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BACKGROUND: The healthcare system in India is tiered and has primary, secondary and tertiary levels of facilities depending on the complexity and severity of health challenges at these facilities. Evidence suggests that emergency services in the country is fragmented. This study aims to identify the barriers and facilitators of emergency care delivery for patients with time-sensitive conditions, and develop and implement a contextually relevant model, and measure its impact using implementation research outcomes. METHODS: We will study 85 healthcare facilities across five zones of the country and focus on emergency care delivery for 11 time-sensitive conditions. This implementation research will include seven phases: the preparatory phase, formative assessment, co-design of Model "Zero", co-implementation, model optimization, end-line evaluation and consolidation phase. The "preparatory phase" will involve stakeholder meetings, approval from health authorities and the establishment of a research ecosystem. The "formative assessment" will include quantitative and qualitative evaluations of the existing healthcare facilities and personnel to identify gaps, barriers and facilitators of emergency care services for time-sensitive conditions. On the basis of the results of the formative assessment, context-specific implementation strategies will be developed through meetings with stakeholders, providers and experts. The "co-design of Model 'Zero'" phase will help develop the initial Model "Zero", which will be pilot tested on a small scale (co-implementation). In the "model optimization" phase, iterative feedback loops of meetings and testing various strategies will help develop and implement the final context-specific model. End-line evaluation will assess implementation research outcomes such as acceptability, adoption, fidelity and penetration. The consolidation phase will include planning for the sustenance of the interventions. DISCUSSION: In a country such as India, where resources are scarce, this study will identify the barriers and facilitators to delivering emergency care services for time-sensitive conditions across five varied zones of the country. Stakeholder and provider participation in developing consensus-based implementation strategies, along with iterative cycles of meetings and testing, will help adapt these strategies to local needs. This approach will ensure that the developed models are practical, feasible and tailored to the specific challenges and requirements of each region.

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Introduction: Bony subungual growths arising on the digital tip are uncommon. Among these, subungual exostosis is a common cause. Case Presentation: We describe a 35-year-old-male patient with a rare occurrence of a fibro-osseus pseudotumor of the digit. It presents with reactive intramembranous ossification, with no continuity with the distal phalanx, helping differentiate it from a subungual exostosis. The patient presented with an asymptomatic subungual growth, lifting up the nail plate distally causing onycholysis. The characteristic clinical, radiological, and histopathological features of the case are described, which helped confirm the diagnosis. Conclusion: Cases with fibro-osseus pseudotumor of the digit reported in literature are reviewed comprehensively. The factors helping differentiate this from the other bony tumors affecting the distal phalanx, including subungual exostosis, myositis ossificans, and osteosarcoma are also highlighted.

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The screening and evaluation of different waste lignocellulosic biomasses to meet the ever-increasing energy demand, from the widely available waste lignocellulosic biomasses evaluated. For the current study, peanut shell biomass is considered for energy procreation. However, the energy content of biomass is still lesser as compared to conventional fossil fuels like coal and petroleum. The dilute acid pretreatment has been proven to improve the energy content of the lignocellulosic biomasses to a significant extent. Various pretreatment process parameters have been reported to have different degrees of impact on the betterment of energy procreation. Among various types of pretreatments, dilute acid pretreatment holds notable cognizance. Accordingly, the current manuscript is to evaluate the impact of various pretreatment process parameters (time, temperature, acid concentration, mass:liquor ratio, and particle size which were defined through an exhaustive literature search) for improving the energy recovery potential. The obtained results indicated notable changes in the devolatilization characteristics of the biomass as a result of pretreatment, thereby resulting in the upgradation of the fuel properties. A sustainability investigation has been carried out to point out the efficacy of the optimized pretreatment of biomass in terms of environmental sustainability and was also compared with the raw variant (untreated form of biomass). The proposed scheme of study will definitely be beneficial toward the mitigation of the energy crisis in the state of Jharkhand.

