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Abhay Kumar Yadav,1 Nitish Kumar Singh,1 Ankur Singh,2 Ashish Ashish,3 Suchitra Singh,1 Sachchida Nand Rai,4 Santosh Kumar Singh,4 Royana Singh1 1Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, 221005, India; 2Department of Pediatrics, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, 221005, India; 3Multidisciplinary Research Unit, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, 221005, India; 4Centre of Experimental Medicine and Surgery, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, 221005, IndiaCorrespondence: Royana Singh, Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, 221005, India, Email royanasingh@bhu.ac.inPurpose: Short stature is prevalent among children worldwide, particularly in developing countries. Various trace elements, including zinc, magnesium, iron, copper, chromium and selenium, are crucial for proper body development. The aim of this study is to explore the relationship between trace elements and TNF-α and IL-6 to elicit and possible pathway responsible for short stature.Methods: Two hundred and twenty samples were recruited for this study, 100 short statures and 120 controls were randomly selected. Six trace elements were measured using graphite furnace atomic absorption spectrometry. The concentrations of IL-6 and TNF-α in serum were assessed utilizing the Enzyme-Linked-Immunosorbent Assay (ELISA). Superoxide dismutase was also analysed to determine the oxidative stress response.Results: The study revealed notable distinctions in serum trace element levels of short stature. They exhibited significant lower levels of zinc and magnesium, alongside higher levels of copper. The altered Cu/Zn ratio seemed to have a positive correlation with short stature. Conversely, no significant disparities were observed in iron, chromium, and selenium levels. Furthermore, a significant rise was noted in proinflammatory marker TNF-α and cytokine IL-6. Additionally, superoxide dismutase was low in the short statures In silico study shows a high affinity of Zinc with TNF alpha. It may be suggested that inflammation at any time during childhood, with the rise in TNF alpha tightly binds with zinc and may have led to a decrease in zinc serum levels, altered redox homeostasis and resulted in short stature.Conclusion: The altered Cu/Zn ratio along with high TNF alpha and IL6 may be used as a marker for short stature in the initial years of growth in children before they reach maturity at the age of 18. Thereafter, introducing zinc supplementation could potentially enhance stature by mitigating TNF-alpha level. Further experimental studies will help to establish the exact role of zinc with TNF alpha in short stature.Keywords: short stature, zinc, trace element, superoxide dismutase and inflammation

Ashok Kumar Patra,1 Shreenath Nayak,1 Anandita Moharana,1 Purusottam Ojha,1 Sanjeet Kumar Das,1 Jabed Akhtar,1 Bishwaranjan Giri,1 Sujay Singh1,2 1Protein Expression Lab, Imgenex India Pvt. Ltd. E-5, Bhubaneswar, Odisha, India; 2Sujan Biologics, Inc., San Diego, California, USACorrespondence: Ashok Kumar Patra, Director, Biologics Development, Imgenex India Pvt. Ltd, E 5, Infocity, Technology Corridor, Chandaka Industrial Area, Bhubaneswar, Odisha, India, 751024, Email apatra@imgeneindia.comPurpose: The study aimed to develop and characterize Indikizumab, a novel humanized anti-IL-17A monoclonal antibody (mAb), for potential therapeutic use in inflammatory indications such as psoriasis, psoriatic arthritis, rheumatoid arthritis, and ankylosing spondylitis.Methods: The research involved the purification of IL-17 isoforms, epitope mapping, affinity ranking, and comparative binding assessment of anti-IL-17 antibodies. The study also included cell-based neutralization assays and in vivo studies using mouse models to evaluate the efficacy of Indikizumab.Results: Indikizumab demonstrated a high binding affinity (KD=27.2 pM) and specificity for IL-17A, with comparable potency to Secukinumab. In cell-based neutralization assays, Indikizumab effectively neutralized the effects of IL-17A and demonstrated a statistically significant reduction in plasma KC (Keratinocyte) levels in a mouse model. In imiquimod-induced psoriasis mouse model, Indikizumab showed potential in reducing the psoriasis index.Conclusion: Indikizumab represents a promising therapeutic option for inflammatory indications with its high binding affinity, specificity for IL-17A, and effectiveness in neutralizing IL-17A effects in vivo.Keywords: monoclonal antibody, neutralization assay, psoriasis, inflammation. keratinocyte

Shubham Kanaujiya,1,* Dilip Kumar Arya,1,* Prashant Pandey,1 Sneha Singh,2 Giriraj Pandey,1 Shabnam Anjum,3 Md Meraj Anjum,1 Daoud Ali,4 Saud Alarifi,4 Vijayakumar MR,1 Sri Sivakumar,2 Saurabh Srivastava,5 PS Rajinikanth1 1Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Lucknow, India; 2Department of Chemical Engineering, IIT Kanpur, Kanpur, India; 3Department of Tissue Engineering, School of Intelligent Medicine, China Medical University, Shenyang, Liaoning, 110122, People’s Republic of China; 4Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia; 5Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India*These authors contributed equally to this workCorrespondence: PS Rajinikanth, Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Lucknow, India, Email psrajinikanth222@gmail.comBackground: The healing of burn wounds is a complicated physiological process that involves several stages, including haemostasis, inflammation, proliferation, and remodelling to rebuild the skin and subcutaneous tissue integrity. Recent advancements in nanomaterials, especially nanofibers, have opened a new way for efficient healing of wounds due to burning or other injuries.Methods: This study aims to develop and characterize collagen-decorated, bilayered electrospun nanofibrous mats composed of PVP and PVA loaded with Resveratrol (RSV) and Ampicillin (AMP) to accelerate burn wound healing and tissue repair.Results: Nanofibers with smooth surfaces and web-like structures with diameters ranging from 200 to 400 nm were successfully produced by electrospinning. These fibres exhibited excellent in vitro properties, including the ability to absorb wound exudates and undergo biodegradation over a two-week period. Additionally, these nanofibers demonstrated sustained and controlled release of encapsulated Resveratrol (RSV) and Ampicillin (AMP) through in vitro release studies. The zone of inhibition (ZOI) of PVP-PVA-RSV-AMP nanofibers against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) was found 31± 0.09 mm and 12± 0.03, respectively, which was significantly higher as compared to positive control. Similarly, the biofilm study confirmed the significant reduction in the formation of biofilms in nanofiber-treated group against both S. aureus and E. coli. X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR) analysis proved the encapsulation of RSV and AMP successfully into nanofibers and their compatibility. Haemolysis assay (%) showed no significant haemolysis (less than 5%) in nanofiber-treated groups, confirmed their cytocompatibility with red blood cells (RBCs). Cell viability assay and cell adhesion on HaCaT cells showed increased cell proliferation, indicating its biocompatibility as well as non-toxic properties. Results of the in-vivo experiments on a burn wound model demonstrated potential burn wound healing in rats confirmed by H&E-stained images and also improved the collagen synthesis in nanofibers-treated groups evidenced by Masson-trichrome staining. The ELISA assay clearly indicated the efficient downregulation of TNF-alpha and IL-6 inflammatory biomarkers after treatment with nanofibers on day 10.Conclusion: The RSV and AMP-loaded nanofiber mats, developed in this study, expedite burn wound healing through their multifaceted approach. Keywords: electrospinning, nanofiber, resveratrol, ampicillin, burn wound healing, collagen

Introduction: Non-invasive ventilation (NIV) is strongly recommended in patients with acute cardiogenic pulmonary oedema (ACPE). Recently, helmet has been introduced as an interface for NIV. This study was planned to compare helmet and face mask interface for administering NIV. Methods: This was a prospective, randomized control trial conducted in patients with ACPE with respiratory failure treated with either face masks or helmet. Patients in Group H (Helmet) received minimum positive end expiratory pressure (PEEP) of 10, with a pressure support (PS) of 15. The cushion was inflated to 100 cm H20 and pressurization/ rise time was kept 0.1 seconds. Group F (Facemask) patients received pressure support with expiratory positive airway pressure (EPAP) of 8 and inspiratory positive airway pressure (IPAP) of 16 cm H20. EPAP & IPAP were adjusted according to tidal volume (TV) and respiratory rate (RR) respectively. Results: Patients using helmet as the interface had less failure rate (0.0%) as compared to facemask 9 (22.5%), Odds Ratio (OR)[95% Confidence Interval (CI)]- 0.04 (0.0, 0.71) (p= 0.001) and less complications such as nasal and skin ulcers 3 (8.6%) in Group H as compared to 16 (45.7%) in Group F, OR (95% CI) o--0.11 (0.03,0.43) (p= 0.01). Conclusion: Helmet was better than face mask in terms of reduced requirement of intubations, better patient tolerance and reduced complications.

