ 0.05) effect on the phytochemicals. The optimum process conditions for Rhododendron flowers were found to be 3 min blanching time, 2000 ppm KMS, 0% citric acid, and 26.28 min dipping time along with 0.917 desirability. In the nutshell, it is concluded that KMS in combination with blanching, prior to drying has been proven beneficial in the preservation of the phytocompounds and has the potential to utilize as a new ingredient in various food products.

Background: The nursing process is an important tool that has transformed the standards of nursing practices. Application of the nursing process required proper training, guidelines and resources to be used by the nurses. Aim: The objective of this study was to assess the knowledge and practice of nursing process among nurses and explore factors influencing its applications by nurses. Methods: An exploratory, descriptive study was conducted among 210 nurses using a simple random sampling technique. A pre-designed, self-structured questionnaire on knowledge and practice of nurses regarding nursing process and factors influencing its application were used to collect data. The data were analysed using descriptive and inferential statistics. Results: Most of the nurses were female (60.5%), had General Nursing and Midwifery (76.2%) as professional education, working in general medicine units (52.5%) and had more than 5 years of professional experience. The mean knowledge and practice score regarding nursing process were 13.93 ± 5.204 and 6.51 ± 0.96, respectively. Major hindering factors were the absence of a format for recording nursing process, poor nurse–patient ratio and excessive workload and never attended in-service education on the nursing process. Many nurses reported working in a stressful environment and were dissatisfied due to excessive clerical paperwork. Conclusion: The majority of nurses had average knowledge of nursing process, but they were not practicing. Certain factors such as no format, in-service education and equipment supplies affected the nursing process application in clinical areas. Hence, it is recommended to modify the above factors for proper application of nursing process.

Abstract Background Metastatic colonization is one of the critical steps in tumor metastasis. A pre-metastatic niche is required for metastatic colonization and is determined by tumor-stroma interactions, yet the mechanistic underpinnings remain incompletely understood. Methods PCR-based miRNome profiling, qPCR, immunofluorescent analyses evaluated the expression of exosomal miR-141 and cell-to-cell communication. LC-MS/MS proteomic profiling and Dual-Luciferase analyses identified YAP1 as the direct target of miR-141. Human cytokine profiling, ChIP, luciferase reporter assays, and subcellular fractionation analyses confirmed YAP1 in modulating GROα production. A series of in vitro tumorigenic assays, an ex vivo model and Yap1 stromal conditional knockout (cKO) mouse model demonstrated the roles of miR-141/YAP1/GROα/CXCR1/2 signaling cascade. RNAi, CRISPR/Cas9 and CRISPRi systems were used for gene silencing. Blood sera, OvCa tumor tissue samples, and tissue array were included for clinical correlations. Results Hsa-miR-141-3p (miR-141), an exosomal miRNA, is highly secreted by ovarian cancer cells and reprograms stromal fibroblasts into proinflammatory cancer-associated fibroblasts (CAFs), facilitating metastatic colonization. A mechanistic study showed that miR-141 targeted YAP1, a critical effector of the Hippo pathway, reducing the nuclear YAP1/TAZ ratio and enhancing GROα production from stromal fibroblasts. Stromal-specific knockout (cKO) of Yap1 in murine models shaped the GROα-enriched microenvironment, facilitating in vivo tumor colonization, but this effect was reversed after Cxcr1/2 depletion in OvCa cells. The YAP1/GROα correlation was demonstrated in clinical samples, highlighting the clinical relevance of this research and providing a potential therapeutic intervention for impeding premetastatic niche formation and metastatic progression of ovarian cancers. Conclusions This study uncovers miR-141 as an OvCa-derived exosomal microRNA mediating the tumor-stroma interactions and the formation of tumor-promoting stromal niche through activating YAP1/GROα/CXCRs signaling cascade, providing new insight into therapy for OvCa patients with peritoneal metastases.

Abstract Background Ganciclovir (GCV) is widely used in solid organ and haematopoietic stem cell transplant patients for prophylaxis and treatment of cytomegalovirus. It has long been considered a mutagen and carcinogen. However, the contribution of GCV to cancer incidence and other factors that influence its mutagenicity remains unknown. Methods This retrospective cohort study analysed genomics data for 121,771 patients who had undergone targeted sequencing compiled by the Genomics Evidence Neoplasia Information Exchange (GENIE) or Foundation Medicine (FM). A statistical approach was developed to identify patients with GCV-associated mutational signature (GCVsig) from targeted sequenced data of tumour samples. Cell line exposure models were further used to quantify mutation burden and DNA damage caused by GCV and other antiviral and immunosuppressive drugs. Results Mutational profiles from 22 of 121,771 patient samples in the GENIE and FM cohorts showed evidence of GCVsig. A diverse range of cancers was represented. All patients with detailed clinical history available had previously undergone solid organ transplantation and received GCV and mycophenolate treatment. RAS hotspot mutations associated with GCVsig were present in 9 of the 22 samples, with all samples harbouring multiple GCV-associated protein-altering mutations in cancer driver genes. In vitro testing in cell lines showed that elevated DNA damage response and GCVsig are uniquely associated with GCV but not acyclovir, a structurally similar antiviral. Combination treatment of GCV with the immunosuppressant, mycophenolate mofetil (MMF), increased the misincorporation of GCV in genomic DNA and mutations attributed to GCVsig in cell lines and organoids. Conclusions In summary, GCV can cause a diverse range of cancers. Its mutagenicity may be potentiated by other therapies, such as mycophenolate, commonly co-prescribed with GCV for post-transplant patients. Further investigation of the optimal use of these drugs could help reduce GCV-associated mutagenesis in post-transplant patients.