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It is a formidable challenge to treat tuberculosis as there are increasing cases of multidrugresistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) cases. Moreover, the emergence of totally drug-resistant tuberculosis (TDR-TB) makes it vital and imperative to develop a new generation of anti-tubercular drugs to have control over resistance. The nitrogencontaining heterocyclic class of compounds is being studied extensively to ascertain their anti-TB potentials. Nitrogen-containing compounds have a broad range of targets; wherein, InhA is the most important one. Hence, the primary focus of this review is to summarize the recent developments in the discovery of nitrogen-containing heterocyclic compounds as InhA inhibitors to combat tuberculosis.

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Stress and lack of quality sleep affect a large portion of the population around the globe, and the COVID-19 pandemic has genuinely brought attention to these problems. This study aimed to investigate whether using a virtual heart-based meditation program is associated with improved stress levels and quality of sleep among participants from the general population during the COVID-19 pandemic. We recruited 63 participants to receive an 8-week virtually conducted Heartfulness meditation program in a prospective pre-post single-arm intervention study from September 28 to November 22 2020. Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI) scores were collected at baseline, at 4 weeks, and 8 weeks. Of the 63 participants enrolled in the study, 36 (57%) completed an 8-week Heartfulness meditation program. There was a significant decrease in PSS (mean difference of 6.68 with 95% C.I. 4.89-8.47, p < 0.0001) and in PSQI (mean difference of 2.05 with 95% C.I. 1.03-3.07, p < 0.0001) between week zero and week eight, regardless of Health Care Professional status. The qualitative thematic analysis strongly supported the survey results. A significant reduction in perceived stress score and improvement in sleep quality index was noted at the end of a virtual Heartfulness meditation program. Moreover, Heartfulness meditation practice may help cultivate the quality of empathy, acceptance, and individual peace. We conclude that the effects of virtually accessible Heartfulness meditation practice need to be explored further in larger studies.

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In December 2019, a large number of coronavirus cases were emerged in Wuhan, Hubei Province, China and rapidly spread to different countries and territories around the world within four months. The World Health Organization (WHO) declared this outbreak as a global health emergency. The spread of COVID-19 over globe is highly contagious; they transmitted from person-to-person through small droplets of infected person. Many diagnosis and treatment methods have been implemented to reduce and control the outbreak. Efforts have been made to develop coronavirus vaccine against S protein or spike glycoprotein of coronavirus. COVID-19 outbreak will affect the Gross Domestic Product (GDP) of the world. At the time of preparing manuscript, total number of active cases reaches to more than 8.9 million and confirmed death reaches to approx. 4.6 lakh. This article highlights the ongoing research and advances in designing vaccine and therapeutics against COVID-19 and also focusing on the epidemiology, transmission, future direction and control the spread of infectious diseases.

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BACKGROUND AND AIM: Benzodiazepines (BZD) are widely prescribed to substance users. However, the nonmedical use of prescription BZD often leads to abuse and dependence. Therefore, it is important to detect BZD among substance users seeking treatment. The aim of the present study was to develop an efficient method for testing BZD on dried urine spot (DUS) and evaluating its clinical applicability. METHODS: This involved optimization of conditions for the detection, recovery, and stability of BZD from dried urine, spotted on filter paper. Enzyme linked immuno-sorbent assay was used for screening whereas confirmation was done by gas chromatography. For clinical applicability, urine samples of BZD users were tested. RESULTS: The recovery was found to be 99.7% in de-ionized water from 20 µl spotted urine samples. Limit of detection, inter-day and intra-day CV were found to be 100 ng/ml, 4.22% and 3.83%, respectively. BZD were found stable in DUS for 3 weeks at room temperature, and for 3 months at 4°C and -20°C. All the urine samples of benzodiazepine users were found positive by conventional method as well as the DUS method. CONCLUSION: DUS method proved to be efficient for BZD testing with advantages of ease of collection, transportation, minimal invasiveness and small sample volume. It offers a useful alternative for BZD testing especially in developing countries where logistics of sample collection and transportation could be an important concern.

