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Abstract Black individuals have lower plasma natriuretic peptide (NP) concentrations than white individuals. However, race-based differences in the NP response to physiological perturbations are unknown. In this physiological trial (NCT#03070184), we measured the NP [mid-regional atrial NP (MR-proANP), N-terminal pro-B-type NP (NT-proBNP), and BNP] response to physiological perturbations among healthy, self-identified Black and white participants aged 18-40 years. The primary and secondary outcomes were the change in plasma NP concentrations at 6 weeks after metoprolol (initiated at 50 mg/day and doubled every 2 weeks) and standardized, aerobic exercise (70% of their maximal oxygen uptake on a salt-standardized background), respectively. Among 40 Black [median age: 27 (22, 32) years; 21 (52.5%) women] and 40 white [median age: 25 (20, 30) years; 19 (47.5%) women] participants, exercise increased MR-proANP (Black: 35%; white: 43%), NT-proBNP (Black: 11%; white: 23%), and BNP (Black: 59%; white: 61%) in both self-reported races. Exercise was associated with an increase in plasma MR-proANP (pinteraction: 0.25) and BNP (pinteraction: 0.87) concentrations which did not vary by self-reported race. However, the increase in plasma NT-proBNP concentrations were higher in white participants than in Black participants. (pinteraction: 0.04) Similarly, metoprolol therapy increased MR-proANP (Black: 18%; white: 16%), NT-proBNP (Black: 95%; white: 99%), and BNP (Black: 45%; white: 74%) in both self-reported races. The metoprolol-associated increase in plasma MR-proANP (pinteraction: 0.85), NT-proBNP (pinteraction: 0.94), and BNP (pinteraction: 0.21) concentrations were similar by self-reported race. In conclusion, the higher increase in plasma NT-proBNP concentrationsamong white patients after exercise suggests that exercise may induce significant physiological variations in NP levels. ClinicalTrials.gov ID: NCT03070184.

The most important factor for a successful percutaneous coronary intervention of an anomalous right coronary artery arising from left sinus is coaxial alignment of guide catheter and adequate backup support. In this report, we describe a novel case in which we used a distally parked balloon to assist in tracking and proper alignment of the guide catheter.

Abstract Background Marriage is a significant milestone in one’s life, and the age at which individuals choose to get married can have various implications. By examining the age at marriage and its determinants in different regions, such as Kerala and Bihar, we can gain insights into Socio-demographic factors that influence this decision. Methods The National Family Health Survey (2019–2021) data was used. A total of 41,392 ever married women from Kerala (8, 579) and Bihar (32,813) were analysed using bivariate and multiple binary logistic regression approaches to meet the study aim. Result The significant association was found between explanatory factors and age at first marriage in Karala and Bihar. In Bihar, educated women from the poorest families had a higher rate of early marriages. Conversely, in Kerala, uneducated women from non-majority religions and larger households (more than 6 members) were more likely to be married before18. After accounting major effects of background characteristics, the adjusted odds ratio showed that In Kerala Muslim religion women have significantly higher odds of getting married before 18 (OR: 3.09, CI 2.67–3.57) then the Hindu women whereas in Bihar Muslim religion women has the significantly lower chance of getting married before turning 18 (OR: 0.87, CI 0.81–0.93) compared to Hindu. In both the states Kerala and Bihar General social group women had the significantly lower odds of getting married below 18 (OR: 0.73, CI 0.57–0.93 and OR: 0.88, CI 0.81–0.96) with respect to SC/ST social group women’s. Conclusion Women in Bihar usually marry in younger age due to socioeconomic and traditional reasons, whereas in Kerala reverse is true, because of a greater emphasis on education and a more progressive social outlook. These regional variations reflect different cultural norms and socioeconomic environments, shape different marriage age patterns between the two regions.

Obtaining diagnostic-quality magnetic resonance imaging (MRI) of the abdomen in critically ill patients can be difficult due to challenges with breath-holding and the inability to follow technologist instructions. Protocols that harness advances in commercially available MRI techniques provide a potential solution, particularly using the golden radial angle sparse parallel (GRASP) technique for dynamic post-contrast T1-weighted imaging. The GRASP technique uses a combination of free-breathing, a stack-of-stars radial acquisition, and compressed sensing reconstruction acquired over several minutes to produce motion-free images at time points defined by the user; these include the non-contrast, arterial, venous, and delayed images, which are typical of abdominal MRI protocols. The three cases discussed herein illustrate the use of this technique in providing both exquisite image quality and diagnostic value in the care of critically ill patients with hepatopancreaticobiliary diseases. Our work aims to raise awareness of this technique and its utility in imaging patients who cannot hold their breath for dynamic T1-weighted post-contrast imaging.

Background Increased awareness of sustainability has renewed academic interest in understanding perception. The objective was to determine the expected behavior among university students concerning air quality mitigation. The theory of planned behavior (TPB) was used as a theoretical framework to understand students’ attitudes toward air quality mitigation along with subjective norms and perceived behavioral control. Method This study uses the systematic literature review (SLR) methodology to provide an understanding of current studies regarding the aspect of air quality and behavior from databases reviewed by experts. The research highlights the gap in the current study area and provides a need for more detailed empirical research. Result The study reviewed 24 articles and proposed a conceptual model based on the TPB framework to understand the means of air quality mitigation behaviors in a campus environment. Conclusion This model aims to guide future research to improve air quality in higher education institutions. The findings also focuses on theoretical contributions by applying TPB.

