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Abstract Introduction We aimed to describe the risk profile of respiratory syncytial virus (RSV) infections among adults ≥ 60 years in Valladolid from January 2010 to August 2022, and to compare them with influenza and COVID-19 controls. Methods This was a retrospective cohort study of all laboratory-confirmed RSV infections identified in centralized microbiology database during a 12-year period. We analyzed risk factors for RSV hospitalization and severity (length of stay, intensive care unit admission, in-hospital death or readmission

Abstract The pandemic has brought attention to the importance of a healthy immune system in preventing infectious diseases. In this in‐depth review, the process by which nutritional interventions and fundamental nutrients affect immune function has been discussed with the goal of enhancing the body's natural defenses against viral infections. We explored the complex interplay between diet and immunology, highlighting the essential nutrients, vitamins, minerals, and bioactive substances that are crucial for enhancing immune response. We also investigated the effect of dietary patterns and supplementation methods on immune function. We assessed the effectiveness and potential mechanisms of action of various nutritional therapies in modifying immune responses through a thorough examination of scientific literature. Additionally, we go through the significance of individualized nutrition and highlight possible factors to consider for vulnerable groups, such as the elderly and people with chronic conditions. This review attempts to provide a thorough understanding of the role of diet in boosting immunity by synthesizing available research. It also offers insights into practical methods for enhancing the immune function during the current epidemic and in the future.

Abstract Background Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly referred to as nonalcoholic fatty liver disease, impacts 30% of the global population. This educational pilot focused on the role primary care providers may play in the delivery of guidelines-based metabolic dysfunction-associated steatohepatitis (MASH) care. Objective Accelerate the application of guidelines-based MASH care pathways to clinical workflows. Methods A panel of six hepatologists was convened in 2021 to develop the care pathway and the subsequent pilot occurred between 2022 – 2023. The pilot was conducted across three U.S. health systems: Boston Medical Center (Boston), Methodist Health System (Dallas), and Weill Cornell Medicine (New York). Clinicians were educated on the care pathway and completed baseline/follow-up assessments. 19 primary care clinicians participated in the educational pilot baseline assessment, nine primary care clinicians completed the two-month assessment, and 15 primary care clinicians completed the four-month assessment. The primary endpoint was to assess clinician-reported adherence to and satisfaction with the care pathway. The pilot was deemed exempt by the Western Consensus Group Institutional Review Board. Results At baseline, 38.10% (n = 8) of respondents felt they had received sufficient training on when to refer a patient suspected of metabolic dysfunction-associated liver disease to hepatology, and 42.86% (n = 9) had not referred any patients suspected of metabolic dysfunction-associated liver disease to hepatology within a month. At four months post-intervention, 79% (n = 15) of respondents agreed or strongly agreed they received sufficient training on when to refer a patient suspected of metabolic dysfunction-associated liver disease to hepatology, and there was a 25.7% increase in self-reported adherence to the institution’s referral guidelines. Barriers to care pathway adherence included burden of manually calculating fibrosis-4 scores and difficulty ordering non-invasive diagnostics. Conclusions With therapeutics anticipated to enter the market this year, health systems leadership must consider opportunities to streamline the identification, referral, and management of patients with metabolic dysfunction-associated steatohepatitis. Electronic integration of metabolic dysfunction-associated steatohepatitis care pathways may address implementation challenges.

Abstract Background Digital health, aiming to boost healthcare accessibility, is an emerging concept in the domain of healthcare administration and delivery in developing countries. In India, according to the National Family Health Survey (NFHS-5), more than half (55%) of the men have reported ever using the internet, while only one-third (33%) of the women have done so. This gendered digital divide is further complicated and worsened by the fact that individuals in the lowest wealth quintile exhibit significantly lower internet usage rates, with only 9% of women and 26% of men. Such intersectionality of the gendered digital divide might prove a barrier to realizing the full potential of digital health in India. Eliminating digital inequalities in all forms and ensuring universal digitalization is essential for desired digital health outcomes. Methods This study aims to explore India’s readiness for digital health in terms of access to basic digital infrastructure, i.e., the internet. We analyze access to the Internet among Indian women of reproductive age using pan-India survey data from the fifth round of the National Family Health Survey (2019–21). We investigate predictors of Internet use in a regression model and apply the Erreygers Concentration Index (ECI) to examine inequalities in Internet access. Using decomposition analyses, we analyze factors contributing to digital inequality in terms of internet use. Results Our inequality analysis based on the ECI [ECI- 0.4444 (p

Background: As per the revised competency-based medical education guidelines given by the National medical council of India, students are offered elective posting after the first part of 3rd phase of the medical professional course. This has been started from the year 2023. There will be various postings offered and at end of the posting they will be assessed on various domains. Aims and Objectives: Our study aims to assess the impact of elective posting on the research skills and students’ perception toward it. It also aims to identify the best methods to implement elective postings. Materials and Methods: In the year 2023, using a complete enumeration technique 86 students from the third phase of MBBS at a medical college in Maharashtra, India, were registered for the 2 months of elective and would be questioned twice following consent using a pre-validated questionnaire. The first interview will take place following the completion of the first block of elective posting, and the second interview will take place following the conclusion of the second block of elective posting. Results: We observed a statistically significant difference when two blocks were compared on the domains of efforts. Students have reported higher efforts toward clinical and surgical postings. We also observed that students reported a statistically significant level of frustration in block two. In our study, we found that research work was taken more during the second block as students were sensitized in the first block regarding research. Conclusion: In our study, we have observed that research activities are taken up and processed for presentation using biostatistics in the second block of elective if resource material and support are provided in the block one. Students develop a better understanding of research with proper training.

Background: Studies on stature estimation models for North West Indian populations are limited. The present study attempts to develop stature estimation models for the Indian population using hand and foot dimensions. Materials and Methods: Hand and foot measurements of 280 individuals (140 males and 140 females) were recorded for the estimation of stature in the present study. The stature and nine hand and foot anthropometric measurements were obtained using standard methods and relevant landmarks. For bilateral and sex differences, independent and paired t-tests were used to statistically analyze the data. Results: The findings showed statistically significant sex differences (P < 0.05) in stature, foot, and hand measurements. However, there were no significant bilateral differences. The Pearson correlation coefficient assessed the association between stature and hand/foot measurements. All the studied parameters in both sexes demonstrated a statistically significant (P < 0.001) and strong positive correlation with stature. Males and females had the strongest correlation coefficients for right-foot length (r = 0.70) and right-hand length (r = 0.64), respectively. Each sex’s regression equations were calculated separately. Stature predictions were accurate to within 4.02–6.64 cm. Conclusion: Stature estimated from hand and foot measurements can help in personal identification by creating an individual’s biological profile. Morphological differences in feet and hands demonstrate the significance of developing ethnic group-specific models to determine stature. According to the study’s findings, the stature of a person belonging to the Indian subcontinent can be estimated using hands and feet for anthropological and forensic purposes.