In patients with sarcoidosis, the development of pulmonary hypertension is associated with significant morbidity and mortality. The global prevalence of sarcoidosis-associated pulmonary hypertension (SAPH) reportedly ranges between 2.9% and 20% of sarcoidosis patients. Multiple factors may contribute to the development of SAPH, including advanced parenchymal lung disease, severe systolic and/or diastolic left ventricular dysfunction, veno-occlusive or thromboembolic disease, as well as extrinsic factors such as pulmonary vascular compression from enlarged lymph nodes, anemia, and liver disease. Early diagnosis of SAPH is important but rarely achieved primarily due to insufficiently accurate screening strategies, which rely entirely on non-invasive tests and clinical assessment. The definitive diagnosis of SAPH requires right heart catheterization (RHC), with transthoracic echocardiography as the recommended gatekeeper to RHC according to current guidelines. A 6-min walk test (6MWT) had the greatest prognostic value in SAPH patients based on recent registry outcomes, while advanced lung disease determined using a reduced DLCO (

Abstract Background Traditionally, the pulmonary valve annulus (PVA) z-score is used to predict the requirement of transannular patch enlargement (TAPE) of right ventricular outflow tract (RVOT) and main pulmonary artery (MPA) in repair of tetralogy of Fallot (TOF). PVA z-score is highly variable and many other parameters are being reported to be accurate in predicting need of TAPE. In this study, we analyze the role of great artery annulus ratio (pulmonary valve annulus to aortic valve annulus ratio, PVA/AVA) to be used as a predictor for TAPE. Methods We analyzed 90 patients of TOF retrospectively who underwent repair between January 2021 and December 2021. The patients were divided as TAPE group who required TAPE of RVOT and MPA and non-TAPE group who did not have TAPE. Their baseline parameters, PVA Z-score, and cut-off great artery annulus ratio were compared. Results Total 44 (48.9%) patients had transannular patch (TAPE) repair and 46 (51.1%) patients had non-transannular patch repair. The great artery annulus ratio and PVA z-score was lower in case of TAPE group with statistical significance. Receiver operating characteristic curve analysis showed great artery annulus ratio as more accurate predictor of TAPE. Conclusion Great artery annulus ratio can be used as a simple and accurate predictor for transannular patch enlargement along with PVA z-score during repair of TOF.

Antisperm antibodies (ASA), as a cause of male infertility, have been detected in infertile males as early as 1954. Multiple causes of ASA production have been identified, and they are due to an abnormal exposure of mature germ cells to the im-mune system. ASA testing (with mixed anti-globulin reaction, and immunobead binding test) was described in the WHO manual 5th edition and is most recently listed among the extended semen tests in the WHO manual 6th edition. The relation-ship between ASA and infertility is somewhat complex. The presence of sperm agglutination, while insufficient to diagnose immunological infertility, may indicate the presence of ASA. However, ASA can also be present in the absence of any sperm agglutination. The andrological management of ASA depends on the etiology and individual practices of clinicians. In this ar-ticle, we provide a comprehensive review of the causes of ASA production, its role in immunological male infertility, clinical indications of ASA testing, and the available therapeutic options. We also provide the details of laboratory procedures for as-sessment of ASA together with important measures for quality control. Additionally, laboratory and clinical scenarios are pre-sented to guide the reader in the management of ASA and immunological male infertility. Furthermore, we report the results of a recent worldwide survey, conducted to gather information about clinical practices in the management of immunological male infertility.

Semen analysis is the first, and frequently, the only step in the evaluation of male fertility. Although the laboratory procedures are conducted according to the World Health Organization (WHO) guidelines, semen analysis and especially sperm mor-phology assessment is very difficult to standardize and obtain reproducible results. This is mainly due to the highly subjective nature of their evaluation. ICSI is the choice of treatment when sperm morphology is severely abnormal (teratozoospermic). Hence, the standardization of laboratory protocols for sperm morphology evaluation represents a fundamental step to ensure reliable, accurate and consistent laboratory results that avoid misdiagnoses and inadequate treatment of the infertile patient. This article aims to promote standardized laboratory procedures for an accurate evaluation of sperm morphology, including the establishment of quality control and quality assurance policies. Additionally, the clinical importance of sperm morphol-ogy results in assisted reproductive outcomes is discussed, along with the clinical management of teratozoospermic patients.

Background: Chronic suppurative otitis media has been acknowledged as a conspicuous pathology affecting the middle ear since times immemorial. Aims and Objectives: The aim of the study was to study the incidence of ossicular involvement and various patterns of its presentation in chronic suppurative otitis media. Materials and Methods: With the objective to study the incidence and pattern of ossicular involvement in chronic suppurative otitis media and also to correlate the various ossicular defects with the type and extent of the disease, we decided to take up this study at our institute. The study involved a total of 100 patients between February 2020 and June 2021. Results: Among the 100 patients included in this study, there were 56 males and 44 females. Among the 100 patients in this study, there were 54 tubotympanic and 46 atticoantral chronic suppurative otitis media patients. Among the tubotympanic cases, ossicular involvement was discovered in 18 cases while 36 cases were without any ossicular involvement. Among the atticoantral cases, 38 cases had ossicular involvement while eight cases had no ossicular disruption. Out of the 56 cases that showed ossicular involvement, incus was involved in 52 cases, malleus was involved in 14 cases, and stapes was involved in 10 cases. Conclusion: Ossicular involvement was seen in 53% of the operated cases of chronic suppurative otitis media. Atticoantral disease is 3 times more prone to having ossicular erosion than tubotympanic disease. Wet ears have 6 times more likelihood of having ossicular involvement in comparison to dry ears. Incus is the most common ossicle involved followed by malleus and stapes. Erosion of the incudal long process is the most common abnormality. Incus is invariably involved in atticoantral disease. Stapes involvement in the form of resorption of the arch of stapes is the most common pattern. An eroded long process along with stapes arch resorption is the most frequent ossicular chain defect.