This case report on recurrent urinary tract infections (UTIs) caused by multidrug-resistant (MDR) Klebsiella pneumoniae in a post-renal transplant patient underscores the significant clinical challenge of managing MDR infections in immunocompromised individuals, particularly in the context of renal transplantation. The patient was treated with an extended infusion of meropenem, which offers prolonged drug exposure and enhances bactericidal activity against MDR pathogens. This approach is critical in overcoming the resistance mechanisms inherent to Klebsiella pneumoniae, thereby improving the likelihood of therapeutic success. The findings presented here highlight the potential efficacy of extended meropenem infusion in treating MDR infections, providing a valuable therapeutic option for clinicians facing similar cases. This report contributes to the growing evidence supporting advanced antibiotic administration techniques in managing complicated urinary tract infections in transplant in resource limited countries.

Background: The leading risk factor for cardiovascular disease, Hypertension, is becoming more prevalent worldwide and is especially prevalent in low- and middle-income nations (LMICs) like India. Objective: This study aims to examine the change in the prevalence of Hypertension and to develop a statistical model for risk factors of Hypertension among Men in India. Materials and Methods: This study used data from the National Family Health Survey (NFHS 4 and 5) samples of men aged 15-54 years whose blood pressure (BP) was measured during the survey. Results: The study shows that the prevalence of Hypertension among men was 16.3% to 21.5% from NFHS-4 to 5 and we also found an increase in the prevalence of Hypertension and association across selected socio-demographic and economic variables for Hypertension. It was found in both NFHS 4 and 5 Hypertension were higher in the 45-54 age group compared to younger age group. Men who consume alcohol had higher odds (OR: 1.32, C.I: 1.27-1.37 and OR: 1.42, C.I: 1.37-1.48) of getting hypertension than those who do not consume alcohol and Education, Employment, marital status, and residence were showing significantly associated and higher odds with hypertension among Men. The accuracy of the logistic regression model has been calibrated to reach 71.1%, with sensitivity and specificity exceeding 70%. Users of the model have access to the modified probabilities. Conclusion: The findings suggest the effect of socioeconomic and habit factors on hypertension which will help in improved interaction with medical services for the treatment of hypertension.

Pneumococcal infection among adults is associated with invasive disease and poor outcomes. Pneumococcal vaccine (PCV) introduction has significantly reduced disease burden, invasive disease and reduced the rates of antimicrobial resistance. Of the various vaccines licensed, PCV 13 and PPSV 23 are available for use in India. Pneumococcal vaccination is suggested for people aged 19–64 years with immunosuppression, chronic cardiac, lung and hepatic disease, impaired splenic function, uncontrolled diabetes mellitus, current smokers, and those abusing alcohol. It is recommended that people >65 years of age are vaccinated with PPSV23. The suggested regimen is to administer PCV13 followed by PPSV23 after one year. The vaccines have minimal side effects and tolerated well. Data on vaccine effectiveness from Indian studies is limited. Hence, documenting population demographics with surveillance on serotype specific pneumococcal disease burden in adults is needed. Following this, studies on safety, immunogenicity, and cost-effectiveness of the available vaccines need to be designed and implemented. It is suggested that in the initial phase, PCV needs to be made available for high-risk population followed by vaccination roll-out for adult population of India.

Cervical cancer ranks as the second most common cancer in women in India, primarily caused by persistent infection with the human papillomavirus (HPV). Given its long latent period, secondary prevention through screening and early detection is essential. However, fear and stigma associated with cancers and the costs involved in disease management are the prominent barriers to its uptake. HPV vaccination is one of the vital components of the World Health Organization’s (WHO) Global Strategy to speed up the elimination of cervical cancer as a public health problem. In India, four prophylactic HPV vaccines are currently available. These vaccines are non-infective and highly immunogenic, safe, and effective when administered before HPV exposure. According to WHO recommendations, the primary target group for HPV vaccination consists of girls between the ages of 9 and 14 years. Further, studies have confirmed that both single-dose and two-dose schedules of the HPV vaccine offer comparable efficacy and protection. HPV vaccines are administered intramuscularly in the deltoid region, with 0.5 ml as the standard dose. These vaccines may cause local reactions, as well as mild systemic reactions, such as headache and myalgia, but they are transient. Implementing catch-up vaccination for adolescent girls aged between 9 and 14 years at the time of HPV vaccine introduction would be a cost-effective and sustainable strategy. This would serve as a crucial component of public health efforts to manage HPV infections and eliminate cervical cancer in India.

Abstract Transthyretin is a transport protein whose misfolding has been implicated in the development of cardiac amyloidosis. Here, we examine the clinical correlates of transthyretin levels, the differences in transthyretin levels according to the pathogenic V142I TTR variant carrier status, and the association of transthyretin levels with outcomes among 35,206 UK Biobank participants who underwent plasma profiling and were free from prevalent cardiovascular disease and chronic renal disease. Transthyretin levels are lower in females, decrease with increasing C-reactive protein levels, and increase with body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol, albumin levels, triglyceride levels, and creatinine levels. V142I non-carriers [n = 35,167, mean: −0.1 (0.3)] have higher adjusted transthyretin levels compared with the carriers [n = 39, mean: −0.5 (0.3)] (p:

