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In the title compound, C25H17NO3, the torsion angle associated with the phenyl benzoate group is −173.7 (2)° and that for the benzyloxy group is −174.8 (2)° establishing an anti-type conformation. The dihedral angles between the ten-membered cyanonaphthalene ring and the aromatic ring of the phenyl benzoate and the benzyloxy fragments are 40.70 (10) and 87.51 (11)°, respectively, whereas the dihedral angle between the aromatic phenyl benzoate and the benzyloxy fragments is 72.30 (13)°. In the crystal, the molecules are linked by weak C—H...O interactions forming S(4) chains propagating parallel to [010]. The packing is consolidated by three C—H...π interactions and two π–π stacking interactions between the aromatic rings of naphthalene and phenyl benzoate with centroid-to-centroid distances of 3.9698 (15) and 3.8568 (15) Å, respectively. Intermolecular interactions were quantified using Hirshfeld surface analysis. The molecular structure was further optimized by density functional theory (DFT) at the B3LYP/6–311+ G(d,p) level, revealing that the energy gap between HOMO and LUMO is 3.17 eV. Molecular docking studies were carried out for the title compound as a ligand and SARS-Covid-2(PDB ID:7QF0) protein as a receptor giving a binding affinity of −9.5 kcal mol−1.

Introduction: An image has the capability to describe things better than words. These lines are applicable, especially in the case of dermatological photography (DP). However, a good image can be obtained if one has good photographic guiding principles. In the present article, we report on the development of standard guidelines for DP. Development of dermatological photographic guidelines with consistency and uniformity. To ensure the best possible dermatological photographs which visualize the finest skin lesion of the patient from various distances. Methods: Guidelines were prepared for each and every aspect of photography such as standardization of instrumentation, camera, lighting condition, and distance of skin lesion (which is variable in size). In setup, Nikon D 3300 Camera was used to take photographs of skin lesions, which is one of the high generations digital single lens reflex camera. Guidelines for lighting conditions were prepared using the LUX meter, by achieving a constant lighting condition. For the distance, an artificial skin lesions model of various sizes from 2 mm to 20 cm was made. Standard guidelines were prepared so that the best possible image was captured. Result and Conclusion: Dermatological photography guidelines with consistency and uniformity made diagnosis easier for further reliability and validation purposes in the study. The best possible quality photographs have been achieved through the above said guidelines. Standard guidelines which were prepared for dermatological photography was found appropriate for various purposes such as skin disease diagnosis, and education.

Background: The process of laryngoscopy and tracheal intubation is potent stressful stimuli that cause sympathetic activation, which is transient. Some of the modalities for attenuation of laryngoscopic and intubation response have been found to be less effective in smokers than in non-smokers. In view of this, the present study was performed to compare the effectiveness of dexmedetomidine in male smoker and non-smoker patients. Aims and Objectives: The aim of this study was to compare the effectiveness of dexmedetomidine in suppressing sympathoadrenal pressor response due to laryngoscopy and endotracheal intubation between smokers and non-smokers. Materials and Methods: This was a hospital-based non-randomized controlled study. Sixty patients were divided into two groups: 30 patients with no history of smoking (Group NS) and 30 patients with a smoking history (Group S). Both groups were received dexmedetomidine 0.75 mcg/kg over 10 min intravenous infusion. Hemodynamic parameters and Ramsay sedation score were measured at perioperative period. Results: Group S patients showed a significant rise in heart rate (HR), systolic blood pressure (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and rate pressure product (RRP) during the immediate post-intubation period, but Group NS showed a decrease in HR, SBP, DBP, MAP and RRP throughout the post-intubation period. Conclusion: Single dose of 0.75 mcg/kg IV dexmedetomidine given over a period of 10 min before the induction of anesthesia is completely effective in attenuating the hemodynamic responses associated with laryngoscopy and intubation in non-smokers, but it is not efficient in smokers.

Background: Monoclonal antibodies (mAbs) are agents that are clones of homogenous parent B cells used in managing and diagnosing multiple conditions. They are used for individualized therapy for patients due to their high specificity for an antigen/epitope. Much needs to be understood about their utilization patterns in a developing country like India, where accessibility and cost play a major role in patient care. Objectives: The objectives of this study were to evaluate the drug prescribing patterns and indications for use of mAbs and compare their availability, with the essential drug list of the World Health Organization (WHO) and the National list of essential medicines in India (NLEM). Materials and Methods: This is a retrospective cross-sectional study conducted from July to December 2021. Data were collected from 237 patients who have visited the tertiary care center or been admitted and have received mAbs. Demographic data, department of admission, diagnosis on admission, and mAbs used during treatment were recorded and analyzed. Results: Out of the 237 patients, who were eligible for this study, 61.6% of them were males and 38.4% were females. The department of ophthalmology used mAbs most commonly (65.8%). Ranibizumab was the most used mAb in this department and overall. Conclusion: Out of the mAbs being used in the tertiary care center, only rituximab was part of the NLEM (India) essential drug list, and six more drugs were present in the WHO essential drug list. The advent of biosimilars is expected to bring costs down significantly for the patient and have better treatment outcomes.

Background: Antimicrobial Resistance (AMR) is one of the top ten global public health threats faced by humanity that requires urgent multisectoral actions. Medical students play a vital role as the future prescribers and stewards of antimicrobials. Their knowledge, attitude and practice (KAP) regarding AMR and Antimicrobial stewardship (AMS) are crucial for ensuring rational and responsible use of antimicrobials in clinical settings. Aim: This study aimed to assess the KAP of medical students regarding AMR and AMS in a tertiary care hospital in North Karnataka, India. Methodology: A cross sectional study design was adopted and Google-form-based questionnaire was administered to MBBS (N=230) students who had passed Microbiology and Pharmacology. The data was analyzed by appropriate descriptive and inferential statistics. Results: Among 230 students, 99% knew that AMR is a global healthcare issue, and that irrational use of antimicrobials contributes to the development of AMR, and have the right concept of AMS. The knowledge regarding prevalence of common resistant phenotypes in India, and antibiotics that are likely to be effective against common resistant phenotypes is varying among the students. Students think that it is important to update about AMR and to adhere to right dose-frequency-duration of antibiotic. Though the students believe that they received adequate training, considering their poor knowledge in some of the topics/ concepts assessed in this questionnaire, they definitely need more focused training to develop better knowledge and practices regarding AMR and AMS. Conclusion: The learning objectives and expected competencies regarding AMR and AMS for medical students need to be clearly delineated and conveyed. They may be made certifiable competencies to ensure effective learning.