Abstract A study was conducted to record the effect of modified atmospheric packaging (MAP), storage conditions (ambient, zero energy cool chamber and refrigerated) as well as storage period on shelf-life and quality of tomatoes produced through Subhash Palekar natural farming (SPNF) and chemical farming (CHEM) systems. Freshly harvested tomatoes (SPNF and CHEM) packed in LDPE pouches (25.40 μm and 10 pin holes/100 cm2 area) and without packaging were stored under ambient (27±2 °C and 70±2% RH), zero energy cool chamber (ZECC) (17±2 °C and 82 ±2 % RH) and low temperature conditions (10±2 ºC and 90 % RH) for shelf-life studies. The shelf-life comparison was done at every two days’ interval up to 24 days based on physiological loss in weight (PLW) and spoilage percentage. SPNF and CHEM tomatoes were compared on the basis of quality attributes (firmness, acidity, TSS, sugars, total phenols, antioxidant activity etc.), mineral content and sensory characteristics. Results revealed that tomato stored in refrigerated condition had significantly (p ˂0.05) lowest PLW and spoilage incidence and highest sensory acceptability up to 24 days and was at par with ZECC stored tomatoes. Quality evaluation indicated that tomatoes grown under SPNF system contained a higher amount of total solids, total sugars, reducing sugars, ascorbic acid, total phenols and ash. The results showed that tomatoes with MAP and stored under refrigerated storage condition retained maximum quality up to 24 days followed by tomatoes stored under ZECC (18 days) compared to 12 days at ambient conditions.

The current WHO 2010 manual for human semen analysis defines leukocytospermia as the presence of peroxidase-positive leukocytes at a concentration >1×106/mL of semen. Granular leukocytes when activated are capable of generating high levels of reactive oxygen species in semen resulting in oxidative stress. Oxidative stress has been correlated with poor sperm quality, increased level of sperm DNA fragmentation and low fertility potential. The presence of leukocytes and pathogens in the semen may be a sign of infection and/or localized inflammatory response in the male genital tract and the accessory glands. Common uro-pathogens including Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrhoeae, Mycoplasma hominis, and Escherichia coli can cause epididymitis, epididymo-orchitis, or prostatitis. The relationship between leukocytospermia and infection is unclear. Therefore, we describe the pathogens responsible for male genital tract infections and their association with leukocytospermia. The review also examines the diagnostic tests available to identify seminal leukocytes. The role of leukocytospermia in male infertility and its management is also discussed.

Retrograde ejaculation (RE) is a condition defined as the backward flow of the semen during ejaculation, and when present can result in male infertility. RE may be partial or complete, resulting in either low seminal volume or complete absence of the ejaculate (dry ejaculate). RE can result from anatomic, neurological or pharmacological conditions. The treatment approaches outlined are determined by the cause. Alkalinizing urinary pH with oral medications or by adding sperm wash media into the bladder prior to ejaculation may preserve the viability of the sperm. This article provides a step-by-step guide to diagnose RE and the optimal techniques to retrieve sperm.

Background: The present study aimed to compare clinical features, management, and outcomes between children and adolescents admitted as cases of multi-system inflammatory syndrome in children (MIS-C) in Indira Gandhi Medical College (IGMC), Shimla. Material and Methods: We conducted a cross-sectional study for MIS-C from January to July 2021, in the pediatric ward of IGMC in Himachal Pradesh. All children admitted with a diagnosis of MIS-C were included in the study. Data regarding socio-demographic factors, clinical features, and treatment modalities were extracted and analyzed using Epi Info V7 software. Results: A total of 31 children diagnosed as cases of MIS-C were included. The mean age was 7.12 ± 4.78 years. 71% were in group 0–10 years, followed by 29% in 11–18 years. Although the duration of hospital stay, mortality, and Kawasaki disease cases were more in children as compared to adolescents, the difference was not significant. Similarly, fever, rash, cough, hematemesis, tachypnea, respiratory distress, hypotension, vomiting, bleeding diathesis, hematuria, seizure, encephalopathy, hepatomegaly, splenomegaly, and lymphadenopathy were greater in children as compared to adolescents but were not significant. Likewise, abnormalities in various biochemical, hematological, inflammatory, and cardiac markers were deranged to a greater extent in children as compared to adolescents, but there was no significant difference. The need for various treatment modalities such as IVIG, methylprednisolone, low-molecular weight heparin, aspirin, respiratory Support, O2, ventilatory support, and inotropic support was more in children as compared to an adolescent, but there was no significant difference. Conclusion: There was no significant difference in socio-demographic factors, clinical presentation, diagnostic test, mode of treatment, duration of stay, and mortality among children and adolescents.

Background: Many women face disrespectful and abusive treatment during childbirth in facilities worldwide. Such treatment violates women's rights to respectful care and jeopardizes their rights to life, health, bodily integrity, and equality. This study aims at identifying the status of respectful maternity care (RMC) in selected hospitals in Rishikesh. Material and Methods: A mixed-method approach was adopted to explore RMC during normal vaginal delivery in a selected hospital in Rishikesh, Uttarakhand. In the quantitative part, 145 women were purposively selected, and data were collected by a pre-structured, validated RMC checklist, developed based on WHO RMC standards. Qualitative data were collected from 18 women, and a face-to-face semi-structured interview was conducted. Results: Forty-two elements of RMC categorized under eight domains show the type of mistreatment and its prevalence faced by women at a health care facility. Data showed that domain-7 (availability of competent and motivated human resources) had higher scoring (95%), and on the other hand, domain-4 (informed consent and effective communication) got lowest-scoring (68.45%). The overall mean percentage score of RMC was 85.68%. There was no statistically significant association between the total score of RMC and the selected socio-demographic variables. Conclusion: The overall RMC score was high, and there was no significant association with mothers' socio-demographic variables. The majority of mothers expressed that competent and motivated professionals were available during their delivery, but their communication skills were found to be lacking.