Introduction: Early diagnosis of neonatal sepsis is very essential part of newborn care to prevent mortality and decrease morbidity in newborns. Aim: The aim of this study is to correlate an increase in C-reactive protein (CRP) titre and a decrease in platelet count with an increased incidence of neonatal septicemia, for an effective subtle approach in neonatal septicemia. Materials and Methods: A retrospective study was conducted in the neonatal intensive care unit (NICU) of a tertiary care hospital from Jan 2022 to July 2023. Neonates admitted to the NICU with suspected sepsis were screened for sepsis. Screening was done by taking blood culture samples before administration of antibiotics, serum samples for CRP and blood samples for platelet count. Result: A total of 270 newborns with suspected sepsis were included in the study. Blood culture positivity was seen in 27.7 (27/75) cases. About 32.9% (89/270) of the neonates with suspected sepsis and 61.3% (46/75) neonates with confirmed sepsis had raised CRP; 32.2% (87/270) neonates with suspected sepsis and 64% (48/75) with confirmed sepsis had decreased platelet count. Both an increase in CRP and a decrease in platelets were seen in 61.3% (46/75) of confirmed cases. Conclusion: In our study, both raised CRP and decreased platelet count were seen in around 60% of confirmed cases of sepsis. So, CRP titre and platelet count can be used as early, rapid diagnostic markers for confirmed sepsis.

An in-depth understanding of the anatomical variations of maxillary molars is essential for endodontic success. Unlike the maxillary second molars, the presence of a second palatal root is uncommon in the first maxillary molar. This case report describes two cases of non-surgical management of maxillary molars with extra palatal roots. Careful clinical examination, knowledge of the internal anatomy, and the use of advanced radiographic modalities like cone beam computed tomography (CBCT) can reveal the presence of variations in the internal and external anatomy of any tooth. Therefore, for nonsurgical as well as surgical management clinicians should always watch out for any deviations in a tooth and utilize all the available tools to diagnose and manage them successfully.

Abstract Cell-fate decisions during mammalian gastrulation are poorly understood outside of rodent embryos. The embryonic disc of pig embryos mirrors humans, making them a useful proxy for studying gastrulation. Here we present a single-cell transcriptomic atlas of pig gastrulation, revealing cell-fate emergence dynamics, as well as conserved and divergent gene programs governing early porcine, primate, and murine development. We highlight heterochronicity in extraembryonic cell-types, despite the broad conservation of cell-type-specific transcriptional programs. We apply these findings in combination with functional investigations, to outline conserved spatial, molecular, and temporal events during definitive endoderm specification. We find early FOXA2 + /TBXT- embryonic disc cells directly form definitive endoderm, contrasting later-emerging FOXA2/TBXT+ node/notochord progenitors. Unlike mesoderm, none of these progenitors undergo epithelial-to-mesenchymal transition. Endoderm/Node fate hinges on balanced WNT and hypoblast-derived NODAL, which is extinguished upon endodermal differentiation. These findings emphasise the interplay between temporal and topological signalling in fate determination during gastrulation.

Abstract The most widely used method of determining impact direction employs asymmetric ejecta distribution around the crater. However, the active terrestrial landscape seldom preserves the pristine ejecta blanket, making it challenging for this analysis to be carried out. The deeply eroded Dhala impact structure, formed during the Proterozoic, is devoid of an ejecta blanket. We, therefore, utilize the variation in the full width at half maxima (FWHM) of the quartz (100) peak in X-ray diffraction (XRD) spectra and the P10 microfracture intensity in the monomict breccia to estimate the probable downrange direction of the Dhala impact structure. The monomict breccia rocks of the Dhala impact structure have experienced low shock pressures (

Abstract Sickle cell disease is a devastating blood disorder that originates from a single point mutation in the HBB gene coding for hemoglobin. Here, we develop a GMP-compatible TALEN-mediated gene editing process enabling efficient HBB correction via a DNA repair template while minimizing risks associated with HBB inactivation. Comparing viral versus non-viral DNA repair template delivery in hematopoietic stem and progenitor cells in vitro, both strategies achieve comparable HBB correction and result in over 50% expression of normal adult hemoglobin in red blood cells without inducing β-thalassemic phenotype. In an immunodeficient female mouse model, transplanted cells edited with the non-viral strategy exhibit higher engraftment and gene correction levels compared to those edited with the viral strategy. Transcriptomic analysis reveals that non-viral DNA repair template delivery mitigates P53-mediated toxicity and preserves high levels of long-term hematopoietic stem cells. This work paves the way for TALEN-based autologous gene therapy for sickle cell disease.

Fiberoptic bronchoscopy in children requires sedation, while routinely employed techniques for oxygenation under sedation don’t provide airway protection.LMA during FOB can provide safer ventilation with good operative views.Although the use of laryngeal mask airway for FOB was described in 1982, its application has not been established in pediatric patients. The aim of our study was to compare the safety and efficacy of LMA-assisted bronchoscopy compared to nasal airway with oxygenation-assisted bronchoscopy. The study was conducted on 12 patients, 6 in each group. Data collected includes monitoring of oxygen saturation, hemodynamics, ETCO2, and complications. LMA group children had lower episodes of desaturation as compared to nasal airway group. ETCO2 values were maintained and rate of complications were less in LMA group. Hemodynamic stability in both groups were comparable. Hence the use of LMA allows better airway conduit, with stable O2 saturation and ETCO2 values than nasal airway-assisted bronchoscopy.

The bronchogenic cyst is a class of lung malformations that are congenital and non-vascular. Surgical excision per se is a great challenge for anesthesiologists as there have been cases with complications of fatal tension pneumothorax. Our patient is an 11-month-old child who underwent surgical excision of the bronchogenic cyst compressing the left bronchus. Intraoperatively, due to positive pressure ventilation, tension pneumothorax developed, ultimately leading to cardiac arrest. Prompt treatment with cardiopulmonary resuscitation followed by needle insertion in the second intercostal space on the right side, followed by an intercostal drain, revivedthe patient. An early diagnosis and an adequate approach to possible complications is the key to successful anesthetic management.