Background: A desired target for cancer therapy is a cancer-specific metabolism which is associated with innate or acquired therapeutic resistance, malignancies, and aggressive cancer growth. Nevertheless, these cells utilize manifold metabolic routes to prolong their mass explosion. Human hexokinase 2 (HK2), phosphofructokinase, muscle (PFKM), pyruvate kinase M2 (PKM2), and lactate dehydrogenase A (LDHA) are fundamental signature players of cancer glycolysis playing a role in cancer cell regulation. Reflecting their metabolic roles may be possible with a better grasp of the metabolism transition in the early onset and spread of cancer. This study was designed to assess the serum protein levels of HK2, PFKM, PKM2, and LDHA in women with breast carcinoma and its correlation with phosphatidylinositol-3-kinase (PI3K)/Akt and the mammalian target of rapamycin (mTOR) pathway. Methods: In the current research, case–control investigation was undertaken with breast cancer women (n = 30) and compatible healthy women (n = 30) visiting Justice K. S. Hegde Charitable Hospital, Deralakatte, Mangaluru, who were selected on the basis of inclusion and exclusion criteria. Baseline characteristics for the study population were marked down. The HK2, PFKM, PKM2, and LDHA levels within serum were estimated by means of sandwich enzyme-linked immunosorbent assay. Results: We observed a difference that was significant among the two groups with regard to age and postmenopausal status and also a difference in first-degree family history. The levels of PKM2 and key glycolytic enzymes in serum varied between the case and control groups. There was a positive correlation that was observed in breast carcinoma subjects with glycolytic proteins and signaling pathway (PI3K/Akt/mTOR). Conclusions: Nevertheless, assured processes that persuade the target enzymes remain vague and require further in-depth exploration. Overall, discovering anticancer therapeutics that target glycolytic enzymes involved in glucose metabolism remains a dilemma.

Background Septal myectomy and alcohol septal ablation (ASA) are septal reduction therapies for patients with symptomatic obstructive hypertrophic cardiomyopathy. Operator and hospital volume may influence outcomes, but contemporary data on this relationship are limited. Methods and Results This retrospective cohort study used data from the Vizient Clinical Data Base (2016–2022). Patients with undergoing septal myectomy and ASA were identified using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes and stratified into low‐, medium‐, and high‐volume groups based on annualized operator and hospital volumes. The outcomes were 30‐day in‐hospital mortality and 90‐day readmission, analyzed using multivariable adjusted logistic and Cox models. Among 5725 patients with hypertrophic cardiomyopathy (3990 septal myectomy; 1735 ASA), most operators and hospitals performed

Let GX be a graph obtained from a simple graph G by attaching a self-loop at each vertex of [Formula: see text]. The general extended adjacency matrix for the graph GX is defined and the bounds for the degree based energy of the graph GX are obtained. The study extends the notion of degree based energy of simple graphs to graphs with self-loops. For the graph GX of order n and size m with σ self-loops, the adjacency energy, [Formula: see text]. The spectral radius [Formula: see text] of its adjacency matrix is always less than or equal to [Formula: see text], where Δ is the maximum degree in the graph GX and the equality conditions are given for [Formula: see text]. Few more bounds for [Formula: see text] are also obtained. The study shows that, the spectral radius [Formula: see text] of its extended adjacency matrix satisfies: [Formula: see text]. We conclude the article by computing the extended adjacency spectrum of complete graph and complete bipartite graphs with self-loops.

Background: Kinesthesia, the ability to perceive movements, is diminished in individuals with type II diabetes mellitus. People with frozen shoulders also experience kinesthetic deficits. Thus, obtaining accurate information on shoulder kinesthetic function in individuals with diabetes mellitus, both with and without a frozen shoulder, will aid in developing preventive and therapeutic strategies to optimize shoulder function. Aim: The study aims to investigate kinesthetic deficits in the shoulder among individuals with diabetes mellitus, both with and without frozen shoulder. Materials and Methods: A thorough literature search was performed using PubMed, Cochrane, CINAHL, and Science Direct. Free full-text articles in English, published from 2010 to October 2020, were identified using keywords and MeSH terms. Inclusion and exclusion criteria were developed based on the PICO format. The search results were then screened to identify relevant articles for this scoping review. Results: This review included fourteen articles, encompassing systematic reviews, cross-sectional studies, and prospective studies. Six studies examined the impact of diabetes mellitus on shoulder kinesthesia. These kinesthetic deficits adversely affected basic daily activities, recreational pursuits, and occupational tasks. Conclusion: Reduced kinesthetic function in the shoulder is attributed to structural changes such as capsular tightness, alterations in the fascicle length of rotator cuff muscles, the long head of the biceps, and glenohumeral joint laxity. Factors contributing to the loss of kinesthetic function include muscular fatigue from repetitive shoulder motion, limited joint mobility, blood glucose levels, and decreased muscle strength. This study provides valuable insights for clinicians to design rehabilitation programs, enhance shoulder function, and prevent re-injury risk.

Purpose Mediastinal staging in non-small-cell lung carcinoma (NSCLC) is essential for appropriate treatment. Invasive mediastinal staging is necessary and mediastinoscopy has been the gold standard, but it is associated with morbidity. The aim of this study is to evaluate the efficacy of endobronchial ultrasonography transbronchial needle aspiration (EBUS-TBNA), compare it with mediastinoscopy, and assess the endosonographic features of lymph nodes for prediction of metastasis.

Abstract Background Despite rising public awareness and improvements in diagnostic and treatment methods, there are adverse effects brought on by drug resistance, an increase in overall treatment costs, and unanticipated side effects from pharmaceuticals. Main body Therefore, efforts for development strategy that is more efficient, more affordable, and more secure are underway. Such a strategy involves employing naturally occurring phytochemicals to delay the beginning, prevent it from happening, or treat it, and it sparks an increase in interest in studies looking for an effective agent in herbs and other plant materials used in traditional medicines. Urolithins are polyphenol chemicals generated by the gut microbiota studied for potential health benefits and have a high bioavailability. After being ingested, urolithins can move throughout the body and mediate in different locations. Urolithins are studied for over 40 years, but their mechanistic role has been explored recently in understanding their potential health benefits. Short conclusion This review gives an overview of the current Urolithin A research on human health. The findings highlight the importance of exploring the potential of urolithins as a natural compound for therapeutic applications. Elucidating the mechanisms behind the disease process and pinpointing candidate molecules and pathways to target preventive and therapeutic intervention are the need of the hour.