This systematic review analyzes monosodium glutamate (MSG) in the Alzheimer’s disease-like condition to enhance translational research. Our review seeks to understand how MSG affects the brain and causes degenerative disorders. Due to significant preclinical data linking glutamate toxicity to Alzheimer’s disease and the lack of a comprehensive review or meta-analysis, we initiated a study on MSG’s potential link. We searched PubMed, ScienceDirect, ProQuest, DOAJ, and Scopus for animal research and English language papers without time constraints. This study used the PRISMA-P framework and PICO technique to collect population, intervention or exposure, comparison, and result data. It was registered in PROSPERO as CRD42022371502. MSG affected mice’s exploratory behaviors and short-term working memory. The brain, hippocampus, and cerebellar tissue demonstrated neuronal injury-related histological and histomorphometric changes. A total of 70% of MSG-treated mice had poor nesting behavior. The treated mice also had more hyperphosphorylated tau protein in their cortical and hippocampus neurons. Glutamate and glutamine levels in the brain increased with MSG, and dose-dependent mixed horizontal locomotor, grooming, and anxiety responses reduced. MSG treatment significantly decreased phospho-CREB protein levels, supporting the idea that neurons were harmed, despite the increased CREB mRNA expression. High MSG doses drastically lower brain tissue and serum serotonin levels. In conclusion, MSG showed AD-like pathology, neuronal atrophy, and short-term memory impairment. Further research with a longer time span and deeper behavioral characterization is needed.Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier [CRD42022371502].

Sachin Yadav,1,* Dilip Kumar Arya,1,* Prashant Pandey,1 Sneha Anand,1 Anurag Kumar Gautam,1 Shivendu Ranjan,2 Shubhini A Saraf,1 Vijayakumar Mahalingam Rajamanickam,1 Sanjay Singh,1 Kumarappan Chidambaram,3 Taha Alqahtani,3 Paruvathanahalli Siddalingam Rajinikanth1,4 1Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Lucknow, India; 2School of Nano Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India; 3Department of Pharmacology and Toxicology, King Khalid University, Abha, Saudi Arabia; 4Department of Pharmaceutical Technology, School of Pharmacy, Taylor’s University Lakeside Campus, Kuala Lumpur Malaysia*These authors contributed equally to this workCorrespondence: Paruvathanahalli Siddalingam Rajinikanth, Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Lucknow, 226025, India, Email psrajinikanth222@gmail.comIntroduction: Foot ulceration is one of the most severe and debilitating complications of diabetes, which leads to the cause of non-traumatic lower-extremity amputation in 15– 24% of affected individuals. The healing of diabetic foot (DF) is a significant therapeutic problem due to complications from the multifactorial healing process. Electrospun nanofibrous scaffold loaded with various wound dressing materials has excellent wound healing properties due to its multifunctional action.Purpose: This work aimed to develop and characterize chitosan (CS)-polyvinyl alcohol (PVA) blended electrospun multifunctional nanofiber loaded with curcumin (CUR) and zinc oxide (ZnO) to accelerate diabetic wound healing in STZ-induced diabetic rats.Results: In-vitro characterization results revealed that nanofiber was fabricated successfully using the electrospinning technique. SEM results confirmed the smooth surface with web-like fiber nanostructure diameter ranging from 200 – 250 nm. An in-vitro release study confirmed the sustained release of CUR and ZnO for a prolonged time. In-vitro cell-line studies demonstrated significantly low cytotoxicity of nanofiber in HaCaT cells. Anti-bacterial studies demonstrated good anti-bacterial and anti-biofilm activities of nanofiber. In-vivo animal studies demonstrated an excellent wound-healing efficiency of the nanofibers in STZ–induced diabetic rats. Furthermore, the ELISA assay revealed that the optimized nanofiber membrane terminated the inflammatory phases successfully by downregulating the pro-inflammatory cytokines (TNF-α, MMP-2, and MMP-9) in wound healing. In-vitro and in-vivo studies conclude that the developed nanofiber loaded with bioactive material can promote diabetic wound healing efficiently via multifunction action such as the sustained release of bioactive molecules for a prolonged time of duration, proving anti-bacterial/anti-biofilm properties and acceleration of cell migration and proliferation process during the wound healing.Discussion: CUR-ZnO electrospun nanofibers could be a promising drug delivery platform with the potential to be scaled up to treat diabetic foot ulcers effectively.Graphical Abstract: Keywords: electrospinning, curcumin, zinc oxide, chitosan, polyvinyl alcohol, diabetic wound healing

Using simulations at multiple imaginary chemical potentials for (2 + 1)-flavor QCD, we construct multi-point Padé approximants. We determine the singularties of the Padé approximants and demonstrate that they are consistent with the expected universal scaling behaviour of the Lee-Yang edge singularities. We also use a machine learning model, Masked Autoregressive Density Estimator (MADE), to estimate the density of the Lee-Yang edge singularities at each temperature. This ML model allows us to interpolate between the temperatures. Finally, we extrapolate to the QCD critical point using an appropriate scaling ansatz.

We have performed the measurement of the 27Al(α, n) cross section at IFIN-HH for a range of energies from 2.5 to 5.2 MeV, using an array of 28 3He counters arranged in 3 concentric rings (ELIGANT-TN). Here we present the experimental setup and discuss the role of the 13C contamination which effects the measurements in the low-energy region. Energy-dispersive X-ray spectroscopy carried out before and after the experiment suggested an increase in the 13C concentration during the experiment.

The nuclear data group at the RPI Gaerttner LINAC Laboratory uses a 60 MeV pulsed electron LINAC to produce short pulses of neutrons and perform cross section and other nuclear data measurements in a wide energy range from below 1 meV to about 20 MeV. This paper will cover several recent activities that are of interest to nuclear applications. Interest in thermal neutron scattering evaluations prompted the need for accurate thermal total cross section measurements for validation. To improve the neutron flux in the sub-thermal region (below 0.01 eV) a cold moderator was designed and installed. A polyethylene moderator operating at about 26 K resulted in a factor of 8 increase in neutron flux below 0.01 eV. Using this new capability, several transmission measurements were performed with samples of polyethylene, polystyrene, Plexiglas, and yttrium hydride. Neutron capture and transmission measurements in the keV energy range were made for 54Fe, which will be used in an evaluation effort that is underway. Capture measurements were collected on an array of C6D6 detectors that was expanded from 4 to 7 detectors, and a complementary transmission measurement was also performed. Finally, research aimed at experimental validation of neutron capture gamma production is in progress. Energy dependent capture gamma cascades are measured with the RPI 16-segment gamma multiplicity detector. Measurements are then compared to capture gamma cascades generated from nuclear structure evaluations processed with DICEBOX and transported with a modified version of MCNP. This system provides important information on the completeness of primary gamma-ray databases.