Abstract Background The SARS CoV-2 pandemic has resulted in more than 1.1 million deaths in the USA alone. Therapeutic options for critically ill patients with COVID-19 are limited. Prior studies showed that post-infection treatment of influenza A virus-infected mice with the liponucleotide CDP-choline, which is an essential precursor for de novo phosphatidylcholine synthesis, improved gas exchange and reduced pulmonary inflammation without altering viral replication. In unpublished studies, we found that treatment of SARS CoV-2-infected K18-hACE2-transgenic mice with CDP-choline prevented development of hypoxemia. We hypothesize that administration of citicoline (the pharmaceutical form of CDP-choline) will be safe in hospitalized SARS CoV-2-infected patients with hypoxemic acute respiratory failure (HARF) and that we will obtain preliminary evidence of clinical benefit to support a larger Phase 3 trial using one or more citicoline doses. Methods We will conduct a single-site, double-blinded, placebo-controlled, and randomized Phase 1/2 dose-ranging and safety study of Somazina® citicoline solution for injection in consented adults of any sex, gender, age, or ethnicity hospitalized for SARS CoV-2-associated HARF. The trial is named “SCARLET” (Supplemental Citicoline Administration to Reduce Lung injury Efficacy Trial). We hypothesize that SCARLET will show that i.v. citicoline is safe at one or more of three doses (0.5, 2.5, or 5 mg/kg, every 12 h for 5 days) in hospitalized SARS CoV-2-infected patients with HARF (20 per dose) and provide preliminary evidence that i.v. citicoline improves pulmonary outcomes in this population. The primary efficacy outcome will be the SpO2:FiO2 ratio on study day 3. Exploratory outcomes include Sequential Organ Failure Assessment (SOFA) scores, dead space ventilation index, and lung compliance. Citicoline effects on a panel of COVID-relevant lung and blood biomarkers will also be determined. Discussion Citicoline has many characteristics that would be advantageous to any candidate COVID-19 therapeutic, including safety, low-cost, favorable chemical characteristics, and potentially pathogen-agnostic efficacy. Successful demonstration that citicoline is beneficial in severely ill patients with SARS CoV-2-induced HARF could transform management of severely ill COVID patients. Trial registration The trial was registered at www.clinicaltrials.gov on 5/31/2023 (NCT05881135). Trial status Currently enrolling.

Introduction: Interproximal contacts between primary teeth have traditionally been reported as broad and flat. A new system of classification for contacts called OXIS- O (open contact), X (point contact), I (straight contact), and S (curved contact) was introduced in 2018, based on the shapes observed occlusally. Understanding interproximal contacts in primary teeth is essential to comprehend the caries risk of the individual. Aim: To assess the prevalence of OXIS contact areas between non carious primary molars in 3 to 9 years old children and to determine the most common type of contact before and after the eruption of the first permanent molar. Materials and Methods: A cross-sectional study was conducted to determine the prevalence of the types of contacts between primary teeth through direct observation in a sample size of 260 contact areas. The study was carried out in the Department of Paediatric and Preventive Dentistry, Navi Mumbai, India, between August 2022 to February 2023. Ethical clearance from the university was obtained. A single calibrated examiner examined photographs of the interproximal contacts between primary molars. The contacts were assessed as O (open contact), X (point contact), I (straight contact), and S (curved contact) using the OXIS classification system. The prevalence of each contact type was recorded. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) 18.0 software. The prevalence of contact types was recorded in numbers and percentages. A comparison of contact types before and after the eruption of the first permanent molar was conducted using the Chi-square test. Result: The most common contact type was I (65.00%) both before and after the eruption of the first permanent molar. This was followed by S (19.62%), X (11.15%), and O (4.23%) in the primary dentition. After the eruption of the first permanent molars, I contact was the highest at 66.41%, followed by S (20.90%), X (12.68%), and O (0%). Conclusion: This study confirms the presence of O, X, I, and S types of interproximal contact areas in caries-free primary molars in 3 to 9 years old children.

Purpose – The study investigates the relationship between hospital environmental factors and the well-being of geriatric in-patients. It aims to identify the impact of architectural design on comfort, safety, privacy and stress levels experienced by elderly patients during their hospital stays. Design/methodology/approach – Employing a mixed-methods approach, the research assesses the experiences of 100 geriatric in-patients across various hospital types through surveys, observational checklists and state anxiety measurements. The methodology involves examining architectural features, patient perceptions and correlations among environmental variables and patient experiences. Statistical analyses, including correlations and chi-square tests, were employed to discern associations between environmental variables and patient experiences. Findings – The research identified key architectural features significantly impacting geriatric patients' experiences. Factors such as sturdy beds, furniture quantity, lighting conditions, proximity to facilities and ward occupancy levels were found to influence spatial, sensory and social comfort. Notably, proximity to facilities and control over the immediate environment were crucial for self-control and safety perceptions. Privacy, highly valued by patients, correlated with the presence of curtains and ward occupancy. Moreover, patient stress levels exhibited correlations with autonomy, privacy and ward occupancy. Originality/value – This research offers significant insights into the criticality of specific architectural elements in enhancing comfort and reducing stress for geriatric in-patients. These findings hold substantial value for healthcare facility design, emphasizing the need to prioritize certain design aspects to promote the well-being of elderly patients during hospitalization.

Abstract We report the de novo design of small (

Background: Unmanaged sanatorium waste carries a severe threat of nosocomial infections, which are contagious. Improper disposal of biomedical waste poses a significant environmental and health threat to healthcare facilities, staff and communities, highlighting the growing challenges of managing this waste. Aims and Objectives: The study was aimed at evaluating the adequacy of knowledge and practice concerning biomedical waste management amongst nurses and laboratory technicians. Materials and Methods: It was a cross-sectional study involving 101 participants, including 50 nurses and 51 laboratory technicians, from June 2022 to 2023, using a validated self-administered Google Form questionnaire. The study used the Chi-square approach to conduct intergroup comparisons amongst nurses and laboratory technicians. Results: Statistically significant P values were found for age, sex, qualification and years of experience in a survey, with the highest qualification being postgraduation (46.5%). However, 45.5% had

Introduction: Recent evidence reveals that type 1 diabetes mellitus (T1DM) impairs muscle function (MF) in adolescents. However, despite its importance in physical well-being, data on dynamic MF in Indian children and adolescents (C and Y) with T1DM are scarce. We assessed MF using Jumping Mechanography (JM, a measurement method for motion analysis and assessment of muscle power and force). (1) To assess dynamic MF by JM in C and Y with T1DM as compared to healthy controls (2) To determine predictors of MF in children with T1DM. Methods: A cross-sectional observational study on 266 children (133 – T1DM duration >1 year with no known comorbidities + 133 age and gender-matched healthy controls) aged 6–19 years. Anthropometry, body composition, and MF (maximum relative power Pmax/mass, maximum relative force Fmax/BW by JM) were recorded. The lean mass index (LMI) was calculated as lean mass (kg)/height (m2). HbA1c was assessed in T1DM. Independent sample t-test and linear regression were performed. Results: MF parameters (Pmax/mass 33.5 ± 7.2 vs 38.0 ± 8.6 W/kg and Fmax/BW 10.5 ± 2.9 vs 11.4 ± 4.1 N/kg, P < 0.05) were significantly lower in T1DM group vs controls. Positive association of body mass index and LMI with both MF parameters and negative association of insulin requirement and HbA1c with Fmax was observed in T1DM. Predictors of MF identified were MMI (Pmax/mass:b = 1.6,95%CI = 0.6–2.6; Fmax/BW:b =2.0,95%CI = 1.6–2.4) and HbA1c (Pmax/mass:b = −2.1,95%CI = −4.5–−0.5; Fmax/BW:b = −1.1,95%CI = −2.0–−0.2) (P < 0.05). Conclusion: C and Y with T1DM exhibits compromised muscle function. Poor glycaemic control increases the risk of having decreased MF, irrespective of diabetes duration and may contribute to sarcopenia in adulthood.