Objective: The objective of this study was to assess and compare job satisfaction and organizational commitment among nurses working on temporary versus permanent basis at a tertiary care teaching hospital, Uttarakhand, India. Materials and Methods: A total of 250 nurses (125 temporary and 125 permanent) were selected using stratified disproportionate random sampling techniques from a tertiary care teaching hospital. Sociodemographic datasheet, Job Satisfaction Survey scale, and Organizational Commitment scale were used to collect data. Results: The study results revealed that the job satisfaction score was significantly higher in permanent nurses (139.1 ± 15.4) than in temporary nurses (131.3 ± 12.2) (P < 0.001). However, temporary nurses (85.2 ± 14.4) were more committed toward organization than permanent nurses (80.0 ± 16.0) (P < 0.001). There was a significant association between nurses' job satisfaction and their gross salary (P < 0.001) and their organizational commitment with the selected profession by own will (P < 0.001). Conclusion: The present study concluded that majority of temporary and permanent nurses reported a moderate level of job satisfaction and organizational commitment. This study suggests enhancing employee satisfaction can improve organizational commitment. As well, this study's findings can serve as a valuable foundation for designing policies to enhance organizational commitment in the future.

Semen analysis is a basic test for evaluating male fertility potential, as it plays an essential role in driving the future management and treatment of infertility in couples. Manual semen analysis includes the evaluation of both macroscopic and microscopic parameters, whereas automated semen analysis is conducted through a computer-aided sperm analysis system and can include additional parameters that are not evaluated by manual analysis. Both quality control (QC) and quality assurance (QA) are important to ensure reproducible results for semen analysis, and represent fundamental checks and balances of all stages (pre-analytical, analytical, and post-analytical) of semen analysis. To ensure accuracy and precision, the laboratory technicians’ performance should be evaluated biannually. This narrative review aims to describe standardized laboratory procedures for an accurate assessment of semen parameters that incorporate both QC and QA practices.

Abstract Background Drug resistance to sorafenib greatly limited the benefits of treatment in patients with hepatocellular carcinoma (HCC). MicroRNAs (miRNAs) participate in the development of drug resistance. The key miRNA regulators related to the clinical outcome of sorafenib treatment and their molecular mechanisms remain to be identified. Methods The clinical significance of miRNA-related epigenetic changes in sorafenib-resistant HCC was evaluated by analyzing publicly available databases and in-house human HCC tissues. The biological functions of miR-23a-3p were investigated both in vitro and in vivo. Proteomics and bioinformatics analyses were conducted to identify the mechanisms that regulating miR-23a-3p. Luciferase reporter assay and chromatin immunoprecipitation (ChIP) assay were used to validate the binding relationship of miR-23a-3p and its targets. Results We found that miR-23a-3p was the most prominent miRNA in HCC, which was overexpressed in sorafenib non-responders and indicated poor survival and HCC relapse. Sorafenib-resistant cells exhibited increased miR-23a-3p transcription in an ETS Proto-Oncogene 1 (ETS1)-dependent manner. CRISPR-Cas9 knockout of miR-23a-3p improved sorafenib response in HCC cells as well as orthotopic HCC tumours. Proteomics analysis suggested that sorafenib-induced ferroptosis was the key pathway suppressed by miR-23a-3p with reduced cellular iron accumulation and lipid peroxidation. MiR-23a-3p directly targeted the 3′-untranslated regions (UTR) of ACSL4, the key positive regulator of ferroptosis. The miR-23a-3p inhibitor rescued ACSL4 expression and induced ferrotoptic cell death in sorafenib-treated HCC cells. The co-delivery of ACSL4 siRNA and miR-23a-3p inhibitor abolished sorafenib response. Conclusion Our study demonstrates that ETS1/miR-23a-3p/ACSL4 axis contributes to sorafenib resistance in HCC through regulating ferroptosis. Our findings suggest that miR-23a-3p could be a potential target to improve sorafenib responsiveness in HCC patients.

Context: Immunohistochemistry (IHC) to differentiate germ cell tumors. Aims: The aim of the study is to differentiate seminomatous and nonseminomatous germ cell tumors (GCTs) with morphological overlap using a minimal and affordable panel of IHC markers. Settings and Design: This is a retrospective observational study. Subjects and Methods: All testicular GCTs (TGCT) which were diagnosed on biopsies and/or resection specimens (prechemotherapy) between January 2014 and June 2019. The demographic, clinical, and imaging findings were noted from the medical records. Hematoxylin and eosin (H and E)-stained sections were reviewed for morphology. The IHC markers constituted Octamer-binding transcription factor (OCT) 3/4, glypican 3 (GPC3), CD117, CD30, placental-like alkaline phosphatase, Sal-like protein 4, and β-human chorionic gonadotropin (HCG). IHC markers were performed in various combinations depending on the morphology, and a panel constituting OCT 3/4, CD117, GPC3, and CD30 was performed on cases with diagnostic dilemma and morphological overlaps. Statistical Analysis Used: Sensitivity, specificity, positive (PPV), and negative predictive value (NPV) were calculated for suggested panel of IHC OCT 3/4, CD117, GPC3, and CD30. Results: The study included 36 patients with TGCT with a mean age of 27 (15–58) years. Nonseminomatous tumors were the most common (86%). The concise panel was performed in 20/36 (56%) tumors to resolve the diagnosis. The sensitivity, specificity, PPV, and NPV for OCT3/4 were 80%, 55%, 31%, and 92% in seminomas and 65%, 100%, 100%, and 46% in embryonal carcinomas (EC), for CD117 was 89%, 82%, 73%, and 93% in seminomas and 60%, 77%, 60%, and 77% in yolk sac tumors (YST), for GPC3 was 95%, 90%, 95%, and 90% in YST, CD30 96%, 100%, 100%, and 91% in ECs, respectively. Conclusions: Designing a novel concise and affordable IHC panel constituting OCT 3/4, CD117, GPC3, and CD30 has good sensitivity and specificity in differentiating seminomas, YST, and EC, respectively. Additional markers, namely β-HCG, can be used in identifying the choriocarcinoma component.