Background Globally, the number of older adults is increasing rapidly; simultaneously, there is an epidemiological shift toward chronic diseases. One such chronic disease is type 2 diabetes mellitus (DM) which is caused either by the inability to produce insulin or due to the ineffective use of insulin. In recent years, self-management programmes for chronic conditions have gained importance, especially among occupational therapists. Though there is an increasing focus on ‘self-management interventions’ among older adults, there is still a lack of such interventions for older adults with type 2 DM in low- or middle-income countries (LMICs).Objectives Summarise the existing literature on self-management intervention programmes for community-dwelling older adults with type 2 DM; identify the principles, practices and criteria that define a self-management intervention programme for community-dwelling older adults with type 2 DM in LMICs.Methods This present study will be a scoping review, combining quantitative and qualitative literature with a parallel results convergent synthesis design. The synthesis applies to analysing existing principles and practices that influence the selection and application of ‘diabetes self-management intervention’ among older adults in community settings with type 2 DM in LMICs.Ethics and dissemination As a secondary analysis, this scoping review does not require ethics approval. The final review results will be submitted for publication in a peer-reviewed journal in the rehabilitation, diabetes, occupational therapy or health promotion-related fields. Other dissemination strategies may be an oral presentation at international conferences or through various social media networks.

Orthodontic extrusion of canines, although challenging, can yield excellent results without tooth extraction. Temporary anchorage devices (TADs), involving mini-implants in the alveolar bone, offer stable anchorage via biomechanics. This case report details orthodontic extrusion of bilaterally impacted maxillary canines using TAD mini-implants and elastics. The patient had bimaxillary protrusion, moderate crowding, deep bite, and vertical growth pattern, necessitating careful treatment planning. The combination of TAD mini-implants with Class-II elastics simplified biomechanics. The treatment achieved efficient results, maintained adjacent teeth positioning, and improved patient compliance.

Background: About 10% of Indians have common mental disorders (CMDs) which include depression and anxiety. These disorders are common in women, which not only impacts on their quality of life but also their family members. The objective of the study was to estimate the prevalence of CMDs, and factors associated with them among women residing in coastal Karnataka. Methods: A cross-sectional study was carried out among 980 women aged between 18 and 60 years from 2019 to 2021. Women were administered a baseline questionnaire along with Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder questionnaire-7 (GAD-7) and Cohen’s Perceived Stress Scale-4 (PSS-4). Data were collected using Epi-info and were analysed using SPSS version 15.0. Association between CMDs and socio-demographic, reproductive health and behavioural factors were expressed as crude and adjusted odds ratio (OR) with 95% confidence intervals (CI). Results: The prevalence of CMDs among women was 5.7%, with 4.6% having depression and 3.37% with anxiety disorders. Multivariate logistic regression analysis showed that residing in urban areas (OR = 2.15; 95% CI:1.10–4.17), having a chronic illness (OR = 2.38; 95% CI:1.14–4.97), history of recent bereavement in the family (OR = 2.20; 95% CI:1.02–4.75), early marriage (OR = 2.63; 95% CI:1.09–6.33), history of abortion (OR = 2.89; 95% CI:1.42–5.92), and exposure to domestic violence (OR = 3.08; 95% CI:1.14–8.33) were significantly correlated with CMDs in this sample. Conclusions: The study revealed that CMDs were prevalent among the surveyed women, which calls for routine screening of women for CMDs in primary care settings for early identification and appropriate interventions.

Phosphodiesterase 3A (PDE3A) gene mutations have recently been associated with hypertension and brachydactyly syndrome (HTNB). This report shows how the recent recognition of the role of the PDE3A gene in HTNB facilitated the diagnosis of HTNB in a 20-year-old female who could not be diagnosed at her initial presentation at 6 years of age.

Short chain fatty acids (SCFA) have been linked to women's reproductive health, though to a lesser extent, alteration in the production of SCFA and SCFA-producing bacteria has been associated significantly with pregnancy-related complications, unfavourable pregnancy outcomes, menstrual anomalies, and gynaecological cancer.The female reproductive system is a delicate, intricate, hormone-dependent group of tissues required for the continuity of life and the species' survival. Reproductive health impacts the ovarian function to implantation and foetal development. Several environmental and physiological factors contribute to mammalian infertility concerns caused by a change in reproductive health status. Several lifestyle factors have been demonstrated to affect reproductive health, including age, body weight, smoking, alcohol consumption, work stress, exercise, diet, and nutrition. Nutrition influences puberty, the menstrual cycle, ovulation, conception, implantation and early foetal development. This review provides an overview of how intestinal derived SCFAs maintains female reproductive health summarizing the current knowledge and future perspectives. Microbial SCFAs improve human metabolism by interfering with, glucose homeostasis, appetite regulation and lipid metabolism. Also affect host immunity and intestinal barrier integrity via primary by inhibition of Histone deacetylases (HDAC) mechanism. Therefore, SCFAs exhibit anti-inflammatory, anti-obesity, immunoregulatory, anti-diabetes, anti-cancer, hepatoprotective, cardiovascular protective and neuroprotective properties.This review highlights recent findings on SCFA and gynaecological pathologies such as preeclampsia, gestational diabetes, pregnancy complications, polycystic ovary syndrome, bacterial vaginosis, and endometriosis to describe current knowledge of the relationship between SCFA and reproductive health and disease in women.