Over the past few decades, bioceramic materials have developed from extremely biocompatible, but low-strength dental materials to novel product compositions for broader clinical uses in pediatric dentistry. The most crucial thing is to better understand the elements that encourage remineralization and how they operate dynamically. Some of the major drawbacks of prior generations of endodontic materials have been effectively solved by new bioceramic materials. In particular, these materials have been used for vital pulp therapy treatment, restorative, and root canal procedures in a variety of dental applications. They may be used in clinical pediatric dentistry since they have been demonstrated to be more biocompatible, induce tissue regeneration, have low cytotoxicity, excel at sealing, cause little to no postoperative pain, and have improved physiochemical properties. When employing bioceramic materials, it is crucial to adhere to suitable clinical standards and techniques to guarantee positive results in pediatric dentistry. Therefore, the focus of this review is on the properties and advantages of using bioceramic materials in pediatric dentistry.

This case report focuses on the rising incidence of oral and maxillofacial tumors, requiring multimodal therapy involving surgery and radiotherapy. Radiotherapy, integral to cancer treatment, poses oral health challenges, notably radiation-related caries. Severe complications such as mucositis, xerostomia, and osteoradionecrosis highlight the critical role of optimal oral hygiene practices in managing these conditions. The presented case involves a 38-year-old male with a history of verrucous carcinoma, undergoing composite resection, modified neck dissection, and pectoralis major myocutaneous flap reconstruction. Adjuvant radiotherapy requires a comprehensive approach to minimize complications. Here, the focus is on fluoride treatment, specifically Fluoritop SR Dental Varnish, to prevent radiation-related caries. A multidisciplinary approach, including fluoride application, vigilant monitoring, patient education, and collaboration, is crucial for minimizing complications in oral malignancy radiotherapy. Emphasizing fluoride’s significance in preventing radiation-related caries, this care plan contributes to awareness and improves oral health outcomes in this patient population.

Trichostasis spinulosa is a disorder of hair follicles characterized by the retention of vellus telogen club hair, leading to the formation of comedo-like lesions. It usually presents over the face and is frequently asymptomatic. We report a 53-year-old female who presented with multiple itchy, discrete, bluish-black, 2–3 mm comedo-like follicular papules and pustules on her breast and lower abdomen for the past 2 years. In-vivo dermoscopy showed keratotic plugs with a tuft of hair. Extraction dermoscopy yielded a cystic structure filled with keratin and multiple vellus telogen club hairs. Histology showed a cyst lined by squamous epithelium containing abundant laminated keratinous debris and a vellus hair shaft. Truncal or breast involvement, as seen in the present case, is relatively rare, and can be pruritic, causing significant morbidity due to itching and secondary bacterial infections. Dermoscopy, especially ex-vivo extraction dermoscopy, can show diagnostic features and obviate the need for abiopsy.

Lupus Anticoagulant (LAC) is a group of auto antiantibodies that interfere with phospholipid dependent tests like Activated Partial Thromboplastin time (APTT) and dilute Russell Viper venom time (dRVVT) on in vitro basis. LA, anti cardiolipin antibodies (aCL) IgG/IgM, and anti-β2 glycoprotein I antibodies [aβ2GPI]IgG/IgM are three diagnostic criteria for laboratory diagnosis of anti-phospholipid antibodies (aPL). The circulating aPLs in the clinical setting of hypercoagulability state or adverse pregnancy outcomes is termed as anti-phospholipid syndrome (APS). The laboratory diagnosis of APS is complicated, it includes constellation of tests like solid phase immunoassays for measurement of aCL and a β 2GPI by and coagulation based assays for detection of LAC. LAC diagnosis is especially challenging in the setting of anti-coagulation therapy, numerous modifications to circumvent this interference have rendered success. The Thrombin generation assays [TGA] for LAC detection and estimation of LAC pathogenicity are available but are yet to be accepted as routine laboratory tests. The medley of assays like Enzyme-linked immunosorbent and chemiluminescent assays are available for detection of aCL and aβ2GPI but due to the non-availability of universal calibrators and standards there is lack of harmonization between various solid phase assays. In this article we intend to highlight new recommendations of laboratory diagnosis of LAC with special emphasis on diagnosis in the setting of pregnancy and anti-coagulation. For risk assessment in APS other non-criteria aPL like as anti-domain β2 glycoprotein I and anti-phosphatidyl serine/prothrombin antibodies are under evaluation. There is an ongoing quest towards harmonization of detection of LAC, thus there has been succession of guidelines to meet the challenges and incorporate newly found knowledge every time, namely International Society for Thrombosis and Hematology- Scientific Standardization Committee (ISTH-SSC) guidelines, followed by British Committee for Standards in Hematology (BCSH), Clinical and Laboratory Standards Institute (CLSI) guidelines 2014 and finally guidelines/updates issued by ISTH- SSC in 2018.

Abstract Given the relationship between poor engagement and worse treatment outcomes, improving engagement has been the focus of attention in recent years. Engagement is a particular challenge among minoritized and otherwise challenged youth, such as those from socioeconomically disadvantaged groups, including youth in low- and middle-income countries (LMICs), where they face lower levels of access to resources, including mental health treatment. The present study describes engagement challenges that arose in an uncontrolled pre-post evaluation of a school-based, modular, multi-problem, stepped-care intervention delivered in urban Indian communities. Specifically, the study aimed to (1) characterize barriers and facilitators of youth treatment engagement; and (2) evaluate treatment acceptability and fit of treatment from the youth perspective. Youth participants completed semi-structured interviews, which were transcribed and coded using thematic analysis. Participants described numerous facilitators to engagement (e.g., positive therapeutic relationship) and reported high overall satisfaction with the intervention, while also identifying barriers to engagement (e.g., concerns about confidentiality) and offering suggestions to increase fit and acceptability (e.g., more visually appealing treatment materials). Findings highlight ways in which engagement can be enhanced and implementation supports improved to maximize treatment effectiveness among minoritized and disadvantaged youth in LMICs.