Objective: This study aimed to assess smartphone dependency and its impact on academics among medical and nursing students. Materials and Methods: A cross-sectional study was carried out on Bachelor of Medicine and Bachelor of Surgery (MBBS) and Bachelor of Science in Nursing (BScN) students in a medical teaching institute. The Smartphone Dependency Scale and self-structured questionnaire on impact of smartphone on academics were used to assess smartphone dependency and its impact on academics. A total of 436 students were selected using the total enumerative sampling technique. Data were analyzed using the descriptive (frequency, percentage, mean, and standard deviation) and inferential (t-test, Chi-square test) statistics. Results: The mean age of students was 20.6 ± 1.29 years, 81% were females, and the mean body mass index score was 21.59 ± 3.41 kg/m2. The mean impact on academics and smartphone dependency scores was 19.92 ± 7.01 and 48.58 ± 11.46, respectively. The impact on academics had a significant association with student category (P < 0.001) and gender (P < 0.001). A significant association was found between the impact on academics (P = 0.003) and smartphone dependency (P = 0.05) with studying class. Conclusion: The use of smartphones is more among medical students. Students studying in the first and second years are found to be more dependent on smartphone, which caused a serious impact on their academics. Smart appliances have become mandatory in this era of technology, and it is not possible to stop its usage but negative impact of smartphones on students' academic performance needs to be addressed. Therefore, it is mandatory to organize educational seminars and workshops to promote the appropriate use of smartphones.

The use of simulation is a unique teaching–learning approach in medical and nursing education to empower undergraduates with desired clinical skills. Simulation duplicates the events from the real world and influences the learner in a naturalistic setup and evokes a real experience to the learner. This method of learning facilitates students to practice multiple times to attain proficiency in a particular technique without compromising on patient safety. They can rely on simulation exercises in clinical skill laboratories (CSL), which boost their confidence level, reduce anxiety, and promote satisfaction before performing or dealing in real clinical settings. Simulation has been widely used for formative evaluation and is a reliable assessment tool as it ensures a high level of objectivity. The simulation-based approach in undergraduate medical and nursing education is an effective way of learning that can be incorporated into the educational strategy. This article presents the evolutionary growth, modalities, prerequisites, usefulness, and challenges for simulation-based learning.

The investigation was undertaken and micro nutrients status of the area was assessed. During February-March 2020, 50 soil sampling locations from tomato growing areas were selected at random and 100 representative surface (0-15 cm) and sub-surface (15-30 cm) soil samples were collected. Various micronutrients, i.e. DTPA-extractable Zn, Cu, Mn and Fe were examined. The soils were neutral to slightly alkaline, and the EC values of all the soil samples were within normal limits. The general state of the soil organic carbon concentration was medium to high. The DTPA- Mn, Fe, Cu and Zn in soils of the studied area were found to be in medium category. Positive correlations between the DTPA-extractable iron, copper, zinc and manganese with the organic carbon content was observed.

ABSTRACT Type III polyketide synthases (PKSs) found across Streptomyces species are primarily known for synthesis of a vast repertoire of clinically and industrially relevant secondary metabolites. However, our understanding of the functional relevance of these bioactive metabolites in Streptomyces physiology is still limited. Recently, a role of type III PKS harboring gene cluster in producing alternate electron carrier, polyketide quinone (PkQ) was established in a related member of the Actinobacteria, Mycobacteria, highlighting the critical role these secondary metabolites play in primary cellular metabolism of the producer organism. Here, we report the developmental stage-specific transcriptional regulation of homologous type III PKS containing gene cluster in freshwater Streptomyces sp. strain MNU77. Gene expression analysis revealed the type III PKS gene cluster to be stringently regulated, with significant upregulation observed during the dormant sporulation stage of Streptomyces sp. MNU77. In contrast, the expression levels of only known electron carrier, menaquinone biosynthetic genes were interestingly found to be downregulated. Our liquid chromatography–high-resolution mass spectrometry (LC-HRMS) analysis of a metabolite extract from the Streptomyces sp. MNU77 spores also showed 10 times more metabolic abundance of PkQs than menaquinones. Furthermore, through heterologous complementation studies, we demonstrate that Streptomyces sp. MNU77 type III PKS rescues a respiratory defect of the Mycobacterium smegmatis type III PKS deletion mutant. Together, our studies reveal that freshwater Streptomyces sp. MNU77 robustly produces novel PkQs during the sporulation stage, suggesting utilization of PkQs as alternate electron carriers across Actinobacteria during dormant hypoxic conditions. IMPORTANCE The complex developmental life cycle of Streptomyces sp. mandates efficient cellular respiratory reconfiguration for a smooth transition from aerated nutrient-rich vegetative hyphal growth to the hypoxic-dormant sporulation stage. Polyketide quinones (PkQs) have recently been identified as a class of alternate electron carriers from a related member of the Actinobacteria, Mycobacteria, that facilitates maintenance of membrane potential in oxygen-deficient niches. Our studies with the newly identified freshwater Streptomyces sp. strain MNU77 show conditional transcriptional upregulation and metabolic abundance of PkQs in the spore state of the Streptomyces life cycle. In parallel, the levels of menaquinones, the only known Streptomyces electron carrier, were downregulated, suggesting deployment of PkQs as universal electron carriers in low-oxygen, unfavorable conditions across the Actinobacteria family.