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JNK pathway regulates various physiological processes including inflammatory responses, cell differentiation, cell proliferation, cell death, cell survival and expression of proteins. Deregulation of JNK is linked with various diseases including neurodegenerative disease, autoimmune disease, diabetes, cancer, cardiac hypertrophy and asthma. Three distinct genes JNK1, JNK2 and JNK3 have been identified as regulator of JNK pathway. JNK1 and JNK2 have broad tissue distribution and play a potential role in insulin resistance, inflammation and cell signaling. JNK3 is predominantly found in the CNS neurons, making it an attractive target for neurodegenerative disorders. In this review, we summarize the evidence supporting JNK as a potent therapeutic target, and small molecules from various chemical classes as JNK inhibitors.

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Enhanced production of steviol glycosides (SGs) was observed in callus and suspension culture of Stevia rebaudiana treated with proline and polyethylene glycol (PEG). To study their effect, yellow-green and compact calli obtained from in vitro raised Stevia leaves were sub-cultured on MS medium supplemented with 2.0 mg l(-1) NAA and different concentrations of proline (2.5-10 mM) and PEG (2.5-10 %) for 2 weeks, and incubated at 24 ± 1 °C and 22.4 µmol m(-2) s(-1) light intensity provided by white fluorescent tubes for 16 h. Callus and suspension culture biomass (i.e. both fresh and dry weight content) was increased with 5 mM proline and 5 % PEG, while at further higher concentrations, they got reduced. Further, quantification of SGs content in callus (collected at 15th day) and suspension culture (collected at 10th and 15th day) treated with and without elicitors was analysed by HPLC. It was observed that chemical stress enhanced the production of SGs significantly. In callus, the content of SGs increased from 0.27 (control) to 1.09 and 1.83 % with 7.5 mM proline and 5 % PEG, respectively, which was about 4.0 and 7.0 times higher than control. However, in the case of suspension culture, the same concentrations of proline and polyethylene glycol enhanced the SG content from 1.36 (control) to 5.03 and 6.38 %, respectively, on 10th day which were 3.7 times and 4.7 times higher than control.

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BACKGROUND: Immunization remains one of the most important public health interventions and a cost-effective strategy to reduce both the morbidity and mortality associated with infectious diseases. Over two million deaths are delayed through immunization each year worldwide. AIMS: This study sought to identify specific factors associated with immunization coverage in order to advance improved intervention, policies/strategies therefore raising overall immunization coverage. MATERIALS AND METHODS: A cross-sectional study was conducted among a total of 198 children aged 12-23 months at Urban Health and Training Centre (UHTC), Era's Lucknow Medical College, Lucknow, over a period of 6 months i.e., from July 2012-December 2012. Data were collected, compiled and tabulated using Microsoft Excel and analyzed using SPSS 17.0 version. RESULTS: A total of 198 children of age 12-23 months were included in this study, of which 74.7% of children were fully immunized, 11.1% were partially immunized and 14.1% were not immunized at all. The most common reason for partial or non-immunization was family problems (24%) of the respondents followed by lack of knowledge of immunization (20%), and fear of side effects (16%). The odds of risk of partial/non-immunization in illiterate women is 5.78 more than the graduate women (P = 0.039). CONCLUSIONS: Although in the present study, majority of the children were immunized, it is still not up to the mark. We have to make it 100%, so that we can reduce mortality due to vaccine-preventable diseases. Increasing awareness and reducing fear of side effects of immunization among parents through health education, counseling, etc. can increase the percentage of immunized children.