Bone marrow embolism is known to occur after fractures of long bones such as the femur and pelvis. We report a case of multiple fractures in a 32-year-old female patient, demonstrating bone marrow elements in the peripheral blood as early as 2 hours after trauma. This is the first case being reported with an ante-mortem demonstration of circulating marrow emboli in the peripheral blood, while the previously reported cases have demonstrated the emboli in post-mortem examination. A careful correlation of the clinical history of trauma, hematology auto-analyzer results, and the presence of bone marrow particles and fat globules in peripheral blood helped in arriving at the diagnosis of fat embolism in our case irrefutably.

This article investigates the staff outcomes that are influenced by physical environment features in a healthcare facility. Over the past few decades, research on the physical environment and its effects on hospital staff has advanced steadily. Focusing on the physical environment has become a research area with great potential because it is crucial to provide a favorable work environment for health professionals, which directly impacts the quality of care. A systematic literature review was conducted to identify research articles from two scientific databases and a healthcare journal. Articles that fulfilled the inclusion and exclusion criteria for relevant articles were included in this review. Relevant data were derived from the final shortlisted articles. The features identified in the articles were divided into three dimensions of the physical environment. The results demonstrate different outcomes for staff. This review shows the need to develop a comprehensive study involving the most important features of the three dimensions of the physical setting and its effects on staff. This study contributes invaluable insights for hospital administrators, architects, and designers by informing them about the critical factors shaping the healthcare workplace environment.

AbstractSome of the most comprehensively studied degree-based topological indices are the Zagreb indices. The first Zagreb index [Formula: see text] of a graph G is defined as the sum of squares of the degrees of the vertices. Let [Formula: see text] and let [Formula: see text] be the graph obtained from the simple graph G, by attaching a self-loop to each of its vertices belonging to X. In this article, some sharp bounds for the first Zagreb index of graphs with self-loops using various parameters has been put forward.

Problem considered: Cervical cancer is a major public health problem among women worldwide and it is the second most common cancer among women in India. The present study was conducted to assess awareness, attitudes, and practices towards cervical cancer and its prevention among rural women in southern India. Methods: This community-based study was carried out from January to December 2017 among 1100 married women aged 20–65 years residing in southern Karnataka, India. A household survey was undertaken, and eligible women were interviewed using a pre-designed questionnaire. The socio-demographic details of the women and their awareness, attitude, and practices towards cervical cancer prevention and screening were documented. The association of women's knowledge adequacy with their socio-demographic factors was evaluated and is expressed as odds ratios with 95% confidence intervals. Results: About 67% of the participants had heard the term “cervical cancer” earlier and 47.9% of them were aware that cervical cancer is preventable. Poor genital hygiene (41.4%) and early age at sexual intercourse (35.4%) were the commonly quoted risk factors for cervical cancer. Only 35.7% of participants had adequate awareness regarding cervical cancer screening and it was significantly associated with their age, education level, employment, and socio-economic status. The majority (99%) of women had a favorable attitude toward cervical cancer screening though it failed to translate into practices. Conclusions: Despite a favorable attitude, awareness and practice towards cervical cancer prevention were suboptimal. Periodic awareness programs and ensuring access to cervical cancer screening are crucial in this context.

Abstract Background Polycystic ovary syndrome is a common multifactorial endocrinopathy disorder affecting 5–15% of reproductive women worldwide. The CYP19 gene encodes key enzyme aromatase involved in androgen-to-estrogen conversion which plays a crucial role in the pathophysiology of the syndrome. Very few studies have been done in the Indian population; hence, we investigated whether CYP19 gene rs2414096 SNP is associated with PCOS and hyperandrogenism susceptibility in Karnataka women. Methods Three-hundred subjects including 150 PCOS and 150 age-matched controls were involved in the current case–control study. Sex hormones and biochemical estimation were performed by ELISA. Sanger sequencing and PCR–RFLP were used to genotype the SNP rs2414096. Genotypic-phenotypic association was studied. Statistical analysis was performed. Results The GG genotype was more common in patients, while the GA genotype was more common in control women. LH/FSH was significantly increased in GG genotype in PCOS when compared with AA and GA genotypes. Variations of CYP19 rs2414096 were not statistically significant with PCOS. Conclusion CYP19 rs2414096 polymorphism was not associated with PCOS; however, the homozygous wild GG genotype may exhibit reduced aromatase activity with subsequent hyperandrogenism implicating endocrine abnormalities.

Medical Imaging Phantoms (MIPs) calibrate imaging devices, train medical professionals, and can help procedural planning. Traditional MIPs are costly and limited in customization. Additive manufacturing allows for customizable, patient-specific phantoms. This study examines the CT attenuation characteristics of contrast-injectable, chambered 3D-printed phantoms to optimize tissue-mimicking capabilities. A MIP was constructed from a CT of a complex pelvic tumor near the iliac bifurcation. A 3D reconstruction of these structures composed of three chambers (aorta, inferior vena cava, tumor) with ports for contrast injection was 3D printed. Desired attenuations were 200 HU (arterial I), 150 HU (venous I), 40 HU (tumor I), 150 HU (arterial II), 90 HU (venous II), and 400 HU (tumor II). Solutions of Optiray 350 and water were injected, and the phantom was scanned on CT. Attenuations were measured using ROIs. Mean attenuation for the six phases was as follows: 37.49 HU for tumor I, 200.50 HU for venous I, 227.92 HU for arterial I, 326.20 HU for tumor II, 91.32 HU for venous II, and 132.08 HU for arterial II. Although the percent differences between observed and goal attenuation were high, the observed relative HU differences between phases were similar to goal HU differences. The observed attenuations reflected the relative concentrations of contrast solutions used, exhibiting a strong positive correlation with contrast concentration. The contrast-injectable tumor phantom exhibited a useful physiologic range of attenuation values, enabling the modification of tissue-mimicking 3D-printed phantoms even after the manufacturing process.