Pursuing electric mobility has led to a growing demand for efficient battery enclosures that can withstand dynamic forces and vibrations. This study focuses on advancing the structural integrity and vibrational resilience of battery enclosures through a holistic optimization approach. This research identifies optimal design parameters that minimize deformation and stress while maximizing resonance frequency by leveraging finite element analysis, modal analysis, and multi-objective optimization techniques. The study unveils three candidate designs that showcase remarkable improvements, including a 49.41% reduction in deformation, a 35.79% reduction in stress, and a 19.92% increase in resonance frequency. These findings underscore the potential of integrated design strategies to drive innovation in sustainable electric vehicle technologies.

Dengue fever, a mosquito-borne viral infection, poses a significant global health threat, and early diagnosis is crucial for effective disease management. The utilization of advanced materials in the design ensures an improved surface area, facilitating a heightened interaction between the sensor and the target. In this study, the incorporation of biomass-derived high-surface porous carbon-based materials not only contributed to the sensor's sensitivity but also ensured a cost-effective and scalable manufacturing process. The electrochemical nature of the biosensor added a layer of precision to the detection process and offered a reliable, rapid method for identifying the infection of the dengue virus. The enhanced sensitivity of the biosensor allowed the detection of even trace amounts of the NS1 protein, enabling early diagnosis in the initial stages of dengue infection. The system exhibited a high sensitivity with a wide linear range between 1 pg/mL and 100 μg/mL, and the extremely low detection limit of 0.665 pg/mL ranks this as one of the most efficient biosensors for the detection of dengue virus NS1 protein. Selectivity studies, coupled with computational insights, showcased the biosensor's prowess in distinguishing NS1 protein from potential interfering substances, laying the foundation for reliable diagnostics in complex biological matrices. Real sample analysis using human serum spiked with NS1 protein offers a tantalizing glimpse into the transformative potential of biosensors in real-world scenarios. This innovative biosensor holds great promise for addressing the pressing need for early detection of dengue virus infections.

Background & Objective: Globally, 16% of the world’s population, or 1 in 6 of us, experience significant disability. Persons with Disabilities (PWDs) are likely to encounter insufficient healthcare provider skills to address their specific needs, to encounter denial of care, and to experience mistreatment from healthcare providers. In the diverse field of medicine, medical practitioners are often confronted with the challenge of providing equitable and effective healthcare to all patients, including those with disabilities. Material & Methods: A quasi experimental study to evaluate the effectiveness of a need-based structured module on disability competencies with a pre-, post-, and retention post-test design. The study included 75 first year MBBS foundations students who completed the entire module. Data on knowledge regarding disability competencies was collected using a pre-test, an immediate post-test, and a retention post-test after 3 months of intervention. We used RMANOVA to compare the pretest, post-test, and 3-month retention post test scores at the 0.05 significance level. Results: Totally, 45 (53.3%) boys and 35 (46.7%) girls participated in the study. Overall pretest scores was 10.92 ± 1.75 (95% CI: 10.54 – 11.30), which significantly increased to 19.24 ± 2.63 (95% CI: 18.66–19.82) (p < 0.001) following the course, and the scores were sustained at 18.67 ± 2.72 (95% CI: 18.07–19.27) even after 3 months following training. RMANOVA determined the increase in mean scores was statistically significant between assessment stages (pretest, post-test, and retention test) (F (1.3, 95.5) = 460.69, p < 0.001). The scores increased significantly across all domains of disability competency training (p < 0.001). A paired t test between scores shows a significant increase in scores across all domains between pre-test and post-test (p < 0.001); scores did not reduce significantly even after 3 months. Conclusion: Training medical students in disability competencies using structured modules increased their knowledge significantly post-training, which was retained even after 3 months. Disability competency training is crucial to ensure equitable and inclusive healthcare, reduce healthcare disparities, and improve overall patient care outcomes.

Abstract Background Epilepsy affects ∼60 million people worldwide. Most antiseizure medications in the market act on voltage-gated sodium or calcium channels, indirectly modulating neurotransmitter GABA or glutamate levels or multiple targets. Earlier studies made significant efforts to directly deliver GABA into the brain with varied success. Herein, we have hypothesized to directly deliver exogenous GABA to the brain with epilepsy through extracellular vesicles (EVs) from human GABA-producing cells and their progenitors as EVs largely mimic their parent cell composition. Methods Human neural stem cells (NSCs), medial ganglionic eminence (MGE) cells, and GABAergic interneurons (INs) were generated from induced pluripotent stem cells (iPSCs) and characterized. EVs were isolated from NSCs, MGE cells, and INs and characterized for size and distribution, morphological features, and molecular markers. Exogenous GABA was passively loaded to the isolated EVs as a zwitterion at physiological pH, and the encapsulated dose of GABA was quantified. Epilepsy was developed through status epilepticus induction in Fisher rats by administration of repeated low doses of kainic acid. The extent of the seizures was measured for 10 h/ day for 3–6 months by video recording and its evaluation for stage III, IV and V seizures as per Racine scale. EVs from INs, MGE cells, and NSCs encapsulated with exogenous GABA were sequentially tested in the 4th, 5th, and 6th months by intranasal administration in the rats with epilepsy for detailed seizure, behavioral and synapse analysis. In separate experiments, several controls including exogenic GABA alone and EVs from INs and MGE cells were evaluated for seizure-controlling ability. Results Exogenic GABA could enter the brain through EVs. Treatment with EVs from INs and MGE cells encapsulated with GABA significantly reduced total seizures, stage V seizures, and total time spent in seizure activity. EVs from NSCs encapsulated with GABA demonstrated limited seizure control. Exogenic GABA alone and EVs from INs and MGE cells individually failed to control seizures. Further, exogenic GABA with EVs from MGE cells improved depressive behavior while partially improving memory functions. Co-localization studies confirmed exogenous GABA with presynaptic vesicles in the hippocampus, indicating the interaction of exogenous GABA in the brain with epilepsy. Conclusion For the first time, the study demonstrated that exogenous GABA could be delivered to the brain through brain cell-derived EVs, which could regulate seizures in temporal lobe epilepsy. It is identified that the cellular origin of EVs plays a vital role in seizure control with exogenous GABA.