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CONTEXT: Placenta accreta is the abnormal adherence of the placenta to the uterine wall and the most common cause for emergency postpartum hysterectomy. Accurate prenatal diagnosis of affected pregnancies allows optimal obstetric management. AIMS: To summarize our experience in the antenatal diagnosis of placenta accreta on imaging in a tertiary care setup. To compare the accuracy of ultrasound (USG) with color Doppler (CDUS) and magnetic resonance imaging (MRI) in prenatal diagnosis of placenta accreta. SETTINGS AND DESIGN: Prospective study in a tertiary care setup. MATERIALS AND METHODS: A prospective study was conducted on pregnant females with high clinical risk of placenta accreta. Antenatal diagnosis was established based on CDUS and MRI. The imaging findings were compared with final diagnosis at the time of delivery and/or pathologic examination. STATISTICAL ANALYSIS USED: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both CDUS and MRI. The sensitivity and specificity values of USG and MRI were compared by the McNemar test. RESULTS: Thirty patients at risk of placenta accreta underwent both CDUS and MRI. Eight cases of placenta accreta were identified (3 vera, 4 increta, and 1 percreta). All patients had history of previous cesarean section. Placenta previa was present in seven out of eight patients. USG correctly identified the presence of placenta accreta in seven out of eight patients (87.5% sensitivity) and the absence of placenta accreta in 19 out of 22 patients (86.4% specificity). MRI correctly identified the presence of placenta accreta in 6 out of 8 patients (75.0% sensitivity) and absence of placenta accreta in 17 out of 22 patients (77.3% specificity). There were no statistical differences in sensitivity (P = 1.00) and specificity (P = 0.687) between USG and MRI. CONCLUSIONS: Both USG and MRI have fairly good sensitivity for prenatal diagnosis of placenta accreta; however, specificity does not appear to be as good as reported in other studies. Both modalities have complimentary role and in cases of inconclusive findings with one imaging modality, the other modality may be useful for obtaining the diagnosis. CDUS remains the first primary modality for antenatal diagnosis of placenta accreta, with MRI reserved for cases where USG is inconclusive.

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Steviol glycosides are natural non-caloric sweeteners which are extracted from the leaves of Stevia rebaudiana plant. Present study deals the effect of salts (NaCl and Na2CO3) on callus and suspension culture of Stevia plant for steviol glycoside (SGs) production. Yellow-green and compact calli obtained from in vitro raised Stevia leaves sub-cultured on MS medium supplemented with 2.0 mg l(-1) NAA and different concentrations of NaCl (0.05-0.20%) and Na2CO3 (0.0125-0.10%) for 2 weeks, and incubated at 24 ± 1 °C and 22.4 µmol m(-2) s(-1) light intensity provided by white fluorescent tubes for 16 h. Callus and suspension biomass cultured on salts showed less growth as well as browning of medium when compared with control. Quantification of SGs content in callus culture (collected on 15th day) and suspension cultures (collected at 10th and 15th days) treated with and without salts were analyzed by HPLC. It was found that abiotic stress induced by the salts increased the concentration of SGs significantly. In callus, the quantity of SGs got increased from 0.27 (control) to 1.43 and 1.57% with 0.10% NaCl, and 0.025% Na2CO3, respectively. However, in case of suspension culture, the same concentrations of NaCl and Na2CO3 enhanced the SGs content from 1.36 (control) to 2.61 and 5.14%, respectively, on the 10th day.

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BACKGROUND: Roughly 3 million children die every year of vaccine preventable diseases and a significant number of these children live in developing countries. The present study was conducted to assess the reasons for failure of immunization among 12-23-month-old children of Lucknow city in India. MATERIALS AND METHODS: Out of all villages in rural areas and mohallas in urban areas of Lucknow district, eight villages and eight mohallas were selected by simple random sampling. A community based cross-sectional study was done among 450 children aged 12-23 months. The immunization status of the child was assessed by vaccination card and by mother's recall. A pre-designed and pre-tested questionnaire was used to elicit information on reasons for failure of immunization. Data was analysed using statistical package for social services (SPSS) version 11.5. Chi square test was used to find out the significant association. RESULTS: Overall, 62.7% children were fully immunized, 24.4% children were partially immunized, and 12.9% children were not immunized. The major reasons for failure of immunization were postponing it until another time, child being ill and hence not brought to the centre for immunization, unaware of the need of immunization, place of immunization being too far, no faith in immunization, unaware of the need to return for 2(nd) and 3(rd) dose, mother being too busy, fear of side reactions, wrong ideas about immunization, and polio was considered only vaccine, and others. CONCLUSION: More awareness should be generated among the people living in rural and urban areas to immunize their children.

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On dissection of the abdomen of an adult male cadaver, in addition to the normal inferior vena cava on the right side, an unusual venous channel which connected the left renal vein with the left common iliac vein was found; (probably the left inferior vena cava). The left testicular and the left suprarenal veins were opening into the left renal vein as usual. Other than this, a retrocaval ureter was found on the right side. The works of previous authors have highlighted the incidence of a venacaval duplication and its surgical implications, but here, we are presenting a unique case of a double inferior vena cava with an anomalous retrocaval ureter. A conglomeration of such vascular malformations is of immense surgical importance, and it is indicative of a grossly defective angiogenesis. Keeping in mind the clinical relevance of the variations which were observed, an attempt was made to explain them in the light of the embryogenic development.