Antiphospholipid syndrome (APS) is an acquired autoimmune clinical disorder characterized by persistently raised levels of anti-phospholipid antibodies and clinical feature of hypercoagulability (recurrent vascular thrombosis and pregnancy morbidities). Primary APS is idiopathic in nature though secondary APS is associated with other connective tissue diseases like SLE. Here, we present an instance of primary APS with recurrent cerebral venous sinus thrombosis in a youthful unmarried female who clinically presented with generalized epilepsy. Level of anti-cardiolipin (aCL) and anti-beta 2 GP1 antibodies were found elevated on two occasions 12 weeks apart. The patient was treated with anticoagulation therapy along with anti-epileptic therapy and she responded well to the therapy. This case report highlights that clinicians should always suspect APS in female patients who had history of seizures and ischemic or thrombotic lesions on brain imaging, irrespective of presence of pregnancy comorbidities.

Suchismita Sarkar, Ranjana Verma, Sonu Singh Department of Anatomy, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, 201310, IndiaCorrespondence: Suchismita Sarkar, Department of Anatomy, Government Institute of Medical Sciences, Gautam Buddha Nagar, Greater Noida, Uttar Pradesh, 201310, India, Tel +91-7678642842, Email dr.suchi02@gmail.comIntroduction: Experiencing is essential to learning anything in life. Medical educators across the world aim at achieving profound learning experiences for their students. Several applications of experiential learning into health professions education have been witnessed over the past two decades. Though many researchers have tried to implement authentic learning experiences in medical education, only a handful have been able to demonstrate its effectiveness in anatomical sciences education. In this study, the authors asked the question – Can experiential learning-based dissection hall sessions be innovated to improve the contextual learning of anatomical sciences during early clinical exposure?Methods: Three experiential learning theory (ELT)-based sessions were conducted. Perceptions from faculty and students were collected.Results: The satisfaction index of the students’ perception of the ELT based sessions was of 96.1% and for faculty was 100%. The emergent facilitating factors in the learning process were found to be: more profound and interactive contextual learning experience; improved problem-solving approaches based on dominant skill activities of dissection hall; and learning experiences created to cater to different learning needs of students. The optimal facilitator to student ratio range suggested for these sessions was 1:10 to 1:15.Discussion: The faculties were motivated to utilize this learning experience to further research teaching innovations at the present institution. Experiential learning-based sessions applied to anatomical sciences education can effectively foster positive student engagement and profound learning experience.Keywords: anatomy practical sessions, case-based learning, contextual learning, dissection hall teaching, experiential learning

Veena S Singaram,1 Kimesh L Naidoo,2 Shenuka Singh3 1Clinical and Professional Practice, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; 2Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; 3Discipline of Dentistry, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South AfricaCorrespondence: Veena S Singaram Email singaram@ukzn.ac.zaPurpose: Self-directed learning (SDL) has been advocated for effective training of final-year health professions students. COVID-19 challenges conventional teaching, learning, and assessment in the clinical environment. This study aimed to identify and explore enablers and barriers to SDL among final-year health professions students training during the COVID-19 pandemic.Methods: Adopting the SWOT (strengths, weaknesses, opportunities and threats) framework, this study explored the clinical learning and training experiences of final-year health professions students during the pandemic. A survey was conducted via online platforms. Data from 155 respondents were thematically analyzed.Results: Personal attributes such as reflection, self-determination, motivation, resilience, and positive learning behaviors and skills were identified as SDL enablers. Collaborative learning networks and online learning platforms facilitate learning needs and goals. Fear and anxiety, untrusted learning sites, uncertainty about graduation, financial issues and challenges in the learning environments were the major themes related to barriers to SDL.Conclusion: The importance of SDL as a skill for uncertain times warrants further investigation in the training of future healthcare professionals. Inclusive planning and engagement with final-year health professions students to address identified stressors, as well as the creation of shared platforms where students are part of the decision-making processes for clinical learning and training are recommended. Responsive curricula that optimize unpredictable disruptions in clinical training are needed to equip students to diagnose their own learning needs and implement appropriate learning strategies.Keywords: undergraduate medical students, learning environment, clinical training, medical curriculum, self-directed learning, COVID-19, health professions students

Present research investigation was aimed at morphological and biochemical assessment of Passiflora quadrangularis L. commonly known as giant granadilla and locally called as vegetable squash grown as vegetable crop by the Adi tribe of Arunachal Pradesh. Seven genotypes collected during survey were characterized for different morphological and biochemical traits. Results showed that average fruit weight was 432.57g/fruit, with juice content 100.11 mL/fruit, vitamin C content 25.79 mg, vitamin A content 1.65 mg, Mean total flavonoids content was 16.75 mg/100 g of fruit juice, total soluble solids 12.040 Brix, antioxidant activity (DPPH) 6.07 %, titratable acidity 1.69 %, total carbohydrates 9.95 %, phenol content 338.38 mg/100 g of leaf was noted among the genotypes tested. The mean anthocyanin content in leaf was 1.20 mg/100 g, tendril 0.90 mg/100 g and petiole 1.69 mg/ 100 g among the genotypes. Seed protein profiling of Passiflora quadrangularis L. with SDS- PAGE showed diverse molecular weights ranging from 11 KD to 163.53 KD. However, monomorphic banding pattern among the protein profiling of giant granadilla was recorded among the selected genotypes. The results of the study show that the collected genotypes are belonged to Passiflora quadrangularis L. and are good source of nutritive value which can be used as source of vegetable.

Titilope John Jayeoye,1 Fredrick Nwude Eze,2,3 Oladipupo Odunayo Olatunde,4,5 Sudarshan Singh,6 Jian Zuo,7– 9 Opeyemi Joshua Olatunji10 1Department of Chemistry, Faculty of Physical Science, Alex-Ekwueme Federal University Ndufu-Alike, Abakalilki, Ebonyi State, Nigeria; 2Faculty of Pharmaceutical Science, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand; 3Drug Delivery System Excellence of Center, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand; 4Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada; 5Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, MB, R3T 6C5, Canada; 6Food Technology and Innovation Research Center of Excellence, Institute of Research and Innovation, Walailak University, Nakhon Si Thammarat, 80160, Thailand; 7Department of Traditional Chinese Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, 241001, People’s Republic of China; 8Key Laboratory of Non-Coding RNA Transformation Research of Anhui Higher Education Institution, Wannan Medical College, Wuhu, 241001, People’s Republic of China; 9Research Center of Integration of Traditional Chinese and Western Medicine, Wannan Medical College, Wuhu, 241001, People’s Republic of China; 10Faculty of Thai Traditional Medicine, Prince of Songkla University, Hat Yai, 90110, ThailandCorrespondence: Opeyemi Joshua OlatunjiFaculty of Thai Traditional Medicine, Prince of Songkla University, Hat Yai, 90110, ThailandEmail opeyemi.j@psu.ac.thTitilope John JayeoyeDepartment of Chemistry, Faculty of Physical Science, Alex-Ekwueme Federal University, Ndufu-Alike (AE-FUNAI), P.M.B. 1010, Abakaliki, Ebonyi State, NigeriaEmail titilope12@gmail.comIntroduction: The use of environmentally benign resources for nanoparticles synthesis is consistently pushed to the front burner in a bid to ensure and enhance environmental protection and beneficiation. In this light, application of different plant parts for the reduction and stabilization of nanoparticles is gaining popularity.Materials and Methods: In this contribution, we have exploited Securidaca inappendiculata stem extract (SISE), as the reducing and stabilizing agent for room temperature synthesis of highly stable and dispersed AgNPs. The major bioactive compounds in SISE were profiled using an ultra-high-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry (UHPLC-MS-QTOF-MS).Results and Discussion: SISE could reduce silver salts to its nanoparticles almost instantaneously with a maximum absorption spectrum at 423 nm, under the optimal conditions. The fabricated SISE AgNPs was extensively characterized using FTIR, TEM, SEM, XRD, EDS, Zeta analysis/DLS and TGA/DTG analysis. SISE AgNPs with average particles size between 10– 15 nm and a zeta potential value of − 19.5 ± 1.8 mV was obtained. It was investigated for in-vitro biological applications by carrying out, antimicrobial, antioxidant, hemolytic, cytotoxicity and antidiabetic assays. It was found that SISE AgNPs exhibited potent antimicrobial capacity against some food borne microbes, good antioxidant property, while also demonstrating high biocompatibility. Moreover, with a view to extending further the applications SISE AgNPs, it was tested as a colorimetric nanoprobe for Hg2+ detection in aqueous environment, where good linearity between 0.10 and 10.0 μM, with a detection limit of 26.5 nM, were obtained. The practicality of the probe was investigated by carrying out Hg2+ detection in water sample, with good accuracy and precision.Discussion: Overall, this work introduced a new stabilizer for biocompatible AgNPs with far-reaching applications.Keywords: silver nanoparticles, Securidaca inappendiculata, biological applications, mercury (II) ion, colorimetric probe