Introduction: Immunization is one of the most substantial contributions from the medical field to human beings as a low-cost intervention to prevent major illnesses that contribute to the mortality of children in developing countries like India. Parent’s knowledge plays a vital role in determining the health status of children. Purpose of the study: To assess knowledge, attitude, and compliance of immunization, and explore barriers of immunization among parents of under-five children. Methodology: A cross-sectional study was conducted among 200 parents of under-five children at selected government hospitals in Dehradun district. Study participants were selected by consecutive sampling technique, and data were collected using pre-tested, structured questionnaires. The data was analyzed using descriptive and inferential statistics. Results: Of 200, 39 (19.5%) parents reported that their child was not vaccinated as per schedule. A vast proportion (84.5%) of parents had an average to good level of knowledge regarding under-five immunization. Out of ten components of attitude, most of the parents had agreed in favor of vaccination. The most common barriers of compliance reported by parents were: unaware of the next scheduled doses, illness in family, and absence of vaccine at health centre. Conclusion: Most of the parents of the under-five child had basic knowledge and positive attitude regarding immunization, but the compliance rate for immunization was not 100%. We recommend that health agencies must develop multiple education interventions regarding immunization and periodic reminders for scheduled vaccination for their child. Also, concerned authorities should consider feedback and resolve the issues of parents appropriately.

Introduction: Research on Coronavirus Disease-2019 (COVID-19) seroprevalence in children and adolescent population across the globe is quite limited. In India, there is a dearth of data on COVID-19 seropositivity, especially in unvaccinated paediatric population, particularly in the Himalayan region. Aim: To estimate the seroprevalence of COVID-19 in children presenting in a tertiary care health institution. Materials and Methods: A hospital-based cross-sectional serosurvey was conducted on 500 children, from October 2021 to March 2022 in paediatric age group, attending Indira Gandhi Medical College Shimla, Himachal Pradesh, India, for various health related concerns such as fever, cough, loose stools, vomiting and fast breathing using convenience sampling. Socio-demographic profile was recorded and blood sample was drawn for COVID-19 antibody titre estimation. Chi-squared and Fisher’s-exact tests for proportions was used for testing statistical significance. Results: A total of 500 children, age ranged from 12 hours to 17 years 7 months were enrolled with maximum children belonging to 01-05 years age group and there was slight male preponderance. Seropositivity in males (27.3%) was significantly higher than females (8.3%). Highest (42.3%) seropositivity was seen in age group of 06 months to 01 year. About 10.8% of cases were positive for Immunoglobulin (Ig)G antibody, 4.4% were positive for IgM antibody, while about 6.6% cases were positive for both antibodies. Conclusion: The seroprevalence status of children and adolescents is quite low in this region, revealing the high susceptibility of children to SARS-CoV-2 in the study region. It further emphasises benefits of serological testing in children for SARS-CoV-2 as well as the need of safe and effective vaccination for the unimmunised, unprotected and vulnerable paediatric age group.

Purpose: In response to the COVID-19 pandemic, the American Center for Reproductive Medicine (ACRM) transitioned its annual training in assisted reproductive technology (ART) from a hands-on, laboratory-based training course to a fully online training endorsed by the American College of Embryology. Here we describe our experience and assess the quality of an online training format based on participant outcomes for the first three modules of a planned series of online ART training. Materials and Methods: These modules included manual semen analysis, sperm morphology and ancillary semen tests (testing for leukocytospermia, sperm vitality, and anti-sperm antibody screening). The virtual format consisted of lecture presentations featuring laboratory protocols with corresponding video demonstrations of routine techniques and best practices. Practical scenarios, troubleshooting, and clinical interpretation of laboratory results were also discussed. At the end of each module, an optional multiple choice question test was held as a prerequisite to obtain certification on the topics presented. Course quality was assessed using participant responses collected via online surveys. Results: The digital delivery methods used were found to have largely or completely met the participants’ expectations for all questions (>85%). The majority (>87%) of the participants either strongly agreed or agreed that the course content was well-structured with appropriate depth, and that their overall expectations of the course had been met. Conclusions: This training format appears to be a realistic teaching option to freely share highly specialized expertise and technical knowledge with participants from anywhere in the world with varying levels of competency or experience.

Mulberry (Morus alba L.) is having numerous natural phytocompounds, which possess nutritional and pharmaceutical value. Due to its perishable nature and limited availability, it is not yet much explored except for its value addition. However, the wholesomeness in terms of shape has been always ignored. Therefore, the aim of present study was to optimize the processing conditions for production of osmo-dehydrated (OD) mulberry and retaining the shape of the fruit. The effect of three process variables i.e., blanching time (0 to 180 s), syrup concentration (45 to 75 obrix) and drying temperature (45–60 °C) was evaluated on the quality attributes of OD mulberry. All the phytochemicals were significantly (p ≤ 0.05) affected during processing conditions. The optimized conditions for the development of OD mulberry were 170 s blanching time, 66.52°brix syrup concentration and 53.48 °C drying temperature with 0.84 desirability. All the variables possess an important role in the quality of mulberry as revealed during cluster analysis. The optimized sample had more nutritional and phytochemical potential as confirmed during the qualitative analysis. In a nutshell, it is concluded that optimized conditions can be used to produce OD mulberry along with maintenance of original shape and to make it available at off places and during off seasons.