Background: India accounts for 79% of global malaria burden. With progress towards malaria elimination, assessment of true disease burden and determinants of its transmission risk is critical. The present study aimed to estimate the burden of malaria and identify socioecological factors determining the disease prevalence. Methods: A community-based cross-sectional study was carried out among 839 households covering 2910 individuals residing in Udupi taluk. A representative sample from urban, rural tribal and migrant communities were recruited and a questionnaire was used to collect information on socio-demographic, housing & behavioral factors. Data was collected using Epi-info mobile application version 7.2.4 and analyzed using SPSS version 16.0. Results: Among the population covered a total of 15 participants had a history of malaria in the past. Advancing age (AOR = 3.60; 95% CI: 2.14–6.04), illiteracy (AOR = 2.28; 95% CI:1.35–3.85), (AOR = 1.96; 95% CI:1.24–3.11) and rural (AOR = 1.96; 95% CI:1.39–2.74), tribal (AOR = 2.38; 95% CI:1.49–3.79), migrant (AOR = 4.28; 95% CI:2.30–7.98) localities were found to be independent predictors of disease awareness. With respect to malaria prevention practices, households from middle (AOR = 0.73; 95% CI: 0.49–1.09) & low SES (AOR = 0.30; 95% CI: 0.19–0.46) and those from migrant localities (AOR = 0.66; 95% CI: 0.38–1.14) were less likely to have poor practices. Conclusion: Age, education, socioeconomic status, and locality were found to be significantly associated with knowledge and practice towards malaria prevention. Creating awareness regarding malaria and its prevention with enhanced community participation in control activities jointly with local authority is further emphasized.

Thermo-acoustic instability has been observed in gas turbines, rocket engines, and aero-engines. Acoustic perturbations grow and change the characteristics of the flow due to instability. The present work describes the use of pulsating air jets to suppress the thermo-acoustic instabilities. In present study pulsatile micro-jets are placed downstream of the burner radially which breaks the coupling between acoustic waves and unsteady heat release.A microphone connected to LIFA (LabVIEW Interface for Arduino) was used to detect the sound pressure levels. By controlling the airflow rate of the pulsatile jets, the sound pressure levels were suppressed down to the background noise level using minimum energy and time. A closed-loop control system is developed for this purpose, which works on the feedback signal acquired from microphone. To simulate the one dimensional combustion phenomenon, an experimental setup called Rijke tube was used. The suppression was most effective for the pulsatile jets of 27-33 Hz pulsation frequency range and at a flow rate of 6.8 LPM. This control strategy effectively controlled the combustion instability of around 35-42 dB. • The closed loop control method is built on DAQ and Arduino using the LabVIEW interface for Arduino (LIFA). • Developed closed loop active control method was observed to be effective for suppression of thermo-acoustic instability. • Optimum position of the radial planes of micro-jets with respect to the burner was decided to improve the efficacy of the pulsatile jets towards suppression of thermo-acoustic instability.

Background and Aim: Stomatitis being one of the most common oral complications of radiotherapy increases the mortality rates in patients with head and neck cancer. Providing preventive measures and cure for these side effects right after their onset is of primary importance. The aim of this study was to assess the effect of honey on radiation induced stomatitis in head and neck cancer patients. Materials and Methods: Thirty patients diagnosed with head-and-neck cancer requiring radiation or radiation combined with chemotherapy were divided into two groups. Patients of Group 1 were advised to mix 3 mL of chlorhexidine in 100 mL of water and rinse for about 1 min. Patients of Group 2 were advised to take 20 mL of honey in a glass of water and divide it into two equal parts and then rinse each part for about 30 s. Patients were evaluated at baseline, week 1, and week 2 for the development of radiation-induced stomatitis using the WHO Mucositis Scale. Results: The grade of stomatitis in head-and-neck cancer patients undergoing radiotherapy, treated with honey, was significantly lower than those treated with chlorhexidine (P < 0.05 for each). Conclusions: Topical application of honey is a simple and cost-effective treatment in radiation-induced stomatitis which needs further multicenter randomized trials to validate our finding. The results of the present study conducted on head-and-neck cancer patients will be useful in the administration of oral care. These findings are also important to the nurses who are assigned with the responsibility of stomatitis management.

Introduction: We at our centre practice a PAlliative Split COurse RAdiotherapy (PASCORA) of 22.5Gy in 5 fractions followed by a gap of 4 weeks and then again repeat 22.5Gy in 5 fractions for locally advanced squamous cell carcinoma patients treated with a palliative intent. Aim was t0 assess the symptomatic relief at 3 months following PASCORA regimen. Materials & Methods: 49 Patients with LAHNSCC between January 2014 to January 2021, planned for PASCORA regimen were evaluated. Symptomatic relief was assessed on an objective scale. OS was determined using Kaplan Meir survival curves. Results: Median age was 61 years, multiple comorbidities (37%) were the most commonly documented reason for these patients being treated with a palliative intent. 25% of our patients had an excellent symptomatic relief, 26% of our patients had a good symptomatic relief and 31% had a partial relief. Median OS was 38 months in patients who had an excellent symptomatic relief and 3-8 months in patients with no or partial symptomatic relief ( p value=0.000) 6% of our patients had Grade 3 /4 RTOG toxicity. Conclusion: PASCORA regimen offers a good symptomatic relief with good local control rates and acceptable level of toxicity and comparable OS.