Sumeeta Khurana,1 Shreya Singh,2 Abhishek Mewara1 1Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research, Chandigarh, India; 2Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaCorrespondence: Sumeeta KhuranaDepartment of Medical Parasitology, Research Block A, PGIMER, Chandigarh, IndiaTel +91-9872814817Fax +0172-2744401Email sumeetakhurana@hotmail.comAbstract: Soil-transmitted helminth (STH) infections (hookworms, Trichuris, Ascaris) and Strongyloides spp. are associated with a substantial global burden and high morbidity. Sensitive and specific methods for diagnosis of these infections are essential for mapping the burden in communities, accurate assessment of infection levels, to guide interventions and monitoring the success of STH control programs. Despite considerable progress to control STH over several decades, we are still far from identifying a fully adequate diagnostic test. Conventional microscopy-based methods such as direct Kato–Katz smear or mounts after stool centrifugation/flotation-based concentration techniques have been the mainstay of diagnosis, especially in resource-poor countries where these infections abound. However, recently, these are being adapted to closed, easy to perform, digital formats, thereby improving the sensitivity as well as applicability in a remote, resource-limited setting. The use of image analysis systems to identify and quantify helminth eggs, with potential adaptation to smartphones, is also promising. Antibody detection tests have a limited role mostly in the case of Strongyloides hyperinfection. Coproantigen detection tests have been developed and used in veterinary practice for detection of STH, but these have not been evaluated for use in humans. More sensitive molecular diagnostics, including assays developed with new bioinformatic tools and techniques such as polymerase chain reaction (PCR), quantitative PCR (qPCR) and loop-mediated amplification assay, can help in the clear and precise assessment of STH burden during elimination phase and are of immense value for diagnosis in areas with low endemicity and in travelers to endemic regions. Moreover, the molecular techniques will help detect new species that may emerge. Sample preservation and efficient DNA extraction are critical and significantly affect the efficiency of molecular diagnostic tests. In addition to the diagnosis of clinical or asymptomatic infection in humans, detection of STH eggs in environmental samples is imperative to boost STH control efforts. Overall the diagnostic performance, cost-effectiveness, ease of performance, rapidity and in-field applicability of any test should be considered when choosing from the various diagnostic assays in areas with different endemicity, in addition to striving towards the development of novel technologies and optimization of existing methods.Keywords: soil-transmitted helminths, diagnosis, microscopy, molecular

Gebra Cuyún Carter,1 Maitreyee Mohanty,2 Keri Stenger,1 Claudia Morato Guimaraes,1 Shivaprasad Singuru,3 Pradeep Basa,3 Sheena Singh,3 Vanita Tongbram,2 Sherko Kuemmel,4,5 Valentina Guarneri,6 Sara M Tolaney7 1Eli Lilly and Company, Indianapolis, IN, USA; 2Global Health Economics and Outcomes Research, ICON Plc, New York, NY, USA; 3Global Health Economics and Outcomes Research, ICON Plc, Bangalore, Karnataka, India; 4Interdisciplinary Breast Unit, Kliniken Essen-Mitte (KEM), Essen, Germany; 5Charité – Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany; 6Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, PD, Italy; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, PD, Italy; 7Dana-Farber Cancer Institute, Brookline, MA, 02215, USACorrespondence: Maitreyee MohantyGlobal Health Economics and Outcomes Research, ICON Plc., New York, NY, USAEmail Maitreyee.Mohanty@iconplc.comPurpose: Advanced breast cancer is a heterogeneous disease with several well-defined subtypes, among which, hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2–) is most prevalent. Determination of HR and HER2 status influences prognosis and, thus, disease management. Although literature on these prognostic factors exist, especially in the early breast cancer setting, it remains unclear to what extent these factors can guide clinical decision-making in the advanced disease setting. Therefore, we sought to identify the strength and consistency of evidence for prognostic factors in patients with HR+/HER2– advanced breast cancer.Methods: A systematic literature review (SLR) of the major electronic databases was conducted in November 2018 for primary research studies published since 2010. Endpoints of interest were tumor response, progression-free survival (PFS), overall survival (OS), and breast cancer-specific survival (BCSS).Results: Seventy-nine studies were included wherein all patients were diagnosed with advanced breast cancer and ≥ 50% of the population were HR+/HER2–. OS was the most commonly assessed endpoint (n=67) followed by PFS (n=33), BCSS (n=5) and tumor response (n=3). The prognostic factors with strongest evidence of association with worse OS were negative progesterone receptor status, higher tumor grade, higher circulating tumor cell (CTC) count and higher Ki67 level, number of metastatic sites (eg multiple vs single) and sites of metastases (eg presence of liver metastases vs absence), shorter time to recurrence or progression to advanced breast cancer, poor performance status, prior therapy attributes in the early or metastatic setting (type of therapy, treatment line, response of prior therapy), and race (black vs white). The prognostic factors that had strongest evidence of association with PFS included CTC count, number and sites of metastases, and absence of prior therapy or higher lines of therapy in the early or metastatic setting. The directionality of association was consistent for all prognostic factors except between lymph node and OS, and de novo metastatic breast cancer and PFS.Conclusion: Multiple disease, treatment, and patient-related prognostic factors impact survival, particularly OS, in patients with HR+/HER2– advanced breast cancer. Treatment outcomes can vary considerably due to these factors. Understanding poorer prognostic factors for patients can result in improved clinical decision-making.Keywords: advanced breast cancer, prognostic factors, survival

Murugan Sudhakar, Rashmi Rikhi, Sathish Kumar Loganathan, Deepti Suri, Surjit Singh Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaCorrespondence: Deepti SuriDepartment of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, IndiaEmail surideepti@gmail.comAbstract: Wiskott–Aldrich syndrome (WAS) is an uncommon X-linked combined-immunodeficiency disorder characterized by a triad of thrombocytopenia, eczema, and immunodeficiency. Patients with WAS are also predisposed to autoimmunity and malignancy. Autoimmune manifestations have been reported in 26%– 72% of patients with WAS. Autoimmunity is an independent predictor of poor prognosis and predisposes to malignancy. Development of autoimmunity is also an early pointer of the need for hematopoietic stem–cell transplantation. In this manuscript, we have collated the published data and present a narrative review on autoimmune manifestations in WAS. A summary of currently proposed immunopathogenic mechanisms and genetic variants associated with development of autoimmunity in WAS is also included.Keywords: thrombocytopenia, vasculitis, genetics, hematopoietic stem–cell transplant, bleeding, malignancy