Introduction Primary synovial sarcoma (SS) of the prostate is the rarest variety of prostate sarcoma. The first documented and confirmed case of SS of the prostate was published by Iwasaki et al in the year 1999; since then, only a few cases of primary SS of the prostate have been published in English literature. Case Report We report a unique case of primary SS in a young patient who presented with acute urinary retention and underwent emergency suprapubic catheterization, and on evaluation was diagnosed with primary SS of the prostate. Patient was managed with radical cystoprostatectomy and resection of the anterior wall of rectum infiltrated by the tumor with bilateral pelvic lymph node dissection and adjuvant chemotherapy. Patient died after 2 months of surgery. Conclusion Primary SS of the prostate is a rare disease and important clinical entity to be included in differential diagnosis of acute urinary retention in young patients. It is associated with high local recurrence and poor prognosis, which warrants multidisciplinary approach of treatment.

Cardiac sarcoidosis (CS) is a rare inflammatory disorder characterised by the presence of non-caseating granulomas within the myocardium. Contemporary studies have revealed that 25–30% of patients with systemic sarcoidosis have cardiac involvement, with detection rates increasing in the era of advanced cardiac imaging. The use of late gadolinium enhancement cardiac magnetic resonance and 18fluorodeoxy glucose positron emission tomography (FDG-PET) imaging has superseded endomyocardial biopsy for the diagnosis of CS. Echocardiography has historically been used as a screening tool with abnormalities triggering the need for advanced imaging, and as a tool to assess cardiac function. Regional wall thinning or aneurysm formation in a noncoronary distribution may indicate granuloma infiltration. Thinning of the basal septum in the setting of extracardiac sarcoidosis carries a high specificity for cardiac involvement. Abnormal myocardial echotexture and eccentric hypertrophy may be suggestive of active myocardial inflammation. The presence of right-ventricular involvement as indicated by free-wall aneurysms can mimic arrhythmogenic right-ventricular cardiomyopathy. More recently, the use of myocardial strain has increased the sensitivity of echocardiography in diagnosing cardiac involvement. Echocardiography is limited in prognostication, with impaired left-ventricular (LV) ejection fraction and LV dilatation being the only established independent predictors of mortality. More research is required to explore how advanced echocardiographic technologies can increase both the diagnostic sensitivity and prognostic ability of this modality in CS.

Introduction: Ineffective breastfeeding techniques is one of the factors contributing to poor breastfeeding outcomes in post-cesarean mothers. To assist post-cesarean mothers to find a comfortable breastfeeding position, a trial was conducted to compare different positions of breastfeeding in these individuals. Methods: A randomized clinical parallel trial was carried out on primipara post-cesarean mothers admitted to All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India. Participants were enrolled by convenience sampling technique, which was further randomized (block size= 4) and allocated to receive either "L" shape (n= 30) or side-lying (n= 30) position for breastfeeding. The assigned intervention was provided at least six times a day for four consecutive days. Data were collected using breastfeeding assessment Tool, maternal breastfeeding evaluation scale and numeric pain rating scale. Data were analyzed using SPSS software version 23. Results: The baseline characteristics of participants in both groups were similar. The mean comparison of breastfeeding outcome and maternal satisfaction indicated no significant difference between the two positions. However, the mean scores of maternal pain were statistically significant. Hence, it was inferred that the maternal pain was significantly less in post-cesarean mothers in "L" shape compared to side-lying. Conclusion: There is significantly less pain in post-cesarean mothers during breastfeeding in "L" shape than side-lying. Furthermore, maternal satisfaction and breastfeeding outcomes were found to be similar in both positions.

Although the health care systems in Europe are considered the global benchmark, European nations were severely affected by the coronavirus disease 2019 (COVID-19) pandemic. This manuscript aimed to examine the strategies implemented to combat the COVID-19 pandemic by France, the United Kingdom, Spain, Italy, Germany, and Russia and their outcomes in terms of the number of cases, testing, and deaths. This is the first review of its kind that extensively analyzes the preparedness, mitigation, and response strategies against the COVID-19 pandemic adopted by these nations. This paper further suggests a strategic preparedness model for future pandemics. From the analysis, we found that a decentralized approach, prompt decision-making and timely execution, coordination between local health authorities, and public participation in the implementation of strategies could substantially reduce the case fatality rate. Nations with a high percentage of gross domestic product invested in the health sector, as well as more nurses, physicians, hospital beds, intensive care unit beds, and ventilators, better managed the pandemic. Instead, nations that postponed their pandemic response by delaying tracking, tracing, testing, quarantine, and lockdown were badly affected. The lessons learned from the present pandemic could be used as a guide to prepare for further pandemics.

Purpose: Aberrant expression of seminal plasma proteins are associated with altered homeostasis that may affect the fertilizing ability of spermatozoa. However, the precise roles of seminal exosomes on sperm function remain unclear. The objective of this study was to identify the differentially expressed proteins (DEPs) associated with varicocele-mediated infertility by comparing seminal plasma protein profile of unilateral varicocele patients with proven fertile donors. Materials and Methods: Semen samples were obtained from 10 proven fertile donors with normal semen parameters and 33 infertile patients with unilateral varicocele. For proteomic analysis, 5 samples from each group were pooled and run in triplicate. Key DEPs (ANXA2, TF, CD63, KIF5B, SEMG1) associated with the exosome function were selected by bioinformatic tools and validated using Western blotting. Results: A total of 47 seminal plasma proteins were differentially expressed in unilateral varicocele patients compared to fertile donors. Validation of exosome-associated DEPs in unilateral varicocele patients (n=7) and fertile donors (n=7) revealed significant upregulation of ANXA2 (p=0.0016) and downregulation of KIF5B (p=0.009). The main upstream regulators of the DEPs in seminal plasma of unilateral varicocele group were androgen receptor, YB1 and NRF2. Conclusions: This is the first report to identify DEPs in seminal plasma of unilateral varicocele patients compared to fertile donors. Based on the detection of DEPs associated with exosomal function, Western blotting was used to validate the presence of defective exosome machinery in seminal plasma of unilateral varicocele patients. KIF5B and ANXA2 can be utilized as potential biomarkers of infertility in unilateral varicocele patients.