Introduction: Understanding the patterns of utilisation of primary health services can help to improve service delivery and utilisation, thereby reducing common morbidities in the community. The study aimed to assess the patterns of utilisation of services provided at an outreach healthcare centre. Methods: A community-based survey was conducted among families residing in the field practice area of an outreach centre for more than a year. Data were collected using a questionnaire administered to adults aged ≥18 years. Collected data were entered into and analysed using the Statistical Package for the Social Sciences version 16.0. Results: Approximately 65.1% of the respondents were aged 31–59 years, and 67.4% were women. Among 126 surveyed households, 50.7% had utilised services from the outreach centre. The facilitators of utilisation among 64 households included proximity to their area of residence (90.6%) and availability of good-quality services (40.6%). The most common barriers included a lack of awareness (30.9%) and inconvenient timings (18.2%) of the healthcare centre. The respondents aged 45 years (OR=2.65; 95% CI=1.57–4.47) had higher odds of utilising services than those aged 18–45 years. The female respondents (OR=2.89; 95% CI=1.86–4.51) were more likely to utilise services than the male respondents. Conclusion: Creating awareness regarding the outreach healthcare centre and designing services based on the observed needs of the community can further improve the utilisation of services provided at the healthcare centre.

Background: Multidisciplinary tumor boards (MDTB) are an integral part of cancer management. However, owing to COVID 19 global pandemic it becomes a challenge to have a MDTBs maintaining the social distance norms. Objectives: To assess the technical challenges faced during a virtual tumor board (VTB) discussion Advantages and Disadvantages of a VTBs. Methods: Technical support for various group meetings taking place virtually were considered. Various trials which have assessed the technical difficulties for conducting such a meeting were assessed. The advantages and disadvantages for using various platforms of social media for such a virtual meeting were assessed and various feedbacks and reviews were taken into consideration. Results: VTBs can be implemented either by a video conferencing or web based conferencing. High speed internet connections of 4 mbps for a 30fps at 4k monitor would be required for smooth lag free interaction. The processors should have a minimum of 2 GB of RAM with quad core processor. Platforms which offer the ability for digital signatures are of paramount importance. Having a VTBs during a global pandemic is of paramount importance for a cancer patient. Conclusion: VTBs are very important for management of cancer patients during a global pandemic. We in our paper have tried to summarize the technical support need for such a platform and also have tried to discuss the advantages and disadvantages of such a platform. We would also like to conclude that setting up such a virtual platform is not technically challenging and can be implemented in smaller centers even through a mobile phone connection. VTBs should be implemented in all cancer centers during a pandemic when in person meetings are a challenge and a health risk.

INTRODUCTION: The prevalence of diabetic foot syndrome is increasing in the Indian population. It is a triad of neurological, vascular, and biomechanical changes due to long term diabetes mellitus (DM). Altered plantar pressure distribution is a risk factor for developing diabetic foot ulcers. The purpose of this study is to evaluate the altered plantar pressure distribution in diabetic peripheral neuropathy individuals with peripheral vascular disease in comparison with diabetic peripheral neuropathy and non-diabetic neuropathy. Therefore, the objective of the study is to evaluate the plantar pressure distribution and parameters in type 2 DM (T2DM) with diabetic foot syndrome.METHODS: In this study, 60 participants with T2DM were recruited in either one of the three groups: 20 Diabetic non-neuropathy (DNN), 20 Diabetic peripheral neuropathy (DPN), and 20 Diabetic peripheral neuropathy with the peripheral arterial disease (DNPAD). Then we compared the plantar pressure parameters like maximum plantar pressure, pressure-time integral, fore foot-hind foot ratio, and total contact area were measured using a WinTrack plantar pressure system.RESULTS: The diabetic peripheral neuropathy with peripheral vascular disease group shown a significant difference in all the plantar pressure parameters measured in comparison with the diabetic peripheral neuropathy group. There was increased Maximum plantar pressure, pressure-time integral and forefoot hindfoot ratio, and reduced total contact area of the foot (p < 0.05).CONCLUSION: For patients, with combined peripheral neuropathy and peripheral vascular disease have increased plantar pressure distribution, are at higher risks of developing neuro-ischemic foot, which further leads to diabetic foot ulcers.

Background: Vitiligo is a common pigmentary disorder affecting 0.1%–2% of the global population. Recently, interest has evoked in the role of Vitamin D in decreasing the risk of several chronic diseases. Little is known about the genetics of vitiligo. This study was conducted to investigate whether Vitamin D receptor (VDR) polymorphisms could be the susceptibility markers for vitiligo. Objectives: (i) To evaluate the potential association between VDR polymorphisms and vitiligo susceptibility and (ii) To estimate the serum levels of 25–hydroxyvitamin D in case and control groups. Materials and Methods: This study included 34 participants (17 with vitiligo and 17 age-and gender-matched healthy controls). After a written informed consent, a detailed history and examination was done. Serum 25(OH)D levels were measured using the enzyme-linked immunosorbent assay kit. Genomic DNA was extracted from the peripheral blood. The VDR polymorphisms were genotyped using the polymerase chain reaction-restriction fragment length polymorphism method. Fok1, Bsm1, Apa1, and Taq1 restriction enzymes were used to determine the genotypes of the respective polymorphisms. Results: Nonsegmental vitiligo was the most common type of vitiligo seen in 14 (82.4%) cases. The mean serum Vitamin D level in cases was 35.64 ± 15.68 ng/ml and in controls was 37.00 ± 16.45 (P = 0.81). There was no significant difference in the distribution of VDR polymorphisms between the case and control groups. Conclusion: In our study, no significant difference was observed in the distribution of Fok1, Bsm1, Apa1, and Taq1 VDR polymorphisms between the case and control groups. However, we observed a significant association between the Fok1 polymorphism and serum 25(OH) Vitamin D levels in vitiligo patients studied.