Ritu Arora,1 Ruchi Goel,1 Samreen Khanam,1 Sumit Kumar,1 Shalin Shah,1 Sonam Singh,1 Mohit Chhabra,1 Ravi Meher,2 Nita Khurana,3 Tanu Sagar,4 Suresh Kumar,5 Sandeep Garg,5 Jyoti Kumar,6 Sonal Saxena,4 Rashmi Pant7 1Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India; 2Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India; 3Department of Pathology, Maulana Azad Medical College, New Delhi, India; 4Department of Microbiology, Maulana Azad Medical College, New Delhi, India; 5Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India; 6Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India; 7Society for Health Education and Allied Research, New Delhi, IndiaCorrespondence: Ruchi GoelDepartment of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, IndiaTel +91 9811305645; +91-11-41440108Email gruchi1@rediffmail.comPurpose: To list the clinico-epidemiological profile and possible risk factors of COVID-19 associated rhino-orbital-cerebral mucormycosis (CA-ROCM) patients presenting to a COVID dedicated hospital during the second wave of COVID-19 in India.Patients and Methods: A cross-sectional, single-center study was done on 60 cases of probable CA-ROCM based on clinical features and supportive diagnostic nasal endoscopic findings and/or radiologic findings. Patients with recent or active COVID-19 were included. The demographic profile, clinical features, possible risk factors and diagnostic workup (microbiological, pathological and radiological) were analysed to identify the triggering factors for CA-ROCM.Results: The age of patients ranged from 29 to 75 years and male–female ratio was 3:1. The duration between the first positive COVID report and onset of CA-ROCM was 0 to 47 days. Forty-nine (81.66%) patients had a recent COVID infection and 11 (18.33%) had active COVID infection at presentation. Thirty-five patients (58%) had ocular/orbital involvement at presentation. In the affected eye, 10 had no perception of light and in the rest visual acuity ranged from log MAR 0 to +1.5. Ocular manifestations were ptosis (29), ophthalmoplegia (23), periocular tenderness and edema (33), proptosis (14), black discoloration of eyelids (3), facial palsy (3), endophthalmitis (4), retinal artery occlusion (8), disc edema (4) and disc pallor (5). Twenty-two (25%) patients had neither received steroids nor oxygen. Thirty patients (50%) were managed with oxygen while 38 patients (63.3%) with systemic steroids. The most common risk factor was diabetes in 59 patients. The average glycosylated hemoglobin (HbA1c) was 10.31 ± 2.59%. Systemic Amphotericin B was started in all the patients. Radical surgical debridement was performed in 12 patients and the remaining were planned.Conclusion: SARS-CoV-2 variant with accompanying glycaemic dysregulation was found to be the triggering factor for the epidemic of CA-ROCM.Keywords: COVID-19 treatment, CA-ROCM, orbital apex syndrome, ophthalmoplegia, retinal arterial occlusion, COVID-19 associated rhino-orbital-cerebral mucormycosis

Osteomyelitis is a chronic infection of bones. Eradication of bone infection is usually with antibiotics and debridement, but it is slow and the infection can recur even after many years. It is now established that osteomyelitis is due to biofilm and a better understanding of the process is required. We review the development of biofilm and apply it to osteomyelitis management. The planktonic microbes' response to adverse conditions is the formation of biofilm. Bacterial infections in planktonic forms cause infections that can be controlled with antibiotics and immunisation, however the same microbe when its phenotype becomes biofilm is more resilient. The understanding of how planktonic bacteria convert to biofilm is one of the aims set out for this article

Shruti Singh,1 Nirav Nimavat,2 Amarjeet Kumar Singh,3 Shamshad Ahmad,4 Nishi Sinha2 1Department of Pharmacology, AIIMS, Patna, Bihar, India; 2Department of Community Medicine, SBKS MIRC, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India; 3Department of Anaesthesia, AIIMS, Patna, Bihar, India; 4Department of Community and Family Medicine, AIIMS, Patna, Bihar, IndiaCorrespondence: Nirav NimavatDepartment of Community Medicine, SBKS MIRC, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, IndiaEmail nkniraj1529@gmail.comBackground: The world is facing the most challenging pandemic in the 21st century. The developed and developing countries are facing the burden equally and no proven treatment options available. Recent studies suggest the plausibility of vitamin D therapy and prophylaxis for COVID-19, in the setting where the deficiency is more prevalent. Though evaluation of vitamin D status is not a routine in India, the present study focuses on the level of Vitamin d among COVID-19 patients.Methods: The study was a hospital-based cross-sectional to find the status of vitamin D among COVID-19 patients in a tertiary care hospital, Patna, Bihar, India. The demographic, comorbidity data were taken, and the level of vitamin D was measured by a chemiluminescence-based immunoassay analyzer. The analysis compared the level of deficiency and insufficiency among different groups of COVID-19 patients. The role of DM and HTN as risk factors for mortality was compared.Results: Among the total study participants (156), 42.31% were obese and 17.31% were severe as per clinical severity. The total prevalence of vitamin D deficiency was 58.97% and insufficiency was 89.1%. The prevalence was found high among male (61.02%), overweight (65.52%), and severe (62.96%) patients. The severity increases with advanced age (p< 0.05) and important risk factors for mortality are DM, HTN, and advanced age.Conclusion: The level of vitamin D can be assessed for the prognosis of COIVD-19 patients and help to modify the treatment protocol. Appropriate therapeutic/preventive intervention of vitamin D can alter the course and severity of COVID-19.Keywords: Vitamin D, COVID-19, SARS-CoV-2, low level of Vitamin D

Nirav Nimavat,1 Shruti Singh,2 Nilesh Fichadiya,3 Parul Sharma,4 Nilesh Patel,1 Manoj Kumar,1 Grishma Chauhan,1 Niraj Pandit1 1Department of Community Medicine, Smt. B.K. Shah Medical Institute & Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India; 2Department of Pharmacology, All India Institute of Medical Sciences, Patna, Bihar, India; 3Department of Community Medicine, P. D. U. Government Medical College, Rajkot, Gujarat, India; 4GMERS Medical College, Patan, Gujarat, IndiaCorrespondence: Nirav NimavatDepartment of Community Medicine, SBKS MIRC, Sumandeep Vidyapeeth Deemed to Be University, Piparia, Vadodara, 391760, Gujarat, IndiaTel +91 8866271087Email nkniraj1529@gmail.comIntroduction: During the COVID-19 pandemic, most educational institutions have opted for online education rather than traditional modes of education to protect their employees and students. Online education has been gaining momentum in almost all countries around the world. This coincides with the recently introduced competency-based medical education in India which has embraced online education. This poses a new challenge for the institutions involved, the instructors or teachers, and the students since they must adapt quickly to the new mode of learning. Online education requires teachers to improve their competency in three major areas; pedagogy, technology, and content knowledge. Some of the challenges include; lack of technological skill, poor time management and lack of infrastructure. As technology rapidly advances, health care education systems must also advance in tandem. To implement the new competency-based system and online education, the institutions and the individuals must realize the importance of online education, identify the barriers and quickly work on solutions for success.Methods: This review was conducted based on various research papers on the topic of online medical education, the challenges faced by faculty members, and the opinion of students on this dilemma. Search terms included online medical education, COVID19, competency-based medical education.Conclusion: This review identified various challenges posed by online education on the current medical curriculum, faced by both faculty members and students, especially under the light of the Competency-Based Undergraduate Curriculum for Indian Graduates. Different solutions were proposed to overcome these challenges.Keywords: online medical education, COVID-19, competency-based medical education