Objective Older patients with cancer have traditionally been under-represented in global clinical trials. There are no data from India regarding this issue.Methods and analysis This was a retrospective analysis done at our institute on interventional studies conducted between 2003 and 2023 in adult patients with malignancies. We excluded studies done exclusively in the paediatric population and observational studies.Results We included 21 894 patients enrolled in 150 interventional trials from the departments of surgical, medical, and radiation oncology, anaesthesia, and clinical pharmacology; 110 (73.3%) were investigator initiated. There were 38 trials (25.3%) in breast cancer (6141 patients, 28%), and 33 (22%) in head and neck cancer (6975 patients, 31.9%). Studies were predominantly phase III (97 trials (64.7%)). Multicentric studies comprised approximately one-third (48, 32%). The median age of enrolled patients was 51 years (IQR 43–59). There were 5132 (23.4%) participants aged ≥60 years, 2678 (12.2%) ≥65 years and 1045 (4.8%) ≥70 years. Data from the hospital registry revealed that 30% of adult registrations were ≥60 years. There was a significant increase in the proportion of older patients enrolled in clinical trials from 2003 (8%) to 2019 (22%) compared with their proportion in the hospital registry (stable at 28%–29%); p

Abstract This research paper explores the performance of electrorheological fluids, widely known as smart fluids, which are popular because they experience immediate changes in their characteristics when applied to exterior magnetic or electric field. On application of high voltage, the ER fluid alters its form to semisolid from viscous liquid within a few milliseconds, which is reversible. The reversible nature of ER fluid was employed to absorb vibrations during hard machining. In this research, the consequence of the application of electric field to the ER characteristics of numerous non‐Newtonian fluids with an accumulation of TiO2 and Al2O3 nano elements are investigated. The purpose of this research is to discover the ER sample, which has the highest viscosity, highest breakdown voltage, but less sedimentation. So the selected sample can be used in ER dampers for the purpose of shock absorption. The ER fluid behaves as a mainspring with nonlinear vibration features that are managed by an arrangement of ER fluid, the structure of plunger, and the constraints of applied electric field. In this research, we have employed steel metallic specimens made from EN24T of 302BHN and the machining experiments are conducted to attain the shape parameters that can reduce the tool vibration and help improve the process of cutting at the time of machining with minimum application of fluid utilizing hard metal inserts. In this work, cutting tool parameters were analyzed like cutting force, tool wear, tool vibration amplitude, and surface roughness. It was observed that ER damper has shown its better performance at 5KV. At 5KV, cutting force was the least, tool wear was the least, tool vibration amplitude was the least, and surface roughness was the least. The use of an ER fluid damper decreases tool vibrations and successfully enhances machining performance. The machining industry will be benefited with commercialization of this technique.

Recurrent focal segmental glomerulosclerosis (FSGS) after kidney transplantation is a serious concern with poor allograft outcomes. Possible circulating permeability factors are postulated as pathogenetic factors leading to recurrence. Genetic FSGS is said to have a negligible risk of posttransplant recurrence. Here, we describe an unfortunate patient of genetic FSGS (pathogenic genetic variant) who had a recurrence within hours after transplant and presented with a sudden onset of anuria. The patient did not respond to plasma exchange and subsequently underwent allograft nephrectomy.

Urinary tract infections (UTIs) are among the most frequently encountered infections for which individuals seek medical attention. They are usually ascending infections and if left untreated the causative agent can ascend the ureters causing pyelonephritis and, furthermore, enter the bloodstream causing systemic infections and urosepsis. Appropriate treatment prevents progression of disease. Escherichia coli is responsible for 80-95% cases of UTI. This study was undertaken to study the antimicrobial resistance among Escherichia coli isolated from patients suffering from UTI over 4 years at a tertiary level medical facility. A retrospective case series study was conducted. All UTI with significant bacteriuria due to E. coli were included in the study. Identification, speciation and antimicrobial susceptibility testing was done as per standard laboratory practices. A total of 555 strains of Escherichia coli were included in the study. Overall highest resistance rates for E. coli were seen among cephalosporins and fluoroquinolones while least overall resistance was seen for nitrofurantoin. There was gradual rise in resistance for carbapenem over the 4 years. The predominant microorganism responsible for all types of infections affecting the urinary tract is Escherichia coli. Empirical antimicrobial therapy for urinary tract infections may be unsuccessful, as resistance rates among E. coli are constantly increasing. The present study provides information regarding the antimicrobial susceptibility pattern over a period of 4 years. It shows that there is a gradual but consistent decrease in antimicrobial susceptibility among the isolates. Hence, it has become necessary that antimicrobial therapy be based on culture reports. Also, frequent and periodic updating of antimicrobial policy is essential.