Background: Dermatoglyphics can be utilised in clinical settings to identify those who are more likely to have impacted teeth. Additionally, dermatoglyphics looks to have potential as a non-invasive diagnostic method for predicting the presence or absence of an impacted tooth. The goal of this study was to look at the most common dermatoglyphic pattern in people who had or didn't have an impacted mandibular third molar teeth and see if there was a dermatoglyphic signature. Methods: A cross-sectional study with 180 participants was conducted (90 cases and 90 controls). The rolling impression technique was used to apply blue duplicating ink to participants' fingertips, which was then recorded. There was an increase in the frequency of the whorl-plain pattern in the right-hand ring finger (60%; p=0.028) and left-hand little finger (33.3%; p=0.009), as well as the loop-ulnar pattern in the right-hand middle finger (74.4%; p=0.024) in individuals with a predisposition to the presence of impacted teeth. Results: The left-hand little finger was found to be the most predictive for impaction in a forward stepwise binary logistic regression analysis. Conclusions: Dermatoglyphics could be used as a non-invasive sign to predict whether or not a tooth is affected. Its value comes in early detection, which helps to avoid the surgical problems that come with symptomatic extraction of an impacted tooth.

Fatty acid transport protein 1 (FATP1) is an integral transmembrane protein that is involved in facilitating the translocation of long-chain fatty acids (LCFA) across the plasma membrane, thereby orchestrating the importation of LCFA into the cell. FATP1 also functions as an acyl-CoA ligase, catalyzing the ATP-dependent formation of fatty acyl-CoA using LCFA and VLCFA (very-long-chain fatty acids) as substrates. It is expressed in various types of tissues and is involved in the regulation of crucial signalling pathways, thus playing a vital role in numerous physiological and pathological conditions. Structural insight about FATP1 is, thus, extremely important for understanding the mechanism of action of this protein and developing efficient treatments against its anomalous expression and dysregulation, which are often associated with pathological conditions such as breast cancer. As of now, there has been no prior prediction or evaluation of the 3D configuration of the human FATP1 protein, hindering a comprehensive understanding of the distinct functional roles of its individual domains. In our pursuit to unravel the structure of the most commonly expressed isoforms of FATP1, we employed the cutting-edge ALPHAFOLD 2 model for an initial prediction of the entire protein’s structure. This prediction was complemented by molecular dynamics simulations, focusing on the most promising model. We predicted the structure of FATP1 in silico and thoroughly refined and validated it using coarse and molecular dynamics in the absence of the complete crystal structure. Their relative dynamics revealed the different properties of the characteristic FATP1.

Three-dimensionally printed phantoms are increasingly used in medical imaging and research due to their cost-effectiveness and customizability, offering valuable alternatives to commercial phantoms. The purpose of this study was to assess the computed tomography (CT) attenuation characteristics of 27 resin materials from Formlabs, a 3D printing equipment and materials manufacturer. Cube phantoms (both solid and hollow constructions) produced with each resin were subjected to CT scanning under varying tube current–time products with attenuation measurements recorded in Hounsfield units (HU). The resins exhibited a wide range of attenuation values (−3.33 to 2666.27 HU), closely mimicking a range of human tissues, from fluids to dense bone structures. The resins also demonstrated consistent attenuation regardless of changes in the tube current. The CT attenuation analysis of FormLabs resins produced an archive of radiological imaging characteristics of photopolymers that can be utilized to construct more accurate tissue mimicking medical phantoms and improve the evaluation of imaging device performance.

Dental cements are in a constant state of evolution, adapting to better align with the intricacies of tooth structure and the dynamic movements within the oral cavity. This study aims to evaluate the efficacy of zirconia-reinforced glass ionomer cement—an innovative variant of modified glass ionomer cements—in terms of its ability to withstand compressive forces and prevent microleakage during dental caries reconstruction. An extensive search was conducted across various databases, encompassing PubMed-MEDLINE, Scopus, Embase, Google Scholar, prominent journals, unpublished studies, conference proceedings, and cross-referenced sources. The selected studies underwent meticulous scrutiny according to predetermined criteria, followed by the assessment of quality and the determination of evidence levels. In total, 16 studies were incorporated into this systematic review and network meta-analysis (NMA). The findings suggest that both compomer and giomer cements exhibit greater compressive strength and reduced microleakage values than zirconia-reinforced glass ionomer cement. In contrast, resin-modified glass ionomer cement (RMGIC) and high-viscosity glass ionomer cement (GIC) demonstrate less favorable performance in these regards when compared with zirconia-reinforced glass ionomer cement.

In this review article, the authors discuss the anatomy and technical aspects of CT-guided biopsy of vertebral lesions. CT guidance is highly useful for vertebral biopsies, as the anatomy of the spine is complex and varies widely across the levels. Prebiopsy imaging should be reviewed and later correlated with the final histopathological diagnosis. The majority of the spine biopsies are performed under local anesthesia, except those in critical locations and pediatric age groups. The biopsy sample is sent for histopathological analysis and/or microbiological analysis depending on the indications. It is preferable to use a coaxial system for biopsies, so multiple cores can be obtained with a single needle puncture, thus minimizing the negative yield and complications. Complications after image-guided percutaneous biopsy are rare and can be managed easily.