Lizbeth Soto Jacome,1 Sachin Kumar Deshmukh,2,3 Padmamalini Thulasiraman,1 Nicolette Paolaungthong Holliday,4 Seema Singh2,3,5 1Department of Biomedical Sciences, College of Allied Health, University of South Alabama, Mobile, AL 36688, USA; 2Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA; 3Department of Pathology, College of Medicine, University of South Alabama, Mobile, AL 36617, USA; 4Department of Obstetrics and Gynecology, University of South Alabama, Mobile, AL 36604, USA; 5Department of Biochemistry and Molecular Biology, University of South Alabama, Mobile, AL 36688, USACorrespondence: Seema SinghDepartment of Pathology, College of Medicine, University of South Alabama, 1660 Springhill Avenue, Mobile, AL 36604, USATel +1 251-445-9843Fax +1 251-460-6994Email seemasingh@health.southalabama.eduAbstract: COVID-19, also known as the coronavirus disease 2019, is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) declared pandemic by the World Health Organization (WHO). As the world faces the coronavirus disease 2019 crisis, the oncology community is being impacted by unprecedented challenges. During this trying time, patients with ovarian cancer (OC) have been affected by a delay in diagnosis, surgery, chemotherapy and radiation treatments, and oncology follow-ups being conducted via telemedicine instead of in-person visits. OC patients and their oncologists are balancing the fears of COVID-19 and cancer treatment with the consequences of delaying cancer care. The delay in treatment care that women with OC are experiencing has resulted in higher levels of cancer worry, anxiety, and depression. In this article, we succinctly review the impact of the COVID-19 pandemic on the diagnosis and treatment and ongoing clinical trials of OC. We also discuss the psychological effects of COVID-19 on women with OC and alternative therapeutic strategies to limit in-person hospital visits to reduce the spread of the disease, and the impact of COVID-19 on OC patients.Keywords: SARS-CoV-2, COVID-19, ovarian cancer management, pandemic, cancer care delay

Sheikh Nizamuddin,1,2 Shivendra Dubey,1 Sakshi Singh,1 Saurav Sharma1 ,† Pratheusa Machha,1,3 Kumarasamy Thangaraj1,3,4 1CSIR-Centre for Cellular and Molecular Biology, Hyderabad 500007, India; 2German Cancer Consortium (DKTK) c/o Zentrale Klinische Forschung (ZKF), University Medical Center, Freiburg, Germany; 3AcSIR (Academy of Scientific and Innovative Research), CSIR-Centre for Cellular and Molecular Biology, Hyderabad 500007, India; 4DBT-Centre for DNA Fingerprinting and Diagnostics, Hyderabad 500039, India†Mr Sharma passed away on June 11, 2019.Correspondence: Kumarasamy ThangarajCSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana 500007, IndiaFax +91-40-27160311Email thangs@ccmb.res.inIntroduction: Allelic frequency distribution of drug metabolizing enzyme genes among populations is important to identify risk groups for adverse drug reaction and to select representative populations for clinical trials. Although India emerged as an important hub for clinical trials, information about the pharmacogenetic diversity for this region is still lacking. Here, we investigated genetic diversity of cytochrome-P450-2C9 (CYP2C9) gene which metabolizes wide range of drugs and is highly expressed in the human liver.Methods: In total, 1278 individuals from 36 diverse Indian populations, 210 individuals from in-house data-repository and 489 other South Asian samples from the 1000 Genomes Project were selected. Variants observed in CYP2C9 gene were subjected to various statistical analyses.Results: High frequency of CYP2C9*3 (∼ 13%) and CYP2C9*3/*3 (∼ 1%) was observed among South Asians, compared to 21 populations living outside the Indian subcontinent. The allelic/genotypic frequency does not correlate with geographical location or linguistic affiliation, except populations speaking Tibeto-Burmans language, who have lower frequency of CYP2C9*3 and CYP2C9*3/*3. Since, South Asians practice strict endogamy, presence of unique mutation and high frequency of homozygous genotypes not surprising. CYP2C9*3 has been associated with therapeutic response.The effect of CYP2C9*3/*3 is more pronounced compared to heterozygous and wild type homozygous genotypes as evident in many in vitro studies. As South Asians have high frequency, it would be interesting to explore potential of CYP2C9*3 as a marker for personalized therapy. Our study revealed several rare functional variants, which form eight novel and rare haplotypes of CYP2C9 (CYP2C9*63–*70). Of which, CYP2C9*64, *65, *66, *68, *69 and *70 haplotypes are South Asian-specific.Conclusion: Overall, we find high genetic heterogeneity within South Asians and identified South Asian-specific putative functional CYP2C9 haplotypes. High frequency of CYP2C9*3 and CYP2C9*3/*3 was observed in South Asian populations. Taken together, current study greatly enriches the knowledge of naturally occurring CYP2C9 variants and its diversity in South Asia, which are relevant to further CYP2C9-related functional research and for personalized medicine.Keywords: pharmacogenetics, CYP2C9, South Asians, genetic diversity

Abdullah Al-Mujaini,1 Rajendra Prakash Maurya,2 Sanjay Bosak,2 Manish Kumar Karan,2 Meghna Roy,2 Virendra Pratap Singh,2 Mahendra Kumar Singh,2 Ajay Kumar,3 Samer Singh4 1Department of Ophthalmology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman; 2Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India; 3Department of Zoology, Institute of Science, Banaras Hindu University, Varanasi 221005, India; 4Centre for Experimental Medicine & Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, IndiaCorrespondence: Rajendra Prakash Maurya; Samer Singh Email mauryarp_bhu@yahoo.com; samersingh@gmail.comObjective: This study aimed to evaluate the epidemiological and clinicopathological spectrum of ocular malignancies among patients presenting to a teaching hospital in Northern India.Methods: A total of 246 histopathologically diagnosed patients with ocular malignancies were included in the study. Tumor type and size, primary origin and location of tumor, clinical staging, radiological findings, histopathological type, and treatment outcomes were assessed.Results: Overall, males over 55 years of age were most commonly affected and the majority of cases were primary ocular or adnexal malignancies (n = 226; 91.87%). The eyelids and periocular structures (n = 92; 37.40%) were the most commonly involved site, followed by the orbit (n = 72; 29.27%), ocular surface (n = 46; 18.70%) and intraocular region (n = 36; 14.63%). The majority of the patients (n = 68; 27.64%) were managed by primary surgical excision and reconstruction. However, 46 patients (18.70%) with advanced lesions underwent neoadjuvant chemotherapy followed by surgical excision and more extensive orbital lesions were treated by exenteration followed by adjuvant chemotherapy (n=48; 19.51%), while patients with metastatic tumor were given palliative chemotherapy/external beam radiation therapy (n= 46; 18.70%). Overall, 45.12% of patients were cured completely, 15.45% showed a partial response to the treatment, 13.04% had progressive disease and 16.67% demonstrated disease recurrence.Conclusion: A clinicopathological analysis of ocular malignancies at a teaching hospital in Northern India indicated the preponderance of primary ocular malignancies, with eyelid sebaceous gland carcinomas being the most common pathological diagnosis. Most of our patients had advanced and extensive disease among them majority belonged to the rural background and poor socio-economic status.Keywords: ocular malignancy, tumors, diagnosis, primary cancer, sebaceous gland carcinoma, neoadjuvant chemotherapy

By 2050, it is predicted that six million hip fractures will occur each year of which the majority will happen in Asia. Malaysia is not spared from this predicted rise and its rate of increase will be one of the highest in this region. Much of this is driven by our unprecedented growth in the number of older people. Characteristics of individuals with hip fractures in Malaysia mirror what has been reported in other countries. They will be older multimorbid people who were already at risk of falls and fractures. Outcomes were poor with at least a quarter do not survive beyond 12 months and in those that do survive have limitation in their mobility and activities of daily living. Reviewing how these fractures are managed and incorporating new models of care, such as orthogeriatric care, could address these poor outcomes. Experts have warned of the devastating impact of hip fracture in Malaysia and that prompt action is urgently required. Despite that, there remains no national agenda to highlight the need to improve musculoskeletal health in the country