Abstract In this article, we present a straightforward in-situ approach for producing Ag NPs incorporated in graphene oxide (GO) blended with glutaraldehyde (GA) cross-linked polyvinyl alcohol (PVA) matrix. Samples are γ-irradiated by doses of 2, 5, and 10 kGy and in comparison with the pristine films, the thermal conductivity (‘k’) and effusivity are measured. ‘k’ decreases with irradiation doses up to 5 kGy and further increase in the dosage results increase in ‘k’. We performed FDTD modeling to verify the effect of polarization and periodicity on the absorptivity and emissivity spectra that are correlated to the ‘k’ and effusivity, empirically. Hence, we can confess that the structural properties of the prepared hybrid nanocomposite are manipulated by γ-irradiation. This attests that the PVA/GO-Ag/GA nanocomposite is radiation-sensitive and could be employed for thermal management systems. Moreover, their strong electrical insulation, as the measured dc conductivity of the γ-irradiated samples is found to be in the range of 2.66 × 10−8–4.319 × 10−7 Sm−1, which is below the percolation threshold of 1.0 × 10−6 Sm−1, demonstrates that they are excellent candidates for the use of thermal management materials. The low ‘k’ values allow us to use this promising material as thermal insulating substrates in microsensors and microsystems. They are also great choices for usage as wire and cable insulation in nuclear reactors due to their superior electrical insulation. Graphical Abstract

Introduction: Female pattern hair loss (FPHL) a nonscarring alopecia, is a common cause of hair loss in women. FPHL shows miniaturization of the hair follicles with thinning of hair. Scalp biopsy is diagnostic of FPHL but usually not needed. Trichoscopy a noninvasive higher magnification method (vs. scalp biopsy) for diagnosis of hair loss allows measurement of anisotrichosis characteristic of FPHL. Materials and methods: A total of 110 patients with clinically diagnosed FPHL of all grades were subjected to clinical and trichoscopic examination, and findings were looked for and compared with the occipital region serving as control. Results: Trichoscopic features apart from yellow dots and 2–3 hairs per unit follicle (HU) were statistically significant like hair diameter diversity, brown and white peripilar sign, one hair per follicular unit, white dots (WD), fine scaling, and honey-comb pigmentation (HCP). Focal atrichia, 2–3 hairs/HU, WD, HCP correlated with the grade of hair loss. Conclusion: Trichoscopy could be excellent tool for diagnosing FPHL in early stages and may aid in differentiating it from other conditions like chronic telogen effluvium and obviating the need of painful procedures like scalp biopsy. The study lacks histo-pathological and hormonal investigations however past studies done have already established correlation of trichoscopic and histo-pathological changes.

Introduction: Dentures aim to replicate natural dentition's esthetics and functions as much as possible. With computer-aided design/computer-aided manufacturing (CAD/CAM) technology, dentistry had a new renaissance with workflow and materials. Aim: The aim is to compare the fracture toughness of the milled, 3D-printed, and conventional polymethyl methacrylate (PMMA) to those processed conventionally. Materials and Methods: 10 CAD MILLED PMMA BLOCKS, 10 3D PRINTED PMMA BLOCKS, and 10 CONVENTIONAL (HEAT CURE) PMMA BLOCKS. Results: A significant difference was seen in the mean flexural module when compared among three study groups as P < 0.05. It was found to be maximum in CAD/CAM PMMA, followed by conventional heat cure and 3D-printed PMMA. Conclusion: Formlabs and Dentca (3D-printed) were significantly weaker in fracture toughness compared to Leucitone 199 (conventional) (P < 0.05). Leucitone 199 (conventional) was significantly weaker in fracture toughness compared to Avadent (CAD CAM) (P < 0.05).

Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a clinicoradiological syndrome first recognized during the influenza pandemic in Japanese population in the late twentieth century.1

Since the onset of the COVID-19 pandemic, a variety of diagnostic approaches, including RT-qPCR, RAPID, and LFA, have been adopted, with RT-qPCR emerging as the gold standard. However, a significant challenge in COVID-19 diagnostics is the wide range of symptoms presented by patients, necessitating early and accurate diagnosis for effective management. Although RT-qPCR is a precise molecular technique, it is not immune to false-negative results. In contrast, CRISPR-based detection methods for SARS-CoV-2 offer several advantages: they are cost-effective, time-efficient, highly sensitive, and specific, and they do not require sophisticated instruments. These methods also show promise for scalability, enabling diagnostic tests. CRISPR technology can be customized to target any genomic region of interest, making it a versatile tool with applications beyond diagnostics, including therapeutic development. The CRISPR/Cas systems provide precise gene targeting with immense potential for creating next-generation diagnostics and therapeutics. One of the key advantages of CRISPR/Cas-based therapeutics is the ability to perform multiplexing, where different sgRNAs or crRNAs can target multiple sites within the same gene, reducing the likelihood of viral escape mutants. Among the various CRISPR systems, CRISPR/Cas13 and CARVER (Cas13-assisted restriction of viral expression and readout) are particularly promising. These systems can target a broad range of single-stranded RNA viruses, making them suitable for the diagnosis and treatment of various viral diseases, including SARS-CoV-2. However, the efficacy and safety of CRISPR-based therapeutics must be thoroughly evaluated in pre-clinical and clinical settings. While CRISPR biotechnologies have not yet been fully harnessed to control the current COVID-19 pandemic, there is an optimism that the limitations of the CRISPR/Cas system can be overcome soon. This review discusses how CRISPR-based strategies can revolutionize disease diagnosis and therapeutic development, better preparing us for future viral threats.

Cannabis sativa is known for producing over 120 distinct phytocannabinoids, with Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) being the most prominent, primarily in their acidic forms. Beyond Δ9-THC and CBD, a wide array of lesser-known phytocannabinoids, along with terpenes, flavonoids, and alkaloids, demonstrate diverse pharmacological activities, interacting with the endocannabinoid system (eCB) and other biological pathways. These compounds, characterized by phenolic structures and hydroxyl groups, possess lipophilic properties, allowing them to cross the blood–brain barrier (BBB) effectively. Notably, their antioxidant, anti-inflammatory, and neuro-modulatory effects position them as promising agents in treating neurodegenerative disorders. While research has extensively examined the neuropsychiatric and neuroprotective effects of Δ9-THC, other minor phytocannabinoids remain underexplored. Due to the well-established neuroprotective potential of CBD, there is growing interest in the therapeutic benefits of non-psychotropic minor phytocannabinoids (NMPs) in brain disorders. This review highlights the emerging research on these lesser-known compounds and their neuroprotective potential. It offers insights into their therapeutic applications across various major neurological conditions.