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BACKGROUND: HIV/AIDS has emerged as the single most formidable challenge to public health. School children of today are exposed to the risk of HIV/AIDS. AIMS: The study was conducted to determine the knowledge among secondary school students regarding HIV/AIDS and provide suggestions for HIV/AIDS education in schools. MATERIALS AND METHODS: A cross-sectional study was conducted among students of tenth to twelfth standard in the intermediate schools of Lucknow, India, from July to October 2011. A total of 215 students, both boys and girls, were enrolled in the study. RESULTS: In this study, for majority of the students (85%), the source of information about HIV/AIDS was the television. Regarding knowledge about modes of transmission of HIV/AIDS among girl students, 95.1% of them told that it is through unprotected sex. A total of 75.8% students said that it was transmitted from mother to child. CONCLUSION: It was observed that the knowledge of the school students was quite satisfactory for most of the variables like modes of transmission, including mother-to-child transmission of the disease. However, schools should come forward to design awareness campaigns for the benefit of the students.

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Desmoid tumors are benign mesenchymal tumors with a strong tendency for local recurrence after surgery. Radiotherapy improves local control following incomplete resection, but nearby organs at risk may limit the dose to the target volume. The patient in this report presented with a recurrent desmoid tumor of the right flank and underwent surgery with microscopically positive margins. Particular problems presented in this case included that the tumor bed was situated in close proximity to the liver and the right kidney and that the right kidney was responsible for 65% of the patient's renal function. Intensity-modulated radiation therapy plans delivering 54 Gy necessarily exposed the right kidney to a V18 of 98% and the liver to a V30 of 55%. Proton therapy plans significantly reduced the right kidney V18 to 32% and the liver V30 to 28%. In light of this, the proton plan was utilized for treatment of this patient. Proton therapy was tolerated without gastrointestinal discomfort or other complaints. Twenty-four months after initiation of proton therapy, the patient is without clinical or radiographic evidence of disease recurrence. In this setting, the improved dose distribution associated with proton therapy allowed for curative treatment of a patient who arguably could not have been safely treated with intensity-modulated radiation therapy or other methods of conventional radiotherapy.

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Microalgae may be the source of high amount of lipid and protein. It has the property for carbon dioxide sequestration, recycling and also can remove pollutants from wastewater. Using traditional methods, collection of algal biomass is either cost effective, time consuming or may be toxic due to use of chemical salts. The aim of this study is to harvest freshwater microalgae (Chlorella sp. CB4) biomass by using polymer. Polyacrylamide grafted starch (St-g-PAM) has been synthesized by microwave assisted method involving a synergism of microwave radiation and ceric ammonium nitrate (CAN) to initiate the grafting reaction. The synthesis was optimized in terms of CAN and monomer (acrylamide) concentration. The algal flocculation efficacy of all the grades of this graft copolymer was studied through standard 'Jar test' procedure. Effects of percentage grafting, pH and zeta potential on percentage recovery of algal biomass were thoroughly investigated.

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OBJECTIVES: To study the knowledge and practices related to newborn care in urban slums of Lucknow city, UP, and to identify critical behaviors, practices, and barriers that influence the survival of newborns. MATERIALS AND METHODS: A cross-sectional study in urban slums of Lucknow city, UP, included 524 women who had a live birth during last 1 year preceding data collection. Data were analyzed using statistical software SPSS 10.0 for windows. RESULTS: Study findings showed that about half of the deliveries took place at home. Majority (77.1%) of the mothers believed that baby should be bathed with warm water and dried with clean cloth and 79.7% mothers practiced it. Only 36.6% mothers initiated breast-feeding within 1 h of birth and 30.2% initiated after 1 day. The mothers who have not given colostrum to their baby, in majority the reason was customs. CONCLUSION: In majority of cases, correct knowledge and correct practices regarding newborn care were lacking among mothers and this should be promoted through improved coverage with existing health services.

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