Nitin Sethi,1 Sukhbir Singh,2 Jasleen Kaur,3 Sonia Raghukumar,4 Chetna Ramchandani,5 Shuba Dharmana,6 Karishma Balani,7 Hema Jain,8 Meenaz Khoja,9 Seema Singhal10 1Plastic & Cosmetic Surgery, Fortis Hospital, Ludhiana, Punjab 141001, India; 2Resplendent the Cosmetic Studio, New Delhi 110048, India; 3Department of Dermatology, SGRDIMS & R, Amritsar, India; 4Hair Fair Skin Clinic, Kochi, India; 5VLCC Clinics, Mumbai, India; 6LeJeune Group of Medspas, Bengaluru, Hyderabad, India; 7SYNOVACARE Clinics, Mumbai, India; 8Health and Harmony Clinic, Pune, India; 9Dermadent Skin and Dental Clinic, Pune, India; 10SPS Hospital, Ludhiana, IndiaCorrespondence: Nitin SethiPlastic & Cosmetic Surgery, Fortis Hospital, Ludhiana, Punjab 141001, IndiaEmail drnitinsethi@gmail.comIntroduction: The COVID-19 is a pandemic which has affected most people directly or indirectly. It being a communicable disease, the best way to control the disease is to prevent its spread. Lockdown in India has resulted in aesthetic practices all over the country being shut down indefinitely. As things return to normal, most aesthetic practitioners are looking forward to opening practices. Hence, there was a definite need for a consensus on how to safely open up practices in India and at the same time reassure patients coming into these clinics that their safety is paramount.Methods: This consensus guidelines use the PICO model in its structure. Five critical areas for opening up clinical establishments were identified and approached independently. A questionnaire was prepared using the modified Likert scale, and all the stakeholders were asked to answer the same. Any differences were then resolved with discussion among the stakeholders. The entire study was divided into five subgroups which were then analyzed in detail.Results: Key recommendations and consensus guidelines were made after detailed analysis. Handy flow diagram reviews of these key areas have been provided. A thorough review of literature was also done on each of the critical areas and recommendations incorporated wherever feasible.Conclusion: These recommendations have considered the difficulties and cultural issues faced by aesthetic practices in India. They are user friendly, easy to understand and implement. These guidelines would help in reassuring practices to open up safely and continue serving patients with utmost care.Level of Evidence: Level V, Consensus guidelines.Keywords: consensus, India, COVID-19, aesthetic clinics

To assess the nature and magnitude of genetic diversity in long day onion germplasm by using the principal component analysis and single linkage cluster analysis an experiment was carried out with 34 onion genotypes. High coefficient of variation with wide range in traits indicated an appreciable variability in germplasm. Genotypes were classified into seven principal components having Eigen value > 1, cumulatively accounted for 83.87% of total variability. Principal Component - I contributed for 24.73% of total variation for followed by principal component-II (15.27%). PC-I had high positive loading for bulb weight (0.401), marketable yield (0.338), total bulb yield (0.401) and PC-II had high positive loading for plant height (0.412), PC-III for high T.S.S. (0.276) PC -IV for A grade bulbs (0.436), PC-V for polar diameter of bulbs (0.514), PC-IV negatively loaded with purple blotch (-0.461) and PC-VII for narrow neck thickness (-0 .515). Plotting PC-I aganist PC-II differenciated CITH-O-13, CITH-O-4, CITH-O-22, CITH-O-19, CITH-O-9, CITH-O-6 and CITH-O2 as most divergent genotype.On the basis of single linkage cluster means cluster-I was most importent for average bulb weight, minimum bolters, high marketble bulb percentage high marketable and total bulb yield whereas cluster -II was important for maximum nuber of leaves/plant and minimum neck thicknes. Highest inter-cluster distance was observed between cluter II and Cluster-I(873.5% ).Most divergent genotypes with high inter cluter distance could be the most appropriate parents for crop impovement in onion.

Ayushman Gupta, 1 Leah R Jayes, 2 Steve Holmes, 3 Opinder Sahota, 4 Melissa Canavan, 5 Sarah L Elkin, 6 Kelvin Lim, 7 Anna C Murphy, 8 Sally Singh, 9, 10 Elizabeth A Towlson, 11 Helen Ward, 12 Jane Scullion, 9 Tricia M McKeever, 2 Charlotte E Bolton 1 1NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK; 2Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK; 3General Practitioner, Park Medical Partnership, Shepton Mallet, UK; 4Department of Geriatric Medicine, Nottingham University Hospitals Trust, Nottingham, UK; 5Department of Respiratory, Respiratory Care Solutions, Leeds, UK; 6Department of Pharmacy, Imperial Healthcare NHS Trust, St Mary’s Hospital, London, UK; 7Eastwood Primary Care Centre, Eastwood, Nottingham, UK; 8Department of Pharmacy, University Hospitals of Leicester NHS Trust, Leicester, UK; 9Department of Respiratory Science, University Hospitals of Leicester NHS Trust, Leicester, UK; 10Department of Respiratory Science, University of Leicester, Leicester, UK; 11Respiratory Nurse, Saxon Cross Surgery, Stapleford, Nottingham, UK; 12Faculty of Medicine, The Royal Wolverhampton NHS Trust, West Midlands, UKCorrespondence: Ayushman GuptaNIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UKEmail ayushman.gupta@nottingham.ac.ukIntroduction: Osteoporosis and bone fractures are common in chronic obstructive pulmonary disease (COPD) and contribute significantly to morbidity and mortality. Current national guidance on COPD management recommends addressing bone health in patients, however, does not detail how. This consensus outlines key elements of a structured approach to managing bone health and fracture risk in patients with COPD.Methods: A systematic approach incorporating multifaceted methodologies included detailed patient and healthcare professional (HCP) surveys followed by a roundtable meeting to reach a consensus on what a pathway would look like.Results: The surveys revealed that fracture risk was not always assessed despite being recognised as an important aspect of COPD management by HCPs. The majority of the patients also stated they would be receptive to discussing treatment options if found to be at risk of osteoporotic fractures. Limited time and resource allocation were identified as barriers to addressing bone health during consultations. The consensus from the roundtable meeting was that a proactive systematic approach to assessing bone health should be adopted. This should involve using fracture risk assessment tools to identify individuals at risk, investigating secondary causes of osteoporosis if a diagnosis is made and reinforcing non-pharmacological and preventative measures such as smoking cessation, keeping active and pharmacological management of osteoporosis and medicines management of corticosteroid use. Practically, prioritising patients with important additional risk factors, such as previous fragility fractures, older age and long-term oral corticosteroid use for an assessment, was felt required.Conclusion: There is a need for integrating fracture risk assessment into the COPD pathway. Developing a systematic and holistic approach to addressing bone health is key to achieving this. In tandem, opportunities to disseminate the information and educational resources are also required.Keywords: COPD, fracture risk, osteoporosis, bone health

The provision of uncontaminated water, sufficient sanitation facilities, and appropriate hygiene behaviours is an essential entitlement of every individual and plays a crucial role in promoting worldwide health and overall welfare. The interconnection between water, sanitation, and hygiene (WASH) exerts a significant influence on the health outcomes of global societies. This study examines the complex relationship between water, sanitation, and hygiene (WASH) within the framework of global health. It specifically highlights the difficulties, prospects, and capacity for significant change that this relationship presents. In a global context characterised by enduring issues such as limited access to water resources, insufficient sanitation infrastructure, and suboptimal hygiene practises, the demand for creative and groundbreaking remedies has become increasingly urgent. This study explores the various complex aspects of Water, Sanitation, and Hygiene (WASH), analysing its direct and indirect influence on health, nutrition, education, and economic advancement. The significance of AquaLives lies in emphasising the pressing need to accomplish the targets set by the Sustainable Development Goals (SDG) pertaining to water, sanitation, and hygiene (WASH) within the timeframe of 2030. This study analyses case studies and best practises from different countries, providing insights into effective strategies that can potentially revolutionise communities’ access to clean water, sanitation, and hygiene education. this research study explores the interconnections between Water, Sanitation, and Hygiene (WASH) initiatives and the growing global health concerns, including the readiness for pandemics and the adaptation to climate change. AquaLives aims to foster a revitalised dedication to Water, Sanitation, and Hygiene (WASH) as a fundamental pillar of worldwide public health. The statement underscores the importance of fostering joint endeavours, promoting policy innovation, and augmenting investments in infrastructure and education.