Abstract Background Varicose vein is a chronic condition that affects the lower extremities of the human body. Several factors have been implicated in the development of this disease, viz age, gender, weight, height and prolonged standing. Recently, genome-wide studies have identified genetic biomarkers that are associated with varicose veins in different ethnic groups. Such genetic studies are lacking in South Asians specifically in Indians where the prevalence of varicose veins is high, and it is important to replicate these variants in the stated population. The study aimed to replicate the association of genetic variants associated with varicose veins in this target population, which were found to be associated with the other ethnic groups. Methodology The studied cohort is of the Indian population comprising unrelated 104 varicose veins cases and 448 non-varicose vein controls. The samples were genotyped using the Illumina Global Screening Array. Using the genomic data from UK BioBank and 23andMe studied cohorts; eight genetic variants were selected to replicate in our dataset. The allelic association was performed to identify the effective allele and risk was estimated using odds ratio and p-value as level of significance. Multifactor Dimensionality Reduction was used to estimate the cumulative effect of variants in Indians. Result Variant rs3791679 of EFEMP1 was found to be associated with varicose veins in Indians. After observing the association of the EFEMP1 with varicose veins, we further ensued to identify all genetic variants within EFEMP1 to uncover the additional variants associated with this trait. Interestingly, we identified six new variants of EFEMP1 gene that have shown association. Moreover, the cumulative effect of all associated variations was estimated and the risk was 2.7 times higher in cases than controls whereas independently their effect ranges from 0.37–1.58. Conclusion This study identifies EFEMP1 as a potential gene related to the risk of varicose veins in Indians. It also highlights that evaluating the maximum number of variants of a gene rather than focusing solely on replicating single variations offers a more comprehensive and nuanced understanding of the genetic factors contributing to a complex trait like varicose veins.

Introduction: Tissue Microarray (TMA) is a novel technique that is now integral in pre-clinical and translational research. In resource-limited settings, automated microarrayers and molds are out of reach, and manual TMA construction may be done instead. Aim: To explore the pitfalls encountered while constructing manual TMAs and to troubleshoot these problems using the available resources. Materials and Methods: A cross-sectional study was done between September 2019 and March 2021 in the Department of Pathology at a tertiary healthcare center in New Delhi using 60 mastectomy specimens. Five manual TMAs were constructed using simple, cheap, and readily available resources. Problems encountered during the construction were identified and documented. Solutions attempted to troubleshoot the common problems were documented, and their outcomes were evaluated. Results: Difficulty in core extraction, cracking of TMAs during core insertion, loss of cores, misalignment of cores, bulging of blocks, difficulty in sectioning due to non-uniform cores, and loss of cores during sectioning were major problems identified. Simple measures such as prior warming of both donor and recipient blocks, use of punch biopsy needles with a plunger, maintaining a margin around the cores, using wax cores to align cores, and adequate cooling prior to sectioning helped in overcoming these problems. Other solutions that were attempted but did not yield satisfying results included the use of agarose in paraffin blocks and the use of liquid wax to seal cracks and gaps. Conclusion: Manual TMA is not only feasible, it is easy to construct once the technique is learned and the problems that commonly arise in its construction are tackled. The modifications suggested in the present study can aid in constructing these microarrays faster and avoid both wastage of time and resources. TMAs can thus be used as an alternative to traditional paraffin-based techniques for research applications in resource-limited centers with high patient loads.

Abstract Context Children with human immunodeficiency virus (HIV) infection frequently present with opportunistic infections of the lung that may be associated with high mortality rate. There is no study, to the best of our knowledge, correlating specific radiographic patterns of chest infections with CD4 levels of immunity in HIV-infected children of Indian subcontinent (where prevalence of respiratory tuberculosis is very high). Aims To study the radiological patterns of chest infections in HIV-infected children, and to correlate these radiological findings with CD4 cell count and final diagnosis. Methods Forty-five HIV-infected children (1–18 years of age) with suspected chest infections were included in the study. The baseline and the most recent CD4 counts were recorded for each patient. Chest X-ray (CXR) was obtained in all the patients, and multi-detector computed tomography (MDCT) chest was done in 27 patients having clinical suspicion of infection with normal or equivocal findings on CXR. Chest radiographs and MDCT chest were analyzed for different radiological patterns of chest infections. Imaging findings were correlated with CD4 count range for disease spectrum. The final etiopathological diagnosis was achieved in combination with clinico-radiological findings, laboratory data, cytohistopathology and follow-up imaging. Results Out of 45 children confirmed to be HIV-infected, 27 (60%) had bacterial infection, 14 (31.11%) had tuberculosis, and four (8.89%) had fungal infection. Consolidation on CXR/CT strongly suggested bacterial etiology (P

Purpose: Proteins and peptides have secured a place as excellent therapeutic moieties on account of their high selectivity and efficacy. However due to oral absorption limitations, current formulations are mostly delivered parenterally. Oral delivery of peptides and proteins (PPs) can be considered the need of the hour due to the immense benefits of this route. This review aims to critically examine and summarize the innovations and mechanisms involved in oral delivery of peptide and protein drugs. Methods: Comprehensive literature search was undertaken, spanning the early development to the current state of the art, using online search tools (PubMed, Google Scholar, ScienceDirect and Scopus). Results: Research in oral delivery of proteins and peptides has a rich history and the development of biologics has encouraged additional research effort in recent decades. Enzyme hydrolysis and inadequate permeation into intestinal mucosa are the major causes that result in limited oral absorption of biologics. Pharmaceutical and technological strategies including use of absorption enhancers, enzyme inhibition, chemical modification (PEGylation, pro-drug approach, peptidomimetics, glycosylation), particulate delivery (polymeric nanoparticles, liposomes, micelles, microspheres), site-specific delivery in the gastrointestinal tract (GIT), membrane transporters, novel approaches (self-nanoemulsifying drug delivery systems, Eligen technology, Peptelligence, self-assembling bubble carrier approach, luminal unfolding microneedle injector, microneedles) and lymphatic targeting, are discussed. Limitations of these strategies and possible innovations for improving oral bioavailability of protein and peptide drugs are discussed. Conclusion: This review underlines the application of oral route for peptide and protein delivery, which can direct the formulation scientist for better exploitation of this route.

Abstract Despite the wealth of publicly available single-cell datasets, our understanding of distinct resident immune cells and their unique features in diverse human organs remains limited. To address this, we compiled a meta-analysis dataset of 114,275 CD45+ immune cells sourced from 14 organs in healthy donors. While the transcriptome of immune cells remains relatively consistent across organs, our analysis has unveiled organ-specific gene expression differences (GTPX3 in kidney, DNTT and ACVR2B in thymus). These alterations are linked to different transcriptional factor activities and pathways including metabolism. TNF-α signaling through the NFkB pathway was found in several organs and immune compartments. The presence of distinct expression profiles for NFkB family genes and their target genes, including cytokines, underscores their pivotal role in cell positioning. Taken together, immune cells serve a dual role: safeguarding the organs and dynamically adjusting to the intricacies of the host organ environment, thereby actively contributing to its functionality and overall homeostasis.