Diabetic retinopathy (DR) stands as a prevalent complication in the eye resulting from diabetes mellitus, predominantly associated with high blood sugar levels and hypertension as individuals age. DR is a severe microvascular complication of both type I and type II diabetes mellitus and the leading cause of vision impairment. The critical approach to combatting and halting the advancement of DR lies in effectively managing blood glucose and blood pressure levels in diabetic patients; however, this is seldom achieved. Both human and animal studies have revealed the intricate nature of this condition involving various cell types and molecules. Aside from photocoagulation, the sole therapy targeting VEGF molecules in the retina to prevent abnormal blood vessel growth is intravitreal anti-VEGF therapy. However, a substantial portion of cases, approximately 30–40%, do not respond to this treatment. This review explores distinctive pathophysiological phenomena of DR and identifiable cell types and molecules that could be targeted to mitigate the chronic changes occurring in the retina due to diabetes mellitus. Addressing the significant research gap in this domain is imperative to broaden the treatment options available for managing DR effectively.

Rationale & Objective: Complementary and alternative medicine (CAM) intake is widely prevalent in many parts of India. Heavy metals are known ingredients in some of these formulations. We studied the spectrum of glomerular diseases in patients using CAM. Study Design: Case series. Setting & Participants: Patients with proteinuria or unexplained acute kidney injury, who underwent a kidney biopsy between May 2021 and September 2022, and who provided a history of recent CAM intake were included in the study. For patients enrolled prospectively, blood and urine samples were analyzed using mass spectrometry for the presence of mercury, lead, arsenic and cadmium. The CAM formulation, when available, was analyzed using inductively coupled plasma-optical emission spectroscopy. Results: Twenty-eight patients were enrolled in the study, with a median duration of CAM intake of 4 months (interquartile range, 2-6 months). Heavy metal screening was performed in 17 patients, of whom 15 had elevated urine mercury levels, 10 had elevated blood mercury levels, and 1 had elevated blood and urine arsenic levels. Of the 6 CAM formulations that were analyzed, all had high levels of mercury. Kidney biopsy findings were membranous nephropathy (n = 19), minimal change disease (n = 8), and mesangial proliferative glomerulonephritis (n = 1). Of the 19 patients with membranous nephropathy, 14 were associated with neural epidermal growth factor-like protein 1 (NELL-1). With conservative management alone, 17 patients achieved complete remission. Limitations: Not all patients underwent blood and urine mercury testing, and only 6 patients provided the CAM samples for analysis. Furthermore, occupational and residential exposure to mercury could not be excluded. Conclusions: The most common kidney pathology noted in our study was membranous nephropathy, which was predominantly associated with neural epidermal growth factor-like protein 1. A significant proportion of the patients recovered completely after withdrawal of the offending agent and initiation of renin-angiotensin system blockade. Plain Language Summary: Complementary and alternative medicine (CAM) intake is widely prevalent in many parts of India, and heavy metals are known ingredients in some of these formulations. We describe the clinical spectrum of kidney disease, among patients who had recently ingested CAM. All patients underwent a kidney biopsy, and the most common finding was an entity called “NELL-1-associated membranous nephropathy,” which is known to be associated with heavy metal toxicity and CAM intake. Of 17 patients screened for such heavy metals, 15 had greater-than-permissible levels of mercury. Furthermore, 6 patients provided the CAM formulations that they had consumed for analysis: all contained high levels of mercury. Most such patients recovered following withdrawal of the offending CAM agent.

Introduction: Both the population's average life expectancy and the number of patients without teeth are rising. A 2012 epidemiological survey in India found that 30% of the population is edentulous. The rehabilitation process with a set of removable maxillary and mandibular complete dentures is the standard treatment for patients who are edentulous. This study is the first to incorporate and compare a novel approach to a single implant-retained mandibular overdenture with a bar attachment fabricated by CAD-CAM and a casting process on a single implant in the symphysis region. Method: Five maxillary and mandibular completely edentulous patients were enrolled in the study. Results: Significant difference was seen in the conventional laboratory time and CAD-CAM time as P < 0.05. Conclusion: Compared to the conventional casting process, the single implant-supported bar mandibular overdenture (SISBOD) with a novel bar required fewer man hours and was more convenient.

Background: Ketamine and propofol are two medications commonly used for procedural sedation because they possess many of the desired characteristics including rapid induction and recovery. The opposing physiologic effects of ketamine and propofol suggest the potential for synergy, and this has led to an interest in their combined use, commonly termed “Ketofol.” The purpose of this study is to compare two different proportions of ketamine and propofol, 1:2 and 1:3 in short surgical procedures. Aims and Objectives: The aim of the study was to compare the quality of analgesia, level of sedation, and respiratory and hemodynamic parameters of two different proportions of ketamine and propofol in the ratio of 1:2 and 1:3 in short surgical procedures. Materials and Methods: After obtaining approval from the institutional ethics and scientific committee, with IEC no.MIMS/IEC/2021/474 dated February 23, 2021, 86 consenting patients of 18–60 years categorized under American Society of Anesthesiologists Category I and II undergoing elective short surgical procedures lasting for about 20 min were selected. The study patients were divided into two groups of 43 each by convenient sampling method. In Group A, 43 patients received 1 mL of ketamine (50 mg/mL) mixed with 10 mL of 100 mg propofol (10 mg/mL). In Group B, 43 patients received 30 mg of ketamine mixed with 9 mL of 90 mg propofol (10 mg/mL). Non-invasive blood pressure, heart rate, oxygen saturation, Ramsay Sedation Score, Modified Aldrete Score, and any incidence of side effects were recorded. Results: The quality of analgesia and level of sedation was achieved better in Group A compared to Group B. No significant difference was observed between the two groups with respect to hemodynamic and respiratory parameters. Conclusion: The combination of propofol and ketamine has several benefits such as hemodynamic stability, lack of respiratory depression, good recovery, and potent procedural analgesia. Ketofol 1:2 proportion is comparatively better and can be used safely in short surgical procedures.