In this study, we report for the first time, the occurrence of pothole features and the processes of their development on the bedrocks of Ghaghghar River, Son valley, India. Pothole geometries were identified and measured from the middle reaches of Ghaghghar River, where it is flowing exclusively over the Rohtas limestone (a Meso-Proterozoic age) of Vindhyan Supergroup, near to the Gurma village. On the basis of field survey and remote sensing study, it has been ascertained that potholes developed in the river bed were only related to local geological and geomorphological conditions of a stream. They are mainly developed due to abrupt slope change along the river course and usually associated with intersect fractures, joints, and veins in the bedrock. The knick point of the river profile also confirms the abrupt slope change of the river in Gurma region. The river changes its course from E-W to N-S due to Markundi fault (ENE-WSW) occurring in the study area and causes the tectonic disturbances to support the development of potholes. The formations of potholes on bedrock of Ghaghghar River were generally governed by abrasion of rock fragments during high-flow regime. The geometrical dimensions of the potholes are controlled by the joints, fractures, and veins developed in bedrock of the river. The veins are typically calcitic in nature and the orientations of long axis of potholes are analogous to the trend direction of the vein. The collapse bedrocks suggest that a pothole can be formed within a short period, but cannot be fully developed and maintained for a long time in a strong incision of riverbed.

Sima Singh,1,* Afzal Hussain,1,* Faiyaz Shakeel,2,* Mohamed Jawed Ahsan,3 Sultan Alshehri,2 Thomas J Webster,4,* Uma Ranjan Lal5 1Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Ranchi 835215, Jharkhand, India; 2Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; 3Department of Pharmaceutical Chemistry, Maharishi Arvind College of Pharmacy, Jaipur, Rajasthan, 302023, India; 4Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USA; 5School of Pharmaceutical Sciences, Shoolini University, Solan 173229, Himacahal Pradesh, India *These authors contributed equally to this work Abstract: Antimicrobial agents have been widely investigated for protecting against microbial infections in modern health. Drug-related limitations, poor bioavailability, toxicity to mammalian cells, and frequent bacteria drug resistance are major challenges faced when exploited in nanomedicine forms. Specific attention has been paid to control nanomaterial-based infection against numerous challenging pathogens in addition to improved drug delivery, targeting, and pharmacokinetic (PK) profiles, and thus, efficient antimicrobials have been fabricated using diverse components (metals, metal oxides, synthetic and semisynthetic polymers, natural or biodegradable polymers, etc). The present review covers several nanocarriers delivered through various routes of administration, highlighting major findings to control microbial infection as compared to using the free drug. Results over the past decade support the consistent development of various nanomedicines capable of improving biological significance and therapeutic benefits against an array of microbial strains. Depending on the intended application of nanomedicine, infection control will be challenged by various factors such as weighing the risk–benefits in healthcare settings, nanomaterial-induced (eco)toxicological hazards, frequent development of antibiotic resistance, scarcity of in vivo toxicity data, and a poor understanding of microbial interactions with nanomedicine at the molecular level. This review summarizes well-established informative data for nanomaterials used for infection control and safety concerns of nanomedicines to healthcare sectors followed by the significance of a unique “safe-by-design” approach. Keywords: recent nanomedicines, infection control, antimicrobial agents, drug delivery, biosafety

Rajni Kumrah, Babu Mathew, Pandiarajan Vignesh, Surjit Singh, Amit Rawat Pediatric Allergy and Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India Abstract: Inborn errors of immunity usually not only result in immunodeficiency but may also manifest as immune dysregulation in the form of autoinflammation, autoimmunity, or sometimes malignancy. One of the most recently discovered monogenic disorder of immune dysregulation is COPA syndrome. COPA syndrome is an inherited autoimmune disorder caused by mutations in COPA gene. COPA gene encodes for α subunit of the COP1 protein, which is involved in the reverse vesicular protein transport from Golgi apparatus to the endoplasmic reticulum (ER). The inheritance pattern of COPA syndrome is autosomal dominant, and the patients typically present with interstitial lung disease with pulmonary hemorrhage and subsequently develop arthritis. Immunological features involve autoantibody formation, elevated expression of IL-1β and IL-6, and increase in the number of Th17 cells. Molecular pathophysiology of COPA syndrome is not clearly understood. However, it is known that accumulation of unfolded proteins in ER leads to ER stress, which is an indirect result of aberrant vesicular transport of proteins from Golgi apparatus to ER and defective cellular autophagy. ER stress induces inflammation and is responsible for pathogenesis of a large number of chronic inflammatory diseases. Unfolded protein response process responds to improperly folded proteins and defends against stress in ER to ensure the fidelity of the protein folding. It maintains the expression of stress-response genes and causes initiation of inflammatory signaling pathways essential for the innate immunity. Mutation in COPA gene associated with defective protein sorting to ER has unearthed a new primary immunodeficiency disease with a unique clinical phenotype. This review highlights the clinical and molecular aspects of COPA syndrome. Keywords: COPA syndrome, endoplasmic reticulum stress, autoimmunity, autoinflammation, protein transport, interstitial lung disease, arthritis, Golgi apparatus, interleukins

Rajashekhar Kanchanapally,1 Sachin Kumar Deshmukh,1 Suhash Reddy Chavva,1 Nikhil Tyagi,1 Sanjeev Kumar Srivastava,1 Girijesh Kumar Patel,1 Ajay Pratap Singh,1,2 Seema Singh1,2 1Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA; 2Department of Biochemistry and Molecular Biology, College of Medicine, University of South Alabama, Mobile, AL 36688, USA Background: Despite tremendous advancement, cancer still remains one of the leading causes of death worldwide. Inefficiency of current drug delivery regimens is one important factor that limits the therapeutic efficacy of existing drugs, thus contributing to cancer mortality. To address this limitation, synthetic nanotechnology-based delivery systems have been developed; however, they raise concern of inducing adverse immunogenic reactions. Exosomes (Exos) are nonimmunogenic nano-sized vesicles that have received significant attention as efficient drug delivery system. Methods: Drug loading in Exos were achieved by incubating different cell types viz pancreatic cancer cells (PCCs), pancreatic stellate cells (PSCs), and macrophages (MØs) with Doxorubicin (DOX). Differential ultracentrifugation was performed to isolate exosome and their size was determined by dynamic light scattering analysis. The efficacy of drug packaging into Exos was evaluated by HPLC. Flow cytometry was performed to examine the apoptosis. Cell viability was determined using the WST-1 assay.Results: PCCs shed the most Exos and were the most efficient in drug loading followed by MØs and PSCs as examined by HPLC quantification. However, when compared for antitumor efficacy, MØ-derived Exos loaded with DOX (MØ-Exo-DOX) showed highest activity followed by PSCs and PCCs. Conclusion: These varying antitumor activities likely resulted from nondrug contents of Exos since we did not observe any significant differences in their uptake by the cancer cells. Altogether, our data suggest that donor cell-specific differences exist in Exos, which could influence their utility as drug carrier for therapeutic purposes. Keywords: exosome, macrophage, pancreatic cancer, drug delivery, doxorubicin