Abstract The aus (Oryza sativa L.) varietal group comprises of aus, boro, ashina and rayada seasonal and/or field ecotypes, and exhibits unique stress tolerance traits, making it valuable for rice breeding. Despite its importance, the agro-morphological diversity and genetic control of yield traits in aus rice remain poorly understood. To address this knowledge gap, we investigated the genetic structure of 181 aus accessions using 399,115 SNP markers and evaluated them for 11 morpho-agronomic traits. Through genome-wide association studies (GWAS), we aimed to identify key loci controlling yield and plant architectural traits. Our population genetic analysis unveiled six subpopulations with strong geographical patterns. Subpopulation-specific differences were observed in most phenotypic traits. Principal component analysis (PCA) of agronomic traits showed that principal component 1 (PC1) was primarily associated with panicle traits, plant height, and heading date, while PC2 and PC3 were linked to primary grain yield traits. GWAS using PC1 identified OsSAC1 on Chromosome 7 as a significant gene influencing multiple agronomic traits. PC2-based GWAS highlighted the importance of OsGLT1 and OsPUP4/ Big Grain 3 in determining grain yield. Haplotype analysis of these genes in the 3,000 Rice Genome Panel revealed distinct genetic variations in aus rice. In summary, this study offers valuable insights into the genetic structure and phenotypic diversity of aus rice accessions. We have identified significant loci associated with essential agronomic traits, with GLT1, PUP4, and SAC1 genes emerging as key players in yield determination.

Abstract Background The COVID-19 pandemic posed numerous obstacles to psychosocial wellbeing for children. We conducted a longitudinal study to evaluate child mental health and social risks during the pandemic. Methods Participants were 172 caregivers of children aged 6–11 years old who attended well child visits within 6 months before pandemic onset at an urban safety net hospital in the US. Prepandemic data was extracted from the electronic medical record, and surveys were administered at three time points between August 2020 and July 2021. We measured mental health symptoms with the Pediatric Symptom Checklist-17, social risks (e.g., food and housing insecurity) with the THRIVE questionnaire, and school modality (in-person, hybrid, remote). Results Compared to pre-pandemic, children had significantly higher PSC-17 total scores (overall mental health symptoms) and THRIVE total scores (total burden of social risks) at all three mid-pandemic waves. Using longitudinal mixed models accounting for time, social risks, and school modality, both social risks (B = 0.37, SE = 0.14, p

Abstract Cross-presentation by type 1 DCs (cDC1) is critical to induce and sustain antitumoral CD8 T cell responses to model antigens, in various tumor settings. However, the impact of cross-presenting cDC1 and the potential of DC-based therapies in tumors carrying varied levels of bona-fide neoantigens (neoAgs) remain unclear. Here we develop a hypermutated model of non-small cell lung cancer in female mice, encoding genuine MHC-I neoepitopes to study neoAgs-specific CD8 T cell responses in spontaneous settings and upon Flt3L + αCD40 (DC-therapy). We find that cDC1 are required to generate broad CD8 responses against a range of diverse neoAgs. DC-therapy promotes immunogenicity of weaker neoAgs and strongly inhibits the growth of high tumor-mutational burden (TMB) tumors. In contrast, low TMB tumors respond poorly to DC-therapy, generating mild CD8 T cell responses that are not sufficient to block progression. scRNA transcriptional analysis, immune profiling and functional assays unveil the changes induced by DC-therapy in lung tissues, which comprise accumulation of cDC1 with increased immunostimulatory properties and less exhausted effector CD8 T cells. We conclude that boosting cDC1 activity is critical to broaden the diversity of anti-tumoral CD8 T cell responses and to leverage neoAgs content for therapeutic advantage.

Abstract Viral fusion proteins facilitate cellular infection by fusing viral and cellular membranes, which involves dramatic transitions from their pre- to postfusion conformations. These proteins are among the most protective viral immunogens, but they are metastable which often makes them intractable as subunit vaccine targets. Adapting a natural enzymatic reaction, we harness the structural rigidity that targeted dityrosine crosslinks impart to covalently stabilize fusion proteins in their native conformations. We show that the prefusion conformation of respiratory syncytial virus fusion protein can be stabilized with two engineered dityrosine crosslinks (DT-preF), markedly improving its stability and shelf-life. Furthermore, it has 11X greater potency as compared with the DS-Cav1 stabilized prefusion F protein in immunogenicity studies and overcomes immunosenescence in mice with simply a high-dose formulation on alum.

Objective: Oral submucous fibrosis (OSMF) is manifested by symptoms such as palpable fibrotic bands, ulceration, presence of stiffness in the mouth and lip, xerostomia, pigmentation in the oral mucosal layer, and burning sensation and drying of the mouth. It poses a challenge for researchers as there is no viable therapy for this gradually debilitating disorder with a high malignancy potential. Ayurveda is a traditional medicinal practice of the past and present times which can be useful in providing a viable cure. Thus, the current study was designed to assess and compare the effect of Oxitard capsule and Immusante tablet on the clinical and subjective symptoms of OSMF. Material and Methods: The study included 36 patients with clinically diagnosed OSMF who were split evenly into two groups: Group A, the Oxitard group, and Group B, the Immusante group. For three months, Group A received two Oxitard capsules twice daily, while Group B received two Immusante tablets twice daily. At regular intervals, the clinical parameters were evaluated, and the data were analysed using repeated measures ANOVA and the Bonferroni post hoc test. P-value≤0.05 was regarded as statistically significant. Results: On assessment of mouth opening, tongue protrusion, cheek flexibility and subjective symptoms there was significant improvement reported in both groups. In group comparison, the Oxitard and Immusante groups showed a significant difference in cheek flexibility at 3 months. There were no significant differences in subjective symptoms in either of the groups pre- and post-treatment. Conclusion: Efficacy of both the drugs were equall was found to be similar when used as an adjunct to tobacco cessation counselling in the management of early stages of oral submucous fibrosis when used as an adjunct to behavioral management.

IntroductionThe acute respiratory distress syndrome (ARDS) is a common complication of severe COVID-19 and contributes to patient morbidity and mortality. ARDS is a heterogeneous syndrome caused by various insults, and results in acute hypoxemic respiratory failure. Patients with ARDS from COVID-19 may represent a subgroup of ARDS patients with distinct molecular profiles that drive disease outcomes. Here, we hypothesized that longitudinal transcriptomic analysis may identify distinct dynamic pathobiological pathways during COVID-19 ARDS.MethodsWe identified a patient cohort from an existing ICU biorepository and established three groups for comparison: 1) patients with COVID-19 ARDS that survived hospitalization (COVID survivors, n = 4), 2) patients with COVID-19 ARDS that did not survive hospitalization (COVID non-survivors, n = 5), and 3) patients with ARDS from other causes as a control group (ARDS controls, n = 4). RNA was isolated from peripheral blood mononuclear cells (PBMCs) at 4 time points (Days 1, 3, 7, and 10 following ICU admission) and analyzed by bulk RNA sequencing.ResultsWe first compared transcriptomes between groups at individual timepoints and observed significant heterogeneity in differentially expressed genes (DEGs). Next, we utilized the likelihood ratio test to identify genes that exhibit different patterns of change over time between the 3 groups and identified 341 DEGs across time, including hemoglobin subunit alpha 2 (HBA1, HBA2), hemoglobin subunit beta (HBB), von Willebrand factor C and EGF domains (VWCE), and carbonic anhydrase 1 (CA1), which all demonstrated persistent upregulation in the COVID non-survivors compared to COVID survivors. Of the 341 DEGs, 314 demonstrated a similar pattern of persistent increased gene expression in COVID non-survivors compared to survivors, associated with canonical pathways of iron homeostasis signaling, erythrocyte interaction with oxygen and carbon dioxide, erythropoietin signaling, heme biosynthesis, metabolism of porphyrins, and iron uptake and transport.DiscussionThese findings describe significant differences in gene regulation during patient ICU course between survivors and non-survivors of COVID-19 ARDS. We identified multiple pathways that suggest heme and red blood cell metabolism contribute to disease outcomes. This approach is generalizable to larger cohorts and supports an approach of longitudinal sampling in ARDS molecular profiling studies, which may identify novel targetable pathways of injury and resolution.