Aim: Neonatal hyperbilirubinemia is defined as yellowish discoloration of the skin, conjunctive, and sclera from the elevated serum or plasma bilirubin in the newborn. The standard of care for the management of neonatal hyperbilirubinemia is phototherapy to prevent long-term neurological sequelae. The aim of this study was to ascertain the predictability of significant rebound hyperbilirubinemia (SRH) in neonates after phototherapy and the factors associated with it. Materials and Methods: Neonates ≥ 35 weeks of gestation, who received treatment for hyperbilirubinemia and admitted in our hospital from 15th of March 2019 to 15th of September 2020 were enrolled after taking parental consent. SRH was defined as bilirubin levels crossing the treatment threshold within 72 hours of phototherapy termination. Logistic regression analysis was used to identify the predictability of SRH. Results: Out of 400 neonates treated with phototherapy, 10% developed SRH. Prematurity (Gestational age < 37 weeks), low birth weight (Birth weight < 2000 gram), ABO and Rh incompatibility, Glucose-6-phophate dehydrogenase deficiency (G6PD) deficiency, sepsis, and longer duration of primary phototherapy were found to be significantly associated with rebound hyperbilirubinemia. The probability of SRH increases for all American Academy of Paediatrics (AAP) risk categories as the gestational age decreases and total serum bilirubin at the stoppage of phototherapy increases. Conclusions: The presence of risk factors should be taken into account while planning discharge and follow-up of neonates admitted for neonatal hyperbilirubinemia to prevent long-term complication of bilirubin neurotoxicity.

Membrane lipid composition is critical for an organism’s growth, adaptation, and functionality. Mosses, as early non-vascular land colonizers, show significant adaptations and changes, but their dynamic membrane lipid alterations remain unexplored. Here, we investigated the temporal changes in membrane lipid composition of the moss Physcomitrium patens during five developmental stages and analyzed the acyl content and composition of the lipids. We observed a gradual decrease in total lipid content from the filamentous protonema stage to the reproductive sporophytes. Notably, we found significant levels of very long-chain polyunsaturated fatty acids, particularly arachidonic acid (C20:4), which are not reported in vascular plants and may aid mosses in cold and abiotic stress adaptation. During vegetative stages, we noted high levels of galactolipids, especially monogalactosyldiacylglycerol, associated with chloroplast biogenesis. In contrast, sporophytes displayed reduced galactolipids and elevated phosphatidylcholine and phosphatidic acid, which are linked to membrane integrity and environmental stress protection. Additionally, we observed a gradual decline in the average double bond index across all lipid classes from the protonema stage to the gametophyte stage. Overall, our findings highlight the dynamic nature of membrane lipid composition during moss development, which might contribute to its adaptation to diverse growth conditions, reproductive processes, and environmental challenges.

The cotton mealybug, Phenacoccus solenopsis Tinsley and papaya mealybug, Paracoccus marginatus Williams and Granara de Willink (Hemiptera: Pseudococcidae) are becoming major threats to the production of Gymnema sylvestre R. Br. (Asclepiadaceae) in India. Management mainly depends on chemical insecticides which cause a serious problem of pesticide residue and insecticide resistance. The use of biorational insecticides such as biopesticides, botanicals, insect growth regulators, and microbial insecticides is important components of an Integrated Pest Management (IPM) program for successful management. We evaluated the bio-efficacy of twelve biorational insecticides, including entomopathogenic fungi (EPF), using the leaf spray method in laboratory conditions at 25 ± 1 °C, 70 % ± 5 % RH. The results revealed that the highest percent mortality was recorded by acetamiprid 20 % SP (100.00 %), followed by azadirachtin (98.27 %), Lecanicillium muscarium (2 × 109 spores/mL) (85.70 %) and Ocimum sanctum leaf extract (76.87 %) at 120 h after treatment (HAT) in P. solenopsis. In P. marginatus, 100.00 %, 96.39 % and 85.67 % and 74.90 % mortalities were achieved by acetamiprid 20 % SP, azadirachtin, L. muscarium (2 × 109 spores/mL) and O. sanctum leaf extract, respectively, at 120 HAT during the first spray. Various biorational insecticides showed a more or less similar trend of percent mortality in both species during the second spray. In both species, the lowest percent mortality was recorded by Andrographis paniculata leaf extract (46.29, 44.54) and (41.03, 46.39) at 120 Hours after treatment in the first and second spray, respectively. It was concluded that all the prescribed treatments are more effective than the control. Overall, azadirachtin recorded the highest percent mortality after acetamiprid and had the shortest LT50 (12.52 h) and (13.87 h) values in P. solenopsis and P. marginatus, respectively. Our study emphasizes that biopesticides like Azadirachtin 1 % EC (10000 ppm), L. muscarium (2 × 109 spores/mL) (5 mL/L) and O. sanctum leaf extract (5 %) may be recommended as alternatives to synthetic insecticides. Botanicals and EPF would be the most effective approach for sustainable integrated management of P. solenopsis and P. marginatus in the G. sylvestre ecosystem.

In this research, discrete wavelet transform (DWT) is combined with MLR and ANN to develop WMLR and WANN hybrid models, respectively, for the Brahmaputra river (Pancharatna station) flow forecasting. Daily flow data for the period of 10 year were decomposed (up to fifth level) into detailed and approximation coefficients (using Daubechies wavelets db1, db2, db3, db8 and db10) which were fed as input to MLR and ANN to get the predicted discharge values two days, four days, seven days and 14 days ahead. For all lead times, the WMLR-db10 model was found to be superior as compared to WANN-db1, WANN-db2, WANN-db3, WANN-db8, WMLR-db1, WMLR-db2, WMLR-db3, WMLR-db8 and single MLR and ANN models. During testing period, the values of determination coefficient (R2) and RMSE for WMLR-db10 model for two-, four-, seven- and 14-day lead time were found to be, respectively, 0.996 (751.87 m3·s–1), 0.991 (1,174.80 m3·s–1), 0.984 (1,585.02 m3·s–1), and 0.968 (2,196.46 m3·s–1). Also, it was observed that for lower order wavelets (db1, db2, db3) WANN’s performance was better, and for higher order wavelets (db8, db10) WMLR’s performance was better. Correspondingly, it was observed that all hybrid models’ efficiency increased with increase in the decomposition level.