Introduction: There is a scarcity of literature about the burden of hemodialysis patients’ caregivers. Caregivers often receive little attention, and the primary focus is always on the patients. Frequent hospitalizations and factors associated with the disease can lead to depression and reduce the caregiver’s quality of life. Objective: The study aimed to determine the burden of caregivers of patients undergoing hemodialysis at a tertiary care hospital. Materials and Methods: This cross-sectional analytical study was conducted in a tertiary care hospital in northern India. A total of 110 caregivers who were providing care to their patients for more than 3 months were selected by purposive sampling method. The study data were collected by self-prepared demographic questionnaire to collect basic information regarding patients and caregivers, and the level of burden was assessed by a revised Zarit Burden Interview (ZBI) standardized on a 5-point scale. Descriptive and inferential (the Chi-square and Fisher exact test, 1-way ANOVA test) statistics were used for data analysis. Results: The mean±SD age of caregivers was 37±13 years. Nearly half of caregivers, 50 (45.46%), reported mild to moderately burdened, while 15 (13.63%) caregivers had moderate to severely burdened. The caregivers were mild to moderately burdened as the mean burden score was 25±12. There was no significant association between the levels of burden scores and selected sociodemographic variables of the participants. Conclusion: It was found that caregivers of hemodialysis patients experienced moderate burden while caring and being with the patient, which may alter their health and quality of life.

India has a high burden of cardiovascular disease, morbidity and mortality due to CVD has been causing a high economic burden and leading to an overall increase in health care cost. Research evidence from different parts of the world indicates that structured approach to secondary prevention such as cardiac rehabilitation (CR) have health-favoring impact. When CR is supplemented with pharmacological interventions and percutaneous coronary intervention (PCI) has shown a significant improvement in quality of life, reduces morbidity, and mortality rate, cardiac-related parameters, depression and minimizes readmission rates among cardiac patients. Primarily, CR is delivered in three phases: Phase – I begin in the hospital, Phase – II outpatient phase, and Phase – III maintenance phase. Various organizations around the world deliver structured home-based and center-based CR program to cardiac patients also provides training and certification courses in CR to healthcare professionals (HCPs). However, in India, no such organization exists; therefore, CR delivery is under prevalent; further, other factors such as lack of skilled task force, adequate infrastructure, education, and training also contribute for suboptimal use of CR in the country. Awareness among HCPs and patients is also considered one of the primary factors to minimize the uptake of CR program in India. Therefore, there is a great need to revisit the CR delivery protocol and develop an evidence-based uniform approach to increase the uptake of the CR program. Government health care agencies should also frame guidelines to facilitating better infrastructure and training to resulting in increased uptake of CR program among cardiac patients. This review article has compiled various international studies to justify the benefits of CR program development necessity and status in India.

Background: Simulation and skill development facilities are essential for the training and preparation of nursing students, which aids in their clinical readiness and professional development. The aim of the study was to assess simulation and skill training facilities, their utility in selected nursing institutes at Uttarakhand. Materials and Methods: This descriptive cross-sectional study was conducted in conveniently selected 16 nursing institutes at Uttarakhand (India). Data were collected from Nov. to Dec. 2019, through a face-to-face interview using a validated self-structured questionnaire. Descriptive and inferential statistics were used to analyze the data. Results: There were 16 institutes from four districts that participated in the study. Of these, five (31%) were government, and 11 (69%) were private. All nursing institutes (100%) had a nursing foundation lab, midwifery, and child health nursing lab, while only 44% of institutes had a medical surgical nursing skill lab. Among skill development facilities, the overall average number [mean (SD)] of mannequins was 3.90 (7.10); and high-fidelity simulators were 2.47 (7.1). In private institutes, the average period [mean (SD)] of laboratory usage was significantly higher than in government institutes [35.82 (6.57) vs 27.40 (5.22); p = 0.025]. The duration of lab usages was significantly associated with the age of the institute (p = 0.04). Conclusions: This study found inadequate simulation and skills training facilities and less utilization of those facilities. There is a great need to find out the key issues that lead to the unavailability and limited use of the required nursing skill development facilities.

Background: The extensive spread of Covid-19 pandemic globally became the main cause of concern for everyone, including security officers working in a health care setting. Objective: To assess the effectiveness of instructional module for Covid-19 prevention among hospital security officers. Methods and Materials: A preexperimental study was conducted at a tertiary care hospital from North India. A total of 344 security officers were selected by the convenient sampling technique. A self-structured knowledge and practice questionnaires and instructional module were developed based on the guidelines released by World Health Organization, Centre for Disease Control and Prevention and Ministry of Health and Family Welfare. Knowledge and practice were pretested, followed by the implementation of a video cum discussion instructional module for Covid-19 prevention. A posttest of knowledge and practice assessment was done after 7 days by using the same questionnaire. Descriptive and inferential statistics were used to compute and analyse the data. Results: The mean age of participants was 29.5 ± 2.25; mos participants (75%) were male security officers. Knowledge and practice scores improved after the implementation of instructional module as mean scores of pretest to mean posttest scores had shown a significant difference (P = 0.00). In practice, instructional module was significantly effective, except for touching hair again and again, as it could be a source of covid-19 infection. Conclusion: This study finding highlights the significance of training security officers about the prevention of Covid-19.