Design Education today is being imparted across the globe by varied institutions. We frequently witness new academic approaches, teaching methods, and pedagogies being discussed, and presented at various Design symposiums, and conferences, in the attempt of improving Design Education. While some investigate new strategies via experimentation and imaginative lenses, others investigate past wisdom to identify its relevance in the present context. The paper explores the latter through the teaching methods of ancient Indian teachers (also called Rishis) and seeks to determine its significance in the modern context. Ancient India had a long and illustrious history of learning and education. There are several examples that stand out and have valuable lessons for educators of today and future. The paper incorporates instances from Pt. Sriram Sharma Acharya's ‘Pragya Purana: Devsanskriti Khand (fourth volume)’, which contains references to Indian culture, gurukuls, and the old Indian educational system. The paper discusses three instances of which one presents an intriguing relationship between diet and education as explained by Maharishi Uddalaka. Another instance is Maharishi Uddalaka's description of how he teaches in the absence of any physical infrastructure, while the last instance is from Takshashila, where Acharya Brahaspati employs a novel method of assessing his Ayurvedic pupil before he graduates. The paper goes into additional detail about the instances cited above from the ‘Pragya Purana’, that demonstrate significant takeaways for the Design education.

Introduction Hepatic artery complications (HACs), such as a thrombosis or stenosis, are serious causes of morbidity and mortality after paediatric liver transplantation (LT). This study will investigate the incidence, current management practices and outcomes in paediatric patients with HAC after LT, including early and late complications.Methods and analysis The HEPatic Artery stenosis and Thrombosis after liver transplantation In Children (HEPATIC) Registry is an international, retrospective, multicentre, observational study. Any paediatric patient diagnosed with HAC and treated for HAC (at age

The current study was aimed to explore the effect of light and traffic noise pollution exposure on behavioral and neurochemical deficits in adult male Wistar rats. We hypothesized that exposure to these pollutants alone or in combination may cause behavioral deficits in rats. Animals were allocated into different groups and were exposed to either varying light cycles (150 lx-5 lx, 14:10 h) or traffic noise with sound level 100 dBA for 6 h/day or both for 28 days. Concurrently, Curcumin (100 mg/kg; per oral; 28 days) was administered in varying light cycles and noise exposed animal groups to study the preventive effect. After the exposure time, the Morris water maze test, elevated plus maze test, novel object recognition test, locomotor activity test, and forced swimming test were conducted. The neurobehavioral results suggested that only combined exposure of light and noise pollution markedly impaired the learning as well as spatial and reference memory in rats. Furthermore, we found significant anxiety (less no. of open arm entries in EPM) and depressive-like behavior (increased immobility time) in light or/and traffic noise pollution exposed group animals in comparison to normal control groups. Curcumin treatment significantly prevented the behavioral anomalies in combined light and noise exposed rats. Furthermore, our results revealed augmentation of acetylcholinesterase, oxidative stress markers and interleukin (IL)-1β in the hippocampal region of noise and light-exposed groups which were markedly ameliorated by curcumin. In conclusion, our results suggest that curcumin significantly modulates light and noise pollution exposed behavioral and neurochemical anomalies in rats.

Abstract Introduction With locally advanced pancreatic cancer (LAPC), uncontrolled local tumor growth frequently leads to mortality. Advancements in radiotherapy (RT) techniques have enabled conformal delivery of escalated‐dose RT (EDR), which may have potential local control and overall survival (OS) benefits based on retrospective and early prospective studies. With evidence for EDR emerging, we characterized the adoption of EDR across the United States and its associated outcomes. Methods We searched the National Cancer Database for nonsurgically managed LAPC patients diagnosed between 2004 and 2019. Pancreas‐directed RT with biologically effective doses (BED10) ≥39 and ≤70 Gy was labeled conventional‐dose RT (CDR), and BED10 >70 and ≤132 Gy was labeled EDR. We identified associations of EDR and OS using logistic and Cox regressions, respectively. Results Among the definitive therapy subset (n = 54,115) of the entire study cohort (n = 91,493), the most common treatments were chemotherapy alone (69%), chemotherapy and radiation (29%), and RT alone (2%). For the radiation therapy subset (n = 16,978), use of pancreas‐directed RT remained between 13% and 17% over the study period (ptrend > 0.999). Using multivariable logistic regression, treatment at an academic/research facility (adjusted odds ratio [aOR] 1.46, p

Este estudio investiga los efectos del día de la semana en el mercado digital, con un enfoque en bitcoin y ethereum, abarcando desde el 1º de julio de 2020 hasta el 31 de diciembre de 2023, en el período posterior al COVID-19. Empleando pruebas paramétricas y no paramétricas junto con el modelo GARCH (1,1), se analizó la dinámica del mercado. Los hallazgos indican un efecto significativo del día de la semana en ethereum, caracterizado por notables variaciones de rendimiento entre diferentes días, mientras que itcoin no muestra anomalías de calendario discernibles, lo que sugiere una mayor eficiencia del mercado. La susceptibilidad de ethereum a estos efectos subraya las complejidades actuales del mercado. Las disparidades en las anomalías del calendario surgen de la evolución de la dinámica del mercado, las diferencias metodológicas y la naturaleza especulativa del comercio de criptomonedas. Además, el mercado descentralizado y global complica la identificación precisa de los efectos en todo el mercado. Este estudio proporciona evidencia empírica sobre los efectos del día de la semana en el mercado de criptomonedas, lo que facilita a los inversionistas refinar las estrategias comerciales y la gestión de riesgos. Se justifica realizar más investigaciones para explorar los mecanismos subyacentes y monitorear los desarrollos regulatorios y tecnológicos para obtener información de los inversionistas.