Scedosporium aurianticum infection developed in 2 recipients of kidney transplants in India, acquired from the same deceased near-drowning donor. Given the substantial risk for death associated with Scedosporium infection among solid-organ transplant recipients, safety protocols for organ transplantation from nearly drowned donors should be thoroughly revaluated and refined.

Background This study aimed to determine the predictive power of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale Pupil (GCS-P) score in determining outcomes for traumatic brain injury (TBI) patients. The Glasgow Outcome Scale (GOS) was used to evaluate patients at 1 month and 6 months after the injury. Methods We conducted a 15-month prospective observational study. It included 50 TBI patients admitted to the ICU who met our inclusion criteria. We used Pearson's correlation coefficient to relate coma scales and outcome measures. The predictive value of these scales was determined using the receiver operating characteristic (ROC) curve, calculating the area under the curve with a 99% confidence interval. All hypotheses were two-tailed, and significance was defined as P

Objective: Histoplasmosis is a systemic, deep mycotic infection caused by Histoplasma capsulatum. Disseminated histoplasmosis (DH) is synonymous with HIV seropositive immunocompromised individuals; however, isolated histoplasmosis involving the head and neck mucosal sites mimicking malignancy is a clinical predicament. The result, in a superficial biopsy with marked pseudoepitheliomatous hyperplasia (PEH), in a tertiary care cancer center where the number of squamous carcinomas far outnumber the infectious diseases, could be catastrophic. Material and Method: The archives of a tertiary care cancer hospital were searched (2010-2019) for cases of histoplasmosis involving the head and neck mucosal sites in HIV non-reactive patients. Results: Six cases of isolated head and neck histoplasmosis were seen in biopsies from 4 men and 2 women, with an age range of 46-72 years. Three of these patients suffered from chronic illnesses. The most common site involved was the larynx (vocal cords) in three cases, two cases were involving lips, and one involving the tongue. The biopsies were reviewed in-house with a clinical diagnoses of malignancy in all and an outside biopsy diagnosis of "squamous cell carcinoma" in 2 cases. The important histological findings in the biopsy were PEH (3 cases), granulomas (2 cases), lymphoplasmacytic inflammation (all cases). Eosinophils were conspicuous by their absence. Intracellular histoplasma was seen in all cases, albeit to varying density, which was confirmed with GMS stain. Conclusion: A high index of suspicion, meticulous history taking by oncologists, and appropriate distinction of PEH from neoplastic squamous proliferation by pathologists in superficial biopsies and an apropos deeper wedge biopsy are essential to clinch the correct diagnosis.

Cefdinir (CEF) is a semi-synthetic third-generation broad-spectrum oral cephalosporin that exhibits poor solubility at lower pH values. Considering this, pH-modulated CEF solid dispersions (ASDs) were produced by solvent evaporation method employing various hydrophilic carriers and alkalizers. Among different carriers, ASDs produced using PEG 6000 with meglumine as alkalizer were found to significantly increase (p < 0.005) the drug solubility (4.50 ± 0.32 mg/mL) in pH 1.2. Fourier transform infrared spectrophotometry confirmed chemical integrity of CEF while differential scanning calorimetry (DSC) and X-ray diffractometry (XRD) indicated CEF was reduced to an amorphous state in ASD8. Antimicrobial assay performed by well diffusion method against Staphylococcus aureus (MTCC96) and Escherichia coli (MTCC118) demonstrated significantly superior (p < 0.001) efficacy of CEFSD compared to CEF. The porous orodispersible tablets (ODTs) of ASD8 (batch F5) were developed by incorporating ammonium bicarbonate as a subliming agent by direct compression, followed by vacuum drying displayed quick disintegration (27.11 ± 1.96 s) that met compendial norms and near-complete dissolution (93.85 ± 1.27%) in 30 min. The ODTs of ASD8 appear to be a promising platform to mitigate the pH-dependent solubility and dissolution issues associated with CEF in challenging physiological pH conditions prevalent in stomach. Thus, ODTs of ASD8 are likely to effectively manage various infections and avoid development of drug-resistant strains, thereby improving the curing rates.

Background: Therapeutic plasma exchange (TPE) can be technically challenging in critically ill children in pediatric intensive care unit (PICU). This study was done to characterize the indications, technical aspects, safety, and outcomes of TPE in critically ill children admitted to PICU. Subjects and Methods: This was a retrospective study by analyzing the electronic medical records of 33 critically ill children (1 month–18 years of age) who underwent TPE in PICU. Results: A total of 33 patients underwent 122 TPE sessions. The most common diagnosis for TPE was acute liver failure (48.48%). Invasive mechanical ventilator (MV) and renal replacement therapy (RRT-continuous RRT [CRRT]/intermittent hemodialysis) were needed in 72.7%. Vasoactive support was needed in 63.6%, of whom 76% needed ≥2 vasoactive medications. Organ dysfunction of ≥3 organs was seen in 66.6%. One patient was also on extracorporeal membrane oxygenation (ECMO) support. Survival to intensive care unit discharge was 59.3%. Mortality was highest for liver failure (9/16: 56%), followed by sepsis with multiple organ dysfunction syndrome (40%). TPE without needing dialysis had a survival rate of 75%, while TPE with CRRT had a survival rate of 45%. Survival with ≥3 organ dysfunction was 36.3%. Factors associated with increased mortality were MV (P = 0.0115), need for vasoactive medications (P = 0.0002), organ dysfunction (P = 0.005), and specific indications (P = 0.0458). Complications were noted in 2.4%. Conclusions: TPE can be performed safely in critically ill children in combination with RRT and ECMO. The need for MV, multiple vasoactive medications, liver failure, sepsis, and higher number of organ failures were significantly associated with mortality.

Context: Kidney transplant recipients (KTRs) represent a high-risk population but were grossly underrepresented in COVID-19 vaccination trials. Aims: The aim was to study the immunogenicity of two COVID-19 vaccines (Covaxin and Covishield) among KTRs. Subjects and Methods: We conducted a prospective observational study among KTRs who consented to receive two doses of the COVID-19 vaccine – either Covaxin or Covishield. Patients who underwent kidney transplant during the previous 6 months or had received antirejection therapy during the previous 1 month were excluded from the study. Antibody titers to the spike protein of COVID-19 were measured at baseline and at 4 weeks after the second dose of the vaccine. Statistical Analysis: A univariate analysis was performed in the subgroup of patients who were seronegative at baseline, to identify factors that were associated with seroconversion. The Chi-square test or the Fisher's exact test was used to compare categorical variables, and the Mann–Whitney U-test was used to compare continuous variables. P < 0.05 was considered statistically significant. Results: A total of 150 KTRs were studied, of whom 98 received Covaxin and 52 received Covishield. At baseline, even before vaccination, 63.3% of patients (n = 95) were found to be seropositive. Among those who were seronegative (n = 55) at baseline, seroconversion was noted in 34.5% of patients (n = 19), of which 15.7% (n = 3) had a robust response with antibody titers >250 U/mL. Conclusions: Among KTRs who were seronegative at baseline, a seroconversion rate of 34.5% was demonstrated after two doses of Covaxin or Covishield.

Extrapulmonary tuberculosis (TB) is more frequently encountered among renal transplant recipients than in normal population. As per the published literature, this is the first case of a renal transplant recipient with multidrug-resistant (MDR) joint TB from our country. A patient in the seventh decade presented with swelling of the left wrist for 1 month. He underwent positron emission tomography–computed tomography-guided joint aspiration in which GeneXpert came out positive for Mycobacterium tuberculosis and rifampicin resistance was detected. The patient had twice received antituberculous therapy in the past for pulmonary and joint TB. He was started on five-drug MDR-TB drug combination, including bedaquiline, and he responded well with subsidence of joint swelling. Treatment of MDR-TB in a renal transplant recipient is a difficult task as the MDR-TB drugs are potentially toxic and some have drug interactions with immunosuppressive agents that can lead to difficulties in maintaining therapeutic trough levels.

Objective: The purpose of the study was to evaluate the efficacy and safety of therapy with nandrolone decanoate and alendronate compared with alendronate monotherapy in patients with osteoporosis. Materials and Methods: Osteoporotic patients with T scores less than or equal to -2.5 (World Health Organization) either at lumbar vertebrae or hip, fulfilling inclusion criteria were enrolled in the study. Patients were randomized into two groups. Patients in group A were administered injection of Deca Durabolin (nandrolone decanoate) 50-mg intramuscular every 3 weeks for 12 weeks followed by every 4 weeks for the next 36 weeks along with alendronate 70 mg per oral (p.o) every week for 48 weeks. Patients in group B received only alendronate 70 mg (p.o) for 48 weeks. Follow-up was done at 3, 6, and 12 months for clinical evaluation and answering the questionnaire. Results: A total of 230 patients with the mean age of 60 years were enrolled in the study. At the end of 1 year, 53 patients were lost to follow‑up, and 177 patients were included in the study analysis. Enrolled patients were randomized to group A (n = 89) and group B (n = 88). Patients in group A had significantly higher improvement in bone mineral density (BMD) of lumbar spine, frailty score, quality-of-life (QOL) score compared with patients in group B. Patients in both groups had improvement in BMD of hip, lean mass, body fat, Oswestry disability index, and visual analog score but it was not statistically significant on the intergroup comparison. Conclusion: Our results demonstrate that the addition of nandrolone decanoate to alendronate therapy increases lumbar spine BMD. Improvement in bone quality also translates into an improvement in patient-related outcome measures such as QOL and frailty scores.

BACKGROUND: Maternal health is an important indicator of a woman's health and society. Safe motherhood is still a nightmare in many communities. Medical services related to maternal health are almost free in India, yet many families face significant out-of-pocket (OOP) expenditure, especially in poor communities in the rural areas, leading to more poverty and exclusion. This study has the aim of revealing OOP expenditure on maternal health care in rural areas. METHODS: A community-based cross-sectional study was conducted among 386 randomly selected mothers who had delivered a baby in the past 2 years in two backward districts of Karnataka using a mixed method. Univariate, bivariate, and t-tests were used for the analysis. RESULTS: The findings revealed that poor education and low income have a significant association with OOP expenditure. Getting laboratory services, purchasing medicine from the market, informal payments to the hospital staff, and other indirect costs are the major components of catastrophic expenditure for the poor mothers. CONCLUSION: It is concluded that there is strong evidence to support the high burden of maternal health-care spending. More comprehensive schemes are needed in the government's maternal health-care services to reduce out-of-pocket expenses.

Research articles represent the scientific community's viewpoints and serve as a guide for publishing, offering insight into the dynamics of the knowledge ecosystem in a situation that affects innovation and public policy. This bibliometric study aimed to determine the key features of research articles published at the BLDE (Deemed to be University [DU]) from 1992 to 2021, which were indexed in Scopus. A total of 847 research articles were authored by 520 writers, most of the subjects under medical science. The preferred source of BLDE (DU) authors is JCDR and Krishna Institute of Medical Sciences University Journal. Arun Inamadar was the most prolific and well-quoted author. The early stages of research publications represented contingent features of health science's global, regional, and national trajectory. Research articles enable the scientific community to participate in continuous conversations throughout the growing and fast-evolving health science crises.