Utilizing agricultural and industrial wastes, potent reservoirs of nutrients, for nourishing the soil and crops through composting embodies a sustainable approach to waste management and organic agriculture. To investigate this, a 2-year field experiment was conducted at ICAR-IARI, New Delhi, focusing on a pigeon pea–vegetable mustard–okra cropping system. Seven nutrient sources were tested, including a control (T1), 100% recommended dose of nitrogen (RDN) through farmyard manure (T2), 100% RDN through improved rice residue compost (T3), 100% RDN through a paddy husk ash (PHA)–based formulation (T4), 75% RDN through PHA-based formulation (T5), 100% RDN through a potato peel compost (PPC)–based formulation (T6), and 75% RDN through PPC-based formulation (T7). Employing a randomized block design with three replications, the results revealed that treatment T4 exhibited the significantly highest seed (1.89 ± 0.09 and 1.97 ± 0.12 t ha−1) and stover (7.83 ± 0.41 and 8.03 ± 0.58 t ha−1) yield of pigeon pea, leaf yield (81.57 ± 4.69 and 82.97 ± 4.17 t ha−1) of vegetable mustard, and fruit (13.54 ± 0.82 and 13.78 ± 0.81 t ha−1) and stover (21.64 ± 1.31 and 22.03 ± 1.30 t ha−1) yield of okra during both study years compared to the control (T1). Treatment T4 was on par with T2 and T6 for seed and stover yield in pigeon pea, as well as okra, and leaf yield in vegetable mustard over both years. Moreover, T4 demonstrated notable increase of 124.1% and 158.2% in NH4-N and NO3-N levels in the soil, respectively, over the control. The enhanced status of available nitrogen (N) and phosphorus (P) in the soil, coupled with increased soil organic carbon (0.41%), total bacteria population (21.1%), fungi (37.2%), actinomycetes (44.6%), and microbial biomass carbon (28.5%), further emphasized the positive impact of T4 compared to the control. Treatments T2 and T6 exhibited comparable outcomes to T4 concerning changes in available N, P, soil organic carbon, total bacteria population, fungi, actinomycetes, and microbial biomass carbon. In conclusion, treatments T4 and T6 emerge as viable sources of organic fertilizer, particularly in regions confronting farmyard manure shortages. These formulations offer substantial advantages, including enhanced yield, soil quality improvement, and efficient fertilizer utilization, thus contributing significantly to sustainable agricultural practices.

The applications of divergence measures in the fields of information is the study of related problems in information processing, information storage, information retrieval and so on. In particular, in this paper, with the help of the new f-divergence measure, we obtained the new information inequalities which related to two divergence measures. Also discussed about convexity of the function and bounds for divergence measures using new f- divergence measures and their properties.

The experiments were conducted during winter (rabi) seasons of 2020–21 and 2021–22 at Rajasthan College of Agriculture, Maharana Pratap University of Agriculture and Technology, Udaipur, Rajasthan to study the effect of fertility levels and biofertilizers on malt barley (Hordeum vulgare L.). Factorial randomized block design (F-RBD) was used comprising 15 treatment combinations involved 3 fertility levels, viz. 50 N + 25 P2O5 + 15 K2O kg/ha; 60 N + 30 P2O5 + 20 K2O kg/ha; and 70 N + 40 P2O5 + 25 K2O kg/ha; alongside 5 liquid biofertilizers, viz. control; Azotobacter; Phosphorous solubilizing bacteria; Potassium mobilizing bacteria; and Azotobacter + Phosphorous solubilizing bacteria + Potassium mobilizing bacteria. The findings indicate that applying a fertilizer combination of 70 N + 40 P2O5 + 25 K2O kg/ha to malt barley crop significantly enhanced plant height at harvest (118.74 cm), dry- matter accumulation/m row at harvest (356.88 g), leaf area index (LAI) at 50 DAS (days after sowing) (1.69) and 75 DAS (2.87), number of total tillers (89.97) and growth efficiency values, substantially greater than other fertility levels. The findings demonstrated that inoculating seeds with a combination of liquid biofertilizers containing Azotobacter + Phosphorous solubilizing bacteria + Potassium mobilizing bacteria significantly improved growth parameters, viz. plant height at harvest (117.55 cm), dry-matter accumulation/m row at harvest (371.25 g), LAI at 50 DAS (1.68) and 75 DAS (2.96), number of total tillers (90.08) and growth efficiency values.

The greenness assessment of analytical methods is an important aspect of green analytical chemistry, which focuses on making analytical procedures eco-friendly and safer. This study conducts a thorough comparative analysis of chromatographic methods utilized in the analysis of Cilnidipine (CLN), a commonly employed antihypertensive medication. The research aims to not only evaluate the analytical performance of different chromatographic techniques but also assess their environmental impact, with a focus on promoting sustainable and eco-friendly practices in pharmaceutical analysis.The greenness profiles of twelve chromatographic methods for CLN and its derivatives were evaluated utilizing multiple assessment metrics including the Green Analytical Procedure Index (GAPI), Analytical GREEness (AGREE), Analytical eco-scale (ESA), Chloroform-oriented Toxicity Estimation (ChlorTox scale), Blue Applicability Grade Index (BAGI), and Red-Green-Blue 12 (RBG 12). By quantifying the environmental implications, the study aims to highlight the importance of adopting greener practices in pharmaceutical analysis. This assessment encompasses considerations such as solvent used, energy consumed, and waste generated by the method. The outcomes of this research contribute valuable insights into the selection of environmentally friendly chromatographic methods for CLN, promoting a balance between analytical efficiency and ecological responsibility in the pharmaceutical field.

The purpose is to describe image quality metrics such as modulation transfer function (MTF) and Strehl ratio and higher order aberration (HOA) with corneo scleral lens (CSL) in keratoconus. A 25-year-old male visited the outpatient department with a complaint of diminution of distance vision in the right eye. His best-corrected visual acuity was 6/60 and 6/6 partial in the right and left eyes, respectively. Slit-lamp examination revealed right eye keratoconus and left eye was Forme fruste keratoconus. There was a history of corneal collagen cross-linking with riboflavin in the right eye. The patient was dispensed with corneo-scleral contact lens and the left eye was managed with spectacle. Corneal HOA, MTF, and Strehl ratio were measured without and with CSL using iTrace aberrometer. A significant reduction in corneal HOA and improvement in image quality metrics were noted with CSL.

Since 2008, Baclofen’s gamut has gradually evolved from an anti-spastic agent to an off label anti-craving agent in Alcohol Use Disorders. However, with its accreditation in addictions psychiatry, have emerged additional risk of abuse of its relaxant properties. Over the last decade there have been increase in reports of its abuse for recreation or intentional self-harm. A high index of suspicion should be exercised in patients of Alcohol Use Disorders presenting with unexplained features of central nervous system depression. We hereby report a case of alcoholic dependence syndrome who presented in an unconscious state with bradycardia, bradypnea and pin-pointed fixed pupils after ingestion of 200 mg of tablet Baclofen with around 65 grams of alcohol and posed a diagnostic challenge.